Some Hot Topics for March Recalls
Paediatric case of acute tonsillitis. Ask for management. Abx or not?
Enuresis in boy management Constipation with overflow Cholestatic jaundice pregnancy Rubella vaccine in early pregnancy
Early pregnancy screening for downs most accurate Bowel obstruction large and small
Urinary incontinence Testicular cancer
COPD X-ray and management
ECGs stemi, mangement, mobitz type 1/wenkebach ECG Rheumatic fever in rural child diagnostic tests
Gout with tophi
Cellulitis of obese abdomen antibiotic treatment Breast bloody discharge, purulent discharge Breast investigation for suspicious mass Ovarian cancer
Cervical cancer screening (similar to past recall) Benign adrenal gland mass found incidental Alcoholic fatty liver
Acute pancreatitis imaging Chronic pancreatitis Cholestatic jaundice with ERCP Hepatitis A,B,C vs EBV
HIV testing serology
Baby from Sudan with vitamin D deficiency Farmer with cut on leg and broken leg Melanocyte spreading on legs
Guillain barre tests
Lack of pincer grip and loss of sensation in 4 and 5 finger Stats: sensitivity, incidence
Ethics competent patient, witnessing the signing of a will,
Psych schizophrenia; narcissistic pd, factious disorder, lithium and other drug interactions
Drug interactions and side effects Antibiotics
Bartholin gland Cyst management Knee injury after minor fall in child
Slipped upper femoral epiphysis overweight child Pilonidal cyst management
Haemorrhoids and management Hydradenitis suppritiva
Child with labial adhesions after irritant bubble bat management
Child with vomiting and bright red blood in stools but still only breast feeding Intussusception vs enterocolitis milk allergy
Child with sneezing runny nose and fevers management Acute limb ischemia management
Bisphosphonate tests before starting DKA mangement
Interpreting blood gas analysis after severe vomiting and dehydration
Blood gas analysis in person attempted suicide with car exhaust Fumes Dementia
17 yr old wants to discharge self with 10% burns for conservative management
Need an interpreter in hospital who is best? Security guard, nurse, pts sibling, or wait for phone translator to be ready (but pt sustained facial injuries emergency)
Orbital floor fracture signs
Pelvic organ prolapse management Thyroid
Anorexia nervosa signs Primary amenorrhea
High prolactin in pt on antipsychotics
Paeds: Hereditary spherocytosis with very low iron, management Anaemia of chronic disease iron treatment
Post menopausal bleeding management
Lower back pain patient prescribed oxycodone now using heroin for pain management
Psych pt on many drugs for bipolar etc what is cause of her hair loss Infant with meningitis management
Contraceptive advice for young girl mother and sister both had unprovoked DVTs
Pregnant lady with PE and DVT very high pretest probability (obese, recent plane ride, pregnant, tachycardia, swollen leg) investigation
Nut allergy in restaurant previously happened when eating carrot cake? Gluten allergy?
- Severe headache with facial pain
- Severe headache with ptosis and fixed dilated pupil
3 Trauma head injury 3 hours away by plane to neurosurgery unit management
8 wk-old boy born at 31 wks gestation via cesarean delivery for preeclampsia with severe features & breech presentation is in routine follow-up. Appropriate immunization scheduling?
- Immunizations are given according to the chronologic age
- Immunizations are given according to the corrected gestational age
- Immunizations are given when weight ≥4 kg
- Toxoid vaccines are given according to chronologic age, but live attenuated
vaccines are given according to corrected gestational age 19-yr-old woman complains of continuous clear, slightly malodorous vaginal discharge. Vagina pH of 6. She is 6 wks postpartum from a vaginal delivery of a stillborn baby. Exam shows a small, red area of granulation tissue on the anterior vaginal wall. Establish diagnosis by?
- Bladder dye test
- Cervical nucleic acid amplification test
19 yr-old man involved in a motor vehicle collision complains of abdominal pain in the left upper quadrant. A Focused Assessment with Sonography for Trauma (FAST) exam reveals free fluid in the left subphrenic space. Next step?
- CT scan of abdomen and pelvis
- Diagnostic peritoneal lavage
24 yr-old woman sexually assaulted by a male coworker. She is tearful & avoids eye contact. She is also anxious about STD. Otherwise, police notified. Exam shows tender abrasions on labia minora. Emergency contraception given. Next step?
- Admission for inpatient psychiatric evaluation
- Empiric sexually transmitted infection treatment
56 yr-old woman comes with worsening fatigue & edema. Family history is significant for hypothyroidism in her sister. Exam reveals mild hepatomegaly & pitting edema of the bilateral lower extremities. Cause?
4 hr-old boy is evaluated for routine newborn care. A soft mass inferior to the umbilical stump is 1.4 cm in diameter & covered by skin. The mass increases in size when the infant cries & reduces into the abdominal cavity with gentle ressure. Next step?
- Abdominal ultrasound
- Immediate surgery
- Observation only
65 yr-old man comes due to tremor in his left hand & stiffness in his left arm. Generalized slowness in movements & loses balance when he tries to turn or stop suddenly while walking. Next step?
- CT scan of the head
- MRI of the head
- No additional diagnostic testing needed
38 yr-old woman comes with left anteromedial knee swelling, mildly tender on palpation. Has type 2 diabetes mellitus. BMI is 35 kg/m2. 4-cm area of swelling, 3 cm below the joint line. Next step?
- Diagnostic aspiration of the swollen area
- Immobilization with a rigid knee brace
- Quadriceps and hamstring muscle exercises
23 yr-old man comes with right wrist pain. During a baseball game, he landed forcefully on his outstretched right hand with the palm facing down. Maximal tenderness proximal to the base of the first metacarpal & the pain worsens with radial deviation of the wrist. Next step?
- Analgesics and physical therapy
- Local anesthetic and corticosteroid injection
- Thumb spica splint and repeat radiography in 10 days
30 yr-old woman complains of increasing muscle weakness in her hands. In a motor vehicle collision 7 yrs ago whereby she sustained a whiplash cervical spine injury. Exam reveals moderate wasting of the small muscles of the hand, impaired pain & temp ensation. Diagnosis?
- Amyotrophic lateral sclerosis
- Cervical spondylosis
31 yr-old woman comes due to fatigue & weight gain. Under stress at work lately, feeling “down” & stopped socializing with friends. On mental status exam she appears sad & tired but is able to smile when appropriate. Diagnosis?
- Adjustment disorder
- Major depressive disorder
45 yr-old woman comes due to frequent nighttime cough & wheezing. Lately, similar episodes during daytime. Medical history includes hypertension, hyperlipidemia& obesity. JVP is 3 cm H2O. Lungs show good air movement with expiratory wheezes & no crackles. Pathogenesis of symptoms?
- Gastric acid-induced laryngeal irritation
- Hypertrophic occlusion of the pulmonary arteries
- Leukocyte-induced bronchoconstriction
25 yr-old man is brought with an anterior abdominal stab injury. Undergoes urgent exploratory laparotomy. Anesthesia terminated after successful repair of liver & small intestinal lacerations. Prior readings: BP 160/90, pulse 130, respirations 9. An hour later, BP 110/60, pulse 70, respirations 7. Reason for postoperative findings?
- Acute cardiogenic pulmonary edema
- Anesthesia-induced hypermetabolic state
- Delayed emergence from anesthesia
7 mth-old girl is brought due to decreased use of her left arm. Born at 31 wks gestation to 25-yr-old primigravid who received corticosteroids, tocolytics & magnesium sulfate for preterm labor management. Brain MRI shows white matter injury adjacent to the right lateral ventricle. Cause?
- Delivery at preterm gestation
- Inherited thrombophilia
42 yr-old woman is evaluated for sudden-onset tachycardia & dyspnea 15 min after surgery. Underwent a dilation & curettage for gestational trophoblastic diseases complicated by intraoperative bleeding that required 2 units of packed red blood cells. Diagnosis?
- Disseminated intravascular coagulation
- Malignant hyperthermia
25 yr-old woman with asthma comes with severe shortness ofbreath after been exposed to some cleaning chemicals. Noninvasive ventilation is started & continuous nebulized albuterol & intravenous methylprednisolone are administered. Hours later, she has muscle weakness. Next step
- Carboxyhemoglobin level
- Discontinuation of corticosteroid
- Serum electrolyte level
49 yr-old woman comes with depression. Medical history is significant for obesity, type 2 diabetes mellitus & hypercholesterolemia. Major depressive disorder is diagnosed. Pharmacotherapy?
“CAGE” is used to screen for alcohol use disorder. 2 out of 4 positive responses is considered to be positive for AUD. If it changed to 3 out of 4, what is the effect on the sensitivity & specificity of this test?
- Both sensitivity and specificity of the test will decrease
- Both sensitivity and specificity of the test will increase
- Sensitivity will decrease but specificity will increase
84 yr-old woman with Alzheimer dementia is reported to be found on the floor next to her bed. She is in pain. Her right leg appears shorter than her left. Able to wiggle her toes. No evidence of head trauma & the lower leg compartments are soft. Diagnosis?
- Femoral neck fracture
- Femoral shaft fracture
A term newborn is evaluated. 1/6 systolic murmur at the left upper sternal border that radiates to the axilla. Underdeveloped penis. Urethral meatus is at the ventral surface of the base & flanked by the surrounding scrotal sac. Gonads are not palpable. Back shows a sacral dimple. Next step?
- Head ultrasound
- Karyotype analysis
A healthy 22-yr-old woman, gravida 2 para 1, comes for a routine prenatal visit. 28 wks pregnant, no bleeding, fluid leakage or uterine contractions & feels fetal movement. Next step?
- Anti-D immune globulin
- Group B Streptococcus
12 yr-old girl diagnosed with idiopathic aplastic anemia is given a platelet transfusion. Patient develops diffuse, urticaria rash on her chest that spreads to the rest of the body. Transfusion is stopped & patient receives diphenhydramine. Rash improves slightly. Next step?
- Culture of the transfused product
- Direct antibody (Coombs) test
- No additional evaluation indicated
45 yr-old woman fell & landed forcefully on her left palm. Maximal tenderness at the dorsoradial wrist lateral to the tendon of the extensor pollicis longus. Radiographs reveal a radiolucent line across the waist of the scaphoid bone. Treated with analgesics & immobilization. Potential complications?
- Bacterial tenosynovitis
- Fat embolism
37 yr-old gravida 1 para 0, at 34 weeks gestation comes with nausea, vomiting & severe epigastric pain. Fetal heart rate 170 with minimal variability. Tenderness to palpation over the epigastrium & right upper quadrant, with no rebound or guarding. Given blood result, hypoglycemia with raised AST, ALT, bilirubin, amylase and thrombocytopenia. Diagnosis?
- Acetaminophen toxicity
- Acute cholecystitis
- Acute fatty liver of pregnancy
17 yr-old white female comes for evaluation of fatigue present for the past 4 mths. Exam shows scars on the dorsum of her hands & dental erosions. Urine chloride concentration is 15 mmol/L. Diagnosis?
- Chronic diarrhea
- Diuretic abuse
- Surreptitious vomiting
12 yr-old boy has a cystic left neck mass & a small pit anterior to the sternocleidomastoid muscle that is leaking mucopurulent fluid. 1 mth ago, he had a fever & upper respiratory tract infection symptoms. Diagnosis?
- Actinomyces lymphadenitis
- Branchial cleft cyst
40 yr-old woman is brought with sudden-onset, severe headache, progressive right-sided weakness & slurred speech. Decreased pinprick sensation in the right upper & lower extremities. A noncontrast CT scan of the head reveals a left thalamic hemorrhage with no midline shift. Etiology?
- Carotid Doppler study
- Urine toxicology screen
49 yr-old woman complains of heavy menses. US reveals a 3 x 4 cm intramural leiomyoma, a thin endometrium & normal-appearing ovaries. Outcome for leiomyoma?
- Intermittent torsion
- Malignant transformation
- Spontaneous regression
16 yr-old girl is brought for a routine health maintenance exam. Sexually active with one partner for the past 2 yrs & takes oral contraceptive daily. Patient’s parents have type 2 diabetes mellitus. Her maternal grandfather died of a myocardial infarction at age 68. Next step?
- Chlamydia and gonorrhea testing
30 yr-old gravida 3 para 2, at 37 wks gestation comes for regular, painful contractions. Tocodynamometer shows contractions every 3-4 min. Cervix is 4 cm dilated, 90% effaced & a taut, bulging bag is palpable with no presenting fetal part. Next step?
- Cesarean delivery
- Transabdominal ultrasound
50 yr-old woman has bilateral symmetric 3+ pitting edema of both lower extremities, without any skin changes or varicosities. Edema started 6 wks ago. Medical history is significant for hypertension, treated with metoprolol for 3 yrs. 2 mths ago, amlodipine was added. Cause?
- Heart failure
- Liver disease
- Medication side effect
42 yr-old woman comes for evaluation of a 2-cm mass on the extensor surface of her right wrist. Mass is firm, mobile & nontender to palpation & it transilluminates on penlight exam. Medical conditions include hyperlipidemia & rheumatoid arthritis. Diagnosis?
- Epidermoid cyst
- Ganglion cyst
12 yr-old boy is brought by his parents as “he cannot walk anymore.” 2 wks ago, had a febrile diarrheal. a Recently visited a petting zoo. Symmetric flaccid paralysis of the lower extremities & absent ankle & patellar deep tendon reflexes. Sensation is intact to light touch. Structures impaired?
- Anterior horn cells
- Dorsal and lateral spinal columns
- Peripheral nerve fibers
Physician-researcher study the effectiveness of a novel nerve stimulator device for chronic pain. He has received payments for lectures about the device. The device will be tested as part of a large double-blinded, randomized clinical trial. It is funded partially by the device manufacturer and federal gov as nonpharmaceutical mx of pain as a high national research priority. The researcher has previously received payments from the device manufacturer for lectures about the device given at national conferences. The physician and support staff from the institution will be responsible for study design and implementation, and an academic researcher and biostatistician from the manufacturing company will oversee analysis of study results. Which of the following best describes the potential for COI generated by the manufacturer’s involvement in the research?
- COl is likely present and can be sufficiently addressed by disclosing financial relationships to the subjects
- COI is likely present, and the proposed study should not proceed under these terms due to high risk of bias
81 yr-old woman comes due to worsening shortness of breathassociated with nausea, diaphoresis. Medical history is significant for hypertension, hyperlipidemia & type 2 diabetes mellitus. Bilateral crackles are heard on lung auscultation. IV furosemide is administered. Next step?
- Dopamine infusion and transfer to the cardiac intensive care unit
- Emergency cardiac catheterization
44 yr-old man with extensive small bowel resection for Crohndisease has been on total parenteral nutrition for 2 yrs. Has epigastric & right upper quadrant pain. Ultrasonogram shows several gallstones. Cause?
- Estrogen-induced increase in cholesterol secretion
- Gallbladder stasis
56 yr-old woman on routine check. Postmenopausal for 4 yrs & not using hormone therapy. Has well-controlled hypertension & hyperlipidemia. 2 cesarean deliveries & a tubal ligation with her last delivery at age 30. Pap test shows endometrial cells & no cervical intraepithelial lesions. No mention about HPV test. Next step?
- Endometrial biopsy
6 yr-old boy on annual wellness check. An abdominal mass is palpated in the right upper quadrant. A common bile duct cyst is identified by abdominal ultrasound & confirmed by MR cholangiopancreatography. Next step?
- Serial abdominal ultrasounds to screen for cirrhosis
- Serial abdominal ultrasounds to screen for malignancy
- Surgery now to prevent malignancy
2 yr-old boy is brought due to difficulty breathing that started 6 hrs earlier. Diagnosed with croup, administered oral dexamethasone. Oxygen saturation is 96% & respirations 40/min. Patient has inspiratory stridor at rest & subcostal & intercostal retractions. Next step?
- Chest radiograph
- Intubation and mechanical ventilation
- Nebulized racemic epinephrine
46 yr-old man comes for follow-up due to a B/P reading of 150/95 during a preemployment exam. Ex-smoker with a 10-pack-yr history. Family history of hypertension & his father died of a stroke at age 68. BMI 29. Screening for?
- Abdominal aortic aneurysm
- Brain aneurysm
- Diabetes mellitus