Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_111
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A 35-year-old who was injured at his work site presents to your department with a minor wound that got dirty. The patient has no symptoms other than the bleeding he had after the injury and the pain he feels at the site of injury. He was previously healthy and has had regular check-ups and appropriate immunizations. His last tetanus booster was 7 years ago. Which of the following is the most appropriate course of action?
a) Give tetanus immune globulin (TIG)
b) Give tetanus toxoid alone
c) Give both TIG and tetanus toxoid
d) Clean the wound and give amoxicillin
e) Clean wound and monitor for symptoms
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A 35-year-old who was injured at his work site presents to your department with a minor wound that got dirty. The patient has no symptoms other than the bleeding he had after the injury and the pain he feels at the site of injury. He was previously healthy and has had regular check-ups and appropriate immunizations. His last tetanus booster was 7 years ago. Which of the following is the most appropriate course of action?
a) Give tetanus immune globulin (TIG)
b) Give tetanus toxoid alone
c) Give both TIG and tetanus toxoid
d) Clean the wound and give amoxicillin
e) Clean wound and monitor for symptoms
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_111 | #answer
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β B
π Explanation
Since this patientβs wound is dirty, it would be inappropriate to fail taking prophylactic measures against tetanus, therefore choices D and E that do not include tetanus prophylaxis are incorrect. If the patient has already received tetanus booster in the last 5 years, usually the vaccine is not needed. Since this patient was last administered the tetanus toxoid 7 years ago, he
should receive a shot of tetanus toxoid today (choice B).
β Tetanus immune globulin (TIG) alone would not be enough prophylaxis in this patient.
β Tetanus immune globulin and tetanus toxoid (choice C) would be appropriate in a patient who has not received a booster in the last 10 years.
π Key point:
For dirty wounds, tetanus prophylaxis should be considered as follows: If the patient has not received the tetanus booster in the last 10 years, both tetanus toxoid and tetanus immunoglobulin (TIG) are given, if the patient has received the booster in the last 10 years but not within the last 5 years, then the tetanus toxoid is given, if a patient has received the tetanus vaccine booster within the last 5 years, neither the vaccine nor the immunoglobulin are necessary
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β B
π Explanation
Since this patientβs wound is dirty, it would be inappropriate to fail taking prophylactic measures against tetanus, therefore choices D and E that do not include tetanus prophylaxis are incorrect. If the patient has already received tetanus booster in the last 5 years, usually the vaccine is not needed. Since this patient was last administered the tetanus toxoid 7 years ago, he
should receive a shot of tetanus toxoid today (choice B).
β Tetanus immune globulin (TIG) alone would not be enough prophylaxis in this patient.
β Tetanus immune globulin and tetanus toxoid (choice C) would be appropriate in a patient who has not received a booster in the last 10 years.
π Key point:
For dirty wounds, tetanus prophylaxis should be considered as follows: If the patient has not received the tetanus booster in the last 10 years, both tetanus toxoid and tetanus immunoglobulin (TIG) are given, if the patient has received the booster in the last 10 years but not within the last 5 years, then the tetanus toxoid is given, if a patient has received the tetanus vaccine booster within the last 5 years, neither the vaccine nor the immunoglobulin are necessary
π1
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_112
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A 38 year old white female presents to your office with a 4-cm palpable nodule in her right breast. Fine-needle
aspiration yields 4 cc of bloody fluid. Following the aspiration, the breast nodule is no longer palpable. Which one of the following would be most appropriate at this point?
a) No further workup
b) Cytologic examination of the fluid
c) Surgical referral for core needle biopsy
d) Surgical referral for excisional biopsy
e) Ultrasonography of the breast
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A 38 year old white female presents to your office with a 4-cm palpable nodule in her right breast. Fine-needle
aspiration yields 4 cc of bloody fluid. Following the aspiration, the breast nodule is no longer palpable. Which one of the following would be most appropriate at this point?
a) No further workup
b) Cytologic examination of the fluid
c) Surgical referral for core needle biopsy
d) Surgical referral for excisional biopsy
e) Ultrasonography of the breast
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_112 | #answer
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β B
π Explanation
When straw-colored or gray-green fluid is obtained by fine-needle aspiration of a breast nodule and the lesion completely disappears, the diagnosis is simple cyst. The fluid should not be sent for analysis because the risk for cancer is exceedingly small. If the fluid is bloody or otherwise unusual, it should be sent for cytologic examination because about 7% of bloodstained aspirates are associated with cancer
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β B
π Explanation
When straw-colored or gray-green fluid is obtained by fine-needle aspiration of a breast nodule and the lesion completely disappears, the diagnosis is simple cyst. The fluid should not be sent for analysis because the risk for cancer is exceedingly small. If the fluid is bloody or otherwise unusual, it should be sent for cytologic examination because about 7% of bloodstained aspirates are associated with cancer
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_113
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A 70 year old man has had an indolent, unhealing ulcer at the heel of the right foot for several weeks, since he started wearing his new shoes. He indicates that neither the blister nor the ulcer ever gave him any pain. The ulcer is 3.5 cm in diameter, the ulcer base looks dirty, and there is hardly any granulation tissue. The skin around the ulcer looks normal. The patient has no sensation to pin prick anywhere in that foot. Peripheral pulses are weak but palpable. He is obese and has varicose veins, high cholesterol, and poorly controlled type 2 diabetes mellitus. Which of the following most accurately characterizes the ulcer?
a) Diabetic ulcer due to trauma, neuropathy, and microvascular disease
b) Ischemic ulcer due to arteriosclerosis
c) Ischemic ulcer due to embolization
d) Neoplastic in nature, probably squamous cell carcinoma
e) Stasis ulcer due to venous insufficiency
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A 70 year old man has had an indolent, unhealing ulcer at the heel of the right foot for several weeks, since he started wearing his new shoes. He indicates that neither the blister nor the ulcer ever gave him any pain. The ulcer is 3.5 cm in diameter, the ulcer base looks dirty, and there is hardly any granulation tissue. The skin around the ulcer looks normal. The patient has no sensation to pin prick anywhere in that foot. Peripheral pulses are weak but palpable. He is obese and has varicose veins, high cholesterol, and poorly controlled type 2 diabetes mellitus. Which of the following most accurately characterizes the ulcer?
a) Diabetic ulcer due to trauma, neuropathy, and microvascular disease
b) Ischemic ulcer due to arteriosclerosis
c) Ischemic ulcer due to embolization
d) Neoplastic in nature, probably squamous cell carcinoma
e) Stasis ulcer due to venous insufficiency
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_113 | #answer
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β A
π Explanation
Diabetic ulcers typically develop at pressure points, and the heel is a favorite location. The patient has evidence of neuropathy, and the correlation with the trauma inflicted by the new shoes is classic. Diabetic ulcers tend to occur in the following areas:
-Areas most subjected to weight bearing, such as the heel, plantar metatarsal head areas, the tips of the most prominent toes (usually the first or second), and the tips of hammer toes (Ulcers also occur over the malleoli because these areas commonly are subjected to trauma.)
-Areas most subjected to stress, such as the dorsal portion of hammer toes
Ischemic ulcers, whether due to arteriosclerosis or embolization are typically seen at the tip of the toes, as far away from the heart as one can get.
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β A
π Explanation
Diabetic ulcers typically develop at pressure points, and the heel is a favorite location. The patient has evidence of neuropathy, and the correlation with the trauma inflicted by the new shoes is classic. Diabetic ulcers tend to occur in the following areas:
-Areas most subjected to weight bearing, such as the heel, plantar metatarsal head areas, the tips of the most prominent toes (usually the first or second), and the tips of hammer toes (Ulcers also occur over the malleoli because these areas commonly are subjected to trauma.)
-Areas most subjected to stress, such as the dorsal portion of hammer toes
Ischemic ulcers, whether due to arteriosclerosis or embolization are typically seen at the tip of the toes, as far away from the heart as one can get.
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_114
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A 35-year-old male consults you about a vague chest pain he developed while sitting at his desk earlier in the day. The pain is right-sided and was sharp for a brief time when it began, but it rapidly subsided. There was no hemoptysis and the pain does not seem pleuritic. His physical examination, EKG, and oxygen saturation are unremarkable. A chest film shows a 10% right pneumothorax. Which one of the following is true in this situation?
a) He is likely to be an overweight smoker with a chronic cough
b) Rupture of subpleural bullae would be an unlikely cause of his problem
c) Outpatient observation with a repeat chest radiograph in 24 hours is indicated
d) A chest tube should be placed expeditiously
e) After treatment his probability of recurrence is less than 15%
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A 35-year-old male consults you about a vague chest pain he developed while sitting at his desk earlier in the day. The pain is right-sided and was sharp for a brief time when it began, but it rapidly subsided. There was no hemoptysis and the pain does not seem pleuritic. His physical examination, EKG, and oxygen saturation are unremarkable. A chest film shows a 10% right pneumothorax. Which one of the following is true in this situation?
a) He is likely to be an overweight smoker with a chronic cough
b) Rupture of subpleural bullae would be an unlikely cause of his problem
c) Outpatient observation with a repeat chest radiograph in 24 hours is indicated
d) A chest tube should be placed expeditiously
e) After treatment his probability of recurrence is less than 15%
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_114 | #answer
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β C
π Explanation
The majority of patients presenting with spontaneous pneumothorax are tall, thin individuals under 40 years of age. Most do not have clinically apparent lung disease, and the chest pain is sometimes minimal at onset and may resolve within 24 hours even if untreated. Patients with small pneumothorax involving less than 15% of the hemithorax may have a normal physical examination, although tachycardia is occasionally noted. The diagnosis is confirmed by chest radiographs. Studies of recurrence have found that an average of 30% of patients will have a recurrence within 6 months to 2 years. The treatment of an initial pneumothorax of less than 20% may be monitored if a patient has few symptoms. Follow-up should include a chest radiograph to assess stability at 24-48 hours. Indications for treatment include progression, delayed expansion, or the development of symptoms. The majority of patients with spontaneous pneumothoraces, and perhaps almost all of them, will have subpleural bullae on a CT scan.
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β C
π Explanation
The majority of patients presenting with spontaneous pneumothorax are tall, thin individuals under 40 years of age. Most do not have clinically apparent lung disease, and the chest pain is sometimes minimal at onset and may resolve within 24 hours even if untreated. Patients with small pneumothorax involving less than 15% of the hemithorax may have a normal physical examination, although tachycardia is occasionally noted. The diagnosis is confirmed by chest radiographs. Studies of recurrence have found that an average of 30% of patients will have a recurrence within 6 months to 2 years. The treatment of an initial pneumothorax of less than 20% may be monitored if a patient has few symptoms. Follow-up should include a chest radiograph to assess stability at 24-48 hours. Indications for treatment include progression, delayed expansion, or the development of symptoms. The majority of patients with spontaneous pneumothoraces, and perhaps almost all of them, will have subpleural bullae on a CT scan.
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_115
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A 50-year-old known hypertensive man was brought to the emergency department after a sudden feeling of numbness and weakness of his left arm and left half of the face. No other symptoms could be elicited and the patient could engage in dialogue, normally. Vital signs including blood pressure were stable. Left shoulder, upper arm, forearm and hand muscles have power of 2. Pain and temperature sensations are impaired on the left arm and left side of the face. No motor or sensory impairment could be detected on the right side or left lower side of the body. Visual fields were normal. The rest of physical examination was normal. Ischemic stroke was suspected. Which of the following arteries is the most likely site of blockage?
a) Right middle cerebral artery
b) Superior division of right middle cerebral artery
c) Inferior division of right middle cerebral artery
d) Lenticulostriate branches of the right middle cerebral artery
e) Right anterior cerebral artery
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A 50-year-old known hypertensive man was brought to the emergency department after a sudden feeling of numbness and weakness of his left arm and left half of the face. No other symptoms could be elicited and the patient could engage in dialogue, normally. Vital signs including blood pressure were stable. Left shoulder, upper arm, forearm and hand muscles have power of 2. Pain and temperature sensations are impaired on the left arm and left side of the face. No motor or sensory impairment could be detected on the right side or left lower side of the body. Visual fields were normal. The rest of physical examination was normal. Ischemic stroke was suspected. Which of the following arteries is the most likely site of blockage?
a) Right middle cerebral artery
b) Superior division of right middle cerebral artery
c) Inferior division of right middle cerebral artery
d) Lenticulostriate branches of the right middle cerebral artery
e) Right anterior cerebral artery
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_115 | #answer
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β B
π Explanation
The superior division of the right middle cerebral artery (MCA) (choice B) is the most likely site of blockage in this
patient. Patients with blockage of this division of MCA usually present with contralateral weakness and sensory loss on the arm and face. This division of the right MCA supplies the lateral surface of the right cerebral hemisphere above the lateral fissure but short of the superolateral portions, which are supplied by the anterior cerebral artery (ACA). Thus, motor, sensory and sensory association areas for the left upper part of the body (arm and face) are supplied by this division of MCA and weakness and sensory impairment are expected to affect these parts of the body. The lower limb is spared because its motor and sensory representation is located in the superolateral of frontal and parietal lobes which are supplied by the ACA. Because the right or non-dominant hemisphere is affected, our patient does not have any form of aphasia.
β Patients with MCA blockage (choice A) usually present with symptoms and signs of blockage of its superior division (choice B), inferior division (choice C) and lenticulostriate division (choice D). Thus, these patients are expected to present with left sided weakness and hemianesthesia affecting the face, arm, and leg. Because the non-dominant right hemisphere is affect, hemi-neglect, astereognosis and anosognosia, hemianopsia rather than aphasia are also present.
β Patients with inferior division of right middle cerebral artery (MCA)blockage (choice C) usually present with left sided homonymous hemianopsia because this artery supplies the parts of optic pathway that pass through the temporal lobe. Because the non-dominant hemisphere is affected, hemi-neglect, astereognosis, and anosognosia rather than aphasia accompanies the hemianopsia.
β Patients with blockage of lenticulostriate branches of the right MCA(choice D) usually present with left sided hemianesthesia and hemiparesis of the leg, arm, and face. The lenticulostriate branches of the right MCA together with anterior choroidal artery supply the posterior limb of the internal capsule on the right where the motor and sensory fibers pass between the cortex and brain stem. Because motor and sensory fibers for both upper and lower parts of the body come close to each other, both of these parts of the body are affected.
β Patients with right anterior cerebral artery (ACA) blockage (choice E) usually present with left sided hemianesthesia
and hemiparesis of the leg. The right ACA supplies the superolateral portions of the right frontal and parietal lobes, which due homunculus topography, contains the motor and sensory areas of the lower part of the body (leg). The arms and the face are usually not affected by blockage of the ACA because cortical areas representing these parts of the body are located along the lateral surface of the cerebral hemisphere and are supplied by superior division of MCA.
πKey point:
Weakness and anesthesia of the left arm and left half of the face and sparing of the lower leg is most likely caused by
blockage in the territory of the middle cerebral artery (MCA) other than the lenticulostriate division. Absence of hemi-neglect and hemianopsia exclude blockage of the inferior division and favours blockage of the superior division of the right MCA
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β B
π Explanation
The superior division of the right middle cerebral artery (MCA) (choice B) is the most likely site of blockage in this
patient. Patients with blockage of this division of MCA usually present with contralateral weakness and sensory loss on the arm and face. This division of the right MCA supplies the lateral surface of the right cerebral hemisphere above the lateral fissure but short of the superolateral portions, which are supplied by the anterior cerebral artery (ACA). Thus, motor, sensory and sensory association areas for the left upper part of the body (arm and face) are supplied by this division of MCA and weakness and sensory impairment are expected to affect these parts of the body. The lower limb is spared because its motor and sensory representation is located in the superolateral of frontal and parietal lobes which are supplied by the ACA. Because the right or non-dominant hemisphere is affected, our patient does not have any form of aphasia.
β Patients with MCA blockage (choice A) usually present with symptoms and signs of blockage of its superior division (choice B), inferior division (choice C) and lenticulostriate division (choice D). Thus, these patients are expected to present with left sided weakness and hemianesthesia affecting the face, arm, and leg. Because the non-dominant right hemisphere is affect, hemi-neglect, astereognosis and anosognosia, hemianopsia rather than aphasia are also present.
β Patients with inferior division of right middle cerebral artery (MCA)blockage (choice C) usually present with left sided homonymous hemianopsia because this artery supplies the parts of optic pathway that pass through the temporal lobe. Because the non-dominant hemisphere is affected, hemi-neglect, astereognosis, and anosognosia rather than aphasia accompanies the hemianopsia.
β Patients with blockage of lenticulostriate branches of the right MCA(choice D) usually present with left sided hemianesthesia and hemiparesis of the leg, arm, and face. The lenticulostriate branches of the right MCA together with anterior choroidal artery supply the posterior limb of the internal capsule on the right where the motor and sensory fibers pass between the cortex and brain stem. Because motor and sensory fibers for both upper and lower parts of the body come close to each other, both of these parts of the body are affected.
β Patients with right anterior cerebral artery (ACA) blockage (choice E) usually present with left sided hemianesthesia
and hemiparesis of the leg. The right ACA supplies the superolateral portions of the right frontal and parietal lobes, which due homunculus topography, contains the motor and sensory areas of the lower part of the body (leg). The arms and the face are usually not affected by blockage of the ACA because cortical areas representing these parts of the body are located along the lateral surface of the cerebral hemisphere and are supplied by superior division of MCA.
πKey point:
Weakness and anesthesia of the left arm and left half of the face and sparing of the lower leg is most likely caused by
blockage in the territory of the middle cerebral artery (MCA) other than the lenticulostriate division. Absence of hemi-neglect and hemianopsia exclude blockage of the inferior division and favours blockage of the superior division of the right MCA
π1
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_116
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A 47-year-old female presents with progressive difficulty hearing. She is employed as an office worker, has no significant past medical history, and takes no medications. Physical examination shows no gross abnormalities of her outer ears. The external ear canals are free of cerumen, and the tympanic membranes move well to insufflation. Weberβs test and the Rinne test have results that are compatible with a conductive hearing loss. Which one of the following is the most likely cause of this patientβs hearing loss?
a) Noise-induced hearing loss
b) Meniereβs disease
c) Otosclerosis
d) Acoustic neuroma
e) Perilymphatic fistula
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A 47-year-old female presents with progressive difficulty hearing. She is employed as an office worker, has no significant past medical history, and takes no medications. Physical examination shows no gross abnormalities of her outer ears. The external ear canals are free of cerumen, and the tympanic membranes move well to insufflation. Weberβs test and the Rinne test have results that are compatible with a conductive hearing loss. Which one of the following is the most likely cause of this patientβs hearing loss?
a) Noise-induced hearing loss
b) Meniereβs disease
c) Otosclerosis
d) Acoustic neuroma
e) Perilymphatic fistula
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_116 | #answer
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β C
π Explanation
Otosclerosis typically presents between the third and fifth decades, and is more common in women. The chief feature of
otosclerosis is a progressive conductive hearing loss. Occasionally, when lesions impinge on the stapes footplate, a sensorineural loss may occur. All of the other choices are exclusively sensorineural in character. Meniereβs disease also causes fluctuating hearing loss. Noise-induced hearing loss frequently and characteristically is accompanied by tinnitus. Perilymphatic fistula is associated with sudden unilateral hearing loss with tinnitus and vertigo. Acoustic neuroma is associated with tinnitus and gradual hearing impairment
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β C
π Explanation
Otosclerosis typically presents between the third and fifth decades, and is more common in women. The chief feature of
otosclerosis is a progressive conductive hearing loss. Occasionally, when lesions impinge on the stapes footplate, a sensorineural loss may occur. All of the other choices are exclusively sensorineural in character. Meniereβs disease also causes fluctuating hearing loss. Noise-induced hearing loss frequently and characteristically is accompanied by tinnitus. Perilymphatic fistula is associated with sudden unilateral hearing loss with tinnitus and vertigo. Acoustic neuroma is associated with tinnitus and gradual hearing impairment
β€2π1
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_117
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A 15-year-old female is brought to the hospital by her mother because she has never had menstrual periods and the mother is concerned. On physical examination the girl appears short, has a webbed neck. Four-limb blood pressures were also evaluated: higher blood pressures were noted in the arms while the ones of the lower extremities were normal. Which of the following is the best way to confirm this girlβs diagnosis?
a) Echocardiography
b) FSH, LH, and Estrogen levels
c) Karyotype
d) Brain MRI
e) Bone age assessment
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A 15-year-old female is brought to the hospital by her mother because she has never had menstrual periods and the mother is concerned. On physical examination the girl appears short, has a webbed neck. Four-limb blood pressures were also evaluated: higher blood pressures were noted in the arms while the ones of the lower extremities were normal. Which of the following is the best way to confirm this girlβs diagnosis?
a) Echocardiography
b) FSH, LH, and Estrogen levels
c) Karyotype
d) Brain MRI
e) Bone age assessment
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_117 | #answer
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β C
π Explanation
This girl has primary amenorrhea, a webbed neck, and a significant difference between the blood pressure in the upper and lower extremities (suggesting possible coarctation of the aorta). These findings suggest Turner syndrome as the most likely diagnosis. The best way to confirm this diagnosis is a standard 30 cell Karyotype, which in Turner syndrome would reveal 45, XO cell line or a cell line with deletion of the short arm of the X chromosome.
β An echocardiography (choice A) is useful in evaluating cardiovascular abnormalities of Turner syndrome such as the coarctation of the aorta; while this is an important characteristic of Turner syndrome, it is not the best way to confirm it.
β FSH, LH, and Estrogen (choice B) are likely to be abnormal in this patient. With estrogen being low while FSH and LH are elevated; this, however, is not the best way to confirm Turner syndrome.
β Brain MRI (choice D) would be useful in cases of amenorrhea caused by pituitary pathology such as craniopharyngioma, it is not the best way to confirm Turner syndrome.
β Bone age assessment (choice E) will be useful in the management of this patient as hormone therapy is being considered; however, this is not the best way to confirm Turner syndrome.
π Key point:
When Turner syndrome is suspected, Karyotype is the best way to confirm it.
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β C
π Explanation
This girl has primary amenorrhea, a webbed neck, and a significant difference between the blood pressure in the upper and lower extremities (suggesting possible coarctation of the aorta). These findings suggest Turner syndrome as the most likely diagnosis. The best way to confirm this diagnosis is a standard 30 cell Karyotype, which in Turner syndrome would reveal 45, XO cell line or a cell line with deletion of the short arm of the X chromosome.
β An echocardiography (choice A) is useful in evaluating cardiovascular abnormalities of Turner syndrome such as the coarctation of the aorta; while this is an important characteristic of Turner syndrome, it is not the best way to confirm it.
β FSH, LH, and Estrogen (choice B) are likely to be abnormal in this patient. With estrogen being low while FSH and LH are elevated; this, however, is not the best way to confirm Turner syndrome.
β Brain MRI (choice D) would be useful in cases of amenorrhea caused by pituitary pathology such as craniopharyngioma, it is not the best way to confirm Turner syndrome.
β Bone age assessment (choice E) will be useful in the management of this patient as hormone therapy is being considered; however, this is not the best way to confirm Turner syndrome.
π Key point:
When Turner syndrome is suspected, Karyotype is the best way to confirm it.
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_118
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A 27-year-old man with advanced HIV is sent for evaluation of his nephrotic syndrome. His blood pressure is 142/84 mm Hg. He has 3+ edema in both legs. His risk factor for AIDS is his IV heroin use. His creatinine is 2.1 mg/dL, and his urine reveals +3 protein, no blood. A kidney biopsy would most likely reveal which of the following?
a) Diabetic nephropathy
b) Focal glomerular sclerosis
c) IgA nephropathy
d) Membranous nephropathy
e) Minimal change disease
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A 27-year-old man with advanced HIV is sent for evaluation of his nephrotic syndrome. His blood pressure is 142/84 mm Hg. He has 3+ edema in both legs. His risk factor for AIDS is his IV heroin use. His creatinine is 2.1 mg/dL, and his urine reveals +3 protein, no blood. A kidney biopsy would most likely reveal which of the following?
a) Diabetic nephropathy
b) Focal glomerular sclerosis
c) IgA nephropathy
d) Membranous nephropathy
e) Minimal change disease
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_118 | #answer
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β B
π Explanation
Focal glomerular sclerosis is the type of nephropathy most commonly seen in IV drug users with AIDS. It is likely to lead to a very rapid loss of renal function.There is no clinical evidence to indicate that this person has diabetes, making diabetic nephropathy unlikely. Minimal change disease and IgA nephropathy and membranous nephropathy are only very rarely associated with AIDS.
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β B
π Explanation
Focal glomerular sclerosis is the type of nephropathy most commonly seen in IV drug users with AIDS. It is likely to lead to a very rapid loss of renal function.There is no clinical evidence to indicate that this person has diabetes, making diabetic nephropathy unlikely. Minimal change disease and IgA nephropathy and membranous nephropathy are only very rarely associated with AIDS.
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_119
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For two weeks, a 62-year-old male with biopsy-documented cirrhosis and ascites has had diffuse abdominal discomfort, fever, and night sweats. His current medications are furosemide (Lasix) and spironolactone (Aldactone). On examination, his temperature is 38.0Β°C (100.4Β°F), blood pressure 100/60 mm Hg, heart rate 92 beats/min and regular. The heart and lung examination is normal. The abdomen is soft with vague tenderness in all quadrants. There is no rebound or guarding.
The presence of ascites is easily verified. Bowel sounds are quiet. The rectal examination is normal, and the stool is negative for occult blood. You perform diagnostic paracentesis and send a sample of fluid for analysis.
Which one of the following findings would best establish the suspected diagnosis of spontaneous bacterial peritonitis?
a) pH < 7.2
b) Bloody appearance
c) Neutrophil count > 300/mL
d) Positive cytology
e) Total protein > 1 g/dL
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For two weeks, a 62-year-old male with biopsy-documented cirrhosis and ascites has had diffuse abdominal discomfort, fever, and night sweats. His current medications are furosemide (Lasix) and spironolactone (Aldactone). On examination, his temperature is 38.0Β°C (100.4Β°F), blood pressure 100/60 mm Hg, heart rate 92 beats/min and regular. The heart and lung examination is normal. The abdomen is soft with vague tenderness in all quadrants. There is no rebound or guarding.
The presence of ascites is easily verified. Bowel sounds are quiet. The rectal examination is normal, and the stool is negative for occult blood. You perform diagnostic paracentesis and send a sample of fluid for analysis.
Which one of the following findings would best establish the suspected diagnosis of spontaneous bacterial peritonitis?
a) pH < 7.2
b) Bloody appearance
c) Neutrophil count > 300/mL
d) Positive cytology
e) Total protein > 1 g/dL
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_119 | #answer
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β C
π Explanation
Diagnostic paracentesis is recommended for patients with ascites of recent onset, as well as for those with chronic ascites who present with new clinical findings such as fever or abdominal pain. A neutrophil count > 250/mL is diagnostic for peritonitis. Once peritonitis is diagnosed, antibiotic therapy should be started immediately without waiting for culture results. Bloody ascites with abnormal cytology may be seen with hepatoma, but is not typical of peritonitis. The ascitic fluid pH does not become abnormal until well after the neutrophil count has risen, so it is a less reliable finding for treatment purposes. A protein level > 1 g/dL is actually evidence against spontaneous bacterial peritonitis
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β C
π Explanation
Diagnostic paracentesis is recommended for patients with ascites of recent onset, as well as for those with chronic ascites who present with new clinical findings such as fever or abdominal pain. A neutrophil count > 250/mL is diagnostic for peritonitis. Once peritonitis is diagnosed, antibiotic therapy should be started immediately without waiting for culture results. Bloody ascites with abnormal cytology may be seen with hepatoma, but is not typical of peritonitis. The ascitic fluid pH does not become abnormal until well after the neutrophil count has risen, so it is a less reliable finding for treatment purposes. A protein level > 1 g/dL is actually evidence against spontaneous bacterial peritonitis
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_120
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A 35-year-old male complains of 2 months of right shoulder pain. He does not recall an injury, but says it is painful to lie on his right side or to work with his right hand above his head. On examination, the shoulder appears normal and there is no pain with external rotation of the shoulder, bringing the arm across the body (scarf test), or attempted external and internal rotation of the shoulder against resistance. Lowering the arm from full abduction (painful arc), attempted abduction above 45Β° against resistance, and elevating the internally rotated arm above 90Β° against resistance are all painful.The most likely diagnosis is:
a) Subdeltoid bursitis
b) Adhesive capsulitis
c) Impingement syndrome
d) Glenohumeral osteoarthritis
e) Acromioclavicular osteoarthritis
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A 35-year-old male complains of 2 months of right shoulder pain. He does not recall an injury, but says it is painful to lie on his right side or to work with his right hand above his head. On examination, the shoulder appears normal and there is no pain with external rotation of the shoulder, bringing the arm across the body (scarf test), or attempted external and internal rotation of the shoulder against resistance. Lowering the arm from full abduction (painful arc), attempted abduction above 45Β° against resistance, and elevating the internally rotated arm above 90Β° against resistance are all painful.The most likely diagnosis is:
a) Subdeltoid bursitis
b) Adhesive capsulitis
c) Impingement syndrome
d) Glenohumeral osteoarthritis
e) Acromioclavicular osteoarthritis
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_120 | #answer
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β C
π Explanation
The combination of a painful arc and pain on use of the supraspinatus muscle indicates impingement syndrome (also called painful arc syndrome, supraspinatus syndrome, swimmer's shoulder, and thrower's shoulder), which is due to irritation of the rotator cuff under the coracoacromial arch. It is by far the most common cause of shoulder pain seen by family.
β Subdeltoid bursitis is a much more acute problem, and impairs shoulder mobility in all directions.
β Adhesive capsulitis produces loss of external rotation.
β Glenohumeral arthritis produces pain with external rotation, and variable amounts of impaired mobility, depending on progression of the problem over time.
β Acromioclavicular joint arthritis produces a positive scarf sign, and often a visible bump over the joint, since it lies so close to the skin surface
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β C
π Explanation
The combination of a painful arc and pain on use of the supraspinatus muscle indicates impingement syndrome (also called painful arc syndrome, supraspinatus syndrome, swimmer's shoulder, and thrower's shoulder), which is due to irritation of the rotator cuff under the coracoacromial arch. It is by far the most common cause of shoulder pain seen by family.
β Subdeltoid bursitis is a much more acute problem, and impairs shoulder mobility in all directions.
β Adhesive capsulitis produces loss of external rotation.
β Glenohumeral arthritis produces pain with external rotation, and variable amounts of impaired mobility, depending on progression of the problem over time.
β Acromioclavicular joint arthritis produces a positive scarf sign, and often a visible bump over the joint, since it lies so close to the skin surface
π1
Forwarded from MohammaDJ
π¨π¦ MCCQE1,2 | #Case_121
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A 76-year-old female is hospitalized for fever and weakness of several daysβ duration. Her history and physical findings are otherwise unremarkable except for a temperature of 38.2Β°C (100.8Β°F), a pulse rate of 100 beats/min, and a blood pressure of 110/70 mm Hg. A urinalysis reveals 10-15 WBCs/hpf and a urine culture reveals methicillin-sensitive Staphylococcus aureus. The most appropriate action at this point is to:
a) reculture the urine, as the bacteria on the first urine culture is most likely a skin contaminant
b) obtain a blood culture and examine the patient for a portal of entry
c) obtain a blood culture and start the patient on intravenous vancomycin (Vancocin)
d) start the patient on oral cephalexin (Keflex)
e) order echocardiogram
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A 76-year-old female is hospitalized for fever and weakness of several daysβ duration. Her history and physical findings are otherwise unremarkable except for a temperature of 38.2Β°C (100.8Β°F), a pulse rate of 100 beats/min, and a blood pressure of 110/70 mm Hg. A urinalysis reveals 10-15 WBCs/hpf and a urine culture reveals methicillin-sensitive Staphylococcus aureus. The most appropriate action at this point is to:
a) reculture the urine, as the bacteria on the first urine culture is most likely a skin contaminant
b) obtain a blood culture and examine the patient for a portal of entry
c) obtain a blood culture and start the patient on intravenous vancomycin (Vancocin)
d) start the patient on oral cephalexin (Keflex)
e) order echocardiogram