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  • Question 1 - A 64 year old female presents with sudden onset pain, swelling and stiffness...

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    • A 64 year old female presents with sudden onset pain, swelling and stiffness in her right knee. Her medical history is significant for osteoarthritis affecting her hand joints and diet controlled diabetes mellitus. On examination, the right knee is swollen, erythematous and tender. Which of the following tests would be most useful in the diagnosis of this case?

      Your Answer: Aspiration and examination of the synovial fluid

      Explanation:

      Arthrocentesis should usually be done when there is a suspicion of pseudogout or septic arthritis as in this case which leads to an early diagnosis and prompt treatment. Polarized microscopy demonstrates weakly positively birefringent rhomboid crystals which are blue when parallel to light and yellow when perpendicular to light. Elevated serum uric acid levels that cause gout are usually found after large consumption of alcohol or meat, or post surgery. Autoimmune diseases like SLE, RA etc require an autoimmune screen.

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  • Question 2 - A 35-year-old female patient presents with butterfly rash, haematuria and photosensitivity. She is...

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    • A 35-year-old female patient presents with butterfly rash, haematuria and photosensitivity. She is currently on TB treatment. Which antibody would you expect positive?

      Your Answer:

      Correct Answer: Anti-Histone

      Explanation:

      This patient is probably suffering from a drug-induced lupus. There’s a 95% chance that anti-histone antibodies are positive. Drug-induced lupus is a lupus-like disease caused by certain prescription drugs. The drugs most commonly connected with drug-induced lupus are: hydralazine (used to treat high blood pressure or hypertension), procainamide (used to treat irregular heart rhythms) and isoniazid (used to treat tuberculosis).

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  • Question 3 - A 32 year old female is diagnosed with SLE based on her complaints...

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    • A 32 year old female is diagnosed with SLE based on her complaints of polyarthralgia, mouth ulcers and ANA positivity. Labs reveal normal urinalysis, urea and electrolytes. ESR is 90mm in the first hour. How will you manage this patient?

      Your Answer:

      Correct Answer: Hydroxychloroquine 200 mg/day

      Explanation:

      Hydroxychloroquine is used in the management of SLE as it prevents disease progression and has relatively mild side effects, for instance headache, nausea etc. Its use reduces the usage of corticosteroids. It is particularly effective when the disease is less severe and there is no organ involvement. Cyclophosphamide and prednisolone are indicated in cases of renal, neurological and lung involvement.

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  • Question 4 - A 28 year old male complained of the following: nausea, vertigo, vomiting for...

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    • A 28 year old male complained of the following: nausea, vertigo, vomiting for longer than 30 minutes, tinnitus, and hearing loss in his left ear. Which of the following treatment options is most appropriate for this patient?

      Your Answer:

      Correct Answer: Cyclazine (1st line)

      Explanation:

      Cyclizine and prochlorperazine are both used for the treatment of Meniere’s disease.

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  • Question 5 - A 24-year-old man is brought to the hospital by his relatives. They noticed...

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    • A 24-year-old man is brought to the hospital by his relatives. They noticed that lately he is behaving in a bizarre way. Which symptom would you expect in order to establish the diagnosis of schizophrenia?

      Your Answer:

      Correct Answer: Thought insertion

      Explanation:

      According to WHO, thought insertion alone is a major criterion for schizophrenia. Thought insertion is defined as feeling as if one’s thoughts are not one’s own, but rather belong to someone else and have been inserted into one’s mind. The person experiencing thought insertion will not necessarily know where the thought is coming from, but makes a distinction between their own thoughts and those inserted into their minds. Thought insertion is a common symptom of psychosis and occurs in many mental disorders and other medical conditions. However, thought insertion is most commonly associated with schizophrenia.

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  • Question 6 - A 50 year old male was taken to hospital after he experienced tightness...

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    • A 50 year old male was taken to hospital after he experienced tightness in his chest and a chronic cough. Upon examination, he revealed that he has been smoking 20 cigarettes a day for the past 35 years, and was subsequently diagnosed with COPD. From the list of options, choose the most appropriate ABG picture.

      Your Answer:

      Correct Answer: Respiratory Acidosis

      Explanation:

      COPD impairs the lung’s ability to remove CO2 from the blood, and this removes acid from the body. Excess CO2 causes the pH of the blood to increase, making it far too acidic, and causing respiratory acidosis.

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  • Question 7 - A 34 year old woman presents to the emergency department due to right...

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    • A 34 year old woman presents to the emergency department due to right sided weakness. Past history reveals a DVT following the birth of her daughter, and two miscarriages. Head CT confirms an ischaemic stroke in the territory of left middle cerebral artery. What would be the most likely finding on echocardiography?

      Your Answer:

      Correct Answer: Normal

      Explanation:

      The patient most likely suffers from antiphospholipid syndrome. The clinical criteria consist of vascular thrombosis and pregnancy morbidity. Vascular thrombosis is defined as one or more clinical episodes of arterial, venous, or small-vessel thrombosis in any tissue or organ confirmed by findings from imaging studies, Doppler studies, or histopathology. ASD, VSDs would cause paradoxical emboli and stroke, however the recurrent pregnancy loss in this case is strongly suggestive of antiphospholipid syndrome. The ECG would be normal in most cases associated with anti phospholipid syndrome.

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  • Question 8 - A post-surgical patient presents with a swollen left leg. The leg looks tender...

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    • A post-surgical patient presents with a swollen left leg. The leg looks tender and passive movements are painful. The diameter of the affected calf is noticeably increased. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Deep venous thrombosis (DVT)

      Explanation:

      Homan’s sign test also called dorsiflexion sign test is a physical examination procedure that is used to test for Deep Vein Thrombosis (DVT). A positive Homan’s sign in the presence of other clinical signs including a swollen, tender leg, and pain on passive movement is suggestive of DVT.

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  • Question 9 - A 25-year-old pregnant mother who is known to have hepatitis B gave birth...

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    • A 25-year-old pregnant mother who is known to have hepatitis B gave birth to a male infant. She is now concerned about her child contracting hep B. Which of the following is the most suitable option for the baby in this case?

      Your Answer:

      Correct Answer: HepB full vaccine and Ig

      Explanation:

      Hepatitis B full vaccine and Ig should be given to babies born to hepatitis B positive mothers. Hepatitis B vaccine alone or Ig alone is not sufficient to prevent the infection in the new-born baby.

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  • Question 10 - A 31 year old female with systemic lupus erythematosus wants to know if...

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    • A 31 year old female with systemic lupus erythematosus wants to know if she has any predisposing factors for the disease. Which of the following carries the greatest risk of developing SLE?

      Your Answer:

      Correct Answer: Monozygotic twin

      Explanation:

      An overall concordance rate in monozygotic twins was documented to be 25% as compared to dizygotic twins with 3%. First degree relatives have a chance of around 3% of developing the disease. Caucasians show an increase frequency of HLA-B8. The Japanese lupus patients had a stronger association with HLA-DR2.

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