Medicine Final Exam 6th Year 2020

Medicine final exam 6th year medical students 2020 Rheumatology 1- Patient with left sided weakness, don't do : Anti-CCP antibody.... 2- whats not likely with polymyositis : - ocular artery - raynauds - involvement of Extraocular muscles 3- Antibodies associated with congenital heart block Ro/ La 4- Reumatoid factor right : -directed against portion of IgM -related to disease activity -pathognomonic for RA -associated with milder disease -positive in cryoglobulinemia 5- If pt on azathioprine, which of the following we should pay attention when giving it - allopuranol 6- which of the following are likely to be HLA B 27 positive - young male with back pain and stifness - old male with symmetrical hand involovment -.... 7- all of the following in reactive arthritis except: - conjunctivitis - genitla ulcers - keratoderma blennorrhagia - tenosynovitis - balanitis 8- pt with elevated CPK, ALt, AST, all might occur in him except - dysphagia - raynaud - Interstitial Lung Disease 9- RA: erosive arthritis 10- Wegner's : - leukocytoclastic vasculitis - ANCA +ve - needs steroids and cychlophosphamide - associated with MPGN* Hematology 1- which of the following is the definitive test to distinguish hemophilia A from B: - PTT - factor assay** - male - X linked 2- which of the following is the characteristic cell seen in the peripheral blood in patients with autoimmune hemolytic anemia warm antibodies: - densely hemoglobinated spherocytes** - anisocytosis and poikilocytosis - helmint cells 3- Patient with : Anemia, Leukopenia and Neutropenia, thrombocytopenia.....Hypoplastic Marrow..... prestented with fever.... best treatment ? - Give Packed RBCs And Platelets and IV ABx... - Give GCSF & IV ABx - Give Steriods 4- Patient with increased Hb and WBCs and Platelets..... Dx. ? Polycythemia Rubra Vera 5- a young female, c/p menorrhagia and fever from 2 weeks, acute onset, no splenomegaly, she has 6 sisters and none complain of bleeding ... labs showed Hb 7, Plt 10,000, WBC 1000 with 2% neutophilles, bone marrow examination showed severely hypocellular bone marrow, what would you do to her? - immediatelly look for matched HLA to do bone marrow transplant - give her prednisolone and cyclo -Give Packed RBCs And Platelets and IV ABx... -Give GCSF & IV ABx & EPO - gice iron, vit b12, and folate replacement 6- CML vs leukemoid reaction vs ET vs PRV: Hb 14.5 , WBC 56000 , plts 960,000 , 80% neutrophils, 3% basophils all other myelogenous cells are present 7- with the advancement of iron chelating in patient undergoing frequent transfusion ... which is true - parentral deforexamine remains the drug of choice, 2 times a week - oral deferasirox is the first line treatment - once organ damage has established nothing can be done to reverse it 8- scenario of vit b 12 deficiency, what are the cells in peripheral blood - macrospheres - nucleated RBC -blasts 9- all of the following help to distinguish qualitative platelet disorder except: - platelet size* - clot retraction - platelet aggragation - bone marrow cytogenatics - platelet flow cytometry 10- AML with myelomonocytes what do u see in cytogenetics : inv 16 11- all of the following are indicated to stage a patient with NHL except: - brain CT - bone marrow - chest, abd, pelvic CT - LDH - bone scan 12- female told that she has heterozygous factor V leiden ... what would you tell her - start of LMWH for lifelong - start on heparin and warfarin then stop heparin - do nothing - do lower limb doppler and treat acoordingly 13- case of hypocellular BM, everything low = aplastic anemia : BMT (definitive Rx for patients who are young and have an HLA-matched family member (10-year survival > 80%). GI 1- Patient just returned from Thailand with Jaundice... least useful test: Acetaminophin level.... 2- Patient with elevated liver enzymes and proteinuria and low complement..... Next step: Test for Hepatitis C. 3- Patients taking Azathioprine should be also monitored if taking another drug: Allopurinol. 4- One of the following is an indication to repeat endoscopy : Hyperplastic Gastric polyp ??? Dr Said Esophageal Varices 5- Patient with intermittent Dysphagia..... and Esophagial webs..... and Eiosinophils on Biopsy.... best treatment : Inhaled corticosteroids sprayed in the mouth and swallowed ?? 6- Patient with UC, started 10 years ago, he is in remission now, asks you about frequency of colonscopy : -after 5 years since he is in remission -every one year -every 7 years for 14 years then every 3 years -do colectomy now 7- Patient with crohn's on azathioprine presented with perianal fistulas, what to do next ? -ASA oral -ASA rectal -pednisone oral -infleximab 8- 60 year old female, presented with high liver enzymes, normal GGT and Alk phosphatase, all are important for diagnosis except : -ANA -ferritin -serum ceruloplasmin -ANA -hepatitis C 9- Patient presented with upper GI bleeding, found to have duodenal ulcer on EGD and H pylori, you started eradication treatment, what to do next ? -restet by EGD 8 weeks later -by fecal antigen 8 weeks later -by serolgy -no need to repeat tests -keep him on omeprazole lifelong 10- Male patient, with 1 year history of diarrhea and weight loss, chronic alcohol ingestion, had recurrent abdominal pain in the past and underwent terminal ileal resection for appenditis, upper and lower GI endoscopy are normal, what to do next : -capsule ensoscopy -imaging of small intestine -h pylori testing -fecal elastase 11- Patient with crohn's, on azathioprine, presented with perianal abscess and intersphinter abscess, what to do next ? -ASA oral -ASA rectal -pednisone oral -infleximab - refer to surgery **** 12- pt with chronic liver cirrhosis and enchaphelopathy, all can be done except - TIPSS *** - large volume peritoneal tap - diuretics Respiratory 1- Alcoholic patient with Rt. upper lobe Pneumonia.... Most likely organism : Klibsella.... 2- Patient with Pnuemonia : RR:32 Age : 66 Urea : 78 BP: 75/55 CURB 65 is ?? 4 3- Polysomnography: Episodes of Decreased Flow (but not fully cessated) goes more with Hypopnea. 4- Flow Volume Loop: PROGRESSIVE SOB over 2 years with Box shaped FVL: - Retrosternal Goiter, hx of wheeze? Vocal Cord Paralysis (unlikely to be progressive?) 5- COPD Patient with Low O2 High CO2: V/Q mismatch with hypoventilation? 6- Pt with Kyphoscoliosis and High CO2: Hypoventilation. 7- Pressure volume curve : emphysema 8- spirometry., obstructive pattern ... which is the likely casue - bronchiolitis - chronic bronchitis - emphesema - sarcidosis -... 9- which goes with left heart faliure more than ARDS - po2/fio2 100 - pcwp 18 - increased left atrial pressure** - .... 10- which is the least likely cause of upper airway obstruction - epiglotitis - TB - pneumoccus - ??? 11- all of the following may trigger asthma except - normal saline** - methacoline 12- Pt with pneumonia o u started him on antibiotics next day his xray showed multiple pocketing what do u do: Wait for antibiotics to work Chest tube and streptokinase** Endocrinology 1. Old man with Recent Dx of DM, well controlled, taking Simvastatin, Glimeperide, Other 2 drugs.... Presented with Peripheral Neuropathy... What explains that? - DM Induced Neuropathy. - Glimepiride. - Simvastatin induced Vitamin B12 Deficiency. - Metformin induced Vitamin B12 Deficiency 2- 11 weeks pregnant woman with Nausea and Vomiting, TSH:low , free t4 & t3 : upper limit of normal...... dx. : Hyperemesis Gravidarum. 3- turner syndrome which is least likely : 1) fsh 5 (4-9) 2)tsh 10 3) under developed breasts 4) low estrogen 4- klinfelter syndrome what is least likely to find : 1) soft normal testicles** 2) azoospermia 3) upper body higher than lower 5- hypoglycemia and high insulin and low c-protein : - psychiatry evaluation** - urine sulfonylurea 6- Patient with limited financial status she has typical symptoms of hypothyroidism , what is the next step TSH Scan U/S 7- Patient with raised plasma metanephrines, which drug shouldn't be used as initial treatment for his HTN Propranolol ACEIs CCB alpha blocker Cardiology 1- Patient with prolonged fever & weight loss, changing murmur , and embolic phenomena, ESR 70, Echo showed Lt. Atrial mass.... dx : Atrial Myxoma infective endocarditis. 2- ECG : SVT..... Give: IV Adenosine... 3- patient with inferior MI, became hypotensive with edema and elevated JVP.... Management : Give 500ml bolus plus 100ml/hr fluid... 4- Which of the following Causes Short QT Interval: Digitalis 5- ECG showing STEMI whats not true : wait until cardic enzymes are elevated to treat patient presented with peaked t wave , proloneg PR interval , wide QRS , what to give the patient IV calcium iv magnesium iv phosphate iv potassium 6- 70 year old male presented for evaluation for his HTN, on echo he was found to have aortic stenosis with area of 1 cm, gradient 50, LVEF 52%, asymptotic, how to manage : - aortic valve replacement -aortic valve repair -medical management and modification of risk factors 7- Who should receive prophylaxis for infective endocarditis : -ASD -VSD -tetralogy of fallot 8- Young male patient, complains of headache especially after exercise, has grade 3 systolic murmur on aortic outflow tract, radiating to carotid, A component of S2 is spared, next step : -echo -measure blood pressure in upper and lower limbs 9- ECG for patient with BP 70/50, treatment: -defibrillation -synchronized DC shock 10- which is correct - ASD premimum is associated with AF - ASD secondum is associated with BBB*** 11- which is the mcc of infective endocarditis - s aureus - s epidermidis - GBS 12- ECG showing delta wave and wide qrs...wpw ( accessory pathway parallel to av node) 13- Patient with st elevation in 1, 2, 3 , vi ,, (multiple leads) and has chest pain increased by breathing u give him: Colchicine* Aspirin and heparin 14- HCM asx: treadmill stress test 15- Bad prognostic factor in MI: female gender the degree of ST elevation Infectious Diseases 1- One of these goes with Dx of AIDS : CD4 count = 300 2- pcp pneumonia : CD4 < 200 3- bacillus cerues : rice 4- Man went to india now has bloody diarrhea all of these are possible except : Shigella Salmonella Cholera** Campylobacter 5- Patient has prostatitos for which he takes an antibiotic he now developed right shoulder and he cant move his arm what can this antibiotic be Cipro* Sulfa-trime Doxycyclin Ampicillin 6- Common variable immune deficiency, which is true : -recurrent infections in childhood - low IgA and IgG -decreased b lymphocytes 7- which is false about sepsis: blood culture is positive in 80% of cases 8- Bacterial meningitis : neutrophils and glu < 20 9- endocarditis "bdon infective 7ta" mostly by : -staph aureus** -staph epidermides -strep pneumo -group A beta hemolytic -strep bovis 10- CVID: Common variable immune def: correct is : low IGs (IgG, IgA, IgM) Misc. (Neurology+Psychiatry+Dermatology) 1. Among the following, which one is considered the most common presentation of Multiple Sclerosis: Optic Neuritis. 2. Not used to treat Status Epilepticus: Carbamazepine. 3. Which of the following is used in opiate detoxification? - Naloxone - Methadone . 4. True about Bullous Pemphigoid: - Flaccid Bullus - Poor General Health. - oral involvement is common - related to urticarial illness 5- arm , face leg stroke : int capsule Thalamus 6- which of the following is likely to represent a CSF with bacterial menengitis - glu (low), WBC high, neutrophiles high 7- all of the following are indicators to do CT before LP except: - focal neurological sx - papilledema - seziure - comma - bilaterla kerning sign positive 8- all cause acquired icthyosis except diabetes mellitus Hyperparathyroidism 9- A patch with irregular , spreading, varying shades of pigmentation most accurately represents which of the following types of melanoma: 1) Superfical spreading melanoma <----- I believe this is the answer 2) Acral lentiginous. 3) Nodular. 4) Lentigo maligna. 5) SCC 10- which of the following indicate alcohol dependancy - drinking at morning 11- small hippocampus + complex partial seizures (originating in temporal lobe)..... which was most likely to be present in the patient's history, not sure of the choices.... I remember : Hx. of childhood febrile seizures neurofibromatosis DM 12- bullous pemphigoid : related to urticarial illness** general bad condition = oral involvement = acantholysis (which are in pemphigus vulgaris) 13- Pt with peripheral neuropathy all of these justified invistigations except B12 DM HIV test Vit d * not sure 14- not a cause of pseuotumor cerebri (IIH): Tetracycline hypervitaminosis D DM hypothyroidism hypervitaminosis A Nephrology 1- Acid base problem : Non- anion Gap acidosis + Anion gap acidosis : Salicylate poisoning. 2- patient with lower limb edema, started 2 years ago, presented with flank pain, protein to creatinine ratio in urine = 9 renal vein thrombosis: so: renal U/S + duplex... 3- 40 yr old female Patient with Hodgkin Lymphoma plus Nephrotic Synd. .... Cause of Nephrotic Synd. ?? Membranous GN or Minimal Change disease. 4- Case of 16 year old boy.... with dehydration and hypernatremia +Hypokalemia and Elevated urine Ca.... Dx: Barrter Synd. 5- Patient with sever HTN and low Potasium and high Sodium and Alkalosis... and low Plasma Renin Activity.... Best Treatment ACE Amiloride Spironolactone 6- acid-base problem : young female with vomitting and naseua , pain 2ry to renal stones, labs : Na 140 , K 3.sth , bicarb 20, CO2 43 , cl 109 , what is the acid-base status (without pH !!) elmohem: 1- "Non" anion gap metabolic acidosis 2-"normal" anion gap metabolic acidosis with respiratory alkalosis 3- wide anion gap metabolic acidosis 4- wide anion gap metabolic acidosis with respiratory acidosis 5- respiratory acidosis 7- pt with polyurea, Nocturia for 1 week, wt loss. Na normal, K normal, serum osm 300, urine osm 200 ... ?? - DM - DI... 8- which is not the correct match of mechanism of action of diuretics: - hydrochlorothiazide: NaCl cotransporter in the cortical collecting duct - acetazolamide: CAI in the distal tubule - spironolactone : compete aldo at the receptor at the DCT - furo : inhibite NaK2Cl at thick ascending loop 9- female with hematurea after exercise for the last 2 weeks, mild muscle tenderness ..... what is the likely cause - IgA nephropathy - PSGN - wegener - Rhabdomyolysis 10- Hodgkin's lymphoma: MCD 11- Patient with resistant hypertension otherwise normal has b.p of 160/100 and has strong family history of htn, father died at the age of 30 because of stroke and he has hyporenimic hyperaldosteronism on imaging adrenals are normal next start him on: Amiloride Spirnolactone Thiazide Furosemide