Day 8 Flashcards
Q1-Gun shot in the upper limb in the triceps, wound was sutured, later on there was swelling and pain, on evaluation found to have discharge reportd by gram stain showed gram positive in chains
A-Streptococcus pneumonia gangrene B-Staph gangrene C-Group A beta hemolytic streptococcus gangrene D-Clostridia gangrene E-Synergetic gangrene
Ans: C
Q2-The following can be used as prophylaxis for malaria in chlorquine resistant area except:
A-Mefloquine B-Doxycycline C-Chlorquine with Proguanil D-Pyrimethamin E-Dapsone
Ans: E. Dapsone, also known asdiaminodiphenyl sulfone(DDS) is anantibioticcommonly used in combination withrifampicinandclofaziminefor the treatment ofleprosy. It is a second-line medication for the treatment and prevention ofpneumocystis pneumoniaand for the prevention oftoxoplasmosisin those who havepoor immune function Additionally, it has been used foracne,dermatitis herpetiformis, and various other skin conditions.Dapsone is available both topically and by mouth.
Severe side effects may include adecrease in blood cells,red blood cell breakdownespecially in those withglucose-6-phosphate dehydrogenase deficiency(G-6-PD), or hypersensitivity.Common side effects include nausea and loss of appetite.Other side effects includeliver inflammationand a number of types of skin rashes.While the safety of use during pregnancy is not entirely clear some physicians recommend that it be continued in those with leprosy.It is of thesulfoneclass.
Q3-A 39-year-old Indian man presents emergency room with a 6-week history of haemoptysis, night sweats and weight loss. Chest x-ray reveals some shadowing in the left upper zone. What is the most appropriate diagnostic investigation?
A-Blood cultures B-Full blood count C-CT chest D-Ziehl–Neelsen sputum staining E-Tuberculin skin testing
Ans: D. The case in this question should raise the suspicion of tuberculosis. The investigation of choice to confirm the diagnosis is Ziehl–Neelsen sputum staining (D) for acid fast bacilli. Blood cultures (A) should be sent if thepatient is pyrexial on presentation, but are not useful in the diagnosis of tuberculosis. A CT chest (C) is not used in the diagnosis of tuberculosis. Tuberculin skin testing (E) is used to check immunity to tuberculosis andnot to confirm the diagnosis. The diagnosis of tuberculosis can also be confirmed with sputum cultures, which are taken and grown in Lowenstein–Jensen medium for up to 12 weeks.
A full blood count (B) would notprovide any definitive information leading to a diagnosis here.
Q4-A 44-year-old man presents with non-specific symptoms of fever, shortness of breath and syncope. Blood tests show a raised erythrocyte sedimentation rate (ESR) and a transoesophageal echo shows an atrial myxoma. What is characteristically heard on auscultation in atrial myxoma?
A-End-diastolic murmur B-Loud first heart sound C-Fourth heart sound D-Pansystolic murmur E-Loud third heart sound
Ans: E. in atrial myxoma a characteristic loud third heart sound (E) or ‘tumour plop’is heard along with a mid-diastolic murmur. An end-diastolic murmur (A) typically occurs in mitral or tricuspid stenosis, while a pansystolic murmur (D) typically occurs in mitral regurgitation and ventral septal defects. A loud first heart sound (B) is associated with mitral stenosis and Wolff–Parkinson–White syndrome. A fourth heart sound (C) tends to occur due to ventricular hypertrophy, which can be due to a number of causes such as chronic hypertension, aortic stenosis and congestive heart failure.
Q5-50 years old patient come with history of weight loss, palpitation, cold intolerance and firm neck swelling, what is most likely diagnosis?
A-Simple goiter B-Diffuse toxic goiter (gravis disease) C-Toxic nodular goiter D-Parathyroid adenoma E-Thyroiditis
Ans: C. Toxic multinodular goiteris an activemultinodular goiterassociated withhyperthyroidism.
It is a common cause of hyperthyroidismin which there is excess production ofthyroid hormonesfrom functionally autonomousthyroid nodules, which do not require stimulation fromthyroid stimulating hormone(TSH).
Toxic multinodular goiter is the second most common cause of hyperthyroidism (afterGraves’ disease) in the developed world, whereas iodine deficiency is the most common cause ofhypothyroidismin developing-world countries where the population is iodine-deficient. (Decreased iodine leads to decreased thyroid hormone.) However, iodine deficiency can cause goiter (thyroid enlargement); within a goitre,nodulescan develop. Risk factors for toxic multinodular goiter include individuals over 60 years of age and being female
Q6-20-year male presented with stabbed wound in the abdomen. The most appropriate statement:
A-Should be explored
B-Observation as long as vital signs are stable
C-Exploration depends on peritoneal lavage findings.
D-Exploration depends on ultrasound findings.
E-Exploration depends on whether there is peritoneal penetration or not.
Ans: A
Q7-Woman complains of non-fluctuated tender cyst at the vulva. She complains of pain during coitus and walking, cyst diagnosed as Bartholin cyst, what is the most appropriate treatment?
A-Incision & drainage
B-Refer to the surgery to excision
C-Reassurance the patient
D- Give Antibiotic
Ans: A. If the Bartholin’s cysts is not painful or uncomfortable, treatment may not be necessary. Small, asymptomatic cysts can be observed over time to assess their development. In cases that require intervention, a catheter may be placed to drain the cyst, or the cyst may be surgically opened to create a permanent pouch (marsupialization). Intervention has a success rate of 85%, regardless of the method used, to alleviate swelling and discomfort.
Catheterization is a minor procedure that can be performed locally as an outpatient procedure. A small tube with a balloon on the end (known as a Word catheter) may be inserted into the cyst.The balloon is then inflated to keep it in place. The catheter stays in place for 2 to 4 weeks, draining the fluid and causing a normal gland opening to form, after which the catheter is removed.[11]The catheters do not generally impede normal activity, but sexual intercourse is generally abstained from while the catheter is in place.
Cysts may also be opened permanently, a procedure calledmarsupialization,which involves opening the gland through an incision to ensure that the secretion channel remains open.
If a cyst is infected, it may break open and start to heal on its own after 3 to 4 days. Nonprescription pain medication such asibuprofenrelieves pain, and asitz bathmay increase comfort and use pain. Warm compresses can also speed up healing. If a Bartholin gland abscess comes back several times, the gland and duct can be surgically removed.
Q8-Barrett esophagus all true except?
A-It’s a precancerous lesion
B-Can be only diagnosed by Endoscopy-its biopsy diagnosis
C-If diagnosed then treatment is PPI and repeat endoscopy every 2-3 years
D-Low grade dysplasia needs endoscopic mucosal resection
E-All of above correct
Ans: D. low grade dysplasia need’s only PPI and endoscopy repeat every 3-6 monthly. no resection.MTB-2-page193
Q9-A four-year-old girl presents to her GP, with her mother, with a 2-day history of fevers and diarrhoea. Her mother has contacted her nursery, who have informed her that several of the other children have been off sick with the same problem. What is the most likely causative organism?
A-Rotavirus B-Salmonella C-Enterotoxigenic Escherichia coli D-Influenza E-Varicella zoster virus
Ans: A Rotavirus (A) is an important cause of outbreaks of childhood diarrhoea
and should be considered as the most likely answer in this question.
Salmonella (B) may cause outbreaks of gastroenteritis when food(commonly poultry) is contaminated. The age group of the affectedindividual and the absence of an obvious contaminated food source makessalmonella less likely than rotavirus. Enterotoxigenic E. coli (C) is the mostcommon cause of travellers’ diarrhoea. The absence of a travel historymakes this an unlikely option in this case. Influenza (D) does not usuallycause gastroenteritis. Rather, this presents with fever, headache, myalgiaand dry cough. Therefore, it is the incorrect answer. Varicella zoster virus(E) is the cause of chicken pox and shingles, not gastroenteritis.
Q10-25- year female has had a sore left great toe for the past 4 weeks. On examination, the lateral aspect of the left toe is erythematous and puffy, with pus oozing from the corner between the nail and the skin tissue surrounding the nail. This is the first occurrence of this condition in this patient. At this time, what should you do?
A-Nothing and reassurance
B-Have the patient soaks her toe in saline three times daily.
C-Have the patient apply a local antibiotic cream and prescribes systemic antibiotics to be taken for 7-10days
D-Under local anesthesia, remove the whole toenail.
E-Debride the wound
Ans: C
Q11-40- year female presented to the clinic with central neck swelling which is moving with swallowing. The mass is hard and the patient gave history of dysphagia. You should:
A-Request thyroid function tests and follow-up in 2 months
B-Refer the patient to Gastroenterology for the diagnosis of dysphagia
C-Admit the patient as a possible cancer thyroid and manage accordingly
D-Give the patient thyroxin and send her home
E-If the patient is euthyroid; ask her to come in 6 months
Ans: A
Q12-Vasculitis+Eosinophilia+Asthma most likely diagnosis is
A-Polyartritis Nodosa B-Wegener’s Granulomatosis C-Churg-Strauss D-Takayasu’s Artritis E-None of above
Ans: C. Churg-Strauss syndrome is a disorder marked by blood vessel inflammation. This inflammation can restrict blood flow to organs and tissues, sometimes permanently damaging them. This condition is also known as eosinophilic granulomatosis with polyangiitis (EGPA).
Asthma is the most common sign of Churg-Strauss syndrome. The disorder can also cause other problems, such as hay fever, rash, gastrointestinal bleeding, and pain and numbness in your hands and feet.
Q13-A patient with depression presents with altered mental statusfrom ingesting multiple toxic substances. You know for certainthat he took some lorazepam only today, for the first time. There is no response to naloxone or dextrose. The patient is givenflumazenil and immediately seizes.
What is the most likely cause of the seizure?
A-Cocaine withdrawal B-Opiate withdrawal C-Tricyclic antidepressants D-SSRIs E-Aspirin
Ans: C. Although flumazenil can cause seizures from reversing chronic benzodiazepine dependence, this case quite specifically states the benzodiazepine ingestion was today only.
Benzodiazepines, however, can prevent seizures from Tricyclic toxicity. When you reverse the benzodiazepines, you remove the suppression of the tricyclic toxicity. Opiate withdrawal does not cause seizures. Cocaine toxicity causes seizures, not withdrawal.Coingestion of tricyclics and benzodiazepines is very common.
Q14-Treatment of Sleep Apnea is all except?
A-CPAP B-BiPAP C-Surgival correction of Uvula, Palate, Pharynx D-Acetazolamide E-Medroxyprogesterone F-All of the above can be used
Ans: F. Sleep Apnea- It’s defined as the cessation of air flow longer than 10 sec that occurs more than 10 times per hour during sleep. During the apneic episodes, O2 saturation decreases, and pulmonary pressures increase.
Essentials of diagnosis and treatment
1. Daytime somnolence with loud snoring, apneic events, sleepiness, and fatigue are the major symptoms of sleep apnea. If it’s severe, systemic hypertension, pulmonary hypertension, and cor pulmonale may develop.
- There are two main classes:
(1) Obstructive sleep apnea (OSA): It accounts for 95% of sleep apnea and occurs because of floppy airways despite adequate ventilatory effort. Risk factors include older age, male gender, obesity, craniofacial or upper airway soft tissue abnormalities, smoking, nasal congestion, and family history.
Treatment mainly includes weight reduction, exercise, avoidance of alcohol and certain medications, and nasal continuous positive airway pressure.
(2) Central sleep apnea (CSA): It’s < 5% of the cases and is caused by inadequate ventilatory drive. Treatment is acetazolamide, progesterone, and supplemental O2. 3. Definite diagnosis is made by polysomnography (sleep testing).
Q15-A boy who was bitten by his brother and received tetanus shot 6 months ago and his laceration was 1 cm and you cleaned his wound next you will:
A-Amoxicillin+Calvulanate
B-Suture the wound
C-Give tetanus shot
D-Send home with close observation and return in 48 hours
Ans: A.Cat, Dog, and Human Bites
Pathogens in cat and dog bites—Pasteurella multocida is the most common. Rabies (virus) is rare but fatal. Rabies vaccination is required if patient is bit by a raccoon, a stray dog that cannot be observed or diagnosed, or a dog with bizarre behavior or altered mental status.
Pathogens in human bites: Staph-aureus and Eikennella (Bacteroides) corrodens are common.
Treatment
- Empirical therapy with amoxicillin + clavulanate.
- Give a booster tetanus vaccination if the last immune shot was more than 5 years ago.
