2015 - 6th Flashcards
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
B. IV fluid infusion
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
B. Ejection systolic murmur at the right upper sternal border
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
B. Complex partial seizure
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. pH = 7.11
empyema gives a pH <7.2 and needs to be drained)
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
B. Synchronized DC shock
An IV drug user presented with history of fever, weight loss, and night sweats of two-month duration. Over the past 2 weeks, he has been experiencing a sharp chest pain relieved by sitting up and leaning forward. He has been becoming progressively dyspnic during the last week. On examination, he has an elevated JVP, pulsus paradoxus, and his heart sounds are barely audible. No murmurs were heard. His chest X-ray is shown below. What is the diagnosis in this patient?
A. Viral pericarditis
B. Tuberculous pericarditis
C. Malignant pericarditis
D. Pleural effusion
E. Infective endocarditis
B. Tuberculous pericarditis
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. Pulmonary embolism (S1Q3T3 pattern)
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
D. Sodium valproate
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
B. Guillain-Barré syndrome
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. Tachycardia
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. Subtotal occlusion due to a plaque rupture (unstable angina)
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
B. Optic chiasm
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
B. Low Lymphocyte
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
C. Hypothalamus
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. Pericardial friction rub
A 25-year-old previously healthy female came to the clinic for advice on OCP use. She was found to have a blood pressure of 165/95 mmHg. A renal renogram was done and is shown below. What is the most appropriate management?
A. ACEI
B. ARB
C. CCB
D. Nitrates
C. CCB
An obese female presented with frequent headaches. On examination, fundoscopy revealed papilledema and signs of CN 6 palsy. What is the likely diagnosis?
Idiopathic intracranial hypertension
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
C. Atonic seizure
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
D. Switch to DPP-4 inhibitor
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. Cryoglobulinemia
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
C. carbimazole
as it can cause agranulocytosis. Has to be stopped if the patient was taking it and developed unexplained fever or URI symptoms)
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
B. Perform coronary angiography before surgery
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
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.
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. Crohn’s colitis ACrohn’s disease can cause fistula formation between trom the intestine to urinary tract)
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
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
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- Most patients die before they reach stage 5
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
D. progressive supranuclear gaze palsy
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. Check her JVP
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. Pericardiectomy (constrictive pericarditis)
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
B. Absent deep tendon reflexes
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
B. Good pasture disease
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
B. Gentamicin
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. c. difficile
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
D- Diarrhea
Which of the following is used to lower potassium in patient with hyperkalemia?
A- NaHCO3
B- Glucose
C- Beta blockers
D- Calcium gluconate
A- NaHCO3 cacium aluconate does not ower ootassium evels. tuscorotecis the hearttom the hyperkalemia)
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
C. Add spironolactone (Conn’s disease)