2013 - 6th Flashcards
A young female complained of tiredness and fatigue at the end of the day. Her
svmptoms are less severe when she wakes vo. but she develops proxima weakness at the end of the day. Examination showed diplopia and bilateral ptosis. Antibody production against which of the following cellular structures is responsible for this
disease?
A) Myelin basic protein
B) Acetylcholine
C) Acetylcholine receptors
D Fresvnantic calcium channels
E) It is not an antibody-mediated disease
C) Acetylcholine receptors
A patient presented with sudden onset of chest pain and dyspnea. An ECG was done and showed S wave in lead I and Q wave and T wave inversion in lead III. A ventilation perfusion scan showed a perfusion defect. What is the most likely diagnosis in this patient?
A) Acute MI
B) Pulmonary embolism
C) Pulmonary hemorrhage
D) Pericarditis
E) Myocarditis
B) Pulmonary embolism
A 21-year-old male complains of dyspnea on exertion and occasionally, chest pain and dizziness. He mostly experiences these symptoms whenever he plays football. He has a sibling who recently passed away due to a non-investigated cardiac condition. Physical examination revealed a jerky carotid pulse and an ejection systolic murmur. What is the most likely diagnosis?
A) Aortic stenosis
B) Pulmonary stenosis
C) Aortic regurgitation
D) Hypertrophic cardiomyopathy
E) Mitral regurgitation
D) Hypertrophic cardiomyopathy
Which of the following is more associated with ulcerative colitis than Crohn’s disease?
A) Granuloma formation
B) Lymph node enlargement
C) Rectal bleeding
D) Skip lesions
C) Rectal bleeding
An elderly patient with previous history of repeated syncopal attacks presented to the emergency department with another syncopal episode. An ECG was done and is shown below. What is the diagnosis?
A) Ventricular tachycardia
B) Ventricular fibrillation
C) Atrial fibrillation
D) Supraventricular tachycardia
E) Left bundle branch block
A) Ventricular tachycardia
A young female presented with severe joint pain. One week ago, she had an episode of throat infection. Her serum ESR and CRP were elevated. She was diagnosed with acute rheumatic fever. On examination, what do you look for to confirm carditis?
A) Pre-systolic murmur at the apex
B) Pansystolic murmur at the mid-left sternal border
C) Pericardial friction rub
D) Pleural rub
E) Ejection systolic murmur at the right upper sternal border
C) Pericardial friction rub
A 32-year-old man presented with acute onset of weakness in his feet that progressed proximally to his lower limbs over few days. He had a history of an upper respiratory tract infection a week ago. Examination showed upper and lower limb weakness and numbness. He couldn’t lift his legs from the bed, and deep tendon reflexes were absent. Which of the following is the most likely diagnosis in this patient?
A) Gullian barre svndrome
B) Multiple sclerosis
G Transverse mvelitis
D) Peripheral neuropathy
A) Gullian barre svndrome
A 35-year-old female presented with tingling sensation in her arms and legs. Upon flexing the neck, she had an electric-shock-like sensation spreading throughout her back. Which of the following does this sign indicate?
A) Syrinx of the cervical spine
B) Demyelinating disease of the cervical spine
C) Prolapsed cervical disc compressing the nerve roots
D) Herniation ot medulla through foramen magnum
B) Demyelinating disease of the cervical spine
A young male presented with history of bilateral headache lasting around 4-6 hours and occurring several times per month. The headache was moderate in intensity and did not stop him from working except that he takes breaks sometimes. It was also associated with photophobia but not phonopbobia. Which of the following is the most likely diagnosis?
A) Migraine with aura
B) Paroxysmal hemicrania
C) Cluster headache
D) Tension headache
E) SUNCT
D) Tension headache
What is the rationale behind slowly tapering the dose of therapeutic steroids in patients who are treated with long-term steroids?
A) Not to precipitate acute adrenal insufficiency
B) To brevent sudden rise in serum glucose
C) To prevent cerebral edema
D) To prevent central pontine myelinolysis
A) Not to precipitate acute adrenal insufficiency
A patient was recently diagnosed with hypercholesterolemia. What do you expect to
fInd on onvsica examination of this patient?
A) Tendon Xanthoma
B) Pancreatitis
C) Lipemia retinalis
D senile arcus
A) Tendon Xanthoma
A patient was brought to the ER with generalized tonic-clonic seizure. He was given IV diazepam but continued convulsing for 10 minutes. What is the next step in the management?
A) Give another dose of diazepam
B) Phenytoin
C) Phenobarbital
D Carbamazepine
E) Propofol
B) Phenytoin
A 26-year-old male presented with chronic progressive dry cough and breathing difficulty over the past 6 months. He has no complains of weight loss or sweating. There were no skin changes. Upon further investigation, his serum electrolyte profile was normal, including a normal calcium level. A chest X ray was done and showed bilateral hilar lymphadenopathy. A CT scan was done and showed bilateral lymphadenopathy and small nodules in the perihilar lesion. Which of the following is the best next step in the evaluation of this patient?
A) Bronchoscopy with biopsy
B) Sputum induction for acid fast bacilli
C) Serum histoplasma serology
D) Chemotherapy
E) Reassure the patient
A) Bronchoscopy with biopsy
What is the most likely presentation for the following CT scan?
A) Left-sided ataxia in the upper and lower limbs
B) Left sided weakness in the upper and lower limbs
C) Right sided ataxia in the upper and lower limbs
D) Right-sided weakness in the upper and lower limbs
E) Speech disturbance and left sided weakness
A) Left-sided ataxia in the upper and lower limbs
A young female was found to have a blood pressure reading of 150/90 mmH associated with occasional headache. She also reports a 10-Kg weight gain over the last year. Which of the following tests is the least contributory in the evaluation of this patient?
A) 1 mg dexamethasone suppression test
B) TSH level
C) Aldosterone: renin ratio
D) GH level
E) Abdominal US
D) GH level
An IV drug user presented with history of fever, weight loss, and night sweats of two-month duration. Over the past 2 weeks, he has been experiencing a sharp chest pain relieved by sitting up and leaning forward. He has been becoming progressively dyspnic during the last week. On examination, he has an elevated JVP, pulsus paradoxus, and his heart sounds are barely audible. No murmurs were heard. His chest X-ray is shown below. What is the diagnosis in this patient?
A) Viral pericarditis
B) Tuberculous pericarditis
C) Malignant pericarditis
D) Pleural effusion
E) Infective endocarditis
B) Tuberculous pericarditis
15-year-old boy presented with history of recurrent attacks of sudden loss of muscle tone and falling to the ground, and in some occasions only his head drops. Which of the following is the most likely type of seizure in this patient?
A) Tonic-clonic seizure
B) Myoclonic seizure
C) AtonIc seizure
D’ Absence seizure
E) complex partial seizure
C) AtonIc seizure
A 35-year-old male presented with dyspnea, orthopnea, and a frothy sputum. On examination, the patient had a barely audible diastolic murmur. Echocardiography showed minimal
movement of the mitral valve. An X-ray was done in the emergency department and is shown below. What is the pathophysiology of his symptoms?
A) An increase in the left ventricular diastolic pressure
B) An increase in the right ventricular pressure
C) An increase in the right atrial pressure
D) An increase in the pulmonary capillary wedge pressure
E) An increase in the pulmonary arterial pressure
D) An increase in the pulmonary capillary wedge pressure
A patient presented with a sudden onset of numbness involving his right upper and lower limbs. Which of the following is the most likely site of the pathology?
A) Midbrain
B\ Pons
C) Thalamus
D) Medulla oblongata
E) Posterior limb of internal capsule
C) Thalamus
A 32-year-old male, who is a known diabetic and hypertensive, presented with chest pain and sweating. On auscultation, he had muffled heart sounds, and a murmur was heard. The JVP was elevated and its analysis showed a prominent V wave. ECG showed ST elevation in leads II, III, and AVF. Which of the following is the most likely murmur that was heard?
A) Pansystolic murmur at the apex
B) Pansystolic murmur at left lower sternal border
C) Ejection systolic murmur at the right upper sternal border
D) Early diastolic murmur at the mid-sternal border
E) Mid-systolic click followed by late systolic murmur
B) Pansystolic murmur at left lower sternal border
An old patient with previous history of myocardial infarction developed sudden chest pain, diaphoresis, nausea, and vomiting. On arrival to the hospital, he was found to have cold peripheries, bilateral basal crackles, and raised JVP. His systolic blood pressure was found to be 80 mmHg. Subsequently, the patient was given inotropic agents; however, his systolic blood pressure remained 80 mmHg. What is the most appropriate next step in the management?
A) Continue inotropes
B) Coronary angiography followed by emergency graft
C) Insertion of aortic balloon pump followed by emergency stenting
D) IV antibiotics with normal saline
E) Echocardiography
C) Insertion of aortic balloon pump followed by emergency stenting
A 50-year-old man with a recent history of viral illness is complaining of a continuous chest pain. This pain is worse in supine position and deep inspiration and is relieved by sitting up and leaning forward. He had elevated inflammatory markers, and his ECG is shown below. What is the best management for this patient?
A) Nitroglycerin
B) PCI
C) NSAIDs
D) Glucocorticoids
E) Beta blockers
C) NSAIDs
In which of the following patients do you expect renal function deterioration to occur after taking ACEl?
A A 25-vear-old temale with unilateral renal arterv stenosis
B) A 23-year-old female with watery diarrhea and a low JVP
C) A 75-year-old male with adult polycystic kidney disease
D) A 32-year-old diabetic male with serum Creatinine of 210 mol/L (Normal: 44 -
120) and abdominal US showed normal size of the kidneys
B) A 23-year-old female with watery diarrhea and a low JVP
A 28-year-old female presented with worsening cough productive of greenish sputum, dyspnea, and wheezing. She had similar attacks 1 or 2 times during the last year. She also reports history of recurrent chest infections during childhood. On physical examination, vital signs were normal. She had finger clubbing and 02 saturation of 93%.
Examination of the cardiovascular system was normal. There were bilateral rhonchi and coarse crackles throughout both lung fields. Chest X-ray revealed peribronchial thickening, ring shadows, and air fluid levels. Which of the following investigations is likely to reveal the diagnosis?
A) Sputum induction for acid fast bacilli
B) High resolution CT scan
C) ANCA serology
D) Open lung biopsy
B) High resolution CT scan
A 24-year-old male presented with history of bloody diarrhea. On examination, he was found to have tenderness at the left iliac fossa. Which of the following will mostly likely be found on colonoscopy?
A) Friable, erythematous, circumferential mucosal ulcerations
B) Perianal disease
C) Rectal sparing
D) Deep ulcerating lesion with strictures
E) Fistula formation
A) Friable, erythematous, circumferential mucosal ulcerations
A 42-year old female patient presented to her family physician with one-year history of myalgia of the proximal muscles of the upper and lower limbs. She also complains of progressive weight gain, cold intolerance, and constipation. On examination, her muscle power was normal. There was no skin rash. Her laboratory investigations showed the following:
WBC: 8.1 X 109/L, Hb: 119 g/L, Platlets: 347 X 109/L BUN: 4.7 mmol/L, Creatinine: 59 mol/L
Serum Ca’ 2 5 mmo
Urine analysis: Normal
CPK: 3470 IU/L (23-232)
AST: 19 IU/L (5-40)
ALT: 19 IU/L (5-36)
Which of the following tests should be the first step in evaluating this patient?
A) Muscle biopsy
B) Serum Jo-1 antibody
C) EMG
D) TSH level
E) Repetitive nerve stimulation
D) TSH level
A 63-year-old patient presented with sudden onset of severe retrosternal chest pain that was not relieved by nitrates, along with dyspnea and diaphoresis. On his way to the hospital, the patient collapsed. What is the most likely cause of collapse in this patient?
A) Cardiogenic shock
B) Ventricular arrhythmia
C) Left sided heart failure
D) Ischemic stroke
E) Pulmonary embolism
B) Ventricular arrhythmia
A patient presented with drooping on one side of the face along with pain behind the ear over the mastoid process and hyperacusis. On examination, he had loss of the wrinkles in his forehead on the left side, and he could not close his left eye. Which of the following is the most important treatment to start in this patient?
A) Prednisolone
B) Antibiotics
C) Rituximab
D) IVIG
E) Acyclovir
A) Prednisolone
A patient with history of an uneventful myocardial infarction 2 weeks ago presents now with
fever and sharp chest pain. His pain is exacerbated by deep breathing or lying supine and relieved by leaning forward. An ECG was done and is shown below. What do you look for in this patient to confirm the diagnosis?
A) Pericardial friction rub
B) Pleural friction rub
C) Pansystolic murmur at the apex
D) Ejection systolic murmur in the aortic area E) Radio-radial delay
A) Pericardial friction rub (The ECG given in the exam did not show any abnormal findings apart from low QRS voltage.)
Which of the following conditions increases the risk of colorectal cancer the most?
A) Amoebic colitis
B) Ischemic colitis
C) Infectious colitis
D) Ulcerative colitis
D) Ulcerative colitis
A 32-year-old male presented with a 6-month history of diarrhea and weight loss of 5
Kg. On examination, he was febrile with a temperature of 38.2° and he was found to have a right lower quadrant mass with severe tenderness. Which of the following would be the best next step in diagnosing this patient?
A) Colonoscopy with ileoscopv
B) Abdominal CT scan
C) Abdominal Ultrasound
D) Abdominal X-ray
B) Abdominal CT scan
A 57-year-old man presented with sudden onset of left-sided weakness and visual disturbance
of the left eye. CT scan of the head was done and showed a hypodensity involving the right motor cortex and another hypodensity in the left occipital cortex. His ECG showed atrial fibrillation. Which of the following medications is likely to decrease the incidence of the condition in the future?
A) Aspirin
B) Clopidogrel
C) Intravenous heparin
D) Warfarin
E) ACEI
D) Warfarin
A 20-year-old female student, who is previously healthy, presented with dyspnea and bilateral lower limb edema. She has a history of fever, myalgia, and arthralgia one week prior to her presentation. On physical examination, she was tachypneic and her JVP was elevated. Echocardiography showed a poorly contractile left ventricle and global ventricular dilation
with ejection fraction of 20%. What is the most likely finding on physical examination of this patient?
A) S3 heart sound at the apex
B) Mid-systolic click followed by late systolic murmur
C) Pericardial friction rub
D) Pulsus alternans
E) Ejection systolic murmur in the aortic area
A) S3 heart sound at the apex
A An elderly diabetic woman on dietary control, statin, beta blocker, and aspirin has undergone a hip replacement surgery 2 weeks ago. She now presents with sudden onset of dyspnea and
chest pain. An ECG was done in the emergency department and is shown below. What is
most likely diagnosis in this patient?
A) ST-elevation myocardial infarction
B) Restrictive cardiomyopathy
C) Pulmonary embolism
D) Unstable angina
E) Stable angina
C) Pulmonary embolism (The given ECG shows sinus tachycardia and S1Q3T3 pattern typical of PE.)
A 50-year-old male, known smoker and hypertensive, presented with history of multiple
episodes of sweating and chest pain that woke him up at night. He underwent an exercise stress test 1 year ago, which was normal. His ECG now is shown below. What is the pathophysiology of his condition?
A) Thrombus formation with partial occlusion
B) Plaque rupture, platelet aggregation, and total occlusion by a thrombus
C) Coronary artery vasospasm
D) Coronary artery aneurysm
E) Coronary artery dissection
B) Plaque rupture, platelet aggregation, and total occlusion by a thrombus
A 30-year-old male presented with diplopia. On examination, the patient could not abduct his left eye. The picture demonstrates the patient’s eye position on an attempt to look to the left. Which of the following nerves is affected?
A) Abducens
B Oculomotor
C) Trochlear
D) Facial
E) Trigeminal
A) Abducens
A middle-aged laborer presented with a sudden onset of severe occipital headache. CT scan of the head was done and is shown. What is the most likely underlying pathology?
A) Rupture of berry aneurysm
B) Ischemic stroke
C) Atrial fibrillation
D) Pituitary adenoma
A) Rupture of berry aneurysm
A 25-year-old previously healthy female came to the clinic for advice on OCP use. She was found to have a blood pressure of 165/95 mmHg. A renal renogram was done and is shown below. What is the most appropriate management?
A) ACEI
B) ARB
C) CCB
D) Nitrates
C) CCB
A young female prisoner who is a known drug abuser was found short of breath with a fever. She also reports being unusually sweaty at night. When examined, her jugular venous pressure was elevated, and lower limb edema was present. A chest x-ray was performed and is shown
below. What is the management of this patient?
A) Pericariectomy
B) TB chemotherapy
C) Pericardiocentesis
D) Intravenous diuretics
E) Reassurance
A) Pericariectomy
A 22-year-old smoker male presented with pounding sensation for 30 minutes. He has a previous history of sudden, transient, similar attacks, for which he was investigated with Holter monitoring that was normal. He came to the casualty with a BP of 110/70 mmHg. ECG was done and is shown below. What will be your immediate management?
A) DC Cardioversion
B) IV Amiodarone
C) IV. Propranolol
D) IV Digoxin
E) IV Adenosine
E) IV Adenosine
