⏳ Case-based MCQ | #Case_328
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A 2-year-old boy is brought to the clinic for evaluation of “acne.” His mother describes a recent onset of pain in his left foot and in his right hand. She says he has been hospitalized once for lymphadenitis, but he has been otherwise healthy. His review of systems is otherwise negative. He as two maternal uncles who died
in childhood from pneumonia. The child is afebrile, with a heart rate of 64/min, blood pressure of 108/70 mm Hg, and respiratory rate of 15/min. Physical examination reveals multiple scarred lesions on his skin, two of which are 1 cm in diameter and filled with purulent material. Pain is elicited by palpation of the purulent lesions, and they are somewhat warm to the touch. From which immunodeficiency disorder is this patient most likely suffering?
(A) Ataxia-telangiectasia
(B) Chédiak-Higashi syndrome
(C) Chronic granulomatous disease
(D) Hyper IgE syndrome
(E) Wiskott-Aldrich syndrome
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A 2-year-old boy is brought to the clinic for evaluation of “acne.” His mother describes a recent onset of pain in his left foot and in his right hand. She says he has been hospitalized once for lymphadenitis, but he has been otherwise healthy. His review of systems is otherwise negative. He as two maternal uncles who died
in childhood from pneumonia. The child is afebrile, with a heart rate of 64/min, blood pressure of 108/70 mm Hg, and respiratory rate of 15/min. Physical examination reveals multiple scarred lesions on his skin, two of which are 1 cm in diameter and filled with purulent material. Pain is elicited by palpation of the purulent lesions, and they are somewhat warm to the touch. From which immunodeficiency disorder is this patient most likely suffering?
(A) Ataxia-telangiectasia
(B) Chédiak-Higashi syndrome
(C) Chronic granulomatous disease
(D) Hyper IgE syndrome
(E) Wiskott-Aldrich syndrome
⏳ Case-based MCQ | #Case_328 | #answer
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✅ C
The patient described in the vignette has chronic granulomatous disease (CGD). Although the presentation of CGD is variable, the diagnosis should be suspected in patients with recurrent lymphadenitis, multiple-site osteomyelitis, cutaneous abscesses (confused with “acne”), hepatic abscesses, a family history of recurrent infections, or unusual infections with catalasepositive organisms such as Staphylococcus aureus or Aspergillus. In many of these cases, the patient is asymptomatic or with much fewer signs and symptoms (e.g., lack of fever) than would otherwise be expected given the infectious burden. The disease is caused by mutations in genes encoding proteins involved in generating a respiratory burst. One of these, phox91, is on the X chromosome, providing an X-linked pattern of inheritance as demonstrated by the family history.
⚠ Answer A is incorrect. Ataxia-telangiectasia is a T-lymphocyte disorder that manifests as oculocutaneous telangiectasias and progressive cerebellar ataxia. It is caused by a DNA repair defect resulting from a mutation in the ATM gene encoding a protein critical for repair of DNA breaks. Ataxia generally begins when the child learns to walk, and the telangiectasias generally become apparent between 3 and 6 years of age.
⚠ Answer B is incorrect. Chédiak-Higashi syndrome includes neutropenia, neuropathy, and oculocutaneous albinism. It is inherited in an autosomal-recessive manner. The disorder is caused by a defect in neutrophil chemotaxis resulting from mutations in the LYST gene required for sorting of lysosomal granule contents. Patients have albinism due to abnormal melanosomes and inappropriate delivery of melanin in the skin.
⚠ Answer D is incorrect. Hyper IgE syndrome (HIES) is characterized by recurrent bacterial infection and cavitating pneumonia. It is typically associated with impaired inflammation giving rise to so-called “cold abscesses.” Although abscesses are found in HIES, granulomas are generally not. Furthermore, HIES occurs in an autosomal dominant or autosomal recessive pattern of inheritance and not in the X-linked pattern suggested by the case history.
⚠ Answer E is incorrect. Wiskott-Aldrich syndrome is an X-linked disorder with B- and T-lymphocyte dysfunction. Affected patients typically present with eczema and thrombocytopenia. Although patients have abnormalities of their skin, these are heralded by petechiae (from the thrombocytopenia) and eczema. The disease results from mutations of the Wiskott-Aldrich syndrome protein (WASp) gene on the X chromosome. WASp is important for rearranging the actin cytoskeleton in immune cells and thus enables responsiveness.
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✅ C
The patient described in the vignette has chronic granulomatous disease (CGD). Although the presentation of CGD is variable, the diagnosis should be suspected in patients with recurrent lymphadenitis, multiple-site osteomyelitis, cutaneous abscesses (confused with “acne”), hepatic abscesses, a family history of recurrent infections, or unusual infections with catalasepositive organisms such as Staphylococcus aureus or Aspergillus. In many of these cases, the patient is asymptomatic or with much fewer signs and symptoms (e.g., lack of fever) than would otherwise be expected given the infectious burden. The disease is caused by mutations in genes encoding proteins involved in generating a respiratory burst. One of these, phox91, is on the X chromosome, providing an X-linked pattern of inheritance as demonstrated by the family history.
⚠ Answer A is incorrect. Ataxia-telangiectasia is a T-lymphocyte disorder that manifests as oculocutaneous telangiectasias and progressive cerebellar ataxia. It is caused by a DNA repair defect resulting from a mutation in the ATM gene encoding a protein critical for repair of DNA breaks. Ataxia generally begins when the child learns to walk, and the telangiectasias generally become apparent between 3 and 6 years of age.
⚠ Answer B is incorrect. Chédiak-Higashi syndrome includes neutropenia, neuropathy, and oculocutaneous albinism. It is inherited in an autosomal-recessive manner. The disorder is caused by a defect in neutrophil chemotaxis resulting from mutations in the LYST gene required for sorting of lysosomal granule contents. Patients have albinism due to abnormal melanosomes and inappropriate delivery of melanin in the skin.
⚠ Answer D is incorrect. Hyper IgE syndrome (HIES) is characterized by recurrent bacterial infection and cavitating pneumonia. It is typically associated with impaired inflammation giving rise to so-called “cold abscesses.” Although abscesses are found in HIES, granulomas are generally not. Furthermore, HIES occurs in an autosomal dominant or autosomal recessive pattern of inheritance and not in the X-linked pattern suggested by the case history.
⚠ Answer E is incorrect. Wiskott-Aldrich syndrome is an X-linked disorder with B- and T-lymphocyte dysfunction. Affected patients typically present with eczema and thrombocytopenia. Although patients have abnormalities of their skin, these are heralded by petechiae (from the thrombocytopenia) and eczema. The disease results from mutations of the Wiskott-Aldrich syndrome protein (WASp) gene on the X chromosome. WASp is important for rearranging the actin cytoskeleton in immune cells and thus enables responsiveness.
❤1👍1
⏳ Case-based MCQ | #Case_329
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A 28 year old type 1 diabetic has intermittent diarrhoea and abdominal bloating over the last 6 months. He also complains of feeling tired all the time. His blood results show the following:
Haemoglobin 135 g/L (130-180 g/L)
Ferritin 30 ng/ml (20-300 ng/ml)
Thyroid stimulating hormone (TSH) 2.5 mU/L (0.5-5.7 mU/L)
Immunoglobulin A (IgA) tissue transglutaminase positive
What is the SINGLE most appropriate next step in action?
A. Duodenal biopsy
B. Colonoscopy
C. Sweat test
D. Thyroid function test
E. Advice patients to go on a gluten-free diet
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
A 28 year old type 1 diabetic has intermittent diarrhoea and abdominal bloating over the last 6 months. He also complains of feeling tired all the time. His blood results show the following:
Haemoglobin 135 g/L (130-180 g/L)
Ferritin 30 ng/ml (20-300 ng/ml)
Thyroid stimulating hormone (TSH) 2.5 mU/L (0.5-5.7 mU/L)
Immunoglobulin A (IgA) tissue transglutaminase positive
What is the SINGLE most appropriate next step in action?
A. Duodenal biopsy
B. Colonoscopy
C. Sweat test
D. Thyroid function test
E. Advice patients to go on a gluten-free diet
⏳ Case-based MCQ | #Case_329 | #answer
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
✅ A
There is an association between type 1 diabetes and coeliac disease.
The gold standard to diagnose coeliac disease is a jejunal/duodenal biopsy.
In the past, small-bowel biopsies for diagnosis of coeliac disease were taken from the jejunum, but nowadays most gastroenterologists take endoscopic biopsies from the distal duodenum.
Coeliac disease is caused by sensitivity to the protein gluten. Repeated exposure leads to villous atrophy which in turn causes malabsorption.
🟣Signs and symptoms
• Chronic or intermittent diarrhoea
• Stinking stools/steatorrhoea
• Persistent or unexplained gastrointestinal symptoms including bloating, nauseaand
vomiting
• Fatigue
• Recurrent abdominal pain, cramping or distension
• Sudden or unexpected weight loss
• Unexplained iron, vitamin B12 or folate deficiency. Note that the one of the most common presentation of coeliac disease is iron deficiency anaemia. Also,folate deficiency is more common than vitamin B12 deficiency in coeliac disease Complications
• osteoporosis
• T-cell lymphoma of small intestine (rare)
🟣Investigation
Diagnosis is made by a combination of immunology and jejunal biopsy. Any test for coeliac disease is accurate only if a gluten-containing diet is eaten during the diagnostic process. The person should not start a gluten-free diet until diagnosis is confirmed.
NICE issued guidelines on the investigation of coeliac disease in 2009. If patients arealready taking a gluten-free diet they should be asked, if possible, to reintroduce
glutenfor at least 6 weeks prior to testing.
🟣Specific auto-antibodies
• Tissue transglutaminase (TTG) antibodies (IgA) are first-choice according to NICE
• Endomysial antibody (IgA)
🟣Jejunal/duodenal biopsy
A biopsy is still needed to diagnose coeliac disease even if antibody test confirm the diagnosis of coeliac disease.
• Villous atrophy
• Crypt hyperplasia
• Increase in intraepithelial lymphocytes
🟣Management
• Gluten-free diet
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
✅ A
There is an association between type 1 diabetes and coeliac disease.
The gold standard to diagnose coeliac disease is a jejunal/duodenal biopsy.
In the past, small-bowel biopsies for diagnosis of coeliac disease were taken from the jejunum, but nowadays most gastroenterologists take endoscopic biopsies from the distal duodenum.
Coeliac disease is caused by sensitivity to the protein gluten. Repeated exposure leads to villous atrophy which in turn causes malabsorption.
🟣Signs and symptoms
• Chronic or intermittent diarrhoea
• Stinking stools/steatorrhoea
• Persistent or unexplained gastrointestinal symptoms including bloating, nauseaand
vomiting
• Fatigue
• Recurrent abdominal pain, cramping or distension
• Sudden or unexpected weight loss
• Unexplained iron, vitamin B12 or folate deficiency. Note that the one of the most common presentation of coeliac disease is iron deficiency anaemia. Also,folate deficiency is more common than vitamin B12 deficiency in coeliac disease Complications
• osteoporosis
• T-cell lymphoma of small intestine (rare)
🟣Investigation
Diagnosis is made by a combination of immunology and jejunal biopsy. Any test for coeliac disease is accurate only if a gluten-containing diet is eaten during the diagnostic process. The person should not start a gluten-free diet until diagnosis is confirmed.
NICE issued guidelines on the investigation of coeliac disease in 2009. If patients arealready taking a gluten-free diet they should be asked, if possible, to reintroduce
glutenfor at least 6 weeks prior to testing.
🟣Specific auto-antibodies
• Tissue transglutaminase (TTG) antibodies (IgA) are first-choice according to NICE
• Endomysial antibody (IgA)
🟣Jejunal/duodenal biopsy
A biopsy is still needed to diagnose coeliac disease even if antibody test confirm the diagnosis of coeliac disease.
• Villous atrophy
• Crypt hyperplasia
• Increase in intraepithelial lymphocytes
🟣Management
• Gluten-free diet
👍4❤1
⏳ Case-based MCQ | #Case_330
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A 10 year old boy has been diagnosed with nephrotic syndrome and started on steroids. 5 days later he presents with flank pain, haematuria and fluctuating urea levels. A diagnosis of renal vein thrombosis is made. What is the SINGLE most likely cause for renal vein thrombosis?
A. Protein C deficiency
B. Vasculitis
C. Loss of antithrombin III
D. High oestrogen levels
E. Stasis
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
A 10 year old boy has been diagnosed with nephrotic syndrome and started on steroids. 5 days later he presents with flank pain, haematuria and fluctuating urea levels. A diagnosis of renal vein thrombosis is made. What is the SINGLE most likely cause for renal vein thrombosis?
A. Protein C deficiency
B. Vasculitis
C. Loss of antithrombin III
D. High oestrogen levels
E. Stasis
Case-based MCQ
⏳ Case-based MCQ | #Case_330 〰〰〰〰〰〰〰〰〰〰〰〰〰〰 A 10 year old boy has been diagnosed with nephrotic syndrome and started on steroids. 5 days later he presents with flank pain, haematuria and fluctuating urea levels. A diagnosis of renal vein thrombosis is made.…
⏳ Case-based MCQ | #Case_330 | #answer
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
✅ C
Nephrotic syndrome is the combination of proteinuria, oedema and hypoalbuminaemia.
Not only is albumin is lost in the urine, anti-coagulation factors are also lost such as antithrombin III. A reduction or deficiency in antithrombin III predisposes patients to venous thromboembolism. Protein C is present in the urine of nephrotic patients and its deficiency can also predispose to venous thromboembolism. However, plasma levels remain within normal limits and it is not thought to be involved in the development of renal vein thrombosis in these patients.
Treatment of a renal vein thrombosis is with anticoagulation. It is unclear why the renal vein is susceptible to thrombosis.
The most common cause of nephrotic syndrome in children is minimal change disease
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✅ C
Nephrotic syndrome is the combination of proteinuria, oedema and hypoalbuminaemia.
Not only is albumin is lost in the urine, anti-coagulation factors are also lost such as antithrombin III. A reduction or deficiency in antithrombin III predisposes patients to venous thromboembolism. Protein C is present in the urine of nephrotic patients and its deficiency can also predispose to venous thromboembolism. However, plasma levels remain within normal limits and it is not thought to be involved in the development of renal vein thrombosis in these patients.
Treatment of a renal vein thrombosis is with anticoagulation. It is unclear why the renal vein is susceptible to thrombosis.
The most common cause of nephrotic syndrome in children is minimal change disease
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⏳ Case-based MCQ | #Case_331
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A 57 year old man with known squamous cell lung carcinoma has chronic right shoulder pain which had been well controlled with oral morphine in the past. He has now, however, been switched to a fentanyl patch to control his pain due to the nausea and vomiting side effects that he experienced from his morphine treatment. The patient claims that a few hours after he was switched to the fentanyl patch and gibven metoclopramide for his vomiting, his neck became weak and stiff. Other than his chronic pain medication, the patient takes no other medication or over-the-counter drugs. What is the SINGLE most likely cause of this patient’s neck stiffness?
A. Malignat hyperthermia
B. Fentanyl patch
C. Hypercalcaemia
D. Metastatic meningitis
E. Side effect of metoclopramide treatment
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
A 57 year old man with known squamous cell lung carcinoma has chronic right shoulder pain which had been well controlled with oral morphine in the past. He has now, however, been switched to a fentanyl patch to control his pain due to the nausea and vomiting side effects that he experienced from his morphine treatment. The patient claims that a few hours after he was switched to the fentanyl patch and gibven metoclopramide for his vomiting, his neck became weak and stiff. Other than his chronic pain medication, the patient takes no other medication or over-the-counter drugs. What is the SINGLE most likely cause of this patient’s neck stiffness?
A. Malignat hyperthermia
B. Fentanyl patch
C. Hypercalcaemia
D. Metastatic meningitis
E. Side effect of metoclopramide treatment
⏳ Case-based MCQ | #Case_331 | #answer
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
✅ E
This patient’s symptoms have everything to do with the fact that he was given metoclopramide for his nausea.
It is important to note that neck stiffness can be communicated as being anything from muscle weakness to muscle pain by the patient.
Extrapyramidal symptoms are most commonly caused by antipsychotic drugs such as
haloperidol. Other anti-dopaminergic drugs, like the antiemetic metoclopramide, can also result in extrapyramidal side effects. Acute dystonic reactions can occur as well, and these occur shortly after treatment with metoclopramide
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
✅ E
This patient’s symptoms have everything to do with the fact that he was given metoclopramide for his nausea.
It is important to note that neck stiffness can be communicated as being anything from muscle weakness to muscle pain by the patient.
Extrapyramidal symptoms are most commonly caused by antipsychotic drugs such as
haloperidol. Other anti-dopaminergic drugs, like the antiemetic metoclopramide, can also result in extrapyramidal side effects. Acute dystonic reactions can occur as well, and these occur shortly after treatment with metoclopramide
👍1
⏳ Case-based MCQ | #Case_332
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A 42 year old lady had corrective surgery for cyanotic congenital heart disease at the age of 3 after having a palliative operation during infancy. On examination, a parasternal heave and a diastolic murmur at the left upper sternal edge is noted. What is the SINGLE most likely diagnosis?
A. Aortic regurgitation
B. Mitral regurgitation
C. Aortic stenosis
D. Pulmonary stenosis
E. Pulmonary regurgitation
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
A 42 year old lady had corrective surgery for cyanotic congenital heart disease at the age of 3 after having a palliative operation during infancy. On examination, a parasternal heave and a diastolic murmur at the left upper sternal edge is noted. What is the SINGLE most likely diagnosis?
A. Aortic regurgitation
B. Mitral regurgitation
C. Aortic stenosis
D. Pulmonary stenosis
E. Pulmonary regurgitation
⏳ Case-based MCQ | #Case_332 | #answer
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
✅ E
Pulmonary regurgitation is a common complication after surgical or percutaneous relief of pulmonary stenosis and following repair of Fallot's tetralogy. Pulmonary regurgitation is usually asymptomatic unless severe, when it may lead to signs of right heart failure. It is possible for patients to live for many decades following surgical repair of tetralogy of Fallot but a major problem encountered is the development of pulmonary regurgitation which may require pulmonary valve replacement.
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✅ E
Pulmonary regurgitation is a common complication after surgical or percutaneous relief of pulmonary stenosis and following repair of Fallot's tetralogy. Pulmonary regurgitation is usually asymptomatic unless severe, when it may lead to signs of right heart failure. It is possible for patients to live for many decades following surgical repair of tetralogy of Fallot but a major problem encountered is the development of pulmonary regurgitation which may require pulmonary valve replacement.
⏳ Case-based MCQ | #Case_333
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A 55 year old woman presents to A&E with the complaint of aching chest pain. She is very nervous and anxious as she thinks that this could be a heart attack. She has no family history of cardiac disease and has no other medical problems. She was given sublingual GTN which has failed to relieve her symptoms. Upon further questioning, she admits that the pain is worse when she breathes in. Her chest X-ray is reported as ‘normal’ and an ECG is performed, which also shows no significant acute changes. Her vitals are as follows:
Temperature: 37.2 °C
Heart rate: 110 beats/minute
Blood pressure: 125/85 mmHg
A full blood count has been done and shows:
Haemoglobin: 12.8 g/dL
Platelets: 320 x 10`9/L
White chell count: 7.8 x 10`9/L
CRP is 10.7 mg/L
What is the SINGLE most likely diagnosis in this patient?
A. Costochondritis
B. Pericarditis
C. Acute coronary syndrome
D. Unstable angina
E. Pneumonia
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
A 55 year old woman presents to A&E with the complaint of aching chest pain. She is very nervous and anxious as she thinks that this could be a heart attack. She has no family history of cardiac disease and has no other medical problems. She was given sublingual GTN which has failed to relieve her symptoms. Upon further questioning, she admits that the pain is worse when she breathes in. Her chest X-ray is reported as ‘normal’ and an ECG is performed, which also shows no significant acute changes. Her vitals are as follows:
Temperature: 37.2 °C
Heart rate: 110 beats/minute
Blood pressure: 125/85 mmHg
A full blood count has been done and shows:
Haemoglobin: 12.8 g/dL
Platelets: 320 x 10`9/L
White chell count: 7.8 x 10`9/L
CRP is 10.7 mg/L
What is the SINGLE most likely diagnosis in this patient?
A. Costochondritis
B. Pericarditis
C. Acute coronary syndrome
D. Unstable angina
E. Pneumonia
👍2
⏳ Case-based MCQ | #Case_333 | #answer
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
✅ A
This patient’s investigations have all returned back normal. The clue here is picking up the fact that her symptoms were not relieved by sublingual GTN. This tells us that it is unlikely ACS or unstable angina although in reality we do not use people’s response to glyceryl trinitrate (GTN) to make a diagnosis. However, this is an exam, and these phrases are sometimes used to inform you that this is not an ischaemic event. In reality, if bloods were requested and taken, a troponin would likely be added in and sent off as well.
The stem also drops another hint letting you know that she has no medical problems. She therefore does NOT have diabetes, hypertension, hypercholesterolaemia or a
smoking history which are risk factors for an acute coronary syndrome. Do not get thrown by the slight tachycardia in the stem as it is likely the result from anxiety of the chest discomfort.
Costochondritis is the answer here and can sometimes mimic symptoms of an acute coronary syndrome. Movements of the rib cage can produce pain. Costochondritis is inflammation of costochondral junctions of ribs or chondrosternal joints of the anterior chest wall. It is sometimes called Tietze’s syndrome, but it is not the same thing. Tietze’s syndrome is the addition of swelling over the affected joints of the anterior chest wall.
🟣COSTOCHONDRITIS
• Usually presents in patients over 40
• Painmay be described as sharp or aching
• The pain is aggravated by movement such as deep inspiration, coughing or
sneezing
• Tenderness to palpation at sides of sternum
The diagnosis is a clinical one and it is a self-limiting disease. Mild pain medication such as non-steroidal anti-inflammatory drugs may be given.
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
✅ A
This patient’s investigations have all returned back normal. The clue here is picking up the fact that her symptoms were not relieved by sublingual GTN. This tells us that it is unlikely ACS or unstable angina although in reality we do not use people’s response to glyceryl trinitrate (GTN) to make a diagnosis. However, this is an exam, and these phrases are sometimes used to inform you that this is not an ischaemic event. In reality, if bloods were requested and taken, a troponin would likely be added in and sent off as well.
The stem also drops another hint letting you know that she has no medical problems. She therefore does NOT have diabetes, hypertension, hypercholesterolaemia or a
smoking history which are risk factors for an acute coronary syndrome. Do not get thrown by the slight tachycardia in the stem as it is likely the result from anxiety of the chest discomfort.
Costochondritis is the answer here and can sometimes mimic symptoms of an acute coronary syndrome. Movements of the rib cage can produce pain. Costochondritis is inflammation of costochondral junctions of ribs or chondrosternal joints of the anterior chest wall. It is sometimes called Tietze’s syndrome, but it is not the same thing. Tietze’s syndrome is the addition of swelling over the affected joints of the anterior chest wall.
🟣COSTOCHONDRITIS
• Usually presents in patients over 40
• Painmay be described as sharp or aching
• The pain is aggravated by movement such as deep inspiration, coughing or
sneezing
• Tenderness to palpation at sides of sternum
The diagnosis is a clinical one and it is a self-limiting disease. Mild pain medication such as non-steroidal anti-inflammatory drugs may be given.
⏳ Case-based MCQ | #Case_334
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A 22 year old woman who was diagnosed with a missed miscarriage a week ago presented to the hospital last night with abdominal pain and vaginal bleeding. Since then, she has passed a small fetus. A transvaginal ultrasound was repeated which showed an empty uterus. The pain is slowly easing off.
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
A 22 year old woman who was diagnosed with a missed miscarriage a week ago presented to the hospital last night with abdominal pain and vaginal bleeding. Since then, she has passed a small fetus. A transvaginal ultrasound was repeated which showed an empty uterus. The pain is slowly easing off.
What is the SINGLE most likely diagnosis?
Anonymous Poll
6%
A. Threatened miscarriage
7%
B. Inevitable miscarriage
22%
C. Incomplete miscarriage
53%
D. Complete miscarriage
12%
E. Spontaneous miscarriage
⏳ Case-based MCQ | #Case_334 | #answer
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
✅ D
Complete miscarriage is a spontaneous abortion with expulsion of the entire fetus through the cervix. Pain and uterine contractions cease after the fetus has been
expelled. An ultrasound scan would show an empty uterus
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
✅ D
Complete miscarriage is a spontaneous abortion with expulsion of the entire fetus through the cervix. Pain and uterine contractions cease after the fetus has been
expelled. An ultrasound scan would show an empty uterus
⏳ Case-based MCQ | #Case_335
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A 33 year old female complains of double vision which started yesterday. On examination, a fixed dilated pupil which does not accommodate and drooping eyelid can be seen on the left eye. Her left eye is displaced outward and downwards. She has no significant past medical history. There was no history of trauma.
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A 33 year old female complains of double vision which started yesterday. On examination, a fixed dilated pupil which does not accommodate and drooping eyelid can be seen on the left eye. Her left eye is displaced outward and downwards. She has no significant past medical history. There was no history of trauma.
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What is the SINGLe most appropriate investigation to perform?
Anonymous Poll
20%
A. Ophthalmoscopy
45%
B. Computed tomographic angiography
15%
C. Thyroid function test
14%
D. Visual field test
5%
E. Red reflex examination
👍1
♠♦♣♥ Get ready to challenge your medical knowledge !
🏟 https://t.me/joinchat/De8XUlQZJDdwKMDv7ZN3ag
🕟 Sat, December 19 at 16.30 GMT
🏟 https://t.me/joinchat/De8XUlQZJDdwKMDv7ZN3ag
🕟 Sat, December 19 at 16.30 GMT
⏳ Case-based MCQ | #Case_335 | #answer
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
✅ B
This is a case of oculomotor nerve palsy. Diplopia, mydriasis, ptosis, outward downward deviation of the eye as described here are clinical features of oculomotor nerve palsy.An oculomotor nerve palsy can be associated with vascular disorders such as diabetes,or particularly posterior communicating artery aneurysm. Other causes include space occupying tumours, infarction. abscess and trauma.
Angiographic imaging studies are often necessary in the evaluation of acute oculomotornerve palsy. A computed tomographic angiography would be a good option here to help exclude a posterior communicating artery aneurysm. Note that this can also be done with a magnetic resonance angiography. MRI would also be useful as it is a more sensitive imaging technique than CT scan for picking out a small intraparenchymal brainstem lesion, such as infarction, small abscess, or tumor however CT scan is more sensitive than MRI to demonstrate subarachnoid hemorrhage. All of these have potential to cause an oculomotor nerve palsy.
Oculomotor nerve palsy
- The initial sign is often a fixed dilated pupil which does not accommodate
- Then ptosis develops
- Unopposed lateral rectus causes outward deviation of the eye. Characteristicdown and out position of the affected eye.
The simple method to remember this for the exam is:
CN III - Oculomotor nerve
- Will have features of either ptosis and/or a dilated pupil on the nerve on the same side as the affected eye
- Mnemonic: Letter “O” for oculomotor which with good imagination canrepresents a dilated pupil
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✅ B
This is a case of oculomotor nerve palsy. Diplopia, mydriasis, ptosis, outward downward deviation of the eye as described here are clinical features of oculomotor nerve palsy.An oculomotor nerve palsy can be associated with vascular disorders such as diabetes,or particularly posterior communicating artery aneurysm. Other causes include space occupying tumours, infarction. abscess and trauma.
Angiographic imaging studies are often necessary in the evaluation of acute oculomotornerve palsy. A computed tomographic angiography would be a good option here to help exclude a posterior communicating artery aneurysm. Note that this can also be done with a magnetic resonance angiography. MRI would also be useful as it is a more sensitive imaging technique than CT scan for picking out a small intraparenchymal brainstem lesion, such as infarction, small abscess, or tumor however CT scan is more sensitive than MRI to demonstrate subarachnoid hemorrhage. All of these have potential to cause an oculomotor nerve palsy.
Oculomotor nerve palsy
- The initial sign is often a fixed dilated pupil which does not accommodate
- Then ptosis develops
- Unopposed lateral rectus causes outward deviation of the eye. Characteristicdown and out position of the affected eye.
The simple method to remember this for the exam is:
CN III - Oculomotor nerve
- Will have features of either ptosis and/or a dilated pupil on the nerve on the same side as the affected eye
- Mnemonic: Letter “O” for oculomotor which with good imagination canrepresents a dilated pupil
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⏳ Case-based MCQ | #Case_336
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A 2 year old child wasbrought by his mother with swelling on the right side of his neck extending from the angle of the mouth to the middle one third of the sternocleidomastoid muscle. The swelling is on the anterolateral side of the sternocleidomastoid muscle. On examination, the mass is partially compressible, when subjected to light test is brilliantly translucent.
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A 2 year old child wasbrought by his mother with swelling on the right side of his neck extending from the angle of the mouth to the middle one third of the sternocleidomastoid muscle. The swelling is on the anterolateral side of the sternocleidomastoid muscle. On examination, the mass is partially compressible, when subjected to light test is brilliantly translucent.