2013 - 5th Flashcards
A young male patient was brought to the casualty with abdominal pain, nausea and vomiting. The patient looked very ill and dehydrated. Earlier that day, he passed large amounts of urine and was feeling unusually thirsty too. His blood glucose was found to be very high, pH was 7.23 and urine was positive for ketones. A diagnosis of diabetic ketoacidosis complicating undiagnosed case of type 1 diabetes mellitus was confirmed. Which of the following would be the initial step in managing this patient?
A. Infusion of normal saline and insulin immediately
B. Wait for the ICU setting to give insulin
C. Administration of Ringer’s lactate and subcutaneous insulin
D. Administer insulin first then check the fluid levels
E. Wait for electrolyte results then administer insulin and NS
E. Wait for electrolyte results then administer insulin and NS
Note: K level should be < 4 replace if low or administer NS first because the patient is dehydrated.
A 17 years old patient had back pain then developed grouped vesicular lesions on her trunk that was confined to a dermatome, what is the causative agent?
A. Herpes Zoster Virus
B. Herpes Simplex Virus
A. Herpes Zoster Virus
A women with idiopathic intracranial hypertension came to the hospital to do LP. what is the most common complication of LP?
A. headache
B. epidural hematoma
C. transtentorial herniation
D. infection
A. headache
A 28 years old engineer who was previously healthy. he had hypopigmentation spots on unexposed area of his trunks and body. What is the most likely cause?
A. Mycosis fungoides
B. Chemical leukoderma
C. Hansen’s disease
D. Pityriasis versicolor
E. Early vitiligo
D. Pityriasis versicolor (not sure)
Scenario describing Cushing syndrome. what is the best initial test?
A. Serum cortisol
B. dexamethasone suppression test
B. dexamethasone suppression test
what is the most sensitive indicator of contrast-induced nephropathy?
a. urine output < 600
b. hematuria
c. rising creatinine > 26 in 24 hours
c. rising creatinine > 26 in 24 hours
A 36-year-old obese female complains of frequent headaches, tinnitus, and visual obscurations. On neurological examination, fundoscopy reveals papilledema. She also had signs of sixth cranial nerve palsy. What is the likely diagnosis according to this patient’s presentation?
Idiopathic intracranial hypertension
MSD Raed ‘headaches’
Idiopathic Intracranial Hypertension
* Headache, pain in the neck and shoulders and upper back. * Worse with the morning and with coughing/straining.
* Pulsatile tinnitus.
* Transient visual obscurations.
* Diplopia ( Abducens Nerve Palsy )
A young lady experienced chest tightness and wheezes upon exposure to dust. she came to ER with O2 saturation 92%. on examination she had bilateral rhonchi. what will the spirometry most likely show? what is true about her condition?
a. obstructive pattern significantly reversible with bronchodilator
b. normal spirometry
c. obstructive pattern largely irreversible with bronchodilator
a. obstructive pattern significantly reversible with bronchodilator
Allergic asthma presents this way clinically and will have a reversible obstructive pattern on PFT.
49-year-old woman has a history of joint pain and morning stiffness for four months. Examination reveals swelling of the wrists and MCPs. Which of the following can be used to monitor the activity of rheumatoid arthritis?
A. C-RP
B. Rheumatoid factor
C. Complement levels
A. C-RP ( CRP is useful to detect the disease activity and the respond to therapy however RF is not useful for the activity its more used in the prognosis of the disease, these information are from the MSD of dr. mona)
A 25-year-old man presented with one month history of right sided chest pain with progressive shortness of breath and dry cough. He now has a fever as well. Upon examination, his right chest had increased vocal resonance, dullness on percussion and normal breath sounds compared to the left side. What is the most likely diagnosis?
a. left pneumothorax
b. Right consolidation
c. Right effusion
d. Left effusion
e. Right collapse
b. Right consolidation
Consolidation due to pneumonia usually will reveal these physical examination findings. The other diagnoses don’t fit with the findings.
Which results would be a cause of established essential hypertension rather than secondary hypertension in a young lady?
a. Bilateral renal cysts
b. LowK
c. pH 7.4
d. Hypercalcemia
e. Hypernatremia
c. pH 7.4
According to AMBOSS: in secondary HTN pt will have metabolic alkalosis and low K. so all the options are for secondary expect C.
A 30 year old female who is a known case of systemic lupus erythematosus, presented with polyarthralgia, palor and jaundice. Which of the following tests confirms the diagnosis?
A. Direct Coombs test
B. Bone Morrow Aspiration
C. Osmotic fragility test
A. Direct Coombs test (SLE can cause autoimmune hemolytic anemia which will be diagnosed by positive direct coombs test)
A 65 years old man with with melena. He had 4 upper endoscopies, 3 colonoscopies, and barium follow through that all turned out to be negative. what is the best next step ?
A. CT of abdomen
B. Mesentric angiography
C. CT-angiograpy with intravenoues heparin
D. Wireless capsule endoscopy
E. Repeat colonscopy
D. Wireless capsule endoscopy
Wireless capsule endoscopy indication: obscure gastrointestinal bleeding, meaning that it is used as an investigation tool when the site/cause of bleeding is unknown.
A 48-year-old woman with alcoholic cirrhosis is evaluated because of increasing ascites and a right-sided pleural effusion. Her liver disease is classified as Child-Pugh Class B. She has no history of encephalopathy. The ascites is being managed by dietary sodium restriction and administration of furosemide and spironolactone but has required large-volume para-centesis approximately every 10 days. Paracentesis shows low-protein ascetic fluid and a serum-ascites gradient of 1.5. Previous attempts to increase her diuretic dosage resulted in orthostasis and azotemia and have only partially reduced the volume of ascites.
On physical examination, she has tense ascites but no pedal edema. Which of the following is most appropriate at this time?
A. TIPS
B. Portocaval shunt
C. Peritoneocaval shunt
D. Repeat Abdominal paracentesis
E. Chest tube draining the ascites and pleurodesis
A. TIPS
Management of ascites:
1. Medications; diuretics: spironolactone, and if the response is poor furosemide is added.
2. If resistant to medical therapy, paracentesis is done.
3. If resistant/refractory ascites, TIPS is done as a last resort
elderly patient with atrial fibrillation presented with severe peri-umbilical pain, no guarding or tenderness , what is the investigation you want to order?
A. CT of abdomen
B. Mesenteric angiography
C. laporotomy
B. Mesenteric angiography
ACUTE MESENTERIC ISCHEMIA:
Caused by compromised blood supply, usually an emboli due to a cardiac origin (A Fib). Therefore mesenteric angiography is the definitive diagnostic method.
Patients usually present with severe abdominal pain that is disproportionate to physical findings.
A 63 years old hypertensive male had a stroke. After which, he couldn’t read but he could write and speech was intact. he also had right homonymous hemianopia. where is the lesion?
A. Left heschl’s gyrus
B. Left visual cortex
C. Corpus Collusum
D. Corpus Callosum and left visual cortex
E. Broca area
D. Corpus Callosum and left visual cortex
• Lesions of the left heschl’s gyrus produce problems of speech perception with difficulty in discriminating speech.
• Broca’s area function is speech production and language comprehension.
• Left visual area explains only the right homonymous hemianopia.
• Lesions in corpus callosum causes inability to read with intact speech and writing abilities.
Young male, sudden left sided chest pain. Upon examination, the trachea deviated to the right and there was hyper-resonance, decreased breath sounds in his left side.
a. left pneumothorax
b. Right pneumothorax
c. Left effusion
d. lung collapse
a. left pneumothorax
Pneumothorax will show hyperresonance on percussion, decreased breath sounds on auscultation, and tracheal deviation to the opposite side.
A 58 year old obese female presented with pain in her left knee associated with morning stiffness that lasted 15 minutes. What is the most likely diagnosis?
Osteoarthritis
You were about to prescribe PPI to a lady. She was worried about the side effects. Which of the folowing nutrients require acid for absorption?
A. Vit B12, Vit C, Vit E
B. iron, Vit B12, Vit E
C. iron, Vit B12, Calcium
D. Vit B12, Vit C, Vit B12
C. iron, Vit B12, Calcium
PPIs are given to lower the acidity, therefore any nutrients that require acidity for absorption will be affected.
What is the quickest way to decrease cerebral edema?
A. Mannitol
B. Hyperventilation
C. Head elevation
B. Hyperventilation
Hyperventilation causes cerebral vasoconstriction, which reduces cerebral blood flow and volume to decrease the oxygen supply in both normal and injured areas. Hyperventilation decreases the intracranial pressure and relaxes the brain.
A 24 year old man presented with weakness and fatigue. On physical examination, he was found to have postural hypotension and raised JVP. Provided are his lab results: PO2: 12.8 Kpa (normal); PCO2: 24 mmHg; HCO3: 15 mmHg; pH: 7.28; Na: 135; Urine Na: 9; Glucose: 5; Urea: 7; Chloride: 115 (high); S-osmolality: 308; K: 3.8. What is the diagnosis?
a. Lactic acidosis
b. Ethanol intoxication
c. Renal failure
d. Renal tubular acidosis
e. Diarrhea
e. Diarrhea
Reminder of plasma anion gap: (Na + K) – (HCO3 + Cl), normal anion gap with signs of dehydration -> diarrhea
Vogelstien model, Which of the following gene is responsible for the transformation of adenoma into carcinoma?
A. p53 mutation
B. activation of kras oncogene
C. DCC mutation
D. APC mutation
E. DNA methylation
A. p53 mutation
a known hypertensive diabetic smoker presented with compressing chest pain and diaphoresis. his ECG was given and he has anterior MI. what murmur would you hear on auscultation?
A. pansystolic murmur at the apex
B. ejection systolic murmur
C. mid-diastolic murmur
D. early diastolic murmur
A. pansystolic murmur at the apex
MI -> rupture chordae tendineae -> Mitral regurgitation -> Pan systolic murmur.
A pan systolic murmur at left lower sternal border- > Tricuspid regurgitation.
A 34-year-old male presented with backache and spinal deformity with kyphosis. He also reports SOB on exertion and palpitations. His BP is 160/50. A murmur was heard on auscultation. Which of the following is likely to be present in this patient?
A. Aortic regurgitation
B. Mitral regurgitation
C. Mitral stenosis
D. Mitral valve prolapse
A. Aortic regurgitation
-Backache and spinal deformity with kyphosis are features of ankylosing spondylitis,and it is one of the etiologies of Aortic regurgitation.
-160/50=wide pulse pressure ,which is one of the physical signs that is found in AR.
patient with mildly elevated liver enzymes. her BMI= 31 . she has no other complaints. what is the diagnosis?
A. NASH
B. Wilson’s disease
C. Autoimmune hepatitis
A. NASH
BMI > 30 = obese and mildly elevated enzymes is associated with NASH. Nothing indicates defective copper metabolism, therefore answer is not Wilson. For AIH, liver enzymes are greatly elevated due to inflammation that leads to hepatocellular injury.
what is the antidote of Unfractionated heparin ?
protamine sulfate
A 15-year-old, previously healthy, school student presents with sudden onset of dyspnea and orthopnea. She gave a history of ‘flu’ like illness one week prior to the presentation. Examination revealed bilateral basal crepitations. Echocardiogram showed dilated poorly contracting left ventricle. The most likely additional finding on examination will be?
A. Normal jugular venous pressure
B. Pulsus paradoxus
C. S3 galop at the apex
D. Single second sound
E. Pericardial rub
C. S3 galop at the apex
- Dilated left ventricles means there is systolic dysfunction, and since the patient is young it is most probably dilated cardiomyopathy.
- Systolic dysfunction= S3 galop
- History of flu like illness could mean that the dilated cardiomyopathy resulted from an infectious agent.
- Most commonly associated infectious disease with dilated cardiac myopathy are: Viral(coxsackie B,HIV), Chagas disease, Lyme disease, Rickettsial disease, Acute rheumatic fever, and toxoplasmosis.
- Bilateral basal crepitation indicates pulmonary edema that resulted from left ventricular failure.
- B is incorrect, Pulsus paradoxus is not found in patient with dilated cardiomyopathy, but it is rather found in:
1) Cardiac tamponade
2) Cardiogenic shock
3) Pulmonary embolism (large)
4) Tension pneumothorax
5) Severe obstructive pulmonary disease
6) Constrictive pericarditis-rarely
Lacunar stroke causes pure motor hemeparesis. A lesion in which of the following areas is least likely to be associated with pure motor hemeparesis?
A. anterior limb of internal capsule
B. posterior limb of internal capsule
C. infarction of cerebral peduncle
D. infarction of basis pontis
E. infarction of medullary pyramid
A. anterior limb of internal capsule
A 60 year old female presented with painless left sided visual loss, he described it as “descending curtain”. A diagnosis of amaursis fugax (transient monocular visual loss) was made. What is the most common cause of this condition?
A. Ipsilateral Internal carotid artery atherosclerosis
B. Ophthalmic artery spasm
C. Hypotension
D. Migraine with aura
A. Ipsilateral Internal carotid artery atherosclerosis
Which of the folowing is used to lower potassium in patients with hyperkalemia?
a. Calcium gluconate
b. Glucose
c. Insulin
d. Salmetrol
c. Insulin (dr. Wael)
d. Salmetrol (dr. Kamel)
I think we have to give dextrose with the insulin.
According to UpToDate: the first line treatment in hyperkalemia: calcium gluconate if we have ECG changes, second line: insulin, third: sodium bicarb (but in case of metabolic acidosis it is controversial -> fluid overload with hypernatremia and metabolic alkalosis -> heart failure and CKD), third: B2 agonist, in nonacute cases , the effect last for 2 hrs.
A 30 year old female with sickle cell anemia developed anemia, thrombocytopenia, and leukopenia. On examination, she had tender splenomegaly. What is the most likely cause?
a. Autosplenectomy
b. Splenic sequestration crisis
c. TTP
b. Splenic sequestration crisis
A patient presented with recurrent boils on different parts of his body. He is not known to be diabetic or on any immunosuppressive agents. What is the most likely diagnosis?
A. Hidradenitis suppurative
B. Erythema induratum
C. Recurrent furunculosis
C. Recurrent furunculosis
A 25 year old female with more than 5-year history of rheumatoid arthritis has high Rheumatoid Factor and high Anti-CCP. Which of the folowing is an extra articular manifestation in RA?
Pleural effusion
A diabetic patient hospitalized for an anterior MI. During his hospital stay, he developed breathlessness and chest pain that is aggravated by lying down and relived by standing or leaning forward. What is the diagnosis?
Pericarditis
- Pain that is aggravated by lying down and relived by standing or leaning forward is defined as pleuritic pain.
- Pericarditis can occur post MI in two different clinical situation:
1) Acute: by direct extension of myocardial inflammation, 1-7 days post MI.
2) Dresser syndrome: Auto-immune reaction, 2-8 weeks post MI.
A patient with asthma on maximum doses of inhaled corticosteroids (fluticasone) and LABA. Despite this, his symptoms are uncontrolled and he still gets frequent exacerbation attacks. What is the correct statement about management for this patient?
a. Montelukast, a leukotriene receptor antagonist, is to be added.
b. Theophylline, a methylxanthine drug with wide therapeutic index, is to be added.
c. Omalizumab, a monoclonal antibody against IL-2, might benefit him.
d. Lebrikizumab, a monoclonal antibody against IgE, might benefit him.
a. Montelukast, a leukotriene receptor antagonist, is to be added
From Batch 2013: “The descriptions of all other choices are wrong. Omalizumab is an anti-IgE. Lebrikizumab is anti-IL-13.”
Comment: According to the latest GINA guidelines for treating asthma, I would have chosen Omalizumab ONLY if its definition was written correctly in the exam. The guidelines state that if a patient’s severity is “severe persistent”, he should be on medium/or high dose inhaled steroids, LABA, and an add-on like anti-IgE (Omalizumab) or anti-IL5/5R. He is already on high dose steroids and LABA so what’s left is the omalizumab. Leukotriene receptor antagonists are used in the previous severities along with a low or medium dose steroid, NOT high dose.
الله أعلم In the end ):
A 70 year old man who used to work as a constructor worker in shipyard. He presented with progressive shortness of breath. pulmonary function test showed restrictive lung pattern and normal DLCO. what will you find on his CXR?
a. calcified pleural plaques
b. cavity in the upper lung
c. Diaphragmatic plaque
a. calcified pleural plaques
Pleural plaques = pathognomonic for prior asbestos exposure, which is found in shipyards, construction sites, and car mechanics. (asbestosis)
A patient with a history of rheumatic fever. he had exertional dyspnea and palpitation. On auscultation a murmur is heard. What does the patient have?
A. Aortic regurgitation
B. Mitral regurgitation
C. Aortic stenosis
D. Mitral stenosis
B. Mitral regurgitation
The previous figure shows the hemodynamics of mitral regurgitation:
During systolic contraction blood regurgitates from the left ventricle into the left atrium across incompetent mitral valve resulting in audible holosystolic murmur between S1 and S2 .The portion of the left ventricle and diastolic volume that regurgitates into the left atrial myocardium increases left atrial pressure resulting in tall V-wave (in the JVP)
A 45 year old male presented with shortness of breath and cough productive of yellow sputum which has started insidiously. He is known to have hypertension and type 2 diabetes mellitus. Chest x-ray was normal. Results of his pulmonary function tests are provided.
FEV1/FVC 60% FEV1 60% FVC 110% (probably a typo) RV 125% TLC 120% DLCO 60%
What is the diagnosis?
a. Emphysema
b. Chronic bronchitis
c. Acute bronchitis
a. Emphysema
Which of the following is a typical finding in diabetic ketoacidosis?
A. Low HCO3
A man presented with symmetrical joint pain in the proximal interphalangeal, metacarpal joints, and carpometacarpal joint with swelling. he has negative RF. what is the best thing you want to do next for this patient?
A. Consult a rheumatologist to confirm the diagnosis
B. Serology for ANA
C. Treat as general non-RA pain with prednisolone
A. Consult a rheumatologist to confirm the diagnosis
A 20 year old patient presented with headache, photophobia, nausea and vomiting. Fundoscopy showed papilledema. Which of the following indicates a red flag?
A. Age
B. Photophobia
C. Papilledema
C. Papilledema
MSD Dr Suhail ‘headaches’
Red flags for secondary headaches SNOOP4 Systemic signs and symptoms
Neurological finding in examination
Older than 50 y/o
Postural headache
Precipitation of headache with valsava Progression of headache
Presence of papilledema
A young lady with joint pain. labs showed positive anti-histone antibody.her medication includes hydralazine. what is the most appropriate management?
Discontinue hydralazine ( one of the drugs that induces lupus)
A female presented with a few-day history of fever, jaundice, and purpura all over her body. According to her family, she has been confused lately. Labs showed
low HB, low platelets, and high LDH. Coagulation profile was normal. What is the best treatment modality?
a. Observation
b. Plasma exchange
c. Fresh frozen plasma
d. Packed red blood cells
e. Prednisone
b. Plasma exchange
A 38-year-old female was referred to a rheumatologist with active rheumatoid arthritis in more than 20 joints. What is the best treatment?
A. Imuran
B. Plaquenil
C. Methotrexate
D. Cyclophosphamide
E. Aminoslalicylic acid
C. Methotrexate
A patient underwent coronary angiography. Which of the following would you expect to find in contrast-induced nephropathy?
a. proteinuria > 2.6
b. hematuria
c. small kidneys
d. eosinophiluria
e. increased urine osmolarity
e. increased urine osmolarity
Dr. Wael said this is the correct answer for this Q (not hematuria)
A 52-year-old man developed an erythematous scaly rash and polyarticular joint pain (Psoriasis). His heels are painful. What musculoskeletal manifestation is he likely to have?
A. Enthesitis
B. Proximal myopathy
C. Palpable osteophytes
D. Subcutaneous nodules
A. Enthesitis (enthesitis, dactylitis, arthritis mutilans are musculoskeletal manifestation of psoriasis)
An elderly man presented with LUQ pain and splenomegaly. Below are his CBC and PBS results.
Hb: Low; Platelets: High; WBCs: High (mostly neutrophils) - PBS: Promyelocyts, myelocytes, metamyelocytes, band cells, segmented forms, and 3% eosinophils. Which of the following can be used to treat this condition?
a. Hydroxyurea
b. Tyrosine Kinase inhibitor - Imatinib
c. JAK 2 inhibitor – Ruxolitinib
b. Tyrosine Kinase inhibitor - Imatinib
Note: The scenario indicates CML
Which of the following conditions increases DLCO?
a. Pulmonary HTN
b. Polycythemia
c. COPD
b. Polycythemia
When pulmonary blood flow is increased, the diffusing capacity will consequently increase as well. The opposite is also true (anemia = low DLCO)
A patient presented with recent history of Jaundice and right upper queadrant pain. which of the following would be the most cost-effective to diagnose viral hepatitis in this patient?
A. HAV IgM, HBSAg, Anti-HCV
B. HAV IgM, HBsAg, HBc IgM, and Anti-HCV
B. HAV IgM, HBsAg, HBc IgM, and anti-HCV
(other options were not including HAV IgM so we excluded them)
A 32-year-old lady who is pregnant in the second trimester was found to have a high blood
pressure on a regular follow-up. What drug should be used to manage her condition?
a. Methyldopa
b. Angiotensin converting enzymeinhibitor
c. Beta-Blocker
a. Methyldopa
A young female who is taking a drug for depression presented to your clinic with respiratory symptoms. This is her flow-volume loop. What is the most likely diagnosis?
a. Asthma
b. Löffler syndrome
c. ILD
d. Vocal cord dysfunction
e. COPD
d. Vocal cord dysfunction
(**The loop shows variable upper airway obstruction with truncation of
the inspiratory limb.)
Vocal cord dysfunction manifests as an upper airway obstruction. This would show as a flattened inspiratory limb.
What substance plays a role in the pathophysiology of migraine headaches?
A. Serotonin
B. Histamine
C. Acetylcholine
Serotonin
A 55 year old man with alcoholic cirrhosis presents with increasing ascites that is not responding to diuretics. An ascitic fluid aspiration is performed and the fluid analysis results are as follows:
A. Acute portal vein thrombosis
B. Hepatocellular cancer with peritoneal metastases
C. Spontaneous bacterial peritonitis
D. Tuberculous peritonitis
E. Pancreatic ascites
answer: C. Spontaneous bacterial peritonitis Neutrophil count > 250 cells/mm3 = SBP
B. Hepatocellular cancer with peritoneal metastases Cytology is required
C. Spontaneous bacterial peritonitis Neutrophil count > 250 cells/mm3 = SBP
D. Tuberculous peritonitis Elevated lymphocytes
E. Pancreatic ascites Elevated amylase (pancreatic enzymes)
A 44 yr old female presented with left pleuritic chest pain and shortness of breath of 1 hour duration. Also swollen painful legs of few days duration. Previous records show that the patient had DVT 7 years ago and was treated with heparin and developed HIT. what is the best initial management?
a. LMW heparin
b. unfractioned heparin
c. warfarin
d. aspirin and clopidogrel
e. factor Xa inhibitor
e. factor Xa inhibitor
Note: the first line treatment for HIT is factor Xa inhibitor
scenario describing ILD. how to confirm?
a. bronchoscopy with biopsy
b. HRCT
b. HRCT
An old lady presented with vomiting for 1 week. Now she she has persistent epigastric pain. Her creatinine level is 200 and urine sodium was 12. What is the next step for management?
A. IV normal saline and antibiotics
B. PPI and endoscopy
C. Upper endoscopy
D. CT scan with contrast to identify the source of her pain
A. IV normal saline and antibiotics
Read the stem of the question carefully, keep an eye to whether the question is asking for the next or the best management. Vomiting for 1 week in a old lady would most probably lead to dehydration and volume depletion, which is supported by her creatinine levels and the urine sodium. Therefore the next step is to rehydrate by IV saline (think ABCs).
A 15 year old girl presented with involuntary chorea movements. She had recurrent rheumatic fever episodes. What might the workup of this patient reveal?
A. Chronic arthritis
B. Involvement of spinal joints
C. Erythema nodosum
D. High ASO titer
D. High ASO titer
-An involuntary chorea movement in a patient with recurrent rheumatic fever -› Sydenham chorea.
-Sydenham chorea is neurological disorder of childhood resulting from infection by group A beta-hemolytic streptococcus, the bacterium that causes rheumatic fever.
-Answer A is incorrect because the type of arthritis in rheumatic fever is acute (less than 6 weeks) not chronic.
-Spinal joints is not involved in rheumatic fever, and the most commonly involved joints are the knees, ankles, elbows, and wrists.
-Answer C is incorrect, rheumatic fever is associated with erythema marginatum and subcutaneous nodules.
Regarding the paraneoplastic syndromes, which of the following malignancies is most likely to be associated with hypercalcemia?
a. Small cell carcinoma
b. Large cell carcinoma
c. Adenocarcinoma
d. Squamous cell carcinoma
d. Squamous cell carcinoma
Squamous cell carcinoma is commonly associated with PTH-like hormone secretion resulting in hypercalcemia. REMEMBER:
A 14 years old boy with known bleeding disorder presented with severe pain in both legs. examination revealed splenomegaly. what is the diagnosis?
a. sickle with thalassemia
b. Sickle trait
c. sickle SS
d. Sickle SC
e. Thalassemia major
a. sickle with thalassemia
Note: The blood film of a patient with sickle cell/ beta thalassemia compound heterozygosity shows sickle cells, boat-shaped cells, target cells, nucleated red cells, anisocytosis, poikilocytosis.
A patient presented with painless lymphadenopathy. He also had weight loss and night sweats. Pictures were provided.
a. Hodgkin’s lymphoma
b. NonHodgkin’s disease
c. infectious mononucleosis
d. thyroid cancer
a. Hodgkin’s lymphoma
A patient presented with anemia and glossitis. Deficiency of which of the following causes this condition?
Vitamin B12
A 34-year-old Caucasian female presented with non-specific musculoskeletal symptoms, fatigue, and mild RUQ pain. Her labs showed (AST=353, ALT=267, ALP=220, bilirubin=60). Ultrasound of the liver showed mild enlargement and echogenicity. A biopsy was taken and is shown below. Based on the previous scenario, what is the best treatment option for this patient?
A) gradual weight reduction
B) ursodeoxycholic acid
C) prednisone
D) piglitazone
E) methotrexate
C) Prednisone
AUTOIMMUNE HEPATITIS - MSD DR WALEED ALAZMI
– Clinical presentation: Symptoms are commonly nonspecific fatigue and mild right upper quadrant discomfort.
– Lab work: Characteristic pattern is hepatocellular injury rather than cholestasis, therefore raised LFTs is seen.
– Management: prednisone.
A women who has mitral stenosis and Atrial fibrillation underwent valve replacement and she got St. Jude prosthetic valve. what is the best anticoagulation?
A. warfarin
B. aspirin
C. clopidogrel
D. dabigatran
A. warfarin
A child took ampicillin for 3 days for his illness. he came with a creatinine of 200 (it was description of acute renal failure) no microscopic hematuria, no edema. what would you do?
a. give normal saline
b. nothing, it is just post-strept glomerulonephritis
c. give steroids
c. give steroids
This is from Dr.Salman Alotaibe
A patient with complains of chronic pancreatitis (see x-ray) , how will you treat this patient?
Pancreatic enzyme supplements
Calcified pancreas on x-ray= chronic pancreatitis
Therefore treatment is enzyme supplements, since the pancreas is calcified and is no longer viable to produce the required enzymes.
A patient with sensory symptoms neck and shoulder pain. he also noticed tingling and loss of sensation in the fourth and fifth fingers of his hand . What is the most likely diagnosis ?
A. C5 radiculopathy
B. C6 radiculopathy
C. C7 radiculopathy
D. C8 radiculopathy
E. T1 radiculopathy
D. C8 radiculopathy
