Board Questions Feb/2024

1- IBS - increase pain with defecation (other options: bloating, nausea )

2- Crohn’s lady - on azathioprine and mesalazine (what to stop or continue both or half the
dose of azathoprine)

3- HOCM expected to see ECG - RBBB ( other options: ant Q waves , T wave inversion on inf
leads )

4- Pt was in sudan drank and slept in villages had lower back pain and fever - brucellosis

5- Pt was in africa , had low hct , high bili , picture of malaria - tt artsunate

6- Pt with afib and PCI stent : asprin clopidogril and warfarin then stop asprin after 1 month and
clopidogrel after 12 months keep on warfarin afterwads (repeated)

7- pt with hx of CAD and st changes with + trop : agressive intervention with PCI (temi score)

8- pt with stage 2 lupus : tt with ACE

9- case of compratment syndrome can be caused by chicken pox

10- ABGs question straightforward : NAGMA

11- ABGs question NAGMA hyperosmolar (high anion gap, high osmolar gap) with normal
opthalmic test : methanol

12- fever and diaphoresis and tachycardia during ansethesia with propofol and isoflorane , pt
has high co2, cause of the picture : malignant hyoerthermia

13- RTA hypokalemia , urine PH 6.5 : distal (type 1)

14- stone not dependent on pH: Oxalate , cystine ??? (other options :calcium , phostphate ,
struvite)

15- smoker with central lung mass and hyponatremia : small cell

Pass medicine > 16- COPD pt with poor management , candidate for pneumenectom : upper
lobe predominant , low exercise tolerance
- or question was high mortality in pneumonectomy, young female patient , COPD : non upper
lobe and high exercise
17- pt asymptomatic with incedental log QT >470 ECG: reassure / BB ??

18- immunocompromised with cavitated lung infection, unresolving fever for 5 days with abx,
CBC differential was given , diagnosis: asperigilloma or TB??

19- a pt post op 7 days with DIC , high LDH , low plt , new CVA , cause : ciprofloxacin given

20- pt with recurrent UTI, vanco resistant enterococcus , tt: linozolid

21- pt with fever on vanco and ceftriaxone , fever subsided , kept on vanco trough 19 , echo with
vegetation , mg : gentamicin and rifampicin (kindly revise IE)

22- Does not improve after better glycemic control: microalbuminuria/ nephropathy/
neuropathy / retinopathy

23- most indication for renal biopsy

24- pt with rasha , cANCA : granulomatosis with polyangitis

25- sickle cell pt wants to get pregnant advice regarding pregnancy and hydroxyuria ( when to
start and stop hydroxiurea and if SCD increases risk for abortion)

26- pt with proxmimal and distal muscle weakness - inclusion body

27- antiemitic in parkinson : domperidone or odansteron??

28- pt with ascending paralysis and arm weakness , loss of sensation below T4 , diagnostic
measure : Cervical MRI? (other options : brain MRI , EMG)

29- lupus pt with a headache of several days and now DLOC , diagnostic measures: CTV? (other
options:LP/ CTA / CTV)

30- pt had spine surgery for spondylosis , has high Calcium and above normal PO4 , diagnosis :
vit D toxicity (other options: CKD, hyperthyroidism)

31- boy with bruising , post viral infection, low plt : observe (other options : IVIG, steroids)

32- pt with chronic VTE, right heart strain , next step : pulm angio with right heart cath (other
options : VTE , increase warfarin , switch to NOAC)
33- pt with PE on warfarin , has worsning symptoms and R heart failure : refer for
endarterectomy

34- pt with LGIB , mouth ulcers , shin lesions , next step: colono

35- pt with epigastric pain , hematemesis , pt not on nsaid , on endoscopy had multiple
duodenal ulcers , pts father with pancreatic Ca, next step test: Fasting gastrin test (other
options : secretin stimulation test )

36- pt with variceal bleeding, not recommended in tt: PPI drip ( other options : antibiotics ,
octreotide , albumin )

37- pt with CLD, fever, ascitis and abdominal pain, ascitic culture has fecales bacteria , next step:
abdomen CT (other options : antibiotics , albumin )

38- lady with pruritis , jaundice , investigations : AMA

39- pt with DKA for the first time managed with basal bolus improved , was admitted again for
ortho and was found to have low insulin requirement and low A1C , what to give after discharge
clinic follow up ? Switch to metformin (other option: sulfonyluria , glargine , keep on basal
bolus)

40- anorexic pt with refeeding sydrome was intubated due to respiratory distress :
hypophosphatemia

41- pt on chemo hyperkalemia , hypocalcemia , hyperphosphatemia : TLS

42- pt with crohns on azathioprine , developed gout given allopurinol , presented with abnormal
labs (evidence of bone marrow suppression) : allopurinol azathioprine interaction

43- pt after cath 1 month presneted with EF 35% and V tach , mgx : ICD (other options: beta
blocker , statin )

44– ICD in asymptomatic neuromuscular pt :options no indication for ICD unless documented
heart block / EP STUDY / all pts need ICD

45- pt with foot drop and pic of wegners , mgx? Pulse mthyl and cyclophosphamide (other
options :oral pred / plasma exchange)

46- which of the following is in favor of MODY: contoled on low dose of insulin (other options :
elevated morning glucose levels, strong family hx , nocturnal hypoglycemia)

47- pt with severe CAD : CABG type 1B recommendation (other options : PCI , CABG
recommendation type 2B)
48- empty sella , incidental finding: reassure pt, lab follow up

49- BMI 29 , DM not controlled on metformin , add: linagliptin

50- left leg weakness , no reflex , left arm weakness , brisk (mixed upper and lower motor
neuron lesion) : ALS

51- hypotension during dialysis , which is not a management approach: give furosemide 120 X 2
(Other options: decrease salt intake/good hydration/ ask pt not to take amlodipine prior to
session/increase session time)

52- pt with neutropenic fever: manage with IV antibiotics --- > ANC > 500 + afebrile for 48hrs

53- glucagon moa in hypoglycemia : adenlyate cyclase

54- not to order in sarcoidosis workup: Calcium / phosphorus/ creatinine/ ALP / CBC

55- A 45 lady, smoker on OCP and recent travel with LL swelling : high probability for DVT (well’s
score DVT)

56- not to give for TB in CLD pt : pyrazinamide / isoniazid ??

57- pt with positive IGRA , no symptoms , latent TB , next step : CXR

58- pt with ascending paralysis , picture of GBS , MC involved cranial nerve: facial

59- pt most MI , on BB , statin .. presented with bradychardia , next step: reduce metoprolol
(other options atropine/ nore..)

60- pt with bidirectional VT , mutation: calcium ryanodine receptor ( Other options sarcomeric/
potassium/ sodium)

61- all cause protienuria except : lithium (Other options sjogren / lupus / scleroderma)

62- COPD with RR 22 , intubated what to alter to improve pH 7.2 ???

63- myasthenia , sob , max insp capacity 19 : intubate (other options : methyl , IVIG ,
Plasmaphoresis)

64- pt with RA hx of PUD put on MTX and NSAID next step : add omeprazole (other choice
change to celecoxib )
65- pt with FSGS 3 weeks after transplant has proteinuria , normal KFT , cause : recurrance of
FSGS ?(other options EBV, renal vein thrombosis )

66- pt with APKD associated with: mitral valve prolapse

67- pt with 2ry amenorrhea , low FSH , high prolactin cause : pituitary tumor (other options
PROM)

68- pt with pit adenoma and blurring of vision : refer to neurosurgery

69- pt with osteoporosis, shaves beard once weekly , what to test for : total testosterone level

70- pt with crohn’s , has lower back pain and limited range of motion, best next investigation :
pelvic CXR (other options: MRI , HLA B27)

71- pt with MCA , PMH of HTN , which investigation is validated : Sleep study

72- pt with PMR , got better on 15mg prednisone then got eye pain on range of motion , next
step: increase prednisone to 60 mg

73- dermatomyocytis muscle biopsy : complement induced muscle inflammation ?

74- which is true abt procalcitonin : in covid it’s a good indicator for r/o bacterial infection
( other options : decreases days of abx tt )

75- comparison btw NSTEMI and STEMI, correct : STEMI has worse long term survival

76- pt with paget , hip pain , paget picture on hip MRI , next step in tt: zolendronic acid 5mg
( other options alendronate 70 weekly)

77- OSA CPAP epidemiology: CPAP decreases cardiovascular OSA risk ? ( other option :
decreases OSA mortality / nasal is better full)

78- DIC pt: give hydro??

79- pt after RTA , long bone fracture , best way to avoid massive transfusion complications:
warm blood and do sgx management / limit plasma to citrate

80- pt with recent valve and wants to do dental work, allergic to amoxicillin, give: clindamycin
600 prior to precedure (Other options : clinda prior and after / cipro)
81- UGIB , varecial , low plt < 50 , hb 9 , INR 4 , mgx: endoscopy within 12-24 hrs (other options
give plt/ give blood/ correct INR)

82- to diagnose sarcoidosis, pt underwent LN biopsy and found to have non-caseating

83- aspiration pneumonia not resposive to tt , loculated abscess on CT , mgx : drainage

84- P wave after each QRS : junctional tachycardia ? (options : ventricular escape , junctional
escape )

85- Which of these options not with V tach : pt with QRS getting narrower with tachycardia
(options: runs of P waves through the ECG , RSR with one R smaller than the other , Pericordial
leads concordance)

86- pt with fever negative for everything(viral/bacterial/HIV), next step: bone marrow / PET scan
/ discharge and follow up

87- pt with picture of DIC from AML ,next step: consult heme for all trans retinoic acid (options:
send for t 15:17 / furthur blood workup/ consult heme for chemo)

88- pt recived blood and developed fever what to do next : dont give blood / nore / hydro ?

89- Case of MI pt intubated and got better, after extubation , deteriorated developed pulmonary
edema, what is the cause : increased left vent pre and afterload (options : bulging of left
ventrcular septum)

90- pt has c dif treated with vanco for 10 days , returned with C dif next step : fidaxomicin

91- Pt developed CVA after 5 days of MI what if given is likely to prevent CVA : warfarin for 3
months (other options : warfarin for life , asprin and clopidogrel )

92- post transplant neutrophils 0 given blood developed fever , mgx: options hydro / antibiotics

93- pt with mononuritis multiplex , diagnosis : eosinophilic granulomatosis

94- pt with CKD and hyperphosphatemia on vit D tt , mgx : add sevelemir

95- pt with scleroderma, SIBO , which of the following would not become difficient : folate
( other options : vit b12 , Vit A )