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Medicine ELOOPS > 2017 > Flashcards

2017 Flashcards

1
Q
  1. What is the diagnosis?
  2. How would you treat the patient if he is hypotensive?
A
  1. Ventricular tachycardia
  2. Synchronous DC cardioversion
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2
Q

Patient presented with severe retrosternal chest pain of 2 hours duration. Shown is his ECG (ST segment elevation in V1-V4 only)
1. What is the diagnosis based on the ECG?
2. Mention two definitive Rx?

A
  1. Anterior wall ST segment elevation myocardial infarction
  2. Thrombolytic therapy, percutaneous coronary intervention (PCI)
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3
Q

A marathon runner has multiple episodes of dizziness, he presented to the ER after losing consciousness
1. What is the diagnosis based on the ECG?
2. What is the definite treatment?

A
  1. LBBB
  2. Pacemaker
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4
Q

A 40 year old lawyer presented with minimal dyspnea with effort and central chest pain. ECG shows the following:
1. What is the diagnosis?
2. What can be heard on auscultation?

A
  1. Anterior wall STEMI
  2. S3 gallop
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5
Q

A 60 year old patient presented with dizziness and frequent episodes of syncope. He is a known case of heart disease. This is his ECG:
1. What is the diagnosis?
2. What is the treatment?

A
  1. Third degree AV block
  2. Permanent Pacemaker
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6
Q

A 50- year old man with a previous history of MI presented to the ER unconscious. This is his ECG
1. What is the diagnosis
2. What is the definitive treatment?

A
  1. Ventricular tachycardia
  2. Synchronized cardioversion
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7
Q

A 25 year old waitress from Senegal presents with fever and chills of 3 weeks duration, skin lesions on her shin and sore throat. This is her chest x-ray:
1. Mention 2 findings on the chest x-ray:
2. What treatment will you give to this patients and what is her prognosis?

A
  1. Bilateral pulmonary infiltrates Hilar lymphadenopathy
  2. Treatment: Oral steroids for 6 to 24 months
    Prognosis: spontaneous recovery in 40-70% of cases
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8
Q

A 38 year old man presented with dyspnea and chest pain.
1. What is the diagnosis?
2. Two other signs seen in clinical examination?
3. What is the immediate management?

A
  1. Tension pneumothorax of right lung (trachea is mildly deviated to the opposite side)
  2. Deviated trachea, hyperresonant, absent breath sounds
  3. Needle decompression in the second intercostal space in the midclavicular line, followed by chest tube insertion
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9
Q

A 26 year old presented with dry cough. This is her chest x-ray:
1. What is the diagnosis?
2. What are two investigations would you order?

A

-

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10
Q
  1. Mention two of the possible clinical findings?
  2. What is the most useful investigation?
A

-

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11
Q

A female patient with a history of breast cancer presented with shortness of breath. CXR is given:
1. What is the first investigation done to confirm diagnosis?
2. Which method can have both therapeutic and diagnostic benefits?

A

-

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12
Q
  1. What finding would you notice in this patient JVP?
  2. What is the finding in this patient pulse?
A
  1. Raised JVP with inspiration (kussmaul’s sign)
  2. Pulse maybe regular or irregularly irregular (one third have Afib)
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13
Q

A female patient with normal PFT and a positive family history of bronchial asthma.
1. What is the name of this test?
2. What is the diagnosis based on the graph?

A
  1. Methacholine challenge test
  2. 20% change in FEV1 is positive for asthma
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14
Q
  1. What immunological investigation would you order?
  2. Name 2 blood tests to diagnose this patient.
  3. What are two neurological manifestations of this condition.
A
  1. High CD4 to CD8 T-cell ratio, IL2, Serum Amyloid A (not sure)
  2. Serum ACE level, CBC showing normocytic normochromic anemia with elevated ESR, and Serum Calcium.
  3. Cranial nerve palsies and Polyneuropathy
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15
Q

A PFT of a smoker patient showed a restrictive pattern.
1. What pattern is this?
2. What is the cause?

A
  1. Restrictive pattern
  2. Obesity
    [it showed his weight on top of the pft]
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16
Q

Patient presented with progressive SOB and non-productive cough. He has negative occupational history. CT scan shown:
1. Describe the finding of CT scan?
2. Mention two symptoms the affect the patient the most?
3. What are the treatment methods/what is the definitive management ?

A
  1. Honeycomb appearance with traction bronchiectasis
  2. SOB & dry cough?
  3. O2, specialized therapy such as pirfenidone/nintedanib (not steroids)

(if the question was definitive management then the answer is lung transplant)

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17
Q

A 60 year old smoker male with cough and dyspnea
1. What is the ventilatory defect?
2. Give an example.

A
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18
Q

A 50 year old gardener presented with progressive shortness of breath and cough for the past 2 months
1. Describe the finding of CT scan?
2. What is the best treatment?

A
  1. Honeycomb appearance with traction bronchiectasis
  2. It wasn’t clear from the scenario whether this was idiopathic pulmonary fibrosis or interstitial pneumonitis because the patient is a gardener.
    If it was IPF: antifibrotics (nintedanib or pirfenidone) and eventually the patient will likely need lung transplant. If it was hypersensitivity pneumonitis: avoidance of exposure and he may need prednisolone in large doses to regress the disease in early stage.
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19
Q

An old man suspected to have ischemic stroke presented as seen in the picture:
1. What is the diagnosis?
2. Give two causes of this condition?

A
  1. RT-sided Bell’s palsy (LMNL of RT facial nerve)
  2. -
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20
Q

3rd CN palsy with dilated pupils. The patient also has right sided body weakness
1. Where is the lesion?
2. What is the diagnosis?

A

-

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21
Q
  1. What is the name of the sign?
  2. What does it indicate?
A
  1. Babinski sign
  2. Upper motor neuron lesion
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22
Q

Patient is a case of Parkinson’s and has a pill rolling tremor
1. What are the cardinal features of Parkinson’s disease?
2. What is the mainstay treatment of Parkinson’s disease?

A
  1. ● Bradykinesia: slowing of movements or difficulty initiating movements.
    ● Tremor: Resting tremor usually most obvious in the hands improved by voluntary movement and worsens with anxiety.
    ● Rigidity: increase in tone with resistance to passive extension throughout movement.
    ● Postural changes: a stoop,
  2. Dopamine replacement improves the motor symptoms and is the basis of:
  3. Pharmacological therapy ( levodopa, dopamine agonists, monoamine oxidase Inhibitors etc.. ).
    Other treatments include physiotherapy to improve gait and prevent falls. Deep Brain stimulation has proved to be a major therapeutic advance in selected patients.
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23
Q

A 70 year old with a history of headache for two days
1. What is the most likely diagnosis?
2. What laboratory test would you do to confirm the diagnosis?

A
  1. Giant cell arteritis
  2. ESR (very high), CRP, P-ANCA(?)
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24
Q
  1. What is the abnormality shown in the figure?
  2. Is it acute or chronic condition?
  3. What is the cause?
  4. Is the lesion a LMN or UMN?
A
  1. ● Deviation of the protruded tongue to the left
    ● Tongue wasting and fasciculations
  2. Chronic condition
  3. Left LMN hypoglossal (CN XII) palsy
  4. LMN (CN 12)
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25
Q

A 53-year-old diabetic patient complains of painful vesicles that appeared above his left eye.
1. Which cranial nerve is affected in this condition?
2. Which division of this cranial nerve is affected?

A
  1. Trigeminal nerve (CN V)
  2. Ophthalmic division (V1)
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26
Q

A 70 year old female presented with an acute ischemic stroke. She had weakness on the left side of her body. She was asked to draw a clock, and this is shown to you:
1. What is the cerebral deficit shown in the picture?
2. Which part of the brain is damaged in this patient?

A
  1. Spatial neglect
  2. Right parietal lobe
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27
Q

A female presented with tingling of her hand
1. What is the nerve affected?
2. What is the diagnosis?

A
  1. Median nerve
  2. Carpal Tunnel syndrome
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28
Q
  1. Name this test?
  2. What would be the finding if the patient has conductive deafness?
A
  1. Rinne’s test
  2. Bone conduction > Air conduction
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29
Q

A 50-year-old female with hypothyroidism presents with worsening pruritus and fatigue. She has no abdominal pain. Abdominal ultrasound was normal. Physical examination reveals the following:
1. What is the most specific blood test
2. What is the best medical therapy?

A
  1. Serology (Anti-mitochondrial Abs)
  2. Ursodeoxycholic acid
30
Q

49 year old presented with chronic abdominal pain and weight loss despite good appetite. Pale, foul-smelling stool for 6 months > 25mg/dl
1. What is the abnormality in x-ray and CT
2. How to treat the symptoms?

A
  1. Calcifications of the pancreas
  2. Replacement of pancreatic enzymes
31
Q
  1. Mention serology tests
  2. What is the management of this condition?
A
  1. Anti-transglutaminase Ab Anti-endomysial Ab
  2. Gluten Free diet
32
Q

What is the cause?

A

-

33
Q

A patient presented with bloody diarrhea.
1. What is the diagnosis?
2. What is the most commonly associated biliary condition?

A
  1. Ulcerative colitis
  2. Primary sclerosing cholangitis
34
Q

A smoker with a history of gastric acid reflux and epigastric pain:
1. What is the diagnosis?
2. Mention 3 risk factors for this condition?

A
  1. Barrett’s esophagus
  2. GERD, smoking, obesity
35
Q

A patient presented with? She has a positive family history of gastrointestinal cancers
1. What is the diagnosis?
2. Mention two GI cancers associated with this condition?

A
  1. Familial adenomatous polyposis
  2. -
36
Q

Part A: Mrs C is a 31 year old female with T1DM since age 10. She is a full time worker now. She uses insulin pump since 2015 & metformin. The following is the flash download readings of her blood glucose levels:
1. What is most important abnormality noticed in her readings?

A
  1. Many hypoglycemic events in late night and early morning

The same monitor and graph parameters were in the exam but the readings were different
Her average glucose level was about 7
The glucose level was in target 23% of the time
Below target 46% of the time
Above target 31% of time
The glucose level did not fluctuate much during the day however her
overnight glucose ( from 12- 6 am) was mostly below target (showed
hypoglycemia)

37
Q

Part B: Circle the type of food that the patient needs to cover with her insulin injection

A
38
Q

You must be able to correlate the severity of the disease with complications the patient has.

Mild disease would be considered no peripheral, vascular, or neural complications. Moderate would include one of them. Severe or very severe included amputation

A
39
Q

A 30 yr old male known to have T1DM for the past 20 years. His blood glucose is erratic despite taking his dosages matched to his food intake. While examining him, you have noticed a lump in his abdomen.
What is the reason for this finding?

A

Lipohypertrophy caused by repeated insulin injections in the same site

40
Q

Mark the sites for insulin injection on the below picture:

A
41
Q

Patient with type 2 DM, 10 g monofilament test is used.
1. Describe how to do the test
2. Mark on the feet where you would apply the filament.

A
  1. Take consent. then I will take the filament and touch it on the patient hands and arm to show it is not painful, then place the filament on the designated areas on the foot, then hold the filament perpendicular to the skin then add pressure to filament to make it bend, with each touch and increase in bend of the filament ask the patient if they can feel it. And compare both feet.
    2.
42
Q

A 35 year old patient presents with back pain of 3 months duration. This is his x-ray:
1. Mention 2 characteristics of his back pain:
2. Mention 2 physical/clinical tests that would aid in diagnosis:

A
  1. Inflammatory pain associated with morning stiffness > 3o mins, not improved by rest, associated with limitation of movement
  2. Schober test
43
Q

A picture of a hand with either calcinosis scleroderma or tophous gout (not sure)
*What is the initial test to order?
*What are the complications of this disease?

A

?

44
Q

A young female with bilateral joint pain
1. What is the finding?
2. Name two differential diagnosis

A
  1. Swelling of the index and middle fingers of the right hand
  2. RA, SLE
45
Q

A 55 year old lady with long standing pain and swelling in the small joints of her hands and feet and morning stiffness lasting more than one hour
1. Mention 2 blood tests that can assess disease activity:
2. What is the probable diagnosis?

A
  1. ESR CRP
  2. Rheumatoid arthritis
46
Q

A 40 year old overweight man complains of fatigue and hoarseness of voice TSH 25 (High), T4 9 (Low), Thyroid peroxidase antibody: positive
1. What is the diagnosis?
2. What is the treatment?

A
  1. Primary hypothyroidism (Hashimoto’s thyroidistis)
  2. Levothyroxine
47
Q

A young female with tender breasts presented with amenorrhea, normal renal function, and negative pregnancy test. Lab results showed: high TSH, Low T4, High prolactin
1. Interpret the lab results and give two diagnoses
1. What possible association is there between the results?

A
  1. -
  2. -

Note: prolactin was high but not to the level of prolactinoma. It was mildly high

48
Q

A 19 year old presented with vomiting, headache, confusion, with history of 8kg weight loss over 3 months. On examination BP 86/50, HR 120 BPM.
1. What are three lab findings would you see?
2. What will be the first management in the emergency room?

A
  1. Hyponatremia, Hypoglycemia, Hyperkalemia
  2. ABC, aggressive volume replacement, correct electrolyte abnormality, IV Hydrocortisone.
49
Q

A couple came for family counseling. The mother has the following Hb electrophoresis: (HbA 52% , HbS 47%, HbF 1%). The father has thalassemia minor.
What is the the condition of the mother?
What is the probability of a child having a similar condition to his mother?

A

?

50
Q

A 68 years old man presented with 3 months history of low back pain and fatigue. Investigations revealed hypercalcemia and M spike.
1. Describe the finding in the x ray
2. What is the most likely diagnosis?

A
  1. Multiple osteolytic [punched out] lesions in the skull
  2. Multiple myeloma
51
Q

A 34 year old female suffers from shortness of breath, fatigue and palpitations on exertion.
1. What is the sign ?
2. What is the diagnosis?

A
  1. Koilonychia
  2. Iron deficiency anemia
52
Q
  1. What substance does this cell release?
  2. List two causes where this cell count is high:
A
  1. Major basic protein, eosinophilic cationic protein
  2. allergies/parasitic infections
53
Q
  1. Name this cell
  2. What is the diagnosis?
A
  1. Reed Sternberg cell
  2. Hodgkin lymphoma
54
Q

A 56-year-old patient presented with headache, pruritus (itchiness), palmar erythema, and facial plethora. CBC shows pancytopenia. His BP was high
1. What is the diagnosis
2. What is the test confirmed the diagnosis?

A
  1. Polycythemia vera
  2. Genetic testing for JAK2
55
Q

Blood film shown of a patient with hypercalcemia and bone pain
1. What is the abnormal finding seen in the blood film?
2. What is the diagnosis?

A
  1. Rouleaux formation of RBCs
  2. Multiple myeloma
56
Q

A 58 year old man known to have T2DM and CHF presented to the emergency room with one day history of altered mental status. His family stated that he receives metformin for his diabetes.
Calculate the anion gap and comment on on his acid-base status. Mention two etiologies of his acid-base status.

A

?

57
Q
  1. Name this test?
  2. What is the mode of treatment?
A
  1. Gram stain
  2. Antibiotics
58
Q

A young lady who wants to get pregnant just recently obtained a cat. She came complaining of allergic reactions but refuses to get rid of the cat.
1. Give three symptoms of allergic rhinitis?
2. What concerns are we worried about if she gets pregnant?

A
  1. Runny nose, cough, wheeze, teary eyes, SOB
  2. The cat litter box maybe a threat to the pregnant lady as the feces might have toxoplasmosis and it is teratogenic
59
Q

Covid-19 Cases
What is the mechanism of action of the monoclonal antibody (infliximab) ?
What is the best anti inflammatory drugs fo covid-19 ?

A

?

60
Q

A 34 year old Indian male, who came to Kuwait a year ago, had fever, cough, and night sweats
What other symptoms will the patient have?
What is the possible diagnosis?

A

?

61
Q

Italian boy running a marathon
What is the diagnosis?
His father died at a young age, what does that tell you?

A

?

62
Q

A patient with CKD on hemodvalisis presented with hyperkalemia and the following ECG. How would you manage this patient?

A
  • IV calcium gluconate (to protect the heart)
  • Insulin dextrose
  • Keep the patient on hemodialysis
63
Q
  1. Describe what you see on this ray
  2. What’s the diagnosis?
A
  1. Dilated colon (More than 6 cm) with thin walls
  2. Toxic megacolon (complication of ulcerative colitis)
64
Q

60 y.o man with Rt shoulder and back pain. (can’t remember the rest of the senario)
Couldn’t find the exact CXR but it had Bilateral Hilar lymphadenopathy (Some students said it’s pancoast tumor but I went with Sarcoidosis
1. What are the abnormalities in this CXR?
2. What eve manifestation can the patient develop (if the answer was sarcoidosis?

A
  1. 1-Hilar lymphadenopathy
    2- Bilateral Pulmonary infiltrates ??Not sure
    3- Some students noticed Rt apical fibrosis
    • Uveitis (Granulomatous anterior uveitis)
    • Episcleritis, Scleritis
    • Retinitis
65
Q
  1. Whats the diagnosis:
  2. Mention 2 causes?
A
  1. -Papilledema
  2. -Pseudotumor cerebri (Idiopathic
    Intracranial HT)
    -Intracranial tumor / hemorrhage
    -Malignant Hypertention
66
Q

The below picture is a flow volume loop of a patient. Mention one sign and one cause that can lead to this flow volume loop
1. Sign:
2. Cause:

A
  1. Stridor
  2. 1) Vocal cord paralysis or dvsfunction
    2) Foreign obiect
67
Q
  1. Whats the diagnosis?
  2. Mention 2 diagnostic tests:
A
  1. Multiple Myeloma
    • Bone marrow biopsy (clonal plasma cells ≥ 10 percent)
    • Serum protein electrophoresis (SPEP)
    • Urine protein electrophoresis (UPEP)
68
Q
  1. What is seen on this CXR?
  2. Mention 1 cause:
A
  1. Pericardial calcification (constrictive pericarditis)
  2. -Autoimmune ( SLE- RA)
    -Prior mediastinal radiation therapy
    -TB and Sarcoidosis
    -Idiopathic
69
Q
  1. What’s the name of this cell?
  2. What’s the diagnosis?
A
  1. Reed sternberg cell (Owl’s eve)
  2. Hodgkin’s lymphoma
70
Q
  1. What’s the immediate treatment after ABCs? (Angiodema/anaphvlaxis after peanut consumption)
  2. What causes hypotension in this patient?
A
    • Intramuscular Epinephrine injection (Epi-pen)
      - Antihistamines
      - Corticosteroids
  2. Type I hypersensitivity (anaphylaxis): allergens cross-link IgE-bound mast cells resulting in histamine release, which causes vasodilation and increased capillary permeability leading to Hypotension.
71
Q
  1. What’s the findings on this X-ray?
  2. What’s the diagnosis?
A
    • Periarticular soft tissue swelling
      - Periarticular osteoporosis
      - Uniform loss of joint space in the
      MCPs and PIPs
      - Ulnar deviation
      - Marginal erosions
  2. Rheamatoid arthritis

Medicine ELOOPS (9 decks)

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