TREAT HER AS MIGREN HEADACH

_________________________________________________________________________

_

467-55 ys old male pt, presented with just mild hoarsness, on exam, there was a mid cervical mass, best inv is:

Indirect laryngioscopy??

CT brain CT neck Biopsy

aspiration

_________________________________________________________________________

____

468-4 years old child, was diagnosed as SCD,so many times came to hospitals with, dyspnia, dactylites , ( he put sign of acute crises ), the best strategy for prolonged therapy is:

IV hydration fluids with analgesia follow in Out pt clinic

refer to tertiary haem center.

469- Long scenario for a pt came to ER after RTA, splenic rupture was clear, accurate sentences describe long term management:

We give pneumococcal vaccine for high risky people just, we sld give ABs prophylaxis if there Hx of contact even with vaccination against pneumococcal,

pneumoccal vaccine should not be given at same time with MMR 470- Female pregnant, 32weeks of gestational age, diabetic, and she has a Hx of full term fetal demise, but her DM now well controlled, and BPP show no fetal distress,best management:

Wait for SVD

report a CS in 36 weeks Teminate pregnancy

471- Triad of heart block, uveites and sacroileatis,Dx:

Ankylosing spondylites, lumbar stenosis, multiple myeloma

472-72 years old Man with loss of vision in one eye , jaw claudication : Temporal arteritis .

473-GDM with diagnostic GGT what will u do:

-repeat GTT -diet

-start with monotherapy

-insulin then change to monotherapy -insulin test

____________________________________________________________________

474- Lt sternal border murmur,ejection systolic, but not radiation to carotid:

>AS

> PS .

475-commenst cause of failure to thrive:

psychosocial??

allergy to milk and protein 476-child with umblical hernia:

-sponteneous recovery before school age(: 90% disappear spontaneously during the first 5 years of life

____________________________________________________________________

477-commenst cause of hearing loss in children:

-chronic otitis media

-dysfunction eschian tube -antenatal causes.

478-child with meningitis symptoms and no nuchal rigidty ,whats the next diagnostic investigation:

CSF

479-patient given 3 liter 10% dextrose then started to develop confusion and leg cramps:

hyperkalemia hypokalemia

hypernatremia

480-table shows only hyponatremia and low plasma osmolality with normal urine osmolality :

_inappropriate secretion of ADH -cushing syndrome

-addison

481-german measles cause what:

482-man had gun shot to left lung with decrease breath sound, what well u do :

-2^nd midclavicular needle.

-5^th midaxillary needle -5^th midaxillary tube.

-ab.

483-> How did we differentiate between snoring and sleep apnea ? I think !!!!! Read about Sleep study chart !

> Michegan chart . My answer

> Different names of chart -_-"

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484-> Pt K/C of crohns , present with hip and Back pain , normal Ab Ex and hip ROM , what to do next :

> Hip CT

> Ab US

> IVP

> Abdominal CT

> Renal US

____________________________________________________________________

485- Patient with around Rt eye pain with tearing and headache , lid swelling , Dx :

> Migrane with aura

> Tension headache

> Cluster headache .

> Glucoma

---486- Recurrent swelling in the natal cleft with skin tract and recurrence , Dx :

> Hydrandinitis suuporitiva .

> Frunclosis .

> F..dermatic

487-> Recently diagnosed with DM type II , 32 years old , exercise for 8 weeks and BMI changed from 32 to 31 ..

Labs shown on table ? But no table !!!!!

> Continue exercise . My answer

> Start medication

488-74-year old female patient of Cushings syndrome, had hip fracture falling off stool, what will you screen for while also treating her fracture:

Hyperparathyroidism Osteomyelitis

Osteoporosis Osteomalacia

489-Very long scenario about middle age man (50 years) with family history of heart disease, active lifestyle, on self induced diet with 50%

fat, 35% protein and 15 % carbohydrates, table showing labs, elevated LDL, low HDL, elevated triglycerides and cholesterol, normal RFTs and all other labs.

No risk of heart disease

Heart disease risk can be avoided by taking statins

Heart disease can be prevented by decreasing calorie intake

490-18 month old patient, parents were treating baby for flu-like illness with fever with increased water intake at home, patient developed

generalized tonic-clonic convulsions, presented to you after 1 hour with (description of post-ictal stage). Now baby becomes fully conscious.

What is the next most appropriate step?

rapid sponging to reduce fever

Give acetaminophen and antipyretics

Treat fever, Get MRI done and treat after result

491-9. Middle aged female patient with history of Stage 2 breast cancer treated successfully, now presents with moderate to severe pain in left leg, not relieved by lying down, pain on extension of leg and walking, O/E Tender region in L3-L4 lower back. No Physical sign of cancer

recurrence. Last saw oncologist 2 years back. What is most appropriate scenario:

Refer to oncologist Do DEXA Scan Do MRI

Hospitalize and do neurology and oncology consultations

492-11. Baby present with weeping, shiny and crusting lesions around mouth :

Impetigo

493-Male patient was advised to undergo Arterial Graft Bypass surgery at other clinic after having episode of pain in leg, now is asymptomatic.

Came to you, Non-smoker, elevated cholesterol and early atherosclerotic plaques on some descending aortal branches. What will you advise:

Undergo Bypass Grafting

Take medication to prevent formation of Arterial plaques

To undergo frequent arterial scans to see extent of disease.

494­1st line class of drugs against Post partum hemorrhage:

Uterine Contractile Uterine Relaxant

495­Patient recovering from Viral Gastroenteritis, vomiting and diarrhea abated but still having Anorexia. What will you advise:

Bananas

Rice cereal and apple juice Chopped pears yougurt and .

Granola, .

496­Patient with idiopathic anovulation. What drug to give:

Clomiphene Progesteron LH

FSH

497­Description of PCOS. Mechanism of PCOS:

Androgen Excess

498­Prostitute with multiple sex partners presents with history of painless vaginal sore which healed and did not leave scar. O/E has generalized lymphadenopathy. What is your diagnosis:

Syphilis

_________________________________________________________________________

_

499­Female patient with wide-open eyes, tremors in hands that do not diminish with intention, What investigation will you do:

1 Pituitary Scan 2 T4 Levels

500­Middle age patient alcoholic with H/O fullness in epigastric region and mild pain, History of nausea and vomiting. Labs: Increased Serum Amylase, Diagnosis:

Pancreatic Pseudocyst Pancreatic Cystadenoma Choledochal Cyst

Liver Cirrhosis

501­Which one of these patients with pneumonia will you treat as outdoor patient:

a. 80 Year old with 104 F temperature, BR 24/min PR 126/min, BP 180/110 b. 60 year old with 102 F temperature BR 22/min PR 124/min, BP 160/110 c. 50 year old with 98 F temperature, BR 20/min. HR 110/min, BP 180/110 d. 80 year old with 96 F temperature, BR 18/min, HR 70/min, BP 110/80

http://pda.ahrq.gov/clinic/psi/psicalc.asp

according to pneumonia severty index calculator (class IV and V need hospitalization class III depend on clinical judgment) the high blood pressure is not involved in calculation.

a-classIII B-classII c-class I D-class III

502-Long scenario of 28 year old male patient with symptoms of Ulcerative Colitis+ anemia related to UC. Sigmoidoscopy revelaed multiple polyps, Biopsy of polyps Carcinoma in situ. What is the most definitive therapy that will be effective in the long-term:

3. Correct Anemia

4. Left hemicolectomy and Colostomy 5.

Total Colectomy and Ilectomy

6. Removal of all polyps by Colonoscopy

503­Female patient came with hypertension, azootemia and GFR of 44.

What is her condition due to:

a. Pheochromocytoma b.Renal artery stenosis c.

Renal Parenchymal Disease

(pheochromocytoma is excluded from the scenario

renal artery stenosis :1- Significant functional impairment of autoregulation, leading to a decrease in the GFR, is not likely to be observed until arterial luminal narrowing exceeds 50%

2-Patients with documented or possible renovascular hypertension may experience progressive azotemia as a consequence of the renal ischemia and/or the persistence of significant hypertension.

3-Refractory hypertension (ie, poor control of blood pressure despite treatment with 3 or more antihypertensive agents) may occur. (emedicine)

renal parenchymal disease: 1- present with HTN.

2-the GFR OF 44>>>means chronic kidney disease stage 3

0) Normal kidney function – GFR above 90mL/min/1.73m² and no proteinuria 1) CKD1 – GFR above 90mL/min/1.73m² with evidence of kidney damage

2) CKD2 (Mild) – GFR of 60 to 89 mL/min/1.73m² with evidence of kidney damage 3) CKD3 (Moderate) – GFR of 30 to 59 mL/min/1.73m²

4) CKD4 (Severe) – GFR of 15 to 29 mL/min/1.73m²

5) CKD5 Kidney failure - GFR less than 15 mL/min/1.73m² Some people add CKD5D for those stage 5 patients requiring dialysis; many patients in CKD5 are not yet on dialysis

504- Patient comes with attack of Strep Throat, had history of previous attack(RF), what is his chance of getting RHD now?

Nothing, he is immune due to previous infection.

100%

Needs Immunoglobulin to prevent re-infection.

50% chance of re-infection.

In the United States, rheumatic fever rarely develops before age 3 or after age 40 and is much less common than in developing countries, probably because antibiotics are widely used to treat streptococcal infections at an early stage. However, the incidence of

rheumatic fever sometimes rises and falls in a particular area for unknown reasons.

Overcrowded living conditions seem to increase the risk of rheumatic fever, and heredity seems to play a part. In the United States, a child who has a streptococcal throat infection but is not treated has only a 0.4 to 3% chance of developing rheumatic fever. About half of the children who have had rheumatic fever develop it again after another streptococcal throat infection if it is not treated. Rheumatic fever follows streptococcal infections of the throat but not those of the skin (impetigo) or other areas of the body. The reasons are not known.

http://www.merckmanuals.com/home/childrens_health_issues/bacte rial_infections_in_infants_and_children/rheumatic_fever.html

505-pediatric patient from developing country presented with muscle wasting, weight loss and absent edema. What is the diagnosis:

1

Marasmus 2 Kwashiorkor

3 Muscle wasting syndrome Marasmus:1-present of muscle wasting

2-body weight less than 80%of average weight.

3-absence of edema 4-increase prior to age 1

kwashiorkor: 1-presence of edema 2-increase in >18month

muscle wasting syndrome:1-loss of weight.

2-muscle atrophy.

3-in older pt with chronic disease.

(ref. wikepidia)

The most suitable answer is :marasmus

506-Patient with decreased vision, also peripheral vision decreased, using tonometer pressure in right eye 24 mm and left eye 22 m. What is the mechanism:

a.

Obstruction in trabecular meshwork and ciliary muscle leads to pupillary blockage and drainage of aqueous humor.

b.Obstruction at ciliary muscle leads to blockage in drainage of Aqueous Humor.

In cases where POAG is associated with increased IOP, the cause for the elevated IOP generally is accepted to be decreased facility of aqueous outflow through the trabecular meshwork. Occurrence of this increase in resistance to flow has been suggested by multiple theories

http://emedicine.medscape.com/article/1206147-overview#a0104 507-Picture of optic disc. (Looks like this:

http://www.revophth.com/content/d/cover_focus/i/1315/c/25316/) What does it show?

a. Normal disc

b. Cupping of optic disc

508- Picture of Patients legs (calves) showing maculopapular rash. H/O red rah appearing on extensor surfaces. Rash is tender to palpate but does not blanch on pressure. What is the diagnosis:

4

Henoch-Schnolein Purpura 5 Polyarteritis nodusa

Henoch-Schoenlein purpura begins with a symmetrical erythematous macular rash on the lower extremities that quickly evolves into purpura. The rash may initially be confined to malleolar skin but usually extends to the dorsal surface of the legs, the buttocks, and the ulnar side of the arms. Within 12-24 hours, the macules evolve into purpuric lesions that are dusky red and have a diameter of 0.5-2 cm. The lesions may coalesce into larger plaques that resemble ecchymoses. Several cases of Henoch-Schoenlein purpura have been observed after varicella infections.

6 (emedicine)

______________________________________________________________________

509- Female patient comes with history of periorbital swelling, itching all over body, O/E there is lymphadenopathy. Liver and spleen are enlarged.

What is the diagnosis?

a.Urticarial b.Angioedema c.Lymphoma??

510- Picture of base of mouth showing a white patch with sharply-demarcated edges. Patient is male, long- term smoker and chews

tobacco, presents with painless lesion in mouth. What is the next most important step:

Topical Fluconazole Biopsy

Wide surgical excision Diagnosis is :leukoplakia:

1-painless white plaque 2-associated with smoking

3- on the mucous membranes of the oral cavity, including the tongue, but also other areas of the gastro-intestinal tract, urinary tract and the genitals.

4-Tobacco, either smoked or chewed, is considered to be the main culprit in its development

5-5% to 25% of leukoplakias are premalignant lesions; therefore, all leukoplakias should be treated as premalignant lesions by dentists and physicians - they require histologic evaluation or biopsy (ref. wikepidia)

511- What drug is likely to cause heat-stroke as it inhibits sweating :

Orphanedrine

Hyoscamine Sulfate

Hyoscamine sulfate Warnings:

In the presence of high environmental temperature, heat prostration can occur with drug use (fever and heat stroke due to decreased sweating)

http://www.drugs.com/pro/hyoscyamine-sulfate-elixir.html other drugs:

Anticholinergics

Cogentin and Artane are examples of anticholinergic drugs. They are both used in the treatment of  Parkison's disease. Medscape.com suggests that anticholinergic medications are involved in the 

development of heat stroke. These drugs inhibit the body's sweating mechanism, leading to inadequate  heat elimination.

Thermal Analyzer Leaders In Analytical Instruments Contact Us For Quality Products. www.Scinco.com

Sponsored Links Neuroleptics

Neuroleptic drugs are also known as antipsychotic medications. They are used to treat mental health  problems like schizophrenia and bipolar disorder. Some drugs in this class of psychiatric medications are  Haldol, Prolixin and Thorazine. According to "Goldfrank's Toxicologic Emergencies," antipsychotic drugs inhibit the body's normal response to heat. They reduce the body's ability to increase blood supply to the  skin for the purpose of heat elimination. Due to this, individuals taking medications from this drug class  may be at risk for heat stroke.

Diuretics

Robert Wood Johnson University Hospital reports that dehydrated individuals who cannot cannot sweat  enough to cool their body may experience heat stroke because their internal temperature may rise to  dangerously high levels. Diuretics are drugs that put individuals at risk for heat stroke because they  promote dehydration, according to "Irwin and Rippe's Intensive Care Medicine." They work by making  the body eliminate fluids through urine. Furosemide and hydrochlorothiazide are diuretic medications.

Sympathomimetics

Sympathomimetic drugs, as stated in "Synthesis of Essential Drugs," mimic the actions of the body's  sympathetic nervous system. They increase heart rate, open up the airways and constrict the blood vessels. 

Sympathomimetic drugs such as amphetamines, cocaine and ephedrine can lead to heat stroke, because  they constrict the blood vessels and do not permit heat loss through blood vessel dilation. This class of  drugs are also risk factors for heat stroke because they increase the amount of heat produced within the  body

Antihypertensives

Antihypertensive medications are used to treat high blood pressure and also put individuals at risk for heat  stroke. Examples of drugs in this class are beta­blockers such as propanolol and calcium channel blockers. 

These drugs reduce heart rate, the strength with which the heart contracts and the amount of blood pumped out to the body. This leads to decreased blood flow to the skin and a reduction in the body's ability to  eliminate heat.

Read more: http://www.livestrong.com/article/118891-medications-predispose-heat-stroke/#ixzz1jMAxCHRd

http://www.livestrong.com/article/118891-medications-predispose-heat-stroke/

512- CT of Brain picture. Scenario: Patient with sudden severe occipital headache came to emergency.

Subarachnoid Hemorrhage Intracerberal Hemorrhage Meningitis

The classic symptom of subarachnoid hemorrhage is thunderclap headache (a headache described as "like being kicked in the head",^[4] or the "worst ever", developing over seconds to minutes). This headache often pulsates towards the occiput (the back of the head).^[

(wikepidia)

intracerberal hem.:Patients with intraparenchymal bleeds have symptoms that correspond to the functions controlled by the area of the brain that is damaged by the bleed.^[3] Other symptoms include those that indicate a rise in intracranial pressure due to a large mass putting pressure on the brain.^[3] Intracerebral hemorrhages are often misdiagnosed as subarachnoid

hemorrhages due to the similarity in symptoms and signs. A severe headache followed by vomiting is one of the more common symptoms of intracerebral hemorrhage. Some patients may also go into a coma before the bleed is noticed.

513- Patient with severe pain in forehead, over nose and sides of face, also present are shiny blisters on surface of forehead, face and nose.

What is the diagnosis:

Post-herpetic neuralgia Varicella

Herpes Simplex Herpes Zoster

Herpes zoster is a viral disease characterized by a painful skin rash with blisters in a limited area on one side of the body, often in a stripe. The initial infection with varicella zoster virus (VZV) causes the acute (short-lived) illness chickenpox which generally occurs in children and young people. Once an episode of chickenpox has resolved, the virus is not eliminated from the body

but can go on to cause shingles—an illness with very different symptoms—often many years after the initial infection. Herpes zoster is not the same disease as herpes simplex despite the name similarity (both the varicella zoster virus andherpes simplex virus belong to the same viral subfamily Alphaherpesvirinae).

Varicella zoster virus can become latent in the nerve cell bodies and less frequently in non-neuronal satellite cells of dorsal root, cranial nerveor autonomic ganglion,^[1] without causing any symptoms.^[2] Years or decades after a chickenpox infection, the virus may break out of nerve cell bodies and travel down nerve axons to cause viral infection of the skin in the region of the nerve. The virus may spread from one or more ganglia along nerves of an affected segment and infect the corresponding dermatome (an area of skin supplied by one spinal nerve) causing a painful rash.^[3][4] Although the rash usually heals within two to four weeks, some sufferers experience residual nerve pain for months or years, a condition called postherpetic neuralgia.

Herpes simplex:1-blisters containing infectious particles.

2-common infection may affect:1-face mouth(orofacial) 2-genitalia(genital herpes) 3-hands(heraptic whitlow)

3-can cause herpes keratitis.

Varicella: is a highly contagious illness caused by primary infection with varicella zoster

virus (VZV).^[1] It usually starts withvesicular skin rash mainly on the body and head rather than at the periphery and becomes itchy, raw pockmarks, which mostly heal without scarring.

Post-herpetic neuralgia:

s a neuralgia caused by the varicella zoster virus. Typically, the neuralgia is confined to

a dermatomic area of the skin and follows an outbreak of herpes zoster (HZ, commonly known as shingles) in that same dermatomic area. The neuralgia typically begins when the

HZ

vesicles have crusted over and begun to heal, but it can begin in the absence of HZ, in which case zoster sine herpete is presumed (see Herpes zoster).

The most likely answer is herpes zoster.

_____________________________________________________________________

514­ Patient had fly in his eye. On removal of the foreign object what will he need:

7 Topical corticosteroids 8

Topical Antibiotics 9 Oral corticosteroids 10Oral Antibiotics

11Answered based on the sle studing group couldn’t find a ref.

515­ Patient complains of discomfort in the eye. There is no discharge.

O/E with dye, a dendritic shaped ulcer is seen on the surface of the cornea. What is the diagnosis:

Keratitis Uveitis

A corneal ulcer , or ulcerative keratitis , or eyesore is an inflammatory or more seriously, infective condition of the cornea involving disruption of its epithelial layer with involvement of the corneal stroma.

(Wikepidia)

________________________________________________________________

516- A patient complains of 2  day history of stuck together lashes on waking up. There is muco- purulent discharge. Anterior Chamber, uvea and iris are clear. What is the diagnosis?

a.

Bacterial Infection b. Viral Infection c. Allergy

Bacterial conjunctivitis is usually a benign self-limiting illness,¹ although it can sometimes be serious or signify a severe underlying systemic disease. Occasionally, significant ocular and

Bacterial conjunctivitis is usually a benign self-limiting illness,¹ although it can sometimes be serious or signify a severe underlying systemic disease. Occasionally, significant ocular and

In document 1000 Prometric GP MCQ + Exp (Page 66-200)