Case-based MCQ

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🧠 Case-based MCQ 🔸 #MCQ_24 🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤 A 25-year-old man is stabbed in the right chest with a 5-cm-long knife blade. On arrival at the emergency department, he is wide awake and alert. He is speaking with a normal tone of voice but complaining of shortness of breath. The right hemithorax is hyperresonant to percussion and has no breath sounds; the rest of the initial survey is negative. His blood pressure is 100/75 mm Hg, pulse is 86/min, and venous pressure is 4 cm H2O. Pulse oximetry shows a saturation of 86%.

🧠 Case-based MCQ 🔸 #MCQ_23 🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤 The correct answer is A. The sympathomimetic toxidrome is seen with the acute abuse of cocaine, amphetamines, or decongestants. Cocaine causes the release of dopamine, epinephrine, norepinephrine, and serotonin. The greatest impact comes from adrenergic stimulation by norepinephrine and epinephrine. Norepinephrine causes vasoconstriction by stimulating alpha-adrenergic receptors on vascular smooth muscle. Epinephrine increases myocardial contractility and heart rate through stimulation of beta-1-adrenergic receptors. In addition to causing catecholamine release, the reuptake of these neurotransmitters is inhibited. Clinically, patients are usually hypertensive, tachycardic, and exhibit mydriatic pupils. In massive overdoses, cardiovascular collapse can result in shock and wide-complex dysrhythmias. central nervous system effects include seizures. Sympathomimetic toxidrome is sometimes difficult to distinguish from anticholinergic toxidrome. The difference is that patients usually present with dry mucous membranes with an anticholinergic overdose, whereas patients are diaphoretic with sympathomimetics. Treatment is usually supportive. Benzodiazepines should be administered for agitation, hypertension, and hyperthermia. ❌Choice B is not correct: Fluoxetine is a selective serotonin reuptake inhibitor (SSRI). In overdose, the increased serotonin has its greatest effect on the gastrointestinal (nausea, vomiting, abdominal pain), cardiovascular (tachycardia, bradycardia, QTc prolongation), and central nervous systems (dizziness, hyperreflexia, agitation). Overdose of fluoxetine alone rarely produces serotonin syndrome. ❌Choice C is not correct: Phencyclidine (PCP) is a dissociative agent that, when smoked, leads to a wide variety of findings. Patients may exhibit bizarre behavior, agitation, and violence. A blank or catatonic stare is common. Vertical, horizontal, and rotary nystagmus are often present. ❌Choice D is not correct: Dextromethorphan, a common ingredient in cold preparations, shares similar properties to phencyclidine (PCP) and other opioid compounds. It inhibits the uptake of serotonin and blocks the N-methyl-D-aspartate receptor at the PCP binding site. Clinically, overdose causes lethargy, agitation, dysarthria, ataxia, diaphoresis, hypertension, and nystagmus. At high doses, intoxication resembles that of LSD, with euphoria and hallucinations. Dystonic reactions have been reported in children after therapeutic administration. Because dextromethorphan inhibits the uptake of serotonin when it is ingested with a serotonin reuptake inhibitor, it can induce serotonin syndrome. ✅Summarized Points: Cocaine intoxication causes sympathomimetic toxidrome, which causes diaphoresis (unlike anticholinergic overdose), seizures and agitation (treated with benzodiazepines), and wide-complex dysrhythmias (treated with sodium bicarbonate). Beta-blockers should be avoided in cocaine intoxication.

🧠 Case-based MCQ 🔸 #MCQ_23 🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤 A 19-year-old man presents to the emergency department in police custody after using an unknown drug. Vital signs include a blood pressure of 170/85 mm Hg, pulse 120/min, temperature 37.8°C, respiratory rate 18/min, and pulse ox 99% on room air. On exam, he is agitated and diaphoretic. His pupils are 7 mm and reactive.

🧠 Case-based MCQ 🔸 #MCQ_22 🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤 The correct answer is C. The study involved taking a group of people who had exposure to a risk factor and a control group with minimal exposure, and following them over time to determine whether there is a relationship between sun exposure and skin cancer. This describes a cohort study. ❌Choice A is not correct: A case series study is useful for studying rare diseases. It involves descriptions of the clinical presentation of several people who are believed to have a particular disease. There is no control group, so causality is not able to be established. ❌Choice B is not correct: A case-control study is a retrospective study that is useful for studying rare diseases. This type of study involves finding a group of people with a disease and a control group without the disease and then looking for risk factors that led to the disease. ❌Choice D is not correct: This type of study is useful for determining the prevalence of a disease in a population. It involves a one-time sampling of a population to determine whether they have a certain disease and then examining the prevalence of risk factors in the population. It cannot establish causality. ❌Choice E is not correct: A randomized clinical trial is the gold standard of studies. It involves randomly separating two groups and then exposing one group to the trial substance and the other group to placebo to determine the effects of the exposure. Randomization helps control for confounding factors. ✅Summarized Points: Cohort studies are prospective studies that examine a group exposed to a risk factor and a group not exposed, and then determine who gets the disease.

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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.

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✅️ 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

🇨🇦 Offical MCCQE Part I Preparatory Materials ✅ MCCQE Part I - MCQ and CDM Test - (August 2023) ✅ MCCQE Part I - Prep Exam-Lite (July 2023) - MCQ + CDM ✅ MCCQE Part I Full - length Preparatory Examination (PE) Qbank (April 2023) 🔻 Follow @Mediccount 🔻 Contact Admin: @Mediccounts

🧠 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.