Day 10 Flashcards
Q1-A 73-year-old man has his third syncopal episode in the last 6months. An EKG done in the field shows ventricular tachycardia. His stress test is normal.
What is the most appropriate next step in the management ofthis patient?
A-Metoprolol B-Diltiazem C-Angiography D-Implantable defibrillator E-EP (Electro Physiological) studies
Ans: D. There is no point in doing an EP study when the EKG shows a clear etiology of the syncope. We already know he has an unprovoked ventricular rhythm disorder. Metoprolol is not sufficient when syncope or sudden death has occurred. Calcium channel blockers like diltiazem are useless in preventing or treating ventricular tachycardia. The stress test is normal and there is no chest pain, so There is no point in doing angiography. An implantable defibrillator will prevent the next episode of sudden death or syncope
Q2-A man complains of loss of sensation in his little and ring finger. Which nerve is most likely to be involved?
A-Median nerve B-Ulnar nerve C-Radial nerve D-Long thoracic nerve E-Axillary nerve
Ans: B. In the forearm, the ulnar nerve pierces the two heads of theflexor carpi ulnaris, and travels deep to the muscle, alongside the ulna. Three main branches arise in the forearm:
• Muscular branch–innervates two muscles in the anterior compartment of the forearm.
• Palmar cutaneous branch– innervates the medial half of the palm.
• Dorsal cutaneous branch– innervates the dorsal surface of the medial one and a half fingers, and the associated dorsal handarea.
https://teachmeanatomy.info/upper-limb/nerves/ulnar-nerve/
Q3-A 60-year man presents to accident and emergency with sudden onset pain in the right metatarsophalangeal joint. He is unable to walk without a stick. On further questioning, the patient reports experiencing two similar episodes in the past. Blood tests reveal a raised urate. What is the most appropriate treatment?
A-NSAIDs B-Intra-articular steroid injection C-Methotrexate D-Allopurinol E-Paracetamol and bed rest
Ans: A. the case in this question is describing a patient presenting with acute gout.
The most common presentation of acute gout is inflammation of the first
Metatarsophalangeal joint. The treatment of acute gout episodes is with an
NSAID (A). Patients should also initiate conservative measures to reduce
urate levels. These include weight loss and avoiding excess alcohol. Intraarticular
steroid injection (B) can be given in some cases of acute gout, for example when NSAIDs are contraindicated. However, the first-line therapy is treatment with NSAIDs to control the local inflammation. Methotrexate (C) is a disease-modifying anti-rheumatic drug (DMARD) that is used in thetreatment of rheumatoid arthritis. It is not however, used in the treatment of acute gout. Allopurinol must not be started during the acute attack of gout as it may worsen symptoms. This can be started after a few weeks to prevent further attacks. While paracetamol and bed rest may provide some symptomatic relief, the use of an NSAID is needed to control the acute inflammatory response.
Q4-A 35-year car driver crashed into a concrete block without a safety belt on. Thirty minutes after and on the way by ambulance to the hospital he begins to become breathless. On administration of 100% oxygen there is not much improvement in this condition. On arrival at the Emergency Department he has lost consciousness and appears cyanosed with markedly distended jugular veins.
Blood pressure 80/40 mmHg Heart rate 120 /min Respiratory rate 34 /min Temperature 36.6 C Oxygen saturation 60% on room air. What’s immediate action should be taken?
A-Intubation and 100% oxygen
B-Rapid infusion of crystalloid
C-Needle decompression
D-IV 0.2 mg adrenaline
Ans: C. Ref-MTB-needle compression first then chest tube insertion.
Q5-A mother is running after her child as he runs into the road. Almost as she reaches the road a car comes by and she must stop suddenly to avoid being hit by the car. As she stops she falls forwards and is unable to get up and has to be carried by stretcher into an ambulance. On admission to the Emergency Department her right knee is swollen and twice it’s normal size.
What structure of the knee is most likely to have been injured?
A-Lateral collateral ligament
B-Infra patella ligament
C-Anterior cruciate
D-Medial meniscus
Ans: C. Anterior cruciate ligament (ACL) injury is the most common knee ligament injury.
Anterior cruciate ligament injury
Etiology-Direct trauma to the knee
Sign and symptoms-Pain and positive anterior drawer sign
Diagnosis done by-MRI
Treatment –done by Arthroscopic repair
Q6-A nine-year-old boy with sickle cell disease has become increasingly tired but now says he is having right hypochondrial pain after meals. He has had multiple blood transfusions. What should be the first investigation?
A-CT abdomen
B-Ultrasound abdomen
C-Plain X-ray
D-MRI scan
Ans: B. Ultrasound first.Its gall bladder stone. In people withsickle celldisease, mostgallstonesare produced from excess bilirubin, which is caused by the constant breakdown of red bloodcells. Biliary sludge (formed when excess bile settles in the duct) can also lead togallstonesforming in people withsickle celldisease.
https://www.stjude.org/treatment/patient-resources/caregiver-resources/patient-family-education-sheets/hematology/gallstones-and-sickle-cell-disease.html
Q7-Screenings of 12-year young male before participation in marathon race is?
A-No screening required B-Detailed history and physical examination C-ECG D-2 D Echo E-Exercise test
Ans: B
Q8- A 15 year old boy presents with a limb and pain in the knee. On examination, the leg is externally rotated and 2 cm shorter. There is limitation of flexion, abduction, and medial rotation. As the hip is flexed external rotation is increased. Choose the single most likely diagnosis.
A-Juvenile rheumatoid arthritis B-Osgood Schlatter disease C-Reactive arthritis D-Slipped femoral epyphisis E-Transient synovitis of the hip
Ans: D. SCFE (Slipped capital femoral epiphysis) is the most common hip disorder in adolescence. SCFEs usually cause groin pain on the affected side, but sometimes cause knee or thigh pain. One in five cases involve both hips, resulting in pain on both sides of the body. SCFEs occurs slightly more commonly in adolescentmales, especially young black males, although it also affects females. Whilst it can occur in any child, the major risk factor is childhood obesity.[1] Symptoms include the gradual, progressive onset of thigh or knee pain with a painful limp. Hip motion will be limited, particularly internal rotation. Running, and other strenuous activity on legs, will also cause the hips to abnormally move due to the condition and can potentially worsen the pain. Stretching is very limited.
Q9-Which of the following is most likely to cause muscle weakness in children?
A-Hypokalemia
B-Iron overload
C-Hypernatremia
D-Severe anemia
Ans: A secondary to gastroenteritis
Q10-A 55 year old man returns for routine follow-up six weeks after a myocardial infarction. He gets breathless when walking uphill. His ECG shows ST elevation in chest leads V1, V2, V3 and V4.
What is the single most likely explanation for the abnormal investigation?
A-Heart Block B-Right Ventricular Strain C-Atrial Thrombus D-Left Ventricular Aneurysm E-Dressler Syndrome
Ans: D. LV aneurysm shows changes in anterior leads v1 to v4.Dresslers requires 3ps. Pericarditis, Pleurisy, Pericardial effusion and Fever. Dresslers occurs from 2 weeks to 2 months post myocardial infarction.
Q11-A 17-year anxious Chinese boy presents to clinic with a 1-day history of
Haematuria. He first noticed the abnormality after a rugby match. His blood pressure is 123/75 mmHg. There is nothing significant on physical examination and the patient denies any recent illness or on-going medical problems. Urine dipstick confirms the presence of blood and protein. The most likely diagnosis is:
A-Urinary tract infection B-Nephrotic syndrome C-IgA nephropathy D-Renal cell cancer E-Bladder cancer
Ans: C. The most common cause of idiopathic haematuria, particularly in Asia, is
IgA nephropathy (C) which usually presents following a streptococcal throat infection or strenuous exercise. Mild proteinuria is also an associated feature. A urinary tract infection (A) is unlikely in painless haematuria and would most likely be associated with urinary symptoms such as urinaryfrequency, dysuria and the presence of leukocytes and nitrates detectablein the urine. The nephrotic syndrome (B) typically includes proteinuria, low serum albumin and oedema, which is not present in this case. Renalcell carcinoma (D) is usually associated with flank pain and an abdominalor flank mass which is again not present in this patient. Bladder malignancy (E) is a common and worrying cause of painless haematuria, however
patient demographics typically describe patients above the age of 50 yearswith risk factors, such as smoking and exposure to chemicals, present inrubber, industrial dyes, etc.
Q12-A three-year-old child is noted to have a microcytic anemia. Haemoglobin electrophoresis demonstrated increased concentration of Hemoglobin A2.
What is the most likely diagnosis?
A-Iron deficiency
B-G6PD deficiency
C-Sickle cell anemia
D-B- thalassemia trait
Ans: D. Iron deficiency anemia -has low Hb, low MCV,low ferritin,low iron and High TIBC but HbA2 is normal(not high)
G6PD deficiency- iron,TIBC and ferritin is within normal limit,HBA2 is normal
Anemia develops with stress and sulpha drug usage
Sickle cell anemia-HBA2 is normal.HBS is high can be from 60-90%
Thalassemia trait- its minor gene defect of Beta globin chain where Iron TIBC ferritin is normal but patient has mild anemia .low MCV with high RBC count and high HBA2.
Q13-You are asked to see the relatives of a 68-year-old man who has undergone surgery for repair of a ruptured aortic aneurysm. Prior to surgery he was well, with a creatinine of 119 micromol/l at baseline. Although the operative procedure went well, the period of acute hypotension has resulted in an episode of acute tubular necrosis (ATN) and he has undergone renal dialysis on a number of occasions in the past week. Which of the following most accurately represents the chance of recovery of renal function to the level where dialysis is not required?
A-0% B-95% C-5% D-50% E-25%
Ans: Correct Answer B-95% ATN usually occurs after an acute ischaemic or toxic event, in this case a period of severe hypotension resulting from the ruptured aneurysm. Only around 5% of patients require long-term renal replacement therapy. Around 50% have some impairment of renal function on a permanent basis; around another 5% undergo a slow deterioration in their renal function. Prognosis of ATN is poorer in patients with severe sepsis or trauma, where mortality rates can approach 50-60%. Infections are the leading cause of death in acute renal failure.
Q14-The drug of choice in the treatment of Oxyrus worm is?
A-Metronidazole
B-Levamisol
C-Tenidazol
D-Pyrantel pomoate
Ans: D. Pinworm (Enterobiasis, Oxyuriasis, Threadworm).
Drugs of choice are mebendazole, albendazole, or pyrantel pamoate
http://wwwnc.cdc.gov/…/pinworm-enterobiasis-oxyuriasis.
Q15-In breast cancer, all true except?
A-1.5 cm mass with lymphnode axilla is stage I
B-Chemotherapy is must for pre-menopausal with positive axillary lymphnode
C-Radical mastectomy is the choice of surgery
D-Yearly mammogram for contra-lateral breast in followup
Ans: C. Radical MRM (Modified Radical Mastectomy) is NOT always choice in young female, she can go for Breast conservative surgery known as BCS.
Rest are correct option including D as annualy contralateral means (if MRM done then the normal opposite breast mammogram must have done annualy irrespective of age and if breast conservative surgery is done then both breast mammogram can be done to early relapse evaluation.3% risk of relapse on opposite breast in known breast cancer patient.
