August 30, 2012

How To Take A Full Medical History

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Medicine has been described as both a science and an art. The overall purpose of medical practice is to relieve suffering1. In order to achieve this purpose, it is important to make a diagnosis, to know how to approach treatment, and to design an appropriate scheme of management for each patient1.

It is therefore essential to understand each person as fully as possible, whatever their social class or ethnic and cultural background1. The first step toward understanding any patient is taking a medical history.

The art of obtaining a good medical history itself is a skill that is acquired through study and experience. It is necessary to be methodical and detailed, so as not to miss out facts that may seem little but in reality be the keystone to making the right diagnosis.

August 26, 2012

Additional $225m Grant To Fight Malaria in Nigeria

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NIGERIA and the Global Fund to Fight AIDS, TB and Malaria, at the weekend, signed two grant agreements valued at $225 million as part of a Phase-2 grant to boost malaria prevention and treatment in the country.

Minister of Health, Professor Onyebuchi Chukwu, at the signing ceremony in Abuja, stressed that Phase 2 of the grant would be implemented in 36 states including the Federal Capital Territory.

He was hopeful that with lessons learned from Phase 1, the current phase would be successful and provide a successful model for other countries.

60 year old with severe abdominal pain radiating to the back

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A 60 year old patient presents with three days onset of severe abdominal pain radiating to the back. On physical examination, a pulsatile mass in the periumbilical region is found. The patient is hemodynamically stable.

The next appropriate step would be:

a) Serum glucose
b) Oral cholecystogram
c) Liver biopsy
d) Intravenous urogram
e) Endoscopy
f) CT scan of the abdomen
g) Blood culture
h) Serum alcohol level
i) Serum amylase
j) Ultrasound of the abdomen

August 25, 2012

7 year old with mild icterus, moderate splenomegaly and hyperbilirubinemia

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A 7 year old is noted to have mild icterus. On examination he is found to have moderate splenomegaly. Investigations reveal a conjugated hyperbilirubinemia. There are normal levels of AST, ALT, albumin, alkaline phosphatase. Tests on the urine reveal an elevated total coproporphyrin excretion of 5 times the normal with 25% being coproporphyrin I. A liver biopsy is normal.

A likely diagnosis is:

a) Pancreatic carcinoma
b) Hemochromatosis
c) Laennec's cirrhosis
d) Hepatitis A
e) Hepatocellular carcinoma
f) Rotor's Syndrome
g) Primary biliary cirrhosis
h) Gilbert's Syndrome
i) Hepatitis B
j) Hemolysis

August 24, 2012

Patient with allergic rhinitis and acute urticaria

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A patient with allergic rhinitis develops acute urticaria. This is best relieved by:

a) Antigen avoidance
b) Immunotherapy against the known offending antigen
c) Antihistamine-decongestant preparation
d) Topical adrenergic agonist
e) Oral adrenergic agonist
f) Systemic corticosteroids
g) Topical corticosteroids
h) Subcutaneous injections of atropine
i) Conjunctival challenge
j) Combination of H1 and H2 antagonists

August 23, 2012

Coinfection of a RNA virus with a DNA virus

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A lecturer is giving a talk about a ribonucleic acid virus that causes hepatitis. He is describing how this virus requires coinfection with a deoxyribonucleic acid virus to support its replication. This virus has been confined primarily to populations with frequent percutaneous exposures, such as drug addicts and hemophiliacs.

Which virus or viral agent is he talking about?

a) Recombinant hepatitis B vaccine
b) Hepatitis C virus
c) Hepatitis B surface antigen
d) Hepatitis C vaccine
e) Hepatitis D
f) Hepatitis B immune globulin (HBIG)
g) Hepatitis B virus DNA
h) Hepatitis B e antigen
i) Hepatitis A
j) Atopic dermatitis

American College of Physicians Announces Internal Medicine 2013 Meeting

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The American College of Physicians (ACP) is happy to announce its Internal Medicine 2013 which will be held on the days April 11-13 in San Francisco, CA; USA. This annual event is the "The Most Comprehensive Conference in Internal Medicine".

August 22, 2012

Pregnant woman with recurrent vaginal bleeding

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A pregnant woman complains of recurrent vaginal bleeding. Her fetus is small for dates at 32 weeks gestation. The next most appropriate step is:

a) Angiography of the iliac vessels
b) Ultrasound localisation of placenta
c) Doppler cord blood flow studies
d) CTG
e) Maternal ECG
f) Hgb estimation
g) Rhesus status
h) Speculum exam
i) Kleihauser test
j) Coagulation profile

August 19, 2012

Cytotoxic drugs leading to cardiotoxicity

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Cardiotoxicity is a well-known side effect of several cytotoxic drugs. Which of the following cytotoxic drugs is most likely to lead to long term morbidity due to cardiotoxicity?

a) Doxorubicin
b) 5-fluorouracil
c) taxoids
d) cyclopentenyl cytosine
e) trastuzumab

August 18, 2012

What an Extra-Ordinary Nerve-Racking Medical Week!

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What a week it has been! From the near-nerve-wracking weekend call to my usual Tuesday Unit Emergency Room call (ER take) and then, the Consultants ward-round bashing the very next day, with students looking on with eyes full of pity for me. What can I say? Its been an all-round bashing spree for me from both patients and senior colleagues. Boy, I've never had it this rough before now.

August 17, 2012

Cytotoxic drugs leading to haemorrhagic cystitis

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Nephrotoxicity is a known side effect of several cytotoxic drugs. Which of the following cytotoxic drugs is most likely to lead to haemorrhagic cystitis?

a) Cyclophosphamide
b) 5-fluorouracil
c) Taxoids
d) Cyclopentenyl cytosine
e) Trastuzumab

August 16, 2012

A 35 year old sexually promiscous woman

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35 year old sexually promiscous woman has painful lower abdominal cramps, fever and increased vaginal discharge. A pelvic examination demonstrates adnexal tenderness. The most appropriate treament would include:

a) zidovudine (ZDV) plus lamivudine (3TC) plus IDV
b) intravenous Trimethoprim/Sulfamethoxazole
c) combination of ticarcillin and gentamicin
d) 1-time dose of metronidazole
e) IM ceftriaxone plus doxycycline

August 15, 2012

Patient with suspected Pseudomembranous colitis

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A patient suffering from suspected Pseudomembranous colitis is treated with metronidazole. The role of metronidazole in eradicating the causative organism is to:

a) cleave bacterial DNA
b) dissolve the pseudomembranes
c) disrupt bacterial mitochondrial function
d) compete with broad spectrum antibiotics
e) this statement is false, metronidazole is contraindicated in suspected Pseudomembranous colitis

August 14, 2012

Cytotoxic drugs leading to pulmonary disease

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Vascular abnormalities are a known side effect of several cytotoxic drugs. Which of the following cytotoxic drugs is most likely to lead to pulmonary veno-occlusive disease?

a) bleomycin
b) 5-fluorouracil
c) taxoids
d) cyclopentenyl cytosine
e) trastuzumab

August 13, 2012

International Health Resources

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Organizations and Agencies; Publications and Databases; and Guides to International Health Resources (originally from University of California Berkeley Library).

August 12, 2012

70 year old female with left lower quadrant abdominal pain

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A 70 year old female patient presents with new onset of left lower quadrant abdominal pain, a low-grade fever, focal tenderness with guarding and an elevated white blood cell count.

The most likely diagnosis is:

a) endometrioma
b) hemorrhagic ovarian cyst
c) tubo-ovarian abscess
d) ovarian torsion
e) diverticulitis

August 11, 2012

What is the radiological image diagnosis

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Study the radiological image below. What is the most likely diagnosis?

[click image to enlarge]
a) Ventricular septal defect
b) Patent ductus arteriosus
c) Coarctation of aorta
d) Supravalvular aortic stenosis
e) Pulmonary valve stenosis

Branches of the External Carotid Artery

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In human anatomy, the external carotid artery is a major artery of the head and neck. It arises from the common carotid artery when it bifurcates into the external and internal carotid artery[1].

The external carotid artery begins at the level of the upper border of the thyroid cartilage, and, taking a slightly curved course, passes upward and forward, and then inclines backward to the space behind the neck of the mandible, where it divides into the superficial temporal and maxillary artery within the parotid gland[1].

It rapidly diminishes in size in its course up the neck, owing to the number and large size of the branches given off from it[1]. From inferior to superior, the branches of the external carotid artery are:

August 10, 2012

Cytotoxic drugs leading to leukemia

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Secondary malignancy is a known side effect of several cytotoxic drugs. Which of the following cytotoxic drugs is most likely to lead to the acute nonlymphoblastic leukaemia (ANLL)?

a) melphalan
b) 5-fluorouracil
c) taxoids
d) cyclopentenyl cytosine
e) trastuzumab

August 09, 2012

30 year old man with malaria fever

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A 30yr old man visiting Africa developed high grade fever associated with chills and rigors. The doctor there diagnosed it to be malaria and the man was treated with chloroquine. The patient responded to the medication and became asymptomatic.

He immediately returned home to USA and after about 4 weeks again developed high grade fever associated with chills and rigors. The man was diagnosed to have a recurrence of malaria.

The most probable cause for his recurrence is:

a) re-infection by the organism
b) survival of the exo-erythrocytic phase of the parasite
c) survival of a dormant form of the parasite in his bone marrow
d) survival of the erythrocytic phase of the parasite
e) chloroquine is not effective against malaria

August 02, 2012

Concerning inflammatory and allergic reactions

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A certain type of cell plays a central role in inflammatory and immediate allergic reactions and settles in connective tissues and usually does not circulate in the blood stream.

This type of cell is known as a:

a) Basophil
b) Mast cell
c) Eosinophil
d) Neutrophil
e) Macrophage

August 01, 2012

A 38 year old farmer with severe headache, fever, and cough

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A 38 year old farmer is seen with severe headache and fever. He has a history of a ten day cough with bloody sputum and consolidation on a chest xray for which he was given erythromycin by his physician. Physical examination was unremarkable except for bilateral inspiratory crackles and a lumbar puncture was performed. This demonstrated a highly pleomorphic coccobacillii with gram-negative cell wall.

These features are characteristic of:

a) Streptococcus pneumoniae
b) Bacteroides fragilis
c) Coxiella burnetii
d) Escherichia coli
e) Haemophilus influenzae