2012 - 5th Flashcards
Patient had a surgery to repair his heart’s septal defect. After surgery he developed salpitations, tachycardia, etc. What is the most likely diagnosis?
open cardiac syndrome or something like that
What is found in primary ovarian failure?
A. high FSH / low estradiol/ normal prolactin
A patient came with alopecia, and other extra articular manifestation (mouth ulcer etc.) what will be positive in this case?
Anti-nuclear antibodies (suspecting SLE)
Which is true about contrast dye in a renal impaired patient?
a. likely to cause irreversible kidney damage
b. takes 2 weeks for the adverse effects to develop
a. likely to cause irreversible kidney damage
* An irreversible decline in kidney function after recovery is more likely in patients over age 65 years, lower baseline GFR, hypoalbuminemia, and comorbidities including hypertension and heart failure “up-to-date” (2012 Tafree’3)
Right Ear hearing loss, weber’s test shows lateralization to right ear, rinne’s test on the right ear shows bone conduction > air conduction and left ear showing air conduction superior to it. What’s the likely diagnosis?
A. Right Ear hearing Conductive loss
B. Right ear sensorineural loss
A. Right Ear hearing Conductive loss
A 68 yr old man presented with hemoptysis and rapidly progressive renal failure, his biopsy showed anti GBM antibodies with linear deposition on immunofluorescence, what’s the most likely dx:
Good pasture syndrome
Post streptococcal
Wagner’s granulomatosis
Lupus nephritis
Good pasture syndrome
Female gets diplopia after reading for 10 minutes, and muscle weakness after climbing stairs, she is completely normal at rest. What test helps in the diagnosis?
Tesilon test (edrophonium) or serum Anti-AChR or nerve stimulation test
Patient with severe headache (11/10). When asked about photophobia he answered yes. He can’t sit still, and walks back and forth.
A. tension headache
B. migraine
C. subarachnoid hemorrhage D. cluster headache
?
assuming that the patient CAN’T sit still
A case with PMN > 600
SBP (maybe) (spontaneous bacterial peritonitis)
Neutrophil count > 250 cells/mm3 = SBP
68-year-old patient with chronic kidney disease about to undergo dialysis. What can you
tell him about dialysis?
Peritoneal dialysis is chosen treatment in Chronic Heart Disease
since hemodialysis can cause cardiovascular stress
A patient with asymmetrical hypertrophy and MR?
a. pulses alternates
b. pulses paradoxical
c. pulses bigiminus
a. pulses alternates
I think this question is missing more details, but:
Pulsus alternans:
-It is characterized by beat to beat variability of the arterial pressure waveform.
-It occurs most commonly in heart failure due to increased resistance to LV ejection,as occurs in hypertension,aortic stenosis, coronary atherosclerosis ,and dilated cardiomyopathy.
Pulsus paradoxus:
-It is characterized by exaggerated fall in patient’s blood pressure during inspiration by greater than 10 mmHg(normally should be less than 10).
-It is often due to pericardial disease ,particularly cardiac tamponade and to a lesser degree constrictive pericarditis.
Pulsus bigeminus:
-It is characterized by groups of two heart beats closed together followed by a longer pause .The second pulse is weaker than the first.
-The most common cause of pulsus bigeminus is hypertrophic obstructive cardiomyopathy.
Note:
-there is many types of HCM ,and one of these types is asymmetrical septal hypertrophy with obstruction which can lead to
MR(I think the previous question is about this type, but more details is needed ).so for me the answer is pulsus bigeminus.
-If the question mentioned AS rather than MR with signs of heart failure ,it is most probably pulsus alternans.
The following article explains the association between HOCM and MR:
A 31-year-old previously healthy woman with no past medical history presents with anxiety, insomnia, heat intolerance and new onset atrial fibrillation. Which of the following would explain the patient’s symptoms?
A. TSH is abnormally high
B. TSH is abnormally low
C. The patient has unexplained weight gain
D. The patient’s symptoms are due to panic attack
E. The patient’s symptoms are due to type IV hypersensitivity reaction
B. TSH is abnormally low
Patient with severe headache, photophobia, intolerance to sound. A. migraine without aura
B. migraine with aura C. cluster headache D. tension headache
A. migraine without aura
*the question didn’t mention anything about preceding symptoms (Aura)
Question about paralysis and sensory loss at umbilicus what level?
T10
50-year-old female with retrosternal chest pain after eating with bitter taste. No difficulty or pain while swallowing. What is the best investigation to evaluate the etiology of her symptoms? a. 24 hr esophageal pH.
*GERD is a clinical diagnosis based on response to PPI. Endoscopy has specific indications (failure of response to PPI or alarming symptoms). If endoscopy is normal and diagnosis is still questioned, 24hr pH monitor & esophageal manometry are used.
5-year-old with facial dropping, can’t maintain puffed cheeks, has flat nasolabial folds, left eye closure is slightly weaker than right eye. Where is the lesion?
*he has complete lower face paralysis and slightly upper face paralysis left-sided lower motor lesion of the facial nerve
A patient presented with anaphylactic shock after eating peanuts. What would give
him?
A. Epinephrine
B. Propranolol
A. Epinephrine
Q4. A hypertensive patient regularly taking his medication developed pedal edema. What’s the name of the drug?
a. Ca channel blocker
*“-dipines”
A young woman who is tall and lean with short anterior diameter of the chest with occasional palpitations was diagnosed with mitral regurgitation with anterior and posterior valve prolapsed. What is the best management?
a. Mitral valve replacement
b. Beta-blockers
b. Beta-blockers
-The previous question describes features of Marfan’s syndrome and it is associated with myxomatous degeneration that leads to mitral prolapse and can prognose to mitral regurgitation in some cases.
- in the case of mitral prolapse, if the patient is:
1)Asymptomatic:no treatment reassurance.
2)Symptomatic:B blocker and avoidance of stimulants(caffeine) for significa : palpitation, anticoagulants if Afib.
3)surgical treatment is only indicated if symptomatic and significant MR, and mitral repair is favored over replacement.
Note:Advantage of repair over replacement:low rate of endocarditis,no anticoagulation is needed ,and less chance of re-operation.
Indications of mitral valve replacement(patients who are not good candidate for percutaneous ballon valvotomy and mitral valve repair who are:
1)Moderate to severe MS and NYHA class 3-4
Z)severe MS (mitral valve area <lcm) and severe pulmonary HI (pulmonary artery systolic pressure >60 mmlig,
Bisevere mira stenosis who are underooino suroerv for another reason.
A severe MS who would have been candidates for valotomy but have contraindications to the procedure
brecurrent thromboembolic exisodes despite anficooulation in coniunction with mitra stenosis
A patient came to the clinic complaining from a unilateral headache. She said when it comes she can’t tolerate loud sounds, TV, and become sensitive to lights. She can’t know when it will come.
A. Migraine with aura
B. Migraine without aura C. Cluster
D. Tension headache
B. Migraine without aura
A patient had hemoptysis and hematuria (a wegner granumalatosis case). What will be positive?
c-ANCA
A patient with signs and symptoms of UC is at risk of what disease?
sclerosing cholangitis
Patient with autoimmune disease heard that some autoimmune diseases can
predispose to cancer. What can you tell her about this?
A. Rheumatoid Arthritis can cause lymphoma
B. Pernicious anemia with leukemia
C. Good pasture with lung cancer
A. Rheumatoid Arthritis can cause lymphoma
A female with arrhythmia. which drug can work on slow Ca channel?
a. Varapamil
b. Adensine
c. Amiodarone
d. Phenvtoin
a. Varapamil
- Verapamil is a class 4 antiarrhythmic drug which works as a calcium channel blocker -> slows phase 4 spontaneous depolarization -> slows AV conduction.
-Adenosine is an adenosine receptor agonist. - Amiodarone is a class 3 antiarrhythmic drug ,which works by blocking potassium channel -> prolongs phase 3 reporalization -> prolongs refractory period.
-Phenytoin is an anticonvulsant ,which work as NA channel blocker.
Which substance is food for the small bowl?
glutamine
A patient came with UGIB. You did the ABC and resuscitated him. On endoscopy you saw varices with stigma of recent bleeding. What’s the most appropriate next step?
a. IV omeprazole
b. Band ligation
c. TIPS
d. Balloon tamponade
b. Band ligation
How to approach upper GI bleed (stepwise): 1) if varices- iv octreotide and iv antibiotics, if PUD- iv ppi 2) Esophageal banding 3) if banding fails, insert a Sengstaken-blakemore tube 4) followed by emergent TIPS 5) to prevent further bleeding, give beta blockers.
A question about Child Pugh
?
patient having hyponatremia + high serum osmolality:
Hyperglycemia
Hyperlipiddmia
SIADH
Hyperglycemia
*hyperlipidemia causes pseudohyponaterima, however, plasma osmolality would be normal. On the other hand, hyperglycemia increases plasma osmolality and decreases sodium through osmotic diuresis.
A female with jaundice, nausea, and anorexia recently traveled to Syria and has no drug history. ALT & AST are very high (thousands), Bil and ALP elevated, PT normal. What antibody would you find?
HAV IgM
Clinical picture of jaundice, nausea, and anorexia indicates hepatitis. Elevated ALT and AST
indicates a hepatocellular injury which is usually found in hepatitis. Nothing in the stem
indicates a parental/sexual/transfusion cause, therefore it has to be fecal-oral (either HAV or
HEV). Also a recent travel to Syria is more relevant with HAV.
Case of pancreatitis, what signifies bad prognosis?
low oxygen saturation
*check Ranson’s criteria
They put a picture of reed Sternberg cells of Hodgkin lymphoma and the patient had the lumps in his neck and groin area. What stage is this?
a. IB
b. IIIb (assuming the question had B symptoms)
c. IV A
b. IIIb (assuming the question had B symptoms)
