Forwarded from MohammaDJ
#Case_1
A 72-year-old man, who speaks no English, attends with his son who is able to explain that his father has just arrived in Australia as a refugee from Bosnia 1 month before. He teds you that his father is suffering from irritability, insomnia and nightmares connected with his experiences in the civil war. On further questioning, the father appears vague, concentrates poorly and cannot recall details of his recent experiences in Bosnia. The MOST LIKELY diagnosis is
A. jet lag.
B. culture shock.
C. depression.
D. post-traumatic stress disorder.
E. dementia
✏#psychiatry
🌐 https://t.me/joinchat/De8XUlQZJDf4yxHQlHyFcQ
A 72-year-old man, who speaks no English, attends with his son who is able to explain that his father has just arrived in Australia as a refugee from Bosnia 1 month before. He teds you that his father is suffering from irritability, insomnia and nightmares connected with his experiences in the civil war. On further questioning, the father appears vague, concentrates poorly and cannot recall details of his recent experiences in Bosnia. The MOST LIKELY diagnosis is
A. jet lag.
B. culture shock.
C. depression.
D. post-traumatic stress disorder.
E. dementia
✏#psychiatry
🌐 https://t.me/joinchat/De8XUlQZJDf4yxHQlHyFcQ
👍9❤4
Forwarded from MohammaDJ
#Case_2
A thyrotoxic patient was subjected to subtotal thyroidectomy after she had been made euthyroid by medical treatment. The day after the operation her temperature is 39°C and her pulse rate 110/min and regular. She is most likely to be suffering from which one of the following?
A. Pulmonary atelectasis.
B. Thyroid crisis.
C. Pulmonary emboli.
D. Wound infection.
E. Septicemia.
#pulmonology
👥 https://t.me/joinchat/De8XUlQZJDf4yxHQlHyFcQ
A thyrotoxic patient was subjected to subtotal thyroidectomy after she had been made euthyroid by medical treatment. The day after the operation her temperature is 39°C and her pulse rate 110/min and regular. She is most likely to be suffering from which one of the following?
A. Pulmonary atelectasis.
B. Thyroid crisis.
C. Pulmonary emboli.
D. Wound infection.
E. Septicemia.
#pulmonology
👥 https://t.me/joinchat/De8XUlQZJDf4yxHQlHyFcQ
👍7❤1
Forwarded from MohammaDJ
#Case_3
An elderly female patient has been hospitalized for urosepsis. She was started on Piperacillin/tazobactam empirically. One week later, the patient recovered and was discharged on oral antibiotics. 6 days later, she developed severe watery diarrhea associated with abdominal colic and fever. Vitals reveal: pulse is 110/min, Temp is 39°C, BP: 120/70mm Hg and RR is 16/min. abdominal exam reveals tenderness in the lower abdomen with no evidence of peritoneal signs.CBC shows a WBC count of 16 x10^9/L.
After adequate fluid rehydration, what is the most appropriate next step in the management of this patient?
a) Give metronidazole and continue the antibiotics
b) Stop the antibiotics
c) Stop the antibiotics and give IV metronidazole
d) Stop the antibiotics and give oral metronidazole
e) Stop the antibiotics and give oral vancomycin
#infectious_disease
#gastroenterology
✍ https://t.me/joinchat/De8XUlQZJDf4yxHQlHyFcQ
An elderly female patient has been hospitalized for urosepsis. She was started on Piperacillin/tazobactam empirically. One week later, the patient recovered and was discharged on oral antibiotics. 6 days later, she developed severe watery diarrhea associated with abdominal colic and fever. Vitals reveal: pulse is 110/min, Temp is 39°C, BP: 120/70mm Hg and RR is 16/min. abdominal exam reveals tenderness in the lower abdomen with no evidence of peritoneal signs.CBC shows a WBC count of 16 x10^9/L.
After adequate fluid rehydration, what is the most appropriate next step in the management of this patient?
a) Give metronidazole and continue the antibiotics
b) Stop the antibiotics
c) Stop the antibiotics and give IV metronidazole
d) Stop the antibiotics and give oral metronidazole
e) Stop the antibiotics and give oral vancomycin
#infectious_disease
#gastroenterology
✍ https://t.me/joinchat/De8XUlQZJDf4yxHQlHyFcQ
👍7🤔1
Forwarded from MohammaDJ
#Case_3
#answer
✅D
Explanation:
Pseudomembrenous colitis is a very hot topic for the licensing exams!
Our patient has developed severe watery diarrhea, abdominal pain, and fever while taking antibiotics for long duration.
She is most likely suffering from pseudomembranous colitis caused by Clostridium difficile. After proper diagnosis with Cytotoxin assay of the stool, oral metronidazole is the antibiotics of choice for this condition.
The antibiotics should be always stopped; however, discontinuing the antibiotics alone is not enough, the patient is complaining of severe symptoms.
IV metronidazole is not as effective as oral metronidazole; we need the highest concentration of the drug in the colon!
Oral vancomycin is a very effective medication against C. diff; however, it is an expensive drug and we do not want to use it too much in order to decrease the incidence of vancomycin resistant enterococci.
📎 https://t.me/joinchat/De8XUlQZJDf4yxHQlHyFcQ
#answer
✅D
Explanation:
Pseudomembrenous colitis is a very hot topic for the licensing exams!
Our patient has developed severe watery diarrhea, abdominal pain, and fever while taking antibiotics for long duration.
She is most likely suffering from pseudomembranous colitis caused by Clostridium difficile. After proper diagnosis with Cytotoxin assay of the stool, oral metronidazole is the antibiotics of choice for this condition.
The antibiotics should be always stopped; however, discontinuing the antibiotics alone is not enough, the patient is complaining of severe symptoms.
IV metronidazole is not as effective as oral metronidazole; we need the highest concentration of the drug in the colon!
Oral vancomycin is a very effective medication against C. diff; however, it is an expensive drug and we do not want to use it too much in order to decrease the incidence of vancomycin resistant enterococci.
📎 https://t.me/joinchat/De8XUlQZJDf4yxHQlHyFcQ
👍15
Forwarded from MohammaDJ
#Case_4
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A 28-year-old white female at 28 weeks gestation with an uncomplicated pregnancy presents with pain in the right wrist.
She thinks it may be related to hand-washing several articles of clothing in a creek and hanging them on a line to dry while on a camping trip. The pain in the wrist radiates down the thumb and the radial side of the wrist. There is no history of trauma or penetrating injury.
On examination there is tenderness when the right radial styloid is compressed. The pain is exacerbated by ulnar rotation of the wrist while the patient’s fingers are folded over the thumb.
What is the most likely diagnosis?
a) Osteoarthritis of the first carpometacarpal joint
b) Occult navicular fracture
c) Radial sensory nerve entrapment
d) Carpal tunnel syndrome
e) De Quervain’s tenosynovitis
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#orthopedics
🌐 https://t.me/joinchat/De8XUlQZJDf4yxHQlHyFcQ
〰〰〰〰〰
A 28-year-old white female at 28 weeks gestation with an uncomplicated pregnancy presents with pain in the right wrist.
She thinks it may be related to hand-washing several articles of clothing in a creek and hanging them on a line to dry while on a camping trip. The pain in the wrist radiates down the thumb and the radial side of the wrist. There is no history of trauma or penetrating injury.
On examination there is tenderness when the right radial styloid is compressed. The pain is exacerbated by ulnar rotation of the wrist while the patient’s fingers are folded over the thumb.
What is the most likely diagnosis?
a) Osteoarthritis of the first carpometacarpal joint
b) Occult navicular fracture
c) Radial sensory nerve entrapment
d) Carpal tunnel syndrome
e) De Quervain’s tenosynovitis
〰〰〰〰〰〰〰〰〰〰〰〰〰〰〰
#orthopedics
🌐 https://t.me/joinchat/De8XUlQZJDf4yxHQlHyFcQ
👍5
Forwarded from MohammaDJ
#Case_4
#answer
✅E
🔎 Explanation:
De Quervain’s tenosynovitis is a cumulative movement disorder due to chronic overuse of the wrist and hand, involving the abductor pollicis longus and extensor pollicis brevis tendons, which share a common tendon sheath. Repeated forceful gripping, grasping, and wringing movements lead to thickening of the tendon sheath and subsequent inflammation and
stenosis of the sheath as it passes over the distal radius. This can progress to fibrosis and loss of flexibility in the thumb in flexion. The condition is more common in pregnancy, after trauma, and with rheumatoid arthritis.
The diagnosis is made by physical examination. There is tenderness over the radial styloid, and resisting thumb extension and abduction will elicit pain. Finkelstein’s test, folding the fingers over the thumb and gently passively deviating the thumb in an ulnar direction, will often cause such pain that the patient will lift the shoulder to prevent the examiner from
stretching the tendon.
⚠→ Other diagnostic considerations include osteoarthritis of the first carpometacarpal joint (choice A), which may also
cause pain over the radial styloid, and a positive Finkelstein’s test. If injecting the site with local anesthetic gives relief, an arthritic etiology can be excluded.
⚠→ Navicular (scaphoid) fracture (choice B) is caused by a fall or a direct blow to the wrist. The symptoms are pain on the thumb side of the wrist, swelling in that area, and difficulty gripping objects.
⚠→ Individuals with radial sensory nerve entrapment (choice C) will have paresthesias over the dorsum of the hand and a positive Tinel’s sign over the nerve in the mid-forearm, just distal to the belly of the brachioradialis muscle. Hyperpronation of the forearm reproduces these symptoms.
⚠→ Carpal tunnel syndrome (choice D) involves entrapment of the median nerve, causing pain in the thumb, index finger, long finger, and radial half of the ring finger.
〰〰〰〰〰〰〰〰〰〰〰
🌐 https://t.me/joinchat/De8XUlQZJDf4yxHQlHyFcQ
#answer
✅E
🔎 Explanation:
De Quervain’s tenosynovitis is a cumulative movement disorder due to chronic overuse of the wrist and hand, involving the abductor pollicis longus and extensor pollicis brevis tendons, which share a common tendon sheath. Repeated forceful gripping, grasping, and wringing movements lead to thickening of the tendon sheath and subsequent inflammation and
stenosis of the sheath as it passes over the distal radius. This can progress to fibrosis and loss of flexibility in the thumb in flexion. The condition is more common in pregnancy, after trauma, and with rheumatoid arthritis.
The diagnosis is made by physical examination. There is tenderness over the radial styloid, and resisting thumb extension and abduction will elicit pain. Finkelstein’s test, folding the fingers over the thumb and gently passively deviating the thumb in an ulnar direction, will often cause such pain that the patient will lift the shoulder to prevent the examiner from
stretching the tendon.
⚠→ Other diagnostic considerations include osteoarthritis of the first carpometacarpal joint (choice A), which may also
cause pain over the radial styloid, and a positive Finkelstein’s test. If injecting the site with local anesthetic gives relief, an arthritic etiology can be excluded.
⚠→ Navicular (scaphoid) fracture (choice B) is caused by a fall or a direct blow to the wrist. The symptoms are pain on the thumb side of the wrist, swelling in that area, and difficulty gripping objects.
⚠→ Individuals with radial sensory nerve entrapment (choice C) will have paresthesias over the dorsum of the hand and a positive Tinel’s sign over the nerve in the mid-forearm, just distal to the belly of the brachioradialis muscle. Hyperpronation of the forearm reproduces these symptoms.
⚠→ Carpal tunnel syndrome (choice D) involves entrapment of the median nerve, causing pain in the thumb, index finger, long finger, and radial half of the ring finger.
〰〰〰〰〰〰〰〰〰〰〰
🌐 https://t.me/joinchat/De8XUlQZJDf4yxHQlHyFcQ
👍6
Forwarded from MohammaDJ
#Case_5
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A 6-year-old boy comes to your office for evaluation. He is not doing well in school and has a difficult time finishing his school work in the time allotted. His mother tells you that his teacher is constantly having to redirect him, and that at time he is staring off into space day-dreaming. When you question Mom, she has also noticed that he has recurrent episodes of
brief staring spells. You examine the patient and order an EEG. What is the EEG likely to show?
a) Generalized symmetric 3-per-second spike and wave pattern
b) Generalized, diffuse slowing
c) Hypsarrhythmia
d) Localized spike and wave pattern
〰〰〰〰〰〰〰〰〰〰〰
#pediatrics
🌐 https://t.me/joinchat/De8XUlQZJDf4yxHQlHyFcQ
〰〰〰〰〰〰〰〰〰〰〰
A 6-year-old boy comes to your office for evaluation. He is not doing well in school and has a difficult time finishing his school work in the time allotted. His mother tells you that his teacher is constantly having to redirect him, and that at time he is staring off into space day-dreaming. When you question Mom, she has also noticed that he has recurrent episodes of
brief staring spells. You examine the patient and order an EEG. What is the EEG likely to show?
a) Generalized symmetric 3-per-second spike and wave pattern
b) Generalized, diffuse slowing
c) Hypsarrhythmia
d) Localized spike and wave pattern
〰〰〰〰〰〰〰〰〰〰〰
#pediatrics
🌐 https://t.me/joinchat/De8XUlQZJDf4yxHQlHyFcQ
👍9❤1
Forwarded from MohammaDJ
#Case_5
#answer
✅ A
🔎 Explanation:
The patient described in the clinical vignette most likely has petit mal or absence seizures.
The characteristic EEG pattern for these seizures is the generalized symmetric 3-per-second spike and wave pattern. Petit mal or absence seizures are brief, repetitive episodes associated with alterations in consciousness, and the child is unaware of the episodes. There is usually no post-ictal period and the child quickly returns to the task at hand. Hypsarryhthmia is the characteristic EEG pattern seen in infantile spasm. The two other EEG patterns listed are not specific for any particular disorder.
〰〰〰〰〰〰〰〰〰〰〰
https://t.me/joinchat/De8XUlQZJDf4yxHQlHyFcQ
#answer
✅ A
🔎 Explanation:
The patient described in the clinical vignette most likely has petit mal or absence seizures.
The characteristic EEG pattern for these seizures is the generalized symmetric 3-per-second spike and wave pattern. Petit mal or absence seizures are brief, repetitive episodes associated with alterations in consciousness, and the child is unaware of the episodes. There is usually no post-ictal period and the child quickly returns to the task at hand. Hypsarryhthmia is the characteristic EEG pattern seen in infantile spasm. The two other EEG patterns listed are not specific for any particular disorder.
〰〰〰〰〰〰〰〰〰〰〰
https://t.me/joinchat/De8XUlQZJDf4yxHQlHyFcQ
👍5❤1
Forwarded from MohammaDJ
#Case_6
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A 67-year-old male comes to your office with severe periumbilical abdominal pain, vomiting, and diarrhea which began suddenly several hours ago. His temperature is 37.0°C (98.6°F), blood pressure 110/76 mm Hg, and respirations 28/min. His abdomen is slightly distended, soft, and diffusely tender; bowel sounds are normal. Other findings include clear lungs, a rapid and irregularly irregular heartbeat, and a pale left forearm and hand with no palpable left brachial pulse. Right arm and lower extremity pulses are normal. Urine and stool are both positive for blood on chemical testing. His hemoglobin level is 164 g/L and his WBC count is 25.3 x 10^9/L.The diagnostic imaging procedure most likely to produce a specific diagnosis of his abdominal pain is:
a) Intravenous pyelography (IVP)
b) Sonography of the abdominal aorta
c) A barium enema
d) Celiac and mesenteric arteriography
e) Contrast venography
〰〰〰〰〰〰〰〰〰〰〰
🌐 https://t.me/joinchat/De8XUlQZJDf4yxHQlHyFcQ
〰〰〰〰〰〰〰〰〰〰〰
A 67-year-old male comes to your office with severe periumbilical abdominal pain, vomiting, and diarrhea which began suddenly several hours ago. His temperature is 37.0°C (98.6°F), blood pressure 110/76 mm Hg, and respirations 28/min. His abdomen is slightly distended, soft, and diffusely tender; bowel sounds are normal. Other findings include clear lungs, a rapid and irregularly irregular heartbeat, and a pale left forearm and hand with no palpable left brachial pulse. Right arm and lower extremity pulses are normal. Urine and stool are both positive for blood on chemical testing. His hemoglobin level is 164 g/L and his WBC count is 25.3 x 10^9/L.The diagnostic imaging procedure most likely to produce a specific diagnosis of his abdominal pain is:
a) Intravenous pyelography (IVP)
b) Sonography of the abdominal aorta
c) A barium enema
d) Celiac and mesenteric arteriography
e) Contrast venography
〰〰〰〰〰〰〰〰〰〰〰
🌐 https://t.me/joinchat/De8XUlQZJDf4yxHQlHyFcQ
👍12🤔3
Forwarded from MohammaDJ
#Case_7
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A 37-year-old female presents to your department because complaining of nausea and vomiting for the last 3 days. She has also been having headaches. Physical examination is only remarkable for abdominal distension and BP 165/100 mmHg. Her BP has been high the last 3 months despite treatment with amlodipine that was started at 5 mg once a day and was later increased to 10 mg once a day. Comprehensive metabolic panel reveals:
BUN: 7 mmol/L
Creatinine: 80 micromol/L
Calcium: 2.40 mmol/L
Chloride: 96 mmol/L
Bicarbonate: 31 mmol/L
Glucose test: 5 mmol/L
Potassium test: 2.7 mmol/L
Sodium: 148 mmol/L
Albumin: 42 g/L
What is the most likely diagnosis?
a) Liver cirrhosis
b) Cushing's syndrome
c) Conn's syndrome
d) Pheochromocytoma
e) Addison’s disease
〰〰〰〰〰〰〰〰〰〰〰
🌐 https://t.me/joinchat/De8XUlQZJDf4yxHQlHyFcQ
〰〰〰〰〰〰〰〰〰〰〰
A 37-year-old female presents to your department because complaining of nausea and vomiting for the last 3 days. She has also been having headaches. Physical examination is only remarkable for abdominal distension and BP 165/100 mmHg. Her BP has been high the last 3 months despite treatment with amlodipine that was started at 5 mg once a day and was later increased to 10 mg once a day. Comprehensive metabolic panel reveals:
BUN: 7 mmol/L
Creatinine: 80 micromol/L
Calcium: 2.40 mmol/L
Chloride: 96 mmol/L
Bicarbonate: 31 mmol/L
Glucose test: 5 mmol/L
Potassium test: 2.7 mmol/L
Sodium: 148 mmol/L
Albumin: 42 g/L
What is the most likely diagnosis?
a) Liver cirrhosis
b) Cushing's syndrome
c) Conn's syndrome
d) Pheochromocytoma
e) Addison’s disease
〰〰〰〰〰〰〰〰〰〰〰
🌐 https://t.me/joinchat/De8XUlQZJDf4yxHQlHyFcQ
👍3🤔1