Case-based MCQ

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🧠 Case-based MCQ 🔸 #MCQ_61 🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤 A 45-year-old man returns to the office after experiencing an acute ST-elevation myocardial infarction 4 weeks ago. The patient underwent urgent right coronary artery revascularization with the placement of a drug-eluting stent. He is motivated to quit smoking but thinks that he needs help. The patient's discharge medications include atorvastatin, metoprolol, aspirin, and prasugrel. Physical examination is unremarkable. During the current visit, he is prescribed varenicline. Appropriate behavioral support is also provided.  Which of the following should be assessed at this patient's follow-up visit in a week? A. Weight gain B. Muscle aches C. Bleeding issues D. Liver function tests E. Unusual behaviors

🧠 Case-based MCQ 🔸 #MCQ_61 🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤 The correct answer is E. Maternal vaccination is beneficial to both mother and fetus, and the optimal time for administration is prior to conception. Vaccinations during pregnancy are indicated if the vaccine has minimal risk if a significant risk exists for infection exposure and if increased morbidity and mortality are associated with infection. Vaccines that are safe during pregnancy include immunoglobulins (e.g., Rho(D) immunoglobulin), toxoids (e.g., tetanus toxoid), and inactivated vaccines (e.g., tetanus toxoid-reduced diphtheria toxoid-acellular pertussis [Tdap], injectable influenza virus). Live-attenuated vaccines (e.g., intranasal influenza, measles-mumps-rubella [MMR], varicella) are contraindicated during pregnancy due to the theoretical risk of congenital infection. Pertussis (whooping cough) in infants is associated with high rates of disease complications (e.g., seizure, renal failure, pneumonia) and mortality. Because infant pertussis infection is so severe, Tdap vaccination is recommended for women during each pregnancy regardless of vaccination history. The Tdap vaccine is safe during every trimester. Vaccination during the third trimester is preferred, as it facilitates both the maternal antibody response and the transfer of maternal antibodies through the placenta, providing passive immunity to the fetus. ❌Choice A,B and D are not correct: Due to the theoretical risk of congenital infection, live-attenuated vaccines (e.g., intranasal influenza, measles-mumps-rubella [MMR], varicella) are contraindicated during pregnancy. ❌Choice C is not correct: The pneumococcal vaccine is safe in pregnancy; however, it is recommended for patients who have risk factors for invasive pneumococcal infection (e.g., chronic lung disease, immune deficiency). ✅Summarized Points: Tetanus toxoid-reduced diphtheria toxoid-acellular pertussis vaccination is recommended for women during each pregnancy regardless of vaccination history. Vaccination during the third trimester protects the mother against pertussis and provides passive immunity to the infant

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🫀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