Professional Practice II
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Professional Practice for medical students
- 1.A 34 year old man presents to the emergency department in excruciating abdominal pain. It woke him from sleep about one hour ago and he now has severe right lower quadrant pain radiating into his testicle. He is nauseated and has vomited twice in the past hour. The pain is not relieved in any position, and he has never experienced anything like this before. What should be asked or performed next?
- A.
Past medical history
- B.
Social history
- C.
System review
- D.
Abdominal examination
- 2.After further history taking, he has type 1 diabetes but claims it is well controlled. His only medication is insulin, and he has no allergies.What should be done next?
- A.
Abdominal examination
- B.
Full blood count
- C.
Abdominal X-ray
- D.
Vital signs
- 3.Abdomen: soft, bowel sounds present, right-sided tenderness worse in upper quadrant Genitalia: uncircumcised phallus, non bloody meatus, non tender descended testis Rectal: normalThink about your differential diagnosis, then reveal the options and choose the one most likely diagnosis.
- A.
Acute appendicitis
- B.
Acute renal colic
- C.
Bowel obstruction
- D.
Cholecystitis
- E.
Testicular torsion
- 4.Choose the initial investigation which is not helpful to confirm your suspected diagnosis from the last question
- A.
Unenhanced CT scan
- B.
Serum creatinine
- C.
IV pyelogram
- D.
Full Blood Count with differential
- E.
KUB X-rays
- 5.CT reveals a stone 4 mm in diameter in the right distal ureter. The lab results are as follows: Blood: - WBC 9,600/uL (4,000-10,000) - BUN 11 mg/dL (8-20) - creatinine 1.0 mg/dL (0.7-1.3) Urinalysis: - specific gravity 1.040 - RBC: 60-100/hpf - no bacteria - pH 5 Your initial management includes all this except:
- A.
Morphine 10 mg IM/SC q4h prn
- B.
Instruct patient to strain urine
- C.
Admission to hospital
- D.
IV fluids
- 6.Which of the following is FALSE regarding renal colic?
- A.
Gross or microscopy hematuria is seen in over 75% of patients
- B.
CT scan or IVP is required to confirm the diagnosis
- C.
Pain is characteristically intense, radiates from the flank to the groin, and is of sudden onset
- D.
Urinary extravasation is an operative indication
- 7.A 12 year old boy with Crohn's disease presents to the ER with an acute abdomen. The pediatric ER physician completes a complete workup and diagnoses the boy with a small bowel obstruction. Medical management was unsuccessful and he underwent surgical resection of the ileum. Which of the following nutritional deficiencies is he now at risk for?
- A.
Vitamin B12 deficiency
- B.
Folic acid deficiency
- C.
Calcium deficiency
- D.
Iron deficiency
- 8.A three month old infant, Jason, presents with irritability. Mom describes him to be "incredibly fussy and always crying". He is difficult to settle down to sleep and if placed on his back he will not stop crying until held or rolled onto his stomach. It is impossible to go anywhere in the car because he "hates his car seat and won't stop screaming". He has been irritable since birth but it wasn't until about 3 weeks ago that she began to worry. Mom is exasperated and does not know what to do. Upon further questioning you discover that Jason only likes to be held on his side or in a vertical position, not cradled horizontally. He is feeding from one or both breasts every 2-3 hours however after he is done mom finds that he is continually swallowing and arching his back. In addition he often vomits a small amount after feeds. He has no signs of respiratory distress. Jason's growing along the 50th percentile for height and weight. Mom had a normal pregnancy with no significant prenatal history or complications during or after delivery. Jason is an otherwise healthy baby. What is the most likely diagnosis?
- A.
Viral gastroenteritis
- B.
Gastroesophageal reflux disease
- C.
GI obstruction
- D.
Intussusception
- 9.A 23-year old woman has been seeing her family doctor for crampy abdominal pain and constant diarrhea, which is occasionally bloody. She says the pain is mostly in her right lower quadrant. She's lost about 15 pounds over the past year. Upon reviewing her labs in a follow up visit, the doctor notices her erythrocyte sedimentation rate and C-reactive protein are elevated. What would top your differential diagnosis?
- A.
Ulcerative colitis
- B.
Coeliac disease
- C.
Irritable bowel syndrome
- D.
Crohn's colitis
- 10.What fat-soluble vitamin is administered to all newborn infants?
- A.
Vitamin A
- B.
Vitamin D
- C.
Vitamin E
- D.
Vitamin K
- 11.Aims and objectives of an AMS are these except...
- A.
To promote secondary health care
- B.
To advocate for Aboriginal self determination and community control
- C.
To serve as a peak body and forum
- D.
To alleviate sickness and assist aboriginal groups
- 12.What is the most common aetiology of albumin proteinuria?
- A.
increased glomerular permeability
- B.
overflow of tubular reabsorptive capacity
- C.
reduced tubular reabsorption
- D.
chyluria
- 13.An otherwise healthy 20 year old patient of yours visited yesterday complaining of fever, sore throat, cough, and general cruminess. He mentioned that his pee had been darker over the last little while, but he didn't think much of it because it comes and goes about once a year. What is the most appropriate diagnostic testing to do?
- A.
Full blood count
- B.
Urinalysis
- C.
Sputum test
- D.
ESR and CRP
- 14.He's back today to discuss his urinalysis (red cells, otherwise bland) and blood work (unremarkable). Thankfully, you called a nephrologist buddy of yours who told you to...
- A.
start him on prednisone
- B.
get a biopsy to solidify the diagnosis
- C.
diagnose IgA nephropathy and monitor with urinalysis/renal function testing (GFR)
- D.
aggressively treat his blood pressure with an AT-II blocker and an ACE inhibitor
- 15.These are all management for stress incontinence except...
- A.
Tension free vaginal taping
- B.
Pelvic floor exercises
- C.
Periurethral bulking injections or artificial sphincter
- D.
Drinking less water
- 16.In patient centered management of chronic disease, the important aspects are these except...
- A.
Empowering self-responsibility or Self management and therefore compliance
- B.
Patient education – evidence shows that a knowledgeable patient achieves better outcomes
- C.
Continuity of care – creates a healing relationship (patient and doctor) and efficient organization
- D.
Integration of care provided by the doctor
- 17.What are not the secondary causes of osteoarthritis of the hip?
- A.
Developmental dysplasia (DDH)
- B.
Slipped femoral capital epiphysis
- C.
Fracture
- D.
Idiopathic
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