2018 MCQ Flashcards by Nevinka Fonseka

66 yo M presents to ED w/ angina pectoris. Admin med. which acts by releasing NO and his sx.s are relived. What is the most likely med?

GTN

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twin-twin transfusion syndrome

Diagnosis requires 2 criteria
1. the presence of a MCDA pregnancy
2. presence of oligohydramnios (defined as a maximal vertical pocket of <2cm) in one sac AND of polyhydramnios (max. vertical pocket of >8cm) in the other sac

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MCDA pregnancy

Monochorionic, diamniotic (MCDA)
- product of single fertilised egg= genetically identical twins
- share single placenta (Blood supply) but have separate amniotic sac

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Which of the following drugs is most likely to reduce mortality and morbidity in patients
with either diastolic or isolated systolic hypertension?
A. Calcium blockers
B. Thiazide-like diuretics
C. Alpha blockers
D. ACE inhibitors
E. Beta blockers

B
- note sure why answer isn’t CCB
- compared to CCBs or thiazide diuretics, ACEi/ ARBs have distinctly less efficacy in patients w/ isolated systolic HTN

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Why is carbidopa used in the Tx of parkinson’s

Levodopa is converted to dopamine in the brain and peripheral tissue and replenishes the depleted striatal dopamine. It is given w/….
Carbidopa (or benserazide)= peripheral dopa decarboxylase inhibitor: To reduce the metabolism of L-Dopa in the periphery.
And therefore reduce production of dopamine in the periphery and also reduce adverse effects (e.g. nausea, vomiting, hypotension)

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autograft, allograft, isograft, xenograft, technograft

Autograft: transplant to self from self

AllograftL transplant between genetically different ppl
IsograftL transplant btw genetically identical people
Xenograft: transplant btw different species

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A previously well 14 month-old child, presents with a history of sudden onset of cough
and wheeze. He was playing with some toys earlier. On examination, there is evidence of
reduced air entry and wheeze over the right lung. Which of the following is the most likely
diagnosis?
A. Asthma
B. Bronchiolitis
C. Congenital airway abnormality
D. Inhaled foreign body
E. Pneumonia

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Woman presents 10 weeks pregnant and gets a FBC, it shows a microcytic anaemia
and the blood film showed thalassemia B traits. The blood status of the partner is
unknown. What is the management?

Prevention of B thalassaemia major include:
- genetic counselling or antenatal diagnosis using fetal blood or DNA then ‘therapeutic’ abortion

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28yo male with acute psychosis was admitted to the psychiatric ward for treatment for
10 days. Experienced sudden intense painful neck muscle cramping/stiffness and a
forward flexion of head. What is the drug that most likely caused his symptoms?
A. Benztropine
B. Fluoxetine
C. Haloperidol
D. Lithium
E. Olanzapine

and why

Haloperidol
- the pt has torticollis (dystonic EPSE)
-typical antipsychotics like haloperidol have more EPSEs than atypical e.g. olanzapine

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what is it

pilonidal cyst (discomfort when sitting down, 23yo M)

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35 y/o male feels anxious, gets tingling sensation in the lips (and other Sx) in certain
situations. He is worried to have these symptoms in front of others, therefore he avoids
crowded places. He is soon to be promoted to a higher position at work and wasn’t sure if
he could cope with it.
A. Generalised Anxiety Disorder
B. Panic Disorder
C. Social Phobia
D. Post-traumatic disorder
E. Depression

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MoA donepezil

main therapeutic use is in alzheimer’s to increase cortical acetylcholine (acetylcholinesterase inhibitors)

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30y/o lady, G2P2, comes in with 6 week old son for routine appointment. Has
symptoms of poor concentration, sleep, fatigue, loss of weight to below pre-pregnancy
weight. Vehemently denies being depressed, didn’t feel that way with first child. What is
the diagnosis?
A. Post natal depression
B. Post natal psychosis
C. Adjustment disorder
D. Baby blues
E. Persistent depressive disorder

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23 year old married woman presents with vaginal discharge/pain. Dysuria but no
pruritus. On examination she has a raised painful inguinal lymph nodes with red ulcers on
both vulva and the cervix appears red and ulcerated. There is no malodour but profuse
clear discharge. Diagnosis?

Herpes genitalia
- genital herpes presents w/ panful genital ulcers vs primary syphilis presents w. painLESS ulcers (chancre)

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7yo well, asymptomatic girl has loud pansystolic murmur, palpable thrill at left sternal
edge. Routine check. Heart sounds and apex beat otherwise normal. Diagnosis?

Ventricular septal defect (VSD)
- harsh pansystolic murmur at LSE w/ systolic thrill +/- L parasternal heave

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19 yo male comes to GP very distressed. Worried about his nose, think’s it’s big and is
very conscious of it and wants to get plastic surgery because he looks at it in the mirror all
the time and he thinks the girls won’t like him because of it.
A. Body dysmorphic disorder
B. Delusional disorder
C. Micropenis
D. OCD
E. Congenital nasal hypertrophy

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80 Year old female presents with sudden vision loss in left eye one hour ago. Over the
past week she has been having pain in her jaw when she chews. O/E she has tender,
enlarged superficial temporal arteries. What is the most appropriate immediate
management?
A. Temporal artery biopsy
B. Thombolytic therapy
C. Commence steroids
D. Cerebral angiogram
E. Urgent referral to ophthalmologist

GCA: start prednisolone 60mg/day PO immediately and do temporal aa bx w/in 14 days of starting steroids

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20yo man brought into ED by housemates. Has rapid speech but could be interrupted.
Thought the Prime Minister was a robot sent from the future, like terminator, to kill him and
then destroy the human race. Diagnosis?
A. Mengele alogia
B. Grandiose Delusion
C. Persecutory delusion
D. Formal thought disorder
E. Projection

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Young boy presented with sudden testicular pain. Felt nauseous and vomited.
Diagnosis?
A. Epididymitis
B. Testicular torsion
C. Hydrocoele
D. Varicocele

sudden onset of pain in ONE testis: makes walking uncomfortable
pain in abdo, n+v

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28yo male presented with firm, non-tender intratesticular lump that is hypoechoic on
ultrasound. What do you do to confirm the diagnosis?
A. Inguinal orchiectomy
B. Trans-scrotal open biopsy
C. Trans-scrotal core biopsy
D. Fine needle aspirate
E. Serum B-HCG

why

when testicular cancer is suspected entire testicle is removed (orchiectomy)

testicular bx is NOT performed as a a part of evaluation due to concern that it may result in tumour seeding into the scrotal sac or mt.s into inguinal nodes

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Pregnant woman completed first stage of labour in 7 hours, and second stage in 3
hours. She is well. What medication does she need now?
A. Syntocinon 10U IM
B. Syntocinon IV infusion
C. Ergometrine

syntocinon 10U IM

3rd stage of labour interventions
-The use of uterotonics are recommended for ALL births to prevent PPH (post partum haemorrhage)
-oxytocin 10IU IV/IM is recommended

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35y/o female presented with a 2 year history of a slowly enlarging lump on her neck,
the mass is mobile and non tender, on the left side of her neck. She is euthyroid and
asymptomatic. Likely diagnosis is:
A. Hashimoto’s
B. Thyroid cancer
C. Simple thyroid cyst
D. Thyroid adenoma
E. Toxic multinodular goitre

simple thyroid cyst

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A 30yo pregnant woman presents with premature rupture of membranes at 32 weeks.
She needs transfer to a more established hospital. In the meantime, what medications
should you give her?

vancomycin + flucloxacillin

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9-month-old infant female presents distressed with proteins +++, nitrites +, leukocytes
+ on urine dipstick. She is febrile 38°C. What is the next single best step?
A. Renal USS
B. Cephalexin TDS
C. Wait until MCS to give antibiotics
D. Renal biopsy

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30yoF BIBA after being in a fight with friends who were trying to stop her overdosing on some medication. She has had 13 similar episodes previously. Her most notable feature was her emotional lability. Diagnosis? A. Borderline Personality disorder B. Bipolar C. Schizophrenia D. Psychotic Depression E. Premenstrual syndrome

What is the primary action of the COCP

inhibit ovulation

32yo male, Iraqi refugee who has been in Australia for 12 months. Presented to DEM escorted by police after neighborhood disturbance. Has had four such presentations in the last four weeks. States the Iraqi police are watching him through his TV and his body feeling has changed. Also states insects buzzing around him so to rectify this he decided to get rid of them via lighting ring of fire with petrol in his front yard. This is what resulted in him being brought into ED, he had never been admitted under the psychiatry team before. Also smokes marijuana 2-3 cones/week. Diagnosis? A. Culture shock B. Factitious disorder C. Schizophrenia D. Somatoform disorder E. Substance abuse

Young female presents with copious milky discharge from her vagina. She also noticed that there is a “foul fishy” smell. No clue cells on microscopy. Diagnosis? A. Bacterial vaginosis B. Candidiasis C. Genital herpes D. HPV E. Chlamydia WHY

A bacterial vaginosis likely: thin, white d/c from vagina which is fishy smelling candidiasis or vaginal trhush: creamy, thick (cottage cheese) d/c with no smell. Vulval irritation. Recnt Abs for sore throat. Genital herpes: raised nodules that are painful. Chlamydia: ost common asx

Young man feels worried about a lot of things. Seems to have no clear trigger on his symptoms of palpitations, tremor and sweating. He is taking on a lot of responsibilities at work however recently he has taken plenty of sick leave off work. Diagnosis? A. Generalised Anxiety Disorder B. Panic Disorder C. Social Phobia D. Post-traumatic disorder E. Depression

16yo F complaints of irregular periods. Her menstrual cycle is 3-7 weeks long, and she is concerned about her irregular bleeding. You note that she also has acne greasy skin and a BMI of 24. What’s your management? A. Start COCP B. Start metformin C. Lifestyle change D. Start insulin WHY

A - address pt concern first and since it's irregular bleeding- start COCP but ofc lifestyle changes and stuff are plausible options

Middle-aged woman presents wanting a script for the COCP. She is 6 months postpartum, breastfeeding, has had a previous episode of DVT and suffers from migraine without aura. Which is the absolute contraindication to COCP? A. 6 months postpartum B. Breastfeeding C. Previous episode of DVT D. Migraine without aura

previous DVT

A grandmother brings her child in. She is concerned about the injuries he sustained when he was staying with his mother. The child appears to be on high alert. There are some fingermark bruising on his arms and thighs. What should you do next? A. Call child protection services B. Call the police C. Investigate the FBC and coagulation studies of the child

An infant had a difficult labour. The midwives decided to use forceps to aid delivery. The infant then had a V-shaped bruise on forehead with image provided. Diagnosis?

forceps bruise

pregnant woman had a Caesarean section. 1 week after the operation, she presented with offensive-smelling lochia. What is the diagnosis? A. Endometritis B. Wound infection C. Retained products of conception

endometritis (lochia is vaginal d/c after birth)

young kid ate PB and has anaphylaxis- mx?

IM adrenaline

50 year old man comes into general practice for regular check-up. Asks about screening for bowel cancer. No FHx and no symptoms. What would you suggest? A. Colonoscopy B. CT colonogram C. FOBT D. Flexible sigmoidoscopy E. No screening required

Middle-aged man presents with sweating, weight loss of 6kg over past year and tremor. Has two-year history of diffuse painless swelling at the base of neck. Examination demonstrates mild tachycardia and fine peripheral tremor. Diagnosis? A. Toxic multinodular goitre B. Grave’s Disease C. Toxic adenoma D. Subacute thyroiditis E. Hashimoto's/autoimmune.

65 year old man presented with some shoulder pain and loss of range of abduction (both passive and active) between 45 and 135 degrees. Movement was normal and pain free from 0-45 and 135-180. What is the most likely pathology?

Rotator cuff pathology

what is CREST syndrome and what medication would improve peripheral circulation?

CREST - calcinosis -Reynaud's -eosophageal dymotility -sclerodactyly -telangiectasias (spider veins, visible small linear and red blood vessels)' medication: nifedipine

diagnostic criteria for Kawasaki dx

fever for >5days+ at least 4 of the following: 1. bilateral non-purulent conjunctivitis 2. neck lymphadenopathy (>1.5cm across) 3. pharyngeal injection, dry fissured lips, strawberry tongue 4. polymorphous rash (especially on trunk) 5. changes in extremities: arthralgia, palmar erythema or later fingertip desquamation+ swelling of hands/ feet

OCD vs OCPD

OCD: egodystonic OCPD: (OC personality disorder or anakastic PD): egosyntonic

A 76 year-old female with known cardiomyopathy and poor left ventricular function, presents to the Emergency Department with palpitations, dyspnoea at rest and dizziness. Her pulse rate is 148/minute and irregularly irregular. Her ECG shows an irregularly irregular rhythm with no P waves and normal QRS complexes. Which of the following drugs would be appropriate for long-term control of venticular rate? and why? A. Digoxin B. Verapamil C. Metoprolol D. Amiodarone E. Adenosine

metoprolol generally, for AF you do rhythm control for younger patients but rate control for older

A 45 year-old male presents to the Emergency Department with rapid regular palpitations that came on while he was exercising. He is found to have a pulse rate of 148/minute and regular, with a BP of 105/60. His ECG shows a regular tachycardia with no P waves and with normal QRS complexes. Which of the following drugs would be the most appropriate for the acute management of this patient? and WHY A. Digoxin B. Verapamil C. Metoprolol D. Lignocaine E. Adenosine

adenosine - patient has supraventricular tachycardia - adenosine is appropriate

A pregnant woman presented with rupture of membranes at 28 weeks. She was given steroids and the baby was born 6 hours later. The neonate’s APGAR 1 minute was fine but at 5 min, the neonate had respiratory distress. Diagnosis? A. Hyaline membrane disease B. Wet lung C. Meconium aspiration

hyaline membrane dx - pre-term babies -given bethamethasone to try accelerate dev. of fetal lungs -immature lungs; do not have adequate surfactant and therefore alveoli collapse -respi distress start at or soon after delivery and get worse over the first 48 hrs

64yo male presented with right colicky loin to groin pain. Apart from fever (Temp = 38.8degC), physical examination was normal. Urinalysis revealed positive WCC and nitrites. CT showed 4mm stone and pelvic ureteric junction w/dilated ureter proximal to it. What is appropriate mx and why?

Urgent decompression - 95% renal stones <5mm pass spontaneously by just increasing fluid intake HOWEVER, persistent infection and obstruction warrants urgent intervention.

Which of the following antibiotics is most appropriate for the treatment of a patient infected with Shigella dysenteriae? A. Flucloxacillin B. Penicillin G C. Ciprofloxacin D. Fluconazole E. Amoxicillin

shigella: ciprofloxacin

7yo boy presents with moderate SOB and moderate increased WOB. He has a past history of asthma. SpO2 92% What is the initial management for the boy in the ED? A. Nebulized SABA B. Nebulized adrenaline C. MDI SABA with spacer and why

C Guidelines recommend MDI SABA w/ spacer for mild-moderate asthma attacks. Only use nebulized salbutamol (SABA) if child is confused, exhausted w. silent chest

A child can roll over and sit with support. They can pass toys from one hand to the other but don’t have pincer grip. They can drink from a bottle. They respond to their own name, can babble but don’t yet have any words. They don’t have stranger anxiety. Which option best describes the child’s developmental age: A. 3 months B. 6 months C. 9 months D. 12 months E. 18 months

6 months

Middle-aged man presented with a small lesion on his cheek. A 1.5cm excisional biopsy was done. How do you close the lesion up? A. Direct closure B. Local advancement flap C. Free flap D. Split skin graft

local advancement flap

A man suffered a graze from glass about 2 cm long on his cheek. What material should be used to close this? A. Polyglactin 00 (Vicryl) B. 2-0 Chromic catgut suture C. 2-0 prolene D. 5-0 prolene E. 10-0 prolene and why

5-0 prolene A monofilament non-absorbable suture is preferred for an uncomplicated laceration.

What do you do to close a wound where the edges tend to invert? A. Continuous suture B. Simple interrupted suture C. Vertical mattress D. Skin glue

vertical mattress suture (recommended for wounds under tension and w/ edged that tend to invert)

An 8 year old girl presents with reduced hearing. When a tuning fork is placed on the mastoid process, she is able to hear better bilaterally than when it is placed close to the external auditory meatus. When the tuning fork is placed on her forehead, she is able to hear it better on the left side. Diagnosis? A. Bilateral conductive hearing loss, worse on the left side. B. Bilateral conductive hearing loss, worse on the right side. C. Bilateral sensorineural hearing loss, worse on the left side. D. Sensorineural hearing loss on the right side. E. Conductive hearing loss on the left side, sensorineural hearing loss on the right side.

Middle-aged man presents with fatigue, enlarged lymph nodes and splenomegaly. FBC reveals normal Hb, raised WCC, raised lymphocyte count, normal platelets. A. AML B. CML C. CLL D. Hodgkin’s lymphoma E. Non-Hodgkin’s lymphoma

CLL

Ideas of reference, delusions of persecutions and auditory hallucinations are a result of? A. Alcohol intoxication B. Opiate intoxication C. Diazepam overuse D. Amphetamine overdose E. Heroin use

amphetamine overdose (and the sx.s may be impossible to differentiate from schizophrenia) B and E basically the same= opiates and wrong

98. Middle-aged man presents with elevated bilirubin levels but no changes in any of the other LFT's: GGT, AST, ALT, ALP. What is the diagnosis? A. Alcoholic Liver Disease B. Hepatitis C. Gilbert's syndrome D. Asymptomatic Cholelithiasis and why

Gilbert's syndrome: common cause of unconjugated hyperbilirubinaemia due to reduce UGT-1 activity (the enzyme that conjugates bilirubin w/ glucuronic acid)

young boy presents with hearing loss, haematuria and proteinuria. He mentions that his grandfather needed a kidney transplant too. Diagnosis?

alport syndrome genetic, hearing loss, kidney dx and eye abnormalities

Middle-aged woman recently took esomeprazole for reflux. Her serum creatinine is now 400 with eGFR of 9 mL/min/1.73m3

acute tubulointerstitial nephritis could aslo be AKI but apparently it's just better to out a more specific dianosis

Middle-aged man presented with hypertension, loin pain and haematuria. Ultrasound scan of the kidneys show a small calculi in the left ureter with multiple cysts on bilateral kidneys

polycystic kidney dx

young boy got stung by a bee. He later presented with periorbital swelling, peripheral oedema and proteinuria ++++

minimal change dx

47yoF with lower back pain. Has had multiple admissions in the past. Last admission was 2 weeks ago for overdosing on IV heroin. Currently presenting with 3 day history of worsening lower back pain. Patient is unable to sleep because of the pain. Pain is aggravated by movement and not relived with rest. Patient has a low-grade fever. Patient reluctant to stand for the examination because of the pain. Diffuse tenderness over lumbar region during examination. Pain only at lower back and not anywhere else. Neurological examination showed no abnormalities why

vertebral osteomyelitis pain over lumbar region, IV drug use= risk of infection, low-grade fever also indicates Ix (haematogenous spread) - not relived by rest so unlikely to be osteoarthritis

Middle-aged lady with a pathological fracture of the vertebra. Also feeling tired. Imaging of the spine shows multiple lytic lesions on the vertebrae. why

multiple myeloma

Young guy with 2/12 increasing lump in posterior triangle. In the last few weeks has become tired, night sweats and has mild cervical lymphadenopathy. Biopsy of lump shows Reed Sternberg cells.

Hodgkin's lymphoma characteristic Reed-Sternberg cells (mirror-image nuclei)

32 y.o. Man presents to the Emergency department with large amounts of bright red blood in his stools. He has a history of increasing fatigue over several weeks, bleeding gums and pain in his back and ribs. On examination he has petechiae everywhere

AML

4yo boy who has been well comes to GP with his mum. On examination he appears well, he is not cyanotic, but on auscultation has a soft ejection systolic murmur in pulmonary area. There is a wide fixed splitting of S2. why?

Atrial septal defect - young patient -wide splitting of s2 occurs in pulmonary stenosis but wide FIXED splitting of s2 occurs in ASD

8yo F well child presents with systolic murmur that radiates to carotids, otherwise well

aortic stenosis

A previously active 8yo presents with limping for past 2 weeks and complains of right knee pain over last 2 weeks. Child has no memory of any trauma

juvenile idiopathic arthritis JIA can affect knees vs slipped femoral epiphysis and Perthes dx only affects hip jt

17yo M: fever and sore hip. O/E: R thigh swollen and red

osteomyelitis (septic arhtirtis wasn't an option)

5mnth-old F w/ bruised painful lower leg, Pt says she feel over while walking

non-accidental injury

4yo child initially developed normally and began walking. Later developed difficulty walking upstairs. Symmetrical waddling gait, O/E: neurologically intact but noticed have thick calves

Duchenne MD

22-month-old child, not walking, when she crawls she tends to drag her legs behind her. When you stand her up she stands on her toes.

Cerebral palsy

what Ix should you do? options ● CXR & AXR ● CT ● Laparotomy ● Diagnostic Laparoscopy ● Gastroscopy ● Colonoscopy ● Abdominal Ultrasound ● No investigations required a. 14 year old male presents with increasing central and right sided abdominal pain. O/E: 38 temp, and a hard abdomen with rebound tenderness & guarding. He has an elevated white cell count. b. 40yo F presents with intermittent RUQ pain, exacerbated after eating

a. diagnostic lapraoscopy b. abdo USS

27yo M, moved Hobart from Sydney after breakup w/ partner. very paranoid re. Obama and Putin putting info inside his mind

Schizophrenia w/ thought insertions and paranoid delusions

27yo M who works in HBA. works inefficiently and starts many tasks w/o completing them. Bought a new car and some clothes in the last week. Drives to Burnie twice a week and makes it to work next morning.

manic episode

young teen girl present to ED w/ self-harm. Broke up w/ bf recently and threatened to kill herself to make him happy. Emotional liability noted.

Borderline PD

Options: ● Salmonella typhi ● Hookworm ● C. difficile ● Norovirus ● Trichuris trichiura ● Enterotoxic E.coli ● Giardia intestinalis ● Shigella a. 40yo M Aboriginal man from remote community had occasional diarrhoea, abdo pain, mild anaemia. Liked to walk around barefooted. b. A medical student was travelling somewhere and had been drinking unfiltered, untreated rain tank water for 4 weeks. He presented with 6 loose bowel motions daily for 5 weeks. He also noticed floaty, foul smelling stool.

a. Hookworm (likes to walk barefoot) b. Giardia (floaty, foul smelling stool, unfiltered water and travel)

Elderly lady was getting pissed off and started avoiding social places. She was also wondering why she couldn’t hear her grandchildren much anymore. She was wondering why the young people wouldn’t speak up!

presbycusis (age-related hearing loss of both ears)

young F, URTI 2.52, now complaining of feeling fullness in ears and pain

acute suppurative OM

21 M, returned from recent diving trip in Maldives; complains of R ear pain, d/c and sensation of blocked ear

ruputred tympanic membrane

83yo F, constant diarrhoea and incontinence, has to wear pad day and night. Constipated previously

faecal impaction

23yo F, 3yr hx intermittent abdo pain, bloating and flatulence. Colonsocopy normal. anti-tissue transglutaminase Ab negative

IBS

55yo stopped period 4years ago. Present w/ irregular PV spotting

endometrial cancer

young F, found collapsed at home and BIBA. Lower abdo pain, no period for >6 weeks

(ruptured) ectopic pregnancy

27 yo F, headaches around menstruation preceded by nausea prodrome

migraine

F, frontotemproal headache radiating to occiput accompanied by n+v, relived by dark room and rest

migraine

Young M presents to ED: pounding heart, SOB,, blurry vision, chest pain 3rd presentation this month and during prev presentations serious lung and heart conditions have been ruled out he still insists dr.s may have missed something

panic disorder

60yo M, fullness in ear, hearing loss, n/v and dizziness >30mins

Menieres

28yo F, PHx of iritis. Now dizziness and vertical nystagmus

4yo M, skin lesions 2-4mm

molluscum contagiousum

young patient 7 days hx fever, bilateral conjunctivitis, red pals and red mucosa

Kawasaki dx

pregnant lady, prev well, presented w. jt pain and widespread rash. Later had foetal demise due to hydrops fetalis

Parvovirus B19 if parvovirus B19 occurs in 1st half of pregnancy, fetus may become anaemic (virus replicates in erythroid progeniroe cells) and hydrops fetalis and miscarriage can occur

40yo M being treated for ALL woke up at night from pain in foot. Went to toilet in the dark, stubbed his toe and screamed out in pain. Went back to bed w. foot outside covers. O/E: afebrile, red swollen 1st MTP jt tender to soft touch

acute gout

4yo M returns w. parents to Tassie after living in a commune in the NT for 2 years. SOB, clear nasal d/c >1 week. Worsened over >24hrs and now has fever, fatigue, cough, SOB, generalised rash and small white lesions covering reddened pharynx and buccal mucosa

measles presents as an acute febrile exanthemarous illness w. Koplick spots (characteristic white lesions on buccal mucosa representing grains of salt opposite molars)

11-month-old M, 2day hx URTI sx.s currently off food and drink, super clingy to mother, appeared alert mild tachypnoea and tachycardia w/ reduces SPpO2 w/ mild increase WOB (subcostal and intercostal recession) clinical findings: generalised widespread wheeze and some crackles what is the condition and likely C.A?

respiratory syncytial virus, bronchiolitis

3yo F, unwell, febrile and then dev. inspiratory stridor and nasty-sounding barking cough

parainfluenza- croup note: croup: barking cough vs whooping cough (bacterial): high-pitched gasp/ whooping noise

how to manage pt w/ schizophrenia experiencing psychotic sx.s despite trying 3 different antipsychotics?

clozapine

pt polyuria, polydipsia, recent LoW recurrent bouts abdo pain w/ loose bulky pale stools

chronic pancreatitis

45yo M, polyuria, polydipsia, headaches and profuse weating. Last year had bilateral carapl tunnel release and had to have wedding ring enlarged. BP O/E: 150.100mmHg

acromegaly (excessive GH release by pituitary) features include: increased growth of hands, coarsening face, macroglossia, widely spaced teeth, skin darkening and oily, carpal tunnel sign 50%, HTN, signs of pituitary mass, excessive sweating complications: DM, cardiomyopathy

G4P3, 34 weeks pregnant lady presents with some dark red PV bleeding and constant abdominal pain. The fundus is tense on palpation

placental abruption

30yo woman, G2P1 at 28 weeks pregnant presents with painless bright red PV bleeding. Fetal HR is 140 bpm.

placenta previa

A middle-aged man was seen by the GP, and noticed he looked darker than usual, presented with RUQ pain and arthralgias. Genetic testing showed a C282Y mutation

haemochromatosis

Young 2yo boy has a swollen knee after a fall. His mum also says he previously had several episodes of epistaxis (nosebleed) before. Coagulation studies showed raised APTT. The PT, INR and Fibrinogen levels are all normal. What is the coagulation disorder?

haemophilia A

You’re assessing a 50yo lady. She appears well. You are able to understand what she is saying however you cannot catch up because she speaks too fast.

pressured speech

70yo M, sad, insomnia, poor appetite and LoW speaks very little only using monosyllabic words w/o many conjunctions

poverty of speech (decreased quality not rate of speech)

assessing a pt w/ schizophrenia. Can't seem to understand him because he goes off topic easily

loosening of associations (thoughts move quickly fron one idea to the next- seem not to be connected at all. Experienced as muddles or illogical speech)

middle-aged M schizophrenia "hemislayer" was hunting him down and lock him in the "interschizal dimension"

neologisms

assessing old M on ward. Nurse says he is able to understand what you are saying. When he tried to speak, he can't articulate his words as they appear slurred

dysarthria

CEO comes and tells him his F coworker is crazy. Despite multiple rejections, she continues sending him flowers and love letters

erotomania/ De Clerambault's syndrome delusion of being secretly loved, usually by someone of higher social status/ Delusions of love are more common in F vs delusions of jealousy are more common in M

middle-aged M feels that soon he will not exist/ He visits church very regularly, and while walking on the streets, he points to ppl and says the end is near.

nihilism

middle-aged M, red painful eye and hypopyon (pus in anterior chamber), recent eye surgery

endopthalmitis

60 yo F, acute painful eye seeing through mist, preceded by halos of light n+v, similar less painful episodes in past L pupil dilates and uncreative for both direct and consensual light reflexes. R eye NAD

acute glaucoma

morphological appearance of lungs in chronic smokers

centrilobular emphysema predominantly upper lobe

morphological appearance of lungs in ppl w/ a1 antitrypsin deficiency

panlobular emphysema predominantly lower lobe

45yo M, shot close range to mid-abdo. ED BP 80/50 despite aggressive fluid resus at the scene. Bloods sent for crossmatch following massive transfusion protocol. What is your best clinical mx?

blood transfusion/ laparotomy some argue that you need transfusion before surgery and others argue that you need surgery to stop leek before the transfusion

21yo F, 4cm mass deep to SCM, it's directed anteriorly

branchial cyst

lobulated mass located just posterior and above angle of jaw

submandibular duct stone

firm tender 1.5cm mass posterior and below jaw

lymph node

young M, redness and swlling of a lump located centrally on neck. Dad says he has had lump since he was younger, lump moves when he sticks his tongue out

thyroglossal cyst

M, prev well, presented w. fever, jaundice, RUQ pain

ascending cholangitis (charcot's triad)

22yo F, 2 day hx abdo pain, n, v, pain maximal over McBurney's point

acute appendicitis

F present w/ fever, dysuria, left flank pain. Has new sexual partner since few days ago

pyelonephritis

37yo M w/ intermittent severe L flank pain w Hx of Chron's. Urinalysis shows small amounts of Blood and leukocytes, no nitrates

renal colic

Malodourous d/c green and frothy. Vulva is sore and dypareunia.

trichomonas vaginalis (flagellete), metronidazole is the tx

Abdo examination: mild suprapubic tenderness and PV she is tender on both fornices. She feels she has a slight temp and feels generally unwell.

PID

usual tx of chlamydia

azithromycin

2018 MCQ Flashcards

(124 cards)