90 Questions
What is the likely diagnosis of a patient with severe pain in the right upper quadrant, associated with nausea and non-bilious emesis, but no fever, weight loss, malaise, or ill contacts?
Cholelithiasis
What is the likely cause of a 5-year-old girl's fever and severe abdominal pain, which worsens with hip extension?
Acute appendicitis
What is the most likely explanation for a 65-year-old woman's constant, severe abdominal pain and decreased urine output?
Bladder cancer with urinary retention
A 44-year-old man comes to the emergency department with abdominal pain and nausea. What is the most likely diagnosis?
Cholelithiasis
What is the likely cause of a patient's severe right upper quadrant pain, nausea, and vomiting?
Choledocholithiasis
A patient is diagnosed with acute appendicitis. What muscle is most likely to be irritated?
Psoas major muscle
What is the most likely finding on imaging of a patient with bladder cancer and urinary retention?
Bilateral hydronephrosis
What is the most likely cause of a patient's abdominal pain, nausea, and vomiting, with a normal abdominal exam?
Acute gastroenteritis
What is the most likely diagnosis of a patient with severe abdominal pain, nausea, and vomiting, with a history of smoking?
Bladder cancer
What is the most probable diagnosis of a midline swelling in the anterior neck that moves on swallowing and protrusion of the tongue?
Thyroglossal Cyst
A diffusely enlarged thyroid that is tender to touch is likely a sign of which condition?
Hashimoto's thyroiditis
A 16-year-old girl presents with a diffuse swelling in her neck that is not associated with a bruit on auscultation. What is the most likely diagnosis?
Simple goitre
What is the most likely diagnosis of a fluctuant swelling on the lateral neck that is asymptomatic and recently enlarged following an upper respiratory tract infection?
Scrofula
What is the most likely diagnosis of a neck swelling in a child that is associated with pain and severe fever?
Lymphadenitis
A patient presents with a swelling in the front of the neck that is enlarging over time. What is the most likely diagnosis?
Non-toxic multinodular goiter
A patient presents with a midline swelling in the anterior neck that is mobile and fluctuant. What is the most likely diagnosis?
Thyroglossal Cyst
What is the most likely diagnosis of a neck swelling that is associated with irritability and stress?
Hyperthyroidism
A patient presents with a diffusely enlarged thyroid that is not tender to touch. What is the most likely diagnosis?
Simple goitre
What is the characteristic of herpes simplex keratitis?
Corneal hyposthesia
What is the immediate action to be taken for a patient with a full thickness corneal laceration?
Put a clear eye shield on the eye
What is the type of gland affected in chalazion?
Meibomian gland
What is the best treatment for deep leucoma?
Penetrating keratoplasty
Where do blood vessels in a trachomatous pannus lie?
Between Bowman's membrane & Epithelium
What type of cells are characteristic in vernal catarrh?
Eosinophils
Which muscle is paralyzed in Horner's syndrome, leading to ptosis?
Muller's muscle
What is the treatment for severe congenital ptosis with no levator function?
Fascia lata sling operation
Where is Fleischer ring found?
Keratoconus
What is the most likely diagnosis for the patient experiencing constant abdominal pain that radiates to the back and flanks?
Pancreatitis
What is the significance of the patient's family history of pancreatitis in his father and paternal uncle?
It increases the patient's risk of pancreatitis
What is the most likely cause of the patient's abdominal distension?
Pancreatitis
What is the significance of the patient's abdominal examination findings?
They indicate pancreatitis
What is the most specific laboratory result for diagnosing pancreatitis?
Serum lipase > 3 times the upper limit of normal
What is the most likely diagnosis for the 22-year-old man with right lower quadrant abdominal pain?
Appendicitis
What is the most likely cause of the 22-year-old man's rebound tenderness?
Inflammation of the appendix
What is the most likely cause of the 26-year-old man's generalized fatigue?
Inflammatory bowel disease
What is the significance of the 26-year-old man's family history of colon cancer?
It increases his risk of colon cancer
What is the most likely cause of a patient's symptoms with a cloudy ascitic fluid, SAAG < 1.1, and triglyceride count > 200 mg/dL?
Intra Abdominal lymphoma
What is the next step in management for a 75-year-old man with hematochezia and hemodynamic instability?
NG tube, proctosigmoidoscopy, and a tagged RBC scan with or without mesentery angiography
What is the most likely test performed by a gastroenterologist to confirm a patient's ulcerative colitis flare-up?
Colonoscopy
What is the rationale for using lactulose in a patient with hepatic encephalopathy?
To reduce ammonia levels in the gut
What is the most likely diagnosis for a patient with ascites, spider angiomas, and icteric sclerae?
Chronic liver disease
What is the most likely cause of a patient's altered mental status and flapping tremors?
Hepatic encephalopathy
What is the significance of a SAAG < 1.1 in a patient with ascites?
It indicates a non-portal hypertensive cause of ascites
What is the most likely finding on laboratory investigation in a patient with chronic liver disease?
Elevated liver enzymes and bilirubin
What is the next step in management for a patient with hepatic encephalopathy?
Lactulose administration
What is the most appropriate initial management for a patient with a 10% pneumothorax on the right?
Needle decompression
What is the next step in management for a 62-year-old man presenting with mild breathlessness on exertion, occasional right-sided chest pain, and sweats?
Pleural ultrasound and diagnostic aspiration
What is the most appropriate therapy for a 70-year-old man with a history of heavy smoking and COPD, who reports cough, chills, pleuritic chest pain, and low-grade fever?
Gram-negative cocci antibiotics
What is the most likely diagnosis for a patient with a small dense infiltrate in the right lower lobe?
Pneumonia
What is the most appropriate management for a patient with a pneumothorax and underlying COPD?
Needle decompression and chest tube insertion
What is the most likely cause of a patient's symptoms with a large pneumothorax?
Underlying lung disease
What is the most appropriate next step in management for a patient with a recurrent pneumothorax?
Thoracotomy with blebectomy
Which of the following is the preferred imaging technique for diagnosing acute pulmonary embolism?
CT angiography
A 27-year-old pregnant woman presents with sudden-onset right-sided chest pain and shortness of breath. What is the most appropriate next step in diagnosis?
Ventilation/perfusion scan
What is the differential diagnosis for a patient suspected of having pulmonary embolism?
All of the above
What is the most common symptom of pulmonary embolism?
Shortness of breath
Which of the following is a complication of pulmonary embolism?
All of the above
What is the treatment of choice for acute pulmonary embolism?
Anticoagulation therapy
Which of the following is a contraindication for fibrinolytic therapy in pulmonary embolism?
All of the above
What is the most appropriate next step in management for the 14-year-old girl with recurrent episodes of shortness of breath and nonproductive cough?
Inhaled budesonide-formoterol as needed
What is the most appropriate initial pharmacotherapy for the 28-year-old man with newly diagnosed asthma?
Low-dose steroid inhaler
What is the most likely diagnosis for the 55-year-old male with a history of IV drug use presenting with fever, chills, and chest pain?
Endocarditis
What is the most appropriate next step in management for the 14-year-old girl who is brought to the physician with acute onset of dyspnea and wheezing?
Albuterol inhaler
What is a common feature of empyema?
Staphylococcus aureus, Streptococcus, and gram-negative bacilli are common causes
What is the most likely diagnosis for the patient with a normal FEV1 and no abnormalities on cardiopulmonary examination and x-ray of the chest?
Gastroesophageal reflux disease
What is the most appropriate first step in treatment for the 28-year-old man with newly diagnosed asthma and symptoms once or twice a week?
Short-acting beta-2 agonist inhaler
What is the most likely cause of bilateral interstitial infiltrates in a 68-year-old man with atrial fibrillation and hypertension?
Amiodarone
What is the most likely diagnosis for the 14-year-old girl with recurrent episodes of shortness of breath and nonproductive cough, which have resolved spontaneously with rest?
Asthma
What is the diagnosis of a 25-year-old woman with cough, unintentional weight loss, and an 8-cm cavity in the right upper lobe on chest x-ray?
Tuberculosis
What is the most likely diagnosis of a patient with pleural fluid pH 6.95 and gram-negative rods on Gram stain?
Empyema
What is the most common cause of empyema?
Staphylococcus aureus and Streptococcus
What is the next step in management of a patient with empyema?
Drainage with a chest tube
What is the significance of a low pH in pleural fluid?
Suggests an exudative effusion
What is the most likely diagnosis for a 55-year-old sandblaster presenting with cough, fatigue, and pleuritic chest pain?
Silicosis
What is the most likely etiology of a 35-year-old HIV-positive man’s presentation with sudden onset of right-sided chest pain and shortness of breath?
Pneumothorax
What is the first step in managing a patient with pneumothorax?
Administer oxygen therapy
What is the indication for fibrinolytic therapy in a patient with pulmonary embolism?
All of the above
What is the most common occupational lung disease caused by inhaling silica particles?
Silicosis
What is the most likely complication of HIV-related respiratory disease?
Pneumocystis jirovecii pneumonia
What is the goal of management in a patient with pneumothorax?
Prevent recurrence
What is the most likely diagnosis based on an x-ray of the chest showing hyperinflation and hypertranslucency of the lower lobes of both lungs?
Emphysema
Which antihypertensive medication is responsible for a dry cough in a 48-year-old woman?
Lisinopril
What is the most likely diagnosis based on a productive cough with blood-tinged sputum, lethargy, night sweats, and decreased appetite in a 56-year-old man who recently returned from India?
Tuberculosis
What is the most appropriate next step in the evaluation of a 45-year-old male with asthma whose symptoms have worsened despite medication?
Exercise physiology testing
What is the most likely occupation-related lung disease in a 45-year-old textile worker with episodic cough and wheezing?
Byssinosis
What is the most appropriate initial management for a patient with a 10% pneumothorax on the right?
Observation
What is the most likely diagnosis in a patient with chronic cough, fever, and weight loss, and a history of HIV infection?
Pneumocystis pneumonia
What is the most appropriate therapy for a 70-year-old man with a history of heavy smoking and COPD, who reports cough, chills, pleuritic chest pain, and low-grade fever?
Antibiotics and bronchodilators
What is the most likely diagnosis in a patient with a small dense infiltrate in the right lower lobe?
Pneumonia
What is the next step in management for a 62-year-old man presenting with mild breathlessness on exertion, occasional right-sided chest pain, and sweats?
Chest x-ray
Study Notes
Thyroid and Neck Swellings
- A 15-year-old girl presents with a discrete mobile fluctuant midline swelling of the anterior neck at the level of the hyoid bone, moving on swallowing and protrusion of the tongue. The probable diagnosis is a thyroglossal cyst.
- A 45-year-old woman presents with an enlarging mass in the front of her neck, feeling well with no changes in her health. The most likely diagnosis is Hashimoto's thyroiditis.
Eye Conditions
- Herpes simplex keratitis is characterized by corneal hyposthesia.
- A 40-year-old male had a trauma to his right eye while hammering a metallic nail. Immediate action is to put a clear eye shield on the eye.
- Chalazion is a chronic inflammatory granuloma of the Meibomian gland.
- Deep leucoma is best treated by penetrating keratoplasty.
- Blood vessels in a trachomatous pannus lie between Bowman's membrane and epithelium.
- In vernal catarrh, the characteristic cells are eosinophils.
- Ptosis in Horner's syndrome is due to paralysis of Muller's muscle.
- Severe congenital ptosis with no levator function can be treated by fascia lata sling operation.
- Fleischer ring is found in keratoconus.
Abdominal Conditions
- A patient presents with a swelling in the neck, pain, and fever. The most likely diagnosis is a cervical lymphoepithelial cyst.
- A 5-year-old girl is brought to the emergency department because of fever and severe abdominal pain. Acute appendicitis is diagnosed, and the inflamed structure associated with these symptoms is most likely in contact with the psoas major muscle.
- A 65-year-old woman is admitted to the hospital for constant, severe abdominal pain that has worsened over the prior week. The most likely diagnosis is bladder cancer, and bilateral hydronephrosis is likely to be detected upon imaging.
- A 44-year-old man comes to the emergency department with abdominal pain and nausea for the past 24 hours. The pain started a few hours after dinner, and the most specific laboratory result in diagnosing this patient's condition is serum lipase > 3 times the upper limit of normal.
- A 22-year-old man develops marked right lower quadrant abdominal pain over the past day. The pain experienced by this patient is predominantly the result of prostaglandin and bradykinin.
Other Conditions
- A 26-year-old man comes to the physician because of a 6-month history of increasing generalized fatigue, inability to work out, lower abdominal pain, and occasionally bloody diarrhea. The most likely cause of this patient's symptoms is chylous ascites.
- A 75-year-old man develops hematochezia and presents with hemodynamic instability. The most appropriate next step in management is NG tube, mesentery angiography, and colonoscopy.
- A 28-year-old man presents to his gastroenterologist with a two-week history of abdominal pain, bloody diarrhea, and urgency to have a bowel movement. The most likely diagnosis is a flare-up of ulcerative colitis.
- L, a patient with chronic liver disease, presents with altered mental status and flapping tremors. The rationale for using lactulose in this patient is to treat hepatic encephalopathy.
Pneumothorax
- A 10% pneumothorax on the right can cause diminished breath sounds, hyperresonance, and decreased tactile fremitus in the right lung field.
- The most appropriate initial management for a 10% pneumothorax is needle decompression.
Management of Chest Pain
- For a 62-year-old man with a three-day history of mild breathlessness on exertion, occasional right-sided chest pain, and sweats, the next step in management is pleural ultrasound and diagnostic aspiration.
- For a 70-year-old man with a history of heavy smoking and COPD, the most appropriate therapy is antibiotics, such as for gram-negative cocci.
Differential Diagnosis of PE
- PE should be considered in the differential diagnosis of patients suspected of having cardiac ischemia, heart failure, COPD exacerbation, pneumothorax, pneumonia, sepsis, acute chest syndrome, and acute anxiety with hyperventilation.
- The preferred imaging technique for diagnosing acute PE is CT angiography.
Chest Pain in Pregnancy
- For a 27-year-old woman who is 7 months pregnant with sudden-onset right-sided chest pain and shortness of breath, the most appropriate next step in diagnosis is CT angiography or ventilation/perfusion scan.
Empyema
- Empyema is typically caused by Staphylococcus aureus, Streptococcus, and gram-negative bacilli.
- Gross purulence is diagnostic of empyema, and the absence of frank pus rules out infection.
COPD and Pulmonary Fibrosis
- A 68-year-old man with a worsening nonproductive cough and progressive shortness of breath may have bilateral interstitial infiltrates due to medication, such as amiodarone.
- A 55-year-old man with a history of IV drug use and fever, chills, and chest pain may have a grade II/VI systolic murmur and petechial skin lesions due to endocarditis.
Asthma
- For a 25-year-old woman with a 4-month history of cough and unintentional weight loss, the most appropriate next step in management is to start treatment with oral medications.
- For a 14-year-old girl with recurrent episodes of shortness of breath and nonproductive cough, the most appropriate initial pharmacotherapy is an albuterol inhaler.
- For a 28-year-old man with asthma, the most appropriate first step in treatment is a short-acting beta-2 agonist inhaler or a low-dose steroid inhaler.
Other Respiratory Conditions
- A 35-year-old HIV-positive man with right-sided chest pain and shortness of breath may have a pneumothorax due to Pneumocystis jiroveci pneumonia.
- A 55-year-old man with a history of sandblasting and cough, fatigue, and pleuritic chest pain may have silicosis.
- A 48-year-old woman with a dry cough that has not improved despite taking cough linctus and antibiotics may have a medication-related side effect, such as from ACE inhibitors.
Infections
- A 56-year-old man with a productive cough with blood-tinged sputum, lethargy, night sweats, and decreased appetite after returning from India may have tuberculosis.
- A 45-year-old male with episodic cough and wheezing that responded initially to inhaled bronchodilators and inhaled corticosteroids may have occupational asthma.
This quiz consists of solved questions related to thyroid and neck disorders, including symptoms and diagnosis. It's a useful resource for medical students and professionals.
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