2017 Flashcards
1
Q
A 55-year-old patient with a 13 year history of asthma and on inhaled corticosteroids, he presented with 4 week history of hypertension. Which medications should not be given?
A) Propranolol
B) Verapamil
C) Nifedipine
D) Hydrochlorothiazide
A
A) Propranolol
2
Q
A previously healthy 14-year-old boy presented with decreased urine output and a rise in serum creatinine to 200 following one tablet of ampicillin for his sore throat. Urine routine and microscopy show RBCs 5-7 WBCs 10-15/HBF with protein +1, How should he be treated?
A) Normal saline
B) Corticosteroids
C) Nothing since it is post streptococcal glomerulonephritis
D) Hemodialysis
A
C) Nothing since it is post streptococcal glomerulonephritis
3
Q
A type 1 diabetes patient had hyperglycemia of 26 and Na=130. What is the cause of the hyponatremia?
A) Low aldosterone
B) High blood osmolarity
A
B) High blood osmolarity
4
Q
A patient on a medication showed anti-histone antibodies, what will you do?
A
Stop the medication
5
Q
20-year-old women presented with weight loss, intermittent right iliac fossa pain, perianal discharge and diarrhea for 6 months. Physical examination showed aphthous ulcer in the mouth and tender right iliac fossa mass. What is the best way to investigate her condition?
A) Colonoscopy
B) Upper gastrointestinal endoscopy
C) Pill colonoscopy
D) small bowel enteroscopy
A
A) Colonoscopy
6
Q
A patient with fever and sore throat, a radio scan showed diffused reduced uptake. On physical exam she had tenderness of the thyroid gland (+/- with a hard mass in the right lobe), what is the best investigation to confirm the diagnosis?
A) fine needle aspiration cytology
B) increased thyroglobulin
C) increased TSH
A
A) fine needle aspiration cytology
7
Q
Myasthenia gravis –> _______ on repeated nerve stimulation?
A
decrement
8
Q
Before giving azathioprine, what enzyme should be investigated?
A) Azathioprine dehydrogenase
B) Xanthine oxidase
C) Thiopurine methyltransferase
A
C) Thiopurine methyltransferase
9
Q
A 22-year-old man was pulled out of a collapsed building, what is the most important measure to prevent renal failure?
A) Start iv normal saline
B) Start iv calcium carbonate
C) Start dialysis regardless of renal function
A
A) Start iv normal saline
10
Q
A patient underwent coronary angiography. Which if the following would you expect to find in contrast induce nephropathy?
A) Proteinuria > 2.6
B) Hematuria
C) Eosinophiluria
D) Increased urine osmolarity
A
D) Increased urine osmolarity
11
Q
A 58-year-old lady with symptoms of grade 2 dyspnea on NYHA, the doctor suspected Sjogren syndrome as the patient was also experiencing dry eyes and mouth. Which would support this diagnosis?
A) Anti-CCP
B) Anti ro ssa/la ssa
c) C-ANCA
A
B) Anti ro ssa/la ssa
12
Q
20-year old gentleman presented with right lower quadrant pain, diarrhea and weight loss for 6 months. On physical examination he had finger clubbing and palpable mass in the right iliac fossa and perianal discharge, (a different barium enema image was provided in our exam).
A) Acute appendicitis
B) Carcinoma of the colon
C) Chronic amoebiasis
D) Crohn’s Disease
A
D) Crohn’s Disease
13
Q
A patient with psoriasis developed severe pain in the back of his ankle. Which of the following is a musculoskeletal manifestation of his disease?
A) Heberden nodules
B) Bouchard Nodules
C) Enthesitis
A
C) Enthesitis
14
Q
52 year old male came in for a checkup. He had no symptoms. normal physical exam. relevant past medical history of colorectal carcinoma, normal CBC, he also had positive fecal occult blood. What is your next step of management?
A) Colonoscopy
B) Flexible sigmoidoscopy
C) Reassurance
A
A) Colonoscopy
15
Q
Patient presented with prolonged PT and everything else was normal, what factor is deficient?
A) Factor 12 deficiency
B) Factor 13 deficiency
C) Factor 7 deficiency
D) Von-wilebrand factor deficiency
A
C) Factor 7 deficiency
16
Q
A young high school student with BP of 160/90. What make the diagnosis essential hypertension rather than secondary hypertension?
A) K = 1.4 (hypokalemia)
B) Ph = 7.4
C) Bilateral renal cyst
D) Proteinuria > 2 mg
A
B) Ph = 7.4
17
Q
A patient with hearing loss due to middle ear problem, the air conduction will be?
A) less than the bone
b more than the bone
c) same as the bone
A
A) less than the bone (conductive deafness?)
18
Q
A patient was diagnosed with rheumatoid arthritis, and she follows up in rheumatology clinic. What is best used to follow up the patient?
A
CRP
19
Q
- Which of the following pathological changes favors UC over Crohn’s?
A) Villous atrophy
B) Granulomas
C) Transmural involvement
D) Crypt abscess
A
D) Crypt abscess
20
Q
A patient presented with proximal DVT, she has a history of recurrent abortions and immuno-thrombocytopenia. What could be the reason of current presentation?
A) SLE
B) Aspirin
C) Primary Anti-phospholipid syndrome
D) Estrogen
A
C) Primary Anti-phospholipid syndrome
21
Q
A 23 year old female presents with cough and purulent sputum. She has been having chronic respiratory symptoms since childhood including nasal congestion, sinusitis. Two of her siblings have a similar condition. Which organism is associated with exacerbations of her condition?
A) Pseudomonas aeruginosa
B) Streptococcus pneumonia
C) Chlamydia pneumonia
D) Candida albicans
A
A) Pseudomonas aeruginosa
22
Q
A 41 year old male with 7 years history of diabetes, hypertension, &obstructive sleep apnea. He now
presents with constipation and colonoscopy showed multiple polyps. He also complains of fatigue, decreased libido, headache and change in vision that progressively worsens over the years. What is the next investigation test?
A) 1 mg dexamethasone suppression test
B) C peptide level
C) Insulin suppression test
D) Insulin like growth factor 1 level
A
D) Insulin like growth factor 1 level
23
Q
40-year-old female known case of rheumatoid arthritis was scheduled for abdominal surgery. What investigation should be done prior to intubation?
A) Hand x-ray
B) Foot x-ray
C) Cervical x-ray
D) Lumbar x-ray
A
C) Cervical x-ray
24
Q
24-year-old female with malar rash mouth ulcers and symmetrical joints pain. what serological test will you ask for to determine the diagnosis?
A) ANA
B) Anti-CCP
C) Rheumatoid factor
D) Anticardiolipin
A
A) ANA
25
What would make you suspect secondary headache in a man in his 40s?
Sudden onset
26
A diabetic patient with non-proliferative retinopathy, HT, dyslipidemia, neuropathy. He says that he is adherent to his medication (sartan? and statin) and to his
two DM drugs (metformin and empaglifozin), his BMI is 31 and his urine study was normal however his HbcA1 is 7.7. How to manage?
A) switch to basal-bolus
B) Bariatric surgery.
C) Add GLP-1 or SGLT1? not sure
B) Bariatric surgery. not sure
27
A patient with occasional chest pain on exertion, woke up in the middle of the night feeling dyspneic. ECG shows no changes and high troponin, what is the diagnosis?
A) Unstable angina
B) NSTEMI
B) NSTEMI
28
A lady with secondary amenorrhea, normal LH & FSH levels, low estradiol level. MRI showed a mass near sella turnica right to the pituitary, what is the likely diagnosis?
A) Lactoadenoma
B) Gonadoadenoma
A) Lactoadenoma
29
A young nurse presented with 4 days history of sharp central chest pain, worse with activity, lying flat and breathing but better with sitting forward, what is the likely diagnosis?
A) Pleurisy
B) Pericarditis
B) Pericarditis
30
A 22 years old woman presented with severe hypertension (180/110), she has normal renal function and normal kidney sizes, she denies palpitations or sweating, she did not have cushingoid features, her electrolytes:
Na: 146 (135-145)
K: 2.9 (3.5-5)
Ph: 7.5
What's the best diagnostic test:
A) Serum catecholamines
B) 24-hour urinary metanephrines
C) Serum cortisol
D) Aldosterone : renin ratio
D) Aldosterone : renin ratio
31
Which is an extra-articular manifestation of sero-positive rheumatoid arthritis?
A) Myopathy
B) Pleural effusion
B) Pleural effusion
32
25-year-old male with history of progressive cervical lymph nodes, over the last months. Biopsy showed non-caseating granuloma, what is the likely diagnosis?
A) Sarcoidosis
B) Hodgkin Lymphoma
C) Non-Hodgkin Lymphoma
D) Tb
A) Sarcoidosis
33
A 19 years old patients diagnosed with diabetes two years ago. She is on a healthy diet, exercises regularly, and is on multiple insulin injections. She had multiple low blood glucose readings (2.4-3.2) both while fasting and before her meals. She did not experience any hypoglycemia symptoms excepts once two months ago during which the device reading was OL. What is the most appropriate management?
A) Reduce her basal insulin
B) Reduce her bolus insulin
C) Reduce her meal intake
D) Change the device
A) Reduce her basal insulin
34
A 65-year-old patient with hip pain and short morning stiffness, what is the first line therapy?
A) Paracetamol
B) Prednisone
A) Paracetamol
35
A man who is a vegetarian (vegan) had fatigue, weakness and numbness, what is expected to be found?
A) Hyper-segmented neutrophils
B) Low folic acid
A) Hyper-segmented neutrophils
36
A 64-year-old lady complains of pain in her left knee and morning stiffness that lasts about 15 minutes. What would the X-ray most probably show?
A) Subchondral sclerosis
B) Symmetrical joint narrowing
C) Increased joint space
D) Osteophyte
E) osteopenia
D) Osteophyte
37
Rheumatic fever case with abnormal cardiac examination, penicillin was administered, what else will you give?
A) Aspirin
B) Prednisone
C) Colchicine
B) Prednisone
38
29-year-old lady with sickle cell disease and admitted previously for vaso-occlusive crisis recently has been diagnosed with pneumonia and septicemia. What complication predisposed her to having this condition?
A) Splenic atrophy
B) Hypogammaglobulinemia
C) Drug induced neutropenia
D) Weakened T cells
A) Splenic atrophy
39
which is not a characteristic of cerebellar lesions?
A) Dysdikinokinesia
B) Hypermeteria
C) Hypertonia
D) Ataxia
C) Hypertonia
40
A patient with hypernatremia, what will happen if the sodium is correct in a fast rate?
A) Cerebral edema
B) Cerebral pontine myelinosis
A) Cerebral edema
41
A young female with 5 years history of SLE presented with right sided hemiplegia, no active synovitis or cutaneous lesions, MRI showed hypertense T2 lesion in MCA territory. What investigation is important to plan her management?
A) ANA
B) Anti-Jo
C) Anti-cardiolipin
D) CSF of anti-ribosomal p protein antibody
C) Anti-cardiolipin
42
Chest pain scenario with ECG attached, which artery is affected?
A) Right coronary artery
B) Left anterior descending coronary artery
C) Left circumflex artery
B) Left anterior descending coronary artery
(ANTERIOR WALL)
43
which of the following is used to lower potassium in a patient with hyperkalemia?
A) NaHCO3
b) Glucose
C) Beta blockers
D) Calcium gluconate
A) NaHCO3
44
An old man presented with hemoptysis and rapidly progressive renal failure, immunofluorescence shows anti-GBM antibodies, what is the diagnosis?
A) Goodpasture syndrome
B) SLE
C) Wagner granulomatosis
A) Goodpasture syndrome
45
what is the diagnosis?
A) atrial fibrillation
B) atrial flutter
A) atrial fibrillation
46
A female from Algeria came to Kuwait 1 year ago. She recently presented with one- month history of cough with yellow to green sputum, intermittent fever, sweating, & 4kg weight loss. She's a lifetime smoker. Physical examination was unremarkable except for a low-grade fever of 37.8°. Chest X ray showed right upper lobe cavity with surrounding consolidation and CBC was normal. What is the most appropriate initial investigation?
A) CT chest
B) Blood culture with sensitivity
C) Sputum sample for Zeihl-Nelson
D) Treat with broad spectrum antibiotics and repeat chest x ray in two weeks
C) Sputum sample for Zeihl-Nelson
47
A 25-year-old female presented with urticaria eruption in her trunk and legs. She has fever of 39, sore knee and ankle. There is a history of pharyngitis and otitis media. She was on Cefaclor. Urticarial eruption has resolved, but she still has joint pain, fever, and (something forgotten?). What is the diagnosis?
A) Urticaria
B) Serum sickness
C) Serum sickness-like reaction
D) Urticaria vasculitis
C) Serum sickness-like reaction
48
How to detect rheumatoid factor?
Nephelometry
49
A patient recently diagnosed with hypertension and diabetes is having microalbuminuria, how to prevent the progression of diabetic nephropathy?
A) ACEI
B) Beta blocker
C) Thiazides
A) ACEI
50
A woman takes naps during her work time and dozes off during the day time. On examination, her BMI is 30, neck circumference is 18 inches and has redundant tissue in her nasopharynx. How will you proceed to management?
A) Advise her to lose 10-15 kg in 3 months
B) Put her on c-PAP device during sleep
C) Put her on oxygen therapy during sleep
D) Refer her to ENT surgeon to do a uvulopalatopharyngoplasty
A) Advise her to lose 10-15 kg in 3 months
B) Put her on c-PAP device during sleep
Answer: A vs B
(as losing weight might take time so you should start cPAP meantime)?
51
70-year-old male presents with chest pain, exertional dyspnea and syncopal episodes, on auscultation a musical murmur was heard all over the pericardium, what’s the diagnosis?
A) Aortic stenosis
52
A young female presents with palpitations, sweating tremor, positive family history of hypothyroidism and her mom has vitB12 deficiency anemia. On examination she had NO eye symptoms but has thyroid bruit. Both of the thyroid lobes were enlarged with a nodule on the right lobe. Her labs showed high T3 & T4 and low TSH. What is the diagnosis?
A) Graves' disease
B) Solitary nodule
A) Graves' disease
53
A patient taking anti-hypertensive drug, presented with the following, which drug is she taking?
A) CCB
B) ACEI
A) CCB
54
A patient with an evidence of liver cirrhosis, ascites, and fluid thrill and shifting dullness on physical examination, what is the initial step to manage this patient?
A) Salt restriction
B) Fluid restriction
C) Diuretics
D) protein free diet
A) Salt restriction
55
which of the following is indicative for history of seizures?
A) palpitations & chest pain prior to
B) tongue biting & urinary incontinence
C) previous history of same symptoms
D) NOT confused after gaining consciousness
B) tongue biting & urinary incontinence
56
A patient with big toe pain and swelling, what is the diagnosis?
A) Rheumatoid arthritis
B) Gouty arthritis
C) Septic arthritis
B) Gouty arthritis
57
49-year-old patient during his routine checkup for diabetes, what confirms his diagnosis of diabetes mellitus?
A) HbA1c>7%
B) HbA1c>6.5%
C) Random glucose 7.2
B) HbA1c>6.5%
58
Which of the following is considered as type 1 hypersensitivity?
A) 17 year old female developed pruritic rash 2 days after wearing a necklace
B) 20 year old male developed abdominal cramps and diarrhea shortly after drinking a glass of milk
C) 20 year old male developed shortness of breath and chest tightness shortly after sitting in his garden
D) 35 year old female with lupus erythematosus who developed lupus nephritis
C) 20 year old male developed shortness of breath and chest tightness shortly after sitting in his garden
59
What is your diagnosis?
A) SLL
B) ALL
C) CML
D) AML
D) AML
60
Which drug should not be used for life long maintenance treatment in crohn's disease patients?
A) Mercaptopurine
B) Methotrexate
C) Anti TNF agent
D) Azathioprine
E) steroids
E) steroids
61
63-year-old patient has bilateral knee pain with less than 15-minutes morning stiffness, what is the initial step of investigation?
A) Anti-CCP
B) Rheumatoid factor
C) Knee x-ray
C) Knee x-ray
62
28 year old female teacher presented with 6 weeks history of cough and wheeze. This is her 16th week of gestation, what is the best prescription for her?
A) SOS (when needed) salbutamol is enough at this stage of pregnancy
B) Regular beclomethasone and SOS (when needed) inhaled salbutamol
C) Montelukast is enough at this stage of pregnancy
D) Mucolytic syrup is safe at this stage of pregnancy
A) SOS (when needed) salbutamol is enough at this stage of pregnancy
63
40-year-old lady presented with jaundice, weakness, fatigue, diagnosed with AIHA by coombs test, what is the first line therapy?
A) Observation and blood transfusion when needed
B) Splenectomy
C) Rituximab
D) Prednisolone
D) Prednisolone
64
A patient presenting with wheeze for multiple times, preventing her from attending classes and affecting her daily life, which medication should be starting on?
A) SABA
B) LABA
C) ICS
C) ICS
65
What is a nodule?
A) Solid elevation with dermal extension
B) Hard elevation within .. cm
C) Hard elevation with firm consistency
D) Hard elevation with fluid
C) Hard elevation with firm consistency
66
A scenario of diabetic neuropathy, what is the best investigation to do?
A) Brain MRI
B) Spine MRI
C) Lumbar puncture
D) Nerve conduction study
D) Nerve conduction study
67
A 33-year-old patient with only right leg weakness. Where is the lesion?
A) Pons
B) Midbrain
C) Cortex
D) Medulla
C) Cortex
68
A patient with ulcerative colitis and IDA, what is the best measure to maintain his iron level?
A) IV iron
B) Oral iron
C) Iron rich food
A) IV iron?
69
A 46-year-old man, a known case of alcoholic cirrhosis, presented to ER with hematemesis and jaundice. He's been doing well until this bleeding episode. physical exam is normal, alert and oriented. No ascites. He received IV fluids and IV octreotide, and gastroenterology was consulted for an upper endoscopy. (Hg: 128. Platelets: 80, INR:1.3) what's the best next step?
A) IV antibiotics
B) Blood transfusion
C) TIPPS
D) Sengstaken Blackmore tube
A) IV antibiotics
70
A 44-year-old female with breast cancer and metastasis, presented with tingling sensation on arm and leg and urinary incontinence. Cranial nerves were intact. Where is the lesion?
A) brain stem
B) cerebrum
C) Cervical spine
D) Lumbar spine
C) Cervical spine
71
A patient with right Middle cerebral artery infraction, what will be his presentation?
A) Aphasia
B) Weakness in the lower limb more than upper limb
A) Aphasia
72
A patient had valve replacement 6 weeks ago presented with fever and ?? , what is the most likely organism?
A) st. pneumonia
B) st. viridains
C) chlamydia
Answer: ? (St. epid was not an option)
Healthy valve --> staph.aureus
Diseased valve --> strep.viridians
Prosthetic valve (<60 days of surgery) --> staph.epidermidis
Prosthetic valve (>60 days of surgery) --> streptococcus
73
A patient with evidence of altered mental status confusion, palmar erythema, flapping tremor and fetor hapitcus, does not have constipation nor electrolytes abnormalities. He does not have a fever, what do you give him to relieve his confusion?
Lactulose
74
What is the mechanism of action of octreotide?
Splanchnic vasoconstriction
75
A 25 year old lady with 5 year history of SLE presented with fatigue. She is on hydroxychloroquine 200 mg. She has active synovitis in her joints, jaundice, and pallor. Hemoglobin levels measured were 63 (low). What is the best test to guide therapy?
A) Direct coombs test
B) Anti ribosomal p
C) Anti-CCP
D) Antiphospholipid
A) Direct coombs test
76
32-year-old female with SLE. She decided to stop her glucocorticoids because she "was feeling fine", 1 week later she presented to the emergency department. Which of the following is likely to be seen in her serum analysis?
A) Hypoglycemia
B) Hypernatremia
C) Hypokalemia
D) High ACTH
A) Hypoglycemia
77
A 64-year-old female was diagnosed with idiopathic pulmonary fibrosis (IF). prognostically speaking, which of the following statements is true?
A) The median survival at the time of diagnosis (without treatment) is 3 years
B) Smoking has no role in prognosis
C) Females have a worse prognosis
D) young patients have worse prognosis
A) The median survival at the time of diagnosis (without treatment) is 3 years
78
A 23-year-old women admitted with pneumonia. She was given IV ampicillin and gentamicin. She also had CT with contrast on the fist day. On the 4th day her serum creatinine was normal. On the 8th day her serum creatinine was 250. What is the cause of AKI?
A) Sepsis due to pneumonia
B) Contrast
C) Gentamicin
D) AIN
C) Gentamicin
79
A patient brought for evaluation of his frequent falls. On examination, he had shuffling gait.
Bradykinesia, resting tremor, and rigidity. The doctor gave him a treatment which he improved after.
What is this drug?
A) Levodopa
B) Beta blocker
C) Calcium channel blocker
A) Levodopa
80
A patient underwent an aortic valve replacement with St. jude mechanical valve, she had history of rheumatic heart disease and pulmonary edema. She was successfully treated and now she must be discharged. what do you give her as lifelong treatment?
A) Clopidogrel
B) Warfarin and aspirin
C) Rivaroxaban
D) Dabigatran
B) Warfarin and aspirin
81
30 year old male, smoker, with family history of tuberculosis, with the following X- ray (the scenario in the exam was different and longer), what abnormality will be heard on auscultation?
A) Systolic murmur (and something)
B) Early diastolic murmur (and something)
C) Loud S1
D) Soft S2
C) Loud S1
82
30-year-old man, known case of asthma controlled on daily inhaled steroids and LABA, had symptoms of SOB, cough with purulent sputum and fever of 38 degrees one week ago.
The exam provided 2 x-rays:
1. The first x-ray was taken 1 week ago: it shows an opacity in the middle third of the right lung.
2. The second one is a recent x ray: I think it was normal the opacity wasn't there.
They also provided lab tests that compared results from 2 years and recent blood test IgE, WBCs, eosinophils were all increased compared to results from 2 years ago.
What’s the diagnosis?
For the diagnosis I am not sure about the choices but i chose allergic bronchopulmonary aspergillosis
83
A 55-year-old female presented with 6 months of worsening fatigue and pruritis. She has past medical history of hypothyroidism. On examination, she had xanthelasma and liver was palpable. Lab results (were given in a table) show normal ALT, AST, direct bilirubin, indirect bilirubin, and high ALP (reference ranges were given). What is the diagnosis?
A) Primary biliary cholangitis
B) Primary sclerosing cholangitis
C) Autoimmune hepatitis
D) Overlap syndrome
A) Primary biliary cholangitis
84
A patient with obstructive sleep apnea and COPD and a scenario of polycythemia signs and symptoms (make sure you know them), what will be the finding (on CBC)?
High erythropoietin
85
what is the cause of erosion in RA?
Panus formation
86
A lady had abdominal surgery 6 weeks ago, two weeks ago she traveled for 4 hours, presented with right sided chest pain and difficulty breathing. She also has left red swollen leg. According to well criteria of PE, which accounts for the highest pretest probability?
A) Travel
B) Surgery
C) Swollen leg
C) Swollen leg
87
which type of ataxia does Romberg test detect?
A) Cerebellar ataxia
B) sensory ataxia
B) sensory ataxia
88
which of the following is a migraine prophylaxis?
A) Sumatriptan
B) Propranolol
C) Narcotics
D) Paracetamol
B) Propranolol
89
A 65-year-old patient, a known case of DM and scleroderma, presents with abdominal pain, which does not relate to any food, and he denies weight loss. What is the diagnosis?
A) IBS
B) Colonic carcinoma
C) Celiac disease
D) PUD
D) PUD
90
A patient with typical meningitis history with CS analysis showing high protein and high PMN, what is the diagnosis?
A) Bacterial meningitis
B) Viral meningitis
C) TB meningitis
A) Bacterial meningitis
91
55-year-old diabetic male presented with burning sensation in hands and feet. He has decreased sensory, vibration, and proprioception in his lower limbs. What you would choose to investigate?
A) EEG
B) Nerve conduction study
B) Nerve conduction study
92
A young man complains of dyspnea, chest pain, and fainted while going to Friday prayer. His past history is significant for a heart murmur discovered 15 years ago, however he did not experience any symptoms till today. This is his X-ray below. What is the diagnosis?
A) Pulmonary stenosis
B) Bicuspid calcified aortic valve
C) Calcified aortic stenosis
A) Pulmonary stenosis
93
A 65-year-old patient presents with recent history of obstructive jaundice. On physical examination, a palpable non-tender gallbladder was present. What is the most likely diagnosis?
A) Pancreatic head cancer
B) Cholecystitis
C) Biliary colic
D) Lower esophageal tumor
A) Pancreatic head cancer
94
A 67-year-old non-smoker male, came with history of night sweats, fever, and 5kg weight loss for the past 2 months. A CT scan was done and showed right sided hilar mass. A diagnosis of lung cancer was made. What is the next investigation?
A) Chest ultrasound
B) Chest MRI
C) Bronchoscopy and biopsy
C) Bronchoscopy and biopsy
95
1. A 55 year old women developed a proximal deep vein thrombosis after she underwent an elective abdominal surgery, Which of the following is correct?
A) IVC Filter
B) Anticoagulants for 3 months
C) Aspirin
D) Lifelong anticoagulants
B) Anticoagulants for 3 months
96
A 28-year-old patient came to the clinical due to > 5 years history of recurrent productive cough waxes and wanes. On examination the patient had clubbing, basal crackles on the left base and left axillary area. A diagnosis of bronchiectasis was made after HRCT was done.
what is the best long-term management for the patient?
A) Start systemic steroids for 3 months
B) Bronchoscopic lavage
C) Postural drainage
D) Long term azathioprine
C) Postural drainage
97
Patient with right ptosis in the eye and pupil dilation, what patient mostly have?
A) Horner svndrome
B) Oculomotor nerve
B) Oculomotor nerve
98
How to diagnose scleroderma?
A) serum anti-SCL70
B) CXR
A) serum anti-SCL70
99
35-year-old construction worker complains of nocturnal paresthesia of his first, second, and middle fingers. He also has thenar muscle atrophy and positive Tinel sign. What is the diagnosis?
A) Carpal tunnel
B) Rheumatoid arthritis of the wrist
C) De Quervain synovitis
A) Carpal tunnel
100
Which microbial infection is associated with eosinophilia?
A) Streptococcus pneumonia
B) Cryptococcus neoformans
C) Treponema pallidum
D) Strongyloides stercoralis
D) Strongyloides stercoralis
101
A 15 year old female presented with intermittent inframammary chest pain, and palpitations. BP 118/70, and HR was 86 bpm. She was thin built and nervous individual. On auscultation, there was late systolic murmur with mid-systolic click, Rest of cardiovascular exam was normal. What’s the most likely diagnosis?
A) Innocent systolic murmur
B) Mitral regurgitation
C) Mitral valve prolapse
C) Mitral valve prolapse
102
A 30-year-old patient presented with hypertension. Urinalysis showed microscopic hematuria. 24-hour urine protein collection revealed protein 0.75 mg. complement levels were normal. what is the most likely diagnosis?
A) SLE
B) IgA nephropathy
C) Post-streptococcus GN
D) Membranous GN
B) IgA nephropathy
103
An old man with aortic valve replacement presented with syncope and heart rate of 40 bpm, what will you see when examining his JVP?
A) Cannon A wave
B) Absent A wave
C) V wave
D) Normal JVP
A) Cannon A wave
104
24-year-old female with sickle cell anemia presented with severe anemia and low reticulocyte, a diagnosis of aplastic crisis has been done, What has precipitated it?
A) Parvo virus b19
B) Shigella Salmonella
C) Heroes zoster
A) Parvo virus b19
105
An old lady, who gave up smoking years ago, has productive cough and exertional dyspnea. On physical examination, she had an increased AP diameter of the chest and the chest was hyper-resonant.
PFT results were provided showing low FEV, low FVC, with low FEV/FVC, with irreversible obstructive pattern with bronchodilator, high TLC, low DLCO), which of the following supports the diagnosis of COPD in this patient?
A) Post bronchodilator irreversibility in FEV1
B) Post bronchodilator irreversibility in FEV1/FVC ratio
C) Low DLCO
D) High TLC
A) Post bronchodilator irreversibility in FEV1
106
A 40-year-old man with primary hyperaldosteronism. Which is expected to be found?
D (primary hyperaldosteronism)
107
A 30-year-old male with a history of kyphosis and back pain presented with palpitation and progressive dyspnea. On examination of the neck, bilateral visible pulsations can be seen. On auscultation, a murmur is heard. Which of the following is the most likely diagnosis?
A) Aortic stenosis
B) Aortic regurgitation
C) Mitral stenosis
D) Tricuspid regurgitation
B) Aortic regurgitation
108
50-year-old patient with HCV-related cirrhosis admitted to the hospital with increased confusion. Which of these would improve the patient mental status?
A) Lactulose
B) Furosemide
C) Ceftrixone
A) Lactulose
109
How to differentiate between obstructive or central sleep apnea?
A) ECG
B) PO2
C) PCO2
D) Thoraco-abdominal movement
D) Thoraco-abdominal movement
110
A patient with muscle wasting, fasciculations, and Hoffman's sign, what is the diagnosis?
A) Multiple sclerosis
B) Diabetic neuropathy
C) Motor neuron disease
C) Motor neuron disease
111
A Patient came for regular check-up, results showed mildly elevated ALT and AST (ALP, and bilirubin were normal). He has a disease running in his family but he does not remember what it is. What is the next investigation?
A) ANCA
B) Immunoglobulin
C) AMA
D) HCV
D) HCV
112
A 68-year-old man with CKD on hemodialysis, when compared to a man in his age without CKD, what will he have?
A) Higher serum Ca
B) Higher coronary calcification
C) Higher Hb
D) Higher survival time
B) Higher coronary calcification
113
A 42-year-old male presented with serum creatinine of 340 (high). He had a serum creatinine of 70 four months ago. Labs showed 30 RBC/HPF. Serum complements were low. Granular IF pattern. What is the most likely diagnosis?
A) Good pasture syndrome
B) Systemic polyangitis
C) Cryoglobinemia
D) Church Strauss
C) Cryoglobinemia
114
A 23-year-old female presented with non-reactive dilated pupils bilaterally, visual acuity was normal. Ankles reflex was absent. What is the most likely diagnosis?
A) Cervical Tumor
B) Multiple sclerosis
C) Brainstem Glioma
D) Adie Syndrome
D) Adie Syndrome
115
A 56-year-old obese male, history of successful weight loss with restrictive calorie diet, presents with feeling hungry. what is responsible for his hunger feeling?
A) Leptin
B) Ghrelin
C) Peptide yy
D) Glucagon like peptide
B) Ghrelin
116
A patient recently took amoxicillin for pharyngitis developed dusky discoid papules and plaques on his face, trunk, and limbs that are easily desquamate upon rubbing the skin, what is the diagnosis?
A) Pampigoid vulgaris
B) Erythema multiforme
C) Toxic epidermal necrolysis
D) DRESS (Drug reaction and eosinophilia and systemic symptoms)
C) Toxic epidermal necrolysis
117
A scenario of bronchiectasis and the diagnosis of bronchietasis was confirmed, what is the best practical treatment for patient with bronchiectasis?
A) Postural drainage
B) Immune modulation
C) Steroids
D) Azathioprine
A) Postural drainage
118
A 19-year-old patient with nausea, abdominal pain, diarrhea for the past days. Urine output is low.
Serum creatinine is high. Serum Na is normal. (Don't remember the rest of the question)
A) normal saline
B) D5W
C) fluid restriction by 500 (not sure of what the option was)
D) do nothing because autoregulation
D) do nothing because autoregulation?
119
A 64 year old woman present with (?can't remember). menopause was 11 years ago. Blood sample was significant for elevated corrected Ca2+ and low PTH. what is responsible for her hypercalcemia?
A) Primary hyperparathyroidism
B) Decreased osteoclastic function
C) Secondary hyperparathyroidism
D) Underlying lymphoma
D) Underlying lymphoma
120
A patient with hemophilia A, given factor 8 but no response what happened (paraphrasing)?
factor 8 inhibitor -mixed factor
121
a pregnant lady was found to have high blood pressure on a regular check-up, what drug should be used to manage her condition?
A) Methyldopa
B) ACEI
C)ARB
A) Methyldopa
122
What's the probability of having a son with major thalassemia If both mother and father are minor?
25% chance of having thalassemia major?
123
Patient with chronic kidney disease, has high ALP, low Ca, 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) Calcimimitec drugs
D) Parathyroidectomy
B) Calcium carbonate and alpha vitamin D
124
A patient with major thalassemia on transfusion therapy, presented with cardiac symptoms. and echo showed biventricular hypertrophy and both systolic and diastolic dysfunction. What is the cause?
A) Amyloidosis
B) Iron overload
B) Iron overload
