monday one mcq

By Dr.hessa Alkaabi

monday one mcq

Multiple Choice

In the prenatal workup for a 24-year-old patient, you discover she is

not immune to rubella. When is the best time to vaccinate her against

rubella?

• a. Immediately

• b. In the second trimester of pregnancy

• c. In the third trimester of pregnancy

• d. In the early postpartum period

• e. At least 4 weeks postpartum

6. The answer is d. (Bope, pp 141-142.) Rubella is normally a mild self-

limited illness, but infection during pregnancy can result in fetal death

 

or congenital defects known as congenital rubella syndrome (CRS).​CRS

 

is devastating, and rubella immunity is important for women consider-

ing pregnancy. If a woman is found to be rubella nonimmune, vaccination

 

should not occur if she is pregnant or planning pregnancy in the next

4 weeks. Although the vaccine is contraindicated in pregnancy, inadvertent

vaccination is not an indication for therapeutic abortion. If the patient is

currently pregnant and nonimmune, she should be vaccinated as early in

the postpartum period as possible.

Multiple Choice

A 19-year-old sexually active homosexual male asks you about his

risk for hepatitis. He is currently asymptomatic and unsure of his immune

status. Which of the following should you recommend?

• a. Vaccination against hepatitis A only

• b. Vaccination against hepatitis B only

• c. Vaccine against hepatitis C only

• d. Vaccinations against both hepatitis A and B

• d. Vaccinations against both hepatitis A and B

96. The answer is d. (South-Paul, pp 664-673.) The unique health needs

of gay men may often be overlooked by physicians, especially if not alert

to appropriate and sympathetic sexual history-taking. Since hepatitis A is

transmitted orally/fecally, and many gay men participate in oral/anal sexual

activity, vaccination against hepatitis A is appropriate. Since hepatitis B is

 

transmitted through blood and body fluids, and sometimes by anal inter-

course, hepatitis B vaccination is indicated. There is no vaccination against

 

hepatitis C.

Multiple Choice

You are evaluating a 41-year-old man in your office who reports

abdominal pain. He says the pain began suddenly and is located in the

right lower quadrant. He describes the pain as “gnawing” and it seems to

get worse after eating. He has vomited twice since the pain began. Which

historical feature would lead you toward an emergent evaluation?

• a. The pain’s location in the right lower quadrant

• b. The fact that the pain began suddenly

• c. The description of the pain

• d. The fact that it is worse after eating

• e. The fact that it is associated with emesis

107. The answer is b. (South-Paul, pp 310-328.) The first priority when

evaluating abdominal pain is to determine whether the pain is acute or

chronic. Sudden and/or severe onset of pain should lead the clinician

toward an emergent evaluation. Right lower quadrant pain is suspicious

for an acute appendicitis, but by itself is not specific enough to warrant

an emergent workup. A “gnawing” sensation is often described with ulcer

 

disease, while pain that worsens after eating is associated with many con-

ditions—pancreatitis, gallbladder disease, or even reflux. In the absence of

 

hemodynamic instability, those causes are less likely to warrant emergent

workup. Emesis with pain is not enough, by itself, to warrant emergent

workup.

Multiple Choice

108. A 42-year-old woman presents to your office complaining of the

 

recent onset of abdominal pain. She describes pain that starts in the mid-

epigastric region, radiating to the back. It is associated with nausea and vomiting. What is the most likely diagnosis?

• a. Acute appendicitis

• b. Pancreatitis

• c. Gallbladder disease

• d. Esophageal spasm

• e. Gastroesophageal reflux disease (GERD)

108. The answer is b. (South-Paul, pp 310-328.) The location and radia-

tion of pain is often helpful in determining the cause of abdominal pain.

 

Pain from an acute appendicitis usually starts in the periumbilical region

before moving to the right lower quadrant. Pancreatitis generally settles in

the midepigastric region with radiation to the back and is associated with

nausea and vomiting. Gallbladder pain is typically in the epigastric or right

upper quadrant and radiates to the scapula. Esophageal spasm is often

referred higher in the chest. GERD is midepigastric and generally does not

radiate.

Multiple Choice

109. An 80-year-old man presents with mild, crampy, bilateral lower

quadrant pain, decreased appetite, and low-grade fever for about 48 hours.

Which of the following is the most likely diagnosis?

• a. Small-bowel obstruction

• b. Appendicitis

• c. Constipation

• d. Irritable-bowel syndrome (IBS)

• e. Pancreatitis

109. The answer is b. (South-Paul, pp 310-328.) Advanced age can change

 

the presentation and perception of abdominal pain. In fact, studies esti-

mate that there is a 10% to 20% reduction in the perceived intensity of

 

the pain per decade after the age of 60. Only 22% of elderly patients with

appendicitis present with classic symptoms, making the diagnosis more

difficult. Therefore, a high index of suspicion is necessary. Small-bowel

obstruction and constipation may cause bilateral lower quadrant pain and

decreased appetite, but fever indicates something different. IBS is chronic

and generally not associated with fever. Pancreatitis is associated with food

intolerance but the associated pain is usually in the epigastric region.

be ready for next week quiz !