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Medicine Final > 2015 - 6th > Flashcards

2015 - 6th Flashcards

1
Q

A female presents with one-week history of abdominal pain and vomiting. Her serum creatinine is found to be 150. What is your next step of management?
A. CT with contrast to diagnose the cause
B. IV fluid infusion

A

B. IV fluid infusion

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2
Q

An 18-year-old male presented with syncope upon exertion. His family history is positive for sudden death at young age. Upon performing an echocardiogram, there was thickening of the ventricular septum obstructing the left ventricular outflow. If the precordium was auscultated, what murmur would you hear?
A. Pansystolic murmur at left lower sternal border
B. Ejection systolic murmur at the right upper sternal border
C. Early diastolic murmur at the mid-sternal border
D. Mid-systolic click followed by late systolic murmur

A

B. Ejection systolic murmur at the right upper sternal border

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3
Q

A 24-year-old female was with her friend when she became unresponsive for 2 minutes. She had lip smacking with some repetitive movements
When the attack finished, she did not remember at all what happened.
Which of the following the underlying cause of her symptoms?
A. Aosence selzure
B. Complex partial seizure
C. Simple partial seizure
D Tonic-clinic seizure

A

B. Complex partial seizure

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4
Q

1.A 52-vear-old temale presented with communitv acquired pneumonia complicated by pleural effusion. Thoracocentesis was done and the results are pH 7.11, WBC 3,800 (90% are polymorphs), glucose 5.5, LDH 285. Gram stain was performed and it didn’t not show any organisms. Cultures are pending. What is an indication for inserting a chest tube?
A. pH = 7.11
B. 90% polymorphs
C. Glucose = 5.5
D. Lactate dehydrogenase (LDH) is more than 2/3 serum LDH
Answer: A empyema gives a pH <7.2 and needs to be drained)

A

A. pH = 7.11
empyema gives a pH <7.2 and needs to be drained)

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5
Q

A patient was hemodynamically unstable. On physical examination, his pulse was found to be weak. What is the management?
A. Defibrillation
B. Synchronized DC shock

A

B. Synchronized DC shock

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6
Q

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

A

B. Tuberculous pericarditis

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7
Q

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. Pulmonary embolism
B. STEMI
C. Restrictive cardiomyopathy

A

A. Pulmonary embolism (S1Q3T3 pattern)

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8
Q

A 23-year-old female, known case of epilepsy, recently got married. What drug should be avoided to prevent teratogenic effect on her fetus?
A. Carbamazebine
B. Topiramate
C. Phenytoin
D. Sodium valproate

A

D. Sodium valproate

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9
Q

A 27-year-old man presented with ascending paresthesia in the lower limb.
He also complained of weakness of both lower limbs. On examination,
there was diffuse bilateral areflexia. He had an URTI one week ago. What is the likelv cause?
A. spinal cord compression
B. Guillain-Barré syndrome
C. leprosy
D. peripheral neuropathy

A

B. Guillain-Barré syndrome

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10
Q

A 75-year-old man, known to be hypertensive and diabetic, presented with a history of productive cough for the past few days. The sputum was purulent. Chest radiograph showed right middle lobe consolidation. Third generation cephalosporin and azithromycin were given. Which of the following associated with poor prognosis in his presentation?
A. Tachycardia
B. Leukocytosis
C. Bacteremia
D. Single lobe involvement

A

A. Tachycardia

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11
Q

A patient was previously healthy but he had a short history of stable angina and then he developed angina that was not relived with rest and lasted for
20 minutes. His cardiac enzymes are minimally elevated and ECG is shown below. What is the pathophysiology behind it?
A. Subtotal occlusion due to a plaque rupture
B. Subtotal due to a thick fibrous cap
C. Total occlusion
D. Vasospasm

A

A. Subtotal occlusion due to a plaque rupture (unstable angina)

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12
Q

Another patient came for a complaint of headache. On further examination, bitemporal hemianopia was documented. What is site of the lesion?
A. Right optic nerve
B. Optic chiasm
C. Occipital lobe

A

B. Optic chiasm

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13
Q

A COVID-19 patient exposed in December 2020. What lab test is
characteristic of COVID?
A. Low total WBC
B. Low Lymphocyte
C. Low platelets
D. No specific lab finding for COVID-19

A

B. Low Lymphocyte

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14
Q

A patient presented to the clinic with amenorrhea and infertility. Her lab
results showed low LH.SH.and estradio. What is the site ot her pathology?
A Ovaries
B. Uterus
C. Hypothalamus

A

C. Hypothalamus

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15
Q

A 55-year-old hypertensive diabetic business man presented with sharp central chest pain for 2 days duration. The pain is aggravated by lying supine and taking deep breaths and relieved with sitting up and leaning forward. He had an uneventful recovery from a myocardial infarction 2 weeks ago. What do you expect to find on physical examination?
A. Pericardial friction rub
B. Pleural rub
C. Mid systolic click
D. Pan systolic murmur at the apex

A

A. Pericardial friction rub

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16
Q

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

A

C. CCB

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17
Q

An obese female presented with frequent headaches. On examination, fundoscopy revealed papilledema and signs of CN 6 palsy. What is the likely diagnosis?

A

Idiopathic intracranial hypertension

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18
Q

A 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-cionic seizure
B. Mvocionic seizure
C. Atonic seizure
D. Absence seizure
E. Complex partial seizure

A

C. Atonic seizure

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19
Q

A patient develops stage 4 diabetic nephropathy and his HBA1C was 7.5
high. the normal range tor chronic kidnev oisease is 6 5 - 7 5. He was on metformin for 10 years and later he develops frequent hypoglycemic attacks. What is the management?
A. Reduce the dose of metformin
B. Keep the same dose and increase carbohydrate intake
C. Switch to SGLT2 inhibitor
D. Switch to DPP-4 inhibitor

A

D. Switch to DPP-4 inhibitor

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20
Q

A patient with hepatitis C presented with purpura, digital infarction and renal failure. His complement level was low. What is the diagnosis?
A. Cryoglobulinemia
B. IgA nephropathy

A

A. Cryoglobulinemia

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21
Q

A 45-year-old woman presented with fatigability, increased appetite, increased sweating and palpitations. On examination, she had tremor and exophthalmos. A drug was given and, later, she developed fever and respiratory infection. Her doctor advised her to stop the medication. What
is the medication?
A. levotyroxine
B. provranolo
C. carbimazole
D. folic acid

A

C. carbimazole
as it can cause agranulocytosis. Has to be stopped if the patient was taking it and developed unexplained fever or URI symptoms)

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22
Q

A 60-year-old lady, who is a known case of severe aortic valve stenosis, is being evaluated for possible treatment. Which of the following is the most appropriate management plan?
A. Prepare the patient for surgery
B. Perform coronary angiography before surgery
C. Pretreatment of the patient with warfarin is recommended
D. Medical treatment is recommended for this patient
E. Severe aortic valve stenosis is treated only with surgical repair

A

B. Perform coronary angiography before surgery

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23
Q

Following a massive blood and blood product transfusion to a patient with trauma, thrombocytopenia and hypertibrinogenemia were noticed. Which of the following explains the pathophysiology of thrombocytopenia in the patient?
A. ПР
B. Megakaryocytic maturation arrest in the bone marrow
C. Drug-induced thrombocytopenia
D. DIC

A

D. DIC (With massive transfusion protocols, DIC can happen due to dilution of clotting factors. The high fibrinogen levels are associated with
poor clinical outcome in those patients.

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24
Q

A patient presented with recurrent UTIs, brown discoloration of urine, and air bubbles seen in urine (pneumaturia). What is the diagnosis?
A. Crohn’s colitis
B. ulcerative colitis
C. Collagenous
D. MicroscopIc

A

A. Crohn’s colitis ACrohn’s disease can cause fistula formation between trom the intestine to urinary tract)

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25
Q

A male presented with bouts of bloody diarrhea 4 times a day, but he is hemodynamically stable. All his CBC, HB, WBC and platelet levels are normal.
His CRP is elevated. Colonoscopy was done and showed inflammatory changes suggestive of UC. He was given oral mesalazine (ASA), but did not improve his symptoms. On the other hand, he is still well and stable with no systemic symptoms. What is the appropriate next management?
A. Oral prednisone
B. IV corticosteroid
C. Rectal corticosteroid
D. Oral azathioprine

A

C. Rectal corticosteroid (As initial therapy, we use a combination of an oral 5-ASA agent plus rectal mesalamine for patients with left-sided or extensive mildly-to-moderately active UC. Symptomatic improvement is usually seen within two
to four weeks (UpToDate). Then, using

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26
Q

What is true about chronic kidney disease?
A- Most patients die before they reach stage 5
B- Most will reach stage 5
C- Stage 5 can be reversed to stage 1 with treatment
D- Stage 1,2, and 3 are clinically prevalent

A

A- Most patients die before they reach stage 5

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27
Q

A 65-year-old man presented with progressive gait difficulty and neck stiffness. He was previously healthy. His neurology examination revealed abnormal restriction of vertical gaze. What is the diagnosis?
A. Alzheimer
B. Parkinson’s
C. Lowy body dementia
D. progressive supranuclear gaze palsy

A

D. progressive supranuclear gaze palsy

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28
Q

A diabetic patient was given a medication for her hypertension and subsequently developed lower limb edema. What would you check for to rule out right-sided heart failure?
A. Check her JVP
B. Perform an ECG
C. Check urine for protein

A

A. Check her JVP

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29
Q

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 she was 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 E. Reassurance

A

A. Pericardiectomy (constrictive pericarditis)

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30
Q

Which of the following physical findings do you expect to find in patients with Guillain-Barré syndrome?
A. Muscle fasciculations
B. Absent deep tendon reflexes
C. Spasticity
D. Clonus
E. Brisk reflexes

A

B. Absent deep tendon reflexes

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31
Q

A patient presented with hemoptysis and glomerulonephritis. Immunofluorescence shows linear deposition. Anti-GBM antibodies were detected. What is the diagnosis?
A. weaner disease
B. Good pasture disease
C. IgA nephropathy

A

B. Good pasture disease

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32
Q

23-year-old woman admitted with lobar pneumonia. she was given IV ampicillin and gentamicin she also had a CT with contrast on the first day. one the 4th day her serum creatinine was normal. On the 8th day her serum creatinine was 250. what is the main cause of her AKI?
A. Sepsis due to pneumonia
B. Gentamicin
C. Contrast
D. AIN

A

B. Gentamicin

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33
Q

A patient underwent a hip replacement surgery then developed a perfused diarrhea. What is the causative organism?
A. c. difficile
B. campylobacter coli
C. s aureus
D. salmonella

A

A. c. difficile

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34
Q

A 24 year old man presented with weakness and fatigue. On physical examination, he was found to have postural hypotension and raised JVP. Provided are his lab results: PO2: 12.8 Kpa (normal); PCO2:
24 mmHg; HCO3: 15 mmHg; pH: 7.28 Na: 135; Urine Na: 9; Glucose: 5; Urea: 7; Chloride: 115 (high); S-osmolality: 308; K: 3.8 What is the diagnosis?
A- Lactic acidosis
B- Renal failure
C- Renal tubular acidosis
D- Diarrhea

A

D- Diarrhea

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35
Q

Which of the following is used to lower potassium in patient with hyperkalemia?
A- NaHCO3
B- Glucose
C- Beta blockers
D- Calcium gluconate

A

A- NaHCO3 cacium aluconate does not ower ootassium evels. tuscorotecis the hearttom the hyperkalemia)

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36
Q

A 48-year-old man has uncontrolled hypertension despite being on
multiple medications. He came to the clinic complaining of muscle
weakness. His blood pressure was 174/95 mmHg. The patient’s medications
were adjusted; however, his symptoms increased in severity and his blood
pressure did not improve. On further evaluation, he was found to have a
serum potassium level of 3.1 mEq/L (normal range: 3.5-5.3 mEq/L). His CBC
and remaining electrolyte profile were normal. Which of the following would be the best for management of this patient?
A. Add oral potassium
B. Add furosemide
C. Add spironolactone
D. Add ARB
E. Reassure the patient

A

C. Add spironolactone (Conn’s disease)

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37
Q

A patient is rescued from a falling building. What is the most important step to prevent rhabdomyolysis?

A

A. IV fluids

38
Q

Patient Developed seizures ( Scenario of Hyponatremia), at what rate should sodium be infused?
A. 16 mmol/
B. 6-8 mmol/l
C. 12 mmol/|

A

B. 6-8 mmol/l

(sodium should always be corrected at a rate less than 8 (up to 10) to prevent pontine myelinosis, there were no other options in the exam less than 8 other than B)

39
Q

What would you look for in patient that might have his prostate cancer compressing his spinal cord?

A

Sensorv level

40
Q

A 32-year-old man presented with a 6-month history of diarrhea and weight loss of 5 kg. On examination, he was febrile with a temperature of
382 4 and he was tound to have a right lower guadrant mass with severe
tenderness. Which of the following would be the best next step in diagnosing this patient?
A. Colonoscopy with Ileoscopy
b. Abdominal CT scan
C. Abdominal Ultrasound
D. Abdominal X-ray

A

b. Abdominal CT scan

41
Q

A patient came with heart failure following an episode of fever and URTI. What would you look for on auscultation?
A. S3 gallop
B. Ejection systolic murmur
C. Pulsus paradoxus

A

A. S3 gallop

42
Q

A 20-year-old male presented with shaking of the right hand, then it progressed to generalized tonic clinic seizure. What is the most common lobe affected in partial (focal) seizure?
A. parletar
B. temporal
C. frontal
D. occipital

A

B. temporal

43
Q

A 30-year-old patient presented with hypertension. Urinalysis showed microscopic hematuria.
24 hour urine protein collection revealed protein 0.75 mg. complement levels were normal. what is the most likely diagnosis?
A- SLE
B- IgA nephropathy
C- post-strent GIN
D- membranous GIN

A

B- IgA nephropathy

44
Q

A 40-year-old male, who is a known case of hepatitis C, liver cirrhosis, and
portarvertension. was round to nave a low platelet count. vnich ot the following is the most likely underlying mechanism of thrombocytopenia in this condition?
A. Splenomegaly
B. Tromboniotein deticiencv
C. Erythropoietin deficiency
D. Immune-mediated destruction
E. Iron deticiency

A

B. Tromboniotein deticiencv

45
Q

What is the murmur heard?
A. Ejection systolic murmur
B. Early diastolic murmur
C. Mid-diastolic murmur
D. Pansystolic murmur

A

C. Mid-diastolic murmur (mitral stenosis)

46
Q

A 30-year-old female presented with history of pricking chest pain and discomfort. She also reports occasional palpitations and dyspnea. While doing physical examination, you noticed that she has a tall stature and flat chest. She has a mid-systolic click followed by a late systolic murmur in the mitral area. Echocardiography showed prolapse of the anterior and posterior mitral leaflets into the left atrium during systole and mild mitral regurgitation. There was no left ventricular hypertrophy and the left ventricular ejection fraction was 64%. How would you manage this patient? A. Mitral valve repair
B. Aspirin
C. Calcium channel blockers
D. Diuretics
E. Reassure the patient about the benign prognosis

A

E. Reassure the patient about the benign prognosis

47
Q

A 30-year-old Indian patient presented with confusion and fever. His neurological exam showed neck stiffness and temperature of 39°C. Which of the following CSF findings is NOT suggestive of tuberculosis meningitis?
A. turbid fluid
B. high protein
C. high polymorphs
D. high monocytes

A

C. high polymorphs

48
Q

A housewife with 8-months history of dry cough and progressive dyspnea.
HRCT was performed and showed bilateral reticular infiltration (honeycomb appearance). What is your management
A. Oral pirfenidone
B. Inhaled steroids
C. Azathioprine

A

A. Oral pirfenidone

49
Q

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

A

C. NSAIDs

50
Q

A patient, known to have iron-deficiency anaemia, developed bouts of pertused foul, pale, offensive diarrhea. He has low HB and ferritin. B12 was normal. He was found to have elevated bilirubin. His alcohol intake is 14 unites per week. What was the complication that has occurred?
A. whipple disease
B. Chronic pancreatitis
C. Malabsorption syndrome
D. Colon hypermotility

A

B. Chronic pancreatitis

51
Q

A patient has stage 4 chronic kidney disease due to diabetic nephropathy.
His blood pressure is 130/80 and he is taking ACEI. What should be done?
A. Switch to Angiotensin receptor antagonist (ARB)
B. Stop ACEI and observe
C. Switch to CCB
D. Add ARB

A

C. Switch to CCB
(In case of stage 4 and 5, we don’t use ACEl or ARB)

52
Q

Chest x/rays shows mid and lower cavitation in the lungs. And the patient has Patients with hemoptysis and rapidly progressive renal failure. What should be done to diagnose?
A. Sodium
B. Creatinine
C. ANCA
D. hbhcal

A

C. ANCA

53
Q

What is the most sensitive test to rule out myasthenia gravis?
A. repetitive stimulation test
B. ice-pack test
C. single-fiber EMG
D. Acetylcholine receptor antibodies (anti-Ach)

A

C. single-fiber EMG

54
Q

A patient with sodium level of 163 mol/L, lowering it to fast will lead to ?

A

Cerebral edema

55
Q

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

A

D. Hypertrophic cardiomyopathy

56
Q

Which of the following would most likely induce a long-term remission in a patient with Immune Thrombocytopenia (ITP)?
A. High dose prednisolone
B. IV immunoglobulin
C. Splenectomy
D. Immunosuppressive agents

A

C. Splenectomy

57
Q

A 45-year-old female has 6 months history of tiredness. She is not able to complete her daily 30-minute walk and her work at house. He musculoskeletal examination shows full range of motion, but she has many tender points. Her CBC, LFT and RFT are all normal. ES was found to be 15.
What is the diagnosis?
A. Polymyositis
B. Fibromyalgia
C. Polymyalgia rheumatica
D. Rheumatoid arthritis

A

B. Fibromyalgia

58
Q

What is the rationale behind tapering steroid therapy in a patient with
Polvmvositis?

A

A. Prevent adrenal crisis

59
Q

A patient came for a complaint of headache. On further questioning and examination, itchiness and vesicles were documented. What’s the cause of her headache?
A. Migraine
B. Giant cell arteritis
C. Herpes zoster

A

C. Herpes zoster

60
Q

A 65-year-old male presented with unilateral tremor in the right hand. He also has positive family history of essential tremor. The treating neurologist started him on levodopa and he is improving. What is the most sensitive test you would order to differentiate between essential tremor and
Parkinson disease in him?
A. brain MRI
B. DaT scan
C. nerve conduction studv
D. PET scan

A

B. DaT scan

61
Q

Patient hypertensive and diabetic and now he is having microalbuminuria, how to prevent progression of the diabetic nephropathy?
A. ACEI
B. Beta blocker
C. Thiazides

A

A. ACEI

62
Q

A 35-year-old lorry driver presents with increasing central chest heaviness and breathlessness on exertion and relieved by rest for the past 6 months. On further inquiry, he reveals that he has suffered 2 syncopal attacks in the past while carrying heavy weight. He is known to have a heart murmur detected on medical school checkup. His Chest x-ray is shown below. What treatment would you recommend for him?
A. replacement with mechanical prosthetic valve B. replacement with bioprosthetic valve
C. trans-arterial valve replacement
D. medical therapy

A

A. replacement with mechanical prosthetic valve (post-stenotic dilatation. Aortic stenosis)

63
Q

A diabetic patient complains of bilateral night pain in her lower limb. She also has burn on her heels that she is unaware of. What is her diagnosis?
A. Diabetic neuropathy
B. Necrobiosis lipoidica diabeticorum

A

A. Diabetic neuropathy

64
Q

a 61-year-old patient had low urine output one day after coronary angiography. What will be a characteristic finding in urine?
A- Eosinophiluria
B- proteinuria 2.5
C- urine with high osmolarity

A

C- urine with high osmolarity

65
Q

A 41-year-old man, who is a known case of combined rheumatic mitral stenosis and regurgitation, is scheduled for valve replacement. He visited his dentist for a tooth extraction. The dentist referred the patient to the cardiologist for further evaluation with regards to his valvular heart disease and determining his candidacy for infective endocarditis prophylaxis. He is not allergic to penicillin. What should be done in terms of infective endocarditis prophylaxis?
A. Prescribe erythromycin
B. Prescribe benzyl penicillin for 10 years
C. Prescribe benzyl penicillin for 5 years
D. Do nothing

A

D. Do nothing

66
Q

A 40-year-old man referred to Neurology outpatient clinic. History of ataxia, chorea, and cognitive decline. He was diagnosed with Huntington’s disease.
Which of the following is correlated with this condition?
A. Autosomal recessive inheritance
B. All his daughters will be affected but none of his sons
C. All his offspring have a 50% chance of getting the disease
D. It is caused by a mitochondrial DNA mutation

A

C. All his offspring have a 50% chance of getting the disease

67
Q

A 25-year-old female presented with episode of visual loss. Brain MRI was used to check dissemination in space. How to check for dissemination in time?
A. Visual evoked potentials
B. Somatosensory evoked potentials
C. CSF oligoclonal bands
D. CT with contrast

A

C. CSF oligoclonal bands

68
Q

A 30-year-old secretory presented with a 3-month history of numbness in both hands. The numbness is mainly nocturnal and on doing manual activities. It improves when asking of her hands. She aained 15 kg in the last 4 months. Tapping both wrists with a hummer also produces her symptoms.
Entrapment of which of the following nerves would result in this presentation?
A. Ulnar
B. Median
C. Radial
D. Anterior interosseous

A

B. Median

69
Q

A 25-year-old presented with 5 years history of unilateral headache that increases during menses. It is associated with photophobia, nausea and vomiting. What is the diagnosis?
A. Cluster headache
B. Migraine
C. Subarachnoid hemorrhage
D. Meningitis

A

B. Migraine

70
Q

Botulinum toxin works on:
A. presynaptic receptors
B. postsynaptic receptors

A

A. presynaptic receptors

71
Q

A 55-year-old female presented with history of hip, shoulder, and neck pain and stiffness for the past few months. Her laboratory work-up showed Hb =
10 g/dL (low) and ESR = 100 mm/hour (markedly elevated). What is the most likely diagnosis?
A. Polymyalgia rheumatica
B. Fibromyalgia
C. Rheumatoid arthritis
D. Lupus arthritis
E. Osteoarthritis

A

A. Polymyalgia rheumatica

72
Q

What is the most common cause of collapse during the first 24 hours of myocardial infarction?
A. Septal perforation
B. Ventricular fibrillation
C. Atrial fibrillation
D. Pericarditis

A

B. Ventricular fibrillation

73
Q

A 50-year-old man had nephrotic syndrome due to membranous nephropathy. He is still in relapse and has not responded to treatment. He is at risk to get:
A. Arrhythmia
B. Pulmonarv embolism
C. Cerebralemorrace
D. Hypotension

A

B. Pulmonarv embolism

74
Q

what is the most sensitive indicator of contrast-induced nephropathy?
A. urine output < 600
B. hematuria
C. rising creatinine > 26 in 24 hours

A

C. rising creatinine > 26 in 24 hours

75
Q

A smoker engineer presented with right sided weakness and dysarthria.
The initial CT was normal. What is the thrombolytic time window according to the new guidelines?

A

A. 3-4.5 hours

76
Q

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. The doctors tried vagal message and it did not help. What should we do next?
A. DC Cardioversion
B. IV Amiodarone
C. IV Propranolol
D. IV Digoxin
E. IV Adenosine

A

E. IV Adenosine

77
Q

A pregnant who is at 32 weeks of gestation. She had low platelets with
mild vow nemodiooin. Her olood pressure was normal and she does not have proteinuria. What is the diagnosis?
A. Pre-eclampsia/HELLP
B. Gestational thrombocytopenia
C. ITP
D. Hemolytic-uremic syndrome (HUS)

A

C. ITP

78
Q

What is true with regards to differentiating between cervical spondylolisthesis and amyotrophic lateral sclerosis (ALS)?

A

A. Sensory loss is not seen with ALS

79
Q

A patient was in the hospital and took NSAIDs then developed signs of AIN. What is the most sensitive method to diagnose drug induced AIN?
A. Kidney biopsy showing lymphocytes
B. Hematuria with BBC casts
C. Hyperkalemia with acidosis
D. Urine sodium less than 20

A

A. Kidney biopsy showing lymphocytes
or
C. Hyperkalemia with acidosis

(D means its ore renal failure so It is out. and B is wrong because BBC casts occurs in glomerulonephritis not AIN. C is definitely right but may not be specific to AIN, and in AIN biopsy can show eosinophils (most important) and lymphocytes so A can also be
correct

80
Q
  1. What would you listen for on auscultation to diagnose carditis in a patient with acute rheumatic fever?
    A. Pansystolic murmur at the left mid sternal border
    B. Early diastolic murmur at the left 4th intercostal space
A

B. Early diastolic murmur at the left 4th intercostal space (Aortic regurgitation occurs during acute RF)

81
Q

A 60-year-old patient is diagnosed with nephrotic syndrome. His renal biopsy showed IgG deposits in the glomerular membrane with granular cast. What is your next step in management?
A. Refer to nephrology
b. search for cancer

A

b. search for cancer

82
Q

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

A

D. An increase in the pulmonary capillary wedge pressure

83
Q

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

A

B. Pansystolic murmur at left lower sternal border

84
Q

A patient presented with asymptomatic thyroid nodule. Her TFT result
came back as normal. vhat is vour next thing to order?
A. Ultrasound
B. Radioactive iodine uptake

A

A. Ultrasound

85
Q

A vound temale is newlv diagnosed with idiopathic generalize seizure. The neurologist would like to start her on anti-epileptic medication and he found out she is overweight. Which anti-epileptic treatment help her reduce her weight?
A. Topiramate
B. phenytoin
C. carbamazepine

A

A. Topiramate

86
Q

What is the mechanism of action of phenytoin?

A

Sodium channels blocker

87
Q

A 55-year-old patient was found to have an ejection systolic murmur on the right second intercostal space. Her ECG is shown below. What do you expect to see on examination of her JVP?
A. Prominent V wave
B. X descent
C. Cannon A wave

A

C. Cannon A wave (this is a trifasicular block - LBBB+RBBB+3rd degree block)

88
Q

A 42-year-old female presented with 1 year history of myalgia of the
proxima muscies. one also complains o progressive weiant aain cola intolerance and constipation. On examination, her muscle power was normal. There was no skin rash. Her labs were normal. Which of the following tests should be done?
A. TSH
B. EMG
C. Muscle biopsy

A

A. TSH

89
Q

What would you find on examining a patient with elevated cholesterol?

A

Tendon xanthoma

90
Q

A young male presented to the neurology clinic with shaking hands. It started few years ago and is getting worse. He can’t even hold a cup of tea and is worse with anxiety. His father and grandfather had the same problem. What’s the diagnosIs?
A. Parkinson
B. Hyperthyroidism
C. Hypothyroidism
D. Essential tremor

A

D. Essential tremor

Medicine Final (18 decks)

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