Medicine Exam 6th Year 2022

Medicine Exam 6th year - ***Infectious*** 1-AII true about C.difficle Except : a-most antibiotic-induced diarrhea not caused by CD b-most cases of pseudo membranous colitis are caused by CD c-may be found in healthy people d-immune complex mediated* e-Metronidazole is DOC 2-AII true about staph.Aur. food poisoning except: a-fever* b-nausea and vomiting c-Diarrhea less than 24 Hours d-abdominal cramping e-attack rate >80% after initial infection 4-AII true about Gastric Ulcer except : a-mostly caused by H.pylori and NSAIDs b-increased basal acid secretion* c-when doing endoscopy take Bx to r/o neoplasm d-do H.pylori testing to confirm eradication 5-primary sclerosing cholangitis, all true except: a-anti mitochondrial ABs* b-increased Alkaline phosphatase c-increased circulatory immune complexes d-P-ANCA 6-all true about intrahepatic cholestasis in pregnancy except : a-jaundice is common b-increased risk for post par tum hemorrhage c-takes many months after delivery to turn back to normal d-increased bile acids in blood* ***GI*** 1-least useful to Dx H.pylori : a-urea breath test b-rapid urease test c-stool antigen test d-tissue culture for Gastric ulcer* e-tissue histology for Gastric ulcer 2-Anti -Calprotectin, True Except : a-express neutrophills activity b-bind Ca and Zinc c-indicates inflammation d-small intestinal inflammation* e-correlates with Ulcerative colitis activity 3-patient with UC, increased Alkaline phosphatase, increased Bilirubin, Normal AST/ALT, next step : a-Abdominal CT b-ERCP* C-Liver Biopsy d-Liver U/5 7-About SBP, all true except : a-mcc is E.Coli b-fever isn't always present c-recurrence rate > 20% per year d-neutrophils >250 sufficient for Dx* c-Aibumin infusion prevents renal failure 8-patient with jaundice, his sister died 2 years ago with liver disease, low ceruloplasmin, increased ALT/AST, normal Alkaline phosphatase, next test is : a-24 hour urine Copper measurement* b-liver Biopsy* c-liver US d-serum protein electrophoresis 9-AII true about osmotic diarrhea except : a-osmotic gap > 125 b-doesn't decrease at night c-Anemia not common d-dehydration is the role* e-malabsorption and laxatives are common causes e-tracheal stenosis 10-Good prognostic factors for HCV infection except : a-Obesity* b-young age c-genotype 2 d-decreased HCV RNA e-minimal liver fibrosis 4-all goes in favor of emphysema rather than chronic bronchitis : a-Age b-family Hx c-DLCO less than 60% of normal d-methacholine challenge test* 11-Patient with cystic fibrosis, all true except : a-brochiactatic changes in upper lobes on CXR b-vitamin B12 is the most common vitamin deficiency* c-infertility due to absent vas deferens d-Dnase replacement part of treatment e-autosomal recessive chromosome 7 5-polysomnography : Central sleep Apnea 12-Fiu-like illness, fever, became jaundiced, normal ALT,AST,Aikaline phosphatase, increased bilirubin (direct 0.4, total 4), jaundice resolved after a while: a-Gilbert syndrome* b-PSC c-PBC d-Gall stones e-acute Viral hepatitis ***Respiratory*** !-Represented by point C: 1-FEVl.O 25% 2-TLC* 3-FEVl.O 75% 4-maximum expiatory flow 2-Assess pneumonia in patient with sepsis : a-procalcitonin* b-ESR c-CRP d-IL-l e-troponin 3-Pulmonary flow loop : a-brachial asthma* b-severe emphysema* c-IPF d-vocal cord dysfunction 6-differentiate between ARDS and cardiogenic pulmonary edema : 1-BNP below <100* 2-Pa02/Fi02 >350 3-PCWP 25 7-AII true about ARDS ( in the Q CXR showing bilateral pulmonary infiltrates) except : a-glucococrticoids have minimal effect b-permissive hypercapnia is beneficial c-PEEP used in treatment d-swan-Ganz catheter improves mortality* e-shunt is the mechanism of hypoxia 8-all cause bronchospasm except : a-histamine b-methacholine c-normal saline* d-adenosine e-exercise 9-True about COPD: a-most smokers develop COPD b-tiotropium used in all patients with COPD c-02 therapy improves life quality not survival* d-re habitation increase survival in severe COPD e-glucocorticoids increase rate of infection in COPD pneumonia 10-20 years old female Dx with asthma, taking salmetrol & des .. , came back with continuous dry cough and wheezes, FEVl >92%,FVC>90%: a-double the dose of the drugs b-change to another drugs c-Anti IgE if IgE is elevated d-repeat flow volume loop looking for important inspiratory limitation* 11-AII increase risk of PE except : a-hip replacement surgery b-Age > 75 Years c-major srugery > 3 hours d-heterozygous mutation in HEE .... gene* ***Endocrine*** 1-Female patient presented after Head CT with sellar masswith extension to suprasellar area, prolactin=50 (increased),increased TSH, normal T4, most likely cause is : a-prolactinoma b-craniopharygioma c-metastatic tumor 4-non functioning pituitary adenoma* 2-Patient with hypothyroidism on levothyroxine, presented with fatigue, skin tanning, muscle weakness, Glu 64, Na 126, TSH 3, K 5.5, T4 15, most appropriate next step is: a-ACTH level b-cosynotropin stimulating test* c-abdominal CT d-Biopsy from adrenals 3-patient with T4=29.9, uptake is 2%(1ow), all of the following are possible Dx except: a-exogenous thyroid hormones b-infectious thyroiditis c-subacute thyroiditis d-struma ovarii e-TSH-secreting pituitary tumor* 4-female patient presented with palpitations, 4 months ago she gave birth, diffuse goiter, T4=24, TSH=0.01, most appropriate next step: a-repeat TFT after 3 months b-Anti-TBg & anti-thyroid perioxidase c-U/5 d-measure TBG levels c- radioactive 125 scan* S-male patient with delayed puberty, arm span>length, small soft testicles, low testosterone, lower-normal LH & FSH, prolactin decreased, most likely Dx a-hypothysitis b-5 alpha reductase deficiency c-androgen insensitivity d-abnormal karyotyping 5-GnRH deficiency* 6-ICU patient with sinus tachycardia, T4=19.9, T3=3(decreased),TSH(0.01), the most appropriate regarding patient's condition: a-thyroid uptake and scan should be done* b-triiodothrynine should be given c-pituitary MRI d-TBG levels are decreased* e-anti thyroids maybe beneficial ?-female patient presented with abdominal pain, CT was done and showed 2.6 em mass, most appropriate next step is : a-24 hr metanephrins and cortisol* b-needle guided Biopsy c-surgical removal 8-Most to go with heterozygous familial hypercholestrolinemia TC LDL HDL TG A 34 110 B 870 570 34 110 c 223 34 110 D 196 140 34 110 E NA 34 730 Answer : E (not sure about it ) 9-diuretic beneficial for patient with osteoporosis a-loop b-Thiazide* c-ACEi ***Hematology*** 1-Wrong about CML increased platlet count* 2-AML treatment all-trans retinoic acid* 3-hemophilia A, true statment: severity depend on level of factor VIII 4-Autoimmune hemolytic anemia give IV prednisone 5-Multiple myeloma stage 3: Chemotherapy and Bone marrow transplant 6-patient post.op, develop drug induced ischemic signs in his hands, what do u expect to find in labs : decrease >50% in platlet count 7-case presentation including tear drop cells: idiopathic myelofibrosis 8-lymphoma with best prognosis Follicular lymphoma 9-staging for lymphoma Bone marrow biopsy 10-patient with recurrent 2nd tri. pregnancy loss, least likely to be changed: a-PT* b-PTT c-PC 11-20-year old patient, right leg swelling, bilaterla DVT, PC normal, PT normal, PTT increased, next step : a-Vitamin K levels b-d-dimer levels c-mixing study* 12-TTP, wrong statment hemodialysis for renal involvment 77 ***Dermatology*** zalameh with polygonal lesions--> Lischen planus ***Rheumatology*** 1-Father with Gout, brother with Gout, the patient is hyperuricemic but no symptoms, what to do: a-Allopurinol b-cholchicine c-probenacid d-AIIpurinol+cholchicine e-Do nthn, ask the patient to come back when joint symptoms* 2-60 year old male patient with long Hx of ankylosing spondylitis, come to clinic with law back pain after a trivial accident, wakes him at night, recetly he is depressed, loosing interest in things, not going out, what to do: a-give him indomethacin, and ask him to come back again after 3 weeks. b-give him antidepressant c-do spine MRI* 3-AII true about RA except: a-lymphoadenpathy b-mononeuritis multiplex c-lung fibrosis d-+ve coomb test* 4-adult onset still's disease, wrong is : a-high ferritin b-pruritic skin rash c-spleenomegaly d-High Anti-RO Abs* 5-strong familial predisposition : a-Priamry Osteoarthritis* b-hip OA c-knee OA d-spine OA 6-70 year old male, with back pain, least important to do : a-urine protein electrophoresis b-plasma protein electrophoresis c-HLA-B27* d-MRI e-brucella 7-all present with red eye, photophobia and blurred vision except : a-70 year old male with skin rash, photophobia, myalgia and arthritis* 4-ANCA +Patient, with glomerulonephritis, plasma exchange is beneficial by a-removing pathogenic ABs b-removing activated complement* e-re moving cytokines a-scleroderma with renal HTN : give ACEi* b-replenish the plasma with Abs e-new plasma has anti inflamamtory action 9-all used to assess sclerdoderma except : a-DLCO b-ECHO c-abdominal CT d-esophageal studies e-skin Biopsy* 10- diagnostic for wegners: a-C-ANCA b-P-ANCA c-Tissue biopsy* d-Sinus CT e-Chest CT 5-Patient with history of Confusion, vomiting, decreased skin turgor, decreased Na, decreased K, decreased Cl, increased HC03, increased Urea, Increased urinary PH, normal Na in urine, Normal cortisol : a-bartter syndrome b-distral tubular acidosis c-pyloric stenosis* d-addisonian crisis e-SIADH 6-patient with fatigue, high JVP, pericardia! friction rub, low C3, normal C4, increased lgA, most appropriate Dx: a-lgA nephropathy 11-patient with jaw claudication, pulsless temporal b-FSGS artery .. etc, next step: a-MRI/MRA b-ESR** c- c-membranous nephropathy temporal artery biopsy d-isolated renal vasculitis e-lnfective endocarditis* ***Nephrology*** 7-patient with RA, was on Gold regimen for 5 year, discontinued 9 months, started diclofenac since the last 2 years, recent lower limb edema, proteinurea, Dx 1-Main mechanism for renovascular HTN: baroreceptors sense decreasing perfusion pressure hence releasing renin* a-Gold-induced membranous GN* b-interstitial nephritis* c-Amyloid* 2-all better in peritoneal dialysis compared to hemodialysis except: d-Minimal change disease e-vasculitis a-no vascular access b-no anticoagulants c-more biocompatabile d-better outcome* 8-patient with Hx of fever, spleenomegaly,rash on abdomen and back, lymph nodes, recently microalbuminurea, most important test: a-ANCA 3-DM 1, BP=135/85, electrolytes normal (K=5.1, .... ), urine albumin/creatinine Increased, which is true: a-intense glucose control decrease progression to over ptoteinurea* b-AN A* c-Cryoglobins d-Piasma electrophoresis e-EBV titer* b-Anti hypertensives not needed because he has normal blood pressure c-ACEi contraindicated due to hyperkalemia 9-47 year old female patient, her husband works as a nurse, measure her BP regularly at home and it 120/80, at clinic its 138/85, most important step in addition to life style modification is a-Ambulatory BP measurement* b-Continue home BP measurements Drug not given with elevated serum Creatinine : cyclosporin A* c-rena I artery Doppler. rapid correction of hyponatremia .. central pontine myelinolysis ***Neurology*** 1-not supplied by median nerve : Supinator muscle* 2-absence seizures: sodium valproate* 3-loss of pressure and vibration sensation in LL with spastic paresis and tingling sensation,which vitamin Deficiency : B12* 4-intact comprehension, cant repeat short phrases, cant write, cant speak: broca's aphasia* 5-most common cause for brain abscess : Hematogenous spread * 6-not given in essential tremors: L.dopa 7-case of Bipolar : Valporic acid 8-20 years old female thinking she has no stomach, so she isnt eating ... etc. schitzophreniform or schizoaffective ?? 9-someone thinking people want to hurt him, he is seeing snakes .. etc psycho stimulant abuse* 10-70 year-old male recently became forgetful, agitated, withdrawn .. major depression* Pseudotumor cerebri, wrong :CSF >35 lymphocytes antiepileptic causing renal stone ... topiramate ***Cardiology*** 1-ECG showing Delta wave : accessory pathway parallel to AV node 2-patient with marrow complex arrhythmia IV adenosine 3-all increase digitalis toxicity except : a-hyperparathyroidism b-COPD with hypoxia c-hyperthyroidism* d-loop diuretics e-Quinidine 4-Long QT, all except : a-digitalis* b-amiodarone c-macrolides d-TCA e-cerebral injury 5-improve survival, all except a-digitalis* b-ACEi e-BB d-nitrates e-spiranolactone 6-patient with syncopal episodes, anterior motion on mitral valve on echo, the true statement is : a-murmur decrease with hand gripping* b-murmur radiates to carotids c-impaired systolic function of heart ?-patient with history of fever, presents with left sided weakness, increased ESR, Echo shows shadow on left atrium, Dx is a-Infective endocarditis b-emboli from mural thrombus c-atrial myoxoma* c-transcutanous closure is beneficial d-surgical closure to decrease risk of infective endocarditis** 15-wrong statment: 1-fatty acids main energy supply 8-unstable plaque, all true except : a-thin fibrous cap b-high inflammatory content c-lipid core d-high smooth muscle cell content* e-few fibroblasts 9-patient with aortic stenosis, wrong about it : !-degeneration is the most common cause in elderly 2-muffled 52* 3-ACEi improve survival* 10-tropinin increase with all except : Pulmonary edema* 11-wrong about paroxysmal SVTs : Amlodipine improves it* 12-patient with MI, admitted to hospital, after 12 hours his BP decrease to 90/60, HR 110 , first to do : a-IV NE b-IV dopamine c-Normal saline infusion* 13-patient with long Hx for DM, he is on thiazide, but his BP not controlled, what to do: a-add lisopril* b-remove thiazide c-remove thiazide and add lisopril 14-wrong about ASD : a-osteum secondum associated with RBBB like feature b-osteum primium associated with mitral valve abnormalities 2- AV node supplied by RCA 3- during exercise heart will increase 02 extraction** 4- coronary perfusion increase with diastole 5- SA node in the superior Posterior Rt Atruim