2015 - 5th Flashcards by Fajer e

These findings were obtained from a patient who was admitted to the ICU with septic shock: WBC: 40 (high); Hb:105 (low); Platelets: 25 (low); PT: 20 (high); APTT: 60 (high); TT: 20 (high); D- dimer: 4000 (high); FDP: 1.1 (high). What is the most appropriate management for this patient?
a. Treat the underlying infection
b. Fresh frozen plasma infusion
c. Anticoagulation with heparin
d. Packed RBCs transfusion

a. Treat the underlying infection

Note: Patient has DIC, the most important step is to fix the underlying cause.

How well did you know this?

Not at all

Perfectly

A 48-year-old heavy smoker was admitted to the hospital with anterior MI from which he was recovering. One week later he experienced severe lower leg pain. It was pale, cold, and puseless. What is the cause?
A. cerebral embolism
B. arterial embolism
C. deep venous thrombosis
D. peripheral vascular disease

B. arterial embolism

First, deep vein thrombosis is characterized by the following:
1)Cause: Virchow triad (endothelial injury ‚venous stasis, hypercoagulability) gives rise to venous thrombosis.
2)Classic findings (all have low sensitivity and specificity):
-Low extremity pain and swelling (worse with dependency/walking, better with elevation and rest).
-Homans sign(calf pain on ankle dorsiflexion).
-Palpable cord.
-Fever.
What is the difference between peripheral vascular disease and acute arterial occlusion(embolism):

How well did you know this?

Not at all

Perfectly

A 75-year-old patient came for his regular checkup. His lab test values were as follows:
Hb 146 (normal)
MCV 90 (normal)
WBC 52x10^9 (very high)
Platelets 257 (normal)
Lymphocytes 80% of total WBC, most were smudge cells What is the most possible complication?
a. Autoimmune hemolytic anemia
b. Polycythemia vera

a. Autoimmune hemolytic anemia

How well did you know this?

Not at all

Perfectly

A diabetic and hypertensive patient presents with chest pain upon walking and climbing stairs specially after food. The pain has been there for two weeks but becoming more severe in the past two days. What is the most likely diagnosis?
A. Diffuse esophageal spasm
b. Unstable angina
C. Vasospastic angina

b. Unstable angina

How well did you know this?

Not at all

Perfectly

what is the most sensitive indicator of contrast-induced nephropathy?
a. urine output < 600
b. hematuria
c. rising creatinine > 26 in 24 hours

c. rising creatinine > 26 in 24 hours

How well did you know this?

Not at all

Perfectly

A patient presented with painless lymphadenopathy. He also had weight loss and night sweats. What is the diagnosis?
a. Hodgkin’s lymphoma
b. Non-hodgkin’s disease
c. Infectious mononucleosis
d. Thyroid cancer

a. Hodgkin’s lymphoma

How well did you know this?

Not at all

Perfectly

A patient with the history of valvular heart disease presents with this ECG. What do you give to prevent disabling neurological damage?
A. Beta blockers
B. Warfarin
C. Aspirin

B. Warfarin

Anticoagulants should be used with atrial fibrillation to prevent thromboembolism. The large left atrium predisposes to atrial fibrillation, giving rise to symptoms such as palpitations. Atrial fibrillation may result in systemic emboli, most commonly in cerebral vessels, producing neurological sequelae, but mesenteric, renal, and peripheral emboli are also seen, so anticoagulant should be used to prevent thromboembolism.

How well did you know this?

Not at all

Perfectly

25 years old Kuwaiti woman, history of continuous productive cough at childhood. Admitted to the hospital several times during childhood for recurrent dyspnea, cough, and fever. Increased symptoms the last 1 month. On physical examination, somewhat tachypneic, localized crackles in left lower zone, and bilateral rhonchi.
What is the diagnosis that explains the above?
A. Bronchiectasis
B. Acute exacerbating of asthma
C. Pneumonia
D. Congenital emphysema

A. Bronchiectasis

How well did you know this?

Not at all

Perfectly

A patient with progressive right-side hearing loss. Upon Weber test he heard louder on the left side. What is his condition?
A. Left conductive deafness
B. Right sensorineural defenses
C. Right conductive deafness
D. Left sensorineural deafness

B- Right sensorineural defenses

How well did you know this?

Not at all

Perfectly

A patient with T2DM and ESRD presenting to the ER with a fever of 38. He was found to have right lower lobe pneumonia. Sodium is 123, glucose is 60, and PH is 7.38. Which of the followingis true? (I think urea is missing?)
A. He is in DKA
B. He is in a hyperosmolar state
C. The cause of his hyponatremia is due to osmotically-active glucose-mediated diuresis
D. He has a high osmolal gap

B. He is in a hyperosmolar state

How well did you know this?

Not at all

Perfectly

A patient presented to the clinic with gait instability, he cannot walk keeping his heel touching his toe, what does he have?

Cerebellar ataxia (gait ataxia?)

How well did you know this?

Not at all

Perfectly

A patient with blisters on the face (shingles) (they didn’t say where exactly on the face), what nerve is hurt?
A. Facial
B. Trigeminal

B. Trigeminal

How well did you know this?

Not at all

Perfectly

A type 2 diabetic patient is on metformin and statins, he however now has high triglycerides despite being on statins. What should be given to him?
A. Fenofibrate
B. Clofibrate
C. Gemfibrozil
D. Omega 3

Answer: B. Clofibrate (most likely, not 100% sure)

Note: Gemfibrozil increases blood levels of repaglinide (Prandin) in people with diabetes, increasing the likelihood of developing low blood sugar (hypoglycemia). This combination should be avoided.

How well did you know this?

Not at all

Perfectly

A young patient spontaneously had golden crusted painful lesions in upper lip chin and nasolabial folds. Also had fever. What is the most common organism cause if this condition worldwide?
A. Staphylococcal aureus
B. Streptococcus pyogenes
C. Staphylococcus epidermis

B. Streptococcus pyogenes
(this is impetigo)

How well did you know this?

Not at all

Perfectly

A patient with long arm and hands with a diastolic murmur what will you find on examination?
A. Pulses bisternis or alterntis
B. Collapsing pulse

B. Collapsing pulse
(aortic regurgitation in patients with marfans syndrome)

How well did you know this?

Not at all

Perfectly

What is the best time for the patient to take omeprazole if once daily regimen?
A) before bedtime
B) before breakfast
C) before lunch time
D) before dinner

B) before breakfast

How well did you know this?

Not at all

Perfectly

A patient is having tonic-clonic seizure, after 10 minutes he is still in the seizure. How will you manage?
A. Brain CT
B. Electroencephalogram
C. Administer IV phenytoin
D. Carbamazepine

C. Administer IV phenytoin
(Carbamazepine does not have a role in treating status epilepticus)

How well did you know this?

Not at all

Perfectly

A patient with chronic pancreatitis presented with steatorrhea. He is a smoker and an alcohol drinker. How would you treat him?
A. Insulin
B. Pancreatic enzymes replacement

B. Pancreatic enzymes replacement

How well did you know this?

Not at all

Perfectly

A patient underwent subtotal thyroidectomy and was given levothyroxine. Came in later with palpitations and TSH was found low. how to manage?
A. Lower the dose
B. Leave the dose

A. Lower the dose

How well did you know this?

Not at all

Perfectly

A patient with beta thalassemia major, hypopituitarism, infertility, and dark skin. What is your management for this patient?
a. iron chelating therapy
b. bone marrow transplantation
c. wait and re-evaluate approach / wait for one year
d. reduce amount of transfusions

a. iron chelating therapy

How well did you know this?

Not at all

Perfectly

A female patient who is a known case of rheumatoid arthritis and given both her RF and anti-citrullinated antibodies are high. Which of the following is not one of the extra manifestations of the disease?
A. Amyloidosis
B. lung fibrosis
C. myositis
D. entrapment neuropathy

C. myositis (the musculoskeletal extra manifestation are: tenosynovitis, bursitis, and carpal tunnel. myositis is not one of them)

How well did you know this?

Not at all

Perfectly

Which of the following cannot be obtained from a spirometer?
A. Inspiratory capacity
B. Expiratory reserve volume
C. Functional residual capacity

C. Functional residual capacity

How well did you know this?

Not at all

Perfectly

A 23 year old female with polyarticular joint pain for the past 2 months. Which of the following suggesting inflammatory arthritis?
A. morning stiffness less than 15 min
B. fatigue
C. pain worse with movement
D. weight gain

B. fatigue

How well did you know this?

Not at all

Perfectly

Which is a characteristic of ulcerative colitis and not Crohn’s?
A- rectal involvement
B- Segmental involvement
C- Granuloma at biopsy
D- Palpable abdominal mass

A- rectal involvement

How well did you know this?

Not at all

Perfectly

A patient underwent an aortic valve replacement with St. Jude mechanical valve as he had rheumatic heart disease. No postoperative complications seen. Now he must be discharged. What do vou give him as a lifelong treatment? A. Clopidogrel B. Warfarin and aspirin C. Dabigatran D. Rivaroxaban

B. Warfarin and aspirin -Both Dabigatran and Rivaroxaban are contraindicated in mechanical heart valve.

A patient had a stroke and developed weakness of the right side (face and arms) and right homonymous hemianopia and disturbed speech. Which arterial territory is affected? A- Left middle cerebral artery B- Posterior cerebral artery C- Posterior inferior cerebellar artery D- Anterior choroidal artery

A- Left middle cerebral artery (MCA stroke symptoms: unilateral weakness and/or numbness, facial droop, and speech deficits ranging from mild dysarthria and mild aphasia to global aphasia.) (Posterior circulation strokes commonly present with symptoms of altered mental status, vision changes, speech changes, nystagmus, vertigo, ataxia, limb weakness, headache.)

Patient with fibrosis involving upper zones of the lung predominates. What is the most likely diagnosis? A. IPF B. Asbestosis C. Sarcoidosis D. Scleroderma

C. sarcoidosis (bilateral lymphadenopathy and infiltrate in the mid upper zones are characteristic of sarcoidosis.)

25-year-old female with SLE, presented with anemia, jaundice, dark urine, high reticulocytes, high LDH. A. Liver cell failure B. Autoimmune hemolytic anemia C. Paroxysmal nocturnal hemoglobinuria D. Thalassemia major

B. Autoimmune hemolytic anemia

Which of the following microbial infections is associated with eosinophilia (or esoniphiluria)? A. Treponema Palladium B. Streptococcus Pneumonia C. Cryptococcus Neoformans D. Strongyloides Stercoralis

D. Strongyloides Stercoralis

A patient with symmetrical joint narrowing and suspected rheumatoid arthritis. How to detect Rheumatoid factor? A. Nephelometey B. Flow cytometry C. ELISA D. Immunoflurocence

A. Nephelometey

A pair of newlyweds took a premarital screening test for inherited blood disorders, one of them has sickle cell trait and the other has thalassemia trait. Which of the following statement is true? a. There is 25% that their children will have thalassemia major b. There is 25% that their children will have thalassemia trait c. All their children will have thalassemia/sickle disease d. All their children will have abnormal genes

b. There is 25% that their children will have thalassemia trait

A blood film report came mentioning the presence of “howel-jolly bodies”. What does thid finding indicate? a. autoimmune hemolytic anemia b. splenomegaly c. splenectomy d. liver cell failure

c. splenectomy

A 70-year-old patient came with progressive cough and shortness of breath, no other abnormalities, and no past medical history. What is true about diagnosis of IPF? A. HRCT scan can diagnose IPF with confidence B. Bronchioalveolar lavage and biopsy is needed for diagnosis

A. HRCT scan can diagnose IPF with confidence

A 35-year old lady who works as a secretary, presented with productive cough and low-grade fever. Physical examination showed clubbing, febrile 37.5 c, BP 110/70. Cardiovascular and abdominal examination were unremarkable. On chest examination, coarse crackles were heard in left axillary base and right posterior base. As a teenager, she experienced recurring bouts of productive cough that worsened over the years, but she ignored following up with her GP. What is the best test to diagnose her condition? A. Bronchoscope and lavage B. Throat swab C. High Resolution CT scan

C. High Resolution CT scan Note: HRCT is gold standard diagnosis of bronchiectasis

A patient was taking lamotrigine. Two weeks later he developed a scaling rash. what is true about this condition? (there was a picture in black and white —> toxic epidermal necrolysis from the picture) A. Patients develop conjunctivitis and corneal ulceration B. Patients should get a skin prick test as they are allergic to this drug C. Patients have an infection with EBV D. Patients have antibodies against desmoglein 1 and 3

A. Patients develop conjunctivitis and corneal ulceration

A patient was admitted to the hospital with sudden onset of chest pain. ECG was shown (Inferior MI). Which artery is affected? A. Right coronary artery B. Left anterior descending coronary artery C. Left circumflex artery

A. Right coronary artery Areas of infraction/ischemia:

A 30-year-old patient presented with itchy skin, scaly excoriation on trunk, scattered papules, few pustules on body but face is spared. Nodules on scrotum and linear rashes all over the body. What is a secondary finding? A. Excoriation B. Vesicle C. Papule D. Pustule

A. Excoriation (secondary means due to the primary lesions being itchy, there are excoriation marks due to the scratching, this scenario likely depicts scabies)

A 30-year-old patient presented with hypertension. Urinalysis showed microscopic hematuria. 24 hour urine protein collection revealed protein 0.75 mg. complement levels were normal. what is the most likely diagnosis? a. SLE b. IgA nephropathy c. post-strept GN d. membranous GN

b. IgA nephropathy

Patient presents with weight loss you suspect diabetes type 1 which will confirm the diagnosis? A. fasting plasma glucose 6.5 B. fasting plasma glucose 7.5 C. random glucose 10.5 D. plasma glucose 10 mmol after OGTT

B. fasting plasma glucose 7.5 Note: if the potassium is LOW or NORMAL we either fix the abnormality or give prophylactic KCL because the insulin will definitely lower the potassium. We only refrain from KCL infusion when the potassium is high before starting NS

A pregnant lady presents with fever and cough. On examination, there is consolidation in the right lower zone. What is the diagnosis? A. Asthma B. Pneumonia

B. Pneumonia

A patient presented with unilateral miosis and ptosis. He has a history of tackle in American football. What is the diagnosis? A. Horner syndrome B. Myasthenia gravis C. Third nerve palsy

A. Horner syndrome • Horner syndrome causes unilateral miosis and ptosis • Myasthenia gravis doesn’t affect pupils • 3rd n. palsy causes ptosis and mydriasis (pupils dilation).

A 25-year-old female, hypertensive on hydralazine, presented with joint pain. Labs show ANA+ anti histone positive, negative dsDNS. What is the most appropriate management? A. Stop hydralazine B. Start azathioprine

A. Stop hydralazine ( a mnemonic for drug induced lupus My Two HIPS: methyledopa, TNA-alpha inhibitors, Hydralazine, Isoniazid, Procanamide/Phenytoin, Sulfa drugs)

A 32 years old male, who has stress at work, presents with diarrhea relived by defecation. He underwent a colonoscopy, which showed multiple diverticulosis otherwise normal mucosa. He went back to work after the appointment and had abdominal pain relieved by defecation. What is the diagnosis? A. Diverticulitis B. Irritable bowel syndrome

B. Irritable bowel syndrome Bloating, constipation and abdominal pain that is relieved by defecating is IBS. IBS is associated with a normal colon on colonoscopy, and is mainly induced by stress.

A tall female, with mid-systolic click and a late systolic murmur. What is the most likely finding on echo? A. Myxomatous degeneration of mitral valve B. Thick intersental wall C. Calcified aortic valves

A. Myxomatous degeneration o mitral valve Mid systolic click and late systolic murmur >Mitral valve prolapse

A patient with psoriasis. What is an extra musculoskeletal manifestation? (there was a scenario indicating psoriasis scaly erythematous rash and polyarticular joint?) A. Dactylitis B. Heberden nodes C. Bochard nodes D. Subcutaneous nodules

A. Dactylitis ( all of the others are not in psoriasis and please check the extra manifestation of psoriasis)

A lesion (1 or more than one cm) raised, flat, solid with length more than depth? A. Papule B. Nodule C. Patch D. Plaque

D. Plaque

A healthy 35-year-old male presented with indigestion and retrosternal heartburn. No alarm symptoms. Labs within normal limits. Which of the following is most proper initial step? A) Empiric trial of PPI B) Esophageal manometry C) Non-invasive H. Pylori tests D) Upper GI endoscopy.

A) Empiric trial of PPI Indigestion and retrosternal heartburn indicate GERD. GERD is mainly a clinical diagnosis, a trial of PPIs for two weeks with patient response is usually sufficient to make a diagnosis.

23-year-old woman admitted with lobar pneumonia. she was given IV ampicillin and gentamicin. she also had a CT with contrast on the first day. one the 4th day her serum creatinine was normal. On the 8th day her serum creatinine was 250. what is the main cause of her AKI? a. Sepsis due to pneumonia b. Gentamicin c. Contrast d. AIN

b. Gentamicin The effect of gentamicin starts in the second week

A 27-year-old female had a left sided unilateral throbbing headache associated with nausea, vomiting, and years ago, she experienced similar episode. how would you treat her?

Sumatriptan

What is true about antibodies? A. IgM antibodies form a dimer in the blood B. IgG and IgA antibodies can cross the placenta C. Ig’s can only have a single light chain kappa or lambda D. During infection, IgG appears first in the blood then IgM

C. Ig’s can only have a single light chain kappa or lambda

A 37-year old smoker (30 pack years) presented with dyspnea that is worsening. Chest x- ray is significant for heterogeneous translucency of both upper and lower lobes and flattened diaphragm. Which test is helpful? A. Leptin B. alpha 1 anti-trypsin level C. ghrelin level D. protease level

B. alpha 1 anti-trypsin level

Patient with sickle cell disease and presented with signs/symptoms of pancytopenia and big spleen. What is the diagnosis?

splenic sequestration crisis

Which of the following supports the diagnosis of bacterial meningitis? A. Normal glucose levels in CSF B. High lymphocyte count C. Negative gram stain D. WBC > 2000

D. WBC > 2000

51 y/o Female with moderate to severe headache and photophobia, her mother is migraineur. Which of the following raises suspicion of secondary headache? A. moderately to severe headache B. photophobia C. age after 50 D. family history

C. age after 50 Red flags for secondary headaches: SNOOP4 • Systemic signs and symptoms • Neurological finding on examination • Older than 50 y/o • Onset sudden • Postural headache • Precipitated by valsava, cough, or sneeze • Progression of headache • Presence of papilledema

a 61-year-old patient had low urine output one day after coronary angiography. What will be a characteristic finding in urine? a. Eosinophiluria b. proteinuria 2.5 c. urine with high osmolarity

c. urine with high osmolarity

Patient was diagnosed with MS and was found to have oligoclonal bands in CSF, what are oligoclonal bands?

A. immunoglobulins in CSF

A female presents with one-week history of abdominal pain and vomiting. Her serum creatinine is found to be 150. What is your next step of management? a. CT with contrast to diagnose the cause b. IV fluid infusion

b. IV fluid infusion The patient had dehydration!

Which of the following conditions increases the risk of having carcinoma of the colon? A. Diverticular colitis B. Ischemic colitis C. Microscopic colitis D. Ulcerative colitis

D. Ulcerative colitis

Which part of the skin is absent in the lesional skin of psoriasis? A. Stratum Corneum B. Stratum Spinosum C. Stratum Basale D. Stratum Granulosum

D. Stratum Granulosum

A 16 year old patient was being investigated for amenorrhea, past medical history is negative and she has no other complaints, liver function tests show elevated liver enzymes as well as elevated direct and total bilirubin and ALP, (I think total protein were also elevated) what is the most likely diagnosis A. autoimmune hepatitis B. genetic hemochromatosis C. PBC

A. autoimmune hepatitis AIH patients usually present with nonspecific symptoms, with a biochemistry that shows hepatocellular injury ie. raised liver enzymes.

A 52-year-old male came for routine physical examination, he feels well, has no medical conditions and not taking any medications. He has no family history for colorectal cancer. CBC and other labs were normal except for positive fecal occult test. What should be done next? A- Colonoscopy B- repeat fecal occult test C- flexible sigmoidoscopy D- Barium enema

A- Colonoscopy A positive FOBT is always followed by colonoscopy.

Common causative organism of community acquired pneumonias is the following: A. Viruses B. Tb C. Acinetobacter D. Actinimycosis

A. Viruses

A 45-year-old patient underwent a surgery recently to replace his aortic valve. Few days later, he developed fever, high temperature 39 and hypotension. There is no sign of chest infection. Which of the following is the best next step to investigate this patient? A. Transthoracic echocardiogram B. Complete blood count and ESR C. Blood culture D. Chest x-ray

C. Blood culture

a 66-year-old lady diagnosed with metastatic colorectal cancer presented with proximal DVT, which of the following statements is true: a. IVC filter is the treatment of choice b. aspirin is used as a prophylaxis for DVT in metastatic cancer c. LMWH is better than warfarin for cancer patients d. pneumonic compression device is ideal for these patients

c. LMWH is better than warfarin for cancer patients

A 45-year-old female with BP 140/95 started on medication. she is diabetic on metformin. Two weeks later, the patient presents with following picture. What was the cause? A. Calcium channel blocker B. Heart failure C. ACEI D. Diabetic nephropathy

A. Calcium channel blocker

A Male diagnosed at 8 years old with diabetes type 1. He and his non-diabetic wife are expecting a baby soon. What is the chance that their child will have type 1 diabetes? A. 1-5% B. 5-10% C. 10-15% D. >15%

B. 5-10%

A 36-year-old man presents to the emergency room at 1 am in the morning complaining of vomiting approximately 200 ml of bright red blood. Earlier in the evening he was at a party and had consumed excessive amount of alcohol. He had become sick while at the party and had experienced repeated retching and vomiting but no hematemesis. There was no past history of indigestion or gastrointestinal bleeding but his father and grandfather both died from gastric carcinoma. Physical examination revealed pallor but no other abnormality. What is the most likely cause of his hematemesis? A. Gastric carcinoma B. Acute alcoholic gastritis C. Mucosal tear at the esophagogastric junction D. Esophageal varices

C. Mucosal tear at the esophagogastric junction Mallory weiss syndrome: This is a mucosal tear at (or just below) the gastroesophageal junction as a result of forceful vomiting or retching. It usually occurs after repeated episodes of vomiting. It is most commonly associated with binge drinking in alcoholics.

A 70-year-old smoker with progressive SOB and productive cough. His spirometry showed moderate obstructive pattern (FEV1/FVC= 54) No reversibility. Which of the following best fits the etiology of his disease: A. All individuals who smoke more than 20 pack years develop this disease. B. 20% of patients with this disease are not smokers C. Shisha doesn't cause this disease D. Pigeons are a known cause of it

B. 20% of patients with this disease are not smokers

A patient with hepatitis C presented with purpura, digital infarction and renal failure. His complement level was low. What is the diagnosis? a. Cryoglobulinemia b. IgA nephropathy

a. Cryoglobulinemia

ECG showing MI. The patient had a murmur, what is the likely murmur due to?

Mitral regurgitation Note: -Patient post MI can develop also Tricuspid regurgitation. -Both MR and TR cause pansystolic murmur, But: In MR:murmur is heard at the apex. In 'TR:murmur heard at left lower sternal border.

A woman took NPH insulin in the morning only. At 1:30 the patient was sweating and had palpitations. The next morning she presented semi conscious and on physical examination the deep tendon reflexes were increased on the right side and she smelled of alcohol. What is the cause of this presentation? A. Hypoglycemia B. CVA C. Delerium tremens D. DKA

B. CVA (Confirmed with Dr. Jasem al hashel. This is a repeated question for years and the answer is NOT hypoglycemia. The patient presented with UNILATERAL increased reflexes and the only cause of this presentation could only be a brain infarct. Yes the patient could also be hypoglycemic and in theory that could cause a brain infarction but it would have to be extremely severe/repeated hypoglycemia attacks and she presented a whole day later. Additionally, the fact that she experienced palpitations could explain why the stroke occurred)

Chest x/rays shows mid and lower cavitation in the lungs. Patient presents with hemoptysis and rapidly progressive renal failure. What should be done to diagnose? a. Sodium b. Creatinine c. ANCA d. HbA1c

c. ANCA

A patient came to the emergency with elbow pain and swelling. What is the first investigation? (details are missing) A- Xray of the elbow B- Check for rheumatoid factor/crystals C- Synovial joint aspiration

A- Xray of the elbow (start with non-invasive)

What suggests essential rather than secondary hypertension? A. Low potassium B. Normal pH (7.4) C. Low pH

B. Normal pH (7.4)

A 22-year old female has hypertension (180/40), Na high, K low, ph 7.4, has normal renal function. What is the best diagnostic test? A. Renin:aldosterone ratio B. urine cortisol C. urine metanephrine D. blood and urine catecholamines

A. Renin:aldosterone ratio

A 55-year-old smoker (1 pack for 30 years) with COPD came to ER after she experienced convulsions. Her sister denies a previous history of convulsions. CXR showed a large central mass. She has hypercalcemia as well, what is the most relatable cause of her presentation? A. Small cell lung carcinoma B. Squamous cell carcinoma C. Adenocarcinoma

B. Squamous cell carcinoma Note: convulsions can be due to the hypercalcemia. SCLC can cause hypercalcemia but squamous cell carcinoma is the most common cause of hypercalcemia in all the types of lung malignancies

A 44-year-old male recently diagnosed with T2DM. His BP was found to be 134/74 mmHg. How to manage? a. monitor BP and lifestyle modification b. start HTN medications desired BP >120/80 c. start HTN medication desired BP >130/80 d. sart HTN medications if BP >140/90

b. start HTN medications desired BP >120/80 (This question was not by Dr. Wael, it is probably by cardiology so follow the updated AHA blood pressure guidelines which state that anvthing above 120 is elevated blood pressure and >130 is stage I hypertension. The answer iS most probably B because patients with stage I HTN are usually started on medications along with lifestyle modifications). A could also work but it is less likely.

A patient had unilateral weakness and is known to have atrial fibrillation. What is the next step of management? A. CT scan B. CT angiography

A. CT scan

A patient diagnosed with HOCM presents with exertional palpitations. What would you give to relieve his symptoms?

Beta blockers

A diabetic female had irregular asymptomatic plaque with orange discoloration, telangiectasia,and ulcers with dilated veins on shins. What is the diagnosis? A. Necrobiosis lipoidica diabeticorum B. Acanthosis nigricans C. Mycosis fungoidis

A. Necrobiosis lipoidica diabeticorum

What drug is contraindicated in pregnancy in case of treating Crohn’s disease? A. Methotrexate B. 6-mercaptopurine C. Sulfasalazine

A. Methotrexate Methotrexate (MTX), a folic acid antagonist, is contraindicated in pregnancy (category X), because it is an abortifacient and has teratogenic effects.

A diabetic 60-year-old patient with HTN and hyperlipidemia had an MI. He had premature ventricular contractions and palpitations. He is on statins, aspirin, and ACEI. What can we give to lower risk of mortality from CAD? A. calcium channel blockers B. beta blockers

All of the following drugs can reduce mortality: aspirin, statins, b-blockers, ACE inhibitors, aldosterone antagonists

You’re in the outpatient department, a 40 y/o male who smokes 20 cigarettes/ day presented with 3 weeks history of low grade fever, cough and purulent sputum. His chest radiograph showed a cavity in the left upper zone. What is the best next investigation? A. CT chest B. Fine needle aspiration of the cavity C. Sputum examination for acid fast bacilli organism

C. Sputum examination for acid fast bacilli organism Note: always go for less invasive to more invasive/ time consuming

A patient comes with the following cath graph. What is the first symptom the patient will have? (Cannot remember the details) A- Exertional dyspnea B. Exertional palpitations C. Exertional chest pain D. exertional synocpe

A- Exertional dyspnea -This figure shows the hemodynamic of mitral stenosis. -Dyspnea is the most common and often the only symptoms of mitral stenosis, which occur in up to 70% of symptomatic patients.Dyspnea usually results from the elevation in left atrial pressure, and pulmonary venous hypertension, which leads to reduce compliance of lungs, a decrease in vital capacity ,and increased work of breathing. Dyspnea also may be related to an inability to increase the cardiac output with increased metabolic demands

A 23-year-old woman presented to the emergency department complaining of bruising and bleeding from gums. She never had bleeding problems before. Her menarche was at 13 and she had regular menses. On examination, she had ecchymosis and petechiae. Rest of examination was normal. Her labs show: Normal PT, APT, INR, WBC, and Hb. Low platelets. What is the management? a. oral prednisolone b. tranexamic acid c. plasma exchange

a. oral prednisolone

A 60-year-old patient came with dyspnea and fatigue with blood test showing microcytic hypochromic anemia, raised RDW, negative celiac serology. What is the reason behind his symptoms? A- Iron deficiency anemia due to celiac disease B- Iron deficiency anemia due to GI bleeding

answer: B- Iron deficiency anemia due to GI bleeding A- Iron deficiency anemia due to celiac disease - negative celiac serology

A middle aged woman with polyuria and polydipsia and other signs of SIADH. Xray could show what? (or what is the cause?)

small cell lung cancer

What is classified as type 1 hypersensitivity reaction? A. 17-year female with pruritic rash around her neck developed 2 days after she wore a new necklace. B. 20-year male with abdominal cramps and diarrhea shortly after a glass of milk. C. 20-year male with chest wheeze and difficulty breathing shortly after he sat in the garden. D. Patient with SLE who developed lupus nephritis.

C. 20-year male with chest wheeze and difficulty breathing shortly after he sat in the garden.

A patient presents with SOB. Which of the following will be there during spirometry in a patient with pulmonary hypertension? A. Low DLCO B. Low FEV1

A. Low DLCO Note: Pulmonary HTN ( low DLCO ), pulmonary hemorrhage ( high DLCO )

A patient with rheumatic heart disease. On auscultation, you heard a mid-diastolic murmur. What else can you hear on examination? A. Opening snap B. Pansystolic murmur

A. Opening snap -Mid-diastolic murmur- >Mitral stenosis -In mitral stenosis, opening snap following loud P2 can be heard best during expiration. Note: Short A2-OS interval correlates with Worse MS.

A patient with Addison. How do you treat? A. Fludrocortisone B. Glucocorticoids C. Metformin

A. Fludrocortisone

A patient with pleuritic left chest pain and exertional SOB. His X-ray is shown. What is this? (pointed by arrow). They just wanted us to name the structure. A- Main pulmonary artery B- Ascending aorta C- Thymus D- Right atrium

B- Ascending aorta (a case of aortic stenosis with post-stenotic dilation)

Patient with chronic kidney disease, has high ALP, low calcium, High PTH, normal phosphate. How would you treat this patient? a. calcium carbonate and non-calcium phosphate binders b. Calcium carbonate and alpha vitamin D c. Calcimimetic drugs d. Parathyroidectomy

b. Calcium carbonate and alpha vitamin D

A 60-year-old man with cirrhosis due to non-alcoholic fatty liver disease presented with abdominal distention and lower limb edema of 1 week duration. Physical examination including vitals was normal. Ascitic fluid analysis: WBC: 1000, Polymorphs: 60%, Lymphocytes: 40%, total protein: 11, albumin 8 (serum albumin 28) Fluid culture pending What is the most appropriate next step in the management of this patient? A. start cefotaxime B. start cefotaxime plus metronidazole C. start ciprofloxacin plus metronidazole D. give diuretics and albumin

A. start cefotaxime (patient has SBP, empirical treatment is with a 3rd gen cephalosporin )

A patient needs to be anticoagulated for life. He previously developed heparin-induced thrombocytopenia. What is the drug of choice? A. Heparin B. Low molecular weight heparin C. Novel oral anticoagulants (NOACs)

C. Novel oral anticoagulants (NOACs)

A male nurse came with weakness & fatigue, no ophthalmopathy or pretibial myxedema. No palpable thyroid tissue, high T4. What is the diagnosis? A. Factitious hyperthyroidism B. Subacute thyroiditis C. Thyroid adenoma D. Multinodular goiter

A. Factitious hyperthyroidism

A patient with diabetes, which of these causes increase in ALT? (the scenario was about metabolic syndrome.The patient also has high BMI)

NAFLD

What reverses heparin’s effect? A. protamine sulfate B. FFP

A. protamine sulfate

A 66-year-old male presented with 1-year history of tremor and now he noticed that he takes longer time for moving from the room to the door. What do u expect to see on examination? A- Left sided UMN weakness B- Left sided LMN weakness C- Mild Cogwheel rigidity D- Bilateral UMN patten

C- Mild Cogwheel rigidity

A patient was in the hospital and took NSAIDs then developed signs of AIN. What is the most sensitive method to diagnose drug induced AIN? a. Kidney biopsy showing lymphocytes b. Hematuria with RBC casts c. Hyperkalemia with acidosis d. Urine sodium less than 20

A or C • D means its pre renal failure so it’s wrong. • B is wrong because RBC casts occurs in glomerulonephritis not AIN. • C is definitely right but may not be specific to AIN. • A can also be correct because AIN biopsy can show eosinophils (most important) and lymphocytes.

Blood glucose readings of a type 1 diabetic patient showed high blood sugar before lunch. The patient is treated with pre- mixed insulin (short and intermediate acting) twice daily. What’s the best action? A. Increase morning dose of intermediate acting insulin B. Increase morning dose of short acting insulin

B. Increase morning dose of short acting insulin Note: ( according to Dr. salman Alotaibi ) indication to increase long acting/ intermediate insulin are a) high BG at breakfast b) more than one reading is high. because long acting cover for longer period thus can correct multiple incorrect readings However, single increase in Lunch, Dinner, or bedtime we always increase short acting insulin.

A 44-year-old female patient complaining of neck pain and fever. The pain is worse with turning the head and swallowing. She had a cold recently. On examination she has erythematous pharynx, and the tympanic membrane is fine. Thyroid was palpable and tender. What you will find in the histology of the thyroid? A. Inflammatory infiltration with multinucleated giant cell B. Lymphocytic infiltration with some germinal center formation C. Lymphoid infiltration with germinal center and hurthle cells D. Papillary like structures and psammoma bodies

A. Inflammatory infiltration with multinucleated giant cell Subacute granulomatous thyroiditis-Giant cell thyroiditis (de Quervain thyroiditis). A transient and self-resolving patchy inflammation of the thyroid gland that is associated with granuloma formation. Often occurs after a viral upper respiratory infection and is more common among women. The clinical course is typically triphasic, beginning with hyperthyroidism, followed by hypothyroidism, and finally a return to the euthyroid state. Classically presents with tender goiter, elevated ESR, and jaw pain.

A 24-year-old patient was diagnosed (1-2 months ago) with diabetes, he is on metformin and gliclazide. He stated that his father and grandfather had diabetes in their twenties. Now he is presenting with 7kg weight loss, BMI (30), glucose 18, hba1c 7.1, c peptide 20 (was below normal), GAD positive. What is your diagnosis? A. late onset diabetes of autoimmunity B. Diabetes mellitus 1 C. Diabetes mellitus 2 D. Maturity onset diabetes of the young

A. late onset diabetes of autoimmunity Note: LADA is late onsent form of T1DM that is often confused for T2DM as in this case

A 24 year old patient complained of bloody diarrhea and tenesmus, stool cultures were negative and antibiotics did not help, on examination the patient is underweight and there’s left illiac fossa pain. What is the most appropriate diagnostic step? A- MR enterography B. Capsule endoscopy C. Colonoscopy with illeoscopy D. CT

C. Colonoscopy with illeoscopy Bloody diarrhea, tenesmus, and abdominal pain is relevant with IBD, which is diagnosed via colonoscopy as a gold standard investigation.

An adult patient presented with green sputum (in the community) and what is the most common organism? A. S.pneumonie B. S.aures

A. S.pneumonie

A 17-year-old girl presented with new onset amenorrhea. She previously had normal menstrual cycles since menarche at age 11 years old and her periods were regular. For the past 9 months, her caloric intake was less that 1000 kcal a day and her BMI is 16. What could be the cause of her amenorrhea? A. Hyperprolactinemia B. hypothalamic suppression C. 21 alpha hydroxylase deficiency

B. hypothalamic suppression

a- cannon a waves

A 55-year-old female presented with spasticity, fasciculation, hyperreflexia, (more findings indicating upper motor neuron lesion), what does this patient have ? A. Multiple sclerosis B. Motor neuron disease C. Diabetic neuropathy D. Subacute sclerosing panencephalitis

B. Motor neuron disease Motor neuron diseases (e.g., ALS) has both upper and lower motor neuron lesion symptoms

a patient presented with hemoptysis and glomerulonephritis. Immunofluorescence shows linear deposition. Anti-GBM antibodies were detected. What is the diagnosis? a. Wegner disease b. Good pasture disease c. IgA nephropathy

b. Good pasture disease

Where is the pathology in myasthenia gravis? A. Muscle fibers B. Neuromuscular junction C. Presynaptic neurons D. CNS

B. Neuromuscular junction Myasthenia gravis is an autoimmune disorder caused by an Ab-mediated blockade of NMJ transmission resulting in skeletal muscle weakness and rapid muscle fatigue.

A young female presented with tinnitus and bilateral papilledema. What is the most likely diagnosis? A. Idiopathic intracranial hypertension B. Stroke

A. Idiopathic intracranial hypertension

A patient with loss of proprioception and joint sensation will lose the balance when?

He closes his eye

What is true about chronic kidney disease? a. Most patients die before they reach stage 5 b. Most will reach stage 5 c. Stage 5 can be reversed to stage 1 with treatment d. Stage 1,2, and 3 are clinically prevalent

a. Most patients die before they reach stage 5

A 77-year-old patient was admitted for selective cholecystectomy. Lab tests showed the following results: prolonged PT but normal aPTT. What is the most likely cause? A. factor V deficiency B. Warfarin deficiency C. Factor VII deficiency D. Factor X deficiency

C. Factor VII deficiency

A 30-year-old male from India presented with bloody diarrhea and was shown to have flask shaped ulcers in his colon. Cyst drained from his liver with thick brown pus. What is the causative organism causing this infection? A. Candida albicans B. CMV C. Entameaba histolytica D. Giradia lambia

C. Entameaba histolytica (Amoebiasis starts in the colon then seeds to the liver through the portal circulation. Drained fluid is usually described as anchovy sauce. The mainstay of treatment is medical with metronidazole)

Which of the following is used to lower potassium in patient with hyperkalemia? a. NaHCO3 b. Glucose c. Beta blockers d. Calcium gluconate

a. NaHCO3 (calcium gluconate does not lower potassium levels, it just protects the heart from the hyperkalemia)

Which of the following best indicates the severity of Obstructive Sleep Apnea: A. BMI B. Sleep Epworth score C. Apnea Hypopnea score D. Stop Bang score

C. Apnea Hypopnea score Classification of OSA by severity: Severity is graded by the number of sleep-related obstructive breathing events, most commonly using the AHI (apnea hypopnea index): * AHI 5–15: mild OSA * AHI 16–30: moderate OSA * AHI > 30: severe OSA

Patient with characteristics of Marfan syndrome having palpitations. What will you find on echocardiogram?

Prolapsed mitral valve (Marfan's syndrome is also associated with AR and MR.)

A patient with COPD and is a heavy smoker of hubble bubble. What is the best long term management of his case? A. Council him to stop smoking B. Prescribe prednisolone C. O2 therapy

A. Council him to stop smoking

A 30-year-old female with severe retrosternal chest pain. She is taking treatment for her acne. She is not experiencing any heart burn or reflux. She is only taking doxycycline. Physical examination and lab results were unremarkable. What is the likely diagnosis? A. Candida esophagitis B. Pill-induced esophagitis C. Reflux esophagitis D. Eosinophilic esophagitis

B. Pill-induced esophagitis

What is the mechanism of action of the drug best to treat grave’s disease? A. It interferes with the step that causes the iodination and coupling of tyrosine residues in Thyroglobulin B. It inhibits iodine uptake into follicles

A. It interferes with the step that causes the iodination and coupling of tyrosine residues in Thyroglobulin

Patient with hyperthyroidism: high T3 and T4, what is the mechanism of the drug of choice given to her?

Inhibits the incorporation of iodine molecules into the amino acid tyrosine

74 year old male patient with type 2 DM well controlled with oral hypoglycemic undergo urgent cholecystectomy. The procedure was complicated and the patient has low urine output. He was confused with high glucose level, no ketones, high anion gap=20. Which drug is the cause of this complication?

Metformin

What is the best definition of obstructive sleep apnea? A. Partial or complete cessation of airflow despite respiratory effort B. Partial or complete cessation of respiratory effort despite airflow C. Loud sleep time snoring

A. Partial or complete cessation of airflow despite respiratory effort

A 52-year-old male a known case of cirrhosis presented with ascites and lower limb edema. Ascetic fluid was consistent with cirrhosis. No evidence of spontaneous bacterial peritonitis. The patient started furosemide 40 mg for 3 days. However ascetic fluid and lower limb edema did not improve. What could be the cause? A. high aldosterone level causing more absorption of sodium in distal tubule B. low compliance with the medication C. impaired absorption of furosemide D. furosemide dose was suboptimal

D. furosemide dose was suboptimal

A 24 year old man presented with weakness and fatigue. On physical examination, he was found to have postural hypotension and raised JVP. Provided are his lab results: PO2: 12.8 Kpa (normal); PCO2: 24 mmHg; HCO3: 15 mmHg; pH: 7.28 Na: 135; Urine Na: 9; Glucose: 5; Urea: 7; Chloride: 115 (high); S-osmolality: 308; K: 3.8 What is the diagnosis? a. Lactic acidosis b. Renal failure c. Renal tubular acidosis d. Diarrhea

d. Diarrhea (no normal values were given in the exam)

Who would most likely benefit from DVT prophylaxis? A. 19 y/o male investigating for infertility B. 20 y/o woman having tooth extraction C. a man who has follicular tonsillitis D. 30y/o woman who has just delivered by c section E. 40y/o woman who has family history of VT and want to travel to Dubai by airplane

E. 40y/o woman who has family history of VT and want to travel to Dubai by airplane

A 70 year old man is complaining of fatigue, pallor, increasing forgetfulness, unstable gait, feet numbness, his blood film is shown below. Which of the following tests would you order next? a. serum ferritin b. vitamin b12 level c. anti-endomysial antibodies d. WBC immunophenotyping

b. vitamin b12 level

Patient hypertensive and diabetic and now he is having microalbuminuria, how to prevent progression of the diabetic nephropathy? A. ACEI B. Beta blocker C. Thiazides

A. ACEI Ace inhibitors have an antihypertensive and antiproteinuric effects, and it works by lowering the glomerular capillary pressure.

Which statement is true about adult onset asthma? A. Patients cannot get severe exacerbations in the first year B. Adults compared to kids are more likely to lose it with time C. Smoking does not affect the rate of pulmonary function decline D. Women are more affected than men

D. Women are more affected than men

Patient had unilateral facial weakness, what would make it more likely to be upper motor neuron lesion ? A. tinnitus B. hyperacusis C. pronator drift D. corneal ulceration

C. pronator drift (this question was tricky, in the exam there was a specified side affected. If the facial weakness was on the right and its UMN the lesion in the brain should be on the left side. Therefore, the pronator drift would be on the right side as well. We aren’t sure which side they mentioned so we didn’t include it so pay attention during the exam about specific sides as pronator drift could be wrong if the side isn’t consistent with the lesions’s location).

A woman has a 3-month history of inability getting up from a low seat or toilet, she is also found it difficult to raise her arm up to do her hair, What is the best investigation to show the location of the patient's deficit? A- brain MRI B- spine MRI C- lumbar puncture D- Nerve conduction study/electromyography

D- Nerve conduction study/electromyography

As compared to patients who acquire C.difficile infection in the hospital setting, those who acquire the infection in the community are more likely to present in? A. Cancer patient B. Male Sex C. Use PPI D. Recent exposure to antibiotics

D. Recent exposure to antibiotics

Patient developed seizures (scenario of hyponatremia), at what rate should sodium be infused? A. 16 mmol/l B. 6-8 mmol/l C. 12 mmol/l

B. 6-8 mmol/l (sodium should always be corrected at a rate less than 8 (up to 10) to prevent pontine myelinosis, there were no other options in the exam less than 8 other than B)

A patient with sodium level of 163 mmol/L, lowering it too fast will lead to?

Cerebral edema

A patient presenting with the features of Ankylosing spondylitis has pain at the back of the heel, what is the likely cause?

Enthesistis

A patient is rescued from a falling building. What is the most important step to prevent rhabdomyolysis?

IV fluids

A patient newly diagnosed with osteoarthritis. What is the initial therapy? A. Paracetamol B. Prednisolone

A. Paracetamol

A patient presents with high thrombocyte count and high WBC with band cells of 2% and massive splenomegaly. How would you treat her? A. Imatinib (tyrosine kinase inhibitor) B. Splenectomy

A. Imatinib (tyrosine kinase inhibitor)

How to diagnose diffuse scleroderma? A. Serum anti-SCL-70 B. Chest x-ray

A. Serum anti-SCL-70

An obese patient presents with big toe pain and swelling. What is the diagnosis? A. Rheumatoid arthritis B. Septic arthritis C. Gouty arthritis

C. Gouty arthritis

A patient presents with fever, knee pain, swelling and movement restriction. His labs show leukocytosis. What is the best step of management? A. Synovial fluid aspiration B. X-ray C. CT scan D. MRI

A. Synovial fluid aspiration

A 64-year-old obese lady complains of pain in her left knee and morning stiffness that lasts about 15 minutes. What would the plain radiograph of her knee most probably show? A. subchondral sclerosis B. symmetrical joint space narrowing C. increased joint space D. osteophyte E. osteopenia

D. osteophyte

A patient is on insulin glargine developed diabetic ketoacidosis, glucose was 18? Positive ketones in pH: 7.18? urine K was 4.1 (4.4?). How will you manage? A. add insulin and normal saline B. Insulin potassium and normal saline C. Insulin normal saline and NaHCO3 D. Insulin and NS

B. Insulin potassium and normal saline (if the potassium is LOW or NORMAL we either fix the abnormality or give prophylactic KCL because the insulin will definitely lower the potassium. We only refrain from KCL infusion when the potassium is high before starting NS)

What is the extra articular manifestation of psoriatic arthritis ? A. Polyneuropathy B. Aortitis C. Intermittent claudication D. Leukocytoclastic vasculitis

B. Aortitis

A 46-year-old female who is a known case of Rheumatoid Arthritis and is on treatment is scheduled for abdominal surgery. What is mandatory before inserting tracheal intubation? A. Chest x-ray B. Hands x-ray C. Cervical x-ray D. Lumbar x-ray

C. Cervical x-ray

A 35-year-old lady diagnosed with unprovoked pulmonary embolism and had a history of recurrent abortions. She was treated for ITP 2 years ago. On physical examination livedo reticularis in upper and lower extremities. How to confirm the diagnosis?

Lupus anticoagulant and anticardiolipin antibodies

A 65-year-old female with progressive osteoarthritis that now made her “participation restricted”. According to WHO “definition of participation restricted”, which of the following is true? A. patient is having a problem in handling situations in her life B. patient is unable to carry out or initiate tasks C. a problem in body function or structure D. wheelchair and bedridden

A. patient is having a problem in handling situations in her life

22-year-old female was diagnosed with rheumatoid arthritis. What test is used for monitoring the activity of rheumatoid arthritis? A. rheumatoid factor B. sedimentation rate C. anti-CCP D. C4 level

B. sedimentation rate

2015 - 5th Flashcards

(149 cards)