Sixth Year Medicine 2021

Sixth year Medicine, Rheumatology 1) Patient was started on Allopurinol, what drug should you monitor : a-Azathioprine* b-mycophenolate mofetil 2) A patient with back pain that is worse when going down, and better with bending, (lumbar canal stenosis ), what is next : a- plasma electrophoresis b- MRI back* c-CRP 3) Which of the following has symmetrical narrowing of the joint space ? a-primary OA b-secondary OA of hip c-secondary OA of knee d-secondary OA from Rheumatoid arthritis** 4) A case describing a pt who had a nasal ulcer and polyarthralgia , all of the autoimmune studies were -ve (including ANA, c-ANCA, p-ANCA, cryoglobulins, C3, C4, ... ) Then the ANCA became trace positive and he developed full blown GN with crescents. What is the most appropriate treatment: a-Oral steroids b-Ora! steroids+ cyclophosphamide** c-Oral steroids+ azathioprine 5) Which is associated with Adult onset still's disease: a-high ferritin levels* b-anti-RO c- +ve ANA 6) In scleroderma, which is not indicated in follow up a-DLCO b-echo c- esophageal studies d-skin biopsy** 7) a patient with high uric acid 9mg/dl, he is asymptomatic. His father has gout. Next step: a-nothing, tell him to get back when he has symptoms** b-start allopurinol 8) best way to dx HSP: a-s kin biopsy showing immune complexes with lgA deposition** b-Renal biopsy 9) a patient with diffuse sclerosis. Best way to manage renal crisis (it appeared twice!) a-Ace inhibitors* Respiratory: 10) Flow volume loop in a patient with progressive SOB for 2 years, he also had prominent inspiratory and to lesser extent expiratory wheezes, what is the dx: a-Vocal cord dysfunction** b-tracheal tumor 11) compliance curve (pressure vs volume) showing three patients, patient 2 is? (Obstructive pattern) A-pulmonary edema b-fibrosis c-pneumonia d-emphysema** e-sarcoidosis 12) CURB65 pneumonia patient management, he is young, with CURB 3, what is next? a-outpatient a.bs with b-ad mit to flow with IV meropenem and levofloxacin c-ICU with IV meropenem and levofloxacin *? d-floor admission with levofloxacin 13) not in severe asthma: a-wheezy chest** b-accessory muscle c- incomplete sentences d-cyanosis 14) which enhance lifestyle and decrease dyspnea in COPD patients: a- salmeterol and inhaled steroids?? B-lung rehabilitation c-tiotropium d- oxygen therapy during exertion?? 15) Massive PE question, which is not seen: a-loud 52 b-TR c-loud A2* d-pulmonary regurge e-left sternal heave 16) a patient with chronic cough since two years with chest pain, she has the symptoms for several weeks then resolve. With symptoms mainly occurring after URTI, examination is normal, spirometry is normal. Next step: a-stress echo b-bronchoscopy c-endoscopy d- methacholine challenge test*** 17) Worse asthma patient, she has a baseline of C02 36. A-a gradient =25 b-Fev165% c-PaC02 of 40*** 18) a patient in dead see was seen his C02 at admission 60 and 02 30, after oxygen administration 02=60 mmHg. What was the cause of his hypoxia? a-hypoventilation b-VQ mismatch c- VQ mismatch with hypoventilation** (upon calculating the A-a gradient, it's elevated) d-Shunt 19) A patient with chest infection, u hear heart sounds on right a- kartagener! * 20} Not a Risk factor for OSA: a-big chin* it's a small one (micrognathia) b-short neck c-large abd ex d-large tongue e-large uvula 21) Wrong about ARDS: a- bilateral infiltrates b-increased atrial pressure*** c-can benefit from PEEP d-Shunt is the mechanism of hypoxia e-po2.FI02 < 200 22} COPD what is true a-Steroids decrease the number of exacerbations and their severity*** b-COPD eventually develops in all smokers c-02 therapy improves quality but not mortality d-tiotropium is used in mid COPD Infectious 23) Not for pseudomonas a-ceftriaxone*** b-ceftazidime c-cefepime 24) About brucella , which is wrong a-recurrence rate 40% *** b-in goat and sheep mainly brucella melitensis c-cause of death is infective endocarditis d-treatment is for at least 6 weeks with two a.bs 25) Case of c-diffcle diarrhea (it mentioned the endoscopic finding of microabscesses) rx with metronidazole*** 26) Not a side effect of vancomycin a-red man b-phlebitis c-rena I toxicity d-seizures * 27) Seen in old DM patients, causing Otitis externa : a- pseudomonas aeruginosa * b- staph aureus 28) a case of infective endocarditis, patient 4Syo healthy she, did a root extraction at dentist clinic, started to have new murmur, which is the most likely organism : a-staph aurues b-alpha hemolytic strep ••• c-e-coli d-bactriodes e-staph epidermidis 29) a patient with VZV shingles, which is wrong ( smth is weird abt this q) a-observe b-give ganicylovir c-give acyclovir d-give levofloxacin** e- do HIV test Gl: 30) Not useful in the follow up in H pylori : a-Serology** b-breath test c-stool antigen d-histology e-biopsy with urea on it 31) Thumbprint sign, seen in : a-UC** b-mesenteric ischemia c-crohn's d- none of the above** ? **actually thumb printing is pathognomonic for ischemic colitis not mesenteric ischemia, however some say that is can also be seen in UC** 32) A long case describing +ve P-ANCA patient, and he has UC: a- PSC** 33} difference between UC and Crohns, what's wrong: a- UC patient has more stones* b-erythema nodosum in UC correlate with disease activity c-smoking worsens CD 34) Indication for intubation in upper Gl bleeding: a-pt with decreased level of consciousness and hematemesis** b-all patients with hematemesis c-all patients with hematemesis unless it delays endoscopic intervention 35) HBV case, it was HBsAg+, HBeg+, high virus load but normal LFT a- Immune Tolerance** b-immune active c-precore mutant 36) HCV case , she was HCV+, but asymptomatic, next step : a-RNA viral load * ? b-AST c-HbsAg d- liver biopsy 37) esophageal varices, all are use to acutely manage them except a- VASOPRESSIN IV? b- octreotide c-propranolol *?{since it's for maintenance 38) not risk for Colon Cancer: a-FAP b-peutz jeger c-Osier Weber Telangiectasia ** d-PSC 39) Acute pancreatitis, which is not seen a- Low Albumin less than 3? b- Hypoglycemia * c- hypocalcaemia 40) Mesenteric Ischemia: a- Lady pain after meal with P/E disproportionate 41) all can be rx for Wilson except a- penicillamine b-zinc c-liver transplant d-trientine e- simeprevir *** 42) Acute pancreatitis first thing to do: a-IV fluids** b-Antibiotics c- pain management**?? Hemato: 43} CML case: wrong ... positive globulin test. 44} True in DIC: increased PT 45) wrong in TIP case: give platelets. 46} CLL case, treatment of autoimmune hemolytic anemia: Steroids 47} increase thrombosis except: heterozygous something. 48} True about hemophilia: factor 8 level correlates with severity. 49} Multiple Myeloma stage 3: give chemo+BM transplant 50} Worst lymphoma: Burkitt;s. 5l}True in myelofibrosis: hypercellular BM with +2 fibrosis 52} How to complete staging of a lymphoma case: BM biopsy or MRI abdomen? Endocrine: 53} All are initial steps to treat a DKA patient with potassium 6.1, except: a- K-axalat* b-insulin c-start glucose when his BR is 250 mg d-IV fluids 54) postpartum thyroditis a- Uptake* b-scan 55) Cushing disease, suppressed by low dose, next step a- High dose Dexa b- ACTH * 56} Drug resistant patient (taking the three maximal dose of antiHT meds) what is most likely causing that: a-NSAIDS * b- pioglitazone** (I think this is the answer since thiazolidinediones are associated with fluid retention) 57} Patient on a chemotherapy for adrenal cancer,{mitotane) plus replacement for his steroids, he started to vomit and having a having diarrhea, fatigue and dizziness a- stop mitotane b- increase dose of steroids? c-start anti-emetic * ? d-refer to endoscopy 58} a patient with OM type 1, now she has high PTH , low Ca, normal P04 low 25-0H vitamin D, elevated alkaline phosphatase, What is next a- PTH technium b-see levels of 1,25 Vit D c- TIG antibodies * (celiac disease causing vit D malabsorption) d- Bone biopsy 59}a TB patient, he is sick and all. Thyroid TSH low T4 border line T3, so apparently it is either euthyroid sick syndrome or central hypothyroidism what is correct about it : a-do brain MRI**? b-its due to decrease peripheral conversion of t4 to t3 * ? 60} HTN hypokalemia, Virilization, CAH, so a-118 hydroxylase deficiency** b-21 OH def c-17 alpha OH def 61} HTN/Hypokalemia/Renin High/Aido high: a-Renovascular Fibrodysplasia b-conn's c- licorice ** Cardia: 62) a young girl with palpitations, ECG strip » SVT: IV Adenosine acute 63) Afib case and low ejection fraction; a-Amiodarone*** b-sotalol c-procainamide d-flecainide 64) A case with a 40 years old man who is now in pulmonary edema, PEX shows a murmur that is accentuated with valsalva and decreased with hand grip(u get it's a HOCM case ) so what is next for him (he is already taking BB and diuretics) a-ICD?? b- Myomectomy?? c-Mitral surgery d- carvedilol 65) an old guy with severe chest pain , ECG shows anterior Ml (STEM I), which is wrong: Wait for troponin Before cath * * 66) A man with chest pain and normal ECG findings, it is not relieved with NG , , CXR mediastinal widening ( so Aortic Dissection case) what is next a-CT Angio with contrast** 67) Anterior Ml, 5 days later he decompensated , and his 502% drops, given oxygen, still didn't raise, he has pulmonary crackles, auscultation shows a systolic murmur at left boarder, (so it's a VSD, with a shunt) what to do? a-mitral valve repair b-peri cardi ocen tes is c-VSD repair** 68) Ml case was given NG and morphine and suddenly his BP dropped, what caused that? A-cardiac shock b- he had inferior Ml with RV infarction** 69) Asymptomatic AS, AS area 1 and EF 52% a-: Keep on medical therapy and follow up*** b-valve replacement c-balloon repair d- refer to cath lab (the indication for surgical repair in AS is either valve area less than 0.6 or gradient across the valve more than 50) 70) Drug to add for HF on ACE I and thiazide: a- furosemide (not GFR dependent)** b- carvedilol ** c-digoxin**? d- amlodipine 71) Pericarditis case, wrong: a- First line therapy steroid for pericarditis.** b-colchicines reduces recurrence c-NSAIDs is used with colchicines d-majority are asymptomatic 72) chest pain, with +ve markers, you at the ECG , there is ST depression ! What is wrong a-: thrombolytics is indicated * 73) A question about a patient with chest pain, with minimal pericardia I effusion ( pericarditis vs myocarditis), he had cardiomegaly or cxr and crackles on pex : what to do a- bb and ace-1 *** b-give ceftriaxone c-steriods Nephro 74) A pt with severe vomiting for 7 days with the following labs Sodium: 140 K: low-normal Chloride: 80 Bicarb: 11 PH:7.1 PaC02: 24 What is the acid base status? -non anion gap metabolic acidosis a -non anion gap metabolic acidosis b-an ion gap met acidosis with respiratory alkalosis c-anion gap met acidosis with metabolic alkalosis*** 75) A patient who is kidney transplant recipient and is on prednisone, mycophenolate and cyclosporine. He developed severe diarrhea with anorexia, labs were (I am not sure about the exact values) Bicarb: low potassium: low-normal sodium: high normal. What would you expect to find on his urinalysis a-* No protein, ph of 5, specific gravity 1.005 b-* No protein , ph of 5, specific gravity 1.03 c-* Trace protein, ph of 7, gravity 1.005 d-* Trace protein, ph of 7, gravity 1.03*** e-* No protein, ph of 7, gravity 1.005 76) All of these are measures used to decrease the incidence of catheter related UTI except: a-avoid catheterization as possible b-use closed collection system c-use sterile techniques d-use prophylactic antibiotics*** 77} All of these are complications of hemodialysis except: a- Muscle weakness b- Hypotension c- Anaphylaxis d- Fever?? e- Hypoglycemia*** 78} A pt with severe hyponatremia (sodium 110} developed grand mal seizures, what is the treatment: a- conivaptan b- Fluid restriction c- 3% saline at rate of 30-40 ml/hour*** d- Demeclocycline 79) A patient who is in acute renal failure, of these what is the absolute indication for dialysis: a-* Potassium >7 b-* Bicarb <15 c-* BUN >90 (or something) d-* Presence of pericardia! rub on auscultation*** 80) A patient went to the dead sea marathon, he became severely dehydrated and hypernatremic, sodium was 175 and his weight was 60kg. Calculate the free water deficit: a-0. 75 L b-1.5 L c-7.5 L d-15 L*** e-25L (Note that -since the pt is severely dehydrated- you should add 10% of his body weight to the number you got from the calculation which is 9) 81) A case of orthostatic proteinuria, what is the next step: a- Reassurance** b- Follow up with blood tests 82) renal crisis in scleroderma : enalpril * 83) Doesn't increase uric acid SIADH** Neuro: 84) headache case, what is not useful » EEG 85) myoclonic seizure» sodium valproate 86) a patient with metastatic prostate cancer, +ve babinski, sensation loss in LL >>thoracic compression 87) back pain radiating to leg,, loss of sensation on lateral border of forefoot and no plantar flexion but preserved eversion and inversion a-sl * b-LS c-L4 d-sl 88) Headache with diplopia raised ICP not a good test : ? a-skull.xray with Sella Turcia view b-good drug hx c-CSF analysis after proper imaging is done 89) stroke q 1st test a-non contrasted ct 90) temporal lobe epilepsy what is wrong a-surgery is not beneficial b-history of febrile seizure is related 91) long case having symptoms of MS and diplopia and can't adduct the eye and the other goes into nystagmus, where is the lesion causing her eye symptoms? a- bilateral medial longitudinal fasciculus Derma 92) non scarring alopecia a-sarcoidosis b-SLE c-carbuncle d-2ry syphilis* c93) which is not a side effect of retinoids a-liver toxicity b-nail dystrophy c-rena I toxicity* d-hair loss 94) All can be treatment for psoriasis except a-oral fumaric esters b-ora I steroids* c-topical steroids d-topical cyclosporine 95) all can cause squamous cell carcinoma except a- chronic venous insufficiency b-chronic persistent psoriasis* c- immunosuppresion d-orallichen planus Psychiatry 96-a case of paracetamol toxicity NAC 97-pt with hallucination all possible diagnosis except: delusional disorder 98-pt with sudden cloudiness of consciousness, he was healthy before. Delirium 99-a young man, typical schizophrenia hx: schizophrenia 100} chronic alcohol use man, treatment of his condition a-clonidine b-benzodiazepam ) I .. ;.__ .·'1' ___'")