id
stringlengths 36
36
| question
stringlengths 243
1.57k
| opa
stringlengths 1
265
| opb
stringlengths 1
247
| opc
stringlengths 1
240
| opd
stringlengths 1
195
| cop
class label 4
classes | choice_type
stringclasses 2
values | exp
stringlengths 8
8.48k
⌀ | subject_name
stringclasses 21
values | topic_name
stringclasses 263
values | token_count
int64 101
359
| data
dict | Context
stringlengths 1
1.35k
| Question_formatted
stringlengths 2
1.39k
| Options
dict | Final_answer
stringlengths 4
250
|
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
54a8e50c-5b3f-4839-ba33-3cf36a9aed76 | A 22 year old female, Neeta presented to you with complaints of headache and vomiting since 2 months. She is having amenorrhea but urine pregnancy test is negative. She also complained of secretion of milk from the breasts. A provisional diagnosis of hyper prolactinemia was made and MRI was suggested. MRI confirmed the presence of a large pituitary adenoma. Neeta was advised surgery, however, she is not willing to undergo surgery. Which of the following medications is most likely to be prescribed? | Sumatriptan | Bromocriptine | Ergotamine | Allopurinol | 1b
| multi | Ans. (B) Bromocriptine(Ref: KK Sharma 2/e p550, KDT 8/e p24)Bromocriptine is a D2 agonist and is useful in hyperprolactinemia by its action to inhibit the release of prolactin. | Pharmacology | Endocrinology | 106 | {
"Correct Answer": "Bromocriptine",
"Correct Option": "B",
"Options": {
"A": "Sumatriptan",
"B": "Bromocriptine",
"C": "Ergotamine",
"D": "Allopurinol"
},
"Question": "A 22 year old female, Neeta presented to you with complaints of headache and vomiting since 2 months. She is having amenorrhea but urine pregnancy test is negative. She also complained of secretion of milk from the breasts. A provisional diagnosis of hyper prolactinemia was made and MRI was suggested. MRI confirmed the presence of a large pituitary adenoma. Neeta was advised surgery, however, she is not willing to undergo surgery. Which of the following medications is most likely to be prescribed?"
} | A 22 year old female, Neeta presented to you with complaints of headache and vomiting since 2 months. She is having amenorrhea but urine pregnancy test is negative. She also complained of secretion of milk from the breasts. A provisional diagnosis of hyper prolactinemia was made and MRI was suggested. MRI confirmed the presence of a large pituitary adenoma. Neeta was advised surgery, however, she is not willing to undergo surgery. | Which of the following medications is most likely to be prescribed? | {
"A": "Sumatriptan",
"B": "Bromocriptine",
"C": "Ergotamine",
"D": "Allopurinol"
} | B. Bromocriptine |
f4afed71-c767-4074-9458-f2dca8bc1e59 | A 27-year-old man develops acute pain and swelling of the left knee 5 days after an episode of urethritis. On physical examination, the left knee is swollen, warm, and tender to the touch. No other joints are affected. Laboratory examination of fluid aspirated from the left knee joint shows numerous neutrophils. A Gram stain of the fluid shows with gram-negative intracellular diplococci. No crystals are seen. Which of the following infectious agents is most likely responsible for his condition? | Borrelia burgdorferi | Haemophilus influenzae | Neisseria gonorrhoeae | Staphylococcus aureus | 2c
| single | Gonorrhea should be considered the most likely cause of acute suppurative arthritis in sexually active individuals; in some cases, multiple joints can be involved. In men, urethritis may occur with a gonorrheal infection. Borrelia burgdorferi causes Lyme disease, characterized by chronic arthritis that may mimic rheumatoid arthritis. Haemophilus influenzae is a short, gram-negative rod that can cause osteomyelitis in children. Staphylococcus aureus is the most common cause of osteomyelitis, but the Gram stain would show gram-positive cocci. Treponema pallidum infection, also a sexually transmitted disease, can lead to syphilitic gummas in the tertiary phase of syphilis that may produce joint deformity. There is no preceding urethritis, however. Tertiary syphilis may be preceded years earlier by a primary syphilitic chancre. | Pathology | Osteology | 104 | {
"Correct Answer": "Neisseria gonorrhoeae",
"Correct Option": "C",
"Options": {
"A": "Borrelia burgdorferi",
"B": "Haemophilus influenzae",
"C": "Neisseria gonorrhoeae",
"D": "Staphylococcus aureus"
},
"Question": "A 27-year-old man develops acute pain and swelling of the left knee 5 days after an episode of urethritis. On physical examination, the left knee is swollen, warm, and tender to the touch. No other joints are affected. Laboratory examination of fluid aspirated from the left knee joint shows numerous neutrophils. A Gram stain of the fluid shows with gram-negative intracellular diplococci. No crystals are seen. Which of the following infectious agents is most likely responsible for his condition?"
} | A 27-year-old man develops acute pain and swelling of the left knee 5 days after an episode of urethritis. On physical examination, the left knee is swollen, warm, and tender to the touch. No other joints are affected. Laboratory examination of fluid aspirated from the left knee joint shows numerous neutrophils. A Gram stain of the fluid shows with gram-negative intracellular diplococci. No crystals are seen. | Which of the following infectious agents is most likely responsible for his condition? | {
"A": "Borrelia burgdorferi",
"B": "Haemophilus influenzae",
"C": "Neisseria gonorrhoeae",
"D": "Staphylococcus aureus"
} | C. Neisseria gonorrhoeae |
9b0a957d-3247-47c6-9304-4638c80c87be | A 24-year-old woman presents with foot and leg weakness that is progressively getting worse over the past 1 week. Initially, she developed tingling in her feet and noticed that they would drag, but now she has difficulty standing and walking due to the leg weakness. Three weeks ago she had a "chest cold," which resolved on its own. On examination, muscle bulk is normal, motor strength is 2 out of 5 in the quadriceps, and 1 out of 5 in the feet. Reflexes at the ankle and knee are absent, and sensation testing is normal. The upper limb examination is normal. The CSF protein is very high, glucose is normal, and cell count is slightly elevated. Which of the following is the most likely diagnosis? | diabetic neuropathy | alcoholic neuropathy | Guillain-Barre syndrome | cyanide poisoning | 2c
| multi | Guillain-Barre syndrome often appears days to weeks after a viral upper respiratory or gastrointestinal (GI) infection. The initial symptoms are due to symmetric limb weakness. Paresthesia may be present. Unlike most other neuropathies, proximal muscles may be affected more than distal muscles early in the disease. Tendon reflexes are usually lost within a few days. Protein content of the CSF is usually high within a few days of onset. Diabetic and alcoholic neuropathy do not have an acute onset type presentation as this patient did. Cyanide poisoning can cause paralysis, but it is generalized not just localized to the lower limbs. | Medicine | C.N.S. | 157 | {
"Correct Answer": "Guillain-Barre syndrome",
"Correct Option": "C",
"Options": {
"A": "diabetic neuropathy",
"B": "alcoholic neuropathy",
"C": "Guillain-Barre syndrome",
"D": "cyanide poisoning"
},
"Question": "A 24-year-old woman presents with foot and leg weakness that is progressively getting worse over the past 1 week. Initially, she developed tingling in her feet and noticed that they would drag, but now she has difficulty standing and walking due to the leg weakness. Three weeks ago she had a \"chest cold,\" which resolved on its own. On examination, muscle bulk is normal, motor strength is 2 out of 5 in the quadriceps, and 1 out of 5 in the feet. Reflexes at the ankle and knee are absent, and sensation testing is normal. The upper limb examination is normal. The CSF protein is very high, glucose is normal, and cell count is slightly elevated. Which of the following is the most likely diagnosis?"
} | A 24-year-old woman presents with foot and leg weakness that is progressively getting worse over the past 1 week. Initially, she developed tingling in her feet and noticed that they would drag, but now she has difficulty standing and walking due to the leg weakness. Three weeks ago she had a "chest cold," which resolved on its own. On examination, muscle bulk is normal, motor strength is 2 out of 5 in the quadriceps, and 1 out of 5 in the feet. Reflexes at the ankle and knee are absent, and sensation testing is normal. The upper limb examination is normal. The CSF protein is very high, glucose is normal, and cell count is slightly elevated. | Which of the following is the most likely diagnosis? | {
"A": "diabetic neuropathy",
"B": "alcoholic neuropathy",
"C": "Guillain-Barre syndrome",
"D": "cyanide poisoning"
} | C. Guillain-Barre syndrome |
623b9acd-57fc-448d-af90-af9368d0f8d3 | A 77-year-old woman fell and fractured her ankle. She has spent most of her time in bed for the past 16 days. She develops sudden chest pain, dyspnea, and diaphoresis. On examination, she has left thigh swelling and tenderness. A chest CT shows areas of decreased attenuation in the right and left pulmonary arteries. A day later she has difficulty speaking. MR angiography shows focal occlusion of a left middle cerebral artery branch. Which of the following cardiac abnormalities is she most likely to have? | Atrial myxoma | Infective endocarditis | Nonbacterial thrombotic endocarditis | Patent foramen ovale | 3d
| single | This is the infamous "paradoxical embolus" that has appeared far more often in question sets than in real life. She started with thrombophlebitis that led to pulmonary embolism, but there must be an explanation for the "stroke" that then occurred. Pulmonary emboli can obstruct the pulmonary arterial circulation, raising right atrial pressure, and opening a patent foramen ovale that normally remains closed because of higher left atrial pressure. The remaining choices do not explain pulmonary thromboembolism. A left atrial myxoma can embolize to the brain; lesions of endocarditis are most often on the left side of the heart and could produce cerebral emboli; a ventricular aneurysm is virtually always on the left side of the heart because it results from a healed infarction, and can be filled with mural thrombus that can embolize. | Pathology | C.V.S | 111 | {
"Correct Answer": "Patent foramen ovale",
"Correct Option": "D",
"Options": {
"A": "Atrial myxoma",
"B": "Infective endocarditis",
"C": "Nonbacterial thrombotic endocarditis",
"D": "Patent foramen ovale"
},
"Question": "A 77-year-old woman fell and fractured her ankle. She has spent most of her time in bed for the past 16 days. She develops sudden chest pain, dyspnea, and diaphoresis. On examination, she has left thigh swelling and tenderness. A chest CT shows areas of decreased attenuation in the right and left pulmonary arteries. A day later she has difficulty speaking. MR angiography shows focal occlusion of a left middle cerebral artery branch. Which of the following cardiac abnormalities is she most likely to have?"
} | A 77-year-old woman fell and fractured her ankle. She has spent most of her time in bed for the past 16 days. She develops sudden chest pain, dyspnea, and diaphoresis. On examination, she has left thigh swelling and tenderness. A chest CT shows areas of decreased attenuation in the right and left pulmonary arteries. A day later she has difficulty speaking. MR angiography shows focal occlusion of a left middle cerebral artery branch. | Which of the following cardiac abnormalities is she most likely to have? | {
"A": "Atrial myxoma",
"B": "Infective endocarditis",
"C": "Nonbacterial thrombotic endocarditis",
"D": "Patent foramen ovale"
} | D. Patent foramen ovale |
e6c230b5-eb43-4a34-82f5-9b94e785438d | An 8-year-old boy presents with headaches, dizziness, and malaise. He was seen for a severe sore throat 2 weeks ago. Physical examination reveals facial edema. The blood pressure is 180/110 mm Hg. A 24-hour urine collection demonstrates oliguria, and urinalysis shows hematuria. What finding on microscopic urinalysis indicates that hematuria in the patient is caused by a renal process, rather than bleeding from another site in the urinary tract? | Blood clots | Hemoglobin crystals | Phagocytosed hemoglobin | Red blood cell casts | 3d
| single | Injury to the glomerular capillaries results in spillage of protein and blood cells into the urine. Hematuria is also seen in patients with bleeding from the lower urinary tract. However, RBC casts in the urine sediment originate from erythrocytes compacted during passage through the renal tubules and denote a renal origin of hematuria.Diagnosis: Postinfectious glomerulonephritis, nephritic syndrome | Pathology | Kidney | 107 | {
"Correct Answer": "Red blood cell casts",
"Correct Option": "D",
"Options": {
"A": "Blood clots",
"B": "Hemoglobin crystals",
"C": "Phagocytosed hemoglobin",
"D": "Red blood cell casts"
},
"Question": "An 8-year-old boy presents with headaches, dizziness, and malaise. He was seen for a severe sore throat 2 weeks ago. Physical examination reveals facial edema. The blood pressure is 180/110 mm Hg. A 24-hour urine collection demonstrates oliguria, and urinalysis shows hematuria. What finding on microscopic urinalysis indicates that hematuria in the patient is caused by a renal process, rather than bleeding from another site in the urinary tract?"
} | An 8-year-old boy presents with headaches, dizziness, and malaise. He was seen for a severe sore throat 2 weeks ago. Physical examination reveals facial edema. The blood pressure is 180/110 mm Hg. A 24-hour urine collection demonstrates oliguria, and urinalysis shows hematuria. | What finding on microscopic urinalysis indicates that hematuria in the patient is caused by a renal process, rather than bleeding from another site in the urinary tract? | {
"A": "Blood clots",
"B": "Hemoglobin crystals",
"C": "Phagocytosed hemoglobin",
"D": "Red blood cell casts"
} | D. Red blood cell casts |
cc803e38-775d-42df-8d60-13f5a97ed526 | A 40-year-old woman wishes to donate blood to help alleviate the chronic shortage of blood for transfusion. She is found to be positive for HBsAg and is excluded as a blood donor. She feels fine. There are no significant physical examination findings. Laboratory findings for total serum bilirubin, AST, ALT, alkaline phosphatase, and albumin are normal. Further serologic test results are negative for IgM anti-HAV, anti-HBc, and anti-HCV. Repeat testing 6 months later yields the same results. Which of the following is the most appropriate statement regarding the pathophysiology of this patient's condition? | Chronic carrier state with no therapy indicated | Clinically overt hepatitis will occur within 1 year | Erroneous test results that need to be repeated | Hepatitis B vaccination series is now required | 0a
| multi | The persistence of HBsAg in serum for 6 months or more after initial detection denotes a carrier state. Worldwide, most individuals with a chronic carrier state for HBV acquired this infection in utero or at birth. Only 1% to 10% of adult HBV infections yield a chronic carrier state. The carrier state is stable in most individuals, the so-called "inactive" carrier state, without an elevation in liver enzymes, and some infected persons may eventually clear the virus. There is currently no therapy to aid this viral clearance Vaccination is useful to prevent infection, not clear the virus, although carriers become a reservoir for infection of others. | Pathology | Liver & Biliary Tract | 135 | {
"Correct Answer": "Chronic carrier state with no therapy indicated",
"Correct Option": "A",
"Options": {
"A": "Chronic carrier state with no therapy indicated",
"B": "Clinically overt hepatitis will occur within 1 year",
"C": "Erroneous test results that need to be repeated",
"D": "Hepatitis B vaccination series is now required"
},
"Question": "A 40-year-old woman wishes to donate blood to help alleviate the chronic shortage of blood for transfusion. She is found to be positive for HBsAg and is excluded as a blood donor. She feels fine. There are no significant physical examination findings. Laboratory findings for total serum bilirubin, AST, ALT, alkaline phosphatase, and albumin are normal. Further serologic test results are negative for IgM anti-HAV, anti-HBc, and anti-HCV. Repeat testing 6 months later yields the same results. Which of the following is the most appropriate statement regarding the pathophysiology of this patient's condition?"
} | A 40-year-old woman wishes to donate blood to help alleviate the chronic shortage of blood for transfusion. She is found to be positive for HBsAg and is excluded as a blood donor. She feels fine. There are no significant physical examination findings. Laboratory findings for total serum bilirubin, AST, ALT, alkaline phosphatase, and albumin are normal. Further serologic test results are negative for IgM anti-HAV, anti-HBc, and anti-HCV. Repeat testing 6 months later yields the same results. | Which of the following is the most appropriate statement regarding the pathophysiology of this patient's condition? | {
"A": "Chronic carrier state with no therapy indicated",
"B": "Clinically overt hepatitis will occur within 1 year",
"C": "Erroneous test results that need to be repeated",
"D": "Hepatitis B vaccination series is now required"
} | A. Chronic carrier state with no therapy indicated |
fd2073fc-15c0-49d6-8152-d1dbf92c1ad2 | A 52-year-old woman has had a chronic cough for the past 2 years, accompanied by a small amount of occasionally blood-streaked, whitish sputum. On physical examination, her temperature is 37.9deg C, pulse is 72/min, respirations are 22/min, and blood pressure is 125/80 mm Hg. Crackles are heard on auscultation over the upper lung fields. Heart sounds are faint, and there is a 15 mm Hg inspiratory decline in systolic arterial pressure. The chest radiograph shows prominent heart borders with a "water bottle" configuration. Pericardiocentesis yields 200 mL of the bloody fluid. Infection with which of the following organisms is most likely to produce these findings? | Candida albicans | Coxsackievirus B | Group A streptococcus | Mycobacterium tuberculosis | 3d
| multi | The clinical features are those of pericarditis with effusion, and the most common causes of hemorrhagic pericarditis are metastatic carcinoma and tuberculosis. An effusion of this size is sufficient to produce some cardiac tamponade that diminishes cardiac output; the paradoxical drop in pressure (more than 10 mm Hg) is called pulsus paradoxus and can be caused by pericarditis and by tamponade. Candida is a rare cardiac infection in immunocompromised individuals. Coxsackieviruses are known to cause myocarditis. Group A streptococci are responsible for rheumatic fever; in the acute form, rheumatic fever can lead to fibrinous pericarditis, and in the chronic form, it can lead to serous effusions from congestive heart failure. Staphylococcus aureus is most often a cause of infective endocarditis. | Pathology | C.V.S | 170 | {
"Correct Answer": "Mycobacterium tuberculosis",
"Correct Option": "D",
"Options": {
"A": "Candida albicans",
"B": "Coxsackievirus B",
"C": "Group A streptococcus",
"D": "Mycobacterium tuberculosis"
},
"Question": "A 52-year-old woman has had a chronic cough for the past 2 years, accompanied by a small amount of occasionally blood-streaked, whitish sputum. On physical examination, her temperature is 37.9deg C, pulse is 72/min, respirations are 22/min, and blood pressure is 125/80 mm Hg. Crackles are heard on auscultation over the upper lung fields. Heart sounds are faint, and there is a 15 mm Hg inspiratory decline in systolic arterial pressure. The chest radiograph shows prominent heart borders with a \"water bottle\" configuration. Pericardiocentesis yields 200 mL of the bloody fluid. Infection with which of the following organisms is most likely to produce these findings?"
} | A 52-year-old woman has had a chronic cough for the past 2 years, accompanied by a small amount of occasionally blood-streaked, whitish sputum. On physical examination, her temperature is 37.9deg C, pulse is 72/min, respirations are 22/min, and blood pressure is 125/80 mm Hg. Crackles are heard on auscultation over the upper lung fields. Heart sounds are faint, and there is a 15 mm Hg inspiratory decline in systolic arterial pressure. The chest radiograph shows prominent heart borders with a "water bottle" configuration. Pericardiocentesis yields 200 mL of the bloody fluid. | Infection with which of the following organisms is most likely to produce these findings? | {
"A": "Candida albicans",
"B": "Coxsackievirus B",
"C": "Group A streptococcus",
"D": "Mycobacterium tuberculosis"
} | D. Mycobacterium tuberculosis |
6b695430-6bf1-4e3b-8297-1e38797540e3 | A 19-year-old woman complains of swelling of her eyelids, abdomen, and ankles. At bedtime, there are depressions in her legs at the location of the elastic in her socks. A chest X-ray shows bilateral pleural effusions. Urine protein electrophoresis demonstrates 4+ proteinuria. A percutaneous needle biopsy of the kidney establishes the diagnosis of minimal change nephrotic syndrome. Soft tissue edema in this patient is most likely caused by which of the following mechanisms of disease? | Active hyperemia | Chronic passive congestion | Decreased intravascular oncotic pressure | Hyperalbuminemia | 2c
| single | The pressure differential between the intravascular and the interstitial compartments is largely determined by the concentration of plasma proteins, especially albumin. Any condition that lowers plasma albumin levels, whether from albuminuria in nephrotic syndrome or reduced albumin synthesis in chronic liver disease, tends to promote generalized edema.Diagnosis: Minimal change nephrotic syndrome | Pathology | Hemodynamics | 106 | {
"Correct Answer": "Decreased intravascular oncotic pressure",
"Correct Option": "C",
"Options": {
"A": "Active hyperemia",
"B": "Chronic passive congestion",
"C": "Decreased intravascular oncotic pressure",
"D": "Hyperalbuminemia"
},
"Question": "A 19-year-old woman complains of swelling of her eyelids, abdomen, and ankles. At bedtime, there are depressions in her legs at the location of the elastic in her socks. A chest X-ray shows bilateral pleural effusions. Urine protein electrophoresis demonstrates 4+ proteinuria. A percutaneous needle biopsy of the kidney establishes the diagnosis of minimal change nephrotic syndrome. Soft tissue edema in this patient is most likely caused by which of the following mechanisms of disease?"
} | A 19-year-old woman complains of swelling of her eyelids, abdomen, and ankles. At bedtime, there are depressions in her legs at the location of the elastic in her socks. A chest X-ray shows bilateral pleural effusions. Urine protein electrophoresis demonstrates 4+ proteinuria. A percutaneous needle biopsy of the kidney establishes the diagnosis of minimal change nephrotic syndrome. | Soft tissue edema in this patient is most likely caused by which of the following mechanisms of disease? | {
"A": "Active hyperemia",
"B": "Chronic passive congestion",
"C": "Decreased intravascular oncotic pressure",
"D": "Hyperalbuminemia"
} | C. Decreased intravascular oncotic pressure |
fa9e391b-0f9e-4724-b292-6498a8925d65 | A 65-year-old woman with a history of multinodular goiter complains of increasing nervousness, insomnia, and heart palpitations. She has lost 9 kg (20 lb) over the past 6 months. Physical examination reveals a diffusely enlarged thyroid. There is no evidence of exophthalmos. Laboratory studies show elevated serum levels of T3 and T4. Serologic tests for antithyroid antibodies are negative. Which of the following is an important complication of this patient's endocrinopathy? | Autoimmune hepatitis | Cardiac arrhythmia | Follicular carcinoma of the thyroid | Medullary carcinoma of the thyroid | 1b
| single | Hyperthyroidism refers to the clinical consequences of an excessive amount of circulating thyroid hormone. The principal metabolic products of the thyroid gland are triiodothyronine (T3) and tetraiodothyronine (thyroxine; T4). T4 is principally a prohormone; the major effector of thyroid function is T3. These molecules are formed by the iodination of tyrosine residues of thyroglobulin within the follicular cells. Iodinated thyroglobulin is then secreted into the lumen of the follicle. Many patients with nontoxic goiter, usually over the age of 50 years, eventually develop a toxic form of the disease. Since patients with toxic goiter tend to be older, cardiac complications, including atrial fibrillation and congestive heart failure, dominate the clinical presentation.Diagnosis: Hyperthyroidism, toxic goiter | Pathology | Endocrine | 109 | {
"Correct Answer": "Cardiac arrhythmia",
"Correct Option": "B",
"Options": {
"A": "Autoimmune hepatitis",
"B": "Cardiac arrhythmia",
"C": "Follicular carcinoma of the thyroid",
"D": "Medullary carcinoma of the thyroid"
},
"Question": "A 65-year-old woman with a history of multinodular goiter complains of increasing nervousness, insomnia, and heart palpitations. She has lost 9 kg (20 lb) over the past 6 months. Physical examination reveals a diffusely enlarged thyroid. There is no evidence of exophthalmos. Laboratory studies show elevated serum levels of T3 and T4. Serologic tests for antithyroid antibodies are negative. Which of the following is an important complication of this patient's endocrinopathy?"
} | A 65-year-old woman with a history of multinodular goiter complains of increasing nervousness, insomnia, and heart palpitations. She has lost 9 kg (20 lb) over the past 6 months. Physical examination reveals a diffusely enlarged thyroid. There is no evidence of exophthalmos. Laboratory studies show elevated serum levels of T3 and T4. Serologic tests for antithyroid antibodies are negative. | Which of the following is an important complication of this patient's endocrinopathy? | {
"A": "Autoimmune hepatitis",
"B": "Cardiac arrhythmia",
"C": "Follicular carcinoma of the thyroid",
"D": "Medullary carcinoma of the thyroid"
} | B. Cardiac arrhythmia |
c4dccf52-fb47-484b-9296-ca09ab58e736 | A 56-year-old man undergoes a left upper lobectomy. An epidural catheter is inseed for postoperative pain relief. Ninety minutes after the first dose of epidural morphine, the patient complains of itching and becomes increasingly somnolent. Blood-gas measurement reveals the following: pH 7.24, PaCO2 58, PaO2 100, and HCO3 - 28. Which of the following is the most appropriate initial therapy for this patient? | Endotracheal intubation | Intramuscular diphenhydramine (Benadryl) | Epidural naloxone | Intravenous naloxone | 3d
| single | Thoracic epidural narcotics have become an increasingly popular means of postoperative pain relief in thoracic and upper abdominal surgery. Local action on g-opiate receptors ensures pain relief and consequent improvement in respiration without vasodilation or paralysis. The less lipid-soluble opiates are effective for long periods. Their slow absorption into the circulation also ensures a low incidence of centrally mediated side effects, such as respiratory depression or generalized itching. When these do occur, the intravenous injection of an opiate antagonist is an effective antidote. The locally mediated analgesia is not affected. One poorly understood side effect, which is apparently unrelated to systemic levels, is a profound reduction in gastric activity. This may be an impoant consideration after thoracic surgery when an early resumption of oral intake is anticipated. | Anaesthesia | Miscellaneous | 109 | {
"Correct Answer": "Intravenous naloxone",
"Correct Option": "D",
"Options": {
"A": "Endotracheal intubation",
"B": "Intramuscular diphenhydramine (Benadryl)",
"C": "Epidural naloxone",
"D": "Intravenous naloxone"
},
"Question": "A 56-year-old man undergoes a left upper lobectomy. An epidural catheter is inseed for postoperative pain relief. Ninety minutes after the first dose of epidural morphine, the patient complains of itching and becomes increasingly somnolent. Blood-gas measurement reveals the following: pH 7.24, PaCO2 58, PaO2 100, and HCO3 - 28. Which of the following is the most appropriate initial therapy for this patient?"
} | A 56-year-old man undergoes a left upper lobectomy. An epidural catheter is inseed for postoperative pain relief. Ninety minutes after the first dose of epidural morphine, the patient complains of itching and becomes increasingly somnolent. Blood-gas measurement reveals the following: pH 7.24, PaCO2 58, PaO2 100, and HCO3 - 28. | Which of the following is the most appropriate initial therapy for this patient? | {
"A": "Endotracheal intubation",
"B": "Intramuscular diphenhydramine (Benadryl)",
"C": "Epidural naloxone",
"D": "Intravenous naloxone"
} | D. Intravenous naloxone |
3f0cbc76-87e6-406c-b0ab-2d91722ac9ef | A 60–year–old male Suresh is hospitalized with muscle pain, fatigue, and dark urine. His past medical history is significant for stable angina. The patient's medications include atenolol, atorvastatin, and aspirin. His urine dipstick test is positive for blood but urine microscopy did not reveal RBCs in the urine. Serum creatinine kinase was significantly raised in this person. The addition of which of the following medications is most likely to have precipitated this patient's condition? | Erythromycin | Rifampin | Griseofulvin | Azithromycin | 0a
| single | null | Pharmacology | null | 109 | {
"Correct Answer": "Erythromycin",
"Correct Option": "A",
"Options": {
"A": "Erythromycin",
"B": "Rifampin",
"C": "Griseofulvin",
"D": "Azithromycin"
},
"Question": "A 60–year–old male Suresh is hospitalized with muscle pain, fatigue, and dark urine. His past medical history is significant for stable angina. The patient's medications include atenolol, atorvastatin, and aspirin. His urine dipstick test is positive for blood but urine microscopy did not reveal RBCs in the urine. Serum creatinine kinase was significantly raised in this person. The addition of which of the following medications is most likely to have precipitated this patient's condition?"
} | A 60–year–old male Suresh is hospitalized with muscle pain, fatigue, and dark urine. His past medical history is significant for stable angina. The patient's medications include atenolol, atorvastatin, and aspirin. His urine dipstick test is positive for blood but urine microscopy did not reveal RBCs in the urine. Serum creatinine kinase was significantly raised in this person. | The addition of which of the following medications is most likely to have precipitated this patient's condition? | {
"A": "Erythromycin",
"B": "Rifampin",
"C": "Griseofulvin",
"D": "Azithromycin"
} | A. Erythromycin |
7d10840b-d6f2-4307-a0f7-e92fd3910fac | A 35-year old female presented with a swelling in the neck for the past 2 months, she had the treatment for Hodgkin’s lymphoma when she was 22 years with irradiation. On examination, her vitals were normal, there was a single, firm, irregular nodule, moving with deglutition in the left side of midline. Clinical examination also revealed a single node in the left side of the neck. The most likely clinical diagnosis of this condition is: | Recurrence of lymphoma | Malignant goiter | Benign multinodular goiter | Toxic nodular goiter | 1b
| single | Papillary Carcinoma of Thyroid:
Accounts for 80% of all thyroid malignancies in iodine-sufficient areas.
MC thyroid cancer in children and individuals exposed to external radiation.
More often in women, 30-40 years.
Pathology:
Grossly: Hard and whitish and remain flat on sectioning with a blade with macroscopic calcification, necrosis, or cystic changes.
Multifocality is common (up to 85% of cases) on microscopic examination.
Multifocality is associated with an increased risk of cervical nodal metastases.
Rarely invade adjacent structures such as the trachea, esophagus, and RLN.
Rarely encapsulated (PCT are seldom encapsulated).
Other variants: Tall cell, insular, columnar, diffuse sclerosing, clear cell, trabecular, and poorly differentiated types; account for about 1%; associated with a worse prognosis.
Histological characteristics of Papillary Carcinoma Thyroid:
Papillary projections: PTC contains branching papillae of cuboidal epithelial cells
Orphan Annie eyed nuclei: The nuclei contain finely dispersed chromatin, which imparts an optically clear or empty appearance, giving rise to term ground glass or Orphan Annie eyed nuclei.
Invaginations of cytoplasm in cross-sections: Intranuclear inclusions (pseudo-inclusion) or intranuclear grooves.
Diagnosis of PTC is based on these nuclear characteristics even in the absence of papillary structures.
Psammoma bodies: Microscopic, calcified deposits representing clumps of sloughed cells.
Clinical Features:
Most patients are euthyroid and present with a slow-growing painless mass in the neck.
Dysphagia, dyspnea and dysphonia are associated with locally advanced invasive disease.
Lymph node metastases are common, especially in children and young adults, and may be the presenting complaint.
“Lateral aberrant thyroid” almost always denotes a cervical lymph node that has been invaded by metastatic cancer.
Distant metastases are uncommon at initial presentation, but may ultimately develop in up to 20% of patients.
The MC sites of metastasis: Lungs >bone >liver >brain.
Diagnosis:
Diagnosis is established by FNAC of the thyroid mass or lymph node.
Once thyroid cancer is diagnosed on FNAC, a complete neck ultrasound to evaluate the contralateral lobe and for LN metastases in the central and lateral neck compartments.
Treatment: Total or near-total thyroidectomy
During thyroidectomy, enlarged central neck nodes should be removed.
Biopsy-proven lymph node metastases detected clinically or by imaging in the lateral neck in patients with papillary carcinoma are managed with modified radical neck dissection.
Prognosis:
PTC have an excellent prognosis with a >95% 10-year survival rate | Surgery | null | 101 | {
"Correct Answer": "Malignant goiter",
"Correct Option": "B",
"Options": {
"A": "Recurrence of lymphoma",
"B": "Malignant goiter",
"C": "Benign multinodular goiter",
"D": "Toxic nodular goiter"
},
"Question": "A 35-year old female presented with a swelling in the neck for the past 2 months, she had the treatment for Hodgkin’s lymphoma when she was 22 years with irradiation. On examination, her vitals were normal, there was a single, firm, irregular nodule, moving with deglutition in the left side of midline. Clinical examination also revealed a single node in the left side of the neck. The most likely clinical diagnosis of this condition is:"
} | A 35-year old female presented with a swelling in the neck for the past 2 months, she had the treatment for Hodgkin’s lymphoma when she was 22 years with irradiation. On examination, her vitals were normal, there was a single, firm, irregular nodule, moving with deglutition in the left side of midline. Clinical examination also revealed a single node in the left side of the neck. | The most likely clinical diagnosis of this condition is: | {
"A": "Recurrence of lymphoma",
"B": "Malignant goiter",
"C": "Benign multinodular goiter",
"D": "Toxic nodular goiter"
} | B. Malignant goiter |
87d5de73-0420-4492-a972-ccc77f43f211 | A 59-year-old woman with a 10-year history of type 2 diabetes mellitus is noted by her physician to have bilateral pitting edema of the ankles and feet. No erythema is noted. On questioning, the patient also repos shoness of breath on exeion and states that she has been using 3 pillows at night in order to sleep comfoably. A chest x-ray film demonstrates pulmonary venous congestion and interstitial edema indicative of pulmonary edema. Which of the following physiologic mechanisms is most likely the immediate cause of the pulmonary edema? | Damage to endothelial cells | Damage to the epithelial lining of the alveoli | Elevated pulmonary capillary pressure | Low serum albumin | 2c
| single | The cause of pulmonary edema in congestive hea failure is an increase in the hydrostatic pressure at the level of the capillaries of the lung. This increased pressure serves to drive fluid out of the capillaries and into the alveoli. The other reasons cited in the choices can also cause pulmonary edema, but occur in other clinical settings. Damage to endothelial cells can occur in vasculitis. Damage to the epithelial lining of the alveoli can occur in pneumonia and respiratory distress syndrome. Low serum albumin can be seen in liver and kidney disease. | Physiology | null | 123 | {
"Correct Answer": "Elevated pulmonary capillary pressure",
"Correct Option": "C",
"Options": {
"A": "Damage to endothelial cells",
"B": "Damage to the epithelial lining of the alveoli",
"C": "Elevated pulmonary capillary pressure",
"D": "Low serum albumin"
},
"Question": "A 59-year-old woman with a 10-year history of type 2 diabetes mellitus is noted by her physician to have bilateral pitting edema of the ankles and feet. No erythema is noted. On questioning, the patient also repos shoness of breath on exeion and states that she has been using 3 pillows at night in order to sleep comfoably. A chest x-ray film demonstrates pulmonary venous congestion and interstitial edema indicative of pulmonary edema. Which of the following physiologic mechanisms is most likely the immediate cause of the pulmonary edema?"
} | A 59-year-old woman with a 10-year history of type 2 diabetes mellitus is noted by her physician to have bilateral pitting edema of the ankles and feet. No erythema is noted. On questioning, the patient also repos shoness of breath on exeion and states that she has been using 3 pillows at night in order to sleep comfoably. A chest x-ray film demonstrates pulmonary venous congestion and interstitial edema indicative of pulmonary edema. | Which of the following physiologic mechanisms is most likely the immediate cause of the pulmonary edema? | {
"A": "Damage to endothelial cells",
"B": "Damage to the epithelial lining of the alveoli",
"C": "Elevated pulmonary capillary pressure",
"D": "Low serum albumin"
} | C. Elevated pulmonary capillary pressure |
170b773a-fc28-45e5-85d2-f150b3c74584 | A 24-year-old woman presents 6 months after the delivery of her first child, a healthy girl, for evaluation of fatigue. She suspects that the fatigue is related to getting up at night to breastfeed her baby, but she has also noticed cold intolerance and mild constipation. She recalls having a tremor and mild palpitations for a few weeks, beginning 3 months after delivery. On examination, her BP is 126/84 and her pulse rate is 56. The thyroid gland is two times normal in size and nontender. The rest of the physical examination is normal. Laboratory studies reveal a free T4 level of 0.7 ng/mL (normal 0.9-2.4) and an elevated thyroid-stimulating hormone (TSH) at 22 microU/mL (normal 0.4-4). What is the likely course of her illness? | Permanent hypothyroidism requiring lifelong replacement therapy | Eventual hyperthyroidism requiring methimazole therapy | Recovery with euthyroidism | Infertility | 2c
| multi | This patient has postpartum thyroiditis, a condition that follows 5% to 8% of all pregnancies. Like other forms of destructive thyroiditis (including subacute or de Quervain thyroiditis), this illness is triphasic. Initially there is hyperthyroidism due to inflammation and release of preformed thyroid hormone from the inflamed follicles; this phase usually lasts 2 to 4 weeks. In subacute thyroiditis, the initial phase is usually noticed because of pain and tenderness over the thyroid gland, but in postpartum thyroiditis the thyroid is usually painless, and the hyperthyroid phase may be overlooked. This phase is then followed by transient hypothyroidism, usually lasting 1 to 3 months. The third phase is resolution and euthyroidism. Whereas Hashimoto thyroiditis usually leads to permanent autoimmune hypothyroidism, most patients with destructive thyroiditis have a full recovery. Some will be symptomatic enough to require thyroid supplementation for 1 to 3 months until the process resolves. Although the initial hyperthyroid phase can suggest Graves' disease, in thyroiditis the absence of infiltrative ophthalmopathy and a suppressed radioiodine uptake will make the distinction.Antithyroid drug treatment of thyroiditis is ineffective and puts the patient at unnecessary risk of toxicity such as agranulocytosis. Although hypothyroidism can cause amenorrhea and hence impair fertility, the hypothyroid phase of postpartum thyroiditis is transient. Low-level radiation exposure, but not thyroiditis, increases the risk of subsequent development of thyroid cancer. Interestingly, therapeutic radioactive iodine, such as is given for Graves' disease, does not increase the long-term risk of cancer, probably because the thyroid cells are destroyed. | Medicine | Endocrinology | 189 | {
"Correct Answer": "Recovery with euthyroidism",
"Correct Option": "C",
"Options": {
"A": "Permanent hypothyroidism requiring lifelong replacement therapy",
"B": "Eventual hyperthyroidism requiring methimazole therapy",
"C": "Recovery with euthyroidism",
"D": "Infertility"
},
"Question": "A 24-year-old woman presents 6 months after the delivery of her first child, a healthy girl, for evaluation of fatigue. She suspects that the fatigue is related to getting up at night to breastfeed her baby, but she has also noticed cold intolerance and mild constipation. She recalls having a tremor and mild palpitations for a few weeks, beginning 3 months after delivery. On examination, her BP is 126/84 and her pulse rate is 56. The thyroid gland is two times normal in size and nontender. The rest of the physical examination is normal. Laboratory studies reveal a free T4 level of 0.7 ng/mL (normal 0.9-2.4) and an elevated thyroid-stimulating hormone (TSH) at 22 microU/mL (normal 0.4-4). What is the likely course of her illness?"
} | A 24-year-old woman presents 6 months after the delivery of her first child, a healthy girl, for evaluation of fatigue. She suspects that the fatigue is related to getting up at night to breastfeed her baby, but she has also noticed cold intolerance and mild constipation. She recalls having a tremor and mild palpitations for a few weeks, beginning 3 months after delivery. On examination, her BP is 126/84 and her pulse rate is 56. The thyroid gland is two times normal in size and nontender. The rest of the physical examination is normal. Laboratory studies reveal a free T4 level of 0.7 ng/mL (normal 0.9-2.4) and an elevated thyroid-stimulating hormone (TSH) at 22 microU/mL (normal 0.4-4). | What is the likely course of her illness? | {
"A": "Permanent hypothyroidism requiring lifelong replacement therapy",
"B": "Eventual hyperthyroidism requiring methimazole therapy",
"C": "Recovery with euthyroidism",
"D": "Infertility"
} | C. Recovery with euthyroidism |
1a75c37f-9a1a-4300-9899-ae1d1ea458b1 | A 13-year-old patient with sickle-cell anemia presents with respiratory distress; she has an infiltrate on chest radiograph. The laboratory workup of the patient reveals the following: hemoglobin 5 g/dL; hematocrit 16%; white blood cell count 30,000/mL; and arterial blood (room air) pH 7.1, PO2 35 mm Hg, and PaCO2 28 mm Hg. These values indicate which of the following? | Acidemia, metabolic acidosis, respiratory alkalosis, and hypoxia | Alkalemia, respiratory acidosis, metabolic alkalosis, and hypoxia | Acidosis with compensatory hypoventilation | Long-term metabolic compensation for respiratory alkalosis | 0a
| single | While some texts use the terms acidosis and acidemia interchangeably, there are subtle differences. The low pH in the arterial blood can be called acidemia; it is caused by a metabolic acidosis that is a direct result of poor perfusion and lactic acid produced by anaerobic metabolism in tissues with inadequate oxygen delivery. Inadequate oxygenation is caused by the low PO2 , the low oxygen-carrying capacity of the blood (Hgb 5 g/dL), and circulatory inadequacy due to the sickling itself and to the vascular disease it produces. The low PCO2 reflects the hyperventilation, which is secondary to the respiratory difficulty, and to the anemia, and is also respiratory compensation for the metabolic acidosis. Note that some texts distinguish the two terms by using acidemia to refer specifically to inborn errors of metabolism that lead to low serum pH. | Pediatrics | Respiratory System | 109 | {
"Correct Answer": "Acidemia, metabolic acidosis, respiratory alkalosis, and hypoxia",
"Correct Option": "A",
"Options": {
"A": "Acidemia, metabolic acidosis, respiratory alkalosis, and hypoxia",
"B": "Alkalemia, respiratory acidosis, metabolic alkalosis, and hypoxia",
"C": "Acidosis with compensatory hypoventilation",
"D": "Long-term metabolic compensation for respiratory alkalosis"
},
"Question": "A 13-year-old patient with sickle-cell anemia presents with respiratory distress; she has an infiltrate on chest radiograph. The laboratory workup of the patient reveals the following: hemoglobin 5 g/dL; hematocrit 16%; white blood cell count 30,000/mL; and arterial blood (room air) pH 7.1, PO2 35 mm Hg, and PaCO2 28 mm Hg. These values indicate which of the following?"
} | A 13-year-old patient with sickle-cell anemia presents with respiratory distress; she has an infiltrate on chest radiograph. The laboratory workup of the patient reveals the following: hemoglobin 5 g/dL; hematocrit 16%; white blood cell count 30,000/mL; and arterial blood (room air) pH 7.1, PO2 35 mm Hg, and PaCO2 28 mm Hg. | These values indicate which of the following? | {
"A": "Acidemia, metabolic acidosis, respiratory alkalosis, and hypoxia",
"B": "Alkalemia, respiratory acidosis, metabolic alkalosis, and hypoxia",
"C": "Acidosis with compensatory hypoventilation",
"D": "Long-term metabolic compensation for respiratory alkalosis"
} | A. Acidemia, metabolic acidosis, respiratory alkalosis, and hypoxia |
d1a88eca-e1f3-4286-b5f7-b0dbd1f76e4d | A 51-year-old man is seen in clinic because he feels chronically ill. Physical examination is notable for a palpable, nodular liver. Serum studies for hepatitis virus markers are positive for anti-HCV and negative for HbsAg and HBcAg. Core biopsy of the liver is performed to evaluate the extent of his disease, and demonstrates chronic hepatitis with severe activity and severe fibrosis. The patient is treated with interferon for 6 months, but fails to respond. His condition continues to deteriorate, and he is treated with ohotopic liver transplantation. One year after ohotopic liver transplantation, the man develops rising transaminase and bilirubin levels. In order to minimize chronic rejection injury to hepatic endothelial cells, immunosuppressive therapy should be aimed at downregulating which of the following components of the immune response? | Autoantibody production | Complement protein synthesis | HLA antigen expression | T-lymphocyte activity | 3d
| multi | We are presently undergoing a hidden epidemic of hepatitis C infection in this country. While many individuals may have very slowly progressive courses with good health for decades, some develop cirrhosis relatively earlier in their disease process. These individuals are increasingly becoming candidates for liver transplantation, although the number of available livers is far less than the number of people with end-stage hepatitis C infection who might use one. Hepatitis C can recur in the new liver, but often does not become a serious problem. Instead, chronic rejection turns out to more often limit the longevity of the transplant. Chronic rejection of any solid organ entails cellular injury to endothelial cells, resulting in intimal proliferation, fibrosis, and eventually, ischemic injury to the graft. Immunosuppressive therapy is directed at controlling lymphocyte activity and minimizing cellular rejection. Autoantibodies are not involved in organ transplant rejection. The antibodies produced are alloantibodies directed only to the graft, but not to the host. Complement proteins are involved in the humoral component of acute rejection, and complement binding to alloantibodies increases graft damage. Complement protein production, however, is not affected by immunosuppressive therapy. HLA antigen expression is central to recognition of foreign cells in grafted tissue. HLA antigens are expressed constitutively by all normal cells, and immunosuppression does not affect their production. | Microbiology | null | 176 | {
"Correct Answer": "T-lymphocyte activity",
"Correct Option": "D",
"Options": {
"A": "Autoantibody production",
"B": "Complement protein synthesis",
"C": "HLA antigen expression",
"D": "T-lymphocyte activity"
},
"Question": "A 51-year-old man is seen in clinic because he feels chronically ill. Physical examination is notable for a palpable, nodular liver. Serum studies for hepatitis virus markers are positive for anti-HCV and negative for HbsAg and HBcAg. Core biopsy of the liver is performed to evaluate the extent of his disease, and demonstrates chronic hepatitis with severe activity and severe fibrosis. The patient is treated with interferon for 6 months, but fails to respond. His condition continues to deteriorate, and he is treated with ohotopic liver transplantation. One year after ohotopic liver transplantation, the man develops rising transaminase and bilirubin levels. In order to minimize chronic rejection injury to hepatic endothelial cells, immunosuppressive therapy should be aimed at downregulating which of the following components of the immune response?"
} | A 51-year-old man is seen in clinic because he feels chronically ill. Physical examination is notable for a palpable, nodular liver. Serum studies for hepatitis virus markers are positive for anti-HCV and negative for HbsAg and HBcAg. Core biopsy of the liver is performed to evaluate the extent of his disease, and demonstrates chronic hepatitis with severe activity and severe fibrosis. The patient is treated with interferon for 6 months, but fails to respond. His condition continues to deteriorate, and he is treated with ohotopic liver transplantation. One year after ohotopic liver transplantation, the man develops rising transaminase and bilirubin levels. | In order to minimize chronic rejection injury to hepatic endothelial cells, immunosuppressive therapy should be aimed at downregulating which of the following components of the immune response? | {
"A": "Autoantibody production",
"B": "Complement protein synthesis",
"C": "HLA antigen expression",
"D": "T-lymphocyte activity"
} | D. T-lymphocyte activity |
29607896-137b-40e2-85b8-d6669c30aacb | A 60-year-old male, chronic smoker presented with gross hematuria, pain in the left flank along with significant history of weight loss, fever and shoness of breath for 3 months. O/E, a mass was palpated in the left flank which was firm in consistency and about 5x5 cm in dimensions along with a left sided varicocele was noted. Lab findings revealed anemia along with hypercalcemia. Kidney biopsy was also done. Chest X-ray CECT pelvis All of the following are approved for the above condition except: - | Sunitinib | Pazopanib | Temsirolimus | Nilotinib | 3d
| multi | Nilotinib is a tyrosine kinase inhibitor given in CML. This is a case of metastatic renal cell carcinoma with cannon ball metastasis in lungs. Chest x-ray shows multiple, bilateral, rounded soft tissue density massessuggestive of cannon ball metastasis in renal cell carcinoma. CT image shows the classical renal cell carcinoma. HPE image is classical of clear cell renal carcinoma. DRUGS APPROVED FOR RENAL CELL CARCINOMA: - Cytokines: - High dose interleukin-2, Interferon-alpha Tyrosine kinase inhibitors: - Sorafenib, Sunitinib, Pazopanib, Axitinib, Carbozantinib, Lenvatinib VEGF ligand antibody: - Bevacizumab mTOR inhibitors: - Temsirolimus, Everolimus PD-1 inhibitor: - Nivolumab | Unknown | Integrated QBank | 118 | {
"Correct Answer": "Nilotinib",
"Correct Option": "D",
"Options": {
"A": "Sunitinib",
"B": "Pazopanib",
"C": "Temsirolimus",
"D": "Nilotinib"
},
"Question": "A 60-year-old male, chronic smoker presented with gross hematuria, pain in the left flank along with significant history of weight loss, fever and shoness of breath for 3 months. O/E, a mass was palpated in the left flank which was firm in consistency and about 5x5 cm in dimensions along with a left sided varicocele was noted. Lab findings revealed anemia along with hypercalcemia. Kidney biopsy was also done. Chest X-ray CECT pelvis All of the following are approved for the above condition except: -"
} | A 60-year-old male, chronic smoker presented with gross hematuria, pain in the left flank along with significant history of weight loss, fever and shoness of breath for 3 months. O/E, a mass was palpated in the left flank which was firm in consistency and about 5x5 cm in dimensions along with a left sided varicocele was noted. Lab findings revealed anemia along with hypercalcemia. Kidney biopsy was also done. | Chest X-ray CECT pelvis All of the following are approved for the above condition except: - | {
"A": "Sunitinib",
"B": "Pazopanib",
"C": "Temsirolimus",
"D": "Nilotinib"
} | D. Nilotinib |
0593c2e0-741a-4350-a5ab-1a610056af6a | A 16-year-old girl has had frequent nosebleeds since childhood. Her gums bleed easily, even with routine tooth brushing. She has experienced menorrhagia since menarche at age 13 years. On physical examination, there are no abnormal findings. Laboratory studies show hemoglobin, 14.1 g/dL; hematocrit, 42.5%; MCV, 90 mm3; platelet count, 277,400/ mm3; and WBC count, 5920/ mm3. Her platelets fail to aggregate in response to ADP, collagen, epinephrine, and thrombin. The ristocetin agglutination test result is normal. There is a deficiency of glycoprotein IIb/IIIa. Prothrombin time is 12 seconds, and partial thromboplastin time is 28 seconds. What is the most likely diagnosis? | Disseminated intravascular coagulation | Glanzmann thrombasthenia | Immune thrombocytopenic purpura | Vitamin C deficiency | 1b
| single | Glanzmann thrombasthenia is a rare autosomal recessive disorder with defective platelet aggregation from deficiency or dysfunction of glycoprotein IIb/IIIa. The platelet aggregation studies described here are characteristic of this disorder. Disseminated intravascular coagulation results in the consumption of all coagulation factors and platelets, so the prothrombin time and partial thromboplastin time are elevated with thrombocytopenia. Immune thrombocytopenic purpura is caused by antibodies to platelet membrane glycoproteins IIb/IIIa or Ib/IX. Scurvy resulting from vitamin C deficiency causes bleeding into soft tissues and skin from increased capillary fragility, but platelet number and function are normal. Von Willebrand disease is one of the most common bleeding disorders and results from qualitative or quantitative defects in von Willebrand factor. | Pathology | Blood | 203 | {
"Correct Answer": "Glanzmann thrombasthenia",
"Correct Option": "B",
"Options": {
"A": "Disseminated intravascular coagulation",
"B": "Glanzmann thrombasthenia",
"C": "Immune thrombocytopenic purpura",
"D": "Vitamin C deficiency"
},
"Question": "A 16-year-old girl has had frequent nosebleeds since childhood. Her gums bleed easily, even with routine tooth brushing. She has experienced menorrhagia since menarche at age 13 years. On physical examination, there are no abnormal findings. Laboratory studies show hemoglobin, 14.1 g/dL; hematocrit, 42.5%; MCV, 90 mm3; platelet count, 277,400/ mm3; and WBC count, 5920/ mm3. Her platelets fail to aggregate in response to ADP, collagen, epinephrine, and thrombin. The ristocetin agglutination test result is normal. There is a deficiency of glycoprotein IIb/IIIa. Prothrombin time is 12 seconds, and partial thromboplastin time is 28 seconds. What is the most likely diagnosis?"
} | A 16-year-old girl has had frequent nosebleeds since childhood. Her gums bleed easily, even with routine tooth brushing. She has experienced menorrhagia since menarche at age 13 years. On physical examination, there are no abnormal findings. Laboratory studies show hemoglobin, 14.1 g/dL; hematocrit, 42.5%; MCV, 90 mm3; platelet count, 277,400/ mm3; and WBC count, 5920/ mm3. Her platelets fail to aggregate in response to ADP, collagen, epinephrine, and thrombin. The ristocetin agglutination test result is normal. There is a deficiency of glycoprotein IIb/IIIa. Prothrombin time is 12 seconds, and partial thromboplastin time is 28 seconds. | What is the most likely diagnosis? | {
"A": "Disseminated intravascular coagulation",
"B": "Glanzmann thrombasthenia",
"C": "Immune thrombocytopenic purpura",
"D": "Vitamin C deficiency"
} | B. Glanzmann thrombasthenia |
822c972a-37f2-4e93-8df1-c154ff2a9097 | A 28-year-old man presents to the clinic for evaluation of painful urination and cloudy-color penile discharge. The symptoms started 2 days ago and are not associated with any other symptoms. His past medical history is not significant and he is not on any medications.His physical examination is completely normal except for a purulent discharge that can be expressed from his penis. A swab of the fluid reveals Gram-negative diplococci within neutrophils. Which of the following is the most appropriate treatment? | intramuscular ceftriaxone plus oral doxycycline | oral penicillin G | intramuscular penicillin V | intramuscular ampicillin and oral penicillin V | 0a
| multi | This patient has gonorrhea, and since 1986, increasing penicillin resistance has meant that penicillin/ampicillin are no longer drugs of choice. Alternatives to ceftriaxone include ciprofloxacin, ofloxacin, or cefixime given orally, with 7 days of doxycycline, or a single 1 g dose of azithromycin in case of coinfection with Chlamydia. In Asia and the Pacific (as well as in California), quinolones are not considered first-line therapy because of the high rate of resistant organisms. In these locations, ceftriaxone is the drug of choice. In pregnant women, erythromycin replaces doxycycline. Disseminated gonococcal infection should be treated in a hospital with IV antibiotics. | Medicine | Infection | 104 | {
"Correct Answer": "intramuscular ceftriaxone plus oral doxycycline",
"Correct Option": "A",
"Options": {
"A": "intramuscular ceftriaxone plus oral doxycycline",
"B": "oral penicillin G",
"C": "intramuscular penicillin V",
"D": "intramuscular ampicillin and oral penicillin V"
},
"Question": "A 28-year-old man presents to the clinic for evaluation of painful urination and cloudy-color penile discharge. The symptoms started 2 days ago and are not associated with any other symptoms. His past medical history is not significant and he is not on any medications.His physical examination is completely normal except for a purulent discharge that can be expressed from his penis. A swab of the fluid reveals Gram-negative diplococci within neutrophils. Which of the following is the most appropriate treatment?"
} | A 28-year-old man presents to the clinic for evaluation of painful urination and cloudy-color penile discharge. The symptoms started 2 days ago and are not associated with any other symptoms. His past medical history is not significant and he is not on any medications.His physical examination is completely normal except for a purulent discharge that can be expressed from his penis. A swab of the fluid reveals Gram-negative diplococci within neutrophils. | Which of the following is the most appropriate treatment? | {
"A": "intramuscular ceftriaxone plus oral doxycycline",
"B": "oral penicillin G",
"C": "intramuscular penicillin V",
"D": "intramuscular ampicillin and oral penicillin V"
} | A. intramuscular ceftriaxone plus oral doxycycline |
a1cf2781-81d8-4dfc-ad24-ac9ce371363c | A 55-year-old female was admitted to ICU 8 days ago after suffering burns \ Currently she is febrile with 102 degree F. Blood cultures were obtained with following finding. The Doctor on duty is worried about a blood infection and plans to sta with empiric combination therapy containing aminoglycosides directed against Pseudomonas aeruginosa. Old usg record of the patient is shown below: The patient could not come for follow up due to lockdown. The doctor, currently is concerned about nephrotoxicity profile of the drugs. Which of the following drug is most safe? | Gentamycin | Tobramycin | Neomycin | NONE | 3d
| multi | Usg shows raised renal coical echogenecity suggestive of renal parenchymal disease and therefore should avoid aminoglycosides. All aminoglycosides have complication of being ototoxic and nephrotoxic. Ototoxicity and nephrotoxicity are more likely : when therapy is continued for > 5 days at higher doses Elderly renal insufficiency. Concurrent use with loop diuretics or other nephrotoxic antimicrobial agents (eg, vancomycin or amphotericin. Ototoxicity is most likely seen with: Neomycin Kanamycin amikacin vestibulotoxic agent- Streptomycin gentamicin nephrotoxic agents: Neomycin Tobramycin gentamicin | Anatomy | Integrated QBank | 127 | {
"Correct Answer": "NONE",
"Correct Option": "D",
"Options": {
"A": "Gentamycin",
"B": "Tobramycin",
"C": "Neomycin",
"D": "NONE"
},
"Question": "A 55-year-old female was admitted to ICU 8 days ago after suffering burns \\ Currently she is febrile with 102 degree F. Blood cultures were obtained with following finding. The Doctor on duty is worried about a blood infection and plans to sta with empiric combination therapy containing aminoglycosides directed against Pseudomonas aeruginosa. Old usg record of the patient is shown below: The patient could not come for follow up due to lockdown. The doctor, currently is concerned about nephrotoxicity profile of the drugs. Which of the following drug is most safe?"
} | A 55-year-old female was admitted to ICU 8 days ago after suffering burns \ Currently she is febrile with 102 degree F. Blood cultures were obtained with following finding. The Doctor on duty is worried about a blood infection and plans to sta with empiric combination therapy containing aminoglycosides directed against Pseudomonas aeruginosa. Old usg record of the patient is shown below: The patient could not come for follow up due to lockdown. The doctor, currently is concerned about nephrotoxicity profile of the drugs. | Which of the following drug is most safe? | {
"A": "Gentamycin",
"B": "Tobramycin",
"C": "Neomycin",
"D": "NONE"
} | D. NONE |
f30ec643-c2ae-45ef-82f1-008385b8ef83 | A truck driver was involved in a serious accident and received second and third degree burns over his body. He was placed in the burn unit and, on his twelfth day of his admission, developed a wound infection with a bluish-green exudate. Treatment with chloramphenicol and tetracycline was unsuccessful. A gram-negative, motile organism was isolated that was oxidase-positive, did not ferment lactose, sucrose, or glucose, but grew on MacConkey's agar and produced a fruity aroma on that medium. Which of the following organisms was most likely isolated? | Candida albicans | Clostridium perfringens | Escherichia coli | Pseudomonas aeruginosa | 3d
| single | Pseudomonas aeruginosa is a very common oppounist in burn patients, in whom it classically causes secondary wound infections and septicemia. It may also cause cystitis in patients with urinary catheters and pneumonia in patients with cystic fibrosis. The organism is found in water and usually gains access to the body this source, as a contaminant in the water used in respirators or in water baths, etc. used to cleanse wounds. This organism is a non-fermenter, that is, it does not metabolize sugars by classic pathways. It produces a blue-green, water-soluble pigment (pyocyanin), and has a fruity odor when growing on laboratory media. It has a propensity for developing antibiotic resistance; current therapy employs the synergistic combination of an aminoglycoside, such as amikacin, with a cell wall synthesis inhibitor (carbenicillin, ticarcillin, or piperacillin). Candida albicans is a normal flora yeast that will appear as very large, gram- positive, spherical-to-ovoid organisms with budding daughter cells in Gram-stained preparations. Candidiasis is an oppounistic infection in individuals with a compromised immune system. The fungus usually causes mucocutaneous lesions, but in severely compromised individuals like AIDS patients, systemic disease may occur. Oral candidiasis appears as creamy, white patches of exudate that can be scraped off an inflamed tongue or buccal mucosa. Clostridium perfringens is a gram-positive, spore-forming, anaerobic rod. It is a common cause of gas gangrene when it is introduced into a wound. The organism produces a variety of toxins and enzymes that enable it to destroy muscle tissue and spread through the soft tissues of the body. Escherichia coli is a lactose-fermenting, gram-negative rod commonly seen as normal flora of the intestine of man. It is the most common cause of pyelonephritis, and sepsis in patients with indwelling urinary catheters. It is also the major cause of traveler's diarrhea with watery stools and is a very impoant pathogen in neonates, who become infected during passage through the bih canal. Ref: Brooks G.F. (2013). Chapter 16. Pseudomonads, Acinetobacters, and Uncommon Gram-Negative Bacteria. In G.F. Brooks (Ed), Jawetz, Melnick, & Adelberg's Medical Microbiology, 26e. | Microbiology | null | 120 | {
"Correct Answer": "Pseudomonas aeruginosa",
"Correct Option": "D",
"Options": {
"A": "Candida albicans",
"B": "Clostridium perfringens",
"C": "Escherichia coli",
"D": "Pseudomonas aeruginosa"
},
"Question": "A truck driver was involved in a serious accident and received second and third degree burns over his body. He was placed in the burn unit and, on his twelfth day of his admission, developed a wound infection with a bluish-green exudate. Treatment with chloramphenicol and tetracycline was unsuccessful. A gram-negative, motile organism was isolated that was oxidase-positive, did not ferment lactose, sucrose, or glucose, but grew on MacConkey's agar and produced a fruity aroma on that medium. Which of the following organisms was most likely isolated?"
} | A truck driver was involved in a serious accident and received second and third degree burns over his body. He was placed in the burn unit and, on his twelfth day of his admission, developed a wound infection with a bluish-green exudate. Treatment with chloramphenicol and tetracycline was unsuccessful. A gram-negative, motile organism was isolated that was oxidase-positive, did not ferment lactose, sucrose, or glucose, but grew on MacConkey's agar and produced a fruity aroma on that medium. | Which of the following organisms was most likely isolated? | {
"A": "Candida albicans",
"B": "Clostridium perfringens",
"C": "Escherichia coli",
"D": "Pseudomonas aeruginosa"
} | D. Pseudomonas aeruginosa |
f87cfd7e-979e-470c-a1ec-efbfb7fbce2a | An outbreak of gastroenteritis occurred in a youth group camp. Water at the camp, which was not chlorinated or filtered, was obtained from a spring on the premises. The farmland near the camp was grazed by cattle and sheep. Run-off from the pasture entered the camp spring. The isolated microorganism required an atmosphere containing reduced oxygen and increased carbon dioxide for its growth. In most cases, the gastroenteritis was self-limiting. Those requiring antibiotic treatment responded to erythromycin. Which is the most likely causative agent? | Campylobacter jejuni | Enteroinvasive Escherichia coli (EIEC) | Enteropathogenic Escherichia coli (EPEC) | Vibrio cholerae | 0a
| single | Campylobacter jejuni may be part of the normal flora of different domesticated animals including poultry, sheep, and cattle. Surface waters and soil where animal graze may be contaminated with C. jejuni. Therefore, C. jejuni outbreaks, which are zoonotic, may result from the ingestion of contaminated water that has not been treated. The main symptoms of C. jejuni infection are gastroenteritis, abdominal pain, fever, and malaise. The symptoms often peak at 24 to 48 hours after onset or may last for 7 to 10 days. The disease is generally self-limited. Due to the susceptibility of Campylobacter to different antibiotics including macrolides, erythromycin is the drug of choice to treat severe enteritis caused by C. jejuni. Optimum growth of Campylobacter occurs under reduced oxygen and increased carbon dioxide (5%-10%). Infection with V. cholerae results in a massive watery diarrhea that progresses to severe dehydration and hypovolemic shock. Infection with V. parahaemolyticus is associated with explosive watery diarrhea, abdominal pain, and fever. The gastroenteritis is self-limited. V. parahaemolyticus is usually found in an estuarine and marine environment and is associated with ingestion of contaminated shellfish. Enteropathogenic and entero-invasive E. coli strains are major causes of diarrhea in underdeveloped countries. Both cause watery diarrhea and vomiting. E. coli grows rapidly under aerobic conditions. | Microbiology | Bacteria | 112 | {
"Correct Answer": "Campylobacter jejuni",
"Correct Option": "A",
"Options": {
"A": "Campylobacter jejuni",
"B": "Enteroinvasive Escherichia coli (EIEC)",
"C": "Enteropathogenic Escherichia coli (EPEC)",
"D": "Vibrio cholerae"
},
"Question": "An outbreak of gastroenteritis occurred in a youth group camp. Water at the camp, which was not chlorinated or filtered, was obtained from a spring on the premises. The farmland near the camp was grazed by cattle and sheep. Run-off from the pasture entered the camp spring. The isolated microorganism required an atmosphere containing reduced oxygen and increased carbon dioxide for its growth. In most cases, the gastroenteritis was self-limiting. Those requiring antibiotic treatment responded to erythromycin. Which is the most likely causative agent?"
} | An outbreak of gastroenteritis occurred in a youth group camp. Water at the camp, which was not chlorinated or filtered, was obtained from a spring on the premises. The farmland near the camp was grazed by cattle and sheep. Run-off from the pasture entered the camp spring. The isolated microorganism required an atmosphere containing reduced oxygen and increased carbon dioxide for its growth. In most cases, the gastroenteritis was self-limiting. Those requiring antibiotic treatment responded to erythromycin. | Which is the most likely causative agent? | {
"A": "Campylobacter jejuni",
"B": "Enteroinvasive Escherichia coli (EIEC)",
"C": "Enteropathogenic Escherichia coli (EPEC)",
"D": "Vibrio cholerae"
} | A. Campylobacter jejuni |
255b7237-0e9a-443a-88c7-f4780f79793b | A 40-year-old woman with a history of hyperparathyroidism presents with a 2-month history of burning epigastric pain. The pain can be relieved with antacids or food. The patient also repos a recent history of tarry stools. She denies taking aspirin or NSAIDs. Laboratory studies show a microcytic, hypochromic anemia . Gastroscopy reveals a bleeding mucosal defect in the antrum. Which of the following best characterizes the pathogenesis of epigastric pain in this patient? | Decreased Calcium resorption by renal tubules | Decreased serum levels of PTH | Gastric nonresponsiveness to PTH | Increased secretion of Gastrin | 3d
| single | - Given clinical features point towards Peptic ulcer disease, secondary to hyper-parathyroidism. - Incidence of peptic ulcer disease is increased in patients with hyperparathyroidism, because hypercalcemia increases serum gastrin, thereby stimulating gastric acid secretion. - None of the other choices are associated with gastric ulcers. - Peptic ulcers in context of MEN-1 may be secondary to Zollinger Ellison syndrome | Pathology | Parathyroids | 115 | {
"Correct Answer": "Increased secretion of Gastrin",
"Correct Option": "D",
"Options": {
"A": "Decreased Calcium resorption by renal tubules",
"B": "Decreased serum levels of PTH",
"C": "Gastric nonresponsiveness to PTH",
"D": "Increased secretion of Gastrin"
},
"Question": "A 40-year-old woman with a history of hyperparathyroidism presents with a 2-month history of burning epigastric pain. The pain can be relieved with antacids or food. The patient also repos a recent history of tarry stools. She denies taking aspirin or NSAIDs. Laboratory studies show a microcytic, hypochromic anemia . Gastroscopy reveals a bleeding mucosal defect in the antrum. Which of the following best characterizes the pathogenesis of epigastric pain in this patient?"
} | A 40-year-old woman with a history of hyperparathyroidism presents with a 2-month history of burning epigastric pain. The pain can be relieved with antacids or food. The patient also repos a recent history of tarry stools. She denies taking aspirin or NSAIDs. Laboratory studies show a microcytic, hypochromic anemia . Gastroscopy reveals a bleeding mucosal defect in the antrum. | Which of the following best characterizes the pathogenesis of epigastric pain in this patient? | {
"A": "Decreased Calcium resorption by renal tubules",
"B": "Decreased serum levels of PTH",
"C": "Gastric nonresponsiveness to PTH",
"D": "Increased secretion of Gastrin"
} | D. Increased secretion of Gastrin |
fa0dd81d-23af-4d69-b6f1-7bc3e810f025 | 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.
This infection is reported to have an increased incidence in | Diabetes mellitus | HIV | Tuberculosis | Syphilis | 1b
| multi | null | Dental | null | 119 | {
"Correct Answer": "HIV",
"Correct Option": "B",
"Options": {
"A": "Diabetes mellitus",
"B": "HIV",
"C": "Tuberculosis",
"D": "Syphilis"
},
"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\nThis infection is reported to have an increased incidence in"
} | 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.
This infection is reported to have an increased incidence in | {
"A": "Diabetes mellitus",
"B": "HIV",
"C": "Tuberculosis",
"D": "Syphilis"
} | B. HIV |
c8e7fee6-9962-4a21-a798-f06447cae74d | A 30-year-old man presents with coughing up blood and sputum. There is no associated dyspnea, fever, or pleuritic chest pain. His past medical history is significant for recurrent pneumonias and a chronic cough productive of foul-smelling purulent sputum. The sputum production is usually worse when lying down and in the morning. He quit smoking 5 years ago and started when he was 18 years old. On physical examination, he appears chronically ill with clubbing of the fingers. Wet inspiratory crackles are heard at the lung bases posteriorly. CXR shows scaring in the right lower lobe, which on chest CT scan is identified as airway dilatation, bronchial wall thickening, and grapelike cysts. Which of the following is the most likely diagnosis? (See Figure given below.) | bronchiectasis | chronic bronchitis | disseminated pulmonary tuberculosis | pulmonary neoplasm | 0a
| multi | Bronchiectasis is defined as a permanent abnormal dilatation of large bronchi due to destruction of the wall. It is a consequence of inflammation, usually an infection. Other causes include toxins or immune response. Persistent cough and purulent sputum production are the hallmark symptoms. | Medicine | Respiratory | 182 | {
"Correct Answer": "bronchiectasis",
"Correct Option": "A",
"Options": {
"A": "bronchiectasis",
"B": "chronic bronchitis",
"C": "disseminated pulmonary tuberculosis",
"D": "pulmonary neoplasm"
},
"Question": "A 30-year-old man presents with coughing up blood and sputum. There is no associated dyspnea, fever, or pleuritic chest pain. His past medical history is significant for recurrent pneumonias and a chronic cough productive of foul-smelling purulent sputum. The sputum production is usually worse when lying down and in the morning. He quit smoking 5 years ago and started when he was 18 years old. On physical examination, he appears chronically ill with clubbing of the fingers. Wet inspiratory crackles are heard at the lung bases posteriorly. CXR shows scaring in the right lower lobe, which on chest CT scan is identified as airway dilatation, bronchial wall thickening, and grapelike cysts. Which of the following is the most likely diagnosis? (See Figure given below.)"
} | A 30-year-old man presents with coughing up blood and sputum. There is no associated dyspnea, fever, or pleuritic chest pain. His past medical history is significant for recurrent pneumonias and a chronic cough productive of foul-smelling purulent sputum. The sputum production is usually worse when lying down and in the morning. He quit smoking 5 years ago and started when he was 18 years old. On physical examination, he appears chronically ill with clubbing of the fingers. Wet inspiratory crackles are heard at the lung bases posteriorly. CXR shows scaring in the right lower lobe, which on chest CT scan is identified as airway dilatation, bronchial wall thickening, and grapelike cysts. | Which of the following is the most likely diagnosis? (See Figure given below.) | {
"A": "bronchiectasis",
"B": "chronic bronchitis",
"C": "disseminated pulmonary tuberculosis",
"D": "pulmonary neoplasm"
} | A. bronchiectasis |
f78c9e61-90c9-4e1c-9fd6-018ce1162a28 | A 30-year-old man presents with coughing up blood and sputum. There is no associated dyspnea, fever, or pleuritic chest pain. His past medical history is significant for recurrent pneumonias and a chronic cough productive of foul-smelling purulent sputum. The sputum production is usually worse when lying down and in the morning. He quit smoking 5 years ago and started when he was 18 years old. On physical examination, he appears chronically ill with clubbing of the fingers. Wet inspiratory crackles are heard at the lung bases posteriorly. CXR shows scaring in the right lower lobe, which on chest CT scan is identified as airway dilatation, bronchial wall thickening, and grapelike cysts. Which of the following is the most likely diagnosis? | bronchiectasis | chronic bronchitis | disseminated pulmonary tuberculosis | pulmonary neoplasm | 0a
| multi | (a) Source: (Kasper, p. 1542) Bronchiectasis is defined as a permanent abnormal dilatation of large bronchi due to destruction of the wall. It is a consequence of inflammation, usually an infection. Other causes include toxins or immune response. Persistent cough and purulent sputum production are the hallmark symptoms. | Medicine | Respiratory | 176 | {
"Correct Answer": "bronchiectasis",
"Correct Option": "A",
"Options": {
"A": "bronchiectasis",
"B": "chronic bronchitis",
"C": "disseminated pulmonary tuberculosis",
"D": "pulmonary neoplasm"
},
"Question": "A 30-year-old man presents with coughing up blood and sputum. There is no associated dyspnea, fever, or pleuritic chest pain. His past medical history is significant for recurrent pneumonias and a chronic cough productive of foul-smelling purulent sputum. The sputum production is usually worse when lying down and in the morning. He quit smoking 5 years ago and started when he was 18 years old. On physical examination, he appears chronically ill with clubbing of the fingers. Wet inspiratory crackles are heard at the lung bases posteriorly. CXR shows scaring in the right lower lobe, which on chest CT scan is identified as airway dilatation, bronchial wall thickening, and grapelike cysts. Which of the following is the most likely diagnosis?"
} | A 30-year-old man presents with coughing up blood and sputum. There is no associated dyspnea, fever, or pleuritic chest pain. His past medical history is significant for recurrent pneumonias and a chronic cough productive of foul-smelling purulent sputum. The sputum production is usually worse when lying down and in the morning. He quit smoking 5 years ago and started when he was 18 years old. On physical examination, he appears chronically ill with clubbing of the fingers. Wet inspiratory crackles are heard at the lung bases posteriorly. CXR shows scaring in the right lower lobe, which on chest CT scan is identified as airway dilatation, bronchial wall thickening, and grapelike cysts. | Which of the following is the most likely diagnosis? | {
"A": "bronchiectasis",
"B": "chronic bronchitis",
"C": "disseminated pulmonary tuberculosis",
"D": "pulmonary neoplasm"
} | A. bronchiectasis |
6e042042-7998-40cb-8850-1c2b1062297a | An 18 year old male comes to the university clinic suppoed by his roommates because he cannot walk. He describes a rapidly evolving weakness affecting his legs and feet staing 2 days ago. On physical examination he cannot move his feet or ankles and he can barely raise his thighs off the bed. He has symmetrical hyporeflexia of the legs, but his sensorium is completely intact. Scanning his cha, the physician notes that he was treated 10 days previously for an upper respiratory tract infection. The immunological response producing the patient's symptoms is most intense at which of the following locations? | Lateral coicospinal tracts | Neuromuscular junction | Precentral gyrus | Spinal motor nerves | 3d
| single | The patient has developed Guillain-Barre syndrome, also known as inflammatory polyneuropathy. This presentation is classic-rapidly evolving limb weakness with symmetrical hyporeflexia but normal sensation. The syndrome frequently follows viral infections and may evolve into complete paralysis with respiratory failure. Guillain-Barre syndrome is thought to be an autoimmune disease. The clinical course is correlated with a chronic inflammatory infiltrate and demyelination of peripheral nerves, especially spinal and cranial motor nerve roots. Inflammation localized to a small poion of spinal cord (lateral coicospinal tracts) or cerebral coex (precentral gyrus) may occur in progressive multifocal leukoencephalopathy (PML) or in multiple sclerosis (MS). PML occurs in the immunosuppressed, and MS presents with hyperreflexia (upper motor neuron signs). The classic autoimmune disease involving the neuromuscular junction is myasthenia gravis. Although the weakness caused by myasthenia gravis may affect the legs, extraocular muscles are involved in the majority of cases, and isolated limb weakness is rare. Ref: Smith M.L., Bauman J.A., Grady M. (2010). Chapter 42. Neurosurgery. 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 | 127 | {
"Correct Answer": "Spinal motor nerves",
"Correct Option": "D",
"Options": {
"A": "Lateral coicospinal tracts",
"B": "Neuromuscular junction",
"C": "Precentral gyrus",
"D": "Spinal motor nerves"
},
"Question": "An 18 year old male comes to the university clinic suppoed by his roommates because he cannot walk. He describes a rapidly evolving weakness affecting his legs and feet staing 2 days ago. On physical examination he cannot move his feet or ankles and he can barely raise his thighs off the bed. He has symmetrical hyporeflexia of the legs, but his sensorium is completely intact. Scanning his cha, the physician notes that he was treated 10 days previously for an upper respiratory tract infection. The immunological response producing the patient's symptoms is most intense at which of the following locations?"
} | An 18 year old male comes to the university clinic suppoed by his roommates because he cannot walk. He describes a rapidly evolving weakness affecting his legs and feet staing 2 days ago. On physical examination he cannot move his feet or ankles and he can barely raise his thighs off the bed. He has symmetrical hyporeflexia of the legs, but his sensorium is completely intact. Scanning his cha, the physician notes that he was treated 10 days previously for an upper respiratory tract infection. | The immunological response producing the patient's symptoms is most intense at which of the following locations? | {
"A": "Lateral coicospinal tracts",
"B": "Neuromuscular junction",
"C": "Precentral gyrus",
"D": "Spinal motor nerves"
} | D. Spinal motor nerves |
7971bfb0-2fff-448c-aaa5-d3baf50c5e75 | A 55-year-old woman presents to her physician complaining of acute pain and redness in her right eye, with nausea and vomiting. She repos seeing halos around lights. On examination, lacrimation, lid edema, conjunctival injection, a steamy cornea, and a fixed mid-dilated pupil are seen. She has markedly elevated intraocular pressure (IOP), and a visual acuity of 20/200 in her right eye. She has no family history of eye diseases. Which of the following is the most likely diagnosis? | Acute closed-angle glaucoma | Corneal laceration | Ocular hypeension without glaucoma | Open angle glaucoma | 0a
| single | This patient has acute closed-angle glaucoma, as evidenced by the pain and redness of her eye, the steamy cornea, her description of halos around lights, and her markedly elevated intraocular pressure. The fixed mid-dilated pupil indicates ischemia to the iris. Unlike open angle glaucoma, closed-angle glaucoma (also called narrow-angle or angle-closure glaucoma) is a medical emergency, and requires immediate diagnosis and treatment to prevent permanent visual impairment. The anterior and posterior chambers of the eye are filled with aqueous humor, which flows from the posterior chamber, through the pupil, into the anterior chamber, into the trabecular network, and then exits the eye the canal of Schlemm. Individuals with a shallow or narrow anterior chamber or thickened lens may be predisposed to this type of glaucoma because their iris is in close opposition to the chamber angle and cornea (narrow angle). If the aqueous humor is produced at a greater rate than it can be drained, intraocular pressure rises. Any stimulus that causes pupillary dilation (e.g., anticholinergic medications, sympathomimetics, emotional upset, dim lighting) can precipitate an attack. The cornea may look hazy because of edema, but corneal laceration is produced by trauma. There is no history of trauma in this patient and the symptoms exhibited by this patient strongly suggest acute closed-angle glaucoma. Intraocular hypeension is a condition in which IOP is higher than normal (greater than 21 mm Hg), but there is no damage to the optic nerve or visual loss. About 90% of people with elevated IOP never develop glaucoma. There is no associated pain or visual symptoms associated with this. Known as the "sneak thief of sight," open-angle glaucoma has no early warning signs or symptoms, and accounts for 90% of all glaucoma cases. It is a slow progressive condition, usually affecting both eyes, in which there is an increase in resistance to the outflow of aqueous humor. This resistance is associated with a normal rate of production of the fluid and normal anterior chamber angle. Elevated IOP is the most common finding and age-related changes in the trabecular region are the most likely explanation of this disease. | Ophthalmology | null | 117 | {
"Correct Answer": "Acute closed-angle glaucoma",
"Correct Option": "A",
"Options": {
"A": "Acute closed-angle glaucoma",
"B": "Corneal laceration",
"C": "Ocular hypeension without glaucoma",
"D": "Open angle glaucoma"
},
"Question": "A 55-year-old woman presents to her physician complaining of acute pain and redness in her right eye, with nausea and vomiting. She repos seeing halos around lights. On examination, lacrimation, lid edema, conjunctival injection, a steamy cornea, and a fixed mid-dilated pupil are seen. She has markedly elevated intraocular pressure (IOP), and a visual acuity of 20/200 in her right eye. She has no family history of eye diseases. Which of the following is the most likely diagnosis?"
} | A 55-year-old woman presents to her physician complaining of acute pain and redness in her right eye, with nausea and vomiting. She repos seeing halos around lights. On examination, lacrimation, lid edema, conjunctival injection, a steamy cornea, and a fixed mid-dilated pupil are seen. She has markedly elevated intraocular pressure (IOP), and a visual acuity of 20/200 in her right eye. She has no family history of eye diseases. | Which of the following is the most likely diagnosis? | {
"A": "Acute closed-angle glaucoma",
"B": "Corneal laceration",
"C": "Ocular hypeension without glaucoma",
"D": "Open angle glaucoma"
} | A. Acute closed-angle glaucoma |
8461818f-b58a-46e4-b381-5ad6890a9434 | A 26 years old female at 39 weeks gestation presents with gush of fluid and regular contractions. On examination, she is grossly ruptured, contraction every two minutes and a cervical dilatation of 4 cms. The fetal heart rate is 140/min and reactive. She was admitted for labor and delivery. Over the next four hours, the cervical dilatation progressed to 9 cms. In the past hour, the fetal heart rate increased from the baseline of 140/min to 160/min. There is moderate to severe variable decelerations are seen with each contraction. The fetal heart rate does not responds to scalp stimulation. It was decided to proceed for caesarean section. The most important reason for the decision is | Fetal distress | Fetal acidemia | Fetal hypoxic encephalopathy | Non reassuring fetal heart rate tracing | 3d
| single | Answer: d) Non reassuring fetal heart rate tracingCardio toco graphy-Continuous electric fetal monitoring:CharacterNormalBaseline FHR110-150bpmBaseline variability5-25bpmAcceleration2 in 20 minDecelerationNone or earlyBaseline FHR is the mean level of FHR between the peaks and the depressions in beats per minute (bpm).Baseline variability is the oscillation of baseline FHR excluding the accelerations and decelerations. A base line variability of 5-25 bpm is a sign of fetal wellbeing.Accelerations are increased in FHR by 15 bpm or more lasting for at least 15 secs. Denotes healthy fetus.Deceleration is decrease in FHR below the baseline by 15 bpm or more. Three basic types of deceleration are observed:Early decelerationLate decelerationVariable decelerationType-1 dips.Due to headcompression.Type-ll dips.Due to utero-placentalinsufficiency and fetal hypoxiaIndicates cord compression and may disappear with the change in position of the patient.Pneumonic: (VEAL-CHOP)V- variable decelerationsC- cord compression/ prolapseE- early decelerationsH- Head compressionA- AccelerationsO-OKL- late acceelrationsP-Placental insuffiencyWith each uterine contraction, blood flow to the placenta decreases, and the fetus is exposed to transient hypoxia.As the labor progresses and more and more contractions occur, this hypoxia can eventually lead to a change from aerobic to anaerobic metabolism- fetal acidemia.However, the fetus has a variety of protective mechanisms, including a blood buffering system and the diving reflex (a lowering of the heart rate in times of hypoxic stress), to protect it from becoming dangerously acidemic.Electronic fetal monitoring is not a very specific tool for identifying fetal acidemia.Many fetuses with a non-reassuring fetal heart rate tracing do not have acidemia and are not in distress.However, it can be very difficult to distinguish non-acidemic fetuses with non-reassuring fetal heart rate tracings from acidemic fetuses with non-reassuring fetal heart rate tracings.Thus, the delivery of many fetuses is expedited because of the concern for fetal acidemia when, in fact, the fetus is not acidemic at all.Thus, it is most accurate to state, as is in this case, that the fetus was delivered because of the non-reassuring fetal heart rate tracing.Fetal acidemia is not the reason for delivery. In fact, there is a strong likelihood that this fetus is not acidemic at all.Fetal distress is not the reason for delivery. There is a strong likelihood that this fetus is perfectly healthy and will have high neonatal APGAR scores and no distress at all.Fetal hypoxic encephalopathy is not the reason for delivery. The desire to prevent hypoxic/acidemic damage to organs, including the brain, is the reason for expediting delivery.However, the non-reassuring fetal tracing does not indicate that hypoxic encephalopathy is necessarily occurring.Low neonatal APGAR scores can be a marker of fetal acidemia.However, many fetuses with non-reassuring fetal heart rate tracings do not have low neonatal APGAR scores. | Gynaecology & Obstetrics | Miscellaneous (Gynae) | 161 | {
"Correct Answer": "Non reassuring fetal heart rate tracing",
"Correct Option": "D",
"Options": {
"A": "Fetal distress",
"B": "Fetal acidemia",
"C": "Fetal hypoxic encephalopathy",
"D": "Non reassuring fetal heart rate tracing"
},
"Question": "A 26 years old female at 39 weeks gestation presents with gush of fluid and regular contractions. On examination, she is grossly ruptured, contraction every two minutes and a cervical dilatation of 4 cms. The fetal heart rate is 140/min and reactive. She was admitted for labor and delivery. Over the next four hours, the cervical dilatation progressed to 9 cms. In the past hour, the fetal heart rate increased from the baseline of 140/min to 160/min. There is moderate to severe variable decelerations are seen with each contraction. The fetal heart rate does not responds to scalp stimulation. It was decided to proceed for caesarean section. The most important reason for the decision is"
} | A 26 years old female at 39 weeks gestation presents with gush of fluid and regular contractions. On examination, she is grossly ruptured, contraction every two minutes and a cervical dilatation of 4 cms. The fetal heart rate is 140/min and reactive. She was admitted for labor and delivery. Over the next four hours, the cervical dilatation progressed to 9 cms. In the past hour, the fetal heart rate increased from the baseline of 140/min to 160/min. There is moderate to severe variable decelerations are seen with each contraction. The fetal heart rate does not responds to scalp stimulation. It was decided to proceed for caesarean section. | The most important reason for the decision is | {
"A": "Fetal distress",
"B": "Fetal acidemia",
"C": "Fetal hypoxic encephalopathy",
"D": "Non reassuring fetal heart rate tracing"
} | D. Non reassuring fetal heart rate tracing |
a396c72e-15a5-4825-80b9-11149bf76bd8 | A 50-year-old man presents to the emergency in a wheelchair complaining of weakness that has developed over the past 2 days. He first noticed that he had generalized fatigue and felt like he was having a hard time moving his feet. Over the past 24 hours, the weakness has progressed to the point that he can barely stand with assistance. He is beginning to feel that it is difficult to lift his arms. He also complains of a sharp pain in his shoulders and along his spine. Both his hands and feet are tingling. On physical examination, his initial blood pressure is 140/80 mmHg. On repeat 1 hour later, it is 90/50 mmHg. His hea rate is 106 bpm, respiratory rate is 25 breaths/min, temperature is 37.0degC, and SaO2 is 96% on room air. Deep tendon reflexes are absent at the knee, ankle, and wrist. The brachioradialis reflex is 1+. Strength throughout the lower extremities is diminished as the patient is unable to lift either leg against gravity. What is the appropriate diagnosis? | Botulinism | G.B.S | Snake bite | Polio | 1b
| multi | Choice A is ruled out as it presents with descending paralysis. Snake bite will have autonomic features and is unlikely that patient does not feel the pain Polio is ruled out as it has descending paralysis. Ascending paralysis, areflexia and sphincter sparing is feature of GBS GBS 1. Lumbar puncture analysis CSF opening pressure - Normal Cells - Normal Sugar - Normal Color- Normal Protein- Raised Albumino - cytological dissociation(Also seen in Froin's loculation Syndrome) 2. Nerve conduction velocity - F - Reflex - Latency period|3. MRI spine - Demyelination4. Antibody of G.B.S : Anti GM1 A/b Rx- I.V Immunoglobulin's - DOCPlasmapheresis - Efficacy of IV Ig & plasmapheresis is equal. | Medicine | Guillian Barre syndrome & Alzheimer's disease | 245 | {
"Correct Answer": "G.B.S",
"Correct Option": "B",
"Options": {
"A": "Botulinism",
"B": "G.B.S",
"C": "Snake bite",
"D": "Polio"
},
"Question": "A 50-year-old man presents to the emergency in a wheelchair complaining of weakness that has developed over the past 2 days. He first noticed that he had generalized fatigue and felt like he was having a hard time moving his feet. Over the past 24 hours, the weakness has progressed to the point that he can barely stand with assistance. He is beginning to feel that it is difficult to lift his arms. He also complains of a sharp pain in his shoulders and along his spine. Both his hands and feet are tingling. On physical examination, his initial blood pressure is 140/80 mmHg. On repeat 1 hour later, it is 90/50 mmHg. His hea rate is 106 bpm, respiratory rate is 25 breaths/min, temperature is 37.0degC, and SaO2 is 96% on room air. Deep tendon reflexes are absent at the knee, ankle, and wrist. The brachioradialis reflex is 1+. Strength throughout the lower extremities is diminished as the patient is unable to lift either leg against gravity. What is the appropriate diagnosis?"
} | A 50-year-old man presents to the emergency in a wheelchair complaining of weakness that has developed over the past 2 days. He first noticed that he had generalized fatigue and felt like he was having a hard time moving his feet. Over the past 24 hours, the weakness has progressed to the point that he can barely stand with assistance. He is beginning to feel that it is difficult to lift his arms. He also complains of a sharp pain in his shoulders and along his spine. Both his hands and feet are tingling. On physical examination, his initial blood pressure is 140/80 mmHg. On repeat 1 hour later, it is 90/50 mmHg. His hea rate is 106 bpm, respiratory rate is 25 breaths/min, temperature is 37.0degC, and SaO2 is 96% on room air. Deep tendon reflexes are absent at the knee, ankle, and wrist. The brachioradialis reflex is 1+. Strength throughout the lower extremities is diminished as the patient is unable to lift either leg against gravity. | What is the appropriate diagnosis? | {
"A": "Botulinism",
"B": "G.B.S",
"C": "Snake bite",
"D": "Polio"
} | B. G.B.S |
a0d533fe-bf7b-4bc6-b4f3-55409479f22b | A 24-year-old man presents in septic shock from an empyema. He is febrile to 103degF, tachycardic in the 120s, and hypotensive to the 90s. His oxygen saturation is 98% on 2-L oxygen. His white blood cell count is 25,000/mL and creatinine is 0.8 mg/dL. His blood pressure does not respond to fluid administration despite a CVP of 15. Which of the following therapies is indicated in managing this patient? | Intubation | Recombinant human activated protein C | Epinephrine | Norepinephrine | 3d
| single | ) Early goal-directed therapy should be employed for patients with septic shock or severe sepsis. The tenets of resuscitation include intubation if hypoxic, fluid resuscitation to a central venous pressure target of 8 to 12 mm Hg if not intubated and infusion of vasopressors to maintain a mean aerial pressure of 65 mm Hg. Norepinephrine and dopamine are the vasopressors of choice; epinephrine vasoconstricts peripherally as well as increases cardiac contractility and is not a first-line agent for septic shock. Inotropes such as dobutamine have been used if oxygen delivery is low, but should not be used to push delivery to supranormal levels. Fuhermore, cultures should be drawn immediately and empiric antibiotics initiated; if there is a surgical source of sepsis, then operative intervention for source control should be promptly performed after initial resuscitative effos. Recombinant-activated protein C is indicated in patients with severe sepsis with a predicted high risk of moality (ie, older age, increased severity of disease); this patient does not have evidence of end-organ dysfunction such as acute renal or respiratory failure at this time. The use of coicosteroids for septic shock is controversial, but should only be considered in the setting of shock nonresponsive to fluids and vasopressors. Miller&;s anaesthesia 9th edition page no 786 | Anaesthesia | Miscellaneous | 126 | {
"Correct Answer": "Norepinephrine",
"Correct Option": "D",
"Options": {
"A": "Intubation",
"B": "Recombinant human activated protein C",
"C": "Epinephrine",
"D": "Norepinephrine"
},
"Question": "A 24-year-old man presents in septic shock from an empyema. He is febrile to 103degF, tachycardic in the 120s, and hypotensive to the 90s. His oxygen saturation is 98% on 2-L oxygen. His white blood cell count is 25,000/mL and creatinine is 0.8 mg/dL. His blood pressure does not respond to fluid administration despite a CVP of 15. Which of the following therapies is indicated in managing this patient?"
} | A 24-year-old man presents in septic shock from an empyema. He is febrile to 103degF, tachycardic in the 120s, and hypotensive to the 90s. His oxygen saturation is 98% on 2-L oxygen. His white blood cell count is 25,000/mL and creatinine is 0.8 mg/dL. His blood pressure does not respond to fluid administration despite a CVP of 15. | Which of the following therapies is indicated in managing this patient? | {
"A": "Intubation",
"B": "Recombinant human activated protein C",
"C": "Epinephrine",
"D": "Norepinephrine"
} | D. Norepinephrine |
6af77266-6814-49b8-bfd4-a12924e7e95b | An 18-year-old woman has eaten homemade preserves. Eighteen hours later, she develops diplopia, dysarthria, and dysphagia. She presents to the emergency room for assessment and on examination her blood pressure is 112/74 mmHg, heart rate 110/min, and respirations 20/min. The pertinent findings are abnormal extraocular movements due to cranial nerve palsies, difficulty swallowing and a change in her voice. The strength in her arms is 4/5 and 5/5 in her legs, and the reflexes are normal. Which of the following is the most likely causative organism? | Clostridium botulinum toxin | staphylococcal toxin | salmonellosis | brucellosis | 0a
| multi | The incubation period of C botulinum toxin is 18-36 hours but ranges from a few hours to days. There are no sensory symptoms. Foodborne botulinum is associated primarily with home- canned food. Severe foodborne botulinum can produce diplopia, dysarthria, and dysphagia; weakness then can progress rapidly to involve the neck, arms, thorax, and legs. There is usually no fever. Nausea, vomiting, and abdominal pain can precede the paralysis or come afterward. | Medicine | Infection | 139 | {
"Correct Answer": "Clostridium botulinum toxin",
"Correct Option": "A",
"Options": {
"A": "Clostridium botulinum toxin",
"B": "staphylococcal toxin",
"C": "salmonellosis",
"D": "brucellosis"
},
"Question": "An 18-year-old woman has eaten homemade preserves. Eighteen hours later, she develops diplopia, dysarthria, and dysphagia. She presents to the emergency room for assessment and on examination her blood pressure is 112/74 mmHg, heart rate 110/min, and respirations 20/min. The pertinent findings are abnormal extraocular movements due to cranial nerve palsies, difficulty swallowing and a change in her voice. The strength in her arms is 4/5 and 5/5 in her legs, and the reflexes are normal. Which of the following is the most likely causative organism?"
} | An 18-year-old woman has eaten homemade preserves. Eighteen hours later, she develops diplopia, dysarthria, and dysphagia. She presents to the emergency room for assessment and on examination her blood pressure is 112/74 mmHg, heart rate 110/min, and respirations 20/min. The pertinent findings are abnormal extraocular movements due to cranial nerve palsies, difficulty swallowing and a change in her voice. The strength in her arms is 4/5 and 5/5 in her legs, and the reflexes are normal. | Which of the following is the most likely causative organism? | {
"A": "Clostridium botulinum toxin",
"B": "staphylococcal toxin",
"C": "salmonellosis",
"D": "brucellosis"
} | A. Clostridium botulinum toxin |
541e9293-a6fb-4d63-b4e0-88afeba4843a | 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 onset of seeing snakes all around him in the room, not recognizing family members, violent behaviour 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? | Delirium tremens | Alcoholic hallucinosis | Korsakoff's psychosis | Wernicke encephalopathy | 0a
| multi | The patient in the question is a chronic alcoholic who has not taken alcohol since 2 days. His symptoms and findings on physical examination are most suggestive of delerium tremens. Delirium tremens is the most severe alcohol withdrawal syndrome. It typically appears after 3-4 days of abstinence from alcohol (24 hours to 7 days). Features of delirium tremens includes: presence of visual hallucinations, loss of orientation as to time and place, tremors and agitation, excess motor activity and features of autonomic nervous system hyperactivity. Ref: Current Diagnosis and Treatment Emergency Medicine, 7th edition, Chapter 37; Current Diagnosis and Treatment: Psychiatry, 2nd edition, Chapter 14 | Psychiatry | null | 112 | {
"Correct Answer": "Delirium tremens",
"Correct Option": "A",
"Options": {
"A": "Delirium tremens",
"B": "Alcoholic hallucinosis",
"C": "Korsakoff's psychosis",
"D": "Wernicke encephalopathy"
},
"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 onset of seeing snakes all around him in the room, not recognizing family members, violent behaviour 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 onset of seeing snakes all around him in the room, not recognizing family members, violent behaviour 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": "Delirium tremens",
"B": "Alcoholic hallucinosis",
"C": "Korsakoff's psychosis",
"D": "Wernicke encephalopathy"
} | A. Delirium tremens |
8999fda7-cfa0-4158-aad4-83785a29d812 | A neonate weighing 1.3 kg is born at 32 weeks' gestation and was transferred to the nursery for prematurity. After 1 hr the nurse repos the infant is tachypnoeic with hea rate 150 bpm, respiratory rate 76/min, temperature 95degF and oxygen saturation of 98%. The lungs are clear with bilateral breath sounds and there is no murmur and x-ray chest is normal. Which of the following is the next step in management of the neonate? | Administer intravenously 5ml of D50. | Obtain a complete blood count and differential | Perform a lumbar puncture | Place the infant under a warmer | 3d
| multi | Clinical description s/o hypothermia in neonate. A room temperature of 24degC provides a cold environment for newborn infants. At bih, infants (especially preterm) are wet, have a relatively large surface area for their weight, and have little subcutaneous fat. Within minutes of delivery, the infants are likely to become pale or blue and their body temperature drops. A preterm infant is likely to have respiratory distress and unable to oxygenate properly, lactate can accumulate and lead to a metabolic acidosis. Infants rarely shiver in response to a need to increase heat production. Therefore, to prevent infant from hypothermia, Place the infant under a warmer. If the tachypnea persists after warming the infant, sepsis, pneumonia, and primarysurfactant deficiency are all possible. | Pediatrics | Neonatal hypothermia | 113 | {
"Correct Answer": "Place the infant under a warmer",
"Correct Option": "D",
"Options": {
"A": "Administer intravenously 5ml of D50.",
"B": "Obtain a complete blood count and differential",
"C": "Perform a lumbar puncture",
"D": "Place the infant under a warmer"
},
"Question": "A neonate weighing 1.3 kg is born at 32 weeks' gestation and was transferred to the nursery for prematurity. After 1 hr the nurse repos the infant is tachypnoeic with hea rate 150 bpm, respiratory rate 76/min, temperature 95degF and oxygen saturation of 98%. The lungs are clear with bilateral breath sounds and there is no murmur and x-ray chest is normal. Which of the following is the next step in management of the neonate?"
} | A neonate weighing 1.3 kg is born at 32 weeks' gestation and was transferred to the nursery for prematurity. After 1 hr the nurse repos the infant is tachypnoeic with hea rate 150 bpm, respiratory rate 76/min, temperature 95degF and oxygen saturation of 98%. The lungs are clear with bilateral breath sounds and there is no murmur and x-ray chest is normal. | Which of the following is the next step in management of the neonate? | {
"A": "Administer intravenously 5ml of D50.",
"B": "Obtain a complete blood count and differential",
"C": "Perform a lumbar puncture",
"D": "Place the infant under a warmer"
} | D. Place the infant under a warmer |
4d4bae21-73e4-4b1b-9699-872b9fca19c8 | A person is consuming alcohol since 10 years is brought to hospital emergency with complains of fearfulness, misrecognition, self talking and seeing snakes and reptiles all around him. Physical dependence is present since last 2 years. He has an intense craving for alcohol and from last 1 year, he is having behavioural changes and experiencing different family and social issue. Sometimes he is said to have few tremors during night. The person is suffering from: March 2013 (b, d, f) | Alcoholic psychosis | Delirium tremens | Wernicke's Korsakoff syndrome | Schizophrenia | 1b
| multi | Ans. B i.e. Delirium tremens | Psychiatry | null | 106 | {
"Correct Answer": "Delirium tremens",
"Correct Option": "B",
"Options": {
"A": "Alcoholic psychosis",
"B": "Delirium tremens",
"C": "Wernicke's Korsakoff syndrome",
"D": "Schizophrenia"
},
"Question": "A person is consuming alcohol since 10 years is brought to hospital emergency with complains of fearfulness, misrecognition, self talking and seeing snakes and reptiles all around him. Physical dependence is present since last 2 years. He has an intense craving for alcohol and from last 1 year, he is having behavioural changes and experiencing different family and social issue. Sometimes he is said to have few tremors during night. The person is suffering from: March 2013 (b, d, f)"
} | A person is consuming alcohol since 10 years is brought to hospital emergency with complains of fearfulness, misrecognition, self talking and seeing snakes and reptiles all around him. Physical dependence is present since last 2 years. He has an intense craving for alcohol and from last 1 year, he is having behavioural changes and experiencing different family and social issue. Sometimes he is said to have few tremors during night. | The person is suffering from: March 2013 (b, d, f) | {
"A": "Alcoholic psychosis",
"B": "Delirium tremens",
"C": "Wernicke's Korsakoff syndrome",
"D": "Schizophrenia"
} | B. Delirium tremens |
a3ce0f33-c761-411d-b548-f889e3b9c30e | A 43-year-old woman develops acute renal failure following an emergency resection of a leaking abdominal aoic aneurysm. One week after surgery, the following laboratory values are obtained: Serum electrolytes (mEq/L): Na + 127, K+ 5.9, Cl - 92, HCO3 - 15 Blood urea nitrogen: 82 mg/dL Serum creatinine: 6.7 mg/dL The patient has gained 4 kg since surgery and is mildly dyspneic at rest. Eight hours after these values are repoed, the following electrocardiogram is obtained. Which of the following is the most appropriate initial treatment in the management of this patient? | 10 mL of 10% calcium gluconate | 0.25 mg digoxin every 3 hours for 3 doses | 100 mg lidocaine | Emergent hemodialysis | 0a
| single | The electrocardiogram demonstrates changes that are essentially diagnostic of severe hyperkalemia. Correct treatment for the affected patient includes discontinuation of exogenous sources of potassium, administration of a source of calcium ions (which will immediately oppose the myocardial effects of potassium), and administration of sodium bicarbonate (which, by producing a mild alkalosis, will shift potassium into cells); each will temporarily reduce serum potassium concentration. Infusion of glucose and insulin would also effect a temporary transcellular shift of potassium. However, these maneuvers are only temporarily effective; definitive treatment calls for removal of potassium from the body. The sodium-potassium exchange resin sodium polystyrene sulfonate (Kayexalate) would accomplish this removal, but over a period of hours and at the price of adding a sodium ion for each potassium ion that is removed. Hemodialysis or peritoneal dialysis is probably required for this patient, since these procedures also rectify the other consequences of acute renal failure, but they would not be the first line of therapy, given the acute need to reduce the potassium level. Both lidocaine and digoxin would be not only ineffective but contraindicated, since they would fuher depress the myocardial conduction system. | Anaesthesia | Preoperative assessment and monitoring in anaesthesia | 151 | {
"Correct Answer": "10 mL of 10% calcium gluconate",
"Correct Option": "A",
"Options": {
"A": "10 mL of 10% calcium gluconate",
"B": "0.25 mg digoxin every 3 hours for 3 doses",
"C": "100 mg lidocaine",
"D": "Emergent hemodialysis"
},
"Question": "A 43-year-old woman develops acute renal failure following an emergency resection of a leaking abdominal aoic aneurysm. One week after surgery, the following laboratory values are obtained: Serum electrolytes (mEq/L): Na + 127, K+ 5.9, Cl - 92, HCO3 - 15 Blood urea nitrogen: 82 mg/dL Serum creatinine: 6.7 mg/dL The patient has gained 4 kg since surgery and is mildly dyspneic at rest. Eight hours after these values are repoed, the following electrocardiogram is obtained. Which of the following is the most appropriate initial treatment in the management of this patient?"
} | A 43-year-old woman develops acute renal failure following an emergency resection of a leaking abdominal aoic aneurysm. One week after surgery, the following laboratory values are obtained: Serum electrolytes (mEq/L): Na + 127, K+ 5.9, Cl - 92, HCO3 - 15 Blood urea nitrogen: 82 mg/dL Serum creatinine: 6.7 mg/dL The patient has gained 4 kg since surgery and is mildly dyspneic at rest. Eight hours after these values are repoed, the following electrocardiogram is obtained. | Which of the following is the most appropriate initial treatment in the management of this patient? | {
"A": "10 mL of 10% calcium gluconate",
"B": "0.25 mg digoxin every 3 hours for 3 doses",
"C": "100 mg lidocaine",
"D": "Emergent hemodialysis"
} | A. 10 mL of 10% calcium gluconate |
64cad0d4-0f67-45ec-b6f3-1777d5091a69 | A 45-year-old male, Sonu presented to OPD with severe pain in the knee and shoulder joint. On examination and further investigations, a diagnosis of rheumatoid arthritis was made and the patient was started on methotrexate 15mg weekly. However, even after 6 months of using methotrexate, recurrent episodes of arthritis continued. The physician wanted to add another DMARD that inhibit the pyrimidine synthesis by inhibiting dihydroorotate dehydrogenase enzyme. Which of the following drug, the physician is thinking about? | Sulfasalazine | Infliximab | Leflunomide | Abatacept | 2c
| single | null | Pharmacology | null | 116 | {
"Correct Answer": "Leflunomide",
"Correct Option": "C",
"Options": {
"A": "Sulfasalazine",
"B": "Infliximab",
"C": "Leflunomide",
"D": "Abatacept"
},
"Question": "A 45-year-old male, Sonu presented to OPD with severe pain in the knee and shoulder joint. On examination and further investigations, a diagnosis of rheumatoid arthritis was made and the patient was started on methotrexate 15mg weekly. However, even after 6 months of using methotrexate, recurrent episodes of arthritis continued. The physician wanted to add another DMARD that inhibit the pyrimidine synthesis by inhibiting dihydroorotate dehydrogenase enzyme. Which of the following drug, the physician is thinking about?"
} | A 45-year-old male, Sonu presented to OPD with severe pain in the knee and shoulder joint. On examination and further investigations, a diagnosis of rheumatoid arthritis was made and the patient was started on methotrexate 15mg weekly. However, even after 6 months of using methotrexate, recurrent episodes of arthritis continued. The physician wanted to add another DMARD that inhibit the pyrimidine synthesis by inhibiting dihydroorotate dehydrogenase enzyme. | Which of the following drug, the physician is thinking about? | {
"A": "Sulfasalazine",
"B": "Infliximab",
"C": "Leflunomide",
"D": "Abatacept"
} | C. Leflunomide |
61797166-b3eb-4563-b79e-90aa3e875b87 | A 25-year-old woman presents to your office with complaints of pain during intercourse for 2 months. The pain occurs with initial penetration and continues throughout the entire episode. She relates that she and her husband have been married for a year and previously had a pleasurable, pain- free relationship. She tells you that she has been to several area doctors and had a "full work-up" without a diagnosis, including a pelvic examination, Pap smear with cultures, and pelvic sonogram. On examination, she has a normal pelvic examination with no pain. You are unsure of the differential diagnosis, so you continue taking more history. She admits to vaginal dryness and low libido during this same timeframe. You ask if anything in her life changed 2 months ago. She suddenly begins to cry and states she found evidence of her husband's infidelity 2 months ago. What is the most appropriate recommendation for your patient? | Marriage counseling | Estrogen vaginal cream for vaginal dryness | Vaginal dilators for treatment of vaginismus | Antidepressant therapy | 0a
| single | An organic cause of this patient's sexual dysfunction is unlikely. Her pain during intercourse, poor desire, and lack of sufficient lubrication probably stem from the psychological stress from her husband's infidelity. Marital counseling may aid in resolving the issues that resulted in the infidelity, and the aftermath. Female sexual dysfunction consists of four broad categories: dyspareunia, orgasmic disorder, arousal disorder, and impaired sexual drive. Sexual dysfunction may result from physical conditions, such as neuropathy or sleep deprivation, or from psychological conditions, such as depression or a history of abuse. A thorough evaluation should include medical conditions as well as psychosocial questions pertaining to the health of her relationship with her partner and personal issues that contribute to her sexual well-being. Topical intravaginal estrogens are useful for perimenopausal vaginal dryness, and vaginal dilators are often tried for vaginismus, but neither would help her obvious psychological distress. Antidepressants would not address the cause of her symptoms. Low-dose testosterone has not been approved for the management of hypoactive sexual desire disorder and would not address the cause of this woman's distress. | Medicine | Miscellaneous | 185 | {
"Correct Answer": "Marriage counseling",
"Correct Option": "A",
"Options": {
"A": "Marriage counseling",
"B": "Estrogen vaginal cream for vaginal dryness",
"C": "Vaginal dilators for treatment of vaginismus",
"D": "Antidepressant therapy"
},
"Question": "A 25-year-old woman presents to your office with complaints of pain during intercourse for 2 months. The pain occurs with initial penetration and continues throughout the entire episode. She relates that she and her husband have been married for a year and previously had a pleasurable, pain- free relationship. She tells you that she has been to several area doctors and had a \"full work-up\" without a diagnosis, including a pelvic examination, Pap smear with cultures, and pelvic sonogram. On examination, she has a normal pelvic examination with no pain. You are unsure of the differential diagnosis, so you continue taking more history. She admits to vaginal dryness and low libido during this same timeframe. You ask if anything in her life changed 2 months ago. She suddenly begins to cry and states she found evidence of her husband's infidelity 2 months ago. What is the most appropriate recommendation for your patient?"
} | A 25-year-old woman presents to your office with complaints of pain during intercourse for 2 months. The pain occurs with initial penetration and continues throughout the entire episode. She relates that she and her husband have been married for a year and previously had a pleasurable, pain- free relationship. She tells you that she has been to several area doctors and had a "full work-up" without a diagnosis, including a pelvic examination, Pap smear with cultures, and pelvic sonogram. On examination, she has a normal pelvic examination with no pain. You are unsure of the differential diagnosis, so you continue taking more history. She admits to vaginal dryness and low libido during this same timeframe. You ask if anything in her life changed 2 months ago. She suddenly begins to cry and states she found evidence of her husband's infidelity 2 months ago. | What is the most appropriate recommendation for your patient? | {
"A": "Marriage counseling",
"B": "Estrogen vaginal cream for vaginal dryness",
"C": "Vaginal dilators for treatment of vaginismus",
"D": "Antidepressant therapy"
} | A. Marriage counseling |
bad8ef8f-e46c-49e6-bd49-0b52f058d407 | A 5-year-old boy has had repeated bouts of earache for 3 years. Each time on examination, the bouts have been accompanied by a red, bulging tympanic membrane, either unilaterally or bilaterally, sometimes with a small amount of yellowish exudate. Laboratory studies have included cultures of Staphylococcus aureus, Pseudomonas aeruginosa, and Moraxella catarrhalis. The most recent examination shows that the right tympanic membrane has perforated. The boy responds to antibiotic therapy. Which of the following complications is most likely to occur as a consequence of these events? | Cholesteatoma | Eosinophilic granuloma | Labyrinthitis | Otosclerosis | 0a
| multi | Cholesteatomas are not true neoplasms, but they are cystic masses lined by squamous epithelium. The desquamated epithelium and keratin degenerates, resulting in cholesterol formation and giant cell reaction. Although their histologic findings are benign, cholesteatomas can gradually enlarge, eroding and destroying the middle ear and surrounding structures. They occur as a complication of chronic otitis media. Although cholesteatomas have a squamous epithelial lining, malignant transformation does not occur. An eosinophilic granuloma of bone occasionally may be seen in the region of the skull in young children, but it is characterized by the presence of Langerhans cells. Labyrinthitis typically is caused by a viral infection and is self-limited. Otosclerosis is abnormal bone deposition in the ossicles of the middle ear that results in bone deafness in adults. | Pathology | Head & Neck | 130 | {
"Correct Answer": "Cholesteatoma",
"Correct Option": "A",
"Options": {
"A": "Cholesteatoma",
"B": "Eosinophilic granuloma",
"C": "Labyrinthitis",
"D": "Otosclerosis"
},
"Question": "A 5-year-old boy has had repeated bouts of earache for 3 years. Each time on examination, the bouts have been accompanied by a red, bulging tympanic membrane, either unilaterally or bilaterally, sometimes with a small amount of yellowish exudate. Laboratory studies have included cultures of Staphylococcus aureus, Pseudomonas aeruginosa, and Moraxella catarrhalis. The most recent examination shows that the right tympanic membrane has perforated. The boy responds to antibiotic therapy. Which of the following complications is most likely to occur as a consequence of these events?"
} | A 5-year-old boy has had repeated bouts of earache for 3 years. Each time on examination, the bouts have been accompanied by a red, bulging tympanic membrane, either unilaterally or bilaterally, sometimes with a small amount of yellowish exudate. Laboratory studies have included cultures of Staphylococcus aureus, Pseudomonas aeruginosa, and Moraxella catarrhalis. The most recent examination shows that the right tympanic membrane has perforated. The boy responds to antibiotic therapy. | Which of the following complications is most likely to occur as a consequence of these events? | {
"A": "Cholesteatoma",
"B": "Eosinophilic granuloma",
"C": "Labyrinthitis",
"D": "Otosclerosis"
} | A. Cholesteatoma |
85f0d498-eca5-43cf-91f1-b40d4633d39f | A 30 year old G5 P3 A1 comes to your OPD in exhausted state with labour pains since 12 hours and history of drainage of liquor 10 hours back. On examination her pulse is 96/ min, tongue is dry and coated. By PA examination it is term pregnancy with good uterine contractions and with absent fetal hea sound. On PV examination cervix is thick, 6-7 cm dilated membrane absent, big caput is present and station of head is + 3. Your most likely diagnosis is:- | Normal labour finding | Prolonged labour | Obstructed labour | Abnormal uterine action | 2c
| single | This is a classic presentation of obstructed labour. There are features of exhaustion, dehydration and tachycardiA. The FI-IS is absent the fetus may die in such cases because of asphyxia acidosis or hemorrhage). The PA and PV findings are also ourable for diagnosis of obstl1lcted labour. Obstructed labour may or may not be associated with prolonged labour. Abnormal uterine actions may follow obstructed labour as Bandl's ring formation. ' | Gynaecology & Obstetrics | null | 118 | {
"Correct Answer": "Obstructed labour",
"Correct Option": "C",
"Options": {
"A": "Normal labour finding",
"B": "Prolonged labour",
"C": "Obstructed labour",
"D": "Abnormal uterine action"
},
"Question": "A 30 year old G5 P3 A1 comes to your OPD in exhausted state with labour pains since 12 hours and history of drainage of liquor 10 hours back. On examination her pulse is 96/ min, tongue is dry and coated. By PA examination it is term pregnancy with good uterine contractions and with absent fetal hea sound. On PV examination cervix is thick, 6-7 cm dilated membrane absent, big caput is present and station of head is + 3. Your most likely diagnosis is:-"
} | A 30 year old G5 P3 A1 comes to your OPD in exhausted state with labour pains since 12 hours and history of drainage of liquor 10 hours back. On examination her pulse is 96/ min, tongue is dry and coated. By PA examination it is term pregnancy with good uterine contractions and with absent fetal hea sound. On PV examination cervix is thick, 6-7 cm dilated membrane absent, big caput is present and station of head is + 3. | Your most likely diagnosis is:- | {
"A": "Normal labour finding",
"B": "Prolonged labour",
"C": "Obstructed labour",
"D": "Abnormal uterine action"
} | C. Obstructed labour |
a52b5853-7139-4204-b5b2-de482d1970ef | A 17-year-old girl notices a small, sensitive, gray-white area forming along the lateral border of her tongue 2 days before the end of her final examinations. On examination by the physician's assistant, the girl is afebrile. There is a shallow, ulcerated, 0.3-cm lesion with an erythematous rim. No specific therapy is given, and the lesion disappears within 2 weeks. The history shows that the girl does not use tobacco or alcohol. Which of the following is the most probable diagnosis? | Aphthous ulcer | Herpes simplex stomatitis | Leukoplakia | Oral thrush | 0a
| multi | An aphthous ulcer is a common lesion that also is known as a canker sore. The lesions are never large, but are annoying and tend to occur during periods of stress. Aphthous ulcers are not infectious; they probably have an autoimmune origin. Herpetic lesions are typically vesicles that can rupture. Leukoplakia appears as white patches of thicker mucosa from hyperkeratosis. It may be a precursor to squamous cell carcinoma in a few cases. The temperance ditty mentioned in the history is a cautionary note for all young people. Oral thrush is a superficial candidal infection that occurs in diabetic, neutropenic, and immunocompromised patients. Inflammation of a salivary gland (sialadenitis), typically a minor salivary gland in the oral cavity, may produce a localized, tender nodule. | Pathology | Head & Neck | 113 | {
"Correct Answer": "Aphthous ulcer",
"Correct Option": "A",
"Options": {
"A": "Aphthous ulcer",
"B": "Herpes simplex stomatitis",
"C": "Leukoplakia",
"D": "Oral thrush"
},
"Question": "A 17-year-old girl notices a small, sensitive, gray-white area forming along the lateral border of her tongue 2 days before the end of her final examinations. On examination by the physician's assistant, the girl is afebrile. There is a shallow, ulcerated, 0.3-cm lesion with an erythematous rim. No specific therapy is given, and the lesion disappears within 2 weeks. The history shows that the girl does not use tobacco or alcohol. Which of the following is the most probable diagnosis?"
} | A 17-year-old girl notices a small, sensitive, gray-white area forming along the lateral border of her tongue 2 days before the end of her final examinations. On examination by the physician's assistant, the girl is afebrile. There is a shallow, ulcerated, 0.3-cm lesion with an erythematous rim. No specific therapy is given, and the lesion disappears within 2 weeks. The history shows that the girl does not use tobacco or alcohol. | Which of the following is the most probable diagnosis? | {
"A": "Aphthous ulcer",
"B": "Herpes simplex stomatitis",
"C": "Leukoplakia",
"D": "Oral thrush"
} | A. Aphthous ulcer |
3343195f-e0d9-4c6b-a887-06d13d6e13a4 | A 16-year-old boy presents with a 24-hour history of severe abdominal pain, nausea, vomiting, and low-grade fever. The pain is initially periumbilical in location but has migrated to the right lower quadrant of the abdomen, with maximal tenderness elicited at a site one-third of the way between the crest of the ileum and the umbilicus (McBurney point). The leukocyte count is 14,000/mm3, with 74% segmented neutrophils and 12% bands. Surgery is performed. Which of the following describes the expected findings at the affected site? | Fistula (abnormal duct or passage) connecting to the abdominal wall | Granulomatous inflammation with prominent aggregates of epithelioid cells and multinucleated giant cells | Massive infiltration of lymphocytes and plasma cells | Prominent areas of edema, congestion, and a purulent reaction with localized areas of abscess formation | 3d
| multi | The clinical findings are typical of acute appendicitis, another example of severe acute inflammation. Because the danger of perforation is great, early appendectomy is the treatment of choice. Suppurative or purulent inflammation is characterized by:- Prominent areas of edema (Due to increased vascular permeability, congestion, and a purulent (pus-containing) exudate consisting of necrotic cells and large numbers of neutrophils) Congestion is prominent | Pathology | Chronic Inflammation | 132 | {
"Correct Answer": "Prominent areas of edema, congestion, and a purulent reaction with localized areas of abscess formation",
"Correct Option": "D",
"Options": {
"A": "Fistula (abnormal duct or passage) connecting to the abdominal wall",
"B": "Granulomatous inflammation with prominent aggregates of epithelioid cells and multinucleated giant cells",
"C": "Massive infiltration of lymphocytes and plasma cells",
"D": "Prominent areas of edema, congestion, and a purulent reaction with localized areas of abscess formation"
},
"Question": "A 16-year-old boy presents with a 24-hour history of severe abdominal pain, nausea, vomiting, and low-grade fever. The pain is initially periumbilical in location but has migrated to the right lower quadrant of the abdomen, with maximal tenderness elicited at a site one-third of the way between the crest of the ileum and the umbilicus (McBurney point). The leukocyte count is 14,000/mm3, with 74% segmented neutrophils and 12% bands. Surgery is performed. Which of the following describes the expected findings at the affected site?"
} | A 16-year-old boy presents with a 24-hour history of severe abdominal pain, nausea, vomiting, and low-grade fever. The pain is initially periumbilical in location but has migrated to the right lower quadrant of the abdomen, with maximal tenderness elicited at a site one-third of the way between the crest of the ileum and the umbilicus (McBurney point). The leukocyte count is 14,000/mm3, with 74% segmented neutrophils and 12% bands. Surgery is performed. | Which of the following describes the expected findings at the affected site? | {
"A": "Fistula (abnormal duct or passage) connecting to the abdominal wall",
"B": "Granulomatous inflammation with prominent aggregates of epithelioid cells and multinucleated giant cells",
"C": "Massive infiltration of lymphocytes and plasma cells",
"D": "Prominent areas of edema, congestion, and a purulent reaction with localized areas of abscess formation"
} | D. Prominent areas of edema, congestion, and a purulent reaction with localized areas of abscess formation |
da02f50c-cfc5-405c-8dc3-1f79c9d60350 | A 56-year-old lady comes to medicine OPD with chief complains of headache, dizziness and generalized itching paicularly after taking hot shower. She also complained of intense burning in hands and feet as shown. She repos that taking aspirin relieves her of this issue. Physical examination: splenomegaly with raised BP. Blood workup shows: HB- 20.1 g/dl Hematocrit-60-% WBC-15800 Platelet count- 500000E PO- low spO2 - 98% LAP- increased. Which of the following is the most common mutation seen in the above disease: - | JAK2 | CALR | RAS | MYC | 0a
| multi | The clinical and blood investigation reveal the diagnosis of Polycythemia vera. The image of foot shows erythromelalgia. ERYTHROMELALGIA Characterized by burning pain and erythema. Feet > hands Males > females. Most common in middle age. It may be primary (also termed erythermalgia - Mutations in the SCN9A gene) Secondary erythromelalgia myeloproliferative disorders such as polycythemia vera and essential thrombocytosis. drugs, such as calcium channel blockers, bromocriptine, and pergolideo neuropathies connective tissue diseases such as SLE paraneoplastic syndromes. POLYCYTHEMIA VERA mutation JAK2 : replaces valine with phenylalanine (V617F), leading to constitutive kinase activation-- PV pathogenesis. CLINICAL FEATURES Isolated thrombocytosis Leukocytosis splenomegaly high hemoglobin, hematocrit, or red cell count Aquagenic pruritus : distinguish PV from other causes of erythrocytosis. Hyperviscosity -Neu rologic symptoms such as veigo, tinnitus, headache, visual distur bances, and transient ischemic attacks (TIA) | Unknown | Integrated QBank | 143 | {
"Correct Answer": "JAK2",
"Correct Option": "A",
"Options": {
"A": "JAK2",
"B": "CALR",
"C": "RAS",
"D": "MYC"
},
"Question": "A 56-year-old lady comes to medicine OPD with chief complains of headache, dizziness and generalized itching paicularly after taking hot shower. She also complained of intense burning in hands and feet as shown. She repos that taking aspirin relieves her of this issue. Physical examination: splenomegaly with raised BP. Blood workup shows: HB- 20.1 g/dl Hematocrit-60-% WBC-15800 Platelet count- 500000E PO- low spO2 - 98% LAP- increased. Which of the following is the most common mutation seen in the above disease: -"
} | A 56-year-old lady comes to medicine OPD with chief complains of headache, dizziness and generalized itching paicularly after taking hot shower. She also complained of intense burning in hands and feet as shown. She repos that taking aspirin relieves her of this issue. Physical examination: splenomegaly with raised BP. Blood workup shows: HB- 20.1 g/dl Hematocrit-60-% WBC-15800 Platelet count- 500000E PO- low spO2 - 98% LAP- increased. | Which of the following is the most common mutation seen in the above disease: - | {
"A": "JAK2",
"B": "CALR",
"C": "RAS",
"D": "MYC"
} | A. JAK2 |
46b96228-0be9-4ea3-8477-67fe64bd2d13 | A 35-year-old man is evaluated in the clinic for symptoms of shortness of breath. He reports no other lung or heart disease. He smokes half pack a day for the past 10 years. On examination, his JVP is at 2 cm, heart sounds normal, and lungs are clear. A CXR shows hyperinflation and increased lucency of the lung fields. A chest CT reveals bullae and emphysematous changes in the lower lobes, while pulmonary function tests show an FEV1/FVC ratio of < 70%. Evaluation of his family reveals other affected individuals. Which of the following is the most likely diagnosis? | alpha 1-antitrypsin deficiency | beta-glycosidase deficiency | glucose-6-phosphatase deficiency | glucocerebrosides deficiency | 0a
| single | Most people have two MM genes and a resultant alpha 1-antitrypsin level in excess of 2.5 g/L. Homozygotes with ZZ or SS genotypes have severe alpha 1-antitrypsin deficiency and develop severe panacinar emphysema in the third or fourth decade of life. Smoking is an important cofactor in the development of disease. Heterozygotes (MZ or MS) have intermediate levels of alpha 1-antitrypsin (i.e., genetic expression is that of an autosomal codominant allele). This heterozygous state is common (5-14% of general population), but it is unclear whether it is associated with lung function abnormalities. | Medicine | Respiratory | 138 | {
"Correct Answer": "alpha 1-antitrypsin deficiency",
"Correct Option": "A",
"Options": {
"A": "alpha 1-antitrypsin deficiency",
"B": "beta-glycosidase deficiency",
"C": "glucose-6-phosphatase deficiency",
"D": "glucocerebrosides deficiency"
},
"Question": "A 35-year-old man is evaluated in the clinic for symptoms of shortness of breath. He reports no other lung or heart disease. He smokes half pack a day for the past 10 years. On examination, his JVP is at 2 cm, heart sounds normal, and lungs are clear. A CXR shows hyperinflation and increased lucency of the lung fields. A chest CT reveals bullae and emphysematous changes in the lower lobes, while pulmonary function tests show an FEV1/FVC ratio of < 70%. Evaluation of his family reveals other affected individuals. Which of the following is the most likely diagnosis?"
} | A 35-year-old man is evaluated in the clinic for symptoms of shortness of breath. He reports no other lung or heart disease. He smokes half pack a day for the past 10 years. On examination, his JVP is at 2 cm, heart sounds normal, and lungs are clear. A CXR shows hyperinflation and increased lucency of the lung fields. A chest CT reveals bullae and emphysematous changes in the lower lobes, while pulmonary function tests show an FEV1/FVC ratio of < 70%. Evaluation of his family reveals other affected individuals. | Which of the following is the most likely diagnosis? | {
"A": "alpha 1-antitrypsin deficiency",
"B": "beta-glycosidase deficiency",
"C": "glucose-6-phosphatase deficiency",
"D": "glucocerebrosides deficiency"
} | A. alpha 1-antitrypsin deficiency |
046e5581-d5ec-4698-9a0a-4d558c2dbf7a | A 63-year-old woman presents with a several-week history of headaches and difficulties with speech. A sister who lives with her claims that her language "has recently not been making much sense" and that she is a bit confused. Her condition seems to be deteriorating. On neurologic examination, she has a moderately severe aphasia, with difficulty understanding language and following commands, and she makes frequent paraphasic errors when she speaks. There are no other motor or sensory deficits. An MRI with intravenous contrast reveals the presence of a ring-enhancing mass lesion within the substance of the left temporal lobe. The lesion is approximately 3 cm in great-est diameter, poorly demarcated from the surrounding brain, and surrounded by a moderate amount of cerebral edema. Findings on routine admission tests, including a chest x-ray and serum chemistry, are unremarkable. What is the most likely diagnosis? | Low-grade cerebral astrocytoma | Glioblastoma multiforme | Metastasis to the brain from an occult primary cancer | Meningioma | 1b
| single | Glioblastoma multiforme is a highly malignant neoplasm, arising from glial cells or their precursors within the CNS. It is the most common of all primary malignancies of the CNS and its peak incidence is within the fifth to sev-enth decade of life. A low-grade astrocytoma is a tumor derived from glial cells of astrocytes. Fig. 11-4, shows a large cystic giant astrocytoma on T2 weighted MRI where fluid is shown as a white area with midline shift (not glioblastoma multiforme presented in this question). | Surgery | CNS Tumors | 184 | {
"Correct Answer": "Glioblastoma multiforme",
"Correct Option": "B",
"Options": {
"A": "Low-grade cerebral astrocytoma",
"B": "Glioblastoma multiforme",
"C": "Metastasis to the brain from an occult primary cancer",
"D": "Meningioma"
},
"Question": "A 63-year-old woman presents with a several-week history of headaches and difficulties with speech. A sister who lives with her claims that her language \"has recently not been making much sense\" and that she is a bit confused. Her condition seems to be deteriorating. On neurologic examination, she has a moderately severe aphasia, with difficulty understanding language and following commands, and she makes frequent paraphasic errors when she speaks. There are no other motor or sensory deficits. An MRI with intravenous contrast reveals the presence of a ring-enhancing mass lesion within the substance of the left temporal lobe. The lesion is approximately 3 cm in great-est diameter, poorly demarcated from the surrounding brain, and surrounded by a moderate amount of cerebral edema. Findings on routine admission tests, including a chest x-ray and serum chemistry, are unremarkable. What is the most likely diagnosis?"
} | A 63-year-old woman presents with a several-week history of headaches and difficulties with speech. A sister who lives with her claims that her language "has recently not been making much sense" and that she is a bit confused. Her condition seems to be deteriorating. On neurologic examination, she has a moderately severe aphasia, with difficulty understanding language and following commands, and she makes frequent paraphasic errors when she speaks. There are no other motor or sensory deficits. An MRI with intravenous contrast reveals the presence of a ring-enhancing mass lesion within the substance of the left temporal lobe. The lesion is approximately 3 cm in great-est diameter, poorly demarcated from the surrounding brain, and surrounded by a moderate amount of cerebral edema. Findings on routine admission tests, including a chest x-ray and serum chemistry, are unremarkable. | What is the most likely diagnosis? | {
"A": "Low-grade cerebral astrocytoma",
"B": "Glioblastoma multiforme",
"C": "Metastasis to the brain from an occult primary cancer",
"D": "Meningioma"
} | B. Glioblastoma multiforme |
90647401-70ed-4065-804d-1520face1dec | A term baby is going to deliver caesarean section to a mother with multiple medical problems:(1) seizures, for which she takes phenytoin (2)Rheumatic hea disease, taking penicillin daily (3) hypeension, for which she takes propranolol and (4) DVT in her right calf, for which she was staed on a heparin therapy. Which of the following medications is most likely to cause harm in this newborn at delivery? | Penicillin | Phenytoin | Propranolol | Heparin | 2c
| single | Heparin does not cross the placental barrier and does not appear to directly affect the fetus once pregnancy is well established. Phenytoin may cause bih defects when given during the first trimester. Penicillin have not been found to affect the fetus. Propranolol, which may cause growth retardation when given throughout pregnancy, diminishes the ability of an asphyxiated infant to increase hea rate and cardiac output. It has also been associated with hypoglycemia and apnea. | Pediatrics | IUGR and Feeding of Preterm Neonate | 103 | {
"Correct Answer": "Propranolol",
"Correct Option": "C",
"Options": {
"A": "Penicillin",
"B": "Phenytoin",
"C": "Propranolol",
"D": "Heparin"
},
"Question": "A term baby is going to deliver caesarean section to a mother with multiple medical problems:(1) seizures, for which she takes phenytoin (2)Rheumatic hea disease, taking penicillin daily (3) hypeension, for which she takes propranolol and (4) DVT in her right calf, for which she was staed on a heparin therapy. Which of the following medications is most likely to cause harm in this newborn at delivery?"
} | A term baby is going to deliver caesarean section to a mother with multiple medical problems:(1) seizures, for which she takes phenytoin (2)Rheumatic hea disease, taking penicillin daily (3) hypeension, for which she takes propranolol and (4) DVT in her right calf, for which she was staed on a heparin therapy. | Which of the following medications is most likely to cause harm in this newborn at delivery? | {
"A": "Penicillin",
"B": "Phenytoin",
"C": "Propranolol",
"D": "Heparin"
} | C. Propranolol |
a34017f1-f190-4a2f-9e52-93c1147cce2b | A 24-year-old woman presents to the emergency department with symptoms of fever, chills and rigors. On physical examination, she looks unwell; the temperature is 39.4degC, blood pressure 100/60 mm Hg, pulse 110/min, and oxygen saturation 95%. There is a 3/6 pansystolic murmur at the right sternal border, which increases with inspiration. Her arms have multiple tattoos and needle marks from injection drug use. Blood cultures (2/2 sets) are positive for S aureus, and she is started on appropriate antibiotics. Her renal function is mildly impaired and her urinalysis is positive for protein, and microscopy reveals red cell casts. Which of the following mechanisms is the most likely explanation for her renal abnormalities? | septic emboli | cardiac failure with prerenal azotemia | a high level of circulating immune complexes | fungal disease | 2c
| single | Glomerulonephritis, arthritis, and many of the mucocutaneous lesions are secondary to circulating immune complexes. The clinical manifestations of infective endocarditis are a result of three factors: (1) direct infection in the heart, (2) septic emboli, and (3) high levels of circulating immune complexes. Renal emboli cause hematuria and flank pain, but rarely impair renal function. | Medicine | Infection | 169 | {
"Correct Answer": "a high level of circulating immune complexes",
"Correct Option": "C",
"Options": {
"A": "septic emboli",
"B": "cardiac failure with prerenal azotemia",
"C": "a high level of circulating immune complexes",
"D": "fungal disease"
},
"Question": "A 24-year-old woman presents to the emergency department with symptoms of fever, chills and rigors. On physical examination, she looks unwell; the temperature is 39.4degC, blood pressure 100/60 mm Hg, pulse 110/min, and oxygen saturation 95%. There is a 3/6 pansystolic murmur at the right sternal border, which increases with inspiration. Her arms have multiple tattoos and needle marks from injection drug use. Blood cultures (2/2 sets) are positive for S aureus, and she is started on appropriate antibiotics. Her renal function is mildly impaired and her urinalysis is positive for protein, and microscopy reveals red cell casts. Which of the following mechanisms is the most likely explanation for her renal abnormalities?"
} | A 24-year-old woman presents to the emergency department with symptoms of fever, chills and rigors. On physical examination, she looks unwell; the temperature is 39.4degC, blood pressure 100/60 mm Hg, pulse 110/min, and oxygen saturation 95%. There is a 3/6 pansystolic murmur at the right sternal border, which increases with inspiration. Her arms have multiple tattoos and needle marks from injection drug use. Blood cultures (2/2 sets) are positive for S aureus, and she is started on appropriate antibiotics. Her renal function is mildly impaired and her urinalysis is positive for protein, and microscopy reveals red cell casts. | Which of the following mechanisms is the most likely explanation for her renal abnormalities? | {
"A": "septic emboli",
"B": "cardiac failure with prerenal azotemia",
"C": "a high level of circulating immune complexes",
"D": "fungal disease"
} | C. a high level of circulating immune complexes |
ce4ec57d-12ec-468e-82db-4512185cf484 | A 60-year-old alcoholic smoker abruptly develops high fever, shakes, a severe headache, and muscle pain. He initially has a dry, insignificant cough, but over the next few days he develops marked shoness of breath requiring assisted ventilation. Chest x-ray demonstrates homogeneous radiographic shadowing that initially involves the left lower lobe but continues to spread until both lungs are extensively involved. Culture of bronchoalveolar lavage fluid on buffered charcoal yeast extract (BCYE) demonstrates a coccobacillary pathogen. Which of the following is the most likely causative organism? | Legionella pneumophila | Listeria monocytogenes | Streptococcus pneumoniae | Staphylococcus aureus | 0a
| multi | The patient has a severe, potentially fatal, pneumonia with prominent systemic symptoms. Culture on BCYE is the specific clue that the organism is Legionella pneumophila. The disease is respiratory Legionellosis, also known as Legionnaire's disease, because the disease was first described when it occurred in epidemic form following an American Legion convention at a Philadelphia hotel. Patients tend to be older (40-70 years old) and may have risk factors including cigarette use, alcoholism, diabetes, chronic illness, or immunosuppressive therapy. Listeria monocytogenes causes listeriosis and is not a notable cause of pneumonia. Staphylococcus aureus can cause pneumonia, but is easily cultured on routine media. Ref: Levinson W. (2012). Chapter 19. Gram-Negative Rods Related to the Respiratory Tract. In W. Levinson (Ed), Review of Medical Microbiology & Immunology, 12e. | Microbiology | null | 120 | {
"Correct Answer": "Legionella pneumophila",
"Correct Option": "A",
"Options": {
"A": "Legionella pneumophila",
"B": "Listeria monocytogenes",
"C": "Streptococcus pneumoniae",
"D": "Staphylococcus aureus"
},
"Question": "A 60-year-old alcoholic smoker abruptly develops high fever, shakes, a severe headache, and muscle pain. He initially has a dry, insignificant cough, but over the next few days he develops marked shoness of breath requiring assisted ventilation. Chest x-ray demonstrates homogeneous radiographic shadowing that initially involves the left lower lobe but continues to spread until both lungs are extensively involved. Culture of bronchoalveolar lavage fluid on buffered charcoal yeast extract (BCYE) demonstrates a coccobacillary pathogen. Which of the following is the most likely causative organism?"
} | A 60-year-old alcoholic smoker abruptly develops high fever, shakes, a severe headache, and muscle pain. He initially has a dry, insignificant cough, but over the next few days he develops marked shoness of breath requiring assisted ventilation. Chest x-ray demonstrates homogeneous radiographic shadowing that initially involves the left lower lobe but continues to spread until both lungs are extensively involved. Culture of bronchoalveolar lavage fluid on buffered charcoal yeast extract (BCYE) demonstrates a coccobacillary pathogen. | Which of the following is the most likely causative organism? | {
"A": "Legionella pneumophila",
"B": "Listeria monocytogenes",
"C": "Streptococcus pneumoniae",
"D": "Staphylococcus aureus"
} | A. Legionella pneumophila |
78fc1390-bdf6-4a6b-a75f-3e6cab1786fc | A 20-year-old man is brought to the hospital emergency department by a friend who found him unconscious in his apartment after trying to contact him for 3 days. On arrival, the patient is in a state of respiratory depression. He experiences convulsions for 2 minutes, followed by cardiac arrest. Advanced cardiac life support measures are instituted, and he is stabilized and intubated. On physical examination, there are needle tracks in the left antecubital fossa, miosis, and a loud diastolic heart murmur. His temperature is 39.2deg C. Use of which of the following substances by this man most likely produced these findings? | Cocaine | Ethanol | Flurazepam | Heroin | 3d
| single | Heroin is an opiate narcotic that is a derivative of morphine. Opiates are central nervous system (CNS) depressants, and overdoses are accompanied by respiratory depression, convulsions, and cardiac arrest. The typical mode of administration is by injection. An infection, such as endocarditis explaining his heart murmur, often results from such use because the nonsterile injection technique is employed. Cocaine is most often inhaled rather than injected, and acutely produces a state of excited delirium. Ethanol is typically ingested and, in excess, can lead to coma and death. Flurazepam is most often ingested; excessive use can lead to respiratory depression. Meperidine is an analgesic that can cause respiratory depression and bradycardia in overdosage. Phencyclidine (PCP) is a schizophrenomimetic and is usually ingested; users have a history of erratic behavior. Lysergic acid (LSD) is a hallucinogen. | Pathology | Environment & Nutritional Pathology | 138 | {
"Correct Answer": "Heroin",
"Correct Option": "D",
"Options": {
"A": "Cocaine",
"B": "Ethanol",
"C": "Flurazepam",
"D": "Heroin"
},
"Question": "A 20-year-old man is brought to the hospital emergency department by a friend who found him unconscious in his apartment after trying to contact him for 3 days. On arrival, the patient is in a state of respiratory depression. He experiences convulsions for 2 minutes, followed by cardiac arrest. Advanced cardiac life support measures are instituted, and he is stabilized and intubated. On physical examination, there are needle tracks in the left antecubital fossa, miosis, and a loud diastolic heart murmur. His temperature is 39.2deg C. Use of which of the following substances by this man most likely produced these findings?"
} | A 20-year-old man is brought to the hospital emergency department by a friend who found him unconscious in his apartment after trying to contact him for 3 days. On arrival, the patient is in a state of respiratory depression. He experiences convulsions for 2 minutes, followed by cardiac arrest. Advanced cardiac life support measures are instituted, and he is stabilized and intubated. On physical examination, there are needle tracks in the left antecubital fossa, miosis, and a loud diastolic heart murmur. His temperature is 39.2deg C. | Use of which of the following substances by this man most likely produced these findings? | {
"A": "Cocaine",
"B": "Ethanol",
"C": "Flurazepam",
"D": "Heroin"
} | D. Heroin |
21df983b-cb62-43d5-93c3-25a7368efea3 | A 28-year-old woman presents to the emergency department with a recent episode of coughing up some blood, frequent nosebleeds, and now decreased urine output. On physical examination, a nasal mucosa ulcer is seen on inspection and the remainder of the examination is normal. Her urinalysis is positive for protein and red cells consistent with acute glomerulonephritis (GN). The CXR shows two cavitary lesions and her serology is positive for antineutrophil cytoplasmic antibodies (ANCA) Which of the following is the most likely diagnosis? | Wegener granulomatosis | bacterial endocarditis | Goodpasture syndrome | lupus erythematosus | 0a
| single | Wegener is typically associated with anti-neutrophil cytoplasmic antibodies and respiratory epithelium involvement such as frequent nose bleeds or nasal ulcers. Numerous diseases are associated with renal and pulmonary manifestations, including lupus, Goodpasture syndrome, and microscopic polyangiitis. Right-sided bacterial endocarditis can cause renal and lung involvement but serology of ANCA is negative in endocarditis. This is less likely to be Goodpasture because of the nasal involvement. | Medicine | Oncology | 120 | {
"Correct Answer": "Wegener granulomatosis",
"Correct Option": "A",
"Options": {
"A": "Wegener granulomatosis",
"B": "bacterial endocarditis",
"C": "Goodpasture syndrome",
"D": "lupus erythematosus"
},
"Question": "A 28-year-old woman presents to the emergency department with a recent episode of coughing up some blood, frequent nosebleeds, and now decreased urine output. On physical examination, a nasal mucosa ulcer is seen on inspection and the remainder of the examination is normal. Her urinalysis is positive for protein and red cells consistent with acute glomerulonephritis (GN). The CXR shows two cavitary lesions and her serology is positive for antineutrophil cytoplasmic antibodies (ANCA) Which of the following is the most likely diagnosis?"
} | A 28-year-old woman presents to the emergency department with a recent episode of coughing up some blood, frequent nosebleeds, and now decreased urine output. On physical examination, a nasal mucosa ulcer is seen on inspection and the remainder of the examination is normal. Her urinalysis is positive for protein and red cells consistent with acute glomerulonephritis (GN). | The CXR shows two cavitary lesions and her serology is positive for antineutrophil cytoplasmic antibodies (ANCA) Which of the following is the most likely diagnosis? | {
"A": "Wegener granulomatosis",
"B": "bacterial endocarditis",
"C": "Goodpasture syndrome",
"D": "lupus erythematosus"
} | A. Wegener granulomatosis |
7425ce1f-939c-4ab5-b490-46fea5637780 | A 30-year-old G2P1L1 at 37 weeks gestational age is here for a routine visit. Her first was a vaginal delivery of a 4.3 kgs baby boy after 30 min of pushing. This fetus is breech. Vaginal exam demonstrates that the cervix is 50% effaced and 1 to 2 cm dilated. The presenting breech is high out of the pelvis. The estimated fetal weight is about 3.2 kgs. A sonogram confirms a fetus with a frank breech, normal amniotic fluid present, and the head is well flexed. The following are possible management plans except: | Allow the patient to undergo a vaginal breech delivery whenever she goes into labor | Cesarean section now | Pinard's maneuver can be done for delivery of extended legs | Schedule an external cephalic version in the next few days | 1b
| multi | -External cephalic version can be done in this case because Period of gestation is 37 weeks(ideal time) Liquor is adequate - Frank breech is the best breech for vaginal delivery, so a trial of labor is given. whereas in case of footling breech, an Elective L.S.C.S is done. - Vaginal breech delivery can be assisted and is allowed to progress and at whichever sage , breech get stuck , the obstetrician can perform C-section. - Pinard's maneuvre is done for delivery of extended legs. There is no indication for performing and Elective LSCS at this moment at 37 weeks, unless there were any other obstetric indication like a previous LSCS or placenta pre etc. | Gynaecology & Obstetrics | Obstetrics | 144 | {
"Correct Answer": "Cesarean section now",
"Correct Option": "B",
"Options": {
"A": "Allow the patient to undergo a vaginal breech delivery whenever she goes into labor",
"B": "Cesarean section now",
"C": "Pinard's maneuver can be done for delivery of extended legs",
"D": "Schedule an external cephalic version in the next few days"
},
"Question": "A 30-year-old G2P1L1 at 37 weeks gestational age is here for a routine visit. Her first was a vaginal delivery of a 4.3 kgs baby boy after 30 min of pushing. This fetus is breech. Vaginal exam demonstrates that the cervix is 50% effaced and 1 to 2 cm dilated. The presenting breech is high out of the pelvis. The estimated fetal weight is about 3.2 kgs. A sonogram confirms a fetus with a frank breech, normal amniotic fluid present, and the head is well flexed. The following are possible management plans except:"
} | A 30-year-old G2P1L1 at 37 weeks gestational age is here for a routine visit. Her first was a vaginal delivery of a 4.3 kgs baby boy after 30 min of pushing. This fetus is breech. Vaginal exam demonstrates that the cervix is 50% effaced and 1 to 2 cm dilated. The presenting breech is high out of the pelvis. The estimated fetal weight is about 3.2 kgs. A sonogram confirms a fetus with a frank breech, normal amniotic fluid present, and the head is well flexed. | The following are possible management plans except: | {
"A": "Allow the patient to undergo a vaginal breech delivery whenever she goes into labor",
"B": "Cesarean section now",
"C": "Pinard's maneuver can be done for delivery of extended legs",
"D": "Schedule an external cephalic version in the next few days"
} | B. Cesarean section now |
4b536643-4dd0-4304-b366-292812cbd63a | A 62-year-old man is admitted with abdominal pain and weight loss of 5 lb over the past month. He has continued to consume large amounts of rum. Examination reveals icteric sclera. The indirect bilirubin level is 5.6 mg/dL with a total bilirubin of 6 mg/dL. An ultrasound shows a 4-cm pseudocyst. What is the most likely cause of jaundice in a patient with alcoholic pancreatitis? | Alcoholic hepatitis | Carcinoma of pancreas | Intrahepatic cyst | Pancreatic pseudocyst | 0a
| single | A recent increase in alcohol consumption explains the jaundice secondary to alcoholic hepatitis in the majority of such patients. Carcinoma of the pancreas is relatively rare but often causes difficulty in the differentiation from pancreatitis. A pseudocyst measuring 4 cm is not likely to be associated with nonobstructive jaundice in this patient. | Surgery | Pancreas | 102 | {
"Correct Answer": "Alcoholic hepatitis",
"Correct Option": "A",
"Options": {
"A": "Alcoholic hepatitis",
"B": "Carcinoma of pancreas",
"C": "Intrahepatic cyst",
"D": "Pancreatic pseudocyst"
},
"Question": "A 62-year-old man is admitted with abdominal pain and weight loss of 5 lb over the past month. He has continued to consume large amounts of rum. Examination reveals icteric sclera. The indirect bilirubin level is 5.6 mg/dL with a total bilirubin of 6 mg/dL. An ultrasound shows a 4-cm pseudocyst. What is the most likely cause of jaundice in a patient with alcoholic pancreatitis?"
} | A 62-year-old man is admitted with abdominal pain and weight loss of 5 lb over the past month. He has continued to consume large amounts of rum. Examination reveals icteric sclera. The indirect bilirubin level is 5.6 mg/dL with a total bilirubin of 6 mg/dL. An ultrasound shows a 4-cm pseudocyst. | What is the most likely cause of jaundice in a patient with alcoholic pancreatitis? | {
"A": "Alcoholic hepatitis",
"B": "Carcinoma of pancreas",
"C": "Intrahepatic cyst",
"D": "Pancreatic pseudocyst"
} | A. Alcoholic hepatitis |
96336d28-443a-4a0c-8f27-914a4a2656e9 | A 42-year-old man is on amitriptyline for depression. Recently he has been feeling more lethargic and unwell. His clinical examination is normal. Serum sodium is 125 mEq/L and osmolality is 260 mOsm/kg, and urine sodium is 40 mEq/L and osmolality is 450 mOsm/kg.For the above patient with hyponatremia, select the most likely diagnosis. | congestive heart failure (CHF) | extrarenal sodium and fluid losses | SIADH | polydipsia | 2c
| multi | Amitriptyline is one of the psychoactive drugs that cause SIADH. Others include phenothiazines, serotonin reuptake inhibitors, and monoamine oxidase inhibitors (MAOIs). Antineoplastic drugs such as vincristine and cyclophosphamide also cause SIADH, as does the hypoglycemic agent chlorpropamide. | Medicine | Oncology | 101 | {
"Correct Answer": "SIADH",
"Correct Option": "C",
"Options": {
"A": "congestive heart failure (CHF)",
"B": "extrarenal sodium and fluid losses",
"C": "SIADH",
"D": "polydipsia"
},
"Question": "A 42-year-old man is on amitriptyline for depression. Recently he has been feeling more lethargic and unwell. His clinical examination is normal. Serum sodium is 125 mEq/L and osmolality is 260 mOsm/kg, and urine sodium is 40 mEq/L and osmolality is 450 mOsm/kg.For the above patient with hyponatremia, select the most likely diagnosis."
} | A 42-year-old man is on amitriptyline for depression. Recently he has been feeling more lethargic and unwell. His clinical examination is normal. | Serum sodium is 125 mEq/L and osmolality is 260 mOsm/kg, and urine sodium is 40 mEq/L and osmolality is 450 mOsm/kg.For the above patient with hyponatremia, select the most likely diagnosis. | {
"A": "congestive heart failure (CHF)",
"B": "extrarenal sodium and fluid losses",
"C": "SIADH",
"D": "polydipsia"
} | C. SIADH |
bdc4ecc8-7a7d-4d00-b278-850545dc31c2 | A 70-year-old female presented with chronic productive cough, low grade fever and progressive weight loss for 4 months. Patient had a history of Pulmonary TB 3 years back for which she took ATT for 6 months. The doctor ordered a chest X-ray and a CT to be done. Her sputum sample was taken. Acid fast bacilli were observed. The patient did not respond to the ATT. Some other infection was suspected. Which of the following is the most appropriate regimen to be given in the following condition: - | Ethambutol + Clarithromycin + Rifabutin | Pyrazinamide + Clarithromycin + Rifabutin | Ethambutol + Clindamycin + Rifabutin | Ethambutol + Clarithromycin + Rifaximin | 0a
| single | This is a case of MAC infection (Mycobacterium avium complex infection). Chest x-ray shows hyperinflated lung with extensive bilateral ring shadows consistent with bronchiectasis with upper zone scarring is likely a result of previous TB. CT shows the classical tree-in-bud appearance and B/L bronchiectasis with bronchiolar inflammation, typical of non-tuberculous mycobacterial infection. MAC infection Seen in immunocompromised and patients with underlying lung disease. Patients with an underlying lung disease and history of previous TB - should receive antibiotics. Appropriate regimen is: - Clarithromycin + Ethambutol + Rifabutin x 12 months Pyrazinamide, isoniazid, rifampicin and ethambutol. | Anatomy | Integrated QBank | 110 | {
"Correct Answer": "Ethambutol + Clarithromycin + Rifabutin",
"Correct Option": "A",
"Options": {
"A": "Ethambutol + Clarithromycin + Rifabutin",
"B": "Pyrazinamide + Clarithromycin + Rifabutin",
"C": "Ethambutol + Clindamycin + Rifabutin",
"D": "Ethambutol + Clarithromycin + Rifaximin"
},
"Question": "A 70-year-old female presented with chronic productive cough, low grade fever and progressive weight loss for 4 months. Patient had a history of Pulmonary TB 3 years back for which she took ATT for 6 months. The doctor ordered a chest X-ray and a CT to be done. Her sputum sample was taken. Acid fast bacilli were observed. The patient did not respond to the ATT. Some other infection was suspected. Which of the following is the most appropriate regimen to be given in the following condition: -"
} | A 70-year-old female presented with chronic productive cough, low grade fever and progressive weight loss for 4 months. Patient had a history of Pulmonary TB 3 years back for which she took ATT for 6 months. The doctor ordered a chest X-ray and a CT to be done. Her sputum sample was taken. Acid fast bacilli were observed. The patient did not respond to the ATT. Some other infection was suspected. | Which of the following is the most appropriate regimen to be given in the following condition: - | {
"A": "Ethambutol + Clarithromycin + Rifabutin",
"B": "Pyrazinamide + Clarithromycin + Rifabutin",
"C": "Ethambutol + Clindamycin + Rifabutin",
"D": "Ethambutol + Clarithromycin + Rifaximin"
} | A. Ethambutol + Clarithromycin + Rifabutin |
b836c6af-f19b-4a28-84b1-61e333ba074b | A 65-year-old man undergoes a technically difficult abdominoperineal resection for a rectal cancer during which he receives three units of packed red blood cells. Four hours later in the intensive care unit he is bleeding heavily from his perineal wound. Emergency coagulation studies reveal normal prothrombin, partial thromboplastin, and bleeding times. The fibrin degradation products are not elevated but the serum fibrinogen content is depressed and the platelet count is 70,000/mL. The most likely cause of the bleeding is | Delayed blood transfusion reaction | Autoimmune fibrinolysis | A bleeding blood vessel in the surgical field | Factor VIII deficiency | 2c
| multi | Whenever significant bleeding is noted in the early postoperative period, the presumption should always be that it is due to an error in surgical control of blood vessels in the operative field. Hematologic disorders that are not apparent during the long operation are most unlikely to surface as problems postoperatively. Blood transfusion reactions can cause diffuse loss of clot integrity; the sudden appearance of diffuse bleeding during an operation may be the only evidence of an intraoperative transfusion reaction. In the postoperative period, transfusion reactions usually present as unexplained fever, apprehension, and headache all symptoms difficult to interpret in the early postoperative period. Factor VIII deficiency (hemophilia) would almost certainly be known by history in a 65-year-old man, but if not, intraoperative bleeding would have been a problem earlier in this long operation. Severely hypothermic patients will not be able to form clots effectively, but clot dissolution does not occur. Care should be taken to prevent the development of hypothermia during long operations through the use of warmed intravenous fluid, gas humidifiers, and insulated skin barriers. | Surgery | Wounds, Tissue Repair & Scars | 118 | {
"Correct Answer": "A bleeding blood vessel in the surgical field",
"Correct Option": "C",
"Options": {
"A": "Delayed blood transfusion reaction",
"B": "Autoimmune fibrinolysis",
"C": "A bleeding blood vessel in the surgical field",
"D": "Factor VIII deficiency"
},
"Question": "A 65-year-old man undergoes a technically difficult abdominoperineal resection for a rectal cancer during which he receives three units of packed red blood cells. Four hours later in the intensive care unit he is bleeding heavily from his perineal wound. Emergency coagulation studies reveal normal prothrombin, partial thromboplastin, and bleeding times. The fibrin degradation products are not elevated but the serum fibrinogen content is depressed and the platelet count is 70,000/mL. The most likely cause of the bleeding is"
} | A 65-year-old man undergoes a technically difficult abdominoperineal resection for a rectal cancer during which he receives three units of packed red blood cells. Four hours later in the intensive care unit he is bleeding heavily from his perineal wound. Emergency coagulation studies reveal normal prothrombin, partial thromboplastin, and bleeding times. The fibrin degradation products are not elevated but the serum fibrinogen content is depressed and the platelet count is 70,000/mL. | The most likely cause of the bleeding is | {
"A": "Delayed blood transfusion reaction",
"B": "Autoimmune fibrinolysis",
"C": "A bleeding blood vessel in the surgical field",
"D": "Factor VIII deficiency"
} | C. A bleeding blood vessel in the surgical field |
59d8efd7-8e5f-4a5b-980f-80ea67978d1c | A 7-month-old infant who was recently staed on top feeds, presented with diarrhea, vomiting, nausea, abdominal pain and distension leading to poor feeding and poor weight gain. On examination hepatosplenomegaly was observed. Lab findings Blood sugar- decreased Serum bilirubin- increased Uric acid-increased. Urine- a reducing substance was found during the episode of hypoglycemia. All of the following statements are true about the following condition except: - | The enzyme involved catalyzes the hydrolysis of fructose- 1,6-bisphosphate into triose phosphate and glyceraldehyde phosphate. | The enzyme involved catalyzes the conversion of fructose to fructose-1 phosphate | The enzyme involved catalyzes the conversion of galactose-1-phosphate to glucose-1-phospate. | The enzyme involved catalyzes the conversion of galactose to galactose-1-phosphate | 0a
| multi | This is a case of hereditary fructose intolerance because the age of presentation is after 6 months as after 6 months fructose containing food are introduced into the diet. It occurs due to the deficiency aldolase B enzyme. Aldolase B catalyzes the conversion of fructose- 1,6-bisphosphate into triose phosphate and glyceraldehyde phosphate It leads to profound hypoglycemia and vomiting after consumption of fructose (or sucrose, which yields fructose on digestion). OPTION B is essential fructosuria which is due to the deficiency of fructokinase which conves fructose into fructose-1-phosphate and is an asymptomatic condition. OPTION C is classical galactosemia due to the deficiency of galactose-1 phosphate uridyl transferase and usually presents in the 2nd week of life and not after 6 months and presents with jaundice, hepatomegaly, vomiting, hypoglycemia, seizures, hepatic failure, ascites, splenomegaly, or intellectual disability. OPTION D is galactokinase deficiency and presents with increased galactose levels in serum if the child consumes a high lactose diet. | Unknown | Integrated QBank | 101 | {
"Correct Answer": "The enzyme involved catalyzes the hydrolysis of fructose- 1,6-bisphosphate into triose phosphate and glyceraldehyde phosphate.",
"Correct Option": "A",
"Options": {
"A": "The enzyme involved catalyzes the hydrolysis of fructose- 1,6-bisphosphate into triose phosphate and glyceraldehyde phosphate.",
"B": "The enzyme involved catalyzes the conversion of fructose to fructose-1 phosphate",
"C": "The enzyme involved catalyzes the conversion of galactose-1-phosphate to glucose-1-phospate.",
"D": "The enzyme involved catalyzes the conversion of galactose to galactose-1-phosphate"
},
"Question": "A 7-month-old infant who was recently staed on top feeds, presented with diarrhea, vomiting, nausea, abdominal pain and distension leading to poor feeding and poor weight gain. On examination hepatosplenomegaly was observed. Lab findings Blood sugar- decreased Serum bilirubin- increased Uric acid-increased. Urine- a reducing substance was found during the episode of hypoglycemia. All of the following statements are true about the following condition except: -"
} | A 7-month-old infant who was recently staed on top feeds, presented with diarrhea, vomiting, nausea, abdominal pain and distension leading to poor feeding and poor weight gain. On examination hepatosplenomegaly was observed. Lab findings Blood sugar- decreased Serum bilirubin- increased Uric acid-increased. Urine- a reducing substance was found during the episode of hypoglycemia. | All of the following statements are true about the following condition except: - | {
"A": "The enzyme involved catalyzes the hydrolysis of fructose- 1,6-bisphosphate into triose phosphate and glyceraldehyde phosphate.",
"B": "The enzyme involved catalyzes the conversion of fructose to fructose-1 phosphate",
"C": "The enzyme involved catalyzes the conversion of galactose-1-phosphate to glucose-1-phospate.",
"D": "The enzyme involved catalyzes the conversion of galactose to galactose-1-phosphate"
} | A. The enzyme involved catalyzes the hydrolysis of fructose- 1,6-bisphosphate into triose phosphate and glyceraldehyde phosphate. |
5c0f5ecf-0e3b-4e6a-bce6-073b04e37e88 | A 45-year-old man has had poorly controlled hypertension ranging from 150/90 mm Hg to 160/95 mm Hg for the past 11 years. Over the past 3 months, his blood pressure has increased to 250/125 mm Hg. On physical examination, his temperature is 36.9deg C. His lungs are clear on auscultation, and his heart rate is regular. There is no abdominal pain on palpation. A chest radiograph shows a prominent border on the left side of the heart. Laboratory studies show that his serum creatinine level has increased during this time from 1.7 mg/dL to 3.8 mg/dL. Which of the following vascular lesions is most likely to be found in this patient's kidneys? | Fibromuscular dysplasia | Granulomatous arteritis | Renal arterial stenosis | Necrotizing arteriolitis | 3d
| single | Malignant hypertension can suddenly complicate and be superimposed on less severe, benign essential hypertension. The arterioles undergo concentric thickening and luminal narrowing with malignant hypertension, called hyperplastic arteriolosclerosis, and fibrinoid necrosis is a prominent feature. Fibromuscular dysplasia can involve the main renal arteries, with medial hyperplasia producing focal arterial obstruction. This process can lead to hypertension, but not typically malignant hypertension. Granulomatous arteritis is the most characteristic of anti-neutrophil cytoplasmic autoantibody (ANCA)-associated granulomatous vasculitis, which often involves the kidney but typically involves the lung and other organs. Hyaline arteriolosclerosis is seen with long-standing essential hypertension of moderate severity. These lesions give rise to benign nephrosclerosis. The affected kidneys become symmetrically shrunken and granular because of progressive loss of renal parenchyma and consequent fine scarring. Polyarteritis nodosa produces a vasculitis that can involve the kidney. | Pathology | Blood Vessels | 174 | {
"Correct Answer": "Necrotizing arteriolitis",
"Correct Option": "D",
"Options": {
"A": "Fibromuscular dysplasia",
"B": "Granulomatous arteritis",
"C": "Renal arterial stenosis",
"D": "Necrotizing arteriolitis"
},
"Question": "A 45-year-old man has had poorly controlled hypertension ranging from 150/90 mm Hg to 160/95 mm Hg for the past 11 years. Over the past 3 months, his blood pressure has increased to 250/125 mm Hg. On physical examination, his temperature is 36.9deg C. His lungs are clear on auscultation, and his heart rate is regular. There is no abdominal pain on palpation. A chest radiograph shows a prominent border on the left side of the heart. Laboratory studies show that his serum creatinine level has increased during this time from 1.7 mg/dL to 3.8 mg/dL. Which of the following vascular lesions is most likely to be found in this patient's kidneys?"
} | A 45-year-old man has had poorly controlled hypertension ranging from 150/90 mm Hg to 160/95 mm Hg for the past 11 years. Over the past 3 months, his blood pressure has increased to 250/125 mm Hg. On physical examination, his temperature is 36.9deg C. His lungs are clear on auscultation, and his heart rate is regular. There is no abdominal pain on palpation. A chest radiograph shows a prominent border on the left side of the heart. Laboratory studies show that his serum creatinine level has increased during this time from 1.7 mg/dL to 3.8 mg/dL. | Which of the following vascular lesions is most likely to be found in this patient's kidneys? | {
"A": "Fibromuscular dysplasia",
"B": "Granulomatous arteritis",
"C": "Renal arterial stenosis",
"D": "Necrotizing arteriolitis"
} | D. Necrotizing arteriolitis |
04cde576-1e9a-4465-941e-00816aa63731 | A 25-year-old man presents to the emergency room with several red, swollen, tender bite wounds on both arms that he stated occurred yesterday when he rescued his dog from a dogfight involving three other dogs, whose owner(s) is unknown. His right wrist and left elbow are also swollen and there is axillary lymphadenopathy on the left side. Gram stain of purulent material from the worst wound shows small gram-negative pleomorphic coccobacilli. The patient reports his last tetanus vaccination was 2 years ago. In addition to antibiotics, which of the following should be included in this patient's treatment? | Hepatitis B virus prophylaxis | IV immunoglobulins (nonspecific) | Rabies prophylaxis | Tetanus prophylaxis | 2c
| multi | The patient has bite wounds most likely infected with Pasteurella multocida. Since the wounds were caused by dogs whose owners were unknown, the patient should also begin rabies prophylaxis (c). There is no need for varicella-zoster prophylaxis (e) since there is no history of shingles at this time. The patient is up to date on his tetanus immunization, so tetanus prophylaxis is not needed either (d). IV immunoglobulins (nonspecific) (b) are used to treat patients with IgG deficiency. Hepatitis B virus (HBV) prophylaxis is not needed unless the bites were inflicted by a human whose HBV status was unknown and could not be determined. | Microbiology | General | 127 | {
"Correct Answer": "Rabies prophylaxis",
"Correct Option": "C",
"Options": {
"A": "Hepatitis B virus prophylaxis",
"B": "IV immunoglobulins (nonspecific)",
"C": "Rabies prophylaxis",
"D": "Tetanus prophylaxis"
},
"Question": "A 25-year-old man presents to the emergency room with several red, swollen, tender bite wounds on both arms that he stated occurred yesterday when he rescued his dog from a dogfight involving three other dogs, whose owner(s) is unknown. His right wrist and left elbow are also swollen and there is axillary lymphadenopathy on the left side. Gram stain of purulent material from the worst wound shows small gram-negative pleomorphic coccobacilli. The patient reports his last tetanus vaccination was 2 years ago. In addition to antibiotics, which of the following should be included in this patient's treatment?"
} | A 25-year-old man presents to the emergency room with several red, swollen, tender bite wounds on both arms that he stated occurred yesterday when he rescued his dog from a dogfight involving three other dogs, whose owner(s) is unknown. His right wrist and left elbow are also swollen and there is axillary lymphadenopathy on the left side. Gram stain of purulent material from the worst wound shows small gram-negative pleomorphic coccobacilli. The patient reports his last tetanus vaccination was 2 years ago. | In addition to antibiotics, which of the following should be included in this patient's treatment? | {
"A": "Hepatitis B virus prophylaxis",
"B": "IV immunoglobulins (nonspecific)",
"C": "Rabies prophylaxis",
"D": "Tetanus prophylaxis"
} | C. Rabies prophylaxis |
3a5cc7b4-dac7-4e7d-a341-b2a19bbc0492 | A 64-year woman with Type II diabetes for 10 years now develops increasing fatigue, dyspnea, and pedal edema. On examination, her blood pressure is 165/90 mm Hg, pulse 90/min, JVP is 4 cm, heart sounds are normal, lungs are clear, and there is 3+ pedal edema. Her urinalysis is positive for 3 gm/L of protein and no casts. Which of the following renal diseases is the most likely diagnosis in this patient? | acute glomerulonephritis | obstructive uropathy | glomerulosclerosis with mesangial thickening | renal infarction | 2c
| single | The patient is most likely to develop glomerulosclerosis. This can be diffuse or nodular (Kimmelstiel-Wilson nodules). Poor metabolic control is probably a major factor in the progression of diabetic nephropathy. | Medicine | Endocrinology | 112 | {
"Correct Answer": "glomerulosclerosis with mesangial thickening",
"Correct Option": "C",
"Options": {
"A": "acute glomerulonephritis",
"B": "obstructive uropathy",
"C": "glomerulosclerosis with mesangial thickening",
"D": "renal infarction"
},
"Question": "A 64-year woman with Type II diabetes for 10 years now develops increasing fatigue, dyspnea, and pedal edema. On examination, her blood pressure is 165/90 mm Hg, pulse 90/min, JVP is 4 cm, heart sounds are normal, lungs are clear, and there is 3+ pedal edema. Her urinalysis is positive for 3 gm/L of protein and no casts. Which of the following renal diseases is the most likely diagnosis in this patient?"
} | A 64-year woman with Type II diabetes for 10 years now develops increasing fatigue, dyspnea, and pedal edema. On examination, her blood pressure is 165/90 mm Hg, pulse 90/min, JVP is 4 cm, heart sounds are normal, lungs are clear, and there is 3+ pedal edema. Her urinalysis is positive for 3 gm/L of protein and no casts. | Which of the following renal diseases is the most likely diagnosis in this patient? | {
"A": "acute glomerulonephritis",
"B": "obstructive uropathy",
"C": "glomerulosclerosis with mesangial thickening",
"D": "renal infarction"
} | C. glomerulosclerosis with mesangial thickening |
7f9f27bb-82e7-44fa-8b88-a1bedc5618bf | A 43-year-old woman has had a headache and fever for the past 2 weeks following a severe respiratory tract infection accompanying bronchiectasis. On physical examination, her temperature is 38.3degC. There is no papilledema. She has no loss of sensation or motor function, but there is decreased vision in the left half of her visual fields. CT scan of the head shows a sharply demarcated, 3-cm, a ring-enhancing lesion in the right occipital region. A lumbar puncture is done, and laboratory analysis of the CSF shows numerous leukocytes, increased protein, and normal glucose levels. What is the most likely diagnosis? | Cerebral abscess | Glioblastoma | Metastatic carcinoma | Multiple sclerosis | 0a
| single | A cerebral abscess is most often a complication of an infection, such as pneumonia or endocarditis, with onset days to weeks earlier. The bacteria spread hematogenously. As the abscess organizes, it is ringed by fibroblasts that deposit collagen; this feature is characteristic of an abscess in the CNS. A neoplasm occasionally may be ring-enhancing, but glioblastoma is an aggressive malignancy that is not well demarcated. Metastases are mass lesions that are typically multifocal. A multiple sclerosis plaques is generally not large, is found in white matter, and does not typically have ring enhancement. An infarct would produce sudden signs and symptoms that improve over time, and the CSF protein would not be increased. | Pathology | Central Nervous System | 143 | {
"Correct Answer": "Cerebral abscess",
"Correct Option": "A",
"Options": {
"A": "Cerebral abscess",
"B": "Glioblastoma",
"C": "Metastatic carcinoma",
"D": "Multiple sclerosis"
},
"Question": "A 43-year-old woman has had a headache and fever for the past 2 weeks following a severe respiratory tract infection accompanying bronchiectasis. On physical examination, her temperature is 38.3degC. There is no papilledema. She has no loss of sensation or motor function, but there is decreased vision in the left half of her visual fields. CT scan of the head shows a sharply demarcated, 3-cm, a ring-enhancing lesion in the right occipital region. A lumbar puncture is done, and laboratory analysis of the CSF shows numerous leukocytes, increased protein, and normal glucose levels. What is the most likely diagnosis?"
} | A 43-year-old woman has had a headache and fever for the past 2 weeks following a severe respiratory tract infection accompanying bronchiectasis. On physical examination, her temperature is 38.3degC. There is no papilledema. She has no loss of sensation or motor function, but there is decreased vision in the left half of her visual fields. CT scan of the head shows a sharply demarcated, 3-cm, a ring-enhancing lesion in the right occipital region. A lumbar puncture is done, and laboratory analysis of the CSF shows numerous leukocytes, increased protein, and normal glucose levels. | What is the most likely diagnosis? | {
"A": "Cerebral abscess",
"B": "Glioblastoma",
"C": "Metastatic carcinoma",
"D": "Multiple sclerosis"
} | A. Cerebral abscess |
dd9db34f-a342-47b0-a171-c01a6af3e8bb | A 40-year-old man presents with muscle weakness. He cannot open his hand for a handshake and cannot extend his arm after flexing it. On physical examination, he has marked atrophy of leg and arm muscles, ptosis, and a fixed facial expression. There is testicular atrophy. Laboratory studies demonstrate mild diabetes. A muscle biopsy reveals atrophy of type I fibers, hyperophy of type II fibers, and numerous fibers with centrally located nuclei. Which of the following is the most likely diagnosis? | Dermatomyositis | Duchenne muscular dystrophy | Nemaline myopathy | Myotonic dystrophy | 3d
| multi | Myotonic dystrophy most common form of adult muscular dystrophy, Autosomal dominant disorder Characterized by slowing muscle relaxation (myotonia) and progressive muscle weakness andwasting. Includes hea, smooth muscle, central nervous system, endocrine glands, and eye. Myotonic dystrophy can be separated into two clinical groups: Adult-onset:Atrophy of type I fibres and hyperophy of type II fibres Congenital Unlike the other choices, internally situated nuclei are a constant feature. Necrosis and regeneration, although occasionally present, are not as prominent as they are in Duchenne muscular dystrophy (choice B). Dermatomyositis is a systemic autoimmune disease that typically presents with proximal muscle weakness and skin changes, damage to small blood vessels contributes to muscle injury. Biopsies of muscle and skin may show deposition of the complement membrane attack complex (C5b-9) within capillary beds. Perifascicular atrophy, heliotrope rash and Gottron papules are characteristic. Nemaline myopathy - Childhood weakness; some with more severe weakness, hypotonia at bih ("floppy infant"). Aggregates of spindle-shaped paicles (nemaline rods); occur predominantly in type 1 fibers; derived from Z-band material (a-actinin) and best seen on modified Gomori stain or by electron microscopy. | Pathology | Skin, Bones and Joints | 105 | {
"Correct Answer": "Myotonic dystrophy",
"Correct Option": "D",
"Options": {
"A": "Dermatomyositis",
"B": "Duchenne muscular dystrophy",
"C": "Nemaline myopathy",
"D": "Myotonic dystrophy"
},
"Question": "A 40-year-old man presents with muscle weakness. He cannot open his hand for a handshake and cannot extend his arm after flexing it. On physical examination, he has marked atrophy of leg and arm muscles, ptosis, and a fixed facial expression. There is testicular atrophy. Laboratory studies demonstrate mild diabetes. A muscle biopsy reveals atrophy of type I fibers, hyperophy of type II fibers, and numerous fibers with centrally located nuclei. Which of the following is the most likely diagnosis?"
} | A 40-year-old man presents with muscle weakness. He cannot open his hand for a handshake and cannot extend his arm after flexing it. On physical examination, he has marked atrophy of leg and arm muscles, ptosis, and a fixed facial expression. There is testicular atrophy. Laboratory studies demonstrate mild diabetes. A muscle biopsy reveals atrophy of type I fibers, hyperophy of type II fibers, and numerous fibers with centrally located nuclei. | Which of the following is the most likely diagnosis? | {
"A": "Dermatomyositis",
"B": "Duchenne muscular dystrophy",
"C": "Nemaline myopathy",
"D": "Myotonic dystrophy"
} | D. Myotonic dystrophy |
7c2352ed-67ff-4279-9714-5bcf531f000d | An 81-year-old female presents to ER. Her son gives a collateral history, as the patient is very difficult to understand. He repos that the patient has had difficulty walking and could not lift her left arm for the past hour. He has also noticed the patient's speech doesn't make sense. O/E-The patient is right-handed. There is reduced power (MRC 2/5) and flaccidity in the left arm and leg. Light touch sensation is also decreased on the left arm and leg. The right arm and leg appear normal. Visual fields are normal, but there is a detion of both eyes to right. According to the Oxford Classification of Stroke, what type of stroke is this ? | Total Anterior Circulation Infarction | Paial Anterior Circulation Infarction | Superior Cerebellar Aery Infarction | Lacunar Infarction | 1b
| multi | -Difficulty walking, difficulty in movements- DYSAHRIA (unclear speech). -Visual field are N but optic detion in both eyes i.e optic radiation to the contralateral side at the site of lesion as in coical stroke can be seen. Therefore, here problem in LEFT side, patient's eyes is deted to contra lateral side/towards the side of stroke. Since the question mentions weakness in the arms & legs we can diagnose it as Ant. CIRCULATION. Option C- gait ataxia and cerebellar damage features not mentioned & cannot be the answer. Option D- Causes either pure motor or pure sensory but here there is motor+ sensory involvement affected. Oxford Stroke Classification Type of infarct Criteria and features Total anterior circulation infarct (TACI) Combination of all 3: 1. Unilateral hemiparesis and/or hemisensory loss of face, arm and legs-(motor and sensory coex affected) 2. Homonymous hemianopia (involvement of the optic radiation) 3. Higher cognitive dysfunction: - Expressive or receptive Dysphasia (Dominant hemisphere involved) - Visual and sensory inattention - Neglect(Non dominant hemisphere involved) Paial anterior circulation infarcts (PACI) 2/3 of the criteria for TACI Lacunar Infarction (LACI) Coex is spared(No higher coical function defect) One of the following is needed for diagnosis: - Pure motor hemiparesis - Pure hemi sensory loss - Sensorimotor stroke - Ataxic hemiparesis - Dysahria Posterior Circulation Infarction (POCI) "Crossed" syndromes, with I/L cranial nerve palsy C/L motor and/or sensory deficit Features include: - Ataxia - Cerebellar syndrome - Horner's Syndrome - Isolated homonymous hemianopia (occipital lobe supplied by posterior cerebral aery) - Coical blindness (basilar aery occlusion affecting both occipital coices) | Medicine | Stroke and TIA | 146 | {
"Correct Answer": "Paial Anterior Circulation Infarction",
"Correct Option": "B",
"Options": {
"A": "Total Anterior Circulation Infarction",
"B": "Paial Anterior Circulation Infarction",
"C": "Superior Cerebellar Aery Infarction",
"D": "Lacunar Infarction"
},
"Question": "An 81-year-old female presents to ER. Her son gives a collateral history, as the patient is very difficult to understand. He repos that the patient has had difficulty walking and could not lift her left arm for the past hour. He has also noticed the patient's speech doesn't make sense. O/E-The patient is right-handed. There is reduced power (MRC 2/5) and flaccidity in the left arm and leg. Light touch sensation is also decreased on the left arm and leg. The right arm and leg appear normal. Visual fields are normal, but there is a detion of both eyes to right. According to the Oxford Classification of Stroke, what type of stroke is this ?"
} | An 81-year-old female presents to ER. Her son gives a collateral history, as the patient is very difficult to understand. He repos that the patient has had difficulty walking and could not lift her left arm for the past hour. He has also noticed the patient's speech doesn't make sense. O/E-The patient is right-handed. There is reduced power (MRC 2/5) and flaccidity in the left arm and leg. Light touch sensation is also decreased on the left arm and leg. The right arm and leg appear normal. Visual fields are normal, but there is a detion of both eyes to right. | According to the Oxford Classification of Stroke, what type of stroke is this ? | {
"A": "Total Anterior Circulation Infarction",
"B": "Paial Anterior Circulation Infarction",
"C": "Superior Cerebellar Aery Infarction",
"D": "Lacunar Infarction"
} | B. Paial Anterior Circulation Infarction |
caca3c73-2431-4886-af04-ebd73b03708c | A mother brings her 1-year-old daughter to the physician. She says that for the last 2 days her daughter has been fussy and crying more than usual. She also refuses formula. The patient has a fever of 39.4degC (102.9degF). Meningitis is suspected, and a lumbar puncture is per- formed. Analysis of the cerebrospinal fluid shows an opening pressure of 98 mm H2O, a leukocyte count of 1256/mm3, a protein level of 210 mg/dL, and a glucose level of 31 mg/dL.. The mother says that the patient has received no immunizations. Which of the following organisms is most likely responsible for this patient's illness? | Clostridium botulinum | Haemophilus influenza | Neisseria meningitides | Streptococcus pneumoniae | 1b
| single | (B) Haemophilus influenzae > Most common cause of meningitis in the 1-year-old age group Haemophilus influenzae. Clostridium botulinum floppy baby | Microbiology | Misc. | 164 | {
"Correct Answer": "Haemophilus influenza",
"Correct Option": "B",
"Options": {
"A": "Clostridium botulinum",
"B": "Haemophilus influenza",
"C": "Neisseria meningitides",
"D": "Streptococcus pneumoniae"
},
"Question": "A mother brings her 1-year-old daughter to the physician. She says that for the last 2 days her daughter has been fussy and crying more than usual. She also refuses formula. The patient has a fever of 39.4degC (102.9degF). Meningitis is suspected, and a lumbar puncture is per- formed. Analysis of the cerebrospinal fluid shows an opening pressure of 98 mm H2O, a leukocyte count of 1256/mm3, a protein level of 210 mg/dL, and a glucose level of 31 mg/dL.. The mother says that the patient has received no immunizations. Which of the following organisms is most likely responsible for this patient's illness?"
} | A mother brings her 1-year-old daughter to the physician. She says that for the last 2 days her daughter has been fussy and crying more than usual. She also refuses formula. The patient has a fever of 39.4degC (102.9degF). Meningitis is suspected, and a lumbar puncture is per- formed. Analysis of the cerebrospinal fluid shows an opening pressure of 98 mm H2O, a leukocyte count of 1256/mm3, a protein level of 210 mg/dL, and a glucose level of 31 mg/dL.. The mother says that the patient has received no immunizations. | Which of the following organisms is most likely responsible for this patient's illness? | {
"A": "Clostridium botulinum",
"B": "Haemophilus influenza",
"C": "Neisseria meningitides",
"D": "Streptococcus pneumoniae"
} | B. Haemophilus influenza |
fcd4f1be-538b-4572-bbf2-d987a52c86c2 | A 28-year-old man presents with coughing up blood and sputum. He gives 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 nonsmoker. 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 | Bronchography has been superseded by a CT scan in defining the extent of bronchiectasis. Occasionally, advanced cases of saccular bronchiectasis can be diagnosed by routine CXR. The use of high-resolution CT scanning, in which the images are 1.5 mm thick, has resulted in excellent diagnostic accuracy. | Medicine | Respiratory | 141 | {
"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 with coughing up blood and sputum. He gives 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 nonsmoker. 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 with coughing up blood and sputum. He gives 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 nonsmoker. 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 |
fff6d804-c8d9-4f5e-91c7-c879336fa49c | A female infant appeared normal at bih but developed signs of liver disease and muscular weakness at 3 months. She had periods of hypoglycemia, paicularly on awakening. Examination revealed hepatomegaly. Laboratory analyses following fasting revealed ketoacidosis, blood pH 7.25, and elevations in both alanine transaminase (ALT) and aspaate transaminase (AST). Administration of glucagon following a carbohydrate meal elicited a normal rise in blood glucose, but glucose levels did not rise when glucagon was administered following an overnight fast. Liver biopsy revealed an increase in the glycogen content. To prevent the frequent episodes of hypoglycemia, which of the following dietary supplements would be most appropriate for this patient? | Casein (milk protein) | Uncooked cornstarch | Fructose | Lactose | 1b
| multi | Because fasting hypoglycemia results from an inability to break down glycogen past the limit dextrin of phosphorylase, a patient with type III glycogen storage disease should be given frequent meals high in carbohydrates. Uncooked cornstarch is an effective supplement because it is slowly digested, and therefore the glucose is released slowly into the bloodstream, helping to maintain blood glucose concentrations. Ref: Powers A.C., D'Alessio D. (2011). Chapter 43. Endocrine Pancreas and Pharmacotherapy of Diabetes Mellitus and Hypoglycemia. In L.L. Brunton, B.A. Chabner, B.C. Knollmann (Eds), Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e. | Biochemistry | null | 155 | {
"Correct Answer": "Uncooked cornstarch",
"Correct Option": "B",
"Options": {
"A": "Casein (milk protein)",
"B": "Uncooked cornstarch",
"C": "Fructose",
"D": "Lactose"
},
"Question": "A female infant appeared normal at bih but developed signs of liver disease and muscular weakness at 3 months. She had periods of hypoglycemia, paicularly on awakening. Examination revealed hepatomegaly. Laboratory analyses following fasting revealed ketoacidosis, blood pH 7.25, and elevations in both alanine transaminase (ALT) and aspaate transaminase (AST). Administration of glucagon following a carbohydrate meal elicited a normal rise in blood glucose, but glucose levels did not rise when glucagon was administered following an overnight fast. Liver biopsy revealed an increase in the glycogen content. To prevent the frequent episodes of hypoglycemia, which of the following dietary supplements would be most appropriate for this patient?"
} | A female infant appeared normal at bih but developed signs of liver disease and muscular weakness at 3 months. She had periods of hypoglycemia, paicularly on awakening. Examination revealed hepatomegaly. Laboratory analyses following fasting revealed ketoacidosis, blood pH 7.25, and elevations in both alanine transaminase (ALT) and aspaate transaminase (AST). Administration of glucagon following a carbohydrate meal elicited a normal rise in blood glucose, but glucose levels did not rise when glucagon was administered following an overnight fast. Liver biopsy revealed an increase in the glycogen content. | To prevent the frequent episodes of hypoglycemia, which of the following dietary supplements would be most appropriate for this patient? | {
"A": "Casein (milk protein)",
"B": "Uncooked cornstarch",
"C": "Fructose",
"D": "Lactose"
} | B. Uncooked cornstarch |
3a676303-a3b2-4a51-9974-d0937de61d00 | A study of HIV-infected persons shows that those with CD4+ lymphocyte counts below 100 cells/mL are found to be at increased risk for pulmonary infections. Some of them have concurrent hepatosplenomegaly and lymphadenopathy, as well as malabsorption with weight loss, night sweats, and fever. Bronchoalveolar lavage specimens examined microscopically show macrophages filled with acid-fast infectious organisms. Which of the following infections have these persons developed? | Aspergillus niger | Candida albicans | Legionella pneumophila | Mycobacterium avium-complex | 3d
| multi | Nontuberculous mycobacterial infections such as Mycobacterium avium-complex (MAC) are likely to become disseminated illnesses in immunocompromised persons. In immunocompetent persons, such infections are more likely to resemble tuberculosis. The acid-fast MAC organisms proliferate profusely in macrophages within the mononuclear phagocyte system. Extensive and severe aspergillosis and candidiasis are more likely to occur with profound neutropenia, not lymphocytopenia. Legionella produces an extensive bacterial pneumonia, not disseminated disease. Nocardiosis occurs in immunocompromised patients, and the organisms can be weakly acid-fast, but focal nodules or a chronic abscessing inflammatory response are more likely. | Pathology | Respiration | 103 | {
"Correct Answer": "Mycobacterium avium-complex",
"Correct Option": "D",
"Options": {
"A": "Aspergillus niger",
"B": "Candida albicans",
"C": "Legionella pneumophila",
"D": "Mycobacterium avium-complex"
},
"Question": "A study of HIV-infected persons shows that those with CD4+ lymphocyte counts below 100 cells/mL are found to be at increased risk for pulmonary infections. Some of them have concurrent hepatosplenomegaly and lymphadenopathy, as well as malabsorption with weight loss, night sweats, and fever. Bronchoalveolar lavage specimens examined microscopically show macrophages filled with acid-fast infectious organisms. Which of the following infections have these persons developed?"
} | A study of HIV-infected persons shows that those with CD4+ lymphocyte counts below 100 cells/mL are found to be at increased risk for pulmonary infections. Some of them have concurrent hepatosplenomegaly and lymphadenopathy, as well as malabsorption with weight loss, night sweats, and fever. Bronchoalveolar lavage specimens examined microscopically show macrophages filled with acid-fast infectious organisms. | Which of the following infections have these persons developed? | {
"A": "Aspergillus niger",
"B": "Candida albicans",
"C": "Legionella pneumophila",
"D": "Mycobacterium avium-complex"
} | D. Mycobacterium avium-complex |
e87cb25b-9c94-457e-bdb8-c1dcfe708d86 | A 26-year-old obstetric patient becomes acutely ill during her first trimester with infectious mononucleosis-like symptoms, but her heterophil antibody test was negative. A careful history reveals that the family has two cats in the house. The appropriate laboratory tests indicate the expectant mother is infected with Toxoplasma gondii. Months later, the woman delivers a full term baby with no obvious signs of infection with the protozoan parasite. The best test to diagnose acute infection in the neonate would be a parasite-specific ELISA for which isotype of immunoglobulin? | IgA | IgG 1 | IgG 4 | IgM | 3d
| single | IgM immunoglobulin directed against Toxoplasma would provide evidence of infection in the newborn baby. IgM is the only antibody that a baby can form with an acute infection. It is the first antibody that is formed in an infection and it is also the antibody that is present on the surface of immature and mature B cells. IgA is the antibody that is produced in response to mucosal infections. It cannot cross the placenta. The baby's immune system is still not well developed at bih and cannot produce IgA immunoglobulin. In adults or older children, IgA is exists in serum in a monomeric form but is present in seromucous secretions as a dimer. IgG1 and IgG4 immunoglobulins might be present in the baby, but would not indicate infection in the infant. The presence of these isotypes would indicate that the mother was infected with the organism and produced antibody that was transpoed across the placenta in utero. IgG is the only immunoglobulin that can cross the placenta, providing protection to the baby during the first few months of life. Ref: Levinson W. (2012). Chapter 52. Blood & Tissue Protozoa. In W. Levinson (Ed),Review of Medical Microbiology & Immunology, 12e. | Microbiology | null | 122 | {
"Correct Answer": "IgM",
"Correct Option": "D",
"Options": {
"A": "IgA",
"B": "IgG 1",
"C": "IgG 4",
"D": "IgM"
},
"Question": "A 26-year-old obstetric patient becomes acutely ill during her first trimester with infectious mononucleosis-like symptoms, but her heterophil antibody test was negative. A careful history reveals that the family has two cats in the house. The appropriate laboratory tests indicate the expectant mother is infected with Toxoplasma gondii. Months later, the woman delivers a full term baby with no obvious signs of infection with the protozoan parasite. The best test to diagnose acute infection in the neonate would be a parasite-specific ELISA for which isotype of immunoglobulin?"
} | A 26-year-old obstetric patient becomes acutely ill during her first trimester with infectious mononucleosis-like symptoms, but her heterophil antibody test was negative. A careful history reveals that the family has two cats in the house. The appropriate laboratory tests indicate the expectant mother is infected with Toxoplasma gondii. Months later, the woman delivers a full term baby with no obvious signs of infection with the protozoan parasite. | The best test to diagnose acute infection in the neonate would be a parasite-specific ELISA for which isotype of immunoglobulin? | {
"A": "IgA",
"B": "IgG 1",
"C": "IgG 4",
"D": "IgM"
} | D. IgM |
d24e7d12-6289-4243-8186-be0f73a69d7f | A 2 year old child is seen on a routine visit in the pediatric clinic. Abdominal examination demonstrates a palpable, non-tender mass on the left side of the abdomen. The mother had no idea the mass was present and the pediatrician did not note the presence of the mass at the child's 18-month's visit for immunisation. Physical examination is otherwise unremarkable. If a CT guided biopsy of the mass were performed, which of the following histological patterns would be most suggestive of the likely diagnosis? | Cords of clear cells with rounded or polygonal shape and abundant clear cytoplasm | Invasive papillary lesions with delicate connective tissue stalk covered with epithelium resembling that lining the bladder. | Small dark cells embedded in a finely fibrillar matrix with formation of numerous rosettes | Triphasic pattern with tubule formation, spindle cells, and blastemal elements | 3d
| multi | Adequate sampling of most Wilms tumors will detect the three distinct growth patterns that are most characteristic of this tumor: less cellular tumor areas containing spindle cells; densely cellular (blastemal) areas with closely packed small cells with scanty cytoplasm and darkly blue nuclei; and areas with production of more mature-appearing epithelium that may form occasional tubules. The tissues present are similar to those present in the developing kidney, and may also include primitive glomeruli. Wilms tumors may additionally contain heterologous elements, such as skeletal muscle, smooth muscle, squamous or mucinous epithelium, adipose tissue, cailage, bone, or neural tissue. First choice suggests renal cell carcinoma,second choice suggests transitional cell carcinoma & third choice suggests neuroblastoma. | Surgery | null | 109 | {
"Correct Answer": "Triphasic pattern with tubule formation, spindle cells, and blastemal elements",
"Correct Option": "D",
"Options": {
"A": "Cords of clear cells with rounded or polygonal shape and abundant clear cytoplasm",
"B": "Invasive papillary lesions with delicate connective tissue stalk covered with epithelium resembling that lining the bladder.",
"C": "Small dark cells embedded in a finely fibrillar matrix with formation of numerous rosettes",
"D": "Triphasic pattern with tubule formation, spindle cells, and blastemal elements"
},
"Question": "A 2 year old child is seen on a routine visit in the pediatric clinic. Abdominal examination demonstrates a palpable, non-tender mass on the left side of the abdomen. The mother had no idea the mass was present and the pediatrician did not note the presence of the mass at the child's 18-month's visit for immunisation. Physical examination is otherwise unremarkable. If a CT guided biopsy of the mass were performed, which of the following histological patterns would be most suggestive of the likely diagnosis?"
} | A 2 year old child is seen on a routine visit in the pediatric clinic. Abdominal examination demonstrates a palpable, non-tender mass on the left side of the abdomen. The mother had no idea the mass was present and the pediatrician did not note the presence of the mass at the child's 18-month's visit for immunisation. Physical examination is otherwise unremarkable. | If a CT guided biopsy of the mass were performed, which of the following histological patterns would be most suggestive of the likely diagnosis? | {
"A": "Cords of clear cells with rounded or polygonal shape and abundant clear cytoplasm",
"B": "Invasive papillary lesions with delicate connective tissue stalk covered with epithelium resembling that lining the bladder.",
"C": "Small dark cells embedded in a finely fibrillar matrix with formation of numerous rosettes",
"D": "Triphasic pattern with tubule formation, spindle cells, and blastemal elements"
} | D. Triphasic pattern with tubule formation, spindle cells, and blastemal elements |
d5876c48-e7d7-4eea-913b-603e38b01f1b | Guddu if I wear a old female was brought to the emergency with fever, headache and confusion. A provisional diagnosis of bacteria meningitis was made. The baby developed in severe allergic reaction to to penicillin around 6 months back. She was admitted and intravenous antibiotics we're staed . Few days later her investuinvest revealed as Hemoglobin 6.0g/L Erythrocyte count 1.2x10^6/cubic mm Leukocyte count 1500/cubic mm Which of the following is the most likely drug responsible for the above finding | Gentamicin | Chloramphenicol | Doxycycline | Vancomycin | 1b
| multi | (Ref:Katzul 11/e p803) The patient's shows decreased erythrocytes, leukocvtes, and platelets.This condition is called pancytopenia or aplastic anemia. It occurs due to suppression of stem cell function in the bone marrow. Chloramphenicol can cause both dose-dependent and dose-independent aplastic anemia.Dose-dependent aplastic anemia associated with chloramphenicol reversible after the medication is withdrawn. Dose-independent anemia is usually severe and may be fatal. | Anatomy | Other topics and Adverse effects | 123 | {
"Correct Answer": "Chloramphenicol",
"Correct Option": "B",
"Options": {
"A": "Gentamicin",
"B": "Chloramphenicol",
"C": "Doxycycline",
"D": "Vancomycin"
},
"Question": "Guddu if I wear a old female was brought to the emergency with fever, headache and confusion. A provisional diagnosis of bacteria meningitis was made. The baby developed in severe allergic reaction to to penicillin around 6 months back. She was admitted and intravenous antibiotics we're staed . Few days later her investuinvest revealed as Hemoglobin 6.0g/L Erythrocyte count 1.2x10^6/cubic mm Leukocyte count 1500/cubic mm Which of the following is the most likely drug responsible for the above finding"
} | Guddu if I wear a old female was brought to the emergency with fever, headache and confusion. A provisional diagnosis of bacteria meningitis was made. The baby developed in severe allergic reaction to to penicillin around 6 months back. She was admitted and intravenous antibiotics we're staed . | Few days later her investuinvest revealed as Hemoglobin 6.0g/L Erythrocyte count 1.2x10^6/cubic mm Leukocyte count 1500/cubic mm Which of the following is the most likely drug responsible for the above finding | {
"A": "Gentamicin",
"B": "Chloramphenicol",
"C": "Doxycycline",
"D": "Vancomycin"
} | B. Chloramphenicol |
1c35a64f-8bb4-45b2-994c-d72cfe175fa6 | A baby is born with a testicular mass. Histologic sections made of the homogeneous yellow white mass after its removal demonstrate epithelial-lined spaces that have flattened-to-cuboidal epithelial cells with vacuolated cytoplasm containing eosinophilic, hyaline-like globules. Scattered structures resembling primitive glomeruli (endodermal sinuses) are also seen. If appropriate immunohistochemical stains are performed, the eosinophilic cytoplasmic globules would most likely contain which of the following? | Alpha-fetoprotein | Estrogen receptors | Human chorionic gonadotropin | Human papilloma virus | 0a
| single | The malignant tumor is a yolk sac tumor, also known as infantile embryonal carcinoma and endodermal sinus tumor. The biggest tip-off in the question stem is the presence of endodermal sinuses that resemble primitive glomeruli. The cytoplasmic globules described contain alpha-fetoprotein, indicating yolk cell differentiation, and alpha-1-antitrypsin. Alpha-fetoprotein can also be used as a serum marker for recurrent disease. Yolk sac tumors occur in pure form in infants and children and may be pa of mixed tumours in adults.Estrogen receptors are impoant markers in breast cancer because they predict tumor response to hormonal manipulation. Human chorionic gonadotropin is found in the syncytial cells of embryonal carcinoma. Human papillomavirus can be found in condylomas, cervical cancer, penile cancer, laryngeal polyps, and was. Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 13. Prenatal Diagnosis and Fetal Therapy. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e. | Gynaecology & Obstetrics | null | 108 | {
"Correct Answer": "Alpha-fetoprotein",
"Correct Option": "A",
"Options": {
"A": "Alpha-fetoprotein",
"B": "Estrogen receptors",
"C": "Human chorionic gonadotropin",
"D": "Human papilloma virus"
},
"Question": "A baby is born with a testicular mass. Histologic sections made of the homogeneous yellow white mass after its removal demonstrate epithelial-lined spaces that have flattened-to-cuboidal epithelial cells with vacuolated cytoplasm containing eosinophilic, hyaline-like globules. Scattered structures resembling primitive glomeruli (endodermal sinuses) are also seen. If appropriate immunohistochemical stains are performed, the eosinophilic cytoplasmic globules would most likely contain which of the following?"
} | A baby is born with a testicular mass. Histologic sections made of the homogeneous yellow white mass after its removal demonstrate epithelial-lined spaces that have flattened-to-cuboidal epithelial cells with vacuolated cytoplasm containing eosinophilic, hyaline-like globules. Scattered structures resembling primitive glomeruli (endodermal sinuses) are also seen. | If appropriate immunohistochemical stains are performed, the eosinophilic cytoplasmic globules would most likely contain which of the following? | {
"A": "Alpha-fetoprotein",
"B": "Estrogen receptors",
"C": "Human chorionic gonadotropin",
"D": "Human papilloma virus"
} | A. Alpha-fetoprotein |
c8a553fa-e3fd-450a-8fa7-0a43e31a9c56 | A 42-year-old man is brought to the emergency room in an ambulance after suffering a grand mal seizure at home. There is no history of recent illness, fever, headache, seizures, or head trauma. He drinks alcohol occasionally and denies any other drug use. Neurologic exam shows the patient to be ale and oriented. No focal abnormalities are noted. A CT scan of the head reveals multiple punctate calcifications, and two enhancing cystic lesions with surrounding edema. What is the most likely diagnosis? | Amebiasis | Cytomegalovirus infection | Echinococcosis | Neurocysticercosis | 3d
| multi | Cysticercosis is a parasitic infection caused by the larval cysts of the tapeworm Taenia solium. Patients acquire the infection by ingesting the eggs, which reach a larval stage in various tissues. When the central nervous system (CNS) is involved, the condition is known as neurocysticercosis. It is the most common parasitic infection of the CNS. Infection with this organism is most frequently encountered in individuals from Mexico, South Central America, the Philippines, and Southeast Asia. In the CNS, the cysts act as space-occupying lesions and can cause hydrocephalus and/or seizures. Seizures are the most common initial presentation of patients with neurocysticercosis and may be focal or generalized. Signs of increased intracranial pressure such as headache, nausea, vomiting, or visual changes may also be present. Amebiasis is caused by Entamoeba histolytica. Patients typically present with diarrhea (often bloody), right lower quadrant abdominal pain, and fever. Amebic abscesses in the liver are a complication due to invasion of the poal venous system by the amoeba. Cytomegalovirus produces neonatal infections and infections in immunocompromised patients such as AIDS patients. CD4 counts are usually Echinococcosis is a parasitic nematode infection caused by either Echinococcus granulosis or E. multilocularis. The disease is hydatid cyst disease. The patient ingests the eggs from dogs and becomes an intermediate host. The cysts are classically in the liver, are calcified, and the patient shows eosinophilia. | Microbiology | null | 104 | {
"Correct Answer": "Neurocysticercosis",
"Correct Option": "D",
"Options": {
"A": "Amebiasis",
"B": "Cytomegalovirus infection",
"C": "Echinococcosis",
"D": "Neurocysticercosis"
},
"Question": "A 42-year-old man is brought to the emergency room in an ambulance after suffering a grand mal seizure at home. There is no history of recent illness, fever, headache, seizures, or head trauma. He drinks alcohol occasionally and denies any other drug use. Neurologic exam shows the patient to be ale and oriented. No focal abnormalities are noted. A CT scan of the head reveals multiple punctate calcifications, and two enhancing cystic lesions with surrounding edema. What is the most likely diagnosis?"
} | A 42-year-old man is brought to the emergency room in an ambulance after suffering a grand mal seizure at home. There is no history of recent illness, fever, headache, seizures, or head trauma. He drinks alcohol occasionally and denies any other drug use. Neurologic exam shows the patient to be ale and oriented. No focal abnormalities are noted. A CT scan of the head reveals multiple punctate calcifications, and two enhancing cystic lesions with surrounding edema. | What is the most likely diagnosis? | {
"A": "Amebiasis",
"B": "Cytomegalovirus infection",
"C": "Echinococcosis",
"D": "Neurocysticercosis"
} | D. Neurocysticercosis |
9bbff51a-c15a-4ec6-a956-310e0d78f50a | A 60-year-old comes to the casualty complaining of bright red blood per rectum. The bleeding began abruptly several hours prior to his visit. He has lightheadedness when he stands up rapidly, but has no abdominal pain, cramping, fever, nausea, or vomiting. He has no history of previous episodes of bleeding or abdominal pain, but has a history of coronary aery disease and takes aspirin as a "blood thinner". He is afebrile, slightly hypotensive and tachycardic, but stable. On examination, he has decreased skin turgor, and dry mucous membranes. He has no abdominal tenderness. Rectal examination is positive for gross blood. Which of the following is the most likely diagnosis? | Aeriovenous malformation | Diveiculitis | Infectious colitis | Ischemic colitis | 0a
| single | Painless hematochezia or bright red lower GI bleeding can come from many sources. While bright red lower GI bleeding tends to indicate lower GI bleeding (bleeding distal to the ligament of Treitz), brisk upper GI bleeding can also be the source. The clinical manifestations of such bleeding range from negligible to hemodynamic instability, depending upon the rate of bleeding. The differential diagnosis for painless hematochezia includes AV malformations, gastric erosions, esophageal varices, esophagitis, duodenal or gastric ulcer, hemorrhoids, diveiculosis, and colonic neoplasm. Diveiculitis occurs when a colonic outpouching or diveiculum becomes inflamed. Patients tend to be elderly and present with fever, abdominal pain, and abdominal tenderness on examination. While painful, these lesions do not bleed significantly (unlike their uninflamed counterpas in diveiculosis). Infectious colitis may present as rectal bleeding, but this bleeding is typically accompanied by pain, cramping, and fever. Causative organisms may include Salmonella, Shigella, Campylobacter jejuni, E. coli, and Entamoeba histolytica. Ischemic colitis may have rectal bleeding, but the hallmark of ischemic colitis is severe abdominal pain out of propoion to examination findings. | Surgery | null | 156 | {
"Correct Answer": "Aeriovenous malformation",
"Correct Option": "A",
"Options": {
"A": "Aeriovenous malformation",
"B": "Diveiculitis",
"C": "Infectious colitis",
"D": "Ischemic colitis"
},
"Question": "A 60-year-old comes to the casualty complaining of bright red blood per rectum. The bleeding began abruptly several hours prior to his visit. He has lightheadedness when he stands up rapidly, but has no abdominal pain, cramping, fever, nausea, or vomiting. He has no history of previous episodes of bleeding or abdominal pain, but has a history of coronary aery disease and takes aspirin as a \"blood thinner\". He is afebrile, slightly hypotensive and tachycardic, but stable. On examination, he has decreased skin turgor, and dry mucous membranes. He has no abdominal tenderness. Rectal examination is positive for gross blood. Which of the following is the most likely diagnosis?"
} | A 60-year-old comes to the casualty complaining of bright red blood per rectum. The bleeding began abruptly several hours prior to his visit. He has lightheadedness when he stands up rapidly, but has no abdominal pain, cramping, fever, nausea, or vomiting. He has no history of previous episodes of bleeding or abdominal pain, but has a history of coronary aery disease and takes aspirin as a "blood thinner". He is afebrile, slightly hypotensive and tachycardic, but stable. On examination, he has decreased skin turgor, and dry mucous membranes. He has no abdominal tenderness. Rectal examination is positive for gross blood. | Which of the following is the most likely diagnosis? | {
"A": "Aeriovenous malformation",
"B": "Diveiculitis",
"C": "Infectious colitis",
"D": "Ischemic colitis"
} | A. Aeriovenous malformation |
54207d99-6ce0-4085-8d03-fd1edb040a3f | A 12-year-old boy is referred for evaluation of nocturnal enuresis and short stature. The blood pressure is normal. The blood urea is 112 mg/dl, creatinine 6 mg/dl, sodium 119 mEq/l, potassium 4 mEcill, calcium 7 mg/dl, phosphate 6 mg/dl and alkaline phosphatase 400 U/l. 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 | null | Medicine | null | 137 | {
"Correct Answer": "Nephronophthisis",
"Correct Option": "D",
"Options": {
"A": "Alport's syndrome",
"B": "Medullary sponge kidney",
"C": "Chronic glomerulonephritis",
"D": "Nephronophthisis"
},
"Question": "A 12-year-old boy is referred for evaluation of nocturnal enuresis and short stature. The blood pressure is normal. The blood urea is 112 mg/dl, creatinine 6 mg/dl, sodium 119 mEq/l, potassium 4 mEcill, calcium 7 mg/dl, phosphate 6 mg/dl and alkaline phosphatase 400 U/l. 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 12-year-old boy is referred for evaluation of nocturnal enuresis and short stature. The blood pressure is normal. The blood urea is 112 mg/dl, creatinine 6 mg/dl, sodium 119 mEq/l, potassium 4 mEcill, calcium 7 mg/dl, phosphate 6 mg/dl and alkaline phosphatase 400 U/l. 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 |
e71e76c6-920f-4220-a47b-b49d4a9725a7 | A 10 year old boy, unconscious with 2 days h/o fever, comes to pediatric ICU with R.R. 46/min, B.P. 110/ 80 and E1 V1 M3 on Glasgow coma scale, next step of Mx includes –a) Intubate and ventilateb) Give 0.9% NaClc) Start dopamine at the rate of 1–2 g /min/kgd) Dopamine at the rate of 1–g/min/kg & furosemidee) Start antibiotic and order for CT Scan | ae | b | ab | ad | 0a
| multi | Management of unconscious child
Unconsciousness (coma) is usually graded according to a standard scale so that changes in the level of consciousness can be evaluated accurately.
Glasgow coma scale is commonly used evaluation system. In this scale : -
Total score = Eye opening + motor response + verbal response
The best response is scored. The lowest score is 3, and the highest is 15 (fully conscious child). A score of 8 or less suggests severe brain dysfunction, a score of 9-12 moderate brain dysfunction and a score of 13-15 minor brain dysfunction.
Investigations
If the cause of coma is unknown, following investigations may be required : -
Lumbar puncture
ECG
Skull radiography/CT/MRI
Cervical spine imaging
Blood is drawn for a CBC, electrolyte determination, toxicology tests, blood gas analysis, BUN and cross matching. Management
Care of the child in coma is directed towards maintaining body function in optimal state until the child regains consciousness. Management includes : -
1) Airway
As a general rule, place the child on his/her side to reduce the risk of aspiration. Oral suctioning to remove mucus from the mouth and pharynx may be necessary.
If Glassgow score is 8 or less and clinical circumstances do not suggests improvement then intubation is indicated to secure airway.
2) reathing
Oxygen is given especially when oxygen saturation is low.
3) Circulation
Venous access is obtained.
Signs of shock are assessed and treated as indicated.
4 rugs and specific therapy
After maintenance of breathing and circulation, specific therapy is given e.g., antibiotics for infection, dextrose in hypoglycemia, naloxone in opiates poisoning etc. | Pediatrics | null | 123 | {
"Correct Answer": "ae",
"Correct Option": "A",
"Options": {
"A": "ae",
"B": "b",
"C": "ab",
"D": "ad"
},
"Question": "A 10 year old boy, unconscious with 2 days h/o fever, comes to pediatric ICU with R.R. 46/min, B.P. 110/ 80 and E1 V1 M3 on Glasgow coma scale, next step of Mx includes –a) Intubate and ventilateb) Give 0.9% NaClc) Start dopamine at the rate of 1–2 g /min/kgd) Dopamine at the rate of 1–g/min/kg & furosemidee) Start antibiotic and order for CT Scan"
} | A 10 year old boy, unconscious with 2 days h/o fever, comes to pediatric ICU with R.R. 46/min, B.P. | 110/ 80 and E1 V1 M3 on Glasgow coma scale, next step of Mx includes –a) Intubate and ventilateb) Give 0.9% NaClc) Start dopamine at the rate of 1–2 g /min/kgd) Dopamine at the rate of 1–g/min/kg & furosemidee) Start antibiotic and order for CT Scan | {
"A": "ae",
"B": "b",
"C": "ab",
"D": "ad"
} | A. ae |
d8c2c1ac-bec0-442a-9304-e5f793ffc9d9 | A 22-year-old man is brought into the emergency department following a brawl in a tavern. He has severe pain radiating across his back and down his left upper limb. He supports his left upper limb with his right, holding it close to his body. Any attempt to move the left upper limb greatly increases the pain. A radiograph is ordered and reveals an unusual sagittal fracture through the spine of the left scapula. The fracture extends superiorly toward the suprascapular notch. Which nerve is most likely affected? | Suprascapular nerve | Thoracodorsal nerve | Axillary nerve | Subscapular nerve | 0a
| single | The suprascapular nerve passes through the suprascapular notch, deep to the superior transverse scapular ligament. This nerve is most likely affected in a fracture of the scapula as described in the question. The thoracodorsal nerve runs behind the axillary artery and lies superficial to the subscapularis muscle and would therefore be protected. The axillary nerve passes posteriorly through the quadrangular space, which is distal to the suprascapular notch. The subscapular nerve originates from the posterior cord of the brachial plexus, which is distal to the site of fracture. | Anatomy | Upper Extremity | 110 | {
"Correct Answer": "Suprascapular nerve",
"Correct Option": "A",
"Options": {
"A": "Suprascapular nerve",
"B": "Thoracodorsal nerve",
"C": "Axillary nerve",
"D": "Subscapular nerve"
},
"Question": "A 22-year-old man is brought into the emergency department following a brawl in a tavern. He has severe pain radiating across his back and down his left upper limb. He supports his left upper limb with his right, holding it close to his body. Any attempt to move the left upper limb greatly increases the pain. A radiograph is ordered and reveals an unusual sagittal fracture through the spine of the left scapula. The fracture extends superiorly toward the suprascapular notch. Which nerve is most likely affected?"
} | A 22-year-old man is brought into the emergency department following a brawl in a tavern. He has severe pain radiating across his back and down his left upper limb. He supports his left upper limb with his right, holding it close to his body. Any attempt to move the left upper limb greatly increases the pain. A radiograph is ordered and reveals an unusual sagittal fracture through the spine of the left scapula. The fracture extends superiorly toward the suprascapular notch. | Which nerve is most likely affected? | {
"A": "Suprascapular nerve",
"B": "Thoracodorsal nerve",
"C": "Axillary nerve",
"D": "Subscapular nerve"
} | A. Suprascapular nerve |
238d268e-193f-46b5-8ecc-719021c7f8ea | Which of the following statements regarding diaphragm are true? (a) The crura join to form the lateral arcuate ligament. (b) The fascia overlying the psoas muscle is thickened and gives origin to the diaphragm. (c) The IVC passes through the posterior diaphragmatic openings. (d) The aoa enters the thorax anterior to the crura. (e) The eosphagus passes through the muscular pa of the diaphragm in the region of the right crus. | (a)(c)(d) True & (b)(e) False | (b)(e) True & (a)(c)(d) False | (a)(c)(e) True & (b)(d) False | (b)(c)(d) True & (a)(e) False | 1b
| multi | The median arcuate ligament is a tendinous structure in the midline. The lateral arcuate ligament is fascia overlying the quadratus lumborum muscles. The IVC pierces the central tendinous pa of the diaphragm and is patent in all phases of respiration. It is the most anterior of the three openings. The aoa passes posterior to the median arcuate ligament in the retrocrural space. | Anatomy | null | 110 | {
"Correct Answer": "(b)(e) True & (a)(c)(d) False",
"Correct Option": "B",
"Options": {
"A": "(a)(c)(d) True & (b)(e) False",
"B": "(b)(e) True & (a)(c)(d) False",
"C": "(a)(c)(e) True & (b)(d) False",
"D": "(b)(c)(d) True & (a)(e) False"
},
"Question": "Which of the following statements regarding diaphragm are true? (a) The crura join to form the lateral arcuate ligament. (b) The fascia overlying the psoas muscle is thickened and gives origin to the diaphragm. (c) The IVC passes through the posterior diaphragmatic openings. (d) The aoa enters the thorax anterior to the crura. (e) The eosphagus passes through the muscular pa of the diaphragm in the region of the right crus."
} | Which of the following statements regarding diaphragm are true? (a) The crura join to form the lateral arcuate ligament. (b) The fascia overlying the psoas muscle is thickened and gives origin to the diaphragm. (c) The IVC passes through the posterior diaphragmatic openings. (d) The aoa enters the thorax anterior to the crura. | (e) The eosphagus passes through the muscular pa of the diaphragm in the region of the right crus. | {
"A": "(a)(c)(d) True & (b)(e) False",
"B": "(b)(e) True & (a)(c)(d) False",
"C": "(a)(c)(e) True & (b)(d) False",
"D": "(b)(c)(d) True & (a)(e) False"
} | B. (b)(e) True & (a)(c)(d) False |
604c8857-39b6-43da-adee-7f2c81f6906f | A 20-year-old male patient presented to the ER with complaints of abdominal pain, nausea and vomiting. The pain was initially peri-umbilical in nature, however, with time, the pain worsened and shifted to right lower quadrant. On palpating the abdomen, tenderness is present over right lower quadrant with guarding. Patient is febrile and lab repos show leukocytosis. Emergency laparotomy is planned and the inflamed organ is identified by the confluence of taenia coli. Which position of the above-mentioned organ is considered to be the most dangerous position? | D | A | C | B | 3d
| multi | A- Post ileal B- Pre ileal C- Retro-cecal D- Pelvic The patient is suffering from acute appendicitis. During laparotomy, the appendix is identified by confluence of taenia coli. Pre-ileal variety of splenic position is considered to be the most dangerous position because it is associated with higher chances of spread to general peritoneal cavity. Retrocecal variety is the most common and Pelvic is the 2nd most common anatomical position of the appendix. | Unknown | Integrated QBank | 121 | {
"Correct Answer": "B",
"Correct Option": "D",
"Options": {
"A": "D",
"B": "A",
"C": "C",
"D": "B"
},
"Question": "A 20-year-old male patient presented to the ER with complaints of abdominal pain, nausea and vomiting. The pain was initially peri-umbilical in nature, however, with time, the pain worsened and shifted to right lower quadrant. On palpating the abdomen, tenderness is present over right lower quadrant with guarding. Patient is febrile and lab repos show leukocytosis. Emergency laparotomy is planned and the inflamed organ is identified by the confluence of taenia coli. Which position of the above-mentioned organ is considered to be the most dangerous position?"
} | A 20-year-old male patient presented to the ER with complaints of abdominal pain, nausea and vomiting. The pain was initially peri-umbilical in nature, however, with time, the pain worsened and shifted to right lower quadrant. On palpating the abdomen, tenderness is present over right lower quadrant with guarding. Patient is febrile and lab repos show leukocytosis. Emergency laparotomy is planned and the inflamed organ is identified by the confluence of taenia coli. | Which position of the above-mentioned organ is considered to be the most dangerous position? | {
"A": "D",
"B": "A",
"C": "C",
"D": "B"
} | D. B |
5892c53c-6a71-4119-9981-e95e94a3e5a0 | A 75-year-old man has experienced headaches for the past 2 months. On physical examination, his vital signs are temperature, 37deg C; pulse, 68/min; respirations, 15/min; and blood pressure, 130/85 mm Hg. His right temporal artery is prominent, palpable, and painful to the touch. His heart rate is regular, and there are no murmurs. His erythrocyte sedimentation rate is 100 mm/hr. A temporal artery biopsy is performed, and the segment of the temporal artery excised is grossly thickened and shows focal microscopic granulomatous inflammation. He responds well to corticosteroid therapy. Which of the following complications of this disease is most likely to occur in untreated patients? | Blindness | Gangrene of the toes | Hemoptysis | Malignant hypertension | 0a
| single | Giant cell (temporal) arteritis typically involves large to medium-sized external carotid artery branches in the head (especially temporal arteries), but also vertebral and ophthalmic arteries. The involvement of the latter can affect vision. Because the involvement of the kidney, lung, and peripheral arteries of the extremities is much less common, renal failure, hemoptysis, and gangrene of toes are unusual complications of giant cell arteritis. There is no association between hypertension and giant cell arteritis, but some patients may have polymyalgia rheumatica. | Pathology | Blood Vessels | 167 | {
"Correct Answer": "Blindness",
"Correct Option": "A",
"Options": {
"A": "Blindness",
"B": "Gangrene of the toes",
"C": "Hemoptysis",
"D": "Malignant hypertension"
},
"Question": "A 75-year-old man has experienced headaches for the past 2 months. On physical examination, his vital signs are temperature, 37deg C; pulse, 68/min; respirations, 15/min; and blood pressure, 130/85 mm Hg. His right temporal artery is prominent, palpable, and painful to the touch. His heart rate is regular, and there are no murmurs. His erythrocyte sedimentation rate is 100 mm/hr. A temporal artery biopsy is performed, and the segment of the temporal artery excised is grossly thickened and shows focal microscopic granulomatous inflammation. He responds well to corticosteroid therapy. Which of the following complications of this disease is most likely to occur in untreated patients?"
} | A 75-year-old man has experienced headaches for the past 2 months. On physical examination, his vital signs are temperature, 37deg C; pulse, 68/min; respirations, 15/min; and blood pressure, 130/85 mm Hg. His right temporal artery is prominent, palpable, and painful to the touch. His heart rate is regular, and there are no murmurs. His erythrocyte sedimentation rate is 100 mm/hr. A temporal artery biopsy is performed, and the segment of the temporal artery excised is grossly thickened and shows focal microscopic granulomatous inflammation. He responds well to corticosteroid therapy. | Which of the following complications of this disease is most likely to occur in untreated patients? | {
"A": "Blindness",
"B": "Gangrene of the toes",
"C": "Hemoptysis",
"D": "Malignant hypertension"
} | A. Blindness |
e8bbf8cf-b6bf-4d6f-ad59-58fa11b900b1 | A 50-year, old patient tSCIILS wnn n1 ea i-,ess and bleeding episodes. His leukocyte count was 48 x 109 cells/L and platelet count was 50 x 109 cells/L. There was dysplasia of neutrophils with a differential count showing 76% neutrophils, 8% blast cells, 12% myelocytes and metamyelocytes and 4% other cells Bonemarrow examination showed 14% blasts. Cytogenetics showed t(8, 21). The most likely diagnosis is: | Acute myeloid leukemia | Chronic myeloid leukemia | Chronic lymphoid leukemia | Myelodysplastic syndrome | 0a
| single | Ans. a. Acute myeloid leukemia | Pathology | null | 132 | {
"Correct Answer": "Acute myeloid leukemia",
"Correct Option": "A",
"Options": {
"A": "Acute myeloid leukemia",
"B": "Chronic myeloid leukemia",
"C": "Chronic lymphoid leukemia",
"D": "Myelodysplastic syndrome"
},
"Question": "A 50-year, old patient tSCIILS wnn n1 ea i-,ess and bleeding episodes. His leukocyte count was 48 x 109 cells/L and platelet count was 50 x 109 cells/L. There was dysplasia of neutrophils with a differential count showing 76% neutrophils, 8% blast cells, 12% myelocytes and metamyelocytes and 4% other cells Bonemarrow examination showed 14% blasts. Cytogenetics showed t(8, 21). The most likely diagnosis is:"
} | A 50-year, old patient tSCIILS wnn n1 ea i-,ess and bleeding episodes. His leukocyte count was 48 x 109 cells/L and platelet count was 50 x 109 cells/L. There was dysplasia of neutrophils with a differential count showing 76% neutrophils, 8% blast cells, 12% myelocytes and metamyelocytes and 4% other cells Bonemarrow examination showed 14% blasts. Cytogenetics showed t(8, 21). | The most likely diagnosis is: | {
"A": "Acute myeloid leukemia",
"B": "Chronic myeloid leukemia",
"C": "Chronic lymphoid leukemia",
"D": "Myelodysplastic syndrome"
} | A. Acute myeloid leukemia |
a30e621e-54f7-484d-a7a5-e06061688518 | A 15 year old male presents with hematuria. he has previous diagnoses of deafness and corneal dystrophy. Urinalysis shows I + proteins, no ketones, no glucose, 1+blood, and no leukocytes. A renal biopsy reveals tubular epithelial foam cells by light microscopy. By electron microscopy the glomerular basement membrane shows areas of attenuation, with splitting and lamination of lamina dense in other thickened areas. The most probable diagnosis is ? | Acute tubular necrosis | Berger disease | Membranous glomerulonephritis | A 1po syndrome | 3d
| single | Ans. is 'd' i.e., Alpo syndromeo Glomerulonephritis, deafness, corneal dystrophy with foam cells and attenuation of GBM suggest the diagnosis of Alpo syndrome. | Pathology | null | 102 | {
"Correct Answer": "A 1po syndrome",
"Correct Option": "D",
"Options": {
"A": "Acute tubular necrosis",
"B": "Berger disease",
"C": "Membranous glomerulonephritis",
"D": "A 1po syndrome"
},
"Question": "A 15 year old male presents with hematuria. he has previous diagnoses of deafness and corneal dystrophy. Urinalysis shows I + proteins, no ketones, no glucose, 1+blood, and no leukocytes. A renal biopsy reveals tubular epithelial foam cells by light microscopy. By electron microscopy the glomerular basement membrane shows areas of attenuation, with splitting and lamination of lamina dense in other thickened areas. The most probable diagnosis is ?"
} | A 15 year old male presents with hematuria. he has previous diagnoses of deafness and corneal dystrophy. Urinalysis shows I + proteins, no ketones, no glucose, 1+blood, and no leukocytes. A renal biopsy reveals tubular epithelial foam cells by light microscopy. By electron microscopy the glomerular basement membrane shows areas of attenuation, with splitting and lamination of lamina dense in other thickened areas. | The most probable diagnosis is ? | {
"A": "Acute tubular necrosis",
"B": "Berger disease",
"C": "Membranous glomerulonephritis",
"D": "A 1po syndrome"
} | D. A 1po syndrome |
fa8c2765-c2f2-4f2b-8b7d-cb26664f7c89 | A 40 year old male presented to his physician with a history of back pain that staed 2 weeks previously. The patient stated that while he was cleaning the garden he felt a little pain in his lower back. Over the past few days he noticed that pain had got worse. He had stiffness of his back & could not sit for longer periods. Walking seemed to help. Whenever he coughed or sneezed, the pain would shoot down his right leg. Physical examination revealed that he was in moderate distress. He has spasm and tenderness of the paraspinal muscles on the right lumbar region. Straight leg raising test was 500 on the right, but full on the left. Additional examination of the right foot revealed weak dorsiflexion and hypesthesia over the first web space. The rest of the neurological examination was normal. What is the most likely reason for his symptoms? | Prolapsed interveebral disk at L4-L5 level | Prolapsed interveebral disk at L5-S1 level | Spinal cord astrocytoma | Epidural hematoma | 0a
| single | This patient has a prolapsed interveebral disk at L4-L5 level. Herniated disk at this level will compress the 5th lumbar nerve root. In such cases sensory deficit would be along the medial side of the leg and in the web spaces between the first and the second toe. Weak dorsiflexion is also expected as 5th lumbar nerve root is involved. These patients have difficulty standing on their heels. | Surgery | null | 187 | {
"Correct Answer": "Prolapsed interveebral disk at L4-L5 level",
"Correct Option": "A",
"Options": {
"A": "Prolapsed interveebral disk at L4-L5 level",
"B": "Prolapsed interveebral disk at L5-S1 level",
"C": "Spinal cord astrocytoma",
"D": "Epidural hematoma"
},
"Question": "A 40 year old male presented to his physician with a history of back pain that staed 2 weeks previously. The patient stated that while he was cleaning the garden he felt a little pain in his lower back. Over the past few days he noticed that pain had got worse. He had stiffness of his back & could not sit for longer periods. Walking seemed to help. Whenever he coughed or sneezed, the pain would shoot down his right leg. Physical examination revealed that he was in moderate distress. He has spasm and tenderness of the paraspinal muscles on the right lumbar region. Straight leg raising test was 500 on the right, but full on the left. Additional examination of the right foot revealed weak dorsiflexion and hypesthesia over the first web space. The rest of the neurological examination was normal. What is the most likely reason for his symptoms?"
} | A 40 year old male presented to his physician with a history of back pain that staed 2 weeks previously. The patient stated that while he was cleaning the garden he felt a little pain in his lower back. Over the past few days he noticed that pain had got worse. He had stiffness of his back & could not sit for longer periods. Walking seemed to help. Whenever he coughed or sneezed, the pain would shoot down his right leg. Physical examination revealed that he was in moderate distress. He has spasm and tenderness of the paraspinal muscles on the right lumbar region. Straight leg raising test was 500 on the right, but full on the left. Additional examination of the right foot revealed weak dorsiflexion and hypesthesia over the first web space. The rest of the neurological examination was normal. | What is the most likely reason for his symptoms? | {
"A": "Prolapsed interveebral disk at L4-L5 level",
"B": "Prolapsed interveebral disk at L5-S1 level",
"C": "Spinal cord astrocytoma",
"D": "Epidural hematoma"
} | A. Prolapsed interveebral disk at L4-L5 level |
aeee8519-8370-4ee8-a564-4d31fabe021b | A 70-year-old intensive care unit patient complains of fever and shaking chills. The patient develops hypotension, and blood cultures are positive for gram-negative bacilli. The patient begins bleeding from venipuncture sites and around his Foley catheter. Laboratory studies are as follows:Hct: 38%WBC: 15,000/mLPlatelet count: 40,000/mL (normal 150,000-400,000)Peripheral blood smear: fragmented RBCsPT: elevated PTT: elevatedPlasma fibrinogen: 70 mg/dL (normal 200-400)Which of the following is the best course of therapy in this patient? | Begin heparin | Treat underlying disease | Begin plasmapheresis | Give vitamin K | 1b
| single | This patient with gram-negative bacteremia has developed disseminated intravascular coagulation (DIC), as evidenced by multiple-site bleeding, thrombocytopenia, fragmented red blood cells on peripheral smear, prolonged PT and PTT, and reduced fibrinogen levels from depletion of coagulation proteins. Initial treatment is directed at correcting the underlying disorder-in this case, infection. Although heparin was formerly recommended for the treatment of DIC, it is now used rarely and only in unusual circumstances (such as acute promyelocytic leukemia). For the patient who continues to bleed, supplementation of platelets and clotting factors (with fresh frozen plasma or cryoprecipitate) may help control life-threatening bleeding. Red cell fragmentation and low platelet count can be seen in microangiopathic disorders such as thrombotic thrombocytopenic purpura (TTP), but in these disorders the coagulation pathway is not activated. Therefore, in TTP the prothrombin time, partial thromboplastin time, and plasma fibrinogen levels will be normal. Plasmapheresis, vitamin K therapy, and RBC transfusion will not correct the underlying cause. | Medicine | Oncology | 159 | {
"Correct Answer": "Treat underlying disease",
"Correct Option": "B",
"Options": {
"A": "Begin heparin",
"B": "Treat underlying disease",
"C": "Begin plasmapheresis",
"D": "Give vitamin K"
},
"Question": "A 70-year-old intensive care unit patient complains of fever and shaking chills. The patient develops hypotension, and blood cultures are positive for gram-negative bacilli. The patient begins bleeding from venipuncture sites and around his Foley catheter. Laboratory studies are as follows:Hct: 38%WBC: 15,000/mLPlatelet count: 40,000/mL (normal 150,000-400,000)Peripheral blood smear: fragmented RBCsPT: elevated PTT: elevatedPlasma fibrinogen: 70 mg/dL (normal 200-400)Which of the following is the best course of therapy in this patient?"
} | A 70-year-old intensive care unit patient complains of fever and shaking chills. The patient develops hypotension, and blood cultures are positive for gram-negative bacilli. The patient begins bleeding from venipuncture sites and around his Foley catheter. | Laboratory studies are as follows:Hct: 38%WBC: 15,000/mLPlatelet count: 40,000/mL (normal 150,000-400,000)Peripheral blood smear: fragmented RBCsPT: elevated PTT: elevatedPlasma fibrinogen: 70 mg/dL (normal 200-400)Which of the following is the best course of therapy in this patient? | {
"A": "Begin heparin",
"B": "Treat underlying disease",
"C": "Begin plasmapheresis",
"D": "Give vitamin K"
} | B. Treat underlying disease |
40a4641d-7bfe-4e01-b3f2-15b8a62085b4 | A 5-year-old girlcame to the Emergency Dept. in evening with the complaint of sudden onset of "difficulty in breathing" and fever,pruritus.She has no past history of lung infection, no recent travel history. She have an history of pica. Little kid is worried about his puppy at home during his hospital stay. On Examination wheezing and hepatomegaly is present. On Peripheral smear, marked eosinophilia,leucocytosis is seen. Best test that helps in diagnosis? | Tuberculin skin test | ELISA for Toxocara | Histoplasmin test | Silver stain of gastric aspirate | 1b
| single | Above clinical history suggestive of Visceral larva migrans of Toxocara canis. Clinical features:- Fever, cough, wheezing, bronchopneumonia, anemia, hepatomegaly, leukocytosis, eosinophilia, pruritus, eczema, and uicaria. Investigation:- ELISA is used to confirm diagnosis Treatment:- Albendazole(400 mg orally twice daily for 5 days) | Pediatrics | Impoant Parasitic Infections in Children | 106 | {
"Correct Answer": "ELISA for Toxocara",
"Correct Option": "B",
"Options": {
"A": "Tuberculin skin test",
"B": "ELISA for Toxocara",
"C": "Histoplasmin test",
"D": "Silver stain of gastric aspirate"
},
"Question": "A 5-year-old girlcame to the Emergency Dept. in evening with the complaint of sudden onset of \"difficulty in breathing\" and fever,pruritus.She has no past history of lung infection, no recent travel history. She have an history of pica. Little kid is worried about his puppy at home during his hospital stay. On Examination wheezing and hepatomegaly is present. On Peripheral smear, marked eosinophilia,leucocytosis is seen. Best test that helps in diagnosis?"
} | A 5-year-old girlcame to the Emergency Dept. in evening with the complaint of sudden onset of "difficulty in breathing" and fever,pruritus.She has no past history of lung infection, no recent travel history. She have an history of pica. Little kid is worried about his puppy at home during his hospital stay. On Examination wheezing and hepatomegaly is present. On Peripheral smear, marked eosinophilia,leucocytosis is seen. | Best test that helps in diagnosis? | {
"A": "Tuberculin skin test",
"B": "ELISA for Toxocara",
"C": "Histoplasmin test",
"D": "Silver stain of gastric aspirate"
} | B. ELISA for Toxocara |
65aa93e5-f2df-40b1-8eb7-c06db283c670 | A 27-year-old male has had a hard to control hypeension for 2 years. He is taking clonidine, hydrochlorothiazide, verapamil, and lisinopril. His blood pressure is 170/105 mmHg, pulse 90 beats/min, and respirations 16/min. The cardiopulmonary exam is normal. Pedal pulses are intact and there is no edema or mis-distribution of fat. Laboratories show potassium of 2.7 mEq/L, BUN 20 mg/dL, creatinine 1.2 mg/dL, bicarbonate 33 mg/dL, and fasting glucose 98 mg/dL. What is the most likely diagnosis? | Conn syndrome | Renal vascular hypeension | Cushing syndrome | Carcinoid syndrome | 0a
| single | Presentation: K+|| RFT= N HCO3(22-26) here || so alkalosis present Therefore, Hypokalemic alkalosis with HTN Option A- characterized by ||BP as aldosterone is elevated which also l/t urinary loss of K+ and hydrogen causing Hypokalemic alkalosis. Option B- In renal vasculature hypeension there is |RFT Option C- presents with weight gain in patients, HTN as coisol can stimulate aldosterone receptors l/t hypokalemic alkalosis. Option D- carcinoid syndrome doesn't lead to hypeension because metabolites produced may cause bronchospasm and Histamine/Serotonin release which will cause vasodilation not HTN. 1ST likely diagnosis= CONN syndrome | Medicine | Disorders of Adrenal Gland | 159 | {
"Correct Answer": "Conn syndrome",
"Correct Option": "A",
"Options": {
"A": "Conn syndrome",
"B": "Renal vascular hypeension",
"C": "Cushing syndrome",
"D": "Carcinoid syndrome"
},
"Question": "A 27-year-old male has had a hard to control hypeension for 2 years. He is taking clonidine, hydrochlorothiazide, verapamil, and lisinopril. His blood pressure is 170/105 mmHg, pulse 90 beats/min, and respirations 16/min. The cardiopulmonary exam is normal. Pedal pulses are intact and there is no edema or mis-distribution of fat. Laboratories show potassium of 2.7 mEq/L, BUN 20 mg/dL, creatinine 1.2 mg/dL, bicarbonate 33 mg/dL, and fasting glucose 98 mg/dL. What is the most likely diagnosis?"
} | A 27-year-old male has had a hard to control hypeension for 2 years. He is taking clonidine, hydrochlorothiazide, verapamil, and lisinopril. His blood pressure is 170/105 mmHg, pulse 90 beats/min, and respirations 16/min. The cardiopulmonary exam is normal. Pedal pulses are intact and there is no edema or mis-distribution of fat. Laboratories show potassium of 2.7 mEq/L, BUN 20 mg/dL, creatinine 1.2 mg/dL, bicarbonate 33 mg/dL, and fasting glucose 98 mg/dL. | What is the most likely diagnosis? | {
"A": "Conn syndrome",
"B": "Renal vascular hypeension",
"C": "Cushing syndrome",
"D": "Carcinoid syndrome"
} | A. Conn syndrome |
499ca38b-17d3-4203-a749-77abf0347aff | A 26-year-old woman comes to the emergency complaining of 2 day of worsening right leg pain and swelling. She drove in a car 8 hours back from a hiking trip 2 days ago and then noticed some pain in the leg. At first she thought it was due to exeion, but it has worsened over the day. Her past medical history is related to difficulty getting pregnant, with two prior spontaneous aboions. Her physical examination is notable for normal vital signs, hea, and lung examination. Her right leg is swollen from the mid-thigh down and is tender. Doppler studies demonstrate a large deep venous thrombosis in the femoral and ileac veins extending into the pelvis. Laboratory studies show normal electrolytes, normal WBC and platelet counts, normal PT, and an aPTT 3x normal. Her pregnancy test is negative. Low-molecular-weight heparin therapy is initiated in the emergency depament. Subsequent therapy should include which of the following? | Rituximab 375 mg/m2 per week for 4 weeks | Warfarin with international normalized ratio (INR) goal of 2.0-3.0 for 3 months | Warfarin with INR goal of 2.0-3.0 for 12 months | Warfarin with INR goal of 2.5-3.5 for life | 3d
| single | This patient has a typical presentation of antiphospholipid syndrome (APS) with a deep venous thrombosis, history of spontaneous aboion, and isolated elevated aPTT due to a lupus anticoagulant. Clinical Feature: Recurrent aerial and venous thromboembolism Recurrent Foetal loss Stroke, Seizures, Cerebral venous thrombosis Pulmonary aerial hypeension Livedo reticularis Myocardial infarction Gangrene in fingers After diagnosis of a thrombotic event due to APS, patients should receive warfarin for life with a goal international normalized ratio (INR) of 2.5- 3.5 alone or in combination with daily aspirin. Treatment: -During pregnancy, patients should receive heparin plus aspirin. -Patients who develop recurrent thrombosis while on effective anticoagulation may benefit from a 5-day infusion of IV g-globulin or 4 weeks of rituximab therapy. -Warfarin for 3 months with INR goal of 2.0-3.0 is recommended therapy for deep vein thrombosis (DVT) with a known reversible precipitating event. Warfarin for 6-12 months with an INR goal of 2.0-3.0 is recommended therapy for first episode of idiopathic DVT. | Medicine | Miscellaneous QBank | 208 | {
"Correct Answer": "Warfarin with INR goal of 2.5-3.5 for life",
"Correct Option": "D",
"Options": {
"A": "Rituximab 375 mg/m2 per week for 4 weeks",
"B": "Warfarin with international normalized ratio (INR) goal of 2.0-3.0 for 3 months",
"C": "Warfarin with INR goal of 2.0-3.0 for 12 months",
"D": "Warfarin with INR goal of 2.5-3.5 for life"
},
"Question": "A 26-year-old woman comes to the emergency complaining of 2 day of worsening right leg pain and swelling. She drove in a car 8 hours back from a hiking trip 2 days ago and then noticed some pain in the leg. At first she thought it was due to exeion, but it has worsened over the day. Her past medical history is related to difficulty getting pregnant, with two prior spontaneous aboions. Her physical examination is notable for normal vital signs, hea, and lung examination. Her right leg is swollen from the mid-thigh down and is tender. Doppler studies demonstrate a large deep venous thrombosis in the femoral and ileac veins extending into the pelvis. Laboratory studies show normal electrolytes, normal WBC and platelet counts, normal PT, and an aPTT 3x normal. Her pregnancy test is negative. Low-molecular-weight heparin therapy is initiated in the emergency depament. Subsequent therapy should include which of the following?"
} | A 26-year-old woman comes to the emergency complaining of 2 day of worsening right leg pain and swelling. She drove in a car 8 hours back from a hiking trip 2 days ago and then noticed some pain in the leg. At first she thought it was due to exeion, but it has worsened over the day. Her past medical history is related to difficulty getting pregnant, with two prior spontaneous aboions. Her physical examination is notable for normal vital signs, hea, and lung examination. Her right leg is swollen from the mid-thigh down and is tender. Doppler studies demonstrate a large deep venous thrombosis in the femoral and ileac veins extending into the pelvis. Laboratory studies show normal electrolytes, normal WBC and platelet counts, normal PT, and an aPTT 3x normal. Her pregnancy test is negative. Low-molecular-weight heparin therapy is initiated in the emergency depament. | Subsequent therapy should include which of the following? | {
"A": "Rituximab 375 mg/m2 per week for 4 weeks",
"B": "Warfarin with international normalized ratio (INR) goal of 2.0-3.0 for 3 months",
"C": "Warfarin with INR goal of 2.0-3.0 for 12 months",
"D": "Warfarin with INR goal of 2.5-3.5 for life"
} | D. Warfarin with INR goal of 2.5-3.5 for life |
3a282879-8038-4bc0-9960-bd3155bd2650 | A 72-year-old man complains of memory difficulties. He is worried that he has Alzheimer disease. He has trouble recalling the names of friends, and last month forgot his son's birthday, which had never happened before. On two occasions he became lost driving to a familiar department store. He is now afraid to make trips away from home. His children tell him that he has forgotten things they have discussed even 1 day previously. He lives independently and has not had any difficulty preparing meals, paying bills, using the telephone, or taking his medications. He takes lisinopril and hydrochlorothiazide for hypertension. He does not use alcohol. Folstein MMSE score is 27/30 and Montreal Cognitive Assessment (MoCA) score is 26/30. Neurologic examination is normal. Which of the following is most appropriate? | Inform the patient that his symptoms are a normal consequence of aging and that his risk of Alzheimer disease is no higher than average | Tell the patient that he has dementia and must stop driving | Perform screening tests for vitamin deficiency and psychiatric disease | Begin donepezil | 2c
| multi | Difficulty recalling names and temporarily misplacing objects are commonly seen with advancing age but becoming lost and having trouble recalling recent conversations are more worrisome symptoms of significant cognitive impairment. This patient does not have dementia, which requires impairment in memory and one other cognitive domain (language, spatial orientation, or executive function). The Folstein mini-mental state examination (MMSE) and the Montreal Cognitive Assessment (MoCA) are screening tests for Alzheimer disease. Most authorities use MMSE and MoCA scores of less than 26 as a positive screen. This patient is on the borderline of a positive screen. Patients with isolated but significant cognitive impairment, but who do not meet the diagnostic criteria for dementia, are often classified as having mild cognitive impairment (MCI). MCI is often accompanied by depression and can be due to vitamin B12 deficiency, for which the patient should be screened. Patients with mild cognitive impairment are at higher risk for progression to frank dementia (12% per year in some series), but some of these patients will never develop progressive memory loss. Randomized trials of the acetylcholinesterase inhibitors donepezil and galantamine have failed to establish efficacy of either of these drugs in patients with MCI. Holter monitoring is used to detect cardiac arrhythmias, which can be associated with syncope but not selective memory impairment. | Medicine | C.N.S. | 176 | {
"Correct Answer": "Perform screening tests for vitamin deficiency and psychiatric disease",
"Correct Option": "C",
"Options": {
"A": "Inform the patient that his symptoms are a normal consequence of aging and that his risk of Alzheimer disease is no higher than average",
"B": "Tell the patient that he has dementia and must stop driving",
"C": "Perform screening tests for vitamin deficiency and psychiatric disease",
"D": "Begin donepezil"
},
"Question": "A 72-year-old man complains of memory difficulties. He is worried that he has Alzheimer disease. He has trouble recalling the names of friends, and last month forgot his son's birthday, which had never happened before. On two occasions he became lost driving to a familiar department store. He is now afraid to make trips away from home. His children tell him that he has forgotten things they have discussed even 1 day previously. He lives independently and has not had any difficulty preparing meals, paying bills, using the telephone, or taking his medications. He takes lisinopril and hydrochlorothiazide for hypertension. He does not use alcohol. Folstein MMSE score is 27/30 and Montreal Cognitive Assessment (MoCA) score is 26/30. Neurologic examination is normal. Which of the following is most appropriate?"
} | A 72-year-old man complains of memory difficulties. He is worried that he has Alzheimer disease. He has trouble recalling the names of friends, and last month forgot his son's birthday, which had never happened before. On two occasions he became lost driving to a familiar department store. He is now afraid to make trips away from home. His children tell him that he has forgotten things they have discussed even 1 day previously. He lives independently and has not had any difficulty preparing meals, paying bills, using the telephone, or taking his medications. He takes lisinopril and hydrochlorothiazide for hypertension. He does not use alcohol. Folstein MMSE score is 27/30 and Montreal Cognitive Assessment (MoCA) score is 26/30. Neurologic examination is normal. | Which of the following is most appropriate? | {
"A": "Inform the patient that his symptoms are a normal consequence of aging and that his risk of Alzheimer disease is no higher than average",
"B": "Tell the patient that he has dementia and must stop driving",
"C": "Perform screening tests for vitamin deficiency and psychiatric disease",
"D": "Begin donepezil"
} | C. Perform screening tests for vitamin deficiency and psychiatric disease |
58057ffc-6f26-48ab-9145-17db1fba76db | A 20-year-old woman complains of headache and discomfort in both sides of her jaw. Physical examination reveals enlarged parotid glands that are slightly tender on palpation. There is reddening of the orifice of Stensen's duct on intra oral examination; her temperature is 38.3degC, and the pulse rate is 80/min. Laboratory data show hemoglobin 14 g/dL; hematocrit 40%; WBC 11000/mL, with 33% segmented neutrophils, 7% monocytes, and 60% lymphocytes. Which of the following diagnostic tests will help to confirm the diagnosis of epidemic parotitis? | single blood sample for a specific immunoglobulin G (IgG) | blood cell count | blood culture | single blood test for a specific immunoglobulin M (IgM) | 3d
| multi | Acute and convalescent titres of specific IgG antibodies will confirm the diagnosis of mumps. A single test revealing a specific IgM antibody can also confirm the disease. Urine, saliva, and throat swabs will grow the mumps virus, but blood does not. Salivary amylase is elevated but is relatively nonspecific. Of course, a typical presentation during an epidemic probably does not require any confirmatory tests. Sporadic cases require more active confirmation. Other causes of parotitis requiring specific treatment include calculi, bacterial infections, and drugs. Tumors, sarcoid, TB, leukemia, Hodgkin's disease, Sjogren's syndrome, and lupus erythematosus can also cause parotid enlargement. | Medicine | Infection | 146 | {
"Correct Answer": "single blood test for a specific immunoglobulin M (IgM)",
"Correct Option": "D",
"Options": {
"A": "single blood sample for a specific immunoglobulin G (IgG)",
"B": "blood cell count",
"C": "blood culture",
"D": "single blood test for a specific immunoglobulin M (IgM)"
},
"Question": "A 20-year-old woman complains of headache and discomfort in both sides of her jaw. Physical examination reveals enlarged parotid glands that are slightly tender on palpation. There is reddening of the orifice of Stensen's duct on intra oral examination; her temperature is 38.3degC, and the pulse rate is 80/min. Laboratory data show hemoglobin 14 g/dL; hematocrit 40%; WBC 11000/mL, with 33% segmented neutrophils, 7% monocytes, and 60% lymphocytes. Which of the following diagnostic tests will help to confirm the diagnosis of epidemic parotitis?"
} | A 20-year-old woman complains of headache and discomfort in both sides of her jaw. Physical examination reveals enlarged parotid glands that are slightly tender on palpation. There is reddening of the orifice of Stensen's duct on intra oral examination; her temperature is 38.3degC, and the pulse rate is 80/min. Laboratory data show hemoglobin 14 g/dL; hematocrit 40%; WBC 11000/mL, with 33% segmented neutrophils, 7% monocytes, and 60% lymphocytes. | Which of the following diagnostic tests will help to confirm the diagnosis of epidemic parotitis? | {
"A": "single blood sample for a specific immunoglobulin G (IgG)",
"B": "blood cell count",
"C": "blood culture",
"D": "single blood test for a specific immunoglobulin M (IgM)"
} | D. single blood test for a specific immunoglobulin M (IgM) |
5cbaefdd-8887-4278-8330-804aa2635949 | A 50 year old chronic alcoholic male agricultural worker presented with high grade fever of one week duration with spells of chills and rigor. Examination of the respiratory system revealed bilateral crepitations with scattered rhonchi. Multiple subcutaneous nodules were found on the extensor surface of the left forearm, arm and left leg. Direct microscopy of the pus aspirated from the skin nodule revealed plenty of Gram negative bacilli with bipolar staining. Culture revealed distinct rough corrugated grey-white colonies on Blood agar. The organisms were motile and oxidase positive. The most likely diagnosis is | Plague | Melioidosis | Bartonellosis | Actinomycosis | 1b
| single | null | Microbiology | null | 120 | {
"Correct Answer": "Melioidosis",
"Correct Option": "B",
"Options": {
"A": "Plague",
"B": "Melioidosis",
"C": "Bartonellosis",
"D": "Actinomycosis"
},
"Question": "A 50 year old chronic alcoholic male agricultural worker presented with high grade fever of one week duration with spells of chills and rigor. Examination of the respiratory system revealed bilateral crepitations with scattered rhonchi. Multiple subcutaneous nodules were found on the extensor surface of the left forearm, arm and left leg. Direct microscopy of the pus aspirated from the skin nodule revealed plenty of Gram negative bacilli with bipolar staining. Culture revealed distinct rough corrugated grey-white colonies on Blood agar. The organisms were motile and oxidase positive. The most likely diagnosis is"
} | A 50 year old chronic alcoholic male agricultural worker presented with high grade fever of one week duration with spells of chills and rigor. Examination of the respiratory system revealed bilateral crepitations with scattered rhonchi. Multiple subcutaneous nodules were found on the extensor surface of the left forearm, arm and left leg. Direct microscopy of the pus aspirated from the skin nodule revealed plenty of Gram negative bacilli with bipolar staining. Culture revealed distinct rough corrugated grey-white colonies on Blood agar. The organisms were motile and oxidase positive. | The most likely diagnosis is | {
"A": "Plague",
"B": "Melioidosis",
"C": "Bartonellosis",
"D": "Actinomycosis"
} | B. Melioidosis |
d74b6add-7206-4968-95f4-c3480ce86e68 | A 25-year-old man is brought to the emergency depament by ambulance after falling 20 ft from a ladder. He was placed on a backboard for spinal stabilization. Intravenous access was obtained en route, and he received infusion of crystalloids. The patient is unconscious upon arrival. His blood pressure is 91/44 mm Hg, pulse is 129/min, and respirations are 8/min. Pulse oximetry is at 85%. Evaluation shows several superficial facial lacerations, a depressed temporal skull fracture, and a forearm fracture. There are no periorbital or periauricular hematomas, and there is no significant neck edema. Which of the following is the most appropriate next step in management of this patient? | Orotracheal intubation | Needle cricothyroidotomy | Nasotracheal intubation | Laryngeal mask placement | 0a
| multi | The patient would've sustained a cervical spine trauma after the fall. The 1st step in evaluating such patients is stabilize the cervical spine and spinal column backboard, cervical collar until a spinal injury is eliminated. The next step is to assess airway, patient is hypoxic and hypopneic requires emergency airway access - Orotracheal intubation with rapid sequence intubation is the preferred way to establish an airway unless there is a significant facial trauma . | Surgery | Trauma | 163 | {
"Correct Answer": "Orotracheal intubation",
"Correct Option": "A",
"Options": {
"A": "Orotracheal intubation",
"B": "Needle cricothyroidotomy",
"C": "Nasotracheal intubation",
"D": "Laryngeal mask placement"
},
"Question": "A 25-year-old man is brought to the emergency depament by ambulance after falling 20 ft from a ladder. He was placed on a backboard for spinal stabilization. Intravenous access was obtained en route, and he received infusion of crystalloids. The patient is unconscious upon arrival. His blood pressure is 91/44 mm Hg, pulse is 129/min, and respirations are 8/min. Pulse oximetry is at 85%. Evaluation shows several superficial facial lacerations, a depressed temporal skull fracture, and a forearm fracture. There are no periorbital or periauricular hematomas, and there is no significant neck edema. Which of the following is the most appropriate next step in management of this patient?"
} | A 25-year-old man is brought to the emergency depament by ambulance after falling 20 ft from a ladder. He was placed on a backboard for spinal stabilization. Intravenous access was obtained en route, and he received infusion of crystalloids. The patient is unconscious upon arrival. His blood pressure is 91/44 mm Hg, pulse is 129/min, and respirations are 8/min. Pulse oximetry is at 85%. Evaluation shows several superficial facial lacerations, a depressed temporal skull fracture, and a forearm fracture. There are no periorbital or periauricular hematomas, and there is no significant neck edema. | Which of the following is the most appropriate next step in management of this patient? | {
"A": "Orotracheal intubation",
"B": "Needle cricothyroidotomy",
"C": "Nasotracheal intubation",
"D": "Laryngeal mask placement"
} | A. Orotracheal intubation |
f14fb9dc-63b9-4d77-a69e-6765a6b1266b | A 30-year-old female patient complains that she has been weak and easily fatigued over the past 6 months. She has a 3-month acute history of severe hypertension that has required treatment with antihypertensive medications. She has recently gained 4.5 kg (10 lb) and currently weighs 75 kg (165 lb). Her blood pressure is 170/100 mm Hg. Purple striae are seen over the abdomen on physical examination and she possesses a "buffalo hump." Fasting serum glucose concentration is 140 mg/dl. A CT scan of the abdomen shows a 6-cm mass immediately posterior to the inferior vena cava. Which of the following organs is the most likely origin of the mass? | Suprarenal (adrenal) gland | Appendix | Gallbladder | Ovary | 0a
| multi | The right adrenal gland is a retroperitoneal organ on the superomedial aspect of the right kidney, partially posterior to the inferior vena cava. The appendix is a narrow, hollow tube that is suspended from the cecum by a small mesoappendix. The gallbladder is located at the junction of the ninth costal cartilage and the lateral border of the rectus abdominis, quite anterior to the pathologic mass. The ovaries and uterus are both inferior to the confluence of the inferior vena cava. | Anatomy | Abdomen & Pelvis | 166 | {
"Correct Answer": "Suprarenal (adrenal) gland",
"Correct Option": "A",
"Options": {
"A": "Suprarenal (adrenal) gland",
"B": "Appendix",
"C": "Gallbladder",
"D": "Ovary"
},
"Question": "A 30-year-old female patient complains that she has been weak and easily fatigued over the past 6 months. She has a 3-month acute history of severe hypertension that has required treatment with antihypertensive medications. She has recently gained 4.5 kg (10 lb) and currently weighs 75 kg (165 lb). Her blood pressure is 170/100 mm Hg. Purple striae are seen over the abdomen on physical examination and she possesses a \"buffalo hump.\" Fasting serum glucose concentration is 140 mg/dl. A CT scan of the abdomen shows a 6-cm mass immediately posterior to the inferior vena cava. Which of the following organs is the most likely origin of the mass?"
} | A 30-year-old female patient complains that she has been weak and easily fatigued over the past 6 months. She has a 3-month acute history of severe hypertension that has required treatment with antihypertensive medications. She has recently gained 4.5 kg (10 lb) and currently weighs 75 kg (165 lb). Her blood pressure is 170/100 mm Hg. Purple striae are seen over the abdomen on physical examination and she possesses a "buffalo hump." Fasting serum glucose concentration is 140 mg/dl. A CT scan of the abdomen shows a 6-cm mass immediately posterior to the inferior vena cava. | Which of the following organs is the most likely origin of the mass? | {
"A": "Suprarenal (adrenal) gland",
"B": "Appendix",
"C": "Gallbladder",
"D": "Ovary"
} | A. Suprarenal (adrenal) gland |
79e554d5-d5a0-4aed-9b1b-9e920904e31f | A 6-month-old child was at the 50th percentile at birth for length, weight, and head circumference. His growth curve from his last visit 1 week ago is shown. On his developmental assessment, you noted that he rolled from stomach to back occasionally but not very well from back to stomach. He could bear weight on his legs but would not sit without assistance. Today, the family calls you urgently at 7:00 AM noting that their child seems unable to move the right side of his body. Which of the following conditions might explain this child's condition? | Phenylketonuria | Homocystinuria | Cystathioninuria | Maple syrup urine disease | 1b
| multi | The growth curve shown demonstrates poor growth over the 6 months of this child's life. Homocystinuria is an autosomal recessive metabolic disease caused by deficiencies of cystathionine b-synthase, methylenetetrahydrofolate reductase, or the coenzyme for N5-methyltetrahydrofolate methyltransferase. Manifestations include poor growth, arachnodactyly, osteoporosis, dislocated lenses, and mental retardation. In addition, thromboembolic phenomena may be seen in the pulmonary and systemic arteries and particularly in the cerebral vasculature; vascular occlusive disease is, in turn, one of the many causes of acute infantile hemiplegia. None of the other disorders listed in the question is associated with acute hemiplegia. Phenylketonuria causes retardation and, on occasion, seizures; maple syrup urine disease, an abnormality of the metabolism of leucine, leads to seizures and rapid deterioration of the CNS in newborn infants; and histidinemia and cystathioninuria are most likely a benign aminoaciduria with no effect on the CNS. Many states now include these diseases in their newborn screening programs. | Pediatrics | Musculo Skeletal Disorders | 119 | {
"Correct Answer": "Homocystinuria",
"Correct Option": "B",
"Options": {
"A": "Phenylketonuria",
"B": "Homocystinuria",
"C": "Cystathioninuria",
"D": "Maple syrup urine disease"
},
"Question": "A 6-month-old child was at the 50th percentile at birth for length, weight, and head circumference. His growth curve from his last visit 1 week ago is shown. On his developmental assessment, you noted that he rolled from stomach to back occasionally but not very well from back to stomach. He could bear weight on his legs but would not sit without assistance. Today, the family calls you urgently at 7:00 AM noting that their child seems unable to move the right side of his body. Which of the following conditions might explain this child's condition?"
} | A 6-month-old child was at the 50th percentile at birth for length, weight, and head circumference. His growth curve from his last visit 1 week ago is shown. On his developmental assessment, you noted that he rolled from stomach to back occasionally but not very well from back to stomach. He could bear weight on his legs but would not sit without assistance. Today, the family calls you urgently at 7:00 AM noting that their child seems unable to move the right side of his body. | Which of the following conditions might explain this child's condition? | {
"A": "Phenylketonuria",
"B": "Homocystinuria",
"C": "Cystathioninuria",
"D": "Maple syrup urine disease"
} | B. Homocystinuria |
aefe79e7-e641-4413-b68d-b87028ec93d2 | During a regular visit to the pediatrician 1 week after birth, an infant's size and head circumference are recorded as being in the seventy-fifth percentile. Repeat measurement 1 month later still shows the size of the baby at the seventy-fifth percentile, but the baby's head circumference is now at the ninety-fifth percentile. The pediatrician notices that the baby's anterior fontanelle is tense and that the skull sutures are open. He obtains an MRI of the brain with intravenous contrast. This study shows the presence of greatly dilated lateral and third ventricles. The aqueduct of Sylvius cannot be easily visualized. The fourth ventricle is small. There are no lesions within the subarachnoid space or cerebral parenchyma. The appearance of the MRI is consistent with which of the following? | Noncommunicating hydrocephalus | Communicating hydrocephalus | Normal-pressure hydrocephalus | Arnold-Chiari malformation with herniation of the cerebellum into the foramen magnum | 0a
| multi | Noncommunicating hydrocephalus is defined as hydrocephalus caused by obstruction of CSF flow and obstruction within the ventricular system. In this case, the ventricular system is dilated upstream from the obstruction caused by stenosis of the aqueduct of Sylvius and collapsed distally. Communicating hydrocephalus occurs when the obstruction to CSF flow occurs within the subarachnoid space or at the level of its resorption into the bloodstream by the arachnoid granulations. In this case, all ventricles are dilated proportionately. | Surgery | Nervous System | 171 | {
"Correct Answer": "Noncommunicating hydrocephalus",
"Correct Option": "A",
"Options": {
"A": "Noncommunicating hydrocephalus",
"B": "Communicating hydrocephalus",
"C": "Normal-pressure hydrocephalus",
"D": "Arnold-Chiari malformation with herniation of the cerebellum into the foramen magnum"
},
"Question": "During a regular visit to the pediatrician 1 week after birth, an infant's size and head circumference are recorded as being in the seventy-fifth percentile. Repeat measurement 1 month later still shows the size of the baby at the seventy-fifth percentile, but the baby's head circumference is now at the ninety-fifth percentile. The pediatrician notices that the baby's anterior fontanelle is tense and that the skull sutures are open. He obtains an MRI of the brain with intravenous contrast. This study shows the presence of greatly dilated lateral and third ventricles. The aqueduct of Sylvius cannot be easily visualized. The fourth ventricle is small. There are no lesions within the subarachnoid space or cerebral parenchyma. The appearance of the MRI is consistent with which of the following?"
} | During a regular visit to the pediatrician 1 week after birth, an infant's size and head circumference are recorded as being in the seventy-fifth percentile. Repeat measurement 1 month later still shows the size of the baby at the seventy-fifth percentile, but the baby's head circumference is now at the ninety-fifth percentile. The pediatrician notices that the baby's anterior fontanelle is tense and that the skull sutures are open. He obtains an MRI of the brain with intravenous contrast. This study shows the presence of greatly dilated lateral and third ventricles. The aqueduct of Sylvius cannot be easily visualized. The fourth ventricle is small. There are no lesions within the subarachnoid space or cerebral parenchyma. | The appearance of the MRI is consistent with which of the following? | {
"A": "Noncommunicating hydrocephalus",
"B": "Communicating hydrocephalus",
"C": "Normal-pressure hydrocephalus",
"D": "Arnold-Chiari malformation with herniation of the cerebellum into the foramen magnum"
} | A. Noncommunicating hydrocephalus |
1613052d-3cf1-4200-921b-bfc9d18da96e | A 23 year old man was found roaming aimlessly near New Delhi Railway Station. When the police enquired about his whereabouts he appeared confused and was not able to tell details about his name and address. He was not able to give any information about how he reached the railway station and could not recall anything about his past. His belongings included an AADHAR CARD, where the address was of srinagar, jammu & kashmir. When his family was contacted, they repoed that his father had died yesterday and since than he went missing. What is the likely diagnosis? | Dissociative fugue | Dissociative identity disorder | Post traumatic stress disorder | Depersonlaization/derealization | 0a
| multi | History of a travel, with inability to recall details of travel and inability to recall impoant personal information is suggestive of dissociative fugue. The presence of a stressor , fuher aids in the diagnosis. Kindly remember that in DSM-5, dissociative fugue has been subsumed under the diagnosis of dissociative amnesia. | Psychiatry | Neurotic, Stress Related and Somatoform Disorders | 121 | {
"Correct Answer": "Dissociative fugue",
"Correct Option": "A",
"Options": {
"A": "Dissociative fugue",
"B": "Dissociative identity disorder",
"C": "Post traumatic stress disorder",
"D": "Depersonlaization/derealization"
},
"Question": "A 23 year old man was found roaming aimlessly near New Delhi Railway Station. When the police enquired about his whereabouts he appeared confused and was not able to tell details about his name and address. He was not able to give any information about how he reached the railway station and could not recall anything about his past. His belongings included an AADHAR CARD, where the address was of srinagar, jammu & kashmir. When his family was contacted, they repoed that his father had died yesterday and since than he went missing. What is the likely diagnosis?"
} | A 23 year old man was found roaming aimlessly near New Delhi Railway Station. When the police enquired about his whereabouts he appeared confused and was not able to tell details about his name and address. He was not able to give any information about how he reached the railway station and could not recall anything about his past. His belongings included an AADHAR CARD, where the address was of srinagar, jammu & kashmir. When his family was contacted, they repoed that his father had died yesterday and since than he went missing. | What is the likely diagnosis? | {
"A": "Dissociative fugue",
"B": "Dissociative identity disorder",
"C": "Post traumatic stress disorder",
"D": "Depersonlaization/derealization"
} | A. Dissociative fugue |
2a0a1631-c915-47db-bdb5-f9bb1742cbed | A 40 year old male k/c/o DM-2 and is on oral hypoglycemic drugs presents to OPD for routine check up.Patient is obese with BMI of 28.5 kg/m2. His blood workup and vitals are as follows:Blood pressure=150/90 mm of Hg, Fasting glucose=118 mg/dl, Post-prandial glucose=154 mg/dl. Currently he is on low calorie diet and do regular exercise. What would you prescribe for the obesity in this patient? | Bariatric surgery | Diet modulation and exercise alone are enough | Anti-obesity drugs along with diet modulation and exercise | None of the above | 2c
| multi | Patient is obese with diabetes mellitus and hypeension . In this case anti-obesity drugs along with diet and exercise should be staed. A GUIDE TO OPTING FOR TREATMENT FOR OBESITY TREATMENT BMI CATEGORY(kg/m2) 25-26.9 27-29.9 30-34.9 35-39.9 >=40 Diet,exercise,behavioral therapy With comorbidites With comorbidites + + + Pharmacotherapy - With comorbidites + + + Surgery - - - With comorbidites + | Medicine | Diabetes Mellitus | 119 | {
"Correct Answer": "Anti-obesity drugs along with diet modulation and exercise",
"Correct Option": "C",
"Options": {
"A": "Bariatric surgery",
"B": "Diet modulation and exercise alone are enough",
"C": "Anti-obesity drugs along with diet modulation and exercise",
"D": "None of the above"
},
"Question": "A 40 year old male k/c/o DM-2 and is on oral hypoglycemic drugs presents to OPD for routine check up.Patient is obese with BMI of 28.5 kg/m2. His blood workup and vitals are as follows:Blood pressure=150/90 mm of Hg, Fasting glucose=118 mg/dl, Post-prandial glucose=154 mg/dl. Currently he is on low calorie diet and do regular exercise. What would you prescribe for the obesity in this patient?"
} | A 40 year old male k/c/o DM-2 and is on oral hypoglycemic drugs presents to OPD for routine check up.Patient is obese with BMI of 28.5 kg/m2. His blood workup and vitals are as follows:Blood pressure=150/90 mm of Hg, Fasting glucose=118 mg/dl, Post-prandial glucose=154 mg/dl. Currently he is on low calorie diet and do regular exercise. | What would you prescribe for the obesity in this patient? | {
"A": "Bariatric surgery",
"B": "Diet modulation and exercise alone are enough",
"C": "Anti-obesity drugs along with diet modulation and exercise",
"D": "None of the above"
} | C. Anti-obesity drugs along with diet modulation and exercise |
fb5f2a82-5365-43ed-9ec2-e9a7211670ac | A 37-year-old woman comes to the emergency depament with sudden onset of left leg weakness. There is no history of any prior medical illness. On neurological examination, there is no wasting, muscle tone is normal, deep-tendon reflexes are normal, and plantars show 'flexor' response. The patient cannot raise her left leg off the bed while supine and is very worried that something is wrong. MRI brain does not reveal any abnormality. Which of the following is the most likely diagnosis? | Conversion disorder | Factitious disorder | Illness anxiety disorder | Malingering | 0a
| single | This patient had a sudden onset of neurological symptoms , and the symptoms and clinical examination findings are inconsistent. This is a strong pointer towards conversion disorder. Please note that there is no la belle indifference (lack of concern for the symptoms) in this patient. La belle indifference is not seen in all patients with conversion disorder. In contrast to conversion disorders, patient with factitious disorders voluntarily produce the symptoms and the question gives a hint about it. | Psychiatry | Neurotic, Stress Related and Somatoform Disorders | 105 | {
"Correct Answer": "Conversion disorder",
"Correct Option": "A",
"Options": {
"A": "Conversion disorder",
"B": "Factitious disorder",
"C": "Illness anxiety disorder",
"D": "Malingering"
},
"Question": "A 37-year-old woman comes to the emergency depament with sudden onset of left leg weakness. There is no history of any prior medical illness. On neurological examination, there is no wasting, muscle tone is normal, deep-tendon reflexes are normal, and plantars show 'flexor' response. The patient cannot raise her left leg off the bed while supine and is very worried that something is wrong. MRI brain does not reveal any abnormality. Which of the following is the most likely diagnosis?"
} | A 37-year-old woman comes to the emergency depament with sudden onset of left leg weakness. There is no history of any prior medical illness. On neurological examination, there is no wasting, muscle tone is normal, deep-tendon reflexes are normal, and plantars show 'flexor' response. The patient cannot raise her left leg off the bed while supine and is very worried that something is wrong. MRI brain does not reveal any abnormality. | Which of the following is the most likely diagnosis? | {
"A": "Conversion disorder",
"B": "Factitious disorder",
"C": "Illness anxiety disorder",
"D": "Malingering"
} | A. Conversion disorder |
dc6316d9-f4cd-4db8-8b1f-d7a808b64dae | A 56-year-old woman has noticed an enlarging lump on the right side of her neck for the past 7 months. On physical examination, there is a 3-cm nodule in the right upper neck, medial to the sternocleidomastoid muscle and lateral to the trachea at the angle of the mandible. CT scan shows a circumscribed, solid mass adjacent to the carotid bifurcation. Microscopic examination of the excised mass shows nests of round cells with pink, granular cytoplasm. Tests for immunohistochemical markers chromogranin and S-100 are positive. Electron microscopy shows neurosecretory granules in the tumor cell cytoplasm. The tumor recurs 1 year later and is again excised. What is the most likely diagnosis? | Metastatic squamous cell carcinoma | Metastatic thyroid medullary carcinoma | Mucoepidermoid carcinoma | Paraganglioma | 3d
| single | Paragangliomas are neuroendocrine tumors that rarely produce sufficient catecholamines to affect blood pressure, in contrast to their adrenal medullary counterpart, pheochromocytoma. The microscopic appearance of these lesions does not always correlate with their biological behavior. There is a tendency for recurrence and metastasis despite the tumor's "bland" appearance. Metastases always should be considered in patients this age. About 5% of squamous cell carcinomas of the head and neck manifest initially as a nodal metastasis, without an obvious primary site, but the microscopic pattern here is not that of squamous cell carcinoma. Some thyroid cancers initially may manifest as a nodal metastasis, but the microscopic pattern in this case fits best with paraganglioma. A mucoepidermoid carcinoma or a Warthin tumor arises in a salivary gland. | Pathology | Head & Neck | 171 | {
"Correct Answer": "Paraganglioma",
"Correct Option": "D",
"Options": {
"A": "Metastatic squamous cell carcinoma",
"B": "Metastatic thyroid medullary carcinoma",
"C": "Mucoepidermoid carcinoma",
"D": "Paraganglioma"
},
"Question": "A 56-year-old woman has noticed an enlarging lump on the right side of her neck for the past 7 months. On physical examination, there is a 3-cm nodule in the right upper neck, medial to the sternocleidomastoid muscle and lateral to the trachea at the angle of the mandible. CT scan shows a circumscribed, solid mass adjacent to the carotid bifurcation. Microscopic examination of the excised mass shows nests of round cells with pink, granular cytoplasm. Tests for immunohistochemical markers chromogranin and S-100 are positive. Electron microscopy shows neurosecretory granules in the tumor cell cytoplasm. The tumor recurs 1 year later and is again excised. What is the most likely diagnosis?"
} | A 56-year-old woman has noticed an enlarging lump on the right side of her neck for the past 7 months. On physical examination, there is a 3-cm nodule in the right upper neck, medial to the sternocleidomastoid muscle and lateral to the trachea at the angle of the mandible. CT scan shows a circumscribed, solid mass adjacent to the carotid bifurcation. Microscopic examination of the excised mass shows nests of round cells with pink, granular cytoplasm. Tests for immunohistochemical markers chromogranin and S-100 are positive. Electron microscopy shows neurosecretory granules in the tumor cell cytoplasm. The tumor recurs 1 year later and is again excised. | What is the most likely diagnosis? | {
"A": "Metastatic squamous cell carcinoma",
"B": "Metastatic thyroid medullary carcinoma",
"C": "Mucoepidermoid carcinoma",
"D": "Paraganglioma"
} | D. Paraganglioma |
0f5eae2e-3a97-446e-8a5f-81ae34ddf775 | A 50-year-old man presents with feeling tired and unsteady on his feet. He has a poor appetite and has lost 10 lb. On examination, he appears cachectic, his heart and lungs are normal, but his liver span is 18 cm. His lab tests show a very low magnesium level (0.7 mEq/L). On further questioning, he reports drinking heavily since losing his job. Which of the following is the most likely explanation for his low magnesium level? | alcoholism | chronic malabsorption | diabetes mellitus (DM) | kwashiorkor | 0a
| single | Magnesium deficiency is most commonly due to alcoholism. Renal loss and malabsorption are also common causes. Magnesium deficiency is not seen in hypervitaminosis E. Causes of magnesium deficiency also include milk diets in infants, the diuretic phase of acute tubular necrosis, chronic diuretic therapy, acute pancreatitis, and inappropriate antidiuretic hormone. The symptoms of hypomagnesemia include anorexia, nausea, tremor, and mood alteration. Symptoms can also be caused by the associated hypocalcemia or hypokalemia. | Medicine | Endocrinology | 103 | {
"Correct Answer": "alcoholism",
"Correct Option": "A",
"Options": {
"A": "alcoholism",
"B": "chronic malabsorption",
"C": "diabetes mellitus (DM)",
"D": "kwashiorkor"
},
"Question": "A 50-year-old man presents with feeling tired and unsteady on his feet. He has a poor appetite and has lost 10 lb. On examination, he appears cachectic, his heart and lungs are normal, but his liver span is 18 cm. His lab tests show a very low magnesium level (0.7 mEq/L). On further questioning, he reports drinking heavily since losing his job. Which of the following is the most likely explanation for his low magnesium level?"
} | A 50-year-old man presents with feeling tired and unsteady on his feet. He has a poor appetite and has lost 10 lb. On examination, he appears cachectic, his heart and lungs are normal, but his liver span is 18 cm. His lab tests show a very low magnesium level (0.7 mEq/L). On further questioning, he reports drinking heavily since losing his job. | Which of the following is the most likely explanation for his low magnesium level? | {
"A": "alcoholism",
"B": "chronic malabsorption",
"C": "diabetes mellitus (DM)",
"D": "kwashiorkor"
} | A. alcoholism |
03a9f92b-8055-45f9-a8de-8a203906f0f4 | A 40 years old female patient attends the OG department with swelling of legs for past one day. There is no history of fever. 2 years back she had a metastatic breast adenocarcinoma which was treated with paclitaxel and radiotherapy. Blood pressure 120/76 mmHg, Pulse rate 84/min, temperature 37.6 C, Respiratory rate 16/ min. Saturation was 99% in room air. There was warmth and tenderness over the left leg and left thigh. Auscultation of lungs revealed clear fields. Urine pregnancy test was negative. CT chest was normal. USG of left leg revealed thrombus in the superficial femoral vein. The most appropriate treatment is | Dalteparin and enoxaparin together | Warfarin therapy with a goal to maintain INR of 2-3 | Enoxaparin and warfarin therapy with a goal to maintain INR of 2-3 | Aspirin and warfarin therapy with a goal to maintain INR of 2-3 | 2c
| single | Answer: c) Enoxaparin and warfarin therapy with a goal to maintain INR of 2-3 (HARRISON 19TH ED, P-1635)DEEP VEIN THROMBOSISMost common site of DVT - calf veinsRisk of pulmonary embolism is much higher with proximal DVT (40% to 50%) than with clots confined to the distal calf vessels (5% to 10%)Pain and swelling are the major complaints from patients with DVTA large number of patients are asymptomatic, particularly if the DVT is restricted to the calfPain with dorsiflexion of the foot (Homan's sign) may be present, but the low sensitivity and the low specificity limit the usefulness of this sign in the diagnosis of lower-extremity DVTDiagnosis of DVTD-dimer elevation is a highly sensitive indicator of DVT (but not specific)Duplex ultrasonography has greater sensitivity in detecting proximal DVT than distal DVT of the lower extremities.Contrast venography is the "gold standard" test, but it is invasive and technically difficultTreatmentImmediate Anticoagulation:Unfractionated heparin, bolus and continuous infusion, to achieve aPTT 2-3 times the normal, or Enoxaparin or Dalteparin or Fondaparinux.Continue parenteral anticoagulation for a minimum of 5 daysUnfractionated heparin, low-molecular-weight heparin, and fondaparinux are the usual immediately effective "bridging agents" used when initiating warfarinWarfarin Anticoagulation: Usual start dose is 5 mg; Titrate to INR, target 2.0-3.0 | Medicine | Blood | 160 | {
"Correct Answer": "Enoxaparin and warfarin therapy with a goal to maintain INR of 2-3",
"Correct Option": "C",
"Options": {
"A": "Dalteparin and enoxaparin together",
"B": "Warfarin therapy with a goal to maintain INR of 2-3",
"C": "Enoxaparin and warfarin therapy with a goal to maintain INR of 2-3",
"D": "Aspirin and warfarin therapy with a goal to maintain INR of 2-3"
},
"Question": "A 40 years old female patient attends the OG department with swelling of legs for past one day. There is no history of fever. 2 years back she had a metastatic breast adenocarcinoma which was treated with paclitaxel and radiotherapy. Blood pressure 120/76 mmHg, Pulse rate 84/min, temperature 37.6 C, Respiratory rate 16/ min. Saturation was 99% in room air. There was warmth and tenderness over the left leg and left thigh. Auscultation of lungs revealed clear fields. Urine pregnancy test was negative. CT chest was normal. USG of left leg revealed thrombus in the superficial femoral vein. The most appropriate treatment is"
} | A 40 years old female patient attends the OG department with swelling of legs for past one day. There is no history of fever. 2 years back she had a metastatic breast adenocarcinoma which was treated with paclitaxel and radiotherapy. Blood pressure 120/76 mmHg, Pulse rate 84/min, temperature 37.6 C, Respiratory rate 16/ min. Saturation was 99% in room air. There was warmth and tenderness over the left leg and left thigh. Auscultation of lungs revealed clear fields. Urine pregnancy test was negative. CT chest was normal. USG of left leg revealed thrombus in the superficial femoral vein. | The most appropriate treatment is | {
"A": "Dalteparin and enoxaparin together",
"B": "Warfarin therapy with a goal to maintain INR of 2-3",
"C": "Enoxaparin and warfarin therapy with a goal to maintain INR of 2-3",
"D": "Aspirin and warfarin therapy with a goal to maintain INR of 2-3"
} | C. Enoxaparin and warfarin therapy with a goal to maintain INR of 2-3 |
fe8a620a-28e1-4ae4-8c82-49bf9a536f8a | A 70-year-old woman complained of sudden onset of severe abdominal pain in the epigastric region which was progressively increasing rapidly. She has a history of myocardial ischemia and peripheral vascular disease. The patient states that she has had nausea and vomiting. On examination, she was writhing in pain. Bowel sounds were normal and there was minimal tenderness. A small amount of blood was present in the stool specimen.The electrolytes showed bicarbonate level at 15 mEq/L, and the serum lactate level was high, which were indicative of tissue receiving insufficient oxygenation leading to tissue injury. CT was planned with following finding. (source - radiopedia.org) What anatomical structure is likely involved? | B | D | C | A | 2c
| multi | CT scan show acute mesenteric ischemia secondary to occluded SMA from an embolic source (arrow). Image shows- A- Celiac aery B- Left kidney C- Superior mesenteric aery D- Right kidney This elderly woman complains of sudden-onset severe abdominal pain in the epigastric region that is inconsistent with the physical findings. She has a history of widespread atherosclerotic vascular disease affecting the coronary aeries and peripheral vasculature. The presence of blood in the stool suggests bowel injury, and the low level of serum bicarbonate is consistent with a metabolic acidemia. Bowel ischemia or necrosis is causative. Aerial occlusion may occur from rupture of the atherosclerotic plaque or embolization from another clot. This patient's mid abdominal symptoms suggest aeriography of the SMA, and the celiac aery might be diagnostic. On confirmation, surgical embolectomy is usually helpful. The moality rate is high in such patients. Although the first pa of the duodenum is supplied by the superior pancreaticoduodenal aery, which receives its blood from the celiac aery, the remainder of the small intestines is supplied by branches of the SMA. | Unknown | Integrated QBank | 149 | {
"Correct Answer": "C",
"Correct Option": "C",
"Options": {
"A": "B",
"B": "D",
"C": "C",
"D": "A"
},
"Question": "A 70-year-old woman complained of sudden onset of severe abdominal pain in the epigastric region which was progressively increasing rapidly. She has a history of myocardial ischemia and peripheral vascular disease. The patient states that she has had nausea and vomiting. On examination, she was writhing in pain. Bowel sounds were normal and there was minimal tenderness. A small amount of blood was present in the stool specimen.The electrolytes showed bicarbonate level at 15 mEq/L, and the serum lactate level was high, which were indicative of tissue receiving insufficient oxygenation leading to tissue injury. CT was planned with following finding. (source - radiopedia.org) What anatomical structure is likely involved?"
} | A 70-year-old woman complained of sudden onset of severe abdominal pain in the epigastric region which was progressively increasing rapidly. She has a history of myocardial ischemia and peripheral vascular disease. The patient states that she has had nausea and vomiting. On examination, she was writhing in pain. Bowel sounds were normal and there was minimal tenderness. A small amount of blood was present in the stool specimen.The electrolytes showed bicarbonate level at 15 mEq/L, and the serum lactate level was high, which were indicative of tissue receiving insufficient oxygenation leading to tissue injury. CT was planned with following finding. | (source - radiopedia.org) What anatomical structure is likely involved? | {
"A": "B",
"B": "D",
"C": "C",
"D": "A"
} | C. C |
08817250-85d9-4f13-b5ec-4bfa4166f1dd | A 73 year-old man presents with progressive dyspnea on exertion over the past one year. He reports a dry cough but no wheezes, sputum production, fevers or hemoptysis. He is a life-long non-smoker and worked as a lawyer until retiring 3 years ago. His pulmonary function testing is as follows. What is the most probable diagnosis? Pre-Bronchodilator (BD)TestActualPredicted% PredictedFVC (L)1.574.4635FEV1 (L)1 283.3938FEV1/FVC (%)8276 FRC1 733.8045RV (L)1.122 5943TLC (L)2.706.4542RV/TLC (%)4142 DLCO corr5.0631.6416 | Bronchitis. | Emphysema. | Idiopathic Pulmonary Fibrosis. | Asthma. | 2c
| single | Ans. C. Idiopathic Pulmonary Fibrosis.a. This patient has a reduced FEV1 and FVC with a preserved FEV1/FVC ratio.b. The total lung capacity is reduced and the patient, therefore, has a restrictive defect.c. The flow-volume loop also has the characteristic appearance of a restrictive process - tall, narrow and a short expiratory phase.d. Based on the fact that his TLC is below 50% predicted, this would be classified as a "severe" restrictive defect.e. His DLCO is also markedly reduced indicating he has a reduced alveolocapillary interface for gas exchange and suggesting that the cause of his restrictive process lies within the lung parenchyma.f. Idiopathic pulmonary fibrosis might be a cause in this case. | Physiology | Respiratory System | 201 | {
"Correct Answer": "Idiopathic Pulmonary Fibrosis.",
"Correct Option": "C",
"Options": {
"A": "Bronchitis.",
"B": "Emphysema.",
"C": "Idiopathic Pulmonary Fibrosis.",
"D": "Asthma."
},
"Question": "A 73 year-old man presents with progressive dyspnea on exertion over the past one year. He reports a dry cough but no wheezes, sputum production, fevers or hemoptysis. He is a life-long non-smoker and worked as a lawyer until retiring 3 years ago. His pulmonary function testing is as follows. What is the most probable diagnosis? Pre-Bronchodilator (BD)TestActualPredicted% PredictedFVC (L)1.574.4635FEV1 (L)1 283.3938FEV1/FVC (%)8276 FRC1 733.8045RV (L)1.122 5943TLC (L)2.706.4542RV/TLC (%)4142 DLCO corr5.0631.6416"
} | A 73 year-old man presents with progressive dyspnea on exertion over the past one year. He reports a dry cough but no wheezes, sputum production, fevers or hemoptysis. He is a life-long non-smoker and worked as a lawyer until retiring 3 years ago. His pulmonary function testing is as follows. | What is the most probable diagnosis? Pre-Bronchodilator (BD)TestActualPredicted% PredictedFVC (L)1.574.4635FEV1 (L)1 283.3938FEV1/FVC (%)8276 FRC1 733.8045RV (L)1.122 5943TLC (L)2.706.4542RV/TLC (%)4142 DLCO corr5.0631.6416 | {
"A": "Bronchitis.",
"B": "Emphysema.",
"C": "Idiopathic Pulmonary Fibrosis.",
"D": "Asthma."
} | C. Idiopathic Pulmonary Fibrosis. |
Subsets and Splits