Case-based MCQ

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🧠 Case-based MCQ 🔸 #MCQ_68 🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤 A mother brings her 2-year-old male child in the emergency department.The child ingested a detergent powder 2 hours ago.There is no intra-oral burn and child is otherwise stable. What will you do next? A. Give oral fluids B. Gastric lavage C. Activated charcoal D. Intravenous fluids E. Intravenous corticosteroids

🧠 Case-based MCQ 🔸 #MCQ_67 🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤 Correct Answer Is A Allergic rhinitis is caused by allergens that trigger a local hypersensitivity reaction. Specific IgE antibodies attach to circulating mast cells or basophils. Mast cell degranulation leads to a cascade of inflammatory mediators. Vasomotor rhinitis, the second most common cause of rhinitis after allergic disease, is usually perennial and is not associated with itching. In allergic rhinitis, nasal turbinates appear pale and boggy (rather than red and inflamed as in infectious rhinitis). Avoidance measures alone are often ineffective. Antihistamines and intranasal corticosteroids are usually necessary for adequate symptom relief. Chronic use of nasal decongestants should be avoided, since it often causes rhinitis medicamentosa and can perpetuate her nasal congestion.

Correct Answer(s) • Urine test for cytology. The concern in this history is for a genitourinary malignancy, so a urine test for cytology is the most appropriate next step. Retrograde pyelography is an outdated study and is no longer appropriate in this scenario. Pelvic ultrasonography without renal ultrasonography is insufficient. Prostate cancer does not routinely present with hematuria; therefore, obtaining a prostate-specific antigen level is not necessary. Random renal biopsy is not indicated in the workup for genitourinary malignancy.

A 25-year-old female complains of watery rhinorrhea and pruritus of the eyes and nose that occurs around the same season each year. Symptoms are not exacerbated by weather changes, emotion, or irritants. She is on no medications and is not pregnant. Which of the following statements is correct? A. Her symptoms are likely produced by an IgE antibody against a specific allergen. B. She has vasomotor rhinitis. C. The patient's nasal turbinates are likely to be very red. D. Avoidance measures alone are almost always effective. E. Decongestant nasal sprays can suppress her symptoms

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🧠 Case-based MCQ 🔸 #MCQ_66 🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤 An 82-year-old man presents with urinary urgency and 2 episodes of gross hematuria over the past month. He has a history of immunoglobulin nephropathy. He has been feeling generally well and is afebrile. His urine culture is negative, and his creatinine level is stable at 180 µmol/L (49–93). Which one of the following is the most appropriate next step? A) Retrograde pyelography. B) Renal biopsy. C) Urine test for cytology. D) Prostate-specific antigen level. E) Pelvic ultrasonography

The Correct answer is C Haloperidol, a typical antipsychotic drug, is the preferred initial treatment for an agitated and combative patient with acute mania. Its quick onset will allow for rapid sedation. A mood stabilizer should eventually be initiated and titrated for long-term maintenance therapy, but this will take a few days to take effect and she is in need of rapid stabilization at this time.   Choice A is not correct: Valproate, an anticonvulsant, is commonly used to treat bipolar disorder and tonic-clonic seizures. Its mood-stabilizing effects make it a first-line choice for long-term maintenance treatment following an acute manic episode. However, its slow onset makes it less useful as initial treatment in an agitated patient with acute mania. Choice B is not correct: Venlafaxine, serotonin norepinephrine reuptake inhibitors (SNRI), is commonly used in the treatment of major depressive disorder, anxiety, and panic disorder. It can actually worsen or trigger manic episodes, and should not be used in patients with history of mania. Choice D is not correct: Lithium, a mood stabilizer, is still commonly used for the treatment of bipolar affective disorder. It is effective in preventing both manic episodes and depression in bipolar patients when employed for long-term maintenance therapy. However, its slower onset makes it less useful as initial therapy in an agitated patient with an acute manic episode. Choice E is not correct: Clozapine, an antipsychotic, is used for treatment-resistant schizophrenia. Because of its potential adverse effect of agranulocytosis, it is reserved as maintenance therapy in patients with refractory schizophrenia and requires close monitoring. It is not used for the treatment of bipolar disorder or acute mania, as this patient has. Summarized Points: This patient's history of elevated mood, reckless behavior, insomnia, pressured speech, and psychosis are consistent with an acute manic episode. Her uncooperative and combative nature will influence our choice of initial therapy.

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🧠 Case-based MCQ 🔸 #MCQ_65 🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤 A 24-year-old woman comes to the office due to 3 days of burning with urination and increased urinary frequency. She has had no fever, abdominal pain, back pain, or vaginal discharge. The patient has no known drug allergies. Vital signs are normal. Examination shows suprapubic tenderness without flank tenderness. The remainder of the examination is normal. Urine pregnancy test is negative. Urinalysis shows trace blood, moderate leukocyte esterase, and moderate nitrites. Which of the following is the best next step in the management of this patient? A. Amoxicillin B. Azithromycin C. Nitrofurantoin D. Ceftriaxone E. Ciprofloxacin

🧠 Case-based MCQ 🔸 #MCQ_64 🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤 The Correct answer is C Haloperidol, a typical antipsychotic drug, is the preferred initial treatment for an agitated and combative patient with acute mania. Its quick onset will allow for rapid sedation. A mood stabilizer should eventually be initiated and titrated for long-term maintenance therapy, but this will take a few days to take effect and she is in need of rapid stabilization at this time.   ❌Choice A is not correct: Valproate, an anticonvulsant, is commonly used to treat bipolar disorder and tonic-clonic seizures. Its mood-stabilizing effects make it a first-line choice for long-term maintenance treatment following an acute manic episode. However, its slow onset makes it less useful as initial treatment in an agitated patient with acute mania. ❌Choice B is not correct: Venlafaxine, serotonin norepinephrine reuptake inhibitors (SNRI), is commonly used in the treatment of major depressive disorder, anxiety, and panic disorder. It can actually worsen or trigger manic episodes, and should not be used in patients with history of mania. ❌Choice D is not correct: Lithium, a mood stabilizer, is still commonly used for the treatment of bipolar affective disorder. It is effective in preventing both manic episodes and depression in bipolar patients when employed for long-term maintenance therapy. However, its slower onset makes it less useful as initial therapy in an agitated patient with an acute manic episode. ❌Choice E is not correct: Clozapine, an antipsychotic, is used for treatment-resistant schizophrenia. Because of its potential adverse effect of agranulocytosis, it is reserved as maintenance therapy in patients with refractory schizophrenia and requires close monitoring. It is not used for the treatment of bipolar disorder or acute mania, as this patient has. ✅Summarized Points: This patient's history of elevated mood, reckless behavior, insomnia, pressured speech, and psychosis are consistent with an acute manic episode. Her uncooperative and combative nature will influence our choice of initial therapy.

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🧠 Case-based MCQ 🔸 #MCQ_64 🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤 A 22-year-old woman is brought to the emergency department 20 minutes after being detained by campus police for attempting to steal from the bookstore. Her roommate says that the patient has been acting strangely over the last 2 weeks. She has not slept in 4 days and has painted her room twice in that time span. She has also spent all of her savings on online shopping and lottery tickets. She has no history of psychiatric illness or substance abuse and takes no medications. During the examination, she is uncooperative, combative, and refusing care. She screams, “Let me go, God has a plan for me and I must go finish it!”. Her temperature is 37.2°C (99°F), pulse is 75/min, respirations are 16/min, and blood pressure is 130/80 mm Hg. Physical examination shows no abnormalities. On mental status examination, she describes her mood as “amazing.” She has a labile affect, speaks rapidly, and her thought process is tangential. She denies having any hallucinations. Which of the following is the most appropriate initial pharmacotherapy?   A. Valproate B. Venlafaxine C. Haloperidol D. Lithium E. Clozapine

🧠 Case-based MCQ 🔸 #MCQ_63 🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤 The correct answer is E. The "number needed to treat" (NNT) is the number of patients who need to be treated in order to prevent one additional bad outcome. It is an important way to present the results of a study or assess the usefulness of treatment or prophylaxis.   Myocardial infarction No Myocardial infarction     Aspirin Group 40   400   Placebo Group 80   400   Total     800   number needed to treat (NNT) = 1/Absolute risk reduction  Absolute risk reduction = Incidence of Event in control arm – Incidence of Event in treatment arm Incidence of Event in control arm= 80/400 = 0.2 Incidence of Event in treatment arm= 40/400=0.1 Absolute risk reduction= 0.2-0.1=0.1 NNT= 1/0.1= 10   ✅Summarized Points: Number needed to treat (NNT) is the number of patients who need to be treated in order to prevent one additional bad outcome; it is actually the inverse of absolute risk reduction.