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?
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
👍1
🫁 Pulmonary manifestations in patients with RA may include:
- Interstitial lung disease
- Pleura inflammation (thickening & effusions)
- Pulmonary hypertension
- Caplan syndrome
- Interstitial lung disease
- Pleura inflammation (thickening & effusions)
- Pulmonary hypertension
- Caplan syndrome
🙏1
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?
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
45 woman presents with weight gain, facial rounding and proximal muscle weakness. What is the most appropriate initial investigation to evaluate her condition?
Anonymous Quiz
47%
24-hour urinary free cortisol
27%
Early morning serum cortisol
10%
Plasma ACTH level
16%
Low-dose dexamethasone suppression test
patient with a positive urea breath test, what is your next step?
Anonymous Quiz
68%
Esomeprazole, amoxicillin, clarithromycin for 14 days
3%
Esomeprazole, amoxicillin, clarithromycin for 7 days
26%
Esomeprazole, ciprofloxacin,metronidazole for 14 days
2%
Esomeprazole, ciprofloxacin,metronidazole for 7 days
💡 Remember:
Avoid clarithromycin and levofloxacin based regimens in the absence of demonstrated antibiotic susceptibility.
First-line eradication regimens for H. pylori infection is optimized bismuth quadruple therapy for 14 days (PPI, bismuth subcitrate, tetracycline and metronidazole)
**Previous question is from an old SMLE Q-bank 😁
Avoid clarithromycin and levofloxacin based regimens in the absence of demonstrated antibiotic susceptibility.
First-line eradication regimens for H. pylori infection is optimized bismuth quadruple therapy for 14 days (PPI, bismuth subcitrate, tetracycline and metronidazole)
**Previous question is from an old SMLE Q-bank 😁
heart failure patient on IV furosemide (–1.5 L net) remains oxygen-dependent. VBG shows metabolic alkalosis (pH 7.53, high HCO₃⁻). What is the next step?
Anonymous Quiz
39%
Start acetazolamide
39%
Stop furosemide
7%
Continue same
16%
Add metolazone
💧 Strategies for managing common adverse effects during diuresis include:
- For symptomatic hypotension, consider decreasing the diuretic dose
- For hypokalemia and hypomagnesemia, consider adding a MRA, potassium and magnesium supplement.
- For hyperkalemia due to MRAs, consider decreasing the dose of MRA or discontinuing therapy (based on the potassium level).
- For worsening kidney function consider discontinuing use of thiazide diuretics for patients receiving a combination of a loop and thiazide diuretics.
- For metabolic alkalosis, Consider acetazolamide if the serum creatinine is < 4 mg/dL and the patient is not volume contracted or hypokalemic.
- For symptomatic hypotension, consider decreasing the diuretic dose
- For hypokalemia and hypomagnesemia, consider adding a MRA, potassium and magnesium supplement.
- For hyperkalemia due to MRAs, consider decreasing the dose of MRA or discontinuing therapy (based on the potassium level).
- For worsening kidney function consider discontinuing use of thiazide diuretics for patients receiving a combination of a loop and thiazide diuretics.
- For metabolic alkalosis, Consider acetazolamide if the serum creatinine is < 4 mg/dL and the patient is not volume contracted or hypokalemic.
22-year-old man presents with fever and acute right knee swelling one week after a sore throat. The knee is warm, erythematous, and tender. What is the next best step?
Anonymous Quiz
6%
Throat swab
36%
ASO titer
42%
Arthrocentesis
16%
NSAIDs and observe
❤1
🦠 Post-streptococcus complications:
- Otitis media
- Peritonsillar abscess
- Retropharyngeal abscess
- Lemierre syndrome (necrobacillosis)
- Acute rheumatic fever: only after pharyngitis, not streptococcal skin infections
- Poststreptococcal glomerulonephritis: after throat or skin infections
- Streptococcal toxic shock syndrome
- Poststreptococcal reactive arthritis: overlap with ARF
- Otitis media
- Peritonsillar abscess
- Retropharyngeal abscess
- Lemierre syndrome (necrobacillosis)
- Acute rheumatic fever: only after pharyngitis, not streptococcal skin infections
- Poststreptococcal glomerulonephritis: after throat or skin infections
- Streptococcal toxic shock syndrome
- Poststreptococcal reactive arthritis: overlap with ARF
43 year old male felt drowsy while awaiting in the clinic waiting room. His blood sugar was low. What is the best management?
Anonymous Quiz
78%
Fruit juice
14%
Intravenous 5% dextrose
1%
Normal saline
6%
Intramuscular glucagon
What is the most common cause of death in chronic kidney disease?
Anonymous Quiz
77%
Cardiovascular disease
11%
Hyperkalemia
9%
Uremic complications
3%
Coagulation disorder
👍1
adult with asthma exacerbation was given SABA and ICS but did not improve.
IV magnesium sulfate was administered.
Lab results: PCO2 normal, pH 7.29, P02 decreased. Next step?
IV magnesium sulfate was administered.
Lab results: PCO2 normal, pH 7.29, P02 decreased. Next step?
Anonymous Quiz
31%
Non-invasive ventilation
17%
Ipratropium
48%
Mechanical ventilation
5%
IV SABA
❤1👍1
Remember:
Normal/Elevated PaCO₂ with low pH in asthma exacerbation is a red flag, indicating respiratory muscle fatigue and impending respiratory failure 🫁.
Normal/Elevated PaCO₂ with low pH in asthma exacerbation is a red flag, indicating respiratory muscle fatigue and impending respiratory failure 🫁.
❤1
patient diagnosed with TB & started on anti-TB. He presented to the clinic for a follow-up with signs of gout. laboratory investigations showed increased uric acid level. What drug causing this?
Anonymous Quiz
67%
Pyrazinamide
8%
Ethambutol
22%
Isoniazid
3%
Rifampicin
👍1
patient with hepatitis C, cirrhosis, and upper gastrointestinal bleeding (UGIB)
presents to the ER with frothy secretions. What is the most appropriate initial management?
presents to the ER with frothy secretions. What is the most appropriate initial management?
Anonymous Quiz
44%
Endotracheal intubation
17%
Emergency endoscopy
35%
Octreotide
3%
Blood transfusion
👍1
patient is admitted with a diagnosis of lower lobe pneumonia. You are planning to obtain blood cultures. When is the best time to collect them?
Anonymous Quiz
32%
1 hour before event
20%
1 hour after event
46%
During a fever attack
2%
After the seizure
🔥2