Case Studies & Practical Application Flashcards

A 26-year-old woman presents requesting contraception. She has migraines with aura, smokes 10 cigarettes/day, and has a family history of DVT. Which contraceptive method is most appropriate?

Answer: Levonorgestrel IUD

Migraine with aura and smoking are absolute contraindications to combined hormonal contraceptives (Category 4); progestin-only methods like the LNG-IUD are safe.

A 4-year-old boy is brought in for 3 days of fever (39.5°C), bilateral conjunctivitis, cracked red lips, strawberry tongue, and a diffuse polymorphous rash. On day 5, he develops desquamation of the fingertips. What is the most important treatment consideration?

Answer: Administer IVIG and high-dose aspirin to prevent coronary artery aneurysms

Kawasaki disease treated within 10 days with IVIG plus aspirin significantly reduces the risk of coronary artery aneurysms.

A 48-year-old woman with bipolar disorder is stabilized on lithium. She presents with polyuria, polydipsia, and a fine hand tremor. Serum lithium level is 0.9 mEq/L. What is the most likely cause of her symptoms?

Answer: Nephrogenic diabetes insipidus as a side effect of lithium

Lithium commonly causes nephrogenic DI by reducing renal collecting duct responsiveness to ADH, resulting in polyuria and compensatory polydipsia.

A 35-year-old man presents with recurrent painful oral ulcers, genital ulcers, and anterior uveitis. He also has pustular skin lesions. He is of Middle Eastern descent. What is the most likely diagnosis?

Answer: Behçet's disease

Behçet's disease presents with the triad of recurrent oral ulcers, genital ulcers, and uveitis, with higher prevalence along the Silk Road including the Middle East.

A 60-year-old man with a 40 pack-year smoking history presents with hemoptysis, a 20-lb weight loss, and a hilar mass on CXR. He also notes weakness in his proximal leg muscles that improves with repeated use. The most likely paraneoplastic syndrome is:

Answer: Lambert-Eaton myasthenic syndrome

Lambert-Eaton myasthenic syndrome is associated with small cell lung cancer; proximal muscle weakness that improves with repetitive activity distinguishes it from myasthenia gravis.

A 22-year-old woman presents with sudden-onset right lower quadrant pain that began periumbilically and migrated, anorexia, and a fever of 38.4°C. WBC is 14,200/μL with a left shift. Which physical exam finding most supports the diagnosis of acute appendicitis?

Answer: Rovsing's sign — RLQ pain with LLQ palpation

Rovsing's sign is positive when palpation of the left lower quadrant produces pain in the right lower quadrant, suggesting peritoneal irritation at the appendix.

A 55-year-old woman with rheumatoid arthritis on methotrexate 20 mg/week presents for routine follow-up. She is asymptomatic. Which laboratory monitoring is required?

Answer: CBC, hepatic function panel, and creatinine every 4–8 weeks

Methotrexate requires regular CBC and liver function monitoring due to risks of bone marrow suppression and hepatotoxicity.