2016 - 6th

Question 1

Male patient, know case of CHF due to ischemic heart disease, presents with shortness of breath for the past few hours. BP 130/90. Auscultation bibasilar crackles. What of the following is true?
A) Treatment with IV furosemide
B) Beta blockers can be given
C) Morphine is contraindicated due to risk of pulmonary edema

Answer 1

A) Treatment with IV furosemide
(decompensated HF)

Question 2

A 3-year-old girl presented with a patchy crusty rash on her face leaking golden yellow fluid. What is the diagnosIs?
A) Cellulitis
b) DIscoId eczema
C) Impetigo

Answer 2

C) Impetigo

Question 3

64-year-old man presented with progressive lower limb edema, scrotal swelling, and ascites ove past 4 months. Cr is normal, albumin is low. Urine analysis shows proteinuria (+4) and RBCs (<5). RE biopsy shows thickening of glomerular membrane and subepithelial lg deposits. What is the nexi of management?
A Search for cancer
B Plasma exchange to remove immune complexes
C) Treat with corticosteroids
D) Refer to nephrology

Answer 3

A Search for cancer

Question 4

A clinica scenario of microanaiopathic haemovtic anaemia (low Ho. Low platelets. and schistovtes
on blood film). ADAMTS13 levels were low. Management?
A) Plasma exchange and prednisolone
B) Plasma infusion and corticosteroid
C) Rituximab

Answer 4

A) Plasma exchange and prednisolone

Question 5

What is the pathophysiology of myocyte destruction in polymyositis?
Al Th1 medicated
B) NK cells and macrophages
C) Antibody mediated destruction
D) Complements deposition

Answer 5

Al Th1 medicated

Question 6

A 42-year-old woman came for the afternoon appointment. She is has no medical problems, asymptomatic. No history of medication. Family history of diabetes in her mother and she is concerned wether she is at risk for developing diabetes herself. Her BMI is 30, waist circumference 88 cm. Her non fasting blood glucose at the office was 7.2 mmol. According to the American diabetes association guidelines, what is the best used to confirm diagnosis of diabetes Mellitus?
A) Non fasting blood sugar of 7 or more.
B) Polydipsia and polyuria.
C) HbA1c of 6.5 or more.
D) HbA1c of 7 or more.

Answer 6

C) HbA1c of 6.5 or more.

Question 7

25-vear-old man returned from holidav 2 weeks ago where he had unprotected sex. He presents with a painful ulcer on his penis along with right suppurative lymphadenopathy. What is the diagnosis?
A) Granuloma inguinale
B) Chancroid
G Svphilis
D) Herpes

Answer 7

B) Chancroid

Question 8

A female patient has a 10-year history of diarrhea that is not mucoid or bloody, along with occasIonal incontinence. She denies laxative abuse. Her blood test showed hypokalaemia only.
Colonoscopy was done and shows melanosis coli. What is the likely diagnosis?
A) Lactose intolerant
B) Irritable bowel syndrome
C) Cronn’s disease
D) Laxative abuse

Answer 8

D) Laxative abuse

Question 9

5-year-old boy known to have type 1 DM, had an episode of hypoglycaemia. Random blood glucose
3mmol/. He is conscious and oriented. What is the best way to manage the patient?
A) Oral carbohydrate
B) IM glucagon
C) IV normal saline
D) Iv dextrose

Answer 9

A) Oral carbohydrate

Question 10

32-year-old male with HIV for 5 years presented with nephrotic syndrome. His creatinine was normal
4 months ago. Today it its 600. On ultrasound, his kidneys were enlarged. Complement is normal. What is your diagnosis?
A) Membranous glomerulonephritis
B) Collapsing focal glomerulosclerosis
C) Membranoproliferative glomerulonephritis
D) Minimal change disease

Answer 10

B) Collapsing focal glomerulosclerosis

Question 11

Which of the following will improve with treatment of ulcerative colitis flare?
A) Ankylosing spondylitis
B) Erythema nodosum
C) Primary sclerosing cholangitis

Answer 11

B) Erythema nodosum

Question 12

Classic case of celiac disease. Upon investigations, anti-translutaminase antibodies were positive.
How to confirm the diagnosIs?

Answer 12

Upper gastroduodenoscopy with duodenal biopsy

Question 13

In which of the following patients do expect renal function deterioration to occur after taking ACE?
A) A 25-year-old female with unilateral renal artery stenosis
B) A 23-vear-old female with waterv diarrhea and a ow VP
C) A 75-year-old male with Adult Polycystic Kidney Disease
D) A 32-year-old diabetic male with serum Creatinine of 210 mol/L (High) and abdominal US showed normal size of the kidneys

Answer 13

B) A 23-vear-old female with waterv diarrhea and a ow VP

Question 14

28-year-old housemaid presents with itchy hands that worsen after touching detergents?
A) Atopic dermatitis
B) Contact dermatitis
C) Scabies
D) Seborrheic dermatitis

Answer 14

B) Contact dermatitis

Question 15

Patient with pharyngitis that was treated with amoxicillin presents 5 days later with an exanthematous rash all over his body. What test would best help confirm the diagnosis?
A) Prick skin test
B) Monospot test
C) ASO titre

Answer 15

B) Monospot test

Question 16

25-year-old male complains of dizziness when lifting heavy objects. His blood pressure was 130/100. He has a family history of hypertension & has a sibling who recently passed away due cardiac condition. Physical examination revealed Normal HR with a double pulse and a jerky ejection systolic murmur and also pan-systolic murmur. Echo showed left ventricular hypertrophy and asymmetrical
thickening of the intraventricular septum. What is the likely diagnosis?
A) Dilated cardiomyopathy
B) Hypertrophic cardiomyopathy
C) Restrictive cardiomyopathy
D) Constrictive pericarditis

Answer 16

B) Hypertrophic cardiomyopathy

Question 17

Post covid, complaining of bilateral symmetrical paraesthesia of the lower limbs (ascending?)?
A) GBS
B) Polyneuropathy

Answer 17

?

Question 18

allopurinol-> DRESS 20. Patient presents with erosive lesions over trunk and limbs along with mucosal involvement after taking medication. Diagnosis?
A) TEN
B) SJS

Answer 18

A) TEN

Question 19

A 67-year-old lady, known case of diabetes mellitus, complaining of shoulder pain and stiffness. On examination, she was able to abduct 45 degrees with limitations, inability to pertorm external and internal rotation, as well as forward flexion and extension. X-ray of the shoulder joint was normal. What is the diagnosis in this case?
A) Adhesive capsulitis
B) Biceps tendinopathy
C) Rotator cuff tendinopathy
D) Subdeltoid bursitis

Answer 19

A) Adhesive capsulitis

Question 20

30-vear-old female under evaluated after a stroke. O/E she had livedo reticularis and an ulcer on medial aspect of left lower limb. She reports that the skin changes were present before the stroke. Best lab to do?
A) Anti-dsDNA assay
B) ANCA assay
C) Antiphospholipid panel
D) Electrophoresis

Answer 20

C) Antiphospholipid panel

Question 21

20-year-old male presents with shaking of the in the right hand that progressed to generalized tonic clonic seizure. Which lobe is likely affected?
A) Frontal
BiTemporal
C) Parietal
D) Occipital

Answer 21

BiTemporal

Question 22

A type 1 diabetic patient had potassium level = 2.1 (low, N=3.5-5), glucose
= 17 (high) and he was positive for urine ketones. His pH was low. The patient was diagnosed with DKA and 500 ml NS was given. What to do next?
A. 0.6 units insulin + 40 mEq K + 500 NS
B. 6 units insulin + 40 mEq K + 500 NS
C. delay insulin infusion + 40 mEq K + 500 NS

Answer 22

C. delay insulin infusion + 40 mEq K + 500 NS

Question 23

Middle aged man presents with multiple painful ulcers on his penis. Examination of swab under microscopy demonstrated a “school of fish” appearance?
A) Haemophilus ducreyi
B) Herpes simplex
C) Kiebsiella granulomatis

Answer 23

A) Haemophilus ducreyi

Question 24

32 years old male presented with painless indurated ulcer on the penis shaft with several painless inguinal lymphadenopathy for 1 week. He had unprotected sexual intercourse three weeks prior. What is the first serological test taht will be positive?
A) VDRL
B) RPP
C) FTA -ABS
D) TPPA

Answer 24

C) FTA -ABS
OR
D) TPPA

Question 25

Middle aged male patient presents with multiple painful genital vesicles that had an annular border, and was associated with painful inguinal lymphadenopathy and penile edema. What is the manadement? A) Ceftriaxone B) Doxycycline C) Ciprofloxacin D) Penicillin

Answer 25

review management of STDs. (Chancroid/ceftriaxone - LGV/doxy)

Question 26

Repeated question about bronchiectasis

Question 27

A 42-year-old female presents to her family physician with one year history of muscle weakness in her upper and lower limbs. She additionally complains of progressive weight gain, cold intolerance and constipation. On examination, her muscles were of normal power and tone but were tender. Her laboratory investigations showed the following: WBC: 8.1 x 109 Hb: 119 g/L Platelets: 347 x 109 BUN: 4.7 mmol/L CREATINE: 59 umol/L Serum calcium: 2.5 mmol/L Urinalysis: Normal Creatine phosphokinase: 3470 |U/L (normal: 23-232) AST: 19 IU/L (normal: 5-40) ALT: 17 |U/L (normal: 5-36) What is the most appropriate next step to be conducted in this patient? A) Measure TSH level B) Perform a muscle biopsy C) Start her on prednisolone D) Check anti-Jo1 antibody titers E) Conduct electromyography

Answer 27

A) Measure TSH level (Hypothyroid myopathy)

Question 28

Patient presents 7 days after taking a new medication with pustules over his neck and fever of 39C. Biopsy of the lesion showed neutrophils, dermal edema and eosinophils. Diagnosis? A) Sweet syndrome (acute febrile neutrophilic dermatosis) B) DRESS G Pustular psoriasis D) eosinophilic folliculitis

Answer 28

A) Sweet syndrome (acute febrile neutrophilic dermatosis)

Question 29

What is expected in a 15-year-old with post-strep glomerulonephritis? A) Oliguria B Clinical presentation of nephrotic syndrome C) Normal GFR D) Positive ANCA

Answer 29

A) Oliguria

Question 30

35-year-old woman with 20-year history of T1 DM. She has retinopathy and proteinuria of 300 mg/d. Her s-creatinine was 160 k/mol/L (53-97.2 mol/L) 6 months ago. Her glucose was badly controlled. She now reports improvement in glucose control to the desired range of 6-9 in the past 3 months despite being on the same diet and same insulin dose. What explains the improvement of her glucose? A) Improvement of proteinuria B) Worsening renal function C) Increase urine output D) Decreased glucose absorption from the gut

Answer 30

B) Worsening renal function

Question 31

55-year-old female with chronic kidney disease is recently started on erythropoietin injections to treat her anaemia. What's the target haemoglobin that you should aim for? A) 9 - 10 B) 10 - 11 C) 11 - 12 D) 13 - 14

Answer 31

C) 11 - 12

Question 32

Which virus causes deterioration in a patient with renal transplant and on immunosuppressive therapy? A) Hepatitis B B) Polyoma virus C) Adenovirus D) Influenza virus

Answer 32

B) Polyoma virus

Question 33

A fluid filled skin lesion that is more than 1 cm in diameter? A) Bulla B) Vesicle C) Cyst D) Nodule

Answer 33

A) Bulla

Question 34

A 45 year old patient presents with nephrotic syndrome. He was diagnosed with membranous glomerulopathy. He has an increased risk of developing which of the following? A) Arrhythmia B) Cerebral hemorrhage C) Pulmonary embolism D) Gouty arthritis

Answer 34

C) Pulmonary embolism

Question 35

46-year-old man with a history of gastric bypass 10 years ago presents with progressive lower back pain, proximal muscle weakness, and inability to ambulate. Labs: ALT and AST normal, ALP high, PTH high, Ca low. Which helps confirm the diagnosis? A. Vitamin D level B. Vitamin B12 level C. Bone densitv scan D. Parathyroid scan

Answer 35

A. Vitamin D level

Question 36

Patient with chronic kidney disease. What will further worsen his condition? A) Strict control of his BP B) Strict control of blood glucose C) Control protein intake D) Use of NSAIDs

Answer 36

D) Use of NSAIDs

Question 37

Male presents with 2 episodes frank haemoptysis. Upon further inquiry, he has 4-week history of fever and cough productive of purulent sputum. He also has positive travel history to a 3rd world country. Examination revealed crepitations in the upper lung. A CXR was obtained. Next step in management? A) Morning sputum and culture B) bronchoscopy and gastric lavage C) CT D) Treat as pneumonia until the results of culture show

Answer 37

A) Morning sputum and culture (Pulmonary TB)

Question 38

A 30-year-old female with low haemoglobin, low MCV, low MCH. She has severe menorrhagia and fatigue. Which of the following confirms the diagnosis? A) Serum ferritin B) Serum iron C) Transferrin

Answer 38

A) Serum ferritin

Question 39

35-year-old female referred from the family physician with 6-month history of localized pain in the upper back. Examination revealed tender points in the cervico-thoracic region. There were no other physical signs, and her laboratory tests were Hb: 120 g/L, WBC: 7 X 109/L, ESR 20 (<10), CK normal. What is the most likely diagnosis? A) Osteoporosis B) Myositis C) Myofascial pain syndrome D) Cervical radiculopathy E) Ankylosing spondylitis

Answer 39

C) Myofascial pain syndrome

Question 40

65-year-old patient presented with altered mental status. He is on beta blocker, nitrate, statin, and aspirin. His BP 80/40, HR 80, central venous pressure is 4 mmHg, peripheral pulse are weak, chest is clear, cold extremities, and normal heart sounds no murmur. What is the type of shock? A) cardiogenic B) Hypovolemic C) Distributive D) Obstructive

Answer 40

B) Hypovolemic

Question 41

30-vear-old pregnant at 30 weeks ot gestation comes on routine visit. CBC showed a platelet count of 8 × 109/L. Haemoglobin was normal. Examination revealed some petechia around her ankles. Blood pressure was normal. Most likely diagnosis? A) Severe preeclampsia BI HELP C) ITP D Gestational thromoocviopenla

Answer 41

C) ITP (Platelet count way too low for GT)

Question 42

34-year-old presents 6 weeks postpartum with 2-day history of fatigue, dark urine, and petechia. No significant past medical history presents WBC (high) - Platelets (low) - Hb(low) - Normal electrolytes - Normal coagulating factors - Creatinine (high) - LDH is 4 times higher than normal - urinalysis showed haemoglobin with no blood. A) Haemolytic anaemia with IT (Evans syndrome) B) DIC C) TTP D) IgA (HSP)

Answer 42

C) TTP (schistocytes on blood film indicate MAHA)

Question 43

A young woman presented with history ot generalized body aches and pain and multiple tender points over her boov. she also has histor of disturbed sleeo. There is no histor of muscle weakness What is the most likely diagnosis? A) Chronic fatigue syndrome B) Polymyositis C) Fibromyalgia D) Polymyalgia rheumatica

Answer 43

C) Fibromyalgia

Question 44

A 28-year-old computer technician presented with bilateral pulsating headache, preceded by flickering lights and temporary loss of vision of the left eye. Diagnosis? A Cluster headache B) Migraines C) Temporal arteritis D) Optic neuritis

Answer 44

B) Migraines

Question 45

What is true regarding lgA nephropathy? A) It's common in adult B) ANCA is positive C) It presents with AKI D) Oliguria is common

Answer 45

A) It's common in adult

Question 46

A 65-year-old woman present with extensive erosions and ulcers on her trunk and limbs for one year duration. She denies any new medications. There was no mucosal involvement. What is the likely diagnosis? A) Bullous pemphigoid B) Pemphigus vulgaris C) SUS/TEN D) Paraneoplastic pemphigus

Answer 46

A) Bullous pemphigoid

Question 47

22-year-old female with persistent IT, her current platelet count is 63 × 109/L. What is the most appropriate management? A) Observation and regular monitoring of platelet count B) Splenectomy C) corticosterolas D) IVIG

Answer 47

A) Observation and regular monitoring of platelet count