Day 1 Flashcards
Q1-A 36-year-old woman witha past medical history ofhypercholesterolemia and type2 DM presents with intermittentdull RUQ discomfort. The patientdoes not drink alcohol. Her physicalexam is unremarkable. Lab studiesshow elevated AST and ALT but areotherwise normal. Hepatitis serologies are negative. What is the most likelydiagnosis?
A-Non alcoholivc fatty liver disease
B-Primary Sclerosing Cholangitis
C-Primary Billiary cirrhosis
D-Alpha one antitrypsin deficiency
Ans: A. Nonalcoholic fatty liver disease (NAFLD), a condition that is associated
With insulin resistance and metabolic syndrome.
It refers to hepatic ballooning and fat degeneration, mainly associated with hyperlipidemia, obesity, alcoholism, mostly reversible after alcohol cessation. Related drugs are amiodarone, tetracycline, valproic acid, and anti-HIV medicines. Treatment- For nonalcoholic fatty liver, only weight loss is effective. For alcoholic fatty liver, only alcohol abstinence is effective. Vitamin E may be helpful. Hepatic steatosis: Late stage of fatty liver, with PMN infiltration, necrosis, and high ALT and AKP. Prevention of cirrhosis is needed.
Q2- A student was performing a laboratory test with a chemical when his sleeves suddenly caught on fire, and both of his arms were burned severely. 5 days later now, both his arms appear dry, white, leathery, and painless. The burns are circumferential all around the arms and forearms. His vital signs are stable. What’s the best next step?
A-Monitoring of peripheral pulses and capillary filling B-Escharotomy C-Fasciotomy D-Eschar removal E-Respiratory support
Ans: A.This is a 3rd-degree, circumferential burn: the leathery eschar will not expand, but the area under the burn will develop massive edema that can decrease circulation (as circumferential burns of the chest can compromise breathing). First monitor the peripheral circulation, and then perform escharotomy with signs of decreased circulation. ‘C’ may be needed for deeper burns. An open space burn is rarely associated with respiratory burn.
Q3- A 27-year lady had an uncomplicated pregnancy so far. She came to the hospital 2hours ago after her water broke. The midwife is looking at her now. She has regular contractions. P.V examrevealed 2cm dilated cervix. Vital signs are normal. What stage of labour is she in?
A-Second stage B-First stage C-Latent stage D-Third stage E-Active phase
Ans: B.What is thelatent phase of labour? The start oflabouris called thelatent phase. This is when your cervix becomes soft and thin as it gets ready to open up (dilate) for your baby to be born. For this to happen, you’ll start having contractions, which may be irregular and vary in frequency, strength and length.
First stage: Initiation of contraction to full dilatation of the cervix. (10 cm).
Second stage: Full dilatation of the cervix to delivery of the baby.
Third stage: Delivery of the baby to delivery of the placenta.
Q4- A 57-year-old woman who underwent emergent cholecystectomy for a perforated gallbladder 3 days prior now has a fever of 103°F and is complaining of chills. The patient has not been ambulating and says she is in a great deal of pain at her incision. What is the most likely cause of her fever?
A-Atelectasis B-UTI (Urinary tract Infection) C-Wound infection D-DVT (Deep vein thrombosis) E-Abscess
Ans: B. POST OP DAY and likely etiology
Day 1 and 2-Atelectesis, post op pneumonia (Wind)
Day 3-5.urinary tract infection (Water)
Day 5-7.DVT or thrombophlebitis of IV line. Also consider pulmonary embolism for new dyspnea and tachycardia (Walk)
Day 7-wound infection and cellulitis (wound)
Day 8 to 15-drug fever or deep abscess
Ref-MTB step 2 ck-page-400
Q5-A 19-year-old man takes a hard blow from the oncoming defense during his second college football game. He complains of severe progressive pain in his knee and has difficulty ambulating. He is seen by the team doctor, who tells him to ice the knee. A week later the pain and swelling are still present. His family doctor orders an MRI that shows a torn ACL?
What is the best therapy?
A- Total knee replacement B- Rehabilitation C- NSAIDs D- Arthroscopic repair E- Reassurance
Ans: D. When thisligamenttears, unfortunately, it does not heal and often leads to the feeling of instability in the knee.ACL reconstructionis a commonly performed surgical procedure and with recent advances inarthroscopic surgerycan now be performed with minimal incisions and low complication rates.
Q6-Most effective method of achieving smoking cessation by use of?
A-Nicotin patch
B-Bupropion
C-Buspiron
D-Nicotin gum
Ans: B. Bupropion is an effective pharmacotherapy to aid smoking cessation (Ludvig et al 2005;Ross et al 2005) and should be considered as a first line agent along with NRT alone or in combination (Mansourati et al 2005). Both pragmatic observational trials and explanatory randomized trials of bupropion therapy have shown approximately 1 in 5 smokers will successfully remain abstinent from smoking at one year (Hurt et al 1997;Jorenby et al 1999;Tonnesen et al 2003;Tonstad et al 2003;Zellweger et al 2005;Wilkes et al 2005;Paluck et al 2006). Varenicline is also considered as a first line pharmacotherapy for motivated smokers expressing a desire to stop smoking (Frishman 2007;NICE 2007;Nides et al 2007). Varenicline’s initial higher quit rate compared to bupropion tails off to similar rates between the two drugs at one year (Gonzales et al 2006;Jorenby et al 2006;Oncken et al 2006;Tonstad et al 2006). Nortriptyline and clonidine have proven efficacy for smoking cessation and are considered as second line agents for smoking cessation (McRobbie et al 2005). There is no evidence to support prolonged bupropion therapy beyond its current license of 7 to 9 weeks and any decision to limit re-treatment is purely a pragmatic one (Killen et al 2006). NICE recommend re-treatment after a period of six months (NICE 2002). Also there is only limited evidence that bupropion therapy has a modifying effect upon withdrawal and craving following cessation of treatment (Warner et al 2005).
The next steps in smoking cessation strategies for many countries are the introduction of smoking bans in public places. Bupropion, varenicline and NRT will however continue to play a significant part in helping smokers to quit. Pharmacotherapies alone will not confer successful smoking cessation; psychological support and personal motivation as well as modifying environmental factors are paramount to successful smoking cessation.
Q7-You are told that a patient has been admitted to accident and emergency with
Jaundice and right upper quadrant pain. What levels of plasma bilirubin would this patient have in order for jaundice to be clinically visible?
A- >30μmol/L B- >25μmol/L C- >35μmol/L D- >15μmol/L E- >20μmol/L
Ans: C. Jaundice, also known as icterus, refers to yellow pigmentation of the skin,
Sclerae and mucosa due to raised plasma bilirubin, usually visible at35mol/L. Jaundice can be categorised according to: (1) The site of theproblem: pre-hepatic (e.g. haemolysis, physiological in neonates,dyserythropoesis, glucuronyl transferase deficency), hepatic (e.g. viralhepatitis, CMV, Epstein–Barr virus (EBV), drug induced, alcoholic hepatitis,cirrhosis) and post-hepatic (e.g. gallstones in the common bile duct,pancreatic cancer, cholangiocarcinoma, primary biliary cirrhosis); or (2)The type of circulating bilirubin (conjugated or unconjugated).
Q8-A 70-year-old man presents to theED in February with a high feverand a productive cough. He wastreated for influenza 1 week ago, and his symptoms improved until 3days ago, when they returned withgreater severity. Exam now revealscyanosis, tactile fremitus, and dullness to percussion over the left lowerlobe. Against what organism shouldantibiotic therapy be directed?
A-Staph Aureus
B-Streptococcus Pneumoniae
C-Herpes simplex
D-Legionella
Ans: A.S aureus.Post viral pneumonia is an important complication of influenza, especially in the elderly.Staphylococcus is the most common organism responsible for early bacterial super infection, presenting just days after the onset of influenza.
Necrotizing bronchopneumonia with cavitation and abscess formation is characteristic.
Q9-A 65 year woman presented with transient arm and leg weakness as well as a sudden loss of vision in the left eye. Her symptoms resolved within the next couple of hours. What is the most appropriate next investigation?
A-CT brain B-Echo C-Doppler USG D-Arteriography E-24hour ECG
Ans: A TIA/STROKE FIRST –NON CONTRAST CT BRAIN
Diagnostic Testing
The best initial diagnostic test for either stroke or TIA is a CT scan of the head
Without contrast. Within the first several days, all nonhemorrhagic strokesshould Be associated with a normal head CT scan.
AFTER you have done CT scan and given thrombolytics or aspirin, most important is to determine the origin of stroke to prevent another episode of stroke or TIA.do following tests like 2 D echo, carotid Doppler, ECG, Holter and blood workup like ESR, VDRL, ANA and Protein C, S and anti thrombin III.
Q10- A toddler is brought for a regular developmental check-up. He can run, jump, and walks up and down the stairs. He can also undress himself, make a 4-cube tower, say “I want,” and follow instructions to “Put it down and come over here.” What’s his most likely age?
A-1 year B- 2 years C-3 years D-4 years E-5 years
Ans: B. Developmental Milestones Age, motor, language, cognitive/social
2 m: Lifts head/chest while prone, tracks past midline; attends to sound, coos; social smile; recognizes parents.
4-5 m: Moves head, rolls; grasp objects and brings to mouth, sits with aid; orients to voice, making consonant sounds; laughs out, looks around.
6-7 m: Sits without aid, rolls over; babbles, repeats vowels, transfer objects; stranger anxiety.
9-10 m: Crawls, pulls to stand; says non-specific “mama/dada”; waves bye-bye.
12 m: Stands and walks alone, uses mature pincer grasp; says specific “mama/dada”, understands 1-2 word; imitates actions, plays ball.
15 m: Walks backward, uses a bowl/cup; uses > 4 words; temper tantrums. 2 y: Runs well, jumps, walks up/down steps with help, makes 4-cube tower, takes off clothes; uses 2-word phrases; follows 2-step orders.
3 y: Rides tricycle, copies a circle; uses > 3-word sentences; washes hands with help.
4 y: Hops, throws a ball, copies a square; tells a story, knows numbers; group playing, toileting alone.
5 y: Skips, copies a triangle, uses > 5-word sentences; role and dress-up playing.
Q11-A 69-year-old man with a 50 pack-year smoking history is brought to the ER by his wife, who reports he seems“confused.” He feels weak and has mid-abdominal pain. He is apale, elderly male in moderate distress. BP is 84/55 mm Hg; pulse is 120 bpm. There is a palpable, pulsatile mass in the patient’s abdomen.
What is the most likely diagnosis?
A-Ruptured peptic ulcer
B-Hemorrhagic gastritis
C-Hemorrhagic pancreatitis
D-Ruptured abdominal aortic aneurysm
Ans: D. The key to the diagnosis of this patient is a painful, pulsatile mass in the abdomen with signs of hypovolemia (hypotension and tachycardia). The ruptured aorta is pouring blood into the retroperitoneal space, and it bulges with every heart beat.Smoking and age is two risk factors for AAA.
Management of AAA (Abdominal Aortic Anurysm)
3.0–4.0 cm: ultrasound every 2–3 years
4.0–5.4 cm: ultrasound or CT every 6–12 months
≥ 5.5 cm, asymptomatic: surgical repair (AAA)
Q12-34years female with HIV, her recent Pap smear is negative, about next cervical cancer screening, when to do?
A-After 3months if negative repeat after 6months
B-After 6months and annually
C-After 1year and annually
Ans: B. Cervical cancer screening is important for all women.The availability of screening tests allows detection of preinvasive disease, cervical intraepithelial neoplasia (CIN). CIN can be treated to prevent progression to invasive cancer. Human papillomavirus (HPV) infection is the etiology of most cervical cancers.
Screening for cervical cancer is of particular importance for women and adolescent girls infected with human immunodeficiency virus (HIV). The incidence of CIN, as confirmed by colposcopy, is four to five times higher in HIV-infected women and adolescents compared with HIV-negative women and adolescents with high-risk sexual behaviors.CIN is common in HIV-infected women because
● Both HIV and HPV are sexually transmitted
● HIV-infected women are more likely to have persistent HPV infection
● Persistent infection with one or more oncogenic HPV subtypes is a major factor in the pathogenesis of premalignant and malignant cervical disease
Q13-A 19-year-old man takes a hard blow from the oncoming defense during his second college football game. He complains of severe progressive pain in his knee and has difficulty ambulating. He is seen by the team doctor , who tells him to ice the knee. A week later the pain and swelling are still present. His family doctor orders an MRI that shows a torn ACL. What is the best therapy?
A-Total knee replacement B-Rehabilitation C-NSAIDs D-Arthroscopic repair E-Reassurance
Ans: D. Arthroscopic repair is the most definitive therapy, followed by rehabilitation. The risk factor that should be considered is that he had direct trauma to the front of his knee. The mechanism of injury can give some insight into the type of problem that may subsequently arise.
Q14- A 30-year man and his wife present to the reproductive endocrine clinic because of infertility. The man is tall, has bilateral gynecomastia. Examination of the testes reveals bilateral small, firm testes. Which of the following investigation is most helpful in diagnosis?
A-CT of pituitary B-Chromosomal analysis C-Measure of serum gonadotropins D-Measure of serum testosterone E-Semen analysis
Ans: B - Klinefelter syndrome (KS) also known as 47, XXY or XXY, is the set of symptoms that result from two or more X chromosomes in males. The primary feature is sterility. Often symptoms may be subtle and many people do not realize they are affected. Sometimes symptoms are more prominent and may include weaker muscles, greater height, poor coordination, less body hair, smaller genitals, breast growth, and less interest in sex. Often it is only at puberty that these symptoms are noticed. Intelligence is usually normal; however, reading difficulties and problems with speech are more common. Symptoms are typically more severe if three or more X chromosomes are present.
Q15-A 71-year old man is undergoing femoro-popliteal bypass for severe claudication of left leg, which causesunbearable pain with exercise. The patient’s past history is significant for insulindependentDM type 2 and appendectomy. What preoperative testing is recommended?
A-Basic metabolic panel (BMP) only B-BMP + EKG C-BMP + EKG + PFTs (Pulmonary Function Test) D-BMP + EKG + exercise stress test E-BMP + EKG + thallium stress test
Ans: E. Vascular surgery is very high risk surgery. This patient has two significant risk factors for a cardiacevent: diabetes (coronary disease equivalent) and age > 70. Therefore, the patient needs a thorough workup including a stress test. Since his claudication prevents him from exercising, it must be nonexercise stress testing.
