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A 53-year-old woman presents complaining of fatigue over the past 6 months. During this time, she has also developed pruritus and lost 4 pounds. She is not sexually active, and her past medical history is significant only for Sjögren syndrome. On physical examination, she is afebrile and has mildly icteric sclera. There are excoriations noted on all four extremities and trunk and back. The liver edge is smooth and non-tender and measures 9 cm at the midclavicular line. There is no ascites, splenomegaly, or peripheral edema. Laboratory results reveal a normal complete blood count, normal electrolytes, and liver function tests with an alkaline phosphatase of 260 U/L (normal, <110 U/L), total bilirubin of 3.1 mg/dL, and normal transaminase levels. Which of the following is the most likely diagnosis? a) Acute cholecystitis b)Acute hepatitis A infection c)Bacterial cholangitis d)Primary biliary cirrhosis e)Primary sclerosing cholangitis  Explanation: The cor...

  A 37-year-old woman presents with complaints of severe heartburn with or without meals. She has a history of hypertension, which has been treated with captopril. She also has a history of Raynaud disease, multiple facial telangiectasias, and very taut skin on the dorsum of both hands. She has failed to obtain relief for her heartburn with large doses of antacids, ranitidine, or omeprazole. Esophageal manometry is ordered. Which of the following would be the most likely results of this test? a) Decreased esophageal peristalsis and decreased LES pressure b)Decreased esophageal peristalsis and increased LES pressure c)Increased esophageal peristalsis and decreased LES pressure d)Increased esophageal peristalsis and increased LES pressure e) Normal esophageal peristalsis and normal LES pressure Explanation: The correct answer is A. This patient has the classic presentation of gastroesophageal reflux disease (GERD) in association with scleroderma. These patient...

A 74-year-old woman presents to her physician for a postoperative medical visit. Three days ago, she underwent a left total knee replacement for severe osteoarthritis. She has a past medical history significant for type 1 diabetes mellitus and glaucoma. Her hospital course was uneventful. She continues to take daily NPH insulin and has good control of her blood glucose. She also takes oxycodone, which was given to her in the hospital for pain. She is involved in a physical therapy rehabilitation program at the local hospital. On review of her medications, which of the following is most acutely indicated at this time? a) An ACE inhibitor b)A nonsteroidal anti-inflammatory agent c)Oral aspirin d)Oral Coumadin e) Subcutaneous unfractionated heparin Explanation: The correct answer is D. This patient is post a total knee replacement and is currently not on any anticoagulation therapy. The risk of deep venous thrombosis (DVT) and subsequent pulmonary embolism is v...

Title Page Book 1 GRIP FOR FINAL YEAR Medicine 1 Medicine 2 Paedetric Medicine Backcover Title Page Book 2 GRIP FOR FINAL YEAR GENERAL SURGERY SPECIAL SURGERY GYNAECOLOGY OBSTETRICS Backcover "GRIP" COMPREHENSIVE HELPING STUFF FOR ALL MEDICAL STUDENTS... IT GUIDES THE STUDENTS WHAT TOPICS THEY HAVE TO STUDY , MARKS DISTRIBUTION OF EACH UNIT AND NO OF MCQS ,SEQS FROM EACH UNIT ... SYLLABUS , TOS ...... UHS POOL OF SEQs  AND MCQs , MOST REPEATED QUESTIONS AND TOPICS EXTRACTED FROM PAS T PAPERS OF EACH SUBJECT.... Author : DR. HAFIZ BASHIR AHMAD NOOR Published by : Allied book company aminpur bazar faisalabad price : Rs 400 only edition : 1st Copies: 1000 Available now only in FAISALABAD at ALLIED BOOK COMPANY AMINPUR BAZAR BOOK will be distributed in lahore , sargodha , rawalpindi , multan , bahawalpur after Eid vacations ... most probably on saturday . process for home delivery described earlier ... value paid post by Pakistan post for booking in advan...

1.Breast cancer poor prognosis factors are all except 1.Estrogen receptor positive 2. Her 2 status 3. Stage / grade 4. Lymph node status 5. Size Please contribute to the discussion by posting the answer with references and pointing out any errors in the question! 2. The tumor, which may occur in the residual breast or overlying skin following wide local excision and radiotherapy for mammary carcinoma, is: A. Leiomyosarcoma B. Squamous cell carcinoma C. Basal cell carcinoma D. Angiosarcoma Correct answer : D. Angiosarcoma Angiosarcoma can occur as a late complication following breast conservation surgery. 3.In which of the following types of breast carcinoma, would you consider biopsy of opposite breast? A. Adenocarcinoma-poorly differentiated B. Medullary carcinoma C. Lobular carcinoma D. Comedo carcinoma Correct answer : C. Lobular carcinoma Lobular carcinoma has higher incidence of bilaterality compared to other carcinomas 4. The most important pro...

1.Allen’s test is useful in evaluating: A. Thoracic outlet compression B. Presence of cervical rib C. Integrity of palmar arch D. Digital blood flow Correct answer : C. Integrity of palmar arch How to perform allen’s test: (To check for patency of radial and ulnar arteries and to confirm integrity of the palmar arterial arch between them) 2.The patient makes a tight fist The examiner compresses the radial and ulnar arteries distally The fist is released and compression of the ulnar artery is released The speed of return of colour to the palm is looked for Steps 1 and 2 are … 3. The most common cause of acquired arteriovenous fistula is; A. Bacterial infection B. Fungal infection C. Blunt trauma D. Penetrating trauma Correct answer : D. Penetrating trauma 4. Which of the following statements is true regarding testicular tumors? A. Are embryonal cell carcinomas in 95% of cases B. Bilateral in up to 10% cases C. Teratomas are more common than seminomas ...

1.A new born presented with bloated abdomen shortly after birth with passing of less meconium. A full thickness biopsy of the rectum was carried out. Which one of the following rectal biopsy findings is most likely to be present? A. Fibrosis of submucosa B. Hyalinisation of the muscular coat C. Thickened Muscularis propria D. Lack of ganglion cells Correct answer : D. Lack of ganglion cells The history is suggestive of congenital aganglionic megacolon (Hirschprung disease). The ganglion cells in the intestinal wall are absent. It occurs due to arrest in migration of neural crest cells. … 2. In which one of the following conditions is sialography contraindicated? A, Ductal calculus B. Chronic parotitis C. Acute parotitis D. Recurrent sialadenitis Correct answer : C. Acute parotitis Acute parotitis is a contraindication for saliography. 3. Abbey Estlander flap is used in the reconstruction of: A. Buccal mucosa B. Lip C. Tongue D. Palate Correct answer : B. ...

1.Which one of the following soft tissue sarcomas frequently metastasizes to lymph nodes? A. Fibrosarcoma B. Osteosarcoma C. Embryonal Rhabdomyosarcoma D. Alveolar soft part sarcoma Correct answer : C. Embryonal Rhabdomyosarcoma Rhabdomyosarcoma is a soft tissue sarcoma which frequently metastasizes to lymph nodes. 2. The earliest manifestation of increased intracranial pressure following head injury is: A. Ipsilateral pupillary dilatation B. Contralateral pupillary dilatation C. Altered mental status D. Hemiparesis Correct answer : C. Altered mental status 3.The following statements regarding finasteride are true except: A. It is used in the medical treatment of benign Prostatic hypertrophy (BPH) B. Impotence is well documented after its use C. It blocks the conversion of dihydrotestosterone to testosterone D. It is a 5-alpha reductase inhibitor Correct answer : C. It blocks the conversion of dihydrotestosterone to testosterone Finasteride blocks the con...