Final Clinical

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1) You are consulting a patient with a pulsating headache that is typically occurring

on the right or left of the head, accompanied by nausea, and the patient prefers
to sleep as the pain subsides after sleep. This type of headache was reported by
her mother as well. What diagnosis would you suspect with this information?
Migraine

2) Your patient with acute headache, vomiting, decreased consciousness was


undergoing lumbar puncture, during which his condition suddenly deteriorated
and he requires assistive ventilation due to breathing depression, What may be
the reason for this sudden deterioration? Brain herniation due to lumbar puncture

3) Your patient with acute headache, vomiting, decreased consciousness was


undergoing lumbar puncture, during which his condition suddenly deteriorated
and he requires assistive ventilation due to breathing depression what
investigation should have be performed before lumbar puncture ?Neuroimaging
to rule out masses in the posterior fossa

4) A patient with headache and fever for the past 10-16 hours is continuously
deteriorating his headache is severe, and has neck rigidity. You noted, macular
rash on the body ,‚What is the gold standard in this case for diagnosis
Lumbar puncture
5) 8 years old boy with vertigo and periodic chronic headache. You will start
consultation with taking anamnesis

6) A patient with a headache that started this morning suddenly and was like
thunder. What condition should you rule out?

Subarachnoid hemorrhage

7) You have a patient with a severe headache, intolerance of light and sound,
cervical muscles are rigid. What diagnosis should you rule out immediately?

Meningitis

8) The less reliable indicator for the assessment of headache severity is

subjective assessment of pain by the patient


9)Migraine headache may disappear / diminish – choose several answers

all of the mentioned

10) Migraine headache is characterized by – choose several answers

pulsating pain , usually on one side , nausea vomiting, sensitivity to light and
sound

11) Pain in right shoulder in acute cholecystitis is


Referred pain

12) X ray abdomen shown is diagnostic of

Acute small intestinal obstruction

13) the hormone which is regulating he sleep cycle is

Melatonin

14 ) the most common triad of diabetes

Intolerable thirst, constant urination , weight loss

15) the following are correct for night terrors except

It is characterized by autonomic signs


16) Aura is characteristic for classic migraine true

17)Migraine is more prevalent in men False

18) The most frequent types of migraine aura are cognitive and hemiplegic False

19)cluster headache mostly occurs in men True

20) Lumbar puncture should be performed after neurovisualisation True

21 ) Vertigo is the main symptom of peripheral vestibular system disorders True

22)MRI investigation is mandatory in all cases of headache False

23) Radicular pain is exacerbated during sneezing/coughing True

24) In patients with asthma the process of inspiration is prolonged more than expiration
False

25) Elderly persons as well as people with immunosuppression may have no fever even
in bacterial infections True

26)In most cases of syncope in children the underlying reason is of cardiac origin –
structural heart disease, arrhythmias or coronary insufficiency False

27) Tension type headache is mostly in women True

28) Auscultation in abdominal examination is performed before palpation True

29) Cluster headaches last 24-72 hours False

30) Low back pain always indicates of vertebral origin False

31) There are no particular abnormalities on ECG in-between the attacks of angina
pectoris true
32)Severe chest pain, itching sensation on the left side along a rib, and rash at the
same area is more characteristic for Herpes Zoster True

33) sleep palsy occurs in people with neurological disorders, False

34)Radicular pain is sharp, burning, radiating to the leg down to foot and ankle on
lateral and posterior surface True

35) Night back pain is a worrisome symptom because it may be due to tumor,
inflammation or infection True

36) sleep terrors are most frequent in boys true

37) insomnia is defined as inability to fall asleep or maintain sleep true

38) Unilateral redness of the eye may indicate the allergy or systemic disease false

39) infection can cause a rise in glucose true

40) bacterial infections are the most important triggers of bronchial asthma in children
false

41) Aortic dissection is common non threatening condition with chest pain false

42) elderly patients and patients with immunosuppression may have no fever even in
bacterial infection true

43 ) pain that is alleviated by heat and rest may be due to musculoskeletal cause true
44) sudden loss of vision with red painful eye may indicates to acute angle glaucoma
true

46) brain parenchyma contains many pain receptors false

47)ECGis the gold standard for diagnosis of arrhythmia true


48) What is the most common cause of vertigo

The most common cause of vertigo is benign positional paroxysmal vertigo (BPPV).
This is caused by crystals in the balance center of the inner ear moving out of place.

49) REM PARASOMNIA

REM-associated parasomnias include nightmares, REM-sleep behavior disorder, and


hypnagogic and hypnopompic hallucinations. REM sleep occurs in a cyclical fashion
throughout the night.

50) non REM parasomnia

Non rapid eye movement (NREM) parasomnias are abnormal behaviors arising
primarily but not exclusively during non-REM stage three (N3) sleep. Phenotypes
include sleepwalking, sleep terrors, confusional arousals, sexsomnia, and sleep-related
eating disorder (SRED).

51) restless leg symptoms


overwhelming urge to move your legs , an uncomfortable sensation in your legs. The
sensation may also affect your arms, chest and face. It's been described as: tingling,
burning, itching or throbbing.

52)what diagnosis would you suggest in patient with morning productive yellow cough
and long term history of smoking

Bronchitis is an infection of the main airways of the lungs (bronchi), causing them to
become irritated and inflamed. The main symptom is a cough, which may bring up
yellow-grey mucus (phlegm). Bronchitis may also cause a sore throat and wheezing.

53) appendicitis localization of pain

initiated in periumbilical , abdominal pain that localizes to the right lower quadrant
right lower quadrant pain in Mcburrny‘s area, initiated periumbilical abdominal pain
and localized in the right lower quadrant .
54 ) first symptoms of diabetes
increased thirst and urination, increased hunger, fatigue, blurred vision, numbness ,
unexplained weight loss.

55) complications caused by diabetes

Cardiovascular disease, Nerve damage (neuropathy), Kidney damage (nephropathy),


Eye damage (retinopathy), Skin conditions ( Acanthosis Nigricans )and Alzheimer‘s
disease.

56) how to prevent diabetic foot

Diabetic foot can be prevented with good glycaemic control, regular foot assessment,
appropriate footwear, early referral for pre-ulcerative lesion, Examine and screen the
feet for any lesions for peripheral neuropathy and peripheral arterial disease, control
sugar level.

57) how to differentiate pericarditis pain vs pleuritic pain

A common symptom of acute pericarditis is a sharp, stabbing chest pain, usually


coming on quickly. It often is in the middle or left side of the chest, and there may be
pain in one or both shoulders. Sitting up and leaning forward tends to ease the pain,
while lying down and breathing deeply worsens it.

58) pleuritic pain

Pleuritic chest pain is characterized by sudden and intense sharp, stabbing, or burning
pain in the chest when inhaling and exhaling. Pulmonary embolism is the most common
serious cause

59)What is the definition of bronchial asthma

Bronchial asthma is a chronic inflammatory disease of the airways characterized by


bronchial hyperreactivity and a variable degree of airway obstruction.

60) what characteristic of sputum is important for differential diagnosis

Color , smell , frequency , consistency


61 what instrumental investigation is important for headache
Pet scan , electroencephalography , transcranial doppler , MRI, angiography of brain

62) what is the secondary headache


Secondary headaches are not dependent diseases but are due to an underlying
medical condition, such as a neck injury or a sinus infection. a secondary headache
may be a sign of a serious underlying medical condition such as: brain infection such as
encephalitis or an abscess or brain tumor.

63) the most frequent causes of lightheadedness

Some of the main causes are: dehydration(not having enough fluids in your body) and a
drop in blood pressure when you stand up quickly. feelings of anxiety or panic.

64) What diagnosis should be excluded in a child with vomiting, fever, headache?
Meningitis , viral infections

65) Auscultation method during abdominal examination is used to check for (what
sound)?
Auscultation of the abdomen is performed for detection of altered bowel sounds, rubs,
or vascular bruits. Normal peristalsis creates bowel sounds that may be altered or
absent by disease. Irritation of serosal surfaces may produce a sound (rub) as an organ
moves against the serosal surface.

66) What instrumental investigation should be performed in a 62 old patient with lower
back pain most severe in night time, and irradiating to the leg?
CT , DISCOGRAPHY ,ELECTRO MYOGRAPHY
67) Cluster headaches usually occur?
MOSTLY in 1-2 hours after falling asleep AND HAPPENS AT THE SAME TIME
68) Which are the signs of narcolepsy?
sleep paralysis, sleep attacks, cataplexy and excess day time sleep , hallucination,
change in rem sleep
69) What is most important at the first stage in neurological emergencies?
to take complete history and perform physical exam as early as possible

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