Medical MCQs

425. A 12-year-old boy is very distraught because every time he thinks or hears the word God or passes in front of a church, swear words pop into his mind against his will. He also feels compelled to repeat the end of every sentence twice and to count to 20 before answering any question. If he is interrupted, he has to start from the beginning. Which of the following medications has been proven effective with this disorder?

a. Alprazolam
b. Clomipramine
c. Propranolol
d. Phenobarbital
e. Lithium

424. A 34-year-old secretary climbs 12 flights of stairs every day to reach her office because she is terrified by the thought of being trapped in the elevator.She has never had any traumatic event occur in an elevator; nonetheless,she has been terrified of them since childhood. Which of the followingis the most likely diagnosis?

a. Social phobia
b. Performance anxiety
c. Generalized anxiety disorder
d. Specific phobia
e. Agoraphobia

423. A 40-year-old man has the sudden onset of excruciating head and neck pain while carrying books from the basement to the attic. His temperature is 37 C (98.6 F), blood pressure is 130/90mm Hg, and pulse is90/min. He has photophobia and develops eye pain with lateral eye movements. His neck is markedly stiff and cannot be passively flexed. He has diffuse hyperreflexia in all extremities with normal strength and sensation. Plantar reflexes are flexor bilaterally.Which of the following is the most likely diagnosis?

A Cervical osteoarthritis
B Meningitis
C Ruptured cervical disc
D Subarachnoid hemorrhage
E Syringomyelia

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422. A 30 year old man presents with fever of 101F and a murmur at the apex. On examination he has painful, red, raised lesions on the hands and hemorrhages under the nail bed. He also has conjunctival petechiae. Retinal hemorrhages with pale centers were noted on fundoscopy. Abdominal examination showed splenomegaly and a transthoracic echo was ordered that showed vegetation. Blood was sent for culture. What is the best initial empiric therapy?

A. Vancomycin and Gentamicin
B. Ceftriaxone
C. Oxacilin
D. Ceftriaxone plus amphotericin
E. Ampicillin and gentamicin

421. A 51-year-old man complains of a slight cough he has had for about a week. He is a non-smoker. On physical examination auscultation of the chest reveals clear lung fields. A chest radiograph shows a subpleural "coin lesion" 2 cm in diameter in the right upper lobe. Which of the following is the most likely diagnosis?

A Small cell anaplastic carcinoma
B Granuloma
C Bronchiectasis
D Exogenus lipid pneumonia
E Silicosis

Types of MR Images:

There are several types of MR sequences/images, each of which have unique characteristics and are good for different purposes or in combination can help discern tissue composition. The two most basic image types are T1 and T2 images. T1 or T2 images are obtained by manipulating two basic parameters, TR and TE. TR, repetition time, is the time between one RF transmission, or excitation, and the next. TE, echo time, is the time between the excitation and when the coil is programmed to receive the resultant signal. Other image types include T2 FLAIR, T2*, PD (proton density), and DWI (diffusion weighted imaging). Fat saturation can also be applied to make fat look dark instead of bright. Contrast, in the form of gadolinium, can be administered to highlight different structures or pathology.

420. A 49-year-old man develops an acute myocardial infarction because of the sudden occlusion of the left anterior descending coronary artery. The areas of myocardial necrosis within the ventricle can best be described as

a. Coagulative necrosis
b. Liquefactive necrosis
c. Fat necrosis
d. Caseous necrosis
e. Fibrinoid necrosis

419. A 41-year-old woman has hypocalcemia, hyperphosphatemia, and decreased urinary phosphate excretion. Injection of parathyroid hormone (PTH) causes an increase in urinary cyclic adenosine monophosphate (cAMP). The most likely diagnosis is

(A) primary hyperparathyroidism
(B) vitamin D intoxication
(C) vitamin D deficiency
(D) hypoparathyroidism after thyroid surgery
(E) pseudohypoparathyroidism

418. A 35-year-old alcoholic male is admitted for nausea, vomiting, and abdominal pain that radiates to the back. The laboratory value that suggests a poor prognosis in this patient is

A) Elevated serum lipase
B) Elevated serum amylase
C) Leukocytosis of 20,000/?m
D) Diastolic blood pressure greater than 90 mmHg

417. A 43-year-old, insulin-dependent diabetic patient is diagnosed with hypertension and begins therapy with an antihypertensive agent. Three days later, he measures his blood glucose at home and finds that it is 53 mg/dL. He recalibrates his glucose testing apparatus and repeats the test, only to find that the first reading was accurate. He is concerned that his hypoglycemia did not produce the normal premonitory signs and symptoms. Which of the following medications was most likely prescribed to treat his hypertension?

A. Captopril
B. Diltiazem
C. Methyldopa
D. Prazosin
E. Propranolol

416. A 55-‐year-‐old man has weight loss, dyspnoea and syncope. He smokes 30 ci******es a day. He is thin and breathless at rest. His blood pressure on standing is 110/60mmhg and on lying is 140/80mmHg. What is the most appropriate initial investigation in establishing a diagnosis?

a. Chest X-‐ray
b. Echocardiogram
c. Electrocardiogram (ECG)
d. Pulmonary function tests
e. 24 hours taped ECG

Justify your answer

415. Drugs to be withheld before cardiac stress testing? Which drugs can be continued?

414. McCune Albright syndrome ???

413. Tocolysis is contraindicated in all EXCEPT:

A. twin preg in labor at 33 wk
B. cervix 3 cm
C. chorioamnionitis
D. single pregnancy in labor at 34 wk
E. maternal hypertension

412. 57 yr man with 2 yr H/o increasing lt knee pain.initially pain was only during running or playing basket ball.but now all the time,during 6 mnths he was awaking at night with pain.at age 16 he sustained an fracture of tibia abd underwent OR and IF.he has occasional swelling of knee.Exam shows varus deformity,anterior and posterior drwaer test negative.what is the Dx/?

a.nonunion of prior fracture
b.post traumatic arthritis
c.patella tendonitis
d.medial meniscal tear
e.tear of antr cruciate ligamen

411. Abdominal aortic aneurysm .. Which of the following is the highest rate of aneurysm expansion and rupture??

A. Uncontrolled HTN
B. Uncontrolled DM
C. Smoking
D. Alcohol
D. LDL > 130

410. A mother puts a bitter substance on her 9-year-old son’s fingernails in order to break his nail-biting habit. This is an example of the type of learning best described as

(A) operant conditioning
(B) aversive conditioning
(C) spontaneous recovery
(D) modeling
(E) stimulus generalization

409. A 70-year old man, who, over the past year, has developed memory loss, spatial impairment, and language difficulties, has recently started to show a fine tremor and gait disturbances. The patient tells the doctor that he is also disturbed by vivid visual hallucinations. The patient’s wife reports that at night the patient is very restless during sleep and often hits and punches her. Two days after being started on risperidone to control the hallucinations, the patient begins to show severe muscular rigidity. Aside from these symptoms, physical findings and laboratory studies are unremarkable. This clinical picture is most consistent with

(A) delirium
(B) Huntington disease
(C) Lewy body dementia
(D) Alzheimer disease
(E) acquired immunodeficiency syndrome

408. A 10 year old boy presents to your clinic with a history of a bee sting on his right forearm two days ago. He had no systemic symptoms the day of the sting. The day after the sting, he developed significant arm redness and swelling around the site of the sting that improved somewhat with the application of ice. The area is not pruritic and is much better than it was the previous day. What should your next step(s) be?

A. Skin testing for stinging insect allergy
B. Give the patient a prescription for autoinjectable epinephrine
C. Suggest venom immunotherapy
D. All of the above
E. None of the above

407.

406. Which of the following is NOT a symptom of narcolepsy?

A. Catalepsy
B. Sleep paralysis
C. Hypnogogic hallucinations
D. Restless and disturbed sleep
E. Persistent daytime sleepiness

405. A 40 year old businessman has reported with c/o day time sleepiness sometimes even during meetings and car driving. His sleep in interrupted by repeated awakenings thought without vivid hallucinations. He feels tired and c/o headache on awakening. His BMI is 32 and blood gas analysis is normal. What is the diagnosis?

A. Narcolepsy
B. Obstructive sleep apnea
C. Central sleep apnea
D. Obesity hypoventilation syndrome
E. CO2 narcosis

404. A 25 year old man, previously in good health was playing tennis. While playing, he suddenly felt severe pain in left side of chest and collapsed on the spot. He had no previous h/o any major health problem and was a non-smoker. He was found to be dsypnic and cyanosed in emergency but vital signs were normal. What is the most likely diagnosis?

A. Pulmonary embolism
B. Tension pneumothorax
C. Myocardial infarction
D. Dissection of aorta
E. Left ventricular failure

403. Five different patients have been admitted in medical ward. All of them with progressive dyspnea and lung infiltrates on x-ray chest. In which of them bronchoscopy with bronchoalveolar lavage would be most useful for diagnosis?

A. A 35 year old woman with suspected Sarcoidosis
B. A 30 year old man with positive Rheumatoid factor
C. A 40 year old HIV patient with CD count of 150
D. A 50 year old woman with suspected Interstitial lung disease
E. A 30 year old man with suspected pulmonary tuberculosis

402. X-ray chest PA view of a middle aged person shows a solitary nodule. Patient has a history of 20 pack years of smoking and there is a concern to rule out malignancy in this case. Which of the following feature would raise the suspicion of malignancy?

A. More than 3 cm in diameter
B. Smooth margins
C. Presence of calcification in the nodule
D. Lack of contrast enhancement
E. Presence of fat in the nodule