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Medicine Final > 2016 - 5th > Flashcards

2016 - 5th Flashcards

1
Q

MG –> _______ on repeated nerve stimulation?

A

decrement

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2
Q

A 24-year-old female presented with symmetrical joint pain in PIP, MCP. Which of the following is used to treat her?
A. Methotrexate
B. Plaquinil

A

A. Methotrexate

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3
Q

A question about hashimoto, if biopsied what is seen?
A. Lymphocyte infiltration
B. Granuloma

A

A. Lymphocyte infiltration

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4
Q

Patient with nuchal rigidity, photophobia, normal glucose, high lymphocytes. I think proteins were also high. What is the diagnosis?
A. bacteria meningitis
B. Viral meningitis
C. TB meningitis

A

B. Viral meningitis

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5
Q

Best indicator to assess renal function of a 25-year-old pregnant lady?
A. Uric acid
B. Cystatin C
C. serum creatinine

A

A. Uric acid

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6
Q

Young man previously healthy presented with central chest pain worse when lying down better with sitting up. Raised jvp, bp 90/70. On echo, echo free space around the heart, with diastolic collapse of left atrial wall. What will be found on evaluation?
A. Pulse low in inspiration increase with expiration
B. S3 gallop with pansystolic murmur

A

A. Pulse low in inspiration increase with expiration

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7
Q

Extra-articular manifestation of rheumatoid arthritis?
A. Pleural effusion
B. Myopathy

A

A. Pleural effusion

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8
Q

Thin COPD (emphysema) causes:

A

Hypoventilation
Air trapping
Low lung compliance

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9
Q

A 60-year-old Kuwaiti man with duodenal ulcer presented with the following results:
Low Hb
Low MCV
Low MCH
High RDW
What is the cause?
A. IDA due to GI bleeding
B. IDA due to celiac disease
C. Pernicious anemia

A

A. IDA due to GI bleeding

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10
Q

CT showing infract, what is the most common risk factor?
A. HTN
B. Family history
C. Smoking
D. Cholesterol

A

A. HTN

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11
Q

A question about gingival bleeding, post infection (scenario was post-infection but only signs of primary hemostasis defect)
A. DIC
B. ITP

A

B. ITP

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12
Q

What is an intrinsic renal cause of AKI?
A. Rhabdomyolysis
B. Obstruction with renal stone
C. Hepatorenal syndrome
D. Renal artery stenosis

A

A. Rhabdomyolysis

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13
Q

A vague scenario was given, and they mentioned TB in it to confuse us but the answer basically depended on the X-ray provided. What’s the diagnosis?

A

Mitral stenosis It showed clear mitralization of the heart

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14
Q

What should you do initially with a patient who tested positive for anti- transglutaminase antibodies?
A. Refer him to a dietician
B. Refer him to upper endoscopy
C. Refer to rheumatologist

A

B. Refer him to upper endoscopy
(Celiac is confirmed w/ EGD & biopsy)

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15
Q

A 21-year-old male complains of dyspnea on exertion and occasionally, chest pain and dizziness. He has a sibling who recently passed away due to a non-investigated cardiac condition. Physical examination revealed a jerky pulse and an ejection systolic murmur. What is the likely diagnosis?
A. Aortic stenosis
B. Pulmonary stenosis
C. Hypertrophic cardiomyopathy

A

C. Hypertrophic cardiomyopathy

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16
Q

Lab tests showed: prolonged PT and everything else was normal. What’s the likely cause?
A. Factor VIl deficiency
B. Factor XII deficiency
C. Factor XIII deficiency
D. Von-willebrand factor deficiency

A

A. Factor VIl deficiency

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17
Q

What autoimmune disease is associated with what disease?
A. Addison’s - vitiligo
B. Giant cell arteritis - deafness
C. Myasthenia gravis - papillary thyroid cancer
D. Rheumatoid arthritis - cauda equina

A

A. Addison’s - vitiligo

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18
Q

Patient presenting with increased sensitivity to noises. An infratentorial mass.
A. Facial nerve
B. Trigeminal nerve
C. Vestibulocochlear nerve
D. Glossopharyngeal nerve

A

A. Facial nerve
(remember that the facial nerve innervates the stapedius muscle which functions to dampen the loud sounds by attenuating excessive vibrations from passing to the cochlea)

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19
Q

A question about HBV infection. And a Picture showing perfusion to the kidney.
A. Polyarteritis nodosa
B. Cryoglobulinemia
C. Acute polycystic kidney

A

A. Polyarteritis nodosa
(HBV associated w/ Polyarteritis nodosa [HBV-PAN] is a typical form of classic PAN whose pathogenesis has been attributed to immune complex deposition with antigens excess- Pubmed)

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20
Q

A case showed linear immunofluorescence.
A. Goodpasture syndrome
B. Microscopic polyangitis
C. Churg-Strauss syndrome

A

A. Goodpasture syndrome

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21
Q

A scenario of psoriatic arthritis with nail pitting. What’s the best treatment?

A

Methotrexate

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22
Q

A patient had severe AKI. What is true about the phases?
A. Diuretic phase (>2500) is followed by an oliguric phase (<400)
B. Oliguric phase lasts about 1-2 days
C. Urine output is improved betore renal recovery (improve in S creatinine)
D. Recoverv of renal tubules is because of fibroblasts

A

C. Urine output is improved betore renal recovery (improve in S creatinine)

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23
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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24
Q

A 29-year-old with a previous history of sore throat and joint pain in childhood presents with shortness of breath and hemoptysis. Her ECG is shown below. Which of the following is the best to prevent complications associated with her condition?
A. Warfarin
B. Heparin
C. Dabigatran
D. Rivaroxaban

A

A. Warfarin

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25
Q

A 44-year-old female with breast cancer and metastasis, presented with tingling sensation on arm and leg and urinary incontinence. Cranial nerves were intact. Where is the lesion?
A. Brain stem
B. Cerebrum
C. Cervical spine
D. Lumbar spine

A

C. Cervical spine?

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26
Q

Smoker got diagnosed with Crohn’s disease. How to prevent relapses?
A. Infliximab
B. Stop smoking
C. Stop drinking

A

B. Stop smoking

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27
Q

A 70-year-old male presented for the first time with progressive SOB of one year period. On physical examination, oxygen saturation was 92% room air. On auscultation, the breath sounds were …?.. uniformly. PFT showed FEV1/FVC less than 70. Diagnosis?
A. Asthma
B. COPD
C. Pulmonary fibrosis
D. bronchiectasis

A

We remember answering B. It was much clearer in the exam, some info is missing. Resp
questions were ver specific.

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28
Q

An adult patient presented with cough & green sputum. What is the most common organism?
A. S.pneumonie
B. S.aures

A

A. S.pneumonie

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29
Q

Question about inducing hoffman’s sign

A
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30
Q

there are 2 devices for the diagnosis of obstructive sleep apnea, polysomnography at the clinic and in-home sleep study, what is the difference:
A. Clinic polysomnography has EEG detecting arousal during sleep
B. Clinic polysomnography can detect central sleep apnea but not in- home device

A

A. Clinic polysomnography has EEG detecting arousal during sleep

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31
Q

A patient with psoriasis developed severe pain in the back of his ankle. Which of the following is a musculoskeletal manifestation of his disease?
A. Heberden nodules
B. Bouchard nodules
C. Enthesitis

A

C. Enthesitis

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32
Q

CD4 cell count in AIDS:
A <50
B. < 100
C. < 200
D <300

A

C. < 200

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33
Q

A patient suffered from acute chest pain and dyspnea after an abdominal surgery for colorectal cancer. What is the best management?
A. Anticoagulants for less than 3 months
B. Anticoagulants for a year
C. Anticoagulants until there is no evidence of cancer
D. Anticoagulants are contraindicated because of recent abdominal surgey

A

C. Anticoagulants until there is no evidence of cancer

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34
Q

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

A

C. Gentamicin

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35
Q

Which of the following indicates essential hypertension rather than secondary hypertension?
A. Proteinuria < 2
B. Sweating and palpitations
C. Hypokalemia
D. Bilateral renal cysts

A

?
A. Proteinuria < 2

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36
Q

A patient with newly diagnosed with osteoarthritis. What is the initial therapy?
A. Paracetamol
B. Prednisone

A

A. Paracetamol

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37
Q

A 63-year-old lady with fragility fracture who was later diagnosed with osteoporosis. She was put on bisphosphonate. What is the mechanism of action of bisphosphonate?
A. Increase RANKL
B. Decrease osteoclastic activity

A

B. Decrease osteoclastic activity

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38
Q

Scenario about type4 hypersensitivity reaction after wearing a ring:
A. Description of type 1 reaction
B. If you biopsy, Tells response
C. Most likely it’s hypersensitivity from cobalt

A

B. If you biopsy, Tells response

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39
Q

A patient presented with eruption of left upper eyelid 2 weeks ago. The patient mentioned applying a new nail polish for the first time in 2 months.
What is the appropriate test to diagnose this case?
A. Skin biopsy
B. Patch test
C. KOH test
D. Skin prick test

A

B. Patch test
Patch test for contact dermatitis. Skin prick for atopic dermatitis. Skin bx not helpful for differentiating between different dermatitides. KOH for fungal infection

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40
Q

A 35-year-old who is previously healthy, presented to the ER with painful swollen right knee (effusion + redness) associated with malaise and fever, no other systematic symptoms. What is the best investigation?
A. X-ray of the knee
B. ESR
C. Complete blood picture
D. Synovial fluid analysis

A

D. Synovial fluid analysis

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41
Q

A young female with 5-year history of SLE presented with hemiplegia, no active synovitis or cutaneous lesion, MRI showed high 2T lesion. What investigation will you order?
A. ANA
B. Anti-Jo
C. Anti-cardiolipin
D. CSF of anti-ribosomal p protein antibody

A

C. Anti-cardiolipin

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42
Q

Restrictive lung disease. Which of the following is not affected by extrapulmonary disease?
A. FEV1
В. FVC
C. DLCO

A

C. DLCO

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43
Q

(Asthma attack case). Which of the following is involved in the late phase of allergic reaction?
A. Eosinophils
B. Basophils
C. Mast cells

A

A. Eosinophils
(mast cells involved in early phase)

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44
Q

A 35-year-old female presented with nocturnal paresthesia of the right thumb, index and middle finger with atrophy of the thenar eminence and +ve tinel sign.
A. ALS
B. Carpal tunnel syndrome

A

B. Carpal tunnel syndrome

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45
Q

A patient underwent coronary angiography. Which of the following would you expect to find in contrast-induced nephropathy?
A. Proteinuria > 2.6
B. Hematuria
C. Eosinophiluria
D. Increased urine osmolarity

A

D. Increased urine osmolarity

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46
Q

Patient is a male smoker with dry cough, dyspnea, and 15 kg weight loss. Presented with Na 122 mEq/L. Which of these is likely to be elevated?

A

ADH

47
Q

There was a question about a lung nodule on the lung in a 45-year-old patient. What makes you think it’s benign?

A

Size of nodule was also mentioned, but it wasn’t large (<2 cm). Can’t remember the choices but make sure to review investigation of pulmonary nodule
https://radiologyassistant.nl/chest/solitary-pulmonary-nodule/benign-versus-malignant

48
Q

Patient was brought for evaluation of his frequent falls. On examination, he had shuffling gait, bradykinesia, resting tremor and rigidity. The doctor gave him a treatment which he improved after. What is the drug?
A. Levodopa
B. Beta blocker
C. Calcium channel blocker

A

A. Levodopa

49
Q

A patient with loss of proprioception and joint sensation will lose balance when?

A

He closes his eyes.

50
Q

Hypertension management in pregnancy.
A. Methyldopa
B. ACE inhibitor
C. Calcium channel blocker

A

A. Methyldopa

51
Q

A 70-year-old patient came with dizziness and an episode of fainting. On examination HR = 40 and an ejection systolic murmur was heard on the aortic area. What would you look for in the JVP?
A. Cannon A wave
B. Prominent X descent
C. Prominent V wave
D. Absent A wave

A

A. Cannon A wave

(the age, bradycardia, and the dizziness and fainting
(although these last two can be due to a severe AS) all suggest complete heart block which produces cannon A waves on the JVP due to dissociation between the atrial and ventricular contraction)

52
Q

A scenario of a patient with obstructive cardiomyopathy. What medication would you give him to relieve his symptoms?
A. Amiodarone
B. Beta-blockers

A

B. Beta-blockers

53
Q

A patient with recurrent painful oral and scrotal ulcers for five years, polyarthritis and (ulcers or inflammation) in the eye. What’s the diagnosis?
A. Behcet disease
B. Reiter’s disease

A

A. Behcet disease

54
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-strept GN
D. Membranous GN

A

B. IgA nephropathy

55
Q

A vegan came with fatigue and numbness. What is expected to be found?

A

A. Hyper-segmented neutrophils

56
Q

A patient had a stroke and developed weakness of the right side of the face and arms and right homonymous hemianopia and disturbed speech. What arterial territory is affected?
A. Posterior cerebral artery
B. Posterior inferior cerebellar artery
C. Left middle cerebral artery
D. Left anterior cerebral artery

A

C. Left middle cerebral artery

57
Q

A patient presented with fever, myalgia, and headache. He was in contact with someone with COVID-19. What is the best way to diagnose COVID-19?
A. Serology of IgM against S spike protein
B. Reverse PCR to detect mRNA by nasopharyngeal swab
C. Antigen detected by nasopharyngeal swab

A

B. Reverse PCR to detect mRNA by nasopharyngeal swab?

58
Q

Patient with occasional chest pain on exertion woke up in the middle of night feeling dyspneic, ECG showed ST depression and high troponin
A. NSTEMI
B. Unstable angina

A

A. NSTEMI

59
Q

Healthcare worker with everything negative for hepatitis viruses
Only (anti HbsAg) positive

A

Status: vaccinated healthcare worker

60
Q

A 58-old-man complaining of hematuria, he didn’t have it 3 months ago. Has increased creatinine. Has bronchial asthma and pupuric rash.
A. SLE
B. Microscopic polyangitis
C. Churg-Strauss

A

C. Churg-Strauss

61
Q

A 24-year-old patient complains of migraine headache with aura. What would be prophylaxis for her migraine?
A. Paracetamol
B. Sumatriptan
C. Propranolol
D. Narcotic

A

C. Propranolol

62
Q

Which of the following asymptomatic findings is an indication for cholecystectomy?
A. Cholelithiasis
B. Cholesterolosis
C. Calcification of the gallbladder (Porcelain gallbladder)
D. Gallbladder sludge

A

C. Calcification of the gallbladder (Porcelain gallbladder)

63
Q

Which of the following tests diagnose autoimmune hemolytic anemia?
A. Reticulocytes
B. High bilirubin
C. spherocytes
D. Direct anti-globulin test

A

D. Direct anti-globulin test

64
Q

Patient presenting with left knee pain and swelling with psoriatic lesions on the extensor surfaces of both elbows and knees. What is the likely extra-articular manifestation?
A. Peripheral neuropathy
B. Raynaud’s phenomenon
C. Nail pitting

A

C. Nail pitting

65
Q

What antibodies are found in primary biliary cirrhosis?
A. AntI-nuclear antibodies
B. Anti-mitochondrial antibodies

A

B. Anti-mitochondrial antibodies

66
Q

A 65-year-old patient presents with recent history of obstructive jaundice. On physical examination, a palpable non-tender gallbladder was present. What is the most likely diagnosis?
A. Pancreatic head cancer
B. Cholecystitis
C. Biliary colic
D. Lower esophageal tumor

A

A. Pancreatic head cancer

67
Q

Upper lobe fibrosis?
A. Sarcoidosis
B. Asbestosis
C. IPF
D. TB

A

A. Sarcoidosis

68
Q

A 25-year-old asymptomatic female PFT results were provided (reveal obstructive pattern with no reversibility), how would you further investigate?
A. Methacholine challenge test
B. HRCT

A

?

69
Q

Rheumatic fever case with joint involvement. Cardiac examination was normal but there were other symptoms. Penicillin was administered. What else will you give?
A. Aspirin
B. Prednisone
C. Colchicine

A

A. Aspirin

(when the joints are involved in rheumatic fever, aspirin
is given with the penicillin, but when the heart is involved, prednisolone is the choice, with penicillin)

70
Q

A 17 year old female with pricking chest pain and palpitations for one year. She’s thin and nervous with 110/70 BP, no raised JVP, she had mid-systolic click and late systolic murmur. What is the most likely diagnosis?
A. Innocent systolic murmur
B. Hyperthyroidism
C. Mitral valve prolapse

A

C. Mitral valve prolapse

71
Q

A patient with muscle wasting, fasciculations and hoffman’s sign. What is the diagnosis?
A. Multiple sclerosis
B. Diabetic neuropathy
C. Motor neuron disease

A

C. Motor neuron disease

72
Q

A 68-year-old man with CKD on hemodialysis, when compared to a man in his age without CKD, what will he have?
A. Higher serum Ca
B. Higher coronary calcification
C. High Hb
D. High survival time

A

B. Higher coronary calcification

73
Q

70-year-old with severe anemia, biopsy showed tear drop cells and left shift in granulocytosis. What is the mutation?
A. BCR-Abl
B. JAK2
C. Chromosome 1q

A

B. JAK2

74
Q

A patient with sickle cell disease presenting with massive splenomegaly and abdominal distention. What is the cause?
A. Splenic sequestration
B. Transformation to AML

A

A. Splenic sequestration

75
Q

A patient with SLE stopped her glucocorticoid abruptly, saying she is feeling fine, 1 week later she came feeling terrible. What will her serum analysis show?
A. elevated ACTTH
B. hypoglycemia
C. hypernatremia
D. hypokalemia

A

A. elevated ACTTH
or
B. hypoglycemia

76
Q

What differentiates primary polycythemia from secondary polycythemia?
A. High erythropoietin
b. splenomegaly
c. low ferritin

A

A. High erythropoietin

(in secondary polycythemia, erythropoietin production increases in response to certain stresses, such as reduced oxygenation, thus leading to increased RBC production; however, primary polycythemia (polycythemia vera) is caused by autonomous, uncontrolled increase in RBC production due to genetic mutation [JAK2])

77
Q

A patient presented with history of jaundice and right upper quadrant pain. Which of the following would be the most cost effective to diagnose viral hepatitis in this patient?

A

Only one of the choices had IgM (the right answer) and all the others included only IgG.

78
Q

What is not associated with optic neuritis?
A. Relative afferent pupillary defect
B. Homonymous hemianopia
C. Decreased visual acuity
D. Loss of red colored vision

A

B. Homonymous hemianopia

79
Q

A 22-year-old female was diagnosed with rheumatoid arthritis. What test is used to monitor the activity of the disease?
A. Rheumatoid factor
B. Sedimentation rate
C. Anti-CCP
D. C4 level

A

B. Sedimentation rate

80
Q

A young girl, presented with flu like illness 1 week ago, myalgia, polyarthralgia. Presents to you to the clinic with S3, dilated JVP & other heart changes. What is the diagnostic test?
A. Echo
B. ASO titers

A

B. ASO titers

81
Q

A 28-year-old lady is unable to conceive for the past 8 months. She had amenorrhea for the past 6 months. Physical examination reveals no abnormalities. LH, FSH, and estradiol are all low. What could be the reason for this?
A. Hypothalamus
B. Hypergonadotrphic hypogonadism
C. Adrenal

A

A. Hypothalamus
since all are low. then it is a problem in the whole
hypothalamic-pituitary-ovarian axis, and this is a common cause especially for females who are “stressed” about being unable to conceive

82
Q

A healthcare workers blood work up showed the following:
* HBsAg (Negative)
* Anti-HBsAg (Positive)
* HBeAg (Negative)
* Anti-HBeAg(Negative)
* Anti-HBcAg (Negative)
What is his status:
A. Acute HBV
B. Chronic HBV high infectivity
C. Chronic HBV low infectivity
D. Recovery
E. Immunized

A

E. Immunized

83
Q

A patient with progressive right-side hearing loss. Upon Weber test he heard louder on the left side. What is his condition?
A. Left conductive deatness
B. Right sensorineural defenses
C. Right conductive deafness
D. Left sensorineural deafness

A

B. Right sensorineural defenses

84
Q

A patient with symmetrical joint narrowing and suspected rheumatoid arthritis. How to detect rheumatoid factor?
A. Nephelometry
B. Flow cytometry
C. ELISA
D. Immunofluorescence

A

A. Nephelometry

85
Q

A 40-year-old man with primary hyperaldosteronism. Which is expected to be found?

A

D (pay attention that it is primary)

86
Q

A 46-year-old man with alcoholic cirrhosis comes to the ER because of hematemesis. He had been doing well until this bleeding episode occurred. On PE, he is alert and oriented. There is no ascites. The patient received IV Octreotide. Vital signs and blood workup were provided. What is the next step?
A. Transjugular intrahepatic portosystemic shunt
B. IV antibiotics
C. Insertion of Sengstaken-Blackmore tube to tamponade the bleeding site

A

B. IV antibiotics
(Antibiotics are given in case of (suspected) variceal bleeding to prevent spontaneous bacterial peritonitis)

87
Q

A mother of 5 children had RUQ pain that was constant for 2 hours with nausea. The next day, she was jaundiced and had dark urine. Her labs showed high ALP, high ALT (but not very much high), high serum bilirubin. What would be the cause?
A. Gilbert disease
B. Cancer at ampulla of vater
C. Biliary colic
D. Drug induced jaundice due to oral contraceptives

A

C. Biliary colic

(Based on the whole scenario, we would come up with the following conclusion: the patient had gallstones that produced the RUQ pain. Then one of the stones passed through the cystic duct to the common bile duct and caused the presentation of obstructive jaundice in the next day)

88
Q

A type 1 diabetes mellitus patient had hyperglycemia of 26 with Na = 130.
What is the cause of the hyponatremia?
A. High blood osmolarity
b. Low aldosterone

A

A. High blood osmolarity

89
Q

30-year-old woman who hasn’t menstruated for 7 months, low FSH low LH low Estradiol. Which of the following is most likely?
A. Primary ovarian failure
B. Pregnancy
C. Sheehan
D. Hypogonadism

A

Answer: Most likely sheehan as this is pituitary pathology. Question may be incomplete as sheehan has a specific presentation.

90
Q

A child took penicillin for 3 days for his illness. He came with a creatinine of 200 and no microscopic hematuria, no edema. What would you do?
A. Give normal saline
B. Nothing, it is just post-strept glomerulonephritis
C. Give steroid

A

C. Give steroid

91
Q

A patient with sickle cell disease who has a history of multiple vaso-occlusive crisis presented with pneumococcal pneumonia. What is the reason for the increased susceptibility to infections?

A. All patients with SCD have hypogammaglobulinemia
B. Hydroxyurea, which is used to treat SCD
C. Shrunken spleen

A

C. Shrunken spleen

92
Q

At the level of C6
Ipsilateral loss of upper limb vibration?
Contralateral loss of upper limb temp?

A
93
Q

A 34-year-old diabetic on metformin with muscle cramps. He had low K, normal Na and low HCO3. What is the cause?
A. Metformin
B. Lactic acidosis
C. Hyporeninic hypoaldosteronism
D. Osmotic diuresis

A

D. Osmotic diuresis

94
Q

A 33-year-old woman experienced acute right orbital pain after tennis match, on examination she had mild right ptosis and anisocoria, the right pupil is 2 mm smaller than the left, but both react normally to direct light stimulation, visual acuity and visual field and movement are all normal. What is the diagnosis?
A. Horner syndrome
B. Myasthenia gravis
C. Abducent nerve palsy
D. Internuclear ophthalmoplegia

A

A. Horner syndrome?

95
Q

A nodule in the periphery of the lung 5mm, how would you investigate it?
A. Lung radiograph
B. Aspiration
C. Cancer markers
D. Sputum cytology

A

B. Aspiration
(if the nodule was central, then sputum cytology is the investigation you perform. But for a nodule in the periphery, FNA/radiology-guided biopsy is performed)

96
Q

Reduced lung expansion bilaterally, FEV1/FVC ratio <70%. What’s the diagnosis?
A. Asthma
B. COPD
C. Bronchiectasis
D. Pulmonary fibrosis

A

more information is missing from the question

97
Q

All the following precipitate hepatic encephalopathy, except:
A. Gl bleeding
B. Constipation
C. Low protein diet
D. Infection?

A

C. Low protein diet

98
Q

What is the most common symptom of crohn’s disease?
A. Bloody diarrhea
B. Perianal disease (ex: skin tags)
C. Abdominal pain
D. Mouth ulcers

A

C. Abdominal pain

99
Q

A 35-year-old smoker presented with worsening dyspnea. Chest X-ray is significant for heterogenous translucency of both upper and lower lobes and flattened diaphragm. Which test is helpful?
A. Leptin levels
B. Alpha 1 antitrypsin level
C. Ghrelin level
D. Protease level

A

B. Alpha 1 antitrypsin level

100
Q

Patient underwent cardiac surgery when he was one years old, the surgeon found a small organ and resected it. Which of the following risks is increased?
A. Recurrent infections
B. Recurrent infections + Autoimmune diseases
C. Recurrent infections + Autoimmune diseases + Malignancy
D. Recurrent infections + Autoimmune diseases + Malignancy + Complement
deficiency

A

B. Recurrent infections + Autoimmune diseases (not sure)

DiGeorge syndrome w/thymic aplasia –> T-cell deficiency –> Recurrent infections & autoimmunity.

Not sure about malignanacy. Complement synthesis not affected.

101
Q

A 27-year-old male had severe inflammatory papuleplusters? and nodules on his face with scales and hyperpigmentation for 8 years. What is the best management?
A. Isotretinoin
B. Methotrexate

A

A. Isotretinoin

102
Q

Recurrent aspiration pneumonia with halitosis and valsalva maneuvers made it better.
A. Zenker’s diverticulum
B. Achalasia
C. Tracheosophageal fistula

A

A. Zenker’s diverticulum

103
Q

A case of ulcerative colitis. What is the most appropriate management to induce remission?
A. Oral 5-aminosalicylates
B. Oral prednisolone
C. IV corticosteroids
D. Recta corticosteroids

A

A. Oral 5-aminosalicylates

104
Q

Primary immunization against Hepatitis B. What levels need to be checked 4 months later to ensure adequate response?
A. Anti-HBs
B. Anti-HBc
C. HBeAg
D. HBsAg

A

A. Anti-HBs

105
Q

SARS-CoV-2 is an mRNA corona virus surrounded by a membrane and an envelope with several surface proteins. What is the most pathogenic protein that allows it to invade and enter human cells?
A. “N” Nucleocapsid protein
B. “M” Nucleocapsid protein
C. “E” Nucleocapsid protein
D. “S” Nucleocapsid protein

A

D. “S” Nucleocapsid protein

106
Q

A 45-year-old woman was diagnosed with hypertension based on multiple readings, she is a known case of DM type 2 and is taking metformin. She developed the sign shown below, what is the cause?
A. ACE inhibitors
B. Metformin
C. Ca channel blocker
D. Heart failure

A

C. Ca channel blocker

107
Q

ECG showing irregular R-R intervals (can’t remember how the ECG looked like)
A. Atrial fibrillation
B. Atrial flutter
C. Paroxysmal SVT

A

A. Atrial fibrillation

108
Q

A 21-year-old female was diagnosed with rheumatoid arthritis 6 months ago, she follows up in a rheumatology clinic. What is used to follow up the patient?
A. Rheumatoid factor
B. Anti-citrullinated peptide antibody
C. Complement 3 level
D. ESR

A

D. ESR
UpToDate: The main clinically useful biologic markers in patients with rheumatoid arthritis (RA) that aid
in assessing disease activity and predicting functional and radiographic outcomes include acute phase reactants, particularly the erythrocyte sedimentation rate (ESR) and C-reactive protein)

109
Q

A female with pallor, jaundice and enlarged facial bone had fetal hemoglobin 86%. What is the diagnosis?
A. Sickle cell disease
B. B-thalassemia major

A

B. B-thalassemia major

110
Q

50-year-old patient undergoing dialysis because of CKD. You want to give her erythropoietin, what is the targeted hemoglobin level?
A. 10-11
B. 11-12
C. 12-13
D. 13-14

A

B. 11-12

111
Q

A 65-year-old female presented to her general practitioner with polyarticular joint pain, swelling and fever. She is being treated for hypertension with hydralazine. Her lab tests showed the following:
Positive ANA and antihistone
Negative dsDNS
Normal C3/CA
How will you proceed?
A. Treat with Azothioprine
B. Stop Hydralazine
C. Treat with Prednisolone
D. Treat Hydroxychloroquine

A

B. Stop Hydralazine

112
Q

Patient with enlarged liver, duputyren contracture and enlarged parotid glands. What is the most probable cause of this presentation?
A. Alcoholic liver disease
B. Hepatocellular carcinoma
C. Autoimmune hepatitis
D. Viral hepatitis

A

A. Alcoholic liver disease

113
Q

Patient presented with DKA and was managed accordingly. Her glucose levels have normalized. How will you proceed?
A. Stop IV insulin and give subcutaneous basal insulin at the same time
B. Stop IV insulin and give subcutaneous basal insulin at the same
C. Do not give any insulin. Glucose levels are normalized.
D. Give subcutaneous insulin 2 hours before stopping IV insulin

A

D. Give subcutaneous insulin 2 hours before stopping IV insulin
(because SC insulin doesn’t peak until 2hrs after administration)

114
Q

A 41-year-old man has a history of mitral stenosis scheduled for valve replacement. He went to his dentist for a tooth extraction. The dentist refers the patient to a cardiologist for evaluation with regards to his valvular disease and determining his candidacy for infective endocarditis prophylaxis. He is allergic to penicillin. What should be done in terms of prophylaxis?
A. Nothing should be done
B. Prescribes him erythromycin

A

A. Nothing should be done

Medicine Final (18 decks)

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