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ad725e37-f81b-4c4d-9bc4-917984b289b8 | A 40-year-old non-alcoholic male patient presented to the OPD with jaundice, lethargy, ahralgia, skin pigmentation, loss of libido, polyuria, polydipsia and exeional dyspnea. O/E, Hepatosplenomegaly Increased pigmentation and spider angiomas Ahropathy Ascites Loss of body hair and testicular atrophy Iron studies were done. LFTs were deranged and insulin levels were raised. Liver biopsy was also performed. Patient had no history of intake of any long-term medication. Iron studies are: - Plasma iron - 200 microgm/dL TIBC- 300 microgm/dL Transferrin saturation -90% Serum ferritin -5000 microgm/L Liver iron -10000 microgm/ gm of dry weight Hepatic iron index - 3 Which is the most common mutation seen in the above condition: - | C282Y | H63D | H62D | C283Y | 0a
| multi | This is a case of haemochromatosis with C282Y mutation. HPE image shows Prussian blue-stained section, hepatocellular iron appears blue. The most common HFE mutation is a cysteine-to-tyrosine substitution at amino acid 282 (called C282Y). The other common mutation is H63D (histidine at position 63 to aspaate). DETERMINATION NORMAL SYMPTOMATIC HAEMOCHROMATOSIS PLASMA IRON (microgm/dL) 9-27 180-300 TIBC (microgm/dL) 45-66 200-300 TRANSFERRIN SATURATION % 22-45 50-100 SERUM FERRITIN (microgm/L) 20-150 1000-6000 LIVER IRON (microgm/ gm dry wt.) 300-1400 6000-18000 HEPATIC IRON INDEX <1 >2 | Unknown | Integrated QBank | 199 | {
"Correct Answer": "C282Y",
"Correct Option": "A",
"Options": {
"A": "C282Y",
"B": "H63D",
"C": "H62D",
"D": "C283Y"
},
"Question": "A 40-year-old non-alcoholic male patient presented to the OPD with jaundice, lethargy, ahralgia, skin pigmentation, loss of libido, polyuria, polydipsia and exeional dyspnea. O/E, Hepatosplenomegaly Increased pigmentation and spider angiomas Ahropathy Ascites Loss of body hair and testicular atrophy Iron studies were done. LFTs were deranged and insulin levels were raised. Liver biopsy was also performed. Patient had no history of intake of any long-term medication. Iron studies are: - Plasma iron - 200 microgm/dL TIBC- 300 microgm/dL Transferrin saturation -90% Serum ferritin -5000 microgm/L Liver iron -10000 microgm/ gm of dry weight Hepatic iron index - 3 Which is the most common mutation seen in the above condition: -"
} | A 40-year-old non-alcoholic male patient presented to the OPD with jaundice, lethargy, ahralgia, skin pigmentation, loss of libido, polyuria, polydipsia and exeional dyspnea. O/E, Hepatosplenomegaly Increased pigmentation and spider angiomas Ahropathy Ascites Loss of body hair and testicular atrophy Iron studies were done. LFTs were deranged and insulin levels were raised. Liver biopsy was also performed. Patient had no history of intake of any long-term medication. | Iron studies are: - Plasma iron - 200 microgm/dL TIBC- 300 microgm/dL Transferrin saturation -90% Serum ferritin -5000 microgm/L Liver iron -10000 microgm/ gm of dry weight Hepatic iron index - 3 Which is the most common mutation seen in the above condition: - | {
"A": "C282Y",
"B": "H63D",
"C": "H62D",
"D": "C283Y"
} | A. C282Y |
b801d5fc-5dd0-42fe-805a-c989a5ae0eba | A 50-year-old male patient presented to the OPD with the complaint of progressive dysphagia for 4 months both to solids and liquids but more to the solids. There was history of significant weight loss, loss of appetite, pain while swallowing, a hoarse voice and cervical lymphadenopathy. Upper GI endoscopy and barium studies were conducted. During endoscopy a sample of the lesion was also taken and sent for HPE examination: - ] All of the following are risk factors for the above disease except: - | Smoking | Plummer Vinson syndrome | Achalasia cardia | Barrett's esophagus | 3d
| multi | This is a case of carcinoma esophagus (squamous cell carcinoma) 1ST image shows a mass in the lumen of the esophagus. 2nd image shows the rat tailing seen on Barium swallow in carcinoma esophagus. 3rd image shows the classical keratin pearl seen in squamous cell carcinoma. Barret's esophagus is a risk factor adenocarcinoma of the esophagus. | Unknown | Integrated QBank | 111 | {
"Correct Answer": "Barrett's esophagus",
"Correct Option": "D",
"Options": {
"A": "Smoking",
"B": "Plummer Vinson syndrome",
"C": "Achalasia cardia",
"D": "Barrett's esophagus"
},
"Question": "A 50-year-old male patient presented to the OPD with the complaint of progressive dysphagia for 4 months both to solids and liquids but more to the solids. There was history of significant weight loss, loss of appetite, pain while swallowing, a hoarse voice and cervical lymphadenopathy. Upper GI endoscopy and barium studies were conducted. During endoscopy a sample of the lesion was also taken and sent for HPE examination: - ] All of the following are risk factors for the above disease except: -"
} | A 50-year-old male patient presented to the OPD with the complaint of progressive dysphagia for 4 months both to solids and liquids but more to the solids. There was history of significant weight loss, loss of appetite, pain while swallowing, a hoarse voice and cervical lymphadenopathy. Upper GI endoscopy and barium studies were conducted. | During endoscopy a sample of the lesion was also taken and sent for HPE examination: - ] All of the following are risk factors for the above disease except: - | {
"A": "Smoking",
"B": "Plummer Vinson syndrome",
"C": "Achalasia cardia",
"D": "Barrett's esophagus"
} | D. Barrett's esophagus |
6986f11f-7d58-4778-8b9f-693017a3d4e5 | A 23-year-old man presents with prolonged nose bleeds. He has always noted easy bruising, and ongoing bleeding after minor cuts. There is no prior history of surgery or dental procedures. His hemoglobin is 14.5 g/dL, platelets 200,000/mL, and PT/PPT is normal. Further testing reveals that the bleeding time is elevated; the factor VIII level is reduced, as is the ristocetin cofactor assay.For the above patient with a bleeding disorder, select the most likely diagnosis. | von Willebrand's disease | hemophilia A | hemophilia B | thrombotic thrombocytopenic purpura (TTP) | 0a
| multi | von Willebrand's disease is the most common inherited bleeding disorder. The abnormal plasma glycoprotein, von Willebrand factor (vWF), has two major functions: facilitating platelet adhesion and serving as a carrier for factor VIII. The disease is heterogeneous in its manifestations but can be very severe (type III disease). Evaluation reveals a prolonged bleeding time and decreased factor VIII activity. | Medicine | Blood | 116 | {
"Correct Answer": "von Willebrand's disease",
"Correct Option": "A",
"Options": {
"A": "von Willebrand's disease",
"B": "hemophilia A",
"C": "hemophilia B",
"D": "thrombotic thrombocytopenic purpura (TTP)"
},
"Question": "A 23-year-old man presents with prolonged nose bleeds. He has always noted easy bruising, and ongoing bleeding after minor cuts. There is no prior history of surgery or dental procedures. His hemoglobin is 14.5 g/dL, platelets 200,000/mL, and PT/PPT is normal. Further testing reveals that the bleeding time is elevated; the factor VIII level is reduced, as is the ristocetin cofactor assay.For the above patient with a bleeding disorder, select the most likely diagnosis."
} | A 23-year-old man presents with prolonged nose bleeds. He has always noted easy bruising, and ongoing bleeding after minor cuts. There is no prior history of surgery or dental procedures. His hemoglobin is 14.5 g/dL, platelets 200,000/mL, and PT/PPT is normal. | Further testing reveals that the bleeding time is elevated; the factor VIII level is reduced, as is the ristocetin cofactor assay.For the above patient with a bleeding disorder, select the most likely diagnosis. | {
"A": "von Willebrand's disease",
"B": "hemophilia A",
"C": "hemophilia B",
"D": "thrombotic thrombocytopenic purpura (TTP)"
} | A. von Willebrand's disease |
7ec42bad-f304-4d2a-ac90-e749c49e07f3 | A 36-year-old woman has become increasingly icteric for 1 month. She has had several bouts of colicky, midabdominal pain for 3 years. On physical examination, she has generalized jaundice with scleral icterus. Her BMI is 32. There is tenderness in the right upper quadrant, and the liver span is normal. A liver biopsy is obtained, and microscopic examination shows bile duct proliferation and intracanalicular bile stasis, but no inflammation or hepatocyte necrosis. The level of which of the following is most likely to be increased in the patient's serum? | Alkaline phosphatase | Ammonia | Antimitochondrial antibody | Hepatitis C antibody | 0a
| single | The findings suggest obstructive jaundice from biliary tract disease (e.g., gallstones). Elevation of the serum alkaline phosphatase level is characteristic of cholestasis from biliary obstruction. The alkaline phosphatase comes from the bile duct epithelium and hepatocyte canalicular membrane. The blood ammonia concentration increases with worsening liver failure. When hepatic failure is sufficient to cause hyperammonemia, mental obtundation is seen. In this case, the patient has only jaundice. Primary biliary cirrhosis with an increased antimitochondrial antibody titer is much less common, and PBD eventually leads to bile duct destruction. Most cases of active HCV infection are accompanied by some degree of inflammation with fibrosis. In obstructive biliary tract disease, the direct bilirubin, not the indirect bilirubin, should be elevated. | Pathology | Liver & Biliary Tract | 129 | {
"Correct Answer": "Alkaline phosphatase",
"Correct Option": "A",
"Options": {
"A": "Alkaline phosphatase",
"B": "Ammonia",
"C": "Antimitochondrial antibody",
"D": "Hepatitis C antibody"
},
"Question": "A 36-year-old woman has become increasingly icteric for 1 month. She has had several bouts of colicky, midabdominal pain for 3 years. On physical examination, she has generalized jaundice with scleral icterus. Her BMI is 32. There is tenderness in the right upper quadrant, and the liver span is normal. A liver biopsy is obtained, and microscopic examination shows bile duct proliferation and intracanalicular bile stasis, but no inflammation or hepatocyte necrosis. The level of which of the following is most likely to be increased in the patient's serum?"
} | A 36-year-old woman has become increasingly icteric for 1 month. She has had several bouts of colicky, midabdominal pain for 3 years. On physical examination, she has generalized jaundice with scleral icterus. Her BMI is 32. There is tenderness in the right upper quadrant, and the liver span is normal. A liver biopsy is obtained, and microscopic examination shows bile duct proliferation and intracanalicular bile stasis, but no inflammation or hepatocyte necrosis. | The level of which of the following is most likely to be increased in the patient's serum? | {
"A": "Alkaline phosphatase",
"B": "Ammonia",
"C": "Antimitochondrial antibody",
"D": "Hepatitis C antibody"
} | A. Alkaline phosphatase |
cdc0feed-b89a-4fe7-b0f2-a6f41a583245 | A 40-year-old obese man presents with intense pain in his left first metatarsophalangeal (MTP) joint for the past few hours. He has no history of trauma, fever, chills, and no previous similar episode. He has no history of renal disease or diabetes though he has been told he is "prediabetic." He does not recall any recent skin infections and no family members have had any reported staphylococcal infection. On examination he has a swollen, red, warm, tender first MTP joint on the left. Uric acid level is 9 mg/dL; serum creatinine is normal. What is the best treatment approach for this patient? | Start allopurinol immediately and titrate for a uric acid level below 6. Add colchicine if this is not effective within the first 24 hours. | Begin prednisone until symptoms subside. | Begin indomethacin. As the patient improves, reduce the dose to minimize gastrointestinal side effects. | Prescribe a narcotic until pain is under control. | 2c
| multi | This patient is experiencing his first episode of acute gout. The first MTP joint is the most commonly affected, and 80% of acute gout attacks will be monoarticular. Predisposing conditions include trauma, surgery, starvation, high intake of beer and hard liquor (not wine), or diets high in meat and seafood. Certain medications also increase the chances of acute gout including thiazide and loop diuretics and even the initiation of uric acid lowering drugs such as allopurinol and uricosuric agents. Appropriate initial treatment must be tailored to the patient and their comorbidities. The patient in this question has no contraindication, so a potent NSAID (indomethacin) can be used and is likely to be highly effective. Other acceptable alternatives would have been to start colchicine immediately or oral prednisone in relatively high doses. Since this patient is "prediabetic," steroids may result in overt hyperglycemia and hence would not be the first choice. Allopurinol should not be started until the acute attack has been controlled by anti-inflammatory regimens. All agents that lower uric acid levels (either allopurinol or uricosuric agents) can cause worsening of joint pain, probably by mobilizing uric acid microcrystals previously deposited in the synovial membrane. While narcotics may lessen the pain, they are less effective than anti-inflammatories. Referring the patient to a rheumatologist is unnecessary and would leave the patient in pain and suffering in the meantime. | Medicine | Miscellaneous | 144 | {
"Correct Answer": "Begin indomethacin. As the patient improves, reduce the dose to minimize gastrointestinal side effects.",
"Correct Option": "C",
"Options": {
"A": "Start allopurinol immediately and titrate for a uric acid level below 6. Add colchicine if this is not effective within the first 24 hours.",
"B": "Begin prednisone until symptoms subside.",
"C": "Begin indomethacin. As the patient improves, reduce the dose to minimize gastrointestinal side effects.",
"D": "Prescribe a narcotic until pain is under control."
},
"Question": "A 40-year-old obese man presents with intense pain in his left first metatarsophalangeal (MTP) joint for the past few hours. He has no history of trauma, fever, chills, and no previous similar episode. He has no history of renal disease or diabetes though he has been told he is \"prediabetic.\" He does not recall any recent skin infections and no family members have had any reported staphylococcal infection. On examination he has a swollen, red, warm, tender first MTP joint on the left. Uric acid level is 9 mg/dL; serum creatinine is normal. What is the best treatment approach for this patient?"
} | A 40-year-old obese man presents with intense pain in his left first metatarsophalangeal (MTP) joint for the past few hours. He has no history of trauma, fever, chills, and no previous similar episode. He has no history of renal disease or diabetes though he has been told he is "prediabetic." He does not recall any recent skin infections and no family members have had any reported staphylococcal infection. On examination he has a swollen, red, warm, tender first MTP joint on the left. Uric acid level is 9 mg/dL; serum creatinine is normal. | What is the best treatment approach for this patient? | {
"A": "Start allopurinol immediately and titrate for a uric acid level below 6. Add colchicine if this is not effective within the first 24 hours.",
"B": "Begin prednisone until symptoms subside.",
"C": "Begin indomethacin. As the patient improves, reduce the dose to minimize gastrointestinal side effects.",
"D": "Prescribe a narcotic until pain is under control."
} | C. Begin indomethacin. As the patient improves, reduce the dose to minimize gastrointestinal side effects. |
1b26e503-4f77-4831-9bea-8f4c75225dae | A–13–year old boy is referred for evaluation of nocturnal enuresis and short stature. His blood pressure is normal. The hemoglobin level is 8g/dl.urea 112 mg/dl, creatinine 6 mg/dl, sodium 119 mEq/ dl, potassium 4 mEq/l, calcium 7 mg/dl, phosphate 6 mg/dl and alkaline phosphatase 300 U/I. Urinalysis shows trace proteinuria with hyaline casts; no red and white cells are seen. Ultrasound shows bilateral small kidneys and the micturating cystourethrogram is normal. The most likely diagnosis is – | Alport's syndrome | Medullary sponge kidney. | Chronic glomerulonephritis. | Nephronophthisis | 3d
| multi | Features seen in this 13 yr. old boy
Short Stature
Nocturnal enuresis
Normal B.P.
Reduced hemoglobin
Hyponatremia (N level in 136-145 meq/dl)
Hypocalcemia (N level is 9-10.5 mg/dl)
Normal potassium level (N is 3.5 to 5 meq/dl)
B/L small kidneys
Increased blood urea (N is 10 - 40 mg/dl)
Increased alkaline phosphates (N is upto 130 IU)
Increased serum creatinine (N is < 1.5 m g/dl)
This pt. gives a classical presentation of nephronophthisis,
About other options
Alport syndrome
It can be easily ruled out as it presents with
Microscopic hematuria (first symptom)
Proteinuria
Sensorineural hearing loss
b/l anterior lenticonus
Medullary sponge kidney
Easily ruled out as the kidneys are normal or increased is size in MSK and also the age of presentation is third or fourth decade.
Chronic glomerulonephritis
pts of CGN usually have heavy proteinuria, frank or occult hematuria and hypertension. | Pediatrics | null | 147 | {
"Correct Answer": "Nephronophthisis",
"Correct Option": "D",
"Options": {
"A": "Alport's syndrome",
"B": "Medullary sponge kidney.",
"C": "Chronic glomerulonephritis.",
"D": "Nephronophthisis"
},
"Question": "A–13–year old boy is referred for evaluation of nocturnal enuresis and short stature. His blood pressure is normal. The hemoglobin level is 8g/dl.urea 112 mg/dl, creatinine 6 mg/dl, sodium 119 mEq/ dl, potassium 4 mEq/l, calcium 7 mg/dl, phosphate 6 mg/dl and alkaline phosphatase 300 U/I. Urinalysis shows trace proteinuria with hyaline casts; no red and white cells are seen. Ultrasound shows bilateral small kidneys and the micturating cystourethrogram is normal. The most likely diagnosis is –"
} | A–13–year old boy is referred for evaluation of nocturnal enuresis and short stature. His blood pressure is normal. The hemoglobin level is 8g/dl.urea 112 mg/dl, creatinine 6 mg/dl, sodium 119 mEq/ dl, potassium 4 mEq/l, calcium 7 mg/dl, phosphate 6 mg/dl and alkaline phosphatase 300 U/I. Urinalysis shows trace proteinuria with hyaline casts; no red and white cells are seen. Ultrasound shows bilateral small kidneys and the micturating cystourethrogram is normal. | The most likely diagnosis is – | {
"A": "Alport's syndrome",
"B": "Medullary sponge kidney.",
"C": "Chronic glomerulonephritis.",
"D": "Nephronophthisis"
} | D. Nephronophthisis |
c42da81b-7c36-4117-b7fe-c65fe5f1e884 | A 27-year-old, previously healthy man suddenly collapses at a party where both legal and illicit drugs are being used. En route to the hospital, he requires resuscitation with defibrillation to establish a normal cardiac rhythm. On physical examination, his temperature is 40deg C; respirations, 30/ min; heart rate, 110/min; and blood pressure, 175/90 mm Hg. He has dilated pupils, a perforated nasal septum, and a prominent callus on the right thumb. CT scan of the head shows an acute right frontal lobe hemorrhage. Which of the following substances is most likely responsible for these findings? | Amphetamine | Barbiturate | Cocaine | Ethanol | 2c
| multi | Cocaine is a powerful vasoconstrictor and has various vascular effects, including ischemic injury to the nasal septum following the route of administration, which is inhalation in this case. Many complications result from the cardiovascular effects, which include arterial vasoconstriction with ischemic injury to the heart, arrhythmias, and central nervous system (CNS) hemorrhages. Hyperthermia is another complication with "excited delirium" in some cases of cocaine intoxication. The callus is caused by flicking a lighter for use of a crack cocaine pipe. Amphetamines are CNS stimulants. Barbiturates are CNS depressants. Acute ethanolism may lead to CNS depression, but it does not have serious immediate cardiac effects. Opiates can depress CNS and respiratory function, and heroin may produce acute pulmonary edema. Marijuana (with active agent delta-9-tetrahydrocannabinol) has no serious acute toxicities. Phencyclidine (PCP) produces acute toxicity that mimics psychosis. | Pathology | Environment & Nutritional Pathology | 145 | {
"Correct Answer": "Cocaine",
"Correct Option": "C",
"Options": {
"A": "Amphetamine",
"B": "Barbiturate",
"C": "Cocaine",
"D": "Ethanol"
},
"Question": "A 27-year-old, previously healthy man suddenly collapses at a party where both legal and illicit drugs are being used. En route to the hospital, he requires resuscitation with defibrillation to establish a normal cardiac rhythm. On physical examination, his temperature is 40deg C; respirations, 30/ min; heart rate, 110/min; and blood pressure, 175/90 mm Hg. He has dilated pupils, a perforated nasal septum, and a prominent callus on the right thumb. CT scan of the head shows an acute right frontal lobe hemorrhage. Which of the following substances is most likely responsible for these findings?"
} | A 27-year-old, previously healthy man suddenly collapses at a party where both legal and illicit drugs are being used. En route to the hospital, he requires resuscitation with defibrillation to establish a normal cardiac rhythm. On physical examination, his temperature is 40deg C; respirations, 30/ min; heart rate, 110/min; and blood pressure, 175/90 mm Hg. He has dilated pupils, a perforated nasal septum, and a prominent callus on the right thumb. CT scan of the head shows an acute right frontal lobe hemorrhage. | Which of the following substances is most likely responsible for these findings? | {
"A": "Amphetamine",
"B": "Barbiturate",
"C": "Cocaine",
"D": "Ethanol"
} | C. Cocaine |
5270a661-5e17-46f5-b499-ae233cc39d9a | An 86-year-old man has become progressively unable to live independently for the past 10 years, and he now requires assistance with bathing, dressing, toileting, feeding, and transfers in and out of chairs and bed. On physical examination, he has no motor or sensory deficits. He cannot give the current date or state where he is. Six months later, he suddenly becomes comatose and dies. At autopsy, there is a large superficial left parietal lobe hemorrhage. Histologic examination of the brain shows numerous neocortical neuritic plaques and neurofibrillary tangles. The peripheral cerebral arteries and the core of each plaque stain positively with Congo red. Which of the following mechanisms is most likely responsible for his disease? | Aggregation of Ab peptide | Conformational change in the prion protein (PrP) | Dopamine deficiency | Expansion of polyglutamine repeats | 0a
| single | Alzheimer's disease (AD) can be complicated by cerebral amyloid angiopathy and terminal hemorrhagic stroke. Formation and aggregation of the Ap peptide are now considered central to the pathogenesis of AD. Ap peptide is derived from the abnormal processing of amyloid precursor protein (APP). When APP, a transmembrane protein, is cleaved by a-secretase within the Ap sequence, followed by g-secretases, a soluble nontoxic fragment is formed. Cleavage of the Ap sequence by b-secretase and then g-secretase gives rise to Ap peptides that aggregate and form the amyloid cores that elicit a microglial and astrocytic response to form neuritic plaques. Conformational change in prion protein leads to Creutzfeldt-Jakob disease, rapidly progressive dementia with spongiform encephalopathy but not neuritic plaques or amyloid deposition. Loss of dopaminergic neurons with a deficiency of dopamine is central to the pathogenesis of Parkinson's disease. Expansion of polyglutamine repeats owing to CAG trinucleotide repeat-expansion underlies Huntington disease. Although abnormally phosphorylated forms of tau protein are found in neurofibrillary tangles seen in AD, there is no mutation of the tau gene, and the tangles are not considered primary in the pathogenesis of AD. Mutation of the tau gene can be found in frontotemporal lobe dementias. | Pathology | Central Nervous System | 155 | {
"Correct Answer": "Aggregation of Ab peptide",
"Correct Option": "A",
"Options": {
"A": "Aggregation of Ab peptide",
"B": "Conformational change in the prion protein (PrP)",
"C": "Dopamine deficiency",
"D": "Expansion of polyglutamine repeats"
},
"Question": "An 86-year-old man has become progressively unable to live independently for the past 10 years, and he now requires assistance with bathing, dressing, toileting, feeding, and transfers in and out of chairs and bed. On physical examination, he has no motor or sensory deficits. He cannot give the current date or state where he is. Six months later, he suddenly becomes comatose and dies. At autopsy, there is a large superficial left parietal lobe hemorrhage. Histologic examination of the brain shows numerous neocortical neuritic plaques and neurofibrillary tangles. The peripheral cerebral arteries and the core of each plaque stain positively with Congo red. Which of the following mechanisms is most likely responsible for his disease?"
} | An 86-year-old man has become progressively unable to live independently for the past 10 years, and he now requires assistance with bathing, dressing, toileting, feeding, and transfers in and out of chairs and bed. On physical examination, he has no motor or sensory deficits. He cannot give the current date or state where he is. Six months later, he suddenly becomes comatose and dies. At autopsy, there is a large superficial left parietal lobe hemorrhage. Histologic examination of the brain shows numerous neocortical neuritic plaques and neurofibrillary tangles. The peripheral cerebral arteries and the core of each plaque stain positively with Congo red. | Which of the following mechanisms is most likely responsible for his disease? | {
"A": "Aggregation of Ab peptide",
"B": "Conformational change in the prion protein (PrP)",
"C": "Dopamine deficiency",
"D": "Expansion of polyglutamine repeats"
} | A. Aggregation of Ab peptide |
b2a9a600-a583-4d2b-967c-759dcd1e4f7c | A 28-year-old man is evaluated in the primary care office for new onset rash on both legs for 1 week. He is a healthy person with no past medical illness and is not taking any medications. There is no history of recent fever but he has noticed occasional gum bleeding and one episode of nosebleed 4 days ago. He does not smoke, drinks alcohol only socially, and does not use any recreational drug. On physical examination, he is a healthy appearing man with no lymphadenopathy or hepatosplenomegaly. Laboratory studies reveal hemoglobin 14.8 gm/dL, hematocrit 42, MCV 86 fL, leukocyte count 6,000/mL, and platelet 22,000/mL. Liver function and renal function studies are normal. Peripheral smear reveals decrease in platelet count and no red cell abnormalities. What is the most probable diagnosis? | Acute lymphoblastic leukemia | Immune thrombocytopenic purpura | Leukemoid reaction | Chronic lymphocytic leukemia | 1b
| multi | Chronic lymphocytic leukemia is monoclonal proliferation of mature lymphocytes, often found incidentally during routine checkup. Some patients may have constitutional symptoms such as weight loss, fever, night sweats, and fatigue. Painless lymphadenopathy is the most common physical finding. Hepatosplenomegaly can occur as well. Lymphocytosis is the most striking feature, and peripheral smear usually contains numerous mature lymphocytes. Bone marrow usually contains lymphocytes accounting for >30% of all nucleated cells.Immune thrombocytopenic purpura is a common cause of thrombocytopenia in otherwise normal individual; it is caused by immune-mediated destruction of platelets by antibodies against platelet antigens. Other causes of thrombocytopenia including sepsis, viral and other infections, drugs, pregnancy, liver disease, and hypersplenism should be ruled out. Patients may present with petechiae, purpura, epistaxis, or severe hemorrhage. Glucocorticoids and intravenous immune globulin (IVIG) are usually the first choice to treat this condition. Anti-D (RhoGAM) can be used instead of IVIG in patients with Rh-positive blood. Thrombotic thrombocytopenic purpura (TTP) usually presents with microangiopathic hemolytic anemia, nonimmune thrombocytopenia, fever, renal insufficiency, and CNS involvement. The peripheral smear in TTP contains schistocytes and decreased number of platelets.Hemophilia is an X-linked recessive disorder resulting is Factor VIII or Factor IX deficiency. It mainly manifests as bleeding in joints, muscles, subcutaneous tissue, and from the gastrointestinal tract; the bleeding may be spontaneous or trauma-related, depending on the severity of deficiency. A normal platelet count and prothrombin time but prolonged activated partial thromboplastin time (aPTT) are suggestive of hemophilia. Mild cases may escape detection until adulthood. Obtaining a detailed family history is very important. Specific assays for Factor VIII and Factor IX will confirm the diagnosis.Acute lymphoblastic leukemia is primarily a malignancy of childhood and young adulthood and presents commonly with bone pain and lymph-adenopathy. The peripheral smear and bone marrow usually contain a large number of lymphoblasts. Leukemoid reaction is a reactive leukocytosis with increased number of myelocytes, metamyelocytes, and bands in the peripheral circulation. | Medicine | Oncology | 193 | {
"Correct Answer": "Immune thrombocytopenic purpura",
"Correct Option": "B",
"Options": {
"A": "Acute lymphoblastic leukemia",
"B": "Immune thrombocytopenic purpura",
"C": "Leukemoid reaction",
"D": "Chronic lymphocytic leukemia"
},
"Question": "A 28-year-old man is evaluated in the primary care office for new onset rash on both legs for 1 week. He is a healthy person with no past medical illness and is not taking any medications. There is no history of recent fever but he has noticed occasional gum bleeding and one episode of nosebleed 4 days ago. He does not smoke, drinks alcohol only socially, and does not use any recreational drug. On physical examination, he is a healthy appearing man with no lymphadenopathy or hepatosplenomegaly. Laboratory studies reveal hemoglobin 14.8 gm/dL, hematocrit 42, MCV 86 fL, leukocyte count 6,000/mL, and platelet 22,000/mL. Liver function and renal function studies are normal. Peripheral smear reveals decrease in platelet count and no red cell abnormalities. What is the most probable diagnosis?"
} | A 28-year-old man is evaluated in the primary care office for new onset rash on both legs for 1 week. He is a healthy person with no past medical illness and is not taking any medications. There is no history of recent fever but he has noticed occasional gum bleeding and one episode of nosebleed 4 days ago. He does not smoke, drinks alcohol only socially, and does not use any recreational drug. On physical examination, he is a healthy appearing man with no lymphadenopathy or hepatosplenomegaly. Laboratory studies reveal hemoglobin 14.8 gm/dL, hematocrit 42, MCV 86 fL, leukocyte count 6,000/mL, and platelet 22,000/mL. Liver function and renal function studies are normal. Peripheral smear reveals decrease in platelet count and no red cell abnormalities. | What is the most probable diagnosis? | {
"A": "Acute lymphoblastic leukemia",
"B": "Immune thrombocytopenic purpura",
"C": "Leukemoid reaction",
"D": "Chronic lymphocytic leukemia"
} | B. Immune thrombocytopenic purpura |
29c81ebc-ef77-4793-8f00-5e281b9ae6b7 | A 58-year-old man has the sudden onset late one evening of severe pain in his left great toe. There is no history of trauma. On examination there is edema with erythema and pain on movement of the left 1st metatarsophalangeal joint, but there is no overlying skin ulceration. A joint aspirate is performed and on microscopic examination reveals numerous neutrophils. Over the next 3 weeks, he has two more similar episodes. On physical examination between these attacks, there is minimal loss of joint mobility. Which of the following laboratory test findings is most characteristic for his underlying disease process? | Hyperglycemia | Positive antinuclear antibody | Hyperuricemia | Hypercalcemia | 2c
| single | Many patients with gout will have hyperuricemia, but not all. The big toe is the most common joint involved with gout. Acute gouty attacks are associated with intense pain from acute inflammation.
Incorrect 1. Hyperglycemia is a feature of diabetes mellitus, which is associated with peripheral vascular disease that increases the risk for foot ulcerations and osteomyelitis.
Incorrect 2. The arthralgias common to many autoimmune diseases with a positive ANA, such as systemic lupus erythematosus, are not usually associated with joint swelling, redness, or deformity.
Incorrect 4. There can be bone luceny with hyperparathyroidism, but the joints are not greatly affected, nor is there swelling or redness. | Unknown | null | 130 | {
"Correct Answer": "Hyperuricemia",
"Correct Option": "C",
"Options": {
"A": "Hyperglycemia",
"B": "Positive antinuclear antibody",
"C": "Hyperuricemia",
"D": "Hypercalcemia"
},
"Question": "A 58-year-old man has the sudden onset late one evening of severe pain in his left great toe. There is no history of trauma. On examination there is edema with erythema and pain on movement of the left 1st metatarsophalangeal joint, but there is no overlying skin ulceration. A joint aspirate is performed and on microscopic examination reveals numerous neutrophils. Over the next 3 weeks, he has two more similar episodes. On physical examination between these attacks, there is minimal loss of joint mobility. Which of the following laboratory test findings is most characteristic for his underlying disease process?"
} | A 58-year-old man has the sudden onset late one evening of severe pain in his left great toe. There is no history of trauma. On examination there is edema with erythema and pain on movement of the left 1st metatarsophalangeal joint, but there is no overlying skin ulceration. A joint aspirate is performed and on microscopic examination reveals numerous neutrophils. Over the next 3 weeks, he has two more similar episodes. On physical examination between these attacks, there is minimal loss of joint mobility. | Which of the following laboratory test findings is most characteristic for his underlying disease process? | {
"A": "Hyperglycemia",
"B": "Positive antinuclear antibody",
"C": "Hyperuricemia",
"D": "Hypercalcemia"
} | C. Hyperuricemia |
a4fd8d12-a3db-4bb7-9825-b16f91703184 | A 17-year-old man presents to the clinic with new symptoms of fatigue, malaise, fever, and a sore throat. He has no significant past medical history and is not on any medications. Physical examination is entirely normal except for enlarged, palpable cervical lymph nodes. He reports no weight loss or night sweats. Laboratory investigations include a normal chest x-ray, negative throat swab, but abnormal blood film with atypical lymphocytes. The hemoglobin is 15.5 g/dL; hematocrit 42%; platelets 290,000/mL; WBC 10500/mL, with 45% segmented neutrophils, 1% eosinophils, and 54% lymphocytes, of which 36% were atypical. Which of the following is the most appropriate initial diagnostic test? | lymph node biopsy | bone marrow | erythrocyte sedimentation rate (ESR) | heterophil antibody (Monospot) test | 3d
| multi | Heterophil antibodies are present in 50% of children and 90%-95% of adolescents and adults with infectious mononucleosis. Monospot tests are the best diagnostic tools but may not turn positive until the second or third week of the illness. The presence of IgG antibodies by the indirect immunofluorescence test indicates recent or prior EBV infection. IgM antibodies indicate recent infection only. Specific EBV antibodies and cultures are rarely used. | Medicine | Infection | 181 | {
"Correct Answer": "heterophil antibody (Monospot) test",
"Correct Option": "D",
"Options": {
"A": "lymph node biopsy",
"B": "bone marrow",
"C": "erythrocyte sedimentation rate (ESR)",
"D": "heterophil antibody (Monospot) test"
},
"Question": "A 17-year-old man presents to the clinic with new symptoms of fatigue, malaise, fever, and a sore throat. He has no significant past medical history and is not on any medications. Physical examination is entirely normal except for enlarged, palpable cervical lymph nodes. He reports no weight loss or night sweats. Laboratory investigations include a normal chest x-ray, negative throat swab, but abnormal blood film with atypical lymphocytes. The hemoglobin is 15.5 g/dL; hematocrit 42%; platelets 290,000/mL; WBC 10500/mL, with 45% segmented neutrophils, 1% eosinophils, and 54% lymphocytes, of which 36% were atypical. Which of the following is the most appropriate initial diagnostic test?"
} | A 17-year-old man presents to the clinic with new symptoms of fatigue, malaise, fever, and a sore throat. He has no significant past medical history and is not on any medications. Physical examination is entirely normal except for enlarged, palpable cervical lymph nodes. He reports no weight loss or night sweats. Laboratory investigations include a normal chest x-ray, negative throat swab, but abnormal blood film with atypical lymphocytes. The hemoglobin is 15.5 g/dL; hematocrit 42%; platelets 290,000/mL; WBC 10500/mL, with 45% segmented neutrophils, 1% eosinophils, and 54% lymphocytes, of which 36% were atypical. | Which of the following is the most appropriate initial diagnostic test? | {
"A": "lymph node biopsy",
"B": "bone marrow",
"C": "erythrocyte sedimentation rate (ESR)",
"D": "heterophil antibody (Monospot) test"
} | D. heterophil antibody (Monospot) test |
89ab6795-8533-4097-afcd-b2499cc76e8d | A 72-year-old man with COPD develops acute shortness of breath and presents to the hospital. He appears uncomfortable: blood pressure is 120/90 mm Hg, pulse 100/min, oxygen saturation 85% on room air. On examination of the chest, there is absent fremitus, absent breath sounds, and hyper resonant percussion of the right lung. The trachea is shifted to the left.For the above patient with abnormal pulmonary physical findings, select the most likely diagnosis. | acute asthmatic attack | complete pneumothorax | large pleural effusion | atelectasis | 1b
| multi | Careful physical examination can be very useful in diagnosing many common pulmonary disorders. Atelectasis and large pleural effusions both can present with decreased fremitus, dullness or flatness to percussion, and absent breath sounds. In atelectasis, tracheal shift, if present, is toward the affected side, and the opposite for a large pleural effusion. Asthma's most typical manifestations are prolonged expiration and diffuse wheezing. However, impaired expansion, decreased fremitus, hyperresonance, and low diaphragms can also be found. A complete pneumothorax results in absent fremitus, hyperresonance or tympany, and absent breath sounds. Lobar pneumonia is characterized by consolidation with increased fremitus, dullness, and auscultatory findings of bronchial breathing, bronchophony, pectoriloquy, and crackles. | Medicine | Respiratory | 110 | {
"Correct Answer": "complete pneumothorax",
"Correct Option": "B",
"Options": {
"A": "acute asthmatic attack",
"B": "complete pneumothorax",
"C": "large pleural effusion",
"D": "atelectasis"
},
"Question": "A 72-year-old man with COPD develops acute shortness of breath and presents to the hospital. He appears uncomfortable: blood pressure is 120/90 mm Hg, pulse 100/min, oxygen saturation 85% on room air. On examination of the chest, there is absent fremitus, absent breath sounds, and hyper resonant percussion of the right lung. The trachea is shifted to the left.For the above patient with abnormal pulmonary physical findings, select the most likely diagnosis."
} | A 72-year-old man with COPD develops acute shortness of breath and presents to the hospital. He appears uncomfortable: blood pressure is 120/90 mm Hg, pulse 100/min, oxygen saturation 85% on room air. On examination of the chest, there is absent fremitus, absent breath sounds, and hyper resonant percussion of the right lung. | The trachea is shifted to the left.For the above patient with abnormal pulmonary physical findings, select the most likely diagnosis. | {
"A": "acute asthmatic attack",
"B": "complete pneumothorax",
"C": "large pleural effusion",
"D": "atelectasis"
} | B. complete pneumothorax |
1476b7a3-8969-47b3-8d68-dfdfcd296042 | A mother gave bih to a male baby in her home 2 days ago. The mother complaints that she is anxious, unable to tolerate heat and is fatigued most of the time, and repos that she has not gained much weight despite having an increased appetite. She also told that before pregnancy too she had similar complaints. On examination, she has a tremor, her HR is 100 bpm and has bulging eyes. Based on mother's findings, baby is most likely at risk for development of which of the following? | Hea failure | Constipation | Third-degree hea block | Macrocephaly | 0a
| single | Neonate is probably at risk for neonatal thyrotoxicosis. Neonatal thyrotoxicosis: Occurs due of maternally acquired thyrotropin receptor-stimulating antibody (TRSAb). Usually disappears within 2 to 4 months as the concentration of TRSAb falls. Unlike TRSAb, TSH does not cross the placenta. All forms of thyrotoxicosis are more common in females, except for neonatal thyrotoxicosis, which has an equal sex distribution. C/F: Tachycardia, tachypnea, irritability, low bih weight with microcephaly, severe vomiting and diarrhoea, thrombocytopenia, jaundice, hepatosplenomegaly and hea failure. Eye signs are not commonly seen in children Third-degree hea block is sometimes seen in infants born to mothers with SLE. | Pediatrics | Thyroid disorders | 110 | {
"Correct Answer": "Hea failure",
"Correct Option": "A",
"Options": {
"A": "Hea failure",
"B": "Constipation",
"C": "Third-degree hea block",
"D": "Macrocephaly"
},
"Question": "A mother gave bih to a male baby in her home 2 days ago. The mother complaints that she is anxious, unable to tolerate heat and is fatigued most of the time, and repos that she has not gained much weight despite having an increased appetite. She also told that before pregnancy too she had similar complaints. On examination, she has a tremor, her HR is 100 bpm and has bulging eyes. Based on mother's findings, baby is most likely at risk for development of which of the following?"
} | A mother gave bih to a male baby in her home 2 days ago. The mother complaints that she is anxious, unable to tolerate heat and is fatigued most of the time, and repos that she has not gained much weight despite having an increased appetite. She also told that before pregnancy too she had similar complaints. On examination, she has a tremor, her HR is 100 bpm and has bulging eyes. | Based on mother's findings, baby is most likely at risk for development of which of the following? | {
"A": "Hea failure",
"B": "Constipation",
"C": "Third-degree hea block",
"D": "Macrocephaly"
} | A. Hea failure |
82148d5e-8855-47ae-a824-a6e3447496e9 | A 30-year-old male patient presents with complaints of weakness in right upper and both lower limbs for last 4 months. He developed digital infarcts involving 2nd and 3rd fingers on right side and 5th finger on left side. On examination. BP was 160 140 mm Hg. all peripheral pulses were palpable and there was asymmetrical neuropath). Investigations showed Hb 12 gm%, TLC 12,000 per cu. mm. Platelets 4.30.000 and ESR 49 mm. Urine examination showed Proteinuria and RBC-10-15 hpf with no casts. What is the most likely diagnosis - | Polyarteritis nodosa | Systemic lupus erythematosus | Wegener's granulomatosis | Mixed cryoglobulinemia | 0a
| multi | null | Medicine | null | 155 | {
"Correct Answer": "Polyarteritis nodosa",
"Correct Option": "A",
"Options": {
"A": "Polyarteritis nodosa",
"B": "Systemic lupus erythematosus",
"C": "Wegener's granulomatosis",
"D": "Mixed cryoglobulinemia"
},
"Question": "A 30-year-old male patient presents with complaints of weakness in right upper and both lower limbs for last 4 months. He developed digital infarcts involving 2nd and 3rd fingers on right side and 5th finger on left side. On examination. BP was 160 140 mm Hg. all peripheral pulses were palpable and there was asymmetrical neuropath). Investigations showed Hb 12 gm%, TLC 12,000 per cu. mm. Platelets 4.30.000 and ESR 49 mm. Urine examination showed Proteinuria and RBC-10-15 hpf with no casts. What is the most likely diagnosis -"
} | A 30-year-old male patient presents with complaints of weakness in right upper and both lower limbs for last 4 months. He developed digital infarcts involving 2nd and 3rd fingers on right side and 5th finger on left side. On examination. BP was 160 140 mm Hg. all peripheral pulses were palpable and there was asymmetrical neuropath). Investigations showed Hb 12 gm%, TLC 12,000 per cu. mm. Platelets 4.30.000 and ESR 49 mm. Urine examination showed Proteinuria and RBC-10-15 hpf with no casts. | What is the most likely diagnosis - | {
"A": "Polyarteritis nodosa",
"B": "Systemic lupus erythematosus",
"C": "Wegener's granulomatosis",
"D": "Mixed cryoglobulinemia"
} | A. Polyarteritis nodosa |
cf044375-49eb-486f-a17b-7a50d80d0176 | A 32-year-old woman goes to an emergency depament because she has developed severe, watery diarrhea. About 36 hours later, she developed vomiting and an abrupt, painless, watery diarrhea. The volume of diarrhea has been copious, and she has subsequently developed intense thirst, oliguria, muscle cramps, and weakness. At the time of being seen in the emergency depament, she is noted to have marked loss of tissue turgor, sunken eyes, and wrinkling of the skin of her fingers. Laboratory studies demonstrate hemoconcentration and severe metabolic acidosis with potassium depletion. An organism cultured from the patient's stool is subsequently characterized as an oxidase-positive, gram-negative curved rod with polar flagella that shows "shooting star" mobility and grows best on TCBS medium. Which of the following is the most likely pathogen? | Pseudomonas | Salmonella | Shigella | Vibrio cholerae | 3d
| single | The features noted are those of Vibrio cholerae, the causative organism of the severe diarrheal disease, cholera. The diarrhea is the result of the action of the cholera enterotoxin, which acts by ADP-ribosylating adenylate cyclase, leading to increased cyclic AMP with secondary increased efflux of Cl- and H2O. World-wide, cholera is usually spread by fecally contaminated water. Pseudomonas is an oxidase-positive, gram-negative rod that characteristically produces the blue pigment, pyocyanin. Salmonella is a motile, gram-negative rod that is a non-lactose fermenter that produces H2S. Shigella are non-motile gram-negative rods. | Microbiology | null | 179 | {
"Correct Answer": "Vibrio cholerae",
"Correct Option": "D",
"Options": {
"A": "Pseudomonas",
"B": "Salmonella",
"C": "Shigella",
"D": "Vibrio cholerae"
},
"Question": "A 32-year-old woman goes to an emergency depament because she has developed severe, watery diarrhea. About 36 hours later, she developed vomiting and an abrupt, painless, watery diarrhea. The volume of diarrhea has been copious, and she has subsequently developed intense thirst, oliguria, muscle cramps, and weakness. At the time of being seen in the emergency depament, she is noted to have marked loss of tissue turgor, sunken eyes, and wrinkling of the skin of her fingers. Laboratory studies demonstrate hemoconcentration and severe metabolic acidosis with potassium depletion. An organism cultured from the patient's stool is subsequently characterized as an oxidase-positive, gram-negative curved rod with polar flagella that shows \"shooting star\" mobility and grows best on TCBS medium. Which of the following is the most likely pathogen?"
} | A 32-year-old woman goes to an emergency depament because she has developed severe, watery diarrhea. About 36 hours later, she developed vomiting and an abrupt, painless, watery diarrhea. The volume of diarrhea has been copious, and she has subsequently developed intense thirst, oliguria, muscle cramps, and weakness. At the time of being seen in the emergency depament, she is noted to have marked loss of tissue turgor, sunken eyes, and wrinkling of the skin of her fingers. Laboratory studies demonstrate hemoconcentration and severe metabolic acidosis with potassium depletion. An organism cultured from the patient's stool is subsequently characterized as an oxidase-positive, gram-negative curved rod with polar flagella that shows "shooting star" mobility and grows best on TCBS medium. | Which of the following is the most likely pathogen? | {
"A": "Pseudomonas",
"B": "Salmonella",
"C": "Shigella",
"D": "Vibrio cholerae"
} | D. Vibrio cholerae |
6de20134-c86c-4394-8e0b-42bb5628f16d | A 35-year-old woman complains of aching all over. She sleeps poorly and all her muscles and joints hurt. Her symptoms have progressed over several years. She reports that she is desperate because pain and weakness often cause her to drop things. Physical examination shows multiple points of tenderness over the neck, shoulders, elbows, and wrists. There is no joint swelling or deformity. A complete blood count and ESR are normal. Rheumatoid factor is negative. Which of the following is the best therapeutic option in this patient? | Graded aerobic exercise | Prednisone | Weekly methotrexate | Hydroxychloroquine | 0a
| multi | The patient's multiple tender points, associated sleep disturbance, and lack of joint or muscle findings make fibromyalgia a likely diagnosis. Patients with fibromyalgia often report dropping things due to pain and weakness, but objective muscle weakness is not present on examination. The diagnosis hinges on the presence of multiple tender points in the absence of any other disease likely to cause musculoskeletal symptoms. CBC and ESR are characteristically normal. Cognitive behavioral therapy and graded aerobic exercise programs have been demonstrated to relieve symptoms. Tricyclic antidepressants are considered if medication is needed and may help restore sleep. Cyclobenzaprine is a next step medication. If both of those fail, then a trial of gabapentin, pregabalin, or duloxetine can be undertaken. Aspirin, other anti-inflammatory drugs (including corticosteroids), and DMARDs (such as methotrexate or hydroxychloroquine) are not helpful, nor are simple stretching/flexibility exercises. Of note, rheumatoid factor and ANAs occur in a small number of normal individuals. They are more frequent in women and increase in frequency with age. It is not uncommon for an individual with fibromyalgia and an incidentally positive RF or ANA to be misdiagnosed as having collagen vascular disease. Therefore, it is necessary to be careful to separate subjective tenderness on examination from objective musculoskeletal findings and to assiduously search for other criteria before diagnosing RA, SLE, or other collagen vascular disease. | Medicine | Immunology and Rheumatology | 109 | {
"Correct Answer": "Graded aerobic exercise",
"Correct Option": "A",
"Options": {
"A": "Graded aerobic exercise",
"B": "Prednisone",
"C": "Weekly methotrexate",
"D": "Hydroxychloroquine"
},
"Question": "A 35-year-old woman complains of aching all over. She sleeps poorly and all her muscles and joints hurt. Her symptoms have progressed over several years. She reports that she is desperate because pain and weakness often cause her to drop things. Physical examination shows multiple points of tenderness over the neck, shoulders, elbows, and wrists. There is no joint swelling or deformity. A complete blood count and ESR are normal. Rheumatoid factor is negative. Which of the following is the best therapeutic option in this patient?"
} | A 35-year-old woman complains of aching all over. She sleeps poorly and all her muscles and joints hurt. Her symptoms have progressed over several years. She reports that she is desperate because pain and weakness often cause her to drop things. Physical examination shows multiple points of tenderness over the neck, shoulders, elbows, and wrists. There is no joint swelling or deformity. A complete blood count and ESR are normal. Rheumatoid factor is negative. | Which of the following is the best therapeutic option in this patient? | {
"A": "Graded aerobic exercise",
"B": "Prednisone",
"C": "Weekly methotrexate",
"D": "Hydroxychloroquine"
} | A. Graded aerobic exercise |
ea5a1191-50a5-4261-882b-d640078e0984 | A 30 years old male reported with chief complaint of constant radiating, gnawing pain that is intensified by eating spicy foods and chewing. He also reported a "metallic" foul taste and an excessive amount of "pasty"saliva. A general examination revealed fever and increased pulse rate. Intra-oral examination showed punched-out, crater like depressions at the crest of the interdental gingival papillae, covered by a gray pseudomembranous slough, in the upper anterior teeth.
The most likely infection is | Necrotizing ulcerative gingivitis | Localized aggressive periodontitis | Acute herpetic gingivostomatitis | Desquamative gingivitis | 0a
| multi | null | Dental | null | 114 | {
"Correct Answer": "Necrotizing ulcerative gingivitis",
"Correct Option": "A",
"Options": {
"A": "Necrotizing ulcerative gingivitis",
"B": "Localized aggressive periodontitis",
"C": "Acute herpetic gingivostomatitis",
"D": "Desquamative gingivitis"
},
"Question": "A 30 years old male reported with chief complaint of constant radiating, gnawing pain that is intensified by eating spicy foods and chewing. He also reported a \"metallic\" foul taste and an excessive amount of \"pasty\"saliva. A general examination revealed fever and increased pulse rate. Intra-oral examination showed punched-out, crater like depressions at the crest of the interdental gingival papillae, covered by a gray pseudomembranous slough, in the upper anterior teeth.\n\nThe most likely infection is"
} | A 30 years old male reported with chief complaint of constant radiating, gnawing pain that is intensified by eating spicy foods and chewing. He also reported a "metallic" foul taste and an excessive amount of "pasty"saliva. A general examination revealed fever and increased pulse rate. | Intra-oral examination showed punched-out, crater like depressions at the crest of the interdental gingival papillae, covered by a gray pseudomembranous slough, in the upper anterior teeth.
The most likely infection is | {
"A": "Necrotizing ulcerative gingivitis",
"B": "Localized aggressive periodontitis",
"C": "Acute herpetic gingivostomatitis",
"D": "Desquamative gingivitis"
} | A. Necrotizing ulcerative gingivitis |
d326c818-0bf8-42fd-92a1-f6e0942fa1cf | A 47-year-old HIV-positive man is brought to the emergency room because of weakness. The patient has HIV nephropathy and adrenal insufficiency. He takes trimethoprim-sulfamethoxazole for PCP prophylaxis and is on triple-agent antiretroviral treatment. He was recently started on spironolactone for ascites due to alcoholic liver disease. Physical examination reveals normal vital signs, but his muscles are diffusely weak. Frequent extrasystoles are noted. He has mild ascites and 1+ peripheral edema. Laboratory studies show a serum creatinine of 2.5 with a potassium value of 7.3 mEq/L. ECG shows peaking of the T-waves and QRS widening to 0.14. What is the most important immediate treatment? | Sodium polystyrene sulfonate (Kayexalate) | Acute hemodialysis | IV normal saline | IV calcium gluconate | 3d
| single | This patient has life-threatening hyperkalemia as suggested by the ECG changes in association with documented hyperkalemia. Death can occur within minutes as a result of ventricular fibrillation, and immediate treatment is mandatory. Intravenous calcium is given to combat the membrane effects of the hyperkalemia, and measures to shift, potassium acutely into the cells must be instituted as well. IV regular insulin 10 units and (unless the patient is already hyperglycemic) IV glucose (usually 25 g) can lower the serum potassium level by 0.5 to 1.0 mEq/L. Nebulized albuterol is often used and is probably more effective than IV sodium bicarbonate. It is crucial to remember that measures to promote potassium loss from the body (Kayexalate, furosemide, or dialysis), although important in the long run, take hours to work. These measures will not promptly counteract the membrane irritability of hyperkalemia. IV normal saline will not lower the serum potassium level. | Medicine | Kidney | 173 | {
"Correct Answer": "IV calcium gluconate",
"Correct Option": "D",
"Options": {
"A": "Sodium polystyrene sulfonate (Kayexalate)",
"B": "Acute hemodialysis",
"C": "IV normal saline",
"D": "IV calcium gluconate"
},
"Question": "A 47-year-old HIV-positive man is brought to the emergency room because of weakness. The patient has HIV nephropathy and adrenal insufficiency. He takes trimethoprim-sulfamethoxazole for PCP prophylaxis and is on triple-agent antiretroviral treatment. He was recently started on spironolactone for ascites due to alcoholic liver disease. Physical examination reveals normal vital signs, but his muscles are diffusely weak. Frequent extrasystoles are noted. He has mild ascites and 1+ peripheral edema. Laboratory studies show a serum creatinine of 2.5 with a potassium value of 7.3 mEq/L. ECG shows peaking of the T-waves and QRS widening to 0.14. What is the most important immediate treatment?"
} | A 47-year-old HIV-positive man is brought to the emergency room because of weakness. The patient has HIV nephropathy and adrenal insufficiency. He takes trimethoprim-sulfamethoxazole for PCP prophylaxis and is on triple-agent antiretroviral treatment. He was recently started on spironolactone for ascites due to alcoholic liver disease. Physical examination reveals normal vital signs, but his muscles are diffusely weak. Frequent extrasystoles are noted. He has mild ascites and 1+ peripheral edema. Laboratory studies show a serum creatinine of 2.5 with a potassium value of 7.3 mEq/L. ECG shows peaking of the T-waves and QRS widening to 0.14. | What is the most important immediate treatment? | {
"A": "Sodium polystyrene sulfonate (Kayexalate)",
"B": "Acute hemodialysis",
"C": "IV normal saline",
"D": "IV calcium gluconate"
} | D. IV calcium gluconate |
370b177b-dc10-473a-b740-ab8dc536c5f0 | A 42-year-old female executive is referred to the sleep clinic with jaw pain. She complains that after she arrives home at night around 10 pm she frequently drinks 3-4 gin and tonics to help “quiet her mind.” She wakes up the next morning around 3am to read the international stock market news, at which point she states her teeth ache an unbearable amount. A study is performed on the patient and it is noted that she grinds her teeth and mutters during roughly half of her sleep.
Which of the following would you expect to see on her EEG and at which stage of sleep would you expect her jaw pain to be caused? | Alpha waves, N2 | Beta waves, N3 | Delta waves, N3 | Sleep spindles, N2 | 3d
| single | null | Social & Preventive Medicine | null | 137 | {
"Correct Answer": "Sleep spindles, N2",
"Correct Option": "D",
"Options": {
"A": "Alpha waves, N2",
"B": "Beta waves, N3",
"C": "Delta waves, N3",
"D": "Sleep spindles, N2"
},
"Question": "A 42-year-old female executive is referred to the sleep clinic with jaw pain. She complains that after she arrives home at night around 10 pm she frequently drinks 3-4 gin and tonics to help “quiet her mind.” She wakes up the next morning around 3am to read the international stock market news, at which point she states her teeth ache an unbearable amount. A study is performed on the patient and it is noted that she grinds her teeth and mutters during roughly half of her sleep. \n\nWhich of the following would you expect to see on her EEG and at which stage of sleep would you expect her jaw pain to be caused?"
} | A 42-year-old female executive is referred to the sleep clinic with jaw pain. She complains that after she arrives home at night around 10 pm she frequently drinks 3-4 gin and tonics to help “quiet her mind.” She wakes up the next morning around 3am to read the international stock market news, at which point she states her teeth ache an unbearable amount. A study is performed on the patient and it is noted that she grinds her teeth and mutters during roughly half of her sleep. | Which of the following would you expect to see on her EEG and at which stage of sleep would you expect her jaw pain to be caused? | {
"A": "Alpha waves, N2",
"B": "Beta waves, N3",
"C": "Delta waves, N3",
"D": "Sleep spindles, N2"
} | D. Sleep spindles, N2 |
a3b4950e-131b-4154-b8b3-42cf15f7d032 | Mirizzi syndrome, all are true except -Gallstone ulcerating into common ductImpacted in cystic ductSevere pericholecystic inflammationObsturctive jaundiceAns: None > CSolution:Ans. is None > 'c' i.e., None > Severe pericholecystic inflammation * Options A, B, D are definitely true.* One can also expect pericholecystic inflammation if the stone ulcerates in Mirizzi SyndromeMirizzi syndrome'common hepatic duct obstruction caused by an extrinsic compression from an impacted stone in the cystic duct or Hartmann's pouch of the gallbladder'Type I mirizzi syndromeType II mirizzi syndromeAn impacted stone in the gallbladder infundibulum or cystic duct can compress the bile duct, usually at the level of the common hepatic duct.A stone can erode from the gallbladder or cystic duct into the common hepatic duct, resulting in a cholecystochole- dochal fistula.ClinicalPatients are seen with symptoms of acute cholecystitis but with the additional finding of hyperbilirubinemia and elevated alkaline phosphatase.ManagementLaproscopic approach is not recommended as it results in high conversion rate and high complication rates.Open cholecystectomy is the gold standard for treatment when this condition is identified preoperatively.In the acute setting, the biliary obstruction often resolves after cholecystectomy and resolution of the inflammatory process.If inflammation has obliterated the triangle of Calot, a partial cholecystectomy with removal of any stones may be all that is possible and usually resolves the condition.Best initial test for achalasia cardia - | Barium meal | Bariun meal follow through | Enteroclysis | Barium swallow | 3d
| multi | Ans. is 'd' i.e., Barium swallow Diagnosis of achalasia* Chest x-ray - shows absence of gastric air bubble, an air-fluid level in the mediastinum in the upright position representing retained food in oesophagus.* Barium swallow - shows dilated esophagus with tapering narrowing in the terminal end of esophagus described as 'birds' beak' appearance. Fluoroscopy shows loss of normal peristalsis in the lower two thirds of esophagus.* Endoscopy may be done to rule out any secondary cause of achlasia eg. carcinoma, stricture at LES.* Manometry It's the most confrmatory investigation. It is able to distinguish between various forms of motor disorders of esophagus manometric characteristics of Achlasia# Incomplete lower esophageal sphincter relaxation (< 75% relaxation)# Elevated LES pressure# Loss of primary peristaltic waves in the esophageal body, but disorganized muscular activity may be present.# Increased intraesophageal baseline pressure relative to gastric baseline.* Cholecystokinin (CCK) which normally causes a fall in the sphincter pressure, paradoxically causes contraction of the LES (the CCK test). This paradoxical response occurs because, in achlasia the neurally transmitted inhibitory effect of CCK is absent owing to the loss of inhibitory neurons. | Surgery | Oesophagus | 352 | {
"Correct Answer": "Barium swallow",
"Correct Option": "D",
"Options": {
"A": "Barium meal",
"B": "Bariun meal follow through",
"C": "Enteroclysis",
"D": "Barium swallow"
},
"Question": "Mirizzi syndrome, all are true except -Gallstone ulcerating into common ductImpacted in cystic ductSevere pericholecystic inflammationObsturctive jaundiceAns: None > CSolution:Ans. is None > 'c' i.e., None > Severe pericholecystic inflammation * Options A, B, D are definitely true.* One can also expect pericholecystic inflammation if the stone ulcerates in Mirizzi SyndromeMirizzi syndrome'common hepatic duct obstruction caused by an extrinsic compression from an impacted stone in the cystic duct or Hartmann's pouch of the gallbladder'Type I mirizzi syndromeType II mirizzi syndromeAn impacted stone in the gallbladder infundibulum or cystic duct can compress the bile duct, usually at the level of the common hepatic duct.A stone can erode from the gallbladder or cystic duct into the common hepatic duct, resulting in a cholecystochole- dochal fistula.ClinicalPatients are seen with symptoms of acute cholecystitis but with the additional finding of hyperbilirubinemia and elevated alkaline phosphatase.ManagementLaproscopic approach is not recommended as it results in high conversion rate and high complication rates.Open cholecystectomy is the gold standard for treatment when this condition is identified preoperatively.In the acute setting, the biliary obstruction often resolves after cholecystectomy and resolution of the inflammatory process.If inflammation has obliterated the triangle of Calot, a partial cholecystectomy with removal of any stones may be all that is possible and usually resolves the condition.Best initial test for achalasia cardia -"
} | Mirizzi syndrome, all are true except -Gallstone ulcerating into common ductImpacted in cystic ductSevere pericholecystic inflammationObsturctive jaundiceAns: None > CSolution:Ans. | is None > 'c' i.e., None > Severe pericholecystic inflammation * Options A, B, D are definitely true.* One can also expect pericholecystic inflammation if the stone ulcerates in Mirizzi SyndromeMirizzi syndrome'common hepatic duct obstruction caused by an extrinsic compression from an impacted stone in the cystic duct or Hartmann's pouch of the gallbladder'Type I mirizzi syndromeType II mirizzi syndromeAn impacted stone in the gallbladder infundibulum or cystic duct can compress the bile duct, usually at the level of the common hepatic duct.A stone can erode from the gallbladder or cystic duct into the common hepatic duct, resulting in a cholecystochole- dochal fistula.ClinicalPatients are seen with symptoms of acute cholecystitis but with the additional finding of hyperbilirubinemia and elevated alkaline phosphatase.ManagementLaproscopic approach is not recommended as it results in high conversion rate and high complication rates.Open cholecystectomy is the gold standard for treatment when this condition is identified preoperatively.In the acute setting, the biliary obstruction often resolves after cholecystectomy and resolution of the inflammatory process.If inflammation has obliterated the triangle of Calot, a partial cholecystectomy with removal of any stones may be all that is possible and usually resolves the condition.Best initial test for achalasia cardia - | {
"A": "Barium meal",
"B": "Bariun meal follow through",
"C": "Enteroclysis",
"D": "Barium swallow"
} | D. Barium swallow |
798bea47-d43e-4df4-9825-fdb9c24c2e87 | A 34-year-old man who works as a carpenter presents with symptoms of jaw discomfort, dysphagia, and pain as well as stiffness in his neck, back, and shoulders. On examination, he is unable to open his jaw, his proximal limb muscles are stiff as is his abdomen and back, but the hands and feet are relatively spared. He occasionally has violent generalized muscles spasms that cause him to stop breathing, but there is no loss of consciousness. A clinical diagnosis is made and he is treated with antibiotics, antitoxin, and diazepam as well as muscle relaxants for the spasms.For the above patient, select the most likely infecting organism. | toxoplasmosis | tetanus | syphilis | Streptococcus | 1b
| multi | Patients with tetanus develop hypertonus, seizures, respiratory distress, and asphyxia unless they are treated with diazepam and muscle relaxants. The treatment of tetanus requires diazepam, muscle relaxants, antitoxin, respiratory care, and managing autonomic dysfunction. Antibiotics are given but are probably of little help. | Medicine | Infection | 142 | {
"Correct Answer": "tetanus",
"Correct Option": "B",
"Options": {
"A": "toxoplasmosis",
"B": "tetanus",
"C": "syphilis",
"D": "Streptococcus"
},
"Question": "A 34-year-old man who works as a carpenter presents with symptoms of jaw discomfort, dysphagia, and pain as well as stiffness in his neck, back, and shoulders. On examination, he is unable to open his jaw, his proximal limb muscles are stiff as is his abdomen and back, but the hands and feet are relatively spared. He occasionally has violent generalized muscles spasms that cause him to stop breathing, but there is no loss of consciousness. A clinical diagnosis is made and he is treated with antibiotics, antitoxin, and diazepam as well as muscle relaxants for the spasms.For the above patient, select the most likely infecting organism."
} | A 34-year-old man who works as a carpenter presents with symptoms of jaw discomfort, dysphagia, and pain as well as stiffness in his neck, back, and shoulders. On examination, he is unable to open his jaw, his proximal limb muscles are stiff as is his abdomen and back, but the hands and feet are relatively spared. He occasionally has violent generalized muscles spasms that cause him to stop breathing, but there is no loss of consciousness. | A clinical diagnosis is made and he is treated with antibiotics, antitoxin, and diazepam as well as muscle relaxants for the spasms.For the above patient, select the most likely infecting organism. | {
"A": "toxoplasmosis",
"B": "tetanus",
"C": "syphilis",
"D": "Streptococcus"
} | B. tetanus |
16562263-4bef-4a37-b1ce-e4091b941af2 | A 65-year-old woman who has a 12-year history of symmetrical polyahritis is admitted to the hospital. Physical examination reveals splenomegaly, ulcerations over the lateral malleoli, and synovitis of the wrists, shoulders, and knees. There is no hepatomegaly. Laboratory values demonstrate a white blood cell count of 2500/uL and a rheumatoid factor titer of 1:4096. This patient's white blood cell differential count is likely to reveal | Basophilia | Lymphopenia | Granulocytopenia | Lymphocytosis | 2c
| multi | (Braunwald, 15/e, pp 369,1932.)Felty syndrome consists of a triad of rheumatoid ahritis, splenomegaly, and leukopenia. In contrast to the lymphopenia observed in patients who have systemic lupus rythematosus, the leukopenia of Felty syndrome is related to a reduction in the number of circulating polymorphonuclear leukocytes. The mechanism of the granulocytopenia is poorly understood. Felty syndrome tends to occur in people who have had active rheumatoid ahritis for a prolonged period. These patients commonly have other systemic features of rheumatoid disease such as nodules, skin ulcerations, the sicca complex, peripheral sensory and motor neuropathy, and aeritic lesions. | Surgery | null | 112 | {
"Correct Answer": "Granulocytopenia",
"Correct Option": "C",
"Options": {
"A": "Basophilia",
"B": "Lymphopenia",
"C": "Granulocytopenia",
"D": "Lymphocytosis"
},
"Question": "A 65-year-old woman who has a 12-year history of symmetrical polyahritis is admitted to the hospital. Physical examination reveals splenomegaly, ulcerations over the lateral malleoli, and synovitis of the wrists, shoulders, and knees. There is no hepatomegaly. Laboratory values demonstrate a white blood cell count of 2500/uL and a rheumatoid factor titer of 1:4096. This patient's white blood cell differential count is likely to reveal"
} | A 65-year-old woman who has a 12-year history of symmetrical polyahritis is admitted to the hospital. Physical examination reveals splenomegaly, ulcerations over the lateral malleoli, and synovitis of the wrists, shoulders, and knees. There is no hepatomegaly. Laboratory values demonstrate a white blood cell count of 2500/uL and a rheumatoid factor titer of 1:4096. | This patient's white blood cell differential count is likely to reveal | {
"A": "Basophilia",
"B": "Lymphopenia",
"C": "Granulocytopenia",
"D": "Lymphocytosis"
} | C. Granulocytopenia |
43e080bd-de1d-432d-9c9a-650e87a0cadd | An experimental diagnostic test is developed to noninvasively detect the presence of trisomy 21, Down's syndrome. The test is administered to a group of 500 women considered to be at risk for a Down's fetus based on blood tests. The results of this test are shown below. What is the sensitivity of this new test? \r\n \r\n\r\n\r\n \r\n\r\nTrisomy 21\r\n\r\n\r\nNormal Karyotype\r\n\r\n\r\n\r\n\r\nPositive Test\r\n\r\n\r\n100\r\n\r\n\r\n50\r\n\r\n\r\n\r\n\r\nNegative Test\r\n\r\n\r\n100\r\n\r\n\r\n250\r\n\r\n\r\n\r\n | 40% | 50% | 67% | 71% | 1b
| single | Sensitivity is defined as the ability of a test to detect the presence of a disease in those who truly have the disease. It is calculated as the number of people with a disease who test positive (true positive) divided by the total number of people who have the disease (true positive+ false negative). In this case, sensitivity equals the number of babies born with trisomy 21 whose mothers tested positive (100) divided by the total number of babies born with trisomy 21. This yields 100/200 = 50% (not a very sensitive test). 40% corresponds to the prevalence of the disease in the tested population, which in this case equals the total number of babies with Down's syndrome (true positive + false negative = 100 + 100= 200) divided by the total number of people tested (500). This yields 200/500= 40%. 67% corresponds to the positive predictive value of the test, which equals the number of babies with Down's whose mothers test positive (true positives = 100) divided by the total number of mothers testing positive(true positive + false positive = 150). This yields 100/150 = 67%. 71% corresponds to the negative predictive value of the test, which equals the number of normal babies whose mothers tested negative (250) divided by the total number of people testing negative (350). This yields 250/350 = 71%. | Social & Preventive Medicine | null | 171 | {
"Correct Answer": "50%",
"Correct Option": "B",
"Options": {
"A": "40%",
"B": "50%",
"C": "67%",
"D": "71%"
},
"Question": "An experimental diagnostic test is developed to noninvasively detect the presence of trisomy 21, Down's syndrome. The test is administered to a group of 500 women considered to be at risk for a Down's fetus based on blood tests. The results of this test are shown below. What is the sensitivity of this new test? \\r\\n \\r\\n\\r\\n\\r\\n \\r\\n\\r\\nTrisomy 21\\r\\n\\r\\n\\r\\nNormal Karyotype\\r\\n\\r\\n\\r\\n\\r\\n\\r\\nPositive Test\\r\\n\\r\\n\\r\\n100\\r\\n\\r\\n\\r\\n50\\r\\n\\r\\n\\r\\n\\r\\n\\r\\nNegative Test\\r\\n\\r\\n\\r\\n100\\r\\n\\r\\n\\r\\n250\\r\\n\\r\\n\\r\\n\\r\\n"
} | An experimental diagnostic test is developed to noninvasively detect the presence of trisomy 21, Down's syndrome. The test is administered to a group of 500 women considered to be at risk for a Down's fetus based on blood tests. The results of this test are shown below. | What is the sensitivity of this new test? \r\n \r\n\r\n\r\n \r\n\r\nTrisomy 21\r\n\r\n\r\nNormal Karyotype\r\n\r\n\r\n\r\n\r\nPositive Test\r\n\r\n\r\n100\r\n\r\n\r\n50\r\n\r\n\r\n\r\n\r\nNegative Test\r\n\r\n\r\n100\r\n\r\n\r\n250\r\n\r\n\r\n\r\n | {
"A": "40%",
"B": "50%",
"C": "67%",
"D": "71%"
} | B. 50% |
5d00669c-751c-4f32-acba-abf86445487b | A perimenopausal woman presents with increasing swallowing difficulty and fatigue. Physical examination reveals that her thyroid is enlarged (palpable goiter). Laboratory examination of her serum reveals T4 of 4.9 mg/dL, free T4 of 2.5 ng/dL, and TSH of 5.5 mIU/mL. No thyroidstimulating immunoglobulins are identified in the serum, but antimicrosomal antibodies are present. Which one of the listed histologic findings, if present in a thyroid biopsy from this individual, would be most consistent with a diagnosis of Hashimoto's thyroiditis? | Lymphocytic infiltrate without follicle formation | Intense lymphoplasmacytic infiltrate with lymphoid follicles and scattered oxyphilic cells | Hyperplasia of follicular cells with scalloping of colloid at the margin of follicles | Granulomatous inflammation with multinucleated giant cells surrounding fragments of colloid | 1b
| multi | Four types of thyroiditis may be associated with hypothyroidism. Hashimoto's thyroiditis, one of the autoimmune thyroid diseases, is associated with the HLA-B8 haplotype and high titers of circulating autoantibodies, including antimicrosomal, antithyroglobulin, and anti-TSH receptor antibodies. This abnormality is not uncommon in the United States. Histologically, there is infiltration of the thyroid stroma by an intense lymphoplasmacytic infiltrate, with the formation of lymphoid follicles and germinal centers. This produces destruction and atrophy of the follicles and transforms the thyroid follicular cells into acidophilic cells. There are many different names for these cells, including oxyphilic cells, oncocytes, Huhle cells, and Askanazy cells. Not uncommonly, patients develop hypothyroidism as a result of follicle disruption, and the manifestations consist of fatigue, myxedema, cold intolerance, hair coarsening, and constipation. Rarely, cases of Hashimoto's thyroiditis may develop hypehyroidism (Hashitoxicosis), while the combination of Hashimoto's disease, pernicious anemia, and type I diabetes mellitus is called Schmidt's syndrome. This is one type of multiglandular syndrome. Although subacute thyroiditis and Riedel's thyroiditis may have similar symptoms to Hashimoto's thyroiditis, biopsy findings in these disorders are distinctly different. Subacute (de Quervain's, granulomatous, or giant cell) thyroiditis is a self-limited viral infection of the thyroid. It typically follows an upper respiratory tract infection. Patients develop the acute onset of fever and painful thyroid enlargement, and may develop a transient hypothyroidism. Histologically there is destruction of the follicles with a granulomatous reaction and multinucleated giant cells that surround fragments of colloid. One-half of patients with Riedel's thyroiditis are hypothyroid, but, in contrast to the other types of thyroiditis, microscopic examination reveals dense fibrosis of the thyroid gland, often extending into extrathyroidal soft tissue. This fibrosis produces a rock-hard enlarged thyroid gland that may produce the feeling of suffocation. This combination of signs and symptoms may be mistaken clinically for a malignant process. Additionally, these patients may develop similar fibrosis in the mediastinum or retroperitoneum. Subacute lymphocytic thyroiditis is also a self-limited, painless enlargement of the thyroid that is associated with hypothyroidism, but that lacks antithyroid antibodies or lymphoid germinal centers within the thyroid Hashimoto's thyroiditis Reference: Robbins & Cotran Pathologic Basis of Disease, 9edition | Pathology | Endocrinology | 127 | {
"Correct Answer": "Intense lymphoplasmacytic infiltrate with lymphoid follicles and scattered oxyphilic cells",
"Correct Option": "B",
"Options": {
"A": "Lymphocytic infiltrate without follicle formation",
"B": "Intense lymphoplasmacytic infiltrate with lymphoid follicles and scattered oxyphilic cells",
"C": "Hyperplasia of follicular cells with scalloping of colloid at the margin of follicles",
"D": "Granulomatous inflammation with multinucleated giant cells surrounding fragments of colloid"
},
"Question": "A perimenopausal woman presents with increasing swallowing difficulty and fatigue. Physical examination reveals that her thyroid is enlarged (palpable goiter). Laboratory examination of her serum reveals T4 of 4.9 mg/dL, free T4 of 2.5 ng/dL, and TSH of 5.5 mIU/mL. No thyroidstimulating immunoglobulins are identified in the serum, but antimicrosomal antibodies are present. Which one of the listed histologic findings, if present in a thyroid biopsy from this individual, would be most consistent with a diagnosis of Hashimoto's thyroiditis?"
} | A perimenopausal woman presents with increasing swallowing difficulty and fatigue. Physical examination reveals that her thyroid is enlarged (palpable goiter). Laboratory examination of her serum reveals T4 of 4.9 mg/dL, free T4 of 2.5 ng/dL, and TSH of 5.5 mIU/mL. No thyroidstimulating immunoglobulins are identified in the serum, but antimicrosomal antibodies are present. | Which one of the listed histologic findings, if present in a thyroid biopsy from this individual, would be most consistent with a diagnosis of Hashimoto's thyroiditis? | {
"A": "Lymphocytic infiltrate without follicle formation",
"B": "Intense lymphoplasmacytic infiltrate with lymphoid follicles and scattered oxyphilic cells",
"C": "Hyperplasia of follicular cells with scalloping of colloid at the margin of follicles",
"D": "Granulomatous inflammation with multinucleated giant cells surrounding fragments of colloid"
} | B. Intense lymphoplasmacytic infiltrate with lymphoid follicles and scattered oxyphilic cells |
000ed90b-b9ce-45e1-9ae4-4c63cb009d41 | A 9-month-old child presented to the ER with characteristic "barking" cough and hoarseness of voice. She had a history of rhinorrhoea, pharyngitis, mild cough, and low-grade fever for 1-3 days. Symptom worsened at night. O/E: - Normal to moderately inflamed pharynx Increased respiratory rate Nasal flaring Suprasternal, infrasternal, and intercostal retractions Continuous inspiratory stridor X-RAY NECK All of the following statements are true about the treatment of the above condition except: - | Nebulized racemic epinephrine is an accepted treatment for moderate or severe croup. | Patients can be safely discharged home after a 2-3 hr period of observation provided, they have no stridor at rest; have normal air entry, normal pulse oximetry, and normal level of consciousness; and have received steroids. | Coicosteroids decrease the edema in the laryngeal mucosa through their anti-inflammatory action. | Oral steroids are not beneficial in mild croup | 3d
| multi | This is a case of acute laryngotracheobronchitis (croup). Acute infectious process M/C cause- parainfluenza viruses (types 1, 2, and 3) Presents with: - Bark-like / Brassy cough Hoarseness Inspiratory stridor Respiratory distress 4. Treatment Mainstay - airway management and treatment of hypoxia. Nebulized racemic epinephrine for moderate or severe croup. Oral steroids -beneficial even in mild croup | Unknown | Integrated QBank | 123 | {
"Correct Answer": "Oral steroids are not beneficial in mild croup",
"Correct Option": "D",
"Options": {
"A": "Nebulized racemic epinephrine is an accepted treatment for moderate or severe croup.",
"B": "Patients can be safely discharged home after a 2-3 hr period of observation provided, they have no stridor at rest; have normal air entry, normal pulse oximetry, and normal level of consciousness; and have received steroids.",
"C": "Coicosteroids decrease the edema in the laryngeal mucosa through their anti-inflammatory action.",
"D": "Oral steroids are not beneficial in mild croup"
},
"Question": "A 9-month-old child presented to the ER with characteristic \"barking\" cough and hoarseness of voice. She had a history of rhinorrhoea, pharyngitis, mild cough, and low-grade fever for 1-3 days. Symptom worsened at night. O/E: - Normal to moderately inflamed pharynx Increased respiratory rate Nasal flaring Suprasternal, infrasternal, and intercostal retractions Continuous inspiratory stridor X-RAY NECK All of the following statements are true about the treatment of the above condition except: -"
} | A 9-month-old child presented to the ER with characteristic "barking" cough and hoarseness of voice. She had a history of rhinorrhoea, pharyngitis, mild cough, and low-grade fever for 1-3 days. Symptom worsened at night. | O/E: - Normal to moderately inflamed pharynx Increased respiratory rate Nasal flaring Suprasternal, infrasternal, and intercostal retractions Continuous inspiratory stridor X-RAY NECK All of the following statements are true about the treatment of the above condition except: - | {
"A": "Nebulized racemic epinephrine is an accepted treatment for moderate or severe croup.",
"B": "Patients can be safely discharged home after a 2-3 hr period of observation provided, they have no stridor at rest; have normal air entry, normal pulse oximetry, and normal level of consciousness; and have received steroids.",
"C": "Coicosteroids decrease the edema in the laryngeal mucosa through their anti-inflammatory action.",
"D": "Oral steroids are not beneficial in mild croup"
} | D. Oral steroids are not beneficial in mild croup |
84c96b51-a12e-4db4-8880-0039f5a34e9d | A 65-year-old coal miner is admitted for evaluation of chronic lung disease. The patient admits to smoking one pack of cigarettes a day for 40 years. On physical examination, he is noticed to have a barrel chest and use accessory muscles for inspiration. His face is puffy and red. He has 2+ pitting edema of the lower extremities. A chest X-ray is compatible with diffuse fibrosis, with some nodularity in central areas. Which of the following is the most likely diagnosis? | Anthracosis | Asbestosis | Diffuse alveolar damage | Sarcoidosis | 0a
| single | Coal workers' pneumoconiosis is lung disease caused by inhalation of coal paicles and other admixed forms of dust. Coal workers' pneumoconiosis is also known as "black lung disease" due to massive deposits of carbon paicles. Complicated coal workers' pneumoconiosis (progressive massive fibrosis) occurs on a background of simple disease and generally requires many years to develop. In a minority of cases (fewer than 10%), progressive massive fibrosis develops, leading to increasing pulmonary dysfunction, pulmonary hypeension, and cor pulmonale (symptoms in the given case). The characteristic pulmonary lesions include palpable coal dust nodules scattered throughout the lung as 1- to 4-mm black foci. Nodules consist of dust-laden macrophages associated with a fibrotic stroma. | Pathology | Interstitial lung diseases | 106 | {
"Correct Answer": "Anthracosis",
"Correct Option": "A",
"Options": {
"A": "Anthracosis",
"B": "Asbestosis",
"C": "Diffuse alveolar damage",
"D": "Sarcoidosis"
},
"Question": "A 65-year-old coal miner is admitted for evaluation of chronic lung disease. The patient admits to smoking one pack of cigarettes a day for 40 years. On physical examination, he is noticed to have a barrel chest and use accessory muscles for inspiration. His face is puffy and red. He has 2+ pitting edema of the lower extremities. A chest X-ray is compatible with diffuse fibrosis, with some nodularity in central areas. Which of the following is the most likely diagnosis?"
} | A 65-year-old coal miner is admitted for evaluation of chronic lung disease. The patient admits to smoking one pack of cigarettes a day for 40 years. On physical examination, he is noticed to have a barrel chest and use accessory muscles for inspiration. His face is puffy and red. He has 2+ pitting edema of the lower extremities. A chest X-ray is compatible with diffuse fibrosis, with some nodularity in central areas. | Which of the following is the most likely diagnosis? | {
"A": "Anthracosis",
"B": "Asbestosis",
"C": "Diffuse alveolar damage",
"D": "Sarcoidosis"
} | A. Anthracosis |
8351f702-29ac-4945-96f2-eade6ecb8183 | A 25 year old male repos episodic "spells" characterized by palpitations, sweating, nervousness, and feelings of anxiety. On examination, the man's blood pressure is 165/95 mm Hg. Plasma norepinephrine is 450 pg/mL (normal, 150-400 pg/mL), plasma epinephrine is 115 pg/mL (normal, 25-100 pg/mL), and 24-hour urinary VMA is 11 mg (normal, < 8 mg). Which of the following is the most likely cause of the patient's hypeension? | 11-beta-hydroxylase deficiency | Conn's syndrome | Pheochromocytoma | Renin-secreting tumor | 2c
| single | A pheochromocytoma is a tumor arising from chromaffin cells that secretes excess catecholamines (norepinephrine, epinephrine, or both). It is one endocrine cause of hypeension, due to peripheral vasoconstriction and/or increased cardiac output. While most patients have higher than normal baseline plasma levels of catecholamines, it is not uncommon for paroxysmal symptomatic episodes to be superimposed upon the basal problem. These "attacks" may occur several times a week (or more often) and last for up to 15 minutes. During an attack, respiration can increase, the patient may become aware of a forceful pounding of the hea that progresses to include a throbbing headache, and peripheral vasoconstriction can raise body temperature and lead to reflex sweating. Marked anxiety may also accompany the episode. Diagnosis can be confirmed by measuring increased plasma or urinary catecholamines or their metabolites. 11-beta-hydroxylase deficiency is a congenital disorder than can cause hypeension due to excessive production of the weak mineralocoicoid, deoxycoicosterone, by the inner two zones of the adrenal coex. This results in excessive renal retention of sodium and water and subsequent hypeension. While the hypeension is usually present from bih, a late-onset variant of this disorder has been described in which the symptoms do not present until late childhood or adolescence. Virilization is also present due to excessive secretion of adrenal androgens. Conn's syndrome is another endocrine cause of hypeension. In this case, the increase in blood pressure is due to excessive renal retention of sodium and water resulting from the increased plasma concentration of aldosterone. The paroxysmal symptoms and increased catecholamines present in this patient are not present with primary hyperaldosteronism. Renin-secreting tumors are rare and can be confused with primary hyperaldosteronism. The excessive secretion of renin by the tumor can increase the formation of angiotensin II with subsequent hyperaldosteronism. Sodium and water retention, together with hypokalemia, are present. Increased plasma renin and plasma aldosterone are suggestive of a renin-secreting tumor, whereas primary hyperaldosteronism would present as increased plasma aldosterone, but decreased plasma renin. Ref: Lal G., Clark O.H. (2010). Chapter 38. Thyroid, Parathyroid, and Adrenal. In F.C. Brunicardi, D.K. Andersen, T.R. Billiar, D.L. Dunn, J.G. Hunter, J.B. Matthews, R.E. Pollock (Eds), Schwaz's Principles of Surgery, 9e. | Surgery | null | 139 | {
"Correct Answer": "Pheochromocytoma",
"Correct Option": "C",
"Options": {
"A": "11-beta-hydroxylase deficiency",
"B": "Conn's syndrome",
"C": "Pheochromocytoma",
"D": "Renin-secreting tumor"
},
"Question": "A 25 year old male repos episodic \"spells\" characterized by palpitations, sweating, nervousness, and feelings of anxiety. On examination, the man's blood pressure is 165/95 mm Hg. Plasma norepinephrine is 450 pg/mL (normal, 150-400 pg/mL), plasma epinephrine is 115 pg/mL (normal, 25-100 pg/mL), and 24-hour urinary VMA is 11 mg (normal, < 8 mg). Which of the following is the most likely cause of the patient's hypeension?"
} | A 25 year old male repos episodic "spells" characterized by palpitations, sweating, nervousness, and feelings of anxiety. On examination, the man's blood pressure is 165/95 mm Hg. Plasma norepinephrine is 450 pg/mL (normal, 150-400 pg/mL), plasma epinephrine is 115 pg/mL (normal, 25-100 pg/mL), and 24-hour urinary VMA is 11 mg (normal, < 8 mg). | Which of the following is the most likely cause of the patient's hypeension? | {
"A": "11-beta-hydroxylase deficiency",
"B": "Conn's syndrome",
"C": "Pheochromocytoma",
"D": "Renin-secreting tumor"
} | C. Pheochromocytoma |
68b540a3-dfdd-47aa-8c60-40c22363c45d | A 72-year-old man undergoes a subtotal colectomy for a cecal perforation due to a sigmoid colon obstruction. He has had a prolonged recovery and has been on total parenteral nutrition (TPN) for 2 weeks postoperatively. After regaining bowel function, he experienced significant diarrhea. Examination of his abdominal wound demonstrates minimal granulation tissue. He complains that he has lost his taste for food. He also has increased hair loss and a new perioral pustular rash. Which of the following deficiencies does he most likely have? | Zinc | Selenium | Molybdenum | Chromium | 0a
| single | The patient has a zinc deficiency. Alopecia, poor wound healing, night blindness or photophobia, anosmia, neuritis, and skin rashes are all characteristic of patients with zinc deficiency, which often results in the setting of excessive diarrhea. Selenium deficiency is characterized by the development of a cardiomyopathy. Molybdenum deficiency is manifested by encephalopathy due to toxic accumulation of sulfur-containing amino acids. Chromium deficiency can occur in patients on long-term TPN and is characterized by difficult-to-control hyperglycemia and peripheral neuropathy and encephalopathy. Thiamine deficiency results in beriberi, which includes symptoms of encephalopathy and peripheral neuropathy; patients with beriberi can also develop cardiovascular symptoms and cardiac failure. | Anaesthesia | Preoperative assessment and monitoring in anaesthesia | 115 | {
"Correct Answer": "Zinc",
"Correct Option": "A",
"Options": {
"A": "Zinc",
"B": "Selenium",
"C": "Molybdenum",
"D": "Chromium"
},
"Question": "A 72-year-old man undergoes a subtotal colectomy for a cecal perforation due to a sigmoid colon obstruction. He has had a prolonged recovery and has been on total parenteral nutrition (TPN) for 2 weeks postoperatively. After regaining bowel function, he experienced significant diarrhea. Examination of his abdominal wound demonstrates minimal granulation tissue. He complains that he has lost his taste for food. He also has increased hair loss and a new perioral pustular rash. Which of the following deficiencies does he most likely have?"
} | A 72-year-old man undergoes a subtotal colectomy for a cecal perforation due to a sigmoid colon obstruction. He has had a prolonged recovery and has been on total parenteral nutrition (TPN) for 2 weeks postoperatively. After regaining bowel function, he experienced significant diarrhea. Examination of his abdominal wound demonstrates minimal granulation tissue. He complains that he has lost his taste for food. He also has increased hair loss and a new perioral pustular rash. | Which of the following deficiencies does he most likely have? | {
"A": "Zinc",
"B": "Selenium",
"C": "Molybdenum",
"D": "Chromium"
} | A. Zinc |
65e8b791-212e-4510-978f-99b42faeb4a2 | A 19-year-old G2P1 woman at 9 weeks' gestation presents to the obstetrics and gynaecology clinic for her second prenatal visit. She reports no complaints other than occasional nausea. She had her first child by spontaneous vaginal delivery without complications. She is taking no medications and denies ethanol, tobacco, or current drug use. While she does admit to a history of intravenous drug abuse, she denies using them since the birth of her first child. Over the past several months she has had multiple sexual partners and does not use contraception. On physical examination she is in no acute distress. Lungs are clear to auscultation bilaterally. Her heart has a regular rate and rhythm, with no murmurs, rubs, or gallops. She is informed that she will need the routine prenatal tests, including an HIV test. The physician informs her of the risks and benefits of the HIV test.1What else should the physician inform the patient before performing the test: | Despite the potential for fetal infection , she may opt out from the test | Early retroviral therapy will absolutely decrease the chances of transmitting infection to the baby. | CDC recommends screening only for patients with high risk factors | Risk of the test include potential for fetal loss. | 0a
| multi | The CDC and ACOG (2008) has recommended prenatal screening for HIV using an “optout approach” this means that the woman is notified that HIV testing is included in a comprehensive set of antenatal tests, but that testing may be declined.
Women are given information regarding HIV but are not required to sign a specific consent.
Screening is performed using an ELISA test which has a sensitivity of > 99.5%
A positive test is confirmed with either a western blot or immunofluorence assay (IIFA) both of which have high specificity.
According to CDC, antibody can be detected in most patients within 1 month of infection and thus antibody serotesting may not exclude early infection. | Gynaecology & Obstetrics | null | 203 | {
"Correct Answer": "Despite the potential for fetal infection , she may opt out from the test",
"Correct Option": "A",
"Options": {
"A": "Despite the potential for fetal infection , she may opt out from the test",
"B": "Early retroviral therapy will absolutely decrease the chances of transmitting infection to the baby.",
"C": "CDC recommends screening only for patients with high risk factors",
"D": "Risk of the test include potential for fetal loss."
},
"Question": "A 19-year-old G2P1 woman at 9 weeks' gestation presents to the obstetrics and gynaecology clinic for her second prenatal visit. She reports no complaints other than occasional nausea. She had her first child by spontaneous vaginal delivery without complications. She is taking no medications and denies ethanol, tobacco, or current drug use. While she does admit to a history of intravenous drug abuse, she denies using them since the birth of her first child. Over the past several months she has had multiple sexual partners and does not use contraception. On physical examination she is in no acute distress. Lungs are clear to auscultation bilaterally. Her heart has a regular rate and rhythm, with no murmurs, rubs, or gallops. She is informed that she will need the routine prenatal tests, including an HIV test. The physician informs her of the risks and benefits of the HIV test.1What else should the physician inform the patient before performing the test:"
} | A 19-year-old G2P1 woman at 9 weeks' gestation presents to the obstetrics and gynaecology clinic for her second prenatal visit. She reports no complaints other than occasional nausea. She had her first child by spontaneous vaginal delivery without complications. She is taking no medications and denies ethanol, tobacco, or current drug use. While she does admit to a history of intravenous drug abuse, she denies using them since the birth of her first child. Over the past several months she has had multiple sexual partners and does not use contraception. On physical examination she is in no acute distress. Lungs are clear to auscultation bilaterally. Her heart has a regular rate and rhythm, with no murmurs, rubs, or gallops. She is informed that she will need the routine prenatal tests, including an HIV test. | The physician informs her of the risks and benefits of the HIV test.1What else should the physician inform the patient before performing the test: | {
"A": "Despite the potential for fetal infection , she may opt out from the test",
"B": "Early retroviral therapy will absolutely decrease the chances of transmitting infection to the baby.",
"C": "CDC recommends screening only for patients with high risk factors",
"D": "Risk of the test include potential for fetal loss."
} | A. Despite the potential for fetal infection , she may opt out from the test |
40401013-8a93-40a9-ad7f-eaee905e53fd | A 40-year-old man experiences weakness and easy fatigability of 2 months' duration. Physical examination yields no remarkable findings. Laboratory studies show a serum calcium of 11.5 mg/dL, inorganic phosphorus of 2.1 mg/dL, and serum parathyroid hormone of 58 pg/mL, which is near the top of the reference range. A radionuclide bone scan fails to show any areas of increased uptake. What is the most likely cause of these findings? | Chronic renal failure | Hypervitaminosis D | Medullary thyroid carcinoma | Parathyroid adenoma | 3d
| single | When a patient develops hypercalcemia, a disorder of the parathyroid glands or malignancy at a visceral location must be considered. The elevated parathyroid hormone (PTH) suggests primary hyperparathyroidism. The most common cause of primary hyperparathyroidism is a parathyroid adenoma. Secondary hyperparathyroidism, most commonly resulting from renal failure, is excluded when the serum inorganic phosphate level is low because phosphate is retained with chronic renal failure. Hypervitaminosis D can cause hypercalcemia because of increased calcium absorption, but in these cases, the PTH levels are expected to be near the low end of the reference range because of feedback suppression. Serum PTH levels near the high end of the reference range indicate autonomous PTH secretion unregulated by hypercalcemia. Although medullary carcinomas of the thyroid often have positive immunohistochemical staining for calcitonin, and plasma levels are sometimes increased, there is typically no major reduction in serum calcium as a result. | Pathology | Endocrine | 107 | {
"Correct Answer": "Parathyroid adenoma",
"Correct Option": "D",
"Options": {
"A": "Chronic renal failure",
"B": "Hypervitaminosis D",
"C": "Medullary thyroid carcinoma",
"D": "Parathyroid adenoma"
},
"Question": "A 40-year-old man experiences weakness and easy fatigability of 2 months' duration. Physical examination yields no remarkable findings. Laboratory studies show a serum calcium of 11.5 mg/dL, inorganic phosphorus of 2.1 mg/dL, and serum parathyroid hormone of 58 pg/mL, which is near the top of the reference range. A radionuclide bone scan fails to show any areas of increased uptake. What is the most likely cause of these findings?"
} | A 40-year-old man experiences weakness and easy fatigability of 2 months' duration. Physical examination yields no remarkable findings. Laboratory studies show a serum calcium of 11.5 mg/dL, inorganic phosphorus of 2.1 mg/dL, and serum parathyroid hormone of 58 pg/mL, which is near the top of the reference range. A radionuclide bone scan fails to show any areas of increased uptake. | What is the most likely cause of these findings? | {
"A": "Chronic renal failure",
"B": "Hypervitaminosis D",
"C": "Medullary thyroid carcinoma",
"D": "Parathyroid adenoma"
} | D. Parathyroid adenoma |
01f4d86f-5e84-4ff0-87f6-98289e0f0f82 | A 23-year-old woman with no other medical history was diagnosed with hypertension 6 months ago. She was initially treated with hydrochlorothiazide, followed by the addition of lisinopril, followed by a calcium channel blocker, but her blood pressure has not been well controlled. She assures the provider that she is taking all of her medicines. On examination her blood pressure is 165/105 in each arm, and 168/105 when checked by large cuff in the lower extremities. Her pulse is 60. Cardiac examination reveals an S4 gallop but no murmurs. She has a soft mid-abdominal bruit. Distal pulses are intact and equal. She does not have hyperpigmentation, hirsutism, genital abnormalities, or unusual distribution of fat. Her sodium is 140, potassium 4.0, HCO3 22, BUN 15, and creatinine 1.5. Which of the following is the most likely cause of her difficult-to-control hypertension? | Primary hyperaldosteronism (Conn syndrome) | Cushing syndrome | Congenital adrenal hyperplasia | Renal artery fibromuscular dysplasia | 3d
| multi | This patient is abnormally young to have essential hypertension, and the renal bruit is highly suggestive of a secondary cause of the condition: renal artery stenosis caused by fibromuscular dysplasia (FMD). FMD is more common in young females (85%-90% of patients are women). The exact etiology of the condition is unknown, but renal artery stenosis causing hypertension is a common presentation. Renal angiography is the diagnostic modality of choice, although duplex ultrasonography, CT angiography, and MR angiography can also be utilized. Etiologies that can mimic fibromuscular dysplasia include atherosclerosis and vasculitis. The patient has no physical findings to make one suspect Cushing syndrome (abnormal fat distribution, ecchymoses, hirsutism, etc.), congenital adrenal hyperplasia (virilization), or coarctation of the aorta (BP lower in legs than in arm). She does not have the metabolic alkalosis and hypokalemia of primary hyperaldosteronism | Medicine | Kidney | 224 | {
"Correct Answer": "Renal artery fibromuscular dysplasia",
"Correct Option": "D",
"Options": {
"A": "Primary hyperaldosteronism (Conn syndrome)",
"B": "Cushing syndrome",
"C": "Congenital adrenal hyperplasia",
"D": "Renal artery fibromuscular dysplasia"
},
"Question": "A 23-year-old woman with no other medical history was diagnosed with hypertension 6 months ago. She was initially treated with hydrochlorothiazide, followed by the addition of lisinopril, followed by a calcium channel blocker, but her blood pressure has not been well controlled. She assures the provider that she is taking all of her medicines. On examination her blood pressure is 165/105 in each arm, and 168/105 when checked by large cuff in the lower extremities. Her pulse is 60. Cardiac examination reveals an S4 gallop but no murmurs. She has a soft mid-abdominal bruit. Distal pulses are intact and equal. She does not have hyperpigmentation, hirsutism, genital abnormalities, or unusual distribution of fat. Her sodium is 140, potassium 4.0, HCO3 22, BUN 15, and creatinine 1.5. Which of the following is the most likely cause of her difficult-to-control hypertension?"
} | A 23-year-old woman with no other medical history was diagnosed with hypertension 6 months ago. She was initially treated with hydrochlorothiazide, followed by the addition of lisinopril, followed by a calcium channel blocker, but her blood pressure has not been well controlled. She assures the provider that she is taking all of her medicines. On examination her blood pressure is 165/105 in each arm, and 168/105 when checked by large cuff in the lower extremities. Her pulse is 60. Cardiac examination reveals an S4 gallop but no murmurs. She has a soft mid-abdominal bruit. Distal pulses are intact and equal. She does not have hyperpigmentation, hirsutism, genital abnormalities, or unusual distribution of fat. Her sodium is 140, potassium 4.0, HCO3 22, BUN 15, and creatinine 1.5. | Which of the following is the most likely cause of her difficult-to-control hypertension? | {
"A": "Primary hyperaldosteronism (Conn syndrome)",
"B": "Cushing syndrome",
"C": "Congenital adrenal hyperplasia",
"D": "Renal artery fibromuscular dysplasia"
} | D. Renal artery fibromuscular dysplasia |
49c25122-3125-4bd9-b82f-f76f52f788a9 | A 64-year-old man presents with symptoms of difficulty swallowing and weight loss of 10 lb. He has no prior history of heartburn, stomach ulcers, or difficulty swallowing. He smokes one pack a day for the past 45 years and drinks approximately 5 oz of alcohol a day. He is thin appearing, there are no oral lesions, and the remaining examination is normal. Esophagoscopy reveals a midesophageal narrowing with ragged ulcerating, and biopsies are taken. Which of the following is the most likely diagnosis? | adenocarcinoma of esophagus | esophageal web | achalasia | squamous cell carcinoma of esophagus | 3d
| multi | The history of weight loss and dysphagia suggests carcinoma of the esophagus, and squamous cell carcinoma is a disease that occurs in older men who drink and smoke heavily. Smoking and or excessive drinking are considered etiologic factors in the development of squamous cell carcinoma. Adenocarcinomas arise within dysplastic columnar epithelium in the distal esophagus, usually in the presence of chronic gastric reflux. | Medicine | Oncology | 117 | {
"Correct Answer": "squamous cell carcinoma of esophagus",
"Correct Option": "D",
"Options": {
"A": "adenocarcinoma of esophagus",
"B": "esophageal web",
"C": "achalasia",
"D": "squamous cell carcinoma of esophagus"
},
"Question": "A 64-year-old man presents with symptoms of difficulty swallowing and weight loss of 10 lb. He has no prior history of heartburn, stomach ulcers, or difficulty swallowing. He smokes one pack a day for the past 45 years and drinks approximately 5 oz of alcohol a day. He is thin appearing, there are no oral lesions, and the remaining examination is normal. Esophagoscopy reveals a midesophageal narrowing with ragged ulcerating, and biopsies are taken. Which of the following is the most likely diagnosis?"
} | A 64-year-old man presents with symptoms of difficulty swallowing and weight loss of 10 lb. He has no prior history of heartburn, stomach ulcers, or difficulty swallowing. He smokes one pack a day for the past 45 years and drinks approximately 5 oz of alcohol a day. He is thin appearing, there are no oral lesions, and the remaining examination is normal. Esophagoscopy reveals a midesophageal narrowing with ragged ulcerating, and biopsies are taken. | Which of the following is the most likely diagnosis? | {
"A": "adenocarcinoma of esophagus",
"B": "esophageal web",
"C": "achalasia",
"D": "squamous cell carcinoma of esophagus"
} | D. squamous cell carcinoma of esophagus |
bf73ac1b-8a7c-464f-a7e3-852a3b770ee6 | A 6-year-old girl has become increasingly lethargic over the past 2 weeks. On examination, she has puffiness around the eyes. Her temperature is 36.9degC, and her blood pressure is 100/60 mm Hg. Laboratory findings show serum creatinine, 0.7 mg/ dL; urea nitrogen, 12 mg/dL; and cholesterol, 217 mg/dL. Urinalysis shows pH, 6.5; specific gravity, 1.011; 4+ proteinuria; lipiduria; and no blood or glucose. The 24-hour urine protein level is 3.8 g. The child's condition improves after glucocorticoid therapy. Which of the following findings by electron microscopy is most likely to characterize this disease process? | Areas of thickened and thinned basement membrane | Effacement of podocyte foot processes | Increased mesangial matrix | Reduplication of glomerular basement membrane | 1b
| single | A child with nephrotic syndrome and no other clinical findings is most likely to have minimal change disease, a name that reflects the paucity of pathologic findings. There is a fusion of podocyte foot processes, which can be seen only by electron microscopy. This fusion leads to selective proteinuria of low molecular weight proteins (albumin). Variability of basement membrane thickening may be seen in Alport syndrome. The mesangial matrix is expanded in some forms of glomerulonephritis (e.g., IgA nephropathy) and other diseases, such as diabetes mellitus, but not in minimal change disease. Reduplication of the glomerular basement membrane may be seen with membranoproliferative GN. Subepithelial electron-dense humps represent immune complexes and are seen in postinfectious GN. | Pathology | Kidney | 176 | {
"Correct Answer": "Effacement of podocyte foot processes",
"Correct Option": "B",
"Options": {
"A": "Areas of thickened and thinned basement membrane",
"B": "Effacement of podocyte foot processes",
"C": "Increased mesangial matrix",
"D": "Reduplication of glomerular basement membrane"
},
"Question": "A 6-year-old girl has become increasingly lethargic over the past 2 weeks. On examination, she has puffiness around the eyes. Her temperature is 36.9degC, and her blood pressure is 100/60 mm Hg. Laboratory findings show serum creatinine, 0.7 mg/ dL; urea nitrogen, 12 mg/dL; and cholesterol, 217 mg/dL. Urinalysis shows pH, 6.5; specific gravity, 1.011; 4+ proteinuria; lipiduria; and no blood or glucose. The 24-hour urine protein level is 3.8 g. The child's condition improves after glucocorticoid therapy. Which of the following findings by electron microscopy is most likely to characterize this disease process?"
} | A 6-year-old girl has become increasingly lethargic over the past 2 weeks. On examination, she has puffiness around the eyes. Her temperature is 36.9degC, and her blood pressure is 100/60 mm Hg. Laboratory findings show serum creatinine, 0.7 mg/ dL; urea nitrogen, 12 mg/dL; and cholesterol, 217 mg/dL. Urinalysis shows pH, 6.5; specific gravity, 1.011; 4+ proteinuria; lipiduria; and no blood or glucose. The 24-hour urine protein level is 3.8 g. The child's condition improves after glucocorticoid therapy. | Which of the following findings by electron microscopy is most likely to characterize this disease process? | {
"A": "Areas of thickened and thinned basement membrane",
"B": "Effacement of podocyte foot processes",
"C": "Increased mesangial matrix",
"D": "Reduplication of glomerular basement membrane"
} | B. Effacement of podocyte foot processes |
fb162da9-43f4-4695-a130-68a98f7e2901 | A 6-year-old child presented with a Trendelenburg gait to the OPD. History of progressive muscle weakness and intellectual impairment was present. He had gained head control by the age of 7 months and had staed walking by the age of 18 months. Her child also had trouble in running and going upstairs. Serum CK levels were elevated drastically O/E Lordotic posture Difficulty in standing up from a sitting position X ray spine was also taken. Muscle biopsy from the quadriceps femoris NCV studies were done and were normal. Which of the following protein is involved in the given diagram: - | A | B | C | D | 3d
| multi | This is a case of Duchenne muscular dystrophy Due to deficiency of the dystrophin gene. Presents with Delayed developmental milestones, waddling gait, Gower's sign, difficulty in running and jumping with frequent falls. X-ray shows scoliosis which is a common finding in DMD Muscle biopsies shows: - Segmental myofiber degeneration Regeneration Admixture of atrophic muscle fibres. Replacement of muscle tissue by collagen and fat cells ("fatty replacement" or "fatty infiltration"). STRUCTURE OF CELL MEMBRANE AND SARCOLEMMAL PROTEINS | Unknown | Integrated QBank | 124 | {
"Correct Answer": "D",
"Correct Option": "D",
"Options": {
"A": "A",
"B": "B",
"C": "C",
"D": "D"
},
"Question": "A 6-year-old child presented with a Trendelenburg gait to the OPD. History of progressive muscle weakness and intellectual impairment was present. He had gained head control by the age of 7 months and had staed walking by the age of 18 months. Her child also had trouble in running and going upstairs. Serum CK levels were elevated drastically O/E Lordotic posture Difficulty in standing up from a sitting position X ray spine was also taken. Muscle biopsy from the quadriceps femoris NCV studies were done and were normal. Which of the following protein is involved in the given diagram: -"
} | A 6-year-old child presented with a Trendelenburg gait to the OPD. History of progressive muscle weakness and intellectual impairment was present. He had gained head control by the age of 7 months and had staed walking by the age of 18 months. Her child also had trouble in running and going upstairs. Serum CK levels were elevated drastically O/E Lordotic posture Difficulty in standing up from a sitting position X ray spine was also taken. Muscle biopsy from the quadriceps femoris NCV studies were done and were normal. | Which of the following protein is involved in the given diagram: - | {
"A": "A",
"B": "B",
"C": "C",
"D": "D"
} | D. D |
0281d8d3-714e-4b0b-81be-f189a349805d | An 18 years old male reported with chief complaint of sensitivity and deep, dull, radiating pain during chewing. Intra-oral examination showed sparase plague and dental calculus deposits, distolabial migration of the maxillary incisors with diastema formation, mobility of maxillary and mandibular incisors and first molars. Prescribed radiographs showed an arch shaped loss of alveolar bone extending from the distal surface of the mandibular second premolar to the mesial surface of the second molar. There was vertical bone loss in the maxillary incisor region.
The most likely disease is | Chronic periodontitis | Refractory periodontitis | Localized aggressive periodontitis | Necrotizing ulcerative periodontitis | 2c
| single | null | Dental | null | 128 | {
"Correct Answer": "Localized aggressive periodontitis",
"Correct Option": "C",
"Options": {
"A": "Chronic periodontitis",
"B": "Refractory periodontitis",
"C": "Localized aggressive periodontitis",
"D": "Necrotizing ulcerative periodontitis"
},
"Question": "An 18 years old male reported with chief complaint of sensitivity and deep, dull, radiating pain during chewing. Intra-oral examination showed sparase plague and dental calculus deposits, distolabial migration of the maxillary incisors with diastema formation, mobility of maxillary and mandibular incisors and first molars. Prescribed radiographs showed an arch shaped loss of alveolar bone extending from the distal surface of the mandibular second premolar to the mesial surface of the second molar. There was vertical bone loss in the maxillary incisor region.\n\nThe most likely disease is"
} | An 18 years old male reported with chief complaint of sensitivity and deep, dull, radiating pain during chewing. Intra-oral examination showed sparase plague and dental calculus deposits, distolabial migration of the maxillary incisors with diastema formation, mobility of maxillary and mandibular incisors and first molars. Prescribed radiographs showed an arch shaped loss of alveolar bone extending from the distal surface of the mandibular second premolar to the mesial surface of the second molar. | There was vertical bone loss in the maxillary incisor region.
The most likely disease is | {
"A": "Chronic periodontitis",
"B": "Refractory periodontitis",
"C": "Localized aggressive periodontitis",
"D": "Necrotizing ulcerative periodontitis"
} | C. Localized aggressive periodontitis |
78e7faca-6e86-4af6-8064-14d049ca417d | A neonate is note to have an abnormally shaped face with a very small jaw. On examination he has systolic murmur. Several hours after bih, the baby develops convulsions and tetany. Serum chemistries show Sodium 40mEq/L Potassium 4mEq/L Chloride 100mEq/L Bicarbonate 24mEq/ L Magnesium 2mEq/L Calcium 5mEq/dL Glucose 100mg/ dL This child's disorder is associated with aplasia or hypoplasia of which of the following organs? | Ovaries | Pituitary | Thymus | Thyroid | 2c
| multi | Dysmophic features with low calcium and murmur point towards DiGeorge syndrome. Features can be summarized using the mnemonic CATCH-22 to describe DiGeorge syndrome, with the 22 to remind one the chromosomal abnormality is found on the 22 chromosome, as below Cardiac Abnormality (especially tetralogy of fallot) Abnormal facies Thymic aplasia Cleft palate Hypocalcemia/Hypoparathyroidism. Reference: GHAI Essential pediatrics, 8th edition | Pediatrics | All India exam | 127 | {
"Correct Answer": "Thymus",
"Correct Option": "C",
"Options": {
"A": "Ovaries",
"B": "Pituitary",
"C": "Thymus",
"D": "Thyroid"
},
"Question": "A neonate is note to have an abnormally shaped face with a very small jaw. On examination he has systolic murmur. Several hours after bih, the baby develops convulsions and tetany. Serum chemistries show Sodium 40mEq/L Potassium 4mEq/L Chloride 100mEq/L Bicarbonate 24mEq/ L Magnesium 2mEq/L Calcium 5mEq/dL Glucose 100mg/ dL This child's disorder is associated with aplasia or hypoplasia of which of the following organs?"
} | A neonate is note to have an abnormally shaped face with a very small jaw. On examination he has systolic murmur. Several hours after bih, the baby develops convulsions and tetany. | Serum chemistries show Sodium 40mEq/L Potassium 4mEq/L Chloride 100mEq/L Bicarbonate 24mEq/ L Magnesium 2mEq/L Calcium 5mEq/dL Glucose 100mg/ dL This child's disorder is associated with aplasia or hypoplasia of which of the following organs? | {
"A": "Ovaries",
"B": "Pituitary",
"C": "Thymus",
"D": "Thyroid"
} | C. Thymus |
499329d9-56d9-46a9-a1f7-6ec582d00e17 | A 30-year-old person met with a roadside accident. On admission his pulse rate was 120/minute, BP was 100/60 mmHg. USG examination revealed laceration of the lower pole of spleen and hemoperitoneum. He was resuscitated with blood and fluid. Two hours later, his pulse was 84/ minute and BP was 120/70 mm Hg. The most appropriate course of management in this case would be: | Exploring the patient followed by splenectomy | Exploring the patient followed by excision of the lower pole of spleen | Splenorrhaphy | Continuation of conservative treatment under close monitoring system and subsequent surgery if fuher indicated | 3d
| single | - The most appropriate course of management in this case would be Conservative management - CECT | Depending upon the findings proceed for surgery | Surgery | Spleen | 108 | {
"Correct Answer": "Continuation of conservative treatment under close monitoring system and subsequent surgery if fuher indicated",
"Correct Option": "D",
"Options": {
"A": "Exploring the patient followed by splenectomy",
"B": "Exploring the patient followed by excision of the lower pole of spleen",
"C": "Splenorrhaphy",
"D": "Continuation of conservative treatment under close monitoring system and subsequent surgery if fuher indicated"
},
"Question": "A 30-year-old person met with a roadside accident. On admission his pulse rate was 120/minute, BP was 100/60 mmHg. USG examination revealed laceration of the lower pole of spleen and hemoperitoneum. He was resuscitated with blood and fluid. Two hours later, his pulse was 84/ minute and BP was 120/70 mm Hg. The most appropriate course of management in this case would be:"
} | A 30-year-old person met with a roadside accident. On admission his pulse rate was 120/minute, BP was 100/60 mmHg. USG examination revealed laceration of the lower pole of spleen and hemoperitoneum. He was resuscitated with blood and fluid. Two hours later, his pulse was 84/ minute and BP was 120/70 mm Hg. | The most appropriate course of management in this case would be: | {
"A": "Exploring the patient followed by splenectomy",
"B": "Exploring the patient followed by excision of the lower pole of spleen",
"C": "Splenorrhaphy",
"D": "Continuation of conservative treatment under close monitoring system and subsequent surgery if fuher indicated"
} | D. Continuation of conservative treatment under close monitoring system and subsequent surgery if fuher indicated |
19033308-685c-4c0b-b32c-8c7cec028e39 | A 25-year-old woman has recently moved to a new city. She comes today for her first routine visit and annual physical assessment. She feels well, reports no new symptoms, and her past medical history is negative. Her only medication is the oral contraceptive pill; she is currently in university and drinks on a social basis. She reports smoking in her teens but quit 7 years ago. The physical examination is completely normal. She asks you about screening tests for cancer at her age. Which of the following cancer screening tests are recommended for her age group? | mammography every 5 years | Pap smear at least every 3 years | stool for occult blood | chest x-ray (CXR) every 3 years | 1b
| single | There is universal agreement on the need for regular Pap smears in young women. There is no need to screen for colon cancer (fecal occult blood) or lung tumors (CXR), particularly at this age. Mammography, if indicated for screening, would be only for older women. Many authorities recommend breast self-examination as well as physical examination by a physician. | Medicine | Oncology | 113 | {
"Correct Answer": "Pap smear at least every 3 years",
"Correct Option": "B",
"Options": {
"A": "mammography every 5 years",
"B": "Pap smear at least every 3 years",
"C": "stool for occult blood",
"D": "chest x-ray (CXR) every 3 years"
},
"Question": "A 25-year-old woman has recently moved to a new city. She comes today for her first routine visit and annual physical assessment. She feels well, reports no new symptoms, and her past medical history is negative. Her only medication is the oral contraceptive pill; she is currently in university and drinks on a social basis. She reports smoking in her teens but quit 7 years ago. The physical examination is completely normal. She asks you about screening tests for cancer at her age. Which of the following cancer screening tests are recommended for her age group?"
} | A 25-year-old woman has recently moved to a new city. She comes today for her first routine visit and annual physical assessment. She feels well, reports no new symptoms, and her past medical history is negative. Her only medication is the oral contraceptive pill; she is currently in university and drinks on a social basis. She reports smoking in her teens but quit 7 years ago. The physical examination is completely normal. She asks you about screening tests for cancer at her age. | Which of the following cancer screening tests are recommended for her age group? | {
"A": "mammography every 5 years",
"B": "Pap smear at least every 3 years",
"C": "stool for occult blood",
"D": "chest x-ray (CXR) every 3 years"
} | B. Pap smear at least every 3 years |
44cd1462-2a78-4009-8a26-52c42dce3f01 | A 78 year old male is admitted with chest pain. His ECG shows widespread ST depression in all leads except aVR which shows ST elevation. Whilst in ER, he passes melaena and on fuher questioning, gave history of altered bowel habit, weight loss and dark stools for 2-3 months. O/E he is pale, pulse rate is 115 bpm and BP is 80/50 mmHg. Blood tests demonstrate a hemoglobin of 3.6g/l and a high-sensitivity troponin of 140ng/l. What is the best initial management? | Aggressive treatment with dual antiplatelets | Packed RBC transfusion | Nitrates to relieve ischemia | Beta blocker to slow hea rate and reduce ischaemia | 1b
| multi | Dx is NSTEMI : Type 2 MI (due to Anemia) Option A : No, as he is already having GI bleeding, so antiplatelet therapy is not given. Option B : Yes, packed RBC transfusion is useful for anemia component to | oxyhemoglobin. Option C : Nitrates are C/I if Systolic B.P <80 mm Hg Option D : He's already having hypotension & b blockers are C/I in hypotension | Medicine | Emergency Clinical Scenario | 129 | {
"Correct Answer": "Packed RBC transfusion",
"Correct Option": "B",
"Options": {
"A": "Aggressive treatment with dual antiplatelets",
"B": "Packed RBC transfusion",
"C": "Nitrates to relieve ischemia",
"D": "Beta blocker to slow hea rate and reduce ischaemia"
},
"Question": "A 78 year old male is admitted with chest pain. His ECG shows widespread ST depression in all leads except aVR which shows ST elevation. Whilst in ER, he passes melaena and on fuher questioning, gave history of altered bowel habit, weight loss and dark stools for 2-3 months. O/E he is pale, pulse rate is 115 bpm and BP is 80/50 mmHg. Blood tests demonstrate a hemoglobin of 3.6g/l and a high-sensitivity troponin of 140ng/l. What is the best initial management?"
} | A 78 year old male is admitted with chest pain. His ECG shows widespread ST depression in all leads except aVR which shows ST elevation. Whilst in ER, he passes melaena and on fuher questioning, gave history of altered bowel habit, weight loss and dark stools for 2-3 months. O/E he is pale, pulse rate is 115 bpm and BP is 80/50 mmHg. Blood tests demonstrate a hemoglobin of 3.6g/l and a high-sensitivity troponin of 140ng/l. | What is the best initial management? | {
"A": "Aggressive treatment with dual antiplatelets",
"B": "Packed RBC transfusion",
"C": "Nitrates to relieve ischemia",
"D": "Beta blocker to slow hea rate and reduce ischaemia"
} | B. Packed RBC transfusion |
9eb17295-7776-45a3-aa9a-55c6c61595c5 | A 45-year-old woman underwent a modified radical mastectomy 4 years ago. She was treated for multiple bone metastases with cyclophosphamide, doxorubicin, and fluorouracil for 6 months. She is complaining of exeion on exercise, swelling of the legs, and swelling around eyes in the morning. On examination, she has bilateral rales in the lungs, Sl, S2 audible, S3, S4 gallop present. Her BP is 149/117 mm Hg, PR is 80/min, and RR is 18/min. What is the most likely cause for her cardiac condition? | Systolic dysfunction CHF | Drug induced cardiac toxicity | Metastatic cardiac disease | Pneumonia | 1b
| multi | Answer is B (Drug induced cardiac toxicity) Features of cardiac failure in a patient on doxorubicin suggests the possibility of Anthracycline induced cardiac toxity.Risk of Anthracyclinc induced cardiac toxicity is increased with concomitent radiation and cyclophosphamide. cardiac failure after 6 months of chemotherapy with doxorubicin (anthracycline) and cyclophosphamide, is consistent with a diagnosis of drug induced cardiac toxity which is the single best answer of choice. | Medicine | null | 139 | {
"Correct Answer": "Drug induced cardiac toxicity",
"Correct Option": "B",
"Options": {
"A": "Systolic dysfunction CHF",
"B": "Drug induced cardiac toxicity",
"C": "Metastatic cardiac disease",
"D": "Pneumonia"
},
"Question": "A 45-year-old woman underwent a modified radical mastectomy 4 years ago. She was treated for multiple bone metastases with cyclophosphamide, doxorubicin, and fluorouracil for 6 months. She is complaining of exeion on exercise, swelling of the legs, and swelling around eyes in the morning. On examination, she has bilateral rales in the lungs, Sl, S2 audible, S3, S4 gallop present. Her BP is 149/117 mm Hg, PR is 80/min, and RR is 18/min. What is the most likely cause for her cardiac condition?"
} | A 45-year-old woman underwent a modified radical mastectomy 4 years ago. She was treated for multiple bone metastases with cyclophosphamide, doxorubicin, and fluorouracil for 6 months. She is complaining of exeion on exercise, swelling of the legs, and swelling around eyes in the morning. On examination, she has bilateral rales in the lungs, Sl, S2 audible, S3, S4 gallop present. Her BP is 149/117 mm Hg, PR is 80/min, and RR is 18/min. | What is the most likely cause for her cardiac condition? | {
"A": "Systolic dysfunction CHF",
"B": "Drug induced cardiac toxicity",
"C": "Metastatic cardiac disease",
"D": "Pneumonia"
} | B. Drug induced cardiac toxicity |
4fddfb2f-46f5-46f0-9050-126298381db9 | A 58-year-old woman presents with a 2-month history of abdominal discomfort and dark stools. Physical examination shows pallor but no evidence of jaundice. Laboratory studies disclose a microcytic, hypochromic anemia, with a hemoglobin level of 6.7 g/dL. A barium swallow radiograph reveals a "leather bottle" appearance of the stomach. Microscopic examination shows diffusely infiltrating malignant cells, many of which are "signet ring" cells, in the stomach wall. Which of the following is the most likely diagnosis? | Fungating adenocarcinoma | Gastric leiomyosarcoma | Gastric lymphoma | Linitis plastica | 3d
| multi | Diffuse adenocarcinoma constitutes10% of all stomach cancers. No true tumor mass is seen macroscopically. Instead, the wall of the stomach is conspicuously thickened and firm, accounting for the radiologic "leather bottle" appearance. When the entire stomach is involved, the term linitis plastica is applied. The invading tumor cells induce extensive fibrosis in the submucosa and muscularis of the stomach wall. Gastric carcinomas typically metastasize to regional lymph nodes and the liver. Signet ring cells are so named because intracellular mucin displaces the nuclei to the periphery of the tumor cells. Gastric carcinomas and linitis plastica, in particular, have a poor prognosis. The other choices do not show the characteristic morphologic appearance of linitis plastica and generally do not exhibit signet ring cells.Diagnosis: Gastric adenocarcinoma | Pathology | G.I.T. | 120 | {
"Correct Answer": "Linitis plastica",
"Correct Option": "D",
"Options": {
"A": "Fungating adenocarcinoma",
"B": "Gastric leiomyosarcoma",
"C": "Gastric lymphoma",
"D": "Linitis plastica"
},
"Question": "A 58-year-old woman presents with a 2-month history of abdominal discomfort and dark stools. Physical examination shows pallor but no evidence of jaundice. Laboratory studies disclose a microcytic, hypochromic anemia, with a hemoglobin level of 6.7 g/dL. A barium swallow radiograph reveals a \"leather bottle\" appearance of the stomach. Microscopic examination shows diffusely infiltrating malignant cells, many of which are \"signet ring\" cells, in the stomach wall. Which of the following is the most likely diagnosis?"
} | A 58-year-old woman presents with a 2-month history of abdominal discomfort and dark stools. Physical examination shows pallor but no evidence of jaundice. Laboratory studies disclose a microcytic, hypochromic anemia, with a hemoglobin level of 6.7 g/dL. A barium swallow radiograph reveals a "leather bottle" appearance of the stomach. Microscopic examination shows diffusely infiltrating malignant cells, many of which are "signet ring" cells, in the stomach wall. | Which of the following is the most likely diagnosis? | {
"A": "Fungating adenocarcinoma",
"B": "Gastric leiomyosarcoma",
"C": "Gastric lymphoma",
"D": "Linitis plastica"
} | D. Linitis plastica |
64e59cb4-900a-4c56-a2ac-562bee908e6b | A 34-year-old man complains of sudden attacks of dizziness, blurred vision, and excruciating headaches of 4 months in duration. During one of these attacks, his blood pressure was 180/120 mm Hg. The patient's father had been treated for thyroid cancer about 15 years ago. Laboratory studies show normal serum levels of aldosterone, renin, and angiotensin. A 24-hour urinalysis reveals increased metanephrines. Episodic hypeension in this patient is most likely caused by a tumor in which of the following endocrine organs? | Adrenal | Kidney | Parathyroid | Pituitary | 0a
| single | - Given clinical features suggests the diagnosis of Pheochromocytoma - Pheochromocytoma Arising from chromaffin cells of adrenal medulla that secretes catecholamines. Can originate in extra-adrenal sites - Paragangliomas. Clinical features are caused d/t release of catecholamines. - The other choices do not include tumors that lead to episodic hypeension. | Pathology | Systemic Pathology | 129 | {
"Correct Answer": "Adrenal",
"Correct Option": "A",
"Options": {
"A": "Adrenal",
"B": "Kidney",
"C": "Parathyroid",
"D": "Pituitary"
},
"Question": "A 34-year-old man complains of sudden attacks of dizziness, blurred vision, and excruciating headaches of 4 months in duration. During one of these attacks, his blood pressure was 180/120 mm Hg. The patient's father had been treated for thyroid cancer about 15 years ago. Laboratory studies show normal serum levels of aldosterone, renin, and angiotensin. A 24-hour urinalysis reveals increased metanephrines. Episodic hypeension in this patient is most likely caused by a tumor in which of the following endocrine organs?"
} | A 34-year-old man complains of sudden attacks of dizziness, blurred vision, and excruciating headaches of 4 months in duration. During one of these attacks, his blood pressure was 180/120 mm Hg. The patient's father had been treated for thyroid cancer about 15 years ago. Laboratory studies show normal serum levels of aldosterone, renin, and angiotensin. A 24-hour urinalysis reveals increased metanephrines. | Episodic hypeension in this patient is most likely caused by a tumor in which of the following endocrine organs? | {
"A": "Adrenal",
"B": "Kidney",
"C": "Parathyroid",
"D": "Pituitary"
} | A. Adrenal |
86b3d765-4a7a-4f84-9e51-795022686a4c | A 15 year-old boy presented with one day history of bleeding gums, subconjunctival bleed and purpuric rash. Investigations revealed the following results: Hb -6.4 gm/dL; TLC -26, 500 mm3; Platelet -35, 000/ mm3; prothrombin time -20 sec with a control of 13 sec; paial thromboplastin time-50 sec; and Fibrinogen 10 mg/dL. Peripheral smear was suggestive of acute myeloblastic leukaemia. Which of the following is the most likely ? | Myeloblastic leukemia without maturation | Myeloblastic leukemia with maturation | Promelocytic leukemia. | Myelomoncytic leukemia | 2c
| single | TEXT BOOK OF PATHOLOGY HARSHMOHAN 6TH EDITION PG NO 363 Thrombocytopenia . The platelet count is usually moderately to severely reduced (below 50,000/ml) but occasionally it may be normal. Bleeding tendencies in AML are usually correlated with the level of thrombocytopenia but most serious spontaneous haemorrhagic episodes develop in patients with fewer than 20,000/ml platelets. Acute promyelocytic leukaemia (M3) may be associated with a serious coagulation abnormality, disseminated intravascular coagulation (DIC)count is usually moderately to severely reduced (below 50,000/ml) but occasionally it may be normal. Bleeding tendencies in AML are usually correlated with the level of thrombocytopenia but most serious spontaneous haemorrhagic episodes develop in patients with fewer than 20,000/ml platelets. Acute promyelocytic leukaemia (M3) may be associated with a serious coagulation abnormality, disseminated intravascular coagulation (DIC) <\p> | Pathology | Haematology | 135 | {
"Correct Answer": "Promelocytic leukemia.",
"Correct Option": "C",
"Options": {
"A": "Myeloblastic leukemia without maturation",
"B": "Myeloblastic leukemia with maturation",
"C": "Promelocytic leukemia.",
"D": "Myelomoncytic leukemia"
},
"Question": "A 15 year-old boy presented with one day history of bleeding gums, subconjunctival bleed and purpuric rash. Investigations revealed the following results: Hb -6.4 gm/dL; TLC -26, 500 mm3; Platelet -35, 000/ mm3; prothrombin time -20 sec with a control of 13 sec; paial thromboplastin time-50 sec; and Fibrinogen 10 mg/dL. Peripheral smear was suggestive of acute myeloblastic leukaemia. Which of the following is the most likely ?"
} | A 15 year-old boy presented with one day history of bleeding gums, subconjunctival bleed and purpuric rash. Investigations revealed the following results: Hb -6.4 gm/dL; TLC -26, 500 mm3; Platelet -35, 000/ mm3; prothrombin time -20 sec with a control of 13 sec; paial thromboplastin time-50 sec; and Fibrinogen 10 mg/dL. Peripheral smear was suggestive of acute myeloblastic leukaemia. | Which of the following is the most likely ? | {
"A": "Myeloblastic leukemia without maturation",
"B": "Myeloblastic leukemia with maturation",
"C": "Promelocytic leukemia.",
"D": "Myelomoncytic leukemia"
} | C. Promelocytic leukemia. |
0e29b9df-7c44-4e6b-ad2e-6cbc821c803e | A 34-year-old female cab driver, a smoker, is admitted with acute shoness of breath and mild hemoptysis. Her review of systems is otherwise unremarkable. Physical examination: pulse 100 bpm; temperature 99degF; respirations 21/min; blood pressure 160/84 mm Hg. The patient is overweight with a BMI of 30. Other peinent findings: lungs have decreased breath sounds with crackles in both bases. Hea: NSR with loud P2 and grade 2/6 systolic murmur in the left parasternal area. Extremities reveal trace bilateral pedal edema. Laboratory data: Hb 15 g/dL; Hct 45%; WBCs 7.0/uL. EKG shows mild LV strain with no acute current of injury. ABGs on room air: pH 7.38; PCO2 45 mm Hg; PO2 70 mm Hg. CXR is shown in . The likely diagnosis is | Mycoplasma/atypical pneumonia | Obstructive sleep apnea | Chronic bronchitis | Pulmonary embolism | 3d
| multi | The PA view is slightly overpenetrated. Lumbar interspaces are visible in this patient. The cardiac silhouette is large. The left costophrenic angle is blunted and there appears to be increased density behind the hea that paially obscures the diaphragm. There are bilateral linear opacities in the lower zones consistent with discoid or linear atelectasis. Mycoplasma or atypical pneumonia may present with a similar radiographic picture, but in the absence of an acute febrile illness, that diagnosis seems unlikely. Chronic bronchitis is a clinical diagnosis and is defined per ATS criteria as a history of chronic sputum production for most of the days in a 3-mo period for at least two successive years. The chest x-ray may show large pulmonary vessels if there is longstanding cor pulmonale and generally does not show any focal opacities. Although the patient is obese and 60% of patients with obstructive sleep apnea (OSA) are overweight, there is no history of hypersomnolence, sleep fragmentation, sleep disorder, or other clinical evidence of sleep apnea syndrome. The clinical scenario presented is suggestive of pulmonary embolism. The physical exam suggesting bilateral atelectasis and the chest radiograph depicting those changes and representing congestive atelectasis are consistent with that diagnosis. | Radiology | Respiratory system | 225 | {
"Correct Answer": "Pulmonary embolism",
"Correct Option": "D",
"Options": {
"A": "Mycoplasma/atypical pneumonia",
"B": "Obstructive sleep apnea",
"C": "Chronic bronchitis",
"D": "Pulmonary embolism"
},
"Question": "A 34-year-old female cab driver, a smoker, is admitted with acute shoness of breath and mild hemoptysis. Her review of systems is otherwise unremarkable. Physical examination: pulse 100 bpm; temperature 99degF; respirations 21/min; blood pressure 160/84 mm Hg. The patient is overweight with a BMI of 30. Other peinent findings: lungs have decreased breath sounds with crackles in both bases. Hea: NSR with loud P2 and grade 2/6 systolic murmur in the left parasternal area. Extremities reveal trace bilateral pedal edema. Laboratory data: Hb 15 g/dL; Hct 45%; WBCs 7.0/uL. EKG shows mild LV strain with no acute current of injury. ABGs on room air: pH 7.38; PCO2 45 mm Hg; PO2 70 mm Hg. CXR is shown in . The likely diagnosis is"
} | A 34-year-old female cab driver, a smoker, is admitted with acute shoness of breath and mild hemoptysis. Her review of systems is otherwise unremarkable. Physical examination: pulse 100 bpm; temperature 99degF; respirations 21/min; blood pressure 160/84 mm Hg. The patient is overweight with a BMI of 30. Other peinent findings: lungs have decreased breath sounds with crackles in both bases. Hea: NSR with loud P2 and grade 2/6 systolic murmur in the left parasternal area. Extremities reveal trace bilateral pedal edema. Laboratory data: Hb 15 g/dL; Hct 45%; WBCs 7.0/uL. EKG shows mild LV strain with no acute current of injury. ABGs on room air: pH 7.38; PCO2 45 mm Hg; PO2 70 mm Hg. CXR is shown in . | The likely diagnosis is | {
"A": "Mycoplasma/atypical pneumonia",
"B": "Obstructive sleep apnea",
"C": "Chronic bronchitis",
"D": "Pulmonary embolism"
} | D. Pulmonary embolism |
4c6b0669-83fa-469a-83c5-99d048c83e52 | A 28-year-old man presents to the emergency room complaining of coughing up blood and sputum He provides a history of recurrent pneumonias and a chronic cough productive of foul-smelling purulent sputum He has no other past medical history and is a lifetime non-smoker. On physical examination, there are no oral lesions, heart sounds are normal, and wet inspiratory crackles are heard at the lung bases posteriorly. He also has clubbing of his fingers, but there is no hepatosplenomegaly or any palpable lymph nodes. CXR show fibrosis and pulmonary infiltrates in the right lower lung. Which of the following is the most appropriate initial diagnostic test? | chest CT scan | bronchoscopy | bronchography | open thoracotomy | 0a
| single | CT scan can confirm the diagnosis and define the extent of bronchiectasis. Occasionally, advanced cases of saccular bronchiectasis can be diagnosed by routine CXR. Open thoracotomy is usually not necessary to make the diagnosis of bronchiectasis, and a BAL is performed only if cultures are required. | Medicine | Respiratory | 144 | {
"Correct Answer": "chest CT scan",
"Correct Option": "A",
"Options": {
"A": "chest CT scan",
"B": "bronchoscopy",
"C": "bronchography",
"D": "open thoracotomy"
},
"Question": "A 28-year-old man presents to the emergency room complaining of coughing up blood and sputum He provides a history of recurrent pneumonias and a chronic cough productive of foul-smelling purulent sputum He has no other past medical history and is a lifetime non-smoker. On physical examination, there are no oral lesions, heart sounds are normal, and wet inspiratory crackles are heard at the lung bases posteriorly. He also has clubbing of his fingers, but there is no hepatosplenomegaly or any palpable lymph nodes. CXR show fibrosis and pulmonary infiltrates in the right lower lung. Which of the following is the most appropriate initial diagnostic test?"
} | A 28-year-old man presents to the emergency room complaining of coughing up blood and sputum He provides a history of recurrent pneumonias and a chronic cough productive of foul-smelling purulent sputum He has no other past medical history and is a lifetime non-smoker. On physical examination, there are no oral lesions, heart sounds are normal, and wet inspiratory crackles are heard at the lung bases posteriorly. He also has clubbing of his fingers, but there is no hepatosplenomegaly or any palpable lymph nodes. CXR show fibrosis and pulmonary infiltrates in the right lower lung. | Which of the following is the most appropriate initial diagnostic test? | {
"A": "chest CT scan",
"B": "bronchoscopy",
"C": "bronchography",
"D": "open thoracotomy"
} | A. chest CT scan |
b6dfc99d-9595-4a96-b15e-37585ede0b36 | A 40-year-old, moderately obese man presents with a persistent productive cough. The cough has been present for several weeks, but recently the man noted that his sputum has assumed a greenish color. Fuher questioning elicits a history of productive cough, usually in the winter months, over the past several years. He has smoked two packs of cigarettes per day since he was 16 years old. On examination, the man is febrile (100deg F), and coarse rhonchi and wheezes can be appreciated bilaterally. Which of the following is the MOST likely diagnosis? | Bronchogenic carcinoma | Chronic bronchitis with superimposed infection | Cystic fibrosis | Emphysema | 1b
| multi | The diagnosis of chronic bronchitis requires the presence of chronic productive cough for over at least 3 months of the year for 2 successive years. The symptoms in this patient (green productive sputum, fever) suggest that he has an acute infection superimposed on chronic bronchitis (history of cigarette smoking, history of excessive mucus production over many years). Histologically, the mucus-producing glands in the bronchi would show hyperplasia and hyperophy and extend to a greater depth in the bronchial wall, resulting in a higher Reid index (ratio of thickness of mucus gland to thickness of bronchial wall).Although the patient is a smoker and is at increased risk for bronchogenic carcinoma, this is unlikely to be the cause of his symptoms. Hemoptysis and weight loss might also be present if he had cancer. Cystic fibrosis presents earlier in life and may be associated with severe production of mucus, especially if bronchiectasis supervenes. The age of the patient and the relative late onset of disease preclude this diagnosis. This patient may also have emphysema, as chronic bronchitis and emphysema are often coexistent. However, although pure emphysema might cause dyspnea, it would not be associated with a fever or a productive cough. Ref:Tallman T.A. (2011). Chapter 67. Acute Bronchitis and Upper Respiratory Tract Infections. In J.E. Tintinalli, J.S. Stapczynski, D.M. Cline, O.J. Ma, R.K. Cydulka, G.D. Meckler (Eds), Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e. | Pathology | null | 127 | {
"Correct Answer": "Chronic bronchitis with superimposed infection",
"Correct Option": "B",
"Options": {
"A": "Bronchogenic carcinoma",
"B": "Chronic bronchitis with superimposed infection",
"C": "Cystic fibrosis",
"D": "Emphysema"
},
"Question": "A 40-year-old, moderately obese man presents with a persistent productive cough. The cough has been present for several weeks, but recently the man noted that his sputum has assumed a greenish color. Fuher questioning elicits a history of productive cough, usually in the winter months, over the past several years. He has smoked two packs of cigarettes per day since he was 16 years old. On examination, the man is febrile (100deg F), and coarse rhonchi and wheezes can be appreciated bilaterally. Which of the following is the MOST likely diagnosis?"
} | A 40-year-old, moderately obese man presents with a persistent productive cough. The cough has been present for several weeks, but recently the man noted that his sputum has assumed a greenish color. Fuher questioning elicits a history of productive cough, usually in the winter months, over the past several years. He has smoked two packs of cigarettes per day since he was 16 years old. On examination, the man is febrile (100deg F), and coarse rhonchi and wheezes can be appreciated bilaterally. | Which of the following is the MOST likely diagnosis? | {
"A": "Bronchogenic carcinoma",
"B": "Chronic bronchitis with superimposed infection",
"C": "Cystic fibrosis",
"D": "Emphysema"
} | B. Chronic bronchitis with superimposed infection |
dc61a8d0-cbfa-45d6-9843-28c7311d3715 | The surgical specimen is sent fresh from the surgical suite to the laboratory for frozen section examination. Before cutting into the specimen, the pathologist makes a careful gross examination, which demonstrates that most of the specimen has replacement of the normally fatty breast tissue with strands of dense, white, firm tissue. In a few areas, roughly spherical lesions up to 3-cm diameter with a bluish hue to them are seen. Palpation of these areas produces a fluctuant sensation. Which of the following is the MOST likely diagnosis based on the gross evaluation? | Breast cancer | Changes of pregnancy | Fibroadenoma | Fibrocystic disease | 3d
| multi | While a careful pathologist will wait for appropriate frozen or permanent tissue histologic examination, the description given in the question stem is most suggestive of fibrocystic disease. The fibrous pa of the lesion forms the dense, white tissue strands, while the blue lesions are what are called "blue-domed cysts". The blue color comes from the presence of darkly colored fluid (which usually means old hemorrhage) within the cyst. The interior cyst wall is usually smooth. These blue-domed cysts are a ourite of examiners because they produce a distinctive gross picture and should be specifically associated with fibrocystic disease, but you should be aware that in real life they do not occur with anything near the frequency of fibrocystic disease without obvious large cysts grossly (but many smaller cysts on microscopic examination). Fibrocystic disease of the breast is a very common lesion, and a frequent source of palpable lumps in the breast, which may require fuher evaluation through either excisional biopsy (as in this case), Tru-cut needle biopsy (producing a thin core about 1 cm long), or needle aspiration (producing fluid or cells for cytology). Also know: While a diagnosis of breast cancer should obviously be confirmed microscopically before telling the clinician, invasive breast cancer can be suspected when there is a hard, white, nodular area of the breast that has irregular (but often reasonably well-defined - in contrast to the fibrotic areas of fibrocystic disease) boundaries. The changes of pregnancy cannot be reliably picked up on gross examination of the breast. Fibroadenoma , like breast cancer, tends to produce a well-defined mass lesion, but it typically has smooth borders and may have a slightly gray and slightly mucoid (e.g., shiny or oily appearing) surface on cross-section. Ref: Chandrasoma P., Taylor C.R. (1998). Chapter 56. The Breast. In P. Chandrasoma, C.R. Taylor (Eds), Concise Pathology, 3e. | Pathology | null | 111 | {
"Correct Answer": "Fibrocystic disease",
"Correct Option": "D",
"Options": {
"A": "Breast cancer",
"B": "Changes of pregnancy",
"C": "Fibroadenoma",
"D": "Fibrocystic disease"
},
"Question": "The surgical specimen is sent fresh from the surgical suite to the laboratory for frozen section examination. Before cutting into the specimen, the pathologist makes a careful gross examination, which demonstrates that most of the specimen has replacement of the normally fatty breast tissue with strands of dense, white, firm tissue. In a few areas, roughly spherical lesions up to 3-cm diameter with a bluish hue to them are seen. Palpation of these areas produces a fluctuant sensation. Which of the following is the MOST likely diagnosis based on the gross evaluation?"
} | The surgical specimen is sent fresh from the surgical suite to the laboratory for frozen section examination. Before cutting into the specimen, the pathologist makes a careful gross examination, which demonstrates that most of the specimen has replacement of the normally fatty breast tissue with strands of dense, white, firm tissue. In a few areas, roughly spherical lesions up to 3-cm diameter with a bluish hue to them are seen. Palpation of these areas produces a fluctuant sensation. | Which of the following is the MOST likely diagnosis based on the gross evaluation? | {
"A": "Breast cancer",
"B": "Changes of pregnancy",
"C": "Fibroadenoma",
"D": "Fibrocystic disease"
} | D. Fibrocystic disease |
afd5ce7d-6fe8-4851-8c0b-28e78f43a6e5 | The data presented below compares the results of a diagnostic test in the presence and absence of a disease.\r\n\r\n \r\n\r\n\r\nTest Result\r\nDisease Present\r\nDisease Absent\r\n\r\n\r\nPositive Test\r\n40\r\n5\r\n\r\n\r\nNegative Test\r\n10\r\n95\r\n\r\n\r\nTotal\r\n50\r\n100\r\n\r\n\r\n\r\n\r\n \r\nThe specificity of the test is? | 0.05 | 0.4 | 0.8 | 0.95 | 3d
| single | Specificity is the propoion of persons without the disease who are correctly identified by the test as being disease-free. It is given by TN/(FP + TN), where TN stands for true negatives (people who do not have the disease and test negative on the test) and FP stands for false positives (people who do not have the disease but test positive on the test). In this case, 95/(5 + 95) = 95/100=0.95. | Social & Preventive Medicine | null | 112 | {
"Correct Answer": "0.95",
"Correct Option": "D",
"Options": {
"A": "0.05",
"B": "0.4",
"C": "0.8",
"D": "0.95"
},
"Question": "The data presented below compares the results of a diagnostic test in the presence and absence of a disease.\\r\\n\\r\\n \\r\\n\\r\\n\\r\\nTest Result\\r\\nDisease Present\\r\\nDisease Absent\\r\\n\\r\\n\\r\\nPositive Test\\r\\n40\\r\\n5\\r\\n\\r\\n\\r\\nNegative Test\\r\\n10\\r\\n95\\r\\n\\r\\n\\r\\nTotal\\r\\n50\\r\\n100\\r\\n\\r\\n\\r\\n\\r\\n\\r\\n \\r\\nThe specificity of the test is?"
} | . | The data presented below compares the results of a diagnostic test in the presence and absence of a disease.\r\n\r\n \r\n\r\n\r\nTest Result\r\nDisease Present\r\nDisease Absent\r\n\r\n\r\nPositive Test\r\n40\r\n5\r\n\r\n\r\nNegative Test\r\n10\r\n95\r\n\r\n\r\nTotal\r\n50\r\n100\r\n\r\n\r\n\r\n\r\n \r\nThe specificity of the test is? | {
"A": "0.05",
"B": "0.4",
"C": "0.8",
"D": "0.95"
} | D. 0.95 |
30739838-aeea-4eee-9dbe-b3b6f0be5485 | A 30 year old known SLE female presents with ankle swelling. Her BP is 170/100 mmHg and she has marked lower limb edema. Urine dip stick discloses 4+ proteins with no hematuria. Plasma creatinine is 1.4 mg/dl, albumin is 1.5 g/dl and urine protein excretion rate was 6 gms for 24 hours. What is the cause of this presentation? | Amyloidosis | Class II lupus nephritis | Class V lupus nephritis | Pericardial effusion | 2c
| single | null | Medicine | null | 102 | {
"Correct Answer": "Class V lupus nephritis",
"Correct Option": "C",
"Options": {
"A": "Amyloidosis",
"B": "Class II lupus nephritis",
"C": "Class V lupus nephritis",
"D": "Pericardial effusion"
},
"Question": "A 30 year old known SLE female presents with ankle swelling. Her BP is 170/100 mmHg and she has marked lower limb edema. Urine dip stick discloses 4+ proteins with no hematuria. Plasma creatinine is 1.4 mg/dl, albumin is 1.5 g/dl and urine protein excretion rate was 6 gms for 24 hours. What is the cause of this presentation?"
} | A 30 year old known SLE female presents with ankle swelling. Her BP is 170/100 mmHg and she has marked lower limb edema. Urine dip stick discloses 4+ proteins with no hematuria. Plasma creatinine is 1.4 mg/dl, albumin is 1.5 g/dl and urine protein excretion rate was 6 gms for 24 hours. | What is the cause of this presentation? | {
"A": "Amyloidosis",
"B": "Class II lupus nephritis",
"C": "Class V lupus nephritis",
"D": "Pericardial effusion"
} | C. Class V lupus nephritis |
820e866c-b4d1-473a-9db4-b2db989ba55f | A 62-year-old man reports early satiety, fatigue, and generally feeling unwell. On examination he has a large spleen, appears pale, and the rest of the examination is normal. His blood count is abnormal; the WBC is 50,000/mL with increased mature granulocytes, hemoglobin 9.5 g/dL, and platelets 450,000/mL. Which of the following cytogenetic changes is most characteristic of his condition? | deletion of chromosome 14 | reciprocal translocation of 9 and 22 (Philadelphia chromosome) | translocation of the renal artery stenosis (RAS) oncogene | trisomy 21 | 1b
| multi | This is a case of chronic myelogenous leukemia. The reciprocal translocation involves the long arms of 22 and 9, and results in translocation of the ABL proto-oncogene from chromosome 9 adjacent to a portion of the BCR gene on chromosome 22. The resultant abnormal chromosome 22 is known as the Philadelphia (Phi) chromosome. | Medicine | Blood | 106 | {
"Correct Answer": "reciprocal translocation of 9 and 22 (Philadelphia chromosome)",
"Correct Option": "B",
"Options": {
"A": "deletion of chromosome 14",
"B": "reciprocal translocation of 9 and 22 (Philadelphia chromosome)",
"C": "translocation of the renal artery stenosis (RAS) oncogene",
"D": "trisomy 21"
},
"Question": "A 62-year-old man reports early satiety, fatigue, and generally feeling unwell. On examination he has a large spleen, appears pale, and the rest of the examination is normal. His blood count is abnormal; the WBC is 50,000/mL with increased mature granulocytes, hemoglobin 9.5 g/dL, and platelets 450,000/mL. Which of the following cytogenetic changes is most characteristic of his condition?"
} | A 62-year-old man reports early satiety, fatigue, and generally feeling unwell. On examination he has a large spleen, appears pale, and the rest of the examination is normal. His blood count is abnormal; the WBC is 50,000/mL with increased mature granulocytes, hemoglobin 9.5 g/dL, and platelets 450,000/mL. | Which of the following cytogenetic changes is most characteristic of his condition? | {
"A": "deletion of chromosome 14",
"B": "reciprocal translocation of 9 and 22 (Philadelphia chromosome)",
"C": "translocation of the renal artery stenosis (RAS) oncogene",
"D": "trisomy 21"
} | B. reciprocal translocation of 9 and 22 (Philadelphia chromosome) |
5585e3b6-db40-435e-9585-d84078252ceb | A 22-year-old primagravida woman develops hypertension at 32 weeks. She reports no vision change, headache, shortness of breath, or abdominal symptoms. Her pregnancy is uneventful until now. She has no significant past medical history and is not on any medications except vitamins.On examination the blood pressure is 160/100 mm Hg, heart rate is 100/min, and the rest of the examination is normal except for 1+ pedal edema. Her complete blood count, liver enzymes, and electrolytes are normal. The urinalysis is positive for proteinuria. Which of the following is true for this type of hypertension? | improves in the third trimester | leads to large-birth-weight babies | should be controlled with medications | spares the placenta | 2c
| multi | This patient has preeclampsia and needs treatment of her hypertension and close follow-up. In the past, there was concern that rigorous drug treatment would harm the fetus. Approximately 5%- 1% of all pregnant women develop preeclampsia which is defined as new-onset hypertension with BP > 140/90 mmHg and proteinuria > 300 mg/24h after 20 weeks of gestation.Studies now show benefit in controlling blood pressure with drugs, but ACE inhibitors and angiotensin receptor blockers (ARB) are contraindicated because they cause renal abnormalities in the fetus. Women who develop hypertension during pregnancy have a higher risk of developing hypertension in later life.Preeclampsia does not improve during the third trimester, it leads to premature birth or low- birth-weight babies, and injures the placenta. | Medicine | C.V.S. | 141 | {
"Correct Answer": "should be controlled with medications",
"Correct Option": "C",
"Options": {
"A": "improves in the third trimester",
"B": "leads to large-birth-weight babies",
"C": "should be controlled with medications",
"D": "spares the placenta"
},
"Question": "A 22-year-old primagravida woman develops hypertension at 32 weeks. She reports no vision change, headache, shortness of breath, or abdominal symptoms. Her pregnancy is uneventful until now. She has no significant past medical history and is not on any medications except vitamins.On examination the blood pressure is 160/100 mm Hg, heart rate is 100/min, and the rest of the examination is normal except for 1+ pedal edema. Her complete blood count, liver enzymes, and electrolytes are normal. The urinalysis is positive for proteinuria. Which of the following is true for this type of hypertension?"
} | A 22-year-old primagravida woman develops hypertension at 32 weeks. She reports no vision change, headache, shortness of breath, or abdominal symptoms. Her pregnancy is uneventful until now. She has no significant past medical history and is not on any medications except vitamins.On examination the blood pressure is 160/100 mm Hg, heart rate is 100/min, and the rest of the examination is normal except for 1+ pedal edema. Her complete blood count, liver enzymes, and electrolytes are normal. The urinalysis is positive for proteinuria. | Which of the following is true for this type of hypertension? | {
"A": "improves in the third trimester",
"B": "leads to large-birth-weight babies",
"C": "should be controlled with medications",
"D": "spares the placenta"
} | C. should be controlled with medications |
053232e4-95d6-4a05-9f65-3ed0d26ea4fb | A 30-year-old woman with diabetes mellitus presents to her physician at 19 weeks' gestation. She is obese and did not realize that she was pregnant until recently. She also has not been "watching her sugar" lately, but is now motivated to improve her regimen. A dilated ophthalmologic examination shows no retinopathy. An ECG is normal. Urinalysis is negative for proteinuria. Laboratory studies show: Hemoglobin A 1c: 10.8% , Glucose: 222 mg/dL , Thyroid-stimulating hormone: 1.0 μU/mL, Free thyroxine: 1.7 ng/dL ,Creatinine: 1.1 mg/dL.
In which of the following condition the risk of developing it is same in diabetics as the general population. | Asymptomatic bacteriuria | Preeclampsia | Congenital adrenal hyperplasia | PPH after delivery | 2c
| single | In the question, patient is presenting with overt diabetes mellitus i.e. she had diabetes before pregnancy also. The question says, in which the following conditions the risk of developing the condition is same in diabetic as well as nondiabetic patients in other words, which of the options is not a complication of diabetes during pregnancy.
Option ‘a’ – asymptomatic bacteriuvea – Diabetes during pregnancy, increases the chances of infections including asymptomatic bacteriuria Dutta Obs. 7/e, p 283
Option ‘b’ – preeclampsia – In all diabetic patients, there are increased chances of preeclampsia (25%) Dutta Obs. 7/e p 283
Option ‘c’ – Congenital adrenal hyperplasia – It does not have any relation whatsoever with diabetes.
Option ‘d’ – PPH after delivery – Diabetic pregnancy leads to polyhydramnios which can lead to PPH after delivery.
Option ‘e’ – Shoulder dystocia is a result of macrosomia during pregnancy. | Gynaecology & Obstetrics | null | 180 | {
"Correct Answer": "Congenital adrenal hyperplasia",
"Correct Option": "C",
"Options": {
"A": "Asymptomatic bacteriuria",
"B": "Preeclampsia",
"C": "Congenital adrenal hyperplasia",
"D": "PPH after delivery"
},
"Question": "A 30-year-old woman with diabetes mellitus presents to her physician at 19 weeks' gestation. She is obese and did not realize that she was pregnant until recently. She also has not been \"watching her sugar\" lately, but is now motivated to improve her regimen. A dilated ophthalmologic examination shows no retinopathy. An ECG is normal. Urinalysis is negative for proteinuria. Laboratory studies show: Hemoglobin A 1c: 10.8% , Glucose: 222 mg/dL , Thyroid-stimulating hormone: 1.0 μU/mL, Free thyroxine: 1.7 ng/dL ,Creatinine: 1.1 mg/dL. \nIn which of the following condition the risk of developing it is same in diabetics as the general population."
} | A 30-year-old woman with diabetes mellitus presents to her physician at 19 weeks' gestation. She is obese and did not realize that she was pregnant until recently. She also has not been "watching her sugar" lately, but is now motivated to improve her regimen. A dilated ophthalmologic examination shows no retinopathy. An ECG is normal. Urinalysis is negative for proteinuria. Laboratory studies show: Hemoglobin A 1c: 10.8% , Glucose: 222 mg/dL , Thyroid-stimulating hormone: 1.0 μU/mL, Free thyroxine: 1.7 ng/dL ,Creatinine: 1.1 mg/dL. | In which of the following condition the risk of developing it is same in diabetics as the general population. | {
"A": "Asymptomatic bacteriuria",
"B": "Preeclampsia",
"C": "Congenital adrenal hyperplasia",
"D": "PPH after delivery"
} | C. Congenital adrenal hyperplasia |
5a8585f6-b497-4ade-9af3-ef7abf5be706 | An enzyme-catalyzed reaction was carried out with the initial substrate concentration 1,000 times greater than the Km for that substrate. After 9 minutes, 1% of the substrate had been conveed to the product, and the amount of product was 12 mmol. If, in a separate experiment, one-third as much enzyme and twice as much of the substrate is combined, how long it would to take for the same amount (12 mmol) of product to be formed? | 13.5 mins | 27 mins | 8 mins | 9 mins | 1b
| single | Since we know that Enzyme is more impoant than substrate, so enzyme concentration we have to see first if that is reduced then it doesn't matter whether we increase substrate concentration or not time will increase only. So, since enzyme is decreased to 1/3 time will increase by 3 times irrespective of increase in substrate concentration By using Michaelis-Menten equation, that is, V0 = Vmax x / Km + and by definition Vmax = Kcat x Where is enzyme concentration, Kcat is turnover number So, Similarly, As velocity is 3 times slower than first velocity so same amount of product formation will require 3x more time. Hence, Time taken will be = 3 x t = 3 x 9 = 27 minutes | Biochemistry | Enzyme kinetics | 107 | {
"Correct Answer": "27 mins",
"Correct Option": "B",
"Options": {
"A": "13.5 mins",
"B": "27 mins",
"C": "8 mins",
"D": "9 mins"
},
"Question": "An enzyme-catalyzed reaction was carried out with the initial substrate concentration 1,000 times greater than the Km for that substrate. After 9 minutes, 1% of the substrate had been conveed to the product, and the amount of product was 12 mmol. If, in a separate experiment, one-third as much enzyme and twice as much of the substrate is combined, how long it would to take for the same amount (12 mmol) of product to be formed?"
} | An enzyme-catalyzed reaction was carried out with the initial substrate concentration 1,000 times greater than the Km for that substrate. After 9 minutes, 1% of the substrate had been conveed to the product, and the amount of product was 12 mmol. | If, in a separate experiment, one-third as much enzyme and twice as much of the substrate is combined, how long it would to take for the same amount (12 mmol) of product to be formed? | {
"A": "13.5 mins",
"B": "27 mins",
"C": "8 mins",
"D": "9 mins"
} | B. 27 mins |
f304dff7-ace7-4ca4-9cdb-7f469899d703 | A 45-year-old woman underwent a modified radical mastectomy 4 years ago. She was treated for multiple bone metastases with cyclophosphamide, doxorubicin, and fluorouracil for 6 months. She is complaining of exeion on exercise, swelling of the legs, and swelling around eyes in the morning. On examination, she has bilateral rales in the lungs. S1, S2 audible, S3 and S4 gallop is present. Her BP is 149/117 mm Hg, PR is 80/min, and RR is 18/min. What is the MOST likely cause of her cardiac condition? | Systolic dysfunction CHF | Drug induced cardiac toxicity | Metastatic cardiac disease | Pneumonia | 1b
| multi | This patient is showing features of congestive hea failure which has most probably resulted from the use of doxorubicin. It is a leading cause of chemotherapy induced hea disease, it cause this during therapy, weeks after completion of therapy or unexpectedly after years. Traditionally, the cardiac-limiting dose of doxorubicin has been described as 550 mg/m2, when this drug is combined with cyclophosphamide cardiotoxicity is noted at a lower dose of 300 mg/m2. During acute therapy ECG changes occur in 30% of patients and usually regress in weeks. The occurrence of early ECG abnormalities does not predict cardiomyopathy and is not an indication to discontinue therapy. If an otherwise stable oncology patient develops persistent sinus tachycardia, ventricular dysfunction and impending CHF should be suspected. Ref: Hurst's The Hea, 13e chapter 94, By Andrew L. Smith; Wendy M. Book. | Medicine | null | 141 | {
"Correct Answer": "Drug induced cardiac toxicity",
"Correct Option": "B",
"Options": {
"A": "Systolic dysfunction CHF",
"B": "Drug induced cardiac toxicity",
"C": "Metastatic cardiac disease",
"D": "Pneumonia"
},
"Question": "A 45-year-old woman underwent a modified radical mastectomy 4 years ago. She was treated for multiple bone metastases with cyclophosphamide, doxorubicin, and fluorouracil for 6 months. She is complaining of exeion on exercise, swelling of the legs, and swelling around eyes in the morning. On examination, she has bilateral rales in the lungs. S1, S2 audible, S3 and S4 gallop is present. Her BP is 149/117 mm Hg, PR is 80/min, and RR is 18/min. What is the MOST likely cause of her cardiac condition?"
} | A 45-year-old woman underwent a modified radical mastectomy 4 years ago. She was treated for multiple bone metastases with cyclophosphamide, doxorubicin, and fluorouracil for 6 months. She is complaining of exeion on exercise, swelling of the legs, and swelling around eyes in the morning. On examination, she has bilateral rales in the lungs. S1, S2 audible, S3 and S4 gallop is present. Her BP is 149/117 mm Hg, PR is 80/min, and RR is 18/min. | What is the MOST likely cause of her cardiac condition? | {
"A": "Systolic dysfunction CHF",
"B": "Drug induced cardiac toxicity",
"C": "Metastatic cardiac disease",
"D": "Pneumonia"
} | B. Drug induced cardiac toxicity |
e97eb8aa-f401-4e8e-bb9c-34c2ecd6a727 | A 69 year old woman is brought to the emergency room after falling off a step stool and fracturing her hip. Her past medical history is significant for several bouts of pneumonia during the past year. Laboratory results indicate a normal white blood cell count, but platelets are decreased, and the erythrocyte sedimentation rate (ESR) is elevated. X-rays reveal multiple lytic bone lesions. Serum electrophoresis demonstrates an M-protein spike. Which of the following is the most likely diagnosis? | Chronic lymphocytic leukemia | Monoclonal gammopathy of unceain significance | Multiple myeloma | Plasmacytoma | 2c
| multi | The patient is suffering from multiple myeloma, a neoplastic proliferation of plasma cells (or their precursors) found within the bone marrow. These malignant cells are responsible for the production of excessive amounts of immunoglobulin (usually IgG or IgA), producing an M- protein spike, and increasing the ESR. The decreased platelet count probably reflects infiltration of the bone marrow by myeloma cells. It is not unusual for patients with malignant myeloma to have recurring bacterial infections, paicularly pneumococcal pneumonia, because the overall production of normal immunoglobulins of all isotypes is decreased. Lytic bone lesions due to infiltration by myeloma cells may lead to pathological fractures. All of the other disorders listed can be associated with an M- protein spike, but this is a nonspecific finding. Chronic lymphocytic leukemia is ruled out by the normal white count, since this type of leukemia is generally associated with an absolute lymphocytosis. Patients with monoclonal gammopathy of undetermined significance (choice B) are generally asymptomatic, although they have a predisposition for subsequently developing myeloma, lymphoma, amyloidosis, or Waldenstrom's macroglobulinemia. Plasmacytoma (solitary myeloma) is a rare, isolated plasma cell neoplasm in bone or soft tissues. If the primary cancer is in bone, it is likely to disseminate; extra osseous tumors tend to remain localized. Since this patient had multiple lytic bone lesions, multiple myeloma is the correct diagnosis. Ref: van Rhee F., Anaissie E., Angtuaco E., Bael T., Epstein J., Nair B., Shaughnessy J., Yaccoby S., Barlogie B. (2010). Chapter 109. Myeloma. In J.T. Prchal, K. Kaushansky, M.A. Lichtman, T.J. Kipps, U. Seligsohn (Eds), Williams Hematology, 8e | Pathology | null | 105 | {
"Correct Answer": "Multiple myeloma",
"Correct Option": "C",
"Options": {
"A": "Chronic lymphocytic leukemia",
"B": "Monoclonal gammopathy of unceain significance",
"C": "Multiple myeloma",
"D": "Plasmacytoma"
},
"Question": "A 69 year old woman is brought to the emergency room after falling off a step stool and fracturing her hip. Her past medical history is significant for several bouts of pneumonia during the past year. Laboratory results indicate a normal white blood cell count, but platelets are decreased, and the erythrocyte sedimentation rate (ESR) is elevated. X-rays reveal multiple lytic bone lesions. Serum electrophoresis demonstrates an M-protein spike. Which of the following is the most likely diagnosis?"
} | A 69 year old woman is brought to the emergency room after falling off a step stool and fracturing her hip. Her past medical history is significant for several bouts of pneumonia during the past year. Laboratory results indicate a normal white blood cell count, but platelets are decreased, and the erythrocyte sedimentation rate (ESR) is elevated. X-rays reveal multiple lytic bone lesions. Serum electrophoresis demonstrates an M-protein spike. | Which of the following is the most likely diagnosis? | {
"A": "Chronic lymphocytic leukemia",
"B": "Monoclonal gammopathy of unceain significance",
"C": "Multiple myeloma",
"D": "Plasmacytoma"
} | C. Multiple myeloma |
2bbefa15-39e2-4a1c-a85c-070e7184531b | A 25-year-old man with a history of hearing voices is brought to the emergency department by his family because the voices are telling him to kill his mother. He believes that aliens are trying to abduct him. These delusions and hallucinations have been present over the past 6 months. His family denies a history of depression or manic episodes. The patient is admitted to an inpatient psychiatry unit and started on haloperidol. Three hours after the initiation of therapy, he develops stiffness and muscle spasms of the neck and spine muscles.
Which of the following is the mechanism of action of the drug that should be used in the acute management of this patient? | Anticholinergic | Increase in glutamate | Increase of intracellular Ca+2 concentration | Serotonin agonist | 0a
| multi | null | Pharmacology | null | 138 | {
"Correct Answer": "Anticholinergic",
"Correct Option": "A",
"Options": {
"A": "Anticholinergic",
"B": "Increase in glutamate",
"C": "Increase of intracellular Ca+2 concentration",
"D": "Serotonin agonist"
},
"Question": "A 25-year-old man with a history of hearing voices is brought to the emergency department by his family because the voices are telling him to kill his mother. He believes that aliens are trying to abduct him. These delusions and hallucinations have been present over the past 6 months. His family denies a history of depression or manic episodes. The patient is admitted to an inpatient psychiatry unit and started on haloperidol. Three hours after the initiation of therapy, he develops stiffness and muscle spasms of the neck and spine muscles. \n\nWhich of the following is the mechanism of action of the drug that should be used in the acute management of this patient?"
} | A 25-year-old man with a history of hearing voices is brought to the emergency department by his family because the voices are telling him to kill his mother. He believes that aliens are trying to abduct him. These delusions and hallucinations have been present over the past 6 months. His family denies a history of depression or manic episodes. The patient is admitted to an inpatient psychiatry unit and started on haloperidol. Three hours after the initiation of therapy, he develops stiffness and muscle spasms of the neck and spine muscles. | Which of the following is the mechanism of action of the drug that should be used in the acute management of this patient? | {
"A": "Anticholinergic",
"B": "Increase in glutamate",
"C": "Increase of intracellular Ca+2 concentration",
"D": "Serotonin agonist"
} | A. Anticholinergic |
12b4cb0a-44f0-4cac-8124-767aa8a583d2 | A 26 year old third gravida mother delivered a male baby weighing 4–2 kg at 37 weeks of gestation through an emergency caesarean section, for obstructed labour. The child developed respiratory distress one hour after birth. He was kept nil per orally (NPO) and given intravenous fluids. He maintained oxygen saturation on room air. No antibiotics were given. Chest radiograph revealed fluid in interlobar fissure. Respiratory distress settled by 24 hours of life. What is the most likely diagnosis ? | Transient tachypnea of the newborn | Meconium aspiration syndrome | Persistent fetal circulation | Hyaline membrane disease | 0a
| multi | Respiratory distress, which resolves within 24 hours without any respiratory support and fluid in interlobar fissure on chest X-ray suggest the diagnosis of TTN. | Pediatrics | null | 113 | {
"Correct Answer": "Transient tachypnea of the newborn",
"Correct Option": "A",
"Options": {
"A": "Transient tachypnea of the newborn",
"B": "Meconium aspiration syndrome",
"C": "Persistent fetal circulation",
"D": "Hyaline membrane disease"
},
"Question": "A 26 year old third gravida mother delivered a male baby weighing 4–2 kg at 37 weeks of gestation through an emergency caesarean section, for obstructed labour. The child developed respiratory distress one hour after birth. He was kept nil per orally (NPO) and given intravenous fluids. He maintained oxygen saturation on room air. No antibiotics were given. Chest radiograph revealed fluid in interlobar fissure. Respiratory distress settled by 24 hours of life. What is the most likely diagnosis ?"
} | A 26 year old third gravida mother delivered a male baby weighing 4–2 kg at 37 weeks of gestation through an emergency caesarean section, for obstructed labour. The child developed respiratory distress one hour after birth. He was kept nil per orally (NPO) and given intravenous fluids. He maintained oxygen saturation on room air. No antibiotics were given. Chest radiograph revealed fluid in interlobar fissure. Respiratory distress settled by 24 hours of life. | What is the most likely diagnosis ? | {
"A": "Transient tachypnea of the newborn",
"B": "Meconium aspiration syndrome",
"C": "Persistent fetal circulation",
"D": "Hyaline membrane disease"
} | A. Transient tachypnea of the newborn |
55958872-dc26-4d84-8f61-9eb4ee1f686b | A 33 year old lady present! with polydipsia and polyuria. Har symptoms staed soon after a road traffic accident 6 months ago. The blood pressure is 120/80 mm Hg with no postural drop. The daily urinary output Is 6-8 liters. Investigation showed, Na 130 mEq/L, KJ.5 mEq/L, urea 15mg/dL, sugar-65 mg/dL. The plasma osmolality is 268 mosmol/L and urine osmolatity 45 mosmol/L. The most likely diagnosis is- | Central diabetes insipidus | Nephrogenic diabetes insipidus | Resolving acute tubular necrosis | Psychogenic polydipsia | 3d
| single | here there is no thirst and polydipsia due to psychosis ( Harrison 17 pg 2219) | Medicine | Endocrinology | 134 | {
"Correct Answer": "Psychogenic polydipsia",
"Correct Option": "D",
"Options": {
"A": "Central diabetes insipidus",
"B": "Nephrogenic diabetes insipidus",
"C": "Resolving acute tubular necrosis",
"D": "Psychogenic polydipsia"
},
"Question": "A 33 year old lady present! with polydipsia and polyuria. Har symptoms staed soon after a road traffic accident 6 months ago. The blood pressure is 120/80 mm Hg with no postural drop. The daily urinary output Is 6-8 liters. Investigation showed, Na 130 mEq/L, KJ.5 mEq/L, urea 15mg/dL, sugar-65 mg/dL. The plasma osmolality is 268 mosmol/L and urine osmolatity 45 mosmol/L. The most likely diagnosis is-"
} | A 33 year old lady present! with polydipsia and polyuria. Har symptoms staed soon after a road traffic accident 6 months ago. The blood pressure is 120/80 mm Hg with no postural drop. The daily urinary output Is 6-8 liters. Investigation showed, Na 130 mEq/L, KJ.5 mEq/L, urea 15mg/dL, sugar-65 mg/dL. The plasma osmolality is 268 mosmol/L and urine osmolatity 45 mosmol/L. | The most likely diagnosis is- | {
"A": "Central diabetes insipidus",
"B": "Nephrogenic diabetes insipidus",
"C": "Resolving acute tubular necrosis",
"D": "Psychogenic polydipsia"
} | D. Psychogenic polydipsia |
226549a4-e352-470f-a4fb-8df87a3234e3 | A 57-year-old woman experiences frequent symptoms of heartburn. She reports no weight loss, diarrhea, or dysphagia symptoms. Past medical history is significant for vitamin B12 deficiency treated with monthly injections. She appears well, and the examination is normal, except for some patches on her arms where she has lost all the skin pigmentation. Her upper endoscopy is normal, except for gastric biopsies commenting on gastritis.For the above patient with gastritis, select the most likely mechanism of injury. | bile acid reflux implicated in pathogenesis | immune or autoimmune pathogenesis suspected | ischemia of the gastric mucosa implicated in the pathogenesis | associated with Helicobacter pylori infection | 1b
| multi | Type A chronic gastritis may lead to pernicious anemia. Antibodies to parietal cells and to intrinsic factor are frequently seen in the sera, suggesting an immune or autoimmune pathogenesis. These patients can also have autoimmune thyroid disease and vitiligo. | Medicine | G.I.T. | 107 | {
"Correct Answer": "immune or autoimmune pathogenesis suspected",
"Correct Option": "B",
"Options": {
"A": "bile acid reflux implicated in pathogenesis",
"B": "immune or autoimmune pathogenesis suspected",
"C": "ischemia of the gastric mucosa implicated in the pathogenesis",
"D": "associated with Helicobacter pylori infection"
},
"Question": "A 57-year-old woman experiences frequent symptoms of heartburn. She reports no weight loss, diarrhea, or dysphagia symptoms. Past medical history is significant for vitamin B12 deficiency treated with monthly injections. She appears well, and the examination is normal, except for some patches on her arms where she has lost all the skin pigmentation. Her upper endoscopy is normal, except for gastric biopsies commenting on gastritis.For the above patient with gastritis, select the most likely mechanism of injury."
} | A 57-year-old woman experiences frequent symptoms of heartburn. She reports no weight loss, diarrhea, or dysphagia symptoms. Past medical history is significant for vitamin B12 deficiency treated with monthly injections. She appears well, and the examination is normal, except for some patches on her arms where she has lost all the skin pigmentation. | Her upper endoscopy is normal, except for gastric biopsies commenting on gastritis.For the above patient with gastritis, select the most likely mechanism of injury. | {
"A": "bile acid reflux implicated in pathogenesis",
"B": "immune or autoimmune pathogenesis suspected",
"C": "ischemia of the gastric mucosa implicated in the pathogenesis",
"D": "associated with Helicobacter pylori infection"
} | B. immune or autoimmune pathogenesis suspected |
c16ce37f-f56e-48a2-bff6-486bdacadf9c | An 8 month female baby presented with 1 day h/o lethargy. She had vomited several times. Her drug addict mother said she appeared "intoxicated".O/E: baby was obtunded but she was easily arousable and muscle tone was normal. RR = 60/min. Pupils are normal. BP was 112/62.Ix: Na+= 135 K+ = 4.2 ,Glucose 5.9 mmol/l , Cl- = 116 ,Urinalysis: pH = 5.0; negative for glucose & ketones, positive for calcium oxalate crystals. ABG: pH = 7.19, pCO2 = 20, PO2 = 100 , HCO3 = 6.2 ? | Metabolic acidosis compensated | Metabolic acidosis paially compensated | Metabolic alkalosis compensated | Metabolic alkalosis paially compensated | 1b
| multi | Impoant points in history: * Drug addict mother * Tachypnea * Pupils normal - no CNS depression by opioids * Calcium oxalate crystal - d/t ethylene glycol poisoning Ethylene glycol poisoning - leads to - acute tubular necrosis ABG: pH = 7.19, pCO2 = 20, PO2 = 100 , HCO3 = 6.2 Calculation: Anion gap: Na - (Cl- + HCO3) = 135-(116+6) = 135-122 = 13 pH is 7.19 acidic.(normal pH 7.35-7.45) pCO2 is 16( low )that cannot explain acidotic PH (normal pco2 40) HCO3 is 6.2 which is low that explain low pH. therefore acidic pH is metabolic problem.i.e.metabolic acidosis in this CASE compensation is going on which is hyperventilation leading to CO2 washout.low PCo2 since is PH is not normalised so paial compensation From ABG: metabolic acidosis paially compensated. expected PCO2 =15+HCO3=15+6=21 actual PCO2 is almost equal to expected value this implies compensation is going fine. | Medicine | ABG Analysis Simplified | 175 | {
"Correct Answer": "Metabolic acidosis paially compensated",
"Correct Option": "B",
"Options": {
"A": "Metabolic acidosis compensated",
"B": "Metabolic acidosis paially compensated",
"C": "Metabolic alkalosis compensated",
"D": "Metabolic alkalosis paially compensated"
},
"Question": "An 8 month female baby presented with 1 day h/o lethargy. She had vomited several times. Her drug addict mother said she appeared \"intoxicated\".O/E: baby was obtunded but she was easily arousable and muscle tone was normal. RR = 60/min. Pupils are normal. BP was 112/62.Ix: Na+= 135 K+ = 4.2 ,Glucose 5.9 mmol/l , Cl- = 116 ,Urinalysis: pH = 5.0; negative for glucose & ketones, positive for calcium oxalate crystals. ABG: pH = 7.19, pCO2 = 20, PO2 = 100 , HCO3 = 6.2 ?"
} | An 8 month female baby presented with 1 day h/o lethargy. She had vomited several times. Her drug addict mother said she appeared "intoxicated".O/E: baby was obtunded but she was easily arousable and muscle tone was normal. RR = 60/min. Pupils are normal. BP was 112/62.Ix: Na+= 135 K+ = 4.2 ,Glucose 5.9 mmol/l , Cl- = 116 ,Urinalysis: pH = 5.0; negative for glucose & ketones, positive for calcium oxalate crystals. | ABG: pH = 7.19, pCO2 = 20, PO2 = 100 , HCO3 = 6.2 ? | {
"A": "Metabolic acidosis compensated",
"B": "Metabolic acidosis paially compensated",
"C": "Metabolic alkalosis compensated",
"D": "Metabolic alkalosis paially compensated"
} | B. Metabolic acidosis paially compensated |
8185e4ff-3a0e-4f2b-82d5-3238f2eac2da | Which of the following statements are True or False? 1. Genetic polymorphisms of the P450 enzyme system, specifically CYP1A1, or chromosome fragility are associated with the development of lung cancer. 2. Cigarette smoking increases the risk of squamous and small cell lung cancer cell types only. 3. Varenicline-nicotinic acetylcholine receptor paial agonist is used for nicotine dependence. 4. Low-dose, noncontrast, thin-slice helical or spiral chest CT has emerged as a possible new tool for lung cancer screening. 5. Extrathoracic metastatic disease is found at autopsy in 20% of patients with squamous carcinoma. | 1,2,3 True & 4,5 False | 1,3,4 True & 4,5 False | 2,4,5 True & 1,3-False | 2,5 True & 1,3,4-False | 1b
| multi | Cigarette smoking increases the risk of all the major lung cancer cell types. Extrathoracic metastatic disease is found at autopsy in >50% of patients with squamous carcinoma. This is an impoant topic for entrance read thoroughly. Ref: Harrisons Principles of Medicine, 18th Edition, Pages 741-42 | Medicine | null | 151 | {
"Correct Answer": "1,3,4 True & 4,5 False",
"Correct Option": "B",
"Options": {
"A": "1,2,3 True & 4,5 False",
"B": "1,3,4 True & 4,5 False",
"C": "2,4,5 True & 1,3-False",
"D": "2,5 True & 1,3,4-False"
},
"Question": "Which of the following statements are True or False? 1. Genetic polymorphisms of the P450 enzyme system, specifically CYP1A1, or chromosome fragility are associated with the development of lung cancer. 2. Cigarette smoking increases the risk of squamous and small cell lung cancer cell types only. 3. Varenicline-nicotinic acetylcholine receptor paial agonist is used for nicotine dependence. 4. Low-dose, noncontrast, thin-slice helical or spiral chest CT has emerged as a possible new tool for lung cancer screening. 5. Extrathoracic metastatic disease is found at autopsy in 20% of patients with squamous carcinoma."
} | Which of the following statements are True or False? 1. Genetic polymorphisms of the P450 enzyme system, specifically CYP1A1, or chromosome fragility are associated with the development of lung cancer. 2. Cigarette smoking increases the risk of squamous and small cell lung cancer cell types only. 3. Varenicline-nicotinic acetylcholine receptor paial agonist is used for nicotine dependence. 4. Low-dose, noncontrast, thin-slice helical or spiral chest CT has emerged as a possible new tool for lung cancer screening. 5. | Extrathoracic metastatic disease is found at autopsy in 20% of patients with squamous carcinoma. | {
"A": "1,2,3 True & 4,5 False",
"B": "1,3,4 True & 4,5 False",
"C": "2,4,5 True & 1,3-False",
"D": "2,5 True & 1,3,4-False"
} | B. 1,3,4 True & 4,5 False |
62adab44-b508-43df-bebb-7c7754ecc8e9 | Ramla, 65 yrs old male presents with low backpain especially at L3, anaemia and fatiguability) His investigation profile reveals -Hb =7gm%, TLC-9000/cmm, DLC -N- 55%, L-30%, M-10%, E-1%, -2%,Serum proteins-8gm %, ratio-2.9/5.9, ESR-90 and serum creatinine-3.2 mg%. Likely diagnosis is - | Waldenstroms macroglobulinemia | Multiple myeloma | TB spine | Secondaries in spine | 1b
| multi | null | Medicine | null | 109 | {
"Correct Answer": "Multiple myeloma",
"Correct Option": "B",
"Options": {
"A": "Waldenstroms macroglobulinemia",
"B": "Multiple myeloma",
"C": "TB spine",
"D": "Secondaries in spine"
},
"Question": "Ramla, 65 yrs old male presents with low backpain especially at L3, anaemia and fatiguability) His investigation profile reveals -Hb =7gm%, TLC-9000/cmm, DLC -N- 55%, L-30%, M-10%, E-1%, -2%,Serum proteins-8gm %, ratio-2.9/5.9, ESR-90 and serum creatinine-3.2 mg%. Likely diagnosis is -"
} | Ramla, 65 yrs old male presents with low backpain especially at L3, anaemia and fatiguability) His investigation profile reveals -Hb =7gm%, TLC-9000/cmm, DLC -N- 55%, L-30%, M-10%, E-1%, -2%,Serum proteins-8gm %, ratio-2.9/5.9, ESR-90 and serum creatinine-3.2 mg%. | Likely diagnosis is - | {
"A": "Waldenstroms macroglobulinemia",
"B": "Multiple myeloma",
"C": "TB spine",
"D": "Secondaries in spine"
} | B. Multiple myeloma |
97cac6f1-7b82-4089-ab2c-c676730e79fd | A 60-year-old woman complained of weakness, lethargy and easy fatigability. Investigation showed that she had iron deficiency anaemia (Hb. 8 g/dl). She was prescribed cap. ferrous fumarate 300 mg twice daily. She returned after one month with no improvement in symptoms. Her Hb. level was unchanged. On enquiry she revealed that she felt epigastric distress after taking the iron capsules, and had started taking antacid tablets along with the capsules. What could be the possible reason for her failure to respond to the oral iron medication? | Lower pH is required for absorption of oral iron salts | Higher pH is required for absorption of oral iron salt | Oral iron can not cross biomembranes in any form | Any of the above can be possible reason. | 0a
| multi | Gastric acid is required for the absorption of oral iron salts. Concurrent ingestion of antacid tablets could have interfered with iron absorption. Hence, the anaemia failed to improve. | Pharmacology | null | 159 | {
"Correct Answer": "Lower pH is required for absorption of oral iron salts",
"Correct Option": "A",
"Options": {
"A": "Lower pH is required for absorption of oral iron salts",
"B": "Higher pH is required for absorption of oral iron salt",
"C": "Oral iron can not cross biomembranes in any form",
"D": "Any of the above can be possible reason."
},
"Question": "A 60-year-old woman complained of weakness, lethargy and easy fatigability. Investigation showed that she had iron deficiency anaemia (Hb. 8 g/dl). She was prescribed cap. ferrous fumarate 300 mg twice daily. She returned after one month with no improvement in symptoms. Her Hb. level was unchanged. On enquiry she revealed that she felt epigastric distress after taking the iron capsules, and had started taking antacid tablets along with the capsules. What could be the possible reason for her failure to respond to the oral iron medication?"
} | A 60-year-old woman complained of weakness, lethargy and easy fatigability. Investigation showed that she had iron deficiency anaemia (Hb. 8 g/dl). She was prescribed cap. ferrous fumarate 300 mg twice daily. She returned after one month with no improvement in symptoms. Her Hb. level was unchanged. On enquiry she revealed that she felt epigastric distress after taking the iron capsules, and had started taking antacid tablets along with the capsules. | What could be the possible reason for her failure to respond to the oral iron medication? | {
"A": "Lower pH is required for absorption of oral iron salts",
"B": "Higher pH is required for absorption of oral iron salt",
"C": "Oral iron can not cross biomembranes in any form",
"D": "Any of the above can be possible reason."
} | A. Lower pH is required for absorption of oral iron salts |
ab98aecc-fc88-45dd-90bc-3d05e20058ac | In a 60-year-old female with polydipsia, water deprivation test was performed and the values obtained are as following -Baseline: Na - 139 mEq, K-3.6mEq. Osm.plasma-274 mosm/l, Osm. urine-150 after vasopressin: Na-142mEq, K-3.9mEq, Plasma osm-271 mosm/ l,Urine osm - 489 mosm/l. These findings suggest a diagnosis of - | Cranial diabetes insipidus | Psychogenic polydypsia | Nephrogenic diabetes insipidus | SAIDH | 0a
| single | null | Medicine | null | 120 | {
"Correct Answer": "Cranial diabetes insipidus",
"Correct Option": "A",
"Options": {
"A": "Cranial diabetes insipidus",
"B": "Psychogenic polydypsia",
"C": "Nephrogenic diabetes insipidus",
"D": "SAIDH"
},
"Question": "In a 60-year-old female with polydipsia, water deprivation test was performed and the values obtained are as following -Baseline: Na - 139 mEq, K-3.6mEq. Osm.plasma-274 mosm/l, Osm. urine-150 after vasopressin: Na-142mEq, K-3.9mEq, Plasma osm-271 mosm/ l,Urine osm - 489 mosm/l. These findings suggest a diagnosis of -"
} | In a 60-year-old female with polydipsia, water deprivation test was performed and the values obtained are as following -Baseline: Na - 139 mEq, K-3.6mEq. Osm.plasma-274 mosm/l, Osm. urine-150 after vasopressin: Na-142mEq, K-3.9mEq, Plasma osm-271 mosm/ l,Urine osm - 489 mosm/l. | These findings suggest a diagnosis of - | {
"A": "Cranial diabetes insipidus",
"B": "Psychogenic polydypsia",
"C": "Nephrogenic diabetes insipidus",
"D": "SAIDH"
} | A. Cranial diabetes insipidus |
fadac01d-2d9c-40bd-bf98-d848bfcbb106 | A 70-year-old male presented to the OPD with complaints of abdominal pain, nausea, headache, malaise, persistent fever for 2 weeks along with constipation. On examination a characteristic rash was observed on the trunk and chest. BP - 120/70 mm of Hg HR- 65 bpm Hepatomegaly Splenomegaly Blood culture did not show any organism, hence a bone marrow culture was taken. Gram staining was done. Which of the following pulses will be most likely seen in the above condition: - | <img style="max-width: 100%" src=" /> | <img style="max-width: 100%" src=" /> | <img style="max-width: 100%" src=" /> | <img style="max-width: 100%" src=" /> | 3d
| multi | This is a case of Salmonella infection. The image shows faint, salmon coloured blanching maculopapular rash located on trunk and chest (Rose spots). Gram stain shows gram negative bacillus. Salmonella Does not ferment lactose Relative bradycardia Pulsus dicroticus is seen. Typical rash called rose spots Drug of choice - Ciprofloxacin Drug of choice in resistant variety- Ceftriaxone Image A shows pulsus parvus et tardus Image B shows collapsing/ water hammer pulse. Image C shows pulsus bisfiriens Image D shows pulsus dicroticus | Unknown | Integrated QBank | 116 | {
"Correct Answer": "<img style=\"max-width: 100%\" src=\" />",
"Correct Option": "D",
"Options": {
"A": "<img style=\"max-width: 100%\" src=\" />",
"B": "<img style=\"max-width: 100%\" src=\" />",
"C": "<img style=\"max-width: 100%\" src=\" />",
"D": "<img style=\"max-width: 100%\" src=\" />"
},
"Question": "A 70-year-old male presented to the OPD with complaints of abdominal pain, nausea, headache, malaise, persistent fever for 2 weeks along with constipation. On examination a characteristic rash was observed on the trunk and chest. BP - 120/70 mm of Hg HR- 65 bpm Hepatomegaly Splenomegaly Blood culture did not show any organism, hence a bone marrow culture was taken. Gram staining was done. Which of the following pulses will be most likely seen in the above condition: -"
} | A 70-year-old male presented to the OPD with complaints of abdominal pain, nausea, headache, malaise, persistent fever for 2 weeks along with constipation. On examination a characteristic rash was observed on the trunk and chest. BP - 120/70 mm of Hg HR- 65 bpm Hepatomegaly Splenomegaly Blood culture did not show any organism, hence a bone marrow culture was taken. Gram staining was done. | Which of the following pulses will be most likely seen in the above condition: - | {
"A": "<img style=\"max-width: 100%\" src=\" />",
"B": "<img style=\"max-width: 100%\" src=\" />",
"C": "<img style=\"max-width: 100%\" src=\" />",
"D": "<img style=\"max-width: 100%\" src=\" />"
} | D. <img style="max-width: 100%" src=" /> |
f83fefd7-da63-4e39-a103-e98e4ad14bdb | A 68-year-old man is seen in the emergency room after an unwitnessed syncopal episode. His wife heard a strange noise and found him confused and on the floor of the living room where he had been watching television. His wife tells you that he has no ongoing medical problems, does not take any medications, and does not use alcohol or illicit drugs. On examination the patient is drowsy, has a tongue laceration, and his pants are wet with urine. Serum electrolytes (including sodium and calcium) are normal and urine drug screen is negative. Which of the following is the best next step in evaluation? | MRI scan of brain | Lumbar puncture | Holter monitor | CT scan of head | 0a
| multi | Though syncope is often due to a cardiovascular cause, the presence of a tongue laceration and urinary incontinence suggest syncope due to a seizure. Furthermore, patients with syncope due to cardiac causes usually recover normal mentation within a few minutes. Prolonged drowsiness is a common postictal phenomenon that can follow a generalized seizure. These findings all point to the likelihood of an unwitnessed seizure in this patient. New-onset seizure in a young person is often idiopathic or related to substance abuse (amphetamine or cocaine), but seizures that begin in older adults are worrisome for structural brain disease. The evaluation of a new seizure in an older adult includes an electroencephalogram (EEG) to confirm the diagnosis, even though the EEG will be nondiagnostic in about one-half of patients. An MRI is the best test to look for structural brain disease, such as a brain tumor, old stroke, brain abscess, or vascular malformation. Even small lesions can provide the trigger for a seizure, so the more sensitive MRI is preferred to CT scanning in this circumstance. Though often performed, routine blood tests are rarely helpful in the evaluation of seizures. Lumbar puncture is performed only if meningitis or encephalitis is suspected. Holter monitoring is used to detect rhythm disturbances that can be associated with syncope, but cardiac syncope is rarely associated with seizures. Another cause of cardiac syncope is aortic stenosis that could be detected by echocardiography, but syncope associated with aortic stenosis is almost never associated with seizures. | Medicine | C.N.S. | 129 | {
"Correct Answer": "MRI scan of brain",
"Correct Option": "A",
"Options": {
"A": "MRI scan of brain",
"B": "Lumbar puncture",
"C": "Holter monitor",
"D": "CT scan of head"
},
"Question": "A 68-year-old man is seen in the emergency room after an unwitnessed syncopal episode. His wife heard a strange noise and found him confused and on the floor of the living room where he had been watching television. His wife tells you that he has no ongoing medical problems, does not take any medications, and does not use alcohol or illicit drugs. On examination the patient is drowsy, has a tongue laceration, and his pants are wet with urine. Serum electrolytes (including sodium and calcium) are normal and urine drug screen is negative. Which of the following is the best next step in evaluation?"
} | A 68-year-old man is seen in the emergency room after an unwitnessed syncopal episode. His wife heard a strange noise and found him confused and on the floor of the living room where he had been watching television. His wife tells you that he has no ongoing medical problems, does not take any medications, and does not use alcohol or illicit drugs. On examination the patient is drowsy, has a tongue laceration, and his pants are wet with urine. Serum electrolytes (including sodium and calcium) are normal and urine drug screen is negative. | Which of the following is the best next step in evaluation? | {
"A": "MRI scan of brain",
"B": "Lumbar puncture",
"C": "Holter monitor",
"D": "CT scan of head"
} | A. MRI scan of brain |
9a8f368f-6ad9-49d4-9f0e-3b500cf652e4 | A 25-year-old man experiences pain in the right knee while skiing, causing his knee to twist and him to fall to the ground. His knee is swollen. He cannot bear full weight or fully extend or bend his leg. There is tenderness over the medial joint line (Figure below). Emergency- room x-ray findings were normal, and the range of motion (ROM), although restricted, is stable to varus and valgus stress. Straight-leg raise is unrestricted. Which is the most likely type of injury?Superior aspect of the right tibia showing ligaments. | Anterior cruciate ligament | Tuberosity | Transverse genicular ligament | Medial meniscus | 3d
| multi | Restriction of motion ("locking"), effusion ("swelling"), and medial joint-line tenderness are the hallmarks of meniscal tears. Stability-to-stress testing eliminates collateral ligament rupture, and the ability to elevate the straight leg eliminates patella dislocation and quadriceps tendon ruptures. In addition, patella dislocation would also be characterized by gross patella deformity laterally. | Surgery | Trauma | 119 | {
"Correct Answer": "Medial meniscus",
"Correct Option": "D",
"Options": {
"A": "Anterior cruciate ligament",
"B": "Tuberosity",
"C": "Transverse genicular ligament",
"D": "Medial meniscus"
},
"Question": "A 25-year-old man experiences pain in the right knee while skiing, causing his knee to twist and him to fall to the ground. His knee is swollen. He cannot bear full weight or fully extend or bend his leg. There is tenderness over the medial joint line (Figure below). Emergency- room x-ray findings were normal, and the range of motion (ROM), although restricted, is stable to varus and valgus stress. Straight-leg raise is unrestricted. Which is the most likely type of injury?Superior aspect of the right tibia showing ligaments."
} | A 25-year-old man experiences pain in the right knee while skiing, causing his knee to twist and him to fall to the ground. His knee is swollen. He cannot bear full weight or fully extend or bend his leg. There is tenderness over the medial joint line (Figure below). Emergency- room x-ray findings were normal, and the range of motion (ROM), although restricted, is stable to varus and valgus stress. Straight-leg raise is unrestricted. | Which is the most likely type of injury?Superior aspect of the right tibia showing ligaments. | {
"A": "Anterior cruciate ligament",
"B": "Tuberosity",
"C": "Transverse genicular ligament",
"D": "Medial meniscus"
} | D. Medial meniscus |
823c8044-244b-4a7f-9374-90f074e7be9b | A 2-year-old boy is brought to the physician by his parents, who complain that their son continually loses his balance. They also report that his speech seems more slurred. Physical examination confirms the truncal ataxia and wide-based gait. The child appears lethargic, and there is bobbing of the head while he is sitting. Muscle tone is normal. A lumbar puncture is performed in the patient, and neoplastic cells are found. A suboccipital craniotomy is performed, and a tumor is resected. Microscopic examination of the surgical specimen would most likely reveal which of the following histologic patterns? | Malignant epithelial cells with prominent tonofilaments | Perivascular collections of neoplastic lymphocytes | Small, hyperchromatic cells and rare neuroblastic rosettes | Vacuolated tumor cells and an abundant capillary network | 2c
| multi | Medulloblastomas and, less commonly ependymomas and pineal parenchymal tumors, have a propensity to disseminate by way of the CSF throughout the CNS. Since medulloblastomas are close to the fourth ventricle, they may disseminate downstream into the spinal cord. The detection of neuronal and progenitor cell markers (e.g., synaptophysin or nestin) may be diagnostically informative in distinguishing these tumors from metastatic epithelial tumors, lymphomas, or other neuroectodermal malignancies. Medulloblastomas are characterized by cells with hyperchromatic, round-to-oval nuclei and scant cytoplasm, which often crowd together with no structural pattern. The neuroblastic character of the cells is occasionally expressed in rosette formation, a histologic feature of neuroblasts. The other choices do not describe midline, cerebellar tumors arising in children.Diagnosis: Medulloblastoma | Pathology | Central Nervous System | 134 | {
"Correct Answer": "Small, hyperchromatic cells and rare neuroblastic rosettes",
"Correct Option": "C",
"Options": {
"A": "Malignant epithelial cells with prominent tonofilaments",
"B": "Perivascular collections of neoplastic lymphocytes",
"C": "Small, hyperchromatic cells and rare neuroblastic rosettes",
"D": "Vacuolated tumor cells and an abundant capillary network"
},
"Question": "A 2-year-old boy is brought to the physician by his parents, who complain that their son continually loses his balance. They also report that his speech seems more slurred. Physical examination confirms the truncal ataxia and wide-based gait. The child appears lethargic, and there is bobbing of the head while he is sitting. Muscle tone is normal. A lumbar puncture is performed in the patient, and neoplastic cells are found. A suboccipital craniotomy is performed, and a tumor is resected. Microscopic examination of the surgical specimen would most likely reveal which of the following histologic patterns?"
} | A 2-year-old boy is brought to the physician by his parents, who complain that their son continually loses his balance. They also report that his speech seems more slurred. Physical examination confirms the truncal ataxia and wide-based gait. The child appears lethargic, and there is bobbing of the head while he is sitting. Muscle tone is normal. A lumbar puncture is performed in the patient, and neoplastic cells are found. A suboccipital craniotomy is performed, and a tumor is resected. | Microscopic examination of the surgical specimen would most likely reveal which of the following histologic patterns? | {
"A": "Malignant epithelial cells with prominent tonofilaments",
"B": "Perivascular collections of neoplastic lymphocytes",
"C": "Small, hyperchromatic cells and rare neuroblastic rosettes",
"D": "Vacuolated tumor cells and an abundant capillary network"
} | C. Small, hyperchromatic cells and rare neuroblastic rosettes |
ceddf762-e410-4835-85f8-5319a40af431 | A 24 year old underweight woman presents to you with progressive abdominal discomfo, dyspnoea, nausea and vomiting. Abdominal examination revealed cystic enlargement of ovaries. Relevant investigations results are as follows: Hematocrit - 57% Total count - 25000 /mm3 RFT -Impaired LFT - Mildly impaired USG - Massive ascites Serum peak oestradiol- 9000 pg/ ml X ray chest - shows pulmonary oedema History revealed that she had polycystic ovarian disease (PCOD) and was on treatment for infeility. She had received an injection last week from her infeility specialist. What is your diagnosis? | Budd Chiari syndrome | Meigs syndrome | Ovarian hyperstimulation syndrome | Pseudomyxoma peritonei | 2c
| single | Here note that the serum peak oestradiol is very high and she had received an injection as a pa of her treatment for infeility which may have been human chorionic gonadotropin. This resulted in ovarian hyperstimulation syndrome. In Budd Chiari syndrome or Meigs syndrome oestradiol need not be this high. Note that thromboembolic complication may ensue ovarian hyperstimulation syndrome. Risk factors for ovarian hyperstimulation syndrome Age>35 years Asthenic habitus Pregnancy PCOS Serum oestradiol > 4000 pg/ml Luteal phase hcg stimulation >35 follicles Ref: Oxfords Handbook of clinical specialities, 8th Edition, Page 311 | Gynaecology & Obstetrics | null | 153 | {
"Correct Answer": "Ovarian hyperstimulation syndrome",
"Correct Option": "C",
"Options": {
"A": "Budd Chiari syndrome",
"B": "Meigs syndrome",
"C": "Ovarian hyperstimulation syndrome",
"D": "Pseudomyxoma peritonei"
},
"Question": "A 24 year old underweight woman presents to you with progressive abdominal discomfo, dyspnoea, nausea and vomiting. Abdominal examination revealed cystic enlargement of ovaries. Relevant investigations results are as follows: Hematocrit - 57% Total count - 25000 /mm3 RFT -Impaired LFT - Mildly impaired USG - Massive ascites Serum peak oestradiol- 9000 pg/ ml X ray chest - shows pulmonary oedema History revealed that she had polycystic ovarian disease (PCOD) and was on treatment for infeility. She had received an injection last week from her infeility specialist. What is your diagnosis?"
} | A 24 year old underweight woman presents to you with progressive abdominal discomfo, dyspnoea, nausea and vomiting. Abdominal examination revealed cystic enlargement of ovaries. Relevant investigations results are as follows: Hematocrit - 57% Total count - 25000 /mm3 RFT -Impaired LFT - Mildly impaired USG - Massive ascites Serum peak oestradiol- 9000 pg/ ml X ray chest - shows pulmonary oedema History revealed that she had polycystic ovarian disease (PCOD) and was on treatment for infeility. She had received an injection last week from her infeility specialist. | What is your diagnosis? | {
"A": "Budd Chiari syndrome",
"B": "Meigs syndrome",
"C": "Ovarian hyperstimulation syndrome",
"D": "Pseudomyxoma peritonei"
} | C. Ovarian hyperstimulation syndrome |
0f3bfa5a-9e64-438b-bd93-c4270ed6a49a | A 40 year old male, with history of daily alcohol consumption for the last 7 years, is brought to the hospital emergency room with acute onsent of seeing snakes all around him in the room, not recognizing family members, violent behavior and tremulousness for few hours. There is history of his having missed the alcohol drink since 2 days. Examination reveals increased blood pressure, tremors, increased psychomotor activity, fearful affect, hallucinatory behaviour, disorientation, impaired judgement and insight. He is most likely to be suffering from- | Alcoholic hallucinosis | Delirium tremens | Wernicke encephalopathy | Korsakoff's psychosis | 1b
| multi | This person is having symptoms of delirium after alcohol withdrawal → delirium tremens. | Psychiatry | null | 113 | {
"Correct Answer": "Delirium tremens",
"Correct Option": "B",
"Options": {
"A": "Alcoholic hallucinosis",
"B": "Delirium tremens",
"C": "Wernicke encephalopathy",
"D": "Korsakoff's psychosis"
},
"Question": "A 40 year old male, with history of daily alcohol consumption for the last 7 years, is brought to the hospital emergency room with acute onsent of seeing snakes all around him in the room, not recognizing family members, violent behavior and tremulousness for few hours. There is history of his having missed the alcohol drink since 2 days. Examination reveals increased blood pressure, tremors, increased psychomotor activity, fearful affect, hallucinatory behaviour, disorientation, impaired judgement and insight. He is most likely to be suffering from-"
} | A 40 year old male, with history of daily alcohol consumption for the last 7 years, is brought to the hospital emergency room with acute onsent of seeing snakes all around him in the room, not recognizing family members, violent behavior and tremulousness for few hours. There is history of his having missed the alcohol drink since 2 days. Examination reveals increased blood pressure, tremors, increased psychomotor activity, fearful affect, hallucinatory behaviour, disorientation, impaired judgement and insight. | He is most likely to be suffering from- | {
"A": "Alcoholic hallucinosis",
"B": "Delirium tremens",
"C": "Wernicke encephalopathy",
"D": "Korsakoff's psychosis"
} | B. Delirium tremens |
6d037e82-e2e8-47f9-ae49-dcfb815adc4f | A 46-year-old man presented to the casualty with acute onset of seeing lizards all all around him in the room. He has been violent towards members of his brother who tried to bring him to hospital. On history he has a longstanding history of drinking alcohol and using cannabis for 7 years. He had missed his drinks for the last 3 days. On examination his blood pressure is high and he has global confusion. Which of the following can be used in the immediate treatment of the condition? | Diazepam | Chlordiazepozide | Morphine | Carbamazepine | 1b
| multi | The clinical presentation suggests severe alcohol (ethanol) withdrawal or Delirium Tremens. The immediate management includes the use of long-acting benzodiazepines. In the given choices both Chlordiazepoxide (Librium) and Diazepam are long acting. However, Chlordiazepoxide (Librium) is longer acting than diazepam. The longer acting benzos prevent the serious complications of seizures. Thiamine and multivitamins are used in the initial phase to prevent Wernicke's encephalopathy. | Psychiatry | null | 102 | {
"Correct Answer": "Chlordiazepozide",
"Correct Option": "B",
"Options": {
"A": "Diazepam",
"B": "Chlordiazepozide",
"C": "Morphine",
"D": "Carbamazepine"
},
"Question": "A 46-year-old man presented to the casualty with acute onset of seeing lizards all all around him in the room. He has been violent towards members of his brother who tried to bring him to hospital. On history he has a longstanding history of drinking alcohol and using cannabis for 7 years. He had missed his drinks for the last 3 days. On examination his blood pressure is high and he has global confusion. Which of the following can be used in the immediate treatment of the condition?"
} | A 46-year-old man presented to the casualty with acute onset of seeing lizards all all around him in the room. He has been violent towards members of his brother who tried to bring him to hospital. On history he has a longstanding history of drinking alcohol and using cannabis for 7 years. He had missed his drinks for the last 3 days. On examination his blood pressure is high and he has global confusion. | Which of the following can be used in the immediate treatment of the condition? | {
"A": "Diazepam",
"B": "Chlordiazepozide",
"C": "Morphine",
"D": "Carbamazepine"
} | B. Chlordiazepozide |
1678c7e9-8148-4257-9d22-05bc7b8bb4a6 | A 63-year-old man presents with weakness and hemoptysis, but no fever, cough, or sputum. He has a 60-pack-per-year history of smoking. The chest x-ray (CXR) reveals a lung mass with mediastinal widening. On examination, there is a blue purple discoloration of the upper eyelids and erythema on his knuckles. He has proximal muscle weakness rated 4+/5, normal reflexes, and sensation. Which of the following is the most likely diagnosis for his muscle weakness? | SLE | scleroderma | dermatomyositis (DM) | polyarteritis | 2c
| single | This man has dermatomyositis, a paraneoplastic phenomenon of many cancers. The most common tumors associated with DM have been bronchogenic carcinomas, ovarian cancers, breast cancers, and melanoma but many others have occurred. The malignancy may antedate or postdate the myositis. Older age makes malignancy more likely. The extent of the workup for malignancy, if DM is the presentation, depends on clinical circumstances, but history and physical examination, not x-rays, are the cornerstones of evaluation. | Medicine | Miscellaneous | 116 | {
"Correct Answer": "dermatomyositis (DM)",
"Correct Option": "C",
"Options": {
"A": "SLE",
"B": "scleroderma",
"C": "dermatomyositis (DM)",
"D": "polyarteritis"
},
"Question": "A 63-year-old man presents with weakness and hemoptysis, but no fever, cough, or sputum. He has a 60-pack-per-year history of smoking. The chest x-ray (CXR) reveals a lung mass with mediastinal widening. On examination, there is a blue purple discoloration of the upper eyelids and erythema on his knuckles. He has proximal muscle weakness rated 4+/5, normal reflexes, and sensation. Which of the following is the most likely diagnosis for his muscle weakness?"
} | A 63-year-old man presents with weakness and hemoptysis, but no fever, cough, or sputum. He has a 60-pack-per-year history of smoking. The chest x-ray (CXR) reveals a lung mass with mediastinal widening. On examination, there is a blue purple discoloration of the upper eyelids and erythema on his knuckles. He has proximal muscle weakness rated 4+/5, normal reflexes, and sensation. | Which of the following is the most likely diagnosis for his muscle weakness? | {
"A": "SLE",
"B": "scleroderma",
"C": "dermatomyositis (DM)",
"D": "polyarteritis"
} | C. dermatomyositis (DM) |
7ffa620c-aa61-4cf2-a7ca-5061d91c3c82 | A 5-year-old child is brought to the hospital with the complaint of fever, cough, breathlessness and chest pain. On examination he is found to be dull, but irritable with fast pulse (116/min), rapid breathing (RR 50/min) and indrawing of lower chest during inspiration, wheezing, crepitations and mild dehydration. Body temperature is 40°C (104°F). The paediatrician makes a provisional diagnosis of acute pneumonia and orders relevant haematological as well as bacteriological investigations. He decides to institute antibiotic therapy.In case he selects an antibiotic which can be given orally as well as by i.m. or i.v. injection,which route of administration will be most appropriate in this case? | Oral | i.m. | i.v. | s.c. | 2c
| multi | Since the child is seriously ill, a fast and more predictable action of the antibiotic is needed; a parenteral route of administration is appropriate. Moreover, oral dosing may be difficult in this case as the child is dull and irritable. Entering a vein for i.v. injection is relatively difficult in children, particularly in the presence of dehydration. Therefore, the antibiotic may be injected i.m. However, if an i.v. line is set up for rehydration, the antibiotic may be administered through the i.v. line. | Pharmacology | null | 199 | {
"Correct Answer": "i.v.",
"Correct Option": "C",
"Options": {
"A": "Oral",
"B": "i.m.",
"C": "i.v.",
"D": "s.c."
},
"Question": "A 5-year-old child is brought to the hospital with the complaint of fever, cough, breathlessness and chest pain. On examination he is found to be dull, but irritable with fast pulse (116/min), rapid breathing (RR 50/min) and indrawing of lower chest during inspiration, wheezing, crepitations and mild dehydration. Body temperature is 40°C (104°F). The paediatrician makes a provisional diagnosis of acute pneumonia and orders relevant haematological as well as bacteriological investigations. He decides to institute antibiotic therapy.In case he selects an antibiotic which can be given orally as well as by i.m. or i.v. injection,which route of administration will be most appropriate in this case?"
} | A 5-year-old child is brought to the hospital with the complaint of fever, cough, breathlessness and chest pain. On examination he is found to be dull, but irritable with fast pulse (116/min), rapid breathing (RR 50/min) and indrawing of lower chest during inspiration, wheezing, crepitations and mild dehydration. Body temperature is 40°C (104°F). The paediatrician makes a provisional diagnosis of acute pneumonia and orders relevant haematological as well as bacteriological investigations. He decides to institute antibiotic therapy.In case he selects an antibiotic which can be given orally as well as by i.m. or i.v. | injection,which route of administration will be most appropriate in this case? | {
"A": "Oral",
"B": "i.m.",
"C": "i.v.",
"D": "s.c."
} | C. i.v. |
04b608cb-630a-4885-8541-ab8faba93b75 | A 30 years old male patient presents with complaints of weakness in right upper and both lower limbs of last 4 months. He developed digital infarcts involving 2nd and 3rd fingers on right side and 5`h fingeron left side. On examination, BP was 160/140 mm Hg, all peripheral pulses were palpable and there was asymmetrical neuropathy. Investigations showed a Hb 12 gm, TLC-12000 Cu mm, Platelets 4,30,000, ESR-49 mm. Urine examination showed proteinuria and RBC - 10-15/hpf with no casts. Which of the following is the most likely diagnosis? | Polyaeritis nodosa | Systemic lupus erythematosus | Wegener's granulomatosis | Microscopic polyangitis | 0a
| multi | Answer is A (Polyaeritis nodosa): Renal disease manifesting as hypeension without RBC cast in urine (No glomerulonephritis) is characteristic of polyaeritis Nodosa Digital gangrene is usually associated with vasculitis of medium sized vessels. Amongst options provided PAN is a medium vessel vasculitis and presence of digital ischaemia is more characteristic of PAN than MPA or WG. Digital gangrene may however be seen (less frequent) in cases of MPA and WG. | Medicine | null | 157 | {
"Correct Answer": "Polyaeritis nodosa",
"Correct Option": "A",
"Options": {
"A": "Polyaeritis nodosa",
"B": "Systemic lupus erythematosus",
"C": "Wegener's granulomatosis",
"D": "Microscopic polyangitis"
},
"Question": "A 30 years old male patient presents with complaints of weakness in right upper and both lower limbs of last 4 months. He developed digital infarcts involving 2nd and 3rd fingers on right side and 5`h fingeron left side. On examination, BP was 160/140 mm Hg, all peripheral pulses were palpable and there was asymmetrical neuropathy. Investigations showed a Hb 12 gm, TLC-12000 Cu mm, Platelets 4,30,000, ESR-49 mm. Urine examination showed proteinuria and RBC - 10-15/hpf with no casts. Which of the following is the most likely diagnosis?"
} | A 30 years old male patient presents with complaints of weakness in right upper and both lower limbs of last 4 months. He developed digital infarcts involving 2nd and 3rd fingers on right side and 5`h fingeron left side. On examination, BP was 160/140 mm Hg, all peripheral pulses were palpable and there was asymmetrical neuropathy. Investigations showed a Hb 12 gm, TLC-12000 Cu mm, Platelets 4,30,000, ESR-49 mm. Urine examination showed proteinuria and RBC - 10-15/hpf with no casts. | Which of the following is the most likely diagnosis? | {
"A": "Polyaeritis nodosa",
"B": "Systemic lupus erythematosus",
"C": "Wegener's granulomatosis",
"D": "Microscopic polyangitis"
} | A. Polyaeritis nodosa |
0776f05c-cfb2-48b0-ac5d-b8c548e7c682 | A 32-year-old woman presents to the emergency department after acutely developing a high fever, lightheadedness on standing, and a rash. At the hospital she develops vomiting, diarrhea, confusion, and abdominal pain. She goes on to develop evidence of multiorgan failure and is transferred to the intensive care unit. One week after the acute illness she develops desquamation of the skin. On further history, the illness started 3 days after the onset of menstruation. Which of the following is the most likely diagnosis? | S aureus toxic shock syndrome (TSS) | streptococcal infection (scarlet fever) | clostridial infection | Rocky mountain spotted fever (RMSF) | 0a
| single | TSS is most characteristically seen in females using vaginal tampons and is secondary to staphylococcal enterotoxins called TSS toxin 1 (TSST-1). Abrupt onset is characteristic. The clinical criteria for diagnosis include high fever, a diffuse rash that desquamates on the palms and soles over the subsequent 1-2 weeks, hypotension, and involvement in 3 or more organ systems. This involvement can include GI dysfunction (vomiting and diarrhea), renal insufficiency, hepatic insufficiency, thrombocytopenia, myalgias with elevated creatine kinase (CK) levels, and delirium Staphylococcal-scaled-skin syndrome most often affects new-born and children. It results in localized or quite extensive fluid-filled blisters that easily rupture to expose denuded skin. It is caused by an exfoliative toxin. | Medicine | Infection | 109 | {
"Correct Answer": "S aureus toxic shock syndrome (TSS)",
"Correct Option": "A",
"Options": {
"A": "S aureus toxic shock syndrome (TSS)",
"B": "streptococcal infection (scarlet fever)",
"C": "clostridial infection",
"D": "Rocky mountain spotted fever (RMSF)"
},
"Question": "A 32-year-old woman presents to the emergency department after acutely developing a high fever, lightheadedness on standing, and a rash. At the hospital she develops vomiting, diarrhea, confusion, and abdominal pain. She goes on to develop evidence of multiorgan failure and is transferred to the intensive care unit. One week after the acute illness she develops desquamation of the skin. On further history, the illness started 3 days after the onset of menstruation. Which of the following is the most likely diagnosis?"
} | A 32-year-old woman presents to the emergency department after acutely developing a high fever, lightheadedness on standing, and a rash. At the hospital she develops vomiting, diarrhea, confusion, and abdominal pain. She goes on to develop evidence of multiorgan failure and is transferred to the intensive care unit. One week after the acute illness she develops desquamation of the skin. On further history, the illness started 3 days after the onset of menstruation. | Which of the following is the most likely diagnosis? | {
"A": "S aureus toxic shock syndrome (TSS)",
"B": "streptococcal infection (scarlet fever)",
"C": "clostridial infection",
"D": "Rocky mountain spotted fever (RMSF)"
} | A. S aureus toxic shock syndrome (TSS) |
49780525-b8eb-4f12-9b2a-4cfd10416bdc | A 29-year-old man presents to the clinic because he is concerned about blue fingers. He reports no other symptoms and is otherwise healthy. On physical examination, his vital signs are normal except for an oxygen saturation of 87% on room air. His lung and cardiac exams are normal but there is bluish discoloration of his fingers consistent with cyanosis. A blood gas reveals hypoxemia and hypercapnia, while the CBC suggests polycythemia. With voluntary hyperventilation he is able to restore his blood gases to normal. Which of the following is the most likely location for the abnormalities seen on his blood gases? | cerebral cortex | kidney | heart | respiratory center | 3d
| multi | The primary pathology is likely to be located in the respiratory center. Cyanosis, especially when asleep, is caused by a combination of polycythemia and hypoxia. The symptoms of alveolar hypoventilation are caused by both hypercarbia and hypoxemia. | Medicine | Respiratory | 132 | {
"Correct Answer": "respiratory center",
"Correct Option": "D",
"Options": {
"A": "cerebral cortex",
"B": "kidney",
"C": "heart",
"D": "respiratory center"
},
"Question": "A 29-year-old man presents to the clinic because he is concerned about blue fingers. He reports no other symptoms and is otherwise healthy. On physical examination, his vital signs are normal except for an oxygen saturation of 87% on room air. His lung and cardiac exams are normal but there is bluish discoloration of his fingers consistent with cyanosis. A blood gas reveals hypoxemia and hypercapnia, while the CBC suggests polycythemia. With voluntary hyperventilation he is able to restore his blood gases to normal. Which of the following is the most likely location for the abnormalities seen on his blood gases?"
} | A 29-year-old man presents to the clinic because he is concerned about blue fingers. He reports no other symptoms and is otherwise healthy. On physical examination, his vital signs are normal except for an oxygen saturation of 87% on room air. His lung and cardiac exams are normal but there is bluish discoloration of his fingers consistent with cyanosis. A blood gas reveals hypoxemia and hypercapnia, while the CBC suggests polycythemia. With voluntary hyperventilation he is able to restore his blood gases to normal. | Which of the following is the most likely location for the abnormalities seen on his blood gases? | {
"A": "cerebral cortex",
"B": "kidney",
"C": "heart",
"D": "respiratory center"
} | D. respiratory center |
084c57d8-716a-49a9-91c2-22967ab01a27 | A 35-year-old man has a 5-year history of episodic wheezing and coughing. The episodes are more common during the winter months, and he has noticed that they often follow minor respiratory tract infections. In the period between the episodes, he can breathe normally. There is no family history of asthma or other allergies. On physical examination, there are no remarkable findings. A chest radiograph shows no abnormalities. A serum IgE level and WBC count are normal. Which of the following is the most likely mechanism that contributes to the findings in his illness? | Accumulation of alveolar neutrophilic exudate | Bronchial hyperreactivity to chronic inflammation | Emigration of eosinophils into bronchi | Hyperresponsiveness to Aspergillus spores | 1b
| multi | This history is typical of nonatopic, or intrinsic, asthma. There is no family history of asthma, no eosinophilia, and a normal serum IgE level. The fundamental abnormality in such cases is bronchial hyperresponsiveness (i.e., the threshold of bronchial spasm is intrinsically low). When airway inflammation occurs after viral infections, the bronchial smooth muscle spasms, and an asthmatic attack occurs. Such bronchial hyperreactivity also may be triggered by inhalation of air pollutants, such as ozone, sulfur dioxide, and nitrogen dioxides. Even exercise and cold air may act as a trigger. Accumulation of neutrophils is typical of bacterial pneumonia, which could follow viral infection, but lead to lung consolidation. Bronchopulmonary aspergillosis refers to colonization of asthmatic airways by Aspergillus, which is followed by development of additional IgE antibodies. Secretion of interleukin (IL)-4 and IL-5 by type 2 helper T cells also occurs in cases of allergic asthma. | Pathology | Respiration | 118 | {
"Correct Answer": "Bronchial hyperreactivity to chronic inflammation",
"Correct Option": "B",
"Options": {
"A": "Accumulation of alveolar neutrophilic exudate",
"B": "Bronchial hyperreactivity to chronic inflammation",
"C": "Emigration of eosinophils into bronchi",
"D": "Hyperresponsiveness to Aspergillus spores"
},
"Question": "A 35-year-old man has a 5-year history of episodic wheezing and coughing. The episodes are more common during the winter months, and he has noticed that they often follow minor respiratory tract infections. In the period between the episodes, he can breathe normally. There is no family history of asthma or other allergies. On physical examination, there are no remarkable findings. A chest radiograph shows no abnormalities. A serum IgE level and WBC count are normal. Which of the following is the most likely mechanism that contributes to the findings in his illness?"
} | A 35-year-old man has a 5-year history of episodic wheezing and coughing. The episodes are more common during the winter months, and he has noticed that they often follow minor respiratory tract infections. In the period between the episodes, he can breathe normally. There is no family history of asthma or other allergies. On physical examination, there are no remarkable findings. A chest radiograph shows no abnormalities. A serum IgE level and WBC count are normal. | Which of the following is the most likely mechanism that contributes to the findings in his illness? | {
"A": "Accumulation of alveolar neutrophilic exudate",
"B": "Bronchial hyperreactivity to chronic inflammation",
"C": "Emigration of eosinophils into bronchi",
"D": "Hyperresponsiveness to Aspergillus spores"
} | B. Bronchial hyperreactivity to chronic inflammation |
50c39ed5-5c03-4851-a02d-bc3dba5a591e | A neonate is born at term with multiple problems. He is small for gestational age and has cataract, hepatosplenomegaly and thrombocytopenia with purpura. Fuher studies demonstrate patent ductus aeriosus, bone lucency, pneumonia, and meningoencephalitis. The mother is a 17-year-old girl who had no prenatal care and had a mild maculopapular rash in mid-pregnancy. Which of the following is the most likely diagnosis? | Congenital cytomegalovirus infection | Congenital rubella | Congenital syphilis | Congenital toxoplasmosis | 1b
| multi | The rubella virus is one of the causes of devastating prenatal infection. In adults and older children, the virus can cause asymptomatic infection or a relatively mild febrile illness (German measles) with upper respiratory symptoms, lymphadenopathy, maculopapular rash, and sometimes joint symptoms. The effects on the fetus range from apparently asymptomatic infection to multiple anomalies to death in utero. Among the more common abnormalities are intrauterine growth retardation, involvement of the senses and nervous system (meningoencephalitis, cataracts, retinopathy, hearing loss), cardiac involvement (patent ductus aeriosus, pulmonary aerial hypoplasia), hepatosplenomegaly, purpura (due to thrombocytopenia), bluish red skin lesions (secondary to dermal erythropoiesis), and pneumonia. Apparently asymptomatic babies should be monitored for subsequent development of hearing loss, mental retardation, endocrinopathies, and (rarely) progressive encephalitis. Treatment is suppoive, as no specific antiviral therapy is available for this infection. The rubella vaccine should be given to women of childbearing age who are not pregnant at the time. Cytomegalovirus infections can cause asymptomatic to devastating disease in newborns; look for periventricular calcifications and mothers with a flu-like illness. Congenital syphilis can cause devastating disease in newborns and can occur in early forms (look for the rash of secondary syphilis) or late forms (look for bone and teeth abnormalities). Congenital toxoplasmosis can produce devastating infection in newborns; look for a maternal history of cleaning cat litter boxes. | Microbiology | null | 109 | {
"Correct Answer": "Congenital rubella",
"Correct Option": "B",
"Options": {
"A": "Congenital cytomegalovirus infection",
"B": "Congenital rubella",
"C": "Congenital syphilis",
"D": "Congenital toxoplasmosis"
},
"Question": "A neonate is born at term with multiple problems. He is small for gestational age and has cataract, hepatosplenomegaly and thrombocytopenia with purpura. Fuher studies demonstrate patent ductus aeriosus, bone lucency, pneumonia, and meningoencephalitis. The mother is a 17-year-old girl who had no prenatal care and had a mild maculopapular rash in mid-pregnancy. Which of the following is the most likely diagnosis?"
} | A neonate is born at term with multiple problems. He is small for gestational age and has cataract, hepatosplenomegaly and thrombocytopenia with purpura. Fuher studies demonstrate patent ductus aeriosus, bone lucency, pneumonia, and meningoencephalitis. The mother is a 17-year-old girl who had no prenatal care and had a mild maculopapular rash in mid-pregnancy. | Which of the following is the most likely diagnosis? | {
"A": "Congenital cytomegalovirus infection",
"B": "Congenital rubella",
"C": "Congenital syphilis",
"D": "Congenital toxoplasmosis"
} | B. Congenital rubella |
46203354-604b-4471-a3c3-9668fbe334be | A 29 year old woman was found to have a hemoglobin of 7.8 g/dl. with a reticulocyte count of 0.8%. The peripherial blood smear showed microcytic hypochromic anemia, Hemoglobin A2 and hemoglobin F levels were 2.4% and 1.3% respectively. The serum iron and the total iron binding capacity were 15 micro g/dl, and 420 micro g/dl, respectively. The most likely cause of anemia is: | Iron deficiency anemia. | Beta-thalassemia minor | Sideroblastic anemia | Anemia due to chronic infection | 0a
| single | Answer is A (Iron deficiency anemia) Hypochromic microcytic anemia with decreased serum iron and an increased total iron binding capacity (TIBC) suggests a diagnosis of 'iron deficiency anemia' Parameter Normal index Patient in question Inference Hb Male 14-18 g/dl Female 12-16 g/dl 7.8 g/dl 4, Serum Iron 50-150 lig/di 15 mg/di .1, % Saturation 30-50% ? Serum Ferritin 50-200 !AWL - ? Total iron binding capacity 300-600 ug/dl 420iig/d1 1' HbA2 1.5 to 3.5% of total Hb. 2.4% N HbF <2% of total Hb. 1-3% N Remember: Hypochromic microcytic anemia with decreased serum iron and increased TIBC is iron deficiency anemiae Hypochromic microcytic anemia with decreased serum iron and decreased TIBC is anemia of chronic diseasee Differential diagnosis of Microcytic Hypochromic Anemia Parameters Iron deficiency Thalassemia Sideroblastic Chronic Inflammatory Smear Microcytic hypochromic + target cell Microcytic hypochromic Variable Normocytic Se Fe < 30 (,i,) N N ,l, (< 50) TIBC > 360 (T) N N ,l, (< 300) Saturation < 10 4) 1' (30-80) 1' (30-80) 1, (10-20) Ferritin < 15 (4.) 1' (50-300) 1.' (50-300) '1' (30-200) | Medicine | null | 116 | {
"Correct Answer": "Iron deficiency anemia.",
"Correct Option": "A",
"Options": {
"A": "Iron deficiency anemia.",
"B": "Beta-thalassemia minor",
"C": "Sideroblastic anemia",
"D": "Anemia due to chronic infection"
},
"Question": "A 29 year old woman was found to have a hemoglobin of 7.8 g/dl. with a reticulocyte count of 0.8%. The peripherial blood smear showed microcytic hypochromic anemia, Hemoglobin A2 and hemoglobin F levels were 2.4% and 1.3% respectively. The serum iron and the total iron binding capacity were 15 micro g/dl, and 420 micro g/dl, respectively. The most likely cause of anemia is:"
} | A 29 year old woman was found to have a hemoglobin of 7.8 g/dl. with a reticulocyte count of 0.8%. The peripherial blood smear showed microcytic hypochromic anemia, Hemoglobin A2 and hemoglobin F levels were 2.4% and 1.3% respectively. The serum iron and the total iron binding capacity were 15 micro g/dl, and 420 micro g/dl, respectively. | The most likely cause of anemia is: | {
"A": "Iron deficiency anemia.",
"B": "Beta-thalassemia minor",
"C": "Sideroblastic anemia",
"D": "Anemia due to chronic infection"
} | A. Iron deficiency anemia. |
0f75c9f8-fbeb-455f-bb38-628853199390 | A group of sports-science researchers is trying to determine what physical characteristics are positive predictors for success at the quarterback position in high school sports. A thorough physical examination is planned for all high school participants, including ethnicity, height, weight. BMI, and other variables. One of the testing sites in the Midwest region places the measurement stick 4 inches off of the ground, generously adding to the height of each athlete in their training center.
This mistake can be categorized as which kind of bias if not addressed by the researchers? | Hawthorne bias | Measurement bias | Procedure bias | Sampling bias | 1b
| multi | null | Social & Preventive Medicine | null | 106 | {
"Correct Answer": "Measurement bias",
"Correct Option": "B",
"Options": {
"A": "Hawthorne bias",
"B": "Measurement bias",
"C": "Procedure bias",
"D": "Sampling bias"
},
"Question": "A group of sports-science researchers is trying to determine what physical characteristics are positive predictors for success at the quarterback position in high school sports. A thorough physical examination is planned for all high school participants, including ethnicity, height, weight. BMI, and other variables. One of the testing sites in the Midwest region places the measurement stick 4 inches off of the ground, generously adding to the height of each athlete in their training center. \n\nThis mistake can be categorized as which kind of bias if not addressed by the researchers?"
} | A group of sports-science researchers is trying to determine what physical characteristics are positive predictors for success at the quarterback position in high school sports. A thorough physical examination is planned for all high school participants, including ethnicity, height, weight. BMI, and other variables. One of the testing sites in the Midwest region places the measurement stick 4 inches off of the ground, generously adding to the height of each athlete in their training center. | This mistake can be categorized as which kind of bias if not addressed by the researchers? | {
"A": "Hawthorne bias",
"B": "Measurement bias",
"C": "Procedure bias",
"D": "Sampling bias"
} | B. Measurement bias |
5b4e1857-d350-46ac-92f1-a52cb7bd53d1 | A 30-year-old male presents to ER with multiple episodes of chest pain, lasting between 10-20 minutes over the last 2 hours. He admits that he did "a bit of coke" at a house pay. Clinical assessment reveals: Pulse: 95/min, Blood pressure: 135/93mm Hg, Sp02= 97% on room air. ECG during a fuher chest pain episode reveals ST elevation in leads V2-V6 and Troponin T is negative.Which of the following is the most appropriate intervention for this patient? | Percutaneous coronary intervention | Enoxaparin | Calcium channel blocker | Atenolol | 2c
| single | Cocaine leads to coronary vasoconstriction & ECG will show ST elevation. Option A: No, PCI because it is not case of STEMI, it is case of Cocaine vasoconstriction so dilate the vessel. Option B: Enoxaparin given to prevent development of re-occlusion of blood vessel or to prevent redevelopment of thrombus in case of MI. Option C: Calcium channel blocker Option D= b Blocker will not relieve vasospasm. Types of Mi Causes 1 MI Due to coronary aery thrombosis or coronary aery dissection 2 MI Anemia (severe), Cocaine overdose 3 MI Sudden cardiac death 4A MI During PCI 4B MI Latent stent thrombosis 5 MI During CABG | Medicine | CVS | 126 | {
"Correct Answer": "Calcium channel blocker",
"Correct Option": "C",
"Options": {
"A": "Percutaneous coronary intervention",
"B": "Enoxaparin",
"C": "Calcium channel blocker",
"D": "Atenolol"
},
"Question": "A 30-year-old male presents to ER with multiple episodes of chest pain, lasting between 10-20 minutes over the last 2 hours. He admits that he did \"a bit of coke\" at a house pay. Clinical assessment reveals: Pulse: 95/min, Blood pressure: 135/93mm Hg, Sp02= 97% on room air. ECG during a fuher chest pain episode reveals ST elevation in leads V2-V6 and Troponin T is negative.Which of the following is the most appropriate intervention for this patient?"
} | A 30-year-old male presents to ER with multiple episodes of chest pain, lasting between 10-20 minutes over the last 2 hours. He admits that he did "a bit of coke" at a house pay. Clinical assessment reveals: Pulse: 95/min, Blood pressure: 135/93mm Hg, Sp02= 97% on room air. | ECG during a fuher chest pain episode reveals ST elevation in leads V2-V6 and Troponin T is negative.Which of the following is the most appropriate intervention for this patient? | {
"A": "Percutaneous coronary intervention",
"B": "Enoxaparin",
"C": "Calcium channel blocker",
"D": "Atenolol"
} | C. Calcium channel blocker |
bb62a0de-d12a-4297-99cf-55ba17f12e59 | A nulliparous woman in spontaneous labor was examined by you at 2pm and was found to be 6 cm dilated, 80% effaced with absent membranes, clear liquor and fully effaced cervix and vertex at 0 station and oxytocin was started to augment the contractions. At 6pm, she is reassessed and found to have same findings, but now with a caput formation and grade 3 moulding. Her contractions were seen to have been adequate for the last 4 hrs. What is the next step? | Wait and watch for another two hours | Oxytocin augmentation | Shift her to OT for caesarean | Vacuum delivery | 2c
| multi | Ans. C. Shift her to OT for caesareana. The woman is diagnosed with arrest of active stage of laborb. ACOG has updated the definition of arrest of 1st stage of labor in woman undergoing spontaneous labor to decrease the incidence of first caesarean section.c. Arrest in dilatation in active labor is defined at more than or equal to 6cm dilatation, with membrane rupture with no cervical change and one of the following:d. 4 hours or more of adequate uterine contractions (more than 200 Montevideo Units) ORe. 6 hours or more of inadequate uterine contractions | Gynaecology & Obstetrics | Miscellaneous (Obs) | 117 | {
"Correct Answer": "Shift her to OT for caesarean",
"Correct Option": "C",
"Options": {
"A": "Wait and watch for another two hours",
"B": "Oxytocin augmentation",
"C": "Shift her to OT for caesarean",
"D": "Vacuum delivery"
},
"Question": "A nulliparous woman in spontaneous labor was examined by you at 2pm and was found to be 6 cm dilated, 80% effaced with absent membranes, clear liquor and fully effaced cervix and vertex at 0 station and oxytocin was started to augment the contractions. At 6pm, she is reassessed and found to have same findings, but now with a caput formation and grade 3 moulding. Her contractions were seen to have been adequate for the last 4 hrs. What is the next step?"
} | A nulliparous woman in spontaneous labor was examined by you at 2pm and was found to be 6 cm dilated, 80% effaced with absent membranes, clear liquor and fully effaced cervix and vertex at 0 station and oxytocin was started to augment the contractions. At 6pm, she is reassessed and found to have same findings, but now with a caput formation and grade 3 moulding. Her contractions were seen to have been adequate for the last 4 hrs. | What is the next step? | {
"A": "Wait and watch for another two hours",
"B": "Oxytocin augmentation",
"C": "Shift her to OT for caesarean",
"D": "Vacuum delivery"
} | C. Shift her to OT for caesarean |
4b704d1a-ea71-4bdf-8041-b2744a05e9b1 | A 30-year-old non-smoker presented with cough and shoness of breath, fatigue, fever and night sweats for 3 weeks. On examination, specific skin lesions were noted over the lower limbs and on ophthalmoscopic examination anterior uveitis was diagnosed. Lab findings revealed elevated alkaline phosphatase levels along with hypercalcemia and raised ACE levels. Lung biopsy was taken. CHEST X -RAY HRCT CHEST What is the diagnosis in the above patient: - | Sarcoidosis | IPF | Hypersensitivity pneumonitis | Emphysema | 0a
| multi | This is a case of sarcoidosis. 1st image is of erythema nodosum. 2nd image shows maculopapular lesions on skin. Chest x ray shows bilateral hilar adenopathy, stage 1 disease. CT image shows patchy reticular nodularity, including areas of confluence HPE image shows an epithelioid cell granuloma. Rest of the 3 options are ruled out as they don't have any of the skin lesions. | Unknown | Integrated QBank | 101 | {
"Correct Answer": "Sarcoidosis",
"Correct Option": "A",
"Options": {
"A": "Sarcoidosis",
"B": "IPF",
"C": "Hypersensitivity pneumonitis",
"D": "Emphysema"
},
"Question": "A 30-year-old non-smoker presented with cough and shoness of breath, fatigue, fever and night sweats for 3 weeks. On examination, specific skin lesions were noted over the lower limbs and on ophthalmoscopic examination anterior uveitis was diagnosed. Lab findings revealed elevated alkaline phosphatase levels along with hypercalcemia and raised ACE levels. Lung biopsy was taken. CHEST X -RAY HRCT CHEST What is the diagnosis in the above patient: -"
} | A 30-year-old non-smoker presented with cough and shoness of breath, fatigue, fever and night sweats for 3 weeks. On examination, specific skin lesions were noted over the lower limbs and on ophthalmoscopic examination anterior uveitis was diagnosed. Lab findings revealed elevated alkaline phosphatase levels along with hypercalcemia and raised ACE levels. Lung biopsy was taken. | CHEST X -RAY HRCT CHEST What is the diagnosis in the above patient: - | {
"A": "Sarcoidosis",
"B": "IPF",
"C": "Hypersensitivity pneumonitis",
"D": "Emphysema"
} | A. Sarcoidosis |
bdb3a389-979a-418c-b60d-1ba7df5764b3 | Several children between the ages of 3 and 6 years have been admitted to a local hospital because of the encephalopathic crisis. They have lived in the same community all their lives. All have previously exhibited retarded psychomotor development. On physical examination, the children have diffuse abdominal pain and are experiencing nausea and vomiting. Head CT scans show marked cerebral edema. Laboratory studies show microcytic anemia. An investigator sent to the housing project where the children live finds a rundown apartment complex with extensive water damage, poor plumbing, and ventilation. Toxic exposure to which of the following substances best accounts for these findings? | Ethylene glycol | Kerosene | Lead | Methanol | 2c
| multi | Old flaking paint that is lead-based has a sweet taste, attracting small children to ingest it. The major risk to children from lead ingestion is neurologic damage. Venous blood lead levels should normally be less than 10 mg/dL. Ethylene glycol is found in antifreeze and can produce acute renal tubular necrosis. Kerosene, a hydrocarbon used in some household heating devices, can generate carbon monoxide fumes if not properly ventilated and can cause gastrointestinal and respiratory toxicity when ingested. Methanol ingestion can cause acute central nervous system depression, acidosis, and blindness. Household bleach (sodium hypochlorite) is a local irritant and is not likely to be found in the living conditions of these children. | Pathology | Environment & Nutritional Pathology | 126 | {
"Correct Answer": "Lead",
"Correct Option": "C",
"Options": {
"A": "Ethylene glycol",
"B": "Kerosene",
"C": "Lead",
"D": "Methanol"
},
"Question": "Several children between the ages of 3 and 6 years have been admitted to a local hospital because of the encephalopathic crisis. They have lived in the same community all their lives. All have previously exhibited retarded psychomotor development. On physical examination, the children have diffuse abdominal pain and are experiencing nausea and vomiting. Head CT scans show marked cerebral edema. Laboratory studies show microcytic anemia. An investigator sent to the housing project where the children live finds a rundown apartment complex with extensive water damage, poor plumbing, and ventilation. Toxic exposure to which of the following substances best accounts for these findings?"
} | Several children between the ages of 3 and 6 years have been admitted to a local hospital because of the encephalopathic crisis. They have lived in the same community all their lives. All have previously exhibited retarded psychomotor development. On physical examination, the children have diffuse abdominal pain and are experiencing nausea and vomiting. Head CT scans show marked cerebral edema. Laboratory studies show microcytic anemia. An investigator sent to the housing project where the children live finds a rundown apartment complex with extensive water damage, poor plumbing, and ventilation. | Toxic exposure to which of the following substances best accounts for these findings? | {
"A": "Ethylene glycol",
"B": "Kerosene",
"C": "Lead",
"D": "Methanol"
} | C. Lead |
9d7e56b4-d547-4391-a2f5-56c3aa6d451a | A 4-year-old boy presents with a history of constipation since the age of 6 months. His stools, produced every 3 to 4 days, are described as large and hard. His growth velocity is normal. Physical examination is normal; rectal examination reveals a large ampulla, poor sphincter tone but present anal wink, and stool in the rectal vault. The plain film of his abdomen is shown. Which of the following is the most appropriate next step in the management of this child? | Lower gastrointestinal (GI) barium study | Parental reassurance and dietary counseling | Serum electrolyte measurement | Upper GI barium study | 1b
| multi | The radiograph demonstrates a stool-filled megacolon. Finding a dilated, stool-filled anal canal with poor tone on the physical examination of a well-grown child supports the diagnosis of functional constipation. Hirschsprung disease is usually suspected in the chronically constipated child despite the vast majority of such children having functional constipation. The treatment of functional constipation, once it has been established as the diagnosis, emphasizes dietary changes and counseling of parents regarding proper toileting behavior. Effective stool softeners are available as a second line option. An extensive workup of this patient would likely be negative and expensive, and is not indicated. Hirschsprung usually presents in infancy with increasingly difficult defecation in the first few weeks of life. Typically no stool is found in the rectum, and anal sphincter tone is abnormal. Diagnosis of Hirschsprung disease may be made with rectal manometry and rectal biopsy. | Pediatrics | Gastro Intestinal System | 105 | {
"Correct Answer": "Parental reassurance and dietary counseling",
"Correct Option": "B",
"Options": {
"A": "Lower gastrointestinal (GI) barium study",
"B": "Parental reassurance and dietary counseling",
"C": "Serum electrolyte measurement",
"D": "Upper GI barium study"
},
"Question": "A 4-year-old boy presents with a history of constipation since the age of 6 months. His stools, produced every 3 to 4 days, are described as large and hard. His growth velocity is normal. Physical examination is normal; rectal examination reveals a large ampulla, poor sphincter tone but present anal wink, and stool in the rectal vault. The plain film of his abdomen is shown. Which of the following is the most appropriate next step in the management of this child?"
} | A 4-year-old boy presents with a history of constipation since the age of 6 months. His stools, produced every 3 to 4 days, are described as large and hard. His growth velocity is normal. Physical examination is normal; rectal examination reveals a large ampulla, poor sphincter tone but present anal wink, and stool in the rectal vault. The plain film of his abdomen is shown. | Which of the following is the most appropriate next step in the management of this child? | {
"A": "Lower gastrointestinal (GI) barium study",
"B": "Parental reassurance and dietary counseling",
"C": "Serum electrolyte measurement",
"D": "Upper GI barium study"
} | B. Parental reassurance and dietary counseling |
b2deb849-34bd-4193-994d-6b92719b6db3 | A male born at term after an uncomplicated pregnancy, labor and delivery develops severe respiratory distress within a few hours of bih. Results of routine culture were negative. The chest roengogram reveals a normal hea shadow and fine reticulonodular infiltrates radiating from the hilum. ECHO findings reveal no abnormality. Family history reveals similar clinical course and death of a male and female sibling at 1 month and 2 months of age respectively. The most likely diagnosis is: | Neonatal Alveolar Proteinosis | Total Anomalous Pulmonary Venous Circulation (TAPVC) | Meconium Aspiration Syndrome | Diffuse Herpes simplex infection | 0a
| single | Answer is.A (Neonatal Alveolar Proteinosis): The child in question is presenting with characteristic features of Neonatal Pulmonary Alveolar Proteinosis (PAP). Familial cases of Neonatal Pulmonary Alveolar Proteinosis have been observed and a genetic basis has been suggested. None of the other options have a familial basis and hence neonatal PAP is the single best answer of choice. TAPVC is unlikely as ECHO is unremarkable and TAPVC does not have a familial basis. Meconium aspiration syndrome is unlikely as it does not have a familial basis and the question provides no other clinical clues to suggest meconium aspiration such as meconium staining Congenital Herpes infection has an entirely different mode of presentation and can he safely excluded. Pulmonary Alveolar Proteinosis (PAP) PAP is a disorder characterized by the intra-alveolar accumulation of pulmonary surfactant proteins Etiology Defect in surfactant proteins (SP) (SP -B & SP -C) Defect in colony stimulating factor receptor (GM -CSF) gene Defect in ATP - binding cassette transpoer Gene (ABCA3 It may present in neonates (Neonatal PAP) and in older infants, children and adults Neonatal (Congenital PAP) This has a fulminant course and is often fatal PAP in older children and Adults (Adult PAP) This has a gradually progressive course (Note that the neonatal and adult forms are distinct entities and have different etiologies and manifestations) Familial cases have been observed and a genetic basis (Autosomal recessive) has been suggested for neonatal congenital PAP. No Gender difference in frequency has been observed. Neonatal PAP presents with severe respiratory distress in the neonatal period. Radiological features resemble those of hyaline membrane disease and may show fine reticulonodular infiltrates radiating from the hilum. It has a fulminant course and leads to death from rapidly developing respiratory failure. | Medicine | null | 102 | {
"Correct Answer": "Neonatal Alveolar Proteinosis",
"Correct Option": "A",
"Options": {
"A": "Neonatal Alveolar Proteinosis",
"B": "Total Anomalous Pulmonary Venous Circulation (TAPVC)",
"C": "Meconium Aspiration Syndrome",
"D": "Diffuse Herpes simplex infection"
},
"Question": "A male born at term after an uncomplicated pregnancy, labor and delivery develops severe respiratory distress within a few hours of bih. Results of routine culture were negative. The chest roengogram reveals a normal hea shadow and fine reticulonodular infiltrates radiating from the hilum. ECHO findings reveal no abnormality. Family history reveals similar clinical course and death of a male and female sibling at 1 month and 2 months of age respectively. The most likely diagnosis is:"
} | A male born at term after an uncomplicated pregnancy, labor and delivery develops severe respiratory distress within a few hours of bih. Results of routine culture were negative. The chest roengogram reveals a normal hea shadow and fine reticulonodular infiltrates radiating from the hilum. ECHO findings reveal no abnormality. Family history reveals similar clinical course and death of a male and female sibling at 1 month and 2 months of age respectively. | The most likely diagnosis is: | {
"A": "Neonatal Alveolar Proteinosis",
"B": "Total Anomalous Pulmonary Venous Circulation (TAPVC)",
"C": "Meconium Aspiration Syndrome",
"D": "Diffuse Herpes simplex infection"
} | A. Neonatal Alveolar Proteinosis |
eac35508-9f60-4b32-8657-147d37e85633 | A 30 years man presented with nausea, fever and jaundice of 5 days duration. The biochemical tests revealed a bilirubin of 6.7 mg/dl (conjugated 5.0 mg/d1) with SGOT/SGPT (AST/ALT) of 1230/900 IU/ml. The serological tests showed presence of HBs Ag IgM anti-HBc and HBeAg. The most likely diagnosis: | Chronic hepatitis B infection with high infectivity | Acute hepatitis B infection with high infectivity | Chronic hepatitis B infection with low infectivity | Acute hepatitis B infection with low infectivity | 1b
| single | Ans. (b) Acute hepatitis B infection with high infectivity See the following table, Do not try to learn it, just try to understand Commonly Encountered Serologic Patterns of Hepatitis B Infection HBsAg Anti-HBc Anti-Hac HBeAg Anti-HBe Interpretation + - lgM + - Acute hepatitis B, high infectivity + - lgG + - Chronic active Hepatitis B, high infectivity + - lgG - + 1. Late acute or chronic hepatitis B, low infectivity 2. HBeAg-negative (precore mutant) hepatitis B + + + +/- +/- 1. HBsAg of one subtype and heterotypic anti-HBs (common) 2. Process of seroconversion from HBsAg to anti-HBs (rare) - - lgM +/- +/- Acute hepatitis B Anti-HBc "window" - - lgG - +/- Low-lenel hepatitis B carrier or hepatitis B in remote post - + lgG - +/- Recovery from hepatitis B - + - - - 1. lmmunization with HBsAg (after vaccination)2. Hepatitis B in the remote past3. False-positive | Microbiology | null | 101 | {
"Correct Answer": "Acute hepatitis B infection with high infectivity",
"Correct Option": "B",
"Options": {
"A": "Chronic hepatitis B infection with high infectivity",
"B": "Acute hepatitis B infection with high infectivity",
"C": "Chronic hepatitis B infection with low infectivity",
"D": "Acute hepatitis B infection with low infectivity"
},
"Question": "A 30 years man presented with nausea, fever and jaundice of 5 days duration. The biochemical tests revealed a bilirubin of 6.7 mg/dl (conjugated 5.0 mg/d1) with SGOT/SGPT (AST/ALT) of 1230/900 IU/ml. The serological tests showed presence of HBs Ag IgM anti-HBc and HBeAg. The most likely diagnosis:"
} | A 30 years man presented with nausea, fever and jaundice of 5 days duration. The biochemical tests revealed a bilirubin of 6.7 mg/dl (conjugated 5.0 mg/d1) with SGOT/SGPT (AST/ALT) of 1230/900 IU/ml. The serological tests showed presence of HBs Ag IgM anti-HBc and HBeAg. | The most likely diagnosis: | {
"A": "Chronic hepatitis B infection with high infectivity",
"B": "Acute hepatitis B infection with high infectivity",
"C": "Chronic hepatitis B infection with low infectivity",
"D": "Acute hepatitis B infection with low infectivity"
} | B. Acute hepatitis B infection with high infectivity |
e93af3de-992e-431e-85b8-c82d28cbfe05 | A 58-year-old man with no prior cardiac history presents to the emergency department with symptoms of retrosternal chest pain starting at rest and lasting 30 minutes. The pain radiates to the left arm and is associated with diaphoresis and dyspnea.On physical examination, his blood pressure is 150/90 mm Hg, pulse is 100/min, the heart sounds are normal, and the lungs are clear to auscultation. Which of the following is the next most appropriate investigation? | CT scan - chest | CXR | cardiac troponin | ECG | 3d
| single | This man has acute coronary syndrome (ACS) until proven otherwise. The ECG is the most useful initial investigation since it identifies individuals with ST-segment elevation who maybe candidates for either thrombolysis or primary angioplasty (PCI). The troponins are important in diagnosing myocardial necrosis. The other investigations may be important in looking for alternate causes of chest pain once ST-elevation MI has been ruled out. | Medicine | C.V.S. | 110 | {
"Correct Answer": "ECG",
"Correct Option": "D",
"Options": {
"A": "CT scan - chest",
"B": "CXR",
"C": "cardiac troponin",
"D": "ECG"
},
"Question": "A 58-year-old man with no prior cardiac history presents to the emergency department with symptoms of retrosternal chest pain starting at rest and lasting 30 minutes. The pain radiates to the left arm and is associated with diaphoresis and dyspnea.On physical examination, his blood pressure is 150/90 mm Hg, pulse is 100/min, the heart sounds are normal, and the lungs are clear to auscultation. Which of the following is the next most appropriate investigation?"
} | A 58-year-old man with no prior cardiac history presents to the emergency department with symptoms of retrosternal chest pain starting at rest and lasting 30 minutes. The pain radiates to the left arm and is associated with diaphoresis and dyspnea.On physical examination, his blood pressure is 150/90 mm Hg, pulse is 100/min, the heart sounds are normal, and the lungs are clear to auscultation. | Which of the following is the next most appropriate investigation? | {
"A": "CT scan - chest",
"B": "CXR",
"C": "cardiac troponin",
"D": "ECG"
} | D. ECG |
87f606b2-8e1c-423e-9a9c-8c887c4c4323 | A 50-year-old man complains of swelling of the neck and shoness of breath for 7 days. He has noticed some nasal stuffiness with hoarseness of his voice for about 4 weeks and had attributed these symptoms to an upper respiratory infection. He denies the use of alcohol but has smoked two packs of cigarettes per day for 35 years. Lately, he feels as though something is pushing against his throat. On physical examination, the patient's face appears ruddy and swollen. The jugular veins are distended. Following sign is observed in the patient. Chest x ray was done with the following findings. What is the most likely diagnosis? | Retrosternal goiter | Thymoma | SVC syndrome | Congestive cardiac failure | 2c
| single | 1st image shows the classical Pembeon sign. 2nd image shows a mass in the right mediastinum-s/o CA lung causing compression of SVC. The SVC receives venous drainage from the head, neck, upper limb, and thorax. Located in the upper mediastinum, this thin-walled vessel is susceptible to pressure from external sources. The most common cause of such external compression is malignancy, usually from a right-side bronchogenic carcinoma. Presents with dyspnea, hoarseness and Horner syndrome. The development of SVC syndrome is often an emergency because the trachea may be obstructed, leading to respiratory compromise. | Unknown | Integrated QBank | 137 | {
"Correct Answer": "SVC syndrome",
"Correct Option": "C",
"Options": {
"A": "Retrosternal goiter",
"B": "Thymoma",
"C": "SVC syndrome",
"D": "Congestive cardiac failure"
},
"Question": "A 50-year-old man complains of swelling of the neck and shoness of breath for 7 days. He has noticed some nasal stuffiness with hoarseness of his voice for about 4 weeks and had attributed these symptoms to an upper respiratory infection. He denies the use of alcohol but has smoked two packs of cigarettes per day for 35 years. Lately, he feels as though something is pushing against his throat. On physical examination, the patient's face appears ruddy and swollen. The jugular veins are distended. Following sign is observed in the patient. Chest x ray was done with the following findings. What is the most likely diagnosis?"
} | A 50-year-old man complains of swelling of the neck and shoness of breath for 7 days. He has noticed some nasal stuffiness with hoarseness of his voice for about 4 weeks and had attributed these symptoms to an upper respiratory infection. He denies the use of alcohol but has smoked two packs of cigarettes per day for 35 years. Lately, he feels as though something is pushing against his throat. On physical examination, the patient's face appears ruddy and swollen. The jugular veins are distended. Following sign is observed in the patient. Chest x ray was done with the following findings. | What is the most likely diagnosis? | {
"A": "Retrosternal goiter",
"B": "Thymoma",
"C": "SVC syndrome",
"D": "Congestive cardiac failure"
} | C. SVC syndrome |
321c5671-dcd5-4ead-bafa-77517de37126 | A 26-year-old woman with a 6-month history of depression accompanied by active suicidal ideation ingests 35 g of acetaminophen. She quickly experiences nausea and vomiting. Within 1 day, she becomes progressively obtunded. On physical examination, her temperature is 36.9deg C, pulse is 75/min, respirations are 15/min, and blood pressure is 100/65 mm Hg. She is treated with N-acetylcysteine. Depletion of which of the following is most likely to accentuate her organ damage? | Glutathione (GSH) | Amylase | Creatine kinase | Ketone bodies | 0a
| single | Acetaminophen toxicity leads to hepatic necrosis, indicated by rising ALT and AST levels. If death is not immediate, hyperbilirubinemia also can be seen. N-Acetylcysteine augments glutathione by contributing a sulfhydryl group for binding to toxic metabolites. Elevated serum amylase is seen in pancreatitis. Elevated serum creatine kinase is seen with injury to skeletal and cardiac muscle. Ketonuria is a feature of absolute insulin deficiency in diabetes mellitus; it also is a feature of starvation. Hypokalemia can be a feature of renal diseases and glucocorticoid deficiency. | Pathology | Environment & Nutritional Pathology | 126 | {
"Correct Answer": "Glutathione (GSH)",
"Correct Option": "A",
"Options": {
"A": "Glutathione (GSH)",
"B": "Amylase",
"C": "Creatine kinase",
"D": "Ketone bodies"
},
"Question": "A 26-year-old woman with a 6-month history of depression accompanied by active suicidal ideation ingests 35 g of acetaminophen. She quickly experiences nausea and vomiting. Within 1 day, she becomes progressively obtunded. On physical examination, her temperature is 36.9deg C, pulse is 75/min, respirations are 15/min, and blood pressure is 100/65 mm Hg. She is treated with N-acetylcysteine. Depletion of which of the following is most likely to accentuate her organ damage?"
} | A 26-year-old woman with a 6-month history of depression accompanied by active suicidal ideation ingests 35 g of acetaminophen. She quickly experiences nausea and vomiting. Within 1 day, she becomes progressively obtunded. On physical examination, her temperature is 36.9deg C, pulse is 75/min, respirations are 15/min, and blood pressure is 100/65 mm Hg. She is treated with N-acetylcysteine. | Depletion of which of the following is most likely to accentuate her organ damage? | {
"A": "Glutathione (GSH)",
"B": "Amylase",
"C": "Creatine kinase",
"D": "Ketone bodies"
} | A. Glutathione (GSH) |
b6d59fe5-c3f3-4016-9272-7dd7933986db | Children 6 to 10 years old in the same community are observed by the local physician to be doing poorly in school, which has been attributed to behavioral problems. Their parents state that these children have poor appetites, complain of nausea, and have frequent headaches. On physical examination, they have decreased sensation to touch over the lower extremities. They exhibit loss of fine motor control of movement and have a slightly ataxic gait. A representative CBC shows hemoglobin of 11.8 g/dL, hematocrit of 35.2%, MCV of 82 mm3, platelet count of 282,300/ mm3, and WBC count of 4745/ mm3. Examination of the peripheral blood smear shows basophilic stippling of the RBCs. Excessive chronic ingestion of which of the following substances is most likely to explain these findings? | Cadmium | Copper | Iron | Lead | 3d
| single | Lead poisoning is mainly manifested by neurologic disorders, particularly in children. Lead absorption is enhanced by zinc deficiency; zinc is a trace metal. Lead inhibits heme incorporation into hemoglobin, leading to increased amounts of zinc protoporphyrin with anemia. Cadmium is a heavy metal associated with toxicity to the gastrointestinal tract, kidneys, and lungs. Copper is a trace metal that is unlikely to cause toxicity from environmental sources, although copper accumulation can occur with Wilson disease. Acute iron poisoning is associated with gastrointestinal, renal, and CNS toxicities. Nickel jewelry may cause skin rash; inhaled nickel produces respiratory problems. | Pathology | Blood | 191 | {
"Correct Answer": "Lead",
"Correct Option": "D",
"Options": {
"A": "Cadmium",
"B": "Copper",
"C": "Iron",
"D": "Lead"
},
"Question": "Children 6 to 10 years old in the same community are observed by the local physician to be doing poorly in school, which has been attributed to behavioral problems. Their parents state that these children have poor appetites, complain of nausea, and have frequent headaches. On physical examination, they have decreased sensation to touch over the lower extremities. They exhibit loss of fine motor control of movement and have a slightly ataxic gait. A representative CBC shows hemoglobin of 11.8 g/dL, hematocrit of 35.2%, MCV of 82 mm3, platelet count of 282,300/ mm3, and WBC count of 4745/ mm3. Examination of the peripheral blood smear shows basophilic stippling of the RBCs. Excessive chronic ingestion of which of the following substances is most likely to explain these findings?"
} | Children 6 to 10 years old in the same community are observed by the local physician to be doing poorly in school, which has been attributed to behavioral problems. Their parents state that these children have poor appetites, complain of nausea, and have frequent headaches. On physical examination, they have decreased sensation to touch over the lower extremities. They exhibit loss of fine motor control of movement and have a slightly ataxic gait. A representative CBC shows hemoglobin of 11.8 g/dL, hematocrit of 35.2%, MCV of 82 mm3, platelet count of 282,300/ mm3, and WBC count of 4745/ mm3. Examination of the peripheral blood smear shows basophilic stippling of the RBCs. | Excessive chronic ingestion of which of the following substances is most likely to explain these findings? | {
"A": "Cadmium",
"B": "Copper",
"C": "Iron",
"D": "Lead"
} | D. Lead |
2790062f-dea0-4931-b341-37a2da2e8abf | A 37-year-old woman presents to the emergency room after falling down some stairs at work. She reports no pre-monitory symptoms prior to the fall or any loss of consciousness. Recently she has noticed persistent symptoms of fatigue, muscle weakness, and unexpected weight gain. She has no past medical history and is not taking any medications.On examination, the blood pressure is 164/92 mm Hg and heart rate is 84/min. There are multiple skin bruises, facial fullness, and truncal obesity with red "stretch marks." Muscle strength in the proximal muscles is 4/5 and the reflexes are normal. Which of the following is the most appropriate initial diagnostic test? | computerized tomography (CT) scan of the abdomen | fasting glucose | overnight dexamethasone suppression test | electromyogram (EMG) studies | 2c
| multi | This patient has Cushing syndrome. The diagnosis is established by demonstrating increased cortisol secretion (24-hour urine cortisol collection) or by failure to suppress AM cortisol levels after overnight dexamethasone administration. Investigations for either adrenal tumor or pituitary adenoma (with CT or MR) are only considered once the diagnosis of Cushing syndrome is established. | Medicine | Endocrinology | 144 | {
"Correct Answer": "overnight dexamethasone suppression test",
"Correct Option": "C",
"Options": {
"A": "computerized tomography (CT) scan of the abdomen",
"B": "fasting glucose",
"C": "overnight dexamethasone suppression test",
"D": "electromyogram (EMG) studies"
},
"Question": "A 37-year-old woman presents to the emergency room after falling down some stairs at work. She reports no pre-monitory symptoms prior to the fall or any loss of consciousness. Recently she has noticed persistent symptoms of fatigue, muscle weakness, and unexpected weight gain. She has no past medical history and is not taking any medications.On examination, the blood pressure is 164/92 mm Hg and heart rate is 84/min. There are multiple skin bruises, facial fullness, and truncal obesity with red \"stretch marks.\" Muscle strength in the proximal muscles is 4/5 and the reflexes are normal. Which of the following is the most appropriate initial diagnostic test?"
} | A 37-year-old woman presents to the emergency room after falling down some stairs at work. She reports no pre-monitory symptoms prior to the fall or any loss of consciousness. Recently she has noticed persistent symptoms of fatigue, muscle weakness, and unexpected weight gain. She has no past medical history and is not taking any medications.On examination, the blood pressure is 164/92 mm Hg and heart rate is 84/min. There are multiple skin bruises, facial fullness, and truncal obesity with red "stretch marks." Muscle strength in the proximal muscles is 4/5 and the reflexes are normal. | Which of the following is the most appropriate initial diagnostic test? | {
"A": "computerized tomography (CT) scan of the abdomen",
"B": "fasting glucose",
"C": "overnight dexamethasone suppression test",
"D": "electromyogram (EMG) studies"
} | C. overnight dexamethasone suppression test |
53992cc3-3882-45b0-a669-85b9b71abb48 | A 16-year-old boy is rushed to the emergency room after sustaining a stab wound to the chest during a fight. Physical examination reveals a 1-cm entry wound at the right 5th intercostal space in the midclavicular line. His temperature is 37degC (98.6degF), respirations are 35 per minute and blood pressure is 90/50 mm Hg. A chest X-ray shows air in the right pleural space. Which of the following pulmonary conditions is the expected complication of pneumothorax arising in this patient? | Atelectasis | Chylothorax | Diffuse alveolar damage | Pyothorax | 0a
| single | Pneumothorax is defined as the presence of air in the pleural cavity, may be due to traumatic perforation of the pleura or may be spontaneous. Traumatic causes include penetrating wounds of the chest wall (e.g., stab wound or a rib fracture). Pneumothorax causes collapse of a previously expanded lung, a condition that is termed atelectasis. Chylothorax is the accumulation of lymphatic fluid within the pleural space and is a rare complication of trauma. | Pathology | Respiratory Distress Syndrome | 125 | {
"Correct Answer": "Atelectasis",
"Correct Option": "A",
"Options": {
"A": "Atelectasis",
"B": "Chylothorax",
"C": "Diffuse alveolar damage",
"D": "Pyothorax"
},
"Question": "A 16-year-old boy is rushed to the emergency room after sustaining a stab wound to the chest during a fight. Physical examination reveals a 1-cm entry wound at the right 5th intercostal space in the midclavicular line. His temperature is 37degC (98.6degF), respirations are 35 per minute and blood pressure is 90/50 mm Hg. A chest X-ray shows air in the right pleural space. Which of the following pulmonary conditions is the expected complication of pneumothorax arising in this patient?"
} | A 16-year-old boy is rushed to the emergency room after sustaining a stab wound to the chest during a fight. Physical examination reveals a 1-cm entry wound at the right 5th intercostal space in the midclavicular line. His temperature is 37degC (98.6degF), respirations are 35 per minute and blood pressure is 90/50 mm Hg. A chest X-ray shows air in the right pleural space. | Which of the following pulmonary conditions is the expected complication of pneumothorax arising in this patient? | {
"A": "Atelectasis",
"B": "Chylothorax",
"C": "Diffuse alveolar damage",
"D": "Pyothorax"
} | A. Atelectasis |
27ff2c7f-bd6b-4afa-9c75-550384eba9b8 | A 15-year-old boy is rushed to the emergency room after suffering a tonic-clonic seizure 4 weeks after a spelunking expedition. The boy appears irritable and agitated, and his parents state that he has difficulty swallowing fluids. Lumbar puncture shows numerous lymphocytes. The patient becomes delirious, slips into a coma, and expires. At autopsy, the brain stem shows infiltrates of lymphocytes around small blood vessels and evidence of neuronophagia. Some neurons contain eosinophilic inclusions. What is the proper name for these neuronal inclusions? | Councilman bodies | Hirano bodies | Lewy bodies | Negri bodies | 3d
| multi | Rabies is an encephalitis caused by the rabies virus, which is transmitted to humans through contaminated saliva introduced by a bite. Dogs, wolves, foxes, and skunks are the principal reservoirs, but the infection is also acquired from the bite of rabid bats, which often inhabit caves. Viral replication initiates at the site of the bite, and transport to the CNS is mediated by viral entry into peripheral nerves. Destruction of the brainstem neurons by rabies virus initiates painful spasms of the throat, difficulty swallowing, and a tendency to aspirate fluids, which has prompted the designation "hydrophobia." Encephalopathy progresses to death within 1 to several weeks. Pathologic features of rabies encephalitis include perivascular cuffing by lymphocytes, neuronophagia, microglial nodules, and "Negri bodies," which are distinctive eosinophilic, cytoplasmic inclusions in infected nerve cells. Councilman bodies (choice A) are remnants of apoptotic hepatocytes seen in acute viral hepatitis. Lewy bodies (choice C) are features of Parkinson disease.Diagnosis: Rabies | Pathology | Central Nervous System | 120 | {
"Correct Answer": "Negri bodies",
"Correct Option": "D",
"Options": {
"A": "Councilman bodies",
"B": "Hirano bodies",
"C": "Lewy bodies",
"D": "Negri bodies"
},
"Question": "A 15-year-old boy is rushed to the emergency room after suffering a tonic-clonic seizure 4 weeks after a spelunking expedition. The boy appears irritable and agitated, and his parents state that he has difficulty swallowing fluids. Lumbar puncture shows numerous lymphocytes. The patient becomes delirious, slips into a coma, and expires. At autopsy, the brain stem shows infiltrates of lymphocytes around small blood vessels and evidence of neuronophagia. Some neurons contain eosinophilic inclusions. What is the proper name for these neuronal inclusions?"
} | A 15-year-old boy is rushed to the emergency room after suffering a tonic-clonic seizure 4 weeks after a spelunking expedition. The boy appears irritable and agitated, and his parents state that he has difficulty swallowing fluids. Lumbar puncture shows numerous lymphocytes. The patient becomes delirious, slips into a coma, and expires. At autopsy, the brain stem shows infiltrates of lymphocytes around small blood vessels and evidence of neuronophagia. Some neurons contain eosinophilic inclusions. | What is the proper name for these neuronal inclusions? | {
"A": "Councilman bodies",
"B": "Hirano bodies",
"C": "Lewy bodies",
"D": "Negri bodies"
} | D. Negri bodies |
3749a59c-d685-4be5-9eda-b39a31ad63cf | A 32-year-old G3P2 woman at 35 weeks' gestation has a past medical history significant for hypertension. She was well-controlled on hydrochlorothiazide and lisinopril as an outpatient, but these drugs were discontinued when she found out that she was pregnant. Her blood pressure has been relatively well controlled in the 120-130 mm Hg systolic range without medication, and urinalysis has consistently been negative for proteinuria at each of her prenatal visits. She presents now to the obstetric clinic with a blood pressure of 142/84 mm Hg. A 24-hour urine specimen yields 0.35 g of proteinuria.Which of the following is the most appropriate next step? | Start iv furosemide | Induce labor after doing Bischop score | Put her on hydralazine | Initial inpatient evaluation followed by restricted activity and outpatient management. | 3d
| multi | In the question patient has past history of hypertension which was controlled on diuretics and ACE inhibitors prior to pregnancy.Till date her B/P was normal, she was not using any antihypertensive and now all of a sudden her BP is 142/84 mm of hg and proteinuria is 0.35 g all this suggests a possibility of superimposed preeclamplsia on chronic hypertension.
In this situation since BP is not much raised falling in the category of mild preeclampsia and gestational age is 35 weeks, no need to induce labor (labor should be induced at 37 weeks in mild preeclampsia) i.e option ‘b’ ruled out.
I/V Furosemide and hydralazine again are not justified in mild preeclampsia patients (Role of antihypertensives is controversial in the setting of mild preeclampsia) i.e. option ‘a’ and ‘c’ ruled out.
Her pre pregnancy regime which consisted of a diuretic along with ACE inhibitor cannot be started as ACE inhibitors are contraindicated during pregnancy ruling out option ‘e’.
So we are left with option d-initial inpatient evaluation followed by restricted activity and outpatient management, which is the most logical step . | Gynaecology & Obstetrics | null | 160 | {
"Correct Answer": "Initial inpatient evaluation followed by restricted activity and outpatient management.",
"Correct Option": "D",
"Options": {
"A": "Start iv furosemide",
"B": "Induce labor after doing Bischop score",
"C": "Put her on hydralazine",
"D": "Initial inpatient evaluation followed by restricted activity and outpatient management."
},
"Question": "A 32-year-old G3P2 woman at 35 weeks' gestation has a past medical history significant for hypertension. She was well-controlled on hydrochlorothiazide and lisinopril as an outpatient, but these drugs were discontinued when she found out that she was pregnant. Her blood pressure has been relatively well controlled in the 120-130 mm Hg systolic range without medication, and urinalysis has consistently been negative for proteinuria at each of her prenatal visits. She presents now to the obstetric clinic with a blood pressure of 142/84 mm Hg. A 24-hour urine specimen yields 0.35 g of proteinuria.Which of the following is the most appropriate next step?"
} | A 32-year-old G3P2 woman at 35 weeks' gestation has a past medical history significant for hypertension. She was well-controlled on hydrochlorothiazide and lisinopril as an outpatient, but these drugs were discontinued when she found out that she was pregnant. Her blood pressure has been relatively well controlled in the 120-130 mm Hg systolic range without medication, and urinalysis has consistently been negative for proteinuria at each of her prenatal visits. She presents now to the obstetric clinic with a blood pressure of 142/84 mm Hg. | A 24-hour urine specimen yields 0.35 g of proteinuria.Which of the following is the most appropriate next step? | {
"A": "Start iv furosemide",
"B": "Induce labor after doing Bischop score",
"C": "Put her on hydralazine",
"D": "Initial inpatient evaluation followed by restricted activity and outpatient management."
} | D. Initial inpatient evaluation followed by restricted activity and outpatient management. |
61f9175b-48b2-48ef-9b01-501d6cdb31c7 | An 18-year-old man is seen in the clinic for routine assessment. He reports no active symptoms, there is no past medical history and he is not taking any medications. He mentions that his brother has a "low blood count" that is hereditary but does not recall the name of the disorder.His physical examination is entirely normal. A complete blood count reveals a hemoglobin of 10.5 g/dL and microcytic red cells on the blood film. A hemoglobin electrophoresis confirms the diagnosis of beta-thalassemia minor. Which of the following findings is characteristic of this condition? | an increased amount of fetal hemoglobin (HbF) or hemoglobin A2 (HbA2) | increased osmotic fragility of the red cells | absent bone marrow iron | increased macroglobulin's in the serum | 0a
| multi | An increased amount of HbF or HbA2 is present in patients with beta-thalassemia. As the hemoglobin beta-chains are decreased in beta-thalassemia, the excess alpha-chains combine with gamma-and delta-chains to make HbF and HbA2, respectively. Increased osmotic fragility of red cells is a feature hereditary spherocytosis and not thalassemia. Most patients with thalassemia have normal quantities of bone marrow iron, and HbS is not a feature of thalassemia but of sickle cell disease. | Medicine | Blood | 128 | {
"Correct Answer": "an increased amount of fetal hemoglobin (HbF) or hemoglobin A2 (HbA2)",
"Correct Option": "A",
"Options": {
"A": "an increased amount of fetal hemoglobin (HbF) or hemoglobin A2 (HbA2)",
"B": "increased osmotic fragility of the red cells",
"C": "absent bone marrow iron",
"D": "increased macroglobulin's in the serum"
},
"Question": "An 18-year-old man is seen in the clinic for routine assessment. He reports no active symptoms, there is no past medical history and he is not taking any medications. He mentions that his brother has a \"low blood count\" that is hereditary but does not recall the name of the disorder.His physical examination is entirely normal. A complete blood count reveals a hemoglobin of 10.5 g/dL and microcytic red cells on the blood film. A hemoglobin electrophoresis confirms the diagnosis of beta-thalassemia minor. Which of the following findings is characteristic of this condition?"
} | An 18-year-old man is seen in the clinic for routine assessment. He reports no active symptoms, there is no past medical history and he is not taking any medications. He mentions that his brother has a "low blood count" that is hereditary but does not recall the name of the disorder.His physical examination is entirely normal. A complete blood count reveals a hemoglobin of 10.5 g/dL and microcytic red cells on the blood film. A hemoglobin electrophoresis confirms the diagnosis of beta-thalassemia minor. | Which of the following findings is characteristic of this condition? | {
"A": "an increased amount of fetal hemoglobin (HbF) or hemoglobin A2 (HbA2)",
"B": "increased osmotic fragility of the red cells",
"C": "absent bone marrow iron",
"D": "increased macroglobulin's in the serum"
} | A. an increased amount of fetal hemoglobin (HbF) or hemoglobin A2 (HbA2) |
eae94154-fe5e-4206-bbd5-f15f8c93a580 | A 25-year-old woman has a 3-year history of arthralgias. Physical examination shows no joint deformity, but she appears pale. Laboratory studies show a total RBC count of 4.7 million/ mm3, hemoglobin of 12.5 g/dL, hematocrit of 37.1%, platelet count of 217,000/ mm3, and WBC count of 5890/ mm3. The peripheral blood smear shows hypochromic and microcytic RBCs. Total serum iron and ferritin levels are normal. Hemoglobin electrophoresis shows 93% hemoglobin A1 with elevated hemoglobin A2 level of 5.8% and hemoglobin F level of 1.2%. What is the most likely diagnosis? | Anemia of chronic disease | Autoimmune hemolytic anemia | b-Thalassemia minor | Infection with Plasmodium vivax | 2c
| single | Although b-thalassemia minor and iron deficiency anemia are both characterized by hypochromic and microcytic RBCs, there is no increase in hemoglobin A2 in iron deficiency states. A normal serum ferritin level also excludes iron deficiency. In contrast to b-thalassemia major, there is usually mild anemia without major organ dysfunction with b-thalassemia minor. Diseases that produce hemolysis and increase erythropoiesis (e.g., autoimmune hemolytic anemia, malaria) do not alter the composition of b-globin chain production. Anemia of chronic disease may mimic iron deficiency and thalassemia minor with respect to hypochromia and microcytosis; however, anemia of chronic disease is associated with an increase in the serum concentration of ferritin. | Pathology | Blood | 177 | {
"Correct Answer": "b-Thalassemia minor",
"Correct Option": "C",
"Options": {
"A": "Anemia of chronic disease",
"B": "Autoimmune hemolytic anemia",
"C": "b-Thalassemia minor",
"D": "Infection with Plasmodium vivax"
},
"Question": "A 25-year-old woman has a 3-year history of arthralgias. Physical examination shows no joint deformity, but she appears pale. Laboratory studies show a total RBC count of 4.7 million/ mm3, hemoglobin of 12.5 g/dL, hematocrit of 37.1%, platelet count of 217,000/ mm3, and WBC count of 5890/ mm3. The peripheral blood smear shows hypochromic and microcytic RBCs. Total serum iron and ferritin levels are normal. Hemoglobin electrophoresis shows 93% hemoglobin A1 with elevated hemoglobin A2 level of 5.8% and hemoglobin F level of 1.2%. What is the most likely diagnosis?"
} | A 25-year-old woman has a 3-year history of arthralgias. Physical examination shows no joint deformity, but she appears pale. Laboratory studies show a total RBC count of 4.7 million/ mm3, hemoglobin of 12.5 g/dL, hematocrit of 37.1%, platelet count of 217,000/ mm3, and WBC count of 5890/ mm3. The peripheral blood smear shows hypochromic and microcytic RBCs. Total serum iron and ferritin levels are normal. Hemoglobin electrophoresis shows 93% hemoglobin A1 with elevated hemoglobin A2 level of 5.8% and hemoglobin F level of 1.2%. | What is the most likely diagnosis? | {
"A": "Anemia of chronic disease",
"B": "Autoimmune hemolytic anemia",
"C": "b-Thalassemia minor",
"D": "Infection with Plasmodium vivax"
} | C. b-Thalassemia minor |
29ae4d68-15bf-4a5a-9c26-4b84d6048bb7 | Using a new technique, Hb was estimated in a blood sample. The test was repeated for 10 times. The repos were : 9.5, 9.2, 9.4, 9.6, 9.7, 9.9, 10.2, 10.3, 10.5, 12.1. Accurate value of Hb was estimated by standard tests to be 10.2. The new technique has ? | High validity and high reliability | Low validity and low reliability | High validity and low reliability | Low validity and high reliability | 1b
| single | Ans. is 'b' i.e. low validity and low reliability Validity (Accuracy) o The validity of a test is the extent to which it accurately measures which it purpos to measure. In other words its the ability to show which individuals have the disease in question and which do not. o Validity has two components - sensitivity & specificity. To be truly valid, a test should be highly sensitive, specific and unbiased. In this question the test results are not accurate (accurate value is 10.2) Test has low validity. Reliability (or Repeatability, reproducibility or precision) Reliability or precision or repeatability is the level of agreement between repeated measurements of the same variable i.e. a highly reliable test must give consistent results when repeated more than once on the same individual or material, under the same conditions. In this question test is not showing consistent results --> Test has low reliability. | Social & Preventive Medicine | null | 107 | {
"Correct Answer": "Low validity and low reliability",
"Correct Option": "B",
"Options": {
"A": "High validity and high reliability",
"B": "Low validity and low reliability",
"C": "High validity and low reliability",
"D": "Low validity and high reliability"
},
"Question": "Using a new technique, Hb was estimated in a blood sample. The test was repeated for 10 times. The repos were : 9.5, 9.2, 9.4, 9.6, 9.7, 9.9, 10.2, 10.3, 10.5, 12.1. Accurate value of Hb was estimated by standard tests to be 10.2. The new technique has ?"
} | Using a new technique, Hb was estimated in a blood sample. The test was repeated for 10 times. The repos were : 9.5, 9.2, 9.4, 9.6, 9.7, 9.9, 10.2, 10.3, 10.5, 12.1. Accurate value of Hb was estimated by standard tests to be 10.2. | The new technique has ? | {
"A": "High validity and high reliability",
"B": "Low validity and low reliability",
"C": "High validity and low reliability",
"D": "Low validity and high reliability"
} | B. Low validity and low reliability |
9ed5c2cb-b0b6-42f4-828f-4aed53e0c504 | A 41-year-old man presented to the emergency department with a 9-month history of cough, exertional dyspnea, nocturnal diaphoresis, and weight loss of 10 kg. The physical examination revealed painless, massive, discrete, rubbery cervical, supraclavicular and axillary lymphadenopathy. Plain radiography of the chest showed bilateral hilar lymphadenopathy. The serum calcium level was elevated at 16.2 mg per deciliter; serum parathyroid hormone is within normal range.
The treatment regimen consists of | Chemotherapeutic regimen of doxorubicin, bleomycin, vinblatine, and dacarbazine | Anti tuberculosis regimen of INH, rifampicin, ethambutol and PAS | Lineac radiation to the chest | Radial thyroidectomy and neck node dissection | 0a
| single | null | Medicine | null | 116 | {
"Correct Answer": "Chemotherapeutic regimen of doxorubicin, bleomycin, vinblatine, and dacarbazine",
"Correct Option": "A",
"Options": {
"A": "Chemotherapeutic regimen of doxorubicin, bleomycin, vinblatine, and dacarbazine",
"B": "Anti tuberculosis regimen of INH, rifampicin, ethambutol and PAS",
"C": "Lineac radiation to the chest",
"D": "Radial thyroidectomy and neck node dissection"
},
"Question": "A 41-year-old man presented to the emergency department with a 9-month history of cough, exertional dyspnea, nocturnal diaphoresis, and weight loss of 10 kg. The physical examination revealed painless, massive, discrete, rubbery cervical, supraclavicular and axillary lymphadenopathy. Plain radiography of the chest showed bilateral hilar lymphadenopathy. The serum calcium level was elevated at 16.2 mg per deciliter; serum parathyroid hormone is within normal range.\n\nThe treatment regimen consists of"
} | A 41-year-old man presented to the emergency department with a 9-month history of cough, exertional dyspnea, nocturnal diaphoresis, and weight loss of 10 kg. The physical examination revealed painless, massive, discrete, rubbery cervical, supraclavicular and axillary lymphadenopathy. Plain radiography of the chest showed bilateral hilar lymphadenopathy. | The serum calcium level was elevated at 16.2 mg per deciliter; serum parathyroid hormone is within normal range.
The treatment regimen consists of | {
"A": "Chemotherapeutic regimen of doxorubicin, bleomycin, vinblatine, and dacarbazine",
"B": "Anti tuberculosis regimen of INH, rifampicin, ethambutol and PAS",
"C": "Lineac radiation to the chest",
"D": "Radial thyroidectomy and neck node dissection"
} | A. Chemotherapeutic regimen of doxorubicin, bleomycin, vinblatine, and dacarbazine |
8e812c65-f67e-4497-8d59-af33e9376475 | A 35-year-old woman complains of slowly progressive dyspnea. Her history is otherwise negative, and there is no cough, sputum production, pleuritic chest pain, or thrombophlebitis. She has taken appetite suppressants at different times. Physical examination reveals jugular venous distention, a palpable right ventricular lift, and a loud P2 heart sound. Chest x-ray shows clear lung fields. Oxygen saturation is 94%. ECG shows right axis deviation. A perfusion lung scan is normal, with no segmental deficits. Which of the following is the most likely diagnosis? | Pulmonary arterial hypertension | Recurrent pulmonary emboli | Right-to-left cardiac shunt | Interstitial lung disease | 0a
| single | Although a difficult diagnosis to make, pulmonary arterial hypertension (PAH) is the most likely diagnosis in this young woman who has used appetite suppressants. Pulmonary arterial hypertension (also known as primary pulmonary hypertension) has been associated with fenfluramine-type appetite suppressants. The predominant symptom is dyspnea, which is usually not apparent until the disease has advanced. When physical findings, chest x-ray, or echocardiography suggest pulmonary hypertension, recurrent pulmonary emboli must be ruled out. In this case, a normal perfusion lung scan makes pulmonary angiography unnecessary. Right-to-left cardiac shunts cause hypoxia (oxygen desaturation) that characteristically does not improve with oxygen supplementation. Restrictive lung disease should be ruled out with pulmonary function testing but is unlikely with a normal chest x-ray. An echocardiogram will show right ventricular enlargement and a reduction in the left ventricle size consistent with right ventricular pressure overload. Left ventricular dysfunction can cause pulmonary edema but not pulmonary hypertension. | Medicine | Respiratory | 129 | {
"Correct Answer": "Pulmonary arterial hypertension",
"Correct Option": "A",
"Options": {
"A": "Pulmonary arterial hypertension",
"B": "Recurrent pulmonary emboli",
"C": "Right-to-left cardiac shunt",
"D": "Interstitial lung disease"
},
"Question": "A 35-year-old woman complains of slowly progressive dyspnea. Her history is otherwise negative, and there is no cough, sputum production, pleuritic chest pain, or thrombophlebitis. She has taken appetite suppressants at different times. Physical examination reveals jugular venous distention, a palpable right ventricular lift, and a loud P2 heart sound. Chest x-ray shows clear lung fields. Oxygen saturation is 94%. ECG shows right axis deviation. A perfusion lung scan is normal, with no segmental deficits. Which of the following is the most likely diagnosis?"
} | A 35-year-old woman complains of slowly progressive dyspnea. Her history is otherwise negative, and there is no cough, sputum production, pleuritic chest pain, or thrombophlebitis. She has taken appetite suppressants at different times. Physical examination reveals jugular venous distention, a palpable right ventricular lift, and a loud P2 heart sound. Chest x-ray shows clear lung fields. Oxygen saturation is 94%. ECG shows right axis deviation. A perfusion lung scan is normal, with no segmental deficits. | Which of the following is the most likely diagnosis? | {
"A": "Pulmonary arterial hypertension",
"B": "Recurrent pulmonary emboli",
"C": "Right-to-left cardiac shunt",
"D": "Interstitial lung disease"
} | A. Pulmonary arterial hypertension |
Subsets and Splits