Aquifer Internal Medicine End of Case Questions

A 20-year old male presents to the internal medicine clinic with concerns of right knee pain and an inability to bear weight. He states that he was practicing speed drills (accelerating, decelerating, and changing directions), when he heard a "pop" in his right knee followed by immediate right knee instability and swelling. What is the MOST likely diagnosis? A. Anterior cruciate ligament (ACL) tear B. Lateral collateral ligament (LCL) tear C. Medial collateral ligament (MCL) tear D. Patellar subluxation E. Posterior cruciate ligament (PCL) tear - The answer is A. From IM 31. A 21-year-old college student presents to the hospital with one day of fever, headache, and neck stiffness. His retinal and neurological examinations are normal. Ceftriaxone is given, and a lumbar puncture is performed which shows the following: Cloudy fluid White blood cell (WBC): 2,400; 85% polymorphonuclear cells (PMNs) Red blood cell (RBC): 2 mg/dL Protein: 250 mg/dL Glucose: 32 mg/dL. Gram stain: Gram-negative diplococci Which finding in the man's cerebrospinal fluid (CSF) is most specific for bacterial infection? A. Cloudy fluid B. High CSF protein C. Low CSF glucose (hypoglycorrhachia) D. Pleocytosis with neutrophil predominance E. Positive Gram stain - The answer is E. From IM 24. A 21-year-old male with history of hepatitis C, cholelithiasis, sickle cell disease, and alcohol use disorder presents to the hospital with one day of severe abdominal and chest pain, worse in the right-upper quadrant. A fractionated bilirubin reveals the following: Total bilirubin: 5.6 Indirect bilirubin: 4.6 Direct bilirubin: 1.0 What is the most likely cause of the bilirubin pattern in this patient? A. Alcoholic hepatitis B. Choledocholithiasis C. Non-alcoholic steatohepatitis D. Sickle cell crisis E. Viral hepatitis - The answer is D. From IM 11