A 70-year-old man with prostatic cancer has had severe acute back pain waking him up at night for 6wks.What is appropriate investigation?
Answer(s): A
Radionuclide bone scan. MRI is good for soft tissue but not for bone. If it was radiculopathy, spina compression or prolapsed disc creating pressure on nerve MRI would be fine but not for bony metastasis. Her choice is radionuclide bone scan.
A 62-year-old man diagnosed with T2DM with BMI=33. Lifestyle modifications have failed to control blood. Labs: urea=3.6mmol/l, creatinine=89mmol/l.What is the next appropriate management?
Answer(s): C
Patient is obese type 2 diabetic. So biguanide is the treatment of choice
A 65-year-old man presents with significant weight loss and complains of cough, SOB and chest pain. Exam constricted, drooping of left eyelid.What is the most likely diagnosis?
Answer(s): D
The strongest type of epidemiological studies is:
Answer(s): B
Prospective cohort study is a cohort study that follows over time a group of similar individuals (cohorts) who differ with respect to certain factors under study, to determine how these factors affect rates of a certain outcome. For example, one might follow a cohort of middle-aged truck drivers who vary in terms of smoking habits, to test the hypothesis that the 20-year incidence rate of lung cancer will be highest among heavy smokers, followed by moderate smokers, and then nonsmokers. The prospective study is important for research on the etiology of diseases and disorders. The distinguishing feature of a prospective cohort study is that at the time that the investigators begin enrolling subjects and collecting baseline exposure information, none of the subjects have developed any of the outcomes of interest. After baseline information is collected, subjects in a prospective cohort study are then followed "longitudinally," i.e. over a period of time, usually for years, to determine if and when they become diseased and whether their exposure status changes outcomes. In this way, investigators can eventually use the data to answer many questions about the associations between "risk factors" and disease outcomes. For example, one could identify smokers and non- smokers at baseline and compare their subsequent incidence of developing heart disease. Alternatively, one could group subjects based on their body mass index (BMI) and compare their risk of developing heart disease or cancer. Prospective cohort studies are typically ranked higher in the hierarchy of evidence than retrospective cohort studies and can be more expensive than a case control study. One of the advantages of prospective cohort studies is they can help determine risk factors for being infected with a new disease because they are a longitudinal observation over time, and the collection of results is at regular time intervals, so recall error is minimized.
A 2-year-old baby with atrophy of the buttocks, distended abdomen with frequent offensive smelly stool.What is the most likely investigation?
Answer(s): E
Endomysium/alphagliadin antibody. Atrophy of buttock due to fat malabsorption and distended abdo (sometimes with everted umbilicus) with frequent offensive smelly stools are seen in coeliac disease. Hence gliadin antibody should be done.
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