Day 7 Flashcards
Q1-Most American centers use which contrast material in radiology study?
A-Non-ionic, low osolality Intravenous Contrast
B-Non-ionic, high osolality Intravenous Contrast
C-Ionic, low osolality Intravenous Contrast
D-Ionic, high osolality Intravenous Contrast
Ans: A
http://fpnotebook.com/Rad/Pharm/CtIntrvnsCntrst.htm
Q2-Android obesity occurs
A-When more fat is lain down in the hips than in the abdomen
B-In an individual who appears pear-shaped
C-When lots of fat is deposited around visceral organs
D-Usually in younger adults
E-When more fat is deposited below the waist than above the waist
Ans: C
For more details check www.medicalmcq4all.com.
Q3-A female presented with swelling over the neck that moves with swallowing with lymphadenopathy at external jugular vein. Swallowing diagnosed as thyroid carcinoma. She has most likely which type?
A-Papillary carcinoma
B-Follicular carcinoma
C-Medullary carcinoma
Ans: A. Papillary thyroid cancer generally grows very slowly, but can often spread to lymph nodes in the neck. It also can spread elsewhere in the body. Follicular thyroid cancers usually do not spread to the lymph nodes, but in some cases can spread to other parts of the body, such as the lungs or bones.
Q4-Old lady came to clinic as routine visit, she mentions decrease intake of Calcium food doctor suspect Osteoporosis, next initial investigation?
A-Dexa scan
B-Serum calcium
C-Thyroid function test
D-Vitamin D level
Ans: A. as old lady, history and doctor suspect osteoporosis so best from all option is Dexa scan which confirms the diagnosis irrespective of other results weather favourable or unfavourable
Q5-Non obese female can not take Sulfonylurea or Metformin.what is the drug of choice now? A-Insulin B-Thiazolidinediones C-Gliclazide D-Meglitinides
Ans: B
Q6-Pathological result from thyroid tissue showed papillary carcinoma, the next step:
A-Surgical removal
B-Apply radioactive I131
C-Give antithyroid drug
D-Follow up the patient
Ans: A. Papillary carcinoma. Most common, excellent prognosis. Empty-appearing nuclei with central clearing (“Orphan Annie” eyes) A, psamMoma bodies, nuclear grooves (Papi and Moma adopted Orphan Annie). risk with RET/PTC rearrangements and BRAF mutations, childhood irradiation. Papillary carcinoma: most Prevalent, Palpable lymph nodes. Good prognosis.
Q7-An alcoholic who has completely given up drinking, now he hears voices. What is the most appropriate treatment?
A-Olanzapine B-Diazepam C-Disulfiram D-Acamprosate E-Haloperidol
Ans: B. Treatment in general, alcohol abusers with withdrawal symptoms, such as alcoholic hallucinosis, have a deficiency of several vitamins and minerals and their bodies could cope with the withdrawal easier by taking nutritional supplements. Alcohol abuse can create a deficiency of thiamine, magnesium, zinc, folate and phosphate as well as cause low blood sugar. However, several tested drugs have shown the disappearance of hallucinations. Neuroleptics and benzodiazepines showed normalization. Common benzodiazepines are chlordiazepoxide and lorazepam. It’s been shown that management has been effective with a combination of abstinence from alcohol and the use of neuroleptics. It is also possible to treat withdrawal before major symptoms start to happen in the body. Diazepam and chlordiazepoxide have proven to be effective in treating alcohol withdrawal symptoms such as alcoholic halluciniosis. With the help of these specific medications, the process of withdrawal is easier to go through making alcoholic hallucinosis less likely to occur.
Q8-50- year old patient, diagnosed with hypertension, he is used to drink one glass of wine every day, he is also used to get high Na and high K intake, his BMI is 30.what is the strongest risk factor for having hypertension in this patient?
A-Wine
B-High Na intake
C-High K intake
D-BMI-30
Ans: D
Q9-An 88-year-old woman who lives in a nursing home has a past medical history of hypertension, diabetes and ischaemic stroke resulting in left-sided hemiplegia. She suffers from frequent urinary tract infections. Her drug history includes aspirin, simvastatin, insulin and lisinopril. She presents with an ulcer on her left heel. Her HbA1c = 6.1 per cent. Her BM is 8.9, blood pressure is 112/87, heart rate 62. She seems comfortable at rest. Her lungs are clear and her abdomen is soft and nontender. There is a 2 × 2 cm ulcer on her left heel. Her right foot is normal. What isthe most likely cause of her ulcer?
A-Decubitus ulcer B-Venous insufficiency C-Hyperglycaemia D-Arterial insufficiency E-Bacterial infection
Ans: A This woman is unable to move her left side secondary to ischaemic stroke.
Hemiplegia means ‘paralysis’ as opposed to hemiparesis which is ‘weakness’.
She has developed a pressure sore or decubitus ulcer (A) as she is unable tomove her leg, resulting in decreased perfusion from the weight of her ownbody resulting in ischaemia and breakdown of tissue. Good nursing care isimportant. Venous ulcers (B) typically affect the gator area, especially themedial maleolus. Nothing to suggest venous insufficiency is mentioned,such as varicose veins or previous deep vein thrombosis (DVT), shallow,irregular ulcers with surrounding skin changes (lipodermatosclerosis).
She certainly has risk factors for arterial insufficiency (D). These typically‘punched-out’ ulcers also have a predilection for the heel or betweenthe toes, however you would expect reduced or absent leg pulses andperhaps a history of claudication. Bed sores better fit the history in thiscase. Diabetic ulcers (C) typically occur at the base of the first metatarsalhead as a result of neuropathy causing decreased sensation and pressureulcers. The neuropathy is typically symmetrical and you would expectbilateral sensory loss. There is nothing to suggest active bacterialinfection (E).
Q10-A patientpresent with fever, dry cough and breathlessness. He is tachypneic but chest is clear. Oxygen saturation is normal at rest but drops on exercise. What is the single most likely diagnosis?
A-CMV infection B-Candida infection C-Pneumocystis carinii infection D-Cryptococcal infection E-Toxoplasma abscess
Ans: C. Pneumocystis carinii infection. [Fever, dry cough, breathlessness, tachypnoea with clear chest is seen in pneumocystis carinii pneumonia. Normal oxygen saturation which drops on exercise is characteristic of pneumocystis carinii pneumonia].
Q11-Which of the following is most sensitive for detecting diabetic nephropathy?
A-Serum creatinine level B-Creatinine clearance C-Urine albumin D-Glucose tolerance test E-Ultrasonography
Ans: C. Nephropathy is a leading cause of death in diabetic patients. Diabetic nephropathy may be functionally silent for 10 to 15 years. Clinically detectable diabetic nephropathy begins with the development of microalbuminuria (30 to 300 mg of albumin per 24 h). The glomerular filtration rate actually may be elevated at this stage. Only after the passage of additional time will the proteinuria be overt enough (0.5 g/L) to be detectable on standard urine dipsticks. Microalbuminuria precedes nephropathy in patients with both non-insulin- dependent and insulin-dependent diabetes. An increase in kidney size also may accompany the initial hyperfiltration stage. Once the proteinuria becomes significant enough to be detected by dipstick, a steady decline in renal function occurs, with the glomerular filtration rate falling an average of 1 mL per minute per month. Therefore, azotemia begins about 12 years after the diagnosis of diabetes. Hypertension clearly is an exacerbating factor for diabetic nephropathy.
Q12-Boy presented to the Emergency Room complaining of sudden onset of abdominal pain & leg cramps, he had history of vomiting 2 days ago, he was dehydrated. Na-150, K-5.4, glucose =23mmol, the best initial investigation is
A-CBC B-Blood culture C-Arterial Blood Gas D-Urinalysis E-Ultrasound
Ans: D as 23mmol/L sugar means around 414mg% blood sugar.we are thinking of diabetic ketoacidosis so urine ketone helps to diagnose this patient.
Q13- A 45 y/o female presents with fever and a painful mass in the front of her neck for the past week, accompanied with anxiety, sweating, tremor, and a “pounding heart.” Now she complains of lethargy, fatigue, and “always feeling cold.” P/E finds normal results except for mild bradycardia and an enlarged thyroid with tenderness. Lab tests show mild TSH increase and T4 decrease. The best initial treatment is
A-Aspirin B-Corticosteroids C-T4 supplement D-Propranolol E-Observation
Ans: A. This is typical subacute thyroiditis–URI and brief hyperthyroidism followed by hypothyroidism. Tx is Anti-inflammation or symptomatic, with aspirin as the best option for this patient. The disease eventually returns to normal state over months. ‘B’ is best for
Riedel thyroiditis–hypothyroidism caused by idiopathic fibrosis of the thyroid (painless, non-toxic goiter). T4 is best for Hashimoto’s thyroiditis–an autoimmune inflammatory disease of the thyroid causing a painless goiter with hypothyroidism mostly in children. ‘D’ is best for lymphocytic thyroiditis–a self-limited episode of thyrotoxicosis (painless goiter).
Q14-A 32-year-old woman with a history of depression comes to theemergency department 30 minutes after taking a bottle of pillsin an attempt to commit suicide. Blood pressure is 118/70 mmHg, pulse is 90 per minute, and respirations are normal at 14 perminute. She refuses to tell you what she took.
What is the most appropriate next step in the management ofthis patient?
A-Induce emesis with ipecac B-Gastric lavage C-Psychiatric consultation D-Serum chemistry E-Urine toxicology screen F-Naloxone
Ans: B. When ingestion is extremely recent, it is possible to try toremove the substance from the body prior to its absorption. Gastricemptying has very limited value because there is not much timebetween the ingestion and passage of the pills beyond the pyloricsphincter from where they cannot be removed. Pills, on an emptystomach, can leave in as little as 30 to 60 minutes. Gastric lavage can
be attempted up to 2 hours after ingestion, but it will remove only 50%of pills at one hour and 15% at 2 hours. After 2 hours, it is useless.Although serum chemistry and urine toxicology screen should bedone, they are not helpful this soon after ingestion. Ipecac and theinduction of vomiting is wrong when a patient is already in theemergency department. Inducing vomiting needs 15 to 20 minutes towork, and only delays the administration of antidotes such as N-acetylcysteine, which can be given orally.
Q15-A type 2 diabetic patient has been taking metformin1500mg with good effect for the last four months. He has started to lose weight and maintained good glucose control. In the last two months, however, the patient has been persistently hyperglycaemic despite maximum metformin dosage and HbA1c targets have not been achieved. The most appropriate management is:
A-Thiazolidinedione B-Insulin C-Sulfonylurea D-Increase metformin dose E-Exenatide
Ans: C. Although metformin is a good first-line drug in overweight type 2 diabetics
With poor glucose control, adjuncts are often needed. Metformin dosage should be titrated in the first few weeks of therapy to avoid the risk. Of Gastrointestinal symptoms; however further increases should be avoided (D). The next step after metformin therapy is metformin and sulphonylurea, the latter has superior glucose-lowering ability and should be used as first line treatment in overweight or obese patients with poor glucose control.
Insulin secretagogues (C) (these include sulphonylureas and rapid-actinginsulin secretagogues such as nateglinide and repaglinide) are particularlyeffective in controlling HbA1c levels and improve cardiovascular outcomes. Patients unable to maintain or achieve adequate glucose control may usesulphonylureas as second-line therapy and are only contraindicated if hypoglycaemia is a common problem for which thiazolidinedione (A) is used as a replacement. Insulin therapy (B) is only considered if, aftermetformin and sulphonylurea therapy, the patient’s HbA1c remains above7.5 per cent. Exenatide (E) can be used at this point as an alternative ifweight is a particular problem.
