Feb Part 1 2024 Flashcards
A 7 days old baby presented with bilious vomiting, feeding intermittently, no fever, vitals stable. What to do initially?
X-ray abdomen
An elderly female 30 yr, urine exam shows 20 WBC, and culture E. coli. But no symptoms. What to do?
Nothing
A 33 weeks pregnant lady presented with vaginal bleeding and abdominal pain, abdominal tender moderately, BP 145/90, urine dipstick with + protein, + RBC. She has a previous history of preterm labor due to preeclampsia. Which one precludes tocolysis?
Vaginal bleeding
A case of skin mass excised with clear margins of 2mm. Then biopsy returned with melanoma of 0.6mm thickness. What to do?
Further excision
A young pregnant lady in 8 weeks comes to you concerning about thrombosis risk. Her mother has a PE history, her sister also with repeated DVT history. Which one is most likely to use for screening her?
Screening for thrombophilia
32 yr old female comes to you for Mirena, she is on regular condoms, has no medical history, sometimes heavy menses of 30-35 days cycles, doesn’t want pills because of forgetfulness. Which one is true regarding Mirena?
Pregnancy rate is less than 1%
A 50 yr male with right shoulder pain for days, complaining from restriction of abduction and pain in that shoulder, partially benefited from intra-articular steroid injection before. What to recommend for him as next?
Intra-articular steroid
A 53 yr old female with breast mass, mammogram done showing dense breast tissue, ultrasound showing cystic lesion. What to do next?
FNAC
An abdominal X-ray of an elderly patient with 1 day of abdominal distension, constipation, nausea, and vomiting. History of appendectomy 20 years ago.
Sigmoid volvulus/Adhesion causing obstruction
Refugee 55 yr patient with hemoptysis, cough, fever with CXR showing upper lobe apical infiltration. Sputum culture done. What to do besides this?
CT scan
Patient with long-lasting dry cough not responding to symptomatic treatment. Asking microorganism?
Mycoplasma
Child case with fever, irritability, cough, dyspnea, crepitations on exam, CXR given with 2 lesions showing fluid level. Asking for AB?
Clindamycin + Ceftriaxone
Child case with swelling, pain in left eye, cannot open that eye, high fever. Asking for AB?
IV flucloxacillin
A 55 yr old DM female BMI 31 presented for control visit regarding her cellulitis in the left leg. Mentioned that this is her 4th cellulitis event in the same leg. Healed cellulitis, both legs with varicosities but no chronic venous insufficiency signs, but between toes there is tinea infections. Asking what is the major factor causing her problem?
Diabetes Mellitus (DM)
Child with impetigo, cephalosporin prescribed, asking school exclusion.
24 hours after starting antibiotics
A patient working as a manager in a company with delaying in work, studies postponed, and difficulties in organizing work with poor concentration. All started after an event 3 months ago. Asking what you look to support diagnosis?
Anxious and fidgeting appearance
A child patient with URTI and then symptoms of rheumatic heart disease, arthritis, murmur, fever. Asking what to do to confirm?
Next ASO titre, swab test or antigen test
Best - écho
An Anti-Streptolysin O (ASO) titre is a blood test used to measure the levels of antibodies against streptolysin O, a toxin produced by Group A Streptococcus bacteria. Here’s how it relates to rheumatic heart disease:
- Diagnosis of Recent Streptococcal Infection: ASO titres help in identifying a recent streptococcal infection, which is crucial because rheumatic heart disease often follows an untreated or inadequately treated strep throat infection.
- Supporting Diagnosis of Rheumatic Fever: Elevated ASO titres can support the diagnosis of rheumatic fever, an inflammatory disease that can develop after a streptococcal infection. Rheumatic fever can cause damage to the heart valves, leading to rheumatic heart disease.
- Assessing Risk for Rheumatic Heart Disease: By confirming a recent streptococcal infection through ASO titres, clinicians can identify individuals at risk for developing rheumatic fever and subsequent rheumatic heart disease.
In summary, ASO titres are used to detect recent streptococcal infections, supporting the diagnosis of rheumatic fever, which can lead to rheumatic heart disease if not properly treated.
18 month old child presented with tonic-clonic seizure, controlled with lorazepam, temp 39, tachycardia, confused. 3 days ago, diarrhea and vomiting preceded, investigations showing sodium 119, K 4.5, C 85, Bicarb 18. Asking what to do to confirm diagnosis?
Lumbar puncture (LP)
A long scenario about a patient on warfarin, previously for URTI receiving multiple AB treatments, now on CT abdomen a large mass like appeared in anterior abdomen.
Rectus sheath hematoma
A man with RTA, GCS 6/15, has long heavy beard, BP 100/75, RR 9, SaO2 88. Asking initial step to do?
100% O2 mask ventilation immediately
A pregnant in her last trimester presented with MVA, GCS 8/15, spontaneously breathing, SaO2 95, BP 90/60, PR 105. Asking what to do first?
Put on left lateral position and urgent cross-matching
A man with midline mass 1cm. Asking what is important to support diagnosis?
Tongue extrusion
A renal pelvis stone 2 cm. Asking management?
PCNL
A question asking a patient with an accidental finding of 2.2 cm splenic artery aneurysm. What to do?
Refer for angiography/surgery
Patient for cellulitis treated with cefazolin, then picture given after 3 days of treatment, macular drug reaction on trunk. Asking the Cefazolin stopped, which one not good for patient for future?
Just cefazolin
DM patient with sudden painless loss of vision before 3 days. Asking most probably cause?
Retinal detachment/Vitreous hemorrhage
2 years old child with umbilical hernia, irritable parents concerning what to do?
Refer to emergency if <4-5 years
Patient with poker playing (gambling). Asking about most appropriate initial treatment?
CBT
Parents concerning about their 8 year old child’s behavior. Child with isolation, not prefers to play with his peers, just playing with one peer, difficult to control in school, tantrums, normal language, normal eye contact, but in his room all dolls are parallel locating, making sudden screaming occasionally. Asking diagnosis?
Autism Spectrum Disorder
AF ECG and 80 yr old patient coming to routine control, has GFR 35, creatinine high, other investigations normal, BP 145/90, PR 88 irregular, no signs of HF, DM2 on multiple drugs (aspirin, atorvastatin, metformin). Asking what to give?
Rivaroxaban
For an 80-year-old patient with atrial fibrillation (AF), a GFR of 35, and an irregular pulse, rivaroxaban can be a suitable choice for anticoagulation. Here’s why:
Reasoning for Choosing Rivaroxaban:
- Stroke Prevention: In patients with AF, anticoagulation is essential to prevent stroke. Rivaroxaban, a direct oral anticoagulant (DOAC), is effective in reducing stroke risk in AF patients.
- Renal Function: With a GFR of 35, the patient has moderate chronic kidney disease (CKD). Rivaroxaban can be used in patients with reduced renal function, although dose adjustment is necessary for those with a GFR < 50. It is often preferred over warfarin, which requires frequent monitoring and dose adjustments.
- Convenience and Compliance: Rivaroxaban has the advantage of fixed dosing and does not require regular INR monitoring, making it more convenient for patients, especially elderly ones who may have difficulty with frequent blood tests.
- Efficacy and Safety: Studies have shown that rivaroxaban is as effective as warfarin in preventing strokes in AF patients and has a similar safety profile concerning bleeding risks.
- Drug Interactions: While the patient is on multiple medications (aspirin, atorvastatin, metformin), rivaroxaban has fewer food and drug interactions compared to warfarin, simplifying the management of multiple medications.
Clinical Considerations:
- GFR and Dosing: Adjust the rivaroxaban dose according to the patient’s renal function. For a GFR of 15-49 mL/min, the recommended dose is 15 mg once daily.
- Monitoring: Although rivaroxaban does not require routine INR monitoring, it is still important to periodically monitor renal function and assess for any signs of bleeding.
- Bleeding Risk: Consider the patient’s bleeding risk, particularly given their advanced age and concomitant use of aspirin. The benefits of stroke prevention should outweigh the risks of bleeding.
Conclusion:
Rivaroxaban is chosen for this patient due to its efficacy in preventing stroke in AF, convenience, and appropriateness for patients with moderate CKD, provided dose adjustments are made. It also offers a favorable profile in terms of drug interactions and patient compliance.
Female over 3 months develops gradual loss of superior quadrants of visual fields. Asking what is the cause?
Temporal lobe tumor
A young 34 yr female with known schizophrenia on risperidone for years, has bilateral milky nipple discharge, no visual symptoms, prolactin 1200. Asking what is the cause?
Risperidone
4 month old baby brought by parents concerning about not gaining weight well, mother noticed baby’s mouth is dusky, on exam systolic murmur heard. Asking diagnosis?
Tetralogy of Fallot
An intern discovered that a medical student reached medical records of his relative who is a patient in the ward. What should the intern do?
Tell the student not to do this again
A 40 yr male patient presented to ED with sudden severe chest pain radiating to his back, long flight history of 18 hrs. ECG normal. What to do next?
CT pulmonary angiography
24 year old young lady undergoes laparoscopic cholecystectomy, 4 days later has severe shoulder tip pain. What to do next?
Ultrasound abdomen
Rupture of membrane then immediately fetal bradycardia. Scenario of cord prolapse. Asking what to do next?
Re-place the cord
An ECG of pulmonary embolism (S1Q3T3) in 45 year old female. Asking what is the most appropriate next step?
CT angiography
A female presented with labor, slow progression, oxytocin commenced, and after a while there was deceleration on CTG, 6 cm dilatation with caput and molding, baby’s part just 1 cm above the pelvic rim. What to do next?
Stop oxytocin
Another obstetric case with ROM, meconium stained, but everything was well, no deceleration on CTG, +1 station, good contractions, good effacement with 7 cm dilation. What to do next?
Continue CTG monitoring
A diabetic patient with a history of foot ulcers, presenting with a new ulcer, fever, and increased WBC. What is the next step?
Admit for IV antibiotics
A patient with recent travel history presenting with fever, headache, and maculopapular rash. What is the likely diagnosis?
Dengue fever
An elderly patient with a history of hypertension and diabetes presenting with sudden onset of hemiplegia. What is the initial investigation?
CT scan of the head
A patient with a history of HIV presenting with progressive cognitive decline, ataxia, and urinary incontinence. What is the most likely diagnosis?
Progressive multifocal leukoencephalopathy (PML)
A 30-year-old female with fatigue, hair loss, and weight gain. What is the most likely diagnosis?
Hypothyroidism
A 60-year-old male with a history of smoking presenting with hematuria. What is the next step?
Cystoscopy
A patient presenting with acute onset of severe chest pain radiating to the back, with a history of hypertension. What is the most likely diagnosis?
Aortic dissection
A 25-year-old male presenting with a painless testicular mass. What is the next step?
Scrotal ultrasound
A child presenting with a barking cough, stridor, and fever. What is the most likely diagnosis?
Croup
A patient with a history of IV drug use presenting with fever and a new heart murmur. What is the most likely diagnosis?
Infective endocarditis
A 45-year-old female presenting with bilateral hand pain and morning stiffness lasting over an hour. What is the most likely diagnosis?
Rheumatoid arthritis
A patient presenting with sudden onset of severe headache, neck stiffness, and photophobia. What is the initial investigation?
Lumbar puncture
A 50-year-old male presenting with jaundice, pruritus, and a history of inflammatory bowel disease. What is the most likely diagnosis?
Primary sclerosing cholangitis
A patient presenting with episodic palpitations, sweating, and headache. What is the most likely diagnosis?
Pheochromocytoma
A 70-year-old male with a history of COPD presenting with increasing shortness of breath and purulent sputum. What is the next step?
Antibiotics and supportive care
A patient with a history of alcoholism presenting with confusion, ataxia, and ophthalmoplegia. What is the most likely diagnosis?
Wernicke’s encephalopathy
A child presenting with a high fever, rash, and strawberry tongue. What is the most likely diagnosis?
Kawasaki disease
A 30-year-old female with a history of systemic lupus erythematosus presenting with pleuritic chest pain and a new pericardial rub. What is the most likely diagnosis?
Lupus pericarditis
A 40-year-old male with a history of gout presenting with acute monoarthritis of the big toe. What is the next step?
Joint aspiration
A patient presenting with polyuria, polydipsia, and a fasting blood glucose of 180 mg/dL. What is the most likely diagnosis?
Diabetes mellitus
A 65-year-old female with a history of osteoporosis presenting with sudden onset of severe back pain after a minor fall. What is the most likely diagnosis?
Vertebral compression fracture
A child presenting with a fever, erythema, and swelling of the left knee. What is the next step?
Joint aspiration and culture
A patient presenting with a chronic cough, weight loss, night sweats, and hemoptysis. What is the most likely diagnosis?
Tuberculosis
A 50-year-old male with a history of hypertension presenting with sudden severe headache and vomiting. What is the initial investigation?
CT scan of the head
A young male presenting with a painless ulcer on the genitalia. What is the most likely diagnosis?
Syphilis
A patient with a history of smoking presenting with a chronic cough and a chest X-ray showing a cavitary lesion. What is the most likely diagnosis?
Lung cancer
A patient presenting with progressive difficulty in swallowing solids and liquids, regurgitation of food, and weight loss. What is the most likely diagnosis?
Achalasia
A 35-year-old female presenting with fatigue, bruising, and petechiae. What is the most likely diagnosis?
Acute leukemia
A child presenting with recurrent abdominal pain, diarrhea, and growth retardation. What is the most likely diagnosis?
Crohn’s disease
A patient presenting with a painful red eye, photophobia, and decreased vision. What is the most likely diagnosis?
Uveitis
A 60-year-old male with a history of chronic liver disease presenting with confusion and asterixis. What is the most likely diagnosis?
Hepatic encephalopathy
A patient with a history of recent travel presenting with fever, jaundice, and hemolysis. What is the most likely diagnosis?
Malaria
