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Question

A 30-year-old female presents with palpitations, heat intolerance, weight loss despite increased appetite, and bilateral proptosis with lid lag. Physical examination reveals an enlarged, non-tender thyroid with an audible vascular bruit. Laboratory evaluation shows TSH <0.01 mIU/L and Free T4 of 3.8 ng/dL. What is the mechanism of action of Methimazole, the primary antithyroid drug used in this condition?

Internal Medicine

Question · Medium

Question

A 48-year-old male with a history of hepatitis B cirrhosis presents with increasing abdominal distension and confusion. Physical examination reveals asterixis (flapping tremor), jaundice, and tense ascites. Diagnostic paracentesis yields cloudy fluid. Analysis reveals: Total leukocyte count 1,200/uL with 75% polymorphonuclear cells (absolute PMN count = 900/uL), total protein 0.8 g/dL, and serum-ascites albumin gradient (SAAG) of 1.6 g/dL. What is the immediate treatment of choice?

Internal Medicine

Question · Hard

Question

A 36-year-old female presents with episodic palpitations, diaphoresis, and severe pounding headaches. On physical examination, her blood pressure is 210/120 mmHg and heart rate is 112 bpm. Plasma free metanephrines and 24-hour urinary fractionated metanephrines are elevated over four times the upper limit of normal. Abdominal MRI identifies a 4.5 cm right adrenal mass. Prior to surgical adrenalectomy, which pharmacologic sequence is mandatory to prevent intraoperative hypertensive crises and fatal arrhythmias?

Internal Medicine

Question · Hard

Question

A 28-year-old male is brought to the emergency department following a motor vehicle collision. He is in severe respiratory distress with cyanosis, tachypnea (RR 34/min), tachycardia (HR 138 bpm), and hypotension (BP 75/45 mmHg). Physical examination reveals absent breath sounds and hyperresonance on the right hemithorax, along with tracheal deviation to the left and distended neck veins. What is the immediate, life-saving intervention?

General Surgery

Question · Easy

Question

A 30-year-old firefighter weighing 70 kg sustains full-thickness and deep partial-thickness burns involving the entire anterior torso (18%) and both entire upper extremities (9% each = 18%), totaling 36% Total Body Surface Area (TBSA). Using the standard Parkland formula, how much crystalloid fluid (Lactated Ringer's) should be administered in the first 24 hours, and what fraction must be infused during the first 8 hours post-injury?

General Surgery

Question · Hard

Question

A 26-year-old male is brought to the trauma bay after a high-speed motorcycle crash. His Glasgow Coma Scale is 14. Vital signs show BP 80/48 mmHg, HR 135 bpm, and RR 28/min. Breath sounds are clear and symmetric bilaterally. Pelvis is stable. Bedside Focused Assessment with Sonography for Trauma (FAST) demonstrates free fluid in Morison's pouch (hepatorenal space) and the splenorenal recess. Despite a 1-liter bolus of warm crystalloid, blood pressure remains 82/50 mmHg. What is the most appropriate next step in management?

General Surgery

Question · Hard

Question

A 67-year-old male presents with fatigue, generalized weakness, and dyspnea on exertion for 3 months. Laboratory testing reveals microcytic hypochromic anemia (Hemoglobin 7.8 g/dL, MCV 71 fL, Ferritin 8 ng/mL). Stool testing is positive for occult blood. He denies bright red blood per rectum or change in stool caliber. Colonoscopy reveals an exophytic mass in the cecum, confirmed as adenocarcinoma. Why do right-sided (cecal/ascending) colon cancers typically present with occult blood loss rather than early bowel obstruction?

General Surgery

Question · Medium

Question

A 62-year-old male develops a temperature of 38.6°C on postoperative day 1 (POD 1) following an elective open bowel resection. He is tachypneic (RR 24/min) and SpO2 is 93% on room air. Chest auscultation reveals decreased breath sounds and fine crackles at the bilateral lung bases. Surgical incision is clean and dry. What is the most common cause of fever occurring within the first 24 to 48 hours following major surgery, and what is the primary initial intervention?

General Surgery

Question · Medium

Question

A 58-year-old female presents with fever, shaking chills, jaundice, and severe right upper quadrant pain. Her blood pressure is 85/50 mmHg, heart rate is 128 bpm, and she is somnolent and disoriented (Reynolds' pentad). Laboratory tests show leukocytosis (22,000/uL), total bilirubin 6.8 mg/dL, and alkaline phosphatase 450 IU/L. Ultrasound demonstrates a dilated common bile duct (14 mm) with choledocholithiasis. After initiating IV fluid resuscitation and broad-spectrum antibiotics, what is the most definitive emergent procedure?

General Surgery

Question · Medium

Question

A 16-year-old boy presents to the emergency department with sudden-onset severe right testicular pain that awakened him from sleep 2 hours ago, accompanied by nausea and vomiting. Physical examination reveals an exquisitely tender, swollen, high-riding right testis with a transverse horizontal lie and an absent right cremasteric reflex. Elevation of the testis does not relieve the pain (negative Prehn sign). What is the definitive management?

General Surgery

Question · Easy

Question

A 24-year-old male sustains a closed mid-shaft tibial fracture following a sports injury, which is immobilized in a tight plaster cast. Six hours later, he complains of severe, excruciating leg pain that is unresponsive to increasing doses of parenteral opioids. On physical examination, the anterolateral calf compartment is tense and woody to palpation, and there is severe pain elicited upon passive plantar flexion and dorsiflexion of the great toe. Distal dorsalis pedis pulses are palpable. What is the most sensitive early clinical indicator of acute compartment syndrome, and what is the definitive treatment?

General Surgery

Question · Hard

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