2012 Flashcards
1
Q
A 25 year old male developed shortness of breath and chest pain.
1. What are two ECG changes?
2. What is your clinical diagnosis?
A
- Deep S waves in V1, V2, and Tall R waves in V6
- Left ventricular hypertrophy, Hypertrophic cardiomyopathy (HCOM)
2
Q
A man developed an arrhythmia after having a myocardial infarction
1. What is the likely diagnosis?
2. What is the management for the following case?
A
- Ventricular tachycardia
- DC shock
3
Q
A 40 year old male complaining of cold intolerance, weight gain and fatigue.
1. What are two ECG changes seen in this case.
2. What would you give to treat this patient and how to calculate the total effective dose?
A
- Sinus bradycardia, T wave inversion, prolongation of PR and QT intervals
- Thyroxine, dose is 1.7 mcg/kg/day
4
Q
A 45 year old male presented with acute retrosternal chest pain that lasted for hours and not relieved by anything.
1. What is the diagnosis based on the ECG?
2. Give 2 definitive treatment options?
A
- Inferior wall ST elevated myocardial infarction
- Thrombolytic, Aspirin, and nitrates
5
Q
A 52 year old man with chronic kidney disease on hemodialysis developed shortness of breath.
1. What is your clinical diagnosis?
2. What treatment would you give for symptomatic relief?
A
- Pericardial effusion
- Pericardiocentesis
6
Q
A 53 year old smoker male with history of hemoptysis and shortness of breath.
1. What is the finding in the x-ray?
2. Name two causes for this
A
- Solitary pulmonary nodule
- Bronchogenic carcinoma Tuberculosis
7
Q
A 56 year old male presented to the hospital complaining of sudden attack of shortness of breath. He also complained of inability to lie flat and sudden awake from sleep at night with shortness of breath during the past 2 months. Chest X-ray shown below
1. What is the diagnosis?
2. What is the pathophysiology of this condition?
A
- Pulmonary edema complicating acute left ventricular failure
- Left-sided heart failure leads to increased left atrial pressure backwards, leading to increased pulmonary pressures, pulmonary congestion, and edema
8
Q
A 9 year old boy has a recent history of sore throat after which he developed skin lesions and joint pain. / A 15 year old girl with past history of multiple sore throats presented with this and a pansystolic murmur at the apex.
1. What is the sign shown?
2. What is the diagnosis?
A
- Sydenham’s chorea
- Acute rheumatic fever
9
Q
- Describe the finding in the x ray and clinical diagnosis
- List 2 causes
A
- Bilateral increased opacity in
the middle zones with cephalization of pulmonary veins – Pulmonary edema - Congestive heart failure Non-cardiogenic: acute respiratory distress syndrome
10
Q
- Describe the finding in the picture
- List 2 causes
A
- Raised JVP
- Right sided heart failure Pericardial tamponade
11
Q
- What immunological investigation would you order?
- Name 2 blood tests to diagnose this patient.
- What are two neurological manifestations of this condition.
A
- High CD4 to CD8 T-cell ratio, IL2, Serum Amyloid A (not sure)
- Serum ACE level, CBC showing normocytic normochromic anemia with elevated ESR, and Serum Calcium.
- Cranial nerve palsies and Polyneuropathy
12
Q
A 27 year old male has been diagnosed with lower respiratory tract infection after suffering from influenza.
1. What is the name of the test shown?
2. Describe the findings of the test and name the organism
A
- Gram stain
- Gram positive cocci in pairs (diplococci); streptococcus pneumonia
13
Q
A 32 year old with wheezing and shortness of breath.
1. By what percentage should the FEV1 drop to assess severity of asthma?
2. If this test was not definitive, what test is used to diagnose his condition?
A
- By 20%
- Methacholine challenge
14
Q
- What test produces the figure?
- Name the three patterns given by the figure.
A
- Spirometry
- A: Restrictive pattern B: normal pattern
C: Obstructive pattern
15
Q
A 60 year old nonsmoker male with history of persistent dry cough of 3 months duration.
1. Describe the finding in the CT scan?
2. What is your clinical diagnosis?
A
- Honeycombing in the periphery of the lung
- Idiopathic pulmonary fibrosis
16
Q
- What is test being done here?
- What are the findings and interpretation?
A
- Overnight pulse oximetry
- Multiple desaturations and hypoxemic events with oxygen saturation below 95% suggestive of obstructive sleep apnea.
17
Q
Patient Came to the ER with this vision.
1. Name the abnormality.
2. Mention one cause.
A
- Right Upper homonymous quadrantanopia
- Stroke in the left temporal lobe
18
Q
- What is the test done?
- State its afferent and efferent limbs
A
- Corneal reflex
- Afferent by trigeminal nerve and efferent by facial nerve
19
Q
https://www.youtube.com/watch?v=0-t4RTQ0EsM
1. What is the finding shown?
2. What is the clinical diagnosis?
A
- Pill-rolling resting tremor
- Parkinson’s disease
20
Q
- What is the diagnosis
- Mention 2 causes.
A
- Abducent nerve palsy/ 6th cranial nerve palsy/ CN6 palsy.
- Tumor compressing the nerve
- Infection
- Ischemia localized to the nerve
- Cavernous sinus thrombosis
- Hypertension
- Tumor
- Diabetes mellitus
21
Q
- Is this an upper or lower motor neuron lesion?
- What is the cause of this?
A
- Lower motor neuron lesions
- HSV (herpes simplex virus)
22
Q
- What is being tested in the picture?
- What other test can be done?
A
- Posterior column (fasciculus gracilis and fasciculus cuneatus)
- joint position ( proprioception ), romberg’s test
23
Q
https://docs.google.com/file/d/1MI5h9Z-JOHQJB5QJvnP9Lvsv7OCq0d8C/preview
1. What is the sign shown?
2. Where is the lesion?
A
- Fasciculations
- In lower motor neurons
24
Q
https://docs.google.com/file/d/1_iqoDZz0I_8-06Pph4qaEZAQglj9jQBM/preview
1. What abnormality does this patient have?
2. What is the cause?
A
- Inability to abduct her right eye
- Right abducens nerve palsy
25
https://docs.google.com/file/d/1rohmukAYphYFu1lKCLYG6YL472EwPTge/preview
1. What is the sign shown?
2. Name two other signs this patient might have on neurological examination
1. Intention tremor
2. Dysdiadochokinesia, rebound phenomenon, nystagmus
26
https://docs.google.com/file/d/1ZuCUVdiHGnea92ALqDhrHrBWcYqKbMYg/preview
1. What is this signs?
2. What are two other signs you’ll see in this patient?
1. Hoffman’s sign
2. Positive Babinski, Increased deep tendon reflexes (knee, ankle)
27
1. Describe the lesion
2. Where is the lesion?
1. Left lower homonymous quadrantanopia
2. Right parietal lobe
28
1. What is the name of the examination in the first picture?
2. What is the most likely abnormality if the patient has a pituitary adenoma?
1. Visual field test
2. Bitemporal hemianopia
29
https://docs.google.com/file/d/1jDqs019gUVmFcOcRWvtYmEJ3ppTBWsBz/preview
1. Name the sign seen in this video
2. What test would you do to confirm?
1. Brudzinski’s sign
2. Lumbar puncture
30
1. What is the abnormality in this patient?
2. Which muscles are responsible for this position?
1. Ptosis and the eyeball is turned down and out (3rd oculomotor nerve palsy)
2. Unopposed actions of lateral rectus and superior oblique and paralysis of superior, medial and inferior rectus and inferior oblique muscles.
31
Patient presented with stroke. Video of the eyes of the patient.
1. What is the diagnosis?
2. If the pupils were spared, what could be the cause?
1. Oculomotor nerve palsy
2. Diabetes mellitus
32
https://docs.google.com/file/d/1xzwhfBWkc9jSFCPZXpc2g8rVeJgsd5x0/preview
A 67-year-male with a history of constipation was found to have iron deficiency anemia. Colonoscopy was performed.
1. What is the diagnosis?
2. How can the incidence of this condition be reduced?
1. Colorectal carcinoma
2. By screening with colonoscopy at 45 years of age
33
A 26 year old female with a history of chronic bloody diarrhea presents with severe abdominal pain.
1. Describe the finding in this abdominal x-ray
2. What is the diagnosis?
3. What is the most feared complication?
1. Colon dilation more than 6 cm
2. Toxic megacolon
3. Perforation/ shock/ sepsis
34
A 19 year old male with a history of chronic diarrhea and weight loss was examined. He presented with painful raised red nodules over bilateral shins.
1. Name the lesion shown
2. What is the underlying gastrointestinal disease?
1. Erythema nodosum
2. Inflammatory bowel disease
35
A 67 year old male reports a history of constipation. He was found to have iron deficiency anemia which was investigated.
1. What is the finding shown?
2. How can the mortality from this disease be reduced in the population?
1. A large mass occupying the colonic lumen, most likely colorectal carcinoma
2. By screening with colonoscopy at 50 years in average risk population (45 years in Kuwait)
36
A 56 year old diabetic woman was found to have a BMI of 31 kg/m2. Her investigations are shown in the table
1. Describe the histological findings shown
2. What is the diagnosis?
1. Steatosis and neutrophilic inflammatory infiltrate
2. Non-alcoholic steatohepatitis
37
Name the stomas
A. Ileostomy B. Colostomy
38
https://docs.google.com/file/d/1K6CgN7uoA7yATNsuvXnrGcxIlsWFhxjU/preview
55 year old smoker had pain in his right lower quadrant.
1. Describe the findings in the colonoscopy
2. What is the most likely diagnosis?
1. Skip lesions, bleeding, polyps, inflammation
2. Crohn’s disease
39
A 52-year old man presents with progressive abdominal distention
1. List two abnormalities seen in the CT scan.
2. List two etiological agents which can lead to this condition.
1. Ascites (fluid in the peritoneum) and shrunken liver
2. Alcoholic liver cirrhosis, viral hepatitis, hemochromatosis, Wilson's disease
40
This is the feet of a diabetic man.
1. What is shown?
2. What is the causative organism?
1. Tinea pedis
2. Dermatophytes (Trichophyton rubrum, Epidermophyton floccosum, Trichophyton mentagrophytes var. interdigital, Epidermophyton floccosum)
41
A diabetic patient is on this kind of therapy to manage his condition.
1. Mention two side effects of this therapy
2. What are two pieces advice that could be given to this patient prior to his injection?
1. Lipohypertrophy, allergic reactions, hypoglycemia
2.
● to change the site of injection every now and then
● to inform him about the side effects of insulin
● check the expiry date of insulin before using it
42
This patient had a history of arthralgia, and stiffness mainly in the morning
1. What is the finding shown in the figure?
2. What is the diagnosis?
1. Nail pitting
2. Psoriatic arthritis
43
1. What are the 2 signs?
2. What is the diagnosis?
1. Heberden and Bouchard nodes
2. Osteoarthritis
44
A patient complains of back pain
1. What is your clinical diagnosis?
2. Name two pulmonary manifestations.
1. Rheumatoid arthritis
2. Interstitial lung disease Pleural effusion
45
A 57 year old female experienced pain in her fingers and noticed some color changes.
1. What is this sign?
2. Name two associated conditions
1. Raynaud's phenomenon
2. Systemic lupus erythematosus Rheumatoid Arthritis Scleroderma
46
Patient with swollen joint
1. Name three causes for this picture.
2. What is the investigation of choice?
1. Gout, osteoarthritis, hemoarthrosis, trauma, septic arthritis
2. Needle aspiration of the joint
47
What are the pulmonary complications?
Pleural effusion
Lung fibrosis
48
Patient complaining of perioral numbness & paresthesia in his hand and feet after thyroidectomy
1. What would you do to elicit the sign?
2. Mention two other findings ( Signs or investigations)
1. Inflate a blood pressure cuff just above the systolic pressure for 3 mins, when hypocalcemia has caused muscular irritability, the hand will develop flexure spasm.
2.
● Hypocalcemia in biochemistry profile
● Chvostek’s sign
49
A 42 year old man presents with postural hypotension and weight loss
1. What’s the diagnosis?
2. Mention two biochemical abnormalities this patient is likely to have
3. What's the key diagnostic test?
1. Addison's disease
2. Hyponatremia and hyperkalemia
3. Short ACTH (synacthen) stimulation test
50
1. What are the antibodies responsible for this patient’s problem?
2. What nuclear scan would be associated with this patient and mention one other specific manifestation you will find.
1. TSH-Stimulating Receptor Autoantibodies (TRAb)
2. B, pretibial myxedema, diffuse goiter with bruit
51
A 29 year old woman with a weight of 76 kg and a height of 163 cm wants to lose 10 kilos to fit into her wedding dress.
1. Classify her nutritional status according to her BMI
2. Name the parameter is being measured in the picture shown and mention one importance
1. She's overweight
2. Waist circumference; high values (more than 80 in females) are associated with increased risk of developing type 2 diabetes mellitus
52
A 32 year old man came complaining of headaches and tightening of his wedding ring.
1. Mention two signs in this picture.
2. What is the diagnosis?
3. What is the gold standard test to diagnose this condition?
1. Prominent supraorbital ridge, prognathism
2.
3. Oral glucose tolerance test (OGTT)
53
A 68 years old man presented with 3 months history of low back pain and fatigue. Investigations revealed hypercalcemia and M spike.
1. Describe the finding in the x ray
2. What is the most likely diagnosis?
1. Multiple osteolytic [punched out] lesions in the skull
2. Multiple myeloma
54
A 34 year old female suffers from shortness of breath, fatigue and palpitations on exertion.
1. What is the sign ?
2. What is the diagnosis?
1. Koilonychia
2. Iron deficiency anemia
55
A 56-year-old patient presented with headache, pruritus (itchiness), palmar erythema, and facial plethora. CBC shows pancytopenia. His BP was high
1. What is the diagnosis
2. What is the test confirmed the diagnosis?
1. Polycythemia vera
2. Genetic testing for JAK2
56
15-years old boy developed jaundice after eating falafel (fava beans).
1. Diagnose
2. What is shown in the blood smear?
1. G6PD deficiency
2. Heinz bodies
57
15-years old boy with a hereditary disorder had a swelling in his knee.
1. Name the finding
2. What is the name of the disease?
1. Hemarthrosis
2. Hemophilia
58
1. What does this patient with this certain chromosomal abnormality have?
2. A patient with sickle cell anemia presented with bone pain and an x-ray was done. What is your diagnosis?
1. Chronic myelogenous leukemia (CML)
2. Avascular necrosis of the femur head
59
A 56 year old male presented with headaches, itchiness and palmar erythema.
What does he have?
Polycythemia rubra vera
60
A 40 year old male presented with pancytopenia and splenomegaly.
What does he have?
Myelofibrosis
61
A 30 year old female presented to the ER with bleeding from her nose and ears and a rash on her legs and was hypotensive with cold extremities. Culture showed gram negative bacteria.
1. What does she have?
2. What is one complication from the test showed in pic B?
1. Disseminated intravascular coagulation
2. Recurrent abortions Clots and thrombosis
62
1. What is the cell in pic A?
2. A 22 year old male who just returned from Africa developed a fever with splenomegaly, what infection does he have?
1. Eosinophil
2. Malaria (this is a blood smear of the ring stage of malaria in the RBC’s)
63
1. What’s the type of anemia in pic A?
2. What is the disease in the bone marrow in pic B?
1. Microcytic hypochromic anemia (iron deficiency anemia)
2. Aplastic anemia
64
1. What is the diagnosis?
2. What is the causative agent?
1. Tinea versicolor
2. Malassezia furfur
65
A 25 year old male presented with recurrent episodes of very distinct, widely distributed skin rash involving palms, soles, limbs, and trunk.
1. Describe the finding
2. What is the diagnosis?
1. Target Lesions
2. Erythema multiforme
66
This boy just ate peanuts.
1. What would you give the patient?
2. Briefly explain the pathophysiology
1. Intramuscular Epinephrine Injections (if laryngeal involvement)
2. Type I anaphylactic or IgE mediated with histamine release causing vasodilation and increased capillary permeability
67
1. Which part of the antibody binds to antigen?
2. Which antibody first appears after infection?
1. A
2. IGM
68
A woman complaining of sneezing, increased nasal discharge, and coughing during a season.
1. If you take a sample of her nasal turbinators, what cells would the cytology show?
2. What is released by these cells?
1. Mast cells
2. Histamine
69
A woman complaining of sneezing, increased nasal discharge, and coughing during a season.
1. What drug would cause this condition?
2. What is the pathophysiology of this?
1. Angiotensin converting enzyme inhibitor (ACEI)
2. ACE inhibitors inhibit Angiotensin
converting enzyme which is responsible for breaking down bradykinin into kinin. Bradykinin peptide is a potent vasodilator and increases vascular permeability, leading to rapid accumulation of fluid in the interstitium.
70
1. measure BMI
2. what are the ranges for BMI
3. give 3 advices to lose weight
1. image
2. normal: 18.5-24.9
overweight: 25-29.9
obese: 30-34.9
severely obese: 35- 39.9
morbidly obese: >= 40
3. - diet - exercise - decreased alcohol consumption
71
A 1 year old child with a septal defect in the heart with a pansystolic murmur had a surgery. They found a small atrophied organ on his heart and removed it.
1. What is this organ?
2. What type of blood cells would be deficient if this organ is removed?
1. Thymus glan
2. T lymphocytes
72
1. Mention two cardiac causes for this.
2. Mention two non-cardiac causes for this.
1. Subacute bacterial endocarditis Congenital cyanotic heart disease
2. Bronchogenic carcinoma, empyema, bronchiectasis, IBD, celiac, cirrhosis, thyrotoxicosis.
