Internal medicine hub
1.13K subscribers
118 photos
1 video
2 files
2 links
IM tips & Q-bank for SMLE and part
https://tellonym.me/user.IMhub/nhie

Ask me here: @llqkq
Download Telegram
Elderly patients known case of CKD, presented with low grade fever and pleuritic chest pain. ECG and Troponin unremarkable. What is the best next step?
Anonymous Quiz
56%
Hemodialysis
10%
Aspirin
19%
Amoxicillin
15%
Prednisone 60mg
๐Ÿ’ก Remember:

ECG in uremic pericarditis does not show typical diffuse ST and T wave elevation
โค1
SLE patient on steroid, azathioprine hydroxychloroquine Present with 3 week history of right hip pain with walking. O/E pain with internal rotation of right leg. XR unremarkable. Likely diagnosis ?
Anonymous Quiz
81%
Avascular necrosis
11%
Active lupus arthritis
5%
Septic arthritis
2%
Osteogenesis imperfect
๐Ÿฆด Risk factors for avascular necrosis: โ€œSโ€
- Steroids
- Sickle cell disease
- SLE
- Smoking/alcohol
- biSphosphonate
๐Ÿ‘1
25-year-old presents with dark urine and confirmed blood in the urine test, 3 weeks after a throat infection. What is the most likely diagnosis?
Anonymous Quiz
2%
Burger's disease
15%
IgA nephropathy
81%
Post-streptococcal glomerulonephritis
3%
Membranous glomerulonephritis
๐Ÿฆ  Poststreptococcal GN may occur 1-6 weeks after resolution of infection:

โ€ข 1-2 weeks after pharyngitis
โ€ข 4-6 weeks after impetigo
โ€ข 3-6 weeks after a pyoderma
patient with rheumatoid arthritis (RA) who is on methotrexate and was previously in remission now has elevated LFTs. What is the next step in management?
Anonymous Quiz
9%
Start glucocorticoids
61%
Stop methotrexate
11%
Investigate for hepatitis infection
19%
Switch to Azathioprine
๐Ÿ’Š Methotrexate & RA:

- First DMARD given for RA
- Maximum dose is 25 mg per week
- Hold for 1-2 after seasonal influenza vaccination
- Reported to have a protective effect in reducing the risk of DM in patients with inflammatory disease (RA)
- Folate supplementation may reduce GI side effects of methotrexate (1 mg/day or 5 mg/week)
- Hepatic toxicity usually resolves within 10 days
- Antidote: LEUCOVORIN
โค1๐Ÿ‘1
Indian male presents with weight loss and hemoptysis and has a right-sided pleural effusion, Based on the most likely diagnosis in such a case, most sensitive test from pleural fluid?
Anonymous Quiz
6%
Glucose less than 100
15%
High lymphocyte count
34%
AFB
45%
ADA
47-year-old alcoholic patient presents with a 6-week history of weight loss, fever, and right hypochondrium pain. Lab results and imaging findings include: Alpha fetoprotein: 120 ng/mL (normal: 0-40 ng/mL)
Abdominal ultrasound: Ascites and a focal liver lesion in a cirrhotic liver.
Which of the following is the most likely diagnosis?
Anonymous Quiz
6%
Liver abscess
8%
Pancreatic cancer
11%
Hydatid liver disease
76%
HCC
patient presents with sudden severe chest pain, shortness of breath, a systolic ejection murmur BP 220/100. What is the most appropriate immediate
management?
Anonymous Quiz
30%
Nitroglycerin with esmolol
62%
Labetalol followed by nitroprusside
5%
Nifedipine๏ปฟ๏ปฟ๏ปฟ
3%
Hydralazine
๐Ÿ‘1
๐Ÿšซ Donโ€™t be tricked:

- in aortic dissection:
give BB first then vasodilation (nitroprusside)
- in Pheochromocytoma: give Alpha-blocker then BB
- in Myxedema Coma:
give hydrocortisone first then levothyroxine
๐Ÿ‘2
43-year-old male presented to the ER with syncope and hypotension. ECG showed supraventricular tachycardia (SVT). What is the best next step?
Anonymous Quiz
46%
IV adenosine
5%
Defibrillation
44%
Cardioversion
5%
IV metoprolol
โค1
30F with RA presents with SOB and dry cough for 3 months
denies fever or weight loss examination: cyanosis, digital clubbing, and bibasilar end-inspiratory crackles (velcro crackle). Likely diagnosis?
Anonymous Quiz
2%
Lung abscess
21%
Bronchiectasis
8%
Bronchogenic carcinoma
69%
Interstitial pulmonary fibrosis
๐Ÿ‘1
๐Ÿซ Pulmonary manifestations in patients with RA may include:
- Interstitial lung disease
- Pleura inflammation (thickening & effusions)
- Pulmonary hypertension
- Caplan syndrome
๐Ÿ™1
ู…ุจุฑูˆูƒ ู„ุฌู…ูŠุน ุงู„ู…ู‚ุจูˆู„ูŠู† ูˆุญุธ ุงูˆูุฑ ู„ู„ุจู‚ูŠุฉ ๐Ÿ™Œ๐Ÿปโค๏ธโค๏ธ
#matching2025
โค4
When should an adult with FSGS be considered glucocorticoid-resistant?
Anonymous Quiz
19%
4 weeks
41%
8 weeks
32%
12 weeks
8%
16 weeks
patient diagnosed with cough variant asthma on albuterol
Initially symptoms improved, but they still complain of cough, need to clear the throat, especially at night & when lying down. Next step?
Anonymous Quiz
12%
Add long-acting beta-agonist
41%
Add inhaled corticosteroid
44%
Add PPI
3%
Add oral steroid
๐Ÿซ Asthma subtypes & variants