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“Enhance Your Medical Expertise with Case Based MCQ – Your Go-To Telegram Channel for Challenging, Real-World MCQs and Continuous Learning.
Admin: @Mohamm_ADs”
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19 229
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19 225
🇨🇦 MCCQE1,2 | #Case_125 | #answer
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✅ E
🔎 Explanation
This patient has classic presentation of toxic megacolon. The most common cause of toxic colon is inflammatory bowel disease (IBD), especially ulcerative colitis. The three week history of diarrhea in a young person that has worsened dramatically ending in bowel obstruction with systemic toxicity is a classic scenario of ulcerative colitis complicated with toxic megacolon. Toxic megacolon is an emergent life threatening condition that should be managed immediately with IV
fluids, steroids and NG tube.
⚠ In the absence of antibiotics intake, pseudomembrenous colitis (choice A) becomes unlikely.
⚠ Colon cancer (choice B) is very unlikely to present as toxic megacolon; moreover, the patient’s young age favors against this diagnosis.
⚠ Although Crohn’s disease (choice C) can also lead to a fulminant colitis, it is very rare.
⚠ Intestinal perforation, not fulminant colitis, is the classic complication described in typhoid fever (choice D).
19 225
🇨🇦 MCCQE1,2 | #Case_125
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A 28-year-old male comes to the ED complaining of intermittent cramps in his lower abdominal pain, rectal urgency and diarrhea with occasional blood in the stools of 3 weeks duration. His condition has been worsening progressively for the last 3 days. He has vomited several times and feels chilly. He denies the intake of any antibiotics recently. Vitals signs show: pulse is PR: 102/min, BP is 125/75 mmHg, Temp is 39°C and RR is 16/ min. Physical exam reveals a distended and tender to palpation abdomen without any evidence of peritoneal signs. Bowel sounds are absent. Rectal exam shows blood and mucus. Upright X-ray film of the abdomen discloses a hugely distended transverse colon filled with gas. Which of the following diseases would be the most likely precipitant of the patient’s condition?
a) Clostridium difficile colitis
b) Colon cancer
c) Crohn’s disease
d) Typhoid enteritis
e) Ulcerative colitis
19 225
🇨🇦 MCCQE1,2 | #Case_124 | #answer
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✅ C
🔎 Explanation
Malignant otitis externa (MOE), skull base osteomyelitis, is the most likely diagnosis of this patient. MOE is usually seen in diabetics and immunosuppressed patients and often presents with a very intense ear pain and ear discharge. Fever is often present and the pain may radiate to the TMJ. Resistance to topical antibiotics along with the history of diabetes should be a useful clue. The most common cause of malignant otitis externa is Pseudomonas aeruginosa(choice C).
⚠ Aspergillus species (choice A) especially the fumigatus type may be occasionally the cause of MOE.
⚠ Escherichia coli (choice B) is the most common cause of UTI and not MOE.
⚠ Streptococcus pneumoniae (choice D) is the most common cause of otitis media and not externa.
⚠ Streptococcus pyogenes (choice E) and Staphylococcus aureus may be superadded; however very rarely to be the responsible agents.
🔖 Key point:
Know the infections associated with diabetes well! Malignant otitis externa, erysipelas, cellulitis, mucormycosis, fournier’s gangrene and emphysematous cholecystitis are frequently asked!
19 225
🇨🇦 MCCQE1,2 | #Case_124
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A 65-year-old diabetic male comes to the office complaining of excruciating pain in his left ear that began last night. The pain is 10/10 in intensity and radiates to his mandible. He also complains of ear discharge along with the pain. His condition is worsening progressively despite the use of Tobradex™ ear drops (Tobramycin + dexamethasone). Review of systems is otherwise normal. His vitals signs are within normal limits except for a temp of 38°C. HEENT exam shows the presence of granulation tissue in the lower part of his external auditory canal at the junction between the cartilaginous and bony parts of the canal. When the patient is asked to smile, some weakness of the left facial nerve is noticed. Which of the following pathogens is most likely to be responsible for this patient’s condition?
a) Aspergillus nigrican
b) Escherichia coli
c) Pseudomonas aeruginosa
d) Streptococcus pneumonia
e) Streptococcus pyogenes
19 225
🇨🇦 MCCQE1,2 | #Case_123 | #answer
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✅ B
🔎 Explanation
This female has Prinzmetal variant angina, which is caused by coronary vasospasms. Sumatriptan is a 5HT1D and 1B agonist, which will have a vasoconstrictive effect. A side effect of this particular drug is that it induces vasospasms, hence contraindicated in individuals with this particular angina
19 225
🇨🇦 MCCQE1,2 | #Case_123
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A 43-year-old female with a known history of migraines comes to your office today complaining of unusual chest pains. There is no family history of any coronary artery disease and she is neither a smoker nor does she have hypertension. She describes the discomfort occurring at times of rest and during exertion. However the episodes vary and arise unexpectedly. She is otherwise healthy with no other complaints. Which of the following is contraindicated in this patient?
a) Nifedipine
b) Sumatriptan
c) Lisinopril
d) Verapamil
e) Flunarizine
19 225
🇨🇦 MCCQE1,2 | #Case_122 | #answer
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✅ D
🔎 Explanation
Instead of dementia, this patient has signs of pseudodementia of depression, which usually has a subacute onset. Memory usually is intact when adequate time is taken to carefully evaluate the patient.
⚠ The onset of Alzheimer’s disease, however, is gradual and includes memory loss.
⚠ Lewy body dementia is associated with hallucinations, and the onset is gradual.
⚠ Frontotemporal dementia generally occurs before age 60. Memory is usually preserved for orientation, although information retrieval may be difficult.
⚠ The onset of mild cognitive impairment is gradual and includes memory loss.
19 225
🇨🇦 MCCQE1,2 | #Case_122
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A 72-year-old Asian-Canadian female is brought to your office by her husband because he thinks she might have Alzheimer’s disease. For the past 3 months she has complained of confusion, poor appetite, and lack of energy. She has been unable to do routine housework. On brief questioning, her short-term recall seems to be impaired, but a more detailed examination indicates that her memory is fine.Which one of the following is the most likely diagnosis?
a) Alzheimer’s disease
b) Lewy body dementia
c) Frontotemporal dementia
d) Pseudodementia
e) Mild cognitive impairment
19 225
🇨🇦 MCCQE1,2 | #Case_121 | #answer
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✅ B
🔎 Explanation
Staphylococcus aureus is an unusual genitourinary pathogen; when found in the urine, it should be assumed to have migrated from a primary location. The patient should be examined carefully for a portal of entry such as a skin ulcer, intravenous site, or area of dermatitis.
⚠ An echocardiogram is often required to rule out endocarditis.
⚠ Methicillin-sensitive S. aureus can be treated with a penicillinase-resistant penicillin or a first-generation
cephalosporin.
⚠ Vancomycin should be reserved for treating methicillin-resistant S. aureus.
⚠ Although oral cephalexin can be used to treat methicillin-sensitive S. aureus, this particular patient is too ill and needs to be evaluated for bacteremia
19 225
🇨🇦 MCCQE1,2 | #Case_121
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A 76-year-old female is hospitalized for fever and weakness of several days’ duration. Her history and physical findings are otherwise unremarkable except for a temperature of 38.2°C (100.8°F), a pulse rate of 100 beats/min, and a blood pressure of 110/70 mm Hg. A urinalysis reveals 10-15 WBCs/hpf and a urine culture reveals methicillin-sensitive Staphylococcus aureus. The most appropriate action at this point is to:
a) reculture the urine, as the bacteria on the first urine culture is most likely a skin contaminant
b) obtain a blood culture and examine the patient for a portal of entry
c) obtain a blood culture and start the patient on intravenous vancomycin (Vancocin)
d) start the patient on oral cephalexin (Keflex)
e) order echocardiogram
19 225
🇨🇦 MCCQE1,2 | #Case_120 | #answer
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✅ C
🔎 Explanation
The combination of a painful arc and pain on use of the supraspinatus muscle indicates impingement syndrome (also called painful arc syndrome, supraspinatus syndrome, swimmer's shoulder, and thrower's shoulder), which is due to irritation of the rotator cuff under the coracoacromial arch. It is by far the most common cause of shoulder pain seen by family.
⚠ Subdeltoid bursitis is a much more acute problem, and impairs shoulder mobility in all directions.
⚠ Adhesive capsulitis produces loss of external rotation.
⚠ Glenohumeral arthritis produces pain with external rotation, and variable amounts of impaired mobility, depending on progression of the problem over time.
⚠ Acromioclavicular joint arthritis produces a positive scarf sign, and often a visible bump over the joint, since it lies so close to the skin surface
19 225
🇨🇦 MCCQE1,2 | #Case_120
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A 35-year-old male complains of 2 months of right shoulder pain. He does not recall an injury, but says it is painful to lie on his right side or to work with his right hand above his head. On examination, the shoulder appears normal and there is no pain with external rotation of the shoulder, bringing the arm across the body (scarf test), or attempted external and internal rotation of the shoulder against resistance. Lowering the arm from full abduction (painful arc), attempted abduction above 45° against resistance, and elevating the internally rotated arm above 90° against resistance are all painful.The most likely diagnosis is:
a) Subdeltoid bursitis
b) Adhesive capsulitis
c) Impingement syndrome
d) Glenohumeral osteoarthritis
e) Acromioclavicular osteoarthritis
19 225
🇨🇦 MCCQE1,2 | #Case_119 | #answer
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✅ C
🔎 Explanation
Diagnostic paracentesis is recommended for patients with ascites of recent onset, as well as for those with chronic ascites who present with new clinical findings such as fever or abdominal pain. A neutrophil count > 250/mL is diagnostic for peritonitis. Once peritonitis is diagnosed, antibiotic therapy should be started immediately without waiting for culture results. Bloody ascites with abnormal cytology may be seen with hepatoma, but is not typical of peritonitis. The ascitic fluid pH does not become abnormal until well after the neutrophil count has risen, so it is a less reliable finding for treatment purposes. A protein level > 1 g/dL is actually evidence against spontaneous bacterial peritonitis
19 225
🇨🇦 MCCQE1,2 | #Case_119
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For two weeks, a 62-year-old male with biopsy-documented cirrhosis and ascites has had diffuse abdominal discomfort, fever, and night sweats. His current medications are furosemide (Lasix) and spironolactone (Aldactone). On examination, his temperature is 38.0°C (100.4°F), blood pressure 100/60 mm Hg, heart rate 92 beats/min and regular. The heart and lung examination is normal. The abdomen is soft with vague tenderness in all quadrants. There is no rebound or guarding.
The presence of ascites is easily verified. Bowel sounds are quiet. The rectal examination is normal, and the stool is negative for occult blood. You perform diagnostic paracentesis and send a sample of fluid for analysis.
Which one of the following findings would best establish the suspected diagnosis of spontaneous bacterial peritonitis?
a) pH < 7.2
b) Bloody appearance
c) Neutrophil count > 300/mL
d) Positive cytology
e) Total protein > 1 g/dL
19 225
🇨🇦 MCCQE1,2 | #Case_118 | #answer
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✅ B
🔎 Explanation
Focal glomerular sclerosis is the type of nephropathy most commonly seen in IV drug users with AIDS. It is likely to lead to a very rapid loss of renal function.There is no clinical evidence to indicate that this person has diabetes, making diabetic nephropathy unlikely. Minimal change disease and IgA nephropathy and membranous nephropathy are only very rarely associated with AIDS.
19 225
🇨🇦 MCCQE1,2 | #Case_118
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A 27-year-old man with advanced HIV is sent for evaluation of his nephrotic syndrome. His blood pressure is 142/84 mm Hg. He has 3+ edema in both legs. His risk factor for AIDS is his IV heroin use. His creatinine is 2.1 mg/dL, and his urine reveals +3 protein, no blood. A kidney biopsy would most likely reveal which of the following?
a) Diabetic nephropathy
b) Focal glomerular sclerosis
c) IgA nephropathy
d) Membranous nephropathy
e) Minimal change disease
19 225
🇨🇦 MCCQE1,2 | #Case_117 | #answer
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✅ C
🔎 Explanation
This girl has primary amenorrhea, a webbed neck, and a significant difference between the blood pressure in the upper and lower extremities (suggesting possible coarctation of the aorta). These findings suggest Turner syndrome as the most likely diagnosis. The best way to confirm this diagnosis is a standard 30 cell Karyotype, which in Turner syndrome would reveal 45, XO cell line or a cell line with deletion of the short arm of the X chromosome.
⚠ An echocardiography (choice A) is useful in evaluating cardiovascular abnormalities of Turner syndrome such as the coarctation of the aorta; while this is an important characteristic of Turner syndrome, it is not the best way to confirm it.
⚠ FSH, LH, and Estrogen (choice B) are likely to be abnormal in this patient. With estrogen being low while FSH and LH are elevated; this, however, is not the best way to confirm Turner syndrome.
⚠ Brain MRI (choice D) would be useful in cases of amenorrhea caused by pituitary pathology such as craniopharyngioma, it is not the best way to confirm Turner syndrome.
⚠ Bone age assessment (choice E) will be useful in the management of this patient as hormone therapy is being considered; however, this is not the best way to confirm Turner syndrome.
🔖 Key point:
When Turner syndrome is suspected, Karyotype is the best way to confirm it.
19 225
🇨🇦 MCCQE1,2 | #Case_117
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A 15-year-old female is brought to the hospital by her mother because she has never had menstrual periods and the mother is concerned. On physical examination the girl appears short, has a webbed neck. Four-limb blood pressures were also evaluated: higher blood pressures were noted in the arms while the ones of the lower extremities were normal. Which of the following is the best way to confirm this girl’s diagnosis?
a) Echocardiography
b) FSH, LH, and Estrogen levels
c) Karyotype
d) Brain MRI
e) Bone age assessment
19 225
🇨🇦 MCCQE1,2 | #Case_116 | #answer
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✅ C
🔎 Explanation
Otosclerosis typically presents between the third and fifth decades, and is more common in women. The chief feature of
otosclerosis is a progressive conductive hearing loss. Occasionally, when lesions impinge on the stapes footplate, a sensorineural loss may occur. All of the other choices are exclusively sensorineural in character. Meniere’s disease also causes fluctuating hearing loss. Noise-induced hearing loss frequently and characteristically is accompanied by tinnitus. Perilymphatic fistula is associated with sudden unilateral hearing loss with tinnitus and vertigo. Acoustic neuroma is associated with tinnitus and gradual hearing impairment
19 225
🇨🇦 MCCQE1,2 | #Case_116
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A 47-year-old female presents with progressive difficulty hearing. She is employed as an office worker, has no significant past medical history, and takes no medications. Physical examination shows no gross abnormalities of her outer ears. The external ear canals are free of cerumen, and the tympanic membranes move well to insufflation. Weber’s test and the Rinne test have results that are compatible with a conductive hearing loss. Which one of the following is the most likely cause of this patient’s hearing loss?
a) Noise-induced hearing loss
b) Meniere’s disease
c) Otosclerosis
d) Acoustic neuroma
e) Perilymphatic fistula
