IMLE 3/2019

A 25 year old female complain of severe pelvic pain during menses and sexual intercourses. She is having unprotected intercourses for the past year and has not conceived. On exam-palpable and tender small lesion at the sacro-uterine ligaments.
Which of the is a risk factor for her suspected diagnosis?

A 32-year-old woman undergoes diagnostic laparoscopy for pelvic pain. Peritoneal lesion were biopsied and demonstrated hemosiderin accumulation and endometrial nodules with no evidence of malignancy. The lesions were found only on the peritoneum and the sacro-uterine ligaments.
Which of the following is correct regarding this case?

A 25-year-old couple os diagnosed with idiopathic primary infertility. They have had tow cycles of ovary stimulation and intrauterine insemination with no conception. They are considering in vitro fertilization (IVF) and are concerned about complications.
Which of the following success rates and risks is relevant to this couple?

A couple married for 4 years has failed to conceive. The women has regular ovulation and a normal utero-salpingography. Sperm test-revealed sperm volume of 2 ml, 1,000,000 cells/ml, 50% motility, and 5% with normal morphology according to kruger. A repeat sperm test revealed no significant changes.
Which of the following is the best treatment for this couple?

A 35-year-old woman with normal menstrual cycles presents to the clinic with a 1-week delay in here menstrual bleeding. Past medical is positive for Hodgkin’s lymphoma treated with ABVD (adriamycin, bleomycin, vincristine and doxorubicin) 10 years ago. Blood work revealed estradiol 998 pmol/L, progesterone <2nmol/L, FSH 23 IU/L, LH 56 IU/L.
Which of the following is true regarding her condition?

71 years old man with (HOCM) hypertrophic cardiomyopathy and pneumonia. Systolic B.P is 90 mmHg. Body temperature is 38.8
Ecg shown

51 year old male arrived to the ER due to severe central chest pain that radiated to the jaw and right arm. Past medical history is positive for hypertension, diabetes mellitus and dyslipidemia. In lung auscultation – moist rales and crepitations are heard at the base of both lungs. Systolic B.P is 85 mmHg.

88 years old female with dyspnea. Evaluated chest x-ray diagnosis pulmonary edema.
Heart echo identified that her aortic valve area is 0.59 cm2 with a gradient of 30mmHg. The LVEF is 20%. What is the most probable diagnosis?

27 years old complains of chest pain that worsens when bending forward. During the past week she has elevated body temperature, general malaise and dyspnea. Below is the ECG at the E.R
what is the most appropriate next step?

A 46-year-old male complaines of dry cough and dyspnea for the past week. Chest X-ray is below. What is the most appropriate next test?
Chest X-ray: solid mass on the right lower lobe.

A 55 year old male that is usually healthy is admitted due to general malaise, nausea, and vomiting .
Labs-creatinine 2.7 mg/dl(normal at baseline), urea 102 mg/dl, hemoglobin 9.2g/dl, calcium 13.3 mg/dl, PTH lower then normal.
Which of the following best describes this patient ?

A 19 year old type 1 diabetic patient complains of abdominal pain and nausea.
Labs- bicarbonate 13 meq/l, hyperglycemia of 303 mg/dl, systolic blood pressure is 77 mmHg.
What is the most probable diagnosis?

A 72 year old male is admitted due to lower abdominal pain. Physical examination suggests large urinary retention. U/s diagnoses 900 ml in the urinary bladder.
What is the most appropriate management?

A 51 year old male with FMF now presents with end stage renal failure. His blood pressure is low and there fore he cannot undergo hemodialysis. He complains of diarrhea, malabsorption and weight loss.
Which of the following phenomena explains this entity?

A 55 year old male with APLA syndrome just landed after a flight from the USA and complains of dyspnea , stabbing left chest pain and cough with small drops of blood.
What is the most appropriate next step in diagnosis?

A 92 year old female is admitted for treatment of urinary tract infection. During `her first night at the hospital she develops sever agitation and hits her roommate. She claims that “they are here to take me”. Her temperature is 38.6 °c.
What is the most likely diagnosis that explains her behavior?

19 years old soldier just trained in the Sharon area , two days later he began to complain of high fever , sever headache and a rash on the trunk and the palms of the hands. Labs : anemia and thrombocytopenia.
Which of the following should be initiated immediately?

10 Y.O male with osteomyelitis , history of multiple skin abscess.
Culture of abcess grew staphylocuucs aeurus, 2 years ago he had lymphadenitis requiring antibitics. What is the diagnosis ?

15 YO concerned about pubertal development , 3ml testes bilaterally not firm, not able to smell coffe , FSH and LH , testosterone are low.
Diagnosis?

5 YO girl , short stature , restless, dificcult sleep at night .
Lab:hyperthyroid, on physical exam multiple jagged hyperpigmented macule on her back, abdomen don’t cross mid line , has tarnner 2 breast development , diagnosis ?

6 YO with history of 1 week nocturnal perinanal itching
No symptom , physical exam normal , probable etiology?

Sexually active 15 years male presents with 3 hours history of left side testicular pain and dysuria, he reports no history of trauma. On exam scrotum is painful and red. The patient reports pain relief when you elevate the testis.
Which diagnostic test când help confirm the diagnosis?

10 month old boy seen because of unusual movements of his eyes they seems to jitter with extreme nystagmus. Around the eyes dark coloration is noted.
What is the most likely diagnosis?

15 weeks old boy presents with poor appetite, weight loss, abdominal distention and decreased energy. Laboratory results reveals elevated AST, Alt and total birubin. Stool is very pale in color.
What is the most common reason for liver failure and need for liver transplantation patient this age

15 years old girl with history of lymphoma received a hematopoietic stem cell transplant after a myeloablative conditioning regimen 100 days ago. Her early course was unremarkable. She presents now with cough, low grade fever and dyspnoea. She has tachypnea and her chest radiograph is normal. She reports missing one of her post transplant medications for the past 2 months.
This medication is most likely;

5 month old is diagnosed with glycogen storage disease type 1a.
What is the most appropriate mechanism tie prevent night time hypoglycemia?