Case-based MCQ

A 45-year-old woman presents with a 3-month history of intermenstrual bleeding and increasing vaginal discharge with an unpleasant odor. Her last PAP smear was 8 years ago. On pelvic examination, the cervix appears friable with an irregular, ulcerated surface. What is the most likely diagnosis? 👍A. Endometrial cancer B. Nabothian cysts C. Cervical polyps D. Cervicitis E. Invasive cervical cancer The combination of intermenstrual bleeding, malodorous discharge, and a friable cervix with an irregular, ulcerated surface is characteristic of invasive cervical cancer.

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🧩 Medical Mnemonics “🄳🄺🄰” for VIPoma  - 𝗗iarrhea (watery, profuse)  - 𝗞+ lost (hypokalemia) - 𝗔chlorhydria #endocrinology 〰〰〰〰〰〰〰〰〰〰〰 ©Medical Mnemonics

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Correct Answer Is B A pH of 7.34 indicates acidemia, and low bicarbonate (20 mEq/L) suggests that the primary disorder is metabolic acidosis. Using Winters' formula to assess respiratory compensation, the expected PCO₂ is (1.5 × 20) + 8 ± 2 = 38 ± 2 mm Hg; the measured PCO₂ of 38 mm Hg indicates appropriate compensation. The anion gap is calculated as 140 - (98 + 20) = 22 mEq/L, corrected to 24.5 mEq/L for hypoalbuminemia, confirming high anion gap metabolic acidosis. The delta gap is (24.5 - 12)/(24 - 20) = 12.5/4 = 3.1; a delta gap > 2 indicates concurrent metabolic alkalosis. In this patient, uremia due to acute-on-chronic kidney injury is the likely cause of the high anion gap metabolic acidosis. Vomiting causes metabolic alkalosis through gastric acid loss, which is further compounded by contraction alkalosis due to intravascular volume depletion.

A 62-year-old woman with stage 4 chronic kidney disease presents to the emergency department with 3 days of progressive nausea and vomiting. She appears dehydrated and reports decreased urine output. Vital signs are BP, 90/55; P, 115; R, 24. Arterial blood gas shows pH 7.34, PCO2 38 mm Hg, and bicarbonate 20 mEq/L. Basic metabolic panel shows sodium 140 mEq/L, chloride 98 mEq/L, BUN 95 mg/dL, creatinine 4.5 mg/dL, and glucose 92 mg/dL. Albumin level is 3.0 g/dL. What is the correct interpretation of this patient's acid-base status? A. Mixed disorder: high anion gap metabolic acidosis and respiratory acidosis 👍B. Mixed disorder: high anion gap metabolic acidosis and metabolic alkalosis C. Simple metabolic alkalosis with appropriate respiratory compensation D. Simple high anion gap metabolic acidosis with appropriate respiratory compensation E. Mixed disorder: high anion gap metabolic acidosis and respiratory alkalosis

A 59-year-old man with a history of chronic alcohol use disorder and recent hospitalization for sepsis presents to the ED with generalized weakness and confusion. He moved in with his daughter 3 days ago so she could cook for him after she noticed he had stopped buying food for himself and lost a lot of weight. He has no chest pain or dyspnea. Vital signs are BP, 104/68 mm Hg; P, 118; R, 22; T, 37.1°C (98.8°F). Physical examination reveals tremulousness and diminished deep tendon reflexes. Laboratory results show sodium 138 mEq/L, potassium 3.2 mEq/L, magnesium 1.3 mg/dL, calcium 8.6 mg/dL, phosphate 0.8 mg/dL, and glucose 176 mg/dL. ECG shows sinus tachycardia without ischemic changes. Which of the following is the most appropriate initial management step in the ED? A. Administer intravenous calcium gluconate and potassium chloride B. Begin dextrose-containing intravenous fluids C. Administer intravenous phosphate replacement 👍 D. Provide oral phosphate, calcium, and magnesium supplementation and discharge with close follow-up E. Administer intravenous calcium gluconate and magnesium This patient has severe hypophosphatemia secondary to refeeding syndrome, commonly seen in malnourished or alcoholic patients after reintroduction of carbohydrates. Intravenous phosphate repletion is indicated when levels are below 1.0 mg/dL, the patient is symptomatic and/or they are unable to take oral medications. Monitoring for hypocalcemia, hypomagnesemia, and arrhythmias is essential during replacement.

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A 42-year-old woman presents with acute onset severe headache and visual changes. She reports amenorrhea and breast tenderness for several months. Physical examination shows severe bitemporal hemianopsia. Vital signs are BP, 88/52; P, 118; T, 36.8°C (98.2°F). Laboratory studies show sodium 124 mEq/L, potassium 4.2 mEq/L, and glucose 62 mg/dL. What is the most appropriate immediate management? A. Start IV fluids and arrange endocrinology consultation within 24 hours B. Obtain urgent MRI and admit for inpatient endocrinology consultation C. Administer IV methylprednisolone and obtain ophthalmology consultation D. Perform lumbar puncture and obtain head CT E. Administer IV hydrocortisone and obtain urgent neurosurgical consultation

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