Case-based MCQ

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🧠 Case-based MCQ 🔸 #MCQ_21 🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤 A 40-year-old man comes to the emergency department with black, tarry stools for the past 2 days. He is otherwise in good general health and takes no prescription medications. His supine blood pressure is 120/80 mm Hg and pulse is 84/min; after 1 minute of standing they are 118/76 mm Hg and 90/min. Physical examination is remarkable for pallor. Upper gastrointestinal endoscopy shows a nonbleeding duodenal ulcer with visible vessel, and endoscopic therapy is performed.

🧠 Case-based MCQ 🔸 #MCQ_20 🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤 The Correct answer is C Excessive impulsivity, as well as hyperactivity and inattention with impairment of the social, occupational, or academic performance, are the core features of attention deficit hyperactive disorder (ADHD). About 60% of patients with Tourette syndrome develop concomitant ADHD, making it the most common comorbidity. Obsessive-compulsive disorders (OCD) are also common in patients with Tourette syndrome. ❌Choice A is not correct: Defiant and hostile behavior toward teachers and parents is a classic feature of oppositional defiant disorders. Behavioral problems must persist over a period of ≥ 6 months to make the diagnosis. This patient most likely has Tourette syndrome, which is associated with numerous neuropsychiatric conditions, including oppositional defiant disorders and conduct disorders (15% of cases). However, another childhood neuropsychiatric condition is much more common, occurring in 60% of patients with Tourette syndrome. ❌Choice B is not correct: Dyscalculia is a specific learning disorder that is characterized by problems processing numerical information, learning arithmetic facts, and performing accurate or fluent calculations. Learning disorders may occur in isolation or in association with other neuropsychiatric disorders. Although learning disabilities occur in more than 20% of patients with Tourette syndrome, they are generally associated with concomitant ADHD rather than the tics themselves. ❌Choice D is not correct: This boy most likely has Tourette syndrome, which has a high incidence of psychiatric comorbidities. Patients often express shame and anxiety regarding their tics. It is not, however, associated with an increased risk for major depression disorder (MDD). MDD is however associated with a wide range of comorbidities, such as neurodegenerative diseases (e.g., Alzheimer's), chronic inflammatory diseases (e.g., systemic lupus erythematosus or inflammatory bowel disease), or other psychiatric disorders (e.g., panic disorder). ❌Choice E is not correct: Recurrent episodes of intense fear, accompanied by vegetative symptoms (sweating, nausea, difficulty breathing, tachycardia) are characteristic of panic attacks. Although patients with Tourette syndrome may develop anxiety disorders such as panic attacks, another childhood neuropsychiatric condition is much more common, occurring in 60% of patients with Tourette syndrome. ✅Summarized Points: This patient's presentation of involuntary blinking, shrugging, and grunting in combination with a normal physical examination indicates Tourette syndrome, which has a high incidence of comorbidities.

The Correct answer is C Excessive impulsivity, as well as hyperactivity and inattention with impairment of the social, occupational, or academic performance, are the core features of attention deficit hyperactive disorder (ADHD). About 60% of patients with Tourette syndrome develop concomitant ADHD, making it the most common comorbidity. Obsessive-compulsive disorders (OCD) are also common in patients with Tourette syndrome. Choice A is not correct: Defiant and hostile behavior toward teachers and parents is a classic feature of oppositional defiant disorders. Behavioral problems must persist over a period of ≥ 6 months to make the diagnosis. This patient most likely has Tourette syndrome, which is associated with numerous neuropsychiatric conditions, including oppositional defiant disorders and conduct disorders (15% of cases). However, another childhood neuropsychiatric condition is much more common, occurring in 60% of patients with Tourette syndrome. Choice B is not correct: Dyscalculia is a specific learning disorder that is characterized by problems processing numerical information, learning arithmetic facts, and performing accurate or fluent calculations. Learning disorders may occur in isolation or in association with other neuropsychiatric disorders. Although learning disabilities occur in more than 20% of patients with Tourette syndrome, they are generally associated with concomitant ADHD rather than the tics themselves. Choice D is not correct: This boy most likely has Tourette syndrome, which has a high incidence of psychiatric comorbidities. Patients often express shame and anxiety regarding their tics. It is not, however, associated with an increased risk for major depression disorder (MDD). MDD is however associated with a wide range of comorbidities, such as neurodegenerative diseases (e.g., Alzheimer's), chronic inflammatory diseases (e.g., systemic lupus erythematosus or inflammatory bowel disease), or other psychiatric disorders (e.g., panic disorder). Choice E is not correct: Recurrent episodes of intense fear, accompanied by vegetative symptoms (sweating, nausea, difficulty breathing, tachycardia) are characteristic of panic attacks. Although patients with Tourette syndrome may develop anxiety disorders such as panic attacks, another childhood neuropsychiatric condition is much more common, occurring in 60% of patients with Tourette syndrome. Summarized Points: This patient's presentation of involuntary blinking, shrugging, and grunting in combination with a normal physical examination indicates Tourette syndrome, which has a high incidence of comorbidities.

🧠 Case-based MCQ 🔸 #MCQ_20 🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤 A 7-year-old boy is brought to the physician because of repetitive, involuntary blinking, shrugging, and grunting for the past year. His mother states that his symptoms improve when he is physically active, while tiredness, boredom, and stress aggravate them. He has felt increasingly embarrassed by his symptoms in school, and his grades have been dropping from average levels. He has met all his developmental milestones. Vital signs are within normal limits. Mental status examination shows intact higher mental functioning and thought processes. Excessive blinking, grunting, and jerking of the shoulders and neck occur while at rest. The remainder of the examination shows no abnormalities.

🧠 Case-based MCQ 🔸 #MCQ_19 🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤 The absolute risk reduction is the difference in the event risk between the test group and placebo group. First, we must set up a table to determine the risk of each occurrence. Absolute risk reduction = Incidence of Event in Control – Incidence of the event in the treatment Incidence of event in control = 90/100→0.9 Incidence of event in treatment = 30/100 → 0.3 Absolute risk reduction=0.9-0.3= 0.6 or 60% ❌Choice A is not correct: It gives you the nonevent rate for the placebo group ❌ Choice B is not correct: It does not occur as any statistic in this problem ❌Choice D is not correct: It is the nonevent rate for the treatment group ❌Choice E is not correct: It is the event rate for the placebo group ✅Summarized Points: Absolute risk reduction = Incidence of Event in Control – Incidence of the event in the treatment

🧠 Case-based MCQ 🔸 #MCQ_19 🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤 A drug ad in a recent magazine explains the use of its medication in effectively reducing the transmission of the Influenza virus. The study used a sample of 200 college students who were selected within 4 hours of the appearance of symptoms. The group was divided into two groups of 100 patients. The first group was given the new treatment and the second group was given a placebo. In the test group 70 patients showed resolution within 24 hours whereas in the placebo group only 10 patients showed resolution in 24 hours.

🧠 Case-based MCQ 🔸 #MCQ_18 🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤 The correct answer is A. Mid-facial fractures commonly occur with blunt trauma to the face and are classified by their involvement of different areas of the mid-face. Le Fort injuries often present dramatically, with significant hemorrhage, early swelling, bilateral orbital ecchymosis, and cerebrospinal fluid leaks in Le Fort II and III injuries. Patients with Le Fort injuries often present with significant hemorrhage, requiring airway protection and nasal packing. Oral packing is often required for control of fractures involving the hard palate. Although CT scanning will be the definitive diagnostic tool in any facial fractures, a clinical exam can identify the type of fracture you expect to see. Further management will include antibiotics, tetanus prophylaxis, pain management, and surgical repair. Le Fort I is a fracture through the pterygoid plate and nasal septum that allows free movement of the hard palate and teeth. Le Fort II involves the central maxilla as well as the hard palate and free movement of the nose is included. Le Fort III is a fracture involving the frontozygoma, orbit, through the nose, and ethmoids. The hard palate through the inferior orbits are mobile in this case. Le Fort IV is any involvement of the frontal bone. ❌Choice B is not correct: Le Fort II involves the central maxilla as well as the hard palate and free movement of the nose is included. ❌Choice C is not correct: Le Fort III is a fracture involving the frontozygoma, orbit, through the nose, and ethmoids. The hard palate through the inferior orbits are mobile in this case. ❌Choice D is not correct: Le Fort IV is any involvement of the frontal bone. ✅Summarized Points: One way to assess for Le Fort fractures is to stabilize the forehead with one hand and rock the hard palate with the other.  If just the hard palate moves you can assume Le Fort I, if the nasal bridge moves it is associated with Le Fort II, and if the inferior orbits move then a Le Fort III is likely present.

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The correct answer is A. Mid-facial fractures commonly occur with blunt trauma to the face and are classified by their involvement of different areas of the mid-face. Le Fort injuries often present dramatically, with significant hemorrhage, early swelling, bilateral orbital ecchymosis, and cerebrospinal fluid leaks in Le Fort II and III injuries. Patients with Le Fort injuries often present with significant hemorrhage, requiring airway protection and nasal packing. Oral packing is often required for control of fractures involving the hard palate. Although CT scanning will be the definitive diagnostic tool in any facial fractures, a clinical exam can identify the type of fracture you expect to see. Further management will include antibiotics, tetanus prophylaxis, pain management, and surgical repair. Le Fort I is a fracture through the pterygoid plate and nasal septum that allows free movement of the hard palate and teeth. Le Fort II involves the central maxilla as well as the hard palate and free movement of the nose is included. Le Fort III is a fracture involving the frontozygoma, orbit, through the nose, and ethmoids. The hard palate through the inferior orbits are mobile in this case. Le Fort IV is any involvement of the frontal bone. Choice B is not correct: Le Fort II involves the central maxilla as well as the hard palate and free movement of the nose is included. Choice C is not correct: Le Fort III is a fracture involving the frontozygoma, orbit, through the nose, and ethmoids. The hard palate through the inferior orbits are mobile in this case. Choice D is not correct: Le Fort IV is any involvement of the frontal bone. Summarized Points: One way to assess for Le Fort fractures is to stabilize the forehead with one hand and rock the hard palate with the other.  If just the hard palate moves you can assume Le Fort I, if the nasal bridge moves it is associated with Le Fort II, and if the inferior orbits move then a Le Fort III is likely present.

🧠 Case-based MCQ 🔸 #MCQ_18 🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤 A 32-year-old man arrives as a trauma activation. He was riding a mountain bike downhill when he lost control and went over the handlebars. He was wearing a helmet however presents with severe facial pain and trauma. While stabilizing his forehead with one hand and using the other hand to gently rock the hard palate, only the hard palate and teeth move.

🧠 Case-based MCQ 🔸 #MCQ_17 🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤 The correct answer is C. The patient has an acute arterial occlusion, which is associated with the six P’s—Pain, Pallor, Paresthesias, Paralysis, Poikilothermia, and Pulseless (absence of pulse). The most likely cause is an embolus, but trauma could also be responsible. In an embolic arterial occlusion, there is no antecedent history of claudication pain. Emboli can spring from a recent myocardial infarct, mitral stenosis, artificial heart valve, or an aortic aneurysm. The condition occurs suddenly. The limb is cold to touch, and loss of motor function generally ensues within hours after onset of pain. For this reason, embolic arterial occlusion is an emergency. The first loss of function is the inability to move the toes. (In the case of venous occlusion, on the other hand, motor function is not lost.) Immediately anticoagulation with intravenous heparin followed by embolectomy and thrombectomy is the preferred treatment. The popliteal artery is the most susceptible vessel for occlusion because it is commonly affected by atherosclerosis and is a small-caliber artery. ❌Choice A is not correct: Superficial thrombophlebitis in the saphenous system of the legs presents with pain and tenderness along the course of the vessel. ❌Choice B is not correct: A herniated disk would not be expected to involve the whole leg, nor would it present with the given symptom/sign complex. A history of back pain followed by pain going down the leg (radicular pain) would be usual. Findings would include hypesthesia along the lateral or inner aspect of the leg, depending on which intervertebral disk has herniated, and weakness of the plantar or dorsiflexors of the foot. Straight leg raise test would be positive, and the deep tendon jerks may or may not be affected, depending on the level of herniation. The pulses will be normal, and skin temperature would be normal. ❌Choice D is not correct: Deep venous insufficiency is associated with superficial varicose veins and stasis dermatitis around the ankle. ❌Choice E is not correct: Hypovolemic shock produces hypotension, generalized pallor, and cold, clammy skin. ✅Summarized Points: Acute occlusion of an artery, usually caused by embolization which present with the six P’s—Pain, Pallor, Paresthesias, Paralysis, Poikilothermia, and Pulseless (absence of pulse). Immediately anticoagulation with intravenous heparin followed by embolectomy and thrombectomy is the preferred treatment

🧠 Case-based MCQ 🔸 #MCQ_16 🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤 A 68-year-old man with a long history of coronary artery disease and recent history of myocardial infarction is seen in the emergency room with a history of sudden onset of pain in the right leg. The patient also complained of numbness in the leg. Physical examination revealed pallor of the right leg, the skin was cool to the touch, and the patient had difficulty in moving his toes. Raising his leg increased the pallor, and the dorsalis pedis pulse could not be felt.

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🧠 Case-based MCQ 🔸 #MCQ_16 🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤 The correct answer is D. The patient displays many of the characteristics and feelings that are seen in borderline personality disorder. These patients often have childhoods that are characterized by inconsistent parenting and often a significant amount of abuse. The parents may not reinforce the validity of the patient’s inner feelings. The patients tend to divide people into all good or all bad categories, a well-known phenomenon termed “splitting.” They often have chronic feelings of emptiness and have many relationships that are labile in nature. Borderline patients have severe trouble regulating their emotions, as seen when the patient could not control her own anger at the therapist, and are therefore very impulsive. ❌ Choice A is not correct: The patient does not show a consistent disregard for the rules of society and the rights of others, which is characteristic of antisocial personality disorder. ❌ Choice B is not correct: The patient does not discuss being extremely afraid of situations that may result in interpersonal rejection, a key characteristic of avoidant personality disorder. ❌ Choice C is not correct: Although the patient displays shallow emotions, a characteristic of histrionic personality disorder, she also displays splitting, impulsivity, and volatile characteristics more indicative of a borderline personality disorder. Histrionic personality disorder is characterized by a pervasive pattern of excessive emotionality and attention seeking. ❌ Choice E is not correct: The patient does not exhibit grandiosity in her self-perception, making narcissistic personality disorder less likely. ✅ Summarized Points: The borderline personality disorder patient often has childhoods that are characterized by inconsistent parenting and often a significant amount of abuse.