Case-based MCQ

🫀Cardiology Cases | #case29 A 75-year-old female had a syncopal episode at the airport. She had no memory of the event. There was no report of chest pain. On arrival in the emergency department, she was asymptomatic; her examination was normal except for a forehead laceration.

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🧠 Case-based MCQ 🔸 #MCQ_61 🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤 A 26-year-old primigravid woman comes to the office during the fall to establish prenatal care after a positive home pregnancy test. Her last menstrual period was 7 weeks ago. The patient is healthy and takes no medications. Ultrasound shows a viable intrauterine gestation. Prenatal laboratory results reveal susceptibility to rubella and varicella. She is up to date on vaccinations. Which of the following vaccines is recommended during this patient's pregnancy? A. Intranasal influenza B. Measles-mumps-rubella C. Pneumococcal D. Varicella E. Tetanus-reduced diphtheria-acellular pertussis

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🧠 Case-based MCQ 🔸 #MCQ_61 🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤 The correct answer is A. This patient's acute onset pelvic pain and tender adnexal mass are concerning for ovarian torsion, a gynecologic emergency. During ovarian torsion, the ovary rotates around the infundibulopelvic ligament, resulting in ovarian vessel occlusion and subsequent loss of its blood supply. Ovarian blood flow can be assessed via Doppler evaluation of the ovary during pelvic ultrasound which shows decreased or absent blood flow in patients with ovarian torsion. This impeded ovarian blood supply causes the ovary to become edematous (e.g., acute pain, tender adnexal mass) and, eventually, necrotic (e.g., fever, leukocytosis). Because ovarian torsion is common in reproductive-age women (particularly during pregnancy or ovulation induction), immediate surgical management is required as ovarian necrosis can result in the loss of ovarian function (e.g., infertility, menopause). Surgery definitively diagnoses ovarian torsion and allows for mechanical ovarian detorsion and removal of any contributory cysts or masses. If the ovary still appears necrotic after these measures, oophorectomy is performed. ❌Choice B is not correct: An ectopic pregnancy can present with acute unilateral pelvic pain and a tender adnexal mass. This patient has a negative pregnancy test, making this diagnosis unlikely. ❌Choice C is not correct: The cysts associated with polycystic ovary syndrome are small; therefore, patients usually have bilateral, minimally enlarged ovaries. Due to chronic anovulation, patients do not typically have associated pain. ❌Choice D is not correct: A tubo-ovarian abscess can present with unilateral adnexal tenderness; however, patients typically have associated fever, making this diagnosis unlikely. ❌Choice E is not correct: A pedunculated uterine leiomyoma can present as an adnexal mass; however, patients typically have a concomitant enlarged, irregularly shaped uterus. ✅Summarized Points: Ovarian torsion typically presents with acute-onset unilateral pelvic pain and a tender adnexal mass. It is a gynecologic emergency requiring immediate surgical management as prolonged torsion can result in ovarian necrosis and loss of ovarian function

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🧠 Case-based MCQ 🔸 #MCQ_61 🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤

🧠 Case-based MCQ 🔸 #MCQ_59 🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤 A 32-year-old woman comes to the emergency department due to right-sided pelvic pain. The pain began suddenly 2 hours ago and is not relieved with ibuprofen. For the past hour, the patient has also had uncontrolled vomiting. Temperature is 36.7 C (98 F), blood pressure is 146/80 mm Hg, and pulse is 110/min. Physical examination reveals a small, mobile uterus and a tender mass in the right adnexa. The urine pregnancy test is negative. Which of the following is the most likely diagnosis in this patient? A. Ovarian torsion B. Ectopic pregnancy C. Polycystic ovary syndrome D. Tubo-ovarian abscess E. Uterine leiomyoma

🧠 Case-based MCQ 🔸 #MCQ_59 🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤 🔤 The correct answer is A. Biliary atresia is the most common congenital biliary anomaly. Typical symptoms include variable degrees of jaundice, dark urine, and light stools. In most cases of biliary atresia, infants are typically full-term, although a higher incidence of low birth weight may be observed. In the majority of cases, acholic stools are not noted at birth but develop over the first few weeks of life. Conjugated hyperbilirubinemia can be seen in laboratory evaluation. A "triangular cord sign" can be seen on abdominal ultrasound. No primary medical treatment is relevant in the management of extrahepatic biliary atresia. Once biliary atresia is suspected, surgical intervention is the only mechanism available for a definitive diagnosis (intraoperative cholangiogram) and therapy (Kasai portoenterostomy). ❌Choice B is not correct: Autoimmune hepatitis typically presents with elevated liver transaminases and does not typically cause jaundice in a newborn. ❌Choice C is not correct: Choanal atresia refers to obliteration or blockage of the posterior nasal aperture and is not a cause of jaundice. ❌Choice D is not correct: Hemolytic disease of the newborn, or erythroblastosis fetalis, presents with jaundice within the first 24 hour of life. In the above scenario, jaundice is not identified at birth and the newborn is discharged 24 hour following a term vaginal delivery, suggesting another etiology. ✅Summarized Points: Suspect biliary atresia in newborns who develop jaundice, dark urine, and light-coloured stools several weeks following birth

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🧠 Case-based MCQ 🔸 #MCQ_59 🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤 A 2-week-old infant develops new-onset jaundice and light-coloured stools. The infant was delivered via spontaneous vaginal delivery at term and was discharged from the hospital 24 hour later with no complications. No jaundice was noted at the time of discharge. What is the most likely diagnosis? A. Biliary atresia B. Autoimmune hepatitis C. Choanal atresia D. Erythroblastosis fetalis

🧠 Case-based MCQ 🔸 #MCQ_59 🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤 The correct answer is B. Cyanosis is a bluish discoloration of the skin that is often caused by hypoxia. It is not a sensitive indicator of hypoxia, as it is only apparent with more severe hypoxia (often at a saturation < 85%). Cyanosis is often classified as central and peripheral. Central cyanosis is always considered pathologic and is caused by impaired oxygenation. Possible causes may include hypoventilation from respiratory depression, ventilation-perfusion mismatch in the lung, bronchospastic lung disease (such as in asthma), hypothermia, heart failure, and structural heart abnormalities. In contrast, peripheral cyanosis occurs in the extremities such as the fingertips and may or may not be pathologic or life-threatening. Possible causes of peripheral cyanosis include heart failure, cardiogenic shock, local vasoconstriction (such as from cold or Raynaud phenomenon), and arterial obstruction. On occasion, differential cyanosis may be seen, which is a difference in cyanosis between the upper and lower extremities and may indicate congenital cardiac abnormalities (such as aortic coarctation). ❌Choice A, C and D are not correct: Arterial vasospasm, hyperviscosity, and hypothermia are all possible causes of peripheral cyanosis but would not cause isolated central cyanosis. ✅Summarized Points: When the systemic arterial concentration of deoxygenated hemoglobin (Hb) in the blood exceeds 50 g/L (oxygen saturation≤ 85 percent), the patient develops central cyanosis. In contrast, patients with peripheral cyanosis, on the other hand, have normal systemic arterial oxygen saturation, but enhanced oxygen extraction causes a large systemic arteriovenous oxygen difference and increased deoxygenated blood on the venous side of the capillary beds. Causes include vasomotor instability, vasoconstriction caused by exposure to cold, venous obstruction, elevated venous pressure; polycythemia; and low cardiac output.

A 12-hour-old girl presents to the emergency department for what her mother describes as “turning blue.” She was born at home without prenatal care. Her mother states she did not notice any abnormalities at birth. Vitals and intravenous access are being obtained. Physical exam reveals the finding below. Which of the following is a possible cause of this patient’s symptoms? A. Arterial vasospasm B. Congenital heart lesion C. Hyperviscosity D. Hypothermia