Mp+ Flashcards
72yo, chest pain, radiating to the back
diastolic murmur
CXR wide mediastinum
Acute MI
next step?
A. Give alteplase
B. Consider urgent MRI of the cervical and thoraci spine
C. Give aspiring and Intravenous morphine
D. Refer the patient to cardiology clinic
E. Give Morphine, B-blocker and arrange for trans-oesophageal echocardiogram
E. Give Morphine, B-blocker and arrange for trans-oesophageal echocardiogram
DX: Aortic Dissection
ECG findings: ST elevation
34yo M, temp 40 C, agtiation, hypersalivation, diaphoresis and HTN, HYprereflexia
W/c favours dx of Serotonin Syndrome over neuroleptic malignant syndrome?
A. HTN
B. Hyperthermia
C. Agitation
D. Hyperreflexia
E. Diaphoresis
D. Hyperreflexia
Nerve palsy that can cause :
Ptosis
Eyes facing down and out
Dilated pupils
Sluggish light reflex
Third Cranial Nerve Palsy
It can cause ptosis and diplopia
with no pupil abnormality.
Myasthenia Gravis
It is associated with progressive opthalmoplegia and limb wdakness induced by exercise.
does not involve the pupils.
Mitochondrial Myopathy
Ptosis, miosis (constricted pupils), ipsilateral loss of sweating
Horner’s Syndrome
72yo,M, past history of Pulmonary Emobolism,
fever 5 days post-chemotherapy for Hodgkin’s lymphoma, neutrophil cpunt 0.
Given IV antibiotics and isolation maintained to prevent any infection.
Current medications: Warfarin, Cefepime, Candesartan and Omeprazole
Plt ct dec to 22000/mul, What will you do next?
A. Cease Cefepime
B. Cease Omeprazole
C. Cease Warfarin
D. No action needed
E. Cease Candesartan
C. Cease Warfarin
Dx: thrombocytopenia
65yo M, history of persistent low back pain for 6 months, pain is increased on walking and relived on resting.
Shooting pain sensation over Left foot.
Local tenderness over lumbar region.
Which is the best management?
A. Trial of analgesia
B. MRI
C.. Surgery
D. CT Scan
E. Exercise therapy
B. MRI
increasing side of hands and feet
mandibular enlargement
macroglossia
Most appropriate screening test ?
Insulin-like Growth factor
Dx; Acromegaly
What are the other clinical features of Acromegaly?
Frontal bossing
Increased hand and foot size
Mandibular enlargement with prognathism
Widened space between the lower incisor teeth
Characteristic coarse facial features
Large fleshy nose
Cardiomegaly, macroglossia
What is the other test that is performed for the confirmation of Acromegaly if the Insulin-like growth factor is elevated?
Growth Hormone Suppression Test
<0.4 ug/L within 1-2 h of an oral glucose load (75g) = Confirmatory for Acromegaly
10 yo F, bouts of abdominal pain
facial oedema
positive family hx similar episodes - with mother and elder sister
Which of the ff is useful to diagnose the condition?
C1 esterase inhibitor
Dx; Hereditary Angioedema
- low C1 esterase inhibitor level
- C4 level is also low during episodes
Which one is the strongest risk for developing cervical cancer?
A. Sexual activity
B. Age
C. Oral Contraceptive pill for more than 5 years
D. Non-smoking
E. Mild obesity
C. Oral Contraceptive pill for more than 5 years
What are the other high risk factors for developing cervical carcinoma?
Oral contraceptive pills for more than 5 years
Smoking
Immunosuppression
Presistence infection of high risk HPV infection
Sexual activity - average risk factor
Mild obesity with healthy lifestyle - unlikely to develop cervical ca
3wk old baby, umbilical swelling
pesistent discharge from the umbilicus after the cord has dried and separated
Swelling appears soft and pink with mild discharge.
What is the next most appropriate treatment?
Silver nitrate
Dx; Umbilical Granuloma
-MC umbilical mass in neonates
- overgrowth of tissure during the healing process of the belly button (umbilicus)
- looks like soft pink or red lump and often is wet or leaks small amounts of clear or yellow fluid
- Mc in the firt few weeks of baby’s life
Tx: Cauterisation of Silver Nitrate
- put pteroleum jelly to the surrounding and remove the excess silver nitrate to avoid the chemical burns and skin staining
CT KUB (non-contrast)
* is the most appropriate choice of investigation tro assess the renal stones
Renal US - used only if there is risk of excessive radiation exposure such as pregnancy and children younger than 16 yo
Swollen R upper limb for one week,
R arm including hand and forearm is swollen and oedematous,
Tenderness on the inner apsect of the arm
papulopustular lesions with tender lymphadenopath.
Her cat was also unwell 3 weeks ago but now not feeling well.
What is the dx?
Cat-Scatch disease
Cause: transmission of B, henselae from cats to humans thru contaminated cat scratch wound or across a mucosal surface
CP: papulopustular lesions at the bite site and enlarged tender regional lymph nodes
+/- fever, headache, chills, backache, abdmonal pain
This can occur in sportsmen after strenous exercise like wrestling.
May present with oedema and redness but tender lymphadenopathy is absent
Axillary Vein thrombosis
Inflammatory condition of vessels of the hands and feet.
20-40 yo
MC in males with hx of smoking
CP: distal extremity ischemia like pain at rest.
ischemic ulcers or gangrene but no Lymphadenopathy and pustular lesions
Buerger’s disease
The CSF analysis in Acute Polyneuritis?
Normal Cell count
High Protein
Which one of the ff is the most suggestive for orbital floor fracture?
A. Facial Numbness
B. Epistaxis
C. Decreased sensation along the cheek and upper lip/gingiva
D. Loss of visual acuity
E. Enolphthalmos
E. Enolphthalmos
- classic presentation of orbital fractures
21 yo male, decreased facial and axillary hair growth, decreased libido
Decreased penile length, small testes and gynecomastia.
Learning difficulties as a child.
He is at irsk of developing all of the ff except?
Autoimmune Thyroid Disease
Klinefelter Syndrome
Chromosome XXY abnormality
due to meiotic nondisjunction
Tall Stature
Small testes
Small penis
Gynecomastia
Decreased Facial and Maxillary hair growth
Decreased Libido
At high risks of following complications:
Breast tumours
Thromboembolic disease
Obesity
DM type 2
Varicose veins
Learning disabilities
75yo M, left calf claudication
40 pack year history of smoking
- all peripheral pulses are palpable on the R side
- all pulses palpable except dorsalis pedis
ABI (ankle-brachial index) on the R side is 1 and on the left side is 0.70.
What is the most appropriate management?
Advice for smoking cessation.
What is the most common symptom of PAD?
Intermittent claudication affecting calf muscles
What is the gold standard for imaging peripheral arteries?
It is rarely used because of its invasice nature and the availability of non-invasive imaging modalities (DUS, CTA, MRA)
Duplex ultrasound is used to guide most endovascular intervantions but surgeons prefer this for planning open revascularisation procedures particularly tibial and pedal bypass procedures.
Digital Subtraction Angiography
(DSA)
Which of the followint does not increase the risk of endometrial cancer?
A. Tamoxifen
B. Exposure to unopposed estrogen
C. Norethisterone
D. Strong family history of endometrial cancer
E.. Nulliparity
C. Norethisterone
34 yo F, hx of unilateral headaches,
accompanied by nasal stuffness,
conjunctival injection and lacrimation.
Best treatment of choice?
A. Paracetamol
B. 100% oxygen
C. Verapamil
D. Sumatriptan
E. Propanolol
Verapamil
Dx: Cluster Headache
Tx: Verapamil, Methysergide. lithim and bridging treatment with prednisolone
100% oxygen inhalation for 15 mins - treatment of choice for an acute attack of a cluster headache.
Sumatriptan - second line treatment of a cluster headache if oxygen therapy fails
Propanolol - is used for prevention of migraine headaches
It is characterized by unilateral headache, often at night,
retro-orbital headache,
rhinorrhea and lacrimation.
Cluster Headache
Clinical feature of Polycystic Kidney Disease?
A. Incisional hernia
B. Type 2 DM
C. Dysphagia
D. Hypotension
E. Polyuria and nocturia
Polyuria and Nocturia
What are the other features of Polycystic Kidney Disease?
Renal Failure
Hypertension
Abdominal Wall and Inguinal hernias
Colonic diverticulitis
Hepatic Cysts
Subarachnoid or cerebral Hemorrhage
Cardiac Anomalies including MVP
12yo F, isolating herself from other kids, school performance dropped over last 6 months. She has collection of her toys and plays with an imaginary friend. Had difficulty in sleeping and gets irritable with other kids.
Which of the ff is she likely to develop in the future?
A. Alcohol abuse
B. Anorexia Nervosa
C. Schizophreniform psychosis
D. GAD
E. OCD
C. Schizophreniform psychosis
Furesimide
wk old neonate, discharge and redness both eyes
mild hyperemia with thick mucopurulent discharge.
What is the most likely diagnosis?
A. Meningitis
B. Gonococcal Conunctivitis
C. Viral infection
D. Chlamydia Conjunctivitis
E. Chemical Conjunctivitis
Chlamydia Conjunctivitis
47yo F,
incidental finding of 2.5 cm gallstone on abdominal US
No symptoms.
What is your best next management?
A. ERCP
B. Prophylactic Cholecystectomy
C. CT ANgiogram
D. No further action needed
E. MRI
No further action needed
65yo M, 2 hr hx of left-sided facial droop and dysphasia
hx of type 2 DM
taking Metformin daily 1000mg
ECG: Soft systolic cardiac murmur
CT unremarkable
ECG and Echocardiogram : Normal
What is the most important next investigation in his assessment?
A. Stress Echocardiogram
B. CT angiogram of coronary arteries
C. Carotid Artery Doppler ultrasound
D. 24 hr holter monitoring
E. repeat CT Brain in 48 hrs
C. Carotid Artery Doppler ultrasound
34yo F, hx of migraine on progesterone-only pills for last 2 years.
Lives with her partner, both sexually active.
Hx of epilepsy, HTN, DM2.
Current medications: Phenytoin, Metformin, Gliclazide and Ramipril.
Which among the ff can increase the risk of contraception failure?
A. Phenytoin
B. Ramipril
C. Gliclazide
D. Beta Blocker
E. Metformin
A. Phenytoin
Phenytoin is a hepatic enzyme inducing antiepileptic drugs.
Digitalis Toxicity produces all of the ff changes in the ECG except?
A. Inverted T wave
B. Prolonged QT interval
C. ST depression
D, Prolonged PR interval
D. Bigemini
B. Prolonged QT interval
Cirrhosis with Portal Hypertension
Which of the ff is the most likely to increase the risk of developmental dysplasia of the hip?
A. Iron Deficiency
B. Asian origin
C. Maternal Smoking during pregnancy
D. Breech presentation
E, being male
Breech Presentation
24yo F, recently diagnosed with Familial Adenomatous Polyposis.
prophylactic colectomy. Genetic testing showed APC gene mutation. Recently married and planning to conceive in the next 3 months.
What is the chance of disease transmission to her children if she becomes pregnant?
A. 100%
B. 75%
C. No chancee of transmission
D. 50%
E. 25%
D. 50%
newborn baby, ambiguous genitalia,
gonads not palpable, no family hx of congenital problems
Karyotype confirmed: 46 xx genetic makeup
Which is the next appropriate investigation?
A. pelvic ultrasound
B. Xray abdomen
C. 17-hydroxy Progesterone
D. CT pelvis
E. Testosterone Level
C. 17-hydroxy Progesterone
Dx for absence of palpable gonads:
Congenital Adrenal Hyperplasia sec to 21-hydroxylase deficiency
- 17-hydroxy Progesterone is elevated
32 yo secretary, premenstrual syndrome associated with severe mastalgia.
What is the best treatment?
A. Vitamin E
B. Mefenamic Acid
C. Danazol
D. Spironolactone
E. Bromocriptine
C. Danazol
DOC for premenstrual sydnrome associated with severe mastalgia or breast pain
- 200mg daily from the onset of symptoms to the onset of menses.
Others:
Mefenamic Acid = DOC for premenstrual sydnrome associated with dysmenorrhea
Spironolactone - DOC for premenstrual sydnrome related to fluid retention. Use daily 3 days before expected onset of symptoms today one of menstruation.
29yo F, blurry vision of the eyelid , hit by the squash ball into the L orbit during play.
Examination - eyelid swelling, decreased visual acuity and vertical diplopia of the L eye that disappears when R eye is closed.
Which of the ff is the most likely cause of this presentation?
A. Zygomatic Fracture
B. Nasal bone fracture
C. Tripod Fracture
D. Superior Orbital Wall fracture
E. orbital Floor fracture
E. Orbital Floor fracture
W/c of the ff is the risk factor for the development of infant hypertrophic pyloric stenosis in a 4 wks old infant?
A. Maternal Smoking during pregnancy
B. Asian background
C. Breast feeding
D. Female
E. All of the listed answers
A. Maternal Smoking during pregnancy
-infant hypertrophic pyloric stenosis is mc in this one.
Hypertrophic Pyloric Stenosis
- progressive thickening of the circular muscle of the pylorus.
- this leads to gastric outlet narrowing.
- condition usually presents between 2 and 6 weeks of age.
34yoF, 37 wks gestation, noticed sudden gush of clear fluid from her vagina. Speculum exam reveals pooling of liquor in the posterior fornix. She developed fever, tachycardia and chills for 12 hours after this episode.
What will you do apart from giving her antibiotics?
A. Perform a Vaginal Examination
B. Give corticosteroids
C. Continue pregnancy until natural delivery
D. Induce labor now
E. Discharge from hospital on 14 days of antibiotics
D. Induce labor now
TSH
Common Peroneal Damage
- mc presentation is at the fibular neck - the acute foot drop
- (difficulty in dorsiflexing the foot against resistance of gravity.)
Oral glucose test with serial GH measurements
It results from persistent hypersecretion of Growth Hormone (GH). Coarse facial hair, spade-like hands, the increase in show size, large tongue, prognathism, excessive sweating and oily skin, hypopituitarism, headaches, bitemporal hemianopia.
Acromegaly
35yo F, taking Temazepam 10kg at nigfht for the last 6 months for chronic insomnia. Had vivid dreams and rebound insomnia when she tried to stop taking it. Restarted taking on the same dose of temazepam. A
Prescribe high dose oral contraceptive pills (microgynon 50)
2wk old, aborginal, + fever, bulging fontanelle, CSF -strep organism was isolated. Which is the cause of this presentation?
Prematurity
Midline neck swelling which moves with the tongue protrusion?
Known Left Ventricular infarction
Prescribe high dose oral contraceptibe pill
(microgynon 50)
Carpometacarpal joint of the thumb
Prematurity
Known Left Ventricular Infarction
Refer to orthopedic surgeon
Progesterone Only pills
Threatened Miscarriage
Overvalued idea
B
Barium Swallow
B
A
