Forwarded from MohammaDJ
#Case_15
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A 62-year-old woman comes to the office because of pain in the left lower quadrant of her abdomen for the past 48 hours. The pain is associated with tenesmus, loss of appetite and a sensation of being febrile. She has a history of long standing irritable bowel symptoms and has not taken any pharmacotherapy.
Vital signs are: temperature 37.3°C (99.2°F), pulse 84/min and regular and respirations 12/min. On physical examination the abdomen is tender in the left lower quadrant; there is no rebound tenderness and bowel sounds are normal. Leukocyte count is 10.2 x10^9/L with 71% segmented neutrophils and 3% band forms. The patient is sent home on a liquid diet and amoxicillin-clavulanate therapy. Three days later she returns because the pain has become worse and she is now having chills.Which of the following is the most appropriate next step?
a) Admit her to the hospital and begin cefoxitin therapy, intravenously
b) Admit her to the hospital and prepare her for an immediate operation
c) Change to clindamycin therapy, orally, and send her home
d) Continue the present course of therapy
e) Do colonoscopy
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👥 MCCEE/MCCQ1,2
━━━━━━━━━━━━━━━━
A 62-year-old woman comes to the office because of pain in the left lower quadrant of her abdomen for the past 48 hours. The pain is associated with tenesmus, loss of appetite and a sensation of being febrile. She has a history of long standing irritable bowel symptoms and has not taken any pharmacotherapy.
Vital signs are: temperature 37.3°C (99.2°F), pulse 84/min and regular and respirations 12/min. On physical examination the abdomen is tender in the left lower quadrant; there is no rebound tenderness and bowel sounds are normal. Leukocyte count is 10.2 x10^9/L with 71% segmented neutrophils and 3% band forms. The patient is sent home on a liquid diet and amoxicillin-clavulanate therapy. Three days later she returns because the pain has become worse and she is now having chills.Which of the following is the most appropriate next step?
a) Admit her to the hospital and begin cefoxitin therapy, intravenously
b) Admit her to the hospital and prepare her for an immediate operation
c) Change to clindamycin therapy, orally, and send her home
d) Continue the present course of therapy
e) Do colonoscopy
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👥 MCCEE/MCCQ1,2
👍4
Forwarded from MohammaDJ
#Case_15
#answer
✅ A
🔎 Explanation:
The patient described has diverticulosis leading to diverticulitis. You must start antibiotics that cover the gram-positive cocci, gram-negative bacilli and anaerobes found in the abdomen. Cefoxitin (choice A) fits the bill.The severity of the inflammatory and infectious processes, as well as the underlying health of the patient, determines the appropriate treatment for patients with diverticulitis. Hospitalization is recommended if patients show signs of significant inflammation, are unable to take oral fluids, are older than 85 years, or have significant comorbid conditions.
These patients should be placed on bowel rest and treated with intravenous fluids and intravenous antibiotics.
⚠ Immediate surgery (choice B) is too aggressive at this point. Most patients with acute diverticulitis respond to
conservative inpatient medical management.
⚠The usual outpatient antibiotic regimen includes ciprofloxacin (500 mg PO twice daily) plus metronidazole (500 mg PO three times daily). For patients intolerant to metronidazole, clindamycin (choice C) may be an acceptable alternative.
⚠ Continuing the present therapy (choice D) is incorrect because the worsening pain and chills imply infection.
⚠ Colonoscopy (choice E) is dangerous in diverticulitis because it can lead to perforation
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🔗 MCCEE/MCCQE1,2
#answer
✅ A
🔎 Explanation:
The patient described has diverticulosis leading to diverticulitis. You must start antibiotics that cover the gram-positive cocci, gram-negative bacilli and anaerobes found in the abdomen. Cefoxitin (choice A) fits the bill.The severity of the inflammatory and infectious processes, as well as the underlying health of the patient, determines the appropriate treatment for patients with diverticulitis. Hospitalization is recommended if patients show signs of significant inflammation, are unable to take oral fluids, are older than 85 years, or have significant comorbid conditions.
These patients should be placed on bowel rest and treated with intravenous fluids and intravenous antibiotics.
⚠ Immediate surgery (choice B) is too aggressive at this point. Most patients with acute diverticulitis respond to
conservative inpatient medical management.
⚠The usual outpatient antibiotic regimen includes ciprofloxacin (500 mg PO twice daily) plus metronidazole (500 mg PO three times daily). For patients intolerant to metronidazole, clindamycin (choice C) may be an acceptable alternative.
⚠ Continuing the present therapy (choice D) is incorrect because the worsening pain and chills imply infection.
⚠ Colonoscopy (choice E) is dangerous in diverticulitis because it can lead to perforation
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🔗 MCCEE/MCCQE1,2
👍4
Forwarded from MohammaDJ
#Case_16
A 40-year-old black female presents to your office complaining of a persistent dry cough for the last 3 months. This seemed to start with a “bad chest cold”. She went to an urgent-care facility 6 weeks ago and the physician prescribed albuterol (Proventil, Ventolin) by metered-dose inhaler empirically for presumed reactive airways disease. This did not help. Now she also reports dyspnea on exertion that is noticeable when walking uphill. She has been taking nitrofurantoin (Macrodantin) for chronic urinary tract infections, but has an otherwise negative history. She works as a legal secretary. On examination, she is tachypneic. There is no cyanosis or clubbing. Her lungs are clear. Her height is 160 cm (63 in) and her weight is 60 kg (132 lb). Office pulmonary function tests reveal a forced vital capacity (FVC) of 1.6 L (average 3.3) and a 1-second forced expiratory volume (FEV1) of 1.4 L (average 2.8). An inhaled bronchodilator produces no improvement in these numbers.Which one of the following is the most likely cause of her problem?
a) Chronic asthma
b) Persistent coughing resulting from a viral respiratory illness
c) Cardiac disease
d) Interstitial lung disease
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👥 MCCEE/MCCQ1,2
A 40-year-old black female presents to your office complaining of a persistent dry cough for the last 3 months. This seemed to start with a “bad chest cold”. She went to an urgent-care facility 6 weeks ago and the physician prescribed albuterol (Proventil, Ventolin) by metered-dose inhaler empirically for presumed reactive airways disease. This did not help. Now she also reports dyspnea on exertion that is noticeable when walking uphill. She has been taking nitrofurantoin (Macrodantin) for chronic urinary tract infections, but has an otherwise negative history. She works as a legal secretary. On examination, she is tachypneic. There is no cyanosis or clubbing. Her lungs are clear. Her height is 160 cm (63 in) and her weight is 60 kg (132 lb). Office pulmonary function tests reveal a forced vital capacity (FVC) of 1.6 L (average 3.3) and a 1-second forced expiratory volume (FEV1) of 1.4 L (average 2.8). An inhaled bronchodilator produces no improvement in these numbers.Which one of the following is the most likely cause of her problem?
a) Chronic asthma
b) Persistent coughing resulting from a viral respiratory illness
c) Cardiac disease
d) Interstitial lung disease
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👥 MCCEE/MCCQ1,2
👍7
Forwarded from MohammaDJ
#Case_16
#answer
✅ D
🔎 Explanation:
This patient has a reduced FVC with an FEV1/FVC ratio of 87.5%. This is consistent with moderately severe pulmonary restriction. Most likely the patient has chronic interstitial restrictive lung disease. Nitrofurantoin can cause this picture, usually after continuous treatment for 6 or more months, and pulmonary function may be impaired permanently. A wide variety of additional causes have been described including noxious gases, pulmonary hypersensitivities, neoplasia, and systemic diseases (e.g., sarcoidosis). Management includes avoidance of the offending agent or treatment of the underlying condition.
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🔗 MCCEE/MCCQE1,2
#answer
✅ D
🔎 Explanation:
This patient has a reduced FVC with an FEV1/FVC ratio of 87.5%. This is consistent with moderately severe pulmonary restriction. Most likely the patient has chronic interstitial restrictive lung disease. Nitrofurantoin can cause this picture, usually after continuous treatment for 6 or more months, and pulmonary function may be impaired permanently. A wide variety of additional causes have been described including noxious gases, pulmonary hypersensitivities, neoplasia, and systemic diseases (e.g., sarcoidosis). Management includes avoidance of the offending agent or treatment of the underlying condition.
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🔗 MCCEE/MCCQE1,2
Forwarded from MohammaDJ
#Case_17
A 65-year-old white female presents with symptoms and signs of intermittent claudication. She has a history of increasing angina pectoris leading to coronary artery bypass surgery three years ago. She has generally done well since the surgery, and you have provided appropriate medical management forpostoperative coronary artery disease. She has reduced her cigarette smoking, but still smokes and leads a sedentary lifestyle.In addition to emphasizing smoking cessation and recommending an exercise program, which one of the following would be most effective for managing this patient’s claudication?
a) Clopidogrel
b) Aspirin + Clopidogrel
c) Pentoxifylline
d) Ginkgo biloba
e) Percutaneous intervention
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👥 MCCEE/MCCQ1,2
A 65-year-old white female presents with symptoms and signs of intermittent claudication. She has a history of increasing angina pectoris leading to coronary artery bypass surgery three years ago. She has generally done well since the surgery, and you have provided appropriate medical management forpostoperative coronary artery disease. She has reduced her cigarette smoking, but still smokes and leads a sedentary lifestyle.In addition to emphasizing smoking cessation and recommending an exercise program, which one of the following would be most effective for managing this patient’s claudication?
a) Clopidogrel
b) Aspirin + Clopidogrel
c) Pentoxifylline
d) Ginkgo biloba
e) Percutaneous intervention
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👥 MCCEE/MCCQ1,2
👍2❤1
Forwarded from MohammaDJ
#Case_17
#answer
✅ A
🔎 Explanation:
For patients with asymptomatic PAD with an ABI < 0.9, low-dose ASA (75-162 mg daily) may be considered for those at high risk because of associated atherosclerotic risk factors in the absence of risk factors for bleeding (Class IIb, Level C). For patients with symptomatic PAD without overt CAD or cerebrovascular disease, low-dose ASA (75-162 mg daily) or clopidogrel 75 mg daily (choice A) is recommended providing the risk for bleeding is low (Class IIb, Level B). The choice of drug may depend on patient preference and cost considerations. For patients allergic or intolerant to ASA, use of clopidogrel is suggested (Class IIa, Level B). For patients with intermittent claudication, dipyridamole should not be used in addition to ASA (Class III, Level C).
⚠ For patients with intermittent claudication, using clopidogrel 75 mg daily in addition to ASA 75-162 mg daily (choice B) is not recommended unless the patient is judged to be at high vascular risk along with a low risk of bleeding.
⚠ Neither pentoxifylline (choice C) nor ginkgo biloba (choice D), a dietary supplement with antiplatelet, vasodilating, and antioxidant activity, has been shown to be more effective than placebo. At best, they would be a weak intervention for peripheral artery disease.
⚠ If the patient has been compliant with risk reduction strategies, yet six months to a year of exercise therapy and adjunctive pharmacotherapy have failed to provide satisfactory improvement, referral for possible intervention (choice E) can be suggested.
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🔗 MCCEE/MCCQE1,2
#answer
✅ A
🔎 Explanation:
For patients with asymptomatic PAD with an ABI < 0.9, low-dose ASA (75-162 mg daily) may be considered for those at high risk because of associated atherosclerotic risk factors in the absence of risk factors for bleeding (Class IIb, Level C). For patients with symptomatic PAD without overt CAD or cerebrovascular disease, low-dose ASA (75-162 mg daily) or clopidogrel 75 mg daily (choice A) is recommended providing the risk for bleeding is low (Class IIb, Level B). The choice of drug may depend on patient preference and cost considerations. For patients allergic or intolerant to ASA, use of clopidogrel is suggested (Class IIa, Level B). For patients with intermittent claudication, dipyridamole should not be used in addition to ASA (Class III, Level C).
⚠ For patients with intermittent claudication, using clopidogrel 75 mg daily in addition to ASA 75-162 mg daily (choice B) is not recommended unless the patient is judged to be at high vascular risk along with a low risk of bleeding.
⚠ Neither pentoxifylline (choice C) nor ginkgo biloba (choice D), a dietary supplement with antiplatelet, vasodilating, and antioxidant activity, has been shown to be more effective than placebo. At best, they would be a weak intervention for peripheral artery disease.
⚠ If the patient has been compliant with risk reduction strategies, yet six months to a year of exercise therapy and adjunctive pharmacotherapy have failed to provide satisfactory improvement, referral for possible intervention (choice E) can be suggested.
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🔗 MCCEE/MCCQE1,2
👍1
Forwarded from MohammaDJ
#Case_18
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A 53-year-old male accountant comes to your office with progressive facial weakness on the left side that began yesterday. He also reports pain behind the left ear and decreased lacrimation from the left eye. He has been in good health and had his yearly physical examination 1 week ago, which was normal. His lipid levels, chemistry profile, and CBC were all normal. He has not been involved in any outdoor activities, nor does he engage in any high-risk sexual behavior.On examination, there is flattening of the left nasolabial fold and decreased ability to close the left eye. The mouth appears to be drawn to the right. The remainder of his general examination and neurologic examination are normal.Which one of the following would be the most appropriate management at this time?
a) Carotid ultrasonography
b) High-resolution CT
c) MRI with gadolinium enhancement
d) Aspirin and observation
e) Prednisone and valacyclovir (Valtrex)
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👥 MCCEE/MCCQ1,2
━━━━━━━━━━━━━━━━
A 53-year-old male accountant comes to your office with progressive facial weakness on the left side that began yesterday. He also reports pain behind the left ear and decreased lacrimation from the left eye. He has been in good health and had his yearly physical examination 1 week ago, which was normal. His lipid levels, chemistry profile, and CBC were all normal. He has not been involved in any outdoor activities, nor does he engage in any high-risk sexual behavior.On examination, there is flattening of the left nasolabial fold and decreased ability to close the left eye. The mouth appears to be drawn to the right. The remainder of his general examination and neurologic examination are normal.Which one of the following would be the most appropriate management at this time?
a) Carotid ultrasonography
b) High-resolution CT
c) MRI with gadolinium enhancement
d) Aspirin and observation
e) Prednisone and valacyclovir (Valtrex)
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👥 MCCEE/MCCQ1,2
🤔1
Forwarded from MohammaDJ
#Case_18
#answer
✅ E
🔎 Explanation:
Acute partial or complete paralysis of the peripheral facial nerves is called Bell’s palsy. The etiology is still unknown, but it could be genetic, metabolic, autoimmune, vascular, entrapment, or infectious. There is reasonable evidence indicating that the condition may be due to reactivation of herpes simplex virus, resulting in a viral-induced neuritis.Associated infections may be viral (herpes simplex, herpes zoster, HIV, mumps, adenovirus, coxsackievirus, polio, Epstein-Barr virus, influenza) or bacterial (otitis media, Lyme disease, syphilis, leprosy). Women who are pregnant have a risk three times higher than that of nonpregnant women. Sarcoidosis, multiple sclerosis, and post-infectious demyelination are other possibilities. Hypertension, diabetes mellitus, and hypothyroidism may be risk factors, but are probably not etiologic agents.The key diagnostic point is determining the time of onset. If the onset occurs over a day or two and maximal paralysis is reached in 3 weeks or less, it is likely a Bell’s palsy. A prolonged, slowly progressive, or relapsing course suggests tumor,especially if there is no recovery. Examination for middle ear disease and checking for parotid masses should be part of the evaluation.Tests may be necessary if the etiologies noted above have been ruled out. There is some evidence to show that treatment with prednisone and an antiviral agent such as valacyclovir is beneficial
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🔗 MCCEE/MCCQE1,2
#answer
✅ E
🔎 Explanation:
Acute partial or complete paralysis of the peripheral facial nerves is called Bell’s palsy. The etiology is still unknown, but it could be genetic, metabolic, autoimmune, vascular, entrapment, or infectious. There is reasonable evidence indicating that the condition may be due to reactivation of herpes simplex virus, resulting in a viral-induced neuritis.Associated infections may be viral (herpes simplex, herpes zoster, HIV, mumps, adenovirus, coxsackievirus, polio, Epstein-Barr virus, influenza) or bacterial (otitis media, Lyme disease, syphilis, leprosy). Women who are pregnant have a risk three times higher than that of nonpregnant women. Sarcoidosis, multiple sclerosis, and post-infectious demyelination are other possibilities. Hypertension, diabetes mellitus, and hypothyroidism may be risk factors, but are probably not etiologic agents.The key diagnostic point is determining the time of onset. If the onset occurs over a day or two and maximal paralysis is reached in 3 weeks or less, it is likely a Bell’s palsy. A prolonged, slowly progressive, or relapsing course suggests tumor,especially if there is no recovery. Examination for middle ear disease and checking for parotid masses should be part of the evaluation.Tests may be necessary if the etiologies noted above have been ruled out. There is some evidence to show that treatment with prednisone and an antiviral agent such as valacyclovir is beneficial
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🔗 MCCEE/MCCQE1,2
Forwarded from MohammaDJ
#Case_19
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A 31-year-old male with type 1 diabetes mellitus is admitted to the hospital with diabetic ketoacidosis and pneumonia.
After initial treatment in the emergency department with intravenous fluids and insulin, laboratory tests reveal a serum phosphate level of 0.80 mmol/L. He is asymptomatic except for related pneumonia symptoms.Which one of the following would be appropriate management of this patient’s low serum phosphate level?
a) No therapy
b) Oral phosphate replacement, 2.5-3.5 g/day in divided doses
c) Oral phosphatereplacement, 2.5-3.5 g/day in divided doses, and oral vitaminD supplementation, 400-800 IU/day
d) Intravenous phosphate replacement, 0.08-0.16 mmol/kg over 6 hours
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👥 MCCEE/MCCQ1,2
━━━━━━━━━━━━━━━━
A 31-year-old male with type 1 diabetes mellitus is admitted to the hospital with diabetic ketoacidosis and pneumonia.
After initial treatment in the emergency department with intravenous fluids and insulin, laboratory tests reveal a serum phosphate level of 0.80 mmol/L. He is asymptomatic except for related pneumonia symptoms.Which one of the following would be appropriate management of this patient’s low serum phosphate level?
a) No therapy
b) Oral phosphate replacement, 2.5-3.5 g/day in divided doses
c) Oral phosphatereplacement, 2.5-3.5 g/day in divided doses, and oral vitaminD supplementation, 400-800 IU/day
d) Intravenous phosphate replacement, 0.08-0.16 mmol/kg over 6 hours
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👥 MCCEE/MCCQ1,2
👍3
Forwarded from MohammaDJ
#Case_19
#answer
✅ A
🔎 Explanation:
Symptomatic hypophosphatemia rarely occurs unless serum phosphate levels are below 0.64 mmol/L. Serious symptoms, including rhabdomyolysis, do not occur until serum phosphate concentrations fall below 0.32 mmol/L. Thus, treatment of hypophosphatemia with phosphate levels greater than or equal to 0.64 mmol/L is targeted at an underlying etiology.Hypophosphatemia in diabetic ketoacidosis cases is related to the internal redistribution of phosphate from extracellular fluid during treatment, and will resolve when normal dietary intake resumes (choice A).
⚠ Phosphate supplementation (choice B and choice C) in this setting has not been shown to be beneficial.
⚠ Intravenous administration (choice D) of phosphate can be dangerous, resulting in the precipitation of calcium and producing the adverse effects of hypocalcemia, renal failure, and possibly fatal arrhythmias
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🔗 MCCEE/MCCQE1,2
#answer
✅ A
🔎 Explanation:
Symptomatic hypophosphatemia rarely occurs unless serum phosphate levels are below 0.64 mmol/L. Serious symptoms, including rhabdomyolysis, do not occur until serum phosphate concentrations fall below 0.32 mmol/L. Thus, treatment of hypophosphatemia with phosphate levels greater than or equal to 0.64 mmol/L is targeted at an underlying etiology.Hypophosphatemia in diabetic ketoacidosis cases is related to the internal redistribution of phosphate from extracellular fluid during treatment, and will resolve when normal dietary intake resumes (choice A).
⚠ Phosphate supplementation (choice B and choice C) in this setting has not been shown to be beneficial.
⚠ Intravenous administration (choice D) of phosphate can be dangerous, resulting in the precipitation of calcium and producing the adverse effects of hypocalcemia, renal failure, and possibly fatal arrhythmias
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🔗 MCCEE/MCCQE1,2
👍1
Forwarded from MohammaDJ
#Case_20
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A 77-year-old woman develops acute hoarseness, difficulty swallowing, dizziness, and falling to the right side. On examination, there is decreased sensation to pain on the right side of her face and left side of her body. The palate and pharynx move very little on the right side, and there is loss of coordination of the right arm and leg. Motor power in the arms and legs is normal. While attempting to walk, she falls to the right side, and complains of vertigo. An MRI scan confirms the diagnosis of the ischemic stroke. Which of the following is the most likely location of the stroke?
(A) right medial medulla
(B) right lateral medulla
(C) right internal capsule
(D) right parietal cortex
(E) right cerebellum
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👥 MCCEE/MCCQ1,2
━━━━━━━━━━━━━━━━
A 77-year-old woman develops acute hoarseness, difficulty swallowing, dizziness, and falling to the right side. On examination, there is decreased sensation to pain on the right side of her face and left side of her body. The palate and pharynx move very little on the right side, and there is loss of coordination of the right arm and leg. Motor power in the arms and legs is normal. While attempting to walk, she falls to the right side, and complains of vertigo. An MRI scan confirms the diagnosis of the ischemic stroke. Which of the following is the most likely location of the stroke?
(A) right medial medulla
(B) right lateral medulla
(C) right internal capsule
(D) right parietal cortex
(E) right cerebellum
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👥 MCCEE/MCCQ1,2
Forwarded from MohammaDJ
#Case_20
#answer
✅ B
🔎 Explanation:
The lateral medullary syndrome (also known as Wallenberg syndrome) causes ipsilateral numbness but also contralateral involvement of pain and thermal sense by affecting the spinothalamic tract. It can be caused by occlusion of the vertebral arteries; posterior-inferior cerebellar arteries; and superior, middle, or inferior medullary arteries. Ipsilateral ataxia and falling to the side of the lesion are common. Ipsilateral paralysis of the tongue is characteristic of medial medullary syndrome, which also causes contralateral paralysis of arm and leg. Paralysis of the body is not characteristic of lateral medullary syndrome, but ipsilateral paralysis of palate and vocal cord does occur. Ipsilateral Horner syndrome, nystagmus, diplopia, vettigo, nausea, and vomiting are characteristic.
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🔗 MCCEE/MCCQE1,2
#answer
✅ B
🔎 Explanation:
The lateral medullary syndrome (also known as Wallenberg syndrome) causes ipsilateral numbness but also contralateral involvement of pain and thermal sense by affecting the spinothalamic tract. It can be caused by occlusion of the vertebral arteries; posterior-inferior cerebellar arteries; and superior, middle, or inferior medullary arteries. Ipsilateral ataxia and falling to the side of the lesion are common. Ipsilateral paralysis of the tongue is characteristic of medial medullary syndrome, which also causes contralateral paralysis of arm and leg. Paralysis of the body is not characteristic of lateral medullary syndrome, but ipsilateral paralysis of palate and vocal cord does occur. Ipsilateral Horner syndrome, nystagmus, diplopia, vettigo, nausea, and vomiting are characteristic.
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🔗 MCCEE/MCCQE1,2
👍3
Forwarded from MohammaDJ
#Case_21
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A 9-mo-old child is brought to the emergency room by her parents. They state the child has been irritable for the last several days and progressively lethargic. The infant vomited several times in the car on the way to the hospital. The parents state that the infant has not been previously ill. They deny any history of trauma or accidental ingestion of medication or poisons. On physical examination, the child is lethargic and difficult to arouse. Her vital signs are normal. There is no evidence of external trauma, but retinal hemorrhages are visible on funduscopic examination. Her fontanel is bulging. Which of the following is the most likely diagnosis?
a. Bacterial meningitis
b. Oligodendroglioma
c. DiGeorge syndrome
d. Fetal alcohol syndrome
e. Shaken baby syndrome
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👥 MCCEE/MCCQ1,2
━━━━━━━━━━━━━━━━
A 9-mo-old child is brought to the emergency room by her parents. They state the child has been irritable for the last several days and progressively lethargic. The infant vomited several times in the car on the way to the hospital. The parents state that the infant has not been previously ill. They deny any history of trauma or accidental ingestion of medication or poisons. On physical examination, the child is lethargic and difficult to arouse. Her vital signs are normal. There is no evidence of external trauma, but retinal hemorrhages are visible on funduscopic examination. Her fontanel is bulging. Which of the following is the most likely diagnosis?
a. Bacterial meningitis
b. Oligodendroglioma
c. DiGeorge syndrome
d. Fetal alcohol syndrome
e. Shaken baby syndrome
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👥 MCCEE/MCCQ1,2
🤔1
Forwarded from MohammaDJ
#Case_21
#answer
✅ E
🔎 Explanation
Retinal hemonhages with no evidence of external trauma along with a history of initability, lethargy, volniting, and a bulging fontanel suggest increased intracranial pressure from a chronic subdural hematoma or "shaken baby syndrome." Increased head circumference is also suggestive of increased intracranial pressure. DiGeorge syndrome is a congenital disorder; infants present with cardiac defects, tetany from hypocalcelnia secondary to an tmderdeveloped parathyroid gland, facial abnormalities, and thymus gland maldevelopment causing an isolated T-cell deficiency. Oligodendroglioma commonly involves the temporal lobe, and patients often present with seizures. Fetal alcohol syndrome is the number one cause of congenital malformations. Infants are born with developmental retardation and facial, heart, lung, and limb abnormalities
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🔗 MCCEE/MCCQE1,2
#answer
✅ E
🔎 Explanation
Retinal hemonhages with no evidence of external trauma along with a history of initability, lethargy, volniting, and a bulging fontanel suggest increased intracranial pressure from a chronic subdural hematoma or "shaken baby syndrome." Increased head circumference is also suggestive of increased intracranial pressure. DiGeorge syndrome is a congenital disorder; infants present with cardiac defects, tetany from hypocalcelnia secondary to an tmderdeveloped parathyroid gland, facial abnormalities, and thymus gland maldevelopment causing an isolated T-cell deficiency. Oligodendroglioma commonly involves the temporal lobe, and patients often present with seizures. Fetal alcohol syndrome is the number one cause of congenital malformations. Infants are born with developmental retardation and facial, heart, lung, and limb abnormalities
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🔗 MCCEE/MCCQE1,2
👍1
Forwarded from MohammaDJ
#Case_22
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During a comprehensive health evaluation a 65-year-old black male reports mild, very tolerable symptoms of benign prostatic hyperplasia. He has never smoked, and his medical history is otherwise unremarkable. Objective findings include an enlarged prostate that is firm and nontender, with no nodules. A urinalysis is normal and his prostate-specific antigen level is 1.8 ng/mL. Based on current evidence, which one of the following treatment options is most appropriate at this time?
a) Observation, with repeat evaluation in 1 year
b) Saw palmetto
c) An alpha-receptor antagonist
d) A 5-alpha-reductase inhibitor
e) Urologic referral for transurethral resection of the prostate
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👥 MCCEE/MCCQ1,2
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During a comprehensive health evaluation a 65-year-old black male reports mild, very tolerable symptoms of benign prostatic hyperplasia. He has never smoked, and his medical history is otherwise unremarkable. Objective findings include an enlarged prostate that is firm and nontender, with no nodules. A urinalysis is normal and his prostate-specific antigen level is 1.8 ng/mL. Based on current evidence, which one of the following treatment options is most appropriate at this time?
a) Observation, with repeat evaluation in 1 year
b) Saw palmetto
c) An alpha-receptor antagonist
d) A 5-alpha-reductase inhibitor
e) Urologic referral for transurethral resection of the prostate
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👥 MCCEE/MCCQ1,2
👍1
Forwarded from MohammaDJ
#Case_22
#answer
✅ A
🔎 Explanation
Watchful waiting with annual follow-up (choice A) is appropriate for men with mild benign prostatic hyperplasia (BPH). Prostate-specific antigen (PSA) levels correlate with prostate volume, which may affect the treatment of choice, if indicated. PSA levels > 2.0 ng/mL for men in their 60s correlate with a prostatic volume > 40 mL. This patient’s PSA falls below this level.
⚠ A recent high-quality, randomized, controlled trial found no benefit from saw palmetto (choice B) with regard to symptom relief or urinary flow after 1 year of therapy. The current guidelines do not recommend the use of phytotherapy for BPH.
⚠Alpha-blockers (choice C) provide symptomatic relief in men whose disease has progressed to the point that they have moderate to severe BPH symptoms.
⚠In men with a prostatic volume > 40 mL, 5 alpha-reductase inhibitors (choice D) should be considered for treatment.
⚠ Surgical consultation (choice E) is appropriate when medical therapy fails or the patient develops refractory urinary retention, persistent hematuria, or bladder stones.
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🔗 MCCEE/MCCQE1,2
#answer
✅ A
🔎 Explanation
Watchful waiting with annual follow-up (choice A) is appropriate for men with mild benign prostatic hyperplasia (BPH). Prostate-specific antigen (PSA) levels correlate with prostate volume, which may affect the treatment of choice, if indicated. PSA levels > 2.0 ng/mL for men in their 60s correlate with a prostatic volume > 40 mL. This patient’s PSA falls below this level.
⚠ A recent high-quality, randomized, controlled trial found no benefit from saw palmetto (choice B) with regard to symptom relief or urinary flow after 1 year of therapy. The current guidelines do not recommend the use of phytotherapy for BPH.
⚠Alpha-blockers (choice C) provide symptomatic relief in men whose disease has progressed to the point that they have moderate to severe BPH symptoms.
⚠In men with a prostatic volume > 40 mL, 5 alpha-reductase inhibitors (choice D) should be considered for treatment.
⚠ Surgical consultation (choice E) is appropriate when medical therapy fails or the patient develops refractory urinary retention, persistent hematuria, or bladder stones.
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🔗 MCCEE/MCCQE1,2
❤1👍1
Forwarded from MohammaDJ
#Case_23
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A 25-year-old graduate student is visiting his parents during fall break when he develops an acute headache, fever, and rash. When you see him in your office, he has a widespread petechial rash and a stiff neck, and his blood pressure is 78/40 mm Hg. You start intravenous fluids and ceftriaxone (rocephin) and call for emergency transport. The patient dies shortly after arrival at the hospital's emergency department. The spinal fluid from a tap done just before his death reveals a large number of polynuclear leukocytes and gram-negative diplococci.Which one of the following is true regarding control measures for this disease?
a) Throat and nasopharyngeal cultures of contracts should be performed, and persons with positive cultures treated
b) Since this case likely represents a sporadic one, no contacts in your community should receive prophylaxis
c) Since the attack rate of this disease in household contacts is only slightly higher than that of the general population, these contacts should not receive prophylaxis
d) Immunoprophylaxis with a seragroup-specific, multivalent vaccine is the management of choice for those who need treatment
e) When chemoprophylaxis is indicated, ciprofloxacin (Cipro) is an acceptable agent
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👥 MCCEE/MCCQ1,2
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A 25-year-old graduate student is visiting his parents during fall break when he develops an acute headache, fever, and rash. When you see him in your office, he has a widespread petechial rash and a stiff neck, and his blood pressure is 78/40 mm Hg. You start intravenous fluids and ceftriaxone (rocephin) and call for emergency transport. The patient dies shortly after arrival at the hospital's emergency department. The spinal fluid from a tap done just before his death reveals a large number of polynuclear leukocytes and gram-negative diplococci.Which one of the following is true regarding control measures for this disease?
a) Throat and nasopharyngeal cultures of contracts should be performed, and persons with positive cultures treated
b) Since this case likely represents a sporadic one, no contacts in your community should receive prophylaxis
c) Since the attack rate of this disease in household contacts is only slightly higher than that of the general population, these contacts should not receive prophylaxis
d) Immunoprophylaxis with a seragroup-specific, multivalent vaccine is the management of choice for those who need treatment
e) When chemoprophylaxis is indicated, ciprofloxacin (Cipro) is an acceptable agent
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👥 MCCEE/MCCQ1,2
🤔1
Forwarded from MohammaDJ
#Case_23
#answer
✅ E
🔎 Explanation
The patient died of presumed Neisseria meningitidis septicemia and meningitis. Only high-risk contacts should receive prophylaxis. Throat and nasopharyngeal cultures are of no value for deciding who should receive prophylaxis. Close contacts of patients with invasive disease, whether it is a sporadic case or part of an outbreak, are at high risk and should receive prophylaxis within 24 hours of the diagnosis of the primary case. The attack rate for household contacts is > 300 times higher than the rate in the general population. If the serogroup identified is contained in the vaccine (A, C, Y, or W-135), immunoprophylaxis may be useful as a secondary control measure. However, chemoprophylaxis is considered the primary treatment option.Ciprofloxacin is an acceptable form of chemoprophylaxis for N. meningitidis in adults. It is not recommended for persons < 18 years of age or pregnant women.
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🔗 MCCEE/MCCQE1,2
#answer
✅ E
🔎 Explanation
The patient died of presumed Neisseria meningitidis septicemia and meningitis. Only high-risk contacts should receive prophylaxis. Throat and nasopharyngeal cultures are of no value for deciding who should receive prophylaxis. Close contacts of patients with invasive disease, whether it is a sporadic case or part of an outbreak, are at high risk and should receive prophylaxis within 24 hours of the diagnosis of the primary case. The attack rate for household contacts is > 300 times higher than the rate in the general population. If the serogroup identified is contained in the vaccine (A, C, Y, or W-135), immunoprophylaxis may be useful as a secondary control measure. However, chemoprophylaxis is considered the primary treatment option.Ciprofloxacin is an acceptable form of chemoprophylaxis for N. meningitidis in adults. It is not recommended for persons < 18 years of age or pregnant women.
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🔗 MCCEE/MCCQE1,2
👍1
Forwarded from MohammaDJ
#Case_24
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A 40-year-old white female complains of discomfort in her anterior neck. She also gives a history of malaise, low-grade fever, and a tender thyroid gland.Laboratory Findings:
WBCs: 12.1 x 10^9/L
Granulocytes: 30% (N 42-75)
Monocytes: 4% (N 2-9)
Lymphocytes: 66% (N 20-51)
Free thyroxine (FT4): 36 pmol/L,
Erythrocyte sedimendation rate (Westergren): 60 mm/hr (N 0-20)
Which one of the following would most likely be seen on a thyroid nuclear medicine study?
a) Slightly increased uptake
b) Normal uptake
c) Markedly decreased radioactive iodine uptake
d) A single hot node
e) Multiple cold areas
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👥 MCCEE/MCCQ1,2
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A 40-year-old white female complains of discomfort in her anterior neck. She also gives a history of malaise, low-grade fever, and a tender thyroid gland.Laboratory Findings:
WBCs: 12.1 x 10^9/L
Granulocytes: 30% (N 42-75)
Monocytes: 4% (N 2-9)
Lymphocytes: 66% (N 20-51)
Free thyroxine (FT4): 36 pmol/L,
Erythrocyte sedimendation rate (Westergren): 60 mm/hr (N 0-20)
Which one of the following would most likely be seen on a thyroid nuclear medicine study?
a) Slightly increased uptake
b) Normal uptake
c) Markedly decreased radioactive iodine uptake
d) A single hot node
e) Multiple cold areas
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👥 MCCEE/MCCQ1,2
👍3🤔1
Forwarded from MohammaDJ
#Case_24
#answer
✅ C
🔎 Explanation
This patient has a clinical presentation typical of subacute thyroiditis. An elevated erythrocyte sedimentation rate is an almost certain feature, and slight leukocytosis may also be seen, as well as a modest degree of thyrototoxicosis and a slightly elevated serum T4 level. A small thyroid gland would be expected on a thyroid scan. Because the disease interferes with iodine metabolism, radioiodine uptake is decreased. Hot, toxic nodules or a multinodular goiter would not be expected. Generalized thyroid enlargement and increased radioactive iodine uptake would be expected with Graves’ disease
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🔗 MCCEE/MCCQE1,2
#answer
✅ C
🔎 Explanation
This patient has a clinical presentation typical of subacute thyroiditis. An elevated erythrocyte sedimentation rate is an almost certain feature, and slight leukocytosis may also be seen, as well as a modest degree of thyrototoxicosis and a slightly elevated serum T4 level. A small thyroid gland would be expected on a thyroid scan. Because the disease interferes with iodine metabolism, radioiodine uptake is decreased. Hot, toxic nodules or a multinodular goiter would not be expected. Generalized thyroid enlargement and increased radioactive iodine uptake would be expected with Graves’ disease
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🔗 MCCEE/MCCQE1,2
Forwarded from MohammaDJ
#Case_25
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A 27 year old white male has been in rehabilitation for C6 complete quadriplegia. His health had been good prior to a diving accident 2 months ago which caused his paralysis. The patient has been catheterized since admission and his recovery has been steady. His vital signs have been normal and stable.The nurse calls and tells you that for the past hour the patient has experienced sweating, rhinorrhea, and a pounding headache. His heart rate is 55/min and his blood pressure is 220/115 mm Hg. His temperature and respirations are reported as normal. There has been no vomiting and his neurologic examination is unchanged. The most likely diagnosis is:
a) Cluster headache
b) Autonomic hyperreflexia
c) Sepsis
d) Intracranial hemorrhage
e) Progression of the spinal cord lesion
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👥 MCCEE/MCCQ1,2
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A 27 year old white male has been in rehabilitation for C6 complete quadriplegia. His health had been good prior to a diving accident 2 months ago which caused his paralysis. The patient has been catheterized since admission and his recovery has been steady. His vital signs have been normal and stable.The nurse calls and tells you that for the past hour the patient has experienced sweating, rhinorrhea, and a pounding headache. His heart rate is 55/min and his blood pressure is 220/115 mm Hg. His temperature and respirations are reported as normal. There has been no vomiting and his neurologic examination is unchanged. The most likely diagnosis is:
a) Cluster headache
b) Autonomic hyperreflexia
c) Sepsis
d) Intracranial hemorrhage
e) Progression of the spinal cord lesion
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👥 MCCEE/MCCQ1,2
👍1