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

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