Tiêu đề General Practitioner DHA 250+.pdf ✅

info@alphatsm com | www alphatsm com | www alphahmc com ALPHA TRAINING & STRATEGIC MANAGEMENT OPPOSITE HAZZA BIN STADIUM, AL KHABISI, AL AIN TEL - +971 3 780 2818 ALPHA HEALTH CONSULTANCIES 1101, 11TH FLOOR, DAMAS TOWER, DUBAI TEL - +971 4 591 4084 ALPHA HEALTH MEDICAL SERVICES PVT LTD 79B AL MANAR ROAD, MARUTHAMUNAI 02, SRI LANKA TEL - +94 67 2056 453 ALPHA MEDICAL ENGINEERING CONSULTANCY ABU DHABI, UAE TEL - 600ALPHA (24742) MAIN OFFICE DUBAI BRANCH SRI LANKA BRANCH ABU DHABI BRANCH DHA MCQs (250+) General Practitioner
Alpha Health Group 1 1. A 66-year-old man is reviewed on the coronary care unit 3 days after a myocardial infarction. He states that he feels very breathless. On examination you can hear a pansystolic murmur that is maximal at the lower left sternal edge. What is the SINGLE most likely diagnosis? a. Mitral regurgitation b. Mitral stenosis c. Ventricular septal defect d. Tricuspid stenosis e. Dressler syndrome  Post myocardial infarction ventricular septal defect (VSD) is a rare but serious complication, which may result in cardiac wall rupture. It tends to develop 2-3 days after the myocardial infarction and 85% of patients that develop it will go on to die within 2 months without surgical intervention. The murmur of a VSD is a pansystolic murmur that is maximal at the lower left sternal edge. An accompanying thrill is also often present. Dressler’s syndrome is a type of pericarditis that develops 2-10 weeks after a myocardial infarction or cardiac surgery. It is characterised by sharp chest pain that is typically relieved by sitting forwards. A pericardial rub, pulsus paradoxus and signs of right ventricular failure can also be seen. Mitral regurgitation also causes a pansystolic murmur, however it is best heard at the apex and radiates to the axilla. Tricuspid stenosis causes an early diastolic murmur, best heard at the lower left sternal edge in inspiration. Mitral stenosis causes a rumbling mid-diastolic murmur best heart at the apex, in the left lateral position, in expiration with the bell of the stethoscope. 2. A 70-year-old man with poorly controlled hypertension develops sudden visual loss in his right eye. The visual acuity on the right is reduced to hand movements only. Visual acuity on the right is 6/6. On examining his fundi you note engorgement of the retinal veins, disc oedema, multiple flame-shaped haemorrhages and cotton wool spots spread across the entire retina. What is the SINGLE most likely diagnosis? a. Central retinal vein occlusion b. Vitreous haemorrhage c. Central retinal artery occlusion
Alpha Health Group 2 d. Diabetic maculopathy e. Wet age-related macular degeneration  Central retinal vein occlusion (CRVO) typically causes painless, unilateral visual loss. The retina has a characteristic appearance that has been likened to a ‘pizza thrown against a wall’. There is engorgement of the retinal veins, disc oedema, multiple flame- shaped haemorrhages and cotton wool spots evident on fundoscopic examination. Hypertension is found in approximately 65% of patients presenting with CRVO and it is most common in patients over the age of 65. Central retinal artery occlusion (CRAO) also presents with sudden, painless, unilateral visual loss. The appearance of the retina is quite distinct to that of CRVO however, with a pale retina and attenuation of the vessels. There is often a ‘cherry-red spot’ visible at the centre of the macula, which is supplied by the underlying choroid. Examination also frequently reveals an afferent papillary defect. Vitreous haemorrhage occurs when there is bleeding into the middle chamber of the eye (‘the vitreous’). Causes include proliferative diabetic retinopathy, trauma and retinal detachment. The appearance has been likened to ‘blood within a bloodless gel’ and there is a diffuse red appearance to the retina without the focal flame-shaped haemorrhages that are visible with a CRVO. Diabetic maculopathy occurs when there is evidence of diabetic eye disease within one disc diameter of the macula. Wet age-related macular degeneration (ARMD) causes visual loss due to choroidal neovascularisation, which leads to blood and protein leakage below the macula. There can be haemorrhages evident on the retina, however, the appearance is not consistent with the fundus shown in the photo above. 3. A 62-year-old female smoker presents with weight loss, dysphagia and intermittent vomiting. On examination you note a mass in the left iliac fossa and can also palpate a fullness in the right iliac fossa. An ultrasound scan is organised, which demonstrates bilateral, solid ovarian masses, with clear well-defined margins. What is the SINGLE most likely underlying diagnosis? a. Primary ovarian carcinoma b. Oesophageal carcinoma c. Gastric carcinoma d. Benign ovarian tumour