2019 Flashcards
67 years old female came for routine investigation
She was Asymptomatic and her vital signs as follow
BP 126/ 86
Heart rate : 88
Temperature: 36.8
Lab investigation
cholesterol 5mmol Normal <5
LDH 2.3
HDL 1.9
Which of the following is consider risk factor for developing
heart disease?
cholesterol
29 years old Asymptomatic came for pre job evaluation
His ECG is showing
First Degree AV block
45 years old male presented with history of chest pain
radiating to both shoulders with nausea and vomiting
ECG obtained
inferior MI
During periodic heath exam or pre employment Patient
was found to have systolic murmur 3/6 , in the left sternal
border , increased when standing with physiological splitting
of second heart sound
It was not radiating to the carotid, and normal apical impulse
No femoral delay
What is must likely causing this murmur?
Pulmonary stenosis
You are caring for a 38-year-old male patient who reports
episodic chest pain. He reports that the pain feels like
“tightness,” is located right behind his sternum, lasts less than
3 minutes, and is relieved with rest. He takes no medications,
has no family history of coronary disease, and has never
smoked. His ECG in the office is normal. Which of the
following tests should be done to determine whether or not
his chest pain is due to ischemia?
Exercise ECG
Asthmatic patient presented With acute asthma
exacerbation , he can’t complete sentence
Which of the following is indication for hospital referral?
PEF <40%
19 year old , came complaining of cough , runny nose
on examination: exudate on tonsils only and mild congestion
of the throat
chest X-ray attached : normal
appropriate management ?
amoxicillin
25 year old , present with sore throat , on examination
tonsillar exudate, with anterior cervical lymph node and
Denali cough , temperature 38
what is the appropriate management?
oral penicillin
construction worker presented
with SOB and cough , on
examination he has wheezing and
clubbing ..
what is the diagnosis ?
asbestosis
Case about old patient heavy smoker , presented with
productive cough On examination, bilateral wheezing, he is
on LABA and antibiotics , what you will add?
prednisolone
Child came with acute asthma exacerbation, he is using
his salbutamol inhaler frequently and his symptoms increase
when he is at home , His father is smoker
What appropriate step in management ?
Family counseling
21 years old know case of type 1 Diabetes, presented with
this lab finding
HBsAg +ve
HBsAb -ve
HBc IgM -ve
Hbe Ag -ve
Hbe Ab +ve
Anti c AB +ve
What is most likely interpreting?
chronic infection
26 years old female patient was complaining of
abdominal pain and bloating with diarrhea change to be
loose sometimes what to do next :
anti-tissue transglutaminase antibody
A 44-year-old woman is admitted to the hospital for acute
right upper quadrant pain consistent with biliary colic. Her
symptoms have been present for 4 hours, and she also has
fever and a positive Murphy sign. She has a history of
asymptomatic gallstones, identified incidentally several years
ago. Her laboratory evaluation is as follows:
Endoscopic retrograde cholangiopancreatography (ERCP)
Patient came with diarrhea history of use of amoxicillin
antibiotics 2w back what investigation to order ?
Clostridioides difficile immunoassay
40 years old patient , Know to have DM on Metformin,
HTN and chronic osteoarthritis on ibuprofen
From 2 weeks He Complain of epigastric Abdominal Pain .
O/E , abdomen soft lax with mild tenderness in the epigastric
pain .
What is You Management ?
Start omeprazole
34 year old Female Complaining From RUQ abdominal
Pain Radiated To Back , history of Previous Same Complain.
Its invitations:
ALT , AST : mild increase
Lipase, amylase : Normal
What is Your Diagnosis ?
Acute Cholecystitis
Patient with Epigastric that increase in the morning,Pain
relieved by food?
Duodenal ulcer
32 Years old Male , Complain from abdominal pain ,Vomiting, his pain increase after eating
He did Gastric Sleeve before 2 Weeks …
What is you Diagnosis :
Dumping Syndrome
A 20 year old man presented with fever, sore throat, and
fatigue for one week. He took a friend’s antibiotic after 2 days
of illness and developed a red rash all over his body, so he
stopped the antibiotic. His oropharynx is mildly red without
exudates, and he has multiple lymphadenopathy and tip of
spleen was palpable .
Which one of the following is the most likely management?
antipyretic and avoid sport
On a routine-screening complete blood count, a 7-yearold is noted to have a microcytic anemia. A follow-up
hemoglobin electrophoresis demonstrates an increased
concentration of hemoglobin A2 7% . The child is most likely
to have:
β-thalassemia trait
female Patient known case of DM on metformin came for
evaluation for her numbness , absent ankle reflex , positive
Babnski sign , with anemia , her MCV 106
What most likely diagnosis ?
Vitamin B12 deficiency
Patient came from South Africa, develop fever headache ,
lethargy and fatigue , symptoms of malaria
Which of the following appropriate to establish diagnosis?
Thin and thick Blood film
Diabetic on insulin glargin and short acting insulin he
feel dizziness and sweating while he walking on treadmill
and fasting blood surge in morning 140 what to do
snacks before exercising
Male Pt Know to Have DM HTN , on Maximum Dose of Metformin , gliclazide , valsartan
Bp 150/89
What you will Add more for HTN
amlodopine
Diabetic patient, high A1c , to start insulin. weight is 120kg
how to start insulin?
long acting insulin 30U . and short acting 10 U pre meals
10 Years old Girl Complaining from Recurrent genital
itching.. She have Family history Of Dm2 and Diabetes …
On Examination: there is acanthosis nigrican on her Neck and
axilla, she have Stage 3 breast development Stage ,pubic hair
stage 3 , BMI>95th
What is your Diagnosis ?
DM type 2
You note a thyroid nodule in a 35-year-old AfricanAmerican woman whois not demonstrating clinical features of
thyroid dysfunction. Which of the following patient
characteristics, or features would increase
your suspicion of malignancy?
persistent hoarseness
A 61-year-old white postmenopausal woman comes to
your office for a routine health examination. She has a history
of osteoarthritis, and she smokes one pack of cigarettes per
day.. She is on no medications. Her blood pressure is 120/80
mm Hg, BMI 27. The rest of her physical examination is
normal.
Which of the following is an established risk factor for
osteoporosis?
history of fragility fracture in first-degree
In a patient presenting with truncal obesity, hypertension,
type 2 diabetes mellitus, hirsutism, osteopenia, and skin
fragility, which one of the following tests is needed to confirm
the diagnosis ?
Urinary free cortisol
in UTD it says in a high index of suspicion such as those with features suggestive of Cushing syndrome, we do two or three first-line tests
1- bedtime salivary cortisol (two measurements)
2- 24-hour urinary free cortisol (UFC) excretion (two measurements)
3- the overnight 1 mg dexamethasone suppression test (DST).
Female patient with amenorrhea and history of weight gain
Her lab investigation
Testosterone 9
FSH 20
LH 60
What is most likely diagnosis?
PCOS
Patient with poorly controlled DM , HTN and
osteoarthritis
His BMI 45 ,Ha1c 11% what is most appropriate step?
Bariatric surgery
Diabetic patient with confusion , high blood sugar and no ketones in the urine , RBS= 35 mmol/L = 630mg/dl
what is most likely diagnosis?
HHS
5-year-old female who is 3 months post partum presents
with multiple complaints, including increasing weakness and
fatigue, intolerance to warm environments, a weight loss of
30 lb despite an increased appetite, difficulty sleeping,
awareness that her heart is beating faster and “pounding” in
her chest, increasing restlessness and difficulty concentrating,
increased tremulousness, and a significant swelling in her
neck. She takes no medication, has experienced no recent
trauma, and has not ingested large amounts of iodine.
When you examine her you find no exophthalmos or lid lag
and no pretibial edema, but her skin is warm, smooth, and
moist. You also find a smooth, non-nodular, nontender,
enlarged thyroid gland, clear lungs, a resting tremor, and
hyperactive reflexes.
Laboratory testing reveals a low TSH level, elevated free T3
and free T4, and high uptake on a radioactive iodine uptake
scan.
Which one of the following is the most likely diagnosis?
Graves disease
60 years old Complaining of dizziness, fallen twice, no LOC. No abnormal movement. He is known case of HTN, CKD, DM on low dose metfomin,losartan,hydrochlorothazide.
Na 132
K 3.2
Cr 120
A1c 7.5%
stop hydrochlorothazide
On routine physical examination, a 28-year-old woman is
found to have a thyroid nodule. She denies pain, hoarseness,
hemoptysis, or local symptoms. Serum TSH is normal. Which
of the following is the best next step in evaluation?
Thyroid ultrasonography
40 year old man presents with a 3 day
history of earache and dizziness ,
asymmetrical face and loss of taste. on
examination he has a right facial weakness.
which of the following is the most likely
diagnosis ?
Bell’s palsy
Patient with absent ankle jerk and Cant walk on his toes and loss of lateral sensations of the foot
S1
22 years old divorced female presented with on & off
band-like headache mainly on the back of the head for 3
weeks. Increase with emotional stress Examination is normal.
What is the treatment?
NSAID
A 12-year-old girl has an acute, recurrent, pulsatile
headache localized behind the eyes that tends to occur more
frequently She has no symptoms that occur prior to the
headache; her neurologic examination is normal.
Choose the headache associated with the clinical
presentation listed
migraine headache
a patient is known case of Diabetes Mellitus for 10 years came with tingling and burning sensation what is the most likely diagnosis?
diabetic neuropathy
A 32-year-old woman has a long history of recurrent
aphthous oral ulcers. .on examination she has vulvar lesions
and scar on her back , and acne like lesions
What is the most likely diagnosis?
Behçet disease
70 year old female co unilateral headache with
tenderness on temporal bone and lacrimation , history of shoulder and neck pain with high ESR
Giant cell arteritis
Knee pain bilaterally more on one side with mild swelling, no erythema or effusion, what most likely diagnosis?
Osteoarthritis
Female teacher with fatigue of 4 months , macrocytic anemia and elevated ESR,
Rheumatoid Arthritis
A 25 year old male patients Presents with a purulent
urethral discharge for one day. he had unprotected sexual
intercourse 3 nights ago. in order to initiate empirical
treatments while waiting laboratory test for this sexual
transmitted illness.
What period do you need to know ?
incubation
A 42-year-old woman presents with a history of falling on
outstretched hand presented with chief complaint of right
hand numbness. Decreased sensation in the volar aspect of
the little finger inability to abduct the finger
This presentation indicates a problem in which of the
following?
Ulnar nerve
You are seeing a 45-year-old woman who reports
increasingly severe right foot pain for 2 weeks. She has been
trying to lose weight, and has recently started a walking
regimen. She describes a sharp pain in the inferior heel when
weight bearing after a period of rest. With continued
movement, the pain improves, but becomes more dull and
achy. She has tried anti- inflammatory agents with only
temporary relief. Of the following, which is the best next step?
Arch support
A patient comes to see you after a skiing accident 6 days
ago. She reports twisting her left knee during a fall, feeling a
“pop,” and noting significant immediate swelling. She was
able to bear weight immediately, but did not ski for the rest of
the trip. Her pain is now improved, and she is ambulating, but
she says the knee feels unstable. On examination, she has a
tense effusion in her left knee and is unable to extend her
knee fully. Which of the following is the most likely cause of
her symptoms?
ACL tear
You are seeing a 16-year-old high school football player to
discuss a recent injury. Last night, during football practice, he
dislocated his shoulder. His trainer took him to an urgent care
where an x-ray confirmed the diagnosis. They relocated his
shoulder and put him in a sling. This is the first time he has
dislocated his shoulder. Which of the following represents the
most appropriate next steps?
Immobilization for 2 to 3 weeks, then begin physical
therapy.
A 12-year-old male obese patient is brought to your office
with-a 3-week history of left groin pain that is most
bothersome after she participates in gym class at her middle
school. She does not recall a specific injury and does not
participate in extracurricular sports. She had an upper
respiratory infection about a month ago but has otherwise
been well.
An examination reveals a BMI at the 95th percentile for her
age. Her vital signs are within normal limits. A
musculoskeletal examination is remarkable for limited
internal rotation of the hip.
Which one of the following is the most likely diagnosis?
slipped capital femoral epiphysis
pateint fall on outstretched hand one day prior to his
presentation with this X-ray
What is appropriate management?
Close reduction and cast
You are seeing a 67-year-old man who is following up in
your office 2 days after being involved in a motor vehicle
collision. He was the restrained driver and was going 45 mi/h
when he ran into a car that was stopped in front of him.
Thankfully, he denies head injury or loss of consciousness. He
was ambulatory after the event and only had slight neck pain,
but was taken to the emergency department for evaluation.
They released him that evening without any imaging studies.
On follow-up with you, he denies neck pain or numbness and
tingling in his extremities. His range of motion is appropriate
for his age. What testing, if any, should be done at this time?
He should have C-spine radiographs
You are seeing a 14-year-old boy who was brought
emergently to your office after developing severe testicular
pain while weight lifting 3 hours ago. He had a sudden onset
of severe pain without fever, and has had associated nausea
and vomiting. On examination, his cremasteric reflex is
absent, and when the patient is in the supine position,
elevation of the testis increases the pain.
Which of the following is the most likely diagnosis?
Testicular torsion
67 years old male with past history of 20 years of smoking
was evaluated for abdominal aortic aneurysm and was found
to be 4.2 cm
He is Asymptomatic
What is appropriate approach for him
Repeat evaluation after 6-12 months
A 34-year-old man presents after a high-speed motor
vehicle crash. Chest x-ray is performed and shown Which of the following is the most likely diagnosis?
Diaphragmatic rupture
A 36 year-old female who is in excellent health presents
for a routine physical examination. Family history reveals that
the patient’s mother and grandmother died of breast cancer at
the age of 50 years. Which of the following statements best
describes this patient?
Referral for BRCA mutation
A 22-year-old woman is seeing her physician with complaints of breast pain. It is associated with her menstrual cycle and is described as a bilateral “heaviness” that radiates
to the axillae and arms. Examination reveals groups of small breast nodules in the upper outer quadrants of each breast. They are freely mobile and slightly tender. Which of the
following statements is most accurate?
Reassurance
2 years old child with crying spells and
cyanosis
The mother noticed him one time closing his
knee to the chain with cyanosis when ever he
is upset , on examination child growth
parameters are normal with systolic ejection
murmur at the left mid and upper sternal
border
Chest radiograph
What is most likely cause of this child presentation?
tetralogy of fallot
24 child on breast feeding cannot run and can not walk
up and down stairs has dental caries, growth in 3rd percentile
, hypotonia , lab hypocalcemia hypophosphatemia , high
parathyroid hormone , high alkaline phosphatase
what is the diagnosis ?
Vitamin D deficiency rickets
a 2 years old child , complaining of anal itching mainly at
night , on examination anal erythema
stool analysis : 3 consecutive samples were normal
what is the management?
albendazole and repeat after 2 weeks
2 years old presented with 3 weeks
history of fever reaching 40c , the mother
also noticed swelling of the finger and rash
on the face ، no conjunctivitis ….
picture attached
what is the possible diagnosis?
Juvenile rheumatoid arthritis
7 years old female presented with her mother
The Mother was concerning about breast enlargement and
development on examination you find breast development
with pubic hair and normal neurological examination
what is most likely etiology of this child presentation?
Idiopathic
13 year old female presented with her mother who is
concerning about that she is not menstruating yet. In history
you found that she is always the shortest one comparing with
her colleagues by examination you found low set hair line
and thick skin fold in the neck, high
arched palate.
turner stage 3& scattered pubic hair
What is your diagnosis :
Turner syndrome
Patent with bluish white macule with erythmatous oral
mucusa, two days later an erythramtous generalized macular
rash develops, the rash began on forehead and progressed to
involve entire body, he has upper respiratory symptoms,
cough , conjunctivitis and fever
The most likely diagnosis is ?
Measles
An old postmenopausal lady came with vaginal
bleeding; last pap smear was normal, what initial step in
evaluation ?
initial Transvaginal US
confirm Endometrial biopsy
Females patient with symptoms of irritability for the last 8 months , the symptoms occur 5 days before period and
resolve 3rd day of mensuration , with affection on her
performance
What is most effective treatment
SSRI
Pregnant Lady on 16 week of Gestational, presented for
antenatal visit with following lab
FBS= 7.3
A1c = 6.9
?What is most likely diagnosis
DM 2
Old female patient with uterine prolapse, which of the following indicates progression of the prolapse?
Anal incontinence
Male patient was diagnosed with HIV , he is asking you
not to tell his wife , what are you going to do
alert health authority
father concerned about his child and stuff from social
media that he heard and the what type of communication
empathy
Best study to reduce confounding ?
randomization
Forest blot chart , odd ratio and CI with antihypertensive
drug in chart what is the best ?
Thiazide diuretics
a patient with Rheumatic fever symptoms . how to
confirm diagnosis?
ASO titer
We conducted a study to compare the risk in 2
population in 500 people 400 where affected and in the
control group of 500, 100 were affected. Calculate the absolute risk ratio?
60
60%
