jay1
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7) A 27-year-old man is found to have a solitary thyroid nodule during a routine health maintenance examination. A thyroid scintiscan shows uptake of radioactive iodine by the nodule. Which of the following is the most likely diagnosis?
A) Papillary carcinoma
B) Granulomatous thyroiditis
C) Chronic autoimmune (Hashimoto's) thyroiditis
D)Medullary carcinoma
E)Follicular adenoma
8)A 55-year-old man with a long history of poorly controlled hypertension suddenly develops severe retrosternal chest pain that radiates into the upper back between the scapulae. On examination he has diaphoresis and severe shortness of breath. Pulse is 125/min and regular, and blood pressure is 130/60 mm Hg in the left arm and 80/50 mm Hg in the right arm. There are diffuse, wet, inspiratory crackles in both lung fields, distant heart sounds, and a previously undetected grade 2/6, blowing, early diastolic murmur in the second right and third left intercostal spaces adjacent to the sternum. The most likely diagnosis is
A)ruptured chordae tendineae
B)myocardial infarction
C)pulmonary embolism
D)dissecting aortic aneurysm
E)ventricular septal rupture
F)pericarditis with tamponade
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| mash
Forum Fanatic
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1 E
2 D
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| suvi21
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agree with mash,
1)E
2) diss aortic aneurysm; however, I don't get the increase in SBP in the left arm........ can anyone explain pls?
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| bright_nnn
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1 B
2 D
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| mani
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these Qs were posted a short while ago as well. i have same query as survi
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| Renegade
Forum Elite
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About 2... I was thinking of dissecting aortic aneurysm too until I read the different BP in the left and right arm / crackles in both lung fields / early diastolic murmur. How does the aneurysm cause this... was the rupture before left subc. artery? Those are extremely rare these days. I'd go for A myself.
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| hiwa
Forum Senior
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1- E( discovered on routin check this is the clue, granulomatous thyroiditis is very painful)
2-It is a history of aortic aneurysm, that extended from the aortic root(caused aortic regurgitation by dilaatation of aortic ring, it is one of the manifeastations of the dissecting aneurysm) extended to the root of right subclavian artery, but has not reached left one. and the basal cracles because of increased left ventricular pressure also because of aortic regurg.
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| hiwa
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It is because the patient is known hypertensive, and dissecting aneurysm is very painful condition that cause increase PR and BP, (Patient has not lost any blood yet)
another clue of aortic regurg is Pulse pressure which is increased in high cardiac output
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| mani
Forum Guru
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good explanation hiwa. one more query: why not the Q1 is papillary CA, i mean whats the clue to follicular ca?
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| hiwa
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Actually by exclusion, because of the age it is not papillary,
it is follicular adenoma , asymptomatic
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