2016 - 7th Flashcards by Fajer e

A 26-year-old woman presented with history of increased fatigability especially at the end of the day. She could not keep her eyes open. The doctor wanted to use the most sensitive test for myasthenia gravis. What is this test?
A) Anti-acteylcholine antibodies
B) EMG
C) Single fiber EMG
D) LP

C) Single fiber EMG

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A 40 year old truck driver previously healthy presented to the ER with dyspnea and cough for 4 months he recently drove to areas with gardens and farms. His O2 sat was 94%, febrile. Whats the diagnosis?
A) hypersensitivity pneumonitis
B) acute asthma attack
C) bronchiectasis

A) hypersensitivity pneumonitis

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a 19 years old male patient presented with 12 weeks history of bloody diarrhea. Diagnosed as ulcerative colitis. Which of the following is the best first line treatment?
A) Meselamine
B) Azathioprine
C) Infliximab
D) Methotrexate

A) Meselamine
(5-ASA)

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A 70-year-old man was brought by his son for evaluation of his frequent falls. On examination, he had rigidity, bradykinesia, resting tremor, and shuffling gait. The doctor prescribed him a medication after which he improved dramatically. What was the medication?
A) Beta Blocker
B) Calcium Channel Blocker
C) GABA agonist
D) Levodopa

D) Levodopa

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60 year old lady complaining of generalized malaise and fatigue, recurrent infections, bleeding gums after brushing teeth, labs showed low hg, low plt, low wbc, bone marrow shows myeloid blast cells with
translocation 15:17.What’s the most likely diagnosis
a. CML
b. Acute promyelocytic leukemia

b. Acute promyelocytic leukemia

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Patient with multiple hemolytic episodes. PBS showed spherocytosis. Grandfather had similar condition.
What is the pathology of this condition?
a) spectrin deficiency
b) alpha-gene point mutation
c) gene deletion
d) balanced chromosomal translocation

a) spectrin deficiency

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A 34-year-old lady presented with icterus and impaired renal function but with normal urine output 2 weeks after the delivery of her baby. Peripheral blood smear showed Helmet cells (schistocytes). She also had low platelets. What is the appropriate treatment?
A) Steroids only
B) Steroids and cyclophosphamide
C) Steroids and plasma exchange
D) Dialysis

C) Steroids and plasma exchange?

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A pregnant lady in the second trimester presented with pleuritis chest pain. ECG showed deep S in lead 1 and q wave with T wave inversion in lead 3. VQ scan showed areas of infarction. What is the diagnosis?

Pulmonary embolism

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A 72 year old hypertensive patient. He is known case of asthma and ischemic heart disease. Lab investigations revealed hyperkalemia. What is the best medication for his condition?
1) Beta blocker
2) ACEI
3) Vasodilators
4) Thiazide diuretics

4) Thiazide diuretics

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A younge male pateint presented with red raised annular plaques on the dorsumof the hands and trunk. The margins were raised and braded with central regression. Biposy showed palisading granuloma. What is the diagnosis?
A) Lichen planus
B) Discoid lupus
C) Granuloma annulare
D) Nicrobiosis lipidocia dibeticorum

C) Granuloma annulare

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A young patient known to have Down-syndrome and IgA defficincy presents with iron deficiency anemia and diarrhea. How to confirm the diagnosis?
A) Endoscopy and biopsy
B) TTG- antibodeis

A) Endoscopy and biopsy

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A 60 year-old known case of HTN, DM, hyperlipidemia, presented with chest pain. While in the hospital he fainted. ECG showed ST elevation V1-V6 and lead 1 and AVL. His BP was 70 so he was given epinephrine, after which his BP was 80. What will you do next?
A) Coronary angiography and emergent CABG
B) IABP with stenting of the culprit coronary artery
C) Infusion of ionotropes

B) IABP with stenting of the culprit coronary artery

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A patient was recently diagnosed with multiple sclerosis. She is asking weather she can take a vitamin that can prevent exacerbations. What would you recommend
A) Vit A
B) Vit D

B) Vit D

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Most common type of aura in migraine?
a) Visual
b) Motor
c) Olfactory
d) Auditory

a) Visual

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30 year old female previously healthy nonxsmoker came to your clinic to know risk of type 2 DM. Father diabetic. She runs 20min 5 times a week. Her BMI 27%; Hba1c 5.3; Fasting blood sugar 5.5. What can you advise her to decrease her T2DM risk?
A) Increase to 20min exercise daily
B) Intermittent fasting 5 days a week
C) Diet good quality food
D) Start antidepressants

C) Diet good quality food

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Patient with medullary throid carcnioma. also has HTN and elvated urinary metanephriens. what will you also find?
A) orthostatic hypotension
B) bitemporal hemianopsia
C) abdominal striae
D) lower limb lesions

A) orthostatic hypotension

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A 56 year old came to the outpatients clinic with 2 episodes of shingles within the past 2 months. He has persistent lymphadenopathy. The patient feels well. On examination there’s petechia, cervical lymphadenopathy, and mild splenomegaly.
Hb = 90
WBC = 48x10^9
PLT = 116 x 10^9
(normal ranges were provided)
Blood film: small sized cells with mature chromatin, what is the diagnosis?
A) Hairy cell leukemia
B) Splenic Lymphoma
C) Non Hodgkin Lymphoma
D) Chronic lymphocytic leukemia

D) Chronic lymphocytic leukemia

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A 67 year old man with gouty arthritis for 4 years. He has a 3-4 attacks per year. He has a history of a surgery for kidney stones. Which medication would you prescribe?
a) colchicine
b) indomethacin
c) prednisolone
d) allopurinol

d) allopurinol

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36 yr ,Male, Nephrotic syndrome 2 years, High creatinine, Diarrhea , Carpel tunnel syndrome, Dystolic dysfunction. Has Normal kidney size Which one is most associated with the condition?
A) easy bruising
B) HBA1c high

A) easy bruising amyloidosis

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A 24-year-old woman had an uneventful vaginal delivery a couple of weeks back. She now presents with shortness of breath and easy fatiguability. On examination, she was found to have a raised JVP, S3gallop and lower limb edema. An echocardiogram was performed and showed a dilated heart and an ejection fraction of 20%. Which of the following pulses is this patient likely to have?
A) Pulsus alternans
B) Pulsus paradoxus
C) Pulsus bisferiens
D) Pulsus parvus et tardus

A) Pulsus alternans

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Patient with essential hypertension treated with beta-blocker, his BP dropped to 120/80. Which of the following parameters are seen in this patient post-therapy?
A.↓Renin, ↓Angiotensin 2, ↓Aldosterone
B.↑Renin, ↑Angiotensin 2, ↑Aldosterone
C.↓Renin, ↑Angiotensin 2, ↑Aldosterone
D.↑Renin, ↓Angiotensin 2, ↓Aldosterone

A.↓Renin, ↓Angiotensin 2, ↓Aldosterone

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50 years male with long standing diabetes came to ER with ascending parasthesia and absent deep tendon reflexes. Lumbar puncture was done csf showed high protein, others are normal. What is the likely cause?
A) Peripheral neuropathy
B) Vitamin b12 deficiency
C) Guillain-Barre
D) Cord compression

C) Guillain-Barre

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A patient developed bilateral lung infiltrates within 1 hour after blood transfusion. What happened?
A. Transfusion related acute lung injury (TRALI)
B. Transfusion associated circulatory overload (TACO)

A. Transfusion related acute lung injury (TRALI)

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Male patient with history of prostate cancer 1 year ago presented with back pain and paresthesia of both lower limbs. Which of the following is indicative acute cord compression?
A) Sensory level
B) Hyperreflexia
C) Clonus
D) Weakness

D) Weakness

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Scenario. What is the diagnosis:

A) Consrtictive pericarditis

30 years old female, presented with generalized weakness, no hepatomegaly or lymphadenopathy. His CBC showed: Hb 110 low Mcv 123 high WBCs 3000 normal Platlets 45 low Retics 1% Macrocytic Blood film. What is the diagnosis? A) Megaloblastic anemia B) Aplastic anemia C) Liver disease D) hypothyroidism

C) Liver disease

40 yr/o male, coming for annual checkup. History and Physical exam normal Hyperuricemia 520 micromole (200-430) Tx? A) Start allopurinol B) Start colchicine C) Start indomethacin D) Reassure without intervention

D) Reassure without intervention

A 45-year-old Indian gentleman is a known case of rheumatic mitral stenosis. He now presents with recent onset of low-grade fever and malaise. On initial assessment, the patient was ill-looking with a pansystolic murmur detected at the apex on chest auscultation. Echocardiography was performed and showed the presence of suspicious lesions on a regurgitant valve. What is the most likely causative organism of this patient’s presentation? A. Staphylococcus aureus B. Streptococcus viridans C. Staphylococcus epidermidis D. Streptococcus bovis

B. Streptococcus viridans

a young athletic patient presented with exsertional dyspnea and central chest pain after playing football. there is a family history of early death. physical examination showed ejection systolic murmur at left sternal border and pan systolic murmur at apex. ECG: LLLB and left ventricular hypertrophy. Echo was done and showed hypertrophic inter ventricular septum. What medical treatment can help in relieving symptoms? A) beta blocker B) nitrate C) furosemide

A) beta blocker

25 yearold man with recurrent painful ulcers on scrotum and oral mucosa since he was 18 years old, he also has red eyes, arthritis (i think) A) behcet disease B) Reiters C) Sweets

A) behcet disease

A 62 year old woman was brought to the emergency room by her family due to recent change in mental status. Upon examination, she had high calcium 3.7 secondary to multiple myeloma. What could be another finding upon further evaluation of the patient? A) Low pth B) Low phosphorus C) Prolonged qt D) Chovstek sign

A) Low pth

Known case of ulcerative colitis presenting with dark urine, jaundice, and puritus. Lab results reveals high ALP high GGT high direct bilirubin. Ultrasound shows gallstones. MRCP was performed showing multiple intrahepatic and extrahepatic beading (narrowing), common hepatic duct stricture, there are also multiple small gall stones in the gall bladder. What is the best next step? A. ERCP B. Laparoscopic cholecystectomy C. Liver biopsy

A. ERCP or B. Laparoscopic cholecystectomy

Young female came to neurological clinic with nausea head and tinnitus with vision problems. CT head was normal. She was using a medication, what vit in that medication is responsible for her symptoms? A) Vit A B) Vit B C) Vit C D) Vit D

A) Vit A

A male patient presented with fatigue and pallor. Hematocrit 23%. You are suspecting hemolytic anemia. Which one is NOT true regarding hemolytic anemia: A. Elevated haptoglobin B. Elevates retics C. Elevated LDH D. Elevated bilirubin

A. Elevated haptoglobin

Adhesive capsulitis repeated question

A woman presented 3 months after delivery with *nontender* thyroid swelling, high T4 and low TSH with tachycardia, anxiety. What is the mechanism/ cause of the disease ? A) Lymphocytic infiltration of thyroid B) Lymphocytic infiltration of pituitary C) Granulomatous infiltration of thyroid D) High B-HCG

A) Lymphocytic infiltration of thyroid

A 53 year old female went to the opd complaining about her irregular period. She said that her period was normal until 2 years back, then started to be abnormal and suddenly stopped a few months back. She now has hot flashes and dryness in the vagina. Her pregnancy test is negative. Which of hormone would guide us towards the diagnosis ? A. Estrodial B. Fsh C. Progesteone D. Bhcg

B. Fsh

Patient who is known smoker, presenting with weakness and fatigue. Na level= 123 serum osmolality= low Urine osolality= normal Blood glucose= 6mmol what is the most likely cause? A. Underlying lung cancer B. Patient has received IV sodium bicarbonate C. Diabetes insipidus

A. Underlying lung cancer

56 yo male welder presented w/SOB and dry cough. Imaging revealed interstitial pattern in the upper zone w/perihilar calcifications. What is the diagnosis? A) Silicosis B) Asbestosis C) Sarcoidosis D) Berylliosis

A) Silicosis

Patient with recent MI and stenting, he has hypertension, hyperlipidemia performed a sleep study with AHI index of 45. The patient denied daytime sleepeness or waking up during sleep. What would you recommend for the patient? A. Start CPAP B. Reassurance and follow up with cardiology C. Observe and repeat sleep study in 6 months

A. Start CPAP

A 50-year-old female presented with weakness, lethargy & muscle cramps & constipation. Her blood pressure was 220/110. She was started on thiazide, verapamil & nimodipine at the polyclinic and then referred to the hospital. When she went to the hospital her blood pressure was 190/90. Labs were conducted and all were normal except K+ = 3.1 mmol/L she claims that she has been taking her durgs properly. What is the cause of her hypertension? What is your diagnosis? A) Pheochromocytoma B) Conns C) Essential hypertension D) Coarctation

B) Conns

Pt presented w/hip fx. Imaging revealed an osteolytic lesion. Bx of the lesion revelaed sheets of plasma cells. No CRAB features. Mild elevation in Igs. Bone marrow bx was normal. No other osteolytic lesions anywhere in the body. Dx? A) Solitary plasmacytoma B) MM C) MGUS

A) Solitary plasmacytoma

57 years old male prented with “dizziness”, and nearly fainting but did not faint. He has no history of chest pain. He reprted having dyspnia on hoing uphill. He is hypertensive and treated with propranolol and aspirin. He has bradycardia currently and his BP is 130/80. What is the most appropriate next step: A) evaluate for coronary artery disease B) insert perminant pacemaker

B) insert perminant pacemaker (Third degree heart block)

A 34 years old lady presented to gastronology clinic complaining of chronic abdominal pain for 5 years. The pain was all over the abdomen and intermittent. It was associated with constipation relived by defecation. She denied history of bleeding per rectum and no weight loss. Her labs were all normal. Colonoscopy and upper endoscopy were done all normal. What is your next management step? A) Reassure patient. B) Repeat colonoscopy. C) Repeat upper endoscopy. D) CT abdomen.

A) Reassure patient.

What is the best test to monitor SLE activity? A. Complement levels B. CRP C. WBC D. ESR

A. Complement levels

A 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 will you give for the patient’s symptoms? A) Beta blocker B) Calcium channel blocker

A) Beta blocker

55 years old with a positive fecal occult blood test, all other labs are normal, what is the appropriate next step? A) Flexible Sigmoidoscopy B) Double contrast barium enema C) Colonoscopy D) CT abdomen and pelvis

C) Colonoscopy

a 22 year old medical student presented to the er with bizarre jerky movements in both upper limbs. there was no urinary incontinence and no tongue biting. she has a sister with epilepsy on treatment. what investigation will show actual seizures A) prolactin B) TSH C) TRH

A) prolactin

A 54 year old male with history of chronic cough with sputum for many years. He now presentes with one day history of hemoptsis. On presentation he was coughing about 150 ml of blood within 2 hours. His pulse was 100, blood pressure was 130/80, he was afebrile. On examination he had bilateral coarse crackles. What is the appropriate step? A) high resolution CT scan B) Bronchoscope C) CT pulmonary angiography D) Pulmonary artery embolization

B) Bronchoscope? should be bronchoscopy then CT according to sixth year MSD

A 35 year old male presented with acute left knee pain and swelling, his arthrocentesis showed 50,000 wbc cells. What is the most likely causative organism A) Streptococcus B) Staph epidermidis C) Staph aureus D) Hemophilus influenza

C) Staph aureus

A 9 year old boy developed sudden puffy eyelids, ascites and scrotal edema. BP is normal Urine study showed +4 proteinuria. What will the biopsy show? A) Endothelial +ve IG deposition B) No abnormality C) Crescent formation D) IgA mesangial cell deposition

B) No abnormality

A patient with T1DM presented witha picture of DKA, K: 4.1, bicarb: 15, sodium 135. What is the propper treatment? A) Hypotonic 0.45% saline with insulin B) IV fluids, pottasium, insulin C) IV fluids, insulin

B) IV fluids, pottasium, insulin

A 24 year old man was referred from GP for anemia. He’s asymptomatic, physical examination is normal Hb 110 Mcv 65 Electrophoresis HbA 91.7 HbA2 7.1 HbF 1.2 What is the diagnosis? A. Alpha thalassemia trait B. Hemoglobin H disease C. Beta thalassemia minor D. Beta thalassemia major

C. Beta thalassemia minor

A Female had prolonged bleeding after dental extraction, and she needed 2 units of packed RBCs. Her brother died because of prolonged post-operative bleeding and she has relatives who also have prolonged bleeding, both males and females. Her PT was normal, APTT prolonged, and bleeding time normal. What coagulative factor deficiency is likely present? a. Factor VII b. Factor VIII c. Factor XI d. Factor XII

c. Factor XI

A 36 years old philipino male presented with a history of fever pleuritic chest pain (wight loss?). Exray showed pleural effusion which yeilded: LDH 600, total protein 450, ph: 7.22, WBC was elevated with 70% lymphocytes. serum LDH: 300. What is the best next step? A) thocostomy tube B) Pleural biopsy C) Tuberculin skin test D) T spot test

B) Pleural biopsy

Young female is scheduled for lap chole. She has a bleeding disorder that runs in her family (mother and sisters) that involves heavy bleeding after tooth extraction and menorrhagia. She denies history of bleeding into joints. Lab tests showed thrombocytopenia, normal APTT and PT. What is the cause? A. Bernard-Soulier syndrome B. vWD

B. vWD

38yr had a sudden back pain after carrying grocery shop bags last week. He has Thin extremities central obesity round face and proximal muscles weakness. Imaging showed t12 fracuture with 1x2 adrenal tumor. Surgery was arranged. What is the perioperative treatment? A) Alpha blockage then beta blockage before surgery B) Beta blockage then alpha blockage after surgery C) Glucocorticoid supplement after surgery D) Mineralocorticoid antagonist after surgery

C) Glucocorticoid supplement after surgery

A 52 years old patient presented with headache ,pain on mastication blurry vision, ESR = 90 (normal <20). What is the diagnosis.

giant cell arteritis

A 57 patient known hypothyroid, not compliant to her medications. She has been recently diagnosed with a fracture bcs of osteoporosis, her BMI: 23.her TSH: 6 (high) What is the most important risk factor? A) Low peek bone mass in adulthood B) Low bmi C) post menopause slowed bone resorption D) high TSH

A) Low peek bone mass in adulthood

a 30 or 40 years old female has been recently diagnosed with T2DM, she followed a diet and lost 5 kg in 6 months. She has a significant history of recurrent UTI. She is on metformin 850 mg BD. Her HbA1c is 7.8%, and her BMI is 35. What is the best added measure for better control? A) add SGLT2 B) add GLP-1 analogue C) increase metformin dose

18 year old female brought by her mother for excessive weight loss. She lost 5 kg over the past 2 months. She doesn’t use tobacco, alcohol, or elicit drugs. Her mother is hypothyroid. On examination she is anxious. Her BP is 132/70, pulse is 106. Thyroid is small on palpation with no nodules. Tsh is low t4 is high. Negative thyroglobulin. What is to be seen on thyroid biopsy? A) diffuse atrophy of thyroid follicles with decreased colloid B) Excessive lymphocytic infiltrate

B) Excessive lymphocytic infiltrate

70 year old woman presented with an acute episode of painless lower gastrointestinal bleeding. She also has orthostatic hypotension. Physical examination was unremarkable except for gross blood in rectal vault. Upper GI endoscopy revealed copious bile and no blood. What is the most likely diagnosis? A. Diverticulosis B. Colorectal Ca C. AV malformation D. Mesenteric ischemia

A. Diverticulosis or B. Colorectal Ca

A 25-year-old man was found to have microscopic hematuria and proteinuria after excercise. He was also hypertensive. The patient had normal complement levels. What is the likely diagnosis?

IgAnephropathy

A 20 year old patient with active Crhon’s ( peri anal fistula) which of the following will induce fistula healing in 4-6 weeks? A) infliximab B) iv methotrexate C) oral cyclosporine D) oral 6 mercaptolurine

A) infliximab

A 9 years old patient has peanut allergy, he came with a history of peanut ingestion. His blood pressure is 80/30, has angioedema and urticaria, he was given one dose epinephrin, his blood pressure now is 80/40. What is the best next step? A) Administer a second dose of epinephrin in full dose B) Administer half dose of epinephrin C) Administer IV corticosteroid D) Administer IV antihistamine

A) Administer a second dose of epinephrin in full dose UpToDate and AMBOSS: you can give up to 3 doses of IM epinephrin. Review the algorithm

Young pt w marfanoid features complaining of SOB, palpitaions. Auscultatory finding revealed late systolic murmur at the apex. Echo showed mitral valve prolapse w/moderate regurgitation. EDV = 50, EF = 50%. Management? A) Reassurance B) Mitral valve repair C) Mitral valve replacement

C) Mitral valve replacement

A young patient with 2 years history of abdominal pain and diarrhea was diagnosed with Irritable bowel syndrome (IBS). He was referred from the family physician because of suspicious celiac disease and ask you for your advice. The patient was found to have: 2x upper limit of normal anti endomysial Ab, Upper limit normal of anti-TTG, Normal IgA levels, Negative DQ2 and DQ8. No other lab abnormalities. What is your advice? A) patient have celiac disease and should be started on gluten free diet B) patient don’t have celiac and shouldn’t be started on gluten free diet C) patient don’t have celiac and should be started on gluten free diet D) The presence or absence of celiac is indeterminate, and the patient need further investigations

D) The presence or absence of celiac is indeterminate, and the patient need further investigations

Young female presented with chronic diarrhea and iron-deficiency anemia. She was negative for anti-endomyseal antibodies. Upper GI endoscopy was done and revealed villous atrophy. Which of these is she deficient in? A) IgA B) IgG C) Dermatitis herpetiformis

A) IgA

A 40 year old female presented with a history of dyspnea for two years, she also gets bluish discoloration of her fingers when exposed to cold, everything else was normal. whats your next step? A) ECG B) CT coronary angiography C) Echo D) Holter monitor

A) ECG

Patient known NAFLD, presented to ER with 2 days history of fever and abdominal pain It was complicated by ascitis for which the patient was on diuretics & underwent paracentesis It showed 750 WBc ( high ). What is the Management: A) IV vancomycin + IV albumin B) IV ceftiaxone + IV albumin C) IV albumin & await for the culture results

B) IV ceftiaxone + IV albumin

A patient has type 2 diabetes for for years. Has retinopathy. His lab resultes: - Urine miroalbumin: 150 (N: <30) - Serum createnin: normal - C3, C4: negative - Has retinopathy and hypertension What is an indication for kidney biopsy? A) Diagnosis less than 5 years B) The patient has retinopathy C) No indication for biopsy D) The patient has hypertension

C) No indication for biopsy

patient presented with eruted dusky red macules and patches on all four extremities, along with oral erosions after he had been prescribed a drug. What is the most likely diagnosis? A. Steven Johnson syndrome B. Toxic epidermal necrolysis

A. Steven Johnson syndrome

40 year old female with history of 2 episodes of unprovoked of DVT. Not associated with any risk factors. Has family history of thrombotic event. Which is most likely the inherited hypercoagulopathy? A) inactive protein C (factor 5 liden) B) protein C deficiency C) Antithrombin 3 deficiency D) prothrombin A20210G mutation

A is more common answer: B) protein C deficiency

patient presents with history of headache, associated with nasal congestion and dropping eyelid, this happened at the same time last year. What is the most important risk factor of this disease? A) Hypertension B) Diabetes C) Smoking D) hyperlipidemia

C) Smoking

How to differentiate between hemothorax and bloody pleural effusion? A) Looking at both fluids under direct light B) Measuring serum and pleural hematocrit C) We have to rely on history of trauma because we cant rely

B) Measuring serum and pleural hematocrit

A patient with Type 2 diabetes treated with glimepiride was taken to the emergency room because of disorientation and slurred speech. His blood glucose is 50 mg/dl (2.8 mmol/L). In addition to a bolus injection of dextrose, the next step in care would be to A) Re-check his blood glucose after 15 minutes B) Administer a carbohydrate-rich meal C) Infuse glucose 10% solution and admit the patient to the hospital for at least 24 hours D) Infuse glucose 10% solution and plan for discharge at 6 hours if the blood glucose has normalized

C) Infuse glucose 10% solution and admit the patient to the hospital for at least 24 hours

A patient has visual field defect, amenorrhea. She is diagnosed as prolactinoma and treated with cabergolin. Which of the following is ture after the treatment?

Improved visual feild, improved amenorrhea, improved prolactin

72 yo male pt admitted for ACS now on clopidogrel & aspirin. He had upper GI bleeding 12 years ago and was treated w/H pylori eradication and was put on H2 receptor antagonist since then (ranitidine 150mg BD). What would you do? A) Retreat H pylori for eradication B) Continue same regimen C) Switch ranitidine to PPI D) Incraese Ranitidine dose to 300 mg

B) Continue same regimen

20 years old student presented with 2 episodes of syncope earlier today. First was while showering, was preceded by nausea and diaphoresis and followed by syncope. After waking she tried standing and felt nauseated, vomited and lost consciousness again. She’s previously healthy, but had ‘flu’ for 3 days. Her past history, physical exam, ECG, and labs are all normal. She had history of fainting once upon drawing blood from her vein for lab test. What should be done for her? A) holter monitoring B) mri brain C) echocardiogram D) reassure about benign course

A) holter monitoring

male presented with proximal muscle weakness. He had polyarthritis, raynauds phenomenon, (hemoptysis/ sob). HRCT showed interestitial lung disease. Which of the serological markers are likely to be positive/ diagnose this patient? A- anti Jo1 antibodies B- anticiturullinated peptide antibodies C- anti neutroophil cytoplasmic antibodies D- anti Ro antibodies

A- anti Jo1 antibodies

50 year old painter progressive dyspnea for 2 years. Smoker 10 cigarettes/day since he was 25. Father had lung cancer, 2 brothers had troubles breathing but did not know the diagnosis. FEV1 52%, FEV 88%, FEV1/FVC 66%, TLC 120%, RV 156%, DLCO 56% What should be done to improve method of treatment? A. Methacholine challenge test B. FEV1 after and before bronchodilator C. Alpha 1 protease inhibitor D. Gallium scan

C. Alpha 1 protease inhibitor

A young athletic female who was incidentally discovered to have systolic thrill and murmur. Her JVP has occasional prominent a waves. This is her chest x-ray. How to manage? A) Device close for patent ductus B) Pulmonary valve valvuloplasty

B) Pulmonary valve valvuloplasty

A 40-year-old male developed central chest pain while jogging. He presented to ER within 1 hour. He is conscious and was given sublingual nitrates which relieved his chest pain. His HR is 90 bpm, bp is 150/80 and his JVP is elevated with prominent V wave. His ECG is shown below. What is the next step in the management? A. Admit, cardiac catheterization + coronary angiography + stenting B. Admit, administer aspirin, clopidogrel, BB, LMWH C. Admit, administer aspirin, clopidogrel, LMWH, thrombolytics D. Echocardiogram to conform cardiac tamponade and emergency pericardiocentesis

A. Admit, cardiac catheterization + coronary angiography + stenting

A diabetic patient with peripheral neuropathy and loss of proprioception and tendency to fall. he is on metformin. whats the next best step to confirm the diagnosis? A) b12 levels B) b6 level C) electromeylography and neurocndution studies

A) b12 levels

a middle age – elderly male, Known to have HTN and osteoarthritis taking naproxen had iron diffecincy anemia. Colonoscopy showed terminal ileum ulcer, biopsy showed submucosal fibrosis, no crypt abscess What to do next? A) Do MR enterography B) Start infeliximab C) Start meselamine D) Stop naproxen

D) Stop naproxen

pt with ckd, dm and hypertension. What is the ideal bp target? A) 130/80 B) 120/70

A) 130/80

A40-year-old presented with itchy redwell-demarcated dark lesions on his axilla and groin. Wood lamp showed coral-red appearance. A) Erythrasma B) Erysipelas C) Tinea versicolor D) Tinea capitis

A) Erythrasma

A pregnant women with sudden severe headache, nausea and vomiting. When she reached to the hospital she had convulsions and on examination she had papilledema. what do we have to rule out first? A) Cerebral venous thrombosis B) Meningitis C) Meningioma

A) Cerebral venous thrombosis

A 60 year old patient was taking NSAIDs for his back pain that he’s been having for many years. He had low blood hemoglobin. Urine dipstick showed trace albumin levels. Albumin/protein ratio >0.3. A 24-hour urine protein level was 1.8 g/L. What do you expect to find in this patient? A. Mononeuritis multiplex B. Renal biopsy showing fractured tubular casts C. Congo red stain positive

B. Renal biopsy showing fractured tubular casts (N.B. Reversal of albumin/protein ratio implies overproduction of globulins, which along with bone pain and anemia (CRAB), is suggestive of MM. A negative urine dipstick in this scenario implies Bence Jones proteinuria (undetected free light chains in the urine). Urine protein level is in the tubular range (not nephrotic), which makes amyloidosis unlikely.)

UC patient, showing pictures of colon with different involvement pattern, which one has the most risk of cancer? A) A B) B C) C

A) A (risk of colon ca)

A 58-year-old woman is a known case of chronic kidney disease on dialysis. Biochemical investigations showed low serum calcium, elevated parathyroid hormone, elevated alkaline phosphatase and elevated phosphate levels. What skeletal abnormality is likely to be found on bone x-ray of this patient? * Rugger jersey spine * Dense lesions in the long bones * Hair-on-end appearance * Lumbar syndesmophytes * Cotton-wool appearance of the skull

* Rugger jersey spine

What is true regarding these vaccines A) Leukemia on treatment can safely take pneumococcal vaccine B) DTP is live attenuated C) Pregnant avoid influenza vaccine D) In case of hep b vaccine: +hbs-ab ,+hbc-ab, and negative hbs-ag

A) Leukemia on treatment can safely take pneumococcal vaccine

patient kc of psoriasis with psoritatic plaques over the extensor surfaces for 15 years Presented with 3 months history of lower back pain with stiffness of more than 60 mins with Achilles tendon insertion site pain and swelling. A diagnosis of psoriatic arthritis was made. What is the best treatment? A) anti tnf B) Hydroxychloroquine C) Steroids D) Methotrexate

A) anti tnf

A 25 year old male mechanic presented with acute weakness & difficulty urinating after carrying a heavy object , MRI was done & showed a herniated disc. How would you intially treat this patient ? A) ivig B) isotnic saline C) mannitol D) iv steroids

D) iv steroids

diabetic recently changed to triple therapy. What is the maximum time you should wait to check HbA1c for good control before deciding to switch to insulin? a)1 month b) 3 months c) 6 months d) 12 months

b) 3 months

What is tho most common cause of bacretial mengitis in the general population?

Strept. Pneumo

A 34 year old female at 6 weeks post-partum with no other medical conditions is admitted to the ER with 2 days fatigue, petechia and dark urine. Labs are as follow. WBC’s (11200), hb (72), platelets (38,000). Electrolytyes were unremarkable except creatinine (300). Urinalysis showed only hemoglobin without blood. LDH was 4 times the upper limit of the reference range. That was her blood smear: A) Disseminated intravascular coagulation B) immune thrombocytopenic purpura and hemolytic anemia (evan syndrome) C) thrombotic thrombocytopenic purpura D) henoch schonlein purpura (igA vasculitis)

C) thrombotic thrombocytopenic purpura

A patient developed a septic transfusion reaction after transfusion of RBCs What is the commonest organism caused by transfusion reactions ? A) Staphylococus epidermidis B) Yresinia entrococi C) Klebsilla pneumonia D) Entrococus

B) Yresinia entrococi

A female has typical symtoms of graves disease and proptosis. She took antithyroid medication which partially improved the proptosis. What does this drug affect? A) Inflammatory infiltrate B) Thyroglobulin cleavage and T4/T3 release C) Increase trapped iodide?

B) Thyroglobulin cleavage and T4/T3 release

Patient has proximal weakness, polyarthritis, Raynaud’s phenomenonFound to have interstitial lung disease. What would you find? a)Anti Jo-1 b) Anti CCP c) ANCA d) Anti Ro

a)Anti Jo-1

A 26-year-old male presents with a swollen, painful ankle. On examination, the ankle joint looks erythematous and is tender to touch. He was also noted to have a pustular rash on the dorsum of his foot. He reported having a recent urethral discharge. What is the likely diagnosis in this patient? A. Reactive arthritis B. Gonococcal arthritis C. Henöch-Schonlein purpura D. Psoriatic arthritis

B. Gonococcal arthritis

68 years old male ,ex-smoker,K/C/O COPD, on triple therapy (ICS, LAMA, LABA). Complaining of recurrent exacerbation and copious sputum production in morning. Management to reduce exacerbations: A) Long term oxygen therapy B) Oral corticosteroid C) Oral tablet amphylaphil D) Oral fluomoncklast

A) Long term oxygen therapy

A patient with recurrent infections, presented with greenish sputum (picture of bronchiectasis). What is the likely orgainsm? A) Influenza A B) Pseudomonas aeruginosa C) Ecoli

B) Pseudomonas aeruginosa

pt with seafood allergy , consumed seadfood by accident. Developed angioedema. BP (90/60) respiratory 26. You order epinephrine but the nurse tells you that he has hypertension, and diagnosed with is ischemic heart disease 2 years ago (cardiac catheterization with stents) what would you do ? A) give full dose of epinephrine B) hold epi and give IV glucocorticoid C) give half he dose of epinephrine D) Half epi and Iv glucocorticoid

A) give full dose of epinephrine (UpToDate: there is NO absolute contraindication, and recommend against reluctance of administering epinephrin in patients with CVD since anaphylaxis causes more dmage)

A 60 years old patient smoker for 20 years 2 packs per day presented with heartburn, progressive dysphagia and regurgitation. Barium study showed tapering of the esophagus at the gastroesophageal junction(no pictures were provided). What is the most appropriate management? A) Esophageal manometry B) Esophagiscopy with biopsy C) Esophageal ballon dilation D) Double contrast barium meal study

B) Esophagiscopy with biopsy

A 56 years old patient presented with stoke. His workup revealed slightly elevated Hb (exactly what was written in the exam) and platlets: 1150 (150-450). What is most likely the diagnosis ? A) Polycythemia vera B) Essential thrombocythemia

B) Essential thrombocythemia

A patient treated in the ICU, has acute kidney injury, what is the earliest indicator recovery of renal function? A) Urine output B) Serum creatinine C) 24 hour urine GFR

A) Urine output? (diuretic phase)

A 26-year-old woman was admitted with diabetic ketoacidosis. After 24 hours of treatment with intravenous fluids, potassium and insulin, her normal subcutaneous insulin regimen was resumed. However, she felt nauseated and there was a concomitant increase in blood ketones to 3.5 mmol/L (<0.3). On examination, her pulse was 118 beats per minute and her blood pressure was 106/66 mmHg. Labs: Na 136, K 4.4,Bicarb 15 (20- 28), Creatinine 78 (60-110), random glucose 7.3 mmol/l. A) Increase subcutaneous basal insulin at bed B) Increase subcutaneous bolus insulin with meals C) Start fixed-rate IV insulin infusion D) Start glucose 10% with fixed-rate IV insulin

D) Start glucose 10% with fixed-rate IV insulin

Patient with hypothyroidism and high prolactin, what is the pathophysiology behind increased prolactin? A) TRH-induced activation of lactotrophs B) TSH- induced activation of lactotrophs

A) TRH-induced activation of lactotrophs

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

3 to 4 .5 hours

A young Male presented with shaking of his hands when he performs tasks. It was aggravated by anxiety. He says that his father and grandfather have the same problem. What is the most likely diagnosis? A) Parkinson's Disease B) Hypothyroidism C) Hyperthyroidism D) Essential Tremor E) MS

D) Essential Tremor

A 32 year-old woman presented with hemoptysis and hematuria. No joint pain or arthritis. C3 and C4 normal. Urinalysis revealed RBCs with casts but no WBCs. What is the most likely diagnosis?

Anti- GBM

30 year old female presented with painful tender red nodules on her shins. She has fever and arthralgia. One month ago she had sore throat and dry cough. Investigation shows high ESR, lymphocytosis, and negative tuberculin test. Chest x-ray is normal. A) erythema induratum B) erythema nodosum C) Erythema multiforme D) Erythema annulare centrifugum

B) erythema nodosum

A 55-year-old female presented with history of hip, shoulder, and neck pain and stiffness for the past few months. Her laboratory work-up showed Hb = 10 g/dL (low) and ESR = 100 mm/hour (markedly elevated). What is the most likely diagnosis? A) Polymyalgia rheumatica B) Fibromyalgia C) Rheumatoid arthritis D) Lupus arthritis E) Osteoarthritis

A) Polymyalgia rheumatica

66 year old Female, known to have hepatitis c virus cirhossis Presented with increased confusion. No history of GI bleed, trauma, fever,constipation. Sh has been admitted multiple times for the same reason. She is on lactulose and compliant and passes stool 2-4xper day On P/E: she is disoriented and has flapping tremor Other than lactulose what would u add to the management A) Piperacillin tazobactam IV B) Albumin IV C) Low protein D) Rifaxamin

D) Rifaxamin

a 30 yrs old previously healthy nurse presented to the ER with sharp central chest pain, the pain was worse on lying supine and made better with sitting up. She had 1 week history of mild fever , headache , arthralgia & myalgia. P/E : normal jvp Bp 110/70 normal auscultation no murmur or gallop. ECG in ER ( st elevation of all leads?) Echo: showed minor hypoechoic space bt heart and pericardium Whats is the best next management for this patient? A-emergency pericardiocentesis B- ibuprofen, colchicine & continue observation C- urgent ct to look for malignancy or Tb D- antibiotics+?

B- ibuprofen, colchicine & continue observation