MOCK

28問 • 1年前

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A-79-year-old woman undergoes total hip replacement surgery. After 4 days, she develops a swollen right leg. The circumference of the right calf is 4 cm greater than that of the left leg. The right leg feels warm to touch and is slightly tender. Which one of the following is most appropriate diagnostic tool to use for a diagnosis?

Duplex Doppler ultrasound.

A 52-year-old man comes to your GP practice complaining of difficulty holding and grasping objects. He has smoked 20 sticks per day for the past 15 years but is otherwise well. You immediately notice his hands as shown in the photo below. On further probing, the patient tells you that he has similar findings on his feet. Which of the following is the most likely diagnosis?

Buerger Disease

The 9-year-old Tim is brought to the Emergency Department by his mum after he fell off his bike and hurt his left shoulder. The left shoulder is painful, and he is barely moving his left arm due to the pain. On physical examination, there is no bruise or deformity of the left shoulder, but there is tenderness over the middle third of the left clavicle. Neurovascular examination of the left arm and hand is normal. Which one of the following is the most appropriate next step investigation?

X-ray of the left clavicle; AP view

A 30-year-old woman, who is 34 weeks pregnant, presents with dysuria and frequency. On examination, she has a temperature of 37.3°C. There is no nausea and vomiting, flank pain or tenderness A urine dipstick test is positive for nitrites and leucocytes. A mid-stream urine sample is sent for culture and sensitivity. In the meanwhile, which one of the following antibiotics is the medication of choice for empiric therapy in this woman?

Cephalexin

A 32-year-old woman presents to your practice at 28 weeks gestation with recurrent vulval warts previously treated with cryotherapy. Which one of the following options would be the most appropriate management option?

Cryotherapy

A 75-year-old man presents to your clinic with cough and rusty-colored sputum for2 days. On examination, he has a blood pressure of 110/85 mmHg, pulse of 125bpm, respiratory rate of 32 breaths per minute and temperature of 38.6°C. Chest X-ray (CXR) shows consolidation in the right middle and lower lobes. Which one of the following is the most appropriate management?

Intravenous penicillin.

A 60-year-old man presents to the emergency department with a 3-day history of increased sputum production, fever and progressive shortness of breath. He has had productive cough with greenish sputum for the past 3 years. He explains that he coughs up of a cupful of green sputum every morning. A chest X-ray is obtained showing consolidation of the right lower lobe. Which one of the following would be the most appropriate treatment option?

Ticarcillin-clavulanate.

As part of a health check, an immigrant Sudanese woman is found to have a positive tuberculin skin test (TST). A chest X-ray is obtained with inconclusive results. Sputum microscopy and culture are positive for tuberculosis (TB). She is planned to be started on four-drug therapy. She has a 4-year-old son and you make arrangements for him to have an interferon gamma release assay (IGRA) which turns out positive. The child is healthy and has no symptoms. Which one of the following would be the next best step in management?

Obtain a chest X-ray.

2 An experimenter conducts a test of a new medication compared with the current standard medication. Alpha is selected to be 0.05. At the conclusion of the trial, the sample of patients receiving the new medication shows more improvement than the comparison p-value is 0.002. What will the experimenter conclude?

The likelihood that a type I error has actually been committed is less than the maximum risk the experimenter was wiling to accept.

A 56-year-old man presents to the emergency department with acute right eye pain, redness and blurred vision. On examination, he has eye injection and corneal haziness, and the eye feels hard to palpation. Which one of the following is the most appropriate immediate management?

cartelol

A 15-year-old girl presents with an upper respiratory tract infection (URTI). On examination, she has a temperature of 38.1°C and an erythematous pharynx with no exudate. She is otherwise healthy. A urine dipstick is positive for blood for which you order a urinalysis (UA). UA is reported back significant for red blood cells, 1+ proteinuria, no WBCs, and negative for nitrite. Which one of the following would be the next best step in management?

Repeat UA after the URTI resolves.

A 5-year-old boy is brought to the Emergency Department by ambulance after he had a generalized tonic-clonic seizure at home 20 minutes ago. Upon arrival to the hospital, he was assessed immediately. He is not having a seizure now but is lethargic and confused. His blood pressure is 105/65 mmHg, pulse rate 76 bpm, respiratory rate 16 breaths/min, and temperature 37°C. His mucous membranes are not dry, skin turgor is normal, and capillary refill time is 2 seconds. The rest of the examination, including cardiovascular, respiratory and neurological exam is completely normal. Pathology results are as following: FBE: Normal Random blood sugar: 8.3 mmol/L (4 - 11.1 mmol/L) Sodium: 120 mmol/L (135-145 mmol/L) Potassium: 4.1 mmol/L (3.5 – 5.5 mmol/L) Bicarbonate: 24 mmol/L (22-32 mmol/L) Creatinine: 80 µmol/L (60-110 µmol/L) Urea: 4.5 mmol/L (2.5-7.1 mmol/L) Calcium: 3.1 mmol/L (2.2-2.7 mmol/L) Which one of the following could be the most likely cause to this presentation?

SIADH

Concerned parents of a 6-year-old girl has brought her to your GP clinic as they have noticed scattered growth of pubic hair in their daughter recently. On examination, she has sparse pubic hair growth and Tanner I breast. Her height and weight are on 75% and 50% percentiles respectively. Which one of the following is the most appropriate next step in management?

Review in 3 months

A 2-day-old boy, born at 39 weeks to a 17-year-old primigravida with no prenatal care, had an uncomplicated delivery with Agar scores of 9 at both 1 and 5 minutes. He is formula-feeding well and has stooled twice but has had only a single wet diaper in the past 48 hours. He weighs 2.89 kg, which is a 3% decrease from birth weight. His physical examination is unremarkable.What is the next step in management?

Increase fluid intake

A 10-day-old boy is brought to the emergency department due topersistent bilious vomiting for the past 10 hours. He is irritable,refuses to feed, and had his last bowel movement 24 hours ago.On examination, his abdomen is firm and distended with hypoactive bowel sounds and tenderness to palpation. There is a small amount of stool in the rectal vault, and occult blood is present in is the stool.What is the next step in management?

Exploratory laparotomy

A 54-year-old woman presents to your clinic, with complaint of a vulvar lesion associate with severe itching. Her problem started nearly 6 months ago and has progressed in severity. She has been menopausal since the age 50 years. On examination, atrophic white plaques are evident as well as excoriation marks over and around the vulva. The labia minora is slightly atrophic and there is interoitus stenosis. Vaginal examination is normal. The appearance of the vulva is shown in the accompanying photograph. Which one of the following is the most appropriate option for treatment of this patient?

Clobetasol cream

A 39-week pregnant woman is admitted to the Labor Unit due to commencement of labor pain and contractions. The woman is placed in left lateral decubitus position and started on supplemental oxygen by face mask. An intravenous line is established and isotonic fluids and cyntocinon drip is started according to the protocol. A CTG is performed that shows a fetal heart rate of 140 which drops to 70 bpm and returns back to the base line of 140 bpm in two minutes. Which one of the following is the most appropriate immediate management?

Stop cyntocinon.

review in 3months

What is the answer?

A patient is diagnosed with chronic superlative suparrative otitis media. AURAL toileting is done what should be done next?

Ciprofloxacin eardrops

What is the answer?

Please the leg above the level of the heart

Reassurance explanation and support

Cellulitis

Malignant melanoma

During taking a history from a patient in a psychiatry ward, you ask him if there is any history of mental illnesses in the family. He answers: “Good question. Now that you’ve asked, I must tell you something. Whales are good creatures. We take their oil and use it to light the world. My father hunted whales as did my grandpa. The business runs in the family and of course, we are all sane and sound. Do you think we are crazy?” Which one of the following is present in this patient’s speech? • A. Flight of ideas • B. Word salad • C. Circumstantiality • D. Derailment • E. Tangentiality

increase weight

A 25-year-old man is brought to the emergency department by an ambulance after he was found on the streets behaving bizarrely and reported to the police. During the initial assessment, he cooperates nicely and interacts appropriately and seems to be oriented to time, place, and people but at some point, he mentions that he is feeling the urge to punch you in the face as you do not understand him. He believes neutrons represent the spirit and electrons are a way of telecommunication with the higher realm. When you ask him how he knows these, he says God speaks to him and gives him directions to save the world from a network of sinister beings crawling over the internet. Which one of the following is the most appropriate next step in management? A. Give him 10mg of haloperidol and wait to see if it works. B. Ask a nurse to help you restrain him. C. Call security immediately. D. Perform a urinary drug screen test. E. Involuntary psychiatric admission.

SPI version D pt 2

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