Med MCQs

 A 27-year old male presents with complaints of general malaise, fever, vague joint and muscle pain that have been going on for about 12 weeks. Last 4 days, he has had 2 episodes of hemoptysis and coughing spells. He claims that he has never had an appetite for food and was never able to participate in sports because he was always short of breath. He has been to many healthcare providers but no cause was ever found. On physical, his vitals are BP 160/95, P 110, RR 26 and T 99.8 F. Auscultation reveals crackles bilaterally. He has mild pedal edema. Blood work reveals elevated BUN and creatinine levels with a mild leucocytosis. The urine shows microscopic hematuria and red cell casts. The patient is admitted and referred to a nephrologist who performs a kidney biopsy. The immunofluorescence stain is shown in the image. Five days later, the patient develops massive hemoptysis and his blood pressure is 90/55. The patient’s arterial blood gas is pH 7.21, PO2 87, PCO2 50 and bicarbonate 18.3. What is your next step in the management of this patient?

A. Hemodialysis

B. Plasmapheresis

C. Immediate Thoracotomy

D. Angiographic embolization

E. Start corticosteroids IV

1. Goodpasture disease is rare cause of glomerulonephritis and may present with or without pulmonary hemorrhage

2. The key laboratory feature is the presence of circulating anti–glomerular basement membrane (anti-GBM) antibodies. This binding of antibodies can be visualized as the linear deposition of immunoglobulin along the glomerular basement membrane and, less commonly, the alveolar basement membranes, by direct immunofluorescent techniques.

3. In many studies, plasmapheresis has been shown to be beneficial in the treatment of Goodpasture syndrome by removal of anti-GBM antibodies. Plasmapheresis is usually performed after the diagnosis of Goodpasture syndrome is established either by renal biopsy or by detection of anti-GBM antibodies.

4. When a patient presents in a life-threatening situation secondary to pulmonary hemorrhage, however, plasmapheresis may be initiated if the diagnosis appears very likely, even though confirmation is not available immediately.

More MCQs

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Med & Cardiol MCQs

 A young patient is brought in by EMS after developing a syncopal episode. In the ED, the patient has regained consciousness and the vital signs are stable. The patient is unable to provide much of a history except to state that her primary healthcare provider had started her on terfenadine for her allergies. She denies any other past medical history and has no allergies. A 12-lead ECG is shown below. The astute medical student highlights what he believes is the problem area. For people who develop this syndrome in response to medications, the MOST common risk factor is?

A. Age

B. Female gender

C. Use of digitalis

D. Underlying renal dysfunction

E. Exercise

F. Fever

For answer & explanation

https://www.youtube.com/watch?v=r4pKz1yji8w

Anat & ENT MCQs

 During which of the following procedures is the nerve supply to the muscles shown in the image most likely to be damaged?

A. Biopsy of a paratracheal lymph node

B. Dissection of the parathyroid glands

C. Excision of the superior pole of the thyroid gland

D. During surgical excision of a thyroglossal duct cyst

E. Tracheostomy

F. Excision of the lower parathyroid glands

Answer C

1. The cricothyroid muscles are innervated by the superior laryngeal branch of the vagus nerve. (it gives off the external branch of the superior laryngeal nerve)

2. The cricothyroid muscles tense the larynx during phonation. The muscles are attached to the  anterolateral aspect of the cricoid and the inferior cornu and lower lamina of the thyroid cartilage. Their action causes the thyroid to tilt forward and tense the vocal cords.

3. The external branch of the superior laryngeal nerve is at risk for injury when undertaking surgery on the superior pole of the thyroid. It is here that the superior thyroid vessel is ligated and the nerve is very close by

4. Injury to the superior laryngeal nerve can result  in voice fatigue, lowered voice fundamental frequency, lowered voice projection, and inability to achieve high-frequency sounds.

More MCQs

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Surg & Med MCQs

A 65-yo male is being worked up for an elective umbilical hernia repair and found to have the following vascular disorder (See image). He is a smoker, has hypertension, diabetes, gout, eczema, and arthritis. He is on an inhaler, allopurinol, hydrochlorothiazide, and aspirin. He denies any symptoms. On presentation, his blood pressure was 165/95 with a pulse of 100. The patient is seen by the cardiologist and anesthesiologist. What is the best management for him?

A. Stent the lesion and perform umbilical hernia surgery later

B. Fix the umbilical hernia and only perform the vascular problem if patient has symptoms

C. Start him on beta blockers and perform elective surgery for the umbilical hernia

D. Do not fix the umbilical hernia

For answer & explanation-

https://www.youtube.com/watch?v=r4pKz1yji8w

Surg & Med MCQs

 A 28-year-old female presents with 2 episodes retching and vomiting of bright red blood over the past 12 hours. She undergoes immediate endoscopy and following is noted (see image). The CXR is clear and her abdominal exam is otherwise unremarkable. Which of the following blood work is recommended in the patient?

a. Prothrombin time

b. Urine HCG

c. White cell count

d. Platelet count

e. Renal function

f. Partial prothrombin time

g. INR

1. Any adolescent female who presents with a diagnosis of Mallory Weiss tear, should have a urine HCG to rule of pregnancy. 

2. Hyperemesis gravidum is a common cause of Mallory Weiss tear. 

3. If the female is pregnant, the treatment selected should be safe for the mother and the fetus

4. In most cases, Mallory Weiss bleeding stops spontaneously

More MCQs

https://www.youtube.com/watch?v=oAbFL1MaWsE&t=11s