2020 Flashcards
23 y Female had 2 episodes of convulsion at age of 18 and started on anti epileptic
(valporic acid )after the second episode , she did EEG and it was normal ..she has free
attack since started the medication .. pt Asking to stop medication because she wants to
get pregnant or she was pregnant:-
agree gradual decrease antiepliptic
female on OCP from long time came with ..(Melasma )what is management:
Hydroquinone
Callus on latral malleulus
reassurance
- Pt with depression started on ecitalopram 10mg came after 1w because he is not
improving
Continue same it takes 6 to 12 weeks to adequately trail the medication
17 m came for f/o 3 d after otitis media, treated with antibiotics, he is stable,his brother got infection , and his mother is pregnant, regarding mmr and varecilla vaccines
regarding the mother wait till after delivery and the bother can take both now
Old patient came with dyspnea , orthopnea ,PND, lower limb edema ,
What is the first medication?
Furosemide - ADHF
Female on alpha-blocker and another medication ,has Irregular mens , fatigue +
nipple discharge ,
FSH, TSH, prolactin all high, t4 is normal , visual normal ,With galacturhea what is the
cause:-
hypothyroid
14 y with normal 2nd sexual changes , mother afraid that her daughter didn’t started
menses, mother menarch 13 y
reassurance may the menses start this year and f/u after 1 yr
- Healthy man want to travel to egypt. Which vaccine recomended
HAV
Case of pt with history of old operation came with vomiting , abd pain ,
nausea,hyperactive bowel sound
Ask diagnosis :
Bowel obstruction
- Female come to complain about Heavy bleeding & Irregular:-
Menometrorrhagia
Case with lab finding of
High ldl, High total cholesterol, High hdl, High triglyceride
What to give ?
statin
- Women want to conceive, And now take MMR vaccine, When she recommend her
to conceive :-
4 weeks
Case of women 48 with irregular mencuse , hot flash befor 8 month ask she in stage
of what
perimenepause
Diarrhea with blood mucous , no travel, lab was having stool+RBC ,leukocyte :
needs more Hx
Case of STD male pt present with discharge you order lab and start treatment
Ask about which stage important to know?
incubation stage
School age boy came after fight in school ..vitally stable on exam minimal left ear
tenderness, fluctuant , with picture ,, what to do?
referral for I & D
Vertigo when roll in bed last 20aect then dizzy for 2h! He has family history of
otoseclroisis ( I think his father), what’s next step in management :-
BPPV For diagnosis: dix hallpike test
For treatment: Epley meneuver
- Patient with picture of testicular torsion with flank pain ,nausea, What to do?
US doppler
Pt came after scorpion sting c/o pain at sting site also he has vomiting and
abdominal pain:
scorpion antivenoum
Hypertensive On lisinopril 5 mg , BP:-145/89, What to do?
Increase lisinopril
Px was cervical cancer came to ER with Right sided chest pain /dyspnea
/SOB,,What is the most likely to be abnormal ?
D dimer
suspected PE
Case of history of frequent attack of MI, With history of shortness of breath , lower
limb edema ,Ask what diagnosis :
CHF
Pregnant came to clinic During influenza season and ask about vaccination:-
Tdap in 27-36 week and influenza
Above 50 year old patient , Diabetic,c/o dyspepsia mildly respond to anti acids with
epigastric tenderness No weight loss, no hx of bleeding per rectum: what to order:
h. Bylori testing
35 yr old Patient was having having nonopuritic white lesion inferted in labia
majora and perineum , in the picture
what is the most effective for her:-
lichen vulva - take biopsy
- Case of family want to travel to indonesia , came ask u for travel diarrhea !!!
loperamide for small diarrhea
A case of Rheumatoid arthritis came with dry eyes , enlargement the parotid gland
..What is diagnosis:-
Sjogren syndrome that occurs concomitantly with another autoimmune disease (e.g., rheumatoid arthritis, systemic sclerosis) is classified as secondary Sjogren syndrome.
Diaber dematitis involve the fold with picture ask about treatment
clotrimoxazole
HIV husband patient he insist not tell wife what u will do
contact infection control and his wife
Female in her 50’s came with Itchy erythematous rash I thick plaques also with
bulla (i think no fever) with picture ask about diagnosis:-
Bullous pemphigoid
Tender flactulat lesion, no bleeding, on examination on anal mass , ask about
diagnodis:-
Anorectal abcesss
33 GA, come with uterine contractions it was reccurent and regular contractions in
short time and cervix 3 cm:-
preterm labor
Neonate 1 m , brother has varecella for last 3 days :
contact precaution
Young male (I think) has Blindness at night, he is afraid that his uncle has blindness,
with picture ask about diagnosis:-
retinitis pigmentosa
54 years old known to have DM, (i forget his complaint) but the picture was clear
Macular degeneration
Infants 2 mo old presented by his parents with white discharge from his eye: what is the management :
lacrimal duct obstruction case - lacrimal duct massage is enough , most cases resolve spontaneously by 8 to 10 months , **if it mentions mucopurulent discharge go for abx
Yong man with red eyes were stuck can’t open after waking up with picture ask
about management:
topical chloramphenicol
Patient come to complain about red eye with tearing and itching, with picture , ask
about diagnosis:-
entropion
pt hit on face by football c/o FB sensation ,Flurecince was normal,ask about
managment
NSAID
Elderly patient presented with history of bilateral knee pain when walking, x-ray is
attached what is the next step in management:
Referral to bilateral knee replacement
- Female with 2 weeks cough fatigue develope night sweating + xray
What is appropriate management:-
sputum acid fast (TB)
- 12 y old boy obese hip pain ask about diagnosis:-
slipped capital femoral epiphysis
Child presented to ED with Drooling and refuse eat, what to do as next step:
intubation
Xray of shoulder, Anterior dislocation I think, What to do:-
Reduction
Case of osteoporosis , They already give her vit d and calcium, She was having BMD
- 0.5 , femoral fracture risk (Frax) 3% , no family history of osteoprosis and no previous
history of fracture , what to do?
dexa After 4 years
Child with fever 40 , after fever subsided he developed rash in his face, neck and
trunk, with picture , ask about diagnosis:-
roseola infantum
27 year old female ,removed IUD 3 months ago want to get pregnant, came with
RLQ pain and vaginal spotting, Which confirms the diagnosis
First thing to do pregnancy test
to confirm TVUS
you are reviewing the result of a pap smear of a 29 years old female patinet last month her cytology was (low grade squamous interepithelial lesion ) HPV was -ve what is the next best action:
colposcopy
Female come to your clinic and told for you her hasband has hipatitis B and she
want to check if she has infected or no , what to do to check the acute hbv infection:-
HBVsAg
Patient with prolonged high BP , LL edema , S3 Heart sound . Asking about type
of cardiomyopathy with I think systolic HF:
dilated cardiomyopathy
Hypertensive came with Headache and Blurred vision, Bp: 210/110:
clevidipine
patient came with chest pain , chest pain increase when he lay down and decrease
with leaning forward, and with heart failure With plural effusion, DURING
AUSCULTATION YOU HEAR FRICTION RUB OVER PERICARDIAL REGION,
Which of the following would prove the diagnosis:
Diffuse ST elevation on ECG
Patient come with heartburn ,dysphagia with solid and fluid, with Picture of barium
meal study , Ask about diagnosis:-
Achalasia
Case of patient fall on outstretshed hand , he was having tenderness in base of
thumb X ray attached : whats is the managment
thumb spica
Middle age man k/c of type 1DM he was on insulin pt stoped his basal insulin his
fastin was 11 mlmol he decreed his pre insulin dose( he mention some thing about
decrease oral intake ) best to do:
resume his perviouse dose
Mastitis with picture ask about what is the best next step ,with picture?
-oral antibiotic
- Foot ankle twist not fit for Ottawa roll what to Do ?
Analgisa and support
(RICE)
Obese patient k/O DM and eat sweet food every day and when doctor took to him
about this he told his father also is diabetic and eat food with high sugar and every thing
ok, asking in which stage of behavior change stages he is now?
-precontemplation
Primigravida week 29, Painless bright red vaginal bleeding , vetal heart beat was 150 ,
next step:
TVUS is preferred when placenta previa is suspected
Old patient have problem in both ears and he think the problem more in right ear
Rinne test : normal , Webber test : lateralized to the right?
presbycusis
-Case of child with dysurea , urgency … (uti clinical pic)
Urin analysis> cloudy color , Wbc +ve, Blood +ve, Nitrate +ve ,,, what is the
organism:
E coli
Case senario about ILD patient work plumber or i think in home building,
constructer work and maintenance> progressive dyspnea , opasity in lower lobe, with
cxr, ask about diagnosis:-
asbestosis
4 y/o girl with hx of watery diarrhea and abdominal pain , there is no on of family
member have the same illness, diarrhea after 2 day became bloody , on Ex pt mild
dehydrated with abdominal guarding but no distention , which of the following is the
initial step ?
Urea & electrolyte
Case of hand deformity progressive, with, attached pic what is the cause leading (not risk factor)?
dupuytren
elderly patient k/o Asthma and HTN on CCP patient presented with recurant MI
what is the best to give to decrease mortality in this condition:
ACEI+ selective BB
Case of obese child have recurrent UTI scenario giving some symptoms and sign of
-fat pads ,fold of hair ,with growth chart Ask for diagnosis:
Cushing syndrome
- Young female having low mood and loss of interest, she also has history inability to
control urination, she unable to completely empty her bladder, urine sometimes leaks
out unexpectedly, which is the best treatment for this patient?
Amitriptyline
Mass under the tungue with picture ask about diagnosis: -
mucocele
Middle age male came with few month history of skin lesion on dorsum or proximal
hand I think, with pic. Ask about diagnosis:-
coutanuse wart
BABY with small white rash in the face with pic , ask about diagnosis:-
Milia (C) occur in about half of newborns and consist of retained keratin within the dermis that leads to small white or yellowish papules most commonly found on the face.
Child came with mid line neck mass Move with toung protursion and sowlling,, with
pic
What’s your diagnosis: -
thyroglosal cyst
43 year old male came with compline of bilateral hearing loos he had history of using
aripod or headphones while sleeping, Examination hard to visualize the canal and the
tympanic membrane, pic of Audmetry report was attached, what is the most likely
diagnosis :
cerumen impaction
3 year child who saw doctor 3 days ago given antibiotic amoxicilline and no improvment on examination he has soft palat enlargment and bad breath and unilateral devation of uveli short breathing ?
-refer ent
Old pt came with complain of hand tremor he only noticed when he serve coffee to
other , On examination there is tremor when he writes his name, there was no fine tremors.
essential tremor (intentional tremor)
An essential tremor typically occurs with action. Essential tremor is the most common neurologic disorder that causes postural or action tremor. The incidence of essential tremor increases with age and is often familial.
Rheumatoid arthritis patient came with red eye , vision disturbance and dryness.
What is the diagnosis?
Keratoconjunctivitis sicca
referral for surgical release of the contracture
5 year old child came with impetigo ,With pic. ,, ask about treatment:-
topical muprocin
You contacted study on 1000pt the test was positive in ( ) and was negative in ( ) s.
Calculate specifity:-
92%
SPECIFICITY = TN / (TN+FP)
- Q ask about PPV 30%
30%
PPV= TP / (TP+FP)
closed reduction of the dislocated 3rd toe
Case of diabetic type 1 pt Came with generalised abd pain with mild dehydrated,
Slightly high glucose , normal pH , no ketones, Labs not showing DKA, What to give (
managment )
ORS / oral hydration therapy
Qs about Developmental Dysplasia of the hip ,Barlaw and ortalani +ve in 2 weeks
infant what to do next?
-referral to orthopedic
Male pt k/o HTN and he is smoker came with hypogastric painful pulsatile mass
bellow the umbalicus , abdominal bruit by auscultation, I don’t remember if ask about
what is the next step to diagnose or most diagnostic :
CT angio
Infertility for 1 year , the wife has regular period ,What u will do:-
-semen penetration analysis
Case of painful and single penile ulcer with green discharge , with inguainal lymph
node enlargement, ask about Diagnosis:-
chancroid
X ray of lumber spine , pt has tendernes on posterior inferior somthing in the hip
ankylosis spodolysis
Child 4 month i think came by his family with umblical hernia , his parent asking
about management ?
Management — Because the natural course of the umbilical ring is eventual closure, asymptomatic children with an umbilical ring that continues to decrease in size can be observed, regardless of their age.
Surgery before age four years is not generally recommended, since the risk of recurrence is higher in children who undergo umbilical hernia repair before age four years, and surgery results in higher rates of posthospitalization and emergency department visits
Young male pt , athletic presented with rash in back ( picture attached ) , the condition increased during summer ,, asking about diagnosis ?
pityriasis rosea
Child with Hx of fall down , pain at the elbow ( xray attached) asking about Dx :
radial head Fx
Soldier patient come with infection between toes (fungal infection) , with picture ,
and ask about best treatment:-
terbinafine (Tinea Pedis)
Patent come with itchy lesion silver in color scaly (typical case of psorasis) , with picture, ask about diagnosis:-
psoriasis
Child I think 7 months old came with mucous-bloody diarrhea, with abdominal
pain , ask about diagnosis:-
mickle diverticulum
Child was diagnosed 3 days back with OM came with no improvement
What to do
Augmentin
Female diagnosed with breast fat necrosis after trauma 2 weeks ago and still has
mild brusis and mild tenderness’ in left lower quadrant , what is best to do for her:-
reassurance
60 years old with hx of CKD comes with symptoms of pneumonia. RR 32. BP 100/60 Can not remember other vital. No urea level in question: ask about treatment:
Admission
Patient come with recurrant seasonal SOB and cough 2 attaks in weeks ,not on medications, and has family history of atopy ,what to give:
Inhaled corticosteroid
Pregnant (33 weeks) with headache, moderate elevation BP , protienuria , low
platelets, high liver enzymes, ask about management
Give antihypertensives
and delivery at 34weeks +0 unless mentioned in the question an indication for prompt delivery then the answer is C/S
Patient come with Neck ragidety ,headche ,and fever, Low glucose , High protein
Ask about diagnosis:-
bacterial meningitis
Patient come with Cut wound by glass in the street with laceration in his hand and
last DTap before 4 year what to do:
clean and debridement then close the wound
pt was bitten by a cat (i think they give some hints about excluding rabies), his
vaccination up-to date , the cat look normal, and the site of the bite look inflamed , ask
about managment:-
augmentine
Patient came with acne + comedones , ask about treatment:-
benzoyl peroxide and topical retinoid
Obese female k/o HTN on 3 antihypertensive medications , came with her husband
complaining of stridor , sleeping all the day and can’t sleep at night , BMI~40 ,and still
high BP, how to manage ?
spironolactone
Patient came with symptoms of Gout, and ask which of the following is diagnostic ?
monosudium crystal
GDM case with high readings , asking about the target ..
<120 after 2 h
Young adult male complaining of SOB and syncope after sport ,…, with murmur but I am not sure, Asking about Dx ?
hypertrophic cardiomyopathy
