A Patient On Warfarin With Increased INR

A 65-year-old with a history of chronic atrial fibrillation is being monitored while on warfarin therapy. The nurse calls to inform you the patient’s international normalized ratio (INR) is measured at 7. He has no active signs of bleeding, but is at increased risk of bleeding. Appropriate management at this time includes which of the following:

A) Stop warfarin, observe, and repeat INR in 3 days.
B) Stop warfarin and observe; repeat INR in 24 hours.
C) Stop warfarin, give vitamin K, and repeat INR in 24 hours.
D) Stop warfarin, give vitamin K and fresh-frozen plasma with daily INRs.

Answer:

Tumor Markers

Which of the following tumor markers is correct for the condition?

A) CA (cancer antigen) 27.29 for metastatic cervical cancer
B) CA (cancer antigen) 125 for hepatic carcinoma
C) AFP (α-fetoprotein) for ovarian carcinoma
D) CA (cancer antigen) 19–9 for pancreatic cancer
E) β-hCG (beta unit of human chorionic gonadotropin) for ovarian cancer

Answer:

Retinal Detachment

Which of the following is considered a risk factor for retinal detachment?
A) Glaucoma
B) Diabetic retinopathy
C) Hyphema
D) Myopia

Answer:

D : Myopia

A Case Of Post traumatic Headache

A 45 year old gentleman presents with a history of headache for 3 weeks. His past history reveals a migraine headache since 20 years and a fall 3 weeks ago.

1. What further questions would you explore in the history?
2. List 3 most likely differentials?
3. Outline your management plan?

Question solved:

A Case Of Chest Pain

A 50 year old obese shopkeeper presents to your clinic with central chest pain on walking back to his shop after lunch. The pain occurred twice in the last 10 days, lasted for 10 - 15 minutes each time and subsided after the shopkeeper reached his shop and sat down. Both times when the shopkeeper reached his shop he was bathed in sweat.

1. What are the two most likely diagnosis?
2. How will you evaluate his problem?
3. How will you manage this problem?

Question Solved:

Causes of Delayed Passage Of Meconium In Newborns

Delayed meconium passage occurs in which of the following conditions?

A) Encopresis.
B) Hirschsprung disease.
C) Cystic fibrosis.
D) Hyperthyroidism.
E) B and C.

Answer;

A Case Of Sub Clinical Hypothyroidism

You are seeing a 45-year-old female in your office. As part of a routine blood panel, the patient’s TSH is noted to be elevated at 7.2 uIU/mL (0.27–4.20 uIU/mL). She has a normal free T4 and is asymptomatic. The best option is to:

A) Start levothyroxine at a low dose to normalize the TSH.
B) Begin T3 at a low dose.
C) Reassure the patient and have her follow-up for repeat thyroid studies.
D) Begin a workup for central hypothyroidism.
E) Begin methimazole.

Answer:

Treatment Of Osteoarthritis In Elderly Patients

The preferred initial therapy for elderly patients with arthralgia due to osteoarthritis is which of
the following?

A) NSAIDs.
B) COX-2 inhibitors.
C) Acetaminophen.
D) Combination narcotic analgesics.
E) Early joint replacement.

Answer:

A Case Of Irritable Bowel Syndrome

A 52-year-old woman complains of abdominal pain, bloating, and constipation. Her symptoms started about 5 years ago and became more bothersome within the last 6 months. She describes a dull pain in the left lower abdomen. This pain is alleviated by passing gas or having a bowel movement. The pain is generally related to eating, and she has had intermittent diarrhea and constipation with constipation predominating. Two years ago, she underwent a screening colonoscopy, which was completely normal.
Her review of systems is notable for a weight gain of about 5 pounds within the last 3 years. She is taking only amultivitamin daily.
Her physical examination is normal.

Which is the best next step?
A) Defecogram.
B) Barium enema.
C) Anorectal manometry.
D) TSH level.
E) Colonoscopy.

Answer:

A Case of Spontaneous Pneumothorax

A thin and young 25 years old man presents with sudden pain in the right lower chest and progressive dyspnoea. On examination cyanosis is present. BP is 100/70 mmHg and pulse is 100/min.

1. What is the most likely diagnosis?
2. How will you investigate this patient?
3. How will you manage this patient?

Question Solved:

A Case Of Iatrogenic Cushing Syndrome

MCPS Family Medicine ( Sample Question)

A 46 year old house wife , with known history of asthma attends with the complaints of gaining weight, puffiness of face and high blood pressure for last 2 months. Her asthma control is much better since the start of some hakim (Quack) treatment for the last 2 months. On  examination her BP is 170/95 mm Hg. Her recent blood work shows normal urine D/R , CBC, serum electrolytes, thyroid, renal and hepatic profile. Her fasting blood glucose is 130 mg/dl.

1. What is the most likely diagnosis?
2. What is the most likely cause for it?
3. List 6 relevant questions in the history that will further help in diagnosis?
4. List 6 important features in examination that you must note?
5. What would you do to investigate this patient?

Question Solved:

Age Related Macular Degeneration

A 79-year-old female patient, well known to you from 5 years of treating her hypertension, presents to your office with concerns about her vision and hearing. Over the last year, she has noticed worsening vision in her left eye. She denies eye pain, tearing, and redness. She wears bifocals and last had an eye exam 3 years ago. At that time, she recalls her eye doctor saying her vision was “stable.”  Which of the following is true regarding common visual problems in older adults?

A) Initial symptoms of macular degeneration include decreased visual acuity and central visual field distortion.
B) Cataracts are less common in the older population than is macular degeneration.
C) Symptoms of open-angle glaucoma are dramatic and manifest early in the disease.
D) Initial symptoms of central retinal artery occlusion include severe pain and sudden loss of vision.
E) If a cataract is detectable on physical exam, it should be removed.

Answer:

A 26 Year Old Man With Fever, Cough And Breathlessness for 1 Week

MCPS Family Medicine (Sample Question)

A 26 year old gentle man presents with fever, cough and breathlessness for 1 week. He has no known co morbids. On examination temp is 39 C and respiratory rate is 23/min. Chest examination reveals crepitations in the right mid zone.

1. What further points would you like to explore in history?
2. What investigations should be ordered in this patient?
3. Write 5 points in the management plan?

Question Solved:

Approach To A Patient With Post Menopausal Bleeding

MCPS Family Medicine ( Sample Questions)

A 55 year old diabetic lady presents with post menopausal bleeding for 1 month. She had menopause at the age of 50 years. She has 2 children. On examination she is a healthy looking obese lady. Her abdominal and pelvic examination are normal.

1. What further in history needs to be elaborated?
2. What are the most likely differentials?
3. Outline the relevant investigations and management plan?

Question Solved:

Approach To A Child With Rickets

MCPS Family Medicine  ( Sample Questions)

A mother brings in her 16 month old son who has not started walking yet. His weight is 9 kg and on examination he has wide wrist joints, with open anterior fontanel.

1. What is the most likely diagnosis?
2. What further points would you explore in history?
3. Briefly outline your management plan?

Question Solved:

Differential Diagnosis Of Abdominal Pain

Here is a list for different causes for Abdominal Pain:

Gastrointestinal Causes:

1. Gastroduodenal:

• Peptic Ulcer
• Gastritis
• Gastric Volvulus
• Malignancy

2. Intestinal :

• Appendicitis
• Obstruction
• Diverticulitis
• Gastroenteritis
• Inflammatory bowel disease
• Mesenteric adenitis
• Strangulated hernia
• Intussusception
• Volvulus
• Tuberculosis

3. Hepatobiliary:

• Acute cholecystitis
• Chronic cholecystitis
• Cholangitis
• Hepatitis

4. Pancreatic:

• Acute pancreatits
• Cronic pancreatitis
• Malignancy

5. Splenic:

• Infarction
• Spontaneous rupture

Urinary causes:

Examination Of the Abdomen

A Lung Cancer Patient Complaining Of Back Pain

A 63-year-old male with a diagnosis of non-small-cell lung cancer, undergoing weekly chemotherapy and radiation to a left upper lobe mass, presents to your office. He complains of dull, non radiating back pain in the lower thoracic/upper lumbar area. He denies trauma or any new activities. He has no associated weakness or paresthesias. He denies difficulties with bowel or bladder function.
What is you initial diagnostic and/or therapeutic approach to this patient?

A) MRI of thoracic and lumbar spine and NSAIDs.
B) Plain films of the thoracic and lumbar spine a
COX-2 inhibitor with a 2-week follow-up.
C) Plain films of the thoracic spine and NSAIDs.
D) Prescription for physical therapy and NSAIDs.
E) Urinalysis with culture and antibiotics.

Answer:

A Patient With Diarrhea And Epigastric Pain Unresponsive To Treatment

One of your patients presents complaining of diarrhea and epigastric pain unresponsive to H2 blockers or PPIs. He denies smoking tobacco, taking NSAIDs, or drinking alcohol. Endoscopy reveals several ulcers. Biopsy for H. pylori is negative and there is no malignancy.
Which of the following would be the most appropriate laboratory test to obtain in order to discover an etiology for the multiple ulcers (and diarrhea)?

A) Vasoactive intestinal peptide (VIP).
B) Gastrin.
C) Glucagon.
D) Somatostatin.
E) None of the above.

Answer:

Treatment Of Uncomplicated Urinary Tract Infection

A 20-year-old otherwise healthy woman presents with cloudy urine, burning on urination, and urinary frequency. The patient has no allergies.
Physical examination shows the patient is afebrile. She has mild suprapubic pain with palpation but no costovertebral angle tenderness.
Urinalysis is positive for nitrites and leukocyte esterase. Which of the following is the most appropriate treatment?

A) Hospitalize the patient and administer intravenous antibiotics.
B) Administer macrolide-containing antibiotics on an outpatient basis.
C) Administer sulfa-containing antibiotics plus phenazopyridine (Pyridium) on an outpatient basis.
D) Advise the patient to increase fluid intake, especially with cranberry juice.
E) Arrange for an intravenous pyelogram.

Answer:

Side Effects Of Benzodiazepines Use During Pregnancy

A 30 Year old female G2 P1+0 came in for her antenatal checkup. She is 20 weeks pregnant and it is her first visit with the doctor. She says she has certain family problems and her husband has left her when she was just a few weeks pregnant, and she did not knew about it. She was very depressed that time and took some antidepressants to help her sleep and control her panic attacks. 

The use of benzodiazepiens in pregnancy is associated with  which of the following?

A. Ebstein Abnormality

B. Failure to thrive

C. Development of attention deficit disorder in child.

D. Increased risk of oral clefts.

E. Spina Bifida.

Answer:

Diabetic Foot Examination

Child's Developmental Milestones

A female child is brought for her well child exams. During her visit, she was babbling and crawling around the office. She poked her fingers at the outlet covers (which thankfully were covered) and could use a pincer grasp to pick up a raisin off the floor.

These behaviors are appropriate for the development
of a child at approximately age:
A) 6 months.
B) 9 months.
C) 15 months.
D) 24 months.

Answer:

Cranial Nerve Examiantion

Meningitis in A college Student

What is the most common bacterial cause of meningitis in college-aged patients who live in dormitories?
A) N. meningitidis.
B) S. pneumococcus.
C) L. monocytogenes.
D) Haemophilus influenzae.
E) Escherichia coli.

Answer:

Primary Sclerosing Cholangitis

A 38-year-old English male was investigated after he was found to have an abnormal liver function test during a health insurance medical check. He worked in an information technology firm. Apart from occasional fatigue he was well. He consumed less than 20 units of alcohol per week. The patient had only traveled out of Europe twice and on both occasions he had been to North America. He took very infrequent paracetamol for aches and pains in his ankles and knees. There was no history of hepatitis or transfusion or blood products. He had been married for 5 years.
Systemic inquiry revealed infrequent episodes of loose stool for almost 4 years.
On examination he appeared well. There were no stigmata of chronic liver disease.
Abdominal examination revealed a palpable liver edge 3 cm below the costal margin. There were no other masses.
Examination of the central nervous system was normal.
Investigations were as shown.

• Hb 12.6 g/dl ,WCC 8 109/l ,Platelets 210 109/l, MCV 90 fl
• Sodium 136 mmol/l, Potassium 4.1 mmol/l
• Urea 6 mmol/l , Creatinine 100 mmol/l 
• AST 60 iu/l (NR 10–40 iu/l) , ALT 78 iu/l (NR 5–30 iu/l)
• Alkaline phosphatase 350 iu/l (NR 25–100 iu/l)
• Bilirubin 22 mmol/l (NR 2–17 μmol/l)
• Albumin 38 g/l (NR 34–48 g/l)
• Total cholesterol 5.2 mmol/l , Triglyceride 3.1 mmol/l
• Blood glucose 6 mmol/l
• Ferritin 256 mg/l (NR 15–250 mg/l) , Serum Fe 28 mmol/l( NR 14–32 mmol/l) , TIBC 50 mmol/l (NR 40–80 mmol/l)
• Serum Slightly reduced caeruloplasmin , 24-hr urine copper Slightly elevated
• IgG 19 g/l (NR 7–18 g/l), IgA 4.2 g/l (NR 0.8–4.0 g/l) ,IgM 5.0 g/l (NR 0.4–2.5 g/l)
• Anti-nuclear Positive 1/32 antibodies ,Smooth muscle Not detected antibodies,  Antimitochondrial Not detected antibodies
• Hep B sAg Not detected , Hep C virus Not detected antibodies
• Abdominal ultrasound Normal

What is the most probable diagnosis?
a. Autoimmune hepatitis.
b. Primary sclerosing cholangitis.
c. Primary biliary cirrhosis.
d. Haemochromatosis.
e. Wilson’s disease.

Answer: