A 22-year-old woman presents with a 1-year history of flaking and scaling
around her lashes, along with itching and a burning sensation. She has also
noted her lid margins are red, and some of her lashes are missing.
Her history is significant for diabetes and for seborrheic dermatitis of the scalp,
eyebrows, and external ears.
Question
What is the most likely diagnosis?
Blepharitis
Chalazion
Conjunctivitis
Ectropion
Foreign body Answer - Blepharitis
A 78-year-old Caucasian man presents with unilateral painless loss of vision in
the right eye of 3 hours duration. Examination reveals an elderly man who is
anxious but in no acute distress. Visual acuity is light perception only in the
right eye and 20/30 in the left eye. Pupillary examination is significant for an
afferent pupillary defect on the right side. Penlight examination of the eyes is
otherwise unremarkable. Retinal examination of the right eye reveals a cherry-
red spot. Retinal examination of the left eye is unremarkable.
Question
,What disease process most likely accounts for the patient's presentation?
Adult-onset Tay-Sachs disease
Open-angle glaucoma
Central retinal artery occlusion
Trauma
Cataract Answer - Central retinal artery occlusion
A 30-year-old Black male patient is admitted to the hospital to undergo
stapedectomy for the treatment of otosclerosis. He has experienced increased
hearing loss in the right ear for a few years. The patient's mother had had the
same condition when she was in her 40s, and she underwent a successful
operation. Assessment is performed using the Weber and Rinne tests.
Question
What physical exam finding is expected?
Bone conduction of the affected side is greater than air conduction.
Bone conduction of the affected side is equal to air conduction.
Air conduction of the affected side is greater than bone conduction.
Sound lateralizes to the unaffected ear.
Bone conduction of the unaffected ear is greater than air conduction. Answer -
Bone conduction of the affected side is greater than air conduction
A 41-year-old woman presents to the local emergency department with a 14-
day history of nasal drainage, congestion, fever, and cheek pain. She was
started on amoxicillin/clavulanate initially, but she was switched to levofloxacin
7 days ago due to no improvement in symptoms. After 7 days of levofloxacin
therapy, she presents again, reporting that she is no better. The fever continues
and she now has upper tooth pain. On exam, she is in mild distress, with thick
purulent rhinorrhea and halitosis.
, Question
What is the next step in the care of this patient?
Admission for intravenous antibiotics
Continue current therapy for an additional 10 days
Switch to a broad spectrum antibiotic
Refer to ENT for sinus aspiration
Sinus surgery Answer - Refer to ENT for sinus aspiration
A 44-year-old man presents for follow-up of poorly controlled type 1 diabetes
mellitus that was diagnosed 32 years ago. What change on his funduscopic
examination would indicate a need for urgent referral to an ophthalmologist?
A 42-year-old man presents with a firm painless bump on his left upper eyelid.
On examination, you note a 5 mm mass within the tarsus of the left eye. The
skin is freely movable over the mass. The remainder of the eye exam is
unremarkable.
Question
What is the most likely diagnosis?
Pterygium
Ectropion
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