Question 1

Doorway information about patient The patient is a 50-year-old man who comes to the office due to bilateral leg pain. Vital signs Temperature: 36.7 C (98 F) Blood pressure: 140/80 mm Hg Pulse: 78/min Respirations: 20/min Basic differential diagnosis Bilateral pain Atherosclerotic vascular disease Lumbar spinal stenosis Diabetic polyneuropathy Radiculopathy due to spinal disease Medications, such as statins Trauma Thromboangiitis obliterans Unilateral pain Cellulitis/myofasciitis Deep vein thrombosis Rupture of Baker cyst Osteomyelitis Radiculopathy/sciatica Pathological fracture of the bone

Accepted Answer

Instructions: If the doctor asks you about anything other than these, just say "no," or provide an answer that a normal patient might give. You are a 50-year-old man with bilateral leg pain. History of present illness Onset 2 months ago Pain started gradually and has become progressively worse Throbbing pain with 5-6/10 severity Located in the calf muscles, no radiation Worse with walking, running, and prolonged standing Better while sitting and at rest No history of trauma Review of systems No fever No back pain No weakness, numbness, or tingling in the legs No sexual or bladder symptoms Past medical/family/social history Diabetes for the past 3 years, controlled by diet High cholesterol No surgeries Medications: Simvastatin 40 mg daily at bedtime Allergies: No Father died at age 65 of a stroke; mother and 2 siblings are healthy Occupation: Postal worker Married, live with wife Tobacco: 2 packs a day for past 30 years Alcohol: Occasional beer Recreational drugs: No Physical examination Abdomen: No bruits Extremities: Pulses 2+ and symmetrical in bilateral lower extremities Musculoskeletal: Negative Homans sign No calf tenderness to palpation bilaterally Neurologic: Motor strength 5/6 in both lower extremities Grossly intact sensation Deep tendon reflexes 2+ symmetrically Checklist: Following the encounter, check which of the following items were performed by the examinee. History of present illness/review of systems Asked about the location and radiation of pain Asked about the onset of pain Asked about whether it is continuous or intermittent pain Asked about the intensity of pain Asked about the quality of pain Asked about the course of pain over time Asked about any aggravating or relieving factors Asked about rest pain Asked about swelling of the legs Asked about sensory changes (such as numbness) and paresthesia Asked about any weakness of the legs Asked about any history of back pain Asked about fever Asked about trauma to the legs Asked about other joint pain Asked about recent surgeries or prolonged immobilization Asked about impotence Past medical/family/social history Asked about similar episodes in the past Asked about past medical issues (especially high blood pressure, diabetes, high cholesterol, disc prolapse) Asked about current medications Asked about medication allergies Asked about family health (especially history of blood clots) Asked about tobacco, alcohol, and recreational drug use Asked about occupation Examination Washed hands before examination Examined without gown, not through the gown Examined calf tenderness Elicited Homans sign Checked pulses in both legs and arms Listened for bruit at the distal aorta, iliac, or femoral arteries Checked sensation in both legs Checked reflexes in both legs Checked for vibration sense in both legs Counseling Explained physical findings and possible diagnosis Explained further workup Discussed lifestyle modifications, including quitting smoking Communication skills and professional conduct Knocked before entering the room Introduced self and greeted you warmly Used your name to address you Paid attention to what you said and maintained good eye contact Asked open-ended questions Asked nonleading questions Asked one question at a time Listened to what you said without interrupting Used plain English rather than technical jargon Used appropriate transition sentences Used appropriate draping techniques Expressed empathy and gave appropriate reassurances Asked whether you had any concerns/questions Differential diagnosis Thromboangiitis obliterans Atherosclerotic vascular disease Drug induced (statins) Diabetic polyneuropathy Diagnostic study/studies Creatinine kinase Blood sugar and hemoglobin A1c Lipid profile Arterial doppler study of the lower extremities Duplex venous ultrasound of lower limbs CBC with differential Spine MRI Case 20 Patient Notes The following represents a typical note for this patient encounter. The details may vary depending on the information given by the simulated patient. History: Describe the history you just obtained from this patient. Include only information (pertinent positives and negatives) relevant to this patient's problem(s). 50-yo man with 2 months of worsening bilateral leg pain. Throbbing pain mainly over the calf muscles made worse with walking, running, and prolonged standing. Symptom improvement with rest and sitting. ROS: No pain at rest, fever, trauma, swelling, back pain, weakness, sexual difficulties, numbness, or tingling in legs PMHx: Diabetes for 3 years under diet control, hypercholesterolemia PSHx: None Meds: Simvastatin 40 mg daily at bedtime Allergies: None FHx: Father died at age 65 of stroke; mother and 2 siblings are healthy SHx: 2 PPD smoker for past 30 years, occasional alcohol use Physical examination: Describe any positive and negative findings relevant to this patient's problem(s). Be careful to include only those parts of examination performed in this encounter. Vital signs: Temperature, 36.7 C (98.1 F); blood pressure, 140/80 mm Hg; pulse, 78/min; and respirations, 20/min Abdomen: No bruits Extremities: Pulses 2+ and symmetrical in bilateral lower extremities Musculoskeletal: Negative Homans sign, no calf tenderness to palpation bilaterally Neurologic: Bilateral lower extremities with 5/5 motor strength, intact vibratory sensation and proprioception, and DTR 2+ Data interpretation: Based on what you have learned from the history and physical examination, list up to 3 diagnoses that might explain this patient's complaint(s). List your diagnoses from most to least likely. For some cases, fewer than 3 diagnoses will be appropriate. Then enter the positive or negative findings from the history and the physical examination (if present) that support each diagnosis. Lastly, list initial diagnostic studies (if any) you would order for each listed diagnosis (eg, restricted physical examination maneuvers, laboratory tests, imaging, ECG). Diagnosis #1: Drug-induced (statin) myopathy Diagnosis #2: Atherosclerotic peripheral vascular disease Diagnosis #3: Diabetic polyneuropathy

Question 2

Doorway information about patient The patient is a 35-year-old man who comes to the office due to acute diarrhea. Vital signs Temperature: 36.7 C (98.1 F) Blood pressure: 110/65 mm Hg Pulse: 100/min Respirations: 18/min Basic differential diagnosis Viral gastroenteritis Bacterial gastroenteritis & food-borne pathogens Medication induced Giardiasis Clostridium difficle colitis Inflammatory bowel disease Irritable bowel disease Malabsorption HIV

Accepted Answer

Instructions: If the doctor asks you about anything other than these, just say "no," or provide an answer that a normal patient might give. You are a 35-year-old man who has diarrhea. History of present illness Onset 1 day ago, 6-8 hours after meal Ate salad and shrimp at a local seafood restaurant Loose, watery stools with no blood or mucus 6 or 7 bowel movements in 24 hours Associated symptoms: Diffuse abdominal cramps Nausea and vomiting Difficulty keeping down solids or liquids No fever or chills Nothing seems to make it worse, and you have not tried any over-the-counter treatments 2 friends who ate with you have similar symptoms No recent travel Review of systems Sinus infection 2 weeks ago, treated with amoxicillin (last dose 2 days ago) No chest pain or shortness of breath No urinary symptoms No back pain Past medical/family/social history No significant past medical problems or surgeries No other medications (other than amoxicillin) No medication allergies Both parents and siblings (2 brothers) are healthy Single, live alone Occupation: Software engineer Smoking: No Alcohol: No Recreational drugs: No Physical examination Head and neck: No erythema or exudates in the mouth/pharynx Dry mucous membranes No enlarged lymph nodes Skin: No jaundice Chest/lungs: Clear to auscultation bilaterally Heart: Regular rhythm without murmurs, gallops, or rubs Abdomen: Nontender, nondistended Normoactive bowel sounds throughout Tympanic to percussion No hepatosplenomegaly Checklist: Following the encounter, check which of the following items were performed by the examinee. History of present illness/review of systems Asked to clarify characteristics of diarrhea: Increased frequency? Increased volume? Altered consistency? Asked about the onset and duration of diarrhea Asked about the frequency of diarrhea Asked about associated symptoms (eg, vomiting, fever, abdominal pain, anorexia, prior constipation, myalgia, tenesmus) Asked about any blood or mucus in stools Asked about any recent travel Asked whether any other family members or other contacts are sick Asked about exposure to suspicious foods (eg, unpasteurized/undercooked food, unusual foods, dairy products, seafood) Past medical/family/social history Asked about prior episodes of diarrhea and gastrointestinal illness Asked about other medical issues Asked about medications (especially antibiotics) and medication allergies Asked about recent and previous hospitalizations Asked about any abdominal surgeries Asked about occupation Asked about tobacco, alcohol, and drug use Asked about family history (especially gastrointestinal diseases) Examination Examinee washed hands Examined without gown, not through gown Auscultated abdomen Palpated abdomen superficially Palpated abdomen deeply Examination of skin for any rashes Examination of oral cavity Respiratory examination Cardiac auscultation Counseling Explained the physical findings and possible diagnosis Explained further workup Discussed need for rectal examination Discussed fluids and other basic interventions Communication skills and professional conduct Knocked before entering the room Introduced self and greeted you warmly Used your name to address you Paid attention to what you said and maintained good eye contact Asked open-ended questions Asked nonleading questions Asked one question at a time Listened to what you said without interrupting Used plain English rather than technical jargon Used appropriate transition sentences Used appropriate draping techniques Summarized the history and explained physical findings Expressed empathy and gave appropriate reassurances Asked whether you have any concerns/questions Differential diagnosis Viral gastroenteritis Bacterial gastroenteritis Clostridium difficile diarrhea Diagnostic study/studies Rectal examination Fecal occult blood test CBC with differential count Basic metabolic panel (electrolytes, BUN, creatinine, glucose) Stool for C difficile toxin Stool for fecal leukocytes Case 7 Patient Note The following represents a typical note for this patient encounter. The details may vary depending on the information given by the simulated patient. History: Describe the history you just obtained from this patient. Include only information (pertinent positives and negatives) relevant to this patient's problem(s). 35-yo male with 1 day of diarrhea with 6-7 loose BM/day without blood or mucus. Ate seafood and salad at a restaurant 6-8 hours before symptom onset. Recent sinus infection treated with amoxicillin, last dose 2 days ago. Diffuse crampy abdominal pain, nausea, vomiting, decreased PO intake. Two other friends who ate at the restaurant have the same symptoms. ROS: No fever, chills, chest pain, shortness of breath, burning with urination, recent travel, or back pain PMHx: None PSHx: None Meds: None Allergies: None FHx: Noncontributory SHx: Denies tobacco and alcohol use Physical examination: Describe any positive and negative findings relevant to this patient's problem(s). Be careful to include only those parts of the examination performed in this encounter. Vital signs: Temperature, 36.7 C (98 F); blood pressure, 110/65 mm Hg; pulse,100/min; and respirations, 18/min Head/neck: Oropharynx with dry mucous membranes but no erythema or exudates, no enlarged lymph nodes, no jaundice Chest/lungs: Clear to auscultation bilaterally Heart: RRR without M/G/R Abdomen: Nontender, nondistended, normoactive bowel sounds throughout; tympanic on percussion; no hepatosplenomegaly Data interpretation: Based on what you have learned from the history and physical examination, list up to 3 diagnoses that might explain this patient's complaint(s). List your diagnoses from most to least likely. For some cases, fewer than 3 diagnoses will be appropriate. Then, enter the positive or negative findings from the history and the physical examination (if present) that support each diagnosis. Lastly, list initial diagnostic studies (if any) you would order for each listed diagnosis (e.g., restricted physical exam maneuvers, laboratory tests, imaging, ECG, etc.). Diagnosis #1: Viral gastroenteritis Diagnosis #2: Bacterial gastroenteritis Diagnosis #3: Clostridium difficile colitis

Question 3

Doorway information about patient The patient is a 40-year-old woman who comes to the office due to increased urination. Vital signs Temperature: 36.7 C (98 F) Blood pressure: 110/70 mm Hg Pulse: 86/min Respirations: 16/min Basic differential diagnosis Increased urine volume Diabetes mellitus Diabetes insipidus (central, nephrogenic) Psychogenic polydypsia Diuretic use Hypercalcemia Increased urinary frequency Urinary tract infection Overactive bladder Excess caffeine intake Vaginitis, urethritis

Accepted Answer

Instructions: If the doctor asks you about anything other than these, just say "no," or provide an answer that a normal patient might give. You are a 40-year-old woman complaining of increased urinary frequency. History of present illness Onset 2 months ago Urinating 8-10 times during the day and 2-3 times a night Increased urinary volume Increased feeling of thirst for last month Associated symptoms: Fatigue 4.5-kg (10-lb) weight loss (despite increased appetite) No dysuria or urgency No fever or chills Past medical/family/social history Bipolar disorder diagnosed 20 years ago Minor head injury after falling off bicycle 3 months ago; seen in emergency department and discharged without intervention No surgeries or hospitalizations Medications: Lithium 60 mg twice daily Medication allergies: None Married, live with husband 2 pregnancies with normal vaginal delivery; both children are healthy Both parents have type 2 diabetes mellitus; no siblings Tobacco: No Alcohol: No Recreational drugs: No Physical examination HEENT: PERRLA, EOMI Visual fields intact Heart: Regular rate and rhythm No murmurs, gallops, or rubs Abdomen: Soft and nontender with normal bowel sounds No suprapubic or CVA tenderness Neurologic: Muscle strength 5/5 throughout Sensation in tact in all 4 extremities Reflexes 2+ in all 4 extremities Checklist: Following the encounter, check which of the following items were performed by the examinee. History of present illness/review of systems Asked about the onset of problem Asked about the frequency of urination Asked about nocturia Asked about urine volume Asked about burning on urination Asked about urgency and hesitancy of urination Asked about increased thirst and fluid intake Asked about appetite and changes in weight Asked about the trauma to the head Past medical/family/social history Asked about similar problems in the past Asked about past medical issues, hospitalizations, and surgeries Asked about psychiatric problems (history of bipolar disorder, schizophrenia) Asked about current medications Asked about medication allergies Asked about family health (especially diabetes) Asked about tobacco, alcohol, and drug use Asked about occupation Examination Washed hands before examination Examined without gown, not through gown Examined mucous membranes Examined heart and lungs Tested muscle power in both upper and lower limbs Tested sensation in the lower extremities Tested reflexes in the lower extremities Tested visual fields and examined fundus Tested for suprapubic and costovertebral angle tenderness Counseling Explained physical findings and possible diagnosis Explained further workup Communication skills and professional conduct Knocked before entering the room Introduced self and greeted you warmly Used your name to address you Paid attention to what you said and maintained good eye contact Asked open-ended questions Asked nonleading questions Asked one question at a time Listened to what you said without interrupting Used plain English rather than technical jargon Used appropriate transition sentences Used appropriate draping techniques Expressed empathy and gave appropriate reassurances Asked whether you had any concerns/questions Differential diagnosis Diabetes mellitus Central diabetes insipidus Nephrogenic diabetes insipidus (lithium side effect) Psychogenic polydypsia Hypercalcemia Diagnostic study/studies Fasting blood sugar Urinalysis Serum electrolytes (Na, K, Cl, Co2, BUN, Cr, and calcium) Urine and serum osmolality Case 16 Patient Notes The following represents a typical note for this patient encounter. The details may vary depending on the information given by the simulated patient. History: Describe the history you just obtained from this patient. Include only information (pertinent positives and negatives) relevant to this patient's problem(s). 40-yo woman with 2 months of polyuria, polydipsia, nocturia, and polyphagia. 2-3 months of 4.5-kg (10-lb) weight loss with fatigue. No dysuria or urinary urgency. ROS: No fever or chills PMHx: Bipolar disorder diagnosed 20 years ago; minor head trauma 3 months ago, seen in emergency department and discharged without intervention PSHx: None Meds: Lithium 600 mg 2 times daily Allergies: None FHx: Father and mother have diabetes SHx: No history of tobacco or alcohol use Physical examination: Describe any positive and negative findings relevant to this patient's problem(s). Be careful to include only those parts of the examination performed in this encounter. Vital signs: Temperature, 36.7 C (98.1 F); blood pressure, 110/70 mm Hg; pulse, 86/min; and respirations,16/min HEENT: PERRLA, EOMI, intact visual fields Heart: RRR without murmurs, gallops, or rubs Abdomen: Nontender without suprapubic tenderness, no CVA tenderness Neurologic: Muscle strength 5/5 throughout, sensation grossly intact in bilateral lower extremities, DTR 2+ in bilateral lower extremities Data interpretation: Based on what you have learned from the history and physical examination, list up to 3 diagnoses that might explain this patient's complaint(s). List your diagnoses from most to least likely. For some cases, fewer than 3 diagnoses will be appropriate. Then, enter the positive or negative findings from the history and the physical examination (if present) that support each diagnosis. Lastly, list initial diagnostic studies (if any) you would order for each listed diagnosis (eg, restricted physical examination maneuvers, laboratory tests, imaging, ECG). Diagnosis #1: Diabetes mellitus Diagnosis #2: Diabetes insipidus Diagnosis #3: Psychogenic polydipsia

Question 4

Doorway information about patient The patient is a 35-year-old man who comes to the office due to a cough. Vital signs Temperature: 38.5 C (101.3 F) Blood pressure: 120/75 mm Hg Pulse: 98/min Respirations: 20/min Basic differential diagnosis Common cold Acute sinusitis Allergic rhinitis Acute bronchitis Pneumonia Pertussis Pulmonary embolism Drugs (ACE inhibitors) Asthma Congestive heart failure Chronic obstructive pulmonary disease (COPD) exacerbation

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Question 5

Doorway information about patient The patient is a 24-year-old woman who comes to the office for an initial prenatal visit. Vital signs Temperature: 37.1 C (98.8 F) Blood pressure: 120/75 mm Hg Pulse: 78/min Respirations: 20/min

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Question 6

Doorway information about patient The patient is a 45-year-old man who comes to the emergency department due to right lower abdominal pain. Vital signs Temperature: 37.1 C (98.7 F) Blood pressure: 130/80 mm Hg Pulse: 100/min Respirations: 20/min Basic differential diagnosis Appendicitis Meckel diverticulitis Perforated viscus Intestinal obstruction Yersinia enterocolitica Pancreatitis Urolithiasis Acute cholecystitis Herpes zoster (shingles)

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Question 7

Doorway information about patient The patient is a 65-year-old woman who comes to the emergency department due to arm and leg weakness. Vital signs Temperature: 36.7 C (98.1 F) Blood pressure: 160/90 mm Hg Pulse: 78/min Respirations: 22/min Basic differential diagnosis Neurologic Stroke Transient ischemic attack (TIA) Subarachnoid hemorrhage Subdural hematoma Intracranial mass Guillain-Barré syndrome Spinal cord lesion Complex migraine Metabolic Hypoglycemia Hypothyroidism Adrenal insufficiency Electrolyte disorders Musculoskeletal Myopathy Miscellaneous Conversion disorder Heat-related illness

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Question 8

Doorway information about patient The patient is a 35-year-old woman who comes to the emergency department due to chest pain. Vital signs Temperature: 36.8 C (98.3 F) Blood pressure: 120/75 mm Hg Pulse: 98/min Respirations: 12/min Chest x-ray is as shown in the exhibit. Basic differential diagnosis Pneumonia Gastroesophageal reflux disease Panic disorder/hyperventilation syndrome Hyperthyroidism Angina Costochondritis

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Question 9

Doorway information about patient The patient is a 30-year-old woman who comes to the clinic due to abdominal pain. Vital signs Temperature: 38.5 C (101.3 F) Blood pressure: 120/75 mm Hg Pulse: 98/min Respirations: 22/min Basic differential diagnosis Gastrointestinal Appendicitis Acute cholecystitis Pancreatitis Inflammatory bowel disease Irritable bowel syndrome Diverticulitis Bowel obstruction Acute gastroenteritis Urinary Urinary tract infection/pyelonephritis Renal colic Reproductive Pelvic inflammatory disease Pelvic abscess Endometriosis Ovarian cyst/torsion Ectopic pregnancy Spontaneous abortion Miscellaneous Shingles Aortic dissection

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Question 10

Doorway information about patient The patient is a 56-year-old man who comes to the office for a blood pressure check and medication refill. Vital signs Temperature: 36.1 C (97 F) Blood pressure: 150/90 mm Hg Pulse: 80/min Respirations: 16/min Basic differential diagnosis When patients come for follow-up of known conditions, the primary diagnosis is known. However, you should be aware of complications and associated conditions. Congestive cardiac failure Coronary artery disease (angina) Peripheral vascular disease Retinopathy Side effects of the medications

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Question 11

Doorway information about patient The patient is a 60-year-old man who comes to the emergency department due to acute shortness of breath. Vital signs Temperature: 36.7 C (98 F) Blood pressure: 110/70 mm Hg Pulse: 90/min Respirations: 26/min Basic differential diagnosis Pulmonary embolism Congestive heart failure Chronic obstructive pulmonary disease exacerbation Pneumonia Spontaneous pneumothorax Asthma exacerbation Anxiety/panic attack

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Question 12

Doorway information about patient The patient is a 27-year-old woman who comes to the office due to a rash. Vital signs Temperature: 36.8 C (98.3 F) Blood pressure: 120/75 mm Hg Pulse: 78/min Respirations: 16/min Basic differential diagnosis Infections Bacterial (eg, cellulitis) Viral (eg, herpes zoster/shingles) Fungal (eg, tinea corporis) Parasitic (eg, scabies) Psoriasis Acne vulgaris Rosacea Immune/autoimmune (eg, systemic lupus erythematosus, erythema multiforme) Allergic/irritant (eg, contact dermatitis, drug rash, photodermatitis, urticaria) Stasis dermatitis Bullous disorders (eg, bullous pemphigoid, dermatitis herpetiformis)

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Question 13

Doorway information about patient The patient is a 50-year-old man who comes to the office due to fatigue and weight loss. Vital signs Temperature: 36.7 C (98.1 F) Blood pressure: 120/76 mm Hg Pulse: 78/min Respirations: 18/min Basic differential diagnosis Infection HIV Tuberculosis Metabolic disorders Diabetes mellitus Thyroid disorder Adrenal insufficiency Malignancy Solid tumor Hematologic malignancy Gastrointestinal Hepatitis Malabsorption Other Depression Eating disorder Medication side effect

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Question 14

Doorway information about patient The patient is a 50-year-old man who comes to the clinic due to impotence. Vital signs Temperature: 36.7 C (98 F) Blood pressure: 150/80 mm Hg Pulse: 80/min Respirations: 16/min Basic differential diagnosis Cardiovascular Atherosclerotic vascular disease Metabolic/endocrine Diabetes Hypogonadism Hyperprolactinemia Neurologic Spinal cord disorders Psychological Anxiety Depression Alcohol or other substance abuse Other Medications (eg, antihypertensives)

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Question 15

Doorway information about patient The patient is a 35-year-old woman who comes to the office due to jaundice. Vital signs Temperature: 38.5 C (101.3 F) Blood pressure: 120/75 mm Hg Pulse: 98/min Respirations: 22/min Basic differential diagnosis Infectious hepatitis Hemolytic jaundice Alcoholic hepatitis Drug-induced hepatitis Primary biliary cirrhosis Wilson disease Hemochromatosis Malignancy

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Question 16

Doorway information about patient The patient is a 25-year-old woman who comes to the clinic due to a sore throat. Vital signs Temperature: 38.3 C (101 F) Blood pressure: 120/70 mm Hg Pulse: 90/min Respirations: 22/min Basic differential diagnosis Viral pharyngitis Bacterial pharyngitis Group A streptococcal pharyngitis Mycoplasma pneumoniaNeisseria gonorrhea Epstein-Barr virus mononucleosis Allergic rhinitis/postnasal drip Chronic tonsillitis Primary HIV

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Question 17

Doorway information about patient You will be speaking with the mother of a 1-year-old with fever. Basic differential diagnosis Respiratory tract infection Ear infection Exanthematous disease Meningitis Urinary tract infection Gastroenteritis

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Question 18

Doorway information about patient The patient is a 29-year-old woman with known sickle cell anemia who comes to the emergency department due to chest pain. Vital signs Temperature: 38.5 C (101.3 F) Blood pressure: 120/75 mm Hg Pulse: 110/min Respirations: 22/min Clinical images Electrocardiogram is shown in the image. Basic differential diagnosis Hematologic Chest syndrome due to sickle cell anemia Cardiovascular Pericarditis Acute coronary syndrome Pulmonary Pneumonia Pulmonary thromboembolism Musculoskeletal Costochondritis Salmonella osteomyelitis Other Panic attacks

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Question 19

Doorway information about patient The patient is a 66-year-old man who comes to the clinic due to constipation. Vital signs Temperature: 36.7 C (98 F) Blood pressure: 120/70 mm Hg Pulse: 70/min Respirations: 16/min Basic differential diagnosis Functional constipation Obstructive lesions (eg, bowel obstruction, carcinoma of colon) Metabolic disturbances (eg, hypothyroidism, diabetes mellitus, hypercalcemia) Neurologic dysfunction (eg, stroke, autonomic neuropathy, spinal cord trauma, multiple sclerosis, Parkinson disease) Medication-induced (eg, iron preparations, opiates, anticholinergics)

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Question 20

Doorway information about patient The patient is a 45-year-old woman who comes to the office due to acute right upper quadrant abdominal pain. Vital signs Temperature: 38.3 C (101 F) Blood pressure: 130/80 mm Hg Pulse: 100/min Respirations: 20/min Basic differential diagnosis Gastrointestinal Acute cholecystitis Biliary colic Acute hepatitis Peptic ulcer (perforation) Acute pancreatitis (biliary pain) Pulmonary Right lower lobe pneumonia Cardiovascular Myocardial infarction Heart failure with hepatic congestion Miscellaneous Herpes zoster (shingles)

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Exam 2: STEP 2 CS - Practice Cases

Doorway information about patient The patient is a 24-year-old woman who comes to the office for an initial prenatal visit. Vital signs Temperature: 37.1 C (98.8 F) Blood pressure: 120/75 mm Hg Pulse: 78/min Respirations: 20/min

Doorway information about patient You will be speaking with the mother of a 1-year-old with fever. Basic differential diagnosis Respiratory tract infection Ear infection Exanthematous disease Meningitis Urinary tract infection Gastroenteritis