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SMLE > 151-200 > Flashcards

151-200 Flashcards

1
Q

A 26-year-old pregnant woman visits the clinic for regular follow-up. She is asymptomatc. She is in her 30th week of pregnancy. Her physical examinaton reveals a mid-systolic ejecton murmur at the right upper sternal border. The murmur radiates to carotds. No diastolic murmur is heard. Which of the following is the most likely diagnosis?
A. Aortic stenosis
B. Mitral stenosis
C. Tricuspid stenosis
D. Physiologic murmur of pregnancy

A

A. Aortic stenosis

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2
Q

A 28-year-old man is evaluated in the Emergency Department for severe persistent chest pain for 1-day. The pain is constant but exacerbated when leaning forward and not associated with other symptoms. Physical examinaton is unremarkable apart of a fricton rub at the lef lower sternal border. Electrocardiogram shows difuse, concave upward ST-segment elevatons and PR-segment depression most prominent in leads V1 through V6. Which of the following is the most appropriate treatment?
A. Prednisone
B. Nitroglycerin
C. Warfarin
D. Ibuprofen

A

D. Ibuprofen

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3
Q

A 58-year-old woman was admited with a diagnosis of acute myocardial infarcton received appropriate treatments and now she is ready for discharge. She is so concern about the secondary preventon of infarcton. Which of the following statements is the most appropriate?
A. Ant-platelet agents should be used for short period to reduce the risk of recurrent infarction
B. Calcium channel blockers should be used indefnitely to reduce the risk of recurrent infarction
C. Hormonal replacement therapy should be given to postmenopausal women to prevent coronary events
D. Angiotensin-converting enzyme (ACE) Inhibitors should be used indefinitely by patient with clinically evident heart failure

A

D. Angiotensin-converting enzyme (ACE) Inhibitors should be used indefinitely by patient with clinically evident heart failure

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4
Q

A 55-year-old woman with non-decompensated systolic heart failure and ejecton fracton of 25% presents to the clinic for routne follow-up. Which of the following medicatons is the most appropriate management?
A. Lisinopril
B. Amlodipine
C. Furosemide
D. Spironolactone

A

A. Lisinopril

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5
Q

A 45-year-old woman is evaluated for a 3-week history of progressive shortness of breath that limit her actvites. Medical history is signifcant for asthma and moderate mitral regurgitaton. Her only medicaton is an albuterol inhaler as needed. On physical examinaton, her vital signs are normal. Cardiac examinaton reveals a grade 3/6 holosystolic murmur radiatng to the axilla Lungs are clear to auscultaton. Which of the following is the most appropriate diagnostc test?
A. Spirometry
B. Transthoracic echocardiogram
C. Transesophageal echocardiogram
D. Helical (or spiral) computed tomography (CT) of the chest

A

C. Transesophageal echocardiogram

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6
Q

A 54-year-old man presents with shortness of breath and fever for 1 week. On physical examinaton, the patent is febrile and dyspneic. His oxygen’s saturaton is 89% on room air. Chest examinaton shows absent breath sounds and dullness to percussion over right lung feld. Chest radiography confrms a large right-sided pleural efusion. Which of the following is the most useful to establish a diagnosis of exudatve pleural efusion?
A. Pleural fuid protein/ serum protein < 0.5
B. Pleural fuid pLDH/ serum LDH > 0.6
C. Pleural fuid LDH >1/3 normal upper limit for serum
D. Pleural fuid white cell count > 1000

A

B. Pleural fuid pLDH/ serum LDH > 0.6

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7
Q

A 54-year-old man presents with shortness of breath and fever for 1 week. On physical examinaton, the patent is febrile and dyspneic. His oxygen’s saturaton is 89% on room air Chest examinaton shows absent breath sounds and dullness to percussion over right lung feld. Chest radiography confrms a large right-sided pleural efusion. Which of the following factors indicatng the need for therapeutc thoracentesis?
A. Loculated pleural fluid
B. Pleural fluid pH more than 7.30
C. Pleural fluid glucose more than 80 mg/di
D. Negative gram stain of the pleural fluid

A

A. Loculated pleural fluid

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8
Q

A 67-year-old man presents with insomnia, irritability and palpitaton for 3 months. He is known to have hypertension, depression and atrial fbrillaton. He is on amiodarone, fuoxetne and enalopril. Clinically, he is unremarkable. Blood pressure 130/70 mmHg, Heart rate 76 /min, Oxygen saturaton 95 % Which of the following is the most appropriate next step?
A. Add propranolol
B. Measure thyroxin level and TSH
C. Substtuton of antdepressant drug
D. Refer him for psychiatric assessment

A

B. Measure thyroxin level and TSH

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9
Q

A 62-year-old man presents to Outpatent Clinic with recurrent episodes of steal chest tghtness, which occurs mainly afer heavy physical exerton. He has no chronic medical problems. Clinical examinaton and baseline ECG were normal. Which of the following is the most appropriate next step in diagnosis?
A. Exercise ECG
B. Echocardiography
C. Coronary arteriography
D. Myocardial perfusion scintgraphy

A

A. Exercise ECG

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10
Q

A 28-year-old man presents with recent onset of chest pain. The pain is retrosternal, localized, sharp and constant in intensity. He notced increase in seventy with movement. He started actve exercise program a week prior to the onset of the symptom. Blood pressure 110/70 mmH Heart rate 76 /min Oxygen saturaton 95 % Which of the following is the most appropriate next step in management?
A. Atenolo
B. Ibuprofen
C. Nitroglycerine
D. Reassurance and assess afer 1 week

A

B. Ibuprofen

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11
Q

A 65-year-old woman came for routne annual check-up found to have with harsh ejecton systolic murmur, which propagated to the neck. Which of the following factors is the most important in deciding the tme of the surgery?
A. Low pulse pressure
B. Intensity of the murmur
C. The patient symptoms
D. Left ventricular hypertrophy

A

C. The patient symptoms

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12
Q

A 65-year-old man found to have an ejecton systolic murmur on clinical examinaton. There is no history of chest pain, shortness of breath nor syncope. ECHO confrmed aortc stenosis with good lef ventricular systolic functon. Aortc valve gradient of 40 mmH. Blood pressure 100/65 mmHg Heart rate 67 /min Which of the following is the most appropriate management opton?
A. Follow-up
B. Ant-coagulation
C. Aortc valvoplasty
D. Surgical valve replacement

A

A. Follow-up

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13
Q

A 67-year-old man known to have hypertension came to Emergency Room with acute onset of palpitaton. His pulse on the monitor showing pulse rate of 170/min. He have irregular pulse with normal cardiac and chest examinatons. Blood pressure 120/70 mmHg Respiratory rate 18 /min Oxygen saturaton 91 % Which of the following is the best treatment option?
A. Cardioversion
B. Adenosine
C. Amidorone
D. observation

A

C. Amidorone

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14
Q

A 38-year-old Indian man presents with progressive dyspnea for 3 months. He has past history of old tuberculosis. He has no other medical problems and not on any medicatons. His JVP was elevated and rises further on inspiraton. Cardiac examinaton was normal with no murmurs. Blood pressure 105/60 mmH Heart rate 120 /min Oxygen saturaton 93 % Which of the following is the most likely diagnosis?
A. Myocarditis
B. Corpulmonale
C. Cardiomyopathy
D. Constrictive Pericarditis

A

D. Constrictive Pericarditis

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15
Q

A 28-year-old woman who is a known case of mitral stenosis came to the clinic asking about how critcal is her conditon. Echo was done and mitral valve orifce was recorded. Which of the following mitral valve orifce measurement is consider critcal?
A. <1 cm
B. <2 cm
C. <3 cm
D. <4 cm

A

A. <1 cm

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16
Q

A 72-year-old man presented with acute sever chest pain with an ECG revealing St segment elevaton I1,I,AVF, leads was treated with thrombolysis but 2 days later acutely unwell with sever dyspnea. On examinaton, he has loud systolic murmur at the apex, which radiates to the axilla and bilateral crackles at the base of the lungs. Blood pressure 90/60 mmHg Heart rate 100 /min Respiratory rate 25 /min Oxygen saturaton 88 % Which of the following is the most likely diagnosis?
A. Myocarditis
B. Cariogenic shock
C. Rupture papillary muscle
D. Acute Rt sided heart failure

A

C. Rupture papillary muscle

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17
Q

A 65-year-old man with heart failure requires rate control to treat coexistng atrial fbrillaton. Which of the following is the best treatment opton?
A. Digoxin
B. Adenosine
C. Lidocaine
D. Nitroglycerine

A

A. Digoxin

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18
Q

Asymptomatc healthy 24-year-old woman came for a check-up visit and found to have grade II mid-diastolic murmur over the apex. Which of the following is the best next step in diagnosis?
A. Cardiac MRI
B. Echocardiography
C. Cardiac catheterization
D. Antstreptolysin O ttre

A

B. Echocardiography

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19
Q

A 70-year-old man presented with progressive dyspnea, palpitaton and fatgue for 3 months. He is known to have hypertension on captopril. He underwent echo which showed poor lef ventricular functon so furosemide was added with good control of his symptoms. His vital signs upon the last clinic visit shown below. Blood pressure 150/90 mmHg Heart rate 90 /min Respiratory rate 18 /min Oxygen saturaton 95 % Which of the following medicaton should be added at this stage?
A. Digoxin
B. Carvedilal
C. Nifedipine
D. Hydralazine

A

B. Carvedilal

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20
Q

A 70-year-old man admited with lef lower limb swelling and pain diagnosed as DVT where heparin was started. He has a history of diabetes mellitus, hypertension and chronic heart failure. He is on insulin; furosemide and enalapril (see lab results). Blood pressure 110/70 mmHg, Heart rate 76 /min, Oxygen saturaton 94 % Test Result Normal Values Sodium 135 134-146 mmol/L Potassium 6,0 3.5-5.1 mmol/L Chloride 107 97-108 mmol/L Urea 7.9 2.75-7.4 mmol/L Creatnine 120 44-115 mol/L APTT 50 30-40 sec Prothrombin tme 14 10-13 sec Which of the following medicatons should be discontnued at this stage?
A. Insulin
B. Enalapril
C. Heparin
D. Furosemide

A

B. Enalapril

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21
Q

A 35-year-old man presented to Emergency Room with recurrent atacks of high-grade fever with chills for 1 week. He was on a work trip to Sudan 3 weeks ago. Each atack begins with chills for few hours followed by fever up to 40.5 degree, which resolves with profuse sweatng. The atacks comes every other day. On examinaton, mild splenomegaly was detected. Blood smear at Emergency Room was negatve for parasites. Blood pressure 110/70 mmH, Heart rate 120 /min, Temperature 39 °C Which of the following is the most appropriate next step in diagnosis?
A. Repeat thin blood smear
B. Repeat thick blood smear once more
C. Repeat blood smear during the atack
D. Repeat blood smear every 8 hours for 2 days

A

D. Repeat blood smear every 8 hours for 2 days

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22
Q

A 51-year-old woman presented to the hospital with 2-days history of malaise and headache. The headache became more intense and was associated with pain in her neck. Her husband reported that she had also fever. She was previously well with no signifcant medical history. On examinaton, she looked unwell confused, febrile and with positve Kemig’s sign. CT scan brain was normal. Lumbar puncture done (see lab results). Test Result Normal Values Colour Turbid colourless Cells 200 0-3 /pL Total protein (Women) 0.9 0.15-0.45 g/L Glucose 1.6 2.50-3.89 mmol/L Which of the following is the most likely causatve organism?
A. Escherichia coll
B. Listeria monocytogenes
C. Streptococcus pneumonia
D. Staphylococcus pyogenes

A

C. Streptococcus pneumonia

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23
Q

A 45-year-old man has been diagnosed as a case of pulmonary tuberculosis. which of the following investgatons is essental prior initaton of the therapy?
A. Vitamin B6
B. PPD skin test
C. Plasma glucose
D. Liver function test

A

D. Liver function test

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24
Q

A 39-year-old man came to the clinic for follow-up. He is recently diagnosed as pulmonary tuberculosis and was started on rifampicin, Isoniazid, pyrazinamide and ethambutol for 4 weeks. Basic lab workup were normal. LFT test was repeated (see lab results). Test Result Normal Values Direct bilirubin 56 1.5-6.5 mol/L Total bilirubin 76 3.5-16.5 mol/L Aspartate aminotransferase 465 12-40 IU/L Alanine aminotransferase 620 5-40 IU/L Alkaline phosphatase 720 39-117 IU/L Gamma glutamyltransferase 387 6 to 37 1U/L Which of the following is the most appropriate next step?
A. Stop Isoniazid
B. Stop rifampicin
C. Stop pyrazinamide
D. Stop all medicatons

A

D. Stop all medicatons

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25
Q

An 82-year-old woman admited to the hospital for meningits. Her CSF was obtained and Gram stain showed Gram negatve cocco-bacilli. Which chemo-prophylaxis should be ofered to her contacts?
A. Rifampicin
B. Cefriaxone
C. Ciprofoxacin
D. Azithromycin

A

A. Rifampicin

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26
Q

A 35-year-old man presented with fever, rigors and weight loss for 10 days. He underwent Mitral valve replacement by prosthetc valve a month ago. Echo showed small vegetaton. Blood pressure 90/70 mmHg, Heart rate 100 /min, Temperature 38.7 °C Which of the following organisms is the most likely to be responsible for his presentaton?
A. Coxiella burneti
B. Staphylococcus aureus
C. Streptococcus viridans
D. Staphylococcus epidermis

A

D. Staphylococcus epidermis

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27
Q

A 24-year-old woman came to the clinic complaining of yellowish ofensive vaginal discharge and itching for 2 weeks duraton. She has no other signifcant medical history. Vaginal swab done which showed motle fagellate organisms on wet flm microscopy. Which of the following is the best treatment opton?
A. Tetracycline
B. Cefuroxine
C. Nitrofurantoin
D. Metronidazole

A

D. Metronidazole

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28
Q

A 24-year-old married woman came to the clinic complaining of yellowish ofensive vaginal discharge and itching for 2 weeks duraton. She has no other signifcant medical history. Vaginal swab done which showed motle fagellate organisms on wet flm microscopy. Appropriate treatment was initated. Which of the following is the best management opton for her husband?
A. Tetracyclin
B. Metronidazole
C. No treatment
D. Follow-up in 2 weeks

A

B. Metronidazole

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29
Q

A 25-year-old man developed fever, malaise and rash on the palms of his hands as well as on the soles of both feet. 6 weeks earlier, he had a painless ulcer on his penis. He gave a history of recent travel and extramarital unprotected sex. On examinaton, he has generalized lymphadenopathy. Blood pressure 110/70 mmHg, Heart rate 87 /min, Temperature 38.6 °C Which of the following is the most likely diagnosis?
A. HIV
B. Syphilis
C. Herpes zoster
D. Chlamydia trachomats

A

B. Syphilis

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30
Q

A 45-year-old woman was diagnosed with GERD for 4 years on daily dose of PPI with a good control of her symptoms. However, she reported occasionally heartburn. She underwent endoscopy. which was normal. Gastric biopsy revealed Helicobacter pylori. She gave history of smoking 20 pack-year but she quit 3 years ago, but she gave history of social alcohol drink. On examinaton, she is obese otherwise normal. Which of the following risk factors is mostly contribute to worsening of her GERD and she should control it?
A. Obesity
B. Smoking
C. Alcohol intake
D. Helicobacter pylori

A

A. Obesity

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31
Q

A 46-year-old man came to the clinic asking for advice about eradicaton of H.pylori. He is known to have GERD on daily dose of PPI for 8 years with good control. He developed new onset of epigastric pain and was found to have helicobacter pylori By ELISA testng. Which of the following can happen post H.pylori eradicaton in such patent?
A. No sequel post eradicaton
B. Need to increase the PPI dose
C. Reducing risk of barret’s esophagits
D. Increase the risk of atrophic gastrits

A

B. Need to increase the PPI dose

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32
Q

A 60-year-old man with a history of diabetc mellitus, hypertension and osteoarthrits presents with melena. He gave a history of NSAID use for knee pain. He underwent upper GI endoscopy, which showed 1 cm duodenal ulcer with bleeding vessel, hemoclip was applied with good hemostasis (see lab result). Blood pressure 100/60 mmHg Heart rate 110 /min Oxygen saturaton 95 % Test Result Normal Values Hb 8.4 130-170 g/L (Male) 120-160 g/L (Female) Which of the following is the most appropriate next step in the management?
A. High dose of oral PPI BID
B. High dose of oral H2 blocker
C. IV PPI infusion for 24 hours then oral PPI
D. IV PPI infusion for 72 hours then oral PPI

A

D. IV PPI infusion for 72 hours then oral PPI

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33
Q

A 44-year-old woman known to have gall bladder stones presented with biliary pain and jaundice. US abdomen confrmed CBD stones. She underwent ERCP for stone extracton. Few hours later, she developed sever epigastric pain, nausea and vomitng (see lab results). Test Result Normal Values Hb 11 130-170 g/L (Male) 120-160 g/L (Female) WBC 18 4.5-10.5 x 109/L Urea 11 2.75-7.4 mmol/L Creatnine 110 44-115 mol/L Total bilirubin 23 3.5-16.5 mol/L Lipase 3000 0-160 IU/L Which of the following management optons has proven a survival beneft in such patent?
A. Urgent repeat of ERCP
B. Administraton of IV antbiotcs
C. Rectal indomethacin and IV steroid
D. IV ringer lactate at rate of 250 ml/ours

A

D. IV ringer lactate at rate of 250 ml/ours

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34
Q

A 60-year-old man with a history of chronic alcohol intake presents with chronic dull epigastric pain and diarrhoea for 6 months. He reported 5 bulky stool a day (see reports). 72 hours stool collecton: >42 gram of fat/24 hours. Plain abdomen X-ray: Showed pancreatc calcifcaton. Which of the following is the most efectve strategy to control his symptoms?
A. High dose of PPI BID
B. Long course of metrodidazole
C. Lipase 30.000 IU with each meal
D. Diet modifcaton with small frequent low fat meals

A

C. Lipase 30.000 IU with each meal

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35
Q

A 60-year-old man presented to Emergency Room with 3-days history of epigastric and RT upper quadrant pain and nausea. He gave a history of fever and rigors for 1-day duraton. On Examinaton, Jaundice and tender RT upper abdomen with no rebound (see lab results and report).
Blood pressure 100/70 mmH Heart rate 120 /min Temperature 38.6 °C Test Result Normal Values Hb 11 130-170 g/L. (Male) 120-160 g/L (Female) WBC 16.4 4.5-10.5 x 109/L Direct bilirubin 49 1.5-6.5 umol/L. Total bilirubin 57 3.5-16.5 mol/L Aspartate aminotransferase 150 12-40 IU/L Alanine aminotransferase 200 5-40 IU/L Alkaline phosphatase 250 39-117 IU/L US abdomen: Reveals multple small galistones with mild thickening of the wall. CBD dilated 9 mm. Which of the following is the most likely diagnosis?
A. Acute Hepatitis
B. Liver abscess
C. Acute cholecyctitis
D. Ascending Cholangitis

A

D. Ascending Cholangitis

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36
Q

Which of the following is the least risk factors for cholesterol gallstones?
A. Obesity
B. Nulliparity
C. Rapid weight loss
D. Hypertriglyceridemia

A

B. Nulliparity

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37
Q

A 34-year-old woman presented to the clinic for evaluaton of persistent high liver enzymes for 6 months. She is asymptomatc. She has no signifcant medical or drugs history (see lab results and reports). Test Result Normal Values Direct bilirubin 1.1 1.5-6.5 mol/L Total bilirubin 1.9 3.5-16.5 mol/L Aspartate aminotransferase 53 12-40 IU/L Alanine aminotransferase 43 5-40 IU/L Alkaline phosphatase 546 39-117 IU/L Albumin 35 34-56 g/L US Abdomen: Unremarkable. MRCP: Showed mult focal segmental biliary strictures and dilaton. Which of the following is the best next step in the diagnosis?
A. Liver biopsy
B. Perform colonoscopy
C. Repeat abdomen ultrasound
D. Check ant-nuclear antbodies

A

B. Perform colonoscopy

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38
Q

What is the most common HCV genotype in Saudi Arabia?
A. 1
B. 2
C. 3
D. 4

A

D. 4

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39
Q

A 50-year-old man referred to the clinic with positve CV. He is asymptomatc with no history of drug use or previous blood transfusion. Physical examinaton was unremarkable, Reviewing of his lab test showed normal LFT with positve ant-HCV (ELISA), Hepatts C RNA was negatve. US abdomen showed normal liver. Which of the following is the most appropriate next step in management?
A. Liver fbroscan
B. No further tests
C. Triphasic CT scan of liver
D. Repeat HCV RNA in 6 months

A

B. No further tests

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40
Q

A 43-year-old man who is known to have chronic hepatts B presents to the clinic for evaluaton. He is asymptomatc with normal physical examinaton (see lab results and report). Test Result Normal Values RBC 5 4.7-6.1 x 1012/L (Male) 4.2-5.4 x 1012/L (Female) Hb 11.9 130-170 g/L. (Male) 120-160 g/L (Female) Platelets count 145 150-400 x 109/L WBC 3.9 4.5-10.5 x 109/L Direct bilirubin 17 1.5-6.5 mol/L Total bilirubin 21 3.5-16.5 mol/L Aspartate aminotransferase 89 12-40 IU/L Alanine aminotransferase 61 5-40 IU/L Alkaline phosphatase 160 39-117 IU/L US Abdomen: Showed mild coarse liver echotexture. Which of the following is the most appropriate treatment opton?
A. Entecavir
B. Observation
C. Lamivudine
D. Pegylated Interferon

A

A. Entecavir

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41
Q

Which of the following stool electrolyte testng resuits would most represent a Vibrio cholerae?
A. Stool osmoles of 300 mOsm/kg
B. Stool osmoles of 410 mOsm/kg
C. Fecal osmotc gap of 30 mOsm/kg
D. Fecal osmotc gap of 110 mOsm/kg

A

C. Fecal osmotc gap of 30 mOsm/kg

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42
Q

A 44-year-old woman with heart failure diagnosed 9 months ago is evaluated for 3-month history of non- productve cough. No history of chest pain, dyspnoea or orthopnoea. She has never smoked. Her current medicatons are lisinopril, carvedialol and fruosemide. Unremarkable cardiac and chest examinaton (see reports). Blood pressure 100/70 mmHg Heart rate 76 /min Respiratory rate 18/min Oxygen saturaton 95 % Chest X-ray: Normal ECHO: Showed lef ventricular ejecton fracture 40%. Which of the following is the most appropriate management?
A. Discontnue lisinopril
B. Order pulmonary functon test
C. Increase the dose of fruosemide
D. Start inhaled B2- adrenergic agonist

A

A. Discontnue lisinopril

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43
Q

A 54-year-old man is evaluated prior electve hernia repair surgery. He is known case of bicuspid aortc valve and mechanical aortc valve replacement 4 years ago. He is asymptomatc. Cardiac examinaton showed grade 1/6 ejecton systolic murmur at aortc area. Blood pressure 110/70 mmHg Heart rate 76 /min Respiratory rate 18 /min Oxygen saturaton 95 % Which of the following is the best management opton for endocardits prophylaxis?
A. Amoxicillin
B. Augmentn
C. Cefuroxime
D. No antibiotic

A

D. No antibiotic

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44
Q

A 64-year-old man presented to Emergency Room with symptoms of dyspnoea, SOB, and palpitaton. He is a known case of diabetc mellitus, hypertension and hyperlipidaemia. He is smoker with history of stroke. On examinaton, found to have irregular pulse. Cardiac and chest examinaton showed high JVP, S3 and bi-basal crackles. Atrial fbrillaton on ECG. Blood pressure 150/90 mmH Heart rate 144 /min Oxygen saturaton 89 % What is the CHADS2 score of this patent?
A. 2
B. 3
C. 4
D. 5

A

D. 5

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45
Q

Which of the following diagnostc tools is the best opton for screening for hepatocellular carcinoma in cirrhotc patents?
A. Liver functon test
B. Alpha fetoprotein
C. Ultrasound abdomen
D. Triphasic CT scan of liver

A

C. Ultrasound abdomen

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46
Q

A 36-year-old man presented to the clinic for evaluaton of elevated liver enzyme. He is asymptomatc with no signifcant past medical history. He is a smoker and drinks alcohol every weekend. Examinaton was unremarkable (see lab results and reports). Test Result Normal Values Total bilirubin 12 3.5-16.5 pmol/L. Aspartate aminotransferase 147 12-40 IU/L Alanine aminotransferase 76 5-40 IU/L Alkaline phosphatase 119 39-117 IU/L Albumin 33 34-56 g/L Iron 35 11.7-31.8 mol/L (Male)
9-30.4 pmol/L (Female) Total iron binding capacity 34 11.6-31.3 mol/L (Male) 9-30.4 pmol/L (Female) Ferritn 423 20-300 pg/L (Male) 20-120 g/L (Female) Liver functon tests: Hepatts screen; Negatve HCV, HBAg was negatve with positve HBSAD. US Abdomen: Enlarged liver with no focal lesion. Which of the following is the most likely cause for his underlying liver disease?
A. Hemochromatosis
B. Alcoholic hepatitis
C. Hepatocellular carcinoma
D. Chronic hepatitis B infection

A

B. Alcoholic hepatitis

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47
Q

A 67-year-old man a known case of HCV cirrhosis admited to Emergency Room with massive hematemesis. Variceal bleeding is suspected. On examinaton, he is drowsy with tense ascites (see lab results). Blood pressure 110/70 mmH, Heart rate 86 /min Oxygen saturaton 95 % Test Result Normal Values Hb 8 130-170 g/L (Male) 120-160 g/L (Female) INR 1.3 0.8-1.2 Which of the following management optons has a great beneft in reducing this patent mortality?
A. Octreotd
B. IV cefriaxone
C. Blood transfusion
D. Panataprazole infusion

A

B. IV cefriaxone

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48
Q

A 42-year-old man with hepatts B cirrhosis evaluated for focal lesion at US abdomen. He is asymptomatc. Currently on diuretcs with well-controlled ascites (see lab results and report). Test Result Normal Values Hb 110 130-170 g/L (Male) 120-160 g/L (Female) Platelets count 123 150-400 x 109/L INR 1.5 0.8-1.2 Total bilirubin 16 3.5-16.5 mol/L Aspartate aminotransferase 98 12-40 IU/L Alanine aminotransferase 65 5-40 IU/L Alkaline phosphatase 120 39-117 IU/L Albumin 30 34-56 g/L CT scan of liver: were patent. Demonstrated a 6 cm lesion with arterial enhancement at RT lobe, portal vein and hepatc veins Which of the following is the best treatment opton?
A. Sarafenib
B. Liver transplant
C. Surgical resecton
D. Transarterial chemoembolisaton

A

D. Transarterial chemoembolisaton

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49
Q

A 22-year-old pregnant woman complains of heartburn, which is mainly at night afer the dinner when she is lying on the bed. She was started on antacid syrup with somewhat response to that. She denies history of abdominal pain or nausea. Which of the following is the best next step in the management?
A. Start panotprazole
B. Ambulatory pH testng
C. Lifestyle modifications
D. Perform upper endoscopy

A

C. Lifestyle modifications

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50
Q

A 24-year-old woman presents with 9-months of intermitent abdominal pain and anxiety. Occasionally, the pain associated with loose motons. She denies any alarm symptoms. All basic work-up (CBC, LFT, TSH, CRP and Celiac serology) were normal, Stool C/S and fecal calprotein was negatve. Which of the following is the most appropriate treatment?
A. Metronidazole
B. Increase fbre intake
C. Trial of gluten free diet
D. Tricyclic antidepressants

A

D. Tricyclic antidepressants

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51
Q

A 62-year-old man with no signifcant medical history presented to Emergency Room with 1-day history of 4 episodes of hematochezia. He denies history of abdominal pain, constpaton or weight loss. Blood pressure 90/50 mmH Heart rate 112 /min Which of the following is the most likely diagnosis?
A. Cecal cancer
B. Diverticulosis
C. Internal piles
D. Ischaemic colits

A

B. Diverticulosis

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52
Q

A 25-year-old woman presented with few months history of increase forgetulness, fatgue and numbness of lower limbs. She is a known case of crohn’s disease, post terminal ilium resecton 2 years ago. She is on azathioprine. She denies abdominal pain or diarrhoea (see lab results). Test Result Normal Values RBC 4.5 4.7-6.1 x 1012/L. (Male) 4.2-5.4 x 1012/L (Female) Hb 90 130-170 g/L (Male) 120-160 g/L (Female) MCH 38 28-33 pg/cell MCV 99 80-951 Platelets count 199 150-400 x 109/L A defciency of which of the following nutrients would be responsible for her current clinical presentaton?
A. Zing
B. Thiamine
C. Selenium
D. Vitamin B12

A

D. Vitamin B12

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53
Q

A 23-year-old woman evaluated for dyspnoea and recurrent palpitaton. She has a history of Fallot tetralogy repair at the age of 3. On cardiac examinaton, apex was normal with lef parasternal impulse. S1 is single with grade 2/4 decrescendo diastolic murmur that increases with inspiraton noted at lef sternal border. Blood pressure 110/70 mmg Heart rate 94 /min Oxygen saturaton 92 % Which of the following is the most likely diagnosis?
A. Mitral valve stenosis
B. Ventricular septal defect
C. Tricuspid valve regurgitaton
D. Pulmonary valve regurgitation

A

D. Pulmonary valve regurgitation

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54
Q

A 22-year-old woman presents with fatgue, SOB, arthralgia and fever for 2 weeks. It is worsened with tme specially the fever. She has no signifcant medical history apart from sore throat 3 weeks ago and dental extracton 2 months ago. Skin examinaton revealed petechia over lower limb. Cardiac examinaton demonstrated 3/6 holosystolic murmur that radiates to axilla and mild splenomegaly (see report). Blood pressure 100/60 mmH Heart rate 88 /min Temperature 38.5 °C Urine dipstck: Showed mild proteinuna and microscopic hematuria Which of the following is the most likely diagnosis?
A. Lymphoma
B. Infective endocarditis
C. Group A streptococcus infection
D. Systemic lupus erythematous

A

B. Infective endocarditis

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55
Q

A 30-year-old woman is admited with dyspnea, SOB, PND and orthopnea 3 days post vaginal delivery. She gave a history of lower limb edema. She has no signifcant medical history. On examinaton, she looks in distress with bilateral LL pitng edema, bilateral basal crackles on lung examinaton. On cardiac examinaton, apex was displaced down with pan-systolic murmur at the apex radiatng to axilla and S3 gallop. Blood pressure 90/60 mmH Heart rate 110 /min Temperature 37.6 °C Which of the following is the most likely diagnosis?
A. Viral myocardits
B. Puerperium sepsis
C. Infectve endocardits
D. Peri-partum cardiomyopathy

A

D. Peri-partum cardiomyopathy

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56
Q

A 30-year-old woman is admited with cough, dyspnea, chest pain, SOB, PND and orthopnea 3 days post vaginal delivery. She gave a history of lower limb edema. She has no signifcant medical history. On examinaton, she looks in distress with bilateral LL pitng oedema, bilateral basal crackles on lung examinaton. On cardiac examinaton, apex was displaced down with pan-systolic murmur at the apex radiatng to axilla and S3 gallop
Blood pressure 90/70 mmHg Heart rate 120 /min Temperature 37.6 °C Oxygen saturaton 90 % Which of the following is the most appropriate step in this patent management?
A. Echocardiography
B. Thallium stress test
C. ECG and Chest x-ray
D. Cardiac MRI and PFT

A

A. Echocardiography

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57
Q

A 59-year-old man comes to the clinic, with a 45 cigarete pack-year history, complaining of breathlessness on exerton and a productve cough of white sputum over the last 6 months. Cardiological investgatons are normal (see report). Spirometry: Shows an FEV1/FVC of 60% with minimal reversibility afer a 2-week trial of oral steroids Which of the following is the most likely diagnosis?
A. Asthma
B. Lung fibrosis
C. Left ventricular failure
D. Chronic obstructive pulmonary disease

A

D. Chronic obstructive pulmonary disease

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58
Q

A 62-year-old woman is seen in the clinic with a history of weight loss, loss of appette and shortness of breath for the last 6 weeks. On examinaton, trachea is shifed to lef side; there is reduced air entry and duliness to percussion on the lower to midzones of the right lung. Blood pressure 110/70 mmH Heart rate 102 /min Respiratory rate 22 /min Temperature 37 °C Oxygen saturaton 91 % Which of the following is the most likely diagnosis?
A. Right-sided pleural effusion
B. Right middle lobe pneumonia
C. Pulmonary embolism
D. Right pneumothorax

A

A. Right-sided pleural effusion

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59
Q

A 19-year-old man known to have asthma. He has never been admited to hospital with an asthma exacerbaton and experiences symptoms once or twice a week but he is not on any medicaton. Today he come to discuss the treatment optons and he prefer to start medicatons only if needed during the atacks. His peak expiratory fow reading is currently 85% of the normal predicted value expected for his age and height. Which of the following is the most appropriate frst step in treatment?
A. Short-actng beta-2 agonist Inhaler
B. Long-actng beta-2 agonist inhaler
C. Leukotriene receptor antagonists
D. Low-dose steroid inhaler

A

A. Short-actng beta-2 agonist Inhaler

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60
Q

A 40-year-old man diagnosed with pulmonary TB who started treatment 3 months ago, presents to the clinic with a week’s history of pins and needles in his hands and feet with associated numbness. He tells that his symptoms started since he stopped taking the vitamins given to him
at the start of his TB treatment. Which of the following drugs is responsible for the symptoms described by the patent?
A. Pyrazinamide
B. Ethambutol
C. Rifampicin
D. Isoniazid

A

D. Isoniazid

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61
Q

An 18-year-old woman complains of dizziness feeling light-headed frequently with standing up and weight loss around 5 kg over the last 5 months. She has notced a recent scar on the back of her hand, which has started to turn very dark. Blood pressure 90/60 mmHg, Heart rate 99 /min What is the most appropriate investgaton to confrm the diagnosis?
A. Low-dose dexamethasone test
B. Abdominal ultrasound scan
C. Cortisol measurement
D. Synacthen test

A

D. Synacthen test

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62
Q

A 70-year-old man was hospitalized 6 days ago for a 4-day history of acute leg ischemia treated with angioplasty and stentng. He is now asymptomatc. He has a history of stage 3 chronic kidney disease and hypertension that is well-controlled with diltazem and captopril. Other medicatons are aspirin and clopidogrel. On physical examinaton, the patent is febrile and normal blood pressure. The remainder of the examinaton is unremarkable (see lab results). Test Result Normal Values Creatnine 140 44-115 mol/L Total Cholesterol 5.9 <5.1 mmol/L LDL (cholesterol) 4.9 <4.0 mmol/L Which of the following is the most appropriate therapy for secondary preventon of cardiovascular disease in this patent?
A. Niacin
B. Ezitmibe
C. Rosuvastatn
D. No additonal treatment

A

C. Rosuvastatn

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63
Q

A 43-year-old woman is evaluated during a follow-up visit. She is overweight and has hypertension and type 2 diabetes mellitus, both of which are well controlled. For several years, she has atempted to lose weight through various commercial diets; dietcian-monitored, calorie-restricted diets; and physical actvity but her weight has remained stable. Head, neck, lung, and heart examinatons are normal. Blood pressure 110/70 mmHg Heart rate 76 /min Respiratory rate 13 /min Temperature 36.6 °C BMI 28,5 kg/m2 In additon to contnuing calorie restricton and exercise, which of the following is the most appropriate management to hip this patent achieve weight loss with tolerable side efect?
A. Orlistat
B. Lorcaserin
C. Phentermine-topiramate
D. Roux-en-Y gastric bypass

A

A. Orlistat

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64
Q

A 48-year-old woman had terminal ileum resecton due to Crohn’s disease. She presents this tme with difculty in walking. She is anemic and has lost positon sense bilaterally. Which of the following is the most likely diagnosis?
A. Aplastc anaemia
B. Folate deficiency
C. Hemolytic anaemia
D. Vitamin B12 deficiency

A

D. Vitamin B12 deficiency

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65
Q

A 46-year-old man presents with a 1-day history of abdominal pain, vomitng and hematemesis. History reveals he is a heavy alcohol drinker. He has previously been admited with peptc ulceraton and is receiving proton pump inhibitor therapy. On examinaton, he has tenderness over the epigastrium. Blood pressure 110/69 mmH Heart rate 112 /min Which of the following is the most likely diagnosis?
A. Acute pancreatts
B. Chronic pancreatts
C. Oesophageal varices
D. Pancreatc pseudocyst

A

C. Oesophageal varices

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66
Q

A 22-year-old woman with cystc fbrosis presents with a 4-month history of weight loss, diarrhoea and abdominal bloatng. She has pale stools. There are no specifc abnormalites on examinaton of the abdomen other than she is clubbed with scatered chest crackles. Which of the following is the most likely diagnosis?
A. Acute pancreatitis
B. Pancreatic carcinom
C. Pancreatic pseudocys
D. Chronic pancreatitis

A

D. Chronic pancreatitis

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67
Q

A 30-year-old man comes to the clinic to discuss his recent blood test results. A few months ago, he had a health visit that showed an abnormality on his liver functon tests when the bilirubin level of 41 mol/L (normal 3-20) with the remainder of the liver functon profle being within normal limits. He has no signifcant medical history. On examinaton, no signifcant fndings. The physician orders second blood test, results show a normal full blood count, renal functon and thyroid functon. The liver functon test is done (see lab results). Test Result Normal Values Alkaline phosphatase 115 39-117 IU/L Alanine aminotransferase 38 5-40 IU/L Direct bilirubin 7 1.5-6.5 mol/L Total bilirubin 42 3.5-16.5 mol/L Which of the following is the most likely diagnosis?
A. Cholestasis
B. Viral hepatts
C. Gilberts syndrome
D. Haemochromatosis

A

C. Gilberts syndrome

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68
Q

A 61-year-old man complains of indigeston that has been bothering him for the past 2 months. He has never had these symptoms before and he is eatng and drinking well. He says he has lost weight over this period. His bowel habits are normal and he does not complain of any abdominal pains. Abdominal examinaton is normal. Blood tests including full blood count, renal functon, and liver functon as well as C-reactve protein are normal. Which of the following is the best management plan?
A. Urgent endoscopy
B. Routne abdominal ultrasound
C. Abdominal and erect X-ray today
D. Routne referral to gastroenterology

A

A. Urgent endoscopy

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69
Q

A 58-year-old man with chronic kidney disease has been on haemodialysis for chronic kidney disease for the past 8 years. What is most likely cause of mortality in such case?
A. Ischemic heart disease
B. Dialysis related sepsis
C. Hyperkalaemia
D. Malignancy

A

A. Ischemic heart disease

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70
Q

A 29-year-old man diagnosed with celiac disease 2 years ago. He complains of ongoing diarrhoea, feeling tred and bloatng. Poor compliance with a gluten-free diet is suspected. Which of the following is the most appropriate method to ascertain this?
A. Food diary
B. Refer for a duodenal biopsy
C. Ant-endomysial antbodies
D. Tissue transglutaminase antbodies

A

D. Tissue transglutaminase antbodies

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71
Q

A 61-year-old man with suspected lef ventricular heart failure. He had B-type natriuretc peptde (BNPy test, which came back as being slightly elevated. Which of the following factors cause a falsely elevated NP?
A. ACE inhibitor therapy
B. Furosemide
C. Obesity
D. COPD

A

D. COPD

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72
Q

A 22-year-old woman develops severe vomitng 4 hours afer having lunch at a restaurant. What is the most likely causatve organism?
A. Shigella
B. Campylobacter
C. Escherichia coli
D. Staphylococcus aureus

A

D. Staphylococcus aureus

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73
Q

Which of the following extra-intestnal manifestatons of Cohn’s disease actvity?
A. Clubbing
B. Erythema nodosum
C. Pyoderma gangrenosum
D. Primary sclerosing cholangits

A

B. Erythema nodosum

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74
Q

A 28-year-old woman comes to the clinic for a check-up. She believes that she is allergic to wheat; her symptoms of abdominal bloatng and loose stool have improved over the past few months by eatng a gluten-free diet. Which of the following is the most appropriate advice to her?
A. Dietcian referral
B. Gastroenterology referral
C. No need to Contnue on gluten-free diet
D. Resume eating gluten, bloods for celiac screen

A

D. Resume eating gluten, bloods for celiac screen

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75
Q

A 58-year-old man with chronic obstructve pulmonary disease (COPD) is ready to be discharged home afer acute exacerbaton of the disease. Which of the following parameters indicate ofering long-term oxygen therapy?
A. 1 arterial blood gas measurement with p02 < 7,7 kPa
B. 2 arterial blood gases measurements with p02 < 7.3 kPa
C. 1 arterial blood gas measurement with p02 < 8.0 kPa
D. 2 arterial blood gases measurements with p02 < 6.3 kPa

A

B. 2 arterial blood gases measurements with p02 < 7.3 kPa

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76
Q

A 27-year-old man who has a sister with adult polycystc kidney disease came to screen for the disease. Which of the following is the most appropriate screening test?
A. CT abdomen
B. Urine microscopy
C. Ultrasound abdomen
D. Ant-polycystn 1 antbodies levels

A

C. Ultrasound abdomen

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77
Q

A 61-year-old man with stable chronic kidney disease stage 3. Which of the following drugs is it safe to prescribe for this patent?
A. Nitrofurantoin
B. Metormin
C. Warfarin
D. Lithium

A

C. Warfarin

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78
Q

A 57-year-old man who is intolerant of aspirin is started on clopidogrel for the secondary preventon of ischemic heart disease. Which of the following drugs can make clopidogrel less efectve?
A. Warfarin
B. Omeprazole
C. Beta blockers
D. Selectve serotonin reuptake inhibitors

A

B. Omeprazole

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79
Q

A nurse is biten by a patent who is known to have hepatts B. She has a documented full history of hepatts B vaccinaton and was known to be a responder. What is the most appropriate acton to reduce the chance of contractng hepatts B?
A. Give hepatts B immune globulin + hepatts B vaccine booster
B. Give hepatts B immune globulin
C. Give hepatts B vaccine booster
D. Give oral ribavinn for 4 weeks

A

C. Give hepatts B vaccine booster

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80
Q

A 44-year-old man who was recently diagnosed as chronic kidney disease stage 4, presented to the clinic to discuss the diet in regard to his conditon. He has read that potassium rich food should be consumed in moderate amount. Which of the following foods should he eat in moderaton?
A. Grapes
B. Tomatoes
C. Green beans
D. Cranberry juice

A

B. Tomatoes

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81
Q

A 40-year-old woman is notced to be jaundiced (see lab results). Test Result Ant-HBs Negatve Ant-HBc Positve Bs antgen Positve IgM ant-HBc Negatve What is the patent’s hepatts B status?
A. Chronic hepatitis B
B. Acute hepatts B infection
C. Previous hepatts B infection
D. Previous immunisaton to hepatts B

A

A. Chronic hepatitis B

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82
Q

A 28-year-old woman who is 38 weeks pregnant presents with dysuria and urinary frequency. A urine dipstck is positve for nitrites and leucocytes. Which of the following is the most appropriate management?
A. Cefalexin
B. Doxycycline
C. Nitrofurantoin
D. Advise to increase fuid intake

A

A. Cefalexin

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83
Q

A 36-year-old man has just completed a 2-week course of Helicobacter pylori therapy for dyspepsia. He has stopped his eradicaton therapy today and he wants to repeat the test. How soon can the test be re- performed to test for eradicaton?
A. In 4 weeks
B. In 2 weeks
C. In 1 weeks
D. Straight away

A

A. In 4 weeks

84
Q

A 28-year-old woman with imitable bowel syndrome comes to the clinic complaining that loperamide and antspasmodic medicaton have not eased her symptoms. She has no new symptoms suggestve of any serious conditon. Which of the following is the most appropriate treatment?
A. Cognitive behavior the rap psychological therapy
B. Tricyclic antidepressant
C. Psychological therapy
D. Acupuncture

A

B. Tricyclic antidepressant

85
Q

A 44-year-old woman is diagnosed with non-alcoholic steatohepatts following a liver biopsy. What is the single most important step can help to prevent the progression of her disease?
A. Weight loss
B. Stop smoking
C. Start statn therapy
D. Eat more omega-3 faty acids

A

A. Weight loss

86
Q

A 77-year-old man with a history of atrial fbrillaton is admited to the hospital following an acute coronary interventon and treated with a percutaneous coronary interventon. His medicaton on admission were warfarin, paracetamol and allopurinol. Antthrombotc therapy immediately given afer his event. Which of the following regimen should he be prescribed?
A. Continue warfarin with the additon of 2 antiplatelets
B. Stop warfarin, start 3 antplatelets
C. Stop warfarin, start 2 antplatelets
D. Contnue warfarin monotherapy

A

A. Continue warfarin with the additon of 2 antiplatelets

87
Q

A 59-year-old man presents 4 weeks afer being discharged from hospital. He had been admited with chest pain and thrombolysed for a myocardial infarcton. 2 days later, he developed marked tongue and facial swelling. His vital signs are within the normal limits. Which of the following drugs is most likely to be responsible?
A. Atenolo
B. Ramipril
C. Aspirin
D. Atorvastatn

A

B. Ramipril

88
Q

A 66-year-old man with hypertension comes to the clinic for a follow-up. He is currently taking a combinaton of losartan and amlodipine, which is failing to keep his blood pressure within target. Examinaton is unremarkable. His blood test and renal functon profle were within the normal limits. What is the most appropriate next step assuming he has no relevant contraindicatons?
A. Add ramipril 1.25mg od
B. Add atenolol 50mg od
C. Add doxazosin 1mg od
D. Add indapamide MR 1.5mg od

A

D. Add indapamide MR 1.5mg od

89
Q

A 51-year-old woman with asthma complaining of increasing shortness of breath and wheeze in the past few hours. She has a long-standing diagnosis of asthma but her medicaton history suggests a lack of compliance. Her best peak fow measurements in previous consultatons have been 300 L/min. Which of the following features suggests acute severe asthma in this patent?
A. Heart rate 100/min
B. Respiratory rate >20/min
C. Peak fow rate 200 L/min
D. Inability to complete sentences in one breath

A

D. Inability to complete sentences in one breath

90
Q

A 31-year-old man with asthma complaining of increasing wheeze in the past few hours. His medicaton history suggests a lack of compliance. His best peak fow measurements in previous consultatons have been 600 L/min. Which of the following features suggests acute severe asthma in this patent?
A. A peak fow rate of 250 L/min
B. Respiratory rate >20/min
C. Heart rate 100/min
D. SpO2 95%

A

A. A peak fow rate of 250 L/min

91
Q

A 22-year-old man, whose asthma is uncontrolled on beta agonist therapy, is commenced on a steroid inhaler. Which of the following is the most likely adverse efect?
A. Dysphonia
B. Dental abscess
C. Peptc ulceraton
D. Thrombocytopenia

A

A. Dysphonia

92
Q

A 58-year-old man presents with a 6-month history of breathlessness. He has been smoking all his adult life, he smokes 10-15 cigaretes per day. On examinaton, he has lost the nail fold angle of his fngers. Which of the following is the most likely diagnosis?
A. Chronic obstructve pulmonary disease
B. Bronchial carcinoma
C. Aspergillosis
D. Asthma

A

B. Bronchial carcinoma

93
Q

A 36-year-old man with multple health problems presents to the Emergency Department with an episode of bronchospasm. He has a history of asthma and hypertension. He is undergoing a medicaton review. Which of the following medicatons is most likely to be responsible?
A. Salmeterol
B. Atenolol
C. Ramipril
D. Aspirin

A

B. Atenolol

94
Q

A 21-year-old man presents with paroxysms of coughing for the past week, following a mild fue illness. The paroxysms have been so severe that they have resulted vomitng and chest pain. He had been immunised for pertussis as a child. What is the best advice about the protecton following immunisaton?
A. Immunisaton ofers lifelong immunity against pertussis
B. Immunity following immunization wanes within 3 years
C. Immunity following immunization wanes within 10 years
D. Immunity following immunization wanes afer 25 years

A

B. Immunity following immunization wanes within 3 years

95
Q

A 31-year-old man with asthma complaining of increasing wheeze in the past few hours. He rarely atends asthma clinic and his previous best peak fow readings has been 400 L/min. Which of the following would suggest acute severe asthma?
A. 02 saturaton <95%
B. Respiratory rate >25
C. Carotd pulse > 100 bpm
D. Peak fow rate <300 L/min

A

B. Respiratory rate >25

96
Q

A 38-year-old woman presents for annual asthma review. Her symptoms are very well controlled and she has not had any atacks since her last review a year ago and has not used her salbutamol inhaler once in that year. She is prescribed an inhaled beomethasone steroid twice daily in additon to her salbutamol inhaler. What is the most appropriate next step in modifying her medicaton?
A. Add a leukotriene receptor antagonist
B. Double the dose of the inhaled
C. Stop both the salbutamol and becomethasone inhalers
D. Half the beclomethasone dose and review in 6 months

A

D. Half the beclomethasone dose and review in 6 months

97
Q

A 38-year-old man is admited with a sudden onset dyspnoea and pleuritc chest pain. He is a smoker but has no history of respiratory disease. He considers himself healthy and regularly plays football. On admission, he has a chest x-ray that shows a pneumothorax with a 3cm rim of air. Aspiraton is successful and he is discharged. A follow-up chest x-ray 2 weeks later shows a complete resoluton. What is the single most important piece of advice to reduce his risk of further pneumothoraces?
A. Stop smoking
B. Avoid fying for 12 months
C. Avoid sports for 12 months
D. Arrange a course of respiratory physiotherapy pnemothorax

A

A. Stop smoking

98
Q

A 28-year-old wood worker presents to the clinic complaining of episodic shortness of breath. He describes feeling wheezy and having a tendency to cough. A diagnosis of occupaton asthma is suspected. Which of the following is the most appropriate diagnostc investgaton?
A. Serial peak fow measurements at work and at home
B. Specifc IgE measurements
C. Skin prick test
D. Patch testng

A

A. Serial peak fow measurements at work and at home

99
Q

A 66-year-old man presents with shortness of breath. He smokes 20 cigaretes/day but is otherwise well. Spirometry shows a restrictve picture. Which of the following is the most likely diagnosis?
A. Pulmonary fbrosis
B. Bronchiectasis
C. Heart failure
D. Asthma

A

A. Pulmonary fbrosis

100
Q

A 31-year-old man came for smoking cessaton support as his father has recently been diagnosed with lung cancer. He has a past medical history of epilepsy, which is well-controlled on carbamazepine. Which smoking cessaton medicaton would be contraindicated for this patent?
A. Nicotne replacement therapy
B. E-Cigaretes
C. Varenicline
D. Bupropion

A

D. Bupropion

101
Q

A 47-year-old man presents with intermitent chest pains for the past 2 days. He complains of worsening pain. On examinaton, he tachycardic and sweaty. ECG is done (see image). Blood pressure 133 /81 mmHg. What does the ECG show?
A. Posterior mvocardial infarcton
B. Right bundle branch block
C. Ventricular tachycardia
D. Left bundle branch block

A

D. Left bundle branch block

102
Q

A 61-year-old man comes to the clinic with a 2-day history of dyspnoea on exerton. He has a long standing hypertension and a 30-pack-year smoking history. Physical examinaton is unremarkable except for rare crackles at the bases of the lungs. Which of the following tests would be most helpful for detectng lef ventricular dysfuncton?
A. B-type natriuretc peptde (BNP)
B. C-reactve protein (CRP)
C. Creatnine Kinase (CK)
D. Troponin T

A

A. B-type natriuretc peptde (BNP)

103
Q

A 58-year-old man with diabetes mellitus came for follow-up. He is on metormin (Glucophage), 1000 mg/day, as well as atorvastatn (Lipitor), 40 mg daily for hypertpidaemia. There is no diagnosis of hypertension. His urine albumin/creatnine rato is in the microalbuminuria range for the frst tme (see lab results). Blood pressure 128/77 mmH Test Result Normal Values НА1C 6.3 4.7-5.6 % LDL (cholesterol) 2.1 <4.0 mol/L Which of the following would be most appropriate next step?
A. Renal ultrasonography
B. Repeat urine albumin/creatinine ration
C. Stopping metormin
D. 24-hour urine for microalbumin

A

B. Repeat urine albumin/creatinine ration

104
Q

A 25-year-old woman presents with symptoms of extreme fatgue, no appette, and bloody urine She developed a very sore throat 3 weeks ago but did not have it examined or treated. 3 days ago, she began to have bloody urine and swelling of her hands and feet. Her past health has been excellent. There is no family history of signifcant illness. She has no allergies. On examinaton, she has signifcant edema of both lower extremites. Blood pressure 166/108 mmHg, Heart rate 82 /min Which of the following is the most likely diagnosis?
A. Berger disease
B. Immunoglobulin A nephropathy
C. Poststreptococcal Glomerulonephritis
D. Membranous glomerulonephrits

A

C. Poststreptococcal Glomerulonephritis

105
Q

A 51-year-old man with chronic and progressing renal disease. His GF is decreasing and most likely he will need dialysis sometme within the next year. Which of the following will be the most likely cause of death in his case?
A. Renal failure
B. Coagulopathy
C. Pulmonary edema
D. Cardiovascular disease

A

D. Cardiovascular disease

106
Q

A 77-year-old man with a history of ischemic heart disease is seen in the Hypertension Clinic. He is taking 4 ant-hypertensives drugs. Physical examinaton is unremarkable. Abdominal ultrasound shows asymmetrical kidneys. Blood pressure 169/99 mmHg, Heart rate 79 /min Which of the following is the most likely diagnosis?
A. Renal artery stenosis
B. Cushing’s syndrome
C. Primary hyperaldosteronism
D. Adult polycystc kidney disease

A

A. Renal artery stenosis

107
Q

What is the most common locaton of Crohn’s disease?
A. Ileal
B. Colonic
C. Duodenum
D. Ileocolonic

A

D. Ileocolonic

108
Q

A 30-year-old woman presented with 1-week history of fatgue malaise and nausea. 2 days ago, she notced yellowish discoloraton of the sclera. She denied any history of abdominal pain or drugs intake. She has no signifcant medical history. On examinaton, she is jaundiced with no stgmata of chronic liver disease, conscious with no fapping tremors (see lab results) Blood pressure 110/70 mmHg Heart rate 76 /min Temperature 36.6 °C Test Result Normal Values Direct bilirubin 108 1.5-6.5 mol/L Total bilirubin 129 3.5-16.5 mol/L Aspartate aminotransferase 1235 12-40 IU/L Alanine aminotransferase 1987 5-40 IU/L Alkaline phosphatase 156 39-117 IU/L Gamma glutamyltransferase 60 6 to 37 IU/L Albumin 41 34-56 g/L Which of the following is the most appropriate management?
A. Order PT, INR
B. Discharge her home
C. Admit and start IV dextrose
D. Refer her to liver transplant center

A

A. Order PT, INR

109
Q

A 40-year-old man comes to the clinic complaining of diarrhea and abdominal cramps. The symptoms started a day afer he returned home from trip to India. The stool are watery with no mucus or blood. Blood pressure 100/70 mmHg Heart rate 98 /min Temperature 37.3 °C Which of the following is the most likely pathogen?
A. Rotavirus
B. Escherichia coll
C. Bacillus cereus
D. Clostridum perfringens

A

B. Escherichia coll

110
Q

A 60-year-old man with chronic hepatts C and liver cirrhosis presented to Emergency Room with perforated peptc ulcer that requires urgent laparotomy (see lab results). Test Result Normal Values Hb 90 130-170 g/L (Male) - 120-160 g/L (Female) Platelets count 90 150-400 × 109/L INR 2 0.8-1.2 Prothrombin tme 17 10-13 sec which of the following is the most appropriate next step in the management prior to the procedure?
A. Platelets
B. Cryoprecipitate
C. Fresh frozen plasma
D. Packed red blood cells

A

C. Fresh frozen plasma

111
Q

What is the recommended age for screening colonoscopy for average risk populaton?
A. 40
B. 50
C. 55
D. 60

A

B. 50

112
Q

A 45-year-old obese woman presented with 1-week history of jaundice, anorexia and abdominal pain. She has no chronic illnesses and not on any medicatons. On examinaton, she is jaundiced with stable vital signs and no fever. Abdomen exam showed mild tender liver with span of 13 cm, no splenomegaly (see lab results). Test Result Normal Values RBC 4 4.7-6.1 x 1012/L (Male) 4.2-5.4 x 1012/L (Female) Hb 110 130-170 g/L. (Male) 120-160 g/L (Female) Platelets count 212 150-400 × 109/L WBC 18 4.5-10.5 x 109/L Direct bilirubin 79 1.5-6.5 mol/L Total bilirubin 98 3.5-16.5 mol/L Aspartate aminotransferase 70 12-40 IU/L Alanine aminotransferase 150 5-40 IU/L Alkaline phosphatase 1000 39-117 IU/L Which of the following is the next step in the management?
A. MRCP
B. Liver biopsy
C. Abdominal ultrasound
D. Abdominal CT scan of the liver

A

C. Abdominal ultrasound

113
Q

Charcot triad of fever, upper abdominal pain and jaundice is diagnostc of which of the following conditons?
A. Hepatitis
B. Cholangitis
C. Pancreatitis
D. Cholecystjts

A

B. Cholangitis

114
Q

A 60-year-old woman with recent history of feeling tredness, fatgue and weight loss. She notced as well worsening of her chronic constpaton. Stool for occult blood was positve (see lab resuits). Test Result Normal Values BC 3 4.7-6.1 x 1012/L (Male) 4.2-5.4 x 1012/L (Female) Hb 89 130-170 g/L (Male) 120-160 g/L (Female)
HCT 0.25 0.42-0.52 (Male) 0.37-0.48 (Female) Platelets count 234 150-400 × 109/L Which of the following is the best next step in diagnosis?
A. CT Angiography
B. Barium enema
C. Sigmoidoscopy
D. Colonoscopy

A

D. Colonoscopy

115
Q

A 48-year-old woman with 4-months history progressive dysphagia for solid and liquid and she notced as well weight loss. Lab investgaton was normal apart from mild anemia. Upper GI endoscopy was recommended but she refused as her relatve died post colonoscopy. Which of the following is the best next acton?
A. Explore her concern
B. Discharge her from the clinic
C. Ask her son to sign the consent
D. Call for a meeting with the family

A

A. Explore her concern

116
Q

A 20-year-old man present to the clinic for advice. He has a positve family history of familial polyposis syndrome. He is asymptomatc with normal Lab tests. Which of the following is the best advice at this stage?
A. Close follow-up
B. Order colonoscopy
C. Tumour markers panel
D. His risk is very low and no further acton

A

B. Order colonoscopy

117
Q

A 55-year-old man presented to the Colonoscopy Unit to perform screening colonoscopy. The consent was taken and procedure started. During colonoscopy, a large polyp 4 cm was seen which need to be removed by snare polypectomy which carries a high risk of bleeding and perforaton than the screening colonoscopy. Which of the following is the best acton?
A. Perform the polypectomy
B. Ask the relatve to sign the new consent
C. Let the patent sign afer the procedure
D. Repeat the procedure with high risk consent

A

D. Repeat the procedure with high risk consent

118
Q

A 32-year-old man with 1-year history of intermitent dysphagia for solid with no other alarm symptoms. He has no chronic medical illness. Upper GI endoscopy was recommended but he refused the procedure. Which of the following is the best next acton?
A. Discharge from the clinic
B. Ask the brother to sign the consent
C. Show him that you are upset with his decision
D. Discuss with him other alternative like barium swallowing

A

D. Discuss with him other alternative like barium swallowing

119
Q

A 30-year-old woman presented with hematemesis afer a bout of prolonged vomitng. She has no signifcant medical history and not on any medicatons. Which of the following is the most likely diagnosis?
A. Gastrits
B. Duodenal ulcer
C. Mallory-Weiss tear
D. Barret’s esophagus

A

C. Mallory-Weiss tear

120
Q

A 32-year-old man diagnosed with fbrostenotc ileal crohn’s disease underwent ileocecal resecton of 70 cm from the ileum. 1-month post-operatve, started to complain of diarrhoea watery 5 tmes/day with no mucus or blood. No history of abdominal pain. On examinaton, he is unremarkable. All basic work up was normal including stool culture (see lab result and report). Test Result Normal Values ESR 7 2-10 mm/h (Male) 3-15 mm/h (Female) CT scan of abdomen: Showed normal anastmosis site. Which of the following is the most appropriate treatment?
A. Mesalamine
B. Prednisolone
C. Metronidazole
D. Cholestyramine

A

D. Cholestyramine

121
Q

A 45-year-old woman with systemic lupus erythematosus comes for routne follow-up visit. She was asymptomatc and currently on no medicatons. Her conditon is stable for several years (see lab results). Blood pressure 140/90 mmH Test Result Normal Values 24 hr urine protein 35 0.8-14 mg/di (Male) 2.5-11 mg/di (Female) Protein 500 0-150 mg/24 hr BC 5000 up to 4,000 in 1 ml Urea 20 2.75-7.4 mmol/L Creatnine 160 44-115 mol/L Which of the following is the most appropriate next step in management?
A. Ant Ds-DNA
B. Renal biopsy
C. Doppler renal ultrasound
D. Repeat urine analysis in next visit

A

B. Renal biopsy

122
Q

Which of the following is the most useful therapy to reduce stone formaton in a patent with hypercalciuria?
A. Allopurinol
B. Pencillamine
C. Thiazide diuretcs
D. Dietary calcium restricton

A

C. Thiazide diuretcs

123
Q

A 50-year-old man presented to the clinic with recent onset of numbness of his feet and hands History revealed he has chronic kidney disease for 3 years. Examinaton showed decrease sensaton to pinprick and vibraton stmuli below the knee with absent ankle refexes (see lab results). Blood pressure 140/90 mmHg Test Result Normal Values RBC 4 4.7-6.1 x 1012/L (Male) 4.2-5.4 x 1012/L (Female) Hb 9 130-170 g/L (Male) 120-160 g/L (Female) MCV 73 80-95 f Potassium 5.3 3.5-5.1 mmol/L Urea 46 2.75-7.4 mmol/L Creatnine 674 44-115 umol/L Which of the following is the most appropriate next step in the management?
A. Erythropietn
B. Oral bicarbonate
C. Vitamin B complex
D. Initiation of dialysis

A

D. Initiation of dialysis

124
Q

A 65-year-old man presents with severe chest pain to Emergency Room. ECG showed st segment elevaton of inferior leads. He received thrombolytc therapy (PA). 3 hours later, started to feel dizzy. ECG showed 2:1 AV block. IV atropine given with no efect. Vital signs 3 hours later: Blood pressure 80/45 mmH, Heart rate 39 /min, Respiratory rate 18 /min, Oxygen saturaton 90 % Which of the following is the best management opton?
A. IV fuid
B. Dopamine
C. Isoprenaline
D. Temporary pacemaker

A

D. Temporary pacemaker

125
Q

A 65-year-old man presented to Emergency Room with severe chest pain. He was diagnosed as inferior MI and received thromolytc therapy (PA). Few hours later, he developed dizziness. ECG is done (see image). Blood pressure 80/50 mmg, Heart rate 41 /min Which of the following is the most likely diagnosis?
A. 1st degree heart block
B. 2nd degree heart block
C. 3rd degree heart block
D. 4th degree heart block

A

B. 2nd degree heart block

126
Q

A 34-year-old woman presented to the clinic with new onset SOB and fatgue. She is diagnosed as a case of mitral stenosis with pulmonary hypertension. She is planning to get pregnant and she is hiding the diagnosis from her husband. Which of the following is the most appropriate advice?
A. Close monitor and follow-up
B. She can go ahead with her plan
C. Call her husband and tell him the diagnosis
D. Counselling her about the risk and squally of the pregnancy

A

D. Counselling her about the risk and squally of the pregnancy

127
Q

A 55-year-old patent comes to the clinic. He is hypertensive and on captopril. ECG showed tall, tented T waves. Which of the following is the best next step in management?
A. Reassurance
B. Order cardiac enzyme
C. Check potassium level
D. Admit him with urgent echo

A

C. Check potassium level

128
Q

A 70-year-old woman known to have chronic heart failure resented with sever shortness of breath, paroxysmal nocturnal dyspnea and orthopnea. On examinaton, she looks unwell, high JVP with bilateral basal crackles at both lungs. S3 was heard at the apex. Blood pressure 110/70 mmHg Heart rate 100 /min Oxygen saturaton 88 % Which of the following is the best next step in management?
A. 100% 02
B. Metalazone
C. IV furosemide
D. Order urgent echo

A

C. IV furosemide

129
Q

A 65-year-old woman known to have heart failure presented with sever shortness of breath, paroxysmal nocturnal dyspnea and orthopnea. On examinaton, she looks unwell, high JVP with bilateral basal crackles at both lungs. S3 was heard at the apex. Blood pressure 100/70 mmHg Heart rate 93 /min Oxygen saturaton 88 % Which of the following is the most likely diagnosis?
A. Myocardial infarcton
B. Pulmonary oedema
C. Right-sided heart failure
D. Acute mitral regurgitaton

A

B. Pulmonary oedema

130
Q

A 24-year-old athlete man atended routne clinic visit. He is asymptomatc and has no signifcant past medical history but found to have a restng pulse of 47 beat/min, normal blood pressure and cardiac examinaton. Normal CBC, renal functon, LFT, and TSH. ECG normal only sinus bradycardia. Which of the following is the best advice?
A. Reassurance
B. Order urgent echo
C. Genetc counselling
D. Repeat ECG every 3 months

A

A. Reassurance

131
Q

A 67-year-old woman diagnosed with heart failure being treated with loop diuretc and ACE inhibitor with good control of her symptoms. Which of the following medicatons helps in reducing her long-term mortality?
A. Digoxin
B. Nifedipine
C. Amiodarone
D. Spironolactone

A

D. Spironolactone

132
Q

A 67-year-old diabetc patent with atrial fbrillaton is hesitant to start ant-coagulant due to its risk of inducing bleeding. which of the following factors is the most important in making the decision?
A. The patent has no risk for bleeding
B. The patent has mild risk of thrombosis
C. The bleeding risk is higher than thrombosis risk
D. His risk of thromboembolic events is higher than bleeding

A

D. His risk of thromboembolic events is higher than bleeding

133
Q

A 60-year-old woman admited to the hospital for cardiac catheterizaton but she is concerned about its complicatons. Which of the following is the best way to address her concerns?
A. Tell her it is very rare and no need to worry
B. Inform her that her husband will sign the consent
C. Listen to her concern and explain what are the expected complicatons
D. Listen to her concern and explain what are the expected complicatons and give alternative

A

D. Listen to her concern and explain what are the expected complicatons and give alternative

134
Q

A 57-year-old man with known history of asthma, congestve heart failure and peptc ulcer disease was admited with asthma exacerbaton and rapid atrial fbrillaton. He was managed with nebulized salbutamol, IV digoxin, and his home medicatons was contnued (ACE inhibitor, Ranitdine, Spironolactone). 24 hours later, his serum potassium is noted to be 2.8 mEq/L. Which of the following medicatons is the most likely to cause this abnormality?
A. Digoxin
B. Ranitdine
C. Salbutamol
D. Spironolactone

A

C. Salbutamol

135
Q

A 21-year-old woman with history of recurrent palpitatons, light-headedness and 2 atacks of faintng. ECG showed short PR interval and Inferior leads Q waves. She was diagnosed as Wolf-Parkinson-White (WPW) syndrome. She was given atenolol with no response. Which of the following is the best management opton?
A. Digoxin
B. Amiodarone
C. Increase atenolo dose
D. Radiofrequancy ablaton

A

D. Radiofrequancy ablaton

136
Q

A 20-year-old man presented with 3-months history of watery diarrhea, weight loss of 3 kg and abdominal cramps. He gave a history of travel to Mecca few months back. No other symptoms. Upper Gl endoscopy was normal. Smear from duodenal aspirate revealed many trophozoites (see lab results). Test Result Normal Values Hb 109 130-170 g/L (Male) 120-160 g/L (Female)
Platelets count 459 150-400 x 109/L Which of the following is the most likely diagnosis?
A. Salmonella
B. Giardia lambia
C. Clostridium difcile
D. Campylobacter jejuni

A

B. Giardia lambia

137
Q

A 19-year-old man presented with 3-months history of watery diarrhea, weight loss of 3 kg and abdominal cramps. He gave a history of travel to India few months back. No other symptoms. A smear from duodenal aspirate revealed many trophozites (see lab results). Test Result Normal Values Hb 108 130-170 g/L (Male) 120-160 g/L (Female) Platelets count 458 150-400 × 109/L Which of the following is the most appropriate management?
A. Doxacyclin
B. Rifampicin
C. Metronidazole
D. Chloramphenicol

A

C. Metronidazole

138
Q

What is the best and simplest way to prevent giardiasis infecton?
A. Hand washing
B. Avoid eatng fruits
C. Avoid eatng vegetables
D. Prophylactc antbiotcs

A

A. Hand washing

139
Q

A 67-year-old diabetc patent admited to Intensive Care Unit with sepsis and urinary tract infecton. Blood culture revealed methicillin-resistant staphylococcus aureus. Which of the following is the most appropriate treatment opton?
A. Cefuroxime
B. Vancomycin
C. Gentamycin
D. Flucioxacillin

A

B. Vancomycin

140
Q

What is the best and simplest precauton to prevent spread of MRSA infecton?
A. Hand hygiene
B. Wearing gowns
C. Wearing face mask
D. Daily disinfecton of the beds

A

A. Hand hygiene

141
Q

A patent with infectve endocardits started on antbiotcs. What is the simplest way in monitoring antbiotcs response?
A. Blood culture
B. Daily full blood count
C. Serial echocardiography
D. Serum C-reactve protein concentraton

A

D. Serum C-reactve protein concentraton

142
Q

A 25-year-old man developed fever, malaise and rash on his palm and soles. He gave a history of painless ulcer on his penis 6 weeks earlier. Examinaton was unremarkable a part from generalised lymphadenopathy. Which of the following is the most likely organism causing his presentaton?
A. Coxiella burnet
B. Treponema pallidum
C. Staphylococcus aureus
D. Chylamdia trachomats

A

B. Treponema pallidum

143
Q

A 33-year-old man presented with 2-weeks of lethargy, fever, generalised lymphadenopathy and cough. History revealed he is a business man travels frequently to Far East. On examinaton, he has oral candidiasis (see lab results). Test Result Normal Values RBC 4 4.7-6.1 x 1012/L (Male) 4.2-5.4 x 1012/L (Female) Hb 13 130-170 g/L (Male) 120-160 q/L (Female) Platelets count 145 150-400 x 109/L WBC 11 4.5-10.5 x 109/L Neutrophils 22 40-60% Lymphocytes 69 20-40 % Monocytes 9 2-8 % Which of the following is the most likely diagnosis?
A HIV
B. Syphilis
C. Brucellosis
D. Toxoplasmosis

A

A HIV

144
Q

A 56-year-old diabetc man presented with cough and fever. Chest-XR showed cavity at upper lobe of the lef lung. What is the type of precauton required when dealing with this patent?
A. Droplet
B. Contact
C. Airborne
D. Standard

A

C. Airborne

145
Q

A 22-year-old woman previously healthy was admited with 3-days history of fever, myalgia and pharyngits. She gave history of 1-day macular rash over the trunk afer she received amoxicillin from private clinic. On examinaton, she has generalised lymphadenopathy. Which of the following is the most likely diagnosis?
A. Diphteria
B. Hodgkin’s disease
C. Infectous mononucleosis
D. Cytomegalovirus infecton

A

C. Infectous mononucleosis

146
Q

A 25-year-old woman presented with 4-days history of confusion, lethargy and fever. On examinaton, she was drowsy with mild neck stfness (see report). CT scan brain: Showed area of low atenuaton at right tempo-parietal region. Which of the following is the most likely diagnosis?
A. Brain abscess
B. Premococcal meningits
C. Herpes simplex encephalits
D. Listeria meningoencephalits

A

C. Herpes simplex encephalits

147
Q

A 43-year-old veterinarian man presents with 2-months history of progressive fatgue, back pain and fever. He also notced a recent history of headache, mood /behaviour changes and paraesthesia. He is does not smoke with no history of alcohol or other signifcant medical history. On examinaton, he was uncooperatve and agitated. Abdomen examinaton showed mild hepatosplenomegaly and tender right sacroiliac joint (see lab results). Blood pressure 110/70 mmHg, Heart rate 88 /min, Temperature 38.6 °C Test Result Normal Values RBC 4 4.7-6.1 x 1012/L (Male) 4.2-5.4 x 1012/L (Female) Hb 93 130-170 g/L (Male) 120-160 g/L (Female) Platelets count 120 150-400 x 109/L WBC 9 4.5-10.5 x 109/L Which of the following is the most likely diagnosis?
A. Syphilis
B. Brucellosis
C. Tuberculosis
D. Toxoplasmosis

A

B. Brucellosis

148
Q

A 41-year-old veterinarian man presents with 3-months history of progressive fatgue. back pain and fever. He also notced a recent history of headache, mood /behaviour changes and paraesthesia. He does not smoke and with no history of alcohol or other signifcant medical history. On examinaton, he was uncooperatve and agitated. Abdomen examinaton showed mild hepatosplenomegaly and tender right sacroiliac joint (see lab results). Blood pressure 110/70 mmg Heart rate 86 /min Temperature 38.6 ‘C Test Result Normal Values Hb 98 130-170 g/L. (Male) 120-160 g/L (Female) Platelets count 122 150-400 x 109/L WBC 8 4.5-10.5 x 109/L. Which of the following is the most appropriate next step in management?
A. Liver functon
B. X-ray sacroiliac joint
C. Tuberculin skin test
D. Tube agglutnaton test

A

D. Tube agglutnaton test

149
Q

A 43-year-old man was recently diagnosed with neurobrucellosis. He is started on rifampicin (600 mg/day) and doxycycline (100 mg twice daily orally). which of the following is the recommended treatment duraton?
A. 6 weeks
B. 8 weeks
C. 4 months
D. 6 months

A

D. 6 months

150
Q

A 22-year-old man known case with AIDS on actve antretroviral therapy (HART) presented with history of headache and weakness at lef side of the body. On examinaton, he is found to have lef hemiparesis, hemianopia, aphasia, ataxia, and 6/7 cranial nerve palsies. Investgaton showed a rising tters of ant- toxoplasma immunoglobulin G (IgG) antbodies and positve immunoglobulin M (IgM) antbody (see report). Brain MRI scans: Demonstrated multple hypodense lesions in white mater and basal ganglia with mass efects. Which of the following is the best treatment opton?
A. Rifampicin and cefuroxime
B. Doxacyclin and clindamycin
C. Cholramphenicol and leucovorin
D. Sulfadiazine and pyrimethamine

A

D. Sulfadiazine and pyrimethamine

151
Q

A 55-year-old man presents in the Emergency Department with nausea, pallor and lethargy. He has no past medical history of note. On examinaton, he has normal vital signs and unremarkable systemic examinaton (see lab results and report). Test Result Normal Values Sodium 139 134-146 mol/L Potassium 6.9 3.5-5.1 mmol/L Bicarbonate 14 21-28 mmol/L. Blood urea nitrogen 14 2.8 to 8.9 mmol/L Creatnine 240 44-115 mol/L ECG: Showed tall peaked T waves. Which of the following is the most appropriate inital management?
A. Haemodialysis
B. Nebulised salbutamol
C. Insulin dextrose infusion
D. Intravenous calcium gluconate

A

D. Intravenous calcium gluconate

152
Q

A 62-year-old man presents with progressive lower limbs edema for the last 4 months otherwise he is asymptomatc. He is known to have diabetes complicated with diabetc nephropathy and hypertension. His current medicatons are insulin, thiazide, ramipril and amlodipine. On examinaton blood pressure is 144/78 mmg, JVP not raised, +3 lower limbs edema with normal cardiac and respiratory examinaton. Renal functon was similar to 3 months ago (see lab results). Test Result Normal Values Sodium 138 134-146 mol/L Potassium 4.8 3.5-5.1 mmol/L Urea 12.9 2.75-7.4 mmol/L Creatnine 230 44-115 mol/L Creatnine clearance 22 70-103 mol/L which of the following is the most appropriate acton?
A. Switch thiazide to furosemide
B. No change to his medication
C. Add a beta-blocker D. Stop ramipril

A

A. Switch thiazide to furosemide

153
Q

A 55-year-old man who has developed chronic kidney disease secondary to focal segmental glomeruloscierosis is reviewed in the clinic. His renal functon is deterioratng. Haemodialysis is planned to start soon (see lab result). Test Result Normal Values Creatnine clearance 10 70-103 mol/L What is the preferred method of access to start Haemodialysis?
A. Arteriovenous graf
B. Arteriovenous fistula
C. Tunelled venous catheter
D. Non-tunelled venous catheter

A

B. Arteriovenous fistula

154
Q

which of the following scenario with acute kidney injury should be referred for urgent Haemodialysis?
A. Patent with eGFR < 5
B. Potassium of 7.5 afer 3 courses of medical management
C. Patent who has had 10ml of urine output over the last 24 hours
D. Patent who has previously had acute kidney injury three tmes

A

B. Potassium of 7.5 afer 3 courses of medical management

155
Q

A 65-year-old man has been admited with abdominal pain and he need urgent contrast- enhanced CT but there is a concer regarding his kidney status as he has chronic kidney disease stage 3 (see lab results). Test Result Normal Values Sodium 143 134-146 mmol/L Potassium 4.5 3.5-5.1 mmol/L Blood urea nitrogen 9 2.8 to 8.9 mmol/L Creatnine 160 44-115 mol/L Which of the following is the most important step in reducing the risk of contrast-induced nephropathy?
A. Oral N-acetylcysteine
B. Oral sodium bicarbonate
C. Intravenous furosemide pre-procedure
D. Intravenous 0.9% sodium chloride pre- and post-procedure

A

D. Intravenous 0.9% sodium chloride pre- and post-procedure

156
Q

A 55-year-old man is seen in the Emergency Department complaining of lethargy for the last 2 days. On physical examinaton, vital signs are stable with unremarkable physical examinaton. ECG shows no acute changes (see lab results). Test Result Normal Values Sodium 139 134-146 mmol/L Potassium 6.6 3.5-5.1 mmol/L Bicarbonate 15 21-28 mmol/L Blood urea nitrogen 9 2.8 to 8.9 mmol/L Creatnine 118 44-115 mol/L Which of the following is the most appropriate inital treatment?
A. Haemodialysis
B. Intravenous bicarbonate
C. Insulin dextrose infusion
D. Intravenous normal saline

A

C. Insulin dextrose infusion

157
Q

A 26-year-old woman is recently diagnosed as nephrotc syndrome secondary to minimal change glomerulonephrits afer being presented with proteinuria. Which of the following is the most appropriate inital treatment to reduce proteinuria?
A. Prednisolone
B. Low protein diet
C. No treatment required
D. Angiotensin-convertng-enzyme inhibitor

A

A. Prednisolone

158
Q

A 30-year-old woman with Crohn’s disease presents with hypokalemia refractory to aggressive paranteral and oral KCI supplementaton. Which of the following is the next step in managment?
A. Assess her serum plasma aldosterone to plasma renin rato
B. IV magnesium sulfate
C. Start spironolactone
D. Observaton

A

B. IV magnesium sulfate

159
Q

A 60-year-old woman presents to the clinic with a 10-year history of type 2 diabetes treated with insulin. Recently diagnosed to have hypertension and proteinuria (see lab results). Blood pressure 150/90 mmHg Heart rate 87 /min BMI 29 kg/m2 Test Result Normal Values Blood urea nitrogen 4 2.8 to 8.9 mmol/L Creatnine 80 44-115 mol/L Glucose, fastng 6.4 3.5-6.5 mmol/L НЬА1C 7 4.7-5.6 % Which of the following is the most appropriate management?
A. Life style modifcaton for 6 months
B. Increase Insulin doses
C. Start ACE inhibitors
D. Start atenolol

A

C. Start ACE inhibitors

160
Q

A 69-year-old man is evaluated during a routne examinaton. He reports his blood pressure to be around 150/84 mmHg on several occasions. He is known to have mild benign prostatc hyperplasia, and hyperlipidemia for which he is taking simvastatn. Cardiac examinaton is normal, and the remainder of the physical examinaton is unremarkable. Laboratory studies show a normal chemistry panel; a urine dipstck demonstrates no blood or protein. An electrocardiogram shows no evidence of lef ventricular hypertrophy Blood pressure 147/86 mmHg Heart rate 80 /min Respiratory rate 14 /min Temperature 36.6 °C Oxygen saturaton 95 % BMI 31 kg/m2 Which of the following is the most appropriate next step in management?
A. Repeat blood pressure determinaton in 4 months
B. Lifestyle modifcatons and weight loss
C. Start Amlodipine
D. Start B-blockers

A

B. Lifestyle modifcatons and weight loss

161
Q

A 60-year-old man is evaluated during a follow-up visit for management of newly diagnosed hypertension and diabetes mellitus started on metormin and gliclazide but not started on anthypertensive therapy. Physical examinaton is unremarkable (see lab results). Blood pressure 155/95 mmH Heart rate 80 /min BMI 32.5 kg/m2 Test Result Normal Values Blood urea nitrogen 5 2.8 to 8.9 mmol/L Creatnine 100 44-115 mol/L Random Glucose 6 3.9-5.5 mmol/L НА1C 6.9 4.7-5.6 % Protein Present absent Glucose Absent absent Which of the following is the most appropriate anthypertensive treatment for this patent?
A. Lisinopril
B. Atenolol
C. Amlodipine
D. Hydrochlorothiazide

A

A. Lisinopril

162
Q

A 20-year-old woman is diagnosed of type 1 diabetes mellitus afer presentng with diabetc ketoacidosis. Her blood sugars are now stable and she is ready for discharge. Which of the following is the best insulin regime she should be ofered as outpatent?
A. Twice daily NPH insulin
B. Once daily mixtard insulin
C. Basal-bolus insulin regimen with once-daily insulin glargine
D. Rapid-actng insulin analogue before each meal with no longer actng insulin

A

C. Basal-bolus insulin regimen with once-daily insulin glargine

163
Q

A 70-year-old woman known to have type 2 diabetes mellitus. She is currently taking metormin 1g bid physical examinaton is unremarkable (see lab results). Test Result Normal Values Creatnine 80 44-115 mol/L Glucose, fastng 6 3.5-6.5 mmol/L Random Glucose 7.5 3.9-5.5 mmol/L НbА1C 6.9 4.7-5.6 % Which of the following is the most appropriate next step in management plan?
A. Increase dose of metormin
B. Add glimepiride
C. Add Sitagliptn
D. No changes

A

D. No changes

164
Q

A 30-year-old woman presents with secondary amenorrhea afer stopping the oral contraceptve pill 6 months ago. She gets regular headaches and visual disturbance. On examinaton, she has visual felds showed bilateral defects in the upper outer quadrants (see lab results and report). Test Result Normal Values Thyroid-Stmulatng Hormone 0.1 0.4 - 5.0 wU/mL. Thyroxine (T4 free serum) 7.5 8.5 - 15.2 pmol/L Follicle-stmulatng hormone 0.2 5-20 IU/L (Follicular phase) 15-35 IU/L (Mid cycle peak)
5-15 IU/L (Luteal phase) 50-100 IU/L (Postmenopausal women) 5-20 IU/L (men) Luteinizing hormone 0.3 3-15 U/L (Male) 5-22 U/L (Follicular phase) 5-22 U/L (Luteal phase) 30-250 U/L (ovulatory phase) > 30 U/L (Postmenopausal) Prolactn 950 < 652 pmol/L (Male) < 870 pmol/L (Female) Cortsol 8 a.m. 30 138-635 mol/L Pituitary MRI: 4 cm pituitary mass compressing optc chiasm. Which of the following is the defnitve treatment opton?
A. Octreotde
B. Bromocriptne
C. Stereotactc radiotherapy
D. Trans-sphenoidal surgery

A

D. Trans-sphenoidal surgery

165
Q

A 32-year-old woman was admited 2 days ago complaining of feeling unwell with vomitng, postural dizziness and weight loss. Synacthen test confrmed the diagnosis with Addison’s disease. She was started on treatment with hydrocortsone 3 tmes a day, as well as fudrocortsone on a daily basis. She has been taking hydrocortsone 10mg at 9:00 and then 5mg at 12:00 and 15:00. On discharge, she informs the medical team that she sometmes does shif-work. What is the most appropriate advice to give regarding steroid dosing for night shifs?
A. On shif days omit taking steroids
B. Take doses at 09:00, 12:00 and 15:00 regardless of shif paterns
C. On shif days take doses at 09:00, but then take other doses at night
D. Adjust to take frst dose at waking, then doses at 3 and 6 hours from startng

A

D. Adjust to take frst dose at waking, then doses at 3 and 6 hours from starting

166
Q

A 34-year-old woman presents with increasing symptoms of heat intolerance, diarrhea and anxiety over the past couple of weeks. She is 28 weeks pregnant with her frst baby and has a past medical history of hyperthyroidism, currently treated with 15 mg carbimazole. She has no other past medical history. She does not smoke, drink alcohol nor take any other drugs (see lab results). Blood pressure 110/70 mmHg Heart rate 120 /min Respiratory rate 18 /min Temperature 37.6 °C Oxygen saturaton 95 % Test Result Normal Values Thyroid-Stmulatng Hormone 0.1 0.4 - 5.0 U/mL Triiodothyronine (T3 free serum) 12 3.5 - 6.5 pmol/L Thyroxine (T4 free serum) 25 8.5 - 15.2 pmol/L Which of the following is the most appropriate next step in management?
A. Refer patent for immediate caesarean secton
B. Increase carbimazole dose to 20mg once daily
C. Switch carbimazole to propyithiouracil
D. Refer for a thyroidectomy

A

B. Increase carbimazole dose to 20mg once daily

167
Q

A 40-year-old woman is 6 weeks pregnant, presented to Endocrinology Clinic with diarrhea, heat intolerance and palpitaton for the last month. She has no past medical history but she has strong family history of thyroid disease (see lab results). Heart rate 90 /min Respiratory rate 18 /min Temperature 37.2 °C Test Result Normal Values TSH 0.001 0.4 - 5.0 yU/mL Free T4 45 8.5 - 15.2 pmol/L TSH receptor antbodies Positve negatve Which of the following is the most appropriate inital management?
A. Propranolol
B. Carbimazole
C. Propyithiouracil
D. Total thyroidectomy

A

C. Propyithiouracil

168
Q

A 45-year-old woman is referred to the Endocrinology Clinic due to abnormal thyroid functon tests. Otherwise, she is asymptomatc. On examinaton, there is no evidence of goiter (see lab results). Blood pressure 139/85 mmHg Heart rate 66 /min Temperature 36.6 °C BMI 29 kg/m2 Test Result Normal Values Thyroid-Stmulatng Hormone 15 0.4 - 5.0 pU/mL. Thyroxine (T4 free serum) 6.5 8.5 - 15.2 pmol/L Which of the following is the most appropriate management plan?
A. Reassure and discharge
B. Arrange for US of the neck
C. Repeat blood tests in 6 months
D. Start levothyroxine replacement

A

D. Start levothyroxine replacement

169
Q

A 27-year-old woman presents with 2-day history of generally unwell, nausea, vomitng and lethargy. She is a known type 1 diabetc using a long-standing subcutaneous insulin regime. She was started on treatment for diabetc ketoacidosis with intravenous fuids and fxed rate insulin. Her blood sugar is reviewed 3 hours afer treatment was initated. On admission, blood tests are done (see lab results). Test Result Normal Values ABG HCO3- 8 22-28 mmol/L pH 7.2 7.36-7.45 Random Glucose 32 3.9-5.5 mmol/L What should be the aim in managing hyperglycemia in a diabetc ketoacidosis patent?
A. Reduce blood glucose to under 14 mol/I as quickly as possible
B. Reduce blood glucose by 3mmol/I per hour
C. Reduce blood glucose by 6 mmol/ per hour
D. Aim blood glucose above 18 mmol/

A

B. Reduce blood glucose by 3mmol/I per hour

170
Q

A 20-year-old man with type 1 diabetes presents to the Emergency Department with vomitng and abdominal pain. He has been sufering from diarrhea for 2 days and then became severely dehydrated and started to vomit. He has not had his insulin for the last 24 hours. Normally, he has a basal bolus regime with Glargine as a long-actng insulin, and Humalog as short-actng. On admission, he is found to have acidosis, elevated serum ketones and elevated blood glucose, and was diagnosed with diabetc ketoacidosis. He is started on IV fuid What insulin should he be prescribed now?
A. Fixed rate IV insulin as well as long-actng insulin
B. Sliding scale SC insulin
C. Fixed rate IV insulin
D. Insulin mixtard bid

A

A. Fixed rate IV insulin as well as long-actng insulin

171
Q

A 55-year-old man presents with excessive sweatng and headache. An oral glucose tolerance test and MRI brain were ordered to confrm the diagnosis of acromegaly What other investgaton will be required in the future?
A. Transesophageal echocardiography
B. No further investgatons required
C. Colonoscopy
D. CT abdomin

A

C. Colonoscopy

172
Q

A 55-year-old man is referred to the Diabetes Clinic afer presentng with polyuria and polydipsia with strong family history of type 2 diabetes mellitus. Physical examinaton is unremarkable (see lab results). Blood pressure 136/85 mmHg Heart rate 76 /min Temperature 36.6 °C BMI 34 kg/m2 Test Result Normal Values Glucose, fastng 9 3.5-6.5 mmol/L НА1C 7.8 4.7-5.6 % Which of the following is the most appropriate frst-line treatment?
A. Dietary advice, exercise and metormin
B. Dietary advice and exercise
C. Sulphonylurea
D. Exenatde

A

A. Dietary advice, exercise and metormin

173
Q

A 43-year-old man comes to the clinic for a follow-up. He has been recently diagnosed with type 2 diabetes and has been following a plan of lifestyle measures to improve his diet and increase his level of exercise (see lab result). Blood pressure 129/80 mmHg BMI 32 kq/m2 Test Result Normal Values НА1C 6.9 4.7-5.6 % Which of the following is the most appropriate treatment opton now?
A. Insulin
B. Metormin
C. Sulphonylurea
D. Further diet and exercise

A

B. Metormin

174
Q

A 40-year-old man was diagnosed with primary hyperparathyroidism based on the biochemistry results (elevated calcium, low phosphate and raised PTH levels) and parathyroid ultrasound images, which showed lef lower parathyroid adenoma Which of the following is considered a valid indicaton for consideraton for electve parathyroidectomy?
A. Age >50 years
B. Evidence of osteoporosis
C. Normal renal functon test
D. High parathyroid hormone level

A

B. Evidence of osteoporosis

175
Q

An 18-year-old woman presented to the Emergency Room with spasms of hands along with twitching around the mouth. Her general physical and systemic examinaton was unremarkable except for pallor, dental caries and small body built. She had prolonged QT interval on ECG (see lab results). Test Result Normal Values Calcium 1.6 2.15-2.62 mmol/L Phosphate, inorganic 0.7 0.82-1.51 mmol/L Parathyroid hormone (intact PTH levels) 4.5 1.1-5.3 pmol/L 25-Hydroxy Vitamin D3 (Women) 10 25-90 mol/L Which of the following is the most appropriate inital treatment approach?
A. Oral calcium
B. Cholecalciferol
C. Intravenous calcium
D. Oral phosphate supplementaton

A

C. Intravenous calcium

176
Q

A 70-year-old man with ischemic heart disease developed dizziness and confusion following accidental ingeston of a higher dose of atenolol. Blood pressure 70/40 mmH Heart rate 46 /min In additon to holding atenolol and administraton of intravenous fuid, which of the following drugs is the most appropriate?
A. Nifedipine
B. Glucagon
C. Salbutamol nebulizer
D. Aminophylline infusion

A

B. Glucagon

177
Q

A 60-year-old man with diabetes, hypertension and intermitent claudicaton due is diagnosed to have stable angina. Decision is made to manage him with intensive medical therapy. He is started on aspirin, rosuvastatn and nitroglycerine but stll gets angina with moderate exercise. Blood pressure 130/85 mmHg Heart rate 86 /min Which of the following is the most appropriate additonal drug?
A. Diltazem
B. Nifedipine
C. Amlodipine
D. Metoprolol

A

A. Diltazem

178
Q

A 20-year-old woman presents to the Emergency Department with palpitatons for 2-hours (see image and lab results). Blood pressure 135/80 mmHg Heart rate 150 /min Test Result Normal Values Hb 138 130-170 g/L (Male) 120-160 g/L (Female) Thyroid-Stmulatng Hormone 3.2 0.4 - 5.0 U/mL Which of the following is the most appropriate inital management?
A. Oral amiodarone
B. Carotid sinus massage
C. Intravenous adenosine
D. Electrical cardioversion

A

B. Carotid sinus massage

179
Q

A 65-year-old man with diabetes is admited to the Coronary Care Unit with diagnosis of acute ST elevaton anterior myocardial infarcton. He developed massive hematemesis following streptokinase infusion. Which of the following drugs would reverse the acton of streptokinase?
A. Factor VIII concentrate
B. Aminocaproic acid
C. Protamine
D. Vitamine K

A

B. Aminocaproic acid

180
Q

A 69-year-old man is admited with acute chest pain and shortness of breath. Workup confrmed acute myocardial infarcton. Upon discharge, he is advised to quit smoking. but he is unwilling to do so. What should be said to the patent during the counseling session?
A. “We feel that you are uncooperatve”
B. “We will involve the family in this issue”
C. “If you do not stop smoking you will die”
D. “Contnuing smoking means more complicatons*

A

D. “Contnuing smoking means more complicatons*

181
Q

A 50-year-old man who works as a bank employee is discharged following a 7-day admission for acute myocardial infarcton. He was given 5 diferent drugs. What further informaton regarding life style and daily actvites should be given to him?
A. Advise him to change his job
B. Start driving 2 days afer discharge
C. Refrain from sexual actvites for 3 months
D. Perform mild aerobic exercise from next week

A

D. Perform mild aerobic exercise from next week

182
Q

A 50-year-old man known to have advanced dilated cardiomyopathy is admited to the Coronary Care Unit for the 5th tme during the past 2 months. This admission! Ate is in refractory heart failure despite being on high doses of inotropic agents and nasal CAP, Decision is made to consider him for heart transplantaton. Afer setng the scene, how would you break the news?
A. Start with a warning shot and deliver the news in small steps
B. Do not waste tme, tell him the decision directly
C. Deal with his concerns by expressing sympathy
D. Discuss the decision with his son

A

A. Start with a warning shot and deliver the news in small steps

183
Q

A 60-year-old man presents with epigastric pain and early satety associated with 10% weight loss over 8 months (see lab results). Test Result Normal Values Hb 98 130-170 g/L (Male) 120-160 g/L (Female) MCV 70 80-95 f1 Which of the following is the best inital acton in management?
A. Gastroscopy
B. Ultrasound of abdomen
C. Empirical therapy for H. pylori
D. Trial of proton pump inhibitor for 6 weeks

A

A. Gastroscopy

184
Q

A 30-year-old woman complains of epigastric pain, heartburn and bloatng afer meals for 3 months. No history of hematemesis or weight loss. A trial of esomeprazole 40mg for 8 weeks did not relief her symptoms (see lab result and reports). Test Result Normal Values Hb 140 130-170 g/L (Male) 120-160 g/L (Female) Gastroscopy: Normal. Urea breath test: Negatve. Ultrasound of abdomen: Normal. Which of the following is the best next step in management?
A. Ranitdine
B. Hyoscine butylbromide
C. Tricyclic antidepressant
D. Increase the dose of esomeprazole to 80mg/day

A

C. Tricyclic antidepressant

185
Q

In a patent with liver cirrhosis and bleeding esophageal varices, treated with esophageal banding, which of the following drugs is efectve in preventng future bleeding?
A. Nadolol
B. Verapamil
C. Octreotde
D. Vasopressin

A

A. Nadolol

186
Q

An 18-year-old girl presents with chronic diarrhea and intermitent abdominal pain. No history of upper or lower Gl bleeding. On examinaton, she is slim and has pallor. No jaundice (see lab results. Hb 100 130-170 g/L (Male) 120-160 g/L (Female) MCV 100 80-95 f Platelets count 540 150-400 x 109/L WBC 6 4.5-10.5 x 109/L Vitamin B12 (Women) 0.074 0.12-0.66 mol/L Folic Acid (Women) 0.099 <0.1 mol/L Which of the following is the most likely diagnosis?
A. Celiac disease
B. Crohns disease
C. Ulceratve colits
D. Whipples disease

A

B. Crohns disease

187
Q

An 18-year-old girl brought by her parents to the Gastroenterology Clinic as they notced her to have a fne tremor of both hands. Further examinaton showed jaundice and just palpable spleen (see lab results). Test Result Normal Values Copper 0.8 1.72-3.54 mmol/L (Male) 1.72-3.76 mmol/L (Female) Direct bilirubin 22.32 1.5-6.5 mol/L Total bilirubin 38.2 3.5-16.5 mol/L Aspartate aminotransferase 243 12-40 IU/L Alanine aminotransferase 165 5-40 IU/L Albumin 23 34-56 g/L Total Proteins 46 60-84 cc Serum ceruloplasmin Low 24 hours urine copper High Which of the following is the most appropriate treatment?
A. Cortcosteroid
B. D-penicillamine
C. Desferrioxamine
D. Ursodeoxycholic acid

A

B. D-penicillamine

188
Q

A 70-year-old man is mechanically ventlated in the Intensive Care Unit following massive cerebral hemorrhage. 7 days later, he developed cofee ground vomitus. history is only signifcant for hypertension. Which of the following is the most likely the cause?
A. Stress gastrits
B. Functonal dyspepsia
C. Helicobacter gastrits
D. Gastrosophageal refux

A

A. Stress gastrits

189
Q

A 45-year old with chronic hepatts B is noted to develop increasing jaundice for the last 2 weeks assoclated with fatgue (see lab results). Test Result Normal Values Direct bilirubin 28.43 1.5-6.5 umol/L Total bilirubin 39 3.5-16.5 mol/L Aspartate aminotransferase 345 12-40 IU/L Alanine aminotransferase 523 5-40 IU/L Albumin 34 34-56 a/L Total Proteins 60 60-84 cc Hepatts B DNA level Low Which of the following is the most appropriate next step in management?
A. Start vitamin E
B. Perform liver biopsy
C. Start alpha interferon
D. Request ant-Delta antbody

A

D. Request ant-Delta antbody

190
Q

A middle-aged woman with hepatomegaly underwent upper abdomen MRI and found to have a 3cm lesion in the liver that shows peripheral beaded enhancement in the early phase with progressive central flling in the delayed phase. Which of the following is the most likely diagnosis?
A. Hepatoma
B. Metastasis
C. Hydatd cyst
D. Hemangioma

A

D. Hemangioma

191
Q

A patent presents with chronic dyspepsia and recurrent upper Gl bleeds. Urea breath test is positve. Which of the following regimen is the best to treat the underlying cause?
A. Oral omeprazole for 6 weeks
B. Ranitdine plus bismuth for 6 weeks
C. Sucralfate plus metronidazole for 6 weeks
D. Esomeprazole, amoxicillin and clarithromycin for 14 days

A

D. Esomeprazole, amoxicillin and clarithromycin for 14 days

192
Q

A 40-year-old woman is under treatment for a recurrent helicobacter-associated duodenal ulcer. She notced that her stool is turned non-tarry black (see lab result). Blood pressure 110/70 mmH Heart rate 70 /min Test Result Normal Values Hb 152 130-170 g/L (Male) 120-160 g/L (Female) What drug is likely to be the cause of the black stools?
A. Ranitdine
B. Pantoprazole
C. Bismuth subsalicylate
D. Alumunium hydroxide

A

C. Bismuth subsalicylate

193
Q

A 25-year-old patent presented with diarrhea for 5 months, which is mostly related to eatng bread and wheat products. Which of the following skin lesions would suggest the likely diagnosis?
A. Psoriasis
B. Hyperpigmentaton
C. Dermatts herpitformis
D. Pyoderma gangrenous

A

C. Dermatts herpitformis

194
Q

A 38-year old woman who was previously healthy came to the Emergency Department with recurrent episodes of passing black stools and sometmes fresh blood per-rectum over the last 2 months. Physical examinaton was unremarkable apart from pallor (see lab results and reports). Test Result Normal Values Hb 88 130-170 g/L (Male) 120-160 g/L (Female) Upper and lower Gl endoscopy: Showed no signifcant pathology. Which of the following is the best next investgaton?
A. CT abdomen
B. Capsule endoscopy
C. Barium meal and follow
D. Radio-isotope scan of abdomen

A

B. Capsule endoscopy

195
Q

A 23-year-old woman is brought to the Emergency Department afer she ingested 15 tablets of paracetamol in a suicidal atempt 6 hours earlier. Actvated charcoal is administered by the Emergency doctor. Which of the following is the best next opton in management?
A. Hyperbaric oxygen
B. N-acetylcysteine
C. D-penicillamine
D. Hemodialysis

A

B. N-acetylcysteine

196
Q

A 43-year-old man is known to have hepatts B virus infecton presented with fever and confusion. On examinaton, he is disoriented, has asterixis and positve shifing dullness (see report). Ascetc Fluid analysis: Showed serum albumin ascitc fuid gradient (SAAG) of 1.2 and 350 neutrophils. Culture is bending. Which of the following is the best management?
A. IV diuretcs and metronidazole
B. Lactulose enema and IV cefriaxone
C. Oral Lactulose and sedaton with diazepam
D. High volume ascetc fuid aspiraton and propranolol

A

B. Lactulose enema and IV cefriaxone

197
Q

A 60-year-old man presents to Emergency Department with altered sensorium. He was recently diagnosed to have inoperable small cell carcinoma of the lung. On examinaton, he is euvolemic (see lab results). Blood pressure 110/70 mmHg Heart rate 76 /min Test Result Normal Values Sodium 115 134-146 mmol/L Potassium 3.8 3.5-5.1 mmol/L Urea 4.3 2.75-7.4 mmol/L Creatnine 76 44-115 mol/L Which of the following is the best inital management?
A. 5% destrose
B. Normal saline
C. Hypertonic saline
D. Half normal saline

A

C. Hypertonic saline

198
Q

A 70-year-old man presented to Emergency Department with generalized fatgability. 2 days ago, he had CT brain with contrast for possible transient ischemic atack. Physical examinaton is unremarkable (see lab results). Blood pressure 130/70 mmHg Heart rate 76 /min Test Result Normal Values Hb 170 130-170 g/L (Male) 120-160 q/L (Female) Urea 30.4 2.75-7.4 mmol/L Creatnine 378 44-115 mol/L Which of the following is the most likely mechanism for the renal impairment?
A. Pre-renal azotemia
B. Acute tubular necrosis
C. Acute intersttal nephrits
D. Acute glomerular nephrits

A

B. Acute tubular necrosis

199
Q

A 30-year-old man is found to have a repeated BP of 170/110 mmg. He is not on any medicatons. Physical examinaton is unremarkable (see lab results). Test Result Normal Values Sodium 138 134-146 mmol/L Potassium 2.1 3.5-5.1 mmol/L Urea 3.67 2.75-7.4 mmol/L Creatnine 66 44-115 mol/L Which of the following is the most likely diagnosis?
A. Primary hyperaldosteronism
B. Polycystc kidney disease
C. Coarctaton of the aorta
D. Primary hypertension

A

A. Primary hyperaldosteronism

200
Q

A 20-year-old man presents with hematuria, 1-day following a throat infecton. Which of the following is the most likely diagnosis?
A. IgA nephropathy
B. Membranous nephropathy
C. Post-infectous glomerular nephrits
D. Focal segmental glomerulosclerosis

A

A. IgA nephropathy

201
Q

A 22-year-old woman is admited with pulmonary hemorrhage and rapidly progressive glomerulonephrits. She has history of recurrent sinusits and numbness in her right upper limb and lef lower limb. Which of the following is the most likely diagnosis?
A. Giant cell arterits
B. Polyarterits nodosa
C. Henoch-Schonlein purpura
D. Granulomatosis with polyangits

A

D. Granulomatosis with polyangits

202
Q

A 50-year-old man with diabetes, hypertension and chronic kidney disease. presents to the Nephrology Clinic for follow-up (see image and lab results). Blood pressure 160/98 mmHg, Heart rate 80 /min Test Result Normal Values Potassium 6.5 3.5-5.1 mmol/L Creatnine 440 44-115 mol/L Which of the following is the best immediate step in management?
A. Intravenous calcium gluconate
B. Intravenous NAHCO3
C. Insulin with dextrose
D. Dialysis

A

A. Intravenous calcium gluconate

203
Q

An 18-year-old man is complaining of red urine for 5 days. He has no abdominal pain and no dysuria, urgency or frequency. His history is signifcant for tonsillits 3 weeks ago. Physical examinaton is normal except for elevated blood pressure. Blood pressure 160/100 mmH, Heart rate 76 /min Which of the following is the most likely diagnosis?
A. Kidney stone
B. Hypernephroma
C. IgA nephropathy
D. Post streptococcal glomerulonephrits

A

D. Post streptococcal glomerulonephrits

204
Q

A 68-year-old woman known to have dilated cardiomyopathy with an ejecton fracton of 30% one month ago is admited with a diagnosis of acute gastroenterits. She had repeated vomitng and watery diarrhea for 3 days. Her urine output is reduced in volume. She is on furosemide, lisinopril, spironolactone, and carvedilol. On examinaton, she is dehydrated, confused, has cold clammy skin and the JVP is 1 cm above the sternal angle (see lab results and reports). Blood pressure 88/55 mmH Heart rate 70 /min Test Result Normal Values Sodium 142 134-146 mmol/L Potassium 5.5 3.5-5.1 mmol/L Urea 230 2.75-7.4 mmol/L Creatnine 220 44-115 mol/L Sodium 15 40-230 mmal/day Osmolality 1300 280-910 mOsm/Kg H20 Central venous line: inserted and is 3 cm of H20. Fractonal excreton of sodium: 0.6%. What is the best opton in management?
A. Increase the dose of furosemide
B. Intravenous dobutamine infusion
C. Carful intravenous saline infusion
D. Increase the dose of spironolactone

A

C. Carful intravenous saline infusion

205
Q

A patent with actve rheumatoid arthrits presents with pleural efusion. Which of the following is typical fnding in the pleural fuid analysis?
A. Hemorrhagic
B. Transudatve
C. High pH, > 7.64
D. Glucose content of 1 mmol/L

A

D. Glucose content of 1 mmol/L

206
Q

A 40-year-old woman presents with recurrent atacks of dyspnea and cough when exposed to dust and perfumes. Physical examinaton is normal except for mild expiratory wheeze on lung auscultaton. Which of the following tests has the highest diagnostc value?
A. Spirometry
B. Chest X-ray
C. Arterial blood gases
D. Methacholine challenge test

A

A. Spirometry

SMLE (8 decks)

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