4th Year IM Exam PDF

**Cardiology** 1. **Which of the following is the most common cause of left-sided heart failure?** - A\) Myocardial infarction - B\) Aortic stenosis - C\) Chronic hypertension - D\) Acute myocarditis - **Answer: C) Chronic hypertension** 2. **A patient pres...

**Cardiology** 1. **Which of the following is the most common cause of left-sided heart failure?** - A\) Myocardial infarction - B\) Aortic stenosis - C\) Chronic hypertension - D\) Acute myocarditis - **Answer: C) Chronic hypertension** 2. **A patient presents with chest pain, dyspnea, and a new murmur. A transthoracic echocardiogram reveals left ventricular hypertrophy and aortic valve thickening. What is the most likely diagnosis?** - A\) Mitral regurgitation - B\) Aortic stenosis - C\) Dilated cardiomyopathy - D\) Pericarditis - **Answer: B) Aortic stenosis** 3. **A 60-year-old woman presents with fatigue, dyspnea, and orthopnea. Physical examination reveals bilateral basilar crackles and pitting edema. Which of the following is the most likely diagnosis?** - A\) Acute myocardial infarction - B\) Congestive heart failure - C\) Pulmonary embolism - D\) Chronic obstructive pulmonary disease - **Answer: B) Congestive heart failure** 4. **Which of the following is a common complication of untreated atrial fibrillation?** - A\) Hypotension - B\) Pulmonary embolism - C\) Stroke - D\) Myocardial infarction - **Answer: C) Stroke** 5. **Which of the following medications is most commonly used for rate control in atrial fibrillation?** - A\) Metoprolol - B\) Enalapril - C\) Digoxin - D\) Warfarin - **Answer: A) Metoprolol** 6. **Which of the following is the first-line treatment for acute coronary syndrome?** - A\) Thrombolytics - B\) Angioplasty - C\) Beta-blockers and aspirin - D\) Calcium channel blockers - **Answer: C) Beta-blockers and aspirin** 7. **Which of the following is the most common cause of sudden cardiac death?** - A\) Acute myocardial infarction - B\) Aortic dissection - C\) Ventricular arrhythmias - D\) Pulmonary embolism - **Answer: C) Ventricular arrhythmias** 8. **A 75-year-old male with a history of chronic hypertension and diabetes presents with sudden-onset severe chest pain radiating to the back. Which of the following is the most likely diagnosis?** - A\) Myocardial infarction - B\) Aortic dissection - C\) Pulmonary embolism - D\) Gallbladder disease - **Answer: B) Aortic dissection** 9. **Which of the following is a key feature of congestive heart failure with preserved ejection fraction (HFpEF)?** - A\) Decreased stroke volume - B\) Elevated left ventricular end-diastolic pressure - C\) Reduced cardiac output - D\) Enlarged coronary arteries - **Answer: B) Elevated left ventricular end-diastolic pressure** 10. **Which of the following is a contraindication for thrombolytic therapy in the setting of acute myocardial infarction?** - A\) Chest pain duration of 30 minutes - B\) History of stroke within the last 3 months - C\) Age over 70 years - D\) Elevated serum troponins - **Answer: B) History of stroke within the last 3 months** **Hematology** 11. **Which of the following is a characteristic finding in the peripheral blood smear of a patient with iron deficiency anemia?** - A\) Spherocytes - B\) Target cells - C\) Microcytic hypochromic cells - D\) Hypersegmented neutrophils - **Answer: C) Microcytic hypochromic cells** 12. **What is the most common inherited bleeding disorder?** - A\) Hemophilia A - B\) Von Willebrand disease - C\) Factor V Leiden mutation - D\) Vitamin K deficiency - **Answer: B) Von Willebrand disease** 13. **A 45-year-old woman with a history of heavy menstrual bleeding presents with fatigue and pallor. Laboratory tests show a hemoglobin level of 8 g/dL, and peripheral blood smear reveals anisocytosis and poikilocytosis. What is the most likely diagnosis?** - A\) Iron deficiency anemia - B\) Aplastic anemia - C\) Thalassemia - D\) Hemolytic anemia - **Answer: A) Iron deficiency anemia** 14. **Which of the following is a common cause of microangiopathic hemolytic anemia?** - A\) Acute blood loss - B\) Malaria - C\) Hemolytic uremic syndrome - D\) Vitamin B12 deficiency - **Answer: C) Hemolytic uremic syndrome** 15. **A 70-year-old man with a history of smoking presents with weight loss, fatigue, and night sweats. Laboratory tests show an elevated white blood cell count and peripheral blood smear reveals an increased number of blasts. What is the most likely diagnosis?** - A\) Acute myeloid leukemia - B\) Chronic lymphocytic leukemia - C\) Lymphoma - D\) Multiple myeloma - **Answer: A) Acute myeloid leukemia** 16. **Which of the following is the first-line treatment for polycythemia vera?** - A\) Chemotherapy - B\) Phlebotomy - C\) Radiation therapy - D\) Bone marrow transplant - **Answer: B) Phlebotomy** 17. **Which of the following laboratory findings is most commonly seen in vitamin B12 deficiency?** - A\) Microcytic anemia - B\) Elevated homocysteine and methylmalonic acid - C\) Decreased serum ferritin - D\) Elevated iron saturation - **Answer: B) Elevated homocysteine and methylmalonic acid** 18. **Which of the following is a characteristic feature of chronic myelogenous leukemia (CML)?** - A\) Philadelphia chromosome (BCR-ABL fusion gene) - B\) Increased eosinophils - C\) Elevated hematocrit - D\) Increased reticulocyte count - **Answer: A) Philadelphia chromosome (BCR-ABL fusion gene)** 19. **What is the most common cause of thrombocytopenia in hospitalized patients?** - A\) Idiopathic thrombocytopenic purpura - B\) Heparin-induced thrombocytopenia - C\) Thrombotic thrombocytopenic purpura - D\) Viral infections - **Answer: B) Heparin-induced thrombocytopenia** 20. **Which of the following is a hallmark finding of multiple myeloma?** - A\) Elevated white blood cell count - B\) Hypercalcemia and renal failure - C\) Thrombocytosis and leukocytosis - D\) Sickle cells on peripheral smear - **Answer: B) Hypercalcemia and renal failure** 21. **Which of the following is the most common cause of iron overload?** - A\) Hemochromatosis - B\) Hemolytic anemia - C\) Acute blood transfusions - D\) Chronic alcohol use - **Answer: A) Hemochromatosis** 22. **A 55-year-old man with a history of chronic alcohol use presents with bleeding gums, petechiae, and bruising. His platelet count is 50,000/mm³. Which of the following is the most likely cause of his thrombocytopenia?** - A\) Cirrhosis - B\) Leukemia - C\) Idiopathic thrombocytopenic purpura - D\) Vitamin B12 deficiency - **Answer: A) Cirrhosis** 23. **Which of the following is a feature of the myelodysplastic syndromes?** - A\) Hypercellular bone marrow - B\) Cytopenias with dysplastic cells - C\) Marked increase in leukocytes - D\) Massive splenomegaly - **Answer: B) Cytopenias with dysplastic cells** 24. **Which of the following conditions is associated with an increased risk of deep vein thrombosis (DVT)?** - A\) Systemic lupus erythematosus - B\) Chronic kidney disease - C\) Atrial fibrillation - D\) Obesity - **Answer: D) Obesity** 25. **Which of the following is a common complication of sickle cell disease?** - A\) Pulmonary embolism - B\) Stroke - C\) Hypertension - D\) Anemia - **Answer: B) Stroke** **Nephrology** 26. **A 60-year-old male with a history of hypertension presents with a creatinine level of 2.5 mg/dL. Urinalysis shows proteinuria and hematuria. What is the most likely cause of his renal impairment?** - A\) Diabetic nephropathy - B\) Chronic glomerulonephritis - C\) Hypertensive nephrosclerosis - D\) Acute tubular necrosis - **Answer: C) Hypertensive nephrosclerosis** 27. **A patient presents with swelling of the legs and decreased urine output. His urine is frothy. Urinalysis reveals proteinuria. What is the most likely diagnosis?** - A\) Acute kidney injury - B\) Nephrotic syndrome - C\) Nephritic syndrome - D\) Urethral obstruction - **Answer: B) Nephrotic syndrome** 28. **Which of the following is the most common cause of chronic kidney disease (CKD) in adults?** - A\) Polycystic kidney disease - B\) Diabetic nephropathy - C\) Glomerulonephritis - D\) Hypertensive nephropathy - **Answer: B) Diabetic nephropathy** 29. **A 50-year-old man with hypertension presents with blood in the urine and reduced urine output. His serum creatinine is elevated. Which of the following is the most likely diagnosis?** - A\) Acute tubular necrosis - B\) Nephrolithiasis - C\) Renal cell carcinoma - D\) Glomerulonephritis - **Answer: D) Glomerulonephritis** 30. **Which of the following is characteristic of nephritic syndrome?** - A\) Proteinuria \> 3.5 g/day - B\) Hematuria and hypertension - C\) Hyperlipidemia and edema - D\) Hyperkalemia and acidosis - **Answer: B) Hematuria and hypertension** 31. **A 30-year-old woman presents with edema, proteinuria, and hypoalbuminemia. She has no history of systemic disease. What is the most likely cause?** - A\) Minimal change disease - B\) Systemic lupus erythematosus - C\) Focal segmental glomerulosclerosis - D\) Diabetic nephropathy - **Answer: A) Minimal change disease** 32. **Which of the following is the most common cause of nephrotic syndrome in children?** - A\) Focal segmental glomerulosclerosis - B\) IgA nephropathy - C\) Minimal change disease - D\) Membranous nephropathy - **Answer: C) Minimal change disease** 33. **Which electrolyte disturbance is most commonly associated with acute kidney injury (AKI)?** - A\) Hyperkalemia - B\) Hypocalcemia - C\) Hypernatremia - D\) Hypomagnesemia - **Answer: A) Hyperkalemia** 34. **A patient with chronic kidney disease develops hyperkalemia, acidosis, and fluid overload. What is the most appropriate next step in management?** - A\) Dialysis - B\) Sodium bicarbonate - C\) Diuretics - D\) Potassium restriction - **Answer: A) Dialysis** 35. **Which of the following is the best initial treatment for a patient with stage 1 chronic kidney disease and proteinuria?** - A\) Angiotensin-converting enzyme (ACE) inhibitor - B\) Calcium channel blocker - C\) Diuretic therapy - D\) Steroid therapy - **Answer: A) Angiotensin-converting enzyme (ACE) inhibitor** 36. **Which of the following is the most common cause of nephrolithiasis?** - A\) Uric acid crystals - B\) Calcium oxalate crystals - C\) Struvite stones - D\) Cystine stones - **Answer: B) Calcium oxalate crystals** 37. **A 45-year-old woman with a history of systemic lupus erythematosus presents with proteinuria and hematuria. What is the most likely renal manifestation of her disease?** - A\) Acute tubular necrosis - B\) Lupus nephritis - C\) Polycystic kidney disease - D\) Diabetic nephropathy - **Answer: B) Lupus nephritis** 38. **Which of the following is an indication for dialysis in patients with chronic kidney disease?** - A\) Serum creatinine \> 1.5 mg/dL - B\) Fluid overload unresponsive to diuretics - C\) Elevated blood pressure despite treatment - D\) Hyperlipidemia - **Answer: B) Fluid overload unresponsive to diuretics** 39. **Which of the following is the most common cause of nephrogenic diabetes insipidus?** - A\) Lithium toxicity - B\) Hypercalcemia - C\) Renal tubular acidosis - D\) Cystic fibrosis - **Answer: A) Lithium toxicity** 40. **A 25-year-old woman presents with a history of recurrent urinary tract infections and hematuria. Urinalysis reveals the presence of RBC casts. What is the most likely diagnosis?** - A\) Nephrolithiasis - B\) Acute pyelonephritis - C\) Glomerulonephritis - D\) Bladder carcinoma - **Answer: C) Glomerulonephritis** 41. **Which of the following is a common complication of nephrotic syndrome?** - A\) Hypertension - B\) Hyperlipidemia - C\) Hyperkalemia - D\) Hypoglycemia - **Answer: B) Hyperlipidemia** 42. **A 55-year-old man with a history of diabetes and hypertension presents with a creatinine level of 3.0 mg/dL. What is the most likely cause of his kidney dysfunction?** - A\) Acute kidney injury - B\) Diabetic nephropathy - C\) Chronic glomerulonephritis - D\) Polycystic kidney disease - **Answer: B) Diabetic nephropathy** 43. **Which of the following conditions is most commonly associated with nephrotic syndrome in adults?** - A\) Systemic lupus erythematosus - B\) Focal segmental glomerulosclerosis - C\) IgA nephropathy - D\) Minimal change disease - **Answer: B) Focal segmental glomerulosclerosis** 44. **Which of the following is the most likely cause of hematuria in a 50-year-old man with a history of smoking?** - A\) Nephrolithiasis - B\) Bladder cancer - C\) Urinary tract infection - D\) Acute glomerulonephritis - **Answer: B) Bladder cancer** 45. **What is the most common electrolyte abnormality in patients with chronic kidney disease?** - A\) Hyperkalemia - B\) Hypocalcemia - C\) Hypernatremia - D\) Hypokalemia - **Answer: A) Hyperkalemia** 46. **A 60-year-old man with hypertension and diabetes presents with proteinuria and an elevated serum creatinine. What is the most appropriate next step in management?** - A\) Initiate angiotensin-converting enzyme (ACE) inhibitors - B\) Start insulin therapy - C\) Refer for renal biopsy - D\) Perform renal ultrasound - **Answer: A) Initiate angiotensin-converting enzyme (ACE) inhibitors** 47. **Which of the following is the first-line treatment for acute post-streptococcal glomerulonephritis?** - A\) Diuretics - B\) Steroids - C\) Antibiotics - D\) Plasmapheresis - **Answer: C) Antibiotics** 48. **Which of the following is a common cause of prerenal acute kidney injury (AKI)?** - A\) Acute tubular necrosis - B\) Dehydration - C\) Glomerulonephritis - D\) Renal artery stenosis - **Answer: B) Dehydration** 49. **Which of the following conditions is most commonly associated with polycystic kidney disease?** - A\) Liver cysts - B\) Pancreatic cancer - C\) Retinal degeneration - D\) Cardiac arrhythmias - **Answer: A) Liver cysts** 50. **What is the most appropriate management for a patient with a single, symptomatic kidney stone?** - A\) Observation - B\) Surgery (stone removal) - C\) Extracorporeal shock wave lithotripsy - D\) Medical management with hydration and pain control - **Answer: C) Extracorporeal shock wave lithotripsy** **Pulmonology** 51. **A 60-year-old smoker presents with a chronic cough and sputum production for the last 3 months. On examination, he has wheezing and decreased breath sounds. What is the most likely diagnosis?** - A\) Chronic bronchitis - B\) Asthma - C\) Tuberculosis - D\) Pulmonary embolism - **Answer: A) Chronic bronchitis** 52. **Which of the following is a hallmark feature of asthma?** - A\) Decreased forced expiratory volume in 1 second (FEV1) - B\) Increased residual volume - C\) Hyperinflation of the lungs - D\) Normal chest X-ray during an exacerbation - **Answer: A) Decreased forced expiratory volume in 1 second (FEV1)** 53. **A 55-year-old male with a 40-pack-year smoking history presents with weight loss, hemoptysis, and a persistent cough. What is the most likely diagnosis?** - A\) Pneumonia - B\) Chronic obstructive pulmonary disease (COPD) - C\) Lung cancer - D\) Tuberculosis - **Answer: C) Lung cancer** 54. **Which of the following is the most common cause of community-acquired pneumonia in adults?** - A\) Streptococcus pneumoniae - B\) Mycoplasma pneumoniae - C\) Legionella pneumophila - D\) Haemophilus influenzae - **Answer: A) Streptococcus pneumoniae** 55. **A 45-year-old woman with a history of asthma presents with sudden-onset shortness of breath, wheezing, and chest tightness after exposure to a known allergen. What is the most appropriate treatment for this acute exacerbation?** - A\) Oral corticosteroids - B\) Inhaled short-acting beta-agonists - C\) Oxygen therapy - D\) Antibiotics - **Answer: B) Inhaled short-acting beta-agonists** 56. **Which of the following is a common risk factor for the development of pulmonary embolism?** - A\) Systemic lupus erythematosus - B\) Deep vein thrombosis (DVT) - C\) Chronic cough - D\) Asthma - **Answer: B) Deep vein thrombosis (DVT)** 57. **A 60-year-old woman with a history of smoking presents with worsening dyspnea, a productive cough, and a history of frequent respiratory infections. On examination, she has barrel chest and decreased breath sounds. What is the most likely diagnosis?** - A\) Asthma - B\) Chronic obstructive pulmonary disease (COPD) - C\) Pneumonia - D\) Lung cancer - **Answer: B) Chronic obstructive pulmonary disease (COPD)** 58. **Which of the following is the primary treatment for acute exacerbations of chronic obstructive pulmonary disease (COPD)?** - A\) Inhaled corticosteroids - B\) Antibiotics - C\) Oxygen therapy and bronchodilators - D\) Surgery - **Answer: C) Oxygen therapy and bronchodilators** 59. **A 50-year-old male presents with cough, hemoptysis, and weight loss. A chest X-ray reveals a cavitary lesion in the upper lobe of the lung. What is the most likely diagnosis?** - A\) Lung cancer - B\) Tuberculosis - C\) Pneumonia - D\) Pulmonary embolism - **Answer: B) Tuberculosis** 60. **Which of the following is the most common cause of hospital-acquired pneumonia?** - A\) Streptococcus pneumoniae - B\) Pseudomonas aeruginosa - C\) Mycoplasma pneumoniae - D\) Klebsiella pneumoniae - **Answer: B) Pseudomonas aeruginosa** 61. **Which of the following is the primary test used to diagnose obstructive sleep apnea?** - A\) Polysomnography (sleep study) - B\) Chest X-ray - C\) Pulmonary function tests - D\) Arterial blood gas - **Answer: A) Polysomnography (sleep study)** 62. **A 35-year-old woman presents with a non-productive cough, fatigue, and shortness of breath. She has a history of exposure to bird droppings. Which of the following is the most likely diagnosis?** - A\) Pneumonia - B\) Hypersensitivity pneumonitis - C\) Tuberculosis - D\) Asthma - **Answer: B) Hypersensitivity pneumonitis** 63. **Which of the following is the hallmark finding in the chest X-ray of a patient with emphysema?** - A\) Pulmonary infiltrates - B\) Flattened diaphragm - C\) Consolidation - D\) Pleural effusion - **Answer: B) Flattened diaphragm** 64. **A patient with a history of COPD presents with worsening dyspnea, increased sputum production, and purulent sputum. What is the most likely cause of this acute exacerbation?** - A\) Pneumothorax - B\) Pulmonary embolism - C\) Respiratory infection - D\) Lung cancer - **Answer: C) Respiratory infection** 65. **Which of the following is a common finding in patients with chronic pulmonary fibrosis?** - A\) High-pitched wheezing - B\) Digital clubbing - C\) Stridor - D\) Hyperinflation on chest X-ray - **Answer: B) Digital clubbing** 66. **What is the most appropriate first-line treatment for active tuberculosis?** - A\) Rifampin and isoniazid - B\) Azithromycin and doxycycline - C\) Ceftriaxone and clindamycin - D\) Streptomycin and pyrazinamide - **Answer: A) Rifampin and isoniazid** 67. **Which of the following is the most common cause of interstitial lung disease in nonsmokers?** - A\) Silicosis - B\) Asbestosis - C\) Idiopathic pulmonary fibrosis - D\) Sarcoidosis - **Answer: C) Idiopathic pulmonary fibrosis** 68. **A 70-year-old man with a history of smoking presents with worsening cough, dyspnea, and chest pain. Chest X-ray reveals a mass in the lung apex. What is the most likely diagnosis?** - A\) Pneumonia - B\) Pulmonary metastasis - C\) Primary lung cancer - D\) Tuberculosis - **Answer: C) Primary lung cancer** 69. **Which of the following is the most common type of lung cancer in nonsmokers?** - A\) Small cell lung cancer - B\) Squamous cell carcinoma - C\) Adenocarcinoma - D\) Large cell carcinoma - **Answer: C) Adenocarcinoma** 70. **A 50-year-old woman with a long history of asthma presents with increased difficulty breathing and wheezing. The best next step in management is:** - A\) Chest X-ray - B\) Inhaled corticosteroids - C\) Peak flow measurement - D\) Oral corticosteroids - **Answer: C) Peak flow measurement** 71. **A patient presents with a sudden-onset, sharp chest pain that worsens with inspiration. On examination, there is tenderness over the rib cage. What is the most likely diagnosis?** - A\) Pulmonary embolism - B\) Pneumothorax - C\) Costochondritis - D\) Myocardial infarction - **Answer: C) Costochondritis** 72. **A 40-year-old male with a history of chronic asthma presents with progressively worsening dyspnea, cough, and wheezing. What is the most likely cause of his symptoms?** - A\) Acute asthma exacerbation - B\) Pulmonary embolism - C\) COPD - D\) Bronchiectasis - **Answer: A) Acute asthma exacerbation** 73. **A 25-year-old woman presents with a persistent dry cough and malaise after visiting a farm. What is the most likely diagnosis?** - A\) Pneumonia - B\) Hypersensitivity pneumonitis - C\) Tuberculosis - D\) Asthma - **Answer: B) Hypersensitivity pneumonitis** 74. **A 65-year-old male with a history of smoking and COPD presents with a new, productive cough, fever, and pleuritic chest pain. Chest X-ray shows consolidation in the lower lobe. What is the most likely diagnosis?** - A\) Acute exacerbation of COPD - B\) Pneumonia - C\) Pulmonary embolism - D\) Lung cancer - **Answer: B) Pneumonia** 75. **Which of the following is a characteristic finding in the pulmonary function tests of a patient with restrictive lung disease?** - A\) Increased FEV1/FVC ratio - B\) Decreased FEV1/FVC ratio - C\) Increased total lung capacity - D\) Decreased vital capacity - **Answer: A) Increased FEV1/FVC ratio** **Gastrointestinal** 76. **A 50-year-old male presents with severe epigastric pain radiating to the back, nausea, and vomiting. His amylase and lipase levels are elevated. What is the most likely diagnosis?** - A\) Acute cholecystitis - B\) Acute pancreatitis - C\) Peptic ulcer disease - D\) Gastroesophageal reflux disease (GERD) - **Answer: B) Acute pancreatitis** 77. **A 45-year-old female presents with a history of heartburn, regurgitation, and difficulty swallowing. Endoscopy reveals a hiatal hernia. What is the most likely cause of her symptoms?** - A\) Peptic ulcer disease - B\) Gastroesophageal reflux disease (GERD) - C\) Achalasia - D\) Esophageal carcinoma - **Answer: B) Gastroesophageal reflux disease (GERD)** 78. **Which of the following is the most common cause of lower gastrointestinal bleeding in adults?** - A\) Colorectal cancer - B\) Hemorrhoids - C\) Diverticulosis - D\) Inflammatory bowel disease - **Answer: C) Diverticulosis** 79. **A 60-year-old man with a history of alcohol use presents with jaundice, ascites, and hepatomegaly. His liver function tests are markedly elevated. What is the most likely diagnosis?** - A\) Hepatitis B - B\) Cirrhosis - C\) Hepatic carcinoma - D\) Cholelithiasis - **Answer: B) Cirrhosis** 80. **Which of the following is the most common complication of cirrhosis?** - A\) Hepatorenal syndrome - B\) Portal hypertension - C\) Pancreatitis - D\) Gastritis - **Answer: B) Portal hypertension** 81. **A 30-year-old male presents with weight loss, fatigue, and right upper quadrant pain. Ultrasound shows a gallbladder filled with stones, but no signs of acute cholecystitis. What is the most likely diagnosis?** - A\) Cholelithiasis - B\) Hepatitis C - C\) Chronic cholecystitis - D\) Gallbladder carcinoma - **Answer: C) Chronic cholecystitis** 82. **Which of the following is a common risk factor for the development of colon cancer?** - A\) High-fiber diet - B\) Family history of colorectal cancer - C\) Regular exercise - D\) Low-fat diet - **Answer: B) Family history of colorectal cancer** 83. **A 65-year-old female presents with blood in the stool and weight loss. Colonoscopy reveals a mass in the sigmoid colon. What is the most likely diagnosis?** - A\) Diverticulitis - B\) Colorectal carcinoma - C\) Irritable bowel syndrome - D\) Crohn\'s disease - **Answer: B) Colorectal carcinoma** 84. **A patient presents with a history of intermittent upper abdominal pain, bloating, and nausea, particularly after meals. Which of the following is the most likely diagnosis?** - A\) Irritable bowel syndrome - B\) Peptic ulcer disease - C\) Gastroesophageal reflux disease (GERD) - D\) Functional dyspepsia - **Answer: D) Functional dyspepsia** 85. **Which of the following is the most common cause of chronic diarrhea in adults?** - A\) Inflammatory bowel disease - B\) Irritable bowel syndrome - C\) Celiac disease - D\) Lactose intolerance - **Answer: B) Irritable bowel syndrome** 86. **A 55-year-old male with a history of smoking presents with dysphagia and weight loss. A barium swallow shows a narrowing of the esophagus. What is the most likely diagnosis?** - A\) Achalasia - B\) Esophageal carcinoma - C\) Gastroesophageal reflux disease (GERD) - D\) Peptic ulcer disease - **Answer: B) Esophageal carcinoma** 87. **A 45-year-old male presents with intermittent colicky abdominal pain, bloating, and changes in bowel habits (diarrhea and constipation). What is the most likely diagnosis?** - A\) Celiac disease - B\) Irritable bowel syndrome - C\) Crohn's disease - D\) Colorectal cancer - **Answer: B) Irritable bowel syndrome** 88. **Which of the following is the gold standard test for diagnosing celiac disease?** - A\) Stool antigen test - B\) Duodenal biopsy - C\) Colonoscopy - D\) Serum antigliadin antibody test - **Answer: B) Duodenal biopsy** 89. **A 40-year-old female with a history of inflammatory bowel disease presents with fever, fatigue, and abdominal pain. Colonoscopy reveals continuous colonic involvement with superficial ulcers. What is the most likely diagnosis?** - A\) Crohn\'s disease - B\) Ulcerative colitis - C\) Ischemic colitis - D\) Diverticulitis - **Answer: B) Ulcerative colitis** 90. **A patient presents with right upper quadrant pain, fever, and jaundice. Liver function tests reveal elevated bilirubin. What is the most likely diagnosis?** - A\) Acute hepatitis - B\) Gallstones with cholangitis - C\) Cirrhosis - D\) Hepatic abscess - **Answer: B) Gallstones with cholangitis** **Rheumatology** 91. **A 25-year-old female presents with joint pain, fatigue, and a butterfly-shaped rash across her cheeks and nose. What is the most likely diagnosis?** - A\) Rheumatoid arthritis - B\) Systemic lupus erythematosus - C\) Psoriatic arthritis - D\) Dermatomyositis - **Answer: B) Systemic lupus erythematosus** 92. **A 50-year-old woman presents with morning stiffness in her hands and wrists. She has joint swelling and deformity. What is the most likely diagnosis?** - A\) Osteoarthritis - B\) Rheumatoid arthritis - C\) Gout - D\) Systemic lupus erythematosus - **Answer: B) Rheumatoid arthritis** 93. **A 45-year-old male presents with pain, swelling, and redness of the big toe. What is the most likely diagnosis?** - A\) Rheumatoid arthritis - B\) Osteoarthritis - C\) Gout - D\) Psoriatic arthritis - **Answer: C) Gout** 94. **Which of the following is a characteristic feature of osteoarthritis?** - A\) Symmetric joint involvement - B\) Morning stiffness lasting \> 1 hour - C\) Joint deformities with nodules - D\) Joint involvement of the wrist and elbows - **Answer: C) Joint deformities with nodules** 95. **A 35-year-old male with a history of back pain and stiffness presents with limited spinal mobility. He also has a positive HLA-B27 test. What is the most likely diagnosis?** - A\) Rheumatoid arthritis - B\) Ankylosing spondylitis - C\) Osteoarthritis - D\) Gout - **Answer: B) Ankylosing spondylitis** 96. **A 40-year-old woman presents with joint pain, a positive antinuclear antibody (ANA) test, and a history of photosensitivity. What is the most likely diagnosis?** - A\) Rheumatoid arthritis - B\) Systemic lupus erythematosus - C\) Fibromyalgia - D\) Osteoarthritis - **Answer: B) Systemic lupus erythematosus** 97. **A patient presents with bilateral carpal tunnel syndrome, Raynaud's phenomenon, and skin thickening. What is the most likely diagnosis?** - A\) Systemic lupus erythematosus - B\) Scleroderma - C\) Rheumatoid arthritis - D\) Psoriatic arthritis - **Answer: B) Scleroderma** 98. **Which of the following is the first-line treatment for rheumatoid arthritis?** - A\) Nonsteroidal anti-inflammatory drugs (NSAIDs) - B\) Methotrexate - C\) Steroids - D\) Biologic agents - **Answer: B) Methotrexate** 99. **Which of the following is most commonly associated with the development of systemic sclerosis (scleroderma)?** - A\) Smoking - B\) Recurrent viral infections - C\) Silica exposure - D\) Autoimmune diseases - **Answer: D) Autoimmune diseases** 100. **A 60-year-old woman presents with pain and swelling in the knee joint after prolonged activity. Radiographs show joint space narrowing and osteophytes. What is the most likely diagnosis?** - A\) Osteoarthritis - B\) Rheumatoid arthritis - C\) Gout - D\) Bursitis - **Answer: A) Osteoarthritis** **Infectious Diseases MCQs** 1. **A 35-year-old man presents with a high fever, night sweats, and a productive cough with blood-streaked sputum for the past month. A chest X-ray shows upper lobe cavitary lesions. Which of the following is the most appropriate initial test for diagnosis?**\ A) Blood culture\ B) Sputum acid-fast bacilli (AFB) smear and culture\ C) Bronchoscopy with biopsy\ D) Rapid influenza test 2. **A 27-year-old woman presents with fever, headache, and a stiff neck. Lumbar puncture reveals an elevated white blood cell count, increased protein, and decreased glucose in cerebrospinal fluid. Which of the following is the most common cause of her condition in adults?**\ A) Neisseria meningitidis\ B) Streptococcus pneumoniae\ C) Listeria monocytogenes\ D) Enterovirus 3. **A 40-year-old man with poorly controlled diabetes presents with a rapidly spreading infection of the soft tissue in his leg, associated with crepitus and foul-smelling discharge. What is the most likely causative organism?**\ A) Staphylococcus aureus\ B) Clostridium perfringens\ C) Streptococcus pyogenes\ D) Pseudomonas aeruginosa 4. **A patient with HIV presents with progressive confusion, focal neurological deficits, and seizures. MRI reveals multiple ring-enhancing lesions in the brain. Which of the following is the most likely diagnosis?**\ A) Toxoplasmosis\ B) Cryptococcal meningitis\ C) Progressive multifocal leukoencephalopathy\ D) Cytomegalovirus encephalitis 5. **A 28-year-old woman presents with fever, malaise, pharyngitis, and posterior cervical lymphadenopathy. Monospot test is positive. Which of the following complications is most concerning in this patient?**\ A) Myocarditis\ B) Splenic rupture\ C) Bacterial superinfection\ D) Rheumatic fever 6. **A 55-year-old male presents with sudden-onset high fever, hypotension, and purpura. He recently had a splenectomy after a motor vehicle accident. Blood cultures grow an encapsulated Gram-negative diplococcus. Which of the following pathogens is most likely responsible?**\ A) Klebsiella pneumoniae\ B) Neisseria meningitidis\ C) Streptococcus pneumoniae\ D) Haemophilus influenzae 7. **A patient presents with severe watery diarrhea after returning from a trip to South America. The diarrhea is rice-water in appearance. Stool cultures grow oxidase-positive, comma-shaped bacteria. What is the most appropriate treatment?**\ A) Metronidazole\ B) Ciprofloxacin\ C) Oral rehydration therapy\ D) Vancomycin 8. **A 32-year-old woman presents with a painless genital ulcer. Serologic testing for syphilis is positive. What is the treatment of choice for this patient?**\ A) Azithromycin\ B) Doxycycline\ C) Penicillin G\ D) Ceftriaxone