Podcast
Questions and Answers
What is the most appropriate next step for a 70-year-old female patient with a family history of thyroid and lung cancers, who has quit smoking and had a colonoscopy 3 years ago?
What is the most appropriate next step for a 70-year-old female patient with a family history of thyroid and lung cancers, who has quit smoking and had a colonoscopy 3 years ago?
What lab finding is expected in an infant with hypertrophic pyloric stenosis?
What lab finding is expected in an infant with hypertrophic pyloric stenosis?
In a middle-aged female presenting with jaundice, pruritus, and positive AMA antibodies, what should be measured next?
In a middle-aged female presenting with jaundice, pruritus, and positive AMA antibodies, what should be measured next?
What is the preferred modality of imaging for a patient diagnosed with acute pancreatitis and significant pain radiating to the back?
What is the preferred modality of imaging for a patient diagnosed with acute pancreatitis and significant pain radiating to the back?
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In the case of an 8-year-old with blunt abdominal trauma showing bruises but stable condition and unremarkable x-ray, what is the next best action?
In the case of an 8-year-old with blunt abdominal trauma showing bruises but stable condition and unremarkable x-ray, what is the next best action?
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What action should be taken next for a patient with peritonitis and board-like rigidity after X-rays show air under the diaphragm?
What action should be taken next for a patient with peritonitis and board-like rigidity after X-rays show air under the diaphragm?
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What is the most appropriate next step for a patient who experienced severe rectal bleeding, had chest pain, and presented with bilious fluid in NGT with no visible source found during colonoscopy?
What is the most appropriate next step for a patient who experienced severe rectal bleeding, had chest pain, and presented with bilious fluid in NGT with no visible source found during colonoscopy?
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What is the most likely cause of migrating thrombophlebitis in an elderly patient?
What is the most likely cause of migrating thrombophlebitis in an elderly patient?
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A patient with recurrent giardiasis is most likely to have a selective deficiency in which immunoglobulin?
A patient with recurrent giardiasis is most likely to have a selective deficiency in which immunoglobulin?
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What factor deficiency is most likely responsible for a young female patient with prolonged bleeding and heavy menses, with no petechiae noted?
What factor deficiency is most likely responsible for a young female patient with prolonged bleeding and heavy menses, with no petechiae noted?
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What is the best intervention to help a patient with multiple sclerosis experiencing bilateral internuclear ophthalmoplegia?
What is the best intervention to help a patient with multiple sclerosis experiencing bilateral internuclear ophthalmoplegia?
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In the case of an old female patient with right arm weakness, which is the most appropriate next step?
In the case of an old female patient with right arm weakness, which is the most appropriate next step?
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In a patient with a recent history of severe headaches and advanced melanoma presenting with neurological symptoms, what is the recommended next step for managing increased intracranial pressure?
In a patient with a recent history of severe headaches and advanced melanoma presenting with neurological symptoms, what is the recommended next step for managing increased intracranial pressure?
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Which condition is indicated by an old male patient presenting with upper motor neuron lesion (UMNL) and lower motor neuron lesion (LMNL) symptoms?
Which condition is indicated by an old male patient presenting with upper motor neuron lesion (UMNL) and lower motor neuron lesion (LMNL) symptoms?
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What level of the spinal cord is most likely affected in a patient with upper and lower muscle weakness, hyperreflexia, and a positive Babinski sign?
What level of the spinal cord is most likely affected in a patient with upper and lower muscle weakness, hyperreflexia, and a positive Babinski sign?
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What condition is most consistent with an old man experiencing 3-month memory loss and difficulty in daily tasks?
What condition is most consistent with an old man experiencing 3-month memory loss and difficulty in daily tasks?
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What underlying pathophysiology is associated with a clinical picture of meralgia paresthetica?
What underlying pathophysiology is associated with a clinical picture of meralgia paresthetica?
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What is the most likely cause of bilateral papilledema in a female with high BMI and hypertension?
What is the most likely cause of bilateral papilledema in a female with high BMI and hypertension?
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A 47-year-old woman suffering from recurrent sinopulmonary infections and bronchiectasis is likely to have which of the following immunodeficiencies?
A 47-year-old woman suffering from recurrent sinopulmonary infections and bronchiectasis is likely to have which of the following immunodeficiencies?
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Which deficiency is most likely causing perifollicular hemorrhage and petechiae in a homeless male patient with a history of alcoholism?
Which deficiency is most likely causing perifollicular hemorrhage and petechiae in a homeless male patient with a history of alcoholism?
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What is the most appropriate first-line treatment for a chronic smoker experiencing recurrent cough and bronchitis?
What is the most appropriate first-line treatment for a chronic smoker experiencing recurrent cough and bronchitis?
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In the context of neonatal tetanus, what is the primary mechanism of its pathological effects?
In the context of neonatal tetanus, what is the primary mechanism of its pathological effects?
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What is the next important step in diagnosing a patient with bilateral headache and jaw pain on chewing suspected to have giant cell arteritis?
What is the next important step in diagnosing a patient with bilateral headache and jaw pain on chewing suspected to have giant cell arteritis?
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What is the recommended treatment for a patient exhibiting signs of opioid overdose, such as respiratory rate of 6 and miosis?
What is the recommended treatment for a patient exhibiting signs of opioid overdose, such as respiratory rate of 6 and miosis?
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What is the most likely diagnosis for a patient who developed respiratory distress and has an X-ray showing fluffy cotton balls?
What is the most likely diagnosis for a patient who developed respiratory distress and has an X-ray showing fluffy cotton balls?
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In the context of flail chest, what is the primary mechanism contributing to respiratory distress?
In the context of flail chest, what is the primary mechanism contributing to respiratory distress?
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Which parameter is typically decreased in a patient with severe kyphosis during pulmonary function testing (PFT)?
Which parameter is typically decreased in a patient with severe kyphosis during pulmonary function testing (PFT)?
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What is the most appropriate next step for a patient with hoarseness and a laryngeal lesion who has a significant smoking history?
What is the most appropriate next step for a patient with hoarseness and a laryngeal lesion who has a significant smoking history?
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For a patient presenting with fever, reduced breath sounds at the lung base, and increased vocal fremitus, what is the most likely diagnosis?
For a patient presenting with fever, reduced breath sounds at the lung base, and increased vocal fremitus, what is the most likely diagnosis?
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What is the underlying pathophysiological cause of cystic fibrosis (CF)?
What is the underlying pathophysiological cause of cystic fibrosis (CF)?
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Given a child with pneumonia who developed pleural effusion, elevated LDH and normal glucose, what is the likely cause of the pleural effusion?
Given a child with pneumonia who developed pleural effusion, elevated LDH and normal glucose, what is the likely cause of the pleural effusion?
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What is the expected effect of diuretics on elderly patients that may cause them to wake up more frequently at night?
What is the expected effect of diuretics on elderly patients that may cause them to wake up more frequently at night?
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What is the most appropriate next step for a 50-year-old female with blood in urine, weight loss, and flank pain?
What is the most appropriate next step for a 50-year-old female with blood in urine, weight loss, and flank pain?
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What could be a risk factor for aminoglycoside toxicity in elderly patients?
What could be a risk factor for aminoglycoside toxicity in elderly patients?
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Which mechanism is primarily responsible for diabetic nephropathy?
Which mechanism is primarily responsible for diabetic nephropathy?
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What medication is best suited to prevent renal deterioration in a diabetic patient with hypertension?
What medication is best suited to prevent renal deterioration in a diabetic patient with hypertension?
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In a child presenting with hematuria, joint pain, and a malar rash, which condition is most likely?
In a child presenting with hematuria, joint pain, and a malar rash, which condition is most likely?
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What is the primary causative organism in a typical case of UTI?
What is the primary causative organism in a typical case of UTI?
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What would be the next step to confirm the diagnosis of a child experiencing bloody diarrhea and edema?
What would be the next step to confirm the diagnosis of a child experiencing bloody diarrhea and edema?
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What is the likely cause of obstructive nephropathy in a patient with multiple abdominal lymph nodes and elevated renal function tests?
What is the likely cause of obstructive nephropathy in a patient with multiple abdominal lymph nodes and elevated renal function tests?
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An infant presenting with a current infection due to pneumocystis and signs of failure to thrive is suggestive of which type of immunodeficiency?
An infant presenting with a current infection due to pneumocystis and signs of failure to thrive is suggestive of which type of immunodeficiency?
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Which deficiency is most likely responsible for prolonged bleeding and heavy menses in a young female with no petechiae observed?
Which deficiency is most likely responsible for prolonged bleeding and heavy menses in a young female with no petechiae observed?
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A male patient with a history of alcoholism and presenting with symptoms such as perifollicular hemorrhage and petechiae is most likely to have a deficiency in which vitamin?
A male patient with a history of alcoholism and presenting with symptoms such as perifollicular hemorrhage and petechiae is most likely to have a deficiency in which vitamin?
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In a patient experiencing recurrent giardiasis, which immunoglobulin is most likely deficient?
In a patient experiencing recurrent giardiasis, which immunoglobulin is most likely deficient?
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What is the primary pathophysiological mechanism leading to neonatal tetanus?
What is the primary pathophysiological mechanism leading to neonatal tetanus?
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In the context of acute management of increased intracranial pressure (ICP) after traumatic brain injury, which of the following interventions is recommended?
In the context of acute management of increased intracranial pressure (ICP) after traumatic brain injury, which of the following interventions is recommended?
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What is the most likely cause of an old male patient presenting with upper and lower motor neuron lesions in the context of bulbar symptoms?
What is the most likely cause of an old male patient presenting with upper and lower motor neuron lesions in the context of bulbar symptoms?
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In a patient with lumbar stenosis, which sign or symptom is typically present?
In a patient with lumbar stenosis, which sign or symptom is typically present?
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For a patient experiencing bilateral internuclear ophthalmoplegia, which intervention is most effective in managing their condition?
For a patient experiencing bilateral internuclear ophthalmoplegia, which intervention is most effective in managing their condition?
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In a case of an elderly male patient with memory loss and daily activity impairments, which type of dementia is the most likely diagnosis?
In a case of an elderly male patient with memory loss and daily activity impairments, which type of dementia is the most likely diagnosis?
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What is the most appropriate imaging study for a patient presenting with acute right arm weakness and suspected intracranial causes?
What is the most appropriate imaging study for a patient presenting with acute right arm weakness and suspected intracranial causes?
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In a patient presenting with upper and lower muscle weakness and positive Babinski sign, at which spinal cord level is the lesion most likely located?
In a patient presenting with upper and lower muscle weakness and positive Babinski sign, at which spinal cord level is the lesion most likely located?
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For a female patient with symptoms of hypertension and bilateral papilledema, which condition is most consistent with her presentation?
For a female patient with symptoms of hypertension and bilateral papilledema, which condition is most consistent with her presentation?
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In a case of suspected giant cell arteritis in a female with bilateral headaches and jaw pain, which diagnostic test should be performed first?
In a case of suspected giant cell arteritis in a female with bilateral headaches and jaw pain, which diagnostic test should be performed first?
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What is the most effective first-line treatment for a patient with suspected opioid overdose exhibiting respiratory depression and miosis?
What is the most effective first-line treatment for a patient with suspected opioid overdose exhibiting respiratory depression and miosis?
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In a chronic smoker with recurrent cough and a desire to quit smoking, what is the recommended next step in management?
In a chronic smoker with recurrent cough and a desire to quit smoking, what is the recommended next step in management?
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What is the primary cause of urinary retention in a patient taking diphenhydramine alongside losartan and finasteride?
What is the primary cause of urinary retention in a patient taking diphenhydramine alongside losartan and finasteride?
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What is the most appropriate immediate management for a patient with benign prostatic hyperplasia (BPH) who complains of minimal urination?
What is the most appropriate immediate management for a patient with benign prostatic hyperplasia (BPH) who complains of minimal urination?
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In a case of an older man presenting with urine leakage during physical activity and an enlarged prostate, what is the most likely underlying cause?
In a case of an older man presenting with urine leakage during physical activity and an enlarged prostate, what is the most likely underlying cause?
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What is the recommended next step for a mother exhibiting signs of emotional detachment toward her newborn after giving birth?
What is the recommended next step for a mother exhibiting signs of emotional detachment toward her newborn after giving birth?
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For a 42-year-old with generalized anxiety disorder (GAD), what is considered the best long-term management strategy?
For a 42-year-old with generalized anxiety disorder (GAD), what is considered the best long-term management strategy?
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What is the diagnosis for an 8-year-old girl who is daydreaming in class and whose academic performance is suffering, despite not being disruptive?
What is the diagnosis for an 8-year-old girl who is daydreaming in class and whose academic performance is suffering, despite not being disruptive?
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What is the probable diagnosis for a patient with schizophrenia who shows confusion, muscle rigidity, and elevated creatine kinase after being on haloperidol?
What is the probable diagnosis for a patient with schizophrenia who shows confusion, muscle rigidity, and elevated creatine kinase after being on haloperidol?
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What is the most appropriate treatment for managing anaphylaxis resulting from a bee sting?
What is the most appropriate treatment for managing anaphylaxis resulting from a bee sting?
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What is the most likely mechanism of respiratory distress in a patient who developed clinical symptoms of flail chest following trauma?
What is the most likely mechanism of respiratory distress in a patient who developed clinical symptoms of flail chest following trauma?
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Which abnormality is most indicative of parapneumonic effusion observed in pleural fluid analysis from a child with pneumonia?
Which abnormality is most indicative of parapneumonic effusion observed in pleural fluid analysis from a child with pneumonia?
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In a patient with severe kyphosis, which pulmonary function test parameter is expected to be decreased?
In a patient with severe kyphosis, which pulmonary function test parameter is expected to be decreased?
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What is the most appropriate next step for a heavy smoker with hoarseness and a laryngeal lesion?
What is the most appropriate next step for a heavy smoker with hoarseness and a laryngeal lesion?
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What is the likely diagnosis for a patient exhibiting acute dyspnea and tachypnea but with no active infection?
What is the likely diagnosis for a patient exhibiting acute dyspnea and tachypnea but with no active infection?
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What condition is characterized by defective chloride ion channels causing respiratory symptoms?
What condition is characterized by defective chloride ion channels causing respiratory symptoms?
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Which clinical finding is most likely in a patient who presents with pneumonia, reduced breath sounds at the lung base, and increased vocal fremitus?
Which clinical finding is most likely in a patient who presents with pneumonia, reduced breath sounds at the lung base, and increased vocal fremitus?
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In older adults using diuretics, which factor is most likely contributing to more frequent awakenings at night?
In older adults using diuretics, which factor is most likely contributing to more frequent awakenings at night?
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What is the probable cause of a young male presenting with scrotal pain and symptoms of epididymitis?
What is the probable cause of a young male presenting with scrotal pain and symptoms of epididymitis?
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Which condition is indicated by a firm mass found on the testicles of a young patient?
Which condition is indicated by a firm mass found on the testicles of a young patient?
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What is the most likely diagnosis for a child with a facial rash that didn't improve with topical creams?
What is the most likely diagnosis for a child with a facial rash that didn't improve with topical creams?
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What is the primary treatment for a child diagnosed with scabies?
What is the primary treatment for a child diagnosed with scabies?
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In a case of hypercalcemic crisis, what is the best initial management step?
In a case of hypercalcemic crisis, what is the best initial management step?
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What is the mechanism of malignancy-induced hypercalcemia in patients with bone metastasis?
What is the mechanism of malignancy-induced hypercalcemia in patients with bone metastasis?
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What is the pathophysiological basis of Dupuytren's contracture?
What is the pathophysiological basis of Dupuytren's contracture?
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What treatment should be considered for a patient with toxic epidermal necrolysis (TEN)?
What treatment should be considered for a patient with toxic epidermal necrolysis (TEN)?
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What is the most likely immunodeficiency present in an infant experiencing failure to thrive and a familial history of early death in siblings?
What is the most likely immunodeficiency present in an infant experiencing failure to thrive and a familial history of early death in siblings?
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In a 47-year-old female with recurrent sinopulmonary infections and bronchiectasis, which immunodeficiency is most likely?
In a 47-year-old female with recurrent sinopulmonary infections and bronchiectasis, which immunodeficiency is most likely?
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A young female patient with heavy menses and prolonged bleeding but no petechiae is likely experiencing a deficiency in which factor?
A young female patient with heavy menses and prolonged bleeding but no petechiae is likely experiencing a deficiency in which factor?
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In a male patient with a history of alcoholism presenting with perifollicular hemorrhage and pale sclera, which vitamin deficiency is suspected?
In a male patient with a history of alcoholism presenting with perifollicular hemorrhage and pale sclera, which vitamin deficiency is suspected?
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What is the most likely cause of increased intracranial pressure in a patient with subdural hematoma and unchanged ICP reading?
What is the most likely cause of increased intracranial pressure in a patient with subdural hematoma and unchanged ICP reading?
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In the context of neonatal tetanus, which is the primary pathophysiological mechanism involved?
In the context of neonatal tetanus, which is the primary pathophysiological mechanism involved?
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What is the key pathophysiological feature in a patient presenting with meralgia paresthetica?
What is the key pathophysiological feature in a patient presenting with meralgia paresthetica?
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For a patient with ALS asking about treatment options, which medication is considered appropriate?
For a patient with ALS asking about treatment options, which medication is considered appropriate?
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What is the most effective treatment for a patient with multiple sclerosis experiencing bilateral internuclear ophthalmoplegia?
What is the most effective treatment for a patient with multiple sclerosis experiencing bilateral internuclear ophthalmoplegia?
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In a right-handed elderly female with right arm weakness, what diagnostic procedure is most appropriate?
In a right-handed elderly female with right arm weakness, what diagnostic procedure is most appropriate?
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Identify the level of spinal cord pathology indicated by upper and lower muscle weakness, hyperreflexia, and a positive Babinski sign.
Identify the level of spinal cord pathology indicated by upper and lower muscle weakness, hyperreflexia, and a positive Babinski sign.
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What type of dementia is characterized by memory loss, social withdrawal, and difficulty managing daily tasks in an elderly man?
What type of dementia is characterized by memory loss, social withdrawal, and difficulty managing daily tasks in an elderly man?
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What is the underlying cause of bilateral papilledema in a female who is overweight and has hypertension?
What is the underlying cause of bilateral papilledema in a female who is overweight and has hypertension?
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What is the next best therapeutic intervention for a chronic smoker experiencing recurrent cough and bronchitis?
What is the next best therapeutic intervention for a chronic smoker experiencing recurrent cough and bronchitis?
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What initial diagnostic test should be performed for a patient suspected to have giant cell arteritis with headache and jaw pain?
What initial diagnostic test should be performed for a patient suspected to have giant cell arteritis with headache and jaw pain?
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In treating a patient showing signs of opioid overdose, what is the immediate antidote?
In treating a patient showing signs of opioid overdose, what is the immediate antidote?
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What cardiac condition is indicated by exertional shortness of breath, fatigue, and a murmur that increases with the Valsalva maneuver?
What cardiac condition is indicated by exertional shortness of breath, fatigue, and a murmur that increases with the Valsalva maneuver?
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What is the most appropriate medication to initiate for a patient presenting with a patent ductus arteriosus (PDA) in a newborn?
What is the most appropriate medication to initiate for a patient presenting with a patent ductus arteriosus (PDA) in a newborn?
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Which intervention is recommended for a patient who developed sudden chest pain and a new systolic murmur two days after a myocardial infarction?
Which intervention is recommended for a patient who developed sudden chest pain and a new systolic murmur two days after a myocardial infarction?
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What is the first-line diagnostic procedure for a patient suspected of having a pulmonary embolism following recent symptoms of dyspnea after physiotherapy?
What is the first-line diagnostic procedure for a patient suspected of having a pulmonary embolism following recent symptoms of dyspnea after physiotherapy?
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In the management of a patient with inferior myocardial infarction, which medication is crucial for preventing future cardiac events?
In the management of a patient with inferior myocardial infarction, which medication is crucial for preventing future cardiac events?
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What condition is characterized by tachycardia, hypotension, and QRS tachycardia following colorectal surgery?
What condition is characterized by tachycardia, hypotension, and QRS tachycardia following colorectal surgery?
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What is the most likely diagnosis for a diabetic female patient exhibiting severe left arm pain with crepitus on examination?
What is the most likely diagnosis for a diabetic female patient exhibiting severe left arm pain with crepitus on examination?
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Which mechanism is primarily responsible for the formation of vegetations on prosthetic heart valves?
Which mechanism is primarily responsible for the formation of vegetations on prosthetic heart valves?
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What is the most likely diagnosis for a patient presenting with a clinical picture of hyperthyroidism, including tremors and weight loss?
What is the most likely diagnosis for a patient presenting with a clinical picture of hyperthyroidism, including tremors and weight loss?
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In managing a female patient with a hypoactive thyroid nodule and normal TSH levels, what is the recommended next step?
In managing a female patient with a hypoactive thyroid nodule and normal TSH levels, what is the recommended next step?
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What is the best initial management step for a patient diagnosed with hyperthyroidism presenting with severe symptoms?
What is the best initial management step for a patient diagnosed with hyperthyroidism presenting with severe symptoms?
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What should be the next step for a patient with a lipid profile suggesting hypothyroidism and high cholesterol?
What should be the next step for a patient with a lipid profile suggesting hypothyroidism and high cholesterol?
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For a teenager with dry skin, thin hair, and low blood pressure, combined with irregular menstrual periods, what is the most likely underlying condition?
For a teenager with dry skin, thin hair, and low blood pressure, combined with irregular menstrual periods, what is the most likely underlying condition?
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What is the calculated sensitivity of the PSA test based on the given data for detecting prostate cancer?
What is the calculated sensitivity of the PSA test based on the given data for detecting prostate cancer?
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What is the absolute risk reduction (ARR) for a seasonal disease that affected 40% of children and was reduced to 10%?
What is the absolute risk reduction (ARR) for a seasonal disease that affected 40% of children and was reduced to 10%?
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In a double-blind study where neither the physician nor the patient knows the treatment group, what is the significance of this design?
In a double-blind study where neither the physician nor the patient knows the treatment group, what is the significance of this design?
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What is the most likely cause of an itchy rash that starts on the feet and extends up to the ankle in a child who just returned from vacation?
What is the most likely cause of an itchy rash that starts on the feet and extends up to the ankle in a child who just returned from vacation?
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In a clinical case of cellulitis post mastectomy, which organism is most commonly responsible for the infection?
In a clinical case of cellulitis post mastectomy, which organism is most commonly responsible for the infection?
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A patient with sickle cell disease is most vulnerable to infection from which of the following organisms?
A patient with sickle cell disease is most vulnerable to infection from which of the following organisms?
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For a 5-month-old infant with otitis media and bulging tympanic membrane, what is the recommended treatment?
For a 5-month-old infant with otitis media and bulging tympanic membrane, what is the recommended treatment?
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In a sexually active female with disseminated Neisseria gonorrhoeae, what is the most appropriate next step in management?
In a sexually active female with disseminated Neisseria gonorrhoeae, what is the most appropriate next step in management?
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A woman experiences moderate vaginal bleeding 30 minutes after uncomplicated labor. What is the most likely cause?
A woman experiences moderate vaginal bleeding 30 minutes after uncomplicated labor. What is the most likely cause?
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In postmenopausal women presenting with irregular vaginal bleeding, what is the best initial diagnostic step?
In postmenopausal women presenting with irregular vaginal bleeding, what is the best initial diagnostic step?
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For a patient with flu symptoms who later develops sinusitis with purulent discharge, what is the most likely causative organism?
For a patient with flu symptoms who later develops sinusitis with purulent discharge, what is the most likely causative organism?
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Study Notes
Immunology & Hematology
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SCID: Infants with SCID have an increased susceptibility to infections, including pneumocystis pneumonia.
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CVID: Patients with CVID have recurrent sinopulmonary infections and bronchiectasis due to a compromised immune system.
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IgA Deficiency: Patients with IgA deficiency suffer recurrent giardiasis infections.
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Von Willebrand Disease: Prolonged bleeding, especially heavy menses, is a hallmark of this inherited bleeding disorder.
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Folic Acid Deficiency: Symptoms like perifollicular hemorrhage, splinter hemorrhages, and pale sclera, suggest a deficiency of folate.
Neurology
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ALS: Riluzole is a drug used to slow the progression of ALS, a progressive neurodegenerative disease.
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Neonatal Tetanus: This condition occurs due to the inhibition of GABA neurons presynaptically.
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Lumbar Stenosis: A common cause of back pain, lumbar stenosis is a narrowing of the spinal canal in the lumbar region.
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Meralgia Paresthetica: Compression of the lateral femoral cutaneous nerve causes burning and tingling sensations in the outer thigh.
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Increased Intracranial Pressure (ICP): After an RTA, subdural hematoma, and elevated ICP, the next step is to hyperventilate and intubate to manage ICP.
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Cerebral Edema: Post-RTA, a sustained ICP with normal ABGs suggests that cerebral edema may be the underlying cause.
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MS: In patients with previously diagnosed MS experiencing internuclear ophthalmoplegia, high-dose steroids are recommended.
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Alzheimer’s Dementia: Progressive memory loss, social withdrawal, and worsening executive functions are characteristic of Alzheimer's dementia.
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Parkinsonism: This condition is characterized by tremors, rigidity, and bradykinesia.
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Otosclerosis: An inherited condition causes progressive hearing loss due to abnormal bone growth in the middle ear.
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3-Year-Old Development: The child's gross motor skills (climbing stairs, bicycle riding) and social communication skills (using vocabulary and two-word phrases) are all within the normal range for a 3-year-old.
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Increased Intracranial Pressure: Obesity, hypertension, and papilledema are signs of increased intracranial pressure.
Respiratory
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Opioid Overdose: The hallmark of opioid overdose involves respiratory depression (low respiratory rate) and miosis (pinpoint pupils). Treatment involves the administration of naloxone.
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ARDS: This condition is characterized by acute lung injury, manifesting as fluffy infiltrates on chest X-ray and respiratory distress.
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Flail Chest: A V/Q mismatch is the underlying mechanism for respiratory distress in flail chest.
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COPD: Spirometry is the gold standard for diagnosing COPD.
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Parapneumonic Effusion: Pleural effusion associated with pneumonia, particularly with high LDH and normal glucose, suggests a parapneumonic effusion.
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Cystic Fibrosis: CF is a genetic disorder characterized by defective chloride ion channels, leading to thick mucus buildup in the lungs.
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Small Cell Carcinoma of the Lung: This type of lung cancer produces ectopic ACTH.
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Kyphosis: Severely restricted vital capacity, residual volume, and decreased FEV1/FVC with a non-responsive bronchodilator test are consistent with kyphosis.
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Hoarseness of Voice: In a heavy smoker with hoarseness and a visible lesion on the vocal cords, the first step is a biopsy.
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Pneumonia: Reduced breath sounds and increased vocal fremitus are consistent with pneumonia in a heavy smoker.
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Asthma: A patient with a dog, a history of smoking and house painting, and shortness of breath with O2 saturation over 95% at rest suggests asthma.
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Pneumothorax: Acute dyspnea and tachypnea in a CF patient without active infection suggest a pneumothorax.
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Diuretic Use: Frequent awakenings during sleep in an elderly patient on diuretics for hypertension could be due to frequent urination triggered by diuretics.
Gastrointestinal
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Cystic Fibrosis: Chronic diarrhea and recurrent chest infections are associated with cystic fibrosis.
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Hypochloremic Hypokalemic Alkalosis: Significant dehydration and hypochloremic hypokalemic alkalosis are associated with HPS.
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Primary Biliary Cholangitis: Jaundice, pruritus, and elevated AMA antibodies are characteristic of primary biliary cholangitis.
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GERD: Treatment of GERD typically involves proton pump inhibitors (e.g., pantoprazole) and H2-receptor antagonists (e.g., ranitidine).
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Dysphagia: Patients with dysphagia and a sensation of food sticking in their throat often require an endoscopy to assess the cause.
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Ulcerative Colitis: Recurrent abdominal pain and diarrhea in a young boy are consistent with ulcerative colitis.
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Acute Appendicitis: Right lower quadrant pain and tenderness, along with other symptoms, support a diagnosis of acute appendicitis.
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Acute Pancreatitis: In patients with suspected pancreatitis, the next step is an abdominal ultrasound, provided the amylase level is elevated.
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Blunt Abdominal Trauma: Following an RTA, a hemodynamically stable child with bruises and petechiae on the abdomen should have CT abdomen, particularly if x-ray is unremarkable.
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Peritonitis: The immediate management of peritonitis includes emergency surgery, particularly when x-ray reveals free air under the diaphragm.
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Upper GI Endoscopy: In a patient with rectal bleeding, hematochezia, chest pain (with ECG changes that resolved), and bilious fluid from an NGT, the next step is upper GI endoscopy.
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Malignancy: Migrating thrombophlebitis, especially in older patients, is commonly associated with malignancy.
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Obstruction at the Ampulla of Vater: A photo of a PTC lesion, often located at the obstruction of the ampulla of Vater, suggests pancreatic cancer.
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Colorectal Cancer: A 47-year-old female whose father had colorectal cancer at 52 years old should have a colonoscopy done immediately.
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NSAID-Induced Erosive Gastritis: In an elderly patient taking NSAIDs, erosive gastritis can be caused by NSAID use, and cessation of these medications is crucial.
Renal
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HUS (Hemolytic Uremic Syndrome): Bloody diarrhea, lower limb edema, and hematuria with RBC casts in a child are suggestive of HUS, and serum creatinine levels should be checked for confirmation.
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Aminoglycoside Toxicity: Patients with decreased glomerular filtration rate are at higher risk for aminoglycoside-induced nephrotoxicity.
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Diabetic Nephropathy: Glomerular sclerosis is a common pathophysiological mechanism for diabetic nephropathy.
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ACE Inhibitors: To prevent renal deterioration in a diabetic patient with hypertension, ACE inhibitors are the preferred medication.
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Systemic Lupus Erythematosus (SLE): Joint pain, malar rash, hematuria, and RBC casts are suggestive of SLE.
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CT Abdomen: In a female patient with hematuria, weight loss, and flank pain, CT abdomen is the next step in the diagnostic process.
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Acute Cystitis: For a positive nitrate and leukocyte esterase in a UA, nitrofurantoin is typically the first-line treatment.
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Gout: Allopurinol is the most effective medication in preventing gout attacks and lowering uric acid levels.
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Nephrolithiasis: Flank pain radiating to the groin with hematuria in a pregnant woman, without fever or costovertebral tenderness, points to nephrolithiasis.
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Obstructive Nephropathy: AKI associated with retroperitoneal lymphadenopathy and obstructive uropathy is frequently related to lymph node compression.
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Overflow Incontinence: An enlarged and firm prostate, along with urinary leakage during physical activity, suggests overflow incontinence.
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Gram-Positive Enterococcus Faecalis: This organism is a common cause of UTIs.
Immunology & Hematology
- Severe Combined Immunodeficiency (SCID) is a genetic disorder characterized by a deficiency in both T and B lymphocytes, leading to a severely compromised immune system. The case of an infant with recurrent infections (pneumocystis) and failure to thrive, along with a family history of similarly affected siblings, is strongly suggestive of SCID.
- Common Variable Immunodeficiency (CVID) is an acquired immunodeficiency characterized by low levels of immunoglobulins, particularly IgG. Patients with CVID often present with recurrent respiratory infections, such as sinusitis and bronchiectasis, due to impaired antibody production.
- Selective IgA Deficiency is an immunodeficiency characterized by a lack of IgA antibodies in the body. IgA is the main antibody found in mucosal surfaces like the gastrointestinal tract. Patients with this deficiency are prone to recurrent or chronic infections, particularly those affecting the gastrointestinal system, such as giardiasis.
- Von Willebrand Disease is a genetic bleeding disorder caused by a deficiency or dysfunction of von Willebrand factor (VWF), a protein that helps platelets stick together and adhere to the damaged blood vessel walls. This defect leads to prolonged bleeding, especially in patients with minor injuries, heavy menstrual bleeding, or surgeries.
- Folate deficiency is a common cause of macrocytic anemia (elevated MCV), characterized by symptoms like fatigue, pallor, and various other manifestations. The patient’s history of alcoholism, perifollicular hemorrhage, splinter hemorrhages, and petechiae further supports a diagnosis of folate deficiency in this case.
Neurology
- Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease that affects both upper (UMN) and lower motor neurons (LMN), causing progressive muscle weakness, atrophy, and muscle spasms. Riluzole is a medication used to slow the progression of ALS.
- Neonatal tetanus is a condition where a newborn develops tetanus due to bacterial infection (clostridium tetani). The bacteria produce a potent toxin that interferes with the release of GABA, an inhibitory neurotransmitter at presynaptic terminals. This leads to excessive muscle contraction and spasticity.
- Lumbar stenosis is a narrowing of the spinal canal in the lumbar region, which can compress the spinal nerves.
- Meralgia paresthetica is a condition caused by compression of the lateral femoral cutaneous nerve, resulting in numbness, tingling, and pain in the outer thigh.
- Increased intracranial pressure (ICP) can be a serious complication of various neurological conditions, including brain tumors. Management strategies may involve measures to reduce ICP, such as hyperventilation and intubation.
- Cerebral edema is a condition where the brain tissue swells due to an excess buildup of fluid. This can lead to increased ICP and must be addressed promptly to prevent severe neurological injury.
- Multiple Sclerosis (MS) is a chronic inflammatory disease that affects the central nervous system. High-dose steroids are often used to manage acute exacerbations of MS and potentially prevent future complications.
- Alzheimer’s disease is a neurodegenerative disease characteristic of progressive cognitive decline, particularly memory impairments, impacting daily activities. It is the most common cause of dementia.
- Parkinson’s disease is a movement disorder caused by degeneration of dopamine-producing neurons in the substantia nigra. Symptoms include tremor, rigidity, bradykinesia, and postural instability.
Cardiology
- Tussive syncope is a brief loss of consciousness that may occur following a coughing fit. It is believed to be caused by a sudden drop in blood pressure during coughing, possibly due to increased intrathoracic pressure.
- Anaphylaxis is a severe allergic reaction that involves the immune system releasing histamine and other chemicals. It typically leads to a rapid drop in blood pressure and difficulty breathing. The mainstay of treatment for anaphylaxis is immediate administration of epinephrine.
- Acute respiratory distress syndrome (ARDS) is a severe lung injury characterized by inflammation and fluid accumulation in the alveoli. This condition can develop after various triggers, such as sepsis, pneumonia, or trauma.
- Flail chest is a condition where multiple ribs are broken and become detached from the chest wall. This leads to a paradoxical movement of the chest with breathing, which impairs ventilation.
- Chronic obstructive pulmonary disease (COPD) is a lung disease that causes airflow obstruction and makes it difficult to breathe. It is often associated with smoking.
- Parapneumonic effusion is a pleural effusion that develops as a complication of pneumonia. It involves the accumulation of fluid in the pleural space.
- Cystic fibrosis (CF) is a genetic disorder that affects the lungs and other organs. It is caused by a mutation in the gene that codes for a protein called cystic fibrosis transmembrane conductance regulator (CFTR), which is involved in regulating chloride ion transport.
- Small cell carcinoma of the lungs (SCLC) is a type of lung cancer that tends to grow rapidly and metastasize early. It can release various substances, including ACTH, which can lead to ectopic Cushing’s syndrome.
- Kyphosis is a condition where the spine curves forward, leading to a hunchback appearance. It can affect lung function by restricting chest expansion.
Musculoskeletal, Rheumatology
- Atopic dermatitis is a common inflammatory skin condition that causes dry, itchy, and inflamed skin. It is often associated with allergies and asthma.
- Melanoma is a type of skin cancer that arises from melanocytes, the cells that produce melanin. It is a serious form of cancer that requires prompt diagnosis and treatment.
- Acne is common in adolescence and can range from mild to severe. Topical benzoyl peroxide and oral or topical isotretinoin are used to treat acne.
- Scabies is a contagious skin infection caused by a tiny parasitic mite called Sarcoptes scabiei. Treatment is often with permethrin, a topical insecticide.
- Toxic epidermal necrolysis (TEN) is a rare but serious adverse reaction to certain medications. It is characterized by widespread blistering and peeling of the skin.
- Osteoarthritis is a common form of arthritis that causes breakdown of cartilage in joints. It is often associated with aging and overuse.
- Lumbosacral strain is a common injury that affects the muscles and ligaments in the lower back. It is often caused by overuse or sudden movements.
- Legg-Calvé-Perthes disease is a condition that affects the blood supply to the femoral head, a part of the hip joint. It usually affects children.
- Slipped capital femoral epiphysis is a condition that occurs when the head of the femur (thighbone) slips off the neck of the femur. It usually affects adolescents during growth spurts.
- Dupuytren’s contracture is a progressive condition characterized by thickening and contracture of the fascia in the palm, causing the fingers to curl in a bent position.
Endocrine
- Pheochromocytoma is a tumor that develops in the adrenal glands, which are located above the kidneys. It releases excessive amounts of catecholamines, hormones like adrenaline and noradrenaline.
- Hyperosmolar hyperglycemic state (HHS) is a serious complication of diabetes characterized by very high blood glucose levels, extreme dehydration, and altered mental status. IV fluids are used to rehydrate the patient and IV short-acting insulin is used to lower blood glucose levels.
- Hypercalcemic crisis is a life-threatening condition characterized by a dangerously high level of calcium in the blood. The initial step in treatment is generally IV fluids to help expand intravascular volume and flush out excess calcium.
- Malignancy-induced hypercalcemia occurs when tumors secrete factors that disrupt calcium metabolism, leading to increased levels of calcium in the body. The most common mechanism is the production of parathyroid hormone-related protein (PTHrp).
Immunology & Hematology
- Infant with a family history of SCID, presents with pneumocystis infection and failure to thrive. This suggests combined T and B cell immunodeficiency.
- 47-year-old female with bronchiectasis and recurrent sinopulmonary sinusitis. The most likely underlying condition is common variable immunodeficiency (CVID).
- Patient with recurrent giardiasis. This is suggestive of a selective IgA deficiency.
- Young female patient with prolonged bleeding, heavy menses, and a swelling in the hernia region. The symptoms suggest Von Willebrand factor deficiency, excluding ITP.
- Homeless male patient with a history of alcoholism presents with perifollicular hemorrhage, splinter hemorrhages, petechiae, and pale sclera. CBC shows low MCV and Hb. This suggests folic acid deficiency.
Neurology
- Old male patient with upper motor neuron lesions (UMNL), lower motor neuron lesions (LMNL), dysphasia, and bulbar symptoms. This is consistent with amyotrophic lateral sclerosis (ALS). Treatment includes Riluzole.
- Newborn with clinical picture of neonatal tetanus. It's caused by presynaptic inhibition of GABA neurons.
- Patient with lumbar stenosis is diagnosed.
- Clinical picture of meralgia paresthetica, characterized by peripheral nerve compression.
- Old male patient with a history of advanced melanoma presents with neurological symptoms and a metastatic lesion on CT. This suggests increased intracranial pressure. The next step is to intubate and hyperventilate.
- Post-RTA patient with small subdural hematoma on imaging, but no midline shift or mass effect. With normal PaCO2 but elevated ICP, the most likely cause is cerebral edema.
- Patient with known MS with bilateral internuclear ophthalmoplegia. The treatment to prevent complications is high-dose steroids.
- Old right-handed female patient presents with right arm pain and weakness. The next step is CT head.
- Patient with upper and lower muscle weakness, upper distal muscle weakness (interosseous muscle wasting), hyperreflexia of triceps, more prominent weakness in the lower limbs, and positive Babinski sign. This suggests a cervical spinal cord lesion.
- Old man with 3-month memory loss, disengagement from family activities, and difficulty with lists and bills. He recalls 2/5 objects. This is suggestive of Alzheimer's dementia.
- Parkinsonism is diagnosed based on the classical clinical picture.
- Otosclerosis is diagnosed.
- A 3-year-old girl can go up and down stairs one foot at a time, can ride a bicycle, and walk. She speaks in two-word sentences. Her gross motor and language development are normal for her age.
- Female patient with high BMI, hypertension, and bilateral papilledema. This suggests increased intracranial pressure.
- Female chronic smoker wants to quit smoking due to recurrent cough and bronchitis. The next step is to give nicotine patch.
- Female patient with bilateral headache and jaw pain on chewing, suggestive of Giant Cell Arteritis (GCA). The next step is to measure ESR.
- Clinical picture of opioid overdose (RR = 6, miosis). The treatment is naloxone.
- 40-year-old man presents with confusion, sweating, and symptoms of TCA toxicity, indicating TCA toxicity.
- Classic picture of pericarditis after URTI with ECG showing PR depressions & diffuse ST elevations. This is indicative of pericarditis.
Cardiovascular
- BPH patient on alpha-1-blocker, fainted on his way to the bathroom. This is consistent with orthostatic hypotension.
- Clinical picture of exertional shortness of breath, fatigue, and murmur best heard in the lower left sternum, increasing with Valsalva maneuver. These symptoms are suggestive of Hypertrophic Obstructive Cardiomyopathy (HOCM).
- 1-month old newborn with progressive worsening and a 2/6 systolic murmur best heard at the left upper border, further evaluation confirms a PDA. The recommended treatment is alprostadil (PGE1 analogue).
- Patient with inferior MI, the next step to prevent another MI is to give beta-blockers.
- Old patient developed dyspnea after physiotherapy session (likely PE). The initial diagnostic step is CT angiogram.
- Old male chronic smoker with clinical picture of decompensated HF (exertional SOB, LL edema) with chest x-ray. The next step is transthoracic echocardiogram.
- 2 days post-MI, patient developed sudden chest pain and new systolic murmur. This suggests papillary muscle rupture.
- Obese man with alcohol consumption but no smoking wants to prevent hypertension. The best step to take is lose weight.
- Man in his 30s with a healthy lifestyle presents with elevated cholesterol and LDL, but normal HDL. The next step in cardiac risk assessment is no further testing is indicated.
- Mechanism of vegetation on prosthetic heart valve is macrophage activation.
- Myocardial contusion is diagnosed.
- Post colorectal surgery patient developed tachycardia 140 bpm, hypotension 60/50, showing QRS tachycardia and monophasic VT on ECG. The management is electrical cardioversion.
Respiratory
- Diabetic female patient with severe left arm pain, crepitus on the superior part of the chest, and bullae on the upper arm. These findings point towards pneumomediastinitis.
- Labs reveal serum protein = 7.5, albumin normal, PO4 = 2.1, Ca+ = 10.9, cortisol level = 15, free t4 = 4.6. This is suggestive of hyperthyroidism.
- Female patient with a thyroid nodule that was hypoactive on scan. Serum TSH and thyroid hormones within reference range. The next step is FNAC.
- Clinical picture of hyperthyroidism (tremors, exophthalmos, weight loss). The best initial step is beta-blockers twice a day.
- Patient with hypothyroidism and very high cholesterol, LDL level, and TGs. The next step is to measure serum TSH.
- Female patient with irregular menses, facial hair, high testosterone, and 17-hydroxyprogesterone. This is suggestive of Congenital Adrenal Hyperplasia (CAH).
- Teenager with irregular menstrual periods, dry skin, thin hair, low pulse, low blood pressure, and BMI 18. This is suggestive of hypothyroidism.
Ethics & Biostatistics
- Elderly patient with a terminal illness, his son doesn't want him to know. The ethical approach is to involve the patient in the decision-making process and ask how much he is willing to know about his diagnosis.
- A study was done to determine the efficacy of PSA in detecting prostate cancer in 1000 men. 275 men had high PSA levels and prostate cancer, and 25 men had normal PSA but prostate cancer. The sensitivity of the PSA test is 275/300.
- The absolute risk reduction (ARR) for a disease that occurs in 40% of children and is reduced to 10% is 30%.
- In a double-blind study involving both a physician and patient, neither knows which group they are assigned. This is important to minimize bias and ensure objective evaluation of the treatment effectiveness.
Infectious Diseases
- Child on vacation developed an itchy rash on his feet that spread upwards, presenting as long erythematous, irregular lines. This indicates Ancylostoma (hookworm) infection.
- Clinical picture of cellulitis post-mastectomy. The causative organism is likely Streptococcus pyogenes, as Staphylococcus aureus was not in the options.
- SCD in a patient makes them more vulnerable to infection by Pneumococcus pneumoniae.
- Treatment for traveler's diarrhea (not prophylaxis) is adequate hydration.
- Patient with flu symptoms then developed sinusitis with yellowish-greenish discharge. The causative organism is likely Streptococcus pneumoniae.
- 5-month-old infant with otitis media, hyperemia of the pharynx, and an erythematous, bulging tympanic membrane. The recommended treatment is oral amoxicillin.
- Male patient presenting with gas discharge from the urethra, indicating urethritis.
Obstetrics & Gynecology
- Clinical picture of PCOS, associated with an increased risk of endometrial carcinoma.
- Contraception for a smoker with heavy menstrual bleeding is Levonorgestrel IUD.
- Female patient with disseminated Neisseria gonorrhoeae with right wrist pain, rash, and multiple lesions. The next step in management is cefotaxime.
- Mucopurulent discharge from the cervix is consistent with chlamydia infection.
- Amenorrhea in a patient who took low-dose estrogen OCP for years is due to endometrial atrophy.
- Young sexually active patient with HIL lesions on pap smear and positive HPV test. The next step in management is colposcopy.
- Female patient with uncomplicated labor, intact placenta delivered, experiencing moderate vaginal bleeding after 30 minutes. This is likely uterine atony.
- 47-year-old female with previously light periods every 1-6 months, experiencing vaginal bleeding every few weeks. The next best step is endometrial biopsy.
- Patient given oxytocin, but contractions became more irregular. The next step is to give terbutaline.
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Test your knowledge on key concepts in immunology and neurology, including conditions like SCID, CVID, and ALS. This quiz covers a range of disorders, their symptoms, and treatments. Perfect for students and professionals looking to reinforce their understanding of these fields.
