4th Year Medicine Questions 2021

4th year Medicine 16/5/2021 questions Nephrology 1. A 45 year old man presented with sudden onset headache and loss of consciousness. He has a history of hypertension and CKD. His father and grandfather died of intracranial hemorrhages. What is the most likely diagnoses: Medullary sponge kidney Polycystic kidney disease* Renal cell carcinoma Which of the following doen't have low complement? SLE nephritis IgA nephropathy* Post streptococcal glomerulonephritis Cryoglobulinemia 3. Patient with CKD .DM HTN .on B blockers ACEI and statin.Blood glucose >240 k+=7. CPK =300. Which one of the following doesn't contribute to hyperkalemia in her condition? Beta blockers CKD Use of ACEI Hyperglycemia Rhabdomyolysis* Note: the answer is rhabdomyolysis is because although statins cause rhabdomyolyis, in this case the rise in CPK is not in range of frank rhabdomyolysis which should be in thousands 2. 4. Patient with polydipsia and polyuria and nocturia .low urine osmolarity with no renal disease in his family history (Signs and symptoms of D.I) what is the next step: Desmopressing administration Water deprivation test* Administer Amiloride 5. Which of the following causes CKD with enlarged kidneys: Amyloidoses* HTN Glomerulonephritis Hepatitis 6. Patient with history of cellulitis of 3 weeks.took cephalosporin’s.. developed SOB bilateral lower limb edema .fever ..Elevated Cr with 1-2 RBCs . Cause : interstial nephritis . post strep GN* MCD 7. A patient with renal failure is expected to have hypocalcemia due to : Decreased hydroxylation of vitamin D* decreased absorption of vit D Rheumatology 1. A 40 year old female with arthralgia, dry eye and dry mouth. She’s anti Ro positive.Which of the following is true about her case She is advised not to get pregnant She is at risk of developing lymphoma* 2. Which of the following is true about ankylosing spondylitis May be polyarticular symmetrical Gumma formation Aortic stenosis Buttock pain* 3. True about psoriatic arthritis: involves SI joints causes circunate balanitis causes enthesitis* Medicine 16/5/2021 questions 4. One is not a risk factor of osteoporosis Obesity* Age Female sex Alcohol Smoking 5. A 30 year old female with Rheumatoid arthritis on sulfasalazine but still complains of joint pain, and imaging shows joint erosions. She was prescribed methotrexate, what is wrong about this medication Causes pancytopenia Causes pneumonitis Can cause elevated liver enzymes} Cannot be given with sulfasalazine* can be given once weekly 6. What is wrong about SLE: low complement C1q HLA DR3 HLA B27* 7. What antibody is associated with subacute cutaneous lupus erythematosus: ANA Anti-DsDNA Anti Ro* Anti-Smith 8. A 65 year old female patient with headache and temporal tenderness with jaw claudications which of the following is true? She’s at risk of losing vision* Angiogram is the diagnostic procedure One negative biopsy rules out the disease She responds to low dose IV hydrocortisone 9. What is wrong about gout Solubility of uric acid in men is 7 Females of child bearing age have higher uric acid levels in their blood* 10. True about Rheumatoid arthritis: Not an erosive arthritis Relieved by rest* Relieved by exercise 11. Osteoarthritis: Exacerbated by exercise* Cardiology 1. ECG patient with hx of DM, HTN and retrosternal chest pain : Anterior M.I 2. ECG: 3rd degree heart block 3. Which of the following doesn’t improve mortality in heart failure: Beta blockers Ace inhibitors Spironolactone Hydralazine Furosemide* 4. Which of the following doesn’t increase mortality in myocardial infarction Hypertension Female gender St segment elevation more than 5 mm* 5. a patient with ejection click on upper left sternal bordor with 4/6 systolic murmur with suprasternal notch thrill: aortic stenosis poulmonic stenosis* HOCMP aortic regurgitation 6. Which of the following does not have pulsusparadoxas? Hypertrophic cardiomyopathy* Cardiac tamponade Constrictive pericarditis Severe asthma 7. What is wrong about Constrictive pericarditis: Medicine 16/5/2021 questions 8. 9. 10. 11. 12. 13. Friction rub is heard on auscultation Early diastolic sound is heard on auscultation  he means the pericardial knock Pulsus alrernans is a feature* JVP is increased on inspiration Which of the following does not increase the risk of thromboembolic events in A.fib patients Hypertension Age above 60 CHF DM High LDL* (remember CHAD VASC) All decrease HDL except Smoking Obesity Low carbohydrate intake* Which is not consistent with JVP of 4 cm above the neck with lower limb edema Nephrotic syndrome Budd chiarri syndrome Right sided heart failure* Most common causative organism of infective endocarditis in IV drug users Staph aureus staph epidermidis* Strep viridians (alpha hemolytic strep) (Remember that staph aureus is the MCC of infective endocarditis overall as well, it used to be viridians years ago (this is 2015 :p)) a patient with hx suggesting pericarditis (chest pain decrease by leaning forward), what is wrong colchicine decrease recurrence steroids are 1st line therapy* All increase the risk of rupture of atheroma except: high smooth muscle cell content high lipid content thin fibrous cap 14. all have a risk of thromboembolism except A.fib sick sinus syndrome constrictive pericarditis* endocarditis heart aneurysm 15. all are risk factors for CAD except: truncal obesity high insulin low homocystine * smoking Hematology (Leukemia and lymphoma questions were from revision sheet for doctor Abbadi) 1. Which of the following mutations indicate severe hemophilia? Ans: inversion 22 2. A 65 year old healthy male was incidentally found to have on his labs: WBC of 70K with lymphocyte predominance, platelets of 250k, Hb 12. He does not have any lymph node enlargement or splenomegaly or hepatomegaly. Cytoanalysis of lymphocytes showed 5% of cd38 (ZAP) positive cells. The rest were cd 19 and cd 20 positive. Smudge cells were seen. Which of the following is true about this case: (Note: choices here might not be very accurate, but the point of the question is to know that the patient has very good prognosis: refer to sheet) The patient will survive for years* The patient will develop generalized Medicine 16/5/2021 questions 3. 4. 5. 6. 7. 8. lymphadenopathy and splenomegaly in a year A patient with gingival bleeding and increased bleeding time and normal PT and PTT and normal platelet count, parents are cousins, what’s the diagnosis: Glanzmans thrombosthenia* VWD Hemophilia ITP A 54 year old male complains of abdominal discomfort , weight loss, sweating and headache. P/E: showed splenomegaly. Platelets 800k.WBC 120K neutrophils 80% and basophils 2%.Uric acid elevated.Hb 13. What is the diagnoses ALL CLL CML in chronic phase* Richter transformation A female patient with headache bleeding from mucosal surface was found to have low platelet count. Hb is decreased with schistocytes on blood smear.Her temperature is 38.5. WBC are normal,PT and PTT are normal. What’s the most probable explanation: Antibodies against ADAMTS-13 Transfusion related acute lung injury is most probable of which blood DONOR : Multiparous women Which of the following causes hemolysis in G6PD patients: Sulfonamides* erythromycin azathioprine AML: what is associated with very poor prognosis: t(15:17) inv(16) del (7) * NMP1 mutaion (7 is a very unlucky number in hematology/oncology so whenever it is present in a question it’s associated with bad prognosis (whether inversion, deletion or anything). 9. A question about a patient with extravascular hemolysis and positive coombs: Warm agglutinin (IgG antibodies) against RBCs 10. Which of the following is curative for hemochromatosis of chronic dialysis in beta thalassemia major B.M transplant defirasorax (not sure about the answer, defirasorax is the drug of choice, but the word “curative” is confusing) Endocrinology 1. Elderly patient , asymptomatic , on thyroid u/s a nodule was found . TSH within normal range 0.9 . What is the Most appropriate next step? FNA . * uptake . scan start on antithyroid medications Measure T4 2. Patient with upper limit normal PTH and elevated corrected calcium, what is the most likely diagnosis: Primary hyperparathyroidism* Secondary hyperparathyroidism tertiary hyperparathyroidism Vitamin D deficiency 3. A patient with symptoms and signs of acromegaly and developed bitemporal hemianopia. What is the definitive test Medicine 16/5/2021 questions for the diagnosis: IGF-BP3 Glucose suppression test* MRI (remember that imaging is only done after diagnosis is established to confirm, IGF is the SCREENING test) 4. 21 year old, test showed he had diabetes, has a very strong family hx for Diabetes in father and grandfather without complications, no acanthosis nigricans, antibodies were negative: what is the type of diabetes: LADA MODY* DM1 DM2 A note about MODY and LADA: MODY: is an autosomal dominant form of diabetes, which justifies the strong family history in the question. It is due to a defect of a gene in the endocrine pancreas (glucokinase), so it’s called “monogenic diabete” and is not an autoimmune phenomenon which goes with the negative antibodies in the question. LADA: Is a form of type 1 DM which occurs in the adults (i.e slower onset than type one but the same etiology). And it’s also called type 1.5 DM 5. A Patient with DM on metformin and glemiperide, what nutrient u should monitor: B12* B6 vitamin E zinc (according to Dr Munther Momani, metformin may causes B12 deficiency) 6. A female pt came to the ER with hypoglycemic attacks,her lab tests showed normal Insulin normal Cpeptide and low Glucose (31), what is the next step? CT abdomen MRI test for sulfonylurea in urine * psychiatric evaluation 7. Which of the following is considered diabetic: Fasting blood glucose 135 with symptoms* OGTT of 230 (One time is not enough without symptoms) Know this: Diabetes is diagnosed in case of: In a symptomatic patient with one of the following: -Fasting blood glucose 126 or more -Random blood glucose of 200 or more -OGTT of 200 or more In a non-symptomatic patient you have to do the test you used from the above three tests twice if it came positive in the first time. 8. Which of the following drugs cause neutropenia: Carbimazole* Clomipramine Erythromycin Aminoglycosides 9. True about HbA1C : evaluates glycemic control in the past 3 weeks evaluates glycemic control in the past 3 months* evaluates glycemic control in the past 6 months 10. A patient diagnosed with Cushing (overnight low dose dexamethasone Medicine 16/5/2021 questions suppression test was positive), what is the next step: ACTH levels* High dose desxamethasone suppression test XT chest MRI brain Respiratory 1. Polysomnography what does it show: Ans: hypopnea (don’t forget to take a look at respiratory curves before exam. Study how hypopnea, apnea wither central or peripheral show on polysomnogrpahy. Use the dossiers or the internet) 2. Two questions about flow volume loops: one is showing variable extrathoracic obstruction (vocal cord dysfunction) and the other is showing fixed upper airway obstruction (tracheal stenosis, goiter) Study them from the dossier or the internet. 3. Which of the following is most specific for asthma: variability test Methacholine challenge 4. A patient with kyphoscoliosis and pco2 of 65 pO2 of 45 the mechanism involved is: Hypoventilation* V/Q mismatch Hyoventilation and V/Q mismatch 5. A 70 year old patient with BUN of 50 and respiratory rate of 18 and blood pressure of 80/50, CURB65 score is: 1 2 3* 4 6. Which one of the following volumes doesn't change with severe asthma : FVC RV TLC inspiratory arm of flow volume loop* 7. Which of the following is not seen in severe asthma bilateral wheezes 8. A non smoking 30 year old COPD patient with emphysema predominance, what is wrong: Thin patient Large sputum production* Increased AP diameter Pursed lips 9. Compliance curve (Shows decreased compliance): what does it show Emphysema Chronic bronchitis P.Fibroses* 10. About PFT what is wrong it is effort dependent spirometry is used to demonestrate variability * DLCO can’t defferntiate IPF and emphysema bronchiolitis oblerterans can cause low DLCO 11. patient with acute asthma, what is the mechanism of dysnea Resp acidosis Medicine 16/5/2021 questions resp alkalosis hypoxia hypercapnea increased work of breathing* 12. A flow volume loop was shown and the question is asking about the distance between two points what does it represent: answer: FVC 13. Which of the following is least likely to cause pulmonary edema: Malignant hypertension Heart failure Massive pulmonary embolism* Bicuspid regurgitation 5. Gastroenterology 1. Eradication of H.pylori will improve all of following except : gastric ulcer doudenal ulcer gastritis maltoma GERD* 2. Patient with HTN, DM, hyperlipidemia, BMI 38, liver enzymes transaminases greater than twice the upper limit of normal..what is the most appropriate thing to do to reduce enzyme levels? Reduction of weight* Metformin Smoking cessation 3. Doesn't cause unconjugated hyperbilirubinemia: gilbert Rotor's syndrome * hemolysis megaloblastic anemia large hematoma 4. A 35 yr male patient has itching, ALK= 450, GGT= 500, AST =45, ALT= 55, 6. 7. 8. ultrasound is normal, next step: ANCA AMA* Anti smooth muscle Ab MRCP (remember that PBC is more in femles, AMA is the test. PSC is more in males, MRCP is the test, the trick is: although that the pt is a male, normal LFT, so it is PBC not PSC) Female pt with history of diarrhea for the last 3 months/ endoscopy shows ulcerations in terminal elium / skip lesions/ granulomas, what should you tell the patient? You have 20% risk for developing anal fistulae * You won't have malignancy panproctocoloectomy is curative Note: Although this question is about a ratio that you probably don’t know; it can be solved by exclusion. All other choices were wrong. 21 year old male had massive UGI bleeding, was managed medically in the weekend and 2 days later endoscopy was done and it was normal, most likely diagnosis: esophageal varices gastric varices angiodysplasia watermelon gastritis dieulafoy lesion* what causes is an independent risk factor for HCC without causing cirrhosis: HBV* HCV HDC EBV Pt with Hip replacement surgery and prolonged hospital stay, developed Medicine 16/5/2021 questions 9. 10. 11. 12. 13. diarrhea, what is the most likely cause: C.difficile Alcoholic patient with history of bleeding varices .things to do to decrease recurrence except ? Proponol banding TIPS stop alcohol spironlactone* A patient with suspect spontaneous bacterial peritonitis, how to confirm it? Peritoneal aspirate with >250 neutrophils* Pt with DM, cirrhosis, bronze skin, infertility you get that what is true(hemochromatosis): autosomal dominant C282Y is a common mutation * early detection wouldn't change course A fairly young male patient complaining of dysphasia to both solids and liquids had an endoscopy performed that showed dilated esophagus with difficulty passing through the GE sphincter. What is the most likely diagnosis? hypertensive GE sphincter achalasia * Extrinsic compression A 25 year old lady with one year history of diarrhea, anemia and vesicular skin lesions on her extensor surfaces. Anti endomysial antibodies were negative. What is the best next step? Stool analysis colonoscopy Upper endoscopy* Note: negative celiac antibodies do not necessarily rule out celiac disease especially with high degree of suspicion. 14. Risk of chronicity of hepatitis B in an infant after transmission from mother: 5 10 50 75 95* Infectious diseases 1. Most common cause of viral encephalitis HSV* CMV VZV EBV West nile virus 2. Which on the following is true about SIRS Bands more than 10% 3. About brucellosis, what is wrong: more common in males most common focal lesion is in bone B. abortus is the most virulent (wrong.. its meletensis) 4. AIDS defining disease: CD4<300 viral load >10000 TB* VZV 5. HIV in jordan, what is wrong: vertical transmission has occured 3000 case including undiagnosed cases affects males more than females risk age group is 15-20 (wrong, it 25-35) 6. What is the risk of being infected with HIV after needle stick injury? - 0.3 % * Medicine 16/5/2021 questions - 30 % - 3% 7. A man complains of itching around his anus especially at night. He was found to have a worm infection and it was 2 cm in length. What is the worm Enterobius vermicularis* Ascaris 8. What is correct about TB: Meningeal TB has low infectivity* surgical mask is approved for reducing risk of transmission (note it is a special tight mask that is approvred-check its name from the lectures) positive pressure rooms are for reducing risk of transmission