Internal Medicine 6th Year 2023

Internal medicine 6th year 2023 Psychiatry 1- which drug is considered an antidepressant? 2- a girl who came to the ER repeatedly with normal physical complaining of feeling of impeding death..... take a psychosocial history from her. 3- doctor patient relationship: certain roles must be played 4- depression: is a disability Dermatology 1-wrong about urticaria and angioedema: - the primary lesion is macule (it is wheal) 2-Wrong about primary lesions: - macule is change in color of skin within slightly raised lesion* - bulla is raised fluid filled lesion > 0.5 cm - papule is raised lesion 0.5 - 1 cm 3-Wrong about psoriasis: - It can affect infants - asymmetrical oligoarthritis is the m.cpresentation in psoriatic arthritis Neurology 1- What causes reversible dementia : -alzheimer -pick's -normal pressure hydrocephalus -? 2- internal carotid TIA is NOT likely to cause : -amoursis fugax -diplopia -hemiparesis -hemisensory loss -?? 3-anterior lobe is not responsible for: -high intellectual fxns - personality -verbal * -conjugate eye movement 4-lower motor neuron disease causes: Fasciculations Nephrology 1. Male tired for 5 days then sudden dark urine: - IgA deposit in Capillary* (the answer is either IgA deposits or crescent formation depending on how you diagnose) 2. Case of alport, ocuular problem; - Ant. Lenticonus* - Lens dislocation 3. Female with pyelonephritis, crystal u see in urine: -Magnisium, - urate, - phosphate* -Cystine 4. Not a risk for kidney stones: a. Hypercaleuria b. Hypercalcemia C. Hypercitraturia* D.hyperurecemia 5. Patient with persistent HTN, Cr 4.4 not responding to medication, Next step: a. Renal doppler US (i think this) B. Renal angiography 6. Male with UTI, u see in UA; WBCs cast* 7. Dialysis in ESRD, mcc of death: -Cardiovascular (ex MI) 8. Acid base disorder: Posthypercapnic metab alkalosis* 9. A bipolar patient was prescribed SSRI , he has poyluria polydipsia , serum osmolaltity was low ~165 . Urine osmolality was also low ~60 . What is the diagnosis: 1. DI 2. psychongenic polydipsia** 3. SIADH 4.? Respiratory 1. Trauma to chest with rib fracture , mechanism of hypoxia: (The presentation was that of ARDS with bilateral chest infiltrate and PaO2 not responding to 100% O2) so you conclude that this is intrapulmonary shunt -Shunt*** 2. To prevent decrease in FEV in COPD: -Smoking cessation* 3. Not in Sarcoidosis: a. BAL with abundunat neutrophil* b. Hypercalcemia 4. Patient with severe respiratory distress: -Intubation** 5. Patient with CURB 65 score 4 MANS: ICU admission with IV ceftriaxone and IV Azithromycin and IV fluids 6. Asthma patient came for follow up he is on salmetrol and inhaled steroid with good control ... what to do ? - Salmetrol with half dose inhaled steroid (i guess) 7. Patient with massive pe all can be found on P/E except ? a. Loud p2. b. S3 C. Reversed Split of s2 (actually there will be a loud P2 with enhanced physiologic (wide) splitting but no reverse splitting so the answer is C reversed splitting of s2) 8- when is non-invasive ventilation not needed?--Obesity hypoventilation syndrome 9- patient with acute respiratory acidosis due to pulmonary edema from heart failure, he is tired but still oriented and awake..management? -SABA with IV furosemide Rheumatology 1. Shoulder stiffness w -ve Rf : -Polymyalgia rheumatica* 2. Drug induced lupus: -Hydralazine* 3. Not in Dermatomyositis ? -Calcinosis , -erythema nodosum , -fissuring of finger tips 4. 21 FEMALE Spiking fever, with knee pain her mother had a hx fo knee pain: a.Still's disease* b. Juvenile RA 5. Female with microscopic hematuria and lower limb, least: -Scleroderma* -Wegner 6. Patient with RA taking methotrexate, suddenly developed one joint swelling, dx: Joint aspiration** 7. Patient underwent abdominal surgery, in 5th day developed wrist pain and erythema: a. Acute vasculitits b. Reiter* 8. Renal crisis in Scleroderna:: captopril 9.Not a cause of mononeuritic multiplex: -uremia 10. A pt develops acute painful red tender wrist in hospital after 3 days of abdominal surgery, Most likely cause: -Gouty* -Reactive -Endocarditis -Palindromic 11.A young female with palpable lower limbs purpura, microscopic hematuria and FOB. Least likely cause is: -Systemic sclerosis -Microscopic polyangiitis -SLE -IgA Infectious 1.HAV, not true: a. Viral shed in feces at onset of sx** 2. Vaccine CI in immunocompromised:: -MMR* 3. Most infective TB: -Cavitating pulmonary** 4. Follicular tonsillitis: a. Strep A b. Strep. Pyogens*** 5. Treatment of HIV; a. Start when diagnosed***** b. When CD4 < 250 6. Tinea: a. cystcercosis caused by tinea B. Tinea solium in cattle** C. Tinea Saginatum in pork 7. Not a side effect of Metronidazole: -Red man syndrome* 8. Antiretroviral drug:: 9. 90% congenital rubella syndrome if mother got infected in first trimester 10. CSF :low glu ,,high protein,,lymphocytes, least likely : -Brucellosis -TB -HSV * -Sarcoidosis 11. Chylothorax wrong : cholesterol more than 200 HAV does not cause splenomegaly .! Cardiology 1. Pericarditis ttt--> colchicine* 2. NHL w months ago with sx and sx of effusion: pericardiocentesis** (Patient was having pulsus paradoxus and therefore it was tamponade that's why the answer is pericardiocentesis) 3. Patient with prev. MI from 3 years, came for follow up and he is asx but st elevation V2-V4, dx: Left ventricular aneurysm** 4. ECG : ECG was showing complete 3rd degree heart block (hint: before rushing to say there is progressive prolongation of PR interval look for dissociation between P and QRS which was the case in our exam) 5. Cardiac markers: a. Isoform CKMB is more sensitive*** b. Troponin can indicate re-infarct 5. According to JNC 8, not considerd as 1st line : B. B-Blocker **) 6. V. Fib ECG --> defibrillation 7. Patient with chest pain not relieved by NTG: Dx: CT aorta with contrast** 8. Poor prognosis in inferior MI: Elevated JVP*** 9. Pt. with lower acute limb pain, least likely: Constrictive pericarditis* 10. Patient sar 3ndo elevation bel creatinine after taking anti hypertensive drugs from which one was lisinopril .. He is normotensive now what to do ? Stop lisinopril , continue medications Endocrine: 1.50 year Patient with HBA1C 6.8 and FBD 180, normal KFT: next step Metformin and life style modification** 2. Female with thyroid nodule normal TFT, next step: FNA** 3. Patient with subacute viral thyroiditis with HR 110, palpitation, next : Observation Propranolol* 4. Patient with hyperglycemia hospitalized: Insulin basal and pre-prandial 5. Patient with Acromegaly, best to diagnose: Glucose supp. Test* 6. Female with hypercalcemia and Normal PTH, her brother has Hypercalcemia, next step; Urine Ca and creatinin* 7. 76 yo male with TSH 66 not improved in 2nd lab test: a. Levothyroxine 25 mcg* B. Levothyroxine 100 mcg C. Uptake and scan The patient is elderly and had hx of heart disease that's why you start with low dose thyroxine unlike what you would do with a young pt with no cardiac hx 8. Patient on long term cortisol therappy and suddenly stopped, came with adrenal insuff sx; IV hydrocortisone* GI 1. Defferntiate between UC and chrons: A. Non- caseating granuloma 2. M.c.c of lower Gi bleed in elderly: Diverticulosis 3. Associated with H. Pylori : a. GERD b. Lymphoma* 4. Patient admitted as a case of diarrhea with recent hx of Abx use and colonscopy findings: Pseudomembarnous colitis 5. Wrong about C. Diff: Diagnosed by routine culture** 6. Cause of Liver fibrosis: - Methotrexate** 7. Netcracker with chest pain:: Hyperprestaltic movement of esophagus*" 8. Patient with recurrent duednal ulcer and diarrhea, dx:: Gastrin level with abdomin CT** Hematology 1. AML with M3 --> DIC 2. Young female Aplastic anemia --> allogenic BMT 3. Elderly with autoimmune hemolysis --> look for lemphoid problem and Hodgkin an NHL 4. Not used for Dx of NHL --> B2 microglobulin 5. Normal platelet count and increased bleeding time with gingival bleeding: --Glinzman thrombocthenia 6. Rivaroxapan mecahnism --> anti factor Xa 7. Male with iliofemoral thrombosis ???? 8. Patient with antiphospholipid syndrome --> not correcting with mixing study 9. Anemic with MCV 112 and macrocytes in smear, MANS : vit B 12 leve 10. All of the following distinguish qualitative platelet disorders except:: - platelet size 11.Not associated with sickle cell : 1. AML ** 2. Priapisim 3. Stroke 4. Acute chest syndrome 12.Best to differentiate bet. Hemophilia A and B:: Factor assay"**