Property:Prompt
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A 65 year old man is brought to an emergency room after he suffered from convulsions. He has no history of seizures, head trauma, hypertension, and diabetes. He has been taking escitalopram from last 2 months for depression, but he forgot to take it in last 3 days. The patient is confused and unable to answer any question. Which of the following medicine you would administer? +
A 80 years old woman is in a nursing home. Her sleep-awake cycle is altered, concentration is impaired, and is not oriented to time place and person. Her symptoms started yesterday and their severity seems to be fluctuating. Her urine examination revealed puss cells and is suggestive of urinary tract infection. There is no history of dementia, stroke, hypertension. What is the first line treatment in the managing delirium? +
The parents of a 7-year-old boy divorce. The boy lives with the mother and sees his father every-other weekend. During these visits, the boy is sullen and angry with the father, but when it is time to return home, he clings to the father and cries in a desperate manner while saying "I'm sorry! I want you and mom to live together forever." This is an example of, +
A 6 year old girl with low IQ is complaining of pain in abdomen, constipation, vomiting was brought to an emergency room. She is well groomed, but highly irritable and uncooperative. On examination her vitals are stable, and has tender abdomen. A physician ordered X ray of the abdomen, which revealed multiple metallic particles spread across her gastrointestinal tract, and a couple of rounded foreign objects in stomach measuring about 3mm. Endoscopic removal was ordered as the foreign object would have not passed through the gastrointestinal tract. Blood lead level is 18 μg/dL. The family of girl lives in a very old house. In the past, she was diagnosed with chronic constipation and her pediatrician prescribed laxatives at bedtime. She is the 51th percentile for height and weight. What is the most likely diagnosis? +
A 44 year fashion coordinator, had a daughter, who suffered from major depressive disorder. She was on fluvoxamine and lorazepam. 2 weeks back daughter was found dead in her apartment with syringes and heroin by her side. She went to see a psychiatrist and started discussing suicide, she regrets being a bad mother and concentrating too much in career. She has started seeing her daughter in garage and laundry room. Psychiatrist decides to keep a close follow up and asks her to return after 1 week. On the second visit, she seems to be increasingly obsessed with suicide. She started drinking 6 beer everyday, unable to concentrate on work, and appears to be withdrawn. Psychiatrist provides reassurance and asks to visit after a week. On the third visit, she mentions difficulty in falling sleep, waking up at 3am in the morning, feeling of worthlessness, and loss of interest. She never had a problem with drugs or alcohol, but has a past history of major depressive disorder. What is the most likely diagnosis? +
A 41-year-old woman was brought to an emergency room by police. She has swallowed 5 pills of alprazolam of 0.5mg, in front of her best friend. Her friend called psychiatrist and psychiatrist asked the local police department to escort the patient to the hospital emergency room. On examination, her left forearm has many healed cut marks. She told an emergency room physician that, she broke up with her boyfriend 2 hours back. She always had a rocky relationship and was never able to sustain a long term relationship. On further questioning, she revealed, that she takes Fluoxamine 40mg OD, Alprazolam 1mg at bed time, Lithium 900mg extended release, Oxycodone 2.5 mg two times a day, and Ibuprofen XR PRN. She always had extreme emotional outbursts like panic, rage, and threatening behavior to the stressors. Also an empty feeling and sense of abandonment. Her vitals were stable. What should be the next best step in the management? +
36 year old man comes to a primary care doctor, with complains of depressed mood and loss of interest from last 7 months when he lost his wife in a car accident. On examinations, his vitals were stable and lab reports were,
*Hb 14
*AST 12 U/L
*ALT 14 U/L
*ALP 15 U/L
*Total bilirubin 0.6 mg/dl
*BUN 14 mg/dL
The dexamethasone suppression test did not reveal an adrenal axis pathology, also TSH was normal. His mood brightened when he learns about positive events. He had a 20 pound weight gain in last 6 months and sleeping 10 hours a day. Also, he described a heavy feeling in his arms and legs. What is the next step in the management? +
34-year-old struggling actress, brought herself to the emergency room complaining of a progressively growing rash from last 1 week. When dermatological evaluation revealed no abnormality, when this was explained to her, she says that she can’t keep herself safe at home. She was obsessed with the idea of skin cancer. Her neurological examination, laboratory tests, and toxicology screen did not reveal any cause for psychosis. In the interview she demonstrated tangential thinking and constant concern about skin cancer. She described her mood as low. Her thoughts were overly and intensely concentrated on cancer. She suddenly started crying because she believed she felt her cancer crawling under skin and spreading to the eyes. She denied suicidal or homicidal idealization, hallucinations, ingestion of drugs or alcohol, family history of psychiatric illness, or any relevant medical problem. What is the most likely diagnosis? +
A 60 year old Caucasian woman presents to the clinic with a complaint of swelling in front of her neck which she noticed recently. She denies any history suggestive of either hyper or hypothyroidism symptoms. She denies any history of fever, neck pain, difficulty in breathing or swallowing and any recent change in her voice. She is currently not on any medications and neither has a history of exposure to radiation nor any family history of thyroid illness. On examination, her vital signs are blood pressure of 120/80 mmHg, pulse rate of 90 beats/min, respiratory rate of 12 breaths/min and temperature of 37 C. A 3 x 2 cm nodule is palpated in her right thyroid lobe. Lab tests revealed normal TSH levels. Fine needle aspiration cytology of the nodule and subsequent histopathological analysis revealed papillary carcinoma of thyroid. What is the next best step in management of this patient? +
41 year old man is diagnosed with a new vertebral fracture. He also complains of difficulty concentrating, fatigue, frequent bowel movements, heat intolerance, increased appetite, increased sweating, nervousness, restlessness and insomnia, from last 8 months. Ten years back, he underwent subtotal thyroidectomy, as he was suffering from graves disease. He denies family history of prostate cancer, osteomalacia and osteopetrosis. What is the most likely cause of vertebral fracture? +
On examination physician notices a horizontal scar in front of the neck. His vitals are as follows,
BP 138/88 mm of Hg
Pulse 98b/m
Temperature 99F
His systemic examination is otherwise normal, except hypereflexia in all four extremities. What is the next best step in the management of osteoporosis? +
The patient is moving to Nepal for next 4 years, which of the following tests you will recommend to follow up with a new primary care doctor? +
A 43 year old man, is complaining of increased frequency of urination, increased thirst, weakness and fatigue. He is exercising regularly and trying to reduce weight. He denies difficulties in the vision, and tingling and numbness in hands and feet. His BMI is 27.2, however his appearance is otherwise normal. The fasting blood glucose was 121mg/dl and Hb A1c: 7.1
Glucose tolerance test results are,
1 hr blood glucose level is 186mg/dl and 2 hr blood glucose is 154mg/dl. What is the most likely diagnosis? +
A 23 year old woman is complaning of repeated thoughts about germs, and dirt. She tries to be overly tidy and followed same rituals over and over, such as washing hands, washing silverware, changing sheets and cleaning floor. She neither can control the unwanted thoughts and behaviors nor gets a pleasure out of it. This is causing distress and disrupts daily life. Which of the following will curtail her symptoms? +
A 17-year-old female presents to a pediatrician with her mother. The mother expresses concern that her daughter has never menstruated.The physician asks the mother to leave the room and begins taking a detailed history. The patient denies any history of penetrative sex, abdominal pain or STDs. The physician notes that the patient is in Tanner stage 3, and there is an absence of androgenic hair distribution. Pelvic and vaginal exam is unremarkable. What is the next best step in the management of this patient? +
A 60 year old Caucasian woman presents to the clinic with a complaint of swelling in front of her neck which she noticed recently. She denies any history suggestive of either hyper or hypothyroidism. She denies any history of fever, neck pain, difficulty in breathing or swallowing and any recent change in her voice. She is currently not on any medications and neither has a history of exposure to radiation nor any family history of thyroid illness. On examination, her vital signs are blood pressure of 120/80 mmHg, pulse rate of 90 beats/min, respiratory rate of 12 breaths/min and temperature of 37° C. A 3 x 2 cm nodule is palpated in her right thyroid lobe. Lab tests revealed normal TSH levels. Fine needle aspiration cytology of the nodule and subsequent histopathological analysis revealed papillary carcinoma of the thyroid. She then underwent a near total thyroidectomy along with radioactive ablation and radioiodine scan. What is the next best step in management of this patient? +
A 53-year-old married African-American presents to the clinic with a complaint of persistent cough with mucoid sputum for the past 2 months. He denies any history of fever, malaise, or weight loss. He has a history of smoking half a pack of cigarette a day for the past 20 years, which he stopped before three years. He lives with his wife and exercises regularly three times a week. He has been working as an office manager in a mining industry for the past 20 years. He has a past medical history of three episodes of similar illness lasting for more than three months in the past two year and hypertension for the past five years, for which he is taking chlorthalidone daily. His vital signs are temperature 36.7 C, blood pressure 130/80 mmHg, pulse 86/minute, and respirations 14/minute. On physical examination, mild wheeze in both the lungs and pharyngeal erythema without exudates could be elicited. What is the most likely cause of this patient’s persistent cough? +
A 62 year old man presents to his primary care physician after noticing bright red blood in his stool for the past month. On review of systems, he describes occasional constipation and fatigue. Sigmoidoscopy reveals a 2.5 cm mass at the rectosigmoid junction. Pathological evaluation reveals a microsatellite-unstable adenocarcinoma that invades beyond the muscularis propria. Metastatic workup reveals no distant metastases or lymph node involvement.
Which of the following best describes this tumor?
Note:Stages refer to AJCC stages +
A 72 year old woman presents to the emergency room for a one week history of bright red blood per rectum and constipation. The patient is hemodynamically stable and shows no signs of acute obstruction or peritonitis. She refuses to drink GoLYTELY to prepare for a colonoscopy, but agrees to administration of the solution by nasogastric tube. Which of the following tests is best to confirm the proper placement of the nasogastric tube? +
A 58 year old man presents to the emergency department with upper abdominal pain. He was playing poker and drinking whiskey with his friends when the pain began. He describes the pain as radiates to the back, 8/10 and colicky. On physical exam, the patient exhibits unintentional guarding and the abdomen is rigid. Laboratory evaluation reveals the following:
Sodium: 135
Potassium: 4.1
Chloride: 100
Calcium: 10.1
Hematocrit: 40%
Hemoglobin: 13 mg/dL
WBC: 20,000 cells/mm3
Neutrophils: 15,000
Amylase: 500 mg/dL
Lipase: 1,000 mg/dL
LDH: 385 mg/dL
AST: 400 mg/dL
ALT: 250 mg/dL
Which of the following is not a component of the criteria typically used for risk assessment in this patient's condition? +