Day 4 Flashcards
Q1-A 60-year-old man presents to his GP with gradually increasing fatigue and some exertional dyspnoea. Blood pressure is 118/74 mmHg and pulse rate is 81/minute.There are no abnormal physical findings and on echocardiography the ejection fraction is 0.47. However, the clinical impression remains one of early heart failure. Which of the following circulating biomarkers would lend support to that conclusion?
A-Atrial natriuretic peptide B-Brain natriuretic peptide C-Endothelin D-Noradrenaline E-Adrenomedullin
Ans: B. Brain natriuretic peptide (B) is considered to have the greatest power as a
diagnostic biomarker of the given answer options. In established heart failure,
high levels of endothelin (C) and noradernaline (D) in particular are associated
with poor prognosis. All of the given answers, including atrial natriuretic
peptide (A) and adrenomedullin (E), may be increased in heart failure
Q2-Female with recently inserted IUCD coming with thin grayish white vaginal discharge & abdominal pain. What is the most likely diagnosis?
A-Uterine rupture
B-Ovarian torsion
C-Bacterial vaginosis
D-Ectopic pregnancy
Ans: C. IUCD is foreign body and risk of infection is more common.
Q3-What is the most effective treatment of ocular Rosacea?
A-Clindamycine local application
B-Erythromycin
C-Topical steroids
D-Oral Doxycycline
Ans: D.Topical metronidazole. For severe or ocular disease, use oral doxycycline.
Q4-10- year child brought by his parents because they where concern about his weight, he eats a lot of fast food and French fries, your main concern to manage this patient is:
A-His parents concerning about his weight
B-His BMI > 33
C-Family history of heart disease
D-Eating habit (fast food, French fries)
Ans: B
Q5-Baby born & discharge with his mother, 3weeks later he started to develop difficulty in breathing and become cyanotic, what is most likely Diagnosis?
A-VSD (Ventricular Septal Defect)
B-Hypoplastic Left ventricle
C-Coarctaion of aorta
D-Subaortic hypertrophy
Ans: B. Hypoplastic left heart syndrome(HLHS) is a rarecongenital heart defectin which the left side of the heart is severely underdeveloped. It may affect theleft ventricle,aorta,aortic valve, ormitral valve.[2]
Closing of theductus arteriosusin a heart that is severely underdeveloped on the left results incyanosisand respiratory distress which can progress tocardiogenic shockand death. The first symptoms are cyanosis that does not respond to oxygen administration or poor feeding. Peripheral pulses may be weak and extremities cool to the touch.
HLHS often co-occurs with low birth weight and premature birth.
In neonates with a small atrial septal defect, termed “restrictive”, there is inadequate mixing of oxygenated and deoxygenated blood. These neonates quickly decompensate and developacidosisand cyanosis.[3]
On EKG, right axis deviation and right ventricular hypertrophy are common, but not indicative of HLHS. Chest x-ray may show a large heart (cardiomegaly) or increased pulmonary vasculature. Neonates with HLHS do not typically have aheart murmur, but in some cases, a pulmonary flow murmur ortricuspid regurgitationmurmur may be audible.[3]
Co-occurring tricuspid regurgitation or right ventricular dysfunction can causehepatomegalyto develop
Q6-60- year male, diagnosed to have acute pancreatitis, what is the appropriate nutrition:
A-TPN (Total Parental Nutrition)
B-Regular diet with low sugar
C-High protein, high calcium, low sugar
D-Naso-jujenal feeding
Ans: D. http://gi.org/guideline/acute-pancreatitis/
Q7-Old patient with neck swelling, nodular, disfiguring, with History of muscle weakness, cold intolerance, hoarseness, what is your management:
A-Levothyroxine
B-Carbimazole
C-Thyroid lobectomy
D-Radio-active iodine
Ans: A
Q8-A 2-year boy fell off his tricycle and hurt his arm and crying, he went pale, unconscious and rigid. He recovered after 1-2 mins but remained pale. After an hour he was back to normal. His mother says she was afraid that he will going to die. Hehad a similar episode 3 months’ prior after falling down some steps. What single investigation isindicated?
A-CT head B-EEG C-CBC D-None E-Skeletal survey
Ans: D.Itsbreath holding spasm
Q9-Factor which determine recurrence of breast cancer:
A-Site & size of breast mass
B-Number of positive lymph nodes
C-Positive estrogen receptor
D-Positive progesterone receptor
Ans: B. REMEMBER TNMclassification means T=Tumor,N=Nodes and M=Metastasis so Node positivity reflects prognosis.more lymphnode positive for cancer poor the prognosis.possitive Estrogen receptor(ER) and progesterone Receptor (PR) carries good prognosis .
Q10-A 46 y/o man complains of “dull stomach pain” 0.5-1 hour after meals, and occasional nausea/vomiting (N/V) and black stools for the past 2 months. He has a 5-year history of smoking and alcohol use. P/E finds a soft abdominal with epigastric tenderness. CBC reveals
microcytic anemia. FOBT is (+). What’s the best next step?
A-H. pylori test B-Ba X-ray C-Endoscopy D-Ba X-ray + endoscopy E-H. pylori test + Ba X-ray
Ans: E. Most likely it’s a case of type B chronic gastritis with risk factors of cancer, and thus ‘E’ is the best initial Dx step to confirm H. pylori infection and exclude cancer. Usually type A (atrophic) gastritis is associated with Vit-B12 deficiency and gastric ACC.
Q11-A 40 year old man complains of (c/o) intermittent abdominal discomfort, decreased appetite, and 5 kg weight loss for the past 3 mo. He has a history of smoking and alcohol drinking for 5 yrs, and two previous blood transfusions. P/E results are mostly normal. Ultrasound (U/S) shows a normal liver image without any mass. Serology results: liver function tests (LFTs) are normal; HBsAg, HBeAg, and antiHBs, anti-HBc, and anti-HBe IgGs are all (+). What’s the best explanation?
A-Liver cell carcinoma
B-Chronic Hepatitis B, with low viral replication
C-Chronic Hepatitis B, with active viral replication
D-Recovery from Hepatitis B, with immunity
E-Chronic hepatitis B, with heterotypic Anti-HBs
Ans: E
Q12-Which of the following conditions from the list below is not associated with
Cutaneous hyperpigmentation?
A-Hypopituitarism B-Pregnancy C-Addison’s disease D-Cushing’s syndrome E-Nelson’s syndrome
Ans: A. (B–E) are all associated with cutaneous hyperpigmentation.
Hypopituitarism (A), however, leads to decreased hormone levels of pituitary
melanotrophic hormones leading to generalized (hypopigmentation) pale yellow-tinged skin (with associated skin atrophy and loss of hair in androgenic-dependent areas).
Q13-Organophosphorus poisoning, what is the antidote?
A-Atropine B-Physostigmine C-Neostigmine D-Pilocarpine E-Endrophonium
Ans: A.Pharmacologic Treatment
• Atropine – The endpoint for atropine is dried pulmonary secretions and adequate oxygenation. Tachycardia and mydriasis must not be used to limit or to stop subsequent doses of atropine. The main concern with OP toxicity is respiratory failure from excessive airway secretions. Start with a 1-2 mg IV bolus, repeat q3-5min prn for desire effects (drying of pulmonary secretions and adequate oxygenation). Consider doubling each subsequent dose for rapid control of patients in severe respiratory distress. An atropine drip titrated to the above endpoints can be initiated until the patient’s condition is stabilized.
• Pralidoxime – Nucleophilic agent that reactivates the phosphorylated AChE by binding to the OP molecule. Used as an antidote to reverse muscle paralysis resulting from OP AChE pesticide poisoning but is not effective once the OP compound has bound AChE irreversibly (aged). Current recommendation is administration within 48 h of OP poisoning. Because it does not significantly relieve depression of respiratory center or decrease muscarinic effects of AChE poisoning, administer atropine concomitantly to block these effects of OP poisoning. Start with 1-2 g (20-40 mg/kg) IV in 100 mL isotonic sodium chloride over 15-30 min; repeat in 1 h if muscle weakness is not relieved; then repeat q3-8h if signs of poisoning recur; other dosing regimens have been used, including continuous drip.
https://www.openanesthesia.org/organophosphate_poisoning_diagnosis_and_treatment/
Q14-Regarding Postpartum Psychosis:
A-Recurrences are common in subsequent pregnancies
B-It often progresses to frank schizophrenia
C-It has good prognosis
D-It has insidious onset
E-It usually develops around the 3rd week postpartum
Ans: A. Postpartum Blues (“Baby Blues”): Mild depression sometimes occurs immediately after birth and lasts up to 2 weeks. Mother may have sadness, mood lability, and tearfulness, but cares about the baby. It’s self-limited and no treatment is necessary.
Postpartum depression: Typical depressed symptoms usually occur within 1-3 months after birth (mostly the 2nd baby) and symptoms may continue more than 1 month. Patient usually has depressed mood, excessive anxiety, sleep disturbances, and weight changes. The mother may have negative thoughts of hurting the baby. Treat the patient with antidepressants.
Postpartum psychosis: Severe depression and psychosis may occur 2-3 weeks after the first birth and may continue. Patient usually has depression and delusion, and may have thoughts of hurting the baby. Treat with anti-depressants and mood stabilizers or antipsychotics.
Q15-A child presented with clean wound, but he never been immunized as his parents were worried about it. There is no contraindication to immunization. what is the best management?
A-Full course of DTP B-1 single injection of DTP C-1 single injection of DT D-Only immunoglobulin E-Antibiotic
Ans: A
