Heroin addict want to start a program to eliminate the addiction, which drug would you choose ?
A- Naloxone
B- Methadone
Abdulrahman: The answer is B. Pharmacologic therapy for heroin addiction focuses on ameliorating withdrawal symptoms and reducing cravings. Methadone (long-acting) maintenance therapy has been the standard of care for more than 30 years. Naloxone (short-acting) is an antidote that is used in intoxication. Methadone, a long-acting opioid agonist, binds to and occupies mu-opioid receptors, preventing withdrawal symptoms for 24 hours or longer, reduces craving for opioids, and, by maintaining high levels of opioid tolerance, reduces the euphoric effects of subsequent illicit opioid use.
A- Naloxone
B- Methadone
Abdulrahman: The answer is B. Pharmacologic therapy for heroin addiction focuses on ameliorating withdrawal symptoms and reducing cravings. Methadone (long-acting) maintenance therapy has been the standard of care for more than 30 years. Naloxone (short-acting) is an antidote that is used in intoxication. Methadone, a long-acting opioid agonist, binds to and occupies mu-opioid receptors, preventing withdrawal symptoms for 24 hours or longer, reduces craving for opioids, and, by maintaining high levels of opioid tolerance, reduces the euphoric effects of subsequent illicit opioid use.
During the influenza season, the supply of recombinant influenza vaccine (RIV4) is limited. Who gets the priority of receiving the vaccine?
A) School children
B) Pregnant woman
C) Isolated hypertension adults
D) Iron deficiency anemia children
Abdulrahman: The answer is B according to the CDC. Williams + UTD: Vaccinate all women who will be pregnant during flu season. Vaccinate high-risk women prior to flu season. They all should receive the inactivated influenza vaccine as soon as it becomes available and before onset of influenza activity in the community, regardless of their stage of pregnancy. CDC: Emphasis should be placed on targeting vaccines to high-risk groups. Those groups include:
- Healthy children aged 6 to 23 months
- People 65 years and older
- Pregnant women in their second or third trimester during the flu season
- Anyone 2 years or older who has a chronic health condition.
A) School children
B) Pregnant woman
C) Isolated hypertension adults
D) Iron deficiency anemia children
Abdulrahman: The answer is B according to the CDC. Williams + UTD: Vaccinate all women who will be pregnant during flu season. Vaccinate high-risk women prior to flu season. They all should receive the inactivated influenza vaccine as soon as it becomes available and before onset of influenza activity in the community, regardless of their stage of pregnancy. CDC: Emphasis should be placed on targeting vaccines to high-risk groups. Those groups include:
- Healthy children aged 6 to 23 months
- People 65 years and older
- Pregnant women in their second or third trimester during the flu season
- Anyone 2 years or older who has a chronic health condition.
A 47 year old male with 12 hour pain in first metatarsal joint with swelling and tenderness. Temperate 38 C. Cause of Presentation?
A) Disseminated Gonococcus
B) Staphylococcus Aureus
C) Monosodium Urate Crystals
D) Calcium Pyrophosphate Crystals
Abdulrahman: This question is very vague, since both infection and gout can cause fever. We cannot differentiate between septic arthritis and gout without arthrocentesis. Although in this case, the hint is that the location of the pain (first metatarsal joint). I would go with C. Here’s a table that will help you distinguish Gout (Choice C) from pseudogout (D) in the full question.
A) Disseminated Gonococcus
B) Staphylococcus Aureus
C) Monosodium Urate Crystals
D) Calcium Pyrophosphate Crystals
Abdulrahman: This question is very vague, since both infection and gout can cause fever. We cannot differentiate between septic arthritis and gout without arthrocentesis. Although in this case, the hint is that the location of the pain (first metatarsal joint). I would go with C. Here’s a table that will help you distinguish Gout (Choice C) from pseudogout (D) in the full question.
A 25 year old primigravida at 36 weeks gestation presented with feeling fatigue and unwell. She shortly developed shortness of breath and died. What is the likely cause of her presentation?
A) Amniotic Fluid Embolism
B) Peripartum Cardiomyopathy
Abdulrahman: The signs and symptoms here are vague, since both AFE and PPM both can cause shortness of breath and sudden death. You can check the differences between the two entities and decide when the full question comes in the exam:
A) Amniotic Fluid Embolism
B) Peripartum Cardiomyopathy
Abdulrahman: The signs and symptoms here are vague, since both AFE and PPM both can cause shortness of breath and sudden death. You can check the differences between the two entities and decide when the full question comes in the exam:
Another question: 20 pregnant primigravida female 24 week gestation , suddenly developed SOB and CXR shows enlarge heat , she died despite intensive mx Cause?
A⁃ MI
B⁃ IHD
C⁃ VHD
D ⁃ Peripartum cardiomyopathy
Abdulrahman: D
Another recall: 20 years old primigravida 31 week presented to ED with fatigue and tiredness, patient admitted to the hospital and suddenly developed SOB and died .X-ray: show increases cardiac shadow What is the cause?
A. Peripartum cardiomyopathy
B. Amniotic fluid embolism
C. Pulmonary embolism
Abdulrahman: A
A⁃ MI
B⁃ IHD
C⁃ VHD
D ⁃ Peripartum cardiomyopathy
Abdulrahman: D
Another recall: 20 years old primigravida 31 week presented to ED with fatigue and tiredness, patient admitted to the hospital and suddenly developed SOB and died .X-ray: show increases cardiac shadow What is the cause?
A. Peripartum cardiomyopathy
B. Amniotic fluid embolism
C. Pulmonary embolism
Abdulrahman: A
A 13 year old boy medically free presented with neck swelling. One of the relatives recently diagnosed with lymphoma and the family is worried about their child. Which of the following is an indication for lymph node biopsy?
A- Absence of fever
B- Presence of Hepatosplenomegaly
C- Lymph node size > 1cm
D- Tender and hot lymph node
Abdulrahman: I would go with B, since the lymph node size in most textbooks mention that the lymph node size in children should be larger than 2 cm to be considered abnormal and are predictive of granulomatous diseases (i.e., tuberculosis, cat-scratch disease or sarcoidosis) or cancer (predominantly lymphomas). Absence of fever and tender/hot lymph nodes are not red flags for malignancy.
Taghreed: UTD: "Early" excisional biopsy refers to biopsy when the child is initially seen at a referral center. Early excisional biopsy is indicated for children with worrisome features:
A- Absence of fever
B- Presence of Hepatosplenomegaly
C- Lymph node size > 1cm
D- Tender and hot lymph node
Abdulrahman: I would go with B, since the lymph node size in most textbooks mention that the lymph node size in children should be larger than 2 cm to be considered abnormal and are predictive of granulomatous diseases (i.e., tuberculosis, cat-scratch disease or sarcoidosis) or cancer (predominantly lymphomas). Absence of fever and tender/hot lymph nodes are not red flags for malignancy.
Taghreed: UTD: "Early" excisional biopsy refers to biopsy when the child is initially seen at a referral center. Early excisional biopsy is indicated for children with worrisome features:
A 28 year old female presented following radiation of neck with neck swelling. Ultrasound showed swelling in the left lobe of the thyroid of 3x4cm of papillary thyroid cancer. Which of the following is the best management?
A- Left Lobectomy
B- Left Lobectomy with Isthmusectomy
C- Subtotal Thyroidectomy
D- Total Thyroidectomy
Abdulrahman: The answer is D due to the history of radiation.
A- Left Lobectomy
B- Left Lobectomy with Isthmusectomy
C- Subtotal Thyroidectomy
D- Total Thyroidectomy
Abdulrahman: The answer is D due to the history of radiation.
An 8 year old girl with persistent and continuous diarrhea, she drinks 3 pints of goat milk per day and is a fussy eater. Which of the following conditions explain her presentation?
Labs: Hb Low, MCV Low and MCHC High
A- Physiologic Deprivation
B- Giardiasis Parasitic Infection
C- Aplastic Anaemia
D- Hypothyroidism
Abdulrahman: This is a difficult question and is missing important info. I think there is something wrong in the given labs. Dr. Safdar’s answer is A. Consuming too much dairy which can cause diarrhea, even if the patient is not lactose intolerant. Drinking a lot of goat milk can cause folate deficiency (high MCV). Let’s exclude:
Labs: Hb Low, MCV Low and MCHC High
A- Physiologic Deprivation
B- Giardiasis Parasitic Infection
C- Aplastic Anaemia
D- Hypothyroidism
Abdulrahman: This is a difficult question and is missing important info. I think there is something wrong in the given labs. Dr. Safdar’s answer is A. Consuming too much dairy which can cause diarrhea, even if the patient is not lactose intolerant. Drinking a lot of goat milk can cause folate deficiency (high MCV). Let’s exclude:
A 33 year old female G5P3L2, breastfeeding her 5 months old child, presented to the antenatal clinic with a positive pregnancy test, patient does not know her last menstrual period. Which of the following represents an accurate measurement of the gestational age?
A- Transvaginal ultrasound as soon as possible during the first trimester
B- Abdominal ultrasound during 18 weeks of gestation
C- Maternal perception of fetal size
Abdulrahman: The answer is A. Ultrasound measurement of the embryo or fetus in the first trimester (up to 14 weeks) is the most accurate method to establish or confirm gestational age.
Measurement of the crown–rump length (CRL) has an accuracy of ±5–7 days.
A- Transvaginal ultrasound as soon as possible during the first trimester
B- Abdominal ultrasound during 18 weeks of gestation
C- Maternal perception of fetal size
Abdulrahman: The answer is A. Ultrasound measurement of the embryo or fetus in the first trimester (up to 14 weeks) is the most accurate method to establish or confirm gestational age.
Measurement of the crown–rump length (CRL) has an accuracy of ±5–7 days.
A 33 year old female G5P3L2, breastfeeding her 5 months old child, presented to the antenatal clinic with a positive pregnancy test, patient does not know her last menstrual period. Which of the following represents an accurate measurement of the gestational age?
A- Transvaginal ultrasound as soon as possible during the first trimester
B- Abdominal ultrasound during 18 weeks of gestation
C- Maternal perception of fetal size
Abdulrahman: The answer is A. Ultrasound measurement of the embryo or fetus in the first trimester (up to 14 weeks) is the most accurate method to establish or confirm gestational age.
Measurement of the crown–rump length (CRL) has an accuracy of ±5–7 days.
A- Transvaginal ultrasound as soon as possible during the first trimester
B- Abdominal ultrasound during 18 weeks of gestation
C- Maternal perception of fetal size
Abdulrahman: The answer is A. Ultrasound measurement of the embryo or fetus in the first trimester (up to 14 weeks) is the most accurate method to establish or confirm gestational age.
Measurement of the crown–rump length (CRL) has an accuracy of ±5–7 days.
8 YO female presents to the clinic after finding of hilar lymphadenopathy on
CXR. She has on and off cough, but denies any fever, headache, n/v, weight loss all negative. Labs insignificant except for hypercalcemia X-ray shows confirmed bilateral hilar lymphadenopathy CT guided biopsy shows noncaseating granuloma What is the best next step in management
A- Observe
B- Start prednisolone
C- Start azithromycin
D- Start anti TB medication
Abdulrahman: This is a case of sarcoidosis stage I. It is quite a controversial topic as to when to start management. I will go B, because the patient has an on-off cough and has hypercalcemia. Other people might suggest observation only.
CXR. She has on and off cough, but denies any fever, headache, n/v, weight loss all negative. Labs insignificant except for hypercalcemia X-ray shows confirmed bilateral hilar lymphadenopathy CT guided biopsy shows noncaseating granuloma What is the best next step in management
A- Observe
B- Start prednisolone
C- Start azithromycin
D- Start anti TB medication
Abdulrahman: This is a case of sarcoidosis stage I. It is quite a controversial topic as to when to start management. I will go B, because the patient has an on-off cough and has hypercalcemia. Other people might suggest observation only.
5 y/o boy one testicles undescended. What is the most appropriate management?
A- Orchidectomy
B- Orchidopexy
C- Wait till puberty
Abdulrahman: This is also a controversial topic as to do either orchidectomy or orchidopexy. Some references have the cut-off at 2 years of age due to the high-risk of finding an atrophic testicle and risk of oligospermia, azoospermia, torsion, or even malignancy. Orchidopexy decreases the risk of torsion and blunt trauma to testicle. Based on this, I would go with B, unless the testicle is atrophied. Dr. Thawab also agrees with this answer:
A- Orchidectomy
B- Orchidopexy
C- Wait till puberty
Abdulrahman: This is also a controversial topic as to do either orchidectomy or orchidopexy. Some references have the cut-off at 2 years of age due to the high-risk of finding an atrophic testicle and risk of oligospermia, azoospermia, torsion, or even malignancy. Orchidopexy decreases the risk of torsion and blunt trauma to testicle. Based on this, I would go with B, unless the testicle is atrophied. Dr. Thawab also agrees with this answer:
Case of rheumatoid arthritis compliance on Methotrexate, improved and stable for years without attack, the LFT abnormal, what will you do?
A- Stop MTX
B- Adalimumab
Abdulrahman: The patient is stable for years but is having elevated LFT levels. Methotrexate has been known to cause hepatotoxicity as compared to adalimumab. The answer depends on the LFT levels. According to UTD:
- If the patient is 3-5 or more the upper normal limit, hold MTX and repeat the LFT after 2 weeks. If still high, look for other causes. If the LFTs are decreasing, reduce the dose of MTX.
- If the patient LFT high but 2x or less of the upper normal level, continue the dose and repeat after 2 weeks. if still high, reduce the dose.
A- Stop MTX
B- Adalimumab
Abdulrahman: The patient is stable for years but is having elevated LFT levels. Methotrexate has been known to cause hepatotoxicity as compared to adalimumab. The answer depends on the LFT levels. According to UTD:
- If the patient is 3-5 or more the upper normal limit, hold MTX and repeat the LFT after 2 weeks. If still high, look for other causes. If the LFTs are decreasing, reduce the dose of MTX.
- If the patient LFT high but 2x or less of the upper normal level, continue the dose and repeat after 2 weeks. if still high, reduce the dose.
A 43 year old male while awaiting in the waiting room in clinic felt drowsy and was found hypoglycemic. What would you do in this scenario?
A- Grape Fruit Juice
B- 5% Dextrose Intravenous
C- Normal Saline
D- Intravenous Glucagon
Abdulrahman: The answer is most likely D. Since he is in the hospital, you must give something quickly to replenish his blood sugar level. Grapefruit has a low-glycemic index and may not raise the sugar enough as compared to other types of juices or sugary drinks. 5% dextrose IV is used for maintenance (not to correct the hypoglycemia acutely). Normal saline will not do anything. IM and IV glucagon injection are an emergency choice when patients have passed out or cannot take some form of sugar by mouth.
A- Grape Fruit Juice
B- 5% Dextrose Intravenous
C- Normal Saline
D- Intravenous Glucagon
Abdulrahman: The answer is most likely D. Since he is in the hospital, you must give something quickly to replenish his blood sugar level. Grapefruit has a low-glycemic index and may not raise the sugar enough as compared to other types of juices or sugary drinks. 5% dextrose IV is used for maintenance (not to correct the hypoglycemia acutely). Normal saline will not do anything. IM and IV glucagon injection are an emergency choice when patients have passed out or cannot take some form of sugar by mouth.