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
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_102 | #answer
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β C
π Explanation
The scenario described is suspicious for an occult fracture of the scaphoid bone of the wrist. The mechanism of injury, falling on an outstretched hand with the wrist extended, combined with tenderness in the anatomic snuff box (between the extensor pollicis longus and extensor pollicis brevis tendons) raises the possibility of a scaphoid fracture even if initial radiographs are negative. In order to reduce the potential for serious complications, including vascular necrosis and non-union, it is imperative that both the wrist and the thumb be immobilized. In the case described, a thumb spica splint is the best option initially. It should be worn continuously until a follow-up evaluation, including radiographs, in 1-2 weeks.
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β C
π Explanation
The scenario described is suspicious for an occult fracture of the scaphoid bone of the wrist. The mechanism of injury, falling on an outstretched hand with the wrist extended, combined with tenderness in the anatomic snuff box (between the extensor pollicis longus and extensor pollicis brevis tendons) raises the possibility of a scaphoid fracture even if initial radiographs are negative. In order to reduce the potential for serious complications, including vascular necrosis and non-union, it is imperative that both the wrist and the thumb be immobilized. In the case described, a thumb spica splint is the best option initially. It should be worn continuously until a follow-up evaluation, including radiographs, in 1-2 weeks.
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_103
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A 3-year-old male is carried into the office by his mother. Yesterday evening he began complaining of pain around his right hip. Today he has a temperature of 37.6Β°C(99.7Β°F), cries when bearing weight on his right leg, and will not allow the leg to be moved in any direction. A radiograph of the hip is normal.Which one of the following would be most appropriate at this time?
a) A CBC and an erythrocyte sedimentation rate
b) A serum antinuclear antibody level
c) Ultrasonography of the hip
d) MRI of the hip
e) In-office aspiration of the hip
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A 3-year-old male is carried into the office by his mother. Yesterday evening he began complaining of pain around his right hip. Today he has a temperature of 37.6Β°C(99.7Β°F), cries when bearing weight on his right leg, and will not allow the leg to be moved in any direction. A radiograph of the hip is normal.Which one of the following would be most appropriate at this time?
a) A CBC and an erythrocyte sedimentation rate
b) A serum antinuclear antibody level
c) Ultrasonography of the hip
d) MRI of the hip
e) In-office aspiration of the hip
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_103 | #answer
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β A
π Explanation
This presentation is typical of either transient synovitis or septic arthritis of the hip. Because the conditions have very different treatment regimens and outcomes, it is important to differentiate the two. It is recommended that after plain films, the first studies to be performed should be a CBC and an erythrocyte sedimentation rate (ESR). Studies have shown that septic arthritis should be considered highly likely in a child who has a fever over 38.7 degrees C (101.7 degrees F), refuses to bear weight on the leg, has a WBC count 3 > 12^9/L, and has an ESR > 40 mm/hr. If several or all of these conditions exist, aspiration of the hip guided by ultrasonography or fluoroscopy should be performed by an experienced practitioner. MRI may be helpful in cases that are unclear based on standard data, or if other etiologies need to be excluded
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β A
π Explanation
This presentation is typical of either transient synovitis or septic arthritis of the hip. Because the conditions have very different treatment regimens and outcomes, it is important to differentiate the two. It is recommended that after plain films, the first studies to be performed should be a CBC and an erythrocyte sedimentation rate (ESR). Studies have shown that septic arthritis should be considered highly likely in a child who has a fever over 38.7 degrees C (101.7 degrees F), refuses to bear weight on the leg, has a WBC count 3 > 12^9/L, and has an ESR > 40 mm/hr. If several or all of these conditions exist, aspiration of the hip guided by ultrasonography or fluoroscopy should be performed by an experienced practitioner. MRI may be helpful in cases that are unclear based on standard data, or if other etiologies need to be excluded
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_104
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During a preparticipation examination of a 5-year-old male for summer soccer camp, his mother states that he frequently awakens during the night with complaints of cramping pain in both legs, and that he seems to experience this after a day of heavy physical activity. She says that he appears to drag his legs at times, but she has never noticed a definite limp. A physical examination of the hips, knees, ankles, and leg musculature is entirely normal.Which one of the following would be the most appropriate next step in the evaluation and management of this patient?
a) Plain films of both hips and knees
b) Serum electrolyte levels
c) Recommending that he not participate in running sports
d) Reassurance, with no activity restrictions or treatment
e) Referral to a pediatric orthopedist
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During a preparticipation examination of a 5-year-old male for summer soccer camp, his mother states that he frequently awakens during the night with complaints of cramping pain in both legs, and that he seems to experience this after a day of heavy physical activity. She says that he appears to drag his legs at times, but she has never noticed a definite limp. A physical examination of the hips, knees, ankles, and leg musculature is entirely normal.Which one of the following would be the most appropriate next step in the evaluation and management of this patient?
a) Plain films of both hips and knees
b) Serum electrolyte levels
c) Recommending that he not participate in running sports
d) Reassurance, with no activity restrictions or treatment
e) Referral to a pediatric orthopedist
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_104 | #answer
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β D
π Explanation
Benign nocturnal limb pains of childhood (growing pains) occur in as many as one-third of children, most often between 4 and 6 years of age. The etiology is unknown, but the course does not parallel pubescent growth, as would be expected if bone growth was the source of pain. The pain often awakens the child within hours of falling asleep following an active day. The pain is generally localized around the knees, most often in the shins and calves, but also may affect the thighs and the upper extremities. A characteristic history coupled with a normal physical examination will confirm the diagnosis. Reassurance that no additional tests or treatments are necessary and that the condition is self-limiting is the most appropriate response.
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β D
π Explanation
Benign nocturnal limb pains of childhood (growing pains) occur in as many as one-third of children, most often between 4 and 6 years of age. The etiology is unknown, but the course does not parallel pubescent growth, as would be expected if bone growth was the source of pain. The pain often awakens the child within hours of falling asleep following an active day. The pain is generally localized around the knees, most often in the shins and calves, but also may affect the thighs and the upper extremities. A characteristic history coupled with a normal physical examination will confirm the diagnosis. Reassurance that no additional tests or treatments are necessary and that the condition is self-limiting is the most appropriate response.
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_105
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A 75-year-old male complains of pain with defecation, and loose stools. This problem seems to have developed gradually over the last several months. His past medical history includes prostate cancer treated with radiation therapy 5 years ago, hypertension, and osteoarthritis. Medications include hydrochlorothiazide (HydroDIURIL), a Beta-blocker, and acetaminophen. On colonoscopy, no polyps or cancer are found, but the rectal and sigmoid areas show pallor with friability and telangiectasias.The most likely diagnosis is:
a) Familial angiodysplasia
b) Osler-Weber-Rendu syndrome
c) Radiation proctitis
d) Late-onset ulcerative colitis
e) Sensitivity to acetaminophen breakdown products
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A 75-year-old male complains of pain with defecation, and loose stools. This problem seems to have developed gradually over the last several months. His past medical history includes prostate cancer treated with radiation therapy 5 years ago, hypertension, and osteoarthritis. Medications include hydrochlorothiazide (HydroDIURIL), a Beta-blocker, and acetaminophen. On colonoscopy, no polyps or cancer are found, but the rectal and sigmoid areas show pallor with friability and telangiectasias.The most likely diagnosis is:
a) Familial angiodysplasia
b) Osler-Weber-Rendu syndrome
c) Radiation proctitis
d) Late-onset ulcerative colitis
e) Sensitivity to acetaminophen breakdown products
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_105 | #answer
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β C
π Explanation
Chronic radiation proctitis develops months to years after radiation and is characterized by pain with defecation, diarrhea, and sometimes rectal bleeding. On colonoscopy, the mucosa is pale and friable with telangiectases which are sometimes large, multiple, and serpiginous
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β C
π Explanation
Chronic radiation proctitis develops months to years after radiation and is characterized by pain with defecation, diarrhea, and sometimes rectal bleeding. On colonoscopy, the mucosa is pale and friable with telangiectases which are sometimes large, multiple, and serpiginous
π1
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_106
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A 39-year-old white male is seen in your office with a history of sudden painful swelling of the right parotid gland. He also reports occasional foul taste in the mouth. The patient has a temperature of 38.2Β°C (100.8Β°F). The parotid gland is tender on examination. Which one of the following would be most appropriate at this point?
a) Observation only
b) Asking about pets in the household
c) Tuberculin test
d) A CT scan
e) Antibiotics
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A 39-year-old white male is seen in your office with a history of sudden painful swelling of the right parotid gland. He also reports occasional foul taste in the mouth. The patient has a temperature of 38.2Β°C (100.8Β°F). The parotid gland is tender on examination. Which one of the following would be most appropriate at this point?
a) Observation only
b) Asking about pets in the household
c) Tuberculin test
d) A CT scan
e) Antibiotics
π1