2015 - 7th Flashcards by Fajer e

A 16vear old patient was beind investidated tor amenorrhea. past medicar nistor 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

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A blood film report came mentioning the presence of “howell-jolly bodies”, what does this finding indicate?
A. autoimmune hemolvtic anemia
B. splenomegaly
C. splenectomy
D. liver cell failure

C. splenectomy

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A 70-vear-old smoker with proaressive SOb and productive cough. His spirometr 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

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

A. Fludrocortisone

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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)

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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

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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 syncope

A- Exertional dyspnea

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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

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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 ot alcohol. He had become sick while at the part 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

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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- AmyIolaosis
B- lung fibrosis
C- myositis
D- entrapment neuropathy

C- myositis

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A patient with fibrosis involving upper zones of the lung predominates. What is the most likely diagnosis?
A- IPF
B- Ashestosis
C- sarcoidosis
D- scleroderma

C- sarcoidosis

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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, ACEI. What can we give to lower risk of mortality from CAD?
A. calcium channel blockers
B. beta blocker

B. beta blocker

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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

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A 55-vear-old smoker (1 back tor 30 vears with COPD came to ER atter she experienced
convulsions. Her sister denies a previous history of convulsions. CXR showed a large central mass. She has hypercalcemla as well, what is the most relatable cause of her presentation?
A- Small cell lung carcinoma
в- Squamous cells carcinoma
C- Adenocarcinoma

в- Squamous cells carcinoma convulsions can be due to the hypercalcemia. SUL can cause hypercalcemia but squamous cell carcinoma is the most common cause of hypercalcemia in all the types of lung malignancies)

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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 jugular venous pressure of this patient?
A- Cannon a waves
B- Prominent X descent
C- Absent A wave
D- Elevated JVP

A- Cannon a waves

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What is classified as type 1 Hypersensitivity reaction?
A- 17-year female with pruritic rash around her neck developed 2 days after she wear 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

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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. chest
B. fine needle aspiration of the cavity
C. sputum examination for acid fast bacilli organism

C. sputum examination for acid fast bacilli organism (always go for less invasive to more invasive/time consuming)

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

prolapsed mitral valve

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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

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

D- Recent exposure to antibiotics

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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

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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)

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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

(LADA is late onsent form of T1 DM that is often confused for T2DM as in this case)

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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

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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 laos were normal except for positive recal occult test. vat should be done next! A- Colonoscoov B- repeat fecal occult test C- flexible sigmoidoscov D- Barium enema

A- Colonoscoov

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

A- Nephelometey (MSD rheuma)

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

6. A 60-year-old patient came with dyspnea and fatigue with blood test showing microcytic hypochromic anemia, raisedco 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 Gl bleeding

B- Iron deficiency anemia due to Gl bleeding

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 23-yearold 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

A Male diagnosed at 8 ears 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%

An adult patient presented with green sputum (in the community) and what is the most common organism?

S. pneumonie

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

immunoglobulins in CSF

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

A. protamine sulfate

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

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

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

A patient with pleuritic left chest pain and exertional SOB. His X-ray is shown. What is this? (pointed by white 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)

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

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

E. 40v/o woman who has familv historv of VT and want to travel to Dubai by airplane

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

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

Lupus anticoagulant and anticardiolipin antibodies

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

5. 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

A 23-vear-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 petechia. Rest of examination was normal. Her labs show. Normal PT Normal APTT Normal INR Normal WBC Normal Hb Low platelets What is the management? A. oral prednisolone B. tranexamic acid C. plasma exchange

A. oral prednisolone

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 pregnisolone C. O2 therapy

A. Council him to stop smoking

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

B. fasting plasm glucose 7.5

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

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

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

B. Autoimmune hemolvtic anemia

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

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

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 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 norma 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).

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 interseptal wall C. Calcified aortic valves

A. Myxomatous degeneration of mitral valve

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 following is true? (I think urea is missing?) A Heis 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

A patient presented with painless lymphadenopathy. He also had weight loss and night sweats. What is the diagnosis? A- Hodgkin's lymphoma B- NonHodgkin's disease C- Infectious mononucleosis D- Thyroid cancer

A- Hodgkin's lymphoma

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 46-year-old female who is a known case of Rheumatoid Arthritis and is on treatment is scheduled for abdomina surgerv What is mandatory before inserting tracheal intubation? A. Chestx-ray B. Hands x-ray C. Cervical x-ray D. Lumbarx-rav

C. Cervical x-ray

A healthy 35-year-old male presented with indigestion and retrosternal heartburn. No alarm svmptoms. Labs within normal limits. Which of the following is most proper initial step? A- Empiric trial of PPl B- Esophageal manometry C- Noninvasive h. Pylori tests D- Upper Gl endoscopy.

A- Empiric trial of PPl

A 22-year old female has hypertension (180/40), Na high, K low, ph 7.4, has normal renal function, what's the best diagnostic test? A- Renin:aldosterone ratio b- urine cortisor C- urine metanephrine D- blood and urine catecholamines

A- Renin:aldosterone ratio

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

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

A. Inhibits the incorporation of iodine molecules into the amino acid tyrosine

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 maior 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 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-rav C. Ct scan D. MRI

A. Synovial fluid aspiration

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 modifications B- start HTN medications desired BP >120/80 C- start HTN medication desired BP >130/80 D- start HTN medications if BP >140/90

Answer: B (This question was not by Dr. Wael, it is probably by cardiology so follow the updated AHA blood pressure guidelines which state that anything above 120 is elevated blood pressure and >130 is stage 1 hypertension. The answer is most probably B because patients with stage 1 HTN are usually started on medications along with lifestyle modifications). A could also work but it is less likely.

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

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

A. Paracetamol

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

4. 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 (patient has DIC, the most important step is to fix the underlying cause)

7.22-year-old female was diagnosed with rheumatoid arthritis. what test is used for monitoring the activity of rheumatoid arthritis: A. rheumatic tacior B. sedimentation rate C. anti-CCP D. C4 level

B. sedimentation rate

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

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

A 75-year-old patient came for his regular checkup. His lab test values were as follows: H6 146 (normal) MCV 90 (normal) WBC 52x1019 (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

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

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

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

Mitral regurgitation

Which of the following is not a musculoskeletal manifestation in osteoarthritis? A. Dactylitis B. Heberden nodes C. Bochard nodes D. Subcutaneous nodules

A. Dactylitis

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

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

B. Aortitis

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

A. Imatinib (tyrosine kinase inhibitor)

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

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 ?)

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 pulseless. I is the cause? A. cerebral embolism B. arterial embolism C. deep venous thrombosis D. peripheral vascular disease

B. arterial embolism

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

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

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 you give him as a lifelong treatment? A- Clopidogrel B- Warfarin and aspirin C- Dabigatran D- Rivaroxaban

B- Warfarin and aspirin

What drug is contraindicated in pregnancy in case of treating crohn's disease? A- methotrexate B- 6-mercaptopurine C- Sulfasalazine

A- methotrexate

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 NOT SURE if it was the C- ACEI D- Diabetic nephropathy

A- Calcium channel blocker

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

splenic sequestration crisis

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- betore dinner

B- before breakfast

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

A- Viruses

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 vou order next? A- serum ferritin B- vitamin b12 level C- anti-endomvsia antibodies D- WBC immunophenotping

B- vitamin b12 level

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

How to diagnose diffuse scleroderma? A. Serum anti-SCL-70 b. chest x-rav

A. Serum anti-SCL-70

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

A. Right coronary artery

25 years old Kuwaiti women history of continuous productive cough at childhood. Admitted to the hospital several times during childhood for resurrect dyspnea, cough, 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

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 azathionrine

A- Stop hydralazine

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

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

Beta blockers

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- Gemtibrozil D- Omega 3

most likely B- Clofibrate

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

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

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 aosorotion or turosemid D. furosemide dose was suboptimal

D. furosemide dose was suboptimal

a 27-year-old female had a left sided unilateral throbbing headache associated with nausea, vomiting, and photophobia. 3 years ago, she experienced similar episode. how would you treat her?

Sumatriptan

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 but the mainstay of treatment is medical with metronidazole)

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

A- Dactylitis

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

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

He closes his eye

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 about which side they mentioned so we didn't include it so pav attention during the exam about specific sides as pronator drift could be wrong if the side is not consistent with the lesion's location)

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

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

B. Normal pH (7.4)

A 77-vear-old patient was admitted for selective cholecvstectomy. 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 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 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 70-year-old patient came with progressive cough and shortness of breath, no other abnormalities, and no past medical historv. What is true about diagnosis of IPF? A- HRO scan can diagnose IF- with confidence b- bronchioalveolar lavage and biopsy is needed for diagnosis

A- HRO scan can diagnose IF- with confidence

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 O. sian clororioxacin olus metronidazole D. give diuretics and albumin

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

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

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

Enthesistis

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

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

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

B. Neuromuscular junction

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

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 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

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

A. Partial or complete cessation of airflow despite respirator effort

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

NAFLD

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

Blood glucose readings ot 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

What is the mechanism of action of the drug best to treat graves' 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

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

A. Homer svndrome

117) Which of the following is true regarding hypokalemia? A. It can be accompanied by the development of U wave on ECG B. It can happen in the setting of mineralocorticoid deficiency C. It is a known side effect of spironolactone D. It is associated with metabolic acidosis

A. It can be accompanied by the development of U wave on ECG

120) A female patient has a 10-year history of diarrhea. She denies laxative abuse. Her blood test showed hypokalemia only. Colonoscopy was done and shows melanosis coli. What is the likely diagnosis? A. Lactose intolerant B. UC C. Crohns D. Laxative abuse diarrhea

D. Laxative abuse diarrhea

121) A 62 year old with male with hypertension underwent cardiac angiography, in which a contrast dye was used; which is correct statement: A. Contrast induced nephrotoxicity is irreversible B. Contrast induced nephrotoxicity is prevented with proper fluid before the contrast study C. Eosinophiluria D. Treated with steroids

B. Contrast induced nephrotoxicity is prevented with proper fluid before the contrast study

122) A 30-year-old male with recurrent nose bleeds, weight loss and cough. ENT consultation showed nasal septal perforation. He had pulmonary infiltrates seen on chest x-ray. What is the diagnosis? A. Churg-Strauss syndrome B. Systemic polyangitis with granulomatosis (exactly what was written in the exam) C. Polyarteritis nodosa D. Microscopic polyangiitis

B. Systemic polyangitis with granulomatosis (exactly what was written in the exam)

123) A 45-year-old male patient presents with generalized edema and proteinuria. On presentation, the patient had a blood pressure of 147/88. Renal function tests were markedly deranged. A renal biopsy was taken and showed diffuse thickening of the glomerular basement membrane and subepithelial deposits. IgG granular deposits were present under immunofluorescence. What should be done for this patient? A. Look for an underlying malignancy B. Investigate the presence of antinuclear and dsDNA antibodies C. Observe the patient since this is a self-limiting condition D. Start the patient on a trial of corticosteroids

A. Look for an underlying malignancy

124) A 22-year-old female presented with a painful vesicular rash that was confined to her right upper back. What is the causative organism? A) Herpes simplex B) Herpes zoster C) EBV D) CMV E) Coxsackie virus

B) Herpes zoster

125) A 40 years old woman is evaluated for worsening asthma symptoms after resolution of an acute respiratory tract infection that was treated with supportive measures. The patient has a 15 year history of asthma that has been well controlled on moderate dose inhaled corticosteroids puls as needed inhaled albuterol. Since her respiratory tract infection 10 days ago, her asthma symptoms have worsened; she has had frequent nighttime episodes of wheezing and has used albuterol inhaler six to eight times a day. Which of the following is the most appropriate management for this patient? A) 7 day course of fluroquinolone B) Long actine beta agonist C) Nebulized albuterol at home D) Short course of an oral corticosteroids E) Leukotriene modifying agent

D) Short course of an oral corticosteroids

126) Young man presented 2 hours after alcohol intake in party. One hour before he has retching and nausea only with no vomiting. Now he presents with 200 ml of blood vomit. His father has gastric cancer. What will you find in upper endoscopy? A) Mucosal tear in gastroesophgeal junction B) Adenocarcinoma in stomach

A) Mucosal tear in gastroesophgeal junction

127) A guy with high BP refractory to 3 medications has diabetes, polyurea, and hypokalemia. HBA1c was high . what is the diagnosis? A) Cushings syndrome B) Conns

128) A 32-year-old male patient complains of back stiffness and low back pain. What is the best imaging modality used to detect findings of ankylosing spondylitis? A) MRI of the sacroiliac joints B) Lumbosacral x-ray C) Bone scan D) CT scan of the pelvis E) X-ray of the cervical spine

A) MRI of the sacroiliac joints

129) A patient has an active duodenal ulcer presented with joint pain that was diagnosed as gout. What is the best management?

A) Intra articular steroids

130) A 75-year-old diabetic hypertensive man presented with profuse sweating and severe pain in the center of the chest for the past 4 hours. No past history of chest discomfort. He was taken to the emergency room and an ECG was done, which is given below. Soon after the patient developed cardiac arrest due to ventricular fibrillation and he died despite repeated DC shock and cardiac resuscitation. An ECG of ST- elevation in V1-V4. On autopsy, which artery is likely to show total occlusion and athero-thrombosis? A) Right coronary artery B) Left anterior descending artery C) Posterior descending coronary artery D) Circumflex coronary artery

B) Left anterior descending artery

131) A 26-year-old gentleman comes to the emergency room after developing sudden onset of palpitations. The patient says that he never had previous similar episodes. He now complains of chest discomfort but no dizziness. When initially assessed, the patient looked generally well and maintained full consciousness. His heart rate was 146/min and blood pressure was 112/71. His ECG is shown below. Non-pharmacological measures failed to terminate the episode. How should this patient be managed in this setting? A) Electrical cardioversion B) Digoxin C) Intravenous adenosine D) Radiofrequency ablation

C) Intravenous adenosine

133) A 49-year-old woman has a history of joint pain and morning stiffness for four months. Examination reveals swelling of the wrists and metacarpophalangeal joints. Which of the following is the most specific serological marker for rheumatoid arthritis? A) Rheumatoid factor B) Antinuclear antibodies C) Anti-dsDNA antibodies D) Anti-cyclic citrullinated antibodies (anti-CCP)

D) Anti-cyclic citrullinated antibodies (anti-CCP)

134) A 40 year old male patient with IBD for 10 years, he had multiple erythematous to purple ulcerated eruptions in his left lower limb. Those eruptions are not improving on antibiotics. What is the likely diagnosis? A) Erthyema nodusm B) Pyoderma gangernosum

B) Pyoderma gangernosum

135) A 28-year-old female came during her second pregnancy. She is worried about her renal function. What is the most sensitive test in her condition? A) Serum creatinine B) 24-hour urine collection to estimate GFR C) Serum uric acid

C) Serum uric acid

136) A young boy presented with history of bleeding into the joints. He has a similar family history that affects male only. What his coagulation profile likely shows? a) prolonged APTT b)prolonged template bleeding time c) prolonged PT d) low platelets

137) What is the quickest way to decrease cerebral edema? A) Mannitol B) Hyperventilation C) Head elevation

B) Hyperventilation

138) A 22-year-old female patient is a known case of ulcerative colitis on steroids. She presented to the clinic complaining of uncontrolled symptoms. She reports increased bowel habits and rectal bleeding. It was decided to start her on 6-mercaptopurine to control her symptoms. One week later, she presents to the ER with severe epigastric abdominal pain that radiates to the back. Her WBC count was found to be 3.5 x109 (normal: 4 - 10 x109). How would you manage?

A) Stop azathioprin ( it causes acute pancreatitis)