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Entrance > Day 12 > Flashcards

Day 12 Flashcards

1
Q

Q1-After the B-hCG titer become undetectable, the patient treated for hydatidiform mole should be followed with monthly titers for a period of:

A-3 months
B-6 months
C-1 year
D-2 years

A

Ans: C

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2
Q

Q2-Elderly patient with glossitis, diarrhea, weight loss, anorexia and macrocytic anemia.what is likely diagnosis?

A-Iron deficiency anemia
B-Pernicious anemia
C-Colon cancer
D-Thalassemia

A

Ans: B. Impaired DNA synthesis secondary to vitamin B12 (cobalamin) or folate deficiency leads to megaloblastic anemia. Vitamin B12 deficiency is caused by intestinal malabsorption, traditionally from pernicious anemia (autoimmune destruction of parietal cells, which produce the intrinsic factor needed for cobalamin absorption), gastrectomy, pancreatic insufficiency, Crohn disease, celiac disease, topical sprue, tapeworms, or low dietary intake (eg, vegetarian or vegan diet).
Correct the underlying cause of the anemia. If B12 deficiency is caused by malabsorption, replenish stores with IM hydroxycobalamin. If the cause is dietary, give oral B12. Folate replacement corrects the hematologic problems of B12, but not the neurologic problems.

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3
Q

Q3-Surveillance of patient on hormone replacement therapy includes all of the following except:

A-Blood pressure
B-Breast examination
C-Glucose tolerance test
D-Pelvic examination
E-Endometrial sampling in the presence of abnormal bleeding
A

Ans: C

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4
Q

Q4-All of the following anti retroviral drugs produce dyslipidemia except?

A-Saquinavir
B-Amprinavir
C-Nelfinavir
D-Atazanavir

A

Ans: D. it has a neutral action on lipid profile so is suitable for those in whom hyperlipidemia is a problem.

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5
Q

Q5-Cardiotoxicity induced by doxorubicin can be reduced by?

A-Amifostine
B-Bisphosphonates
C-Leucovorin
D-Dexrazoxane

A

Ans: D

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6
Q

Q6-Pneumothorax is a complication of which of the following blocks?

A-High spinal
B-Brachial
C-Epidural
D-Axillary

A

Ans: B. Brachial- Due to piercing of Sibson’s fascia

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7
Q

Q7-Individuals who have had an anaphylactic reaction to egg proteins should NOT receive which one of the following vaccines?

A-Hepatitis A vaccine 
B-Hepatitis B vaccine 
C-Influenza vaccine 
D-Polio vaccine 
E-Rabies vaccine
A

Ans: C

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8
Q

Q8-4 years old in his normal state of health presented with decrease visual acuity bilaterally without any defect in visual field his visual Aquity Right eye= 20/100, Left eye=20/160. Fundoscopic examination showed early signs ofcataract and drusen with irregular pigmentations. No macular edema or neovasculirization. The appropriate action beside antioxidants and Zinc is:

A-Refer the patient for emergency laser therapy
B-Refer the patient for cataract surgery
C-See the patient next month
D-No need to do anything

A

Ans: B

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9
Q

Q9-Patient has complete ptosis in his right eye. Pupil is out and down, fixed dilated.Restrictedocular movements. What is most likely diagnosis?

A-3rd cranial nerve palsy
B-4th cranial nerve palsy
C-3rd and 4th
D-6th cranial nerve palsy

A

Ans: A

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10
Q

Q10-Ophthalmoplegic migraine is best characterised as?

A-Recurrent headache with transient palsy of ophthalmic nerve
B-Headache associated with irreversible palsy of 3rd nerve
C-Recurrent headache with transient palsy of 3, 4 and / or 6th cranial nerves
D-Headache with optic neuritis

A

Ans: C. Recurrent headache with transient palsy of 3, 4 and / or 6th cranial nerves

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11
Q

Q11-Bitemporal hemianopia is a characteristic feature of?

A-Glaucoma
B-Optic neuritis
C-Pituitary tumour
D-Retinitis pigmentosa

A

Ans: C

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12
Q

Q12-A 43-year-old man, smoker since age of 13, he was admitted to theemergency room with pain and injury to his right big toe. On physical examination, there is decrease in temperature in right leg, toes and have cyanosis. Absence of popliteal pulse, tibialis posterior and anterior in both sides. What’s the most likely etiology?

A-Idiopathic Arteritis
B-Thromboangiitis obliterans
C-Takayasu's arteritis
D-Atherosclerosis
E-Arterial embolism
A

Ans: B

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13
Q

Q13-Which one of the following types of oral steroid has the least amount of mineralocorticoid activity?

A-Dexamethasone
B-Hydrocortisone 
C-Fludrocortisone
D-Prednisolone 
E-Cortisone
A

Ans: A. Dexamethasonealso has minimalmineralocorticoid activity, but it is much more potent and has a longer duration ofactionthan prednisone and prednisolone

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14
Q

Q14-A 40-year-old man presents with visible haematuria. He denies any other symptoms such as fever or pain, and suffers from no other medical problems. He does not smoke or drink alcohol and denies any illicit substance abuse. The most appropriate management is?

A-Repeat urine dipstick
B-Cystoscopy
C-Record blood pressure
D-Record albumin: creatinine ratio
E-Urine microscopy, culture and sensitivity
A

Ans: E The protocol for visible and non-visible haematuria starts with identifying
transient causes such as a urinary tract infection, hence urinarymicroscopy, culture and sensitivity is the most appropriate management(E). Once this has been excluded in non-visible haematuria, a repeaturine dipstick (A) should be performed. If this is still positive, then bloodpressure (C) and albumin: creatinine ratio (D) should be recorded. Thealbumin: creatinine ratio is helpful in quantifying the degree ofproteinuria, especially in diabetic patients. If these factors are abnormalthe patient is then considered for more invasive nephrology or urological
assessments such as cystoscopy (B). In visible haematuria, once causessuch as a urinary tract infection have been excluded, patients are sentimmediately for a urological assessment such as imaging and cystoscopy.

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15
Q

Q15-DMARD (Disease Modifying Anti Rheumatic drugs) is used in RheumatoidArthritis, which one of the following is drug of choice when Methotrexate not works or toxicity occurs?

A-Tumor necrosis factor inhibitors (TNF-Inhibitors)
B-Rituximab
C-Hydroxychloroquin
D-Sulphasalazine

A

Ans: A. Methotrexate is drug of choice as DMARD as first line in moderate to severe and erosive disease, when MTX is intolerant or not responding then INF-inhibitors is drug of choice
Rituximab is used when MTX and TNF-Inhibitors doesn’t works
Hydroxychloroquin-is in milder cases usually with MTx used
Sulphasalazine is used when INF-Inhibitors does not works
NSAIDS and steroid for acute pain-first NSAIDs if no response then steroid-neither NSAIDS Nor steroid helps to prevent disease progression-both are for acute pain management and bridging therapy while DMARD starts acting because they requires long time to prevent disease.

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16
Q

Q16- Regarding Boutonniere deformity which one is true?

A-Flexion of PIP &hyperextension of DIP
B-Flexion of PIP & flexion of DIP
C-Extension of PIP & flexion of DIP
D-Extension of PIP & extension of DIP

A

Ans: A

17
Q

Q17-Which of the following favour diagnosis of SLE

A-Joint deformity
B-Lung cavitation 
C-Severe raynaud phenomenon
D-Cystoid body in retina
E-Anti RNP
A

Ans: E

18
Q

Q18-50-yearmale diagnosed to have lower limb deep vein thrombosis (DVT), you are going to start anticoagulation therapy for this patient.his liver function, kidney function and CBC is within normal limit. What would be the appropriate regimen from below to start with?

A-LMWH (clexane) subcutaneously 1mg/kg twice a day with warfein 5mg per day
B-LMWH (clexane) subcutaneously 2mg/kg twice a day with warfein 5mg per day
C-LMWH (clexane) subcutaneously 1mg/kg once a day with warfein 5mg per day
D-LMWH (clexane) subcutaneously 2mg/kg once a day alone

A

Ans: A

19
Q

Q19- A 74-year woman is referred to osteoporosis clinic for advice on management of osteoporosis. She has a history of hiatus hernia, hypertension, hypercholesterolemia, chronic kidney disease stage 4 and COPD. She has recently been found to have osteoporosis after a Colles’ fracture. She is taking calcitriol and other medication for her comorbidities.
Based on the information above, which would be the most appropriate agent for treatment of her osteoporosis?

A-Alendronate
B-Calcium and vitamin D supplements
C-Denosumab
D-Intravenous zoledronate
E-Strontium ranelate
A

Ans: C. Denosumab.Calcium and vitamin D supplements should not be given to someone with CKD stage 4, due to risk of hypercalcaemia. She is already on calcitriol. Of the other options, only denosumab is licensed for use in patients with eGFR<30ml/min.

20
Q

Q20- Known risk factors for suicide include all the following except?

A-Repeated attempts at self injury
B-Male sex
C-Symptoms of depression with guilt
D-Drug and alcohol dependence
E-If the doctor asked the patient about suicide
A

Ans: E

21
Q

Q21-A 29- year waiter consulted you regarding what he describes as “an Intense fear” before he begins his nightly performance. He tells you that it is only a matter of time before he “makes a real major mistake”.What is the most likely diagnosis in this patient?

A-A Specific Phobia
B-A social phobia
C-A mixed phobia
D-Panic disorder without agoraphobia
E-Panic disorder with agoraphobia
A

Ans: B. The defining feature ofsocial anxietydisorder, also calledsocial phobia, is intenseanxietyor fear of being judged, negatively evaluated, or rejected in asocialor performance situation.

22
Q

Q22- A 44-year man presents with a 3-day history of haemoptysis. He has suffered from a chronic cough in the last three months, but has only recently noticed blood in the sputum. He denies any medical problems and does not drink or smoke. A urine dipstick is positive for haematuria and proteinuria and inspiratory crackles are ausculated over both lung bases. Blood results confirm the presence of antiglomerular basement membrane antibodies and blood pressure is 125/86 mmHg.The most likely diagnosis is?

A-Goodpasture’s syndrome
B-Wegener’s granulomatosis
C-Post-streptococcal glomerulonephritis
D-Multiple Myeloma

A

Ans: A the presentation of haematuria and haemoptysis raises the clinical suspicion
of Goodpasture’s syndrome (A) for which anti-glomerular basement membrane antibodies are pathognomonic. The antibodies, usually IgG,attack both the alveolar and basement membranes. Primary biliary cirrhosisis usually associated with anti-mitochondrial antibodies (C). Wegener’sgranulomatosis (B) is most commonly associated with anti-neutrophilic cytoplasmic antibodies. Pernicious anaemia (D) clinically presents with features of anaemia, such as pallor, malaise and shortness of breath, and is most commonly associated with anti-parietal antibodies. Post-streptococcal glomerulonephritis (E) is usually associated with haematuria and hypertension following a streptococcal infection, which leads to an acute nephritis due to antibody cross-reactivity. There is no associated alveolar damage.

23
Q

Q23- A 56-year man has been hospitalized for a myocardial infarction.
Two days after admission, he awakens in the middle of the night and
Screams that there is a man standing by the window in his room. When the nurse enters the room and turns on a light, the patient is relieved to learn that the “man” was actually a drape by the window. This misperception of reality is best described by which of the following psychiatric terms?

A-Delusion
B-Hallucination
C-Illusion
D-Projection
E-Dementia
A

Ans: C. Illusion- misperception of real external stimulus

  • Delusion is fixed and false belief can not be corrected by logic
  • Hallucination-False sensory perception experienced without real external stimulus
24
Q

Q24-Which is the best test to differentiate between lung cancer and pulmonary tuberculosis?

A-History of weight loss, fever and lymphadenopathy
B-Sputum examination
C-CT scan chest
D-Biopsy from suspected lesion

A

Ans: D

25
Q

Q25-What is the single most accurate test for myeloma?

A-Skull x-rays
B-Bone marrow biopsy
C-24-hour urine
D-SPEP(Serum Protein Electrophoresis)
E-Urine immunoelectrophoresis (Bence-Jones protein)
F-History, examination, CBC, highESR, M band

A

Ans: B. Nothing besides myeloma is associated with greaterthan 10% plasma cells on bone marrow biopsy. The most commonwrong answer is SPEP. Of those with an “M-spike” ofimmunoglobulins, 99% do nothave myeloma. Most IgG spikes arefrom monoclonal gammopathy of unknown significance that does notprogress or need treatment. Skull x-rays show lytic lesions, but this isnot as specific as massive plasma cell levels in the marrow.

Entrance (27 decks)

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