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11/12/2021

A 17-year-old Anushka is admitted to the emergency department with severe retrosternal chest pain. The pain began suddenly after an episode of self-induced vomiting following a large meal. The patient's parents say that she is very restricted in the foods she eats and induces vomiting frequently after meals. Her blood pressure is 100/60 mm Hg, heart rate is 98/min, respiratory rate is 14/min, and temperature is37.9°C (100.2°F). The patient is pale and appears to be in severe distress. Her lungs are clear to auscultation. On cardiac examination, a crunching, raspy sound is auscultated over the precordium that is synchronous with the heartbeat. The abdomen is soft and non-tender. Which of the following tests is likely to confirm the diagnosis in this patient?

: 👇
A. Upper endoscopy
B. ECG
C. Echocardiography
D. Contrast esophagram

10/12/2021

🤔 A 56-year-old raj presents for a follow up regarding management for type 2 diabetes
mellitus (DM). He was diagnosed about 7 years ago and recently started on insulin therapy because
oral agents were insufficient to control his glucose levels. He is currently on a regimen combining
insulin lispro and neutral protamine Hagedorn (NPH) insulin. He takes insulin lispro 3 times a day
before meals and NPH insulin once in the morning. He has been on this regimen for about 2 months.
His glucose reading at night averages around 200 mg/dL and remains close to 180 mg/dL before his
shot of NPH in the morning. The readings during the rest of the day range between 100-120 mg/dL.
He denies vision changes or numbness/tingling in the extremities. His latest HbA1C level was 6.2%.
Which of the following adjustments to his insulin regimen would be most effective in helping this
patient achieve better glycemic control?

👇

A. Add another dose of insulin lispro in the evening.
B. Add another dose of NPH in the evening.
C. Add insulin glargine to the current regime.
D. Replace lispro with insulin aspart.

09/12/2021

: A 25-year-old homeless Kinjal presents to an urgent care clinic for vaginal bleeding. She also reports vague right lower abdominal pain that started a few hours ago and is increasing in intensity. Her medical history is significant for chronic hepatitis C infection and she claims to take a pill for it "every now and then." Her temperature is 36.0°C (98.6°F), blood pressure is 70/41 mmHg, and pulse is 131/min. Physical exam reveals localized right adnexal tenderness with rebound tenderness and guarding. Transvaginal ultrasonography demonstrates a 2-cm gestational sac in the right fallopian tube. After starting a fluid bolus, which of the following is the most appropriate next step in management?

: 👇
A. Laparoscopic salpingostomy
B. Methotrexate
C. Pelvic CT without contrast
D. Paracentesis

09/12/2021

: A primigravida, 29-year-old Neha presents in her 18th week of pregnancy for evaluation of 3 hours of vaginal bleeding and abdominal pain. She denies any trauma and states that this is the first time she has had such symptoms. Her prenatal care has been optimal and all of her antenatal screenings have been within normal limits. Her vita: signs are unremarkable. Physical examination reveals a small amount of blood in the vaginal canal, and the cervical os is closed. Ultrasound imaging demonstrates positive feta cardiac activity. What is the most likely diagnosis?

: 👇
A. Incomplete abortion
B. Inevitable abortion
C . Missed abortion
D. Threatened abortion

09/12/2021

: A 44-year-old Dhaval is brought to the emergency department after sustaining high-voltage electrical burns over his left upper limb. On examination, the tip of his left middle finger is charred, and there are 2nd-degree burns involving the whole of the left upper limb. Radial and ulnar pulses are strong, and there are no signs of compartment syndrome. An exit wound is present over the sole of his right foot. His temperature is 37.7°C (99.8°F), the blood pressure is 110/70 mm Hg, the pulse is 105/min, and the respiratory rate is 26/min. His urine is reddish-brown, and urine output is 0.3 mL/kg/h. Laboratory studies show:

Hemoglobin 19.9 g/dL
Hematocrit 33%
Leukocyte count 11,111/mm3
Serum
Creatinine 4.6 mg/dL
Creatine 123 U/L
Phosphokinase
K+ 7.7mEq/L
Na+ 143 mEq/L
What is the most likely mechanism for this patient's renal failure?
:👇
A. Fluid and electrolyte loss and hypovolemia

B. Rhabdomyolysis, myoglobinuria, and renal injury

C. Direct visceral electrical injury to the kidneys

D. Septicemia leading to acute pyelonephritis

. A 24-year-old virat is hospitalized for an elective gastrointestinal surgery 24 hours before the scheduled day of...
07/12/2021

. A 24-year-old virat is hospitalized for an elective gastrointestinal surgery 24 hours before the scheduled day of surgery. The surgeon has ordered food and liquids to be withheld from the patient for the 12 hours leading up to the surgery and for the administration of intravenous isotonic saline. Based on his body weight, his fluid requirement for 12 hours is 900 mL However, the following day, the surgeon finds that 3 pints of isotonic fluid (1 pint 500 mL) were administered over the preceding last 12 hours. Which of the following options best describes the resulting changes in the volume of intracellular fluid (ICF) and the body. osmolality of the patient?🤔

Options :👇

A. Increased ICF volume, no change in body osmolality

B. Increased ICF volume. decreased body osmolality

C. Decreased ICF volume, no change in body osmolality

D. No change in ICF volume, no change in body osmolality

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