2018 Flashcards
A man came with right flank pain radiating to the groin, no fever, he was unable to sit still on an ER stretcher, hematuria was detected on dipstick, no fever. What is the most likely diagnosis?
Renal Calculi
2-month-old child brought by mother for follow-up. on exam he has a
continuous machinery pansystolic murmur best heard over the left first and
second intercostal spaces. The patient most likely has
PDA
80-year-old man has diabetes & dementia brought by his family because he can’t take his medication or control his diet; what’s your advice to the family?
Avoid hypoglycemia
17-year-old female came with irregular periods last month and amenorrhea for 2 months, when should you ask about sexual activity?
If it is relevant to her care
30-year-old man diabetic has history of weight loss, decreased libido for 6 months and testicular atrophy, he is unable to conceive; lab tests showed low testosterone. How to diagnose?
Brain CT
A 3-year-old child was playing beside his family then suddenly began to
rock his head forward and backward with his eyes closed. What to do?
Upper endoscopy
A boy fell in extended arm while playing football, he has shoulder pain. Which of the following would be the most possible complication?
Axillary nerve injury
Mother came for her first prenatal visit after 6 weeks of delivery,
complaining of tearfulness and sadness, but she has no sleep disturbance,
change in appetite or suicidal thoughts, what is the most likely diagnosis?
Postpartum depression
Patient had burn involving his entire right arm and right leg. What would be an accurate percentage of the area involved?
27%
Female patient presented with history of abdominal pain last week. on exam: there is a bulge below and lateral to the pubic tubercle. What is the most likely diagnosis?
Femoral hernia
Patient has epigastric pain at night that is relieved by eating food. What is the most likely diagnosis?
Duodenal ulcer
Patient came 2 weeks after gastric bypass surgery complaining of
abdominal bloating, flushing of the face, sweating, dizziness and palpitations
shortly after eating, what is the most likely diagnosis?
Dumping syndrome
A mother, 3 days postpartum was not breastfeeding her baby because she says that she has no milk in her breast, what to do?
Referral to lactation clinic
A breast-feeding lady came with erythema & swelling of the breast. What’s your next step?
Oral antibiotic and cont. breast feeding
A pregnant female presents early in pregnancy with vaginal spotting and
abdominal pain, US shows intrauterine gestational sac with viable cardiac beat,
by examination; cervix is close. What is the most likely diagnosis?
Threatened abortion
A female, nonsmoker, with history of controlled seizure, on
carbamazepine. What’s the best contraception for her
IUD
13 years old boy came with parents at 5th percentile, parenteral height at 50th percentile, parents were concerned about his short stature. What is your next step?
Bone age (constitutional delay)
Female with headache around her right eye for the last week that lasts for 1 hour at night, with eye miosis, ptosis and anhidrosis. What is the most likely diagnosis?
Cluster headache
48-year-old patient, smoker with recurrent productive cough and
shortness of breath with exertion, PFT result showing:
Before bronchodilator:
FEV1/FVC = 58%
FVC = 41
After bronchodilator:
FEV1/FVC = 65%
FVC = 49
COPD
Asthmatic patient came with daily symptoms frequently at night. on SABA,
what to add as outpatient therapy?
Inhaler corticosteroid
60-year-old Patient with SOB, pink frothy sputum, raised JVP, bibasilar crepitations & lower limb edema, what is the most likely diagnosis?
Pulmonary edema
A female patient came with 3 days history of tenderness at the right iliac fossa & guarding, vomiting, high WBC (Only); what’s your next step?
US
A child brought by mother. she was concerned that he had low grade fever, shortness of breath and barking cough. What is
he most likely diagnosis?
Croup
Old patient, hypertensive, smoker, came with past history of stroke. Came for follow-up after his stroke. What could be done as tertiary prevention?
Stroke rehabilitation program
A guy got stung by a bee then developed stridor, wheeze, edema in the lipsand hypotension, what’s the next step?
Subcutaneous adrenaline1:1000
38 weeks pregnant lady went into labor. Vaginal examination reveals; 5 cm opened cervix and 40% effacement, at what stage of labor is she?
1st stage
A study about the relation between tobacco and Asthma was conducted by
randomly interviewing people by phone. What is the design of study that have
been used?
Cross sectional
An ill-appearing 2-year-old with fever (38.4 C) and stiff neck appears to have meningitis. His parents refuse a lumbar puncture on the grounds that they have
heard spinal taps are extremely dangerous and painful. How should you proceed?
Start empirical antibiotic
A drug was studied and found to reduce risk of stroke from 8% to 4%,
calculate the NNT?
25
62-year-old man with episodic substernal chest tightness occurs after
physical exertion and is relieved by rest, the patient has noted that the amount of
activity sufficient to trigger the pain is relatively constant, such as climbing three
flights of stairs or walking uphill for a few minutes. ECG recorded at rest;
however, fail to show any abnormalities, which of the following is the most
appropriate next step in diagnosis?
Exercise ECG
2 by 2 table asking for specificity of a test. ( D was 130, total was 140)
92%
A study was done on the effect of regular exercise in prevention of
diabetes. Which of the following will affect validity of the study?
Loss of patient follow up
A patient with abdominal pain on right lower side. Colonoscopy showed inflammation around the cecal area and a ileocecal stricture. What is the most likely diagnosis?
Crohn’s disease
A man was playing soccer. Got hit on his knee, lachman test was positive, which of the following is the most likely injured ligament?
Anterior Cruciate Ligament
A 42-year-old female came with right hand pain and stiffness in the right
hand including multiple PIP and DIP joints, with one Heberden’s nodule. Which
of the following is the most likely diagnosis?
Osteoarthritis
A 35-year-old guy came worried about his risk as his father died from heart disease at his 50’s. he is asymptomatic, his lab results reveals; elevated LDH,
total cholesterol, TG and low HDL, what’s your next step?
Start statin
26-year-old male asthmatic, follows for HTN, standing BP and sitting BP difference is lower than 10 systolic and 5 diastolic. Below his lab results;
Na = 142
K = 2.9
Glucose = 5
Bun = 4
Which of the following is the most likely diagnosis?
Conn syndrome
A patient with back pain has loss of sensation in the anterior thigh and
dorsum of the foot and weak dorsiflexion. Which root is affected?
L4-L5
A baby brought by mother has runny nose and cough, ear examination
showed erythema & bulging of the tympanic membrane, how will you treat this patient?
Oral antibiotic
Pregnant asymptomatic lady with positive urine dipstick. what is the
treatment of choice?
Ampicillin
A lady with frothy greenish to yellowish vaginal discharge with punctate red
spots in the cervix, and inflamed vaginal wall. What is the most likely diagnosis?
Trichomonas vaginalis
55-year-old female postmenopausal complaining of vaginal dryness and dyspareunia, O/E; there is decrease in hair pale pink vagina, loss of rugae what is
the most likely diagnosis?
Atrophic vaginitis
A 20-year-old guy came complaining of dry cough, fever (symptoms of pneumonia), x-ray reveals left mid zone consolidation. His colleagues at his
university have the same symptoms, which of the following is the most likely causative organism?
Mycoplasma pneumonia
Patient with history of hiatal hernia had two episodes of abdominal pain and one episode of emesis came with painless hematemesis, what is the most
likely diagnosis?
Mallory-Weiss syndrome
A pregnant mother in week 38 and her 3 years old child got exposed to
chickenpox from her daughter. Both the mother and child are susceptible. What
should be given to them?
Immunoglobulin to the pregnant mother and vaccine to the sibling
Asymptomatic nurse with negative PPD test last year tested positive this
year with 10 mm induration. Chest X-ray is normal. What is the most appropriate
management?
Isoniazid (INH) for 6 months
A nurse accidentally got pricked with a needle of an HIV patient, which of
the following is considered to have the highest risk for transmission?
Depth of the injury
Obese hypertensive patient came complaining of severe foot pain for 3
days. She can’t walk on it. There was no history of trauma, (*x-ray attached),
what is the most likely diagnosis?
Acute gout
10 weeks pregnant lady presents with one day history of vaginal bleeding.
Examination reveals uterine enlargement greater than expected for gestational
age, snowstorm appearance on US and her BHCG = 100,000, what is the most
likely diagnosis?
Hydatidiform mole
A guy had a RTA and hit the dashboard with direct hit on one of his knees, by examination the leg looked shorter than the other leg with adduction and internal rotation position, what is the most likely diagnosis?
Posterior hip dislocation
Child had URTI 3 days ago presented with left eye swelling. Which of the following tests has the highest diagnostic value?
Orbital CT
Case of female with irregular bleeding, BMI 28. labs are listed; LH:18,
FSH:6, FSH / LH value was 1:3. What is the most likely diagnosis?
PCOS
A 3 year old child with cervical lymphadenopathy and cracked lips, swollen, and erythematous palms and soles, painless conjunctivitis, and other symptoms.
What is your management?
IVIG
Patient with fever, night sweating, weight loss, and hepatosplenomegaly.
X-ray showed multiple diffuse symmetrical pulmonary nodules. what is the most
likely diagnosis?
Miliary TB
16-year-old girl presents with cyclic abdominal pain each month, last for about 6 days. She never had menses. Secondary sexual characteristics present.
Her mother is worried because all of her sisters got their menses by the age of
13. Tense bulge at lower abdomen. What is the most likely diagnosis?
Imperforate hymen
Patient with rheumatoid arthritis complains of neck pain, upper and lower limb weakness for 1 year, what to do next?
Cervical x-ray
20-year-old patient had trauma to the back of his head while playing football, he had severe headache and neck rigidity along with nausea and
vomiting, what is the most likely diagnosis?
SAH
One week following an uncomplicated delivery, a 27 year-old-woman
presents with polyuria and excessive thirst. Her pregnancy was normal, but she
reports that she began to feel an unusual craving for ice water in the last month of gestation. She is forced to get up at night several times to void and drinks
large amounts of water. Her blood pressure is 120/80 mmHg. Serum electrolytes
are within normal limits. A 24-hour urine yields the following results:
Total volume 10 L
Specific gravity < 1.006
Glucose Absent
Protein < 150 mg
Which of the following is the most appropriate next step in management?
Perform vasopressin challenge test
Patient brought to the ER with history of gasping, pulse and blood pressure
can’t be obtained, with VT showing on ECG, what’s your immediate action?
Immediate defibrillator
A child with failure to thrive was brought to your clinic, (*x-ray attached shows Rachitic Rosary). What is the most likely diagnosis?
Rickets
A mother came to the clinic with her baby reporting weight loss and chronic diarrhea. There is a rash on the extensors of upper extremity. he has positive anti tTG. which of the following is the definitive test for diagnosis?
Small bowel biopsy for celiac disease
A patient complaining of a mass at the back of the wrist. It is smooth round
shaped slightly mobile compressible transilluminating lump on the back of the
wrist. What is the most likely diagnosis?
Ganglion cyst
