2012 - 6th Flashcards
Patient with a history of TB came with elbow hyperpigmentation, hypotension, after stopping his antibiotics. How what you confirm his diagnosis? (2ndary adrenal insufficiency)
Cortisol & ACTH
Patient with locked-in syndrome, where is the lesion?
Ventral pons
Patient with weakness and atrophy of triceps of the right arm and loss of sensation of right thumb and index. She also had brisk reflexes of ankles. What will make your diagnosis of cervical spondylosis more probable than amyotrophic lateral sclerosis?
a. brisk retexes
b. weakness
c. Sensor loss
d. Wasting of muscles
c. Sensor loss
(Repeated question) about old, obese lady, with hypothyroidism with signs and symptoms of infective endocarditis, what’s the organism responsible and what’s the route of transmission?
a. Strept bovis from colon cancer
b. Strept viridance from UTI
c. Strept from teeth extraction
a. Strept bovis from colon cancer
Patient with a history of MI, died despite of arrival to hospital, what’s the cause of death?
Ventricular arrhythmia
Patient with right iliac fossa pain and tenderness with a mass at the ilocecal area, he also had 2 neck sinuses with discharge and fever
a. Ileocecal crohns
b. Ileocecal lymphoma
c. Cecal diverticulitis
a. Ileocecal crohns
Patient came with right sided weakness and sensory loss 1.5 hours after symptoms started. He is hvpertensive and ECG showed AF. What’s the next step?
aCT scan
b. Start tissue plasminogen activator
aCT scan
Patient with fever, neck stiffness, and photophobia. CT showed edema in temporal lobes and was diagnosed with meningioencephalitis. What’s the treatment?
a. Acvciovir. ceftriaxone. vancomvcin
b. Acyclovir, ceftriaxone, gentamycin
c. Acyclovir, ampicillin, vancomycin
d. Acyclovir, ceftriaxone
a. Acvciovir. ceftriaxone. vancomycin
History of a young female with recurrent throat infection, came with fever, high ESR, prolonged PR interval, joint pain, and myalgia, x-ray showed cardiomegaly, what will you find upon examination? (acute rheumatic fever gives regurgitation)
a. Opening snap
b. Loud S1
c. Early diastolic murmur
d. Ejection systolic murmur at left sternal boarder e. Ejection systolic murmur at right sternal boarder
c. Early diastolic murmur
Young patient with syncope attacks and exertional SOB and pain, x-ray was given showing “post-aortic dilation”, what’s the cause?
Aortic stenosis with low CO
Patient with homonomes hemianopia, where’s the lesion?
a. Optic nerve
b. Optic chiasm
c. Retina
d. Cortical lesion
d. Cortical lesion
A patient with ejection systolic murmur and on ECG tall R wave in V1 and deep S1 wave in V6, where’s the lesion? (R1,V1,H1)
a. Aortic stenosis
b. Pulmonary stenosis
c. Mitral regurgitation
b. Pulmonary stenosis
Young female with chronic abdominal pain, diarrhea, constipation, (there was more in the question but no indication of IBS)
Patient with crushing retrosternal pain, sweating and STEMI on V1-V3 was given thrombolytic therapy, five days later he develops another sever pain, how can you confirm re-infarction?
. High CK-MB
(Repeated question) patient with compensated HF on B blocker, taking paracetamol for his osteoarthritis, got worsening of SOB, PND, and orthopnea, he had an irregular heart rhythm, what’s the most probable cause of his worsening HF?
a. Paracetamol
b. B blocker
c. Atrial fibrillation
c. Atrial fibrillation
Obese female Patient with migraine responding to ibuprofen. What’s the best long term prophylaxis?
a. Amliotryptin
b. Topiramate
c. Triptans
d.Bockers
b. Topiramate
Patient with MS in remission, comes with symptoms of flare attack. Doctor told her this is a pseudoflare because it lasted <24 hours. Which of the following is not likely to cause a psuedoflare? (psuedoflare is an attack with symptoms of relapse MS <24 hrs, its not a relapse! Usually happens with high temperature due to incomplete myelination plus fever slows down nerve conduction causing the symptoms reappear)
a. Exercise
b. Pregnancy
c. Fever
d. UTI
e. Hot shower
b. Pregnancy
Patient had a slow rising carotid pulsation in a long scenario, what’s the diagnosis? (he also had syncope attacks and exertional chest pain)
a. Aortic stenosis
b. Hypertrophic cardiomyopathy
a. Aortic stenosis
What is the most sensitive test of myasthenia gravis
a. Repetitive nerve stimulation
b. Anti-acetylcholine receptor Ab
c. Single fiber EMG
d. CT scan of thymus
c. Single fiber EMG
Case suggesting gallian barre syndrome, what’s correct about the results of
investigation?
CSF shows high proteins and normal cell count
Patient with paresthesia that started on his foot, then it reached his knees bilaterally with involvement on the hands, this lesion is due to a pathology of:
a. Spinal cord
b. Thalamus
c. Basal ganglia
d. Cortex
e. Peripheral neuropathy
e. Peripheral neuropathy
Patient with signs and symptoms of heart failure, S3 gallop, dilated heart on X-ray, what will you find on examination?
Pansystolic murmur
Patient with weakness, bradykinesia, and pin rolling tremor
Parkinsons disease
Patient with ptosis and restricted eye movements, which of the following makes compressive oculomotor nerve lesion more likely horners?
a. Partial ptosis
b. Failure of abduction of eye
c. Dilated pupils
d. Constricted pupils
c. Dilated pupils
Patient with history of prematurity and NICU admission, had a murmur when he was at school before but because of his family issues he did not consult a doctor, now he has
a murmur below his left clavicle, what’s the diagnosis?
a. ASD
b. VSD c. PDA
?
Diabetic patient with paresthesia and weakness of his hands and feet, whats the most common neuropathy of his condition?
a. Autonomic neuropathy
b. Radiculopathy
c. Peripheral sensorimotor polyneuropathy
c. Peripheral sensorimotor polyneuropathy
Patient with signs of pericarditis and pericardial effusion. What is the best options that describes his case?
a. Fluid accumulation of 200 mL
b. Pericardiectomy
c. Xray showing cardiomegaly
c. Xray showing cardiomegaly
History of a patient with hypertension and LVH. Picture showed renal artery stenosis. What’s the diagnosis?
a. Renal artery stenosis
Patient with pericarditis and effusion, developed hypotension and tachycardia, what’s the management?
IV fluids and pericardiocentisis
A pregnant lady with hypertension. How will you manage her hypertension?
Methyledopa
Patient with ptosis at the end of the day, fatigability and tiredness. When she looks up, after a couple of minutes, ptosis occurs. There’s fatigability on examination when you tell her to do the fly test (abduction and adduction of arms for multiple times), what would you find in this patient?
Thymoma
Patient with ankle reflexes but upward going toe flexion. Which of the following can
be excluded?
a. Motor neuron disease
b. Multiple sclerosis
c. Spinal cord
d. B12 deficiency
b. Multiple sclerosis
Young died while playing football with a positive family history, what will you find in his pathology report?
Hypertrophic cardiomyopathy
Patient with ST segment elevation in L2, L3, and aVF, came with sudden SOB and palpation, what will you find on examination? (this is acute MR)
a. Mid diastolic murmur at apex
b. Opening snap
c. Early diastolic murmur at left sternal boarder d. Pansystolic murmur at apex
d. Pansystolic murmur at apex
Female patient (not pregnant) came to you with history of amenorrhea for the past 6 months. She failed to menstruate after progesterone challenge test. Her labs: estrogen low, FH high, FSH high, TSH normal, prolactin normal. Whats the diagnosis?
a. Pituitartv histrocutosis
b. Prolactinoma
c. Sheehan syndrome
d. PCOS
e. Primary ovarian failure
e. Primary ovarian failure
Patient after knee replacement surgery, developed sudden SOB and tachycardia, he has a history of ischemic heart disease and on his medications (B blocker, aspirin, etc) ECG was given (showed S1, T3, Q3 lesion with tachycardia and tall R wave in V1)
a. Pulmonary embolism
- Patient came with myalgia, fatigue, and cold intolerance. On examination, muscle power and tone were normal, but had tenderness at examination. What’s the appropriate next step?
a. Check TSH level
Patient with dejà vu, and fear, what will your investigation be?
MRI sections of the hippocampus
Young male with staring, automatism, not responding to peple. MRI showed hippocampal atrophy?
a. Absence seizure
b. Complex partial seizure
b. Complex partial seizure
Patient with optic disc swelling. On examination he had failure of adduction of left eye with right eye nystagmus (INO)
a. Multiple sclerosis
b. Myasthenia gravis
a. Multiple sclerosis
Patient presenting after trauma to E with bleeding that continued despite receiving
Hb, FFP, and plts. APTT 1 and PT 1. What would cause this?
a. Factor VIlI
b. Factor VII,
C. Severe thrombocytopenia
d.Low albumin
e. Low fibrinogen
e. Low fibrinogen
Patient with huntingtons diease, whats correct about the mode of inheritance?
a. Autosomal recessive
b. All his daughters will be affected but not his sons
c. All his children have a 50% chance ot beina attected
C.No male-male transmissior
c. All his children have a 50% chance ot beina attected
Patient with mid systolic murmur and a fixed split S2 on school routine examination, what’s the most probably diagnosis?
ASD
What’s correct about neuromyelitis optica?
a. Mild episodes of myelitis and optic neuritis
b. You’ll find aquaporin 4-antigen antibody
b. You’ll find aquaporin 4-antigen antibody
Complication of topiromate?
a. Rena stones
b. Liver failure
a. Rena stones
An ECG was given for a case with fever and sharp chest pain that gets relieved by leaning forward, ECG was showing diffused ST segment elevation, what will you find on examination?
Pericardial to-and-fro leathery murmurq
Patient with palpitations, anxiety, and nervousness. Labs showed low TSH, high free T4. Examination showed non tender thyroid nodule. Radioactive iodine isotrope had low uptake. What’s the management?
a. Radioactive iodine
b. Carbimazole
c. Beta blocker
d. Thyroidectomy
c. Beta blocker
Patient was hypotensive with tachycardia and ECG showed wide QRS at a regular pace, whats the management? (VT)
a. Synchronized cardioversion
b. Defibrillation
a. Synchronized cardioversion
Patient with marfan syndrome, SOB, and murmur was found. He also had exaggerated pulsations of the carotid. X-ray was given (not sure with or without cardiomegaly, but there was a shadow on the left side), what’s the lesion?
a. Aortic regurgitation
b. Pulmonary stenosis
c. Mitral valve prolapse
a. Aortic regurgitation
Child with a seizure after blowing a balloon of staring, not responding to people, with lip smacking, lasting 2 minutes, with no recall of events. What’s the most likely diagnosis?
a. vasovagal attacK
b. complex partial seizure
c. childhood absence seizure
c. childhood absence seizure
patient came with palpitations and apprehension. She was found to have severe hypertension. The hypertension was refractory to medical therapy. Labs shows Hot slightly elevated, fasting glucose 8.6 and Ca high slightly. What’s your diagnosis?
a. Renal arterv stenosis
b. Pheochromocytoma
c. Essential HTN
b. Pheochromocytoma
60 year old with hip and shoulder pain. Examination was normal except for tenderness of hip and shoulder. There was no restriction of movement. What’s the management?
a. Analgesics alone
b. Steroids alone
c. Analgesics and steroids
D. Muscle relaxant
E. Immunosuppression
b. Steroids alone
Botulinum acts on:
a. Post synaptic receptors
b. Pre synaptic receptors
b. Pre synaptic receptors
Patient is known to have IT on steroids, what would lead to long term remission?
a. High dose of steroids
b. Steroids and immunosuppressive combination
c. Splenectomy
d. Occasional plasmapheresis
The most sensitive test of MS?
a. MRI
b. CSF with oligoclonal bands
a. MRI
Patient scenario was given with echo showing commissural fusion of the mitral valve <1 cm with vegetation, what will you find on auscultation?
a. Opening snap
b. Low S1 sound (vegetation prevent strong closure)
b. Low S1 sound (vegetation prevent strong closure)
Patient with Hb normal, WBC normal, Pit was low. What’s the most probable cause?
a. Aplastic anemia
b. LeUkemia
c. Alcoholic liver cirrhosis
d. Hepatitis A
e. Antiphospholipid syndrome
c. Alcoholic liver cirrhosis
Patient with dejà vu, automatisms, and memory impairment. Where’s the lesion?
temporal lobe
Patient with right coronary artery occlusion, what’s the ECG finding?
St segment elevation in leads L2, L3, and aVF
Young female was hypertensive with headache and occasional nose bleed, she gets claudication and fatigue when she climbs the stairs, relieved by rest, what will you
find on examination?
Brachio-radial delay
Obese female with generalized type epilepsy controlled on oxcarbazepine. She’s having frequent seizures now. But shes newly married and wants to get pregnant. What
Would you give her?
a. valproic acid
b. Phyntoin
c. Carbamazepine
d. levetricitam
e. Topiromate
d. levetricitam
Patient with weight loss and a positive family history of celiac disease. What would you find in his serum that will aid in his diagnosis?
a. Antiglidin Ab
b. Anti tissue trasglutaminase IgG
c. igA + igG anti transgutaminase
d. igA antigladin with IgA anti transglutaminase
e. igA levels
d. igA antigladin with IgA anti transglutaminase
Patient with parkinsons disease, what type of tremor you would find?
a. Resting tremor
Patient with history of chronic liver disease with jaundice and esophageal varices.
Presenting with low platelets. What’s the cause of low platelets?
a. Low erythropoietin
b. Splenomegaly
c. Low thrombopeitin
d. Low coagulation factors
b. Splenomegaly
