Case-based MCQ

A 34-year-old man comes to the office due to intermittent dizziness over the past 3 months.  The patient has had episodes of a sudden spinning sensation, accompanied by nausea, that resolve spontaneously after approximately a minute.  Symptoms occur when he is lifting heavy weights, riding on an elevator, or after sneezing.  He has had no headache or ear pain but has trouble hearing out of the right ear.  The patient had a concussion after a bicycle collision 4 months ago but has no other medical conditions and has had no recent upper respiratory illness.  Vital signs are within normal limits.  Physical examination shows normal ears, including tympanic membranes.  There is no extremity weakness or sensory loss.  No nystagmus is present at rest but performing a Valsalva maneuver provokes nystagmus and the other reported symptoms.  Which of the following is the most likely diagnosis? A. Benign paroxysmal positional vertigo B. Eustachian tube dysfunction C. Ménière disease D. Orthostatic hypotension E. Perilymphatic fistula

Correct Answer Is B There is an increased risk of floppy iris syndrome with the use of selective-alpha blockers (especially tamsulosin) and interrupting treatment does not reduce this risk. The ophthalmologist may need to use a different operative technique and therefore it is important that the ophthalmologist is aware of past and / or current selective-alpha blocker use prior to surgery. While prazosin is a cheaper option, it has more side effects and requires multiple doses each day. Therefore, it is not recommended in international BPH guidelines. Tamsulosin is likely to reduce blood pressure and is not likely to worsen his hypertension. The 5-alpha reductase inhibitors (rather than the alpha-adrenoreceptor antagonists) can take several months to reach maximal effect in terms of symptoms. While sildenafil may improve voiding symptoms, it is not traditionally prescribed as a first-line option for BPH

A 67 year old male presents to see you for review after being started on tamsulosin two months ago by a colleague for symptomatic management of benign prostatic hyperplasia. He wishes to discuss the new medication with you today and is keen to know more about alternative options as his friends with similar problems are taking different medications to him. He has a past history of hypertension and is having cataract surgery in two weeks. Which piece of advice below is most appropriate for him? A. You advise him that prazosin may be a cheaper option compared with tamsulosin with less adverse effects B. You advise him that the tamsulosin may affect his cataract surgery and the ophthalmologist will need to be notified prior to surgery C. You advise him the tamsulosin is likely to worsen his hypertension and should be ceased D. You advise him that the tamsulosin can take several months to provide maximal improvement in symptoms and he should continue taking it for now E. You advise him that sildanafeil is a more effective first-line treatment for benign prostatic hyperplasia compared with tamsulosin

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🧩 Medical Mnemonics Short metacarpals Differentials “The fingerTIPS are short” 🖐 ▫Turner’s syndrome ▫Injury 📍Iatrogenic 📍Infection 📍Idiopathic ▫Pseudohypoparathyroidism 📍Pseudopseudohypoparathyroidism ▫Sickle cell disease (post- dactylitis) #radiology   〰〰〰〰〰〰〰〰〰〰〰 ©Medical Mnemonics

⚠️ 🔔 𝐒𝐀𝐕𝐄 𝐓𝐇𝐈𝐒 𝐋𝐈𝐒𝐓 𝐅𝐎𝐑 𝐀 𝐑𝐀𝐈𝐍𝐘 𝐃𝐀𝐘 !   ⬇️ 1. 🧩 𝗠𝗘𝗗𝗜𝗖𝗔𝗟 𝗠𝗡𝗘𝗠𝗢𝗡𝗜𝗖𝗦 (𝗟𝗘𝗔𝗥𝗡 𝗘𝗔𝗦𝗜𝗟𝗬) 2. 𝗖𝗔𝗦𝗘 - 𝗕𝗔𝗦𝗘𝗗 𝗠𝗖𝗤𝗦 ❔ 3. 🇨🇦 𝗠𝗖𝗖𝗤𝗘 𝗣𝗥𝗘𝗣𝗔𝗥𝗔𝗧𝗜𝗢𝗡 4. 🩺 𝗘𝗗𝗟 𝗠𝗘𝗗𝗜𝗖𝗢𝗦 (𝗠𝗘𝗗𝗜𝗖𝗔𝗟 𝗕𝗢𝗢𝗞𝗦 𝗔𝗡𝗗 𝗟𝗜𝗡𝗞𝗦) 5. 📚 𝗘𝗗𝗟 𝗣𝗛𝗔𝗥𝗠 6. 🏛📷 𝗢𝗡𝗟𝗜𝗡𝗘 𝗠𝗘𝗗𝗜𝗖𝗔𝗟 𝗦𝗖𝗛𝗢𝗢𝗟 7. 𝗥𝗘𝗦𝗜𝗗𝗘𝗡𝗖𝗬 𝗜𝗡 𝗚𝗘𝗥𝗠𝗔𝗡𝗬 🇩🇪 8. 𝗣𝗥𝗔𝗖𝗧𝗜𝗖𝗘 𝗜𝗡 𝗔𝗨𝗦𝗧𝗥𝗔𝗟𝗜𝗔 🇦🇺 9. 𝗠𝗕𝗕𝗦 & 𝗥𝗘𝗦𝗜𝗗𝗘𝗡𝗖𝗬 𝗜𝗡 𝗜𝗧𝗔𝗟𝗬 🇮🇹 10. 𝗥𝗘𝗦𝗜𝗗𝗘𝗡𝗖𝗬 𝗜𝗡 𝗨𝗞 🇬🇧 11. 𝗥𝗘𝗦𝗜𝗗𝗘𝗡𝗖𝗬 𝗜𝗡 𝗨𝗦 🇺🇸 12. 𝗥𝗘𝗦𝗜𝗗𝗘𝗡𝗖𝗬 𝗜𝗡 𝗖𝗔𝗡𝗔𝗗𝗔 🇨🇦 13. 𝗙𝗥𝗘𝗡𝗖𝗛 𝗠𝗘𝗗𝗜𝗖𝗔𝗟 𝗕𝗢𝗢𝗞𝗦 🇫🇷 14. 𝗚𝗘𝗥𝗠𝗔𝗡 𝗠𝗘𝗗𝗜𝗖𝗔𝗟 𝗕𝗢𝗢𝗞𝗦 🇩🇪 15. 𝗠𝗘𝗗𝗜𝗖𝗔𝗟 𝗥𝗘𝗦𝗘𝗔𝗥𝗖𝗛 🎓🫥 16. 📸 𝗗𝗘𝗥𝗠𝗔𝗧𝗢𝗟𝗢𝗚𝗬 𝗔𝗧𝗟𝗔𝗦 17. 𝗢𝗘𝗧 𝗣𝗥𝗘𝗣𝗔𝗥𝗔𝗧𝗜𝗢𝗡 ✅ 18. 𝗠𝗘𝗗𝗜𝗖𝗔𝗟 𝗔𝗠𝗔𝗭𝗢𝗡  🌐 19.  𝗖𝗔𝗥𝗗𝗜𝗢𝗟𝗢𝗚𝗬 𝗖𝗔𝗦𝗘𝗦 🫀 20. 💠 𝗨𝗪𝗢𝗥𝗟𝗗 𝗘𝗗𝗨𝗖𝗔𝗧𝗜𝗢𝗡𝗔𝗟 𝗢𝗕𝗝𝗘𝗖𝗧𝗜𝗩𝗘𝗦 21. 𝗠𝗘𝗗𝗜𝗖𝗖𝗢𝗨𝗡𝗧 - 𝗠𝗘𝗗𝗜𝗖𝗔𝗟 𝗔𝗖𝗖𝗢𝗨𝗡𝗧 🔄 22. 🏛 𝗠𝗘𝗗𝗜𝗖𝗔𝗟 𝗦𝗖𝗜𝗘𝗡𝗖𝗘𝗦 𝗔𝗣𝗣𝗟𝗬

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A 65-year-old woman presents to a hospital with confusion.Her heart rate is 52 beats/min, SaO2 is 89% on room air, respiratory rate is 9/min, the temperature is 29°C and blood sugar level-7.0mmol/l. Pupils are equal in diameter and reactive to light. Past medical history included hypothyroidism diagnosed 10 years ago. ECG shows sinus bradycardia. Laboratory investigations confirm the presence of mild normocytic normochromic anaemia, mild hyponatremia, normal serum potassium and primary hypothyroidism. All of the followings are treatment options except? A. IV T4 given B. Give oral T4 when patient is stable C. IV steroids D. Nalaxone and glucose E. O2 inhalation