2014 - 6th Flashcards
A male patient was diagnosed with a brain tumor in the right parietal region. He started to develop disturbances in his vision. What visual filed defect is this patent likely to have?
a. Left lower quadrantonopia
b. Right lower quadrantonopia
c. Left upper quadrantonopia
d. Right upper quadrantonopia
a. Left lower quadrantonopia
A 50 year old man has been recovering from MI in the CCU. He suddenly collapses with nausea and vomiting and ECG shows wide QRS complexes. What is the diagnosis?
a. Supraventricular tachycardia
b. Ventricular tachycardia
c. Atrial fibrillation
d. Bundle branch block
b. Ventricular tachycardia
A Female had prolonged bleeding after dental extraction, and she needed 2 units of packed RBCs. Her
brother died because ot prolonged post-operative bleeding and she has relatives who also have prolonged bleeding, both males and females. Her PT was normal, APTT prolonged, and bleeding time normal. What coagulative factor deficiency is likely present?
a.ractor vIl
b. Factor VIll
c. Factor X
d. Factor XII
c. Factor X
A 25-year-old young man presented with headache and occasional nose bleed. Also, he had leg pain upon going up the stairs, which was relieved after rest. On examination, his blood pressure was 160/80. What additional finding is associated with this condition?
a. elevated plasma catecholamine level
b. low serum potassium
c. renal artery bruit
d. brachio-femoral delay
d. brachio-femoral delay
A 21 year old man with recurrent bloody diarrhea with mucus. Colonoscopy showed deep linear ulcers with skip lesions involving cecum, ascending, transverse and sigmoid colon. Rectum was spared.
What’s the most likely diagnosis?
a. Crohn’s colitis
b. Ulcerative colitis
c. Pseudomembranous colitis
d. Ischemic colitis
a. Crohn’s colitis
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. Pericardiectomy
b. TB chemotherapy
c. Pericardiocentesis
d. Intravenous diuretics
a. Pericardiectomy
A 43-year-old woman developed progressive muscle weakness in her upper arms over the last six weeks. She has difficulty getting out of chairs and climbing stairs. She has no muscle pain, however. A diagnosis ot polymyositis was made. what is expected to be round in the muscle biopsy of this patient?
a. Endomysial infiltration of CD8 cells (or Th1 cells)
lady from Morocco presented with cough and hemoptysis (other details were Provided including the fact that she is a smoker and had yellowish/green sputum I think they also mentioned that the X-ray showed apical cavity). What is the most appropriate action?
Not sure about the choices but:
a. Acid fast stain
b. Culture and antibiotics
c. send morning sputum for culture and stain
d. treat as pneumonia until it is proven by lab tests to be pneumonia
?
A 50 year old patient, known to have diabetes and hypertension, presents with sweating, shortness of breath and chest pain. Troponin was elevated. ECG showed ST Elevation in leads aVF, II, III. What murmur do you expect to hear?
a. Pansystolic murmur at the apex
b. Ejection systolic at the upper left sternal border c. Ejection systolic at the upper right sternal border d. Mid diastolic in the midline
a. Pansystolic murmur at the apex
A young female presents with ataxia, muscle weakness and sensory abnormalities. Deep tendon reflexes were exaggerated and there was an upward plantar reflex. Her fundoscopic examination showed pale optic disc. On further asking, she admitted she had an episode of blurred vision a few months ago. What is the best management plan?
a.steroids
b. Interferone beta
a.steroids
A 55 year old man, who is a smoker, hypertensive, diabetic, hyperlipidemic, had 2 episodes of exertional syncope. He had previously been admitted for severe dyspnea. He denies any angina. On examination, he had an ejection systolic murmur and a thrill. Echo showed severely calcified aortic valve with gradient of 50mmHg. Which of the following would you do?
a. Request the surgeon for early AV replacement b. Request coronary angiography before surgery c. Request urgent head CT
d. Request electrophysiology studies
b. Request coronary angiography before surgery
A 40 year old man with type 2 diabtes had hypertension and takes beta blockers, calcium channel blockers and ACE inhibitors, all of which failed to control his high blood pressure. He had hypertensive retinopathy type 2 and ECG showed sinus tachycardia and left ventricular hypertrophy. Blood tests showed: Low potassium, High glucose, Na=144. What is the underlying cause?
a. Conn’s syndrome
b. Cushing syndrome
c. Pheachromacvtoma
d. Renal artery stenosis
a. Conn’s syndrome
A young male with recent palpitations. He has a history of acute rheumatic fever. On examination, bilateral neck pulsations were seen and apex was hyperdynamic. Which of the following is expected to be heard on auscultation?
a. pansystolic murmur at the apex
b. Ejection systolic murmur at left upper sternal border
c. Early diastolic murmur at left mid sternal border
d. Mid-diastolic murmur with opening snap
c. Early diastolic murmur at left mid sternal border
A middle aged man presents with headache. CBC showed slightly elevated BC count with elevated platelets of 1500 × 109/L. What is your initial diagnosis?
a. Polycythemia vera
b. Essential thromboctosis
c. CML
b. Essential thromboctosis
A patient can with pain in his left shoulder after playing tennis. He noticed that he noticed decreased sensation on his left side of face with increased weakness on his right arm and leg. Moreover, he has ptosis and small pupil on his left side. What is the most probable injury? (it was the same exact presentation the only difference maybe was with the source of injury instead of tennis maybe it was a maneuver to the neck or trauma)
a. left vertebral artery dissection
b. intervertebral disc prolapse
a. left vertebral artery dissection
What antihypertensive drug is the best during pregnancy?
methyldopa
A 70 year old man with previous history of diabetes, hypertension and atrial fibrillation on warfarin was brought to the ER at 17:50. His wife said that she came back home and found him on the ground with right sided weakness and speech arrest. The wife’s call with the ambulance was registered at 17:30.
The patient had an inguinal hernia repair 3 months ago, and his brother had hemorrhagic stroke at the age of 67 years. Which of the following is an absolute contraindication of thrombolysis in this patient?
a. Recent surgery
b. Time of onset
c. Family history of hemorrhage
d. Platelets= 150.000
b. Time of onset
An Indian man presented with 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
A 20-year-old man had 11 episodes of meningitis over the past 3 months. He’s healthy in between the attacks. What’s the cause of his recurrent episodes of meningitis?
a. Otitis media
b. whioble disease
c. CSF leak
d. Multiple sclerosis
d. Multiple sclerosis
A young patient who is a known case of asthma is getting worse despite being on medications, including inhaled steroids. His mother savs that her son is wheezv almost everdav and is having a productive cough. Laboratory investigations show a high WBC count and high eosinophil count. What other investigation would confirm the cause of this patient’s presentation?
a. IgE antibodies to Aspergillus fumigatus
b. Blood culture
c. HIVtest
d. Blood film and bone marrow aspiration
a. IgE antibodies to Aspergillus fumigatus
A patient presented with frothy sputum, sever dyspnea, raised JVP and was found to have an ejection fraction of 30%. What is the pathophysiology of his symptoms?
a. Increased pulmonary artery resistance
b. Increased pulmonary capillary hydrostatic pressure
c. Increased diastolic pressure in the left ventricle
b. Increased pulmonary capillary hydrostatic pressure
A woman came with her husband to the hospital. He has a resting tremor, stooped posture, a shuffling gait, tendency to fall, and a blank face. Also, the wife mentioned that her husband had accidently hit her during sleep. Which of the following is not a finding of Parkinson’s disease?
a. REM sleep disturbance
b. Broad based gait
c.oor arm swing
d. Autonomic instability
b. Broad based gait
What would you look for in patient that might have his prostate cancer compressing his spinal cord?
Sensorv level
While performing a lumbar puncture, you felt a bony resistance. Where should you move the needle?
a. Right of patient
b. Left of patient
c. Head of patient
d. Feet of patient
c. Head of patient
A 55-year-old man presents to the clinic with 4 months history of shortness of breath and pallor. His
CBC showed low Hb and low BBC count. Iron profile showed low ferritin. serum iron and transferrir saturation, as well as high total iron binding capacity. What is the best next step in management?
a. IV iron
B. orantron
c. bone marrow bIODsv
d. Colonoscopy
d. Colonoscopy
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
A 60 year old lady presented with tremor in her right hand. Which of the following is suggestive of parkinson’s disease?
a. increase tremor as the hand gets closer to target
b. increase muscle tone and bradykinesia
c. increase muscle tone and parasthesia on same side of the bodv
d. chorea and muscle nvootonia
b. increase muscle tone and bradykinesia
A 3 month old infant with findings consistent with a ventricular septal defect. When you had examined him soon after birth, you had found no cardiac abnormality and had reassured the parents about a normal heart. Which of the following physiological changes in the neonatal period will account for this?
a. Increasing cardiac output
b. Fall in the pulmonary vascular resistance
c. Decreasing hemoglobin level
d. Closure of ductus arteriosus
e. Continued patency of foramen ovale
b. Fall in the pulmonary vascular resistance
A 23 year old male was stabbed in the neck. After being stabilized, an MRI was done and showed right hemiscetion at the level of C6. What are the likely clinical findings?
a. Paralysis of the diaphragm
b. Absence of the temperature sensation in the left hand
c. Absence of the light touch in the left hand
d. Paralysis of the left hand
b. Absence of the temperature sensation in the left hand
A thin built 20 year old male came for a cardiac evaluation before joining a excercise training program. On examination, he is tall thin with long finger and hyperextensible joints and he has prominant pulsations of the neck and BP of 130/60 mmHg. Examination of the precordium revealed there was a heart murmur. (xray)
What is the likely cardiological diagnosis ?
a. MVP
b. MS
c. AR
d. PS
c. AR
A 55 year old patient, diagnosed with type 2 diabetes mellitus 4 years ago, presented with generalized fatigue, arthralgia, and myalgia. Urinalysis showed RBC= 20/hpf, Microalbuminuria= 150 mg, no retinopathy, BP= 150/90. 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
B. Persistent Hematuria
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 40-year-old man is rejected from applying to the military. He reports six-month history of central heaviness and dyspnea as well as syncopal attacks in the past month. His past medical history is significant for a heart murmur that was discovered 15 years back. Shown is his chest x -ray. Which of the following is an expected finding during auscultation of the chest?
a. Ejection click at the apex
b. Wide and fixed splitting of S2
c. Early diastolic murmur at the right sternal border
d. Soft pulmonary component of S2
a. Ejection click at the apex
A 25-year-old man with a long history of chronic intdiarrhea presents with one week history of exacerbating symptoms. Over the last 24 hours, the severity of diarrhea has decreased, but he non complains of abdominal pain and distention. On physical examination, the patient is extremely ill a pale, abdomen is distended, tympanic to percussion and diffusely tender. His vital signs are as follo blood pressure 93/60, heart rate 113 beats/min, respiratory rate 18 breaths/min and temperature
C. His abdominal x-ray is shown. Which of the following should be used as part of management for of this patient?
a. Infliximab
b. Oral steroids
c. Oral metronidazole
d. Methotrexate
e. Mercaptopurine-6
a. Infliximab
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 To-and-fro leathery murmur
b. Pleural friction rub
c. Pansystolic murmur at the apex
d. Ejection systolic murmur in the aortic area e. Radio-radial delay
a. Pericardial To-and-fro leathery murmur
