Npexam Classic Cases

Front 1

immunocompromised adult patient complaise of fevers, anorexia, fatigue and night sweats along with a mild nonproductive cough (early phasee). agressive infections (later sign) will have productive cough with blood-stained sputum along with weight loss (late sige)

Back 1

Tuberculosis

Front 2

elderly male with a history of many years of smoking complains of gradually worsening dyspnea over several years that is starting to limit physical activity. SOB upon physical exertion. Chronic cough with white to light yellow sputum

Back 2

COPD

Front 3

middle aged to elderly adult complains of sudden onset of fever, chills and a productive cough. Green to rust color. pleuritic chest pain with coughing and appears tired and ill.

Back 3

bacterial pheumonia

Front 4

teenage to young adult complains of fatigue with severe coughing nonproductive. onset is gradual. illness started with a sore throat, clear rhinisit and low grade fever. Malaise but continues to work or go to school.

Back 4

atypical pneumonia
walking pneumonia

Front 5

young adult complains of frequent episodes of severe cough that is nonproductive or productive of small amounts of phlegm. May complain of mild wheezing. Cough keeps pt awake at night. c/o's chest pain from severe coughing

Back 5

acute bronchitis

Front 6

patient complains of acute onset sneezing accompanied by nasal itchiness that progresses to a sore throat. Nasal congestion, runny eyes and clear mucoid rhinitis with low grade fever and malaise

Back 6

Common cold (viral upper resp inf)

Front 7

yound to middle ages pt complains of worsening symptoms after a recent bout of viral upper resp. infe ction. SOB, wheezing chest tightness with dry cough in early morning. Using increasing inhaler usage to self treat symptoms

Back 7

asthma

Front 8

pallor of the conjunctive and nailbeds. C/o's daily fatigue and sore red tongue (glossitis). Craving for nonfood items such as ice or dirt. Severe anemia will have spoon shaped nails (Koilonchia) dyspnea and tachy

Back 8

Iron deficiency anemia

Front 9

microcytic and hypochromic red blood cells. Trbc's may be mildly elevated. Ethnic background Mediterranean or Asain. asymptomatic
gold standard: hemoglobin electyrophorsis

Back 9

Thalassemia minor or trait

Front 10

Older to elderly female complains of gradual onset of paresthesias on feet/hands slowly getting more severe. Neuropathy starts in peripheral nerves and migrates centrally, difficulty walking, diff performing fine motor skills.

Back 10

Macrocytic/megaloblastic anemias can be vit b 12 or pernicious anemia.

Front 11

alocoholic male c/o's tiredness, fatigue and a reddenend and sore tongue. pallor no neurological c/o's

Back 11

folic acid deficiency

Front 12

flex hip 90% ask pt to push against resistance and straighten leg. Pain in lower abdomen

Back 12

psoas/llopsoas sign
appy or ectopic preg

Front 13

rotate right hip through full range of motion + if pain with movement or flexion of hip

Back 13

obturator sign,
appy or ectobic preg

Front 14

deep palpation of left lower quadrant of abdomen results in referred pain to right lower quadrant

Back 14

rovsings sign

Front 15

tenderness or pain in lower right quadrant above iliac crest and umbilicus

Back 15

McBurney's sign
appy

Front 16

instruct pt to raise heels and drop suddenly. +if pain

Back 16

Marlke test (heel jar)

Front 17

abdominal palpation, abdominal miscles reflexively become tense or boadlike

Back 17

involuntary gaurding

Front 18

pt complains that abd pain is worse when the palpating hand is released compared to pain felt during palpation

Back 18

rebound tenderness

Front 19

young adult to middle aged female c/o's of intermittent episodes of moderate to severe cramping pain in lower abdomen, espieially on left lower quadrant. Bloating with flatus. relief obtained after BM. Stools range from diarrhea to constipation or both types with increased frequency of BM's

Back 19

Irritable bowel syndrome

Front 20

middle aged to older adult c/o's of epigastric pain, burning/gnawing pain, or ache 80%. Pain relieved by food or antcaids 50% with reocurrence from 2-4 house after a meal. self medicating with otc antacids. May be taking NSAIDS or ASA

Back 20

Gastric ulcer or duodenal ulcer dz

Front 21

middle aged to older adult c/o's of chronic heartburn of many years . symptoms assoc with large or fatty meals and worse when supine. Long term history of self medication or otc antacids. chronic NSAID , asa or etoh.

Back 21

GERD

Front 22

elderly pt presents with acute onset of fever with left lower quadrant abdominal pain with anorexia, N/V

Back 22

Diverticulitis

Front 23

adult to older patient complains of acute onset of gaurding and tenderness over epigastric area or upper abomen. Epigastric/abdominal pain that radiates to midback and anorexia. may be accompained by fever, tachycardia and S/S of shock. refer to ER

Back 23

acute pancreatitis

Front 24

no chronic or carrier state, fecal oral routh from contaminated food. self limiting infection. treatment symptomatic. Havrix vaccine and recommended for travelors

Back 24

hep A

Front 25

sexual, blood or blood products tranmission

Back 25

Hep B

Front 26

IV drug use 50%, blood or blood products, sex or frequent blood transufsions
highest risk of chronic hepatitis infections and cirrhosis

Back 26

Hep C

Front 27

secually active adult complains of new onset fatigue, Nuases and dark colored urine for several says. New sexual partner

Back 27

acute hepatitis

Front 28

sexually active female c/o's new onset of dysuria, frequency, frequent urge to urinate and nocturia. suprapubic discomfort

Back 28

Urinary tract infection

Front 29

patient presents with acute onset of high fever, chills and one sided flank pain. s/o's dysuria, frequency and urgency. Anorexia with N/V may appear toxic

Back 29

acute pylonephritis

Front 30

15 - 30 y/o males nodule, sensation of heaviness or aching, one larger testicle or tenderness of one testicle
white males

Back 30

testicular cancer

Front 31

older to elderly male, new onset low back pain, rectal area and perineal pain or discomfort accompanied by obstructive voiding sympotms weak stream and nocturia. may be asymptomatic, black men with + cancer hisxoty and >50yrs old

Back 31

prostate cancer

Front 32

adult male c/o's acute sudden onset of localized pain on one testicle with indurated and tender blue colored mass underneath scrotal skin. No voiding or obstructive symptoms

Back 32

Blue dot sign

Front 33

older male c/o's urinary obstructive symptoms, dribbling, decreased force or stream, post void dribbline, urinary retention and frequency. Nocturia very common Prostate is enlarged

Back 33

Benign prostatic hypertrophy

Front 34

older male with history of same signs and symptoms for weeks to months. gradual onset. c/o's of suprapubic discomfort or perineal discomfort . If frostrate is enlarged will c/o of nocturia and weaker stream and dribbling.

Back 34

chronic prostatitis

Front 35

adult to older male c/o's of systemic symptoms fever, chills, and anorexia with unilateral testicular pain. tender and indurated epididymitis.

Back 35

acute bacterial epididymitis