2013 - 7th Flashcards
(153 cards)
1
Q
A 70-year-old man was brought by his son for evalaution of his frequent falls. On examination, he had a shuffling gait, bradykinesia, resting tremor, and rigidity. The doctor gave him a treatment after which he improved dramatically. What is the medication?
A. Beta blocker
Calcium channel blocker
C. GABA agonist
D. Levodopa
A
D. Levodopa
2
Q
What is the most common cause of ATN?
a. NSAIDs
b. Aminoglycoside c. Acyclovir
d. Penicillin
A
b. Aminoglycoside
3
Q
COPD patient presented with increasing breathlessness and yellow sputum. His RR is 23 and heart rate is 110 bpm. Chest X-ray showed bilateral bronchoalveolar infiltrates.
pH was low. Which broad spectrum antibiotic will you prescribe?
a. Ceftazidime
b. Clindamycin
c. Amoxicillin and clavulanic acid
A
c. Amoxicillin and clavulanic acid
The current guidelines recommend the use of amoxycillin/clavulanate in patients with acute exacerbations of mild to moderate COPD, since it covers the most frequent pathogens, mainly Haemophilus.
4
Q
A 12-vear old girl presents with a history of fever. joint pain and breathlessness of one week
duration. She had a history of sore throat 3 weeks prior to the presentation. On examination, she has raised VP, cardiac enlargement, pansystolic murmur at the apex and an early diastolic
murmur at mid left sternal border. The anti-inflammatorv agent vou will prescribe for her will be
A. Steroid + Penicillin
B. Steroid
A
A. Steroid + Penicillin
-The diagnosis is rheumatic fever.
-A penicillin is used to eradicate streptococcus.
-Steroids is used if there is cardiac involvement If no cardiac involvement ->don’t use steroids.
5
Q
A 46 year old female underwent gastric bypass 10 years ago. She presented with 9 months history of gait disturbances, wide based gate, tingling and decreased pinprick sensation in the LL, irritability, and loss of joint proprioception. Which vitamin deficiency is responsible for this presentation?
A. VitB1/thiamine
B. VitB2/Riboflavin
C. VitB7/Biotin
D. VitB12/Cyanocobalamin
A
D. VitB12/Cyanocobalamin
Gastric bypass > vit b12 malabsorption > neurological features: peripheral polyneuropathy and subacute combined degeneration of spinal cord.
6
Q
Which of the following is an indication for kidney biopsy in patients with type 2 DM?
a. Microalbuminuria
b. Persistent Hematuria
c. DM less than 5 years
d. Absence of retinopathy
A
b. Persistent Hematuria
(Choices ‘C’ and ‘D’ apply to T1DM)
7
Q
How to confirm the diagnosis of bronchiectasis?
A
a. HRCT
8
Q
What is the best way to relieve dyspnea in emphysema?
a. Systemic salbutamol
b. Pneumectomy
c. Lung volume reduction
d. Pleurodesis
A
c. Lung volume reduction
From uptodate: Lung volume reduction surgery (LVRS) may be beneficial for advance emphysema patients. It has been suggested that LVRS reduces the size mismatching between the hyperinflated lungs and the chest cavity, thereby restoring the outward circumferential pull on the bronchioles (ie, increasing elastic recoil) and improving expiratory airflow.
9
Q
A 65-year-old man was put on hydralazine for hypertension presents now with a low- grade fever, chest pain, and joint pain. On examination, he has a pericardial rub. His chest X-ray showed bilateral pleural effusions. What is the most probable diagnosis?
A. Polymyositis
B. Lupus
C. Reactive arthritis D. Scleroderma
A
B. Lupus (these are some of the manifestation of SLE also hydralazine is a drug
that induces lupus)
10
Q
Which of the following is associated with poor outcome in Scleroderma patients?
A. Female gender
B. Dysphagia
C. Pulmonary HTN
D. Raynaud’s phenomenon
A
C. Pulmonary HTN
11
Q
A 42 year old woman presented with fatigue and shortness of breath on exertion. Her past medical history includes diabetes complicated by diabetic neuropathy, hypertension, and morbid obesity (170 kg). She underwent roux en y gastric bypass and lost 80 kg since the surgery. She now presents with peripheral neuropathy and inability to walk properly. Her CBC showed low Hb, high MCV, low WBC, low platelet count. Blood film showed anisocytosis, poikilocytosis, and hypersegmented neutrophils. Labs showed high LDH, high indirect bilirubin, and normal ferritin.
What is the cause of her complaints?
a. Iron deficiency anemia
b. B12 deficiency anemia
c. Trace element copper deficiency
d. None of the above
A
b. B12 deficiency anemia
12
Q
Which of the following is a predictor of poor prognosis in AML?
a. Normal karyotype
b. Deletion of chromosome 7
c. NPM1 mutation
d. Translocations 8:21
A
b. Deletion of chromosome 7
Note: Poor prognostic factors in AML are chromosome 5 del (5q), chromosome 7 del, or complex karyotype
13
Q
Which of the following is a side effect of a drug used in the treatment of pheochromocytoma?
a. Hyperkalemia
b. Miosis
c. Mydriasis
d. Acute angle glaucoma
A
b. Miosis
In pheochromocytoma we treat the patient with phenoxybenzamine as a first line drug which is irreversible alpha-adrenergic blocker. This drug has many side effects and since it is alpha blocker it will cause nasal congestion, miosis and fatigue.
14
Q
Which virus causes deterioration in a patient with renal transplant and on immunosuppressive therapy?
a. Hepatitis B
b. Polyoma virus
c. Adenovirus
d. Influenza virus
A
b. Polyoma virus
15
Q
Asian lady presented with night sweats, weight loss, dyspnea, and hemoptysis. Which of the following is the most contributing factor for TB medication resistance?
a. Previous use of anti-TB medications
b. Country of origin
c. Duration from disease to symptoms
A
a. Previous use of anti-TB medications
This phenomenon is especially relevant if there was non-compliance with that TB regimen in the past.
16
Q
A patient was diagnosed with Type 2 respiratory failure. What is true about his condition?
a. Diagnosed by pulse oximetry
b. Diagnosed by ABG
A
b. Diagnosed by ABG
Type 2 Respiratory Failure consists of hypoxemia + hypercapnia. The PaO2 and PaCO2 are measured via arterial blood gas (ABG).
17
Q
A 68-year-old male was vomiting blood heavily. Systolic blood pressure was 60 mmHg. According to the given information, which of the following is the least important intervention for him?
A. 5% albumin
B. FFP
C. Isotonic saline
D. Packed RBC
A
A. 5% albumin
Hypovolemia with or without shock: During fluid resuscitation in patients with hypovolemia, IV albumin is suggested as a second line therapy if there is an inadequate response to crystalloids.
18
Q
Which of the following drugs is known to cause the side effect shown in the picture (gynecomastia)?
A. Spironolactone
B. ACEI
C. Beta blocker
D. Loop diuretic
A
A. Spironolactone
19
Q
A patient was found to have peripheral neuropathy and evidence of diastolic dysfunction on echocardiography. Kidney biopsy showed positive congo red stain within the glomerulus. What do you expect to find in this patient?
a. Easy bruising b. Hypercalcemia c. High HbA1c
A
a. Easy bruising
20
Q
A middle aged male patient presented with symptoms of itching and tinnitus. His labs show elevated hemoglobin and RBC count. BM showed hyper-cellularity with increased megakaryocytes and reduced iron stain. He also complained of pain in his arms that resolved by cooling. What’s the most probable mutation?
a. BCR/ABL
b. JAK2
c. GPI anchor d. Factor 8
A
b. JAK2
Note: the scenario indicates Polycythemia Vera
21
Q
A 66-year-old gentleman is a known case of chronic kidney disease. He was admitted due to deteriorating renal function. His renal function tests and serum electrolytes came back as follows: creatinine 445 μmol/L (normal: 44-110), blood urea nitrogen 21 mmol/L (normal: 2.8- 8.1), sodium 130 mmol/L (normal: 135-145), potassium 6.1 mmol/L (3.5-5). An ECG was done and showed a slowed rhythm, a widened QRS complex and a tall T wave. How should this patient be immediately managed?
a. Intravenous calcium gluconate
b. Bisphosphonate administration
c. Vigorous intravenous hydration
d. Class Ia anti -arrhythmics
A
a. Intravenous calcium gluconate
22
Q
A 26-year-old male patients presents with a swollen, painful ankle. On examination, the ankle joint looks erythematous and is tender to touch. He was also noted to have a pustular rash on the dorsum of his feet. He reported having a recent urethral discharge. What is the likely diagnosis in this patient?
A. Gonococcal arthritis
B. Staphylococcus auras
A
A. Gonococcal arthritis
23
Q
46 years old woman has a history of jaundice and pruritis. Laboratory investigations revealed dramatically elevated levels of alkaline phosphatase but mildly elevated ALT and AST. Which of the following serological markers is likely to present in this patient?
a. Anti mitochondrial antibodies
b. Antinuclear antibodies
c. Antismooth muscle antibodies
A
answer: a. Anti mitochondrial antibodies Primary biliary cholangitis; biliary duct involvement raises ALP mainly
b. Antinuclear antibodies AIH; raises ALT and AST mainly
c. Antismooth muscle antibodies AIH; raises ALT and AST mainly
24
Q
A case of rapidly-progressive renal failure and coughing blood. What is the next test to order?
A
Ant i-GBM anti -body
25
A 15-year-old boy presented with history of tender wrist joint, then few days later, his left wrist and right ankle became extremely tender. He had a history of tonsill its few weeks ago.
On examination, he had fever and pansystolic murmur at the apex. ECG showed prolonged PR interval. Echocardiogram showed mild aortic regurgitation. ESR and CRP were elevated. What will aid in making the diagnosis in this patient?
A. Generalized papular rash
B. Polyarthritis
C. Antistreptolysin O titer < 1:200
D. Positive throat culture for Staph. aureus
B. Polyarthritis
-Polyarthiritis is one of the major criteria to diagnose rheumatic fever.
-Answer A is wrong, the dermatological changes that occur in rheumatic are subcutaneous nodules and erythema marginatum
-Answer B is wrong, because an ASO test value below 200 is considered normal.
-Answer D is wrong because rheumatic fever is caused by strep infection and not staph.
26
An 80-year-old patient was admitted to the medical ward, diagnosed and treated for hyponatremia. The Na started to rise. The nurse called you, you saw the patient and he was unable to move and needed intubation. What’s the reason behind that?
a. Stroke
b. Central pontine myelinolysis
b. Central pontine myelinolysis
When hyponatremia is corrected rapidly the patient will develop osmotic demyelination syndrome
27
A 59-year-old lady presented with a dark lesion in her inguinal area. She has a history of dark lesion on her leg that was removed 2 years ago. What is the most likely diagnosis?
A. Granuloma inguinale
B. Metastatic malignant melanoma
C. Verrucous carcinoma
B. Metastatic malignant melanoma
28
A woman with history of Graves disease treated with radioiodine therapy presented to the OPD for follow up after starting levothyroxine few months ago post- radioiodine treatment . She is complaining of palpitations. What is the best management?
A. Reduce the dose of levothyroxine
B. Maintain the same dose of levothyroxine
C. Stop levothyroxine
D. Keep levothyroxine, add beta blocker
A. Reduce the dose of levothyroxine
29
A patient with type 2 diabetes treated with glimeperide was taken to the emergency room because of disorientation and slurred speech. His blood glucose is 2.8 mmol/L. In addition to a bolus injection of dextrose, the next step in management would be to: A. Re-check his blood glucose after 15 minutes
B. Administer a carbohydrate-rich meal
C. Infuse glucose 10% solution and admit the patient to the hospital for at least
24 hours
D. Infuse glucose 10% solution and plan for discharge at 6 hours if the blood
glucose has normalized
C. Infuse glucose 10% solution and admit the patient to the hospital for at least
24 hours
Note: Th e duration of action of Glimeperide (sulfonylurea) is 24 hours and hence, the patient has to be admitted and monitored for recurrence of hypoglycemia. If the patient took an overdose of Novorapid, then “D” would be the answer.
30
An obese female with cirrhosis, hypertension, and diabetes presented with mild right upper quadrant pain. Labs showed slightly elevated AST and ALT. What would you advise her?
A. Beta blockers are contraindicated in hypertension
B. U/S every 6 months
B. U/S every 6 months
Query NAFLD/NASH
31
A young female patient presented with diplopia that worsens by the end of the day. What is the diagnosis?
A. Mysthania gravis
B. Multiple sclerosis
A. Mysthania gravis
Myasthenia gravis is an autoimmune disorder caused by an Ab-mediated blockade of NMJ transmission resulting in skeletal muscle weakness and rapid muscle fatigue.
32
54 years old male with Type 2 DM has been recommended to undergo a bariatric surgery. He has no contraindications. What BMI is least required?
A. 25
B. 27
C. 35
D. 40
C. 35
33
A young boy is complaining of itchy vesicles on the extensor surfaces of both upper limbs. The lesions shown did not respond to many treatment methods. The patient gave a history of actor recommending a special diet. What is true regarding the lesions?
A. IgG to gliadin peptide is used to confirm the diagnosis
B. IgE to gliadin peptide is used to confirm the diagnosis
C. Strict gluten free diet alone is usually sufficient to control his condition
C. Strict gluten free diet alone is usually sufficient to control his condition
Photo indicates dermatitis herpetiformis, with the deposition of IgA at the
skin (A and B incorrect). Gluten free diet improves both gut and skin manifestations
34
COPD patient presented to the ER with shortness of breath. He was cyanosed and drowsy but arousable. SpO2 = 60%. pH = 7.2. What is the initial treatment in this patient?
a. Venturi mask 24%
b. Non-invasive ventilation
c. Immediate intubation
d. High-flow O2 supplementation
a. Venturi mask 24%?
This is from PubMed:
Emergency department assessment stage: Although history taking and clinical examination may clarify the diagnosis, oxygen at 40%–60% should be continued until blood gas results are available unless the patient is drowsy or is known to have had previous episodes of Hypercapnic respiratory failure. In these circumstances, a lower FiO2 may be required such as 2–4 l/min via a medium concentration mask (equivalent to approximately 28%–40% oxygen) or preferably by the use of controlled oxygen at 24% or 28% via a Venturi mask titrated upwards or downwards to maintain an oxygen saturation of 90%–92% pending the results of blood gas estimations.
35
A 45-year-old patient presents with a swollen, tender knee joint and fever. Aspiration of the synovial fluid was done and showed turbid fluid with a markedly elevated neutrophil count. It was negative for crystals. What is the most common causative organism of this patient’s presentation?
A. Staphylococcus aureus
B. Salmonel la entertidis
C. Neisseria gonorrhea
D. Group B streptococci
A. Staphylococcus aureus ( most common causative organism for septic arthritis is staph aureus)
36
A patient has hypertension and DM nephropathy. What do you want his blood pressure to be?
a. 130/80
b. 140/90
c. 110/70
d. 150/90
a. 130/80
The target BP is 140/80 for patients < 60 YO, 150/90 for patients >60 YO, 130/80 for patients with diabetes, CKD, or cardiovascular disease
37
A 36-year-old patient is a known case of type 1 DM on insulin pump. Her Carb ratio 1:10 Insulin ratio 1:2. Urinalysis showed proteinuria without hematuria. Insulin pump- glucose curve was provided. Apart from educating her about episodes of hypoglycemia and diet, which of the following would you do?
(The curve showed blood glucose values over the last 3 days in mg/dL with 3 peaks between 9 PM and 3 am + 10 am to 1 PM + 3 to 5 PM)
A. Reduce the overnight insulin infusion
B. Educate the patient about gastroparesis
C. Educate the patient about changing the location of the injection to avoid
lipohypertrophy
D. Change Carb Ratio from 1:10 to 1:12
D. Change Carb Ratio from 1:10 to 1:12
(not sure)
Note: she had 3 peaks after meals (dinner 9-3 / breakfast 10-1 / lunch 3-5) which means the number of insulin units are not sufficient to keep the blood glucose level normal because she is eating large amount of carbs. So instead of having one unit of insulin for every 10 g carbs , we change it to be 1 unit of insulin for every 12 g e.g. let’s say she wants to eat a meal with 120g if the insulin to carb ratio is 1: 10 then she needs 12 unit to burn the carbs but if the ICR 1:12. She will need only 10 units of insulin to burn the carbs because the unit of insulin burn 12g instead of 10g.
38
A patient who had an MI 5 days ago was about to leave the hospital when he developed sudden chest pain radiating to the left arm. Which of the following tests will confirm the
presence of another MIF
CK-MB
Why not troponin?
-Troponin I and Troponin T stays elevated up to 2 weeks.
-CK-MB stays elevated up to 3 days.
39
A patient developed bilateral lung infiltrates within 1 hour after blood transfusion.
What happened?
a. Transfusion related acute lung injury (TRALI)
b. Transfusion associated circulatory overload (TACO)
a. Transfusion related acute lung injury (TRALI)
Note:
Transfusion acute lung injury > Fever, Dyspnea, With bilateral infiltrates on CXR, NO SIGNS OF hypervolemia (No elevated JVP, NO pedal edema)
Transfusiom associated circulatory overload > CXR shows bilateral infiltrates, WITH signs of hypervolemia (Elevated JVP, Pedal edema)
(Dr Salman AlOtaibi explanation )
40
A patient presented with asymptomatic dusky red macules and patches on all four
extremities, along with oral erosions after he had been prescribed a drug. What is the most likely diagnosis?
A. Steven Johnson syndrome
B. Toxic epidermal necrolysis
A. Steven Johnson syndrome
N.B. The answer has not been confirmed; however, I believe that involvement of all 4 extremities doesn’t necessarily mean the patient has TEN, especially that the lesions are painless and detachment was not mentioned at all.
41
73 year old women had weakness in her hands and difficulty opening jars. On examination there was tenderness in her first metacarpal, thenar atrophy, and bony nodes were felt in her distal intercarpals. ESR: 20 (normal up to 20), uric acid: 450 (normal is 200-400). X-ray showed joint space narrowing and osteophytes. What is the Diagnosis?
A. Rheumatoid arthritis
B. Osteoarthritis
C. Gout
B. Osteoarthritis
42
A 26-year-old male with history of epilepsy on anti-epileptic medication did routine investigations. Lab investigations showed a hematological abnormality. His blood smear is shown below. What is the likely diagnosis?
a. Vitamin B 12 deficiency
b. Secondary polycythemia
c. Leukomoid reaction
d. Immune thrombocytopenia
a. Vitamin B 12 deficiency
43
middle aged man who has DCM with no other risk factors, presented with high blood pressure and was put on multiple medications (B-Blockers - ACE-I - Thiazide diuretic – vasodilator). He came after 6 months, blood pressure was measured and it is still high. What is the most likely diagnosis?
a. Bilateral renal stenosis
b. Pheochromocytoma
c. Viral myocarditis
d. Amyloid
b. Pheochromocytoma
Dilated cardiomyopathy is associated with pheochromocytoma
44
A middle aged woman complains of headache and tenderness over her scalp. She can’t comb her hair due to pain. Visual acuity in the right eye is decreased, but fundoscopy is normal. ESR was very high. What is the most likely diagnosis?
A. Giant cell arteritis
B. Takayasu arteritis
C. Fibromyalgia
A. Giant cell arteritis
45
Patient with Crohn’s disease who had bowel resection, now presented with watery diarrhea. What will you give this patient?
A. cholestyramine
B. antibiotics C. probiotics
A. cholestyramine
46
Which virus causes deterioration in a patient with renal transplant and on immunosuppressive therapy?
A. Hepatitis B
B. Polyoma virus
C. Adenovirus
D. Influenza virus
B. Polyoma virus
47
A young female is scheduled for lap chole. She tells you that she has a bleeding disorder that runs in her family and all her sisters and mother are affected. She denies history of bleeding into joints. Lab tests showed thrombocytopenia, normal APTT and PT.
What is the cause?
a. Bernard–Soulier syndrome
b. vWD (A subtype of vWD can have thrombocytopenia.)
b. vWD (A subtype of vWD can have thrombocytopenia.)
48
A patient presented with loss of pain and temperature sensation in the upper limbs with preservation of light touch. He also had decreased reflexes in the upper limbs. What’s the diagnosis?
A. Syringomyelia
B. Vitamin E deficiency
C. Spinal muscular atrophy
A. Syringomyelia
Syrinx interrupts the decussating spinothalamic fibers that mediate pain and temperature sensibility, resulting in loss of these sensations, while light touch, vibration, and position senses are preserved (dissociated sensory loss).
When the cavity enlarges to involve the posterior columns, position and vibration senses in the feet are lost
49
Which of the following is true regarding idiopathic pulmonary fibrosis?
a. Steroids increase mortality
b. Steroids are the mainstay of therapy
c. Oxygen is the mainstay of therapy
d. Anti-fibrotics don’t help
a. Steroids increase mortality
(from batch 13: There is evidence that steroids increase mortality in IPF patients, so nowadays their use is limited to short courses during exacerbations only. This does
not apply to other ILDs.)
Unlike other interstitial lung diseases which benefit from steroid therapy, steroids are mostly contraindicated in IPF patients and anti-fibrotics are used instead.
50
What is the most common cause of status epilepticus? A. Noncompliance to anti-epileptic medications
B. Alcohol withdrawal
C. Central nervous system infection
D. Cryptogenic
A. Noncompliance to anti-epileptic medications
51
A 45-vear-old man has fever. He had a new murmur and was hypotensive and short of breath. He had an aortic valve replacement recently. What is the best next step to investigate his condition?
A. Multiple blood cultures
b. cardiac enzymes
C. Electrocardiogram
D Chest X-ray
A. Multiple blood cultures
New murmur + prosthetic valve >think about infective endocarditis.
-Multiple blood culture is considered as a major criteria to diagnose IE
52
A scenario describing multiple sclerosis patient with history of optic neuritis. What you will find on brain imaging?
periventricular white matter lesions
53
A 64-year-old obese lady complains of pain in her left knee and morning stiffness that lasts about 15 minutes. What would the plain radiograph of her knee most probably show?
A. Symmetrical joint space narrowing B. Increased joint space
C. Osteophytes
C. Osteophytes
54
A patient with SLE who is on hydroxychloroquine and steroids. She is now 3 weeks pregnant. What is your advice regarding her medications?
A. Continue both drugs
B. Continue hydroxychloroquine and stop prednisone
C. Stop both
A. Continue both drugs
55
A 51-year-old man was admitted with anterior MI. He was successfully managed with coronary revascularization and stabilized. Two days later, the patient started to complain of palpitations and dizziness. He became immediately unresponsive with a blood pressure of 92/56. His ECG is shown below. What is the appropriate management?
A. DC cardioversion
B. IV amiodarone
A. DC cardioversion
-This is an ECG of ventricular tachycardia.
-Treatment:
Sustained VT (>30) is an emergency requiring immediate treatment.
Hemodynamic compromise:electrical cardioversion.
No hemodynamic compromise:electrical cardioversion, amiodarone, type la agents (procianamide, quinidine)
56
A 55 year old male presented with features nephrotic syndrome. Creatinine level was 167 and complement level was normal. Urinalysis showed proteinuria, Oval fat bodies, WBC 1-2 HPF, and RBC 2-3 HPF. He had increased free serum lambda light chains and kidney biopsy showed nodal sclerosis, apple- green birefringence of congo red stain under polarized light. What is the diagnosis?
a. Multiple myeloma
b. amyloidosis
b. amyloidosis
57
A young boy is complaining of itchy vesicles on the extensor surfaces of both upper
limbs. The lesions shown did not resapond to many treatment methods. The patient gave a history of actor recommending a special diet. What is true
regarding the lesions?
A. IgG to gliadin peptide is used to confirm the diagnosis
B. IgE to gliadin peptide is used to confirm the diagnosis
C. Strict gluten free diet alone is usually sufficient to control his condition
C. Strict gluten free diet alone is usually sufficient to control his condition
58
25-year old female with type 1 diabetes mellitus on insulin, diagnosed with diabetic nephropathy. Her glucose levels are high and uncontrolled despite taking insulin 3 times daily. A year later, she came for a follow up. Currently, She has good control with persistent hypoglycemic attacks despite being on the same dose of insulin & diet. What is the reason behind her hypoglycemia?
A. Worsening of renal function
B. Increase in the synthesis of insulin by B-cells
C. Increased glucose in the urine
D. She is taking steroids
A. Worsening of renal function
59
A 25-year-old male presented with recurrent painful scrotal and oral ulcers since he was 18 years old. He also had red eyes, joint pains & red papules and pustules over his trunk. What is your diagnosis?
A. Behcet ’s disease
B. Sweet syndrome
C. Reiter’s syndrome
D. Recurrent HSV infection
A. Behcet ’s disease
60
An 18 year old girl presented with new onset amenorrhea. She previously had normal menstrual cycles since menarche at age 11 and her periods were regular. She claims that she has a caloric intake of less than 1000 a day and her BMI is 16. What could be the cause of her amenorrhea?
A. Hyperprolactinemia
B. Hypothalamic suppression
B. Hypothalamic suppression
61
A 13 year old Female had a seizure after staying up all night in a camp. She was started on lamotrigine (lamictal) 50 mg twice daily. She had 2 seizures in the last month. How would you manage this patient?
A. Add valporic acid to lamictal
B. Add levetiracetam to lamictal C. Switch to Valporic acid
D. Increase the dose of lamictal
D. Increase the dose of lamictal
(The maximum dose of lamictal has not been reached yet.)
62
What is the best test to monitor SLE activity?
A. Complement levels
B. CRP
C. WBC
D. ESR
A. Complement levels
63
What is true about factor V Leiden mutation?
a. Prevalence is 5-10% in the population
b. Failure of protein S to prolong APTT
a. Prevalence is 5-10% in the population
64
An 18-year-old male patient developed gross hematuria after strenuous exercise. Urine sediment shows 30 RBC/HPF and red cell casts. The patient reports a previous similar episode shortly after an upper respiratory tract infection. Renal function was normal at presentation. What is the likely diagnosis?
a. IgA nephropathy
b. Post-streptococcal glomerulonephritis
c. Hemolytic uremic syndrome
d. Interstitial nephritis
a. IgA nephropathy
65
A 52-year-old gentleman who is a known case of hypertension, asthma, and ischemic heart disease. His labs showed hyperkalemia. Which antihypertensive would you use in this patient?
a. Beta blockers
b. ACE inhibitors
c. Thiazide diuretics
d. Vasodilators
c. Thiazide diuretics
I solved this Q. I think that since the pt has asthma: A is wrong, and bc of the hyperkalemia B is wrong so I would go with C.
66
A 55 year-old lady referred by a dermatologist because of pruritis. She’s otherwise healthy. No family history. No medications. On physical examination she had mild hepatomegaly. Liver profile: ALT : 60, AST: 50, GGT: 780, ALP:627, Total bilirubin normal, U/S abdomen normal. Which of the following will likely reveal the diagnosis?
A. Ceroplasmin level
B. CT abdomen
C. Anti mitochondrial antibodies
ALP and GGT mainly
D. Ferritin level
C. Anti mitochondrial antibodies Primary biliary cholangitis; biliary duct involvement raises
67
A pregnant lady presented with fatigue, dyspnea, and petechiae. She was found to have low Hb, low platelets, high LDH, high reticulocyte count, and high total and indirect bilirubin. Coagulation profile was normal. PBS showed schistocytes. What is the best treatment for this patient (the scenario describes TTP)?
a. Steroids and plasma exchange
b. IVIG
a. Steroids and plasma exchange
Note: N.B. Acquired TTP due to neutralizing antibodies against ADAMTS13 commonly occurs during pregnancy.
Thrombotic thrombocytepenic purpura is diagnosed Clinically by Confusion, Low Hb and Low platelets and signs of hemolysis (Low Haptoglobin/ High LDH)
The Peripheral Blood smear will show shistocytes
The First Step on managment is giving *Fresh frozen plasma*
Defenitive treatment is by *Plasma Exchange*.
Pathogenesis: *Deficiency of *ADAMST13*, which breaks the Large vWF into smaller ones. (Dr Salman AlOtaibi explanation)
68
A patient is a known case of renal failure, presented with signs and symptoms of hyperparathyroidism. What’s the cause of his symptoms?
Secondary hyperparathyroidism due to renal failure
69
A 28-year-old woman was diagnosed with Graves’ disease 8 months ago and started on radio-iodine treatment 2 months after diagnosis. She now presents with
weight gain and menorrhagia. Her TSH is 12. Levothyroxine 75 mcg is initiated and she is put on calcium and vitamin supplements. what is true regarding her management?
A. Serum TSH should be checked every 2-3 weeks for response
B. Calcium carbonate is recommended one hour after levothyroxine
C. Measuring anti-TSH receptor ab levels during pregnancy is recommended
D. Levothyroxine is stopped once TSH normalizes
C. Measuring anti-TSH receptor ab levels during pregnancy is recommended
Note: Calcium carbonate and Iron supplements should be taken at least 4 hours after levothyroxine
70
A 25 year old woman with SLE, presented with sudden onset of dyspnea and pleuritic chest pain. Her oxygen saturation was 90%. What test should be done?
a. ECG to rule out ischemia.
b. Pulmonary CT angiography.
c. Skin Biopsy.
d. Serology for ANA
b. Pulmonary CT angiography.
This patient most likely has PE. The most common cardiopulmonary manifestations in SLE are: libmann-sacks endocarditis, pericarditis, pleuritis, pleural effusion, and pneumonitis. However, antiphospholipid syndrome is also very common in SLE patients, which puts them at high risk of developing pulmonary emboli. Pulmonary CT angio is the test of choice for PE.
71
A diabetic male took an extra dose of his medication and developed hypoglycemia. What’s the management?
A. Glucagon
B. Insulin
A. Glucagon
72
A 67 year old lady, known case of breast cancer that was treated with mastectomy and chemotherapy. Later on examination, she was able to abduct 45 degrees with limitations, inability to perform external and internal rotation, as well as forward flexion and extension. X-ray of the shoulder joint was normal. What is the diagnosis in this case?
A. Adhesive Capsulitits
B. Biceps tendonpath
C. Rotator cuff tendinopathy
D. Subdeltoid bursitis
A. Adhesive Capsulitits
73
What is the correct clinical scenario to describe hyperemesis gravidarum? A. Nausea and vomiting are not correlated with the level of maternal B HCG
B. Symptoms resolve in 20 weeks’ gestation in 91% of cases
C. Symptoms usually start in 3rd trimester
D. Multiparous smoker women have worse symptoms.
B. Symptoms resolve in 20 weeks’ gestation in 91% of cases
74
Which of the following drugs is contraindicated in a pregnant lady with hypertension?
A. BB
B. CCB
C. ACEI
C. ACEI
-Ace inhibitor is contraindicated because there is an increased risk of malformation after first trimester exposure to ACE inhibitors among women treated for hypertension
75
A 34 year-old lady complains of dizziness and fatigue. She also reports nausea & vomiting on occasions. Physical examination revealed areas of hyperpigmentation. Labs: high K, low Na, low HCO, high CO2, & low pH. Which of the following medications will most likely help in correcting her electrolyte abnormalities?
a. Fludrocortisone b. Dexamethasone c. Spironolactone d. Democylcine
a. Fludrocortisone
The scenario describes Addison disease so there is low glucocorticoid and primary renal insufficiency leading to high Na in the urine to reduce it fludrocortisone is used.
76
14. A 50-year-old smoker, hypertensive male presented with multiple episodes of sweating and chest pain that woke him up at night. He has an exercise stress test 1 year ago which was
normal and his ECG now is given. What is the next step in the management of his condition?
A. Reassure the patient and discharge him home
B. Admit the patient to CCU and take him for PCI
C. Admit the patient and administer aspirin, LMWH, clopidogrel
D. Admit the patient, administer aspirin, LMWH, clopidogrel and initiate thrombolytic therapy
B. Admit the patient to CCU and take him for PCI
(I think this is the most likely answer. Medications absolutely have to be
administered. but
being confronted with such choices. I believe that 'B' is a better answer.)
According to Dr,Salman Alotaibi ,C is a better answer.
77
.Blood glucose readings of a type 1 diabetic patient showed high blood sugar before lunch. The patient is treated with pre-mixed insulin (short and intermediate acting) twice daily. What’s the best action?
A. Increase morning dose of intermediate acting insulin B. Increase morning dose of short acting insulin
B. Increase morning dose of short acting insulin
Note: indication to increase long acting/ intermediate insulin are a) high BG at breakfast b) more than one reading is high. because long acting cover for longer period thus can correct multiple incorrect readings
However, single increase in Lunch, Dinner, or bedtime we always increase short acting insulin.
78
A man presented with shortness of breath. His PFT results showed: FEV1 33%, FVC 60%, DLC0 44%, residual volume 190%, what is true regarding his condition?
a. Smoking history is essential
b. Steroids are the mainstay of treatment
a. Smoking history is essential
The patient most likely has COPD.
79
16-year-old epileptic patient was managed with gabapentin for years. The doctor made the decision to add lamotrigine to the patient’s anticonvulsant regimen three weeks back. The patient presents now with widespread erythematous rash, fever, lymphadenopathy and hepatomegaly. Laboratory tests show elevated liver enzymes. What is the diagnosis?
A. DRESS Syndrome
B. Steven Johnson’s syndrome
C. Toxic epidermal necrolysis
D. Anaphylaxis
A. DRESS Syndrome
80
A patient had painful eruptive vesicles (VZV). What is the treatment?
A. Valacyclovir
B. Gabapentin
A. Valacyclovir
81
A Young patient started OCP 2 months ago presented with mildly elevated AST & ALT. Bilirubin was elevated. Ultrasound showed gallstones with no dilatation of CBD. What test would you perform?
A. AFP
B. CA19-9
C. ERCP
D. MRCP
answer: D. MRCP
A. AFP Rule out hepatic cancer
B. CA19-9 Rule out pancreatic cancer
82
A 40-year-old male patient with IBD for 10 years, he had multiple erythematous to
purple ulcerated eruptions in his left lower limb. Those eruptions are not improving on antibiotics. What is the likely diagnosis?
A. Erthyema nodusm
B. Pyodermagangernosum
B. Pyodermagangernosum
83
A patient with history of Hypertension, diabetes, smoking, heavy alcohol consumption, and weight loss for 2 years. His X-ray shows pancreatic calcification. What ’s true about alcohol induced chronic pancreatitis?
A. Abdominal pain responds better to pancreatic supplements than steatorrhea B. Alcohol, but not smoking, is a risk factor for the patient’s condition
C. 1/3 of patients with chronic pancreatitis have diarrhea without abdominal pain D. Pancreatic cancer risk is 4-5% in 20 years
D. Pancreatic cancer risk is 4-5% in 20 years
84
A patient presented with 2-month history of fatigue and early satiety. His CBC showed high WBC, high neutrophils , low Hemoglobin, and high platelets. PBS showed myelocytes, metamyelocytes, and increased neutrophil bands. Blasts: 0%, Genetic study showed a translocation at 9:22. What is the diagnosis?
a. Myelofibrosis
b. CML accelerated phase
c. CML chronic phase
d. Primary polycythemia
c. CML chronic phase
Note: The 3 phases of CML, as defined by the World Health Organization (WHO), are:
Chronic phase: Blasts < 10%
Accelerated phase: Blasts comprising 10-19% Blast crisis: Blasts ≥ 20%
85
A patient with hypertension presented with and central chest pain radiating to the back and
interscapular region. What is the most important condition to rule out:
A. Mvocardial infarction
B Aortic dissection
C. Pericarditis
D. Aortic stenosis
B Aorric dissection
Long standing systemic hypertension is the most important predisposing factor of Aortic dissection.
- It is characterized by severe tearing/ripping/stabbing pain, typically abrupt in onset ,either in anterior or back of the chest.
86
A 40 year old male patient with IBD for 10 years, he had multiple erythematous to purple ulcerated eruptions in his left lower limb. Those eruptions are not improving on antibiotics. What is the likely diagnosis?
A. Erthyema nodusm
B. Pyoderma gangernosum
answer: B. Pyoderma gangernosum
A. Erthyema nodusm - characterized by tender, red bumps, usually found symmetrically on the shins
87
Patient presented with dysphagia for solid food, especially bread and meat. He has no history of GERD or heartburn. What’s the diagnosis?
A. Barrett's esophagus
B. Achalasia
C. Schatzki ring
answer: C. Schatzki ring Motility disorder, therefore dysphagia for solid foods mainly
A. Barrett's esophagus Usually caused by long standing GERD/heartburn
B. Achalasia Motility disorder, therefore dysphagia for both solid and liquid foods
88
A description of patient with Turner syndrome, breast development: tanner stage 3. What do you expect to find regarding her ovaries?
A. Hypoplastic ovaries with fibrous tissue and scant follicles.
B. Hypoplastic ovaries with fibrous tissue and abundant follicles
C. Hyperplastic ovaries with fibrous tissue and scant follicles
D. Hyperplastic ovaries with fibrous tissue and abundant follicles
A. Hypoplastic ovaries with fibrous tissue and scant follicles.
89
A medical lab worker presented with symptoms suggestive of occupational asthma. Which of the following is the next step to diagnose occupational asthma?
a. Pre and post bronchodilator spirometry
b. Provocation challenge test with animal extracts from the lab
c. Measure serum IgE levels to lab animal antigens
d. Serial peak expiratory flow rates daily over 2-4 weeks
d. Serial peak expiratory flow rates daily over 2-4 weeks
Measuring peak expiratory flow rate will help us show the trend in values, so that we can determine if it’s worsening during the times where the patient is at her occupation.
90
Patient presents with sharp central chest pain radiating to shoulder and left arm aggravated by deep breathing and relieved with sitting up. His BP is 107/76 & heart rate is 113.
Physical exam is unremarkable except for the tachycardia. ECG done shows ST elevation in all leads except aVR. On the third day patient becomes hypotensive with raised JVP, what is the
management:
A. motropes
B. Emergent pericardiocentesis
C. Penicil lin and saline
D. Ant icoagulation
B. Emergent pericardiocentesis
-Pain that is aggravated by deep breathing and relieved by sitting ›pleuritic pain, and with diffuse ST elevation in most of the leads ->Acute pericarditis.
-One of the complication of acute pericarditis is cardiac tamponade ,and that explain why the patient became hypotensive with raised JVP.
-Pericardiocentesis is the definitive method to treat cardiac tamponade.
91
What’s true about fatal or near fatal asthma exacerbation?
a. Happens in mild, moderate, and severe asthma
b. GERD is a risk factor
c. Occurs in children more than older adults
a. Happens in mild, moderate, and severe asthma
92
A 45-year-old man presented with recurrent infections, epistaxis, gingival hyperplasia, and gum bleeds. Labs showed high WBC, low Hb, low RBC, low platelets, and low reticulocyte count.
Flow cytometry detected CD11c, CD 13, CD 14, CD33, and MPO (myeloperoxidase) Which of the following is true regarding his condition?
a. Commonly occurs after chemotherapy
b. Most common in children
c. Confirmed by >20% blast cells
d. Does not respond to chemotherapy
c. Confirmed by >20% blast cells
Note: the flow cytometry results indicate AML which is confirmed by > 20% blast cells
93
A 20-year-old female is known to have sickle cell anemia and asthma. She has recent onset of tender sinuses, nasal blockage, and mild wheezes. She’s saying that she’s not her usual self lately. Her hemoglobin dropped from her baseline (from Hb = 9 to 6.5). What is the most appropriate management plan?
a. Inhaled steroids, bronchodilators, and anti -histamines.
b. Inhaled steroids, bronchodilators, chest X-ray, blood transfusion, and repeat chest Xray
c. Inhaled steroids, bronchodilators, chest X-ray, and blood transfusion.
d. Inhaled steroids, bronchodilators, and blood transfusion.
b. Inhaled steroids, bronchodilators, chest X-ray, blood transfusion, and repeat chest Xray
Not sure – R/O acute chest syndrome)
Since the patient is a sickler, we need to rule out acute chest syndrome in addition to the mainstay treatment for her asthma exacerbation and blood drop. Diagnosing acute chest syndrome must include a new pulmonary infiltrate on chest xray + at least 1 symptoms such as fever, wheezing, chest pain, cough, etc..
So a chest xray is needed, but I’m not sure if it should be repeated as well or not.
94
A 26 year old man with long history of intermittent bloody diarrhea presents with a 7-day history of increasing symptoms. Over the last 24 hours, the diarrhea has decreased but he now complains of abdominal pain and distention. On physical examination, he appears acutely ill and pale. The abdomen is distended and tympanic to percussion. Vital signs: BP 95/65, HR 105, RR 17, Temp 37.9. plain radiograph of the abdomen is shown. What is the most likely diagnosis?
A. Colon cancer with perforation of large bowel B. Acute diverticulitis with abscess formation
C. Ischemic bowel with necrosis
D. Ulcerative colitis is with toxic megacolon
D. Ulcerative colitis is with toxic megacolon
95
A 45 diabetic male is treated with daily insulin glargine and sulfonylurea. He took his medicine this morning. Presented to the ER comatose, with alcoholic breath, and exaggerated reflexes on the right side. What is the most likely diagnosis?
A. Hypoglycemia
B. Delirium tremens
C. CVA
A. Hypoglycemia
96
Mr. Ibrahim, a 45-year-old man came with erythematous scaly patches on the extensor surfaces of his body. He complained of back pain and morning stiffness. Which of the following drugs is best to control his condition?
A. Methotrexate
B. Anti-TNF
C. Imuran
D.Dapsone
B. Anti-TNF
97
A 20 year old man had a road traffic accident. His GCS was 3. He had hemorrhage and contusions. He was declared brain dead. Which ancillary test is the least helpful?
A. EEG
B. SSEP
C. Trans-cranial Doppler
D. SPECT
C. Trans-cranial Doppler?
98
Which of the following is a side effect of carbamazepine?
a. Hyponatremia b. hyperkalemia c. hypokalemia d. hypoglycemia
a. Hyponatremia
(Carbamazepine is associated with SIADH)
99
A 64-year-old patient was admitted to the ICU with pneumonia. One day after, the patient deteriorated and went on to develop septic shock. Which of the following is used to monitor the kidneys’ function on a daily basis?
a. Serum creatinine
b. 24-hour urine collection
c. Estimated GFR
d. Fractional excretion of electrolytes
a. Serum creatinine
100
A 45-year-old patient presents with a swollen, tender knee joint and fever. Aspiration of the synovial fluid was done and showed turbid fluid with a markedly elevated neutrophil count. It was negative for crystals. What is the most common causative organism of this patient’s presentation?
A. Staphylococcus aureus
B. Salmonella entertidis
C. Neisseria gonorrhea
D. Group B streptococci
A. Staphylococcus aureus
101
40 year old woman came with abdominal pain, sweating, nausea and vomiting. On Examination, her abdomen was tender and guarding. This Is her ECG: What is the underlying mechanism?
a) Pancreatitis
b) Cholecystitis
c) Peptic ulcer
d) Mesenteric embolism
d) Mesenteric embolism
ACUTE MESENTERIC ISCHEMIA: Caused by compromised blood supply, usually an emboli due to a cardiac origin (A Fib). ECG shows no p waves and irregularly irregular rhythms, indicating A Fib. Patients usually present with severe abdominal pain that is disproportionate to physical findings.
102
A 65-year-old patient presented with fatigue, lymphadenopathy and recurrent infections. His Peripheral blood smear showed small cells with mature chromatin.
What is the most likely diagnosis?
a. Hairy cell leukaemia
b. CLL
c. AML
d. CML
b. CLL
Note: Peripheral blood smear in CLL shows small, mature lymphocytes and smudge cells.
103
A 24-year-old male presented with exertional chest pain on exercise. On examination, he has jerky carotid pulse and an ejection systolic murmur. An echocardiogram was performed and revealed markedly thickened interventricular septum. He has a family history of sudden cardiac death. What could be used for symptomatic relief?
A. Beta blocker
B. Angiotensin converting enzyme inhibitors
C. Digoxin
D. Nitrates
A. Beta blocker
-The diagnosis is HOCM.
-B-Blockers are the best initial therapy for HOCM.
- Agents with strong negative inotropic effect such as Verapimil(calcium channel blocker), and disopyramide(antiarrhythmic) can also be useful.
-HOCM specific therapy include:
1)Implantable defibrillators :should be used in HOCM patients with syncope.
2) Ablation of the septum:should be first tried with a catheter placing absolute alcohol in the muscle causing small infraction.
3)Surgical myomectomy :is the therapy only if all medical and catheter procedures fails.
-Do not use the following in patient with HOCM:ACE inhibitors,Digoxin, Amlodipine,and nitrates.
104
What ’s responsible for the damage in Crohn’s disease? A. Ab to intestinal antigens
B. IL-4 and IL-10
C. TNF-ɑ and interferon
C. TNF-ɑ and interferon
105
A woman presented with history of spontaneous abortions and thromboembolic events. How will you diagnose her?
A. Anti-B2 glycoprotein antibody ( antiphospholipid syndrome )
B. ANA
C. Anti-Jo1
D. Anti-topoisomerase
A. Anti-B2 glycoprotein antibody ( antiphospholipid syndrome )
106
A 66-year-old man who is an ex-smoker presented with progressive dyspnea and cough. He has PaO2 of 90%. ECG and echo showed evidence of right ventricular enlargement. Which of the following is among the measures of management of this patient?
a. Beta blocker
b. Long acting Calcium channel blocker
c. Nitroglycerin patch
d. Long term O2 therapy
d. Long term O2 therapy
This patient most likely has COPD. Pulmonary hypertension and cor pulmonale may occur in these patients, especially those with chronic hypoxemia. Long term O2 therapy has been shown to improve survival and is used when it meets one of these criteria:
- PaO2 55mmHg OR:
- O2 saturation less than or equal to 88%
- PaO2 55-59 mmHg plus polycythemia or evidence of cor pulmonale
We don’t know what’s the PaO2 of this patient, but we know that he has signs of cor pulmonale. Additionally, all the other answers offered are not used at all in COPD (process of elimination)
107
A woman is currently in her second trimester of pregnancy. What is the most sensitive method for measuring renal function in this patient?
a. Serum creatinine
b. Uric acid
b. Uric acid
108
A 22 year old female had a routine blood test which showed low Hb, low platelets, and low WBC, with normal peripheral blood smear. What is the most likely diagnosis?
a. TTP
b. Aplastic anemia
c. ALL
b. Aplastic anemia
109
Female with type 2 DM, presented with crude vaginal discharge. What’s the treatment?
A. Tinidazole
B. Fluconazole
B. Fluconazole
110
After a road traffic accident, a patient was found to have loss of pain and temperature sensation on the left side up to T10 level, along with loss of vibration and proprioception up to T10 level on the right side. What else do you expect to find in this patient?
A. Weakness in the right lower limb
B. Weakness in the left lower limb
C. Weakness in the right upper limb
D. Weakness in the left upper limb
A. Weakness in the right lower limb
N.B. Brown-Sequard syndrom e: Loss of motor and posterior column (vibration and proprioception) functions on the ipsilateral side of the lesion, accompanied by loss of light touch, pain, and temperature sensation on the contralateral side.
111
What is the most important risk for duodenal ulcer rebleeding?
History of rebleed
112
A 20-year-old female is known to have sickle cell anemia and asthma. She has recent onset of tender sinuses, nasal blockage, and mild wheezes. She’s saying that she’s not her usual self lately. Her hemoglobin dropped from her baseline (from Hb = 9 to 6.5). What is the most appropriate management plan?
A. Inhaled steroids, bronchodilators, and anti -histamines.
B. Inhaled steroids, bronchodilators, chest X-ray, blood transfusion, and repeat chest X- ray
C. Inhaled steroids, bronchodilators, chest X-ray, and blood transfusion.
D. Inhaled steroids, bronchodilators, and blood transfusion.
B. Inhaled steroids, bronchodilators, chest X-ray, blood transfusion, and repeat chest X- ray
Note: Not sure of the answer- R/O acute chest syndrome
113
A19 y/o patient with T1DM on glaringe 20 units at night and insulin aspart started drinking alcohol and presented with vomiting. Blood glucose level was 44, pH = 7, Ketones +4. What’s your management?
A. Continue aspart
B. 8.4% sodium bicarbonate till ph 7.1
C. Insulin infusion w normal saline until beta hydroxybutyrate becomes normal
D. Low carb and high fat diet
C. Insulin infusion w normal saline until beta hydroxybutyrate becomes normal
114
A patient was found to have a fasting blood glucose level of 6.3 and HbA1C level of 6.8%. Which of the following is true?
A. Since his HBA1c is below 7% (the target), he has no increased risk of cerebrovascular diseases
B. Diet and exercise have no effect in lowering blood glucose
C. Hyperglycemia per se is the cause of macro-vascular complications of diabetes.
D. Fasting blood glucose level is abnormal
D. Fasting blood glucose level is abnormal
Note: if the patient is diabetic, the HbA1C target is <7 but for previously healthy is <6.5
115
A patient presented with signs and symptoms of ankylosing spondylitis. Which test you will do next?
A. Lumbosacral x-ray
B. MRI of both sacroiliac joints
B. MRI of both sacroiliac joints ( more sensitive than CT in detecting
sacroiliitis in early stages which happens in ankylosing spondylitis)
116
What is the management of hypofibrinogenimia?
a. Cryoprecipitate
b. FFP
a. Cryoprecipitate
Note: Cryoprecipitate is given primarily to treat acquired and congenital hypofibrinogenemia
117
A patient with Crohn’s disease has previously undergone bowel resection. Now she is going to undergo another bowel resection. Which of the following is a risk factor for Crohn’s recurrence after surgery?
A. End-to-side anastomosis
B. Female gender
C. History of previous stricture
D. Previous history of bowel resection
D. Previous history of bowel resection
118
Patient with chest pain only while jogging. What to do next?
Stress ECG test
-An exercise stress ECG test uses treadmill or bicycle exercise with ECG and blood pressure monitoring.
Indication to do this test:
1) Patient with intermediate (10-90%) protest probability of CAD based on age ‚gender ‚and symptoms).
2)ST depression <1mm at rest ,no left bundle branch block ,no digoxin or estrogen use.
Important contraindication to exercise testing:
1)Acute MI, aortic dissection, pericarditis, myocarditis ,PE.
2)Severe AS, arterial HTN
3)Inability to exercise adequately.
119
Which of the following is a sign of diffuse rather than limited SS?
A. Anterior chest wall skin thickening
B. Facial telangectasia
C. Dysphagia
A. Anterior chest wall skin thickening
120
A 62-year-old man, known case of heart failure, presented with gynecomastia. Which of the following drugs of his treatment plan caused this side effect?
A. Spironolactone
B. ACEI
C. Diuretics
D. Beta blockers
A. Spironolactone
121
A 34-year-old patient presented with headache, fever, and a focal seizure. Brain MRI showed temporal lobe edema and hemorrhage, CSF: high protein, low glucose, and negative Gram stain. What your management?
A. Rifampicin, isoniazid, ethambutol and pyrazinamide
B. IV Acyclovir
C. Wait for and give medications according to CSF culture D. IV Ceftriaxone
B. IV Acyclovir
122
woman with bronchiectasis. What is the best management?
a. Chest physiotherapy
b. Bronchial lavage
a. Chest physiotherapy
123
A 68-year-old man presented with shuffling gait, small steps, difficulty in initiating movements, and resting tremor. What is the diagnosis?
A. Idiopathic Parkinson’s disease
B. Essential tremor
A. Idiopathic Parkinson’s disease
124
A 60 year old patient was taking NSAIDs for his back pain that he’s been having for many years. He had low blood hemoglobin. Urine dipstick showed trace albumin levels. Albumin/protein ratio >0.3. A 24-hour urine protein level was 1.8 g/L. What do you expect to find in this patient?
a. Mononeuritis multiplex
b. Renal biopsy showing fractured tubular casts
c. Congo red stain positive
b. Renal biopsy showing fractured tubular casts
(N.B. Reversal of albumin/protein ratio implies overproduction of globulins, which along with bone pain and anemia (CRAB), is suggestive of MM. A negative urine dipstick in this scenario implies Bence Jones proteinuria (undetected free light chains in the urine). Urine protein level is in the tubular range (not nephrotic), which makes amyloidosis unlikely.)
125
A 36-year-old lady with 8-year-old history of rheumatoid arthritis. X-ray of her hand shows erosions of metacarpophalangeal joints. What is the pathology behind it?
Pannus formation
126
A female patient has a 10-year history of diarrhea. She denies laxative abuse. Her blood test showed hypokalemia only. Colonoscopy was done and shows melanosis coli. What is the likely diagnosis?
A. Lactose intolerant
B. UC
C. Crohns
D. Laxative abuse diarrhea
D. Laxative abuse diarrhea
127
What is the most important risk factor for the development of stress ulcer? A. Sepsis and lower GI bleed
B. ICU admission and renal failure
C. Mechanical ventilation and coagulopathy
D. Head trauma and low dose steroids
C. Mechanical ventilation and coagulopathy
128
A 28 year old South Asian female presented with proteinuria. Investigations revealed strongly positive ANA. Renal biopsy revealed diffuse progressive glomerulonephritis. What is your recommended treatment regimen?
a. Azathioprine only
b. Prednisone and Azathioprine
c. Prednisone only
d. Prednisone and iv cyclophosphamide
d. Prednisone and iv cyclophosphamide
The treatment for rapidly progressive glomerulonephritis: glucocorticoids and cyclophosphamide in case of Goodpasture: plasmapheresis and immunosuppression to eliminate the antibodies. In case of RPGN due to ANCA: steroids and rituximab
129
A 26-year-old male patients presents with a swollen, painful ankle. On examination, the ankle joint looks erythematous and is tender to touch. He was also noted to have a pustular rash on the dorsum of his feet. He reported having a recent urethral discharge. What is the likely diagnosis in this patient?
Gonococcal arthritis
130
A pregnant lady was found to have hemolytic anemia and thrombocytopenia, along with schistocytes in her PBS.
What is the best next step in the management?
a. Request ADAMTS 13 and initiate plasma exchange
Note: the same scenario as Q17
131
A 29 year old female was found to have the following results: hemoglobin 78, reticulocytes 0.8, microcytic hypochromic anemia, HbA2 2.4%, HbF 1.3%. Serum Fe and TIBC were 15 (normal) and 470 (increased), respectively. What’s the diagnosis?
a. Iron deficiency anemia
b. Sideroblastic anemia
c. Thalassemia minor
d. anemia of chronic disease
a. Iron deficiency anemia
Note: Iron studies in Iron deficiency anemia include high TIBC
Anemia of chronic diseases: both Fe and TIBC are low
In thalassemia and Sideroblastic anemia: Fe is normal and TIBC is normal or low
132
A male patient presented with ptosis, constricted pupil, tearing, and severe retro- orbital headache. What is the most likely diagnosis?
A. Cluster headache
B. SAH due to PCA rupture
A. Cluster headache
Cluster headaches are excruciating attacks of pain in one side of the head Msd headaches by suhail
133
Mr. Ibrahim, a 45-year-old man came with erythematous scaly patches on the extensor surfaces of his body. He complained of back pain and morning stiffness. Which of the following drugs is best to control his condition?
A. Methotrexate
B. Ant i-TNF
C. Imuran
D. Dapsone
B. Ant i-TNF
134
What is the mechanism of action of drugs used in the treatment of MI?
A. P2Y12 antagonists
B. Cox activators
A. P2Y12 antagonists
Two important classes of Antiplatlets that work as P2Y12 antagonists:
1)Thienopyridines (Examples: Clopidogrel, ticlopidine, prasugrel).
2) Nucleoside analogues(Example: ticagrelor).
135
4. Which of the following is true regarding hypokalemia?
a. It can be accompanied by the development of U wave on ECG
b. It can happen in the setting of mineralocorticoid deficiency
c. It is a known side effect of spironolactone
It is associated with metabolic acidosis
a. It can be accompanied by the development of U wave on ECG
136
A 62 year old with male with hypertension underwent cardiac angiography, in which a contrast dye was used; which is correct statement:
a. Contrast induced nephrotoxicity is irreversible
b. Contrast induced nephrotoxicity is prevented with proper fluid before the contrast study
c. Eosinophiluria
d. Treated with steroids
b. Contrast induced nephrotoxicity is prevented with proper fluid before the contrast study
137
Arterian lady presented with night sweat, weight loss, dyspnea, and hemoptysis.
Which of the following is the most contributing factor for TB medication resistance?
A. Previous use of anti-TB medications
B. Country of origin
C. Duration from disease to symptoms
A. Previous use of anti-TB medications
138
25 years old engineer presents with a recent sharp central chest pain. His BP 110/70, HR 100,
Temp 38. and Ive was normal. He had distant heart sounds. echo showed mild bericardial
effusion with normal heart chambers. Which is the best management for this patient?
whiter
A. Urgent pericardiocentesis
B. Anti Inflammatory agent and continued observation
C. Aggressive hemodynamic monitoring
B. Anti Inflammatory agent and continued observation
-There is diffuse ST elevation in most of the cardiac leads ->Acute pericarditis.
-Acute pericarditis is treated with anti-inflammatory agents(High dose NSAIDs), Except for pericarditis post MI where you will use Aspirin.
-Another drug that can be used in combination with the anti inflammatory agent is Colchicine to reduce the rate of recurrent pericarditis
-you will manage the patient with pericardiocentesis only if there is a severe pericardial effusion ,or if the acute pericarditis is complicated with cardiac tamponade
139
A patient went into diet and lost weight. Now he is feeling hungry. What is the cause of his hunger symptoms?
A. Ghrelin
B. Leptin
C. GLP
answer: A. Ghrelin - a hunger hormone that stimulates appetite.
B. Leptin - does not affect food intake from meal to meal but, instead, acts to alter food intake and control energy expenditure over the long term.
C. GLP - delays gastric emptying therefore helps in satiety.
140
A young male presented with recurrent painful genital ulcers associated with target
lesions on his trunk. What is the most likely diagnosis?
A. Recurrent erythema multiform due to herpes progenitalis
B. Behcet’sdisease
A. Recurrent erythema multiform due to herpes progenitalis
141
A patient presented with a droop in the right angle of his mouth when smiling. He neither could wrinkle his forehead nor close his right eye. What is the best management?
A. Steroids
B. Ant virals
A. Steroids
142
A patient presented with distended neck veins, muffled heart sounds and irregular respiration. Chest X-ray is shown. What do you expect to find?
A. Pulsus paradoxus
B. Pulsus alternans
C. Pulses parvus et tardus
D. Pulsus bisferiens
A. Pulsus paradoxus
-cardiac tamponade is characterized by the following:
1)Hypotension.
2)Increased JVP
3)Tachycardia
4) Pulsus paradoxus
143
A 33 year old teacher presented with sore throat, fever, and chills. She is on Graves medications.
HR 11, BP116/80, T38.5, normal RBC, normal Hb, low WBC, low neutrophils, normal TSH What causes the pt condition?
a. Thyroid storm
b. Aplastic anemia
c. Drug induced neutropenia
d. Viral induced neutropenia
c. Drug induced neutropenia
Note: Anti-thyroid medications is associated with Neutropenia.
144
A patient presented with epigastric pain, watery diarrhea, high gastrin levels, and hypercalcemia. How to confirm the diagnosis?
A. 72 hour fecal fat and electrolytes B. urea breath test
C. Somatostatin scintigraphy
C. Somatostatin scintigraphy
Stem indicates Zollinger Ellison Syndrome, clinical features include abdominal pain, diarrhea, and elevated gastrin levels (gastrinoma). Somatostatin scintigraphy is used to locate tumors, especially pancreatic neuroendocrine tumors.
145
The main structure of Coronavirus COV-SARS2?
A. Double Stranded DNA, enveloped, encoding
B. Double Stranded RNA, enveloped, encoding
C. Single Stranded RNA, enveloped, encoding
D. Single Stranded DNA, enveloped, encoding
C. Single Stranded RNA, enveloped, encoding
146
An 83-year-old male presented with 2-day history of LLQ abdominal pain that is constant and not relieved by position or defecation. He has a fever of 38°C. A palpable mass is felt in the LLQ with no rebound tenderness. WBCs are 14x10^5. All other labs are normal. CXR is normal and no air under diaphragm. What is your next step in diagnosis?
A. Double contrast barium enema
B. Colonoscopy with terminal ileoscopy
C. Contrast CT of abdomen and pelvis
D. Small bowel follow through
C. Contrast CT of abdomen and pelvis
Old age, LLQ abdominal pain, fever, and elevated WBCs are indicative of diverticulitis. The test of choice to diagnose diverticulitis is contrast CT of abdomen and pelvis.
147
A 52-year-old gentleman presented with acute onset of unilateral facial numbness and vertigo. On examination, he had right-sided ptosis, decreased pain and temperature sensation on the right side of the face, as well as right sided ataxia. What is the likely affected artery in this patient?
A. Vertebral artery
B. Posterior cerebral artery
C. Superior cerebellar artery
D. AICA
A. Vertebral artery
the vertebral arteries supply blood to the upper spinal cord, brainstem, cerebellum, and posterior part of brain.
148
A 21-year-old man underwent a routine check-up before getting employed. He was incidentally found to have a slightly elevated level of unconjugated bilirubin. What is the most likely cause?
A. Gilbert syndrome
B. Crigler-Najjar syndrome C. Cystic fibrosis
D. Alpha-1 anti -trypsin
A. Gilbert syndrome “slightly elevated level of unconjugated bilirubin”
Gilbert's syndrome is a harmless liver condition in which the liver doesn't properly process
bilirubin. Patients might not know they have Gilbert's syndrome until it's discovered incidentally,
such as when a blood test shows elevated bilirubin levels.
149
A woman who is from KSA presented with recurrent upper respiratory tract
infections. Maxillary sinus shows air fluid levels in maxillary sinuses on X-ray. What is the best diagnostic test?
a. CT of sinuses
b. Biopsy of the sinus with stain
c. Electron microscopy of ciliary brush nasal biopsy
c. Electron microscopy of ciliary brush nasal biopsy
(The patient most likely has primary ciliary dyskinesia.)
150
A Patient diagnosed with Multiple Myeloma.
What is the cause of his recurrent infections?
a. Hypogammaglobulinemia
b. loss of complements
a. Hypogammaglobulinemia
Note: Recurrent infections due to ineffective normal antibodies production and hypogammaglobinemia.
151
A 55 year old smoker with history of COPD came to the emergency department by an ambulance after he experienced a convulsion. His sister denies a history of convulsions. Na 135 & serum osmolality is low. What is the most relatable cause of his presentation?
a. Squamous cell carcinoma of the lung
b. Small cell carcinoma of the lung
c. Adenocarcinoma of the lung
b. Small cell carcinoma of the lung
Patient has hyponatremia. Next thing you analyze is the serum osmolality. If it’s low, next check the volume status to narrow down the cause.
- Hypovolemic: nonrenal salt loss (diarrhea, vomiting, dehydration)
- Euvolemic: psychogenic polydipsia, SIADH
- Hypervolemic: heart failure, cirrhosis, nephrosis (fluid overload states)
The answers only involve lung cancers, so now we know the cause is likely SIADH. Small cell lung carcinoma is the most common type to have SIADH.
152
53-year-old male who is a heavy smoker with chronic cough, presented with fatigue and lethargy. His lab investigations showed the following: Na 123 mmol/L; Blood glucose 6 mmol/L Serum osmolarity 270 mOsm (NR: 290-325); Urine osmolarity 450 mOsm (NR: 200-1000) Choose the correct statement:
a. His condition is mostly due to diabetes insipidus
b. The underlying cause is probably lung cancer
c. Rapid correct ion of his hyponatremia will result in cerebral edema
d. Fanconi syndrome is possible in this patient.
b. The underlying cause is probably lung cancer
All the patient symptoms suggest lung cancer. And in squamous cell lung cancer Ca+2 will be high which increase the osmolarity.
153
A female complained of fatigue. She had high liver enzymes, high ALP, high LDH, and high total and indirect bilirubin. Blood smear showed schistocytes. Flow cytometry showed low CD55 and CD59. What’s the diagnosis?
a. TTP
b. Hereditary spherocytosis
c. Autoimmune hemolytic anemia
d. Paroxysmal nocturnal hemoglobinuria
d. Paroxysmal nocturnal hemoglobinuria
Note: Paroxysmal nocturnal hemoglobinuria is an acquired disorder caused by a deficiency of the complement regulatory proteins CD 55 and 59.
