4th Year Medicine Exam 2020

4th year MEDICINE exam 2020 Rheumatology 1-Which of the following is true regarding Rheumatoid arthritis: RF is not specific for the disease. 2- Not involved in Rheumatoid arthritis? Thoracic intervertebral joint 3- Which doesn't indicate severe rheumatoid arthritis? Acute onset 4- Not from SLE criteria? Oral ulcers / neutropenia / perotinints/ thrombocytosis* 5- True about Diffuse scleroderma? Reynaud's precedes sx many years. renal crises occurs early in less than 20% of pts* 6- 16 year old young lady, works in nursing, had vomiting, abdominal pain,,, Polyarteritis Nodosa 7- young male pt, has lower back pain of 3 moths duration, improve with exercise what will reveal the dx? HLA-B27 X-ray for sacral spine* 8- Wrong about EGPA (Eosinophilic Granulomatosis with Polyangitis)? Fixed infiltrates on CXR 9- 70 year old lady, complains of headache in temporal area, with jaw claudication, on examination she had scalp tenderness, almost absent pulse in temporal artery, next step to confirm dx ? Temporal artery biopsy Respiratory 1- Pt, came with acute asthma attack, cyanosis, wheezing, all of the following findings indicate that it is sever except: cyanosis bilateral wheeze** 2- COPD patient, developed pnemothorax, all are signs goes with the dx except??? hyperreasonance on percussion decreased transmitted sounds on the side of pnemothorax Increase tactile vocal fremitus 3- Lady with history of 1 year cough, she is a cleaner in a bakery from 2 years, the symptoms improve in holiday and off days, dx? Occupational asthma 4- Pt has respiratory symptoms, recurrent RTI when he was child, he and his partner are visiting doctor for infertility, p/e: clubbing, most likely he has? Cystic fibrosis Bronchitis Primary Ciliary Dyskinesa* 5- Flow volume loop, dx? Tracheal tumor 6- PFT results table showing the finding and the expected (normal) values, [↑RV, ↓FEV, ↓FVC, ↓DLCO] dx ? Emphysema 7- Pt with pneumonia, 67 year old, awake, RR 28, BUN 50, BP 85/56, CURB65? 3 8- Not in PE? Loud A2 9- Not in OSA? Large chin 10-Not related to OSA? Hypergonadism GERD 11- Upper large mass, ↑Ca++ , caviating? squamous cell carcinoma 12- case of progressive dyspnea and dry cough for 6 months, CXR shows infiltrates IPF 13- old patient was treated with radiotherapy for Hodgkin 30 years ago, came with pleural effusion yellowish in colour, rich in lymphocytes and atypical cells, he is not a smoker, most likely the cause is? adenocarcinoma recurrence of Hodgkin 14- case of pleural effusion Infectious 1- regarding brucellosis what is true? b.canis most common in sheep and gouts most common focal disease in MSS* 2- in case of needle stick, base line test should be done for all of the following except? Baseline for HVC baseline for HIV PCR… 3- Which of the following needs only contact isolation? TB measles influenza MRSA* 4- Which of the following is not a defining disease for AIDS? CMV retinitis TB Kaposi sarcoma cryptosporidiosis Oral candidiasis* 5- true about HIV? Increased number of survivals 6- What is the most common cause of diarrhea in adults? rotavirus Norovirus* 7-most common Ig deficiency IgA 8-a parasite causing IDA? 9- true about sepsis? Hypothermia is a poor prognosis sign 10- which one of the following causes erysipelas? Group A -β hemolytic streptococcus 11- doesn't cause severe diarrhea? Bacillus cereus Cardiology 1- ECG , dx ? - type 2, 2n degree heart block 2- Case scenario of bradycardia, chest pain, and hypotension? IV adenosine 3- Case of weak femoral pulse (aortic coarctaion) what to do in ER ? ct angio/ give plavix/ ct with contrast 4- does not incease the survival in HF? digoxin 5- Doesn’t increase troponin? Pericarditis Acute heart failure 6-not a risk factor for CAD? OCP Obesity hypertension 7- Regarding cardiac enzymes, what is wrong? troponin can be used 8 days after MI to asses re-infarction 8- case scenario of peripartum cardiomyopathy 9- patient with signs of right Heart Failure, clear lungs, was treated with radiation for Hodgkin.. ? Constrictive pericarditis 10-Fixed splitting of S2 throughout the respiratory cycle,, Dx? ASD 11- All of the following conditions cause chest pain on exertion EXCEPT? Aortic stenosis uncontrolled HTN HOCM Constrictive pericarditis* Nephrology 1- Distinctive for distal RTA? Kidney stones */ fanconi syndrome/ hypokalemia/ hypercalceuria 2- Case scenario most likely APKD, which of the following goes with the dx? Cerebral aneurysm 3- ABGs and electrolytes results [PCO2=38, pH=7.12, HCO3- =12] dx ? Anoin gap metabolic acidosis and respiratory acidosis HAGMA and respiratory acidosis 4- Case of hematuria, all investigations and U/S normal, next step? Doppler ultrasound/ renal biopsy 6- Patient with abdominal pain, purpuric rash on legs and hematuria, Dx? HSP 7- patient treated with gold for 5 years, RA for 30 years presented with nephrotic syndrome, most likely Dx? Renal amyliod Gold induced membranous nephropathy 8- Not a cause of hyponatremia? lithium 9- Hematology 1- not a risk factor for developing VTE: sickle cell disease obesity homozygous leiden V 2- not an acute complication for blood transfusion: Rh hemolysis 3-CML case t(9,22), with ph chromosome 4- patient with heridetry spherocytosis presented with ↓Hb, ↓reticulocytes,? Parvovirus B19 5- a case of TTP? ↓ADAMTS 13 6- wrong in polycythemia vera? 50% become AML 7-doesn’t occur in blood transfusion? hypokalemia 8- Young patient with painful axillary and inguinal lymph nodes, abnormal lymphocytes ( most likely EBV), what is the most common cause of this problem? Close contact with another person 9-Seen in advanced melanoma? ↑B2 microglobulin 10- wrong about Ig of ABO system? They frequently cross the placenta causing hemolysis 11- a case of HIT, most likely seen? Skin necrosis at injection site GI 1- not found in celieac disease duodenal biopsy: lymphocytes infiltrate eosinophilic infiltrate* ? villous atrophy crypt hyperplasia crypts of Lieberkühn 2- male, MRCP showed bleeding of the bile ducts, Dx? PSC 3- An alcoholic patient with epigastric pain for 3 months, all of the following you can do except? HAV IgM 4- patient had clostridium defficile infection and diarrhea, now he doesn’t complain of anything, what to do? do not do anything 5-which is not associated with severe Ulcerative Colitis flare? Abdominal pain Extra-intestinal manifestation (arthritis) tachycardia stool per day bleeding per rectum 6-patient with cirrhosis has massive UGI bleeding, which of the following doesn’t contribute to his decompensation? spironolactone 7-patient with jaundice and history of CBD stone and ERCP, most appropriate next step? MRCP 8- Patient with Wislon's disease, which is wrong? ↑ alkaline phosphatase 9- 70 year old female patient with lower abdominal pain and constipation, she had similar symptoms in the past, most likely cuase? Sigmoid volvulus diverticular disease colon dyskinesia Endocrinology 1- Vitamin D deficiency what is wrong? normal PTH 2-female patient, ↑ serum Ca ↑PTH ↓urine Ca, and family history of ↑ Ca, dx? FHH 3-Normal TSH, thyroid nodule, MANS? FNA 4- Erectile dysfunction in a 29 year old man, most common cause of his condition? psychological diabetes 5- ↓FSH, ↓LH, ↓Testosterone, and anosmia, Dx? Kallman syndrome 6- male with goiter, ↑T4, ↓TSH, MANS is? 24 hour urine cortisol 7- Adrenal insufficiency, MANS? ACTH stimulation test 8- Patient with cushing, ↑ 24 hr urine cortisol, MANS? ACTH level 9- Patient with signs and symptoms of cushing MANS? 24 hr urine cortisol 10- Acromegaly, diagnostic test? OGTT 11- Acromegaly, best treatment? trans- sphenoidal surgery 12- Psychotic patient, which drug causes her ↑Ca? lithium 13- Obesity doesn't cause? osteoporosis Arteriosclerosis 14- diagnostic test of diabetes? FPG< 127 several times 15- hypoglycemia + ↑ insulin, MANS? C-peptide Pro insuiln