Internal Medicine 4th Year 2023

Internal medicine 4th year 2023 Cardiology 1234- Wrong about constrictive pericarditis – pulsus alternans Patient with stable angina, not a factor that increases risk of adverse event – high HDL Not a component of the metabolic syndrome – LDL > 130 A character that makes the atheromatous plaque less likely to cause ACS – high smooth cells 5- Not a drug that reduces mortality in a patient with congestive heart failure – furosemide 6- ECG – complete heart block 7- Least likely to cause systolic dysfunction – severe mitral stenosis 8- Least likely to cause atrial fibrillation – hypothyroidism (mostly) 9- A patient with bilateral lower limb edema and normal JVP, most likely cause for their edema – nephrotic syndrome 10- A patient receiving doxorubicin for their osteosarcoma, their heart failure grade is – A 11- A patient with left upper sternal border systolic murmur, ejection click, single S2 and a parasternal lift, most likely cause – pulmonic stenosis 12- A patient with a systolic murmur that increases with standing and valsalva, and decreases with squatting, most likely cause – hypertrophic obstructive cardiomyopathy 13- Thiazide does not cause – hypouricemia 14- Blood pressure 135/92, stage of HTN is – stage 1 15- A patient with hypertension, most likely cause of death is – CAD (mostly) 16- A patient on sildenafil, contraindicated drug – nitrite 17- Next step in helping a gasping, unresponsive patient – call 911 Pulmonolgy 18- Flow volume loop – emphysema 19- Flow volume loop, part not changed – maximum inspiratory flow rate 20- Wrong about asthma spirometry – FEV1/FVC <75% 21- Best tool for the diagnosis of asthma – spirometry with reversibility 22- Best for the evaluation of severity of asthma attack – FEV1/FVC (maybe) 23- Doesn’t cause chest wheeze – IPF 24- Not associated with normal or high DLCO – emphysema 25- Most significant for the diagnosis of cystic fibrosis – sweat chloride test >60 26- A patient presenting with facial swelling and neck dilated veins with shortness of breath, most likely – SVC obstruction by a lymph node 27- A patient with bilateral chest infiltrate, something that favors him to have ARDS rather than cardiogenic edema – pulmonary venous wedge pressure of 18 28- Strep pneumonae pneumonia, wrong – poor response to treatment (mostly) 29- Alcoholic and smoker with pneumonia, wrong – blood culture has high yield 30- Not a cause of tissue hypoxia – increased EPO Gastroenterology 31- A 55-year old patient presented with bleeding with feces and claims to have hemorrhoids, what’s next to do – upper endoscopy or colonoscopy (not sure) 32- An indication for acute hepatic failure in viral hepatitis – PT 33- Not a cause of unconjugated hyperbilirubinemia – Rotor’s syndrome 34- Negative in primary sclerosing cholangitis – AMA 35- A patient with 2 years of solid and fluid dysphagia, no weight loss or anemia, most likely cause – achalasia 36- Wrong about gastric ulcers – not sure 37- Wrong about duodenal ulcers – causes malignancy (mostly) 38- Not used in diagnosing H. pylori – culture 39- True about Celiac disease – associated with GI lymphomas 40- The least important Hepatitis B serum level – HbcAg 41- Not a mode of transmission for hepatitis B – fecooral 42- Bile acids and B122 are absorbed via – distal intestine Endocrinology 43- A patient with thyroid nodule, hypoechoic on US, next step – TSH 44- A cause of low uptake thyrotoxicosis – factitious thyrotoxicosis 45- A patient with decreased libido, fatigue, small, firm testicles, family history of infertility, 1.92 metres in height, next step – karyotyping 46- Gold standard for confirming low growth hormone in a child with short stature – Insulin Tolerance Test 47- Not associated with insulin resistance – cystic fibrosis 48- Hypoglycemic patient with high insulin and low C-peptide, most likely cause – exogenous insulin 49- A patient of multiple myeloma and constipation, Ca is 10.2, next step in evaluating Ca – serum albumin 50- A an asymptomatic patient with high calcium and normal PTH, normal creatinine, most likely cause – primary hyperparathyroidism 51- Not a cause of high phosphate and low calcium – vitamin D deficiency 52- A patient with adrenal insufficiency on steroids, not an indication to increase steroid dose – hypertension 53- A patient suspected to have Cushing’s syndrome, has positive low-dose dexa test and 24h urine cortisol, next step – serum ACTH 54- A patient with weight loss, decreased appetite, fatigue, hypotension. Has Hypothyroidism and vitiligo, next step – ACTH stimulation test for cortisol 55- Confirms DM diagnosis - polydipsia, polyuria, weight loss and FBG of 135 Rheumatology 56- A patient with SLE, presented with multiple seizures, least useful test is – CBC blood film (mostly) 57- A patient with systemic sclerosis, presented with shortness of breath and dry cough of months, least useful test is – kidney function 58- Most likely eye manifestation seen in RA is – scleritis 59- Mostly is RF negative – ankylosing spondylitis 60- A patient with knee swelling and pain, clacinosis in the cartilage and negative culture, mostly – pseudogout 61- True about polymyositis – acute proximal muscle weakness (mostly) 62- Unique about psoriatic arthritis – arthritis mutilans 63- Consistent with hemochromatosis arthritis – involves the 2nd and 3rd MCPs as in OA 64- True about enthesitis – the inflammation of ligament or tendon insertion to bone 65- Neonatal lupus has – anti-Ro and anti-La Nephrology 66- AKI and hyperkalemia, least likely cause – vomiting 67- Hypokalemia, hyperchloremia, low bicarbonate, normal BP, urine pH is 6.5, most likely cause is – RTA 68- Not associated with hypokalemia – Addison’s disease 69- 17 years old with lower limb swelling and proteinuria, DM1 since 4 years, controlled. Most likely diagnosis – minimal change disease 70- A patient with colonic cancer, developed proteinuria and hematuria, mostly – membranous glomerulonephritis 71- A patient with MI, persistent hypotension for 3 days, developed AKI with granular deposits in urine, mostly – acute tubular necrosis 72- A patient with thigh abscess, treated, developed hematuria, proteinuria, positive urine WBCs, RBCs and eosinophils, mostly – drug-induced interstitial nephritis 73- Absolute indication for dialysis in stage V CKD patient – pericarditis 74- A bad prognostic factor for a patient with diabetic nephropathy – BP of 155/95 75- An intubated patient with normal BP, JVP and no swellings, has hypernatremia, urine osmolality is 350, most likely cause – SIADH 76- A patient with crush injury, developed heme positive, dark urine with no RBCs, most likely – rhabdomyolysis 77- Wrong about nephrotic syndrome – hypertension 78- True about kidney blood supply - NSAIDs cause constriction of the efferent arteriole Hematology 79- Consistent with IDA – hypochromic, microcytic cells, poikelocytosis, anisocytosis, normal platelets and WBCs 80- Consistent with autoimmune hemolytic anemia – spherocytes, retic 8%, positive direct antiglobulin test 81- Thrombocytopenia, consistent with DIC – prolonged PT, PTT and TT 82- Consistent with Glanzmann’s thrombasthenia – prolonged BT, normal PT, PTT, TT and Plt, and absent clot retraction 83- Genetic test for hemophilia A – intron 22 inversion 84- Poor prognosis in AML – deletion 7 85- WBC 52k, no blasts, positive APL/BCR, mostly – CML, chronic phase 86- True about NHLs – mostly are B cell 87- Drug known to trigger G6PD hemolysis – sulpha containing drugs 88- A patient with HL, LN involve cervical and inguinal groups, and there is no involovemnt of the spleen, liver, bone marrow or mediastinum. The patient complains of sweating, weight loss and fever, his stage – IIIB 89- Most common mutational thrombophilia associated with VTE is – factor V Leiden 90- More likely to cause TRALI – multipara woman Infectious diseases 91- Wrong about influenza vaccine – contraindicated in bone marrow transplant patients 92- Wrong about Brucellosis – transmitted from humans to humans, and most common cause of death is splenic abscess 93- A patient developed epigastric abdominal pain 4 hours after eating custard, mostly – Staphylococcus aureus 94- Most common cause of cellulitis – Staphylococcus aureus (Streptococcus pyogens is more common but it was not a choice) 95- An antibiotic that causes arthropathy – levofloxacin 96- An antibiotic contraindicated in pregnancy – doxycycline 97- An antibiotic that triggers G6PD hemolysis – trimethoprim/sulphamethoxazole 98- The percentage of transmitting HIV infection from the mother to the child – 25% 99- Not in the management of common cold – antibacterial drug administration 100True about C. difficile – diagnosed via stool toxin