Day 24 Flashcards
Q1-What is the most common serious complication of polymyositis/dermatomyositis?
A-Rhabdomyolysis
B-Hyperkalemia
C-Metabolic acidosis
D-Malignancy
Ans: D. For unclear reasons, the most common serious threat to life from PM/DM is malignancy. DM has a greater risk than PM. Cancer hits the cervix, lungs, pancreas, breasts, and ovaries.
Q2-A 58-year woman presented with dysuria, frequency and urinary incontinence. She complains of Dyspareunia.urine cultureis been done and is sterile. What is the most appropriate step?
A-Oral Antibiotics B-Topical Antibiotics C-Topical Estrogen D-Oral estrogen E-Oral antibiotic and topical Estrogen
Ans: C
Q3-A 65-yearman with a history of anemia from a bleeding peptic ulcer comes for evaluation. He is constipated and has black stool. His medications are omeprazole, oral ferrous sulfate, and occasional liquid antacids. What would you do next?
A-EGD B-Colonoscopy C-Guaiac testing/hemoccult D-Discontinue omeprazole E-Increase the dose of ferrous sulfate
Ans: C. Oral ferrous sulfate can turn the stool black, but elemental iron such as this does not make the stool guaiac positive. Only the iron in hemoglobin or myoglobin can make the stool guaiac card positive.
Q4-A 65-year woman is found on routine CBC to have a hematocrit of 32 percent (normal 37–42) and an MCV of 70 (normal 80–100). Her stool is heme negative.
What should you do next?
A-Colonoscopy B-Sigmoidoscopy C-Barium enema D-Upper endoscopy E-Two more stool tests now
Ans: A. Colonoscopy is indicated in all patients > 50 simply as routine screening. Hence, in this case, the patient needs colonoscopy anyway, regardless of what the stool tests show. Another reason to go straight to colonoscopy is the presence of microcytic anemia. Unexplained microcytic anemia in a patient above 50 is most likely caused by colon cancer. Sigmoidoscopy will do nothing to evaluate the right side of the colon and would miss nearly 40 percent of cancers. No matter what a sigmoidoscopy showed, you would need to inspect the right side of the colon. Capsule endoscopy is done to evaluate bleeding when the upper and lower endoscopy are normal and the source of bleeding is likely to be in the small bowel.
Q5-A 32 years old teacher complaining of excessive water drinking and frequency of urination, on examination Normal. You suspect Diabetes Mellitus and request FBS, which comes as 6.8mmol/L. What’s likely condition?
A-Diabetes Mellitus B-Diabetes Insipidus C-Impaired fasting glucose D-Normal blood sugar E-Impaired glucose tolerance
Ans: C
Q6- A pregnant woman comes with weakness and elevated liver function tests. She is in her 35th week of pregnancy. The prothrombin time is normal. The smear of blood shows fragmented red cells. Platelet count is low. What is the treatment?
A-Transfuse platelets B-Plasmapheresis C-Fresh frozen plasma D-Delivery of the baby E-Prednisone
Ans: D. Deliver the baby with the HELLP syndrome. HELLP syndrome stands for hemolysis, elevated liver function tests, and low platelets. This disorder is idiopathic and can be distinguished from DIC by the normal coagulation studies, such as the prothrombin time and aPTT.
Q7-Patient with Raynaud’s phenomena he is living with roommate smoker, along
Scenario but this is the importance, treatment:
A-Anti-vibrating gloves
B-Keep core body temperature warm in cold
C-Negative smoking is not a trigger of disease
D-Keep hands warm away from cold
Ans: B
Q8-Prognostic factor in head injury
A-Age of patient
B-Glasgow coma scale
C-Mode of injury
D-Presence of facial trauma
Ans: B
Q9-A generally healthy patient comes with epistaxis and petechiae. No spleen is felt on examination. The platelet count is 27,000. What is the next step in management?
A-Prednisone B-Bone marrow biopsy C-Antiplatelet antibodies D-Sonogram E-Hematology consultation
Ans: A. Prednisone is the most important thing to do first in mild ITP. The main point of most ITP questions is that initiating therapy is more important than determining a specific diagnosis, particularly since ITP is a diagnosis of exclusion. All of the answers listed would be given on a CCS case at the same time. In a single best answer case, however, the most important thing is to start therapy.
Q10-A 33 years old man complaining of dysuria. He was diagnosed as a case of acute prostatitis. Microscopic examination showed gram negative rods which grow on agar yeast. The organism is:
A-Chlamydia
B-Legionella
C-Mycoplasma
Ans: B
Q11-Patient who had history of previous infective endocarditis, and now came with dental caries for dental procedure, what is the appropriate prophylaxis:
A-Amoxycillin 2gm one hour before procedure
B-Amoxycillin 1gm one hour before procedure
C-Clindamycin 2gm one hour before procedure
D-Clindamycin 1gm one hour before procedure
Ans: A
Q12-An HIV-positive man comes in with progressive dysphagia and odynophagia. He has 75 CD4 cells but no history of opportunistic infections. What is the next best step in management?
A-Fluconazole B-Amphotericin C-Barium swallow D-Endoscopy E-Antiretroviral therapy
Ans: A. Odynophagia is pain on swallowing. Dysphagia is simply difficulty swallowing (i.e., food getting “stuck” in the esophagus). When odynophagia occurs in an HIV-positive patient, particularly when there are < 100 CD4 cells, the diagnosis is most likely esophageal candidiasis, and giving empiric fluconazole is both therapeutic as well as diagnostic. Amphotericin is not necessary.
Q13-A patient comes with epigastric pain that is associated with substernal chest pain and an unpleasant metallic taste in the mouth. What is the next best step in management?
A-Endoscopy B-Barium studies C-Proton pump inhibitors (PPIs) D-H2 (histamine) blockers E-24-hour pH monitor
Ans: C. Proton pump inhibitors (PPIs) are preferred as the first line of therapy and also serve as a diagnostic test. Using PPIs is far easier than other testing.
Q14-A 60-year-old man comes to the office for evaluation of epigastric discomfort for the last several weeks. He is otherwise asymptomatic with no weight loss. His stool is heme-negative. What is the next best step in management?
A-Upper endoscopy
B-Serology for Helicobacter pylori
C-Urea breath testing for Helicobacter pylori
D-PPI, amoxicillin, and clarithromycin for 2 weeks
E-Ranitidine empirically
Ans: A. Upper endoscopy should be performed in any patient above the age of 45 with persistent symptoms of epigastric discomfort. This is, essentially, to exclude the possibility of gastric cancer. There is no way to be certain, without endoscopy, who has gastric cancer.
Q15-A 55-year-old man has epigastric discomfort. He is seropositive for Helicobacter pylori. Upper endoscopy reveals no gastritis and no ulcer disease. Biopsy of the stomach shows Helicobacter. What should you do?
A-Breath testing
B-PPI alone as symptomatic therapy
C-Repeat endoscopy after 6 weeks of PPIs
D-PPI, amoxicillin, and clarithromycin
Ans: B. You do not need to treat Helicobacter pylori unless there is gastritis or ulcer disease. This patient has epigastric pain and Helicobacter but no ulcer or gastritis. This is non-ulcer dyspepsia. Treat it symptomatically with a PPI. Enormous numbers of people are colonized with H. pylori; you do not need to eradicate it from the world without evidence of disease. H. pylori is not the cause of non-ulcer dyspepsia.
