2022 Flashcards by Sheila Sarmiento

LOW LEVEL Of PAPP - A

Evaluation of Growth Screening

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white thicky creamy cheese vaginal discharge
itchy, soreness and redness
colour white curd like discharge

Candida Albicans

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Yellow green vaginal discharge
strawberry appearance of the vagina

Trichomonas

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gray watery profuse vaginal discharge
foul smelling
wet mount test positive positive clue cell

Bacterial vaginosis

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Yellow green
thick mucupurulent
SIGNS of PID

Cervicitis

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cervical motion tenderness

PID

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Colles Farcture
How will you apply the cast

FUDP
Flexion
Ulnar Deviation
Pronation

or Flexion and below elbow

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eye trauma and reduce vision.
dx?

Lens dislocation

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A 25 yo female
Patient took rubella vaccine 2 weeks ago, 1 week before her period
She missed her periods and now is pregnant . What will you do?

Rubella Serology

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5.1 cm stone at Uteropelvic junction
What to do?

ESWL
Extracorporeal Shock Wave Lithotripsy

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Best way to prevent Trachoma in a community?

Handwash

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Studying a case if food poisoning that happened one week ago in a marriage. Appropriate study?

Cohort

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Abdominal Plain Xray normal small bowel filled with gas, asked investigations?

Colonoscopy

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0.2 ABI and patient smokes 40 cigarette a day. What to do next?

CT arteriogram

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When to intubate?

GCS below 8

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Rhinorrhea, CSF+ , Periorbital hematoma
What to do next?

CT Scan

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5yo with asthma attack and was given inhaled Salbutamol and symptoms were relieved/ Now he is discharged. What to give to prevent future attacks?

Fluticasone(ICS)

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Admitted and discharged shortly
Asthma attacks

Oral prednisolone must during discharge

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best way to prevent exercise induced asthma

SABA

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32.-3.6 cm aortic aneurysm increase in 2 years. When do you screen?

Every 2 years

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Floaters and flashes

Retinal Detachment

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Hematuria and hemoptysis
What is the inital Diagnosis?

Urine Culture

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DHematuria and hemoptysis
What is the confirmatory Diagnosis?

anti-GBM antibodies

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hematuria associated with sensorineural deafness and eye disorders
it progress to renal failure

Alport Sydnrome

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if patient with asthma doesnt present symptom

LABA

Severe asthma: A. nocturnal asthma more than 1 per week B. symptoms most day C. Multiple ED visits

SABA prn and LABA with ICS add Ipratropium bromide (Nebuliser) or Oral Prednisolone

History of duodenal ulcer H pylori in biopsy

Triple Therapy

MTX and pred long term no remission Now wants to get pregnant

Change to SULFA DRUGS OF CHOICE FOR RA in pregnancy: CASH Cyclosporine Azathioprine Sulfasalazine Hydroxychloroquine

develops fever, malaise, sore throat and dry cough, hacking cough diffuse rales and rhonchi What is the diagnosis?

S. pneumoniae Atypical pneumionaie

Alcoholics lungs abscess organism?

Kleibsiella pneumoniae

COPD organism?

Haemophilus influenzae

Recent viral infection org?

Staphylococcus aureus

poor dentition aspiration organism?

Anaerobes

Young, healthy patients pneumonia org?

Mycoplasma pneumoniae

haorseness pneumonia org?

Chlamydia pneumoniae

contaminated water sourdes air conditioning ventilation systems pneumoniae org?

Legionella

Birds pneumoniae org?

Chlamydia Psitacci

1st year pneumoniae

BEL beta Hemolytic E coli Listeria

animals at the time of giving birth veterinarians farmers pneumonia org?

Coxiella burnetii

Right Upper lobe collapse

Pancoast tumor history asking diagnosis Pemberton Sign SVC obstruction

Horner's Syndrome

outpouching that occurs at the junction of the lower part of the throat and upper portion of the esophagus the poucg forms because the muscle that divides the throat from the esophagus the cricopharyngeal CP muscle, fails to relax during swallowing

Zenker's diverticulum

keratin pearls and intercellular bridges hilar mass arising from bronchgus

Squamous cell Carcinoma

Genetic test for cystic fibrosis

Sweat Chloride Test

88 yo woman slipped and hit her head on the tub now confused and only knows her name not the date and where she is at diagnosis?

Subdural hematoma bridging veins - most commonly affected vessel next best step and initial diagnosing test ? - CT scan without contrast - classic finding - crescent shaped hematoma most appropriate therapy - immediate surgical evaluation and hematoma evacuation thourgh either a burr hole or craniotomy

intermittent stream and difficult in voiding, soft DR with moderately enlarge, painless hematuria. What to do next?

Urinalysis if it is painless, always initial is Urinalysis then followed by if >55 yo, macroscopic - Cystoscopy if >35 yo. macroscopic - CT abdomen if >55 yo, microscopic - USG or Cytoscopy if >30 yo, microscopic - USG or Cytoscopy if it is painful, initial is still urinalysis then followed by if >40 yo - Xray to confirm then Spiral CT scan

A premenstrual 47 yo fatigue, breast tenderness and bloating pills alleviated PMS symptoms except for depression and emotionals What is the next step?

Fluoxetine 20mg or Sertraline 50 mg in the morning for 14 days before the anticipated period

post menopausal symptoms

1. Hot flush

old man with voiding difficulties, prostate DRE done and its normal what's next step?

Day to day activities

A man with HTN and COPD, cramps in the calf muscles upon walking one block diminised popliteal and pedal pulses what medication should be used to avoid ?

ACEIs

Choice of antihypertensive in different situations - with Asthma?

CCBs Diuretics Beta Blockers, ACEIs - is contraindicated

Choice of antihypertensive in different situations - in Pregnancy?

if there is emergency - Beta Blockers ( Labetalol BP 150/) Essential Hypertension ( random visits then increased BP) - Methyldopa

Choice of antihypertensive in different situations - in Renal Artery Stenosis?

Unilateral - ACEIs or Bilateral - Diuretics (ACEIs is contraindicated)

Choice of antihypertensive in different situations - Chronic Kidney Disease?

ACEIS ARBs

Choice of antihypertensive in different situations - Post dialysis ?

CCBS Beta Blockers ACEIs Cannot give Diuretics - there is already too much fluid

Choice of antihypertensive in different situations - Acute Renal Failure

in case of congestion - DIURETICS is stable case - BETA BLOCKERS

Choice of antihypertensive in different situations - End stage Renal Disease?

Transplantation

Man with urinary retention mass above the pubic symphysis DRE shows enlarged prostate with palpable median sulcus catheter inserted what is the most appropriate step?

Trans Rectal Ultrasound Guided biopsy

woman with cardiac artery stenting, debelops episodes of transient visual loss to her left eye. Vision returns within 30 minutes. 10 of these within the past 3 months. Symptoms?

Retinal Vein Thrombosis

40yo male patient with RA, on Methotrexate and Hydroxycholorquine, planning to start family. What is your advice?

A. Stop Methotrexate and continue Hydroxychloroquine

a 32 yo woman came with greenish vaginal discharge. She had an implanon 3 years ago. She lives with her female sexual partner. A diagnosis of bacterial vaginosis was made and she was given Metronidazole. What else will you do?

Treat her partner

A 5 day infant - mild puruelnt eye discharge mild cursted yellowish discharge in both eyes without a prominent swelling and inflammation of eyelids org?

Gonorrhea

neonatal eye discharge first day

Chenical Irritation

neonatal eye discharge 1st week

Gonorrhea

neonatal eye discharge 1- 2 wks

Chlamydia tx: Azithromycin 20 mg/kg orally for 3 days

female first trimester. trying to stop smoking. How will you help?

Nicotine Patch

Man working in garden fell and rubbed his face on grass vision blurring, no pain, no conjunctivitis. What is the next investigation?

Fluorescien

28 yo female positive for HPV 16, 18 and negative for 16 and 18

Cervical screen 6-12 months

10 cm cyst two months after pancreatic, middle age patient comes with epigastric pain, a cyst is exactly posterior stomach, best managed asled?

Endoscopic Gastrostomy up to 40 % of pseudocyst resolve without intervention Pseudocysts smaller than 6 cm - usually disappears without intervention if it is larger than 6 cm with symp, > 6 wks - surgically drained less than 6cm without symp - careful observation with periodic CT scan

Xray of slipped Capitofemoral joint of a 14 year old boy with BMI 30. What will you do?

Pinning of joint

A young patient has got often light headedness normal CXR ECG normal Holter monitor reveals ventricular ectopic

Plain echo

45 from Sri Lanka with painless haematuria. probable dx?

UTI

Female with gestational diabetes fx, normal OGTT at 8 wks What to do?

24-28 wks

7 days post op patient with dyspnea and breathlessness Most appropriate investigation?

Since he is post op Patient then answer is CTPA

CTG of primigravida given, FHR at 120 bpm What to do?

FHR is normal so continue Fetal heart monitoring if there is late decelerations then scalp ph sampling then put mother in left lateral position then second give O2 and third if hypo - give synto and do monitor CTG every 4 hrs.

An old age patient with cataract had improve vision after surgery, in post op day 4 he had painful eye and blurred vision. What is the diagnosis? A. Conjunctivitis B. Uveitis C. Suture infection and Abscess D. Hypopyon E. Acute Glaucoma

C. Suture infection and Abscess

A ball hitting the eye leading to floaters and vision loss asking cause?

Retinal Detachment The five F Fall of vision Flashes of light Floaters in the vitreous Fundus findings Field changes

Baby 17 days old with jaundice Normal weight gain Stools and urine also normal What can be the cause? A. Biliary atresia B. Breast Milk jaundice C. ABO incompatibility

B. Breast Milk jaundice ABO incompatibility - is a first day jaundice so within 24 hrs but this baby is 17 days old While Biliary atresia - will have obstructive features such as dark urine and pale stool.

Covid Positive 6 days symptoms 88% saturation after oxygen treatment A. Ceftriaxone B. Amoxiclav C. Remdesivir D. Prednisolone

D. Prednisolone

Case of temporal lobe epilepsy in a lady asking about which step will help you to make diagnosis? A, Video EEG - never the first line B. History from the witness C. CT head D. ECG E, Carotid message

B. History from the witness

What is the first line investigation for seizure?

Electrolytes recurrent time - glucose

patient went to Jakarta but did not visit rural area only city and hotel. Fever, malaise and rash. What is the investigation?

Dengue Ns1

What are the complications of Malaria?

CHAPLIN Cerebral Malaria or Coma Hypoglycemia Anaemia Pulmonary edema Lactic Acidosis Infections Necrosis of Renal tubules

Gastrointestinal symptoms, hepatomegaly, neurasthenia, cholangitis. cholecystitis Dx? It is a common infection of dogs and other fish -eating carnivores (reservoir final hosts) in China, Korea, Republic of Kora and Vietnam, Cambodia and Taiwan

Clonorchiasis

Transmission is tru undercooked fish bilary tract inflammation - pigmented gallstones associated with cholangiocarcinoma

Clonorchis sinensis Tx: Praziquantel

Short Intubation and Long intubation

# D Cambodia

Cholangitis Liver Abscess

India

Enteric

patient went to Thailand fever malaise hepatosplenomegaly DX

HIV other diseases: Pneumonia STD Chikunguniya Viral Hepatitis Measles Anthrax Ricketssiae

Old female patient is abusing alcohol laboratory test to confirm this A. MCV B. ALT C. MCH D. AST

A. MCV

Which of the ff abnormalities not associated with long QT segment? A. Hypokalaemia B. Hypocalcaemia C. Hypomagnesemia D. Hyponatremia E. Bradycardia

D. Hyponatremia

A boy with ADHD was initially treated with methylprhenidate after 6 month how do you adjust the dose? A. Assess the level of hyperacitivity B. Side effects C. Reduced Symptoms D. Improve lifestyle E. Good grades in school

A. Assess the level of hyperacitivity

Alcohol withdrawal synmptoms

Delirium Tremens Tx:

Tx for Adjustment disorder

Psychodynamic therapy

Tx for OCD

Exposure and Response Therapy

Tx for Tourettes Syndrome

Habit Reversal therapy

Tx for ASD

Behavioural modification program

tx for Persistent depressive disorder

Insight Oriented Psycotherapy

Tx for grief

Supportive Therapy

Tx for ODD

Family therapy

TX for Kleptomania

Insight Oriented Therapy

Tx for Separation Anxiety DIsorder

CBT and Psychotherapy

TX for ADHD

Behavioural Therapy

Tx for Specific Phobia

Systematic Desensitization and Exposure therapy

Tx for all dissociative disorders

Psychotherapy

tx for Anger management

CBT or anger management therapy

Divorded parents Child lives with father, complains abdominal pain O/e normal. Tx? A. COgnitive therapy b. Behavioural therapy C. Fluoxetine D. Amitriptylline

b. Behavioural therapy

tx for alcoholics + agitated

Tx for alcoholic + psychosis

Haloperidol nonalcoholic + agitated Nonalcoholic + psychosis TX; Haloperidol

Teen boy falling grades Plays video games all day knows that video games is affecting his studies Wants a career in video games dx? A. Normal adolescent behaviour B. Drug addiction C. ADHD D. ODD

A. Normal adolescent behaviour

Patient stopped eating for 2 days. Says she has no gut. Patient does not want ECT A. Give ECT on the ground of patient no care no consent needed B. mental Health ribunal C. COnsent of husband

B. mental Health ribunal

Patient lawyer wants his medical records as he is going to appear in the court. What do you do? A. give him the records B. Tell him need court order C. Need to do forensic assessment before giving records

B. Tell him need court order

All of the following can cause Serotonin Sydnrome except: A. Haloperidol B. L tryptophan C. Clonazepam D. Meclobemide E. Dectromorphan

C. Clonazepam

Pt hit the eye by a ball orbital floor fracture A. Diplopia upward and outward gaze B. Diplopia on downward gaze C. Pain on opening mouth

A. Diplopia upward and outward gaze

Features of Orbital FLoor fracture

decreased visual acuity binocular vertical diplopia eyelid swelling ipsilateral hyperaesthesia Enopthlamos is a late feature that can be seen after edema settles.

horizontal diplopia and chewing

Zygomatic Fracture

Specific feature of orbital floor fracture

ipsilateral hyperaesthesia

most common feature of orbital floor fracture

vertical diplopia

cluster of autonomic, motor and mental status changes resulting from excess 5-HT

Serotonin Syndrome tx: Cyproheptadine

Asymptomatic with 30% pneumothorax

Intercostal tube with large bore catheter <25% collapse with no symptoms - observe <25% collpase with symptoms - Drain >25% collapse - usually drain

Symptoms and Management in Serotonin Syndrome

mediastinal shifting

Tension Pneumothorax tx: Needle throcostomy

newly diagnosed ankylosing spondylitis treatment asde from physiotherapy? A. Naproxen B. TNF inhibitors C. Paracetamol D. morphine

A. Naproxen

If NSaids Failed what is the second line management for Ankylosing Spondylitis?

Etenercept Adalimumab Infliximab

What is the accurate method to diagnose Ankylosing spondylitis? biomarker for AS - HLAB27

MRI

Acute Tophous gout treatment?

Prednisolone Prophylaxis of a flare of gout Cochicine 0.5 mg daily or bid or Predinisolone 6mg daily or NSAID eg Diclofemac 25-50 mg up to 200 mg/daily

60 lady joint pain with Heberden's nodes. How to diagnose?

Osteoarthritis - Xray - ESR and CRP is not raised. coz it is non-inflammatory

polarized light microscopy positive birefringence

Pseudogout

polarized light microscopy negative birefringence

Gout

Tx of Gout with Renal problem

Corticosteroids if its not in the choice low dose colchicine

How to treat Seborrheic Keratoses?

freezing them with liquid nitrogen or cryotheraphy , or electrocuatery or laser resurfacing or Ablative laser

4yo child with sudden onset of fever, resp distress, drooling, soft inspiratory stridor. Diagnosis? A. Croup B. Epiglottitis C. Bronchiolitis

B. Epiglottitis

81yo 3 month progressive constipation Pain for 5 days Xray is given A. sigmoid Volvulus B. Colon Cancer

A. sigmoid Volvulus more common in older men and has sudden and severe onset

4months runny nose - low grade fever and family members got infected wheezing, cough. cause? A. RSV - bronchiolitis B. Pertussis C, Influenza

A. RSV**** Bronchiolitis is for less than 1 month old

Initial investigation for bronchiolitis and pertussis?

Nasopharyngeal Swab

boggy swelling of knee. Clicking sound. Inv? A. Xray B. MRI C. Arthrocentesis

B. MRI Dx - ACL tear

Croup, what org?

Parainfluenza Adenovirus Influenza

Old patient, bilateral shoulder and hip pain. Lab given ESR raised, Ck normal Treatment? A. Prednisolone B. Paracetamol

A. Prednisolone

myopathy CK and ESR both elevated

Polymyositis

myopathy ESR and CK both normal

Drug induced - steroids - statin

myopathy ESR is raised and CK is normal

Polymyalgia Rheumatica

Long standing angioedema can be associated with what medications?

ACEIs

Age > 50 new headache - throbbing, unilateral diplopia polymyalgia rheumatica loss of pulsation of temporal artery jaw claudication temporal artery 5cm is diagnostic

Temporal Arteritis

fatigue / malaise + headache + jaw claudication

Temporal Arteritis

Inv for temporal arteritis

ESR is elevated C-reactie protein elevated mild anaemia 0r normochromic normocytic

Thyroid operation done After sometime develop difficulty breathing management? A. Intubation B. Open the sutures

B. Open the sutures

Right Homonymous hemianopia with macular sparing where is the lesion?

Left Occipital cortex

Epigastric hernia on linea alba commonly contains what?

Extraperitoneal Fat

Collegue is HIV positive doesnt want to reveal the condition and continues to practice what to do?

Report to APHRA

patient that takes medications for RA well controlled Ibuprofen, Sulfasalazine, prednisolone, cyclosporine suddenly feeling tiredness and elevated platelets and abnormal labs

Ibuprofen

Female patient hx of syncope. ECG normal, bp sitting and lying same and normal. What is next?

Holter to rule out cardiac arrythmias dx: Fatigue + dizziness +/- Syncope = Cardiac Arrythmias

Patient gf came to pick up prescription for insulin?

Confirm over the phone

Patient suicidal. Involuntarily admitted. Dad lives with him comes later and asks for what happened? A. Tell father B. Don't tell father because of confidentiality

B. Don't tell father because of confidentiality

Foster mother wants to return girl child as she was doing unusual sexual behavior with other kids A. Inform child protection B. Arrange another foster home C. Get psychiatric evaluation D. Chase collateral information about the family structure E. Notify hospital admission

C. Get psychiatric evaluation

Down's patient ear pain. Carer says patient has intermenstrual bleeding. She doesn't want you to allow to examine her and just wants to discuss about the ear pain? What will you do? A. Examine her under GA B. Ask her about the knowledge of intermentstrual bleeding C. Arrange for ultrasound

B. Ask her about the knowledge of intermentstrual bleeding

38 wks, amniotomy meconium stained, CTG is normal. What is next?

STOP CTG

Child healthy, playful, no bruise anywhere, mild urti. Mother young very sickly, bruise on both hands, lives on uncle's basement and eats leftover, coffee, beer and cigarettes. What to do? A. Child protection B. Child health services C. Emergency shelter service

C. Emergency shelter service

female bruising all over. Says bf abuses. What to do? A. Photograph B. Encourage to report C. Arrange shelter

C. Arrange shelter Protect first

Allopurinol dosage

50 - 300 mg

Picture of heberden nodes. Which condition causes this?

Celiac Disease

Hyperkalemia

Previous 1 week h/o headache, fever. Now came with h/o dark urine, jaundice, hepatomegaly, splenomegaly. Sexual partner is well. What is the diagnosis?

EBV

34wks pregnant patient, came with complaints of itching What is the diagnosis

Cholestasis of Pregnancy

presents in the last trimester with symptoms of fulminant hepatitis - jaundice, vomitinh, abdominal pain, headache and possibly coma

Acute Fatty Liver of pregnancy

40 yo male with visible hematuria. Kidneys palpable. No pain symtoms what is the diagnosis?

Polycystic Kidney Disease palpable kidneys

Good pasture disease. Investigation to confirm the diagnosis? A. Antibuclear antibody B. Anti basement membrane antibody

B. Anti basement membrane antibody Anti-GBM antibody tx for GBM - plasmapheresis and immunossuppression the defect is in the alpha 3 subunit of type IV collagen

DXT: failure to thrive + chronic cough + loose bowel actions

Cystic Fibrosis dx: Sweat chloride test

Picture of prolapsed hemorrhoids. What is the appropriate management?

Rubber Band ligation

tx for ADHD

Methylphenidate

vulva itchiness that doent respond to two course Itraconazole White lesion on examination mgt?

Lichen Sclerosus Ans- Bethamethasone (steroid) cream

A woman came to you with infertility, she also has hirsutism. What will be your next investigation?

PCOS - FSH/LH (same with infertility cases - always check this one out first)

During routine check up, adrenal mass is seen in CT and MRI, but no symptoms and all well. What will you do? A. CT in 6 months B. Percutaneous biopsy C. Tumor resection

A. CT in 6 months

Middle aged man, comes with lower back pain, radiating to the right thigh, leg pain, hard to walk, difficulty with everyday activities. H/o urine incontinence, O/e verterbal local tenderness. Which one of these condition is more consistent with spinal cord compression? A, Urine incontinence B. Leg pain C. Impaired ankle jerk D. Vertebral local tenderness E. Lower back pain

D. Vertebral local tenderness

Women concerned about ovarian cancer, because her Grandma got one. She is on COCP. What will you do next? A. Continue COCP B. Increase the dose C. Decrease the dose D. CHange POP E. Condoms

A. Continue COCP

A woman came for OCP, mother and sister have recent DVT. What will you advice A, Thrombophilia Test B. Low dose COCP C. High dose estrogen COCP E. POP

E. POP

32 yo woman, came with amenorrhea for 12 mos, no sexual activity since 1 yr ago. best inv?

Beta-HCG always exclude pregnancy first

mother with car accident, bruises in abdomen by seatbelt, condition is good, fetal heart sound auscultation is good, What is next?

Admit and hospitalize

5 year old child leg pain during night but well at daytime, normal well development. What is the next step?

Reassure Dx; Growing pains

an old lady fell on her shoulder 6 wks ago sustained no fractures now returns with the swelling and mottling on her shoulder and proximal area of her arm complains of hypersthesia and extends from arm to mid-forearm Normal doppler sonogram Diagnosis?

CRPS Complex Regional Pain Syndrome

Young man after jogging and going up slopes pain in lateral aspect of knee tenderness in 30 degree knee flexion in lateral distal femur what is the diagnosis? A. Iliotibial band syndrome B. Lateral meniscus C. Stress Fracture of Lateral condyle of femur

Ilotibial Band Syndrome

Young lady with epilepsy for which she was on phenytoin. She wants contraceptive for 2 years. What is best for her? A. COCP with 30 ug ethinyl estradiol B. POP C. Copper IUCD D. Implanon

C. Copper IUCD

Symmetrical arthralgia in small joints of both hands. ANA, ENA (anti roSSA), RF and dsDNA positive Anti CCP negative What is the diagnosis?

SLE

Patient in cardiac care unit for MI 2 days ago PCI done Now ECG of 3rd degree heart blocl What to do? A. transcutaneous pacemaker B. Permanent pacemaker

B. Permanent pacemaker

Patient presenting with diarrhea, generalized arthralgia, rash on lower extremities since 2 days. Treated for sore throat with Amoxiccillin 7 days before. What is tyhe cause?

HSP

char by tetrad of palpable petechial rash or purpuric rash, arthralgia/ arthritis, abdominal pain and nephritis

IgA Vasculitis (HSP_

17 yo boy admitted for some leg fracture. Asked nurse to give morphine. Now the boy is complaining of severe pain. Found out nurse decided that he doesnt need morphine so gave him PCM. What will you do? A. Notify AHPRA B. Incident report C. notify the hospital administrator D. Discuss the issue in nursing head meeting

B. Incident report

if patient has breath sounds decrease on left upper side of the back and Xray shows opacity in the left upper lobe. What is next?

CT chest

Assistant of specialist came to you complaining of work overload. Distressed because of that. Specialist is your friend so what will you do? A. Declare conflict of interest B. Tell specialist about this C. Tell her its okay D. Ask her to find new GP

A. Declare conflict of interest

# Z

equivalent amount of radiation in Xray

400

55yo has diplopia for 1 day R eye Glucose is normal ECG shows occasional ventricular ectopic Management?

Observation

A man presents with pansystolic murmur which is radiating to the axilla What is the diagnosis?

MR MR. Pan napunta sa axilla Mitral Regurgitation

B is correct PVT - cannot stop the heart from poundingA

B Stop patient's metoprolol

65 yo man digoxin with HF and basal crepitation came with SOB in emergency pedal edema Management?

A. Furosemide

A. TEE

young, basketball player, swollen arm, edematous, mild discoloration, tender o/e small lymph nodes are palpable but not tender cat is unwell A. Cat scratch disease B. Cellulitis C. Axillary vein thrombosis

C. Axillary vein thrombosis (vs catscratch - with fever)

Athlete + fever for few days + lymphadenopathy usually painful + animal / cat sick + limb swelling

Cat Scatch disease

swelling in the arm with pain high in the axilla seen in people working above their head, such as painters and basketballers. it is an emergency requiring antithrombotic therapy.

Subclavian or Axillary Vein thrombosis

68 yo hip fracture, comes for third day with SOB with chest tightness What is your probable diagnosis? A. Fat Embolism B. Pulmonary Embolism C. MI D. Cardiac Tamponade

A. Fat Embolism It occurs within 24-48 hrs after trauma but thromboembolism is uncommon before 5 days after immobilization.

Hampton's hump Wedge opacity

Pulmonary Embolism

`28yo diagnosed with HOCM and now is worried if her 10 years old child has the same. ECG echo normal what next? A. Stress Echo B. ECG echo in 2-3 years C. repeat Echo

B. ECG echo in 2-3 years

Melanoma in the eye (on eyelid) treatment A. send plastic surgeon B. Observation

A. send plastic surgeon

What will you do for follow - up with Melanoma A. Chest CT B. Mammography C. LFT D. Brain CT

Chest CT

An 28 alcohol male patient agitated brought to the hospital glucose is 4. Qhat is the immediate thing you will do in the ER before definitive treatment? A. IV glucose B. IV thiamine

A. IV glucose

Adult, agitation, woman, alcoholic A. Blood Glucose B. Look for Oral Diazepam C. Haloperidol IM

C. Haloperidol IM

Four years snakebite (black snake) boy is alert plus conscious. First step at site A. Immobilize plus pressure B. Do nothing C. tourniquet

A. Immobilize plus pressure

diabetic ketoacidosis in 19 yo , glucose 22 mmol. A. IV fluids B. Insulin C. KCL

A. IV fluids

What does the comatose patient needs

water sodium (3L normal saline) Potassium (KCL) Insulin

Diaphragmatic rupture what to diagnose?

Abdominal CT scan

Diarrhea with HCO3 = 8 (N 24). What will you add to the IV fluid? A. NaHCO3 B. Fluid restriction

A. NaHCO3

All of the ff can cause serotonin Sydnrome except?

Clonazepam

bloody diaarrhea, and o n Sulfasalazine now came with red rash on leg picture of

Erythema Nodosum

CT is given - adeno, chronic calcification pancreatitits, woman 3 glasses of wine intake, weight loss dx?

Pancreatic carcinoma

colicky abdominal pain and anorexia for 7 days 2 days with diarrhea tenderness all over the abdomen with guarding temp 39 diagnosis?

Perforated appendicitis

Acute tophous gout treatment?

Allopurinol

Abdominal ultrasound - focal hepatic lesion abdominal ct scan - enhaving focal mass suring the arteril phase with rapid washout during the portal venous phase diagnosis?

Liver cancer

fever and petechial rash diagnosis is meningitis What is the next step in the management? A. Blood Cultures B, Intravenous access C. Lumbar puncture D. Intravenous ceftriaxone E. Intravenous Benzoyl Penicillin

B, Intravenous access

Vietnam travel - What prophytlaxis is required? A. Doxycycline B. Ampicillin

A. Doxycycline

Salmonella travel advice? A. TRSD Vaccine B. Doxycycline C. Avoid street food D. Drink Bottle water

C. Avoid street food

boggy swelllling at the knee, clicking sound

ACL dx: MRI

Why do you notify Salmonella A. To research B. To prevent spread

B. To prevent spread

Typhoid travel advise best suggestion A. Vaccine B. Personal hygiene

``` A. Vaccine ```

70 male, recent travel to asia, now confused, neighbors brought to ED axillary and lymph node enlargement. What test will you do A. HIV B. Syphilis serology

A. HIV

Varicella Zoster

PCR

Cellulitis red swollen hand antibiotic?

IV Fluctox

27yof, breast mass 0.5 cm, painless, no swelling, , nontender and firm. aunt had breast ca age 65

USG

A young woman with pap smear results: LSIL and HPV test was negative for none 16 and 18. Management?

54 yo, asymptomatic man, comes concerned with colon cancer, father has colon cancer at 67. What can he do for cancer screening?

FOBT now

patient is in hospital for cholecystectomy tachycardis + increased BP + chest pain + dyspnea + ECG ST segment depression management?

Cath Lab

sputum fever, CXR lower lobe consolidation Probable cause?

Streptococcus Pneumoniae

54yo F, with stress incontinence What is next?

Urine analysis

A young man with mass in the lft testis separated from the testicle, painless, mass is compressible, nontender and can be felt soft and firm. What is your diagnosis? A. Varicocele B. Epididymal cyst C. Inguinal hernia D. Non seminomal testis cancer E. Seminomal testis cancer

Inguinal hernia

bulge above the umbilical. mass located above the umbilical, painful, does not get smaller by lying down and does not disappear dx?

Epigastric hernia

yellowish greenish offensive discharge thin and foamy + vaginal itching dx?

Trichomonas

which indicates severe infectivity with Hepatitis B?

HbeAg

A young man has come complains of epigastric pain. Pain gets worse after eating, urease test positive. management?

D. PPI + Amoxiciillin + Clarithromycin

nuchal translucency

Oligohydramnios

HX of intermittent acute right iliac pain by vomting no vaginal bleeding LMP 12 wks ago dx?

Ruptured Ovarian Cyst inv: TVS RX: reassurance - sinple cyst ,$cm why not torsion? - very ill patient, severe cramping mobile mass in abdomen - laparoscopy

amenorrhea + abdominal pain + vaginal bleed urinary b-hcg test can be negative

Ectopic pregnancy

most approp treatment for umbilical hernia?

Mesh Repair

left leg and hip muscle weakness and weakness of left hand fasciculation in lower limb and left lower limb hyperreflexia, weakness of ankle joint. what is most likely the site involved?

Cervical spine

A man concerned of Prostate cancer. PR is done and normal. What is next?

PSA after 2 weeks pf performing DRE PSA every 2 yrs from 50-69 - men at average risk of prostate cancer

A man prescribed oxycodone for lumbar pain, recentlu because of severe pain he took heroin what is next? A. Reduce oxycodone B. Switch to Tramadol C. Check Oxycodone level

A. Reduce oxycodone (it is less potent 6 x than heroin)

Abdominal pain elderly sudden onset

Sigmoid Volvulus

most common affected site leading to intermittent claudication

Superficial femoral Artery

pregenancy, 18 wks, TSH - low palpitations, lethargy, ecg ectopic beats whats next?

Free T4 - Primary Hyperthyroidism -

38 male with epigastric discomfort increased with alcohol and spicy food. No weight loss. What to do next? A. CT abdomen B. Upper GI endoscopy C. Urea breath test D. fecal occult blood

C. Urea breath test

39 pt with Warfarin, INR 9 with bleeding What to do?

STOP WARFARIN Stop the offending drug first

15 yo, bilateral, exaggerated reflex, ataxia, joint position all gone

Friedrichs Ataxia

Back pain what features in the history make you think of doing more investigations? Reflex Fever Pain Radiation Local tenderness

Fever

1+ proteinuria on routine health check No other abnormalities A. Repeat Urinalysis B. 245hr Urinary Protein C. Urine culture

A. Repeat Urinalysis

Child have psychotic problem started Risperidone what should be suspected in the consequence?

RISPERIDONE = WEIGHT GAIN

endoscopy shows a narrow ring in esophagus in biopsy treatment?

Budesonide tx for EoE

infertility, female with prolactin level 5500 taken Paracetamol and Esomeprazole. What is the cause?

Pituitary Adenoma >4000 - Pituitary Tumour < 4000 - Drugs

Lurias test- frontal lobe test, unable to perform dementia symptoms also mentioned, what investiagtion to help the diagnosis? A. Serum Vitamin B12 B. Blood Alcohol C. Urine Drug screen D. No option of CT

A. Serum Vitamin B12

GBS scenario with CSF - albuminocytological dissociation, most approp test for diagnosis? A. Nerve conduction studies B. EMG C. MRI brain D. MRI spine

A. Nerve conduction studies

consequence of RISPERIDONE

Gynecomastia or Weight gain

athlete, h/o multiple neck injuries, diarrhea 2 wks ago, difficulty in extending wrist and elbow, numbness in posterior aspect of lower third of arm. Nerve and nerve root asked

C6-C7

man with h/o criminal records now h/o insomnia, agitated, recently charged with minor assault A. Oral Olanzapine b. IM Diazepam C. IV Phenytoin D. IV morphine

b. IM Diazepam

earache and droopy face episodes of viral illness in the past difficulty closing his R eye and has a right sided facial droop Right otoscopy shows crusted eruptions in the External auditory Meatus What is the cause? A. Drug induced allergic reaction B. Fungal infection of external canal C. Reactivation of herpes zoster virus

C. Reactivation of herpes zoster virus

Treatment of gout when allopurinol didnt work

Febuxostat

fixed semi-dilated pupil tx?

Pilocarpine dx: Acute Angle Closure Glaucoma

Persistent diarrhea more than 2-3 days

Metronidazole

child limping and difficulty in walking no fever

Perthes is in children 4-8 yo

Pt with complains of multiple symptoms but no records for that even after search Diagnosis?

Factitious disorder

HLAB27 positive with back ache on methotrexate and hydroxycholoroquine What to do?

Cease Methotrexate

rash on abdomen in 18 months old child with previous fever

Herpes 6

Antibiotic to give post splenectomy

Amoxicillin

Acute limb ischemia what is the next step?

Heparin

Rash on abdomen in 18 months old child with previous fever

Herpes 6

Post splenectomy tx?

Amoxicillin for 2 years

Typical drussen

Intravitreal Becavizumab

Sjogrens anti ro + dry eyes tx?

Naproxen

Molar Pregnancy

Hydatid form

Orbital floor fracture

Diplopia

What is the late feature for the Orbital Floor Fracture

Enopthlamos

redness and swellling just anterior to the neck Mgt?

Regular Sialogogues

Foot deformity with a high arch (pes cavus) Invrted champagne bottles Diagnosis?

Charcot Marie Tooth Syndrome

Clear discharge from urethra and dysuria mgt?

Azithromycin

Initial management for hyperemesis gravidarum

IV fluids

Abdominal distention which electrolyte can cause

Calcium

History of hoarding what to look?

Social Anxiety

swelling and redness in scrotal 36-72 hours

Testicular Torsion

USG of testis showing hypoechoic area Next step

Afp USG - Beta-HCG- AFP But afp if theres no other ans

swelling i the testicular region swelling not tense transilluminate next step?

Defer surgery for 1 yr Hydrocoele - dx

pain in lateral epicondyle difficulty in flexing the wrist what is next?

Inj Corticosteroids

post appendectomy 3 years ago dyspareunia

Pelvic Adhesions

Patient stable on Clonzapine BMI 41 What is next

Aripiprazole

Eosinophilia means

New growth for parasites

# A Preg 6 wk with intense itching what is advice

HCC post partum screen

tx for atropic vagina

Estrogen Cream

Tx for meningcoccal meningitis antibiotic of choice for 5 yo

Ceftriaxone

What drug to stop in hyponatremia

HCThiazide

Upper abdominal pain + worse after eating and at night

GERD

What is the physical examination finding of Polycythemia vera

Splenomegaly

What is the most common cause of death in peole with Polycythemia vera

Thrombosis

Diplopia + arthralgia + hematuria + hemoptysis + HT

Good pasture Disease

White band ring floater increasing

Vitreous hemorrhage

For Asthma, spo2> 92 What to give?

Steroids

For Asthma, if spo2 <92 What to give?

Ipratropium then steroids

What is the treatment for Lichen Sclerosis

Clobetasol

bilateral mastalgia and bilateral nipple discharge with greenish yellow staining

Mammary duct ectasia

pregnancy and itching

Cholestasis

confused and restless after day 2 abdmonail surgery and hiatus hernial repair

Electrolyte imbalance

Diabetic foot ulcer treatment

toileting the wound

protreinuria, hematuria, 2 days of sore throat (1-4days)

IgA Nephropathy

protreinuria, hematuria, 2 wks of sore throat (1-2 wks)

PSGN

Basilar skull nfracture Racoon eyes, CSF leaking What to do next?

Oral Gatric tube

Fertility

Sulfasalazine

Body pain Test are all normal tx?

Amitriptyllline

post op day 5 painless distention of abdomen rectal examination unremarkable Small bowel distentoon nxt?

NG tube and decompression

Joint pain tenosynovitis swollen joints vesicular eruptions in arms

Gonococcal athritis

erectile dysfunction enlarged tongue widening of joint spaces, low testosterone and hyperglycemia What is the diagnosis?

Acromegaly

intense photophobia, painful red eye but pupils reacting normally what is the diagnosis ?

Keratitis

flattened deltoid

Ac dislocation

2 yo, blood in stools, abdominal pain

Meckel's diverticulum

premature ejaculation but no problem with erection

SSRI

edema and pain in the lower extremity loss of pulse diuplex of the leg is negative what is next?

CT angio

multiple, dilated loops of small bowel post cholecystectomy site of anatomic obstruction?

Jejunum

HUntington disease chances of offspring to get the disease

50%

Site of reflux in GERD and location of hiatal hernias Transposition point between stratified swquamous and columnar

Gastroesophageal junction

distal portion of the stomach site of the hypertrophic pyloric stenosis obstruction leads to the gastric outlet obstruction

Gastric antrum / pylorus

Site of small bowel obstruction prior abdominal surgery

Duoedenum / jejunum/ ileum

Transition between small bowel and large bowl site of intussusception and gallstone ileus

Ileocecal junction

Watershed blood supply Splenic flexure : SMA (artery of Drummond) and IMA (left colic supply) Rectosigmoid junction: IMA (sigmoid and internal iliac (superior rectal) supply

Splenic flexure and Rectosigmoid junction

older males acquired weakness of transversalis fascia within the hesselbachs triangle (medial to inferior epigastric vessels)

Direct Inguinal Hernia

young males incomplete obliteration of processus vaginalis lateral to inferior epigastric vessels through deep and superficial inguinal ring

Indirect Inguinal Hernia

Highest risk of incarceration

Femoral Hernia

AST 500 U/L , ALT 510 U/L positive smooth muscle antibodies

Autoimmune hepatitis

elevated alkaline phosphatase anti-mitochondrial antibody

Primary Biliary Cholangitis (IgM) - middle aged women

p-ANCA antibody asso with ulcerative colitis "onion-skin appearance of bile ducts, beads on a string

Primary Sclerosing cholangitis

RUQ pain, fever, jaundice gallstone obstructing common bile duct history of cholelithiasis

Acute Cholangitis

CAG repeat

Huntingtons disease

weakness in facial muscle, frontalis having swallowing difficulties coughs when he tries to drink water

Bell's Palsy

Postpartum mother with heavy vaginal bleeding

Amoxicillin

10 month, rep distress, exp and insp wheezing, intercostal recession

Nasopharyngeal swab

sign of intestinal ischaemia

A fib

Patient wsith subarachnoid what willl you add for long term management

Nimodipine

Boy with head trauma playing foot ball fainted for some seconds, became drosy and unconscious

CT Scan

feels detached from the environment

Take collateral history from relatives who have seen her

PCOS scenario what to expect in the lab

High free androgen index or free testosterone

patient had MI and is on aspiring for 10 years and doppler shows 60% stenosis in both sides in the Right and Left carotids What's next?

Endarterectomy

back pain labs raised ALP 500 cause?

Paget's disease

vertigo, nausea, nystagmus and ataxia with no hearing impairment diagnosis?

Vestibular neuritis

swelling 2cm in non tender below the inguinal ligament medial to the femoral artery pain increases upon internal rotation and hyperflexion of the hip. cause of the pain?

Femoral Hernia

left sided chest pain, no spine tenderness, no skin changes but pain on upon trunk rotation and numbness over the bilateral lower limbs and ankle reflex loss

Anterior Cord compression

hypertensive medication that should be avoided in bilateral renal artery stenosis and is useful in diabetic patients

ACE inhibitors

Hypertensive medication that can treat nephrogenic diabetes insipidus, icreases lithium concentrations side effects: gout, hypercalcemia, hyponatremia Inhibits the Na/Cl cotransporter in DCT

Thiazide Diuretics

Inhinits calcium channels in vascular amooth muscle helpful in treating Raynaud syndrome causing orthostasis and lower extremity edema

Dihydropyridine calcium Channel blockers

blocks AT11 receptor side effects: hyperkalemia and Acute kidney injury its avoids the ACEI cough

Angiotensin II receptor blockers

Man eating in restaurant and has severe allergy involving SOB, resp distress tx?

Adrenaline

prebious cs secondary to obstructed labout came with labor pains at term, at 2nd stage loss 1.5 L of blood, abdomen soft and tender

Uterine Aton

Abdominal pain.irregular pulse next?

Xray followed by CT - Mesenteric Ischemia

slow growing persistent red scaly patch on areas of skin exposed to the sun

Bowen disease

Patient has dysmenorrhea, no improvement with NSAIDs and COCPS

USG then Laparoscopy

history of back pain, renal involvement, increased calcium and increased phosphorus What is the next inv?

Serum electrophoresis

female with hair loss, alopecia, rash and pancytopenia and thrombosis present, which antibody to order?

Anti Cardiolipin

enlarged testis, transillumination test is negative What is the next step?

USG of the testis

male patient with history of travel comes with a long pain and fever and jauncie. fluid given stones in the gallbladder and ducts Next immediate management?

Endoscopic decompression of the Bile ducts

48 female mother had breast cancer at 60, father had colon cancer at 70, brother is diabetic what to order?

FBS is correct

RTA (major) + internal bleeding + INR (INR < 5 patient is quite stable) + Vital BP 80'60 + mgt?

Stop Warfarin and give FFP and Do immediate surgery

rape victim is irritable and have flashbacks Dx?

PTSD

How would calculi in gallbladder look on USG

Single FIlling defect

female patient hsuband dies a year ago, she develops insomina, tiredness , weight loss and irritability for the last 3 months Dx?

Pathological Grief

Patient is given with sertraline pain in abdomen, psychotic symptoms improves what to do?

Decrease the dose

Alcoholic patient third day post op, confused and agitated What to do

Haloperidol IM

child 5 months weaned from breast milk to cows milk presents with altered bowel habits what is the cause?

Cow milk protein allergy

45yo f, colonoscopy and endoscopy normal, blood transfusion is required 2 units per day to maintain Hb of 9 gm/ dl What will you do?

Capsule Endoscopy

Pt accidentally taken Warfarin and now INR - 7 what to do next?

Cease Warfarin

Molluscum contagiousum Advice?

Avoid taking bath

pain, tenderness to palpation to malleoulus intolerance to weight bearing

Xray

transillumination test, upper pole discomfort with compressible mass Dx?

Inguinal Hernia

PSA > 20, Irregular DRE, bone metastasis and back pain What is the treatment to be given?

Radiotherapy - EBRT

A mom has a kid 2 yrs with pertussis and has a 2 wk old baby. they are against vaccination What you will do?

Isolate the baby at home

Pt with COPD, had recurrent admission, most impt to reduce the recurrence of hospitalization?

Long term use of O2 at home

Indication for an operation in a lady with neck swelling that becomes larger and has bleeding from it

Dysphagia

A lady with swelling looks like parotid swelling. What is the investigation needed?

Ultrasound

A lady with greenish discharge from the breast next inv?

Breast ultrasound

A man with prostate cancer and back pain Lumbosacral xray shown What is the best therapy to improve the pain?

Androgen Deprivation Therapy

cause of pneumonia in a 1 year old

RSV

starting dose of Allopurinol

50mg

PCOS scenario What is the cancer that you need to check?

Endometrial cancer

claudication pain while sleeping , history of ACS tips to toes pain

Peripheral Artery Disease

Fundsocopy given blood clot bigger than 7 figure as in mirror Central visual loss and straight lines wavy initial Investigation?

Amsler Grid

10 mm nodular lesion on the cheek been present for the past 12 months and now started increasing Management???

Excision

3 yo milestone

copy circle

Diminished breath sound / tracheal deviation dullness on percussion What next?

Large bore Chest Tube