OlgaG
Forum Newbie
Topics: 2
Posts: 23
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Hello Dear colleagues!
I am preparing for Step 1 and started to make every week Q Gank Challenge.
Some questions are really difficult!
If you don't mind let's discuss them 
Thanks,
Olga
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| OlgaG
Forum Newbie
Topics: 2
Posts: 23
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There are a couple of test which were difficult for me today.
How do you think where is the right answer?
1. 79 y.o. man has a pain in the upper part of his neck during swallowing. He sometimes regurgitates undigested food shortly after eating. Diagnosis?
A. Mallory- Weiss tears
B. Plummer-Vinson syndrome
C. Schatzki rings
D. Traction diverticula
E. Zenker's diverticulum
I think the right answer is E.
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| OlgaG
Forum Newbie
Topics: 2
Posts: 23
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2.
17 y.o. boy has been take to the emergency department 3 times for acute abdominal pain but was released without a definitive diagnosis.
Phisicians have labeled him as having "irritable bowl syndrome".
On the 4th time urinalysis was performed: colour - yellow brown, gravity - 1.0025, WBC-25, RBC-0. Microscopic: gram "-"rods, mixed flora.
DS?
A. Celiac Disease
B. Crohn disease
C. Diverticulus
D. Ulcerative colitis
E. Whipple disease
I think the right aswer is dverticulus, colovesical fistula and urinary truct infection.
What is your opinion?
Thanks a lot!
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| GoodGirl
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Topics: 121
Posts: 1,718
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I would say Zenker's too, as it is most common diverticulum, and is in upper part.
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| GoodGirl
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Topics: 121
Posts: 1,718
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Question No 2 :
I would say it's Crohn ( B ) , with colovesical fistula.
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Prioritize & simplify
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| OlgaG
Forum Newbie
Topics: 2
Posts: 23
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Thank you!
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| Medusin
Forum Elite
Topics: 19
Posts: 296
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I agree with good girl.
Olga: I think diverticulosis would be right but the patient is too young to have it. IBD usually has an early onset (age 15-30 typically) and diverticulosis mostly affects the elderly.
Any other comments anyone???
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| OlgaG
Forum Newbie
Topics: 2
Posts: 23
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Yes i agree with you! Thank you!
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| vaibhavbora
Forum Elite
Topics: 17
Posts: 320
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ans .. 1 zenker diver,,
2 B. Crohn disease
diverticula = old age , apendicitis = young
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VB
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| drdokhtar
Forum Newbie
Topics: 3
Posts: 12
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Hi ... did anyone find out the answer to that question? It sounds more like Whipple's disease to me .. diarrhea with the gram neg rods?
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| vaibhavbora
Forum Elite
Topics: 17
Posts: 320
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but its gram -ve rod on urinalysis
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VB
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| hmmm_hmmm
Forum Senior
Topics: 16
Posts: 105
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i think its diverticulitis because the patient is in the emergency room.
diverticulitis is an emergency, not Crohn's.
Crohn would be my second best answer, but Crohns is usually in females in their 20s.
This boy can have a Meckel's Diverticulum which has ruptured.
Its a tough question, but more clues lead me to believe its Diverticulitis.
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| OlgaG
Forum Newbie
Topics: 2
Posts: 23
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Hello everybody! How are you? I hope you are doing well
Test #1
74 y.o. woman dies 2 days after she had severe chest pain. ECG, Echocardiographic and laboratory results confirmed myocardial infarction.
Posmortem histologic examination - ischemic necrosis infiltrated by neutrophils. No infarcts were found in the brain, kidneys, or spleen.
Which of the following was the most likely complications leading to this patient's death?
a. Arrhythmia
b. fibrinous pericarditis
c. Mural thrombosis
d. ventricular aneurysm
e. ventricular rupture
(I think that correct answer is e. ventricular ruptre bcz if it is ischemic necrosis with neutrophils this is have to be 1-3 days after IM - in our case 2 days, so the ventricular rupture is possible. Also arrhythmia is also can be a right answer...:eyebrow.
What do you think?
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| OlgaG
Forum Newbie
Topics: 2
Posts: 23
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Test #2
50 y.o. man is in emergency department because he has had progressively increasing chest pain for several hours. Although previous episodes of chest pain had been releived by nitroglycerin, the man states that it has not helped with the pain during this episode. This type of angina is thought to be due to which of the following conditions?
a. atherosclerosis alone
b. coronary artery embolism
c. coronary artery spasm
d. thrombosis with or without underlyning atherosclerosis
e. vasculitis
(I think that "a" is a right answer)
What is your opinion?
Thank you!
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| LG
Forum Newbie
Topics: 2
Posts: 52
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for the first q i would go with A ( arrhythmia ); goljan says that rupture of the ventricular wall takes place between day 3 and 7, rarely after 7
for the second q i would go with D ( thrombosis with or without underlining atherosclerosis )...the q stem talks about a patient transitioning from stable angina ( in the past ) to unstable agina ( the episode described above )
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| sigh
Forum Guru
Topics: 36
Posts: 432
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Hi Olya! I agree with LG.
#1 per Kaplan it can be arrhythmia or rupture but they did not give us any "signs" of rupture on postmorten exam...
#2 atherosclerosis is for stable angina when pt has pain on exercion, here pt has progressive pain for hours with no responce on Nitro- ----> unstable angina which due to thrombosis and of course + atherosclerosis
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| OlgaG
Forum Newbie
Topics: 2
Posts: 23
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Thank you very much guys.
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| OlgaG
Forum Newbie
Topics: 2
Posts: 23
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What about this test?
Test # 3
52 y.o. woman has long standing rheumatoid artritis and is being treated with corticosteroids and NSAIDs. Whih of the following cardiac complications may arise in this clinical settings?
a. constrictive pericarditis
b. dilated cardiomyopathy
c. hypersensetivity myocarditis
d. hypertrophic cardiomyopathy
e. restrictive cardiomyopathy
I think it is d. dilated cardiomyopathy because myocarditis (one of the clinical findings in RA) is one of the cause of dilated cardiomyopathy. But I am not sure. What do you think?
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| OlgaG
Forum Newbie
Topics: 2
Posts: 23
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Test #4
Following penicillin treatment for pneumococcal pneumonia, a patient develops a palpable purpuric rush. Result of the biopsy of the rush - vasculitis with hemorhage into the skin. The involved arterioles and venules show fibrinoid necrosis & a neutrophic infiltrate into the wall. Many of the neutrophils are fragmented.
Ds?
a. Allergic granulomatosis & angiitis
b. Giant cell arteriitis
c. Leucocytoclastic angiitis
d. Poliarteritis nodosa
e. Wegener granulomatosis
I think this is "c"
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| Karime
Forum Guru
Topics: 16
Posts: 1,200
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I don't know......having doubts btw B and C.....sorry
http://www.ispub.com/ostia/index.php?xmlFilePath=...
OlgaG wrote:
2.
17 y.o. boy has been take to the emergency department 3 times for acute abdominal pain but was released without a definitive diagnosis.
Phisicians have labeled him as having "irritable bowl syndrome".
On the 4th time urinalysis was performed: colour - yellow brown, gravity - 1.0025, WBC-25, RBC-0. Microscopic: gram "-"rods, mixed flora.
DS?
A. Celiac Disease
B. Crohn disease
C. Diverticulus
D. Ulcerative colitis
E. Whipple disease
I think the right aswer is dverticulus, colovesical fistula and urinary truct infection.
What is your opinion?
Thanks a lot!
___________________
Eterea ……..“Hoc in loco mors succurrere vivis gaudet”……("In this place death comes joyfully to the aid of the living" )
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