IFOM Questions Part 2

Musculoskeletal, rheumatology 91. Question with a photo of a child having a rash all over face, picture attached. Saying that parents did some topical creams, but it didn’t work. What’s the diagnosis → atopic dermatitis 92. Melanoma diagnosis 93. A teenager with open comedones acne → topical benzoyl peroxide, isotretinoin was included in the choices both oral and topical 94. Scabies picture in a child, asking about treatment → permethrin 95. An old patient who took Allopurinol for 2 weeks then developed desquamation of skin and blister → Toxic epidermal Necrolysis (TEN) 96. An old patient with shoulder and hip pain, examination shows no muscle weakness, what to do next? Bone scan 97. Question about pathophysiology of osteoarthritis (a) Decreased proteoglycan (b) Inflammatory process (c) Lysosomal enzyme release 98. Typical lumbosacral strain case, paraspinal tenderness. What to do next? (a) Move as tolerated (b) MRI 99. Legg-Calvé-Perthes disease diagnosis with x-ray image 100. Slipped capital femoral epiphysis diagnosis with x-ray image 101. Another question about osteoarthritis (don't remember the question, I think it's about screening for old patient → bone scan) 102. Dupuytren’s contracture pathophysiology → fibroproliferative Endocrine 103. Pheochromocytoma pathophysiology → Increase in catecholamine 104. Treatment of HHS (a) IV short acting insulin (b) Subcutaneous short acting insulin 105. Hypercalcemic crisis, best initial step → IV fluids, not calcitonin 106. Mechanism of hypercalcemia in a female patient with breast cancer and bone pain likely bone metastasis, asking about mechanism of malignancy induced hypercalcemia? (a) increased vit D (b) increased PTH (c) increased activation of osteolytic factor 107. Mechanism of hypercalcemia in a patient with weight loss and symptoms of malignancy I think might have been squamous cell carcinoma, not sure. (a) Increased osteolytic factor (b) Increased PTHrp 108. An elderly patient with symptoms of hypercalcemia (increased thirst, constipation, fatigue) but no weight loss mentioned. Labs showed the following: Serum protein= 7.5, Albumin normal, PO4 = 2.1, Ca+ =10.9. cortisol level =15, free t4 =4.6. What’s the diagnosis? (a) (b) (c) (d) (e) Multiple Myeloma hypothyroidism hyperthyroidism pituitary adenoma primary AI 109. Female patient with thyroid nodule that was found to be hypoactive on scan. Serum TSH and thyroid hormones within reference range, what to do next? (a) (b) (c) (d) Suppressive levothyroxine therapy FNAC I131 ablation follow up 110. Clinical picture of hyperthyroidism (tremors, exophthalmos, weight loss), what is the best initial step? (a) beta blockers twice a day (b) propylthiouracil once a day (c) Thiamazole once a day (d) thyroidectomy 111. A patient with a picture of hypothyroidism and lipid profile showed very high cholesterol, LDL level, and TGs. What’s the best next step? dry skin, getting tired, what to do next? (a) Start/give atorvastatin (b) Measure serum TSH 112. Female patient with irregular menses, facial hair with high testosterone and 17hydroxyprogesterone, what’s the diagnosis? (a) CAH (b) PCOS 113. Teenager with irregular menstrual period, has dry skin, thin hair, low pulse, low blood pressure, BMI 18 what is the cause? (a) Hypothyroidism (b) anorexia nervosa Ethics and biostatistics 114. An elderly patient with a diagnosis of terminal illness. His son is a doctor and doesn’t want father to know. What do you do? Ask patient how much he is willing to know about his diagnosis 115. A study was done to determine the efficacy of PSA in detecting prostate cancer, in a group of 1000 men. Out of 400, 275 men had high PSA levels and endoscopic findings of prostate cancer. An additional 25 men had normal PSA but were found to have prostate cancer. What is the sensitivity of the PSA test in detecting prostate cancer?Sensitivity = TP/(TP+FN) = 275/25+275 = 275/300 (a) (b) (c) (d) 275/300 275/400 275/700 275/1000 116. Absolute risk reduction (ARR) for a disease that occurs seasonally in 40% of the children and they reduced that number to 10%. Calculate the ARR . Absolute Risk Reduction = Control Group Risk − Treatment Group Risk = 40 –10 =30 % 117. A physician and patient were included in a double-blind study for a new drug used in treating a disease rather than the standard drug. I don't remember the standard drug exactly; I think it might've been an antihypertensive. However, both physician and patient don't know which group they are. Why is that important? Asking about the biases (a) (b) (c) (d) Bias against sample selection or something like that sample size too small to be generalized confounding bias Bias in measuring the outcomes 118. A new test is being studied to detect esophageal disorders. Researchers conducted the test and found that 70 patients had positive findings on endoscopy but only 2 were detected by the test, and 335 patients who didn't have the disease tested negative. What can we tell you about this test? (a) can be used for screening test (b) can't be used as it failed to detect a large number of cases 119. Question mentioning a female that is gaining weight but she clearly stated that she is not eating anything, and is worried and says she cannot reduce food any more than this. Her pulse was 65. What to do next? (a) (b) (c) (d) Endocrine lab tests tell her not to worry about weight gain tell her to follow a certain diet tell her to stop caloric restriction 120. Senior residents and I think a healthcare worker in a nursing home facility got influenza. What to do to prevent the spread of infection? (a) Vaccinate only exposed ones (b) Give everyone vaccination and oseltamivir (c) Isolate all patients with symptoms together 121. Precautions prior to CVC placement? (a) (b) (c) (d) hand washing wear gloves and mask giving prophylactic antibiotics Remove nasogastric tube Infectious disease 122. A young child with fever and a picture of infection developed hypotension and raised papules on IV-line insertion, on examination mottling can be seen. What's the cause? (a) Sepsis (b) Anaphylaxis 123. Picture of a child with a single non bullous impetigo, how to treat it → Topical Mupirocin 124. A picture of meningitis likely Neisseria meningitidis in a university student asking about precaution/ mode of protection → droplet 125. An asymptomatic HIV patient with 5 mm PPD test induration after 48 hrs , asking you what to do next? (a) Treat latent tb (b) Treat active tb (c) Repeat PPD after 1 month (d) Repeat PPD after 6 months 126. Treatment of dengue fever → no further treatment 127. Typical Malaria case: Fever, muscle pain, etc. Picture showing Intraerythrocytic Malaria in the film. Asking for the diagnosis? 128. Patient with symptoms of TB and multiple punctures/signs of drug use seen on examination what's the mechanism of her symptoms → decrease CD4 T cells 129. Question about a child that went on vacation with his family, he developed an itchy rash on his feet that extended up to his ankle, and then spread. The rash was seen as long erythematous, irregular lines → Ancylostoma 130. Clinical picture of cellulitis post mastectomy → Strept pyogenes, staphylococcus aureus was not in the options. 131. SCD in a patient makes him/her more vulnerable to infection by what organism? (a) Pneumococcal pneumoniae (b) pseudomonas 132. Treatment of traveler's diarrhea not prophylaxis → adequate hydration 133. Patient with flu symptoms/ URTI then developed sinusitis with yellowish greenish discharge. What is the causative organism? (a) Strept. pneumoniae (b) Staph aureus 134. A 5-month-old infant with a picture of otitis media, examination revealed a hyperemia of the pharynx and an erythematous, bulging tympanic membrane, what to give? (a) Oral amoxicillin (b) topical ofloxacin 135. A male presenting with gas discharge from urethra ObGyn 136. Clinical picture of PCOS asking increased risk for which cancer? Endometrial carcinoma 137. Asking for contraception for smoker with heavy menstrual bleeding i think 5-7 days → Levonorgestrel IUD 138. A female patient with a picture of disseminated Neisseria gonorrhoeae with right wrist pain and rash. Also having like 10 lesions (rash all over her body). She’s sexually active with no consistent protection. What’s the next step in management? (a) Cefotaxime (b) Azithromycin (c) Doxycycline 139. Mucopurulent discharge from cervix causative organism→ chlamydia 140. Amenorrhea in a patient who took low dose estrogen OCP for years and asking about cause → endometrial atrophy 141. A young sexually active patient who had HIL lesion on pap smear and tested positive for HPV, what is the next step in management? (a) colposcopy (b) cone biopsy 142. A female patient who had an uncomplicated labor, with intact placenta delivered. After 30 mins, she experienced moderate vaginal bleeding, what’s the cause? (a) Uterine Atony (b) Retained products of contraception (c) Vaginal hematoma 143. A 47 or 40 something years old previously had light periods every 1-6 months, suddenly experienced vaginal bleeding every few weeks, what’s the next best step? (a) (b) endometrial biopsy progesterone 144. Patient was given oxytocin, but contractions became more irregular, what to give → terbutaline 145. Picture given of vulvar lichen planus (old patient with itching and agglutinated vulva), asking what to do next → Biopsy 146. Diagnosis of preeclampsia with severe features (proteinuria, HTN and low platelet) 147. Patient that underwent bilateral salpingectomy, came now presenting with amenorrhea for I think 8 weeks or so, with some vaginal bleeding. Next step? (a) pregnancy test (b) ultrasound 148. Unilateral bloody nipple discharge no calcifications on mammography → intraductal papilloma 149. A female with a previous history of ectopic pregnancy, presented with amenorrhea. On US there is a 1 cm gestational sac but no yolk sac, fetal pole. Her B hCG was 1600, then after 48 hrs it was 1000. What to do next (a) (b) (c) (d) Repeat US after 24 hours Repeat US after 1 week Repeat BhCG after 24 hours Repeat BhCG after 1 week i think 150. Hepatitis B in pregnant patient screened during 32 weeks ( HbsAg +ve, HbsAb –ve, total HBc Ab +ve, HBc IgM –ve, Anti HBeAg). What to give newborn → Hep B IVIG + HepB vaccine