sprint123
Forum Guru
Topics: 129
Posts: 870
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Before I forget,today's question..
A 35 /M +Myasthenia+Thymoma presenting with fatigue.Not relieved by pyridostigmine.still complains of dysphagia and fatigue.
Best treatment is :
A.Steroids
B.Thymectomy
C.Increase dose of pyridostigmine
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| Dinie
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answer is thymectomy.
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| docnikki
Forum Guru
Topics: 93
Posts: 680
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should be thymectomy.
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| sprint123
Forum Guru
Topics: 129
Posts: 870
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Thnaks for droping in dinie and docnikki..
U are bang in target-I posted this question just to ensure that you should do thymectomy before starting on immuno-suppressive medication...Planning to post few questions that would make us remember some points which is worth ..
Well..Atlast done with the first read of IM..Still videos left...
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| sprint123
Forum Guru
Topics: 129
Posts: 870
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A 35/m with dyspnoea and decreased breath sounds and dullness to percussion in the right lower base has a friction rub on auscultation.ANA,ds-dna positive.What is the next step?
A.Steroids
B.Nsaids
C.Pleural aspiration
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| docnikki
Forum Guru
Topics: 93
Posts: 680
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this is pleural inflammation with pleural effusion. We should go for aspiration but before that a decubitus Xray should be drawn to confirm the effusion.
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| sprint123
Forum Guru
Topics: 129
Posts: 870
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Yeah...PLeural aspiration can be done and the most imp[ortant thing is to stat with NSAID's and not steroids for serositis in SLE patients..
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| sprint123
Forum Guru
Topics: 129
Posts: 870
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Today's question :
A 42-year-old man is evaluated because of pain and swelling in his right knee of 1 week’s duration. He relates a 15-year history of intermittent pain and swelling over the middle finger of his left hand as well as recurrent attacks of pain and swelling in his knees. Previous blood tests for the presence of rheumatoid factor have been negative, but antinuclear antibody has been present in low titer (1:160, homogeneous pattern). He has previously been treated for nongonococcal urethritis. On physical examination, there is synovial thickening and mild tenderness over the left third proximal interphalangeal joint. The right knee is tender with effusion, and tenderness is noted at the insertion of the right Achilles tendon. Several scaly plaques are present over the soles of both feet. Aspiration of the knee reveals the presence of an inflammatory effusion (leukocyte count, 20,000/µL—predominantly neutrophils), but Gram’s stain and cultures are negative, and no crystals are seen when the fluid is analyzed by polarized microscopy.
Which of the following is the most likely diagnosis?
( A ) Gout
( B ) Rheumatoid arthritis
( C ) Reiter’s syndrome
( D ) Osteonecrosis
( E ) Systemic lupus erythematosus
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| doc08
Forum Senior
Topics: 9
Posts: 153
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is it E? SLE?
the scaly plaques doesnt fit in though , ???
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| sprint123
Forum Guru
Topics: 129
Posts: 870
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This question is interesting..Few ponts to be noted..
1.Scaly plaques doesn't always man psoariasis but can also be in Reiter's syndrome
2.Past history of non-gonococcal urethritis is sufficient to make a diagnosis of reiter's even though the triad is not present.
3.Acille's tendonitis is common in reiter's
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| sprint123
Forum Guru
Topics: 129
Posts: 870
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Today's question
A 65-year-old man has mild left ventricular dilatation with an estimated ejection fraction of 40% as documented by echocardiography. He also has hypertension. For the past 4 years, he has been taking lisinopril, digoxin, and hydrochlorothiazide. He had done well until several months ago, when he developed paroxysmal coughing that is unrelated to recumbency and can occur at any time of the day or night. The cough is nonproductive but has become debilitating and is not relieved by over-the-counter cough drops.
On physical examination, his pulse rate is 72/min and blood pressure is 120/72 mm Hg. There are no signs of an upper respiratory tract infection, but his pharynx is slightly erythematous. The chest is clear. An S4 is audible. There is no edema. The serum creatinine level is normal.
In addition to a chest radiograph, which one of the following should be done next?
( A ) Echocardiography
( B ) CT of the chest
( C ) Pulmonary function tests
( D ) Bronchoscopy
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| sprint123
Forum Guru
Topics: 129
Posts: 870
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Answer for yesterday's questions is Echocardiography.
Points to remember :
1.Whenevr cardiac patient with dry cough-Think of ACE-Inhibitor
2.Cough can be a first manifestation of CHF
3.It takes 2 weeks for the cough to get relieved after discontinuing ACE-I.
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| sprint123
Forum Guru
Topics: 129
Posts: 870
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Today's question :
A 40-year-old man is evaluated because of increasing chest pressure and exertional dyspnea. He had been experiencing exertional dyspnea after climbing two flights of stairs. Physical examination disclosed a regular pulse rate of 65/min. His blood pressure was 155/90 mm Hg. The carotid pulse had a brisk upstroke and a bifid contour. There was a grade 4/6 systolic murmur heard best at the left sternal border in the fourth left interspace. The murmur increased with Valsalva maneuver and became louder with standing. An electrocardiogram was done and showed left ventricular hypertrophy. An M-mode echocardiogram showed thickening of the interventricular septum to 2.0 cm.
Which of the following is the most likely diagnosis?
( A ) Aortic stenosis
( B ) Atrial septal defect
( C ) Coarctation of the aorta
( D ) Hypertrophic cardiomyopathy
( E ) Ventricular septal defect
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| sprint123
Forum Guru
Topics: 129
Posts: 870
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One more WEAK area for me!
A 57-year-old man comes for a routine follow-up examination. He has a 10-year history of an intermittent facial rash. He has been taking propranolol for 2 months for hypertension. Examination shows several erythematous pustules and papules involving the nose and central face. There are telangiectasias at the base of the papules. Which of the following is the most likely explanation for these findings?
A ) Acne rosacea
B ) Acne vulgaris
C ) Basal cell carcinoma
D ) Discoid lupus erythematosus
E ) Seborrheic dermatitis
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| sprint123
Forum Guru
Topics: 129
Posts: 870
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PTR :
*bRISK UPSTROKE AND BIFID contour of carotid puls-Outflow obstruction
*Septal hypertrophy-HOCM-Murumur charqacteristic in manouevers
*Acne Rosacea-Pustules+telangiectasis in face
*Propranalol can exacerbate
Videos are taking along time but I should do it TODAY!!I will open this forum again only when I am done with my portion today...Not much time left
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| sprint123
Forum Guru
Topics: 129
Posts: 870
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I was wayward today evening....I can't resist the temptation of browsing other sites-while doing questions in the computer--I am not sure whether it is correct to spend so much time in here.....A disappointing evening!
Anyway-Today's question:
A 37-year-old male injection drug user comes to the emergency department because of shortness of breath and fever for 6 days. On physical examination, his temperature is 38.5 °C (101.3 °F), pulse rate is 118/min and regular, respiratory rate is 32/min, and blood pressure is 110/60 mm Hg. Carotid upstrokes are normal, and crackles are heard half way up both lung fields. Cardiac auscultation shows a soft S1, an S3, and a grade 2/6 early diastolic murmur at the left sternal border. An echocardiogram is ordered, blood culture specimens are obtained, and intravenous antibiotics are started.
Which of the following is the most likely diagnosis?
( A ) Myocarditis
( B ) Pericarditis
( C ) Aortic value insufficiency
( D ) Septic pulmonary emboli
( E ) Staphylococcal aortitis
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| doc08
Forum Senior
Topics: 9
Posts: 153
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is it C?
gosh i don remember much from my first read
anyway, sprint may i ask the source of these qs if u dont mind?
GL
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| docnikki
Forum Guru
Topics: 93
Posts: 680
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I too think its C.. sprint, its not a wast of time in seeing questions here and there but yes fix ur time for the forums ..like just before starting your day or when u wanna take some rest out....I learn alot from here but obviously loose time too  ..
your questions are very nice. thanks.
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| sprint123
Forum Guru
Topics: 129
Posts: 870
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Thanks doco8 and docnikki-It is really encouraging..Will try my best to keep up my time.Changing from theory to questions and back to theory--I think it is a good way to keep us going.Wat do u guys think?
However,the qeustions in this journal are self-made or from MKSAP -to make sure some important points.That's why,it is not being posted in the corresponding forum.
doc08-u don't have to panic at all-u are bang on target
PTR :
*Acute AR can cause CHF as this patient and remember IE as the cause
*BP will be normal in acute AR due to increased LV fillling pressure
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| sprint123
Forum Guru
Topics: 129
Posts: 870
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Today's shot!
A 30-year-old woman with a history of asthma is evaluated in the emergency department because of severe shortness of breath. She has been using inhaled beta-agonists by metered-dose inhaler (MDI) with increasing frequency, up to every hour, without relief of symptoms.
In the emergency department, she has received continuous beta-agonist by nebulizer for the past hour and 125 mg of intravenous methylprednisolone.
On physical examination, she is using accessory muscles of respiration. Temperature is 37 °C (98.6 °F), pulse rate is 120/min, respiration rate is 32/min, and blood pressure is 130/80 mm Hg. Peak flow is 150 mL/min. Pulsus paradoxus is 18 mm Hg. Cardiac examination reveals tachycardia with distant heart sounds. Lung examination reveals inspiratory and expiratory wheezes in all lung fields. A chest radiograph shows no infiltrates. The leukocyte count is normal. The results of arterial blood gas studies on 60% oxygen by face mask are as follows: Pao2, 150 mm Hg; Paco2, 48 mm Hg; and pH, 7.28.
Which of the following is the most appropriate management option for this patient?
( A ) Intubation and mechanical ventilation
( B ) Intravenous methylprednisolone
( C ) Nebulized ipratropium bromide solution
( D ) Administration of heliox (helium and oxygen mixture)
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| doc08
Forum Senior
Topics: 9
Posts: 153
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i think its A
my rationale is she has already had IV steroid, which is not showing desirable results, since resp rate still high, wheezing still present, resp acidosis, she is in for resp failure next.
but results of peak flow, pulsus paradoxus- i am not sure how to interpret- can u pls explain?
nebu ipratropium is not used acutely right??
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| sprint123
Forum Guru
Topics: 129
Posts: 870
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Hi doc08--You are right..It is A.
Should be careful when we see increased pco2 in ahyperventilating patient or resp.acidosis----Especially in asthma can be an impending status asthmaticus.This is a typical case and Intubation is the answer.
Ipratropium is not used acutely and for that matter-not used in asthma itself for adults.
These medicine tapes are taking a lots and lots of time...Should finish as soon as possible.
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| doc08
Forum Senior
Topics: 9
Posts: 153
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hey sprint
whats up?
r u done with ur medicine tapes?
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| sprint123
Forum Guru
Topics: 129
Posts: 870
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Hey doc08...Thanks for dropping in...tapes have slowed me down...But still it is interesting...NO MATTER WHAT HAPPENS ,FROM NOW ONWARDS -HAVE TO FINISH MY DAILY TARGET BEFORE BED.
Tody's target ----> Infectious disease 3 hours lectures along with the corresponding notes+15 questions+1 hour CS
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| Dr_kholioo
Forum Junior
Topics: 9
Posts: 74
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hey man
keep going u r great,
just want to ask where do u get these questions from ?
___________________
“We all have great inner power. The power is self-faith. There's really an attitude to winning. You have to see yourself winning before you win. And you have to be hungry. You have to want to conquer.” Arnold Schwarzenegger
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