Medicine Final Exam 4th Year 2022

Medicine Exam- Final- 20 41h year Added below some questions are some comments by our colleague Abdallah Mansour Cardiology 1) pt with bilateral lower limb edema, jvp 4cm above sternum ... All can cause his condition except -right side heart failure** -cirrhosis -nephrotic - pelvic venous fibrosis exp: JVP is normal here, so it is not cardiogenic edema. 2) Pt with acute rt lower limb pain, all can cause this except; -constructive pericarditis** -a fib - pa roxysma I SVT -bacterial endocarditis exp: this is acute limb ischemia most likely due to embolus originating in the heart .. all the conditions above cause emboli except constrictive pericarditis. 3) Otherwise healthy 21 year old patient with st elevation in more than 7 leads, What is the best treatment: -colchicine** -Aspirin and heparin -prednisone exp: this pericarditis, its treatment in previously healthy people is colchicine, if it was after Ml, aspirin is the answer. 4) Echocardiogram can show all of the following except: -coronary artery calcification** -aortic stenosis - ASD -mitral incompetence exp: coronary calcium can only be measured by ultrafast CT 5) All can cause st elevation except -coronary spasm -constrictive pericarditis ** -hyperkalemia -ventricular aneurism exp: Constrictive pericarditis is not associated with st elevation, however the acute pericarditis is. 6) Pt on Digoxin developed loss if appetite, vomiting, ... What caused his symptoms -hypokalemia -hypocalcemia -hypoxia -hypothyroidism No idea=\ 7) All of the following are associated with cardiac constrictive pericarditis except - palsus altern us** -edema -ascites -hepatomegaly exp: Pulsus alternans is a physical finding with arterial pulse waveform showing alternating strong and weak beats. It is almost always indicative of left ventricular systolic impairment and carries a poor prognosis. 8) Pt with suprasternal thrills, ejection click after 51, flow ejection systolic murmur, single 52, systolic heave in the left spurasternal fossa, what would be the cause -aortic valve stenosis -Pulmonic valve stenosis - coarcutation of aorta -PDA - A5D exp: it is heard on the left upper sternal border, if the question was right upper border, it would be aortic stenosis. 9) Which of the following doesn't support plaque rupture in atherosclerosis -abundant smooth muscles** - low fibroblast -high inflammatory cells 10) All can be associated with endocarditis except : Anti A50 Hematuria A fib Rhematoid factor ** No idea 11) all of the following is considered a poor prognostic indicator in ant. Ml except: -being a female -sinus tachycardia -persistent hypertension I don't remember the other choices, but the above three are poor prognostic factors! Rheumatology : 1) +ve RF in all of these except:a. scleroderma b. Rhumatoid arthritis c. polymyalgia rhumatica d. viral infection e. chronic liver disease 2) +ve ANA, except: a.SLE b. dermatomyositis c. sjogren's syndrome d.fibromyalgia (or sth else ! ) e. polyarteritis nodosa 3} in SLE, which autoantibody is the characteristic one in the majority of patients:a. anti DNA b. ANA c. anti Ro d. anti sm e. anti Ia 4) about gout, which is true? a. normal adult solubility of serum monosodium urate< 8 mg/dl ** b. women above age of 50 have lower serum cone of uric acid than men at the same age group c. gout may be precipitated by acute illness. e ..... 5) polymyositis, all associated in confirming diagnosis except: a. anti-jo 1 b. ANA c. dysphagia d. pulmonary fibrosis e. thrombocytopenia** 6) not true about ACPA: a. citrullinated proteins originate in the synovium b. sensitivity 70- 80 % c. strong predictor of more severe disease and poorer prognosis d. specific 95-98% e. ACPA is found in many connective tissue diseases.** exP: ACPA is very specific for rheumatoid arthritis. 7) pt with back pain (spondylartropathy), all suspected to be seen except: a. arthritis of the toe IP joints b. sausage digits c. Achilles tenosynovitis d. planter fasciitis e. subcutaneous nodules** 8) anti-sci 70 is specific for : a. CREST syndrome b ..... c. mixed connective tissue disease d. diffuse scleromerma** e ..... 9) adult still's disease is associated with: a) leukocytosis** b )thrombocytopenia c) leukopenia exp: adult still's disease is almost always accompanied by neutrophilic leukocytosis. 10) all are true about septic arthritis except: the most common cause is staph au reus mostly polyarticular** exp: its mostly monoarticular\oligo Gastrointestinal: 1) All of the following may result from hemochromatosis except: -diabetes - pronze colored skin -acute fulminate hepatitis * * -cirrhosis 2) Jaundiced patient whose sister died of liver failure two years ago, Serum ceruloplasmin .15 (normal> .155) what can u do to confirm diagnosis: - liver ultrasound -liver biopsy** - 24hr copper excreted in urine exp: measure copper concentration on liver biopsy is the gold standard for diagnosing Wilson disease .. 24hr copper in urine has low sensitivity and specificity to be used for screening. (Medscape) 3) All of the following are true about diabetics except: - lower rate of gall stones 4) Which of the following is false about celiac disease: -anti gjiadin antibodies are specific** -can be a symptomatic - pt can be obese - biopsy will be negative if pt on gluten free diet -it is known to be complicated with ulcerative jejunitis. exp: they are neither specific nor sensitive! 5) Pt with 3 days hx of Melena and fatigue, hemodynamically stable, no hematemesis no coffee ground vomiting, what would u do him first - colonoscopy - EGDscopy** -start on H2 antagonist -test and treat for H.pylory exp: the patient is most likely having upper Gl bleeding, (he doesn't have to have hematemesis (medstudy)) so the most appropriate next step is upper Gl endoscopy. 6) all of the following are included in child pugh classification except: -encephalopathy -ascitis -total protein** -bilirubin level -prothrombin time exp: Child pugh mentions albumin not total protein. Infectious 1) All of the following in regard to influenza vaccine are true except -contraindicated in pregnancy** -composed if 3 strains -given annually -contraindicated in Giuliani barre syndrome -recommended in AIDS pts exp: they should've told us wether this is inactivated or live attenuated!, assuming this inactivated type, it is not contraindicated in pregnancy! 2) Chance of getting HBV from needle stick injury -30% 3) All about HAV true except: -virus shied in feces at the onset of symptoms** - feco-oral transmission -doesn't cause chronic liver disease -no vaccine against it exp: begins shedding the virus one week before onset of symptoms and continues to shed the virus up to three to four days after onset of jaundice. 4) All true about brucellosis except: - osteoartecular are rare area of localization** -treatment continue for 6 weeks -intracellular organism -B. melitensis is the most prevalent and cause the most sever infection -endocarditis is the most common cause of death 5) About amebia trophozoide found in feces (not true): -treatment for 7-10 days -elevated alkaline phosphatase means liver abscess - blood come from colon ulcers **The above three choices are true - Metromidazole is a treatment of choice 6) HIV which is wrong: -CD 4 count can be used to screen for infection** - ELISA is positive after 3 weeks to 3 months of infection - westren plot used to confirm positive results in ELISA - PCR used to detect primary infection 7) All of the following indicate SIRS except - RR 23 - WBC 10000 * * -temp 39 -bands 13% exp :it should be less than 3000 or more than 12000 8) All of the following are considered positive ppd test except - 17 mm in healthy individual - 8 mm in immune compromised - 10 mm in house hold exposure to TB - 13 mm in person previously known to have negative ppd test** exp: he is low risk, so he should be above 15 to be positive. 9) the only non effective antibiotic against p.aureginosa: A.ceftazidime B.ciprofloxacin C.ceftriaxone ** D. Cefepeme E.ticarcellin exp: the only third generation cephalosporine that is active against p.aurogenosa is ceftazidime .. so ceftriaxone is not. 10) Whats wrong about e.coli o157:h7 ... -we use antibiotics to treat .. **actually antibiotics are contraindicated here. Hematology Pt known to have hemolytic anemia and spherocytes on blood smear, came to ER with reticulocyte zero and Hb 5, WBC and pit normal, what would be the most common cause: » parvovirus B19 infection exp: this is pure red cell aplasia caused by parvo B19 affecting mostly those with sickle cell and spherocytosis. 1) Pt with HIT syndrome, which of the following support your diagnosis: -necrosis at the site if heparin injection** - normal platelet count -normal ptt -absent distal pulses - blood film showing spherocytic hemolytic anemia 2) 3) The most common NHL is >»diffuse large B cell lymphoma All of the following are established risk factors for venous thrombosis except - sickle cell trait - homozygouse laden V -old age -obesity * * All of these causes venous thromboembolism! 4) patient with a 5 day history of fever(?) and cervical lymphadenopathy. P/E generalized lymphadenopathy and splenomegaly. high WBC with large, vaculated cells, low neutrophils (?). A) ALL/ Burkitt type** B) CLL undergoing richter transformation ** C) AML/M3 D) SLL Its most likely B but I am not sure. Nephro (not sure of the stem of the questions nor the choices nor the answers here © ) 1) the most important predictor for a diabetic to develop a nephropathy is : duration of diabetes the development of retinopathy** protienuria exp: studies showed that© 2) Pt with renal stones, urine ph 7, hypokalemia »distal RTA 3) Pt with hypokalemia, HTN, metabolic alkalosis, hyernatemia, lowe aldosterone levels » Iiddie syndrome 4) Obese psychotic patient with Low cain urine, hypomagnesemia, no HTN, hypokalemia » gitelman's »Excessive vomiting »diuretic abuse** Not sure, but I think its diuretic abuse to lose weight=\ 5) Which is wrong about HTN »target of blood reduction in diabetics is< 140/90 mmHg 6) all are causes of secondaru HTN except: Respiratory 1) flow volume loop» severe emphysema 2) flow volume loop» fixed obstruction 3) wrong about pulmonary function test: DLCO to differentiate between emphysema & IPF 4) polysomnography: a. obstructive sleep apnea b. central sleep apnea c. mixed apnea d. hypopnea * 5) Not in case of acute severe asthma : a. ph= 7.3, HC03 = 27 b. PCo2 = 43 c. PCo2 =52 d ..... e. P (A-a) 02 = 22 6) mechanical ventilation, 100% 02, Pa02 = 65, what is the cause of hypoxia? a. V/Q mismatch b. hypoventilation c. ...... d. intrapulmonary shunt** e. decreased DLCO exp: Shunting cannot be fully treated by 100% 02 while V\Q mismatch can. 7) 6 months cough , dyspnea , long expiratory period , FEV1/FVC =60%, normal FVC, may be all except: a. myasthenia gravis** b. asthma c. sarcoidosis d. Tuberculosis e. emphysema -- Restricitve lung disease, myasthenia gravis S)pt 40 y old, diagnosed with COPD from 4 years, FEV 1 FVC 2 .... po2 50% all true except: A- h. Influenza is a common pathogen that can be implcated such condition B- positive pressure respiration will solve his problem** C- pt is hypo ventilated D- pt has ventilation perfusion mismatch exp: he must intubated and ventilated mechanically 9) which of the following support the diagnosis of pulmonary embolism over pneumonia: - site of pain - presence of effusion -loud P2** exp: Others are common for both 10) which of the following most commonly complicate H1N1 influenza infection -streptococcus pneumonia -h. Influenza ** - legionella 11) what the pt CURB65 score, Age 60, in pain, urea 92, BP 80/70, I think it is 2 Endocrine 12) All of the following are diagnosed with diabetes mellitus except ( I cant remember the choices but I think it was the pregnant OGTI -7 not sure) - pt with HbA1c of 6.7% -polyuria, polydepsia, wt loss with random blood sugar of 240 -fasting blood sugar of 127 repeated twice -OGTI ... - pregnant OGTI 13) Pt DM type I from 9 years in ICU, u have been called to evaluate his condition, pt has nightmares, what would be the cause -over treatment with insulin** - under treatment with insulin -diabetic neuropathy -diabetic nephropathy - pt has phobia .. , from insulin needle exp: Somogyi effect a rebound phenomenon occurring in diabetes: overtreatment with insulin induces hypoglycemia, which initiates the release of epinephrine, ACTH, glucagon, and growth hormone, which stimulate lipolysis, gluconeogenesis, and glycogenolysis, which, in turn, result in a rebound hyperglycemia and ketosis. It is characterized by Nightmares! 14) Postpartum from 4 months, developed goiter, symptoms of hyperthyroidism, elevated T4, low TSH .... What would u expect to find -elevated thyroglobulin 15) All of the following are associated with increase uptake except »> TSH secreting adenoma 16)41 year old Pt with prolactine slightly elevated, TSH elevated, T4 normal, brain MRI showed 2.1* 1.3 em mass with suprasellary extension, what would explain the case: - craniopharynioma - prolactenoma -primary hypothyroidism - non functioning pituitary tumor** exp: If he was child, craniopharyngioma will be the choice. 17) What is the screening test for acromegaly »> IGF11evels in blood 18) Diabetic with erectile dysfunction, what would u do -give seldinafil -arrange for penile Doppler •• -nerve conduction studies of lower limb 19) Pt with XXV, what do u expect to find in his blood »>testosterone low, FSH high, LH high, prolactin normal 20) • Beriberi: a. vitamin B1** b. vitamin B3 c. vitamin B6 d. Vitamin B12 e. vitamin C