Medical Jeopardy

Rheumatology

100

A 52 years old nurse presents with diffuse muscle pain and intermittent abdominal discomfort.She was infected with Hepatitis B from a needle stick 15 years ago. Her BP is 180/95. UA is positive for protein and blood. A CT angiogram shows small mesenteric artery aneurysms . Which of the following is the most likely diagnosis? -----a. Behcet's Disease -----b. Takayasu's Arteritis -----c. Polyarteritis Nodosa -----d. Churg-Strauss Vasculitis.

c. Polyarteritis nodosa may present with polymyalgia and mesenteric ischemia along with glomerulonephritis. Exposure to hepatitis B is a risk factor for this disease.

200

A 50 year old man presents with chronic recurrent sinusitis. Recently he had L ear pain and a gradual loss of hearing in L ear. He has cough with occasional hemoptysis. He has multiple nodules and cavities on his chest X-ray. His creatinine is 145 and urine dipstick shows ++ protein and blood. Which test result is most likely? -----A. Positive c- ANCA -----B. Positive ANA -----C. Positive AFB smear -----D. Positive Anti glomerular membrane antibodies -----E. Positive Hep C antibodies with cryo

A. Positive cANCA

300

A 37 year old female teacher presents with a 3 week history of small joint pain and stiffness in her hands and feet. Her past medical history is unremarkable. On ROS: she has no skin rash, no red eyes and no bloody diarrhea. On exam, she has swelling (synovitis) of second and third MCPs bilaterally. All of the following diagnoses can explain the patient’s condition EXCEPT: -----(a)Rheumatoid arthritis -----(b) Viral arthritis -----(c) Fibromyalgia -----(d) Connective tissue disease -----(e) Psoriatic arthritis

(c) Fibromyalgia

400

Which of the following is not included in the American College of Rheumatology (ACR) diagnostic criteria for SLE? -----(a) Thrombocytopenia -----(b) Positive ANA -----(c) Psychosis -----(d) Alopecia -----(e) Photosensitivity

(d) Alopecia

Gastroenterology

100

Secondary bacterial peritonitis should be suspected when ascetic fluid analysis shows the following criteria: ---Total protein greater than 1g/dl ---Glucose less than 50 mg/dl ----LDH higher than the upper limit of normal for serum ----Non of above ---All of above.

e

200

Which of the following is true. ----a--Diagnostic tap should be performed in all patients with new-onset ascites ---b--Diagnostic tap should only be done in OR setting ---c---Diagnostic tap should always be followed by theraputic tap. ---d--IV antibiotic are necessary prior to a diagnostic tap

a

300

The most common site for GIST tumor is ---a--Stomach ---b--Esophagus ---c--Duodenum --d--Colon

A

400

What is the most common cause of infectious esophagitis in general population? ---a---Candida albicans ---b--Herpes simplex virus ---c---cytomegalovirus -

A

500

In developing countries, the prevalence of H.pylori by 20 years of age may reach levels of ---a--40% ---b---80% ---c---60% -

B

pulmonary

100

Appropriate treatment for asthma includes all except: ----A.---- oxygen ----B----. beta agonist ----C----. prednisone ----D.---- beta antagonist

beta antagonist

200

In order to obtain the highest likelihood of successful smoking cessation, you should recommend which of the following? A. Nicotine replacement therapy and behavioral therapy B. Bupropion and behavioral therapy C. Varenicline and behavioral therapy D. Behavioral therapy alone

C

300

In patients with first episode of acute Pulmonary Embolism, the factor that is most predictive of recurrence after completing 6 months course of therapy with warfarin is: ----A.---- A homozygous factor V Leiden mutation ----b---- B. Female gender----C.---- An unprovoked initial event ----D.---- A Perioperative initial event

c

400

What is the most common EKG finding in Pulmonary embolism ---a---Sinus tachycardia---b---RBBB----c----S1 q3 t3 pattern----d----Right ventricular strain pattern

Sinus tachycardia

500

Question-1: 52 YO male HO diabetes. Admitted with 2 days cough, fever and diarrhea. On exam he is dry, P 132 BP 80/60, RR 32/min and right lower lobe crackles. Lab studies showed: pH: 7.32 PaCO2: 32 PH 7.32 PaCO2 32 mmHg PaO2 60 mmHg Na 140 mmol/L K 4.4 mmol/L Cl 100 mmol/L Bicarbonate 16 mmol/L What is the correct interpretation of these data? -----A-----. Inconsistent and uninterruptible data -----B.----- Anion gap metabolic acidosis and non anion gap metabolic acidosis -----C-----. Anion gap metabolic acidosis with appropriate respiratory compensation -----D-----. Anion gap metabolic acidosis, metabolic alkalosis, and respiratory alkalosis

c

ID

100

35 yr old presents with fever and weakness. He has hx of heart murmur detected a long time ago. He denies illicit drug use. Physical exam reveals splinter hemorrhages, small petechiae on palatal mucosa and audible murmur. Which valve is likely affected.---Aortic----b----mitral,-----tricuspid-----d---- pulmonic

Mitral

200

A 12 yr old boy is brough to ER with severe pain in left knee and subsequently diagnosed as osteomyelitis. He has sickle cell disease and hospitalized for sickle cell crisis in the past. Which organism is the most likely cause ---a----Ecoli---b---pseudomonas species---c--- salmonella species---d---staph aureus----e--- gp b strep

salmonella

300

A 22 year old woman comes to the ER after having being bitten by neighbours dog. She provoked him while it was eating. The dog is not immunized against rabies and shows no signs of rabies. Her right forearm which shows a deep bite wound is cleaned. Her last tetanus booster was 3 yrs ago. What is the next appropriate step in management of this patient-----a--- kill the dog---b---observe the dog for 10 days---c---active immunization for rabies----d---passive immunization for rabies---e-- both active and passive immunization for rabies

observe the dog for10 days

400

26 yr old comes to PCP office with two wk hx of fatigue ,fever, muscle aches and arthralgias. He denies any wt loss. temp 37.7, bp 115/75. Pulse 75, RR 14. PE is unremarkable except for splenomegaly. Hg-- 13 gm/dl, WBC 12,000. N 22% lymph 70% monocytes 5% basophils 1% Plts 220---- peripheral smear shows large basophilic lymphocytes with a vacuolated appearance. Heterophile antiboty test is negative. What is the most likely cause of this patients symptoms.---a---Chronic fatigue syndrome ---b--- cytomegalovirus infection---c---acute toxoplasmosis, ---d--- mycobacterial infection---e---- chronic lymphocytic leukemia

cytomegalovirus infection

CVS

100

Which of the following warrants cancellation of surgery? -----a. Atrial fibrillations with a heart rate of 95 beats/min -----b. New lateral T wave inversions on an EKG in your office -----c. Aortic valve stenosis . valve area 1.1cm2 -----d. Mitral valve regurgitation and worsoning leg edema

d. Mitral valve regurgitation and worsening leg edema

200

Which valve is most commonly effected in Rheumatic fever? -----a mitral valve -----b- aortic valve -----c- tricuspid valve -----d- mitral and aortic valve are equally effected

Mitral valve

300

Which valvular lesion will progress to severe aortic stenosis requiring surgery at an earlier stage. -----a- tricuspid aortic valve -----B -bicuspid aortic valve -----C-unicuspid bicommisure aortic valve -----d- unicuspid unicommisure aortic valve

Unicuspid, unicommisure valve

400

What is more common : -----Systolic heart failure ----Diastolic heart failure -----Both are equal

both are equal

500

which of the following tests gives highest radiation to the patient -----a-Diagnositic cardiac catheterization -----Persantine Stress MIBI -----Exercise MIBI -----Coronary CT angiogram -----Thallium Stress Test

Thallium Stress Test