Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_92
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During a routine physical examination of a 35-year-old Asian female, you note a right adnexal fullness. She has had no symptoms of pain or bloating and has been menstruating normally. Her menses occur approximately every 30 days and her next period is expected to occur in 1 week. Pelvic ultrasonography reveals a thin-walled simple cyst 5 cm in diameter. No other abnormalities are seen in the pelvic structures. Which one of the following is the best course of management for this condition?
a) Reassurance only
b) Checking for any increase in adnexal fullness at her next annual physical examination
c) Repeat ultrasonography in 2-3 months to confirm resolution of the cyst
d) Referral for ultrasound guided aspiration of the cyst
e) Referral for laparoscopic removal of the cyst
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During a routine physical examination of a 35-year-old Asian female, you note a right adnexal fullness. She has had no symptoms of pain or bloating and has been menstruating normally. Her menses occur approximately every 30 days and her next period is expected to occur in 1 week. Pelvic ultrasonography reveals a thin-walled simple cyst 5 cm in diameter. No other abnormalities are seen in the pelvic structures. Which one of the following is the best course of management for this condition?
a) Reassurance only
b) Checking for any increase in adnexal fullness at her next annual physical examination
c) Repeat ultrasonography in 2-3 months to confirm resolution of the cyst
d) Referral for ultrasound guided aspiration of the cyst
e) Referral for laparoscopic removal of the cyst
π2
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_92 | #answer
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β C
π Explanation
Adnexal masses in women under 45 years of age are benign in 80%-85% of cases. The specific findings of this case also strongly suggest a benign etiology, namely a thin-walled, simple cyst, a lesion that is less than 8 cm in size, and a patient of relatively young age. No aggressive means are indicated in these situations unless there are significant clinical symptoms such as pain, abdominal pressure, urinary symptoms, or gastrointestinal symptoms. Most experts currently recommend a conservative approach with repeat ultrasonography in at least 2 months, during which time the vast majority of benign cysts resolve spontaneously
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β C
π Explanation
Adnexal masses in women under 45 years of age are benign in 80%-85% of cases. The specific findings of this case also strongly suggest a benign etiology, namely a thin-walled, simple cyst, a lesion that is less than 8 cm in size, and a patient of relatively young age. No aggressive means are indicated in these situations unless there are significant clinical symptoms such as pain, abdominal pressure, urinary symptoms, or gastrointestinal symptoms. Most experts currently recommend a conservative approach with repeat ultrasonography in at least 2 months, during which time the vast majority of benign cysts resolve spontaneously
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_93
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A 36-year-old member of the National Guard who has just returned from Iraq consults you because of several βboilsβ on the back of his neck that have failed to heal over the last 6 months, despite two week-long courses of cephalexin (Keflex). You observe three 1- to 2-cm raised minimally tender lesions with central ulceration and crust formation. He denies any fever or systemic symptoms.The most likely cause of these lesions is:
a) Pyogenic granuloma
b) Leishmaniasis
c) Atypical mycobacterial infection
d) Squamous cell carcinoma
e) Epidermal inclusion cysts
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A 36-year-old member of the National Guard who has just returned from Iraq consults you because of several βboilsβ on the back of his neck that have failed to heal over the last 6 months, despite two week-long courses of cephalexin (Keflex). You observe three 1- to 2-cm raised minimally tender lesions with central ulceration and crust formation. He denies any fever or systemic symptoms.The most likely cause of these lesions is:
a) Pyogenic granuloma
b) Leishmaniasis
c) Atypical mycobacterial infection
d) Squamous cell carcinoma
e) Epidermal inclusion cysts
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_93 | #answer
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β B
π Explanation
The most likely diagnosis is cutaneous leishmaniasis, caused by an intracellular parasite transmitted by the bite of small sandflies. Lesions develop gradually, and are often misdiagnosed as folliculitis or as infected epidermal inclusion cysts, but they fail to respond to usual skin antibiotics. Hundreds of cases have been diagnosed in troops returning from Iraq, most likely due to Leishmania major.Treatment is not always required, as most lesions will resolve over several months; however, scarring is frequent. Military medical facilities and the CDC are coordinating treatment when indicated with sodium stibogluconate.
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β B
π Explanation
The most likely diagnosis is cutaneous leishmaniasis, caused by an intracellular parasite transmitted by the bite of small sandflies. Lesions develop gradually, and are often misdiagnosed as folliculitis or as infected epidermal inclusion cysts, but they fail to respond to usual skin antibiotics. Hundreds of cases have been diagnosed in troops returning from Iraq, most likely due to Leishmania major.Treatment is not always required, as most lesions will resolve over several months; however, scarring is frequent. Military medical facilities and the CDC are coordinating treatment when indicated with sodium stibogluconate.
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_94
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A 90-year-old Asian female who lives in a nursing home is noted to have > 100,000 Escherichia coli on urine culture, performed because her urine βsmelled strong.β She is afebrile and is asymptomatic.
Which one of the following is most appropriate?
a) Antibiotic treatment for 3 days
b) Antibiotic treatment for 10 days
c) A repeat culture and treatment if positive
d) Foley catheter insertion
e) No treatment
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A 90-year-old Asian female who lives in a nursing home is noted to have > 100,000 Escherichia coli on urine culture, performed because her urine βsmelled strong.β She is afebrile and is asymptomatic.
Which one of the following is most appropriate?
a) Antibiotic treatment for 3 days
b) Antibiotic treatment for 10 days
c) A repeat culture and treatment if positive
d) Foley catheter insertion
e) No treatment
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_94 | #answer
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β E
π Explanation
Antibiotic treatment of nursing-home patients with asymptomatic bacteriuria is not beneficial. Chronic incontinence is not improved, subsequent episodes of symptomatic urinary tract infection are not reduced, and there is no decrease in overall mortality
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β E
π Explanation
Antibiotic treatment of nursing-home patients with asymptomatic bacteriuria is not beneficial. Chronic incontinence is not improved, subsequent episodes of symptomatic urinary tract infection are not reduced, and there is no decrease in overall mortality
π1
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_95
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A 25-year-old white male who has a poorly controlled major seizure disorder and a 6-week history of recurrent fever, anorexia, and persistent, productive coughing visits your office. On physical examination he is noted to have a temperature of 38.3Β°C (101.0Β°F), a respiratory rate of 16/min, gingival hyperplasia, and a fetid odor to his breath. Auscultation of the lungs reveals rales in the mid-portion of the right lung posteriorly. Which one of the following is most likely to be found on a chest radiograph?
a) Sarcoidosis
b) Miliary calcifications
c) A lung abscess
d) A right hilar mass
e) A right pleural effusion
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A 25-year-old white male who has a poorly controlled major seizure disorder and a 6-week history of recurrent fever, anorexia, and persistent, productive coughing visits your office. On physical examination he is noted to have a temperature of 38.3Β°C (101.0Β°F), a respiratory rate of 16/min, gingival hyperplasia, and a fetid odor to his breath. Auscultation of the lungs reveals rales in the mid-portion of the right lung posteriorly. Which one of the following is most likely to be found on a chest radiograph?
a) Sarcoidosis
b) Miliary calcifications
c) A lung abscess
d) A right hilar mass
e) A right pleural effusion
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_95 | #answer
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β C
π Explanation
Anaerobic lung abscesses are most often found in a person predisposed to aspiration who complains of a productive cough associated with fever, anorexia, and weakness. Physical examination usually reveals poor dental hygiene, a fetid odor to the breath and sputum, rales, and pulmonary findings consistent with consolidation.
β Patients who have sarcoidosis (choice A) usually do not have a productive cough and have bilateral physical findings.
β A persistent productive cough is not a striking finding in disseminated tuberculosis, which would be suggested by miliary calcifications (choice B) on a chest film.
β The clinical presentation and physical findings are not consistent with a simple mass in the right hilum (choice D) nor with a right pleural effusion (choice E).
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β C
π Explanation
Anaerobic lung abscesses are most often found in a person predisposed to aspiration who complains of a productive cough associated with fever, anorexia, and weakness. Physical examination usually reveals poor dental hygiene, a fetid odor to the breath and sputum, rales, and pulmonary findings consistent with consolidation.
β Patients who have sarcoidosis (choice A) usually do not have a productive cough and have bilateral physical findings.
β A persistent productive cough is not a striking finding in disseminated tuberculosis, which would be suggested by miliary calcifications (choice B) on a chest film.
β The clinical presentation and physical findings are not consistent with a simple mass in the right hilum (choice D) nor with a right pleural effusion (choice E).
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_96
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A 28-year-old male visits your office because he is planning a ski trip. You practice in a coastal area, and he plans to be at an altitude of 14,500 feet. On a previous ski trip to the same altitude he experienced symptoms of headache, poor sleep, anorexia, fatigue, nausea, and vomiting. He asks you what he can do to prevent these symptoms on his upcoming trip.
Which one of the following would you recommend?
a) Caffeine avoidance
b) Caffeine tablets
c) Furosemide (Lasix)
d) Acetazolamide (Diamox)
e) Fluid restriction
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A 28-year-old male visits your office because he is planning a ski trip. You practice in a coastal area, and he plans to be at an altitude of 14,500 feet. On a previous ski trip to the same altitude he experienced symptoms of headache, poor sleep, anorexia, fatigue, nausea, and vomiting. He asks you what he can do to prevent these symptoms on his upcoming trip.
Which one of the following would you recommend?
a) Caffeine avoidance
b) Caffeine tablets
c) Furosemide (Lasix)
d) Acetazolamide (Diamox)
e) Fluid restriction
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_96 | #answer
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β C
π Explanation
This patient experienced acute mountain sickness (AMS), which is the most common altitude illness. It occurs in 40%-50% of persons from low altitudes who ascend to 14,000 feet. The onset can occur within 8 to 96 hours of arrival at altitudes above 8000 feet, although the altitudes at which symptoms begin vary significantly. AMS is a clinical diagnosis, with the most common symptoms consisting of headache, poor sleep, anorexia, fatigue, nausea, and vomiting. Slow ascent is the best way to avoid AMS. Adequate hydration may be helpful. Acetazolamide and dexamethasone help prevent or mitigate the symptoms of AMS. Individuals who have had AMS in the past should probably be treated prophylactically with acetazolamide.Acetazolamide is a carbonic anhydrase inhibitor that causes a hyperchloremic metabolic acidosis through the loss of
bicarbonate, sodium, and potassium in the urine. Respiration is stimulated by the acidosis, which leads to a compensatory respiratory alkalosis. Pretreatment with this agent mimics the acclimated state of acid-base balance, so that during the first day of altitude exposure, subjects taking this drug have values for pH, partial pressure of arterial carbon dioxide, and minute ventilation that are not typically observed until day 5 in control subjects.
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β C
π Explanation
This patient experienced acute mountain sickness (AMS), which is the most common altitude illness. It occurs in 40%-50% of persons from low altitudes who ascend to 14,000 feet. The onset can occur within 8 to 96 hours of arrival at altitudes above 8000 feet, although the altitudes at which symptoms begin vary significantly. AMS is a clinical diagnosis, with the most common symptoms consisting of headache, poor sleep, anorexia, fatigue, nausea, and vomiting. Slow ascent is the best way to avoid AMS. Adequate hydration may be helpful. Acetazolamide and dexamethasone help prevent or mitigate the symptoms of AMS. Individuals who have had AMS in the past should probably be treated prophylactically with acetazolamide.Acetazolamide is a carbonic anhydrase inhibitor that causes a hyperchloremic metabolic acidosis through the loss of
bicarbonate, sodium, and potassium in the urine. Respiration is stimulated by the acidosis, which leads to a compensatory respiratory alkalosis. Pretreatment with this agent mimics the acclimated state of acid-base balance, so that during the first day of altitude exposure, subjects taking this drug have values for pH, partial pressure of arterial carbon dioxide, and minute ventilation that are not typically observed until day 5 in control subjects.
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_97
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A 68-year-old white man comes to the office because of increasing shortness of breath on exertion for the past 2 to 3 months. He has a history of hypertension for which he takes hydrochlorothiazide. On physical examination his pulse is 80/min. There's a diastolic decrescendo murmur heard best at the 3rd intercostal space on the left with the patient sitting up and leaning forward.
Further physical examination is most likely to show:
a) Bifid pulse
b) Low-amplitude pulse
c) Pulsus alternans
d) Pulsus paradoxus
e) Wide pulse pressure
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A 68-year-old white man comes to the office because of increasing shortness of breath on exertion for the past 2 to 3 months. He has a history of hypertension for which he takes hydrochlorothiazide. On physical examination his pulse is 80/min. There's a diastolic decrescendo murmur heard best at the 3rd intercostal space on the left with the patient sitting up and leaning forward.
Further physical examination is most likely to show:
a) Bifid pulse
b) Low-amplitude pulse
c) Pulsus alternans
d) Pulsus paradoxus
e) Wide pulse pressure
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_97 | #answer
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β E
π Explanation
The diastolic murmur best heard when patient leaning forward at Erb's point, located at the 3rd intercostal space on the left, is most likely to be aortic regurgitation. One of the hallmark physical findings of this valvular lesion is the presence of a wide pulse pressure (choice E) secondary to the diastolic run-off back into the ventricle. Other signs such as Quinckeβs pulse or Mussetβs sign may also be present.
β A bifid pulse (choice A) is seen with hypertrophic cardiomyopathy and is best appreciated by palpation of the carotid artery. This bifid pulse occurs as a result of no obstruction to blood flowing out from the left heart chamber in the beginning, followed by an obstruction in the middle of systole, and finally by a lessening of the obstruction at the end of systole.
β Low amplitude pulse (choice B) is seen with peripheral arteriosclerosis.
β Pulsus alternans (choice C) where one pulse feels large, the next pulse feels small, is appreciated with severe congestive heart failure.
β Pulsus paradoxus (choice D) is an exaggeration of a normally present fall is systolic blood pressure with inspiration. Normal decrease in systolic pressure should be 10 mm Hg or less but with pulsus paradoxus, it can be 15-20 mm Hg. This is most commonly seen with constrictive or restrictive diseases of the heart or pericardium.
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β E
π Explanation
The diastolic murmur best heard when patient leaning forward at Erb's point, located at the 3rd intercostal space on the left, is most likely to be aortic regurgitation. One of the hallmark physical findings of this valvular lesion is the presence of a wide pulse pressure (choice E) secondary to the diastolic run-off back into the ventricle. Other signs such as Quinckeβs pulse or Mussetβs sign may also be present.
β A bifid pulse (choice A) is seen with hypertrophic cardiomyopathy and is best appreciated by palpation of the carotid artery. This bifid pulse occurs as a result of no obstruction to blood flowing out from the left heart chamber in the beginning, followed by an obstruction in the middle of systole, and finally by a lessening of the obstruction at the end of systole.
β Low amplitude pulse (choice B) is seen with peripheral arteriosclerosis.
β Pulsus alternans (choice C) where one pulse feels large, the next pulse feels small, is appreciated with severe congestive heart failure.
β Pulsus paradoxus (choice D) is an exaggeration of a normally present fall is systolic blood pressure with inspiration. Normal decrease in systolic pressure should be 10 mm Hg or less but with pulsus paradoxus, it can be 15-20 mm Hg. This is most commonly seen with constrictive or restrictive diseases of the heart or pericardium.
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_98
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A 41-year-old man is seen for hematuria. He states that he has had this on two previous occasions, both in relation to an upper respiratory tract infection. On both previous occasions the urine cleared spontaneously over a period of five to seven days.At the time of the present visit he states that he has been feeling lethargic with a sore throat for the past five days. Blood pressure is 170/95, urine analysis shows specific gravity 1020, nitrites negative, +++ blood and +++ protein. Urine microscopy reveals oxalate crystals, dysmorphic red blood cells and red cell casts. The presence of dysmorphic red blood cells is indicative of:
a) Urine infection
b) Delay in analysis of the urine sample
c) Glomerular bleeding
d) Urothelial malignancy
e) Urinary tract calculus
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A 41-year-old man is seen for hematuria. He states that he has had this on two previous occasions, both in relation to an upper respiratory tract infection. On both previous occasions the urine cleared spontaneously over a period of five to seven days.At the time of the present visit he states that he has been feeling lethargic with a sore throat for the past five days. Blood pressure is 170/95, urine analysis shows specific gravity 1020, nitrites negative, +++ blood and +++ protein. Urine microscopy reveals oxalate crystals, dysmorphic red blood cells and red cell casts. The presence of dysmorphic red blood cells is indicative of:
a) Urine infection
b) Delay in analysis of the urine sample
c) Glomerular bleeding
d) Urothelial malignancy
e) Urinary tract calculus
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_98 | #answer
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β C
π Explanation
The presence of dysmorphic RBC's in urine suggests a renal or glomerular hematuria.This patient most likely suffers from IgA nephropathy. Two common presentations of patients with IgA nephropathy are episodic gross hematuria and persistent microscopic hematuria. Recurrent macroscopic hematuria, usually associated with an upper respiratory tract infection, or, less often, gastroenteritis is the most frequent clinical presentation and is observed in 40-50% of presenting patients. In 30-40% of patients, the disease is asymptomatic, with erythrocytes (RBCs), RBC casts, and proteinuria discovered on urinalysis. Patients with IgA nephropathy can also present with acute or chronic renal failure.
πNote: Common crystals seen even in healthy patients include calcium oxalate, triple phosphate crystals and amorphous phosphates.
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β C
π Explanation
The presence of dysmorphic RBC's in urine suggests a renal or glomerular hematuria.This patient most likely suffers from IgA nephropathy. Two common presentations of patients with IgA nephropathy are episodic gross hematuria and persistent microscopic hematuria. Recurrent macroscopic hematuria, usually associated with an upper respiratory tract infection, or, less often, gastroenteritis is the most frequent clinical presentation and is observed in 40-50% of presenting patients. In 30-40% of patients, the disease is asymptomatic, with erythrocytes (RBCs), RBC casts, and proteinuria discovered on urinalysis. Patients with IgA nephropathy can also present with acute or chronic renal failure.
πNote: Common crystals seen even in healthy patients include calcium oxalate, triple phosphate crystals and amorphous phosphates.
π1
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_99
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A 19-year-old female high-school student is brought to your office by a friend who is concerned about the patient having cut her wrists. The patient denies that she was trying to kill herself, and states that she did this because she βjust got so angryβ at her boyfriend when she caught him sending a text message to another woman. She denies having a depressed mood or anhedonia, and blames her fluctuating mood on everyone who βkeeps abandoning her,β making her feel like sheβs βnothing.β She admits that she has difficulty controlling her anger. Her sleep quality and pattern appear normal, as does her appetite. She denies hallucinations or delusions. The wounds on her wrists appear superficial and there is evidence of previous cutting behavior on her forearms. Her vital signs are stable.Which one of the following would be most beneficial for this patient?
a) Clonazepam
b) Fluoxetine
c) Quetiapine
d) Inpatient psychiatric admission
e) Psychotherapy
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A 19-year-old female high-school student is brought to your office by a friend who is concerned about the patient having cut her wrists. The patient denies that she was trying to kill herself, and states that she did this because she βjust got so angryβ at her boyfriend when she caught him sending a text message to another woman. She denies having a depressed mood or anhedonia, and blames her fluctuating mood on everyone who βkeeps abandoning her,β making her feel like sheβs βnothing.β She admits that she has difficulty controlling her anger. Her sleep quality and pattern appear normal, as does her appetite. She denies hallucinations or delusions. The wounds on her wrists appear superficial and there is evidence of previous cutting behavior on her forearms. Her vital signs are stable.Which one of the following would be most beneficial for this patient?
a) Clonazepam
b) Fluoxetine
c) Quetiapine
d) Inpatient psychiatric admission
e) Psychotherapy
β€1
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_99 | #answer
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β E
π Explanation
This patient displays most of the criteria for borderline personality disorder. This is a maladaptive personality type that is present from a young age, with a strong genetic predisposition. It is estimated to be present in 1% of the general population and involves equal numbers of men and women; women seek care more often, however, leading to a disproportionate number of women being identified by medical providers.Borderline personality disorder is defined by high emotional lability, intense anger, unstable relationships, frantic efforts to avoid a feeling of abandonment, and an internal sense of emptiness. Nearly every patient with this disorder engages in self-injurious behavior (cutting, suicidal gestures and attempts), and about 1 in 10 patients eventually succeeds in committing suicide. However, 90% of patients improve despite having made numerous suicide threats. Suicidal gestures and attempts peak when patients are in their early 20s, but completed suicide is most common after age 30 and usually occurs in patients who fail to recover after many attempts at treatment. In contrast, suicidal actions such as impulsive overdoses or superficial cutting, most often seen in younger patients, do not usually carry a high short-term risk, and serve to communicate distress.
Inpatient hospitalization may be an appropriate treatment option if the person is experiencing extreme difficulties in living and daily functioning, and pharmacotherapy may offer a mild degree of symptom relief. While these modalities have a role in certain patients, psychotherapy is considered the mainstay of therapy, especially in a relatively stable patient such as the one described
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β E
π Explanation
This patient displays most of the criteria for borderline personality disorder. This is a maladaptive personality type that is present from a young age, with a strong genetic predisposition. It is estimated to be present in 1% of the general population and involves equal numbers of men and women; women seek care more often, however, leading to a disproportionate number of women being identified by medical providers.Borderline personality disorder is defined by high emotional lability, intense anger, unstable relationships, frantic efforts to avoid a feeling of abandonment, and an internal sense of emptiness. Nearly every patient with this disorder engages in self-injurious behavior (cutting, suicidal gestures and attempts), and about 1 in 10 patients eventually succeeds in committing suicide. However, 90% of patients improve despite having made numerous suicide threats. Suicidal gestures and attempts peak when patients are in their early 20s, but completed suicide is most common after age 30 and usually occurs in patients who fail to recover after many attempts at treatment. In contrast, suicidal actions such as impulsive overdoses or superficial cutting, most often seen in younger patients, do not usually carry a high short-term risk, and serve to communicate distress.
Inpatient hospitalization may be an appropriate treatment option if the person is experiencing extreme difficulties in living and daily functioning, and pharmacotherapy may offer a mild degree of symptom relief. While these modalities have a role in certain patients, psychotherapy is considered the mainstay of therapy, especially in a relatively stable patient such as the one described
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_100
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A 24-year-old white female in her first trimester of pregnancy presents with low-grade fever, myalgias, headache, and a rash consistent with erythema migrans. Ten days ago she was hiking in an area where deer ticks are present. She remembers being bitten by a tick which she discovered and removed 2 days after her hike. Which one of the following is the most appropriate treatment option?
a) Amoxicillin
b) Azithromycin
c) Doxycycline
d) Erythromycin
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A 24-year-old white female in her first trimester of pregnancy presents with low-grade fever, myalgias, headache, and a rash consistent with erythema migrans. Ten days ago she was hiking in an area where deer ticks are present. She remembers being bitten by a tick which she discovered and removed 2 days after her hike. Which one of the following is the most appropriate treatment option?
a) Amoxicillin
b) Azithromycin
c) Doxycycline
d) Erythromycin
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_100 | #answer
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β A
π Explanation
Amoxicillin is preferred for the treatment of Lyme disease in children, as well as for pregnant or lactating women. Doxycycline is effective, but should not be used in pregnant women. Macrolides are not considered first-line agents because controlled trails of azithromycin or erythromycin in patients with erthema migrans found a high rate of clinical failure.
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β A
π Explanation
Amoxicillin is preferred for the treatment of Lyme disease in children, as well as for pregnant or lactating women. Doxycycline is effective, but should not be used in pregnant women. Macrolides are not considered first-line agents because controlled trails of azithromycin or erythromycin in patients with erthema migrans found a high rate of clinical failure.
π1
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_101
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A 35-year-old woman presents to your office. She and her 32-year-old husband have been unsuccessful in their attempts to get pregnant for the last 6 years. He has fathered two children in a prior marriage and has a normal semen analysis. Her basal body temperature chart is biphasic. Her past history notes multiple episodes of chlamydia and gonorrhea. A hysterosalpingogram demonstrates blocked fallopian tubes bilaterally, and a laparoscope notes dense and profuse peritubal and pelvic adhesions, along with bilateral clubbed tubes. The most appropriate fertility treatment would be:
a) Intrauterine insemination with husbandβs sperm (IUI)
b) Intracytoplasmic sperm injection with husbandβs sperm (ICSI)
c) Gonadotropin induction of ovulation
d) In vitro fertilization (IVF)
e) Gamete intrafallopian transfer (GIFT
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A 35-year-old woman presents to your office. She and her 32-year-old husband have been unsuccessful in their attempts to get pregnant for the last 6 years. He has fathered two children in a prior marriage and has a normal semen analysis. Her basal body temperature chart is biphasic. Her past history notes multiple episodes of chlamydia and gonorrhea. A hysterosalpingogram demonstrates blocked fallopian tubes bilaterally, and a laparoscope notes dense and profuse peritubal and pelvic adhesions, along with bilateral clubbed tubes. The most appropriate fertility treatment would be:
a) Intrauterine insemination with husbandβs sperm (IUI)
b) Intracytoplasmic sperm injection with husbandβs sperm (ICSI)
c) Gonadotropin induction of ovulation
d) In vitro fertilization (IVF)
e) Gamete intrafallopian transfer (GIFT
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_101 | #answer
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β D
π Explanation
With extensive tubal disease on both the HSG and laparoscopy, operative assistance will be needed in order for an egg to reach the uterine cavity. Due to the tubal disease, GIFT is not possible. ICSI is the treatment of choice for azoospermia and severe oligospermia. The patient is ovulatory based on her basal body temperature chart, so ovulation induction alone is not necessary. IVF with transcervical transfer of the embryo is the optimal treatment for this couple. With blastocyst transfer, the current success rates are above 50%.
β The two tests of tubal function both demonstrate that it is highly unlikely for the egg to successfully transport down the tube. Thus, IUI will be of no benefit, since the sperm and egg will not meet.
β ICSI is used for oligospermic and even some azospermic males to achieve fertilization.
β Again, ovulation induction alone will not be successful if the tubes are blocked bilaterally.
β This technique can only be used if there is tubal patency. The egg and sperm mixture is placed in the distal fallopian tube via laparoscopy. The tubes here are blocked
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β D
π Explanation
With extensive tubal disease on both the HSG and laparoscopy, operative assistance will be needed in order for an egg to reach the uterine cavity. Due to the tubal disease, GIFT is not possible. ICSI is the treatment of choice for azoospermia and severe oligospermia. The patient is ovulatory based on her basal body temperature chart, so ovulation induction alone is not necessary. IVF with transcervical transfer of the embryo is the optimal treatment for this couple. With blastocyst transfer, the current success rates are above 50%.
β The two tests of tubal function both demonstrate that it is highly unlikely for the egg to successfully transport down the tube. Thus, IUI will be of no benefit, since the sperm and egg will not meet.
β ICSI is used for oligospermic and even some azospermic males to achieve fertilization.
β Again, ovulation induction alone will not be successful if the tubes are blocked bilaterally.
β This technique can only be used if there is tubal patency. The egg and sperm mixture is placed in the distal fallopian tube via laparoscopy. The tubes here are blocked
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_102
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While playing basketball, a 29-year-old male falls on his outstretched hand with his wrist fully extended. He sees you the following day because of diffuse wrist pain and decreased range of motion. The point of maximal tenderness is on the dorsal aspect of the wrist between the extensor pollicis brevis and extensor pollicis longus tendons. There is no visible deformity. Radiographs show no fracture.Which one of the following is the most appropriate initial treatment of this patient?
a) A wrist extension splint
b) An ulnar gutter splint
c) A thumb spica splint
d) A short arm cast
e) Physical therapy
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While playing basketball, a 29-year-old male falls on his outstretched hand with his wrist fully extended. He sees you the following day because of diffuse wrist pain and decreased range of motion. The point of maximal tenderness is on the dorsal aspect of the wrist between the extensor pollicis brevis and extensor pollicis longus tendons. There is no visible deformity. Radiographs show no fracture.Which one of the following is the most appropriate initial treatment of this patient?
a) A wrist extension splint
b) An ulnar gutter splint
c) A thumb spica splint
d) A short arm cast
e) Physical therapy
π1