MCQ - Choose the Culprit Drug

A 60 year old male with a history of congestive heart failure and atrial fibrillation states his vision has been mostly yellow recently. He has noted lack of appetite and weight loss. Laboratory studies reveal and elevated potassium level. Which of the following is the likely causing his symptoms?

Nitroglycerine

Digoxin

Amiodarone

Spironolactone

Sildenafil

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Cardiology MCQ - Make your Diagnosis

A 72 year old female with a history of breast cancer and tobacco use complains of dizziness and dyspnea on exertion. Her heart sounds are distant and her systolic blood pressure is noted to markedly decrease with inspiration. Which of the following is the most likely diagnosis?

A) Constrictive cardiomyopathy

B) Mitral valve Stenosis

C) Congestive heart failure

D) Pulmonary embolus

E) Cardiac Tamponade

Answer    E

                 Cancer is the most common cause of pericardial effusion and when enough fluid accumulates in the pericardial space, cardiac tamponade occurs. “Pulsus paradoxus” is when there is a decrease in systolic blood pressure during inspiration due to failure of the right ventricle to accept the normal increased venous return that occurs with inspiration. This also results in a “Kussmal’s sign” or elevated jugular venous distension during inspiration (normally the opposite occurs). Treatment is with emergent pericardiocentesis.

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Which of the following laboratory results would be expected?

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A 50 year old gentleman with a history of hypertension and high cholesterol presents to the emergency department with pain in chest for one hour. He describes a substernal chest pressure associated with shortness of breath and sweating. His ECG shows ST elevations consistent with myocardial infarction. Which of the following laboratory results would be expected?

 Elevated myoglobin, normal troponin I, and normal CK-MB

Normal myoglobin, elevated troponin I, and normal CK-MB

Normal myoglobin, normal troponin I, and elevated CK-MB

Normal myoglobin, normal troponin I, and normal CK-MB

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Choose The Most Likely Diagnosis

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A 70 year old woman with a history of breast cancer and tobacco use complains of dizziness and dyspnea on exertion. Her heart sounds are distant and her systolic blood pressure is noted to markedly decrease with inspiration. Which of the following is the likely diagnosis?

Restrictive Cardiomyopathy

Mitral Valve Regurgitation

Congestive Heart Failure

Pulmonary Embolism

Cardiac Tamponade

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Choose The Right Antihypertensive

A 60 year old African American gentlemen with a history of COPD is diagnosed with hypertension. Laboratory studies reveal a creatinine of 3.2 mg/dL and a potassium level of 5.2 mg/dL. Which of the following medications is appropriate to treat his hypertension?

Spironolactone
Amlodipine
Hydrochlorothiazide
Enalapril
Propranolol

Click one out of 5 option to choose your answer

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How to Mentally Prepare yourself For USMLE?

In order to become a doctor in the USA, people must get through a series of examinations that are conducted by the National Board of Medical Examiners. These examinations are collectively known as United States Medical Licensing Examinations, that is, USMLE. There are four separate papers that candidates must pass, in order to earn the eligibility for medical licensure. They are termed as Step 1, Step 2 and Step 3. 

The Step 1 of USMLE exam is designed to test whether a candidate is capable of understanding and applying different concepts of sciences in the medicinal practice. It emphasizes on mechanisms and principles of health, ailments, and types of therapies. This step establishes the fact that not only mastery of sciences, but also mastery of scientific principles are required to provide the foundation for safe and competent medicinal practice in today’s world.

Step 2 of the USMLE exam is designed to test whether a candidate can apply medical knowledge, understanding and skills to provide patient care. This step emphasizes on disease prevention and health promotion. This step establishes the fact that due attention is required to provide sound foundation of safe and competent medicinal practice.

Step 3 is the clinical skills examination. This step basically establishes that mastery of communication and clinical skills, as well as cognitive skills are necessary to obtain medical licensure.

 Medical students must make sure that they are acquainted with most of the medical know-hows, as they prepare for a major exam like USMLE. They must have access to reference texts. Following a proper strategy is important to score high in the USMLE exam. Having said that, other important factors that are important for students seeking an answer to ‘How to Mentally Prepare yourself For USMLE?’ are self-discipline, dedication and mental stamina. Without these qualities a student cannot prepare properly for a major exam like USMLE.

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USMLE - Some Points To remember about Brachial Plexus

If you are preparing for your USMLE Step 1 exams, ignoring studying Anatomy may be a wrong strategy as this is a branch that is sure to score you a few easy points. Don’t we know what difference a mere 5 or 7 points makes to your score? So instead of focusing just on Pharmacology and Pathology, spend time studying this branch as well. A very high yield USMLE Step 1 topic is the injuries that are related to the Brachial Plexus. Here are 4 injuries you should definitely know about.

1. The Median Nerve Injury: This is a kind of injury that occurs due fracture of the supracondyle of the humerus. What it results in is a loss of wrist flexion, thumb movements, finger flexion and forearm pronation. It may also result in the person losing his sensation in the lateral side of the palm and even the thumb.

 

2. The Ulnar Nerve Injury: This is a kind of injury that occurs when the medial epicondyle of the humerus is injured and may lead to the following troubles: impaired adduction of the thumb, the ulnar and two fingers and adduction of wrist and loss of flexion. The patient may also face loss of sensation to the medial half of the pinky and the ring finger as well as to the medial way of the palm.

 

3. The Radial Nerve Injury: This is a kind of injury which may result from the shaft of the humerus to be injured. It may cause the following problems: loss of carpi radialis longus, loss of brachioradialis reflex and loss of triceps reflex. Other than these, the patient may face something called the ‘wrist drop’ and the loss of sensation to posterior brachial cutaneous nerves and posterior antebrachial cutaneous.

 

4. The Axillary nerve Injury: This is a kind of injury that occurs due to two causes: firstly, if there is anterior dislocation of the shoulder or/and if the surgical neck of the shoulder gets injured. When this happens, the deltoid muscle loses its sensation and the movement of the deltoid muscle is completely lost.

 

The above is a basic idea about the 4 common injuries of the Brachial Plexus. 

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