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Medicine ELOOPS > 2013 > Flashcards

2013 Flashcards

1
Q

A 60 year old patient presented with dizziness and frequent episodes of syncope. He is a known case of heart disease. This is his ECG:
1. What is the diagnosis?
2. What is the treatment?

A
  1. Third degree AV block
  2. Permanent Pacemaker
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2
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
  1. Deep S waves in V1, V2, and Tall R waves in V6
  2. Left ventricular hypertrophy, Hypertrophic cardiomyopathy (HCOM)
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3
Q

A young patient develops palpitations of abrupt onset and abrupt offset for the past two weeks.
1. What is the diagnosis?
2. Which drug you would give immediately?

A
  1. Paroxysmal supraventricular tachycardia (Re-entry tachycardia)
  2. IV adenosine
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4
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
  1. Ventricular tachycardia
  2. DC shock
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5
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. What is the pathophysiology behind this condition?

A
  1. Inferior wall ST elevated myocardial infarction
  2. Rupture of atherosclerotic plaque and thrombus formation leading to obstruction in the right coronary artery
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6
Q

A patient with history of rheumatic heart disease presented with unilateral weakness and sluggish speech.
1. What is the diagnosis?
2. How to prevent similar future episodes?

A
  1. Atrial fibrillation
  2. Anticoagulation with warfarin & heparin (When INR = 2, discontinue heparin and continue warfarin lifelong)
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7
Q

A 32-year-old male was taken to the emergency room because of drowsiness, fever, cough, diffuse abdominal pain, and vomiting. Urine showed ++ ketones
1. What are the ABG findings (comment on pH and PCO2)?
2. ECG: Mention two findings that support the diagnosis?

A
  1. Low PH (metabolic acidosis) and low PCO2 (respiratory compensation of the metabolic acidosis)
  2. Tented T-wave, wide QRS complex indicating hyperkalemia
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8
Q

A 55 year old male presented with retrosternal chest pain, sweating and palpitations.
1. What is the diagnosis?
2. Underlying pathophysiology?

A
  1. Anterolateral ST elevation myocardial infarction
  2. Rupture of an atherosclerotic plaque resulted in thrombus formation and occlusion of coronary artery (left anterior descending; LAD)
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9
Q
  1. Comment on the rhythm and rate in the above ECG.
  2. What is the diagnosis?
A
  1. Regular sinus rhythm, Rate: 102 Bpm (17 R x 6)
  2. Antero-septal STEMI (ST segment elevation in V1-V4)
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10
Q

A 26 year old male presented to the hospital with 4 days history of fever, chest pain, and a productive cough. X ray shown below
1. Which lobe is involved?
2. What is the diagnosis?
3. What are three important investigations?

A
  1. Right middle lobe
  2. Pneumonia
  3. -
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11
Q
  1. What is the area pointed at by the red arrow?
  2. What is the structure pointed at the tip of the blue arrow?
  3. What is the area represented by the yellow circle ?
A
  1. Left hilum
  2. Stomach (Gastric bubble)
  3. Aortopulmonary window
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12
Q

A 25 year old female presented with progressive shortness of breath, palpitations, and 2 episodes of hemoptysis.
1. Mention 2 things you see on the CXR.
2. What is the most likely diagnosis

A
  1. Mitralization [straightening] of the left border of the heart
    Double cardiac density shadow Widening of the carina
  2. Mitral stenosis
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13
Q

Patient presented with a four week history of fever, purulent cough of smelly green sputum
1. What is the abnormality (diagnosis):
2. What are two causative organisms?

A
  1. Lung abscess
  2. Staphylococcus Aureus Klebsiella Pneumoniae Anaerobes
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14
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
  1. Pericardial effusion
  2. Pericardiocentesis
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15
Q

Patient presented with this Xray
1. Mention two differential diagnoses
2. What are two other investigations will you do ?

A
  1. Lung abscess, Pneumonia or TB (not sure)
  2. Sputum culture, blood culture, pleural fluid if empyema is present
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16
Q

patient from India presenting with cough and this is his Xray?
1. Describe the finding?
2. What other two investigations will you do?

A
  1. Apical cavitations
  2. Sputum AFB smear and culture Smear/culture of bronchoscopy specimen
    Smear/culture of extrapulmonary sites
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17
Q

A 22 year old patient with history of smoking presented with left sided chest pain and shortness of breath. His chest x-ray is shown.
1. What is the diagnosis?
2. Immediate management?

A
  1. Spontaneous Pneumothorax
  2. Chest tube insertion in the 5th intercostal space mid to anterior axillary line
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18
Q

Patient complains of recurrent sinusitis and this was his chest x-ray.
1. Describe the finding?
2. What investigations are important?

A
  1. Dextrocardia, right sided aortic notch, right gartic bubble all indicating situs inversus
  2. Electron microscopy of cilia ultrastructure.
    Pulmonary function tests, HRCT for bronchiectasis
    Cilia motility testing

Note: Kartagener syndrome is a triad of bronchiectasis, sinusitis and situs inversus

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19
Q

A 60 year old male complaining of progressive shortness of breath and dry cough. This was he chest x-ray
1. Describe the x-ray
2. What is the diagnosis?

A
  1. Bilateral reticulonodular lung infiltrates
  2. Interstitial lung disease
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20
Q

A 37 year old patient underwent colonoscopy. X-ray done few hours later.
1. Describe the finding?
2. What could be the cause?

A
  1. Air under diaphragm
  2. Perforation of the colon.
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21
Q

https://youtu.be/VdgA3fcp7Cs
1. What is the sign shown?
2. Mention one cause?

A
  1. Elevated JVP
  2. Severe tricuspid regurgitation
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22
Q
  1. What is this sign called
  2. What lab test would you order?
A
  1. Xanthelasma
  2. Lipid profile (serum cholesterol and lipoproteins)
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23
Q

A 55 year-old male presented with severe retrosternal chest pain after which he became acutely breathless.
1. What is the diagnosis?
2. What is the finding on auscultation?

A
  1. Acute pulmonary edema due to left ventricular failure
  2. Bilateral bubbling basal crepitations
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24
Q
  1. What clinical sign is shown in the video?
  2. What is your clinical diagnosis?
A
  1. Dancing carotid
  2. Aortic regurgitation
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25
1. What does figure A show 2. What does figure B show?
1. Roth’s spot 2. Splinter hemorrhage
26
1. What is the clinical diagnosis based on this finding? 2. Mention two cardiac complications of this condition.
1. Marfan’s Syndrome 2. Aortic regurgitation Mitral valve prolapse Aortic dissection
27
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?
1. Pulmonary edema complicating acute left ventricular failure 2. Left-sided heart failure leads to increased left atrial pressure backwards, leading to increased pulmonary pressures, pulmonary congestion, and edema
28
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?
1. Sydenham's chorea 2. Acute rheumatic fever
29
A young patient with purulent sputum And fever. Bacteria stained. 1. Mention the test used 2. What is the finding and causative organism
1. Ziehl- Neelsen stain 2. Acid-Fast bacilli, mycobacterium tuberculosis
30
An asthmatic patient was complaining of a cough and chest tightness 1. What percent improvement in FEV1% is considered to be significant?/*What is the percentage change in FEV1 after the administration of bronchodilator to consider the diagnosis of asthma? 2. If the previous test is inconclusive and you still suspect asthma، what test is used to diagnose it? 3. You gave the patient inhaled corticosteroids and the symptoms were not improving, what is the next step?
1. 12% and 200 ml 2. Methacholine challenge test. 3. LABA (long acting beta adrenergic agonists)
31
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
1. Gram stain 2. Gram positive cocci in pairs (diplococci); streptococcus pneumonia
32
Identify 1. What is this sign? 2. Mention two associated conditions
1. Finger clubbing 2. Bronchiectasis, lung abscess, empyema, cystic fibrosis, bronchogenic carcinoma, idiopathic pulmonary fibrosis, cyanotic congenital heart disease, subacute bacterial endocarditis, cirrhosis, celiac disease, inflammatory bowel disease, primary sclerosing cholangitis, Graves disease
33
1. What is the name of the curve shown in the figure? 2. Mention the finding on the curve? Is it normal or abnormal?
1. Flow-volume loop 2. Concave scalloping of the expiratory limb (i.e. obstructive pattern); This is abnormal
34
1. What is the sign shown in the figure? 2. Mention two causes.
1. Box-shaped curve (i.e. truncation of both inspiratory and expiratory limbs) indicating fixed upper airway obstruction 2. Tracheomalacia, goiter, vocal cord dysfunction
35
1. What is the diagnosis? 2. Describe the findings on chest X-ray.
1. Sarcoidosis 2. Bilateral hilar lymphadenopathy and pulmonary infiltrates predominantly in the mid-upper zones
36
1. What are the two lung volumes in A & B? 2. What increases in case of COPD?
1. A: Vital capacity B: residual volume 2. B
37
A 20 year old female underwent methacholine challenge test and results were shown. 1. Interpret the test results? 2. Mention one drug or food that a patient should avoid before doing that test.
1. 20% decrease is significant because the change was less than 20% the test is negative. 2. Caffeinated products
38
A 70 year old male smoker complaining of shortness of breath. 1. Describe the finding? 2. Most likely diagnosis?
1. Solitary pulmonary nodule 2. Lung cancer
38
A 70 year old male smoker complaining of shortness of breath. 1. Describe the finding? 2. Most likely diagnosis?
1. Solitary pulmonary nodule 2. Lung cancer
39
1. What is the abnormality shown in the figure? 2. Is it acute or chronic condition? 3. What is the cause? 4. Is the lesion a LMN or UMN?
1. ● Deviation of the protruded tongue to the left ● Tongue wasting and fasciculations 2. Chronic condition 3. Left LMN hypoglossal (CN XII) palsy 4. LMN (CN 12)
40
A 53-year-old diabetic patient complains of painful vesicles that appeared above his left eye. 1. Which cranial nerve is affected in this condition? 2. Which division of this cranial nerve is affected?
1. Trigeminal nerve (CN V) 2. Ophthalmic division (V1)
41
A 22 year old female with visual impairment. Her CSF had oligoclonal. 1. Describe the MRI finding? 2. What is your Diagnosis?
1. Multiple hyperintense periventricular plaques 2. Multiple sclerosis
42
Patient Came to the ER with this vision. 1. Name the abnormality. 2. Mention one cause.
1. Right Upper homonymous quadrantanopia 2. Stroke in the left temporal lobe
43
A patient presented with diplopia and inability to opened the left eye 1. Which cranial nerve is affected? 2. Mention TWO causes?
1. Left Oculomotor nerve [3rd cranial nerve] 2. Stroke DM PCA aneurysm
44
1. What is the test done? 2. State its afferent and efferent limbs
1. Corneal reflex 2. Afferent by trigeminal nerve and efferent by facial nerve
45
A patient presented with diplopia and inability to opened the left eye 1. Which cranial nerve is affected? 2. Mention TWO causes?
1. Left Oculomotor nerve [3rd cranial nerve] 2. Stroke DM PCA aneurysm
46
A 22 year old female with visual impairment. Her CSF had oligoclonal. 1. Describe the MRI finding? 2. What is your Diagnosis?
1. Multiple hyperintense periventricular plaques 2. Multiple sclerosis
47
A patient complained of nocturnal paresthesia affecting the thumb, index and middle finger. 1. What are the main findings? 2. How would you confirm the diagnosis?
1. Atrophy of the thenar muscles. 2. It is mainly a clinical diagnosis positive tinel and phalen test but nerve conduction studies can be used to confirm the diagnosis.
48
1. What is the diagnosis 2. Mention 2 causes.
1. Abducent nerve palsy/ 6th cranial nerve palsy/ CN6 palsy. 2. 1. Tumor compressing the nerve 2. Infection 3. Ischemia localized to the nerve 4. Cavernous sinus thrombosis 5. Hypertension 6. Tumor 7. Diabetes mellitus
49
1. Is this an upper or lower motor neuron lesion? 2. What is the cause of this?
1. Lower motor neuron lesions 2. HSV (herpes simplex virus)
50
1. Which response is abnormal? 2. Where can an abnormal response be found?
1. B 2. In upper motor neuron lesions (stroke)
51
A 56 year old man presented with Diplopia. 1. What is the diagnosis? 2. Mention two causes
1. Oculomotor nerve palsy 2. Diabetes mellitus, multiple sclerosis, posterior communicating artery berry aneurysm
52
1. What is being tested in the picture? 2. What other test can be done?
1. Posterior column (fasciculus gracilis and fasciculus cuneatus) 2. joint position ( proprioception ), romberg’s test
53
1. What does the above CT show and where is the site of the pathology? 2. What is the most likely cause?
1. Intraparenchymal hemorrhage (hyperintense signal) in the left thalamus 2. Hypertension
54
A patient presented with headache and nuchal rigidity. LP smear is shown in the figure. This patient is suspected of having AIDS. 1. What is the causative agent of meningitis in this patient? 2. What is the cut-off point for CD4 cell count that supports the diagnosis of AIDS?
1. Cryptococcus neoformans 2. Less than 200 cells
55
Perimetry performed in a patient who presented with visual loss. 1. What is the diagnosis? 2. Where is the site of the lesion?
1. Right homonymous hemianopia 2. Left optic tract
56
42 year old woman presents with one year history of blurred vision. The abnormality shown was in both eyes on fundoscopy 1. What is the diagnosis? 2. Mention two causes?
1. Papilledema 2. Increased intracranial pressure due to e.g. brain tumor, Hypertensive retinopathy
57
1. What does the figure show? 2. Mention 2 causes.
1. Left oculomotor (CN III) palsy with pupil involvement (left ptosis, mydriasis, and deviation down and out) 2. 1. Aneurysm of PCOM/PCA 2. Medial temporal herniation
58
A 65-year-old patient suffers from weakness in the hands but no paresthesia. He also has twitches and spasms in the thighs. 1. What does the figure show? 2. What is the diagnosis?
1. Atrophy of the thenar eminence 2. Amyotrophic lateral sclerosis (motor neuron disease)
59
https://docs.google.com/file/d/1MI5h9Z-JOHQJB5QJvnP9Lvsv7OCq0d8C/preview 1. What is the sign shown? 2. Where is the lesion?
1. Fasciculations 2. In lower motor neurons
60
https://docs.google.com/file/d/1U5yIlJ4zPLUXYBYDS3UjojgC-TlbJLne/preview 1. What is the finding shown 2. What is the clinical diagnosis?
1. Resting tremor 2. Benign essential tremor
61
https://docs.google.com/file/d/1_iqoDZz0I_8-06Pph4qaEZAQglj9jQBM/preview 1. What abnormality does this patient have? 2. What is the cause?
1. Inability to abduct her right eye 2. Right abducens nerve palsy
62
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
63
https://docs.google.com/file/d/1tXhMNo6mlL8PdARwb181xCEy6qOBO0EH/preview A patient presented with right-sided weakness. 1. What is the doctor checking in this video? 2. What does it indicate?
1. Plantar response 2. Upper motor neuron lesion
64
1. What type of spell is shown in the video? 2. Mention 2 causes.
1. Generalized tonic-clonic seizure 2. Encephalitis, hemorrhagic stroke, meningitis
65
Patient presented with paraparesis and urinary incontinence. On physical examination this sign was noted 1. Where is the lesion? 2. What does it indicate?
1. Spinal cord 2. An upper motor neuron lesion
66
A patient complains of loss of some of his visual field. The results of his perimetry are shown. 1. What is the visual field defect? 2. Mention one possible cause?
1. Bitemporal hemianopia 2. Pituitary adenoma compressing the optic chiasm
67
Patient presented with right sided weakness. Video of doctor performing a test on the patient. 1. What is the name of the test? 2. Interpret the results.
1. Plantar reflex 2. Extensor plantar reflex (Babinski sign) is present when there is dorsiflexion of the big toe and fanning of the other toes indicating an upper motor neuron lesion
68
1. What is the sign? 2. Where is the lesion?
1. Ankle clonus 2. Upper motor neuron lesion
69
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)
70
A 54-year-old patient presented with a two month history of progressive dysphagia for solid and liquid. A picture of his barium swallow is shown. 1. What is the diagnosis: 2. What is the next step?
1. Esophageal carcinoma 2. Upper GI endoscopy & Biopsy followed by Endoscopic US for staging
71
1. What is the diagnosis? 2. What are the possible complications?
1. Diverticulosis 2. Perforation and inflammation [diverticulitis]
72
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
73
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
74
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
75
Patient with chronic knee pain and they showed and endoscopy with an ulcer 1. What is the finding ? 2. What is the most probable cause in this patient ?
1. Peptic Ulcer 2. NSAIDS
76
Patient presented with these painful ulcers after taking an antibiotic (cotrimoxazole) 1. What is the diagnosis ? 2. Which group of drugs is contraindicated in these patients?
1. Steven johnson Syndrome 2. Antibiotics, NSAIDS, Anticonvulsants
77
https://docs.google.com/file/d/10iWbb9hO4e2AeZ1NBCzOkIMvzj5sAw5F/preview 1. What is the sign shown? 2. Name two associated conditions
1. Flapping tremor (asterixis) 2. Cirrhosis, CO2 retention, uremia
78
A patient developed diarrhea and fever after being treated for a urinary tract infection. Colonoscopy was performed. 1. What is the diagnosis? 2. What medical treatment would you give to this patient?
1. Pseudomembranous colitis 2. Oral metronidazole/vancomycin
79
A 34-year-old female with history of bloody diarrhea and mucus per rectum. 1. What do the figures show? 2. How to confirm the diagnosis?
1. A: Pyoderma gangrenosum B: Sacroiliitis 2. Colonoscopy
80
This patient developed an attack of acute pancreatitis one month ago. Now she presents with abdominal fullness. Amylase 847 (high). Abdominal CT was performed and the result is shown in the figure. 1. What is the findings on the CT scan? 2. Mention two complications of this finding.
1. Pancreatic pseudocyst 2. Gastric outlet obstruction Bile duct obstruction
81
1. What is the rash called? 2. Mention the associated gastrointestinal condition.
1. Dermatitis herpetiformis 2. Celiac disease
82
Video of a colonoscopy for Ulcerative colitis 1. Mention the finding 2. What is your diagnosis?
1. Diffuse inflammation of the mucosa with no skip lesions 2. Ulcerative colitis
83
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)
84
Young patient presented with RUQ abdominal pain. CT scan shows cyst in the liver and aspiration showed fluid with anchovy sauce consistency. 1. Diagnosis? 2. What medical treatment would you offer?
1. Amoebic abscess due to Entamoeba histolytica 2. Metronidazole
85
A young male presented with 3 months history of bloody diarrhea. 1. Describe the findings shown in histology 2. What is the diagnosis?
1. Crypt abscess, inflammatory infiltrate 2. Ulcerative colitis
86
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
87
A Patient with type 2 diabetes Mellitus 1. What is the sign shown in the picture? 2. What is the most common underlying endocrine disorder? 3. What is the plasma insulin level in this patient ?
1. Acanthosis nigricans 2. Diabetes mellitus type 2 3.
88
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
89
1. What are the 2 signs? 2. What is the diagnosis?
1. Heberden and Bouchard nodes 2. Osteoarthritis
90
A 21 year old male presented with 2 days history of knee swelling What bedside examination would you perform ? What is the initial investigation ?
?
91
This patient presented with swollen right knee joint 1. What bedside physical examination would you like to do? 2. What is the most important next step in the evaluation of this patient?
1. Milking test for knee effusion 2. Synovial fluid analysis
92
A 36 year old man presented to you with chronic lower back pain. His x-ray is shown below. 1. Mention two findings on the x-ray. 2. What is the possible diagnosis?
1. Squaring of vertebral bodies Fusion of vertebrae (bamboo spine) 2. Ankylosing spondylitis
93
A patient who worked as a glass blower for 30 years presented with dry cough, SOB, and painful swollen small hand joints. 1. Mention the findings on hand and chest X-rays 2. What is the diagnosis?
1. –Hand X-rays: Symmetric joint space narrowing, marginal erosions, peri-articular osteopenia –CXR: Bilateral multiple peripheral nodular opacities of various sizes 2. Caplan’s Syndrome (Rheumatoid pneumoconiosis)
94
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
95
1. What is the diagnosis? 2. Mention one diagnostic blood test.
1. Rheumatoid arthritis 2. Anti-CCP
96
This patient complains of hair loss, polyarthralgia, and a skin rash that gets worse upon sun exposure 1. Mention one diagnostic blood test. 2. Mention two pulmonary manifestations of this condition. 3. Mention two neurological complications?
1. Anti-DsDNA antibody Anti-Smith antibody 2. Pleuritis Pleural effusion Pneumonitis ILD 3. Seizures, depression, stroke.
97
1. What is the diagnosis? 2. Mention two other findings on physical examination.
1. Scleroderma 2. Sclerodactyly Raynaud’s phenomenon Subcutaneous calcifications
98
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
99
A 27 year old man is complaining of increasing back pain and morning stiffness. This is an xray of his spine 1. Describe the x ray. 2. What’s your diagnosis?
1. Syndesmophytes formation, squaring of vertebrae 2. Ankylosing spondylitis
100
70 year old male presented with recurrent monoarthritis, he also noticed swelling of his big toe. 1. Describe the finding? 2. Diagnosis?
1. Gouty tophi 2. Chronic tophaceous gout.
101
This patient presented with swollen right knee joint. 1. What bedside physical examination would you like to do? 2. What is the most important next step in the evaluation of this patient?
1. Milking test for knee effusion 2. Synovial fluid analysis
102
Patient with High TSH and low T4 1. Mention two symptoms 2. Mention two biochemical findings
1. Bradycardia, cold intolerance, constipation 2. -
103
1. How to confirm your diagnosis? 2. Name the finding in the patient’s eye?
1. EMG, Muscle biopsy 2. Heliotrope rash
104
Abdomino-pelvic US in this patient showed polycystic ovaries. 1. Mention two signs shown in the figure. 2. Mention two hormonal abnormalities.
1. Hirsutism Acanthosis nigricans 2. High free testosterone High LH Low SHBG
105
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
106
A 36 year old woman reports recent weight gain and easy bruising. 1. Mention two findings as shown in the pictures? 2. What is the diagnosis?
1. moon facies, facial plethora, hirsutism,purple abdominal striae 2. Cushing's syndrome
107
30 year old patient complains of increased sweating in his hands with loss of sensation. Picture of his hand is shown. 1. What is the gold standard test to diagnose this condition? 2. Most likely cause of his symptoms ?
1. Oral glucose tolerance test. 2. Pituitary tumor secreting growth hormone causing acromegaly.
108
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
109
A patient presented with fatigue, abdominal pain, and bloody diarrhea. He also has a red sore tongue. 1. What is the main cause of presence of this cell on the right? 2. Which part of GI system is affected?
1. Vitamin B12 deficiency 2. Terminal ileum (Crohn’s disease)
110
1. What substance does this cell release? 2. List two causes where this cell count is high.
1. Histamine 2. * Parasitic infections * Churg Strauss syndrome Although most if not all of us answered the first question as (histamine), I believe an eosinophil doesn’t contain histamine but other substances including: Major basic protein, eosinophil cationic protein
111
PBS of a patient with SLE showed this and he had petechiae and purpura well 1. What is the diagnosis? 2. What other hematological finding you can find in SLE?
1. TTP 2. Hemolytic anemia , anemia of chronic disease, leukopenia, and thrombocytopenia
112
PBS shown: 1. What test would you like to do? 2. What is your diagnosis? (The patient didn’t have any signs of hemolysis)
1. Osmotic fragility test 2. Hereditary spherocytosis
113
A 55 year old man presented with 3 weeks history of low back pain and fatigue. His blood test shows elevated serum calcium levels. 1. Describe the CT findings? 2. What is the diagnosis?
1. Multiple osteolytic lesions 2. Multiple myeloma
114
These are the peripheral blood smears of two people from the premarital test 1. What are the findings? 2. Would you suggest marriage between these two people and why?
1. Sickle cell and the other pbs showed thalassemia 2. No because there is a chance the baby will have both beta thalassemia and sickle cell disease (Not sure)
115
Postmenopausal woman, no past medical history, presented with 3 weeks history of palpitations and fatigue. 1. Describe the blood smear 2. What is most likely etiology?
1. Hypochromic microcytic cells, elliptocytes (pencil cell) 2. Iron deficiency anemia due to e.g. colorectal cancer.
116
1. Mention two findings in this PBS? 2. What is the diagnosis?
1. Microcytic hypochromic anemia Anisocytosis 2. Iron deficiency anemia
117
This peripheral blood smear was obtained from a vegan. 1. What is the diagnosis? 2. Deficiency of which two factors can cause it?
1. Megaloblastic anemia 2. Vitamin B12 or folate
118
A patient presented with bone pain. RFT showed high creatinine. Serum calcium is elevated. 1. What is the diagnosis? 2. What does serum protein electrophoresis (SPEP) show?
1. Multiple myeloma 2. M spike of gamma globulins
119
A 56 year old male presented with headaches, itchiness and palmar erythema and plethora. CBC shows pancytopenia. 1. What is the mutation? 2. Mention two complications?
1. JAK-2 2. Thrombosis, Hemorrhage, gout
120
PBS obtained from a patient with upper respiratory tract infection due to mycoplasma pneumonia. 1. What is shown in the figure? 2. What is the underlying mechanism?
1. Agglutinated/clumped masses of RBCs 2. Production of IgM cold agglutinins due to molecular mimicry between the organism and RBC antigens results in AIHA (autoimmune hemolytic anemia)
121
Patient with history of sickle cell anemia and recurrent hospital admissions presented with hip pain 1. What is shown on X-ray? 2. Mention two complications of this disease?
1. Avascular necrosis of femoral head 2. Acute chest syndrome Autosplenectomy Stroke Leg ulcer
122
A neutrophil engulfing and digesting a an organism. 1. The process of engulfing? 2. What is the metabolic process by which neutrophils kill microorganisms called?
1. Phagocytosis 2. Respiratory burst
123
A neutrophil engulfing and digesting a an organism. 1. What is the cell shown? 2. Mention one infection that increases this cell?
1. Eosinophil 2. Helminth infection e.g. Strongyloides
124
A 57 year old woman travelled for 12 hours by plane and developed leg pain and swelling 1. Mention two diagnostic methods? 2. Complications if untreated?
1. D-Dimer, compression ultrasound, ascending contrast venography. 2. Pulmonary embolism Post-phlebotic syndrome
125
This figure shows hemoglobinuria. 1. Mention two causes of hemoglobinuria. 2. What is the main complication of hemoglobinuria?
126
Patient presented with hemoptysis and this is their renal biopsy and there was a chest x-ray 1. Name two possible conditions ? 2. What other two tests will you do ?
1. Wegener's granulomatosis Goodpasture syndrome 2. Cytoplasmic ANCA (c-ANCA) and perinuclear ANCA (p-ANCA) Anti-GBM antibodies Maybe also immunofluorescent staining
127
A patient taking a statin for his dyslipidemia and alpha methyldopa for his hypertension.The patient is now complaining of dark urine. 1. Mention two possible causes of his dark red/brown urine? 2. What investigation or blood tests would you order to confirm your diagnosis?
1. Side effect of statins is rhabdomyolysis leading to acute kidney injury and myoglobin in the urine Side effect of alpha methyldopa autoimmune hemolytic anemia leading to hemoglobin the urine. 2. Serum creatine kinase (elevated in rhabdomyolysis) Coombs test for autoimmune hemolytic anemia Renal function tests and urinalysis are also needed.
128
A 36 year old male presented to the hospital with a one week history of back and flank pain as well as headache. His blood pressure was measured at 165/95. 1. Describe the finding and what is the most likely diagnosis? 2. What is a CNS manifestation/complication in these patients?
1. Enlarged kidneys with multiple cysts, Autosomal dominant polycystic kidney disease. 2. Rupture of berry aneurysm causing subarachnoid hemorrhage.
129
A young girl was arguing with her family. She came to the ER anxious and angry and developed spasms in her hands. 1. What do you expect her ABG to show? (Comment on pH and PCO2)? 2. What is the mechanism of the sign shown in the figure in this patient?
1. High pH and low PCO2 (Respiratory alkalosis) 2. Hyperventilation (anxiety) washes out CO2, producing an alkaline environment, which reduces the ionized fraction of calcium (hypocalcemia) by increasing its binding to albumin. 385
130
1. Comment on ABG analysis 2. Mention one cause.
1. Respiratory alkalosis without compensation 2. Any cause of hyperventilation e.g. anxiety, PE, high altitude
131
1. What is the diagnosis? 2. What is the causative agent?
1. Tinea versicolor 2. Malassezia furfur
132
1. What is the diagnosis? 2. What is the treatment?
1. Necrobiosis lipoidoca 2. -
133
A 53 diabetic patient complains of painful vesicles that appeared on a dermatome of his lateral chest. 1. What is the diagnosis? 2. What is the causative organism?
1. Shingles 2. Varicella zoster virus (VZV)
134
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
135
Patient presented with 4 days history of fever and itchy skin rash. 1. What is the diagnosis? 2. What is the causative agent?
1. Chicken pox 2. Varicella-zoster virus
136
*We had one question for a PFT curve so you need to know how to describe restrictive and obstructive disease pattern *There was also a peripheral blood smear for leukemia so make sure you know different characteristics of each on blood film
137
Patient thinks that she has allergies. Lab tests: IgE negative. She was told that she has a vasculitis. 1. Diagnosis? 2. Most specific antibody?
1. Granulomatosis with polyangiitis formerly known as Wegner’s granulomatosis 2. C-ANCA (cytoplasmic antineutroph cytoplasmic antibody)

Medicine ELOOPS (9 decks)

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