What is the SINGLE most likely diagnosis?
Anonymous Poll
39%
A. Lymphangioma
30%
B. Branchial cyst
15%
C. Thyroglossal cyst
7%
D. Ranula
8%
E. Graves’ disease
⏳ Case-based MCQ | #Case_336 | #answer
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✅ A
Both lymphangioma and branchial cyst are lateral neck masses. Branchial cysts are not translucent whereas lymphangioma when subjected to light test is brilliantly translucent.
Lymphangiomas
Lymphangiomas are uncommon, hamartomatous, congenital malformations of the lymphatic system that involve the skin and subcutaneous tissues. It occurs as a result of sequestration or obstruction of developing lymph vessels in approximately 1 in 12,000 births. Lymphangiomas can occur anywhere in the skin and the mucous membranes. The most common sites are the head and the neck especially in the posterior triangle of the neck. The cysts are lined by endothelium and filled with lymph. Occasionally unilocular cysts occur, but more often there are multiple cysts infiltrating the surrounding structures and distorting the local anatomy. The mass may be apparent at birth or may appear and enlarge rapidly in the early weeks or months of life as lymph accumulates; most present by age 2 years. (90% of lymphangioma occur in children less than 2 years) Lymphangiomas are soft and nontender and when subjected to light test was brilliantly translucent.
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
✅ A
Both lymphangioma and branchial cyst are lateral neck masses. Branchial cysts are not translucent whereas lymphangioma when subjected to light test is brilliantly translucent.
Lymphangiomas
Lymphangiomas are uncommon, hamartomatous, congenital malformations of the lymphatic system that involve the skin and subcutaneous tissues. It occurs as a result of sequestration or obstruction of developing lymph vessels in approximately 1 in 12,000 births. Lymphangiomas can occur anywhere in the skin and the mucous membranes. The most common sites are the head and the neck especially in the posterior triangle of the neck. The cysts are lined by endothelium and filled with lymph. Occasionally unilocular cysts occur, but more often there are multiple cysts infiltrating the surrounding structures and distorting the local anatomy. The mass may be apparent at birth or may appear and enlarge rapidly in the early weeks or months of life as lymph accumulates; most present by age 2 years. (90% of lymphangioma occur in children less than 2 years) Lymphangiomas are soft and nontender and when subjected to light test was brilliantly translucent.
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⏳ Case-based MCQ | #Case_337
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
A previously healthy 60-year-old male is diagnosed with multiple myeloma after a workup for an incidental finding on routine laboratory work. He has no identified organ or tissue damage and is asymptomatic.
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
A previously healthy 60-year-old male is diagnosed with multiple myeloma after a workup for an incidental finding on routine laboratory work. He has no identified organ or tissue damage and is asymptomatic.
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Which one of the following would be appropriate treatment of this patient’s condition?
Anonymous Poll
39%
a) No treatment
29%
b) Chemotherapy
21%
c) Autologous stem cell transplantation
10%
d) Radiation
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⏳ Case-based MCQ | #Case_337 | #answer
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
✅ A
This patient has smoldering (asymptomatic) multiple myeloma. He does not have any organ or tissue damage related to this disease and has no symptoms. Early treatment of these patients does not improve mortality and may increase the likelihood of developing acute leukemia. The standard treatment for symptomatic patients under age 65 is autologous stem cell transplantation. Patients over 65 who are healthy enough to undergo transplantation would also be appropriate candidates. Patients who are not candidates for autologous stem cell transplantation generally receive melphalan and prednisolone with or without thalidomide. Radiotherapy can be used to relieve metastatic bone pain or spinal cord compression.
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
✅ A
This patient has smoldering (asymptomatic) multiple myeloma. He does not have any organ or tissue damage related to this disease and has no symptoms. Early treatment of these patients does not improve mortality and may increase the likelihood of developing acute leukemia. The standard treatment for symptomatic patients under age 65 is autologous stem cell transplantation. Patients over 65 who are healthy enough to undergo transplantation would also be appropriate candidates. Patients who are not candidates for autologous stem cell transplantation generally receive melphalan and prednisolone with or without thalidomide. Radiotherapy can be used to relieve metastatic bone pain or spinal cord compression.
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⏳ Case-based MCQ | #Case_338
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
A 34 year old man presents with slow progressive dysphagia. He has been using H2 blockers for the last year because of retrosternal discomfort. He has not noticed any weight loss. A haemoglobin level was done a month ago which reads 13.3g/dL.
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
A 34 year old man presents with slow progressive dysphagia. He has been using H2 blockers for the last year because of retrosternal discomfort. He has not noticed any weight loss. A haemoglobin level was done a month ago which reads 13.3g/dL.
What is the SINGLE most likely diagnosis?
Anonymous Poll
8%
A. Foreign body
21%
B. Plummer-Vinson syndrome
13%
C. Pharyngeal pouch
42%
D. Peptic stricture
16%
E. Esophageal Cancer
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⏳ Case-based MCQ | #Case_338 | #answer
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
✅ D
Peptic strictures have an association with gastro-oesophageal reflux disease and can cause dysphagia. The fact that there is no weight loss and haemoglobin is normal points towards a benign cause. Esophageal cancer at this age group is also uncommon.
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
✅ D
Peptic strictures have an association with gastro-oesophageal reflux disease and can cause dysphagia. The fact that there is no weight loss and haemoglobin is normal points towards a benign cause. Esophageal cancer at this age group is also uncommon.
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⏳ Case-based MCQ | #Case_339
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
A 35 year old lady presents with urinary incontinence 4 months after having a normal vaginal delivery of her second child. She says that she urinates a little every time she sneezes or coughs. On a speculum examintion, there are no anatomical abnormalities.
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
A 35 year old lady presents with urinary incontinence 4 months after having a normal vaginal delivery of her second child. She says that she urinates a little every time she sneezes or coughs. On a speculum examintion, there are no anatomical abnormalities.
What is the SINGLE most approprite next step in management?
Anonymous Poll
10%
A. Tension-free vaginal tape operation
10%
B. Bladder drill (retraining)
8%
C. Ring pessary
6%
D. Duloxetine
67%
E. . Pelvic floor exercise
⏳ Case-based MCQ | #Case_339 | #answer
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
✅ E
This lady is suffering from stress incontinence as evident by small amounts of urine leakage when she sneezes or coughs. The best management would be pelvic floor exercises.
Tension-free vaginal tape operation should only be considered after trying conservative methods for treatment of stress incontinence.
Bladder drill (retraining) is a method used for detrusor instability and nto stress incontinence.
Ring pessary is of no use here as there is no cystocele.
Loss of weight, and reducing caffeine are other lifestyle modifications that could be effective but were not given in this questions.
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
✅ E
This lady is suffering from stress incontinence as evident by small amounts of urine leakage when she sneezes or coughs. The best management would be pelvic floor exercises.
Tension-free vaginal tape operation should only be considered after trying conservative methods for treatment of stress incontinence.
Bladder drill (retraining) is a method used for detrusor instability and nto stress incontinence.
Ring pessary is of no use here as there is no cystocele.
Loss of weight, and reducing caffeine are other lifestyle modifications that could be effective but were not given in this questions.
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©Medical Mnemonics
⏳ Case-based MCQ | #Case_340
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
You are called to the newborn nursery to see a baby with a deformed foot. The affected foot is shorter and smaller than the other. The heel is turned downward and inward, while the front of the foot is curved inwardly. The medial crease of the foot is accentuated. The foot has almost no flexibility. You diagnose a unilateral rigid club foot deformity.
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
You are called to the newborn nursery to see a baby with a deformed foot. The affected foot is shorter and smaller than the other. The heel is turned downward and inward, while the front of the foot is curved inwardly. The medial crease of the foot is accentuated. The foot has almost no flexibility. You diagnose a unilateral rigid club foot deformity.
Which statement is NOT true?
Anonymous Poll
10%
a) Rigid clubfoot may require surgery
19%
b) The incidence of clubfoot is more common in males
36%
c) This deformity usually prevents a child from standing and walking
17%
d) After surgery, long‐term observation and bracing is usually necessary
18%
e) With treatment, children are active and participate with peers in the usual physical activities
⏳ Case-based MCQ | #Case_340 | #answer
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
✅ C
Most of these children are healthy infants with a clubfoot of unknown cause and will crawl, stand, and walk. Untreated, this condition may result in severe disability and deformity.
⚠ Rigid clubfoot may respond to manipulation and casting. However, if these interventions fail, surgery will be required (choice A).
⚠ The male‐to‐female ratio is 2:1 (choice B). Bilateral involvement is found in 30‐50% of cases. There is a 10% chance of a subsequent child being affected if the parents already have a child with a clubfoot.
⚠ Very early intervention may produce a shorter treatment period, but if conservative treatment fails (casting), surgery may be required followed by casting and bracing. Patients must then be followed for any evidence of recurrence (choice D).
⚠ Even with successful treatment, the foot may be smaller and possibly less mobile than the normal foot; however, most children will still be able to participate fully in normal activities (choice E).
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
✅ C
Most of these children are healthy infants with a clubfoot of unknown cause and will crawl, stand, and walk. Untreated, this condition may result in severe disability and deformity.
⚠ Rigid clubfoot may respond to manipulation and casting. However, if these interventions fail, surgery will be required (choice A).
⚠ The male‐to‐female ratio is 2:1 (choice B). Bilateral involvement is found in 30‐50% of cases. There is a 10% chance of a subsequent child being affected if the parents already have a child with a clubfoot.
⚠ Very early intervention may produce a shorter treatment period, but if conservative treatment fails (casting), surgery may be required followed by casting and bracing. Patients must then be followed for any evidence of recurrence (choice D).
⚠ Even with successful treatment, the foot may be smaller and possibly less mobile than the normal foot; however, most children will still be able to participate fully in normal activities (choice E).
⏳ Case-based MCQ | #Case_341
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
A 65‐year‐old white male comes to your office with a 0.5‐cm nodule that has developed on his right forearm over the past 4 weeks. The lesion is dome shaped and has a central plug. You schedule a biopsy but he does not return to your office for 1 year. At that time the lesion appears to have healed spontaneously.
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
A 65‐year‐old white male comes to your office with a 0.5‐cm nodule that has developed on his right forearm over the past 4 weeks. The lesion is dome shaped and has a central plug. You schedule a biopsy but he does not return to your office for 1 year. At that time the lesion appears to have healed spontaneously.
The most likely diagnosis is:
Anonymous Poll
27%
a) Benign lentigo
8%
b) Lentigo maligna
11%
c) Basal cell carcinoma
10%
d) Squamous cell carcinoma
43%
e) Keratoacanthoma
❤1
⏳ Case-based MCQ | #Case_341 | #answer
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
✅ E
Keratoacanthoma grows rapidly and may heal within 6 months to a year. Squamous cell carcinoma may appear grossly and histologically similar to keratoacanthoma but does not heal spontaneously. The other lesions do not resemble keratoacanthoma
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
✅ E
Keratoacanthoma grows rapidly and may heal within 6 months to a year. Squamous cell carcinoma may appear grossly and histologically similar to keratoacanthoma but does not heal spontaneously. The other lesions do not resemble keratoacanthoma
A 15-year-old female with Down syndrome will compete in Special Olympics gymnastics. She should be evaluated prior to completion due to the potential risk for subluxation of her:
Anonymous Poll
13%
a. Patella
9%
b. Calcaneus
21%
c. Hip
10%
d. Radial head
47%
e. Atlantoaxial joint
⏳ Case-based MCQ | #Case_342 | #answer
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
✅ E
Patients with Down syndrome have a 15% increased incidence of atlantoaxial instability (AAI). There is a resulting risk of spinal cord injury in these patients. Certain sports are contraindicated for those with AAI, including gymnastics, and radiographs should be obtained prior to participation.
〰〰〰〰〰〰〰〰〰〰〰〰〰〰
✅ E
Patients with Down syndrome have a 15% increased incidence of atlantoaxial instability (AAI). There is a resulting risk of spinal cord injury in these patients. Certain sports are contraindicated for those with AAI, including gymnastics, and radiographs should be obtained prior to participation.
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