2011 - 5th Flashcards by Fajer e

A 56-year-old man develops acute ischemic stroke four hours ago. Which of the following statements is true regarding thrombolytic therapy for stroke?
A. tPA is the only agent available for this purpose
B. Recovery to normal neurological status is not a contraindication to the use of thrombolytic therapy

A. tPA is the only agent available for this purpose
tPA(altepase) had to be given within 3-4.5 hrs of onset and only after CT scanning had ruled out hemorrhagic stroke.

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61-year-old man has a six-month history of dyspepsia without dysphagia or weight loss. Initially, his symptoms responded to antacids and H2-receptor antagonists but not any longer and have been ineffective for the past two months. Physical examination and laboratory investigations are normal. What is the appropriate next step in managing this patient?
* Upper endoscopy
* Eight-week trial of proton pump inhibitors * Serologic testing for Helicobacter pylori

Upper endoscopy
Note: Patients older than 55 years of age and those with alarm symptoms of dysphagia, weight loss, hematemesis and melena presenting with dyspepsia or epigastric pain unresponsive to acid- suppression therapy require an endoscopic diagnosis and exclusion of cancer.

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A 51-year-old lady with 10 year history of rheumatoid arthritis is scheduled for surgery to remove her gallbladder. Which of the following measures is compulsory before endotracheal intubation?

X-ray of the cervical spine

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Which of the following is an established cause of aplastic anemia?
* Vitamin B12 deficiency
* Systemic lupus erythematosus
* Fanconi syndrome
* Corticosteroid therapy

Fanconi syndrome

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32-year-old female was referred to a hematologist for a long-standing history of immune thrombocytopenia. The patient does not have any complaints or symptoms. The hematologist ordered few investigations, which later showed a platelet count of 51x109. How would this patient be further managed?
* Observation
* Prednisolone
* Intravenous immunoglobulin
* Splenectomy

Observation

Note: Adults with platelet counts more than 50,000/mm3 do not require treatment. Treatment is indicated for adults with counts less than 50,000/mm3 and significant mucous membrane bleeding, for those with risk factors for bleeding, e.g. peptic ulcer disease, as well as for asymptomatic patients with a platelet count less than 20 - 30,000/mm3.

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35-year-old man presents with history of acute onset of fever, productive cough and chest pain. On physical examination, respiratory rate was 22 breaths/min, and temperature was 39.5 Co. Percussion yielded a dull note posteriorly. Vocal tactile fremitus was increased, and bronchial breathing was heard as well. What is the likely diagnosis?
a. Consolidation
b. Pleural effusion
c. Pneumothorax
d. Asthma

a. Consolidation

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15)A 21 year old male complains of dyspnea on exertion and occasionally, chest pain and dizziness .He has a sibling who recently passed away due to non investigated cardiac condition.Physical examination revealed jerky pulse and ejection systolic murmur. What is the best likely diagnosis?
A)Hypertrophic cardiomyopathy
B)Aortic stenosis
C)Pulmonary stenosis

A)Hypertrophic cardiomyopathy

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Which of the following drugs can be used for migraine headache prophylaxis? A. Propranolol
B. Aspirin
C. Metochlopramide
D. Opioids
E. Sumatriptan

A. Propranolol

drugs of first choice for migraine prophylaxis
Betablockers
Metoprolol
Propranolol
Calcium channel blockers Flunarizine
Antiepileptic drugs Valproic acid
Topiramate

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1)A 48 year old man presented to the casualty with severe retrosternal chest pain that radiates to his neck and arm .The pain persisted for many hours and was relieved by rest. The patient was nauseous and diaphoretic as well. His ECG is shown .Which of the following is likely to be found on physical examination?

Answer:Pan svstolic murmur best heard on the apex
Note:Myocardial infraction can be complicated by dysfunction or occasionally, rupture of the papillary muscle and hence, resulting in acute mitral regurgitation more commonly inferior MIs.

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A 47-year-old woman developed acute interstitial nephritis and subsequent acute renal failure after she started taking NSAIDs for her back pain. Which of the following is expected to be seen in the urine?
a. Eosinophiluria
b. Pyuria
c. Calcium phosphate crystals

a. Eosinophiluria

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Which of the following is accepted treatment combination for the management of hypertension?
A)Beta Blockers-Congestive heart failure
B)ACE inhibitors-Chronic kidney disease

A)Beta Blockers-Congestive heart failure

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A 43-year-old woman developed progressive muscle weakness in her upper arms over the last six weeks. She has a difficulty getting out of chairs and climbing stairs. She has no muscle pain. On examination, she had a purplish rash that involves both eyelids. Scaly maculopapular rash was also noted on the knuckles. What is the name of the rash on her eyelids?
* Heliotrope rash (dermatomyositis)
* Gottron rash
* Shawl rash
* Malar rash

Heliotrope rash (dermatomyositis)

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A 36-year-old female has two-month history of weight gain. On physical examination, the patient had hirsutism, central obesity and purple abdominal striae. Blood pressure was 158/87 mmHg, and fasting blood glucose was elevated. An abdominal MRI showed an adrenal mass on the right side. What would be the best initial investigation to establish a diagnosis?

A. 24-hour urine free cortisol

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A 66-year-old man complains of a headache and temporal tenderness. He has an ESR of 112. A prominent vessel was visible on the patient’s temple and is tender to palpation. How can the diagnosis of giant cell arteritis be confirmed?
* Temporal artery biopsy
* Angiography
* CT scan of the head

Temporal artery biopsy

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A 71-year-old man was brought to the hospital after feeling dizzy and fainting. Physical examination detected the presence of multiple palpable lymph nodes in the neck, axillae and groin regions. In addition, splenomegaly was present. Laboratory investigations showed high WBC count while blood smear showed mature lymphocytes and smudge cells. Which of the following can occur in the setting of this patient’s condition?

Autoimmune hemolytic anemia

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A 49-year-old woman has a history of joint pain and morning stiffness for four months. Examination reveals swelling of the wrists and MCPs. Which of the following can be used to monitor the activity of rheumatoid arthritis?
* C-RP
* Rheumatoid factor
* Complement level

C-RP

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A 52-year-old female develops rapidly progressive renal failure with very high serum creatinine. She has a history of hepatitis C infection. Digital infarcts were noted on physical examination. Which of the following is a likely diagnosis in this patient?
a. Cryoglobulinemia
b. Systemic sclerosis
c. Hepatorenal syndrome

a. Cryoglobulinemia
- Hepatitis C infection associated with cryoglobulinemia

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According to the most recent guidelines for thrombolytic treatment of stroke, what is the time window from the onset of symptoms that allows administration of tPA for ischemic stroke?

3 to 4.5 hours

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A 53-year-old man comes to the pulmonology clinic. He states that he has been feeling short of breath when climbing stairs. His dyspnea is accompanied by a cough that is non-productive. Pulmonary function tests revealed a low FEV1, low FVC, normal FEV1/FVC ratio and low TLC. Which of the following confirms a diagnosis of restrictive lung disease?
a. Low TLC
b. Low FEV1
c. Low FVC
d. Normal FEV1/FVC ratio

a. Low TLC

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A 66-year-old male patient was evaluated for constipation that he has been having for many months. Barium enema of the colon was performed and revealed a lesion with an apple-core appearance. What is the likely diagnosis?
* Colon cancer
* Irritable bowel syndrome
* Inflammatory bowel disease
* Diverticular disease

Colon cancer

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A 37-year-old patient complains of episodes of palpitations and excessive
sweating. He also reports occasional headaches. He says that standing up from a sitting or supine position would leave him dizzy for a short time. Which of the following mediators is responsible for the symptomatology of this patient?
A. Aldosterone
B. Serotonin
C. Cortisol
D. Epinephrine

D. Epinephrine

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A 43-year-old man was found in the ward to have a high potassium level (K = 6.1 mmol/L). An ECG was performed and is shown below. Which of the following measures should be immediately taken?

Administration of IV calcium gluconate
Note: Severe hyperkalemia (> 6.5 mmol/L) or hyperkalemia (> 6 mmol/L) with ECG changes is a medical emergency that warrants immediate treatment.

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A Patient was diagnosed with Dermatomyositis. What is the name of the rash on her
eyelids?
A. Heliotrope
B. V sign
C. Shawl sign
D. Rosacea

A. Heliotrope

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In Tuberculosis Meningitis the Cerebral Spinal fluid will have?
A. Low Protein
B. High Protein
C. Lowglucose
D. Turbid appearance

B. High Protein

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A 66-year-old man underwent coronary angiography to evaluate his ischemic heart disease. A couple of days later, his urinary output decreases dramatically. Which of the following is a likely finding in contrast-induced nephropathy? a. Increase in urine osmolarity b. Proteinuria c. Hematuria d. Eosinophiluria

a. Increase in urine osmolarity Note: Contrast-induced nephropathy is defined as an increase in serum creatinine within 48 to 72 hours of intravenous contrast administration. Urine osmolarity tends to be less than 350 mOsm/Kg. Although it is a form of acute tubular necrosis, the urinary lab values are an exception from the other forms of ATN. Contrast causes spasm of the afferent arteriole, leading to renal tubular dysfunction and increased reabsorption of sodium and water. This causes a marked increase in specific gravity and hence urine osmolarity.

9)A middle aged male patient with a history of coronary artery disease reports a crushing retrosternal chest pain .On physical examination, a pan systolic murmur was heard at the apex with a soft first heart sound. Which of the following is the least likely mechanism of the murmur heard? A)Commissural fusion of the mitral leaflets B)Rupture of papillary muscle C)Rupture of the interventricular septum D)Dilatation of the mitral valve ring E)Rupture of the chordae tendinae

A)Commissural fusion of the mitral leaflets

A 52-year-old man develops a scaly rash and polyarticular pain. What musculoskeletal manifestation is this patient likely to have? * Enthesitis * Proximal myopathy * Palpable osteophytes * Subcutaneous nodules

* Enthesitis

Which of the following would distinguish diabetic retinopathy from hypertensive retinopathy? A. Microaneurysms B. acular stars C. Hard exudates D. Flame-shaped hemorrhages \

A. Microaneurysms Note: Macular stars and hard exudates can be detected in both diabetic and hypertensive retinopathies while flame-shaped hemorrhages are found in hypertensive retinopathy. On the other hand, diabetic retinopathy is marked by the presence of microaneursysms.

A 57-year-old woman presents with a wheezing chest. On physical examination, palpable purpura were present on her lower limbs. Laboratory investigations reveal eosinophilia. What is the diagnosis? a. Churg-Strauss syndrome b. Cryoglobulinemia c. Helminthic infection d. Henöch-Schonlein purpura

a. Churg-Strauss syndrome

A 21-year-old man underwent a routine check-up before getting into the military academy. He was incidentally found to have a slightly elevated level of unconjugated bilirubin. He was previously known to have a benign liver disease in childhood. What is the likely cause of his elevated bilirubin? * Gilbert syndrome * Crigler-Najjar syndrome * Cystic fibrosis * Alpha1-antitrypsin deficiency

* Gilbert syndrome

Pregnant lady came back from India with LFT 1000. What is the most likely diagnosis? A. Hepatitis B B. HepatitisD C. HepatitisC D. Hepatitis E

D. Hepatitis E

A 53-year-old female presents with history of constipation that she has been having for months. She also reported a fractured wrist after falling on on her arm. Further investigations revealed bilateral kidney stones that the patient was asymptomatic for, but she did recall spontaneously passing small stones in urine during the past year. The laboratory tests showed a high calcium and low phosphate levels. What investigation would further confirm the diagnosis? A. Intact PTH level B. Urine calcium concentration

A. Intact PTH level

What is the most common Pathogen to cause Meningitis in Adults? A. Neisseria Meningitidis B. HemophilusInfluenza C. StreptococcusAgalactiae D. Streptococcus Pneumonia

D. Streptococcus Pneumonia

A couple who both have thalassemia trait came to the premarital screening clinic. They are worried that their future children might have thalassemia. What percentage of their offspring will have the disease? a. 25% b. 50% c. 75% d. 100%

a. 25%

A 48-year-old man who is a known case of cirrhosis presents with ascites and pitting sacral and lower limb edema. What is the initial step in the management of this patient's ascites? * Abdominal paracentesis * Spironolactone and dietary sodium restriction * Furosemide * Transjugular intrahepatic portosystemic shunt * Intravenous infusion of albumin

* Abdominal paracentesis Note: Guidelines from the American association for the study of liver diseases for management of adult patients with ascites due to cirrhosis advocate diagnostic paracentesis in all patients with clinically apparent new-onset ascites.

A 71-year-old woman has a history of back pain. Spine imaging showed a compression fracture in the thoracic spine. Further investigations showed a low serum calcium level, low serum phosphate level, high parathyroid hormone level and high alkaline phosphatase. Which of the following would be the likely etiology of this patient's condition? A. Vitamin D deficiency B. Hyperparathyroidism

B. Hyperparathyroidism

A 63-year-old woman has a six-month history of chronic sinusitis and epistaxis. Her serum creatinine has increased from 110 mg/L to 270 mg/L over the past three weeks. Urinalysis shows proteinuria and hematuria. She is positive for c-ANCA. What is the diagnosis? a. Wegner's granulomatosis b. Goodpasture’s syndrome c. Churg-Strauss syndrome

a. Wegner's granulomatosis -Patient with Wegner’s syndrome presented with sinusitis and epistaxis together with the granulomatosis -Patient with Chug Strauss syndrome presented with asthma, lung infiltration, peripheral neuropathy, purpuric rash, and eosinophilia

Maid with itchy bullae on her hand that's oozing after cleaning the house. She was diagnosed with contact dermatitis. What is the treatment in the bullous, oozing stage? A. wet press B. topicalantibiotics C. topicalanalgesics D. systemic antibiotics E. systemic steroids

A. wet press

A 25-year-old man with a long history of chronic intermittent bloody diarrhea presents with one-week history of exacerbating symptoms. Over the last 24 hours, the severity of diarrhea has decreased, but he now complains of abdominal pain and distention. On physical examination, the patient is extremely ill and pale, abdomen is distended, tympanic to percussion and diffusely tender. His vital signs are as follows: blood pressure 93/60 mmHg, heart rate 113/min, respiratory rate 18 breaths/min and temperature 37.9 Co. His abdominal x-ray is shown. Which of the following is the treatment of choice for the management of this patient? * IV hydrocortisone administered 6 hourly * Oral steroids * Oral metronidazole * Oral azathioprine

* IV hydrocortisone administered 6 hourly

A 44-year-old man is known to have progressive exertional dyspnea and dry cough for the past year. Physical examination shows reduced chest expansion bilaterally with inspiratory crackles heard over the bases. Pulmonary function tests showed a low FEV1, ow FVC, normal FEV1/FVC ratio and low TLC. What is the pathophysiology that underlies this patient's condition? a. Low lung compliance b. Increased lung compliance c. Airway narrowing d. External compression of the lungs

a. Low lung compliance

Which of the following is not found in myasthenia gravis? A. Respiratory failure B. Ocular symptoms C. Antibodies against acetylcholine receptor D. Presynaptic antibodies

D. Presynaptic antibodies MG is an autoimmune disease of the NMJ caused by Ab that attack components of the postsynaptic membrane, impair neuromuscular transmission, and lead to weakness and fatigue of skeletal muscle

19)A 13 year old boy complains of a tender right wrist joint .Few days later, the left wrist and right ankle were tender instead.The boy says even putting his clothes on could elicit severe pain if his joints were lightly touched. His mother says he had a bout of tonsillitis few weeks back that resolved upon treatment. The boy had a fever as well ,and the lab investigations revealed high ESR and CRP. Which of the following will confirm the presence of rheumatic fever? A)generalized popular rash B)Polyarthritis

B)Polyarthritis

A 46-year-old woman has a history of jaundice and pruritus. Laboratory investigations revealed dramatically elevated levels of alkaline phosphatase but mildly elevated ALT and AST. Which of the following serological markers is likely to be present in this patient? * Anti-mitochondrial antibodies * Antinuclear antibodies * Anti-smooth muscle antibodies * Anti-liver/kidney microsomal antibodies

* Anti-mitochondrial antibodies

A 48-year-old man has uncontrolled hypertension despite being on multiple drug regimens. On one visit, his blood pressure was 174/95 mmHg. On further investigations, he was found to have low serum potassium level. Head imaging revealed a small infarct in the right cerebral hemisphere. Which of the following states would best explain this patient's presentation? A. Hyperaldosteronism B. Increased intracranial pressure

A. Hyperaldosteronism

A 23-year-old female developed rapidly progressive renal failure. What is a bad prognostic sign that indicates a deteriorating condition? a. Oliguria b. Proteinuria c. Hematuria

a. Oliguria

A 48-year-old man presents with severe pain and swelling of his right big toe. On examination, the first metatarsophalangeal joint was erythematous, hot and tender to palpation. What is the likely diagnosis? * Gouty arthritis * Osteoarthritis * Systemic lupus erythematosus

* Gouty arthritis

A 38-year-old female was referred to a rheumatologist with active rheumatoid arthritis in more than 20 joints. Plain radiographs of her hands show erosions of the PIPs and MCPs. She denies history of hepatitis B or C infections. What treatment should this patient be started on? * Methotrexate (the drug of choice of RA) * Cyclophosphamide * Cyclosporine * Aminoslalicylic acid

* Methotrexate (the drug of choice of RA)

A 38-year-old man with 12 year history of rheumatoid arthritis was found to have very high levels of rheumatoid factor. He also has high ESR and C- RP. Which of the following extra-articular manifestations is expected to be present in this patient?

* Interstitial lung disease Note: Seropositive rheumatoid arthritis, i.e. for anti-CCP and RF, is associated with more erosive joint disease and extra-articular manifestations than its seronegative counterpart.

A 38-year-old male patient presents with history of headaches. Occasionally, he also reports nausea and vomiting as well as photophobia. However, rhinorrhea and sweating were not experienced. Neurological examination and fundoscopy reveals papilledema. No scalp tenderness or palpable vessels were noted. What is an alarming sign in this patient's clinical presentation? A. Papilledema B. His age C. Photophobia

A. Papilledema MSD Dr Suhail ‘headaches’ Red flags for secondary headaches SNOOP4 Systemic signs and symptoms Neurological finding in examination Older than 50 y/o Postural headache Precipitation of headache with valsava Progression of headache Presence of papilledema

A 45-year-old healthy woman has a BMI of 31. On a regular check-up, she was found to have high blood sugar, high ALT, AST and ALP. She is otherwise asymptomatic. What is the likely diagnosis? * Non-alcoholic steatohepatitis * Obstructive jaundice * Autoimmune hepatitis * Viral hepatitis

* Non-alcoholic steatohepatitis

A 19-year-old previously healthy male says that he started to experience right-sided chest pain and cough three days ago after playing football. He denies any trauma during the match. He said that he hadn't played football for two years before this time. The pain increases when he sleeps on the right side, he says. On physical examination, breath sounds were decreased on the right side. What is the diagnosis with respect to this patient's presentation? a. Pneumothorax b. Collapse c. Pulmonary embolism d. Consolidation e. Muscle strain

a. Pneumothorax

A type 1 diabetes mellitus patient was brought by her parents to the casualty where she was identified as a case of diabetic ketoacidosis. Her electrolyte and ABG profile showed low serum sodium level, high serum potassium level, low pH, low serum bicarbonate and positive urine ketones. Which of the following is true regarding this patient's condition? A. Serum potassium level will self-correct as soon as fluids are started B. Serum potassium level will drop upon starting the infusion of IV fluids

B. Serum potassium level will drop upon starting the infusion of IV fluids

A mother brought her 10-year-old child to the physician for recent onset of symptoms. She says that her child suddenly becomes short of breath and expectorates yellowish sputum multiple times during the last two months. He becomes feverish as well, his mother says. However, he is now asymptomatic. The physician suspects bronchial asthma. What test would be used to confirm the diagnosis of asthma? a. Methacholine challenge test b. Allergy skin prick testing c. Chest radiography d. Spirometry pre- and post-bronchodilator therapy

a. Methacholine challenge test Note: Bronchoprovocation testing with methacholine or histamine is useful when spirometry findings are normal or near normal especially in patients with intermittent or exercise-induced asthma symptoms. A negative test result usually excludes the diagnosis of asthma.

A 33-year-old woman with a known history of systemic lupus erythematous presents with recent onset of fatigue, dizziness, pallor and jaundice. She has polyartharlgia as well. Laboratory investigations revealed a low hemoglobin level. Which of the following tests is appropriate to confirm the cause of her presentation? * Direct and indirect Coombs test * Bone marrow aspiration * Osmotic fragility test

* Direct and indirect Coombs test

A 24-year-old woman presents with a photosensitive butterfly rash, arthralgia, oral ulcers and pleuritic chest pain over several months. She also has a low-grade fever. Which of the following are likely to be found in this patient? * Antinuclear antibodies * High complement levels * Low C-RP level

* Antinuclear antibodies

An elderly female was admitted to the hospital for pneumonia. She has a history of hypothyroidism, which caused her to feel depressed most of the time and gain weight. While in the hospital, the nurse noticed that the patient was passing large amounts of urine. Which of the following would be least likely to have caused her polyuria? A. SIADH B. Diabetes insipidus C. Diabetes mellitus

A. SIADH

A 39-year-old woman presents to the gastroenterology OPD complaining of chronic abdominal pain for the past five years. She says that the pain is all over her abdomen and is intermittent in nature. Most of the time, it is accompanied with episodes of constipation and relieved with defecation. She denies any rectal bleeding, and her weight is stable over the past few years. Her laboratory tests are all within normal ranges. A colonoscopy and upper endoscopy were done one year ago and were normal. Which of the following is most appropriate regarding the management of this patient at this time? * Reassurance * Computed tomography of the abdomen * Repeat colonoscopy * Repeat upper endoscopy * Abdominal ultrasound

* Reassurance ote: Diagnostic criteria for irritable bowel syndrome state that, in the preceding three months, the patient should have three days per month of recurrent abdominal pain or discomfort associated with two or more of the following: 1. Improvement with defecation. 2. Onset associated with a change in frequency or 3. in form of stool. A positive diagnosis of IBS with an explanation of symptoms and reassurance is often helpful and may require no further treatment.

A 64-year-old obese lady complains of pain in her left knee and morning stiffness that lasts about 15 minutes. Plain radiograph of her knee shows osteophytes and joint space narrowing. What is the diagnosis? * Osteoarthritis * Rheumatoid arthritis * Pseudogout * Septic arthritis

* Osteoarthritis

5)An 18 year old female complains of dyspnea on exertion. Her ECG is shown .Which is likely to be found on auscultation of the heart? A)Loud P2 B)Pan svstolic murmur at the apex C)S3 gallop D)Soft SI

A)Loud P2 The ECG depicts a pattern of right ventricular strain :ST depression and a T wave inversion in the leads facing the right ventricle ,.e.VI-V3 .This pattern is seen in right ventricular hypertrophy, one cause of which being pulmonary hypertension and hence, loud P2.

A 25-year-old man presented with one month history of left pleuritic chest pain with progressive shortness of breath and dry cough. He now has a fever as well. Upon examining the patient, dullness was present over the left lung base posteriorly with bronchial breathing in the mid-chest area. Vocal fremitus was judged normal. What is the diagnosis according to this presentation? a. Pleural effusion b. Consolidation

a. Pleural effusion Note: The vignette described in the question stem was derived from the PBL session on pleural effusion.

A 23-year-old woman with history of type 1 diabetes mellitus is on rapid- acting insulin three times a day before meals and glargine at night. She comes to her diabetologist on a follow-up visit with a diary of blood glucose readings at different times of the day as shown below. Breakfast: 9.1 Lunch: 8.6 Dinner: 6.9 Bedtime: 6.4 How should the doctor further manage this patient based on her readings? A. Increase the dose of rapid-acting insulin B. Add an intermediate-acting insulin C. Decrease the dose of glargine D. Increase the dose of glargine

D. Increase the dose of glargine

A 45-year-old lady has a history of dry cough and occasional shortness of breath. Chest x-ray shows bilateral hilar lymphadenopathy with reticulonodular infiltrates of the lung parenchyma. A lung biopsy was taken, and a diagnosis of sarcoidosis was confirmed. What is the biopsy expected to show on histology? a. Chronic interstitial inflammation with widely dispersed granulomas b. Chronic inflammatory changes with eosinophilic infiltration c. Non-necrotizing granulomas and lymphocytosis in a peribronchial and perivascular distribution d. Intra-bronchial infiltration of pigmented macrophages e. Necrotizing granulomatous vasculitis of small- and medium-sized vessels

c. Non-necrotizing granulomas and lymphocytosis in a peribronchial and perivascular distribution

A 50-year-old alcoholic man with history of cirrhosis presents to the casualty with an episode of hematemesis. On physical examination, he is alert and oriented. His blood pressure was 112/70 mmHg and heart rate was 89/min. The patient received antibiotics and was taken for an upper endoscopy. Which of the following is the most appropriate next step? * Infusion of IV octreotide * Administration of beta blockers * Performing transjugular intrahepatic portosystemic shunt * Insertion of a Sangstaken-Blakemore tube

* Infusion of IV octreotide

What are the earliest changes seen in diabetic nephropathy?

Increased glomerular filtration rate and hypertrophic kidney At diagnosis: patient will have renal hyperfiltration, according to the MSD the kidney size in chronic kidney disease is small expect in MM, DM, and amyloidosis in which the kidney size is normal!

25-year-old woman presents with sudden shortness of breath and cough. On physical examination, no wheezing was heard over the chest. Her respiratory rate was 26 breaths/min. Pulmonary function tests showed low FEV1 and FVC, and low DLCO. Which of the following stands against and makes the diagnosis of asthma less likely? a. Her age b. Low DLCO c. The absence of wheezin

b. Low DLCO

A 59-year-old gentleman complains of three-month history of progressive dyspnea on exertion and dry cough. He denies fever or chest pain. Physical examination shows reduced chest expansion bilaterally and inspiratory basal crackles. Chest x-ray shows diffuse basal reticular infiltrates. What does this patient's presentation suggest? a. Interstitial lung disease b. Emphysematous lung disease c. Hypersensitivity pneumonitis d. Bronchiectasis

a. Interstitial lung disease

A 47-year-old female who underwent subtotal thyroidectomy for hyperthyroidism now presents with pedal edema and fatigue three months after being started on her post-thyroidectomy medications. Her thyroid function tests showed that her TSH level is high, and T4 level is low. How should this patient be managed? A. Increase the dose of levothyroxine B. Maintain the same dose of levothyroxine

A. Increase the dose of levothyroxine

Which of the following pairs is correctly matched? * Anti-centromere antibodies - systemic sclerosis * Anti-mitochondrial antibodies - autoimmune hepatitis

* Anti-mitochondrial antibodies

52-year-old man reports being fatigued. His electrolytes and ABG profile was obtained: pH was 7.31, Na was 135 mmol/L, Cl was 115 mmol/L, HCO3 was 15 mmol/L and K was 5 mmol/L. Urine Na was 9 mmol/L. What is the likely diagnosis? a. Diarrhea b. Renal tubular acidosis c. Lactic acidosis d. Renal failure e. Ethanol poisoning

a. Diarrhea Note: A case of normal-anion gap metabolic acidosis with low urine sodium, most likely due to gastrointestinal loss.

A 46-year-old man has silver-white scaly erythematous plaques over his knees and elbows. He also has joint pain in his hands. Which of the following is an extra-articular manifestation of psoriatic arthritis? * Nail pitting * Apical lung fibrosis * Serositis

* Nail pitting

A 27-year-old asthmatic patient is on an maximum dose of inhaled corticosteroids. However, the patient says that his symptoms haven’t improved, and that he still gets frequent exacerbations. He feels short of breath on a daily basis with similar episodes at night. What would be the further management plan for this patient? a. Administration of a leukotriene receptor antagonist b. Adding a long-acting beta agonist c. Adding theophylline

b. Adding a long-acting beta agonist

A girl used Henna and developed contact dermatitis, Purified Protein Derivative(PPD) reaction was positive, which type of immune reaction is this? A. Type I Hypersensitivity B. Type II Hypersensitivity C. Type III Hypersensitivity D. Type IV Hypersensitivity

D. Type IV Hypersensitivity

A 35-year-old lady comes to her physician and is planning to get pregnant soon. She is a known case of SLE that is well controlled on steroids and plaquenil. How would this patient be further counseled? * Continue both drugs * Discontinue both drugs * Stop steroids and continue plaquenil * Stop plaquenil and continue steroids

* Continue both drugs Note: Low-dose steroids and antimalarials are safe to continue in pregnant patients with SLE.

A 34-year-old man who is on cocaine develops hematuria. Which of the following should be checked in this patient?

Urine myoglobin Note: Cocaine use can precipitate rhabdomyolysis, and in patients with coexisting hematuria, a urine myoglobin assay is helpful. A positive urine dipstick for blood in the absence of red blood cells suggests myoglobinuria.

A 35-year-old man was found to have microscopic hematuria and proteinuria. He was also hypertensive. The patient had normal complement levels. What is the likely diagnosis? a. IgA nephropathy b. Membranoproliferative glomerulonephritis c. Lupus nephritis

a. IgA nephropathy

A 32-year-old woman with history of systemic lupus erythematous presents with jaundice, dark urine and dizziness. Which of the following is likely to be normal in this patient? * G6PD level * Reticulocyte count * Hemoglobin level * Bilirubin

* G6PD level

An unmarried Female came to the dermatologist with scars on her face and acne. she Used Retinoid and other ointment but nothing gave the results she wanted. On examination you saw multiple white comedones and pustules. What is the best next treatment? A. Laser B. Daposane C. OralIsotretinoin

C. OralIsotretinoin

A 53-year-old lady presented with a recent complaint of chest pain that increases with breathing. She noticed some weight loss during the last few months due to unexplained loss of appetite. A chest x-ray was taken and showed a peripheral mass in the left lung field. The patient has never smoked in her life. What is the likely diagnosis? a. Squamous cell carcinoma b. Small cell carcinoma c. Adenocarcinoma d. Pulmonary metastasis

c. Adenocarcinoma

Which of the following conditions can be associated with the presence of Howell-Jolly bodies? * Splenomegaly in thalassemia * Bone marrow failure in aplastic anemia * Splenic infarctions due to sickle cell anemia

* Splenic infarctions due to sickle cell anemia

A 36-year-old obese female complains of frequent headaches. On neurological examination, fundoscopy reveals papilledema. She also had signs of sixth cranial nerve palsy. Her BMI is 31. What is the likely diagnosis according to this patient's presentation?

Idiopathic intracranial hypertension Note: Idiopathic intracranial hypertension is a disorder of unknown etiology that predominantly affects obese women of childbearing age. The primary problem is chronically elevated intracranial pressure, and the most important neurologic manifestation is papilledema.

Patient came to the ER complaining of bloody diarrhea with mucus. Which organism is the most likely to give such symptoms? A. Vibrio Cholera B. StaphylococcusAureus C. ClostridiumDifficle D. Shigella Species

D. Shigella Species

A 34-year-old lady complains of dizziness and fatigue. She also reports nausea and vomiting on occasions. Physical examination revealed areas of hyperpigmentation. A diagnosis of Addison's disease was confirmed. Which of the following would not be a feature of this condition? A. High serum potassium level B. Low serum sodium level C. Low serum aldosterone level D. Hypertension

D. Hypertension

Which of the following is true regarding aminoglycoside-induced nephrotoxicity? a. It starts within two weeks of drug administration b. It is of the oliguric type c. It is irreversible on discontinuation of the drug

a. It starts within two weeks of drug Note: Aminoglycoside nephropathy usually starts on the 9th or 10th day after drug administration and is of the non-oliguric type.

A 62-year-old gentleman reports a recent history of headache that started during the last week. He told his physician that he has a family history of headaches, and that his daughter complains of frequent headaches as well. Which of the following points towards a secondary rather than a primary headache in this patient? A. Family history of headaches B. Age more than 60 years

B. Age more than 60 years MSD Dr Suhail ‘headaches’ Red flags for secondary headaches SNOOP4 Systemic signs and symptoms Neurological finding in examination Older than 50 y/o Postural headache Precipitation of headache with valsava Progression of headache Presence of papilledema

A young lady in the postpartum period complains of recent history of palpitations, increased sweating, heat intolerance and weight loss. Her anterior neck was not erythematous or tender. The thyroid scan shows no uptake of iodine. Which of the following would be used to manage this patient? A. Beta blockers B. Carbimazole C. Thyroid hormone supplements

A. Beta blockers Note: Postpartum thyroiditis is a transient form of autoimmune thyroiditis. The characteristic course begins with hyperthyroidism, followed by a hypothyroid phase, then full resolution and return to the euthyroid state. Treatment focuses on reduction of symptoms, and antithyroid medications are not indicated.

A 36-year-old woman has been feeling dizzy and short of breath lately. Her laboratory investigations showed low Hb, low MCV, low MCH and high RDW. Which of the following would help confirm the diagnosis of iron deficiency anemia in this patient? a. Ferritin levels b. Aspiration of the bone marrow

a. Ferritin levels

A 22-year-old man has a history of bloody diarrhea, weight loss and aphthous ulcers. Which of the following extra-intestinal manifestations does not parallel the activity of his disease? * Ankylosing spondylitis * Peripheral oligoarthritis * Episcelritis * Erythema nodosum

Ankylosing spondylitis Note: Large-joint mono- or asymmetrical oligoarthritis parallels the activity of the inflammatory bowel disease and consequently improves as bowel symptoms improve. On the other hand, sacroiliitis or spondylitis occurring in the setting of IBD is not related to the disease activity.

7)On auscultation of the heart of a young female, a mid diastolic murmur was best heard at the apex with old SI.A diagnosis of MS was confirmed on echocardiography. Which of the following is an indicator of the severity of Mitral stenosis? A)A short S2 opening snap interval B)Short duration of the mid diastolic murmur C)Loud SI

A)A short S2 opening snap interval

6)A 32 year old man complains of purulent cough and occasionally hemoptysis. He was also feverish. His chest X-ray shows multiple nodular infiltrates involving both lung fields.On further questioning, he was found to be an IV drug user. Which of the following is likely diagnosis? A)Right sided infective endocarditis B)COPD

A)Right sided infective endocarditis :Intravenous drug abuse endocarditis commonly afflicts the right side of the heart, namely the tricuspid valve. Infected vegetation can embolize via the pulmonary vasculature to the lungs ,producing the symptomatology and pathology mentioned

A 53-year-old man who is known to have alcoholic cirrhosis was admitted to the ward due to decompensation. He was noted to have developed tense ascites and pedal edema. While in the hospital, he had a bout of hematemesis for which he was resuscitated and appropriately managed. This patient was scheduled for liver transplantation given the deterioration of his condition. Which of the following parameters would predict the prognosis of this patient's status during the next six months? * Bilirubin and international normalized ratio * AST, ALT and bilirubin * APTT and albumin

* Bilirubin and international normalized ratio Note: Serum bilirubin, albumin, prothrombin time (INR), ascites and hepatic encephalopathy comprise the Child-Pugh scoring system which classifies and assesses the severity of cirrhosis and the candidacy for liver transplantation.

A 61-year-old man complains of aching epigastric pain that radiates to the back. He also passes foul-smelling fatty stools and reports recent weight loss. An abdominal x-ray was taken and is shown below. How would you manage this patient? * Pancreatic enzymes supplementation * Cholestyramine * Long-chain fatty acid supplements

* Pancreatic enzymes supplementation

An elderly female is on unfractionated heparin after her surgery. While in the ward, she started to to bleed profusely from her wound. Which antidote is used to reverse the anticoagulant effects of heparin? * Vitamin K * Cryoprecipitate * Protamine sulfate

* Protamine sulfate

A 62-year-old man presents to his GP with fatigue and weight loss. He said that these symptoms have been taking place for few months now. His laboratory tests showed low Hb, low MCV, low MCH, low MCHC and high RDW. What is the probable diagnosis? * Colon cancer * Inflammatory bowel disease * Celiac disease * Bacterial overgrowth

* Colon cancer

A 36-year-old female who is a known case of systemic lupus erythematous on medications presents with limb weakness and confusion. Head MRI reveals a hyperintense white signal in the frontal lobe, and CT scan confirms a diagnosis of stroke. Which of the following tests would help design a therapeutic plan for this patient? * Anti-cardiolipin antibodies (antiphospholipid syndrome can manifest as stroke) * Antinuclear antibodies * Erythrocyte sedimentation rate

* Anti-cardiolipin antibodies (antiphospholipid syndrome can manifest as stroke)

A 56-year-old man was found to have pernicious anemia. Which of the following is a possible complication of this condition? a. Hyperparathyroidism b. Osteomalacia c. Intracerebral hemorrhage d. Subacute combined degeneration of the spinal cord

d. Subacute combined degeneration of the spinal cord

A 41-year-old female presented to the emergency department with few days history of fever and fatigue, jaundice, dark urine and purpura all over her body. On occasions, she becomes confused and disoriented, her family says. Laboratory tests showed low Hb, high LDH, low platelets and abnormal kidney function tests. Blood smear detects the presence of fragmented red blood cells and nucleated red blood cells. What is appropriate management for this patient's condition? * Observation * Plasma exchange * Fresh frozen plasma * Backed red blood cells

* Plasma exchange

13)A 53 year old women was brought to the emergency room with central crushing chest pain . Her cardiac enzymes were elevated, and her ECG showed ST segment elevation in the inferior leads ;I, Ill,and a VF.soon after, the patient developed severe hypotension and was found bardycardiac. What is the immediate treatment of choice? A) Atropine B) Digoxin C)Dobutamine D)Phenylephrine E) Amiodarone

A) Atropine Inferior wall MI can be complicated by bradycardia and hypotension due to the involvement of the conductive nodes.

A 35-year-old female patient on oral contraceptives started to feel short of breath. She also started to feel a sharp chest pain that increases with inspiration. Physical examination showed red swollen calf that is tender to palpation. What is the immediate step to manage this patient?

* Start her on low molecular weight heparin

A 44-year-old man sustained severe injuries in a road traffic accident after which he developed rhabdomyolysis. Which of the following is best done to prevent renal failure while on the way to the hospital?

Administration of IV normal saline

A 52-year-old man was brought to the emergency room with symptoms of acute stroke. The radiology report states that the right anterior cerebral artery is occluded with hypoperfusion of its region. What will be the presentation of this patient? A. Right upper limb and facial B. Right lower limb weakness with sensory deficit C. Left upper limb and facial weakness D. weakness Left lower limb weakness with sensory deficit

D. weakness Left lower limb weakness with sensory deficit

Which of the following parameters would be used to check for the long- term control of blood glucose over two to four months in patients with diabetes mellitus?

A. Glycated hemoglobin

14)A 23 year old man was brought to the causality after a high energy motorcycle accident .The injuries sustained include multiple rib fractures ,right femoral fracture, and a head injury.On immediate evaluation of the patient, he was found hypotensive with distended JVP. Auscultating the chest reveals heart sound that are muffled and distant.The doctor noted a rapid drop while measuring the blood pressure on inspiration. What is the immediate step in the management of this management? A)Pericardiocentesis B) Insertion of a chest tube C)CT of the head

A)Pericardiocentesis Note:A case of cardiac tamponade ;immediate pericardiocentesis should follow.

A 61-year-old man was admitted to the ward for lower respiratory tract infection. Few days later, he started to complain of pain in his leg, which was found to be erythematous and red. Soon later, the nurse found him short of breath and tachycardic. Which of the following is true regarding the management of this patient?

a. Thrombolytics are only used if pulmonary embolism was associated with hemodynamic instability

18)A 41 year old man has a history of a mitral stenosis scheduled foe valve replacement. He went to his dentist for a tooth extraction. The dentist refers the patient to a cardiologist for further evaluation with regard to his valvular disease and determining his candidacy for infective endocarditis prophylaxis.he is allergic to penicillin. What should be done in terms of IE prophylaxis? A)Nothing should be done B) Prescribe him erythromycin

A)Nothing should be done

A 44-year-old SLE patient was found to be positive for anti-histone and antinuclear antibodies. Few years back, she was diagnosed with hypertension and was started on methyldopa which has controlled her blood pressure. She now presents with a malar rash and joint pain. Which of the following would be an appropriate step to manage her symptoms? * Discontinue methyldopa * Start her on low-dose steroids * Prescribe antimalarial medications

* Discontinue methyldopa

A 50-year-old farmer who is a heavy smoker reports having two episodes of acute onset of shortness of breath and fever, but was asymptomatic when came to the clinic. Few days later, he was brought by a friend with an acute episode. His temperature was 39.1 Co. Physical examination showed central cyanosis and basal lung crackles. Laboratory investigations showed leukocytosis of 17,000/mm3, with 80% neutrophils and 5% eosinophils. What is the diagnosis? a. Hypersensitivity pneumonitis b. Bacterial pneumonia c. Bronchopulmonary aspergillosis d. Acute exacerbation of COPD

a. Hypersensitivity pneumonitis

A young male patient was brought to the casualty with abdominal pain, nausea, and vomiting. The patient looked very ill and dehydrated. Earlier that day, he passed large amounts of urine and was feeling unusually thirsty too. His blood glucose was found to be very high, pH was 7.23 and urine was positive for ketones. A diagnosis of diabetic ketoacidosis complicating undiagnosed case of type 1 diabetes mellitus was confirmed. Which of the following would be the initial step in managing this patient? A. Infusion of 500 mL of normal saline over two hours B. Administration of Ringer's lactate and subcutaneous insulin

A. Infusion of 500 mL of normal saline over two hours Note: The optimal approach to management is to strike a balance between adequate correction of fluid losses and avoidance of rapid shifts in osmolality and fluid balance, especially in children not to precipitate cerebral edema. Hence, in a child with DKA, an initial IV bolus of normal saline at 10 to 20 mL/kg is given to restore intravascular volume and renal perfusion.

A 45 vear old man has a fever and a new murmur on physical examination. Recently he underwent a surgery to replace his aortic valve .The patient was also found hypotensive and short of breath .Which of the following is the best next step to investigate the patient? A)Multiple blood culture B) Cardiac enzymes C) Electrocardiogram D)Chest X-ray

A)Multiple blood culture

A 22-year-old female complains of a throbbing headache of moderate intensity. It lasts about 4 hours per episode. While having the headache, the patient cannot tolerate light or loud noises. She also feels nauseous and vomits sometimes. What is one characteristic of migraine headaches? A. Compressing in quality B. Unilateral in location C. Always preceded by an aura

B. Unilateral in location

17)A 32 year old lady who is pregnant in the second trimester was found to have high blood pressure on a regular follow up. What drug should be used to manage her condition? A)Methyldopa B)Angiotensin Converting enzvme inhibitors C) Angiotensin receptor Blocker

A)Methyldopa

Which of the following is true regarding hepatorenal syndrome? * It is associated with low urine sodium * Fluid replacement improves kidney function * Renal transplant is the treatment of choice for this condition * This syndrome has a relatively good prognosis

* It is associated with low urine sodium Note: Renal failure in this condition will often only respond to an improvement in the liver function, and hence, liver transplantation is the most effective option to treat hepatorenal syndrome.

A 68-year-old man complains of fever and severe pain in his left knee. On examination, the knee is red, swollen and warm. The patient is unable to walk on it. He remembers having an abrasion few days back just below his knee. Which of the following is the most essential step in diagnosis? * Synovial fluid aspiration * White blood cell count * Erythrocyte sedimentation rate * Knee x-ray

* Synovial fluid aspiration

A 59-year-old man has a long history of chronic kidney disease. He refused to undergo dialysis. He later presents with palpitations and says that his chest feels weird. An electrocardiogram was taken for this patient and is shown below. What is the likely underlying cause of these ECG changes? a. Hyperkalemia b. Atrial fibrillation c. Acute myocardial infarction

a. Hyperkalemia Note: ECG changes that occur in the setting of hyperkalemia include: peaked, tall or hyperacute T waves, widened QRS complexes and small, flat or indiscernible P waves.

A21-year-oldfemalewithtype1diabetesmellituspresentstotheemergencyroom with diabetic ketoacidosis. Which of the following will most likely complicate rapid correction of her fluid deficit over the next 10 hours? A. Congestive heart failure B. Cerebral edema C. Hypokalemia

B. Cerebral edema Note: Given the young age of this patient, cerebral edema is the likely complication. Congestive heart failure would manifest with rapid fluid correction in the elderly.

15-yr old Patient with joint pain in right hand. Then it disappeared and appeared in her left hand and right knee. ESR and CRP are high. She has a history of tonsillitis treated 4 weeks ago. Her PR interval is normal. Which of the following will help in diagnosis? A. ASO Titres of < 1:200 B. Evidence of S. aureus in throat culture C. splinter hemorrhage D. polyarthritis E. generalized rash

A. ASO Titres of < 1:200

A 26-year-old female was incidentally found to have a prolonged partial thromboplastin time. Prothrombin time, bleeding time, platelet count and fibrinogen level were all normal. The patient does not have any history of excessive bleeding from skin or mucous membranes, bruising or swollen joints. Deficiency of which of the following factors will most likely be detected in this patient? * Von Willebrand factor * Factor XII * Factor VIII * Factor IX

* Factor XII Note: Factor XII deficiency, also known as Hageman factor, is a congenital disorder inherited as an autosomal recessive trait and is not associated with bleeding diathesis. It is typically discovered in individuals with an isolated prolonged PTT.

What substance plays a role in the pathophysiology of migraine headaches? A. Serotonin B. Histamine C. Acetylcholine

A. Serotonin

Which immunoglobulin can cross the placenta? A. IgA B. IgM&IgG C. IgGonly D. IgM only

C. IgGonly

which of the following associated with Dermatomyositis? A. Enthesitis B. GingivalHyperplasia C. IrritableBowelDisease D. Gaint Cell Arteritis

A. Enthesitis

A 50-year-old man was admitted to the ward with fever and expectoration of large amounts of greenish sputum. He says that he has a long-standing lung disease for years with occasional exacerbations. Physical examination documents the presence of basal inspiratory crackles and finger clubbing. How would this patient be managed?

Postural drainage and antibiotics

A14-year old boy was found by his parents lying on the ground extremely ill.The patient was known to have type 1 diabetes mellitus. He was brought to the emergency room as a case of diabetic ketoacidosis where he was resuscitated with fluids. His parents said that their son was not adherent to his insulin therapy, and that recently, he had skipped few injections. On evaluation, his blood glucose was found to be 18 mmol/L, pH was 7.3, and urine was positive for ketone bodies. Serum potassium was high. Which of the following would accurately describe this patient's metabolic profile?

A. This patient has low serum bicarbonate

A 38-year-old man complains of being short of breath. He also reports hemoptysis. The patient had microscopic hematuria and was found to be in renal failure as well. Kidney biopsy shows linear deposits under immunoflorescense. What is the likely diagnosis? a. Goodpasture’s syndrome b. Granulomatosis with polyangiitis c. IgA nephropathy

a. Goodpasture’s syndrome

A 28-year-old man has a history of chronic productive cough and recurrent infections for many years. He looks cachectic on physical examination, and finger clubbing was present as well. The sputum he coughed up is green in color with a foul smell. Which of the following would have the highest yield in confirming the diagnosis? a. High-resolution CT scan b. Pulmonary function tests c. Chest x-ray d. Sputum culture

a. High-resolution CT scan

A 7-year-old girl has a long history of anemia. She has frontal bossing and occasional jaundice. Abdominal exam reveals hepatosplenomegaly. Which of the following statements is true with regards to beta thalassemia major? * This condition starts to manifest at 16 months of age * Allogenic bone marrow transplantation is the only curative option

* Allogenic bone marrow transplantation is the only curative option

A 58-year-old man complains of dull abdominal pain and fullness. On physical examination, a tender enlarged spleen was palpated that extends to the right iliac fossa. Further laboratory investigations showed leukocytosis with a differential of 20% mature neutrophils, 15% myelocytes and metamyelocytes and 5% basophils. Blood smear showed mature white blood cells at different stages. What is the likely diagnosis? * Leukomoid reaction * Primary myelofibrosis * Acute myeloid leukemia * Chronic myeloid leukemia

* Chronic myeloid leukemia

8)A 24 year old man was brought the causality with chest pain, shortness of breath, malaise and fever. On physical examination, the patient was hypotensive. Echocardiography showed a dramatic reduction in left ventricular ejection fraction in the setting of ventricular dilatation. What is the most likely cause of this presentation? A) Acute myocarditis B)Mvocardial infraction C) Aortic dissection

A) Acute myocarditis

A 17-year-old male patient with history of Crohn's disease for one year develops thin yellow discharge from the perianal area. Barium enema showed an enterocutaneous fistula. Which of the following would be used to induce the closure of a fistula within four to six weeks? * Infliximab * 6-mercaptopurine * Cyclosporine * Methotrexate * Steroids

* Infliximab

16)A 58 year old man has a history of uncontrolled hypertension despite being on metoprolol, lisinopril, hydrochlorothiazide and nifedipine .Upon measuring his BP ,it was 169/92 mmHg.After further investigation, the patient was found to have dilated cardiomyopathy with an ejection fraction of 30% on echocardiography.Few months later, his blood pressure was measured again and was 171/87 mmH with a resting heart rate 96/min. What could be the culprit of this patient's condition? A)Pheochromocytoma B)Bilateral renal artery stenosis C)Amvloidosis D)Myocarditis

A)Pheochromocytoma Note:Pheochromocytoma is one cause of secondary hypertension that should be managed by targeting the underlying cause ,i.e. resection of the adrenal medullary tumor, and it can be complicated by long term by dilated cardiomyopathy.

A 33-year-old female presents to the neurology clinic with history of pulsating unilateral headache that comes in episodes during the last month. She says that physical activity worsens the headache. She also reports nausea and vomiting as well as photophobia. What is the most common aura in the setting of migraine headaches? A. Motor aura B. Auditory aura C. Visual aura

C. Visual aura MSD Raed Behbehani ‘Neuro-ophthalmologic Causes of Headache’ Migraine: photophobia + visual aura

A 58-year-old obese male complains of excessive daytime sleepiness and morning headaches. He says that he got into two car accidents during the last month. The patient's wife says that her husband snores at night and awakens many times. Which of the following would be an appropriate investigation at this point? a. Arterial blood gas b. Overnight sleep study c. Pulmonary function tests

b. Overnight sleep study

4)A 32 year old man comes to the OPD with a complaint of low back pain and stiffness.On physical examination ,exaggerated thoracic kyphosis was noted ,and a murmur was heard on auscultation of the heart. Which of the following is likely to be found on completion of the physical examination? A)Prominent carotid pulsation B) Tapping apex beat C) Pulsus parvus et tardus

A)Prominent carotid pulsation Note:This scenario describes a case of Ankylosing spondylitis, which happens in close association with aortic regurgitation.

A 28-year-old female reports history of joint pain in her hands and feet. Which of the following favors inflammatory polyarthritis? * Low-grade fever * Morning stiffness less than 30 minutes

* Low-grade fever

A 57-year-old man complains of headache and tenderness over his scalp. He says he cannot even comb his hair due to pain. Visual acuity in the right eye was decreased, but fundoscopy was normal. ESR was found to be very high. What is the likely diagnosis? * Giant cell arteritis * Transient ischemic attack * Trigeminal neuralgia

* Giant cell arteritis

A 67-year-old lady was found to have a bone mineral density T-score of -2.6 on DXA scan. Which of the following factors would be protective against osteoporosis? A. Low BMI B. Physical activity C. Alcohol intake D. Smoking E. Maternal history of hip fracture

B. Physical activity

A father of five came to the Polyclinic complaining of severe itchy skin of his wrists, knees, elbows and periumbilical area mostly at night. He also noticed that his wife and kids started to experience the same itchy skin. On physical exam you saw Burrows of 5mm in length and elongated erythematous papules. What do you think this patient has? A. Eczema B. Psoriasis C. Scabies D. Contact dermatitis

C. Scabies

A 55-year-old lady with high-grade lymphoma is planning to undergo chemotherapy for her condition. Which of the following metabolic abnormalities is likely to be found upon initiating chemotherapy?

Hyperuricemia Note: Chemotherapy results in massive and rapid breakdown of tumor cells, leading to increased serum levels of urate, potassium and phosphate but with hypocalcemia, a condition known as acute tumor lysis syndrome. It is most commonly seen as a complication of treatment of acute leukemia and high-grade lymphoma.

2)A 24 year old man was brought to the emergency room with severe pain in the middle of his chest.Upon initial assessment of his vital signs ,his blood pressure was 180/112.Radial pulses were unequal on both sides. What is the most appropriate step to be done next in this case? A)CT scan with contrast(CT aortogram) B) Administration of throbolvtics C)Cardiac cathetarization

A)CT scan with contrast(CT aortogram) Note:This scenario describes aortic dissection ,one contraindication to thrombolytic therapy.

A 65-year-old lady was admitted to the orthopedic ward for left hip fracture. The patient has a past history of deep vein thrombosis that she was treated for. She is scheduled for a total hip replacement in few days. Which of the following measures should be taken after her surgery? * Prophylactic LMWH * Warfarin

* Prophylactic LMWH Note: Given this patient’s old age, type of surgery she underwent and past history of thromboembolism, she is stratified to be of highest risk to develop deep vein thrombosis. This necessitates her placement on postoperative heparin or enoxaparin plus application of a compression device.

A 45-year-old woman has a recurrent history of pneumonia in the past two decades. She reports having chronic cough productive of copious amounts of foul-smelling purulent sputum which gets worse in the winter months. On physical examination, basal dullness was detected and breath sounds were minimal or absent. However, inspiratory crackles were heard over the bases bilaterally. She had finger clubbing. What is the diagnosis? a. Bronchiectasis b. Chronic obstructive pulmonary disease c. Asthma d. Empyema

a. Bronchiectasis

A 12-year-old boy reports decreased hearing in his right ear. In the neurology clinic, the neurologist performed Weber's test. The test showed lateralization of sound to the right ear. What is the likely diagnosis in this young patient? A. Conductive deafness in the right ear B. Conductive deafness in the left ear C. Sensorineural deafness in the right ear D. Sensorineural deafness in the left ear

A. Conductive deafness in the right ear

A 43-year-old man who is a known case of asthma is on inhaled corticosteroids twice per day and on salmeterol six times per day. He also takes lisinopril and spironolactone for hypertension. He comes to his physician because his asthma symptoms are not improving and exacerbations are not controlled. Laboratory tests showed that the patient is hypokalemic (K = 3.2 mmol/L). What could have caused this patient's hypokalemia? a. Salmeterol b. Inhaled corticosteroids c. Lisinopril d. Spironolactone

a. Salmeterol Note: Beta agonists, e.g. salmeterol, can cause hypokalemia by inducing a shift of serum potassium into the cells. This potassium redistribution is caused by increased activity of the Na/K-ATPase.

A 59 year old lady reports being dizzy and sometimes, having syncopal attacks. Her ECG is shown.Which of the following is likely to be seen on examining the JVP of this patient? A)Canon a wave B)Prominent × descent C)Absent a wave D)Elevated JVP

A)Canon a wave The clinical presentation and ECG together give a picture of a third degree (complete) heart block.In the setting of atrioventricular dissociation ,the right atrium contracts against a closed tricuspid valve producing a large pulsation on JVP, a canon a wave.

Which of the following is contraindicated for live attenuated vaccine? A. Healthy 33 Year-old fertile female B. A 3 Year-old with no health issues C. A 40 Year-old male with a history of appendectomy D. A 50 Year-old with Acute leukemia

D. A 50 Year-old with Acute leukemia

A 49-year-old woman comes to her physician with a complaint of muscle weakness in her shoulders and proximal arms, as well as in her hips and upper thighs. The patient says that she is having a difficulty getting up from a sitting position and climbing up stairs. Which of the following would make a diagnosis of neuropathy stronger than a myopathy? A. Early loss of deep tendon reflexes B. Lack of sensory signs and symptoms

A. Early loss of deep tendon reflexes

A 23-year-old man presents with sudden onset of shortness of breath and acute chest pain. Which of the following investigations is the most important to perform in the emergency room? a. Chest x-ray b. ECG c. Cardiac enzymes and troponins d. CT with contrast

a. Chest x-ray

A 39-year-old woman noticed a lump in her left neck few weeks back. She also says that she feels fatigued most of the time, lost 4 kilograms in the past month and wakes up sweaty at night. What is the likely diagnosis? a. Thyroid cancer b. Infectious mononucleosis c. Hodgkin lymphoma

c. Hodgkin lymphoma

A 24-year-old man with history of weight loss, chronic diarrhea, bloating and loose stools presents with pruritic symmetrical eruption of crusting vesicles over the extensor surfaces of his arms and elbows. What is the likely diagnosis of this presentation? * Dermatitis herpetiformis * Erythema nodosum * Atopic dermatitis * Herpes simplex infection

* Dermatitis herpetiformis

A 44-year-old man was brought to the casualty with fever and was hemodynamically unstable. Laboratory tests show low Hb, high WBCs, low platelets, prolonged PT and PTT, low fibrinogen and high levels of D- dimers. What is the likely diagnosis? a. Acute liver failure b. Disseminated intravascular coagulation c. Warfarin toxicity d. Thrombotic thrombocytopenic purpura

b. Disseminated intravascular coagulation

A 54-year-old lady with a five year history of rheumatoid arthritis presents with an episode of joint pain and swelling. Laboratory tests show high ESR and C-RP. On examination, she had swan-neck and boutonnière deformities. Which of the following is expected to be seen on a plain radiograph of her hands? * Bony erosions * Osteophyte formation * Subcutaneous calcifications * Pencil-in-cup appearance of the joints

* Bony erosions

3)A 29 vear old female with a previous history of sore throat and joint pain in childhood presents with shortness of breath and hemoptysis.Her ECG is shown below.Which of the following is best used to prevent complications associated with her condition? A)Warfarin B)Heparin C)Dabigatran D)rivaroxaban

A)Warfarin Note:Patients with valvular atrial fibrillation immediately qualify for long term anticoagulation without prior calculation of CHA2DS2 VASe score .In addition, Warfarin, not NOACs (which can be used for non -valvular atrial fibrillation),should be used to medicate these patients.

A 43-year-old man is diagnosed with Bell's palsy. On physical examination, the patient had a droop in the right angle of his mouth when smiling. He neither could wrinkle his forehead nor close his right eye. Where is the underlying lesion according to this patient's presentation? A. Lower motor neuron of the right seventh cranial nerve B. Lower motor neuron of the left seventh cranial nerve C. Upper motor neuron of the right seventh cranial nerve D. Upper motor neuron of the left seventh cranial nerve

A. Lower motor neuron of the right seventh cranial nerve

2011 - 5th Flashcards

(151 cards)