Case-based MCQ

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🧠 Case-based MCQ 🔸 #MCQ_2 🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤 A group of investigators wants to study the relationship between sun exposure and squamous cell skin cancer. They enroll a group of lifeguards from several different high schools in three different states, as well as some of their classmates who have minimal sun exposure. This group is followed over the next 40 years for the development of skin cancer.

🧠 Case-based MCQ 🔸 #MCQ_21 🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤 The Correct answer is A Studies show that most stable patients with upper gastrointestinal bleeding have better outcomes with restrictive red blood cell transfusion (e.g., transfusion for hemoglobin <70 g/L) versus liberal transfusion (transfusion for hemoglobin <90 g/L). Restrictive transfusion may be associated with fewer complications, fewer episodes of rebleeding, and decreased mortality. Patients with variceal hemorrhage may have worsened bleeding if blood transfusion results in hemoglobin >100 g/L. ❌Choice B, C, D, and E are not correct: Patients at risk for morbidity in the setting of severe anemia (e.g., unstable coronary artery disease) can benefit from maintaining hemoglobin levels >90 g/L. Also, patients with massive bleeding and hemodynamic instability might require blood transfusion regardless of hemoglobin levels as the levels do not accurately reflect the amount of blood loss. This patient has no comorbidities and is hemodynamically stable without signs of active bleeding; therefore, blood transfusion for hemoglobin >70 g/L is not appropriate. Transfusion with fresh frozen plasma or platelets should be considered in patients with upper gastrointestinal bleeding and evidence of coagulopathy (INR >1.5 or platelets <50,000/mm3). The target INR is <3 prior to endoscopy. Endoscopy can be performed safely with mild to moderate coagulopathy provided patients receive fresh frozen plasma during the procedure. ✅Summarized Points: The threshold for blood transfusion in most stable patients with upper gastrointestinal bleeding is hemoglobin <70 g/L. Patients at risk for morbidity in the setting of severe anemia (e.g., unstable coronary artery disease) may benefit from maintaining hemoglobin >90 g/L.

🎖Best choice for medicos: iMD Some of this app's database: ⬜️ Qbanks: ✅ Uworld 2023 Qbanks ✅ Amboss 2023 Qbanks ✅ USMLE-Rx 2023 Qbanks ✅ NBME Self-assesment ✅ BoardVitals 2023 Qbanks ✅ BMJ OnExamination QBs 2023 ✅ CanadaQbank 2023 ✅ RadPrimer 2023 Qbanks ✅ Prometric MCQ 2023 ✅ AMEDEX & MPlusX 2023 Qbanks ✅ AceQBank - MCCQE 1 - 2023 ✅ MKSAP 2022 ✅ USMLE RX 2023 ✅ Passmedicine 2023 🔵Videos & Lessons: 💠 Boards&Beyond 2023 videos 💠 Kaplan 2022 videos 💠 Osmosis 2023 videos 💠 Pixorize 2023 videos 💠 Lect*urio 2023 videos 💠 Medical Cartoon 2023 videos 💠 Radiopaedia 2023 videos 💠 RadPrimer 2023 Lessons 💠 RadioGraphics Journals 💠 RSNA journals & videos 💠 AHA 2023 videos 💠 Oakstone (CMEInfo) 2023 videos 😀Clinical Support:      ✔️ Uptodate      ✔️ Lexicomp      ✔️ Sanford Guide      ✔️ Epocrates      ✔️ Micromedex      ✔️ eTG Therapeutic      ✔️ 5-Minute Clinical Consult      ✔️ Harrison's 21 Edition 🔹 In addition to thousands of other medical resources and books Supports all Android and iOS devices  🛒 🛒 💳Pay with your local currency 🔻 Contact us to get more info regarding the app @mediccounts 👥 Our channel @mediccount

✅️ Mediccount - Best Medical Sources at Best Price Toronto Notes 2023 Clinical handbook To Purchase the PDF 🏪 Contact Admin @Mediccounts

✅️ Mediccount - Best Medical Sources at Best Price 💧 2022-2023 MedStudy Videos Board Review (CME VIDEOS) 1️⃣Internal medicine 🎥18 Videos 🗃 File Size : 8.29 GB ════════════════════ 2️⃣Pediatrics 🎥27 Videos 🗃File Size = 36.50 GB 🟢 Pediatrics Flashcards PDF Format: 25 PDF files, 1012 flashcards ════════════════════ 🌐 Contact us: @Mediccounts

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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.