86 - miscellaneous 1 bits

QUESTION.
A male child of 15 years, with a mental age of 9 years has an IQ of:
1. 50
2. 60
3. 70
4. 80

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Answer
2. 60. Q or Intelligence Quotient is the basis for the classification of Mental Retardation
IQ is equal to Mental Age ie MA divided by Chronological Age ie CA multiplied by 100 ie IQ = MA/Cax100`
Classification of Mental Retardation is as follows

Mental Retardation Level IQ Range
Mild 50 – 70
Moderate 35 – 50
Severe 20 – 35
Profound <>

Reference
A Short Textbook of Psychiatry by Ahuja 4 ed Page 146

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A 20 year old woman gives a history of sharp pain in the lower abdomen for 2-3 days every month approximately 2 weeks before the menses. The most probable etiology for her pain is:

1. Endometriosis.
2. Dysmenorrhea.
3. Pelvic tuberculosis.
4. Mittelschmerz.

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Answer
4. Mittelschmerz.

Reference
Shaw 12th Edition Page 229

Discussion
Mittleschmerz is Painful Ovulation
· Pain associated with rupture of Ovarian Follicle at the Time of Ovulation
· Pain occurs at regular time in succeeding or intermittent cycles
· Usually at the time of cvulation
· Short Duration <>
· Slight Vaginal Bleeding may be present
· Treated with Analgesics and Assurance

Explanation
1. In Endometriosis pain is at the time of Menstruation.
2. In Dysmenorrhea. pain is at the time of Menstruation
3. In Pelvic tuberculosis pain is not cyclical.
4. Mittelschmerz classically presents as described above.

Comments
The only factor that created concern in this question is that OUR PATIENT experiences pain for 2 to 3 days, where as Shaw says that Mittelschmerz is usually of shorter duration

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Which of the following strategy has been recommended to reduce the hereditary risk for ovarian cancer in women with BRCA I and BRCA II muations?

A. Use of oral contraceptive pills
B. Screening with transvaginal ultrasound
C. Screening with CA 125
D. Prophylactic oophorectomy

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answer is d . check

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pregnant pt with bicornuate uterus.what is likely outcome of pregnant?

a- abortion
b- preturm delivery
c- normal pregnancy outcome

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normal pregnancy outcome . check

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A 58-year-old smoker with a chronic cough attends out-patient with a history of severe pain in his left shoulder and radiating down his left arm. There is some weakness in the intrinsic muscles of the left hand. Sputum cytology reveals malignant keratinised cells. Most likely diagnosis is:

A. Horner's Syndrome

B. Pancoast's Syndrome

C. Peripheral Neuropathy

D. Hypertrophic pulmonary osteoarthropathy

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Correct Answer: B. Pancoast's syndrome

This is a complication of an apically placed lung carcinoma which in most cases is of squamous cell variety. The tumor invades directly into anatomical structures situated in this area including ribs, thoracic vertebrae and nerve roots.

Erosion of the ribs results in severe pain in the shoulder.

Infiltration of the lower part of the brachial plexus (C8-T2) results in:

-Pain down the inner surface of the arm and the fourth and fifth fingers.

-Paralysis and wasting of the muscles of the hand and forearm.

-There may also be a unilateral laryngeal nerve palsy and vocal cord paralysis causing a hoarse voice/ bovine cough.

The other well-recognised syndrome is Horner’s syndrome, caused by involvement of sympathetic fibres as they exit the cord at T1 to ascend to the superior cervical ganglion (miosis, ptosis, enophthalmosis).

Rather confusingly, a Pancoast tumour can lead to both Pancoast’s and Horner’s syndromes.

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