Case-based MCQ

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Case-based MCQ | #MCQ_87 •••••••••••••••••••••••••••••••••••••• The shiny nodule shown in the photograph which appears to be fluid-filled is suggestive of the digital synovial cyst (mucous cyst of the finger ). Mucous (synovial) cysts of the finger are subcutaneous cystic lesions found on the dorsal aspect of the distal phalanx, distal to the distal interphalangeal joint, and overlying the germinal nail bed. They may cause distortion of the nail growth. They are located in the midline or laterally. They grow slowly and may undergo spontaneous resolution. Recurrence is likely if they are inadequately excised.

The lesion shown in the accompanying photograph has been present on the finger of a 56-year-old woman for the past 8 months. It has slowly enlarged since then and is causing mild discomfort. Which one of the following is the most likely diagnosis? A. Chronic paronychia. B. Heberden’s node of osteoarthritis. C. Pyogenic granuloma. D. Mucous (synovial) cyst of the finger. E. Rheumatoid nodule

Case-based MCQ | #MCQ_86 •••••••••••••••••••••••••••••••••••••• The lesion shown has a bluish-glistening color and is dome-shaped. These are characteristics of a benign mucoid cyst. A mucous cyst, also known as a mucocele forms when mucus or saliva escapes into surrounding tissues. A lining of granulation or connective tissue is formed to create a smooth, soft round fluid-filled lump. They most commonly occur on the inner surface of the lower lip (75% of cases) but may also appear on the floor of the mouth or on the gums, buccal mucosa, and tongue. If persistent or bothersome, an incision and evacuation of the cyst are performed. 

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On a routine health examination, the lesion shown in the following photograph is found on the inner side of the lower lip of a 37-year-old man. The lesion is painless. Which one of the following is the most likely diagnosis? A. Sebaceous cyst. B. Peutz - Jegher's syndrome. C. Squamous cell carcinoma of the lip. D. Mucous cyst.  E. Basal cell carcinoma.

Case-based MCQ | #MCQ_85 •••••••••••••••••••••••••••••••••••••• Correct Answer Is A Every lesion suspected of being melanoma should be surgically excised with 2 mm margins both as the initial management and the most appropriate step in diagnosis. Further management is then guided by tne results of the biopsy. If the lesion is proved to be melanoma, a wider excision is needed. The margins of the second excision depend on the reported depth of melanoma. For melanomas greater than 1mm in depth, a sentinel node biopsy is recommended during the second excision to assess the potential metastasis to the subcutaneous tissue and lymph nodes

Case-based MCQ | #MCQ_85 •••••••••••••••••••••••••••••••••••••• A 32-year-old woman presents to your clinic for a skin checkup. On examination, she is found to have a skin lesion on her upper back. The lesion is highly suspected of being melanoma. An excisional biopsy is performed with 2 mm margins and the specimen is sent to a laboratory for histopathological studies. The result is a melanoma of 2.5 mm in depth. The margins, however, are clear. Which one of the following would be the next best step in management? A. A wider excision. B. Radiation therapy. C. Sentinel node biopsy. D. CT scan of the head. E. Chemotherapy

Case-based MCQ | #MCQ_84 •••••••••••••••••••••••••••••••••••••• Carotid endarterectomy is the procedure of choice in some patients with carotid stenosis. This procedure is associated with complications, the most important of which are as follows: Perioperative stroke Myocardial infarction Hyper-reperfusion syndrome Cervical hematoma Nerve injury Infection Carotid restenosis Postoperative cervical wound hematoma is a potentially lethal complication of carotid endarterectomy (CEA). The hematoma can rapidly distort the airway anatomy, making tracheal intubation difficult, and ultimately causing fatal airway obstruction. Post-CEA patients might develop airway emergencies related to hematoma formation either in the hospital or after discharge. The progressive short of breast in this patient is most likely to have been caused by an expanding cervical hematoma. As always, management starts with the ABCD of life support (airway, breathing, circulation, and disability). The first step in this approach is ensuring and maintaining a patent airway.  This patient has a rapidly deteriorating airway in need of urgent attention with intubation (option A). Initial method of airway management is based on the location, severity, and progression of the hematoma. Most patients can be managed successfully using a stepwise approach, beginning with awake fiber-optic intubation if time permits. If this fails, laryngoscopy, with either a direct or video laryngoscope, is a reliable backup. However, in a time-sensitive critical situation where there is impending respiratory compromise or airway loss, opening of all the wound layers at the spot (patient’s bedside in the Emergency Department in this scenario) to decompress the trachea and facilitate airway management should always be considered first as the most immediate action

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A 65-year-old man underwent an uneventful right carotid endarterectomy 4 days ago. Today, he presents with shortness of breath which is progressively becoming worse. Which one of the following would be the best immediate step in management? A. Intubation. B. Tracheostomy. C. Opening all the wound layers in the Emergency Department. D. Supplemental oxygen via face mask. E. Opening all the wound layers in the operating theater

Case-based MCQ | #MCQ_83 •••••••••••••••••••••••••••••••••••••• John has not completed his primary course of tetanus vaccination. On the other hand, his wound is contaminated with soil and is dirty. With an incomplete course of primary immunization and a dirty wound, he should receive TIG for passive and a tetanus-containing vaccine immediately. Since he is under the age of 10 years, the appropriate vaccine for him is a DTPa containing vaccine.

John, 5 years of age, falls from a swing and injures his right leg. Accompanied by his parents, he is now in the Emergency Department. He has a 5 mm deep laceration in a 2x3 abrasion on his right leg. The wound is contaminated with soil. You disinfect the wound and ask his parents about his tetanus vaccination status. He has received 2 doses of DTPa at 2 and 4 months of age, but not the third dose at 6 months or thereafter. Which one of the following is the appropriate management plan for him regarding tetanus vaccination? A. One dose of DTPa now and a booster dose after 2 months. B. One dose of DTPa plus tetanus immunoglobulin (TIG) now. C. One dose of dT plus TIG now. D. One dose of DTPa now plus a 5-day course of topical antibiotic cream. E. One dose of DTPa now plus a 5-day course of oral penicillin

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