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Case scenario:
A 23-year old female walks into a small-town medical clinic complaining of recent malaise, fever and chills, dry cough and myalgia.
Upon examination, she has a temperature of 38.5 C, blood pressure of 100/62 mm Hg, pulse rate of 110 beats per minute, and a respiratory rate of 38/minute. She also reports chest and abdominal pain, but no overseas travel or exposure to birds or rodents.
1. what you believe are the most likely bacterial/viral diseases and why.
2. Give your differential diagnosis of 4 diseases that this case study might be based upon.)
The doctor orders a chest X-ray and cultures her throat/nasopharynx. He also does some rapid serological tests. No diagnosis is made at this time, so he sends her home and waits for test results to decide on appropriate treatment.
When the results are called to the patient, she tells the nurse she's feeling worse, with higher fever, acute dyspnea, and cyanosis. The chest X-ray shows infiltrates and mediastinal widening. The culture shows large, box-car-like, Gram positive rods with "holes" in the center of them.
1- What disease do you now know this is? What is the etiologic agent and how was it acquired?
2- Supportive therapy is recommended during her subsequent hospitalization, but not antibiotics. Why are antibiotics ineffective at this time in the disease process?
3- What virulence factors are involved in this disease? Explain in detail what they are and how each one affects the body.
4- What other ways does this microbe enter the body? Be specific about the source of microbes (reservoirs) for each type. Describe the disease symptoms of each type.
5- Fully describe how this disease can be prevented.
6- What makes this a good weapon for bioterrorism?

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Ononomatopoeia - (say that 10 times fast) or much less encounter it on a spelling bee. By definition it's the formation of a word from a sound associated with what is named (e.g., cuckoo, sizzle ) How many of these can serve as mnemonics in medicine "Kentucky (S3) Tennessee (S4) Pericarditis Pulling Velcro. Do you bright sparks have others?

Clinic at the edge of the world is looking for physicians to join a free clinic in Guatemala

Have you been dreaming of a trip to Latin America, exotic views and new experiences? You got it! Along with meals and accomodation free of charge and a friendly team of professionals, you are offered a great opportunity to volunteer your medical skills at a free clinic. If staying for more than 9 months, travel expenses are also reimbursed.

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A 2-year-old child has been admitted to the emergency department. Antimuscarinic drug overdose is suspected.
Probable signs of atropine overdose include which one of the following?
a. Gastrointestinal smooth muscle cramping
b. Increased heart rate
c. Increased gastric secretion
d. Urinary frequency
e. Pupillary constriction

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a 3 years old child , brought by his mother after she felt a loin mass while bathing her child , he was well 6 months ago , the diagnosis of neuroblastoma was made .. mention " 4" questions you would to ask in the history ..

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Operating as usual

22/05/2020

375. A 48yo lady presents with itching, excoriations, redness, bloody discharge and ulceration around her ni**le. What is the most likely dx?
a. Paget’s disease of the breast
b. Fibrocystic dysplasia
c. Breast abscess
d. Duct papilloma
e. Eczema

22/05/2020

374. A pt presents with longstanding gastric reflux, dysphagia and chest pain. On barium e***a, dilation of esophagus with tapering end is noted. He was found with Barrett’s esophagus. He had progressive dysphagia to solids and then liquids. What is the single most appropriate dx?
a. Achalasia
b. Esophageal spasm
c. GERD
d. Barrett’s esophagus
e. Esophageal carcinoma

22/05/2020

373. A mentally re****ed child puts a green pea in his ear while eating. The carer confirms this.
Otoscopy shows a green colored object in the ear canal. What is the most appropriate single
best approach to remove this object?
a. By magnet
b. Syringing
c. Under GA
d. By hook
e. By instilling olive oil

22/05/2020

\372. A HTN male loses vision in his left eye. The eye shows hand movement and a light shined in the eye is seen as a faint light. Fundus exam: flame shaped hemorrhages. The right eye is normal. What is the cause of this pts unilateral blindness?
a. HTN retinopathy
b. CRA thrombosis
c. CRV thrombosis
d. Background retinopathy
e. Retinal detachmen

22/05/2020

371. A young man who was held by the police was punched while in custody. He is now cyanosed and unresponsive. What is the 1st thing you would do?
a. IV fluids
b. Clear airway
c. Turn pt and put in recovery position
d. Give 100% oxygen e. Intubate and ventilate

22/05/2020

370. A child living with this stepfather is brought by the mother with multiple bruises, fever and
fractures. What do you suspect?
a. NAI
b. Malnutrition
c. Thrombocytopenia
d. HIV

22/05/2020

369. A 34yo woman is referred to the endocrine clinic with a hx of thyrotoxicosis. At her 1st
appointment she is found to have a smooth goiter, lid lag and bilateral exophthalmos with puffy
eyelids and conjunctival injection. She wants to discuss the tx of her thyroid prb as she is keen to become pregnant. What is the most likely tx you would advise? a. 18m of carbimazole alone
b. 18m of PTU alone
c. A combo od anti-thyroid drug an0d thyroxine
d. Radioactive iodine
e. Thyroidectomy

22/05/2020

368. A 39yo coal miner who smokes, drinks and has a fam hx of bladder cancer is suffering from BPH. The most important risk factor for his bladder carcinoma is?
a. Fam hx
b. Smoking
c. Exposure to coal mine
d. BPH

22/05/2020

367. A 32yo woman has severe right sided abdominal pain radiating into the groin which has lasted for 3h. She is writhering in pain. She has no abdominal signs. What is the most likely cause of her abdominal pain?
a. Appendicitis
b. Ruptured ectopic pregnancy
c. Salpingitis
d. Ureteric colic
e. Strangulated hernia

22/05/2020

366. A 65yo known alcoholic is brought into hospital with confusion, aggressiveness and
ophthalmoplegia. He is treated with diazepoxide. What other drug would you like to prescribe?
a. Antibiotics
b. Glucose
c. IV fluids
d. Disulfiram
e. Vit B complex

22/05/2020

364. A 22yo sexually active male came with 2d hx of fever with pain in scrotal area. Exam: scrotal skin
is red and tender. What is the most appropriate dx?
a. Torsion of te**is
b. Orchitis
c. Inguinal hernia
d. Epididymo-orchitis

22/05/2020

363. A 66yo man has the following ECG. What is the most appropriate next step in management?
a. Metoprolol
b. Digoxin
c. Carotid sinus massage
d. Adenosine
e. Amiodarone

22/05/2020

362. A 65yo known case of liver ca and metastasis presents with gastric reflux and bloatedness. On
bone exam there is osteoporosis. He also has basal consolidation in the left lung. What is the
next appropriate step?
a. PPI IV
b. Alendronate
c. IV antibiotics
d. Analgesic
e. PPI PO

22/05/2020

361. A 55yo man has been admitted for elective herniorraphy. Which among the following can be the reason to delay his surgery?
a. Controlled asthma
b. Controlled atrial fib
c. DVT 2yrs ago
d. Diastolic BP 90mmHg e. MI 2 months ago

22/05/2020

360. A 72 yo man has been on warfarin for 2yrs because of past TIA and stroke. What is the most
important complication that we should be careful with?
a. Headache
b. Osteoporosis
c. Ear infection
d. Limb ischemia
e. Diarrhea

22/05/2020

359. A woman has numerous painful ulcers on her v***a. What is the cause?
a. Chlamydia
b. Trichomonas
c. Gardenella
d. HSV
e. EBV

22/05/2020

358. A 35yo construction worker is dx with indirect inguinal hernia. Which statement below best
describes it?
a. Passes through the superficial inguinal ring only
b. Lies above and lateral to the p***c tubercle
c. Does not pass through the superficial inguinal ring
d. Passes through the deep inguinal ring

22/05/2020

357. A 7yo child presented with chronic cough and is also found to be jaundiced on examination.
What is the most likely dx?
a. Congenital diaphragmatic hernia
b. Congenital cystic ade***atoid malformation
c. Bronchiolitis
d. RDS
e. Alpha 1 antitrypsin deficiency

22/05/2020

356. A 1m boy has been brought to the ED, conscious but with cool peripheries and has HR=222bpm.
He has been irritable and feeding poorly for 24h. CXR=borderline enlarged heart with clear lung
fields. ECG=regular narrow complex tachycardia, with difficulty identifying p wave. What is the
single most appropriate immediate tx? a. Administer fluid bolus
b. Administer oxygen
c. Oral beta-blockers
d. Synchronized DC cardio-version
e. Unilateral carotid sinus massage

22/05/2020

355. A 28yo pregnant woman with polyhydramnios and SOB comes for an anomaly scan at 31 wks.
US= absence of gastric bubble. What is the most likely dx?
a. Duodenal atresia
b. Esophageal atresia
c. Gastrochiasis
d. Exomphalos
e. Diaphragmatic hernia

22/05/2020

354. An elderly pt who is known to have DM presents to the hospital with drowsiness, tremors and
confusion. What inv should be done to help in further management?
a. Blood sugar
b. ECG
c. Standing and lying BP
d. Fasting blood sugar
e. CT

22/05/2020

352. A 53yo man presents with a longstanding hx of a 1cm lesion on his arm. It has started bleeding
on touch. What is the most likely dx?
a. Basal cell carcinoma
b. Kaposi’s sarcoma
c. Malignant melanoma
d. Squamous cell carcinoma
e. Kerathoacanthoma

22/05/2020

351. A 35yo lady presents with painful ulcers on her v***a, what is the appropriate inv which will lead to the dx?
a. Anti-HSV antibodies
b. Dark ground microscopy of the ulcer
c. Treponema palladium antibody test
d. Rapid plasma regain test
e. VDRL

22/05/2020

350. A 28yo shipyard worker was admitted for pain in calf while at work which has been increasing
over the last 3m. There is no hx of HTN or DM but he is a smoker. Exam: loss of posterior tibial
and dorsalis pedis pulsation along with a non-healing ulcer at the base of the right 1st MTP joint.
What is the most probably dx?
a. Thromboangitis obliterans
b. Sciatica
c. DVT
d. Baker’s cyst
e. Embolus

22/05/2020

349. A 68yo male presented with swelling in the lower pole of the parotid gland for the last 10yrs.
Exam: firm in consistency. What’s the most probable dx?
a. Pleomorphic adenoma
b. Adenolymphoma
c. Mikulicz’s disease
d. Parotiditis
e. Frey’s syndrome

22/05/2020

348. A 56yo woman with MS presents with drooping of the left side of her lips. She also has loss of
sensation over her face, hearing impairment and some in-coordination of her movements. What
is the most likely anatomical site affected?
a. Cerebellum
b. Cerebrum
c. Spinal cord
d. Brain stem e. Optic nerve

22/05/2020

347. A 57yo woman who is suffering from HTN, presented to the hospital with complaints of
recurrent falls when trying to get out of bed or getting up from sitting. She is on some anti-HTN
therapy with no other med prbs. What is the cause of her fall?
a. CCB
b. Vertibrobasiliar insufficiency
c. Thiazide
d. Hypoglycemia
e. Infection

22/05/2020

346. A child was admitted following a RTA with initial GCS=15. Then during the night the noticed GCS
reduced to 13. What is the management?
a. Refer to neuro-surgeon
b. IV fluids
c. Oxygen
d. CT brain
e. Skull XR

22/05/2020

345. Pt presented with hemoptysis 7d post-tonsillectomy. What is the next step?
a. Packing
b. Oral antibiotics + discharge
c. Admit + IV antibiotics
d. Return to theatre and explore
e. Ice cream and cold fluids

22/05/2020

344. A 68yo man gets repeated attacks of LOC and TIA. What is the most likely cause for this?
a. Atrial fib
b. Mitral stenosis
c. Aortic stenosis d. HOCM
e. Carotid artery stenosis

22/05/2020

343. A 6wk child is very sick-looking. Bloods: Na+=124, K+=2.8. Dehydrated. What would you choose
to resuscitate?
a. 0.18% NS + 4% dextrose + 20mmol KCl
b. 0.9% NS
c. 0.45% NS
d. 0.45% NS + 5% dextrose
e. 0.45% NS + 5% dextrose + 20 mmol KCl

22/05/2020

342. An 8yo returned from Spain with severe pain in one ear. Exam: pus in auditory canal, tympanic
membrane looks normal. What is the tx option?
a. Gentamicin topical
b. Amoxicillin PO c. Analgesia
d. Amoxicillin IV

22/05/2020

341. A 54yo woman has presented with episodes of abdominal ache, vomiting and postural hypotension. She also has a dark pigmentation of her skin. A dx of Addison’s disease was made.
What is the most likely electrolyte abnormality expected in this pt?
a. High Na+, Low K+
b. Low Na+, High K+
c. Low Na+, Low K+
d. High Na+, High K+
e. Low Na+, Normal K+

22/05/2020

340. A pt complains of SOB, wheeze, cough and nocturnal waking. He has dry scaly shin with rashes
that are itchy. What is the single most likely dx?
a. Scabies
b. Eczema
c. Rheumatism
d. Dermatitis
e. Psoriasis

22/05/2020

339. 34yo man was brought to the ED after a RTA. BP=50/0mmHg and chest wall not moving
symmetrically, RR=34bpm. What would be initial action?
a. IV fluid infusion
b. Intubation and ventilation
c. CT chest
d. Transfer to ITU

22/05/2020

338. A 40yo male with pre-existing glumerulonephritis having proteinuria and hematuria suddenly
deteriorates and presents with oliguria and serum K+=7.8mmol/L, urea=13mmol/L, creat=342mmol/L, GFR=19mL/h. The best management would be?
a. Calcium supplement
b. Calcium resonate e***a 30g
c. 10units insulin with 50% dextrose
d. Nebulized salbutamol
e. 10ml of 10% calcium gluconate
f. Hemodialysis urgent

22/05/2020

337. A pt with alternating swings or episodes from elation and depression had underwent tx and
gotten better. What medication needed to be continued so he can stay well?
a. Anxiolytics
b. Mood stabilizers
c. Antidepressants
d. Antipsychotics

22/05/2020

336. A 34yo man after a car crash is in the ED and deteriorating. His GCS has fallen from 13 to 7.
What is the most appropriate next step?
a. CT
b. Burr hole
c. MRI
d. Intubation
e. IV fluids

22/05/2020

335. A 48yo woman who has been taking medications for asthma for a long time has now presented
with decreasing vision. What is the most probable cause for her decrease in vision?
a. Inhaled salbutamol
b. Inhaled steroids
c. Aminophylline
d. Beta-blockers e. Oral steroids

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