Elevated blood pressure in the setting of acute ischemic stroke needs to be judiciously treated because:

Elevated blood pressure in the setting of acute ischemic stroke needs to be judiciously treated because:

A. High blood pressure needs to be treated aggressively in order to decrease the incidence of intracranial bleeding.
B. Acute elevations in blood pressure usually do not spontaneously decline.
C. Blood pressures above 160 mmHg systolic or 100 mmHg diastolic are immediately life-threatening.
D. Areas of ischemic brain lose autoregulation and may be dependent on elevated mean arterial pressure to maintain perfusion.
E. Aggressive lowering of blood pressure with acute ischemic stroke improves outcome.

Answer :

Match the clinical description with the most likely organism.

Match the clinical description with the most likely organism.
a. Streptococcus pneumoniae
b. Staphylococcus aureus
c. Viridans streptococci
d. Providencia stuartii
e. Actinomyces israelii
f. Haemophilus ducreyi
g. Neisseria meningitidis
h. Listeria monocytogenes

A 30-year-old female with mitral valve prolapse and mitral regurgitant murmur develops fever, weight loss, and anorexia after undergoing a dental procedure.

Answer: c. Viridans streptococci

An 80-year-old-male, hospitalized for hip fracture, has a Foley catheter in place when he develops shaking chills, fever, and hypotension.

Answer: d. Providencia stuartii

A young man develops a painless, fluctuant purplish lesion over the mandible. Cutaneous fistula is noted after several weeks

Answer: e. Actinomyces israelii

A sickle cell anemia patient presents with high fever, toxicity, signs of pneumonia, and stiff neck.

Answer: a. Streptococcus pneumoniae

Discussion:

High Eosinophil Count on routine blood work ...

A 32-yr-old man from Uganda is referred to hospital with a high eosinophil count by his GP following routine blood tests. He is entirely asymptomatic and has no past medical history of note.

Which of the following organisms is LEAST likely to be responsible?
A. Strongyloides stercoralis
B. Wuchereria bancrofti
C. Schistosoma mansoni
D. Schistosoma haematobium
E. Entamoeba histolytica

Answer:

Melanosis coli

A 23-year-old female with a history of diarrhoea and weight loss has a colonoscopy to investigate her symptoms.
A biopsy is taken and reported as follows: Pigment laden macrophages suggestive of melanosis coli

What is the most likely diagnosis?
A. Intestinal melanoma
B. Haemochromatosis
C. Ulcerative colitis
D. Laxative abuse
E. Colorectal cancer

Answer:

Septic Arthritis Following an Ear Infection....

A 25-year-old man presents in the casualty department with a two-day history of a painful and swollen left knee. He is pyrexial with a temperature of 38.5 °C. Examination of his cardiovascular and respiratory system is normal. An abdominal examination is normal. He also mentions that he developed a painful right ear and saw his doctor five days ago who told him he had an infected ear and prescribed antibiotics. His left knee is swollen, red, tender and slightly flexed. A diagnosis of septic arthritis is made.

What is the most likely causative organism?
A. Streptococcus viridans
B. Staphylococcus epidermidis
C. Staphylococcus aureus
D. Escherichia coli
E. Neisseria meningitides

Answer:

Venous Thromboembolism: Risk factors

Which one of the following statements regarding the etiology of venous thromboembolism (VTE) is correct?
A. Third generation combined oral contraceptive pills are safer than second generation ones
B. VTE develops in around 5% of patients with rheumatoid arthritis
C. Female gender is a risk factor recurrent VTE
D. The second trimester of pregnancy is associated with a greater risk than the puerperium
E. Tamoxifen therapy increases the risk of VTE

Answer:

A 67 year old woman with a history of breast cancer was diagnosed with Deep vein thrombosis...

A 67-year-old woman is reviewed a week after being diagnosed with having a deep vein thrombosis of her left leg. After receiving low-molecular weight heparin for 5 days she has now been started on warfarin. She has a history of depression, osteoporosis, breast cancer and type 2 diabetes. Which one of her current medications is most likely to have increased her risk of developing a deep vein thrombosis?

A. Trazadone
B. Tamoxifen
C. Sitagliptin
D. Denosumab
E. Rosuvastatin

Answer:

Communicating News Of A Patient’s Death To A Spouse

Case Scenario: A 40-year-old man, is admitted from work with a large anterior myocardial infarct, which is treated with thrombolysis. Unfortunately he arrests and, despite prolonged attempts at resuscitation, he dies. His wife arrives 5 minutes after he dies. You are a junior doctor on a coronary care unit and your task is to inform the wife that his husband is dead.

How will you approach this case?

Key issues to explore: 
What does the patient’s wife know already?
She will be more prepared for bad news if she knows he is gravely ill than if she doesn’t know why he is in hospital. Explaining an unexpected death is one of the most difficult communication tasks that a medical professional has to perform: if it is done with compassion and sensitivity it can ease the inevitable distress that family and friends will go through.

Key points to establish And Steps In Communicating : 

1. Find a quiet room, if possible a relatives’ room, and ask the nurse looking after the patient to accompany you. 
2. Leave your pager with someone else so that you are free of interruptions. 
3. There is no hiding from the fact that you must inform the wife that her husband has had a heart attack and unfortunately has not survived. 

Role of Sputum Gram Stain And Culture In A Patient With Pneumonia

A 30-year-old male with sickle cell anemia is admitted with cough, rusty sputum, and a single shaking chill. Physical examination reveals increased tactile fremitus and bronchial breath sounds in the left posterior chest. The patient is able to expectorate a purulent sample.
Which of the following best describes the role of sputum Gram stain and culture?

a. Sputum Gram stain and culture lack the sensitivity and specificity to be of value in this setting.
b. If the sample is a good one, sputum culture is useful in determining the antibiotic sensitivity pattern of the organism, particularly Streptococcus pneumoniae.
c. Empirical use of antibiotics for pneumonia has made specific diagnosis unnecessary.
d. There is no characteristic Gram stain in a patient with pneumococcal pneumonia.
e. Gram-positive cocci in clusters suggest pneumococcal infection.

Answer And Discussion:

A 59 Year Old Man Presenting With A Complication Following A Myocardial Infarction

A 59-year-old man is hospitalized after suffering a severe myocardial infarction. He is initially
treated with nitrates, β-blockers, and aspirin, and subsequently undergoes cardiac catheterization with placement of two stents. Following the procedure he is hemodynamically stable without recurrence of chest pain. However, 5 days after admission his heart rate is 134/min, blood pressure is 72/35 mm Hg, and respiratory rate is 29/min.
Physical examination reveals distant heart sounds and an elevated jugular venous pressure.
Which of the following complications is most likely causing this patient’s symptoms?

(A) Aneurysm formation
(B) Cardiac arrhythmia
(C) Fibrinous pericarditis
(D) Rupture of the papillary muscle
(E) Rupture of the ventricular free wall

Answer And Discussion: 

A 27 Year Old Man Presents With Several Red, Tender Subcutaneous Nodules On The Anterior Lower Legs

A biopsy of one of several red, tender, subcutaneous nodules from the anterior lower legs of a
27-year-old man is obtained by a dermatologist.
On histopathology, she sees a panniculitis (inflammation of subcutaneous fat) with widening of tissue septa from edema, increased neutrophils, and fibrin exudation.
Which of the following diseases is often present in someone with these nodules?

(A) Acne vulgaris
(B) Crohn’s disease
(C) Eczema
(D) Pancreatitis
(E) Psoriasis

Answer And Discussion:

A 57 Year Old Man Presents With Blurry vision, Difficulty standing, and Mental confusion.

A 57-year-old man is brought to the emergency department because of blurry vision, difficulty standing, and mental confusion.
On physical examination the patient appears malnourished, he had diffuse crackles bilaterally, and on
standing his gait is wide-based and unsteady.
The patient’s friend, who accompanies him, says the patient “hasn’t been himself lately,” and is having difficulty remembering to do everyday tasks. Which neuropathologic findings are most consistent with this patient’s symptoms?

(A) Atrophy of the caudate nucleus
(B) Depigmentation within the substantia nigra pars compacta
(C) Neurofi brillary tangles and widening of ventricles
(D) No neuropathologic fi ndings
(E) Symmetric lesions in the paraventricular regions of the thalamus and hypothalamus, mammillary bodies, and periaqueductal region of the midbrain

Answer And Discussion: