MEDICINE Dally Test Day 05

A 45-year-old man presents complaining of recurrent headaches for the past 3 months.. The headaches occur at all times of the day. Sometimes the pain is accompanied by loss of peripheral vision; however, the patient notes that he has experienced vision loss in the absence of the h|eadaches as well. This winter, he notes that neither his hat nor his gloves fit properly anymore. His wife mentions that he stopped wearing his wedding band last year because it began to cut off the blood supply. Vital signs include a blood pressure of 150/90 mm Hg, heart rate of 82/min, and respiratory rate of 14/min. His physical examination is remarkable only for the position of the point of maximal impulse, which is along the left midaxillary line at the level of the sixth rib. What is the most likely diagnosis?

Extremely high GH levels can be associated with all except

False regarding pathogenesis of acromegaly

4. Single best test for the diagnosis of acromegaly

5. What is the most appropriate treatment for a patient with acromegaly with pituitary adenoma > 10 mm in diameter

6. A 29-year-old woman presents with irregular menstrual cycles for the past 2 years; the intervals between her periods have extended as long as 3 or 4 months. She denies painful cramps but notes that the periods are heavier than before the irregularity began. She and her husband have been trying to conceive for the past year but have not been successful. She denies pain during intercourse. She notes that she has been gaining weight for the past year, estimating that she is nearly 9.1 kg heavier than she was at her last annual checkup. Upon examination, she is 160 cm (5'3") tall and weighs 77 kg. Her face is round and flushed, and her weight is concentrated around her abdomen; her arms and legs are comparatively thinner. Her breast and pelvic examinations are unremarkable, with the exception of thick, reddish-purple streaks around her breasts. What is the most likely diagnosis?

7. Causes of hypercortisolism include all except

8. Most common presenting feature of Cushing syndrome is

9. Most common cause of cushing syndrome

10. In a patient dexamethasone challenge test is done ,in which 1 mg is administered orally around 11 p.M., And serum cortisol is collected at 8 a.M. The following morning. A serum cortisol level < 5 pg/dl

11. False regarding evaluation of Cushing syndrome

12. A 40-year-old man presents with a month-long history of fatigue, light-headedness, and muscle weakness. He notes decreased appetite and a 4.5-kg weight loss over this time, as well as darkening of his skin, particularly over his appendectomy scar, his knuckles, his belt line, and both knees. The light-headedness is particularly severe when he gets out of bed in the morning or rises from a seated position. Throughout the interview, the patient appears irritable and agitated. His blood pressure is 115/70 mm Hg supine and 90/60 mm Hg standing. Relevant laboratory findings are as follows: 1. WBC count: 11,000/mm3, Absolute neutrophil count: 620/mm3 2.Total eosinophil count: 475/pL 3.Serum Na+: 125 mEq/L 4.Serum K+: 5.9 mEq/L 5.Serum glucose: 64 mg/dL (fasting) 6.What is the most likely diagnosis?

13. Which of the following features is seen in Addison's disease but not in secondary adrenal insuffiency

14. What tests could be used to confirm the diagnosis of Addison’s disease?

15. A healthy 24-year-old woman was involved in an automobile accident, and sustained a fracture of her jaw, multiple facial bone fractures, and a brief loss of consciousness. In the emergency department, an intravenous infusion of 5% dextrose in 0.45% normal saline at 125 mL/hr was started. Twelve hours after admission to the hospital, she was awake and alert but had difficulty swallowing and talking because of her injuries, and she complained of extreme thirst. Her urine output was 500-600 mL/hr. Laboratory studies showed that her serum sodium concentration was 156 mEq/L with a plasma osmolality of 320 mOsm/kg. Her urine osmolality was 65 mOsm/kg . What is the most likely diagnosis?

16. Nephrogenic diabetes insipidus is caused by all except

17. Polyuria with urine osmolality > 300 mosm/kg is seen in all except

18. What type of intravenous fluids would be most appropriate for patient with diabetes insipidus?

19. What is treatment of choice in a patient with central diabetes insipidus following trauma?

20. A 9-year-old boy is brought to the pediatrician by his parents for new-onset bedwetting and weight loss. They state that he is eating and drinking more than usual but continues to lose weight. He has been using the bathroom more during the day in addition to his accidents at night. He has also complained of changes in his vision. On physical examination, the child is alert and oriented with stable vital signs; there are no abnorrnal physical findings. Laboratory tests reveal a plasma glucose of 280 mg/dL. What is the most likely diagnosis?

21. False regarding Type 1 diabetes mellitus

22. All are shorter-acting types of insulin except

23. Additional screening tests will be required for type 1 diabetes include all except

24. The child has persistent early-morning hyperglycemia. A dawn phenomenon diagnosed ,what is the treatment of choice?

25. False regarding type 1 diabetes

26. A 20-year-old college student presents to the emergency department after 24 hours of nausea, vomiting, and severe abdominal pain. Two days prior, he attended an end-of-semester party at which he drank at least six beers. He notes that he has lost about 9.0 kg in the past 3 weeks, despite being excessively hungry and thirsty. He also mentions having experienced frequent urination for the past month. On physical examination, he appears pale and diaphoretic, and his breath smells fruity. He has a pulse of 130/min, blood pressure of 100/65 mm Hg, and respiratory rate of 20/min. Relevant laboratory test results are as follows: Serum Na+: 143 mg/dL Serum Cl~: 101 mg/dL Serum glucose: 550 mg/dL Serum bicarbonate: 6 mEq/L Serum pH: 7.2 Serum ketones: positive What is the most likely diagnosis?

27. A 36-year-old woman is seen in the emergency department after having fainted while exercising with her husband. She notes that, despite having maintained the same exercise regimen for the past few years and increasing her caloric intake, she has lost about 6.8 kg over the past 2 months. Furthermore, she sweats much more than she used to, even when not exercising. Her bowel movements have become more frequent and her menstrual cycles are more irregular. Her blood pressure is 130/80 mm Hg, pulse is 112/min, and respiratory rate is 16/min. She finds it difficult to sit still during the physical examination. Her skin is moist and warm. She has mild proptosis bilaterally. The rest of her examination is unremarkable. Laboratory tests reveal the following: TSH: 0.5 uU/mL Total triiodothyronine (T3): 300 ng/dL Total thyroxine (T4): 25 pg/dL TSH-R antibodies: positive What is the most likely diagnosis?

28. False regarding graves' disease

29. False regarding graves' disease

30. Diagnosis of graves' disease can specifically be confirmed by

31. A 33-year-old woman presents with history of ,two months ago, during a visit for a viral upper respiratory infection, her blood pressure had been 140/90 mm Hg. Her physician noted this and requested that she return for further evaluation when her infection resolved. The patient is in generally good health and denies medical problems. Today, her blood pressure is 190/100 mm Hg, heart rate is 8jj)/min, and respiratory rate is 14/min. Her physical examination is otherwise unremarkable. Relevant laboratory values are as follows: Serum glucose: 100 mg/dL (nonfasting) Serum Na+: 147 mg/dL Serum K+: 2.5 mg/dL Serum pH: 7.55 Serum HCO 3 - 32 mg/dL Serum osmolality: 275 mOsm/kg Urine osmolality: 530 mOsm/kg What is the most likely diagnosis?

32. As the serum potassium concentration falls, the initial ECG change is

33. Conn’s syndrome is charecterised by all except

34. Renovascular hypertension is charecterised by

35. Patients with primary hyperaldosteronism due to bilateral adrenal hyperplasia are treated with

36. A 38-year-old woman is brought to the emergency department with confusion and left lower quadrant abdominal pain. One hour earlier, her husband found her wandering around the house looking for the family dog, which had died 3 years ago. The patient is unable to describe the pain but is clearly in distress and is holding her left side. Her husband mentions that she was treated for a kidney stone at the same hospital 9 months earlier. Since then, she has lost approximately 6.8 kg and regularly complains of fatigue and muscle weakness. Upon examination, her blood pressure is 136/72 mm Hg, heart rate is 115/min, and respiratory rate is 16/min. There is tenderness with guarding in the left lower quadrant, as well as tenderness over her lower back. The patient is alert but is not oriented to time or place. Relevant laboratory values are as follows: Serum Na+: 152mg/dL Serum K+: 3.2 mg/dL Serum Ca2+: 17.3 mg/dL Serum phosphate: 1.7 mg/dL Serum Cl- 121 mg/dL. What is the most likely diagnosis?

37. Hypercalcemia is seen in all except

38. False regarding primary hyperparathyroidism

39. False regarding Lab findings in primary hyperparathyroidism

40. A 38-year-old mother of two children presents for a routine checkup. She has been feeling weak and tired for the past 3 months and notes constipation, with bowel movements approximately three times per week. She attributes the fatigue to the increase in menstrual flow and painful cramps she has observed for the past six cycles. For the past 2 months, she has also experienced a general lack of interest in her hobbies and finds it difficult to get out of bed each morning to care for her children. On physical examination, she appears to be shivering slightly. She weighs 12 kg more than she did at her last visit 12 months ago. Her blood pressure is 125/75 mm Hg, pulse is 55/min, and respirations are 12/min. A 5-cm, nontender neck mass is palpable, and her skin is dry and cold. Delayed relaxation of deep tendon reflexes is also noted. Her physician orders blood tests that reveal the following: Hemoglobin: 9.7 g/dL TSH: 14 pU/mL Total triiodothyronine (T;): 60 ng/dL Total thyroxine (T4): 3.2 ug/dL Thyroid peroxidase antibodies: positive What is the most likely diagnosis?

41. Differential diagnosis of Hashimoto's thyroiditis include all except

42. False regarding hashimoto's thyroiditis

43. False regarding evaluation of Primary hypothyroidism

44. A 27-year-old woman presents with left-sided pain that has waxed and waned in severity over several hours. The pain started in her left flank but is now most intense in her left labial region. Her gynecologic history is notable for 12 months of amenorrhea. She is not pregnant but does report irregular milky discharge from both breasts for many months. Last week, she was diagnosed with peptic ulcer disease and given a prescription for omeprazole, which she has been taking as directed. Upon examination, the patient is clearly in distress. She cannot lie flat on the examination table and initially refuses to let the physician palpate her abdomen. Her blood pressure is 110/70 mm Hg, heart rate is 120/min, and respiratory rate is 19/min. Her examination is notable only for some left lower quadrant tenderness. Bowel sounds are normal. Relevant laboratory results include a serum glucose level of 100 mg/dL (nonfasting), a serum Ca2+ level of 12.3 mg/dL, and a serum gastrin level of 253 pg/mL (nonfasting). What is the most likely diagnosis?

45. False regarding multiple endocrine neoplasia type 1

46. MEN1 usually affects the following first

47. Pituitary adenomas seen in MEN1 most commonly produce

48. False regarding blood work in men1

49. False regarding metabolic syndrome

50. Drugs contraindicated in Metabolic syndrome?

51. Target body mass index to be achieved in Metabolic syndrome

52. A 26-year-old woman presents with a 1- week history of a neck mass. She noticed the mass while showering one day and is very concerned because her mother and grandfather both died of thyroid cancer at an early age. She denies any history of neck radiation or heat or cold intolerance. On examination, her temperature is 37.0°C (98.6°F), pulse is 85/min, and blood pressure is 136/90 mm Hg. She has a firm, nontender 3-cm neck nodule located anteriorly just to the left of midline, immediately beneath the thyroid cartilage. The nodule rises when the patient swallows. There is palpable cervical adenopathy bilaterally. Relevant laboratory findings are as follows: Serum Na+: 140 mg/dL Serum K+: 3.9 mg/dL Serum glucose: 90 mg/dL Serum Ca2+: 10.5 mg/dL Serum phosphate: 1.1 mg/dL Serum parathyroid hormone: 70 pg/mL What is the most likely diagnosis?

53. Mucosal neuromas/intestinal ganglioneuromas , Marfanoid body habitus , medullary thyroid cancer are a feature of

54. Differential diagnosis of a thyroid mass concerning for malignancy in a patient with a strong family history of thyroid cancer includes

55. Underlying defect in the MEN2 syndromes is a germline defect in the

56. All patients with which of the following histologic type of throid carcinoma should be evaluated for pheochromocytoma

57. A 65-year-old woman presents with a history of low back pain. She began menopause at age 48 and did not receive hormone replacement therapy. Her mother had a hip fracture at age 71. She spends several hours each day outside gardening and consumes 1500 mg of calcium and 800 IU of Vitamin D each day. She denies any history of loose stools, weight loss, fever, chills, night sweats, or neurological problems. On examination, she is 4'11" tall and weighs 45 kg. Lumbar-spine films reveal a new vertebral fracture at the L4 level and diffusely decreased radiodensity and loss of trabecular structure in her bones. Dual-energy x-ray absorptiometry of the hip reveals a bone mineral density T score of—1.5. Relevant laboratory results are as follows: Serum Ca2+: 9.1 mg/dL Serum phosphate: 3.5 mg/dL Serum alkaline phosphatase: 110 U/L Serum calcidiol: 21 ng/mL What is the most likely diagnosis?

58. Osteoporosis is also defined as a T score less than

59. Osteoporosis is charecterised by

60. Risk factors for osteoporosis include all except

61. Treatment for osteoporosis include all except?

62. False regarding treatment for osteoporosis

63. A 56-year-old man is brought to the emergency department after tripping in his living room while walking .. He cannot put weight on his right leg and feels severe pain in his right thigh. The patient also notes that he has been experiencing pain in both legs for the past few months. The pain is throbbing and persists for a few hours, and then subsides. A heating pad helps to soothe the ache, but the patient has not used any medication for the pain. He is otherwise in good health and denies any history of hepatobiliary disease. Upon examination, his left leg and hip appear to have full range of motion. His right leg is limited on both abduction and adduction; medial rotation causes severe pain. X-ray of the hip reveals multiple spiral fractures of the right femoral diaphysis. Relevant laboratory values include the following: Serum Ca2+: 9.0 mg/dL Serum phosphate: 3.0 mg/dL Serum alkaline phosphatase: 500 U/L Serum calcidiol: 20 ng/mL What is the most likely diagnosis?

64. All are true about Paget's disease except

65. False regarding Paget’s disease

66. A 32-year-old man presents after experiencing a severe headache for 1 week. He has been in generally good health for most of his life, but has lost 3 kg in the past month. He has also begun feeling extremely anxious and "shaky," which he attributes to job-related stress. However, he admits that the level of anxiety exceeds the gravity of his problems at work. He has stopped exercising because of abdominal pain that makes it difficult to lift weights; he cannot localize the pain, noting that his entire abdomen aches at times. He also notes that he sweats much more than he used to and cannot drink enough water to compensate. Upon examination, he is trembling as he sits on the examination table. His blood pressure is 220/160 mm Hg, heart rate 148/min, and respiratory rate 17/min. His abdomen is soft and nontender; bowel sounds are normal. On two occasions during the visit, he experiences severe nausea but does not vomit. What is the most likely diagnosis?

67. Triad of clinical features of Pheochromocytoma include all except

68. Which of the following is used to confirm the diagnosis if a pheochromocytoma is suspected

69. A 66-year-old man is brought into the emergency department after experiencing a generalized tonic-clonic seizure. He was recently diagnosed with small cell carcinoma of the lung but is taking no medications and has not received chemotherapy. Physical examination reveals a patient in the postietal state. His blood pressure is 138/86 mm Hg, and heart rate is 76/min without orthostatic changes. He has no lower extremity edema. Relevant laboratory findings are as follows: Serum: BUN: 5 mg/dL Creatinine: 1.0 mg/dL Glucese: 85 mg/dL Na+: 105 mEq/L K+: 4.0 mEq/L C1-: 70 mEq/L HCOr: 25 mmol/L Urinalysis: Na+: 91 mEq/L K+: 64 mEq/L Urea nitrogen: 140 mg/L What is the most likely diagnosis?

70. Differential diagnosis for euvolemic hyponatremia include all except

71. The diagnostic criteria for SIADH include all except

72. False regarding differential diagnosis of SIADH

73. Rapid correction of serum sodium in hyponatremic patient carries a risk of

74. False regarding treatment of hyponatremia

75. False regarding thyroid nodule

76. False regarding workup of thyroid nodule

77. Total thyroidectomy the treatment of choice for all the following thyroid nodules except

78. If a patient is < 45 years of age and her tumor is < 1 cm in diameter , no cervical lymph node involvement ,with medullary carcinoma of histology ,what is treatment of choice

79. A 33-year-old woman presents to her primary care physician with neck pain. The pain began 2 weeks ago, is constant and sharp, and radiates to her jaw and ears. Over the past few weeks, she has also been having occasional loose stools and experiencing fatigue, malaise, and myalgias. She has no history of medical problems but does report having a "cold" 4 weeks ago. On examination, her temperature is 37.9°C (100.2°F), pulse 96/min,and blood pressure 134/82 mm Hg. There is diffuse enlargement of the thyroid gland, which is exquisitely tender to even mild palpation. Relevant laboratory results include: TSH: decreased Total triiodothyronine (T3 ): 300 ng/dL Total thyroxine (T4 ): 20 ug/dL What is the most likely diagnosis?

80. In which of the following conditions patients typically present in a hyperthyroid state lasting 2-8 weeks, become euthyroid for a very short time, and then become hypothyroid for another period of 2-8 weeks

81. Which of the following commonly presents with acute onset of pain with fever and chills, accompanied by hyperthyroid function tests.

82. All of the following are used in treatment of acute phase of de quervain's thyroiditis except

83. A 29-year-old man presents complaining of back pain and stiffness that has progressively worsened over the past 3 years. Initially, the pain was mild and intermittent, but currently it is 6/10 even at rest. The patient is occasionally awakened from sleep by the pain. The stiffness is worst in the morning and improves somewhat with exercise. On examination, the patient has a marked loss of lateral flexion of the liynbar spine and point tenderness over the sacroiliac joints. Radiographs of the patient's lumbar spine are significant for mild erosion and sclerosis of the subchondral bone within the sacroiliac joint. Relevant laboratory findings are a WBC count of 7200/mm3 and erythrocyte sedimentation rate of 113 mm/hr; results for rheumatoid factor are negative, but results for HLA-B27 are positive. What is the most likely diagnosis?

84. False regarding Ankylosing spondylitis

85. False regarding diffuse idiopathic skeletal hyperostosis

86. Uveitis with arthritis and hla-b27 positivity us seen in

87. False regarding arthritis

88. A 50-year-old nurse from Government general hospital ,Amritsar , presents with numbness and pain in the thumb, index, and middle finger of her right hand. She reports occasionally being awakened from sleep by the pain, which is relieved by moving her fingers. She notes that the pain comes on when she is holding a piece of cloth for a prolonged period while sewing. She also notes that recently she has had difficulty unscrewing jar tops and holding onto a glass or tea cup after a long day at work. She denies any trauma to her right hand, pain in other joints, fevers, or chills. On physical exam, the paresthesia is reproducible by having her hold her wrist flexed at 90 degrees for 30 seconds. Tapping on her right wrist reproduces the pain. What is the most likely diagnosis?

89. Secondary causes of carpal tunnel syndrome include all except

90. False regarding carpal tunnel syndrome

91. Phalen maneuver for diagnosing carpal tunnel syndrome is

92. All of the following are treatment measures for carpal tunnel syndrome except

93. A 28-year-old man involved in a motor vehicle accident while driving in the traffic of Vasant Vihar in New Delhi , is brought by ambulance to the nearest emergency department for evaluation of multiple cuts, bruises, and a swollen and extremely painful leg. On physical examination, his left leg is slightly cool and is swollen and tense relative to his right leg. He describes feeling "pins and needles" in his toes; he also has extreme difficulty dorsiflexing his left ankle. Dorsalis pedis and posteriqjjr tibial pulses are weak. Relevant findings include a temperature of 37° C (99.7° F), a blood pressure of 140/90 mm Hg, and a lateral compartment pressure of 60 mm Hg on compartment manometry of his left leg. What is the most likely diagnosis?

94. Best clinical test for diagnosis of compartment syndrome is

95. A compartment pressure of greater than ------- mm Hg is the criteria on manometry that portends ischemic injury

96. Only proven treatment for acute compartment syndrome of leg

97. A 54-year-old woman from Jalandhar presents to her with muscle weakness and a crusty, scaly rash on her knuckles and over her eyelids. For the past couple of months, she has had difficulty getting out of a chair but attributed it to aging. The rash developed 2 weeks after visiting a self-tanning salon and is extremely pruritic. She has tried taking antihistamines and applying moisturizer to the area but reports no relief. The itching is so severe that it often wakens her at night. She denies fevers, chills, or changes in detergents or creams. She is taking no medication except the antihistamine. On examination, she is afebrile with a heart rate of 70/min, blood pressure of 110/80 mm Hg, and a respiratory rate of 13/min. Notable findings include prominent violaceous papules over the metacarpophalangeal joints of her hands and over her upper eyelids and a rash with a shawl like distribution over her anterior neck, upper chest, and back. Relevant labs are as follows: Erythrocyte sedimentation rate: 60 mm/hr Antinuclear antibody: 1:320 Creatine phosphokinase level: 510 U/L What is the most likely diagnosis?

98. False regarding dermatomyositis

99. False regarding Dermatomyositis

100. False regarding dermatomyositis