,TABLE OF CONTENTS
Internal Medicine ........................................................................... 3
Pediatrics ..................................................................................... 42
Obstetrics & Gynecology ............................................................ 82
Surgery ...................................................................................... 117
Legal Medicine & Medical Jurisprudence ................................ 152
Preventive Medicine .................................................................. 182
,INTERNAL MEDICINE
, QUESTION ANSWER EXPLANATION
1. An 80-year-old man presents to the D D. Exacerbated by position changes.
OPD complaining of heavy and
squeezing chest pain with radiation to Chest pain caused by myocardial ischemia
the right arm. It is sometimes can be characterized as
exacerbated by changes in position. ● Aching
● Heavy
ECG was done which revealed ST ● Squeezing
elevation in leads V1-V2. Which of ● Crushing or constricting
these symptoms is NOT consistent with
the most likely diagnosis? The location is retrosternal. Radiation usually
occurs to the ulnar surface of the left arm,
A. Squeezing chest pain neck, jaw, shoulders, and even the right
B. Radiation to the right arm arm.
C. Chest pain described as
heaviness Chest pain exacerbated by changes in
D. Exacerbated by position position is usually associated with pleuritic
changes pain of pericarditis.
Reference:
Loscalzo J, & Fauci A, & Kasper D, & Hauser S, &
Longo D, & Jameson J. (2022). Chapter 14: Chest
discomfort. In D.A. Marrow (Ed.), Harrison's Principles
of Internal Medicine (21st ed., Vol.1, pp. 601-603). New
York, NY: McGraw Hill.
2. An 80-year-old man presents to the C C. NSTEMI
OPD complaining of heavy and
squeezing chest pain with radiation to To diagnose NSTEMI, the following has to be
the right arm. present:
BP was taken which showed: 70/50 1. Characteristic ischemic chest pain
mmHg 2. ECG with NO ST elevations (e.g., ST
depression)
ECG was done which revealed 3. Troponin I elevation
ST-segment depression in leads V1-V2.
Troponin I was positive. All these 3 are present in this patient with
NSTEMI.
What is the most appropriate
diagnosis? STEMI is diagnosed if the ECG showed ST
elevation.
A. Chronic coronary syndrome
B. Unstable angina Unstable angina would show no elevation of
C. NSTEMI Troponin I.
D. STEMI
Reference:
Loscalzo J, & Fauci A, & Kasper D, & Hauser S, &
Longo D, & Jameson J. (2022). Non-ST-segment
elevation acute coronary syndrome: Non-ST segment
elevation, myocardial infarction, and unstable angina.
In R.P. Giugliano, C.P. Cannon, & E. Braunwald (Eds.),
Harrison's Principles of Internal Medicine (21st ed.,
Vol.1, p. 8758). New York, NY: McGraw Hill.
3. An 80-year-old man with diabetes A A. Refer to Cardio for invasive strategy
and hypertension presents to the OPD
complaining of heavy and squeezing In NSTEMI patients classified as high-risk,
Internal Medicine ........................................................................... 3
Pediatrics ..................................................................................... 42
Obstetrics & Gynecology ............................................................ 82
Surgery ...................................................................................... 117
Legal Medicine & Medical Jurisprudence ................................ 152
Preventive Medicine .................................................................. 182
,INTERNAL MEDICINE
, QUESTION ANSWER EXPLANATION
1. An 80-year-old man presents to the D D. Exacerbated by position changes.
OPD complaining of heavy and
squeezing chest pain with radiation to Chest pain caused by myocardial ischemia
the right arm. It is sometimes can be characterized as
exacerbated by changes in position. ● Aching
● Heavy
ECG was done which revealed ST ● Squeezing
elevation in leads V1-V2. Which of ● Crushing or constricting
these symptoms is NOT consistent with
the most likely diagnosis? The location is retrosternal. Radiation usually
occurs to the ulnar surface of the left arm,
A. Squeezing chest pain neck, jaw, shoulders, and even the right
B. Radiation to the right arm arm.
C. Chest pain described as
heaviness Chest pain exacerbated by changes in
D. Exacerbated by position position is usually associated with pleuritic
changes pain of pericarditis.
Reference:
Loscalzo J, & Fauci A, & Kasper D, & Hauser S, &
Longo D, & Jameson J. (2022). Chapter 14: Chest
discomfort. In D.A. Marrow (Ed.), Harrison's Principles
of Internal Medicine (21st ed., Vol.1, pp. 601-603). New
York, NY: McGraw Hill.
2. An 80-year-old man presents to the C C. NSTEMI
OPD complaining of heavy and
squeezing chest pain with radiation to To diagnose NSTEMI, the following has to be
the right arm. present:
BP was taken which showed: 70/50 1. Characteristic ischemic chest pain
mmHg 2. ECG with NO ST elevations (e.g., ST
depression)
ECG was done which revealed 3. Troponin I elevation
ST-segment depression in leads V1-V2.
Troponin I was positive. All these 3 are present in this patient with
NSTEMI.
What is the most appropriate
diagnosis? STEMI is diagnosed if the ECG showed ST
elevation.
A. Chronic coronary syndrome
B. Unstable angina Unstable angina would show no elevation of
C. NSTEMI Troponin I.
D. STEMI
Reference:
Loscalzo J, & Fauci A, & Kasper D, & Hauser S, &
Longo D, & Jameson J. (2022). Non-ST-segment
elevation acute coronary syndrome: Non-ST segment
elevation, myocardial infarction, and unstable angina.
In R.P. Giugliano, C.P. Cannon, & E. Braunwald (Eds.),
Harrison's Principles of Internal Medicine (21st ed.,
Vol.1, p. 8758). New York, NY: McGraw Hill.
3. An 80-year-old man with diabetes A A. Refer to Cardio for invasive strategy
and hypertension presents to the OPD
complaining of heavy and squeezing In NSTEMI patients classified as high-risk,
