id
stringlengths 36
36
| question
stringlengths 243
1.57k
| opa
stringlengths 1
265
| opb
stringlengths 1
247
| opc
stringlengths 1
240
| opd
stringlengths 1
195
| cop
class label 4
classes | choice_type
stringclasses 2
values | exp
stringlengths 8
8.48k
⌀ | subject_name
stringclasses 21
values | topic_name
stringclasses 263
values | token_count
int64 101
359
| data
dict | Context
stringlengths 1
1.35k
| Question_formatted
stringlengths 2
1.39k
| Options
dict | Final_answer
stringlengths 4
250
|
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
897d6414-57a4-458a-bf59-c5c36436f60a | A 60-year-old man is admitted to the coronary care unit with a large anterior wall myocardial infarction. On his second hospital day he begins to complain of the sudden onset of numbness in his right foot and an inability to move his right foot. On physical examination, the right femoral, popliteal, and pedal pulses are no longer palpable. Vascular consultation is obtained. Diagnosis of acute arterial embolus is made. Which of the following statements concerning this condition is true? | Appropriate management would be embolectomy of the right femoral artery under general anesthesia | Noninvasive hemodynamic testing is required | Prophylactic exploration of the contralateral femoral artery should be done despite the presence of a normal pulse | The source of the embolus is most likely the left ventricle | 3d
| multi | The heart is the most common source of arterial emboli and accounts for 90% of cases. Within the heart, sources include diseased valves, endocarditis, the left atrium in patients with unstable atrial arrhythmias, and mural thrombus on the wall of the left ventricle in patients with a myocardial infarction. The diagnosis in this patient is clear, and therefore neither noninvasive testing nor arteriography is indicated. Arteriography in fact may also prove to be too stressful for a patient undergoing an acute myocardial infarction. Embolectomy of the femoral artery can be performed under local anesthesia with minimal risk to the patient. Emboli typically lodge in one femoral artery; contralateral exploration is not indicated in the absence of signs or symptoms. One should always prepare the contralateral groin in case flow is not restored via simple thrombectomy and femoral-femoral bypass is needed to provide inflow to the affected limb. | Surgery | Arterial Disorders | 104 | {
"Correct Answer": "The source of the embolus is most likely the left ventricle",
"Correct Option": "D",
"Options": {
"A": "Appropriate management would be embolectomy of the right femoral artery under general anesthesia",
"B": "Noninvasive hemodynamic testing is required",
"C": "Prophylactic exploration of the contralateral femoral artery should be done despite the presence of a normal pulse",
"D": "The source of the embolus is most likely the left ventricle"
},
"Question": "A 60-year-old man is admitted to the coronary care unit with a large anterior wall myocardial infarction. On his second hospital day he begins to complain of the sudden onset of numbness in his right foot and an inability to move his right foot. On physical examination, the right femoral, popliteal, and pedal pulses are no longer palpable. Vascular consultation is obtained. Diagnosis of acute arterial embolus is made. Which of the following statements concerning this condition is true?"
} | A 60-year-old man is admitted to the coronary care unit with a large anterior wall myocardial infarction. On his second hospital day he begins to complain of the sudden onset of numbness in his right foot and an inability to move his right foot. On physical examination, the right femoral, popliteal, and pedal pulses are no longer palpable. Vascular consultation is obtained. Diagnosis of acute arterial embolus is made. | Which of the following statements concerning this condition is true? | {
"A": "Appropriate management would be embolectomy of the right femoral artery under general anesthesia",
"B": "Noninvasive hemodynamic testing is required",
"C": "Prophylactic exploration of the contralateral femoral artery should be done despite the presence of a normal pulse",
"D": "The source of the embolus is most likely the left ventricle"
} | D. The source of the embolus is most likely the left ventricle |
fb4c132c-cc8e-443e-afa5-963e33130c10 | A 12-year-old boy has a cough and earache for the past 2 days. He has a history of recurrent infections, including otitis media, diarrhea, and pneumonia. Physical examination shows an erythematous right tympanic membrane, a cleft palate, and murmur suggestive of congenital heart disease. A thoracic CT scan shows a small thymus. Results of laboratory studies suggest mild hypoparathyroidism. Which of the following diagnostic studies is most likely to be helpful in diagnosing this patient's condition? | Adenosine deaminase assay in lymphocytes | Branched DNA assay for HIV-1 RNA level | FISH analysis with a probe for chromosome 22q11.2 | Lymph node biopsy | 2c
| multi | DiGeorge syndrome is an immunodeficiency characterized by infection, a small thymus, congenital malformations, and hypoparathyroidism. This cluster is characteristic of the 22q11.2 deletion syndrome, readily diagnosed by FISH. Adenosine deaminase deficiency can cause immunodeficiency, but it is not associated with congenital malformations. Branched DNA assay can detect HIV infection that can lead to AIDS, but no congenital anomalies are associated with this condition. A lymph node biopsy may show a reduction in T cells or B cells associated with various forms of immunodeficiency, but this is not a specific test that can aid in confirming a specific diagnosis. Trinucleotide repeats of the X chromosome, detected by PCR, are seen in fragile X syndrome, which manifests with mental retardation in males. | Pathology | Genetics | 112 | {
"Correct Answer": "FISH analysis with a probe for chromosome 22q11.2",
"Correct Option": "C",
"Options": {
"A": "Adenosine deaminase assay in lymphocytes",
"B": "Branched DNA assay for HIV-1 RNA level",
"C": "FISH analysis with a probe for chromosome 22q11.2",
"D": "Lymph node biopsy"
},
"Question": "A 12-year-old boy has a cough and earache for the past 2 days. He has a history of recurrent infections, including otitis media, diarrhea, and pneumonia. Physical examination shows an erythematous right tympanic membrane, a cleft palate, and murmur suggestive of congenital heart disease. A thoracic CT scan shows a small thymus. Results of laboratory studies suggest mild hypoparathyroidism. Which of the following diagnostic studies is most likely to be helpful in diagnosing this patient's condition?"
} | A 12-year-old boy has a cough and earache for the past 2 days. He has a history of recurrent infections, including otitis media, diarrhea, and pneumonia. Physical examination shows an erythematous right tympanic membrane, a cleft palate, and murmur suggestive of congenital heart disease. A thoracic CT scan shows a small thymus. Results of laboratory studies suggest mild hypoparathyroidism. | Which of the following diagnostic studies is most likely to be helpful in diagnosing this patient's condition? | {
"A": "Adenosine deaminase assay in lymphocytes",
"B": "Branched DNA assay for HIV-1 RNA level",
"C": "FISH analysis with a probe for chromosome 22q11.2",
"D": "Lymph node biopsy"
} | C. FISH analysis with a probe for chromosome 22q11.2 |
4c13bb22-7676-4b8a-94bb-77bfdb838ed7 | A 94-year-old female nursing home resident is referred for evaluation of anemia of 8 g/dL. She has dementia, and adequate documentation of her past medical history is not available. She eats well and is cooperative. Examination reveals evidence of cognitive impairment, primitive reflexes, and a well-healed midline abdominal scar. Her blood film is shown in Figure below. You presume a relationship between the anemia and the previous surgery. Which of the following surgical procedures is most likely to cause her current anemia? | gastrectomy | vagotomy and pyloroplasty | cholecystectomy | right hemicolectomy | 0a
| single | The macrocytic cells and hyper-segmented neutrophil are characteristic of megaloblastic anemia. Vitamin B12 and folate deficiency are the most common cause. Lack of intrinsic factor because of gastrectomy will eventually result in B12 deficiency. | Medicine | G.I.T. | 107 | {
"Correct Answer": "gastrectomy",
"Correct Option": "A",
"Options": {
"A": "gastrectomy",
"B": "vagotomy and pyloroplasty",
"C": "cholecystectomy",
"D": "right hemicolectomy"
},
"Question": "A 94-year-old female nursing home resident is referred for evaluation of anemia of 8 g/dL. She has dementia, and adequate documentation of her past medical history is not available. She eats well and is cooperative. Examination reveals evidence of cognitive impairment, primitive reflexes, and a well-healed midline abdominal scar. Her blood film is shown in Figure below. You presume a relationship between the anemia and the previous surgery. Which of the following surgical procedures is most likely to cause her current anemia?"
} | A 94-year-old female nursing home resident is referred for evaluation of anemia of 8 g/dL. She has dementia, and adequate documentation of her past medical history is not available. She eats well and is cooperative. Examination reveals evidence of cognitive impairment, primitive reflexes, and a well-healed midline abdominal scar. Her blood film is shown in Figure below. You presume a relationship between the anemia and the previous surgery. | Which of the following surgical procedures is most likely to cause her current anemia? | {
"A": "gastrectomy",
"B": "vagotomy and pyloroplasty",
"C": "cholecystectomy",
"D": "right hemicolectomy"
} | A. gastrectomy |
eb9265e5-239a-4a4b-b146-253b641bbceb | A 40 year old male, with history of daily alcohol consumption for the last 7 years, is brought to the hospital emergency room with acute onsent of seeing snakes all around him in the room, not recognizing family members, violent behavior and tremulousness for few hours. There is history of his having missed the alcohol drink since 2 days. Examination reveals increased blood pressure, tremors, increased psychomotor activity, fearful affect, hallucinatory behaviour, disorientation, impaired judgment and insight. He is most likely to be suffering from: | Alcoholic hallucinosis | Delirium tremens | Wernicke encephalopathy | Korsakoff's psychosis | 1b
| multi | B i.e. Delirium tremens | Psychiatry | null | 113 | {
"Correct Answer": "Delirium tremens",
"Correct Option": "B",
"Options": {
"A": "Alcoholic hallucinosis",
"B": "Delirium tremens",
"C": "Wernicke encephalopathy",
"D": "Korsakoff's psychosis"
},
"Question": "A 40 year old male, with history of daily alcohol consumption for the last 7 years, is brought to the hospital emergency room with acute onsent of seeing snakes all around him in the room, not recognizing family members, violent behavior and tremulousness for few hours. There is history of his having missed the alcohol drink since 2 days. Examination reveals increased blood pressure, tremors, increased psychomotor activity, fearful affect, hallucinatory behaviour, disorientation, impaired judgment and insight. He is most likely to be suffering from:"
} | A 40 year old male, with history of daily alcohol consumption for the last 7 years, is brought to the hospital emergency room with acute onsent of seeing snakes all around him in the room, not recognizing family members, violent behavior and tremulousness for few hours. There is history of his having missed the alcohol drink since 2 days. Examination reveals increased blood pressure, tremors, increased psychomotor activity, fearful affect, hallucinatory behaviour, disorientation, impaired judgment and insight. | He is most likely to be suffering from: | {
"A": "Alcoholic hallucinosis",
"B": "Delirium tremens",
"C": "Wernicke encephalopathy",
"D": "Korsakoff's psychosis"
} | B. Delirium tremens |
edfa5549-021b-411e-a8db-424f3822d0f0 | A 40 years old multi gravida woman comes to the hospital with two months history of worsening right pelvic pain. She experiences the pain daily. The intensity does not vary with menstruation. The patient's waist size was increased despite her poor appetite. The pelvic examination shows irregularly shaped fixed adnexal mass. One week later, the patient undergoes surgery for removal of large ovarian neoplasm. Within the true pelvis, the surgeon can most likely palpate the right ureter immediately anterior to | Gonadal vein | Inferior vena cava | Internal iliac artery | Uterine artery | 2c
| multi | Answer: (c) Internal Iliac arteryURETERS* 25cm long, upper half lies in the abdomen and the lower half in the pelvis. The course is:* Begins within the renal sinus as a funnel shaped dilatation, (the renal pelvis)- Passes through the hilum-Goes downwards & medially-Enters the pelvis by crossing in front of common iliac artery- Reach the base of the bladder -Obliquely enters the bladder wall & opens into it at the lateral angle of trigone.* In pelvis, the ureter is crossed by ductus deferens in men & uterine artery in women.Constrictions on ureter:* At the pelvis - ureteric junction* At the brim of the lesser pelvis: where the ureters cross the common iliac vessels.* At its passage through the bladder wall RELATIONS OF THE URETER ABDOMINAL PART OF URETERAnteriorlyPosteriorlyMediallyRight sideLeft side* Psoas major* Tips of transverse Process* Genitofemor al nerveRight sideIVC* 3rd part of duodenum* Peritoneum* Right colic vessels* Ileocolic vessels* Gonadal vessels* Root of mesentery* Terminal part of Ileum* Peritoneum* Gonadal artery* Left colic vessels* Sigmoid colon* Sigmoid mesocolonLeft side* Left gonadal vein* Inferior mesenteric veinPELVIC PART OF URETER:The internal iliac A begins at the level of IV disc between L5 & SI vertebrae, where it is crossed by ureter.* The ureter passes posterior to the uterine artery through the cardinal ligament within the ureteric tunnel.* In the pelvis the ureter lies in extraperitoneal areolar tissue.* At first it descends posterolaterally on the lateral wall of the lesser pelvis along the anterior border of the greater sciatic notch.* Opposite the ischial spine it turns anteromedially into fibrous adipose tissue above levator ani to reach the base of the bladder.* On the pelvic wall it is anterior to the internal iliac artery and the beginning of its anterior trunk, posterior to which are the internal iliac vein, lumbosacral nerve and sacroiliac joint.* Laterally it lies on the fascia of obturator internus. It progressively crosses to become medial to the umbilical, inferior vesical, and middle rectal arteries.In its Downward CourseIn its Forward CoursePosteriorlyLaterallyIn MalesIn Females* Internal Iliac. A and its anterior division* Internal Iliac.V* Lumbosacral trunk* Sacro-lliac joint* Fascia of obturator internus* Superior vesical.A* Obturator.N* Obturator.A* Obturator.V* Inferior vesical.V* Middle Rectal. A* Ductus deferens crosses from lateral to medial side* Seminal vesicle lies below and behind the ureter* Vesical veins surround its terminal part* Ureter lies in lower & medial part of broad ligament* Uterine. A lies first above and in front and then crosses it from lateral to medial side* Ureter lies 2cm lateral to the supra vaginal portion of cervix & runs above the lateral fornix* The terminal portion lies anterior to vaginaBLOOD SUPPLY:o Upper part - renal artery, common iliac & internal iliaco Middle part-Aortao Pelvic part- Vesical, middle rectal or uterine vessels | Anatomy | Abdomen & Pelvis | 103 | {
"Correct Answer": "Internal iliac artery",
"Correct Option": "C",
"Options": {
"A": "Gonadal vein",
"B": "Inferior vena cava",
"C": "Internal iliac artery",
"D": "Uterine artery"
},
"Question": "A 40 years old multi gravida woman comes to the hospital with two months history of worsening right pelvic pain. She experiences the pain daily. The intensity does not vary with menstruation. The patient's waist size was increased despite her poor appetite. The pelvic examination shows irregularly shaped fixed adnexal mass. One week later, the patient undergoes surgery for removal of large ovarian neoplasm. Within the true pelvis, the surgeon can most likely palpate the right ureter immediately anterior to"
} | A 40 years old multi gravida woman comes to the hospital with two months history of worsening right pelvic pain. She experiences the pain daily. The intensity does not vary with menstruation. The patient's waist size was increased despite her poor appetite. The pelvic examination shows irregularly shaped fixed adnexal mass. One week later, the patient undergoes surgery for removal of large ovarian neoplasm. | Within the true pelvis, the surgeon can most likely palpate the right ureter immediately anterior to | {
"A": "Gonadal vein",
"B": "Inferior vena cava",
"C": "Internal iliac artery",
"D": "Uterine artery"
} | C. Internal iliac artery |
95ebcafc-bde3-4457-ab4c-2553fe8ad5cd | A 49-year-old man presents with jaundice, nausea, and vomiting. He has a history of chronic alcoholism, and is currently drinking over one bottle of red wine a day. On physical examination, he is jaundiced and pale with a large tender liver. Laboratory data include hemoglobin of 9 g/dL, WBC of 4200/mL, and platelet count of 80,000/mL. His liver enzymes and bilirubin are also elevated. Ultrasound of the abdomen reveals liver enlargement with no bile duct obstruction, a normal size spleen, and no ascites. Which of the following is the most likely toxic effect of alcohol on the bone marrow? | developing erythrocytes and myelocytes | mature polymorphonuclear leukocytes | mature red cells | mature platelets | 0a
| single | Alcohol is directly toxic to dividing and maturing cells, but may also affect neutrophil function. The hematologic effects of alcohol may be direct or indirect, via diet, infection, liver disease, and GI disease. The resulting hematologic abnormalities may be profound. | Medicine | Blood | 148 | {
"Correct Answer": "developing erythrocytes and myelocytes",
"Correct Option": "A",
"Options": {
"A": "developing erythrocytes and myelocytes",
"B": "mature polymorphonuclear leukocytes",
"C": "mature red cells",
"D": "mature platelets"
},
"Question": "A 49-year-old man presents with jaundice, nausea, and vomiting. He has a history of chronic alcoholism, and is currently drinking over one bottle of red wine a day. On physical examination, he is jaundiced and pale with a large tender liver. Laboratory data include hemoglobin of 9 g/dL, WBC of 4200/mL, and platelet count of 80,000/mL. His liver enzymes and bilirubin are also elevated. Ultrasound of the abdomen reveals liver enlargement with no bile duct obstruction, a normal size spleen, and no ascites. Which of the following is the most likely toxic effect of alcohol on the bone marrow?"
} | A 49-year-old man presents with jaundice, nausea, and vomiting. He has a history of chronic alcoholism, and is currently drinking over one bottle of red wine a day. On physical examination, he is jaundiced and pale with a large tender liver. Laboratory data include hemoglobin of 9 g/dL, WBC of 4200/mL, and platelet count of 80,000/mL. His liver enzymes and bilirubin are also elevated. Ultrasound of the abdomen reveals liver enlargement with no bile duct obstruction, a normal size spleen, and no ascites. | Which of the following is the most likely toxic effect of alcohol on the bone marrow? | {
"A": "developing erythrocytes and myelocytes",
"B": "mature polymorphonuclear leukocytes",
"C": "mature red cells",
"D": "mature platelets"
} | A. developing erythrocytes and myelocytes |
d65cfbe8-ad34-426d-a815-ae5971b40831 | A 63-year-old man presents to the clinic for evaluation of symptoms of shortness of breath. The symptoms are worse on exertion, but there is no chest discomfort, cough, or sputum production.His physical examination is completely normal. Investigations include a normal CXR, and on the arterial blood gas the PO2 is 74 mm Hg, and PCO2 is 60 mm Hg. Which of the following mechanisms is the most likely cause for the elevated PCO2? | ventilation-perfusion ratio inequality | right-to-left shunt | impaired diffusion | hypoventilation | 3d
| single | Hypoventilation always causes both hypoxemia and hypercapnia. If the hypoventilation syndrome is caused exclusively by impaired respiratory drive (e.g., drug overdose), then the alveolar-arterial PaO2 gradient remains normal. Often, hypoventilation results from more than one disorder in the respiratory system (e.g., COPD plus metabolic alkalosis secondary to diuretics and glucocorticoids). | Medicine | Respiratory | 105 | {
"Correct Answer": "hypoventilation",
"Correct Option": "D",
"Options": {
"A": "ventilation-perfusion ratio inequality",
"B": "right-to-left shunt",
"C": "impaired diffusion",
"D": "hypoventilation"
},
"Question": "A 63-year-old man presents to the clinic for evaluation of symptoms of shortness of breath. The symptoms are worse on exertion, but there is no chest discomfort, cough, or sputum production.His physical examination is completely normal. Investigations include a normal CXR, and on the arterial blood gas the PO2 is 74 mm Hg, and PCO2 is 60 mm Hg. Which of the following mechanisms is the most likely cause for the elevated PCO2?"
} | A 63-year-old man presents to the clinic for evaluation of symptoms of shortness of breath. The symptoms are worse on exertion, but there is no chest discomfort, cough, or sputum production.His physical examination is completely normal. Investigations include a normal CXR, and on the arterial blood gas the PO2 is 74 mm Hg, and PCO2 is 60 mm Hg. | Which of the following mechanisms is the most likely cause for the elevated PCO2? | {
"A": "ventilation-perfusion ratio inequality",
"B": "right-to-left shunt",
"C": "impaired diffusion",
"D": "hypoventilation"
} | D. hypoventilation |
363c9ea4-6fb4-42bf-8f0d-a8b5ed5132c3 | A 3-month-old girl was referred for recurrent fever, pneumonia, diarrhea, chronic dermatitis, failure to thrive, and motor retardation. The patient was the daughter of consanguineous parents and had a female sibling who had died due to recurrent infections. She suffered from oral thrush and a diffuse brownish colored macular rash on the trunk. Chest auscultation revealed bilateral crackles at the lower zones. Chest X-ray, indicated the absence of thymus shadow; a para-cardiac infiltration and an inferolateral squaring scapulae were demonstrated.Laboratory tests revealed mild anemia with profound lymphocytopenia, and hypogammaglobulinemia. adenosine deaminase (ADA) enzyme activities were low.What is the diagnosis? | Gout | Dwarfism | Mental retardation | Immunodeficiency | 3d
| single | Based on the above clinical scenerio,the diagnosis is Severe combined immunodeficiency. Severe combined immunodeficiency (SCID), is a genetic disorder in which both "arms" (B cells and T cells) of the adaptive immune system are impaired due to a defect in one of several possible genes Types of SCID X-linked severe combined immunodeficiency Purine nucleoside phosphorylase deficiency Adenosine deaminase deficiency Omenn syndrome Bare lymphocyte syndrome JAK3 Aemis/DCLRE1C X-linked severe combined immunodeficiency Most cases of SCID are due to mutations in the gene encoding the common gamma chain (gc), a protein that is shared by the receptors for interleukins These interleukins and their receptors are involved in the development and differentiation of T and B cells. The common gamma chain is encoded by the gene IL-2 receptor gamma, or IL-2Rg, which is located on the X-chromosome. For this reason, immunodeficiency caused by mutations in IL-2Rg is known as X-linked severe combined immunodeficiency. The condition is inherited in an X-linked recessive pattern. Adenosine deaminase deficiency: The second most common form of SCID after X-SCID is caused by a defective enzyme, adenosine deaminase (ADA), necessary for the breakdown of purines. Lack of ADA causes accumulation of dATP. The effectiveness of the immune system depends upon lymphocyte proliferation and hence dNTP synthesis. Without functional ribonucleotide reductase, lymphocyte proliferation is inhibited and the immune system is compromised. Purine nucleoside phosphorylase deficiency An autosomal recessive disorder involving mutations of the purine nucleoside phosphorylase (PNP) gene. PNP is a key enzyme in the purine salvage pathway. Impairment of this enzyme causes elevated dGTP levels resulting in T-cell toxicity and deficiency. Symptoms and diagnosis of SCID: Children with SCID are at risk for life-threatening infections. From their first months of life, they have infections that may be frequent, severe, long-lasting or hard to treat. Infections may occur in the lungs (pneumonia), around the brain and spinal cord (meningitis) or in the blood stream. The delay in detection is because newborns carry their mothers antibodies for the first few weeks of life and SCID babies look normal. treatment for SCID: bone marrow transplantation, Transduction of the missing gene to hematopoietic stem cells using viral vectors is being tested in ADA SCID and X-linked SCID gene therapy Reference: Harpers illustrated biochemistry 30th edition | Biochemistry | Metabolism of protein and amino acid | 160 | {
"Correct Answer": "Immunodeficiency",
"Correct Option": "D",
"Options": {
"A": "Gout",
"B": "Dwarfism",
"C": "Mental retardation",
"D": "Immunodeficiency"
},
"Question": "A 3-month-old girl was referred for recurrent fever, pneumonia, diarrhea, chronic dermatitis, failure to thrive, and motor retardation. The patient was the daughter of consanguineous parents and had a female sibling who had died due to recurrent infections. She suffered from oral thrush and a diffuse brownish colored macular rash on the trunk. Chest auscultation revealed bilateral crackles at the lower zones. Chest X-ray, indicated the absence of thymus shadow; a para-cardiac infiltration and an inferolateral squaring scapulae were demonstrated.Laboratory tests revealed mild anemia with profound lymphocytopenia, and hypogammaglobulinemia. adenosine deaminase (ADA) enzyme activities were low.What is the diagnosis?"
} | A 3-month-old girl was referred for recurrent fever, pneumonia, diarrhea, chronic dermatitis, failure to thrive, and motor retardation. The patient was the daughter of consanguineous parents and had a female sibling who had died due to recurrent infections. She suffered from oral thrush and a diffuse brownish colored macular rash on the trunk. Chest auscultation revealed bilateral crackles at the lower zones. Chest X-ray, indicated the absence of thymus shadow; a para-cardiac infiltration and an inferolateral squaring scapulae were demonstrated.Laboratory tests revealed mild anemia with profound lymphocytopenia, and hypogammaglobulinemia. | adenosine deaminase (ADA) enzyme activities were low.What is the diagnosis? | {
"A": "Gout",
"B": "Dwarfism",
"C": "Mental retardation",
"D": "Immunodeficiency"
} | D. Immunodeficiency |
acba2fd0-e49f-444f-916d-2ea2ef802a2f | A 19-year-old woman presented because of the recent onset of breakthrough bleeding. She has been taking the same oral contraceptive Pill for two years, she has not forgotten any pills or had diarrhoea or vomiting. She has been with her current sexual partner for four months and has recently stopped using condoms as additional protection. She is otherwise well. On examination the vulva and vagina are healthy and there is no inflammation. There is a small cervical ectropion and profuse mucopurulent discharge from the cervix. There is no tenderness on bimanual vaginal examination and no masses palpable. What is the causative organism of this STD? | Chlamydia | Gonorrhea | Syphilis | Candida | 0a
| multi | Ans. (a) Chlamydia. Ref 1 = Diagnosis and management The diagnosis is chlamydia infection. It is very often asymptomatic but can have serious consequences of pelvic pain and fertility problems if untreated. It is more common in women who have a cervical ectropion. The presence of mucopurulent discharge should alert the clinician to the possibility of chlamydia. Diagnosis is confirmed by taking an endocervical swab. Treatment is with antibiotics, either azithromycin 1g immediately or doxycycline 100mg twice daily for seven days. Any sexual contacts need to be traced and treated. Possible different diagnoses Gonorrhoea. Cervical ectropion. Trichomonas. Differential diagnosis Gonorrhoea Occasionally presents with skin lesions. May cause pelvic inflammatory disease. Treatment is with antibiotics. Ref-2. teachmeobgyn.com/sexual-health/sexually-transmitted-infections/chlamydia/ Chlamydia is a sexually transmitted infection caused by the bacterium Chlamydia trachomatis. It is the most common bacterial STI reported in the UK - Public Health England reported 200,288 cases in 2015 (46% of all STI diagnoses). In this article we shall cover the pathophysiology and clinical features of a chlamydial infection, common investigations and its management. Pathophysiology C. trachomatis is an obligate intracellular gram negative bacterium of which there are different serotypes: Serotypes A-C - cause ocular infection. Serotypes D-K - responsible for classical genitourinary infection. Serotypes L1-L3 - cause lymphogranuloma venereum (LGV), an emerging infection in men who have sex with men, often resulting in proctitis. Transmission is via unprotected vaginal, anal or oral sex. However, penetration is not always necessary - and the infection can be spread via direct skin-to-skin contact of the genitals. If infected semen/vaginal fluid enters the eye it can cause chlamydial conjunctivitis, and it is also possible for an infected mother to pass on the infection to her baby during delivery. C. trachomatis enters the host cell as an elementary body (infectious form). Once inside the cell it becomes a reticular body, the non-infectious form capable of replication. Following replication, these reticular bodies mature back to elementary bodies, and following cell rupture the elementary bodies infect other cells resulting in inflammation and tissue damage. By TeachMeSeries Ltd (2018) Fig 1 - The replication cycle of chlamydia Risk Factors The following are risk factors associated with Chlamydia, most of which are common to other sexually transmitted infections: Age <25 Sexual partner positive for chlamydia Recent change in sexual partner Co-infection with another STI Non-barrier contraception or lack of consistent use of barrier contraception Clinical Features Chlamydia is often asymptomatic, with 50% of men and 70% of women unaware that they are infected. The incubation period is typically between 7 and 21 days, after which people may become symptomatic. In addition to the genitourinary features below, chlamydia can also infect the conjunctiva of the eye leading to irritation (chlamydial conjunctivitis), the rectum (discomfort and discharge) and the pharynx (often no symptoms). Women CC BY-SA 3.0, Fig 2 - Cervicitis and mucopurulent endocervical discharge in female chlamydial infection. Symptoms Dysuria Abnormal vaginal discharge Intermenstrual or postcoital bleeding Deep dyspareunia Lower abdominal pain Signs Cervicitis +/- contact bleeding Mucopurulent endocervical discharge Pelvic tenderness Cervical excitation Men Symptoms Urethritis Dysuria Urethral discharge Epididymo-orchitis Testicular pain Signs Epididymal tenderness Mucopurulent discharge Differential Diagnoses A full STI screen should be undertaken for a patient presenting with chlamydia due to the common presenting symptoms of various STIs. In particular, it is difficult to clinically differentiate between gonorrhoea and chlamydia so many NAATs now offer dual testing for both diseases. Treatment for gonorrhoea covers both N. gonorrhoeae and C. trachomatis. Investigations Chlamydia tests are available from sexual health clinics, GUM clinics and GP surgeries. There is also a National Chlamydia Screening Programme in England for people aged under 25 and this testing is often available from pharmacies, universities and contraception clinics. Chlamydia is too small to be seen via microscopy so a nucleic acid amplification test (NAAT) is the recommended investigation to diagnose genital chlamydia from specimens taken at examination or by the patient: Women: Vulvo-vaginal swab (first choice), endocervical swab or first catch urine sample. Men: first catch urine sample (first choice) or urethral swab. If indicated, swabs may also need to be taken from the rectum, eye(s) and throat. If positive for chlamydia, contact tracing is necessary so that the patient's current sexual partner(s) and recent partners can be tested and treated. Patients are recommended to have a full STI screen due to the possibility of co-infection and the similar nature of signs and symptoms. Management Antibiotic treatment is recommended for uncomplicated urogenital chlamydial infection: Doxycycline 100mg twice daily for 7 days or Azithromycin 1g single dose Alternative treatment when doxycycline and azithromycin are contraindicated: Erythromycin 500mg twice daily for 10- 14days Ofloxacin 200mg bd or 400mg od for seven days Patients are advised to avoid sexual intercourse and oral sex until they and/or their partner have completed treatment (or 7 days following azithromycin). Test of cure is not usually required unless the patient is pregnant, compliance was poor or when symptoms persist. If aged <25, repeat testing is recommended 3 months after treatment. Complications In women, ascending infection can lead to salpingitis and/or endometritis which can result in pelvic inflammatory disease (PID). PID can lead to perihepatitis, ectopic pregnancy and may ultimately result in infertility. In men, the infection can spread to cause epididymitis or epididymo-orchitis causing the testes to become painful and swollen. If left untreated, it is thought that this can affect fertility. Chlamydia can also result in sexually acquired reactive arthritis where the joints/eyes/urethra become inflamed and this is more common in men. Chlamydia in Pregnancy Chlamydia may increase the risk of premature delivery with low birth weight and it is thought the infection might increase the chance of miscarriage or stillbirth. Chlamydia in pregnancy is treated with antibiotics, however doxycycline and ofloxacin are contraindicated so azithromycin and erythromycin are the drugs of choice. If a baby contracts chlamydia they may present with inflammation and discharge in their eyes, indicative of neonatal chlamydial conjunctivitis (5-12 days after birth) and it is also possible for them to develop pneumonia (1-3 months after birth). If suspected, swabs can be taken from the eyelid or nasopharynx as indicated. Neonates are treated with oral erythromycin. Full details for the management for Chlamydia during pregnancy and for the neonate can be found in the UK national guidelines. | Unknown | null | 134 | {
"Correct Answer": "Chlamydia",
"Correct Option": "A",
"Options": {
"A": "Chlamydia",
"B": "Gonorrhea",
"C": "Syphilis",
"D": "Candida"
},
"Question": "A 19-year-old woman presented because of the recent onset of breakthrough bleeding. She has been taking the same oral contraceptive Pill for two years, she has not forgotten any pills or had diarrhoea or vomiting. She has been with her current sexual partner for four months and has recently stopped using condoms as additional protection. She is otherwise well. On examination the vulva and vagina are healthy and there is no inflammation. There is a small cervical ectropion and profuse mucopurulent discharge from the cervix. There is no tenderness on bimanual vaginal examination and no masses palpable. What is the causative organism of this STD?"
} | A 19-year-old woman presented because of the recent onset of breakthrough bleeding. She has been taking the same oral contraceptive Pill for two years, she has not forgotten any pills or had diarrhoea or vomiting. She has been with her current sexual partner for four months and has recently stopped using condoms as additional protection. She is otherwise well. On examination the vulva and vagina are healthy and there is no inflammation. There is a small cervical ectropion and profuse mucopurulent discharge from the cervix. There is no tenderness on bimanual vaginal examination and no masses palpable. | What is the causative organism of this STD? | {
"A": "Chlamydia",
"B": "Gonorrhea",
"C": "Syphilis",
"D": "Candida"
} | A. Chlamydia |
bc6d9bae-6fde-4d12-917d-b66cdd58cc95 | A 62 year old woman Vasanti, has a 3 month history of increasing right shoulder pain. She is now unable to lift her arm to brush her hair or to take a can off a shelf. She denies any numbness or tingling or radiation of the pain down her arm. On physical examination, she exhibits weakness in abduction and external rotation or her right arm. Her shoulder shows a normal passive range of motion. When asked to hold her arms abducted to 90 degrees, she is unable to do so on the right. There is no motor weakness in her forearm or hand. Her right upper extremity has normal pulses and normal sensation. Which of the following muscles make up the injured structure? | Supraspinatus, infraspinatus, teres major, deltoid | Supraspinatus, infraspinatus, teres major, subscapularis | Supraspinatus, infraspinatus, teres minor, deltoid | Supraspinatus, infraspinatus, teres minor, subscapularis | 3d
| single | The above history describes a rotator cuff tear. Patients classically have difficulty doing overhead activities. On physical examination, she has weakness with abduction and external rotation of her shoulder. The supraspinatus is responsible for abduction and the infraspinatus is responsible for external rotation of the shoulder. These muscles, along with the teres minor and subscapularis, make up the rotator cuff. Brachial plexus injuries commonly present with some type of numbness or tingling in the upper extremity. Glenohumeral ahritis is unlikely because she has a full passive range of motion, and shoulder ahritis is commonly associated with a decreased range of motion. Also this history is relatively sho term. Proximal humerus fracture and shoulder dislocation are unlikely because this process has been present for 3 months. These injuries need more acute treatment. Also she has a full passive range of motion, which is not common with fractures or dislocations. Ref: McMahon P.J., Kaplan L.D. (2006). Chapter 4. Spos Medicine. In H.B. Skinner (Ed), CURRENT Diagnosis & Treatment in Ohopedics, 4e. | Anatomy | null | 145 | {
"Correct Answer": "Supraspinatus, infraspinatus, teres minor, subscapularis",
"Correct Option": "D",
"Options": {
"A": "Supraspinatus, infraspinatus, teres major, deltoid",
"B": "Supraspinatus, infraspinatus, teres major, subscapularis",
"C": "Supraspinatus, infraspinatus, teres minor, deltoid",
"D": "Supraspinatus, infraspinatus, teres minor, subscapularis"
},
"Question": "A 62 year old woman Vasanti, has a 3 month history of increasing right shoulder pain. She is now unable to lift her arm to brush her hair or to take a can off a shelf. She denies any numbness or tingling or radiation of the pain down her arm. On physical examination, she exhibits weakness in abduction and external rotation or her right arm. Her shoulder shows a normal passive range of motion. When asked to hold her arms abducted to 90 degrees, she is unable to do so on the right. There is no motor weakness in her forearm or hand. Her right upper extremity has normal pulses and normal sensation. Which of the following muscles make up the injured structure?"
} | A 62 year old woman Vasanti, has a 3 month history of increasing right shoulder pain. She is now unable to lift her arm to brush her hair or to take a can off a shelf. She denies any numbness or tingling or radiation of the pain down her arm. On physical examination, she exhibits weakness in abduction and external rotation or her right arm. Her shoulder shows a normal passive range of motion. When asked to hold her arms abducted to 90 degrees, she is unable to do so on the right. There is no motor weakness in her forearm or hand. Her right upper extremity has normal pulses and normal sensation. | Which of the following muscles make up the injured structure? | {
"A": "Supraspinatus, infraspinatus, teres major, deltoid",
"B": "Supraspinatus, infraspinatus, teres major, subscapularis",
"C": "Supraspinatus, infraspinatus, teres minor, deltoid",
"D": "Supraspinatus, infraspinatus, teres minor, subscapularis"
} | D. Supraspinatus, infraspinatus, teres minor, subscapularis |
1d4f297a-1b8e-45d3-91db-f1759701e7dc | A 45-year-old woman is admitted to the hospital with a swelling on the side of her face of 2 months' duration. Radiographic examination reveals a parotid gland tumor. An operative procedure is performed in which the tumor is removed from the parotid gland. Three months postoperatively the patient complains that her face sweats profusely when she tastes or smells food, and a diagnosis is made of Frey syndrome (gustatory sweating). Which of the following nerves was most likely injured during the procedure? | Buccal | Inferior alveolar | Auriculotemporal | Facial | 2c
| single | Frey syndrome occurs following damage to parasympathetic axons in the auriculotemporal nerve. When these postganglionic cholinergic axons grow peripherally after parotid surgery, they establish synapses upon the cholinergic sweat glands, which are innervated normally only by sympathetic fibers. As the peripheral nerves make new connections, aberrant connections can be formed between the auriculotemporal nerve and other glands (not usually innervated by the auriculotemporal nerve). This results in flushing and sweating in response to the thought, smell, or taste of food, instead of the previous, normal salivary secretion by the parotid gland. | Anatomy | Head & Neck | 109 | {
"Correct Answer": "Auriculotemporal",
"Correct Option": "C",
"Options": {
"A": "Buccal",
"B": "Inferior alveolar",
"C": "Auriculotemporal",
"D": "Facial"
},
"Question": "A 45-year-old woman is admitted to the hospital with a swelling on the side of her face of 2 months' duration. Radiographic examination reveals a parotid gland tumor. An operative procedure is performed in which the tumor is removed from the parotid gland. Three months postoperatively the patient complains that her face sweats profusely when she tastes or smells food, and a diagnosis is made of Frey syndrome (gustatory sweating). Which of the following nerves was most likely injured during the procedure?"
} | A 45-year-old woman is admitted to the hospital with a swelling on the side of her face of 2 months' duration. Radiographic examination reveals a parotid gland tumor. An operative procedure is performed in which the tumor is removed from the parotid gland. Three months postoperatively the patient complains that her face sweats profusely when she tastes or smells food, and a diagnosis is made of Frey syndrome (gustatory sweating). | Which of the following nerves was most likely injured during the procedure? | {
"A": "Buccal",
"B": "Inferior alveolar",
"C": "Auriculotemporal",
"D": "Facial"
} | C. Auriculotemporal |
ed28ca1c-4b79-4746-928f-dc7e101a0aea | A 33-year-old previously healthy man with persistent fever and heart murmur is diagnosed with infective endocarditis. He receives a high dosage of a cephalosporin antibiotic during the next 10 days. He now has increasing fatigue. On physical examination, he has tachycardia and scleral icterus. Laboratory studies show a hemoglobin level of 7.5 g/dL, platelet count of 261,000/ mm3, and total WBC count of 8300/ mm3. The direct Coombs test is positive. The peripheral blood smear shows reticulocytosis. Which of the following is the most likely cause of his anemia? | Dietary nutrient deficiency | Disseminated intravascular coagulopathy | Immune-mediated hemolysis | Infection with parvovirus | 2c
| single | Drug-induced hemolytic anemias are neither common nor severe enough to be recognized since the hemolysis is mainly extravascular. However, many patients receive drugs, so the potential for a drug reaction exists, and this immune-mediated mechanism must be distinguished from other causes for anemia. Cephalosporins are the most frequent drugs implicated. Treatment consists of cessation of therapy with the drug because most cases are due to drug-dependent antibody formation. Nutrient deficiencies reduce marrow production, so reticulocytosis is unlikely. DIC is unlikely with a normal platelet count. Parvovirus infection may suppress erythropoiesis transiently in individuals with normal red cells but may precipitate an aplastic crisis in those with a hemoglobinopathy. Persons with abnormal red cells are likely to have a history of anemia. Hemoglobinopathies are not Coombs positive. | Pathology | Blood | 152 | {
"Correct Answer": "Immune-mediated hemolysis",
"Correct Option": "C",
"Options": {
"A": "Dietary nutrient deficiency",
"B": "Disseminated intravascular coagulopathy",
"C": "Immune-mediated hemolysis",
"D": "Infection with parvovirus"
},
"Question": "A 33-year-old previously healthy man with persistent fever and heart murmur is diagnosed with infective endocarditis. He receives a high dosage of a cephalosporin antibiotic during the next 10 days. He now has increasing fatigue. On physical examination, he has tachycardia and scleral icterus. Laboratory studies show a hemoglobin level of 7.5 g/dL, platelet count of 261,000/ mm3, and total WBC count of 8300/ mm3. The direct Coombs test is positive. The peripheral blood smear shows reticulocytosis. Which of the following is the most likely cause of his anemia?"
} | A 33-year-old previously healthy man with persistent fever and heart murmur is diagnosed with infective endocarditis. He receives a high dosage of a cephalosporin antibiotic during the next 10 days. He now has increasing fatigue. On physical examination, he has tachycardia and scleral icterus. Laboratory studies show a hemoglobin level of 7.5 g/dL, platelet count of 261,000/ mm3, and total WBC count of 8300/ mm3. The direct Coombs test is positive. The peripheral blood smear shows reticulocytosis. | Which of the following is the most likely cause of his anemia? | {
"A": "Dietary nutrient deficiency",
"B": "Disseminated intravascular coagulopathy",
"C": "Immune-mediated hemolysis",
"D": "Infection with parvovirus"
} | C. Immune-mediated hemolysis |
2e5385c5-e4d2-4e4d-9dd3-99b62b80ffe9 | A 38-year-old woman has been feeling lethargic for 4 months. On physical examination, she is afebrile, and her blood pressure is 140/90 mm Hg. Laboratory findings show the serum creatinine level is 5.8 mg/dL. C3 nephritic factor is present in serum, resulting in hypocomplementemia, and the ANA test result is negative. Urinalysis shows 2+ blood and 1+ protein. A renal biopsy is done; microscopic examination shows hypercellular glomeruli and prominent ribbonlike deposits along the lamina densa of the glomerular basement membrane. Which of the following forms of glomerulonephritis is most likely to be present in this patient? | Chronic glomerulonephritis | Dense deposit disease | Membranous nephropathy | Postinfectious glomerulonephritis | 1b
| single | Dense deposit disease (formerly membranoproliferative glomerulonephritis type II) usually leads to hematuria, and half of the cases end in chronic renal failure. The term chronic glomerulonephritis (GN) often is used when sclerosis of many glomeruli is present with no clear cause. Membranous nephropathy is often accompanied by proteinuria but less likely hematuria and is characterized by thickening of only the basement membrane and small electron-dense deposits. Postinfectious GN is often characterized by a hypercellular glomerulus with infiltration of polymorphonuclear leukocytes, but no basement membrane thickening. A rapidly progressive GN is marked by crescents forming in the Bowman space. | Pathology | Kidney | 159 | {
"Correct Answer": "Dense deposit disease",
"Correct Option": "B",
"Options": {
"A": "Chronic glomerulonephritis",
"B": "Dense deposit disease",
"C": "Membranous nephropathy",
"D": "Postinfectious glomerulonephritis"
},
"Question": "A 38-year-old woman has been feeling lethargic for 4 months. On physical examination, she is afebrile, and her blood pressure is 140/90 mm Hg. Laboratory findings show the serum creatinine level is 5.8 mg/dL. C3 nephritic factor is present in serum, resulting in hypocomplementemia, and the ANA test result is negative. Urinalysis shows 2+ blood and 1+ protein. A renal biopsy is done; microscopic examination shows hypercellular glomeruli and prominent ribbonlike deposits along the lamina densa of the glomerular basement membrane. Which of the following forms of glomerulonephritis is most likely to be present in this patient?"
} | A 38-year-old woman has been feeling lethargic for 4 months. On physical examination, she is afebrile, and her blood pressure is 140/90 mm Hg. Laboratory findings show the serum creatinine level is 5.8 mg/dL. C3 nephritic factor is present in serum, resulting in hypocomplementemia, and the ANA test result is negative. Urinalysis shows 2+ blood and 1+ protein. A renal biopsy is done; microscopic examination shows hypercellular glomeruli and prominent ribbonlike deposits along the lamina densa of the glomerular basement membrane. | Which of the following forms of glomerulonephritis is most likely to be present in this patient? | {
"A": "Chronic glomerulonephritis",
"B": "Dense deposit disease",
"C": "Membranous nephropathy",
"D": "Postinfectious glomerulonephritis"
} | B. Dense deposit disease |
6553134b-f992-4429-a9a2-9672cdfa6509 | A 40 year old male with history of alcohol abuse for 20 years is brought to the hospital emergency with complaints of fearfulness, talking to self, aggressive behavior, tremulousness and saying that there insects crawling under his skin. Physical examination shows tachycardia, palpitations, sweating, and high grade fever. He is unable to recognize few of his family members. There is history of drinking alcohol two days prior to the onset of the present complaints. He is most likely suffering from? | Delirium tremens | Alcoholic hallucinosis | Schizophrenia | Seizure disorder | 0a
| multi | Ans. is 'a' i.e., Delirium tremens * This patient hasA. H/O alcohol abuseB. Abstinence from alcohol drinking since two daysC. Tactile hallucination (insects crawling under the skin)D. Disorientation (not able to recognize family members, talking to self)E. Autonomic disturbances: - Tachycardia, sweating, tremors, fever, Anxiety (fearfulness and tremulousness)* All suggest the diagnosis of delirium tremensDelirium tremens* Delirium tremens is the most severe alcohol withdrawal syndrome. It occurs usually within 2-4 days of complete or significant alcohol abstinence.* It has all the features of delirium : -1. Clouding of consciousness, Confusion or disorientation.2. Poor attention span and distractibility.3. Visual (and also auditory) hallucinations, illusions. Tactile hallucination of insects crawling under the skin (fornication).4. Marked autonomic disturbances: - Tachycardia, sweating, tremors, fever, hypertension, Anxiety and pupillary dilatation.5. Psychomotor agitation, ataxia, Insomnia with disturbed sleep wake cycle.* Benzodiazepines are the drugs of choice for delirium tremens. Chlordiazepoxide is the agent of choice with diazepam as an alternative. | Psychiatry | Substance Abuse | 104 | {
"Correct Answer": "Delirium tremens",
"Correct Option": "A",
"Options": {
"A": "Delirium tremens",
"B": "Alcoholic hallucinosis",
"C": "Schizophrenia",
"D": "Seizure disorder"
},
"Question": "A 40 year old male with history of alcohol abuse for 20 years is brought to the hospital emergency with complaints of fearfulness, talking to self, aggressive behavior, tremulousness and saying that there insects crawling under his skin. Physical examination shows tachycardia, palpitations, sweating, and high grade fever. He is unable to recognize few of his family members. There is history of drinking alcohol two days prior to the onset of the present complaints. He is most likely suffering from?"
} | A 40 year old male with history of alcohol abuse for 20 years is brought to the hospital emergency with complaints of fearfulness, talking to self, aggressive behavior, tremulousness and saying that there insects crawling under his skin. Physical examination shows tachycardia, palpitations, sweating, and high grade fever. He is unable to recognize few of his family members. There is history of drinking alcohol two days prior to the onset of the present complaints. | He is most likely suffering from? | {
"A": "Delirium tremens",
"B": "Alcoholic hallucinosis",
"C": "Schizophrenia",
"D": "Seizure disorder"
} | A. Delirium tremens |
fd4c1028-f2b6-4589-b6f1-e63b3b2f0ff0 | A 55-year-old woman has been steadily gaining weight for the past 30 years. She underwent cholecystectomy for cholelithiasis 5 years ago. She does not smoke. She is now 164 cm (5 ft 4 in) tall and weighs 126 kg (BMI 47). On physical examination, she has a decreased range of motion with pain on movement of the knees. Laboratory studies show a serum glucose level of 176 mg/dL. This patient is at greatest risk of developing which of the following neoplasms? | Colonic adenocarcinoma | Endometrial carcinoma | Hepatocellular carcinoma | Pulmonary adenocarcinoma | 1b
| multi | This patient is morbidly obese. The extra weight puts a strain on joints, particularly the knees, increasing the risk for osteoarthritis. Although the overall risk of cancer increases with obesity, the relationship between endometrial carcinoma and obesity is well established. About 80% of individuals with type 2 diabetes mellitus are obese. The relationship between diet and obesity to colon cancer is not as well established. Worldwide, most hepatocellular carcinomas arise in individuals infected with hepatitis B; chronic alcoholism also is a risk factor. Pulmonary adenocarcinoma is the least likely bronchogenic cancer to be associated with smoking. Some renal cell carcinomas are associated with smoking. | Pathology | Environment & Nutritional Pathology | 125 | {
"Correct Answer": "Endometrial carcinoma",
"Correct Option": "B",
"Options": {
"A": "Colonic adenocarcinoma",
"B": "Endometrial carcinoma",
"C": "Hepatocellular carcinoma",
"D": "Pulmonary adenocarcinoma"
},
"Question": "A 55-year-old woman has been steadily gaining weight for the past 30 years. She underwent cholecystectomy for cholelithiasis 5 years ago. She does not smoke. She is now 164 cm (5 ft 4 in) tall and weighs 126 kg (BMI 47). On physical examination, she has a decreased range of motion with pain on movement of the knees. Laboratory studies show a serum glucose level of 176 mg/dL. This patient is at greatest risk of developing which of the following neoplasms?"
} | A 55-year-old woman has been steadily gaining weight for the past 30 years. She underwent cholecystectomy for cholelithiasis 5 years ago. She does not smoke. She is now 164 cm (5 ft 4 in) tall and weighs 126 kg (BMI 47). On physical examination, she has a decreased range of motion with pain on movement of the knees. Laboratory studies show a serum glucose level of 176 mg/dL. | This patient is at greatest risk of developing which of the following neoplasms? | {
"A": "Colonic adenocarcinoma",
"B": "Endometrial carcinoma",
"C": "Hepatocellular carcinoma",
"D": "Pulmonary adenocarcinoma"
} | B. Endometrial carcinoma |
8af5b0b9-46e5-4d39-878c-e7791df45a17 | Mark the true and false statement about brain tumors: 1. Most common primary brain tumor is astrocytoma 2. Radiation exposure & genetic abnormalities are the risk factors 3. MEN-2 and NF-1 increases the risk 4. Three cardinal symptoms are seizures, raised ICT & focal neurological deficit 5. Dexamethasone reduces peritumoral edema 6. Primary goals of surgery includes histologic diagnosis & reduction of mass effect 7. Anti-epileptics for tumors close to sensorimotor strip 8. Craniospinal irradiation for tumors associated with CSF spread | 1-T, 2-T, 3-T, 4-T, 5-T, 6-T, 7-F, 8-T | 1-T, 2-T, 3-F, 4-T, 5-T, 6-T, 7-T, 8-T | 1-F, 2-T, 3-F, 4-T, 5-T, 6-T, 7-T, 8-T | 1-T, 2-F, 3-T, 4-T, 5-F, 6-T, 7-T, 8-T | 2c
| multi | - MC primary brain tumor - Meningioma (35%)> glial tumorQ(30%) - MC brain tumor - Metastasis - MC malignant BT of childhood - Most radiosensitive BT - Medulloblastoma - BT associated with calcification (COM) - Craniopharyngioma(most) > ODGQ(90%) > Meningioma(20-25%) BRAIN TUMOR - Most brain tumors occur sporadically - Radiation exposure&genetic abnormalities are the risk factors Genetic abnormalities with brain tumors (RL not in MTV GT) - Retinoblastoma - Li-Fraumeni - NF-1 & 2 - MEN 1 - Turcot's syndrome - VHL syndrome - Gorlin syndrome - Tuberous sclerosis Clinical Features - Three cardinal symptoms: Seizures, Raised ICT & focal neurological deficit(FND) - Raised ICT leads to headache (worse in morning & straining, associated with nausea & vomiting) - FND: Progressive over time, characteristic of location - Pituitary adenoma may also present with endocrine abnormalities Diagnosis - IOC for diagnosis: MRI Treatment - Dexamethasone: Reduces peitumoral edema - Anti-epileptics: For tumors close to sensorimotor strip - Mannitol: Adminstered before dural opening & operative resection - Surgery: Primary goals of surgery includes histologic diagnosis & reduction of mass effect preservation of neurological function - Radiotherapy: In case of positive margins & tumor infiltrating surrounding brain - Craniospinal irradiation: For tumors associated with CSF Spread | Surgery | CNS Tumors | 128 | {
"Correct Answer": "1-F, 2-T, 3-F, 4-T, 5-T, 6-T, 7-T, 8-T",
"Correct Option": "C",
"Options": {
"A": "1-T, 2-T, 3-T, 4-T, 5-T, 6-T, 7-F, 8-T",
"B": "1-T, 2-T, 3-F, 4-T, 5-T, 6-T, 7-T, 8-T",
"C": "1-F, 2-T, 3-F, 4-T, 5-T, 6-T, 7-T, 8-T",
"D": "1-T, 2-F, 3-T, 4-T, 5-F, 6-T, 7-T, 8-T"
},
"Question": "Mark the true and false statement about brain tumors: 1. Most common primary brain tumor is astrocytoma 2. Radiation exposure & genetic abnormalities are the risk factors 3. MEN-2 and NF-1 increases the risk 4. Three cardinal symptoms are seizures, raised ICT & focal neurological deficit 5. Dexamethasone reduces peritumoral edema 6. Primary goals of surgery includes histologic diagnosis & reduction of mass effect 7. Anti-epileptics for tumors close to sensorimotor strip 8. Craniospinal irradiation for tumors associated with CSF spread"
} | Mark the true and false statement about brain tumors: 1. Most common primary brain tumor is astrocytoma 2. Radiation exposure & genetic abnormalities are the risk factors 3. MEN-2 and NF-1 increases the risk 4. Three cardinal symptoms are seizures, raised ICT & focal neurological deficit 5. Dexamethasone reduces peritumoral edema 6. Primary goals of surgery includes histologic diagnosis & reduction of mass effect 7. Anti-epileptics for tumors close to sensorimotor strip 8. | Craniospinal irradiation for tumors associated with CSF spread | {
"A": "1-T, 2-T, 3-T, 4-T, 5-T, 6-T, 7-F, 8-T",
"B": "1-T, 2-T, 3-F, 4-T, 5-T, 6-T, 7-T, 8-T",
"C": "1-F, 2-T, 3-F, 4-T, 5-T, 6-T, 7-T, 8-T",
"D": "1-T, 2-F, 3-T, 4-T, 5-F, 6-T, 7-T, 8-T"
} | C. 1-F, 2-T, 3-F, 4-T, 5-T, 6-T, 7-T, 8-T |
1b4c654a-4b3d-4f86-9f33-95848b108944 | A 67-year-old man with severe ARDS is receiving pressure assisted control ventilation. He is requiring an FiO2 of 100% to maintain the following blood gas levels: pH=7.26, PCO2=60, PO2=58. You decide to put the patient in prone position. Fifteen minutes later, on the same vent settings, the patient's tidal volume is now decreased and his blood gas values are pH=7.09, PCO2=76, PO2=89. He is hemodynamically unchanged and his chest x-ray (CXR) is also unchanged. The most likely cause of his worsening respiratory acidosis in the prone position is | Pneumothorax | Increased dead space | Decreased cardiac filling | Reduced chest wall compliance | 2c
| multi | The prone positioning reduces the disparity in mechanics between the dependent and nondependent regions of the lungs. This reduces the collapsing of the alveoli in the dependent portions of the lungs and overdistention in the nondependent portions of the lungs. The prone position also has other effects - it allows a more normal curvature of the diaphragm and allows better function. It also stiffens the chest wall allowing a more even distribution of ventilation and reduction in overventilation of nondependent alveoli | Surgery | Wounds, Tissue Repair & Scars | 149 | {
"Correct Answer": "Decreased cardiac filling",
"Correct Option": "C",
"Options": {
"A": "Pneumothorax",
"B": "Increased dead space",
"C": "Decreased cardiac filling",
"D": "Reduced chest wall compliance"
},
"Question": "A 67-year-old man with severe ARDS is receiving pressure assisted control ventilation. He is requiring an FiO2 of 100% to maintain the following blood gas levels: pH=7.26, PCO2=60, PO2=58. You decide to put the patient in prone position. Fifteen minutes later, on the same vent settings, the patient's tidal volume is now decreased and his blood gas values are pH=7.09, PCO2=76, PO2=89. He is hemodynamically unchanged and his chest x-ray (CXR) is also unchanged. The most likely cause of his worsening respiratory acidosis in the prone position is"
} | A 67-year-old man with severe ARDS is receiving pressure assisted control ventilation. He is requiring an FiO2 of 100% to maintain the following blood gas levels: pH=7.26, PCO2=60, PO2=58. You decide to put the patient in prone position. Fifteen minutes later, on the same vent settings, the patient's tidal volume is now decreased and his blood gas values are pH=7.09, PCO2=76, PO2=89. He is hemodynamically unchanged and his chest x-ray (CXR) is also unchanged. | The most likely cause of his worsening respiratory acidosis in the prone position is | {
"A": "Pneumothorax",
"B": "Increased dead space",
"C": "Decreased cardiac filling",
"D": "Reduced chest wall compliance"
} | C. Decreased cardiac filling |
df4e2b89-6012-41ca-bbc2-2e5e66d86338 | A 19-year-old female college student presents to the emergency department at 10:30 PM on a Friday night with severe left-sided flank and pelvic pain. While she has never had similar pain, she states that she thinks she has a kidney stone. The pain started in her mid-back about a week ago and then subsided and now the pain has increased and moved interiorly along her flank and also extends down into her labia majora. She is taking birth control pills, but is not currently sexually active. She is having her period, but denies the pain is menstrual. Abdominal and pelvic CT are ordered. What two specific locations will one look for in the CTs for obstructing calculi? | At the junction of the renal papilla with the minor calyx and junction of the renal papilla with the major calyx | As the ureter leaves the kidney and as the ureter forms the infundibulum | As the ureter crosses the edge of the false pelvis and as the ureter crosses the edge of the true pelvis | As the ureter crosses the external iliac artery at the pelvic brim and as the ureter passes through the wall of the bladder | 3d
| multi | Answer: (d) As the ureter crosses the external iliac artery at the pelvic brim and as the ureter passes through the wall of the bladder.* Renal and ureteric calculi generally are formed in the kidneys and then lodge at one of three locations:o at the junction of the renal pelvis with the ureter;o as the ureters cross the external iliac vessels at the pelvic brim;o as the ureters pass through the wall of the bladder.* Calculi occasionally form in the minor or major calyces or in the renal pelves and infundibula, but those so called "staghorn"calculi, would produce mid-back pain.* Renal calculi rarely become stuck as the ureter crosses the edge of the false pelvis.* The ureter does not pass through the center of the trigone, but rather opens at the superior lateral edge of the trigone.* The referred pain from ureteric calculi is usually described as from "loin to groin" in that it often starts in the mid back then over the kidney and extends in a band toward the labia majora or scrotum (from T11-L2).* Normally the pain is intermittent and comes and goes in waves and may change in location, generally moving interiorly.* Since the ureters undergo peristaltic movement, the calculi often move with time. | Anatomy | Abdomen & Pelvis | 148 | {
"Correct Answer": "As the ureter crosses the external iliac artery at the pelvic brim and as the ureter passes through the wall of the bladder",
"Correct Option": "D",
"Options": {
"A": "At the junction of the renal papilla with the minor calyx and junction of the renal papilla with the major calyx",
"B": "As the ureter leaves the kidney and as the ureter forms the infundibulum",
"C": "As the ureter crosses the edge of the false pelvis and as the ureter crosses the edge of the true pelvis",
"D": "As the ureter crosses the external iliac artery at the pelvic brim and as the ureter passes through the wall of the bladder"
},
"Question": "A 19-year-old female college student presents to the emergency department at 10:30 PM on a Friday night with severe left-sided flank and pelvic pain. While she has never had similar pain, she states that she thinks she has a kidney stone. The pain started in her mid-back about a week ago and then subsided and now the pain has increased and moved interiorly along her flank and also extends down into her labia majora. She is taking birth control pills, but is not currently sexually active. She is having her period, but denies the pain is menstrual. Abdominal and pelvic CT are ordered. What two specific locations will one look for in the CTs for obstructing calculi?"
} | A 19-year-old female college student presents to the emergency department at 10:30 PM on a Friday night with severe left-sided flank and pelvic pain. While she has never had similar pain, she states that she thinks she has a kidney stone. The pain started in her mid-back about a week ago and then subsided and now the pain has increased and moved interiorly along her flank and also extends down into her labia majora. She is taking birth control pills, but is not currently sexually active. She is having her period, but denies the pain is menstrual. Abdominal and pelvic CT are ordered. | What two specific locations will one look for in the CTs for obstructing calculi? | {
"A": "At the junction of the renal papilla with the minor calyx and junction of the renal papilla with the major calyx",
"B": "As the ureter leaves the kidney and as the ureter forms the infundibulum",
"C": "As the ureter crosses the edge of the false pelvis and as the ureter crosses the edge of the true pelvis",
"D": "As the ureter crosses the external iliac artery at the pelvic brim and as the ureter passes through the wall of the bladder"
} | D. As the ureter crosses the external iliac artery at the pelvic brim and as the ureter passes through the wall of the bladder |
674b2b41-e3f3-470f-b157-6c9467bd844e | A 29-year-old G3P2 woman at 34 weeks&; gestation is involved in a serious car accident in which she lost consciousness briefly. In the emergency depament she is awake and ale and complains of a severe headache and intense abdominal and pelvic pain. Her blood pressure is 150/90 mm Hg, hea rate is 120/min, temperature is 37.4&;&;C (99.3F), and respiratory rate is 22/min. Fetal hea rate is 155/min. Physical examination reveals several minor bruises on her abdomen and limbs, and vaginal inspection receals blood in the voult. Strong, frequint uterine contraction are palpable. Which of the following is most likely a complication of this pts present condition. | DIC | lUGR | Subarachnoid hemorrhage | Vasa pre | 0a
| single | Trauma is a risk factor for APH High BP is risk factor for abruptio On vaginal inspection bleeding is present along with strong uterine so the diagnosis of abruptio is confirmed DIC is due to release of thromboplastin by damaged placenta is a well known complication of abruptio Ref: Dutta Obs 9e pg 243. | Gynaecology & Obstetrics | General obstetrics | 172 | {
"Correct Answer": "DIC",
"Correct Option": "A",
"Options": {
"A": "DIC",
"B": "lUGR",
"C": "Subarachnoid hemorrhage",
"D": "Vasa pre"
},
"Question": "A 29-year-old G3P2 woman at 34 weeks&; gestation is involved in a serious car accident in which she lost consciousness briefly. In the emergency depament she is awake and ale and complains of a severe headache and intense abdominal and pelvic pain. Her blood pressure is 150/90 mm Hg, hea rate is 120/min, temperature is 37.4&;&;C (99.3F), and respiratory rate is 22/min. Fetal hea rate is 155/min. Physical examination reveals several minor bruises on her abdomen and limbs, and vaginal inspection receals blood in the voult. Strong, frequint uterine contraction are palpable. Which of the following is most likely a complication of this pts present condition."
} | A 29-year-old G3P2 woman at 34 weeks&; gestation is involved in a serious car accident in which she lost consciousness briefly. In the emergency depament she is awake and ale and complains of a severe headache and intense abdominal and pelvic pain. Her blood pressure is 150/90 mm Hg, hea rate is 120/min, temperature is 37.4&;&;C (99.3F), and respiratory rate is 22/min. Fetal hea rate is 155/min. Physical examination reveals several minor bruises on her abdomen and limbs, and vaginal inspection receals blood in the voult. Strong, frequint uterine contraction are palpable. | Which of the following is most likely a complication of this pts present condition. | {
"A": "DIC",
"B": "lUGR",
"C": "Subarachnoid hemorrhage",
"D": "Vasa pre"
} | A. DIC |
26b65806-e6e2-4613-bf87-96e3a9669756 | A thiy-year man presented with nausea, fever and jaundice of 5 days duration. The biochemical tests revealed a bilirubin of 6.7 mg/d1 (conjugated 5.0 mg/dl) with SGOT/ SGPT (AST/ALT) of 1230/900 IU/mi. The serological tests showed presence of HBs Ag. IgM anti-HBc and Hbe Ag. The most likely diagnosis is: | Chronic hepatitis B infection with high infectivity. | Acute hepatitis B infection with high infectivity | Chronic hepatitis infection with low infectivity. | Acute hepatitis B infection with low infectivity | 1b
| single | Answer is B (Acute hepatitis B infection with high infectivity): Presence of Anti HB IgM and Hbs Ag indicates acute infection. Presence of Hbe Ag indicates high infectivity | Medicine | null | 103 | {
"Correct Answer": "Acute hepatitis B infection with high infectivity",
"Correct Option": "B",
"Options": {
"A": "Chronic hepatitis B infection with high infectivity.",
"B": "Acute hepatitis B infection with high infectivity",
"C": "Chronic hepatitis infection with low infectivity.",
"D": "Acute hepatitis B infection with low infectivity"
},
"Question": "A thiy-year man presented with nausea, fever and jaundice of 5 days duration. The biochemical tests revealed a bilirubin of 6.7 mg/d1 (conjugated 5.0 mg/dl) with SGOT/ SGPT (AST/ALT) of 1230/900 IU/mi. The serological tests showed presence of HBs Ag. IgM anti-HBc and Hbe Ag. The most likely diagnosis is:"
} | A thiy-year man presented with nausea, fever and jaundice of 5 days duration. The biochemical tests revealed a bilirubin of 6.7 mg/d1 (conjugated 5.0 mg/dl) with SGOT/ SGPT (AST/ALT) of 1230/900 IU/mi. The serological tests showed presence of HBs Ag. IgM anti-HBc and Hbe Ag. | The most likely diagnosis is: | {
"A": "Chronic hepatitis B infection with high infectivity.",
"B": "Acute hepatitis B infection with high infectivity",
"C": "Chronic hepatitis infection with low infectivity.",
"D": "Acute hepatitis B infection with low infectivity"
} | B. Acute hepatitis B infection with high infectivity |
63d3d21b-08aa-4630-b38e-8534ceebe7a5 | A 24 y/o male was brought to psychiatry emergency. He appeared very excited, and was wearing orange t shi and pink pants along with googles. On seeing the doctor he said- 'I am the ultimate doctor, i have done MD and MS in all the specialities and I can cure all the diseases'. The family members repoed that he has not slept in last two days and was saying that he is trying to find the magic formula to reach moon in one hour. What is the drug of choice in this patient? | Lithium | Valproate | Risperidone | Benzodiazepine | 2c
| multi | The history is suggestive of a manic episode. Increased self esteem, grandiose ideas, colorful clothing and decreased sleep is al suggestive of manic episode. 1. The best treatment in such cases is a combination of mood stabilizers + antipsychotics 2. If the combination is not given, in the options. the best treatment for acute mania is antipsychotics 3. The drug of choice for treatment of mania in a pregnant female is also antipsychotics | Psychiatry | Mood Disorders | 111 | {
"Correct Answer": "Risperidone",
"Correct Option": "C",
"Options": {
"A": "Lithium",
"B": "Valproate",
"C": "Risperidone",
"D": "Benzodiazepine"
},
"Question": "A 24 y/o male was brought to psychiatry emergency. He appeared very excited, and was wearing orange t shi and pink pants along with googles. On seeing the doctor he said- 'I am the ultimate doctor, i have done MD and MS in all the specialities and I can cure all the diseases'. The family members repoed that he has not slept in last two days and was saying that he is trying to find the magic formula to reach moon in one hour. What is the drug of choice in this patient?"
} | A 24 y/o male was brought to psychiatry emergency. He appeared very excited, and was wearing orange t shi and pink pants along with googles. On seeing the doctor he said- 'I am the ultimate doctor, i have done MD and MS in all the specialities and I can cure all the diseases'. The family members repoed that he has not slept in last two days and was saying that he is trying to find the magic formula to reach moon in one hour. | What is the drug of choice in this patient? | {
"A": "Lithium",
"B": "Valproate",
"C": "Risperidone",
"D": "Benzodiazepine"
} | C. Risperidone |
f6dfeef5-0665-4361-b66e-58e4417e2928 | A 26 year-old man presents to his primary physician with complaints of intermittent crampy epigastric pain, nausea, and vomiting sholy after eating. He usually vomits undigested food and this relives the pain and nausea. He has preferred to eat soft foods his whole life, and he often relies on liquids. He is otherwise healthy and well developed upper gastrintesrinal barium study reveals a markedly narrowed second poion of the duodemun laboratory studies are unremarkable. Probable diagnosis is? | Gallstone pancreatits | Pancreatic carcinoma | Pancreas divisum | Annular pancreas | 3d
| multi | This patient has symptoms of gastric outlet obstruction or, as in this case, duodenal obstruction, Several of these diseases could result in duodenal obstruction. However, the fact that he is young, otherwise healthy, and has avoided solid foods all his life suggests he has a congenital problem. He does not describe symptoms of biliary colic nor does he have signs of cancer. Episodic pain is not typical during bouts of acute pancreatitis, and pancreas divisum does not cause duodenal obstruction. Annular pancreas fits best with his history, his constellation of presett symptoms, and his upper gastrointestinal study. | Surgery | null | 110 | {
"Correct Answer": "Annular pancreas",
"Correct Option": "D",
"Options": {
"A": "Gallstone pancreatits",
"B": "Pancreatic carcinoma",
"C": "Pancreas divisum",
"D": "Annular pancreas"
},
"Question": "A 26 year-old man presents to his primary physician with complaints of intermittent crampy epigastric pain, nausea, and vomiting sholy after eating. He usually vomits undigested food and this relives the pain and nausea. He has preferred to eat soft foods his whole life, and he often relies on liquids. He is otherwise healthy and well developed upper gastrintesrinal barium study reveals a markedly narrowed second poion of the duodemun laboratory studies are unremarkable. Probable diagnosis is?"
} | A 26 year-old man presents to his primary physician with complaints of intermittent crampy epigastric pain, nausea, and vomiting sholy after eating. He usually vomits undigested food and this relives the pain and nausea. He has preferred to eat soft foods his whole life, and he often relies on liquids. He is otherwise healthy and well developed upper gastrintesrinal barium study reveals a markedly narrowed second poion of the duodemun laboratory studies are unremarkable. | Probable diagnosis is? | {
"A": "Gallstone pancreatits",
"B": "Pancreatic carcinoma",
"C": "Pancreas divisum",
"D": "Annular pancreas"
} | D. Annular pancreas |
dfcc654a-3b2d-4d82-9385-d6cf93aa2c2a | A 45-year-old woman with Crohn's disease and a small intestinal fistula develops tetany during the 2nd week of parenteral nutrition. The laboratory findings includeCa: 8.2 mEq/LNa: 135 mEq/LK: 3.2 mEq/LCl: 103 mEq/LPO4: 2.4 mEq/LAlbumin: 2.4pH: 7.4838 kPaP: 84 kPa bicarbonate 25 mEq/LThe most likely cause of the patient's tetany is | Hyperventilation | Hypocalcemia | Hypomagnesemia | Essential fatty acid deficiency | 2c
| multi | Magnesium deficiency is common in malnourished patients and patients with large gastrointestinal fluid losses. The neuromuscular effects resemble those of calcium deficiency-namely, paresthesia, hyperreflexia, muscle spasm, and ultimately tetany. The cardiac effects are more like those of hypercalcemia. An electrocardiogram therefore provides a rapid means of differentiating between hypocalcemia and hypomagnesemia. Hypomagnesemia also causes potassium wasting by the kidney. Many hospital patients with refractory hypocalcemia will be found to be magnesium deficient. Often this deficiency becomes manifest during the response to parenteral nutrition when normal cellular ionic gradients are restored. A normal blood pH and arterial PCO2 rule out hyperventilation. The serum calcium in this patient is normal when adjusted for the low albumin. Hypomagnesemia causes functional hypoparathyroidism, which can lower serum calcium and thus result in a combined defect. | Surgery | Wounds, Tissue Repair & Scars | 128 | {
"Correct Answer": "Hypomagnesemia",
"Correct Option": "C",
"Options": {
"A": "Hyperventilation",
"B": "Hypocalcemia",
"C": "Hypomagnesemia",
"D": "Essential fatty acid deficiency"
},
"Question": "A 45-year-old woman with Crohn's disease and a small intestinal fistula develops tetany during the 2nd week of parenteral nutrition. The laboratory findings includeCa: 8.2 mEq/LNa: 135 mEq/LK: 3.2 mEq/LCl: 103 mEq/LPO4: 2.4 mEq/LAlbumin: 2.4pH: 7.4838 kPaP: 84 kPa bicarbonate 25 mEq/LThe most likely cause of the patient's tetany is"
} | A 45-year-old woman with Crohn's disease and a small intestinal fistula develops tetany during the 2nd week of parenteral nutrition. | The laboratory findings includeCa: 8.2 mEq/LNa: 135 mEq/LK: 3.2 mEq/LCl: 103 mEq/LPO4: 2.4 mEq/LAlbumin: 2.4pH: 7.4838 kPaP: 84 kPa bicarbonate 25 mEq/LThe most likely cause of the patient's tetany is | {
"A": "Hyperventilation",
"B": "Hypocalcemia",
"C": "Hypomagnesemia",
"D": "Essential fatty acid deficiency"
} | C. Hypomagnesemia |
f562d638-2c49-4b9f-80a8-a1798ef79870 | A 30–year-old male, Rajinder presents to OPD with fatigue, muscle weakness, and headache. His blood pressure is 170/120 mmHg and his heart rate is 100/min. Laboratory evaluation reveals hypokalemia, metabolic alkalosis and decreased plasma renin activity. On CT scan, a mass was noted on the left suprarenal gland. The patient was prescribed a drug for a few weeks and the symptoms subsided. Laboratory values and blood pressure returned to normal values. The likely drug given to this patient is? | Clonidine | Propranolol | Hydrochlorothiazide | Spironolactone | 3d
| single | null | Pharmacology | null | 121 | {
"Correct Answer": "Spironolactone",
"Correct Option": "D",
"Options": {
"A": "Clonidine",
"B": "Propranolol",
"C": "Hydrochlorothiazide",
"D": "Spironolactone"
},
"Question": "A 30–year-old male, Rajinder presents to OPD with fatigue, muscle weakness, and headache. His blood pressure is 170/120 mmHg and his heart rate is 100/min. Laboratory evaluation reveals hypokalemia, metabolic alkalosis and decreased plasma renin activity. On CT scan, a mass was noted on the left suprarenal gland. The patient was prescribed a drug for a few weeks and the symptoms subsided. Laboratory values and blood pressure returned to normal values. The likely drug given to this patient is?"
} | A 30–year-old male, Rajinder presents to OPD with fatigue, muscle weakness, and headache. His blood pressure is 170/120 mmHg and his heart rate is 100/min. Laboratory evaluation reveals hypokalemia, metabolic alkalosis and decreased plasma renin activity. On CT scan, a mass was noted on the left suprarenal gland. The patient was prescribed a drug for a few weeks and the symptoms subsided. Laboratory values and blood pressure returned to normal values. | The likely drug given to this patient is? | {
"A": "Clonidine",
"B": "Propranolol",
"C": "Hydrochlorothiazide",
"D": "Spironolactone"
} | D. Spironolactone |
4c5ecc80-0e7c-441e-94f3-86e0be90ecec | A 73-year-old man has an inferior infarct with ST elevation documented on right-sided precordial leads. He is hypotensive (blood pressure 90/70 mm Hg) and tachycardic. The JVP is 10 cm, the heart sounds are normal, lungs are clear, and his extremities are cool. 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 | 1b
| multi | This man has a right ventricular MI. Primary right ventricular failure is characterized by a disproportionately high right atrial pressure with normal or high wedge pressure. The cardiac output is usually low and systemic vascular resistance is usually normal or increased. | Medicine | C.V.S. | 101 | {
"Correct Answer": "increased RAP, decreased CO, increased SVR",
"Correct Option": "B",
"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 73-year-old man has an inferior infarct with ST elevation documented on right-sided precordial leads. He is hypotensive (blood pressure 90/70 mm Hg) and tachycardic. The JVP is 10 cm, the heart sounds are normal, lungs are clear, and his extremities are cool. What would central hemodynamic monitoring reveal?For the above patient, select the hemodynamic parameters that are most likely to apply."
} | A 73-year-old man has an inferior infarct with ST elevation documented on right-sided precordial leads. He is hypotensive (blood pressure 90/70 mm Hg) and tachycardic. The JVP is 10 cm, the heart sounds are normal, lungs are clear, and his extremities are cool. | 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"
} | B. increased RAP, decreased CO, increased SVR |
b616de46-2526-45c6-b8cd-bcb9ffd11322 | A 24-year-old woman notices pain in her left arm, made worse with use. She also has fatigue, fever, night sweats, and arthralgias. On examination, there are no palpable lymph nodes, and the joints and muscle strength are normal. The left radial pulse is absent, and there is a bruit over the left subclavian and common carotid arteries. Preliminary laboratory investigations reveal an elevated ESR and mild anemia. Which of the following vascular findings is most likely to be found in her? | high pressure in the legs and low pressure in the arms | low pressure in the legs and high pressure in the arms | high-pitched diastolic murmur | a relentless course to death | 0a
| single | High pressure in the legs and low pressure in the arms characterize Takayasu's syndrome. Clinical manifestations include easy fatigability of the arms and atrophy of the soft tissues of the face. The course is variable, and spontaneous remissions can occur. The disease predominantly affects young women. | Medicine | C.V.S. | 113 | {
"Correct Answer": "high pressure in the legs and low pressure in the arms",
"Correct Option": "A",
"Options": {
"A": "high pressure in the legs and low pressure in the arms",
"B": "low pressure in the legs and high pressure in the arms",
"C": "high-pitched diastolic murmur",
"D": "a relentless course to death"
},
"Question": "A 24-year-old woman notices pain in her left arm, made worse with use. She also has fatigue, fever, night sweats, and arthralgias. On examination, there are no palpable lymph nodes, and the joints and muscle strength are normal. The left radial pulse is absent, and there is a bruit over the left subclavian and common carotid arteries. Preliminary laboratory investigations reveal an elevated ESR and mild anemia. Which of the following vascular findings is most likely to be found in her?"
} | A 24-year-old woman notices pain in her left arm, made worse with use. She also has fatigue, fever, night sweats, and arthralgias. On examination, there are no palpable lymph nodes, and the joints and muscle strength are normal. The left radial pulse is absent, and there is a bruit over the left subclavian and common carotid arteries. Preliminary laboratory investigations reveal an elevated ESR and mild anemia. | Which of the following vascular findings is most likely to be found in her? | {
"A": "high pressure in the legs and low pressure in the arms",
"B": "low pressure in the legs and high pressure in the arms",
"C": "high-pitched diastolic murmur",
"D": "a relentless course to death"
} | A. high pressure in the legs and low pressure in the arms |
3473402d-fea6-45a0-8090-05baaf2d9b61 | An 18 year old female patient complains of prominent upper front teeth. Extra-oral examination reveals an acute nasolabial angle and lip strain. Intraoral examination shows a Class II incisor relation with 8 mm overjet and Class I molar relation. Maxillary first premolar extractions have been advised, of which almost all of the premolar space will be required for the retraction of the upper anteriors. According to Burstone’s classification for anchorage requirements, this patient can be categorized into which of the following groups? | Group A | Group B | Group C | Group D | 0a
| multi | It is convenient to classify an extraction arch by the differential space closure required between the anterior and the posterior teeth.
Group A arch is one in which posterior segments must remain in their original position and the full space is used for anterior retraction.
Group B arch requires that approximately one half of the space be used for retraction.
Group C arch requires that approximately all space be closed by protraction of the posterior teeth. | Dental | null | 113 | {
"Correct Answer": "Group A",
"Correct Option": "A",
"Options": {
"A": "Group A",
"B": "Group B",
"C": "Group C",
"D": "Group D"
},
"Question": "An 18 year old female patient complains of prominent upper front teeth. Extra-oral examination reveals an acute nasolabial angle and lip strain. Intraoral examination shows a Class II incisor relation with 8 mm overjet and Class I molar relation. Maxillary first premolar extractions have been advised, of which almost all of the premolar space will be required for the retraction of the upper anteriors. According to Burstone’s classification for anchorage requirements, this patient can be categorized into which of the following groups?"
} | An 18 year old female patient complains of prominent upper front teeth. Extra-oral examination reveals an acute nasolabial angle and lip strain. Intraoral examination shows a Class II incisor relation with 8 mm overjet and Class I molar relation. Maxillary first premolar extractions have been advised, of which almost all of the premolar space will be required for the retraction of the upper anteriors. | According to Burstone’s classification for anchorage requirements, this patient can be categorized into which of the following groups? | {
"A": "Group A",
"B": "Group B",
"C": "Group C",
"D": "Group D"
} | A. Group A |
381e92ad-a6a0-4dc2-b4db-a444143805e9 | A 20-year-old G2P1 patient comes to see you at 17 weeks gestational age to review the results of her triple test done 1 week ago. You tell the patient that her maternal serum a-fetoprotein (MSAFP) level is 2.0 multiples of the median (MOM). The patient's obstetrical history consists of a term vaginal delivery 2 years ago without complications. What do you tell your patient regarding how to proceed next? | Explain to the patient that the blood test is diagnostic of a neural tube defect and she should consult with a pediatric neurosurgeon as soon as possible | Tell the patient that the blood test result is most likely a false-positive result and she should repeat the test at 20 weeks | Refer the patient for an ultrasound to confirm dates | Offer the patient immediate chorionic villus sampling to obtain a fetal karyotype | 2c
| multi | The multiple marker screening test, also referred to as the expanded AFP test or triple screen, consists of maternal serum measurements of estriol, human chorionic gonadotropin, and a-fetoprotein. The multiple marker screening test is used to determine a pregnant patient's risk of having a baby with an- euploidy and a neural tube defect. The AFP test has the greatest sensitivity when done between 16 and 18 weeks. A maternal serum AFP level that is greater than or equal to 2.0 to 2.5 MOM indicates an elevated risk for a neural tube defect and indicates that further workup and evaluation are needed. The first step when an elevated serum AFP result is obtained is to have the patient undergo an ultrasound to verify that the gestational age of the pregnancy is correct. The sonogram can also identify a fetal death in utero, multiple gestation, or a neural tube or abdominal defect, which could all explain the elevated AFP level. A repeat serum AFP test can be done, because at a level of 2.0 MOM there is some overlap between normal and affected pregnancies. The repeat test should be done as soon as possible; waiting until 20 weeks decreases the sensitivity of the test and wastes valuable time in the workup. An amniocentesis is recommended if a neural tube defect is suspected, in order to measure amniotic fluid levels of AFP and therefore confirm the findings of the maternal serum AFP. The physician would not immediately refer the patient for a chorionic villus sampling because this procedure obtains placental tissue for fetal karyotyping and does not add to information regarding the presence of a neural tube defect. A cordocentesis or percutaneous umbilical cord blood sampling (PUBS) is a procedure whereby the umbilical vein is punctured under ultrasonic guidance and a fetal blood sample is obtained. Usually a PUBS is performed when rapid fetal karyotyping must be done, such as in a situation where severe growth restriction exists. PUBS is most commonly used in situations where fetal hydrops exists to obtain information regarding fetal platelet counts and fetal hematocrits. | Gynaecology & Obstetrics | Fetus & New Born and their Diseases | 101 | {
"Correct Answer": "Refer the patient for an ultrasound to confirm dates",
"Correct Option": "C",
"Options": {
"A": "Explain to the patient that the blood test is diagnostic of a neural tube defect and she should consult with a pediatric neurosurgeon as soon as possible",
"B": "Tell the patient that the blood test result is most likely a false-positive result and she should repeat the test at 20 weeks",
"C": "Refer the patient for an ultrasound to confirm dates",
"D": "Offer the patient immediate chorionic villus sampling to obtain a fetal karyotype"
},
"Question": "A 20-year-old G2P1 patient comes to see you at 17 weeks gestational age to review the results of her triple test done 1 week ago. You tell the patient that her maternal serum a-fetoprotein (MSAFP) level is 2.0 multiples of the median (MOM). The patient's obstetrical history consists of a term vaginal delivery 2 years ago without complications. What do you tell your patient regarding how to proceed next?"
} | A 20-year-old G2P1 patient comes to see you at 17 weeks gestational age to review the results of her triple test done 1 week ago. You tell the patient that her maternal serum a-fetoprotein (MSAFP) level is 2.0 multiples of the median (MOM). The patient's obstetrical history consists of a term vaginal delivery 2 years ago without complications. | What do you tell your patient regarding how to proceed next? | {
"A": "Explain to the patient that the blood test is diagnostic of a neural tube defect and she should consult with a pediatric neurosurgeon as soon as possible",
"B": "Tell the patient that the blood test result is most likely a false-positive result and she should repeat the test at 20 weeks",
"C": "Refer the patient for an ultrasound to confirm dates",
"D": "Offer the patient immediate chorionic villus sampling to obtain a fetal karyotype"
} | C. Refer the patient for an ultrasound to confirm dates |
5d7c1140-b431-4abb-8788-379f5c334e8d | A 57-year-old woman with a 20-year history of celiac disease now presents with weight loss, cramps, and abdominal discomfort. She is adherent to her gluten-free diet, and is not taking any new medications. On examination, her abdomen is soft and there is fullness in the right lower quadrant. A small bowel x-ray reveals an area of narrowing in the distal ileum, and there is thickening and nodularity of the mucosal folds. She undergoes surgical resection of the lesion, and the pathology report confirms a tumor that is more common in patients with celiac disease, Crohn's disease, or depressed immune function such as human immunodeficiency virus (HIV).For the above patient with a small bowel tumor, select the most likely diagnosis. | polypoid adenoma | lipoma | adenocarcinoma | primary gastrointestinal (GI) lymphoma | 3d
| multi | Primary small bowel lymphoma is more common in the settings of celiac disease, regional enteritis, congenital immune disorders, prior organ transplantation, autoimmune disorders, and AIDS. | Medicine | G.I.T. | 163 | {
"Correct Answer": "primary gastrointestinal (GI) lymphoma",
"Correct Option": "D",
"Options": {
"A": "polypoid adenoma",
"B": "lipoma",
"C": "adenocarcinoma",
"D": "primary gastrointestinal (GI) lymphoma"
},
"Question": "A 57-year-old woman with a 20-year history of celiac disease now presents with weight loss, cramps, and abdominal discomfort. She is adherent to her gluten-free diet, and is not taking any new medications. On examination, her abdomen is soft and there is fullness in the right lower quadrant. A small bowel x-ray reveals an area of narrowing in the distal ileum, and there is thickening and nodularity of the mucosal folds. She undergoes surgical resection of the lesion, and the pathology report confirms a tumor that is more common in patients with celiac disease, Crohn's disease, or depressed immune function such as human immunodeficiency virus (HIV).For the above patient with a small bowel tumor, select the most likely diagnosis."
} | A 57-year-old woman with a 20-year history of celiac disease now presents with weight loss, cramps, and abdominal discomfort. She is adherent to her gluten-free diet, and is not taking any new medications. On examination, her abdomen is soft and there is fullness in the right lower quadrant. A small bowel x-ray reveals an area of narrowing in the distal ileum, and there is thickening and nodularity of the mucosal folds. | She undergoes surgical resection of the lesion, and the pathology report confirms a tumor that is more common in patients with celiac disease, Crohn's disease, or depressed immune function such as human immunodeficiency virus (HIV).For the above patient with a small bowel tumor, select the most likely diagnosis. | {
"A": "polypoid adenoma",
"B": "lipoma",
"C": "adenocarcinoma",
"D": "primary gastrointestinal (GI) lymphoma"
} | D. primary gastrointestinal (GI) lymphoma |
e675b134-430c-4e38-8e06-89dec30f728e | Two weeks after a viral syndrome, a 2-year-old child develops bruising and generalized petechiae, more prominent over the legs. No hepatosplenomegaly or lymph node enlargement is noted. The examination is otherwise unremarkable. Laboratory testing shows the patient to have a normal hemoglobin, hematocrit, and white blood cell (WBC) count and differential. The platelet count is 15,000/mL. Which of the following is the most likely diagnosis? | Von Willebrand disease (vWD) | Acute leukemia | Idiopathic (immune) thrombocytopenic purpura (ITP) | Aplastic anemia | 2c
| single | In children, ITP is the most common form of thrombocytopenic purpura. In most cases, a preceding viral infection can be noted. No diagnostic test identifies this disease; exclusion of the other diseases listed in the question is necessary. In this disease, the platelet count is frequently less than 20,000/mL, but other laboratory tests yield essentially normal results, including the bone marrow aspiration (if done). Complications are uncommon; significant bleeding occurs in only 5% of cases and intracranial hemorrhage is even rarer. The treatment of childhood ITP is controversial. Patients with mild symptoms such as bruising and self-limited epistaxis may be observed, while patients with significant bleeding should be treated. IVIG and corticosteroids are effective in causing a rapid increase in platelet count, but controversy exists surrounding the use of prednisone before ruling out leukemia with a bone marrow aspirate. For Rh-positive patients with a working spleen, the use of anti-D immunoglobulin also results in an increase in platelet count. For patients with chronic (> 1 year) ITP, a splenectomy may be necessary.Aplastic anemia is unlikely if the other cell lines are normal. vWD might be expected to present with bleeding and not just bruising. It is unlikely that acute leukemia would present with thrombocytopenia only. Thrombotic thrombocytopenic purpura is rare in children. | Pediatrics | Blood | 103 | {
"Correct Answer": "Idiopathic (immune) thrombocytopenic purpura (ITP)",
"Correct Option": "C",
"Options": {
"A": "Von Willebrand disease (vWD)",
"B": "Acute leukemia",
"C": "Idiopathic (immune) thrombocytopenic purpura (ITP)",
"D": "Aplastic anemia"
},
"Question": "Two weeks after a viral syndrome, a 2-year-old child develops bruising and generalized petechiae, more prominent over the legs. No hepatosplenomegaly or lymph node enlargement is noted. The examination is otherwise unremarkable. Laboratory testing shows the patient to have a normal hemoglobin, hematocrit, and white blood cell (WBC) count and differential. The platelet count is 15,000/mL. Which of the following is the most likely diagnosis?"
} | Two weeks after a viral syndrome, a 2-year-old child develops bruising and generalized petechiae, more prominent over the legs. No hepatosplenomegaly or lymph node enlargement is noted. The examination is otherwise unremarkable. Laboratory testing shows the patient to have a normal hemoglobin, hematocrit, and white blood cell (WBC) count and differential. The platelet count is 15,000/mL. | Which of the following is the most likely diagnosis? | {
"A": "Von Willebrand disease (vWD)",
"B": "Acute leukemia",
"C": "Idiopathic (immune) thrombocytopenic purpura (ITP)",
"D": "Aplastic anemia"
} | C. Idiopathic (immune) thrombocytopenic purpura (ITP) |
57ca856a-80da-401d-b12b-c995aa3b26cf | A 68-year-old man has had worsening dyspnea and orthopnea for the past 3 years with increased production of frothy sputum. On examination, crackles are auscultated at lung bases. A chest radiograph shows bilateral interstitial infiltrates, distinct Kerley B lines, and a prominent left heart border. Laboratory studies show Na+, 135 mmol/L; K+, 3.8 mmol/L; Cl-, 99 mmol/L; CO2, 25 mmol/L; glucose, 76 mg/ dL; creatinine, 1.5 mg/dL; and urea nitrogen, 30 mg/dL. Fractional excretion of sodium is less than 1%. Plasma renin, aldosterone, and antidiuretic hormone levels all are increased. B-type natriuretic peptide (BNP) is 200 pg/mL (normal <100 pg/mL). Which of the following pathologic findings is this man most likely to have? | Aldosteronoma | Bilateral adrenal atrophy | Chronic glomerulonephritis | Ischemic heart disease | 3d
| multi | He has left-sided heart failure with pulmonary edema and congestion. His reduced cardiac output leads to diminished renal blood flow that stimulates the renin-angiotensin mechanism to retain salt and water to increase plasma volume. He has prerenal azotemia with a high BUN-to-creatinine ratio and low fractional excretion of sodium. The other options do not explain his pulmonary edema. An aldosterone- secreting adrenal adenoma (Conn syndrome) would increase aldosterone, but decrease the plasma renin. In chronic adrenal failure (Addison disease), there should be hyperkalemia and hypoglycemia accompanying hyponatremia. Chronic glomerulonephritis with chronic renal failure would be associated with a BUN-to-creatinine ratio around 10:1. Pulmonary fibrosis would lead to cor pulmonale and a prominent right heart border with features of right-sided congestive heart failure. The syndrome of inappropriate antidiuretic hormone (ADH) is a paraneoplastic syndrome that can occur with pulmonary small cell carcinomas, and secretion of antidiuretic hormone (SIADH) would increase ADH and cause more severe hyponatremia, but would not have a major effect on the renin-angiotensin mechanism, and sodium excretion would be higher. | Pathology | Respiration | 218 | {
"Correct Answer": "Ischemic heart disease",
"Correct Option": "D",
"Options": {
"A": "Aldosteronoma",
"B": "Bilateral adrenal atrophy",
"C": "Chronic glomerulonephritis",
"D": "Ischemic heart disease"
},
"Question": "A 68-year-old man has had worsening dyspnea and orthopnea for the past 3 years with increased production of frothy sputum. On examination, crackles are auscultated at lung bases. A chest radiograph shows bilateral interstitial infiltrates, distinct Kerley B lines, and a prominent left heart border. Laboratory studies show Na+, 135 mmol/L; K+, 3.8 mmol/L; Cl-, 99 mmol/L; CO2, 25 mmol/L; glucose, 76 mg/ dL; creatinine, 1.5 mg/dL; and urea nitrogen, 30 mg/dL. Fractional excretion of sodium is less than 1%. Plasma renin, aldosterone, and antidiuretic hormone levels all are increased. B-type natriuretic peptide (BNP) is 200 pg/mL (normal <100 pg/mL). Which of the following pathologic findings is this man most likely to have?"
} | A 68-year-old man has had worsening dyspnea and orthopnea for the past 3 years with increased production of frothy sputum. On examination, crackles are auscultated at lung bases. A chest radiograph shows bilateral interstitial infiltrates, distinct Kerley B lines, and a prominent left heart border. Laboratory studies show Na+, 135 mmol/L; K+, 3.8 mmol/L; Cl-, 99 mmol/L; CO2, 25 mmol/L; glucose, 76 mg/ dL; creatinine, 1.5 mg/dL; and urea nitrogen, 30 mg/dL. Fractional excretion of sodium is less than 1%. Plasma renin, aldosterone, and antidiuretic hormone levels all are increased. B-type natriuretic peptide (BNP) is 200 pg/mL (normal <100 pg/mL). | Which of the following pathologic findings is this man most likely to have? | {
"A": "Aldosteronoma",
"B": "Bilateral adrenal atrophy",
"C": "Chronic glomerulonephritis",
"D": "Ischemic heart disease"
} | D. Ischemic heart disease |
04eee52a-a114-4183-af33-bae706a5b984 | Which of the following are TRUE/FALSE regarding pain suppression ("Analgesia") system in the brain and spinal cord: 1. The raphe magnus nucleus, a thin midline nucleus reticularis paragigantocellularis, is located laterally in the medulla. 2. It consists of two main components. 3. The periaqueductal gray (in midbrain) and periventricular areas of the mesencephalon and upper pons surround the aqueduct of sylvius and poions of the third and fouh ventricles. 4. Enkephalins and serotonin are involved in the analgesia system (brain and spinal cord). 5. A pain inhibitory complex is located in the ventral horns of the spinal cord. | 1,2,3 true & 4,5 false | 2,4,5 true & 1,3 false | 1,3,4 true & 2,5 false | All are true | 2c
| multi | Pain suppression ("Analgesia") system in the Brain and Spinal Cord: It consists of three major components: The periaqueductal gray (in midbrain) and periventricular areas of the mesencephalon and upper pons surround the aqueduct of sylvius and poions of the third and fouh ventricles. Neurons from these areas send signals to The raphe magnus nucleus, a thin midline nucleus reticularis paragigantocellularis, located laterally in the medulla. From these nuclei, second order signals are transmitted down the dorsolateral columns in the spinal cord to A pain inhibitory complex located in the dorsal horns of the spinal cord. At this point, the analgesia signals can block the pain before it is relayed to the brain. Note: "Several transmitter substances are involved in the analgesia system (of brain and spinal cord); especially involved are enkephalin and serotonin" . "Along with the opioid receptor, the component nuclei of this pain modulating circuit contain endogenous opioid peptides such as the enkephalins and B-endorphin". About a dozen such opiate-like substances have now been found at different point of the nervous system ; all are breakdown products of three large protein molecules ; pro-opiomelanocoin, proenkephalin, and prodynorphin. Among the major impoant of these opiate-like substances are B-endorphin, met-enkephalin, leu-enkephalin, and dynorphin. Fibers originating in this area send signal to the dorsal horns of the spinal cord to secrete serotonin at their endings. The serotonin cause local cord neurons to secret enkephalin as well. The enkephalin is believe to cause both presynaptic and postsynaptic inhibition of incoming type C and type A/ pain fibers where they synapse in the dorsal horns. The powerful effect of expectation and other psychological variables on the perceived intensity of pain implies the existence of brain circuits that can modulate the activity of the pain transmission pathways. One of these circuits has link in the hypothalamus, midbrain, and medulla, and it selectively controls spinal pain-transmission neurons through a descending pathway. Ref: Harrison 17/e, page 83 ; Guyton 11/e, page 602-03 ; Ganong 23/e, page 177-78 ; Katzung 10/e, page 489. | Physiology | null | 166 | {
"Correct Answer": "1,3,4 true & 2,5 false",
"Correct Option": "C",
"Options": {
"A": "1,2,3 true & 4,5 false",
"B": "2,4,5 true & 1,3 false",
"C": "1,3,4 true & 2,5 false",
"D": "All are true"
},
"Question": "Which of the following are TRUE/FALSE regarding pain suppression (\"Analgesia\") system in the brain and spinal cord: 1. The raphe magnus nucleus, a thin midline nucleus reticularis paragigantocellularis, is located laterally in the medulla. 2. It consists of two main components. 3. The periaqueductal gray (in midbrain) and periventricular areas of the mesencephalon and upper pons surround the aqueduct of sylvius and poions of the third and fouh ventricles. 4. Enkephalins and serotonin are involved in the analgesia system (brain and spinal cord). 5. A pain inhibitory complex is located in the ventral horns of the spinal cord."
} | Which of the following are TRUE/FALSE regarding pain suppression ("Analgesia") system in the brain and spinal cord: 1. The raphe magnus nucleus, a thin midline nucleus reticularis paragigantocellularis, is located laterally in the medulla. 2. It consists of two main components. 3. The periaqueductal gray (in midbrain) and periventricular areas of the mesencephalon and upper pons surround the aqueduct of sylvius and poions of the third and fouh ventricles. 4. Enkephalins and serotonin are involved in the analgesia system (brain and spinal cord). 5. | A pain inhibitory complex is located in the ventral horns of the spinal cord. | {
"A": "1,2,3 true & 4,5 false",
"B": "2,4,5 true & 1,3 false",
"C": "1,3,4 true & 2,5 false",
"D": "All are true"
} | C. 1,3,4 true & 2,5 false |
654c428b-52c9-44ee-a565-c9731806768d | A 15-year-old boy presented with one day history of bleeding gums, subconjunctival bleed and purpuric rash. Investigations revealed the following results: Hb-6.4 gm/dL; TLC-26,500/mm3 Platelet 35,000 mm3; prothrombin time-20 sec with a control of 13 sec; paial thromboplastin time-50 sec; and Fibrinogen 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 | The child presented with acute onset of bleeding, along with the following laboratory findings: Thrombocytopenia (35000/mm3 as compared to normal value of 1, 50,000/mm3) Increased prothrombin time (20s as compared to control of 13s) Increased paial thromboplastin time (50s vs. normal 26-32s) Decreased fibrinogen (10 mg/dL vs. normal of 233- 496 mg/dl) These hematological abnormalities indicate disseminated intravascular coagulation. Most common form of AML associated with DIC is M3-AML (Acute promyelocytic leukemia). All-trans retinoic acid (ATRA), an analogue of vitamin A induce the neoplastic promyelocytes to differentiate into neutrophils rapidly and decrease chance of DIC. other agent useful is AsO3(arsenic trioxide). | Pathology | Acute Myelogenous Leukemia | 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 bleeding gums, subconjunctival bleed and purpuric rash. Investigations revealed the following results: Hb-6.4 gm/dL; TLC-26,500/mm3 Platelet 35,000 mm3; prothrombin time-20 sec with a control of 13 sec; paial thromboplastin time-50 sec; and Fibrinogen 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 bleeding gums, subconjunctival bleed and purpuric rash. Investigations revealed the following results: Hb-6.4 gm/dL; TLC-26,500/mm3 Platelet 35,000 mm3; prothrombin time-20 sec with a control of 13 sec; paial thromboplastin time-50 sec; and Fibrinogen 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 |
b2f49314-f631-496e-9190-8d2207a2f252 | A 47 year old man presents to the hospital complaining of palpitations. The patient repos that while cooking breakfast this morning, he felt his hea "racing in his chest" and was unable to catch his breath. He states that sitting down brought no relief. He called for an ambulance and he was brought to the emergency depament. The man has no significant past medical history and takes no medications regularly, other than ranitidine for occasional heaburn. On examination, the patient is quite thin, but well developed and in mild distress. His globes appear exophthalmic. His pulse is 140/min and irregularly irregular. There are no murmurs, and the lung examination is clear. A non-tender midline thyroid mass is palpable. Which of the following findings on his echocardiogram would suggest a diagnosis of long- standing atrial fibrillation? | Dilated left ventricle | Dilated right ventricle | Enlarged left atrium | Hyperophied ventricular septum | 2c
| multi | Echocardiography is an invaluable tool for assessing cardiovascular function in both normal and disease states. In the case of atrial fibrillation (AF), a chronic course versus an acute and self-limited course poend completely different treatment strategies and long-term prognoses. The most common cause of chronic AF is valvular disease, followed by congestive hea failure (CHF). The most common anatomic correlate seen in patients with AF (Framingham Hea Study) is an enlarged left atrium. A dilated left ventricle is commonly seen with both CHF and AF. However, an enlarged left atrium is more closely correlated with chronic AF than is left ventricular dilation. The causal relationship between an enlarged left atrium and AF is unclear. A dilated right ventricle is commonly seen in severe right hea failure (RHF). The most common cause of RHF is left hea failure (LHF). There is no consistent relationship between right hea size and the presence of AF. A hyperophied ventricular septum is commonly seen in hypeensive hea disease or idiopathic hyperophic aoic stenosis. Chronic AF in these patients, however, is much less common. Ref: Prystowsky E.N., Padanilam B.J., Waldo A.L. (2011). Chapter 40. Atrial Fibrillation, Atrial Flutter, and Atrial Tachycardia. In V. Fuster, R.A. Walsh, R.A. Harrington (Eds), Hurst's The Hea, 13e. | Medicine | null | 184 | {
"Correct Answer": "Enlarged left atrium",
"Correct Option": "C",
"Options": {
"A": "Dilated left ventricle",
"B": "Dilated right ventricle",
"C": "Enlarged left atrium",
"D": "Hyperophied ventricular septum"
},
"Question": "A 47 year old man presents to the hospital complaining of palpitations. The patient repos that while cooking breakfast this morning, he felt his hea \"racing in his chest\" and was unable to catch his breath. He states that sitting down brought no relief. He called for an ambulance and he was brought to the emergency depament. The man has no significant past medical history and takes no medications regularly, other than ranitidine for occasional heaburn. On examination, the patient is quite thin, but well developed and in mild distress. His globes appear exophthalmic. His pulse is 140/min and irregularly irregular. There are no murmurs, and the lung examination is clear. A non-tender midline thyroid mass is palpable. Which of the following findings on his echocardiogram would suggest a diagnosis of long- standing atrial fibrillation?"
} | A 47 year old man presents to the hospital complaining of palpitations. The patient repos that while cooking breakfast this morning, he felt his hea "racing in his chest" and was unable to catch his breath. He states that sitting down brought no relief. He called for an ambulance and he was brought to the emergency depament. The man has no significant past medical history and takes no medications regularly, other than ranitidine for occasional heaburn. On examination, the patient is quite thin, but well developed and in mild distress. His globes appear exophthalmic. His pulse is 140/min and irregularly irregular. There are no murmurs, and the lung examination is clear. A non-tender midline thyroid mass is palpable. | Which of the following findings on his echocardiogram would suggest a diagnosis of long- standing atrial fibrillation? | {
"A": "Dilated left ventricle",
"B": "Dilated right ventricle",
"C": "Enlarged left atrium",
"D": "Hyperophied ventricular septum"
} | C. Enlarged left atrium |
65a1f326-5b76-471f-bd92-ad8975b7204e | A 64-year-old woman is admitted to the hospital after the acute onset of left-sided weakness. She has had a large right cerebral stroke and is confined to bed. On the fifth hospital day, her oxygen saturation is noted to be reduced to 90% on room air. She feels fine, the neurologic weakness is unchanged, blood pressure is 130/90 mm Hg, and pulse 80/min. Examination of the chest reveals decreased fremitus, dullness to percussion, and absent breath sounds in the left lower lung. There is also a tracheal shift towards the left side.For the above patient with abnormal pulmonary physical findings, select the most likely diagnosis. | acute asthmatic attack | complete pneumothorax | large pleural effusion | atelectasis | 3d
| multi | Careful physical examination can be very useful in diagnosing many common pulmonary disorders. Atelectasis and large pleural effusions both can present with decreased fremitus, dullness or flatness to percussion, and absent breath sounds. In atelectasis, tracheal shift, if present, is toward the affected side, and the opposite for a large pleural effusion. Asthma's most typical manifestations are prolonged expiration and diffuse wheezing. However, impaired expansion, decreased fremitus, hyperresonance, and low diaphragms can also be found. A complete pneumothorax results in absent fremitus, hyperresonance or tympany, and absent breath sounds. Lobar pneumonia is characterized by consolidation with increased fremitus, dullness, and auscultatory findings of bronchial breathing, bronchophony, pectoriloquy, and crackles. | Medicine | Respiratory | 144 | {
"Correct Answer": "atelectasis",
"Correct Option": "D",
"Options": {
"A": "acute asthmatic attack",
"B": "complete pneumothorax",
"C": "large pleural effusion",
"D": "atelectasis"
},
"Question": "A 64-year-old woman is admitted to the hospital after the acute onset of left-sided weakness. She has had a large right cerebral stroke and is confined to bed. On the fifth hospital day, her oxygen saturation is noted to be reduced to 90% on room air. She feels fine, the neurologic weakness is unchanged, blood pressure is 130/90 mm Hg, and pulse 80/min. Examination of the chest reveals decreased fremitus, dullness to percussion, and absent breath sounds in the left lower lung. There is also a tracheal shift towards the left side.For the above patient with abnormal pulmonary physical findings, select the most likely diagnosis."
} | A 64-year-old woman is admitted to the hospital after the acute onset of left-sided weakness. She has had a large right cerebral stroke and is confined to bed. On the fifth hospital day, her oxygen saturation is noted to be reduced to 90% on room air. She feels fine, the neurologic weakness is unchanged, blood pressure is 130/90 mm Hg, and pulse 80/min. Examination of the chest reveals decreased fremitus, dullness to percussion, and absent breath sounds in the left lower lung. | There is also a tracheal shift towards the left side.For the above patient with abnormal pulmonary physical findings, select the most likely diagnosis. | {
"A": "acute asthmatic attack",
"B": "complete pneumothorax",
"C": "large pleural effusion",
"D": "atelectasis"
} | D. atelectasis |
7c4ab459-d80b-4492-b7f2-5ffcaf54c093 | A baby that was apparently normal at bih begins to show a delay in motor development by 3 months of age. At one year of age, the child begins to develop spasticity and writhing movements. At age three, compulsive biting of fingers and lips and head-banging appear. At pubey, the child develops ahritis, and death from renal failure occurs at age 25. This patient's condition is due to an enzyme deficiency in which of the following biochemical pathways? | Ganglioside metabolism | Monosaccharide metabolism | Purine metabolism | Pyrimidine metabolism | 2c
| single | The patient has a classical case of Lesch-Nyhan syndrome, an X-linked disorder due to severe deficiency of the purine salvage enzyme hypoxanthine-guanine phosphoribosyl transferase (HP). This defect is associated with excessive de novo purine synthesis, hyperuricemia, and the clinical signs and symptoms described in the question stem. The biochemical basis of the often striking self-mutilatory behavior (which may require restraints and even tooth extraction) has never been established. Treatment with allopurinol inhibits xanthine oxidase and reduces gouty ahritis, urate stone formation, and urate nephropathy. It does not, however, modify the neurologic/psychiatric presentation. | Biochemistry | null | 102 | {
"Correct Answer": "Purine metabolism",
"Correct Option": "C",
"Options": {
"A": "Ganglioside metabolism",
"B": "Monosaccharide metabolism",
"C": "Purine metabolism",
"D": "Pyrimidine metabolism"
},
"Question": "A baby that was apparently normal at bih begins to show a delay in motor development by 3 months of age. At one year of age, the child begins to develop spasticity and writhing movements. At age three, compulsive biting of fingers and lips and head-banging appear. At pubey, the child develops ahritis, and death from renal failure occurs at age 25. This patient's condition is due to an enzyme deficiency in which of the following biochemical pathways?"
} | A baby that was apparently normal at bih begins to show a delay in motor development by 3 months of age. At one year of age, the child begins to develop spasticity and writhing movements. At age three, compulsive biting of fingers and lips and head-banging appear. At pubey, the child develops ahritis, and death from renal failure occurs at age 25. | This patient's condition is due to an enzyme deficiency in which of the following biochemical pathways? | {
"A": "Ganglioside metabolism",
"B": "Monosaccharide metabolism",
"C": "Purine metabolism",
"D": "Pyrimidine metabolism"
} | C. Purine metabolism |
c4b7362f-598a-4889-a324-863b609c8776 | A 40-year-old woman with inflammatory bowel disease has been receiving TPN for over 3 weeks. Workup reveals pelvic abscess. She undergoes exploratory laparotomy, resection of small bowel with anastomosis, and drainage of pelvic abscess. During surgery, TPN is maintained at the original rate of 125 mL/h. In the recovery room, the patient is found to have a urine output of 200 mL/h. CVP is 1, and laboratory results are Na,149;K,3.5;Cl,110;HCO3,18; BUN, 40; and creatinine, 1 mg/dL. Which of the following statements is true regarding this condition? | The patient's urine output is secondary to fluid overload during surgery. | The patient is in high-output renal failure. | Hyperosmolar-nonketotic coma will develop if the condition is not aggressively treated. | Diuresis is a normal response to stress of surgery. | 2c
| multi | Hyperosmolar-nonketotic coma is a serious complication seen when an excessive amount of glucose is given, especially in the presence of sepsis, steroids, or inadequate insulin. Furthermore, the combination of surgery and sepsis results in an increased insulin- resistant state. The increased urine output is secondary to osmolar load from blood glucose. Low CVP, hypernatremia, and BUN-to- creatinine ratio over 20 suggest hypovolemia and not fluid overload. Normal creatinine level and BUN-to-creatinine ratio over 20 rules out high-output renal failure. The stress of surgery is characterized by water retention and not diuresis. Management consists of aggressive hydration, discontinuation of TPN, and insulin drip. Insulin drives the potassium intracellularly and potassium must be replaced. | Surgery | Wounds, Tissue Repair & Scars | 161 | {
"Correct Answer": "Hyperosmolar-nonketotic coma will develop if the condition is not aggressively treated.",
"Correct Option": "C",
"Options": {
"A": "The patient's urine output is secondary to fluid overload during surgery.",
"B": "The patient is in high-output renal failure.",
"C": "Hyperosmolar-nonketotic coma will develop if the condition is not aggressively treated.",
"D": "Diuresis is a normal response to stress of surgery."
},
"Question": "A 40-year-old woman with inflammatory bowel disease has been receiving TPN for over 3 weeks. Workup reveals pelvic abscess. She undergoes exploratory laparotomy, resection of small bowel with anastomosis, and drainage of pelvic abscess. During surgery, TPN is maintained at the original rate of 125 mL/h. In the recovery room, the patient is found to have a urine output of 200 mL/h. CVP is 1, and laboratory results are Na,149;K,3.5;Cl,110;HCO3,18; BUN, 40; and creatinine, 1 mg/dL. Which of the following statements is true regarding this condition?"
} | A 40-year-old woman with inflammatory bowel disease has been receiving TPN for over 3 weeks. Workup reveals pelvic abscess. She undergoes exploratory laparotomy, resection of small bowel with anastomosis, and drainage of pelvic abscess. During surgery, TPN is maintained at the original rate of 125 mL/h. In the recovery room, the patient is found to have a urine output of 200 mL/h. CVP is 1, and laboratory results are Na,149;K,3.5;Cl,110;HCO3,18; BUN, 40; and creatinine, 1 mg/dL. | Which of the following statements is true regarding this condition? | {
"A": "The patient's urine output is secondary to fluid overload during surgery.",
"B": "The patient is in high-output renal failure.",
"C": "Hyperosmolar-nonketotic coma will develop if the condition is not aggressively treated.",
"D": "Diuresis is a normal response to stress of surgery."
} | C. Hyperosmolar-nonketotic coma will develop if the condition is not aggressively treated. |
a60a9456-fe80-4679-944f-122196d9f1a4 | A 73-year-old man from a nursing home develops headache, fever, cough, sore throat, malaise, and severe myalgia during a community outbreak affecting numerous other residents at the home. The symptoms gradually resolve after 3 days, and he starts feeling better but then there is a reappearance of his fever, with cough and yellow sputum production. On examination, his temperature is 38.5degC, pulse 100/min, respiration 24/min, oxygen saturation 88% and crackles in the right lower lung base, bronchial breath sounds and dullness on percussion. CXR reveals a new infiltrate in the right lower lobe. Which of the following is the most likely causative organism? | primary viral pneumonia | an autoimmune reaction | Mycoplasma pneumoniae | Streptococcus pneumoniae | 3d
| multi | This man has a complication of viral influenza; a secondary bacterial pneumonia has developed. This usually occurs 2-3 days after the initial viral symptoms resolve. Primary viral pneumonia with influenza is not common. Spneumoniae, Staphylococcus, and H influenzae are the most common bacterial invaders in pulmonary complications of influenza. Pneumonia is the leading cause of death and may also be due to Spneumoniae and H influenzae. Mixed viral and bacterial pneumonia is common; pure viral pneumonia in influenza is uncommon (but can be very severe). | Medicine | Infection | 157 | {
"Correct Answer": "Streptococcus pneumoniae",
"Correct Option": "D",
"Options": {
"A": "primary viral pneumonia",
"B": "an autoimmune reaction",
"C": "Mycoplasma pneumoniae",
"D": "Streptococcus pneumoniae"
},
"Question": "A 73-year-old man from a nursing home develops headache, fever, cough, sore throat, malaise, and severe myalgia during a community outbreak affecting numerous other residents at the home. The symptoms gradually resolve after 3 days, and he starts feeling better but then there is a reappearance of his fever, with cough and yellow sputum production. On examination, his temperature is 38.5degC, pulse 100/min, respiration 24/min, oxygen saturation 88% and crackles in the right lower lung base, bronchial breath sounds and dullness on percussion. CXR reveals a new infiltrate in the right lower lobe. Which of the following is the most likely causative organism?"
} | A 73-year-old man from a nursing home develops headache, fever, cough, sore throat, malaise, and severe myalgia during a community outbreak affecting numerous other residents at the home. The symptoms gradually resolve after 3 days, and he starts feeling better but then there is a reappearance of his fever, with cough and yellow sputum production. On examination, his temperature is 38.5degC, pulse 100/min, respiration 24/min, oxygen saturation 88% and crackles in the right lower lung base, bronchial breath sounds and dullness on percussion. CXR reveals a new infiltrate in the right lower lobe. | Which of the following is the most likely causative organism? | {
"A": "primary viral pneumonia",
"B": "an autoimmune reaction",
"C": "Mycoplasma pneumoniae",
"D": "Streptococcus pneumoniae"
} | D. Streptococcus pneumoniae |
8d6fd5dc-5eaf-4acf-85d9-cc7624895cff | A 40 year old male was brought to the hospital with acute pain in the upper abdomen. Pateint was in shock with feeble pulse and tachycardia. There was tenderness present in the epigastrium. There is no blood in the gastric aspirate and thepatient felt better after aspiration. X-ray abdomen showed no free gas under the diaphragm. Investigations revealed TLC 13500 serum bilirubin 2.0 mg and serum amylase 800 I.U. The most likely diagnosis is - | Acute cholecystitis | Acute pancreatitis | Acute appendicitis | Acute hepatitis | 1b
| single | Ans. is 'b' i.e., Acute pancreatitis | Surgery | null | 117 | {
"Correct Answer": "Acute pancreatitis",
"Correct Option": "B",
"Options": {
"A": "Acute cholecystitis",
"B": "Acute pancreatitis",
"C": "Acute appendicitis",
"D": "Acute hepatitis"
},
"Question": "A 40 year old male was brought to the hospital with acute pain in the upper abdomen. Pateint was in shock with feeble pulse and tachycardia. There was tenderness present in the epigastrium. There is no blood in the gastric aspirate and thepatient felt better after aspiration. X-ray abdomen showed no free gas under the diaphragm. Investigations revealed TLC 13500 serum bilirubin 2.0 mg and serum amylase 800 I.U. The most likely diagnosis is -"
} | A 40 year old male was brought to the hospital with acute pain in the upper abdomen. Pateint was in shock with feeble pulse and tachycardia. There was tenderness present in the epigastrium. There is no blood in the gastric aspirate and thepatient felt better after aspiration. X-ray abdomen showed no free gas under the diaphragm. Investigations revealed TLC 13500 serum bilirubin 2.0 mg and serum amylase 800 I.U. | The most likely diagnosis is - | {
"A": "Acute cholecystitis",
"B": "Acute pancreatitis",
"C": "Acute appendicitis",
"D": "Acute hepatitis"
} | B. Acute pancreatitis |
e9ca5fc3-86b9-432f-95a0-fd6c49d1c38f | An elderly patient is receiving a blood transfusion for anemia due to myelodysplastic syndrome (MDS). He was diagnosed with MDS 2 years ago and over the past 6 months has required blood transfusions every 6 weeks for symptomatic anemia. His past medical history also includes hypertension, Type 2 diabetes, and coronary artery disease. Halfway through the transfusion of the second unit of packed red blood cells he develops tachypnea, lumbar pain, tachycardia, and nausea. Which of the following is the most likely explanation? | anxiety | fluid overload | hemolysis | pulmonary embolism | 2c
| single | Intravascular hemolysis from blood transfusion is usually due to ABO incompatibility, often from human error. Symptoms of intravascular hemolysis include flushing, pain at the infusion site, chest or back pain, restlessness, anxiety, nausea, and diarrhea. Signs include fever and chills, shock, and renal failure. In comatose patients, hemoglobinuria or bleeding from disseminated intravascular coagulation can be the first sign. Management is supportive. Acute hemolysis can also result from antibodies directed against other RBC antigens such as Rh, Kell, or Duffy. | Medicine | Blood | 121 | {
"Correct Answer": "hemolysis",
"Correct Option": "C",
"Options": {
"A": "anxiety",
"B": "fluid overload",
"C": "hemolysis",
"D": "pulmonary embolism"
},
"Question": "An elderly patient is receiving a blood transfusion for anemia due to myelodysplastic syndrome (MDS). He was diagnosed with MDS 2 years ago and over the past 6 months has required blood transfusions every 6 weeks for symptomatic anemia. His past medical history also includes hypertension, Type 2 diabetes, and coronary artery disease. Halfway through the transfusion of the second unit of packed red blood cells he develops tachypnea, lumbar pain, tachycardia, and nausea. Which of the following is the most likely explanation?"
} | An elderly patient is receiving a blood transfusion for anemia due to myelodysplastic syndrome (MDS). He was diagnosed with MDS 2 years ago and over the past 6 months has required blood transfusions every 6 weeks for symptomatic anemia. His past medical history also includes hypertension, Type 2 diabetes, and coronary artery disease. Halfway through the transfusion of the second unit of packed red blood cells he develops tachypnea, lumbar pain, tachycardia, and nausea. | Which of the following is the most likely explanation? | {
"A": "anxiety",
"B": "fluid overload",
"C": "hemolysis",
"D": "pulmonary embolism"
} | C. hemolysis |
25ad5687-d922-4830-a35b-5362c8d832e7 | A 40-year-old male presented with symptoms of anemia along with weight loss, night sweats, and low-grade fever.On examination, splenomegaly, petechiae, ecchymosis, lymphadenopathy was noted along with some features of poal hypeension.Lab findings revealed anemia, leukocytosis and thrombocytosis. Bone marrow aspiration reveals a dry tap. Bone marrow biopsy was taken and subjected to reticulin staining.. All of the following genes can be mutated in the above condition except: - | JAK2 | CALR | MPL | ACTN3 | 3d
| multi | This is a case of primary myelofibrosis. Primary myelofibrosis. Peripheral smear shows teardrop red blood cells (RBCs) and a leukoerythroblastic picture with nucleated RBC precursors and immature myeloid cells. Bone marrow biopsy from a patient with primary myelofibrosis shows extensive fibrosis which is confirmed by reticulin staining. Mutations in the JAK2, MPL, CALR, and TET2 genes are associated with most cases of primary myelofibrosis. | Unknown | Integrated QBank | 113 | {
"Correct Answer": "ACTN3",
"Correct Option": "D",
"Options": {
"A": "JAK2",
"B": "CALR",
"C": "MPL",
"D": "ACTN3"
},
"Question": "A 40-year-old male presented with symptoms of anemia along with weight loss, night sweats, and low-grade fever.On examination, splenomegaly, petechiae, ecchymosis, lymphadenopathy was noted along with some features of poal hypeension.Lab findings revealed anemia, leukocytosis and thrombocytosis. Bone marrow aspiration reveals a dry tap. Bone marrow biopsy was taken and subjected to reticulin staining.. All of the following genes can be mutated in the above condition except: -"
} | A 40-year-old male presented with symptoms of anemia along with weight loss, night sweats, and low-grade fever.On examination, splenomegaly, petechiae, ecchymosis, lymphadenopathy was noted along with some features of poal hypeension.Lab findings revealed anemia, leukocytosis and thrombocytosis. Bone marrow aspiration reveals a dry tap. Bone marrow biopsy was taken and subjected to reticulin staining.. | All of the following genes can be mutated in the above condition except: - | {
"A": "JAK2",
"B": "CALR",
"C": "MPL",
"D": "ACTN3"
} | D. ACTN3 |
6f32c4cf-a0c1-46c9-8bd7-d55dd4cce99b | A 21-year-old female presents because her urine has turned a brown color. She states that about 2 months ago her urine turned brown 2 days after a cold and stayed brown for about 3 days. At the current time a urinalysis reveals 2+ blood with red cells and red cell casts. Fuher laboratory tests include a complete blood count (CBC), serum electrolytes, BUN, creatinine, glucose, antinuclear antibodies (ANAs), and serum complement levels (C3 and C4). All of these tests are within normal limits. Immunofluorescence examination of a renal biopsy from this patient reveals the presence of large, irregular deposits of IgA/C3 in the mesangium. A linear staining pattern is not found. What is the most likely diagnosis for this patient? | Berger's disease | Goodpasture's disease | Lipoid nephrosis | Membranoproliferative glomerulonephritis | 0a
| multi | Many diseases involve hematuria, and a few of these diseases occur in the setting of an upper respiratory infection or of upper respiratory signs and symptoms. When hematuria follows within 2 days of the onset of an upper respiratory infection without skin lesions in a young patient, IgA nephropathy (Berger's disease) should be considered. This disease involves the deposition of IgA in the mesangium of the glomeruli. Light microscopic examination may suggest the disease, but renal biopsy immunofluorescence (IF) must be performed to confirm it. This disorder may be the most common cause of nephritic syndrome worldwide. The hematuria may become recurrent, with proteinuria that may approach nephrotic syndrome propoions. Serum levels of IgA may be elevated. A small percentage of patients may progress to renal failure over a period of years. In contrast to Berger's disease, a linear IF pattern suggests a type II hypersensitivity reaction, such as Goodpasture's disease, while a granular pattern is seen with poststreptococcal glomerulonephritis (GN), membranous GN, focal segmental glomerulosclerosis, and membranoproliferative GN. Most positive immunofluorescence patterns involve IgG and C3, except that a granular IgM pattern is present in focal segmental glomerulosclerosis, while mesangial IgA is seen in IgA nephropathy (Berger's disease). Lipoid nephrosis would have a negative IF pattern; that is, there would be no staining present. Reference: Robbins & Cotran Pathologic Basis of Disease, 9edition | Pathology | miscellaneous | 168 | {
"Correct Answer": "Berger's disease",
"Correct Option": "A",
"Options": {
"A": "Berger's disease",
"B": "Goodpasture's disease",
"C": "Lipoid nephrosis",
"D": "Membranoproliferative glomerulonephritis"
},
"Question": "A 21-year-old female presents because her urine has turned a brown color. She states that about 2 months ago her urine turned brown 2 days after a cold and stayed brown for about 3 days. At the current time a urinalysis reveals 2+ blood with red cells and red cell casts. Fuher laboratory tests include a complete blood count (CBC), serum electrolytes, BUN, creatinine, glucose, antinuclear antibodies (ANAs), and serum complement levels (C3 and C4). All of these tests are within normal limits. Immunofluorescence examination of a renal biopsy from this patient reveals the presence of large, irregular deposits of IgA/C3 in the mesangium. A linear staining pattern is not found. What is the most likely diagnosis for this patient?"
} | A 21-year-old female presents because her urine has turned a brown color. She states that about 2 months ago her urine turned brown 2 days after a cold and stayed brown for about 3 days. At the current time a urinalysis reveals 2+ blood with red cells and red cell casts. Fuher laboratory tests include a complete blood count (CBC), serum electrolytes, BUN, creatinine, glucose, antinuclear antibodies (ANAs), and serum complement levels (C3 and C4). All of these tests are within normal limits. Immunofluorescence examination of a renal biopsy from this patient reveals the presence of large, irregular deposits of IgA/C3 in the mesangium. A linear staining pattern is not found. | What is the most likely diagnosis for this patient? | {
"A": "Berger's disease",
"B": "Goodpasture's disease",
"C": "Lipoid nephrosis",
"D": "Membranoproliferative glomerulonephritis"
} | A. Berger's disease |
08339c32-e4b2-4028-ae3f-46d1dd95970b | A 50-year-old man has had a chronic cough for the past 18 months. Physical examination shows nasopharyngeal ulcers, and the lungs have diffuse crackles bilaterally on auscultation. Laboratory studies include a serum urea nitrogen level of 75 mg/dL and a creatinine concentration of 6.7 mg/dL. Urinalysis shows 50 RBCs per high-power field and RBC casts. His serologic titer for C-ANCA (proteinase 3) is elevated. A chest radiograph shows multiple, small, bilateral pulmonary nodules. A transbronchial lung biopsy specimen shows a necrotizing inflammatory process involving the small peripheral pulmonary arteries and arterioles. Which of the following is the most likely diagnosis? | Granulomatosis with polyangiitis | Fibromuscular dysplasia | Granuloma pyogenicum | Kaposi sarcoma | 0a
| multi | Anti-neutrophil cytoplasmic autoantibody (ANCA)- associated vasculitis (granulomatosis with polyangiitis) is a form of hypersensitivity reaction to an unknown antigen characterized by necrotizing granulomatous inflammation that typically involves small to medium-sized vessels, although many organ sites may be affected. Pulmonary and renal involvement can be life-threatening. C-ANCAs (antibodies mainly directed against neutrophil proteinase 3) are found in more than 90% of cases. Fibromuscular dysplasia is a hyperplastic medial disorder, usually involving renal and carotid arteries; on angiography, it appears as a "string of beads" caused by thickened fibromuscular ridges adjacent to less involved areas of the arterial wall. Granuloma pyogenicum is an inflammatory response that can produce a nodular mass, often on the gingiva or the skin. Kaposi sarcoma can produce plaque-like to nodular masses that are composed of irregular vascular spaces lined by atypical-appearing endothelial cells; skin involvement is most common, but visceral organ involvement can occur. Polyarteritis nodosa most often involves small muscular arteries, and sometimes veins. It causes necrosis and microaneurysm formation followed by scarring and vascular occlusion, mainly in the kidney, gastrointestinal tract, and skin of young to middle-aged adults. Takayasu arteritis is seen mainly in children and involves the aorta (particularly the arch) and branches such as the coronary and renal arteries, with granulomatous inflammation, aneurysm formation, and dissection. | Pathology | Blood Vessels | 165 | {
"Correct Answer": "Granulomatosis with polyangiitis",
"Correct Option": "A",
"Options": {
"A": "Granulomatosis with polyangiitis",
"B": "Fibromuscular dysplasia",
"C": "Granuloma pyogenicum",
"D": "Kaposi sarcoma"
},
"Question": "A 50-year-old man has had a chronic cough for the past 18 months. Physical examination shows nasopharyngeal ulcers, and the lungs have diffuse crackles bilaterally on auscultation. Laboratory studies include a serum urea nitrogen level of 75 mg/dL and a creatinine concentration of 6.7 mg/dL. Urinalysis shows 50 RBCs per high-power field and RBC casts. His serologic titer for C-ANCA (proteinase 3) is elevated. A chest radiograph shows multiple, small, bilateral pulmonary nodules. A transbronchial lung biopsy specimen shows a necrotizing inflammatory process involving the small peripheral pulmonary arteries and arterioles. Which of the following is the most likely diagnosis?"
} | A 50-year-old man has had a chronic cough for the past 18 months. Physical examination shows nasopharyngeal ulcers, and the lungs have diffuse crackles bilaterally on auscultation. Laboratory studies include a serum urea nitrogen level of 75 mg/dL and a creatinine concentration of 6.7 mg/dL. Urinalysis shows 50 RBCs per high-power field and RBC casts. His serologic titer for C-ANCA (proteinase 3) is elevated. A chest radiograph shows multiple, small, bilateral pulmonary nodules. A transbronchial lung biopsy specimen shows a necrotizing inflammatory process involving the small peripheral pulmonary arteries and arterioles. | Which of the following is the most likely diagnosis? | {
"A": "Granulomatosis with polyangiitis",
"B": "Fibromuscular dysplasia",
"C": "Granuloma pyogenicum",
"D": "Kaposi sarcoma"
} | A. Granulomatosis with polyangiitis |
dd64b6a2-3718-4a9a-993a-b459ec5ba9f3 | A 68 year old male, chronic smoker and alcoholic presented to medicine OP with complaint of persistent vomiting of one month duration. He had a bad headache during these days. Clinical examination was essentially normal except for clubbing. Lab parameters were within normal limits except an elevated ESR. During detailed evaluation he gave history of dry cough of two month duration. Chest X-ray was taken and showed a peripheral opacity. CECT chest showed evidence of carcinoma lung. What could be the cause for his persistent vomiting? | Bronchogenic carcinoma with brain metastasis | Bronchogenic carcinoma with liver metastasis | Bronchogenic carcinoma with paraneoplastic syndrome | Bronchogenic carcinoma with intestinal obstruction | 0a
| multi | More than half of all patients diagnosed with lung cancer present with advanced disease at the time of diagnosis. The prototypical lung cancer patient is a current or former smoker of either sex, usually in the seventh decade of life. A history of chronic cough with or without hemoptysis in a current or former smoker. Here the patient has advanced disease. As he was cmplaining of head ache and vomiting and considering the fact that brain mets are not uncommon in bronchogenic carcinoma, the first possibility in this setting would be bronchogenic carcinoma with brain metastasis. | Medicine | null | 102 | {
"Correct Answer": "Bronchogenic carcinoma with brain metastasis",
"Correct Option": "A",
"Options": {
"A": "Bronchogenic carcinoma with brain metastasis",
"B": "Bronchogenic carcinoma with liver metastasis",
"C": "Bronchogenic carcinoma with paraneoplastic syndrome",
"D": "Bronchogenic carcinoma with intestinal obstruction"
},
"Question": "A 68 year old male, chronic smoker and alcoholic presented to medicine OP with complaint of persistent vomiting of one month duration. He had a bad headache during these days. Clinical examination was essentially normal except for clubbing. Lab parameters were within normal limits except an elevated ESR. During detailed evaluation he gave history of dry cough of two month duration. Chest X-ray was taken and showed a peripheral opacity. CECT chest showed evidence of carcinoma lung. What could be the cause for his persistent vomiting?"
} | A 68 year old male, chronic smoker and alcoholic presented to medicine OP with complaint of persistent vomiting of one month duration. He had a bad headache during these days. Clinical examination was essentially normal except for clubbing. Lab parameters were within normal limits except an elevated ESR. During detailed evaluation he gave history of dry cough of two month duration. Chest X-ray was taken and showed a peripheral opacity. CECT chest showed evidence of carcinoma lung. | What could be the cause for his persistent vomiting? | {
"A": "Bronchogenic carcinoma with brain metastasis",
"B": "Bronchogenic carcinoma with liver metastasis",
"C": "Bronchogenic carcinoma with paraneoplastic syndrome",
"D": "Bronchogenic carcinoma with intestinal obstruction"
} | A. Bronchogenic carcinoma with brain metastasis |
8dcc5d4b-ce7d-4878-87cc-c739c1472b52 | A 35-year-old male with a stab wound on the right upper quadrant of the abdomen just below the costal margin is brought to emergency room with BP 80/50 mm Hg and pulse rate 140/min. FAST reveals blood in Right upper quadrant. Immediately the patient is taken for emergency laparotomy. To stop the bleeding, surgeon tries to occlude the free edge of lesser omentum. However, the bleeding does not stop. Which of the following structure is likely source of haemorrhage? | Hepatic aery | Cystic aery | Poal vein | Inferior vena cava | 3d
| single | The bleeding is likely from wounded liver. The surgeon attempts to occlude the free edge of lesser omentum also known as hepatoduodenal ligament. This maneuver is also known as Pringle's maneuver. Occlusion of hepatoduodenal ligament occludes the following structures: Hepatic aery Poal vein Common bile duct However, if the bleeding does not stop even after occlusion of these structures, the likely source of bleeding is inferior vena cava or hepatic veins. | Unknown | Integrated QBank | 111 | {
"Correct Answer": "Inferior vena cava",
"Correct Option": "D",
"Options": {
"A": "Hepatic aery",
"B": "Cystic aery",
"C": "Poal vein",
"D": "Inferior vena cava"
},
"Question": "A 35-year-old male with a stab wound on the right upper quadrant of the abdomen just below the costal margin is brought to emergency room with BP 80/50 mm Hg and pulse rate 140/min. FAST reveals blood in Right upper quadrant. Immediately the patient is taken for emergency laparotomy. To stop the bleeding, surgeon tries to occlude the free edge of lesser omentum. However, the bleeding does not stop. Which of the following structure is likely source of haemorrhage?"
} | A 35-year-old male with a stab wound on the right upper quadrant of the abdomen just below the costal margin is brought to emergency room with BP 80/50 mm Hg and pulse rate 140/min. FAST reveals blood in Right upper quadrant. Immediately the patient is taken for emergency laparotomy. To stop the bleeding, surgeon tries to occlude the free edge of lesser omentum. However, the bleeding does not stop. | Which of the following structure is likely source of haemorrhage? | {
"A": "Hepatic aery",
"B": "Cystic aery",
"C": "Poal vein",
"D": "Inferior vena cava"
} | D. Inferior vena cava |
d5e9afe4-9078-4c59-b804-b01a777ea0cc | A 65-year-old patient presented to the medicine OPD with weakness and fatigue for 6 months along with some mild abdominal discomfo. On examination, moderate splenomegaly was noted. Lab findings Severe normocytic normochromic anemia Neutropenia with monocytopenia Thrombocytopenia. Bone marrow aspiration was done to look for the cause of decreased cell counts but the tap came 'dry'. So, a bone marrow biopsy was performed. Flow cytometry study revealed that the cells were positive for CD11c, CD103, CD123 and CD25 and were also TRAP positive. BM Biopsy All of the following drugs can be given in the treatment of the above condition except : - | Cladribine | Vemurafenib | 5-fluorouracil | Deoxycoformycin | 2c
| multi | This is a case of hairy cell leukemia. Bone marrow biopsy image shows the classical fried egg appearance. Treatment: - Splenectomy is often associated with prolonged remission. Nucleosides including cladribine and deoxycoformycin are highly active Interferon a is also an effective therapy but is not as effective as nucleosides. Chemotherapy-refractory patients have responded to vemurafenib, a BRAF inhibitor. | Unknown | Integrated QBank | 160 | {
"Correct Answer": "5-fluorouracil",
"Correct Option": "C",
"Options": {
"A": "Cladribine",
"B": "Vemurafenib",
"C": "5-fluorouracil",
"D": "Deoxycoformycin"
},
"Question": "A 65-year-old patient presented to the medicine OPD with weakness and fatigue for 6 months along with some mild abdominal discomfo. On examination, moderate splenomegaly was noted. Lab findings Severe normocytic normochromic anemia Neutropenia with monocytopenia Thrombocytopenia. Bone marrow aspiration was done to look for the cause of decreased cell counts but the tap came 'dry'. So, a bone marrow biopsy was performed. Flow cytometry study revealed that the cells were positive for CD11c, CD103, CD123 and CD25 and were also TRAP positive. BM Biopsy All of the following drugs can be given in the treatment of the above condition except : -"
} | A 65-year-old patient presented to the medicine OPD with weakness and fatigue for 6 months along with some mild abdominal discomfo. On examination, moderate splenomegaly was noted. Lab findings Severe normocytic normochromic anemia Neutropenia with monocytopenia Thrombocytopenia. Bone marrow aspiration was done to look for the cause of decreased cell counts but the tap came 'dry'. So, a bone marrow biopsy was performed. Flow cytometry study revealed that the cells were positive for CD11c, CD103, CD123 and CD25 and were also TRAP positive. | BM Biopsy All of the following drugs can be given in the treatment of the above condition except : - | {
"A": "Cladribine",
"B": "Vemurafenib",
"C": "5-fluorouracil",
"D": "Deoxycoformycin"
} | C. 5-fluorouracil |
30221adb-9c4f-4468-be08-fda290b0262c | A 66-year-old man has experienced fatigue, a 5-kg weight loss, night sweats, and abdominal discomfort for 10 months. On physical examination, he has marked splenomegaly; there is no lymphadenopathy. Laboratory studies show hemoglobin, 10.1 g/dL; hematocrit, 30.5%; MCV, 89 gm3; platelet count, 94,000/mm3; and WBC count, 14,750/mm3 with 55% segmented neutrophils, 9% bands, 20% lymphocytes, 8% monocytes, 4% metamyelocytes, 3% myelocytes, 1% eosinophils, and 2 nucleated RBCs per 100 WBCs. The peripheral blood smear also shows teardrop cells. The serum uric acid level is 12 mg/dL. A bone marrow biopsy specimen shows extensive marrow fibrosis and clusters of atypical megakaryocytes. Which of the following is most likely to account for the enlargement in this patient's spleen? | Extramedullary hematopoiesis | Granulomas with Histoplasma capsulatum | Hodgkin lymphoma | Metastatic adenocarcinoma | 0a
| single | Myelofibrosis with myeloid metaplasia is a myeloproliferative disorder that is also a stem cell disorder in which neoplastic megakaryocytes secrete fibrogenic factors leading to marrow fibrosis. The neoplastic clone then shifts to the spleen, where it shows trilineage hematopoietic proliferation (extramedullary hematopoiesis), in which megakaryocytes are prominent. The marrow fibrosis and the extramedullary hematopoiesis in the spleen fail to regulate orderly release of leukocytes into the blood. The peripheral blood has immature RBC and WBC precursors (leukoerythroblastic picture). Hematopoietic cell proliferation and turnover increases purine metabolism and uric acid production. Teardrop RBCs are misshapen RBCs that are seen when marrow undergoes fibrosis. Marrow injury also can be the result of other causes (e.g., metastatic tumors, irradiation). These causes also can give rise to a leukoerythroblastic picture, but splenic enlargement with trilineage proliferation usually is not seen. The other causes mentioned - Hodgkin lymphoma, portal hypertension, and Histoplasma capsulatum infection - can cause splenic enlargement, but not marrow fibrosis. Metastases to the spleen are uncommon. | Pathology | Blood | 247 | {
"Correct Answer": "Extramedullary hematopoiesis",
"Correct Option": "A",
"Options": {
"A": "Extramedullary hematopoiesis",
"B": "Granulomas with Histoplasma capsulatum",
"C": "Hodgkin lymphoma",
"D": "Metastatic adenocarcinoma"
},
"Question": "A 66-year-old man has experienced fatigue, a 5-kg weight loss, night sweats, and abdominal discomfort for 10 months. On physical examination, he has marked splenomegaly; there is no lymphadenopathy. Laboratory studies show hemoglobin, 10.1 g/dL; hematocrit, 30.5%; MCV, 89 gm3; platelet count, 94,000/mm3; and WBC count, 14,750/mm3 with 55% segmented neutrophils, 9% bands, 20% lymphocytes, 8% monocytes, 4% metamyelocytes, 3% myelocytes, 1% eosinophils, and 2 nucleated RBCs per 100 WBCs. The peripheral blood smear also shows teardrop cells. The serum uric acid level is 12 mg/dL. A bone marrow biopsy specimen shows extensive marrow fibrosis and clusters of atypical megakaryocytes. Which of the following is most likely to account for the enlargement in this patient's spleen?"
} | A 66-year-old man has experienced fatigue, a 5-kg weight loss, night sweats, and abdominal discomfort for 10 months. On physical examination, he has marked splenomegaly; there is no lymphadenopathy. Laboratory studies show hemoglobin, 10.1 g/dL; hematocrit, 30.5%; MCV, 89 gm3; platelet count, 94,000/mm3; and WBC count, 14,750/mm3 with 55% segmented neutrophils, 9% bands, 20% lymphocytes, 8% monocytes, 4% metamyelocytes, 3% myelocytes, 1% eosinophils, and 2 nucleated RBCs per 100 WBCs. The peripheral blood smear also shows teardrop cells. The serum uric acid level is 12 mg/dL. A bone marrow biopsy specimen shows extensive marrow fibrosis and clusters of atypical megakaryocytes. | Which of the following is most likely to account for the enlargement in this patient's spleen? | {
"A": "Extramedullary hematopoiesis",
"B": "Granulomas with Histoplasma capsulatum",
"C": "Hodgkin lymphoma",
"D": "Metastatic adenocarcinoma"
} | A. Extramedullary hematopoiesis |
3e779c66-4604-4b98-9116-a89abef29375 | A nine-month-old boy of Sindhi parents presented to you with complaints of progressive lethargy, irritability and pallor since 6 months of age. Examination revealed severe pallor. Investigation showed Hb-3.8 g%; MCV- 58 fL, MCH-19.4 pg/cell. Osmotic fragility is normal; Blood film shows target cells and 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 | 2c
| multi | Discussing options one by one: a. Iron deficiency anemia: So severe anemia & expansion of erythroid marrow are usually not seen b. Acute lymphoid Leukemia: Low MCV, no obvious involvement of other cell lines, and expansion of erythroid marrow are incompatible with diagnosis of ALL c. Hemoglobin D disease: Low MCV and MCH with target cells suggest abnormality of haemoglobin like HbD disease d. Hereditary spherocytosis: Normal osmotic fragility goes against hereditary spherocytosis | Pediatrics | Nutritional anemia | 109 | {
"Correct Answer": "Hemoglobin D disease",
"Correct Option": "C",
"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 progressive lethargy, irritability and pallor since 6 months of age. Examination revealed severe pallor. Investigation showed Hb-3.8 g%; MCV- 58 fL, MCH-19.4 pg/cell. Osmotic fragility is normal; Blood film shows target cells and 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 progressive lethargy, irritability and pallor since 6 months of age. Examination revealed severe pallor. Investigation showed Hb-3.8 g%; MCV- 58 fL, MCH-19.4 pg/cell. Osmotic fragility is normal; Blood film shows target cells and 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"
} | C. Hemoglobin D disease |
a94ede84-8220-4a30-bed3-dddbb72e7b63 | A 66-year-old man presents with shoness of breath, myalgia, headache along with multiple episodes of fever with rigors. He went to the local doctor who treated him for the flu. However, his symptoms worsened, and by the day of presentation he was complaining of a dry cough and marked shoness of breath and diarrhoea. Patient is a non-smoker. Auscultation of chest reveals bilateral crackles and bronchial breathing in both lower zones posteriorly. Lab findings, Elevated CRP level Hypocalcemia Acidosis and marked hypoxia Gram staining of sputum revealed small, pleomorphic, faint, gram negative bacilli. Chest X-ray What is the drug of choice of the above organism: - | Azithromycin | Ampicillin | Vancomycin | Gentamycin | 0a
| multi | This is a case of Legionella pneumophila pneumonia. The diffuse infiltrates on chest X-ray suggest atypical pneumonia, whereas a lobar pattern tends to occur with streptococcal pneumonia. The 4-day prodromal illness is typical of Legionella pneumonia. Pneumococcal pneumonia which tends to present abruptly with fever and shoness of breath. Legionella infection presents with myalgia, headache and fever. Patients may develop diarrhoea and abdominal pain. As the illness progresses the patient develops a dry cough, chest pain, shoness of breath and acute confusion. 1st line drugs are: - 1. Azithromycin 2. Ciprofloxacin | Unknown | Integrated QBank | 156 | {
"Correct Answer": "Azithromycin",
"Correct Option": "A",
"Options": {
"A": "Azithromycin",
"B": "Ampicillin",
"C": "Vancomycin",
"D": "Gentamycin"
},
"Question": "A 66-year-old man presents with shoness of breath, myalgia, headache along with multiple episodes of fever with rigors. He went to the local doctor who treated him for the flu. However, his symptoms worsened, and by the day of presentation he was complaining of a dry cough and marked shoness of breath and diarrhoea. Patient is a non-smoker. Auscultation of chest reveals bilateral crackles and bronchial breathing in both lower zones posteriorly. Lab findings, Elevated CRP level Hypocalcemia Acidosis and marked hypoxia Gram staining of sputum revealed small, pleomorphic, faint, gram negative bacilli. Chest X-ray What is the drug of choice of the above organism: -"
} | A 66-year-old man presents with shoness of breath, myalgia, headache along with multiple episodes of fever with rigors. He went to the local doctor who treated him for the flu. However, his symptoms worsened, and by the day of presentation he was complaining of a dry cough and marked shoness of breath and diarrhoea. Patient is a non-smoker. Auscultation of chest reveals bilateral crackles and bronchial breathing in both lower zones posteriorly. Lab findings, Elevated CRP level Hypocalcemia Acidosis and marked hypoxia Gram staining of sputum revealed small, pleomorphic, faint, gram negative bacilli. | Chest X-ray What is the drug of choice of the above organism: - | {
"A": "Azithromycin",
"B": "Ampicillin",
"C": "Vancomycin",
"D": "Gentamycin"
} | A. Azithromycin |
fcd0b59b-8f0b-49ca-b08e-d3ff52b79e8f | A 48 year old woman was admitted with a history of weakness for two months. On examination, cervical lymph nodes were found enlarged and spleen was palpable 2 cm below the costal margin. Her hemoglobin was 10.5 g/dl, platelet count 2.7 × 109/L and total leukocyte count 40 × 109/ L, which included 80% mature lymphoid cells with coarse clumped chromatin. Bone marrow revealed a nodular lymphoid infiltrate. The peripheral blood lymphoid cells were positive for CD 19, CD5, CD20 and CD23 and were negative for CD 79 B and FMC-7.The histopathological examination of the lymph node in this patient will most likely exhibit effacement of lymph node architecture by - | A pseudofollicular pattern with proliferation centers | A monomorphic lymphoid proliferation with a nodular pattern. | A predominantly follicular pattern | A diffuse proliferation of medium to large lymphoid cells with high mitotic rate | 0a
| single | Lymphocytes positive for CD 19, CD20, CD23, CD5 suggest the diagnosis of chronic lymphocytic leukemia/small lymphocytic lymphoma.
In CLL/SLL larger lymphocytes show high mitotic activity and form proliferation centre.
Chronic lymphocytic leukemia (CLL), small lymphocytic lymphoma (SLL).
CLL and SLL are identical neoplasm/arise due to an abnormal neoplastic proliferation of B cells.
CLL involves primarily bone marrow and blood, while SLL involves lymph nodes
Morphology of CLL/SLL
The tumor cells of CLL are small B lymphocytes.
Leukemic cells have the morphological appearance of normal small to medium sized lymphocytes with clumped chromatin, inconspicuous nuclei and a small ring of cytoplasm.
The lymph node architecture is diffusely effaced by these tumor cells.
These cells are mixed with variable numbers of larger cells called prolymphocytes.
In many cases, prolymphyocytes gather together focally to form as proliferation centers, so called because they contain relatively large number of mitotic activity.
When present proliferation centers are pathognomonic for CLL/SLL.
In CLL, the peripheral blood contains increased numbers of small, round lymphocytes with scant frequently disrupted in the process of making smears, producing So called smudge cells..
Markers of CLL tumor cells
CLL is a tumor of mature -cells, therefore it expresses the B-cell markers such as CD19, CD20 and surface IgM and IgD.
In addition CD23 and CD5 are also present (In contrast to mantle cell lymphoma which is positive for CD5 but negative for CD23). | Pathology | null | 175 | {
"Correct Answer": "A pseudofollicular pattern with proliferation centers",
"Correct Option": "A",
"Options": {
"A": "A pseudofollicular pattern with proliferation centers",
"B": "A monomorphic lymphoid proliferation with a nodular pattern.",
"C": "A predominantly follicular pattern",
"D": "A diffuse proliferation of medium to large lymphoid cells with high mitotic rate"
},
"Question": "A 48 year old woman was admitted with a history of weakness for two months. On examination, cervical lymph nodes were found enlarged and spleen was palpable 2 cm below the costal margin. Her hemoglobin was 10.5 g/dl, platelet count 2.7 × 109/L and total leukocyte count 40 × 109/ L, which included 80% mature lymphoid cells with coarse clumped chromatin. Bone marrow revealed a nodular lymphoid infiltrate. The peripheral blood lymphoid cells were positive for CD 19, CD5, CD20 and CD23 and were negative for CD 79 B and FMC-7.The histopathological examination of the lymph node in this patient will most likely exhibit effacement of lymph node architecture by -"
} | A 48 year old woman was admitted with a history of weakness for two months. On examination, cervical lymph nodes were found enlarged and spleen was palpable 2 cm below the costal margin. Her hemoglobin was 10.5 g/dl, platelet count 2.7 × 109/L and total leukocyte count 40 × 109/ L, which included 80% mature lymphoid cells with coarse clumped chromatin. Bone marrow revealed a nodular lymphoid infiltrate. | The peripheral blood lymphoid cells were positive for CD 19, CD5, CD20 and CD23 and were negative for CD 79 B and FMC-7.The histopathological examination of the lymph node in this patient will most likely exhibit effacement of lymph node architecture by - | {
"A": "A pseudofollicular pattern with proliferation centers",
"B": "A monomorphic lymphoid proliferation with a nodular pattern.",
"C": "A predominantly follicular pattern",
"D": "A diffuse proliferation of medium to large lymphoid cells with high mitotic rate"
} | A. A pseudofollicular pattern with proliferation centers |
b7c5924b-0131-44ee-839e-dd5c5edb5c25 | A 35-year-old male vet presented with a 3 days history of swelling and discomfo in right axilla. On examination, enlarged, tender right axillary lymph nodes are found as shown. No other areas of lymphadenopathy is seen. USG of right axilla was done and is shown below. Several scratch marks are also present on right arm. Biopsy was planned and HPE findings are shown below. The organism responsible is also associated with which of the following conditions? | Oraya fever | Verruga peruana | Pontiac fever | Bacillary angiomatosis | 3d
| single | USG shows axillary lymphadenopathy. HPE image shows angioproliferation and neutrophilic infiltrate. Occupation with close contact with animals, scratch marks on left arm with tender axillary lymphadenopathy on the same side point towards the diagnosis of Cat scratch fever which is caused by Baonella henselae. Other condition caused by Baonella henselae is Bacillary Angiomatosis. Oraya fever and Verruga peruana are caused by Baonella bacilliformis. Pontiac fever is caused by Legionnella pneumophilla. | Unknown | Integrated QBank | 101 | {
"Correct Answer": "Bacillary angiomatosis",
"Correct Option": "D",
"Options": {
"A": "Oraya fever",
"B": "Verruga peruana",
"C": "Pontiac fever",
"D": "Bacillary angiomatosis"
},
"Question": "A 35-year-old male vet presented with a 3 days history of swelling and discomfo in right axilla. On examination, enlarged, tender right axillary lymph nodes are found as shown. No other areas of lymphadenopathy is seen. USG of right axilla was done and is shown below. Several scratch marks are also present on right arm. Biopsy was planned and HPE findings are shown below. The organism responsible is also associated with which of the following conditions?"
} | A 35-year-old male vet presented with a 3 days history of swelling and discomfo in right axilla. On examination, enlarged, tender right axillary lymph nodes are found as shown. No other areas of lymphadenopathy is seen. USG of right axilla was done and is shown below. Several scratch marks are also present on right arm. Biopsy was planned and HPE findings are shown below. | The organism responsible is also associated with which of the following conditions? | {
"A": "Oraya fever",
"B": "Verruga peruana",
"C": "Pontiac fever",
"D": "Bacillary angiomatosis"
} | D. Bacillary angiomatosis |
2145abd4-88d7-467c-b1d1-3356cf921414 | Following statements are true/false about drugs affecting renin angiotensin aldosterone system?1. Aliskiren acts by inhibiting the secretion of renin2. Enalapril can cause cough and angioedema3. Losartan inhibits the formation of angiotensin II4. Epleronone causes gynaecomastia as an adverse effect5. Sampatrilat has additional inhibitory activity on neprilysin apart from inhibitory effect on ACE. | True: 3, 4; False: 1, 2, 5 | True: 1, 2; False: 3, 4, 5 | True: 2, 5; False: 1, 3, 4 | True: 4, 5; False: 1, 3, 5 | 2c
| multi | Ans. CExplanation:* Aliskiren is a renin inhibitor. It does not inhibit secretion of renin. Rather it inhibits the action of renin after it is secreted. Beta blockers act by inhibiting the secretion of renin.* ACE inhibitors like enalapril prevent the degradation of bradykinin. Excessive bradykinin can result in cough and angioedema as adverse effects.* Losartan is an angiotensin receptor antagonist. It does not inhibit the formation of angiotensin II.* Epleronone is a new aldosterone antagonist like spironolactone, however unlike spironolactone, it does not cause gynaecomastia.* Sampatrilat and omapatrilat are vasopeptidase inhibitors. These can inhibit two enzymes; ACE and neprilysin. | Pharmacology | ACE Inhibitors | 103 | {
"Correct Answer": "True: 2, 5; False: 1, 3, 4",
"Correct Option": "C",
"Options": {
"A": "True: 3, 4; False: 1, 2, 5",
"B": "True: 1, 2; False: 3, 4, 5",
"C": "True: 2, 5; False: 1, 3, 4",
"D": "True: 4, 5; False: 1, 3, 5"
},
"Question": "Following statements are true/false about drugs affecting renin angiotensin aldosterone system?1. Aliskiren acts by inhibiting the secretion of renin2. Enalapril can cause cough and angioedema3. Losartan inhibits the formation of angiotensin II4. Epleronone causes gynaecomastia as an adverse effect5. Sampatrilat has additional inhibitory activity on neprilysin apart from inhibitory effect on ACE."
} | Following statements are true/false about drugs affecting renin angiotensin aldosterone system?1. Aliskiren acts by inhibiting the secretion of renin2. Enalapril can cause cough and angioedema3. Losartan inhibits the formation of angiotensin II4. Epleronone causes gynaecomastia as an adverse effect5. | Sampatrilat has additional inhibitory activity on neprilysin apart from inhibitory effect on ACE. | {
"A": "True: 3, 4; False: 1, 2, 5",
"B": "True: 1, 2; False: 3, 4, 5",
"C": "True: 2, 5; False: 1, 3, 4",
"D": "True: 4, 5; False: 1, 3, 5"
} | C. True: 2, 5; False: 1, 3, 4 |
a23a3f1e-5f12-44b6-a833-2a9d30151f53 | A 23 year old man comes to psychiatry outpatient due to symptoms of sleep disturbances and 'feeling low'. The symptoms staed 2 months back after he found that his girlfriend was cheating on him and was in a relationship with her boss. The patient immediately broke up with her. However since than he has been feeling sad, and repos that nothing makes him feel better anymore. The patient has stopped going to office and doesn't even come out of his room unless its absolutely necessary. He has not slept for seven days and has lost a couple of kilograms in last two months. During interview he said, 'i am a loser, my girlfriend chose a 50 year old man over me, there must be something seriously wrong with me, '. What is the diagnosis? | Major depression | Adjustment disorder | Normal stress response | Post traumatic stress disorder | 0a
| single | This patient has symptoms of sadness of mood, loss of interest in work, sleep and appetite disturbances, negative thoughts and significant impairment in personal and professional life. Though, it was triggered by a breakup, symptoms are severe enough and hence, patient will get a diagnosis of major depression , and not adjustment disorder. If symptoms are sufficient enough, diagnosis of depression gets preference over adjustment disorder. | Psychiatry | Mood Disorders | 158 | {
"Correct Answer": "Major depression",
"Correct Option": "A",
"Options": {
"A": "Major depression",
"B": "Adjustment disorder",
"C": "Normal stress response",
"D": "Post traumatic stress disorder"
},
"Question": "A 23 year old man comes to psychiatry outpatient due to symptoms of sleep disturbances and 'feeling low'. The symptoms staed 2 months back after he found that his girlfriend was cheating on him and was in a relationship with her boss. The patient immediately broke up with her. However since than he has been feeling sad, and repos that nothing makes him feel better anymore. The patient has stopped going to office and doesn't even come out of his room unless its absolutely necessary. He has not slept for seven days and has lost a couple of kilograms in last two months. During interview he said, 'i am a loser, my girlfriend chose a 50 year old man over me, there must be something seriously wrong with me, '. What is the diagnosis?"
} | A 23 year old man comes to psychiatry outpatient due to symptoms of sleep disturbances and 'feeling low'. The symptoms staed 2 months back after he found that his girlfriend was cheating on him and was in a relationship with her boss. The patient immediately broke up with her. However since than he has been feeling sad, and repos that nothing makes him feel better anymore. The patient has stopped going to office and doesn't even come out of his room unless its absolutely necessary. He has not slept for seven days and has lost a couple of kilograms in last two months. During interview he said, 'i am a loser, my girlfriend chose a 50 year old man over me, there must be something seriously wrong with me, '. | What is the diagnosis? | {
"A": "Major depression",
"B": "Adjustment disorder",
"C": "Normal stress response",
"D": "Post traumatic stress disorder"
} | A. Major depression |
13e16be4-d584-4238-8efc-4d217e803b57 | A 68-year-old female smoker is admitted with progressive weakness, weight loss, and dysphagia. Physical exam: pulse 110 bpm; temperature normal; respirations 18/min; blood pressure 110/60 mm Hg. The patient appears cachectic on general exam. Laboratory data: Hb 9 g/dL; Hct 27%; BUN 13 mg/dL; creatinine 0.4 mg/dL; sodium 124 mEq/L; potassium 3.8 mEq/L. Chest x-rays are shown . An associated symptom that may signal mediastinal involvement and inoperability is | Cough | Clubbing | Steady boring chest pain | Diaphoresis | 2c
| single | The PA view shows a large, well-defined opacity in the right hilum. The ascending aoa shadow is not silhouetted, suggesting that this is a posterior opacity. The left hilum and the left PA appear normal. This large posterior mediastinal mass is an esophageal lesion, and the presence of steady, constant, boring pain is indicative of mediastinal involvement and therefore inoperability. Cough may be due to aspiration or laryngeal reflux; clubbing can at times be seen in both benign and malignant lesions of the esophagus and does not indicate mediastinal involvement or inoperability | Radiology | Respiratory system | 142 | {
"Correct Answer": "Steady boring chest pain",
"Correct Option": "C",
"Options": {
"A": "Cough",
"B": "Clubbing",
"C": "Steady boring chest pain",
"D": "Diaphoresis"
},
"Question": "A 68-year-old female smoker is admitted with progressive weakness, weight loss, and dysphagia. Physical exam: pulse 110 bpm; temperature normal; respirations 18/min; blood pressure 110/60 mm Hg. The patient appears cachectic on general exam. Laboratory data: Hb 9 g/dL; Hct 27%; BUN 13 mg/dL; creatinine 0.4 mg/dL; sodium 124 mEq/L; potassium 3.8 mEq/L. Chest x-rays are shown . An associated symptom that may signal mediastinal involvement and inoperability is"
} | A 68-year-old female smoker is admitted with progressive weakness, weight loss, and dysphagia. Physical exam: pulse 110 bpm; temperature normal; respirations 18/min; blood pressure 110/60 mm Hg. The patient appears cachectic on general exam. Laboratory data: Hb 9 g/dL; Hct 27%; BUN 13 mg/dL; creatinine 0.4 mg/dL; sodium 124 mEq/L; potassium 3.8 mEq/L. Chest x-rays are shown . | An associated symptom that may signal mediastinal involvement and inoperability is | {
"A": "Cough",
"B": "Clubbing",
"C": "Steady boring chest pain",
"D": "Diaphoresis"
} | C. Steady boring chest pain |
0eacd5b3-5361-4f86-af4d-edbe5d8016cf | A 60-year-old man with hypeension presents to the emergency depament complaining of veigo, nausea, vomiting and postural instability. His veigo began suddenly 2 hours ago and has been constant.Upon examination, the man cannot walk due to severe instability. The head impulse test is negative. There is left beating nystagmus on left lateral gaze and right beating nystagmus on right lateral gaze. Skew detion is present with quick, veical movements as each eye is uncovered. What is the most likely diagnosis? | Meniere's disease | Cerebellar infarction | Vestibular neuritis | BPPV | 1b
| single | Head Impulse test +ve in: Meniere's disease Vestibular neuritis BPPV Based on the clinical findings, the patient is likely to have central veigo. The other options (A,C & D) are causes of peripheral veigo, cerebellar infarction is the only option that might present with central veigo. Veigo Peripheral causes Central causes Nystagmus Unidirectional, horizontal with some torsion nystagmus that beats towards affected side and never change direction. Can change direction & can be in any direction Presence of neurological deficit None Neurological deficits like diplopia, weakness, paraesthesia and dysahria present Postural instability Pt. lean to the affected side lPt. falls randomly and unable to walk. | Medicine | Stroke and TIA | 112 | {
"Correct Answer": "Cerebellar infarction",
"Correct Option": "B",
"Options": {
"A": "Meniere's disease",
"B": "Cerebellar infarction",
"C": "Vestibular neuritis",
"D": "BPPV"
},
"Question": "A 60-year-old man with hypeension presents to the emergency depament complaining of veigo, nausea, vomiting and postural instability. His veigo began suddenly 2 hours ago and has been constant.Upon examination, the man cannot walk due to severe instability. The head impulse test is negative. There is left beating nystagmus on left lateral gaze and right beating nystagmus on right lateral gaze. Skew detion is present with quick, veical movements as each eye is uncovered. What is the most likely diagnosis?"
} | A 60-year-old man with hypeension presents to the emergency depament complaining of veigo, nausea, vomiting and postural instability. His veigo began suddenly 2 hours ago and has been constant.Upon examination, the man cannot walk due to severe instability. The head impulse test is negative. There is left beating nystagmus on left lateral gaze and right beating nystagmus on right lateral gaze. Skew detion is present with quick, veical movements as each eye is uncovered. | What is the most likely diagnosis? | {
"A": "Meniere's disease",
"B": "Cerebellar infarction",
"C": "Vestibular neuritis",
"D": "BPPV"
} | B. Cerebellar infarction |
33f3bd0f-ec95-4fe9-87bf-193dc4086c99 | An 18-year-old woman presents to the clinic complaining of malaise for the past 3 weeks, fever for 2 weeks, and a sore throat. Physical examination shows pharyngeal infection with enlarged tonsils and a patchy, white exudate; enlarged, palpable anterior and posterior cervical, axillary, and inguinal lymph nodes; tenderness in the right upper quadrant; and minimal splenomegaly. Laboratory data show hemoglobin 14 g/dL; hematocrit 42%; platelets 380,000/mL; WBC 8500/mL, with 35% segmented neutrophils, 1% eosinophils, and 64% lymphocytes, of which 36% were atypical. Which of the following is the most likely diagnosis? | infectious hepatitis | lymphocytic leukemia | infectious mononucleosis | Hodgkin disease | 2c
| single | Infectious mononucleosis is an acute, self-limited infection of the lymphatic system by the EBV Typical infectious mononucleosis has an incubation period of 4-8 weeks. The prodrome includes malaise, anorexia, and chills, and then the classic symptoms of pharyngitis, fever, and lymphadenopathy develop. Headache is also common. | Medicine | Infection | 177 | {
"Correct Answer": "infectious mononucleosis",
"Correct Option": "C",
"Options": {
"A": "infectious hepatitis",
"B": "lymphocytic leukemia",
"C": "infectious mononucleosis",
"D": "Hodgkin disease"
},
"Question": "An 18-year-old woman presents to the clinic complaining of malaise for the past 3 weeks, fever for 2 weeks, and a sore throat. Physical examination shows pharyngeal infection with enlarged tonsils and a patchy, white exudate; enlarged, palpable anterior and posterior cervical, axillary, and inguinal lymph nodes; tenderness in the right upper quadrant; and minimal splenomegaly. Laboratory data show hemoglobin 14 g/dL; hematocrit 42%; platelets 380,000/mL; WBC 8500/mL, with 35% segmented neutrophils, 1% eosinophils, and 64% lymphocytes, of which 36% were atypical. Which of the following is the most likely diagnosis?"
} | An 18-year-old woman presents to the clinic complaining of malaise for the past 3 weeks, fever for 2 weeks, and a sore throat. Physical examination shows pharyngeal infection with enlarged tonsils and a patchy, white exudate; enlarged, palpable anterior and posterior cervical, axillary, and inguinal lymph nodes; tenderness in the right upper quadrant; and minimal splenomegaly. Laboratory data show hemoglobin 14 g/dL; hematocrit 42%; platelets 380,000/mL; WBC 8500/mL, with 35% segmented neutrophils, 1% eosinophils, and 64% lymphocytes, of which 36% were atypical. | Which of the following is the most likely diagnosis? | {
"A": "infectious hepatitis",
"B": "lymphocytic leukemia",
"C": "infectious mononucleosis",
"D": "Hodgkin disease"
} | C. infectious mononucleosis |
aaf47adc-51a9-4600-84ef-5ad5bbcdbb29 | A 19-year-old female presented with fever, cough shoness of breath and diffuse chest pain. She gave a history of reduced water intake since yesterday. On examination, Hypeension Tachycardia SpO2 is 80% on room air B/L wheezing in lower lung zones Lab findings revealed anemia, leukocytosis, reticulocytosis, thrombocytosis, increased serum bilirubin. Peripheral blood smear Chest x-ray CT scan of chest Which is the most appropriate therapy in the above condition: - | Hydroxyurea | Sildenafil | IV ceftriaxone | Streptokinase | 0a
| multi | This is a case of acute chest syndrome in a patient of sickle cell anemia. Presents as acute fever, cough, chest pain and wheezing in a background of sickle cell anemia. X-ray and CT are suggestive of subsegmental atelectasis of right lower lobe. Management: - Transfusion to maintain hematocrit > 30% Emergency exchange transfusion Hydroxyurea is the mainstay. | Unknown | Integrated QBank | 118 | {
"Correct Answer": "Hydroxyurea",
"Correct Option": "A",
"Options": {
"A": "Hydroxyurea",
"B": "Sildenafil",
"C": "IV ceftriaxone",
"D": "Streptokinase"
},
"Question": "A 19-year-old female presented with fever, cough shoness of breath and diffuse chest pain. She gave a history of reduced water intake since yesterday. On examination, Hypeension Tachycardia SpO2 is 80% on room air B/L wheezing in lower lung zones Lab findings revealed anemia, leukocytosis, reticulocytosis, thrombocytosis, increased serum bilirubin. Peripheral blood smear Chest x-ray CT scan of chest Which is the most appropriate therapy in the above condition: -"
} | A 19-year-old female presented with fever, cough shoness of breath and diffuse chest pain. She gave a history of reduced water intake since yesterday. On examination, Hypeension Tachycardia SpO2 is 80% on room air B/L wheezing in lower lung zones Lab findings revealed anemia, leukocytosis, reticulocytosis, thrombocytosis, increased serum bilirubin. | Peripheral blood smear Chest x-ray CT scan of chest Which is the most appropriate therapy in the above condition: - | {
"A": "Hydroxyurea",
"B": "Sildenafil",
"C": "IV ceftriaxone",
"D": "Streptokinase"
} | A. Hydroxyurea |
884549b4-ba0a-4357-bb1f-a093a9303123 | Which of the statements are True/False regarding dengue fever? a) All four distinct dengue viruses have Aedes aegypti as their principal vector. b) A. aegypti usually inhabits dwellings and bites during the day. c) Severe myalgia that gave rise to the colloquial designation "break-bone fever". d) A macular rash on the first day as well as adenopathy, palatal vesicles, and scleral injection. e) Epistaxis and scattered petechiae are features of complicated dengue. | a,b,c,d,e-True & None-False | a,b,c-True & d,e-False | a,b,c,d-True & e-False | a,b,e-True & c,d,-False | 2c
| multi | Epistaxis and scattered petechiae are often noted in uncomplicated dengue. Ref: Harrisons Principles of Internal Medicine, 18th Edition, Page 1621 | Medicine | null | 123 | {
"Correct Answer": "a,b,c,d-True & e-False",
"Correct Option": "C",
"Options": {
"A": "a,b,c,d,e-True & None-False",
"B": "a,b,c-True & d,e-False",
"C": "a,b,c,d-True & e-False",
"D": "a,b,e-True & c,d,-False"
},
"Question": "Which of the statements are True/False regarding dengue fever? a) All four distinct dengue viruses have Aedes aegypti as their principal vector. b) A. aegypti usually inhabits dwellings and bites during the day. c) Severe myalgia that gave rise to the colloquial designation \"break-bone fever\". d) A macular rash on the first day as well as adenopathy, palatal vesicles, and scleral injection. e) Epistaxis and scattered petechiae are features of complicated dengue."
} | Which of the statements are True/False regarding dengue fever? a) All four distinct dengue viruses have Aedes aegypti as their principal vector. b) A. aegypti usually inhabits dwellings and bites during the day. c) Severe myalgia that gave rise to the colloquial designation "break-bone fever". d) A macular rash on the first day as well as adenopathy, palatal vesicles, and scleral injection. | e) Epistaxis and scattered petechiae are features of complicated dengue. | {
"A": "a,b,c,d,e-True & None-False",
"B": "a,b,c-True & d,e-False",
"C": "a,b,c,d-True & e-False",
"D": "a,b,e-True & c,d,-False"
} | C. a,b,c,d-True & e-False |
3ff842d7-8e73-4a4a-9843-f9587405ef09 | A 37 year old newly married man presents with multiple blister-like lesions on the glans of his penis, appearing over the past 2 days. On questioning, he recalls similar episodes over the past 2 years. Examination is remarkable for tender, 3-4 mm vesicular lesions on the shaft of his penis with no apparent crusting, drainage, or bleeding. There is also slight bilateral inguinal adenopathy. During the asymptomatic period between outbreaks, where would the causative agent likely have been found? | Fibroblasts | Lymphocytes | Macrophages | Neurons of the sacral ganglia | 3d
| multi | This is a classic example of an infection with herpes simplex virus (probably type 2). This agent causes lytic infections in mucoepithelial cells. It is then retrogradely transpoed into neurons of the sacral ganglia, where it lays dormant during the asymptomatic phase of the disease. Fibroblasts may be infected by cytomegalovirus, another herpes virus, but this produces a distinctive mononucleosis-like syndrome in most normal individuals. Lymphocytes and macrophages may be infected by herpes simplex type 2 but are not the site of residence of the virus during quiescent periods. Ref: Brooks G.F. (2013). Chapter 33. Herpesviruses. In G.F. Brooks (Ed), Jawetz, Melnick, & Adelberg's Medical Microbiology, 26e. | Microbiology | null | 107 | {
"Correct Answer": "Neurons of the sacral ganglia",
"Correct Option": "D",
"Options": {
"A": "Fibroblasts",
"B": "Lymphocytes",
"C": "Macrophages",
"D": "Neurons of the sacral ganglia"
},
"Question": "A 37 year old newly married man presents with multiple blister-like lesions on the glans of his penis, appearing over the past 2 days. On questioning, he recalls similar episodes over the past 2 years. Examination is remarkable for tender, 3-4 mm vesicular lesions on the shaft of his penis with no apparent crusting, drainage, or bleeding. There is also slight bilateral inguinal adenopathy. During the asymptomatic period between outbreaks, where would the causative agent likely have been found?"
} | A 37 year old newly married man presents with multiple blister-like lesions on the glans of his penis, appearing over the past 2 days. On questioning, he recalls similar episodes over the past 2 years. Examination is remarkable for tender, 3-4 mm vesicular lesions on the shaft of his penis with no apparent crusting, drainage, or bleeding. There is also slight bilateral inguinal adenopathy. | During the asymptomatic period between outbreaks, where would the causative agent likely have been found? | {
"A": "Fibroblasts",
"B": "Lymphocytes",
"C": "Macrophages",
"D": "Neurons of the sacral ganglia"
} | D. Neurons of the sacral ganglia |
2f6dc906-2a5d-4990-b684-b48d1f88486a | A 60-year-old male patient presented to OPD with right upper quadrant abdominal pain, jaundice, fever with a significant history of weight loss, loss of appetite and lethargy. On examination a mass was palpable in the right hypochondrium which was firm in consistency and about 5x5 cm on palpation along with severe hepatomegaly. On seeing the previous records, patient was found to be a known case of Hepatitis C and was on medication for the same. Lab studies, Raised AFP levels Hypercalcemia Erythrocytosis No cirrhotic changes were evident on USG abdomen. Triple phase CT, Liver biopsy were performed. . Which of the following drug has been approved for the above condition: - Sorafenib Imatinib Dasatinib Regorafenib Ramucirumab | 1 and 3 | 1, 2 and 5 | 1, 2 and 4 | 1, 4 and 5 | 3d
| multi | This is a case of hepatocellular carcinoma. HPE image shows malignant hepatocytes growing in distoed versions of normal architecture. The aerial phase in triple phase CT shows a large enhancing lesion suggestive of hepatocellular carcinoma. Imatinib and Dasatinib are tyrosine kinase inhibitors approved for CML. | Unknown | Integrated QBank | 173 | {
"Correct Answer": "1, 4 and 5",
"Correct Option": "D",
"Options": {
"A": "1 and 3",
"B": "1, 2 and 5",
"C": "1, 2 and 4",
"D": "1, 4 and 5"
},
"Question": "A 60-year-old male patient presented to OPD with right upper quadrant abdominal pain, jaundice, fever with a significant history of weight loss, loss of appetite and lethargy. On examination a mass was palpable in the right hypochondrium which was firm in consistency and about 5x5 cm on palpation along with severe hepatomegaly. On seeing the previous records, patient was found to be a known case of Hepatitis C and was on medication for the same. Lab studies, Raised AFP levels Hypercalcemia Erythrocytosis No cirrhotic changes were evident on USG abdomen. Triple phase CT, Liver biopsy were performed. . Which of the following drug has been approved for the above condition: - Sorafenib Imatinib Dasatinib Regorafenib Ramucirumab"
} | A 60-year-old male patient presented to OPD with right upper quadrant abdominal pain, jaundice, fever with a significant history of weight loss, loss of appetite and lethargy. On examination a mass was palpable in the right hypochondrium which was firm in consistency and about 5x5 cm on palpation along with severe hepatomegaly. On seeing the previous records, patient was found to be a known case of Hepatitis C and was on medication for the same. Lab studies, Raised AFP levels Hypercalcemia Erythrocytosis No cirrhotic changes were evident on USG abdomen. Triple phase CT, Liver biopsy were performed. . | Which of the following drug has been approved for the above condition: - Sorafenib Imatinib Dasatinib Regorafenib Ramucirumab | {
"A": "1 and 3",
"B": "1, 2 and 5",
"C": "1, 2 and 4",
"D": "1, 4 and 5"
} | D. 1, 4 and 5 |
99ff60d3-6a4f-4c4f-983b-38f8831fb1d9 | A 67-year-old smoker is brought to the ER with severe abdominal pain and hypotension. He has a h/o hypeension, asthma and type-2 DM. He currently takes Lisinopril and Metformin. O/E- HR: 100 bpm, BP is 100/60mmHg, S1 & S2- normal, chest- clear. Which of the following risk factors is most likely to have contributed to the development of his underlying condition? | Hypeension | Smoking | Diabetes | Family history of cardiovascular disease | 1b
| single | This is case of atherosclerosis with Abdominal Aoa Aneurysm If Aneurysm ruptures - Abdominal pain & we know smoking is biggest risk factor of developing atherosclerosis. | Medicine | Hypeension | 105 | {
"Correct Answer": "Smoking",
"Correct Option": "B",
"Options": {
"A": "Hypeension",
"B": "Smoking",
"C": "Diabetes",
"D": "Family history of cardiovascular disease"
},
"Question": "A 67-year-old smoker is brought to the ER with severe abdominal pain and hypotension. He has a h/o hypeension, asthma and type-2 DM. He currently takes Lisinopril and Metformin. O/E- HR: 100 bpm, BP is 100/60mmHg, S1 & S2- normal, chest- clear. Which of the following risk factors is most likely to have contributed to the development of his underlying condition?"
} | A 67-year-old smoker is brought to the ER with severe abdominal pain and hypotension. He has a h/o hypeension, asthma and type-2 DM. He currently takes Lisinopril and Metformin. O/E- HR: 100 bpm, BP is 100/60mmHg, S1 & S2- normal, chest- clear. | Which of the following risk factors is most likely to have contributed to the development of his underlying condition? | {
"A": "Hypeension",
"B": "Smoking",
"C": "Diabetes",
"D": "Family history of cardiovascular disease"
} | B. Smoking |
63d77114-5cff-476e-a1dd-4fe096ea3cd3 | Ramla, 65 yrs old male, presents with low back pain especially at L3, anaemia and fatigability. His investigation profile reveals - Hb = 7 gm%, TLC9000/cmm, DLC -N- 55%, L-30%, M-10%, E-1%, B2%, Serum proteins-8 gm %, ratio-2.9/5.9, ESR-90 and serum creatinine-3.2 mg%. Likely diagnosis is : | Waldenstroms macroglobulinemia | Multiple myeloma | TB spine | Secondaries in spine | 1b
| multi | Answer is B (Multiple myeloma) This is a 65 year old patient presenting with low back pain along with-a reversed A: G ratio. This indicates an excess of globulin fraction or a possible gammopathy. These findings along with an elevated ESR and Renal involvement (indicated by increased creatinine levels) suggest a diagnosis of Multiple Myeloma. | Medicine | null | 109 | {
"Correct Answer": "Multiple myeloma",
"Correct Option": "B",
"Options": {
"A": "Waldenstroms macroglobulinemia",
"B": "Multiple myeloma",
"C": "TB spine",
"D": "Secondaries in spine"
},
"Question": "Ramla, 65 yrs old male, presents with low back pain especially at L3, anaemia and fatigability. His investigation profile reveals - Hb = 7 gm%, TLC9000/cmm, DLC -N- 55%, L-30%, M-10%, E-1%, B2%, Serum proteins-8 gm %, ratio-2.9/5.9, ESR-90 and serum creatinine-3.2 mg%. Likely diagnosis is :"
} | Ramla, 65 yrs old male, presents with low back pain especially at L3, anaemia and fatigability. His investigation profile reveals - Hb = 7 gm%, TLC9000/cmm, DLC -N- 55%, L-30%, M-10%, E-1%, B2%, Serum proteins-8 gm %, ratio-2.9/5.9, ESR-90 and serum creatinine-3.2 mg%. | Likely diagnosis is : | {
"A": "Waldenstroms macroglobulinemia",
"B": "Multiple myeloma",
"C": "TB spine",
"D": "Secondaries in spine"
} | B. Multiple myeloma |
95fe514a-7116-4d8b-8820-694e5975c697 | A 3 year old boy is recently diagnosed with Acute lymphoblastic leukemia/lymphoma. His peripheral blood film is shown below. A bone marrow biopsy is performed and reveals > 50 % lymphoblasts. Immunostaining reveals cells positive TdT. He is staed on chemotherapy. Few days later his condition deteriorated. The doctor on duty is suspecting that child may have developed tumor lysis syndrome. Which of the following electrolyte abnormality is not seen in the above condition? | Hyperuricemia | Hyperkalemia | Hypokalemia | Hypocalcemia | 2c
| multi | PBF shows lymphoblasts with condensed nuclear chromatin, small nucleoli, and scant agranular cytoplasm s/o Acute lymphoblastic leukemia/lymphoma. Tumor lysis syndrome (TLS) is characterized by : Hyperuricemia hyperkalemia Hyperphosphatemia Hypocalcemia, Etiology: destruction of a large number of rapidly proliferating tumour cells. Acute renal failure may be associated. associated with the treatment of: Burkitt's lymphoma acute lymphoblastic leukemia proliferating lymphomas chronic leukemias solid tumors (rarely) This syndrome has been seen in patients with chronic lymphocytic leukemia after treatment with nucleosides like fludarabine and is increased in frequency in lymphoid neoplasms treated with venetoclax, a bcl-2 antagonist. TLS has been observed with administration of glucocoicoids, hormonal agents such as letrozole and tamoxifen, and monoclonal antibodies such as rituximab and gemtuzumab. TLS usually occurs during or sholy (1-5 days) after chemotherapy. Rarely, spontaneous necrosis of malignancies causes TLS. The standard preventive approach : allopurinol aggressive hydration. Febuxostat Rasburicase Hemodialysis Hemofiltration | Unknown | Integrated QBank | 105 | {
"Correct Answer": "Hypokalemia",
"Correct Option": "C",
"Options": {
"A": "Hyperuricemia",
"B": "Hyperkalemia",
"C": "Hypokalemia",
"D": "Hypocalcemia"
},
"Question": "A 3 year old boy is recently diagnosed with Acute lymphoblastic leukemia/lymphoma. His peripheral blood film is shown below. A bone marrow biopsy is performed and reveals > 50 % lymphoblasts. Immunostaining reveals cells positive TdT. He is staed on chemotherapy. Few days later his condition deteriorated. The doctor on duty is suspecting that child may have developed tumor lysis syndrome. Which of the following electrolyte abnormality is not seen in the above condition?"
} | A 3 year old boy is recently diagnosed with Acute lymphoblastic leukemia/lymphoma. His peripheral blood film is shown below. A bone marrow biopsy is performed and reveals > 50 % lymphoblasts. Immunostaining reveals cells positive TdT. He is staed on chemotherapy. Few days later his condition deteriorated. The doctor on duty is suspecting that child may have developed tumor lysis syndrome. | Which of the following electrolyte abnormality is not seen in the above condition? | {
"A": "Hyperuricemia",
"B": "Hyperkalemia",
"C": "Hypokalemia",
"D": "Hypocalcemia"
} | C. Hypokalemia |
e425718e-fe9f-46b2-bf74-4107534e2c32 | A clinical study is conducted to determine the actions of an unknown test solution on red blood cell volume. One milliliter of heparinized human blood is pipetted into 100 milliliters of test solution and mixed. Samples are taken and analyzed immediately before and at 1-second intervals after mixing. The results show that red blood cells placed into the test solution immediately swell and burst. Which of the following best describes the tonicity and osmolarity of the test solution? | Hypeonic; could be hyperosmotic, hypo-osmotic, or iso-osmotic | Hypeonic; must be hyperosmotic or hypo-osmotic | Hypeonic; must be iso-osmotic | Hypotonic; could be hyperosmotic, hypo-osmotic, or iso-osmotic | 3d
| single | Tonicity and osmolarity are different. Osmolarity is merely another measure of solute concentration. Tonicity depends on the cell membrane and the solute and is determined by the behavior of the cells. The fact that red blood cells placed into the test solution gained volume (swelled) indicates that the test solution is hypotonic. In contrast, the osmolarity of the test solution cannot be determined by the behavior of the cells. | Physiology | Body fluid compaments | 101 | {
"Correct Answer": "Hypotonic; could be hyperosmotic, hypo-osmotic, or iso-osmotic",
"Correct Option": "D",
"Options": {
"A": "Hypeonic; could be hyperosmotic, hypo-osmotic, or iso-osmotic",
"B": "Hypeonic; must be hyperosmotic or hypo-osmotic",
"C": "Hypeonic; must be iso-osmotic",
"D": "Hypotonic; could be hyperosmotic, hypo-osmotic, or iso-osmotic"
},
"Question": "A clinical study is conducted to determine the actions of an unknown test solution on red blood cell volume. One milliliter of heparinized human blood is pipetted into 100 milliliters of test solution and mixed. Samples are taken and analyzed immediately before and at 1-second intervals after mixing. The results show that red blood cells placed into the test solution immediately swell and burst. Which of the following best describes the tonicity and osmolarity of the test solution?"
} | A clinical study is conducted to determine the actions of an unknown test solution on red blood cell volume. One milliliter of heparinized human blood is pipetted into 100 milliliters of test solution and mixed. Samples are taken and analyzed immediately before and at 1-second intervals after mixing. The results show that red blood cells placed into the test solution immediately swell and burst. | Which of the following best describes the tonicity and osmolarity of the test solution? | {
"A": "Hypeonic; could be hyperosmotic, hypo-osmotic, or iso-osmotic",
"B": "Hypeonic; must be hyperosmotic or hypo-osmotic",
"C": "Hypeonic; must be iso-osmotic",
"D": "Hypotonic; could be hyperosmotic, hypo-osmotic, or iso-osmotic"
} | D. Hypotonic; could be hyperosmotic, hypo-osmotic, or iso-osmotic |
76e273d9-1fdc-47a3-9934-71c23342000a | A 30 year old male wants capping of his tooth. History of previous dental treatment in relation to 25. IOPA examination of 24 reveals radiopaque material in root canals and no periapical radiolucency. Dentist prepares the tooth and final impression is made. On next appointment, he decides to cement the crown with zinc phosphate. He mixes the zinc phosphate cement on a cool glass slab, adding a small powder to the liquid every 20 seconds. This is done to gain which of the following advantages? | Stronger final set | Lower solubility | Greater viscosity | Both 1 & 2 | 3d
| multi | The powder is added in small increments. Mixing is done with stainless spatula using brisk circular motion. Each increment is mixed for 15 to 20 seconds. A large area is covered during mixing in order to dissipate the exothermic heat. Maximum amount of powder should be incorporated in the liquid to ensure minimum solubility and maximum strength.
Note: An appropriate consistency is attained by addition of more powder to the liquid and not by allowing a thin mix to thicken. | Dental | null | 115 | {
"Correct Answer": "Both 1 & 2",
"Correct Option": "D",
"Options": {
"A": "Stronger final set",
"B": "Lower solubility",
"C": "Greater viscosity",
"D": "Both 1 & 2"
},
"Question": "A 30 year old male wants capping of his tooth. History of previous dental treatment in relation to 25. IOPA examination of 24 reveals radiopaque material in root canals and no periapical radiolucency. Dentist prepares the tooth and final impression is made. On next appointment, he decides to cement the crown with zinc phosphate. He mixes the zinc phosphate cement on a cool glass slab, adding a small powder to the liquid every 20 seconds. This is done to gain which of the following advantages?"
} | A 30 year old male wants capping of his tooth. History of previous dental treatment in relation to 25. IOPA examination of 24 reveals radiopaque material in root canals and no periapical radiolucency. Dentist prepares the tooth and final impression is made. On next appointment, he decides to cement the crown with zinc phosphate. He mixes the zinc phosphate cement on a cool glass slab, adding a small powder to the liquid every 20 seconds. | This is done to gain which of the following advantages? | {
"A": "Stronger final set",
"B": "Lower solubility",
"C": "Greater viscosity",
"D": "Both 1 & 2"
} | D. Both 1 & 2 |
0882788c-fc16-48d7-b4f1-36519ea28c12 | A 35-year-old man has had an outbreak of pruritic lesions over the extensor surfaces of the elbows and knees during the past month. He has a history of malabsorption that requires him to eat a special diet, but he has had no previous skin problems. On physical examination, the lesions are 0.4- to 0.7-cm vesicles. A 3-mm punch biopsy of one of the lesions over the elbow is performed and on microscopic examination shows the accumulation of neutrophils at the tips of dermal papillae and the formation of small blisters caused by separation at the dermo-epidermal junction. Immunofluorescence studies show granular deposits of IgA localized to tips of dermal papillae. Laboratory studies show serum antigliadin antibodies. What is the most likely diagnosis? | Bullous pemphigoid | Contact dermatitis | Dermatitis herpetiformis | Discoid lupus erythematosus | 2c
| multi | Dermatitis herpetiformis can accompany the celiac disease. The IgA or IgG antibodies formed against the gliadin protein in gluten that is ingested (commonly in wheat, rye, and barley grains) cross-react with reticulin. Reticulin is a component of the anchoring fibrils that attach the epidermal basement membrane to the superficial dermis. This explains the localization of the IgA to the tips of dermal papillae and the site of inflammation. A gluten-free diet may relieve the symptoms. Bullous pemphigoid can occur in older individuals, with an antibody directed at keratinocytes to produce flaccid bullae, but there is no association with celiac disease. Contact dermatitis is most likely to be seen on the hands and forearms. It is a type IV hypersensitivity reaction without immunoglobulin deposition and would not persist for 1 month. Discoid lupus erythematosus is seen in sun-exposed areas and has the appearance of an erythematous rash. Erythema multiforme is a hypersensitivity response to infections and drugs; it produces macules and papules with a red or vesicular center, but it is probably mediated by cytotoxic lymphocytes and not by immunoglobulin deposition. Pemphigus vulgaris is an autoimmune disease in which IgG deposited in acantholytic areas forms vesicles that rupture to form erosions; it is not related to celiac disease. | Pathology | Skin | 175 | {
"Correct Answer": "Dermatitis herpetiformis",
"Correct Option": "C",
"Options": {
"A": "Bullous pemphigoid",
"B": "Contact dermatitis",
"C": "Dermatitis herpetiformis",
"D": "Discoid lupus erythematosus"
},
"Question": "A 35-year-old man has had an outbreak of pruritic lesions over the extensor surfaces of the elbows and knees during the past month. He has a history of malabsorption that requires him to eat a special diet, but he has had no previous skin problems. On physical examination, the lesions are 0.4- to 0.7-cm vesicles. A 3-mm punch biopsy of one of the lesions over the elbow is performed and on microscopic examination shows the accumulation of neutrophils at the tips of dermal papillae and the formation of small blisters caused by separation at the dermo-epidermal junction. Immunofluorescence studies show granular deposits of IgA localized to tips of dermal papillae. Laboratory studies show serum antigliadin antibodies. What is the most likely diagnosis?"
} | A 35-year-old man has had an outbreak of pruritic lesions over the extensor surfaces of the elbows and knees during the past month. He has a history of malabsorption that requires him to eat a special diet, but he has had no previous skin problems. On physical examination, the lesions are 0.4- to 0.7-cm vesicles. A 3-mm punch biopsy of one of the lesions over the elbow is performed and on microscopic examination shows the accumulation of neutrophils at the tips of dermal papillae and the formation of small blisters caused by separation at the dermo-epidermal junction. Immunofluorescence studies show granular deposits of IgA localized to tips of dermal papillae. Laboratory studies show serum antigliadin antibodies. | What is the most likely diagnosis? | {
"A": "Bullous pemphigoid",
"B": "Contact dermatitis",
"C": "Dermatitis herpetiformis",
"D": "Discoid lupus erythematosus"
} | C. Dermatitis herpetiformis |
bbe49af4-ccf8-4296-b796-d6383d3163e9 | 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; partial thromboplastin time-50sec; and Fibrinogen 10ing/dL. Peripheral smear was suggestive off 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 | The child presents with acute onset of bleeding, along with the following laboratory anamolies.
Thrombocytopenia (iii) Increased partial thromboplastin time.
Increased prothrombin time (iv) Decreased Fibrinogen
These hematological abnormalities indicate Disseminated intravascular coagulation
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 associated with DIC.
Promyelocytic (AML-M3) leukemic promyelocytes liberate tissue thromboplastin leading to disseminated intravascular coagulation. | Pathology | null | 128 | {
"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; partial thromboplastin time-50sec; and Fibrinogen 10ing/dL. Peripheral smear was suggestive off 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; partial thromboplastin time-50sec; and Fibrinogen 10ing/dL. Peripheral smear was suggestive off 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 |
ebf37a52-619f-4ff5-aaf3-943c615f5097 | A 34-year-old man presents with dyspnea and increasing peripheral edema. He recently had a "flu-like" illness with intermittent sharp left-sided chest pain. On examination, his jugular venous pressure (JVP) is elevated at 8 cm, heart sounds are soft, and the blood pressure (BP) is 104/76 mm Hg with a 20 mm Hg decrease in systolic arterial pressure during slow inspiration. Which of the following is the most likely diagnosis? | cardiac tamponade | pulmonary hypertension | ventricular septal defect | coarctation of the aorta | 0a
| single | The drop in systolic pressure with inspiration is an important clue to cardiac tamponade, called pulsus paradoxus. When severe, the arterial pulse may weaken on palpation during inspiration. Pulsus paradoxus is uncommon in constrictive pericarditis and rare in restrictive cardiomyopathy. It is commonly found in severe asthma as well. | Medicine | C.V.S. | 107 | {
"Correct Answer": "cardiac tamponade",
"Correct Option": "A",
"Options": {
"A": "cardiac tamponade",
"B": "pulmonary hypertension",
"C": "ventricular septal defect",
"D": "coarctation of the aorta"
},
"Question": "A 34-year-old man presents with dyspnea and increasing peripheral edema. He recently had a \"flu-like\" illness with intermittent sharp left-sided chest pain. On examination, his jugular venous pressure (JVP) is elevated at 8 cm, heart sounds are soft, and the blood pressure (BP) is 104/76 mm Hg with a 20 mm Hg decrease in systolic arterial pressure during slow inspiration. Which of the following is the most likely diagnosis?"
} | A 34-year-old man presents with dyspnea and increasing peripheral edema. He recently had a "flu-like" illness with intermittent sharp left-sided chest pain. On examination, his jugular venous pressure (JVP) is elevated at 8 cm, heart sounds are soft, and the blood pressure (BP) is 104/76 mm Hg with a 20 mm Hg decrease in systolic arterial pressure during slow inspiration. | Which of the following is the most likely diagnosis? | {
"A": "cardiac tamponade",
"B": "pulmonary hypertension",
"C": "ventricular septal defect",
"D": "coarctation of the aorta"
} | A. cardiac tamponade |
563e914d-17fb-4f5a-96bf-ec2f2d9feac3 | A 20-year-old woman presents with headache, fever, and neck stiffness. On examination, her blood pressure is 100/70 mm Hg, pulse 100/min, temperature 38.6, and the neck is stiff and painful to flex and extend. The ears, throat, and sinuses are normal, there are no focal neurologic signs, and the remaining examination is normal. There are no reported similar cases in the community. Which of the following is the most likely source of her infection? | an infected heart valve | nasopharynx | skin | oral ingestion | 1b
| single | S. pneumoniae colonizes the nasopharynx of 5-10% of healthy adults and up to 20-40% of children. The source of pneumococcal meningitis is either direct extension from middle ear or sinus infections, or via seeding from a bacteremia. In the latter circumstance, bacteremia from pneumonia would be more likely than from infective endocarditis. | Medicine | Infection | 111 | {
"Correct Answer": "nasopharynx",
"Correct Option": "B",
"Options": {
"A": "an infected heart valve",
"B": "nasopharynx",
"C": "skin",
"D": "oral ingestion"
},
"Question": "A 20-year-old woman presents with headache, fever, and neck stiffness. On examination, her blood pressure is 100/70 mm Hg, pulse 100/min, temperature 38.6, and the neck is stiff and painful to flex and extend. The ears, throat, and sinuses are normal, there are no focal neurologic signs, and the remaining examination is normal. There are no reported similar cases in the community. Which of the following is the most likely source of her infection?"
} | A 20-year-old woman presents with headache, fever, and neck stiffness. On examination, her blood pressure is 100/70 mm Hg, pulse 100/min, temperature 38.6, and the neck is stiff and painful to flex and extend. The ears, throat, and sinuses are normal, there are no focal neurologic signs, and the remaining examination is normal. There are no reported similar cases in the community. | Which of the following is the most likely source of her infection? | {
"A": "an infected heart valve",
"B": "nasopharynx",
"C": "skin",
"D": "oral ingestion"
} | B. nasopharynx |
af266b9d-26b3-43a3-9ba3-d87c2bc089c3 | A 20-year-old woman presents to the clinic for evaluation of new symptoms of cough and yellow sputum production. She also reports feeling feverish and having intermittent right-sided chest pain on deep breathing. On physical examination, she appears well and the pertinent findings are dullness on percussion in the right lower lobe and inspiratory crackles on auscultation of the lungs. A chest x-ray confirms there is a right lower lobe infiltrate. Which of the following is the most appropriate treatment of community-acquired pneumonia? | carbenicillin | tobramycin | levofloxacin | methicillin | 2c
| single | Levofloxacin would be effective for most strains of Streptococcus pneumoniae, Legionella pneumophila, and other likely pathogens. Other commonly used drugs for community-acquired pneumonia are high-dose amoxicillin, ceftizoxime, trimethoprim-sulfamethoxazole, and doxycycline. Theoretically, empiric therapy should be guided by knowledge of local resistance patterns. | Medicine | Respiratory | 108 | {
"Correct Answer": "levofloxacin",
"Correct Option": "C",
"Options": {
"A": "carbenicillin",
"B": "tobramycin",
"C": "levofloxacin",
"D": "methicillin"
},
"Question": "A 20-year-old woman presents to the clinic for evaluation of new symptoms of cough and yellow sputum production. She also reports feeling feverish and having intermittent right-sided chest pain on deep breathing. On physical examination, she appears well and the pertinent findings are dullness on percussion in the right lower lobe and inspiratory crackles on auscultation of the lungs. A chest x-ray confirms there is a right lower lobe infiltrate. Which of the following is the most appropriate treatment of community-acquired pneumonia?"
} | A 20-year-old woman presents to the clinic for evaluation of new symptoms of cough and yellow sputum production. She also reports feeling feverish and having intermittent right-sided chest pain on deep breathing. On physical examination, she appears well and the pertinent findings are dullness on percussion in the right lower lobe and inspiratory crackles on auscultation of the lungs. A chest x-ray confirms there is a right lower lobe infiltrate. | Which of the following is the most appropriate treatment of community-acquired pneumonia? | {
"A": "carbenicillin",
"B": "tobramycin",
"C": "levofloxacin",
"D": "methicillin"
} | C. levofloxacin |
7a0db08a-fe9c-40d5-b0dc-7809419be567 | An 8 year old boy is brought to the emergency room with a 3-day history of fever to 102 degrees F and abdominal pain. He also complains of pain in his right knee and right elbow. He was seen four weeks ago because of a sore throat and a rash. A throat culture performed at that time grew gram-positive cocci in chains. Amoxicillin was prescribed, but the boy's mother did not fill the prescription. On physical exam his temp is 101.7F, HR 96, and BP 100/60. Cardiac exam reveals a pansystolic blowing murmur heard best at the apex. His right elbow is tender on extension and flexion with mild swelling. Laboratory tests reveal a positive C-reactive protein, an ESR of 40 and a WBC of 22,000 with a left shift. ECG shows a prolonged PR interval. Which of the following tests would be positive for the microorganism responsible for this patient's illness? | Catalase test | Coagulase test | Sensitivity to bacitracin | Sensitivity to novobiocin | 2c
| single | This case is classic for Rheumatic fever, including two of the major Jones criteria (carditis, polyahritis) and several minor criteria (fever, ahralgia, elevated ESR, leukocytosis, C-reactive protein, prolonged PR interval). Rheumatic fever is a sequelae of untreated infection with Group A Streptococcus (S. pyogenes). S. pyogenes is differentiated from the other beta-hemolytic Strep by its sensitivity to the antibiotic bacitracin. The catalase test is used to differentiate Staphylococci from Streptococci. Staphylococci are catalase positive, Streptococci are catalase negative. So, S. pyogenes would be catalase negative. The coagulase test is used to differentiate Staph aureus from the other Staph spp. Staph aureus is coagulase positive; the others are negative. Sensitivity to novobiocin is used to differentiate Staph saprophyticus (resistant) from Staph epidermidis (sensitive). Ref: Levinson W. (2012). Chapter 66. Tolerance & Autoimmune Disease. In W. Levinson (Ed), Review of Medical Microbiology & Immunology, 12e. | Microbiology | null | 213 | {
"Correct Answer": "Sensitivity to bacitracin",
"Correct Option": "C",
"Options": {
"A": "Catalase test",
"B": "Coagulase test",
"C": "Sensitivity to bacitracin",
"D": "Sensitivity to novobiocin"
},
"Question": "An 8 year old boy is brought to the emergency room with a 3-day history of fever to 102 degrees F and abdominal pain. He also complains of pain in his right knee and right elbow. He was seen four weeks ago because of a sore throat and a rash. A throat culture performed at that time grew gram-positive cocci in chains. Amoxicillin was prescribed, but the boy's mother did not fill the prescription. On physical exam his temp is 101.7F, HR 96, and BP 100/60. Cardiac exam reveals a pansystolic blowing murmur heard best at the apex. His right elbow is tender on extension and flexion with mild swelling. Laboratory tests reveal a positive C-reactive protein, an ESR of 40 and a WBC of 22,000 with a left shift. ECG shows a prolonged PR interval. Which of the following tests would be positive for the microorganism responsible for this patient's illness?"
} | An 8 year old boy is brought to the emergency room with a 3-day history of fever to 102 degrees F and abdominal pain. He also complains of pain in his right knee and right elbow. He was seen four weeks ago because of a sore throat and a rash. A throat culture performed at that time grew gram-positive cocci in chains. Amoxicillin was prescribed, but the boy's mother did not fill the prescription. On physical exam his temp is 101.7F, HR 96, and BP 100/60. Cardiac exam reveals a pansystolic blowing murmur heard best at the apex. His right elbow is tender on extension and flexion with mild swelling. Laboratory tests reveal a positive C-reactive protein, an ESR of 40 and a WBC of 22,000 with a left shift. ECG shows a prolonged PR interval. | Which of the following tests would be positive for the microorganism responsible for this patient's illness? | {
"A": "Catalase test",
"B": "Coagulase test",
"C": "Sensitivity to bacitracin",
"D": "Sensitivity to novobiocin"
} | C. Sensitivity to bacitracin |
34135d29-9e1a-4ebd-a3b9-4266d0398917 | A febrile 23-year-old college student presents with fatigue and difficulty swallowing. Physical exam reveals exudative tonsillitis, palatal petechiae, cervical lymphadenopathy, and tender hepatosplenomegaly. A complete blood count reveals mild anemia, lymphocytosis with about 30% of the lymphocytes exhibiting atypical features, and a mild thrombocytopenia. Coombs' test is positive. Which of the following is the most likely complication of this syndrome? | Acute cholecystitis | Ascending cholangitis | Diarrhea | Splenic rupture | 3d
| multi | The syndrome represented by the clinical vignette is infectious mononucleosis. Epstein-Barr virus (EBV) is the usual cause of heterophile-positive infectious mononucleosis; cytomegalovirus is responsible for a minority of cases. Rarely, splenic rupture requiring splenectomy can result from splenomegaly and capsular swelling, usually occurring during the 2nd and 3rd weeks of the illness. Acute cholecystitis is not associated with infectious mononucleosis. The most frequently isolated pathogens are E. coli, Klebsiella spp., group D Streptococcus, Staphylococcus spp., and Clostridium spp. Ascending cholangitis is not associated with infectious mononucleosis. Cholangitis usually presents with biliary colic, jaundice, and spiking fever with chills (Charcot's triad). Blood cultures are usually positive (E. coli is a common isolate), with an accompanying leukocytosis. AIDS-related cholangitis has been repoed, presenting with abdominal pain and obstructive liver symptoms. Potential etiologic agents include Cytomegalovirus, Cryptosporidium parvum, and Microsporidia, including Enterocytozoon cuniculi. Diarrhea is not usually produced by infectious mononucleosis. | Microbiology | null | 107 | {
"Correct Answer": "Splenic rupture",
"Correct Option": "D",
"Options": {
"A": "Acute cholecystitis",
"B": "Ascending cholangitis",
"C": "Diarrhea",
"D": "Splenic rupture"
},
"Question": "A febrile 23-year-old college student presents with fatigue and difficulty swallowing. Physical exam reveals exudative tonsillitis, palatal petechiae, cervical lymphadenopathy, and tender hepatosplenomegaly. A complete blood count reveals mild anemia, lymphocytosis with about 30% of the lymphocytes exhibiting atypical features, and a mild thrombocytopenia. Coombs' test is positive. Which of the following is the most likely complication of this syndrome?"
} | A febrile 23-year-old college student presents with fatigue and difficulty swallowing. Physical exam reveals exudative tonsillitis, palatal petechiae, cervical lymphadenopathy, and tender hepatosplenomegaly. A complete blood count reveals mild anemia, lymphocytosis with about 30% of the lymphocytes exhibiting atypical features, and a mild thrombocytopenia. Coombs' test is positive. | Which of the following is the most likely complication of this syndrome? | {
"A": "Acute cholecystitis",
"B": "Ascending cholangitis",
"C": "Diarrhea",
"D": "Splenic rupture"
} | D. Splenic rupture |
d159d0c9-580b-4c54-bb33-0be09f9ec6ed | A 33-year-old man is complaining of feeling thirsty all the time and passing more urine than usual. His physical examination is normal, except for a JVP at the sternal angle. His serum sodium is 150 mEq/L, glucose 120 mg/dL, and osmolality 315 mOsm/kg. The urine sodium is 20 mE/L and osmolality 260 mOsm/kg. Which of the following drugs is most likely to cause this disorder? | lithium | cyclophosphamide | barbiturates | nicotine | 0a
| multi | Nephrogenic diabetes insipidus can be caused by drugs such as lithium, metabolic factors, vascular disease, ureteral obstruction, and genetic factors. | Medicine | Endocrinology | 110 | {
"Correct Answer": "lithium",
"Correct Option": "A",
"Options": {
"A": "lithium",
"B": "cyclophosphamide",
"C": "barbiturates",
"D": "nicotine"
},
"Question": "A 33-year-old man is complaining of feeling thirsty all the time and passing more urine than usual. His physical examination is normal, except for a JVP at the sternal angle. His serum sodium is 150 mEq/L, glucose 120 mg/dL, and osmolality 315 mOsm/kg. The urine sodium is 20 mE/L and osmolality 260 mOsm/kg. Which of the following drugs is most likely to cause this disorder?"
} | A 33-year-old man is complaining of feeling thirsty all the time and passing more urine than usual. His physical examination is normal, except for a JVP at the sternal angle. His serum sodium is 150 mEq/L, glucose 120 mg/dL, and osmolality 315 mOsm/kg. The urine sodium is 20 mE/L and osmolality 260 mOsm/kg. | Which of the following drugs is most likely to cause this disorder? | {
"A": "lithium",
"B": "cyclophosphamide",
"C": "barbiturates",
"D": "nicotine"
} | A. lithium |
5f463d20-07e0-46b4-be57-3357c84f0cf7 | 1730. A nine month old boy of Sindhl parents presented to you with complaints of progressive lethargy, Irritability & pallor since 6 months of age. Examination revealed severe pallor. Investigation showed Hb-3.8 mg%; MCV-58fl; MCH-19.4 pg/ cell. Blood film shows osmotic fragility Is normal (target cells and 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 | 0a
| multi | <p>In iron deficiency anemia ,hemoglobin will be mild to moderate but occasionally it may be marked(less than 6g/dL). In peripheral smear,microcytic hypochromic red cells are seen;target cells ,polychromatic cells, normoblasts are seen.MCV will be less than 80fl & MCH less than 27pg. The marrow hypercellularity is increased due to marrow hyperplasia .</p><p>Reference :Harsh mohan textbook of pathology sixth edition pg no 299</p> | Medicine | Haematology | 112 | {
"Correct Answer": "Iron deficiency anemia",
"Correct Option": "A",
"Options": {
"A": "Iron deficiency anemia",
"B": "Acute lymphoblastic anemia",
"C": "Hemoglobin D disease",
"D": "Hereditary spherocytosis"
},
"Question": "1730. A nine month old boy of Sindhl parents presented to you with complaints of progressive lethargy, Irritability & pallor since 6 months of age. Examination revealed severe pallor. Investigation showed Hb-3.8 mg%; MCV-58fl; MCH-19.4 pg/ cell. Blood film shows osmotic fragility Is normal (target cells and normoblasts). X-ray skull shows expansion of erythroid marrow. Which of the following Is the most likely diagnosis"
} | 1730. A nine month old boy of Sindhl parents presented to you with complaints of progressive lethargy, Irritability & pallor since 6 months of age. Examination revealed severe pallor. Investigation showed Hb-3.8 mg%; MCV-58fl; MCH-19.4 pg/ cell. Blood film shows osmotic fragility Is normal (target cells and 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"
} | A. Iron deficiency anemia |
0bc1bf5a-fd4a-4efb-a72e-9962451177c3 | A 31-year-old primigravid woman comes to the physician for a prenatal visit. She is known to be HIV positive. She also has asthma, for which she uses an inhaler. She had a diagnostic laparoscopy at age 20 for pelvic pain and has had no other surgeries. She has no known drug allergies. Extensive counseling is given to the patient regarding veical transmission of HIV to the fetus. It is recommended to her that she take antiretroviral therapy during the pregnancy to decrease the veical transmission rate. It is also recommended to her that she have a scheduled cesarean delivery. After consideration of these options, the patient chooses not to take the antiretrovirals and opts for a vaginal delivery. This of the following represents the approximate risk of veical transmission (from the mother to the fetus) for this patient? | 2% | 8% | 25% | 50% | 2c
| multi | Studies have demonstrated that in the absence of maternal treatment with antiretroviral therapy or scheduled cesarean delivery, the rate of veical transmission is approximately 25%. Thus, all pregnant women should be offered HIV testing to identify those patients who are infected so that they may receive antiretroviral therapy and be offered scheduled cesarean delivery to decrease the rate of veical transmission. 2% (choice A) represents the approximate rate of veical transmission in women who receive antiretroviral therapy during the pregnancy and a scheduled cesarean delivery (i.e., a cesarean delivery prior to the onset of labor or rupture of membranes.) 8% (choice B) represents the approximate rate of veical transmission when women are treated with antiretroviral therapy during pregnancy and the neonate is treated postpaum. This rate was identified in the landmark study from the Pediatric AIDS Clinical Trials Group 076 study. This study showed that antepaum, intrapaum, and postpaum zidovudine (ZDV) use would reduce the veical transmission rate from 25% to 8%. | Surgery | null | 179 | {
"Correct Answer": "25%",
"Correct Option": "C",
"Options": {
"A": "2%",
"B": "8%",
"C": "25%",
"D": "50%"
},
"Question": "A 31-year-old primigravid woman comes to the physician for a prenatal visit. She is known to be HIV positive. She also has asthma, for which she uses an inhaler. She had a diagnostic laparoscopy at age 20 for pelvic pain and has had no other surgeries. She has no known drug allergies. Extensive counseling is given to the patient regarding veical transmission of HIV to the fetus. It is recommended to her that she take antiretroviral therapy during the pregnancy to decrease the veical transmission rate. It is also recommended to her that she have a scheduled cesarean delivery. After consideration of these options, the patient chooses not to take the antiretrovirals and opts for a vaginal delivery. This of the following represents the approximate risk of veical transmission (from the mother to the fetus) for this patient?"
} | A 31-year-old primigravid woman comes to the physician for a prenatal visit. She is known to be HIV positive. She also has asthma, for which she uses an inhaler. She had a diagnostic laparoscopy at age 20 for pelvic pain and has had no other surgeries. She has no known drug allergies. Extensive counseling is given to the patient regarding veical transmission of HIV to the fetus. It is recommended to her that she take antiretroviral therapy during the pregnancy to decrease the veical transmission rate. It is also recommended to her that she have a scheduled cesarean delivery. After consideration of these options, the patient chooses not to take the antiretrovirals and opts for a vaginal delivery. | This of the following represents the approximate risk of veical transmission (from the mother to the fetus) for this patient? | {
"A": "2%",
"B": "8%",
"C": "25%",
"D": "50%"
} | C. 25% |
c847e2e1-ed39-4607-8892-a7c3a7c2dd8f | A 43-year-old woman has had increasing difficulty swallowing over the past year. She notices that her hands turn white and are painful on exposure to cold. She remarks, "I may be getting older, but at least I don't have any wrinkles on my face or hands yet." On physical examination, her blood pressure is 115/75 mm Hg. The skin of her face and hands appears taut and shiny. A punch biopsy specimen of the skin of the hand shows dermal collagenous fibrosis and focal calcification. She receives yearly esophageal dilation for the next 20 years, during which time she develops no serious illnesses. Which of the following serologic test results is most likely to be positive in this woman? | Anticentromere antibody | Anti-DNA topoisomerase antibody | Antimicrosomal antibody | Antimitochondrial antibody | 0a
| multi | Limited scleroderma (former CREST syndrome), a form of systemic sclerosis, does not progress to include serious pulmonary fibrosis or renal disease. Therefore she is less likely to have diffuse scleroderma, which is associated with the anti-DNA topoisomerase antibody. Antimicrosomal (anti-thyroid peroxidase) antibodies are seen in autoimmune thyroid diseases, such as Hashimoto thyroiditis and Graves' disease. Antimitochondrial antibody appears most frequently in primary biliary cirrhosis. ANCA can be a marker for various forms of vasculitis. Anti-transglutaminase antibodies are seen in celiac disease, which is marked by malabsorption, not esophageal dysmotility. | Pathology | Misc. | 155 | {
"Correct Answer": "Anticentromere antibody",
"Correct Option": "A",
"Options": {
"A": "Anticentromere antibody",
"B": "Anti-DNA topoisomerase antibody",
"C": "Antimicrosomal antibody",
"D": "Antimitochondrial antibody"
},
"Question": "A 43-year-old woman has had increasing difficulty swallowing over the past year. She notices that her hands turn white and are painful on exposure to cold. She remarks, \"I may be getting older, but at least I don't have any wrinkles on my face or hands yet.\" On physical examination, her blood pressure is 115/75 mm Hg. The skin of her face and hands appears taut and shiny. A punch biopsy specimen of the skin of the hand shows dermal collagenous fibrosis and focal calcification. She receives yearly esophageal dilation for the next 20 years, during which time she develops no serious illnesses. Which of the following serologic test results is most likely to be positive in this woman?"
} | A 43-year-old woman has had increasing difficulty swallowing over the past year. She notices that her hands turn white and are painful on exposure to cold. She remarks, "I may be getting older, but at least I don't have any wrinkles on my face or hands yet." On physical examination, her blood pressure is 115/75 mm Hg. The skin of her face and hands appears taut and shiny. A punch biopsy specimen of the skin of the hand shows dermal collagenous fibrosis and focal calcification. She receives yearly esophageal dilation for the next 20 years, during which time she develops no serious illnesses. | Which of the following serologic test results is most likely to be positive in this woman? | {
"A": "Anticentromere antibody",
"B": "Anti-DNA topoisomerase antibody",
"C": "Antimicrosomal antibody",
"D": "Antimitochondrial antibody"
} | A. Anticentromere antibody |
23bbc9aa-56a3-4fcf-a018-d49faf4c90e9 | A 64-year-old woman with a longstanding diagnosis of mixed connective tissue disorder and pulmonary fibrosis is admitted with symptoms of recent increase in postprandrial retrosternal distress, heaburn, and nocturnal cough. Her ECG shows nonspecific T-wave changes and she finds minimal relief of her symptoms with sublingual NTG. On examination, she is not in any acute distress and is afebrile. Chest exam reveals bilateral crackles. CXR is shown . The cause of this patient's acute symptoms may be | Large hiatal hernia | Mediastinal abscess | Pneumopericardium | Ileus | 0a
| single | This chest x-ray shows a large, air-containing, hyperlucent opacity in the middle poion of the thorax representing a large hernia in the mediastinum. The lung parenchyma shows increased linear and reticular markings, predominantly in the lower zones, consistent with the diagnosis of interstitial disease. The symptoms described are due to an acid reflux disorder, and the chest x-ray shows a large hiatal hernia. Hiatal hernia represents herniation of the stomach through the esophageal hiatus and is frequently found in adults. It occurs as an oval retrocardiac mass, most often with an air-fluid level, and is due to laxity, stretching, and widening of the hiatus. Obesity and increased intraabdominal pressures are contributing factors. The majority of hernias spontaneously reduce and are called sliding hernias. A paraesophageal hernia occurs when the stomach herniates next to the distal esophagus. Patients may be asymptomatic or may have symptoms of reflux. | Radiology | Respiratory system | 111 | {
"Correct Answer": "Large hiatal hernia",
"Correct Option": "A",
"Options": {
"A": "Large hiatal hernia",
"B": "Mediastinal abscess",
"C": "Pneumopericardium",
"D": "Ileus"
},
"Question": "A 64-year-old woman with a longstanding diagnosis of mixed connective tissue disorder and pulmonary fibrosis is admitted with symptoms of recent increase in postprandrial retrosternal distress, heaburn, and nocturnal cough. Her ECG shows nonspecific T-wave changes and she finds minimal relief of her symptoms with sublingual NTG. On examination, she is not in any acute distress and is afebrile. Chest exam reveals bilateral crackles. CXR is shown . The cause of this patient's acute symptoms may be"
} | A 64-year-old woman with a longstanding diagnosis of mixed connective tissue disorder and pulmonary fibrosis is admitted with symptoms of recent increase in postprandrial retrosternal distress, heaburn, and nocturnal cough. Her ECG shows nonspecific T-wave changes and she finds minimal relief of her symptoms with sublingual NTG. On examination, she is not in any acute distress and is afebrile. Chest exam reveals bilateral crackles. CXR is shown . | The cause of this patient's acute symptoms may be | {
"A": "Large hiatal hernia",
"B": "Mediastinal abscess",
"C": "Pneumopericardium",
"D": "Ileus"
} | A. Large hiatal hernia |
e0e7c0a4-e61d-4196-bae6-fef23f5a3309 | A 19-year-old woman is bothered by a tremor at rest, which becomes progressively worse over the next 6 months. She exhibits paranoid ideation with auditory hallucinations and is diagnosed with acute psychosis. On physical examination, she has scleral icterus. A slit-lamp examination shows corneal Kayser-Fleischer rings. Laboratory findings include total serum protein, 5.9 g/dL; albumin, 3.1 g/dL; total bilirubin, 4.9 mg/dL; direct bilirubin, 3.1 mg/dL; AST, 128 U/L; ALT, 157 U/L; and alkaline phosphatase, 56 U/L. Which of the following additional serologic test findings is most likely to be reported in this patient? | Decreased a1-antitrypsin level | Decreased ceruloplasmin level | Increased a-fetoprotein level | Increased ferritin level | 1b
| multi | Wilson disease is an inherited disorder in which toxic levels of copper accumulate in tissues, particularly the brain, eye, and liver. The ATP7B gene for Wilson disease encodes a copper-transporting ATPase in the hepatocytes. With mutations in this gene, copper cannot be secreted into plasma. Ceruloplasmin is an a2 -globulin that carries copper in plasma. Because copper cannot be secreted into plasma, ceruloplasmin levels are low. Chronic liver disease and panlobular emphysema may occur in a1 -antitrypsin deficiency. An increased a-fetoprotein is a marker for hepatocellular carcinoma. Increased serum ferritin may indicate hereditary hemochromatosis. A positive finding for antimitochondrial antibody can be seen in primary biliary cirrhosis. A positive HBsAg result indicates HBV, which infects only the liver. | Pathology | Liver & Biliary Tract | 176 | {
"Correct Answer": "Decreased ceruloplasmin level",
"Correct Option": "B",
"Options": {
"A": "Decreased a1-antitrypsin level",
"B": "Decreased ceruloplasmin level",
"C": "Increased a-fetoprotein level",
"D": "Increased ferritin level"
},
"Question": "A 19-year-old woman is bothered by a tremor at rest, which becomes progressively worse over the next 6 months. She exhibits paranoid ideation with auditory hallucinations and is diagnosed with acute psychosis. On physical examination, she has scleral icterus. A slit-lamp examination shows corneal Kayser-Fleischer rings. Laboratory findings include total serum protein, 5.9 g/dL; albumin, 3.1 g/dL; total bilirubin, 4.9 mg/dL; direct bilirubin, 3.1 mg/dL; AST, 128 U/L; ALT, 157 U/L; and alkaline phosphatase, 56 U/L. Which of the following additional serologic test findings is most likely to be reported in this patient?"
} | A 19-year-old woman is bothered by a tremor at rest, which becomes progressively worse over the next 6 months. She exhibits paranoid ideation with auditory hallucinations and is diagnosed with acute psychosis. On physical examination, she has scleral icterus. A slit-lamp examination shows corneal Kayser-Fleischer rings. Laboratory findings include total serum protein, 5.9 g/dL; albumin, 3.1 g/dL; total bilirubin, 4.9 mg/dL; direct bilirubin, 3.1 mg/dL; AST, 128 U/L; ALT, 157 U/L; and alkaline phosphatase, 56 U/L. | Which of the following additional serologic test findings is most likely to be reported in this patient? | {
"A": "Decreased a1-antitrypsin level",
"B": "Decreased ceruloplasmin level",
"C": "Increased a-fetoprotein level",
"D": "Increased ferritin level"
} | B. Decreased ceruloplasmin level |
780cc12b-a444-4fa4-a137-5c14d06dcbb9 | An 18-year-old man has facial and upper back lesions that have waxed and waned for the past 6 years. On physical examination, there are 0.3- to 0.9-cm comedones, erythematous papules, nodules, and pustules most numerous on the lower face and posterior upper trunk. Other family members have been affected by this condition at a similar age. The lesions worsen during a 5-day cruise to the Adriatic. Which of the following organisms is most likely to play a key role in the pathogenesis of these lesions? | Group A b-hemolytic streptococcus | Herpes simplex virus type 1 | Mycobacterium leprae | Propionibacterium acnes | 3d
| single | Teenagers and young adults are affected by acne vulgaris more often than other age groups, and males are affected more often than females. Propionibacterium acnes organisms break down sebaceous gland oils to produce irritative fatty acids, and this may promote the process. The food on the cruise probably did not play a role, but stress causes the lesions to worsen. Staphylococcus aureus and group A streptococci are implicated in the inflammatory skin condition known as impetigo, which can include pustules and a characteristic pale yellow-brown crust. Herpes simplex virus produces vesicular skin eruptions, most often in a perioral or genital distribution. Mycobacterium leprae causes leprosy, which is a chronic condition that can produce focal depigmentation and areas of skin anesthesia. | Pathology | Skin | 124 | {
"Correct Answer": "Propionibacterium acnes",
"Correct Option": "D",
"Options": {
"A": "Group A b-hemolytic streptococcus",
"B": "Herpes simplex virus type 1",
"C": "Mycobacterium leprae",
"D": "Propionibacterium acnes"
},
"Question": "An 18-year-old man has facial and upper back lesions that have waxed and waned for the past 6 years. On physical examination, there are 0.3- to 0.9-cm comedones, erythematous papules, nodules, and pustules most numerous on the lower face and posterior upper trunk. Other family members have been affected by this condition at a similar age. The lesions worsen during a 5-day cruise to the Adriatic. Which of the following organisms is most likely to play a key role in the pathogenesis of these lesions?"
} | An 18-year-old man has facial and upper back lesions that have waxed and waned for the past 6 years. On physical examination, there are 0.3- to 0.9-cm comedones, erythematous papules, nodules, and pustules most numerous on the lower face and posterior upper trunk. Other family members have been affected by this condition at a similar age. The lesions worsen during a 5-day cruise to the Adriatic. | Which of the following organisms is most likely to play a key role in the pathogenesis of these lesions? | {
"A": "Group A b-hemolytic streptococcus",
"B": "Herpes simplex virus type 1",
"C": "Mycobacterium leprae",
"D": "Propionibacterium acnes"
} | D. Propionibacterium acnes |
a648d58b-c3d7-47b3-b610-f0649ffc852b | A 76-year-old woman is brought to the emergency department due to sudden loss of right-sided motor function in her face, arm, and leg. She has a past medical history of hypertension, hypercholesterolemia, and previous transient ischemic attack, and was recently placed on Coumadin for new-onset atrial fibrillation. A computed tomography (CT) scan is performed and is shown. Which of the following neurologic structures is most commonly involved in this patient's injury? | Corpus callosum | Internal capsule | Putamen | Thalamus | 2c
| multi | Ans. (c) Putamen.This patient has a risk factor for both ischemic and hemorrhagic cerebrovascular accident (CVA); however, her recent onset of Coumadin for atrial fibrillation and imaging is suggestive of hemorrhage. Intracerebral or intraparenchymal bleeds can occur due to hypertension in the thalamus, pons, cerebellum, basal ganglia and internal capsule, and the caudate nucleus. The putamen (a basal ganglia structure) is documented as the most common area for intracerebral hemorrhage, and commonly tested in this regard.Image source- style="font-family: Times New Roman, Times, serif"> | Surgery | Cerebrovascular Disorders | 103 | {
"Correct Answer": "Putamen",
"Correct Option": "C",
"Options": {
"A": "Corpus callosum",
"B": "Internal capsule",
"C": "Putamen",
"D": "Thalamus"
},
"Question": "A 76-year-old woman is brought to the emergency department due to sudden loss of right-sided motor function in her face, arm, and leg. She has a past medical history of hypertension, hypercholesterolemia, and previous transient ischemic attack, and was recently placed on Coumadin for new-onset atrial fibrillation. A computed tomography (CT) scan is performed and is shown. Which of the following neurologic structures is most commonly involved in this patient's injury?"
} | A 76-year-old woman is brought to the emergency department due to sudden loss of right-sided motor function in her face, arm, and leg. She has a past medical history of hypertension, hypercholesterolemia, and previous transient ischemic attack, and was recently placed on Coumadin for new-onset atrial fibrillation. A computed tomography (CT) scan is performed and is shown. | Which of the following neurologic structures is most commonly involved in this patient's injury? | {
"A": "Corpus callosum",
"B": "Internal capsule",
"C": "Putamen",
"D": "Thalamus"
} | C. Putamen |
a484e99c-ccde-4f88-b496-0992f59c7046 | A 32-year-old woman comes to the psychiatry outpatient with complaints of constricting headaches and neck pain as well. The patient repos that her symptoms have worsened in last 6 months after she joined a new job. Her husband repos that she always had a tendency to worry excessively, even about the small things. The patient describes that she feels that her mind never stops working and that she is alway worried about either her job, or her kids or her parents. She repos feeling of irritability and fatigue. Family history is significant for major depressive disorder in her mother. Which of the following is the most likely diagnosis? | Acute stress disorder | Adjustment disorder | Generalized anxiety disorder | Obsessive-compulsive disorder | 2c
| multi | This patient has symptoms of 'excessive worries' and somatic symptoms of anxiety such as irritability, and somatic symptoms of anxiety such as muscle tension (headaches and pain in neck), irritability and fatigue. The symptoms are suggestive of generalised anxiety disorder. The symptoms were present before this job too. | Psychiatry | Neurotic, Stress Related and Somatoform Disorders | 129 | {
"Correct Answer": "Generalized anxiety disorder",
"Correct Option": "C",
"Options": {
"A": "Acute stress disorder",
"B": "Adjustment disorder",
"C": "Generalized anxiety disorder",
"D": "Obsessive-compulsive disorder"
},
"Question": "A 32-year-old woman comes to the psychiatry outpatient with complaints of constricting headaches and neck pain as well. The patient repos that her symptoms have worsened in last 6 months after she joined a new job. Her husband repos that she always had a tendency to worry excessively, even about the small things. The patient describes that she feels that her mind never stops working and that she is alway worried about either her job, or her kids or her parents. She repos feeling of irritability and fatigue. Family history is significant for major depressive disorder in her mother. Which of the following is the most likely diagnosis?"
} | A 32-year-old woman comes to the psychiatry outpatient with complaints of constricting headaches and neck pain as well. The patient repos that her symptoms have worsened in last 6 months after she joined a new job. Her husband repos that she always had a tendency to worry excessively, even about the small things. The patient describes that she feels that her mind never stops working and that she is alway worried about either her job, or her kids or her parents. She repos feeling of irritability and fatigue. Family history is significant for major depressive disorder in her mother. | Which of the following is the most likely diagnosis? | {
"A": "Acute stress disorder",
"B": "Adjustment disorder",
"C": "Generalized anxiety disorder",
"D": "Obsessive-compulsive disorder"
} | C. Generalized anxiety disorder |
96f28ead-c874-44ef-bd5e-f7e62d1942f3 | A 43-year-old man has experienced progressive fatigue, pruritus, and icterus for 4 months. A colectomy was performed 5 years ago for the treatment of ulcerative colitis. On physical examination, he now has generalized jaundice. The abdomen is not distended; on palpation, there is no abdominal pain and there are no masses. Laboratory studies show a serum alkaline phosphatase level of 285 U/L and an elevated titer of anti-neutrophil cytoplasmic antibodies. Cholangiography shows widespread intrahepatic biliary tree obliteration and a beaded appearance in the remaining ducts. Which of the following morphologic features is most likely to be present in his liver? | Concentric "onion-skin" ductular fibrosis | Copper deposition in hepatocytes | Granulomatous bile duct destruction | Interface hepatitis | 0a
| single | The major targets in primary sclerosing cholangitis are intrahepatic bile ducts, and ulcerative colitis coexists in 70% of cases. Ducts undergo destructive cholangitis that leads eventually to periductal fibrosis and cholestatic jaundice. Eventually, cirrhosis and liver failure can occur. The copper deposition is characteristic of Wilson disease, which is associated with chronic hepatitis and cirrhosis. Granulomatous bile duct destruction occurs in primary biliary cirrhosis. Interface hepatitis is characteristic of chronic active viral hepatitis. a1 -Antitrypsin deficiency with PAS-positive periportal globules is associated with cirrhosis. Portal bridging fibrosis with nodular regeneration defines cirrhosis. | Pathology | Liver & Biliary Tract | 157 | {
"Correct Answer": "Concentric \"onion-skin\" ductular fibrosis",
"Correct Option": "A",
"Options": {
"A": "Concentric \"onion-skin\" ductular fibrosis",
"B": "Copper deposition in hepatocytes",
"C": "Granulomatous bile duct destruction",
"D": "Interface hepatitis"
},
"Question": "A 43-year-old man has experienced progressive fatigue, pruritus, and icterus for 4 months. A colectomy was performed 5 years ago for the treatment of ulcerative colitis. On physical examination, he now has generalized jaundice. The abdomen is not distended; on palpation, there is no abdominal pain and there are no masses. Laboratory studies show a serum alkaline phosphatase level of 285 U/L and an elevated titer of anti-neutrophil cytoplasmic antibodies. Cholangiography shows widespread intrahepatic biliary tree obliteration and a beaded appearance in the remaining ducts. Which of the following morphologic features is most likely to be present in his liver?"
} | A 43-year-old man has experienced progressive fatigue, pruritus, and icterus for 4 months. A colectomy was performed 5 years ago for the treatment of ulcerative colitis. On physical examination, he now has generalized jaundice. The abdomen is not distended; on palpation, there is no abdominal pain and there are no masses. Laboratory studies show a serum alkaline phosphatase level of 285 U/L and an elevated titer of anti-neutrophil cytoplasmic antibodies. Cholangiography shows widespread intrahepatic biliary tree obliteration and a beaded appearance in the remaining ducts. | Which of the following morphologic features is most likely to be present in his liver? | {
"A": "Concentric \"onion-skin\" ductular fibrosis",
"B": "Copper deposition in hepatocytes",
"C": "Granulomatous bile duct destruction",
"D": "Interface hepatitis"
} | A. Concentric "onion-skin" ductular fibrosis |
8b135e8f-54c7-4d5f-91e8-2b7d325d5454 | A 35-year-old prostitute is seen in a community health care clinic. About 4 months earlier, she had a painless labial sore and swelling of a right inguinal lymph node, both of which had subsided uneventfully over a period of several weeks. About 3 weeks later she developed fever and a generalized maculopapular skin rash that involved the palms of the hands and the soles of the feet. She has also has flattened, broad-based plaques in anogenital region. The most likely diagnosis is? | Chancre | Chancroid | Condyloma acuminatum | Condyloma lata | 3d
| multi | The patient presents with a lesion of secondary syphilis known as condyloma lata. This stage is marked by painless, superficial lesions of the skin and mucosal surfaces. It occurs 2 to 10 weeks after the primary chancre in approximately 75% of untreated people. Skin lesions frequently occur on the palms or soles of the feet and may be maculopapular, scaly, or pustular. Moist areas of the skin, such as the anogenital region, inner thighs, and axillae, may have broad-based elevated plaques called condylomata lata. The original lesion, the painless ulcer or chancre, is characteristic of primary syphilis. Chancroid is a similar lesion to the primary lesion in syphilis, but instead is painful. Condyloma acuminatum (anogenital was) is a similarly named lesion often referred to as a venereal wa and is due to HPV. Papillary hidradenoma is a common benign tumor of the vulva, presenting as a nodule that may ulcerate and bleed. | Pathology | Female genital Tract | 113 | {
"Correct Answer": "Condyloma lata",
"Correct Option": "D",
"Options": {
"A": "Chancre",
"B": "Chancroid",
"C": "Condyloma acuminatum",
"D": "Condyloma lata"
},
"Question": "A 35-year-old prostitute is seen in a community health care clinic. About 4 months earlier, she had a painless labial sore and swelling of a right inguinal lymph node, both of which had subsided uneventfully over a period of several weeks. About 3 weeks later she developed fever and a generalized maculopapular skin rash that involved the palms of the hands and the soles of the feet. She has also has flattened, broad-based plaques in anogenital region. The most likely diagnosis is?"
} | A 35-year-old prostitute is seen in a community health care clinic. About 4 months earlier, she had a painless labial sore and swelling of a right inguinal lymph node, both of which had subsided uneventfully over a period of several weeks. About 3 weeks later she developed fever and a generalized maculopapular skin rash that involved the palms of the hands and the soles of the feet. She has also has flattened, broad-based plaques in anogenital region. | The most likely diagnosis is? | {
"A": "Chancre",
"B": "Chancroid",
"C": "Condyloma acuminatum",
"D": "Condyloma lata"
} | D. Condyloma lata |
e8f10d54-2bca-4eba-94fa-4261cf6623f3 | A 56-year-old man is evaluated for recent onset painful skin lesion which involves his abdominal wall. The lesion started 3 days ago as a small erythematous macule which has gradually increased in size to a large purpuric lesion with bulla formation. He is afebrile and does not recall any trauma. His medical history is significant for atrial fibrillation; he was recently switched from rivaroxaban to warfarin due to the high cost of rivaroxaban.What is the most probable cause of the condition? | Rivaroxaban | Low-molecular-weight heparin | Warfarin | Low dose aspirin (81 mg/d) | 2c
| multi | Malignancy is a recognized risk factor for venous thromboembolism (VTE), and VTE is the second leading cause of death in cancer patients. Procoagulant molecules expressed both by cancer cells and host tissue contribute to this condition. Low-molecular-weight heparin (LMWH) is the preferred anticoagulant for long-term treatment in patients with cancer. When compared with warfarin, LMWH reduces the rate of recurrent VTE without significant risk of bleeding. Newer anticoagulants such as rivaroxaban have not been adequately tested for cancer-induced VTE yet.Young patients with unprovoked VTE, a history of unexplained VTE, or family history of VTE raise the suspicion of an inherited hypercoagulable disorder. The common inherited hypercoagulable disorders are Factor V Leiden mutation, prothrombin gene mutation, protein S deficiency, protein C deficiency, antithrombin III deficiency, dysfibrinogenemia, and antiphospholipid antibody syndrome. When inherited hypercoagulable disorders are strongly suspected, tests for above mentioned disorders can be ordered. In the event of an acute thrombosis, however, it is not recommended to test for protein C, protein S, and anti-thrombin III since active coagulation can reduce the plasma concentration of these proteins resulting in false-positive result. To avoid confusion, it is recommended to order only Factor V Leiden mutation, prothrombin gene mutation, and antiphospholipid antibody with acute VTE or when patients are on warfarin.Warfarin-induced skin necrosis results from a transient hypercoagulable state. Warfarin initially affects all the vitamin K-dependent clotting proteins (Factors II, VII, IX, X, and proteins C and S). Since Protein C has a short half-life (8-12 hours), the serum protein C concentration drops quickly to 50% of normal in first 24 hours. Since circulating levels of other vitamin K-dependent proteins are still high, this gives rise to a hypercoagulable state which may cause microthrombi in the dermal and subcutaneous vessels, resulting in skin necrosis. The risk is particularly high in case of congenital protein C deficiency; nearly one-third cases of warfarin-induced skin necrosis are associated with congenital protein C deficiency. | Medicine | Oncology | 113 | {
"Correct Answer": "Warfarin",
"Correct Option": "C",
"Options": {
"A": "Rivaroxaban",
"B": "Low-molecular-weight heparin",
"C": "Warfarin",
"D": "Low dose aspirin (81 mg/d)"
},
"Question": "A 56-year-old man is evaluated for recent onset painful skin lesion which involves his abdominal wall. The lesion started 3 days ago as a small erythematous macule which has gradually increased in size to a large purpuric lesion with bulla formation. He is afebrile and does not recall any trauma. His medical history is significant for atrial fibrillation; he was recently switched from rivaroxaban to warfarin due to the high cost of rivaroxaban.What is the most probable cause of the condition?"
} | A 56-year-old man is evaluated for recent onset painful skin lesion which involves his abdominal wall. The lesion started 3 days ago as a small erythematous macule which has gradually increased in size to a large purpuric lesion with bulla formation. He is afebrile and does not recall any trauma. | His medical history is significant for atrial fibrillation; he was recently switched from rivaroxaban to warfarin due to the high cost of rivaroxaban.What is the most probable cause of the condition? | {
"A": "Rivaroxaban",
"B": "Low-molecular-weight heparin",
"C": "Warfarin",
"D": "Low dose aspirin (81 mg/d)"
} | C. Warfarin |
defb1c29-37a3-4d15-bda1-7356b56cba2c | A 35-year-old woman is evaluated for jaundice in an emergency depament. For several days, the patient has had mild flu-like symptoms of anorexia, nausea and vomiting, fatigue, low-grade fever, and malaise. This morning, she noted that her urine was brown in color, and she has also developed moderate, steady, pain of the right upper quadrant of her abdomen. She has not had any similar episodes in the past. On physical examination, the patient is noted to be jaundiced and to have an enlarged, tender liver. Blood chemistry studies are notable for alanine aminotransferase (ALT) of 15,000 mIU/L, aspaate aminotransferase (AST) of 11,000 mIU/L, and alkaline phosphatase of 100 U/L. Which of the following is the most likely diagnosis? | Acute hepatitis | Chronic hepatitis | Gallstone disease | Hepatic cirrhosis | 0a
| multi | This person's markedly elevated AST and ALT with modest elevation of alkaline phosphatase strongly suggests that she has acute hepatitis. The clinical presentation with flu-like symptoms that progress to jaundice is also typical. Chronic hepatitis and cirrhosis would present more insidiously and would not have the extremely high elevations of AST and ALT. Gallstone disease can cause acute abdominal pain, and occasionally jaundice (if a small stone occludes the common bile duct), but would not usually cause the very high elevations of AST and ALT seen in this patient. | Surgery | null | 193 | {
"Correct Answer": "Acute hepatitis",
"Correct Option": "A",
"Options": {
"A": "Acute hepatitis",
"B": "Chronic hepatitis",
"C": "Gallstone disease",
"D": "Hepatic cirrhosis"
},
"Question": "A 35-year-old woman is evaluated for jaundice in an emergency depament. For several days, the patient has had mild flu-like symptoms of anorexia, nausea and vomiting, fatigue, low-grade fever, and malaise. This morning, she noted that her urine was brown in color, and she has also developed moderate, steady, pain of the right upper quadrant of her abdomen. She has not had any similar episodes in the past. On physical examination, the patient is noted to be jaundiced and to have an enlarged, tender liver. Blood chemistry studies are notable for alanine aminotransferase (ALT) of 15,000 mIU/L, aspaate aminotransferase (AST) of 11,000 mIU/L, and alkaline phosphatase of 100 U/L. Which of the following is the most likely diagnosis?"
} | A 35-year-old woman is evaluated for jaundice in an emergency depament. For several days, the patient has had mild flu-like symptoms of anorexia, nausea and vomiting, fatigue, low-grade fever, and malaise. This morning, she noted that her urine was brown in color, and she has also developed moderate, steady, pain of the right upper quadrant of her abdomen. She has not had any similar episodes in the past. On physical examination, the patient is noted to be jaundiced and to have an enlarged, tender liver. Blood chemistry studies are notable for alanine aminotransferase (ALT) of 15,000 mIU/L, aspaate aminotransferase (AST) of 11,000 mIU/L, and alkaline phosphatase of 100 U/L. | Which of the following is the most likely diagnosis? | {
"A": "Acute hepatitis",
"B": "Chronic hepatitis",
"C": "Gallstone disease",
"D": "Hepatic cirrhosis"
} | A. Acute hepatitis |
0fb0edec-68ce-4ae1-904a-4b57761df963 | A 33-year-old farmer presents to the clinic with symptoms of recurrent wheezing and coughing after working in a barn where hay is stored. He has no prior history of asthma, and is not taking any medications. On physical examination, there are bibasilar crackles on auscultation of the lungs, the heart sounds are normal, JVP is 2 cm above the sternal angle, and there is no peripheral edema.His laboratory investigations are normal with no increase in eosinophils on the CBC. The chest x-ray (CXR) reveals patchy lower lobe infiltrates, and a normal cardiac silhouette. Which of the following is the most likely diagnosis? | asthma | chronic obstructive lung disease | hypersensitivity pneumonitis | bronchiectasis | 2c
| multi | Hypersensitivity pneumonitis is an inflammatory disorder of the lungs involving alveolar walls and terminal airways that is caused by repeated exposure to organic agents. In this example of "farmer's lung," the inhalation of antigens present in moldy hay such as thermophilic actinomyces ox Aspergillus species are the causative agents. When exposure to moldy hay is stopped, symptoms and signs of farmer's lung all tend to abate and complete recovery usually follows. In acute syndromes, the presentation is 4-8 hours after exposure. Symptoms include fever, chills, malaise, cough, and dyspnea without wheezing. The rate of disease depends on rainfall (which promotes fungal growth) and agricultural practices related to turning and stacking hay. In acute and subacute presentations, removing exposure to the antigen will result in complete recovery. COPD and bronchiectasis are less likely given the absence of prior smoking exposure or lung injury, and both of these disorders usually do have an associated pulmonary infiltrate on CXR unless there is an concomitant lung infection. Asthma can cause wheezing symptoms, and even have mold or dust as triggers but again there is no infiltrate seen on the CXR. | Medicine | Respiratory | 142 | {
"Correct Answer": "hypersensitivity pneumonitis",
"Correct Option": "C",
"Options": {
"A": "asthma",
"B": "chronic obstructive lung disease",
"C": "hypersensitivity pneumonitis",
"D": "bronchiectasis"
},
"Question": "A 33-year-old farmer presents to the clinic with symptoms of recurrent wheezing and coughing after working in a barn where hay is stored. He has no prior history of asthma, and is not taking any medications. On physical examination, there are bibasilar crackles on auscultation of the lungs, the heart sounds are normal, JVP is 2 cm above the sternal angle, and there is no peripheral edema.His laboratory investigations are normal with no increase in eosinophils on the CBC. The chest x-ray (CXR) reveals patchy lower lobe infiltrates, and a normal cardiac silhouette. Which of the following is the most likely diagnosis?"
} | A 33-year-old farmer presents to the clinic with symptoms of recurrent wheezing and coughing after working in a barn where hay is stored. He has no prior history of asthma, and is not taking any medications. On physical examination, there are bibasilar crackles on auscultation of the lungs, the heart sounds are normal, JVP is 2 cm above the sternal angle, and there is no peripheral edema.His laboratory investigations are normal with no increase in eosinophils on the CBC. The chest x-ray (CXR) reveals patchy lower lobe infiltrates, and a normal cardiac silhouette. | Which of the following is the most likely diagnosis? | {
"A": "asthma",
"B": "chronic obstructive lung disease",
"C": "hypersensitivity pneumonitis",
"D": "bronchiectasis"
} | C. hypersensitivity pneumonitis |
e061e9bc-136e-4cb3-8334-b10571bab1aa | A 68-year-old man presents to the clinic for evaluation of progressive hearing loss, ringing in his ears, and facial pain on the left side. The symptoms started 1 month ago. He has also noticed some difficulty with his balance, but reports no falls. Pertinent physical findings are an unsteady gait and decreased hearing in the left ear. His eye movements, facial sensation, and facial movements are normal. An MRI scan of the brain reveals a tumor at the cerebellopontine angle. Which of the following cranial nerves is this tumor most likely to affect? | fourth cranial nerve | sixth cranial nerve | eighth cranial nerve | tenth cranial nerve | 2c
| multi | A vestibular schwannoma (formerly called acoustic neuroma) is most likely to lead to a palsy of the eighth cranial nerve. Deafness, headache, ataxia, tinnitus, and diplopia are seen, as well as facial paresthesia. Vestibular schwannoma represent 5% - 10% of all intracranial tumors. They develop from Schwann cells and generally grow very slowly. They may be very large before symptoms develop. | Medicine | C.N.S. | 120 | {
"Correct Answer": "eighth cranial nerve",
"Correct Option": "C",
"Options": {
"A": "fourth cranial nerve",
"B": "sixth cranial nerve",
"C": "eighth cranial nerve",
"D": "tenth cranial nerve"
},
"Question": "A 68-year-old man presents to the clinic for evaluation of progressive hearing loss, ringing in his ears, and facial pain on the left side. The symptoms started 1 month ago. He has also noticed some difficulty with his balance, but reports no falls. Pertinent physical findings are an unsteady gait and decreased hearing in the left ear. His eye movements, facial sensation, and facial movements are normal. An MRI scan of the brain reveals a tumor at the cerebellopontine angle. Which of the following cranial nerves is this tumor most likely to affect?"
} | A 68-year-old man presents to the clinic for evaluation of progressive hearing loss, ringing in his ears, and facial pain on the left side. The symptoms started 1 month ago. He has also noticed some difficulty with his balance, but reports no falls. Pertinent physical findings are an unsteady gait and decreased hearing in the left ear. His eye movements, facial sensation, and facial movements are normal. An MRI scan of the brain reveals a tumor at the cerebellopontine angle. | Which of the following cranial nerves is this tumor most likely to affect? | {
"A": "fourth cranial nerve",
"B": "sixth cranial nerve",
"C": "eighth cranial nerve",
"D": "tenth cranial nerve"
} | C. eighth cranial nerve |
e40760c3-5e21-42e5-a03c-710390abee33 | A 58-year-old man with cirrhosis complains of worsening fatigue and confusion over the past 5 days. He also reports that over the past 48 hours he has had a declining urinary output. On examination, he is gaunt and jaundiced. He has tense ascites and a liver span of 7 cm in the midclavicular line. Lab result reveal a WBC 4600/mm3, Hb 9.4 g/dL, and PCB 29%. BUN of 34 mg/dL and a creatinine of 3.1 mg/dL. A urinary Na <10 mEq/L. Most appropriate treatment for his elevated BUN and creatinine? | Large volume paracentesis | Hemodialysis | Mesocaval shunt | Liver transplantation | 3d
| single | This patient with well advanced cirrhosis and portal hypertension has developed the onset of renal insufficiency consistent with hepatorenal syndrome. This occurs during the end stages of cirrhosis and is characterized by diminished urine output and low urinary sodium. In the setting of end-stage liver disease, renal vasoconstriction occurs, and the distal convoluted tubule responds by conserving sodium. Unless the renal function is allowed to deteriorate further, liver transplantation will reverse this vasoconstriction and kidney function will return to normal.
A large volume paracentesis may relieve the ascites but will have no significant benefit on the impaired renal function. There are no indications in this question to suggest that the patient requires acute hemodialysis. A mesocaval shunt is a surgical procedure that may decompress the portal pressure but will not have any benefit on renal function. Renal transplantation is of no value in this patient since the underlying lesion is in the liver; the kidneys will return to normal function if there is improvement in hepatic function. | Unknown | null | 151 | {
"Correct Answer": "Liver transplantation",
"Correct Option": "D",
"Options": {
"A": "Large volume paracentesis",
"B": "Hemodialysis",
"C": "Mesocaval shunt",
"D": "Liver transplantation"
},
"Question": "A 58-year-old man with cirrhosis complains of worsening fatigue and confusion over the past 5 days. He also reports that over the past 48 hours he has had a declining urinary output. On examination, he is gaunt and jaundiced. He has tense ascites and a liver span of 7 cm in the midclavicular line. Lab result reveal a WBC 4600/mm3, Hb 9.4 g/dL, and PCB 29%. BUN of 34 mg/dL and a creatinine of 3.1 mg/dL. A urinary Na <10 mEq/L. Most appropriate treatment for his elevated BUN and creatinine?"
} | A 58-year-old man with cirrhosis complains of worsening fatigue and confusion over the past 5 days. He also reports that over the past 48 hours he has had a declining urinary output. On examination, he is gaunt and jaundiced. He has tense ascites and a liver span of 7 cm in the midclavicular line. Lab result reveal a WBC 4600/mm3, Hb 9.4 g/dL, and PCB 29%. BUN of 34 mg/dL and a creatinine of 3.1 mg/dL. A urinary Na <10 mEq/L. | Most appropriate treatment for his elevated BUN and creatinine? | {
"A": "Large volume paracentesis",
"B": "Hemodialysis",
"C": "Mesocaval shunt",
"D": "Liver transplantation"
} | D. Liver transplantation |
ab567538-d93a-41e8-a36a-346545b46cb5 | A 70 kg man was given a drug in a dose of 100 mg/kg body weight. Its t1/2, is 10 hours, initial plasma concentration is 1.9 mg/ml. True statement is: a) CL is 0.02 litre/hr b) CL is 20 litre/hr c) k is 0.0693 d) k is 6.93 e) CL is 0.2 litre/hr | ab | ad | ce | ae | 2c
| multi | null | Pharmacology | null | 101 | {
"Correct Answer": "ce",
"Correct Option": "C",
"Options": {
"A": "ab",
"B": "ad",
"C": "ce",
"D": "ae"
},
"Question": "A 70 kg man was given a drug in a dose of 100 mg/kg body weight. Its t1/2, is 10 hours, initial plasma concentration is 1.9 mg/ml. True statement is: a) CL is 0.02 litre/hr b) CL is 20 litre/hr c) k is 0.0693 d) k is 6.93 e) CL is 0.2 litre/hr"
} | A 70 kg man was given a drug in a dose of 100 mg/kg body weight. Its t1/2, is 10 hours, initial plasma concentration is 1.9 mg/ml. | True statement is: a) CL is 0.02 litre/hr b) CL is 20 litre/hr c) k is 0.0693 d) k is 6.93 e) CL is 0.2 litre/hr | {
"A": "ab",
"B": "ad",
"C": "ce",
"D": "ae"
} | C. ce |
b2c8e4f8-6299-4c2e-98c7-8cedf6bf05d7 | A 63-year-old asymptomatic woman is seen in the clinic for investigation of a persistently elevated alkaline phosphatase (ALP) level. The elevated ALP is an isolated finding and the remaining liver enzymes are normal. She reports no abdominal symptoms suggestive of biliary colic or hepatitis.On physical examination, the vital signs are normal, she is not icteric, the heart sounds are normal and the lungs are clear. The abdomen is soft and the liver span is 12 cm in the mid- clavicular line.X-rays of the pelvis show multiple porotic and sclerotic lesions with characteristic whorls of trabeculation. Her excretion of urinary hydroxyproline is also elevated. Which of the following is the most likely diagnosis? | rickets and Osteomalacia | osteogenic sarcoma | vitamin D deficiency | Paget disease of bone | 3d
| single | The elevated ALP and hydroxyproline are diagnostic for Paget disease. The bony lesions are osteoblastic, and the sacrum and pelvis are most frequently involved, followed closely by the tibia and femur. Hypercalcemia is not usually a feature of Paget, though can occur as a complication of immobilization. The etiology is unknown. Symptoms may be absent or severe (pain, deformity). In metastatic cancers of most types the lesion are lytic, and the other metabolic abnormalities listed do not have an elevation in hydroxyproline. | Medicine | Endocrinology | 159 | {
"Correct Answer": "Paget disease of bone",
"Correct Option": "D",
"Options": {
"A": "rickets and Osteomalacia",
"B": "osteogenic sarcoma",
"C": "vitamin D deficiency",
"D": "Paget disease of bone"
},
"Question": "A 63-year-old asymptomatic woman is seen in the clinic for investigation of a persistently elevated alkaline phosphatase (ALP) level. The elevated ALP is an isolated finding and the remaining liver enzymes are normal. She reports no abdominal symptoms suggestive of biliary colic or hepatitis.On physical examination, the vital signs are normal, she is not icteric, the heart sounds are normal and the lungs are clear. The abdomen is soft and the liver span is 12 cm in the mid- clavicular line.X-rays of the pelvis show multiple porotic and sclerotic lesions with characteristic whorls of trabeculation. Her excretion of urinary hydroxyproline is also elevated. Which of the following is the most likely diagnosis?"
} | A 63-year-old asymptomatic woman is seen in the clinic for investigation of a persistently elevated alkaline phosphatase (ALP) level. The elevated ALP is an isolated finding and the remaining liver enzymes are normal. She reports no abdominal symptoms suggestive of biliary colic or hepatitis.On physical examination, the vital signs are normal, she is not icteric, the heart sounds are normal and the lungs are clear. The abdomen is soft and the liver span is 12 cm in the mid- clavicular line.X-rays of the pelvis show multiple porotic and sclerotic lesions with characteristic whorls of trabeculation. Her excretion of urinary hydroxyproline is also elevated. | Which of the following is the most likely diagnosis? | {
"A": "rickets and Osteomalacia",
"B": "osteogenic sarcoma",
"C": "vitamin D deficiency",
"D": "Paget disease of bone"
} | D. Paget disease of bone |
55264f27-407a-420c-ba12-3e10a789a9c6 | A 50-year-old man comes with a history of abdominal pain, weakness, lightheadedness, palpitations and shoness of breath. On examination, glossitis along with hyperpigmentation of skin of dorsum of hands and feet and abnormal pigmentation of hair was observed. The family of the patient told that they have observed frequent episodes of increased irritability from the past 1 year. Given below are the laboratory findings and the peripheral blood smear. Later bone marrow aspiration was also done. Hb: 9gm% MCV: 110fl MCH: 36Pg MCHC: 34gm/dl Reticulocyte count: 0.1 x 10^9/L LDH: 600 U/L Indirect bilirubin: 1 mg/dL S. iron: Normal S. Ferritin: Normal WBC: 2 x 10^9/L Platelet count: 90 x 10^9/L PERIPHERAL BLOOD SMEAR BONE MARROW ASPIRATION What is the in infective form of the organism causing the above condition: - | Miracidium | Coracidium | Plerocercoid | Procercoid | 2c
| multi | This is a case of megaloblastic anemia due to Diphyllobothrium latum infection. Lab findings show increased mcv, LDH, indirect bilirubin and normal iron studies, and low reticulocyte, WBC and platelet count. Pbs shows hypersegmented neutrophil. Bone marrow aspiration study shows megaloblasts. DIPHYLLOBOTHRIUM LATUM Humans acquire the infection by ingesting infected raw or smoked fish with plerocercoid larva which is the infective form. Within 3-5 weeks, the tapeworm matures into an adult in the human intestine. Because the tapeworm absorbs large quantities of vitamin B12 and interferes with ileal B12 absorption, vitamin B12 deficiency can develop. Praziquantel (5-10 mg/kg once) is highly effective. Parenteral vitamin B12 should be given if B12 deficiency is manifest. | Unknown | Integrated QBank | 241 | {
"Correct Answer": "Plerocercoid",
"Correct Option": "C",
"Options": {
"A": "Miracidium",
"B": "Coracidium",
"C": "Plerocercoid",
"D": "Procercoid"
},
"Question": "A 50-year-old man comes with a history of abdominal pain, weakness, lightheadedness, palpitations and shoness of breath. On examination, glossitis along with hyperpigmentation of skin of dorsum of hands and feet and abnormal pigmentation of hair was observed. The family of the patient told that they have observed frequent episodes of increased irritability from the past 1 year. Given below are the laboratory findings and the peripheral blood smear. Later bone marrow aspiration was also done. Hb: 9gm% MCV: 110fl MCH: 36Pg MCHC: 34gm/dl Reticulocyte count: 0.1 x 10^9/L LDH: 600 U/L Indirect bilirubin: 1 mg/dL S. iron: Normal S. Ferritin: Normal WBC: 2 x 10^9/L Platelet count: 90 x 10^9/L PERIPHERAL BLOOD SMEAR BONE MARROW ASPIRATION What is the in infective form of the organism causing the above condition: -"
} | A 50-year-old man comes with a history of abdominal pain, weakness, lightheadedness, palpitations and shoness of breath. On examination, glossitis along with hyperpigmentation of skin of dorsum of hands and feet and abnormal pigmentation of hair was observed. The family of the patient told that they have observed frequent episodes of increased irritability from the past 1 year. Given below are the laboratory findings and the peripheral blood smear. Later bone marrow aspiration was also done. Hb: 9gm% MCV: 110fl MCH: 36Pg MCHC: 34gm/dl Reticulocyte count: 0.1 x 10^9/L LDH: 600 U/L Indirect bilirubin: 1 mg/dL S. iron: Normal S. | Ferritin: Normal WBC: 2 x 10^9/L Platelet count: 90 x 10^9/L PERIPHERAL BLOOD SMEAR BONE MARROW ASPIRATION What is the in infective form of the organism causing the above condition: - | {
"A": "Miracidium",
"B": "Coracidium",
"C": "Plerocercoid",
"D": "Procercoid"
} | C. Plerocercoid |
2f0aef92-b5cc-4a9f-906a-899ff5a6b1fd | A 64-year-old man presents with fever, chills and increasing shoness of breath. The patient appears in acute respiratory distress and complains of pleuritic chest pain. Physical examination shows crackles and decreased breath sounds over both lung fields. The patient exhibits tachypnea, with flaring of the nares. The sputum is rusty-yellow and displays numerous neutrophils and erythrocytes. The patient is appropriately treated with antibiotics, which of the following is the most likely outcome? | Abscess formation | Bronchopleural fistula | Bullous emphysema | Resolution | 3d
| multi | Although abscesses and fistulas may occur, the most common outcome of acute bacterial pneumonia is resolution, paicularly with appropriate antibiotic treatment. | Pathology | Infectious Lung Disease: Pneumonia | 105 | {
"Correct Answer": "Resolution",
"Correct Option": "D",
"Options": {
"A": "Abscess formation",
"B": "Bronchopleural fistula",
"C": "Bullous emphysema",
"D": "Resolution"
},
"Question": "A 64-year-old man presents with fever, chills and increasing shoness of breath. The patient appears in acute respiratory distress and complains of pleuritic chest pain. Physical examination shows crackles and decreased breath sounds over both lung fields. The patient exhibits tachypnea, with flaring of the nares. The sputum is rusty-yellow and displays numerous neutrophils and erythrocytes. The patient is appropriately treated with antibiotics, which of the following is the most likely outcome?"
} | A 64-year-old man presents with fever, chills and increasing shoness of breath. The patient appears in acute respiratory distress and complains of pleuritic chest pain. Physical examination shows crackles and decreased breath sounds over both lung fields. The patient exhibits tachypnea, with flaring of the nares. The sputum is rusty-yellow and displays numerous neutrophils and erythrocytes. | The patient is appropriately treated with antibiotics, which of the following is the most likely outcome? | {
"A": "Abscess formation",
"B": "Bronchopleural fistula",
"C": "Bullous emphysema",
"D": "Resolution"
} | D. Resolution |
dff35f24-2963-4557-a41f-685dd07f50b8 | A 42-year-old woman has noted increasing fullness in her neck for the past 7 months. On physical examination, her thyroid gland is diffusely and asymmetrically enlarged and nodular. There is no lymphadenopathy. She undergoes thyroidectomy. Gross examination of the thyroid shows a multicentric thyroid neoplasm; microscopically, the neoplasm is composed of polygonal-to spindle-shaped cells forming nests and trabeculae. There is a prominent, pink hyaline stroma that stains positively with Congo red. Electron microscopy shows varying numbers of intracytoplasmic, membrane-bound, electron-dense granules. Immunohistochemical staining for which of the following antigens is most useful for the diagnosis of this neoplasm? | Calcitonin | CD3 | Cytokeratin | Estrogen receptor | 0a
| multi | Medullary carcinomas are derived from the C cells, or parafollicular cells, of the thyroid, with embryologic origin from the neural crest. Therefore they have the neuroendocrine function, including synthesis of calcitonin. An amyloid stroma is a common feature of this tumor. These tumors occur sporadically in about 70% of cases, but they can be familial and part of multiple endocrine neoplasias types 2A and 2B. CD3 is a useful marker for some lymphoid neoplasms. Although various tissues may show positivity for estrogen receptors, this finding has no clinical significance in the thyroid. Staining for parathyroid hormone is useful to determine if a parathyroid carcinoma is present. Vimentin is a marker for sarcomatous neoplasms, and cytokeratin is a useful marker to determine if a neoplasm is epithelial. | Pathology | Endocrine | 158 | {
"Correct Answer": "Calcitonin",
"Correct Option": "A",
"Options": {
"A": "Calcitonin",
"B": "CD3",
"C": "Cytokeratin",
"D": "Estrogen receptor"
},
"Question": "A 42-year-old woman has noted increasing fullness in her neck for the past 7 months. On physical examination, her thyroid gland is diffusely and asymmetrically enlarged and nodular. There is no lymphadenopathy. She undergoes thyroidectomy. Gross examination of the thyroid shows a multicentric thyroid neoplasm; microscopically, the neoplasm is composed of polygonal-to spindle-shaped cells forming nests and trabeculae. There is a prominent, pink hyaline stroma that stains positively with Congo red. Electron microscopy shows varying numbers of intracytoplasmic, membrane-bound, electron-dense granules. Immunohistochemical staining for which of the following antigens is most useful for the diagnosis of this neoplasm?"
} | A 42-year-old woman has noted increasing fullness in her neck for the past 7 months. On physical examination, her thyroid gland is diffusely and asymmetrically enlarged and nodular. There is no lymphadenopathy. She undergoes thyroidectomy. Gross examination of the thyroid shows a multicentric thyroid neoplasm; microscopically, the neoplasm is composed of polygonal-to spindle-shaped cells forming nests and trabeculae. There is a prominent, pink hyaline stroma that stains positively with Congo red. Electron microscopy shows varying numbers of intracytoplasmic, membrane-bound, electron-dense granules. | Immunohistochemical staining for which of the following antigens is most useful for the diagnosis of this neoplasm? | {
"A": "Calcitonin",
"B": "CD3",
"C": "Cytokeratin",
"D": "Estrogen receptor"
} | A. Calcitonin |
2a78d0e8-2b4d-46c5-9c89-77b86f33eaff | A 6-year-old girl has a blotchy, reddish-brown rash on her face, trunk, and proximal extremities that developed over the course of 3 days. On physical examination, she has 0.2-cm to 0.5-cm ulcerated lesions on the oral cavity mucosa and generalized tender lymphadenopathy. A cough with minimal sputum production becomes progressively worse over the next 3 days. Which of the following viruses is most likely to produce these findings? | Epstein-Barr | Mumps | Rubella | Rubeola | 3d
| single | The rash and the Koplik spots on the buccal mucosa are characteristic findings in measles (rubeola), a childhood infection. It occurs only sporadically when immunizations have been administered to a large part of the population. The severity of the illness varies, and measles pneumonia may complicate the course of the disease, which in some cases can be life-threatening. Mononucleosis, which results from Epstein-Barr (EBV) virus infection, is more likely to occur in adolescence. Mumps produces parotitis and orchitis. Varicella-zoster virus infections in children manifest as chicken-pox. Rubella, also called German measles, is a much milder infection than rubeola. | Pathology | Infectious Disease | 104 | {
"Correct Answer": "Rubeola",
"Correct Option": "D",
"Options": {
"A": "Epstein-Barr",
"B": "Mumps",
"C": "Rubella",
"D": "Rubeola"
},
"Question": "A 6-year-old girl has a blotchy, reddish-brown rash on her face, trunk, and proximal extremities that developed over the course of 3 days. On physical examination, she has 0.2-cm to 0.5-cm ulcerated lesions on the oral cavity mucosa and generalized tender lymphadenopathy. A cough with minimal sputum production becomes progressively worse over the next 3 days. Which of the following viruses is most likely to produce these findings?"
} | A 6-year-old girl has a blotchy, reddish-brown rash on her face, trunk, and proximal extremities that developed over the course of 3 days. On physical examination, she has 0.2-cm to 0.5-cm ulcerated lesions on the oral cavity mucosa and generalized tender lymphadenopathy. A cough with minimal sputum production becomes progressively worse over the next 3 days. | Which of the following viruses is most likely to produce these findings? | {
"A": "Epstein-Barr",
"B": "Mumps",
"C": "Rubella",
"D": "Rubeola"
} | D. Rubeola |
a332a2e2-982f-4640-9b2b-7fca3d89a1ab | A 23-year-old man notices a gradual but progressive increase in breathing difficulty. He has a long history of back pain with prolonged morning stiffness. He has also had an episode of iritis in the past. On examination, there is reduced range of motion in the lumbar spine with forward flexion and pain on palpation of the sacroiliac joint and surrounding soft tissue. X-rays of the pelvis show erosions and sclerosis of the sacroiliac joint. Which of the following is the most likely pulmonary complication of this condition? | fibro cavitary disease | airflow obstruction | bilateral lower lobe involvement | pleural effusions | 0a
| single | Ankylosing spondylitis is characterized by bilateral upper lobe fibrosis, which may be complicated by fibro cavitary disease. The pulmonary involvement is rare and is usually very slowly progressive. The cavities can be colonized by Aspergillus. | Medicine | Respiratory | 112 | {
"Correct Answer": "fibro cavitary disease",
"Correct Option": "A",
"Options": {
"A": "fibro cavitary disease",
"B": "airflow obstruction",
"C": "bilateral lower lobe involvement",
"D": "pleural effusions"
},
"Question": "A 23-year-old man notices a gradual but progressive increase in breathing difficulty. He has a long history of back pain with prolonged morning stiffness. He has also had an episode of iritis in the past. On examination, there is reduced range of motion in the lumbar spine with forward flexion and pain on palpation of the sacroiliac joint and surrounding soft tissue. X-rays of the pelvis show erosions and sclerosis of the sacroiliac joint. Which of the following is the most likely pulmonary complication of this condition?"
} | A 23-year-old man notices a gradual but progressive increase in breathing difficulty. He has a long history of back pain with prolonged morning stiffness. He has also had an episode of iritis in the past. On examination, there is reduced range of motion in the lumbar spine with forward flexion and pain on palpation of the sacroiliac joint and surrounding soft tissue. X-rays of the pelvis show erosions and sclerosis of the sacroiliac joint. | Which of the following is the most likely pulmonary complication of this condition? | {
"A": "fibro cavitary disease",
"B": "airflow obstruction",
"C": "bilateral lower lobe involvement",
"D": "pleural effusions"
} | A. fibro cavitary disease |
bca36dc4-3800-4e58-8447-92016ca74f30 | A 56-year-old male is burned while sleeping in his home. His right upper and lower extremity and the anterior aspect of the upper chest have extensive second-degree burns.The extent of the burn is calculated to represent what percentage of body surface area?Relative Percentages of Areas Affected by GrowthAreaAge1015Adult A = half of head512412312B = half of one thigh414412434Relative Percentages of Areas Affected by GrowthAreaAge015A = half of head912812612B = half of one thigh2343144Table for estimating extent of burns. In adults, a reasonable system for calculating the percentage of body surface burned is the "rule of nines"--Each arm equals 9%, the head equals 9%, the anterior and posterior trunk each equals 18%, and each leg equals 18%; the sum of these percentages is 99% | 10% | 20% | 30% | 40% | 3d
| single | In calculating burn surface area, the rule of "9's" assigns 9% to each upper extremity, 18% to each lower extremity, and 9% to the head and neck. The trunk and abdomen (36%) is divided into four equal parts (9% each). Thus, upper trunk anteriorly would be 9%. | Surgery | Breast | 208 | {
"Correct Answer": "40%",
"Correct Option": "D",
"Options": {
"A": "10%",
"B": "20%",
"C": "30%",
"D": "40%"
},
"Question": "A 56-year-old male is burned while sleeping in his home. His right upper and lower extremity and the anterior aspect of the upper chest have extensive second-degree burns.The extent of the burn is calculated to represent what percentage of body surface area?Relative Percentages of Areas Affected by GrowthAreaAge1015Adult A = half of head512412312B = half of one thigh414412434Relative Percentages of Areas Affected by GrowthAreaAge015A = half of head912812612B = half of one thigh2343144Table for estimating extent of burns. In adults, a reasonable system for calculating the percentage of body surface burned is the \"rule of nines\"--Each arm equals 9%, the head equals 9%, the anterior and posterior trunk each equals 18%, and each leg equals 18%; the sum of these percentages is 99%"
} | A 56-year-old male is burned while sleeping in his home. His right upper and lower extremity and the anterior aspect of the upper chest have extensive second-degree burns.The extent of the burn is calculated to represent what percentage of body surface area?Relative Percentages of Areas Affected by GrowthAreaAge1015Adult A = half of head512412312B = half of one thigh414412434Relative Percentages of Areas Affected by GrowthAreaAge015A = half of head912812612B = half of one thigh2343144Table for estimating extent of burns. | In adults, a reasonable system for calculating the percentage of body surface burned is the "rule of nines"--Each arm equals 9%, the head equals 9%, the anterior and posterior trunk each equals 18%, and each leg equals 18%; the sum of these percentages is 99% | {
"A": "10%",
"B": "20%",
"C": "30%",
"D": "40%"
} | D. 40% |
9f81810c-e748-4c91-85db-0ae47f242eb9 | A 6-year-old boy develops symptoms of cough, fever, and malaise followed by a generalized maculopapular rash that has spread from the head downward. A clinical diagnosis of measles is made. A few days after the onset of the rash he is drowsy, lethargic, and complaining of headache. A lumbar puncture, electroencephalogram (EEG), and computerized tomography (CT) of the brain exclude other etiologies and confirm the diagnosis of encephalitis. Which of the following is the most likely delayed neurologic complication of measles virus encephalitis? | meningitis | pure motor paralysis | autonomic neuropathy | mental retardation or epilepsy | 3d
| single | Subacute sclerosing panencephalitis causes involuntary spasmodic movements and progressive mental deterioration, frequently ending in death within a year. It usually occurs in children whose measles occurred at an early age (= 2 years). It occurs 6-8 years after the primary infection. It presents with nonspecific symptoms such as poor school performance or mood and personality changes. It then progresses to intellectual decline, seizures, myoclonus, ataxia, and visual disturbances. Continued deterioration results in inevitable death. | Medicine | Infection | 128 | {
"Correct Answer": "mental retardation or epilepsy",
"Correct Option": "D",
"Options": {
"A": "meningitis",
"B": "pure motor paralysis",
"C": "autonomic neuropathy",
"D": "mental retardation or epilepsy"
},
"Question": "A 6-year-old boy develops symptoms of cough, fever, and malaise followed by a generalized maculopapular rash that has spread from the head downward. A clinical diagnosis of measles is made. A few days after the onset of the rash he is drowsy, lethargic, and complaining of headache. A lumbar puncture, electroencephalogram (EEG), and computerized tomography (CT) of the brain exclude other etiologies and confirm the diagnosis of encephalitis. Which of the following is the most likely delayed neurologic complication of measles virus encephalitis?"
} | A 6-year-old boy develops symptoms of cough, fever, and malaise followed by a generalized maculopapular rash that has spread from the head downward. A clinical diagnosis of measles is made. A few days after the onset of the rash he is drowsy, lethargic, and complaining of headache. A lumbar puncture, electroencephalogram (EEG), and computerized tomography (CT) of the brain exclude other etiologies and confirm the diagnosis of encephalitis. | Which of the following is the most likely delayed neurologic complication of measles virus encephalitis? | {
"A": "meningitis",
"B": "pure motor paralysis",
"C": "autonomic neuropathy",
"D": "mental retardation or epilepsy"
} | D. mental retardation or epilepsy |
c637bd2a-e508-4a1e-b610-967fda40e7e4 | A 56-year-old man presents to his internist with jaundice. The patient is receiving no medication and his only symptomatic complaint is mild fatigue over the past 2 months. Physical examination is remarkable only for the presence of scleral icterus. The patient has no significant past medical history. Analysis of serum chemistry reveals the following- SGOT : 0.58 microkat/L (35U/L) SGPT : 0.58 microkat/L (35U/L), Total bilirubin: 91.7 micron mol/L (7mg/dL) Direct Bilirubin:85.5 micron mol/L (5 mg/dL) Alkaline phosphatase : 12 micron kat/L(720 U/L) Which of the following is the next most appropriate diagnostic step? | Ultrasound | Liver biopsy | Review of peripheral blood smear | Endoscopic retrograde cholangiopan creatography (ERCP) | 0a
| multi | null | Medicine | null | 177 | {
"Correct Answer": "Ultrasound",
"Correct Option": "A",
"Options": {
"A": "Ultrasound",
"B": "Liver biopsy",
"C": "Review of peripheral blood smear",
"D": "Endoscopic retrograde cholangiopan creatography (ERCP)"
},
"Question": "A 56-year-old man presents to his internist with jaundice. The patient is receiving no medication and his only symptomatic complaint is mild fatigue over the past 2 months. Physical examination is remarkable only for the presence of scleral icterus. The patient has no significant past medical history. Analysis of serum chemistry reveals the following- SGOT : 0.58 microkat/L (35U/L) SGPT : 0.58 microkat/L (35U/L), Total bilirubin: 91.7 micron mol/L (7mg/dL) Direct Bilirubin:85.5 micron mol/L (5 mg/dL) Alkaline phosphatase : 12 micron kat/L(720 U/L) Which of the following is the next most appropriate diagnostic step?"
} | A 56-year-old man presents to his internist with jaundice. The patient is receiving no medication and his only symptomatic complaint is mild fatigue over the past 2 months. Physical examination is remarkable only for the presence of scleral icterus. The patient has no significant past medical history. | Analysis of serum chemistry reveals the following- SGOT : 0.58 microkat/L (35U/L) SGPT : 0.58 microkat/L (35U/L), Total bilirubin: 91.7 micron mol/L (7mg/dL) Direct Bilirubin:85.5 micron mol/L (5 mg/dL) Alkaline phosphatase : 12 micron kat/L(720 U/L) Which of the following is the next most appropriate diagnostic step? | {
"A": "Ultrasound",
"B": "Liver biopsy",
"C": "Review of peripheral blood smear",
"D": "Endoscopic retrograde cholangiopan creatography (ERCP)"
} | A. Ultrasound |
828dae15-180d-4a45-a9a6-deee7ea963bf | A 70 year old woman dies in a nursing home after a hea attack. The time of onset of her clinical symptomatology and the cause of death are unceain; fuhermore, the possibility of neglect is being considered. Therefore, an autopsy investigation is arranged. The forensic pathologist discovers acute thrombosis involving the posterior descending branch of the right coronary aery with resultant myocardial infarction (MI) in the posterior third of the interventricular septum. Histologically, there is coagulation necrosis with associated abundant neutrophilic infiltration. Histiocytes and lymphocytes are scanty. Which of the following is the approximate period between the onset of pain (ie, beginning of ischemic injury) and death? | 1 hour | 12 hours | 2 days | 5 days | 2c
| multi | Following irreversible ischemic injury, the hea (and any other organ) displays an orderly sequence of events that progresses from necrosis of parenchymal cells to inflammatory reaction, granulation tissue, and scar healing. Although ischemic injury manifests with pain almost immediately following vascular occlusion, histologic evidence of necrosis lags behind the clinical symptoms. At 1 hour after ischemia, there is no morphologic change indicative of necrosis. The first signs of necrosis appear 12 hours after irreversible ischemia: myocytes appear intensely eosinophilic and wavy, but there is no inflammatory reaction yet. Acute inflammatory cells (neutrophils) infiltrate the infarcted area beginning 1 day and peaking at approximately 2-3 days after injury. This acute inflammatory response paially overlaps with the subsequent influx of lymphocytes and histiocytes. Reabsorption of necrotic myofibers by histiocytes, as well as proliferation of small blood vessels, marks early formation of granulation tissue at around 5 days. Ref: Wyatt C., Kemp W.L., Moos P.J., Burns D.K., Brown T.G. (2008). Chapter 10. Cardiac Pathology. In C. Wyatt, W.L. Kemp, P.J. Moos, D.K. Burns, T.G. Brown (Eds), Pathology: The Big Picture. | Pathology | null | 154 | {
"Correct Answer": "2 days",
"Correct Option": "C",
"Options": {
"A": "1 hour",
"B": "12 hours",
"C": "2 days",
"D": "5 days"
},
"Question": "A 70 year old woman dies in a nursing home after a hea attack. The time of onset of her clinical symptomatology and the cause of death are unceain; fuhermore, the possibility of neglect is being considered. Therefore, an autopsy investigation is arranged. The forensic pathologist discovers acute thrombosis involving the posterior descending branch of the right coronary aery with resultant myocardial infarction (MI) in the posterior third of the interventricular septum. Histologically, there is coagulation necrosis with associated abundant neutrophilic infiltration. Histiocytes and lymphocytes are scanty. Which of the following is the approximate period between the onset of pain (ie, beginning of ischemic injury) and death?"
} | A 70 year old woman dies in a nursing home after a hea attack. The time of onset of her clinical symptomatology and the cause of death are unceain; fuhermore, the possibility of neglect is being considered. Therefore, an autopsy investigation is arranged. The forensic pathologist discovers acute thrombosis involving the posterior descending branch of the right coronary aery with resultant myocardial infarction (MI) in the posterior third of the interventricular septum. Histologically, there is coagulation necrosis with associated abundant neutrophilic infiltration. Histiocytes and lymphocytes are scanty. | Which of the following is the approximate period between the onset of pain (ie, beginning of ischemic injury) and death? | {
"A": "1 hour",
"B": "12 hours",
"C": "2 days",
"D": "5 days"
} | C. 2 days |
6d95db6e-e553-43ae-91d4-9a2357c60844 | An 82-year-old man presents with a 1 and a half-week history of severe pruritus and eczema. His past medical history includes atopic dermatitis, thyroid disease, and multiple sclerosis. On physical examination, he has dozens of 1-2 cm tense bullae and several erosions over his upper and lower extremities. His oral mucosa is not involved. Nikolsky sign is negative. A skin biopsy is taken and anti-BP 180 is detected in his blood. A potent topical steroid is prescribed. The most likely diagnosis is | Pemphigus vulgaris | Bullous pemphigoid | Necrotising pemphigus | Contact ezema | 1b
| single | Ans. is 'b' Bullous Pemphigoid Pemphigoid is commonly seen in old age (60-80 yrs) as bullous eruptions on lower limb. Both pemphigus and pemphigoid give bullous lesions but they differ in other characteristic. Pemphigus Pemphigoid Nikolsky sign present* Bullae are intraepidermal & flaccid* Mucosa involved* Acantholysis present* Involves upper part of body Age of involvement 40-60 yrs* Prognosis poor Nikolsky sign absent Bullae are supepidermal & tense Mucosa not involved Acantholysis absent Involved lower part of body. Age of involvement 60-80 yrs* Prognosis Good | Unknown | null | 119 | {
"Correct Answer": "Bullous pemphigoid",
"Correct Option": "B",
"Options": {
"A": "Pemphigus vulgaris",
"B": "Bullous pemphigoid",
"C": "Necrotising pemphigus",
"D": "Contact ezema"
},
"Question": "An 82-year-old man presents with a 1 and a half-week history of severe pruritus and eczema. His past medical history includes atopic dermatitis, thyroid disease, and multiple sclerosis. On physical examination, he has dozens of 1-2 cm tense bullae and several erosions over his upper and lower extremities. His oral mucosa is not involved. Nikolsky sign is negative. A skin biopsy is taken and anti-BP 180 is detected in his blood. A potent topical steroid is prescribed. The most likely diagnosis is"
} | An 82-year-old man presents with a 1 and a half-week history of severe pruritus and eczema. His past medical history includes atopic dermatitis, thyroid disease, and multiple sclerosis. On physical examination, he has dozens of 1-2 cm tense bullae and several erosions over his upper and lower extremities. His oral mucosa is not involved. Nikolsky sign is negative. A skin biopsy is taken and anti-BP 180 is detected in his blood. A potent topical steroid is prescribed. | The most likely diagnosis is | {
"A": "Pemphigus vulgaris",
"B": "Bullous pemphigoid",
"C": "Necrotising pemphigus",
"D": "Contact ezema"
} | B. Bullous pemphigoid |
Subsets and Splits