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Medicine ELOOPS > 2018 > Flashcards

2018 Flashcards

1
Q

1.15 y/o male with bone pain and jaundice his electrophoresis showed Hbs (84%)
1. What is the diagnosis?
2. Mention 2 complications:

A
  1. Sickle Cell Disease
  2. Autospelenctomy
    Acute chest syndrome
    Renal papillary necrosis
    (You can mention any complication of SCD)
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2
Q

28 y/o male non smoker. Presented with acute severe chest pain and severe SOB.
1. What is the diagnosis?
2. What mode of therapy would you institute in this patient?

A
  1. Tension pneumothorax
  2. Emergency needle thoracostomy (chest decompression) followed by chest tube insertion
    [because this is tension pneumothorax that’s why it needs needle decompression, if it was just pneumothorax then treatment varies based on severity, it may only need chest tube]
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3
Q
  1. What is the diagnosis?
  2. Which Dermatome is affected?
A
  1. Shingles (VZV reactivation)
  2. T4
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4
Q

17 y/o girl complaining of wheezing and coughing after her brother brought a new dog
1. Explain how the dog allergen will cause an asthmatic reaction?
2. How would you specifically evaluate her allergy to the dog?

A
  1. After a phase of initial sensitization, the allergen will cross link with pre- formed IgE on basophils and mast cells. Cross linking of IgE causes cell degranulation, releasing histamine and other pro-inflammatory mediators which will lead to bronchospasm> leading to cough/wheeze
  2. skin prick test Allergy-specific IgE test
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5
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. Hemi-spatial neglect
  2. Right parietal lobe
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6
Q

The thyroid gland is located near the thoracic inlet with multiple adjacent structures
1. Mention two structures that may be affected by obstruction and/or infiltrative thyroid lesions
2. Mention one sign or symptom correlating to each structure mentioned in the previous question

A
  1. Trachea
    esophagus
    Recurrent laryngeal nerve
  2. Dyspnea
    Dysphagia
    Hoarseness of voice
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7
Q

patient removed from a collapsed building with generalized aches and low urine output S- creatinine 350 (was normal one month ago) Hemoglobin 14 mmol/lUrinalysis:RBC 2 (normal <5/HPF)WBC 2 (normal <5/HPF)Urine sample >pic of red urine
1. What is the confirmatory investigation?
2. What is the immediate therapy?

A
  1. Check muscle enzymes: creatine kinase!!
  2. IV fluid resuscitation
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8
Q

patient with acites that was tapped
1. what two tests to do to know that causative agent from the fluid?
2. what one pharmacological drug and one non pharmacological drug is used to treat it?

A
  1. -Albumin (to calculate SAAG)
    -Cell count and differential (neutrophil count is most important to detect SBP)
  2. Pharmacological: diuretics
    Nonpharmacological: therapeutic paracentesis, salt and fluid restriction
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9
Q

graph respresents 24 hrs glucose and insulin levels for patient without diabetes mellitus
1. what is the daily function repsented by the arrow
2. name a hormone that is normally secreted by the GI in response to this daily activity, explains the incretin effect.

A
  1. Eating
  2. Glucagon like peptide (GLP-1)
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10
Q

Elderly smoker
1. what is the name of the device
2. what is the use of the colored caps
3. what is the most likely disease that the patient has

A
  1. Venturi oxygen mask
  2. determine the oxygen delivery flow rate
  3. COPD (it is important not to over-oxygenate COPD patients, so that’s why venturi masks are used for COPD patients because the different colored valves allow us to chose the flow rate and thus the percentage of oxygen delivered to the patient)
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11
Q
  1. What finding would you notice in this patient JVP?
  2. What is the finding in this patient pulse?
A
  1. Kussmaul sign: JVP increase during inspiration
  2. Tachycardia, possibly pulsus paradoxus

(This is a case of constrictive pericarditis)

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12
Q

55 yo man with right facial weakness and left hemeplegia
1. Where is the location of the lesion?
2. What diagnostic modality is better( ct/mri)

A
  1. Right pons lesion
  2. MRI (question is asking which is better not which is first line)
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13
Q

nodules in the posterior aspect of the knee
1. what is the abnormal finding?
2. what is the investigation?

A
  1. Baker’s cyst
  2. X-ray or ultrasound
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14
Q

Patient with Hematemesis
1. First treatment to prevent the risk of bleeding
2. Other complications associated with this condition

A
  1. Beta blockers
  2. Internal hemorrhoids Ascites
    Congestive splenomegaly

(This is a case of esophageal varies, so the question is asking abt complications of portal hypertension

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15
Q
  1. What is the name of the test
  2. Give 3 respiratory conditions that cause this sign
A
  1. Schamroth window test
  2. Pulmonary fibrosis Lung cancer Bronchiectasis Empyema Abscess
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16
Q

This patient started using antihypertensive drug two months ago.
1. What drug cause this reaction?
2. Explain the pathophysiology?

A
  1. ACE inhibitor
  2. ACE is responsible for degrading bradykinin, which is a vasoactive substance. Inhibition of this pathway leads to accumulation of bradykinin which causes vasodilation and increased capillary permeability
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17
Q

Young patient who felt sudden palpitations while watching a football match.
1. What is the diagnosis?
2. What is the pathophysiology?

A
  1. Paroxysmal SVT
  2. AV nodal re-entry
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18
Q
  1. What is the most likely histology?
  2. What is the most likely complication?
A
  1. Not completely sure of answer but since it is pendunculated (not sessile) and looks benign, it is most likely an adenomators polyp
    histology: tubular, tubulovillous, or villous adenoma
  2. Malignant transformation (also not sure)
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19
Q
  1. circle 4 areas to preform this test and how many milligrams you’ll apply.
  2. What is the more peripheral arteries that you’ll feel and mention their relative position/anatomy/landmark ?
A
  1. 10mg
  2. Posterior tibial artery: behind and below the medial malleolus
    Dorsal is pedis artery: lateral to the extensor hallucis longus tendon on the dorsal surface of the foot
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20
Q

History that indicates osteoarthritis
1. What are the findings?
2. What are the treatment options?

A
  1. Asymmetrical joint space narrowing
    Subchondral sclerosis and subchondral cysts
  2. Pharmacological: NSAIDS, paracetamol, topical anti-inflammatory cream, corticosteroid injections
    Non-pharmacological: heat pads, TENS, knee brace, medical insoles, walking aids, physiotherapy
    Surgical: total joint replacement (last resort)
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21
Q
  1. Give 3 deferential diagnosis?
  2. What test correlates with the activity?
A
  1. Rheumatoid arthritis SLE
    Psoriatic arthritis (OA instead of Psoriatic?)
  2. CRP and ESR (if it was RA)
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22
Q

A diabetic patient with sudden increased sweating, nausea, and vomiting
1. What is the diagnosis?
2. What is the pathophysiology?

A
  1. Anterior wall ST elevation MI
  2. Plaque rupture in the left anterior descending (LAD) coronary artery, which occluded the vessel leading to transmural infarction of the anterior wall of the heart
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23
Q

A 69 year old man has a long history of chronic kidney disease (was on hemodialysis)
1. What is the ECG diagnosis?
2. What is the management for this patient?

A
  1. Hyperkalemia
  2. Calcium gluconate

chronic kidney disease is a hint, renal faliure causes K+ retention

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24
Q

Patient is IVD abuser, who developed severe shortness of breath associated with production of blood-tinged sputum.
1. What is the diagnosis?
2. Mention one auscultatory finding in the infrascapular region and one
for the cardiac apex.

A
  1. pulmonary edema
  2. Infrascapular region: inspiratory crepitations/crackles Cardiac apex: S3 gallop
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25
Q

50 Y/O female with 2 weeks history of fatigue, menorrhagia, gum bleeding, and skin rash
1. What is the finding in the Lower limbs?
2. What is the main abnormality in the blood smear?

A
  1. Purpuric rash
  2. Based on the patients gender and age (female, 50) and presentation (bleeding in mucus membranes and purpuric rash), the patient has
    thrombocytopenia (most likely ITP) So what is the finding in this film?
    Absence of platelets (thrombocytopenia)
26
Q

patient with diplopia and ptosis he applied an icepack pic shows the improvement
1. What is the diagnosis
2. Tumor associated with this condition

A
  1. myasthenia gravis
  2. Thymoma
27
Q
  1. What is the diagnosis?
  2. How would you treat the patient if he is hypotensive?
A
  1. monomorphic ventricular thachycardia
  2. Synchronized shock (electrical cardioversion)
28
Q

Vegan for 5 years with numbness
1. What is the abnormality
2. Mention 2 complications/ neurological manifestation

A
  1. Hypersegmented neutrophil
  2. Subacute combined degeneration of the spinal cord, dementia, polyneuropathy.
29
Q
  1. Mention one diagnostic test
  2. How to manage this patient
A
  1. Endoscopy and biopsy
    Anti-tissue transglutaminase antibodies
  2. Gluten free diet

pay attention to thequestion. If they wrote mention one blood test you cant use the first answer

30
Q

Patient with UC. What is the diagnosis? Name 2 other extraintestinal manifestations of IBD.

A

Pyoderma gangrenosum. erythema nodosum, Sacroillitis, arhritis

31
Q

a. give 2 diffential diagnosis
b. what is the next test you would do?

A
  1. primary achalasia, chagas disease, malignancy.
  2. Manometry to confirm dx, endoscopy and bx to r/o malignancy
32
Q

55 yr male with bloody diarrhea (presented with high amylase and chronic alcoholic consumption).
a- What test is used to diagnose his stool?
b- What are the complications of this condition?

A

CT showing pancreatitis
a. stool elastase test.
b. - Pancreatic pseudocyst
- ARDS
- shock
- Exocrine pancreatic insufficiency→malnutrition + osteopenia or osteoporosis
- Endocrine→diabetes

33
Q

25yr old recurrent episodes palpitations on and off 10-15mins
a. what is abnormality in ECG?
b. What treats palpitation?

A
  1. Delta waves and short PR interval
  2. Unstable: cardioversion, stable: IV procainamide, definite tx: accessory pathway ablation (we think this is the answer)
34
Q

50 year old male, had a heart attack 1 year ago, wakes up from his sleep with severe breathlessness. Coughing with blood stained frothy sputum.
[CXR showed cardiomegaly and pulmonary oedema in the exam]
a) Diagnosis:
b) Pathophysiology of x-ray

A
  1. heart failure
  2. Left-sided heart failure leads to increased left atrial pressure backwards, leading to increased pulmonary pressures, pulmonary congestion, and edema
35
Q

It was a patient with progressive exertional SOB I think with hemoptysis
There was an x-ray with mirtalization i think

  1. What is the abnormalities :
  2. what is the diagnosis:
A
  1. double shadow + mitralization
  2. mitral stenosis
36
Q

A 65 year old with recurrent episodes of palpitations
a) what’s JVP on physical examination
b) most common complication [ECG pic of AFib]

A
  1. Absent a wave.
  2. Thromboembolic event e.g. Stroke.
37
Q
  1. what is the abnormality.
  2. what is the treatment.
A
  1. torsades de pointes.
  2. Patient was unstable so defibrillation + CPR
38
Q

pt. With severe chest pain ecg with diffuse st elevation
1. Diagnosis ?
2. Complications ?

A
  1. Acute pericarditis
  2. Contrictive pericarditis Pericardial effusion
39
Q

20 year old male with nephrotic disease presented with venous thrombosis
a. what’s the diagnosis
b. what’s the cause of his presentation (not sure if this was the exact same picture)

A
  1. I think it was normal glomerulus so minimal change dz
  2. In Nephrotic syndrome, plasma protein is lost→one of the proteins is antithrombin III, which inhibits thrombus formation, so if test the patient will be hypercoagulable leading to renal vein, thrombosis.
40
Q

Pt with hypoglycemia. State whether levels of c peptide, glucose, and insulin are high or low.

A
41
Q

turner’s syndrome
patient with turner syndrome
a. what is the chromosomal abnormality
b. describe the levels of estradiol and FSH

A

XO. Low estradiol and high FSH (primary hypogonadism)

42
Q

26yr old female with celiac disease, she didn’t follow a gluten free diet. Now she complains of generalised bone pain…
A: which graph represents ca and pth level B: explain your answer

A

A.
In celiac disease, malabsorption of calcium leads to secondary hyperparathyroidism. It is well recognized that excess parathyroid hormone (PTH) can be associated with bone loss as it causes Ca to be taken from bone to blood.

43
Q
A
44
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. RT-sided Bell’s palsy (LMNL of RT facial nerve)
45
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
46
Q

(high wbc and low glucose) a. what is diagnosis
b. What 2 csf test to confirm diagnosis

A
  1. -
  2. Bacterial meningitis, culture and gram stain.
47
Q

an 82 year old man was brought to the hospital by his son, he was in confusion state. he is taking a drug for his “irregular heart rhythm”. ( picture of the drug (warfarin), and a CT scan that showed intracranial hemorrhage )
1. what is the mechanism of action of this drug?
2. mention two drugs/products that could reverse the action of this drug?

A
  1. competitively inhibits the vitamin K epoxide reductase complex 1 (VKORC1), an essential enzyme for activating the vitamin K available in the body
  2. vitamin K, use of fresh frozen plasma (FFP)
48
Q

PBS obtained from a patient with upper respiratory tract infection
due to mycoplasma pneumonia.
1. What is shown in the figure?
2. What is the underlying mechanism?

A
  1. Agglutinated/clumped masses of RBCs
  2. Production of IgM cold agglutinins due to molecular mimicry between the organism and RBC antigens results in AIHA (autoimmune hemolytic anemia)
49
Q

Patient with anemia presented with confirmed hemoglobinuria (free hemoglobin)
A. List two diseases that cause this
B. List one complication of hemoglobinuria

A

a. Any intravascular haemolysis
* G6PD deficiency
* Malaria (especially Plasmodium falciparum)
b. acute kidney injury

50
Q

A 28 year old man develops coughing and difficulty breathing after exercise. He has no chest pain and no palpitations. His chest x ray is unremarkable
A) What investigation would you like to perform in this patient?
B) What are the parameters of the previous test that indicate a positive
diagnosis of this patient?

A

a. PFT w/ bronchodilation. If normal, methacholine challenge test b. spirometer: reduce FEV1 + 12% reversibility w bronchodilator methacholine: FEV1 reduction >20% w methacholine challenge
24)

51
Q

77 year old male teacher has been followed up for 5 years in the resp clinic, no prev exposure to pollution, birds
a. 2 findings in the following picture
b. etiology

A

-

52
Q

a. Interpret the ABG
b. Give one common cause of this abnormality

A

pH: 7.46, pco2: low, hco3: normal respiratory alkalosis: hyperthyroidism, CHF, panick attack

53
Q

patient with Diabetes and pain in his foot. a) Whats the
diagnosis? b) Name two causes of this condition

A

a. Charcot foot
b. Any peripheral neuropathy (diabetic
neuropathy, hereditary motor sensory neuropathy- charcot marie tooth)

54
Q

65 year old female a. Name two findings in her hand b. What is the diagnosis

A

Heberden node and bouchard node so osteoarthritis

55
Q

A 39 year old female complaining of recurrent episodes of (pain or discomfort i don’t remember) in her hands that increases in winter
A: What is the diagnosis?
B: Mention 2 associated conditions?

A

Raynaud’s phenomena. Scleroderma, SLE, cryoglobulinemia.

56
Q

a. describe the findings? b. what are the muscles responsible for his eyes?

A

Ptosis and the eyeball is turned down and out (3rd oculomotor nerve palsy) . Unopposed actions of lateral rectus and superior oblique and paralysis of superior, medial and inferior rectus and inferior oblique muscles.

57
Q

patient came with headache vomiting and neck stiffness a. what is the diagnosis? b. what structure is affected that resulted in this presentation?

A

-

58
Q

i think there was a question w a picture of an eosinophil - identify this cell
- list 2 causes where this cell count is high

A

Eosinophilia. Allergy and parasite infection

59
Q

a. risk factors b. complications

A

smoking, alcohol, spicy food. Bleeding, perforation

60
Q
A

-

61
Q

A 56 year old male presented to the hospital complaining of sudden attack of shortness of breath. He also complained of inability to lie flat and sudden awake from sleep at night with shortness of breath during the past 2 months. Chest X-ray shown below
1. What is the diagnosis?
2. What is the pathophysiology of this condition?

similar q but describe xray and give diagnosis

A
  1. Pulmonary edema complicating acute left ventricular failure
  2. Left-sided heart failure leads to increased left atrial pressure backwards, leading to increased pulmonary pressures, pulmonary congestion, and edema
62
Q

A 23 year old female presented with exertional dyspnea and hemoptysis. A picture of an x-ray was shown.
1. What is the diagnosis?
2. What could be the underlying cause?

similar q but describe xray and give diagnosis

A
  1. Mitral Stenosis
  2. Rheumatic Heart Disease

Medicine ELOOPS (9 decks)

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