General Internal Medicine Question: What is the first-line treatment for Brucellosis?
Answer: Doxycycline + Streptomycin for 6-8 weeks
General Internal MedicineQuestion: What is an alternative treatment for Brucellosis?
Answer: Doxycycline + Rifampin for 6-8 weeks.
General Internal MedicineQuestion: What is the duration of treatment for Brucellosis limited to joints?
Answer: Doxycycline for 6 weeks.
General Internal MedicineQuestion: What is the duration of treatment for Neurobrucellosis?
Answer: 6 to 12 months.
General Internal MedicineQuestion: A man presents with fever, headache, back pain, and right sacroiliac joint pain. What is the most likely infecting organism?
Answer: Brucella spp.
General Internal MedicineQuestion: A patient with diarrhea after eating food in India is likely infected with which organism?
Answer: E. coli.
General Internal MedicineQuestion: A patient with a history of rheumatic fever presents with fever after 19 days. What is the diagnosis?
Answer: Bacterial Endocarditis.
General Internal MedicineQuestion: An elderly patient with fever, a new systolic murmur, and signs of endocarditis. What is the causative organism?
Answer: Staphylococcus aureus.
General Internal MedicineQuestion: What are the symptoms of Molluscum Contagiosum?
Answer: Painless, umbilicated lesions.
General Internal Medicine Question: How is Molluscum Contagiosum treated?
Answer: Supportive care (no antibiotics).
General Internal MedicineQuestion: What is the most common cause of gastroenteritis after eating steak from a local restaurant?
Answer: E. coli.
General Internal MedicineQuestion: A patient presents with macules in the cheek and oral cavity, along with lymphadenopathy. What is the diagnosis?
Answer: Epstein-Barr Virus (EBV).
General Internal Medicine Question: What is the best advice for a traveler to prevent gastroenteritis?
Answer: Eat only in clean restaurants.
General Internal MedicineQuestion: A young patient presents to the ER with non-bloody watery diarrhea after traveling. What antibiotic should be given?
Answer: Metronidazole.
General Internal Medicine Question: What is the most likely diagnosis for a young patient with non-bloody watery diarrhea after traveling?
Answer: Giardia.
General Internal Medicine Question: A patient on clindamycin and another antibiotic presents with watery diarrhea. What is the management?
Answer: Metronidazole.
General Internal Medicine Question: A patient presents with white discharge and pseudohyphae on microscopy. What is the diagnosis?
Answer: Candida.
General Internal MedicineQuestion: What is the treatment for Trichomonas?
Answer: Metronidazole.
General Internal MedicineQuestion: A patient presents 1 month after valve replacement with signs of infection. What is the most likely organism?
Answer: Staphylococcus aureus.
General Internal MedicineQuestion: What is the most common organism associated with IV drug abuse or prosthetic valve replacement within 6 weeks?
Answer: Staphylococcus aureus.
General Internal MedicineQuestion: What is the most common organism associated with native valve or prosthetic valve infections after more than 2 months?
Answer: Streptococcus.
General Internal Medicine Question: A traveler with watery diarrhea and trophozoites on examination is most likely infected with what organism?
Answer: Giardia.
General Internal MedicineQuestion: A patient with diarrhea and bloody stool is likely infected with what organism?
Answer: Amebiasis.
General Internal Medicine Question: A child has fever, vomiting, and a rash that spreads all over the body by the 2nd day. What are the differential diagnoses?
Answer: Meningococcemia or Rocky Mountain Spotted Fever.
General Internal Medicine Question: What antibiotic can you give a patient with a UTI caused by E. coli who is allergic to penicillin, sulfa, and shellfish?
Answer: Nitrofurantoin.
General Internal Medicine Question: A young girl presents with lower abdominal pain, diarrhea, fever, and blood mixed with mucus in stool. What is the likely diagnosis?
Answer: Amebiasis.
General Internal MedicineQuestion: A patient presents with a staccato cough. What is the most likely organism?
Answer: Chlamydia pneumonia.
General Internal MedicineQuestion: What are the signs and symptoms of gangrene, and what is the causative organism?
Answer: The causative organism is Clostridium perfringens.
General Internal MedicineQuestion: A recently married woman presents with symptoms of lower UTI. What is the diagnosis?
Answer: Honeymoon cystitis.
General Internal Medicine Question: A patient with febrile neutropenia is admitted. What is the next step?
Answer: Culture from sputum, urine, and blood, and start IV antibiotics.
General Internal Medicine Question: An elderly patient with endocarditis and fingernail splinter hemorrhages. What is the causative organism?
Answer: Streptococcus species.
General Internal Medicine Question: A patient with splinter hemorrhage and other signs of endocarditis, no previous operations. What is the most common organism?
Answer: Streptococcus viridans.
General Internal MedicineQuestion: A patient just returned from South Asia with bloody diarrhea. What is the causative organism?
Answer: Shigella.
General Internal MedicineFlashcard 34 Question: A patient just returned from South Asia with watery diarrhea. What is the causative organism?
Answer: E. coli.
General Internal Medicine Question: A patient presented with urosepsis. Urine culture reveals E. coli >100,000. What is the treatment?
General Internal Medicine Question: A patient returning from Africa has large lymph nodes and high fever. What is the likely diagnosis?
Answer: Epstein-Barr Virus (EBV).
General Internal Medicine Question: An elderly patient with a catheter and a positive culture. What is the next step?
Answer: Check the urine catheter daily.
General Internal Medicine Question: An elderly patient with lower abdominal pain and acute urinary retention. What is the management?
Answer: Foley catheter placement.
General Internal Medicine Question: A patient presents with fever, pharyngitis, maculopapular rash on the trunk, and lymphadenopathy. What is the diagnosis?
Answer: Infectious mononucleosis.
General Internal Medicine Question: A patient with watery diarrhea returning from Egypt. What is the likely diagnosis?
Answer: E. coli.
General Internal Medicine Question: An adult with a positive Kernig sign. What is the causative organism?
Answer: Streptococcus.
General Internal Medicine Question: A patient from Egypt has a tender red lesion on the leg, a penicillin allergy, and develops nausea, vomiting, and watery diarrhea after antibiotics. What is the diagnosis?
Answer: Clostridium difficile (C. difficile).
General Internal Medicine Question: A patient with C. difficile infection. What is the most likely cause?
Answer: Omeprazole use.
General Internal Medicine Question: A patient on clindamycin develops diarrhea, and stool analysis reveals C. difficile toxin. What is management?
General Internal Medicine Question: A patient had positive Cryptococcus findings and a history of multiple unproductive sexual encounters. What should you test for?
Answer: HIV serology.
General Internal Medicine Question: What is the most common cause of gastroenteritis after eating steak?
Answer: E. coli.
General Internal Medicine Question: A patient with a history of URTI 2 weeks ago now presents with a rash. What is the likely diagnosis?
Answer: Pneumococcal infection.
General Internal Medicine Question: What is the most common organism causing lobar pneumonia in adults?
Answer: Streptococcus pneumoniae.
General Internal Medicine Question: A patient presents with a seizure followed by diarrhea. What is the causative organism?
Answer: Shigella.
General Internal Medicine Question: What is the most common cause of otitis media (OM) in pediatric patients?
Answer: Bacterial.
Addison Disease
Addison Disease Question: What are the key lab findings in adrenal insufficiency (Addison’s disease)?
Answer: Hyponatremia, hypotension, hyperkalemia, and hyperpigmentation.
Question: What is the treatment for Addison’s disease? Question: What are the key lab findings in adrenal insufficiency (Addison’s disease)?
Addison Disease Question: A long scenario presents with low BP, hyperkalemia, and hyponatremia. What is the diagnosis?
Answer: Primary hyperaldosteronism.
Addison Disease Question: A female patient presents with fatigue and a scar that turned hypopigmented (dark). What test should be done?
Answer: Synacthen test (ACTH stimulation test).
Addison Disease Question: A woman with a wound that started getting very dark and also has hypotension. What is the first test to perform?
Answer: Synacthen test (ACTH stimulation test).
Addison DiseaseQuestion: A female patient experiences dizziness when standing and has a darkening scar on her hand. What test confirms the diagnosis?
Answer: Synacthen test (ACTH stimulation test).
Addison Disease Question: A female with hypotension, hyperkalemia, hyponatremia, and a dark line in a hand scar. What is the next step?
Answer: Best initial test – Morning serum cortisol levels.
Addison Disease Question: What is the confirmatory test for adrenal insufficiency?
Answer: ACTH stimulation test (Cosyntropin test).
Addison Disease Question: A case of congenital adrenal hyperplasia presents with acidosis, low glucose, low sodium, and high potassium. What is the treatment?
Addison Disease Question: A female elderly diabetic and asthmatic on steroids undergoes surgery, then develops hypotension, low Na, high K, and hypoglycemia in the ICU. What is the cause?
Answer: Adrenal insufficiency.
Addison Disease Question: A female asthmatic using steroids in the ICU presents with low sodium. What is the likely diagnosis?
Answer: Adrenal insufficiency.
Addison DiseaseQuestion: A patient presents with abdominal pain, and an ABD CT shows a 2cm adrenal adenoma. What is the next step?
Answer: Measure metanephrines and cortisol levels.
Addison Disease Question: A female child presents with breast tissue engorgement and adult-like features, but congenital adrenal hyperplasia is excluded. What is the next investigation?
Answer: Pelvic ultrasound.
Addison Disease Question: Before adrenal gland surgery, what should be given to the patient?
Answer: Hydrocortisone.
Addison Disease Question: A child has recurrent vomiting, muscle wasting, skin turgor issues, and abnormal clitoris size. Labs show Na 120, and the child was started on sodium chloride. What is the next management step?
Addison Disease Question: What are the classic signs and symptoms of Congenital Adrenal Hyperplasia (CAH) in females?
Answer: Enlarged clitoris or ambiguous genitalia.
Addison Disease Question: A non-functioning adrenal adenoma (5cm) is found in a patient with vague abdominal pain. What is the management?
Answer: Adrenalectomy.
Addison DiseaseQuestion: A female undergoes a CT scan and an asymptomatic adrenal mass is found. What is the most likely diagnosis?
Answer: Non-functioning adrenal adenoma.
Addison Disease Question: A child presents with hyperpigmentation, petechiae, hyperkalemia, and hyponatremia. What is the treatment?
Answer: Corticosteroids (Hydrocortisone).
Addison Disease Question: A patient presents with brown discoloration of gums and striae, high K, and low Na. What is the treatment?
Answer: Daily Hydrocortisone.
Pheochromocytoma
Pheochromocytoma Question: A patient has an adrenal tumor that increases epinephrine and norepinephrine, leading to episodes of sweating, hypertension, headache, and palpitations. What is the treatment?
Pheochromocytoma Question: A patient presents with hypertension (220/110) not responding to home medications. Abdominal CT shows an adrenal mass, and catecholamine levels are very high. What is the next step in management?
Pheochromocytoma Question: A patient presents with hypertension, abdominal swelling, palpitations, and high catecholamine levels (2100). What is the first-line treatment?
Answer: Alpha blockers (Pheochromocytoma).
Cushing Syndrome
Cushing SyndromeQuestion: A patient has refractory hypokalemia. What is the next step?
Answer: Assess aldosterone and renin ratio.
Cushing Syndrome Question: An athlete gains 25 kg in 4 months, develops muscular upper limbs and acne. What is the most likely cause?
Answer: Anabolic steroid use (Cushing’s features).
Cushing Syndrome Question: A 32-year-old woman with irregular menses, weight gain (face, neck, abdomen), easy bruising, muscle weakness, hypertension, and diabetes. What is the first-line investigation?
Answer: 24-hour urinary free cortisol (Best initial test for Cushing’s disease).
Cushing SyndromeQuestion: A patient presents with Cushing’s signs, low ACTH, and a 5 cm adrenal mass on CT pelvis. What is the appropriate management?
Answer: Surgical resection.
Cushing Syndrome Question: A known case of Cushing’s syndrome undergoing surgery. What should be given preoperatively?
Answer: Steroids.
Cushing Syndrome Question: A Cushing’s patient with high 24-hour urine cortisol and low ACTH. What is the next step?
Cushing Syndrome Question: A Cushing’s patient with positive 24-hour urine cortisol and low ACTH. What is the next management step?
Answer: Abdominal CT (since ACTH is low, the source is adrenal, which is in the lower body).
Cushing Syndrome Question: What is the best initial test to establish the presence of Cushing’s syndrome?
Answer: 24-hour urine cortisol.
Cushing Syndrome Question: What is the best initial test to determine the source of hypercortisolism?
Answer: ACTH level.
Cushing Syndrome Question: What tests help determine the cause of Cushing’s syndrome?
Answer: High-dose dexamethasone suppression test or ACTH level.
Cushing Syndrome Question: A patient with Cushing’s symptoms and new-onset diabetes. What is the best next step?
Answer: Cortisol level.
Cushing Syndrome Question: A psoriasis patient treated with steroids presents with Cushing’s syndrome symptoms. What is the cause?
Answer: Iatrogenic (caused by long-term steroid use).
Cushing Syndrome Question: A Cushing’s case. What is the initial test to diagnose the condition?
Answer: 24-hour urine cortisol.
Cushing Syndrome Question: A patient has resistant glucose intolerance with high glucocorticoid levels. What is the diagnosis?
Answer: Cushing’s Syndrome.
Cushing Syndrome Question: A patient has resistant glucose intolerance with high glucocorticoid levels. What is the diagnosis?
Answer: Cushing’s Syndrome.
Cushing SyndromeQuestion: A 60-year-old female presents with hypertension, proximal muscle weakness, upper body weight gain, and purple striae on the lower abdomen. What test helps determine the etiology of the most likely diagnosis?
Answer: High-dose dexamethasone suppression test.
Celiac disease
Celiac disease Question: What are the extra-intestinal manifestations of Celiac disease?
Answer: Erythema nodosum, perianal disease.
Celiac disease Question: A patient develops diarrhea after eating wheat. What associated manifestation suggests Celiac disease?
Answer: Dermatitis herpetiformis.
Celiac disease Question: A patient has abdominal discomfort that improves with defecation, diarrhea with mucus, tenesmus, and no blood or weight changes. What is the likely diagnosis?
Answer: Celiac disease.
Celiac disease Question: What food should not be prescribed for Celiac patients?
Answer: Barley.
Celiac disease Question: What antibody is associated with Celiac disease?
Answer: Tissue transglutaminase IgA.
Celiac disease Question: Which part of the intestine is most affected in Celiac disease?
Answer: Jejunum.
Celiac disease Question: What is true about Celiac disease?
Answer: Successful treatment with a gluten-free diet is considered diagnostic.
Celiac disease Question: Total villous atrophy on biopsy is diagnostic of what disease?
Answer: Celiac disease.
Celiac disease Question: A patient has a positive tissue transglutaminase IgA test. What is the treatment?
Answer: Gluten-free diet.
Celiac disease Question: A Celiac patient who lost follow-up is expected to have low levels of which vitamins?
Answer: Vitamin B, Vitamin D, Zinc, and Iron.
Celiac disease Question: A Celiac patient who lost follow-up has an X-ray showing cupping and fraying of the metaphysis. What is the cause?
Answer: Vitamin D deficiency.
CNS
CNS Question: A patient with sinusitis had a scope that injured a nerve, causing loss of sensation in the lower eyelid and superior lip. What nerve was injured?
Answer: Infraorbital nerve.
CNS Question: An elderly patient with a history of recent travel presents with difficulty getting aroused/awakened and reports multiple falls. No head wounds, skull intact. What is the most likely diagnosis?
Answer: Post-concussion syndrome.
CNS Question: A 50-year-old patient has a 3-week history of fatigue, tiredness, and lower limb fasciculation. What’s the diagnosis?
Answer: Motor neuron disorder.
CNS Question: A woman presents with left-sided facial twitching, spasticity throughout her body, and unilateral tongue fasciculation. What is the diagnosis?
Answer: Motor neuron disease.
CNS Question: Which symptoms indicate an upper motor neuron issue?
Answer: Spasticity.
CNS Question: Which symptoms indicate a lower motor neuron issue?
Answer: Fasciculation.
CNS Question: If both upper and lower motor neuron features are present, what’s the diagnosis?
Answer: Amyotrophic Lateral Sclerosis (ALS).
CNS Question: A stroke patient arrived within 4 hours. What’s the next step?
Answer: CT scan.
CNS Question: A female patient presents with lethargy; CT scan shows an area of hypodensity in the frontotemporal lobe. What’s the diagnosis?
Answer: Herpes encephalitis.
CNS Question: A patient shows changes in behavior. What’s the diagnosis?
Answer: Frontotemporal dementia.
CNS Question: A patient complains of 4 months of hearing loss and now presents with 7th nerve palsy. What’s the diagnosis?
Answer: Ramsay Hunt syndrome.
CNS Question: A patient with paraplegia has high calcium levels. What’s the cause?
Answer: Immobilization.
CNS Question: What is the management for high calcium levels?
Answer: Normal saline.
CNS Question: A patient presents with transient visual loss. What’s the likely diagnosis?
Answer: Transient Ischemic Attack (TIA).
CNS Question: A patient with neck pain radiating to the left shoulder and numbness of the arm. What nerve is affected?
Answer: Long thoracic nerve.
CNS Question: A patient develops hyperthermia, muscle rigidity, altered mental status, tachycardia, hypertension, after starting metoclopramide. Which drug can also cause these symptoms?
Answer: Fluphenazine.
CNS Question: A patient presents with facial asymmetry, mouth deviation, and absence of forehead wrinkles. Which nerve is affected?
Answer: Facial nerve (VII).
CNS Question: A patient has double vision, and when looking straight, the left eye deviates to the nose side and cannot look laterally. What is the diagnosis?
Answer: Left 6th cranial nerve (CN VI) palsy.
CNS Question: A diabetic patient presents with symptoms of 3rd nerve palsy (ptosis, double vision when looking laterally). What is the diagnosis?
Answer: Diabetic 3rd nerve neuropathy.
CNS Question: A patient presents with 6th nerve palsy and cannot abduct the left eye, leading to diplopia. What is the diagnosis?
Answer: Left 6th cranial nerve (CN VI) palsy.
CNS Question: A patient’s left eye is unable to abduct, and when looking forward, there is a squint towards the nose. Which nerve is affected?
Answer: Left 6th cranial nerve (CN VI).
CNS Question: A patient presents with right eye involvement, normal pupillary reflex, and all other cranial nerves are intact. What is the diagnosis?
Answer: 3rd cranial nerve palsy.
CNS Question: A patient has sudden onset unilateral facial paralysis. What medication is proven to reduce symptom duration?
Answer: Steroids.
CNS Question: Bell’s palsy is treated with what medication?
Answer: Steroids.
CNS Question: Lewy body dementia is characterized by what symptoms?
Answer: Hallucinations, dementia, and sometimes Parkinsonism.
CNS Question: A patient with Parkinson’s disease, early dementia, fluctuating cognition, and visual hallucinations. What is the diagnosis?
Answer: Lewy body dementia.
CNS Question: CT scan shows multiple areas of atrophy. What is the most likely diagnosis?
Answer: Alzheimer’s disease.
CNS Question: A 70-year-old hypertensive male with progressive cognitive decline and MRI showing periventricular white matter hyperintensities. What is the diagnosis?
Answer: Vascular dementia.
CNS Question: An elderly hypertensive patient with gradual cognitive decline, mainly affecting executive function. Imaging shows diffuse periventricular white matter hyperintensity. What is the diagnosis?
Answer: Vascular dementia.
CNS Question: An elderly man’s brother complains of personality changes and mild forgetfulness. MRI shows cortical atrophy. What is the diagnosis?
Answer: Alzheimer’s disease.
CNS Question: Alzheimer’s disease is associated with atrophy of which brain regions?
Answer: Hippocampus and temporal lobes.
CNS Question: An elderly hypertensive patient with cognitive changes, and MRI shows periventricular hyperintensities. What is the diagnosis?
Answer: Vascular cognitive impairment.
CNS Question: An elderly patient develops an unsteady gait, followed by forgetfulness. What is the likely diagnosis?
Answer: Normal pressure hydrocephalus.
CNS Question: An elderly patient presents drowsy and forgetful, with a history of femoral embolization 12 hours ago. What is the most likely diagnosis?
Answer: Multiple infarct dementia.
CNS Question: CT scan shows ventricular enlargement. What is the diagnosis?
Answer: Normal pressure hydrocephalus.
CNS Question: A diabetic patient with poor control presents with orthostatic hypotension and no change in heart rate. What is the diagnosis?
Answer: Autonomic neuropathy.
CNS Question: A patient has difficulty feeding and cannot put a fork in their mouth, also involved in a traffic accident due to poor coordination. Where is the lesion?
Answer: Cerebellum.
Headache
Headache Question: A throbbing, unilateral headache, aggravated by light and movement. What is the diagnosis?
Answer: Migraine.
Headache Question: A patient presents with a frontal sinus headache. How do you reach the diagnosis?
Answer: Full history and examination.
Headache Question: What is the treatment for an acute migraine attack?
Answer: Triptans.
Headache Question: A patient experiences the worst headache of their life after trying to pick up their keys. What is the most likely diagnosis?
Answer: Subarachnoid hemorrhage.
Headache Question: A child has a band-like, throbbing headache that worsens with stress at school. What is the diagnosis?
Answer: Tension headache.
Headache Question: A patient has a headache at 3 AM with eye symptoms. What is the best prophylaxis?
Answer: Verapamil (Cluster headache prophylaxis).
Headache Question: A patient has a headache at 3 AM with eye symptoms. What is the likely diagnosis?
Answer: Cluster headache.
Dermatology and Skin Infections
Dermatology and Skin Infections Question: A patient with psoriasis. What is the best bathing advice?
Answer: No soap.
Dermatology and Skin Infections Question: What is the definitive diagnosis for psoriasis?
Answer: Biopsy.
Dermatology and Skin Infections Question: What is the primary method for diagnosing psoriasis?
Answer: Clinical diagnosis.
Dermatology and Skin Infections Question: What is the management of psoriasis?
Answer: Topical steroids.
Dermatology and Skin Infections Question: What is the pathophysiology of psoriasis?
Answer: Epidermal hyperproliferation.
Dermatology and Skin Infections Question: A patient has well-demarcated skin lesions suspected to be psoriasis. What is the next step?
Answer: Clinical diagnosis is enough.
Dermatology and Skin Infections Question: A patient presents with vesicles in the entire mouth, especially on the posterior and soft palate. What is the diagnosis?
Answer: Herpangina (caused by Coxsackie virus).
Dermatology and Skin Infections Question: What is the most associated outcome of nicotine use?
Answer: Addiction.
Dermatology and Skin Infections Question: A young female presents with vaginal bleeding and bruising. What is the most likely cause?
Answer: Sexual child abuse.
Dermatology and Skin Infections Question: A patient presents with vesicles on the soft palate and posterior oral cavity. What is the diagnosis?
Answer: Herpangina.
Dermatology and Skin Infections Question: A patient presents with skin lesions on the back, some of them crusted, along with bilateral infiltrates. What is the next step?
Answer: Give antibiotics.
Dermatology and Skin Infections Question: A patient with cardiac arrhythmia on amiodarone develops a red, sharply demarcated, tender lesion below the right knee. What is the diagnosis?
Answer: Erysipelas.
Dermatology and Skin Infections Question: A patient develops a rash after using an herbal medication. What is the most likely diagnosis?
Dermatology and Skin Infections Question: A 40-year-old male with a rash. What is the best management?
Answer: Antibiotics, steroids, and platelet supportive care.
Dermatology and Skin Infections Question: A mass in the labia majora with black coloration. What is the most likely diagnosis?
Answer: Melanoma.
Dermatology and Skin Infections Question: A child with lower eyelid swelling, but no photophobia, no visual field defects, no fever, and not responding to antibiotics. What is the likely cause?
Answer: Eye allergy (not cellulitis, as there is no fever and no response to antibiotics).
Dermatology and Skin Infections Question: A patient applies herbal cream on the vulva and notices redness, itching, and tenderness. What is the diagnosis?
Answer: Allergic contact dermatitis.
Dermatology and Skin Infections Question: A patient presents with swelling at the back of the neck, multiple openings, discharge, and redness. What is the diagnosis?
Answer: Carbuncle.
Dermatology and Skin Infections Question: A female with progressive pain and redness on the left hand with a history of a knife prick. What is the most likely diagnosis?
Answer: Cellulitis.
Dermatology and Skin Infections Question: A patient presents with honey-colored crusted lesions. What is the most likely diagnosis?
Answer: Impetigo.
Dermatology and Skin Infections Question: A patient has a significant history of a painless ulcer. What is the likely diagnosis?
Answer: Treponema pallidum (Syphilis).
Dermatology and Skin Infections Question: A patient presents with hyperpigmentation in the axilla and neck. What is the diagnosis?
Answer: Acanthosis nigricans.
Dermatology and Skin Infections Question: What is the most associated outcome of nicotine use?
Answer: Addiction.
Diabetes Melitus and Insipidus
Diabetes Melitus and InsipidusQuestion: A patient with kidney failure. What food should be avoided?
Answer: Tomato (high in potassium).
Diabetes Melitus and Insipidus Question: A patient presents with infertility, recurrent sinusitis, and a semen analysis showing normal count but decreased motility. Chest X-ray shows situs inversus. What is the diagnosis?
Answer: Kartagener's syndrome.
Diabetes Melitus and Insipidus Question: A patient has hypernatremia, hyperglycemia, and low urine osmolality. What is the most likely cause?
Answer: Diabetes insipidus.
Diabetes Melitus and Insipidus Question: A patient with RTA and head trauma develops increased urine output, decreased urine osmolality, and increased blood osmolality. What is the diagnosis?
Answer: Central diabetes insipidus.
Diabetes Melitus and Insipidus Question: A patient has seizures, low sodium, and high urine osmolality. What is the likely diagnosis?
Answer: SIADH (Syndrome of Inappropriate Antidiuretic Hormone secretion).
Diabetes Melitus and Insipidus Question: A patient with suspected Diabetes Insipidus. What is the management?
Answer: Desmopressin.
Diabetes Melitus and Insipidus Question: A patient with major depression, excessive thirst, and urination, along with lung metastases and hyponatremia. What is the likely diagnosis?
Answer: Psychogenic polydipsia (Urine osmolality will be low).
Diabetes Melitus and Insipidus Question: Elevated 5HIAA is associated with which condition?
Answer: Carcinoid syndrome.
Diabetes Melitus and Insipidus Question: How is diabetic nephropathy diagnosed?
Answer: Microalbuminuria detection.
Diabetes Melitus and Insipidus Question: A patient with diabetic nephropathy. How do you assess disease severity?
Answer: Albumin-to-creatinine ratio.
Diabetes Melitus and Insipidus Question: What is the best test for detecting diabetic nephropathy?
Answer: Urine albumin test.
Diabetes Melitus and Insipidus Question: A smoker with peripheral artery disease. What is the best management?
Answer: Smoking cessation program.
Diabetes Melitus and Insipidus Question: A diabetic patient with an A1C of 7, with previous readings of 9-11. How should diabetic neuropathy be managed?
Answer: Strict glycemic control.
Diabetes Melitus and InsipidusQuestion: A 70-year-old diabetic with hypertension. What is the leading cause of fractures in this patient?
Answer: Falls.
Diabetes Melitus and Insipidus Question: A diabetic patient on Metformin is not responding well. What should be added?
Answer: An oral hypoglycemic agent.
Diabetes Melitus and Insipidus Question: A DM patient on Metformin 1g BID still has high random blood glucose and A1C. What should be modified in treatment?
Answer: Add a glinide.
Diabetes Melitus and Insipidus Question: A Type 2 DM patient experiences sudden monocular vision loss lasting 20 minutes. What is the most likely diagnosis?
Answer: Transient Ischemic Attack (TIA).
Diabetes Melitus and Insipidus Question: A diabetic patient with BMI 30, has been on a low-carb diet with no weight loss. What is the next step?
Answer: Medical weight reduction.
Diabetes Melitus and Insipidus Question: Criteria for Bariatric Surgery:
BMI ≥ 40 kg/m² without comorbid illness.
BMI 35–39.9 kg/m² with at least one serious comorbidity (e.g., Type 2 DM, fatty liver disease, hypertension).
Diabetes Melitus and Insipidus Question: Which DPP4 inhibitor is considered safe for lowering blood glucose without major side effects?
Answer: Linagliptin.
Diabetes Melitus and Insipidus Question: Which antibiotic is contraindicated in diabetic patients due to its effect on blood sugar levels?
Diabetes Melitus and Insipidus Question: What is the earliest effect of Diabetes Mellitus on the kidney?
Answer: Sclerosis with increased protein excretion.
Diabetes Melitus and Insipidus Question: How do you confirm microalbuminuria in a diabetic patient?
Answer: 24-hour urine microalbumin test.
Diabetes Melitus and Insipidus Question: A 55-year-old male with a family history of diabetes has HgA1C 6.3 and fasting glucose 7.3. What is the next step?
Answer: Repeat fasting glucose after 3 months (Pre-diabetes).
Diabetes Melitus and Insipidus Question: A patient was just diagnosed with Type 2 Diabetes, with HbA1c of 7.8. How should therapy be started?
Answer: Diet, exercise, and Metformin.
Diabetes Melitus and Insipidus Question: Diabetes Mellitus affects immunity by impairing what function?
Answer: Phagocytosis.
Diabetes Melitus and Insipidus Question: A patient has pulmonary edema and an S3 gallop. What is the safest medication for glycemic control in this patient?
Answer: SGLT2 inhibitors.
Diabetes Melitus and Insipidus Question: A poorly controlled Type 2 DM patient shows decreased BP when standing, but HR does not change. What is the diagnosis?
Answer: Autonomic neuropathy.
Diabetes Melitus and Insipidus Question: What is the most important test in a child with clear symptoms of undiagnosed diabetes?
Answer: HbA1C (not urinalysis).
Diabetes Melitus and Insipidus Question: A Type 2 DM patient on Metformin has an HbA1c of 7.8. What should be the target A1C?
Answer: Less than 7%.
Diabetes Melitus and Insipidus Question: What is the relationship between diabetes and obesity?
Answer: Relative insulin resistance.
Diabetes Melitus and Insipidus Question: An elderly diabetic patient presents with an ingrown toenail. What is the first thing to check?
Answer: Peripheral pulse.
Diabetes Melitus and Insipidus Question: What is the primary prevention method for Type 1 Diabetes?
Answer: Diet control.
Diabetes Melitus and Insipidus Question: A patient with severe diarrhea and vomiting has metabolic acidosis. What clinical sign is expected?
Answer: Kussmaul breathing.
Diabetes Melitus and Insipidus Question: An obese 15-year-old with excessive thirst, urination, and a family history of Type 2 DM. RBS: 395 mg/dL, but no ketones. What is the next investigation?
Answer: Autoantibodies to glutamic acid decarboxylase (to check for Type 1 DM).
Diabetes Melitus and Insipidus Question: A patient has glycosuria, ketonuria, and symptoms of hyperglycemia. What is the diagnosis, and how should it be managed?
Answer: Diabetic ketoacidosis (DKA) → Start IV Normal Saline (NS).
Diabetes Melitus and Insipidus Question: A Type 1 DM patient on Glargine insulin presents with DKA. What insulin should be given first?
Answer: IV Regular Insulin.
Diabetes Melitus and Insipidus Question: How do you start IV insulin for DKA management?
Answer: Regular insulin 0.1 units/kg IV.
Diabetes Melitus and Insipidus Question: A DKA patient is on IV insulin. What complication should be closely monitored?
Answer: Cerebral edema.
Diabetes Melitus and Insipidus Question: A DKA patient receives IV fluids. What is the next step?
Answer: Give insulin.
Diabetes Melitus and Insipidus Question: A DKA patient arrives in the ER. What is the initial step?
Answer: IV fluids.
Diabetes Melitus and InsipidusQuestion: A DKA patient starts to breathe rapidly to buffer acidosis. What mechanism is being used?
Answer: Carbon dioxide exhalation (not monoxide).
Diabetes Melitus and Insipidus Question: How can DKA symptoms be prevented in a child?
Answer: Listen to the child’s concerns about their diabetes management.
Diabetes Melitus and InsipidusQuestion: A Type 1 DM patient diagnosed after DKA is now stable and ready for discharge. What insulin regimen should be used?
Answer: Short-acting insulin before meals + Glargine (long-acting insulin).
Diabetes Melitus and Insipidus Question: A diabetic patient had tight control over the past year (HbA1C 5.8%), previously 9-10%, now complaining of leg pain and loss of sensation. What is the treatment?
Answer: Vitamin B12.
Diabetes Melitus and Insipidus Question: A vitiligo patient needs further investigation. What test should be done?
Answer: Intrinsic factor level.
Diabetes Melitus and Insipidus Question: A patient with macrocytic anemia, peripheral neuropathy, low B12, and normal folic acid. What test should be performed?
Answer: Intrinsic factor level.
Diabetes Melitus and Insipidus Question: An alcoholic patient with a positive Babinski sign and a given blood smear. What is the likely diagnosis?
Answer: Vitamin B12 deficiency.
Diabetes Melitus and Insipidus Question: A patient has tingling sensations. What deficiency should be considered?
Answer: Vitamin B12 deficiency.
Diabetes Melitus and Insipidus Question: A patient has generalized fatigue, palpitations, vitiligo, absent reflexes, low B12, and low Hb, but normal folic acid. What is the treatment?
Answer: Parenteral Vitamin B12 (not folic acid).
Diabetes Melitus and Insipidus Question: A patient has a strong family history of Type 2 Diabetes, high fasting glucose, and HbA1c of 6.5%. What is the next step?
Answer: Oral Glucose Tolerance Test (OGTT).
Diabetes Melitus and Insipidus Question: A 34-year-old healthy man asks about his risk of ischemic heart disease. His two fasting glucose readings are 9.5 and 9.4 mmol/L. What is the diagnosis?
Answer: Diabetes mellitus.
Diabetes Melitus and Insipidus Question: A patient with Turner syndrome and amenorrhea. What test should be done?
Answer: FSH and LH.
Diabetes Melitus and Insipidus Question: A patient with fragility fractures, sparse axillary and facial hair. What test should be done?
Answer: Gonadotropin and Testosterone levels.
Diabetes Melitus and Insipidus Question: What electrolyte imbalance is seen in Tumor Lysis Syndrome?
Answer: Hypocalcemia.
Drug
Drug part 1 Question: What is a common side effect of Furosemide?
Answer: Hypokalemia.
Drug part 1 Question: Chvostek’s sign is an indication of what electrolyte imbalance, and what is the treatment?
Answer: Low calcium → Give IV calcium.
Drug part 1 Question: A child ingested acetaminophen but spilled some on his clothes. After 4 hours of observation in the ER, he is stable. What is the next step?
Answer: Watch for another 4 hours.
Drug part 1 Question: What is a preferred medication for chronic pain?
Answer: Acetaminophen.
Drug part 1Question: What is Cyclosporine used for?
Answer: Steroid-sparing agent.
Drug part 1Question: A patient has high potassium (Hyperkalemia). What is the first step in management?
Answer: Give IV calcium gluconate.
Drug part 1 Question: What is the treatment for sinus infections caused by Haemophilus influenza?
Answer: Steroid inhalation, antibiotics, and decongestants.
Drug part 1 Question: What is the most effective method to decrease stone formation in a patient with hypercalcemia?
Answer: Thiazide diuretics.
Drug part 1 Question: What is the first-line management for hypercalcemia?
Answer: IV normal saline.
Drug part 1 Question: A patient with advanced-stage lung cancer presents with back pain. His oncologist mentioned he has less than a year to live. Labs show calcium levels are three times the normal range. What is the best management?
Answer: IV fluids.
Drug part 1 Question: A grieving woman, who lost a close friend, complains of trouble sleeping. What is the best treatment?
Answer: Lorazepam.
Drug part 1 Question: What medication should NOT be taken with Plavix (Clopidogrel)?
Answer: Omeprazole.
Drug part 1 Question: What is the treatment for pinpoint pupils (opioid toxicity)?
Answer: Naloxone.
Drug part 1 Question: A patient with MI has increased JVP and signs of shock. What is the treatment?
Answer: Dobutamine.
Drug part 1 Question: What is the antidote for beta-blocker toxicity (e.g., atenolol overdose)?
Answer: Glucagon.
Drug part 1Question: What is the first-line treatment for absence seizures?
Answer: Ethosuximide.
Drug part 1 Question: A patient is diagnosed with toxoplasmosis on MRI. What is the treatment?
Answer: Pyrimethamine + Sulfadiazine.
Drug part 1 Question: Which class of medication is Montelukast?
Answer: Leukotriene receptor antagonist.
Drug part 1 Question: A patient with sepsis. Which treatment is not needed?
Answer: Corticosteroids.
Drug part 1 Question: A girl ingested 2 tablets of paracetamol and presented one day later with nausea, vomiting, and RUQ pain. What is the treatment?
Answer: Acetylcysteine.
Drug part 1 Question: When is activated charcoal effective for poisoning?
Answer: Within 1-3 hours post-ingestion.
Drug part 1 Question: A patient has a garlic smell. What is the likely toxicity?
Answer: Organophosphorus poisoning.
Drug part 1 Question: A patient has low-grade fever, oxygen saturation of 88%, and hypotension (90/50). What is the initial step in management?
Answer: Oxygen therapy.
Drug part 1Question: A patient with SLE on prednisone develops neurological symptoms. What should be added to treatment?
Answer: Cyclophosphamide.
Drug part 1 Question: A Type 2 DM patient on Metformin 1g is not controlled. What is the next step?
Answer: Combine with an oral hypoglycemic agent.
Drug part 1 Question: A female with BMI 40 is diagnosed with Type 2 DM. What should be given?
Answer: Metformin.
Drug part 1 Question: Who should be screened for asymptomatic UTI?
Answer: Pregnant women.
Drug part 1 Question: A middle-aged company worker with mild depression and interpersonal conflicts at work. What is the best management?
Answer: Cognitive Behavioral Therapy (CBT).
Drug part 1 Question: A young Type 1 DM patient on rapid and long-acting insulin experiences hypoglycemia. What is the next step in management?
Answer: Decrease both rapid and long-acting insulin doses.
Drug part 1 Question: What is the first step in managing an open wound with a fracture?
Answer: Irrigation and debridement.
Drug part 1 Question: A diabetic patient with CKD has high potassium levels. What is the first-line management?
Answer: IV calcium gluconate.
Drug part 1 Question: What is the treatment for heroin addiction?
Answer: Methadone.
Drug part 1 Question: A man with multiple sexual partners and a history of unprotected sex presents with decreased LOC and CNS symptoms. Toxoplasmosis is confirmed. What is the best treatment?
Answer: Trimethoprim/Sulfamethoxazole.
Drug part 1 Question: A patient experiences vomiting on every flight for more than 1 hour. What is the treatment?
Answer: Scopolamine.
Drug part 1 Question: An older female on OCPs for 12 years develops a small hepatic adenoma. What is the next step?
Answer: Stop OCPs.
Drug part 1 Question: A woman took OCPs for 12 years and presents with RUQ pain. Imaging reveals a 5 cm mass on the right hepatic lobe. What is the best management?
Answer: Excision (surgical resection for tumors >5 cm).
Drug part 1 Question: Tumors under 5 cm related to OCP use. What is the management?
Answer: Stop OCPs and monitor.
Drug part 1 Question: A patient with epilepsy wants to quit smoking. What medication should be avoided?
Answer: Bupropion (contraindicated in epilepsy).
Drug part 1 Question: A pregnant woman with asthma was previously well-controlled on Salbutamol. Now, she has daily symptoms and nighttime symptoms once a week. What is the best treatment?
Answer: Inhaled corticosteroids (ICS) with short-acting bronchodilators.
Drug part 1 Question: Which antihypertensive drug is contraindicated in asthmatics?
Answer: Beta-blockers (can cause bronchoconstriction).
Drug part 1 Question: What is the antidote for beta-blocker overdose?
Answer: Glucagon.
Drug part 1 Question: A patient presents with decreased reflexes, numbness, and vitiligo. What is the best treatment?
Answer: IM Vitamin B12.
Drug part 1 Question: How does Thiazide diuretics help prevent kidney stones?
Answer: They decrease urinary calcium excretion, reducing calcium stone formation.
Drug part 1 Question: How does Allopurinol help in kidney stone prevention?
Answer: It decreases the risk of uric acid stone formation.
Drug part 1 Question: A patient with a penicillin allergy. What antibiotic should be given?
Answer: Clarithromycin or Ciprofloxacin.
Drug part 1 Question: A patient has an asymptomatic UTI after delivery. What is the management?
Answer: No treatment needed.
Drug part 2 Question: What is the most common causative organism of viral conjunctivitis?
Answer: Adenovirus.
Drug part 2 Question: A car accident patient needs glucose control. What helps maintain stable glucose levels?
Answer: Insulin.
Drug part 2 Question: A patient with a chemical burn covering the entire back. What is the first step in the ER?
Answer:
If dry powder: Sweep off the chemical.
If liquid: Wash with clean water for 30 minutes.
Drug part 2 Question: What is the first-line treatment for active status epilepticus?
Answer: Benzodiazepines.
Drug part 2 Question: A DKA patient with blood glucose of 34 mmol/L. What is the recommended glucose reduction rate?
Answer: Decrease by 3 mmol/L per hour.
Drug part 2 Question: A hypertensive patient on antihypertensives has low potassium. What medication may cause treatment failure?
Answer: Pseudoephedrine.
Drug part 2 Question: A patient has a penicillin allergy. Which antibiotic is absolutely contraindicated?
Answer: Piperacillin/Tazobactam.
Drug part 2 Question: A patient experiences dry mouth after chemotherapy. What is the likely cause?
Answer: Hypocalcemia.
Question: What is the antidote for Streptokinase overdose? Question: A patient experiences dry mouth after chemotherapy. What is the likely cause?
Answer: Aminocaproic acid.
Drug part 2 Question: A diabetic and obese patient asks for advice. What is the best recommendation?
Answer: Exercise with a low carbohydrate intake.
Drug part 2 Question: A patient develops lip and face edema. What drug is likely the cause?
Answer: ACE inhibitors (e.g., Lisinopril).
Drug part 2 Question: A patient has low HDL, high LDL, high triglycerides, and high total cholesterol. What is the best treatment?
Answer: Atorvastatin.
Drug part 2 Question: A patient is newly diagnosed with nephrotic syndrome in the clinic. What is the next step?
Answer: Start steroids.
Drug part 2 Question: A patient has an external ear infection. What is the best treatment?
Answer: Topical neomycin (not oral antibiotics).
Drug part 2 Question: What are the side effects of Amiodarone?
Drug part 2 Question: A patient has an allergic reaction after CT contrast. What is the treatment?
Answer: Epinephrine.
Drug part 2 Question: What is the urgent treatment for facial palsy?
Answer: Steroids.
Drug part 2 Question: What is the treatment for Candida infections?
Answer: Topical Terconazole cream.
Drug part 2 Question: Which antibiotics are contraindicated in Chronic Kidney Disease (CKD)?
Answer: Nitrofurantoin & Fosfomycin.
Drug part 2 Question: A patient with renal impairment. Which antibiotic should NOT be given?: A patient has an allergic reaction after CT contrast. What is the treatment?
Answer: Nitrofurantoin.
Drug part 2 Question: A patient with CKD and UTI. What is the safest antibiotic?
Answer: Ciprofloxacin (metabolized by the liver, safe in kidney failure).
Drug part 2 Question: Which drug can be safely taken in CKD stage 3?
Answer: Warfarin.
Drug part 2 Question: When should Metformin be stopped in diabetic patients with CKD?
Answer: If GFR is <30 mL/min (Stage 4 CKD).
Drug part 2 Question: A man presents with flank pain and dysuria. What antibiotic should be given?
Answer: Nitrofurantoin.
Drug part 2 Question: A patient allergic to penicillin and sulfa drugs presents with UTI. What antibiotic should be given?
Answer: Nitrofurantoin.
Drug part 2 Question: What is the treatment for Otitis Media?
Answer: Amoxicillin/Clavulanic Acid.
Drug part 2 Question: A patient has diarrhea for two weeks. Stool test shows trophozoites (Giardiasis). What is the treatment?
Answer: Metronidazole.
Drug part 2 Question: Which antibiotic can cause a prolonged QT interval?
Answer: Erythromycin.
Drug part 2 Question: What is the empirical treatment for Infective Endocarditis involving a heart valve?
Answer: Vancomycin + Ceftriaxone.
Drug part 2 Question: What is the management of Pseudomembranous Colitis?
Answer: Vancomycin.
Drug part 2 Question: An elderly man with tender abdomen and bloody stools took Amoxicillin for 3 weeks for a UTI. Sigmoidoscopy shows inflamed mucosa with plaque-like lesions. What is the diagnosis?
Answer: Pseudomembranous Colitis.
Drug part 2 Question: What is the empirical treatment for Infective Endocarditis?
Answer: Vancomycin + Ceftriaxone (Gentamicin may also be used in some cases).
Drug part 2 Question: What is the empirical treatment for Meningitis caused by Streptococcus pneumoniae?
Answer: Ceftriaxone + Vancomycin.
Drug part 2 Question: A patient with a history of prosthetic heart valves needs treatment for infective endocarditis. What is the empirical antibiotic regimen?
Answer: Vancomycin + Gentamicin + Rifampin.
Drug part 2 Question: What is the treatment for Vancomycin-resistant Staphylococcus aureus (VRSA)?
Answer: Vancomycin.
Drug part 2Question: A patient with MRSA is started on Vancomycin and immediately develops a rash on the trunk. What is the next step?
Answer: Continue Vancomycin but infuse it slowly (Red Man Syndrome).
Drug part 2 Question: A 60-year-old patient wants prophylaxis for meningitis. What is the best option?
Answer: Ciprofloxacin.
Drug part 2 Question: A 40-year-old man presents with Community-Acquired Pneumonia (CAP). What is the empirical antibiotic?
Answer: Ciprofloxacin.
Drug part 2 Question: What is the treatment for Campylobacter jejuni infection?
Answer: Azithromycin.
Drug part 2 Question: What is the prophylactic treatment for meningitis in adults?
Answer: Ciprofloxacin.
Drug part 2 Question: What is the prophylactic treatment for meningitis in children?
Answer: Rifampin.
Drug part 2 Question: What is the treatment for Spontaneous Bacterial Peritonitis (SBP)?
Answer: IV Ceftriaxone.
Drug part 2 Question: A baby on otoscopic exam has no tympanic membrane mobility, is breastfeeding, has no fever, and does not use a pacifier. The condition is unilateral. What is the treatment?
Answer: Amoxicillin.
Drug part 2 Question: A patient with H. pylori infection is on a PPI and an azole drug. What should be added?
Answer: Clarithromycin.
Drug part 2Question: A patient develops a severe allergy to Vancomycin. What is the next step?
Answer: Stop Vancomycin and give Ceftriaxone.
Drug part 2 Question: A patient develops a mild rash due to Vancomycin (Red Man Syndrome). What is the next step?
Answer: Continue Vancomycin with a slower infusion rate.
Rheumatology
RheumatologyQuestion: What condition is associated with calcium pyrophosphate crystals?
Answer: Pseudogout.
RheumatologyQuestion: What condition is associated with negatively birefringent crystals?
Answer: Gout.
RheumatologyQuestion: What condition is associated with negatively birefringent crystals?
Answer: Gout.
RheumatologyQuestion: A patient presents with joint pain, needle-like crystals, and negative birefringence during an acute attack. What medication should NOT be given?
Answer: Allopurinol (avoid during acute gout attack).
RheumatologyQuestion: A diabetic patient presents with severe unilateral knee joint pain. The knee is erythematous, swollen, warm, and the patient has a fever. Joint aspiration shows 55,000 WBC with a negative culture and pending crystal results. What is the diagnosis?
Answer: Septic arthritis.
RheumatologyQuestion: In a patient with gout (big toe inflamed and tender), what is the name of the deposited material?
Answer: Monosodium urate (urate crystals).
RheumatologyQuestion: A patient presents with features of a gout attack. What is the first-line treatment?
Answer: Indomethacin (NSAID).
RheumatologyQuestion: A throbbing, unilateral headache, aggravated by light and movement, is most likely:
Answer: Migraine.
RheumatologyQuestion: A patient presents with a frontal sinus headache. How should the diagnosis be made?
Answer: Full history and examination.
RheumatologyQuestion: A patient presents with an acute migraine. What is the best treatment?
Answer: Triptan.
RheumatologyQuestion: A patient experiences the worst headache of their life after trying to pick up their keys. What is the most likely diagnosis?
Answer: Subarachnoid hemorrhage.
RheumatologyQuestion: A child with a band-like, throbbing headache caused by stress at school. What is the most likely diagnosis?
Answer: Tension headache.
HIV
HIV Question: A patient with a history of unprotected sex for 6 years presents with a positive serum cryptococcal antigen. What is the appropriate test to perform next?
Answer: HIV serology.
HIV Question: A patient with HIV and splinter hemorrhages is suspected to have what condition?
Answer: Endocarditis.
HIV Question: An HIV-positive pregnant woman asks about reducing the risk of transmission to her baby. What is the best advice?
Answer: Advise cesarean section (C/S) to reduce the chance of the baby getting infected.
HIV Question: A patient who tested HIV-positive presents for an infertility assessment. What should you do next?
Answer: Tell the patient (not the wife, as confidentiality should be respected).
HIV Question: An HIV-positive patient is developing CNS problems. What is the appropriate treatment?
Answer: Sulfadiazine and Pyrimethamine (for CNS issues like toxoplasmosis).
HIV Question: A patient with positive cryptococcal antigen and a history of unprotected sex presents. What is the most likely diagnosis?
Answer: HIV (NOT syphilis).
HIV Question: A businessman who frequently travels to the East presents with cough, lymphadenopathy, and oral candida. What is the most likely diagnosis?
Answer: HIV (yeast infections in mucous membranes are common in HIV).
HIV Question: A man presents with oral thrush, generalized fatigue, and lymphadenopathy for 2 weeks. He also has a history of frequent travel. What is the most likely diagnosis?
Answer: HIV.
HIV Question: A patient presents with a painless penile ulcer. What is the most likely diagnosis?
Answer: Syphilis.
CROHN’S AND ULCERATIVE COLITIS
IBDQuestion: A 16-year-old female presents with fever, chronic diarrhea for 10 months, and paraumbilical pain after meals. What is the most likely diagnosis?
Answer: Crohn's disease (given the chronic diarrhea and pain after meals).
IBDQuestion: In a patient with IBD flare who has been managed with IV fluids, what is the next step in treatment?
Answer: Oral Budesonide (a corticosteroid that reduces inflammation).
IBDQuestion: Inflammatory bowel disease (IBD) with gut resection of the jejunum. What should be given post-operatively?
Answer: Fat-soluble vitamin supplements (since the jejunum is where they are absorbed).
IBDQuestion: Management of Crohn's disease with strictures:
Single <5 cm, no complications:
Endoscopic dilatation or strictureplasty.
Long >5 cm or multiple/recurrent strictures:
Small bowel resection.
IBDQuestion: A patient with Crohn's disease has a single 1 cm stricture 1 cm from the ileocecal valve. What is the best treatment?
Answer: Endoscopic dilatation.
IBDQuestion: A woman with progressive dyspnea, fatigue, fine crackles on auscultation, and tender red induration on her shins. What is the next step?
Answer: Chest X-ray (suspecting erythema nodosum, which is related to Crohn’s disease).
IBDQuestion: Bloody diarrhea with transmural inflammation on biopsy. What is the most common site of involvement in Crohn's disease?
Answer: Ileum.
IBDQuestion: What is the most common site for Crohn's disease?
Answer: Ileum and colon. (Ileocolic)
IBDQuestion: Endoscopy shows ulceration with transmural inflammation in patches (not continuous). What is the most likely diagnosis?
IBDQuestion: A male patient with non-bloody diarrhea, pale, and oral ulcers. What is the most likely diagnosis?
Answer: Crohn's disease (oral ulcers are common in Crohn's).
IBDQuestion: Management of Crohn's disease strictures:
-Single stricture <5 cm, no complications:
Endoscopic dilatation.
-Long or multiple strictures, diffuse or recurrent:
Strictureplasty.
-Complicated or multiple strictures in a short segment of bowel:
Small bowel resection.
IBDQuestion: A patient with Crohn’s disease who is on steroids presents with bilious vomiting, abdominal distention, abdominal pain, and tenderness in the RLQ. Imaging reveals a 1 cm stricture proximal to the ileocecal valve. What is the most appropriate management?
Answer: Resection of the stricture (due to obstruction caused by the stricture).
IBDQuestion: A patient with Crohn's disease presents with bilateral anterior shin raised tender nodules. What is the most likely diagnosis?: A patient with Crohn’s disease who is on steroids presents with bilious vomiting, abdominal distention, abdominal pain, and tenderness in the RLQ. Imaging reveals a 1 cm stricture proximal to the ileocecal valve. What is the most appropriate management?
Answer: Erythema nodosum (a common extra-intestinal manifestation of Crohn's disease).
IBDQuestion: An ileal biopsy shows noncaseating granulomas. What is the most likely diagnosis?
Answer: Crohn’s disease (noncaseating granulomas are characteristic of Crohn's).
IBDQuestion: A patient with tender lesions on the shin is being evaluated. What is the likely diagnosis?
Answer: Erythema nodosum (common in Crohn’s disease).
IBDQuestion: Smoking increases the risk of which disease but protects against which other?
Answer: Increases risk of Crohn's disease and protects against ulcerative colitis (UC).
IBDQuestion: Extra-intestinal symptoms of Crohn’s disease include: A) Erythema nodosum B) Pyoderma gangrenosum C) Erythema marginatum (Don't get confused)
Answer: A) Erythema nodosum (a common extra-intestinal symptom).
IBDQuestion: A patient with Crohn’s disease presents with a perianal abscess while on Infliximab and Azithromycin. What is the appropriate next step?
Answer: IV antibiotics (e.g., Ciprofloxacin and Metronidazole).
IBDQuestion: A patient with Crohn's disease and anal discharge and fistula is on steroids and Pentasa for the past 3 weeks. What is the next step in treatment?
Answer: Infliximab (a biologic therapy effective for perianal disease and fistulas in Crohn’s disease).
IBDQuestion: A patient presents with fatigue, pallor, and a history of chronic diarrhea. Labs show microcytic anemia and low B12. What is the most likely diagnosis?
Answer: Celiac disease.
IBDQuestion: A patient with Ulcerative Colitis undergoes ERCP that shows intra and extra-hepatic bile duct strictures. What is the most likely diagnosis?
Answer: Primary sclerosing cholangitis.
IBDQuestion: A patient with chronic diarrhea, microcytic anemia, and low B12 presents. What is the most likely diagnosis?
Answer: Celiac disease.
IBDQuestion: A patient with Ulcerative Colitis undergoes a CT abdomen for investigation. What is the expected diagnosis if there are no other findings?
Answer: Ulcerative Colitis.
IBDQuestion: A patient has diarrhea and weight loss for 3 months, but otherwise is well. What is the next step in management?
Answer: Anti-parasitic treatment (as it could be a parasitic infection).
IBDQuestion: A poorly controlled diabetic patient presents with right-sided eye ptosis and difficulty with adduction and elevation. What is the likely diagnosis?
Answer: Diabetic ophthalmoplegia.
IBDQuestion: A patient with Crohn’s disease has a single stricture 1 cm from the ileocecal valve. How should it be managed?
Answer: Endoscopic dilation (if possible; otherwise, stricturoplasty if dilation is not an option).
IBDQuestion: A patient with Crohn's disease on steroids presents with bilious vomiting, abdominal distention, pain, and tenderness in the RLQ. Imaging reveals a 1 cm stricture proximal to the ileocecal valve. What is the next step in management?
Answer: Resection of the stricture (due to complications like obstruction).
IBDQuestion: Lead pipe appearance on X-ray is most commonly seen in which condition?
Answer: Ulcerative Colitis.
IBDQuestion: What increases the risk of colorectal cancer in Ulcerative Colitis (UC)?
Answer: Primary sclerosing cholangitis.
IBDQuestion: A patient with Crohn's disease develops a fistula and is not currently taking any medications. What is the next treatment?
Answer: Infliximab.
IBDQuestion: A patient with Crohn's disease develops a fistula and is not currently taking any medications. What is the next treatment?
Answer: Infliximab.
IBDQuestion: What is the most common site of involvement in Ulcerative Colitis (UC)?
Answer: Rectum.
IBDQuestion: A patient with Crohn's disease develops a fistula between the ileum and jejunum. What is the most appropriate treatment?
Answer: Open drainage and fistulectomy (for complex fistulas).
IBDQuestion: A patient with fistula in Crohn’s disease is treated with Infliximab. If the fistula heals, should the patient continue the medication?
Answer: Yes, if the fistula is healed, continue Infliximab. However, if the fistula is not healing, consider fistulectomy.
IBDQuestion: For strictures in Crohn’s disease, if the stricture is small (less than 5 cm) and in a single location, what is the best management?
Answer: Endoscopic dilation (balloon dilation or endoscopic procedure).
IBDFlashcard 389 Question: For multiple or long strictures (greater than 5 cm) in Crohn’s disease, what is the best management?
Answer: Small bowel resection (removal of the affected bowel segment).
IBDQuestion: A patient with irritable bowel syndrome (IBS), taking Loperamide and other medications, does not improve. What is the most appropriate next step in management?
Answer: Tricyclic Antidepressants (TCAs), especially if dietary modifications alone do not help.
IBDQuestion: A male patient with IBS presents with abdominal pain relieved by defecation, frequent loose stools, and incomplete emptying. Abdominal examination is normal. What is the best way to confirm the diagnosis?
Answer: Clinical diagnosis (IBS is diagnosed based on symptoms, no further testing needed if symptoms are typical).
IBDQuestion: For managing IBS, what is the first step in treatment?
Answer: High fiber diet (increase fruits and vegetables).
IBDQuestion: If dietary changes do not improve IBS symptoms, what is the next step in treatment?
Answer: Tricyclic Antidepressants (TCA).
IBDQuestion: A teenage girl experiences multiple panic attacks and is scared of dying. What is the most likely diagnosis? A) Agoraphobia B) Panic attack
Answer: B) Panic attack (as the main concern is fear of dying, which is a characteristic of panic attacks).
IBDQuestion: In managing IBS, what is the best advice?
Answer: Increase fruit ingestion (for fiber).
IBDQuestion: If IBS symptoms do not improve with dietary changes, what is the next step in treatment?
Answer: Tricyclic antidepressants (TCA).
IBDQuestion: A patient with IBS is asking for the best management strategy. What is the first step?
Answer: High fiber diet (increase fruits and vegetables).
HEPATITIS
Hepatitis Part 1Question: When you see the term "AG s HB" as positive, what does it indicate?
Answer: It indicates infection, either chronic or acute.
Hepatitis Part 1Question: What should you focus on if you see the term "Antigen" (AG) in the question, not Antibody?
Answer: Antigen (AG) refers to either Chronic infection or Acute infection.
Hepatitis Part 1Question: If the term "AG" appears in a question, and it's linked with IgM, what does it indicate?
Answer: Acute infection.
Hepatitis Part 1Question: If the term "AG" appears in a question, and it's linked with IgG, what does it indicate?
Answer: Chronic infection.
Hepatitis Part 1Question: If the question mentions HBsAG as negative, what does it indicate?
Answer: Natural Immunization (associated with natural infection).
Hepatitis Part 1Question: A 30-year-old female presents with fatigue and jaundice. Her labs show ALT and AST >2500, and liver enzymes are significantly elevated. What is the next step?
Answer: Refer to liver transplantation (due to severe liver damage and potential need for transplantation).
Hepatitis Part 1Question: A 30-year-old female with jaundice and yellow sclera started 2 weeks ago. She denies drug use. Her labs show AST 1400, ALT 1300, GGT 70, and high bilirubin. An ultrasound shows biliary strictures and dilatation. What is the next step in management?
Answer: Order PT & INR (to assess liver function and determine the need for further intervention).
Hepatitis Part 1Question: A young female presents with jaundice, lethargy, and arthralgia. Her lab results show high LFTs and alkaline phosphatase. What is the most likely diagnosis?
Answer: Autoimmune hepatitis (elevated alkaline phosphatase suggests biliary involvement, and autoimmune hepatitis is a common cause).
Hepatitis Part 1Question: For a patient with non-alcoholic fatty liver disease, what is the best advice?
Answer: Reduce weight (weight loss improves liver function and reduces the risk of progression to cirrhosis).
Hepatitis Part 1Question: A patient with chronic hepatitis B has a US showing coarse liver texture, which suggests liver cirrhosis. The patient is asymptomatic, and LFTs show mild elevation. What is the next step?
Answer: No further management, just follow-up (as the patient is stable and asymptomatic).
Hepatitis Part 1Question: The first-line treatment for chronic hepatitis B is:
Hepatitis Part 1Question: Anti-HBs positive, Anti-HBc positive, and HBsAg negative indicates:
Answer: Chronic infection (if IgM is negative).
Hepatitis Part 1Question: A Caucasian patient presents with vomiting, diarrhea, and jaundice after being introduced to regular food. The test result shows HAV IgM. What does this indicate?
Answer: Acute Hepatitis A (IgM indicates recent or acute infection).
Hepatitis Part 1Question: A nurse vaccinated for hepatitis B is a full responder to the vaccine. What should be given to the nurse?
Answer: IVIG vaccines (to boost immunity if exposed to HBV).
Hepatitis Part 1Question: A patient presents with acute hepatitis after eating at a restaurant. What is the most likely cause?
Answer: HAV (Hepatitis A, commonly associated with foodborne transmission).
Hepatitis Part 1Question: A female is HCV antibody positive, but her HCV RNA is negative, and she is asymptomatic with normal labs. What is the next step?
Answer: No need for further testing (as she is healthy and asymptomatic).
Hepatitis Part 1Question: A patient has positive antibodies to HBV but negative HBV DNA. What is the next step in management?
Answer: Nothing (since the patient has no active infection with a negative DNA test).
Hepatitis Part 1Question: Hepatitis C type 4 is treated with which medications?
Answer: Sofosbuvir / Ledipasvir.
Hepatitis Part 1Question: What is the first indicator of acute hepatitis B infection?
Answer: HBsAg (Hepatitis B Surface Antigen).
Hepatitis Part 1Question: Hepatitis A is transmitted through which route?
Answer: Fecal-oral route (transmission is not bloodborne).
Hepatitis Part 1Question: A patient with chronic Hepatitis B has high AST and ALT levels and microchanges on US. How should this be managed?
Answer: Pegylated interferon (recommended for symptomatic chronic Hepatitis B).
Hepatitis Part 1Question: A patient with HCV develops abdominal pain, and CT shows a 6 cm lesion on the liver. What is the likely diagnosis?
Answer: Hepatocellular carcinoma (HCC).
Hepatitis Part 1Question: Hepatocellular carcinoma (HCC) screening for a patient with ascites should include:
Answer: Alpha-fetoprotein (a marker for HCC).
Hepatitis Part 1Question: What is the treatment for Hepatocellular carcinoma (HCC)?
Answer: Surgical resection (if the tumor is operable).
Hepatitis Part 1Question: What is the cause of liver nodules?
Answer: Hepatitis B.
Hepatitis Part 1Question: A patient with HCV develops abdominal pain, and CT shows 6 cm HCC. What is the best treatment?
Answer: Excision (for surgical resection of the tumor).
Hepatitis Part 1Question: A patient is referred due to a positive HCV result. She has no history of blood transfusion or drug abuse. Investigations show ELISA positive for anti-HCV, HCV RNA negative, and normal LFTs. What should be done next?
Answer: Reassurance (the patient is likely in remission, as indicated by negative HCV RNA and normal LFTs).
Hepatitis Part 1Question: If a patient has HCVAb+ and negative HCV PCR, what does this indicate?
Answer: Recovered from the infection (this suggests past exposure with no active infection).
Hepatitis Part 1Question: A girl with no history of HCV risk factors (no injections, blood transfusion, or sexual contact) has HCV Ag+ and negative RNA. What is your next action?
Answer: Repeat the test (to confirm the result, as there is no history of exposure).
Hepatitis Part 2Question: What is the most common HCV genotype in Saudi Arabia?
Answer: Genotype 4.
Hepatitis Part 2Question: A health worker has a needle prick and is at 3% risk of having HCV. What should be considered next?
Answer: Monitor and test for HCV antibodies and RNA based on exposure risk.
Hepatitis Part 2Question: HCV contraindications for breastfeeding:
Answer: Cracks in the nipples (HCV can be transmitted through blood, so cracked nipples pose a risk).
Hepatitis Part 2Question: The recommended hepatitis C treatment is:
Answer: Sofosbuvir / Ledipasvir (if not available, Interferon can be an alternative).
Hepatitis Part 2Question: A patient with HCV and ascites has a neutrophil count of 400 and other symptoms. What is the next step?
Answer: IV antibiotics (to manage possible bacterial infections, like spontaneous bacterial peritonitis).
Hepatitis Part 2Question: A patient with liver cirrhosis and ascites presents with fever, abdominal pain, and high WBC count. What is the next step?
Answer: Antibiotics (to treat potential infections like spontaneous bacterial peritonitis).
Hepatitis Part 2Question: A patient with abdominal fluid and a high SAAG is diagnosed with ascites. What is the next step in management?
Answer: Tapping (paracentesis to evaluate the fluid and determine the cause).
Hepatitis Part 2Question: A patient with HCV presents with weight loss, and a CT scan shows an irregular nodule that occupies 70% of the liver. What is the next step?
Answer: Percutaneous biopsy (to evaluate the nature of the lesion and rule out hepatocellular carcinoma).
Hepatitis Part 2Question: What improves mortality in liver cirrhosis with esophageal varices and bleeding?
Answer: Octreotide (a somatostatin analog that reduces portal pressure).
Hepatitis Part 2Question: A patient with a history of HCV presents with esophageal varices, ascites, and is drowsy. What drug will reduce mortality?
Answer: IV ceftriaxone (for treating spontaneous bacterial peritonitis).
Hepatitis Part 2Question: What is the absolute contraindication for liver transplantation?
Answer: Liver cirrhosis with active alcoholism.
Hepatitis Part 2Question: A patient with liver cirrhosis and upper GI bleeding has an HGB of 8.5. After stabilizing the patient, what is the next step?
Answer: Upper GI endoscopy (to identify and treat the source of bleeding).
Hepatitis Part 2Question: A patient with elevated liver enzymes, jaundice, and no history of IV drug abuse is being evaluated. What is the first investigation you should order?
Answer: A. HAV IgM (to evaluate acute hepatitis A).
Hepatitis Part 2Question: A patient with ascites has an E. coli infection found in the ascitic fluid. What is the most likely cause?
Answer: Perforation (E. coli in ascitic fluid suggests bacterial peritonitis from gastrointestinal perforation).
Hepatitis Part 2Question: A patient with ascites and abdominal pain has E. coli found in the ascitic fluid. If there is no perforation, what is the mechanism of bacterial translocation to the peritoneum?
Answer: Translocation (bacteria move from the gut to the peritoneal cavity through the lymphatic system).
Hepatitis Part 2Question: Detecting HBV positive in pregnant women is an example of what type of prevention?
Answer: Primary prevention (preventing transmission to the newborn).
Hepatitis Part 2Question: A patient has Hepatitis B with surface antigen negative, core antibody positive, and surface antibody positive. What does this indicate?
Answer: Immunized due to resolved infection.
Hepatitis Part 2Question: What is the marker for acute hepatitis B infection?
Answer: HBsAg (Hepatitis B surface antigen).
Hepatitis Part 2Question: What type of Hepatitis B vaccine is used?
Answer: C. Recombinant (the vaccine is made using recombinant DNA technology).
Hepatitis Part 2Question: A patient with chronic hepatitis B presents with jaundice and RUQ pain. LFTs show high liver enzymes (AST > ALT). What is the next step?
Answer: Request Hepatitis D antigen/antibody (to check for Hepatitis D superinfection, which can worsen the disease).
Hepatitis Part 2Question: The husband is a known case of hepatitis B, and the wife is Hep B negative. What is the best advice regarding sexual relationships?
Answer: 1) Wear a condom before ejaculation (to prevent transmission).
Hepatitis Part 2Question: A patient with chronic hepatitis C and ascites presents. What is the treatment?
Answer: A. Spironolactone and diuretics (to manage ascites).
Hepatitis Part 2Question: In a case of Schistosoma mansoni with cardiac or pulmonary complications, what is the best diuretic for ascites?
Answer: Loop diuretics (effective in reducing fluid buildup in ascites).
Hepatitis Part 2Question: Spironolactone is what type of diuretic?
Answer: B. Aldactone (a potassium-sparing diuretic).
Hepatitis Part 2Question: A patient with hepatic cirrhosis due to hepatitis B, with ascites, lower limb edema, basal lung crepitations, slight hypoalbuminemia, and good renal function, requires what treatment?
Answer: Furosemide + spironolactone (combination for managing ascites and edema).
Hepatitis Part 2Question: A patient on insulin, ACE inhibitors, and spironolactone presents with high potassium. What is the cause of the elevated potassium?
Answer: Spironolactone (a potassium-sparing diuretic can cause hyperkalemia).
Hepatitis Part 2Question: A patient with chronic hepatitis B presents with jaundice and highly elevated liver enzymes (500-600). What is the most appropriate next step?
Answer: Request Anti-Delta (to check for Hepatitis D co-infection).
Hepatitis Part 2Question: A 17-year-old male with a history of IV drug use presents for a check-up, asymptomatic. What should you screen for?
Answer: A. HIV (IV drug use increases the risk of HIV transmission).
Hepatitis Part 2
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MIX QUESTION
MIX QUESTION Part 1Question: A patient presents with sharp, shooting neck pain radiating to the shoulder and jaw. What is the most likely diagnosis?
Answer: Cervical disk prolapse.
MIX QUESTION Part 1Question: A patient has shoulder pain radiating to the arm, with tingling and loss of sensation. What is the most likely diagnosis?
Answer: Cervical disk prolapse.
MIX QUESTION Part 1Question: A 40-year-old veterinarian presents with headache, neurological symptoms, agitation, mood changes, and right iliac fossa tenderness. He remembers having a fever two weeks ago. What is the most appropriate next step?
Answer: B. X-ray right iliac joint (to assess for a potential infection or inflammation such as in tuberculous spondylitis).
MIX QUESTION Part 1Question: An elderly patient presents with back pain, and bone density tests show spine -2 and peripheral -1.9. What is the diagnosis?
Answer: Osteopenia (reduced bone density but not yet osteoporosis).
MIX QUESTION Part 1Question: Paper-like cells in the bone marrow suggest which disease?
Answer: Gaucher disease (a lysosomal storage disorder).
MIX QUESTION Part 1Question: A doctor asks a patient to face the wall, lean forward, and let their arm hang unsupported. What condition is being examined?
Answer: Scoliosis (this position can reveal spinal deformities like scoliosis).
MIX QUESTION Part 1Question: A patient with sarcoma in the thigh needs to determine the extent of metastasis. What is the next step?
Answer: C.T for chest (to check for lung metastases, which are common in sarcoma).
MIX QUESTION Part 1Question: A patient with back pain experiences increased pain when walking downstairs. What is the most likely diagnosis?
Answer: Spinal stenosis (narrowing of the spinal canal causing nerve compression).
MIX QUESTION Part 1Question: A patient with spinal stenosis has mild paraspinal muscle spasm. What is the most appropriate treatment?
Answer: Physiotherapy (to manage symptoms and improve mobility).
MIX QUESTION Part 1Question: A 70-year-old with lumbar stenosis requires treatment. What is the most appropriate first step?
Answer: Physiotherapy > NSAIDs > Surgery (start with conservative treatments, and consider surgery if necessary).
MIX QUESTION Part 1Question: A patient with vitamin D deficiency presents with rickets. What is the most likely cause of this condition?
Answer: Vitamin D deficiency (leads to impaired bone mineralization and rickets in children).
MIX QUESTION Part 1Question: A patient presents with flat feet and pain in the medial foot. What structure is most likely involved?
Answer: Spring ligament (also called calcaneonavicular ligament).
MIX QUESTION Part 1Question: While examining the knee, you notice that the tibia is above/anterior to the femur. What ligament is likely injured?
Answer: A. Anterior cruciate ligament (ACL).
MIX QUESTION Part 1Question: A patient presents with knee pain that increases with activity, and tenderness on the medial knee. What is the most likely diagnosis?
Answer: Tendonitis.
MIX QUESTION Part 1Question: A patient has tenderness all over the tibial tuberosity. What is the most likely diagnosis?
Answer: Osgood-Schlatter disease (tenderness over the tibial tuberosity).
MIX QUESTION Part 1Question: A patient with rheumatoid arthritis (RA) presents with knee pain that does not improve with corticosteroids. What should be added to the treatment plan?
Answer: Methotrexate (first-line disease-modifying anti-rheumatic drug for RA).
MIX QUESTION Part 1Question: A patient with bilateral knee pain that increases at night and with rest shows no signs of effusion, erythema, or swelling on examination. What is the next investigation?
Answer: A. Bilateral X-ray (to evaluate for osteoarthritis or other joint issues).
MIX QUESTION Part 1Question: A patient in their 30s presents with right knee swelling. Joint aspiration shows yellow, turbid fluid, positive mucin clot test, 15 WBC, and 90% PMN. What is the diagnosis?
Answer: Septic arthritis.
MIX QUESTION Part 1Question: A young patient presents with right knee pain, erythema, and swelling. What is the likely organism causing cellulitis?
Answer: S. pyogenes (Group A Streptococcus).
MIX QUESTION Part 1Question: A patient with osteoarthritis on NSAIDs presents with symptoms of perforated ulcer. What is the most likely diagnosis?
Answer: NSAID-induced peptic ulcer disease (PUD).
MIX QUESTION Part 1Question: An older woman complains of knee pain that is worse in the morning, improves with rest, and increases with walking. What is the likely diagnosis?
Answer: Osteoarthritis.
MIX QUESTION Part 1Question: The pain pattern for osteoarthritis (OA) improves with rest and worsens with activity, while rheumatoid arthritis (RA) is the opposite. What is the main difference between OA and RA pain?
Answer: OA improves with rest and worsens with activity, while RA improves with activity and worsens with rest.
MIX QUESTION Part 1Question: A patient presents with polyarthralgia and pain in the distal and proximal interphalangeal joints. What is the best treatment option?
Answer: Finger splints (help reduce pain in hand osteoarthritis).
MIX QUESTION Part 1Question: An elderly patient presents with hip pain. An X-ray shows osteophytes and joint space narrowing. What is the likely diagnosis?
Answer: Osteoarthritis.
MIX QUESTION Part 1Question: A female patient complains of back pain after a cough. An X-ray shows a compression fracture. What is the initial step in management?
Answer: Paracetamol (initial analgesia for the compression fracture).
MIX QUESTION Part 1Question: Cervical osteoarthritis is not improving with NSAIDs. What is the next treatment step?
MIX QUESTION Part 1Question: A 75-year-old patient presents with hip pain that increases with activity and is severe before sleeping, but also has morning stiffness for several hours. What is the likely diagnosis?
Answer: Osteoarthritis.
MIX QUESTION Part 1Question: An elderly patient has significant height loss. What is the next investigation?
Answer: Bone density (to assess for osteoporosis).
MIX QUESTION Part 1Question: A patient with peptic ulcer disease (PUD) and osteoarthritis is complaining of pain. What analgesic should be given?
Answer: C. Tramadol (a safer option for patients at high risk for gastrointestinal side effects).
MIX QUESTION Part 1Question: An elderly patient with osteoarthritis and a history of cervical laminectomy for degenerative myelopathy now complains of gait instability and urinary incontinence for 1 month. What is the most likely diagnosis?
Answer: D. Recurrent cervical degenerative disease (suggesting a new episode of compression or degeneration in the cervical spine).
MIX QUESTION Part 1Question: Which pharmacological agent is used in osteoporosis and malignancy-related bone issues?
Answer: Denosumab (a monoclonal antibody used to treat osteoporosis and bone metastases).
MIX QUESTION Part 1Question: A patient with lung cancer complains of pain. Labs show high ionized calcium. What is the appropriate management?
Answer: IV fluids, followed by Denosumab (used to manage high calcium and bone metastases in cancer).
MIX QUESTION Part 1Question: An old lady with hip pain that increases with walking most likely has:
Answer: Osteoarthritis.
MIX QUESTION Part 1Question: An elderly woman with PIP and DIP pain from OA, which is not controlled with NSAIDs, what is the next step in treatment?
Answer: Methotrexate (a disease-modifying drug for inflammatory arthritis like OA).
MIX QUESTION Part 1Question: An elderly patient with a lumbar fracture should be managed with:
Answer: Oral alendronate (a bisphosphonate used for osteoporosis and Paget’s disease).
MIX QUESTION Part 2Question: A 77-year-old man with hypertension on atenolol presents with hearing loss in noisy places. He also has air conduction better than bone conduction. What is the likely cause?
MIX QUESTION Part 2Question: A long case of rash, ANA positive, fever, arthritis, arthralgia, and hyperferritinemia. What is the likely diagnosis?
Answer: Adult Still’s disease (characterized by fever, rash, and arthritis).
MIX QUESTION Part 2Question: What are the 5 A's for smoking cessation?
Answer: Ask, Advise, Assess, Assist, and Arrange.
MIX QUESTION Part 2Question: A 27-year-old female with 10 years of smoking presents with oral lesions like ulcers that have been present for 4 months. What is the best next step?
Answer: Biopsy (to confirm the nature of the lesions).
MIX QUESTION Part 2Question: A man will visit an area endemic for onchocerciasis for one week. What is the chance of being infected?
Answer: B. Mild (since exposure time is short, the risk is typically low).
MIX QUESTION Part 2Question: What is the most accurate test to reveal Helicobacter pylori infection?
Answer: B. Rapid urea test (an accurate test for detecting H. pylori infection).
MIX QUESTION Part 2Question: In Parkinson's disease, which of the following factors is present in patients who are at high risk of developing dementia?
Answer: A. Forgetting future appointments (indicative of cognitive decline in Parkinson's disease).
MIX QUESTION Part 2Question: A patient presents with turbid tea-colored urine, 20-30 RBCs, and 3-5 WBCs. What is the most important investigation to perform?
Answer: A. Urine culture + sensitivity (to check for urinary tract infection or other infectious causes).
MIX QUESTION Part 2Question: A patient with diabetes, a smoker, and peripheral artery disease (PAD) asks what to do to improve their condition. What is the most appropriate action?
Answer: B. Smoking cessation program (stopping smoking is the most effective intervention for PAD).
MIX QUESTION Part 2Question: ST elevation in AVL, V5, V6, V1 on an ECG is indicative of:
Answer: Lateral MI (myocardial infarction involving the lateral wall of the heart).
MIX QUESTION Part 2Question: A 10-year-old patient has high indirect bilirubin, high AST, ALT, and possibly ALP. What is the most likely diagnosis?
Answer: A. Gilbert syndrome (a benign condition characterized by intermittent elevation of indirect bilirubin).
MIX QUESTION Part 2Question: An asthmatic patient is using budesonide (inhaled glucocorticoid) and albuterol (SABA) to control asthma. She becomes pregnant. What should you advise her?
Answer: Continue both, as they are both safe in pregnancy.
MIX QUESTION Part 2Question: Rheumatoid arthritis (RA) patients often experience which symptom?
Answer: Morning stiffness.
MIX QUESTION Part 2Question: The risk of MI in smokers significantly declines after how many years of cessation?
Answer: 1-20 years (risk declines gradually after quitting smoking).
MIX QUESTION Part 2Question: A 20-year-old female newly diagnosed with diabetes is starting insulin therapy. What type of insulin should she be given?
Answer: Basal insulin (typically used for long-term blood glucose control).
MIX QUESTION Part 2Question: An Alzheimer's patient is experiencing hallucinations, with no organic cause. What medication should be considered?
Answer: Olanzapine (an atypical antipsychotic often used for agitation and hallucinations in Alzheimer's disease).
MIX QUESTION Part 2Question: A blood smear shows spherocytosis. What value would you expect to be LOW?
Answer: Reticulocytes (typically low in hereditary spherocytosis due to the reduced production of RBCs).
MIX QUESTION Part 2Question: A retroperitoneal sarcoma is most likely to cause:
Answer: Compressive (invasive) symptoms.
MIX QUESTION Part 2Question: A female typist presents with numbness in her hand. You find a blockage in the superficial palmar artery. Which nerve is likely affected?
Answer: Ulnar nerve (due to compression from anatomical issues in the hand).
MIX QUESTION Part 2Question: An asthmatic patient with hypertension is prescribed medication. Which drug is contraindicated because it may cause bronchospasm?
Answer: A. Atenolol (a beta-blocker that can worsen bronchospasm in asthmatics).
MIX QUESTION Part 2Question: A patient with a chest trauma presents with raised JVP, BP 80/50, and normal air entry bilaterally. What is the most likely diagnosis?
Answer: Cardiac tamponade (due to compression of the heart from fluid accumulation in the pericardium).
MIX QUESTION Part 2Flashcard 528 Question: In a patient undergoing resuscitation, what indicates adequate resuscitation?
Answer: Normalize BP (blood pressure normalization is the key indicator of successful resuscitation).
MIX QUESTION Part 2Question: A patient walks around saying inappropriate things to people. What is the most likely issue?
Answer: Preservation (preservation of speech or behavior is often seen in conditions like frontotemporal dementia).
MIX QUESTION Part 2Question: If the incidence of a disease is the same, what would increase its prevalence?
Answer: Loss of follow-up (this increases the number of people with the disease in the population).
MIX QUESTION Part 2Question: What is the most appropriate test to study 5 different types of exercise given to obese women over time and follow their BMI?
Answer: Cohort study (a cohort study tracks the long-term effects of interventions like exercise on BMI).
Answer: Full recovery (most patients recover with appropriate treatment).
MIX QUESTION Part 2Question: A patient presents with peripheral muscle weakness and a history of infection 3 weeks ago. What is the most likely diagnosis?
Answer: Intravenous immunoglobulin (IVIG) (the standard treatment for GBS).
MIX QUESTION Part 2Question: A female patient presents with positive anticardiolipin antibody and other symptoms. What is the most likely diagnosis?
Answer: Antiphospholipid syndrome (a condition characterized by the presence of antiphospholipid antibodies, which can lead to thrombosis).
MIX QUESTION Part 2Question: What indicates a poor response to IVIG treatment?
Answer: High CRP (elevated C-reactive protein indicates ongoing inflammation and a poor response to intravenous immunoglobulin).
MIX QUESTION Part 2Question: A male patient presents with typical myasthenia gravis symptoms. What medication should be prescribed?
Answer: Pyridostigmine (a cholinesterase inhibitor that improves neuromuscular transmission in myasthenia gravis).
MIX QUESTION Part 2Question: A patient with bilateral ptosis, upper and lower limb weakness, and a positive Simpson test most likely has:
Answer: Myasthenia gravis (a neuromuscular disorder characterized by weakness and fatigue of voluntary muscles).
MIX QUESTION Part 2Question: A patient with myasthenia gravis reports feeling well in the morning but deteriorating throughout the day. What is the underlying pathophysiology of this condition?
Answer: Autoantibodies to acetylcholine receptors (which impair neuromuscular junction function).
MIX QUESTION Part 2Question: The pathogenesis of vitiligo involves:
Answer: Autoantibodies against melanocytes (the immune system attacks melanocytes, leading to depigmentation).
MIX QUESTION Part 2Question: A 55-year-old man is diagnosed with acromegaly. What investigation is required in the future due to the increased risks associated with this condition?
Answer: Colonoscopy (acromegaly increases the risk of colonic polyps and colorectal cancer).
Nephritic and Nephrotic disease
Nephritic and Nephrotic diseaseQuestion: A patient with nephrotic syndrome has been on daily steroids for 4 weeks with no response. What does this indicate?
Answer: Steroid resistance in nephrotic syndrome (suggesting the need for further evaluation, as the patient is not responding to standard treatment).
Nephritic and Nephrotic diseaseQuestion: In acute kidney failure, which of the following indicates heart disease in the patient?
Answer: A. Refractory hyperkalemia (7.5), not responding to medical treatment (hyperkalemia is a sign of impaired kidney function and can indicate heart disease).
Nephritic and Nephrotic diseaseQuestion: To confirm UTI, which of these is the most accurate in urinalysis?
Answer: A. Nitrate (nitrate is produced by certain bacteria and is a reliable indicator of a UTI).
Nephritic and Nephrotic diseaseQuestion: What is the best way to take a sample of urine in suspected UTI?
Answer: A. Midstream sample (provides a clean sample, reducing the risk of contamination).
Nephritic and Nephrotic diseaseQuestion: A patient presents with bilateral hydronephrosis, a dilated bladder, and proximal urethra. What is the most likely diagnosis?
Question: A patient presents with bilateral hydronephrosis, a dilated bladder, and proximal urethra. What is the most likely diagnosis?
Answer: Posterior urethral valve (an obstructing membrane in the posterior male urethra, common in male newborns).
Nephritic and Nephrotic diseaseQuestion: In a patient with suspected trachoma, what is the most appropriate diagnostic tool?
Answer: Bronchoscopy (used to examine the airways for any involvement or complications related to trachoma).
Nephritic and Nephrotic diseaseQuestion: A patient presents with aspirin toxicity. What is the next important step in management?
Answer: Urine alkalinization (to enhance the elimination of aspirin from the body).
Nephritic and Nephrotic diseaseQuestion: A young patient presents with recurrent UTIs, stones, and electrolyte disturbances. Imaging shows bilateral kidney enlargement with multiple cysts of varying sizes throughout the parenchyma. What is the most likely diagnosis?
Answer: Polycystic kidney disease (a genetic disorder leading to the formation of cysts in the kidneys).
Nephritic and Nephrotic diseaseQuestion: A patient presents with absent reflexes, slight anemia, potassium 5.5, high urea, and high creatinine. What is the most appropriate next step in management?
Answer: Dialysis (indicated in patients with severe kidney dysfunction and electrolyte imbalances).
Nephritic and Nephrotic diseaseQuestion: In nephrotic syndrome, which is the most common type in children?
Answer: Minimal change disease (the most common cause of nephrotic syndrome in children).
Nephritic and Nephrotic diseaseQuestion: A patient with nephrotic syndrome is on treatment. How can you determine if the disease is in remission?
Answer: A. Disappearance of albumin in urine (albuminuria is a key indicator of disease activity).
Nephritic and Nephrotic diseaseQuestion: What are the indications for dialysis?
Answer: Hyperkalemia, acidosis, and high urea (these are critical conditions that may necessitate dialysis).
Nephritic and Nephrotic diseaseQuestion: A patient presents with vibration sensation, absent lower limb reflexes, high creatinine (Cr), high potassium (K), and low MCV. What is the most appropriate management?
Answer: A. Hemodialysis (indicated due to severe renal impairment and electrolyte disturbances).
Nephritic and Nephrotic diseaseQuestion: A patient with pyelonephritis shows nitrate in the urinalysis. What is the next best step in management?
Answer: IV antibiotics (to treat the infection effectively).
Nephritic and Nephrotic diseaseQuestion: A patient presents with normal PSA, urinalysis, and examination showing median lobe enlargement of the prostate. What is the most appropriate next step?
Answer: Periodical PSA monitoring (as the median lobe enlargement is a benign condition and monitoring PSA levels is recommended).
Nephritic and Nephrotic diseaseQuestion: A patient with productive cough and asymmetrical kidneys is diagnosed with:
Answer: Renal artery stenosis (a common cause of hypertension and kidney damage).
Nephritic and Nephrotic diseaseQuestion: A hypertensive patient with asymmetrical kidneys should be evaluated for:
Answer: Renal artery stenosis (which can cause secondary hypertension).
Nephritic and Nephrotic diseaseQuestion: A patient is experiencing stress incontinence. What is the most appropriate management?
Nephritic and Nephrotic diseaseQuestion: A patient with pyelonephritis should be managed with:
Answer: Admission and IV antibiotics (to treat the infection).
Nephritic and Nephrotic diseaseQuestion: To prevent calcium stones, what medication is recommended?
Answer: Thiazides (thiazide diuretics reduce calcium excretion in the urine).
Nephritic and Nephrotic diseaseQuestion: A pregnant patient with blood pressure 160/110 and protein in urine should first be given:
Answer: Magnesium sulfate (for pre-eclampsia management to prevent seizures).
Nephritic and Nephrotic diseaseQuestion: A patient has urine leakage and cannot control the urinary stream. The bladder distends after voiding. What type of incontinence is this?
Answer: Overflow incontinence (due to bladder retention and incomplete voiding).
Nephritic and Nephrotic diseaseQuestion: A patient presents with hematuria and hemoptysis. What is the most likely diagnosis?
Nephritic and Nephrotic diseaseQuestion: A patient with fever and dark urine has a history of constipation. Urinalysis shows high leukocytes, high erythrocytes, and high protein. What is the most likely diagnosis?
Answer: A. Pyelonephritis (characterized by fever, chills, pyuria, vomiting, flank pain, and a history of UTI).
Nephritic and Nephrotic diseaseQuestion: A patient has difficulty starting the urinary stream. What is the most likely diagnosis?
Answer: Overflow incontinence (caused by incomplete emptying of the bladder).
Nephritic and Nephrotic diseaseQuestion: A patient with nephrotic syndrome and edema is advised to follow a low sodium diet. What additional treatment should be given?
Answer: Furosemide (a diuretic to manage edema).
Nephritic and Nephrotic diseaseQuestion: A patient with renal impairment and hyperkalemia (6.5) should be treated with:
Answer: Calcium gluconate (to stabilize the cardiac membrane in hyperkalemia).
Nephritic and Nephrotic diseaseQuestion: In a patient with nephrotic syndrome, how can you determine if the disease is in remission?
Answer: Albumin disappearance in urine (indicating that the kidneys are functioning properly again).
Nephritic and Nephrotic diseaseQuestion: Which is the most common type of nephrotic syndrome in children and adults?
Answer: Minimal change disease (common in children) > Focal segmental glomerulosclerosis (FSGS) (common in adults).
Nephritic and Nephrotic diseaseQuestion: A patient with a previous history of URTI two weeks ago presents with a mid-diastolic murmur. How do you confirm the diagnosis?
Answer: ASO (Antistreptolysin O) titre (to exclude poststreptococcal glomerulonephritis).
Nephritic and Nephrotic diseaseQuestion: A patient presents with arthritis and splenomegaly. What is the most likely diagnosis?
Answer: Felty's syndrome (a rare complication of rheumatoid arthritis characterized by arthritis, splenomegaly, and neutropenia).
Nephritic and Nephrotic diseaseQuestion: A patient with multiple joint pain and subcutaneous nodules is suspected to have rheumatic fever. What test should you use to confirm the diagnosis?
Nephritic and Nephrotic diseaseQuestion: A patient had a URTI 3 weeks ago and now presents with renal signs and labs showing hematuria and RBC casts. What is the most likely diagnosis?
Answer: Poststreptococcal glomerulonephritis (PSGN) (often follows a streptococcal throat infection, and is associated with low C3 levels).
Nephritic and Nephrotic diseaseQuestion: What is the most appropriate investigation for Poststreptococcal glomerulonephritis (PSGN)?
Answer: Serum creatinine (to assess renal function and confirm the diagnosis of PSGN).
Nephritic and Nephrotic diseaseQuestion: Felty's syndrome is defined by the presence of three conditions: rheumatoid arthritis, splenomegaly, and neutropenia. What complications can arise from this syndrome?
Answer: Repeated infections (due to neutropenia and compromised immune function).
Nephritic and Nephrotic diseaseQuestion: A patient presents with lymphadenopathy and membranous lesions over the tonsils. What is the likely complication?
Answer: Scarlet fever (which can result from a group A streptococcal infection).
Nephritic and Nephrotic disease Question: The pathology of progressive glomerulonephritis is characterized by:
Answer: Crescent-shaped glomerular lesions (which are associated with rapidly progressive glomerulonephritis, such as in Goodpasture's syndrome or vasculitis).
Nephritic and Nephrotic diseaseQuestion: A patient with nephrotic syndrome has resistant disease despite 4 weeks of steroid therapy. What does this indicate?
Answer: Steroid resistance (a sign that the nephrotic syndrome may not be responsive to standard treatments and may require further investigation or alternative therapies).
Nephritic and Nephrotic diseaseQuestion: Acute kidney failure with refractory hyperkalemia that does not respond to three medications indicates which condition?
Answer: Heart disease (refractory hyperkalemia in acute kidney failure may suggest underlying heart dysfunction, requiring urgent treatment).
Nephritic and Nephrotic diseaseQuestion: To confirm a UTI, which of these is most accurate in urinalysis?
Answer: A. Nitrate (nitrate is produced by some bacteria and is a reliable indicator of UTI).
Nephritic and Nephrotic diseaseQuestion: What is the best way to collect a urine sample in suspected UTI?
Answer: A. Midstream sample (this helps avoid contamination and provides a cleaner sample).
Nephritic and Nephrotic diseaseQuestion: A patient presents with bilateral hydronephrosis, a dilated bladder, and proximal urethra. What is the most likely diagnosis?
Answer: Posterior urethral valve (an obstructing membrane in the posterior male urethra, often seen in male newborns).
Number to know
Number to knowQuestion: What is the minimum muscle strength required per week for health benefits?
Answer: 20 minutes (recommended duration for muscle-strengthening activities per week).
Number to knowQuestion: When should you stop metformin in a patient with kidney issues?
Answer: Less than GFR 30 (if the glomerular filtration rate (GFR) is below 30, metformin should be stopped).
Number to knowQuestion: A patient presents with abdominal pain, nausea, and vomiting after paracetamol overdose. Which stage of paracetamol toxicity does this suggest?
Answer: Stage 1 (the initial stage characterized by nonspecific symptoms like nausea and vomiting).
Number to knowQuestion: If the Mean Arterial Pressure (MAP) is 55 and the Intracranial Pressure (ICP) is 15, what is the Cerebral Perfusion Pressure (CPP)?
Answer: 40 (CPP = MAP - ICP = 55 - 15).
Number to knowQuestion: At what age should dyslipidemia screening begin for females?
Answer: 45 years (recommended screening age for dyslipidemia in females).
Number to knowQuestion: How many quality years does smoking take away from a smoker's life?
Answer: 10 years (smoking significantly reduces life expectancy).
Number to knowQuestion: In a population of 1600 people, 800 have liver disease, and 800 do not. The test shows that 200 of those with the disease are positive. What is the sensitivity of this test?
Number to knowQuestion: How many hours of sleep are associated with weight gain?
Answer: Less than 6 hours (sleep deprivation is associated with increased risk of weight gain).
Number to knowQuestion: A dehydrated child with low glucose is presented. What is the best management?
Answer: 10% dextrose in 1/2 saline (this solution provides both hydration and glucose).
Number to knowQuestion: A 10 kg child with 5% dehydration requires fluid replacement. What is the daily fluid requirement?
Answer: 1500 ml/day (calculated by using the formula for maintenance fluid: first 10 kg x 100, next 10 kg x 50, and remaining weight x 20).
Number to knowQuestion: A young child presents with dehydration, hypotension, and tachycardia. What is the first step in management?
Answer: IV bolus normal saline (NS) (to rapidly restore intravascular volume).
Number to knowQuestion: When should hyperlipidemia screening be done in low-risk males?
Answer: 40 years (recommended screening age for low-risk males).
Number to knowQuestion: Which cancer should be screened for in the general population?
Answer: Colorectal cancer (routine screening for colorectal cancer begins at age 50).
Number to knowQuestion: When should osteoporosis screening be performed?
Answer: 65 years (recommended starting age for osteoporosis screening in women).
Number to knowQuestion: On average, how many years of life does a smoker lose?
Answer: 10 years (smoking significantly reduces life expectancy).
Number to knowQuestion: How many folds does the risk of lung cancer increase with smoking?
Answer: 20-fold (smoking dramatically increases the risk of lung cancer).
Number to knowQuestion: At what age should colon cancer screening begin for those in a low-risk group?
Answer: 50 years (recommended starting age for colon cancer screening).
Number to knowQuestion: What is the minimum workout activity for an adult?
Answer: B. 30 minutes per 5 days (recommended minimum exercise duration for adults).
Number to knowQuestion: What is the osmotic gap of stool in vibrio cholera?
Answer: 40 (osmotic gap is used to assess the cause of diarrhea, and vibrio cholera has an osmotic gap of 40).
Number to knowQuestion: What indicates remission of nephrotic syndrome?
Answer: Urine albumin less than 4 mg/m²/h for 3 consecutive early morning samples (indicating reduced protein loss in urine).
Number to knowQuestion: What is the fluid correction strategy in DKA to avoid complications?
Answer: Give slow rehydration over about 48 hours, avoid hypotonicity, and unnecessary alkali therapy.
Number to knowQuestion: What is the risk of Hepatitis C after a needlestick injury?
Answer: 3% (the risk of transmission from a needlestick injury is approximately 3%).
Number to knowQuestion: A patient with paracetamol overdose presents with right upper quadrant pain, nausea, and vomiting. What stage of paracetamol toxicity is this?
Answer: Stage 2 (stage 2 is characterized by liver damage, right upper quadrant pain, and jaundice).
Number to knowQuestion: What is the most important characteristic of a screening test?
Answer: Sensitive (sensitivity refers to the ability of a test to correctly identify those with the disease, which is crucial for a screening test).
Number to knowQuestion: What is the highest level of evidence to determine the effect of exercise on quality of life?
Answer: A. Cohort observational study (cohort studies provide valuable insights into long-term effects, making them ideal for assessing exercise outcomes).
Number to knowQuestion: What is the target LDL level for a diabetic patient with coronary artery disease?
Answer: LDL less than 70 (target LDL for patients with cardiovascular disease and diabetes is less than 70 mg/dL).
Number to knowQuestion: A patient with bronze skin and hepatomegaly is suspected to have hemochromatosis. What test would you use?
Answer: 24-hour urinary iron (used to diagnose hemochromatosis by assessing iron overload).
Number to knowQuestion: A patient with hemochromatosis has normal LFTs but high ferritin (860). What is the most appropriate management?
Answer: A. Start phlebotomy (phlebotomy is the mainstay treatment for hemochromatosis to reduce iron levels).
Number to knowQuestion: For an asymptomatic hemochromatosis patient, what is the recommended management?
Answer: Regular phlebotomy every month (to manage iron overload in hemochromatosis).
Number to knowQuestion: When should metformin be used in renally impaired patients?
Answer: GFR above 30 (metformin is safe to use in patients with a GFR above 30, but should be avoided in severe renal impairment).
Number to knowQuestion: After a myocardial infarction (MI), when is it safe to perform elective surgery?
Answer: 6 months (elective surgery should generally be postponed for 6 months after an MI to reduce the risk of complications).
PARKINSON'S DISEASE
PARKINSON'S DISEASEQuestion: A patient presents with resting tremors. What is the most likely diagnosis?
Answer: Parkinson's disease (resting tremors are a hallmark of Parkinson's disease).
PARKINSON'S DISEASEQuestion: A patient has mask-like face, bradykinesia, and tremors. What is the most likely diagnosis?
Answer: Parkinson's disease (these are typical symptoms of Parkinson's disease).
PARKINSON'S DISEASEQuestion: A patient with progressive tremors interfering with writing and eating, and also exhibits head bobbing. What is the most appropriate treatment?
Answer: Propranolol (used for essential tremors, not Parkinson's).
PARKINSON'S DISEASEQuestion: In a Parkinson's disease patient, what is the site of pathology?
Answer: Substantia nigra (damage to the substantia nigra leads to the symptoms of Parkinson's disease).
PARKINSON'S DISEASEQuestion: A patient has a shuffling gait and tremors. What is the most likely diagnosis?
Answer: Parkinson's disease (shuffling gait and tremors are classic signs of Parkinson's).
PARKINSON'S DISEASEQuestion: A patient with Parkinson's disease develops hallucinations. What is the most important indicator that they will develop dementia?
Answer: Forgetting appointments (memory issues such as forgetting appointments are an early indicator of dementia in Parkinson's disease).
PARKINSON'S DISEASEQuestion: A patient has difficulty feeding and cannot put the fork to their mouth after a traffic accident. Where is the lesion likely located?
Answer: Cerebellum (the cerebellum controls motor coordination, which is likely impaired in this case).
PARKINSON'S DISEASEQuestion: A woman presents with abnormal behavior and agitation. What is the most likely diagnosis?
Answer: Frontotemporal dementia (characterized by changes in personality and behavior, often seen in frontotemporal dementia).
PARKINSON'S DISEASEQuestion: A 15-year-old girl had her menstruation 2 months ago and is now exhibiting irritability and non-cooperation. What is the most likely cause of her behavior?
Answer: Behavioral changes due to puberty.
PARKINSON'S DISEASEQuestion: A patient has multiple neurological symptoms in different parts of the body. What is the best diagnostic test?
Answer: MRI of the brain and spine (used to diagnose Multiple sclerosis).
PARKINSON'S DISEASEQuestion: A patient with multiple sclerosis develops ocular and lower limb neurological manifestations. What is the most appropriate treatment?
Answer: IV corticosteroids (used to treat acute relapses in multiple sclerosis).
PARKINSON'S DISEASEQuestion: A patient with multiple sclerosis presents with ocular manifestations and lower limb neurological manifestations. What is the next step in investigation?
Answer: Brain and spinal cord MRI (this is the key diagnostic test for multiple sclerosis).
PARKINSON'S DISEASEQuestion: A patient feels better when walking while leaning forward. What is the most likely diagnosis?
Answer: Spinal stenosis (this condition often causes relief when the patient bends forward, which opens the spinal canal).
PARKINSON'S DISEASEQuestion: A patient with nephrotic syndrome and abdominal pain presents with a complication. What is the most likely complication?
Answer: Peritonitis (a common complication in nephrotic syndrome, often due to spontaneous bacterial peritonitis).
PARKINSON'S DISEASEQuestion: A patient with lumbar spinal stenosis experiences painful walking that decreases after 30 minutes of walking. The reflexes are normal. What is the next step in management?
Answer: Physiotherapy (non-surgical management for lumbar spinal stenosis).
PARKINSON'S DISEASEQuestion: An elderly patient with positive bilateral Rinne's test and a Weber test that is better on the right ear is likely experiencing:
Answer: Left sensorineural hearing loss (Weber test lateralizing to the right ear suggests left-sided sensorineural hearing loss).
Pulmonary Embolism and DVT
Pulmonary Embolism and DVTQuestion: A patient with a first-time pulmonary embolism (PE) is treated with anticoagulation. For how long should the anticoagulation therapy continue?
Answer: A. 6 months (if unprovoked, anticoagulation should last for 6 months; if provoked, it lasts for 3 months).
Pulmonary Embolism and DVTQuestion: A young patient presents with unilateral progressive leg swelling without a history of surgery or prolonged bed rest. What is the most important question to ask in the patient's history?
Answer: History of smoking (smoking is a major risk factor for venous thromboembolism).
Pulmonary Embolism and DVTQuestion: If a patient presents with pulmonary embolism (PE) or deep vein thrombosis (DVT) and is stable, what is the appropriate treatment?
Answer: Heparin (5,000 units) or Enoxaparin (1 mg) (both are commonly used for anticoagulation therapy in stable patients).
Pulmonary Embolism and DVTQuestion: A patient with a DVT thrombus from the popliteal vein extends to the femoral vein, and the patient is vitally stable. What is the treatment?
Answer: Enoxaparin (commonly used in DVT treatment).
Pulmonary Embolism and DVTQuestion: A pregnant patient presents with DVT. What is the most appropriate anticoagulant to use?
Answer: Enoxaparin (safe for use in pregnancy for managing DVT).
Pulmonary Embolism and DVTQuestion: A patient with atrial fibrillation (AF) and leg pain is treated with:
Answer: Heparin (used to manage anticoagulation in AF with leg pain).
Pulmonary Embolism and DVT Question: In a case of massive pulmonary embolism, what is the treatment?
Answer: Thrombolytics (the only indication for thrombolytics in massive PE is if the patient is unstable).
Pulmonary Embolism and DVTQuestion: A patient with a history of one-year paraplegia and hypotension is found to have a DVT extending to the thigh on angiography. What is the next step in management?
Answer: Thrombolysis (recommended for massive PE or severe DVT in unstable patients).
Pulmonary Embolism and DVTQuestion: A female patient presents with pyelonephritis and then suddenly develops symptoms of pulmonary embolism (PE) with unstable vitals. What is the best treatment?
Answer: Alteplase (a thrombolytic used for managing massive PE).
Pulmonary Embolism and DVTQuestion: A patient with saddle pulmonary embolism and hypotension. What is the most appropriate treatment?
Answer: Alteplase (thrombolytic therapy for massive PE with hypotension).
Pulmonary Embolism and DVTQuestion: What is the best DVT prophylaxis after a long surgery, such as orthopedic or hip surgery?
Answer: Enoxaparin (Enoxaparin is commonly used to prevent DVT after long surgeries).
Pulmonary Embolism and DVTQuestion: A patient develops massive DVT after surgery. What is the most appropriate treatment?
Answer: Enoxaparin (used to manage DVT after surgery).
Pulmonary Embolism and DVTQuestion: A woman on Enoxaparin for DVT prophylaxis presents with a sudden onset of shortness of breath (SOB) and dyspnea. Imaging shows a pulmonary embolus lodged in the small bronchial tree. What should be done?
Answer: Increase the dose of Enoxaparin (for a patient already on Enoxaparin, the dose may need to be increased if a PE develops).
Pulmonary Embolism and DVTQuestion: A patient develops pulmonary embolism (PE) while on heparin for DVT. There are no contraindications to thrombolytics. What is the next step?
Answer: Increase the dose of Heparin (if thrombolytics are not indicated, increasing heparin dosage is an appropriate step).
Pulmonary Embolism and DVTQuestion: In a patient with DVT and chronic renal failure, what is the best anticoagulant to use?
Answer: Unfractionated heparin (UFH) (UFH is the preferred choice in patients with renal impairment).
Pulmonary Embolism and DVTQuestion: A patient with hypertension, diabetes, and end-stage renal disease (ESRD) is about to undergo hemodialysis. How can you prevent DVT?
Answer: Unfractionated heparin (UFH) (used in dialysis patients to prevent DVT).
Pulmonary Embolism and DVTQuestion: A patient with pyelonephritis and DVT presents. What is the appropriate anticoagulant?
Answer: Enoxaparin (Enoxaparin is used for DVT in patients with pyelonephritis).
Pulmonary Embolism and DVTQuestion: When should a filter IVC be used to remove a clot from the lungs?
Answer: When thrombolytic therapy is contraindicated, such as in patients with a history of intracranial hemorrhage, to prevent further bleeding.
Pulmonary Embolism and DVTQuestion: A 72-year-old male with episodic weakness and a history of AFib asks about treatment. What is the best treatment for this patient?
Answer: Warfarin (INR 2-3) (INR of 2-3 is the target for anticoagulation in patients with AFib).
Pulmonary Embolism and DVTQuestion: A patient presents with signs of DVT but has no family history. What is the most important question to ask in the patient's history?
Answer: Using oral contraceptive pills (OCP) (OCPs increase the risk of DVT).
Pulmonary Embolism and DVTQuestion: What is an absolute contraindication for thrombolytic therapy?
Answer: Intracranial hemorrhage within the past 2 years.
Pulmonary Embolism and DVTQuestion: A patient on heparin develops thrombocytopenia with no obvious symptoms. What is the next step?
Answer: Stop heparin and start Argatroban (for Heparin-Induced Thrombocytopenia).
Pulmonary Embolism and DVTQuestion: A foot wound that does not heal is likely due to:
Answer: Decreased blood supply (commonly seen in patients with diabetes and vascular issues).
Pulmonary Embolism and DVTQuestion: A diabetic smoker presents with claudication, and femoral pulses are intact but distal pulses are diminished. What is the best next step in management?
Answer: Smoking cessation with aggressive blood sugar control (improves circulation and prevents further complications).
Pulmonary Embolism and DVTQuestion: A patient post MI and PCI is on warfarin. What should you do next?
Answer: Continue warfarin + add 2 antiplatelets (standard management after PCI for additional protection).
Pulmonary Embolism and DVTQuestion: A patient post PCI develops AFib and is already on warfarin and statins. What should you do next?
Answer: Continue warfarin and add 2 antiplatelets (to manage both anticoagulation and antiplatelet therapy).
Pulmonary Embolism and DVTQuestion: A man in his 50s with a history of brain infarction 6 months ago is on warfarin. What is the most appropriate management?
Answer: Same Management (continue warfarin as per the standard care for stroke prevention).
Pulmonary Embolism and DVTQuestion: A patient on warfarin has an INR of 7. What should you do next?
Answer: Stop warfarin and repeat INR the next day (INR of 7 is too high, requiring adjustment).
Pulmonary Embolism and DVTQuestion: In a case of peripheral artery disease, what is the best next step in management?
Answer: CTA (computed tomography angiography) to evaluate the arterial blockages.
Pulmonary Embolism and DVTQuestion: A patient with a history of paraplegia after an RTA presents with clear signs of DVT and right-sided heart failure. What is the most appropriate management?
Answer: Enoxaparin (heparin is used in DVT cases, especially in patients with complications like heart failure).
Pulmonary Embolism and DVTQuestion: A patient with arrhythmia on warfarin and a high risk of stroke. What should be done next?
Answer: Only warfarin (continued anticoagulation to reduce the risk of stroke in atrial fibrillation).
Pulmonary Embolism and DVTQuestion: A 77-year-old patient with diabetes, hypertension, and a history of TIA presents with irregular pulse and ECG showing AFib. What is the most appropriate management?
Answer: Give warfarin to prevent stroke (warfarin is the most effective option for stroke prevention in AFib).
Pulmonary Embolism and DVTQuestion: If a patient on warfarin has a low INR, what complication is likely?
Answer: Vitamin K deficiency (low INR indicates that the blood is clotting too quickly, possibly due to insufficient vitamin K).
Pulmonary Embolism and DVTQuestion: A 52-year-old patient diagnosed with chronic AFib. In which of the following is the patient at an increased risk?
Answer: Cerebrovascular accident (stroke is a common complication of chronic atrial fibrillation).
Pulmonary Embolism and DVTQuestion: An elderly patient with DVT is being evaluated. Which of the following would indicate a need for a thrombophilia test?
Answer: Connective tissue disease (connective tissue diseases can increase the risk of thrombophilia).
Pulmonary Embolism and DVTQuestion: A patient with chronic kidney disease (CKD) is being treated. What is the appropriate anticoagulant to use?
Answer: UFH (Unfractionated heparin) (UFH is typically used in patients with renal impairment).
Pulmonary Embolism and DVTQuestion: A patient with a history of ESRD undergoes hemodialysis regularly. What is the best prophylaxis for DVT at the hospital?
Answer: A. UFH (Unfractionated heparin) (recommended as the prophylactic anticoagulant for these patients).
Pulmonary Embolism and DVTQuestion: An elderly patient presents with abdominal pain and a history of heart disease. What is the most likely diagnosis?
Answer: Mesenteric ischemia (abdominal pain combined with heart disease often points to mesenteric ischemia).
Pulmonary Embolism and DVTQuestion: A patient has a thumbprint sign on X-ray. What is the most likely diagnosis?
Answer: Mesenteric ischemia (thumbprint sign on imaging suggests mesenteric ischemia).
Pulmonary Embolism and DVTQuestion: A 65-year-old male with cardiomyopathy presents with sudden abdominal pain lasting for 8 hours. He also has tenderness and abnormal bowel sounds, and his amylase is high. What is the most likely diagnosis?
Answer: Mesenteric ischemia (Sudden abdominal pain with high amylase and abnormal bowel sounds is suggestive of mesenteric ischemia).
Pulmonary Embolism and DVTQuestion: A patient with coronary heart disease (CHD) develops epigastric pain and an increased bowel movement. What is the most likely diagnosis?
Answer: Acute mesenteric emboli (This can cause epigastric pain and bowel movement changes).
Pulmonary Embolism and DVTQuestion: An elderly patient with claudication symptoms presents. What is the most likely diagnosis?
Answer: Aortoiliac insufficiency (claudication is a key symptom of aortoiliac insufficiency).
Pulmonary Embolism and DVTQuestion: A diabetic hypertensive patient presents with claudication after walking 200 meters and no distal pulse. What is the first step in treatment?
Answer: A. Heparin and follow-up (initial management of DVT and arterial insufficiency).
Pulmonary Embolism and DVTQuestion: A patient with hemiparesis due to a previous infarction now presents with a CT infarction and no clinical symptoms. What is the next step in management?
Answer: LWMH (Low molecular weight heparin) (LWMH is recommended for these types of ischemic events).
Pulmonary Embolism and DVTQuestion: A patient develops Heparin-Induced Thrombocytopenia (HIT). What should you do next?
Answer: Stop Heparin and start Argatroban (for HIT, stop heparin and initiate Argatroban, a direct thrombin inhibitor).
Pulmonary Embolism and DVTQuestion: A patient presents with signs of acute limb ischemia, absent peripheral pulses in the right leg, and absent dorsalis pulse in the left leg. What is the next step in treatment?
Answer: Catheter-directed thrombolysis (CDT) (CDT is an endovascular treatment for acute limb ischemia).
Pulmonary Embolism and DVTQuestion: A patient who had retinal surgery 7 days ago now requires DVT prophylaxis. What is the most appropriate option?
Answer: Mechanical compression (recommended as DVT prophylaxis in patients at risk, such as after retinal surgery).
