Patient 1: Questions (you may use the back of the paper if needed): I. Write a problem list for this patient using outline form. List the most important problem as Number 1. Please organize the outline so that related problems are placed together. II. Write the differential diagnosis for the chief problem. Please list the most likely causes first. Be as complete as possible. III. Write a plan for diagnostic tests for this patient. Please list in order that you would prefer, add a short phrase describing why an individual procedure or test battery is necessary. IV. After the patient is sent home he returns 2 weeks later with the chief complaint of marked mental confusion without focal neurologic changes. List 4 potential causes of this change in mental status.

Patient 2:

1. As in Patient 1, write an organized complete problem list.
2. What is the differential diagnosis of the chest pain? Please begin with the most likely cause(s).
3. Four days later he was much improved. Suddenly, he became severely dyspneic, he could not lie flat, the BP fell to 90/65, the pulse rose to 120, and moist bibasilar rales to the mid-scapula could be heard. His neck veins were distended and a new loud grade 4/6 pansystolic murmur was heard at the lower left sternal border. It radiated to the apex and base of the heart. No thrill was palpable. What are the possible causes of this sudden decompensation?

Patient 3, Questions:

What causes of GI bleeding in this elderly woman need to be considered now? Write a list and suggest a diagnosis that might have been missed in the earlier work up.

Patient 4.

a. What substance ingestion appears likely on the basis of the patient's presentation?

b. How would you describe his acid base status?

Patient 5.

a. What condition underlies the patient's confusion?

b. How would you describe his acid base status?

Patient 6.

a. What condition is suggested by the clinical presentation and laboratory findings?

Patient 7.

a. What disorder is most likely to be present?

b. What tests should be ordered?

Patient 8.

a. What is the most likely cause of his abdominal pain?

b. What additional work up should be obtained?

Patient 9.

a. What is the most likely cause of her chest abnormality and skin disorder?

b. On her next visit, a scalene lymph node is palpated. Biopsy of this node will disclose what finding?

Patient 10.

a. What will his urine sodium excretion be?

b. Which will be greater? His sodium deficit or his water deficit?

Patient 11.

For each of the conditions listed name the most likely associated cause of hypertension:

a. Hypokalemia before initiation of diuretic therapy.

b. Palpitations, weight loss, hyperglycemia.

c. Abdominal bruit.

d. Bilateral enlarged, palpable kidneys in a person with a history of familial renal

failure.

Patient 12.

a. What is the most likely cause of her prolonged PT and PTT?

b. What pro-coagulation factors are most likely to be diminished?

c. What inhibitors of cloting are likely to be diminished?

Patient 13.

a. What two inflammatory bowel disorders must be considered?

b. What infectious disorders must be considered?

Patient 14.

a. What is the acid base abnormality?

b. Calculate the anion gap:

c. The formula for the calculation of the serum osmolality is: OSM = (Na) X 2 + (glucose)/18 + BUN/2.8

Based on this formula what is the osmolar gap in this patient?

d. What is the most likely cause of the acid base abnormality in this patient.

Patient 15.

a. What does the fundus show?

b. Although it is clear that she has hypertension, can you give her a more precise diagnosis?

c. What is the cause of the excacerbation of her hypertension?

Patient 16.

a. What is the most likely cause of her arthritis?

b. What laboratory test will be most helpful?

c. What is the cause of her right hand numbness?

d. What additional physical finding might be observed near the patients elbows?

Patient 17.

a. What is the most likely valvular disorder present?

b. Name 3 diseases associated with this valvular dysfunction. Mark the disease

that is associated with the hand findings demonstrated in the photograph.

Patient 18.

a. What is the rhythm disturbance shown on the EKG (ECG)?

b. Name three conditions associated with this disorder:

Patient 19.

a. What are the main abnormalities in his EKG?

b. What is the cause of his EKG changes? Be as specific as possible.

Patient 20.

a. What is the most likely cause of her anemia?

b. Should she receive a blood transfusion while awaiting diagnostic tests? Why or

why not?

Patient 21.

a. What is the most likely cause of the anemia?

b. What tests need to be ordered to evaluate the anemia?

c. Name two other disorders that need to be considered.

Patient 22.

a. What is the cause of this woman's fever?

b. Name three underlying conditions which predispose to the condition named in part

a?

Patient 23.

a. What is the most likely cause of her chest pain?

b. what additional imaging technique is required?

c. What is the underlying disorder?

d. Name two additional physical findings which should be looked for in this patient.

Patient 24.

a. What are the main abnormalities shown?

b. What is the cause of her dyspnea?