Day 25 Flashcards
Q1- Patient overall healthy presented with eye watery discharge, cloudy anteriorChamber with red conjunctiva, Diagnosis:
A-Keratitis
B-Uveitis
C-Retinitis
D-Corneal laceration
Ans: B
Q2-First line investigation for DVT (Deep vein thrombosis)
A-USG/duplex ultrasound
B-MRI
C-Venography
D-Nuclear imaging
Ans: A
Q3-A 70-year man with a history of hypertension and diabetes comes to the emergency department with a sudden onset of weakness in the right arm and leg over the last hour. On exam, he cannot lift the bottom half of the right side of his face. What is the best initial step?
A-Head CT with contrast B-Head CT without contrast C-Aspirin D-Thrombolytics E-MRI
Ans: B. Prior to administering thrombolytics or any anticoagulation, you need to rule out hemorrhagic stroke, which is a contraindication to thrombolytics. You cannot even give aspirin without doing a head CT first. Thrombolytics are indicated within the first 3 hours of the onset of the symptoms of a stroke. Remember, 20 percent of strokes are hemorrhagic. You do not need contrast to visualize blood; contrast is used to detect cancer or infection, such as an abscess.
Q4-A 47-year old man comes to the emergency department with fever, headache, photophobia, and a stiff neck. What is the next best step in the management of this patient?
A-Lumbar puncture B-Head CT scan C-Ceftriaxone and vancomycin D-Penicillin E-Movement of patient to ICU
Ans: A. When you suspect bacterial meningitis, administer antibiotics quickly. Further, do blood cultures stat simultaneously with a lumbar puncture (LP), or immediately prior. Penicillin can never be used as empiric therapy for meningitis; it is not sufficiently broad in coverage to be effective empiric therapy. In this case, perform the LP.
Q5-An elderly man comes to the emergency department with fever, headache, a stiff neck, and photophobia. He is HIV positive with < 50 CD4 cells and a history of pneumocystis pneumonia. His head CT is normal. CSF shows 2,500 white cells that are all neutrophils; Gram stain is normal. What is the best initial therapy?
A-Ceftriaxone and metronidazole B-Cefoxitin and mefloquine C-Ceftriaxone, ampicillin, and vancomycin D-Fluconazole E-Amphotericin
Ans: C. Listeria monocytogenes is a cause of meningitis that is not adequately treated by any form of cephalosporin. Ampicillin is added to the usual regimen of ceftriaxone and vancomycin to cover Listeria. This cannot be fungal meningitis, because the CSF is characterized exclusively by a high number of neutrophils; neutrophils are not consistent with fungal meningitis.
Q6-A 19 yearold male is brought to the emergency department with fever, headache, stiff neck, and photophobia. He has a petechial rash. CSF shows 2,499 neutrophils. Ceftriaxone and vancomycin are started. What should be done next?
A-Test for HIV B-Wait for results of culture C-Add ampicillin D-Enforce respiratory isolation and prescribe rifampin for close contacts E-Enforce respiratory isolation
Ans: D. When an adolescent present with a petechial rash and increased neutrophils on CSF, it is suggestive of Neisseria meningitidis. These patients should be placed on respiratory isolation, and close contacts should receive prophylaxis.
Q7-A 60 year old woman with metastatic breast cancer comes in with back pain. The spine is tender. She has hyperreflexia of the legs. What is the most urgent step?
A-X-ray B-CT/ MRI C-Biopsy D-Radiation E-Steroids
Ans: E. The most urgent step in the management of cord compression is to administer steroids as soon as possible and to relieve pressure on the cord. Imaging studies are done after steroids are given, if the diagnosis of cord compression is clear (as it is in this case with pain, tenderness, and signs of hyperreflexia in the legs).
Q8-A man comes to the emergency department with weakness in his legs that has been getting markedly worse over the last few days. He has weakness and loss of deep tendon reflexes in the legs. He recalls an upper respiratory illness about 2–4 weeks’ prior that resolved. What is the most urgent step?
A-Steroids B-Intravenous immunoglobulins C-Peak inspiratory pressure D-Intubation E-Lumbar puncture
Ans: C. This case is Guillain-Barré. Ascending weakness with loss of deep tendon reflexes is characteristic. Peak inspiratory pressure is the correct answer. The peak inspiratory pressure diminishes as the diaphragm is weakened. Peak inspiratory pressure predicts who will have respiratory failure before it happens. This is the most important factor in determining the need for therapy with either intravenous immunoglobulins(IVIG) or plasmapheresis. Combinations of these medications are not effective. Steroids are not effective. Lumbar puncture will show an elevated protein level with no cells.
Q9-Duration of drug in rheumatoid fever is?
A-6 years
B-15 years
C-Primary prevention lasts for 10 days and secondary prevention lasts for 5years or 10 years depending on presence of cardiatis
Ans: C
Q10-A patient is brought to the emergency department after a seizure leading to prolonged immobility on a sidewalk. He has dark urine and myalgias. What is the most urgent step in the management of this patient?
A-Urinalysis B-Urine myoglobin level C-EKG D-CPK level E-Phosphate level/S.Creatinine
Ans: C. EKG is the most urgent step in an acute case of rhabdomyolysis. This case tests your knowledge of how people die with rhabdomyolysis. Severe muscle necrosis leads to hyperkalemia, which leads to arrhythmia.A specific diagnosis with urinalysis or urine myoglobin is not as important as detecting and treating potentially life-threatening conditions, such as hyperkalemia with peaked T waves. This condition would be treated with immediate intravenous calcium gluconate, insulin, and glucose.
Q11-A 28-year-old man decides to donate a kidney to his brother, who is in chronic renal failure, after HLA typing suggests that he would be a suitable donor. He is admitted to the hospital, and his right kidney is removed and transplanted into his brother. Which of the following indices would be expected to be decreased in the donor after full recovery from the operation?
A-Creatinine clearance B-Creatinine production C-Daily excretion of sodium D-Plasma creatinine concentration E-Renal excretion of creatinine
Ans: A
Q12-Female with recently inserted IUCD coming with watery brownish vaginal discharge & abdominal painwhat is the most likely diagnosis?
A-Uterine rupture
B-Ovarian torsion
C-Bacterial vaginosis
D-Ectopic pregnancy
Ans: C
Q13-What is the best initial investigation in a postmenopausal woman with a breast lump?
A-Ultrasound
B-Mammography
C-MRI
D-Fine needle aspiration biopsy
Ans: A
Q14-65-year Hypertensive patient wakes up in morning with slurred speech, weakness of the left half of his body and drooling. Which part of the brain is affected?
A-Left parietal lobe
B-Right internal capsule
C-Right Midbrain
D-Left frontal lobe
Ans: B
Q15-A 25-year woman comes to sexual clinic and ask for advice for contraception. She is on sodium Valporate. (COCP= Combined Oral contraceptive pills)
COCP=combined oral contraceptive pills
A-She can use COCP
B-She can not use COCP
C-She can use COCP with extra precasution
D-She can use COCP with estrogen 50 microgrma and progesterone higher dose
E-She can use COCP if anti convulsant is changed to carbamezipine
Ans: A. Sodium valproate has no effect on COCP.
