[SEM2] Practice Questions Flashcards
- A 37-year-old male sought consult due to insomnia. When questioned about the nature of the insomnia, he mentioned urinating 3 times at night, which affects his ability to fall back asleep. Vital signs are normal, with a BP of 110/70. What is the most appropriate test to request?
A. 24-hour ambulatory BP monitoring
B. 12-lead ECG
C. Blood chemistry
D. All of the above
C. Blood chemistry
🧠 High-Yield Rationale:
Nocturia (frequent urination at night) may point to underlying metabolic or renal issues like diabetes mellitus or early renal dysfunction. Blood chemistry (especially checking for glucose, BUN, creatinine, electrolytes) is the most direct and cost-effective way to investigate this.
❌ Why not the others:
🅰️ 24-hour ambulatory BP monitoring – Useful if you suspect nocturnal hypertension, but this patient has normal BP, so not indicated first.
🅱️ 12-lead ECG – No cardiac symptoms (e.g., chest pain, palpitations) were reported.
🅳 All of the above – Too broad and unnecessary. Start with the most relevant and specific: blood chemistry.
- A patient was referred to your clinic for further management. The following lab results were found: FBS = 116 mg/dL, lipid profile is normal, and glycosylated hemoglobin is 6.2%. What will be your next recommendation?
A. Request BUN, creatinine, and BUA
B. 75-gram OGTT
C. Start insulin regimen
D. Advise patient to monitor blood sugar at home, record, and follow-up in 2 weeks
B. 75-gram OGTT
🧠 High-Yield Rationale:
FBS between 100-125 mg/dL and HbA1c of 5.7-6.4% indicates prediabetes. To confirm diagnosis, a 75-gram OGTT is the gold standard. If 2-hr post-load glucose ≥200 mg/dL, diabetes is confirmed.
❌ Why not the others:
🅰️ BUN, creatinine, and BUA – Not the priority at this stage; evaluate glucose metabolism first.
🅲 Start insulin regimen – Not needed unless confirmed diabetes with symptoms or very high glucose.
🅳 Home monitoring + FU – May delay diagnosis; you need definitive testing (OGTT) to confirm if it’s diabetes or prediabetes.
- A 29-year-old female sought consultation due to palpitations. ECG showed atrial fibrillation. Physical examination revealed a body mass index of 18, an anterior nodular neck mass that moves with deglutition, clear breath sounds, and an irregularly irregular cardiac rhythm with no murmurs. What are the expected lab results?
A. Elevated TSH, normal FT, normal FT4
B. Low TSH, elevated FT, elevated FT4
C. Elevated TSH, elevated FT, elevated FT4
D. Low TSH, normal FT3, normal FT4
B. Low TSH, elevated FT3, elevated FT4
🧠 High-Yield Rationale:
This is classic hyperthyroidism (likely Graves or toxic nodule): weight loss (BMI 18), thyroid mass, atrial fibrillation, and palpitations. In hyperthyroidism, TSH is suppressed due to negative feedback, and free T3/T4 are elevated.
❌ Why not the others:
🅰️ Elevated TSH, normal FT3/FT4 – Suggests subclinical hypothyroidism, not fitting the clinical picture.
🅲 Elevated TSH, elevated FT3/FT4 – Suggests secondary hyperthyroidism (pituitary cause), which is very rare and doesn’t fit.
🅳 Low TSH, normal FT3/FT4 – Seen in subclinical hyperthyroidism, but this patient has symptoms and signs of overt disease.
- A 68-year-old diabetic sought consultation for a second opinion. The patient was on insulin 70/30, 45 units in the morning and 45 units in the evening. Serial blood glucose monitoring showed morning glucose levels of 80, 74, 79, 60 mg/dL with accompanying body weakness, and evening glucose levels of 120, 118, 130, 115 mg/dL. Which dose of insulin should be adjusted?
A. Morning insulin dose
B. Evening insulin dose
C. Both morning and evening insulin doses
D. No need to change the insulin dose, just adjust the diet
B. Evening insulin dose
🧠 High-Yield Rationale:
This patient is experiencing morning hypoglycemia (lowest: 60 mg/dL) with accompanying weakness — a red flag, especially in the elderly. Since she is using 70/30 insulin (70% NPH + 30% regular), timing matters:
💉 Evening dose of 70/30 insulin peaks overnight to early morning due to the intermediate-acting NPH.
🛌 This overnight peak is what’s causing early morning hypoglycemia.
🩺 Therefore, reduce the evening dose to prevent nocturnal hypoglycemia.
❌ Why not the others:
🅰️ Morning insulin dose
🔸 Affects post-lunch to dinner glucose → and evening glucose levels are within target (115–130 mg/dL).
🔸 Reducing this would lead to evening hyperglycemia.
🅲 Both doses
🔸 Over-correction: only the evening dose is causing hypoglycemia.
🔸 Morning readings are too low, evening readings are just right — no need to touch both.
🅳 No need to change dose, just adjust diet
🔸 Wrong in symptomatic hypoglycemia — especially in older adults, this is dangerous.
🔸 Insulin dose should be adjusted, not just dietary patterns.
- A 28-year-old male seafarer requested a medical certificate for work clearance. His 24-hour ambulatory BP monitoring showed a “physiologic BP response.” On his pre-employment physical examination, BP was 140/90. On your examination, BP was 150/80. What does the patient have?
A. Masked hypertension
B. Hypertension stage 1
C. Hypertension stage 2
D. White coat hypertension
D. White coat hypertension
🧠 High-Yield Rationale:
This is classic white coat hypertension:
🩺 Elevated BP in clinical settings (140/90, 150/80)
📉 Normal BP on ambulatory monitoring (ABPM: “physiologic response” = normal diurnal variation)
💡 No persistent hypertension at home or outside medical settings
❌ Why not the others:
🅰️ Masked HTN – Normal in clinic but high at home (opposite scenario)
🅱️ Stage 1 HTN – Requires persistent elevation (ABPM is normal here)
🅲 Stage 2 HTN – Systolic ≥160 or diastolic ≥100 consistently
- A 35-year-old female bank teller sought consultation with a 24-hour ambulatory BP monitoring result showing a “hypertensive BP response.” Serial BP monitoring at home showed readings of 110/70, 100/60, 90/60, 110/80, and the patient claims to be asymptomatic. What does the patient have?
A. Masked hypertension
B. Hypertension stage 1
C. Hypertension stage 2
D. White coat hypertension
A. Masked hypertension
🧠 High-Yield Rationale:
This is masked hypertension—when BP is normal at home or in casual settings, but elevated in formal/controlled settings like ABPM. It’s the opposite of white coat hypertension and carries a higher cardiovascular risk since it often goes untreated.
❌ Why not the others:
🅱️ Stage 1 HTN – Needs elevated clinic and out-of-office BPs
🅲 Stage 2 HTN – Requires higher consistent readings
🅳 White coat HTN – Would show normal ABPM but elevated clinic BP
- A 24-year-old 3rd-year medical student underwent screening with a Mantoux skin test after his 6-month rotation at Perpetual Help Medical Center. What is the cut-off diameter for a positive PPD skin test in his case?
A. ≥5mm
B. ≥10mm
C. ≥15mm
D. All of the above
B. ≥10mm
🧠 High-Yield Rationale:
A ≥10mm induration is considered positive in individuals with occupational exposure risk like healthcare workers (e.g., medical students). This reflects moderate-risk exposure (not immunocompromised, but not low-risk either).
📌 Tuberculin Skin Test Interpretation Cut-offs:
✅ ≥5mm: HIV+, recent TB contact, organ transplant, immunosuppressed
✅ ≥10mm: HCWs, recent converters, residents of high-risk areas
✅ ≥15mm: No risk factors
❌ Why not the others:
🅰️ ≥5mm – Too low for this exposure group
🅲 ≥15mm – For people with no risk factors
🅳 All of the above – Incorrect; cut-off depends on risk category
- A couple sought consultation with cough and body malaise for 3 days after arriving from a week-long conference held in an old hotel. They self-medicated with salbutamol, carbocisteine, and high doses of vitamin C, affording temporary relief. What could be the possible etiologic agent?
A. Streptococcus pneumoniae
B. Haemophilus influenzae
C. Legionella pneumophila
D. Gram-negative anaerobes
C. Legionella pneumophila
🧠 High-Yield Rationale:
Legionella thrives in stagnant water systems, air conditioners, and old hotel plumbing. Presentation includes:
🟢Dry cough
🟢GI symptoms
🟢Hyponatremia (if labs done)
🟢Environmental exposure history
This is a classic scenario of Legionnaire’s disease (a type of atypical pneumonia).
❌ Why not the others:
🅰️ Streptococcus pneumoniae – Common CAP but no specific environmental link
🅱️ H. influenzae – More likely in COPD patients or post-viral infection
🅳 Gram-negative anaerobes – Usually linked with aspiration pneumonia
- A 25-year-old male Caucasian had intermittent fever, chills, calf tenderness, and conjunctival suffusion after white-water rafting while on vacation. At the ER, he was found to have yellowish discoloration of the sclerae, palms, and frenulum with decreasing urine output. What is the best antibiotic for this patient?
A. Penicillin G
B. Streptomycin
C. Azithromycin
D. Bleomycin
A. Penicillin G
🧠 High-Yield Rationale:
The clinical picture is textbook Weil’s disease, which is a life-threatening manifestation of leptospirosis characterized by:
🌡️ Intermittent fever, chills
🦵 Calf tenderness
👀 Conjunctival suffusion (red eyes without exudates – classic)
🟡 Jaundice (sclera, palms, frenulum)
🧴 Oliguria or anuria (renal involvement)
📌 Treatment of choice for moderate to severe leptospirosis = IV Penicillin G
❌ Why not the others:
🅱️ Streptomycin – Effective but used only as an alternative (especially for mild to moderate disease or when penicillin is contraindicated)
🅲 Azithromycin – Reserved for mild outpatient cases or penicillin-allergic patients
🅳 Bleomycin – Not an antibiotic; chemotherapy agent used in testicular cancer and Hodgkin lymphoma
- A 48-year-old lawyer had sudden onset of epigastric pain (8/10) accompanied by cold, clammy sweats while having an oral argument in court. At the ER, his ECG showed ST depression on leads V3 to V6. Troponin was negative. What is the working impression?
A. Acute coronary syndrome
B. Unstable angina
C. ST elevation myocardial infarction (STEMI)
D. Non-ST elevation myocardial infarction (NSTEMI)
B. Unstable angina
🧠 High-Yield Rationale:
This is a classic case of Acute Coronary Syndrome (ACS). The key features are:
🟢Angina at rest (8/10 pain + diaphoresis)
🟢ECG ST depression (V3–V6: anterior-lateral wall ischemia)
🟢Troponin is negative → no myocardial necrosis
Hence, it is Unstable Angina (UA), the non-infarct type of ACS.
❌ Why not the others:
🅰️ Acute coronary syndrome – Umbrella term; not specific enough as a diagnosis
🅲 STEMI – Requires ST elevation, which is absent here
🅳 NSTEMI – Requires positive troponin to indicate infarction
- An 81-year-old bedridden stroke patient was brought to the hospital due to drowsiness. The relatives said she started coughing while feeding her lunch that day. After lunch, they noticed that they could not wake her up anymore for the duration of the afternoon. At the ER, BP was 80/60, HR 125, RR 26, and temperature was 35.8°C. CBG was 120 mg/dL. What does the patient have?
A. SIRS secondary to an infection
B. Sepsis
C. Septic shock
D. None of the above
C. Septic shock
🧠 High-Yield Rationale:
This is a frail elderly patient likely experiencing aspiration pneumonia (coughing while feeding) → leads to sepsis. Key signs:
🟢 Hypotension (80/60)
🟢 Tachycardia (HR 125)
🟢 Hypothermia (T 35.8°C) = poor prognostic sign
🟢 Drowsiness = altered mentation Despite normal CBG, the vitals confirm septic shock, a life-threatening organ dysfunction + circulatory collapse.
❌ Why not the others:
🅰️ SIRS – Requires 2+ criteria but doesn’t imply infection; outdated classification
🅱️ Sepsis – Present, but shock features elevate this to septic shock
🅳 None of the above – Incorrect; the clinical scenario fits septic shock well
- A 24-year-old male engineer sought consultation due to intermittent fever with chills and body malaise. CBC showed: Hgb 145, Hct 38, WBC 5,000, RBC 4,000, platelet count 120. A tourniquet test was done. What is the cut-off value for a positive tourniquet test?
A. >8 petechiae in 1 square inch
B. >8 petechiae in 1 square foot
C. >10 petechiae in 1 square foot
D. >10 petechiae in 1 square inch
D. >10 petechiae in 1 square inch
🧠 High-Yield Rationale:
A positive tourniquet test (Rumpel-Leede sign) is defined as:
> 10 petechiae per 1 square inch This is a classic screening tool for capillary fragility in dengue hemorrhagic fever and other platelet/coagulopathy disorders.
❌ Why not the others:
🅰️ >8 petechiae in 1 inch² – Too low
🅱️ >8 in 1 foot² – Incorrect area + threshold
🅲 >10 in 1 foot² – Wrong surface area
- A 65-year-old diabetic with IHD sought consult due to shortness of breath, orthopnea, and bipedal edema. Which among the following could be the trigger for decompensated heart failure?
A. Non-compliance to medications
B. Community-acquired pneumonia
C. Urinary tract infection
D. Any of the above
D. Any of the above
🧠 High-Yield Rationale:
Decompensated heart failure can be triggered by a variety of factors that increase cardiac workload or volume, or decrease myocardial function:
💊 Non-compliance with meds (especially diuretics or heart failure meds like ACEi/BBs)
🦠 Community-acquired pneumonia → increases oxygen demand, triggers inflammation
💧 UTI or other infections → systemic inflammation → fluid retention and increased metabolic stress
❌ Why not the others individually:
🅰️ Non-compliance – True, but not the only cause
🅱️ Pneumonia – Common trigger, but again not the only one
🅲 UTI – Yes, but too narrow
👉 Thus, D. Any of the above is the most comprehensive and accurate answer.
- A 40-year-old diabetic came in due to persistent nausea, vomiting, and abdominal pain. She is weak-appearing, with cold clammy perspiration. Capillary blood sugar was 400. BP was 120/80, serum potassium was 2.8, positive for urinary ketones, and ABG showed metabolic acidosis. What is the most likely diagnosis?
A. Hyperglycemic hyperosmolar state
B. Uncontrolled diabetes type 2 with possible urinary tract infection
C. Diabetic ketoacidosis
D. Severe acid reflux in type 2 DM uncontrolled
C. Diabetic ketoacidosis (DKA)
🧠 High-Yield Rationale:
🔹 Classic signs of DKA:
🟢 Polyuria, polydipsia, vomiting, abdominal pain
🟢 High blood sugar (CBG 400)
🟢 Ketonuria
🟢 Metabolic acidosis (ABG)
🟢 Low K⁺ (due to osmotic diuresis)
❌ Why not the others:
🅰️ HHS – Less GI symptoms, higher glucose (>600), minimal ketones/acidosis
🅱️ UTI – May cause DKA, but DKA is the more urgent diagnosis
🅳 Acid reflux – Does not explain metabolic acidosis, hyperglycemia, ketonuria
- A 27-year-old secretary, non-DM, non-HTN, sought consultation because of urinalysis findings during an annual physical examination. Urinalysis showed light yellow, clear, pH 6.8, RBC 0-1/HPF, WBC 6-8/HPF, amorphous urates many, and epithelial cells many. Which of the following is the best management for this patient?
A. 3 days with nitrofurantoin
B. Repeat the urinalysis
C. 14 days with trimethoprim-sulfamethoxazole
D. 3 days with ciprofloxacin
B. Repeat the urinalysis
🧠 High-Yield Rationale:
🔹 The presence of many epithelial cells suggests a contaminated urine sample.
🔹 Asymptomatic + non-specific findings → repeat testing is needed to confirm if there’s a true infection.
❌ Why not the others:
🅰️ Nitrofurantoin 3 days – Used for uncomplicated symptomatic UTI
🅲 TMP-SMX 14 days – For complicated or pyelonephritis cases
🅳 Ciprofloxacin 3 days – Too strong for unclear UTI, risk of resistance
- A 45-year-old male construction worker had remittent fever, flank pains, nausea, and vomiting. Ultrasound showed nephrolithiasis on the left kidney. Urinalysis showed 10-15 WBC/HPF, 10-15 RBC/HPF, and few epithelial cells. What is the minimum duration of antibiotic treatment?
A. 3 days with nitrofurantoin
B. Repeat the urinalysis
C. 14 days with trimethoprim-sulfamethoxazole
D. 3 days with ciprofloxacin
C. 14 days with trimethoprim-sulfamethoxazole
🧠 High-Yield Rationale:
This is a case of complicated UTI (due to nephrolithiasis + systemic signs like fever, flank pain, and vomiting). Complicated UTIs require longer antibiotic courses (10–14 days) to ensure full eradication and avoid progression to pyelonephritis or urosepsis.
❌ Why not the others:
🅰️ 3 days nitrofurantoin – For uncomplicated lower UTI only
🅱️ Repeat UA – Not needed; symptoms and imaging confirm infection
🅳 3 days ciprofloxacin – Also for uncomplicated UTI; too short here
- A 24-year-old male medical student sought consultation due to recurrent substernal chest pains aggravated by skipping meals. He was given ranitidine 75 mg BID. How long should the H2 blocker be given to this patient?
A. 1 week
B. 2 weeks
C. 3 weeks
D. 4 weeks
E. 5 weeks
D. 4 weeks
🧠 High-Yield Rationale:
H₂ blockers like ranitidine are used for functional dyspepsia or mild GERD, especially meal-related.
📌 Standard duration of therapy = 4 weeks
Shorter durations (<2 weeks) often result in incomplete symptom relief.
❌ Why not the others:
🅰️–🅲 1–3 weeks – Insufficient duration for healing and symptom control
🅴 5 weeks – No additional benefit vs 4 weeks; not standard practice
- Follow-up question: The patient continued to take ranitidine for 4 weeks due to upcoming finals. This patient will be at risk for:
A. Barrett’s esophagus
B. Gastritis
C. Gastric cancer
D. Gynecomastia
C. Gastric cancer
🧠 High-Yield Rationale:
Ranitidine was recalled globally due to the detection of NDMA (N-nitrosodimethylamine), a probable human carcinogen, particularly linked to gastric cancer. Prolonged use raised concern about carcinogenic risk.
❌ Why not the others:
🅰️ Barrett’s esophagus – From chronic GERD, not H₂ blocker use
🅱️ Gastritis – Can be caused by H. pylori, NSAIDs; ranitidine treats it
🅳 Gynecomastia – Associated more with cimetidine, not ranitidine
- Monsoon rains affected the coastal cities in India, and the local government units recruited individuals to clean the rivers and canals to decrease flooding. You were asked to head the task force. What prophylaxis should the street sweepers receive?
A. Penicillin
B. Amoxicillin
C. Clindamycin
D. Doxycycline
E. Azithromycin
D. Doxycycline
🧠 High-Yield Rationale:
During floods, people exposed to contaminated water are at high risk for leptospirosis, a zoonotic infection transmitted via rodent urine.
📌 Doxycycline is the drug of choice for prophylaxis in flood response teams and field workers:
💊 100 mg PO once weekly
for prophylaxis
🧪 Highly effective at reducing leptospirosis incidence
❌ Why not the others:
🅰️ Penicillin – Used for treatment, not prophylaxis
🅱️ Amoxicillin – Alternative treatment, not used for prophylaxis
🅲 Clindamycin – No role in leptospirosis
🅴 Azithromycin – Alternative for mild treatment, not first-line prophylaxis
- A 24-year-old G1P0, 8 weeks AOG, was diagnosed with a urinary tract infection. Which of the following antibiotics should NOT be given to this patient?
A. Ampicillin
B. Trimethoprim-sulfamethoxazole
C. Nitrofurantoin
D. Cefipime
B. Trimethoprim-sulfamethoxazole
🧠 High-Yield Rationale:
TMP-SMX is teratogenic during the first trimester due to:
Trimethoprim → folate antagonist → neural tube defects
Sulfamethoxazole → displaces bilirubin later in pregnancy
📌 Avoid during 1st trimester and near term
❌ Why not the others:
🅰️ Ampicillin – Safe in pregnancy
🅲 Nitrofurantoin – Generally safe in 1st and 2nd trimesters (avoid near term)
🅳 Cefepime – A 4th-gen cephalosporin; safe in pregnancy
- A 35-year-old female call center agent sought consultation due to fever, nausea, and vomiting. Physical examination showed bilateral costovertebral tenderness, more on the right. Ultrasound showed staghorn calculi in both calyces. What does this patient have?
A. Acute symptomatic cystitis
B. Uncomplicated pyelonephritis
C. Calcium phosphate crystals in the urine
D. Xanthogranulomatous pyelonephritis
E. Uric acid nephropathy
D. Xanthogranulomatous pyelonephritis
🧠 High-Yield Rationale:
Xanthogranulomatous pyelonephritis (XGP) is a chronic granulomatous infection of the kidney often associated with:
🟢Staghorn calculi
🟢Recurrent or untreated UTIs
🟢Destruction of renal parenchyma
Symptoms: fever, flank pain, CVA tenderness
❌ Why not the others:
🅰️ Acute symptomatic cystitis – No systemic symptoms or flank pain
🅱️ Uncomplicated pyelonephritis – No renal structural anomalies
🅲 Calcium phosphate crystals – Do not explain infection, staghorn, or systemic signs
🅴 Uric acid nephropathy – Seen in tumor lysis syndrome, not infectious
- A 28-year-old patient with renal failure secondary to chronic glomerulonephritis sought consultation with the following blood chemistry levels: FBS 98 mg/dL, Chole 198 mg/dL, LDL 90 mg/dL, HDL 50 mg/dL, TG 150 mg/dL, BUA 40 mg/dL (normal range: 7-20 mg/dL). SGPT and SGOT are 3x the upper limit of normal. Which of the statements is true?
A. Adjust the dose of febuxostat because of renal failure
B. Adjust the dose of febuxostat to renal and liver dose
C. Adjust the dose of febuxostat because of abnormal liver function tests
D. There is no need to adjust febuxostat
D. There is no need to adjust febuxostat
🧠 High-Yield Rationale:
📌 Febuxostat is a non-purine xanthine oxidase inhibitor used for hyperuricemia in gout.
🟢 It does not require dose adjustment in mild to moderate renal impairment.
🟢 However, it is contraindicated in patients with severe hepatic impairment, and caution is advised if liver enzymes are elevated.
In this case, although SGPT/SGOT are 3x ULN, it is still within tolerable limits for close monitoring, especially if there are no clinical signs of liver failure.
❌ Why not the others:
🅰️ Adjust due to renal failure – Febuxostat is renally safe in mild-moderate impairment
🅱️ Adjust to renal + liver dose – Only monitor, not adjust unless liver failure
🅲 Adjust due to abnormal LFTs – No automatic adjustment unless >3x ULN + symptoms
- Which of the following statements is true?
A. Extrapulmonary TB is treated for 6 months.
B. Streptomycin is the drug of choice among pregnant TB patients.
C. Breastfeeding is not allowed while on anti-TB medications because of toxicity in the newborn.
D. Liver disease is an indication to stop anti-TB medications.
E. All of the statements are true.
A & D
📌 A. Extrapulmonary TB is treated for 6 months
📌 D. Liver disease is an indication to stop anti-TB medications
🧠 High-Yield Rationale:
✅ A. Extrapulmonary TB (e.g., lymph nodes, pleura) is usually treated for 6 months, unless TB meningitis, bone/joint TB (which require 9–12 months).
✅ D. Liver disease (especially hepatitis due to TB meds) may warrant discontinuation or adjustment (e.g., stop isoniazid/pyrazinamide, keep ethambutol/streptomycin)
❌ Why not the others:
🅱️ Streptomycin in pregnancy – ❌ Ototoxic; not recommended during pregnancy
🅲 Breastfeeding contraindicated – ❌ Breastfeeding is allowed; anti-TB drugs are not highly toxic in breast milk
🅴 All true – Incorrect, as B and C are false
- Which of the statements is false?
A. Isoniazid can cause hepatitis.
B. Pyrazinamide can cause hemolytic anemia and thrombocytopenia.
C. Ethambutol can cause optic neuritis.
D. None of the above are true.
E. All of the above are true.
B. Pyrazinamide can cause hemolytic anemia and thrombocytopenia
🧠 High-Yield Rationale:
✅ B is false: Pyrazinamide is hepatotoxic, but does NOT commonly cause hematologic effects like hemolysis or thrombocytopenia.
True adverse effects:
🅰️ Isoniazid – Hepatitis, peripheral neuropathy
🅲 Ethambutol – Optic neuritis (reversible with early detection)
❌ Why not the others:
🅰️ Isoniazid hepatitis – True
🅲 Ethambutol optic neuritis – True
🅳 None are true – Incorrect
🅴 All are true – Incorrect, because B is false
- A 52-year-old female complained of nocturnal headache of 1-week duration, which awakens her around 2-3 AM. She did not know her BP levels since she does not have a BP apparatus at home. Which of the following guideline-based recommendations will be the appropriate next step?
A. Admit and do a skull x-ray
B. Advise the patient to come in every day for monitoring
C. 24-hour ambulatory BP monitoring
D. 12-lead ECG
C. 24-hour ambulatory BP monitoring
🧠 High-Yield Rationale:
📌 Nocturnal or early-morning headaches can be a sign of nocturnal hypertension or non-dipping BP pattern (failure of BP to fall at night), which is a known risk factor for cardiovascular and cerebrovascular disease.
🩺 24-hour ABPM is the gold standard to evaluate such patterns and detect masked or nocturnal hypertension.
❌ Why not the others:
🅰️ Skull X-ray – Outdated, low diagnostic yield for headache
🅱️ Daily monitoring in clinic – Impractical and may miss nocturnal elevation
🅳 12-lead ECG – Helpful for cardiac issues, but headache + unknown BP points more to ABPM
- A 62-year-old patient with colon cancer suddenly complained of fecal and urinary incontinence. This patient most likely has:
A. Stage 1
B. Stage 2
C. Stage 3
D. Stage 4
D. Stage 4
🧠 High-Yield Rationale:
📌 Fecal and urinary incontinence indicate neurologic involvement, suggesting distant metastasis (e.g., to the spine causing nerve compression).
This qualifies as Stage 4 in the TNM classification: metastatic disease.
❌ Why not the others:
🅰️–🅲 Stages 1–3 – Indicate localized or regional spread (not distant or systemic symptoms like incontinence) 👉 Incontinence = late-stage (Stage 4) sign due to neurogenic bladder/bowel
- A 62-year-old patient with colon cancer suddenly complained of fecal and urinary incontinence. This patient most likely has:
A. Cauda equina syndrome
B. Tumor lysis syndrome
C. Superior vena cava syndrome
D. Dawn phenomenon
A. Cauda equina syndrome
🧠 High-Yield Rationale:
📌 Cauda equina syndrome results from compression of the lumbosacral nerve roots (L2–S5), causing:
🟢Bilateral lower limb weakness
🟢Fecal/urinary incontinence
🟢Saddle anesthesia
In a patient with known malignancy, suspect spinal metastasis compressing the cauda equina. This is a neurosurgical emergency.
❌ Why not the others:
🅱️ Tumor lysis syndrome – Occurs with rapid cell breakdown, causes electrolyte imbalances, not incontinence
🅲 SVC syndrome – Facial swelling, venous distention, dyspnea; not related to lower spinal symptoms
- A patient sought consultation due to unilateral facial edema with unilateral periorbital edema. During examination, prominent chest wall superficial veins were noted up to the neck. He was previously diagnosed with lymphoma. What does the patient have?
A. Spinal cord compression
B. Cauda equina syndrome
C. Tumor lysis syndrome
D. Superior vena cava syndrome
D. Superior vena cava (SVC) syndrome
🧠 High-Yield Rationale:
📌 SVC syndrome results from obstruction or compression of the superior vena cava, often due to malignancies like lymphoma or lung cancer.
Classic signs include:
🟢Facial and periorbital swelling
🟢Prominent chest wall veins
🟢Dyspnea, orthopnea, and cyanosis in severe cases
❌ Why not the others:
🅰️ Spinal cord compression – Causes motor/sensory deficits, not facial swelling
🅱️ Cauda equina syndrome – Incontinence, saddle anesthesia; unrelated to chest/face
🅲 Tumor lysis syndrome – Metabolic derangement; no localized edema or venous signs
- A male patient with lymphoma had matting of lymph nodes in the cervical region. You suspect SVC syndrome, but the CT scan machine broke down. Which bedside maneuver will you do to confirm your suspicion?
A. Dix-Hallpike maneuver
B. Pemberton sign
C. Nikolsky sign
D. Gerber sign
B. Pemberton sign
🧠 High-Yield Rationale:
📌 Pemberton sign is elicited by:
🟢Asking the patient to raise both arms above the head
🟢Positive if it leads to facial congestion, cyanosis, or jugular vein distention
This maneuver exacerbates venous return obstruction and is a quick bedside clue to SVC syndrome.
❌ Why not the others:
🅰️ Dix-Hallpike – Positional vertigo (for BPPV)
🅲 Nikolsky sign – Dermatologic; skin blistering in pemphigus vulgaris
🅳 Gerber sign – For subscapularis muscle testing in shoulder exams
- A non-compliant TB patient diagnosed 3 months ago sought consultation due to a weeping nodular lesion on his neck and back pain with numbness on his backside. On examination, multiple abscesses were noted on the patient’s neck. This most likely is:
A. Scrofuloderma
B. Pott’s disease
C. Cellulitis
D. Phlebitis
A. Scrofuloderma
🧠 High-Yield Rationale:
📌 Scrofuloderma is a form of cutaneous TB where lymph node TB (typically cervical) spreads to the skin, leading to:
🟢Nodular lesions
🟢Fistulas
🟢Weeping/ulcerating abscesses
Seen in non-compliant or poorly treated TB patients.
❌ Why not the others:
🅱️ Pott’s disease – TB spinal osteomyelitis, presents with back pain and neuro signs, but doesn’t explain neck skin lesions
🅲 Cellulitis – Acute, red, warm infection, not nodular or chronic with draining sinuses
🅳 Phlebitis – Vein inflammation; unrelated to TB or nodular neck lesions
- A patient sought consultation due to unilateral facial edema with unilateral periorbital edema. During examination, he had prominent chest wall superficial veins up to the neck. He was previously diagnosed with lymphoma. The expected chest x-ray finding is:
A. Widening of the mediastinum
B. White out lung
C. Hyper-aerated lungs
D. Flattening of the diaphragm and widening of the intercostal spaces
A. Widening of the mediastinum
🧠 High-Yield Rationale:
📌 This is classic Superior Vena Cava (SVC) Syndrome, commonly caused by:
🟢Lymphoma
🟢Lung cancer
🟢Mediastinal masses
The mass compressing the SVC will typically show as mediastinal widening on chest X-ray.
❌ Why not the others:
🅱️ White out lung – Suggests massive pleural effusion or ARDS, not seen in SVC syndrome
🅲 Hyper-aerated lungs – Seen in emphysema/COPD
🅳 Flattened diaphragm & wide ICS – Also emphysema-related, not relevant here
- A 20-year-old varsity basketball player came home from training exhausted and complained of body malaise. He took a shower and a long nap afterward. Upon waking up, he screamed for help because he could not move his legs. He was rushed to the ER. On examination, neuro PE showed 2/5 on both lower extremities (LE), 5/5 on both upper extremities (UE), sensory 100% intact on all extremities, cranial nerves intact. This patient most likely has:
A. CVD bleed
B. CVD infarct
C. Transient ischemic attack
D. Hypokalemic periodic paralysis
D. Hypokalemic periodic paralysis
🧠 High-Yield Rationale:
📌 Hypokalemic periodic paralysis (HPP) is a transient, symmetric muscle weakness, often triggered by:
🟢Exercise followed by rest
🟢High-carb meals
🟢Rest after activity (post-training nap here)
Key features:
🦵 Sudden leg weakness
🧠 Normal mental status, cranial nerves, and sensation
🔋 Often confirmed with low serum potassium
❌ Why not the others:
🅰️ CVD bleed – Would likely have focal deficits, altered sensorium
🅱️ CVD infarct – Would be asymmetric, not purely LE
🅲 TIA – Usually focal, transient (<24 hours), and not symmetric LE weakness
- A 58-year-old female complained of abdominal pain, nausea, and vomiting. She was very thirsty with dry lips and tongue. Initial CBG was 400 mg/dL, HbA1c 10%. Which of the following will you request first?
A. ABG and ketones
B. Ultrasound of the abdomen and H. pylori test
C. CBC, lipid profile, BUN, creatinine
D. 2D echo and ECG
A. ABG and ketones
🧠 High-Yield Rationale:
📌 Suspected Diabetic Ketoacidosis (DKA) – classic signs:
🟢High CBG
🟢Elevated HbA1c (chronic hyperglycemia)
🟢Dehydration
🟢GI symptoms
First step: Confirm acidosis and ketosis using:
🟢ABG (for metabolic acidosis)
🟢Urine or serum ketones
❌ Why not the others:
🅱️ UTZ + H. pylori test – Not urgent; doesn’t rule out life-threatening DKA
🅲 CBC, lipid, BUN, Cr – Supportive tests but not diagnostic for DKA
🅳 2D echo + ECG – Only if suspecting MI or cardiac involvement, not primary
- A 58-year-old female complained of abdominal pain, nausea, and vomiting. She was very thirsty with dry lips and tongue. Initial CBG was 400 mg/dL, HbA1c 10%. This patient’s water deficit most likely is:
A. 9 liters
B. 6 liters
C. 2 liters
D. None of the above
B. 6 liters
🧠 High-Yield Rationale:
In Diabetic Ketoacidosis (DKA) or Hyperosmolar Hyperglycemic State (HHS), the average water deficit is estimated as:
💧 ~6 liters in DKA
💧 ~9 liters in HHS
This patient likely has DKA, given the symptoms and elevated HbA1c. A 6-liter water deficit is the most consistent estimation.
❌ Why not the others:
🅰️ 9 L – More consistent with HHS, not DKA
🅲 2 L – Underestimates true volume loss
🅳 None of the above – Incorrect, as B is valid
- A 58-year-old female complained of abdominal pain, nausea, and vomiting. She was very thirsty with dry lips and tongue. Initial CBG was 400 mg/dL, HbA1c 10%. While waiting for the lab results, what will you do next?
A. Fast drip 2-3 liters in 1-3 hours
B. Start insulin sliding scale
C. Give 50 mEq sodium bicarbonate slow IV push
D. Give K tablets 1 tablet TID
A. Fast drip 2–3 liters in 1–3 hours
🧠 High-Yield Rationale:
📌 Initial management in DKA always begins with fluid resuscitation:
🟢Use 0.9% NaCl (normal saline)
🟢Give 1–3 liters over the first 1–3 hours
Why?
🟢Replaces intravascular volume
🟢Improves perfusion
🟢Helps lower blood glucose even before insulin
❌ Why not the others:
🅱️ Sliding scale insulin – Not used in DKA; regular IV insulin protocol is preferred
🅲 Sodium bicarbonate – Only indicated if pH < 6.9
🅳 Oral potassium – Not given until K+ level is known; risk of arrhythmia if hypokalemic
- A 58-year-old female complained of abdominal pain, nausea, and vomiting. She was very thirsty with dry lips and tongue. Initial CBG was 400 mg/dL, HbA1c 10%. Which insulin will you start with?
A. Regular insulin
B. Insulin glargine
C. Humulin 70/30
D. Insulin degludec
A. Regular insulin
🧠 High-Yield Rationale:
📌 Regular insulin is the insulin of choice for IV infusion in DKA:
🟢Short-acting and can be given IV
🟢Dosing: 0.1 U/kg IV bolus, then 0.1 U/kg/hr IV drip
❌ Why not the others:
🅱️ Insulin glargine – Long-acting; not used for acute correction
🅲 Humulin 70/30 – Premixed (NPH + regular); not appropriate in DKA
🅳 Insulin degludec – Ultra-long-acting; not suitable for acute settings
- A patient complained of numbness and weakness in her left leg with difficulty in ambulation. You are entertaining the possibility of Pott’s disease. Which of the following will you request?
A. Cervical spine x-ray
B. Thoracic spine x-ray
C. Thoracolumbar spine x-ray
D. Knee x-ray (AP-lateral)
C. Thoracolumbar spine x-ray
🧠 High-Yield Rationale:
📌 Pott’s disease = spinal tuberculosis, most commonly affects the thoracolumbar region (especially T10–L2).
The classic features:
🟢Back pain
🟢Neurologic deficits (e.g., lower limb weakness, numbness)
🟢Gibbus deformity if advanced
🩻 Initial work-up: thoracolumbar spine x-ray, followed by MRI if needed.
❌ Why not the others:
🅰️ Cervical spine x-ray – Not appropriate unless symptoms are in upper extremities/neck
🅱️ Thoracic spine only – May miss lumbar involvement
🅳 Knee x-ray – Localized to joint; irrelevant to spinal etiology of leg weakness
- A 28-year-old female was brought to the hospital because of loss of consciousness. A few days prior to consultation, she had a high-grade fever (38.5°C to 39.8°C), tachycardia, loose watery stools 3x a day, and appeared to be agitated. Her relatives also noted rapid weight loss despite increased appetite. A few hours prior to consultation, she was noted to be unresponsive. On examination, BP was 200/110 mmHg, HR 120 irregular, febrile 39.8°C, cachectic with movable anterior neck mass, and few cervical lymphadenopathy. CBG was 165 mg/dL. The management includes:
A. Methimazole, norepinephrine drip, and antibiotics
B. Insulin drip, hydration, and correct serum electrolytes
C. Propylthiouracil, iodide drops, propranolol, glucocorticoids
D. Amiodarone 300 mg slow IV push followed by amiodarone drip to run for 24 hours
C. Propylthiouracil, iodide drops, propranolol, glucocorticoids
🧠 High-Yield Rationale:
📌 This is a thyroid storm—a life-threatening hyperthyroid crisis. Key features:
🟢High-grade fever
🟢Tachyarrhythmia (AFib)
🟢CNS disturbance (agitation → unconsciousness)
🟢GI symptoms
🟢Goiter/thyroid mass
🩺 Standard treatment involves multi-drug approach:
🟢PTU: Blocks new thyroid hormone synthesis and peripheral conversion of T4 to T3
🟢Iodide: Blocks release of thyroid hormone
🟢Propranolol: Controls HR, also inhibits T4 to T3
🟢Glucocorticoids: Reduce T4 to T3 conversion and treat adrenal suppression
❌ Why not the others:
🅰️ Methimazole + norepinephrine + antibiotics – Methimazole is not preferred in thyroid storm; norepinephrine may worsen BP; antibiotics not primary treatment
🅱️ Insulin + hydration – For DKA, not thyroid storm
🅳 Amiodarone – Can worsen thyroid function due to iodine content
- Using the Burch-Wartofsy scoring criteria, the ECG showed atrial fibrillation. This ECG finding automatically gets how many points?
A. 1 point
B. 5 points
C. 0 points
D. 10 points
D. 10 points
🧠 High-Yield Rationale:
📌 The Burch-Wartofsky Point Scale is used to assess likelihood of thyroid storm.
Atrial fibrillation is considered a major cardiovascular manifestation and is given 10 points on this scoring system.
