2/16/2015 Clinical Sciences Medicine Self Assessment

Clinical Sciences Medicine Self

Assessment
Senior Clerkship Major Rotation

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1. A 25 year old lady is admitted in medical ward with palpitations. She was diagnosed with
rheumatic mitral stenosis and atrial fibrillation four years ago. *
What kind of murmur is expected in this patient?
a. Early diastolic murmur at left sternal edge
b. Ejection systolic murmur in second intercostal space on left
c. Mid-diastolic murmur at apex
d. Pansystolic murmur radiating into axilla

2. A 55 year old male is admitted in medical ward with chest pain and progressive swelling of
limbs. He takes medicines for diabetes, hypertension, COPD and cor-pulmonale and is also
receiving maintenance hemodialysis for end-stage renal disease. Last week, he failed to
come for dialysis. Examination revealed a harsh biphasic scratchy sound over left parasternal
region of chest. *
What is the most likely origin of this sound?
a. Tricuspid valve
b. Mitral valve
c. Pericardium
d. Pleura

3. A 35 yr old male presents with multiple episodes of haematemesis and black tarry stool. On
arrival in ER his BP is 80/60 and pulse is 110bpm. *
What should you do immediately?
a. IV fluid 2 litres via two large bore cannula
b. Send for emergency upper GI endoscopy
c. Start octreotide IV infusion
d. Start proton pump inhibitor IV infusion

4. A 50 year old man presents with recurrent episodes of haemoptysis and copious green
sputum for the last 1 year. He has a previous history of pulmonary tuberculosis 3 years back.

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On examination there is clubbing of fingers and crackles are present in the right upper chest.
*
What is the most likely diagnosis?
a. Bronchogenic carcinoma
b. Bronchiectasis
c. Lung fibrosis
d. Pneumonia

5. A 45yr old male presented with a history of headache, vomiting and photophobia for the
past 5 days. On examination the patient has signs of meningeal irritation. A lumbar puncture
showed TLC 500 (neutrophils 85%, lymphocytes 15%), protein 150mg%, Sugar 10 mg% *
What is the most likely diagnosis?
a. Fungal meningitis
b. Pyogenic meningitis
c. Tubercular meningitis
d. Viral meningitis

6. A 23 yr old man presents with abdominal pain and vomiting and difficulty breathing for 3
days. He has been unwell with weight loss and increased thirst for around 1 month.
Investigations show blood glucose of 438mg% and urine ketones ++. *
What should your immediate management be?
a. IV bicarbonate and IV insulin
b. IV bicarbonate and s/c insulin
c. IV fluids and IV insulin
d. IV fluids and s/c insulin

7. A 65-year-old man presents with progressive shortness of breath. The trachea appears to
be deviated towards left side. Breath sounds are absent on the left side of the chest.
Percussion of the left chest reveals dullness. On palpation of the left side of the chest, when
the patient says “ninety nine,” no tingling is appreciated. *
Which is the most likely diagnoses?
a. Bronchial obstruction
b. Pleural effusion
c. Pneumonia
d. Pneumothorax

8. A 25 yr old man is diagnosed to have chronic liver disease in the past and has portal
hypertension. He presents now in emergency with altered mental status and abnormal gait.
On examination you note that he has a dark ring around the iris of both eyes. *
What is the most likely diagnosis?
a. Alcoholic cirrhosis
b. Chronic hepatitis B infection
c. Primary biliary cirrhosis

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d. Wilson’s disease

9. A 45 year old man comes to your clinic complaining of orange-colored urine after starting
anti-tubercular medicines for his chest problem. *
What should be the next best step in management of his problem?
a. Reassurance
b. Send liver function tests
c. Stop all drugs and re-start one at a time
d. Urine RE/ME

10. A 25 year old man comes to ER with coughing out of blood since morning. On further
inquiry, he mentions that the expectoration contains some blood which was blackish red in
color. He had a binge alcohol the previous evening and had severe vomiting and retching
which later contained coffee-ground particles. Examination reveals no abnormality apart
from some wheezes on bilateral lung fields. *
What is the source of bleeding in this patient?
a. Aspiration pneumonitis
b. Coagulopathy due to cirrhosis
c. Mallory weiss tear
d. Oesophageal varices

11. A 65 year old lady comes to ER with acute onset palpitation and shortness of breath since
morning. She is a known case of COPD under regular medicines which contains inhalers and
oral tablets. On further inquiry, she mentions that she forgot to take her medicines the
previous night so had doubled the dose this morning. Examination reveals she had irregularly
irregular heart rate with some wheezes and crepitations over bilateral lung fields. *
Which drug might have precipitated her symptoms?
a. Inhaled tiotropium
b. Inhaled salbutamol
c. Prednisolone
d. Theophylline

12. A 55 year old woman had elevated BP first noticed one month ago and on repeat testing
today her BP was 160/92. She has no symptoms. On exam, BMI was 32 kg/m2, general and
systemic exam is unremarkable. Baseline bloods were all normal except for LDL cholesterol
elevated at 164 mg/dL and triglycerides were also slightly high at 220 mg/dL. *
What advice would you give to this woman about her hypertension?
a. Abnormalities in her lipid panel further increase her risk of cardiovascular diseases
b. An echocardiogram to evaluate cardiac size should be done because systemic hypertension can
cause left ventricular hypertrophy
c. Her risk of cardiovascular diseases is similar to the general population
d. High salt intake is the most common cause of this condition

13. Rajiv, an 18 year old student, presented with episodic spells of hypertension, sweating,

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headaches and palpitations. His family history is positive for father with sudden cardiac
death at young age and an older sister with a thyroid cancer. Physical exam is normal when
you see him and his blood pressures are normal. *
How would you evaluate this patient?
a. CT scan of abdomen and pelvis with a focus on adrenal glands
b. Electrocardiogram to evaluate for the effect of episodic hypertension on heart
c. Plasma fractionated metanephrine
d. Routine labs first: complete blood count, serum electrolytes and urinalysis

14. A 32 year old schoolteacher sustained a motor vehicle accident injuring his chest and
abdomen. In operating theatre, he was found to have lacerated mesentery and a ruptured
spleen which was taken out. *
Which of the following vaccine is indicated in this gentleman?
a. Flu vaccine
b. MMR vaccine
c. Pneumococcal vaccine
d. Tetanus toxoid vaccine

15. A 55 year old patient with Non Hodgkins’s Lymphoma recently received Rituximab, a
monoclonal antibody against CD20, as part of his chemotherapy. *
Which infection he is at risk because of this therapy?
a. Human immune deficiency virus
b. Mycobacterium tuberculosis
c. Pneumocystis jirovici
d. Streptococcus pneumonia

16. Miss devi a school teacher presented with numbness and painful sensation of both lower
limbs for 2 month. She also gave history of fatiguability ,exertional SOB and paleness of
whole body. On neurological examination there is loss of vibration and position sensations
however intact pain and temperature sensations. *
What is the likely cause in this patient?
a.Iron Deficiency
b. Lead Poisoning
c. Thiamine Deficiency
d. Vit B 12 Deficiency

17. A 22 year lady presented with girdle like sensation around umbilicus and feeling of
senseless below it along with inability to move both limbs for 2 days. She has not passed
stool but passed urine after catheterization . *
What is the site of nervous system involved in this patient?
a. Brain Stem
b.Cortex
c. Peripheral Nerve

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d.Spinal Cord

18. A 54 year old man complains of palpitations which can come on suddenly at any time and
last for around 2 minutes. They are not associated with any chest pain or shortness of breath.
The doctor orders an electrocardiogram. *
Which EKG findings would raise concern for serious underlying cardiac pathology?
a. First degree heart block
b. Right axis deviation
c. Long QT interval
d. Q wave in AVR

19. A 59 year old Nepali farmer complains of fluttering feeling in his chest, dyspnea, cough,
and generalized weakness. He is on no medications. BP is 100/50, pulse is 110, O2 saturation
is 60%, He appears cyanotic, lungs have wheezes, there is pedal edema, a 2/6 systolic murmur
is heard at the R sternal border, and degenerative changes are noted in his knees. *
What is the most likely the cause of his palpitations?
a. Bronchospasm
b. Fluid retention
c. Generalized weakness
d. Hypoxia

20. A 27 year old college girl presents with several months’ history of excessive fatigue,
sleepiness, muscle sores and enlarged thyroid gland. She also shows you the recently done
thyroid function test that reveals markedly elevated TSH and low free T4. *
Which autoantibody will be associated with this disease?
a. Anti- microsomal
b. Anti- glutamic acid decarboxylase
c. Anti- nuclear
d. Anti-21 hydroxylase

21. A 35-year-old woman has the following family history: Her mother died of colon cancer at
age 48 years. Her brother was diagnosed with colon cancer at age 45 years. A maternal aunt
had colon cancer at age 62 years. *
What is most appropriate screening procedure for this patient?
a. Colonoscopy
b. CT scan of abdomen
c. Fecal occult blood testing
d. Flexible sigmoidoscopy

22. A 32-year-old asymptomatic man is found to have blood counts: hemoglobin of 17.1 g/dL,
leukocyte count of 5800/µL, and platelet count of 268,000/µL. You obtain a negative family
history and unremarkable medical history except for a 2-pack per day smoking history.
Physical examination is normal. *
What should be your next step?

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a. Order a red cell mass study
b. Obtain a carbonmonoxyhemoglobin level, arterial blood gases, and serum erythropoietin level.
c. Obtain a bone marrow aspirate for cytogenetic analysis and hematopoietic progenitor culture.
d. Reassure the patient that no further evaluation is necessary

23. A 47-year-old woman is evaluated in the intensive care unit for respiratory failure. She
had severe lower lobe pneumonia and was in septic shock. *
What definition best describes the patient's condition?
a. Sepsis with multiple organ dysfunction
b. Systemic inflammatory response syndrome with hypotension
c. sepsis with hypotension or hypoperfusion despite adequate fluid resuscitation
d. Urine output below 0.5ml/kg/hour and/or plasma lactate more than 1.5 the upper limit of normal

24. A 42 year old school teacher presents to Medical Referral Clinic with the concern of high
blood sugar as several members of his family have diabetes mellitus. He shows you a fasting
blood sugar report of 121mg/dl and another random blood sugar report showing 185mg/dl. *
What is the best term to characterize this condition?
a. Diabetes mellitus
b. Impaired fasting glycaemia
c. Impaired glucose tolerance
d. Prediabetes

25. A 40 yr female comes to the OPD with complaint of swelling of the right upper limb. She
had a right mastectomy with lymph node dissection for cancer of the breast 5 years back. On
examination the right upper limb is swollen and there is non-pitting oedema with coarser
skin. *
What is the diagnosis?
a. Deep vein thrombosis
b. Filariasis
c. Lymphedema
d. Myxedema

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