mbbspg MCQs

MCQ 9

2011-06-02T22:34:00.001-07:00

A 90 year old male complains of hip and back pain. He has also developed headache, hearing loss, and tinnitus. On physical examination the skull appears enlarged, with prominent superficial veins. There is a marked kyphosis , and the bones of the leg appear deformed. Plasma alkaline phosphatase is elevated. A skull X-ray shows sharply demarcated lucencies in the frontal, parietal, and occipital bones. X-rays of the hip show thickening of the pelvic brim. The most likely diagnosis is

a. Multiple myeloma
b. Paget's disease
c. Hypercalcemia
d. Metastatic bone disease

MCQ 8

2011-05-07T23:50:00.001-07:00

A 25 year old woman presents with vaginal spotting and right lower quadrant abdominal pain.There is minimal dark blood in the vaginal vault,and her cervix is closed and thick.Quantitative serum hCG is 4000 mIU/ml. A transvaginal ultrasound (TVUS) shows no evidence of pregnancy inside the uterus. What is the most likely diagnosis?
a. Hydatidiform mole
b. Ectopic pregnancy
c. Appendicitis
d. Endometriosis
Answer and explanation
Correct answer : "b"(ectopic pregnancy)
Explanation : A gestational sac should be seen inside the uterus on a transvaginal ultrasound with a hCG level of 1500mIU/ml. If the pregnancy is not in the uterus investigation should be carried out for an ectopic pregnancy.

The pain in the appendicitis is severe with tenderness at the McBurney point, accompanied with fever and vomiting, hCG levels are not raised nor is there any associated vaginal bleeding.
In endometriosis, the pain is localised to the pelvis and radiates to the lower back and legs. Again hCG levels are not raised.
In hydatidiform mole the TVUS shows snowstorm appearance and vaginal bleeding is painless and there is a history of passing grape like vesicles. The beta hCG levels are markedly raised
In ectopic pregnancy, abdominal pain, dark vaginal bleeding and an empty uterus on TVUS is seen. The beta hCG levels reflect the duration of pregnancy. A level of 4000mIU/ml denotes 5-6 weeks from the LMP.

hCG overview :
1. hCG can be detected in maternal serum and urine.
2. It is a glycoprotein made by trophoblasts.
3. Composed of two subunits—α and β:

α subunit is similar in luteinizing hormone (LH), follicle-stimulating hormone (FSH), thyroid-stimulating hormone (TSH).
β subunits are unique: Urine and serum tests are based on antibody specificity to β subunit of hCG.

4. Function : Helps sustain the corpus luteum during the fi rst 7 weeks. After the first 7 weeks, the placenta makes its own hormones to sustain the pregnancy.
5. Can be detected in the maternal serum or urine 6–12 days after fertilization (3–3.5 weeks after the LMP).

↑ by 66–100% every 48 hours prior to 10 weeks.
In general, hCG should double every two days.
Peaks at 10 weeks gestation.
Nadirs at 14–16 weeks.
Note : If β-hCG does not rise as expected, consider accidents of pregnancy: spontaneous abortion, missed abortion, ectopic pregnancy.

6. Keep in mind that pregnancy tests not only detect hCG produced by the syncytiotrophoblast cells in the placenta, but also in:

Hydatidiform mole.
Choriocarcinoma.
Germ cell tumors.
hCG produced by breast cancers and large cell carcinoma of the lung.

7. A gestational sac can be visualized with transvaginal ultrasound (TVUS) when hCG levels are >1500. If hCG is >1500 and no evidence of intrauterine pregnancy, think “ectopic pregnancy.”

Q7

2011-04-24T17:38:00.000-07:00

Q7.The most useful and predictive tool in evaluating the condition of a patient with an acute asthmatic attack and in assessing response to therapy is
  A. Chest radiography
  B. Arterial blood gas measurement
  C. Measurement of pulsus paradoxus
  D. Observation of accessory muscles use
  E. Measurement of peak expiratory flow or FEV1

answer and explanation will be posted here tommorrow

Q6

2011-04-14T11:22:00.000-07:00

Q6. what skin condition is known for its herald patch and "pine tree" distribution of its lesions

a. Lichen planus
b. Guttate psoriasis
c. Seborrheic dermatitis
d. Pityriasis roses

anser to Q6 :
Answer: "d"

Q5

2011-04-10T18:34:00.000-07:00

Q5. A 16 year old girl is brought by her mother to her physician. Her mother complains that her daughter has a poor sexual physical development, has primary ammenhorrhea and is too short. On inspection the girl appears withdrawn and abrupt. She appears rather pale and thin and has fine coat of hair all over her body. Her parotid glands appear to be enlarged. On investigation the levels of plasma FSH and LH are low. The most likely diagnosis is

a) constitutional delay
b) hypothyroidism
c) anorexia nervosa
d) Kallmann's syndrome
e) ovarian dysgenesis

answer and explanation:
Answer : "C"
Explanation:
It is not uncommon for patients with anorexia nervosa to be referred months after the onset; growth failure may be the first sign, and this condition must be considered in the differential diagnosis of growth failure. Anorexia nervosa, a common cause of gonadotropin deficiency in adolescence, is a functional disorder, apparently increasing in prevalence in girls but rare in boys, and is characterized by a distorted body image, obsessive fear of obesity, and food avoidance that can cause severe weight loss, primary or secondary amenorrhea in affected females, and even death. Other features include onset in middle adolescence, hyperactivity, defective thermoregulation with hypothermia and sensitivity to cold, constipation, bradycardia and hypotension, decreased basal metabolic rate, dry skin, fine downy hypertrichosis, peripheral edema, and parotid enlargement. In anorexia nervosa the levels of plasma FSH, LH, leptin, and estradiol and of urinary gonadotropins are low.

Todays question: Q4

2011-04-07T10:29:00.000-07:00

Question 4:

A 25-year-old female presents with vaginal spotting and right lower quadrantpain. She denies passage of tissue. Her abdomen is tender to mild palpation in the right lower quadrant. There is minimal dark blood in the vaginal vault, and her cervix is closed and thick. Quantitative serum hCG is 4000 mIU/mL. A transvaginal ultrasound(TVUS) shows no evidence of pregnancy inside the uterus. What is the most likely diagnosis?

answer

answer Q4: Ectopic pregnancy

A gestational sac should be seen inside the uteruson a transvaginal ultrasound with an hCG level of 1500 mIU/mL. If the pregnancy is not in the uterus, then an investigation must be carried out for an ectopic pregnancy.

Question 3

2011-04-06T11:12:00.000-07:00

anwer to question 2 :
auscultatory finding : diastolic rumbling murmur
condition : mitral stenosis

Question 3 :

Neisseria meningitides is a gram negative organism which causes meningitis in young adults. The bacteria are most likely to gain entry into the meninges via:

a) the blood stream
b) the lymphatic drainage of the meninges
c) the perineural sheath of the olfactory nerve
d) the neural tracts of the spinal cord
e) the optic nerve and tract

answer and explanation

Correct Answer: C

Explanation:

Neisseria meningitides or Meningococci are strict human parasites which often cause meningitis in young adults. The bacteria gain entry into the human body through the nasopharynx where they cause a mild infection with rhinitis and pharyngitis. Here the organisms multiply and then gain access to the meninges. Theorganism enters the meninges along the perineural sheath of the olfactory nerve, through the cribriform plate of the ethmoid.Spread through the blood is very unlikely because the Meningococci do not cause a septicemia following the nasal infection which is essential in case the organism enters the meninges through the blood. Meninges and nasopharynx do not share their lymphatic drainage so entry through lymphatics is not possible.Meningococci do not infect the peripheral nervous system so entry through the spinal cord is not possible.

mcqs today : 2

2011-04-04T12:32:00.000-07:00

Question 2 :

A 26 year old female had rheumatic fever as a child. She becomes pregnant and starts to have complaints of dyspnea.On auscultation the findings are as follows.Click the play button below to hear her auscultatory findings

a>.Elaborate and discuss the findings of auscultation
b>.What is the condition responsible for producing such auscultatory findings?

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Answer to question 1: "e".

explanation: i have now provided it under question 1. Check it out.

mcqs today : 1

2011-04-03T13:20:00.000-07:00

Question `1 :
A 35 year old female develops a swollen, very painful neck. She has a fever, chills and generally feels ill. She is initially evaluated by a physician assistant for pharyngitis. Her group A, beta hemolytic strep test is negative. She returns to see her doctor the next day On physical examination her heart rate is 95 and her blood pressure is 120/80. She has a temperature of 100F and a mildly enlarged thyroid gland. When her doctor goes to examine her thyroid, she objects, as this area is very sensitive, actually painful. She then lets him palpate her neck, and the physician is able to detect a mildly enlarged thyroid gland. Thyroid tests are done, but the results are pending. What is the most likely diagnosis?

a) myxedema
b) cretinism
c) Graves disease
d) Jod-Basedow phenomenon
e) De Quervain's thyroiditis

Please post your answer in the mbbspg discussion zone on the right. Help others by posting explanation however this is optional. Answer to this question will be posted tommorrow

answer with explanation: click read more below

Answer to question 1: "e".

explanation:

De Quervain's thyroiditis classically presents with a very tender thyroid. There are systemic symptoms, associated with it. There may be symptoms of hyperthyroidism, or as in this case, there may not be symptoms of hyperthyroidism. (Inflammation in the thyroid gland is associated with release of colloid and stored thyroid hormone,but also with damage to the follicular cells and impaired synthesis of new thyroid hormones.As a result T4 and T3 levels are raised for 4-6 weeks until the preformed colloid is depleted .Therefore there is usually a period of hyperthyroidism followed by a period of hypothyroidism of variable severity before the follicular cells recover and normal thyroid function is restored)

Myxedema (choice a) would present with symptoms of weakness, fatigue, cold intolerance, constipation, weight gain.

Cretinism (choice b) is congenital hypothyroid. This is not the case here, as her symptoms developed later in her life.

Graves disease (choice c) present with symptoms of hyperthyroidism. Symptoms of hyperthyroidism would include weight loss, loose stools, and heat intolerance. Signs would include tachycardia, a brisk return on the Achilles reflex, exophthalmos and a palpable thyroid.

Jod-Basedow phenomenon (choice d) is hyperthyroidism cause by iodine ingestion.

Jod is the German word for' iodine'. Induction of thyrotoxicosis in patients previously euthyroid as a result of exposure to large quantities of iodine; occurs most often in geographic areas of endemic iodine-deficient goiter and in patients with multinodular goiter; can also develop following use of iodine-containing agents for diagnostic studies. SYN: iodine-induced hyperthyroidism