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162f7d1d-ac6e-482b-bc36-1cd2d7262885
|
A 45-year-old man is admitted to the hospital for the evaluation of diplopia, weakness of his lower extremities, and gait difficulties. During the interview, the patient reveals that he has been forcing himself to vomit after almost every meal over the last 6 weeks. He denies associated eye pain and discomfo, headache, or dysphagia. He has never experienced such symptoms in the past. Examination of the patient demonstrates slight disorientation, veical nystagmus worse on downgaze, diffuse weakness of the lower extremities, bilateral dysmetria, and hypothermia. Laboratory analyses reveal mild dehydration and hypokalemia. The patient's status has improved after an administration of a vitamin. The physiologically active form of this vitamin acts as a coenzyme for which of the following enzymes?
|
Glycogen phosphorylase
|
L-methylmalonyl-CoA mutase
|
Methionine synthase
|
Pyruvate dehydrogenase
| 3d
|
multi
|
Thiamine (vitamin B1) is conveed intracellularly to its active form, thiamine pyrophosphate, which is an essential cofactor in intermediate carbohydrate metabolism. Thiamine acts as a coenzyme for enzymes involved in the tricarboxylic acid cycle, which plays a critical role in the production of energy from food, and the pentose-phosphate pathway, which produces an impoant intermediate, ribose-5-phosphate, required for the synthesis of ATP, GTP, DNA, RNA, and NADPH. The brain is paicularly vulnerable to thiamine deficiency because it relies exclusively on carbohydrates for immediate energy demands. The selective vulnerability of ceain structures accounts for the specific clinical manifestations of Wernicke encephalopathy. Thiamine pyrophosphate (TPP), the physiologically active form of thiamine, is required for the activity of pyruvate dehydrogenase (PDH). PDH catalyzes oxidative decarboxylation of pyruvate to acetyl-CoA, regulating entry into the citric acid cycle for metabolites leaving glycolysis. The PDH complex is comprised of 3 separate enzymes: pyruvate dehydrogenase (decarboxylase), dihydrolipoamide transacetylase and dihydrolipoamide dehydrogenase. Besides TPP, the complex also requires CoA, NAD, FAD, and lipoic acid as coenzymes. The mechanism of TPP action includes formation of a carbanion that can attack the electron-deficient keto carbon of pyruvate. In addition, TPP functions as a coenzyme for alpha-ketoglutarate dehydrogenase and transketolase. Pyridoxal phosphate serves as a coenzyme for glycogen phosphorylase. Vitamin B12 acts as a cofactor of L-methylmalonyl-CoA mutase, which catalyzes conversion of L-methylmalonyl-CoA to succinyl-CoA. Methionine synthase activation leads to synthesis of methionine from homocysteine with folic acid as a coenzyme.
|
Biochemistry
| null | 172 |
{
"Correct Answer": "Pyruvate dehydrogenase",
"Correct Option": "D",
"Options": {
"A": "Glycogen phosphorylase",
"B": "L-methylmalonyl-CoA mutase",
"C": "Methionine synthase",
"D": "Pyruvate dehydrogenase"
},
"Question": "A 45-year-old man is admitted to the hospital for the evaluation of diplopia, weakness of his lower extremities, and gait difficulties. During the interview, the patient reveals that he has been forcing himself to vomit after almost every meal over the last 6 weeks. He denies associated eye pain and discomfo, headache, or dysphagia. He has never experienced such symptoms in the past. Examination of the patient demonstrates slight disorientation, veical nystagmus worse on downgaze, diffuse weakness of the lower extremities, bilateral dysmetria, and hypothermia. Laboratory analyses reveal mild dehydration and hypokalemia. The patient's status has improved after an administration of a vitamin. The physiologically active form of this vitamin acts as a coenzyme for which of the following enzymes?"
}
|
A 45-year-old man is admitted to the hospital for the evaluation of diplopia, weakness of his lower extremities, and gait difficulties. During the interview, the patient reveals that he has been forcing himself to vomit after almost every meal over the last 6 weeks. He denies associated eye pain and discomfo, headache, or dysphagia. He has never experienced such symptoms in the past. Examination of the patient demonstrates slight disorientation, veical nystagmus worse on downgaze, diffuse weakness of the lower extremities, bilateral dysmetria, and hypothermia. Laboratory analyses reveal mild dehydration and hypokalemia. The patient's status has improved after an administration of a vitamin.
|
The physiologically active form of this vitamin acts as a coenzyme for which of the following enzymes?
|
{
"A": "Glycogen phosphorylase",
"B": "L-methylmalonyl-CoA mutase",
"C": "Methionine synthase",
"D": "Pyruvate dehydrogenase"
}
|
D. Pyruvate dehydrogenase
|
24f3a6e0-d727-40ac-bbe4-331568c694e9
|
A 24-year-old female graduate student repos increasing shoness of breath with exercise and has recently noticed dyspnea on mild activity. One day before presenting at the office, she experienced sudden loss of consciousness while shopping at a grocery store. On physical examination, vital signs are: pulse 88 bpm; temperature 97.8degF; respirations 18/min; blood pressure 100/70 mm Hg. BMI is 34. ABGs on RA: pH 7.43; PCO2 36 mm Hg; PO2 87 mm Hg. Chest x-rays are shown in.The clinical and chest radiographic diagnosis may be commonly associated with
|
A loud A2 on cardiac auscultation
|
Right arm swelling
|
Rib notching
|
A loud P2 on cardiac auscultation
| 0a
|
single
|
The lateral view shows that the anterior clear space behind the sternum is occupied above a poion of the lower one-third of the cardiac shadow. The truncus of the right pulmonary aery seen in front of the trachea is very large and the left main pulmonary aery coursing over the left upper lobe bronchus is greater than 16 mm. These findings are consistent with pulmonary aerial hypeension. The chest x-ray shows large pulmonary aeries, and this, coupled with the clinical scenario, is consistent with primary pulmonary hypeension (PPH). As mentioned in the general discussion, this entity is due to an unknown cause. The physical sign most likely to be present would be a loud P2, and right hea catheterization would confirm the high pulmonary aery (PA) pressures. Patients with PPH may give a history of syncopal episodes. A loud A2 is heard in systemic hypeension, and rib notching is classically seen on the x-ray in coarctation of the aoa. Right arm swelling is seen with either a localized vascular or lymphatic obstruction such as postradiation, malignancy, or superior vena cava syndrome. This patient does not exhibit any of these signs. Since the hilar shadows are of vascular nature, mediastinoscopy or bronchoscopy would not be indicated and in fact may be dangerous if PA pressures are very high.
|
Radiology
|
Respiratory system
| 149 |
{
"Correct Answer": "A loud A2 on cardiac auscultation",
"Correct Option": "A",
"Options": {
"A": "A loud A2 on cardiac auscultation",
"B": "Right arm swelling",
"C": "Rib notching",
"D": "A loud P2 on cardiac auscultation"
},
"Question": "A 24-year-old female graduate student repos increasing shoness of breath with exercise and has recently noticed dyspnea on mild activity. One day before presenting at the office, she experienced sudden loss of consciousness while shopping at a grocery store. On physical examination, vital signs are: pulse 88 bpm; temperature 97.8degF; respirations 18/min; blood pressure 100/70 mm Hg. BMI is 34. ABGs on RA: pH 7.43; PCO2 36 mm Hg; PO2 87 mm Hg. Chest x-rays are shown in.The clinical and chest radiographic diagnosis may be commonly associated with"
}
|
A 24-year-old female graduate student repos increasing shoness of breath with exercise and has recently noticed dyspnea on mild activity. One day before presenting at the office, she experienced sudden loss of consciousness while shopping at a grocery store. On physical examination, vital signs are: pulse 88 bpm; temperature 97.8degF; respirations 18/min; blood pressure 100/70 mm Hg. BMI is 34. ABGs on RA: pH 7.43; PCO2 36 mm Hg; PO2 87 mm Hg.
|
Chest x-rays are shown in.The clinical and chest radiographic diagnosis may be commonly associated with
|
{
"A": "A loud A2 on cardiac auscultation",
"B": "Right arm swelling",
"C": "Rib notching",
"D": "A loud P2 on cardiac auscultation"
}
|
A. A loud A2 on cardiac auscultation
|
87541d61-dd07-4418-83aa-4f494841bbc5
|
A previously healthy 2-year-old black child has developed a chronic cough during the previous 6 weeks. He has been seen in different emergency rooms on two occasions during this period and has been placed on antibiotics for pneumonia. Upon auscultation, you hear normal breath sounds on the left. On the right side, you hear decreased air movement during inspiration but no air movement upon expiration. Inspiratory (A) and expiratory (B) radiographs of the chest are shown below. Which of the following is the most appropriate next step in making the diagnosis in this patient?
|
Measure the patient's sweat chloride.
|
Consult pediatric surgery for bronchoscopy.
|
Prescribe broad-spectrum oral antibiotics.
|
Initiate a trial of inhaled b-agonists.
| 1b
|
multi
|
(b) Source: (Hay et al, pp 499-500. Kliegman et al, pp 1453-1454. McMillan et al, pp 693-694. Rudolph et al, pp 449-451.) Recurrent pneumonias in an otherwise healthy child should suggest the potential for anatomic blockage of an airway. In the patient in this question, the findings on clinical examination suggest a foreign body in the airway. Inspiratory and expiratory films can be helpful. Routine inspiratory films are likely to appear normal or near normal (as outlined in the question and noted in the first radiograph). Expiratory films will identify air trapping behind the foreign body (as noted on the second radiograph). It is uncommon for the foreign body to be visible on the plain radiograph; a high index of suspicion is necessary to make the diagnosis. Suspected foreign bodies in the airway are potentially diagnosed with fluoroscopy, but rigid bronchoscopy is not only diagnostic but also the treatment of choice for removal of the foreign body.
|
Pediatrics
|
Respiratory System
| 117 |
{
"Correct Answer": "Consult pediatric surgery for bronchoscopy.",
"Correct Option": "B",
"Options": {
"A": "Measure the patient's sweat chloride.",
"B": "Consult pediatric surgery for bronchoscopy.",
"C": "Prescribe broad-spectrum oral antibiotics.",
"D": "Initiate a trial of inhaled b-agonists."
},
"Question": "A previously healthy 2-year-old black child has developed a chronic cough during the previous 6 weeks. He has been seen in different emergency rooms on two occasions during this period and has been placed on antibiotics for pneumonia. Upon auscultation, you hear normal breath sounds on the left. On the right side, you hear decreased air movement during inspiration but no air movement upon expiration. Inspiratory (A) and expiratory (B) radiographs of the chest are shown below. Which of the following is the most appropriate next step in making the diagnosis in this patient?"
}
|
A previously healthy 2-year-old black child has developed a chronic cough during the previous 6 weeks. He has been seen in different emergency rooms on two occasions during this period and has been placed on antibiotics for pneumonia. Upon auscultation, you hear normal breath sounds on the left. On the right side, you hear decreased air movement during inspiration but no air movement upon expiration. Inspiratory (A) and expiratory (B) radiographs of the chest are shown below.
|
Which of the following is the most appropriate next step in making the diagnosis in this patient?
|
{
"A": "Measure the patient's sweat chloride.",
"B": "Consult pediatric surgery for bronchoscopy.",
"C": "Prescribe broad-spectrum oral antibiotics.",
"D": "Initiate a trial of inhaled b-agonists."
}
|
B. Consult pediatric surgery for bronchoscopy.
|
dfba108a-7489-40f2-b0b8-e645d47741fe
|
A 50-year-old lady presented With a 3-month history of pain in the lower third of the right thigh. There was no local swelling; tenderness was present on deep pressure. Plain X-rays showed an ill-defined intra medullary lesion with blotchy calcification at the lower end of the right femoral diaphysis,possible enchondroma or chondrosarcoma.Sections showed a cailaginous tumor.Which of the following histological features (if seen)would be most helpful to differentiate the two tumours?
|
Focal necrosis and lobulation
|
Tumor permeation between bone trabeculea at periphery
|
Extensive myxoid change
|
High cellularity
| 1b
|
single
|
Our study confirmed that mitotic figures and nuclear pleomorphism are hallmarks of high-grade secondary peripheral chondrosarcoma. However, despite the substantial agreement, we demonstrated that histology alone cannot distinguish osteochondroma from low-grade secondary peripheral chondrosarcoma in the setting of multiple osteochondromas, since nodularity, the presence of binucleated cells, irregular calcification, cystic/mucoid changes and necrosis were not helpful to indicate malignant transformation of an osteochondroma. On the other hand, among the concordant cases, the cailage cap in osteochondroma was significantly less thick than in low- and high-grade secondary peripheral chondrosarcoma. Therefore, our study showed that a multidisciplinary approach integrating clinical and radio graphical features and the size of the cailaginous cap in combination with a histological assessment are crucial to the diagnosis of cailaginous tumors. REF <a href="
|
Pathology
|
Breast
| 112 |
{
"Correct Answer": "Tumor permeation between bone trabeculea at periphery",
"Correct Option": "B",
"Options": {
"A": "Focal necrosis and lobulation",
"B": "Tumor permeation between bone trabeculea at periphery",
"C": "Extensive myxoid change",
"D": "High cellularity"
},
"Question": "A 50-year-old lady presented With a 3-month history of pain in the lower third of the right thigh. There was no local swelling; tenderness was present on deep pressure. Plain X-rays showed an ill-defined intra medullary lesion with blotchy calcification at the lower end of the right femoral diaphysis,possible enchondroma or chondrosarcoma.Sections showed a cailaginous tumor.Which of the following histological features (if seen)would be most helpful to differentiate the two tumours?"
}
|
A 50-year-old lady presented With a 3-month history of pain in the lower third of the right thigh. There was no local swelling; tenderness was present on deep pressure.
|
Plain X-rays showed an ill-defined intra medullary lesion with blotchy calcification at the lower end of the right femoral diaphysis,possible enchondroma or chondrosarcoma.Sections showed a cailaginous tumor.Which of the following histological features (if seen)would be most helpful to differentiate the two tumours?
|
{
"A": "Focal necrosis and lobulation",
"B": "Tumor permeation between bone trabeculea at periphery",
"C": "Extensive myxoid change",
"D": "High cellularity"
}
|
B. Tumor permeation between bone trabeculea at periphery
|
e2cd0d14-5598-4db8-a34b-1811136ea039
|
A 40 years old patient came to surgery OPD with swelling in the left lateral aspect of the neck. On examination, the swelling was painless, can be moved side to side but not up and down. No history of TB. Blood workup included thyroid profile and CBC which came to be normal. Ultrasound of swelling was performed and showed a highly vascular hypoechoic mass lesion anteriorly to the sternocleidomastoid muscle. Subsequently, a CT angio was performed. what is the Diagnosis ?
|
Fibromatosis colli
|
Tubercular lymph node
|
Soft tissue sarcoma
|
Carotid body paraganglioma
| 3d
|
single
|
Lyre sign- refers to the splaying of the internal and external carotid by a carotid body tumor. Fibromatosis colli is a rare form of infantile fibromatosis that occurs within the sternocleidomastoid muscle. USG is IOC.
|
Radiology
|
Cardiovascular Radiology
| 108 |
{
"Correct Answer": "Carotid body paraganglioma",
"Correct Option": "D",
"Options": {
"A": "Fibromatosis colli",
"B": "Tubercular lymph node",
"C": "Soft tissue sarcoma",
"D": "Carotid body paraganglioma"
},
"Question": "A 40 years old patient came to surgery OPD with swelling in the left lateral aspect of the neck. On examination, the swelling was painless, can be moved side to side but not up and down. No history of TB. Blood workup included thyroid profile and CBC which came to be normal. Ultrasound of swelling was performed and showed a highly vascular hypoechoic mass lesion anteriorly to the sternocleidomastoid muscle. Subsequently, a CT angio was performed. what is the Diagnosis ?"
}
|
A 40 years old patient came to surgery OPD with swelling in the left lateral aspect of the neck. On examination, the swelling was painless, can be moved side to side but not up and down. No history of TB. Blood workup included thyroid profile and CBC which came to be normal. Ultrasound of swelling was performed and showed a highly vascular hypoechoic mass lesion anteriorly to the sternocleidomastoid muscle. Subsequently, a CT angio was performed.
|
what is the Diagnosis ?
|
{
"A": "Fibromatosis colli",
"B": "Tubercular lymph node",
"C": "Soft tissue sarcoma",
"D": "Carotid body paraganglioma"
}
|
D. Carotid body paraganglioma
|
cb37ab58-a61c-4b5d-9666-d84c04ac357e
|
A 50-year-old woman who has a family history of breast cancer presents with a 6-month history of increasing abdominal girth. On close questioning, she volunteers a history of vague abdominal pain dating back 1 year. She has no children and has never been pregnant. Bimanual pelvic examination reveals a 10-cm right adnexal mass. Percussion of the abdomen indicates ascites. Aspiration cytology of the ascites fluid reveals malignant papillary structures with psammoma bodies. A mutation in which of the following genes is most likely associated with this patient's malignant disease?
|
BRCA1
|
p53
|
Rb
|
VHL
| 0a
|
single
|
Malignant papillary structures and psammoma bodies (laminated calcified concretions) in a patient with ascites is most compatible with the diagnosis of papillary serous cystadenocarcinoma of the ovary. The same gene implicated in hereditary breast cancers, namely BRCA1, has been incriminated in the pathogenesis of familial ovarian cancer. Women who bear BRCA1 gene mutations tend to develop ovarian cancer considerably earlier than women who have sporadic ovarian cancer, but their prognosis is considerably better. Mutations in the WT-1 tumor suppressor gene (choice E) are related to Wilms tumor.Diagnosis: Ovarian cancer, papillary serous cystadenocarcinoma
|
Pathology
|
Female Genital Tract
| 123 |
{
"Correct Answer": "BRCA1",
"Correct Option": "A",
"Options": {
"A": "BRCA1",
"B": "p53",
"C": "Rb",
"D": "VHL"
},
"Question": "A 50-year-old woman who has a family history of breast cancer presents with a 6-month history of increasing abdominal girth. On close questioning, she volunteers a history of vague abdominal pain dating back 1 year. She has no children and has never been pregnant. Bimanual pelvic examination reveals a 10-cm right adnexal mass. Percussion of the abdomen indicates ascites. Aspiration cytology of the ascites fluid reveals malignant papillary structures with psammoma bodies. A mutation in which of the following genes is most likely associated with this patient's malignant disease?"
}
|
A 50-year-old woman who has a family history of breast cancer presents with a 6-month history of increasing abdominal girth. On close questioning, she volunteers a history of vague abdominal pain dating back 1 year. She has no children and has never been pregnant. Bimanual pelvic examination reveals a 10-cm right adnexal mass. Percussion of the abdomen indicates ascites. Aspiration cytology of the ascites fluid reveals malignant papillary structures with psammoma bodies.
|
A mutation in which of the following genes is most likely associated with this patient's malignant disease?
|
{
"A": "BRCA1",
"B": "p53",
"C": "Rb",
"D": "VHL"
}
|
A. BRCA1
|
3d8730c2-37f0-4de5-8b1e-86f94e6226d9
|
An 8-year-old boy presented with altered sensorium, nausea, vomiting, severe headache and right sided weakness. There was no history of trauma. On fuher examination, it was observed that the joints of the child were tender and stiff. Mother gave history of easy bruising along with frequent episodes of epistaxis and hematemesis. Lab findings revealed normal hematocrit with normal platelet count and PT and abnormally prolonged aPTT. Which of the following drugs is approved in the mild and moderate variants of the above disease: -
|
Desmopressin
|
Octreotide
|
Conivaptan
|
Sacubitril
| 0a
|
multi
|
This is a case of Hemophilia A. NCcT head reveals an intraparenchymal hemorrhage - suggestive of hemophilia in absence of history of trauma or hypeension. Desmopressin vasopressin analog, or 1-deamino-8-d-arginine vasopressin (DDAVP), is considered the treatment of choice for mild and moderate hemophilia A. It is not effective in the treatment of severe hemophilia. DDAVP stimulates a transient increase in plasma FVIII levels
|
Unknown
|
Integrated QBank
| 111 |
{
"Correct Answer": "Desmopressin",
"Correct Option": "A",
"Options": {
"A": "Desmopressin",
"B": "Octreotide",
"C": "Conivaptan",
"D": "Sacubitril"
},
"Question": "An 8-year-old boy presented with altered sensorium, nausea, vomiting, severe headache and right sided weakness. There was no history of trauma. On fuher examination, it was observed that the joints of the child were tender and stiff. Mother gave history of easy bruising along with frequent episodes of epistaxis and hematemesis. Lab findings revealed normal hematocrit with normal platelet count and PT and abnormally prolonged aPTT. Which of the following drugs is approved in the mild and moderate variants of the above disease: -"
}
|
An 8-year-old boy presented with altered sensorium, nausea, vomiting, severe headache and right sided weakness. There was no history of trauma. On fuher examination, it was observed that the joints of the child were tender and stiff. Mother gave history of easy bruising along with frequent episodes of epistaxis and hematemesis. Lab findings revealed normal hematocrit with normal platelet count and PT and abnormally prolonged aPTT.
|
Which of the following drugs is approved in the mild and moderate variants of the above disease: -
|
{
"A": "Desmopressin",
"B": "Octreotide",
"C": "Conivaptan",
"D": "Sacubitril"
}
|
A. Desmopressin
|
4ce10ad0-ae71-4a60-89bd-2104c8e79c01
|
A 16-year-old boy is found to have hypertension on routine evaluation. He has no symptoms of shortness of breath or chest discomfort, but occasionally on exertion notes that his legs get tired easily. He has no other past medical history.On physical examination, the blood pressure in his arms is 140/90 mm Hg (bilaterally). Measurement of the blood pressure in his legs is 20mm Hg lower than in the arms. The remaining physical examination is normal. Which of the following is the most likely diagnosis?
|
aortic insufficiency
|
coarctation of the aorta
|
normal variant
|
ventricular aneurysm
| 1b
|
multi
|
Coarctation is the third most common form of congenital cardiac disease. One-third of the patients will be hypertensive. The femoral pulses are weak, delayed, and even absent. Besides coarctation of the aorta, aortic occlusive disease, dissection of the aorta, and abdominal aneurysm may lead to differential blood pressure in arms and legs. The other answers listed will not result in the clinical findings described in this patient.
|
Medicine
|
C.V.S.
| 114 |
{
"Correct Answer": "coarctation of the aorta",
"Correct Option": "B",
"Options": {
"A": "aortic insufficiency",
"B": "coarctation of the aorta",
"C": "normal variant",
"D": "ventricular aneurysm"
},
"Question": "A 16-year-old boy is found to have hypertension on routine evaluation. He has no symptoms of shortness of breath or chest discomfort, but occasionally on exertion notes that his legs get tired easily. He has no other past medical history.On physical examination, the blood pressure in his arms is 140/90 mm Hg (bilaterally). Measurement of the blood pressure in his legs is 20mm Hg lower than in the arms. The remaining physical examination is normal. Which of the following is the most likely diagnosis?"
}
|
A 16-year-old boy is found to have hypertension on routine evaluation. He has no symptoms of shortness of breath or chest discomfort, but occasionally on exertion notes that his legs get tired easily. He has no other past medical history.On physical examination, the blood pressure in his arms is 140/90 mm Hg (bilaterally). Measurement of the blood pressure in his legs is 20mm Hg lower than in the arms. The remaining physical examination is normal.
|
Which of the following is the most likely diagnosis?
|
{
"A": "aortic insufficiency",
"B": "coarctation of the aorta",
"C": "normal variant",
"D": "ventricular aneurysm"
}
|
B. coarctation of the aorta
|
a92925d6-f32c-4d48-94ea-66d7e9283007
|
A 29-year-old man who has had no major illnesses experiences acute onset of hemoptysis. On physical examination, he has a temperature of 37deg C, pulse of 83/min, respirations of 28/min, and blood pressure of 150/95 mm Hg. A chest radiograph shows bilateral fluffy infiltrates. A transbronchial lung biopsy on microscopic examination shows focal necrosis of alveolar walls associated with prominent intra-alveolar hemorrhage. Two days later, he has oliguria. The serum creatinine level is 2.9 mg/dL, and urea nitrogen is 31 mg/dL. Which of the following antibodies is most likely involved in the pathogenesis of his condition?
|
Anti-DNA topoisomerase I antibody
|
Anti-glomerular basement membrane antibody
|
Antimitochondrial antibody
|
Anti-neutrophil cytoplasmic antibody
| 1b
|
multi
|
Goodpasture syndrome leads to renal and pulmonary lesions produced by an antibody directed against an antigen common to the basement membrane in glomerulus and alveolus. This leads to a type II hypersensitivity reaction. The anti-DNA topoisomerase I antibody is a marker for scleroderma. Antimitochondrial antibody is associated with primary biliary cirrhosis. C-ANCA and P-ANCA are best known as markers for various forms of systemic vasculitis. ANA is used as a general screening test for various autoimmune conditions, typically collagen vascular diseases such as systemic lupus erythematosus.
|
Pathology
|
Respiration
| 158 |
{
"Correct Answer": "Anti-glomerular basement membrane antibody",
"Correct Option": "B",
"Options": {
"A": "Anti-DNA topoisomerase I antibody",
"B": "Anti-glomerular basement membrane antibody",
"C": "Antimitochondrial antibody",
"D": "Anti-neutrophil cytoplasmic antibody"
},
"Question": "A 29-year-old man who has had no major illnesses experiences acute onset of hemoptysis. On physical examination, he has a temperature of 37deg C, pulse of 83/min, respirations of 28/min, and blood pressure of 150/95 mm Hg. A chest radiograph shows bilateral fluffy infiltrates. A transbronchial lung biopsy on microscopic examination shows focal necrosis of alveolar walls associated with prominent intra-alveolar hemorrhage. Two days later, he has oliguria. The serum creatinine level is 2.9 mg/dL, and urea nitrogen is 31 mg/dL. Which of the following antibodies is most likely involved in the pathogenesis of his condition?"
}
|
A 29-year-old man who has had no major illnesses experiences acute onset of hemoptysis. On physical examination, he has a temperature of 37deg C, pulse of 83/min, respirations of 28/min, and blood pressure of 150/95 mm Hg. A chest radiograph shows bilateral fluffy infiltrates. A transbronchial lung biopsy on microscopic examination shows focal necrosis of alveolar walls associated with prominent intra-alveolar hemorrhage. Two days later, he has oliguria. The serum creatinine level is 2.9 mg/dL, and urea nitrogen is 31 mg/dL.
|
Which of the following antibodies is most likely involved in the pathogenesis of his condition?
|
{
"A": "Anti-DNA topoisomerase I antibody",
"B": "Anti-glomerular basement membrane antibody",
"C": "Antimitochondrial antibody",
"D": "Anti-neutrophil cytoplasmic antibody"
}
|
B. Anti-glomerular basement membrane antibody
|
77b63f32-eebf-4915-9685-7d7fc9778257
|
A 22-year-old primigravid woman at term comes to the labor room because of painful contractions every 2 minutes. She has had no gush of fluid and no bleeding from the vaginA. Her prenatal course was unremarkable. She takes no medications and has no allergies to medications. Examination shows that her cervix is 6 cm dilated and 100% effaced; the fetus is at 0 station. The fetal hea rate has a baseline in the 150s and is reactive. The patient desires an epidural for pain relief. Which of the following should be given orally sholy before the epidural is placed?
|
Antacid
|
Antibiotic
|
Aspirin
|
Clear liquid meal
| 0a
|
multi
|
Aspiration pneumonitis is a major cause of anesthesia-related death in obstetrics. Most often, these aspiration events occur with the use of general anesthesia. Pregnant patients are at greater risk for aspiration because of the delayed gastric emptying that occurs during pregnancy and labor. Pregnancy is associated with increased levels of progesterone and displacement of the pylorus by the pregnant uterus. Labor is associated with pain and stress. All of these factors lead to delayed gastric emptying. Aspiration pneumonitis is caused by acidic gastric juices entering the lungs and inducing a sometimes-lethal chemical pneumonitis. When epidural anesthesia is administered, there is a risk of complications, including the development of total spinal anesthesia. The treatment for this complication is positive-pressure ventilation with 100% oxygen administered through an endotracheal tube. Therefore, when an epidural is going to be placed, the patient should be given an antacid to increase the stomach pH. This will help to prevent aspiration pneumonitis should an aspiration event take place during the administration of general anesthesia. It is not necessary to give an antibiotic prior to the administration of an epidural. Antibiotics are used during labor for the prevention of group B Streptococcus sepsis, for patients with chorioamnionitis, for patients in need of valve or endocarditis prophylaxis, or during cesarean delivery for the prevention of infection. Aspirin is not given prior to the placement of an epidural. A clear liquid meal should not be given to patients prior to the placement of an epidural. Intake of food or liquids during labor places the patient at greater risk of aspiration pneumonitis. Patients in labor should be allowed small sips of water or ice chips.
|
Surgery
| null | 139 |
{
"Correct Answer": "Antacid",
"Correct Option": "A",
"Options": {
"A": "Antacid",
"B": "Antibiotic",
"C": "Aspirin",
"D": "Clear liquid meal"
},
"Question": "A 22-year-old primigravid woman at term comes to the labor room because of painful contractions every 2 minutes. She has had no gush of fluid and no bleeding from the vaginA. Her prenatal course was unremarkable. She takes no medications and has no allergies to medications. Examination shows that her cervix is 6 cm dilated and 100% effaced; the fetus is at 0 station. The fetal hea rate has a baseline in the 150s and is reactive. The patient desires an epidural for pain relief. Which of the following should be given orally sholy before the epidural is placed?"
}
|
A 22-year-old primigravid woman at term comes to the labor room because of painful contractions every 2 minutes. She has had no gush of fluid and no bleeding from the vaginA. Her prenatal course was unremarkable. She takes no medications and has no allergies to medications. Examination shows that her cervix is 6 cm dilated and 100% effaced; the fetus is at 0 station. The fetal hea rate has a baseline in the 150s and is reactive. The patient desires an epidural for pain relief.
|
Which of the following should be given orally sholy before the epidural is placed?
|
{
"A": "Antacid",
"B": "Antibiotic",
"C": "Aspirin",
"D": "Clear liquid meal"
}
|
A. Antacid
|
03386868-6ec3-4f61-85bc-f94e526bf9c8
|
A male neonate develops small-bowel obstruction due to malrotation of the midgut segment. An x-ray of the abdomen confirms the presence of small-bowel obstruction (Figure below). He undergoes an emergency laparotomy, untwisting of the malrotated intestines, and partial small-bowel resection for intestinal infarction. Which of the following statements is true of the small intestine (jejunum and ileum)?Upper GI shows dilation of the bowel secondary to volvulusDistension of duodenum with breaking of the second portion of the duodenum due to volvulus.
|
It is derived entirely from the midgut.
|
In the fetus, it enters the physiologic umbilical hernia in the fifth month.
|
It remains in the physiologic hernia for 4 months.
|
It is attached to the urachus.
| 0a
|
multi
|
The small intestine arises from the midgut segment. The midgut segment extends between the ampulla of Vater and the distal transverse colon. It enters the physiological umbilical hernia at sixth week and returns to the peritoneal cavity by the tenth week. The Vitello intestinal tract (site from which Meckel's diverticulum arises) is attached to the antimesenteric margin of the distal ileum. The urachus is attached to the bladder. The intestinal lymphatic drainage is directed to the preaortic glands.
|
Surgery
|
Small & Large Intestine
| 126 |
{
"Correct Answer": "It is derived entirely from the midgut.",
"Correct Option": "A",
"Options": {
"A": "It is derived entirely from the midgut.",
"B": "In the fetus, it enters the physiologic umbilical hernia in the fifth month.",
"C": "It remains in the physiologic hernia for 4 months.",
"D": "It is attached to the urachus."
},
"Question": "A male neonate develops small-bowel obstruction due to malrotation of the midgut segment. An x-ray of the abdomen confirms the presence of small-bowel obstruction (Figure below). He undergoes an emergency laparotomy, untwisting of the malrotated intestines, and partial small-bowel resection for intestinal infarction. Which of the following statements is true of the small intestine (jejunum and ileum)?Upper GI shows dilation of the bowel secondary to volvulusDistension of duodenum with breaking of the second portion of the duodenum due to volvulus."
}
|
A male neonate develops small-bowel obstruction due to malrotation of the midgut segment. An x-ray of the abdomen confirms the presence of small-bowel obstruction (Figure below). He undergoes an emergency laparotomy, untwisting of the malrotated intestines, and partial small-bowel resection for intestinal infarction.
|
Which of the following statements is true of the small intestine (jejunum and ileum)?Upper GI shows dilation of the bowel secondary to volvulusDistension of duodenum with breaking of the second portion of the duodenum due to volvulus.
|
{
"A": "It is derived entirely from the midgut.",
"B": "In the fetus, it enters the physiologic umbilical hernia in the fifth month.",
"C": "It remains in the physiologic hernia for 4 months.",
"D": "It is attached to the urachus."
}
|
A. It is derived entirely from the midgut.
|
6793e56d-aba7-4c27-92ae-f75de5a72236
|
A 70-year-old man presented to medicine emergency with worsening cough and difficulty in breathing especially at night. On physical examination, raised JVP is noted with bipedal edema. Abdominal examination reveals hepatomegaly. USG was done which reveals hepatomegaly ms. 16.8 cm. USG guided biopsy was carried out. The patient could not be resuscitated. The gross and HPE is shown below. What is the most common eitiology for the patient's clinical condition? Right hea failure Hepatitis A Riedel lobe of liver Metabolic disease of liver.
|
Right hea failure
|
Hepatitis A
|
Riedel lobe of liver
|
Metabolic disease of liver.
| 0a
|
multi
|
Nutmeg liver: Centri-lobular region is depressed (cell death) with adjacent parenchymal accentuation giving this appearance. HPE: Centri-lobular hemorrhage, with variable degree of hepatocyte necrosis and drop outs. Most common cause is right hea failure (increases IVC pressure, that increases central venous pressure and congestion in liver) and left hea failure ( hypoperfusion and ischemia) Right-sided hea failure leads to passive congestion of the liver. On gross examination: liver is mildly enlarged and cyanotic. It often has rounded edges. Microscopically there is congestion of centrilobular sinusoids. Later, hepatocytes become atrophic, resulting in markedly attenuated liver cell plates. Left-sided hea failure or shock: causes liver hypoperfusion and hypoxia, leading to ischemic coagulative necrosis of hepatocytes in the central region of the lobule which is the centrilobular necrosis. Clinically evident as transient elevation of serum aminotransferases or jaundice
|
Unknown
|
Integrated QBank
| 129 |
{
"Correct Answer": "Right hea failure",
"Correct Option": "A",
"Options": {
"A": "Right hea failure",
"B": "Hepatitis A",
"C": "Riedel lobe of liver",
"D": "Metabolic disease of liver."
},
"Question": "A 70-year-old man presented to medicine emergency with worsening cough and difficulty in breathing especially at night. On physical examination, raised JVP is noted with bipedal edema. Abdominal examination reveals hepatomegaly. USG was done which reveals hepatomegaly ms. 16.8 cm. USG guided biopsy was carried out. The patient could not be resuscitated. The gross and HPE is shown below. What is the most common eitiology for the patient's clinical condition? Right hea failure Hepatitis A Riedel lobe of liver Metabolic disease of liver."
}
|
A 70-year-old man presented to medicine emergency with worsening cough and difficulty in breathing especially at night. On physical examination, raised JVP is noted with bipedal edema. Abdominal examination reveals hepatomegaly. USG was done which reveals hepatomegaly ms. 16.8 cm. USG guided biopsy was carried out. The patient could not be resuscitated. The gross and HPE is shown below.
|
What is the most common eitiology for the patient's clinical condition? Right hea failure Hepatitis A Riedel lobe of liver Metabolic disease of liver.
|
{
"A": "Right hea failure",
"B": "Hepatitis A",
"C": "Riedel lobe of liver",
"D": "Metabolic disease of liver."
}
|
A. Right hea failure
|
1d04760a-3277-4ff8-bd53-2cdac20355a1
|
True about the following virus: A. Enveloped, Club or petal shaped projections, Positive ss RNA- Largest genome of RNA virus. B. Diseases caused by these viruses are SARS, MERS. C. Reservoir is horseshoe bats for SARS, likely spread from palm-civets cats contact with humans. D. Symptoms of MERS appear within a day following contact with an infected patient. E. SARS is more severe than MERS. F. MERS infection is more servere in individuals who have a preexisting illness like diabetes and hea diseases.
|
Only A, B, D, E, F are True
|
Only A, B, C, D are True
|
A, B, C, F are True
|
All are True
| 2c
|
multi
|
The given image is of Corona virus. It is an Enveloped virus with Club or petal shaped projections, Positive ss RNA virus. The Wuhan coronavirus or the 2019-nCoV is a positive-sense, single-stranded RNA coronavirus first repoed in late 2019 and linked in the 2019-2020 pneumonia outbreak in Wuhan City in central China. 100-160 nm in size. Disease caused by these viruses are: SARS (severe acute respiratory syndrome) MERS (Middle East respiratory syndrome ) COVID19. Reservoir for SARS is HORSESHOE bats, likely spread from palm-civets cats contact with humans. MERS has a median Incubation Period of 5 days, symptoms appear between 2-14 days. MERS is more severe in individuals who have a preexisting illness like diabetes and hea diseases.
|
Microbiology
|
Virology (RNA Virus Pa-1,2 & Miscellaneous Viruses)
| 121 |
{
"Correct Answer": "A, B, C, F are True",
"Correct Option": "C",
"Options": {
"A": "Only A, B, D, E, F are True",
"B": "Only A, B, C, D are True",
"C": "A, B, C, F are True",
"D": "All are True"
},
"Question": "True about the following virus: A. Enveloped, Club or petal shaped projections, Positive ss RNA- Largest genome of RNA virus. B. Diseases caused by these viruses are SARS, MERS. C. Reservoir is horseshoe bats for SARS, likely spread from palm-civets cats contact with humans. D. Symptoms of MERS appear within a day following contact with an infected patient. E. SARS is more severe than MERS. F. MERS infection is more servere in individuals who have a preexisting illness like diabetes and hea diseases."
}
|
True about the following virus: A. Enveloped, Club or petal shaped projections, Positive ss RNA- Largest genome of RNA virus. B. Diseases caused by these viruses are SARS, MERS. C. Reservoir is horseshoe bats for SARS, likely spread from palm-civets cats contact with humans. D. Symptoms of MERS appear within a day following contact with an infected patient. E. SARS is more severe than MERS. F.
|
MERS infection is more servere in individuals who have a preexisting illness like diabetes and hea diseases.
|
{
"A": "Only A, B, D, E, F are True",
"B": "Only A, B, C, D are True",
"C": "A, B, C, F are True",
"D": "All are True"
}
|
C. A, B, C, F are True
|
083b9e95-5bb5-4745-9c6b-286adca71021
|
A 64-year-old woman presents to the emergency room with flank pain and fever. She noted dysuria for the past 3 days. Blood and urine cultures are obtained, and she is started on intravenous ciprofloxacin. Six hours after admission, she becomes tachycardic and her blood pressure drops. Her intravenous fluid is normal saline (NS) at 100 mL/h. Her current blood pressure is 79/43 mm Hg, heart rate is 128/min, respiratory rate is 26/min, and temperature is 39.2degC (102.5degF). She seems drowsy yet uncomfortable. Extremities are warm with trace edema. What is the best next course of action?
|
Administer IV hydrocortisone at stress dose.
|
Begin norepinephrine infusion and titrate to mean arterial pressure greater than 65 mm Hg.
|
Add vancomycin to her antibiotic regimen for improved gram-positive coverage.
|
Administer a bolus of NS.
| 3d
|
single
|
This patient is septic, and immediate therapy should be directed at correcting her hemodynamic instability. Patients with sepsis require aggressive fluid resuscitation to compensate for capillary extravasation. This patient's vital signs suggest decreased effective circulating volume. Normal saline at 100 cc/h is insufficient volume replacement. The patient should be given a saline bolus of 2 L over 20 minutes, and then her blood pressure and clinical status should be reassessed. The elevated respiratory rate could be evidence of pulmonary edema or respiratory compensation for acidosis from decreased tissue perfusion. Even if the patient has evidence of pulmonary edema, fluid resuscitation remains the first intervention for hypotension from sepsis. She is more likely to die from hemodynamic collapse than from oxygenation issues related to pulmonary edema.Stress doses of hydrocortisone and intravenous norepinephrine are both used in patients with shock refractory to volume resuscitation but should be reserved until after the saline bolus. Vancomycin is a reasonable choice to cover enterococci, which can cause UTI-associated sepsis, but again would not address the immediate hemodynamic problem. If the patient does not improve, a central line (to measure filling pressures and mixed venous oxygen saturation) would allow the "early goal-directed" sepsis protocol to be used.
|
Medicine
|
C.V.S.
| 164 |
{
"Correct Answer": "Administer a bolus of NS.",
"Correct Option": "D",
"Options": {
"A": "Administer IV hydrocortisone at stress dose.",
"B": "Begin norepinephrine infusion and titrate to mean arterial pressure greater than 65 mm Hg.",
"C": "Add vancomycin to her antibiotic regimen for improved gram-positive coverage.",
"D": "Administer a bolus of NS."
},
"Question": "A 64-year-old woman presents to the emergency room with flank pain and fever. She noted dysuria for the past 3 days. Blood and urine cultures are obtained, and she is started on intravenous ciprofloxacin. Six hours after admission, she becomes tachycardic and her blood pressure drops. Her intravenous fluid is normal saline (NS) at 100 mL/h. Her current blood pressure is 79/43 mm Hg, heart rate is 128/min, respiratory rate is 26/min, and temperature is 39.2degC (102.5degF). She seems drowsy yet uncomfortable. Extremities are warm with trace edema. What is the best next course of action?"
}
|
A 64-year-old woman presents to the emergency room with flank pain and fever. She noted dysuria for the past 3 days. Blood and urine cultures are obtained, and she is started on intravenous ciprofloxacin. Six hours after admission, she becomes tachycardic and her blood pressure drops. Her intravenous fluid is normal saline (NS) at 100 mL/h. Her current blood pressure is 79/43 mm Hg, heart rate is 128/min, respiratory rate is 26/min, and temperature is 39.2degC (102.5degF). She seems drowsy yet uncomfortable. Extremities are warm with trace edema.
|
What is the best next course of action?
|
{
"A": "Administer IV hydrocortisone at stress dose.",
"B": "Begin norepinephrine infusion and titrate to mean arterial pressure greater than 65 mm Hg.",
"C": "Add vancomycin to her antibiotic regimen for improved gram-positive coverage.",
"D": "Administer a bolus of NS."
}
|
D. Administer a bolus of NS.
|
689b7012-8ffa-4b07-91bb-2a35ea6400ac
|
A 75-year old woman with chronic atrial fibrillation presented to the hospital with a 2-day of colicky abdominal pain. The physical examination revealed hypoactive bowel sounds and diffuse abdomina tenderness. Laboratory tests showed a white cell count of 19,400 per cubic millimeter with 92 /o neutrophils, a blood urea nitrogen level of 42 mg per deciliter (15 jimol per liter) and a syrum creatinine level of 3.0 mg per deciliter (267 per liter). The common cause for this problem would be-
|
Occlusion of the poal vein
|
Occlusion of the superior mesenteric vessel
|
Occlusion of the inferior mesenteric vessel
|
Perforation of the duodenum back.
| 1b
|
single
|
Acute occlusion of the superior mesenteric aery (SMA) causes extensive bowel necrosis, resulting in a poor prognosis with an extremely high moality rate. As a result, the residual thrombus disappeared and all branches of the SMA became well visualized. Ref Davidson 23rd edition pg 790
|
Medicine
|
Miscellaneous
| 129 |
{
"Correct Answer": "Occlusion of the superior mesenteric vessel",
"Correct Option": "B",
"Options": {
"A": "Occlusion of the poal vein",
"B": "Occlusion of the superior mesenteric vessel",
"C": "Occlusion of the inferior mesenteric vessel",
"D": "Perforation of the duodenum back."
},
"Question": "A 75-year old woman with chronic atrial fibrillation presented to the hospital with a 2-day of colicky abdominal pain. The physical examination revealed hypoactive bowel sounds and diffuse abdomina tenderness. Laboratory tests showed a white cell count of 19,400 per cubic millimeter with 92 /o neutrophils, a blood urea nitrogen level of 42 mg per deciliter (15 jimol per liter) and a syrum creatinine level of 3.0 mg per deciliter (267 per liter). The common cause for this problem would be-"
}
|
A 75-year old woman with chronic atrial fibrillation presented to the hospital with a 2-day of colicky abdominal pain. The physical examination revealed hypoactive bowel sounds and diffuse abdomina tenderness. Laboratory tests showed a white cell count of 19,400 per cubic millimeter with 92 /o neutrophils, a blood urea nitrogen level of 42 mg per deciliter (15 jimol per liter) and a syrum creatinine level of 3.0 mg per deciliter (267 per liter).
|
The common cause for this problem would be-
|
{
"A": "Occlusion of the poal vein",
"B": "Occlusion of the superior mesenteric vessel",
"C": "Occlusion of the inferior mesenteric vessel",
"D": "Perforation of the duodenum back."
}
|
B. Occlusion of the superior mesenteric vessel
|
6e97d00d-852d-4f60-8331-776995ada27d
|
A 6-year-old boy is taken to a paediatrician because he has developed pain in his right hip. On physical examination, the doctor feels a large mass near the iliac crest. Plain X-ray films demonstrate a large lytic lesion of the ilium. MRI studies show that the tumor appears to arise in the bone, but extends into the adjacent soft tissues. A large incisional biopsy demonstrates a tumor composed of sheets of small, round, blue cells. Which of the following is the most likely diagnosis?
|
Chondrosarcoma
|
Ewing sarcoma
|
Giant cell tumor of bone
|
Malignant fibrous histiocytoma
| 1b
|
multi
|
Ewing sarcoma is the second most common type of bone tumor (after osteosarcoma) in children and adolescents. The tumor is usually a lytic bone lesion, and often both invades the medullary cavity of the bone and extends into extraosseous tissues. Grossly, the tumor is often tan-white in color and shows focal areas of hemorrhage and necrosis. Microscopically, it is composed of sheets of small, round cells with scanty cytoplasm that may appear clear because of their glycogen content. Chondrosarcoma is composed of malignant hyaline and myxoid cailage. Giant cell tumor of bone contains multinucleated giant cells in a background of mononuclear stromal cells. Malignant fibrous histiocytoma has a background of spindled fibroblasts in a storiform pattern admixed with bizarre, multinucleated tumor giant cells.
|
Surgery
| null | 106 |
{
"Correct Answer": "Ewing sarcoma",
"Correct Option": "B",
"Options": {
"A": "Chondrosarcoma",
"B": "Ewing sarcoma",
"C": "Giant cell tumor of bone",
"D": "Malignant fibrous histiocytoma"
},
"Question": "A 6-year-old boy is taken to a paediatrician because he has developed pain in his right hip. On physical examination, the doctor feels a large mass near the iliac crest. Plain X-ray films demonstrate a large lytic lesion of the ilium. MRI studies show that the tumor appears to arise in the bone, but extends into the adjacent soft tissues. A large incisional biopsy demonstrates a tumor composed of sheets of small, round, blue cells. Which of the following is the most likely diagnosis?"
}
|
A 6-year-old boy is taken to a paediatrician because he has developed pain in his right hip. On physical examination, the doctor feels a large mass near the iliac crest. Plain X-ray films demonstrate a large lytic lesion of the ilium. MRI studies show that the tumor appears to arise in the bone, but extends into the adjacent soft tissues. A large incisional biopsy demonstrates a tumor composed of sheets of small, round, blue cells.
|
Which of the following is the most likely diagnosis?
|
{
"A": "Chondrosarcoma",
"B": "Ewing sarcoma",
"C": "Giant cell tumor of bone",
"D": "Malignant fibrous histiocytoma"
}
|
B. Ewing sarcoma
|
679afdad-3a57-43df-a199-9cf00c14f00f
|
A 56-year-old woman diagnosed with cancer in her left breast underwent a mastectomy with axillary lymph node dissection. Postoperatively, she develops marked swelling of the left arm that has persisted for 6 months. Now on physical examination, her temperature is 36.9deg C. Her left arm is not tender or erythematous, and it is not painful with movement or to touch, but it is enlarged with a doughy consistency. Which of the following is the most likely mechanism for these findings?
|
Cellulitis
|
Congestive heart failure
|
Decreased plasma oncotic pressure
|
Lymphedema
| 3d
|
single
|
The surgery disrupted lymphatic return, resulting in functional lymphatic obstruction and lymphedema of the arm. The lymphatic channels are important in scavenging fluid and protein that have leaked into the extravascular tissues from the intravascular compartment. Although the amount of fluid that is drained through the lymphatics is not great, it can build up gradually. Cellulitis is caused by an infection of the skin and subcutaneous tissue, and displays erythema, warmth, and tenderness. Congestive heart failure can lead to peripheral edema, which is most marked in dependent areas such as the lower extremities and over the sacrum (in bedridden patients). Decreased plasma oncotic pressure from hypoalbuminemia, or sodium and water retention with heart or renal failure, leads to more generalized edema. Phlebothrombosis leads to swelling with pain and tenderness, but it is uncommon in the upper extremities.
|
Pathology
|
Hemodynamics
| 109 |
{
"Correct Answer": "Lymphedema",
"Correct Option": "D",
"Options": {
"A": "Cellulitis",
"B": "Congestive heart failure",
"C": "Decreased plasma oncotic pressure",
"D": "Lymphedema"
},
"Question": "A 56-year-old woman diagnosed with cancer in her left breast underwent a mastectomy with axillary lymph node dissection. Postoperatively, she develops marked swelling of the left arm that has persisted for 6 months. Now on physical examination, her temperature is 36.9deg C. Her left arm is not tender or erythematous, and it is not painful with movement or to touch, but it is enlarged with a doughy consistency. Which of the following is the most likely mechanism for these findings?"
}
|
A 56-year-old woman diagnosed with cancer in her left breast underwent a mastectomy with axillary lymph node dissection. Postoperatively, she develops marked swelling of the left arm that has persisted for 6 months. Now on physical examination, her temperature is 36.9deg C. Her left arm is not tender or erythematous, and it is not painful with movement or to touch, but it is enlarged with a doughy consistency.
|
Which of the following is the most likely mechanism for these findings?
|
{
"A": "Cellulitis",
"B": "Congestive heart failure",
"C": "Decreased plasma oncotic pressure",
"D": "Lymphedema"
}
|
D. Lymphedema
|
44a231b7-2aff-45e0-a1fe-ed1e7da48261
|
A 33-year-old woman has had fever and increasing fatigue for the past 2 months. Over the past year, she has noticed the soreness of her muscles and joints and has had a 4-kg weight loss. On physical examination, her temperature is 37.5degC, pulse is 80/min, respirations are 15/min, and blood pressure is 145/95 mm Hg. She has pain on deep inspiration, and a friction rub is heard on auscultation of the chest. Laboratory findings show glucose, 73 mg/dL; total protein, 5.2 g/dL; albumin, 2.9 g/dL; and creatinine, 2.4 mg/dL. Serum complement levels are decreased. CBC shows hemoglobin of 9.7 g /dL, platelet count of 85,000/mm3, and WBC count of 3560/mm3. A renal biopsy specimen shows diffuse proliferative glomerulonephritis with extensive granular immune deposits of IgG and C1q in capillary loops and mesangium. After being treated with immunosuppressive therapy consisting of prednisone and cyclophosphamide, her condition improves. Which of the following serologic studies is most likely to be positive in this patient?
|
Anti centromere antibody
|
Anti-DNA topoisomerase I antibody
|
Anti-double-stranded DNA antibody
|
Anti-glomerular basement membrane antibody
| 2c
|
single
|
Lupus nephritis is one manifestation of systemic problems related to immune complex deposition, including fever, arthralgias, myalgias, pancytopenia, and serositis with pericarditis and pleuritis, which are characteristic of systemic lupus erythematosus (SLE). Renal disease is common in SLE, and a renal biopsy helps to determine the severity of involvement and the appropriate therapy. Anti-centromere antibody is most specific for limited scleroderma (formerly CREST syndrome), which is unlikely to have renal involvement. Anti-DNA topoisomerase I antibody is more specific for diffuse scleroderma, which does have renal involvement, although usually, this manifests as vascular disease and not as glomerulonephritis. The anti-glomerular basement membrane antibody is characteristic of Goodpasture syndrome, in which the IgG antibody is deposited in a linear fashion along glomerular capillary basement membranes. Anti-histone antibody may be present in drug-induced lupus. ANCAs can be seen in some forms of vasculitis, such as ANCA-associated granulomatous vasculitis or microscopic polyangiitis. Antiribonucleoprotein is present in mixed connective tissue disease, which has some features of SLE but usually does not include severe renal involvement.
|
Pathology
|
Kidney
| 285 |
{
"Correct Answer": "Anti-double-stranded DNA antibody",
"Correct Option": "C",
"Options": {
"A": "Anti centromere antibody",
"B": "Anti-DNA topoisomerase I antibody",
"C": "Anti-double-stranded DNA antibody",
"D": "Anti-glomerular basement membrane antibody"
},
"Question": "A 33-year-old woman has had fever and increasing fatigue for the past 2 months. Over the past year, she has noticed the soreness of her muscles and joints and has had a 4-kg weight loss. On physical examination, her temperature is 37.5degC, pulse is 80/min, respirations are 15/min, and blood pressure is 145/95 mm Hg. She has pain on deep inspiration, and a friction rub is heard on auscultation of the chest. Laboratory findings show glucose, 73 mg/dL; total protein, 5.2 g/dL; albumin, 2.9 g/dL; and creatinine, 2.4 mg/dL. Serum complement levels are decreased. CBC shows hemoglobin of 9.7 g /dL, platelet count of 85,000/mm3, and WBC count of 3560/mm3. A renal biopsy specimen shows diffuse proliferative glomerulonephritis with extensive granular immune deposits of IgG and C1q in capillary loops and mesangium. After being treated with immunosuppressive therapy consisting of prednisone and cyclophosphamide, her condition improves. Which of the following serologic studies is most likely to be positive in this patient?"
}
|
A 33-year-old woman has had fever and increasing fatigue for the past 2 months. Over the past year, she has noticed the soreness of her muscles and joints and has had a 4-kg weight loss. On physical examination, her temperature is 37.5degC, pulse is 80/min, respirations are 15/min, and blood pressure is 145/95 mm Hg. She has pain on deep inspiration, and a friction rub is heard on auscultation of the chest. Laboratory findings show glucose, 73 mg/dL; total protein, 5.2 g/dL; albumin, 2.9 g/dL; and creatinine, 2.4 mg/dL. Serum complement levels are decreased. CBC shows hemoglobin of 9.7 g /dL, platelet count of 85,000/mm3, and WBC count of 3560/mm3. A renal biopsy specimen shows diffuse proliferative glomerulonephritis with extensive granular immune deposits of IgG and C1q in capillary loops and mesangium. After being treated with immunosuppressive therapy consisting of prednisone and cyclophosphamide, her condition improves.
|
Which of the following serologic studies is most likely to be positive in this patient?
|
{
"A": "Anti centromere antibody",
"B": "Anti-DNA topoisomerase I antibody",
"C": "Anti-double-stranded DNA antibody",
"D": "Anti-glomerular basement membrane antibody"
}
|
C. Anti-double-stranded DNA antibody
|
d773215d-f5f6-409d-b869-c52612622b15
|
A 40-year-old male presented with rapidly progressive dementia for 3 weeks along with rigidity, mask-like facies and mild choreoathetoid movements along with fatigue, sleep disturbance, weight loss, headache, anxiety, veigo, malaise, and ill-defined pain. There is no history of fever. O/E, Visual disturbances Cerebellar disturbances Myoclonus CSF revealed nothing except that there was increase in 14-14-3 protein. CSF revealed nothing except that there was increase in 14-14-3 protein. MRI EEG STUDY
|
Creutzfeldt-Jacob disease
|
Dementia with Lewy bodies
|
Alzheimer's disease
|
Frontotemporal dementia
| 0a
|
multi
|
This is a case of Creutzfeldt Jacob disease as there is rapid and progressive sho-term memory loss along with classical MRI signs and CSF finding of stress protein 14-14-3. The other conditions can be easily ruled as MRI will show specific abnormalities in these conditions. EEG shows slowing and periodic lateralized discharges over the right hemisphere with triphasic morphology. MRI IMAGE shows the classical Pulvinar sign whichrefers to bilateral flair hyperintensities involving thepulvinar thalamic nuclei DWI images show the classical coical ribbon sign. Creutzfeldt-Jacob disease Rapidly progressive Fatal neurodegenerative disorder Caused by an abnormal isoform of a cellular glycoprotein known as the prion protein Presents with acute dementia, visual and cerebellar disturbances Classical Triphasic morphology on EEG waves Positive 14-3-3 CSF assay High signal in caudate/putamen on MRI.
|
Unknown
|
Integrated QBank
| 124 |
{
"Correct Answer": "Creutzfeldt-Jacob disease",
"Correct Option": "A",
"Options": {
"A": "Creutzfeldt-Jacob disease",
"B": "Dementia with Lewy bodies",
"C": "Alzheimer's disease",
"D": "Frontotemporal dementia"
},
"Question": "A 40-year-old male presented with rapidly progressive dementia for 3 weeks along with rigidity, mask-like facies and mild choreoathetoid movements along with fatigue, sleep disturbance, weight loss, headache, anxiety, veigo, malaise, and ill-defined pain. There is no history of fever. O/E, Visual disturbances Cerebellar disturbances Myoclonus CSF revealed nothing except that there was increase in 14-14-3 protein. CSF revealed nothing except that there was increase in 14-14-3 protein. MRI EEG STUDY"
}
|
A 40-year-old male presented with rapidly progressive dementia for 3 weeks along with rigidity, mask-like facies and mild choreoathetoid movements along with fatigue, sleep disturbance, weight loss, headache, anxiety, veigo, malaise, and ill-defined pain. There is no history of fever. O/E, Visual disturbances Cerebellar disturbances Myoclonus CSF revealed nothing except that there was increase in 14-14-3 protein. CSF revealed nothing except that there was increase in 14-14-3 protein.
|
MRI EEG STUDY
|
{
"A": "Creutzfeldt-Jacob disease",
"B": "Dementia with Lewy bodies",
"C": "Alzheimer's disease",
"D": "Frontotemporal dementia"
}
|
A. Creutzfeldt-Jacob disease
|
a8953a0e-e635-4a11-9f1a-9c294b4920fa
|
A 24-year-old woman in her third trimester of pregnancy presents with urinary frequency and burning for the past few days. She denies fever, or chills. She has mild suprapubic tenderness, and a urine dipstick is positive for WBC, protein, and a small amount of blood. Culture produces greater than 100,000 colonies of gram-negative bacilli. Which attribute of this uropathogenic organism is most strongly associated with its virulence?
|
Colonisation factor antigen
|
Heat labile toxins
|
Heat stable toxins
|
P pili
| 3d
|
multi
|
P pili are found in uropathogenic strains of E. coli. By using P pili, E. coli is able to attach to epithelial cells lining the urinary tract. Pili or fimbriae are hair like structures, which are formed by only gram-negative bacteria. They are organs of adhesion and allow the bacteria to adhere to mucosal surface. These are composed of protein subunits called as pilin.
|
Surgery
| null | 101 |
{
"Correct Answer": "P pili",
"Correct Option": "D",
"Options": {
"A": "Colonisation factor antigen",
"B": "Heat labile toxins",
"C": "Heat stable toxins",
"D": "P pili"
},
"Question": "A 24-year-old woman in her third trimester of pregnancy presents with urinary frequency and burning for the past few days. She denies fever, or chills. She has mild suprapubic tenderness, and a urine dipstick is positive for WBC, protein, and a small amount of blood. Culture produces greater than 100,000 colonies of gram-negative bacilli. Which attribute of this uropathogenic organism is most strongly associated with its virulence?"
}
|
A 24-year-old woman in her third trimester of pregnancy presents with urinary frequency and burning for the past few days. She denies fever, or chills. She has mild suprapubic tenderness, and a urine dipstick is positive for WBC, protein, and a small amount of blood. Culture produces greater than 100,000 colonies of gram-negative bacilli.
|
Which attribute of this uropathogenic organism is most strongly associated with its virulence?
|
{
"A": "Colonisation factor antigen",
"B": "Heat labile toxins",
"C": "Heat stable toxins",
"D": "P pili"
}
|
D. P pili
|
6f174bb3-190d-46d6-a690-7c398d654237
|
A 3-year-old boy presented to the pediatrics ER with significant dehydration along with irritability, weakness and severe lethargy. His mother says he suffered from bloody diarrhea along with fever and abdominal pain 8 days ago. Lab findings, Anemia Deranged RFTs Thrombocytopenia Severe hyponatremia Leukocytosis. PT and aPTT -normal Coombs test- negative. Urine analysis revealed microscopic haematuria and low-grade proteinuria. Peripheral blood smear If there would not have been any history of diarrhea in the above patient, which of the following drugs could have been given in the above patient: -
|
Omalizumab
|
Eculizumab
|
Caplacizumab
|
Mepolizumab
| 1b
|
multi
|
This is a case of typical HUS. If history of diarrhoea would had been absent, the diagnosis would had been atypical HU for which FDA has approved eculizumab. Peripheral blood smear shows the presence of burr cells and schistocytes - suggestive of microangiopathic hemolytic anemia. Eculizumab Anti-C5 antibody Inhibits complement activation Approved for the treatment of: - Paroxysmal nocturnal hemoglobinuria (PNH) to reduce hemolysis Atypical hemolytic uremic syndrome to inhibit complement-mediated thrombotic microangiopathy Caplacizumab is a bivalent Single-domain antibody (VHH) designed for the treatment of thrombotic thrombocytopenic purpura and thrombosis Omalizumab and Mepolizumab are given in asthma patients. Hemolytic uremic syndrome Syndrome characterized by: - Progressive renal failure Microangiopathic (nonimmune, coombs-negative) hemolytic anemia Thrombocytopenia Damage to endothelial cells is the primary event in the pathogenesis of hemolytic-uremic syndrome (HUS). Two monoclonal antibodies, eculizumab and ravulizumab, are approved for the treatment of pediatric and adult patients with atypical HUS.
|
Unknown
|
Integrated QBank
| 138 |
{
"Correct Answer": "Eculizumab",
"Correct Option": "B",
"Options": {
"A": "Omalizumab",
"B": "Eculizumab",
"C": "Caplacizumab",
"D": "Mepolizumab"
},
"Question": "A 3-year-old boy presented to the pediatrics ER with significant dehydration along with irritability, weakness and severe lethargy. His mother says he suffered from bloody diarrhea along with fever and abdominal pain 8 days ago. Lab findings, Anemia Deranged RFTs Thrombocytopenia Severe hyponatremia Leukocytosis. PT and aPTT -normal Coombs test- negative. Urine analysis revealed microscopic haematuria and low-grade proteinuria. Peripheral blood smear If there would not have been any history of diarrhea in the above patient, which of the following drugs could have been given in the above patient: -"
}
|
A 3-year-old boy presented to the pediatrics ER with significant dehydration along with irritability, weakness and severe lethargy. His mother says he suffered from bloody diarrhea along with fever and abdominal pain 8 days ago. Lab findings, Anemia Deranged RFTs Thrombocytopenia Severe hyponatremia Leukocytosis. PT and aPTT -normal Coombs test- negative. Urine analysis revealed microscopic haematuria and low-grade proteinuria.
|
Peripheral blood smear If there would not have been any history of diarrhea in the above patient, which of the following drugs could have been given in the above patient: -
|
{
"A": "Omalizumab",
"B": "Eculizumab",
"C": "Caplacizumab",
"D": "Mepolizumab"
}
|
B. Eculizumab
|
f30c229e-2f1b-4e7a-abfc-bcbc6c888144
|
A 71-year-old man is evaluated in the ER for a recent finding of high ESR in a routine blood test. He has history of hypertension, well controlled with metoprolol. His physical examination is completely normal. His laboratory workup reveals hemoglobin 12.6 gm/dL, leukocyte count 8500/mL, and platelet 265,000/mL. Total protein 6.2 g/dL, albumin 3.4 g/dL, BUN 16 mg/dL, creatinine 0.75 mg/dL, and calcium 9.2 mg/dL. Serum protein electrophoresis reveals a sharp, narrow spike, serum immunofixation reveals M-protein 1.2 gm/dL, bone marrow examination reveals less than 10% of monoclonal plasma cells. A skeletal survey is negative for any lytic lesions.
|
Multiple myeloma
|
Smoldering multiple myeloma
|
Monoclonal gammopathy of undetermined significance
|
Waldenstrom macroglobulinemia
| 2c
|
single
|
Multiple myeloma would best explain this patient's presentation. The onset of myeloma is often insidious. Pain caused by bone involvement, anemia, renal insufficiency, and bacterial pneumonia often follow. This patient presented with fatigue and bone pain, then developed bacterial pneumonia probably secondary to Streptococcus pneumoniae, an encapsulated organism for which antibody to the polysaccharide capsule is not adequately produced by the myeloma patient. There is also evidence for renal insufficiency. Hypercalcemia is frequently seen in patients with multiple myeloma and may be life-threatening. Definitive diagnosis of multiple myeloma is made by demonstrating greater than 30% plasma cells in the bone marrow. Seventy-five percent of patients with myeloma will have a monoclonal M spike on serum protein electrophoresis, but 25% will produce primarily Bence-Jones proteins, which, because of their small size, do not accumulate in the serum but are excreted in the urine. Urine protein electrophoresis will identify these patients. Approximately 1% of patients with myeloma will present with a non-secretory myeloma. Patients with non-secretory myeloma have no M-protein on serum/urine electrophoresis and immunofixation; the diagnosis can be made only with bone marrow biopsy. The bone scan in myeloma is usually negative. The radionuclide is taken up by osteoblasts, and myeloma is usually a purely osteolytic process. Renal biopsy might show monoclonal protein deposition in the kidney or intratubular casts but would not be the first diagnostic procedure. Rouleaux formation in peripheral smear is a characteristic finding of myeloma, although it is neither sensitive nor specific.Waldenstrom macroglobulinemia may cause hyper-viscosity syndrome with CNS manifestations including headache, blurring of vision, dizziness, nystagmus, ataxic gait, drowsiness, or even coma. Peripheral neuropathy, coagulopathy, lymphadenopathy, hepatosplenomegaly, and nonspecific constitutional symptoms are often present. An unusual gap between serum total protein and albumin indicates hyperglobulinemia, and a monoclonal IgM spike on serum protein electrophoresis helps establish an initial diagnosis. Bone marrow biopsy revealing more than 10% of lymphoid and plasmacytoid cells confirms the diagnosis. Unlike multiple myeloma, bony lesions are uncommon in Waldenstrom macroglobulinemia, whereas lymphadenopathy and organomegaly are uncommon in myeloma.Monoclonal gammopathy of undetermined significance (MGUS) is a premalignant plasma cell disorder which is often suspected and detected incidentally from routine blood workup. The patients are asymptomatic with no end-organ damage such as renal failure, hypercalcemia, anemia, or lytic bone lesion. The serum electrophoresis reveals an M spike but the amount of M-protein on immunofixation is usually less than 3 gm/dL and bone marrow contains less than 10% of monoclonal plasma cells. Monitoring of patients is important since MGUS can progress to multiple myeloma over a period of time. It is recommended to get the first evaluation 6 months after initial diagnosis followed by annual or biannual checkup.
|
Medicine
|
Oncology
| 195 |
{
"Correct Answer": "Monoclonal gammopathy of undetermined significance",
"Correct Option": "C",
"Options": {
"A": "Multiple myeloma",
"B": "Smoldering multiple myeloma",
"C": "Monoclonal gammopathy of undetermined significance",
"D": "Waldenstrom macroglobulinemia"
},
"Question": "A 71-year-old man is evaluated in the ER for a recent finding of high ESR in a routine blood test. He has history of hypertension, well controlled with metoprolol. His physical examination is completely normal. His laboratory workup reveals hemoglobin 12.6 gm/dL, leukocyte count 8500/mL, and platelet 265,000/mL. Total protein 6.2 g/dL, albumin 3.4 g/dL, BUN 16 mg/dL, creatinine 0.75 mg/dL, and calcium 9.2 mg/dL. Serum protein electrophoresis reveals a sharp, narrow spike, serum immunofixation reveals M-protein 1.2 gm/dL, bone marrow examination reveals less than 10% of monoclonal plasma cells. A skeletal survey is negative for any lytic lesions."
}
|
A 71-year-old man is evaluated in the ER for a recent finding of high ESR in a routine blood test. He has history of hypertension, well controlled with metoprolol. His physical examination is completely normal. His laboratory workup reveals hemoglobin 12.6 gm/dL, leukocyte count 8500/mL, and platelet 265,000/mL. Total protein 6.2 g/dL, albumin 3.4 g/dL, BUN 16 mg/dL, creatinine 0.75 mg/dL, and calcium 9.2 mg/dL. Serum protein electrophoresis reveals a sharp, narrow spike, serum immunofixation reveals M-protein 1.2 gm/dL, bone marrow examination reveals less than 10% of monoclonal plasma cells.
|
A skeletal survey is negative for any lytic lesions.
|
{
"A": "Multiple myeloma",
"B": "Smoldering multiple myeloma",
"C": "Monoclonal gammopathy of undetermined significance",
"D": "Waldenstrom macroglobulinemia"
}
|
C. Monoclonal gammopathy of undetermined significance
|
a8a006be-9d15-4e1d-8175-226aa3cde38a
|
A 26-year-old primigravid woman at 42 weeks' gestation comes to the labor and delivery ward for induction of labor. The prenatal course was significant for a positive group B Streptococcus culture performed at 35 weeks. Antenatal testing over the past 2 weeks has been unremarkable. The patient is staed on lactated Ringer's IV solution. Sterile vaginal examination shows that the patient's cervix is long, thick, and closeD. Prostaglandin (PGE2) gel is placed into the vagina, and electronic fetal hea rate monitoring is continueD. In approximately 60 minutes, the fetal hea rate falls to the 90s, as the tocodynamometer shows the uterus to be contracting every 1 minute with essentially no rest in between contractions. Which of the following was most likely the cause of the uterine hyper stimulation?
|
Infection
|
IV fluids
|
Postdates pregnancy
|
Prostaglandin (PGE2) gel
| 3d
|
multi
|
Prostaglandin (PGE2) gel is widely used for labor induction. In simple terms, it is used "to soften" an unorable cervix, to make the cervix more orable for induction. It has been shown to lead to an improvement in the Bishop's score, a shoer duration of labor, and deliveries. PGE2 gel can also cause uterine contractions. One of the major side effects with PGE2 gel is uterine hyper stimulation. This occurs when uterine contractions come one right after the other, or when there is a tetanic contraction. In this setting, the fetus can become hypoxic with a resultant bradycardia. This patient had the gel placed and 60 minutes later had uterine hyperstimulation. Infection has not been shown to cause uterine hyperstimulation. This patient's group B Streptococcus colonization is likely noncontributory. IV fluids do not cause uterine hyperstimulation. Postdates pregnancy is the reason for this patient's induction and not likely the direct cause of her uterine hyperstimulation. Vaginal examination with a cervical examination can be used for fetal scalp stimulation-rubbing the baby's head to provoke an acceleration of the fetal hea rate. However, this does not usually provoke uterine hyperstimulation.
|
Gynaecology & Obstetrics
| null | 191 |
{
"Correct Answer": "Prostaglandin (PGE2) gel",
"Correct Option": "D",
"Options": {
"A": "Infection",
"B": "IV fluids",
"C": "Postdates pregnancy",
"D": "Prostaglandin (PGE2) gel"
},
"Question": "A 26-year-old primigravid woman at 42 weeks' gestation comes to the labor and delivery ward for induction of labor. The prenatal course was significant for a positive group B Streptococcus culture performed at 35 weeks. Antenatal testing over the past 2 weeks has been unremarkable. The patient is staed on lactated Ringer's IV solution. Sterile vaginal examination shows that the patient's cervix is long, thick, and closeD. Prostaglandin (PGE2) gel is placed into the vagina, and electronic fetal hea rate monitoring is continueD. In approximately 60 minutes, the fetal hea rate falls to the 90s, as the tocodynamometer shows the uterus to be contracting every 1 minute with essentially no rest in between contractions. Which of the following was most likely the cause of the uterine hyper stimulation?"
}
|
A 26-year-old primigravid woman at 42 weeks' gestation comes to the labor and delivery ward for induction of labor. The prenatal course was significant for a positive group B Streptococcus culture performed at 35 weeks. Antenatal testing over the past 2 weeks has been unremarkable. The patient is staed on lactated Ringer's IV solution. Sterile vaginal examination shows that the patient's cervix is long, thick, and closeD. Prostaglandin (PGE2) gel is placed into the vagina, and electronic fetal hea rate monitoring is continueD. In approximately 60 minutes, the fetal hea rate falls to the 90s, as the tocodynamometer shows the uterus to be contracting every 1 minute with essentially no rest in between contractions.
|
Which of the following was most likely the cause of the uterine hyper stimulation?
|
{
"A": "Infection",
"B": "IV fluids",
"C": "Postdates pregnancy",
"D": "Prostaglandin (PGE2) gel"
}
|
D. Prostaglandin (PGE2) gel
|
24a3b80f-bc6a-415d-9c68-9ec9bc5f16d0
|
A 32 year old woamn with two live children was brought to emergency with the history of missed period for 15 dyas, spotting since 7 days and pain abdomen since 6hrs. Her pulse was 120/min, pallor ++, systolic BP BOmmHg. There was fullness and ternderness on per abdomen examination. Cu-T thread was seen through external os on P/S examination On PN examination, cervical movements were tender, uterus was bulky and soft. There was fullness in pouch of Douglas. She is most likely suffering from :
|
Pelvic inflammatory disease
|
Missed aboriton with infectkion
|
Rupture ectopic pregnancy
|
Threatened aboriton
| 2c
|
multi
|
Rupture ectopic pregnancy
|
Gynaecology & Obstetrics
| null | 121 |
{
"Correct Answer": "Rupture ectopic pregnancy",
"Correct Option": "C",
"Options": {
"A": "Pelvic inflammatory disease",
"B": "Missed aboriton with infectkion",
"C": "Rupture ectopic pregnancy",
"D": "Threatened aboriton"
},
"Question": "A 32 year old woamn with two live children was brought to emergency with the history of missed period for 15 dyas, spotting since 7 days and pain abdomen since 6hrs. Her pulse was 120/min, pallor ++, systolic BP BOmmHg. There was fullness and ternderness on per abdomen examination. Cu-T thread was seen through external os on P/S examination On PN examination, cervical movements were tender, uterus was bulky and soft. There was fullness in pouch of Douglas. She is most likely suffering from :"
}
|
A 32 year old woamn with two live children was brought to emergency with the history of missed period for 15 dyas, spotting since 7 days and pain abdomen since 6hrs. Her pulse was 120/min, pallor ++, systolic BP BOmmHg. There was fullness and ternderness on per abdomen examination. Cu-T thread was seen through external os on P/S examination On PN examination, cervical movements were tender, uterus was bulky and soft. There was fullness in pouch of Douglas.
|
She is most likely suffering from :
|
{
"A": "Pelvic inflammatory disease",
"B": "Missed aboriton with infectkion",
"C": "Rupture ectopic pregnancy",
"D": "Threatened aboriton"
}
|
C. Rupture ectopic pregnancy
|
a0a49f3a-6744-48ff-9661-0ecd2dcd6305
|
A 22-year-old woman consults you for treatment of hirsutism. She is obese and has facial acne and hirsutism on her face and periareolar regions and a male escutcheon. Serum LH level is 35 mIU/mL and FSH is 9 mIU/mL. Androstenedione and testosterone levels are mildly elevated, but serum DHAS is normal. The patient does not wish to conceive at this time. Which of the following single agents is the most appropriate treatment of her condition?
|
Oral contraceptives
|
Corticosteroids
|
GnRH
|
Parlodel
| 0a
|
single
|
This patient has polycystic ovarian syndrome (PCOS), diagnosed by the clinical picture, abnormally high LH-to-FSH ratio (which should normally be approximately 1:1), and elevated androgen but normal DHAS. DHAS is a marker of adrenal androgen production; when normal, it essentially excludes adrenal sources of hyperandrogenism. Several medications have been used to treat hirsutism associated with PCOS. For many years contraceptives were the most frequently used agents; they can suppress hair growth in up to two-thirds of treated patients. They act by directly suppressing ovarian steroid production and increasing hepatic binding globulin production, which binds circulating hormone and lowers the concentration of metabolically active (free unbound) androgen. However, clinical improvement can take as long as 6 months to manifest. Other medications that have shown promise include medroxyprogesterone acetate, spironolactone, cimetidine, and GnRH agonists, which suppress ovarian steroid production. However, GnRH analogues are expensive and have been associated with significant bone demineralization after only 6 months of therapy in some patients. Surgical wedge resection is no longer considered an appropriate therapy for PCOS given the success of pharmacologic agents and the ovarian adhesions that were frequently associated with this surgery.
|
Gynaecology & Obstetrics
|
Physiology & Histology
| 110 |
{
"Correct Answer": "Oral contraceptives",
"Correct Option": "A",
"Options": {
"A": "Oral contraceptives",
"B": "Corticosteroids",
"C": "GnRH",
"D": "Parlodel"
},
"Question": "A 22-year-old woman consults you for treatment of hirsutism. She is obese and has facial acne and hirsutism on her face and periareolar regions and a male escutcheon. Serum LH level is 35 mIU/mL and FSH is 9 mIU/mL. Androstenedione and testosterone levels are mildly elevated, but serum DHAS is normal. The patient does not wish to conceive at this time. Which of the following single agents is the most appropriate treatment of her condition?"
}
|
A 22-year-old woman consults you for treatment of hirsutism. She is obese and has facial acne and hirsutism on her face and periareolar regions and a male escutcheon. Serum LH level is 35 mIU/mL and FSH is 9 mIU/mL. Androstenedione and testosterone levels are mildly elevated, but serum DHAS is normal. The patient does not wish to conceive at this time.
|
Which of the following single agents is the most appropriate treatment of her condition?
|
{
"A": "Oral contraceptives",
"B": "Corticosteroids",
"C": "GnRH",
"D": "Parlodel"
}
|
A. Oral contraceptives
|
27c89b71-0f36-493d-8477-3b0b5bf9303a
|
A primigravida with full term pregnancy in labor for 1 day is brought to casualty after dia handing. On examination she is dehydrated, slightly pale, bulse 100/min, BP120 / 80 mm Hg. abdominal examination reveals a fundal height of 36 weeks, cephalic presentation, foetal hea absent, mild uterine contractions present. On PN examination, cervix is fully dialted, head is at +1 station, caput with moulding present, pelvis adequate. Diy, infected discharge is present. What would be the best management option after initial work-up ?
|
Cesarean section
|
Oxytocin drip
|
Ventouse delivery
|
Craniotomy and vaginal delivery
| 2c
|
multi
|
Ventouse delivery
|
Gynaecology & Obstetrics
| null | 135 |
{
"Correct Answer": "Ventouse delivery",
"Correct Option": "C",
"Options": {
"A": "Cesarean section",
"B": "Oxytocin drip",
"C": "Ventouse delivery",
"D": "Craniotomy and vaginal delivery"
},
"Question": "A primigravida with full term pregnancy in labor for 1 day is brought to casualty after dia handing. On examination she is dehydrated, slightly pale, bulse 100/min, BP120 / 80 mm Hg. abdominal examination reveals a fundal height of 36 weeks, cephalic presentation, foetal hea absent, mild uterine contractions present. On PN examination, cervix is fully dialted, head is at +1 station, caput with moulding present, pelvis adequate. Diy, infected discharge is present. What would be the best management option after initial work-up ?"
}
|
A primigravida with full term pregnancy in labor for 1 day is brought to casualty after dia handing. On examination she is dehydrated, slightly pale, bulse 100/min, BP120 / 80 mm Hg. abdominal examination reveals a fundal height of 36 weeks, cephalic presentation, foetal hea absent, mild uterine contractions present. On PN examination, cervix is fully dialted, head is at +1 station, caput with moulding present, pelvis adequate. Diy, infected discharge is present.
|
What would be the best management option after initial work-up ?
|
{
"A": "Cesarean section",
"B": "Oxytocin drip",
"C": "Ventouse delivery",
"D": "Craniotomy and vaginal delivery"
}
|
C. Ventouse delivery
|
886a2305-69db-4fc3-8270-5143c3b6c465
|
A 74-year-old man presents to the emergency department with new symptoms of blood tinged sputum. For the past week he has noticed streaks of blood in his chronic daily sputum production. He reports no fever or chills, but has lost 10 lb in the past 6 months involuntarily. His past medical history is significant for hypertension, dyslipidemia, and a 40-pack year history of smoking.On physical examination, he has bilateral expiratory wheezes, and there is clubbing of his fingers. No lymph nodes are detected and the remaining examination is normal. A CXR reveals a left hilar mass. Which of the following suggests that the tumor is a small cell lung cancer?
|
syndrome of inappropriate anti diuretic hormone (SIADH) secretion
|
acanthosis nigricans
|
Cushing syndrome
|
leukemoid reaction
| 0a
|
multi
|
SIADH is more characteristic of small cell lung cancer. Paraneoplastic syndromes are classified as metabolic, neuromuscular, connective tissue, dermatologic, and vascular. Acanthosis nigricans and other cutaneous manifestations (eg, dermatomyositis) are rare (< 1%). Clubbing is common and occurs in up to 30% of non-small cell lung cancers. The various endocrine syndromes occur in 12% of cases. At times, paraneoplastic syndromes may be the presenting finding in lung cancer or be the first sign of recurrence, most occur with non-small cell lung cancer. Stevens-Johnson syndrome usually follows drug allergy and is not a paraneoplastic syndrome.
|
Medicine
|
Respiratory
| 152 |
{
"Correct Answer": "syndrome of inappropriate anti diuretic hormone (SIADH) secretion",
"Correct Option": "A",
"Options": {
"A": "syndrome of inappropriate anti diuretic hormone (SIADH) secretion",
"B": "acanthosis nigricans",
"C": "Cushing syndrome",
"D": "leukemoid reaction"
},
"Question": "A 74-year-old man presents to the emergency department with new symptoms of blood tinged sputum. For the past week he has noticed streaks of blood in his chronic daily sputum production. He reports no fever or chills, but has lost 10 lb in the past 6 months involuntarily. His past medical history is significant for hypertension, dyslipidemia, and a 40-pack year history of smoking.On physical examination, he has bilateral expiratory wheezes, and there is clubbing of his fingers. No lymph nodes are detected and the remaining examination is normal. A CXR reveals a left hilar mass. Which of the following suggests that the tumor is a small cell lung cancer?"
}
|
A 74-year-old man presents to the emergency department with new symptoms of blood tinged sputum. For the past week he has noticed streaks of blood in his chronic daily sputum production. He reports no fever or chills, but has lost 10 lb in the past 6 months involuntarily. His past medical history is significant for hypertension, dyslipidemia, and a 40-pack year history of smoking.On physical examination, he has bilateral expiratory wheezes, and there is clubbing of his fingers. No lymph nodes are detected and the remaining examination is normal. A CXR reveals a left hilar mass.
|
Which of the following suggests that the tumor is a small cell lung cancer?
|
{
"A": "syndrome of inappropriate anti diuretic hormone (SIADH) secretion",
"B": "acanthosis nigricans",
"C": "Cushing syndrome",
"D": "leukemoid reaction"
}
|
A. syndrome of inappropriate anti diuretic hormone (SIADH) secretion
|
574c048e-6176-4e88-8a5b-77e2baf73a4f
|
Mrs AR G3 P1LIA a full term pregnant female is admitted in labor. On examination, she has uterine contractions 2 in 10 minutes, lasting for 30-35 seconds.On P/A examination 3/5th of the head is palpable per abdomen.On P/V examination-cervix is 4 cms dilated, membranes intact.On repeat examination 4 hours later, cervix is 5 cms dilated, station is unchanged, and cervicograph remains to the right of the alert line. Which of the following statements is true?
|
The head was engaged at the time a of presentation
|
Her cervicographical progress is satisfactory
|
Her cervicographical status suggests intervention
|
On repeat examination, her cervicograph should have touched the action line.
| 2c
|
multi
|
In this patient at the beginning of the labor, three fifths of the head was palpable , which indicates head is not engaged as head is said to be engaged only if 1/5th is palpable per abdomen…
|
Gynaecology & Obstetrics
| null | 121 |
{
"Correct Answer": "Her cervicographical status suggests intervention",
"Correct Option": "C",
"Options": {
"A": "The head was engaged at the time a of presentation",
"B": "Her cervicographical progress is satisfactory",
"C": "Her cervicographical status suggests intervention",
"D": "On repeat examination, her cervicograph should have touched the action line."
},
"Question": "Mrs AR G3 P1LIA a full term pregnant female is admitted in labor. On examination, she has uterine contractions 2 in 10 minutes, lasting for 30-35 seconds.On P/A examination 3/5th of the head is palpable per abdomen.On P/V examination-cervix is 4 cms dilated, membranes intact.On repeat examination 4 hours later, cervix is 5 cms dilated, station is unchanged, and cervicograph remains to the right of the alert line. Which of the following statements is true?"
}
|
Mrs AR G3 P1LIA a full term pregnant female is admitted in labor. On examination, she has uterine contractions 2 in 10 minutes, lasting for 30-35 seconds.On P/A examination 3/5th of the head is palpable per abdomen.On P/V examination-cervix is 4 cms dilated, membranes intact.On repeat examination 4 hours later, cervix is 5 cms dilated, station is unchanged, and cervicograph remains to the right of the alert line.
|
Which of the following statements is true?
|
{
"A": "The head was engaged at the time a of presentation",
"B": "Her cervicographical progress is satisfactory",
"C": "Her cervicographical status suggests intervention",
"D": "On repeat examination, her cervicograph should have touched the action line."
}
|
C. Her cervicographical status suggests intervention
|
a6041966-7695-426e-bd28-340545d93f0a
|
A 56-year-old woman presents to the hospital because of symptoms of dyspnea, blurry vision, and headaches. The symptoms started that morning and are getting worse. Her past medical history is significant for hypertension and osteoarthritis. She stopped taking her anti-hypertensive medications 3 months ago because of side effects.On examination, her blood pressure is 210/130 mm Hg, heart rate 100 beats/min, and oxygen saturation 95%. Her fundi reveal retinal hemorrhages and papilledema. The heart sounds are normal expect for an S4, and the lungs have lower lobe crackles. Which of the following is the most appropriate agent to reduce her blood pressure?
|
IV hydralazine
|
IV labetalol
|
oral methyldopa
|
IV nitroprusside
| 3d
|
single
|
Nitroprusside is very effective in lowering blood pressure and is easy to titrate and adjust to response. Labetalol is also useful since is can be administered in an oral preparation, but has more contraindications. It is particularly useful in the setting of angina or myocardial infarction. Regardless of which drug is selected, early administration of medications for long-term control is mandatory.
|
Medicine
|
C.V.S.
| 152 |
{
"Correct Answer": "IV nitroprusside",
"Correct Option": "D",
"Options": {
"A": "IV hydralazine",
"B": "IV labetalol",
"C": "oral methyldopa",
"D": "IV nitroprusside"
},
"Question": "A 56-year-old woman presents to the hospital because of symptoms of dyspnea, blurry vision, and headaches. The symptoms started that morning and are getting worse. Her past medical history is significant for hypertension and osteoarthritis. She stopped taking her anti-hypertensive medications 3 months ago because of side effects.On examination, her blood pressure is 210/130 mm Hg, heart rate 100 beats/min, and oxygen saturation 95%. Her fundi reveal retinal hemorrhages and papilledema. The heart sounds are normal expect for an S4, and the lungs have lower lobe crackles. Which of the following is the most appropriate agent to reduce her blood pressure?"
}
|
A 56-year-old woman presents to the hospital because of symptoms of dyspnea, blurry vision, and headaches. The symptoms started that morning and are getting worse. Her past medical history is significant for hypertension and osteoarthritis. She stopped taking her anti-hypertensive medications 3 months ago because of side effects.On examination, her blood pressure is 210/130 mm Hg, heart rate 100 beats/min, and oxygen saturation 95%. Her fundi reveal retinal hemorrhages and papilledema. The heart sounds are normal expect for an S4, and the lungs have lower lobe crackles.
|
Which of the following is the most appropriate agent to reduce her blood pressure?
|
{
"A": "IV hydralazine",
"B": "IV labetalol",
"C": "oral methyldopa",
"D": "IV nitroprusside"
}
|
D. IV nitroprusside
|
61df426d-e3aa-4086-9a0d-e623037b9c39
|
During heterosexual intercourse, seminal fluid containing HIV contacts vaginal squamous mucosa. Cells capture virions and transport the virus via lymphatics to regional lymph nodes. Within the germinal centers of these lymph nodes, the virions infect CD4+ lymphocytes and proliferate, causing CD4+ cell lysis with release of more virions, which are taken up on the surface of cells having Fc receptors, allowing continued infection by HIV of more CD4+ cells passing through the nodes. Which of the following types of cells is most likely to capture HIV on its surface via Fc receptors?
|
B lymphocyte
|
CD8+ cytotoxic lymphocyte
|
Follicular dendritic cell
|
Natural Killer cell
| 2c
|
multi
|
Dendritic cells are a form of antigen-presenting cell. Dendritic cells in epithelia are known as Langerhans cells, and those within germinal centers are called follicular dendritic cells (FDCs). The FDCs may become infected but not killed by HIV. They have cell surface Fc receptors that capture antibody-coated HIV virions through the Fc portion of the antibody. These virions attached to the FDCs can infect passing CD4+ lymphocytes. Dendritic cells elaborate type I interferons that up-regulate antiviral proteins in neighboring cells. B cells are a component of humoral immunity, and antibody to HIV does not serve a protective function, but allows serologic detection of infection. CD8+ cells are cytotoxic lymphocytes that lack the receptor necessary for infection by HIV. Because they survive selectively, the CD4+:CD8+ ratio is reversed so that it is typically less than 1 with advanced HIV infection. Innate lymphoid cells resemble NK cells, but shape further lymphoid reactions. Langhans giant cells are "committees" of activated macrophages that are part of a granulomatous response. Macrophages are a type of antigen- presenting cell that can become infected by HIV without destruction. Mast cells have surface-bound IgE, which can be cross-linked by antigens (allergens) to cause degranulation and release of vasoactive amines, such as histamine, as part of anaphylaxis with type I hypersensitivity.
|
Pathology
|
Immunity
| 120 |
{
"Correct Answer": "Follicular dendritic cell",
"Correct Option": "C",
"Options": {
"A": "B lymphocyte",
"B": "CD8+ cytotoxic lymphocyte",
"C": "Follicular dendritic cell",
"D": "Natural Killer cell"
},
"Question": "During heterosexual intercourse, seminal fluid containing HIV contacts vaginal squamous mucosa. Cells capture virions and transport the virus via lymphatics to regional lymph nodes. Within the germinal centers of these lymph nodes, the virions infect CD4+ lymphocytes and proliferate, causing CD4+ cell lysis with release of more virions, which are taken up on the surface of cells having Fc receptors, allowing continued infection by HIV of more CD4+ cells passing through the nodes. Which of the following types of cells is most likely to capture HIV on its surface via Fc receptors?"
}
|
During heterosexual intercourse, seminal fluid containing HIV contacts vaginal squamous mucosa. Cells capture virions and transport the virus via lymphatics to regional lymph nodes. Within the germinal centers of these lymph nodes, the virions infect CD4+ lymphocytes and proliferate, causing CD4+ cell lysis with release of more virions, which are taken up on the surface of cells having Fc receptors, allowing continued infection by HIV of more CD4+ cells passing through the nodes.
|
Which of the following types of cells is most likely to capture HIV on its surface via Fc receptors?
|
{
"A": "B lymphocyte",
"B": "CD8+ cytotoxic lymphocyte",
"C": "Follicular dendritic cell",
"D": "Natural Killer cell"
}
|
C. Follicular dendritic cell
|
b8ffccf7-bd90-4c58-82a8-7fd2cd3be7ae
|
Calculate the specificity of the screening test:\r\n \r\n \r\n\r\n\r\n\r\nScreening test results\r\n\r\n\r\nDiseased\r\n\r\nNot diseased\r\nTotal\r\n\r\n\r\n\r\nPositive\r\n\r\n\r\n400\r\n\r\n\r\n200\r\n\r\n\r\n600\r\n\r\n\r\n\r\n\r\nNegative\r\n\r\n\r\n100\r\n\r\n\r\n600\r\n\r\n\r\n700\r\n\r\n\r\n\r\n\r\nTotal\r\n\r\n\r\n500\r\n\r\n\r\n800\r\n\r\n\r\n1300\r\n\r\n\r\n\r\n
|
70 per cent
|
75 per cent
|
80 per cent
|
85 per cent
| 1b
|
single
|
Specificity is the ability of a test to identify correctly those who do not have the disease, that is, the percentage of "true negatives" among those not diseased. In the above question, there are 600 true negatives among 800 who are not diseased. Hence, the specificity is (600/800)x100 = 75 per cent. Ref: Park's Textbook Of Preventive And Social Medicine, By K. Park, 19th Edition, Pages 118, 119.
|
Social & Preventive Medicine
| null | 167 |
{
"Correct Answer": "75 per cent",
"Correct Option": "B",
"Options": {
"A": "70 per cent",
"B": "75 per cent",
"C": "80 per cent",
"D": "85 per cent"
},
"Question": "Calculate the specificity of the screening test:\\r\\n \\r\\n \\r\\n\\r\\n\\r\\n\\r\\nScreening test results\\r\\n\\r\\n\\r\\nDiseased\\r\\n\\r\\nNot diseased\\r\\nTotal\\r\\n\\r\\n\\r\\n\\r\\nPositive\\r\\n\\r\\n\\r\\n400\\r\\n\\r\\n\\r\\n200\\r\\n\\r\\n\\r\\n600\\r\\n\\r\\n\\r\\n\\r\\n\\r\\nNegative\\r\\n\\r\\n\\r\\n100\\r\\n\\r\\n\\r\\n600\\r\\n\\r\\n\\r\\n700\\r\\n\\r\\n\\r\\n\\r\\n\\r\\nTotal\\r\\n\\r\\n\\r\\n500\\r\\n\\r\\n\\r\\n800\\r\\n\\r\\n\\r\\n1300\\r\\n\\r\\n\\r\\n\\r\\n"
}
|
.
|
Calculate the specificity of the screening test:\r\n \r\n \r\n\r\n\r\n\r\nScreening test results\r\n\r\n\r\nDiseased\r\n\r\nNot diseased\r\nTotal\r\n\r\n\r\n\r\nPositive\r\n\r\n\r\n400\r\n\r\n\r\n200\r\n\r\n\r\n600\r\n\r\n\r\n\r\n\r\nNegative\r\n\r\n\r\n100\r\n\r\n\r\n600\r\n\r\n\r\n700\r\n\r\n\r\n\r\n\r\nTotal\r\n\r\n\r\n500\r\n\r\n\r\n800\r\n\r\n\r\n1300\r\n\r\n\r\n\r\n
|
{
"A": "70 per cent",
"B": "75 per cent",
"C": "80 per cent",
"D": "85 per cent"
}
|
B. 75 per cent
|
858313d5-1414-4f5a-be4b-5cf214465471
|
A 25-year-old woman is concerned about a lump on the left side of her neck that has remained the same size for the past year. Physical examination shows a painless, movable, 3-cm nodule beneath the skin of the left lateral neck just above the level of the thyroid cartilage. There are no other remarkable findings. Fine-needle aspiration of the mass is performed. Her physician is less than impressed by the pathology report, which notes, "Granular and keratinaceous cellular debris". Fortunately, she has saved her Robbins pathology textbook from medical school. She consults the head and neck chapter to arrive at a diagnosis, using the data from the report. Which of the following terms best describes this nodule?
|
Branchial cyst
|
Metastatic thyroid carcinoma
|
Mucocele
|
Mucoepidermoid tumor
| 0a
|
multi
|
Branchial cysts, also known as lymphoepithelial cysts, may be remnants of an embryonic branchial arch or a salivary gland inclusion in a cervical lymph node. They are distinguished from thyroglossal duct cysts by their lateral location, the absence of thyroid tissue, and their abundant lymphoid tissue. Occult thyroid carcinoma, often a papillary carcinoma, may manifest as a metastasis to a node in the neck, but the microscopic pattern is that of a carcinoma. About 5% of squamous cell carcinomas of the head and neck initially manifest as a nodal metastasis, without an obvious primary site. This patient is quite young for such an event, however. Mucoceles form in minor salivary glands; mucoepidermoid tumors form in salivary glands. The nodule in this patient is in the neck. Paragangliomas are solid tumors that may arise deep in the region of the carotid body near the common carotid bifurcation.
|
Pathology
|
Head & Neck
| 150 |
{
"Correct Answer": "Branchial cyst",
"Correct Option": "A",
"Options": {
"A": "Branchial cyst",
"B": "Metastatic thyroid carcinoma",
"C": "Mucocele",
"D": "Mucoepidermoid tumor"
},
"Question": "A 25-year-old woman is concerned about a lump on the left side of her neck that has remained the same size for the past year. Physical examination shows a painless, movable, 3-cm nodule beneath the skin of the left lateral neck just above the level of the thyroid cartilage. There are no other remarkable findings. Fine-needle aspiration of the mass is performed. Her physician is less than impressed by the pathology report, which notes, \"Granular and keratinaceous cellular debris\". Fortunately, she has saved her Robbins pathology textbook from medical school. She consults the head and neck chapter to arrive at a diagnosis, using the data from the report. Which of the following terms best describes this nodule?"
}
|
A 25-year-old woman is concerned about a lump on the left side of her neck that has remained the same size for the past year. Physical examination shows a painless, movable, 3-cm nodule beneath the skin of the left lateral neck just above the level of the thyroid cartilage. There are no other remarkable findings. Fine-needle aspiration of the mass is performed. Her physician is less than impressed by the pathology report, which notes, "Granular and keratinaceous cellular debris". Fortunately, she has saved her Robbins pathology textbook from medical school. She consults the head and neck chapter to arrive at a diagnosis, using the data from the report.
|
Which of the following terms best describes this nodule?
|
{
"A": "Branchial cyst",
"B": "Metastatic thyroid carcinoma",
"C": "Mucocele",
"D": "Mucoepidermoid tumor"
}
|
A. Branchial cyst
|
8c964ed5-4c02-4703-9be0-4292637448e0
|
A 76-year-old woman presents to the office for evaluation of symptoms of weight loss, anxiety, and palpitations. The symptoms started 1 month ago, and are involuntary. She has no prior history of anxiety or palpitations and her only medical history is hypertension for which she is taking losartan.On examination, the blood pressure is 120/70 mm Hg, heart rate is 100/min and regular. On auscultation the heart sounds are normal and the lung clear. There is a thyroid goiter, warm skin, and a fine tremor in her hands. Which of the following is the most likely cardiac finding?
|
prolonged circulation time
|
decreased cardiac output
|
paroxysmal atrial fibrillation
|
pericardial effusion
| 2c
|
single
|
Atrial fibrillation is particularly common in older individuals with hyperthyroidism. Thyroid disease may affect the heart muscle directly or there may be excessive sympathetic stimulation. Common symptoms of thyrotoxic heart disease include palpitations, exertional dyspnea, and worsening angina. Pericardial effusion, and aortic insufficiency are not usual finding in thyrotoxicosis, and the cardiac output is increased in hyperthyroidism, not decreased.
|
Medicine
|
C.V.S.
| 136 |
{
"Correct Answer": "paroxysmal atrial fibrillation",
"Correct Option": "C",
"Options": {
"A": "prolonged circulation time",
"B": "decreased cardiac output",
"C": "paroxysmal atrial fibrillation",
"D": "pericardial effusion"
},
"Question": "A 76-year-old woman presents to the office for evaluation of symptoms of weight loss, anxiety, and palpitations. The symptoms started 1 month ago, and are involuntary. She has no prior history of anxiety or palpitations and her only medical history is hypertension for which she is taking losartan.On examination, the blood pressure is 120/70 mm Hg, heart rate is 100/min and regular. On auscultation the heart sounds are normal and the lung clear. There is a thyroid goiter, warm skin, and a fine tremor in her hands. Which of the following is the most likely cardiac finding?"
}
|
A 76-year-old woman presents to the office for evaluation of symptoms of weight loss, anxiety, and palpitations. The symptoms started 1 month ago, and are involuntary. She has no prior history of anxiety or palpitations and her only medical history is hypertension for which she is taking losartan.On examination, the blood pressure is 120/70 mm Hg, heart rate is 100/min and regular. On auscultation the heart sounds are normal and the lung clear. There is a thyroid goiter, warm skin, and a fine tremor in her hands.
|
Which of the following is the most likely cardiac finding?
|
{
"A": "prolonged circulation time",
"B": "decreased cardiac output",
"C": "paroxysmal atrial fibrillation",
"D": "pericardial effusion"
}
|
C. paroxysmal atrial fibrillation
|
217fdbba-d125-4dab-9cda-4e3224b18acf
|
A 42 year old man comes to ENT OPD. He is a follow up case of recurrent sinus and ear infection from past 1 year. It is also associated with headache. He gives history of pollen allergy. Currently, he presented with complains of blood tinged sputum and cough. Chest x ray is done with B/L nodular infiltrates and cavitary infiltrates. CT SCAN is planned. CT guide biopsy is planned from the above x ray located mass and is shown below: Lab investigation reveal raised ESR and c ANCA positivity Which of the following is the least likely diagnosis?
|
Wegener granulomatosis
|
Churg strauss sundrome
|
Rheumatoid lung involvement
|
Good pasture syndrome
| 2c
|
multi
|
X ray shows bilateral nodular shadow with cavitary lesion i/v/o clinical s/s and lab investigation-possibility of wegener granulomatosis exists. CT scan shows multiple bilateral cavitary lesions. HPE- Histiocytes and giant cells surrounding a central necrotic zone. Vasculitis: neutrophils and lymphocytes involving aeriole wall. Recurrent sinusitis with hemoptysis raises following differential diagnosis: Acute bronchitis Wegener granulomatosis Churg strauss syndrome Goodpasture syndrome Bronchogenic carcinoma Upper and lower respiratory symptoms. With significant cxr and HPE , elevated ESR and cANCA positivity is suggestive of WEGENER granulomatosis as the diagnosis.
|
Unknown
|
Integrated QBank
| 124 |
{
"Correct Answer": "Rheumatoid lung involvement",
"Correct Option": "C",
"Options": {
"A": "Wegener granulomatosis",
"B": "Churg strauss sundrome",
"C": "Rheumatoid lung involvement",
"D": "Good pasture syndrome"
},
"Question": "A 42 year old man comes to ENT OPD. He is a follow up case of recurrent sinus and ear infection from past 1 year. It is also associated with headache. He gives history of pollen allergy. Currently, he presented with complains of blood tinged sputum and cough. Chest x ray is done with B/L nodular infiltrates and cavitary infiltrates. CT SCAN is planned. CT guide biopsy is planned from the above x ray located mass and is shown below: Lab investigation reveal raised ESR and c ANCA positivity Which of the following is the least likely diagnosis?"
}
|
A 42 year old man comes to ENT OPD. He is a follow up case of recurrent sinus and ear infection from past 1 year. It is also associated with headache. He gives history of pollen allergy. Currently, he presented with complains of blood tinged sputum and cough. Chest x ray is done with B/L nodular infiltrates and cavitary infiltrates. CT SCAN is planned.
|
CT guide biopsy is planned from the above x ray located mass and is shown below: Lab investigation reveal raised ESR and c ANCA positivity Which of the following is the least likely diagnosis?
|
{
"A": "Wegener granulomatosis",
"B": "Churg strauss sundrome",
"C": "Rheumatoid lung involvement",
"D": "Good pasture syndrome"
}
|
C. Rheumatoid lung involvement
|
5b5be82e-7b4e-4c9a-ad0e-2a25f448c771
|
A 50-year-old woman is brought to the emergency department unconscious following a motor vehicle accident. She is placed on telemetry to monitor her vitals continuously, and she remains hypotensive despite receiving a bolus of fluids and being placed on IV fluids. She regains consciousness and her pulse is 180/mm. Her ECG shows regularly spaced narrow, QRS complexes. No P wave is visible in most leads, but there is a small downward deflection immediately following QRS complexes in lead II. A carotid massage is performed, and her pulse is reduced to 80/rn in.
Stimulation of the afferent fibres in which of the following nerves most likely resulted in the favourable response observed?
|
Cardiac sympathetic nerves
|
Carotid sympathetic nerves
|
Glossopharyngeal nerve
|
Hypoglossal nerve
| 2c
|
multi
| null |
Medicine
| null | 151 |
{
"Correct Answer": "Glossopharyngeal nerve",
"Correct Option": "C",
"Options": {
"A": "Cardiac sympathetic nerves",
"B": "Carotid sympathetic nerves",
"C": "Glossopharyngeal nerve",
"D": "Hypoglossal nerve"
},
"Question": "A 50-year-old woman is brought to the emergency department unconscious following a motor vehicle accident. She is placed on telemetry to monitor her vitals continuously, and she remains hypotensive despite receiving a bolus of fluids and being placed on IV fluids. She regains consciousness and her pulse is 180/mm. Her ECG shows regularly spaced narrow, QRS complexes. No P wave is visible in most leads, but there is a small downward deflection immediately following QRS complexes in lead II. A carotid massage is performed, and her pulse is reduced to 80/rn in. \nStimulation of the afferent fibres in which of the following nerves most likely resulted in the favourable response observed?"
}
|
A 50-year-old woman is brought to the emergency department unconscious following a motor vehicle accident. She is placed on telemetry to monitor her vitals continuously, and she remains hypotensive despite receiving a bolus of fluids and being placed on IV fluids. She regains consciousness and her pulse is 180/mm. Her ECG shows regularly spaced narrow, QRS complexes. No P wave is visible in most leads, but there is a small downward deflection immediately following QRS complexes in lead II. A carotid massage is performed, and her pulse is reduced to 80/rn in.
|
Stimulation of the afferent fibres in which of the following nerves most likely resulted in the favourable response observed?
|
{
"A": "Cardiac sympathetic nerves",
"B": "Carotid sympathetic nerves",
"C": "Glossopharyngeal nerve",
"D": "Hypoglossal nerve"
}
|
C. Glossopharyngeal nerve
|
cc94d774-751d-4133-a78d-23b3d5247b8c
|
A young motorist suffered injuries in a major road traffic accident. He was diagnosed to have a fracture of the left femur and left humerus. He was also having fractures of multiple ribs anteriorly on both the sides. In the examination, the blood pressure was 80/ 60 mm Hg. and heart rate was 140/minute. The patient was agitated, restless, and tachypneic. Jugular veins were distended. Air entry was adequate in both the lung fields. Heart sounds were barely audible. Femoral pulses were weakly palpable but distally no pulsation could be felt. On a priority basis, the immediate intervention would be -
|
Rapid blood transfusion.
|
Urgent pericardial tap.
|
Intercostal tube drainage on both the sides.
|
Fixation of left femur and repair of femoral artery.
| 1b
|
multi
| null |
Medicine
| null | 143 |
{
"Correct Answer": "Urgent pericardial tap.",
"Correct Option": "B",
"Options": {
"A": "Rapid blood transfusion.",
"B": "Urgent pericardial tap.",
"C": "Intercostal tube drainage on both the sides.",
"D": "Fixation of left femur and repair of femoral artery."
},
"Question": "A young motorist suffered injuries in a major road traffic accident. He was diagnosed to have a fracture of the left femur and left humerus. He was also having fractures of multiple ribs anteriorly on both the sides. In the examination, the blood pressure was 80/ 60 mm Hg. and heart rate was 140/minute. The patient was agitated, restless, and tachypneic. Jugular veins were distended. Air entry was adequate in both the lung fields. Heart sounds were barely audible. Femoral pulses were weakly palpable but distally no pulsation could be felt. On a priority basis, the immediate intervention would be -"
}
|
A young motorist suffered injuries in a major road traffic accident. He was diagnosed to have a fracture of the left femur and left humerus. He was also having fractures of multiple ribs anteriorly on both the sides. In the examination, the blood pressure was 80/ 60 mm Hg. and heart rate was 140/minute. The patient was agitated, restless, and tachypneic. Jugular veins were distended. Air entry was adequate in both the lung fields. Heart sounds were barely audible. Femoral pulses were weakly palpable but distally no pulsation could be felt.
|
On a priority basis, the immediate intervention would be -
|
{
"A": "Rapid blood transfusion.",
"B": "Urgent pericardial tap.",
"C": "Intercostal tube drainage on both the sides.",
"D": "Fixation of left femur and repair of femoral artery."
}
|
B. Urgent pericardial tap.
|
29a3d693-c655-403e-b37e-c3ea7d78e995
|
A study is conducted to assess the risk of acquiring a severely debilitating disease over a 1- year study period. Only males are susceptible to the disease, which can be diagnosed using 4 basic clinical criteria. In a population of 100,000 people. 10 men met all the criteria. An additional 90 men demonstrated mild symptoms but failed to meet the full criteria.
Assuming a male:female ratio of 1:1 in this population, which of the following is the male risk of being diagnosed with this disease?
|
0.01%
|
0.02%
|
0.20%
|
0.40%
| 1b
|
multi
| null |
Social & Preventive Medicine
| null | 115 |
{
"Correct Answer": "0.02%",
"Correct Option": "B",
"Options": {
"A": "0.01%",
"B": "0.02%",
"C": "0.20%",
"D": "0.40%"
},
"Question": "A study is conducted to assess the risk of acquiring a severely debilitating disease over a 1- year study period. Only males are susceptible to the disease, which can be diagnosed using 4 basic clinical criteria. In a population of 100,000 people. 10 men met all the criteria. An additional 90 men demonstrated mild symptoms but failed to meet the full criteria. \nAssuming a male:female ratio of 1:1 in this population, which of the following is the male risk of being diagnosed with this disease?"
}
|
A study is conducted to assess the risk of acquiring a severely debilitating disease over a 1- year study period. Only males are susceptible to the disease, which can be diagnosed using 4 basic clinical criteria. In a population of 100,000 people. 10 men met all the criteria. An additional 90 men demonstrated mild symptoms but failed to meet the full criteria.
|
Assuming a male:female ratio of 1:1 in this population, which of the following is the male risk of being diagnosed with this disease?
|
{
"A": "0.01%",
"B": "0.02%",
"C": "0.20%",
"D": "0.40%"
}
|
B. 0.02%
|
8c79dfd4-6e97-47b1-9e05-f1218cf46f99
|
A young butcher cuts his forearm with a knife. Over the next week, he notices swelling, redness, and warmth at the site. Four days later, he presents to the emergency depament with fever, shaking chills and severe lower back pain. Physical examination reveals a temperature of 39.4 C (102.9 F), swelling in his forearm with an area of central softness, and tenderness to pressure over his lower spine. Laboratory data show a leukocyte count of 14,000/mm3 with 81% polymorphonuclear leukocytes. Blood cultures grew a gram positive cocci in clusters on blood agar; colonies show a yellow pigment, and the organism is positive on mannitol/salt agar. The organism is catalase and coagulase positive. Which of the following is the most likely pathogen?
|
Bacteroides fragilis
|
Clostridium perfringens
|
Escherichia coli
|
Staphylococcus aureus
| 3d
|
single
|
This organism is a gram positive coccus organized into grape-like clusters. It produces a yellow pigment and the positive mannitol salt agar test showed that it could ferment mannitol and had a high salt tolerance. This organism is catalase positive and coagulase positive, two critical tests for the correct identification of Staphylococcus aureus. Bacteroides fragilis is a gram-negative rod that grows anaerobically. It does cause abscesses, but does not have the characteristics described for the organism in this case. Clostridium perfringens is a gram-positive spore forming organism that causes gangrene. It would not grow aerobically on blood agar. The organism can ceainly spread in the skin when introduced by trauma, but would not demonstrate the biochemical profile described. Escherichia coli is a gram-negative rod that would grow on the blood agar but would not produce yellow pigment. Growth on MacConkey's agar after it was gram-stained would indicate lactose fermentation, and other biochemical tests would be used to specifically identify the organism.
|
Microbiology
| null | 177 |
{
"Correct Answer": "Staphylococcus aureus",
"Correct Option": "D",
"Options": {
"A": "Bacteroides fragilis",
"B": "Clostridium perfringens",
"C": "Escherichia coli",
"D": "Staphylococcus aureus"
},
"Question": "A young butcher cuts his forearm with a knife. Over the next week, he notices swelling, redness, and warmth at the site. Four days later, he presents to the emergency depament with fever, shaking chills and severe lower back pain. Physical examination reveals a temperature of 39.4 C (102.9 F), swelling in his forearm with an area of central softness, and tenderness to pressure over his lower spine. Laboratory data show a leukocyte count of 14,000/mm3 with 81% polymorphonuclear leukocytes. Blood cultures grew a gram positive cocci in clusters on blood agar; colonies show a yellow pigment, and the organism is positive on mannitol/salt agar. The organism is catalase and coagulase positive. Which of the following is the most likely pathogen?"
}
|
A young butcher cuts his forearm with a knife. Over the next week, he notices swelling, redness, and warmth at the site. Four days later, he presents to the emergency depament with fever, shaking chills and severe lower back pain. Physical examination reveals a temperature of 39.4 C (102.9 F), swelling in his forearm with an area of central softness, and tenderness to pressure over his lower spine. Laboratory data show a leukocyte count of 14,000/mm3 with 81% polymorphonuclear leukocytes. Blood cultures grew a gram positive cocci in clusters on blood agar; colonies show a yellow pigment, and the organism is positive on mannitol/salt agar. The organism is catalase and coagulase positive.
|
Which of the following is the most likely pathogen?
|
{
"A": "Bacteroides fragilis",
"B": "Clostridium perfringens",
"C": "Escherichia coli",
"D": "Staphylococcus aureus"
}
|
D. Staphylococcus aureus
|
4d196cf2-e061-4bd7-b05c-c3a2457a5613
|
A thyroid biopsy obtained from a 29-year-old woman complains of nervousness and muscle weakness of 6 months in duration. She is intolerant of heat and sweats excessively. She has lost 9 kg (20 lb) pounds over past 6 months, despite increased caloric intake. She frequently finds her hea racing and can feel it pounding in her chest. She also states that she has missed several menstrual periods over the past few months. Physical examination reveals warm and moist skin and bulging eyes (exophthalmos). Which of the following best describes the pathologic findings?
|
Atrophy and fibrosis
|
Dense lymphoid infiltrate with germinal centers
|
Follicular hyperplasia with scalloping of colloid
|
Necrotizing parenchymal granulomas
| 2c
|
multi
|
- Clinical features given suggests the diagnosis of Graves disease - Microscopic findings: Follicular hyperophy & hyperplasia resulting in crowding. Crowding results in papillae formation with no fibrovascular core Colloid is pink & scalloped at periphery adjacent to follicular cells. - Diffuse increase in size of gland is seen - Lymphoid infiltrates consisting predominantly of T cells, with fewer B cells & mature plasma cells are present throughout interstitium.
|
Pathology
|
Hypehyroidism and Goitre
| 122 |
{
"Correct Answer": "Follicular hyperplasia with scalloping of colloid",
"Correct Option": "C",
"Options": {
"A": "Atrophy and fibrosis",
"B": "Dense lymphoid infiltrate with germinal centers",
"C": "Follicular hyperplasia with scalloping of colloid",
"D": "Necrotizing parenchymal granulomas"
},
"Question": "A thyroid biopsy obtained from a 29-year-old woman complains of nervousness and muscle weakness of 6 months in duration. She is intolerant of heat and sweats excessively. She has lost 9 kg (20 lb) pounds over past 6 months, despite increased caloric intake. She frequently finds her hea racing and can feel it pounding in her chest. She also states that she has missed several menstrual periods over the past few months. Physical examination reveals warm and moist skin and bulging eyes (exophthalmos). Which of the following best describes the pathologic findings?"
}
|
A thyroid biopsy obtained from a 29-year-old woman complains of nervousness and muscle weakness of 6 months in duration. She is intolerant of heat and sweats excessively. She has lost 9 kg (20 lb) pounds over past 6 months, despite increased caloric intake. She frequently finds her hea racing and can feel it pounding in her chest. She also states that she has missed several menstrual periods over the past few months. Physical examination reveals warm and moist skin and bulging eyes (exophthalmos).
|
Which of the following best describes the pathologic findings?
|
{
"A": "Atrophy and fibrosis",
"B": "Dense lymphoid infiltrate with germinal centers",
"C": "Follicular hyperplasia with scalloping of colloid",
"D": "Necrotizing parenchymal granulomas"
}
|
C. Follicular hyperplasia with scalloping of colloid
|
2da49705-3f6f-4fda-8cfd-4fa2900434b7
|
An 18-year-old sexually active college student presents with complaints of lower abdominal pain and irregular bleeding for five days. She has no fever. She uses oral contraceptives as method of bih control. Upon examination, the cervix is friable, there is cervical motion tenderness and adnexal tenderness. The pregnancy test is negative. She tells you that she had a similar episode two years ago. What is her risk of infeility following this second clinical episode of pelvic inflammatory disease?
|
< 1%
|
5%
|
10%
|
20%
| 3d
|
multi
|
Chlamydia trachomatis is frequently repoed bacterial sexually transmitted disease (STD). Infections of the cervix may present as a friable cervix, but are most often without signs or symptoms. Pelvic inflammatory disease (PID) caused by chlamydia often presents with milder symptoms than when it is caused by gonorrhea. Prompt treatment reduces the occurrence of long-term sequelae such as infeility, ectopic pregnancy, and chronic pelvic pain. The risk of infeility appears to be higher for chlamydial infections compared to any other STD. Screening women is impoant to reduce the risk of PID and its sequelae.
|
Surgery
| null | 103 |
{
"Correct Answer": "20%",
"Correct Option": "D",
"Options": {
"A": "< 1%",
"B": "5%",
"C": "10%",
"D": "20%"
},
"Question": "An 18-year-old sexually active college student presents with complaints of lower abdominal pain and irregular bleeding for five days. She has no fever. She uses oral contraceptives as method of bih control. Upon examination, the cervix is friable, there is cervical motion tenderness and adnexal tenderness. The pregnancy test is negative. She tells you that she had a similar episode two years ago. What is her risk of infeility following this second clinical episode of pelvic inflammatory disease?"
}
|
An 18-year-old sexually active college student presents with complaints of lower abdominal pain and irregular bleeding for five days. She has no fever. She uses oral contraceptives as method of bih control. Upon examination, the cervix is friable, there is cervical motion tenderness and adnexal tenderness. The pregnancy test is negative. She tells you that she had a similar episode two years ago.
|
What is her risk of infeility following this second clinical episode of pelvic inflammatory disease?
|
{
"A": "< 1%",
"B": "5%",
"C": "10%",
"D": "20%"
}
|
D. 20%
|
15842e21-3e92-414a-b872-80bb9e8da2e9
|
A 29-year-old man notes burning pain on urination with a urethral discharge that has persisted for 3 days. A sample of the exudate is positive by ELISA for Chlamydia trachomatis. The man has increasing stiffness of the knees and ankles and lower back pain 3 weeks later. A radiograph of the lumbar spine shows narrowing with sclerosis of the sacroiliac joints. One month later, he develops painful erythema of the glans penis, and the conjunctivae are red. A follow-up examination shows a slightly irregular heart rate and a murmur suggestive of aortic regurgitation. The back pain continues off and on for 5 more months. Which of the following test results is most likely to be positive in this man?
|
ANCA
|
ANA
|
HLA-B27 genotype
|
Anti-Borrelia antibodies
| 2c
|
single
|
The combination of nongonococcal urethritis, arthritis, and conjunctivitis suggests reactive arthritis, one of the spondyloarthropathies; the changes in the spine can resemble ankylosing spondylitis and can be equally debilitating. ANCA is indicative of various forms of vasculitis, such as granulomatous vasculitis and microscopic polyangiitis. The ANA test result is positive in many autoimmune diseases, such as systemic lupus erythematosus (SLE), but it is not a feature of spondyloarthropathies. Lyme disease can include large joint arthritis, but not urethritis or conjunctivitis. Rapid plasma reagin (RPR) is a screening test for syphilis, which can include arthritis of large joints (Charcot joint) in the tertiary form, but it takes decades to develop. Rheumatoid factor is a feature of rheumatoid arthritis, which initially manifests more commonly in small joints of the hands and feet. U1-RNP is a marker for mixed connective tissue disease, which has features of rheumatoid arthritis, scleroderma, polymyositis, and SLE; arthralgias are not accompanied by joint destruction or deformity.
|
Pathology
|
Misc.
| 165 |
{
"Correct Answer": "HLA-B27 genotype",
"Correct Option": "C",
"Options": {
"A": "ANCA",
"B": "ANA",
"C": "HLA-B27 genotype",
"D": "Anti-Borrelia antibodies"
},
"Question": "A 29-year-old man notes burning pain on urination with a urethral discharge that has persisted for 3 days. A sample of the exudate is positive by ELISA for Chlamydia trachomatis. The man has increasing stiffness of the knees and ankles and lower back pain 3 weeks later. A radiograph of the lumbar spine shows narrowing with sclerosis of the sacroiliac joints. One month later, he develops painful erythema of the glans penis, and the conjunctivae are red. A follow-up examination shows a slightly irregular heart rate and a murmur suggestive of aortic regurgitation. The back pain continues off and on for 5 more months. Which of the following test results is most likely to be positive in this man?"
}
|
A 29-year-old man notes burning pain on urination with a urethral discharge that has persisted for 3 days. A sample of the exudate is positive by ELISA for Chlamydia trachomatis. The man has increasing stiffness of the knees and ankles and lower back pain 3 weeks later. A radiograph of the lumbar spine shows narrowing with sclerosis of the sacroiliac joints. One month later, he develops painful erythema of the glans penis, and the conjunctivae are red. A follow-up examination shows a slightly irregular heart rate and a murmur suggestive of aortic regurgitation. The back pain continues off and on for 5 more months.
|
Which of the following test results is most likely to be positive in this man?
|
{
"A": "ANCA",
"B": "ANA",
"C": "HLA-B27 genotype",
"D": "Anti-Borrelia antibodies"
}
|
C. HLA-B27 genotype
|
153a0bd0-aa76-48a9-8e6a-a7691cef8b6d
|
A 33-year-old woman presents to the emergency depament complaining of nausea and vomiting. She states that she has been having significant nausea that has been worsening over the past 2 weeks. Over the past 2 days, she has had 2 episodes of vomiting. She also notes increased fatigue. She has no abdominal pain or vaginal bleeding. She has no other complaints. Her past medical history is significant for occasional migraine headaches. She has never had surgery. She takes acetaminophen as needed for headache, and has no known drug allergies. She works as a lawyer at a local firm and lives with her husband for three years. She has no family history of cancer or hea disease. Her vital signs are stable. Examination is significant for a bluish-appearing cervix on speculum examination. The remainder of the examination, including the abdominal examination, is benign. Laboratory evaluation shows: Urine hCG: positive Leukocytes: 9,000/mm3 Hematocrit: 41% Platelets: 250,000/mm3 Pelvic ultrasound demonstrates a gestational sac with yolk sac and fetal pole surrounded by myometrium. There is a hea rate of 154 beats per minute. Which of the following is the MOST likely diagnosis?
|
Appendicitis
|
Complete hydatidiform mole
|
Ectopic pregnancy
|
Intrauterine pregnancy
| 3d
|
multi
|
This patient's presentation, exam findings, and studies are all consistent with a diagnosis of intrauterine pregnancy. First, her presenting complaints of nausea, vomiting, and fatigue are consistent with a first trimester pregnancy. Approximately 80% of pregnant women experience some nausea during the pregnancy, especially in the first trimester. This nausea is most commonly called "morning sickness" but it can occur at any time during the day. Fatigue is also a common first trimester complaint. On examination she has a bluish-appearing cervix. This is called "Chadwick's sign" and it is another clue that she is pregnant. Most definitively, though, she has a positive urine pregnancy test. With this positive test, the diagnosis is narrowed to intrauterine pregnancy, ectopic pregnancy, or spontaneous aboion, with mole also being a consideration. The ultrasound that demonstrates an intrauterine pregnancy fully establishes the diagnosis. Note: Appendicitis represents an infection of the appendix. Patients with appendicitis most commonly present with symptoms and signs of infection, including abdominal pain, fever and chills, abdominal tenderness, elevated temperature, and leukocytosis. A patient with a complete hydatidiform mole will not have an intrauterine pregnancy with a fetal hea rate visualized on ultrasound examination. A complete mole often appears as a "snowstorm" pattern on pelvic ultrasound. It is essential to "think ectopic!" whenever a woman of childbearing age presents for medical attention. In fact, this sign ("think ectopic!") and other such similar signs can be seen in many emergency rooms. However, patients with ectopic pregnancy usually complain of abdominal pain or vaginal bleeding. On examination, they will often have abdominal and adnexal tenderness. Pelvic ultrasound will show no intrauterine pregnancy. This patient, with a gestational sac, yolk sac, and fetus seen surrounded by myometrium (that is, within the uterus) can be diagnosed with an intrauterine pregnancy. Ref: Fritz D.A. (2011). Chapter 6. Emergency Bedside Ultrasound. In R.L. Humphries, C. Stone (Eds), CURRENT Diagnosis & Treatment Emergency Medicine, 7e.
|
Gynaecology & Obstetrics
| null | 269 |
{
"Correct Answer": "Intrauterine pregnancy",
"Correct Option": "D",
"Options": {
"A": "Appendicitis",
"B": "Complete hydatidiform mole",
"C": "Ectopic pregnancy",
"D": "Intrauterine pregnancy"
},
"Question": "A 33-year-old woman presents to the emergency depament complaining of nausea and vomiting. She states that she has been having significant nausea that has been worsening over the past 2 weeks. Over the past 2 days, she has had 2 episodes of vomiting. She also notes increased fatigue. She has no abdominal pain or vaginal bleeding. She has no other complaints. Her past medical history is significant for occasional migraine headaches. She has never had surgery. She takes acetaminophen as needed for headache, and has no known drug allergies. She works as a lawyer at a local firm and lives with her husband for three years. She has no family history of cancer or hea disease. Her vital signs are stable. Examination is significant for a bluish-appearing cervix on speculum examination. The remainder of the examination, including the abdominal examination, is benign. Laboratory evaluation shows: Urine hCG: positive Leukocytes: 9,000/mm3 Hematocrit: 41% Platelets: 250,000/mm3 Pelvic ultrasound demonstrates a gestational sac with yolk sac and fetal pole surrounded by myometrium. There is a hea rate of 154 beats per minute. Which of the following is the MOST likely diagnosis?"
}
|
A 33-year-old woman presents to the emergency depament complaining of nausea and vomiting. She states that she has been having significant nausea that has been worsening over the past 2 weeks. Over the past 2 days, she has had 2 episodes of vomiting. She also notes increased fatigue. She has no abdominal pain or vaginal bleeding. She has no other complaints. Her past medical history is significant for occasional migraine headaches. She has never had surgery. She takes acetaminophen as needed for headache, and has no known drug allergies. She works as a lawyer at a local firm and lives with her husband for three years. She has no family history of cancer or hea disease. Her vital signs are stable. Examination is significant for a bluish-appearing cervix on speculum examination. The remainder of the examination, including the abdominal examination, is benign. Laboratory evaluation shows: Urine hCG: positive Leukocytes: 9,000/mm3 Hematocrit: 41% Platelets: 250,000/mm3 Pelvic ultrasound demonstrates a gestational sac with yolk sac and fetal pole surrounded by myometrium. There is a hea rate of 154 beats per minute.
|
Which of the following is the MOST likely diagnosis?
|
{
"A": "Appendicitis",
"B": "Complete hydatidiform mole",
"C": "Ectopic pregnancy",
"D": "Intrauterine pregnancy"
}
|
D. Intrauterine pregnancy
|
d80e71c8-d913-438d-ab7b-8abd700dc7eb
|
A 28-year-old woman complains of chest pain for 1.5 months. Three months prior to the current visit, she developed cough with expectoration, worse in the early morning. There was no shoness of breath or hemoptysis About 2 months after the onset of the cough, she began to have intermittent pleuritic (worse with coughing or deep breathing) left sided chest pain, increasing fatigue and weight loss of 3kgs but no loss of appetite. On auscultation: fine crackles in the suprascapular areas bilaterally were present(L>>R). The left upper lobe was dull to percussion. All are contents of the classic medium used for the above disease except: -
|
Egg suspension
|
Malachite green
|
Glycerol
|
L-glutamine
| 3d
|
multi
|
The patient comes with a constellation of weight loss, productive cough, and cavitary pulmonary infiltrates, which is extremely characteristic of TB. The medium being asked is the Lowenstein-Jensen medium, an egg-based solid medium that suppos the growth of Mycobacterium species, including Mycobacterium tuberculosis. CXR shows well defined cavitary lesions in left upper lung zone and right lower lung zone. COMPOSITION OFLJ MEDIUM Ingredients Potato Flour (Potato Starch) L-Asparagine Monopotassium Phosphate Magnesium Citrate Malachite Green Magnesium Sulfate Glycerol Egg suspension Distilled Water
|
Unknown
|
Integrated QBank
| 152 |
{
"Correct Answer": "L-glutamine",
"Correct Option": "D",
"Options": {
"A": "Egg suspension",
"B": "Malachite green",
"C": "Glycerol",
"D": "L-glutamine"
},
"Question": "A 28-year-old woman complains of chest pain for 1.5 months. Three months prior to the current visit, she developed cough with expectoration, worse in the early morning. There was no shoness of breath or hemoptysis About 2 months after the onset of the cough, she began to have intermittent pleuritic (worse with coughing or deep breathing) left sided chest pain, increasing fatigue and weight loss of 3kgs but no loss of appetite. On auscultation: fine crackles in the suprascapular areas bilaterally were present(L>>R). The left upper lobe was dull to percussion. All are contents of the classic medium used for the above disease except: -"
}
|
A 28-year-old woman complains of chest pain for 1.5 months. Three months prior to the current visit, she developed cough with expectoration, worse in the early morning. There was no shoness of breath or hemoptysis About 2 months after the onset of the cough, she began to have intermittent pleuritic (worse with coughing or deep breathing) left sided chest pain, increasing fatigue and weight loss of 3kgs but no loss of appetite. On auscultation: fine crackles in the suprascapular areas bilaterally were present(L>>R). The left upper lobe was dull to percussion.
|
All are contents of the classic medium used for the above disease except: -
|
{
"A": "Egg suspension",
"B": "Malachite green",
"C": "Glycerol",
"D": "L-glutamine"
}
|
D. L-glutamine
|
2a137fd1-d839-4a95-bdec-cd30f4943529
|
A 65-year-old male presented to the OPD with progressive dyspnea on exeion for 3 months. Patient records told that he had an episode of necrotizing pancreatitis along with ARDS in the past for which he was mechanically ventilated for a long time. Patient is a chronic smoker. On examination, low pitched inspiratory and expiratory wheeze is heard over mid-chest area. PFTs revealed, FEV1 is 78% of predicted. FEV1/FVC ratio is 60%. Flow volume curve is given. What is the most likely diagnosis in the above case: -
|
COPD
|
Subglottic stenosis
|
Idiopathic pulmonary fibrosis
|
Unilateral vocal cord paralysis
| 1b
|
multi
|
Subacute dyspnea, stridor and airway obstruction - consistent with diagnosis of subglottic stenosis - related to his prior prolonged mechanical ventilation. Flow volume curve loop is suggestive of fixed airflow obstruction.
|
Unknown
|
Integrated QBank
| 132 |
{
"Correct Answer": "Subglottic stenosis",
"Correct Option": "B",
"Options": {
"A": "COPD",
"B": "Subglottic stenosis",
"C": "Idiopathic pulmonary fibrosis",
"D": "Unilateral vocal cord paralysis"
},
"Question": "A 65-year-old male presented to the OPD with progressive dyspnea on exeion for 3 months. Patient records told that he had an episode of necrotizing pancreatitis along with ARDS in the past for which he was mechanically ventilated for a long time. Patient is a chronic smoker. On examination, low pitched inspiratory and expiratory wheeze is heard over mid-chest area. PFTs revealed, FEV1 is 78% of predicted. FEV1/FVC ratio is 60%. Flow volume curve is given. What is the most likely diagnosis in the above case: -"
}
|
A 65-year-old male presented to the OPD with progressive dyspnea on exeion for 3 months. Patient records told that he had an episode of necrotizing pancreatitis along with ARDS in the past for which he was mechanically ventilated for a long time. Patient is a chronic smoker. On examination, low pitched inspiratory and expiratory wheeze is heard over mid-chest area. PFTs revealed, FEV1 is 78% of predicted. FEV1/FVC ratio is 60%. Flow volume curve is given.
|
What is the most likely diagnosis in the above case: -
|
{
"A": "COPD",
"B": "Subglottic stenosis",
"C": "Idiopathic pulmonary fibrosis",
"D": "Unilateral vocal cord paralysis"
}
|
B. Subglottic stenosis
|
ecfe3e9b-1d7c-41ec-b6e7-f7ac176275b4
|
A 52-year-old man complains of pain in his back and fatigue for 6 months. He admits to polyuria and polydipsia. An X-ray film of the upper torso reveals numerous lytic lesions in the lumbar vertebral bodies. Laboratory studies show hypoalbuminemia and mild anemia and thrombocytopenia. A monoclonal immunoglobulin peak is demonstrated by serum electrophoresis, and a bone marrow aspiration demonstrates numerous atypical plasma cells. Urinalysis shows 4+ proteinuria. A renal biopsy in this patient would most likely show deposits of which of the following amyloid precursor proteins?
|
Amylin
|
Apo serum amyloid A
|
Fibrinogen
|
Immunoglobulin light chain
| 3d
|
single
|
AL amyloid usually consists of the variable region of immunoglobulin light chains and can be derived from either the kappa (k) or lambda (l) moieties. Since the light chains produced by the neoplastic cells in plasma cell dyscrasias are unique to each patient, AL amyloid isolated from different persons differs in its amino acid sequence. AL protein is common to primary amyloidosis and amyloidosis associated with multiple myeloma, B-cell lymphomas, or other plasma cell dyscrasias. Multiple myeloma is accompanied by amyloidosis in 10% to 15% of cases. The other choices do not involve immunoglobulins.Diagnosis: Multiple myeloma
|
Pathology
|
Immunity
| 132 |
{
"Correct Answer": "Immunoglobulin light chain",
"Correct Option": "D",
"Options": {
"A": "Amylin",
"B": "Apo serum amyloid A",
"C": "Fibrinogen",
"D": "Immunoglobulin light chain"
},
"Question": "A 52-year-old man complains of pain in his back and fatigue for 6 months. He admits to polyuria and polydipsia. An X-ray film of the upper torso reveals numerous lytic lesions in the lumbar vertebral bodies. Laboratory studies show hypoalbuminemia and mild anemia and thrombocytopenia. A monoclonal immunoglobulin peak is demonstrated by serum electrophoresis, and a bone marrow aspiration demonstrates numerous atypical plasma cells. Urinalysis shows 4+ proteinuria. A renal biopsy in this patient would most likely show deposits of which of the following amyloid precursor proteins?"
}
|
A 52-year-old man complains of pain in his back and fatigue for 6 months. He admits to polyuria and polydipsia. An X-ray film of the upper torso reveals numerous lytic lesions in the lumbar vertebral bodies. Laboratory studies show hypoalbuminemia and mild anemia and thrombocytopenia. A monoclonal immunoglobulin peak is demonstrated by serum electrophoresis, and a bone marrow aspiration demonstrates numerous atypical plasma cells. Urinalysis shows 4+ proteinuria.
|
A renal biopsy in this patient would most likely show deposits of which of the following amyloid precursor proteins?
|
{
"A": "Amylin",
"B": "Apo serum amyloid A",
"C": "Fibrinogen",
"D": "Immunoglobulin light chain"
}
|
D. Immunoglobulin light chain
|
bed78849-a1b1-4cec-a517-cbda2e0c24ee
|
A 22 year old woman is evaluated in the emergency for a 3 day h/o dark urine and abdominal distension. O/E: normal mental status, icterus present, hea and lungs normal, Hematocrit: 26, Reticulocytes: 5%, Platelets: 1.3 lakhs, Alk.Phos: 30 units/L, ALT: 110 units/L, AST: 220 units/L, Total bilirubin:13mg% (Direct:4 mg) HBsAg positive and Hepatitis 'A' &'C' negative. Urine drug screen negative. USG abdomen shows a nodular appearing liver and enlarged spleen. Which is the most likely diagnosis?
|
Acetaminophen intoxication
|
Acute viral hepatitis
|
Primary biliary cirrhosis
|
Wilson disease
| 3d
|
single
|
Points in or of diagnosis of Wilson's disease- Low hematocrit of 26% and increased reticulocyte count: hemolysis of RBC due to excess intracellular copper. Unconjugated jaundice due to hemolysis and defective conjugation in liver due to hepatocyte damage. Mild elevation of enzymes unlike acute viral hepatitis where gross elevations in enzyme values Nodular liver with splenomegaly indicating a chronic process. Poal hypeension has already developed in the patient. Hepatitis B positivity in the question was given to confuse you, since it can be an incidental finding. Points against the diagnosis of acute viral hepatitis Jaundice with mild elevation of AST/ALT Nodular enlarged liver Enlarged spleen ALSO KNOW: A prognostic index for wilson diseasecalculated by Nazer (score range 0-12) based on serum bilirubin, serum AST, and prolongation in prothrombin time. KING'S COLLEGE CRITERIA:(were developed to determine which patients with fulminant hepatic failure (FHF) should be referred for liver transplant.)
|
Medicine
|
Liver
| 159 |
{
"Correct Answer": "Wilson disease",
"Correct Option": "D",
"Options": {
"A": "Acetaminophen intoxication",
"B": "Acute viral hepatitis",
"C": "Primary biliary cirrhosis",
"D": "Wilson disease"
},
"Question": "A 22 year old woman is evaluated in the emergency for a 3 day h/o dark urine and abdominal distension. O/E: normal mental status, icterus present, hea and lungs normal, Hematocrit: 26, Reticulocytes: 5%, Platelets: 1.3 lakhs, Alk.Phos: 30 units/L, ALT: 110 units/L, AST: 220 units/L, Total bilirubin:13mg% (Direct:4 mg) HBsAg positive and Hepatitis 'A' &'C' negative. Urine drug screen negative. USG abdomen shows a nodular appearing liver and enlarged spleen. Which is the most likely diagnosis?"
}
|
A 22 year old woman is evaluated in the emergency for a 3 day h/o dark urine and abdominal distension. O/E: normal mental status, icterus present, hea and lungs normal, Hematocrit: 26, Reticulocytes: 5%, Platelets: 1.3 lakhs, Alk.Phos: 30 units/L, ALT: 110 units/L, AST: 220 units/L, Total bilirubin:13mg% (Direct:4 mg) HBsAg positive and Hepatitis 'A' &'C' negative. Urine drug screen negative. USG abdomen shows a nodular appearing liver and enlarged spleen.
|
Which is the most likely diagnosis?
|
{
"A": "Acetaminophen intoxication",
"B": "Acute viral hepatitis",
"C": "Primary biliary cirrhosis",
"D": "Wilson disease"
}
|
D. Wilson disease
|
7c390484-f096-4222-9ea2-20112142b0e4
|
A 50-Year-old diabetic patient presented with orbital pain, swelling and chemosis along with fever. Patient also gave history of orbital cellulitis 1 week back. O/E: - 3rd, 4th and 6th cranial nerves neuropathy Trigeminal neuropathy affecting V1 and V2 divisions The neuropathy was observed initially on left side but later right side was also affected. CT venogram of the patient Which of the following is not a tributary of the involved structure: -
|
Superior ophthalmic vein
|
Superficial middle cerebral vein
|
Central vein of retina
|
Basilar plexus
| 3d
|
multi
|
This is a case of cavernous sinus thrombosis post orbital cellulitis meaning the septic thrombi came the superior ophthalmic vein. It is a life-threatening condition. Presents as orbital/facial pain Orbital swelling and chemosis is seen. 3rd, 4th, 5th and 6th cranial nerves are affected Occurs secondary to infection from orbital cellulitis and sinusitis CT venogram shows distended cavernous sinus with a non-fat density filling defect-likely thrombus. Pathways of spread of infection to cavernous sinus.
|
Unknown
|
Integrated QBank
| 107 |
{
"Correct Answer": "Basilar plexus",
"Correct Option": "D",
"Options": {
"A": "Superior ophthalmic vein",
"B": "Superficial middle cerebral vein",
"C": "Central vein of retina",
"D": "Basilar plexus"
},
"Question": "A 50-Year-old diabetic patient presented with orbital pain, swelling and chemosis along with fever. Patient also gave history of orbital cellulitis 1 week back. O/E: - 3rd, 4th and 6th cranial nerves neuropathy Trigeminal neuropathy affecting V1 and V2 divisions The neuropathy was observed initially on left side but later right side was also affected. CT venogram of the patient Which of the following is not a tributary of the involved structure: -"
}
|
A 50-Year-old diabetic patient presented with orbital pain, swelling and chemosis along with fever. Patient also gave history of orbital cellulitis 1 week back. O/E: - 3rd, 4th and 6th cranial nerves neuropathy Trigeminal neuropathy affecting V1 and V2 divisions The neuropathy was observed initially on left side but later right side was also affected.
|
CT venogram of the patient Which of the following is not a tributary of the involved structure: -
|
{
"A": "Superior ophthalmic vein",
"B": "Superficial middle cerebral vein",
"C": "Central vein of retina",
"D": "Basilar plexus"
}
|
D. Basilar plexus
|
f2778e0b-7e9e-477e-bf2f-19b0b69166c6
|
A 54-year-old obese man was diagnosed with NIDDM 1 year earlier. He was started on glipizide and metformin. His other medications are propranolol and nifedipine for hypertension, and naproxen, which he began 2 weeks ago for severe osteoarthritis. His BP is 154/92. His BUN is 29 mg/dL and a creatinine of 1.8 mg/dL; both had been normal 1 year earlier. Which medications is most likely responsible for the increase in BUN and creatinine?
|
Glipizide
|
Metformin
|
Naproxen
|
Nifedipine
| 2c
|
multi
|
The use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen, may cause a usually mild renal insufficiency, possibly related to a mild interstitial nephritis or glomerulonephritis. Risk of NSAID-induced renal damage is increased in the elderly and in patients with underlying renal disease. Glipizide a second-generation sulfonylurea, may predispose patients to hypoglycemia but is not associated with renal toxicity. Metformin does not induce renal damage but should be used cautiously in patients with underlying renal damage because of the possibility of developing lactic acidosis. Neither nifedipine nor propranolol has a tendency to adversely affect the kidneys.
|
Unknown
| null | 128 |
{
"Correct Answer": "Naproxen",
"Correct Option": "C",
"Options": {
"A": "Glipizide",
"B": "Metformin",
"C": "Naproxen",
"D": "Nifedipine"
},
"Question": "A 54-year-old obese man was diagnosed with NIDDM 1 year earlier. He was started on glipizide and metformin. His other medications are propranolol and nifedipine for hypertension, and naproxen, which he began 2 weeks ago for severe osteoarthritis. His BP is 154/92. His BUN is 29 mg/dL and a creatinine of 1.8 mg/dL; both had been normal 1 year earlier. Which medications is most likely responsible for the increase in BUN and creatinine?"
}
|
A 54-year-old obese man was diagnosed with NIDDM 1 year earlier. He was started on glipizide and metformin. His other medications are propranolol and nifedipine for hypertension, and naproxen, which he began 2 weeks ago for severe osteoarthritis. His BP is 154/92. His BUN is 29 mg/dL and a creatinine of 1.8 mg/dL; both had been normal 1 year earlier.
|
Which medications is most likely responsible for the increase in BUN and creatinine?
|
{
"A": "Glipizide",
"B": "Metformin",
"C": "Naproxen",
"D": "Nifedipine"
}
|
C. Naproxen
|
4240589f-4130-47af-bd69-ca8d3c599e21
|
A 32 year old woman, gravida 4, para 3, at 39 weeks gestation comes the labor and delivery ward with painful contractions. Her prenatal course was unremarkable. Examination shows that her cervix is 5 cm dilated, 100% effaced and the fetal hea rate is in the 130s and reactive. She is given meperidine for pain control. She progresses rapidly and less than 2 hours later she delivers a 3.345Kg male fetus. The one-minute APGAR score is 1 and the infant is making little respiratory effo. Which of the following is the most appropriate next step in management?
|
Blood transfusion
|
Glucose
|
Naloxone
|
Sodium bicarbonate
| 2c
|
multi
|
Meperidine can be used as a systemic analgesia during labor. It is an opioid and readily crosses the placenta; therefore, the fetus is exposed to the medication. As an opioid, it causes respiratory depression. Neonates are at greatest risk for respiratory depression when delivery occurs approximately 2 to 3 hours after meperidine is administered to the mother. This neonate was born approximately 2 hours after maternal administration of meperidine, which makes neonatal respiratory depression likely. Naloxone is a pure opioid antagonist that displaces the opioid from its receptor sites and can help to reverse the opioid- induced respiratory depression. It has a sho duration of action so repeat doses may be necessary. Blood transfusion would not be indicated. Blood transfusions are used when there is evidence that the neonate is anemic. This neonate appears to have respiratory depression and not anemia. Therefore, naloxone, and not blood transfusion, would be indicated. Glucose should be given when there is evidence that the neonate is severely hypoglycemic. This neonate, given that its mother received an opioid 2 hours ago, is most likely to have respiratory depression from the opioid and not hypoglycemia. Sodium bicarbonate should be given to a neonate for documented metabolic acidosis. It is often used during a prolonged resuscitation. The first step for this neonate, however, would be to try to reverse the respiratory depression with naloxone. Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 19. Obstetrical Anesthesia. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e.
|
Gynaecology & Obstetrics
| null | 148 |
{
"Correct Answer": "Naloxone",
"Correct Option": "C",
"Options": {
"A": "Blood transfusion",
"B": "Glucose",
"C": "Naloxone",
"D": "Sodium bicarbonate"
},
"Question": "A 32 year old woman, gravida 4, para 3, at 39 weeks gestation comes the labor and delivery ward with painful contractions. Her prenatal course was unremarkable. Examination shows that her cervix is 5 cm dilated, 100% effaced and the fetal hea rate is in the 130s and reactive. She is given meperidine for pain control. She progresses rapidly and less than 2 hours later she delivers a 3.345Kg male fetus. The one-minute APGAR score is 1 and the infant is making little respiratory effo. Which of the following is the most appropriate next step in management?"
}
|
A 32 year old woman, gravida 4, para 3, at 39 weeks gestation comes the labor and delivery ward with painful contractions. Her prenatal course was unremarkable. Examination shows that her cervix is 5 cm dilated, 100% effaced and the fetal hea rate is in the 130s and reactive. She is given meperidine for pain control. She progresses rapidly and less than 2 hours later she delivers a 3.345Kg male fetus. The one-minute APGAR score is 1 and the infant is making little respiratory effo.
|
Which of the following is the most appropriate next step in management?
|
{
"A": "Blood transfusion",
"B": "Glucose",
"C": "Naloxone",
"D": "Sodium bicarbonate"
}
|
C. Naloxone
|
17339c79-363e-415e-82b7-391f270bae98
|
Which of the following statements regarding dyspnoea are True / False? a) Tripod positioned breathing, characterized by sitting with one's hands braced on the knees is indicative of increased airway resistance b) Paradoxical movement of the abdomen a sign of diaphragmatic weakness c) Left atrial failure should be considered when the patient complains of platypnea d) Raynaud's disease may be an indirect clue to the underlying pulmonary hypeension in a patient with dyspnoea e) If the hea rate is >85% of the predicted maximum an abnormality of the cardiovascular system is likely the explanation for dyspnoea
|
c,d,e -True a,b -False
|
a,d,e -True b,c -False
|
a,b,d,e -True c -False
|
a,d -True b,c,e -False
| 2c
|
multi
|
Evidence for increased work of breathing (use of accessory muscles of ventilation, and the tripod position) is indicative of increased airway resistance. Paradoxical movement of the abdomen (inward motion during inspiration), a sign of diaphragmatic weakness. Left atrial myxoma or hepatopulmonary syndrome should be considered when the patient complains of platypnea. Ref: Harrisons Principles of Internal Medicine, 18th Edition, Pages 277-78.
|
Medicine
| null | 133 |
{
"Correct Answer": "a,b,d,e -True c -False",
"Correct Option": "C",
"Options": {
"A": "c,d,e -True a,b -False",
"B": "a,d,e -True b,c -False",
"C": "a,b,d,e -True c -False",
"D": "a,d -True b,c,e -False"
},
"Question": "Which of the following statements regarding dyspnoea are True / False? a) Tripod positioned breathing, characterized by sitting with one's hands braced on the knees is indicative of increased airway resistance b) Paradoxical movement of the abdomen a sign of diaphragmatic weakness c) Left atrial failure should be considered when the patient complains of platypnea d) Raynaud's disease may be an indirect clue to the underlying pulmonary hypeension in a patient with dyspnoea e) If the hea rate is >85% of the predicted maximum an abnormality of the cardiovascular system is likely the explanation for dyspnoea"
}
|
.
|
Which of the following statements regarding dyspnoea are True / False? a) Tripod positioned breathing, characterized by sitting with one's hands braced on the knees is indicative of increased airway resistance b) Paradoxical movement of the abdomen a sign of diaphragmatic weakness c) Left atrial failure should be considered when the patient complains of platypnea d) Raynaud's disease may be an indirect clue to the underlying pulmonary hypeension in a patient with dyspnoea e) If the hea rate is >85% of the predicted maximum an abnormality of the cardiovascular system is likely the explanation for dyspnoea
|
{
"A": "c,d,e -True a,b -False",
"B": "a,d,e -True b,c -False",
"C": "a,b,d,e -True c -False",
"D": "a,d -True b,c,e -False"
}
|
C. a,b,d,e -True c -False
|
a13d6378-cc48-4db1-84a7-4ae3fd8934b3
|
A 40-year-old primiparous woman suspected to be suffering from endometriosis is subjected to diagnostic laparoscopy. Findings indicate - uterus normal, both the ovaries show presence of chocolate cysts; endometriotic deposits are seen on the round ligament right side, both the fallopian tubes and the pouch of Douglas; moderately dense adhesions are present between the fallopian tubes and the pouch of Douglas. The treatment of choice in this case is
|
Total hysterectomy with bilateral salpingo-oophorectomy
|
Fulguration of endometriotic deposits
|
Progesterone therapy
|
Danazol therapy
| 1b
|
multi
|
Surgery indications
Severe symptoms unresponsive to hormone therapy
Severe and deeply infiltrating endometriosis which distort pelvic anatomy
Endometriomas > 4cms
Laparoscopy is done to destroy endometriotic lesions by excision or ablation or electrodiatherapy,or laser vaporization. Conservative surgical treatment improves fertility outcome.
|
Gynaecology & Obstetrics
| null | 102 |
{
"Correct Answer": "Fulguration of endometriotic deposits",
"Correct Option": "B",
"Options": {
"A": "Total hysterectomy with bilateral salpingo-oophorectomy",
"B": "Fulguration of endometriotic deposits",
"C": "Progesterone therapy",
"D": "Danazol therapy"
},
"Question": "A 40-year-old primiparous woman suspected to be suffering from endometriosis is subjected to diagnostic laparoscopy. Findings indicate - uterus normal, both the ovaries show presence of chocolate cysts; endometriotic deposits are seen on the round ligament right side, both the fallopian tubes and the pouch of Douglas; moderately dense adhesions are present between the fallopian tubes and the pouch of Douglas. The treatment of choice in this case is"
}
|
A 40-year-old primiparous woman suspected to be suffering from endometriosis is subjected to diagnostic laparoscopy. Findings indicate - uterus normal, both the ovaries show presence of chocolate cysts; endometriotic deposits are seen on the round ligament right side, both the fallopian tubes and the pouch of Douglas; moderately dense adhesions are present between the fallopian tubes and the pouch of Douglas.
|
The treatment of choice in this case is
|
{
"A": "Total hysterectomy with bilateral salpingo-oophorectomy",
"B": "Fulguration of endometriotic deposits",
"C": "Progesterone therapy",
"D": "Danazol therapy"
}
|
B. Fulguration of endometriotic deposits
|
eacad337-89b4-4982-baab-52289987b348
|
A 45-year-old woman undergoes an uneventful laparoscopic cholecystectomy for which she receives 1 dose of cephalosporin. One week later, she returns to the emergency room with fever, nausea, and copious diarrhea and is suspected of having pseudomembranous colitis. She is afebrile and has no peritoneal signs on abdominal examination. She has a mild leukocytosis with a left shift. Which of the following is the appropriate initial management strategy?
|
Administration of an antidiarrheal agent
|
Exploratory laparotomy with left hemi-colectomy and colostomy
|
Exploratory laparotomy with subtotal abdominal colectomy and ileostomy
|
Administration of oral metronidazole
| 3d
|
single
|
Treatment of C difficile colitis is metronidazole for firstline therapy and oral vancomycin as a second-tier agent. Recurrence appears in up to 20% of patients. Indications for surgical treatment are intractable disease, failure of medical therapy, toxic megacolon, and colonic perforation; surgical therapy consists of subtotal colectomy with end ileostomy. The diagnosis can be made by either detection of the characteristic appearance of pseudomembranes on endoscopy or detection of either toxin A or toxin B in the stool. Anti-diarrheal agents are contraindicated in suspected C difficile colitis as they may prolong the infection.
|
Anaesthesia
|
Preoperative assessment and monitoring in anaesthesia
| 108 |
{
"Correct Answer": "Administration of oral metronidazole",
"Correct Option": "D",
"Options": {
"A": "Administration of an antidiarrheal agent",
"B": "Exploratory laparotomy with left hemi-colectomy and colostomy",
"C": "Exploratory laparotomy with subtotal abdominal colectomy and ileostomy",
"D": "Administration of oral metronidazole"
},
"Question": "A 45-year-old woman undergoes an uneventful laparoscopic cholecystectomy for which she receives 1 dose of cephalosporin. One week later, she returns to the emergency room with fever, nausea, and copious diarrhea and is suspected of having pseudomembranous colitis. She is afebrile and has no peritoneal signs on abdominal examination. She has a mild leukocytosis with a left shift. Which of the following is the appropriate initial management strategy?"
}
|
A 45-year-old woman undergoes an uneventful laparoscopic cholecystectomy for which she receives 1 dose of cephalosporin. One week later, she returns to the emergency room with fever, nausea, and copious diarrhea and is suspected of having pseudomembranous colitis. She is afebrile and has no peritoneal signs on abdominal examination. She has a mild leukocytosis with a left shift.
|
Which of the following is the appropriate initial management strategy?
|
{
"A": "Administration of an antidiarrheal agent",
"B": "Exploratory laparotomy with left hemi-colectomy and colostomy",
"C": "Exploratory laparotomy with subtotal abdominal colectomy and ileostomy",
"D": "Administration of oral metronidazole"
}
|
D. Administration of oral metronidazole
|
bf6fabc7-a2e1-40e3-a651-560dd4db2b6a
|
A 25-year-old woman presents to the emergency department with symptoms of nausea and vomiting of 2 days duration. She is not on any medications and was previously well until now. The physical examination is normal except for a postural drop in her blood pressure from 110/80 mm Hg supine to 90/80 mm Hg standing. Her serum electrolytes are sodium 130 mEq/L, potassium 3 mEq/L, chloride 90 mEq/L, bicarbonate 30 mEq/L, urea 50 mg/dL, and creatinine 0.8 mg/dL. Which of the following electrolytes is most likely to be filtered through the glomerulus but unaffected by tubular secretion?
|
potassium
|
sodium
|
bicarbonate
|
urea
| 3d
|
multi
|
Urea is filtered at the glomerulus, and thereafter, any movement in or out of tubules is a passive process depending on gradients, not secretion. Reabsorption of urea in the distal tubule and collecting duct, when urine flow is reduced, results in the disproportionate elevation of urea nitrogen over creatinine in prerenal azotemia.
|
Medicine
|
Oncology
| 160 |
{
"Correct Answer": "urea",
"Correct Option": "D",
"Options": {
"A": "potassium",
"B": "sodium",
"C": "bicarbonate",
"D": "urea"
},
"Question": "A 25-year-old woman presents to the emergency department with symptoms of nausea and vomiting of 2 days duration. She is not on any medications and was previously well until now. The physical examination is normal except for a postural drop in her blood pressure from 110/80 mm Hg supine to 90/80 mm Hg standing. Her serum electrolytes are sodium 130 mEq/L, potassium 3 mEq/L, chloride 90 mEq/L, bicarbonate 30 mEq/L, urea 50 mg/dL, and creatinine 0.8 mg/dL. Which of the following electrolytes is most likely to be filtered through the glomerulus but unaffected by tubular secretion?"
}
|
A 25-year-old woman presents to the emergency department with symptoms of nausea and vomiting of 2 days duration. She is not on any medications and was previously well until now. The physical examination is normal except for a postural drop in her blood pressure from 110/80 mm Hg supine to 90/80 mm Hg standing. Her serum electrolytes are sodium 130 mEq/L, potassium 3 mEq/L, chloride 90 mEq/L, bicarbonate 30 mEq/L, urea 50 mg/dL, and creatinine 0.8 mg/dL.
|
Which of the following electrolytes is most likely to be filtered through the glomerulus but unaffected by tubular secretion?
|
{
"A": "potassium",
"B": "sodium",
"C": "bicarbonate",
"D": "urea"
}
|
D. urea
|
f5d4b052-c522-43ce-80bc-c0943ab336ff
|
A two-month-old infant is brought to the hospital emergency with marked respiratory distress. On examination, the infant has cyanosis and bilateral crepitations. Hea rate is 180/min, respiratory rate 56/min and the liver span 7.5 cm. The child has had repeated episodes of fever, cough and respiratory distress since the time of bih. Cardiovascular examination reveals a grade III ejection systolic murmur in left parasternal area and the chest X-ray reveals cardiomegaly with a narrow base and plethoric lung fields. What is the most likely diagnosis ?
|
Congenital methemoglobinemia
|
Transposition of great aeries
|
Cystic fibrosis
|
Tetralogy of Fallot
| 1b
|
multi
|
Ans. is 'b' i.e., Transposition of great aeries
|
Pediatrics
| null | 124 |
{
"Correct Answer": "Transposition of great aeries",
"Correct Option": "B",
"Options": {
"A": "Congenital methemoglobinemia",
"B": "Transposition of great aeries",
"C": "Cystic fibrosis",
"D": "Tetralogy of Fallot"
},
"Question": "A two-month-old infant is brought to the hospital emergency with marked respiratory distress. On examination, the infant has cyanosis and bilateral crepitations. Hea rate is 180/min, respiratory rate 56/min and the liver span 7.5 cm. The child has had repeated episodes of fever, cough and respiratory distress since the time of bih. Cardiovascular examination reveals a grade III ejection systolic murmur in left parasternal area and the chest X-ray reveals cardiomegaly with a narrow base and plethoric lung fields. What is the most likely diagnosis ?"
}
|
A two-month-old infant is brought to the hospital emergency with marked respiratory distress. On examination, the infant has cyanosis and bilateral crepitations. Hea rate is 180/min, respiratory rate 56/min and the liver span 7.5 cm. The child has had repeated episodes of fever, cough and respiratory distress since the time of bih. Cardiovascular examination reveals a grade III ejection systolic murmur in left parasternal area and the chest X-ray reveals cardiomegaly with a narrow base and plethoric lung fields.
|
What is the most likely diagnosis ?
|
{
"A": "Congenital methemoglobinemia",
"B": "Transposition of great aeries",
"C": "Cystic fibrosis",
"D": "Tetralogy of Fallot"
}
|
B. Transposition of great aeries
|
5676d241-e93d-4916-ba3b-af3ed1bdffa0
|
A 64-year-old woman is admitted to the ICU with the clinical diagnosis of acute respiratory distress syndrome (ARDS) secondary to pneumonia. She requires intubation and mechanical ventilation. On the second ICU day, she is difficult to ventilate, requiring increased airway pressures. On physical examination, vital signs are: pulse 159 bpm; temperature 100degF; blood pressure 90/56 mm Hg. Lung exam reveals diffuse crackles, and the patient has a palpable crunch on exam of her chest wall and abdomen. Chest radiograph is shown below.. What will you do next?
|
Place a chest tube
|
Change antibiotics
|
Perform an open thoracotomy
|
Continue management, minimizing volutrauma
| 3d
|
multi
|
This poable chest x-ray taken in the ICU shows an intubated patient with hyperlucent lines in the soft tissue with striations along the fibromuscular bundles of the neck and chest musculature. There is a faint paracardiac hyperlucent line representing air around the pericardium. The diaphragm leaflets are seen clearly across the midline due to the contrasting air shadow representing the "continuous diaphragm sign". All the signs mentioned are representative of a pneumomediastinum. The lower edge of the diaphragm is also visible due to a pneumoperitoneum. Alveolar rupture with increased alveolar-interstitial space gradient can cause pneumomediastinum and subcutaneous emphysema. Subcutaneous emphysema may occur after trauma such as esophageal rupture with direct introduction of air in the mediastinum. It can also occur where there is abdominal and thoracic muscular contraction against a closed glottis. Infection with a gas-forming organism can cause subcutaneous gas formation. Inflammatory bronchiolitis or overinflated alveoli due to mechanical ventilation can cause alveolar rupture, especially if there is airway obstruction with air moving along the bronchovascular sheaths. Pneumomediastinum refers to abnormal air collection within the mediastinum. Air can dissect into the mediastinum from areas of the neck and thorax or from the GI tract or lungs. Pathologically there is continuity between the periaerial and the peribronchial interstitium when an alveolar rupture occurs, creating an air collection within the interstitial connective tissues. Patient-related factors that are found to predispose to volutrauma include lung disease that weakens alveolar walls, such as COPD and necrotizing pneumonia. Mediastinal air accumulates and then decompresses into the subcutaneous tissues and the retroperiteoneal areas. Later, mediastinal pleura may rupture, resulting in a pneumothorax. The Hamman sign, a crunching sound synchronous with the cardiac cycle, is seen in 40% to 50% of patients with pneumomediastinum. When the pneumomediastinum extends caudally, it shows a so-called "continuous diaphragm sign." Treatment is usually conservative, with attempts to reduce airway resistance with bronchodilator therapy and minimize tidal volume and plateau pressure.
|
Radiology
|
Fundamentals in Radiology
| 129 |
{
"Correct Answer": "Continue management, minimizing volutrauma",
"Correct Option": "D",
"Options": {
"A": "Place a chest tube",
"B": "Change antibiotics",
"C": "Perform an open thoracotomy",
"D": "Continue management, minimizing volutrauma"
},
"Question": "A 64-year-old woman is admitted to the ICU with the clinical diagnosis of acute respiratory distress syndrome (ARDS) secondary to pneumonia. She requires intubation and mechanical ventilation. On the second ICU day, she is difficult to ventilate, requiring increased airway pressures. On physical examination, vital signs are: pulse 159 bpm; temperature 100degF; blood pressure 90/56 mm Hg. Lung exam reveals diffuse crackles, and the patient has a palpable crunch on exam of her chest wall and abdomen. Chest radiograph is shown below.. What will you do next?"
}
|
A 64-year-old woman is admitted to the ICU with the clinical diagnosis of acute respiratory distress syndrome (ARDS) secondary to pneumonia. She requires intubation and mechanical ventilation. On the second ICU day, she is difficult to ventilate, requiring increased airway pressures. On physical examination, vital signs are: pulse 159 bpm; temperature 100degF; blood pressure 90/56 mm Hg. Lung exam reveals diffuse crackles, and the patient has a palpable crunch on exam of her chest wall and abdomen. Chest radiograph is shown below..
|
What will you do next?
|
{
"A": "Place a chest tube",
"B": "Change antibiotics",
"C": "Perform an open thoracotomy",
"D": "Continue management, minimizing volutrauma"
}
|
D. Continue management, minimizing volutrauma
|
068c6274-bd22-4e30-86f2-1bd02f12411a
|
A nine month old boy of Sindhi parents presented to you with complaints of progressive lethargy, irritability & pallor since 6 months of age. Examination revealed severe pallor. Investigation showed Hb-3.8 mg%; MCV-58 fl; MCH-19.4 pg/cell. Blood film shows osmotic fragility is normal (target cells and normoblasts). X-ray skull shows expansion of erythroid marrow. Which of the following is the most likely diagnosis?
|
Iron deficiency anemia
|
Acute lymphoblastic anemia
|
Hemoglobin D disease
|
Hereditary spherocytosis
| 0a
|
multi
|
This child is having microcytic (MCV-58Fl), hypochromic(MCHC-19.4pg/cell) anemia with normal osmotic fragility. This is suggestive of iron deficiency anemia (Normal Hb at this age is 12g/dL, MCV is 78 fL). Severe iron deficiency will produce bizzare peripheral blood smear with severely hypochromic cells, target cells, hypochromic pencil shaped cells and occasionally small number of nucleated red blood cells. Ref: O P Ghai Essential Pediatrics, 6th Edition, Pages 300-302
|
Pediatrics
| null | 107 |
{
"Correct Answer": "Iron deficiency anemia",
"Correct Option": "A",
"Options": {
"A": "Iron deficiency anemia",
"B": "Acute lymphoblastic anemia",
"C": "Hemoglobin D disease",
"D": "Hereditary spherocytosis"
},
"Question": "A nine month old boy of Sindhi parents presented to you with complaints of progressive lethargy, irritability & pallor since 6 months of age. Examination revealed severe pallor. Investigation showed Hb-3.8 mg%; MCV-58 fl; MCH-19.4 pg/cell. Blood film shows osmotic fragility is normal (target cells and normoblasts). X-ray skull shows expansion of erythroid marrow. Which of the following is the most likely diagnosis?"
}
|
A nine month old boy of Sindhi parents presented to you with complaints of progressive lethargy, irritability & pallor since 6 months of age. Examination revealed severe pallor. Investigation showed Hb-3.8 mg%; MCV-58 fl; MCH-19.4 pg/cell. Blood film shows osmotic fragility is normal (target cells and normoblasts). X-ray skull shows expansion of erythroid marrow.
|
Which of the following is the most likely diagnosis?
|
{
"A": "Iron deficiency anemia",
"B": "Acute lymphoblastic anemia",
"C": "Hemoglobin D disease",
"D": "Hereditary spherocytosis"
}
|
A. Iron deficiency anemia
|
1484a9d5-4f10-411d-a901-f31ed68954ae
|
A 47-year-old woman presents to the emergency department with symptoms of new-onset transient right arm weakness and word-finding difficulty lasting 3 hours. She is also experiencing exertional dyspnea, and had a syncopal event 1 month ago. Her medical history is only remarkable for 2 uneventful pregnancies, and she is not taking any medications.Physical examination reveals normal vital signs, and no residual focal neurological deficits. The ECG and CT brain are normal but an echocardiogram reveals a cardiac tumor in the left atrium, it is pedunculated, and attached to the endocardium. Which of the following is the most likely cause of this lesion?
|
myxoma
|
sarcoma
|
rhabdomyoma
|
fibroma
| 0a
|
single
|
The myxoma is a solitary globular or polypoid tumor varying in size from that of a cherry to a peach. About 75% are found in the left atrium, and most of the remainder in the right atrium. The clinical presentation is with one or more of the classical triad of constitution symptoms (fatigue, fever, anemia), embolic events, or obstruction of the valve orifice.Sarcomas are the most common malignant tumors of the heart but are usually seen on the right side, while rhabdomyomas and fibromas are more commonly seen in children, and usually occur in the ventricles.
|
Medicine
|
C.V.S.
| 141 |
{
"Correct Answer": "myxoma",
"Correct Option": "A",
"Options": {
"A": "myxoma",
"B": "sarcoma",
"C": "rhabdomyoma",
"D": "fibroma"
},
"Question": "A 47-year-old woman presents to the emergency department with symptoms of new-onset transient right arm weakness and word-finding difficulty lasting 3 hours. She is also experiencing exertional dyspnea, and had a syncopal event 1 month ago. Her medical history is only remarkable for 2 uneventful pregnancies, and she is not taking any medications.Physical examination reveals normal vital signs, and no residual focal neurological deficits. The ECG and CT brain are normal but an echocardiogram reveals a cardiac tumor in the left atrium, it is pedunculated, and attached to the endocardium. Which of the following is the most likely cause of this lesion?"
}
|
A 47-year-old woman presents to the emergency department with symptoms of new-onset transient right arm weakness and word-finding difficulty lasting 3 hours. She is also experiencing exertional dyspnea, and had a syncopal event 1 month ago. Her medical history is only remarkable for 2 uneventful pregnancies, and she is not taking any medications.Physical examination reveals normal vital signs, and no residual focal neurological deficits. The ECG and CT brain are normal but an echocardiogram reveals a cardiac tumor in the left atrium, it is pedunculated, and attached to the endocardium.
|
Which of the following is the most likely cause of this lesion?
|
{
"A": "myxoma",
"B": "sarcoma",
"C": "rhabdomyoma",
"D": "fibroma"
}
|
A. myxoma
|
4ada601f-4935-46c1-8154-240e065c3f89
|
A 48 year old woman was admitted with a history of weakness for two months. On examination, she has enlarged cervical lymph nodes and spleen. Her hemoglobin was 10.5 g/dl, platelet count 2.7 x 109/L and total leukocyte count 40 x 109/L, which included 80% mature lymphoid cells with coarse clumped chromatin. Bone marrow revealed a nodular lymphoid infiltrate. The peripheral blood lymphoid cells were positive for CD 19, CD5, CD20 and CD23 and were negative for CD79B and FMC-7. The histopathological examination of the lymph node in this patient, will most likely exhibit effacement of lymph node arachitecture by:
|
A pseudofollicular pattern with proliferation centers
|
A monomorphic lymphoid proliferation with a nodular pattern
|
A predominantly follicular pattern
|
A diffuse proliferation of medium to large lymphoid cells with high mitotic rate
| 3d
|
single
|
Patient in the question stem is showing features of chronic lymphocytic leukemia. Histopathological examination in a case of CLL shows diffuse effacement of lymphocyte architecture by small to medium sized lymphocytes with clumped chromatin, indistinct or absent nucleoli and scanty cytoplasm. Chronic lymphocytic leukemia (CLL) is a clonal malignancy of B lymphocytes. It is manifested clinically by immunosuppression, bone marrow failure, and organ infiltration with lymphocytes. Ref: Current Medical Diagnosis and Treatment, 2012, Chapter 13
|
Pathology
| null | 166 |
{
"Correct Answer": "A diffuse proliferation of medium to large lymphoid cells with high mitotic rate",
"Correct Option": "D",
"Options": {
"A": "A pseudofollicular pattern with proliferation centers",
"B": "A monomorphic lymphoid proliferation with a nodular pattern",
"C": "A predominantly follicular pattern",
"D": "A diffuse proliferation of medium to large lymphoid cells with high mitotic rate"
},
"Question": "A 48 year old woman was admitted with a history of weakness for two months. On examination, she has enlarged cervical lymph nodes and spleen. Her hemoglobin was 10.5 g/dl, platelet count 2.7 x 109/L and total leukocyte count 40 x 109/L, which included 80% mature lymphoid cells with coarse clumped chromatin. Bone marrow revealed a nodular lymphoid infiltrate. The peripheral blood lymphoid cells were positive for CD 19, CD5, CD20 and CD23 and were negative for CD79B and FMC-7. The histopathological examination of the lymph node in this patient, will most likely exhibit effacement of lymph node arachitecture by:"
}
|
A 48 year old woman was admitted with a history of weakness for two months. On examination, she has enlarged cervical lymph nodes and spleen. Her hemoglobin was 10.5 g/dl, platelet count 2.7 x 109/L and total leukocyte count 40 x 109/L, which included 80% mature lymphoid cells with coarse clumped chromatin. Bone marrow revealed a nodular lymphoid infiltrate. The peripheral blood lymphoid cells were positive for CD 19, CD5, CD20 and CD23 and were negative for CD79B and FMC-7.
|
The histopathological examination of the lymph node in this patient, will most likely exhibit effacement of lymph node arachitecture by:
|
{
"A": "A pseudofollicular pattern with proliferation centers",
"B": "A monomorphic lymphoid proliferation with a nodular pattern",
"C": "A predominantly follicular pattern",
"D": "A diffuse proliferation of medium to large lymphoid cells with high mitotic rate"
}
|
D. A diffuse proliferation of medium to large lymphoid cells with high mitotic rate
|
84a2a07c-4e4f-4ad2-a06a-1dc00ed34f6c
|
A 55-year old man presented with a two-day history of headache, fever and generalized weakness. He had received a cadaveric kidney transplant 5 years earlier. His medications included 5 mg oftacrolimus twice a day and 10 mg of prednisone daily. On neurologic examination, he was confused and incoherent Cranial nerves were normal, but he had a hazy left retina. Magnetic resonance imaging of the brain with the administration of gadolinium showed multiple enhancing lesion in both cerebral hemispheres. The most probable diagnosis is -
|
Cerebral toxoplasmosis
|
Listeria monocytogenes infection
|
Nocardia asteroides infection
|
Miliary tuberculosis
| 2c
|
multi
|
Nocardiosis is an infectious disease affecting either the lungs (pulmonary nocardiosis) or the whole body (systemic nocardiosis). It is due to infection by a bacterium of the genus Nocardia, most commonly Nocardia asteroides or Nocardia brasiliensis. It is most common in adult males, especially those with a weakened immune system. In patients with brain nocardia infection, moality exceeds 80%; in other forms, moality is 50%, even with appropriate therapy. It is one of several conditions that have been called "the great imitator". Cutaneous nocardiosis commonly occurs in immunocompetent hosts Signs and symptoms Pulmonary infection Produces a virulent form of pneumonia (progressive) Night sweats, fever, cough, chest pain Pulmonary nocardiosis is subacute in onset and refractory to treatment with standard antibiotics Symptoms are more severe in immunocompromised individuals Radiologic studies show multiple pulmonary infiltrates, with a tendency to central necrosis Neurological infection: Headache, lethargy, confusion, seizures, sudden onset of neurological deficit CT scan shows cerebral abscess Nocardial meningitis is difficult to diagnose Cardiac conditions: Nocardia has been highly linked to endocarditis as a main manifestation In recorded cases, it has caused damage to hea valves whether natural or prosthetic Lymphocutaneous disease: Nocardial cellulitis is akin to erysipelas but is less acute Nodular lymphangeitis mimics sporotrichosis with multiple nodules alongside a lymphatic pathway Chronic subcutaneous infection is a rare complication and osteitis may ensue May be misidentified and treated as a staph infection, specifically superficial skin infections Cultures must incubate more than 48 hours to guarantee an accurate test Ocular disease: Very rarely, nocardiae cause keratitis Generally there is a history of ocular trauma Disseminated nocardiosis: Dissemination occurs through the spreading enzymes possessed by the bacteria Disseminated infection can occur in very immunocompromised patients It generally involves both lungs and brain Fever, moderate or very high can be seen Multiple cavitating pulmonary infiltrates develop Cerebral abscesses arise later Cutaneous lesions are very rarely seen If untreated, the prognosis is poor for this form of disease Ref Davidson 23rd edition pg 712
|
Medicine
|
Miscellaneous
| 117 |
{
"Correct Answer": "Nocardia asteroides infection",
"Correct Option": "C",
"Options": {
"A": "Cerebral toxoplasmosis",
"B": "Listeria monocytogenes infection",
"C": "Nocardia asteroides infection",
"D": "Miliary tuberculosis"
},
"Question": "A 55-year old man presented with a two-day history of headache, fever and generalized weakness. He had received a cadaveric kidney transplant 5 years earlier. His medications included 5 mg oftacrolimus twice a day and 10 mg of prednisone daily. On neurologic examination, he was confused and incoherent Cranial nerves were normal, but he had a hazy left retina. Magnetic resonance imaging of the brain with the administration of gadolinium showed multiple enhancing lesion in both cerebral hemispheres. The most probable diagnosis is -"
}
|
A 55-year old man presented with a two-day history of headache, fever and generalized weakness. He had received a cadaveric kidney transplant 5 years earlier. His medications included 5 mg oftacrolimus twice a day and 10 mg of prednisone daily. On neurologic examination, he was confused and incoherent Cranial nerves were normal, but he had a hazy left retina. Magnetic resonance imaging of the brain with the administration of gadolinium showed multiple enhancing lesion in both cerebral hemispheres.
|
The most probable diagnosis is -
|
{
"A": "Cerebral toxoplasmosis",
"B": "Listeria monocytogenes infection",
"C": "Nocardia asteroides infection",
"D": "Miliary tuberculosis"
}
|
C. Nocardia asteroides infection
|
e89eddf9-12a1-4419-bb11-5db3b2b44a8b
|
A 71-year-old man is seen with low-grade fever, generalized malaise, and a run-down feeling. He has lost weight and shows stigmata of chronic illness. There is no history of occupational exposure. On physical examination, vital signs are as follows: pulse 110 bpm; temperature 99degF; respirations 19/min; blood pressure 90/60 mm Hg. On exam, the man is frail and appears cachectic with temporal wasting. Other aspects of his physical exam are unremarkable. Laboratory data: Hb 10 g/dL; Hct 30%; MCV 90; WBCs 3000/uL; differential normal; BUN 19 mg/dL; creatinine 1.0 mg/dL; sodium 129 mEq/L; potassium 5.0 mEq/L; ABGs (RA): pH 7.42, PCO2 35 mm Hg, PO2 58 mm Hg. Spirometry: FVC 60% of predicted; FEV1 60% of predicted. PPD skin test is negative (0 mm); induced sputum for AFB smear is negative. Chest radiograph is shown below.What is the most likely diagnosis?
|
Silicosis
|
Miliary TB
|
Metastatic thyroid carcinoma
|
Sarcoidosis
| 1b
|
single
|
This x-ray shows a bilateral diffuse miliary nodular pattern involving both lung fields with no loss of volume. Characteristically, miliary nodules are less than 4 mm in size. They are generally noncalcified and diffuse and are seen in many conditions, such as TB/fungal infections/pneumoconiosis and ceain malignancies such as melanomas/thyroid cancer. Larger, more confluent lesions can be seen in alveolar sarcoid, Wegener's granulomatosis, and metastatic disease. The clinical hints that aid diagnosis include: An occupational history without constitutional symptoms. X-ray that looks worse than the patient's complaints, as in sarcoidosis. History of thromboembolic disease or sepsis, as in septic emboli or pulmonary infarcts. These are generally seen in the lower lung zones. * History of ahritis; may suggest rheumatoid nodules. Presence of eosinophilia in the peripheral smear with fleeting infiltrates; provides clue for pulmonary infiltrates with eosinophilia (PIE) syndrome, in which case history of travel or use of medications/drugs may be helpful and a stool exam may aid in the diagnosis. Immune-compromised patients may have oppounistic infections such as herpes or CMV This elderly patient has all the stigmata of chronic illness. Although the PPD skin test and sputum studies are negative (seen in about 30% of cases), the history and CXR are consistent with miliary TB. Hyponatremia and hypercalcemia are common findings in TB. In this age group sarcoidosis is unlikely. In the absence of occupational exposure, silicosis is also unlikely. Bone marrow aspirate may be positive for TB culture in 60% of patients with miliary TB, and aspiration is a logical step in the diagnostic evaluation. CT scan will not aid fuher in the diagnosis, and thyroid function tests will be normal unless there is clinical evidence of hypo- or hypehyroidism. Open lung or thoracoscopic biopsy is always diagnostic.
|
Radiology
|
Respiratory system
| 279 |
{
"Correct Answer": "Miliary TB",
"Correct Option": "B",
"Options": {
"A": "Silicosis",
"B": "Miliary TB",
"C": "Metastatic thyroid carcinoma",
"D": "Sarcoidosis"
},
"Question": "A 71-year-old man is seen with low-grade fever, generalized malaise, and a run-down feeling. He has lost weight and shows stigmata of chronic illness. There is no history of occupational exposure. On physical examination, vital signs are as follows: pulse 110 bpm; temperature 99degF; respirations 19/min; blood pressure 90/60 mm Hg. On exam, the man is frail and appears cachectic with temporal wasting. Other aspects of his physical exam are unremarkable. Laboratory data: Hb 10 g/dL; Hct 30%; MCV 90; WBCs 3000/uL; differential normal; BUN 19 mg/dL; creatinine 1.0 mg/dL; sodium 129 mEq/L; potassium 5.0 mEq/L; ABGs (RA): pH 7.42, PCO2 35 mm Hg, PO2 58 mm Hg. Spirometry: FVC 60% of predicted; FEV1 60% of predicted. PPD skin test is negative (0 mm); induced sputum for AFB smear is negative. Chest radiograph is shown below.What is the most likely diagnosis?"
}
|
A 71-year-old man is seen with low-grade fever, generalized malaise, and a run-down feeling. He has lost weight and shows stigmata of chronic illness. There is no history of occupational exposure. On physical examination, vital signs are as follows: pulse 110 bpm; temperature 99degF; respirations 19/min; blood pressure 90/60 mm Hg. On exam, the man is frail and appears cachectic with temporal wasting. Other aspects of his physical exam are unremarkable. Laboratory data: Hb 10 g/dL; Hct 30%; MCV 90; WBCs 3000/uL; differential normal; BUN 19 mg/dL; creatinine 1.0 mg/dL; sodium 129 mEq/L; potassium 5.0 mEq/L; ABGs (RA): pH 7.42, PCO2 35 mm Hg, PO2 58 mm Hg. Spirometry: FVC 60% of predicted; FEV1 60% of predicted. PPD skin test is negative (0 mm); induced sputum for AFB smear is negative.
|
Chest radiograph is shown below.What is the most likely diagnosis?
|
{
"A": "Silicosis",
"B": "Miliary TB",
"C": "Metastatic thyroid carcinoma",
"D": "Sarcoidosis"
}
|
B. Miliary TB
|
b47f57e9-8fac-4fdc-a22e-21df75ff8060
|
A middle age male patient met with a road traffic accident & is brought to emergency in an unconscious state. CT abdomen reveals a splenic laceration, emergency splenectomy is done & patient is shifted to ICU. His BP remains low in post op period even after a bolus of normal saline. O/E- he is afebrile, has moon like face with central obesity & presence of violet striae over abdomen. Repeat CT scan of the chest, abdomen, and pelvis shows no hemorrhage. What is the next best step in management of this patient?
|
Return to the operating room for exploratory laparotomy
|
Administer hydrocoisone 100 mg IV
|
Administer vancomycin and piperacillin/tazobactam
|
Perform MRI of the spine.
| 1b
|
multi
|
Moon like facies, central obesity & abdominal striae are signs of glucocoicoid excess - endogenous (Cushing syndrome)/ exogenous. A physiologic stressor (trauma) may trigger adrenal crisis. Acute adrenal insufficiency requires immediate initiation of rehydration (saline infusion at initial rates of 1 L/hr) with continuous cardiac monitoring. Glucocoicoid replacement- initiated by bolus injection of 100 mg of hydrocoisone, followed by the administration of 100-200 mg of hydrocoisone over 24 hours. Mineralocoicoid replacement can be initiated once the daily hydrocoisone dose is <50 mg as at higher doses, hydrocoisone provides sufficient stimulation of mineralocoicoid receptors.
|
Medicine
|
Cushing Syndrome
| 118 |
{
"Correct Answer": "Administer hydrocoisone 100 mg IV",
"Correct Option": "B",
"Options": {
"A": "Return to the operating room for exploratory laparotomy",
"B": "Administer hydrocoisone 100 mg IV",
"C": "Administer vancomycin and piperacillin/tazobactam",
"D": "Perform MRI of the spine."
},
"Question": "A middle age male patient met with a road traffic accident & is brought to emergency in an unconscious state. CT abdomen reveals a splenic laceration, emergency splenectomy is done & patient is shifted to ICU. His BP remains low in post op period even after a bolus of normal saline. O/E- he is afebrile, has moon like face with central obesity & presence of violet striae over abdomen. Repeat CT scan of the chest, abdomen, and pelvis shows no hemorrhage. What is the next best step in management of this patient?"
}
|
A middle age male patient met with a road traffic accident & is brought to emergency in an unconscious state. CT abdomen reveals a splenic laceration, emergency splenectomy is done & patient is shifted to ICU. His BP remains low in post op period even after a bolus of normal saline. O/E- he is afebrile, has moon like face with central obesity & presence of violet striae over abdomen. Repeat CT scan of the chest, abdomen, and pelvis shows no hemorrhage.
|
What is the next best step in management of this patient?
|
{
"A": "Return to the operating room for exploratory laparotomy",
"B": "Administer hydrocoisone 100 mg IV",
"C": "Administer vancomycin and piperacillin/tazobactam",
"D": "Perform MRI of the spine."
}
|
B. Administer hydrocoisone 100 mg IV
|
65d81b9b-ae6c-463e-bb27-79ded6e9b665
|
A 28-year-old woman has noticed increasing lower limb swelling and shortness of breath. She has a 2-year history of facial rash, hair loss, arthralgias, and thrombocytopenia. On examination, her blood pressure is 150/90 mmHg, pulse 80/min, there is a maculopapular rash on her face, JVP is 4 cm, heart sounds normal, lungs clear, and there is pedal and periorbital edema. Her creatinine is very high, a urinalysis reveals many RBCs and RBC casts. A renal biopsy is performed.For the above patient with GN, select the most likely diagnosis on renal biopsy.
|
diffuse proliferative GN
|
crescentic GN
|
focal proliferative GN
|
membranoproliferative GN
| 0a
|
multi
|
Systemic lupus erythematosus (SLE) can cause a wide variety of renal disorders, and can progress to ESRF. Because of the active urine sediment this individual has a proliferative GN. It is difficult to diagnose the type of glomerular involvement in SLE without a biopsy. Based on the biopsy results lupus nephritis (LN) is divided into 6 classes (WHO classification). Class I, minimal mesangial LN; Class II, mesangial proliferative LN; Class III, focal LN; Class TV, diffuse segmental LN; Class V, membranous LN; and Class VI, advanced sclerosing LN.
|
Medicine
|
Oncology
| 153 |
{
"Correct Answer": "diffuse proliferative GN",
"Correct Option": "A",
"Options": {
"A": "diffuse proliferative GN",
"B": "crescentic GN",
"C": "focal proliferative GN",
"D": "membranoproliferative GN"
},
"Question": "A 28-year-old woman has noticed increasing lower limb swelling and shortness of breath. She has a 2-year history of facial rash, hair loss, arthralgias, and thrombocytopenia. On examination, her blood pressure is 150/90 mmHg, pulse 80/min, there is a maculopapular rash on her face, JVP is 4 cm, heart sounds normal, lungs clear, and there is pedal and periorbital edema. Her creatinine is very high, a urinalysis reveals many RBCs and RBC casts. A renal biopsy is performed.For the above patient with GN, select the most likely diagnosis on renal biopsy."
}
|
A 28-year-old woman has noticed increasing lower limb swelling and shortness of breath. She has a 2-year history of facial rash, hair loss, arthralgias, and thrombocytopenia. On examination, her blood pressure is 150/90 mmHg, pulse 80/min, there is a maculopapular rash on her face, JVP is 4 cm, heart sounds normal, lungs clear, and there is pedal and periorbital edema. Her creatinine is very high, a urinalysis reveals many RBCs and RBC casts.
|
A renal biopsy is performed.For the above patient with GN, select the most likely diagnosis on renal biopsy.
|
{
"A": "diffuse proliferative GN",
"B": "crescentic GN",
"C": "focal proliferative GN",
"D": "membranoproliferative GN"
}
|
A. diffuse proliferative GN
|
76009247-07bb-43b4-9b1d-0b7c96dfea39
|
A 27-year-old woman (gravida 3, para 2) comes to the delivery floor at 37 weeks gestation. She has had no prenatal care. She complains that, on bending down to pick up her 2-year-old child, she experienced sudden, severe back pain that now has persisted for 2 h. Approximately 30 min ago she noted bright red blood coming from her vagina. By the time she arrives at the delivery floor, she is contracting strongly every 3 min; the uterus is quite firm even between contractions. By abdominal palpation, the fetus is vertex with the head deeply engaged. Fetal heart rate is 130/min. The fundus is 38 cm above the symphysis. Blood for clotting is drawn, and a clot forms in 4 min. Clotting studies are sent to the laboratory. Which of the following actions can wait until the patient is stabilized?
|
Stabilizing maternal circulation
|
Attaching a fetal electronic monitor
|
Inserting an intrauterine pressure catheter
|
Administering oxytocin
| 3d
|
multi
|
The patient described in the question presents with a classic history for abruption-that is, the sudden onset of abdominal pain accompanied by bleeding. Physical examination reveals a firm, tender uterus with frequent contractions, which confirms the diagnosis. The fact that a clot forms within 4 min suggests that coagulopathy is not present. Because abruption is often accompanied by hemorrhaging, it is important that appropriate fluids (i.e., lactated Ringer solution and whole blood) be administered immediately to stabilize the mother's circulation. Cesarean section may be necessary in the case of a severe abruption, but only when fetal distress is evident or delivery is unlikely to be accomplished vaginally Internal monitoring equipment should provide an early warning that the fetus is compromised. The internal uterine catheter provides pressure recordings, which are important if oxytocin stimulation is necessary. Generally, however, patients with abruptio placentae are contracting vigorously and do not need oxytocin.
|
Gynaecology & Obstetrics
|
Normal Labour
| 195 |
{
"Correct Answer": "Administering oxytocin",
"Correct Option": "D",
"Options": {
"A": "Stabilizing maternal circulation",
"B": "Attaching a fetal electronic monitor",
"C": "Inserting an intrauterine pressure catheter",
"D": "Administering oxytocin"
},
"Question": "A 27-year-old woman (gravida 3, para 2) comes to the delivery floor at 37 weeks gestation. She has had no prenatal care. She complains that, on bending down to pick up her 2-year-old child, she experienced sudden, severe back pain that now has persisted for 2 h. Approximately 30 min ago she noted bright red blood coming from her vagina. By the time she arrives at the delivery floor, she is contracting strongly every 3 min; the uterus is quite firm even between contractions. By abdominal palpation, the fetus is vertex with the head deeply engaged. Fetal heart rate is 130/min. The fundus is 38 cm above the symphysis. Blood for clotting is drawn, and a clot forms in 4 min. Clotting studies are sent to the laboratory. Which of the following actions can wait until the patient is stabilized?"
}
|
A 27-year-old woman (gravida 3, para 2) comes to the delivery floor at 37 weeks gestation. She has had no prenatal care. She complains that, on bending down to pick up her 2-year-old child, she experienced sudden, severe back pain that now has persisted for 2 h. Approximately 30 min ago she noted bright red blood coming from her vagina. By the time she arrives at the delivery floor, she is contracting strongly every 3 min; the uterus is quite firm even between contractions. By abdominal palpation, the fetus is vertex with the head deeply engaged. Fetal heart rate is 130/min. The fundus is 38 cm above the symphysis. Blood for clotting is drawn, and a clot forms in 4 min. Clotting studies are sent to the laboratory.
|
Which of the following actions can wait until the patient is stabilized?
|
{
"A": "Stabilizing maternal circulation",
"B": "Attaching a fetal electronic monitor",
"C": "Inserting an intrauterine pressure catheter",
"D": "Administering oxytocin"
}
|
D. Administering oxytocin
|
4397cfb9-db93-4106-91b4-b966e1ec140a
|
About 90 days post-bone marrow transplant, a 55-year-old white woman began to complain of dry cough, shortness of breath, and chest pain. She was started on antibiotics and blood culture obtained at the time was negative and there was not improvement. A computed tomography (CT) scan of the lungs showed a halo of low attenuation around a nodular lesion. Analysis of lung biopsy was similar to methenamine silver-stained section below. The most likely diagnosis for this patient is
|
Aspergillosis
|
Candidiasis
|
Histoplasmosis
|
Mucormycosis
| 0a
|
single
|
Aspergillus is widespread in nature and produces small conidia that are easily aerosolized. Atopic individuals often develop severe allergic reactions to the conidial antigens. In immunocompromised patients, the conidia may germinate to produce hyphae that invade the lungs and other tissues. Progress of disease can be rapid. A diagnosis of aspergillosis is supported by a tissue biopsy showing invasion by the organism and a positive culture from a normally sterile site. Aspergilli may be airborne in the environment and be laboratory culture contaminants or present in orally obtained samples from patients without apparent clinical illness and at low risk for invasive aspergillosis and such finding should be interpreted with caution. In tissue Aspergillus spp. (most commonly A. fumigatus) have septate hyphae 3 to 6 mm in width that are described as having acute angle branching. In bone marrow transplant patient's infection may occur early after transplant or after several months as in this case. The other infections can occur in a compromised host but would differ from what is shown. Particularly, the septate hyphae and acute angle branching are not consistent with agents of mucormycosis that have wide non-septate hyphae. Histoplasma capsulatum, which causes histoplasmosis in humans, grows in yeast form in the infected person. Normal healthy individuals may be infected; however, in the immunocompromised host the infection can be more severe.
|
Microbiology
|
Mycology
| 103 |
{
"Correct Answer": "Aspergillosis",
"Correct Option": "A",
"Options": {
"A": "Aspergillosis",
"B": "Candidiasis",
"C": "Histoplasmosis",
"D": "Mucormycosis"
},
"Question": "About 90 days post-bone marrow transplant, a 55-year-old white woman began to complain of dry cough, shortness of breath, and chest pain. She was started on antibiotics and blood culture obtained at the time was negative and there was not improvement. A computed tomography (CT) scan of the lungs showed a halo of low attenuation around a nodular lesion. Analysis of lung biopsy was similar to methenamine silver-stained section below. The most likely diagnosis for this patient is"
}
|
About 90 days post-bone marrow transplant, a 55-year-old white woman began to complain of dry cough, shortness of breath, and chest pain. She was started on antibiotics and blood culture obtained at the time was negative and there was not improvement. A computed tomography (CT) scan of the lungs showed a halo of low attenuation around a nodular lesion. Analysis of lung biopsy was similar to methenamine silver-stained section below.
|
The most likely diagnosis for this patient is
|
{
"A": "Aspergillosis",
"B": "Candidiasis",
"C": "Histoplasmosis",
"D": "Mucormycosis"
}
|
A. Aspergillosis
|
5c54792f-89f0-40ac-81c0-b34dd9f7c168
|
A 20-year-old woman presents with a 4-week history of dry mouth, fatigue, fever, and yellow sclerae. Physical examination shows mild jaundice and hepatomegaly Serum total bilirubin is 3.3 mg/dL. Serologic markers for viral hepatitis are negative. The anti-mitochondrial antibody test is negative. A liver biopsy discloses parenchymal and periportal inflammatory cell infiltrates composed primarily of lymphocytes and plasma cells. The patient's signs and symptoms abate following 2 months of treatment with steroids. Which of the following is the most likely diagnosis?
|
Autoimmune hepatitis
|
Extrahepatic jaundice
|
Primary biliary cirrhosis
|
Primary sclerosing cholangitis
| 0a
|
single
|
Autoimmune hepatitis is a type of chronic hepatitis, which is associated with circulating autoantibodies (e.g., antinuclear antibodies) and high levels of serum immunoglobulins. The disease typically affects young women but occasionally afflicts older women and men. It is often accompanied by other autoimmune diseases (e.g., Sjogren syndrome, systemic lupus erythematosus). None of the other choices respond to steroids. Primary biliary cirrhosis (choice C) features anti-mitochondrial antibodies. Primary biliary cirrhosis (choice C) and primary sclerosing cholangitis (choice D) do not manifest the described histologic findings.Diagnosis: Autoimmune hepatitis
|
Pathology
|
Liver & Biliary Tract
| 128 |
{
"Correct Answer": "Autoimmune hepatitis",
"Correct Option": "A",
"Options": {
"A": "Autoimmune hepatitis",
"B": "Extrahepatic jaundice",
"C": "Primary biliary cirrhosis",
"D": "Primary sclerosing cholangitis"
},
"Question": "A 20-year-old woman presents with a 4-week history of dry mouth, fatigue, fever, and yellow sclerae. Physical examination shows mild jaundice and hepatomegaly Serum total bilirubin is 3.3 mg/dL. Serologic markers for viral hepatitis are negative. The anti-mitochondrial antibody test is negative. A liver biopsy discloses parenchymal and periportal inflammatory cell infiltrates composed primarily of lymphocytes and plasma cells. The patient's signs and symptoms abate following 2 months of treatment with steroids. Which of the following is the most likely diagnosis?"
}
|
A 20-year-old woman presents with a 4-week history of dry mouth, fatigue, fever, and yellow sclerae. Physical examination shows mild jaundice and hepatomegaly Serum total bilirubin is 3.3 mg/dL. Serologic markers for viral hepatitis are negative. The anti-mitochondrial antibody test is negative. A liver biopsy discloses parenchymal and periportal inflammatory cell infiltrates composed primarily of lymphocytes and plasma cells. The patient's signs and symptoms abate following 2 months of treatment with steroids.
|
Which of the following is the most likely diagnosis?
|
{
"A": "Autoimmune hepatitis",
"B": "Extrahepatic jaundice",
"C": "Primary biliary cirrhosis",
"D": "Primary sclerosing cholangitis"
}
|
A. Autoimmune hepatitis
|
6a9a033e-f908-4e74-9b9e-06e28e0425bc
|
An enlarging, conical "cutaneous horn" that has been present for more than a year projects 0.5 cm from a 0.7-cm base on the left lateral cheek of the face of a 58-year-old farmer. This lesion is excised, and microscopic 'examination shows basal cell hyperplasia. Some of the basal cells show nuclear atypicalities. This is associated with marked hyper keratosis and parakeratosis. Which of the following lesions best accounts for these findings?
|
Verruca vulgaris
|
Keratoacanthoma
|
Dysplastic nevus
|
Actinic keratosis
| 3d
|
single
|
Actinic keratosis occurs on sun-exposed areas and is considered a precursor of squamous cell' carcinoma. When the atypical basal cells occupy the entire thickness of the epidermis, the lesion transforms into a carcinoma in situ. The presence of a hyperkeratotic layer is characteristic. Occasionally, so much keratin is produced that a "cutaneous horn" is formed. A verruca vulgaris may also be a raised lesion, but it is usually more pebbly, and there is no squamous atypia. Superficial epidermal cells show vacuolation or koilocytosis. A keratoacanthoma is a dome-shaped nodule with a central keratin-filled crater, that is surrounded by epithelial cells. Microscopically, it may mimic a squamous cell carcinoma. A dysplastic nevus is typically a flat, pigmented lesion. A seborrheic keratosis can be raised, but it usually appears as a coinlike plaque
|
Surgery
| null | 108 |
{
"Correct Answer": "Actinic keratosis",
"Correct Option": "D",
"Options": {
"A": "Verruca vulgaris",
"B": "Keratoacanthoma",
"C": "Dysplastic nevus",
"D": "Actinic keratosis"
},
"Question": "An enlarging, conical \"cutaneous horn\" that has been present for more than a year projects 0.5 cm from a 0.7-cm base on the left lateral cheek of the face of a 58-year-old farmer. This lesion is excised, and microscopic 'examination shows basal cell hyperplasia. Some of the basal cells show nuclear atypicalities. This is associated with marked hyper keratosis and parakeratosis. Which of the following lesions best accounts for these findings?"
}
|
An enlarging, conical "cutaneous horn" that has been present for more than a year projects 0.5 cm from a 0.7-cm base on the left lateral cheek of the face of a 58-year-old farmer. This lesion is excised, and microscopic 'examination shows basal cell hyperplasia. Some of the basal cells show nuclear atypicalities. This is associated with marked hyper keratosis and parakeratosis.
|
Which of the following lesions best accounts for these findings?
|
{
"A": "Verruca vulgaris",
"B": "Keratoacanthoma",
"C": "Dysplastic nevus",
"D": "Actinic keratosis"
}
|
D. Actinic keratosis
|
2af71883-fdb5-43d0-b407-d9b1c88221f2
|
A 32-year-old woman presents to you for evaluation of headache. The headaches began at age 18, were initially unilateral and worse around the time of her menses. Initially the use of triptans two or three times a month would provide complete relief. Over the past several years, however, the headaches have become more frequent and severe. Triptans provide only partial relief; the patient requires a combination of acetaminophen, caffeine, and butalbital to achieve some improvement. Prophylactic medications including beta-blockers, tricyclics, and topiramate have been unsuccessful in preventing the headaches, and she has been to the emergency room three times over the past 2 weeks for a "pain shot." The general physical examination is unremarkable. Her funduscopic examination shows no evidence of papilledema, and a careful neurological examination is likewise normal. What is the most likely explanation for her headache syndrome?
|
Status migrainosus
|
Medication overuse headache
|
Space-occupying intracerebral lesion
|
CNS vasculitis
| 1b
|
multi
|
Patients who use medications for headache more than twice weekly are at risk of medication overuse headache. Any analgesic, including triptans themselves, can contribute, but opiates and barbiturates are the main culprits. In this setting, the migraine may "transform" into a chronic daily headache. Medication overuse headaches usually start in the morning and improve but do not completely resolve with analgesic therapy. The patient must completely discontinue the offending drug for 2 to 12 weeks for the headaches to resolve. Treating headaches during the period of abstinence can be very difficult. The physician should be vigilant about the development of another cause of headache (mass lesion, inflammatory disorder) in a patient with transformed migraines. CNS imaging and laboratory workup, not generally recommended in the patient with typical migraine, are sometimes indicated. In this patient without focal neurological findings, however, the most likely diagnosis is still medication overuse headache. Status migrainosus (continuous migraine) and CNS vasculitis are much less common than medication overuse headache. Pseudotumor cerebri usually causes papilledema.
|
Medicine
|
C.N.S.
| 196 |
{
"Correct Answer": "Medication overuse headache",
"Correct Option": "B",
"Options": {
"A": "Status migrainosus",
"B": "Medication overuse headache",
"C": "Space-occupying intracerebral lesion",
"D": "CNS vasculitis"
},
"Question": "A 32-year-old woman presents to you for evaluation of headache. The headaches began at age 18, were initially unilateral and worse around the time of her menses. Initially the use of triptans two or three times a month would provide complete relief. Over the past several years, however, the headaches have become more frequent and severe. Triptans provide only partial relief; the patient requires a combination of acetaminophen, caffeine, and butalbital to achieve some improvement. Prophylactic medications including beta-blockers, tricyclics, and topiramate have been unsuccessful in preventing the headaches, and she has been to the emergency room three times over the past 2 weeks for a \"pain shot.\" The general physical examination is unremarkable. Her funduscopic examination shows no evidence of papilledema, and a careful neurological examination is likewise normal. What is the most likely explanation for her headache syndrome?"
}
|
A 32-year-old woman presents to you for evaluation of headache. The headaches began at age 18, were initially unilateral and worse around the time of her menses. Initially the use of triptans two or three times a month would provide complete relief. Over the past several years, however, the headaches have become more frequent and severe. Triptans provide only partial relief; the patient requires a combination of acetaminophen, caffeine, and butalbital to achieve some improvement. Prophylactic medications including beta-blockers, tricyclics, and topiramate have been unsuccessful in preventing the headaches, and she has been to the emergency room three times over the past 2 weeks for a "pain shot." The general physical examination is unremarkable. Her funduscopic examination shows no evidence of papilledema, and a careful neurological examination is likewise normal.
|
What is the most likely explanation for her headache syndrome?
|
{
"A": "Status migrainosus",
"B": "Medication overuse headache",
"C": "Space-occupying intracerebral lesion",
"D": "CNS vasculitis"
}
|
B. Medication overuse headache
|
39b42c52-ff6c-4bc6-ae30-89af10fbb469
|
A 56-year-old man has been admitted to the ICU in respiratory distress. An endotracheal tube is placed for mechanical ventilation at a tidal volume of 900 mL, a rate of 12 breaths/min, and FiO2 50%. PEEP is 10 cm of water. Medications include subcutaneous heparin and aspirin. He now develops tachycardia and a blood pressure of 70/palpation mm Hg. Cardiac examination reveals multiple premature contractions. His arterial blood gas reveals a PO2 of 40 mm Hg. Most likely cause of this condition is?
|
Cardiac arrhythmia
|
Bronchial secretions
|
Myocardial infarction
|
Pneumothorax
| 3d
|
single
|
The sudden onset of tachycardia and hypotension indicates an acute process. Since the patient is being mechanically ventilated with positive pressure, he is at increased risk of a bullous rupture from barotrauma, leading to a pneumothorax.
Cardiac arrhythmia could lead to tachycardia and hypotension. Ventricular tachycardia and atrial fibrillation with a rapid ventricular response may cause this from decreased ventricular filling. An ECG would aid in this diagnosis. In the setting of mechanical ventilation, however, a pneumothorax must be excluded first. Bronchial secretions usually have a progressively worsening presentation. Furthermore, the patient would exhibit desaturation, but not necessarily hypotension. Myocardial infarction may lead to cardiogenic shock from failure. However, this would most likely be a bit more progressive and less acute. Infarction must remain high on the differential diagnosis, and the patient may require vasopressors because of the shock. In the immediate setting, the pneumothorax is more likely, given the acuity of onset. Pulmonary embolus is on the differential diagnosis of electromechanical dissociation. This patient's risk of an embolus is increased because of prolonged immobilization. However, the subcutaneous heparin should be adequate prophylaxis against an embolism.
|
Unknown
| null | 138 |
{
"Correct Answer": "Pneumothorax",
"Correct Option": "D",
"Options": {
"A": "Cardiac arrhythmia",
"B": "Bronchial secretions",
"C": "Myocardial infarction",
"D": "Pneumothorax"
},
"Question": "A 56-year-old man has been admitted to the ICU in respiratory distress. An endotracheal tube is placed for mechanical ventilation at a tidal volume of 900 mL, a rate of 12 breaths/min, and FiO2 50%. PEEP is 10 cm of water. Medications include subcutaneous heparin and aspirin. He now develops tachycardia and a blood pressure of 70/palpation mm Hg. Cardiac examination reveals multiple premature contractions. His arterial blood gas reveals a PO2 of 40 mm Hg. Most likely cause of this condition is?"
}
|
A 56-year-old man has been admitted to the ICU in respiratory distress. An endotracheal tube is placed for mechanical ventilation at a tidal volume of 900 mL, a rate of 12 breaths/min, and FiO2 50%. PEEP is 10 cm of water. Medications include subcutaneous heparin and aspirin. He now develops tachycardia and a blood pressure of 70/palpation mm Hg. Cardiac examination reveals multiple premature contractions. His arterial blood gas reveals a PO2 of 40 mm Hg.
|
Most likely cause of this condition is?
|
{
"A": "Cardiac arrhythmia",
"B": "Bronchial secretions",
"C": "Myocardial infarction",
"D": "Pneumothorax"
}
|
D. Pneumothorax
|
4f0b9333-cfb8-4da9-b5a4-f35e749370b5
|
A 50-year-old obese woman has long-standing type 2 diabetes mellitus inadequately controlled on metformin and pioglitazone. Insulin glargine (15 units subcutaneously at bedtime) has recently been started because of a hemoglobin A1C level of 8.4. Over the weekend, she develops nausea, vomiting, and diarrhea after exposure to family members with a similar illness. Afraid of hypoglycemia, the patient omits the insulin for 3 nights. Over the next 24 hours, she develops lethargy and is brought to the emergency room. On examination, she is afebrile and unresponsive to verbal command. Blood pressure is 84/52. Skin turgor is poor and mucous membranes dry. Neurological examination is nonfocal; she does not have neck rigidity.Laboratory results are as follows:Na: 126 mEq/LK: 4.0 mEq/LCl: 95 mEq/LHCO3: 22 mEq/LGlucose: 1100 mg/dLBUN: 84 mg/dLCreatinine: 3.0 mg/dLWhich of the following is the most likely cause of this patient's coma?
|
Diabetic ketoacidosis
|
Hyperosmolar nonketotic state
|
Syndrome of inappropriate antidiuretic hormone (ADH) secretion
|
Drug-induced hyponatremia
| 1b
|
single
|
This woman with poorly controlled diabetes has developed hyperglycemia and lethargy during an episode suggestive of viral gastroenteritis. Her presentation is most consistent with hyperosmolar nonketotic state. This condition typically occurs in type 2 diabetics who become volume depleted and develop renal insufficiency. Glucose is no longer able to spill out into the urine, the blood glucose skyrockets, and severe hypertonicity leads to brain dysfunction and coma. Serum osmolarity is calculated by the formula:18Plasmaglucose +2(Na++K+)+2.8bloodureanitrogen This patient's serum osmolarity is as follows:181100 +(126+4)+2.884 =61+260+30=351Thus, the serum osmolarity is greater than 350 mOsm/L. Although the serum sodium is usually the main determinant of osmolarity, extreme hyperglycemia contributes significantly to this patient's hypertonicity. Osmotically active particles in the extracellular fluid space pull water out of the intracellular space. This causes cellular dehydration in the brain and consequently the patient's CNS changes.Diabetic ketoacidosis would be associated with a much lower serum bicarbonate level and with an elevated anion gap. This patient's anion gap is 9 mEq/L (126-), which is well within the normal range. This patient's hyponatremia is minimal and is related to the osmotic effects of hyperglycemia. Patients with SIADH have an inappropriate production of ADH, leading to water retention and consequent hypotonicity (not hypertonicity, as in this case). The diagnosis of SIADH or drug-induced hyponatremia cannot be made in the setting of severe hypovolemia. Although the oral hypoglycemic chlorpropamide can cause drug-induced hyponatremia, this patient was not taking a sulfonylurea. Although meningitis can be associated with hyponatremia, this patient's hypertonicity and lack of meningeal signs point toward hyperosmolar nonketotic state as the cause of her illness.
|
Medicine
|
Endocrinology
| 271 |
{
"Correct Answer": "Hyperosmolar nonketotic state",
"Correct Option": "B",
"Options": {
"A": "Diabetic ketoacidosis",
"B": "Hyperosmolar nonketotic state",
"C": "Syndrome of inappropriate antidiuretic hormone (ADH) secretion",
"D": "Drug-induced hyponatremia"
},
"Question": "A 50-year-old obese woman has long-standing type 2 diabetes mellitus inadequately controlled on metformin and pioglitazone. Insulin glargine (15 units subcutaneously at bedtime) has recently been started because of a hemoglobin A1C level of 8.4. Over the weekend, she develops nausea, vomiting, and diarrhea after exposure to family members with a similar illness. Afraid of hypoglycemia, the patient omits the insulin for 3 nights. Over the next 24 hours, she develops lethargy and is brought to the emergency room. On examination, she is afebrile and unresponsive to verbal command. Blood pressure is 84/52. Skin turgor is poor and mucous membranes dry. Neurological examination is nonfocal; she does not have neck rigidity.Laboratory results are as follows:Na: 126 mEq/LK: 4.0 mEq/LCl: 95 mEq/LHCO3: 22 mEq/LGlucose: 1100 mg/dLBUN: 84 mg/dLCreatinine: 3.0 mg/dLWhich of the following is the most likely cause of this patient's coma?"
}
|
A 50-year-old obese woman has long-standing type 2 diabetes mellitus inadequately controlled on metformin and pioglitazone. Insulin glargine (15 units subcutaneously at bedtime) has recently been started because of a hemoglobin A1C level of 8.4. Over the weekend, she develops nausea, vomiting, and diarrhea after exposure to family members with a similar illness. Afraid of hypoglycemia, the patient omits the insulin for 3 nights. Over the next 24 hours, she develops lethargy and is brought to the emergency room. On examination, she is afebrile and unresponsive to verbal command. Blood pressure is 84/52. Skin turgor is poor and mucous membranes dry.
|
Neurological examination is nonfocal; she does not have neck rigidity.Laboratory results are as follows:Na: 126 mEq/LK: 4.0 mEq/LCl: 95 mEq/LHCO3: 22 mEq/LGlucose: 1100 mg/dLBUN: 84 mg/dLCreatinine: 3.0 mg/dLWhich of the following is the most likely cause of this patient's coma?
|
{
"A": "Diabetic ketoacidosis",
"B": "Hyperosmolar nonketotic state",
"C": "Syndrome of inappropriate antidiuretic hormone (ADH) secretion",
"D": "Drug-induced hyponatremia"
}
|
B. Hyperosmolar nonketotic state
|
d2922f51-5dda-4bf4-91ef-ab9e2cd3b182
|
A 34-year-old woman is seen in the emergency depament. About 5 hours previously, she began to have nausea, vomiting, abdominal cramps, and diarrhea. She then developed double vision, which prompted her to ask her husband to bring her to the emergency depament. When she is asked to go into the examining room, she stumbles. When she tries to answer questions, her voice sounds odd and she seems to mumble. Physical examination demonstrates a dry mouth, drooping eyelids, markedly diminished pupillary light reflex, a flaccid facial expression, and difficulty in opening her mouth. Within an hour, her condition has markedly deteriorated. She can no longer stand and is intubated because of difficulty breathing. Which of the following microbial species is MOST likely to have caused her condition?
|
Clostridium botulinum
|
Clostridium perfringens
|
Clostridium ramosum
|
Clostridium septicum
| 0a
|
single
|
This is a typical presentation of botulism, which is caused by the preformed toxin of Clostridium botulinum. Patients develop a progressive flaccid paralysis that can lead to death if their respiratory system is not adequately suppoed. Mentation is intact in these patients, and they do not exhibit sensory changes except for those, such as the double vision, related to failure of extra- and intraocular muscles. Note: You are probably aware that botulism can follow ingestion of home canned vegetables, fish, fruits, and condiments. You may not be aware that other vehicles that have been the source of outbreaks include commercially prepared canned foods, poultry, and dairy products; and even restaurant-prepared non-canned foods including seafood, foil-wrapped baked potatoes, chopped garlic in oil, and patty melt sandwiches. For this reason, the absence of a classic history of ingestion of home canned food should not be used to exclude the diagnosis of botulism. Treatment is suppoive. Most patients recover from foodborne botulism without sequelae. You should also be aware that C. botulinum can cause true infection coupled with toxin production in wounds and in infants. Clostridium perfringens is one of the causes of gas gangrene. Clostridium ramosum has been associated with intra-abdominal infections after bowel perforation. Clostridium septicum has complicated colorectal malignancy.
|
Microbiology
| null | 166 |
{
"Correct Answer": "Clostridium botulinum",
"Correct Option": "A",
"Options": {
"A": "Clostridium botulinum",
"B": "Clostridium perfringens",
"C": "Clostridium ramosum",
"D": "Clostridium septicum"
},
"Question": "A 34-year-old woman is seen in the emergency depament. About 5 hours previously, she began to have nausea, vomiting, abdominal cramps, and diarrhea. She then developed double vision, which prompted her to ask her husband to bring her to the emergency depament. When she is asked to go into the examining room, she stumbles. When she tries to answer questions, her voice sounds odd and she seems to mumble. Physical examination demonstrates a dry mouth, drooping eyelids, markedly diminished pupillary light reflex, a flaccid facial expression, and difficulty in opening her mouth. Within an hour, her condition has markedly deteriorated. She can no longer stand and is intubated because of difficulty breathing. Which of the following microbial species is MOST likely to have caused her condition?"
}
|
A 34-year-old woman is seen in the emergency depament. About 5 hours previously, she began to have nausea, vomiting, abdominal cramps, and diarrhea. She then developed double vision, which prompted her to ask her husband to bring her to the emergency depament. When she is asked to go into the examining room, she stumbles. When she tries to answer questions, her voice sounds odd and she seems to mumble. Physical examination demonstrates a dry mouth, drooping eyelids, markedly diminished pupillary light reflex, a flaccid facial expression, and difficulty in opening her mouth. Within an hour, her condition has markedly deteriorated. She can no longer stand and is intubated because of difficulty breathing.
|
Which of the following microbial species is MOST likely to have caused her condition?
|
{
"A": "Clostridium botulinum",
"B": "Clostridium perfringens",
"C": "Clostridium ramosum",
"D": "Clostridium septicum"
}
|
A. Clostridium botulinum
|
ef0be526-ac6a-4263-9827-559a59cfc52d
|
A 45-year-old woman is seen by her primary care physician complaining of intermittent colicky pain in the right upper quadrant (RUQ), staing sholy after eating a meal, and lasting about 30 min. During these episodes, she feels bloated and nauseated. The patient also states that over the past 2 days, her stools have become very light in color, like the color of sand, and her skin has become yellow. What is the anatomical basis for the clinical condition?
|
<img style="max-width: 100%" src=" />
|
<img style="max-width: 100%" src=" />
|
<img style="max-width: 100%" src=" />
|
Inflammation of hepatic Glisson's capsule
| 1b
|
single
|
A- Gallstones in gallbladder B- Bile duct obstruction due to gall stones C- Premature activation and leakage of pancreatic enzymes This middle-aged woman has the typical symptoms of biliary colic, which is intermittent crampy abdominal pain in the epigastric region of the RUQ, sometimes radiating to the right shoulder. These symptoms typically appear after meals, paicularly fatty meals. The more concerning signs are the light-colored stools (acholic) and jaundice (icterus). Gallstones (cholelithiasis) are precipitated bile salts in the gallbladder, which may produce inflammation of the gallbladder (cholecystitis). Stones can pass into the cystic duct and into the common bile duct. Since the common bile duct is formed by the union of the cystic and common hepatic ducts, obstruction of the common bile duct prevents bilirubin produced in the liver from reaching the small intestines. The stools thus lack this pigment. As a secondary result of the obstruction, serum bilirubin is elevated, and precipitates in the skin, resulting in the yellow tint. Ultrasound (DOUBLE BARREL/DUCT SIGN) can often make the initial diagnosis. Removal of a common bile duct stone can be performed by upper GI endoscopy through the ampulla of Vater or surgically.
|
Unknown
|
Integrated QBank
| 104 |
{
"Correct Answer": "<img style=\"max-width: 100%\" src=\" />",
"Correct Option": "B",
"Options": {
"A": "<img style=\"max-width: 100%\" src=\" />",
"B": "<img style=\"max-width: 100%\" src=\" />",
"C": "<img style=\"max-width: 100%\" src=\" />",
"D": "Inflammation of hepatic Glisson's capsule"
},
"Question": "A 45-year-old woman is seen by her primary care physician complaining of intermittent colicky pain in the right upper quadrant (RUQ), staing sholy after eating a meal, and lasting about 30 min. During these episodes, she feels bloated and nauseated. The patient also states that over the past 2 days, her stools have become very light in color, like the color of sand, and her skin has become yellow. What is the anatomical basis for the clinical condition?"
}
|
A 45-year-old woman is seen by her primary care physician complaining of intermittent colicky pain in the right upper quadrant (RUQ), staing sholy after eating a meal, and lasting about 30 min. During these episodes, she feels bloated and nauseated. The patient also states that over the past 2 days, her stools have become very light in color, like the color of sand, and her skin has become yellow.
|
What is the anatomical basis for the clinical condition?
|
{
"A": "<img style=\"max-width: 100%\" src=\" />",
"B": "<img style=\"max-width: 100%\" src=\" />",
"C": "<img style=\"max-width: 100%\" src=\" />",
"D": "Inflammation of hepatic Glisson's capsule"
}
|
B. <img style="max-width: 100%" src=" />
|
b28c6225-e07d-4c85-96e3-2217c38ca550
|
A 32-years old male with suspected neurofibroma, tosis was found to have a blood pressure of 178/110 mm Hg at a recent health fair. He complained of palpitations and excessive sweating. Today he presents to the clinic for a checkup because he has developed abdominal discomfo. His blood pressure is now recorded to be 130/80 mm Hg. Physical examination reveals multiple tumors of the oral mucosa and skin. Laboratory investigations reveal: Serum K+ : 3.8 mEq/L (N : 3.5-5.0 mEq/L) Serum Ca2+: 136 mEq/L (N : 135-145 mEq/I,) Serum Ca2+ : 9.4 mg/dL (N : 8.4-10.2 mg/dL) d 14) Genetic studies in this patient will most likely show -
|
N-myc amplification
|
Overexpression of C-kit
|
K-ras mutation
|
RET oncogene
| 3d
|
single
|
The RET proto-oncogene encodes a receptor tyrosine kinase for members of the glial cell line-derived neurotrophic factor (GDNF) family of extracellular signalling molecules.RET loss of function mutations are associated with the development of Hirschsprung's disease, while gain of function mutations are associated with the development of various types of human cancer, including medullary thyroid carcinoma, multiple endocrine neoplasias type 2A and 2B, pheochromocytoma and parathyroid hyperplasia Ref Davidson 23rd edition pg 1057
|
Medicine
|
Miscellaneous
| 200 |
{
"Correct Answer": "RET oncogene",
"Correct Option": "D",
"Options": {
"A": "N-myc amplification",
"B": "Overexpression of C-kit",
"C": "K-ras mutation",
"D": "RET oncogene"
},
"Question": "A 32-years old male with suspected neurofibroma, tosis was found to have a blood pressure of 178/110 mm Hg at a recent health fair. He complained of palpitations and excessive sweating. Today he presents to the clinic for a checkup because he has developed abdominal discomfo. His blood pressure is now recorded to be 130/80 mm Hg. Physical examination reveals multiple tumors of the oral mucosa and skin. Laboratory investigations reveal: Serum K+ : 3.8 mEq/L (N : 3.5-5.0 mEq/L) Serum Ca2+: 136 mEq/L (N : 135-145 mEq/I,) Serum Ca2+ : 9.4 mg/dL (N : 8.4-10.2 mg/dL) d 14) Genetic studies in this patient will most likely show -"
}
|
A 32-years old male with suspected neurofibroma, tosis was found to have a blood pressure of 178/110 mm Hg at a recent health fair. He complained of palpitations and excessive sweating. Today he presents to the clinic for a checkup because he has developed abdominal discomfo. His blood pressure is now recorded to be 130/80 mm Hg. Physical examination reveals multiple tumors of the oral mucosa and skin.
|
Laboratory investigations reveal: Serum K+ : 3.8 mEq/L (N : 3.5-5.0 mEq/L) Serum Ca2+: 136 mEq/L (N : 135-145 mEq/I,) Serum Ca2+ : 9.4 mg/dL (N : 8.4-10.2 mg/dL) d 14) Genetic studies in this patient will most likely show -
|
{
"A": "N-myc amplification",
"B": "Overexpression of C-kit",
"C": "K-ras mutation",
"D": "RET oncogene"
}
|
D. RET oncogene
|
459e5cc4-7ad5-4385-a3cb-29275c51624c
|
A 3 year old child with cystic fibrosis presents with weight loss, irritability, and a chronic productive cough. On physical exam, he is febrile and lung exam reveals intercostal retractions, wheezing, rhonchi, and rales. Chest x-ray demonstrates patchy infiltrates and atelectasis and Gram's stain of the sputum reveals slightly curved, motile gram-negative rods that grow aerobically. The microorganism responsible for this child's pneumonia is also the most common cause of which of the following diseases?
|
Croup
|
Epiglottitis
|
Meningitis
|
Otitis externa
| 3d
|
multi
| null |
ENT
| null | 116 |
{
"Correct Answer": "Otitis externa",
"Correct Option": "D",
"Options": {
"A": "Croup",
"B": "Epiglottitis",
"C": "Meningitis",
"D": "Otitis externa"
},
"Question": "A 3 year old child with cystic fibrosis presents with weight loss, irritability, and a chronic productive cough. On physical exam, he is febrile and lung exam reveals intercostal retractions, wheezing, rhonchi, and rales. Chest x-ray demonstrates patchy infiltrates and atelectasis and Gram's stain of the sputum reveals slightly curved, motile gram-negative rods that grow aerobically. The microorganism responsible for this child's pneumonia is also the most common cause of which of the following diseases?"
}
|
A 3 year old child with cystic fibrosis presents with weight loss, irritability, and a chronic productive cough. On physical exam, he is febrile and lung exam reveals intercostal retractions, wheezing, rhonchi, and rales. Chest x-ray demonstrates patchy infiltrates and atelectasis and Gram's stain of the sputum reveals slightly curved, motile gram-negative rods that grow aerobically.
|
The microorganism responsible for this child's pneumonia is also the most common cause of which of the following diseases?
|
{
"A": "Croup",
"B": "Epiglottitis",
"C": "Meningitis",
"D": "Otitis externa"
}
|
D. Otitis externa
|
38e4bc8a-8d41-4285-8cde-bc763e1baadc
|
A 54-year-old, previously healthy man has experienced minor fatigue on exertion for the past 9 months. On physical examination, there are no remarkable findings. Laboratory studies show hemoglobin of 11.7 g/dL, hematocrit of 34.8%, MCV of 73 mm3, platelet count of 315,000/ mm3, and WBC count of 8035/ mm3. Which of the following is the most sensitive and cost-effective test that the physician should order to help to determine the cause of these findings?
|
Bone marrow biopsy
|
Hemoglobin electrophoresis
|
Serum ferritin
|
Serum haptoglobin
| 2c
|
single
|
With RBC microcytosis, iron deficiency anemia must be considered. It could be a nutritional deficiency in children and pregnant women, but more likely is due to chronic blood loss in adults. The ferritin concentration is a measure of storage iron because it is derived from the total body storage pool in the liver, spleen, and marrow. About 80% of functional body iron is contained in hemoglobin; the remainder is in muscle myoglobin. Individuals with severe liver disease can have an elevated serum ferritin level because of its release from liver stores. A bone marrow biopsy specimen provides a good indication of iron stores because the iron stain of the marrow shows hemosiderin in macrophages, but such a biopsy is an expensive procedure. Some patients with hemoglobinopathies, such as b-thalassemia, also can have microcytic anemia, but this is far less common than iron deficiency. The serum haptoglobin level is decreased with intravascular hemolysis, but the anemia is normocytic because the iron can be recycled. The serum iron concentration or transferrin level by itself gives no indication of iron stores because, in anemia of chronic disease, the patient's iron level can be normal to low, and the transferrin levels also can be normal to low, but iron stores are increased. Transferrin, a serum transport protein for iron, usually has about 33% iron saturation.
|
Pathology
|
Blood
| 126 |
{
"Correct Answer": "Serum ferritin",
"Correct Option": "C",
"Options": {
"A": "Bone marrow biopsy",
"B": "Hemoglobin electrophoresis",
"C": "Serum ferritin",
"D": "Serum haptoglobin"
},
"Question": "A 54-year-old, previously healthy man has experienced minor fatigue on exertion for the past 9 months. On physical examination, there are no remarkable findings. Laboratory studies show hemoglobin of 11.7 g/dL, hematocrit of 34.8%, MCV of 73 mm3, platelet count of 315,000/ mm3, and WBC count of 8035/ mm3. Which of the following is the most sensitive and cost-effective test that the physician should order to help to determine the cause of these findings?"
}
|
A 54-year-old, previously healthy man has experienced minor fatigue on exertion for the past 9 months. On physical examination, there are no remarkable findings. Laboratory studies show hemoglobin of 11.7 g/dL, hematocrit of 34.8%, MCV of 73 mm3, platelet count of 315,000/ mm3, and WBC count of 8035/ mm3.
|
Which of the following is the most sensitive and cost-effective test that the physician should order to help to determine the cause of these findings?
|
{
"A": "Bone marrow biopsy",
"B": "Hemoglobin electrophoresis",
"C": "Serum ferritin",
"D": "Serum haptoglobin"
}
|
C. Serum ferritin
|
2250a94e-d34c-46fa-a4fd-fd16e72ad143
|
A 27-year-old man and his 24-year-old wife have been trying to conceive a child for 6 years. Physical examination shows he has bilateral gynecomastia, reduced testicular size, reduced body hair, and increased length between the soles of his feet and the pubic bone. A semen analysis indicates oligospermia. Laboratory studies show increased follicle-stimulating hormone level and slightly decreased testosterone level. Which of the following karyotypes is this man most likely to have?
|
46, X, I (Xq)
|
47, XYY
|
47, XXY
|
46, XX/47, XX, +21
| 2c
|
single
|
Klinefelter syndrome is a relatively common chromosomal abnormality that occurs in about 1 of 660 live-born males. The findings can be subtle. The 46, X, i (Xq) karyotype is a variant of Turner syndrome (seen only in females), caused by a defective second X chromosome. The 47, XYY karyotype occurs in about 1 in 1000 live-born males and is associated with taller-than-average stature. A person with a mosaic such as 46, XX/47, XX, +21 has milder features of Down syndrome than a person with the more typical 47, XX, +21 karyotype. The 22q11 deletion syndrome is associated with congenital defects affecting the palate, face, and heart and, in some cases, with T cell immunodeficiency.
|
Pathology
|
Genetics
| 106 |
{
"Correct Answer": "47, XXY",
"Correct Option": "C",
"Options": {
"A": "46, X, I (Xq)",
"B": "47, XYY",
"C": "47, XXY",
"D": "46, XX/47, XX, +21"
},
"Question": "A 27-year-old man and his 24-year-old wife have been trying to conceive a child for 6 years. Physical examination shows he has bilateral gynecomastia, reduced testicular size, reduced body hair, and increased length between the soles of his feet and the pubic bone. A semen analysis indicates oligospermia. Laboratory studies show increased follicle-stimulating hormone level and slightly decreased testosterone level. Which of the following karyotypes is this man most likely to have?"
}
|
A 27-year-old man and his 24-year-old wife have been trying to conceive a child for 6 years. Physical examination shows he has bilateral gynecomastia, reduced testicular size, reduced body hair, and increased length between the soles of his feet and the pubic bone. A semen analysis indicates oligospermia. Laboratory studies show increased follicle-stimulating hormone level and slightly decreased testosterone level.
|
Which of the following karyotypes is this man most likely to have?
|
{
"A": "46, X, I (Xq)",
"B": "47, XYY",
"C": "47, XXY",
"D": "46, XX/47, XX, +21"
}
|
C. 47, XXY
|
2cb99ffe-fe25-45c7-a0d3-aaab2b3f995b
|
A 52-year-old recent immigrant from Vietnam complains of abdominal swelling, weight loss, and upper abdominal pain of 3 weeks in duration. His past medical history includes malaria and infection with the liver fluke Clonorchis sinensis. The liver is hard on palpation. An abdominal CT scan shows a hypo-attenuated mass with lobulated margins in the liver. A biopsy discloses well-differentiated neoplastic glands embedded in a dense fibrous stroma. Which of the following is the most likely diagnosis?
|
Carcinoma of the gallbladder
|
Cholangiocarcinoma
|
Hemangiosarcoma
|
Hepatocellular carcinoma
| 1b
|
multi
|
Carcinoma originates anywhere in the biliary tree. Cholangiocarcinoma:- Arising within the liver Associated with substantial fibrosis Confused with metastatic carcinoma and reactive fibrosis. These tumors occur at an increased frequency in persons infected with the liver fluke C. sinensis The other choices are not associated with a history of C. sinensis infestation.
|
Pathology
|
Miscellaneous
| 109 |
{
"Correct Answer": "Cholangiocarcinoma",
"Correct Option": "B",
"Options": {
"A": "Carcinoma of the gallbladder",
"B": "Cholangiocarcinoma",
"C": "Hemangiosarcoma",
"D": "Hepatocellular carcinoma"
},
"Question": "A 52-year-old recent immigrant from Vietnam complains of abdominal swelling, weight loss, and upper abdominal pain of 3 weeks in duration. His past medical history includes malaria and infection with the liver fluke Clonorchis sinensis. The liver is hard on palpation. An abdominal CT scan shows a hypo-attenuated mass with lobulated margins in the liver. A biopsy discloses well-differentiated neoplastic glands embedded in a dense fibrous stroma. Which of the following is the most likely diagnosis?"
}
|
A 52-year-old recent immigrant from Vietnam complains of abdominal swelling, weight loss, and upper abdominal pain of 3 weeks in duration. His past medical history includes malaria and infection with the liver fluke Clonorchis sinensis. The liver is hard on palpation. An abdominal CT scan shows a hypo-attenuated mass with lobulated margins in the liver. A biopsy discloses well-differentiated neoplastic glands embedded in a dense fibrous stroma.
|
Which of the following is the most likely diagnosis?
|
{
"A": "Carcinoma of the gallbladder",
"B": "Cholangiocarcinoma",
"C": "Hemangiosarcoma",
"D": "Hepatocellular carcinoma"
}
|
B. Cholangiocarcinoma
|
d8245966-fb0e-4aab-8c10-d60c6aa586e0
|
A 62-year-old childless woman noticed a blood-tinged vaginal discharge twice during the past month. Her last menstrual period was 10 years ago. Bimanual pelvic examination shows that the uterus is normal in size, with no palpable adnexal masses. There are no cervical erosions or masses. Her body mass index is 33. Her medical history indicates that for the past 30 years she has had hypertension and type 2 diabetes mellitus. An endometrial biopsy specimen is most likely to show which of the following?
|
Adenocarcinoma
|
Choriocarcinoma
|
Leiomyosarcoma
|
Malignant mullerian mixed tumor
| 0a
|
single
|
Postmenopausal vaginal bleeding is a red flag for endometrial carcinoma. Such carcinomas often arise in the setting of endometrial hyperplasia. Increased estrogenic stimulation is thought to drive this process, and risk factors include obesity, type 2 diabetes mellitus, hypertension, and infertility. Choriocarcinomas are gestational in origin. A submucosal leiomyosarcoma could produce vaginal bleeding, but the uterus would be enlarged because leiomyosarcomas tend to be large masses. Malignant mullerian mixed tumors are much less common than endometrial carcinomas, but they could produce similar findings. Malignant mullerian mixed tumors are typically uterine neoplasms that have glandular and stromal elements; the malignant stromal component can be heterologous and may resemble mesenchymal cells that are not ordinarily found in the myometrium, such as cartilage. Squamous carcinomas of the endometrium are rare, and more likely to arise in the cervix.
|
Pathology
|
Female Genital Tract
| 116 |
{
"Correct Answer": "Adenocarcinoma",
"Correct Option": "A",
"Options": {
"A": "Adenocarcinoma",
"B": "Choriocarcinoma",
"C": "Leiomyosarcoma",
"D": "Malignant mullerian mixed tumor"
},
"Question": "A 62-year-old childless woman noticed a blood-tinged vaginal discharge twice during the past month. Her last menstrual period was 10 years ago. Bimanual pelvic examination shows that the uterus is normal in size, with no palpable adnexal masses. There are no cervical erosions or masses. Her body mass index is 33. Her medical history indicates that for the past 30 years she has had hypertension and type 2 diabetes mellitus. An endometrial biopsy specimen is most likely to show which of the following?"
}
|
A 62-year-old childless woman noticed a blood-tinged vaginal discharge twice during the past month. Her last menstrual period was 10 years ago. Bimanual pelvic examination shows that the uterus is normal in size, with no palpable adnexal masses. There are no cervical erosions or masses. Her body mass index is 33. Her medical history indicates that for the past 30 years she has had hypertension and type 2 diabetes mellitus.
|
An endometrial biopsy specimen is most likely to show which of the following?
|
{
"A": "Adenocarcinoma",
"B": "Choriocarcinoma",
"C": "Leiomyosarcoma",
"D": "Malignant mullerian mixed tumor"
}
|
A. Adenocarcinoma
|
69a32c84-1fbd-43c1-a7ba-78ab7c542a11
|
A 40-year-old man presents to casualty with history of regular and heavy use of alcohol for 10 years and morning drinking for one year. The last alcohol intake was three days back. There is no history of head injury or seizures. On examination, there is no icterus, sign of hepatic encephalopathy or focal neurological sign. The patient had coarse tremors, visual hallucinations and had disorientation to time. Which of the following is the best medicine to be prescribed for such a patient: March 2013 (e)
|
Diazepam
|
Haloperidol
|
Imipramine
|
Naltrexone
| 0a
|
multi
|
Ans. A i.e. Diazepam
|
Psychiatry
| null | 116 |
{
"Correct Answer": "Diazepam",
"Correct Option": "A",
"Options": {
"A": "Diazepam",
"B": "Haloperidol",
"C": "Imipramine",
"D": "Naltrexone"
},
"Question": "A 40-year-old man presents to casualty with history of regular and heavy use of alcohol for 10 years and morning drinking for one year. The last alcohol intake was three days back. There is no history of head injury or seizures. On examination, there is no icterus, sign of hepatic encephalopathy or focal neurological sign. The patient had coarse tremors, visual hallucinations and had disorientation to time. Which of the following is the best medicine to be prescribed for such a patient: March 2013 (e)"
}
|
A 40-year-old man presents to casualty with history of regular and heavy use of alcohol for 10 years and morning drinking for one year. The last alcohol intake was three days back. There is no history of head injury or seizures. On examination, there is no icterus, sign of hepatic encephalopathy or focal neurological sign. The patient had coarse tremors, visual hallucinations and had disorientation to time.
|
Which of the following is the best medicine to be prescribed for such a patient: March 2013 (e)
|
{
"A": "Diazepam",
"B": "Haloperidol",
"C": "Imipramine",
"D": "Naltrexone"
}
|
A. Diazepam
|
6c33081c-69d2-4762-bde0-49914242bb31
|
A 50-year-old pulmonologist is diagnosed with pulmonary tuberculosis and staed on standard drug therapy. After 1.5 months, the patient has developed fatigue, low grade fever, muscle aches, bone pains and body aches. The patient also complains of pleuritic chest pain. His sputum tests negative for acid fast bacilli. On fuher investigations, the patient tests positive for anti-histone antibodies. Abnormality in which of the following metabolic processes is responsible for patient's current condition?
|
Sulfation
|
Glucuronide conjugation
|
Acetylation
|
Hydroxylation
| 2c
|
single
|
Patient's symptoms including constitutional symptoms, ahralgia and pleuritic chest pain with positive anti-histone antibodies and recent use of isoniazid point towards the diagnosis of drug induced lupus erythematosus. Drugs undergoing acetylation in liver with the help of N-acetyl transferase are responsible for majority of cases of drug induced SLE. Hepatic expression of N acetyl transferase is genetically determined, and patients with a slow acetylator phenotype are more likely to develop DLE. Drugs undergoing Acetylation and therefore, responsible for DLE: Sulfonamides Hydralazine Isoniazid Procainamide
|
Anatomy
|
Integrated QBank
| 108 |
{
"Correct Answer": "Acetylation",
"Correct Option": "C",
"Options": {
"A": "Sulfation",
"B": "Glucuronide conjugation",
"C": "Acetylation",
"D": "Hydroxylation"
},
"Question": "A 50-year-old pulmonologist is diagnosed with pulmonary tuberculosis and staed on standard drug therapy. After 1.5 months, the patient has developed fatigue, low grade fever, muscle aches, bone pains and body aches. The patient also complains of pleuritic chest pain. His sputum tests negative for acid fast bacilli. On fuher investigations, the patient tests positive for anti-histone antibodies. Abnormality in which of the following metabolic processes is responsible for patient's current condition?"
}
|
A 50-year-old pulmonologist is diagnosed with pulmonary tuberculosis and staed on standard drug therapy. After 1.5 months, the patient has developed fatigue, low grade fever, muscle aches, bone pains and body aches. The patient also complains of pleuritic chest pain. His sputum tests negative for acid fast bacilli. On fuher investigations, the patient tests positive for anti-histone antibodies.
|
Abnormality in which of the following metabolic processes is responsible for patient's current condition?
|
{
"A": "Sulfation",
"B": "Glucuronide conjugation",
"C": "Acetylation",
"D": "Hydroxylation"
}
|
C. Acetylation
|
2c38b344-3ae1-4efa-81d9-ef92b211fc19
|
A 60 year old male was diagnosed with end stage kidney disease 5 years ago & has been managed with hemodialysis since then. He is also hypeensive & diabetic. He is not compliant with his medications & hemodialysis schedule & now presented with bone pain & dyspnea. CXR shows hazy bilateral infiltrates. Chest CT shows ground-glass infiltrates bilaterally. Lab studies show elevated levels of calcium & phosphate, PTH levels of 130 pg/ml. What would be the best management for this patient?
|
Calcitriol 0.5 mg IV with hemodialysis with sevelamer three times daily
|
Calcitriol 0.5 mg orally daily with sevelamer 1600 mg three times daily
|
More aggressive hemodialysis to achieve optimal fluid and electrolyte balance
|
Parathyroidectomy
| 3d
|
multi
|
Given scenario suggests the diagnosis of teiary hyperparathyroidism- commonly seen in patients with chronic kidney disease who are poorly compliant with therapy. Features- bone pain, ectopic calcification & pruritus. Hypoxemia and ground-glass infiltrates on chest CT represent ectopic calcification of the lungs. A technetium-99 bone scan will show increased uptake in the lungs. Lab- Elevated calcium, phosphates & PTH levels Rx- Parathyroidectomy is done in this patient because of severe clinical manifestations.
|
Medicine
|
Disorders of Parathyroid Gland
| 113 |
{
"Correct Answer": "Parathyroidectomy",
"Correct Option": "D",
"Options": {
"A": "Calcitriol 0.5 mg IV with hemodialysis with sevelamer three times daily",
"B": "Calcitriol 0.5 mg orally daily with sevelamer 1600 mg three times daily",
"C": "More aggressive hemodialysis to achieve optimal fluid and electrolyte balance",
"D": "Parathyroidectomy"
},
"Question": "A 60 year old male was diagnosed with end stage kidney disease 5 years ago & has been managed with hemodialysis since then. He is also hypeensive & diabetic. He is not compliant with his medications & hemodialysis schedule & now presented with bone pain & dyspnea. CXR shows hazy bilateral infiltrates. Chest CT shows ground-glass infiltrates bilaterally. Lab studies show elevated levels of calcium & phosphate, PTH levels of 130 pg/ml. What would be the best management for this patient?"
}
|
A 60 year old male was diagnosed with end stage kidney disease 5 years ago & has been managed with hemodialysis since then. He is also hypeensive & diabetic. He is not compliant with his medications & hemodialysis schedule & now presented with bone pain & dyspnea. CXR shows hazy bilateral infiltrates. Chest CT shows ground-glass infiltrates bilaterally. Lab studies show elevated levels of calcium & phosphate, PTH levels of 130 pg/ml.
|
What would be the best management for this patient?
|
{
"A": "Calcitriol 0.5 mg IV with hemodialysis with sevelamer three times daily",
"B": "Calcitriol 0.5 mg orally daily with sevelamer 1600 mg three times daily",
"C": "More aggressive hemodialysis to achieve optimal fluid and electrolyte balance",
"D": "Parathyroidectomy"
}
|
D. Parathyroidectomy
|
55242f21-9a5e-4a64-843a-b251e948328a
|
A previously healthy 58 years old man is admitted to the hospital because of an acute inferior myocardial infarction. Within several hours, he becomes oliguric and hypotensive (blood pressure is 90/60 mmHg). Insertion of a pulmonary artery (Swan-Ganz) catheter reveals the following pressures: pulmonary capillary wedge- 4 mmHg; pulmonary artery- 22/4 mmHg: and mean right atrial- 11 mmHg. This man would best be treated With -
|
Fluids
|
Digoxin
|
Dopamine
|
Intraaortic balloon counterpulsation
| 0a
|
multi
| null |
Medicine
| null | 116 |
{
"Correct Answer": "Fluids",
"Correct Option": "A",
"Options": {
"A": "Fluids",
"B": "Digoxin",
"C": "Dopamine",
"D": "Intraaortic balloon counterpulsation"
},
"Question": "A previously healthy 58 years old man is admitted to the hospital because of an acute inferior myocardial infarction. Within several hours, he becomes oliguric and hypotensive (blood pressure is 90/60 mmHg). Insertion of a pulmonary artery (Swan-Ganz) catheter reveals the following pressures: pulmonary capillary wedge- 4 mmHg; pulmonary artery- 22/4 mmHg: and mean right atrial- 11 mmHg. This man would best be treated With -"
}
|
A previously healthy 58 years old man is admitted to the hospital because of an acute inferior myocardial infarction. Within several hours, he becomes oliguric and hypotensive (blood pressure is 90/60 mmHg). Insertion of a pulmonary artery (Swan-Ganz) catheter reveals the following pressures: pulmonary capillary wedge- 4 mmHg; pulmonary artery- 22/4 mmHg: and mean right atrial- 11 mmHg.
|
This man would best be treated With -
|
{
"A": "Fluids",
"B": "Digoxin",
"C": "Dopamine",
"D": "Intraaortic balloon counterpulsation"
}
|
A. Fluids
|
b8ed426d-c5cc-4b5a-9b1f-159a99c3fc83
|
A 6 week old boy is brought to the Paediatrician in Kanpur. His parents repo that he has not had significant use of his right arm since bih. Bih history is significant for a prolonged labor with difficult breech delivery. On physical examination, his arm hangs at his side and is in a medially rotated position with the forearm in pronation. He will actively use his left arm, but does not move his affected right arm or hand. Injury to which of the following cervical nerve roots account for this patient's posture?
|
C4 and C5
|
C5 and C6
|
C6 and C7
|
C7 and C8
| 1b
|
multi
|
This patient has an Erb-Duchenne palsy, which is the result of an injury to the superior trunks of the C5 and C6 nerve roots.The C8 and T1 nerve roots are injured in a Klumpke's paralysis.The other combinations all may be injured as a result of bih palsy, but do not have distinct syndromes associated with them.
|
Anatomy
| null | 112 |
{
"Correct Answer": "C5 and C6",
"Correct Option": "B",
"Options": {
"A": "C4 and C5",
"B": "C5 and C6",
"C": "C6 and C7",
"D": "C7 and C8"
},
"Question": "A 6 week old boy is brought to the Paediatrician in Kanpur. His parents repo that he has not had significant use of his right arm since bih. Bih history is significant for a prolonged labor with difficult breech delivery. On physical examination, his arm hangs at his side and is in a medially rotated position with the forearm in pronation. He will actively use his left arm, but does not move his affected right arm or hand. Injury to which of the following cervical nerve roots account for this patient's posture?"
}
|
A 6 week old boy is brought to the Paediatrician in Kanpur. His parents repo that he has not had significant use of his right arm since bih. Bih history is significant for a prolonged labor with difficult breech delivery. On physical examination, his arm hangs at his side and is in a medially rotated position with the forearm in pronation. He will actively use his left arm, but does not move his affected right arm or hand.
|
Injury to which of the following cervical nerve roots account for this patient's posture?
|
{
"A": "C4 and C5",
"B": "C5 and C6",
"C": "C6 and C7",
"D": "C7 and C8"
}
|
B. C5 and C6
|
4919f042-07cb-417d-a38e-8ae8052c7034
|
A 74-year-old man presents with fatigue, shortness of breath on exertion, and back and rib pain, which is made worse with movement. Investigations reveal he is anemic, calcium, urea, and creatinine are elevated. X-rays reveal multiple lytic lesions in the long bones and ribs, and protein electrophoresis is positive for an immunoglobulin G (IgG) paraprotein. Which of the following is the most likely mechanism for the renal injury?
|
plasma cell infiltrates
|
tubular damage by light chains
|
glomerular injury
|
vascular injury by light chains
| 1b
|
single
|
In multiple myeloma, tubular damage by light chains is almost always present. The injury is a direct toxic effect of the light chains or indirectly from the inflammatory response. Infiltration by plasma cells and glomerular injury is rare. Hypercalcemia may produce transient or irreversible renal damage as do amyloid and myeloma cell infiltrates.
|
Medicine
|
Kidney
| 102 |
{
"Correct Answer": "tubular damage by light chains",
"Correct Option": "B",
"Options": {
"A": "plasma cell infiltrates",
"B": "tubular damage by light chains",
"C": "glomerular injury",
"D": "vascular injury by light chains"
},
"Question": "A 74-year-old man presents with fatigue, shortness of breath on exertion, and back and rib pain, which is made worse with movement. Investigations reveal he is anemic, calcium, urea, and creatinine are elevated. X-rays reveal multiple lytic lesions in the long bones and ribs, and protein electrophoresis is positive for an immunoglobulin G (IgG) paraprotein. Which of the following is the most likely mechanism for the renal injury?"
}
|
A 74-year-old man presents with fatigue, shortness of breath on exertion, and back and rib pain, which is made worse with movement. Investigations reveal he is anemic, calcium, urea, and creatinine are elevated. X-rays reveal multiple lytic lesions in the long bones and ribs, and protein electrophoresis is positive for an immunoglobulin G (IgG) paraprotein.
|
Which of the following is the most likely mechanism for the renal injury?
|
{
"A": "plasma cell infiltrates",
"B": "tubular damage by light chains",
"C": "glomerular injury",
"D": "vascular injury by light chains"
}
|
B. tubular damage by light chains
|
1afa3537-bc04-47be-ba64-062cd41b086d
|
A 38-year old woman presented with shoness of breath and fatigue. Her history is unremarkable except for a vague history of fever and joint pain as a child. She notes some recent fatigue and difficulty in sleeping that she attributes to job-related stress. On examination, her hea rate is 120 beats/min. ECG of the patient is given ECHO revealed following finding. Auscultation of the hea indicates a systolic murmur (during left ventricular ejection of blood) that is harsh in character. Which of the following pathological finding is not related with the underlying etiology: -
|
<img style="max-width: 100%" src=" />
|
<img style="max-width: 100%" src=" />
|
<img style="max-width: 100%" src=" />
|
<img style="max-width: 100%" src=" />
| 3d
|
multi
|
ECG shows atrial fibrillation and ECHO shows Left atrial enlargement. Images FINDINGS: Acute and chronic rheumatic hea disease A-Aschoff body in a patient with acute rheumatic carditis. B- Acute rheumatic mitral valvulitis: Small vegetations (verrucae) are visible along the line of closure of the mitral valve leaflet C- Neovascularization of anterior mitral leaflet D- Myxomatous degeneration of the mitral valve. This 35-year-old woman most likely has atrial fibrillation with tachycardia that is irregularly irregular. One common cause of atrial fibrillation is left atrial enlargement. In this patient, the history of childhood fever and joint pain likely is the result of streptococcal caused rheumatic fever. If untreated, the microorganism can cause inflammation of the mitral valve, leading to mitral stenosis. After 3-5 years, the mitral stenosis is likely to worsen, leading to atrial enlargement, fibrillation, and pulmonary edema with intolerance to physical exeion.
|
Unknown
|
Integrated QBank
| 128 |
{
"Correct Answer": "<img style=\"max-width: 100%\" src=\" />",
"Correct Option": "D",
"Options": {
"A": "<img style=\"max-width: 100%\" src=\" />",
"B": "<img style=\"max-width: 100%\" src=\" />",
"C": "<img style=\"max-width: 100%\" src=\" />",
"D": "<img style=\"max-width: 100%\" src=\" />"
},
"Question": "A 38-year old woman presented with shoness of breath and fatigue. Her history is unremarkable except for a vague history of fever and joint pain as a child. She notes some recent fatigue and difficulty in sleeping that she attributes to job-related stress. On examination, her hea rate is 120 beats/min. ECG of the patient is given ECHO revealed following finding. Auscultation of the hea indicates a systolic murmur (during left ventricular ejection of blood) that is harsh in character. Which of the following pathological finding is not related with the underlying etiology: -"
}
|
A 38-year old woman presented with shoness of breath and fatigue. Her history is unremarkable except for a vague history of fever and joint pain as a child. She notes some recent fatigue and difficulty in sleeping that she attributes to job-related stress. On examination, her hea rate is 120 beats/min. ECG of the patient is given ECHO revealed following finding. Auscultation of the hea indicates a systolic murmur (during left ventricular ejection of blood) that is harsh in character.
|
Which of the following pathological finding is not related with the underlying etiology: -
|
{
"A": "<img style=\"max-width: 100%\" src=\" />",
"B": "<img style=\"max-width: 100%\" src=\" />",
"C": "<img style=\"max-width: 100%\" src=\" />",
"D": "<img style=\"max-width: 100%\" src=\" />"
}
|
D. <img style="max-width: 100%" src=" />
|
4cb37de5-785c-4841-863e-ec734ff97e1e
|
A 58-year-old man with cirrhosis complains of worsening fatigue and confusion over the past 5 days. He also repos that over the past 48 hours he has had a declining urinary output. On examination, he is gaunt and jaundiced. He has tense ascites and a liver span of 7 cm in the midclavicular line. Lab result reveals a WBC 4600/mm3, Hb 9.4 g/dL, and PCB 29%. BUN of 34 mg/dL and a creatinine of 3.1 mg/dL. A urinary Na <10 mEq/L. Most appropriate treatment for his elevated BUN and creatinine?
|
Large volume paracentesis
|
Hemodialysis
|
Mesocaval shunt
|
Liver transplantation
| 3d
|
single
|
This patient with well-advanced cirrhosis and poal hypeension has developed the onset of renal insufficiency consistent with hepatorenal syndrome. This occurs during the end stages of cirrhosis and is characterized by diminished urine output and low urinary sodium. In the setting of end-stage liver disease, renal vasoconstriction occurs, and the distal convoluted tubule responds by conserving sodium. Unless the renal function is allowed to deteriorate fuher, liver transplantation will reverse this vasoconstriction and kidney function will return to normal.A large volume paracentesis may relieve the ascites but will have no significant benefit on the impaired renal function. There are no indications in this question to suggest that the patient requires acute hemodialysis. A mesocaval shunt is a surgical procedure that may decompress the poal pressure but will not have any benefit on renal function. Renal transplantation is of no value in this patient since the underlying lesion is in the liver; the kidneys will return to normal function if there is the improvement in hepatic function. Ref - Harrison's internal medicine 20e pg 2401,2422
|
Medicine
|
G.I.T
| 151 |
{
"Correct Answer": "Liver transplantation",
"Correct Option": "D",
"Options": {
"A": "Large volume paracentesis",
"B": "Hemodialysis",
"C": "Mesocaval shunt",
"D": "Liver transplantation"
},
"Question": "A 58-year-old man with cirrhosis complains of worsening fatigue and confusion over the past 5 days. He also repos that over the past 48 hours he has had a declining urinary output. On examination, he is gaunt and jaundiced. He has tense ascites and a liver span of 7 cm in the midclavicular line. Lab result reveals a WBC 4600/mm3, Hb 9.4 g/dL, and PCB 29%. BUN of 34 mg/dL and a creatinine of 3.1 mg/dL. A urinary Na <10 mEq/L. Most appropriate treatment for his elevated BUN and creatinine?"
}
|
A 58-year-old man with cirrhosis complains of worsening fatigue and confusion over the past 5 days. He also repos that over the past 48 hours he has had a declining urinary output. On examination, he is gaunt and jaundiced. He has tense ascites and a liver span of 7 cm in the midclavicular line. Lab result reveals a WBC 4600/mm3, Hb 9.4 g/dL, and PCB 29%. BUN of 34 mg/dL and a creatinine of 3.1 mg/dL. A urinary Na <10 mEq/L.
|
Most appropriate treatment for his elevated BUN and creatinine?
|
{
"A": "Large volume paracentesis",
"B": "Hemodialysis",
"C": "Mesocaval shunt",
"D": "Liver transplantation"
}
|
D. Liver transplantation
|
ddc5513f-e167-44a3-b0f1-a9eb66bf1035
|
The mother of a 2-week-old infant reports that since birth, her infant sleeps most of the day; she has to awaken her every 4 hours to feed, and she will take only an ounce of formula at a time. She also is concerned that the infant has persistently hard, pellet-like stools. On your examination you find an infant with normal weight and length, but with an enlarged head. The heart rate is 75 beats per minute and the temperature is 35degC (95degF). The child is still jaundiced. You note large anterior and posterior fontanelles, a distended abdomen, and an umbilical hernia. This clinical presentation is likely a result of which of the following?
|
Congenital hypothyroidism
|
Congenital megacolon (Hirschsprung disease)
|
Sepsis
|
Infantile botulism
| 0a
|
single
|
The clinical findings of congenital hypothyroidism are subtle, and may not be present at all at birth; this is thought to be a result of passage of some maternal T4 transplacentally. Infants with examination findings will usually have an umbilical hernia and a distended abdomen. The head may be large, and the fontanelles will be large as well. The child may be hypothermic and have feeding difficulties; constipation and jaundice may be persistent. Skin may be cold and mottled, and edema may be found in the genitals and extremities. The heart rate may be slow, and anemia may develop. As these findings may be subtle or nonexistent, neonatal screening programs are extremely important for early diagnosis of these infants.Sepsis can cause hypothermia and poor feeding, but the 2-week course makes this choice unlikely. Hirschsprung disease may cause chronic constipation and abdominal distension, but not the other findings. Botulism can cause a flaccid paralysis and poor feeding, but the large fontanelles and umbilical hernia are not caused by this infection.
|
Pediatrics
|
New Born Infants
| 152 |
{
"Correct Answer": "Congenital hypothyroidism",
"Correct Option": "A",
"Options": {
"A": "Congenital hypothyroidism",
"B": "Congenital megacolon (Hirschsprung disease)",
"C": "Sepsis",
"D": "Infantile botulism"
},
"Question": "The mother of a 2-week-old infant reports that since birth, her infant sleeps most of the day; she has to awaken her every 4 hours to feed, and she will take only an ounce of formula at a time. She also is concerned that the infant has persistently hard, pellet-like stools. On your examination you find an infant with normal weight and length, but with an enlarged head. The heart rate is 75 beats per minute and the temperature is 35degC (95degF). The child is still jaundiced. You note large anterior and posterior fontanelles, a distended abdomen, and an umbilical hernia. This clinical presentation is likely a result of which of the following?"
}
|
The mother of a 2-week-old infant reports that since birth, her infant sleeps most of the day; she has to awaken her every 4 hours to feed, and she will take only an ounce of formula at a time. She also is concerned that the infant has persistently hard, pellet-like stools. On your examination you find an infant with normal weight and length, but with an enlarged head. The heart rate is 75 beats per minute and the temperature is 35degC (95degF). The child is still jaundiced. You note large anterior and posterior fontanelles, a distended abdomen, and an umbilical hernia.
|
This clinical presentation is likely a result of which of the following?
|
{
"A": "Congenital hypothyroidism",
"B": "Congenital megacolon (Hirschsprung disease)",
"C": "Sepsis",
"D": "Infantile botulism"
}
|
A. Congenital hypothyroidism
|
e2924713-a49a-4bd2-8af6-764d38392141
|
A 30-year-old woman complains of weakness and fatigability over the past 6 months. She has a 3-month acute history of severe hypertension that has required treatment with antihypertensive medications. Radiographic examination reveals a tumor of her right suprarenal gland. The patient is diagnosed with a pheochromocytoma (tumor of the adrenal medulla) and is scheduled for a laparoscopic adrenalectomy. Which of the following nerve fibers will need to be cut when the adrenal gland and tumor are removed?
|
Preganglionic sympathetic fibers
|
Postganglionic sympathetic fibers
|
Somatic motor fibers
|
Postganglionic parasympathetic fibers
| 0a
|
single
|
The preganglionic sympathetic fibers running to the adrenal gland would be cut during adrenalectomy for they synapse on catecholamine-secreting cells within the adrenal medulla. Unlike the normal route of sympathetic innervation, which is to first synapse in a sympathetic ganglion and then send postganglionic fibers to the target tissue, the chromaffin cells of the adrenal gland are innervated directly by preganglionic sympathetic fibers. This is because the chromaffin cells are embryologically postganglionic neurons that migrate to the medulla and undergo differentiation. The adrenal gland receives no other recognized types of innervation; therefore, the remaining answer choices are all incorrect.
|
Anatomy
|
Abdomen & Pelvis
| 115 |
{
"Correct Answer": "Preganglionic sympathetic fibers",
"Correct Option": "A",
"Options": {
"A": "Preganglionic sympathetic fibers",
"B": "Postganglionic sympathetic fibers",
"C": "Somatic motor fibers",
"D": "Postganglionic parasympathetic fibers"
},
"Question": "A 30-year-old woman complains of weakness and fatigability over the past 6 months. She has a 3-month acute history of severe hypertension that has required treatment with antihypertensive medications. Radiographic examination reveals a tumor of her right suprarenal gland. The patient is diagnosed with a pheochromocytoma (tumor of the adrenal medulla) and is scheduled for a laparoscopic adrenalectomy. Which of the following nerve fibers will need to be cut when the adrenal gland and tumor are removed?"
}
|
A 30-year-old woman complains of weakness and fatigability over the past 6 months. She has a 3-month acute history of severe hypertension that has required treatment with antihypertensive medications. Radiographic examination reveals a tumor of her right suprarenal gland. The patient is diagnosed with a pheochromocytoma (tumor of the adrenal medulla) and is scheduled for a laparoscopic adrenalectomy.
|
Which of the following nerve fibers will need to be cut when the adrenal gland and tumor are removed?
|
{
"A": "Preganglionic sympathetic fibers",
"B": "Postganglionic sympathetic fibers",
"C": "Somatic motor fibers",
"D": "Postganglionic parasympathetic fibers"
}
|
A. Preganglionic sympathetic fibers
|
76b3ef43-4f36-4b92-aca8-8b730d2a325c
|
A 20-year-old woman complains of headache and discomfort in both sides of her jaw. Physical examination reveals enlarged parotid glands that are slightly tender on palpation. There is reddening of the orifice of Stensen duct on intra oral examination; her temperature is 38.3degC, and the pulse rate is 80/min. Laboratory data show hemoglobin 14 g/dL; hematocrit 40%; WBC 11000/mL, with 33% segmented neutrophils, 7% monocytes, and 60% lymphocytes. Which of the following diagnostic tests will help to confirm the diagnosis of epidemic parotitis?
|
single blood sample for a specific immunoglobulin G (IgG)
|
blood cell count
|
blood culture
|
single blood test for a specific immunoglobulin M (IgM)
| 3d
|
multi
|
A single test revealing a specific IgM antibody can confirm the disease. Acute and convalescent titers of specific IgG antibodies will also confirm the diagnosis of mumps. Urine, saliva, and throat swabs will grow the mumps virus, but blood does not. Salivary amylase is elevated but is relatively nonspecific. Of course, a typical presentation during an epidemic probably does not require any confirmatory tests. Sporadic cases require more active confirmation. Other causes of parotitis requiring specific treatment include calculi, bacterial infections, and drugs. Tumors, sarcoid, TB, leukemia, Hodgkin disease, Sjogren syndrome, and lupus erythematosus can also cause parotid enlargement.
|
Medicine
|
Infection
| 145 |
{
"Correct Answer": "single blood test for a specific immunoglobulin M (IgM)",
"Correct Option": "D",
"Options": {
"A": "single blood sample for a specific immunoglobulin G (IgG)",
"B": "blood cell count",
"C": "blood culture",
"D": "single blood test for a specific immunoglobulin M (IgM)"
},
"Question": "A 20-year-old woman complains of headache and discomfort in both sides of her jaw. Physical examination reveals enlarged parotid glands that are slightly tender on palpation. There is reddening of the orifice of Stensen duct on intra oral examination; her temperature is 38.3degC, and the pulse rate is 80/min. Laboratory data show hemoglobin 14 g/dL; hematocrit 40%; WBC 11000/mL, with 33% segmented neutrophils, 7% monocytes, and 60% lymphocytes. Which of the following diagnostic tests will help to confirm the diagnosis of epidemic parotitis?"
}
|
A 20-year-old woman complains of headache and discomfort in both sides of her jaw. Physical examination reveals enlarged parotid glands that are slightly tender on palpation. There is reddening of the orifice of Stensen duct on intra oral examination; her temperature is 38.3degC, and the pulse rate is 80/min. Laboratory data show hemoglobin 14 g/dL; hematocrit 40%; WBC 11000/mL, with 33% segmented neutrophils, 7% monocytes, and 60% lymphocytes.
|
Which of the following diagnostic tests will help to confirm the diagnosis of epidemic parotitis?
|
{
"A": "single blood sample for a specific immunoglobulin G (IgG)",
"B": "blood cell count",
"C": "blood culture",
"D": "single blood test for a specific immunoglobulin M (IgM)"
}
|
D. single blood test for a specific immunoglobulin M (IgM)
|
9520d222-6eab-4f18-ad41-e5e2e30b432d
|
A female infant is born approximately 10 weeks prematurely (at 30 weeks) and weighs 1710 gm. She has respiratory distress syndrome and is treated with endogenous surfactant. She is intubated endotracheally with mechanical ventilation immediately after bih. Over the first 4 days after bih the ventilator pressure and the fraction of inspired oxygen are reduced. Beginning on the fifth day after bih, she has brief desaturations that become more persistent. She needs increased ventilator and oxygen suppo on the seventh day after bih. She becomes cyanotic. Fuher examination, echocardiogram, and x-rays reveal left atrial enlargement, an enlarged pulmonary aery, increased pulmonary vasculature, and a continuous machine-like murmur. Which of the following is the most likely diagnosis?
|
Persistent foramen ovale
|
Patent ductus aeriosus
|
Ventricular septal defect
|
Pulmonary stenosis
| 1b
|
multi
|
Patent ductus aeriosus. The presence of a murmur could be indicative of any of the conditions. The presence of a continuous machine-like murmur is indicative of a patent ductus aeriosus (PDA). Usually, as in this case, the premature baby with PDA does not acutely become cyanotic and ill, although brief desaturations can occur that become more persistent. An atrial septal defect (ASD), such as a persistent foramen ovale, could be eliminated from the diagnosis because the murmur would be heard as an abnormal splitting of the second sound during expiration (answer a). A patent foramen ovale is a common echo finding in premature babies and is usually not followed up unless it appears remarkable to the pediatric cardiologist or there is a persistent murmur. A patent foramen ovale might result in only minimal or intermittent cyanosis during crying or straining to pass stool. A murmur caused by a ventricular septal defect (VSD, answer c), occurs between the first and second hea sounds (S1and S2) and is described as holosystolic (pansystolic) because the amplitude is high throughout systole. Pulmonary stenosis would be heard as a harsh systolic ejection murmur (answer d). PDA refers to the maintenance of the ductus aeriosus, a normal fetal structure. In the fetus, the ductus aeriosus allows blood to bypass the pulmonary circulation, since the lungs are not involved in CO2/O2exchange until after bih. The placenta subserves the function of gas exchange during fetal development. The ductus aeriosus shunts flow from the left pulmonary aery to the aoa. High oxygen levels after bih and the absence of prostaglandins from the placenta cause the ductus aeriosus to close in most cases within 24 hours. A PDA most often corrects itself within several months of bih, but may require infusion of indomethacin (a prostaglandin inhibitor) as a treatment, inseion of surgical plugs during catheterization, or actual surgical ligation.
|
Surgery
| null | 172 |
{
"Correct Answer": "Patent ductus aeriosus",
"Correct Option": "B",
"Options": {
"A": "Persistent foramen ovale",
"B": "Patent ductus aeriosus",
"C": "Ventricular septal defect",
"D": "Pulmonary stenosis"
},
"Question": "A female infant is born approximately 10 weeks prematurely (at 30 weeks) and weighs 1710 gm. She has respiratory distress syndrome and is treated with endogenous surfactant. She is intubated endotracheally with mechanical ventilation immediately after bih. Over the first 4 days after bih the ventilator pressure and the fraction of inspired oxygen are reduced. Beginning on the fifth day after bih, she has brief desaturations that become more persistent. She needs increased ventilator and oxygen suppo on the seventh day after bih. She becomes cyanotic. Fuher examination, echocardiogram, and x-rays reveal left atrial enlargement, an enlarged pulmonary aery, increased pulmonary vasculature, and a continuous machine-like murmur. Which of the following is the most likely diagnosis?"
}
|
A female infant is born approximately 10 weeks prematurely (at 30 weeks) and weighs 1710 gm. She has respiratory distress syndrome and is treated with endogenous surfactant. She is intubated endotracheally with mechanical ventilation immediately after bih. Over the first 4 days after bih the ventilator pressure and the fraction of inspired oxygen are reduced. Beginning on the fifth day after bih, she has brief desaturations that become more persistent. She needs increased ventilator and oxygen suppo on the seventh day after bih. She becomes cyanotic. Fuher examination, echocardiogram, and x-rays reveal left atrial enlargement, an enlarged pulmonary aery, increased pulmonary vasculature, and a continuous machine-like murmur.
|
Which of the following is the most likely diagnosis?
|
{
"A": "Persistent foramen ovale",
"B": "Patent ductus aeriosus",
"C": "Ventricular septal defect",
"D": "Pulmonary stenosis"
}
|
B. Patent ductus aeriosus
|
a2193b93-ca25-4443-b3ba-cb1b997c514c
|
A 49-year-old man has had increasing knee and hip pain for the past 10 years. The pain is worse at the end of the day. During the past year, he has become increasingly drowsy at work. His wife complains that he is a "world class" snorer. During the past month, he has experienced bouts of sharp, colicky, right upper abdominal pain. On physical examination, his temperature is 37degC, pulse is 82/min, respirations are 10/ min, and blood pressure is 140/85 mm Hg. He is 175 cm (5 feet 8 inches) tall and weighs 156 kg (body mass index 51). Laboratory findings show glucose of 139 mg/dL, Hb A1c of 10, total cholesterol of 229 mg/dL, and HDL cholesterol of 33 mg/dL. An arterial blood gas measurement shows pH of 7.35; PCO2, 50 mm Hg; and PO2, 75 mm Hg. Which of the following additional conditions is most likely present in this man?
|
Hashimoto thyroiditis
|
Hypertrophic cardiomyopathy
|
Laryngeal papillomatosis
|
Nonalcoholic fatty liver disease
| 3d
|
multi
|
Morbid obesity can be associated with complications that include obesity hypoventilation syndrome, probable sleep apnea, glucose intolerance, cholelithiasis, and osteoarthritis. Macrovesicular steatosis with hepatomegaly is seen in obesity and may even progress to cirrhosis. Weight gain owing to hypothyroidism, which could occur in Hashimoto thyroiditis, is modest and does not lead to morbid obesity. An "obesity cardiomyopathy" resembles dilated cardiomyopathy, but not hypertrophic cardiomyopathy, which typically involves the interventricular septum with myofiber disarray. Laryngeal papillomatosis, which produces airway obstruction (without snoring), occurs more often in children and is not associated with obesity. The blood gas findings in this case could be seen in emphysema, which is not a complication of obesity; panlobular emphysema is much less common than the centrilobular emphysema associated with smoking. Rheumatoid arthritis tends to involve small joints first, and there is no relationship to obesity.
|
Pathology
|
Misc.
| 253 |
{
"Correct Answer": "Nonalcoholic fatty liver disease",
"Correct Option": "D",
"Options": {
"A": "Hashimoto thyroiditis",
"B": "Hypertrophic cardiomyopathy",
"C": "Laryngeal papillomatosis",
"D": "Nonalcoholic fatty liver disease"
},
"Question": "A 49-year-old man has had increasing knee and hip pain for the past 10 years. The pain is worse at the end of the day. During the past year, he has become increasingly drowsy at work. His wife complains that he is a \"world class\" snorer. During the past month, he has experienced bouts of sharp, colicky, right upper abdominal pain. On physical examination, his temperature is 37degC, pulse is 82/min, respirations are 10/ min, and blood pressure is 140/85 mm Hg. He is 175 cm (5 feet 8 inches) tall and weighs 156 kg (body mass index 51). Laboratory findings show glucose of 139 mg/dL, Hb A1c of 10, total cholesterol of 229 mg/dL, and HDL cholesterol of 33 mg/dL. An arterial blood gas measurement shows pH of 7.35; PCO2, 50 mm Hg; and PO2, 75 mm Hg. Which of the following additional conditions is most likely present in this man?"
}
|
A 49-year-old man has had increasing knee and hip pain for the past 10 years. The pain is worse at the end of the day. During the past year, he has become increasingly drowsy at work. His wife complains that he is a "world class" snorer. During the past month, he has experienced bouts of sharp, colicky, right upper abdominal pain. On physical examination, his temperature is 37degC, pulse is 82/min, respirations are 10/ min, and blood pressure is 140/85 mm Hg. He is 175 cm (5 feet 8 inches) tall and weighs 156 kg (body mass index 51). Laboratory findings show glucose of 139 mg/dL, Hb A1c of 10, total cholesterol of 229 mg/dL, and HDL cholesterol of 33 mg/dL. An arterial blood gas measurement shows pH of 7.35; PCO2, 50 mm Hg; and PO2, 75 mm Hg.
|
Which of the following additional conditions is most likely present in this man?
|
{
"A": "Hashimoto thyroiditis",
"B": "Hypertrophic cardiomyopathy",
"C": "Laryngeal papillomatosis",
"D": "Nonalcoholic fatty liver disease"
}
|
D. Nonalcoholic fatty liver disease
|
5c009e8e-8d0c-4915-a0bc-729fc576fcd4
|
A 40-year-old man is brought to you by his friends. Apparently, he has ingested some unknown medication in a suicide attempt. The patient is disoriented to time. His temperature is 103 F, BP is 120/85 pulse 100/min and irregular, and respirations are 22/min. The skin is flushed and dry. Dilated pupils and muscle twitching are also noted on examination. ECG reveals prolonged QRS complexes. Hepatic transaminases are normal, and ABG shows a normal pH. These findings are most likely due to intoxication by which substance?
|
Acetaminophen
|
Alcohol
|
Benzodiazepines
|
Tricyclic antidepressants
| 3d
|
single
|
This patient's clinical picture is consistent with intoxication with tricyclic antidepressants such as amitriptyline and imipramine. Toxic effects are mediated by peripheral anticholinergic activity and "quinidine-like" action. The anticholinergic effects include mydriasis, tachycardia, impaired sweating with flushed skin, dry mouth, constipation, and muscle twitching. Quinidine-like effects (due to block of sodium channels in the hea) result in cardiac arrhythmias, especially ventricular tachyarrhythmias. In this setting, prolongation of the QRS complex is paicularly impoant in the diagnosis. QRS width is, in fact, an even more faithful parameter of drug toxicity than serum drug levels. In severe intoxication, patients will develop seizures, severe hypotension, and coma. Acetaminophen results in liver toxicity. Liver enzymes would be elevated. Alcohol intoxication manifests with respiratory depression, hypothermia, and coma. The manifestations of benzodiazepine intoxication are similar to alcohol inasmuch as central nervous system depression is common to both drugs. Thus, acute benzodiazepine intoxication produces stupor, coma, and respiratory depression. The sympatholytic propeies of clonidine explain the clinical symptoms of intoxication. Clonidine overdose causes bradycardia, hypotension, miosis, and respiratory depression. Monoamine oxidase (MAO) inhibitors represent a second-line treatment for major depression. Overdose induces ataxia, excitement, hypeension, and tachycardia. Such reactions can be precipitated by concomitant ingestion of tyramine-containing foods. Reference: Kaplon and sadock, 11 th edition, synopsis of psychiatry, 11 th edition, pg no. 1144
|
Psychiatry
|
Treatment in psychiatry
| 131 |
{
"Correct Answer": "Tricyclic antidepressants",
"Correct Option": "D",
"Options": {
"A": "Acetaminophen",
"B": "Alcohol",
"C": "Benzodiazepines",
"D": "Tricyclic antidepressants"
},
"Question": "A 40-year-old man is brought to you by his friends. Apparently, he has ingested some unknown medication in a suicide attempt. The patient is disoriented to time. His temperature is 103 F, BP is 120/85 pulse 100/min and irregular, and respirations are 22/min. The skin is flushed and dry. Dilated pupils and muscle twitching are also noted on examination. ECG reveals prolonged QRS complexes. Hepatic transaminases are normal, and ABG shows a normal pH. These findings are most likely due to intoxication by which substance?"
}
|
A 40-year-old man is brought to you by his friends. Apparently, he has ingested some unknown medication in a suicide attempt. The patient is disoriented to time. His temperature is 103 F, BP is 120/85 pulse 100/min and irregular, and respirations are 22/min. The skin is flushed and dry. Dilated pupils and muscle twitching are also noted on examination. ECG reveals prolonged QRS complexes. Hepatic transaminases are normal, and ABG shows a normal pH.
|
These findings are most likely due to intoxication by which substance?
|
{
"A": "Acetaminophen",
"B": "Alcohol",
"C": "Benzodiazepines",
"D": "Tricyclic antidepressants"
}
|
D. Tricyclic antidepressants
|
d7fc1874-20b6-4ede-858c-12d8ae7a0387
|
A 24-year-old woman presents with abdominal pain, joint discomfort, and lower limb rash. She was well until 1 week before presentation. On examination, she has a palpable purpuric rash on her legs, nonspecific abdominal discomfort, and no active joints. She has 3+ proteinuria, normal WBC, no eosinophils, and elevated creatinine of 1.6 mg/dL. Biopsy of the rash confirms vasculitis with immunoglobulin A (IgA) 3+and C3 (complement 3) deposition on immunofluorescence.For the above patient with vasculitis syndrome, select the most likely diagnosis.
|
polyarteritis nodosa (PAN)
|
Churg-Strauss disease
|
Henoch-Schonlein purpura
|
vasculitis associated with infectious diseases
| 2c
|
multi
|
Henoch-Schonlein purpura, characterized by palpable purpura, arthralgias, GI symptoms, and glomerulonephritis, can be seen in any age-group but is most common in children. It can resolve and recur several times over a period of weeks or months and can resolve spontaneously.
|
Medicine
|
Immunology and Rheumatology
| 142 |
{
"Correct Answer": "Henoch-Schonlein purpura",
"Correct Option": "C",
"Options": {
"A": "polyarteritis nodosa (PAN)",
"B": "Churg-Strauss disease",
"C": "Henoch-Schonlein purpura",
"D": "vasculitis associated with infectious diseases"
},
"Question": "A 24-year-old woman presents with abdominal pain, joint discomfort, and lower limb rash. She was well until 1 week before presentation. On examination, she has a palpable purpuric rash on her legs, nonspecific abdominal discomfort, and no active joints. She has 3+ proteinuria, normal WBC, no eosinophils, and elevated creatinine of 1.6 mg/dL. Biopsy of the rash confirms vasculitis with immunoglobulin A (IgA) 3+and C3 (complement 3) deposition on immunofluorescence.For the above patient with vasculitis syndrome, select the most likely diagnosis."
}
|
A 24-year-old woman presents with abdominal pain, joint discomfort, and lower limb rash. She was well until 1 week before presentation. On examination, she has a palpable purpuric rash on her legs, nonspecific abdominal discomfort, and no active joints. She has 3+ proteinuria, normal WBC, no eosinophils, and elevated creatinine of 1.6 mg/dL.
|
Biopsy of the rash confirms vasculitis with immunoglobulin A (IgA) 3+and C3 (complement 3) deposition on immunofluorescence.For the above patient with vasculitis syndrome, select the most likely diagnosis.
|
{
"A": "polyarteritis nodosa (PAN)",
"B": "Churg-Strauss disease",
"C": "Henoch-Schonlein purpura",
"D": "vasculitis associated with infectious diseases"
}
|
C. Henoch-Schonlein purpura
|
18b1f6fc-c2bc-4573-b5fd-a282dca4b39b
|
A 25-year-old woman complains of low-grade fever, fatigue, and persistent rash over her nose and upper chest. She also notes pain in her knees and elbows. A skin biopsy shows dermal inflammation and granular deposits of IgG and C3 complement along the basement membrane at the epidermal/dermal junction. Urinalysis reveals microscopic hematuria and proteinuria. The ANA is positive. The development of thromboembolic complications (e.g., deep venous thrombosis) in this patient is commonly associated with elevated serum levels of antibodies to which of the following antigens?
|
ABO blood group antigens
|
Class II HLA molecules
|
Clotting factors
|
Phospholipids
| 3d
|
single
|
1/3rd of patients with SLE possess elevated concentrations of anti-phospholipid antibodies. It predisposes these patients to thromboembolic complications (stroke, pulmonary embolism, deep venous thrombosis, and poal vein thrombosis). The clinical course of SLE is highly variable and typically exhibits exacerbations and remissions. The overall 10-year survival rate approaches 90%(Because of early detection & management). -Antibodies against clotting factors (choice C) or fibrinolytic enzymes (choice D) are not involved in the clotting tendency associated with SLE. Diagnosis: Systemic lupus erythematosus
|
Pathology
|
Immunity disorders
| 125 |
{
"Correct Answer": "Phospholipids",
"Correct Option": "D",
"Options": {
"A": "ABO blood group antigens",
"B": "Class II HLA molecules",
"C": "Clotting factors",
"D": "Phospholipids"
},
"Question": "A 25-year-old woman complains of low-grade fever, fatigue, and persistent rash over her nose and upper chest. She also notes pain in her knees and elbows. A skin biopsy shows dermal inflammation and granular deposits of IgG and C3 complement along the basement membrane at the epidermal/dermal junction. Urinalysis reveals microscopic hematuria and proteinuria. The ANA is positive. The development of thromboembolic complications (e.g., deep venous thrombosis) in this patient is commonly associated with elevated serum levels of antibodies to which of the following antigens?"
}
|
A 25-year-old woman complains of low-grade fever, fatigue, and persistent rash over her nose and upper chest. She also notes pain in her knees and elbows. A skin biopsy shows dermal inflammation and granular deposits of IgG and C3 complement along the basement membrane at the epidermal/dermal junction. Urinalysis reveals microscopic hematuria and proteinuria. The ANA is positive.
|
The development of thromboembolic complications (e.g., deep venous thrombosis) in this patient is commonly associated with elevated serum levels of antibodies to which of the following antigens?
|
{
"A": "ABO blood group antigens",
"B": "Class II HLA molecules",
"C": "Clotting factors",
"D": "Phospholipids"
}
|
D. Phospholipids
|
97f86299-87b8-4103-8189-531bd4d3b798
|
A 69-year-old man with a history of chronic obstructive pulmonary disease/chronic bronchitis is admitted with increasing sputum production, fever, chills, and decreased O2 saturation. His chest x-ray shows a left lower lobe nonhomogeneous opacity. He is treated with IV antibiotics and improves. On the fouh hospital day, prior to discharge, CXR is repeated and the radiologist repos that there is no change as compared to the admission x-ray. Chest x-rays are shown.What will you do next?
|
Obtain a CT scan to rule out abscess
|
Defer discharge and resume IV antibiotics
|
Schedule a pulmonary consult for bronchoscopy to improve bronchial drainage
|
Discharge the patient on oral antibiotics
| 3d
|
single
|
This chest x-ray shows an ill-defined, patchy opacity in the left middle and left lower zones. Incomplete consolidation with air bronchogram is seen. The left hea border is clear, but the silhouette of the left diaphragm is lost. This is consistent with the left lower pneumonia. This patient with chronic obstructive pulmonary disease has left lower lobe pneumonia. The clinical history suggests that the patient improved on the fouh hospital day of treatment. Chest x-ray improvement usually lags behind and does not temporally correspond with clinical change. In this case the patient is improving and therefore the best option is to discharge the patient on continued antibiotics. There is no indication for either deferring the discharge or resuming IV antibiotics on the basis of a nonresolving x-ray at this stage. Bronchoscopy for drainage would not be indicated, and obtaining a CT scan would not alter the treatment or management plan at this stage.
|
Radiology
|
Respiratory system
| 111 |
{
"Correct Answer": "Discharge the patient on oral antibiotics",
"Correct Option": "D",
"Options": {
"A": "Obtain a CT scan to rule out abscess",
"B": "Defer discharge and resume IV antibiotics",
"C": "Schedule a pulmonary consult for bronchoscopy to improve bronchial drainage",
"D": "Discharge the patient on oral antibiotics"
},
"Question": "A 69-year-old man with a history of chronic obstructive pulmonary disease/chronic bronchitis is admitted with increasing sputum production, fever, chills, and decreased O2 saturation. His chest x-ray shows a left lower lobe nonhomogeneous opacity. He is treated with IV antibiotics and improves. On the fouh hospital day, prior to discharge, CXR is repeated and the radiologist repos that there is no change as compared to the admission x-ray. Chest x-rays are shown.What will you do next?"
}
|
A 69-year-old man with a history of chronic obstructive pulmonary disease/chronic bronchitis is admitted with increasing sputum production, fever, chills, and decreased O2 saturation. His chest x-ray shows a left lower lobe nonhomogeneous opacity. He is treated with IV antibiotics and improves. On the fouh hospital day, prior to discharge, CXR is repeated and the radiologist repos that there is no change as compared to the admission x-ray.
|
Chest x-rays are shown.What will you do next?
|
{
"A": "Obtain a CT scan to rule out abscess",
"B": "Defer discharge and resume IV antibiotics",
"C": "Schedule a pulmonary consult for bronchoscopy to improve bronchial drainage",
"D": "Discharge the patient on oral antibiotics"
}
|
D. Discharge the patient on oral antibiotics
|
2de1f1dd-d0e7-491c-b2bb-19d3bb3236a5
|
A 70-year-old diabetic and hypeensive patient was being investigated for angina and a coronary angiogram was performed. Two days later, he developed fever and abdominal discomfo and dyspnea and a mottled skin rash. His great toe appeared black. His BP increased to 180/100. His creatinine was found to have risen from a pre-angiography level of 1.2 to 3.6 mg/dl. He has eosinophilia. Which one of the following statements is TRUE regarding this condition?
|
N-acetylcysteine would have prevented this condition
|
This is contrast-induced nephropathy
|
Heparin is the treatment of choice
|
Kidney biopsy will show micro-vessel occlusion with a cleft in the vessel
| 3d
|
multi
|
Diabetes and angina both point to atherosclerosis. In patients undergoing angiography, catheterization can lead to embolism of a vulnerable atherosclerotic plaque in descending aoa downstream to renal aeries leading to an atheroembolic kidney disease. The symptoms of diabetic patient developed after angiography and since atherosclerotic lesion can involve the aoa, the atheroembolic event would explain the events. Presence of eosinophilia and mottling of toes and reduced kidney function confirm the diagnosis as Atheroembolic kidney disease. Hence Choice D is the answer. Lab findings include Rising serum creatinine Transient eosinophilia Elevated sedimentation rate Hypocomplementemia Definitive diagnosis by doing kidney biopsy:- Microvessel obstruction with cholesterol crystals that leave a cleft in the vessel. Contrast-induced nephropathy can occur in diabetics with chronic kidney disease. However rash, toe discoloration with the sudden rise of creatinine and eosinophilia are not seen in contrast-induced nephropathy. Hence choice B is ruled out Choice A is ruled out as it prevents contrast-induced nephropathy Choice C is ruled as out as heparin will not manage cholesterol embolism
|
Medicine
|
Chronic Kidney Disease & Diabetic Nephropathy
| 116 |
{
"Correct Answer": "Kidney biopsy will show micro-vessel occlusion with a cleft in the vessel",
"Correct Option": "D",
"Options": {
"A": "N-acetylcysteine would have prevented this condition",
"B": "This is contrast-induced nephropathy",
"C": "Heparin is the treatment of choice",
"D": "Kidney biopsy will show micro-vessel occlusion with a cleft in the vessel"
},
"Question": "A 70-year-old diabetic and hypeensive patient was being investigated for angina and a coronary angiogram was performed. Two days later, he developed fever and abdominal discomfo and dyspnea and a mottled skin rash. His great toe appeared black. His BP increased to 180/100. His creatinine was found to have risen from a pre-angiography level of 1.2 to 3.6 mg/dl. He has eosinophilia. Which one of the following statements is TRUE regarding this condition?"
}
|
A 70-year-old diabetic and hypeensive patient was being investigated for angina and a coronary angiogram was performed. Two days later, he developed fever and abdominal discomfo and dyspnea and a mottled skin rash. His great toe appeared black. His BP increased to 180/100. His creatinine was found to have risen from a pre-angiography level of 1.2 to 3.6 mg/dl. He has eosinophilia.
|
Which one of the following statements is TRUE regarding this condition?
|
{
"A": "N-acetylcysteine would have prevented this condition",
"B": "This is contrast-induced nephropathy",
"C": "Heparin is the treatment of choice",
"D": "Kidney biopsy will show micro-vessel occlusion with a cleft in the vessel"
}
|
D. Kidney biopsy will show micro-vessel occlusion with a cleft in the vessel
|
35aa9041-637d-4904-a200-49a912845e1a
|
A 65-year-old man, with a 45-pack-per-year history of smoking, presents with hematuria and flank pain. He reports no fever, chills, or dysuria, but he has lost 15 lb. On examination the abdomen is soft, no mass is felt, and there is no flank tenderness on percussion. His hemoglobin (Hb) is 18.5 g/dL, and his liver enzymes are normal. A CT scan of the abdomen reveals a mass in the left kidney with involvement of the renal vein. Which of the following is the most likely diagnosis?
|
renal cyst
|
renal cell carcinoma
|
renal metastases
|
renal abscess
| 1b
|
single
|
Age, history of smoking, and polycythemia in a patient with hematuria strongly suggests a renal cell carcinoma. The elevated hemoglobin represents increased erythropoietin production and is not related to prognosis. Involvement along the renal vein and metastases to the lung is also characteristic of renal cell carcinoma. Elevated liver enzymes and weight loss can represent nonmetastatic effects of malignancy and can reverse with resection. Almost half of patients will have a palpable abdominal mass on presentation. The CT of the thorax is a useful test because three-quarters of those with metastatic disease will have lung metastases.
|
Medicine
|
Oncology
| 127 |
{
"Correct Answer": "renal cell carcinoma",
"Correct Option": "B",
"Options": {
"A": "renal cyst",
"B": "renal cell carcinoma",
"C": "renal metastases",
"D": "renal abscess"
},
"Question": "A 65-year-old man, with a 45-pack-per-year history of smoking, presents with hematuria and flank pain. He reports no fever, chills, or dysuria, but he has lost 15 lb. On examination the abdomen is soft, no mass is felt, and there is no flank tenderness on percussion. His hemoglobin (Hb) is 18.5 g/dL, and his liver enzymes are normal. A CT scan of the abdomen reveals a mass in the left kidney with involvement of the renal vein. Which of the following is the most likely diagnosis?"
}
|
A 65-year-old man, with a 45-pack-per-year history of smoking, presents with hematuria and flank pain. He reports no fever, chills, or dysuria, but he has lost 15 lb. On examination the abdomen is soft, no mass is felt, and there is no flank tenderness on percussion. His hemoglobin (Hb) is 18.5 g/dL, and his liver enzymes are normal. A CT scan of the abdomen reveals a mass in the left kidney with involvement of the renal vein.
|
Which of the following is the most likely diagnosis?
|
{
"A": "renal cyst",
"B": "renal cell carcinoma",
"C": "renal metastases",
"D": "renal abscess"
}
|
B. renal cell carcinoma
|
86012788-6f8c-4ccb-8f75-fbc4dc7902c0
|
A 55-year-old man complains of pain in his back, fatigue and occasional confusion. He admits to polyuria and polydipsia. An X-ray examination reveals numerous lytic lesions in the lumbar veebral bodies. Laboratory studies disclose hypoalbuminemia, mild anemia, and thrombocytopenia. A monoclonal IgG peak is demonstrated by serum electrophoresis. Urinalysis shows 4+ proteinuria. A bone marrow biopsy discloses foci of plasma cells, which account for 18% of all hematopoietic cells. What is the appropriate diagnosis?
|
Acute lymphoblastic lymphoma
|
Chronic lymphocytic leukemia
|
Extramedullary plasmacytoma
|
Multiple myeloma
| 3d
|
multi
|
Plasma cell myeloma (multiple myeloma) is characterized by a multifocal infiltration of malignant plasma cells in the bone marrow. Major diagnostic criteria for plasma cell myeloma include marrow plasmacytosis (>30%), plasmacytoma on biopsy, and immunoglobulin paraprotein (M-component). In this patient, the neoplastic clone secretes excess kappa light chains. Waldenstrom macroglobulinemia is a neoplastic disorder of small lymphocytes that secrete IgM.Diagnosis: Multiple myeloma
|
Pathology
|
Hematology
| 128 |
{
"Correct Answer": "Multiple myeloma",
"Correct Option": "D",
"Options": {
"A": "Acute lymphoblastic lymphoma",
"B": "Chronic lymphocytic leukemia",
"C": "Extramedullary plasmacytoma",
"D": "Multiple myeloma"
},
"Question": "A 55-year-old man complains of pain in his back, fatigue and occasional confusion. He admits to polyuria and polydipsia. An X-ray examination reveals numerous lytic lesions in the lumbar veebral bodies. Laboratory studies disclose hypoalbuminemia, mild anemia, and thrombocytopenia. A monoclonal IgG peak is demonstrated by serum electrophoresis. Urinalysis shows 4+ proteinuria. A bone marrow biopsy discloses foci of plasma cells, which account for 18% of all hematopoietic cells. What is the appropriate diagnosis?"
}
|
A 55-year-old man complains of pain in his back, fatigue and occasional confusion. He admits to polyuria and polydipsia. An X-ray examination reveals numerous lytic lesions in the lumbar veebral bodies. Laboratory studies disclose hypoalbuminemia, mild anemia, and thrombocytopenia. A monoclonal IgG peak is demonstrated by serum electrophoresis. Urinalysis shows 4+ proteinuria. A bone marrow biopsy discloses foci of plasma cells, which account for 18% of all hematopoietic cells.
|
What is the appropriate diagnosis?
|
{
"A": "Acute lymphoblastic lymphoma",
"B": "Chronic lymphocytic leukemia",
"C": "Extramedullary plasmacytoma",
"D": "Multiple myeloma"
}
|
D. Multiple myeloma
|
3183b786-3544-4fc6-bed0-f4becc1c171c
|
An 80-year-old woman is admitted to the intensive care unit with sepsis due to a urinary tract infection. While in the ICU she develops atrial fibrillation with rapid ventricular response and is treated with a loading dose of amiodarone. She converts to sinus rhythm and is sent home on amiodarone to prevent recurrences of atrial fibrillation. In the following weeks she develops increasing fatigue, dry skin, and constipation and her internist finds her TSH to be 25. She is in sinus rhythm. What is the best approach in this situation?
|
Stop the amiodarone and follow the TSH and the clinical response.
|
Start low dose levothyroxine and repeat TSH in 6 weeks.
|
Start a beta-blocker and begin weaning off the amiodarone.
|
Check for anti-TPO antibodies to help guide your decision.
| 1b
|
single
|
Amiodarone is a widely used antiarrhythmic drug. It is related structurally to thyroid hormone and is stored in adipose tissue. The drug has a high iodine content as well. Taking amiodarone on an ongoing basis can lead to hypothyroidism by inhibiting deiodinase activity and by acting as a direct antagonist to T4 . In some cases, amiodarone-induced hypothyroidism resolves within a few months; however, in many, especially when accompanying anti-TPO antibodies are present, treatment with levothyroxine is needed. This can be easily monitored and adjusted. While answer a is a consideration, the patient likely needs the amiodarone given her tendency toward paroxysms of atrial fibrillation and the attendant risk of stroke. While starting a beta-blocker may prevent episodes of rapid ventricular response, this decision would be made with the help of her cardiologist, which is not mentioned. Anti-TPO antibodies increase the risk of hypothyroidism but are not necessary to guide therapy in this patient. Although prednisone may be used for treatment of amiodarone-induced hyperthyroidism, this patient has hypothyroidism, and prednisone is not indicated.
|
Medicine
|
Endocrinology
| 122 |
{
"Correct Answer": "Start low dose levothyroxine and repeat TSH in 6 weeks.",
"Correct Option": "B",
"Options": {
"A": "Stop the amiodarone and follow the TSH and the clinical response.",
"B": "Start low dose levothyroxine and repeat TSH in 6 weeks.",
"C": "Start a beta-blocker and begin weaning off the amiodarone.",
"D": "Check for anti-TPO antibodies to help guide your decision."
},
"Question": "An 80-year-old woman is admitted to the intensive care unit with sepsis due to a urinary tract infection. While in the ICU she develops atrial fibrillation with rapid ventricular response and is treated with a loading dose of amiodarone. She converts to sinus rhythm and is sent home on amiodarone to prevent recurrences of atrial fibrillation. In the following weeks she develops increasing fatigue, dry skin, and constipation and her internist finds her TSH to be 25. She is in sinus rhythm. What is the best approach in this situation?"
}
|
An 80-year-old woman is admitted to the intensive care unit with sepsis due to a urinary tract infection. While in the ICU she develops atrial fibrillation with rapid ventricular response and is treated with a loading dose of amiodarone. She converts to sinus rhythm and is sent home on amiodarone to prevent recurrences of atrial fibrillation. In the following weeks she develops increasing fatigue, dry skin, and constipation and her internist finds her TSH to be 25. She is in sinus rhythm.
|
What is the best approach in this situation?
|
{
"A": "Stop the amiodarone and follow the TSH and the clinical response.",
"B": "Start low dose levothyroxine and repeat TSH in 6 weeks.",
"C": "Start a beta-blocker and begin weaning off the amiodarone.",
"D": "Check for anti-TPO antibodies to help guide your decision."
}
|
B. Start low dose levothyroxine and repeat TSH in 6 weeks.
|
d30d7415-841b-475e-956f-2b334c2367c0
|
A 24-year-old man is brought to the emergency room with symptoms of acute intestinal obstruction. His temperature is 38degC (101degF), respirations are 25 per minute, and blood pressure is 120/80 mm Hg. Physical examination reveals a mass in the right lower abdominal quadrant. At laparoscopy, there are numerous small bowel strictures and a fistula extending into a loop of small bowel. Which of the following is the most likely diagnosis?
|
Adenocarcinoma
|
Carcinoid tumor
|
Crohn disease
|
Pseudomembranous colitis
| 2c
|
multi
|
Crohn disease is a transmural, chronic inflammatory disease that may affect any part of the digestive tract. Intestinal obstruction and fistulas are the most common intestinal complications of Crohn disease. Occasionally, free perforation of the bowel occurs. The risk of small bowel cancer is increased at least threefold in patients with Crohn disease. Pseudomembranous colitis (choice D) and ulcerative colitis (choice E) are not associated with fistula formation. Adenocarcinoma (choice A) rarely, if ever, arises in the terminal ileum.Diagnosis: Crohn disease
|
Pathology
|
G.I.T.
| 107 |
{
"Correct Answer": "Crohn disease",
"Correct Option": "C",
"Options": {
"A": "Adenocarcinoma",
"B": "Carcinoid tumor",
"C": "Crohn disease",
"D": "Pseudomembranous colitis"
},
"Question": "A 24-year-old man is brought to the emergency room with symptoms of acute intestinal obstruction. His temperature is 38degC (101degF), respirations are 25 per minute, and blood pressure is 120/80 mm Hg. Physical examination reveals a mass in the right lower abdominal quadrant. At laparoscopy, there are numerous small bowel strictures and a fistula extending into a loop of small bowel. Which of the following is the most likely diagnosis?"
}
|
A 24-year-old man is brought to the emergency room with symptoms of acute intestinal obstruction. His temperature is 38degC (101degF), respirations are 25 per minute, and blood pressure is 120/80 mm Hg. Physical examination reveals a mass in the right lower abdominal quadrant. At laparoscopy, there are numerous small bowel strictures and a fistula extending into a loop of small bowel.
|
Which of the following is the most likely diagnosis?
|
{
"A": "Adenocarcinoma",
"B": "Carcinoid tumor",
"C": "Crohn disease",
"D": "Pseudomembranous colitis"
}
|
C. Crohn disease
|
1285d99f-16cb-4666-a242-3ad21d2fb19a
|
Kamli Rani 75 yrs old woman present with post myocardial infarction after 6 weeks with mild CHF. He had a history of neck surgery for parathyroid adenoma 5 years ago. EKG shows slow arial fibrillation. Serum Ca+213.0 mg/L and urinary Ca+2 is 300 mg/24h. On examination a small mass is felt in the para tracheal position. Which of the following is the most appropriate management?
|
Repeat neck surgery
|
Treatment with technetium - 99
|
Observation and repeat serum Ca+2 in two months
|
Ultrasound - guided injection of alcohol injection into the mass
| 3d
|
multi
|
The patient in the question is not a good candidate for surgical removal of parathyroid mass due to the underlying medical complications, so ultrasound guided alcohol injection is the most appropriate treatment. Ultrasound guided alcohol injection of the mass is used as an alternate therapy for patients with primary hyperparathyroidism who refuse surgical treatment, who are not good surgical candidate or who present as an emergent life threatening malignant hypercalcemia. It is most commonly used postoperatively in patients with recurrent or persistent hyperparathyroidism who have a sonographically visible residual mass. Ref: Core Topics in Endocrinology in Anaesthesia and Critical Care By George Hall, Page 36; Ultrasound: A Practical Approach to Clinical Problems By Edward I. Bluth, Page 626
|
Surgery
| null | 107 |
{
"Correct Answer": "Ultrasound - guided injection of alcohol injection into the mass",
"Correct Option": "D",
"Options": {
"A": "Repeat neck surgery",
"B": "Treatment with technetium - 99",
"C": "Observation and repeat serum Ca+2 in two months",
"D": "Ultrasound - guided injection of alcohol injection into the mass"
},
"Question": "Kamli Rani 75 yrs old woman present with post myocardial infarction after 6 weeks with mild CHF. He had a history of neck surgery for parathyroid adenoma 5 years ago. EKG shows slow arial fibrillation. Serum Ca+213.0 mg/L and urinary Ca+2 is 300 mg/24h. On examination a small mass is felt in the para tracheal position. Which of the following is the most appropriate management?"
}
|
Kamli Rani 75 yrs old woman present with post myocardial infarction after 6 weeks with mild CHF. He had a history of neck surgery for parathyroid adenoma 5 years ago. EKG shows slow arial fibrillation. Serum Ca+213.0 mg/L and urinary Ca+2 is 300 mg/24h. On examination a small mass is felt in the para tracheal position.
|
Which of the following is the most appropriate management?
|
{
"A": "Repeat neck surgery",
"B": "Treatment with technetium - 99",
"C": "Observation and repeat serum Ca+2 in two months",
"D": "Ultrasound - guided injection of alcohol injection into the mass"
}
|
D. Ultrasound - guided injection of alcohol injection into the mass
|
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