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ABMA – Latest Updates on Internal Medicine/Family Practice/GP – 2015

Medical Quiz

1. A 38-year-old woman is seen in A&E with a history of collapse. She recalls rushing for the bus before feeling faint. Her brother recently died suddenly due to a heart problem. On examination she has a ‘jerky’ pulse, a thrusting cardiac impulse and a mid-systolic murmur.

What is the likely diagnosis?

  1. Dilated cardiomyopathy
  2. Hypertrophic cardiomyopathy
  3. Mitral valve prolapse
  4. Aortic stenosis
  5. Pericarditis

2. A 50-year-old male is brought to A&E with acute-onset central chest pain that started 1½ hours ago. His ECG taken on arrival showed ST elevations of 4 mm in leads II, III, aVF and V4–V6 with hyperacute T waves. His pulse was 60 per minute and his BP was 146/60. The SaO 92%. He was given O2 by mask and two large intravenous cannulas were inserted.

Which of the following blood tests would be most useful to wait for prior to commencing definitive treatment?

  1. Myoglobin
  2. Troponin I
  3. CK-MB
  4. LDH
  5. None

3. What is the diagnosis

medical_quiz

  1. RBBB
  2. LBBB
  3. RBBB WITH LAHB
  4. LAHB

4. All of the following are smoking quitting aids except

  1. Vareniciline
  2. Nicotine Pathces
  3. Bupiprone
  4. Chlorpromazine

5. A 80 year old female presents to A and E , found unwell and unresponsive.she has a H/O hypothyroidism and thyroxine..However , her compliance to treatment is questionable.On exam, she was unresponsive with a aGlasgow coma scale of 6/15. O2 sats 95% on air, and a PR of 44.mt with a bp of 100/70 mm.. Neuro exam, no localizing signs. What is the most corret empirical therapy as an emergency is appropriate

  1. i/v 50% glucose.
  2. IV hydrocortisone.
  3. I/V normal saline.
  4. I/V thyroxine.
  5. Oral thyroxine via NG tube.

6. A 47 years old present to A and E with severe left side post auricular pain, while working in his garge under the car.. on exam. He has neck tenderness and stiffness,impaired coordination of the lefthand and increased tone in the  right limbs. What is the most likely diagnosis.

  1. cervical dislocation.
  2. migrain
  3. subarachnoid haemorrhage.
  4. tension headache.
  5. vertebral artery dissection.

7. A 75 year-old woman presents with a two month history of episodic loss of vision in her right eye. Her ECG was normal and carotid ultrasound reveal a 50% stenosis of the right internal carotid artery What is the most appropriate treatment for this patient?

Available marks are shown in brackets

  1. Aspirin [100]
  2. Carotid endarterectomy
  3. Dipyridamole
  4. Prednisolone
  5. Warfarin

8. Serum biochemistry of a 60 year old man revealed calcium of 1.98 mmol/l and phosphate of 0.55 mmol/l with an alkaline phosphatase of 450 IU/l.Which among the following mosts suits with the above serum biochemistry?

Available marks are shown in brackets

  1. Osteoporosis
  2. Osteomalacia 0
  3. Pagets Disease
  4. Secondary Hyperparathyroidism
  5. Renal failure

9. A 23 year old female presents with a left knee joint pain and a 2 month history of weight loss. She has a good appetite but has had occasional episodes of diarrhoea over this time and tends to pass a loose motion at least twice daily. She is taking no medication but there is a family history of hypothyroidism. She is a non-smoker and drinks modest quantities of alcohol. Examination reveals a swollen, tender left knee joint with a small effusion.

The most likely diagnosis is?

Available marks are shown in brackets

  1. Behcet’s disease
  2. Reiter’s syndrome
  3. Inflammatory bowel disease [100]
  4. Tuberculosis
  5. Thyrotoxicosis

10. A 47 year old woman presenting with breathlessness has arterial blood gases taken which give the following results:

PO2 8.7 kPa (65mmHg),
PCO2 4.4 kPa (33mmHg),
PH 7.46, {HCO3-] 24.

Which of the following is the most likely diagnosis.
Available marks are shown in brackets

  1. Hyperventilation syndrome
  2. Acute severe asthma [100]
  3. Emphysema
  4. Kyphoscoliosis
  5. Opiate overdose

11. A patient with Rheumatoid arthritis complains of progressive breathlessness. Which of the following is the most likely cause?

Available marks are shown in brackets

  1. Pulmonary Eosinophilia
  2. Asthma
  3. Pulmonary nodules
  4. Fibrosing Alveolitis [100]
  5. Pulmonary Embolus

12. Which of the following is a recognised cause of a phrenic nerve palsy?

Available marks are shown in brackets

  1. Aortic aneurysm [100]
  2. Dermoid
  3. Ganglioneuroma
  4. Pericardial cyst
  5. Sarcoidosis

13.Which of the following is true of BCG vaccination?

Available marks are shown in brackets

  1. is contraindicated in neonates
  2. is a killed polysaccharide antigen vaccine
  3. should be given to all children who have a strongly positive tuberculin test
  4. is presently routinely offered in the UK at age 16 years
  5. Provides protection against leprosy [100]

14. Which of the following is most commonly associated with prolonged QT interval?

Available marks are shown in brackets

  1. hypercalcaemia
  2. hyponatraemia
  3. hyperthyroidism
  4. hypocalcaemia [100]
  5. hypomagnesiamia

 


15. A 28-year-old lady develops abdominal pain, jaundice and ascites worsening over a week. She drinks ten units of alcohol each week and takes the oral contraceptive pill. Which of the following findings would make a diagnosis of hepatic vein thrombosis (Budd-Chiari syndrome) MOST likely?

Available marks are shown in brackets

  1. alanine aminotransferase of 885 U/L (5 – 35)
  2. acute liver failure
  3. ankle oedema
  4. ascites fluid protein of 38 g/L
  5. tender enlarged liver [100]

16. A 20-year-old male student is assessed for shortness of breath that occurs whilst running. He has no other symptoms and does not smoke. Examination, full blood count, and chest X-ray are normal. Which of the following is most likely to be helpful in confirming the suspected diagnosis?

Available marks are shown in brackets

  1. Arterial blood gas studies before and after exercise
  2. Determination of lung volumes and diffusing capacity
  3. Measurement of venous blood lactate before and after exercise
  4. Xray Chest
  5. Spirometry before and after exercise [100]

17. A 60-year-old woman diagnosed with giant cell arteritis was commenced on high dose prednisolone therapy.

What is the most appropriate treatment for the prevention of steroid-induced osteoporosis?

Available marks are shown in brackets

  1. Bisphosphonate therapy [100]
  2. Calcium and vitamin D
  3. Hormone replacement therapy
  4. Raloxifene
  5. Salmon Calcitonin 

18. A 25-year-old male presents to casualty with weakness of his right hand. Examination reveals weakness of right wrist and finger extension. What is the most likely diagnosis?

Available marks are shown in brackets

  1. axillary nerve palsy
  2. C8 nerve root lesion
  3. proximal median nerve lesion
  4. radial nerve lesion [100]
  5. ulnar nerve lesion at the elbow

19. Which one of the following cardiac enzymes would be expected to begin to increase between 12-24 hours after a myocardial infarction?

Available marks are shown in brackets

  1. Aspartate transaminase [100]
  2. Creatine kinase
  3. LDH
  4. Troponin I
  5. Troponin T

20. Which of the following regarding the anatomy of the heart is true?

Available marks are shown in brackets

  1. The aortic valve is tricuspid. [100]
  2. The ascending aorta is entirely outside the pericardial sac.
  3. The left atrial appendage is identified readily by transthoracic echocardiography.
  4. The pulmonary trunk lies anterior to the ascending aorta.
  5. The right atrium is posterior to the left atrium.

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