Case-based MCQ

⏳ Case-based MCQ | #Case_336 〰〰〰〰〰〰〰〰〰〰〰〰〰〰 A 2 year old child wasbrought by his mother with swelling on the right side of his neck extending from the angle of the mouth to the middle one third of the sternocleidomastoid muscle. The swelling is on the anterolateral side of the sternocleidomastoid muscle. On examination, the mass is partially compressible, when subjected to light test is brilliantly translucent.

⏳ Case-based MCQ | #Case_335 | #answer 〰〰〰〰〰〰〰〰〰〰〰〰〰〰 ✅ B This is a case of oculomotor nerve palsy. Diplopia, mydriasis, ptosis, outward downward deviation of the eye as described here are clinical features of oculomotor nerve palsy.An oculomotor nerve palsy can be associated with vascular disorders such as diabetes,or particularly posterior communicating artery aneurysm. Other causes include space occupying tumours, infarction. abscess and trauma. Angiographic imaging studies are often necessary in the evaluation of acute oculomotornerve palsy. A computed tomographic angiography would be a good option here to help exclude a posterior communicating artery aneurysm. Note that this can also be done with a magnetic resonance angiography. MRI would also be useful as it is a more sensitive imaging technique than CT scan for picking out a small intraparenchymal brainstem lesion, such as infarction, small abscess, or tumor however CT scan is more sensitive than MRI to demonstrate subarachnoid hemorrhage. All of these have potential to cause an oculomotor nerve palsy. Oculomotor nerve palsy - The initial sign is often a fixed dilated pupil which does not accommodate - Then ptosis develops - Unopposed lateral rectus causes outward deviation of the eye. Characteristicdown and out position of the affected eye. The simple method to remember this for the exam is: CN III - Oculomotor nerve - Will have features of either ptosis and/or a dilated pupil on the nerve on the same side as the affected eye - Mnemonic: Letter “O” for oculomotor which with good imagination canrepresents a dilated pupil

🧩 Medical Mnemonics Learn Pancoast Syndrome Features using Mnemonic "Pancoast" ! Enjoy Learning;) https://www.instagram.com/p/CJY7v7Whykq/?igshid=1f38avhlzjfc4 💻 Join us in the official Instagram page: Online Medical School #pulmonology 〰〰〰〰〰〰〰〰〰〰〰 ©Medical Mnemonics

After more than two years of your honorable companion in Telegram, We would like to see you on the official Instagram page Join us in : Online Medical School Instagram.com/Online_Medical_School

♠♦♣♥ Get ready to challenge your medical knowledge ! 🏟 https://t.me/joinchat/De8XUlQZJDdwKMDv7ZN3ag 🕟 Sat, December 19 at 16.30 GMT

⏳ Case-based MCQ | #Case_335 〰〰〰〰〰〰〰〰〰〰〰〰〰〰 A 33 year old female complains of double vision which started yesterday. On examination, a fixed dilated pupil which does not accommodate and drooping eyelid can be seen on the left eye. Her left eye is displaced outward and downwards. She has no significant past medical history. There was no history of trauma.

⏳ Case-based MCQ | #Case_334 | #answer 〰〰〰〰〰〰〰〰〰〰〰〰〰〰 ✅ D Complete miscarriage is a spontaneous abortion with expulsion of the entire fetus through the cervix. Pain and uterine contractions cease after the fetus has been expelled. An ultrasound scan would show an empty uterus

⏳ Case-based MCQ | #Case_334 〰〰〰〰〰〰〰〰〰〰〰〰〰〰 A 22 year old woman who was diagnosed with a missed miscarriage a week ago presented to the hospital last night with abdominal pain and vaginal bleeding. Since then, she has passed a small fetus. A transvaginal ultrasound was repeated which showed an empty uterus. The pain is slowly easing off.

The best channels in telegram 🌹 1. physiology https://t.me/physiology_yaqob 2. anatomy https://t.me/Anatomy2019 3. biochemistry https://t.me/biochemistry_medical 4.HISTOLOGY https://t.me/histology_haron 5. PHARMACOLOGY https://t.me/pharmacology2017 6. pathology https://t.me/pathology_medical 7. Microbiology https://t.me/Microbilogy_2019 8. Notes https://t.me/tafrighat 8. medical MCQs https://t.me/MCQ_mogahed 9. القناة الطبية https://t.me/medicalpatch_19 10. Cardiovascular system channel https://t.me/cardiology_mogahed 11. Respiratory system channel https://t.me/Respiratory_Mogahed 12.medical app https://t.me/medical_android 13. قناة ترفيهية طبية (لقد وقع الطب فينا ) https://t.me/med_fall_inus 14. BLOOD and lymph channel https://t.me/blood_lymph_mogahed 15. Modern of medicine channel https://t.me/Dr_haron 16 . medical books 📚 https://t.me/medical_books2019 17. Dr. Najeep vedioes https://t.me/joinchat/AAAAAFTv0bO6Kjn905saTQ

⏳ Case-based MCQ | #Case_333 | #answer 〰〰〰〰〰〰〰〰〰〰〰〰〰〰 ✅ A This patient’s investigations have all returned back normal. The clue here is picking up the fact that her symptoms were not relieved by sublingual GTN. This tells us that it is unlikely ACS or unstable angina although in reality we do not use people’s response to glyceryl trinitrate (GTN) to make a diagnosis. However, this is an exam, and these phrases are sometimes used to inform you that this is not an ischaemic event. In reality, if bloods were requested and taken, a troponin would likely be added in and sent off as well. The stem also drops another hint letting you know that she has no medical problems. She therefore does NOT have diabetes, hypertension, hypercholesterolaemia or a smoking history which are risk factors for an acute coronary syndrome. Do not get thrown by the slight tachycardia in the stem as it is likely the result from anxiety of the chest discomfort. Costochondritis is the answer here and can sometimes mimic symptoms of an acute coronary syndrome. Movements of the rib cage can produce pain. Costochondritis is inflammation of costochondral junctions of ribs or chondrosternal joints of the anterior chest wall. It is sometimes called Tietze’s syndrome, but it is not the same thing. Tietze’s syndrome is the addition of swelling over the affected joints of the anterior chest wall. 🟣COSTOCHONDRITIS • Usually presents in patients over 40 • Painmay be described as sharp or aching • The pain is aggravated by movement such as deep inspiration, coughing or sneezing • Tenderness to palpation at sides of sternum The diagnosis is a clinical one and it is a self-limiting disease. Mild pain medication such as non-steroidal anti-inflammatory drugs may be given.

⏳ Case-based MCQ | #Case_333 〰〰〰〰〰〰〰〰〰〰〰〰〰〰 A 55 year old woman presents to A&E with the complaint of aching chest pain. She is very nervous and anxious as she thinks that this could be a heart attack. She has no family history of cardiac disease and has no other medical problems. She was given sublingual GTN which has failed to relieve her symptoms. Upon further questioning, she admits that the pain is worse when she breathes in. Her chest X-ray is reported as ‘normal’ and an ECG is performed, which also shows no significant acute changes. Her vitals are as follows: Temperature: 37.2 °C Heart rate: 110 beats/minute Blood pressure: 125/85 mmHg A full blood count has been done and shows: Haemoglobin: 12.8 g/dL Platelets: 320 x 10`9/L White chell count: 7.8 x 10`9/L CRP is 10.7 mg/L What is the SINGLE most likely diagnosis in this patient? A. Costochondritis B. Pericarditis C. Acute coronary syndrome D. Unstable angina E. Pneumonia

⏳ Case-based MCQ | #Case_332 | #answer 〰〰〰〰〰〰〰〰〰〰〰〰〰〰 ✅ E Pulmonary regurgitation is a common complication after surgical or percutaneous relief of pulmonary stenosis and following repair of Fallot's tetralogy. Pulmonary regurgitation is usually asymptomatic unless severe, when it may lead to signs of right heart failure. It is possible for patients to live for many decades following surgical repair of tetralogy of Fallot but a major problem encountered is the development of pulmonary regurgitation which may require pulmonary valve replacement.

⏳ Case-based MCQ | #Case_332 〰〰〰〰〰〰〰〰〰〰〰〰〰〰 A 42 year old lady had corrective surgery for cyanotic congenital heart disease at the age of 3 after having a palliative operation during infancy. On examination, a parasternal heave and a diastolic murmur at the left upper sternal edge is noted. What is the SINGLE most likely diagnosis? A. Aortic regurgitation B. Mitral regurgitation C. Aortic stenosis D. Pulmonary stenosis E. Pulmonary regurgitation

⏳ Case-based MCQ | #Case_331 | #answer 〰〰〰〰〰〰〰〰〰〰〰〰〰〰 ✅ E This patient’s symptoms have everything to do with the fact that he was given metoclopramide for his nausea. It is important to note that neck stiffness can be communicated as being anything from muscle weakness to muscle pain by the patient. Extrapyramidal symptoms are most commonly caused by antipsychotic drugs such as haloperidol. Other anti-dopaminergic drugs, like the antiemetic metoclopramide, can also result in extrapyramidal side effects. Acute dystonic reactions can occur as well, and these occur shortly after treatment with metoclopramide

⏳ Case-based MCQ | #Case_331 〰〰〰〰〰〰〰〰〰〰〰〰〰〰 A 57 year old man with known squamous cell lung carcinoma has chronic right shoulder pain which had been well controlled with oral morphine in the past. He has now, however, been switched to a fentanyl patch to control his pain due to the nausea and vomiting side effects that he experienced from his morphine treatment. The patient claims that a few hours after he was switched to the fentanyl patch and gibven metoclopramide for his vomiting, his neck became weak and stiff. Other than his chronic pain medication, the patient takes no other medication or over-the-counter drugs. What is the SINGLE most likely cause of this patient’s neck stiffness? A. Malignat hyperthermia B. Fentanyl patch C. Hypercalcaemia D. Metastatic meningitis E. Side effect of metoclopramide treatment

⏳ Case-based MCQ | #Case_330 | #answer 〰〰〰〰〰〰〰〰〰〰〰〰〰〰 ✅ C Nephrotic syndrome is the combination of proteinuria, oedema and hypoalbuminaemia. Not only is albumin is lost in the urine, anti-coagulation factors are also lost such as antithrombin III. A reduction or deficiency in antithrombin III predisposes patients to venous thromboembolism. Protein C is present in the urine of nephrotic patients and its deficiency can also predispose to venous thromboembolism. However, plasma levels remain within normal limits and it is not thought to be involved in the development of renal vein thrombosis in these patients. Treatment of a renal vein thrombosis is with anticoagulation. It is unclear why the renal vein is susceptible to thrombosis. The most common cause of nephrotic syndrome in children is minimal change disease

⏳ Case-based MCQ | #Case_330 〰〰〰〰〰〰〰〰〰〰〰〰〰〰 A 10 year old boy has been diagnosed with nephrotic syndrome and started on steroids. 5 days later he presents with flank pain, haematuria and fluctuating urea levels. A diagnosis of renal vein thrombosis is made. What is the SINGLE most likely cause for renal vein thrombosis? A. Protein C deficiency B. Vasculitis C. Loss of antithrombin III D. High oestrogen levels E. Stasis