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

Clinical Case: Throat Infection

 Q1. A 15 yo presents with a 5-day history of a sore throat, fatigue and malaise. Because of the throat discomfort, he has not been able to eat solid foods. On exam he has a temp of 100.4F and the image of his oropharynx is shown. He has moderate cervical lymphadenopathy. The abdominal exam reveals dullness to percussion in traube space. Your most likely primary diagnosis is?

a. Strep throat

b. Infectious mononucleosis

c. Scarlet fever

d. Peritonsillar abscess

e. Diphtheria

For the rest of the MCQs on this case and answer

https://youtu.be/Yjl0XKGE1QY

 A 54 year old female with a BMI of 25.9 comes for her regular hypertension clinic visit. Today, blood work reveals an HbA1c of 8.7 (normal less than 6.5). Over the past 4 months she has gained 22 pounds and 3 weeks ago she sustained the injury (shown in the image) after a minor fall. Her blood pressure is 155/90, P 90, RR 14 and T 98.7. 

At the moment she is on enalapril, furosemide and diltiazem. What is the next step in her management?

A. Send her for a bariatric consult

B. Order a 24 hour urine cortisol test

C. Refer to physical therapy for an exercise plan

D. Refer to an endocrinologist for management of blood glucose

E. Send urine for metanephrines

F. Dietary consult

Answer B

1. The patient has all the features of excess corticosteroids including Colles fracture as a result of osteoporosis. 

2. The most common endogenous cause of Cushing's syndrome is Cushing's disease. Frequent clinical findings include weight gain, truncal obesity, striae, hypertension, glucose intolerance and infections. 

3. The best screening test for Cushing's syndrome is a 24-hour urine collection with analysis for urinary free cortisol excretion. 

4. Low-dose and high-dose dexamethasone suppression tests, corticotropin assays, a corticotropin-releasing hormone stimulation test and inferior petrosal sinus catheterization may be required for a definitive diagnosis.

More MCQS-

https://www.youtube.com/watch?v=KV0dvDFecq4

Anatomy & MSK MCQs

 A patient suffers a traumatic fracture of the surgical neck of the humerus which was conservatively treated. He presents two months later with weakness in his arm. From the image, which of the following muscles will have undergone atrophy?

A

B

C

D

E

Answer E

1. A supraspinatus B infraspinatus C Subscapularis D Teres major E teres minor

2. The axillary nerve or the circumflex nerve is a nerve of the human body, that originates from the brachial plexus (upper trunk, posterior division, posterior cord) at the level of the axilla (armpit) and carries nerve fibers from C5 and C6. The axillary nerve travels through the quadrangular space with the posterior circumflex humeral artery and vein to innervate the deltoid and teres minor.

3. During humeral neck fracture, the axillary nerve can be damaged. Evaluation should begin with inspection of the soft tissues and skin, as elderly patients are susceptible to poor wound healing. A full neurologic examination can be difficult following trauma, but function of the fingers, wrist, and elbow can often be evaluated. 

4. Axillary nerve innervation of the deltoid needs to be tested as reverse shoulder arthroplasty (RTSA) is a viable treatment option that requires an intact and innervated deltoid. The axillary nerve also innervates Teres Minor

More MCQs at

https://www.youtube.com/watch?v=KV0dvDFecq4

Surgery & Anatomy MCQs

During surgery on the aorta, the following anatomical anomaly is observed during the dissection (see the CT scan). The most important aspect of this finding for the surgeon is:

A. Look for the ureters

B. Divide the kidneys evenly

C. Assess the vascular supply

D. Send the urine for metanephrines

E. Remove all stones from the renal pelvis

For answer

https://www.youtube.com/watch?v=Pf7y1xasrxY