IFOM Questions Part 1

IFOM questions Immunology & Hematology 1. Infant with current infection with pneumocystis and signs of failure to thrive, has familial history of brothers dying at a young age (SCID) → Combined T & B cell 2. A 47 years-old female with clinical picture of bronchiectasis, with history of recurrent sinopulmonary sinusitis about pathophysiology, most likely CVID → immunodeficiency (a) Immunodeficiency (b) impaired chloride ion channels. 3. Patient with recurrent giardiasis, asking about selective deficiency in which Ig? → IgA 4. Young female patient with hernia being assessed for surgery, gave history of prolonged bleeding heavy menses, but no petechiae on examination and swelling in the hernia region. What is the cause of her symptoms, deficiency in what → Von Willebrand factor, no ITP mentioned in the options. (a) antithrombin III (b) protein C (c) Hemophilia (d) Von Willebrand factor 5. A male patient who is homeless, with a history of alcoholism, but last drank alcohol 3 weeks ago presented with perifollicular hemorrhage, splinter hemorrhages, petechiae behind the calf, and pale sclera. CBC showed an MCV of 89 and Hb of 9. What deficiency does he have? Vit c was not within the options! I chose folic acid (a) (b) (c) (d) Vit B1 Vit B6 Vit B12 Folic acid (e) Zinc Neurology 6. An old male patient with UMNL, LMNL, dysphasia and bulbar symptoms (ALS), asking about treatment → Riluzole 7. Newborn with clinical picture of neonatal tetanus, what is the pathophysiology → Presynaptic inhibition of GABA neurons 8. Diagnosis of lumbar stenosis 9. Clinical picture of meralgia paresthetica, asking about pathophysiology → peripheral nerve compression 10. An Old male patient with a history of advanced melanoma, presented with neurological symptoms (I think severe headache), CT was given showed lesion likely metastasis. Asking about what to do next? (Management of ICP) → intubate and hyperventilate 11. A patient post RTA with small subdural hematoma on imaging, but no midline shift or mass effect seen. ABG was given and showed PaCO2 37 mmHg I think 37 and PO2 was normal. ICP was 30 mmHg and remained unchanged for the past 2 hours? What is the cause? I chose cerebral edema (a) Cerebral edema (b) Intracranial hemorrhage (c) Increased volume 12. A patient with known MS with bilateral internuclear ophthalmoplegia, what to give to help the patient’s condition/prevent future complications? Not sure of the question → High dose steroids 13. An old female patient, who is right-handed, I think might’ve been hypertensive with a history of right arm pain, and on examination there’s right arm weakness, otherwise normal neurological exam. What to do next → I chose CT head (a) ambulatory 24 hr ECG (b) CT scan of the head 14. A patient with upper & lower muscle weakness, upper distal muscle weakness of the hand (interosseous muscle wasting and other hand muscles), hyperreflexia of triceps, more prominent weakness in LL and positive Babinski sign. Asking for which level this lesion? (a) Cervical (b) Thoracic (c) Lumbar 15. An old man has 3-month memory loss, no longer wants to participate/engage in family events/activities according to children and has trouble with weekly grocery lists and bills. I think he recalls 2/5 objects → Alzheimer’s dementia (a) (b) (c) (d) Frontotemporal dementia Alzheimer’s dementia Multi-infarct dementia/Vascular dementia Lewy body dementia 16. Classic picture of Parkinsonism, asking about diagnosis? 17. Otosclerosis diagnosis 18. Developmental milestone for a 3-year-old girl that goes up and down the stairs one foot at a time, can ride a bicycle and walk. She uses 10-20 vocabulary words and speaks in two-word sentences - her teachers in preschool don't understand her, but her parents do. Are her gross motor and language development normal for her age? I choose normal – normal 19. A female with high BMI, hypertension, and bilateral papilledema, asking about the cause → Increased intracranial pressure 20. A female who is a chronic smoker, wants to quit smoking because of recurrent cough/bronchitis. I don't remember exactly why. What to do next? No bupropion mentioned (a) Give nicotine patch (b) Other choices: taper smoking in 6 weeks 21. A female patient with bilateral headache and jaw pain on chewing (GCA). What is the next step to diagnosis→ measure ESR, temporal artery biopsy was not given. (a) Measure ESR (b) CT/imaging 22. Clinical picture of opioid overdose (RR =6, miosis), asking for treatment → naloxone 23. A 40 something year old man, who has a son diagnosed with MDD/depression presented to ED with confusion, sweating, and symptoms of TCA toxicity. Asking about the cause → anticholinergic effect 24. Patient was on losartan; finasteride, and I think he took diphenhydramine or something for a cold and developed urinary retention. What is the cause → anticholinergic effect 25. Man with BPH complains of passing 30 ml every few hours? What’s the best next step in management → Catheter 26. An old man who presented with a 6-week history of urine leakage with physical activity and examination revealed an enlarged, firm prostate. What is the cause of his urinary incontinence? (a) Detrusor overactivity (b) overflow (c) mechanical stress on bladder (d) Don't remember Psychiatry 27. A mother after giving birth in the hospital was found whispering to her newborn “I think you're not my baby”, didn't make eye contact with the baby and didn't breastfeed the baby. What to do next → Psychiatry consultation 28. He was a 42-year-old gentleman with “bad feeling”, heartburn and feeling anxious. He had these recurring symptoms during his 20s in university. Most likely GAD. What is the best treatment for long term management of his condition → I chose psychotherapy (a) Alprazolam (b) diazepam (c) Psychotherapy 29. An old man felt anxious and in a low mood, he went to the doctor, and he discovered he had a terminal illness/I think pancreatic malignancy. What is the cause of mood→ Mood related to medical condition. Other choices included anxiety 30. An 8-year-old girl found daydreaming in class, but not disruptive. Her grades were affected, and her parents were informed. She stated she no longer wants to go to school. On exam, she seemed quite distracted. What’s the diagnosis? → ADHD (a) ADHD (b) dissociative disorder (c) malingering 31. A patient with known schizophrenia on long term haloperidol, found by neighbor confused, drooling, has a fever of 38.8. Exam revealed rigid tense muscles with labs showing CK of 4200+ and toxicology screen +ve for benzodiazepines. What is the diagnosis → Neuroleptic Malignant Syndrome Cardiology 32. Patient came presented after losing consciousness for 10 secs after a coughing bout, he also mentioned he did not have breakfast →Tussive Syncope (a) Hypoglycemia (b) Autonomic insufficiency (c) Tussive syncope 33. Anaphylaxis management for a bee sting allergy→ IM epinephrine (a) IM epinephrine (b) IV epinephrine 34. Classic picture of pericarditis following URTI with ECG showing PR depressions and diffuse ST elevations, asking for diagnosis → Pericarditis 35. BPH patient on ∝-1- antagonist, I think terazosin, fainted on his way to the bathroom, what’s the diagnosis → orthostatic hypotension 36. Clinical picture of exertional SOB, fatigue and murmur best heard in the lower left sternum and increases on Valsalva maneuver → HOCM 37. A 1-month newborn with progressive worsening on exam a 2/6 systolic murmur is best heard at left upper border and has PDA on further evaluation, what to give? (a) Alprostadil (PG E1 analogue) (b) Indomethacin 38. Patient with inferior MI, what to give after to prevent another MI → beta blocker 39. An old patient developed dyspnea after a physiotherapy session (most likely PE), what is the best initial step in diagnosis → I chose CT angiogram (a) US of the LL, not duplex just US (b) CT Angio 40. Clinical picture of decompensated HF (exertional SOB, LL edema) in an old male chronic smoker. After doing a chest x-ray, what to do next →Transthoracic echocardiogram 41. 2 days post MI, a patient developed sudden chest pain and new systolic murmur. What's the diagnosis → Papillary muscle rupture 42. An obese man who drinks alcohol but doesn't smoke wants to know how to prevent hypertension. Don't remember if they’ve mentioned his diet. What's the best step to prevent HTN → Lose weight 43. Man in his 30s, jogs 5x/weekly, healthy diet, and no history of CAD, came for a routine checkup. Lipid profile showed cholesterol 220, LDL around 140, normal HDL. Asking what’s the next step/test to do for assessment of cardiac risk? (a) Measure urinary uric acid (b) Measure serum apolipoprotein (c) no further testing is indicated 44. Mechanism of vegetation on prosthetic heart valve? (a) macrophage activation (b) Lymphocytic infiltration 45. Diagnosis of myocardial contusion 46. Post colorectal surgery, patient developed tachycardia 140 bpm, hypotension 60/50 with single ECG strip showing QRS tachycardia and monophasic VT, asking about management? (a) (b) (c) (d) (e) Diltiazem Amiodarone Furosemide and something else Electrical cardioversion IV lidocaine Respiratory 47. A diabetic female patient with severe left arm pain, on examination there is crepitus on superior part of chest and bullae on upper arm (a) (b) (c) (d) Necrotizing fasciitis Ruptured trachea Pneumomediastinitis Pneumothorax 48. Patient developed respiratory distress after some surgery with X-ray showing fluffy cotton ball, what is the diagnosis → ARDS 49. Patient post RTA developed clinical picture of flail chest, asking about mechanism of respiratory distress/pathophysiology → V/Q mismatch 50. COPD diagnosis confirmed by spirometry 51. Child with a picture of pneumonia, developed pleural effusion and gave effusion pleural analysis (glucose was normal I think, protein don't remember, high LDH). Asking for the cause? (a) Parapneumonic effusion (b) Chylothorax (c) Hemothorax 52. Pathophysiology of CF → defective chloride ion channels 53. Paraneoplastic small cell carcinoma of the lungs secretes what→ ACTH 54. Patient with severe Kyphosis for years. Asking about PFT Parameters (in terms of vital capacity, residual volume, FEV1/FVC, bronchodilator response) 55. Decreased vital capacity — decreased residual volume— decreased FEV1/FVC normal — Bronchodilator test/response = no response 56. Patient with a long history of smoking, has hoarseness of voice, works as a telemarketer. Picture of larynx shown with a lesion. Asking what to do next? (a) (b) (c) (d) stop smoking and reexamine in a month Give steroids and reexamine after a while Biopsy Voice training 57. Patient that is a heavy smoker with fever and a picture of pneumonia. He had reduced breath sound at the base of the long and increased vocal fremitus, What’s the diagnosis? (a) Pneumonia (b) COPD (c) Asthma 58. Patient who has a dog for 3 years, smokes for 10 years and works as a house painter has SOB on physical activity, O2sat on activity 95%, and 98% on rest. What to do next to decrease/improve his symptoms? (a) Stop smoking (b) change occupation (c) get rid of dog (d) last option I think was to lose weight not sure 59. A patient with CF that developed acute dyspnea and tachypnea, they did not write the vitals just those 2 words. And they mentioned patient is currently does not have active infection, What's the diagnosis? (these 2 were the options that made sense, I think pneumothorax) (a) Pulmonary embolism (b) Pneumothorax 60. An elder who is getting awake from sleep more often than usual. He is taking diuretics as part of his Hypertensive management. He forgets 2 out 5 objects on mental state examination. Asking about the reason why he wakes up more often. (a) dementia (b) diuretic use (c) Normal aging 61. A Female patient in her 70s came for a routine checkup, her mother had history of thyroid cancer and her father had history of lung cancer at 75. She smoked for 30 years but quit 20 years ago. She has done colonoscopy 3 years ago. What is the best next step? a. chest xray b, colonoscopy c. pap smear GI 62. A patient with chronic diarrhea and chest infections, picture of CF, what’s the diagnosis → CF 63. An infant with picture of HPS, asking about lab findings → pH: high -- K+: low -- Chloride: low (hypochloremic hypokalemic alkalosis) 64. Middle aged female with jaundice and pruritus, has positive AMA antibody (1ry biliary cholangitis). What to measure next? (a) LDH (b) Fasting lipid profile 65. Treatment of GERD (a) (b) (c) (d) (e) Pantoprazole Ranitidine Alginate aluminum hydroxide sucralfate 66. Old patient presenting with dysphagia and sensation that food sticks to his throat → endoscopy 67. A young boy with recurrent abdominal pain for 3 months and diarrhea, what’s the diagnosis → Ulcerative colitis 68. Female with RLQ pain and clinical picture of appendicitis, what's the diagnosis → acute appendicitis. 69. Patient with a picture of acute pancreatitis (epigastric pain that radiates to the back) and amylase of 1000, what’s the next step? (preferred modality of imaging)? (a) gallbladder scintigraphy (b) US abdomen (c) CT abdomen 70. A 4-year-old not in a car seat but in the back seat with seat belt was involved in an RTA, presented with revealed bruises and petechiae on abdomen. She is hemodynamically stable, and x-ray is unremarkable. Exam what to do next? blunt abdominal trauma (a) Observe Hb every 4 hours (b) CT abdomen 71. Patient with peritonitis and board like rigidity, high amylase, and X-ray showed air under the right diaphragm, what to do next? (a) Immediate surgery (b) CT abdomen 72. Patient with severe rectal bleeding and hematochezia, chest pain with ECG showing t wave inversion and diffuse ST elevation I think I'm not sure after giving IV fluids and PRBCs, ECG changes and chest pain resolved. Colonoscopy was done, only blood was seen in the colon, no visible source of bleeding and NGT showed bilious fluid. what to do next? (a) Upper GI endoscopy (b) repeat colonoscopy (c) CT abdomen 73. A picture of migrating thrombophlebitis in an old patient, what is the cause/diagnosis → malignancy 74. Shows a photo of PTC asking where the lesion is? (a) obstruction at level of ampulla of Vater (b) pancreatic cancer (just says that) (c) Other options were not close 75. 74. A female 47 years-old with a history of father getting colorectal cancer at the age of 52 what to do next? Colonoscopy now 76. Erosive gastritis caused by what in an old man who takes NSAIDs 1-2x a month for osteoarthritis. What to do to improve his conditions → stop NSAIDs Renal 77. Child with episodes of diarrhea that are sometimes bloody (HUS). He also developed LL edema, and it says that it reached the knees. What to do to confirm diagnosis? (a) Serum Cr (b) Fractional excretion of Na 78. An elderly patient on aminoglycoside, what is considered a risk factor for aminoglycoside toxicity in this age group? dec GFR / nephrotoxic 79. Mechanism of DM nephropathy → glomerular sclerosis (other option was osmotic diuresis) 80. Diabetic patient with HTN, asking what medication is best to prevent renal deterioration? → ACE inhibitors 81. A child with joint pain in the wrist and knee with malar rash over the nose and cheeks, presented with hematuria and urinalysis with RBC and RBC cast, most likely diagnosis → SLE 82. A Female 50 y/o complaining of blood in the urine sometimes with small clots, weight loss, flank pain, Dx next step? Don't remember the choices but I may have chosen CT abdomen 83. Picture of acute cystitis/UTI with positive nitrate and leukocyte esterase in urine analysis. What to give? (a) nitrofurantoin (b) Ceftriaxone (c) Doxycycline 84. Clinical picture of gout with gout arthritis and high uric acid levels asking about the most appropriate step to prevent symptoms → allopurinol 85. Pregnant lady, with flank pain radiating to groin. There is some blood in the urine, asking what’s the cause but no fever, no costovertebral tenderness → Nephrolithiasis 86. Obstructive nephropathy in a female with high RFTs and has multiple abdominal lymph nodes seen by imaging (retroperitoneal lymphadenopathy). What’s the cause of AKI → Obstructive 87. Old man with 6 weeks history of episodes urine leakage on physical activity, on examination prostate was found to be enlarged and firm. What’s the cause of incontinence? (a) Overflow (b) Mechanical stress on bladder (c) detrusor overactivity 88. Patient presenting with typical cases of UTI. Asking about the causative organism → grampositive enterococcus faecalis 89. A young y/o male came with scrotal pain, left testicle tender, high and symptoms of epididymitis, asking for the cause? (a) Inflammation (b) Failure of the processus vaginalis to close 90. Young patient, with hard mass on testicles. Examination showed that the mass is firm. What is the diagnosis? Testicular cancer