Mp+ Flashcards by Sheila Sarmiento

72yo, chest pain, radiating to the back
diastolic murmur
CXR wide mediastinum
Acute MI
next step?

A. Give alteplase
B. Consider urgent MRI of the cervical and thoraci spine
C. Give aspiring and Intravenous morphine
D. Refer the patient to cardiology clinic
E. Give Morphine, B-blocker and arrange for trans-oesophageal echocardiogram

E. Give Morphine, B-blocker and arrange for trans-oesophageal echocardiogram

DX: Aortic Dissection
ECG findings: ST elevation

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34yo M, temp 40 C, agtiation, hypersalivation, diaphoresis and HTN, HYprereflexia
W/c favours dx of Serotonin Syndrome over neuroleptic malignant syndrome?
A. HTN
B. Hyperthermia
C. Agitation
D. Hyperreflexia
E. Diaphoresis

D. Hyperreflexia

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Nerve palsy that can cause :
Ptosis
Eyes facing down and out
Dilated pupils
Sluggish light reflex

Third Cranial Nerve Palsy

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It can cause ptosis and diplopia
with no pupil abnormality.

Myasthenia Gravis

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It is associated with progressive opthalmoplegia and limb wdakness induced by exercise.
does not involve the pupils.

Mitochondrial Myopathy

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Ptosis, miosis (constricted pupils), ipsilateral loss of sweating

Horner’s Syndrome

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72yo,M, past history of Pulmonary Emobolism,
fever 5 days post-chemotherapy for Hodgkin’s lymphoma, neutrophil cpunt 0.
Given IV antibiotics and isolation maintained to prevent any infection.
Current medications: Warfarin, Cefepime, Candesartan and Omeprazole

Plt ct dec to 22000/mul, What will you do next?

A. Cease Cefepime
B. Cease Omeprazole
C. Cease Warfarin
D. No action needed
E. Cease Candesartan

C. Cease Warfarin

Dx: thrombocytopenia

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65yo M, history of persistent low back pain for 6 months, pain is increased on walking and relived on resting.
Shooting pain sensation over Left foot.
Local tenderness over lumbar region.
Which is the best management?
A. Trial of analgesia
B. MRI
C.. Surgery
D. CT Scan
E. Exercise therapy

B. MRI

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increasing side of hands and feet
mandibular enlargement
macroglossia

Most appropriate screening test ?

Insulin-like Growth factor

Dx; Acromegaly

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What are the other clinical features of Acromegaly?

Frontal bossing
Increased hand and foot size
Mandibular enlargement with prognathism
Widened space between the lower incisor teeth
Characteristic coarse facial features
Large fleshy nose
Cardiomegaly, macroglossia

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What is the other test that is performed for the confirmation of Acromegaly if the Insulin-like growth factor is elevated?

Growth Hormone Suppression Test

<0.4 ug/L within 1-2 h of an oral glucose load (75g) = Confirmatory for Acromegaly

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10 yo F, bouts of abdominal pain
facial oedema
positive family hx similar episodes - with mother and elder sister

Which of the ff is useful to diagnose the condition?

C1 esterase inhibitor

Dx; Hereditary Angioedema
- low C1 esterase inhibitor level
- C4 level is also low during episodes

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Which one is the strongest risk for developing cervical cancer?

A. Sexual activity
B. Age
C. Oral Contraceptive pill for more than 5 years
D. Non-smoking
E. Mild obesity

C. Oral Contraceptive pill for more than 5 years

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What are the other high risk factors for developing cervical carcinoma?

Oral contraceptive pills for more than 5 years

Smoking
Immunosuppression
Presistence infection of high risk HPV infection

Sexual activity - average risk factor
Mild obesity with healthy lifestyle - unlikely to develop cervical ca

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3wk old baby, umbilical swelling
pesistent discharge from the umbilicus after the cord has dried and separated
Swelling appears soft and pink with mild discharge.

What is the next most appropriate treatment?

Silver nitrate

Dx; Umbilical Granuloma
-MC umbilical mass in neonates
- overgrowth of tissure during the healing process of the belly button (umbilicus)
- looks like soft pink or red lump and often is wet or leaks small amounts of clear or yellow fluid
- Mc in the firt few weeks of baby’s life

Tx: Cauterisation of Silver Nitrate
- put pteroleum jelly to the surrounding and remove the excess silver nitrate to avoid the chemical burns and skin staining

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CT KUB (non-contrast)
* is the most appropriate choice of investigation tro assess the renal stones

Renal US - used only if there is risk of excessive radiation exposure such as pregnancy and children younger than 16 yo

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Swollen R upper limb for one week,
R arm including hand and forearm is swollen and oedematous,
Tenderness on the inner apsect of the arm
papulopustular lesions with tender lymphadenopath.
Her cat was also unwell 3 weeks ago but now not feeling well.

What is the dx?

Cat-Scatch disease

Cause: transmission of B, henselae from cats to humans thru contaminated cat scratch wound or across a mucosal surface

CP: papulopustular lesions at the bite site and enlarged tender regional lymph nodes
+/- fever, headache, chills, backache, abdmonal pain

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This can occur in sportsmen after strenous exercise like wrestling.
May present with oedema and redness but tender lymphadenopathy is absent

Axillary Vein thrombosis

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Inflammatory condition of vessels of the hands and feet.
20-40 yo
MC in males with hx of smoking
CP: distal extremity ischemia like pain at rest.
ischemic ulcers or gangrene but no Lymphadenopathy and pustular lesions

Buerger’s disease

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The CSF analysis in Acute Polyneuritis?

Normal Cell count
High Protein

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Which one of the ff is the most suggestive for orbital floor fracture?

A. Facial Numbness
B. Epistaxis
C. Decreased sensation along the cheek and upper lip/gingiva
D. Loss of visual acuity
E. Enolphthalmos

E. Enolphthalmos
- classic presentation of orbital fractures

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21 yo male, decreased facial and axillary hair growth, decreased libido Decreased penile length, small testes and gynecomastia. Learning difficulties as a child. He is at irsk of developing all of the ff except?

Autoimmune Thyroid Disease

Klinefelter Syndrome

Chromosome XXY abnormality due to meiotic nondisjunction Tall Stature Small testes Small penis Gynecomastia Decreased Facial and Maxillary hair growth Decreased Libido At high risks of following complications: Breast tumours Thromboembolic disease Obesity DM type 2 Varicose veins Learning disabilities

75yo M, left calf claudication 40 pack year history of smoking - all peripheral pulses are palpable on the R side - all pulses palpable except dorsalis pedis ABI (ankle-brachial index) on the R side is 1 and on the left side is 0.70. What is the most appropriate management?

Advice for smoking cessation.

What is the most common symptom of PAD?

Intermittent claudication affecting calf muscles

What is the gold standard for imaging peripheral arteries? It is rarely used because of its invasice nature and the availability of non-invasive imaging modalities (DUS, CTA, MRA) Duplex ultrasound is used to guide most endovascular intervantions but surgeons prefer this for planning open revascularisation procedures particularly tibial and pedal bypass procedures.

Digital Subtraction Angiography (DSA)

Which of the followint does not increase the risk of endometrial cancer? A. Tamoxifen B. Exposure to unopposed estrogen C. Norethisterone D. Strong family history of endometrial cancer E.. Nulliparity

C. Norethisterone

34 yo F, hx of unilateral headaches, accompanied by nasal stuffness, conjunctival injection and lacrimation. Best treatment of choice? A. Paracetamol B. 100% oxygen C. Verapamil D. Sumatriptan E. Propanolol

Verapamil Dx: Cluster Headache Tx: Verapamil, Methysergide. lithim and bridging treatment with prednisolone 100% oxygen inhalation for 15 mins - treatment of choice for an acute attack of a cluster headache. Sumatriptan - second line treatment of a cluster headache if oxygen therapy fails Propanolol - is used for prevention of migraine headaches

It is characterized by unilateral headache, often at night, retro-orbital headache, rhinorrhea and lacrimation.

Cluster Headache

Clinical feature of Polycystic Kidney Disease? A. Incisional hernia B. Type 2 DM C. Dysphagia D. Hypotension E. Polyuria and nocturia

Polyuria and Nocturia

What are the other features of Polycystic Kidney Disease?

Renal Failure Hypertension Abdominal Wall and Inguinal hernias Colonic diverticulitis Hepatic Cysts Subarachnoid or cerebral Hemorrhage Cardiac Anomalies including MVP

12yo F, isolating herself from other kids, school performance dropped over last 6 months. She has collection of her toys and plays with an imaginary friend. Had difficulty in sleeping and gets irritable with other kids. Which of the ff is she likely to develop in the future? A. Alcohol abuse B. Anorexia Nervosa C. Schizophreniform psychosis D. GAD E. OCD

C. Schizophreniform psychosis

Furesimide

wk old neonate, discharge and redness both eyes mild hyperemia with thick mucopurulent discharge. What is the most likely diagnosis? A. Meningitis B. Gonococcal Conunctivitis C. Viral infection D. Chlamydia Conjunctivitis E. Chemical Conjunctivitis

Chlamydia Conjunctivitis

47yo F, incidental finding of 2.5 cm gallstone on abdominal US No symptoms. What is your best next management? A. ERCP B. Prophylactic Cholecystectomy C. CT ANgiogram D. No further action needed E. MRI

No further action needed

65yo M, 2 hr hx of left-sided facial droop and dysphasia hx of type 2 DM taking Metformin daily 1000mg ECG: Soft systolic cardiac murmur CT unremarkable ECG and Echocardiogram : Normal What is the most important next investigation in his assessment? A. Stress Echocardiogram B. CT angiogram of coronary arteries C. Carotid Artery Doppler ultrasound D. 24 hr holter monitoring E. repeat CT Brain in 48 hrs

C. Carotid Artery Doppler ultrasound

34yo F, hx of migraine on progesterone-only pills for last 2 years. Lives with her partner, both sexually active. Hx of epilepsy, HTN, DM2. Current medications: Phenytoin, Metformin, Gliclazide and Ramipril. Which among the ff can increase the risk of contraception failure? A. Phenytoin B. Ramipril C. Gliclazide D. Beta Blocker E. Metformin

A. Phenytoin Phenytoin is a hepatic enzyme inducing antiepileptic drugs.

Digitalis Toxicity produces all of the ff changes in the ECG except? A. Inverted T wave B. Prolonged QT interval C. ST depression D, Prolonged PR interval D. Bigemini

B. Prolonged QT interval

Cirrhosis with Portal Hypertension

Which of the ff is the most likely to increase the risk of developmental dysplasia of the hip? A. Iron Deficiency B. Asian origin C. Maternal Smoking during pregnancy D. Breech presentation E, being male

Breech Presentation

24yo F, recently diagnosed with Familial Adenomatous Polyposis. prophylactic colectomy. Genetic testing showed APC gene mutation. Recently married and planning to conceive in the next 3 months. What is the chance of disease transmission to her children if she becomes pregnant? A. 100% B. 75% C. No chancee of transmission D. 50% E. 25%

D. 50%

newborn baby, ambiguous genitalia, gonads not palpable, no family hx of congenital problems Karyotype confirmed: 46 xx genetic makeup Which is the next appropriate investigation? A. pelvic ultrasound B. Xray abdomen C. 17-hydroxy Progesterone D. CT pelvis E. Testosterone Level

C. 17-hydroxy Progesterone Dx for absence of palpable gonads: Congenital Adrenal Hyperplasia sec to 21-hydroxylase deficiency - 17-hydroxy Progesterone is elevated

32 yo secretary, premenstrual syndrome associated with severe mastalgia. What is the best treatment? A. Vitamin E B. Mefenamic Acid C. Danazol D. Spironolactone E. Bromocriptine

C. Danazol DOC for premenstrual sydnrome associated with severe mastalgia or breast pain - 200mg daily from the onset of symptoms to the onset of menses. Others: Mefenamic Acid = DOC for premenstrual sydnrome associated with dysmenorrhea Spironolactone - DOC for premenstrual sydnrome related to fluid retention. Use daily 3 days before expected onset of symptoms today one of menstruation.

29yo F, blurry vision of the eyelid , hit by the squash ball into the L orbit during play. Examination - eyelid swelling, decreased visual acuity and vertical diplopia of the L eye that disappears when R eye is closed. Which of the ff is the most likely cause of this presentation? A. Zygomatic Fracture B. Nasal bone fracture C. Tripod Fracture D. Superior Orbital Wall fracture E. orbital Floor fracture

E. Orbital Floor fracture

W/c of the ff is the risk factor for the development of infant hypertrophic pyloric stenosis in a 4 wks old infant? A. Maternal Smoking during pregnancy B. Asian background C. Breast feeding D. Female E. All of the listed answers

A. Maternal Smoking during pregnancy -infant hypertrophic pyloric stenosis is mc in this one. Hypertrophic Pyloric Stenosis - progressive thickening of the circular muscle of the pylorus. - this leads to gastric outlet narrowing. - condition usually presents between 2 and 6 weeks of age.

34yoF, 37 wks gestation, noticed sudden gush of clear fluid from her vagina. Speculum exam reveals pooling of liquor in the posterior fornix. She developed fever, tachycardia and chills for 12 hours after this episode. What will you do apart from giving her antibiotics? A. Perform a Vaginal Examination B. Give corticosteroids C. Continue pregnancy until natural delivery D. Induce labor now E. Discharge from hospital on 14 days of antibiotics

D. Induce labor now

TSH

Common Peroneal Damage - mc presentation is at the fibular neck - the acute foot drop - (difficulty in dorsiflexing the foot against resistance of gravity.)

Oral glucose test with serial GH measurements

It results from persistent hypersecretion of Growth Hormone (GH). Coarse facial hair, spade-like hands, the increase in show size, large tongue, prognathism, excessive sweating and oily skin, hypopituitarism, headaches, bitemporal hemianopia.

Acromegaly

35yo F, taking Temazepam 10kg at nigfht for the last 6 months for chronic insomnia. Had vivid dreams and rebound insomnia when she tried to stop taking it. Restarted taking on the same dose of temazepam. A