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c823b727-0a73-4c5d-970c-a6145efcffa3 | A 40-year-old hypeensive lady is brought to the emergency room after being unresponsive following a sudden bout of severe headache, vomiting and neck rigidity at work. 0/E her BP is 180/100 mmHg and her respiration is irregular and of Cheyne-Stokes type. She is agitated and doesn't follow commands, but moves her extremities spontaneously. Most likely diagnosis will be: JIPMER 08; AIIMS 13 | Subarachnoid hemorrhage due to rupture cerebral aneurysm | Hypoglycemic coma | Conversion reaction | Addisonian crisis | 0a
| single | Ans. Subarachnoid hemorrhage due to rupture cerebral aneurysm | Forensic Medicine | null | 102 | {
"Correct Answer": "Subarachnoid hemorrhage due to rupture cerebral aneurysm",
"Correct Option": "A",
"Options": {
"A": "Subarachnoid hemorrhage due to rupture cerebral aneurysm",
"B": "Hypoglycemic coma",
"C": "Conversion reaction",
"D": "Addisonian crisis"
},
"Question": "A 40-year-old hypeensive lady is brought to the emergency room after being unresponsive following a sudden bout of severe headache, vomiting and neck rigidity at work. 0/E her BP is 180/100 mmHg and her respiration is irregular and of Cheyne-Stokes type. She is agitated and doesn't follow commands, but moves her extremities spontaneously. Most likely diagnosis will be: JIPMER 08; AIIMS 13"
} | A 40-year-old hypeensive lady is brought to the emergency room after being unresponsive following a sudden bout of severe headache, vomiting and neck rigidity at work. 0/E her BP is 180/100 mmHg and her respiration is irregular and of Cheyne-Stokes type. She is agitated and doesn't follow commands, but moves her extremities spontaneously. | Most likely diagnosis will be: JIPMER 08; AIIMS 13 | {
"A": "Subarachnoid hemorrhage due to rupture cerebral aneurysm",
"B": "Hypoglycemic coma",
"C": "Conversion reaction",
"D": "Addisonian crisis"
} | A. Subarachnoid hemorrhage due to rupture cerebral aneurysm |
111e771e-f00d-4056-a982-757d4bd44ab3 | A 65-year-old man has experienced worsening fatigue for the past 5 months. On physical examination, he is afebrile and has a pulse of 91/min, respirations of 18/min, and blood pressure of 105/60 mm Hg. There is no organomegaly. A stool sample is positive for occult blood. Laboratory findings include hemoglobin of 5.9 g/dL, hematocrit of 18.3%, MCV of 99 mm3, platelet count of 250,000/ mm3, and WBC count of 7800/ mm3. The reticulocyte concentration is 3.9%. No fibrin split products are detected, and direct and indirect Coombs test results are negative. A bone marrow biopsy specimen shows marked erythroid hyperplasia. Which of the following conditions best explains these findings? | Aplastic anemia | Autoimmune hemolytic anemia | Chronic blood loss | Iron deficiency anemia | 2c
| single | The marked reticulocytosis and marrow hyperplasia indicate that the marrow is responding to a decrease in RBCs. The reticulocytes are larger RBCs that slightly increase the MCV. Anaplastic marrow is very hypocellular and unable to respond to anemia; it is associated with pancytopenia. The normal Coombs test results exclude autoimmune hemolytic anemia. Iron deficiency impairs the ability of the marrow to mount significant and sustained reticulocytosis. Iron deficiency anemia is typically microcytic and hypochromic but could be partially masked here by reticulocytosis, which would not be as marked if iron were not available, but his diet is supplying needed iron. Infiltrative disorders, such as metastases in the marrow, would impair the ability to mount reticulocytosis of this degree. | Pathology | Blood | 197 | {
"Correct Answer": "Chronic blood loss",
"Correct Option": "C",
"Options": {
"A": "Aplastic anemia",
"B": "Autoimmune hemolytic anemia",
"C": "Chronic blood loss",
"D": "Iron deficiency anemia"
},
"Question": "A 65-year-old man has experienced worsening fatigue for the past 5 months. On physical examination, he is afebrile and has a pulse of 91/min, respirations of 18/min, and blood pressure of 105/60 mm Hg. There is no organomegaly. A stool sample is positive for occult blood. Laboratory findings include hemoglobin of 5.9 g/dL, hematocrit of 18.3%, MCV of 99 mm3, platelet count of 250,000/ mm3, and WBC count of 7800/ mm3. The reticulocyte concentration is 3.9%. No fibrin split products are detected, and direct and indirect Coombs test results are negative. A bone marrow biopsy specimen shows marked erythroid hyperplasia. Which of the following conditions best explains these findings?"
} | A 65-year-old man has experienced worsening fatigue for the past 5 months. On physical examination, he is afebrile and has a pulse of 91/min, respirations of 18/min, and blood pressure of 105/60 mm Hg. There is no organomegaly. A stool sample is positive for occult blood. Laboratory findings include hemoglobin of 5.9 g/dL, hematocrit of 18.3%, MCV of 99 mm3, platelet count of 250,000/ mm3, and WBC count of 7800/ mm3. The reticulocyte concentration is 3.9%. No fibrin split products are detected, and direct and indirect Coombs test results are negative. A bone marrow biopsy specimen shows marked erythroid hyperplasia. | Which of the following conditions best explains these findings? | {
"A": "Aplastic anemia",
"B": "Autoimmune hemolytic anemia",
"C": "Chronic blood loss",
"D": "Iron deficiency anemia"
} | C. Chronic blood loss |
1653b946-25af-4c0b-9408-f6a7ad21d1a2 | A 45-year-old woman presents with a 6-month history of fatigue and swelling in her neck. Physical examination shows a goiter. A CBC discloses megaloblastic anemia and a normal reticulocyte count. Additionally, there is an elevated serum level of TSH and antithyroid antibodies. Needle aspiration of the left lobe of the thyroid reveals benign follicular cells and numerous lymphocytes. Anemia in this patient is most likely caused by antibodies directed to which of the following targets? | Chief cells | Intrinsic factor | Paneth cells | TSH receptor | 1b
| multi | This patient has chronic lymphocytic thyroiditis (Hashimoto thyroiditis) and pernicious anemia. Pernicious anemia is a megaloblastic anemia that is caused by malabsorption of vitamin B12 due to a deficiency of the intrinsic factor. In many cases, pernicious anemia is associated with other autoimmune diseases (e.g., Hashimoto thyroiditis, Graves disease, Addison disease, or diabetes mellitus type 1). Circulating antibodies to parietal cells, some of which are cytotoxic in the presence of complement, occur in 90% of patients with pernicious anemia. Two thirds of patients display an antibody to the intrinsic factor that prevents its combination with vitamin B12 thereby preventing formation of the complex that is later absorbed in the ileum. Half of all patients with pernicious anemia have circulating antibodies to thyroid tissue.Diagnosis: Pernicious anemia, Hashimoto thyroiditis | Pathology | G.I.T. | 106 | {
"Correct Answer": "Intrinsic factor",
"Correct Option": "B",
"Options": {
"A": "Chief cells",
"B": "Intrinsic factor",
"C": "Paneth cells",
"D": "TSH receptor"
},
"Question": "A 45-year-old woman presents with a 6-month history of fatigue and swelling in her neck. Physical examination shows a goiter. A CBC discloses megaloblastic anemia and a normal reticulocyte count. Additionally, there is an elevated serum level of TSH and antithyroid antibodies. Needle aspiration of the left lobe of the thyroid reveals benign follicular cells and numerous lymphocytes. Anemia in this patient is most likely caused by antibodies directed to which of the following targets?"
} | A 45-year-old woman presents with a 6-month history of fatigue and swelling in her neck. Physical examination shows a goiter. A CBC discloses megaloblastic anemia and a normal reticulocyte count. Additionally, there is an elevated serum level of TSH and antithyroid antibodies. Needle aspiration of the left lobe of the thyroid reveals benign follicular cells and numerous lymphocytes. | Anemia in this patient is most likely caused by antibodies directed to which of the following targets? | {
"A": "Chief cells",
"B": "Intrinsic factor",
"C": "Paneth cells",
"D": "TSH receptor"
} | B. Intrinsic factor |
84b0180b-3089-44ff-af7d-78564b578248 | A 62-year-old man is admitted to the emergency department due to increasing difficulty in urinating over a period of several months. Physical examination reveals prostatic hypertrophy. After several unsuccessful attempts to catheterize the penile urethra, the urologist orders drainage of the urinary bladder by the least invasive procedure, avoiding entry into the peritoneal cavity or the injury of any major vessels or organs. Which of the following spaces needs to be traversed by the needle to reach the bladder? | Ischioanal fossa | Perineal body | Retropubic space (of Retzius) | Superficial perineal cleft | 2c
| single | The retropubic space (of Retzius) is the extraperitoneal space between the pubic symphysis and the bladder. A needle placed over the pubic bone, through the body wall, and into the space of Retzius will enter the full bladder but avoids entry into the peritoneum and there is little risk of damaging major organs or vessels. Entry through the ischioanal fossa would not provide a direct route to the bladder. With entry through the superficial perineal cleft, perineal body, and deep perineal pouch there is a high risk of damaging important structures. | Anatomy | Abdomen & Pelvis | 104 | {
"Correct Answer": "Retropubic space (of Retzius)",
"Correct Option": "C",
"Options": {
"A": "Ischioanal fossa",
"B": "Perineal body",
"C": "Retropubic space (of Retzius)",
"D": "Superficial perineal cleft"
},
"Question": "A 62-year-old man is admitted to the emergency department due to increasing difficulty in urinating over a period of several months. Physical examination reveals prostatic hypertrophy. After several unsuccessful attempts to catheterize the penile urethra, the urologist orders drainage of the urinary bladder by the least invasive procedure, avoiding entry into the peritoneal cavity or the injury of any major vessels or organs. Which of the following spaces needs to be traversed by the needle to reach the bladder?"
} | A 62-year-old man is admitted to the emergency department due to increasing difficulty in urinating over a period of several months. Physical examination reveals prostatic hypertrophy. After several unsuccessful attempts to catheterize the penile urethra, the urologist orders drainage of the urinary bladder by the least invasive procedure, avoiding entry into the peritoneal cavity or the injury of any major vessels or organs. | Which of the following spaces needs to be traversed by the needle to reach the bladder? | {
"A": "Ischioanal fossa",
"B": "Perineal body",
"C": "Retropubic space (of Retzius)",
"D": "Superficial perineal cleft"
} | C. Retropubic space (of Retzius) |
69a56b5f-e45a-46f1-af80-e9a01b481729 | Systolic BP of a group of 200 people follows normal distribution. Mean BP is 120 mm Hg and standard deviation 10. Which of the following is true -a) 68% of people have BP between 110-130 mmHgb) 95% of people have BP between 110-130 mm Hgc) 95% ofpeople have BP between 100-140 mm Hgd) 99% of pepole have BP between 100-140 mm Hg | a | bc | ac | b | 2c
| multi | The data provided in the question
Mean =120
SD =10
1SD distribution
68% of people (136 out of 200) will have BP in range of 120 ± 10 (1SD) =110 —130 mm Hg.
32% of people (64 out of 200) will have BP outside 110-130 mm Hg.
16% of people (32 out of 200) will have BP above 130 mm Hg
16% of people (32 out of 200) will have BP below 110 mm Hg.
2 SD distribution
95% of people (190 out of 200) will have BP in the range of 120 ± 20 (2SD) = 100 —140 mm Hg
5% of people (10 out of 200) will have BP outside 100-140 mm Hg.
2.5% of people (5 out of 200) will have BP above 120 mm Hg
2.5% of people (5 out of 200) will have BP below 100 mm Hg
3SD distribution
99% of people (198 out of 200) will have BP in the range of 120 ± 30 (3SD) = 90 —150 mm Hg
1% of people (2 out of 200) will have BP outside 90 —150 mm Hg.
0.5% of people (1 out of 100) will have BP above 150 mm Hg
0.5% of people (1 out of 100) will have BP below 90 mm Hg | Social & Preventive Medicine | null | 128 | {
"Correct Answer": "ac",
"Correct Option": "C",
"Options": {
"A": "a",
"B": "bc",
"C": "ac",
"D": "b"
},
"Question": "Systolic BP of a group of 200 people follows normal distribution. Mean BP is 120 mm Hg and standard deviation 10. Which of the following is true -a) 68% of people have BP between 110-130 mmHgb) 95% of people have BP between 110-130 mm Hgc) 95% ofpeople have BP between 100-140 mm Hgd) 99% of pepole have BP between 100-140 mm Hg"
} | Systolic BP of a group of 200 people follows normal distribution. Mean BP is 120 mm Hg and standard deviation 10. | Which of the following is true -a) 68% of people have BP between 110-130 mmHgb) 95% of people have BP between 110-130 mm Hgc) 95% ofpeople have BP between 100-140 mm Hgd) 99% of pepole have BP between 100-140 mm Hg | {
"A": "a",
"B": "bc",
"C": "ac",
"D": "b"
} | C. ac |
69a1c96a-bfaa-4c78-aaed-65b684a22dc4 | A study of patients more than 25 years of age with body mass index above 30, dyslipidemia, hypertension, and fasting glucose averaging 115 mg/ dL is performed. They have adipose tissue abnormalities including increased non-esterified fatty acid release, altered adipokines with decreased adiponectin, greater proinflammatory cytokine release, and diminished peroxisome proliferator-activated receptor gamma (PPARg) function. Which of the following is the best initial therapeutic intervention for these patients? | Adrenalectomy | Caloric restriction | Insulin injection | L-Thyroxine | 1b
| multi | The findings are those of insulin resistance from obesity with metabolic syndrome. Insulin resistance drives beta-cell dysfunction, but other factors such as the TCF7L2 gene play a role in the eventual development of overt type 2 diabetes mellitus. Excess free fatty acids may stimulate cytokine release from beta cells to promote inflammation and islet cell dysfunction. Lifestyle modification with dietary modification for weight reduction coupled with increased exercise will aid in reversing the insulin resistance so that no drug therapy is needed to control hyperglycemia. Cushing syndrome may occur from ACTH-independent adrenal cortical lesions, such as primary hyperplasia, adenoma, or carcinoma, and lead to secondary diabetes from glucocorticoid-induced insulin resistance, but primary adrenal lesions are less common than metabolic syndrome from obesity alone, and the study patients lack additional features of Cushing syndrome such as hirsuitism, osteoporosis, and easy bruisability. The absolute decrease of insulin with type 1 diabetes mellitus must be treated with insulin injections. There is modest weight gain with hypothyroidism, but without abnormalities of adipocytes leading to insulin resistance. Liposuction is a plastic surgery technique used for body contouring, not weight reduction. | Pathology | Endocrine | 112 | {
"Correct Answer": "Caloric restriction",
"Correct Option": "B",
"Options": {
"A": "Adrenalectomy",
"B": "Caloric restriction",
"C": "Insulin injection",
"D": "L-Thyroxine"
},
"Question": "A study of patients more than 25 years of age with body mass index above 30, dyslipidemia, hypertension, and fasting glucose averaging 115 mg/ dL is performed. They have adipose tissue abnormalities including increased non-esterified fatty acid release, altered adipokines with decreased adiponectin, greater proinflammatory cytokine release, and diminished peroxisome proliferator-activated receptor gamma (PPARg) function. Which of the following is the best initial therapeutic intervention for these patients?"
} | A study of patients more than 25 years of age with body mass index above 30, dyslipidemia, hypertension, and fasting glucose averaging 115 mg/ dL is performed. They have adipose tissue abnormalities including increased non-esterified fatty acid release, altered adipokines with decreased adiponectin, greater proinflammatory cytokine release, and diminished peroxisome proliferator-activated receptor gamma (PPARg) function. | Which of the following is the best initial therapeutic intervention for these patients? | {
"A": "Adrenalectomy",
"B": "Caloric restriction",
"C": "Insulin injection",
"D": "L-Thyroxine"
} | B. Caloric restriction |
a7019cd3-20a3-46ce-ab86-62218c3fee05 | A 30 years old male patient presents with weakness of right upper and both lower limbs since 4 months. He developed digital infarcts involving 2nd and 3rd fingers on right side and 5th finger on left side. On examination, BP was 160/140 mm Hg, all peripheral pulses were palpable and there was asymmetrical neuropathy. Investigations showed a Hb 12 gm, TLC - 12000 Cu mm. Platelets 4,30.000. ESR - 49 mm. Urine examination showed proteinuria and RBC -10-15/hpf with no casts. Which of the following is the most likely diagnosis? | Polyaeritis nodosa | Mixed cryoglobulinemia | Wegener's granulomatosis | Systemic lupus erythematosus | 0a
| multi | Patient in the question is suffering from hypeension, digital infarcts in presence of palpable peripheral pulses and urine examination showing proteinuria and hematuria. All of these are features of polyaeritis nodosa a necrotizing vasculitis of small and medium-sized muscular aeries with characteristic involvement of the renal and visceral aeries. It does not involve pulmonary aeries, sometimes bronchial vessels may be involved. Clinical features: Patients presents with fever, weight loss, and malaise, headache, abdominal pain and myalgias. Renal involvement manifests as hypeension, renal insufficiency, or hemorrhage due to microaneurysms. Investigations: CBC shows neutrophilic leucocytosis, anemia of chronic disease and an elevated ESR. Antibodies against myeloperoxidase or proteinase-3 (ANCA) is rarely found. Urine shows evidence of proteinuria and hematuria. Diagnosis is made by the biopsy of the organ involved, which shows evidence of vasculitis. Ref: Harrison's Internal Medicine, 18th Edition, Chapter 283; Current Rheumatology Diagnosis and Treatment By John B. Imboden, 2nd Edition, Chapter 33 | Medicine | null | 154 | {
"Correct Answer": "Polyaeritis nodosa",
"Correct Option": "A",
"Options": {
"A": "Polyaeritis nodosa",
"B": "Mixed cryoglobulinemia",
"C": "Wegener's granulomatosis",
"D": "Systemic lupus erythematosus"
},
"Question": "A 30 years old male patient presents with weakness of right upper and both lower limbs since 4 months. He developed digital infarcts involving 2nd and 3rd fingers on right side and 5th finger on left side. On examination, BP was 160/140 mm Hg, all peripheral pulses were palpable and there was asymmetrical neuropathy. Investigations showed a Hb 12 gm, TLC - 12000 Cu mm. Platelets 4,30.000. ESR - 49 mm. Urine examination showed proteinuria and RBC -10-15/hpf with no casts. Which of the following is the most likely diagnosis?"
} | A 30 years old male patient presents with weakness of right upper and both lower limbs since 4 months. He developed digital infarcts involving 2nd and 3rd fingers on right side and 5th finger on left side. On examination, BP was 160/140 mm Hg, all peripheral pulses were palpable and there was asymmetrical neuropathy. Investigations showed a Hb 12 gm, TLC - 12000 Cu mm. Platelets 4,30.000. ESR - 49 mm. Urine examination showed proteinuria and RBC -10-15/hpf with no casts. | Which of the following is the most likely diagnosis? | {
"A": "Polyaeritis nodosa",
"B": "Mixed cryoglobulinemia",
"C": "Wegener's granulomatosis",
"D": "Systemic lupus erythematosus"
} | A. Polyaeritis nodosa |
25f01d04-2ccf-46b9-99b3-45497d11f79e | A 35-year old male with a history of severe bronchial asthma for several months now complains of weight gain and the development of purple stretch marks. Physical examination shod BP - 149/95 mmHg. supraclavicular fullness. The skin was thinned out with areas of bruising. Neurological examination revealed deceased strength in the proximal muscles. Laboratory investigation showed reduced serum coisol and reduced plasma ACTH. An electrolyte workup in this patient will most likely reveal | Hyponatremia | Hypomagnesemia | Hypokalemia | Hypercalcemia | 2c
| single | Patient developed iatrogenic Cushing syndrome. Bronchial asthma (BA) and Allergic rhinitis (AR) are common clinical problems encountered in day to day practice, where inhalational coicosteroids (ICS) or intranasal steroids (INS) are the mainstay of treatment. Iatrogenic Cushing syndrome (CS) is a well known complication of systemic steroid administration. Ref Davidson edition23rd pg 570 | Medicine | Respiratory system | 106 | {
"Correct Answer": "Hypokalemia",
"Correct Option": "C",
"Options": {
"A": "Hyponatremia",
"B": "Hypomagnesemia",
"C": "Hypokalemia",
"D": "Hypercalcemia"
},
"Question": "A 35-year old male with a history of severe bronchial asthma for several months now complains of weight gain and the development of purple stretch marks. Physical examination shod BP - 149/95 mmHg. supraclavicular fullness. The skin was thinned out with areas of bruising. Neurological examination revealed deceased strength in the proximal muscles. Laboratory investigation showed reduced serum coisol and reduced plasma ACTH. An electrolyte workup in this patient will most likely reveal"
} | A 35-year old male with a history of severe bronchial asthma for several months now complains of weight gain and the development of purple stretch marks. Physical examination shod BP - 149/95 mmHg. supraclavicular fullness. The skin was thinned out with areas of bruising. Neurological examination revealed deceased strength in the proximal muscles. Laboratory investigation showed reduced serum coisol and reduced plasma ACTH. | An electrolyte workup in this patient will most likely reveal | {
"A": "Hyponatremia",
"B": "Hypomagnesemia",
"C": "Hypokalemia",
"D": "Hypercalcemia"
} | C. Hypokalemia |
56e578c4-f854-460a-a425-bbe2eca4a568 | A 45-year old female had sought medical attention for her recent increase in weight and proximal limb weakness. She was diagnosed with rheumatoid ahritis. 1 week ago has been staed on prednisolone tablets. Physical examamination revealed truncal obesity; BP - 145/90 mm Hg and PR- -90/ mill. High levies of coisol were found in her blood and 24 hour urine sample. A high dose dexamethasone suppression test was performed and the plasma coisol level was suppressed. Serum ACTH level was high. The etiology of this condition can be confirmed by | CT scan of the chest | MRI of the brain | CT scan of the abdomen | Plasma metanephrine level | 1b
| single | Most of the signs and symptoms of ACTH-secreting tumors come from having too much coisol (an adrenal steroid hormone). But quite a few diseases can cause the body makes too much coisol, which is called Cushing's syndrome. If you have symptoms suggesting this syndrome, you'll need tests to see if it's caused by a pituitary tumor or something else. One of the tests used measures the levels of coisol in your saliva late at night to see if they stay elevated. (They normally drop at night.) Another may include measuring levels of coisol and ACTH in blood samples taken at different times of the day. You also may be asked to collect all of your urine over a 24-hour period, which is then tested to measure your daily production of coisol and other steroid hormones. One test involves taking a dose of a powerful, coisone-like drug called dexamethasone, then checking blood or urine coisol levels. Often more than 1 of these tests is needed to help distinguish ACTH-secreting pituitary tumors from other diseases, such as adrenal gland tumors, that can cause similar symptoms. MRI scans to diagnose and monitor head injuries and to check for abnormalities in the head or brain. Magnetic resonance imaging (MRI) scans provide 3-D images of specific body pas. The scan produces highly detailed images from every angle to rule out various carcinomas such as endocrine cancers,brain tumors haemorrages Ref Davidson 23rd edition pg 678 | Medicine | Immune system | 135 | {
"Correct Answer": "MRI of the brain",
"Correct Option": "B",
"Options": {
"A": "CT scan of the chest",
"B": "MRI of the brain",
"C": "CT scan of the abdomen",
"D": "Plasma metanephrine level"
},
"Question": "A 45-year old female had sought medical attention for her recent increase in weight and proximal limb weakness. She was diagnosed with rheumatoid ahritis. 1 week ago has been staed on prednisolone tablets. Physical examamination revealed truncal obesity; BP - 145/90 mm Hg and PR- -90/ mill. High levies of coisol were found in her blood and 24 hour urine sample. A high dose dexamethasone suppression test was performed and the plasma coisol level was suppressed. Serum ACTH level was high. The etiology of this condition can be confirmed by"
} | A 45-year old female had sought medical attention for her recent increase in weight and proximal limb weakness. She was diagnosed with rheumatoid ahritis. 1 week ago has been staed on prednisolone tablets. Physical examamination revealed truncal obesity; BP - 145/90 mm Hg and PR- -90/ mill. High levies of coisol were found in her blood and 24 hour urine sample. A high dose dexamethasone suppression test was performed and the plasma coisol level was suppressed. Serum ACTH level was high. | The etiology of this condition can be confirmed by | {
"A": "CT scan of the chest",
"B": "MRI of the brain",
"C": "CT scan of the abdomen",
"D": "Plasma metanephrine level"
} | B. MRI of the brain |
d05cd65d-5afe-4885-9549-89cce170f669 | A 20-year-old man is being treated for acute lymphoblastic leukemia. While neutropenic, he becomes severely hypotensive with a temperature of 38.5degC. His blood pressure is 80/60 mm Hg, pulse 120/min, and heart sounds are normal. The JVP is below the sternal angle, lungs are clear, and his extremities are warm and flushed. What would central hemodynamic monitoring reveal?For the above patient, select the hemodynamic parameters that are most likely to apply. | decreased right atrial pressure (RAP), low cardiac output (CO), and increased systemic vascular resistance (SVR) | increased RAP, decreased CO, increased SVR | increased RAP, decreased CO, decreased SVR | decreased RAP, increased CO, decreased SVR | 3d
| multi | In septic shock, right atrial pressure, and systemic vascular resistance are low. Cardiac output can be normal or high in early sepsis. | Medicine | C.V.S. | 116 | {
"Correct Answer": "decreased RAP, increased CO, decreased SVR",
"Correct Option": "D",
"Options": {
"A": "decreased right atrial pressure (RAP), low cardiac output (CO), and increased systemic vascular resistance (SVR)",
"B": "increased RAP, decreased CO, increased SVR",
"C": "increased RAP, decreased CO, decreased SVR",
"D": "decreased RAP, increased CO, decreased SVR"
},
"Question": "A 20-year-old man is being treated for acute lymphoblastic leukemia. While neutropenic, he becomes severely hypotensive with a temperature of 38.5degC. His blood pressure is 80/60 mm Hg, pulse 120/min, and heart sounds are normal. The JVP is below the sternal angle, lungs are clear, and his extremities are warm and flushed. What would central hemodynamic monitoring reveal?For the above patient, select the hemodynamic parameters that are most likely to apply."
} | A 20-year-old man is being treated for acute lymphoblastic leukemia. While neutropenic, he becomes severely hypotensive with a temperature of 38.5degC. His blood pressure is 80/60 mm Hg, pulse 120/min, and heart sounds are normal. The JVP is below the sternal angle, lungs are clear, and his extremities are warm and flushed. | What would central hemodynamic monitoring reveal?For the above patient, select the hemodynamic parameters that are most likely to apply. | {
"A": "decreased right atrial pressure (RAP), low cardiac output (CO), and increased systemic vascular resistance (SVR)",
"B": "increased RAP, decreased CO, increased SVR",
"C": "increased RAP, decreased CO, decreased SVR",
"D": "decreased RAP, increased CO, decreased SVR"
} | D. decreased RAP, increased CO, decreased SVR |
1e2a890b-0caf-4055-89fe-e0125e1a9958 | A 47-year old woman was referred for bone pain and abnormal findings on radiography. The patient repoed that for the past 17 years, she has habitually consumed water from that area. She repoed a 5-years history ofpain in the lower back, arms, legs and hips, Because of brittleness, all her teeth had been extracted. Radiography ofthe forearm revealed interosseous membrane calcification and radiography ofthe spine revealed a rugger-jersey appearance (striated pattern of increased density in the upper and lower zones of the veebrae). The probable diagnosis is | Silicosis | Fluorosis | Vitamin B toxicity | Hypercalcinosis | 1b
| multi | Skeletal fluorosis is a bone disease caused by excessive accumulation of fluoride in the bones. In advanced cases, skeletal fluorosis causes painful damage to bones and joints. Symptoms are mainly promoted in the bone structure. Due to a high fluoride concentration in the body, the bone is hardened and thus less elastic, resulting in an increased frequency of fractures. Other symptoms include thickening of the bone structure and accumulation of bone tissue, which both contribute to impaired joint mobility. Ligaments and cailage can become ossified. Most patients suffering from skeletal fluorosis show side effects from the high fluoride dose such as ruptures of the stomach lining and nausea. Fluoride can also damage the parathyroid glands, leading to hyperparathyroidism, the uncontrolled secretion of parathyroid hormones. These hormones regulate calcium concentration in the body. An elevated parathyroid hormone concentration results in a depletion of calcium in bone structures and thus a higher calcium concentration in the blood. As a result, bone flexibility decreases making the bone more susceptible to fractures Mechanism of action The best way to view the mechanism of action by which fluorine breaks down bones and causes skeletal fluorosis is in a stepwise fashion. Fluoride enters the body by two paths: Ingestion or respiration. Both paths lead to corrosion of exposed tissue in high concentrations. Since the most likely form of fluoride to enter the body is hydrogen fluoride (HF) gas, this is what stas the process. Exposed tissues will be utilized by HF in neutralization reactions. This will leave F- free to pass fuher into the body. It reacts with the concentrated HCl in the stomach to form the weak acid, HF. This compound is then absorbed by the gastro-intestinal tract and passes into the liver the poal vein. Since elemental F is one of the strongest oxidizers currently known, the anion F- is immune to phase 1 metabolic reactions, which are generally oxidation reactions, in the liver. These reactions are the body's first line of defense to biotransform harmful compounds into something more hydrophilic and more easily excreted. The HF is now free to pass into the blood stream and be distributed to all tissues including bones. Bones are largely composed of Ca compounds, paicularly carbonated hydroxyapatite (Ca 5(PO 4) 3(OH)); the reaction of Ca2+ ions and HF forms an insoluble salt, CaF 2. This salt must be cleared by the body, which concomitantly leaches out some of the calcium that would be pa of the bone matrix. This process results in increased density, but decreased strength in bones As of now, there are no established treatments for skeletal fluorosis patients. However, it is reversible in some cases, depending on the progression of the disease. If fluorine intake is stopped, the amount in bone will decrease and be excreted urine. However, it is a very slow process to eliminate the fluorine from the body completely. Minimal results are seen in patients. Treatment of side effects is also very difficult. For example, a patient with a bone fracture cannot be treated according to standard procedures, because the bone is very brittle. In this case, recovery will take a very long time and a pristine healing cannot be guaranteed. However, fuher fluorosis can be prevented by drinking defluoridated water. It is recently suggested that drinking of defluoridated water from the ''calcium amended-hydroxyapatite'' defluoridation method may help in the fluorosis reversal. Defluoridated water from this suggested method provides calcium-enriched alkaline drinking water as generally fluoride contaminated water has a low amount of calcium mineral and drinking alkaline water helps in eliminating the toxic fluoride from the body Ref Davidson 23rd edition pg 715 | Medicine | Miscellaneous | 128 | {
"Correct Answer": "Fluorosis",
"Correct Option": "B",
"Options": {
"A": "Silicosis",
"B": "Fluorosis",
"C": "Vitamin B toxicity",
"D": "Hypercalcinosis"
},
"Question": "A 47-year old woman was referred for bone pain and abnormal findings on radiography. The patient repoed that for the past 17 years, she has habitually consumed water from that area. She repoed a 5-years history ofpain in the lower back, arms, legs and hips, Because of brittleness, all her teeth had been extracted. Radiography ofthe forearm revealed interosseous membrane calcification and radiography ofthe spine revealed a rugger-jersey appearance (striated pattern of increased density in the upper and lower zones of the veebrae). The probable diagnosis is"
} | A 47-year old woman was referred for bone pain and abnormal findings on radiography. The patient repoed that for the past 17 years, she has habitually consumed water from that area. She repoed a 5-years history ofpain in the lower back, arms, legs and hips, Because of brittleness, all her teeth had been extracted. Radiography ofthe forearm revealed interosseous membrane calcification and radiography ofthe spine revealed a rugger-jersey appearance (striated pattern of increased density in the upper and lower zones of the veebrae). | The probable diagnosis is | {
"A": "Silicosis",
"B": "Fluorosis",
"C": "Vitamin B toxicity",
"D": "Hypercalcinosis"
} | B. Fluorosis |
c5c9fe85-4945-4360-8feb-b5145b2ff0ad | Drug X is normally administered to patients at a rate of 50 mg/hour. Elimination of the drug X from body takes place as:
– Hepatic Metabolism 10%
– Biliary Secretion 10%
– Renal Excretion 80%
This drug has to be administered to a 65 years old patient Uttaam Singh, with a GFR of 60 ml/min. (assuming normal GFR is 120ml/min). Liver and biliary functions are normal in this patient. What should be the dose rate of drug X in this patient? | 50 mg/hour | 30 mg/hr | 25 mg/hr | 100 mg/hr | 1b
| multi | null | Pharmacology | null | 126 | {
"Correct Answer": "30 mg/hr",
"Correct Option": "B",
"Options": {
"A": "50 mg/hour",
"B": "30 mg/hr",
"C": "25 mg/hr",
"D": "100 mg/hr"
},
"Question": "Drug X is normally administered to patients at a rate of 50 mg/hour. Elimination of the drug X from body takes place as:\n– Hepatic Metabolism 10%\n– Biliary Secretion 10%\n– Renal Excretion 80%\nThis drug has to be administered to a 65 years old patient Uttaam Singh, with a GFR of 60 ml/min. (assuming normal GFR is 120ml/min). Liver and biliary functions are normal in this patient. What should be the dose rate of drug X in this patient?"
} | Drug X is normally administered to patients at a rate of 50 mg/hour. Elimination of the drug X from body takes place as:
– Hepatic Metabolism 10%
– Biliary Secretion 10%
– Renal Excretion 80%
This drug has to be administered to a 65 years old patient Uttaam Singh, with a GFR of 60 ml/min. (assuming normal GFR is 120ml/min). Liver and biliary functions are normal in this patient. | What should be the dose rate of drug X in this patient? | {
"A": "50 mg/hour",
"B": "30 mg/hr",
"C": "25 mg/hr",
"D": "100 mg/hr"
} | B. 30 mg/hr |
02bfc223-34e0-4885-b89f-4f3edff56ee8 | A 26-year-old healthy man comes to your clinic for an annual wellness examination. He does not take any medications. He smokes half pack of cigarettes daily. He tells you that his father died of colon cancer at the age of 45. He also has a 25-year-old cousin who recently had colonoscopy for rectal bleeding was found to have multiple polyps and is scheduled for total colectomy. Your patient wants to know if he can inherit colon cancer and if there is a way to find out if he is at risk. You talk to him about how some cancers can be caused by genetic mutations. For what genetic mutation is this patient at highest risk? | MEN1 | RET | APC | MSH | 2c
| single | Familial adenomatous polyposis (FAP) is characterized by the appearance of thousands of adenomatous polyps throughout the large bowel. It is transmitted as an autosomal dominant trait. It is associated with a deletion in the long arm of chromosome 5, which contains the APC gene. The colonic polyps are usually evident by age 25. If untreated, patients usually develop colon cancer by the age of 40. Once multiple polyps are detected, patients should undergo a total colectomy, which is the primary therapy to prevent colon cancer. Current guidelines recommend that patients with a family history of FAP should have screening with flexible sigmoidoscopy or colonoscopy beginning at the age of 25, followed by annual screening until age 35. An alternative method for identifying carriers is testing peripheral blood mononuclear cell DNA for the presence of a mutated APC gene. The detection of this mutation can lead to a definitive diagnosis before the development of polyps. The MEN 1 gene is associated with multiple endocrine neoplasia type 1, which does not increase the risk of colon cancer. The RET gene is associated with multiple endocrine neoplasia type 2. The MSH gene is associated with hereditary nonpolyposis colon cancer (HNPCC), also known as Lynch syndrome. In contrast to FAP, patients with HNPCC or Lynch syndrome do not develop multiple polyps but instead develop only one or a few adenomas that rapidly progress to cancer. This condition is also strongly associated with ovarian and endometrial carcinoma. The BRCA gene is associated with familial breast and ovarian cancers. | Medicine | Oncology | 141 | {
"Correct Answer": "APC",
"Correct Option": "C",
"Options": {
"A": "MEN1",
"B": "RET",
"C": "APC",
"D": "MSH"
},
"Question": "A 26-year-old healthy man comes to your clinic for an annual wellness examination. He does not take any medications. He smokes half pack of cigarettes daily. He tells you that his father died of colon cancer at the age of 45. He also has a 25-year-old cousin who recently had colonoscopy for rectal bleeding was found to have multiple polyps and is scheduled for total colectomy. Your patient wants to know if he can inherit colon cancer and if there is a way to find out if he is at risk. You talk to him about how some cancers can be caused by genetic mutations. For what genetic mutation is this patient at highest risk?"
} | A 26-year-old healthy man comes to your clinic for an annual wellness examination. He does not take any medications. He smokes half pack of cigarettes daily. He tells you that his father died of colon cancer at the age of 45. He also has a 25-year-old cousin who recently had colonoscopy for rectal bleeding was found to have multiple polyps and is scheduled for total colectomy. Your patient wants to know if he can inherit colon cancer and if there is a way to find out if he is at risk. You talk to him about how some cancers can be caused by genetic mutations. | For what genetic mutation is this patient at highest risk? | {
"A": "MEN1",
"B": "RET",
"C": "APC",
"D": "MSH"
} | C. APC |
e679dda3-0398-4523-8bb4-33beebfaa12a | A known case of Crohn's disease presented with worsening fatigue over the last 2 months. The 50 year old lady was on Infliximab for the past 2 years and did not have many relapses. Lab findings revealed, Hemoglobin - 8 gm/dl Low serum iron Low serum ferritin Increased TIBC Low transferrin saturation The peripheral blood smear and the hemoglobin electrophoresis is given below. Which of the following is the most likely cause of the above condition: - | Iron deficiency anemia | Thalassemia | Sideroblastic anemia | Anemia of chronic disease | 0a
| multi | This is a case of iron deficiency anemia in the setting of the Crohn's disease. 1st image shows microcytic hypochromic anemia. 2nd image shows a Normal HPLC pattern of hemoglobin, hence ruling out thalassemia. The iron studies differentiate the following types of anemia. Feature Iron deficiency anemia Anemia of chronic disease Sideroblastic anemia Serum iron Low Normal or decreased Normal to high Serum ferritin Low Normal or increased Normal to high TIBC Increased Below normal Normal %tage transferrin saturation Low Below normal Normal to increased Type of anemia Microcytic hypochromic Normocytic normochromic Microcytic hypochromic | Anatomy | Integrated QBank | 105 | {
"Correct Answer": "Iron deficiency anemia",
"Correct Option": "A",
"Options": {
"A": "Iron deficiency anemia",
"B": "Thalassemia",
"C": "Sideroblastic anemia",
"D": "Anemia of chronic disease"
},
"Question": "A known case of Crohn's disease presented with worsening fatigue over the last 2 months. The 50 year old lady was on Infliximab for the past 2 years and did not have many relapses. Lab findings revealed, Hemoglobin - 8 gm/dl Low serum iron Low serum ferritin Increased TIBC Low transferrin saturation The peripheral blood smear and the hemoglobin electrophoresis is given below. Which of the following is the most likely cause of the above condition: -"
} | A known case of Crohn's disease presented with worsening fatigue over the last 2 months. The 50 year old lady was on Infliximab for the past 2 years and did not have many relapses. Lab findings revealed, Hemoglobin - 8 gm/dl Low serum iron Low serum ferritin Increased TIBC Low transferrin saturation The peripheral blood smear and the hemoglobin electrophoresis is given below. | Which of the following is the most likely cause of the above condition: - | {
"A": "Iron deficiency anemia",
"B": "Thalassemia",
"C": "Sideroblastic anemia",
"D": "Anemia of chronic disease"
} | A. Iron deficiency anemia |
998739e0-4b23-4c33-b2bd-09b2576a8048 | A 15-year-old boy presented with one day history of bleedig gums, subconjunctival bleed and purpuric rash. Investigations revealed the following results:Hb-6.4 gm/dL; TLC-26,500/mm3 Platelet 35,000 mm3; prothrombin time-20 sec with a control of 13 sec; paial thromboplastin time-50sec; and Fibrinogen 10mg/dL. Peripheral smear was suggestive of acute myeloblastic leukemia. Which of the following is the most likely - | Myeloblastic leukemia without maturation | Myeloblastic leukemia with maturation | Promyelocytic leukemia | Myelomonocytic leukemia | 2c
| single | Ans. is 'c' i.e. promyelocytic leukemia o The child presents with acute onset of bleeding, along with the following laboratory anamolies. (i) Thrombocytopenia (iii) Increased paial thromboplastin time. (ii) Increased prothrombin time (iv) Decreased Fibrinogen o These hematological abnormalities indicate Disseminated intravascular coagulation o The peripheral blood smear of the patient is suggestive of acute myeloblastic leukemia (mentioned in the question) The AML most likely to occur in this setting is promyelocytic leukemia as it is the most common myeloid leukemia assciated with DIC o Promyelocytic (AML-M3) leukemic promyelocytes liberate tissue thromboplastin leading to disseminated intravascular coagulation. | Pathology | null | 129 | {
"Correct Answer": "Promyelocytic leukemia",
"Correct Option": "C",
"Options": {
"A": "Myeloblastic leukemia without maturation",
"B": "Myeloblastic leukemia with maturation",
"C": "Promyelocytic leukemia",
"D": "Myelomonocytic leukemia"
},
"Question": "A 15-year-old boy presented with one day history of bleedig gums, subconjunctival bleed and purpuric rash. Investigations revealed the following results:Hb-6.4 gm/dL; TLC-26,500/mm3 Platelet 35,000 mm3; prothrombin time-20 sec with a control of 13 sec; paial thromboplastin time-50sec; and Fibrinogen 10mg/dL. Peripheral smear was suggestive of acute myeloblastic leukemia. Which of the following is the most likely -"
} | A 15-year-old boy presented with one day history of bleedig gums, subconjunctival bleed and purpuric rash. Investigations revealed the following results:Hb-6.4 gm/dL; TLC-26,500/mm3 Platelet 35,000 mm3; prothrombin time-20 sec with a control of 13 sec; paial thromboplastin time-50sec; and Fibrinogen 10mg/dL. Peripheral smear was suggestive of acute myeloblastic leukemia. | Which of the following is the most likely - | {
"A": "Myeloblastic leukemia without maturation",
"B": "Myeloblastic leukemia with maturation",
"C": "Promyelocytic leukemia",
"D": "Myelomonocytic leukemia"
} | C. Promyelocytic leukemia |
6c4091f0-43c1-49e4-be4b-4c78cd7216de | A young couple hiking in a wilderness area discovered the body of a man apparently in his 20s. He appeared to have been dead a few days, but animal predation was minimal. A postmortem examination was performed by the county medical examiner, and no evidence of penetrating wounds (bullet, lacerations, etc.) was found. A plain radiograph showed a fractured hyoid bone, but the calvaria and other bones appeared to be intact. Which of the following is the most likely cause of death? | Myocardial infarction (heart attack) | A fall from a height that resulted in fatal in ternal bleeding | Subdural hematoma | Strangulation | 3d
| multi | A fractured hyoid bone is evidence of strangulation. A fall from a height and subdural hematoma would likely be accompanied by fractured bones. Whereas myocardial infarction or poison remain possibilities, the medical examiner would have a high index of suspicion for strangulation because of the fractured hyoid bone. | Anatomy | Head & Neck | 107 | {
"Correct Answer": "Strangulation",
"Correct Option": "D",
"Options": {
"A": "Myocardial infarction (heart attack)",
"B": "A fall from a height that resulted in fatal in ternal bleeding",
"C": "Subdural hematoma",
"D": "Strangulation"
},
"Question": "A young couple hiking in a wilderness area discovered the body of a man apparently in his 20s. He appeared to have been dead a few days, but animal predation was minimal. A postmortem examination was performed by the county medical examiner, and no evidence of penetrating wounds (bullet, lacerations, etc.) was found. A plain radiograph showed a fractured hyoid bone, but the calvaria and other bones appeared to be intact. Which of the following is the most likely cause of death?"
} | A young couple hiking in a wilderness area discovered the body of a man apparently in his 20s. He appeared to have been dead a few days, but animal predation was minimal. A postmortem examination was performed by the county medical examiner, and no evidence of penetrating wounds (bullet, lacerations, etc.) was found. A plain radiograph showed a fractured hyoid bone, but the calvaria and other bones appeared to be intact. | Which of the following is the most likely cause of death? | {
"A": "Myocardial infarction (heart attack)",
"B": "A fall from a height that resulted in fatal in ternal bleeding",
"C": "Subdural hematoma",
"D": "Strangulation"
} | D. Strangulation |
56c8c7a8-159a-4532-9ed3-c53900455137 | For the following disorders, select the serum concentrations (mEq/L) of sodium (Na+) and potassium (K+) with which it is most likely to be associated in a dehydrated patient.A 1-year-old girl has had since about 3 months of age repeated episodes of hypoglycemic seizures and bouts of lactacidosis. She has a protuberant abdomen due to her massive hepatomegaly, a doll-like facies, thin extremities, and is short for her age. Upon drawing her blood, you are struck by the "milky" appearance. | Na+ 118, K+ 7.5 | Na+ 125, K+ 3.0 | Na+ 134, K+ 6.0 | Na+ 144, K+ 2.9 | 1b
| single | Patients with a deficiency of glucose-6-phosphatase (von Gierke disease) are, as a rule, hyperlipidemic. Increased triglyceride concentration in the serum decreases the volume of the aqueous compartment. Because electrolytes are present only in the aqueous compartment of the serum but are expressed in milliequivalents per liter of serum as a whole, the concentrations of sodium and potassium can be factitiously low in these patients. | Pediatrics | Genetics And Genetic Disorders | 120 | {
"Correct Answer": "Na+ 125, K+ 3.0",
"Correct Option": "B",
"Options": {
"A": "Na+ 118, K+ 7.5",
"B": "Na+ 125, K+ 3.0",
"C": "Na+ 134, K+ 6.0",
"D": "Na+ 144, K+ 2.9"
},
"Question": "For the following disorders, select the serum concentrations (mEq/L) of sodium (Na+) and potassium (K+) with which it is most likely to be associated in a dehydrated patient.A 1-year-old girl has had since about 3 months of age repeated episodes of hypoglycemic seizures and bouts of lactacidosis. She has a protuberant abdomen due to her massive hepatomegaly, a doll-like facies, thin extremities, and is short for her age. Upon drawing her blood, you are struck by the \"milky\" appearance."
} | For the following disorders, select the serum concentrations (mEq/L) of sodium (Na+) and potassium (K+) with which it is most likely to be associated in a dehydrated patient.A 1-year-old girl has had since about 3 months of age repeated episodes of hypoglycemic seizures and bouts of lactacidosis. She has a protuberant abdomen due to her massive hepatomegaly, a doll-like facies, thin extremities, and is short for her age. | Upon drawing her blood, you are struck by the "milky" appearance. | {
"A": "Na+ 118, K+ 7.5",
"B": "Na+ 125, K+ 3.0",
"C": "Na+ 134, K+ 6.0",
"D": "Na+ 144, K+ 2.9"
} | B. Na+ 125, K+ 3.0 |
2ac7dbb9-a098-44e1-80dc-612b4e31cd39 | A 40-year-old man with Alport syndrome presents with a 3-month history of headaches. His blood pressure is 165/100 mm Hg. A urinalysis shows 3+ proteinuria and 2+ hematuria. Laboratory studies disclose elevated levels of BUN (48 mg/dL) and creatinine (3.6 mg/dL). This patient's renal disease is caused by mutation in a gene that encodes which of the following extracellular matrix proteins? | Collagen | Entactin | Fibrillin | Fibronectin | 0a
| single | Hereditary nephritis (Alport syndrome) reflects abnormal type IV collagen in the glomerular basement membrane. The syndrome is a proliferative and sclerosing glomerular disease, often accompanied by defects of the ear or the eyes, which is caused by a genetic abnormality in type IV collagen. Hematuria is present early in life in males with X-linked disease and in both sexes with autosomal recessive disease. Proteinuria, progressive renal failure, and hypertension develop later in the course of the disease. Virtually all men with the X-linked syndrome and both sexes with autosomal recessive disease develop end-stage renal disease by ages 40 to 50 years. Patients with Marfan syndrome have mutations in the fibrillin gene (choice C).Diagnosis: Hereditary nephritis, Alport syndrome | Pathology | Kidney | 106 | {
"Correct Answer": "Collagen",
"Correct Option": "A",
"Options": {
"A": "Collagen",
"B": "Entactin",
"C": "Fibrillin",
"D": "Fibronectin"
},
"Question": "A 40-year-old man with Alport syndrome presents with a 3-month history of headaches. His blood pressure is 165/100 mm Hg. A urinalysis shows 3+ proteinuria and 2+ hematuria. Laboratory studies disclose elevated levels of BUN (48 mg/dL) and creatinine (3.6 mg/dL). This patient's renal disease is caused by mutation in a gene that encodes which of the following extracellular matrix proteins?"
} | A 40-year-old man with Alport syndrome presents with a 3-month history of headaches. His blood pressure is 165/100 mm Hg. A urinalysis shows 3+ proteinuria and 2+ hematuria. Laboratory studies disclose elevated levels of BUN (48 mg/dL) and creatinine (3.6 mg/dL). | This patient's renal disease is caused by mutation in a gene that encodes which of the following extracellular matrix proteins? | {
"A": "Collagen",
"B": "Entactin",
"C": "Fibrillin",
"D": "Fibronectin"
} | A. Collagen |
bc553fac-3084-467b-baa6-eeee6dcd398b | A 40-year-old man presented with history of episodic palpitations and headaches. The patient was fine until 1 year back when the patient staed experiencing spells of rapid heabeat. These became more severe and were eventually accompanied by throbbing headaches and drenching sweats. Physical examination revealed a blood pressure of 154/94 mm Hg and hea rate of 86 bpm. During the physical examination, palpation of the abdomen elicited a sudden and typical episode, with a rise in blood pressure to 214/128 mm Hg, hea rate to 128 bpm, profuse sweating, and facial pallor. This was accompanied by severe headache. MRI and PET SCAN is given below. Which of the following is true regarding the patient's condition? | 10% of these tumours are unilateral | 24-hour urinary excretion of VMA is the most sensitive test to diagnose this condition. | Histopathologically, the tumor consists of clusters of polygonal or spindle shaped chromaffin cells suppoed by sustentacular cells in a nest like pattern. | Phenoxybenzamine is a reversible alpha blocker, hence used in the challenge test to diagnose this condition. | 2c
| multi | Episodic palpitations with throbbing headaches and profuse sweating with hypeension and tachycardia is pointing towards the clinical diagnosis of pheochromocytoma. MRI/ 18-F-DOPA findings are suggestive of pheochromocytoma. Rule of 10s for pheochromocytoma: - Ten percent of pheochromocytomas are extra-adrenal (occurring in sites such as the organs of Zuckerkandl and the carotid body) Ten percent of sporadic adrenal pheochromocytomas are bilateral. Ten percent of adrenal pheochromocytomas are biologically malignant, Ten percent of adrenal pheochromocytomas are not associated with hypeension. The most sensitive test to diagnose pheochromocytoma is estimation of plasma levels of metanephrines. Histopathologically, the tumor consists of clusters of polygonal or spindle shaped chromaffin cells suppoed by sustentacular cells in a nest like pattern which is also known as Zellballen pattern. Phenoxybenzamine is an irreversible alpha-adrenergic blocker is used in the treatment of pheochromocytoma. Phentolamine is a reversible alpha-adrenergic blocker is used as a challenge test in diagnosis of pheochromocytoma. | Unknown | Integrated QBank | 170 | {
"Correct Answer": "Histopathologically, the tumor consists of clusters of polygonal or spindle shaped chromaffin cells suppoed by sustentacular cells in a nest like pattern.",
"Correct Option": "C",
"Options": {
"A": "10% of these tumours are unilateral",
"B": "24-hour urinary excretion of VMA is the most sensitive test to diagnose this condition.",
"C": "Histopathologically, the tumor consists of clusters of polygonal or spindle shaped chromaffin cells suppoed by sustentacular cells in a nest like pattern.",
"D": "Phenoxybenzamine is a reversible alpha blocker, hence used in the challenge test to diagnose this condition."
},
"Question": "A 40-year-old man presented with history of episodic palpitations and headaches. The patient was fine until 1 year back when the patient staed experiencing spells of rapid heabeat. These became more severe and were eventually accompanied by throbbing headaches and drenching sweats. Physical examination revealed a blood pressure of 154/94 mm Hg and hea rate of 86 bpm. During the physical examination, palpation of the abdomen elicited a sudden and typical episode, with a rise in blood pressure to 214/128 mm Hg, hea rate to 128 bpm, profuse sweating, and facial pallor. This was accompanied by severe headache. MRI and PET SCAN is given below. Which of the following is true regarding the patient's condition?"
} | A 40-year-old man presented with history of episodic palpitations and headaches. The patient was fine until 1 year back when the patient staed experiencing spells of rapid heabeat. These became more severe and were eventually accompanied by throbbing headaches and drenching sweats. Physical examination revealed a blood pressure of 154/94 mm Hg and hea rate of 86 bpm. During the physical examination, palpation of the abdomen elicited a sudden and typical episode, with a rise in blood pressure to 214/128 mm Hg, hea rate to 128 bpm, profuse sweating, and facial pallor. This was accompanied by severe headache. MRI and PET SCAN is given below. | Which of the following is true regarding the patient's condition? | {
"A": "10% of these tumours are unilateral",
"B": "24-hour urinary excretion of VMA is the most sensitive test to diagnose this condition.",
"C": "Histopathologically, the tumor consists of clusters of polygonal or spindle shaped chromaffin cells suppoed by sustentacular cells in a nest like pattern.",
"D": "Phenoxybenzamine is a reversible alpha blocker, hence used in the challenge test to diagnose this condition."
} | C. Histopathologically, the tumor consists of clusters of polygonal or spindle shaped chromaffin cells suppoed by sustentacular cells in a nest like pattern. |
59aa61ee-d6ce-43cb-84cf-8c80acda7359 | A 36-year-old woman presents with a 6-month history of progressive generalized itching, weight loss, fatigue, and yellow sclerae. She denies use of oral contraceptives or any other medication. Physical examination reveals mild jaundice and steatorrhea. Blood studies show a high cholesterol level of 350 mg/dL, elevated serum alkaline phosphatase (240 U/L), and normal levels of AST and ALT. An intravenous cholangiogram shows no evidence of obstruction. An antimitochondrial antibody test is positive; antinuclear antibodies are not present. For the patient, a liver biopsy would most likely show which of the following pathologic findings? | Central hyaline sclerosis | Cholangiocarcinoma | Hemosiderosis | Intrahepatic bile duct damage | 3d
| single | Primary biliary cirrhosis (nonsuppurative destructive cholangitis) is caused by chronic destruction of intrahepatic bile ducts in the portal tracts. Primary biliary cirrhosis evolves through ductal lesions, scarring, and eventually cirrhosis. Early PBC features chronic destructive cholangitis affecting intrahepatic small and medium-sized bile ducts. The bile ducts are surrounded primarily by lymphocytes (CD8+ T cells), but plasma cells and macrophages are also seen. In some portal tracts, lymphoid follicles are conspicuous. Discrete epithelioid granulomas often occur in the portal tracts and may impinge on the bile ducts. As a result of the destructive chronic inflammatory process, small bile ducts virtually disappear, and scarring of medium-sized bile ducts is common. Proliferation of bile ductules within portal tracts is common and may be florid. Collagenous septae extend from the portal tracts into the lobular parenchyma and encircle some lobules. Cholestasis, when present, may be severe and is located at the periphery of the portal tracts. The end-stage of PBC is cirrhosis, characterized by a dark green bile-stained liver that exhibits fine nodularity. The other choices do not feature destruction of intrahepatic bile ducts.Diagnosis: Primary biliary cirrhosis | Pathology | Liver & Biliary Tract | 145 | {
"Correct Answer": "Intrahepatic bile duct damage",
"Correct Option": "D",
"Options": {
"A": "Central hyaline sclerosis",
"B": "Cholangiocarcinoma",
"C": "Hemosiderosis",
"D": "Intrahepatic bile duct damage"
},
"Question": "A 36-year-old woman presents with a 6-month history of progressive generalized itching, weight loss, fatigue, and yellow sclerae. She denies use of oral contraceptives or any other medication. Physical examination reveals mild jaundice and steatorrhea. Blood studies show a high cholesterol level of 350 mg/dL, elevated serum alkaline phosphatase (240 U/L), and normal levels of AST and ALT. An intravenous cholangiogram shows no evidence of obstruction. An antimitochondrial antibody test is positive; antinuclear antibodies are not present. For the patient, a liver biopsy would most likely show which of the following pathologic findings?"
} | A 36-year-old woman presents with a 6-month history of progressive generalized itching, weight loss, fatigue, and yellow sclerae. She denies use of oral contraceptives or any other medication. Physical examination reveals mild jaundice and steatorrhea. Blood studies show a high cholesterol level of 350 mg/dL, elevated serum alkaline phosphatase (240 U/L), and normal levels of AST and ALT. An intravenous cholangiogram shows no evidence of obstruction. An antimitochondrial antibody test is positive; antinuclear antibodies are not present. | For the patient, a liver biopsy would most likely show which of the following pathologic findings? | {
"A": "Central hyaline sclerosis",
"B": "Cholangiocarcinoma",
"C": "Hemosiderosis",
"D": "Intrahepatic bile duct damage"
} | D. Intrahepatic bile duct damage |
d631ebae-3b57-4060-9ac5-759a1766f4fe | A fifty-year-old man presents to his practitioner complaining that he often feels as if the room is spinning when he gets up from a recumbent position or turns his head. He has not lost consciousness and has had no chest pain. He has no cardiac history and a recent treadmill test showed no abnormalities. On examination, the sensation can be produced by rapidly turning the head. It can be reproduced many times, but it eventually ceases. Nystagmus is elicited. Hearing is normal. Which of the following is the most likely diagnosis? | Benign paroxysmal positional veigo | Brain stem tumor | Meniere's disease | Syncope | 0a
| multi | Benign paroxysmal positional veigo (BPPV) is veigo that is precipitated by head position. It can be precipitated by trauma, but often no precipitating factor is identified. It generally abates after weeks to months. On exam, patients display nystagmus and the symptoms can be reproduced by head movement. In addition, the symptoms show latency, fatigability and habituation. Brain stem tumor and veebrobasilar TIA are causes of central causes of veigo, but would often be associated with other neurologic findings. Meniere disease displays the classic triad of unilateral tinnitus, unilateral deafness, and paroxysmal veigo. Since the patient has normal hearing, this is unlikely to be Meniere syndrome, although hearing loss may not manifest until later stages of the disease. Syncope is defined as transient loss of consciousness of cardiovascular origin. Thus since the patient has a lack of other cardiovascular symptoms and has not lost consciousness, this is not syncope. | ENT | null | 111 | {
"Correct Answer": "Benign paroxysmal positional veigo",
"Correct Option": "A",
"Options": {
"A": "Benign paroxysmal positional veigo",
"B": "Brain stem tumor",
"C": "Meniere's disease",
"D": "Syncope"
},
"Question": "A fifty-year-old man presents to his practitioner complaining that he often feels as if the room is spinning when he gets up from a recumbent position or turns his head. He has not lost consciousness and has had no chest pain. He has no cardiac history and a recent treadmill test showed no abnormalities. On examination, the sensation can be produced by rapidly turning the head. It can be reproduced many times, but it eventually ceases. Nystagmus is elicited. Hearing is normal. Which of the following is the most likely diagnosis?"
} | A fifty-year-old man presents to his practitioner complaining that he often feels as if the room is spinning when he gets up from a recumbent position or turns his head. He has not lost consciousness and has had no chest pain. He has no cardiac history and a recent treadmill test showed no abnormalities. On examination, the sensation can be produced by rapidly turning the head. It can be reproduced many times, but it eventually ceases. Nystagmus is elicited. Hearing is normal. | Which of the following is the most likely diagnosis? | {
"A": "Benign paroxysmal positional veigo",
"B": "Brain stem tumor",
"C": "Meniere's disease",
"D": "Syncope"
} | A. Benign paroxysmal positional veigo |
984dcf84-041a-42e5-9689-452fa91583d5 | A 69-year-old man with a history of recurrent pancreatitis treated with corticosteroids now has increasing fatigue for 2 years. He does not drink alcohol and has no evidence of gallbladder disease. On examination, there are no abnormalities. Laboratory studies show his serum creatinine is 5 mg/dL and urea nitrogen is 48 mg/ dL. His serum IgG4 is elevated. Ultrasound imaging shows bilateral hydronephrosis. What is abdominal CT imaging most likely to show in this man? | Nephrolithiasis | Polypoid cystitis | Retroperitoneal fibrosis | Renal cell carcinoma | 2c
| multi | Bilateral hydronephrosis, without hydroureter or bladder dilation, suggests that the problem involves both ureters. Obstructive uropathy has led to chronic renal failure with uremia. The elevated IgG4 suggests a fibroinflammatory process with IgG4-secreting plasma cells in the retroperitoneum; this process is part of autoimmune pancreatitis and may also involve the biliary tract, salivary glands, and lungs, but is not associated with the other listed choices. Nephrolithiasis could cause ureteropelvic junction obstruction, but bilaterality would be uncommon. Polypoid cystitis results from inflammation but may mimic a tumor mass, and could obstruct one or both ureteral orifices with hydroureter. Renal cell carcinoma is likely to be unilateral but may cause only focal obstruction. Urothelial carcinomas may be multifocal but are unlikely to obstruct both ureters simultaneously. | Pathology | Male Genital Tract | 110 | {
"Correct Answer": "Retroperitoneal fibrosis",
"Correct Option": "C",
"Options": {
"A": "Nephrolithiasis",
"B": "Polypoid cystitis",
"C": "Retroperitoneal fibrosis",
"D": "Renal cell carcinoma"
},
"Question": "A 69-year-old man with a history of recurrent pancreatitis treated with corticosteroids now has increasing fatigue for 2 years. He does not drink alcohol and has no evidence of gallbladder disease. On examination, there are no abnormalities. Laboratory studies show his serum creatinine is 5 mg/dL and urea nitrogen is 48 mg/ dL. His serum IgG4 is elevated. Ultrasound imaging shows bilateral hydronephrosis. What is abdominal CT imaging most likely to show in this man?"
} | A 69-year-old man with a history of recurrent pancreatitis treated with corticosteroids now has increasing fatigue for 2 years. He does not drink alcohol and has no evidence of gallbladder disease. On examination, there are no abnormalities. Laboratory studies show his serum creatinine is 5 mg/dL and urea nitrogen is 48 mg/ dL. His serum IgG4 is elevated. Ultrasound imaging shows bilateral hydronephrosis. | What is abdominal CT imaging most likely to show in this man? | {
"A": "Nephrolithiasis",
"B": "Polypoid cystitis",
"C": "Retroperitoneal fibrosis",
"D": "Renal cell carcinoma"
} | C. Retroperitoneal fibrosis |
8f9606c5-ef30-4e63-8149-24adea45d7ca | A 32-year-old female is admitted to the emergency department with dyspnea, dysphagia, hoarseness, and severe anxiety. Her medical history reveals that she has lived on a liquid diet for some months and has lost more than 30 lb. Over the past several weeks, she has had bloody sputum during attacks of coughing. Fluoroscopy and a barium swallow reveal a 4-cm mass associated with a bronchus and associated compression of the esophagus. Which of the following nerves is most likely to be affected? | Right recurrent laryngeal nerve | Left vagus nerve, posterior to the hilum of the lung | Left recurrent laryngeal nerve | Greater thoracic splanchnic nerve | 2c
| multi | The left recurrent laryngeal nerve passes superiorly in the tracheoesophageal groove after looping around the aorta. The compression of this nerve and compression of the esophagus against the trachea would result in the presenting symptoms. The right recurrent laryngeal nerve loops around the right subclavian artery before passing toward the larynx and therefore does not descend into the thorax. The left vagus nerve courses posterior to the hilum of the lung, after it has already given off its left recurrent laryngeal branch at the level of the aortic arch; therefore, compression of this nerve would not result in the presenting symptoms. The greater thoracic splanchnic nerve arises from sympathetic chain ganglia at levels T5 to T9 and therefore would not cause the presenting symptoms. The phrenic nerve innervates the diaphragm; compression of this nerve would not result in the presenting symptoms. | Anatomy | Thorax | 119 | {
"Correct Answer": "Left recurrent laryngeal nerve",
"Correct Option": "C",
"Options": {
"A": "Right recurrent laryngeal nerve",
"B": "Left vagus nerve, posterior to the hilum of the lung",
"C": "Left recurrent laryngeal nerve",
"D": "Greater thoracic splanchnic nerve"
},
"Question": "A 32-year-old female is admitted to the emergency department with dyspnea, dysphagia, hoarseness, and severe anxiety. Her medical history reveals that she has lived on a liquid diet for some months and has lost more than 30 lb. Over the past several weeks, she has had bloody sputum during attacks of coughing. Fluoroscopy and a barium swallow reveal a 4-cm mass associated with a bronchus and associated compression of the esophagus. Which of the following nerves is most likely to be affected?"
} | A 32-year-old female is admitted to the emergency department with dyspnea, dysphagia, hoarseness, and severe anxiety. Her medical history reveals that she has lived on a liquid diet for some months and has lost more than 30 lb. Over the past several weeks, she has had bloody sputum during attacks of coughing. Fluoroscopy and a barium swallow reveal a 4-cm mass associated with a bronchus and associated compression of the esophagus. | Which of the following nerves is most likely to be affected? | {
"A": "Right recurrent laryngeal nerve",
"B": "Left vagus nerve, posterior to the hilum of the lung",
"C": "Left recurrent laryngeal nerve",
"D": "Greater thoracic splanchnic nerve"
} | C. Left recurrent laryngeal nerve |
c6176860-c22c-450f-8d94-7036fb1f3c4f | A 69-year-old man presents to the emergency depament with painless vision loss of his right eye. He describes the visual loss as a gradual progression from blurry to total blackout over the past two hours. He has no history of prior visual problems. Past medical history is significant for a myocardial infarction three years ago. The patient takes aspirin daily. Vital signs are normal. Physical examination reveals 20/20 vision of the left eye but no vision in the right eye. Extraocular muscles are intact. The neurologic examination is normal. The cardiac examination reveals an S4 hea sound. The most likely cause of this unilateral blindness is which of the following? | Carotid aery dissection | Cavernous sinus thrombosis | Posterior cerebral aery occlusion | Retinal aery occlusion | 3d
| single | This patient has a sudden onset of complete, unilateral, painless loss of vision with intact extraocular muscle movement. This is consistent with occlusion of the retinal aery. The retina derives its blood supply from the internal carotid aery the ophthalmic aery, from which branch the central retinal aery and ciliary aeries. The central retinal aery supplies the inner layers of retina, while ciliary aeries supply blood to the choriocapillaris and the outer retinal layers. Occlusion of small retinal aerioles produces "cotton wool" spots while total occlusion of the ophthalmic aery leads to total ischemia and blindness. This usually occurs secondary to atherosclerotic disease. The key here is recognizing that the loss of vision is an isolated finding with no other neurologic symptoms. Other deficits would be consistent with a stroke of a larger vascular territory such as the internal carotid aery. Carotid aery dissection is less likely than retinal aery occlusion because there would likely be multiple associated neurologic findings in the case of dissection, as the internal carotid aery supplies a large poion of the anterior circulation of the brain. The most likely symptoms among a large cadre of possibilities is face and arm weakness contralateral to the dissection. Cavernous sinus thrombosis would lead to facial pain and possible cranial nerve deficits. The optic nerve (cranial nerve II) extends anteriorly from the optic chiasm through the superior orbital fissure. Posterior cerebral aery occlusion is less likely than retinal aery occlusion because there would likely be multiple associated neurologic findings. Also, the visual field loss resulting from a unilateral posterior cerebral aery occlusion would more likely be a homonymous hemianopia, it would not cause complete blindness in one eye. Other changes that may occur from posterior cerebral aery stroke are complex findings, such as the inability of recognize faces (prosopagnosia), failure to connect visual perception with conscious thought, color vision loss, and difficulty with reading (dyslexia or alexia). Memory problems and motor impairment are also common associated findings. | Ophthalmology | null | 141 | {
"Correct Answer": "Retinal aery occlusion",
"Correct Option": "D",
"Options": {
"A": "Carotid aery dissection",
"B": "Cavernous sinus thrombosis",
"C": "Posterior cerebral aery occlusion",
"D": "Retinal aery occlusion"
},
"Question": "A 69-year-old man presents to the emergency depament with painless vision loss of his right eye. He describes the visual loss as a gradual progression from blurry to total blackout over the past two hours. He has no history of prior visual problems. Past medical history is significant for a myocardial infarction three years ago. The patient takes aspirin daily. Vital signs are normal. Physical examination reveals 20/20 vision of the left eye but no vision in the right eye. Extraocular muscles are intact. The neurologic examination is normal. The cardiac examination reveals an S4 hea sound. The most likely cause of this unilateral blindness is which of the following?"
} | A 69-year-old man presents to the emergency depament with painless vision loss of his right eye. He describes the visual loss as a gradual progression from blurry to total blackout over the past two hours. He has no history of prior visual problems. Past medical history is significant for a myocardial infarction three years ago. The patient takes aspirin daily. Vital signs are normal. Physical examination reveals 20/20 vision of the left eye but no vision in the right eye. Extraocular muscles are intact. The neurologic examination is normal. The cardiac examination reveals an S4 hea sound. | The most likely cause of this unilateral blindness is which of the following? | {
"A": "Carotid aery dissection",
"B": "Cavernous sinus thrombosis",
"C": "Posterior cerebral aery occlusion",
"D": "Retinal aery occlusion"
} | D. Retinal aery occlusion |
10ee3c3b-5458-4e04-a41d-7766fa026c55 | A 62-year-old man has had fever and a 4-kg weight loss over the past 6 months. On physical examination, his temperature is 38.6deg C. He has generalized nontender lymphadenopathy, and the spleen tip is palpable. Laboratory studies show hemoglobin, 10.1 g/dL; hematocrit, 30.3%; platelet count, 140,000/mm3; and WBC count, 24,500/mm3 with 10% segmented neutrophils, 1% bands, 86% lymphocytes, and 3% monocytes. A cervical lymph node biopsy specimen microscopically shows a nodular pattern of small lymphoid cells. A bone marrow biopsy specimen shows infiltrates of similar small cells having surface immunoglobulins that are CD5+, but CD10-. Cytogenetic analysis indicates t (11;14) in these cells. What is the most likely diagnosis? | Acute lymphoblastic lymphoma | Burkitt lymphoma | Follicular lymphoma | Mantle cell lymphoma | 3d
| multi | The immunophenotype is characteristic for mantle cell lymphoma. Of the lesions listed, lymphoblastic lymphoma and Burkitt lymphoma occur in a much younger age group. Burkitt lymphoma has a t (8;14) translocation. The remaining three lesions occur in an older age group. Of these, small lymphocytic lymphoma manifests with absolute lymphocytosis and the peripheral blood picture of chronic lymphocytic leukemia. Follicular lymphoma has a distinct and characteristic translocation t (14;18) involving the BCL2 gene. In contrast, mantle cell lymphoma, seen in older men, has the t (11;14) translocation, which activates the cyclin D1 (BCL1) gene; these tumors do not respond well to chemotherapy, particularly when it involves the peripheral blood. | Pathology | Blood | 217 | {
"Correct Answer": "Mantle cell lymphoma",
"Correct Option": "D",
"Options": {
"A": "Acute lymphoblastic lymphoma",
"B": "Burkitt lymphoma",
"C": "Follicular lymphoma",
"D": "Mantle cell lymphoma"
},
"Question": "A 62-year-old man has had fever and a 4-kg weight loss over the past 6 months. On physical examination, his temperature is 38.6deg C. He has generalized nontender lymphadenopathy, and the spleen tip is palpable. Laboratory studies show hemoglobin, 10.1 g/dL; hematocrit, 30.3%; platelet count, 140,000/mm3; and WBC count, 24,500/mm3 with 10% segmented neutrophils, 1% bands, 86% lymphocytes, and 3% monocytes. A cervical lymph node biopsy specimen microscopically shows a nodular pattern of small lymphoid cells. A bone marrow biopsy specimen shows infiltrates of similar small cells having surface immunoglobulins that are CD5+, but CD10-. Cytogenetic analysis indicates t (11;14) in these cells. What is the most likely diagnosis?"
} | A 62-year-old man has had fever and a 4-kg weight loss over the past 6 months. On physical examination, his temperature is 38.6deg C. He has generalized nontender lymphadenopathy, and the spleen tip is palpable. Laboratory studies show hemoglobin, 10.1 g/dL; hematocrit, 30.3%; platelet count, 140,000/mm3; and WBC count, 24,500/mm3 with 10% segmented neutrophils, 1% bands, 86% lymphocytes, and 3% monocytes. A cervical lymph node biopsy specimen microscopically shows a nodular pattern of small lymphoid cells. A bone marrow biopsy specimen shows infiltrates of similar small cells having surface immunoglobulins that are CD5+, but CD10-. Cytogenetic analysis indicates t (11;14) in these cells. | What is the most likely diagnosis? | {
"A": "Acute lymphoblastic lymphoma",
"B": "Burkitt lymphoma",
"C": "Follicular lymphoma",
"D": "Mantle cell lymphoma"
} | D. Mantle cell lymphoma |
f32eb368-424b-4268-9a5b-ff51450ccb1b | A 7 year old boy is taken to a physician because he has developed pain in his right hip. On physical examination, the physician feels a large mass near the iliac crest. Plain x-ray films demonstrate a large lytic lesion of the ilium. MRI studies show that the tumor appears to arise in the bone, but extends into the adjacent soft tissues. A large incisional biopsy demonstrates a tumor composed of sheets of small, round, blue cells. Which of the following is the most common bone to be affected by this tumor? | Femur | Humerus | Mandible | Maxilla | 0a
| multi | While any bone can be affected by Ewing sarcoma, the most common site is the diaphysis of the femur. Other common sites include the flat bones of the pelvis and the tibia. The other bones listed in the choices are not as common sites of involvement. | Anatomy | null | 110 | {
"Correct Answer": "Femur",
"Correct Option": "A",
"Options": {
"A": "Femur",
"B": "Humerus",
"C": "Mandible",
"D": "Maxilla"
},
"Question": "A 7 year old boy is taken to a physician because he has developed pain in his right hip. On physical examination, the physician feels a large mass near the iliac crest. Plain x-ray films demonstrate a large lytic lesion of the ilium. MRI studies show that the tumor appears to arise in the bone, but extends into the adjacent soft tissues. A large incisional biopsy demonstrates a tumor composed of sheets of small, round, blue cells. Which of the following is the most common bone to be affected by this tumor?"
} | A 7 year old boy is taken to a physician because he has developed pain in his right hip. On physical examination, the physician feels a large mass near the iliac crest. Plain x-ray films demonstrate a large lytic lesion of the ilium. MRI studies show that the tumor appears to arise in the bone, but extends into the adjacent soft tissues. A large incisional biopsy demonstrates a tumor composed of sheets of small, round, blue cells. | Which of the following is the most common bone to be affected by this tumor? | {
"A": "Femur",
"B": "Humerus",
"C": "Mandible",
"D": "Maxilla"
} | A. Femur |
b354624c-b45e-4c90-8f92-74ee6379ad65 | Using a new technique, Hb was estimated in a blood sample. The test was repeated for 10 times. The reports were : 9.5, 9.2, 9.4, 9.6, 9.7, 9.9, 10.2, 10.3, 10.5, 12.1. Accurate value of Hb was estimated by standard tests to be 10.2. The new technique has - | High validity and high reliability | Low validity and low reliability | High validity and low reliability | Low validity and high reliability | 1b
| single | Validity (Accuracy)
The validity of a test is the extent to which it accurately measures which it purports to measure. In other words its the ability to show which individuals have the disease in question and which do not.
Validity has two components - sensitivity & specificity. To be truly valid, a test should be highly sensitive, specific and unbiased.
In this question the test results are not accurate (accurate value is 10.2) → Test has low validity.
Reliability (or Repeatability, reproducibility or precision)
Reliability or precision or repeatability is the level of agreement between repeated measurements of the same variable i.e. a highly reliable test must give consistent results when repeated more than once on the same individual or material, under the same conditions.
In this question test is not showing consistent results → Test has low reliability. | Social & Preventive Medicine | null | 107 | {
"Correct Answer": "Low validity and low reliability",
"Correct Option": "B",
"Options": {
"A": "High validity and high reliability",
"B": "Low validity and low reliability",
"C": "High validity and low reliability",
"D": "Low validity and high reliability"
},
"Question": "Using a new technique, Hb was estimated in a blood sample. The test was repeated for 10 times. The reports were : 9.5, 9.2, 9.4, 9.6, 9.7, 9.9, 10.2, 10.3, 10.5, 12.1. Accurate value of Hb was estimated by standard tests to be 10.2. The new technique has -"
} | Using a new technique, Hb was estimated in a blood sample. The test was repeated for 10 times. The reports were : 9.5, 9.2, 9.4, 9.6, 9.7, 9.9, 10.2, 10.3, 10.5, 12.1. Accurate value of Hb was estimated by standard tests to be 10.2. | The new technique has - | {
"A": "High validity and high reliability",
"B": "Low validity and low reliability",
"C": "High validity and low reliability",
"D": "Low validity and high reliability"
} | B. Low validity and low reliability |
70a764eb-57ab-4fc2-a4fe-3b693ffee552 | A 60 year old man presented to the OPD with symptoms suggestive of acute pancreatitis. He consumes high quantities of alcohol regularly. His symptoms staed 4 days ago. But he continued to consume alcohol. He was admitted for fuher evaluation. Presently, he has severe vomiting. He also complains of dizziness when standing. Examination revealed tenderness in the epigastrium and right hypochondrium. A reddish discolouration is noted in the flanks. Which of the following statements regarding the patient is most accurate? | The patient should be evaluated for concomitant appendicitis | USG is likely to demonstrate pseudocyst of pancreas | Contrast CT scan of the abdomen will reveal severe necrotising pancreatitis | Pancreatic calcification will be seen in X-ray abdomen | 2c
| multi | The history and clinical features (Abdominal tenderness, hypotension due to blood loss, Grey Turner's sign) are suggestive of acute pancreatitis with pancreatic necrosis. Hence a contrast CT scan of the abdomen will reveal severe necrotising pancreatitis.Reddish / bluish discolouration of the flanks is known as Grey Turner's sign. It is named after George Grey Turner, a British surgeon. It is seen in cases of acute pancreatitis with pancreatic necrosis and intra abdominal bleedinAnother feature of pancreatic necrosis is a bluish discolouration around the umbilicus, known as Cullen's sign. It is named after Thomas Stephen Cullen, a Canadian gynecologist who first described the sign in a case of ruptured ectopic pregnancy in 1916. Both these signs take 1-2 days to develop in a case of acute pancreatitiFocal / diffuse enlargement of pancreatic parenchyma Indistinct margins Density changes due to presence of oedema Retroperitoneal stranding Elimination of the other options Pseudocyst of pancreas usually develops a few weeks after the onset of pancreatitis The features are not suggestive of appendicitis Pancreatic calcification is seen in chronic pancreatitis. Ref : Harrison's Principles of Internal Medicine 21st ed | Medicine | All India exam | 111 | {
"Correct Answer": "Contrast CT scan of the abdomen will reveal severe necrotising pancreatitis",
"Correct Option": "C",
"Options": {
"A": "The patient should be evaluated for concomitant appendicitis",
"B": "USG is likely to demonstrate pseudocyst of pancreas",
"C": "Contrast CT scan of the abdomen will reveal severe necrotising pancreatitis",
"D": "Pancreatic calcification will be seen in X-ray abdomen"
},
"Question": "A 60 year old man presented to the OPD with symptoms suggestive of acute pancreatitis. He consumes high quantities of alcohol regularly. His symptoms staed 4 days ago. But he continued to consume alcohol. He was admitted for fuher evaluation. Presently, he has severe vomiting. He also complains of dizziness when standing. Examination revealed tenderness in the epigastrium and right hypochondrium. A reddish discolouration is noted in the flanks. Which of the following statements regarding the patient is most accurate?"
} | A 60 year old man presented to the OPD with symptoms suggestive of acute pancreatitis. He consumes high quantities of alcohol regularly. His symptoms staed 4 days ago. But he continued to consume alcohol. He was admitted for fuher evaluation. Presently, he has severe vomiting. He also complains of dizziness when standing. Examination revealed tenderness in the epigastrium and right hypochondrium. A reddish discolouration is noted in the flanks. | Which of the following statements regarding the patient is most accurate? | {
"A": "The patient should be evaluated for concomitant appendicitis",
"B": "USG is likely to demonstrate pseudocyst of pancreas",
"C": "Contrast CT scan of the abdomen will reveal severe necrotising pancreatitis",
"D": "Pancreatic calcification will be seen in X-ray abdomen"
} | C. Contrast CT scan of the abdomen will reveal severe necrotising pancreatitis |
0069d140-60c1-4b9b-b4ce-5fb8fb68cf83 | A 65 year old retired accountant with a 60 pack year smoking history presents for his annual physical examination. He was last seen 3 years ago, when he presented with an episode of acute bronchitis. He repos that he has been coughing over the past several months with productive green sputum. He denies any dyspnea or limitation in his daily activities. On physical examination, his blood pressure is 126/62 mm Hg, pulse is 80/min, and respirations are 24/min. He has diffuse bilateral expiratory rhonchi with a markedly prolonged expiratory phase. His cardiac examination reveals a second hea sound that increases in intensity with inspiration. The liver edge is 14 cm into the midclavicular line and mildly tender to palpation. There is bilateral lower extremity edema to the knees. A chest x-ray film reveals hyperinflation of both lung fields, and pulmonary function tests reveal a diminished forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) ratio. Routine laboratories are sent. Which of the following would most likely be expected? | A hemoglobin of 9 g/dL | A hemoglobin of 17 g/dL | A platelet count of 84,000 | A platelet count of 102,000 | 1b
| multi | A hemoglobin of 17 g/dL would be expected. The question describes a patient with chronic obstructive pulmonary disease (COPD) confirmed by his physical examination, which also suggests right-sided hea failure, loud P2, and hepatic congestion and peripheral edema due to right-sided hea failure. The pulmonary function tests are consistent with the diagnosis of obstructive airway disease. Given the long history of smoking, this patient most likely has COPD. Because of chronic hypoxia, these patients also develop erythrocytosis in an effo to increase the oxygen carrying capacity. The first choice would be seen in anemia. There is no reason for this patient to develop thrombocytopenia or leukopenia. Ref: Bates C.G., Cydulka R.K. (2011). Chapter 73. Chronic Obstructive Pulmonary Disease. In J.E. Tintinalli, J.S. Stapczynski, D.M. Cline, O.J. Ma, R.K. Cydulka, G.D. Meckler (Eds), Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e. | Medicine | null | 243 | {
"Correct Answer": "A hemoglobin of 17 g/dL",
"Correct Option": "B",
"Options": {
"A": "A hemoglobin of 9 g/dL",
"B": "A hemoglobin of 17 g/dL",
"C": "A platelet count of 84,000",
"D": "A platelet count of 102,000"
},
"Question": "A 65 year old retired accountant with a 60 pack year smoking history presents for his annual physical examination. He was last seen 3 years ago, when he presented with an episode of acute bronchitis. He repos that he has been coughing over the past several months with productive green sputum. He denies any dyspnea or limitation in his daily activities. On physical examination, his blood pressure is 126/62 mm Hg, pulse is 80/min, and respirations are 24/min. He has diffuse bilateral expiratory rhonchi with a markedly prolonged expiratory phase. His cardiac examination reveals a second hea sound that increases in intensity with inspiration. The liver edge is 14 cm into the midclavicular line and mildly tender to palpation. There is bilateral lower extremity edema to the knees. A chest x-ray film reveals hyperinflation of both lung fields, and pulmonary function tests reveal a diminished forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) ratio. Routine laboratories are sent. Which of the following would most likely be expected?"
} | A 65 year old retired accountant with a 60 pack year smoking history presents for his annual physical examination. He was last seen 3 years ago, when he presented with an episode of acute bronchitis. He repos that he has been coughing over the past several months with productive green sputum. He denies any dyspnea or limitation in his daily activities. On physical examination, his blood pressure is 126/62 mm Hg, pulse is 80/min, and respirations are 24/min. He has diffuse bilateral expiratory rhonchi with a markedly prolonged expiratory phase. His cardiac examination reveals a second hea sound that increases in intensity with inspiration. The liver edge is 14 cm into the midclavicular line and mildly tender to palpation. There is bilateral lower extremity edema to the knees. A chest x-ray film reveals hyperinflation of both lung fields, and pulmonary function tests reveal a diminished forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) ratio. Routine laboratories are sent. | Which of the following would most likely be expected? | {
"A": "A hemoglobin of 9 g/dL",
"B": "A hemoglobin of 17 g/dL",
"C": "A platelet count of 84,000",
"D": "A platelet count of 102,000"
} | B. A hemoglobin of 17 g/dL |
de15a0a0-6ff8-4496-a469-afa1bd5330f6 | A 68-year old man who has had a recent syncopal episode is hospitalized with congestive heart failure. His blood pressure is 160/80 mmHg. His pulse rate is 80 beats per minute, and there is a grade III/IV harsh systolic murmur. An echocardiogram shows a disproportionately thickened ventricular septum and systolic anterior motion of the mitral valve. Which of the following findings would most likely be present in this man - | Radiation of the murmur to the neck. | Decrease of the murmur with hand grip | Delayed carotid upstroke | Reduced left ventricular ejection fraction | 1b
| single | null | Medicine | null | 103 | {
"Correct Answer": "Decrease of the murmur with hand grip",
"Correct Option": "B",
"Options": {
"A": "Radiation of the murmur to the neck.",
"B": "Decrease of the murmur with hand grip",
"C": "Delayed carotid upstroke",
"D": "Reduced left ventricular ejection fraction"
},
"Question": "A 68-year old man who has had a recent syncopal episode is hospitalized with congestive heart failure. His blood pressure is 160/80 mmHg. His pulse rate is 80 beats per minute, and there is a grade III/IV harsh systolic murmur. An echocardiogram shows a disproportionately thickened ventricular septum and systolic anterior motion of the mitral valve. Which of the following findings would most likely be present in this man -"
} | A 68-year old man who has had a recent syncopal episode is hospitalized with congestive heart failure. His blood pressure is 160/80 mmHg. His pulse rate is 80 beats per minute, and there is a grade III/IV harsh systolic murmur. An echocardiogram shows a disproportionately thickened ventricular septum and systolic anterior motion of the mitral valve. | Which of the following findings would most likely be present in this man - | {
"A": "Radiation of the murmur to the neck.",
"B": "Decrease of the murmur with hand grip",
"C": "Delayed carotid upstroke",
"D": "Reduced left ventricular ejection fraction"
} | B. Decrease of the murmur with hand grip |
120c0829-ec0c-4997-8e80-85281a4d8bf9 | A 21-year-old man is seen in the clinic for assessment of a nonproductive cough, shortness of breath, and chest pain which changes with breathing. He also complains of pain in the left arm. On physical examination, there is tenderness over the left shoulder, heart sounds are normal, and the lungs are clear. A CXR reveals a lytic lesion in the left humerus and reticulonodular opacities in the upper and middle lobes (Figure below). The eosinophil count is normal. Which of the following is the most appropriate initial diagnostic test? | lung biopsy | humerus bone biopsy | CT scan of chest | bronchoscopy | 2c
| single | The next most appropriate test would be a better definition of the lung findings with a high- resolution CT scan. The other more invasive investigations may be more appropriate after the CT. Primary pulmonary Langerhans cell histiocytosis (PLCH), also called eosinophilic granuloma of the lung, pulmonary Langerhans cell granulomatosis, and pulmonary histiocytosis X, is an uncommon interstitial lung disease that primarily affects young adults. There is a coarse, reticular pattern in the whole lung, somewhat more prominent in the upper lobes, suggesting a honeycomb appearance. It is the density here that is abnormal and not the lucency. | Medicine | Respiratory | 122 | {
"Correct Answer": "CT scan of chest",
"Correct Option": "C",
"Options": {
"A": "lung biopsy",
"B": "humerus bone biopsy",
"C": "CT scan of chest",
"D": "bronchoscopy"
},
"Question": "A 21-year-old man is seen in the clinic for assessment of a nonproductive cough, shortness of breath, and chest pain which changes with breathing. He also complains of pain in the left arm. On physical examination, there is tenderness over the left shoulder, heart sounds are normal, and the lungs are clear. A CXR reveals a lytic lesion in the left humerus and reticulonodular opacities in the upper and middle lobes (Figure below). The eosinophil count is normal. Which of the following is the most appropriate initial diagnostic test?"
} | A 21-year-old man is seen in the clinic for assessment of a nonproductive cough, shortness of breath, and chest pain which changes with breathing. He also complains of pain in the left arm. On physical examination, there is tenderness over the left shoulder, heart sounds are normal, and the lungs are clear. A CXR reveals a lytic lesion in the left humerus and reticulonodular opacities in the upper and middle lobes (Figure below). The eosinophil count is normal. | Which of the following is the most appropriate initial diagnostic test? | {
"A": "lung biopsy",
"B": "humerus bone biopsy",
"C": "CT scan of chest",
"D": "bronchoscopy"
} | C. CT scan of chest |
9a6663b9-9232-43df-9ba8-dcb7cf89d961 | A 4-year-old boy is brought to the physician by his parents because he tires easily. Physical examination reveals weakness in the pelvic and shoulder girdles and enlargement of the child's calf muscle. Serum levels of creatine kinase are elevated. A biopsy of calf muscle shows marked variation in size and shape of muscle fibers. There are foci of muscle fiber necrosis, with myophagocytosis, regenerating fibers, and fibrosis. What will be the likely cause of death in the patient? | Cardiomyopathy | Cerebrovascular disease | End-stage renal disease | Pulmonary saddle embolism | 0a
| single | The symptoms of Duchenne muscular dystrophy (DMD) progress with age. During the first year of life, the infants appear normal, but more than half fail to walk by 18 months of age. More than 90% of afflicted boys are wheelchair bound by the age of 11 years. In advanced disease, cardiac symptoms are almost universal, and cardiomyopathy is a common cause of death. The mean age at death in boys with DMD is 17 years. The other choices are unrelated to DMD.Diagnosis: Duchenne muscular dystrophy | Pathology | Genetics | 104 | {
"Correct Answer": "Cardiomyopathy",
"Correct Option": "A",
"Options": {
"A": "Cardiomyopathy",
"B": "Cerebrovascular disease",
"C": "End-stage renal disease",
"D": "Pulmonary saddle embolism"
},
"Question": "A 4-year-old boy is brought to the physician by his parents because he tires easily. Physical examination reveals weakness in the pelvic and shoulder girdles and enlargement of the child's calf muscle. Serum levels of creatine kinase are elevated. A biopsy of calf muscle shows marked variation in size and shape of muscle fibers. There are foci of muscle fiber necrosis, with myophagocytosis, regenerating fibers, and fibrosis. What will be the likely cause of death in the patient?"
} | A 4-year-old boy is brought to the physician by his parents because he tires easily. Physical examination reveals weakness in the pelvic and shoulder girdles and enlargement of the child's calf muscle. Serum levels of creatine kinase are elevated. A biopsy of calf muscle shows marked variation in size and shape of muscle fibers. There are foci of muscle fiber necrosis, with myophagocytosis, regenerating fibers, and fibrosis. | What will be the likely cause of death in the patient? | {
"A": "Cardiomyopathy",
"B": "Cerebrovascular disease",
"C": "End-stage renal disease",
"D": "Pulmonary saddle embolism"
} | A. Cardiomyopathy |
c2120448-bd3b-4d8f-8963-e92e68ac69e1 | A 36-year-old, alcoholic woman presents with a 1-week history of yellow skin and sclerae. She has suffered persistent headaches. Her vital signs are normal. Physical examination reveals jaundice. Laboratory studies disclose markedly elevated levels of AST and ALT (956 and 1,400 U/L, respectively). A few days later, she develops hepatic encephalopathy and renal failure. A liver biopsy shows prominent centrilobular necrosis. Which of the following is the most likely diagnosis? | Acetaminophen toxicity | Fatty liver of pregnancy | Metastatic carcinoma | Reye syndrome | 0a
| single | Drug toxicity should be suspected in all cases of acute hepatitis. In this case, centrilobular necrosis suggests acetaminophen toxicity. The toxic dose of acetaminophen after a single acute ingestion is in the range of 150mg/kg in children and 7 g in adults. Acetaminophen is rapidly absorbed from the stomach and small intestine and conjugated in the liver to nontoxic agents, which then are eliminated in the urine. In cases of acute overdose, normal pathways of acetaminophen metabolism become saturated. Excess acetaminophen is then metabolized in the liver via the mixed function oxidase P450 system, yielding oxidative metabolites that cause predictable, hepatocellular necrosis. The centrilobular zones are particularly affected (centrilobular necrosis). Centrilobular necrosis is not seen in the other choices. Reye syndrome (choice D) occurs in children. Fatty liver of pregnancy (choice B) features micro vesicular steatosis.Diagnosis: Acetaminophen toxicity, hepatorenal syndrome | Pathology | Liver & Biliary Tract | 109 | {
"Correct Answer": "Acetaminophen toxicity",
"Correct Option": "A",
"Options": {
"A": "Acetaminophen toxicity",
"B": "Fatty liver of pregnancy",
"C": "Metastatic carcinoma",
"D": "Reye syndrome"
},
"Question": "A 36-year-old, alcoholic woman presents with a 1-week history of yellow skin and sclerae. She has suffered persistent headaches. Her vital signs are normal. Physical examination reveals jaundice. Laboratory studies disclose markedly elevated levels of AST and ALT (956 and 1,400 U/L, respectively). A few days later, she develops hepatic encephalopathy and renal failure. A liver biopsy shows prominent centrilobular necrosis. Which of the following is the most likely diagnosis?"
} | A 36-year-old, alcoholic woman presents with a 1-week history of yellow skin and sclerae. She has suffered persistent headaches. Her vital signs are normal. Physical examination reveals jaundice. Laboratory studies disclose markedly elevated levels of AST and ALT (956 and 1,400 U/L, respectively). A few days later, she develops hepatic encephalopathy and renal failure. A liver biopsy shows prominent centrilobular necrosis. | Which of the following is the most likely diagnosis? | {
"A": "Acetaminophen toxicity",
"B": "Fatty liver of pregnancy",
"C": "Metastatic carcinoma",
"D": "Reye syndrome"
} | A. Acetaminophen toxicity |
4e970b0d-8e82-453b-8927-65844236ad8e | A 50-year-old woman develops a sudden, severe headache and is taken to the emergency department. On examination, she has nuchal rigidity. Her blood pressure is 115/83 mm Hg. A lumbar puncture is done; the CSF shows numerous RBCs, no neutrophils, a few mononuclear cells, and a normal glucose level. The Gram stain result is negative. CT imaging shows subarachnoid hemorrhage at the base of the brain. Which of the following vascular events has most likely occurred in this woman? | Bleeding from cerebral amyloid angiopathy | Hematoma formation from arteriolosclerosis | Middle cerebral artery thromboembolism | Rupture of an intracranial berry aneurysm | 3d
| single | About 1 in 50 individuals have a saccular (berry) aneurysm. Although this lesion is present at birth as a congenital defect in the arterial media at intracerebral arterial branch points, it can manifest later in life with aneurysmal dilation and possible rupture. These aneurysms are the most common cause of spontaneous subarachnoid hemorrhage in adults. The bleeding from amyloid angiopathy is in the peripheral cortex, and most likely to occur in association with Alzheimer's disease. A hypertensive hemorrhage from arteriolosclerosis tends to remain within the brain parenchyma. Thromboemboli can cause infarctions, most often in the distribution of the middle cerebral artery in the cortex, and embolic infarcts can be hemorrhagic, but the blood typically does not reach the CSF. A subdural hematoma over the brain surface results from a tear of bridging veins. | Pathology | Central Nervous System | 121 | {
"Correct Answer": "Rupture of an intracranial berry aneurysm",
"Correct Option": "D",
"Options": {
"A": "Bleeding from cerebral amyloid angiopathy",
"B": "Hematoma formation from arteriolosclerosis",
"C": "Middle cerebral artery thromboembolism",
"D": "Rupture of an intracranial berry aneurysm"
},
"Question": "A 50-year-old woman develops a sudden, severe headache and is taken to the emergency department. On examination, she has nuchal rigidity. Her blood pressure is 115/83 mm Hg. A lumbar puncture is done; the CSF shows numerous RBCs, no neutrophils, a few mononuclear cells, and a normal glucose level. The Gram stain result is negative. CT imaging shows subarachnoid hemorrhage at the base of the brain. Which of the following vascular events has most likely occurred in this woman?"
} | A 50-year-old woman develops a sudden, severe headache and is taken to the emergency department. On examination, she has nuchal rigidity. Her blood pressure is 115/83 mm Hg. A lumbar puncture is done; the CSF shows numerous RBCs, no neutrophils, a few mononuclear cells, and a normal glucose level. The Gram stain result is negative. CT imaging shows subarachnoid hemorrhage at the base of the brain. | Which of the following vascular events has most likely occurred in this woman? | {
"A": "Bleeding from cerebral amyloid angiopathy",
"B": "Hematoma formation from arteriolosclerosis",
"C": "Middle cerebral artery thromboembolism",
"D": "Rupture of an intracranial berry aneurysm"
} | D. Rupture of an intracranial berry aneurysm |
282655ba-1e02-4053-b58b-69e96104c7f6 | A 67-year-old man, chronic smoker, presented to the ER with sudden, intense and persistent abdominal and back pain along with altered mental status. O/E: - Hypotension Tachycardia Cyanosis. On abdominal examination, a tender, pulsatile and an expansile mass was noted in the umbilical and the epigastric region. Patient was immediately taken up for surgery but the patient did not survive. On checking the old repos of the patient, some abnormal mass was noted in the abdomen. A CECT film was also found. In asymptomatic cases, what is the indication of surgery? | 5.5 cm | 5.4 cm | 4.5 cm | 4.4 cm | 0a
| single | This is a case of abdominal aoic aneurysm rupture into the intraperitoneal cavity leading to frank shock. Image 1 shows abdominal aoic aneurysm. Image 2 shows hyperdense crescent sign which is a sign of impending aoic rupture Abdominal Aoic Aneurysm Males > females Incidence increases with age Cigarette smoking is a potent modifiable risk factor. M/C below the level of renal aeries 90% associated with atherosclerosis Normally asymptomatic Causes acute pain and hypotension on rupture For asymptomatic aneurysms, abdominal aoic aneurysm repair is indicated if the diameter is >=5.5 cm. | Unknown | Integrated QBank | 128 | {
"Correct Answer": "5.5 cm",
"Correct Option": "A",
"Options": {
"A": "5.5 cm",
"B": "5.4 cm",
"C": "4.5 cm",
"D": "4.4 cm"
},
"Question": "A 67-year-old man, chronic smoker, presented to the ER with sudden, intense and persistent abdominal and back pain along with altered mental status. O/E: - Hypotension Tachycardia Cyanosis. On abdominal examination, a tender, pulsatile and an expansile mass was noted in the umbilical and the epigastric region. Patient was immediately taken up for surgery but the patient did not survive. On checking the old repos of the patient, some abnormal mass was noted in the abdomen. A CECT film was also found. In asymptomatic cases, what is the indication of surgery?"
} | A 67-year-old man, chronic smoker, presented to the ER with sudden, intense and persistent abdominal and back pain along with altered mental status. O/E: - Hypotension Tachycardia Cyanosis. On abdominal examination, a tender, pulsatile and an expansile mass was noted in the umbilical and the epigastric region. Patient was immediately taken up for surgery but the patient did not survive. On checking the old repos of the patient, some abnormal mass was noted in the abdomen. A CECT film was also found. | In asymptomatic cases, what is the indication of surgery? | {
"A": "5.5 cm",
"B": "5.4 cm",
"C": "4.5 cm",
"D": "4.4 cm"
} | A. 5.5 cm |
3bf95515-b334-4cb9-bd89-f79482872997 | A 25 years old female complains of recurrent rhinitis, nasal discharge and bilateral nasal blockage since one year. She has history of asthma and allergy. On examination multiple ethmoidal polyps are noted with mucosal thickening and impacted secretions in both the nasal cavities. Biopsy is taken and the material is cultured which shown the growth of many hyphae and pseudo hyphae with dichotomous branching typically at 45deg. Which of the following is the most likely responsible organism? | Aspergillus fumigatus | Rhizopus | Mucor | Candida | 0a
| multi | Ans. is 'a' i.e., Aspergillus fumigatus(Ref: Harrison, 18th/e, p. 1655, 1656 and 17th/e, p. 1257)* Information provided in this question are:(i) Recurrent rhinitis, nasal discharge, bilateral nasal blockade.(ii) History of asthma and allergy.(iii) Hyphae with dichotomous branching at 45degC.* All suggest the diagnosis of Aspergillus fumigatus.(i) Most common type of fungal infection of nose and paranasal sinuses are due to Aspergillus.(ii) Most common fungus causing allergy is aspergillus.(iii) Aspergillus has septate hyphae that branch typically at 45degC (V shaped). | Microbiology | Mycology | 107 | {
"Correct Answer": "Aspergillus fumigatus",
"Correct Option": "A",
"Options": {
"A": "Aspergillus fumigatus",
"B": "Rhizopus",
"C": "Mucor",
"D": "Candida"
},
"Question": "A 25 years old female complains of recurrent rhinitis, nasal discharge and bilateral nasal blockage since one year. She has history of asthma and allergy. On examination multiple ethmoidal polyps are noted with mucosal thickening and impacted secretions in both the nasal cavities. Biopsy is taken and the material is cultured which shown the growth of many hyphae and pseudo hyphae with dichotomous branching typically at 45deg. Which of the following is the most likely responsible organism?"
} | A 25 years old female complains of recurrent rhinitis, nasal discharge and bilateral nasal blockage since one year. She has history of asthma and allergy. On examination multiple ethmoidal polyps are noted with mucosal thickening and impacted secretions in both the nasal cavities. Biopsy is taken and the material is cultured which shown the growth of many hyphae and pseudo hyphae with dichotomous branching typically at 45deg. | Which of the following is the most likely responsible organism? | {
"A": "Aspergillus fumigatus",
"B": "Rhizopus",
"C": "Mucor",
"D": "Candida"
} | A. Aspergillus fumigatus |
f3f3fb83-e1ec-440e-8922-0357d1b14ac5 | A person involved in a murder is brought to you for determination of age since the defence attorney wants him to be treated as a minor. The results of Xrays are as given below: 1) All the epiphyses of the elbow have fused 2) All the epiphyses of the shoulder joint have fused 3) The epiphyses of the inner end of the clavicles has fused 4) The ramus of pubis and ischium has fused What is the approximate age of this person assuming that it is a male? | 15 - 17 | 18 - 19 | 20 years | 21 or more | 3d
| multi | The epiphyses of the elbow joint fuses by 15 - 17 years in males. The epiphysis of the shoulder joint fuses by 18 - 19 years of age. If the inner end of the clavicle has fused he is at least 21 years of age or more. Also know In females the epiphyses fuses about 2 years earlier than in males. Ref: Textbook of Forensic Medicine and Toxicology by Narayan Reddy, Edition 21, Page -59. | Forensic Medicine | null | 113 | {
"Correct Answer": "21 or more",
"Correct Option": "D",
"Options": {
"A": "15 - 17",
"B": "18 - 19",
"C": "20 years",
"D": "21 or more"
},
"Question": "A person involved in a murder is brought to you for determination of age since the defence attorney wants him to be treated as a minor. The results of Xrays are as given below: 1) All the epiphyses of the elbow have fused 2) All the epiphyses of the shoulder joint have fused 3) The epiphyses of the inner end of the clavicles has fused 4) The ramus of pubis and ischium has fused What is the approximate age of this person assuming that it is a male?"
} | A person involved in a murder is brought to you for determination of age since the defence attorney wants him to be treated as a minor. | The results of Xrays are as given below: 1) All the epiphyses of the elbow have fused 2) All the epiphyses of the shoulder joint have fused 3) The epiphyses of the inner end of the clavicles has fused 4) The ramus of pubis and ischium has fused What is the approximate age of this person assuming that it is a male? | {
"A": "15 - 17",
"B": "18 - 19",
"C": "20 years",
"D": "21 or more"
} | D. 21 or more |
6cc64f33-eb35-4727-8b63-66341ad5401c | 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. The vein which is involved leading to varicocele in the above patient is contributed embryologically by all except: - | Left mesonephric vein | Left subcardinal vein | Intersubcardinal anastomosis | Left supracardinal vein | 3d
| multi | 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. The vein involved is left renal vein. It is contributed by: - Left mesonephric vein Left subcardinal vein Intersubcardinal anastomosis | Anatomy | Integrated QBank | 121 | {
"Correct Answer": "Left supracardinal vein",
"Correct Option": "D",
"Options": {
"A": "Left mesonephric vein",
"B": "Left subcardinal vein",
"C": "Intersubcardinal anastomosis",
"D": "Left supracardinal vein"
},
"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. The vein which is involved leading to varicocele in the above patient is contributed embryologically by all 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. | The vein which is involved leading to varicocele in the above patient is contributed embryologically by all except: - | {
"A": "Left mesonephric vein",
"B": "Left subcardinal vein",
"C": "Intersubcardinal anastomosis",
"D": "Left supracardinal vein"
} | D. Left supracardinal vein |
1636111e-8fee-429e-8893-793d5f676d3f | A 48-year-old right-handed man was admitted with a 3-day history of brief generalised tonic-clonic seizures,muscle weakness, a 3-month history of weight loss with increasing difficulty in eating and a 1-week history of word finding difficulties and speech apraxia with reduced fine motor skills.He had a diagnosis of type 2 diabetes mellitus, epilepsy and a history of a left temporal lobe infarct 3 years ago. MRI of the brain showing bilateral coical-based signal abnormality with associated oedema, with corresponding diffusion hyperintensity. MR spectroscopy showing a lactate doublet peak. HPE of muscle biopsy was shown below.What is the most probable diagnosis? | Duchenne muscular dystrophy | Beckers muscular dystrophy | Myotonic dystrophy | MELA's disease | 3d
| single | The clinical scenario shows a child who had normal development previously and then presenting with symptoms of lactic acidosis and stroke(seizures with focal neurological deficits). The microscopy of muscle biopsy with modified Gomori trichrome staining shows ragged red fibers (arrowhead). Based on these features, the child is probably suffering from mitochondrial encephalopathy, lactic acidosis, and stroke (MELAS), which is a mitochondrial inherited condition due to complex I or complex IV deficiency. Treatment options for MELAS are limited and largely focus on suppoive therapy. Reference: Harpers illustrated biochemistry 30th edition | Biochemistry | Respiratory chain | 145 | {
"Correct Answer": "MELA's disease",
"Correct Option": "D",
"Options": {
"A": "Duchenne muscular dystrophy",
"B": "Beckers muscular dystrophy",
"C": "Myotonic dystrophy",
"D": "MELA's disease"
},
"Question": "A 48-year-old right-handed man was admitted with a 3-day history of brief generalised tonic-clonic seizures,muscle weakness, a 3-month history of weight loss with increasing difficulty in eating and a 1-week history of word finding difficulties and speech apraxia with reduced fine motor skills.He had a diagnosis of type 2 diabetes mellitus, epilepsy and a history of a left temporal lobe infarct 3 years ago. MRI of the brain showing bilateral coical-based signal abnormality with associated oedema, with corresponding diffusion hyperintensity. MR spectroscopy showing a lactate doublet peak. HPE of muscle biopsy was shown below.What is the most probable diagnosis?"
} | A 48-year-old right-handed man was admitted with a 3-day history of brief generalised tonic-clonic seizures,muscle weakness, a 3-month history of weight loss with increasing difficulty in eating and a 1-week history of word finding difficulties and speech apraxia with reduced fine motor skills.He had a diagnosis of type 2 diabetes mellitus, epilepsy and a history of a left temporal lobe infarct 3 years ago. MRI of the brain showing bilateral coical-based signal abnormality with associated oedema, with corresponding diffusion hyperintensity. MR spectroscopy showing a lactate doublet peak. | HPE of muscle biopsy was shown below.What is the most probable diagnosis? | {
"A": "Duchenne muscular dystrophy",
"B": "Beckers muscular dystrophy",
"C": "Myotonic dystrophy",
"D": "MELA's disease"
} | D. MELA's disease |
cacf155f-9ebe-413f-8cbc-4cc692d44e38 | A 40-year-old woman presents with a long history of vague upper abdominal pain and frequent indigestion with abdominal tenderness. Serum bilirubin is elevated (4.2 mg/dL). There is a mild increase in serum AST and ALT (62 and 57 U/L, respectively) and a moderate increase in alkaline phosphatase (325 U/L). Markers for viral hepatitis are negative. Abdominal ultrasound examination shows echogenic stone-like material within the gallbladder and thickening of the gallbladder wall. An intrahepatic mass is also visualized adjacent to the gallbladder. A cholecystectomy is performed. Histologic examination shows dense fibrosis and glandular structures in the wall of the gallbladder. What is the most likely diagnosis? | Carcinoma of the gallbladder | Hemangiosarcoma | Hepatic adenoma | Hepatocellular carcinoma | 0a
| multi | Adenocarcinoma of the gallbladder Arises from the mucosal surface epithelium - Obstructive jaundice (as in this case) by involvement of the extrahepatic biliary tree. The other choices are not associated with a history of chronic cholecystitis and cholelithiasis and infrequently cause obstructive jaundice. | Pathology | Miscellaneous | 168 | {
"Correct Answer": "Carcinoma of the gallbladder",
"Correct Option": "A",
"Options": {
"A": "Carcinoma of the gallbladder",
"B": "Hemangiosarcoma",
"C": "Hepatic adenoma",
"D": "Hepatocellular carcinoma"
},
"Question": "A 40-year-old woman presents with a long history of vague upper abdominal pain and frequent indigestion with abdominal tenderness. Serum bilirubin is elevated (4.2 mg/dL). There is a mild increase in serum AST and ALT (62 and 57 U/L, respectively) and a moderate increase in alkaline phosphatase (325 U/L). Markers for viral hepatitis are negative. Abdominal ultrasound examination shows echogenic stone-like material within the gallbladder and thickening of the gallbladder wall. An intrahepatic mass is also visualized adjacent to the gallbladder. A cholecystectomy is performed. Histologic examination shows dense fibrosis and glandular structures in the wall of the gallbladder. What is the most likely diagnosis?"
} | A 40-year-old woman presents with a long history of vague upper abdominal pain and frequent indigestion with abdominal tenderness. Serum bilirubin is elevated (4.2 mg/dL). There is a mild increase in serum AST and ALT (62 and 57 U/L, respectively) and a moderate increase in alkaline phosphatase (325 U/L). Markers for viral hepatitis are negative. Abdominal ultrasound examination shows echogenic stone-like material within the gallbladder and thickening of the gallbladder wall. An intrahepatic mass is also visualized adjacent to the gallbladder. A cholecystectomy is performed. Histologic examination shows dense fibrosis and glandular structures in the wall of the gallbladder. | What is the most likely diagnosis? | {
"A": "Carcinoma of the gallbladder",
"B": "Hemangiosarcoma",
"C": "Hepatic adenoma",
"D": "Hepatocellular carcinoma"
} | A. Carcinoma of the gallbladder |
dc69483d-4637-4b44-88bd-d0feb4a11317 | A 64-year-old woman presents with 6 weeks of fatigue, dyspnea, and night sweats. She has lost 11 lb. She has no history of trauma, has never had surgery, and takes no medications. Chest x-ray reveals a large right-sided pleural effusion. Thoracentesis yields pleural fluid that appears milky. Pleural fluid triglyceride level is 500 mg/dL. Which of the following disorders is most likely in this patient? | Lymphoma | Congestive heart failure | Pulmonary embolism | Pneumonia | 0a
| single | This patient has a chylothorax. In chylothorax, the pleural fluid appears milky and has a triglyceride level over 110 mg/dL. Chylothorax occurs when chyle accumulates in the pleural space due to disruption of the thoracic duct. This is most often due to traumatic or surgical injury to the thoracic duct. In this patient without trauma or recent surgery, a mediastinal tumor (such as lymphoma) would be most likely. Chylous pleural effusions are usually exudative. Pulmonary embolism, systemic lupus, and pneumonia may all be associated with pleural effusions, but pleural effusions associated with these conditions are not chylous. Congestive heart failure is a very rare cause of chylous pleural effusion but would be much less likely than lymphoma. | Medicine | Respiratory | 103 | {
"Correct Answer": "Lymphoma",
"Correct Option": "A",
"Options": {
"A": "Lymphoma",
"B": "Congestive heart failure",
"C": "Pulmonary embolism",
"D": "Pneumonia"
},
"Question": "A 64-year-old woman presents with 6 weeks of fatigue, dyspnea, and night sweats. She has lost 11 lb. She has no history of trauma, has never had surgery, and takes no medications. Chest x-ray reveals a large right-sided pleural effusion. Thoracentesis yields pleural fluid that appears milky. Pleural fluid triglyceride level is 500 mg/dL. Which of the following disorders is most likely in this patient?"
} | A 64-year-old woman presents with 6 weeks of fatigue, dyspnea, and night sweats. She has lost 11 lb. She has no history of trauma, has never had surgery, and takes no medications. Chest x-ray reveals a large right-sided pleural effusion. Thoracentesis yields pleural fluid that appears milky. Pleural fluid triglyceride level is 500 mg/dL. | Which of the following disorders is most likely in this patient? | {
"A": "Lymphoma",
"B": "Congestive heart failure",
"C": "Pulmonary embolism",
"D": "Pneumonia"
} | A. Lymphoma |
f04549d1-69d0-40e0-96be-c619501c1da3 | A 20-year-old male presented to the OPD with recurrent episodes of lower backache which was more in morning and relieved on movement. Patient gave history of multiple episodes of chest infections in the past for which the patient was hospitalized multiple times. On ophthalmoscopic examination, iritis and conjunctivitis were noted. Lab findings revealed HLA-B27 positivity, elevated CRP and elevated ESR. The doctor ordered the x-ray of the lumbar spine and performed a test. Which of the following interleukins is most commonly involved in the pathogenesis of the above disease: - | IL-1 | IL-17 | IL-5 | IL-10 | 1b
| multi | This is a case of Ankylosing spondylitis. X ray spine shows the classical bamboo spine appearance/ squaring of veebra. The test being performed is the Modified Schober's test. The pathogenesis of AS is immune-mediated. Tumor necrosis factor a (TNF-a) or IL-17A play a central role in the immunopathogenesis of AS. Mast cells and neutrophils are major IL-17-producing cells in peripheral ahritis Neutrophils producing IL-17 are prominent in apophyseal joints. | Unknown | Integrated QBank | 122 | {
"Correct Answer": "IL-17",
"Correct Option": "B",
"Options": {
"A": "IL-1",
"B": "IL-17",
"C": "IL-5",
"D": "IL-10"
},
"Question": "A 20-year-old male presented to the OPD with recurrent episodes of lower backache which was more in morning and relieved on movement. Patient gave history of multiple episodes of chest infections in the past for which the patient was hospitalized multiple times. On ophthalmoscopic examination, iritis and conjunctivitis were noted. Lab findings revealed HLA-B27 positivity, elevated CRP and elevated ESR. The doctor ordered the x-ray of the lumbar spine and performed a test. Which of the following interleukins is most commonly involved in the pathogenesis of the above disease: -"
} | A 20-year-old male presented to the OPD with recurrent episodes of lower backache which was more in morning and relieved on movement. Patient gave history of multiple episodes of chest infections in the past for which the patient was hospitalized multiple times. On ophthalmoscopic examination, iritis and conjunctivitis were noted. Lab findings revealed HLA-B27 positivity, elevated CRP and elevated ESR. The doctor ordered the x-ray of the lumbar spine and performed a test. | Which of the following interleukins is most commonly involved in the pathogenesis of the above disease: - | {
"A": "IL-1",
"B": "IL-17",
"C": "IL-5",
"D": "IL-10"
} | B. IL-17 |
a08b6e6c-f421-4ac7-8e62-4d92c05d3c69 | You are called to the emergency room to see a baby who was unresponsive. The delivery is believed to have occurred at home. It has only been half an hour since the body was born as per the bystander. On examination you find fracture of skull base and a depressed fracture of temporal bone. Neuroimaging revealed contusions on the brain. The baby died within 15 minutes. The ER resident is of the opinion that the injuries must have occurred during labour. The bystander also has the same opinion. What is your opinion regarding the nature of death of the baby? | Accidental | Natural | Homicidal | None | 2c
| multi | Skull bone fracture involving the vault or base is suggestive of head injuries due to blunt force trauma. Depressed fracture with contusion, laceration and hemorrhage in the brain is also suggestive of head injury due to blunt force trauma. So in this scenario the findings are highly in our of homicide. Ref: Textbook of Forensic Medicine and Toxicology by Narayan Reddy, Edition 21, Page 374 | Forensic Medicine | null | 118 | {
"Correct Answer": "Homicidal",
"Correct Option": "C",
"Options": {
"A": "Accidental",
"B": "Natural",
"C": "Homicidal",
"D": "None"
},
"Question": "You are called to the emergency room to see a baby who was unresponsive. The delivery is believed to have occurred at home. It has only been half an hour since the body was born as per the bystander. On examination you find fracture of skull base and a depressed fracture of temporal bone. Neuroimaging revealed contusions on the brain. The baby died within 15 minutes. The ER resident is of the opinion that the injuries must have occurred during labour. The bystander also has the same opinion. What is your opinion regarding the nature of death of the baby?"
} | You are called to the emergency room to see a baby who was unresponsive. The delivery is believed to have occurred at home. It has only been half an hour since the body was born as per the bystander. On examination you find fracture of skull base and a depressed fracture of temporal bone. Neuroimaging revealed contusions on the brain. The baby died within 15 minutes. The ER resident is of the opinion that the injuries must have occurred during labour. The bystander also has the same opinion. | What is your opinion regarding the nature of death of the baby? | {
"A": "Accidental",
"B": "Natural",
"C": "Homicidal",
"D": "None"
} | C. Homicidal |
fce96470-4109-4080-99f8-479831d955cf | A 63-year-old man develops edema, and dyspnea on exertion. He has no prior cardiac or renal conditions, and his examination is significant for macroglossia, elevated jugular venous pressure (JVP), hepatomegaly, and 3+ pedal edema. His investigations reveal 3.5 g/d of protein in the urine, anemia, normal fasting glucose, and serum immunoelectrophoresis is positive for a monoclonal immunoglobulin. Which of the following is the most characteristic neurologic finding associated with this condition? | peripheral motor and sensory neuropathy | spinal cord compression in the lumbar region | spinal cord compression in the thoracic region | a peripheral neuropathy associated with cerebral manifestations | 0a
| single | (a) Source: (Kasper, p. 2027) In addition to peripheral motor and sensory neuropathy, cardiac involvement, tongue enlargement, gastrointestinal (GI) manifestations, and carpal tunnel syndrome are also seen in amyloidosis. The specific diagnosis requires tissue biopsy with presence of amyloid with specific stains. In primary amyloidosis and myeloma, the amyloid protein is of the AL type. In reactive amyloidosis, the protein is of the amyloid A protein (AA) type. | Medicine | Endocrinology | 120 | {
"Correct Answer": "peripheral motor and sensory neuropathy",
"Correct Option": "A",
"Options": {
"A": "peripheral motor and sensory neuropathy",
"B": "spinal cord compression in the lumbar region",
"C": "spinal cord compression in the thoracic region",
"D": "a peripheral neuropathy associated with cerebral manifestations"
},
"Question": "A 63-year-old man develops edema, and dyspnea on exertion. He has no prior cardiac or renal conditions, and his examination is significant for macroglossia, elevated jugular venous pressure (JVP), hepatomegaly, and 3+ pedal edema. His investigations reveal 3.5 g/d of protein in the urine, anemia, normal fasting glucose, and serum immunoelectrophoresis is positive for a monoclonal immunoglobulin. Which of the following is the most characteristic neurologic finding associated with this condition?"
} | A 63-year-old man develops edema, and dyspnea on exertion. He has no prior cardiac or renal conditions, and his examination is significant for macroglossia, elevated jugular venous pressure (JVP), hepatomegaly, and 3+ pedal edema. His investigations reveal 3.5 g/d of protein in the urine, anemia, normal fasting glucose, and serum immunoelectrophoresis is positive for a monoclonal immunoglobulin. | Which of the following is the most characteristic neurologic finding associated with this condition? | {
"A": "peripheral motor and sensory neuropathy",
"B": "spinal cord compression in the lumbar region",
"C": "spinal cord compression in the thoracic region",
"D": "a peripheral neuropathy associated with cerebral manifestations"
} | A. peripheral motor and sensory neuropathy |
cbe0b35b-5343-4e6d-bb53-459176eaee2e | A 21-year-old man has a nonproductive cough, shortness of breath, and chest pain, which changes with breathing. He also has pain in the left arm. On examination, there is tenderness over the left shoulder, heart sounds are normal, and the lungs are clear. CXR reveals a lytic lesion in the left humerus and reticulonodular opacities in the upper and middles lobes (Figure given below). The eosinophil count is normal. Which of the following is the most appropriate initial diagnostic test? | lung biopsy | humerus bone biopsy | CT scan of chest | Bronchoscopy | 2c
| single | Primary pulmonary Langerhans cell histiocytosis (PLCH), also called eosinophilic granuloma of the lung, pulmonary Langerhans cell granulomatosis, and pulmonary histiocytosis X, is an uncommon interstitial lung disease that primarily affects young adults. There is a coarse, reticular pattern in the whole lung, somewhat more prominent in the upper lobes, suggesting a honeycomb appearance. It is the density here that is abnormal and not the lucency. The next most appropriate test would be a better definition of the lung findings with a high-resolution CT scan. The other more invasive investigations may be more appropriate after the CT. | Medicine | Respiratory | 115 | {
"Correct Answer": "CT scan of chest",
"Correct Option": "C",
"Options": {
"A": "lung biopsy",
"B": "humerus bone biopsy",
"C": "CT scan of chest",
"D": "Bronchoscopy"
},
"Question": "A 21-year-old man has a nonproductive cough, shortness of breath, and chest pain, which changes with breathing. He also has pain in the left arm. On examination, there is tenderness over the left shoulder, heart sounds are normal, and the lungs are clear. CXR reveals a lytic lesion in the left humerus and reticulonodular opacities in the upper and middles lobes (Figure given below). The eosinophil count is normal. Which of the following is the most appropriate initial diagnostic test?"
} | A 21-year-old man has a nonproductive cough, shortness of breath, and chest pain, which changes with breathing. He also has pain in the left arm. On examination, there is tenderness over the left shoulder, heart sounds are normal, and the lungs are clear. CXR reveals a lytic lesion in the left humerus and reticulonodular opacities in the upper and middles lobes (Figure given below). The eosinophil count is normal. | Which of the following is the most appropriate initial diagnostic test? | {
"A": "lung biopsy",
"B": "humerus bone biopsy",
"C": "CT scan of chest",
"D": "Bronchoscopy"
} | C. CT scan of chest |
272a9cf1-05bf-4dd1-acb5-09f536f72f05 | A 29-year-old man has developed marked joint pain beginning 12 days after receiving snake antivenom injection. On physical examination, there is diffuse joint pain with movement. The stool is negative for occult blood. Laboratory studies show a serum creatinine level of 4.4 mg/dL and urea nitrogen level of 42 mg/dL. Microscopic examination of a renal biopsy specimen shows focal fibrinoid necrosis of the small arterial and arteriolar vascular media and intravascular microthrombi. Scattered neutrophils are seen in these areas of necrosis. Which of the following laboratory findings in the blood is most likely present in this patient? | CD4+ lymphocytosis | Hypocomplementemia | Increased IgE | Neutropenia | 1b
| multi | In the localized immune complex reaction (Arthus reaction) at the site of injection, there can be activation and depletion of complement C3. The reaction described here is serum sickness in response to the injected foreign protein, and produced more widespread antigen-antibody complex deposition, particularly in the kidneys. CD4+ lymphocytes assist in various antibody-mediated and cell-mediated immune reactions, but their numbers in peripheral blood do not change appreciably. IgE concentration is increased in individuals with atopy and the potential for type I hypersensitivity. Although neutrophils are being recruited locally to the inflammatory reaction in this case, they are not depleted systemically, and they may be increased in the circulation. Thrombocytopenia could be seen with a thrombotic microangiopathy such as thrombotic thrombocytopenic purpura, but not typically in an Arthus reaction. | Pathology | Immunity | 140 | {
"Correct Answer": "Hypocomplementemia",
"Correct Option": "B",
"Options": {
"A": "CD4+ lymphocytosis",
"B": "Hypocomplementemia",
"C": "Increased IgE",
"D": "Neutropenia"
},
"Question": "A 29-year-old man has developed marked joint pain beginning 12 days after receiving snake antivenom injection. On physical examination, there is diffuse joint pain with movement. The stool is negative for occult blood. Laboratory studies show a serum creatinine level of 4.4 mg/dL and urea nitrogen level of 42 mg/dL. Microscopic examination of a renal biopsy specimen shows focal fibrinoid necrosis of the small arterial and arteriolar vascular media and intravascular microthrombi. Scattered neutrophils are seen in these areas of necrosis. Which of the following laboratory findings in the blood is most likely present in this patient?"
} | A 29-year-old man has developed marked joint pain beginning 12 days after receiving snake antivenom injection. On physical examination, there is diffuse joint pain with movement. The stool is negative for occult blood. Laboratory studies show a serum creatinine level of 4.4 mg/dL and urea nitrogen level of 42 mg/dL. Microscopic examination of a renal biopsy specimen shows focal fibrinoid necrosis of the small arterial and arteriolar vascular media and intravascular microthrombi. Scattered neutrophils are seen in these areas of necrosis. | Which of the following laboratory findings in the blood is most likely present in this patient? | {
"A": "CD4+ lymphocytosis",
"B": "Hypocomplementemia",
"C": "Increased IgE",
"D": "Neutropenia"
} | B. Hypocomplementemia |
8d8000f1-5586-40cc-8cd4-1d893e175086 | A 6 year old child presents with pallor that required two blood transfusions previously. He has now developed fever and petechial haemorrhages.His hemoglobin is 9 g/dL, platelet count is 20,000/mm3 and TLC is 60,000/ mm3. Flow cytometry reveals the cells to be CD10 +ve, MPO +ve, CD 19 +ve, CD 33 –ve, CD 117 +ve, and CD3 –ve.
Which of the following is the most likely diagnosis? | ALL | AML | Mixed phenotypic leukaemia | Undifferentiated leukaemia | 2c
| multi | Mixed lineage acute leukemia is alternatively also known as bilineal acute leukemia. As suggested by the name, there are 2 populations of cells which are morphologically and immunophenotypically distinct from each other.
Analyzing the markers on the cells,
B lymphoid markers: CD10, CD19 and CD79.
T lineage markers: CD2, CD3 and CD7.
Myeloid markers; CD13, CD33, CD117 and myeloperoxidase (MPO).
Non lineage specific markers which are expressed in hematopoietic progenitor cells: CD34, HLA-DR and TdT. Comparing this with the information provided in the stem of our question, it is easy to decipher that the cells mentioned are CD10+ve, MPO +ve, CD19+ve, CD33-ve, CD117 +ve and CD3-ve which is showing both lymphoid (CD10, CD19;B lymphoid lineage) and myeloid (CD117 and MPO+-; myeloid lineage) markers.
So, the answer is
Mixed phenotypic leukemia
A word about the last option ‘d’, please note that in un-differentiated acute leukemia, blasts usually lack any evidence of lineage differentiation.
Wintrobes 12th/1814-8 | Pathology | null | 127 | {
"Correct Answer": "Mixed phenotypic leukaemia",
"Correct Option": "C",
"Options": {
"A": "ALL",
"B": "AML",
"C": "Mixed phenotypic leukaemia",
"D": "Undifferentiated leukaemia"
},
"Question": "A 6 year old child presents with pallor that required two blood transfusions previously. He has now developed fever and petechial haemorrhages.His hemoglobin is 9 g/dL, platelet count is 20,000/mm3 and TLC is 60,000/ mm3. Flow cytometry reveals the cells to be CD10 +ve, MPO +ve, CD 19 +ve, CD 33 –ve, CD 117 +ve, and CD3 –ve.\nWhich of the following is the most likely diagnosis?"
} | A 6 year old child presents with pallor that required two blood transfusions previously. He has now developed fever and petechial haemorrhages.His hemoglobin is 9 g/dL, platelet count is 20,000/mm3 and TLC is 60,000/ mm3. | Flow cytometry reveals the cells to be CD10 +ve, MPO +ve, CD 19 +ve, CD 33 –ve, CD 117 +ve, and CD3 –ve.
Which of the following is the most likely diagnosis? | {
"A": "ALL",
"B": "AML",
"C": "Mixed phenotypic leukaemia",
"D": "Undifferentiated leukaemia"
} | C. Mixed phenotypic leukaemia |
5daaa40d-a982-4f8f-a898-da116ac963e0 | A 9-month-old is brought to the emergency center by ambulance. The child had been having emesis and diarrhea with decreased urine output for several days, and the parents noted that she was hard to wake up this morning. Her weight is 9 kg, down from 11 kg the week prior at her 9- month checkup. You note her hea rate and blood pressure to be normal. She is lethargic, and her skin is noted to be "doughy." After confirming that her respiratory status is stable, you send electrolytes, which you expect to be abnormal. You sta an IV. The best solution for an initial IV bolus would be | 1/4 normal saline (38.5 meq sodium/L) | D10 water (100 g glucose/L) | Normal saline (154 meq sodium/L) | 3% saline (513 meq sodium/L) | 2c
| single | The description is that of a child with hypernatremia (in this case, the child's sodium was 170 meq/dL); the "doughy" skin is often seen in hypernatremia. The extracellular fluid and circulating blood volumes tend to be preserved with hypernatremic dehydration at the expense of the intracellular volume. Therefore, hypotension may not be observed, and neither are the other signs of circulatory inadequacy that are typical of isotonic or hypotonic dehydration. Signs suggesting involvement of the central nervous system (such as irritability or lethargy) are characteristic of hypeonic dehydration. Slow correction of this hypernatremia (over 24 to 48 h) prevents significant fluid shifts and increased intercranial pressure. Initial bolus therapy should be with isotonic fluid such as normal saline or lactated Ringer's solution. Blood products such as fresh-frozen plasma are not indicated, and hypotonic solutions such as D10W and 1/4 NS could cause rapid fluid shifts, resulting in cerebral edema and death. Hypeonic (3%) saline is used in the event of seizures caused by rapid rehydration, along with other measures typically used to reduce cerebral edema. | Surgery | null | 139 | {
"Correct Answer": "Normal saline (154 meq sodium/L)",
"Correct Option": "C",
"Options": {
"A": "1/4 normal saline (38.5 meq sodium/L)",
"B": "D10 water (100 g glucose/L)",
"C": "Normal saline (154 meq sodium/L)",
"D": "3% saline (513 meq sodium/L)"
},
"Question": "A 9-month-old is brought to the emergency center by ambulance. The child had been having emesis and diarrhea with decreased urine output for several days, and the parents noted that she was hard to wake up this morning. Her weight is 9 kg, down from 11 kg the week prior at her 9- month checkup. You note her hea rate and blood pressure to be normal. She is lethargic, and her skin is noted to be \"doughy.\" After confirming that her respiratory status is stable, you send electrolytes, which you expect to be abnormal. You sta an IV. The best solution for an initial IV bolus would be"
} | A 9-month-old is brought to the emergency center by ambulance. The child had been having emesis and diarrhea with decreased urine output for several days, and the parents noted that she was hard to wake up this morning. Her weight is 9 kg, down from 11 kg the week prior at her 9- month checkup. You note her hea rate and blood pressure to be normal. She is lethargic, and her skin is noted to be "doughy." After confirming that her respiratory status is stable, you send electrolytes, which you expect to be abnormal. You sta an IV. | The best solution for an initial IV bolus would be | {
"A": "1/4 normal saline (38.5 meq sodium/L)",
"B": "D10 water (100 g glucose/L)",
"C": "Normal saline (154 meq sodium/L)",
"D": "3% saline (513 meq sodium/L)"
} | C. Normal saline (154 meq sodium/L) |
567d6e1f-98c5-4e16-ae1c-2f1a3a44fb9d | A 19-year-old man working as a driver comes to Psychiatrist with excessive anxiety and fear. He repos that every time he drives over a bump in the road, he is convinced that he has accidentally run over a small child. He has to pull over and check underneath his car for blood and retrace his driving route to look for any injured children. As a result, he is always late for work.He also has intrusive thoughts about stabbing his coworkers.He prays to try to erase these thoughts from his mind, but this rarely helps. First-line pharmacological treatment of this patient's condition primarily affects which of the following neurotransmitters? | Acetylcholine | Dopamine | Norepinephrine | Serotonin | 3d
| multi | Patient's behavior is suggestive of Obsessive Compulsive Disorder. Although multiple neurotransmitters and regulatory mechanisms are thought to contribute to the clinical expression of OCD ,serotonin is the primary pharmacological target. First-line treatment is a selective serotonin reuptake inhibitor(SSRI) antidepressant. | Psychiatry | Neurotic, Stress Related and Somatoform Disorders | 130 | {
"Correct Answer": "Serotonin",
"Correct Option": "D",
"Options": {
"A": "Acetylcholine",
"B": "Dopamine",
"C": "Norepinephrine",
"D": "Serotonin"
},
"Question": "A 19-year-old man working as a driver comes to Psychiatrist with excessive anxiety and fear. He repos that every time he drives over a bump in the road, he is convinced that he has accidentally run over a small child. He has to pull over and check underneath his car for blood and retrace his driving route to look for any injured children. As a result, he is always late for work.He also has intrusive thoughts about stabbing his coworkers.He prays to try to erase these thoughts from his mind, but this rarely helps. First-line pharmacological treatment of this patient's condition primarily affects which of the following neurotransmitters?"
} | A 19-year-old man working as a driver comes to Psychiatrist with excessive anxiety and fear. He repos that every time he drives over a bump in the road, he is convinced that he has accidentally run over a small child. He has to pull over and check underneath his car for blood and retrace his driving route to look for any injured children. As a result, he is always late for work.He also has intrusive thoughts about stabbing his coworkers.He prays to try to erase these thoughts from his mind, but this rarely helps. | First-line pharmacological treatment of this patient's condition primarily affects which of the following neurotransmitters? | {
"A": "Acetylcholine",
"B": "Dopamine",
"C": "Norepinephrine",
"D": "Serotonin"
} | D. Serotonin |
3a8cb5ff-008e-49e9-af39-d97abf47fb4f | A 4-year-old boy is brought to the physician by his parents because he falls a lot, cannot jump, and tires easily Physical examination reveals weakness in the pelvic and shoulder girdles and enlargement of the child's calf muscles. The serum level of creatine kinase is elevated. A biopsy of calf muscle reveals marked variation in size and shape of muscle fibers. There are foci of muscle fiber necrosis, myophagocytosis, regenerating fibers, and fibrosis. Molecular diagnostic assays performed on muscle biopsy from the patient would show alterations in the length of the primary transcript for which of the following muscle-associated proteins? | Creatine kinase | Desmin | Dystrophin | Glycogen phosphorylase | 2c
| multi | Dystrophin. Duchenne muscular dystrophy is caused by mutations of a large gene on the short arm of the X chromosome (Xp21). This gene codes for dystrophin, a protein localized to the inner surface of the sarcolemma. Dystrophin links the subsarcolemmal cytoskeleton to the exterior of the cell through a transmembrane complex of proteins and glycoproteins that binds to laminin. Dystrophin-deficient muscle fibers thus lack the normal interaction between the sarcolemma and the extracellular matrix. This disruption may be responsible for the observed increased osmotic fragility of dystrophic muscle, the excessive influx of calcium ions, and the release of soluble muscle enzymes such as creatine kinase into the serum. The other proteins are not altered in patients with Duchenne muscular dystrophy.Diagnosis: Duchenne muscular dystrophy | Pathology | Peripheral Nerve & Skeletal Muscles | 128 | {
"Correct Answer": "Dystrophin",
"Correct Option": "C",
"Options": {
"A": "Creatine kinase",
"B": "Desmin",
"C": "Dystrophin",
"D": "Glycogen phosphorylase"
},
"Question": "A 4-year-old boy is brought to the physician by his parents because he falls a lot, cannot jump, and tires easily Physical examination reveals weakness in the pelvic and shoulder girdles and enlargement of the child's calf muscles. The serum level of creatine kinase is elevated. A biopsy of calf muscle reveals marked variation in size and shape of muscle fibers. There are foci of muscle fiber necrosis, myophagocytosis, regenerating fibers, and fibrosis. Molecular diagnostic assays performed on muscle biopsy from the patient would show alterations in the length of the primary transcript for which of the following muscle-associated proteins?"
} | A 4-year-old boy is brought to the physician by his parents because he falls a lot, cannot jump, and tires easily Physical examination reveals weakness in the pelvic and shoulder girdles and enlargement of the child's calf muscles. The serum level of creatine kinase is elevated. A biopsy of calf muscle reveals marked variation in size and shape of muscle fibers. There are foci of muscle fiber necrosis, myophagocytosis, regenerating fibers, and fibrosis. | Molecular diagnostic assays performed on muscle biopsy from the patient would show alterations in the length of the primary transcript for which of the following muscle-associated proteins? | {
"A": "Creatine kinase",
"B": "Desmin",
"C": "Dystrophin",
"D": "Glycogen phosphorylase"
} | C. Dystrophin |
08f58993-ca46-43e8-a6ce-0320c1d811e3 | A 36-year-old man presents to you complaining of right scrotal swelling. He states that the swelling has been present for 1 week. He initially noticed the swelling sholy after moving furniture for his new living room. He denies any nausea, vomiting, change in bowel habits, abdominal pain, or urinary tract symptoms. He has no other significant medical or surgical history. On examination, he has an enlarged right hemi-scrotum with a mass that appears to be originating at the level of the external inguinal ring. With the patient completely relaxed, the physician is able to reduce the mass by pushing it back through the external inguinal ring. With the mass reduced, the physician instructs the patient to perform a Valsalva maneuver, upon which a protrusion is felt at the external inguinal ring. Once the mass is reduced, the testicle appears normal in size and consistency. Which of the following is the most likely diagnosis? | Hydrocele | Femoral hernia | Inguinal hernia | Testicular cancer | 2c
| multi | This patient has a reducible inguinal hernia. A hernia is a protrusion of a structure, usually intestine, through tissue that normally contains it. Inguinal hernias are either direct or indirect. Indirect inguinal hernias occur through the internal inguinal ring in a protrusion of peritoneum along the spermatic cord in the internal spermatic fascia. Direct inguinal hernias occur through the floor of the inguinal canal, separate from the spermatic cord as a result of breakdown of the transversus abdominis aponeurosis and transversalis fascia. If the mass, i.e., hernia, is easily returned back to its normal position, then it is called reducible. If the mass is not reducible, then this is called incarcerated. And, if the mass becomes incarcerated and develops compromised blood supply, it is termed strangulated. Strangulated hernias require emergent repair because the intestinal contents will necrose and cause the patient to become sick. As long as the mass is reducible, surgical repair can be performed on an outpatient basis. A hydrocele is a fluid collection contained within the tunica vaginalis that surrounds the testicle. It presents as a painless swelling of the scrotum, which transilluminates light when it is placed against the mass. A hydrocele cannot be reduced. Femoral hernias are more common in women, presenting as swellings in the upper pa of the thigh. The neck of the hernia sac lies at the femoral ring, below and lateral to the pubic tubercle, distinguishing these from inguinal hernias, which are above and medial to the tubercle. A mass caused by testicular cancer cannot be reduced either. Patients will complain of a dull, heavy, aching feeling within the testicle. The testicle itself is usually enlarged, hard, irregular, and non tender. | Surgery | null | 197 | {
"Correct Answer": "Inguinal hernia",
"Correct Option": "C",
"Options": {
"A": "Hydrocele",
"B": "Femoral hernia",
"C": "Inguinal hernia",
"D": "Testicular cancer"
},
"Question": "A 36-year-old man presents to you complaining of right scrotal swelling. He states that the swelling has been present for 1 week. He initially noticed the swelling sholy after moving furniture for his new living room. He denies any nausea, vomiting, change in bowel habits, abdominal pain, or urinary tract symptoms. He has no other significant medical or surgical history. On examination, he has an enlarged right hemi-scrotum with a mass that appears to be originating at the level of the external inguinal ring. With the patient completely relaxed, the physician is able to reduce the mass by pushing it back through the external inguinal ring. With the mass reduced, the physician instructs the patient to perform a Valsalva maneuver, upon which a protrusion is felt at the external inguinal ring. Once the mass is reduced, the testicle appears normal in size and consistency. Which of the following is the most likely diagnosis?"
} | A 36-year-old man presents to you complaining of right scrotal swelling. He states that the swelling has been present for 1 week. He initially noticed the swelling sholy after moving furniture for his new living room. He denies any nausea, vomiting, change in bowel habits, abdominal pain, or urinary tract symptoms. He has no other significant medical or surgical history. On examination, he has an enlarged right hemi-scrotum with a mass that appears to be originating at the level of the external inguinal ring. With the patient completely relaxed, the physician is able to reduce the mass by pushing it back through the external inguinal ring. With the mass reduced, the physician instructs the patient to perform a Valsalva maneuver, upon which a protrusion is felt at the external inguinal ring. Once the mass is reduced, the testicle appears normal in size and consistency. | Which of the following is the most likely diagnosis? | {
"A": "Hydrocele",
"B": "Femoral hernia",
"C": "Inguinal hernia",
"D": "Testicular cancer"
} | C. Inguinal hernia |
27390be2-540c-4d25-9219-beede0bb8e13 | A 55 year old male, who is a known case of severe persistent asthma since 14 years of age presents with acute exacerbation of asthma. The disease was well controlled upto 54 years with high dose inhaled corticosteroids. For the past 12 months the disease was not in good control. He complains of nocturnal cough, limitation of daily activities in spite of good compliance with medications. Spirometry was suggestive of bronchial asthma with partial irreversibility of airway obstruction. What is the cause for poor disease control? | Airway epithelial shedding | Airway inflammation | Airway remodeling | Airway hyperresponsiveness | 2c
| single | Answer: c) Airway remodeling (HARRISON 19TH ED, P-1675; ROBBINS 9TH ED, P-682)Airway remodeling:Over time, repeated bouts of allergen exposure and immune reactions result in structural changes in the bronchial wall, referred to as "airway remodeling"Airway remodeling adds an irreversible component to the obstructive disease The characteristic histological findings called 'airway remodeling' consists ofThickening of airway wallSub-basement membrane fibrosisBronchial epithelial basement membrane thickeningIncreased vascularityIncrease in size of submucosal glands and number of airway goblet cellsHypertrophy and/or hyperplasia of bronchial wall muscle | Medicine | Respiratory | 116 | {
"Correct Answer": "Airway remodeling",
"Correct Option": "C",
"Options": {
"A": "Airway epithelial shedding",
"B": "Airway inflammation",
"C": "Airway remodeling",
"D": "Airway hyperresponsiveness"
},
"Question": "A 55 year old male, who is a known case of severe persistent asthma since 14 years of age presents with acute exacerbation of asthma. The disease was well controlled upto 54 years with high dose inhaled corticosteroids. For the past 12 months the disease was not in good control. He complains of nocturnal cough, limitation of daily activities in spite of good compliance with medications. Spirometry was suggestive of bronchial asthma with partial irreversibility of airway obstruction. What is the cause for poor disease control?"
} | A 55 year old male, who is a known case of severe persistent asthma since 14 years of age presents with acute exacerbation of asthma. The disease was well controlled upto 54 years with high dose inhaled corticosteroids. For the past 12 months the disease was not in good control. He complains of nocturnal cough, limitation of daily activities in spite of good compliance with medications. Spirometry was suggestive of bronchial asthma with partial irreversibility of airway obstruction. | What is the cause for poor disease control? | {
"A": "Airway epithelial shedding",
"B": "Airway inflammation",
"C": "Airway remodeling",
"D": "Airway hyperresponsiveness"
} | C. Airway remodeling |
516a5a60-a9d3-42de-ac17-3ff8aaaeb2a4 | A 17-year-old boy comes to the physician because of edema of both legs as well as pen-
orbital edema There is no history of diarrhea and no urinary symptoms suggestive of
infection. He had a throat infection 3 weeks ago. His blood pressure is 110/70 mmHg. He
undergoes a kidney biopsy and light microscopy is normal. The patient is treated and makes
a full recovery.
Which of the following is the most likely diagnosis? | Accelerated hypertension | ANCA associated vasculitis | Minimal change glomerulonephnitis | Post-streptococcal glomerulonephritis | 2c
| multi | null | Pathology | null | 106 | {
"Correct Answer": "Minimal change glomerulonephnitis",
"Correct Option": "C",
"Options": {
"A": "Accelerated hypertension",
"B": "ANCA associated vasculitis",
"C": "Minimal change glomerulonephnitis",
"D": "Post-streptococcal glomerulonephritis"
},
"Question": "A 17-year-old boy comes to the physician because of edema of both legs as well as pen- \norbital edema There is no history of diarrhea and no urinary symptoms suggestive of \ninfection. He had a throat infection 3 weeks ago. His blood pressure is 110/70 mmHg. He \nundergoes a kidney biopsy and light microscopy is normal. The patient is treated and makes \na full recovery. \n\nWhich of the following is the most likely diagnosis?"
} | A 17-year-old boy comes to the physician because of edema of both legs as well as pen-
orbital edema There is no history of diarrhea and no urinary symptoms suggestive of
infection. He had a throat infection 3 weeks ago. His blood pressure is 110/70 mmHg. He
undergoes a kidney biopsy and light microscopy is normal. The patient is treated and makes
a full recovery. | Which of the following is the most likely diagnosis? | {
"A": "Accelerated hypertension",
"B": "ANCA associated vasculitis",
"C": "Minimal change glomerulonephnitis",
"D": "Post-streptococcal glomerulonephritis"
} | C. Minimal change glomerulonephnitis |
5068a197-b4c1-4cba-a858-c9aa143fec02 | It is 1:00 A.M. and a hard-working second-year medical student is intent on finishing her pathology reading assignment. Soon she begins to note that her concentration is fading because 7 hours have passed since she had dinner, and she is feeling famished. Having studied the chapter on ischemic heart disease, she decides to be prudent and forgoes her favorite chocolate cookies, and instead devours two apples, gulping them down with a glass of low-fat milk. Of the following substances, which one was most likely to have increased rapidly when she became hungry and decreased promptly after she finished her healthy snack? | a-MSH | Corticotropin-releasing factor (CRF) | Ghrelin | Leptin | 2c
| single | Appetite and satiety are controlled by a complex system of short-acting and long-acting signals. The levels of ghrelin produced in the stomach increase rapidly before every meal and decrease promptly after the stomach is filled. Leptin released from adipocytes exerts long-term control by activating catabolic circuits and by inhibiting anabolic circuits. a-MSH is an intermediate in leptin signaling. TRH and CRF are among the efferent mediators of leptin signaling, and they increase energy consumption. | Pathology | Environment & Nutritional Pathology | 127 | {
"Correct Answer": "Ghrelin",
"Correct Option": "C",
"Options": {
"A": "a-MSH",
"B": "Corticotropin-releasing factor (CRF)",
"C": "Ghrelin",
"D": "Leptin"
},
"Question": "It is 1:00 A.M. and a hard-working second-year medical student is intent on finishing her pathology reading assignment. Soon she begins to note that her concentration is fading because 7 hours have passed since she had dinner, and she is feeling famished. Having studied the chapter on ischemic heart disease, she decides to be prudent and forgoes her favorite chocolate cookies, and instead devours two apples, gulping them down with a glass of low-fat milk. Of the following substances, which one was most likely to have increased rapidly when she became hungry and decreased promptly after she finished her healthy snack?"
} | It is 1:00 A.M. and a hard-working second-year medical student is intent on finishing her pathology reading assignment. Soon she begins to note that her concentration is fading because 7 hours have passed since she had dinner, and she is feeling famished. Having studied the chapter on ischemic heart disease, she decides to be prudent and forgoes her favorite chocolate cookies, and instead devours two apples, gulping them down with a glass of low-fat milk. | Of the following substances, which one was most likely to have increased rapidly when she became hungry and decreased promptly after she finished her healthy snack? | {
"A": "a-MSH",
"B": "Corticotropin-releasing factor (CRF)",
"C": "Ghrelin",
"D": "Leptin"
} | C. Ghrelin |
472992b7-29a4-416d-9b2e-db28327eec38 | 2 casesCase 1: HIGH BP, tachycardia, tremors, auditory and visual hallucinations, hepatomegaly, disoriented to time, place, person.Case 2: Yawning, diarrhea, diaphoresis, mydriasis, high fever 104degF, rhinorrhea, piloerection.The above symptoms are seen in the withdrawal of which of the following substances?A. AlcoholB. CannabisC. CocaineD. HeroinE. AmphetamineF. MDMAG. KetamineH. LSD | A, F & C | G, H & B | H, G & D | E, G & H | 3d
| multi | Ans. D. E, G & HWithdrawal symptoms of Ketamine:Hallucination (both auditory & visual) - Most common.Emergence delirium (Psychomimetic emergenceCharacteristic during awakening from anesthesia.More likely if anticholinergic premedication is used.Reduced by benzodiazepine.Withdrawal symptoms of Amphetamine:Fatigue and increased need for sleepIncreased appetiteBodily movements and twitchesSlowed reaction and movementAches and painsIrritability and/or agitationDreams that are often vivid and sometimes unpleasantDepressionWithdrawal symptoms of LSD:Long-lasting psychosis such as that seen in schizophrenia, depression or other severe mental health disorders. LSD withdrawal may induce paranoia that needs to be medically treated. Withdrawal of alcohol,cocaine,cannabis and heroin result in strong cravings for the substance along with other symptoms and it is not seen in above cases.Withdrawal symptoms of MDMA is more psychological than physical | Psychiatry | null | 120 | {
"Correct Answer": "E, G & H",
"Correct Option": "D",
"Options": {
"A": "A, F & C",
"B": "G, H & B",
"C": "H, G & D",
"D": "E, G & H"
},
"Question": "2 casesCase 1: HIGH BP, tachycardia, tremors, auditory and visual hallucinations, hepatomegaly, disoriented to time, place, person.Case 2: Yawning, diarrhea, diaphoresis, mydriasis, high fever 104degF, rhinorrhea, piloerection.The above symptoms are seen in the withdrawal of which of the following substances?A. AlcoholB. CannabisC. CocaineD. HeroinE. AmphetamineF. MDMAG. KetamineH. LSD"
} | 2 casesCase 1: HIGH BP, tachycardia, tremors, auditory and visual hallucinations, hepatomegaly, disoriented to time, place, person.Case 2: Yawning, diarrhea, diaphoresis, mydriasis, high fever 104degF, rhinorrhea, piloerection.The above symptoms are seen in the withdrawal of which of the following substances?A. AlcoholB. CannabisC. CocaineD. HeroinE. AmphetamineF. MDMAG. KetamineH. | LSD | {
"A": "A, F & C",
"B": "G, H & B",
"C": "H, G & D",
"D": "E, G & H"
} | D. E, G & H |
e9e699fe-5c3e-4633-b2f7-73f753b3b3ab | A 6-year-old girl presents with a 2-week history of a skin rash over her buttocks and legs and joint pain. The parents report seeing blood in the urine. Physical examination reveals palpable purpuric skin lesions and markedly swollen knees. The results of laboratory studies reveal abnormally high erythrocyte sedimentation rate (30 mm/h), BUN of 25 mg/dL, and serum creatinine of 3 mg/dL. Urinalysis demonstrates RBCs and RBC casts. The stool guaiac test is positive. Biopsy of lesional skin reveals deposits of IgA in the walls of small blood vessels. Which of the following is the most likely diagnosis? | Henoch-Schonlein purpura | Hypersensitivity vasculitis | Kawasaki disease | Polyarteritis nodosa | 0a
| multi | Henoch-Schonlein purpura is the most common type of childhood vasculitis and is caused by vascular localization of immune complexes, containing predominantly IgA. Purpuric skin lesions and glomerulonephritis in a child suggest the diagnosis of Henoch-Schonlein purpura. The other choices do not include deposits of IgA in the blood vessels.Diagnosis: Henoch-Schonlein purpura | Pathology | Blood Vessels | 145 | {
"Correct Answer": "Henoch-Schonlein purpura",
"Correct Option": "A",
"Options": {
"A": "Henoch-Schonlein purpura",
"B": "Hypersensitivity vasculitis",
"C": "Kawasaki disease",
"D": "Polyarteritis nodosa"
},
"Question": "A 6-year-old girl presents with a 2-week history of a skin rash over her buttocks and legs and joint pain. The parents report seeing blood in the urine. Physical examination reveals palpable purpuric skin lesions and markedly swollen knees. The results of laboratory studies reveal abnormally high erythrocyte sedimentation rate (30 mm/h), BUN of 25 mg/dL, and serum creatinine of 3 mg/dL. Urinalysis demonstrates RBCs and RBC casts. The stool guaiac test is positive. Biopsy of lesional skin reveals deposits of IgA in the walls of small blood vessels. Which of the following is the most likely diagnosis?"
} | A 6-year-old girl presents with a 2-week history of a skin rash over her buttocks and legs and joint pain. The parents report seeing blood in the urine. Physical examination reveals palpable purpuric skin lesions and markedly swollen knees. The results of laboratory studies reveal abnormally high erythrocyte sedimentation rate (30 mm/h), BUN of 25 mg/dL, and serum creatinine of 3 mg/dL. Urinalysis demonstrates RBCs and RBC casts. The stool guaiac test is positive. Biopsy of lesional skin reveals deposits of IgA in the walls of small blood vessels. | Which of the following is the most likely diagnosis? | {
"A": "Henoch-Schonlein purpura",
"B": "Hypersensitivity vasculitis",
"C": "Kawasaki disease",
"D": "Polyarteritis nodosa"
} | A. Henoch-Schonlein purpura |
03a31075-3d28-48f5-877a-bc6a7af1b7ec | A 38 years old female patient presented with gradually worsening unsteady gait as well as numbness and tingling in hands and feet. At the time of admission neurological examination revealed slight weakness of distal muscles, bilaterally absent ankle jerk reflexes, bilaterally extensor plantar reflexes, and loss of position and vibration senses in all extremities. Brain MRI was unremarkable. T2 weighted MRI of the cervical spinal cord showed high signal lesions in the posterior columns extending to the upper thoracic spinal cord . This finding is caused due to deficiency of? | Vitamin B-1 | Vitamin B-12 | Vitamin C | Vitamin A | 1b
| multi | Above findings are suggestive of sub-acute degeneration of spinal cord. It is most commonly caused due to vitamin B-12 deficiency. Dorsal column of spinal cord is affected more frequently which result in paresthesias, diminished proprioception and vibration sensation, motor weakness, clonus or hyperreflexia, areflexia, autonomic dysfunction, gait disturbance, intellectual or behavioral impairment, and impaired visual acuity. MR findings include T2 hyperintensity involving the dorsal column of spinal cord and give rise to 'inveed V sign'. | Radiology | Neuroradiology | 118 | {
"Correct Answer": "Vitamin B-12",
"Correct Option": "B",
"Options": {
"A": "Vitamin B-1",
"B": "Vitamin B-12",
"C": "Vitamin C",
"D": "Vitamin A"
},
"Question": "A 38 years old female patient presented with gradually worsening unsteady gait as well as numbness and tingling in hands and feet. At the time of admission neurological examination revealed slight weakness of distal muscles, bilaterally absent ankle jerk reflexes, bilaterally extensor plantar reflexes, and loss of position and vibration senses in all extremities. Brain MRI was unremarkable. T2 weighted MRI of the cervical spinal cord showed high signal lesions in the posterior columns extending to the upper thoracic spinal cord . This finding is caused due to deficiency of?"
} | A 38 years old female patient presented with gradually worsening unsteady gait as well as numbness and tingling in hands and feet. At the time of admission neurological examination revealed slight weakness of distal muscles, bilaterally absent ankle jerk reflexes, bilaterally extensor plantar reflexes, and loss of position and vibration senses in all extremities. Brain MRI was unremarkable. T2 weighted MRI of the cervical spinal cord showed high signal lesions in the posterior columns extending to the upper thoracic spinal cord . | This finding is caused due to deficiency of? | {
"A": "Vitamin B-1",
"B": "Vitamin B-12",
"C": "Vitamin C",
"D": "Vitamin A"
} | B. Vitamin B-12 |
2ba88cf8-abcb-4f67-841d-ff0f57f4b591 | A 2-month-old infant is brought to the clinic because of poor feeding, sweating, and difficulty breathing. The parents state that she was doing very well, and has actually been a "very easy going baby", until about a week ago. They assumed that she was developing a "cold", but it has not passed, and the symptoms have been worsening. Cardiac examination reveals a loud, harsh systolic murmur with a thrill that is heard best at the left sternal border. The most likely underlying abnormality is | aoic stenosis | atrial septal defect | ventricular septal defect | patent ductus aeriosis | 2c
| multi | This patient most likely has a ventricular septal defect, which is the one of the most common acyanotic congenital cardiac anomalies. It is usually due to an opening in the membranous pa of the ventricular septum, and typically leads to symptoms a few weeks after bih, when the pulmonary vascular resistance decreases, and the left-to-right blood shunting increases. The signs and symptoms vary with the size of the defect, and include respiratory distress, failure to thrive, poor feeding, sweating, and a systolic murmur. An echocardiogram confirms the diagnosis. Some small defects close spontaneously, while larger defects may require surgery. Complications include pulmonary vascular obstruction, congestive hea failure, and endocarditis. Critical aoic stenosis (choice A), is more common in boys and is associated with congestive hea failure, and a low-pitched systolic ejection murmur that can be best heard at the second right intercostal space. This murmur is different than the murmur in this case. An atrial septal defect (choice B), is a common acyanotic, left-to-right shunting cardiac anomaly. Infants with this disorder are typically asymptomatic, and it is therefore, diagnosed during a routine examination. There is a systolic ejection murmur that is heard best at the left mid to upper sternal border. There is a wide, fixed split in the second hea sound. Complications include arrhythmias, pulmonary hypeension, and hea failure. The clinical history and findings in this case are inconsistent with this diagnosis. Patent ductus aeriosis (choice D) is usually asymptomatic if it is small. However, a wide pulse pressure, a continuous machinery murmur, apical heave, and a thrill may be present. The patent ductus allows blood to flow from the aoa directly to the pulmonary aery through the ductus aeriosis, (that should normally close by itself immediately after bih). It is typically acyanotic. Indomethacin or surgery is usually indicated to close the ductus. | Surgery | null | 106 | {
"Correct Answer": "ventricular septal defect",
"Correct Option": "C",
"Options": {
"A": "aoic stenosis",
"B": "atrial septal defect",
"C": "ventricular septal defect",
"D": "patent ductus aeriosis"
},
"Question": "A 2-month-old infant is brought to the clinic because of poor feeding, sweating, and difficulty breathing. The parents state that she was doing very well, and has actually been a \"very easy going baby\", until about a week ago. They assumed that she was developing a \"cold\", but it has not passed, and the symptoms have been worsening. Cardiac examination reveals a loud, harsh systolic murmur with a thrill that is heard best at the left sternal border. The most likely underlying abnormality is"
} | A 2-month-old infant is brought to the clinic because of poor feeding, sweating, and difficulty breathing. The parents state that she was doing very well, and has actually been a "very easy going baby", until about a week ago. They assumed that she was developing a "cold", but it has not passed, and the symptoms have been worsening. Cardiac examination reveals a loud, harsh systolic murmur with a thrill that is heard best at the left sternal border. | The most likely underlying abnormality is | {
"A": "aoic stenosis",
"B": "atrial septal defect",
"C": "ventricular septal defect",
"D": "patent ductus aeriosis"
} | C. ventricular septal defect |
3cbe2be8-0744-4ca7-89ce-9cbd5b697f2a | A 36-year-old G1P0 at 35 weeks gestations presents with several days H/O generalised malaise, anorexia, nausea emesis and abd. discomfort. She has loss of apetite and loss of several pounds wt in 1 week. Fetal movements are good. There is no headache, visual changes, no vaginal bleeding, no regular uterine contractions or rupture of membranes. She is on prenatal vitamins. No other medical problem. On exaeration she is mild jaundiced and little confused. Her temp is 100 degree F, PR- 70, BP- 100/62, no significant edema, appears dehydrated. FHR is 160 and is nonreactive but with good variability. Her WBC- 25000, Hct- 42.0, platelets- 51000, SGOT/SGPT-287/ 350, GLUCOSE-43, Creatinine- 2.0, fibrinogen-135, PT/PTT- 16/50, S. Ammonia level- 90 micromol/L. Urine is 3+ Proteins with large amount of ketones.What is the the recommened treatment for this patient | Immediate delivery | Cholecystectomy | Intravenous diphenhydramine | MgSO4 therapy | 0a
| single | A 35-year-old pregnant patient having: | Gynaecology & Obstetrics | null | 287 | {
"Correct Answer": "Immediate delivery",
"Correct Option": "A",
"Options": {
"A": "Immediate delivery",
"B": "Cholecystectomy",
"C": "Intravenous diphenhydramine",
"D": "MgSO4 therapy"
},
"Question": "A 36-year-old G1P0 at 35 weeks gestations presents with several days H/O generalised malaise, anorexia, nausea emesis and abd. discomfort. She has loss of apetite and loss of several pounds wt in 1 week. Fetal movements are good. There is no headache, visual changes, no vaginal bleeding, no regular uterine contractions or rupture of membranes. She is on prenatal vitamins. No other medical problem. On exaeration she is mild jaundiced and little confused. Her temp is 100 degree F, PR- 70, BP- 100/62, no significant edema, appears dehydrated. FHR is 160 and is nonreactive but with good variability. Her WBC- 25000, Hct- 42.0, platelets- 51000, SGOT/SGPT-287/ 350, GLUCOSE-43, Creatinine- 2.0, fibrinogen-135, PT/PTT- 16/50, S. Ammonia level- 90 micromol/L. Urine is 3+ Proteins with large amount of ketones.What is the the recommened treatment for this patient"
} | A 36-year-old G1P0 at 35 weeks gestations presents with several days H/O generalised malaise, anorexia, nausea emesis and abd. discomfort. She has loss of apetite and loss of several pounds wt in 1 week. Fetal movements are good. There is no headache, visual changes, no vaginal bleeding, no regular uterine contractions or rupture of membranes. She is on prenatal vitamins. No other medical problem. On exaeration she is mild jaundiced and little confused. Her temp is 100 degree F, PR- 70, BP- 100/62, no significant edema, appears dehydrated. FHR is 160 and is nonreactive but with good variability. Her WBC- 25000, Hct- 42.0, platelets- 51000, SGOT/SGPT-287/ 350, GLUCOSE-43, Creatinine- 2.0, fibrinogen-135, PT/PTT- 16/50, S. Ammonia level- 90 micromol/L. | Urine is 3+ Proteins with large amount of ketones.What is the the recommened treatment for this patient | {
"A": "Immediate delivery",
"B": "Cholecystectomy",
"C": "Intravenous diphenhydramine",
"D": "MgSO4 therapy"
} | A. Immediate delivery |
e47a009c-7cfd-4d42-9c8c-4f70072340f5 | 36 year old Seema Rani gives a history of corrosive poisoning 3 months back. She has been suffering from severe dysphagia since then and it is more for solids than liquids. Endoscopic evaluation revealed a complex stricture involving the mid esophagus. Endoscopist tried dilatation of the stricture and post dilatation patient was complaining of severe chest pain and swelling of the neck. Resident doctor examined her and found surgical emphysema of the neck. She was kept nil per mouth and chest X-ray was taken. What would be the expected findings in that X-ray? | Left sided pleural effusion and Pneumomediastinum | Right sided pleural effusion with pneumomediastinum | Bilateral pleural effusion with left sided pneumothorax | Collapse of right lung and pericardial effusion | 0a
| single | Iatrogenic perforation is the leading cause of esophageal perforations. Boerhaave's syndrome or spontaneous perforation of esophagus is induced by straining and vomiting. Any patient who presents with pain or fever following forceful vomiting, esophageal instrumentation, or chest trauma should be aggressively evaluated, with the aim of ruling out perforation of the esophagus. X-Ray findings are: Pneumomediastinum, subcutaneous emphysema, mediastinal widening, or a mediastinal air-fluid level. Pneumothorax may be present in up to 77% and 70% of the time it is on the left, 20% on the right and 10% bilaterally. Hydropneumothorax on the left is seen in patients with distal third esophageal perforations. | Medicine | null | 126 | {
"Correct Answer": "Left sided pleural effusion and Pneumomediastinum",
"Correct Option": "A",
"Options": {
"A": "Left sided pleural effusion and Pneumomediastinum",
"B": "Right sided pleural effusion with pneumomediastinum",
"C": "Bilateral pleural effusion with left sided pneumothorax",
"D": "Collapse of right lung and pericardial effusion"
},
"Question": "36 year old Seema Rani gives a history of corrosive poisoning 3 months back. She has been suffering from severe dysphagia since then and it is more for solids than liquids. Endoscopic evaluation revealed a complex stricture involving the mid esophagus. Endoscopist tried dilatation of the stricture and post dilatation patient was complaining of severe chest pain and swelling of the neck. Resident doctor examined her and found surgical emphysema of the neck. She was kept nil per mouth and chest X-ray was taken. What would be the expected findings in that X-ray?"
} | 36 year old Seema Rani gives a history of corrosive poisoning 3 months back. She has been suffering from severe dysphagia since then and it is more for solids than liquids. Endoscopic evaluation revealed a complex stricture involving the mid esophagus. Endoscopist tried dilatation of the stricture and post dilatation patient was complaining of severe chest pain and swelling of the neck. Resident doctor examined her and found surgical emphysema of the neck. She was kept nil per mouth and chest X-ray was taken. | What would be the expected findings in that X-ray? | {
"A": "Left sided pleural effusion and Pneumomediastinum",
"B": "Right sided pleural effusion with pneumomediastinum",
"C": "Bilateral pleural effusion with left sided pneumothorax",
"D": "Collapse of right lung and pericardial effusion"
} | A. Left sided pleural effusion and Pneumomediastinum |
8379877d-c32a-4108-b46b-4285ec294496 | A 68-year-old man complains of several blisters arising over the back and trunk for the preceding 2 weeks. He takes no medications and has not noted systemic symptoms such as fever, sore throat, weight loss, or fatigue. The general physical examination is normal. The oral mucosa and the lips are normal. Several 2- to 3-cm bullae are present over the trunk and back. A few excoriations where the blisters have ruptured are present. The remainder of the skin is normal, without erythema or scale. What is the best diagnostic approach at this time? | Culture of vesicular fluid for herpes viruses | Trial of corticosteroids | Biopsy of the edge of a bulla with some surrounding intact skin | CT scan of the chest and abdomen looking for occult malignancy | 2c
| single | Blistering diseases are potentially serious conditions. Blisters that are smaller than 0.5 cm are termed vesicles; larger lesions are called bullae. The proper diagnosis and treatment of bullous disorders are paramount in order to prevent disability and even death from burn-like denudation of the skin and associated infection. Although many skin diseases such as allergic contact dermatitis, erythema multiforme, and bullous impetigo can cause blisters, this patient is more likely to have bullous pemphigoid or pemphigus. These are immunologically mediated disorders. Skin biopsy with immunofluorescence staining will reveal antibodies at the basal layer of the epidermis (bullous pemphigoid) or within the epidermis (pemphigus). Mucosal, especially oral, involvement is characteristic of pemphigus. Immunosuppressive agents including systemic corticosteroids are often necessary to treat these conditions. Antihistamines, sometimes helpful if itching is prominent, will not treat the underlying condition. It is no longer felt that bullous dermatoses are indicative of underlying malignancy, so a "shotgun" search for occult malignancy is not recommended. Dermatitis herpetiformis and porphyria cutanea tarda are other skin diseases that can be associated with blisters. | Medicine | Skin | 125 | {
"Correct Answer": "Biopsy of the edge of a bulla with some surrounding intact skin",
"Correct Option": "C",
"Options": {
"A": "Culture of vesicular fluid for herpes viruses",
"B": "Trial of corticosteroids",
"C": "Biopsy of the edge of a bulla with some surrounding intact skin",
"D": "CT scan of the chest and abdomen looking for occult malignancy"
},
"Question": "A 68-year-old man complains of several blisters arising over the back and trunk for the preceding 2 weeks. He takes no medications and has not noted systemic symptoms such as fever, sore throat, weight loss, or fatigue. The general physical examination is normal. The oral mucosa and the lips are normal. Several 2- to 3-cm bullae are present over the trunk and back. A few excoriations where the blisters have ruptured are present. The remainder of the skin is normal, without erythema or scale. What is the best diagnostic approach at this time?"
} | A 68-year-old man complains of several blisters arising over the back and trunk for the preceding 2 weeks. He takes no medications and has not noted systemic symptoms such as fever, sore throat, weight loss, or fatigue. The general physical examination is normal. The oral mucosa and the lips are normal. Several 2- to 3-cm bullae are present over the trunk and back. A few excoriations where the blisters have ruptured are present. The remainder of the skin is normal, without erythema or scale. | What is the best diagnostic approach at this time? | {
"A": "Culture of vesicular fluid for herpes viruses",
"B": "Trial of corticosteroids",
"C": "Biopsy of the edge of a bulla with some surrounding intact skin",
"D": "CT scan of the chest and abdomen looking for occult malignancy"
} | C. Biopsy of the edge of a bulla with some surrounding intact skin |
efd050d5-d475-4c0c-afbc-4053000e3387 | A 30-year-old woman is having symptoms of muscle weakness and fatigue. On examination, her blood pressure is 120/80 mm Hg, pulse 80/min, JVP 4 cm, heart sounds normal, and lungs clear. Her serum potassium level is 2.5 mEq/L, and bicarbonate 30 mEq/L. The urine potassium is 10 mEq/L.For the above patient with hypokalemia, select the most likely diagnosis. | lower gastrointestinal (GI) losses | prior use of diuretics | RTA | current use of diuretics | 1b
| multi | In patients who have prior diuretic use, resulting in hypokalemia at the time of evaluation, the bicarbonate tends to be elevated and the urine potassium low (< 25 mmol/F). | Medicine | Oncology | 104 | {
"Correct Answer": "prior use of diuretics",
"Correct Option": "B",
"Options": {
"A": "lower gastrointestinal (GI) losses",
"B": "prior use of diuretics",
"C": "RTA",
"D": "current use of diuretics"
},
"Question": "A 30-year-old woman is having symptoms of muscle weakness and fatigue. On examination, her blood pressure is 120/80 mm Hg, pulse 80/min, JVP 4 cm, heart sounds normal, and lungs clear. Her serum potassium level is 2.5 mEq/L, and bicarbonate 30 mEq/L. The urine potassium is 10 mEq/L.For the above patient with hypokalemia, select the most likely diagnosis."
} | A 30-year-old woman is having symptoms of muscle weakness and fatigue. On examination, her blood pressure is 120/80 mm Hg, pulse 80/min, JVP 4 cm, heart sounds normal, and lungs clear. Her serum potassium level is 2.5 mEq/L, and bicarbonate 30 mEq/L. | The urine potassium is 10 mEq/L.For the above patient with hypokalemia, select the most likely diagnosis. | {
"A": "lower gastrointestinal (GI) losses",
"B": "prior use of diuretics",
"C": "RTA",
"D": "current use of diuretics"
} | B. prior use of diuretics |
7d734a76-d905-448c-88a8-9322bb7a0f9f | A nine month old boy of Sindhi parents presented to you with complaints of pregressive lethargy, irritability & pallor since 6 months of age. Examination revealed severe pallor. Investigation showed Hb–3.8 mg%; MCV–58 fl; MCH–19.4 pg/ cell.hood film shows osmotic fragility is normal (target cells normoblasts). X-ray skull shows expansion of erythroid marrow. Which of the following is the most likely diagnosis – | Iron deficiency anemia | Acute lymphoblastic anemia | Hemoglobin D disease | Hereditary spherocytosis | 1b
| multi | null | Pediatrics | null | 107 | {
"Correct Answer": "Acute lymphoblastic anemia",
"Correct Option": "B",
"Options": {
"A": "Iron deficiency anemia",
"B": "Acute lymphoblastic anemia",
"C": "Hemoglobin D disease",
"D": "Hereditary spherocytosis"
},
"Question": "A nine month old boy of Sindhi parents presented to you with complaints of pregressive lethargy, irritability & pallor since 6 months of age. Examination revealed severe pallor. Investigation showed Hb–3.8 mg%; MCV–58 fl; MCH–19.4 pg/ cell.hood film shows osmotic fragility is normal (target cells normoblasts). X-ray skull shows expansion of erythroid marrow. Which of the following is the most likely diagnosis –"
} | A nine month old boy of Sindhi parents presented to you with complaints of pregressive lethargy, irritability & pallor since 6 months of age. Examination revealed severe pallor. Investigation showed Hb–3.8 mg%; MCV–58 fl; MCH–19.4 pg/ cell.hood film shows osmotic fragility is normal (target cells normoblasts). X-ray skull shows expansion of erythroid marrow. | Which of the following is the most likely diagnosis – | {
"A": "Iron deficiency anemia",
"B": "Acute lymphoblastic anemia",
"C": "Hemoglobin D disease",
"D": "Hereditary spherocytosis"
} | B. Acute lymphoblastic anemia |
05e5fdad-3641-4d25-935e-5485a93da268 | A 29-year-old, previously healthy man has had an enlarging nodular area on his arm for the past 8 months. On physical examination, there is an ulcerated, reddish violet, 3x7 cm lesion on his right forearm and nontender right axillary and left inguinal lymphadenopathy. A chest radiograph shows a 4-cm nodular left pleural mass. An abdominal CT scan shows a 5-cm right retroperitoneal mass. Biopsy of an inguinal node is performed, and microscopic examination shows large cells, some of which contain horseshoe-shaped nuclei and voluminous cytoplasm. The tumor cells cluster around venules and infiltrate sinuses. The patient goes into remission after chemotherapy. Which of the following markers is most likely to be positive in the tumor cells? | ALK protein | CD10 antigen | c-KIT proto-oncogene | IL-2 receptor | 0a
| single | This patient has a form of T-cell neoplasm known as anaplastic large-cell lymphoma, which most often appears in children and young adults. It is often extranodal and has a characteristic gene rearrangement on chromosome 2p23 that results in production of anaplastic lymphoma kinase (ALK) with tyrosine kinase activity. CD10 is a B-cell marker. The T-cell proliferations involving skin, known as mycosis fungoides/ Sezary syndrome, are CD4+. The c-KIT proto-oncogene has been associated with some NK cell lymphomas. The IL-2 receptor is associated with lymphohistiocytosis with macrophage activation. The p24 antigen is part of HIV, which is most often associated with B-cell neoplasms. | Pathology | Blood | 176 | {
"Correct Answer": "ALK protein",
"Correct Option": "A",
"Options": {
"A": "ALK protein",
"B": "CD10 antigen",
"C": "c-KIT proto-oncogene",
"D": "IL-2 receptor"
},
"Question": "A 29-year-old, previously healthy man has had an enlarging nodular area on his arm for the past 8 months. On physical examination, there is an ulcerated, reddish violet, 3x7 cm lesion on his right forearm and nontender right axillary and left inguinal lymphadenopathy. A chest radiograph shows a 4-cm nodular left pleural mass. An abdominal CT scan shows a 5-cm right retroperitoneal mass. Biopsy of an inguinal node is performed, and microscopic examination shows large cells, some of which contain horseshoe-shaped nuclei and voluminous cytoplasm. The tumor cells cluster around venules and infiltrate sinuses. The patient goes into remission after chemotherapy. Which of the following markers is most likely to be positive in the tumor cells?"
} | A 29-year-old, previously healthy man has had an enlarging nodular area on his arm for the past 8 months. On physical examination, there is an ulcerated, reddish violet, 3x7 cm lesion on his right forearm and nontender right axillary and left inguinal lymphadenopathy. A chest radiograph shows a 4-cm nodular left pleural mass. An abdominal CT scan shows a 5-cm right retroperitoneal mass. Biopsy of an inguinal node is performed, and microscopic examination shows large cells, some of which contain horseshoe-shaped nuclei and voluminous cytoplasm. The tumor cells cluster around venules and infiltrate sinuses. The patient goes into remission after chemotherapy. | Which of the following markers is most likely to be positive in the tumor cells? | {
"A": "ALK protein",
"B": "CD10 antigen",
"C": "c-KIT proto-oncogene",
"D": "IL-2 receptor"
} | A. ALK protein |
784fe668-0fb5-40cf-93ad-e5407b34b01c | A 55-year-old male presented to emergency with complains of upper GI bleed. The doctor on duty stabilized the patient. He underwent upper GI endoscopy, that was found to be normal. An extra-luminal mass found on CECT abdomen. CECT is given below, Then CT guided biopsy was taken for histopathological examination revealed the diagnosis as follows. Studies revealed DOG-1 marker positivity and SDH-1 gene mutation. What of the following drugs can be given in the above condition: - | Imatinib | Sorafenib | Bevacizumab | None | 3d
| multi | This is a case of GIST with SDH-1 mutation mean it is resistant to tyrosine kinase inhibitors. The image spindle shaped neoplastic cells - suggestive of GIST. Upper GI bleeding is the most common clinical manifestation of GISTs, manifesting as hematemesis or melena. Bleeding occurs because of pressure necrosis and ulceration of the overlying mucosa with resultant hemorrhage from disrupted vessels. Most common site of GIST is stomach. Upper GI endoscopy is usually normal because of extraluminal mass so usually detected on CT scan. CECT Is IOC for GIST. BUT for recurrent GIST IOC Is PET Scan. Most specific marker is DOG-1 > CD117. Imatinib shows the highest activity in GISTs that contain the mutation in exon 11 of KIT. Most GISTs with PDGFRA gene mutations respond to imatinib. GISTs with mutations in the succinate dehydrogenase (SDH) gene that result in deficiency of SDH are also generally resistant to TKI therapy. Surgical resection is the mainstay of treatment for localized tumors in these patients | Unknown | Integrated QBank | 106 | {
"Correct Answer": "None",
"Correct Option": "D",
"Options": {
"A": "Imatinib",
"B": "Sorafenib",
"C": "Bevacizumab",
"D": "None"
},
"Question": "A 55-year-old male presented to emergency with complains of upper GI bleed. The doctor on duty stabilized the patient. He underwent upper GI endoscopy, that was found to be normal. An extra-luminal mass found on CECT abdomen. CECT is given below, Then CT guided biopsy was taken for histopathological examination revealed the diagnosis as follows. Studies revealed DOG-1 marker positivity and SDH-1 gene mutation. What of the following drugs can be given in the above condition: -"
} | A 55-year-old male presented to emergency with complains of upper GI bleed. The doctor on duty stabilized the patient. He underwent upper GI endoscopy, that was found to be normal. An extra-luminal mass found on CECT abdomen. CECT is given below, Then CT guided biopsy was taken for histopathological examination revealed the diagnosis as follows. Studies revealed DOG-1 marker positivity and SDH-1 gene mutation. | What of the following drugs can be given in the above condition: - | {
"A": "Imatinib",
"B": "Sorafenib",
"C": "Bevacizumab",
"D": "None"
} | D. None |
1ff50abc-f7d6-42c2-b7b2-85f7c3324470 | Which set of aerial blood values describes a patient with paially compensated respiratory alkalosis after 1 month on a mechanical ventilator? pH ,HCO3- (mEq/L), Pco2 (mm Hg) (A) 7.65, 48, 45 (B) 7.50, 15, 20 (C) 7.40, 24, 40 (D) 7.32, 30, 60 (E) 7.31, 16, 33 | A | B | C | D | 1b
| multi | The blood values in respiratory alkalosis show decreased Pco2 (the cause) and decreased and by mass action. The is fuher decreased by renal compensation for chronic respiratory alkalosis (decreased HCO3- reabsorption). | Physiology | Excretory System (Kidney, Bladder) Acid-Base Balance | 126 | {
"Correct Answer": "B",
"Correct Option": "B",
"Options": {
"A": "A",
"B": "B",
"C": "C",
"D": "D"
},
"Question": "Which set of aerial blood values describes a patient with paially compensated respiratory alkalosis after 1 month on a mechanical ventilator? pH ,HCO3- (mEq/L), Pco2 (mm Hg) (A) 7.65, 48, 45 (B) 7.50, 15, 20 (C) 7.40, 24, 40 (D) 7.32, 30, 60 (E) 7.31, 16, 33"
} | . | Which set of aerial blood values describes a patient with paially compensated respiratory alkalosis after 1 month on a mechanical ventilator? pH ,HCO3- (mEq/L), Pco2 (mm Hg) (A) 7.65, 48, 45 (B) 7.50, 15, 20 (C) 7.40, 24, 40 (D) 7.32, 30, 60 (E) 7.31, 16, 33 | {
"A": "A",
"B": "B",
"C": "C",
"D": "D"
} | B. B |
9c8a624e-168e-421b-9e86-36ac90ecef15 | A patient presents with abdominal pain, anorexia, fever, night sweats, malaise, cough and weight loss along with this he complains of pain in the right upper abdomen and right shoulder tip, hiccups and a non-productive cough, past history of bloody diarrhea is present. On physical examination there upper abdominal rigidity, tender hepatomegaly, tender and bulging intercostal spaces are seen. CT of the patient is given, based on the CT what is most likely diagnosis? | Hydatid cyst | Amoebic liver abscess | Liver cyst | Hepatocellular carcinoma | 1b
| single | Ans. (b) Amoebic liver abscess.Diagnostic pointers for infection with Entamoeba histolytica* Bloody mucoid diarrhea in a patient from an endemic area or following a recent visit to such a country* Upper abdominal pain, fever, cough, malaise* In chronic cases, a mass in the right iliac fossa = ameboma* Sigmoidoscopy shows typical ulcers - biopsy and scraping may be diagnostic* Serological tests are highly sensitive and specific outside endemic areas* Ultrasound and CT scans are the imaging methods of choiceImage source- style="font-family: Times New Roman, Times, serif"> | Surgery | Hepatic Tumors, Cysts, and Abscesses | 103 | {
"Correct Answer": "Amoebic liver abscess",
"Correct Option": "B",
"Options": {
"A": "Hydatid cyst",
"B": "Amoebic liver abscess",
"C": "Liver cyst",
"D": "Hepatocellular carcinoma"
},
"Question": "A patient presents with abdominal pain, anorexia, fever, night sweats, malaise, cough and weight loss along with this he complains of pain in the right upper abdomen and right shoulder tip, hiccups and a non-productive cough, past history of bloody diarrhea is present. On physical examination there upper abdominal rigidity, tender hepatomegaly, tender and bulging intercostal spaces are seen. CT of the patient is given, based on the CT what is most likely diagnosis?"
} | A patient presents with abdominal pain, anorexia, fever, night sweats, malaise, cough and weight loss along with this he complains of pain in the right upper abdomen and right shoulder tip, hiccups and a non-productive cough, past history of bloody diarrhea is present. On physical examination there upper abdominal rigidity, tender hepatomegaly, tender and bulging intercostal spaces are seen. | CT of the patient is given, based on the CT what is most likely diagnosis? | {
"A": "Hydatid cyst",
"B": "Amoebic liver abscess",
"C": "Liver cyst",
"D": "Hepatocellular carcinoma"
} | B. Amoebic liver abscess |
47855215-8b94-4b95-8a67-946d743de322 | A 23-year-old male Subhas Raj presents to the medicine OPD with complaint of hematuria. There is no burning sensation during urination. He also has no history suggestive of respiratory tract infection. He gives a history of two of his relatives suffering from ‘some blood disease’. His coagulation studies are within normal limits. The hemoglobin electrophoresis shows the following: Hb A 60% and Hb S 40%. Which of the following is most likely true about this patient? | Irreversible sickle cells are present on the peripheral smear. | Reticulocyte count is elevated | He is protected from Plasmodium falciparum. | MCHC is decreased | 2c
| multi | Patients who are heterozygous for the sickle cell trait (Hb AS) have hemoglobin composed of 35 to 40% hemoglobin S (HbS); they are generally protected from sickle cell crisis, aplastic crisis and sequestration crisis by the presence of > 50% normal hemoglobin (H A).
Amount of HbS Q is the most important factor affecting sickling of the RBCs
The alteration of the hemoglobin (from HbA to HbS) reduces its solubility.
Patients with sickle cell trait are usually asymptomatic, although they may develop hematuria and a limited ability to concentrate urine. A high incidence of UTI and splenic infarction at high altitude may be seen. The heterozygotes enjoy relative protection from Plasmodium falciparum (malaria) because of increased sickling of parasitized sickle-cell trait red blood cells and accelerated removal of these cells by the splenic monocyte macrophage system.
(Choices A, B and D) Peripheral smears are usually normal in sickle cell trait patients; irreversibly sickled cells are not seen. Furthermore, red cell indices and red cell morphology are normal; the reticulate count is not elevated. However, the sickling test will be positive (RBCs will sickle when sodium metabisulfite is added). Increased MCHC, which represents intracellular dehydration, is seen only with homozygous SS (i.e. full-blown sickle cell anemia). | Pathology | null | 136 | {
"Correct Answer": "He is protected from Plasmodium falciparum.",
"Correct Option": "C",
"Options": {
"A": "Irreversible sickle cells are present on the peripheral smear.",
"B": "Reticulocyte count is elevated",
"C": "He is protected from Plasmodium falciparum.",
"D": "MCHC is decreased"
},
"Question": "A 23-year-old male Subhas Raj presents to the medicine OPD with complaint of hematuria. There is no burning sensation during urination. He also has no history suggestive of respiratory tract infection. He gives a history of two of his relatives suffering from ‘some blood disease’. His coagulation studies are within normal limits. The hemoglobin electrophoresis shows the following: Hb A 60% and Hb S 40%. Which of the following is most likely true about this patient?"
} | A 23-year-old male Subhas Raj presents to the medicine OPD with complaint of hematuria. There is no burning sensation during urination. He also has no history suggestive of respiratory tract infection. He gives a history of two of his relatives suffering from ‘some blood disease’. His coagulation studies are within normal limits. The hemoglobin electrophoresis shows the following: Hb A 60% and Hb S 40%. | Which of the following is most likely true about this patient? | {
"A": "Irreversible sickle cells are present on the peripheral smear.",
"B": "Reticulocyte count is elevated",
"C": "He is protected from Plasmodium falciparum.",
"D": "MCHC is decreased"
} | C. He is protected from Plasmodium falciparum. |
e04d360e-5d8c-4f8c-81cc-050d8fba9635 | In humans, two closely linked genetic loci, each made up of two alleles, compose the histocompatibility locus (HL-A). Paired first and second locus antigens are called haplotypes. The HL-A haplotypes (separated by a semicolon) of a child's parents are given below.Father 3, 25; 7, 12Mother 1, 3; 8, 9Assuming that no cross-over events have occurred, the child's histotype could be which of the following? | 1, 3; 7, 8 | 7, 12; 1, 3 | 3, 3; 7, 9 | 1, 25; 7, 12 | 1b
| multi | In the question presented, the haplotypes of the father are 3, 25 and 7, 12 and the haplotypes of the mother are 1,3 and 8,9. (A haplotype is composed of one allele-antigen-from the one gene of a pair and one allele from the other gene.) Each child of this couple would have inherited one haplotype from each parent. Thus, possible offspring haplotypes are (1) 3,25; 1,3; (2) 3,25; 8,9; (3) 7,12; 1,3; and (4) 7,12; 8,9. | Microbiology | Immunology | 113 | {
"Correct Answer": "7, 12; 1, 3",
"Correct Option": "B",
"Options": {
"A": "1, 3; 7, 8",
"B": "7, 12; 1, 3",
"C": "3, 3; 7, 9",
"D": "1, 25; 7, 12"
},
"Question": "In humans, two closely linked genetic loci, each made up of two alleles, compose the histocompatibility locus (HL-A). Paired first and second locus antigens are called haplotypes. The HL-A haplotypes (separated by a semicolon) of a child's parents are given below.Father 3, 25; 7, 12Mother 1, 3; 8, 9Assuming that no cross-over events have occurred, the child's histotype could be which of the following?"
} | In humans, two closely linked genetic loci, each made up of two alleles, compose the histocompatibility locus (HL-A). Paired first and second locus antigens are called haplotypes. | The HL-A haplotypes (separated by a semicolon) of a child's parents are given below.Father 3, 25; 7, 12Mother 1, 3; 8, 9Assuming that no cross-over events have occurred, the child's histotype could be which of the following? | {
"A": "1, 3; 7, 8",
"B": "7, 12; 1, 3",
"C": "3, 3; 7, 9",
"D": "1, 25; 7, 12"
} | B. 7, 12; 1, 3 |
6c5db316-8910-426c-a50b-232ffb8c47ad | A 13-year-old boy has a 3-day history of low-grade fever, symptoms of upper respiratory infection, and a sore throat. A few hours before his presentation to the emergency room, he has an abrupt onset of high fever, difficulty swallowing, and poor handling of his secretions. He indicates that he has a marked worsening in the severity of his sore throat. His pharynx has a fluctuant bulge in the posterior wall. A soft tissue radiograph of his neck is shown. Which of the following is the most appropriate initial therapy for this patient? | Narcotic analgesics | Trial of oral penicillin V | Surgical consultation for incision and drainage under general anesthesia | Rapid streptococcal screen | 2c
| multi | Suppurative infection of the chain of lymph nodes between the posterior pharyngeal wall and the prevertebral fascia leads to retropharyngeal abscesses. The most common causative organisms are S aureus, group A b-hemolytic streptococci, and oral anaerobes. Presenting signs and symptoms include a history of pharyngitis, abrupt onset of fever with severe sore throat, refusal of food, drooling, and muffled or noisy breathing. A bulge in the posterior pharyngeal wall is diagnostic, as are radiographs of the lateral neck that reveal the retropharyngeal mass (the radiograph in the question demonstrates thickening of the prevertebral space). Palpation (with adequate provision for emergency control of the airway in case of rupture) reveals a fluctuant mass. Treatment should include incision and drainage if fluctuance is present. The other answers listed would delay definitive treatment and/or might be life threatening. | Pediatrics | Respiratory System | 117 | {
"Correct Answer": "Surgical consultation for incision and drainage under general anesthesia",
"Correct Option": "C",
"Options": {
"A": "Narcotic analgesics",
"B": "Trial of oral penicillin V",
"C": "Surgical consultation for incision and drainage under general anesthesia",
"D": "Rapid streptococcal screen"
},
"Question": "A 13-year-old boy has a 3-day history of low-grade fever, symptoms of upper respiratory infection, and a sore throat. A few hours before his presentation to the emergency room, he has an abrupt onset of high fever, difficulty swallowing, and poor handling of his secretions. He indicates that he has a marked worsening in the severity of his sore throat. His pharynx has a fluctuant bulge in the posterior wall. A soft tissue radiograph of his neck is shown. Which of the following is the most appropriate initial therapy for this patient?"
} | A 13-year-old boy has a 3-day history of low-grade fever, symptoms of upper respiratory infection, and a sore throat. A few hours before his presentation to the emergency room, he has an abrupt onset of high fever, difficulty swallowing, and poor handling of his secretions. He indicates that he has a marked worsening in the severity of his sore throat. His pharynx has a fluctuant bulge in the posterior wall. A soft tissue radiograph of his neck is shown. | Which of the following is the most appropriate initial therapy for this patient? | {
"A": "Narcotic analgesics",
"B": "Trial of oral penicillin V",
"C": "Surgical consultation for incision and drainage under general anesthesia",
"D": "Rapid streptococcal screen"
} | C. Surgical consultation for incision and drainage under general anesthesia |
3e627b43-76a6-4dab-8374-7c48617c2255 | A four year old boy was admitted with a history of abdominal pain and fever for two months, maculopapular rash for ten days, and dry cough, dyspnea and wheezing for three days. On examination, liver and spleen were enlarged 4 cm and 3 cm respectively below the costal margins. His hemoglobin was 10.0 g/dl, platelet count 37 x 109/L and total leukocyte count 70 x 109/L, which included 80% eosinophils. Bone marrow examination revealed a cellular marrow comprising 45% blasts and 34% eosinophils and eosinophilic precursors. The blasts stained negative for myeloperoxidase and nonspecific esterase and were positive for CD19, CDIO, CD22 and CD20. Which one of the following statements in not true about this disease? | Eosinophils are not pa of the Neoplastic clone | t(5:14) rearrangement may be detected in blasts | Peripheral blood eosinophilia may normalize with chemotherapy | Inv (16) is often detected in the blasts and the eosinophils. | 3d
| multi | Answer is D (Inv (16) is often detected in the blasts and the eosinophils): This is a case of ALL with hypereosinophillic syndrome. Inv (16) is associated with AML and not ALL, and therefore represents the incorrect statement amongst the option Abstract Title: Granular acute lymphoblastic leukemia with hypereosinophilic syndrome. Journal Source: Ann Hematol. 2000 May;79(5):272-4. Authors: Jain P, Kumar R, Gujral S, Kumar A, Singh A, Jain Y, Dubey S, Anand M, Arya LS. A four-year-old boy presented with marked peripheral blood eosinophilia (absolute eosinophil count of 54 x 10(9)/1), features of hypereosinophilic syndrome, and acute lymphoblastic leukemia (ALL-L2), the latter characterized by the presence of granular blasts. Blasts were negative for myeloperoxidase, non-specific esterase, acid phosphatase, periodic-acid Schiff stain, and toluidine blue. They exhibited an early pre-B immunophenotype (TdT, CD19, CDIO, CD20 and CD22 positive) and stained negative for T (CD7, CD2, CD5 and CD3) and myeloid markers (MPO, CD33 and CD13). Chromosomal analysis revealed a normal karyotype. To the best of our knowledge, this case represents the first repo of the coexistence of granular ALL and hypereosinophilic syndrome. Why Hypereosinophillic Syndrome Option A Explanation Idiopathic hypereosinophillic syndrome is a rare condition characterized by extremely high levels of peripheral blood eosinophil counts. (80% of (70 x 109) Leucocytes were eosinophils in this patient) Clinical picture of dry cough, dyspnea, wheezing etc is fuher suggestive of HES. This is differentiated from eosinophillic leukaemia by the absence of eosinophilic blast cells. (Text from case repo: for option A) Explanations to options: Text from case repo 'In contrast to myeloproliftrative disorders where Eosinophils are pa of the Neoplastic clone, eosinophilia in patients with ALL is believed to be a reactive process.' - Case repo 'A normal karyotype has been observed in 45% of patients of ALL/Eo and t (5:14) rearrangement has been documented in same of them.' - Case repo `The child was treated with MCP-841 protocol of NC2 (prednisolone, L-asparginine, vincristine and daunaribicin) and was in remission after 4 weeks of chemotherapy. However, the peripheral blood eosinophils and the pulmonary symptoms normalized 6 weeks after attaining remission. - Case repo. | Medicine | null | 197 | {
"Correct Answer": "Inv (16) is often detected in the blasts and the eosinophils.",
"Correct Option": "D",
"Options": {
"A": "Eosinophils are not pa of the Neoplastic clone",
"B": "t(5:14) rearrangement may be detected in blasts",
"C": "Peripheral blood eosinophilia may normalize with chemotherapy",
"D": "Inv (16) is often detected in the blasts and the eosinophils."
},
"Question": "A four year old boy was admitted with a history of abdominal pain and fever for two months, maculopapular rash for ten days, and dry cough, dyspnea and wheezing for three days. On examination, liver and spleen were enlarged 4 cm and 3 cm respectively below the costal margins. His hemoglobin was 10.0 g/dl, platelet count 37 x 109/L and total leukocyte count 70 x 109/L, which included 80% eosinophils. Bone marrow examination revealed a cellular marrow comprising 45% blasts and 34% eosinophils and eosinophilic precursors. The blasts stained negative for myeloperoxidase and nonspecific esterase and were positive for CD19, CDIO, CD22 and CD20. Which one of the following statements in not true about this disease?"
} | A four year old boy was admitted with a history of abdominal pain and fever for two months, maculopapular rash for ten days, and dry cough, dyspnea and wheezing for three days. On examination, liver and spleen were enlarged 4 cm and 3 cm respectively below the costal margins. His hemoglobin was 10.0 g/dl, platelet count 37 x 109/L and total leukocyte count 70 x 109/L, which included 80% eosinophils. Bone marrow examination revealed a cellular marrow comprising 45% blasts and 34% eosinophils and eosinophilic precursors. The blasts stained negative for myeloperoxidase and nonspecific esterase and were positive for CD19, CDIO, CD22 and CD20. | Which one of the following statements in not true about this disease? | {
"A": "Eosinophils are not pa of the Neoplastic clone",
"B": "t(5:14) rearrangement may be detected in blasts",
"C": "Peripheral blood eosinophilia may normalize with chemotherapy",
"D": "Inv (16) is often detected in the blasts and the eosinophils."
} | D. Inv (16) is often detected in the blasts and the eosinophils. |
8ab1e32d-1998-403e-b855-1a3afd2b2a4b | A 34-year-old man complains of sudden attacks of dizziness, blurred vision, and excruciating headaches of 4 months in duration. During one of these attacks, his blood pressure was 180/120 mm Hg. The patient's father had been treated for thyroid cancer about 15 years ago. Laboratory studies show normal serum levels of aldosterone, renin, and angiotensin. A 24-hour urinalysis reveals increased metanephrines. Episodic hypertension in this patient is most likely caused by a tumor in which of the following endocrine organs? | Adrenal | Kidney | Parathyroid | Pituitary | 0a
| single | Pheochromocytoma is a rare tumor of chromaffin cells of the adrenal medulla thatsecretes catecholamines. Such tumors also originate in extra-adrenal sites, in which case they are termed paragangliomas. The clinical features associated with pheochromocytoma are caused by the release of catecholamines. Patients with pheochromocytoma come to medical attention because of (1) asymptomatic hypertension discovered on a routine physical examination, (2) symptomatic hypertension that is resistant to antihypertensive therapy; (3) malignant hypertension (e.g., encephalopathy, papilledema, proteinuria), (4) myocardial infarction or aortic dissection, or (5) convulsions. The other choices do not include tumors that lead to episodic hypertension.Diagnosis: Pheochromocytoma | Pathology | Endocrine | 128 | {
"Correct Answer": "Adrenal",
"Correct Option": "A",
"Options": {
"A": "Adrenal",
"B": "Kidney",
"C": "Parathyroid",
"D": "Pituitary"
},
"Question": "A 34-year-old man complains of sudden attacks of dizziness, blurred vision, and excruciating headaches of 4 months in duration. During one of these attacks, his blood pressure was 180/120 mm Hg. The patient's father had been treated for thyroid cancer about 15 years ago. Laboratory studies show normal serum levels of aldosterone, renin, and angiotensin. A 24-hour urinalysis reveals increased metanephrines. Episodic hypertension in this patient is most likely caused by a tumor in which of the following endocrine organs?"
} | A 34-year-old man complains of sudden attacks of dizziness, blurred vision, and excruciating headaches of 4 months in duration. During one of these attacks, his blood pressure was 180/120 mm Hg. The patient's father had been treated for thyroid cancer about 15 years ago. Laboratory studies show normal serum levels of aldosterone, renin, and angiotensin. A 24-hour urinalysis reveals increased metanephrines. | Episodic hypertension in this patient is most likely caused by a tumor in which of the following endocrine organs? | {
"A": "Adrenal",
"B": "Kidney",
"C": "Parathyroid",
"D": "Pituitary"
} | A. Adrenal |
725181ee-93cb-441f-aef6-c491ec29c097 | EMQ/EMI Theme: Emergencies in the Dental Chair
A - Adrenaline 1:1000 (1 mg/ml)
B - Adrenaline 1:10 000 (1 mg/10 ml)
C - Aspirin oral
D - Chlorpheniramine
E - Diazepam
F - Glucagon
G - Glucose
H - Glyceryl trinitrate spray
I - Hydrocortisone (IV)
J - Oxygen
K - Salbutamol
For each of the following scenarios, the most appropriate management option from the list above are all EXCEPT.
1 Following oral administration of a 3 g sachet of amoxicillin, a 20-yearold woman reports shortness of breath and the development of a red rash over her body.
2 A 20-year-old man in your dental surgery waiting room is shaking involuntarily, frothing at the mouth and showing signs of incontinence.
3 A 57-year-old woman with type 1 diabetes collapses in the dental chair and a dipstick shows low blood glucose.
4 While being treated, a 60-year-old man complains of severe central crushing chest pain which radiates down the left arm and nausea. The pain does not respond to glyceryl trinitrate spray and oxygen.
5 A 30-year-old known asthmatic patient has just been told that she has to lose several of her teeth. She begins to wheeze and is short of breath. | 1 A Adrenaline 1:1000 (1 mg/ml) | 2 E Diazepam | 3 F Glucagon | 4 K Salbutamol | 3d
| multi | Correct matching should be
1 A Adrenaline 1:1000 (1 mg/ml)
2 E Diazepam
3 F Glucagon
4 C Aspirin oral
5 K Salbutamol
Treatment of medical emergencies is a pass/fail topic and should be known insideout. | Surgery | null | 323 | {
"Correct Answer": "4 K Salbutamol",
"Correct Option": "D",
"Options": {
"A": "1 A Adrenaline 1:1000 (1 mg/ml)",
"B": "2 E Diazepam",
"C": "3 F Glucagon",
"D": "4 K Salbutamol"
},
"Question": "EMQ/EMI Theme: Emergencies in the Dental Chair\nA - Adrenaline 1:1000 (1 mg/ml) \nB - Adrenaline 1:10 000 (1 mg/10 ml) \nC - Aspirin oral \nD - Chlorpheniramine \nE - Diazepam \nF - Glucagon \nG - Glucose \nH - Glyceryl trinitrate spray \nI - Hydrocortisone (IV) \nJ - Oxygen \nK - Salbutamol\nFor each of the following scenarios, the most appropriate management option from the list above are all EXCEPT.\n1 Following oral administration of a 3 g sachet of amoxicillin, a 20-yearold woman reports shortness of breath and the development of a red rash over her body.\n2 A 20-year-old man in your dental surgery waiting room is shaking involuntarily, frothing at the mouth and showing signs of incontinence.\n3 A 57-year-old woman with type 1 diabetes collapses in the dental chair and a dipstick shows low blood glucose.\n4 While being treated, a 60-year-old man complains of severe central crushing chest pain which radiates down the left arm and nausea. The pain does not respond to glyceryl trinitrate spray and oxygen.\n5 A 30-year-old known asthmatic patient has just been told that she has to lose several of her teeth. She begins to wheeze and is short of breath."
} | EMQ/EMI Theme: Emergencies in the Dental Chair
A - Adrenaline 1:1000 (1 mg/ml)
B - Adrenaline 1:10 000 (1 mg/10 ml)
C - Aspirin oral
D - Chlorpheniramine
E - Diazepam
F - Glucagon
G - Glucose
H - Glyceryl trinitrate spray
I - Hydrocortisone (IV)
J - Oxygen
K - Salbutamol
For each of the following scenarios, the most appropriate management option from the list above are all EXCEPT.
1 Following oral administration of a 3 g sachet of amoxicillin, a 20-yearold woman reports shortness of breath and the development of a red rash over her body.
2 A 20-year-old man in your dental surgery waiting room is shaking involuntarily, frothing at the mouth and showing signs of incontinence.
3 A 57-year-old woman with type 1 diabetes collapses in the dental chair and a dipstick shows low blood glucose.
4 While being treated, a 60-year-old man complains of severe central crushing chest pain which radiates down the left arm and nausea. The pain does not respond to glyceryl trinitrate spray and oxygen.
5 A 30-year-old known asthmatic patient has just been told that she has to lose several of her teeth. | She begins to wheeze and is short of breath. | {
"A": "1 A Adrenaline 1:1000 (1 mg/ml)",
"B": "2 E Diazepam",
"C": "3 F Glucagon",
"D": "4 K Salbutamol"
} | D. 4 K Salbutamol |
770c5a55-d51d-4994-b7f9-6668b2e43ec3 | A patient presents to your office for her annual examination. She admits to having intercourse with multiple sexual partners over the past year. Her only medication is an oral contra ceptive pill (O C P ) which she takes very regularly. She has no new symptoms or concerns. On physical examination, a painless punched-out ulcer is appreciated on the left labia.After appropriate testing and treatment, you counsel the patient to practice safer sex in the future. If this patient had not been treated, what would be the next sequelae? | Argyll-Robertson pupil | Gummas on the skin and bones | Tabes dorsalis | Rash involving palms and soles | 3d
| single | Source: style="font-size: 1.04761904761905em; font-family: Times New Roman, Times, serif"> Ans. (d) Rash involving palms and soles.Based on the description of a hard painless chancre, this patient likely has syphilis. The primary stage of syphilis is characterized by painless chancre. Secondary stage includes a red rash involving the palms and soles, Tertiary stage is characterized by Argyll-Robertson pupil, tabes dorsalis, paresis, gummas of skin and bone, and aortic aneurysm. Confused imageDiagnosis and ClueChancroid Painful Ulcer - Look for this in the history | Gynaecology & Obstetrics | Principles of STD Management | 106 | {
"Correct Answer": "Rash involving palms and soles",
"Correct Option": "D",
"Options": {
"A": "Argyll-Robertson pupil",
"B": "Gummas on the skin and bones",
"C": "Tabes dorsalis",
"D": "Rash involving palms and soles"
},
"Question": "A patient presents to your office for her annual examination. She admits to having intercourse with multiple sexual partners over the past year. Her only medication is an oral contra ceptive pill (O C P ) which she takes very regularly. She has no new symptoms or concerns. On physical examination, a painless punched-out ulcer is appreciated on the left labia.After appropriate testing and treatment, you counsel the patient to practice safer sex in the future. If this patient had not been treated, what would be the next sequelae?"
} | A patient presents to your office for her annual examination. She admits to having intercourse with multiple sexual partners over the past year. Her only medication is an oral contra ceptive pill (O C P ) which she takes very regularly. She has no new symptoms or concerns. On physical examination, a painless punched-out ulcer is appreciated on the left labia.After appropriate testing and treatment, you counsel the patient to practice safer sex in the future. | If this patient had not been treated, what would be the next sequelae? | {
"A": "Argyll-Robertson pupil",
"B": "Gummas on the skin and bones",
"C": "Tabes dorsalis",
"D": "Rash involving palms and soles"
} | D. Rash involving palms and soles |
e76c9eb9-e6d3-4d85-8b44-ec5371f3db47 | A patient presents to the emergency complaining of fever, chills, and a painful mass adjacent to his anus. On examination, a tender, fluctuant mass is palpated. Purulent material is noted through the skin and the diagnosis of ischioanal abscess is made. The patient is taken to the operation theatre, and incision and drainage of the abscess is performed. During the procedure, the extent of the lesion is underestimated, and the inferior rectal nerve is damaged. This nerve is a direct branch of which of the following nerves? | Inferior gluteal nerve | Pelvic splanchnic nerve | Pudendal nerve | Sciatic nerve | 2c
| single | The pudendal nerve is a branch of the sacral plexus that exits from the greater sciatic foramen, and then enters the lesser sciatic foramen, to lie in the pudendal canal on the lateral wall of the ischioanal fossa. The inferior rectal nerve is a branch of the pudendal nerve, which crosses the ischioanal fossa to reach the anal canal, where it innervates the external anal sphincter and provides sensory innervation to the area. The inferior gluteal nerve, a branch of the sacral plexus, exits through the greater sciatic foramen and innervates the gluteus maximus muscle. The pelvic splanchnic nerves are branches of the second, third, and fouh sacral nerves that carry preganglionic parasympathetic nerves to several pelvic organs. The sciatic nerve is a branch of the lumbosacral plexus that exits through the greater sciatic foramen, then enters the lower limb to innervate muscles of the posterior thigh, the leg, and the foot, and provides sensory innervation to the area as well. | Anatomy | null | 111 | {
"Correct Answer": "Pudendal nerve",
"Correct Option": "C",
"Options": {
"A": "Inferior gluteal nerve",
"B": "Pelvic splanchnic nerve",
"C": "Pudendal nerve",
"D": "Sciatic nerve"
},
"Question": "A patient presents to the emergency complaining of fever, chills, and a painful mass adjacent to his anus. On examination, a tender, fluctuant mass is palpated. Purulent material is noted through the skin and the diagnosis of ischioanal abscess is made. The patient is taken to the operation theatre, and incision and drainage of the abscess is performed. During the procedure, the extent of the lesion is underestimated, and the inferior rectal nerve is damaged. This nerve is a direct branch of which of the following nerves?"
} | A patient presents to the emergency complaining of fever, chills, and a painful mass adjacent to his anus. On examination, a tender, fluctuant mass is palpated. Purulent material is noted through the skin and the diagnosis of ischioanal abscess is made. The patient is taken to the operation theatre, and incision and drainage of the abscess is performed. During the procedure, the extent of the lesion is underestimated, and the inferior rectal nerve is damaged. | This nerve is a direct branch of which of the following nerves? | {
"A": "Inferior gluteal nerve",
"B": "Pelvic splanchnic nerve",
"C": "Pudendal nerve",
"D": "Sciatic nerve"
} | C. Pudendal nerve |
fb408d24-df50-4071-a9a0-ab731ffabf68 | A 77-year-old woman is brought to the emergency room because of symptoms of nonspecific abdominal discomfort. She has no anorexia, fever, chills, or weight loss. On physical examination, the vital signs are normal, the abdomen is soft and nontender with no masses or organomegaly palpated. Abdominal x-rays show lots of stool in the colon, but no free air or air- fluid levels. Laboratory investigations reveal an amylase of 150 U/L (25-125 U/L), and the rest of her biochemistry and complete blood count are normal. Which of the following conditions can cause a false-positive elevation in the serum amylase? | maturity-onset diabetes mellitus (DM) | gastric ulcer | renal failure | sulfonamide therapy | 2c
| multi | Amylase accumulates in the setting of renal failure, and thus becomes a less-valuable diagnostic test (false positive). Numerous other conditions involving the pancreas, the gut, and the salivary glands can raise amylase levels. Sulfonamides cause pancreatitis; therefore, an elevated amylase is not confusing, but rather a useful test for pancreatitis in patients taking the drug. Morphine can elevate amylase levels in the absence of pancreatitis. | Medicine | G.I.T. | 147 | {
"Correct Answer": "renal failure",
"Correct Option": "C",
"Options": {
"A": "maturity-onset diabetes mellitus (DM)",
"B": "gastric ulcer",
"C": "renal failure",
"D": "sulfonamide therapy"
},
"Question": "A 77-year-old woman is brought to the emergency room because of symptoms of nonspecific abdominal discomfort. She has no anorexia, fever, chills, or weight loss. On physical examination, the vital signs are normal, the abdomen is soft and nontender with no masses or organomegaly palpated. Abdominal x-rays show lots of stool in the colon, but no free air or air- fluid levels. Laboratory investigations reveal an amylase of 150 U/L (25-125 U/L), and the rest of her biochemistry and complete blood count are normal. Which of the following conditions can cause a false-positive elevation in the serum amylase?"
} | A 77-year-old woman is brought to the emergency room because of symptoms of nonspecific abdominal discomfort. She has no anorexia, fever, chills, or weight loss. On physical examination, the vital signs are normal, the abdomen is soft and nontender with no masses or organomegaly palpated. Abdominal x-rays show lots of stool in the colon, but no free air or air- fluid levels. Laboratory investigations reveal an amylase of 150 U/L (25-125 U/L), and the rest of her biochemistry and complete blood count are normal. | Which of the following conditions can cause a false-positive elevation in the serum amylase? | {
"A": "maturity-onset diabetes mellitus (DM)",
"B": "gastric ulcer",
"C": "renal failure",
"D": "sulfonamide therapy"
} | C. renal failure |
6ae51366-5914-47a6-956c-82440bc8a327 | A 63-year-old man with multiple rib fractures and a pulmonary contusion requires prolonged intubation. He is unable to be weaned from the ventilator and is on a volume control mode. He has a tracheostomy and a percutaneous gastrotomy in place through which he is being fed. The surgeon orders a respiratory quotient (RQ), which is the ratio of the rate of carbon dioxide production over the rate of oxygen uptake. The RQ is 1. Based on this information, which of the following is the next step in his management? | Decrease the inspired concentration of oxygen | Decrease the rate on the ventilator | Increase the rate on the ventilator | Decrease the carbohydrates in his enteral feeds | 3d
| multi | The respiratory quotient (RQ) is the ratio of the rate of carbon dioxide production over the rate of oxygen uptake. An RQ of 0.75 to 0.85 is ideal. The RQ is dependent on the composition of nutritional suppo. An RQ of 0.7 indicates a diet comprised largely of lipids. An RQ of 1 or greater indicates a diet comprising primarily carbohydrates, which can impair weaning from the ventilator. Decreasing the carbohydrates in the enteral feeds would facilitate the patient's ventilator wean. Changing ventilator settings by decreasing the inspired concentration of oxygen or the rate may be indicated as pa of the ventilator wean, but these will not affect the RQ. | Anaesthesia | Miscellaneous | 118 | {
"Correct Answer": "Decrease the carbohydrates in his enteral feeds",
"Correct Option": "D",
"Options": {
"A": "Decrease the inspired concentration of oxygen",
"B": "Decrease the rate on the ventilator",
"C": "Increase the rate on the ventilator",
"D": "Decrease the carbohydrates in his enteral feeds"
},
"Question": "A 63-year-old man with multiple rib fractures and a pulmonary contusion requires prolonged intubation. He is unable to be weaned from the ventilator and is on a volume control mode. He has a tracheostomy and a percutaneous gastrotomy in place through which he is being fed. The surgeon orders a respiratory quotient (RQ), which is the ratio of the rate of carbon dioxide production over the rate of oxygen uptake. The RQ is 1. Based on this information, which of the following is the next step in his management?"
} | A 63-year-old man with multiple rib fractures and a pulmonary contusion requires prolonged intubation. He is unable to be weaned from the ventilator and is on a volume control mode. He has a tracheostomy and a percutaneous gastrotomy in place through which he is being fed. The surgeon orders a respiratory quotient (RQ), which is the ratio of the rate of carbon dioxide production over the rate of oxygen uptake. The RQ is 1. | Based on this information, which of the following is the next step in his management? | {
"A": "Decrease the inspired concentration of oxygen",
"B": "Decrease the rate on the ventilator",
"C": "Increase the rate on the ventilator",
"D": "Decrease the carbohydrates in his enteral feeds"
} | D. Decrease the carbohydrates in his enteral feeds |
10e3dd88-8318-494f-9287-643049c78909 | A 26-year-old woman in her sixth month of pregnancy is brought to the emergency department. She had been punched in the abdomen. She is found to have generalized abdominal pain, tenderness, abdominal distention, ileus, and absent fetal heart sounds. The patient's blood pressure is 80/60 mm Hg; despite administration of 3 L of Ringer's lactate, her blood pressure only comes up to 90/60 mm Hg. What is the next step in management? | Application of PASG | Transfusion of 2 U of blood and reevaluate | Exploratory laparotomy and vaginal hysterectomy | Exploratory laparotomy with evacuation of the uterus and closure of the uterus disruption | 3d
| multi | Exploratory laparotomy with evacuation of the uterus and closure of the uterus disruption is the procedure of choice despite continued hypotension. Blood administration should be instituted but is not as critical as gaining surgical hemostasis. A PASG may have a limited temporizing effect but should not be used as an alternative to exploratory laparotomy. Any patient with abdominal trauma who is hypotensive should not be sent for a CT scan. | Surgery | Trauma | 108 | {
"Correct Answer": "Exploratory laparotomy with evacuation of the uterus and closure of the uterus disruption",
"Correct Option": "D",
"Options": {
"A": "Application of PASG",
"B": "Transfusion of 2 U of blood and reevaluate",
"C": "Exploratory laparotomy and vaginal hysterectomy",
"D": "Exploratory laparotomy with evacuation of the uterus and closure of the uterus disruption"
},
"Question": "A 26-year-old woman in her sixth month of pregnancy is brought to the emergency department. She had been punched in the abdomen. She is found to have generalized abdominal pain, tenderness, abdominal distention, ileus, and absent fetal heart sounds. The patient's blood pressure is 80/60 mm Hg; despite administration of 3 L of Ringer's lactate, her blood pressure only comes up to 90/60 mm Hg. What is the next step in management?"
} | A 26-year-old woman in her sixth month of pregnancy is brought to the emergency department. She had been punched in the abdomen. She is found to have generalized abdominal pain, tenderness, abdominal distention, ileus, and absent fetal heart sounds. The patient's blood pressure is 80/60 mm Hg; despite administration of 3 L of Ringer's lactate, her blood pressure only comes up to 90/60 mm Hg. | What is the next step in management? | {
"A": "Application of PASG",
"B": "Transfusion of 2 U of blood and reevaluate",
"C": "Exploratory laparotomy and vaginal hysterectomy",
"D": "Exploratory laparotomy with evacuation of the uterus and closure of the uterus disruption"
} | D. Exploratory laparotomy with evacuation of the uterus and closure of the uterus disruption |
4d07712c-1e4b-44d6-9a19-3c1cb2f70847 | A 22-year-old woman presents with fever, headache, and confusion. She has not been herself for the past 2 days, including not going to work and forgetting events. On examination, she is moving all her limbs, but not oriented to place or time. The remaining examination is normal. A CT scan shows bilateral, small, low-density temporal lobe lesions. Cerebrospinal fluid (CSF) shows mononuclear cell pleocytosis, increased protein, and normal glucose. The electroencephalogram (EEG) shows bilateral periodic discharges from the temporal leads and slow-wave complexes at regular intervals of 2-3/sec. Which of the following is the most appropriate treatment for her condition? | penicillin | chloramphenicol | acyclovir | erythromycin | 2c
| multi | This patient has herpes simplex virus encephalitis. Acyclovir selectively inhibits viral deoxyribonucleic acid (DNA) polymerase. Acyclovir is currently the treatment of choice because of better efficacy and less toxicity than previous drugs. Because it is so nontoxic, therapy can be started even if the diagnosis is only presumptive. | Medicine | C.N.S. | 150 | {
"Correct Answer": "acyclovir",
"Correct Option": "C",
"Options": {
"A": "penicillin",
"B": "chloramphenicol",
"C": "acyclovir",
"D": "erythromycin"
},
"Question": "A 22-year-old woman presents with fever, headache, and confusion. She has not been herself for the past 2 days, including not going to work and forgetting events. On examination, she is moving all her limbs, but not oriented to place or time. The remaining examination is normal. A CT scan shows bilateral, small, low-density temporal lobe lesions. Cerebrospinal fluid (CSF) shows mononuclear cell pleocytosis, increased protein, and normal glucose. The electroencephalogram (EEG) shows bilateral periodic discharges from the temporal leads and slow-wave complexes at regular intervals of 2-3/sec. Which of the following is the most appropriate treatment for her condition?"
} | A 22-year-old woman presents with fever, headache, and confusion. She has not been herself for the past 2 days, including not going to work and forgetting events. On examination, she is moving all her limbs, but not oriented to place or time. The remaining examination is normal. A CT scan shows bilateral, small, low-density temporal lobe lesions. Cerebrospinal fluid (CSF) shows mononuclear cell pleocytosis, increased protein, and normal glucose. The electroencephalogram (EEG) shows bilateral periodic discharges from the temporal leads and slow-wave complexes at regular intervals of 2-3/sec. | Which of the following is the most appropriate treatment for her condition? | {
"A": "penicillin",
"B": "chloramphenicol",
"C": "acyclovir",
"D": "erythromycin"
} | C. acyclovir |
966ac1e5-f2fb-43d2-bfce-e12c219119af | A 37-year-old woman has noted an excessively heavy menstrual flow each of the past 6 months. She also has noticed increasing numbers of pinpoint hemorrhages on her lower extremities in the past month. Physical examination shows no organomegaly or lymphadenopathy. CBC shows hemoglobin of 14.2 g/dL, hematocrit of 42.5%, MCV of 91 mm3, platelet count of 15,000/ mm3, and WBC count of 6950/ mm3. On admission to the hospital, she has melena and after a transfusion of platelets, her platelet count does not increase. Which of the following describes the most likely basis for her bleeding tendency? | Abnormal production of platelets by megakaryocytes | Defective platelet-endothelial interactions | Destruction of antibody-coated platelets by the spleen | Excessive loss of platelets in menstrual blood | 2c
| single | This patient's bleeding tendency is caused by a low platelet count. She most likely has idiopathic chronic immune thrombocytopenic purpura (ITP), in which platelets are destroyed in the spleen after being coated with antibodies to platelet membrane glycoproteins IIb-IIIa or Ib-IX. These antibodies coat both the patient's platelets and any transfused platelets. Because the spleen is the major source of the antibody and the site of platelet destruction, a splenectomy can be beneficial if corticosteroid therapy is not. There is no defect in the production of platelets. Platelet functions are normal in ITP. Chronic blood loss would not lead to thrombocytopenia when normal bone marrow function is present. Abnormal platelet-endothelial interactions are more likely to cause thrombosis. Suppression of pluripotent stem cells gives rise to aplastic anemia, which is accompanied by pancytopenia. | Pathology | Blood | 159 | {
"Correct Answer": "Destruction of antibody-coated platelets by the spleen",
"Correct Option": "C",
"Options": {
"A": "Abnormal production of platelets by megakaryocytes",
"B": "Defective platelet-endothelial interactions",
"C": "Destruction of antibody-coated platelets by the spleen",
"D": "Excessive loss of platelets in menstrual blood"
},
"Question": "A 37-year-old woman has noted an excessively heavy menstrual flow each of the past 6 months. She also has noticed increasing numbers of pinpoint hemorrhages on her lower extremities in the past month. Physical examination shows no organomegaly or lymphadenopathy. CBC shows hemoglobin of 14.2 g/dL, hematocrit of 42.5%, MCV of 91 mm3, platelet count of 15,000/ mm3, and WBC count of 6950/ mm3. On admission to the hospital, she has melena and after a transfusion of platelets, her platelet count does not increase. Which of the following describes the most likely basis for her bleeding tendency?"
} | A 37-year-old woman has noted an excessively heavy menstrual flow each of the past 6 months. She also has noticed increasing numbers of pinpoint hemorrhages on her lower extremities in the past month. Physical examination shows no organomegaly or lymphadenopathy. CBC shows hemoglobin of 14.2 g/dL, hematocrit of 42.5%, MCV of 91 mm3, platelet count of 15,000/ mm3, and WBC count of 6950/ mm3. On admission to the hospital, she has melena and after a transfusion of platelets, her platelet count does not increase. | Which of the following describes the most likely basis for her bleeding tendency? | {
"A": "Abnormal production of platelets by megakaryocytes",
"B": "Defective platelet-endothelial interactions",
"C": "Destruction of antibody-coated platelets by the spleen",
"D": "Excessive loss of platelets in menstrual blood"
} | C. Destruction of antibody-coated platelets by the spleen |
b6dbb07e-c25a-44fc-a7a4-8c01b083455f | THEME AND FOCUS: METABOLISM OF NUCLEOTIDES Case Study: A 17- month- old girl suffered from recurring respiratory infections. Injection of Diphtheria-Peussis-Tetanus (DPT) and Typhoid vaccine produced only a minimal response. The lysate of girl's erythrocytes were found to lack detectable adenosine deaminase activity. Her mother and father both showed approximately 50% of the normal red cell adenosine deaminase activity. Lead Question: Diagnose the disease. | SCID | Crushing Muscular Trauma | Lesch -Nyhan Syndrome | Hypokalemia | 0a
| multi | Severe combined immunodeficiency(SCID) Crushing Muscular Trauma Lesch-Nyhan syndrome ADA (Adenosine Deaminase) deficiency Muscle cell damage resulting from pressure or crushing. Deficiency of Hypoxanthine Guanine Phospho Ribosyl Transferase (HGP). Required for both B & T lymphocytes. Hyperuricemia Self -mutilation | Biochemistry | Nucleotides | 120 | {
"Correct Answer": "SCID",
"Correct Option": "A",
"Options": {
"A": "SCID",
"B": "Crushing Muscular Trauma",
"C": "Lesch -Nyhan Syndrome",
"D": "Hypokalemia"
},
"Question": "THEME AND FOCUS: METABOLISM OF NUCLEOTIDES Case Study: A 17- month- old girl suffered from recurring respiratory infections. Injection of Diphtheria-Peussis-Tetanus (DPT) and Typhoid vaccine produced only a minimal response. The lysate of girl's erythrocytes were found to lack detectable adenosine deaminase activity. Her mother and father both showed approximately 50% of the normal red cell adenosine deaminase activity. Lead Question: Diagnose the disease."
} | THEME AND FOCUS: METABOLISM OF NUCLEOTIDES Case Study: A 17- month- old girl suffered from recurring respiratory infections. Injection of Diphtheria-Peussis-Tetanus (DPT) and Typhoid vaccine produced only a minimal response. The lysate of girl's erythrocytes were found to lack detectable adenosine deaminase activity. Her mother and father both showed approximately 50% of the normal red cell adenosine deaminase activity. | Lead Question: Diagnose the disease. | {
"A": "SCID",
"B": "Crushing Muscular Trauma",
"C": "Lesch -Nyhan Syndrome",
"D": "Hypokalemia"
} | A. SCID |
1db72b24-74d5-4ae5-af3e-c631fa551c7e | A 45-year-old male presents to the Emergency Room with hematemesis and melena, which is actively managed. He has been previously diagnosed with liver cirrhosis. An esophago-gastro- duodenoscopy has been planned and patient has been asked to observe an overnight fast in esophagogastroduodenoscopy preparation of endoscopy. Patient had dinner at 7 pm and endoscopy was performed at 1 pm the next day. At the time of endoscopy, some pathways were generating glucose to maintain serum glucose levels. Which of the following enzymes catalyze the irreversible biochemical reaction of this process? | Enolase | Glycogen phosphorylase | Fructose-1,6-bisphosphatase | Glucose 6P dehydrogenase | 2c
| single | Answer: c) Fructose-1,6-bisphosphatase* Patient is observing a fast for 18 hours.* During fasting, glycogen storage is usually depleted within 12 hours.* After this point, gluconeogenesis is mainly responsible for maintaining serum glucose levels by converting non-glucose substances to glucose.* It occurs within liver and is opposite of glycolysis with four key irreversible steps.* One of those steps is conversion of Fructose 1,6-bisphosphate to Fructose-6-phosphate.* It is catalyzed by the enzyme, Fructose-1,6-bisphosphatase.* The other irreversible steps are:o The conversion of Pyruvate to Oxaloacetate, catalyzed by Pyruvate carboxylase enzyme and requires biotin.o The conversion of Oxaloacetate to Phosphoenolpyruvate, catalyzed by Phosphoenolpyruvate carboxykinase.o The conversion of Glucose-6-phosphate to Glucose, catalyzed by Glucose 6-phosphatase. | Biochemistry | Carbohydrates | 132 | {
"Correct Answer": "Fructose-1,6-bisphosphatase",
"Correct Option": "C",
"Options": {
"A": "Enolase",
"B": "Glycogen phosphorylase",
"C": "Fructose-1,6-bisphosphatase",
"D": "Glucose 6P dehydrogenase"
},
"Question": "A 45-year-old male presents to the Emergency Room with hematemesis and melena, which is actively managed. He has been previously diagnosed with liver cirrhosis. An esophago-gastro- duodenoscopy has been planned and patient has been asked to observe an overnight fast in esophagogastroduodenoscopy preparation of endoscopy. Patient had dinner at 7 pm and endoscopy was performed at 1 pm the next day. At the time of endoscopy, some pathways were generating glucose to maintain serum glucose levels. Which of the following enzymes catalyze the irreversible biochemical reaction of this process?"
} | A 45-year-old male presents to the Emergency Room with hematemesis and melena, which is actively managed. He has been previously diagnosed with liver cirrhosis. An esophago-gastro- duodenoscopy has been planned and patient has been asked to observe an overnight fast in esophagogastroduodenoscopy preparation of endoscopy. Patient had dinner at 7 pm and endoscopy was performed at 1 pm the next day. At the time of endoscopy, some pathways were generating glucose to maintain serum glucose levels. | Which of the following enzymes catalyze the irreversible biochemical reaction of this process? | {
"A": "Enolase",
"B": "Glycogen phosphorylase",
"C": "Fructose-1,6-bisphosphatase",
"D": "Glucose 6P dehydrogenase"
} | C. Fructose-1,6-bisphosphatase |
d9c61fb6-09cf-4817-996f-863b3e35901f | Forty eight hours after sustaining a blunt abdominal injury, a 15 year old boy presents with hematuria and pain in the left side of abdomen. On examination, he has a pulse rate of 96/ minute with a BP of 110/70 mmHg. His Hb is 10-8 gm% with a PCV of 31%. Abdominal examination revealed tenderness in left lumbar region but no palpable mass. The most appropriate investigation to diagnose and find the extent of renal injury would be- | Sonographic evaluation of abdomen | Intravenous pyelography | Contrast enhanced computed tomography | MR urography | 2c
| single | null | Surgery | null | 116 | {
"Correct Answer": "Contrast enhanced computed tomography",
"Correct Option": "C",
"Options": {
"A": "Sonographic evaluation of abdomen",
"B": "Intravenous pyelography",
"C": "Contrast enhanced computed tomography",
"D": "MR urography"
},
"Question": "Forty eight hours after sustaining a blunt abdominal injury, a 15 year old boy presents with hematuria and pain in the left side of abdomen. On examination, he has a pulse rate of 96/ minute with a BP of 110/70 mmHg. His Hb is 10-8 gm% with a PCV of 31%. Abdominal examination revealed tenderness in left lumbar region but no palpable mass. The most appropriate investigation to diagnose and find the extent of renal injury would be-"
} | Forty eight hours after sustaining a blunt abdominal injury, a 15 year old boy presents with hematuria and pain in the left side of abdomen. On examination, he has a pulse rate of 96/ minute with a BP of 110/70 mmHg. His Hb is 10-8 gm% with a PCV of 31%. Abdominal examination revealed tenderness in left lumbar region but no palpable mass. | The most appropriate investigation to diagnose and find the extent of renal injury would be- | {
"A": "Sonographic evaluation of abdomen",
"B": "Intravenous pyelography",
"C": "Contrast enhanced computed tomography",
"D": "MR urography"
} | C. Contrast enhanced computed tomography |
544fa413-d6a2-41ad-859d-cf85704ce236 | A 52-year-old construction worker had an 8-month history of muscle weakness, easy bruising, backache, and headache. Physical examination revealed cutaneous hyperpigmentation, pronounced truncal obesity, purple striae with a "buffalo hump," and blood pressure of 180/100 mm Hg. Laboratory analyses revealed elevated concentrations of circulating coisol with an absence of a circadian rhythm. With high-dose administration of a glucocoicoid agonist, plasma coisol levels reduced significantly. What is the most likely cause of these symptoms? | Adrenocoical hypersecretion of pituitary origin | Congenital adrenal hyperplasia | Ectopic ACTH production in the lung | Primary hyperaldosteronism | 0a
| single | Physical examination revealed features of glucocoicoid excess. ACTH-dependent Cushing syndrome is characterized by elevated glucocoicoid levels caused by excess stimulation by ACTH produced by pituitary or ectopic (extrapituitary tissue) tumors. The most frequent source of ectopically produced ACTH is small cell lung carcinoma. Ectopic secretion of ACTH is usually not suppressed by exogenously administered glucocoicoids (dexamethasone), and this feature is helpful in its differential diagnosis. | Physiology | Endocrinology | 120 | {
"Correct Answer": "Adrenocoical hypersecretion of pituitary origin",
"Correct Option": "A",
"Options": {
"A": "Adrenocoical hypersecretion of pituitary origin",
"B": "Congenital adrenal hyperplasia",
"C": "Ectopic ACTH production in the lung",
"D": "Primary hyperaldosteronism"
},
"Question": "A 52-year-old construction worker had an 8-month history of muscle weakness, easy bruising, backache, and headache. Physical examination revealed cutaneous hyperpigmentation, pronounced truncal obesity, purple striae with a \"buffalo hump,\" and blood pressure of 180/100 mm Hg. Laboratory analyses revealed elevated concentrations of circulating coisol with an absence of a circadian rhythm. With high-dose administration of a glucocoicoid agonist, plasma coisol levels reduced significantly. What is the most likely cause of these symptoms?"
} | A 52-year-old construction worker had an 8-month history of muscle weakness, easy bruising, backache, and headache. Physical examination revealed cutaneous hyperpigmentation, pronounced truncal obesity, purple striae with a "buffalo hump," and blood pressure of 180/100 mm Hg. Laboratory analyses revealed elevated concentrations of circulating coisol with an absence of a circadian rhythm. With high-dose administration of a glucocoicoid agonist, plasma coisol levels reduced significantly. | What is the most likely cause of these symptoms? | {
"A": "Adrenocoical hypersecretion of pituitary origin",
"B": "Congenital adrenal hyperplasia",
"C": "Ectopic ACTH production in the lung",
"D": "Primary hyperaldosteronism"
} | A. Adrenocoical hypersecretion of pituitary origin |
11deb578-61c7-46a0-b624-c2aae1be0294 | A 14-year-old boy presents for a pre-summer camp physical examination. Routine urinalysis discloses 3+ glucosuria. He admits to thirst and frequent urination, accompanied by a 4-kg (9-lb) weight loss over past few months. His parents note that he had a flu-like illness 5 months ago. His blood glucose is 220 mg/dL. Which of the following best explains the pathogenesis of hyperglycemia in this patient? | Excess dietary glucose | Increased peripheral insulin uptake | Irregular insulin secretion | Islet cell destruction | 3d
| single | Type 1 diabetes mellitus (T1DM) -Lifelong disorder of glucose homeostasis that results from autoimmune destruction of b-cells in islets of Langerhans. - Clinical onset coincides with another acute illness, such as febrile viral or bacterial infection. - Characterized by low or absent insulin secretion. - Most characteristic early finding in pancreas is lymphocytic infiltration in islets (insulitis), - As disease becomes chronic, b-cells of islets are progressively depleted. | Pathology | Diabetes | 104 | {
"Correct Answer": "Islet cell destruction",
"Correct Option": "D",
"Options": {
"A": "Excess dietary glucose",
"B": "Increased peripheral insulin uptake",
"C": "Irregular insulin secretion",
"D": "Islet cell destruction"
},
"Question": "A 14-year-old boy presents for a pre-summer camp physical examination. Routine urinalysis discloses 3+ glucosuria. He admits to thirst and frequent urination, accompanied by a 4-kg (9-lb) weight loss over past few months. His parents note that he had a flu-like illness 5 months ago. His blood glucose is 220 mg/dL. Which of the following best explains the pathogenesis of hyperglycemia in this patient?"
} | A 14-year-old boy presents for a pre-summer camp physical examination. Routine urinalysis discloses 3+ glucosuria. He admits to thirst and frequent urination, accompanied by a 4-kg (9-lb) weight loss over past few months. His parents note that he had a flu-like illness 5 months ago. His blood glucose is 220 mg/dL. | Which of the following best explains the pathogenesis of hyperglycemia in this patient? | {
"A": "Excess dietary glucose",
"B": "Increased peripheral insulin uptake",
"C": "Irregular insulin secretion",
"D": "Islet cell destruction"
} | D. Islet cell destruction |
1d1f3e54-7dd9-45d2-9493-31719e46cca7 | A 21-year-old man presents with symptoms of headache, fever, chills, and discomfort in both sides of his jaw. He has also noticed discomfort in his testes, but no dysuria or urethral discharge. Physical examination reveals bilateral enlargement of the parotid glands, as well as bilateral testicular enlargement and tenderness on palpation. His temperature is 38.5degC pulse rate of 92/min, and the remaining examination is normal. Laboratory data show hemoglobin 15 g/dL; hematocrit 40%; WBC 12000/mL, with 30% segmented neutrophils, 8% monocytes, and 62% lymphocytes. Which of the following statements concerning this disease is true? | the disease is caused by a herpesvirus | the incubation period is 3-5 days | the most common complication of this disease in post-pubertal boys and men is orchitis | recurrent infections may occur | 2c
| multi | Orchitis occurs in about 20% of males, but is usually unilateral, thus sterility is rare. The disease is caused by a paramyxovirus and one infection confers lifelong immunity. The incubation period is 14-18 days. Serum amylase is elevated in most cases of mumps because of parotitis, not pancreatitis. Other complications include thyroiditis, myocarditis, and polyarthritis. | Medicine | Infection | 163 | {
"Correct Answer": "the most common complication of this disease in post-pubertal boys and men is orchitis",
"Correct Option": "C",
"Options": {
"A": "the disease is caused by a herpesvirus",
"B": "the incubation period is 3-5 days",
"C": "the most common complication of this disease in post-pubertal boys and men is orchitis",
"D": "recurrent infections may occur"
},
"Question": "A 21-year-old man presents with symptoms of headache, fever, chills, and discomfort in both sides of his jaw. He has also noticed discomfort in his testes, but no dysuria or urethral discharge. Physical examination reveals bilateral enlargement of the parotid glands, as well as bilateral testicular enlargement and tenderness on palpation. His temperature is 38.5degC pulse rate of 92/min, and the remaining examination is normal. Laboratory data show hemoglobin 15 g/dL; hematocrit 40%; WBC 12000/mL, with 30% segmented neutrophils, 8% monocytes, and 62% lymphocytes. Which of the following statements concerning this disease is true?"
} | A 21-year-old man presents with symptoms of headache, fever, chills, and discomfort in both sides of his jaw. He has also noticed discomfort in his testes, but no dysuria or urethral discharge. Physical examination reveals bilateral enlargement of the parotid glands, as well as bilateral testicular enlargement and tenderness on palpation. His temperature is 38.5degC pulse rate of 92/min, and the remaining examination is normal. Laboratory data show hemoglobin 15 g/dL; hematocrit 40%; WBC 12000/mL, with 30% segmented neutrophils, 8% monocytes, and 62% lymphocytes. | Which of the following statements concerning this disease is true? | {
"A": "the disease is caused by a herpesvirus",
"B": "the incubation period is 3-5 days",
"C": "the most common complication of this disease in post-pubertal boys and men is orchitis",
"D": "recurrent infections may occur"
} | C. the most common complication of this disease in post-pubertal boys and men is orchitis |
a3a21a04-354a-4f9c-b756-7ac3701585b1 | A 64 year old man presents to the physician's office complaining of fevers for the past 2 days. Over the past 24 hours, he has developed a productive cough. He also repos that he has frequent chills, and has been waking for the past 2 nights with drenching sweats. His past medical history is remarkable only for mild exeional angina. On physical examination, he does not appear chronically ill but appears moderately dyspneic. His temperature is 38.6 C (101.4 F), blood pressure is 136/94 mm Hg, and respirations are 26/min. There is no jugular venous distention. The lungs have coarse rhonchi at the right lung base with increased fremitus in the same area. He has a regular hea rhythm, with a 1/6 systolic murmur at the left sternal border. The remainder of the physical examination is unremarkable. Which of the following is the most appropriate next step in diagnosis? | ECG | Sputum Gram's stain | Chest CT scan | Pulmonary function test | 1b
| multi | This patient has a classic presentation of an acute community acquired bacterial pneumonia, as demonstrated by the findings of acute onset of fevers, rigors, and a productive sputum. His physical examination is consistent with a right lower lobe pneumonia and consolidation in this region. A sputum Gram's stain may demonstrate the organism responsible for this patient's pneumonia. The next step would then be a chest x-ray to confirm the presence of a pneumonia and identify its size and any associated parapneumonic effusions. A chest x-ray film is also indicated, but may take an hour or more to actually be obtained. For this reason, collecting sputum for a Gram's stain, before the x-ray, may shoen the time to definitive therapy. Chest CT scan is usually reserved for evaluation of suspected masses. Pulmonary function tests and peak expiratory flow rate measurement are usually reserved for evaluation of chronic lung diseases, such as emphysema, chronic bronchitis, pulmonary fibrosis, and asthma. Ref: Leeper, Jr. K.V., Moss M. (2003). Chapter 36. Bacterial Pneumonia. In M.E. Hanley, C.H. Welsh (Eds), CURRENT Diagnosis & Treatment in Pulmonary Medicine | Medicine | null | 221 | {
"Correct Answer": "Sputum Gram's stain",
"Correct Option": "B",
"Options": {
"A": "ECG",
"B": "Sputum Gram's stain",
"C": "Chest CT scan",
"D": "Pulmonary function test"
},
"Question": "A 64 year old man presents to the physician's office complaining of fevers for the past 2 days. Over the past 24 hours, he has developed a productive cough. He also repos that he has frequent chills, and has been waking for the past 2 nights with drenching sweats. His past medical history is remarkable only for mild exeional angina. On physical examination, he does not appear chronically ill but appears moderately dyspneic. His temperature is 38.6 C (101.4 F), blood pressure is 136/94 mm Hg, and respirations are 26/min. There is no jugular venous distention. The lungs have coarse rhonchi at the right lung base with increased fremitus in the same area. He has a regular hea rhythm, with a 1/6 systolic murmur at the left sternal border. The remainder of the physical examination is unremarkable. Which of the following is the most appropriate next step in diagnosis?"
} | A 64 year old man presents to the physician's office complaining of fevers for the past 2 days. Over the past 24 hours, he has developed a productive cough. He also repos that he has frequent chills, and has been waking for the past 2 nights with drenching sweats. His past medical history is remarkable only for mild exeional angina. On physical examination, he does not appear chronically ill but appears moderately dyspneic. His temperature is 38.6 C (101.4 F), blood pressure is 136/94 mm Hg, and respirations are 26/min. There is no jugular venous distention. The lungs have coarse rhonchi at the right lung base with increased fremitus in the same area. He has a regular hea rhythm, with a 1/6 systolic murmur at the left sternal border. The remainder of the physical examination is unremarkable. | Which of the following is the most appropriate next step in diagnosis? | {
"A": "ECG",
"B": "Sputum Gram's stain",
"C": "Chest CT scan",
"D": "Pulmonary function test"
} | B. Sputum Gram's stain |
62ccd1f0-ad65-4e65-8f44-3e0d8c5c7a27 | A 36-year-old primigravid woman at 36 weeks' gestation comes to the physician for a prenatal visit. She is experiencing good fetal movement and has had no loss of fluid, bleeding from the vagina, or contractions. She has no complaints. Her past medical history is significant for mitral stenosis, which she developed after an episode of rheumatic fever as a child. She also has asthma for which she uses an albuterol inhaler daily. She has herpes outbreaks approximately once a year. At her last visit she was found to be positive for Group B Streptococcus colonization. For which of the following disease processes would this patient benefit by having a forceps-assisted vaginal delivery at the time of delivery? | Asthma | Group B Streptococcus (GBS) colonization | Herpes | Mitral stenosis | 3d
| single | Ans:D.)Mitral Stenosis. Mitral valve stenosis is one of the more common valvular lesions seen in pregnancy. The most common cause of mitral stenosis is rheumatic endocarditis. During normal pregnancy there is an increase in the cardiac output and an increase in preload and circulating volume. Patients with mitral stenosis have a fixed, decreased valve area, which places them at risk for the development of pulmonary hypeension and pulmonary edemA. Control of arrhythmias is absolutely essential in these patients because they are at increased risk, given the left atrial enlargement that often goes along with their mitral stenosis. Labor and delivery can be a paicularly dangerous time for these patients. Therefore, patients with significant mitral stenosis should be monitored invasively using a Swan-Ganz catheter. It is recommended that the second stage of labor be shoened using forceps or vacuum to prevent excess maternal Valsalva effos and maternal tachycardia. Asthma ( Choice A)is not an indication for forceps-assisted vaginal delivery. In terms of mode of delivery, asthmatic patients may be managed like any other patient in the second stage of labor. Group B Streptococcus colonization (Choice B) is an indication for intravenous penicillin or clindamycin (if the patient has an allergy to penicillin). These antibiotics are given to prevent GBS sepsis in the neonate. GBS colonization is not an indication for forceps-assisted vaginal delivery. Herpes (Choice C) can be transmitted to the fetus at the time of delivery. Therefore, when lesions are present in the bih canal, most obstetricians recommend cesarean delivery. | Surgery | null | 154 | {
"Correct Answer": "Mitral stenosis",
"Correct Option": "D",
"Options": {
"A": "Asthma",
"B": "Group B Streptococcus (GBS) colonization",
"C": "Herpes",
"D": "Mitral stenosis"
},
"Question": "A 36-year-old primigravid woman at 36 weeks' gestation comes to the physician for a prenatal visit. She is experiencing good fetal movement and has had no loss of fluid, bleeding from the vagina, or contractions. She has no complaints. Her past medical history is significant for mitral stenosis, which she developed after an episode of rheumatic fever as a child. She also has asthma for which she uses an albuterol inhaler daily. She has herpes outbreaks approximately once a year. At her last visit she was found to be positive for Group B Streptococcus colonization. For which of the following disease processes would this patient benefit by having a forceps-assisted vaginal delivery at the time of delivery?"
} | A 36-year-old primigravid woman at 36 weeks' gestation comes to the physician for a prenatal visit. She is experiencing good fetal movement and has had no loss of fluid, bleeding from the vagina, or contractions. She has no complaints. Her past medical history is significant for mitral stenosis, which she developed after an episode of rheumatic fever as a child. She also has asthma for which she uses an albuterol inhaler daily. She has herpes outbreaks approximately once a year. At her last visit she was found to be positive for Group B Streptococcus colonization. | For which of the following disease processes would this patient benefit by having a forceps-assisted vaginal delivery at the time of delivery? | {
"A": "Asthma",
"B": "Group B Streptococcus (GBS) colonization",
"C": "Herpes",
"D": "Mitral stenosis"
} | D. Mitral stenosis |
b04ff4ed-e124-4793-bc15-ff7379450a27 | A 39-year-old male presents with bloody diarrhea. Multiple stool examinations fail to reveal any ova or parasites. A barium examination of the patient's colon reveals a characteristic "string sign." A colonoscopy reveals the rectum and sigmoid poions of the colon to be unremarkable. A biopsy from the terminal ileum reveals numerous acute and chronic inflammatory cells within the lamina propria. Worsening of the patient's symptoms results in emergency resection of the distal small intestines. Gross examination of this resected bowel reveals deep, long mucosal fissures extending deep into the muscle wall. Several transmural fistulas are also found. What is the best diagnosis for this patient? | Ulcerative colitis | Infectious colitis | Eosinophilic colitis | Crohn's disease | 3d
| multi | The two inflammatory bowel diseases (IBDs), Crohn's disease (CD) and ulcerative colitis (UC), are both chronic, relapsing inflammatory disorders of unknown etiology. They both may show very similar morphologic features and associations, such as mucosal inflammation, malignant transformation, and extragastrointestinal manifestations that include erythema nodosum (especially ulcerative colitis), ahritis, uveitis, pericholangitis (especially with ulcerative colitis, in which sclerosing pericholangitis may produce obstructive jaundice), and ankylosing spondylitis. CD is classically described as being a granulomatous disease, but granulomas are present in only 25 to 75% of cases. Therefore, the absence of granulomas does not rule out the diagnosis of CD. CD may involve any poion of the gastrointestinal tract and is characterized by focal (segmental) involvement with "skip lesions." Involvement of the intestines by CD is typically transmural inflammation, which leads to the formation of fistulas and sinuses. The deep inflammation produces deep longitudinal, serpiginous ulcers, which impa a "cobblestone" appearance to the mucosal surface of the colon. Additionally in Crohn's disease, the mesenteric fat wraps around the bowel surface, producing what is called "creeping fat," and the thickened wall narrows the lumen, producing a characteristic "string sign" on x-ray. This narrowing of the colon, which may produce intestinal obstruction, is grossly described as a "lead pipe" or "garden hose" colon. In contrast to CD, UC affects only the colon, and the disease involvement is continuous. The rectum is involved in all cases, and the inflammation extends proximally. Since UC involves the mucosa and submucosa, but not the wall, fistula formation and wall thickening are absent (but toxic megacolon may occur). Grossly, the mucosa displays diffuse hyperemia with numerous superficial ulcerations. The regenerating, nonulcerated mucosa appears as "pseudopolyps." Reference: Robbins & Cotran Pathologic Basis of Disease, 9edition | Pathology | miscellaneous | 146 | {
"Correct Answer": "Crohn's disease",
"Correct Option": "D",
"Options": {
"A": "Ulcerative colitis",
"B": "Infectious colitis",
"C": "Eosinophilic colitis",
"D": "Crohn's disease"
},
"Question": "A 39-year-old male presents with bloody diarrhea. Multiple stool examinations fail to reveal any ova or parasites. A barium examination of the patient's colon reveals a characteristic \"string sign.\" A colonoscopy reveals the rectum and sigmoid poions of the colon to be unremarkable. A biopsy from the terminal ileum reveals numerous acute and chronic inflammatory cells within the lamina propria. Worsening of the patient's symptoms results in emergency resection of the distal small intestines. Gross examination of this resected bowel reveals deep, long mucosal fissures extending deep into the muscle wall. Several transmural fistulas are also found. What is the best diagnosis for this patient?"
} | A 39-year-old male presents with bloody diarrhea. Multiple stool examinations fail to reveal any ova or parasites. A barium examination of the patient's colon reveals a characteristic "string sign." A colonoscopy reveals the rectum and sigmoid poions of the colon to be unremarkable. A biopsy from the terminal ileum reveals numerous acute and chronic inflammatory cells within the lamina propria. Worsening of the patient's symptoms results in emergency resection of the distal small intestines. Gross examination of this resected bowel reveals deep, long mucosal fissures extending deep into the muscle wall. Several transmural fistulas are also found. | What is the best diagnosis for this patient? | {
"A": "Ulcerative colitis",
"B": "Infectious colitis",
"C": "Eosinophilic colitis",
"D": "Crohn's disease"
} | D. Crohn's disease |
c7c34436-70aa-4e05-8678-3231bffd2b8e | A 42-year-old obese woman (BMI =32 kg/m2) presents with severe abdominal pain that radiates to the back. There is no history of alcohol or drug abuse. The blood pressure is 90/45 mm Hg, respirations are 32 per minute, and pulse is 100 per minute. Physical examination shows abdominal tenderness, guarding, and rigidity An X-ray film of the chest shows a left pleural effusion. Laboratory studies reveal elevated serum amylase (850 U/L) and lipase (675 U/L), and hypocalcemia (7.8 mg/dL). Which of the following is the most likely diagnosis? | Acute cholecystitis | Acute pancreatitis | Alcoholic hepatitis | Chronic calcifying pancreatitis | 1b
| single | Acute pancreatitis is defined as an inflammatory condition of the exocrine pancreas that results from injury to acinar cells. The disease presents with a spectrum of signs and symptoms. Severe forms are characterized by the sudden onset of abdominal pain, often accompanied by signs of shock (hypotension, tachypnea, and tachycardia). The release of amylase and lipase from the injured pancreas into the serum provides a sensitive marker for monitoring injury to acinar cells. Left pleural effusion is a common finding in patients with acute pancreatitis due to local irritation below the diaphragm. The other choices do not feature increases in serum amylase and lipase.Diagnosis: Pancreatitis, acute | Pathology | Pancreas | 148 | {
"Correct Answer": "Acute pancreatitis",
"Correct Option": "B",
"Options": {
"A": "Acute cholecystitis",
"B": "Acute pancreatitis",
"C": "Alcoholic hepatitis",
"D": "Chronic calcifying pancreatitis"
},
"Question": "A 42-year-old obese woman (BMI =32 kg/m2) presents with severe abdominal pain that radiates to the back. There is no history of alcohol or drug abuse. The blood pressure is 90/45 mm Hg, respirations are 32 per minute, and pulse is 100 per minute. Physical examination shows abdominal tenderness, guarding, and rigidity An X-ray film of the chest shows a left pleural effusion. Laboratory studies reveal elevated serum amylase (850 U/L) and lipase (675 U/L), and hypocalcemia (7.8 mg/dL). Which of the following is the most likely diagnosis?"
} | A 42-year-old obese woman (BMI =32 kg/m2) presents with severe abdominal pain that radiates to the back. There is no history of alcohol or drug abuse. The blood pressure is 90/45 mm Hg, respirations are 32 per minute, and pulse is 100 per minute. Physical examination shows abdominal tenderness, guarding, and rigidity An X-ray film of the chest shows a left pleural effusion. Laboratory studies reveal elevated serum amylase (850 U/L) and lipase (675 U/L), and hypocalcemia (7.8 mg/dL). | Which of the following is the most likely diagnosis? | {
"A": "Acute cholecystitis",
"B": "Acute pancreatitis",
"C": "Alcoholic hepatitis",
"D": "Chronic calcifying pancreatitis"
} | B. Acute pancreatitis |
268b19f8-e89a-400b-a312-071c079710d1 | An elderly house wife lost her husband who died suddenly of Myocardial infarction couple of years ago. They had been staying alone for almost a decade with infrequent visits from her son and grandchildren. About a week after the death she heard his voice clearly talking to her as he would in a routine manner from the next room. She went to check but saw nothing. Subsequently she often heard his voice conversing with her and she would also discuss her daily matters with him. This however, provoked anxiety and sadness of mood when she was preoccupied with his thought. She should be treated with - | Clomipramine | Alprazolam | Electroconvulsive therapy | Haloperidol | 0a
| single | Once again, most of the guides have given option `d' haloperidol as the answer by saying that there are psychotic symptoms (auditory hallucination) therefore antipsychotic should be given. However, they are wrong. Read below :-
The information in this question -
Death of loved one
Seeing the deceased person
Hearing the voice of deceased
Preoccupation with thoughts of deceased which is producing anxiety and depression (sadness of mood)
Symptoms for > 1 year (couple of years)
So, here the diagnosis is pathological grief reaction. The characteristic symptoms of pathological grief is preoccupation with thoughts of deceased person which may produce anxiety or depressive symptoms. Patient may also see or hear the voice of deceased (these are not psychotic features).
Treatment of pathological grief reaction mainly involve the treatment of depressive symptoms and anxiety.
Antidepressants are the most commonly used drugs. Amongst the given option only clomipramine is the antidepressant.
So, the answer of this question is antidepressant (clomipramine), not antipsychotic (haloperidol) as the symptoms of the patients are classical symptoms of pathological grief (not psychotic features).
You, should also keep in mind that if the symptoms would have been for less than 1 year, the diagnosis will be normal grief and the answer will be option b i.e. alprazolam as normal grief usually does not require any treatment although benzodiazepine may be used for short term. | Psychiatry | null | 122 | {
"Correct Answer": "Clomipramine",
"Correct Option": "A",
"Options": {
"A": "Clomipramine",
"B": "Alprazolam",
"C": "Electroconvulsive therapy",
"D": "Haloperidol"
},
"Question": "An elderly house wife lost her husband who died suddenly of Myocardial infarction couple of years ago. They had been staying alone for almost a decade with infrequent visits from her son and grandchildren. About a week after the death she heard his voice clearly talking to her as he would in a routine manner from the next room. She went to check but saw nothing. Subsequently she often heard his voice conversing with her and she would also discuss her daily matters with him. This however, provoked anxiety and sadness of mood when she was preoccupied with his thought. She should be treated with -"
} | An elderly house wife lost her husband who died suddenly of Myocardial infarction couple of years ago. They had been staying alone for almost a decade with infrequent visits from her son and grandchildren. About a week after the death she heard his voice clearly talking to her as he would in a routine manner from the next room. She went to check but saw nothing. Subsequently she often heard his voice conversing with her and she would also discuss her daily matters with him. This however, provoked anxiety and sadness of mood when she was preoccupied with his thought. | She should be treated with - | {
"A": "Clomipramine",
"B": "Alprazolam",
"C": "Electroconvulsive therapy",
"D": "Haloperidol"
} | A. Clomipramine |
5e2cca7b-8611-4618-ac0f-c2bbd88ebb06 | On November 6, a patient had the onset of an illness characterized by fever, chills, headache, cough, and chest pain. The illness lasted 1 week. On December 5, she had another illness very similar to the first, which lasted 6 days. She had no influenza immunization during this period. Her hemagglutination inhibition antibody titers to nH1N1 influenza virus were as follows:November 6: 10 November 30: 10 December 20: 160There was no laboratory error. Which of the following is the best conclusion from these data? | The patient was ill with influenza on November 6 | The patient was ill with influenza on December 5 | The patient was ill with influenza on December 20 | It is impossible to relate either illness with the nH1N1 influenza virus | 1b
| single | The symptoms described for her illnesses on both November 6 and December 5 are consistent with influenza. However, the November 6 illness (a) was not caused by nH1N1 influenza virus; the low titers (10 on November 6 and 10 on November 30) most likely represent cross-reacting antibodies from the agent that caused her first illness. The greater than fourfold rise in titer from 10 on November 30 (baseline) to 160 on December 20 reflects a definitive diagnostic rise in antibody against nH1N1 influenza virus. Thus, her December 5 illness (b) was influenza. There is enough serologic evidence to make the diagnosis (choice e is incorrect). | Microbiology | Virology | 131 | {
"Correct Answer": "The patient was ill with influenza on December 5",
"Correct Option": "B",
"Options": {
"A": "The patient was ill with influenza on November 6",
"B": "The patient was ill with influenza on December 5",
"C": "The patient was ill with influenza on December 20",
"D": "It is impossible to relate either illness with the nH1N1 influenza virus"
},
"Question": "On November 6, a patient had the onset of an illness characterized by fever, chills, headache, cough, and chest pain. The illness lasted 1 week. On December 5, she had another illness very similar to the first, which lasted 6 days. She had no influenza immunization during this period. Her hemagglutination inhibition antibody titers to nH1N1 influenza virus were as follows:November 6: 10 November 30: 10 December 20: 160There was no laboratory error. Which of the following is the best conclusion from these data?"
} | On November 6, a patient had the onset of an illness characterized by fever, chills, headache, cough, and chest pain. The illness lasted 1 week. On December 5, she had another illness very similar to the first, which lasted 6 days. She had no influenza immunization during this period. Her hemagglutination inhibition antibody titers to nH1N1 influenza virus were as follows:November 6: 10 November 30: 10 December 20: 160There was no laboratory error. | Which of the following is the best conclusion from these data? | {
"A": "The patient was ill with influenza on November 6",
"B": "The patient was ill with influenza on December 5",
"C": "The patient was ill with influenza on December 20",
"D": "It is impossible to relate either illness with the nH1N1 influenza virus"
} | B. The patient was ill with influenza on December 5 |
ef8e8afc-4f80-4ffc-bd98-5694c43dbbad | A 4-year-old child develops a runny nose and cough. After the cough persists for 2 weeks she exhibits paroxysms of coughing so severe she becomes cyanotic. On physical examination, her temperature is 37.4deg C. Her mouth and pharynx reveal no erythema or swelling. On auscultation of the chest, her lungs show crackles bilaterally. She has spasmodic coughing, with a series of coughs on a single breath, bringing up mucus plugs, followed by labored inspiration. The pathogenesis of her disease most likely results from disabling of which of the following? | Ciliary movement | Complement lysis | Immunoglobulin secretion | NK cell activation | 0a
| multi | Bordetella pertussis is the causative agent for whooping cough. These infections occur infrequently when there is widespread childhood vaccination against this organism. This coccobacillary organism is difficult to culture, and direct fluorescent antibody (DFA) testing is the fastest and most reliable way to diagnose the infection. Nasopharyngeal aspirates and swabs are the best specimens because the organisms attach to ciliated respiratory epithelium. The toxin paralyzes cilia. Complement lysis is most useful against circulating infectious agents. Immunoglobulins that circulate can bind organisms, but secretion is an adaptive immune response taking days to weeks. NK cells attack host cells with MHC signaling turned off by intracellular infectious agents such as viruses. Mycobacterial organisms inhibit phagolysosome formation to reduce their intracellular destruction in macrophages. | Pathology | Infectious Disease | 133 | {
"Correct Answer": "Ciliary movement",
"Correct Option": "A",
"Options": {
"A": "Ciliary movement",
"B": "Complement lysis",
"C": "Immunoglobulin secretion",
"D": "NK cell activation"
},
"Question": "A 4-year-old child develops a runny nose and cough. After the cough persists for 2 weeks she exhibits paroxysms of coughing so severe she becomes cyanotic. On physical examination, her temperature is 37.4deg C. Her mouth and pharynx reveal no erythema or swelling. On auscultation of the chest, her lungs show crackles bilaterally. She has spasmodic coughing, with a series of coughs on a single breath, bringing up mucus plugs, followed by labored inspiration. The pathogenesis of her disease most likely results from disabling of which of the following?"
} | A 4-year-old child develops a runny nose and cough. After the cough persists for 2 weeks she exhibits paroxysms of coughing so severe she becomes cyanotic. On physical examination, her temperature is 37.4deg C. Her mouth and pharynx reveal no erythema or swelling. On auscultation of the chest, her lungs show crackles bilaterally. She has spasmodic coughing, with a series of coughs on a single breath, bringing up mucus plugs, followed by labored inspiration. | The pathogenesis of her disease most likely results from disabling of which of the following? | {
"A": "Ciliary movement",
"B": "Complement lysis",
"C": "Immunoglobulin secretion",
"D": "NK cell activation"
} | A. Ciliary movement |
4af505fc-1599-4816-93d3-db57c3180969 | A 24-year-old woman is referred to the clinic for assessment of a low white-cell count. She has no past medical history and is not on any medications. Her only symptoms are of joint discomfort in her hands, and occasional sharp chest pains that change with breathing. On physical examination, there is inflammation of some MCP and DIP joints in both hands, and the rest of the examination is normal. Her WBC is 3500/mL and on the differential the lymphocytes are low (15%) and PMNs are normal. Which of the following is the most likely diagnosis? | periarteritis nodosa | SLE | scleroderma | DM | 1b
| multi | Leukopenia occurs in almost two-thirds of the SLE patients, and the differential count is usually normal. Lymphocytes and platelets can also be reduced. | Medicine | Immunology and Rheumatology | 122 | {
"Correct Answer": "SLE",
"Correct Option": "B",
"Options": {
"A": "periarteritis nodosa",
"B": "SLE",
"C": "scleroderma",
"D": "DM"
},
"Question": "A 24-year-old woman is referred to the clinic for assessment of a low white-cell count. She has no past medical history and is not on any medications. Her only symptoms are of joint discomfort in her hands, and occasional sharp chest pains that change with breathing. On physical examination, there is inflammation of some MCP and DIP joints in both hands, and the rest of the examination is normal. Her WBC is 3500/mL and on the differential the lymphocytes are low (15%) and PMNs are normal. Which of the following is the most likely diagnosis?"
} | A 24-year-old woman is referred to the clinic for assessment of a low white-cell count. She has no past medical history and is not on any medications. Her only symptoms are of joint discomfort in her hands, and occasional sharp chest pains that change with breathing. On physical examination, there is inflammation of some MCP and DIP joints in both hands, and the rest of the examination is normal. Her WBC is 3500/mL and on the differential the lymphocytes are low (15%) and PMNs are normal. | Which of the following is the most likely diagnosis? | {
"A": "periarteritis nodosa",
"B": "SLE",
"C": "scleroderma",
"D": "DM"
} | B. SLE |
e57550c9-12d6-42d0-8608-3f5176771d50 | A 31-year-old woman has had a persistent fever for the past 2 months. Her temperature has ranged from 38.3degC to 38.6degC on multiple occasions. On physical examination, she has diffuse abdominal pain and mild splenomegaly, but no hepatomegaly or lymphadenopathy. Laboratory studies show Hgb, 13.2 g/dL; Hct, 39.8%; MCV, 930 mm3; platelet count, 242,000/ mm3; and WBC count, 12,290/ mm3 with 71% segmented neutrophils, 19% lymphocytes, and 10% monocytes. CT imaging of her abdomen shows an ill-defined pelvic soft- tissue density mass with a mottled lucent center and a small, square, radiopaque area. Review of her medical record reveals that a salpingo-oophorectomy for ectopic pregnancy was performed on the left side 3 months ago. Which of the following is the most likely cause of her persistent fever? | Abscess | Non-Hodgkin lymphoma | Ovarian cystadenocarcinoma | Sarcoidosis | 0a
| multi | She has fever of unknown origin (FUO), at least until a record review correlated with the CT imaging suggests that the mass is a residual hemostatic sponge placed at the time of surgery. Radiopaque markers or radio-frequency identification (RFID) chips can be incorporated into such objects for identification. The mild splenomegaly is consistent with intra-abdominal abscess. There is a long differential diagnosis list for FUO. A mass could represent a neoplasm, but lymphomas do not tend to have significant necrosis and a lucent center. Sarcoidosis tends to involve multiple organs, but lymph node enlargement is likely, although central caseation is not. At the prior surgery, an ovarian neoplasm should have been identified, as would pelvic inflammatory disease that may produce a tubo-ovarian abscess. | Pathology | Misc. | 240 | {
"Correct Answer": "Abscess",
"Correct Option": "A",
"Options": {
"A": "Abscess",
"B": "Non-Hodgkin lymphoma",
"C": "Ovarian cystadenocarcinoma",
"D": "Sarcoidosis"
},
"Question": "A 31-year-old woman has had a persistent fever for the past 2 months. Her temperature has ranged from 38.3degC to 38.6degC on multiple occasions. On physical examination, she has diffuse abdominal pain and mild splenomegaly, but no hepatomegaly or lymphadenopathy. Laboratory studies show Hgb, 13.2 g/dL; Hct, 39.8%; MCV, 930 mm3; platelet count, 242,000/ mm3; and WBC count, 12,290/ mm3 with 71% segmented neutrophils, 19% lymphocytes, and 10% monocytes. CT imaging of her abdomen shows an ill-defined pelvic soft- tissue density mass with a mottled lucent center and a small, square, radiopaque area. Review of her medical record reveals that a salpingo-oophorectomy for ectopic pregnancy was performed on the left side 3 months ago. Which of the following is the most likely cause of her persistent fever?"
} | A 31-year-old woman has had a persistent fever for the past 2 months. Her temperature has ranged from 38.3degC to 38.6degC on multiple occasions. On physical examination, she has diffuse abdominal pain and mild splenomegaly, but no hepatomegaly or lymphadenopathy. Laboratory studies show Hgb, 13.2 g/dL; Hct, 39.8%; MCV, 930 mm3; platelet count, 242,000/ mm3; and WBC count, 12,290/ mm3 with 71% segmented neutrophils, 19% lymphocytes, and 10% monocytes. CT imaging of her abdomen shows an ill-defined pelvic soft- tissue density mass with a mottled lucent center and a small, square, radiopaque area. Review of her medical record reveals that a salpingo-oophorectomy for ectopic pregnancy was performed on the left side 3 months ago. | Which of the following is the most likely cause of her persistent fever? | {
"A": "Abscess",
"B": "Non-Hodgkin lymphoma",
"C": "Ovarian cystadenocarcinoma",
"D": "Sarcoidosis"
} | A. Abscess |
db45db11-a4f9-46d4-be1d-33af9d38c264 | A 25-year-old male gives a history of redness, pain and mild diminution of vision in one eye for past 3 days. There is also a history of low backache for the past one year. On examination there is circumcorneal congestion, cornea is clear apa from a few fine keratic precipitates on the corneal endothelium, there are 2+ cells in the anterior chamber and the intraocular pressure is within normal limits. The patient is most likely suffering from | Acute attack of angle closure glaucoma | HLA B-27 related anterior uveitis | JRA associated uveitis | Herpetic keratitis | 1b
| single | B i.e. HLA-B-27 related | Ophthalmology | null | 105 | {
"Correct Answer": "HLA B-27 related anterior uveitis",
"Correct Option": "B",
"Options": {
"A": "Acute attack of angle closure glaucoma",
"B": "HLA B-27 related anterior uveitis",
"C": "JRA associated uveitis",
"D": "Herpetic keratitis"
},
"Question": "A 25-year-old male gives a history of redness, pain and mild diminution of vision in one eye for past 3 days. There is also a history of low backache for the past one year. On examination there is circumcorneal congestion, cornea is clear apa from a few fine keratic precipitates on the corneal endothelium, there are 2+ cells in the anterior chamber and the intraocular pressure is within normal limits. The patient is most likely suffering from"
} | A 25-year-old male gives a history of redness, pain and mild diminution of vision in one eye for past 3 days. There is also a history of low backache for the past one year. On examination there is circumcorneal congestion, cornea is clear apa from a few fine keratic precipitates on the corneal endothelium, there are 2+ cells in the anterior chamber and the intraocular pressure is within normal limits. | The patient is most likely suffering from | {
"A": "Acute attack of angle closure glaucoma",
"B": "HLA B-27 related anterior uveitis",
"C": "JRA associated uveitis",
"D": "Herpetic keratitis"
} | B. HLA B-27 related anterior uveitis |
d611ca86-1309-48dd-9795-a15d182e1a87 | An 18-year-old man develops fever, headache, confusion, and generalized seizures. On examination, he is moving all his limbs, but incoherent. A CT scan shows bilateral, small, low-density temporal lobe lesions. CSF shows mononuclear cell pleocytosis, increased protein, and normal glucose. The EEG shows bilateral periodic discharges from the temporal leads and slow-wave complexes at regular intervals of 2-3/sec. Which of the following is the most appropriate next step in management? | angiography | observing response to therapy | cerebral biopsy | acute viral titers | 1b
| multi | The patient's findings strongly suggest herpes simplex encephalitis. This is generally caused by herpes simplex virus type 1 (HSVI). When the disease is suspected, appropriate antiviral therapy (acyclovir) should be started immediately. CT scan is not helpful in diagnosis because it becomes positive only late in the disease, but MRI scans may be helpful. Brain biopsy, once the diagnostic test of choice, is the most definitive test but is rarely performed. | Medicine | C.N.S. | 106 | {
"Correct Answer": "observing response to therapy",
"Correct Option": "B",
"Options": {
"A": "angiography",
"B": "observing response to therapy",
"C": "cerebral biopsy",
"D": "acute viral titers"
},
"Question": "An 18-year-old man develops fever, headache, confusion, and generalized seizures. On examination, he is moving all his limbs, but incoherent. A CT scan shows bilateral, small, low-density temporal lobe lesions. CSF shows mononuclear cell pleocytosis, increased protein, and normal glucose. The EEG shows bilateral periodic discharges from the temporal leads and slow-wave complexes at regular intervals of 2-3/sec. Which of the following is the most appropriate next step in management?"
} | An 18-year-old man develops fever, headache, confusion, and generalized seizures. On examination, he is moving all his limbs, but incoherent. A CT scan shows bilateral, small, low-density temporal lobe lesions. CSF shows mononuclear cell pleocytosis, increased protein, and normal glucose. The EEG shows bilateral periodic discharges from the temporal leads and slow-wave complexes at regular intervals of 2-3/sec. | Which of the following is the most appropriate next step in management? | {
"A": "angiography",
"B": "observing response to therapy",
"C": "cerebral biopsy",
"D": "acute viral titers"
} | B. observing response to therapy |
03cb7a8d-1eac-4028-870c-9d5a784328cb | An 18 years old male reported with chief complaint of sensitivity and deep, dull, radiating pain during chewing. Intra-oral examination showed sparase plague and dental calculus deposits, distolabial migration of the maxillary incisors with diastema formation, mobility of maxillary and mandibular incisors and first molars. Prescribed radiographs showed an arch shaped loss of alveolar bone extending from the distal surface of the mandibular second premolar to the mesial surface of the second molar. There was vertical bone loss in the maxillary incisor region.
The antigens consistently associated with this disease are | HLA A9 and B15 | HLA A0 and B30 | HLA A15 and B9 | HLA A30 and B0 | 0a
| single | null | Dental | null | 132 | {
"Correct Answer": "HLA A9 and B15",
"Correct Option": "A",
"Options": {
"A": "HLA A9 and B15",
"B": "HLA A0 and B30",
"C": "HLA A15 and B9",
"D": "HLA A30 and B0"
},
"Question": "An 18 years old male reported with chief complaint of sensitivity and deep, dull, radiating pain during chewing. Intra-oral examination showed sparase plague and dental calculus deposits, distolabial migration of the maxillary incisors with diastema formation, mobility of maxillary and mandibular incisors and first molars. Prescribed radiographs showed an arch shaped loss of alveolar bone extending from the distal surface of the mandibular second premolar to the mesial surface of the second molar. There was vertical bone loss in the maxillary incisor region.\n\nThe antigens consistently associated with this disease are"
} | An 18 years old male reported with chief complaint of sensitivity and deep, dull, radiating pain during chewing. Intra-oral examination showed sparase plague and dental calculus deposits, distolabial migration of the maxillary incisors with diastema formation, mobility of maxillary and mandibular incisors and first molars. Prescribed radiographs showed an arch shaped loss of alveolar bone extending from the distal surface of the mandibular second premolar to the mesial surface of the second molar. | There was vertical bone loss in the maxillary incisor region.
The antigens consistently associated with this disease are | {
"A": "HLA A9 and B15",
"B": "HLA A0 and B30",
"C": "HLA A15 and B9",
"D": "HLA A30 and B0"
} | A. HLA A9 and B15 |
c8b958b5-3994-40cb-8a19-9348cdd9df4a | A 53 year old female lawyer who has been married for 20 years comes to her physician's office because she has not felt "up to par" over the past 2 months. She is married, has two grown sons, and has a good practice. In the past couple of weeks, she has stopped taking care of her appearance and has frequently called in sick to work, when she actually has been having difficulty getting out of bed. She states that she has lost her appetite recently and her interest in sex with her husband has decreased considerably. She recently told her husband that at times she wonders whether she should go on living. She denies any history of drug or alcohol abuse, and a complete physical examination 3 months earlier showed her to be in good health. Which of the following is the mostly likely diagnosis? | Bipolar I disorder | Generalized anxiety disorder | Major depressive disorder | Panic disorder | 2c
| multi | This patient most likely has major depressive disorder. She has had symptoms for 2 months, surpassing the DSM-IV criteria for a minimal length of depression of 2 weeks. Her other symptoms include loss of appetite, hypersomnia, decreased libido, loss of energy and interest in pleasurable activities, and vague suicidal ideation, all of which are criteria for major depression. The diagnosis of bipolar I disorder, requires an episode of mania, with increased grandiosity, irritability, and impulsiveness, either currently or in the past--none of which are seen in this case. Generalized anxiety disorder requires frequent intermittent episodes of anxiety over a more prolonged period than 2 months. This diagnosis is ruled out in this patient by the absence of any prominent symptoms of anxiety. The diagnosis of panic disorder requires discrete episodes known as panic attacks, with tachycardia, diaphoresis, and a sense of impending doom--none of which this patient describes. Ref: Brent D.A., Pan L. (2008). Chapter 38. Depressive Disorders (in Childhood and Adolescence). In M.H. Ebe, P.T. Loosen, B. Nurcombe, J.F. Leckman (Eds),CURRENT Diagnosis & Treatment: Psychiatry, 2e. | Psychiatry | null | 167 | {
"Correct Answer": "Major depressive disorder",
"Correct Option": "C",
"Options": {
"A": "Bipolar I disorder",
"B": "Generalized anxiety disorder",
"C": "Major depressive disorder",
"D": "Panic disorder"
},
"Question": "A 53 year old female lawyer who has been married for 20 years comes to her physician's office because she has not felt \"up to par\" over the past 2 months. She is married, has two grown sons, and has a good practice. In the past couple of weeks, she has stopped taking care of her appearance and has frequently called in sick to work, when she actually has been having difficulty getting out of bed. She states that she has lost her appetite recently and her interest in sex with her husband has decreased considerably. She recently told her husband that at times she wonders whether she should go on living. She denies any history of drug or alcohol abuse, and a complete physical examination 3 months earlier showed her to be in good health. Which of the following is the mostly likely diagnosis?"
} | A 53 year old female lawyer who has been married for 20 years comes to her physician's office because she has not felt "up to par" over the past 2 months. She is married, has two grown sons, and has a good practice. In the past couple of weeks, she has stopped taking care of her appearance and has frequently called in sick to work, when she actually has been having difficulty getting out of bed. She states that she has lost her appetite recently and her interest in sex with her husband has decreased considerably. She recently told her husband that at times she wonders whether she should go on living. She denies any history of drug or alcohol abuse, and a complete physical examination 3 months earlier showed her to be in good health. | Which of the following is the mostly likely diagnosis? | {
"A": "Bipolar I disorder",
"B": "Generalized anxiety disorder",
"C": "Major depressive disorder",
"D": "Panic disorder"
} | C. Major depressive disorder |
a0faf7bf-751b-43ce-a54d-a90259c376b2 | A 60-year-old woman noticed an enlarging "bump" beneath her tongue for the past year. She does not smoke or use alcohol. On physical examination, there is a 2.5-cm, movable, submucosal mass arising in the minor salivary glands on the buccal mucosa beneath the tongue on the right. Histologic examination of the excised mass shows that it is malignant and locally invasive. The tumor recurs within 1 year. Which of the following is the most likely diagnosis? | Non-Hodgkin lymphoma | Mucoepidermoid carcinoma | Primitive neuroectodermal tumor | Pleomorphic adenoma | 1b
| multi | Mucoepidermoid carcinomas can arise in major and minor salivary glands. They account for most neoplasms that arise within minor salivary glands, particularly malignant neoplasms. Low-grade mucoepidermoid carcinomas may be invasive, but the prognosis is usually good, with a 5-year survival of 90%. High-grade mucoepidermoid carcinomas can metastasize and have a 5-year survival of only 50%. Non- Hodgkin lymphomas are found in adjacent cervical lymph nodes or in the Waldeyer ring of lymphoid tissue. A primitive neuroectodermal tumor, also known as an olfactory neuroblastoma, is a small, round, blue cell tumor of childhood; it is likely to arise in the nasopharyngeal region. Pleomorphic adenomas are more common in the major salivary glands than are mucoepidermoid tumors, and they are more likely to be indolent. Squamous cell carcinomas are invasive and arise in the buccal mucosa. Warthin tumors are uncommon and indolent. | Pathology | Head & Neck | 110 | {
"Correct Answer": "Mucoepidermoid carcinoma",
"Correct Option": "B",
"Options": {
"A": "Non-Hodgkin lymphoma",
"B": "Mucoepidermoid carcinoma",
"C": "Primitive neuroectodermal tumor",
"D": "Pleomorphic adenoma"
},
"Question": "A 60-year-old woman noticed an enlarging \"bump\" beneath her tongue for the past year. She does not smoke or use alcohol. On physical examination, there is a 2.5-cm, movable, submucosal mass arising in the minor salivary glands on the buccal mucosa beneath the tongue on the right. Histologic examination of the excised mass shows that it is malignant and locally invasive. The tumor recurs within 1 year. Which of the following is the most likely diagnosis?"
} | A 60-year-old woman noticed an enlarging "bump" beneath her tongue for the past year. She does not smoke or use alcohol. On physical examination, there is a 2.5-cm, movable, submucosal mass arising in the minor salivary glands on the buccal mucosa beneath the tongue on the right. Histologic examination of the excised mass shows that it is malignant and locally invasive. The tumor recurs within 1 year. | Which of the following is the most likely diagnosis? | {
"A": "Non-Hodgkin lymphoma",
"B": "Mucoepidermoid carcinoma",
"C": "Primitive neuroectodermal tumor",
"D": "Pleomorphic adenoma"
} | B. Mucoepidermoid carcinoma |
Subsets and Splits