Paper 1 - 2024 June Medicine Past Paper PDF

### **[Paper 1 - 2024 June - 80 QSTS]** Medicine (40) Paediatrics =========== 1. 16 year old boy, brown urine. Nil dysuria, abdo pain, or flank pain. He ran his first marathon last week. What is the cause of his discoloured urine? a. **Myoglobinuria** b. Haemoglobinuria...

### **[Paper 1 - 2024 June - 80 QSTS]** Medicine (40) Paediatrics =========== 1. 16 year old boy, brown urine. Nil dysuria, abdo pain, or flank pain. He ran his first marathon last week. What is the cause of his discoloured urine? a. **Myoglobinuria** b. Haemoglobinuria c. ? d. IgA nephropathy e. Classic history of myoglobinuria points towards rhabdomyolysis and includes the triad of weakness, muscular pain, and dark urine. **a. Myoglobinuria** **Reasoning:** - **Exercise-Induced Myoglobinuria**: After intense exercise, such as running a marathon, muscle breakdown (rhabdomyolysis) can occur, releasing myoglobin into the bloodstream. Myoglobin is filtered by the kidneys and can cause brownish discoloration of the urine. - **Symptoms and Signs**: The lack of dysuria, abdominal pain, or flank pain suggests that this is not due to an infection or kidney stone. Also, the absence of other symptoms supports myoglobinuria over hematuria. - **Hemoglobinuria**: This might present similarly, but hemoglobinuria is less commonly linked to strenuous exercise without other underlying causes. clinical signs of hemoglobinuria? **Symptoms may include:** - Abdominal pain. - Back pain. - Blood clots, may form in some people. - Dark urine, comes and goes. - Easy bruising or bleeding. - Headache. - Shortness of breath. - Weakness, fatigue. Hemolytic anemia is usually in the form of intravascular hemolysis. The most common presentation is the presence of anemia associated with dark cola-colored urine that is a manifestation of hemoglobinuria. The latter may be **Immunoglobulin A (IgA) nephropathy**- recurrent episodes of macroscopic hematuria accompanied by upper respiratory tract infections or persistent asymptomatic microscopic hematuria with or without proteinuria. Primary IgA nephropathy 1\. Gross hematuria -- Approximately 40-50% of patients present with one or recurrent episodes of gross hematuria, often accompanying an upper respiratory tract infection. These episodes can be provoked by bacterial tonsillitis or by viral upper respiratory tract infections; they may also occur in individuals who have already undergone tonsillectomy.  2. Microscopic hematuria with or without proteinuria --.^ \[(javascript:void(0);)^ 3. Nephrotic syndrome or rapidly progressive glomerulonephritis -- Less than 10% of patients present with either nephrotic syndrome or an acute, rapidly progressive glomerulonephritis characterized by edema, hypertension, and kidney function impairment as well as hematuria. 4. Acute kidney injury -- Rarely, patients develop acute kidney injury with or without oliguria. This may be due to crescentic IgAN or to heavy glomerular hematuria leading to tubular occlusion and/or damage by red cells. The latter is usually a reversible phenomenon, although incomplete recovery of kidney function may occur.^ \[(javascript:void(0);)\]^ Secondary IgA nephropathy Cirrhosis, severe liver disease, celiac disease, HIV infection, and other disorders. 2. APGAR score @ 1 and 5 min; at 1min, HR 80, baby weak crying and grunting, pale in colour. @ 5mins: strong cry, pink with blue hands, HR 120, actively moving all limbs. f. **4, 9** g. 5, 9 h. 4, 8 i. 5, 8 **At 1 minute:** - **Heart Rate**: 80 → 1 point (below 100) - **Respiratory Effort**: Weak cry and grunting → 1 point - **Muscle Tone**: No mention of active movement → likely flaccid or weak → 1 point - **Reflex Irritability**: Weak response/cry → likely 1 point - **Color**: Pale → 0 points **APGAR at 1 minute** = 1 (HR) + 1 (respiratory) + 1 (muscle tone) + 1 (reflex) + 0 (color) = **4** **At 5 minutes:** - **Heart Rate**: 120 → 2 points (above 100) - **Respiratory Effort**: Strong cry → 2 points - **Muscle Tone**: Actively moving all limbs → 2 points - **Reflex Irritability**: Strong cry → 2 points - **Color**: Pink with blue hands (acrocyanosis) → 1 point **APGAR at 5 minutes** = 2 (HR) + 2 (respiratory) + 2 (muscle tone) + 2 (reflex) + 1 (color) = **9** **Correct answer:** **a. 4, 9**  3. A 12 year old boy with complains of bilateral Gynecomastia. He says is is ashamed to perform activities like swimming which require him to take his shirt off. On examination , there is a small 3cm, mobile, tender, firm subaerolar lump, Sexual maturity Grade 3. Treatment: j. **Reassure that it's self limiting and follow up** k. Bromocriptine l. Refer for mammoplasty m. Refer for Therapy 4. 7 year old Girl with [cough] that became productive. Fairly well otherwise. Chest xray showed bilateral diffuse consolidation. What to treat with? n. **Azithromycin** (answer - mycoplasma pneumonia, Dr Fernandes review session) o. Amoxicillin p. Cef or something q. Levofloxacin 5. 6 year old Child with **SVC compression symptoms (distended neck veins),facial edema and dyspnea. Chest xray showed widened mediastinum** and **hilar lymphadenopathy** I believe. What does he have? r. Enlarged thymus s. **Non hodgkin lymphoma** t. neuroblastoma u. Vascular malformation **Its non hodgkin lym phoma... its a child.... THYMOMAS occur in adults...**. But it just says enlarged thymus. I think answer is A. It also says hilar lymphadenopathy No. A is the answer. Dont think the question had lymphadenopathy? Children can get enlarged thymus in infections or autoimmune disease The most likely diagnosis for a 6-year-old child with symptoms of SVC (superior vena cava) compression (distended neck veins, facial edema, dyspnea) and chest X-ray findings of a widened mediastinum and hilar lymphadenopathy is: **b. Non-Hodgkin Lymphoma** **Reasoning:** - **SVC Compression Symptoms**: SVC syndrome can occur when a mediastinal mass compresses the SVC, which is commonly seen in pediatric malignancies. - **Widened Mediastinum and Hilar Lymphadenopathy**: These findings are classic for lymphomatous processes, particularly Non-Hodgkin Lymphoma in children, which often presents with a mediastinal mass. - **Other Options**: - **Enlarged Thymus**: A normal thymus in children can appear prominent on X-ray, but it typically doesn't cause SVC syndrome or hilar lymphadenopathy. - **Neuroblastoma**: This can occur in the mediastinum but is more commonly found in the adrenal glands or along the sympathetic chain. It rarely causes SVC syndrome. - **Vascular Malformation**: Unlikely to present with hilar lymphadenopathy or a widened mediastinum in this context. There are three major types of non-Hodgkin lymphoma found in children: - **Mature B cell lymphoma** involves the B lymphocytes of the immune system. These lymphomas make up about 40 percent of non-Hodgkin lymphoma cases. There are two slightly different forms of mature B cell lymphoma seen in children, Burkitt's lymphoma  (BL) and Diffuse Large B Cell Lymphoma  (DLBCL). Children with this type of non-Hodgkin lymphoma usually have enlarged lymph nodes in the throat, neck or in the abdomen. . - **Anaplastic Large Cell Lymphoma (ALCL)** . This lymphoma can occur in lymph nodes or glands, but also can occur in other body areas such as bones or organs. ALCL is also sometimes seen as a rash or lumps in the skin. - **Lymphoblastic lymphoma (LL)** . This lymphoma can involve either T cells or B cells. LL can cause swollen lymph nodes or glands in any part of the body. Some children with LL may have very swollen nodes that form a large mass in the center of the chest (an area called the mediastinum). LL can also invade the bone marrow or spinal fluid. 6. Child presents to dermatology clinic with patches of hair loss and postauriculsr lymphadenopathy \[same pic as this) h v. **Tinea Capitis** w. SLE x. Sebhorric Dermatitis y. Psoriasis 7. Production of GnRH from the hypothalamus during puberty causes what to be released from pituitary gland A. **FSH + LH** B. Androgen Somethin in C. Prolactin and Vasopressin D. Growth Hormone and Prolactin Prolactin release is stimulated by suckling, IL-1β, IL-2, IL-6, oxytocin, serotonin, and thyrotropin-releasing hormone Adrenal androgens increase in response to ACTH stimulation, while androgens do not influence the ACTH secretion. Also, LH stimulates theca cells of the ovaries to secrete androgens; however, there is no feedback regulatory loop that controls androgen secretion in women.13 May 2024 Growth-hormone-releasing hormone (GHRH, somatoliberin) is the hypothalamic peptide hormone that specifically stimulates synthesis and release of growth hormone (GH, somatotropin) by somatotrope cells of the anterior pituitary gland. 8\. Child who had ascending weakness and no reflexes in lower limb. They gave a table with value and LP showed elevated protein but negative gram stain. A. **GBS** B. Viral Meningitis\-- C. D. Transverse Myelitis Transverse myelitis (TM) is an inflammatory disease of the spinal cord. It almost always begins after a child is sick with a viral infection. Damage to the spinal cord causes weakness, paralysis, numbness, problems with urination, and pain. Children usually recover after weeks or months but may have lasting symptoms.  History [Guillain-Barré syndrome](https://emedicine.medscape.com/article/315632-overview) ) weakness and/or unsteadiness (ataxia). Weakness is a hallmark of GBS. The weakness typically starts in the legs and ascends to the arms (hence, the description progressive ascending flaccid paralysis). This progression may occur over hours to days to weeks. The weakness is usually symmetric. Pain and dysesthesias also are noted, particularly in children. Pain may be the initial manifestation in almost half of affected children. Often, onset of these symptoms is within 2--4 weeks of an illness or immunization. The preceding illness often involves fever, muscle pains, diarrhea or upper respiratory infection. Urinary retention is also noted early in the course of 10--15% of children with GBS. At the peak of illness, about half the pediatric patients with GBS may have associated autonomic dysfunction and cranial nerve (CN) involvement, and about 10--12% require a mechanical ventilator. In those with CN involvement, the facial nerve is most commonly affected, resulting in bilateral facial weakness. Subtypes of GBS - [Acute inflammatory demyelinating polyradiculoneuropathy](https://emedicine.medscape.com/article/1169959-overview)  characterized by an immune-mediated attack on myelin with infiltration of lymphocytes and macrophages with segmental stripping of myelin. Motor and sensory fibers are usually affected simultaneously, producing corresponding deficits. Electrophysiology shows slow nerve conduction velocity and prolonged F waves. - [Acute motor axonal neuropathy](https://emedicine.medscape.com/article/1173756-overview) (AMAN) - axonal degeneration occurs by immune attack within 1--2 weeks after infection. Specific antibodies to axonal membranes of motor fibers attack the nodes of Ranvier. This, in turn, activates complement and intrusion of macrophages into periaxonal space, resulting in destruction of axons. *C jejuni* is the most common preceding infection, and antiganglioside antibodies are usually found in this type. Electrophysiology shows reduction in muscle action potentials with relatively preserved motor nerve conduction velocity and normal sensory nerve action potentials and F waves.^ \[(javascript:void(0);), (javascript:void(0);)\]^ - Acute motor and sensory axonal neuropathy (AMSAN) - - Miller-Fisher syndrome (MFS) - The involvement of CNs is very distinct in this form of GBS. Ocular motor nerves (oculomotor, trochlear, and abducens) are affected and produce a triad of ophthalmoplegia, ataxia, and areflexia. - Polyneuritis cranialis - This is an acute onset of multiple CN palsies (usually bilateral CN VII with sparing of CNs I and II), elevated cerebrospinal fluid protein, and slowed nerve conduction velocity with uncomplicated recovery. - Pharyngo-cervical-brachial syndrome - T - Acute pandysautonomia - Physical Examination Ascending motor weakness is noted along with areflexia in the classic form. Areflexia is a hallmark of [Guillain-Barré syndrome](https://emedicine.medscape.com/article/315632-overview) GBS. Occasionally, some of the more proximal reflexes still may be elicited during the early phase of the disease. progression from normoreflexia/hyporeflexia to areflexia is consistent with acute features of GBS. Occasionally, autonomic instability (26%), ataxia (23%), dysesthesias (20%), and cranial nerve findings (35--50%), predominantly facial palsy, are noted.^ \[(javascript:void(0);)\] ^These latter findings are probably more frequent in children Leg weakness (ie, foot drop) is usually noticed first and weakness eventually involves the calves and thighs. Some children may become non-ambulatory. Weakness also may involve the respiratory muscles, and some children need respiratory support during the course of the disease. Mechanical ventilation is used until respiratory muscle function returns. The autonomic neuropathy involves both the sympathetic and parasympathetic systems. Manifestations include orthostatic hypotension, hypertension, pupillary dysfunction, sweating abnormalities, and sinus tachycardia. The clinical features of pediatric GBS differ from those of adult GBS. Pain is a more frequent complaint in children, in short intervals from disease onset to fulminant, and there is a higher incidence of bulbar dysfunction, which is a risk factor for mechanical ventilation in children. Complications of GBS \] weakness of the respiratory muscles and autonomic instability. Pneumonia, adult respiratory distress syndrome, septicemia, pressure sores, pulmonary embolus, ileus, constipation, gastritis and dysesthesias In pediatrics  intravenous immunoglobulin (IVIG)In general, the outcome of GBS is more favorable in children than in adults; however, the recovery period is long, often weeks to months Immunomodulatory therapy, such as plasmapheresis or the administration of intravenous immunoglobulins (IVIGs), i 9\. Boy with murmur, 2/6, not radiating to back, upper left sternal border, fixed split S2 A. Pulmonary stenosis B. **ASD** C. VSD D. Innocent murmur VSD pansystolic, best heard in the left lower sternal border. The murmur is harsh and loud in small defects, while in large defects, it tends to be softer and less intense. Handgrips increase afterload, intensifying the murmu left-to-right shunt and cause dyspnea with feeding and poor growth during infancy. A loud, harsh, holosystolic murmur at the lower left sternal border is common. Innocent murmur: Soft, blowing, low-pitched systolic ejection murmur, grade 1 to 3/6, usually heard best over the left upper sternal border and may radiate to the back and axilla. Pulmonic stenosis is very similar to that of aortic stenosis. It is a midsystolic high-pitched crescendo-decrescendo murmur heard best at the pulmonic listening post and radiating slightly toward the neck, however the murmur of pulmonic stenosis does not radiate as widely as that of aortic stenosis. Chest pain: Shortness of breath: Fainting 10\. Child w bloody stool, pain relieved on passing stool, waking up at night to pass stool, tenesmus, loose fitting clothes. No family history of IBD, no parasites etc basically all infective causes were ruled out. What do you do to diagnose? A. Ct B. **Upper Endoscopy and colonoscopy** C. Barium enema D. Abdo USS Irritable bowel syndrome is a disorder of the digestive tract that causes recurring abdominal pain and constipation or diarrhea. IBS is a disorder of the movement of the intestines, the sensitivity of the nerves of the intestines, or the way in which the brain controls some of these functions. However, although the normal functioning is impaired, there are no structural abnormalities that can be found with an endoscope (a flexible viewing tube), imaging studies, biopsies, or blood tests. Thus, IBS is identified by the characteristics of the symptoms and, when done, normal results of tests. Symptoms of IBS include abdominal pain related to or relieved by having a bowel movement (defecation). The abdominal pain is associated with a change in stool frequency (such as constipation or diarrhea) or consistency (loose or lumpy and hard). The pain may come in bouts of continuous dull aching or cramps, usually over the lower abdomen. Symptoms of IBS can also include abdominal expansion (distention), mucus in the stool, and the sensation of incomplete emptying after defecation. Bloating, gas, nausea, headaches, fatigue, depression, anxiety, muscle aches, problems with sleep, and difficulty concentrating are other possible symptoms. Ultrasonography of the abdomen or other imaging studies of the intestines, in people who have symptoms that are unusual for IBS, such as fever, bloody stools, weight loss, and vomiting. Colonoscopy usually is done in people over 45 years of age to rule out tumors or polyps in the large intestine. 11\. Stem basically hinting that child had bacterial sinusitis that developed into an orbital abscess, something so, just check the ENT slides. What test to confirm diagnosis: A. **CT of sinuses and orbit** (this is the answer I believe) B. Culture of the nasal discharge? C. MRI sinuses & orbit D. Other stuff Fasting reastfeed child timt to wait for surgery 12\. A 2 day old baby is found to be jaundiced. Mother B positive and is breastfeeding but complains that she is not making a lot of milk.Baby is otherwise asymptomatic. Jaundice due to? Sore nipple A. **breastfeeding jaundice** B. breast milk jaundice C. ABO incompatibility D. G6PD deficiency Suboptimal intake jaundice, also called breastfeeding jaundice, first week of life when breastfeeding is being established. Newborns may not receive optimal milk intake. This leads to elevated bilirubin levels due to increased reabsorption of bilirubin in the intestines. Breast milk jaundice is a type of jaundice that occurs in neonates due to breastfeeding. It happens within the first week of life due to the abnormal accumulation of bilirubin, causing a yellowish discoloration to the neonate\'s skin known as jaundice. If jaundice is seen after the first week of life in a breastfed baby who is otherwise healthy, the condition may be called \"breast milk jaundice.\" At times, jaundice occurs when your baby does not get enough breast milk, instead of from the breast milk itself. This is called \"breastfeeding failure jaundice.\" breast milk [neonatal jaundice](https://emedicine.medscape.com/article/974786-overview) associated with breastfeeding that is characterized by indirect hyperbilirubinemia in an otherwise healthy breastfed newborn that develops after the first 4-7 days of life, persists longer than physiologic jaundice, and has no other identifiable cause.^ \[(javascript:void(0);), (javascript:void(0);), (javascript:void(0);)\]^ Breast milk jaundice should be differentiated from *breastfeeding jaundice*, which manifests in the first 3 days of life, peaks by 5-15 days of life, disappears by week 3 of life, and is caused by insufficient production or intake of breast milk.^ \[(javascript:void(0);)\] ^In contrast to babies with breast milk jaundice, infants suffering from breastfeeding jaundice generally exhibit mild dehydration and weight loss in the first few days of life.^ \[(javascript:void(0);)\]^ 13\. \\ does he have? A. B cell deficiency- can it also not be this?? B. T cell deficiency C. **Complement def (Yes complement C6 deficiency leads to recurrent men.)- from Dr Singh's slides** D. Phagocytic def 14\. A post menopausal woman is on hrt. What is she not at risk of: a. **Colon cancer** b. Breast cancer c. Deep vein thrombosis d. Endometrial cancer Increased risk of uterine cancer: Increased risk of heart disease if you begin using HRT 10 years after menopause starts. Increased risk of blood clots and stroke. There is strong evidence that using HRT raises a woman\'s risk of breast, ovarian and uterine cancers. At the same time, it may lower the risk of colorectal cancer. Combined HRT for menopause is a known cause of breast cancer, mainly in women who recently used or are still using the therapy. HRT is thought to be more physiological (closer to how the body is meant to function) and in the long-term may have a more beneficial effect on blood pressure when compared with the COCP. Hormone replacement is normally recommended until the average age of the natural menopause (around 52 years of age) 15\. Child with kawasaki features described. What is the most important investigation? a. ECG b. **Echocardiogram** c. CSF analysis d. FBC Community Health ================ 16\. Most effective action for health promotion z. **Consult with patients on their determinants and advice accordingly** a. Have focus groups to motivate patients b. Make sure everyone gets a health education session the follow up What is action for health promotion? healthy public policy, create supportive environments for health, strengthen community action for health, develop personal skills, and re-orient health services) and three basic HP strategies (to enable, mediate, and advocate). 17\. Patient is being counseled on possible drugs and their side effects. Doctor explains risks and asks what option she prefers. What relationship between doctor and patient in this scenario? (I think the stem was that the doctor ran out of possible treatment options and asks the patient for their input :/. No this was not part of the stem lol) a. **Mutualism** b. Paternalism c. Consumerism d. Professionalism In a healthcare context "paternalism" occurs when a physician or other healthcare professional makes decisions for a patient without the explicit consent of the patient. The physician believes the decisions are in the patient\'s best interests. 18\. Pt. has to do a surgery and has to sign their consent form. This is in keeping with which of the following: (Something so) A. **Autonomy** B. Justice C. Beneficence D. Fidelity Psychiatry ========== 19\. Young man lives with mother and brother. lost his part time job 2 years ago. No fulfilling employment since then. Six months ago hearing things on social media, hearing stuff. The newscasters on tv and social media he believes were talking about him. He came to ED for breaking tv radio phone in acute rage. What treatment? a. **Clonazepam- he has psychosis and needs to be sedated due to erratic behaviour.** Yeah this was tricky bc did they want acute management or long term management- they asked for immediate i think b. Fluoxetine c. **Aripiprozole ( onset 1 to 2 weeks) ( Atypical anti pschotic)** d. Bispirone Clonazepam onset approximately 20-60 minutes Fluoxetine: Anti depresant treat depression, obsessive-compulsive disorder (SSRI) Buspirone: Anxiety disorders or in the short-term treatment of symptoms of anxiety. anxiolytics. 20\. Man lost his job and his wife left him around the same time. He was depressed for about 1 week.For a week he had delusions and hallucinations. Once he got a job interview symptoms went away. What did he have? Stem sounded like an adjustment disorder but it wasn't an option. A. **Brief psychotic -** **Brief psychotic disorder: Sudden onset of psychotic behavior that lasts less than 1 month followed by complete remission with possible future relapses** B. Schizo C. MDD D. Bipolar 1: one episode lasting \> 1 week, no deprssion, increase energy, euphoria,talking quickly E. Bipolar 2: hypomina 4 days, one depressive disorder, hope less, irritable Schizophreniform disorder is characterized by symptoms identical to those of schizophrenia but that last ≥ 1 month but \< 6 months. Schizophrenia,  at least two of the following symptoms most of the time during a one-month period, with some level of disturbance being present for six months: delusions, such as a belief that a person is being poisoned. 21\. 70 something yr old man depressed, easy crying, says he did an unforgivable sin, family tried to cheer him up to no avail. 4 weeks duration A. **MDD** B. Cyclothymic disorder C. Major neurocognitive disorder - decreased mental function and loss of ability to do daily tasks. Also called dementia. D. Persistent depressive disorder Cyclothymic experience episodes of hypomania and mild depression for at least two years. euthymia), but these periods last fewer than eight weeks. PDD symptoms last for at least 2 years MDD experience depressive episodes that are separated by at least 2 months 22\. Woman with delusions of grandiosity, egotistic and lack of empathy A. **Narcissistic personality disorder** B. Histrionic - a pattern of excessive emotion and attention-seeking. People with histrionic personality disorder may be uncomfortable when they are not the center of attention, may use physical appearance to draw attention to themselves or have rapidly shifting or exaggerated emotions. C. Borderline D. Antisocial:- Failure to conform to social norms concerning lawful behaviors, such as performing acts that are grounds for arrest. Deceitfulness, repeated lying, use of aliases, or conning others for pleasure or personal profit. Impulsivity or failure to plan.  Internal Medicine ================= 23\. A man with a known bicuspid aortic valve with mitral valve regurgitation comes in but it otherwise well, and asks about prophylaxis for infective endocarditis before a dental procedure? 1. **No prophylaxis**- according to uptodate he does not need prophylaxis. Can also cross reference with amboss. 2. Amoxicillin 3. Cefrtriaxone 4. Trimethoprim-sulfa Highest risk -- Antibiotic prophylaxis is warranted for patients with conditions or implanted devices associated with the highest risk of an adverse outcome if IE occurs. Conditions associated with highest risk of adverse outcomes from IE include: Prosthetic cardiac valve or valve repair with prosthetic valve material. -Prosthetic heart valve (surgical or transcatheter) -Cardiac valve repair with prosthetic material (including annuloplasty rings or clips) Durable mechanical circulatory support device (ventricular assist device or artificial heart). Previous, relapsed, or recurrent IE. Certain types of congenital heart disease including: -Unrepaired cyanotic congenital heart disease (patients with palliative shunts and conduits are still considered unrepaired). -Completely repaired congenital heart defect with prosthetic material or device (eg, septal closure device), during the first six months after surgical or transcatheter placement. -Repaired congenital heart disease with residual defect at the site or adjacent to the site of a prosthetic patch or prosthetic device. -Prosthetic pulmonary artery valve or conduit (surgical or transcatheter; eg, Melody valve and Contegra conduit). Cardiac transplant recipients who develop cardiac valvulopathy. Left atrial appendage occlusion device, during the first six months after percutaneous or surgical placement The most common cause of endocarditis for dental, oral, respiratory tract, or esophageal procedures is S viridans (alpha-hemolytic streptococci). Antibiotic regimens for endocarditis prophylaxis are directed toward S viridans, and the recommended standard prophylactic regimen is a single dose of oral amoxicillin 24\. TB drug that Causes numbness and paraesthesia A. **Isoniazid** B. Rifampicin C. Ethambutol D. Pyrazinamide 25\. Which is incorrect? A. 1:200,000 adrenaline B. 0.01 mg/kg adrenaline for child cardiac arrest C. **0.1mg adrenaline for v fib adult - it's 1mg (1ml, 1 ampoule)** D. 0.5mg adrenaline for anaphylaxis in adultlt Medical treatment of pulseless VT usually is carried out along with defibrillation and includes intravenous vasopressors and antiarrhythmic drugs. 1 mg of epinephrine IV should be given every 3 to 5 minutes. Epinephrine can be replaced by vasopressin given 40 units IV once If the patient remains in ventricular fibrillation, pharmacological treatment should begin. Epinephrine is the first drug given and may be repeated every 3 to 5 minutes. If epinephrine is not effective, the next medication in the algorithm is amiodarone 300 mg. **PEDATRICS** The recommended IV/IO dose of adrenaline in children is 10 mcg kg^-1^ (0.1mL kg^-1^ of 1 in 10,000 solution). Subsequent doses of adrenaline are given every 3--5 minutes. Epinephrine at 0.01 mg/kg (maximum, 1 mg) as soon as vascular or intraosseous access is obtained and subsequently every 3 to 5 minutes for patients with a nonshockable rhythm. 26\. A man has HIV and DM but is non-compliant with his medications. He got insect bite on leg a few days ago. He presents with an erythematous leg lesion with swelling but non purulent. Best abx? A. Gentamicin B. **Cefuroxime??** C. Fluconazole D. Metronidazol 27\. A woman presents with acute dyspnea. On examination, there is an irregularly irregular pulse and crackles heard on auscultation. She is found to have atrial fibrillation on ECG with a heart rate of 150 bpm. Already on some meds. What medication is best to give after oxygen therapy and diresis with furosemide. A. **Bisoprolol** (rate control with beta blockers or ccb first) B. Verapamil ( CCB second line) C. Amiodarone D. Adenosine Acutely ill with A fib: hemodynamic instability (hypotension, heart failure) CARDIOVERTED Rate control: Beta blockers, CCB, Digoxin not first line anymore RHYTHM CONTROL: beta blockers contr asthma, deonedarone secondline following cardioversion Amiodarone: coexsiting heart failure Catheter ablation: If no response to meds and who wish to undergo it Anticoagulation: 4 weeks before and during ablation, CHA2DS2 score 0 to 2 months rec anticouglation, if score is \>1 long term antigulation Complicaitons: Cardiac tamponade, stroke, Pulmonary vein stenosis  28\. Man, 45 y/o reports feeling fatigued and is found to have a DVT.Blood investigations show low Hb, low MCV, low ferritin. What next investigation to do. A. **Colonoscopy** B. Echo C. ESR 29\. Picture with two ulcers on the chest that burst -pyoderma gangrenosum? What is the associated condition, previous chronic disease diagnosed 15 months ago. A. **crohns** B. TB C. Sarcoidosis D. Vasculiti 30\. Woman on metformin, sitagliptin but still hyperglycaemic. BMI 26; HbA1C: 7.5%. Urine albumin:Cr ratio \>300. Also on losartan and atorvastatin. What antihyperglycemic to add? a. Acarbose b. **Empaglifozin** Can cause hypoglycemia and weight gain) SGLT2 c. Gliclazide: Indications. Second-line treatment of type 2 diabetes, in patients over 60 years: as monotherapy, when metformin is not tolerated or contra-indicated. in combination with metformin, when glycaemic control is inadequate with metformin alone. 31\. Woman with PMHx of DM, HTN, etc had STEMI (they showed ECG), first trop was negative. Second was positive an hour later. What to do for diagnosis? (They said they saw ST segment changes in the stem so idk about NSTEMI, it looked like a STEMI) A. Repeat troponin**- you need 3 trops, he had two and only one was elevated- NO! If you have ST elevation you dont need to do this. The patient has STEMI in the vignette. This would be if there was no STEMI on ecg.** B. Echo C. **Cardiac catheterisation** D. Exercise stress test PCI) is the preferred treatment for STEMI. This includes use of balloon angioplasty and coornary stent placement to prop open the artery. PCI, patients should receive dual antiplatelet agents, including intravenous heparin infusion as well as an adenosine diphosphate inhibitor receptor (P2Y2 inhibitor), most commonly ticagrelor. 32\. A woman presented with swelling of the lower extremities. She was given diuretics which did not resolve the issue. The swelling got worse and was found to be NON-PITTING. She also has a history of constipation and weight gain. What needs to be tested? A. **TSH** B. PTH C. NT-pro-BNP D. Calcitonin Myxedema, also called thyroid dermopathy, severe or advanced hypothyroidism, low levels of thyroid hormones. increased accumulation of fluids the legs, feet, eyes, or mouth. 33\. Man had total thyroidectomy surgery and now complains of paraesthesia. Has positive trousseau. Blood tests show hypocalcemia. What is needed for IMMEDIATE management: A. Oral Calcitriol B. Subcutaneous PTH hormone replacement C. **IV calcium** D. phosphate binding  \(iv) calcitriol has greater bioavailability than oral calcitriol, it may be more efficacious in suppressing parathyroid hormone (PTH) secretion. Hypothyroidism leads to hypocalcemia Chvostek\'s and Trousseau\'s signs are both indicators of low calcium, but they manifest differently. Chvostek\'s sign is seen in the face when facial muscles twitch after the facial nerve is tapped lightly on the upper cheek, (just in front of the ear). This is caused by increased neuromuscular excitabilit Symptoms of hypocalcemia most commonly include paresthesia, muscle spasms, cramps, tetany, circumoral numbness, and seizure 34\. A diabetic patient has a history of confusion and lethargy. On examination he is found to have [suprapubic tenderness.] Patient on metformin and other dm meds. AG showed high anion gap with increased lactate. [Urinalysis showed leukocyte, nitrites.] Which medication caused it? A. **Metformin- answer** B. **Empaglifozin-** empaglifozin causes UTIs But the patient had an UTi Empaglizin increases the risk for that SGLT2i agents such as dapagliflozin increase the concentration of glucose in the urine, providing an ideal environment for colonization and growth of bacteria, which contribute to the onset of UTIs Results: SGLT-2 inhibitors present a higher risk of UTIs and fungal infections compared to metformin.5 Jun 2024 35\. Man has End stage renal disease and is on medication dialysis. He is found to have hypocalcemia. What is the cause of the hypocalcemia? A. **Deficiency of 1 alpha hydroxylase enzyme** - Needed for activation of vitamin D to help absorption of calcium therefore is the cause of hypocalcemia secondary to CKD. **This is a question from dr hoe review... the answer is A. Also A is produced by the kidney, if your kidney not working you cant make A.** B. Secondary Hyperparathyroidism C. Inadequate oral intake**-** D. Hypercalciuria Hypocalcemia in chronic renal failure is due to two primary causes - increased serum phosphorus and decreased renal production of 1,25 (OH)2 vitamin D. The former causes hypocalcemia by complexing with serum calcium and depositing it into bone and other tissues.2 Jun 2018 36\. 50 year old man with stiffness of finger joints and knee. Last an hour on waking up, relieved with use of his hands, ibuprofen helps sometimes.. X Ray showed synovitis of proximal linterphalangeal joints. Diagnosis? A. **RA** B. OA C. Fibromyalgia D. Polymyalgia rheumatica What are the X-ray findings of hands with rheumatoid arthritis? Plain radiographic findings in the hands of patients with RA may take months to develop. An early finding on x-rays is that of periarticular osteopenia, which may later be followed by more diffuse osteopenia. Soft tissue swelling due to joint effusions and synovitis can be seen early as well. Polymyalgia rheumatica is bilateral shoulder pain and stiffness of acute or subacute onset with bilateral upper arm tenderness. Patients often develop concomitant hip girdle pain and stiffness, as well as pain and stiffness in the posterior neck musculature. Fibromyalgia: Widespread pain, constant dull ache that has lasted for at least three months. To be considered widespread, the pain must occur on both sides of your body and above and below your waist. The main physical signs of OA are coarse crepitus, joint-line tenderness, bony swelling, deformity, and reduced range of movement. Crepitus is a coarse crunching sensation or sound caused by friction between damaged articular cartilage and/or the bone. 37\. A man complains of recurrent headaches (occipital & frontal region) associated with paraspinal muscle tenderness, that occur twice per month that is worse with work related activities and stress. He takes paracetamol and does not get much relief. What is the next best Tx? A. Eletriptan B. **Ibuprofen** C. Amytriptylline D. Benzy something First-Line Medications for Occipital Neuralgia Pain\ \ Typically, the primary mode of treatment involves using nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, before moving on to prescription options or more complex procedures.2 Mar 2024 Triptans comprise a class of medications approved by the US Food and Drug Administration (FDA) as the first-line agent for treating acute migraine episodes with or without aura.2 What is amitriptyline used for? Amitriptyline is a tricyclic antidepressant that is FDA-approved to treat depression in adults. The drug is also used off-label to treat chronic pain syndrome, anxiety, and insomnia. 38\. Basal skull fracture what feature would you not seee? (Can't rem of this was p1 or 2) (I believe it\'s P1. Somsone put it in the surg section already) A. **Parietal bone fracture palpable under scalp laceration** B. CSF rhinorrhea C....Mastoid bone (battle sign) D....bilateral periorbital hematoma mass - Battle\'s sign -- bruising of the mastoid process of the temporal bone. - Raccoon eyes -- bruising around the eyes, i.e. \"black eyes\" - Cerebrospinal fluid rhinorrhea. - Cranial nerve palsy. - Bleeding (sometimes profuse) from the nose and ears. - Hemo tympanum. - Conductive or perceptive deafness, nystagmus, vomiting A. **Spironolactone** (decreases mortality in NYHA class 3 and 4) side eff hyperkalemia B. Digoxin (no effect on prognosis) C. Furosemide (no effect on prognosis, symptomatic control only) D. Amiodarone  (NYHA class II-IV HFmrEF includes the following: Use diuretics in patients with congestion and HFmrEF to alleviate signs/symptoms. An ACEI, ARB, beta blocker, MRA, or sacubitril/valsartan may be considered to reduce the risk of HF hospitalization and death.14 May 2024 WAS there a question about which artery was involved for an MI? RCA, LAD, CIRCUMFLEX??? Surgery (25) Ophthal ======= 40\. NOT a cause of painless loss of vision: a. **Acute closed angle glaucoma( painful)** b. Retinal detachment c. Central retinal vein occlusion d.  Central retinal artery occlusion 41.What does NOT cause ptosis A. Lid oedema B. **Cranial nerve 7 palsy( bell palsy drying of eye, hence eye lid weights)** C. Horner's ( ptosis, miosis, and anhidrosis.) D. Marcus Gunn Jaw winking syndrome (RAPD)v Marcus Gunn Jaw winking syndrome (MGJWS) is one of the congenital cranial dysinnervation disorders (CCDD) and these individuals have variable degrees of blepharoptosis in the resting, primary position. It is associated with synkinetic movements of the upper eyelid during masticating movements of the jaw.  ENT === 42\. **38yr old man complains about loss of hearing in his left ear.** Rinne positive on right and negative on left (both unmasked), weber lateralizes to right. **according to Dr Fundora's slides which is where this exact stem is from, it's a profound left sensorineural hearing loss with a false negative Rinne's (see second photo attached from slides). So the stem did not have an error. The only error was that there was left sensorineural hearing loss twice as an option.** a. Right conductive hearing loss -**.** b. Left conductive hearing loss c. **Left sensorineural hearing loss** (they had 2 of these :D) - answer  A screenshot of a computer Description automatically generated  A chart with text and images Description automatically generated with medium confidence Anaes ===== 43\. A patient was given a non-depolarising Muscle relaxant. What drug is used for reversal? a. **Neostigime** **Neostigmine** is a cholinesterase inhibitor used in the symptomatic treatment of myasthenia gravis by improving muscle tone or succlycholne b. Flumazenil ( reversal benzodiazepine) Signs and symptoms. Symptoms of BZD **overdose** may include the following: Dizziness. Confusion. Drowsiness. Blurred vision. Unresponsiveness. c. Atropine( organophosphate reversal) child in farm or eat sum N=Acyltine ( paracetamol) Naloxone is an emergency medication that can reverse the effects of an overdose of opioids like heroin or methadone opioid triad? The typical symptoms seen in overdose are pinpoint pupils, respiratory depression, and a decreased level of consciousness. This is known as the "opioid overdose triad." Opioids may be agonists, partial agonists, or agonist-antagonists of opioid receptors. IV drug abuse is most commonly associated with heroin, opioids, meth, and cocaine Flumazenil is a benzodiazepine antagonist typically used in overdose emergencies. **Benzodiazepine overdose symptoms** - Extreme drowsiness or being unable to stay awake. - Confusion and cognitive impairment. - Slurred speech and difficulty speaking. - Unsteady or impaired co-ordination. - Muscle weakness. - Shallow or slow breathing. - Blurred or double vision. - Dilated pupils. Atropine is a muscarinic antagonist used to treat poisoning by muscarinic agents, including organophosphates and other drugs. In severe organophosphate toxicity, the prototypical patient may exhibit unresponsiveness, pinpoint pupils, muscle fasciculations, and diaphoresis. Additional symptoms can include emesis, diarrhea, excessive salivation, lacrimation, and urinary incontinence. Paracetamol Over dose In severe overdose, transaminase elevation can be detected as early as 12-16 hours post-ingestion. Toxicity is defined as serum AST or ALT concentrations greater than 1000 IU/L. A rapid progression of transaminase values to 3000 IU/L or greater reflects severe hepatotoxicity. 44\. Woman with morphine overdose 30 mins ago post op. Spo2 80% and snoring. What is the next immediate best step? A. Intubate B. Supraglottic airway C. **Jaw thrust** D. Increase O2 delivery How do you treat morphine induced respiratory depression? If this is the case, oxygenation, rousing by verbal and physical stimulation and decreasing the opioid dose should be tried first. Naloxone, an opioid antagonist, should be avoided if at all possible but, if essential, titrate slowly to respiratory function administering 20--100 µg intravenously every two minutes. A supraglottic airway (SGA) is indicated for securing an airway during resuscitation of an unconscious patient. An SGA is an advanced airway technique to assist with oxygenation and ventilation. chest compressions. SpO2 80 , wouldn't the next step be to intubate????? Keevan Singh said its jaw thrust :(. did he explain why? 45\. A patient for elective cholecystectomy who takes glyburide and metformin. HbA1c was high like 7% or so (it was 6.2%). How would you manage preop? A. Admit night before for iv fluids B. Insulin sliding scale day of surgery C. **Omit oral meds day of surgery** D. Insulin subcutaneous HbA1c levels below 69 mmol/mol are considered safe for planned surgery **canagliflozin, dapagliflozin, and empagliflozin-be stopped three days before scheduled surgery and ertugliflozin stopped up to four days before surge** An HbA1c between 6% and 7% is associated with higher risks of anastomotic leaks, wound infections, major complications, and overall postoperative complications. Therefore, guidelines with an HbA1c threshold \> 7% may be putting pre-optimized patients at risk. 46\. Patient is a homeless IV drug user. They were tachycardic, sweaty, hypertensive, anxious with needle track marks on arm something with dilated pupils. Had a seizure in A&E. What did they overdose on? A. **Amphetamine: A toxicity tachycardia, hypertension, impulsivity, aggression, serotonin syndrome, psychosis, and seizures, underscoring the complexity of its clinical manifestations.** B. Cannabis C. Pethidine-ophiod D. Phenytoin The patient most likely overdosed on **Amphetamine (Option A)**. Here\'s the reasoning: - **Symptoms**: Tachycardia, sweating, hypertension, anxiety, dilated pupils, and seizures are consistent with stimulant overdose, particularly amphetamines. - **IV drug use**: While IV use does not confirm a specific drug, it is common with amphetamines among certain populations. - **Cannabis (Option B)**: Overdose on cannabis typically doesn't present with the intense sympathetic symptoms (tachycardia, hypertension, dilated pupils) and seizures that the patient is experiencing. - **Pethidine (Option C)**: As an opioid, overdose would more likely cause pinpoint pupils and respiratory depression, not the sympathetic overstimulation seen here. - **Phenytoin (Option D)**: Phenytoin toxicity can cause nystagmus, ataxia, and seizures, but it would not typically result in tachycardia, hypertension, or dilated pupils. The neurotoxic effects are concentration-dependent and can range from mild nystagmus to ataxia, slurred speech, vomiting, lethargy, and eventually coma and death. Paradoxically, at very high concentrations, phenytoin can lead to seizures. Symptoms correlate well with the unbound plasma phenytoin concentration. 47\. Which of the following is not a characteristic of compartment syndrome: a. Immediate tx is fasciotomy b. **More common in open than closed fractures (closed fracture plus with cast on)** c. Pain disproportionate to presentation d. Harder to diagnose in ICU patients  48\. A 12 year old child has pain in the anterior thigh and right knee which started 3 months ago but progressively worse over the past 2 weeks. He now is unable to ambulate without crutches. Parents noticed increased external rotation of the limb. Which is the best diagnosis? a. **SUFE** b. Perthes- c. blount's disease  characteristic of Blount\'s Disease is the varus of the knee, a deformity in which the knees bow outward in relation to the pelvis. This deformity is also referred to as Bow Leg Deformity Classically, Blount disease has been described as occurring in two distinct forms: early-onset (or infantile) disease and late-onset (or adolescent) disease. Early-onset Blount disease is diagnosed at age 1-3 years, presenting when a child begins to ambulate; it is less commonly associated with obesity and is often bilateral. Late-onset Blount disease has been further subcategorized into juvenile, occurring at age 4-10 years, and adolescent, occurring at older than 10 years. Blount disease occurring in older children is more commonly seen in association with obesity and is more often unilateral. \[7, 8\] Conservative treatment early-onset Blount disease and consists of brace treatment. In late-onset patients and early-onset patients in whom brace management fails, operative intervention is indicated for increasing severity of symptoms or progression of deformity. \[3\] 49\. Person had adducted internally rotated and flexed hip. Could not dorsiflex ankle. Cause? A. **Sciatic nerve injury ( pain shoot radiates down leg-, pain coughing sneezing,) Stright leg raise +ve** B. Femoral nerve injury C. Lisfranc fracture (Tarsometatarsal fracture) disruption of cuneiform and base of seocnd metatarsal( Tx operative ORIF or Arthrodesis) D. ankle fracture dislocation Sciatica affects back of leg more than front. Pain worse flexion lumbar spine. Innervates 4 hamstring muscles and short head of biceps femoris muscle along back of thigh. Tibial branch derived from L5,S1,S2 and S3 spinal nerves Femoral nerve injury: Ex- Weakness of the quadriceps muscle and decreased patellar reflex. Chronic see wasting of muscle. If reperoneal hematoma hip extension cause pain. Thigh abductors spared innervated by sciatica and obstructor nerve. 50. Patient got shot in the lateral leg, thorax and anterior chest. Had 5/5 power in upper limbs 0/5 lower limbs. What is the likely site of lesion? A. **Spinal cord (ans)** B. Peripheral nerve C. Muscle D. NMJ Thoracic Injury: Loss sensation in and paralysis of muscles from upper chest, mid back and abdomen down to toes. The cervical and thoracic regions of spinal cord injured. Gen Surg ======== 51\. Female has a BMI \>30, with symptoms of GERD. Which is not an appropriate treatment option? a. PPI b. Weight loss c. **Heller myotomy( muscle in cardia (LES)cut allow liquid to pass to stomach for Achalasia)** d. Nissen fundoplication After Heller myotomy a Nissen fundoplication performed prevent GERD from development For GERD symptoms of heartburn, regurgitation without any alarm symptoms, an 8-week trial of OD premeal empiric PPI is recommend Overweight or obese weight loss rec to improve symptoms. Treatment with PPI rec over histamine-2- receptor antagonist for both healing and PPI taken 30-60min before meal rather than bedtime Refractory GERD optimsie PPI Surgical and endoscopic options Antireflux surgery for sever reflux esophagitis Consider magnetic sphincter augmentation MSA as an alternative to lap fundoplication in sting of regurgitation that failed med mgx Medical MGX; PPI: Omeprazole(Prilosec), Esomeprazole(Nexium) Potassium- competitiv Acid Blockers:Vovoprazon insicated for relief of heartburn with nonerosive gastro reflux. H2RAs antagnosit: Cimetidine, Famotidine and Nizatidine Ranitidine(Zantac) 52\. 45 year old man with DVT. Labs showing microcytic anemia. Next investigations A. **Colonoscopy( every 10 years for no risk of colon ca.)** B. Echocardiogram US preventive tast force Adults age 45-75 screened for colorectal cancer May need testing \50% intramural A. 1 B. **2** C. 3 D. 4 Presentation: heavy prolong bleeding, painfuil periods, dyspnoea, easy fatigue,palpations,headachs,orthopenea,faiting Red deneration:in preg and causes obstruction Subserious fibriod- infertility and reccurance of spontanous abortion. Ex: Mass arising from pelvis, differential full bladder, pregnancy, ovarian tubal mass, check lungs, breast, hepatomegaly ascities, mass zize, mobility, character, get below it if moves with cervix on bimanual abdo/vaginal examingitng. Abdo-rectal bimanual ex in virgo intacta patient Investigation- CBC( anemia, thrombocytosis and polycythemia, urea ,cr, electrlytes, Ca 125. US r/o uterioc obstruction and ovarian mass. Asyptomatic no tx. Conservative tx- Anaglesics, iron replacement, Depo provea,Gnrha shrink firbriod, given only 3 to 6 monthscauses osteoporisi. 1 year stop reccure Myomectomy:usterus left intact via hysteroscopy for submucous, laparoscopy for subserous fibriods and laprotomy all tymes Complication myomectomy:bleeding, adhesions,infertility Completed familiyy: hysterectomy total or sub total abdo, laparotomy or lasproscpic 77\. What does the E in PALM-COEIN stand for? A. Endometrial cancer B. Endometrial polyp C. **Endometritis** D. Endometrial hyperplasia Link to: [[Paper 2 - 2024 June]](https://docs.google.com/document/d/150ggh6BAqdQ6xFYEXbQeWqpbbWXF_Km8ObleIPrjP1g/edit#heading=h.skofk2vg7iq4) [[Paper 3 - 2024 June]](https://docs.google.com/document/d/1bPVnWaQbyXfEGoJitXKOyARsZ27-2LvFG6y0p5JVKu4/edit#heading=h.skofk2vg7iq4) [[Paper 4 - 2024 June]](https://docs.google.com/document/d/1TV7-_1FRidkfLq-agaJRolWCCRgfCOtND3Xma0aJaGU/edit#heading=h.dskqd6t6938a) Certainly! Here's a summary of the key **USPSTF (U.S. Preventive Services Task Force)** guidelines you should know for your MBBS exam. The USPSTF provides evidence-based recommendations on a wide range of preventive health services, including screening, counseling, and preventive medications. **1. Breast Cancer Screening** - **Start Age**: 50 years (for average-risk women) - **Frequency**: Every **2 years** (biennial screening) - **Age Range**: Women aged **50--74** years - **Note**: Women aged **40--49** may choose to start screening after discussing potential benefits and harms with their doctor. **2. Cervical Cancer Screening** - **Start Age**: 21 years - **Frequency**: Every **3 years** with **Pap smear** (for women aged 21--29 years) - **For women aged 30--65**: Pap smear **every 3 years** or Pap smear with **HPV testing** every **5 years**. - **Stop Age**: Screening can stop at age **65** if the woman has had regular screening with normal results, or if she has had a hysterectomy. **3. Colorectal Cancer Screening** - **Start Age**: 45 years (for average-risk individuals) - **Frequency**: - **Stool-based tests** (e.g., FIT, stool DNA): Annually - **Colonoscopy**: Every **10 years** - Other methods: Flexible sigmoidoscopy, CT colonography every **5 years** or annually with FIT. - **Stop Age**: Screening can stop at age **75**, or earlier if life expectancy is less than 10 years. **4. Lung Cancer Screening** - **Eligibility**: Adults aged **50--80 years** who have a **30-pack year history of smoking** and currently smoke or have quit within the past 15 years. - **Frequency**: **Annual** screening with **low-dose CT scan**. - **Stop Age**: Discontinue screening if the individual has not smoked for 15 years or has a health problem that limits life expectancy. **5. Hypertension Screening** - **Start Age**: 18 years (for all adults) - **Frequency**: At least **every 2 years** if BP is normal, or annually if BP is elevated. - **Blood Pressure Threshold**: A diagnosis of hypertension is made when BP is ≥140/90 mm Hg. **6. Diabetes Screening** - **Start Age**: 35 years (for adults with **overweight or obesity**, or those with **hypertension**) - **Frequency**: Every **3 years** for adults aged **35--70** who are overweight or obese, or if they have other risk factors. - **Test**: **Fasting glucose**, **HbA1c**, or **oral glucose tolerance test**. **7. Cholesterol Screening (Lipid Screening)** - **Start Age**: - **Men**: At age **35 years** for all men - **Women**: At age **45 years** for women at increased risk of cardiovascular disease. - If risk factors (e.g., hypertension, smoking, diabetes) are present, screening may start earlier. - **Frequency**: Every **5 years** for adults aged **40--75**. **8. Osteoporosis Screening** - **Start Age**: 65 years for women - **Frequency**: Once (for women aged 65 or older) - **Risk Factors**: Women under 65 should be screened if they have risk factors (e.g., low body weight, smoking, history of fractures). - **Test**: **Bone density test** (DXA scan) **9. Hepatitis C Screening** - **Start Age**: One-time screening for adults aged **18--79 years**. - **Risk Factors**: Individuals with a history of injection drug use, recipients of blood products before 1992, or with HIV infection. **10. Skin Cancer (Melanoma) Screening** - The USPSTF **does not recommend** routine skin cancer screening for the general population. - However, **high-risk individuals** (e.g., those with a personal or family history of skin cancer) should be evaluated for early signs of melanoma. **11. Prostate Cancer Screening** - **Start Age**: The USPSTF recommends **no routine screening** for prostate cancer in asymptomatic men of average risk. - **Exceptions**: If a man expresses a preference for screening after discussing potential risks and benefits, screening with a **PSA test** may be considered starting at age **55** and continuing through age **69**. **12. HIV Screening** - **Start Age**: All individuals aged **15--65 years** should be screened at least once. - **Frequency**: Higher-risk individuals (e.g., those with multiple sexual partners or a history of injecting drugs) should be screened more frequently, ideally annually. **13. Depression Screening** - **Start Age**: All **adults** (aged 18 and older) should be screened for depression. - **Frequency**: **Annually**, especially in primary care settings. - **Test**: Use of validated screening tools such as the **PHQ-9**. **14. Intimate Partner Violence Screening** - **Start Age**: All women of reproductive age (14--46 years) should be screened for intimate partner violence, including **psychological, physical, or sexual abuse**. **15. Cognitive Impairment Screening** - **Start Age**: The USPSTF does **not recommend routine screening** for cognitive impairment (such as dementia) in asymptomatic adults, but it may be considered in those with concerns from family members. **General Tips for USPSTF Guidelines in MBBS Exams:** 1. **Know the age ranges** for screenings (start and stop ages) and when the guidelines recommend screening. 2. **Be aware of high-risk populations** for certain diseases (e.g., people with family history, obesity, smoking, or hypertension). 3. **Focus on the most common conditions**: Breast cancer, colorectal cancer, cervical cancer, diabetes, hypertension, and lipid screening. 4. **Be familiar with the frequency** of screenings (e.g., annually, biennially, every 5 years). 5. **Understand the rationale** behind each screening recommendation --- the USPSTF guidelines often consider the balance between potential harms (e.g., false positives, overdiagnosis) and benefits. By understanding these core guidelines, you\'ll be well-prepared for questions on preventive health services in your MBBS exams! 4o mini Top of Form Get smarter responses, upload files and images, and more. Log in Sign up Bottom of Form ChatGPT can make mistakes. Check i