Which of the following statements is true concerning organophosphate poisoning?

Which of the following statements is true concerning organophosphate poisoning?
A. Their principal action is the stimulation of acetylcholinesterase activity
B. They are only absorbed through the respiratory tract
C. Miosis, sweating and hypersalivation are due to nicotinic-receptor effects
D. Atropine is useful in the management of organophosphate poisoning
E. Organophosphate neuropathy occurs within 24 hours

Answer:

Regarding Disorders Of The Thyroid Gland...

Regarding Disorders Of The Thyroid Gland answer the following questions...

1. What are the key features in a patient's history that are important in assessing for a possible functional thyroid disorder?
2. What are the important physical examination findings?
3. What laboratory data are used to confirm or refute the existence of a functional thyroid abnormality?

Answers And Discussion

1. What are the key features in a patient's history that are important in assessing for a possible functional thyroid disorder?
When assessing a patient's history for clues to a functional thyroid disease, it is important to keep in mind that thyroid hormones in general control metabolism. Therefore, when questioning patients about their medical history, it is important to ask specifically about elements related to metabolism.

For example, in the setting of hyperthyroidism,

• weight loss,
• anxiety, 
• tremor, 
• palpitations, 
• heat intolerance, 
• hyperdefecation, 
• insomnia,
• restlessness, and 
• changes in the hair or skin are important features. 

In contrast, in patients with suspected hypothyroidism, look for clues that indicate decreased metabolic activity. These include

Tetralogy Of Fallot - Long Case Study

Presenting Complains:
- Breathlessness for … months
- Bluish discoloration of the lips and fingers during exertion for … months
- Weakness for … months
- Palpitation for … months
- Chest pain for … months
- Cough for … months.

History of Presenting Complains: According to the patient’s statement, she has been suffering from
breathlessness since her childhood. Her breathlessness was less marked in earlier stage, only felt
during moderate to severe activity. But for the last few months, it is progressively increasing, even
during mild exertion. There is no seasonal variation of breathlessness and it is not associated with
exposure to dust, pollen or fume. There is no history suggestive of paroxysmal nocturnal dyspnea or
orthopnea. The patient also noticed bluish discoloration of skin, finger nail, toes and lips for the last
… months, which is more marked during exercise and less by taking squatting position. She also
experiences diffuse chest pain, usually following any activity or after eating, which radiates to left
shoulder and subsides after taking rest. She also complains of palpitation, weakness and occasional
dry cough. Her bowel and bladder habits are normal. Her mother mentioned that the patient used to
become bluish and breathless while feeding or crying during the first few years of life.

On General Physical Examination:
- The patient is emaciated and short in stature
- Dyspneic
- Central cyanosis (involving tongue, lips, fingers and toes) is present
- There is generalized clubbing (involving all fingers and toes)
- Pulse: 112/min, low volume, regular in rhythm and normal character
- BP: 100/60 mm Hg
- Temperature: 98ºF
- Respiratory rate: 28/min
- No anemia, leukonychia, koilonychia, edema, jaundice, lymphadenopathy or thyromegaly

Cardiovascular system
- Pulse: 112/min, low volume, regular in rhythm and normal character
- BP: 100/60 mm Hg
- JVP: prominent “a” wave
- Visible cardiac impulse in apical and epigastric region
- Apex beat—palpable in the left … intercostal space, … cm from midline, normal in character
- Left parasternal lift and epigastric pulsation—present
- Systolic thrill—present in pulmonary area.
- First heart sound—normal in all the areas
- Second heart sound—P2 is soft (or absent) in pulmonary area, A2 is normal
- There is a harsh ejection systolic murmur in the pulmonary area, which radiates to the neck, more
on inspiration.

Examination of other systems reveals normal findings.

What is the Provisional Diagnosis? 
Tetralogy Of Fallot (TOF)

Mention some cyanotic congenital heart disease.
As follows:

• Tricuspid atresia
• Transposition of great vessels
• Pulmonary atresia
• Ebstein’s anomaly.

What investigations are done in TOF?
As follows:

• Chest x-ray- shows boot-shaped heart, pulmonary conus is concave (small pulmonary artery), right ventricle enlarged (prominent elevated apex), oligemic lung, right-sided aortic arch in 25% cases.
• 2D echocardiography and color Doppler (diagnostic—it shows that the aorta is not continuous with the anterior ventricular septum).
• Other investigations: ECG (RVH), cardiac catheterization in some cases.

Regarding Gravidity and Parity...

Regarding Gravidity and Parity...

A G1 P0
B G4 P2
C G0 P0
D G3 P3
E G2 P1
F G1 P2
G G6 P0
H G5 P2
I G1 P1
J G3 P1
K G4 P3
L G2 P0

For each description below, choose the SINGLE most appropriate answer from the above list of options. Each option may be used once, more than once, or not at all.

1 A woman currently pregnant who has had a previous term delivery.
2 A woman not currently pregnant who has had one previous termination, one early miscarriage and one stillbirth at 36/40.
3 A woman who attends for pre-conception counselling, never having been pregnant.
4 A woman currently pregnant with twins who has had one previous early miscarriage.
5 A woman not currently pregnant who previously had a twin delivery at 28/40.

Answers:

What is the leading cause of death in low-income countries?

What is the leading cause of death in low-income countries?
A. Diarrheal diseases
B. Human immunodeficiency virus
D. Ischemic heart disease
D. Lower respiratory disease
E. Malaria

Answer: D. Lower respiratory disease

Discussion:

Although ischemic heart disease is the leading cause of death worldwide, low-income countries have a disproportionate number of deaths caused by lower respiratory tract infections.

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:

Bell's palsy...

Two weeks after a viral illness, a 9-year-old boy presents to your clinic with a complaint of several days of weakness of his mouth. In addition to the drooping of the left side of his mouth, you note that he is unable to completely shut his left eye. His smile is asymmetric, but his examination is otherwise normal.
Which of the following is the most likely diagnosis?
a. Guillain-Barré syndrome
b. Botulism
c. Cerebral vascular accident
d. Brainstem tumor
e. Bell palsy

Answer: e. Bell palsy

Discussion:

Bell palsy is an acute, unilateral facial nerve palsy that begins about 2 weeks after a viral infection. Although the exact pathophysiology is unknown, reactivation of herpes simplex or varicella-zoster virus seems to be the most common cause; demyelination through an autoimmune process or allergic inflammation may also play a part in some cases. On the affected side, the upper and lower face are typically paretic, the mouth droops, and the patient cannot close the eye.

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:

A 19-year-old male presents with a 1-week history of malaise and anorexia followed by fever and sore throat....

A 19-year-old male presents with a 1-week history of malaise and anorexia followed by fever and sore throat.
On physical examination, the throat is inflamed without exudate. There are a few palatal petechiae. Cervical adenopathy is present. The liver is percussed at 12 cm and the spleen is
palpable. Throat culture: negative for group A streptococci
Hct: 38%, Hgb: 12 g/dL, Reticulocytes: 4%
WBC: 14,000/μL, Segmented: 30%, Lymphocytes: 60%, Monocytes: 10%
Bilirubin total: 2.0 mg/dL (normal 0.2 to 1.2)
Lactic dehydrogenase (LDH) serum: 260 IU/L (normal 20 to 220)
Aspartate (AST): 40 U/L (normal 8 to 20 U/L)
Alanine (ALT): 35 U/L (normal 8 to 20 U/L)
Alkaline phosphatase: 40 IU/L (normal 35 to 125)

The most important initial test is
a. Liver biopsy
b. Strep screen
c. Peripheral blood smear
d. Toxoplasmosis IgG
e. Lymph node biopsy

Answer: c. Peripheral blood smear

The most important serum test is
a. Heterophile antibody
b. Hepatitis B IgM
c. Cytomegalovirus IgG
d. ASLO titer
e. Hepatitis C antibody

Answer: a. Heterophile antibody

Corticosteroids would be indicated if
a. Liver function tests worsen
b. Fatigue lasts more than 1 week
c. Severe hemolytic anemia is demonstrated
d. Hepatitis B is confirmed

Answer: c. Severe hemolytic anemia is demonstrated

Discussion:

Regarding the prevention and treatment of hepatitis C?

Which one of the following statements best describes the prevention and treatment of hepatitis C?

A. No vaccine is available and treatment is only successful in around 10-15% of patients
B. No vaccine and no treatment is available
C. A vaccine is available and treatment is successful in around 50% of patients
D. A vaccine is available but no treatment has been shown to be effective
E. No vaccine is available but treatment is successful in around 50% of patients

Answer:

Rheumatic Fever - Long Case Study

Presenting complains:  18 years old female presents with the complains of:
- Migrating polyarthritis involving bigger joints (knee, ankle, elbow) for … days
-  Fever for … days
- Palpitation, chest pain … for days
- Malaise, weakness, fatigue for … days

History of presenting complains: According to the patient’s statement, she was quite fit and well … days back. Then she suffered from sore throat from which she recovered completely within a few days. After … days, she developed severe joint pain. Initially, it involved the right knee joint, but then sequentially the right ankle, left knee, left ankle and elbow joints were involved. The joints are
swollen, red and very painful, even with mild movement. The smaller joints are not involved. There
was no morning stiffness.
The patient also complains of fever, which is high grade, continued and reduces with antipyretic
drugs. It is not associated with chill and rigor, but there is profuse sweating. She also complains of
palpitation, chest pain, malaise, fatigue, weakness during her disease period. There is no history of
abnormal or involuntary movement (chorea) or skin changes. Her bowel and bladder habits are
normal. She denied any history of diarrhea, sexual exposure, skin rash, mouth ulcer, uveitis or any
urinary complaint.

General Physical Examination: 
- Appearance: Ill looking
-  Built: average
- Nutrition: average
-  Anemia: mildly anemic
- No jaundice, cyanosis, clubbing, leukonychia, koilonychia, edema or dehydration.
-  No lymphadenopathy, thyromegaly, etc

Vitals:
- Pulse: 110/min
-  BP: 130/75 mm Hg
-  Temperature: 39°C
-  Respiratory rate: 24/min

Cardiovascular examination ; Normal with no murmurs audible.

Loco-motor examination: (Knee joint involved)
Swollen and red with increased local temperature. Extremely tender on  palpation and restricted movements due to pain.

Other systemic examination ; Normal

Provisional Diagnosis: Acute Rheumatic Fever

Differential Diagnosis: 

Suspecting Acoustic Neuroma On Clinical Signs...

A 45-year-old man presents with dizziness and right-sided hearing loss to his GP. Which one of the following tests would most likely indicate an acoustic neuroma?

A. Jerky nystagmus
B. Left homonymous hemianopia
C. Tongue deviated to the left
D. Fasciculation of the tongue
E. Absent corneal reflex

Answer:

Carbon monoxide Poisoning...

Two patients are brought in from the same flat, unconscious with suspected carbon monoxide poisoning.
Which of the following is true concerning the symptoms, signs and management of carbon monoxide poisoning?
A. Pre-existing arteriosclerosis does not increase mortality
B. Carboxyhaemoglobin concentrations are always below 5% in healthy patients
C. Pregnancy is a contraindication to hyperbaric oxygen therapy
D. Cerebellar signs are the most reliable sign of neurological toxicity
E. Sodium bicarbonate is useful in correcting minor metabolic acidosis


Answer:

Standard measure for determining the impact of a health condition on a population?

Which of the following is the standard measure for determining the impact of a health condition on a population?
A. Disability-adjusted life years
B. Infant mortality
C. Life expectancy
D. Standardized mortality ratio
E. Years of life lost

Answer:

A 20-year-old female college student presents with a 5-day history of cough and low-grade fever ...

A 20-year-old female college student presents with a 5-day history of cough, low-grade fever (temperature 100°F), sore throat, and coryza.
On examination, there is mild conjunctivitis and pharyngitis. Tympanic membranes are inflamed, and one bullous lesion is seen. Chest exam shows few basilar rales.
Laboratory findings are as follows:
Hct: 38
WBC: 12,000/μL
Lymphocytes: 50%
Mean corpuscular volume (MCV): 83 nL
Reticulocytes: 3% of red cells
CXR: bilateral patchy lower lobe infiltrates


The sputum Gram stain is likely to show
a. Gram-positive diplococci
b. Tiny gram-negative coccobacilli
c. White blood cells without organisms
d. Acid-fast bacilli

Answer:

Hepatitis B and Pregnancy

A baby is born to a mother who is known to have chronic hepatitis B. The mothers latest results are as follows:
HBsAg Positive , HBeAg Positive
What is the most appropriate strategy for reducing the vertical transmission rate?
A. Give the newborn hepatitis B vaccine + hepatitis B immunoglobulin
B. Give the newborn hepatitis B vaccine
C. Give the newborn hepatitis B immunoglobulin
D. Give the mother intravenous zidovudine during labour
E. Give the mother hepatitis B immunoglobulin shortly before birth + the newborn hepatitis B vaccine

Answer:

Regarding Diabetes mellitus (DM)

Regarding Diabetes mellitus (DM) answer the following questions :

1. What are the clinical manifestations of DM?
2. What are the major types of DM and what are their distinguishing features?
3. What are the major acute and chronic complications of the disease?
4. What aspects of the medical history require special emphasis?
5. What aspects of the physical examination require special attention?
6. What laboratory tests are essential in the evaluation of the patient with suspected diabetes?
7. What are the goals of diabetes therapy and what treatment modalities are available? How should these be individualized?

Answers And Discussion
1. What are the clinical manifestations of DM?
DM is a complex metabolic disorder characterized by abnormalities of carbohydrate, lipid, and protein metabolism resulting either from a deficiency of insulin or from target tissue resistance to its cellular metabolic effects. It is the most common endocrine-metabolic disorder and affects an estimated 22 million people in the United States, with the incidence of new cases increasing by more than 700,000 per year.
Diabetes is manifested by the finding of hyperglycemia and the time dependent development of chronic complications (retinopathy, neuropathy, nephropathy, and accelerated atherosclerosis) resulting from the multiple metabolic derangements. Accordingly, the presenting clinical signs and
symptoms can be due to hyperglycemia or the complications of the disease, or both. In general, the major classic symptoms of polydipsia, polyuria, weight loss, and fatigue are found in the setting of new -onset diabetes in young patients whose disease is due to insulin deficiency .
On the other hand, older patients with diabetes may be relatively free of symptoms for a long time. In such patients, the diabetes is first detected either incidentally or because one of its chronic complications is discovered.
It is estimated that approximately one third of all the adult cases of diabetes in the United States remain undiagnosed.

Sub acute bacterial Endocarditis(SBE) - Long Case With Questions & Answers

Clinical History:
Mr …, 28-year-old, student, normotensive, nondiabetic, nonsmoker, presented with fever for 1 month, which is low grade, continued, sometimes associated with chills and rigor, also with profuse
sweating, subsides only with paracetamol, highest recorded temperature was 101F. He also complains
of central chest pain, sharp in nature without any radiation, does not aggravate by cough or movement of the chest. He also experiences occasional palpitation, associated with difficulty in breathing after mild to moderate exertion for the last few months, which are relieved by taking rest. There is no history suggestive of orthopnea or paroxysmal nocturnal dyspnea. For the last 2 months, the patient also experiences malaise, generalized weakness, arthralgia, myalgia, anorexia and substantial loss of weight.
There is no history of unconsciousness, hematuria or loin pain (differentiates from embolic phenomena). He does not give any history of dental procedures or cardiac or other surgery or
instrumental procedure (catheterization, colonoscopy, cannula, etc.) or any history of intravenous drug abuse. His bowel and bladder habits are normal.
He has been suffering from some valvular heart disease for several years. There is no family history of such illness. He used to take frusemide, propranolol and vitamins prescribed by the local physicians.

Examination: 
Patient is ill looking, emaciated and toxic, with moderate anemia. There is generalized clubbing: involving all the fingers and toes and there are two splinter hemorrhages in the left index finger.
No cyanosis, jaundice, koilonychia, leukonychia, lymphadenopathy or thyromegaly.
-Pulse: 110/min.
- Blood pressure: 95/75 mm Hg.
- Respiratory rate: 28/min.
- Temperature: 100°F.

On cardiovascular examination a murmur was detected on auscultation.

Provisional Diagnosis: Sub acute bacterial Endocarditis(SBE)

Points supporting the diagnosis:

Regarding Bell's palsy...

A 42-year-old woman presents as she has noticed a 'droop' in the right side of her face since she woke up this morning. There is no associated limb weakness, dysphagia or visual disturbance. On examination you notice right-sided upper and lower facial paralysis.

Which one of the following features would be most consistent with a diagnosis of Bell's palsy?
A. Vesicular rash around the ear
B. Hyperacusis
C. Sensory loss over the distribution of the facial nerve
D. Pins and needles in the right arm
E. Rhinorrhoea

Answer:

Components Of An Informed Consent Before Performing Any Procedure

All of the following are part of the informed consent process EXCEPT:
A. Alternatives and likely consequences of the alternatives to the procedure
B. Ascertainment of understanding by the patient
C. Discussion of the details of the procedure
D. Outlining the patient’s wishes if he or she becomes unable to make decisions
E. Risks and benefits of the procedure

Answer: