USMLE Step 2 CK mini cases

Question 0

12 yo F w/ 2 mo h/o fighting in school, truancy, breaking curfew. Parents recently divorced. Just started school in new district. Before divorce, average student w/o behavoral problems

Answer 0

DD: Adjustment disorder
Substance intoxication/abuse/dependence
Manic Episode
Oppositional defiant disorder
Conduct Disorder
WU: Physical Exam
MSE
Utox

Question 1

9 yo M w/ 2 y h/o angry outbursts in school/home. Mom “he runs around as if driven by a motor.” Teacher: “Can’t sit still in class, interrupts classmates, trouble making friends.”

Answer 1

DD: Attention-deficit hyperactivity disorder
Oppositional defiant disorder
Manic Episode
Conduct Disorder
W/u: Physical Exam
Mental Status exam

Question 2

15 yo M w 1 y h/o failing grades, school absenteeism, legal prob- shoplifting. Spents lots of time alone in his room, when he goes out it is w/new set of friends.

Answer 2

Substance abuse
Conduct disorder 
ODD
Adjustment disorder
WU:
Utox
MSE

Question 3

5 yo M w/ 6 mo h/o temper tantrums: 5-10 min immediately following disappointment or discipline. -sleep prob/appetite changes. Not displayed at daycare.

Answer 3

Age-appropriate behavior
ADHD
ODD

WU:
PE
MES

Question 4

20 day old M w/ fever, decreased breast feeding, lethargy. Born @ 36 wk 2/2 PROM

Answer 4

DD: 1)Neonatal sepsis; 2)Meningitis; 3)Pneumonia; 4)UTI

WU: 1) CBC w/ electrolytes; 2) UA; 3) Urine culture; 4) Blood culture; 5) CXR; 6) LP

Question 5

3 yo M w/ 2d h/o fever +pulling R ear. Otherwise healthy, Immunizations UTD. + Older sister recently w/ cold. +daycare

Answer 5

DD: 1) Accute otitis media; 2) URI; 3) Meningitis; 4) UTI

WU: 1) PE w/otoscope; 2) CBD; 3) UA

Question 6

12 m/o M w/ fever for 2 d + maculopapular rach on face/body. -MMR vaccine

Answer 6

DD: 1) Measles (or other viral exanthem); 2) Rubella; 3) Roseola; 4) Fifth disease; 5) Varicella; 6) Scarlet fever; 7) Meningitis

WU: 1) CBC; 2) Viral ab/titers; 3) Throat swap for culture 4) LP

Question 7

4 yo M w/ diarrhea, vomiting, lethargy, weakness, fever. +sick contacts @ daycare

Answer 7

DD: 1) Gastroenteritis (viral, bacterial, parasitic) 2) Food poisoning 3) UTI 4) URI 5) Volvulus; 6) Intussception

WU: 1) Stool exam w/culture; 2) CBC; 3) Electrolytes; 4) UA w culture; 5) AXR

Question 8

45 yo F w LBP, + radiate to lateral aspect of L foot. (+) straight leg raise. Unable to tiptoe

Answer 8

DD: 1) Disk Herniation; 2) Lumbar muscle sprain; 3) Tumor in vertebral canal

WU: 1) XR- lumbar spine 2) MRI- lumbar spine

Question 9

45 yo F w/ LBP that started after she cleaned her house. - radiation/ sensory deficit/ weakness in legs. + paraspinal muscle tenderness

Answer 9

DD: 1) Lumbar muscle sprain; 2) Disk herniation; 3) Abdominal aortic aneurysm; 4) Vertebral compression fracture

WU: 1) XR- L-spine

Question 10

45 yo M w/ pain in LB and legs during prolonged standing and walking. Relieved by sitting and leaning forward (e.g. pushing a grocery cart)

Answer 10

DD: 1) Lumbar spinal stenosis; 2) Lumbar muscle strain; 3) Tumor in the vertebral canal; 4) Peripheral vascular disease

WU: 1) XR- lumbar spine 2) MRI- lumbar spine; 3) CT-L-spine; 4) Ankle-brachial index

Question 11

17 yo M w/ LBP radiating to L leg. began after he fell on his knee during gym class. Also w/ area of LOS in L foot. Pain and sensory loss do not match any known distribution. He insists on a week off from school.

Answer 11

DD: 1) Malingering; 2) Lumbar muscle strain; 3) Disk herniation; 4) Knee or leg fracture; 5) Ankylosing spondylitis

WU: 1) HEADDS; 2) XR- Lspine; 3) XR knee; 4) MRI- L-spine

Question 12

30 yo F w/ wrist pain & black eye after tripping, falling and hitting her head on the edge of a table. + anxiety/inconsistent story

Answer 12

DD: 1) Domestic violence; 2) Factitious disorder; 3) Substance abuse

WU: 1) XR wrist 2) CT- head 3) U-tox

Question 13

30 yoo F secretary w/ wrist pain, numbness/ burning in palm/1-3 fingers of R hand. Worse at night, relieved by loose shaking of hand. +LOS in fingers 1-3. +Tinel’s sign.

Answer 13

DD: 1) Carpal tunnel syndrome: 2) Median nerve compression in forearm or arm

WU: 1) Nerve conduction study 2) XR-wrist 3) MRI-wrist

Question 14

28 yo F w/ pain in interphalangeal joints, hair loss, butterfly rash on face

Answer 14

DD: 1) Systemic lupus erythematosus; 2) Rheumatiod arthritis; 3) Psoriatic arthritis; 4) Parvovirus B19 infection

WU: 1) ANA 2) anti-dsDNA: 3) ESR; 4) C3: 5) C4; 6) rheumatoid factor; 7) CBC; 8) XR-hands; 9) UA

Question 15

28 yo F w/ pain in metacaropohalangeal joints of both hands. L knee painful and red. Morning stiffness. Mother w/ rheumatoid arthritis.

Answer 15

DD: 1) Rheumatoid arthritis; 2) SLE; 3) Disseminated gonorrhea; 4) Arthritis associated w/ inflammatory bowel disease; 5) Osteoarthritis

WU: 1) ANA 2) anti-dsDNA: 3) ESR; 4) rheumatoid factor; 5) CBC; 6) XR-hands; 7) XR knee; 8) cervical culture, STI screen

Question 16

18 yo M w/pain in interphalangeal joints of both hands. Scaly, salmon-pink lesions on extensor surface of elbows and knees.

Answer 16

DD: 1) Psoriatic arthritis; 2) Rheumatoid arthritis; 3) SLE

WU: 1) RF; 2) ANA; 3) ESR; 4) CBC; 5) XR-hands

Question 17

65 yo F w/ inability to use L leg and bear weight on it after tripping on a carpet. Menopause -20 y w/o HRT/calcium supplements. L leg externally rotated, shortened, adducted. + tenderness in L groin.

Answer 17

DD: 1) hip fracture; 2) Hip dislocation; 3) Pelvic fracture

WU: 1) XR hip; 2) XR pelvis; 3) CT or MRI hip; 4) CBC

Question 18

40 yo M w/ pain in R groin after MVA. R leg flexed @ hip, adducted, internally rotated

Answer 18

DD: 1) Hip dislocation-traumatic; 2) Hip fracture

WU: 1) XR hip; 2) CT or MRI hip; 3) CBC

Question 19

56 yo obese F w/ R knee stiffness/pain worse w/ movement. Sx dradually worsened over 10 y. + swelling/ deformity in joint/ difficulty walkig.

Answer 19

DD: 1) Osteoarthritis; 2) Pseudogout; 3) Gout; 4) Meniscal or ligament damage

WU: 1) XR- knee; 2) CBC; 3) ESR; 4) Knee arthrocentesis w/ synovial fluid analysis (cell count, gram stain, culture, crystals) 5) MRI- knee

Question 20

45 yo M w/ R knee pain w/ swelling and redness

Answer 20

DD: 1) Septic arthritis; 2) Gout; 3) Pseudogout; 4) Lyme arthritis; 5) Trauma; 6) Reiter’s arthritisd

WU: 1) CBC; 2) Knee arthrocentesis w/ synovial fluid analysis (cell count, gram stain, culture, crystals); 3) Blood, urethral cultures; 4) XR-knee; 5) Uric acid; 6) Lyme antibody

Question 21

65 yo M w/ R foot pain. He has been training for a marathon

Answer 21

DD: 1) Stress fracture; 2) Plantar fascitis; 3) Foot sprain or strain

WU: 1) XR-foot; 2) Bone scan- foot

Question 22

65 yo M w/ pain in heel of R foot, most notable w/ 1st few steps and then improves as he continues to walk. No known trauma.

Answer 22

DD: 1) Plantar fascitis; 2) Heel fracture; 3) Splinter/foreign body

WU: 1) XR-heel; 2) bone scan

Question 23

55 yo M w/ pain in elbow w/ tennis. Grip impaired. Tenderness over lateral epicondyle as well as pain on resisted wrist dorsiflexio w/ the elbow in extension

Answer 23

DD: 1) Tennis elbow (lateral epicondylitis); 2) Stress fracture

WU: 1) XR-arm; 2) Bone scan; 3) MRI-elbow

Question 24

27 yo F w/ painful wrists and elbows, swollen/hot knee joint that is painful on flexion, rash on limbs, vaginal discharge. + sex w/ multiple partners, occasional condom use

Answer 24

DD: 1) Disseminated gonorrhea; 2) Rheumatoid arthritis; 3) SLE; 4) Psoriatic arthritis; 5) Reiter's arthritis WU: 1) Knee arthrocentesis w/ synovial fluid analysis (cell count, gram stain, culture, crystals); 2) ANA, anti-dsDNA: 3) ESR; 4) rheumatoid factor; 5) CBC; 6) blood, cervical cultures; 7) XR-knee

Question 25

60 yo F w/ pain in both legs induced by walking, relieved by rest. H/o cardiac bypass surgery -6m + smoking

Answer 25

DD: 1) Peripheral vascular disease (intermittent claudication); 2) Leriche's syndrome (aortoiliac occlusive diseasse); 3) Lumbar spinal stenosis (pseudoclaudication); 4) Osteoarthritis WU: 1) Doppler U/S- LE; 2) Ankle-brachial index; 3) Angiography; 4) MRI-lumbar spine

Question 26

45 yo F w/ R calf pain. +tender/ warm/ red/ swollen. Started OCP's -2m for dysfunctional uterine bleeding.

Answer 26

DD: 1) DVT; 2) Baker's cyst rupture; 3) Myositis; 4) Cellulitis; 5) Superficial venous thrombosis WU: 1) Dobbler U/S- R leg; 2) CBC; 3) CPK; 4) D-dimer

Question 27

60 yo F w/ L arm pain that started while she was swimming and was relieved by rest.

Answer 27

DD: 1) Angina/MI; 2) Tendonitis; 3) Osteoarthritis; 4) Shoulder dislocation WU: 1) CPT-MB; 2) Troponin 3) EKG; 4) CBC; 5) ESR; 6) XR-shoulder; 7) CXR; 8) Stress test

Question 28

50 yo M presents w/ R shoulder pain after falling onto his outstretched hand while skiing. He noticed deformity of his shoulder and had to hold his right arm.

Answer 28

DD: 1) Shoulder dislocation; 2) Fracture of humerus; 3) Rotator cuff injury WU: 1) XR-shoulder; 2) XR-arm; 3) MRI-shoulder

Question 29

55 yo M w/ crampy bilateral thigh and calf pain, fatigue, and dark urine. He is on simvastatin and clofibrate for hyperlipidemia.

Answer 29

DD: 1) Rhabdomyolysis 2/2 simvastatin or clofibrate; 2) Polymyositis; 3) Inclusion body myositis; 4) Thyroid disease WU: 1) CBC; 2) CPK; 3) Aldolase; 4) UA; 5) Urine myoglobin; 6) TSH

Question 30

28 yo F w/ multiple facial and bodily injuries. "Fell down stairs." Hospitalized for injuries -7mo. w/ husband.

Answer 30

DD: 1) Domestic violence; 2) Osteogenesis imperfecta; 3) Substance abuse; 4) Consensual violent sexual behavior; WU: 1) XR-skeletal survey; 2) CT- maxilofacial; 3) Utox; 4) CBC

Question 31

30 yo F w/ multiple facial and physical injuries. She was attacked and raped by two men.

Answer 31

DD: Rape WU: 1) Pelvic exam; 2) Urine hCG; 3) Wet mount, KOH prep, cervical cultures; 4) XR- skeletal survey; 5) CBC; 6) HIV ab; 7) Viral hepatitis serologies

Question 32

40 yo F w/ amenorrhea, morning nausea, vomiting, fatigue, polyuria. LMP -6wk, breasts full/tender. Rhythm method contraception

Answer 32

DD: Pregnancy, Molar pregnancy, Anovulatory cycle, Hyperprolactinemia, UTI, Thyroid disease WU: Pelvic exam, Uring hCG, U/S pelvis, CBC w/ electrolytes, UA w/ culture, Prolactin, TSH

Question 33

23 yo obese F w/ amenorrhea for 6 mo, facial hair, infertility x 3yr

Answer 33

DD: Polycyctic ovary syndrome, Thyroid disease, Hyperprolactinemia, Pregnancy, ovarian or adrenal maliggnancy, premature ovarian failure WU: Pelvic exam, Urine hCG, U/S-pelvis, LH/FSH, TSH, prolactin, testosterone, DHEAS

Question 34

35 yo F w/ amenorrhea, galactorrhea, visual field defects, headaches for 6 months.

Answer 34

DD: Amenorrhea secondary to prolactinoma, Pregnancy, thyroid disease, premature ovarian failure, pituitary tumor WU: Pelvic and breast exam, Urine hCG, Prolactin, LH/FSH, TSH, MRI-brain

Question 35

48 yo F w/ amenorrhea x 6mo w/ hot flushes, night sweats, emoitonal liability, and dyspareunia.

Answer 35

DD: Menopause, Pregnancy, Pituitary tumor, Thyroid disease WU: Pelvic exam, Urine hCG, LH/FSH, TSH, prolactin, testosterone, DHEAS, CBC, MRI-brain

Question 36

35 yo F w/ amenorrhea, cold intolerance, coarse hair, weight loss, fatigue. Hx of abruptio placentae followed by hypovolemic shock and failure of lactation 2 years ago

Answer 36

DD: Sheehan's syndrome, Premature ovarian failure, Pituitary tumor, Thyroid disease, Asherman's syndrome WU: Pelvic exam, Urine hCG, CBC, LH/FSH, prolactin, TSH, FT4, ACTH, MRI-brain, Hysteroscopy

Question 37

18 yo F w/ amenorrhea x 4 mo. Wt loss 95 lbs, hx of vigorous exercise and cold intolerance

Answer 37

DD: Anorexia nervosa WU: CBC, TSH, FT4, ACTH, FSH, LH

Question 38

29 yo F w/ amenorrhea for 6 mo. Hx of occasional palpitations and dizziness. Lost her fiance in a car accident.

Answer 38

DD: Anxiety induced amenorrhea WU: CBC, TSH, FT4, ACTH, Urine cortisol level, Progesterone challenge test, FSH/LH/estradiol levels

Question 39

17 yo F w prolonged excessive menstrual bleeding occurring irregularly over the past six months

Answer 39

DD: Dysfunctional uterine bleeding, Coagulation disorders (e.g. vW, hemophilia), Cervical cancer, Molar pregnancy, Hypothyroidism, DM WU: Urine hCG, Cervical culture, PAP, CBC, ESR, glucose, PT/PTT, Prolactin, LH/FSH, TSH, U/S-pelvis

Question 40

61 yo obese F w/ profuse vaginal bleeding x 1mo. LMP -10 yrs. Hx of hypertension & DM. Nuliparous

Answer 40

DD: Endometrial cancer, cervical cancer, atrophic endometrium, Endometrial hyperplasia, endometrial polyps, atrophic vaginitis WU: Pap, Endometrial biopsy, U/S-pelvis, Endometrial curettage, colposcopy, hysterscopy

Question 41

45 yo G5P5 F w/ postcoital bleeding. +smoking +OCP's

Answer 41

DD: Cervical cancer, Cervical polyp, cervicitis, trauma (cervical laceration) WU: Pap, colposcopy and biopsy

Question 42

28 yo F 8 wk preg w/ lower abdominal pain and vaginal bleeding

Answer 42

DD: Spontaneous abortion, Ectopic pregnancy, Molar pregnancy WU: Urine, hCG, U/S-pelvic, CBC, PT/PTT, quantitative serum hCG

Question 43

32 yo F w/ sudden onset of LLQ pain radiates to scapula/back and associated w/ vaginal bleeding. LMP -5w. HX of PID, unprotected sex

Answer 43

DD: Ectopic pregnancy, ruptured ovarian cyst, ovarian torsion, PID WU: Urine hCG, Cervical cultures, U/S pelvis, quantitative serum hCG

Question 44

28 yo F w/ thin, grayish-white, foul-smelling vaginal discharge

Answer 44

DD: Bacterial vaginosis, Vaginitis-candidal vs trichomonal, Cervicitis (chlamydia, gonorrhea) WU: Wet mount, cervical cultures, KOH prep ("whif test"), pH of vaginal fluid

Question 45

30 yo F w/ thick, white cottage cheese-like, odorless vaginal discharge and vaginal itching

Answer 45

DD: Vaginitis- candidal, Bacterial vaginOSIS, Vaginitis- trichomonal WU: KOH ("whiff test"), Wet mount, Cervical cultures, pH of vaginal fluid

Question 46

35 yo F w/ malodorous, profuse, frothy, greenish vaginal discharge w/ intense vaginal itching/discomfort

Answer 46

DD: Vaginitis-trichomonal, Vaginitis- candidal, bacterial vaginosis, cervicitis (chlamydia, gonorrhea)

Question 47

54 yo F w/ painful intercourse. LMP -9mo. +hot flushes

Answer 47

DD: Atrophic vaginitis, endometriosis, cervicitis, depression, domestic abuse WU: Wet mount, KOH, cervical cultures, U/S pelvis

Question 48

37 yo F w/ dyspareunia, inability to conceive, dysmenorrhea

Answer 48

DD: Endometriosis, Cervicitis, Vaginismus, vulvodynia, PID, Depression, Domestic violence WU: Wet mount, KOH, cervical cultures, U/S pelvis, laparscopy

Question 49

65 yo M w/ painless hematuria. +heavy smoker, works as a painter

Answer 49

DD: Bladder cancer, renal cell carcinoma, nephrolithiasis, acute glomerulonephritis, prostate cancer, coagulation disorder (factor VIII antibodies) Polycystic kidney disease WU: UA, BUN/Cr, PSA, CBC, PT/PTT, cystoscopy, U/S- renal/bladder, CT- abdomen/pelvis, IVP

Question 50

35 yo M w/ painless hematuria. Family hx of kidney problems

Answer 50

DD; Polycystic kidney disease, nephrolithiasis, Acute glomerulonephritis (e.g. IgA), UTI, Coagulation disorder, bladder cancer WU: UA, BUN/Cr, PSA, CBC, PT/PTT, cystoscopy, U/S- renal, CT- abdomen/pelvis, IVP

Question 51

55 yo M w/ flank pain, painless hematuria. +wt loss, fever over the last 2 mo

Answer 51

DD: Renal cell carcinoma, Bladder cancer, nephrolithiasis, acute glomerulonephritis, pyelonephritis, prostate cancer WU: Genitourinary/rectal exam, UA, urine cytology, BUN/Cr, PSA, CBC, PT/PTT, U/S-renal, CT-abdomen pelvis, IVP

Question 52

60 yo M w/ nocturia, urgency, weak stream, terminal dribbling. Denies wt loss/ fatigue/ bone pain. HX/o 2 episodes of urinary retention that required cath

Answer 52

DD: BPH, prostate cancer, UTI, Bladder stones WU: UA, CBC, BUN/Cr, PSA, U/S- prostate (transrectal)

Question 53

71 yo M w/ nocturia, urgency, weak stream, terminal dribbling, hematuria, LBP x 4mo. +wt loss, fatigue

Answer 53

DD: Prostate cancer, BPH, Renal cell carcinoma, UTI, bladder stones WU: UA, CBC, BUN/Cr, PSA, U/S- prostate (transrectal), CT-pelvis, IVP

Question 54

18 yo M w/ burning sensation during urination and urethral discharge.

Answer 54

DD: Urethritis, cyctitis, prostatitis WU: UA w/ culture, Gm stain/ culture of urethral discharge, Chlamydia and gonorrhea PCR

Question 55

45 yo diabetid F w/ dysuria, urinary frequency, fever, chills, nausea x 3d. L CVA tenderness

Answer 55

DD: Acute pyelonephritis, Nephrolitiiasis, Renal cell carcinoma, Lower UTI (cyctitis, urethritis) WU: UA w/ culture & sensitivity, CBC, BUN/Cr, U/S-renal, CT-abdomen

Question 56

47 yo M w/ impotence x 3mo. +HTN s/p 4mo atenolol. +DM on insulin

Answer 56

DD: Drug-related ED, HTN ED, DM ED, psychogenic ED, peyronie's disease WU: Genital/rectal, glucose, CBC

Question 57

67 yo M w/ alternating diarrhea/constipation, decreased stool caliber, blood in stool x 8 mo. +wt loss. Low-fiber diet. Fam hx of colon cancer

Answer 57

DD: Colorectal cancer, IBS, Diverticulosis, GI parasitic infection (ascarias, giardiasis) Inflammatory bowel disease, angoidysplasia WU: CBC, AST/ALT/bilirubin/alk phos, colonoscopy, barium enema, CT- abdomen/pelvis

Question 58

28 yo M w/ constipation x 3 wk. Since his mother died 2 mo ago, he and his father have eaten only junk food

Answer 58

DD: Low-fiber diet, IBS, Substance abuse (heroin), depression, hypothyroidism WU: Rectal exam, TSH, Electrolytes, Utox

Question 59

30 yo F w/ alternating constipation/diarrhea +abd pain relieved by defecation. -nausea/ vomiting/ wt loss/ blood in stool

Answer 59

DD: Irritable bowel syndrome, Inflammatory bowel disease, celiac disease, chronic pancreatitis, GI parasitic infection (ascariasis, giardiasis) Lactose intolerance WU: Rectal w/ stool occult, CBC, Electrolytes, Ova/parasites, AXR, CT-abdomen/pelvis

Question 60

33 yo M w/ watery diarrhea, vomiting, diffuse abdominal pain that began yesterday. +feeling hot. Sick contacts

Answer 60

DD: Infectious diarrhea (gastroenteritis)- bacterial/viral/parasitic/protozoal, food poisoning, Inflammatory bowel disease WU: Rectal, stool occult blood/ leukocytes/ culture, CBC, Electrolytes, CT-abdomen pelvis

Question 61

40 yo F w/watery diarrhea and abd cramps. Last week she was on abx for UTI

Answer 61

DD: Pseudomembranous (C. diff) colitis, Gastroenteritis, cryptosporidiosis, food poisoning, inflammatory bowel disease WU: Stool leukocytes/ culture/ blood, C. diff toxin in stool, electrolytes

Question 62

25 yo M w/ watery diarrhea and abdominal cramps. Recent travel to Mexico

Answer 62

DD: Traveler's diarrhea, giardiasis, amebiasis, food poisoning, Hep A WU: Stool leukocytes/ culture/ giardia antigen/ entamoeba histolytica antigen, electrolytes, AST/ALT/bilirubin/alkaline phosphatase, viral hep serology

Question 63

30 yo F w/ watery diarrhea and abdominal cramping and bloating. Her symptoms are aggravated by milk ingestion and are relieved by fasting.

Answer 63

DD: Lactose intolerance, gastroenteritis, IBD, IBS, Hyperthyroidism WU: Hydrogen breath test? TSH

Question 64

33 yo M w/ watery diarrhea, diffuse abd pain, wt loss x 3wk. He has not responded to antibiotics

Answer 64

DD: Crohn's disease, gastroenteritis, ulcerative colitis, celiac disease, pseudomembranous colitis, hyperthyroidism, small bowel lymphoma, carcinoid WU: Stool exam and culture, CBC w/electrolytes TSH, CT-abdomen, Colonoscopy, small bowel series, urinary 5-HIAA

Question 65

45 up F w cpffee-ground emesis for 3 days. Dark tarry stool. Hx of intermittent epigastric pain relieved by food and antacids

Answer 65

DD: Bleeding peptic ulcer, gastritis, gastric cancer, esophageal varices WU: CBC w/ lytes, AST/ALT/bilirubin/ALP, Endoscopy (incluting H. pylori testing if ulcer is confirmed)

Question 66

40 yo F w/ epigastric pain and coffee-ground emesis. Hx of rheumatoid arthritis tx w/aspirin. Alcoholic.

Answer 66

DD: Gastritis, bleeding peptic ulcer, gastric cancer, Esophageal varices, mallory-weiss tear WU: rectal, CBC w/lytes, AST/ALT/bili/ALP, barium swallow, endoscopy

Question 67

67 yo M w/ blood in his stool, wt loss, constipation. Family hx of colon cancer

Answer 67

DD: colorectal cancer, anal fissure, hemorrhoids, diverticulosis, ischemic bowel disease, angiodysplasia, upper GI bleed, inflammatory bowel disease WU: CBC, PT/PTT, liver panel, CEA, Colonoscopy, CT-abdomen/pelvis, barium enema

Question 68

33 yo F w/rectal bleeding and diarrhea for 1 wk. She has had lower abdominal pain and tenesmus for several months

Answer 68

DD: Ulcerative colitis, crohn's, proctitis, anal fissure, hemorrhoids, diverticulosis, dysentery WU: CBC, PT/PTT, AXR, colonoscopy, ct-abdomen/pelvis, barium enema

Question 69

58 yo M w/ BRB per rectum and chronic constipation. Low fiber diet.

Answer 69

DD: Diverticulosis, anal fissure, hemorrhoids, angiodysplasia, colorectal cancer WU: Rectal exam, CBC, PT/PTT, electrolytes, colonoscopy, CT-abdomen/pelvis