Blue

Question 1

No menstrual periods until 1 wk ago when she had episode of light vaginal bleeding for 7 days.
Taking Tamoxifen since 3 years ago for adjuvant chemotherapy on her breast malignancy. What is the cause for the recent bleeding?

Answer 1

Endometrial POLYP formation due to the TAMOXIFEN

Question 2

Most effective antibiotic to use locally for a patient with a mucopurulent eye discharge and a red eye?

Answer 2

Chloramphenicol

Question 3

Pain in her Left shoulder when hanging out washing and raising the arm above the head away from the body. Unable to lift the arm up at all. Limit on abduction of the arm. Deltoid muscle contracting. The arm can be moved passively to full abduction. Diagnosis?

Answer 3

Rupture of the Supraspinatus Tendon

Question 4

Acutely Painful defecation with spotting of blood in the toilet paper. Diagnosis?

Answer 4

Anal Fissure

Question 5

Colicky

Answer 5

Intussuception

Question 6

Profuse blood loss

Answer 6

Meckel’s diverticulum

Question 7

Blood is mixed with the stool not in the paper

Answer 7

Juvenile Polyp

Question 8

Painful joints, abdominal pain and vasculitic rash

Answer 8

Henoch Schonlein Purpura

Question 9

20yo, Pap smear done , grade 3 cervical intraepithelial neoplasia (CIN 3), Mgt?

Answer 9

Colposcopy

Question 10

Eight week history of pervasive sadness, bouts of crying, anorexia and weight loss, a feeling that his life is not worth living, fatigue and disrupted sleep. Which of the ff abnormal sleep patterns is the most likely to complain?

Answer 10

Early waking after initial sleep - Middle Insomnia
Diagnosis: Depression

Question 11

14 days return from hitchhiking through Asia. He complains of explosive, watery and foul-smelling diarrhea of six to eight motions daily. Weight loss, afebrile and abdominal distention. The stool examination shows greasy and contains mucus. Diagnosis?

Answer 11

Giardiasis

Question 12

Overcrowding and poor sanitation
Fecal Oral spread, stool culture, tx: Ciprofloxacin

Answer 12

Shigellosis

Question 13

Fecal Oral, Tx: Metronidazole

Answer 13

Amebiasis

Question 14

Traveller’s diarrhea, self-limiting without treatment

Answer 14

Enterotoxigenic E coli infection

Question 15

Immunossuppression patients (HIV or patients on Chemotherapy)

Answer 15

Cryptosporidial infection

Question 16

Maintained BMI, 13 years of food restriction and obsessional daily exercise routine. Management of Whiplash injury after a car accident. Which of the ff is most likely to be found on general physical examination of this young woman?

Answer 16

Loss of breast Development
(due to weight loss and malnutrition)

Question 17

Intermittent lower abdominal pain, diarrhea and recurrent lower urinary tract infections with Coliform organisms. History of noticing bubbling in the urinary stream with “whistling down my pipe” What causes this problem?

Answer 17

Diverticular disease of the colon

Question 18

6 month history of weakness of the Right arm and Right leg, 2 months ago had headaches.
Over the last 5 years had number of blackouts which were associated with incontinence. Weakness of the Right upper and lower limbs. Papilloedema. Diagnosis?

Answer 18

A Left Frontal Meningioma

Question 19

Lower abdominal pain lasting for 3 days each month for the last 12 months. When not in abdominal pain shows no evidence of any suprapubic mass or tenderness. Blood test ovulating. What causes her abdominal pain?

Answer 19

Mullerian (Paramesonephric) Agenesis

Question 20

35 yo presents with cyclical mastalgia. Mother had breast cancer at the age of 45 yo and died from metastases. Maternal Grandmother also had breast cancer before age of 50. Mammography normal and is on Oral contraceptive pill. USG shows an uncomplicated cyst with no concerning features in the Right breast. Apart from the simple analgesics and evening Primrose oil for her mastalgia. Which of the ff is the most appropriate advice in the patient’s regimen?

Answer 20

Remain on the OCP, six monthly clinical review,
yearly mammography and Ultrasound

Question 21

31 male with endoscopically proven duodenal ulcer treated with PPI, tested positive for H. pylori. Which of the ff most appropriate ff up for the patient?

Answer 21

Urea breath Test at six weeks

Question 22

MMSE should be more than 26

Answer 22

Normal Ageing Process

Question 23

Decline in memory and self-care skills, suffers from urge incontinence. Disoriented in time and place. MMSE of 18/30. Poor short term memory, mild dysphasia and impaired arithmetic , plannign and visuospatial skills, Normocytic Normochromic Blood film.

Answer 23

Alzheimers dementia

Question 24

Urge incontinence but the absence of focal neurologic signs

Answer 24

Carcinoma of the Prostate

Question 25

SIADH, <125, confusion and sleepiness

Answer 25

Hyponatremia

Question 26

Muscle twitching, drowsiness and coma

Answer 26

Chronic Renail Failure

Question 27

Very heavy bleeding causing her to use ten sanitary pads per day and the bleeding does not seem to be decreasing. What causes this problem?

Answer 27

Bleeding / Coagulation profile
Dx: Von Willebrand Disease

Question 28

65 male presents with increasing weakness in his legs over six months. Upper limbs, bilateral wasting and weakness in the biceps muscles. No sensory charges, spastic paraparesis, increased ankle and knee reflexes.

Answer 28

Cervical Spondylosis with Cervical Myelopathy
- depressed biceps tendon reflexes - cervical cord lesion - C5 and C6

Question 29

Primigravida 39 wks gestation by uncertain dates, fundal height measures 30 cm above the pubic symphysis. P: cervix is long and closed and the baby is presenting cephalically. Most appropriate management?

Answer 29

Ultrasound

Question 30

Bruising and excessive cyclical menstrual loss, enlarged spleen palpable 3 cm below the left costal margin. Decreased platelet count. Diagnosis?

Answer 30

Systemic Lupus Erythematosus

Question 31

Dressmaker had a puncture wound from a sewing needle. In the proximal interphalangeal flexor crease her Left index finger, became swollen along its entire length. Passive extension of the digit elicited severe pain. Diagnosis?

Answer 31

Flexor Tenosynovitis

Question 32

Increasing dyspnea, raised jugular venous pressure (JVP), and displacement of the apex beat.

Answer 32

MItral Regurgitation

Question 33

2 month history of a cramping pain at the Right buttock. The pain occurs when he is walking and comes out after several minutes. Pain radiates from the buttock down to the Right thigh and goes away when he stops walking to rest. Explanation of the symptom?

Answer 33

Stenosis of the Right Common Iliac Artery

Question 34

Severe abdominal pain, abdominal rigidity and intense lower back pain.

Answer 34

Leaking Aortic Aneurysm

Question 35

70F presents blood-stained vaginal discharge. Estocervix and the vagina look atrophic. Cervical cytology shows no evidence of malignant cells although no ectocervical cells were seen. Most appropriate next step in the management?

Answer 35

Hysteroscopy and dilatation and curretage