02-27-2007, 06:05 AM
Q)You are the resident on duty. A pt. under XYZ(attending physician) dies. What do you do next?
Don't recall choices. Probably
A. Communicate the news of the death to the relatives
B.Communicate the news to the attending physician.
C.certify death.
ANSWER IS CERTIFY DEATH
Q) 24 year old male with three day history of testicular swelling progressive, no nausea vomitting,mild fever, dull pain, no radiation. Pain does not diminish on lifting the testis up but aggravates from 6/10 to 7/10.No risk factors for std.
what s your diagnosis
a. torsion
b. epididymitis
Answer is epididymitis (three days of onset)most likely answer
Q) Mother comes with 12 year old child. child is blond with blue eyes.
she ask which is the best way to prevent malign melanoma there is no family history
spf15
spf16
forbid out door activities in sun
tell her to wear protective clothing
Answer is tell her to wear protective clothing
Q) Elderly pt with hx of high bp, controled well, suddenly increase bp what's the cause?
Answer is Most likely non compliance with meds is the answer
Q )Pt c Parkinson disease, tx c L-dopa, had agitation, tx c haloperidal, getting worse, next:
a. increase haloperidal
b. decrease halo...
increase l-dopa
Answer is change it to other antipsychotic Clozapine .. if that not in the choice answer is Decrease / dc haldol.
Q)14 y/o girl pregnant is there increased chance of congenital malformations or not?
ANSwer is No clear increase risk with young age
Q) black male with HTN + DM .what HTsive med do u give?
Answer is ..Ace inhibitor.*htn plus diabetes*
Q) œBILATERALrenal a. stenosis with HTN, what med do you use to tx HTN
Answer is calcium channel blocker. If it was unilateral stenosis then ACE inhibitors. Ace inhibitors are contraindicated in Bilateral stenosis
Q) Estrogen replacement therapy has risks, which one is not
a. gallbladder dx
b. breast ca
c. uterine ca
d. pancreatitis
e. thromboembolic dx no clear answers? I THINK THE Answer is pancreatitis.
Q) A kid with Down syndrome has one parent with down sy. the mother asking about another baby but she scared will have down syndrome, what should tell her?
100% chance
50%
25%
0%
Answer is 50 %
Q) A 5 y/o kid with turner syndrome his mother is pregnant and she is asking what % chance will have this coming baby with TURNER SYNDROME?
ANSWER Is .Somewhat increase chances.. if one previous baby is with turner no clear numbers.
Q) Parents have a kid with Cystic Fibrosis, what is the chance to have another kid with same disease?
Answer is 25 percent chances
Q) Mallory Weiss, next
a) chest x-ray
b) surge consults
c) prepare for urgent endoscopy
Answer is C endoscopy
Q)nausea vomitting taking digoxin, stable, k+6.0
a) give ca gluconate
b) digiband
c) take digoxin levels
d) stop digoxin
Answer is stop digoxin. If this is not in the choice in exam calcium gluconate.read the qs carefully.. if its next step then stop digoxin and treatment is calcium gluconate.
Q) 50 yr annual office visit common finding at this age
1.htn
2.cad
3.cancer
is it HTN or CAD. I think it is HTN.
Q) organ donation in a pt who had a ishemic death
1 but which organ you will take and
2 the time ........]
Brain death. U can take any organ out if its cariac death or ischemic death ..take superficial organs only..skin cornea , fascia and bone. Not other organs like heart lung kidney liver.
Q) Tanning and skin cancer relation with “UVA /UVB
which is more malignant
UVA is the answer Both causes cancerr UVA is causes melagnany melanoma.
Q) pt was bit by an animal (not high risk for rabies) in the zoo. What is the most important question to ask:
1- how long.
2- any disease present in the zoo.
3- from where the animal.
4- any symptoms happened to the patient right after the biting.
ANSWER IS ENQUIRE WHERE THE ANIMAL IS FROM
Q) A child allergic to neighbor™s cat what you do
a ask pt to avoid cat
b antihistamine
c. steroid
d isolate cat
Answer is A
Q) A male pt with thumb base pain what is dxa.
De querene tensovitis is the answer treatment is nsaid and intrathecal steroids.
Q) 12 month child with mouth candida what do you do
Nystatin and treat mom with topical anti fungal cream on breast
Q)neonate c thrush what do you do
obs
antifungal
Answer is anti fungal
Q)a pregnant rh- do not know father what is next?
a give rh antibody 28 w
b test rh titer now
c. no need rh antibody
Answer the B
Q)post mva, pt can not extend knee, decreased low leg medial sensation, which n injury?
a femor n
b tibia n
c. fabula n
answer is A femoral nerve
Q)post mva suspect bladder trauma, most sensitive exam
a ct
b u/s
c peritoneal lavage
d kub
Answer CT
Q)75 y/o male constipation, no other abnormalities, what is most likely cause
Functional causes. Is the answer
Q)pt with s/s of aortic dissection, what is next exam
1 ct
2.TEE
3.U/S
4.cxr
Answer is TEE..or Ct with contrast now becareful how the qs is phrases if it is next step then X ray is a possible answer but if it is diagnostic then TEE. So read carefully.
Q)ileojejunum bypass, diarrhea, what kind of fluid you give?
Total parental nutrition ,BUT normal saline+calcium and magnasium replacement
Q)which of followings is most likely to distinguish pk from major depression
a mask face
b tremor
c rigidity
d imbalance
e brady
Answer is ANSWER IS RIGIDITY,,,,,
Q) pregant pt c urinary stone, next exam
a u/s
b. ivp
c ct
Answer is U/S
Q)subarachnoid hemorrhage in pt taking coumadin:
1- ffp.
2- vit K 3- whole blood.
4- stop coumadin and do nothing.
5- cont coumadin
fresh frozen plasma
Q) A kid with chicken pox, when could he return to school?
Q)shoulder dystocia
next step,
a) mcroberts manover
b)call your collegue
c)tell mother not to push
d)call anesthesia
answer.first step tell mom not to pushthen ******* manouver then c sectionbreaking of clavicle is the last resort
Q)which is not a risk factor of osteoporosis
a) smoking
b)alcohol
c)caffieneted products
d) white race
e) obesity
f)there were 2/3 more but not convincing
answer is obesity ( qs is NOT a risk Factorok)
Q)there was a picture of breast focussed on the nipple area a 43 year old women coming with pruritus,I thaught it must be pagets disease,the question waas what is the next step, mamography normal
a) biopsy
b) steroidd cream call after 7 days
c) scraping the lesion
d) i dont ???remember but wasnt so convincing
answer is Biopsy
Q)most common risk factor of PID
1) multiple sexual partner
2) women with intrauterine contraceptive deivice
answer is multiple sexual partners
Q) primigravida 28 weeks, rh negative ,husband positive anti ***** antibody positive what next
1)give anti rhd2)
dont give anti rhd3)
do amniocentesis,
answer,,,, DON™T DO ANYTHING.
Q)early post partum hemmorage,iv access done,resuccitated,bleeding present
next step
a) do pelic examin
b) uterine massage
Answer is pelvic exam this is how u gonna find out about atony uterus.treatment is uterine massage
During a flu. Season, a pt who did got get flu. Shot and had a flu.s/s for 4 days came in for treatment. You provide for him:
1. amantadine 2. zanamivir 3. only symptomatic support including (Tyleno)
Symptomatic treatment ( amantadine or zanamivir is given within 72 hours of influnza ZANAMIVIR is the best treatment it covers both A and B)
Q)A 4 month-old-boy who is diagnosed as having OM without fever yesterday is brought by his mother for his regular vaccination scheduled. At this time, as his PMD, you: 1. give the boy vaccines scheduled 2. Wait after he recovered from his disease 3. others.
Answer is give vaccination ( ever is not a contraindication )
Q)Most common parasitic infection in usa
Answer is PINWORM (Entrobius vermicularis)
(3 peds questions)
A boy (5 may 8 yrs old) was brought by his mother with c/o right hip pain for 3 days. The boy had upper respiratory infection prior this hip pain. After working up, it is dx as septic arthritis.
1. what is the cause ? a. strep. Pneumo. B. staph. A. c. other bacteria (no surgical intervention)
2. what antibiotics ? a. methicillin b. penicillin c. vancomycin d others
3. 2 days after antbx, now there are a few small maculae (2-3 mm in diameter) without itching or redness. What do you do ? a. d/c antx b. continue the treatment c change to another antx. D others
Answers..1) staph aureus 2) methicillin 3) change the antibiotics
Q)23 yrs old women with a vaginal presure symptoms and on pe has a 5 cm cystic mass,use diaphram for contraception, pregnancy test negative
next step
1.u/s
2.observation for 6-8 weeks
3.birth control pills
4.laprotomy
ultrasound
Q)What is the best method to diagnose CHF
a. Echo
b. PE and symptomes
c ECG
d Serum levels of B-type natriuretic peptide
e CXR
Q)Would anyone post the exact inetrvals for pap smear (cervical cancer screening), breast cancer screeing, prostate cancer screening and colorectal cancer??
This is very important topic as I had many Q in this topic
Q)How do you treat Cocaine abuser with 210/115 BP?
Cocaine induced HTN - treated with Benzo, Nitroglycerin or Nitroprusside drip and Phentolamine 1 mg IV
No beta blockers like propranolol
Q)which is the not a sign of ovulatory bleeding,
1)Infrequent heavy bleeding
2)Presence of premenstrual symptoms
3)Dysmenorrhea
4)Breast tenderness
5)Change in cervical mucus
6)Mittleschmertz answer is 1
Q) which is maximum risk for preoperative assesment of cardiac function
1)Suspected critical aortic stenosis
2)Myocardial infarction within six months with age >70
3)Poor general medical status and emergency operation
4th was easy to be removed
Answer is 1 read below
this was totally confusing as i did not read this topic nicely now i know the answer please try to discuss , lots of questions
Risk
Age older than 70 years 5
Myocardial infarction within six months 10
Myocardial infarction after six months 5
Canadian Cardiovascular Society Angina Classification*
Class III 10
Class IV 20
Unstable angina within six months 10
Alveolar pulmonary edema
Within one week 10
Ever 5
Suspected critical aortic stenosis 20
Arrhythmia
Rhythm other than sinus or sinus plus atrial premature beats 5
More than five premature ventricular beats 5
Emergency operation 10
Poor general medical status 5
SOURCE IS AAFP ALSO AMERICAN HEART INEX
Q)a 8 month old kid cant turn overwhat is the next exam
neuroreflex
check teeth
????
Answer Is neuroexam.neuro reflex
Q)29 yo M c severe diarrhea
o/e listless but responsive
vitals stable
Na 118,K 2.9, hco3 12,,urine na <10
R
a IV hypetonic saline
b hypotonic
c isotonic
d fluid restriction
e hco3
answer is isotonic solution
Q)prom with 34 weeks,
next step
1)take culture
2)start oxytocin
answer is take culture first
what next,bp,smac,cbc.normal
ct with contrast
mri
ivp
do we have to save money by doing ctscan or be more perfect doning mri, i was confused, Kaplan says mri, so i clicked mri.but what are your opinions
answer CT mri requires sedation
Q)A 3-month-old child was exposed to an adult with active pulmonary tuberculosis. What is the recommended approach to this problem?
A. Administer a TST and reevaluate in 3 months.
B. Administer a TST, perform a CXR, and reevaluate in 3 months.
C. Administer a TST, perform a CXR, administer INH, and reevaluate in 3 months.
D. Reevaluate after 3 months.
E. None of the above.
ans: C
the kid should be given INH prophylaxis even if CXR/PPD are negative. You have to reevaluate in 3 months with a skin test:
. if the test is negative :- to D/C INH
. if the test is positive :- to coninue INH for another 6 months (total 9 months )
Q)A pt on warfarin and heparin develops thrombocytopenia and petechias, what is next ?
a. d/c heparin only
b. d/c warfarin only
c continue both
d d/c both
Answer is dc both seems to be the answer
Q)25 yr old male routine visit with his father diag with colon cancer, what will you ask him next
age of onset
family h/o
diet pattern
sign and sym
answer is family history
Q)pt has been treated with lithium and developed hypothyroidism. after stopping lithium, when do you do tsh:
1- 3ds
2- 1w.
3- 2w.
4- 1m.
5- 3m
answer is 4-6 weeks
Q)pt has been treated with 0.075 mg thyroxin for possible hypothyroidism. you want to stop the drug and test the patient to see if he really has hypo-, when:
same options like the previous.
note: the amount is real.
An initial dose of thyroxine of 0.05 to 0.075 mg per day is usually sufficient to normalize the serum thyrotropin level.Patients with coronary artery disease should receive lower initial doses (e.g., 0.0125 to 0.025 mg daily). Serum thyrotropin levels should be measured four to six weeks after therapy is begun, after any change in the dose, and then annually once the levels become stable. Thyroxine requirements may increase over time if there is progressive thyroid failure.
NEJM
Q)pt with history of cancer. dnr. developed stroke at home what do you do.
leave him home
give him drug for pain.
admit
admit the pt. Seems to be the answer
Q)DMI glucose 160 wants to sport:
1- insulin before match.
2- glucose before match.
3-nothing..GLUSOCE BEFORE MATCH OR NOTHING ????
Q))you want give quinolon to a pt. whuch drug of the following should you worn him from:
1- coumadin
2- theophyllin
3- propanolol
answer is theophyliine
Q)50 y.o.w with multiple problems told you she is gonna get married from somebody she has met 2 weeks ago and asking you to attend:
1- congrat.. so nice of you to ask me but i am sorry i cant.
2- no my proffesional cant let me
3-you have so many problems it will affect on you negatively.
4-arent you too old to get married
5-is too soon to get married after two weeks only of knowing him
answer is A
Q)stroke family want dnr. you dont have previllage in that hospital and the doc wount give the familly dnr. the familly now calling you to support them having dnr for their pt:
1- tell them to take the pt to a hosp where he has previllage.
2- ask attorny.
tell me about the pt situation
answer si tell me more about the patient
pictures of fundoscopy ( glaucoma, DM, and cmv)
skin (herpes zoster)
ecg (1st degree block) preop.
Q)pregnant exposed to a lacy rashed boy:
1- it will not affect you.
2- you get mild disease.
3- you are vaccinated to this. no harm
4- your may loose your fetus
Q)pt haevy smoker, loss 8bl lately, surem Ca++ 11.5,
what do you do next?
a.recheck Ca++ level
b.check CXR
answer is chest x ray
Q)pt has unilateral hearing loss, tinnus. also has lung Ca
what is most likely her symptom?
ANSWER IS MAYBE METASTASIS
Q)A diabetic pt with non healing ulcer..next step
Debribment
Antibiotic
Answer si debribe first
Q)A diabetic man with sexual dysfunction,,comes in for evalutaion of depression,, he is found to be depress..what is the best treatment
a)paroxitine (paxil)
b)fluoxetine (prozac)
c)sertraline (zoloft)
d)citalopram (celexa)
e) bupriopram (wellbutrin)
Answer is E.
wellbutrin and serzone are the only antidepressant that I know have least effect on sextual function.
I have checked it out this is not a guess.
Q)Most important risk factor for breast cancer?
a)involment of upper outer quadrent
b)breast cancer in mother
c)breast cancer in sister
d)use of OCP
e) early onset of breast cancer in family
Answer e
Q)karotype of complested hydatidiform mole is?
a) 46 xy
B)45 xy
c)46xx
d)69xxx
e) or somethign else..please specify?
Types
Complete Mole
Total hydatidiform change
Marked proliferation of trophoblastic cells
No evidence of fetal vessels
Karyotype: 46XX
Derived from haploid 23X sperm
Sperm duplicates chromosomes without cell division
Higher risk for malignant change
Partial Mole
Associated with a fetus (may be only vessels)
Moderate trophoblastic proliferation
Karyotype: Triploid (69XXX or 69XXY)
Fertilization by more than one sperm
Malignant change less likely than in complete mole
Q) Painless gross and microscopic hematuira: THESE ARE THE STEPS>>>>U/A > IVP > CT..
Q)Painful gross or microscopic hematuira (s/s -> kidney stone):these are the steps >>>> U/A > KUB > IVP > CT ??
Q)thyroid disorders,
early menopause
or somethign else???
answer is osteoprosis and early menopause AND STRESS FRACTURES
Q)What IS the most common associated finding in patient with paNIC DISORDER?
a)aLCOHOLISM
B)OCD
C)DEPRESSION
D) SUBSTANCE ABUSE DISORDER
Answer is depression
Q) A WOMAN IS TAKING OCP NOW PREGNANT ?effect of OCP ON FETUS
what will u do or say??
a) Sono..if boy consider abortion
b)sono if girl Do abortion
c) tell her no adverse effect on fetus
answer is C. I have cheked this out. No harm to baby
Q)A man with 5x5 cm mass in left lobe of thyroid which is found to be papillary carcinoma..The man has develop HOARSENESS. the right lobe of thyroid is irregular on exam.. what is the best treatment
a)radiation
b)partial thyroidectomy plus radiation
c)total thyroidectomy with left neck dissection
d) total thyroidectomy with removal of enlarged nodes
answer is B or C ?? one of them
Q)2 yo child, mother reports he is pulling his LEFT ear, no fever vomiting, appetite good exam reveals cooperative kid,tympanic membrane red, no fluid on tympanogram..
what will u do?
a)PO amoxillin
b)gentamycin ear drops
c)refer to ENT
d)tylenol only
E) reassurance
Answer is possibly E reassurance.. I guess
DON™T KNOW THE ANSWER
Q)woman with symptomatic Tachycardia, otherwise stable, positive for signs of hyperthyroidism,,,what is the IMMEDIATE way to treat her symptoms?
a)PTU
b)RAI
c)surgery
d)propranolol
answer is D
Q)pt with heart rate of 45/min, BP 90/50, PR constant.Every third wave without QRS complex?
management?
A) atropine IV push
b)observation
c)external pacemaker
d)transvenous pacemaker
Answer is C.
Atropine should not be used to treat Mobitz type II block associated with BBB
Hemodynamically unstable pts should be treated initially temporary transvenous pacemaker insertion followed by permanent pacemaker implantation.
Q) picture of a 7-8 yo boy with ulceration in AXILLA and lateral chest only...what is the most likely diagnosis?
A)impetigo
b)subepidermal bullous dermatosis
c)herpes
d)bullous pehphigoid
Answer is impetigo
Q)most effective contraceptive????
a)condoms
b)IUD
c)ethynyl estradiol +levonorgestrol orally
d)medroxypregestrone acetate IM (depot)
ANSWER IS OCP (COMINED )
Q)CGlucagon is least likely to be used for severe hypoglycemia in
1) Type II DM
2) Malnourished patient
3) Infant overdose of injected insulin
4) Obese patient > 65yrs
answer is B
Q)Can a boy with Type I Diabetes compete in competitive sports? If yes what precautions to be taken, regarding insulin dose?
decrease insuline (and take a snack ?) exercise=insulin so need less insulin prior to exercise.
Q)Infection of which valve is most likely to be associated with the development of heartblock.
a. tricuspid
b. Pulmonic
c. Tricuspic and pulmonic
d. Aortic
e. Mitral
Answer is E
MULTIPLE SCLEROSIS
Q1) how do u check the progression of multiple sclerosis?
Q2) how to u follow Multiple sclerosis?
Q3) Diagnostic test of Multiple sclerosis
Q4) Effect of pregnancy on multiple sclerosis?
Answers to above question
1) Progression based on clinic
2) F/U depend on clinical course
3) Dx MRI
4) Pregnancy? Pregnancy exacerbate MS symptom. Agree with rest of info.
Q)person with symptoms of Obstructive sleep apnea...what is the first/next step?
a)sleep study
b)medical workup
c)CPAP treatment
Answer is Medical w/u as below
1.r/o hypothyrid.ent exam
2.polysomnogram
3.treat-weight reduction(doenot work) >>>cpap
Q)Most common site of pancreatic cancer?
Answer is adeno carcinoma (type) head of the pancreas(site)
Q)A mother is concerned about obese child 3 y. what is the reason child is obese
mother behaviour problem
-child neglect
-genetic
-eating disorder
-ANSWER IS MOTHERS behavioral problems excessive eating may lead to childs excessive eating
Q)OLD lady with hemoptysis,Sob,questionable murmur.X ray chest HTN with Left artial enlargement, EKG a fib,Both artial enlagement AND rt vent hyperthrophy?
what is the diagnosis?
Answer is mitral stenosis
Q)A41 yr old women with a 2 month history of abdominal pain and reports constipation and altered calibre of stool with a history of weight loss of 9 pounds. What is the likely possibilty?
-Inflammatory bowel disease
-Irritable bowel disease
-Colon cancer
-Tropical sprue
-celiac disease
Answer is colon cancer.
Q)A 4 yo comes to ER with muscle weakness, miosis, salivation, diarrhea, heart rate slowing down. You will give;
A. naloxone
B. atropine and pralidoxime
C. flumazenil
D. N-acetylcysteine
E. Pyridoxine
B. atropine and pralidoxime
Q) A 14 year old boy with acne lesions on face and back on benzoic peroxide and topical tretenoin with only partial response. What will you do next
-Oral tretenoin
-Corticosteroids
-Oral tetracycline
-topical erythromycin
Answer is oral antibiotic ( tetra)
Q) Treatment of spasticity in post stroke patient
Answer is beclofen
Q)Pt came with chest pain. No EKG is done yet...after oxygen,,,next step?
a)aspirin
b)captopril
c)heparin
d)metoprolol
e)streptokinase
Answer is aspirin
Q) Treatment of influenza. Indications and limitation of AMANTADINE
Answer is
influ. A amantidine within 48-72 hrs
************************************************** ************************************************** ***
1. labetaolo 2. hydralazine, 3 methyldopa
first, look at the medication she is taking for essential hypertension, if that is ace, change it.
for pregnant patient, good control of BP is very important.
*maintaince of BP can be done with methlydopa tid. If controlled well, keep close monitoring and continue methlydopa.
beta blockers can be safely used and if the patient's hypertension is well controlled on a Beta blocker there is no need to change.
Labetalol and hydralazine can be used for acute control of BP readings.
*for pregnacy+chronic THN
*Labetalol for pre-eclampsia
***********************
the most likely disease that one can get from in discriminate sexual activity:
gonorrhea
chlamydia
HIV
HBV
I had a worse question.
which of the following is not sexually transmitted from a prostitute.
a. Hep B
b. treponema pallidum
c. HPV
d. tricomonas
e. neisseria gonarrhea
I thought of all of those, hepatitis requires blood conatct, but it is just a guess. The rest are pretty much impossible to choose. What about Treponema? I think syphilis is very contageous. What do you think, Raavii?
if it is HEP C, sure pick it.....
Among these....I do not know, can go with HEP B....then..
any suggestions....anyone....
**************************
a young female came with acne you prescribed topical isotretinoin later after few weeks she came with complaint of its itching of amole under her breast which has become itchy after the usage, your response is.
1.isotretinoin causes itching some times
2.itching may be an indication for the removal of the mole.
3.other choices dont remember
sounds like you have to biopsy the mole.. any thoughts?
looks like the mole started to have itch after the medcine topical isotretinoin was started and the Q is asking.....
if it is from the medicine or not?????
so 2 is the answer?
or isotretinoin causes itching some times???
I have no idea.....
***************************
1. Female comes for treatment of recurrent herpes.
Do you tell her to send her sex partner for examination?( That was on the choices.)
2. Female with increased pigmented lines on neck and axilla. Most likely diagnosis.
a. Cushing¡¯s
b. Conn¡¯s syndrome
c. Addison¡¯s disease
d. DM
e. PCOS
is it c or d?????
acanthosis nigrans... DM
foll is some info from emedicine:
ACANTHOSIS NIGRICANS: The definitive cause for AN has not yet been ascertained, although several possibilities have been suggested. Eight types of AN have been described.
Obesity-associated AN, once labeled pseudoacanthosis nigricans, is the most common type of AN.
Lesions may appear at any age but are more common in adulthood.
The dermatosis is weight dependent, and lesions may completely regress with weight reduction.
Insulin resistance is often present in these patients; however, it is not universal.
Syndromic AN is the name given to AN that is associated with a syndrome. In addition to the widely recognized association of AN with insulin resistance, AN has been associated with numerous syndromes (see Picture 2). The type A syndrome and type B syndrome are special examples.
The type A syndrome also is termed the hyperandrogenemia, insulin resistance, and acanthosis nigricans syndrome (HAIR-AN syndrome). This syndrome is often familial, affecting primarily young women (especially black women). It is associated with polycystic ovaries or signs of virilization (eg, hirsutism, clitoral hypertrophy). High plasma testosterone levels are common. The lesions of AN may arise during infancy and progress rapidly during puberty.
The type B syndrome generally occurs in women who have uncontrolled diabetes mellitus, ovarian hyperandrogenism, or an autoimmune disease such as systemic lupus erythematosus, scleroderma, Sjögren syndrome, or Hashimoto thyroiditis. Circulating antibodies to the insulin receptor may be present. In these patients, the lesions of AN are of varying severity.
Acral AN (acral acanthotic anomaly) occurs in patients who are in otherwise good health.
Acral AN is most common in dark-skinned individuals, especially those of African American descent.
The hyperkeratotic velvety lesions are most prominent over the dorsal aspects of the hands and feet.
Unilateral AN, sometimes referred to as nevoid AN, is believed to be inherited as an autosomal dominant trait.
Lesions are unilateral in distribution and may become evident during infancy, childhood, or adulthood.
Lesions tend to enlarge gradually before stabilizing or regressing.
Familial AN is a rare genodermatosis that seems to be transmitted in an autosomal dominant fashion with variable phenotypic penetrance.
The lesions typically begin during early childhood but may manifest at any age.
The condition often progresses until puberty, at which time it stabilizes or regresses.
Drug-induced AN, although uncommon, may be induced by several medications, including nicotinic acid, insulin, pituitary extract, systemic corticosteroids, and diethylstilbestrol.
Rarely, triazinate, oral contraceptives, fusidic acid, and methyltestosterone also have been associated with AN.
The lesions of AN may regress following the discontinuation of the offending medication.
Malignant AN, which is associated with internal malignancy, is the most worrisome of the variants of AN because the underlying neoplasm is often an aggressive cancer.
AN has been reported with many kinds of cancer (see Picture 3), but, by far, the most common underlying malignancy is an adenocarcinoma of gastrointestinal origin, usually a gastric adenocarcinoma. In an early study of 191 patients with malignant AN, 92% had an underlying abdominal cancer, of which 69% were gastric. Another study reported 94 cases of malignant AN, of which 61% were secondary to a gastric neoplasm.
In 25-50% of cases of malignant AN, the oral cavity is involved. The tongue and the lips most commonly are affected with elongation of the filiform papillae on the dorsal and lateral surfaces of the tongue and multiple papillary lesions appearing on the commissures of the lips. Oral lesions of AN seldom are pigmented.
Malignant AN is clinically indistinguishable from the benign forms; however, one must be more suspicious if the lesions arise rapidly, are more extensive, are symptomatic, or are in atypical locations.
Regression of AN has been seen with treatment of the underlying malignancy, and reappearance may suggest recurrence or metastasis of the primary tumor.
Mixed-type AN refers to those situations in which a patient with one of the above types of AN develops new lesions of a different etiology. An example of this would be an overweight patient with obesity-associated AN who subsequently develops malignant AN.
In the light of the above more than one choice in this qs is possible ...any comments welcome.
thanks
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Elderly woman with Alzheimer's becomes agitated. What will you give?
a.tacrolimus
b.trazodone
c.amitriptyline
no mention of haldol or benzodiazepine
recently posted recall...........
Tacrolimus is just a distractor
Trazodone is a good sedating agent with short onset and half life.
Amitryptaline is sedating too but will cause orthostasis and anticholinergic effects in elderly.
Among the above given, choice would to to Trazodone to calm the patient and sedate.
************************
Presentation of ankle sprain with tenderness and swelling. Dx:
* MRI ankle
* XRY foot
* XRY anteropost view of ankle
* XRY lateral view of ankle
Raaviio2, Iknow this q is confusing. Probably the recall is not complete. I think previously either **** frank or somebody mentioned xray is the first step if imaging is required. In certain cases according Ottawa rule no xray is needed.
Ankle sprains involves posible injuries of the anterior talofibular ligament (most prevalent type) and frcture bone. Most sprain injuries to the ankle can be successfully treated conservatively. The ability to bear weight after an ankle injury is an important consideration in deciding whether x-rays are needed. If a patient is unable to bear weight, or if there is significant tenderness at the posterior aspect of the lateral or medial malleolus, then x-rays are needed to rule out a fracture. If there is no evidence of fracture, or one less than 3 mm. of displacement, then conservative care is generally appropriate. I know you concern about the ligament injury, which MRI may better than Xray. However, for initial and general practice ankle X-ray is first.
Hope this help.
Agree, under most circumstances, acute ankle sprain does not need an image. If the presence of inability to walk, then X-ray (AP) will provide more information.
*********************
Long, long time ago, there was a posting that a patient after 16 yrs of renal transplantation (on azithioprine), had severe immunosuppressive. The questions ask what's the reason and what is the outcome of his immunosuppression.
I asked one nephrology fellow at Mayo, he told me that in such a patient, azithioprine use is the reason for his immunosuppression, and this drug could be stopped and the immunosuppression will get better. The reason that azithioprine can be stopped is because of 16 yrs history of renal transplantation without rejection
Hope this will help.
renal transplant patient transplant done 16 yrs ago and pt maintained on chronic azathioprine and prednisone. renal status is perfect and it is not only anemia but pancytpenia now with severe myelosuppression
what next step?
-decrese pred dose
-stop azathioprine
-start erythropoeitin
-start GCSF
-start fluconazole
next question
what wud be prognosis for this patient's myelosuppr
-improve
-worsen
-worsen then improve
-wax and wane
-unpredictable
*********************
Two kids. Older one eats chipped wall-paint and younger one eats newspaper!!
Older brother is having learning problems. Younger one is asymptomatic.
RBC protoporphyrin in older brother is 200
Younger brother 140
( Normal values given.)
What next?
Ans for elder brother is ........
Admit and BAL and EDTA.
2. Choices for younger brother
a. Await See Lead Level
b. Ca EDTA mobilization of lead for 8 hrs.
c. Do nothing.
I will wait and see lead level-ans A
The younger kid has PICA and so may have anemia but we have to check his lead level because he has a risk factor for lead poisoning(being exposure to lead since older brother has lead poisoning) but he is asymptomatic and we have to make a definitive diagnosis before treating.
I don't have any references but I know the standard care for supposed lead exposure without symptoms is determination of blood lead levels.
you know, I know that FEP (free erythrocyte protoporpyrin) is more sensitive than lead level and I know there is a conversion value for FEP to Lead which can tell you what the lead level is, but O don't have much experience with this. At this time, we still go by lead level. One interesting thought that did come up is that patients with anemia (like sicklers) have artificially low serum lead level, because they have artifically low amount of hemoglobin, and this is why the go by protoporphyrin. This is new stuff, and I don't think it will be tested on the boards. Go with lead levels for therpay..
**********************
an old lady with pain in the shoulder and back, and complains of weakness, and limitation in range of motion and physical exam shows upper extremity weakness, what next, and then they give you choice of
-NSAID,
-excercise program,
-bone densitometry,
-EMG
-ESR.
coz PMR is one of the main concerns but then the vignette will have more to it like stiffness of joints,etc
I will go with ESR to rule out any connective tissue disease, especially giant cell arteritis. However, if there is CPK, I probably will go with it if the history suggests polymyolitis. EMG can be used for confirmation of polymyolitis, but at this stage,you need a screening test
***********************
16 year old high school drop out did not have periods for last 3 months. She is sexually active with one patner for 1 year. Does not use contracptives. Preg. test positive.
The reason that this adolescent's failure to use contraceptive
A. Concern about weight gain
B. Cost of Contraception
C. Patner's opposition to contraception (hard to predict, but I will choose this one)
D.Concern about confidentiality
E.Desire to become pregnant
If you live in bif city like LA or NY, you see it all the time. case closed.
*****************************
PDR could you pl. do our favor? short lecture about baby fluid supplement
3% dehydration, what should give
what % dehydration consider severe or moderate, what should order?
thank you in advance
Aslo 15 % dehydration Rx? Thanks!
dehydration.
based on age group:
babies:
mild - 3%
moderate - 6%
severe - 9% or greater
children:
mild - 5%
moderate - 10%
severe - 15%
how do you know how dehydrated a child is? actually, the best way is looking at weight. If weighed 10 kg last week, and weighs 9 kg today, then 10% dehydrated.
- most common cause of dehydration in peds: vomiting, then, diarrhea.
assessing dehydration. first things that you see is thirst, and dry lips. then you see tachycardia, decrease urine output, and urine osmolarity is still normal, and you are still mild dehydration. treatment always should start with oral rehydration using something like pedialyte or an oral rehydration solution. If child is not tolerating p.o., this is reason for admission, and IV fluids. Don't forget to correct underlying illness. IV fluids could include NS bolous for rapid correction, (where you correct only 10% of deficit. If total deficit is 1 liter, then 200cc NS will correct 100C deficit and 100C for current need. Then you correct the rest of deficit with isotonic sugar containing solution (in babies D5 0.225, and in bigger kids D5 045NS over 24 hours. half in the first 8 hours, and second half in next 16 hours. It is the same with moderate and severe dehydration, except severe dehydration (9% in babies, 15% in older kids) you must look at electrolytes. Still, no matter what, don't give hypotonic solution or free water no matter what.
**********************
Q) 16 year old high school drop out did not have periods for last 3 months. She is sexually active with one patner for 1 year. Does not use contracptives. Preg. test positive.
The reason that this adolescent's failure to use contraceptive
A. Concern about weight gain
B. Cost of Contraception
C. Patner's opposition to contraception
D.Concern about confidentiality
E.Desire to become pregnant
Most teenagers think contraceptives cause weight gain
Some contraceptives has wt gain as a RF - OCPS, DMPA, other forms do not. She could use barrier form of contraception, the fact that she is not using anything might indicate that she desires to become pregnant also, b/c is is a drop out.
comments
...but any reference regarding that;
i thought it could be regarding her confidentiality matters.,etc.
it's C. that was what I just to do with my ex-girlfriends a few years ago.. .no more.
All of these choices are possible, however, in this particular case, the most likely reason, I think, is the pressure or the opposition from the partner. A drop out teenage usually has low self-esteem, and like to please her partner, if he does not like any contraceptive, then she won't use it.
All the options are possible. But WT gain is the most common concern among teenage girl.
Agree with Julia,most common concern is wt. gain amoung teenagers.In such questions where both partners can make a difference as to whether something is done or not, we need to watch the wording of the Ques.Here the ques said what are her reason for not using contr. and this tells you that the decision is hers not her partner's because no info. about the partner is given.
The answer could be E too but I chose A because a teenage drop-out will not desire pregnancy unless there is some info. in the ques. that points to that and surveys have proved ans A.Sorry, can't remember any refs.
Zaslau s book.There the answer is :
-Why she doesnt use condom --> Because she doesnt know how to use.
-why didnt she use any contraceptive--->because she didnt think that she gets pregnant in first intercourse.
-why she doesnt want any OCP --> Because she thinks she gains weight
she desires to get pregant.. saw two like that Friday night in the ER
If you live in big cities in America, you will see it. Partner's opposition is not enough for most girls to risk getting pregnant. If she did not want to get pregnant, then she would show up at an adolescent clinic and ask for a Depo shot. See that all the time too. Case closed. Hope I don't see this case again...
********************
Q)67 yrs old with lower extermities BP 180/90. upper extremities 150/85 what is Dx?
a. essential HTN
b. renal artery stenosis
c. pheochromocytoma
d. malignant HTN
e. Stenosis of ascending aorta
Can you tell me why this is your answer. I think something is wrong with the Q.
a person came to ER complaining of generalised abdominal pain first started as periumbilic
pain the most appropriate to diagnose the problem is --guarding and rigidity are present on examination
1.chest xray
2.abdominal xray
3.endoscopy
4.upper GI series
6118
a person came to ER complaining of generalised abdominal pain first started as periumbilic pain the most appropriate to diagnose the problem is --guarding and rigidity are present on examination
1.chest xray
2.abdominal xray
3.endoscopy
4.upper GI series
*********************
treatment of meinere dz?
1 hctz
2.meclizine
meclizine for acute vertigo and hctz for long term prophylaxis and treatment
**************************
patient with IDDM 18 yr old. everything was perfect in her mgmt /OC pills, insulin, diet,exercise
what change ?
........"confused till the end on following choices" (good fellow )..........
-recommend depo
-no change
I think the none of the forum members should be confused with this one again.....
18 yr old patient with IDDM. everything is well for the pt. meds include OCPs, insulin, diet,exercise
IS THERE any need of a change in mgt?
the confusion was b/w
1. every think ok
2. d/c OCP and give depo progestrone..
In short will insulin affect OCPs???????? is my thought....
use low dose ocp's
inc. insulin
ocp's cause glucose intl
but not c/i in iddm
************************************
kid has, enterovirus infection, diarrehea. should stay home or go to day care?
Only if diapers are not able to contain stools, he should stay at home???????????
I am not sure what the USMLE wants here
enterovirus diarrhea is highly contagious, and diaper changing can..
cause transmission in day care setting. Daycare workers probably don't wash their hands properly between diaper changes. My best guess, and my answer on the test is to keep baby from daycare until diarrhea resolved.
***********************
a infant is allergy to cow milk,
is the infant also allergy to soy bean?
how to RX?
usually
unfortunately....that is what they ask,
Home made meat based formula is the remedy.avoid cow's milk and soya.Meet with dietacian.
********************
14 y/o boy has asthma attack with RR 38.
-mask o2
-rebreath mask o2
-intubation
-others
If so, intubate. he should be alkalotic. We usually try albuterol first, but if any sings of respiratory tiredness, like decrease RR, or pCO2 that is not low, we jump on the ETT.
then hit with albuterol nebs and steroid p.o. or IV, but if he keeps getting worse and works harder to breath and too tired to breath so fast, then intubate... If any blood work shows PH less than like 7.45 (needs to be alkalotic because he is hyperventilating) then you worry. Also, remember, stress and steroids cause serum glucose elevation, so don't trip if you see blood glucose is 230 or something.
********************
18 month old with diarrohe, day 3 in hospital , now stable, u are about to dc the pt.. u recived stool culture report positive for salmonella what is the next:
1)ampicillin x 14 days
2)chloremphenicol x 14 days
3)no treatment
4)amp +chlornphencol
no treatment
************************
clinical features of measles, then the child is ataxic, what will you advize the parents
ans) it is one of the complication of measles and it will resolve-
His ans was posted as above.....check out guys>>>>>>>>> was the advise from the great fellow!!!!
What do you think PDR??
is it measles though? are we talking SSPE
pt with clinical features of measles, then the child is ataxic, what will you advize will you give to the parents?
the recaller selected ...the statement below as ans
...it is one of the complication of measles and it will resolve
TO ME...it looks like measles might have progressed to SSPE (I am not sure???) and in short the Q is asking prognosis.....
this is what the CDC says about measles infection in brief
Measles (rubeola) is often a severe disease, frequently complicated by middle ear infection or bronchopneumonia. Encephalitis occurs in approximately 1 of every 2,000 reported cases; survivors often have permanent brain damage and mental retardation. Death, predominantly from respiratory and neurologic causes, occurs in 1 of every 3,000 reported measles cases. The risk of death is known to be greater for infants and adults than for children and adolescents.
Does this help with the answer?
*************************************
ACNE Mx >>>>>>Is this sequence right???
ACNE Mx
>Benzoyl Peroxide>Topical Tretinoin >Topical Antibiotics> Systemic Antibiotic >Systemic Isotretinoin
Start with topical benzoyl peroxide then try (tt) topical clinda, oral tetra and oral erythro.
Next step topical tretinoin.
Last Oral Isotretinoin (teratogenic)
Source : Crush' Page 172.
SO Basically,
Benzoyl Peroxide >Topical Antibiotics> Systemic Antibiotic >Topical Tretinoin > Systemic Isotretinoin
*********************
Two 6 yrs old playing together & one kid bite other kid's hand. how to treat?
a.culture
b.pcn
c.hand xray
d.tetra
e.admit& iv antibiotics
human bites need to be admitted to hospital and iv therapy with ceftriaxone.also culture the wound as bacteriology is variable.---CMDT p1251
"HUMAN BITES". Antibiotics should be given prophylactically for all human bites:
amoxicillin/clavulanate 20 to 40 mg/kg/day divided TID;
cefixime is an alternative.
Consider IV antibiotics if infection has already occurred, especially on the hand.
If a joint may be involved (e.g., MP joint after an altercation), surgical exploration is indicated.
*******************
Q) There is a patient with a picture of retina with cotton wool type lesions. What the underlying diagnosis?
a. Patient with BP 210/112
b. Uncontrolled DM
c. Patient with BP 169/89
d. Eye pigment dz
May see cotton wool spots in HTN, DM, AIDS, but in this question b is the best choice.
*******************************
Q) A 56 y/o man came to PMD, he is s/p CABG 10 yeas back, c/o SOB with exertion and chest pain. He is relived with rest. What is next step?
a. EST
b. thalliun stress test
c. dobutamine test
d. 12 leads EKG
was closed as thallium but......
later on doing MCQs I found that the right ans was EST ...... in that exp as ...........exercise stree test is much cheaper and easier test to do that a nuc med thallium scan for screening.
any comments......
Thalliun stress test also give you the functional status of heart. Especially if the patient previously had MI, the interpretation of EKG in this case will be very difficult
sounds ok here,he doesnt have a pacemaker,all he had done was cabg,12 lead ekg and cardiac enzymes for starters,rest all later....what one want to know is whether he has new ischemia/infarction...
***********************
Q) A 59 y/o lady had seizure came to ER, neurological deficit present. CT scan of the head showed ring enhancing lesion in brain. What is probable organism?
a. cryptococus
b. grm positve micro coccobacilli
c. strepto cocci
Q A 45 y/o man with lung ca came with pain at thoracic region at the back, what is next step?
-CT
- Pain meds
Q A 65 y old patient , died of congestive cardiomyopathy. What organ can be donated?
Q)38. A 35 y/o female patient c/o facial pain and current like sensation. What is next step?
a. amytriptyline
b. carbamazipine
c. steroid
crypto, pain meds, kidneys, carbamazepine
Ring enhanced lesion on Ct-scan - abscess, tumor, TOXO, tumor (Kaplan)
organs to be donated skin & bones
facial pain - carbamazipine
*******
crypto coccus,
for tigeminal nueralgia- carbamazepine best -- mksap
***
A. cryptococus
Pain meds
Skin, bone, and cornea
b. carbamazipine
**************************
1.At what age do you advise moms to start potty training? At 1 yr is it too early?How about 18 months. I know there's no fixed time but for USMLE purposes what should you take?
2.baby around 8 months . Gets up middle of the night and drinks milk. What advise to mom?
-Give water instead of milk.
-Pat and cuddle and put to sleep.
-Ignore crying.
-delay the response to crying.
My baby's pediatrician asked me to do both 1 & 2 when my baby had the problem.But at the exam what is the choice?This was a real exam Q.
The first question is 24 months or 2 years. Just last month, the AAP (American Academy of Pediatrics) started advising a delay to 27 months, becaue rushing the process sometimes makes things worse. For USMLE, the answer is 2 years.
the other question, I think there was more to it. Wasen't it about infant colic? the baby who drank milk and cried a lot? what to do about the crying? right? colic is self limiting after 3 months of life. treatment is position change, supportive, and decrease the carbohydrates (I guess milk), but I am not sure if I go as far as giving baby water instead of milk. Theoretically this means less milk, but it is not standard.
it was simply the baby wakes up in the night crying for milk.After giving milk he goes to sleep.The resposes were the ones i gave. One other was to give a stomach full of milk just before bedtime.which can't be the answer.
This question appears many time and with diff explaination. My own experiance is to delay the response to cry. The important lesson is NOT PICK THE BABY up so easily and often in these benign situation. In other words, don't feed him and don't curdel him.
I found the following mess from web and hope we can close this with consensus:
The First Year - Babies 8 to 9 Months
Crying During the Night
Some babies make a game of calling out for you or dropping toys out of the crib for you to pick up. Other babies cry after you put them to bed. Check on your baby, but keep the lights dim and don't pick him up. If baby is ok, put him on his tummy, pat his back for a minute or two, and leave.
If you try this for a few weeks and baby still wakes up and cries during the night, you may try letting them cry. Here is a way that works for many parents. Pick a weekend night. When baby cries, check on him and rub or pat baby's back, then tell him you'll be back in 10 minutes. Check on baby every 10 minutes even if he is not still crying, until he falls back to sleep. It probably won't take more than a night or two to end the habit for good.
Letting baby cry like this can be hard on you. Be sure you're up to it. Baby may cry for hours. If you give in after an hour, you could be training him to cry for longer periods. The goal is to help baby learn to sleep on his own.
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Ghost
Guest
Posted: Wed Sep 17, 2003 12:10 pm Post subject: Ghost File #2
--------------------------------------------------------------------------------
ALL solved file #2
Q)Pregnant women in third trimester had Placenta abrutio due to MVA had aburtio placenta due to wearing seat belt(lap and shoulder ) question ask what would you recommend pregnant in third trimester?
1. don't wear seat belt
2. wear only shoulder strap seat belt
3. wear only Lap strap seat belt
4. wear the regular shoulder and lap seat belt.
Answer 4 wear both seat belts
Q) A kid had fx. clavicle question than ask what is next management?
1. ?sling
2. ?cast
3. ?sugery
Answer is Sling and immobilize.
Q) 16 year old high school drop out did not have periods for last 3 months. She is sexually active with one patner for 1 year. Does not use contracptives. Preg. test positive.
The reason that this adolescent's failure to use contraceptive
A. Concern about weight gain
B. Cost of Contraception
C. Patner's opposition to contraception
D.Concern about confidentiality
E.Desire to become pregnant
Surprisingly answer is desire to become pregnant?
Q) Which of the following drugs is the least sedating and anticholinergic, which can be prescribed safely to elderly patients with depression?
a.fluoxetine
b.MAOI
c.Imipramine
d.Sertraline
e.Trazodone
*****************************
Q1)
4 year old boy has swallowed a coin...x ray showed coin in lower 1/3 of esophagus..
a.ask the parents to check for coin in stool
b.do and endoscopy
c.give syrup ipecac
d.give a laxative
Q2
a 3 year old boy swallowed a coin and it is in the duodenum...same choices as above...
Answer 1”do endoscopy 2- watch in stool
*******************************
Q) A healthy young pt with ppd test 15 mm induration next step?
Answer is chest x ray
Q)
First child of this lady has Duchenne's. What are the chances that she will again have a baby with Duchenne's?
-25 % overall,
-50 % if it is a boy,
-O% if it is a girl ( assumption is that mother is a carrier and father is healthy)
this is sex-linked recessive disorder. Affected child is boy. The mother must be carrier. So, the chance of her next child to be affected will be 50% among her sons or 25% among all of her children.
Q) A pt has flu and was treated with Amantadine. Now the Q ask the drug is belonged to:
1.chemotherapy
2.antibiotics
Answer is chemotherapy
Q) A 24 y/o woman came to your office with frothy vaginal discharge and rash on her cervix. You diagnosed her with Trichomoniasis vaginitis. You gave her RX for metronidazole. She remined you that she is breastfeeding. What should you do now?
Answer is give metronidazole and ask her not to feed for 24 hours
Q) a patient with tibial osteomylelitis, cultures taken , xray done,antibiotics started which is the next best step leading to diagnosis presents on second day of osteomyleitis
a)mri
b)bone scan ANSWER: MRI
Q) A man with 5x5 cm mass in left lobe of thyroid which is found to be papillary carcinoma..The man has develop HOARSENESS. the right lobe of thyroid is irregular on exam.. what is the best treatment
a)radiation
b)partial thyroidectomy plus radiation
c)total thyroidectomy with left neck dissection
d)total thyroidectomy with removal of enlarged nodes
Answer is C
Q)
Kid with meningitis,but family don't want tx. what to do?
-respect their wish
-court order
-go ahead and treat.
GO ahead and treat.. is the answer.
Q)8wks pregnant women returing from vacationing in conneticult discover a tick on skin, 1 wk later noticed a lesion ask for treatment.?
LYME disease is the scenerio here
Answer is
-amoxicillin or cefta, if CNS involved -
-NO tetracycline because she is pregnant
-If this patient was not pregnant then tetracycline is doc ten day therapy is usually reserved for isolalated erythema migrans....if systemic or severe symptoms therapy is recommended for 21 days.
any one of the following
tetracycline 250 po qid
doxycycline 100 mg po bid
amoxicillin 500 po tid
Q)a parent has asthma since childhood now is pregnant she ask what the chances baby has asthma.
-none
-25
-50
-100
25% if one parent involved 50 % if both have asthma
Q)Stroke pt was treated and vital signs are stable. Now the pt has blood vomiting. Dx:
-1.diffuse gastritis
-2.gastric ulcer
-3.others..
A-nswer is diffuse gastritis
Q) Low back pain with lower extremity neurological s/s and bladder problem. Dx ?
1.spinal stenosis
2.disc hernia
Spinal stenosis is the answer..
Q)Organ donation. Father and sister agree. But mother did not agree. What do you do ?
Point about organ donation.. DO not take organs from the body until FAMILY agrees.. in this situation,,, try to resolve the conflict let them have family meeting educate them etc etc..
If in the end family is not agreeing with the donation..DO NOT Take organs..
Q)Pneumococcal vaccine is indicated for which one of the following?
A-15-year-old with recurrent sinusitis and URI
b- 8-year-old with recurrent tonslitis
c 3-year-old with nephrotic syndrome
d- 6-month-old with sickle-cell disease
e- 3-month-old whose mother has active human immunodeficiency virus (HIV) infection
Answer is C.. minimum age is 2 years.. both nephritic and sickle cele will nedd vaccine
Q)Which one of the following is the most appropriate management?
1-Perform serial L/S ratios until greater than 3.0, followed by prompt delivery
2-Induce labor, with careful fetal monitoring
3-Perform an immediate cesarean section
4-Follow the mother weekly with serial ultrasounds
5-Follow the mother weekly with nonstress tests
Answer is 2. Induce labour and monitor fetus
Q)A 22-year-old white female who works in the newborn nursery of a hospital consults you regarding her exposure yesterday to an infant with congenital rubella. Today she has a positive pregnancy test and is 8 weeks pregnant by dates and examination. Her rubella immunization status is unknown.
Your immediate recommendation is
A) a therapeutic abortion
b) intramuscular gamma globulin
c) oral amantadine (Symmetrel)
d) a rubella antibody test
e) an MMR vaccination
Answer is D. rubella antibody test
Q) In a woman with preeclampsia, the impending onset of eclampsia is most likely to be indicated by
A) urinary protein excretion >300 mg/dL/24 hr
b) facial edema
c) increased serum uric acid
d) headache and visual disturbancesAnswer is D headache and visual disturbances
Q)35 yrs male iv drug abusers with a history of haemorrhagic shock 6 month ago came with weakness, P/E enlarged liver 3cm ALT 400 and rest of the liver function test normal. which one of the following investigations is the most important to diagnose the case?
a)HbS Ag + HbcIgM
b)HBV PCR DNA
C)HCV Ab
d)Liver biopsy
e)HbSAg+ HbcIgM + HDV Ab
Answer is C hepC AB
Q) 45 years old woman with history of DM and mild Hypertension with occational history of seizure for last 6 month came to your office with 6 hours h/o headach right sided partial ptosis,pain in lower half of face and neck rigidity.what would be the cause?
a)Trigeminal neuralgia
b)SAH of Post communicating artery
c)SAH of PICA
d)Brainstem glioma
e)Lacunar stroke
Answer is C..Ipsilateral facial pain sensetion,ipselateral horner's syndrom
and involvement of V11 nerve (bells palsy).
Q) 60 years old female h/o chronic diabetes & Hypertension with a left sided stroke came in ER 3 month ago with repeated attack of seizure there she was given some anti-seizure medication for Chronic control but last two months she developed incontinence with no urinary symptoms.The most likely cause
a)UTI
b)Phenytoin therapy
c)Carbamazapine
d)Valproic acid
e)BHP
Answer is B PHENYTOIN therapy
Q)which of the following anomalies is the major concern with chronic lead intoxication?
a. Abnormal bone growth
b. Hyperurecemia and gout
c. Microcytic anemia
d. lower I.Q. scores
Answer is D lowe IQ score
Q) A 6-year-old Hispanic female develops watery diarrhea, with at least twelve episodes over a 48-hour period. She is taking fluids orally without nausea and vomiting, is afebrile, and has an unremarkable physical examination except for hyperactive bowel sounds. There are no signs of dehydration.
According to current practice guidelines, which one of the following is the most appropriate recommendation?
-Age-appropriate diet without milk products
-Age-appropriate diet
-Clear liquid diet alone
-Clear liquid diet (juices, soft drinks) and loperamide (Lomotil) orally
Answer is B age appropriate diet
Q) what is the most common associated finding in patients with panic disorder?
a. Alcoholism
b. OCD
c. Depression
d. Any substance abuse
Answer is C depression
Q) Which is the most accurate method for detecting Down's syndrome
a. amniocentesis
b. CVS sampling
c. ultrasound
d. MRI
Answer is karotyping BY amniocentesis
Q) what is the single most important risk factor for the development of postpartum depression:
a- history of depression
b- history of bipolar disorder
c- a greater than average postpartum drop in serum progesterone
d- a recent stressful life event
e- the mother's experience as a child in her family of origin
Answer A.. history of depression
Q) A patient with Few pounds weight loss. He has been unable to eat due to pain with swallowing either liquid or solids. He smokes one pack of cigarettes per day. On PE, he is a thin man with diffuse cervical and axillary lymphadenopathy . His T- 101,4. There is no oral thrush and his lung have fine bronchi at right base. What is most appropriate diagnostic test?
A) Barium esophagram
b) endoscopy with biopsy
C) empiric trial of antifungal with ketocanazole
d) empiric treatment with ganciclovir
E) give him a prednisone
Answer is B. barium is the initial/first test Endoscopy/biopsy is the diagnostic
Q) 60 yrs old lady moved to a new residential center a year ago and came for annual exam. She has no specific complain and just mentioned that she only slept for 5 hrs a day. She functions well. Physic examination is WNR. What do you do for short sleep time of this lady.
1. It is normal for old lady
2. Prozac
3. Benzodiazepem
4. lifestyle change with more exersize
Answer is 4. lifestyle change with exercise.it could be normal not sure yet
Q) A 45 year old man comes to the doctors office and complains of "the worst headache in his life".
He is awake and oriented. He refuses to have a CT.
A lumbar puncture yields lightly blood tinged sample with rbc count 300,000
wbc count 55000(90% polyps), protein-88,glucose-20
gram stain is negative.
Most appropriate treatment is
a) E aminocaproic acid
b) angiography
c) ceftriaxone
d) heparin
Answer is B.. SAH diagnosis is angiography.after LP and CT tx is surgical Clipping
Q)A 40 yr old man with a history of DM and sexual dysfunction comes to you with a history of insomnia, loss of apetite, fatigue,feeling of worthlessness, and guilt, diminished ability to concentrate and depressed mood for 4 months. Which of the following would be the most appropriate treatment for this patient
a. Paroxetine
b. fluoxetine
c. sertraline
d. citalopam
e. bupropion
Answer is E Bupriopion
Q)Which of the following is most characteristic of a patient who has vitamin C deficiency?
(A) Diarrhea and delusions
(B) Ocular muscle palsy and dementia
© Cheilosis and beefy red tongue
(D) Perifollicular hemorrhages and hyperkeratosis
(E) Paresthesias and ataxia
Answer is D.
Q) What you will see in a biopsy of lchen planus ?
Answer is hyperkeratosis
Q)Orbital cellulitis
Next step
a) ct scan
b) iv antibiotics
Answer is Iv antibiotics first then investigations
Q) which is the best dx choice of pituitary tumor ?
a. CT
b. MRI
c others
Answer is A MRI is the best
Q)which of the following causes acute hepatic necrosis?
A INH,
B.acetaminophen
C.halothen,
D.methydopa Answer is A. ACETAMINPHEN
Q)A DM type II pt is under glipizide. His current glucose level is 270. what is the next:
A..add insulin
B.add metformin
C.add pioglitazone
D.add glyburide
Answer is B .. add metforminif sulfonylurea failed to control it then add metformin and if both fail to control then add a thiazolidinedone
and if they fail to improve give insulin
Q) a man loss of vision in 24hrs c/o curtain in eyes.,no pain
A)ret.detachment
B)retinal artery obst.
C)retinal vein obt.
Answer is A retinal detachment
) which is the best test for confirming rupture of membrane ?
a. pool test
b. nitrazine test
c. fern test
d. U/S
Answer is B.
Q) In gallbladder sludge by u/s and pt is sym with pain fever and has diabetic,next step
-ct abdomen
-start antibiotic
-ercp
-observation
Answer is CT ( acalcolus cholecystitis )
Q) Which of the following drugs is the least sedating and anticholinergic, which can be prescribed safely to elderly patients with depression?
a.f
Don't recall choices. Probably
A. Communicate the news of the death to the relatives
B.Communicate the news to the attending physician.
C.certify death.
ANSWER IS CERTIFY DEATH
Q) 24 year old male with three day history of testicular swelling progressive, no nausea vomitting,mild fever, dull pain, no radiation. Pain does not diminish on lifting the testis up but aggravates from 6/10 to 7/10.No risk factors for std.
what s your diagnosis
a. torsion
b. epididymitis
Answer is epididymitis (three days of onset)most likely answer
Q) Mother comes with 12 year old child. child is blond with blue eyes.
she ask which is the best way to prevent malign melanoma there is no family history
spf15
spf16
forbid out door activities in sun
tell her to wear protective clothing
Answer is tell her to wear protective clothing
Q) Elderly pt with hx of high bp, controled well, suddenly increase bp what's the cause?
Answer is Most likely non compliance with meds is the answer
Q )Pt c Parkinson disease, tx c L-dopa, had agitation, tx c haloperidal, getting worse, next:
a. increase haloperidal
b. decrease halo...
increase l-dopa
Answer is change it to other antipsychotic Clozapine .. if that not in the choice answer is Decrease / dc haldol.
Q)14 y/o girl pregnant is there increased chance of congenital malformations or not?
ANSwer is No clear increase risk with young age
Q) black male with HTN + DM .what HTsive med do u give?
Answer is ..Ace inhibitor.*htn plus diabetes*
Q) œBILATERALrenal a. stenosis with HTN, what med do you use to tx HTN
Answer is calcium channel blocker. If it was unilateral stenosis then ACE inhibitors. Ace inhibitors are contraindicated in Bilateral stenosis
Q) Estrogen replacement therapy has risks, which one is not
a. gallbladder dx
b. breast ca
c. uterine ca
d. pancreatitis
e. thromboembolic dx no clear answers? I THINK THE Answer is pancreatitis.
Q) A kid with Down syndrome has one parent with down sy. the mother asking about another baby but she scared will have down syndrome, what should tell her?
100% chance
50%
25%
0%
Answer is 50 %
Q) A 5 y/o kid with turner syndrome his mother is pregnant and she is asking what % chance will have this coming baby with TURNER SYNDROME?
ANSWER Is .Somewhat increase chances.. if one previous baby is with turner no clear numbers.
Q) Parents have a kid with Cystic Fibrosis, what is the chance to have another kid with same disease?
Answer is 25 percent chances
Q) Mallory Weiss, next
a) chest x-ray
b) surge consults
c) prepare for urgent endoscopy
Answer is C endoscopy
Q)nausea vomitting taking digoxin, stable, k+6.0
a) give ca gluconate
b) digiband
c) take digoxin levels
d) stop digoxin
Answer is stop digoxin. If this is not in the choice in exam calcium gluconate.read the qs carefully.. if its next step then stop digoxin and treatment is calcium gluconate.
Q) 50 yr annual office visit common finding at this age
1.htn
2.cad
3.cancer
is it HTN or CAD. I think it is HTN.
Q) organ donation in a pt who had a ishemic death
1 but which organ you will take and
2 the time ........]
Brain death. U can take any organ out if its cariac death or ischemic death ..take superficial organs only..skin cornea , fascia and bone. Not other organs like heart lung kidney liver.
Q) Tanning and skin cancer relation with “UVA /UVB
which is more malignant
UVA is the answer Both causes cancerr UVA is causes melagnany melanoma.
Q) pt was bit by an animal (not high risk for rabies) in the zoo. What is the most important question to ask:
1- how long.
2- any disease present in the zoo.
3- from where the animal.
4- any symptoms happened to the patient right after the biting.
ANSWER IS ENQUIRE WHERE THE ANIMAL IS FROM
Q) A child allergic to neighbor™s cat what you do
a ask pt to avoid cat
b antihistamine
c. steroid
d isolate cat
Answer is A
Q) A male pt with thumb base pain what is dxa.
De querene tensovitis is the answer treatment is nsaid and intrathecal steroids.
Q) 12 month child with mouth candida what do you do
Nystatin and treat mom with topical anti fungal cream on breast
Q)neonate c thrush what do you do
obs
antifungal
Answer is anti fungal
Q)a pregnant rh- do not know father what is next?
a give rh antibody 28 w
b test rh titer now
c. no need rh antibody
Answer the B
Q)post mva, pt can not extend knee, decreased low leg medial sensation, which n injury?
a femor n
b tibia n
c. fabula n
answer is A femoral nerve
Q)post mva suspect bladder trauma, most sensitive exam
a ct
b u/s
c peritoneal lavage
d kub
Answer CT
Q)75 y/o male constipation, no other abnormalities, what is most likely cause
Functional causes. Is the answer
Q)pt with s/s of aortic dissection, what is next exam
1 ct
2.TEE
3.U/S
4.cxr
Answer is TEE..or Ct with contrast now becareful how the qs is phrases if it is next step then X ray is a possible answer but if it is diagnostic then TEE. So read carefully.
Q)ileojejunum bypass, diarrhea, what kind of fluid you give?
Total parental nutrition ,BUT normal saline+calcium and magnasium replacement
Q)which of followings is most likely to distinguish pk from major depression
a mask face
b tremor
c rigidity
d imbalance
e brady
Answer is ANSWER IS RIGIDITY,,,,,
Q) pregant pt c urinary stone, next exam
a u/s
b. ivp
c ct
Answer is U/S
Q)subarachnoid hemorrhage in pt taking coumadin:
1- ffp.
2- vit K 3- whole blood.
4- stop coumadin and do nothing.
5- cont coumadin
fresh frozen plasma
Q) A kid with chicken pox, when could he return to school?
Q)shoulder dystocia
next step,
a) mcroberts manover
b)call your collegue
c)tell mother not to push
d)call anesthesia
answer.first step tell mom not to pushthen ******* manouver then c sectionbreaking of clavicle is the last resort
Q)which is not a risk factor of osteoporosis
a) smoking
b)alcohol
c)caffieneted products
d) white race
e) obesity
f)there were 2/3 more but not convincing
answer is obesity ( qs is NOT a risk Factorok)
Q)there was a picture of breast focussed on the nipple area a 43 year old women coming with pruritus,I thaught it must be pagets disease,the question waas what is the next step, mamography normal
a) biopsy
b) steroidd cream call after 7 days
c) scraping the lesion
d) i dont ???remember but wasnt so convincing
answer is Biopsy
Q)most common risk factor of PID
1) multiple sexual partner
2) women with intrauterine contraceptive deivice
answer is multiple sexual partners
Q) primigravida 28 weeks, rh negative ,husband positive anti ***** antibody positive what next
1)give anti rhd2)
dont give anti rhd3)
do amniocentesis,
answer,,,, DON™T DO ANYTHING.
Q)early post partum hemmorage,iv access done,resuccitated,bleeding present
next step
a) do pelic examin
b) uterine massage
Answer is pelvic exam this is how u gonna find out about atony uterus.treatment is uterine massage
During a flu. Season, a pt who did got get flu. Shot and had a flu.s/s for 4 days came in for treatment. You provide for him:
1. amantadine 2. zanamivir 3. only symptomatic support including (Tyleno)
Symptomatic treatment ( amantadine or zanamivir is given within 72 hours of influnza ZANAMIVIR is the best treatment it covers both A and B)
Q)A 4 month-old-boy who is diagnosed as having OM without fever yesterday is brought by his mother for his regular vaccination scheduled. At this time, as his PMD, you: 1. give the boy vaccines scheduled 2. Wait after he recovered from his disease 3. others.
Answer is give vaccination ( ever is not a contraindication )
Q)Most common parasitic infection in usa
Answer is PINWORM (Entrobius vermicularis)
(3 peds questions)
A boy (5 may 8 yrs old) was brought by his mother with c/o right hip pain for 3 days. The boy had upper respiratory infection prior this hip pain. After working up, it is dx as septic arthritis.
1. what is the cause ? a. strep. Pneumo. B. staph. A. c. other bacteria (no surgical intervention)
2. what antibiotics ? a. methicillin b. penicillin c. vancomycin d others
3. 2 days after antbx, now there are a few small maculae (2-3 mm in diameter) without itching or redness. What do you do ? a. d/c antx b. continue the treatment c change to another antx. D others
Answers..1) staph aureus 2) methicillin 3) change the antibiotics
Q)23 yrs old women with a vaginal presure symptoms and on pe has a 5 cm cystic mass,use diaphram for contraception, pregnancy test negative
next step
1.u/s
2.observation for 6-8 weeks
3.birth control pills
4.laprotomy
ultrasound
Q)What is the best method to diagnose CHF
a. Echo
b. PE and symptomes
c ECG
d Serum levels of B-type natriuretic peptide
e CXR
Q)Would anyone post the exact inetrvals for pap smear (cervical cancer screening), breast cancer screeing, prostate cancer screening and colorectal cancer??
This is very important topic as I had many Q in this topic
Q)How do you treat Cocaine abuser with 210/115 BP?
Cocaine induced HTN - treated with Benzo, Nitroglycerin or Nitroprusside drip and Phentolamine 1 mg IV
No beta blockers like propranolol
Q)which is the not a sign of ovulatory bleeding,
1)Infrequent heavy bleeding
2)Presence of premenstrual symptoms
3)Dysmenorrhea
4)Breast tenderness
5)Change in cervical mucus
6)Mittleschmertz answer is 1
Q) which is maximum risk for preoperative assesment of cardiac function
1)Suspected critical aortic stenosis
2)Myocardial infarction within six months with age >70
3)Poor general medical status and emergency operation
4th was easy to be removed
Answer is 1 read below
this was totally confusing as i did not read this topic nicely now i know the answer please try to discuss , lots of questions
Risk
Age older than 70 years 5
Myocardial infarction within six months 10
Myocardial infarction after six months 5
Canadian Cardiovascular Society Angina Classification*
Class III 10
Class IV 20
Unstable angina within six months 10
Alveolar pulmonary edema
Within one week 10
Ever 5
Suspected critical aortic stenosis 20
Arrhythmia
Rhythm other than sinus or sinus plus atrial premature beats 5
More than five premature ventricular beats 5
Emergency operation 10
Poor general medical status 5
SOURCE IS AAFP ALSO AMERICAN HEART INEX
Q)a 8 month old kid cant turn overwhat is the next exam
neuroreflex
check teeth
????
Answer Is neuroexam.neuro reflex
Q)29 yo M c severe diarrhea
o/e listless but responsive
vitals stable
Na 118,K 2.9, hco3 12,,urine na <10
R
a IV hypetonic saline
b hypotonic
c isotonic
d fluid restriction
e hco3
answer is isotonic solution
Q)prom with 34 weeks,
next step
1)take culture
2)start oxytocin
answer is take culture first
what next,bp,smac,cbc.normal
ct with contrast
mri
ivp
do we have to save money by doing ctscan or be more perfect doning mri, i was confused, Kaplan says mri, so i clicked mri.but what are your opinions
answer CT mri requires sedation
Q)A 3-month-old child was exposed to an adult with active pulmonary tuberculosis. What is the recommended approach to this problem?
A. Administer a TST and reevaluate in 3 months.
B. Administer a TST, perform a CXR, and reevaluate in 3 months.
C. Administer a TST, perform a CXR, administer INH, and reevaluate in 3 months.
D. Reevaluate after 3 months.
E. None of the above.
ans: C
the kid should be given INH prophylaxis even if CXR/PPD are negative. You have to reevaluate in 3 months with a skin test:
. if the test is negative :- to D/C INH
. if the test is positive :- to coninue INH for another 6 months (total 9 months )
Q)A pt on warfarin and heparin develops thrombocytopenia and petechias, what is next ?
a. d/c heparin only
b. d/c warfarin only
c continue both
d d/c both
Answer is dc both seems to be the answer
Q)25 yr old male routine visit with his father diag with colon cancer, what will you ask him next
age of onset
family h/o
diet pattern
sign and sym
answer is family history
Q)pt has been treated with lithium and developed hypothyroidism. after stopping lithium, when do you do tsh:
1- 3ds
2- 1w.
3- 2w.
4- 1m.
5- 3m
answer is 4-6 weeks
Q)pt has been treated with 0.075 mg thyroxin for possible hypothyroidism. you want to stop the drug and test the patient to see if he really has hypo-, when:
same options like the previous.
note: the amount is real.
An initial dose of thyroxine of 0.05 to 0.075 mg per day is usually sufficient to normalize the serum thyrotropin level.Patients with coronary artery disease should receive lower initial doses (e.g., 0.0125 to 0.025 mg daily). Serum thyrotropin levels should be measured four to six weeks after therapy is begun, after any change in the dose, and then annually once the levels become stable. Thyroxine requirements may increase over time if there is progressive thyroid failure.
NEJM
Q)pt with history of cancer. dnr. developed stroke at home what do you do.
leave him home
give him drug for pain.
admit
admit the pt. Seems to be the answer
Q)DMI glucose 160 wants to sport:
1- insulin before match.
2- glucose before match.
3-nothing..GLUSOCE BEFORE MATCH OR NOTHING ????
Q))you want give quinolon to a pt. whuch drug of the following should you worn him from:
1- coumadin
2- theophyllin
3- propanolol
answer is theophyliine
Q)50 y.o.w with multiple problems told you she is gonna get married from somebody she has met 2 weeks ago and asking you to attend:
1- congrat.. so nice of you to ask me but i am sorry i cant.
2- no my proffesional cant let me
3-you have so many problems it will affect on you negatively.
4-arent you too old to get married
5-is too soon to get married after two weeks only of knowing him
answer is A
Q)stroke family want dnr. you dont have previllage in that hospital and the doc wount give the familly dnr. the familly now calling you to support them having dnr for their pt:
1- tell them to take the pt to a hosp where he has previllage.
2- ask attorny.
tell me about the pt situation
answer si tell me more about the patient
pictures of fundoscopy ( glaucoma, DM, and cmv)
skin (herpes zoster)
ecg (1st degree block) preop.
Q)pregnant exposed to a lacy rashed boy:
1- it will not affect you.
2- you get mild disease.
3- you are vaccinated to this. no harm
4- your may loose your fetus
Q)pt haevy smoker, loss 8bl lately, surem Ca++ 11.5,
what do you do next?
a.recheck Ca++ level
b.check CXR
answer is chest x ray
Q)pt has unilateral hearing loss, tinnus. also has lung Ca
what is most likely her symptom?
ANSWER IS MAYBE METASTASIS
Q)A diabetic pt with non healing ulcer..next step
Debribment
Antibiotic
Answer si debribe first
Q)A diabetic man with sexual dysfunction,,comes in for evalutaion of depression,, he is found to be depress..what is the best treatment
a)paroxitine (paxil)
b)fluoxetine (prozac)
c)sertraline (zoloft)
d)citalopram (celexa)
e) bupriopram (wellbutrin)
Answer is E.
wellbutrin and serzone are the only antidepressant that I know have least effect on sextual function.
I have checked it out this is not a guess.
Q)Most important risk factor for breast cancer?
a)involment of upper outer quadrent
b)breast cancer in mother
c)breast cancer in sister
d)use of OCP
e) early onset of breast cancer in family
Answer e
Q)karotype of complested hydatidiform mole is?
a) 46 xy
B)45 xy
c)46xx
d)69xxx
e) or somethign else..please specify?
Types
Complete Mole
Total hydatidiform change
Marked proliferation of trophoblastic cells
No evidence of fetal vessels
Karyotype: 46XX
Derived from haploid 23X sperm
Sperm duplicates chromosomes without cell division
Higher risk for malignant change
Partial Mole
Associated with a fetus (may be only vessels)
Moderate trophoblastic proliferation
Karyotype: Triploid (69XXX or 69XXY)
Fertilization by more than one sperm
Malignant change less likely than in complete mole
Q) Painless gross and microscopic hematuira: THESE ARE THE STEPS>>>>U/A > IVP > CT..
Q)Painful gross or microscopic hematuira (s/s -> kidney stone):these are the steps >>>> U/A > KUB > IVP > CT ??
Q)thyroid disorders,
early menopause
or somethign else???
answer is osteoprosis and early menopause AND STRESS FRACTURES
Q)What IS the most common associated finding in patient with paNIC DISORDER?
a)aLCOHOLISM
B)OCD
C)DEPRESSION
D) SUBSTANCE ABUSE DISORDER
Answer is depression
Q) A WOMAN IS TAKING OCP NOW PREGNANT ?effect of OCP ON FETUS
what will u do or say??
a) Sono..if boy consider abortion
b)sono if girl Do abortion
c) tell her no adverse effect on fetus
answer is C. I have cheked this out. No harm to baby
Q)A man with 5x5 cm mass in left lobe of thyroid which is found to be papillary carcinoma..The man has develop HOARSENESS. the right lobe of thyroid is irregular on exam.. what is the best treatment
a)radiation
b)partial thyroidectomy plus radiation
c)total thyroidectomy with left neck dissection
d) total thyroidectomy with removal of enlarged nodes
answer is B or C ?? one of them
Q)2 yo child, mother reports he is pulling his LEFT ear, no fever vomiting, appetite good exam reveals cooperative kid,tympanic membrane red, no fluid on tympanogram..
what will u do?
a)PO amoxillin
b)gentamycin ear drops
c)refer to ENT
d)tylenol only
E) reassurance
Answer is possibly E reassurance.. I guess
DON™T KNOW THE ANSWER
Q)woman with symptomatic Tachycardia, otherwise stable, positive for signs of hyperthyroidism,,,what is the IMMEDIATE way to treat her symptoms?
a)PTU
b)RAI
c)surgery
d)propranolol
answer is D
Q)pt with heart rate of 45/min, BP 90/50, PR constant.Every third wave without QRS complex?
management?
A) atropine IV push
b)observation
c)external pacemaker
d)transvenous pacemaker
Answer is C.
Atropine should not be used to treat Mobitz type II block associated with BBB
Hemodynamically unstable pts should be treated initially temporary transvenous pacemaker insertion followed by permanent pacemaker implantation.
Q) picture of a 7-8 yo boy with ulceration in AXILLA and lateral chest only...what is the most likely diagnosis?
A)impetigo
b)subepidermal bullous dermatosis
c)herpes
d)bullous pehphigoid
Answer is impetigo
Q)most effective contraceptive????
a)condoms
b)IUD
c)ethynyl estradiol +levonorgestrol orally
d)medroxypregestrone acetate IM (depot)
ANSWER IS OCP (COMINED )
Q)CGlucagon is least likely to be used for severe hypoglycemia in
1) Type II DM
2) Malnourished patient
3) Infant overdose of injected insulin
4) Obese patient > 65yrs
answer is B
Q)Can a boy with Type I Diabetes compete in competitive sports? If yes what precautions to be taken, regarding insulin dose?
decrease insuline (and take a snack ?) exercise=insulin so need less insulin prior to exercise.
Q)Infection of which valve is most likely to be associated with the development of heartblock.
a. tricuspid
b. Pulmonic
c. Tricuspic and pulmonic
d. Aortic
e. Mitral
Answer is E
MULTIPLE SCLEROSIS
Q1) how do u check the progression of multiple sclerosis?
Q2) how to u follow Multiple sclerosis?
Q3) Diagnostic test of Multiple sclerosis
Q4) Effect of pregnancy on multiple sclerosis?
Answers to above question
1) Progression based on clinic
2) F/U depend on clinical course
3) Dx MRI
4) Pregnancy? Pregnancy exacerbate MS symptom. Agree with rest of info.
Q)person with symptoms of Obstructive sleep apnea...what is the first/next step?
a)sleep study
b)medical workup
c)CPAP treatment
Answer is Medical w/u as below
1.r/o hypothyrid.ent exam
2.polysomnogram
3.treat-weight reduction(doenot work) >>>cpap
Q)Most common site of pancreatic cancer?
Answer is adeno carcinoma (type) head of the pancreas(site)
Q)A mother is concerned about obese child 3 y. what is the reason child is obese
mother behaviour problem
-child neglect
-genetic
-eating disorder
-ANSWER IS MOTHERS behavioral problems excessive eating may lead to childs excessive eating
Q)OLD lady with hemoptysis,Sob,questionable murmur.X ray chest HTN with Left artial enlargement, EKG a fib,Both artial enlagement AND rt vent hyperthrophy?
what is the diagnosis?
Answer is mitral stenosis
Q)A41 yr old women with a 2 month history of abdominal pain and reports constipation and altered calibre of stool with a history of weight loss of 9 pounds. What is the likely possibilty?
-Inflammatory bowel disease
-Irritable bowel disease
-Colon cancer
-Tropical sprue
-celiac disease
Answer is colon cancer.
Q)A 4 yo comes to ER with muscle weakness, miosis, salivation, diarrhea, heart rate slowing down. You will give;
A. naloxone
B. atropine and pralidoxime
C. flumazenil
D. N-acetylcysteine
E. Pyridoxine
B. atropine and pralidoxime
Q) A 14 year old boy with acne lesions on face and back on benzoic peroxide and topical tretenoin with only partial response. What will you do next
-Oral tretenoin
-Corticosteroids
-Oral tetracycline
-topical erythromycin
Answer is oral antibiotic ( tetra)
Q) Treatment of spasticity in post stroke patient
Answer is beclofen
Q)Pt came with chest pain. No EKG is done yet...after oxygen,,,next step?
a)aspirin
b)captopril
c)heparin
d)metoprolol
e)streptokinase
Answer is aspirin
Q) Treatment of influenza. Indications and limitation of AMANTADINE
Answer is
influ. A amantidine within 48-72 hrs
************************************************** ************************************************** ***
1. labetaolo 2. hydralazine, 3 methyldopa
first, look at the medication she is taking for essential hypertension, if that is ace, change it.
for pregnant patient, good control of BP is very important.
*maintaince of BP can be done with methlydopa tid. If controlled well, keep close monitoring and continue methlydopa.
beta blockers can be safely used and if the patient's hypertension is well controlled on a Beta blocker there is no need to change.
Labetalol and hydralazine can be used for acute control of BP readings.
*for pregnacy+chronic THN
*Labetalol for pre-eclampsia
***********************
the most likely disease that one can get from in discriminate sexual activity:
gonorrhea
chlamydia
HIV
HBV
I had a worse question.
which of the following is not sexually transmitted from a prostitute.
a. Hep B
b. treponema pallidum
c. HPV
d. tricomonas
e. neisseria gonarrhea
I thought of all of those, hepatitis requires blood conatct, but it is just a guess. The rest are pretty much impossible to choose. What about Treponema? I think syphilis is very contageous. What do you think, Raavii?
if it is HEP C, sure pick it.....
Among these....I do not know, can go with HEP B....then..
any suggestions....anyone....
**************************
a young female came with acne you prescribed topical isotretinoin later after few weeks she came with complaint of its itching of amole under her breast which has become itchy after the usage, your response is.
1.isotretinoin causes itching some times
2.itching may be an indication for the removal of the mole.
3.other choices dont remember
sounds like you have to biopsy the mole.. any thoughts?
looks like the mole started to have itch after the medcine topical isotretinoin was started and the Q is asking.....
if it is from the medicine or not?????
so 2 is the answer?
or isotretinoin causes itching some times???
I have no idea.....
***************************
1. Female comes for treatment of recurrent herpes.
Do you tell her to send her sex partner for examination?( That was on the choices.)
2. Female with increased pigmented lines on neck and axilla. Most likely diagnosis.
a. Cushing¡¯s
b. Conn¡¯s syndrome
c. Addison¡¯s disease
d. DM
e. PCOS
is it c or d?????
acanthosis nigrans... DM
foll is some info from emedicine:
ACANTHOSIS NIGRICANS: The definitive cause for AN has not yet been ascertained, although several possibilities have been suggested. Eight types of AN have been described.
Obesity-associated AN, once labeled pseudoacanthosis nigricans, is the most common type of AN.
Lesions may appear at any age but are more common in adulthood.
The dermatosis is weight dependent, and lesions may completely regress with weight reduction.
Insulin resistance is often present in these patients; however, it is not universal.
Syndromic AN is the name given to AN that is associated with a syndrome. In addition to the widely recognized association of AN with insulin resistance, AN has been associated with numerous syndromes (see Picture 2). The type A syndrome and type B syndrome are special examples.
The type A syndrome also is termed the hyperandrogenemia, insulin resistance, and acanthosis nigricans syndrome (HAIR-AN syndrome). This syndrome is often familial, affecting primarily young women (especially black women). It is associated with polycystic ovaries or signs of virilization (eg, hirsutism, clitoral hypertrophy). High plasma testosterone levels are common. The lesions of AN may arise during infancy and progress rapidly during puberty.
The type B syndrome generally occurs in women who have uncontrolled diabetes mellitus, ovarian hyperandrogenism, or an autoimmune disease such as systemic lupus erythematosus, scleroderma, Sjögren syndrome, or Hashimoto thyroiditis. Circulating antibodies to the insulin receptor may be present. In these patients, the lesions of AN are of varying severity.
Acral AN (acral acanthotic anomaly) occurs in patients who are in otherwise good health.
Acral AN is most common in dark-skinned individuals, especially those of African American descent.
The hyperkeratotic velvety lesions are most prominent over the dorsal aspects of the hands and feet.
Unilateral AN, sometimes referred to as nevoid AN, is believed to be inherited as an autosomal dominant trait.
Lesions are unilateral in distribution and may become evident during infancy, childhood, or adulthood.
Lesions tend to enlarge gradually before stabilizing or regressing.
Familial AN is a rare genodermatosis that seems to be transmitted in an autosomal dominant fashion with variable phenotypic penetrance.
The lesions typically begin during early childhood but may manifest at any age.
The condition often progresses until puberty, at which time it stabilizes or regresses.
Drug-induced AN, although uncommon, may be induced by several medications, including nicotinic acid, insulin, pituitary extract, systemic corticosteroids, and diethylstilbestrol.
Rarely, triazinate, oral contraceptives, fusidic acid, and methyltestosterone also have been associated with AN.
The lesions of AN may regress following the discontinuation of the offending medication.
Malignant AN, which is associated with internal malignancy, is the most worrisome of the variants of AN because the underlying neoplasm is often an aggressive cancer.
AN has been reported with many kinds of cancer (see Picture 3), but, by far, the most common underlying malignancy is an adenocarcinoma of gastrointestinal origin, usually a gastric adenocarcinoma. In an early study of 191 patients with malignant AN, 92% had an underlying abdominal cancer, of which 69% were gastric. Another study reported 94 cases of malignant AN, of which 61% were secondary to a gastric neoplasm.
In 25-50% of cases of malignant AN, the oral cavity is involved. The tongue and the lips most commonly are affected with elongation of the filiform papillae on the dorsal and lateral surfaces of the tongue and multiple papillary lesions appearing on the commissures of the lips. Oral lesions of AN seldom are pigmented.
Malignant AN is clinically indistinguishable from the benign forms; however, one must be more suspicious if the lesions arise rapidly, are more extensive, are symptomatic, or are in atypical locations.
Regression of AN has been seen with treatment of the underlying malignancy, and reappearance may suggest recurrence or metastasis of the primary tumor.
Mixed-type AN refers to those situations in which a patient with one of the above types of AN develops new lesions of a different etiology. An example of this would be an overweight patient with obesity-associated AN who subsequently develops malignant AN.
In the light of the above more than one choice in this qs is possible ...any comments welcome.
thanks
*******************
Elderly woman with Alzheimer's becomes agitated. What will you give?
a.tacrolimus
b.trazodone
c.amitriptyline
no mention of haldol or benzodiazepine
recently posted recall...........
Tacrolimus is just a distractor
Trazodone is a good sedating agent with short onset and half life.
Amitryptaline is sedating too but will cause orthostasis and anticholinergic effects in elderly.
Among the above given, choice would to to Trazodone to calm the patient and sedate.
************************
Presentation of ankle sprain with tenderness and swelling. Dx:
* MRI ankle
* XRY foot
* XRY anteropost view of ankle
* XRY lateral view of ankle
Raaviio2, Iknow this q is confusing. Probably the recall is not complete. I think previously either **** frank or somebody mentioned xray is the first step if imaging is required. In certain cases according Ottawa rule no xray is needed.
Ankle sprains involves posible injuries of the anterior talofibular ligament (most prevalent type) and frcture bone. Most sprain injuries to the ankle can be successfully treated conservatively. The ability to bear weight after an ankle injury is an important consideration in deciding whether x-rays are needed. If a patient is unable to bear weight, or if there is significant tenderness at the posterior aspect of the lateral or medial malleolus, then x-rays are needed to rule out a fracture. If there is no evidence of fracture, or one less than 3 mm. of displacement, then conservative care is generally appropriate. I know you concern about the ligament injury, which MRI may better than Xray. However, for initial and general practice ankle X-ray is first.
Hope this help.
Agree, under most circumstances, acute ankle sprain does not need an image. If the presence of inability to walk, then X-ray (AP) will provide more information.
*********************
Long, long time ago, there was a posting that a patient after 16 yrs of renal transplantation (on azithioprine), had severe immunosuppressive. The questions ask what's the reason and what is the outcome of his immunosuppression.
I asked one nephrology fellow at Mayo, he told me that in such a patient, azithioprine use is the reason for his immunosuppression, and this drug could be stopped and the immunosuppression will get better. The reason that azithioprine can be stopped is because of 16 yrs history of renal transplantation without rejection
Hope this will help.
renal transplant patient transplant done 16 yrs ago and pt maintained on chronic azathioprine and prednisone. renal status is perfect and it is not only anemia but pancytpenia now with severe myelosuppression
what next step?
-decrese pred dose
-stop azathioprine
-start erythropoeitin
-start GCSF
-start fluconazole
next question
what wud be prognosis for this patient's myelosuppr
-improve
-worsen
-worsen then improve
-wax and wane
-unpredictable
*********************
Two kids. Older one eats chipped wall-paint and younger one eats newspaper!!
Older brother is having learning problems. Younger one is asymptomatic.
RBC protoporphyrin in older brother is 200
Younger brother 140
( Normal values given.)
What next?
Ans for elder brother is ........
Admit and BAL and EDTA.
2. Choices for younger brother
a. Await See Lead Level
b. Ca EDTA mobilization of lead for 8 hrs.
c. Do nothing.
I will wait and see lead level-ans A
The younger kid has PICA and so may have anemia but we have to check his lead level because he has a risk factor for lead poisoning(being exposure to lead since older brother has lead poisoning) but he is asymptomatic and we have to make a definitive diagnosis before treating.
I don't have any references but I know the standard care for supposed lead exposure without symptoms is determination of blood lead levels.
you know, I know that FEP (free erythrocyte protoporpyrin) is more sensitive than lead level and I know there is a conversion value for FEP to Lead which can tell you what the lead level is, but O don't have much experience with this. At this time, we still go by lead level. One interesting thought that did come up is that patients with anemia (like sicklers) have artificially low serum lead level, because they have artifically low amount of hemoglobin, and this is why the go by protoporphyrin. This is new stuff, and I don't think it will be tested on the boards. Go with lead levels for therpay..
**********************
an old lady with pain in the shoulder and back, and complains of weakness, and limitation in range of motion and physical exam shows upper extremity weakness, what next, and then they give you choice of
-NSAID,
-excercise program,
-bone densitometry,
-EMG
-ESR.
coz PMR is one of the main concerns but then the vignette will have more to it like stiffness of joints,etc
I will go with ESR to rule out any connective tissue disease, especially giant cell arteritis. However, if there is CPK, I probably will go with it if the history suggests polymyolitis. EMG can be used for confirmation of polymyolitis, but at this stage,you need a screening test
***********************
16 year old high school drop out did not have periods for last 3 months. She is sexually active with one patner for 1 year. Does not use contracptives. Preg. test positive.
The reason that this adolescent's failure to use contraceptive
A. Concern about weight gain
B. Cost of Contraception
C. Patner's opposition to contraception (hard to predict, but I will choose this one)
D.Concern about confidentiality
E.Desire to become pregnant
If you live in bif city like LA or NY, you see it all the time. case closed.
*****************************
PDR could you pl. do our favor? short lecture about baby fluid supplement
3% dehydration, what should give
what % dehydration consider severe or moderate, what should order?
thank you in advance
Aslo 15 % dehydration Rx? Thanks!
dehydration.
based on age group:
babies:
mild - 3%
moderate - 6%
severe - 9% or greater
children:
mild - 5%
moderate - 10%
severe - 15%
how do you know how dehydrated a child is? actually, the best way is looking at weight. If weighed 10 kg last week, and weighs 9 kg today, then 10% dehydrated.
- most common cause of dehydration in peds: vomiting, then, diarrhea.
assessing dehydration. first things that you see is thirst, and dry lips. then you see tachycardia, decrease urine output, and urine osmolarity is still normal, and you are still mild dehydration. treatment always should start with oral rehydration using something like pedialyte or an oral rehydration solution. If child is not tolerating p.o., this is reason for admission, and IV fluids. Don't forget to correct underlying illness. IV fluids could include NS bolous for rapid correction, (where you correct only 10% of deficit. If total deficit is 1 liter, then 200cc NS will correct 100C deficit and 100C for current need. Then you correct the rest of deficit with isotonic sugar containing solution (in babies D5 0.225, and in bigger kids D5 045NS over 24 hours. half in the first 8 hours, and second half in next 16 hours. It is the same with moderate and severe dehydration, except severe dehydration (9% in babies, 15% in older kids) you must look at electrolytes. Still, no matter what, don't give hypotonic solution or free water no matter what.
**********************
Q) 16 year old high school drop out did not have periods for last 3 months. She is sexually active with one patner for 1 year. Does not use contracptives. Preg. test positive.
The reason that this adolescent's failure to use contraceptive
A. Concern about weight gain
B. Cost of Contraception
C. Patner's opposition to contraception
D.Concern about confidentiality
E.Desire to become pregnant
Most teenagers think contraceptives cause weight gain
Some contraceptives has wt gain as a RF - OCPS, DMPA, other forms do not. She could use barrier form of contraception, the fact that she is not using anything might indicate that she desires to become pregnant also, b/c is is a drop out.
comments
...but any reference regarding that;
i thought it could be regarding her confidentiality matters.,etc.
it's C. that was what I just to do with my ex-girlfriends a few years ago.. .no more.
All of these choices are possible, however, in this particular case, the most likely reason, I think, is the pressure or the opposition from the partner. A drop out teenage usually has low self-esteem, and like to please her partner, if he does not like any contraceptive, then she won't use it.
All the options are possible. But WT gain is the most common concern among teenage girl.
Agree with Julia,most common concern is wt. gain amoung teenagers.In such questions where both partners can make a difference as to whether something is done or not, we need to watch the wording of the Ques.Here the ques said what are her reason for not using contr. and this tells you that the decision is hers not her partner's because no info. about the partner is given.
The answer could be E too but I chose A because a teenage drop-out will not desire pregnancy unless there is some info. in the ques. that points to that and surveys have proved ans A.Sorry, can't remember any refs.
Zaslau s book.There the answer is :
-Why she doesnt use condom --> Because she doesnt know how to use.
-why didnt she use any contraceptive--->because she didnt think that she gets pregnant in first intercourse.
-why she doesnt want any OCP --> Because she thinks she gains weight
she desires to get pregant.. saw two like that Friday night in the ER
If you live in big cities in America, you will see it. Partner's opposition is not enough for most girls to risk getting pregnant. If she did not want to get pregnant, then she would show up at an adolescent clinic and ask for a Depo shot. See that all the time too. Case closed. Hope I don't see this case again...
********************
Q)67 yrs old with lower extermities BP 180/90. upper extremities 150/85 what is Dx?
a. essential HTN
b. renal artery stenosis
c. pheochromocytoma
d. malignant HTN
e. Stenosis of ascending aorta
Can you tell me why this is your answer. I think something is wrong with the Q.
a person came to ER complaining of generalised abdominal pain first started as periumbilic
pain the most appropriate to diagnose the problem is --guarding and rigidity are present on examination
1.chest xray
2.abdominal xray
3.endoscopy
4.upper GI series
6118
a person came to ER complaining of generalised abdominal pain first started as periumbilic pain the most appropriate to diagnose the problem is --guarding and rigidity are present on examination
1.chest xray
2.abdominal xray
3.endoscopy
4.upper GI series
*********************
treatment of meinere dz?
1 hctz
2.meclizine
meclizine for acute vertigo and hctz for long term prophylaxis and treatment
**************************
patient with IDDM 18 yr old. everything was perfect in her mgmt /OC pills, insulin, diet,exercise
what change ?
........"confused till the end on following choices" (good fellow )..........
-recommend depo
-no change
I think the none of the forum members should be confused with this one again.....
18 yr old patient with IDDM. everything is well for the pt. meds include OCPs, insulin, diet,exercise
IS THERE any need of a change in mgt?
the confusion was b/w
1. every think ok
2. d/c OCP and give depo progestrone..
In short will insulin affect OCPs???????? is my thought....
use low dose ocp's
inc. insulin
ocp's cause glucose intl
but not c/i in iddm
************************************
kid has, enterovirus infection, diarrehea. should stay home or go to day care?
Only if diapers are not able to contain stools, he should stay at home???????????
I am not sure what the USMLE wants here
enterovirus diarrhea is highly contagious, and diaper changing can..
cause transmission in day care setting. Daycare workers probably don't wash their hands properly between diaper changes. My best guess, and my answer on the test is to keep baby from daycare until diarrhea resolved.
***********************
a infant is allergy to cow milk,
is the infant also allergy to soy bean?
how to RX?
usually
unfortunately....that is what they ask,
Home made meat based formula is the remedy.avoid cow's milk and soya.Meet with dietacian.
********************
14 y/o boy has asthma attack with RR 38.
-mask o2
-rebreath mask o2
-intubation
-others
If so, intubate. he should be alkalotic. We usually try albuterol first, but if any sings of respiratory tiredness, like decrease RR, or pCO2 that is not low, we jump on the ETT.
then hit with albuterol nebs and steroid p.o. or IV, but if he keeps getting worse and works harder to breath and too tired to breath so fast, then intubate... If any blood work shows PH less than like 7.45 (needs to be alkalotic because he is hyperventilating) then you worry. Also, remember, stress and steroids cause serum glucose elevation, so don't trip if you see blood glucose is 230 or something.
********************
18 month old with diarrohe, day 3 in hospital , now stable, u are about to dc the pt.. u recived stool culture report positive for salmonella what is the next:
1)ampicillin x 14 days
2)chloremphenicol x 14 days
3)no treatment
4)amp +chlornphencol
no treatment
************************
clinical features of measles, then the child is ataxic, what will you advize the parents
ans) it is one of the complication of measles and it will resolve-
His ans was posted as above.....check out guys>>>>>>>>> was the advise from the great fellow!!!!
What do you think PDR??
is it measles though? are we talking SSPE
pt with clinical features of measles, then the child is ataxic, what will you advize will you give to the parents?
the recaller selected ...the statement below as ans
...it is one of the complication of measles and it will resolve
TO ME...it looks like measles might have progressed to SSPE (I am not sure???) and in short the Q is asking prognosis.....
this is what the CDC says about measles infection in brief
Measles (rubeola) is often a severe disease, frequently complicated by middle ear infection or bronchopneumonia. Encephalitis occurs in approximately 1 of every 2,000 reported cases; survivors often have permanent brain damage and mental retardation. Death, predominantly from respiratory and neurologic causes, occurs in 1 of every 3,000 reported measles cases. The risk of death is known to be greater for infants and adults than for children and adolescents.
Does this help with the answer?
*************************************
ACNE Mx >>>>>>Is this sequence right???
ACNE Mx
>Benzoyl Peroxide>Topical Tretinoin >Topical Antibiotics> Systemic Antibiotic >Systemic Isotretinoin
Start with topical benzoyl peroxide then try (tt) topical clinda, oral tetra and oral erythro.
Next step topical tretinoin.
Last Oral Isotretinoin (teratogenic)
Source : Crush' Page 172.
SO Basically,
Benzoyl Peroxide >Topical Antibiotics> Systemic Antibiotic >Topical Tretinoin > Systemic Isotretinoin
*********************
Two 6 yrs old playing together & one kid bite other kid's hand. how to treat?
a.culture
b.pcn
c.hand xray
d.tetra
e.admit& iv antibiotics
human bites need to be admitted to hospital and iv therapy with ceftriaxone.also culture the wound as bacteriology is variable.---CMDT p1251
"HUMAN BITES". Antibiotics should be given prophylactically for all human bites:
amoxicillin/clavulanate 20 to 40 mg/kg/day divided TID;
cefixime is an alternative.
Consider IV antibiotics if infection has already occurred, especially on the hand.
If a joint may be involved (e.g., MP joint after an altercation), surgical exploration is indicated.
*******************
Q) There is a patient with a picture of retina with cotton wool type lesions. What the underlying diagnosis?
a. Patient with BP 210/112
b. Uncontrolled DM
c. Patient with BP 169/89
d. Eye pigment dz
May see cotton wool spots in HTN, DM, AIDS, but in this question b is the best choice.
*******************************
Q) A 56 y/o man came to PMD, he is s/p CABG 10 yeas back, c/o SOB with exertion and chest pain. He is relived with rest. What is next step?
a. EST
b. thalliun stress test
c. dobutamine test
d. 12 leads EKG
was closed as thallium but......
later on doing MCQs I found that the right ans was EST ...... in that exp as ...........exercise stree test is much cheaper and easier test to do that a nuc med thallium scan for screening.
any comments......
Thalliun stress test also give you the functional status of heart. Especially if the patient previously had MI, the interpretation of EKG in this case will be very difficult
sounds ok here,he doesnt have a pacemaker,all he had done was cabg,12 lead ekg and cardiac enzymes for starters,rest all later....what one want to know is whether he has new ischemia/infarction...
***********************
Q) A 59 y/o lady had seizure came to ER, neurological deficit present. CT scan of the head showed ring enhancing lesion in brain. What is probable organism?
a. cryptococus
b. grm positve micro coccobacilli
c. strepto cocci
Q A 45 y/o man with lung ca came with pain at thoracic region at the back, what is next step?
-CT
- Pain meds
Q A 65 y old patient , died of congestive cardiomyopathy. What organ can be donated?
Q)38. A 35 y/o female patient c/o facial pain and current like sensation. What is next step?
a. amytriptyline
b. carbamazipine
c. steroid
crypto, pain meds, kidneys, carbamazepine
Ring enhanced lesion on Ct-scan - abscess, tumor, TOXO, tumor (Kaplan)
organs to be donated skin & bones
facial pain - carbamazipine
*******
crypto coccus,
for tigeminal nueralgia- carbamazepine best -- mksap
***
A. cryptococus
Pain meds
Skin, bone, and cornea
b. carbamazipine
**************************
1.At what age do you advise moms to start potty training? At 1 yr is it too early?How about 18 months. I know there's no fixed time but for USMLE purposes what should you take?
2.baby around 8 months . Gets up middle of the night and drinks milk. What advise to mom?
-Give water instead of milk.
-Pat and cuddle and put to sleep.
-Ignore crying.
-delay the response to crying.
My baby's pediatrician asked me to do both 1 & 2 when my baby had the problem.But at the exam what is the choice?This was a real exam Q.
The first question is 24 months or 2 years. Just last month, the AAP (American Academy of Pediatrics) started advising a delay to 27 months, becaue rushing the process sometimes makes things worse. For USMLE, the answer is 2 years.
the other question, I think there was more to it. Wasen't it about infant colic? the baby who drank milk and cried a lot? what to do about the crying? right? colic is self limiting after 3 months of life. treatment is position change, supportive, and decrease the carbohydrates (I guess milk), but I am not sure if I go as far as giving baby water instead of milk. Theoretically this means less milk, but it is not standard.
it was simply the baby wakes up in the night crying for milk.After giving milk he goes to sleep.The resposes were the ones i gave. One other was to give a stomach full of milk just before bedtime.which can't be the answer.
This question appears many time and with diff explaination. My own experiance is to delay the response to cry. The important lesson is NOT PICK THE BABY up so easily and often in these benign situation. In other words, don't feed him and don't curdel him.
I found the following mess from web and hope we can close this with consensus:
The First Year - Babies 8 to 9 Months
Crying During the Night
Some babies make a game of calling out for you or dropping toys out of the crib for you to pick up. Other babies cry after you put them to bed. Check on your baby, but keep the lights dim and don't pick him up. If baby is ok, put him on his tummy, pat his back for a minute or two, and leave.
If you try this for a few weeks and baby still wakes up and cries during the night, you may try letting them cry. Here is a way that works for many parents. Pick a weekend night. When baby cries, check on him and rub or pat baby's back, then tell him you'll be back in 10 minutes. Check on baby every 10 minutes even if he is not still crying, until he falls back to sleep. It probably won't take more than a night or two to end the habit for good.
Letting baby cry like this can be hard on you. Be sure you're up to it. Baby may cry for hours. If you give in after an hour, you could be training him to cry for longer periods. The goal is to help baby learn to sleep on his own.
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Ghost
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Posted: Wed Sep 17, 2003 12:10 pm Post subject: Ghost File #2
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ALL solved file #2
Q)Pregnant women in third trimester had Placenta abrutio due to MVA had aburtio placenta due to wearing seat belt(lap and shoulder ) question ask what would you recommend pregnant in third trimester?
1. don't wear seat belt
2. wear only shoulder strap seat belt
3. wear only Lap strap seat belt
4. wear the regular shoulder and lap seat belt.
Answer 4 wear both seat belts
Q) A kid had fx. clavicle question than ask what is next management?
1. ?sling
2. ?cast
3. ?sugery
Answer is Sling and immobilize.
Q) 16 year old high school drop out did not have periods for last 3 months. She is sexually active with one patner for 1 year. Does not use contracptives. Preg. test positive.
The reason that this adolescent's failure to use contraceptive
A. Concern about weight gain
B. Cost of Contraception
C. Patner's opposition to contraception
D.Concern about confidentiality
E.Desire to become pregnant
Surprisingly answer is desire to become pregnant?
Q) Which of the following drugs is the least sedating and anticholinergic, which can be prescribed safely to elderly patients with depression?
a.fluoxetine
b.MAOI
c.Imipramine
d.Sertraline
e.Trazodone
*****************************
Q1)
4 year old boy has swallowed a coin...x ray showed coin in lower 1/3 of esophagus..
a.ask the parents to check for coin in stool
b.do and endoscopy
c.give syrup ipecac
d.give a laxative
Q2
a 3 year old boy swallowed a coin and it is in the duodenum...same choices as above...
Answer 1”do endoscopy 2- watch in stool
*******************************
Q) A healthy young pt with ppd test 15 mm induration next step?
Answer is chest x ray
Q)
First child of this lady has Duchenne's. What are the chances that she will again have a baby with Duchenne's?
-25 % overall,
-50 % if it is a boy,
-O% if it is a girl ( assumption is that mother is a carrier and father is healthy)
this is sex-linked recessive disorder. Affected child is boy. The mother must be carrier. So, the chance of her next child to be affected will be 50% among her sons or 25% among all of her children.
Q) A pt has flu and was treated with Amantadine. Now the Q ask the drug is belonged to:
1.chemotherapy
2.antibiotics
Answer is chemotherapy
Q) A 24 y/o woman came to your office with frothy vaginal discharge and rash on her cervix. You diagnosed her with Trichomoniasis vaginitis. You gave her RX for metronidazole. She remined you that she is breastfeeding. What should you do now?
Answer is give metronidazole and ask her not to feed for 24 hours
Q) a patient with tibial osteomylelitis, cultures taken , xray done,antibiotics started which is the next best step leading to diagnosis presents on second day of osteomyleitis
a)mri
b)bone scan ANSWER: MRI
Q) A man with 5x5 cm mass in left lobe of thyroid which is found to be papillary carcinoma..The man has develop HOARSENESS. the right lobe of thyroid is irregular on exam.. what is the best treatment
a)radiation
b)partial thyroidectomy plus radiation
c)total thyroidectomy with left neck dissection
d)total thyroidectomy with removal of enlarged nodes
Answer is C
Q)
Kid with meningitis,but family don't want tx. what to do?
-respect their wish
-court order
-go ahead and treat.
GO ahead and treat.. is the answer.
Q)8wks pregnant women returing from vacationing in conneticult discover a tick on skin, 1 wk later noticed a lesion ask for treatment.?
LYME disease is the scenerio here
Answer is
-amoxicillin or cefta, if CNS involved -
-NO tetracycline because she is pregnant
-If this patient was not pregnant then tetracycline is doc ten day therapy is usually reserved for isolalated erythema migrans....if systemic or severe symptoms therapy is recommended for 21 days.
any one of the following
tetracycline 250 po qid
doxycycline 100 mg po bid
amoxicillin 500 po tid
Q)a parent has asthma since childhood now is pregnant she ask what the chances baby has asthma.
-none
-25
-50
-100
25% if one parent involved 50 % if both have asthma
Q)Stroke pt was treated and vital signs are stable. Now the pt has blood vomiting. Dx:
-1.diffuse gastritis
-2.gastric ulcer
-3.others..
A-nswer is diffuse gastritis
Q) Low back pain with lower extremity neurological s/s and bladder problem. Dx ?
1.spinal stenosis
2.disc hernia
Spinal stenosis is the answer..
Q)Organ donation. Father and sister agree. But mother did not agree. What do you do ?
Point about organ donation.. DO not take organs from the body until FAMILY agrees.. in this situation,,, try to resolve the conflict let them have family meeting educate them etc etc..
If in the end family is not agreeing with the donation..DO NOT Take organs..
Q)Pneumococcal vaccine is indicated for which one of the following?
A-15-year-old with recurrent sinusitis and URI
b- 8-year-old with recurrent tonslitis
c 3-year-old with nephrotic syndrome
d- 6-month-old with sickle-cell disease
e- 3-month-old whose mother has active human immunodeficiency virus (HIV) infection
Answer is C.. minimum age is 2 years.. both nephritic and sickle cele will nedd vaccine
Q)Which one of the following is the most appropriate management?
1-Perform serial L/S ratios until greater than 3.0, followed by prompt delivery
2-Induce labor, with careful fetal monitoring
3-Perform an immediate cesarean section
4-Follow the mother weekly with serial ultrasounds
5-Follow the mother weekly with nonstress tests
Answer is 2. Induce labour and monitor fetus
Q)A 22-year-old white female who works in the newborn nursery of a hospital consults you regarding her exposure yesterday to an infant with congenital rubella. Today she has a positive pregnancy test and is 8 weeks pregnant by dates and examination. Her rubella immunization status is unknown.
Your immediate recommendation is
A) a therapeutic abortion
b) intramuscular gamma globulin
c) oral amantadine (Symmetrel)
d) a rubella antibody test
e) an MMR vaccination
Answer is D. rubella antibody test
Q) In a woman with preeclampsia, the impending onset of eclampsia is most likely to be indicated by
A) urinary protein excretion >300 mg/dL/24 hr
b) facial edema
c) increased serum uric acid
d) headache and visual disturbancesAnswer is D headache and visual disturbances
Q)35 yrs male iv drug abusers with a history of haemorrhagic shock 6 month ago came with weakness, P/E enlarged liver 3cm ALT 400 and rest of the liver function test normal. which one of the following investigations is the most important to diagnose the case?
a)HbS Ag + HbcIgM
b)HBV PCR DNA
C)HCV Ab
d)Liver biopsy
e)HbSAg+ HbcIgM + HDV Ab
Answer is C hepC AB
Q) 45 years old woman with history of DM and mild Hypertension with occational history of seizure for last 6 month came to your office with 6 hours h/o headach right sided partial ptosis,pain in lower half of face and neck rigidity.what would be the cause?
a)Trigeminal neuralgia
b)SAH of Post communicating artery
c)SAH of PICA
d)Brainstem glioma
e)Lacunar stroke
Answer is C..Ipsilateral facial pain sensetion,ipselateral horner's syndrom
and involvement of V11 nerve (bells palsy).
Q) 60 years old female h/o chronic diabetes & Hypertension with a left sided stroke came in ER 3 month ago with repeated attack of seizure there she was given some anti-seizure medication for Chronic control but last two months she developed incontinence with no urinary symptoms.The most likely cause
a)UTI
b)Phenytoin therapy
c)Carbamazapine
d)Valproic acid
e)BHP
Answer is B PHENYTOIN therapy
Q)which of the following anomalies is the major concern with chronic lead intoxication?
a. Abnormal bone growth
b. Hyperurecemia and gout
c. Microcytic anemia
d. lower I.Q. scores
Answer is D lowe IQ score
Q) A 6-year-old Hispanic female develops watery diarrhea, with at least twelve episodes over a 48-hour period. She is taking fluids orally without nausea and vomiting, is afebrile, and has an unremarkable physical examination except for hyperactive bowel sounds. There are no signs of dehydration.
According to current practice guidelines, which one of the following is the most appropriate recommendation?
-Age-appropriate diet without milk products
-Age-appropriate diet
-Clear liquid diet alone
-Clear liquid diet (juices, soft drinks) and loperamide (Lomotil) orally
Answer is B age appropriate diet
Q) what is the most common associated finding in patients with panic disorder?
a. Alcoholism
b. OCD
c. Depression
d. Any substance abuse
Answer is C depression
Q) Which is the most accurate method for detecting Down's syndrome
a. amniocentesis
b. CVS sampling
c. ultrasound
d. MRI
Answer is karotyping BY amniocentesis
Q) what is the single most important risk factor for the development of postpartum depression:
a- history of depression
b- history of bipolar disorder
c- a greater than average postpartum drop in serum progesterone
d- a recent stressful life event
e- the mother's experience as a child in her family of origin
Answer A.. history of depression
Q) A patient with Few pounds weight loss. He has been unable to eat due to pain with swallowing either liquid or solids. He smokes one pack of cigarettes per day. On PE, he is a thin man with diffuse cervical and axillary lymphadenopathy . His T- 101,4. There is no oral thrush and his lung have fine bronchi at right base. What is most appropriate diagnostic test?
A) Barium esophagram
b) endoscopy with biopsy
C) empiric trial of antifungal with ketocanazole
d) empiric treatment with ganciclovir
E) give him a prednisone
Answer is B. barium is the initial/first test Endoscopy/biopsy is the diagnostic
Q) 60 yrs old lady moved to a new residential center a year ago and came for annual exam. She has no specific complain and just mentioned that she only slept for 5 hrs a day. She functions well. Physic examination is WNR. What do you do for short sleep time of this lady.
1. It is normal for old lady
2. Prozac
3. Benzodiazepem
4. lifestyle change with more exersize
Answer is 4. lifestyle change with exercise.it could be normal not sure yet
Q) A 45 year old man comes to the doctors office and complains of "the worst headache in his life".
He is awake and oriented. He refuses to have a CT.
A lumbar puncture yields lightly blood tinged sample with rbc count 300,000
wbc count 55000(90% polyps), protein-88,glucose-20
gram stain is negative.
Most appropriate treatment is
a) E aminocaproic acid
b) angiography
c) ceftriaxone
d) heparin
Answer is B.. SAH diagnosis is angiography.after LP and CT tx is surgical Clipping
Q)A 40 yr old man with a history of DM and sexual dysfunction comes to you with a history of insomnia, loss of apetite, fatigue,feeling of worthlessness, and guilt, diminished ability to concentrate and depressed mood for 4 months. Which of the following would be the most appropriate treatment for this patient
a. Paroxetine
b. fluoxetine
c. sertraline
d. citalopam
e. bupropion
Answer is E Bupriopion
Q)Which of the following is most characteristic of a patient who has vitamin C deficiency?
(A) Diarrhea and delusions
(B) Ocular muscle palsy and dementia
© Cheilosis and beefy red tongue
(D) Perifollicular hemorrhages and hyperkeratosis
(E) Paresthesias and ataxia
Answer is D.
Q) What you will see in a biopsy of lchen planus ?
Answer is hyperkeratosis
Q)Orbital cellulitis
Next step
a) ct scan
b) iv antibiotics
Answer is Iv antibiotics first then investigations
Q) which is the best dx choice of pituitary tumor ?
a. CT
b. MRI
c others
Answer is A MRI is the best
Q)which of the following causes acute hepatic necrosis?
A INH,
B.acetaminophen
C.halothen,
D.methydopa Answer is A. ACETAMINPHEN
Q)A DM type II pt is under glipizide. His current glucose level is 270. what is the next:
A..add insulin
B.add metformin
C.add pioglitazone
D.add glyburide
Answer is B .. add metforminif sulfonylurea failed to control it then add metformin and if both fail to control then add a thiazolidinedone
and if they fail to improve give insulin
Q) a man loss of vision in 24hrs c/o curtain in eyes.,no pain
A)ret.detachment
B)retinal artery obst.
C)retinal vein obt.
Answer is A retinal detachment
) which is the best test for confirming rupture of membrane ?
a. pool test
b. nitrazine test
c. fern test
d. U/S
Answer is B.
Q) In gallbladder sludge by u/s and pt is sym with pain fever and has diabetic,next step
-ct abdomen
-start antibiotic
-ercp
-observation
Answer is CT ( acalcolus cholecystitis )
Q) Which of the following drugs is the least sedating and anticholinergic, which can be prescribed safely to elderly patients with depression?
a.f