MCQS ON PEDIATRICS -DEVELOPMENTAL MILESTONE,INFECTIONS

 1.Which of the following statements about ideal protocol and transport of the COVID-19 PCR samples in transport tubes is true? *

a. Specimens should be kept in room temperature (22°C) for storage and transported within 72 hours

b. Specimens should immediately be frozen and transported within 72 hours

c. Specimens should be stored at 12°C and transported on an ice pack within 72 hours

d. Specimens should be stored between 2°C and 8°Cand transported with a cold pack within 72 hours

2.Which of the following about development is NOT True: *

a. Pincer grasp at 4 months

b. Sitting at 6 months

c. Social smile at 3 months

d. Can use pleurals at 2 years

3.Newborn commonly has following except: *

a. Milia

b. Mongolian Spots

Clinical Scenario of Thermal injury for Medical students-The patient has blistering open burn wounds involving the circumference of his left arm and left leg, in addition to his entire back and buttock areas.

A 63-year-old man is extracted from fire in the house and brought to the hospital. According to the witness at the scene, the victim was  unconscious in an upstairs bedroom of the house. His pulse rate is 110 beats/minute, blood pressure is 150/90 mm Hg,  and respiratory rate is 28 breaths/minute. The pulse oximeter shows  91% oxygen saturation with oxygen by face mask. His face and the exposed portions of his body are covered with carbonaceous deposit. The patient has blistering open burn wounds involving the circumference of his left arm and left leg, in addition to his entire back and buttock areas. 

 Inference:The man presents with approximately a 45%  TBSA burn(9+18+18) and inhalation injuries sustained in a house fire. 

What should be first step for  management of this thermal injury?

Definitive airway management by intubation is critical in this patient with likely inhalation injuries, carbon monoxide (CO) poisoning, and major burns. 


FIRST-DEGREE BURN WOUNDS: Superficial burns that involve only the epidermis. These wounds appear red and are not blistered. 

PARTIAL-THICKNESS BURN WOUNDS: (Formerly known as second-degree burns) 

INTERNAL MEDICINE MCQS ON GI,HEPATOBILLIARY,CARDIOLOGY,HEMATOLOGY SYSTEM

 

Internal medicine mcqs for NEET PG 2021


1.Diagnosis of Spontaneous bacterial peritonitis based on ascitic fluid PMN count *

a. ˃ 100/mm3

b. ˃ 150/mm3

c. ˃ 200/mm3

d. ˃ 250/mm3

2.The normal portal venous pressure is: *

a. 3 – 5 mm hg

b. 5 – 10 mm hg

c. 10 – 15 mm hg

d. 15 – 20 mm hg

Clinical case scenario of DIABETES MELLITUS and DIABETIC KETOACIDOSIS

A 20-year-old adolescent female is brought to the emergency room by her mother because the daughter seems confused and is behaving strangely. The mother reports the patient has always been healthy and has no significant medical history, but she has lost 20 lb recently without trying and has been complaining of fatigue for 2 or 3 weeks. The patient had attributed the fatigue to sleep disturbance, as recently she has been getting up several times at night to urinate. This morning, the mother found the patient in her room, complaining of abdominal pain, and she had vomited. She appeared confused and did not know that today was a school day.

General Surgery-Surgery MCQS on Trauma Management,Blood transfusion,Shock,Hemorrhage,Wound healing,SIRS,Shock


1.Which one of the following is true about delayed primary suturing? 

a. It is done immediately within 6 hours.

b. It is done on lacerated wounds.

c. Once infection subsides and healthy granulation tissue formed, delayed primary suturing is done.

d. Suturing the wound within 10 to 14 days later is delayed primary suturing.


2.Proliferative phase of wound healing includes except, *

a. Fibroblastic activity increases.

b. Growth of new blood vessels and capillary takes place.

c. Maturation of collagen takes place.

d. Re-epithelization of wound surface occurs.

What is normal level of sodium,potassium,calcium in the blood?

Sodium  :The normal serum sodium level is 135–145 mmol/L.

Hypernatraemia:

This can be caused by hypovolaemia and dehydration as well as primary hyperaldosteronism, Cushing’s syndrome and excess salt intake. Patients present with lethargy, irritability, fever, nausea, vomiting and confusion. Management is with controlled hydration using 4% dextrose with 1/5 normal saline or 5% dextrose solution together with judicious diuretic therapy.

MEDICINE MCQS-KATHMANDU UNIVERSITY

 

1. Addison’s disease is characterized by all of the following except:

A)  Hyperkalemia

Hyponatremia

Hypercalcemia

 Hypotension

ANSWER= (C) 

 

2. Pheochromocytoma predominantly secretes:

    Epinephrine 
ANSWER= (D) 


 

LIVER FUNCTIONS TESTS-LIVER PANEL-LIVER DISEASE

LIVER FUNCTION TESTS

 Aminotransferases (ALT/AST) :

This enzyme has two isoforms: alanine aminotransferase (ALT) and aspartate aminotransferase (AST).

Massive elevation of the serum levels of this enzyme is seen in severe viral hepatitis, hepatotoxic-induced liver injury and ischaemic liver injury.

Moderate elevations are characteristic of mild acute viral hepatitis, chronic active hepatitis, alcoholic hepatitis, cirrhosis and hepatic metastases. 

Usually the ALT elevation parallels AST elevation, but in alcoholic liver disease AST elevation far exceeds that of ALT. The ratio of AST/ALT in this setting is > 2.

Alkaline phosphatase (ALP) :A striking elevation of this enzyme is seen in cholestatic disorders. Moderate and transient elevations are seen in all types of liver pathology, including hepatitis, metastatic disease and hepatic infiltrative conditions such as lymphomas, leukaemia and sarcoidosis.

Gammaglutamyl transpeptidase (GGT): The level of this enzyme correlates with that of ALP. Its level also goes up in alcoholism, diabetes mellitus, cardiac failure, pancreatic disease, fatty liver and renal failure. Elevation of the level of this enzyme is often non-specific. 

Prothrombin time (PT) and international normalised ratio (INR): Elevation of the PT level and the INR is seen when hepatic synthetic function is impaired. All clotting factors except factor V are synthesised in the liver.

Serum albumin level: This marker also reflects the hepatic synthetic capacity, and hence it is low in significant liver disease.

The Approach to the Painful Joint

 The approach to JOINT PAIN/STIFFNESS

 In the clinical assessment it is important first to establish whether the presentation is that of a monarthritis or polyarthritis . Then check the distribution and the symmetry or asymmetry thereof. Other information that is useful includes:

1.Location and the exact joints involved

2.Onset, duration, diurnal pattern 3.Duration of pain and stiffness each day

4.Functional impairment

5.Precipitating and relieving factors and medications consumed so far

6.Progression over time and space

7.Associated other features, such as rash, weight loss, ocular symptoms, oral symptoms, genital symptoms

8.Muscle ache, headache, fever

  Arthritis 

Differential diagnoses that need to be considered include: 

•  rheumatoid arthritis 

Septic Shock -Clinical presentation and Management

CLINICAL CASE SCENARIO OF SEPTIC SHOCK 

A 44-year-old woman is admitted to the ICU after having undergone a 3-hour abdominal operation for the debridement of infected necrotizing pancreatitis (infected pancreas necrosis). The operation resulted in 800 mL of blood loss, and she received 3000 mL of crystalloid, 2 units of packed RBC, and 2 units of fresh  frozen plasma during the operation. Prior to the surgery, she was receiving  imipenem, itraconazole, and micafungin for Gram-negative bacteremia and fungemia. The patient’s skin appears warm and pink. She is intubated and mechanically ventilated. Her vital signs are pulse rate of 110 beats/minute, blood pressure of 94/60 mm Hg, and temperature of 39.1°C (102.4°F). Her breath sounds are present bilaterally and her abdomen is soft and distended. A chest radiograph reveals bibasilar atelectasis. A 12-lead ECG reveals sinus tachycardia. Complete blood count reveals WBC 24,000/mm3, hemoglobin 11 g/dL, and hematocrit 38%.

Likely causes of low blood pressure: Probably a combination of sepsis and blood loss. 

Next steps in the management: Initial efforts should be to restore intravascular volume with crystalloid fluids and blood products. The addition of a vasoconstrictive medication should be considered if volume replacement does not normalize her blood pressure and improve end-organ perfusion.

Fever of unknown origin (FUO) -Causes of FUO


Fever of unknown origin (FUO)

 refers to a prolonged febrile illness that persists without diagnosis after careful initial assessment. Although over 200 causes have been described, including rare diseases, most cases are due to familiar entities presenting in an atypical fashion.

Causes of FUO—The 'big three' are 

(1) infections—including tuberculosis, endocarditis, abdominal and hepatobiliary infections and abscesses, complicated genitourinary tract infections, pleuropulmonary infections, bone and joint infections, salmonellosis, cytomegalovirus, Epstein-Barr virus and HIV; 

(2) tumours—including lymphoma; 

CLINICAL ANATOMY OF UPPER LIMBS-CLAVICLE,SCAPULA,RADIUS,ULNA

CLAVICLE

Peculiarities of the Clavicle 

1 It is the only long bone that lies horizontally. 
2 It is subcutaneous throughout. 
3 It is the first bone to start ossifying.
4 It is the only long bone which ossifies in membrane.
5 It is the only long bone which has two primary centres of                   ossification.
6 There is no medullary cavity. 
7 It is occasionally pierced by the middle supraclavicular nerve. 
It receives weight of upper limb via lateral one-third through coracoclavicular ligament and transmits weight of upper limb to the axial skeleton via medial two-thirds part.

CLINICAL ANATOMY OF CLAVICLE

The clavicle is commonly fractured by falling on the outstretched hand (indirect violence). The most common site of fracture is the junction between the two curvatures of the bone, which is the weakest point. The lateral fragment is displaced downwards by the weight of the limb as trapezius muscle alone is unable to support the weight of upper limb  

The clavicles may be congenitally absent, or imperfectly developed in a disease called cleidocranial dysostosis. 

In this condition, the shoulders droop, and can be approximated anteriorly in front of the chest .


SCAPULA

CLINICAL ANATOMY OF SACPULA

Paralysis of the serratus anterior causes ‘winging’ of the scapula. The medial border of the bone becomes unduly prominent, and the arm cannot be abducted beyond 90° . 
The scaphoid scapula is a developmental anomaly, in which the medial border is concave.


HUMERUS

CLINICAL ANATOMY OF HUMERUS

The common sites of fracture of humerus are the surgical neck, shaft and supracondylar region.
Supracondylar fracture is common in young age. It is produced by a fall on the outstretched hand. The lower fragment is mostly displaced backwards, so that the elbow is unduly prominent, as in dislocation of the elbow joint. This fracture may cause injury to the median nerve. It may also lead to Volkmann’s ischaemic contracture caused by occlusion of the brachial artery.
The humerus has a poor blood supply at the junction of its upper one-third and lower twothirds. Fractures at this site show delayed union or non-union. 
The head of the humerus commonly dislocates inferiorly (subglenoid) 


RADIUS

CLINICAL ANATOMY OF RADIUS

The radius commonly gets fractured about 2 cm above its lower end (Colles’ fracture). This fracture is caused by a fall on the outstretched hand . The distal fragment is displaced upwards and backwards, and the radial styloid process comes to lie proximal to the ulnar styloid process. (It normally lies distal to the ulnar styloid process.) If the distal fragment gets displaced anteriorly, it is called Smith’s fracture  
 A sudden powerful jerk on the hand of a child may dislodge the head of the radius from the grip of the annular ligament. This is known as subluxation of the head of the radius (pulled elbow) . The head can normally be felt in a hollow behind the lateral epicondyle of the humerus.


ULNA
CLINICAL ANATOMY OF ULNA

The ulna is the stabilising bone of the forearm, with its trochlear notch gripping the lower end of the humerus. On this foundation, the radius can pronate and supinate for efficient working of the upper limb.
The shaft of the ulna may fracture either alone or along with that of the radius. Cross-union between the radius and ulna must be prevented to preserve pronation and supination of the hand. 
Dislocation of the elbow is produced by a fall on the outstretched hand with the elbow slightly flexed. The olecranon process shifts posteriorly and the elbow is fixed in slight flexion. Normally, in an extended elbow, the tip of the olecranon process lies in a horizontal line with the two epicondyles of the humerus; and in the flexed elbow, the three bony points form an equilateral triangle. These relations are disturbed in dislocation of the elbow. 
Fracture of the olecranon process is common and is caused by a fall on the point of the elbow. Fracture of the coronoid process is uncommon, and usually accompanies dislocation of the elbow.  
Madelung’s deformity is dorsal subluxation (displacement) of the lower end of the ulna, due to retarded growth of the lower end of the radius.




A case of Ulcerative colitis-A 28-year-old man comes with 2 days of abdominal pain

CLINICAL CASE SCENARIO OF COLITIS 

A 28-year-old man comes to the emergency room complaining of 2 days of abdominal pain and diarrhea. He describes his stools as frequent, with 10 to 12 per day, small volume, sometimes with visible blood and mucus, and preceded by a sudden urge to defecate. The abdominal pain is crampy, diffuse, and moderately severe, and it is not relieved with defecation. In the past 6 to 8 months, he has experienced similar episodes of abdominal pain and loose mucoid stools, but the episodes were milder and resolved within 24 to 48 hours. He has no other medical history and takes no medications. He has no recent travel history nor had contact with anyone with similar symptoms. He works as an accountant and does not smoke or drink alcohol. No member of his family has gastrointestinal (GI) problems. On examination, his temperature is 99°F, heart rate 98 bpm, and blood pressure 118/74 mm Hg. He appears uncomfortable, is diaphoretic, and is lying still on the stretcher. His sclerae are anicteric, and his oral mucosa is pink and clear without ulceration. His chest is clear, and his heart rhythm is regular, without murmurs. 

His abdomen is soft and mildly distended, with hypoactive bowel sounds and minimal diffuse tenderness but no guarding or rebound tenderness. Laboratory studies are significant for a white blood cell (WBC) count of 15,800/mm3 with 82% polymorphonuclear leukocytes, hemoglobin 10.3 g/dL, and platelet count 754,000/mm3. The HIV (human immunodeficiency virus) assay is negative. Renal function and liver function tests are normal. A plain film radiograph of the abdomen shows a mildly dilated air-filled colon with a 4.5-cm diameter and no pneumoperitoneum or air/fluid levels.

Most likely diagnosis: Colitis, probably ulcerative colitis.

Next step: Admit to the hospital, obtain stool samples to exclude infection, and begin therapy with corticosteroids.


The differential diagnosis for colitis includes ischemic colitis, infectious colitis (C difficile, E coli, Salmonella, Shigella, Campylobacter), radiation colitis, and IBD (Crohn disease vs ulcerative colitis). 

Mesenteric ischemia usually is encountered in people older than 50 years with known atherosclerotic vascular disease or other cause of hypoperfusion. The pain usually is acute in onset following a meal and not associated with fevers. With an infectious etiology, patients often have engaged in foreign travel, the symptoms are acute, or the patients recently used antibiotics. Also, family members often have the same symptoms. The IBD is most commonly diagnosed in young patients between the ages of 15 and 25 years. There is a second peak in the incidence of IBD (usually Crohn disease) between the ages of 60 and 70 years. The IBD may present with a low-grade fever. The chronic nature of this patient’s disease (several months) is typical of IBD. Anemia may be present, either due to iron deficiency from chronic GI blood loss, or anemia of chronic disease. Patients with IBD may also report fatigue and weight loss. Ulcerative colitis usually presents with grossly bloody stool, whereas symptoms of Crohn disease are much more variable, mainly chronic abdominal pain, diarrhea, and weight loss. Ulcerative colitis involves only the large bowel, whereas Crohn disease may affect any portion of the GI tract, typically the colon and terminal ileum. Ulcerative colitis always begins in the rectum and proceeds proximally in a continuous pattern; disease is limited to the colon. Crohn disease classically involves the terminal ileum but may occur anywhere in the GI tract from the mouth to the anus. Anal fissures and nonhealing ulcers are often seen in Crohn disease. Additionally, the pattern of Crohn disease is not contiguous in the GI tract; classically, it has a patchy distribution that is often referred to as “skip lesions.” Patients with Crohn may develop strictures caused by fibrosis from repeated inflammation which can lead to bowel obstruction, with  crampy abdominal pain and nausea/vomiting. Ulcerative colitis is characterized by diarrhea and typically leads to bowel obstruction. The diagnosis usually is confirmed after colonoscopy with biopsy of the affected segments of bowel and histologic examination. In ulcerative colitis, inflammation will be limited to the mucosa and submucosa, whereas in Crohn disease, the inflammation will be transmural (throughout all layers of the bowel). 

The treatment of ulcerative colitis can be complex because the pathophysiology of the disease is incompletely understood. Management is aimed at reducing the inflammation. Most commonly, sulfasalazine and other 5-aminosalicylic acid (ASA) compounds such as mesalamine are used and are available in oral and rectal preparations.

 They are used in mid to moderate active disease and to induce remission, and in the maintenance of disease to reduce the frequency of flare-ups. Corticosteroids may be used (po, PR, or IV) to treat patients with moderate to severe disease. Once remission is achieved, the steroids should be tapered over 6 to 8 weeks and then discontinued if possible to minimize their side effects. Immune modulators are used for more severe, refractory disease. Such medications include 6-mercaptopurine, azathioprine, methotrexate, and the tumor necrosis factor (TNF) antibody infliximab. Anti-TNF therapy, such as infliximab, has been an important treatment of patients with Crohn disease who are refractory to steroids, and more recently has shown efficacy in ulcerative colitis. Patients receiving the potent immunomodulator infliximab are at increased risk of infection, including reactivation of latent tuberculosis. Surgery is indicated for complications of ulcerative colitis. Total colectomy is performed in patients with carcinoma, toxic megacolon, perforation, and uncontrollable bleeding. Surgery is curative for ulcerative colitis if symptoms persist despite medical therapy. 

Two very important and potentially lifethreatening complications of ulcerative colitis are toxic megacolon and colon cancer. Toxic megacolon occurs when the colon dilates to a diameter more than 6 cm. 

It usually is accompanied by fever, leukocytosis, tachycardia, and evidence of serious toxicity, such as hypotension or altered mental status. Therapy is designed to reduce the chance of perforation and includes IV fluids, nasogastric tube placed to suction, and placing the patient npo (nothing by mouth). Additionally, IV antibiotics are given in anticipation of possible perforation, and IV steroids are given to reduce inflammation. The most severe consequence of toxic megacolon is colonic perforation complicated by peritonitis or hemorrhage. Patients with ulcerative colitis have a marked increase in the incidence of colon cancer compared to the general population. The risk of cancer increases over time and is related to disease duration and extent. It is seen both in patients with active disease and in patients whose disease has been in remission. Annual or biennial colonoscopy is advised in patients with ulcerative colitis, beginning 8 years after diagnosis of pancolitis, and random biopsies should be sent for evaluation. If colon cancer or dysplasia is found, a colectomy should be performed





Best Website and online lectures for MBBS students

Sometimes textbooks are trying hard to make us understand  concepts but fail to do so.Videos can be very helpful for medical students to understand the topic.We are going to mention some of the good website and Youtube channels for MBBS students that are going to help you to score good marks in your exams and make you a great doctor.

Let us begin:

1.Medscape- Not less than any textbook when it comes to authentication.Medscape consists of Medical articles,Drugs,Diseases and a lot more .Everything for medical student is here.From overview of a disease to its complications ,everything is mentioned in a systematic manner.I strongly suggest you to use Medscape.

2.MSD Manual - MSD Manual is very similar to Medscape but in a very concise form.You will love to look MSD every day for your daily queries during Clinical Postings in the wards.

 3.Pubmed - Everything and everything at one place when you want a deep vision into some approaches.

4.TeachmeAnatomy-Bored of your textbooks and having difficulties understanding relations.Just visit TeachmeAnatomy and enjoy Anatomy.You will be glad that you visited this site.

5.PhysiologyGuru-In my journey of physiology,this app helped me a lot.Dr Vivek is tutor here.He really has amazing concepts that these textbooks fail to convey This one is link to download this app in android.For ios,download here IOSAPP

Lets talk about some good youtube channels that medical students must subscribe.

1.Dr. Najeeb lectures-When he teaches a topic ,there  is a magic .You understand everything.Everything means everything plus his lectures become funny sometimes with his jokes.

2.MEDCRAM-When you are bored of studying ,this channel will help to utilise that time by its videos on different topics.

3.OneMinuteMedicalSchool- This channel is a wonder beacuse of its one minute videos that makes impact not less than hour of lectures.Just one minute and you know the stuffs.Is not it great?


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