IFOM Questions (October 29th, 2024) PDF

**[IFOM questions (October 29th, 2024)]** **Immunology & Hematology** 1. Infant with current infection with pneumocystis and signs of failure to thrive, has familial history of brothers dying at a young age (SCID) → **Combined T & B cell** 2. A 47 years-old female with clinical picture...

**[IFOM questions (October 29th, 2024)]** **Immunology & Hematology** 1. Infant with current infection with pneumocystis and signs of failure to thrive, has familial history of brothers dying at a young age (SCID) → **Combined T & B cell** 2. A 47 years-old female with clinical picture of bronchiectasis, with history of recurrent sinopulmonary sinusitis about pathophysiology, most likely CVID → **immunodeficiency** a. Immunodeficiency b. impaired chloride ion channels. 3. Patient with **recurrent giardiasis**, asking about **selective deficiency in which Ig**? → **IgA** 4. Young female patient with hernia being assessed for surgery, gave history of prolonged bleeding heavy menses, but no petechiae on examination and swelling in the hernia region. What is the cause of her symptoms, deficiency in what → Von Willebrand factor, no ITP mentioned in the options. a. antithrombin III b. protein C c. Hemophilia d. Von Willebrand factor 5. A male patient who is homeless, with a history of alcoholism, but last drank alcohol 3 weeks ago presented with perifollicular hemorrhage, splinter hemorrhages, petechiae behind the calf, and pale sclera. CBC showed an MCV of 89 and Hb of 9. **What deficiency does he have? Vit c was not within the options! I chose folic acid** a. Vit B1 b. Vit B6 c. Vit B12 d. Folic acid e. Zinc **Neurology** 6. An old male patient with UMNL, LMNL, dysphasia and bulbar symptoms **(ALS)**, asking about treatment → **Riluzole** 7. Newborn with clinical picture of neonatal tetanus, what is the pathophysiology → **Presynaptic inhibition of GABA neurons** 8. Diagnosis of **lumbar stenosis** 9. Clinical picture of meralgia paresthetica, asking about pathophysiology → **peripheral nerve compression** 10. An Old male patient with a history of advanced melanoma, presented with neurological symptoms (I think severe headache), CT was given showed lesion likely metastasis. Asking about what to do next? (Management of ICP) → **intubate and hyperventilate** 11. A patient post RTA with small subdural hematoma on imaging, but no midline shift or mass effect seen. ABG was given and showed PaCO2 37 mmHg I think 37 and PO2 was normal. ICP was 30 mmHg and remained unchanged for the past 2 hours? **What is the cause? I chose cerebral edema** a. Cerebral edema b. Intracranial hemorrhage c. Increased volume 12. A patient with known MS with bilateral internuclear ophthalmoplegia, what to give to help the patient's condition/prevent future complications? Not sure of the question → **High dose steroids** 13. An old female patient, who is right-handed, I think might've been hypertensive with a history of right arm pain, and on examination there's right arm weakness, otherwise normal neurological exam. What to do next → **I chose CT head** a. ambulatory 24 hr ECG b. CT scan of the head 14. A patient with upper & lower muscle weakness, upper distal muscle weakness of the hand (interosseous muscle wasting and other hand muscles), hyperreflexia of triceps, more prominent weakness in LL and positive Babinski sign. **Asking for which level this lesion?** a. Cervical b. Thoracic c. Lumbar 15. An old man has 3-month memory loss, no longer wants to participate/engage in family events/activities according to children and has trouble with weekly grocery lists and bills. I think he recalls 2/5 objects → **Alzheimer's dementia** a. Frontotemporal dementia b. Alzheimer's dementia c. Multi-infarct dementia/Vascular dementia d. Lewy body dementia 16. Classic picture of **Parkinsonism**, asking about diagnosis? 17. Otosclerosis diagnosis 18. **Developmental milestone for a 3-year-old girl** that goes up and down the stairs one foot at a time, can ride a bicycle and walk. She uses 10-20 vocabulary words and speaks in two-word sentences - her teachers in preschool don\'t understand her, but her parents do. **Are her gross motor and language development normal for her age? I choose normal -- norma**l 19. A female with high BMI, hypertension, and bilateral papilledema, asking about the cause → **Increased intracranial pressure** 20. A female who is a chronic smoker, wants to quit smoking because of recurrent cough/bronchitis. I don\'t remember exactly why. What to do next? No bupropion mentioned a. Give nicotine patch b. Other choices: taper smoking in 6 weeks 21. A female patient with **bilateral headache and jaw pain on chewing (GCA)**. What is the next step to diagnosis→ **measure ESR,** temporal artery biopsy was not given. a. Measure ESR b. CT/imaging 22. Clinical picture of **opioid overdose** (RR =6, miosis), asking for **treatment → naloxone** 23. A 40 something year old man, who has a son diagnosed with MDD/depression presented to ED with confusion, sweating, and symptoms of TCA toxicity. Asking about the cause → **anticholinergic effect** 24. Patient was on losartan; finasteride, and I think he took diphenhydramine or something for a cold and developed urinary retention. What is the cause → anticholinergic effect 25. Man with BPH complains of passing 30 ml every few hours? What's the best next step in management → Catheter 26. An old man who presented with a 6-week history of urine leakage with physical activity and examination revealed an enlarged, firm prostate. What is the cause of his urinary incontinence? a. Detrusor overactivity b. overflow c. mechanical stress on bladder d. Don\'t remember **Psychiatry** 27. A mother after giving birth in the hospital was found whispering to her newborn "I think you\'re not my baby", didn\'t make eye contact with the baby and didn\'t breastfeed the baby. What to do next → **Psychiatry consultation** 28. He was a 42-year-old gentleman with "bad feeling", heartburn and feeling anxious. He had these recurring symptoms during his 20s in university. Most likely GAD. What is the best treatment for long term management of his condition → I chose psychotherapy a. Alprazolam b. diazepam c. Psychotherapy 29. An old man felt anxious and in a low mood, he went to the doctor, and he discovered he had a terminal illness/I think pancreatic malignancy. What is the cause of mood→ Mood related to medical condition. Other choices included anxiety 30. An 8-year-old girl found daydreaming in class, but not disruptive. Her grades were affected, and her parents were informed. She stated she no longer wants to go to school. On exam, she seemed quite distracted. What's the diagnosis? → ADHD a. ADHD b. dissociative disorder c. malingering 31. A patient with known schizophrenia on long term haloperidol, found by neighbor confused, drooling, has a fever of 38.8. Exam revealed rigid tense muscles with labs showing CK of 4200+ and toxicology screen +ve for benzodiazepines. What is the diagnosis → Neuroleptic Malignant Syndrome **Cardiology** 32. Patient came presented after losing consciousness for 10 secs after a coughing bout, he also mentioned he did not have breakfast →Tussive Syncope a. Hypoglycemia b. Autonomic insufficiency c. Tussive syncope 33. Anaphylaxis management for a bee sting allergy→ IM epinephrine a. IM epinephrine b. IV epinephrine 34. Classic picture of pericarditis following URTI with ECG showing PR depressions and diffuse ST elevations, asking for diagnosis → Pericarditis 35. BPH patient on ∝-1- antagonist, I think terazosin, fainted on his way to the bathroom, what's the diagnosis → orthostatic hypotension 36. Clinical picture of exertional SOB, fatigue and murmur best heard in the lower left sternum and increases on Valsalva maneuver → HOCM 37. A 1-month newborn with progressive worsening on exam a 2/6 systolic murmur is best heard at left upper border and has PDA on further evaluation, what to give? a. Alprostadil (PG E1 analogue) b. Indomethacin 38. Patient with inferior MI, what to give after to prevent another MI → beta blocker 39. An old patient developed dyspnea after a physiotherapy session (most likely PE), what is the best initial step in diagnosis → I chose CT angiogram a. US of the LL, not duplex just US b. CT Angio 40. Clinical picture of decompensated HF (exertional SOB, LL edema) in an old male chronic smoker. After doing a chest x-ray, what to do next →Transthoracic echocardiogram 41. 2 days post MI, a patient developed sudden chest pain and new systolic murmur. What\'s the diagnosis → Papillary muscle rupture 42. An obese man who drinks alcohol but doesn\'t smoke wants to know how to prevent hypertension. Don\'t remember if they've mentioned his diet. What\'s the best step to prevent HTN → Lose weight 43. Man in his 30s, jogs 5x/weekly, healthy diet, and no history of CAD, came for a routine checkup. Lipid profile showed cholesterol 220, LDL around 140, normal HDL. Asking what's the next step/test to do for assessment of cardiac risk? a. Measure urinary uric acid b. Measure serum apolipoprotein c. no further testing is indicated 44. Mechanism of vegetation on prosthetic heart valve? a. macrophage activation b. Lymphocytic infiltration 45. Diagnosis of myocardial contusion 46. Post colorectal surgery, patient developed tachycardia 140 bpm, hypotension 60/50 with single ECG strip showing QRS tachycardia and monophasic VT, asking about management? a. Diltiazem b. Amiodarone c. Furosemide and something else d. Electrical cardioversion e. IV lidocaine **Respiratory** 47. A diabetic female patient with severe left arm pain, on examination there is crepitus on superior part of chest and bullae on upper arm a. Necrotizing fasciitis b. Ruptured trachea c. Pneumomediastinitis d. Pneumothorax 48. Patient developed respiratory distress after some surgery with X-ray showing fluffy cotton ball, what is the diagnosis → ARDS 49. Patient post RTA developed clinical picture of flail chest, asking about mechanism of respiratory distress/pathophysiology → V/Q mismatch 50. COPD diagnosis confirmed by spirometry 51. Child with a picture of pneumonia, developed pleural effusion and gave effusion pleural analysis (glucose was normal I think, protein don\'t remember, high LDH). Asking for the cause? a. Parapneumonic effusion b. Chylothorax c. Hemothorax 52. Pathophysiology of CF → defective chloride ion channels 53. Paraneoplastic small cell carcinoma of the lungs secretes what→ ACTH 54. Patient with severe Kyphosis for years. Asking about PFT Parameters (in terms of vital capacity, residual volume, FEV1/FVC, bronchodilator response) 55. Decreased vital capacity --- decreased residual volume--- decreased FEV1/FVC normal --- Bronchodilator test/response = no response 56. Patient with a long history of smoking, has hoarseness of voice, works as a telemarketer. Picture of larynx shown with a lesion. Asking what to do next? a. stop smoking and reexamine in a month b. Give steroids and reexamine after a while c. Biopsy d. Voice training 57. Patient that is a heavy smoker with fever and a picture of pneumonia. He had reduced breath sound at the base of the long and increased vocal fremitus, What's the diagnosis? a. Pneumonia b. COPD c. Asthma 58. Patient who has a dog for 3 years, smokes for 10 years and works as a house painter has SOB on physical activity, O2sat on activity 95%, and 98% on rest. What to do next to decrease/improve his symptoms? a. Stop smoking b. change occupation c. get rid of dog d. last option I think was to lose weight not sure 59. A patient with CF that developed acute dyspnea and tachypnea, they did not write the vitals just those 2 words. And they mentioned patient is currently does not have active infection, What\'s the diagnosis? (these 2 were the options that made sense, I think pneumothorax) a. Pulmonary embolism b. Pneumothorax 60. An elder who is getting awake from sleep more often than usual. He is taking diuretics as part of his Hypertensive management. He forgets 2 out 5 objects on mental state examination. Asking about the reason why he wakes up more often. a. dementia b. diuretic use c. Normal aging 61. A Female patient in her 70s came for a routine checkup, her mother had history of thyroid cancer and her father had history of lung cancer at 75. She smoked for 30 years but quit 20 years ago. She has done colonoscopy 3 years ago. What is the best next step? a. chest xray b, colonoscopy c. pap smear **GI** 62. A patient with chronic diarrhea and chest infections, picture of CF, what's the diagnosis → CF 63. An infant with picture of HPS, asking about lab findings → pH: high \-- K+: low \-- Chloride: low (hypochloremic hypokalemic alkalosis) 64. Middle aged female with jaundice and pruritus, has positive AMA antibody (1ry biliary cholangitis). What to measure next? a. LDH b. Fasting lipid profile 65. Treatment of GERD a. Pantoprazole b. Ranitidine c. Alginate d. aluminum hydroxide e. sucralfate 66. Old patient presenting with dysphagia and sensation that food sticks to his throat → endoscopy 67. A young boy with recurrent abdominal pain for 3 months and diarrhea, what's the diagnosis → Ulcerative colitis 68. Female with RLQ pain and clinical picture of appendicitis, what\'s the diagnosis → acute appendicitis. 69. Patient with a picture of acute pancreatitis (epigastric pain that radiates to the back) and amylase of 1000, what's the next step? (preferred modality of imaging)? a. gallbladder scintigraphy b. US abdomen c. CT abdomen 70. A 4-year-old not in a car seat but in the back seat with seat belt was involved in an RTA, presented with revealed bruises and petechiae on abdomen. She is hemodynamically stable, and x-ray is unremarkable. Exam what to do next? blunt abdominal trauma a. Observe Hb every 4 hours b. CT abdomen 71. Patient with peritonitis and board like rigidity, high amylase, and X-ray showed air under the right diaphragm, what to do next? a. Immediate surgery b. CT abdomen 72. Patient with severe rectal bleeding and hematochezia, chest pain with ECG showing t wave inversion and diffuse ST elevation I think I\'m not sure after giving IV fluids and PRBCs, ECG changes and chest pain resolved. Colonoscopy was done, only blood was seen in the colon, no visible source of bleeding and NGT showed bilious fluid. what to do next? a. Upper GI endoscopy b. repeat colonoscopy c. CT abdomen 73. A picture of migrating thrombophlebitis in an old patient, what is the cause/diagnosis → malignancy 74. Shows a photo of PTC asking where the lesion is? a. obstruction at level of ampulla of Vater b. pancreatic cancer (just says that) c. Other options were not close 75. 74\. A female 47 years-old with a history of father getting colorectal cancer at the age of 52 what to do next? Colonoscopy now 76. Erosive gastritis caused by what in an old man who takes NSAIDs 1-2x a month for osteoarthritis. What to do to improve his conditions → stop NSAIDs **Renal** 77. Child with episodes of diarrhea that are sometimes bloody (HUS). He also developed LL edema, and it says that it reached the knees. What to do to confirm diagnosis? a. Serum Cr b. Fractional excretion of Na 78. An elderly patient on aminoglycoside, what is considered a risk factor for aminoglycoside toxicity in this age group? dec GFR / nephrotoxic 79. Mechanism of DM nephropathy → glomerular sclerosis (other option was osmotic diuresis) 80. Diabetic patient with HTN, asking what medication is best to prevent renal deterioration? → ACE inhibitors 81. A child with joint pain in the wrist and knee with malar rash over the nose and cheeks, presented with hematuria and urinalysis with RBC and RBC cast, most likely diagnosis → SLE 82. A Female 50 y/o complaining of blood in the urine sometimes with small clots, weight loss, flank pain, Dx next step? Don\'t remember the choices but I may have chosen CT abdomen 83. Picture of acute cystitis/UTI with positive nitrate and leukocyte esterase in urine analysis. What to give? a. nitrofurantoin b. Ceftriaxone c. Doxycycline 84. Clinical picture of gout with gout arthritis and high uric acid levels asking about the most appropriate step to prevent symptoms → allopurinol 85. Pregnant lady, with flank pain radiating to groin. There is some blood in the urine, asking what's the cause but no fever, no costovertebral tenderness → Nephrolithiasis 86. Obstructive nephropathy in a female with high RFTs and has multiple abdominal lymph nodes seen by imaging (retroperitoneal lymphadenopathy). What's the cause of AKI → Obstructive 87. Old man with 6 weeks history of episodes urine leakage on physical activity, on examination prostate was found to be enlarged and firm. What's the cause of incontinence? a. Overflow b. Mechanical stress on bladder c. detrusor overactivity 88. Patient presenting with typical cases of UTI. Asking about the causative organism → gram-positive enterococcus faecalis 89. A young y/o male came with scrotal pain, left testicle tender, high and symptoms of epididymitis, asking for the cause? a. Inflammation b. Failure of the processus vaginalis to close 90. Young patient, with hard mass on testicles. Examination showed that the mass is firm. What is the diagnosis? Testicular cancer **Musculoskeletal, rheumatology** 91. Question with a photo of a child having a rash all over face, picture attached. Saying that parents did some topical creams, but it didn't work. What's the diagnosis → atopic dermatitis 92. Melanoma diagnosis 93. A teenager with open comedones acne → topical benzoyl peroxide, isotretinoin was included in the choices both oral and topical 94. Scabies picture in a child, asking about treatment → permethrin 95. An old patient who took Allopurinol for 2 weeks then developed desquamation of skin and blister → Toxic epidermal Necrolysis (TEN) 96. An old patient with shoulder and hip pain, examination shows no muscle weakness, what to do next? Bone scan 97. Question about pathophysiology of osteoarthritis a. Decreased proteoglycan b. Inflammatory process c. Lysosomal enzyme release 98. Typical lumbosacral strain case, paraspinal tenderness. What to do next? a. Move as tolerated b. MRI 99. Legg-Calvé-Perthes disease diagnosis with x-ray image 100. Slipped capital femoral epiphysis diagnosis with x-ray image 101. Another question about osteoarthritis (don\'t remember the question, I think it\'s about screening for old patient → bone scan) 102. Dupuytren's contracture pathophysiology → fibroproliferative **Endocrine** 103. Pheochromocytoma pathophysiology → Increase in catecholamine 104. Treatment of HHS a. IV short acting insulin b. Subcutaneous short acting insulin 105. Hypercalcemic crisis, best initial step → IV fluids, not calcitonin 106. Mechanism of hypercalcemia in a female patient with breast cancer and bone pain likely bone metastasis, asking about mechanism of malignancy induced hypercalcemia? a. increased vit D b. increased PTH c. increased activation of osteolytic factor 107. Mechanism of hypercalcemia in a patient with weight loss and symptoms of malignancy I think might have been squamous cell carcinoma, not sure. a. Increased osteolytic factor b. Increased PTHrp 108. An elderly patient with symptoms of hypercalcemia (increased thirst, constipation, fatigue) but no weight loss mentioned. Labs showed the following: Serum protein= 7.5, Albumin normal, PO4 = 2.1, Ca+ =10.9. cortisol level =15, free t4 =4.6. What's the diagnosis? a. Multiple Myeloma b. hypothyroidism c. hyperthyroidism d. pituitary adenoma e. primary AI 109. Female patient with thyroid nodule that was found to be hypoactive on scan. Serum TSH and thyroid hormones within reference range, what to do next? a. Suppressive levothyroxine therapy b. FNAC c. I131 ablation d. follow up 110. Clinical picture of hyperthyroidism (tremors, exophthalmos, weight loss), what is the best initial step? a. beta blockers twice a day b. propylthiouracil once a day c. Thiamazole once a day d. thyroidectomy 111. A patient with a picture of hypothyroidism and lipid profile showed very high cholesterol, LDL level, and TGs. What's the best next step? dry skin, getting tired, what to do next? a. Start/give atorvastatin b. Measure serum TSH 112. Female patient with irregular menses, facial hair with high testosterone and 17-hydroxyprogesterone, what's the diagnosis? a. CAH b. PCOS 113. Teenager with irregular menstrual period, has dry skin, thin hair, low pulse, low blood pressure, BMI 18 what is the cause? a. Hypothyroidism b. anorexia nervosa **Ethics and biostatistics** 114. An elderly patient with a diagnosis of terminal illness. His son is a doctor and doesn't want father to know. What do you do? Ask patient how much he is willing to know about his diagnosis 115. A study was done to determine the efficacy of PSA in detecting prostate cancer, in a group of 1000 men. Out of 400, 275 men had high PSA levels and endoscopic findings of prostate cancer. An additional 25 men had normal PSA but were found to have prostate cancer. What is the sensitivity of the PSA test in detecting prostate cancer?Sensitivity = TP/(TP+FN) = 275/25+275 = 275/300 a. 275/300 b. 275/400 c. 275/700 d. 275/1000 116. Absolute risk reduction (ARR) for a disease that occurs seasonally in 40% of the children and they reduced that number to 10%. Calculate the ARR. Absolute Risk Reduction = Control Group Risk − Treatment Group Risk = 40 --10 =30 % 117. A physician and patient were included in a double-blind study for a new drug used in treating a disease rather than the standard drug. I don\'t remember the standard drug exactly; I think it might\'ve been an antihypertensive. However, both physician and patient don\'t know which group they are. Why is that important? Asking about the biases a. Bias against sample selection or something like that b. sample size too small to be generalized c. confounding bias d. Bias in measuring the outcomes 118. A new test is being studied to detect esophageal disorders. Researchers conducted the test and found that 70 patients had positive findings on endoscopy but only 2 were detected by the test, and 335 patients who didn\'t have the disease tested negative. What can we tell you about this test? a. can be used for screening test b. can\'t be used as it failed to detect a large number of cases 119. Question mentioning a female that is gaining weight but she clearly stated that she is not eating anything, and is worried and says she cannot reduce food any more than this. Her pulse was 65. What to do next? a. Endocrine lab tests b. tell her not to worry about weight gain c. tell her to follow a certain diet d. tell her to stop caloric restriction 120. Senior residents and I think a healthcare worker in a nursing home facility got influenza. What to do to prevent the spread of infection? a. Vaccinate only exposed ones b. Give everyone vaccination and oseltamivir c. Isolate all patients with symptoms together 121. Precautions prior to CVC placement? a. hand washing b. wear gloves and mask c. giving prophylactic antibiotics d. Remove nasogastric tube **Infectious disease** 122. A young child with fever and a picture of infection developed hypotension and raised papules on IV-line insertion, on examination mottling can be seen. What\'s the cause? a. Sepsis b. Anaphylaxis 123. Picture of a child with a single non bullous impetigo, how to treat it → Topical Mupirocin 124. A picture of meningitis likely Neisseria meningitidis in a university student asking about precaution/ mode of protection → droplet 125. An asymptomatic HIV patient with 5 mm PPD test induration after 48 hrs , asking you what to do next? a. Treat latent tb b. Treat active tb c. Repeat PPD after 1 month d. Repeat PPD after 6 months 126. Treatment of dengue fever → no further treatment 127. Typical Malaria case: Fever, muscle pain, etc. Picture showing Intraerythrocytic Malaria in the film. Asking for the diagnosis? 128. Patient with symptoms of TB and multiple punctures/signs of drug use seen on examination what\'s the mechanism of her symptoms → decrease CD4 T cells 129. Question about a child that went on vacation with his family, he developed an itchy rash on his feet that extended up to his ankle, and then spread. The rash was seen as long erythematous, irregular lines → Ancylostoma 130. Clinical picture of cellulitis post mastectomy → Strept pyogenes, staphylococcus aureus was not in the options. 131. SCD in a patient makes him/her more vulnerable to infection by what organism? a. Pneumococcal pneumoniae b. pseudomonas 132. Treatment of traveler\'s diarrhea not prophylaxis → adequate hydration 133. Patient with flu symptoms/ URTI then developed sinusitis with yellowish greenish discharge. What is the causative organism? a. Strept. pneumoniae b. Staph aureus 134. A 5-month-old infant with a picture of otitis media, examination revealed a hyperemia of the pharynx and an erythematous, bulging tympanic membrane, what to give? a. Oral amoxicillin b. topical ofloxacin 135. A male presenting with gas discharge from urethra **ObGyn** 136. Clinical picture of PCOS asking increased risk for which cancer? Endometrial carcinoma 137. Asking for contraception for smoker with heavy menstrual bleeding i think 5-7 days → Levonorgestrel IUD 138. A female patient with a picture of disseminated Neisseria gonorrhoeae with right wrist pain and rash. Also having like 10 lesions (rash all over her body). She's sexually active with no consistent protection. What's the next step in management? a. Cefotaxime b. Azithromycin c. Doxycycline 139. Mucopurulent discharge from cervix causative organism→ chlamydia 140. Amenorrhea in a patient who took low dose estrogen OCP for years and asking about cause → endometrial atrophy 141. A young sexually active patient who had HIL lesion on pap smear and tested positive for HPV, what is the next step in management? a. colposcopy b. cone biopsy 142. A female patient who had an uncomplicated labor, with intact placenta delivered. After 30 mins, she experienced moderate vaginal bleeding, what's the cause? a. Uterine Atony b. Retained products of contraception c. Vaginal hematoma 143. A 47 or 40 something years old previously had light periods every 1-6 months, suddenly experienced vaginal bleeding every few weeks, what's the next best step? a. endometrial biopsy b. progesterone 144. Patient was given oxytocin, but contractions became more irregular, what to give → terbutaline 145. Picture given of vulvar lichen planus (old patient with itching and agglutinated vulva), asking what to do next → Biopsy 146. Diagnosis of preeclampsia with severe features (proteinuria, HTN and low platelet) 147. Patient that underwent bilateral salpingectomy, came now presenting with amenorrhea for I think 8 weeks or so, with some vaginal bleeding. Next step? a. pregnancy test b. ultrasound 148. Unilateral bloody nipple discharge no calcifications on mammography → intraductal papilloma 149. A female with a previous history of ectopic pregnancy, presented with amenorrhea. On US there is a 1 cm gestational sac but no yolk sac, fetal pole. Her B hCG was 1600, then after 48 hrs it was 1000. What to do next a. Repeat US after 24 hours b. Repeat US after 1 week c. Repeat BhCG after 24 hours d. Repeat BhCG after 1 week i think 150. Hepatitis B in pregnant patient screened during 32 weeks ( HbsAg +ve, HbsAb --ve, total HBc Ab +ve, HBc IgM --ve, Anti HBeAg). What to give newborn → Hep B IVIG + HepB vaccine