Some questions I'm struggling with

[harsh.boy365]

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[zhopv10]

Hi there, I'm a 2nd year dental student in London and stumbled upon a few questions that you guys can probably help me out with :

1) Pt with GERD who smokes and drinks excess, best advice: Stop smoking and alcohol / treat as h pylori/ urgent scope

Stop smoking and drinking (both increase severity of GERD)

2) Woman gave birth via C-section 42 hours ago, complicated procedure, is now symptomatic with SOB, fever of 39, ....what is it,chest x ray was clear (pneumonia, PE, pneumothorax,amniotic fluid embolism)

Whats most likely wrong with her?


I would say amniotic fluid embolism

3) Which causes red tinted saliva (isoniazid, rifampicin, TB)

Rifampicin

4) Pulm embolus after colectomy and was in pain - options: clop and co dyramole/warfarin and co dydramole/ warfarin & morphine

5) Whilst obtaining a past medical history your patient mentions previous asthmatic episodes. Which one of the following is least likely to indicate the severity of asthma?

• Degree of chest tightness
• Degree of interference with normal activity
• Frequency of inhaler use
• Frequency of night awakenings
• Type of inhaler used

Not sure I would say maybe degree of chest tightness


6) Which condition is least likely to cause a malignancy? coeliacs, UC, crohns, psueudomembranous colitis, primary sclerosing cholangitis

Pseudo membranous colitis I don't think c diff is associated with any malignancy that I know of

7) An 80 year old shipbuilder, who has never smoked before, presents at your practice for a routine visit. He is worried about his progressive shortness of breath over the past 6 months. A recent chest x-ray revealed pleural plaques and unilateral effusion. Which ONE of the following respiratory conditions BEST characterises his conditions?

• Bronchial carcinoma
• Chronic Obstructive pulmonary disease
• Idiopathic Pulmonary disease
• Mesothelioma
• Sarcoidosis

Mesothelioma probably since it is the pleura (shipyard workers had exposure to asbestos)




8) A chronic alcohol abuser was prescribed metronidazole after having an extraction at your practice. All of the following EXCEPT ONE are likely sideeffects the patient may experience if alcohol is consumed with his medication

• Bradycardia
• Facial Flushing
• Headache
• Nausea
• Vomiting

Disulfram like rxn I don't believe bradycardia is one of the sx's

9) A 20 year old man presents with a port wine stain of the skin of the face. On examination, the lesion can be seen to extend from the infraorbital margin to the upper lip areas on the right side only. Intra-oral examination revealed erythmous and swollen soft tissues on the same side. Which ONE of the following best characterises this condition?

• Herpes Zoster (Shingles)
• Rendu-Osler-Weber Disease
• Sturge-Weber Syndrome
• Idiopathic thrombocytopaenia
• Von Hippel – Lindau Syndrome

Can't remember for sure I think maybe sturge Weber....

10) Causes of mucus in stool?

11) 40 year old Patient had mucosal blisters and then noticed skin blisters a week ago but not eye involvement

• *pemphigus vulgaris*
• Mucous membrane pemphigoid
• Bullous pemphigoid

12) 60 year old patient with hepatomegaly and splenomegaly and progressing onset of symptoms

• AML + CML + CLL + ALL + lymphoma

Pemphigus vulgaris most likely




13) Confused dentist cos patient can't open mouth very wide and her skin is stiff and she gets a skin colour change of white to blue to red in the cold, what does she have?

• limited scleroderma
• Diffuse scleroderma
  
  I suppose diffuse scleroderma since they are having mouth involvement idk tho
  
  

14)Patient with freckles on palms of hand + soles of feet + mouth, what department should you refer her to?

• Gastroenterology
• Dermatology
• Oral medicine

I would say derm



15) Rash that starts behind the ear?

16) Woman previously well with persistently low neutrophil count

• Benign ethnic neutropenia
• Cyclic neutropenia
• HIV

I realize theres quite a few :S, but feel free to respond to as few or as many as you want!

Thanks in advance guys!

Here are a few I could think of quick off the top of my head


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[zeevee]

4)Patient with freckles on palms of hand + soles of feet + mouth, what department should you refer her to?

• Gastroenterology---- Peutz Jeghers
• Dermatology
• Oral medicine

An 80 year old shipbuilder, who has never smoked before, presents at your practice for a routine visit. He is worried about his progressive shortness of breath over the past 6 months. A recent chest x-ray revealed pleural plaques and unilateral effusion. Which ONE of the following respiratory conditions BEST characterises his conditions?

• Bronchial carcinoma ----- incidence of bronchial ca is still much higher than mesothelioma in asbestosis
• Chronic Obstructive pulmonary disease
• Idiopathic Pulmonary disease
• Mesothelioma
• Sarcoidosis

Confused dentist cos patient can't open mouth very wide and her skin is stiff and she gets a skin colour change of white to blue to red in the cold, what does she have?

• limited scleroderma---- looks like limited which involves just fingers and face and has Raynauds
• Diffuse scleroderma

I differed with the above answers from zhopv .

 

[zeevee]

Q) Woman previously well with persistently low neutrophil count

• Benign ethnic neutropenia >>>> this should be the answer
• Cyclic neutropenia ( thats neutropenia every 3 wks )
• HIV ( T cells affected )

Q) Rash that starts behind the ear?
Typical of measles

Q) 60 year old patient with hepatomegaly and splenomegaly and progressing onset of symptoms

• AML + CML + CLL + ALL + lymphoma

because of age more towards CML but could be AML .More info is needed

 

[zhopv10]

4)Patient with freckles on palms of hand + soles of feet + mouth, what department should you refer her to?

• Gastroenterology---- Peutz Jeghers
• Dermatology
• Oral medicine

An 80 year old shipbuilder, who has never smoked before, presents at your practice for a routine visit. He is worried about his progressive shortness of breath over the past 6 months. A recent chest x-ray revealed pleural plaques and unilateral effusion. Which ONE of the following respiratory conditions BEST characterises his conditions?

• Bronchial carcinoma ----- incidence of bronchial ca is still much higher than mesothelioma in asbestosis
• Chronic Obstructive pulmonary disease
• Idiopathic Pulmonary disease
• Mesothelioma
• Sarcoidosis

Confused dentist cos patient can't open mouth very wide and her skin is stiff and she gets a skin colour change of white to blue to red in the cold, what does she have?

• limited scleroderma---- looks like limited which involves just fingers and face and has Raynauds
• Diffuse scleroderma

I differed with the above answers from zhopv .

@zeevee Ah ya I totally missed peutz jehgers good call. Ya that's right for limited I couldn't remember if it involved the face so I was on the fence, nice! I still wonder about mesothelioma because even though bronchial carcinoma is more common with asbestos the stem talks about pleural effusions which is more associated with mesothelioma isn't it?


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[harsh.boy365]

For the 1st question how come endoscopy wouldn't be the correct answer? Does alcohol and smoking increase the risk the esophageal carcinoma on top of the GERD she is suffering from?

 

[zeevee]

I think ivory white calcified plaques are pathognomonic for asbestosis .I see why you chose mesothelioma though .Mesothelioma encases the lung and in our minds calcification also sounds like the same kind of restriction around the lung but plaques are a lot smaller than encasement typical of mesothelioma .

 

[zhopv10]

@harsh.boy. It says urgent scope, not really needed right away, you very well might get it later down the road but you would want to remove the simple stuff first see how sx's change. As a test taking strategy moving to the most invasive/expensive procedure first is rarely the right answer.


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[zhopv10]

I think ivory white calcified plaques are pathognomonic for asbestosis .I see why you chose mesothelioma though .Mesothelioma encases the lung and in our minds calcification also sounds like the same kind of restriction around the lung but plaques are a lot smaller than encasement typical of mesothelioma .

Good point, I could get on board with primary bronchial carcinoma then, do you see effusions in that tho?


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[AlphaBeta<3]

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[zeevee]

oh yeah blood tinged pleural effusion + calcified pp = buzz words for asbestosis and MCC ca is bronchial ca

 

[zeevee]

For the 1st question how come endoscopy wouldn't be the correct answer? Does alcohol and smoking increase the risk the esophageal carcinoma on top of the GERD she is suffering from?

For step 1 go with least invasive , preventive measure that is known to decrease symptoms .Step 1 is usually about basics .They are checking whether we know risk factors for GERD well enough .

Changing bad habits and losing weight is the first advice a doctor should give for GERD .

 

[zhopv10]

oh yeah blood tinged pleural effusion + calcified pp = buzz words for asbestosis and MCC ca is bronchial ca

Ah perfect I was only associating the effusion part with mesothelioma and not asbestosis for whatever reason, in that case ya would totally be bronchial cancer no doubt! Thanks!


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[harsh.boy365]

(Deleted)

 

[harsh.boy365]

For step 1 go with least invasive , preventive measure that is known to decrease symptoms .Step 1 is usually about basics .They are checking whether we know risk factors for GERD well enough .

Changing bad habits and losing weight is the first advice a doctor should give for GERD .

Lool, i'm a dental student though :S haha but yeah that makes sense!

 

[zeevee]

Got some more if you guys don't mind :S. I think i know the answers to a few but would love explanations if possible? Thanks guys!

Non-steroidal anti-inflammatory drugs (NSAIDs) may be contraindicated in ALL be ONE of the following patient groups.

1. Asthmatics
2. Children
3. Hepatic Disease---- I think acetaminophen is C/I but NSAIds can be given
4. Patients with gastric ulceration
5. Renal Disease

1. Patient being treated with zoledronate, what disease does she have?

• Osteomalacia>>> this one I think adult form of rickets
• Osteopetrosis
• Dentinogenesis imperfect--- I think this is genetic and requires crowning ( not a dental student )

1. Patient with red scaly rash around nose and near scalp and above eyebrows

• Seborrhoeic eczema ?

1. A woman with anxiety sweating palpitations hypertension before surgery, no longer has symptoms after surgery

• Cushings
• Graves
• Phaecytocroma>>>>> this one
• Hypothyroidism
• Hyperthyroidism

1. Patient has beefy red tongue, tingling hands and fingers and jaundice (in eyes)...

• Chronic alcoholic
• Colon cancer
• Pernicious anaemia>> B12 def
• Something else
• Pemphigoid

1. 66 year old women, red spots on lip, oral mucosa, skin. breathless on exertion, nose bleed since young,

• Iron def anaemia
• hereditary telangiectsia>>>>>>>I think so since its been happening since childhood and she has AV malformation spots
• Idiopathic thrombocytopenia purport

1. 28 years old woman , diffuse headache, back pain , vomit and collapses. She had ache a few days ago

• Encephlitis
• Meningitis
• Migraine
• Subarachnoid haemorrhage

"ache" ?? Looks like meningitis to me because of backache >>> meninges go all along the cord

 

[harsh.boy365]

1. Patient has beefy red tongue, tingling hands and fingers and jaundice (in eyes)...

• Chronic alcoholic
• Colon cancer
• Pernicious anaemia
• Something else
• Pemphigoid

For this, why would they have jaundice?

Could it be chronic alcoholic - which can cause anemia so glossitis (beefy red tongue) and jaundice?

Not sure about the tingling hands part? Can alcoholism cause B12 deficiency or tingling hands in any other way?

 

[zhopv10]

The tingling hands part is tipping you off to Neuro problems caused from the low B12 (accumulation of methylmalonyl CoA) . They can have jaundice because the large RBC's are unstable and lyse and what not

You might get B12 with EtOH although you would probably need to test for the thiamine before that...the more direct answer is the pernicious anemia though and the glossitis, nerve signs, and anemia is all classic


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[harsh.boy365]

The tingling hands part is tipping you off to Neuro problems caused from the low B12 (accumulation of methylmalonyl CoA) . They can have jaundice because the large RBC's are unstable and lyse and what not

You might get B12 with EtOH although you would probably need to test for the thiamine before that...the more direct answer is the pernicious anemia though and the glossitis, nerve signs, and anemia is all classic


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Okay thanks!