2013 module exam Flashcards by Survive Medical School

A patient complains from lower back pain, associated with loss of sensation over the lateral side of the foot & weakness in eversion, what clinical examination would confirm your diagnosis?

a. Brisk ankle reflex
b. Positive straight leg raise test
c. Absent knee reflex

b. Positive straight leg raise

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A 30-year old man complain of pain at the gluteal region and lower back associated with morning stiffness, he claims of not having neurological symptoms or muscle weakness, what clinical examination would confirm your diagnosis?

a. Positive straight leg raise test
b. Schober’s test

b. Schober’s test

(insidious onset of backache and stiffness in an adolescent or young adult suggests inflammatory disease of sacroiliac joints and lumbar spine)

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What is the reason for secondary curvature of the vertebral column?

IVD thicker anteriorly

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A fractured hip of an elderly patient is most known as fracture of the?

a. Ilium
b. Neck of femur
c. Acetabulum

b. Neck of femur

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What is attached to the medial meniscus?

a. Tibial collateral ligament
b. Fibular collateral ligament
c. Lower border of the patella
d. Medial to the patellar ligament
e. Deltoid ligament

a. Tibial collateral ligament

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A 17 year old man fractured his left femur in a car accident, a year later an x-ray was done for check-up and no traces of the fracture were there, what final event lead to the x-ray finding?

a. Bone remodelling
b. Callus formation
c. Hematoma

a. Bone remodelling

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Which compound is produced by both adenine and guanine nucleotides in the catabolism of purines?

a. Inosine
b. Adenine
c. IMP
d. Hypoxanthine
e. Xanthine

e. Xanthine

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A 48 year old female sustained a left humerus fracture, and it was provided that she underwent breast cancer surgery 2 years ago.
PET examination showed red hot spots in her skeleton and lungs. What is the most likely finding?
a. Pathological fracture
b. Non-union
c. Soft callus
d. Hard callus
e. Greenstick

a. Pathological fracture

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A 37 year old female with malar rash, she was exposed to the sun for few hours, and there was positive immunofluorescence of anti IgG antibodies in the lining between dermal and epidermal layers.
What is the most likely reason for that?
a. Release of sequestered Ag
b. Release of IFN gamma
c. Immune complex deposition

c. Immune complex deposition

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What is the effect of smoking on bone healing?

a. Vasoconstriction which diminishes blood flow to the fracture area
b. Produce some cytokines

a. Vasoconstriction which diminishes blood flow to the fracture area

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What prevents vertebra from slipping over the vertebra below?

a. Transverse process
b. Spinous process
c. Vertebral arch
d. Intervertebral disc
e. Lamina
f. Pedicle
g. Articular process

g. articular process

(Dislocation of vertebrae in the thoracic and lumbar regions is uncommon because of the interlocking of their articular processes.)

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A 56 years old female presented with yellow eyes, urticarial rash & symmetric arthritis in her knees and hands, what is the most likely viral infection?

a. Hepatitis A
b. Hepatitis B
c. Hepatitis C
d. Hepatitis D
e. Hepatitis E

b. Hepatitis B

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The lateral sural nerve is a branch of which of the following?

a. Femoral nerve
b. Tibial nerve
c. Obturator nerve
d. Superficial peroneal nerve
e. Common fibular nerve

e. Common fibular nerve

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Which of the following drugs inhibits IL-2?

a. Cyclosporin A
b. Azathioprine

a. Cyclosporin A

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What is the main reason for using multivariate linear regression in this case?

a. Time to event
b. Selection bias
c. Outcome is continuous

c. Outcome is continuous

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What is the initial management for open fracture of humerus?

a. Immediate IV antibiotics
b. Cast
c. Sterile dressing

a. Immediate IV antibiotics

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A 65 year old female presented with a fractured humerus. On examination there was a loss of sensation in the area labelled A. Which nerve is involved?

a. Radial
b. Median
c. Ulnar
d. Musculocutaneous

a. Radial

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What group of lymph nodes are located posterior to pectoralis major?

a. Apical
b. Central
c. Lateral
d. Anterior
e. Posterior

d. Anterior

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Which of the following permits and restricts movement between adjacent vertebras?

a. Transverse process
b. Spinous process
c. Articular process

c. Articular process

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Which muscle is affected by piriformis syndrome?

a. Biceps femoris
b. Piriformis

a. Biceps femoris

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What is the best diagnostic test of tear of labrum?

a. MRI
b. X-ray
c. CT

a. MRI

best modality for soft tissues is MRI

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A section of a retroperitoneal large tumor revealed adipose tissue with large lipoblasts with numerous pleomorphic atypical cells. It was positive for S-100. What is most likely the tumor?

a. Leiomyosarcoma
b. Liposarcoma
c. Osteochondroma
d. Ewing’s sarcoma
e. Rabdhomyosarcoma

b. Liposarcoma

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In a chronic elbow valgus deformity, what nerve is mostly affected?

a. Ulnar nerve
b. Median nerve
c. Radial nerve
d. Posterior interosseous
e. Anterior interosseous

a. Ulnar nerve

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A child with a lymphoma experienced an infection related to the catheter, a biopsy showed branched septate hyphae with acute angle, what is the cause?

a. Cryptococcus neoformans
b. Salmonella enteriditis
c. Candida albicans
d. Aspergillosis

d. Aspergillosis

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Why is it a major challenge to study the epidemiology of OA?

Because there is no correlation between the radiological and clinical findings

``` What is required in both de novo synthesis and purine salvage pathways of purine synthesis? A) IMP B) AMP C) Xanthine D) Guanine E) R5P F) PRPP ```

F) PRPP

What is RR of dying in SLE compared to non-SLE patients? a. 1.0 b. 1.5 c. 2.0 d. 3.0

d. 3.0

Intravenous drug user with arthritis, synovial fluid showed yeast cell pseudohyphae, what is the causative organism? a. Cryptococcus neoformans b. Salmonella enteriditis c. Candida albicans d. Aspergillosis

c. Candida albicans

What differentiates between an inflammatory cause of joint pain and a mechanical cause? a. Morning stiffness b. Crepitus c. Instability d. Destruction

a. Morning stiffness

A clinical sign felt upon palpation in osteoarthritis patients?

Crepitus

Which structure of these is affected in hypereversion of the foot? a. Deltoid ligament b. Fibular collateral c. Tendocalcanes d. Upper end of tibia

a. Deltoid ligament

Which structure is fractured during excessive dorsi-flexion of the foot? a. Calcaneus b. Talus c. Metatarsals

b. Talus

Which bones are affected in dancer's fracture? a. Calcaneus b. Talus c. Metatarsals

c. Metatarsals

What is shared between the medial and lateral malleoli? a. Calcaneus b. Talus

b. Talus

Which of the following muscles causes flexion and abduction of hand? a. Flexor carpi radialis b. Flexor carpi ulnaris

a. Flexor carpi radialis

Why do we use cox multivariate regression? a. Time to event outcome b. Continuous outcome

a. Time to event outcome

Which of the following is produced to attract neutrophils and macrophages? a. IL 1 b. IL 10 c. IL 4 d. TNF alpha

a. IL 1 | IL-1 attract neutrophils and macrophages while TNF activate them

What will happen if we blocked the Na channels? a. Hyperpolarization b. We will not be able to generate action potential

b. We will not be able to generate action potential

Which of the following muscles is the strongest dorsi-flexor? a. Extensor hallucis longus b. Tibialis anterior c. Extensor digitorum longus d. Fibularis tertius e. Flexor digitorum Longus

b. Tibialis anterior

Which of these is the main artery that supplies head and neck of the femur? a. Medial circumflex femoral b. Lateral circumflex femoral c. Obturator

a. Medial circumflex femoral

A 20-year old soccer player male had torn his ACL, he wants to play football matches again, what management would you suggest? a. Knee braces b. Reconstructive knee surgery c. Knee replacement surgery d. Pain killers

b. Reconstructive knee surgery

Which of the following findings is seen in osteoarthritis in the distal inter-phalyngeal joints? a. Heberden's node b. Bouchard's node c. Rheumatoid nodules

a. Heberden's node

A 35 year old woman presented with bright red rash on her face and joint pain, synovial fluid analysis showed viral DNA. What could cause this? a. Rubella virus b. Parvovirus B19

b. Parvovirus B19

What is the nerve supply of flexors at elbow joint? a. Musculocutaneous nerve b. Radial nerve c. Axillary nerve

a. Musculocutaneous nerve

What is the function of Aggrecan?

Gives the cartilage its water retention property

What is early marker of joint disease in osteoarthritis? a. Hyaluronic acid b. N-Acetylglucosamine c. Collagen type II d. Collagen type IV

a. Hyaluronic acid

A patient with multiple old and new fractures, absence of bone architecture, and decrease bone marrow space. What is the diagnosis? a. Osteopetrosis b. Osteogenesis imperfecta

a. Osteopetrosis

``` Which bones form the wrist joint? 1-Trapezium-schapoid-hamate 2-Trapezoid-schapoid-hamate 3-Lunate-capitate-hamatate 4-Lunate-triquitram-pisiform 5-Scaphoid-lunate- triquetrum ```

5-Scaphoid-lunate- triquetrum

What is produced by pentose phosphate pathway? a. PRPP b. IMP c. Ribose-5-phosphate

c. Ribose-5-phosphate

``` Which nerve is compressed in carpal tunnel syndrome? a. Radial n b. Median n c, Ulnar n d. Musculocutaneous n e. Med cutaneous n ```

b. Median n

What is associated with RA?

HLA DR

A 7 year old child presented with a red, swollen, tender, and painful monoarthritis, what is the condition? a. Infective osteomyelitis b. Malignancy c. Septic arthritis d. Acute viral infection e. Chronic fungal infection

c. Septic arthritis

Extension against resistance tests which muscle in the arm? a. Triceps b. Anconues

a. Triceps

What is the best initial management in a man with acute attack of pain due to a lumbar intervertebral disc hernia? a. Surgical discectomy b. Aggressive physiotherapy c. NSAIDS and physiotherapy d. Spinal decompression

c. NSAIDS and physiotherapy

A 60 year old female was admitted to the hospital with a humeral neck fracture which nerve is most likely affected? a. Subscapular b. Axillary

b. Axillary

What enhances the action of Allopurinol?

Azathioprine

Part of the vertebral column fractured in spondylolisthesis?

Pars interarticularis

Which of the following drugs is a non-purine xanthine oxidase inhibitor?

Febuxostat

Radiograph showed injury of facet joint btw L3-L4, which part of spinal nerve will be compressed? a. Posterior cord b. Anterior cord c. Ventral rami d. Trunk e. Recurrent

d. Trunk (not sure)

A 16 year old boy presented with a stab injury in the cubical fossa, which nerve is most likely affected? a. Ulnar b. Radial c. Median d. Musculocutaneous e. Axillary

c. Median

What is targeted in the antibody therapy for rheumatoid arthritis? a. IL1-5 b. IL10 c. TNF alpha d. IFN gamma

c. TNF alpha

Covalent interaction between which elements stabilize mature collagen fibril?

Collagen triple helices

Which vein directly drains vertebral body? a. Spinal b. Intervertebral c. Vertebral d. Basivertebral

d. Basivertebral

A 34 year old male with subcutaneous nodule containing mature adipocytes progressed for 3 years, what is the most likely diagnosis? a. Lipoma b. Liposarcoma c. Lipoblastoma

a. Lipoma

The method part of a research showed the relation between smoking and SLE by multivariate cox regression. Age and gender were covariants. What’s the purpose?

Adjust for age and gender as confounders, outcome is time to event

Which of the following radiological signs indicate injury to anterior cruciate ligament? a. Tibial spine avulsion b. Fibular head avulsion c. Medial femur epicondyle avulsion d. Lateral femoral epicondyle avulsion e. Lateral translation of patellar ligament

a. Tibial spine avulsion

What virus is associated with myocarditis?

Coxsackie

Which rotator cuff muscle is easily impinged? a. Supraspinatus b. Subscapularis

a. Supraspinatus

Where does the small saphenous vein drain? a. Femoral b. Popliteal c. Tibial

b. Popliteal

Which function is lost if the Subscapular nerve is injured? a. Medial shoulder rotation b. Lateral shoulder rotation c. Extension of the forearm d. Extension of the arm e. Flexion of the forearm f. Flexion of the arm

a. Medial shoulder rotation

Which function is lost if the Musculocutaneous nerve is injured? a. Medial shoulder rotation b. Lateral shoulder rotation c. Extension of the forearm d. Extension of the arm e. Flexion of the forearm f. Flexion of the arm

e. Flexion of the forearm

65 year old female presented with chronic knee pain. She was diagnosed with osteoarthritis. What radiological finding can confirm the diagnosis? a. Osteophytes b. Joint space widening c. Juxta-articular osteopenia d. Subchondral osteoporosis e. Joint erosion

a. Osteophytes

A 54 year old man presented with increased levels of alkaline phosphate, the bone showed mosaic pattern. What is the mechanism of this disease?

Osteoclast dysfunction

A decrease in what causes accelerated cartilage breakdown?

TIMPs

Which muscle stabilizes the knee joint? a. Biceps femoris b. Piriformis c. Quadriceps femoris d. Obturator

c. Quadriceps femoris

Why don’t we have primary prevention for RA? a. The cause is not well understood b. High costs c. Low prevalence of the disease

a. The cause is not well understood

A diabetic patient underwent surgery 2 weeks ago. Now he presents with fungal infection with necrosis, non-septate hypha, what is the most likely causative pathogen? a. Mucor b. Coccidiomycosis c. Candida Albicans

a. Mucor | non-septate hyphae branched at right angles: Mucor Septate hyphae branched at acute angles: Aspergillus

A boy in car traffic accident got a fungal infection with budding pseudohyphae. Whats the causative agent? a. Mucor b. Coccidiomycosis c. Candida Albicans

a. Candida Albicans

What is responsible for tissue damage in SLE? a. Neutrophils b. INF gamma activated macrophages

a. Neutrophils

What is the mechanism of action of methotrexate?

Inhibits DHFR

A 45 year old man suffering from headache, fever, and arthritis for the last five days after being bit by a mosquito in a tropical country, what is the most likely diagnosis?

Dengue fever

What is the immunopathogenesis in rheumatoid arthritis? a. Autoantibodies + macrophages b. Cytotoxic cells c. Natural killer cells

Autoantibodies + macrophages

Why do we give paracetamol instead of aspirin to a 3 year old child?

To avoid Reye’s syndrome

What is responsible for pain occurring between 60-120 degrees of abduction in painful arc? a. Osteoarthritis of shoulder b. Biceps tendinitis c. Impingement syndrome d. Subscapularis tendinitis

c. Impingement syndrome

A boy underwent a great saphenous vein transplant surgery, then he felt pain in the medial aspect of his leg, what is the most likely injured nerve? a. Saphenous nerve b. Sural nerve c. Obturator nerve

a. Saphenous nerve

What transports calcium after end of stimulation? a. Na channel b. Ach receptors c. Ryanodine receptors d. DHPR e. SERCA

e. SERCA

What is responsible for conduction of action potential? a. Na channel b. Ach receptors c. Ryanodine receptors d. DHPR e. SERCA

a. Na channel

Which proteins are involved in the docking of vesicles to the synaptic membrane? a. Syntaxin and Synaptobrevin b. Synaptotagmin and Synaptobrevin

a. Syntaxin and Synaptobrevin

Injury to which carpal bone affects the ulnar nerve? a. Hamate b. Scaphoid c. Pisiform

a. Hamate

Which bone heals slowly due to less blood supply? a. Hamate b. Scaphoid c. Pisiform

b. Scaphoid

What is affected when the common fibular nerve is injured near fibular head?

Eversion

Which test is used to test posterior cruciate ligament? a. Anterior drawer b. Posterior drawer c. Valgus stress d. Varus stress

b. Posterior drawer

75 year old woman underwent hip replacement w there was severe articular erosion and cyst cavities formation. What is the cause? a. RA b. Osteoarthris

b. Osteoarthris

Which two muscles are the CHEIF lateral rotators?

Infraspinatus and Teres minor

Which of the following is a feature of fast muscle fibres? a. Lots of mitochondria b. Few mitochondria

b. Few mitochondria

Which of the following is an expansion of the semimembranosus muscle? a. oblique popliteal ligament b. medial collateral ligament c. patellar ligament

a. oblique popliteal ligament

What is the embryological origin of myotomes? a. Intermediate mesoderm b. Paraxial mesoderm c. Lateral mesoderm d. Endoderm

b. Paraxial mesoderm

Which is the main plantar flexor on foot at ankle joint?

Gastrocnemius

What is the best modality used to check for a cruciate ligament tear? a. Ultrasound b. CT c. MRI d. Nuclear study e. Fluoroscopy

c. MRI

Someone with fracture came after 2 weeks and there was swelling and no calcification on x-ray, in which phase is he going through? a. Hard callus b. Soft callus c. Hematoma

b. Soft callus

What is true about back pain? a. Increased in prevalence in the last two decades b. Decreased in prevalence in the last two decades

Increased in prevalence in the last two decades

If someone has recurrent anterior shoulder dislocation, what might be damaged? a. Biceps tendon b. Subscapularis c. Supraspinatus d. Glenoid labrum

d. Glenoid labrum

What is responsible for uni-directional propagation of action potential? a. Depolarization during the refractory period b. Hyperpolarization during the refractory period

b. Hyperpolarization during the refractory period

What causes increase in K+ inside cell?

Na/K+ ATPase

Through which mechanism are neurotransmitters released? a. Exocytosis b. Endocytosis c. Pinocytosis

a. Exocytosis

What is the effect of black spider widow toxin (a-latrotoxin)?

Ca independent exocytosis

what happens if the snake venom bungarotoxin was injected in an animal muscle?

Blocks post synaptic potential, even in the presence of acetylcholine in the synaptic cleft.

what is the most frequent amino acid sequence in cartilage?

Gly-X-Y

A nasal mass in a 5 year old showed round cells with little cytoplasm which were positive for desmin & myo1D? a. Rhabdomyosarcoma b. Ewing carcinoma c. Fibroblastoma

a. Rhabdomyosarcoma

``` Injury to which trunk of the following will affect the function of the subclavius? A) medial cord B) lateral cord C) posterior cord D) superior trunk E) middle trunk F) musculocutaneous nerve G) median nerve H) axillary nerve ```

D) superior trunk

injury to which of the following will affect subscapular? a. Posterior cord b. Anterior cord c. Ventral rami d. Trunk e. Recurrent

a. Posterior cord

A 26 year old man complaining from pain in the knee and small joints in the hand, he is known to be ochronotic. What is the most likely cause of this pain? a. RA b. Gouty arthritis c. Osteoarthritis

c. Osteoarthritis | ochronosis -alkaptonuria- is a risk factor for secondary OA in young people

What deformity will result when the ulnar nerve is injured? a. Claw hand of the little and ring fingers b. Claw hand of the lateral fingers

a. Claw hand of the little and ring fingers

What histological feature indicates loss of motor neuron function? a. Small cells with central nuclei b. Muscle cell has vacuoles c. Adipocytes between muscles cells d. Group Muscle cell atrophy e. Muscle cell hyperplasia

d. Group Muscle cell atrophy

A woman presented with venous and arterial thrombosis, thrombocytopenia, recurrent abortion, and cerebral stroke in SLE is due to?

Anti phospholipid antibodies

Male complains of dark brown urine, black deposits in his ear, & joint pain. What's the diagnosis?

Ochronosis (AKA alkaptonuria)

What is the effect of tetrodotoxin?

Inhibits action potential formation

patient presented with severe pain in his leg that gets worse at night, and relieved by NSAIDs, histology showed lytic lesion lined with reactive bone “osteoblasts”. What’s the diagnosis?

Osteoid osteoma (osteaoblastoma is similar to osteoid osteoma but is larger, it arises in vertebrae, & presents with bone pain that does NOT respond to NSAIDs)

What will happen after powerstroke? a. ATP hydrolysis b. ATP binds

ATP binds

If ATP binds to myosin head, what will happen? a. Myosin detaches from f-actin b. Myosin head is released from actin c. both

c. both | both choices were in the exam & both were counted correct; in another exam it was only B

Affecting which component of the joint will cause Varus deformity in osteoarthritis? a. Articular degradation b. Medial compartment c. Lateral compartment

b. Medial compartment

Which disease is characterized by osteophyte formation at the side of the joint? a. Rheumatoid arthritis b. Osteoarthritis c. Gouty arthritis

b. Osteoarthritis

a 9 year child presents with acute septic arthritis what is the cause a. Staphylococcus aureus b. Haemophilus influenza c. Streptococcus agalactiae d. Pseudomonas aeruginosa

a. Staphylococcus aureus | ts the most common caustive oragnism

A diabetic with septic arthritis what is the causative organism a. Staphylococcus aureus b. Haemophilus influenza c. Streptococcus agalactiae d. Pseudomonas aeruginosa

c. Streptococcus agalactiae diabetic+septic arthritis= Streptococcus agalacteiae diabetic+osteomyelitis= Pseudomonas aeruginosa

An increase in its levels will lead to accelerated degradations of cartilage?

ADAMTs

in the processing of procollagen, which part is removed? a. B sheet b. Random coil c. Linked coil

c. Linked coil