October Flashcards by Sh Nrn

CT picture of a small round white lesion near midline, not in the ventricles. There was a H/O irregularly irregular pulse. What would you do next?
A. Echo
B. MRI
C. CT angiography

خونریزی در نواحی مثل پوتامن و تالاموس و مخچه که معمول در خونریزی های هایپرتاسیو هستند و در افراد هایپرتنسیو دیده میشن معمولا بررسی نمیخواد و ارجاع به نورولوژیست
اما در خونریزی های لوبر که علت دیگه ای مثل اختلال انعقادی نیست باید آنژیو یا سی تی آنژیو شن

اگه واضحا هموراژى باشه كه نياز به كار بيشترى نيست چه ساب اراكنوييد چه اينتراپارانشيمال و بايد إرجاع بده
اما اگه مشكوك باشه كه خونريزى نيست بايد ام ار اى بشه

البته با این سیر حاد تومور خیلی کمتر مطرحه و بیتشتر خونریزی و در نتیجه ارجاع
هر چند مشکوک به تومور هم باشیم باز هم ارجاع

من بنظرم هموراژى چه اينتراپارانشيمال چه ساب اراكنوييد ارجاع
فقط اگه به تومور ميخورد ام ار اى،
شرح حال اگه سردرد حاد بود ارجاع

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Q1810007-A woman with menstrual cycles ranging from 4 to 6 weeks presents with vaginal bleeding following an amenorrhea of 6 weeks duration. A urine pregnancy test is positive. On vaginal exam the OS is closed. An endovaginal ultrasound scan is performed which reveals, an endometrial thickness of 12mm and an empty uterus. Adenexa are clear and there is no fluid in the pouch of Douglas. There is a corpus luteum cyst in the left ovary. Which one of the following would be the most likely diagnosis?
A. Ectopic pregnancy.
B. False positive pregnancy test result.
C. Complete abortion.
D. Incomplete abortion.
E. Complicated corpus luteal cyst
#زنان

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Q188480-A 30 year old woman come with severe abdominal pain. Her LMP was 6 weeks ago. She has her menstrual period every 4-6 weeks and she usually suffers pain one day before and during her first menstrual day. But present pain does not look like as usual and more severe. On exam, BP – 120/80, PR – 80, abdominal tenderness, cervix closed, no adnexal mass, what is your Dx? 
A. Dysmenorrhoea 
B. Endometriosis
C. Ectopic pregnancy 
D. Complicated corpus luteal cyst
E. torsion of ovarian
#GYN

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Q1810014-Pain in RIF tenderness positive guarding present.next appropriate thing to do?
A.appendectomy
B.wbc
C.usg
D.ct abdomen
#جراحی

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Q1810015-A girl was given some tablet in school for nausea now presented ED with eyes rolling over?
A.metoclopramide
B.prochlorperazine
#عوارض_دارویی

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Q1810017-Goiter hoarseness stridor (ca features given)
A.usg
B.fnac
C.thallium scan

اگه لامپ داره نکست سونو

بست fna

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Q1810019-Smoker mass present near pleura of lung what investigation?(no option hrct)
A.bronchoscopy and biopsi
B.mri
C.fnac
#ریه  #جراحی

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Q1810018-Amenorrhea for 12 weeks more fundal height?(molar pregnancy)
A.serum bhcg
B.usg
#زنان

A قدم اول

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Q1810028-A female 50 years old ,BP 130/85 had a strong family history of diabetes ,her FBS was 7.9 mmol/l .what will you do ?
A) give Metformin.
B) do OGTT 
C) give Insulin.
D) repeat FBS

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Q1810029-man comes with progressive dyspnoea and cough ,xray (not given ,just described ) showed diffuse interstitial infiltrates ?which drug is the cause ?
A rosiglitiazone
B Amiodarone
C metformin

B
عوارض ریوی آمیودارون: pulmonary toxicity که هم ممکنه به صورت حاد باشه و به استرویید پاسخ بده و هم به صورت مزمن ( شایعتر) باعث فیبروز مزمن ریه بشه

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Q1810032-59-year-old Caucasian grossly obese male presents with hoarse voice and chronic nocturnal cough for last three months.He also complains of heartburn after meals,on lying down and relieved by antacids.He also complains of belching,acid brash when he has slept for few hours at night.Upper GI endoscopy was done which was normal.
What is the next best step in the management of this patient?
a. 24-hour esophageal pH monitoring with manometry
b. Decrease weight
c. Barium swallow
d. Avoid meal three hours before sleep
e. Consider four weeks of PPIs and then review #داخلی #گوارش

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Q1810034-1.middle age female gravida 8 delivered her baby vaginally after 2 hours her pulse was 100 b/m and BP was 80/50 and she lost approx 500ml of blood vaginally. What is the cause?
A) uterine atony
B) uterine rupture
C) vaginal laceration
D) pocs
#زنان

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Q1810036-Pregnant women in 1st trimester, presents with skin dippling over the right breast. Examination and clinical tests reveal cancer of the right breast. your management?
A terminate the pregnancy
B start radiotherapy
C Wait till delivery then start the treatment
D Surgery
#زنان #جراحی

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Q1810040- Patient with complaint of left leg and hip muscle weakness and weakness of left hand there was fasciculation in lower limb and left lower limb hyperreflexia, weakness of ankle joint. He asked the most likely site involved? 
a-Cerebral Cortex
b. Brainstem
c. Cervical spine
d. Peripheral nerve
#نورولوژی

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Q1810041-Mother came with his 15 y/o son.He has sunburn lesions.She is seeking consult about risk of melanoma in her son Which is the most important factor to be considered?
a-Fair hair and skin
b-Family history of melanoma
c-Atypical naevus
#پوست

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Q1810042-Mother comes with 10 months old baby who was on 50 percentile for height and weight and 25 percentile for head circumference during birth .now his height and weight is on 50 percentile but head circumference has increased to 75 percentile.the child is hypotonic and can not roll over , can sit without support , feeding well what investigation to do next ??
a.TSH
b. Head US 
C.CT head 
D. MRI
#اطفال

Q1810043-young child with abdominal pain and vomiting. +urine glucose and ketones. blood glucose 33mmol/l what would you request to guide your management?
a-ABG
b-HBA1C
c-electrolytes
d-FBC
#اطفال

A
اکی….گویا همتون با ۱ موافقید که می گید هنوز معلوم نیستDKaهست یا نه..باشه با یک می بندیم..ولی لطفا استدلال من رو دردنظر داشته باشین که این با این کتون و قند و علاگم قطعا DKA هست و منطورش منیجمنت هست..
.
با این حال با یک ببندیم

Q1810047-middle-aged female presenting with weeks of shortness of breath, pain on inspiration. with x-ray (which I initially thought to be normal, but in retrospect might have been of scoliosis). normal ecg. what is your next investigation?
a. echo
b. angiogram
c. lateral lumbosacral xray (not sure about this)
d. spirometry
#داخلی #قلب #ریه

جواب اکسترا :
عكس لترال مهره هاى توراسيك
اگر اين گزينه نبود،اكو

Q1810050- 4 you are in a private locus run by a sole practitioner. you noticed that the files are disorganized and some patients complaints/ symptoms were not managed correctly. what would you do?
a-talk to the practitioner
b- report to locus authority

Q1810052-female, G2P1, previous birth via cs, gave birth to a term baby via nsvd, with no problems. pt suddenly had bleeding of about 1500ml. after blood loss, bp=120/80 (normal), other vitals normal. what is the most likely cause of bleeding?
a. uterine atony
b. cervical laceration
c. uterine inversion
#زنان

Q1810053-Breastfeeding mom wants contraception, wishes to conceive after 1 year.wt is best?
A.pop
B.iucd
C.implant
#زنان

Q1810054-Preg lady taking alchol and marijuana and is a smoker..what is most harmful for the fetus?
A smoking
B alcohol
C marujuana
#زنان

Q1810055-2 year old male indigenous child 4 week h/o ear discharge(yellow green),on exm ear drum dull and retracted,which is the most common sequale
A.mastoiditis
B.hearing loss
C.cholestetoma
#گوش_حلق_بینی

شایعترین عارضه aom در این گروه👈 ماستویدیت

Q1810057-lady 14 weeks into pregnancy got exposed to varicella zoster but developed fever and rash what is best management? Don’t know about immunisation history?
a-Varicella vaccine
b-Varicella immunoglobulin
c-Acyclovir
d-Test for varicella ab
#زنان

``` Q1810059-Pregnant women at 37 weeks og gestation presented with pain RIF ..u admit and give antibiotics after few hours she develped rebound tenderness temp 37.8 what will undo a-Laprotomy b-Laproscopy c-Iv fluids d-Induce labour #زنان #جراحی ```

``` Q1810061-young man HIT by a squash ball while playing, apart from headache which resolved by analgesic he complained of decreased in vision. On examination, his visual acuity was 6/12 in the left eye; right eye was 6/6asking the most likely cause? A-vitreous hemorrhage B-retinal detachment C-zygomatic fracture D-orbital floor fracture #چشم #نورولوژی ```

B توي مورتاگ گفته اگر كمتر از يك ساعت باشه ميشه vitreous haemorrhage اما اگر كمتر از هفت روز باشه ميشه retinal detachment, توي اين سوال اشاره به زمان نكرده اما از اونجا كه گفته سردرد داشته و با دارو بهتر شده به نظر ميرسه از يك ساعت گذشته باشد

Q1810062-Bilateral wrist pain with high ESR 70 with anemia, next step ? Steroid for polymyalgia #روماتو

Ra | Mtx

``` Q1810065-Pt of MVA comes to you with pulse of 50 n bp of 86/50. He has a cervical spine fracture. What will u do next? a. ADrenaline b. Atrpine c. Iv fliuids d. tTrenedelenburg poition #جراحی ```

``` Q1810066-A MVA with injury to chest. O/E chest recedes with inspiration no other external injuries saturation 92%.Managment Intubation with PEEP a-Oxygen b-Aspiratiion #جراحی ```

``` Q1810068-Vit C effect on iron tablets” which study you do ? a) Cohort b) Case Control c) Case series d) Double blind e) Random studies or Randomization #آمار ```

Q1810081-A 1 yo boy with bleeding from gum which wasnt stop, lab data no thrombocytopenia, only ptt increased and factor VIII level was 1 percent, ask the inheritance risk of other child in this familly: 1. All male affected 2. All sibling will be affected 3. 1 in 2 male affected and 1 in 2 female carrier 4. All male affected, and all female carrier #اطفال

``` Q1810086-A 75 y.o man with fever,cough, rigor...had chronic cough with greenish yellow sputum for 3 years, and persistent bilateral basal crepitation, now in his cxr has left lower lobe consolidation, what is the most app treatment option for him: 1. Oral rohxithromycin 2. Oral amoxi..calavulant 3. IV flucloxacilin 4. IV ticarcilin-pipracilin 5.IV meropenem #داخلی ```

Dx: acute on chronic Inv: sputum culture Tx: amoxi

``` Q1810087-A ? Man had undergone total colectomy due to CR-Cancer, 5 days post op developed fever 38 c, HR 110, sob, sat 91 % Wof is the most app reach diagnosis? 1. CXR 2.CTPA 3.ABG 4.B/C جراحی# ```

``` Q1810101-A 56 year old farmer presented with a lacerated wound from a farming equipment.he had superficial wound 5 weeks ago and received tetanus toxoid..what is the next most appropriate step for tetanus prophylaxis? A penicillin for 5 days B.give TIG C.Give ADT vaccine d.IM cephalosporin 1 g e. TIG + vaccine #عفونی ```

Q1810105-A 34 year old primi came at term with rapture membranes and meconium stained lecor , you did a CTG , in review of the CTG wts the next best step ? a. CS b. Fetal scalp ph c. Induce labour at once with cintocynon d. Wait for normal delivary e. High forceps #زنان

در meconium-stained liquor که اغلب در پست ترم ها اتفاق میوفته و نشانه ای از دیسترس جنینی است، پرولاپس بند ناف علت مهمی محسوب میشه. البته مکونیوم به تنهایی مطرح کننده پریناتال آسفیکسی نیست و در بچهای نرمال هم شایع هست. در منیجمنت اول شرایط جنین تا زمان لیبر به طور مداوم با CTG چک میشه معاینه پلویس برای بررسی پیشرفت زایمان و کورد پرولاپس انجام میشه اگه همه چیز خوب بود و مشکلی نداشت اجازه میدیم زایمان طبیعی پیش بره ولی اگه حتی کوچکترین ابنرمالیتی در CTG دیده بشه باید fetal scalp PH و لاکتات چک بشه اگر این مرحله هم مشکل داشت CS یا manipulative vaginal delivery انجام میشه Ans: b

``` Q1810106-54yr man post op complain of abdominal pain , nausea , vomiting , BP 110/70 , pulse 85/min , eye was mildly icteric ,alcohol 50-60ml everyday , liver palpable 3cm non tender, ESR 54 ,GGT 236 , ALP increase ,TB 54 , CB 50 , rest all enzyme normal.What next ? A) Aniti mitrochondrial antibody B)Hep B & C serolgy c) serum urea & creat D) Ultrasound #داخلی ```

D با توجه به jaundice هپاتومگالی و بالا بودن GGT ، ALP و بیلی روبین کلستاز مطرح میشه که این کلستار به هر دلیلی ممکنه اتفاق افتاده باشه(تو اسلایدا علل کلستاز ذکر شده) اولین قدم در شک به کلستاز انجام سونوگرافیه Ans: D

Q1810114-23 yr old aggressive had past h/o of violence now in prison brought for consultation by guards because of recent escape attempt on history he is clear conscious and oriented have a deep seated anger against parents and plans to kill them on escape A-Call the police B-Set the patient free on observation C-Increase the number of visits D-Transfer the patient to local psychiatry ward E-Transfer the patient to a prison hospital #اخلاق

``` Q1810115-6 year old girl - took 40 tabs of 600mg paracetamol refuse any medical interventions and treatment A- patient autonomy B- ignore patient and treat C- get court order D- ask senior doctor. #اخلاق ```

زمان مصرف مهمه | یا b یا c