Questions File - Part 2 MedGard 2023.pdf

Questions File - Part 2 MedGard Unleash Your Inner Warrior Note: Some formatting issues exist as the file wasn't reviewed after being OCRed. In case of any confusion, refer to the context to resolve it. Which of the following agents has been s...

Questions File - Part 2 MedGard Unleash Your Inner Warrior Note: Some formatting issues exist as the file wasn't reviewed after being OCRed. In case of any confusion, refer to the context to resolve it. Which of the following agents has been shown to reduce mortality in pa7ents with conges7ve heart failure? A. Digitalis B. Enalapril **C. Furosemide D. Procainamide Which of the following is a recognized side effect of furosemide in conges7ve heart failure? A. Hypokalaemia B. Bronchospasm C. Hypoglycaemia **D. Haemoly7c anaemia A 40-year-old woman presents to the Emergency Department with vomi7ng and generalized abdominal pain. She does not know her medica7ons. She states that her vision has been slightly yellow 7nged recently (see image). Blood pressure 90/50 mmHg Heart rate 60 /min Respiratory rate 16 /min Temperature 37° C Which of the following is the most likely diagnosis? A. Anterolateral MI **B. Digoxin toxicity C. Hypokalaemia D. Hypothermia A 60-year-old pa7ent with a previous ischaemic stroke presents with a regular narrow complex tachycardia. The pa7ent is hemodynamically stable. The decision is made to administer IV adenosine. In the presence of which of the following should the dose of adenosine be reduced? A. Theophylline **B. Dipyridamole C. Chronic renal impairment D. Significant mitral regurgita7on Which of the following drugs used in the treatment of chronic heart failure has been shown to increase survival? A. Digoxin **B. Enalapril C. Furosemide D. Hydralazine A 39-year-old man presents to the clinic with unexplained fever 19 days a\er an a]ack of acute rheuma7c fever. Several of his teeth have been extracted prior to the hospital admission. Clinical examina7on confirms a systolic murmur and splenomegaly (see lab results). Test Result Normal Values WBC 14.0 4.5-10.5 x 109/L Neutrophils 72 40-60% Urinalysis: Erythrocytes 25 0-2 per HPF Which of the following is the most likely diagnosis? A. Floppy mitral valve **B. Bacterial endocardi7s C. Acute myocardial infarc7on D. Recurrent rheuma7c heart disease A 62-year-old man presents with recurrent retrosternal chest pain, which he said has become much worse over the last 3 weeks. He describes the pain as las7ng much longer than before and that it occurs even while he is sieng in a chair or in bed at night reading. Which of the following is the most likely type of angina? **A. Unstable B. Heberden C. Exer7onal D. Prinzmetal A 52-year-old man comes to the clinic for a checkup. He has hypertension for 5 years is currently being treated with hydrochlorothiazide 25 mg/day (see lab results). Blood pressure 155/101 mmHg Heart rate 84 /min Test Result Normal Values Sodium 141 134-146 mmol/L Potassium 4.1 3.5-5.1 mmol/L Crea7nine 105 44-115 umol/L Glucose, fas7ng 7.3 3.5-6.5 mmol/L Which of the following is the most appropriate management modifica7on? A. Add a beta blocker B. Add a Calcium channel blocker C. Double the hydrochlorothiazide dose **D. Add an angiotensin conver7ng enzyme inhibitor A 30-year-old intravenous drug user presents with fever, night sweats, chest pain, and arthralgia. On examina7on, painless erythematous lesions noted on the palms of the hands; with round erythematous lesions and central clearing noted in the re7na and splinter haemorrhage under the fingernails. Which of the following is the most likely diagnosis? A. Syphilis B. HIV infec7on C. Infec7ous hepa77s **D. Bacterial endocardi7s A 77-year-old woman with poorly controlled long-standing type 2 diabetes and hypertension is complaining of dizziness when standing up rapidly. Current medica7ons include aspirin, atenolol, insulin, mejormin and mul7vitamins. Sieng: Blood pressure 140/85 mmH Standing: Blood pressure 115/80 mmH Heart rate 95 /min (unchanged on standing) Respiratory rate 18 /min Temperature 36.6° C Which of the following is the most likely explana7on? A. Hypoglycaemia B. Medica7on side effect **C. Autonomic neuropathy D. Le\ ventricular dysfunc7on A 67-year-old man is brought to the Emergency Department by his family with confusion and a decreased level of consciousness. The family reported his being feverish and feeling unwell for 2 days that was also associated with diarrhea and poor oral intake. The pa7ent has bronchial asthma, hypertension and an old myocardial infarc7on. He has not been able to take his regular medica7ons for 2 days due to the acute illness. On examina7on, the VP is not visible, heart sounds are normal, no cardiac murmurs and lungs are clear with no rhonchi or crepita7on. The pa7ent's extremi7es are cold and peripheral pulses feeble (see report). Blood pressure 83/45 mmH Heart rate 120 /min (regular) Respiratory rate 20 /min Oxygen satura7on 95% (room air) ECG: Sinus tachycardia and evidence of an old inferior myocardial infarc7on. Which of the following is the most appropriate next step in management? **A. IV boluses of normal saline B. Intravenous beta blockers C. Nasogastric tube feeding D. Dopamine infusion A 40-year-old man is brought to the Emergency Department with progressive difficulty in breathing. History reveals, he is being treated for bronchogenic carcinoma. On examina7on, the VP is elevated; lungs clear and heart sounds are very quiet. Blood pressure 88/50 mmHg Heart rate 125 /min (regular) Respiratory rate 24 /min Temperature 36.8 C° Which of the following is the most appropriate test to confirm the diagnosis? A. Chest X-ray **B. Echocardiogram C. Electrocardiogram D. Arterial blood gases A 52-year-old man was diagnosed in the Emergency Department with an acute inferior wall myocardial infarc7on. An intravenous morphine bolus and IV nitroglycerine infusion were administered for severe on-going chest discomfort. 20 minutes later, and while preparing the pa7ent for a primary percutaneous coronary interven7on, his condi7on became worse. His JVP at this 7me was elevated and his lungs were clear. Ini7al Emergency Department Record: Blood pressure 120/70 mmH Heart rate 90 /min (regular) Respiratory rate 22 /min Oxygen satura7on 96% (room air) 30 Minutes Later: Blood pressure 75/40 mmHg Heart rate 105 /min (regular) Which of the following is the most likely cause of the hypotension? A. Cardiac tamponade B. Complete heart block C. Papillary muscle rupture **D. Right ventricular infarc7on A 60-year-old man presents to the Emergency Department with epigastric pain radia7ng to the back. He is a smoker and has long-standing diabetes and hypertension. Abdominal examina7on reveals a pulsa7le supra-umbilical mass. Which of the following is the most likely diagnosis? **A. Abdominal aor7c aneurysm B. Secondary liver metastasis C. Renal cell carcinoma D. Peri-umbilical hernia A 55-year-old man who is a heavy smoker is being evaluated for increasing bilateral lower limb swellings. Chest examina7on confirms resonant lungs with reduced breath sounds and occasional rhonchi. The apex beat could not be easily located. No cardiac murmur is heard, but P2 is markedly loud. The JVP is elevated and bilateral pieng edema was confirmed. Which of the following is the most likely cause of the lower limb swelling? A. Liver cirrhosis B. Bilateral DVT **C. Cor pulmonale D. Nephro7c syndrome A 55-year-old pa7ent presents to the clinic with leg pain brought on by walking and relieved by rest. The pa7ent reports a history of many years of smoking. Physical examina7on confirms loss of hair over the lower shins as well as dystrophic nails. An ankle-brachial index 0.80 Which of the following is the most likely diagnosis? A. Lumbar disc prolapse B. Deep vein thrombosis **C. Chronic limb ischemia D. Chronic venous insufficiency A 15-year-old boy presents to the clinic for an annual physical assessment. The pa7ent has normal growth and development and is able to do usual ac7vi7es. His elder brother died due to a sudden cardiac death while walking to work. On physical examina7on, there is no cardiac murmur. Pulses are equal in all extremi7es. Which condi7on must be excluded before any sport is allowed? A. Bicuspid aor7c valve B. Patent ductus arteriosus C. Ventricular septal defect **D. Hypertrophic cardiomyopathy A 55-year-old diabe7c and hypertensive pa7ent presents with a history of bilateral intermi]ent leg pain brought on by walking for 300 meters and relieved by rest. What is the most likely diagnosis? A. Varicose vein B. Diabe7c foot infec7on C. Peripheral neuropathy **D. Peripheral arterial disease A 58-year-old hypertensive pa7ent presented with a 10-day history of a le\-sided hemiparesis. The CT scan of the brain confirmed an area of infarc7on. There was no significant finding on a clinical examina7on apart from his hemiparesis. The pa7ent had already started physiotherapy, and is taking 20 mg lisinopril and hydrochlorothiazide once daily. Blood pressure 140/90 mmH Heart rate 76 /min Respiratory rate 18 /min Temperature 36.6° C Oxygen satura7on 95% on room air Which of the following is the best management? A. Apixaban B. Warfarin **C. Aspirin D. T-PA1 A 35-year-old woman presents with bilateral leg deep vein thrombosis. She has a history of recurrent s7ll births (see lab result). Test Result Normal Value APTT 55 30-40 sec Which of the following is the most likely diagnosis? **A. An7phospholipid syndrome B. An7thrombin deficiency C. Protein S deficiency D. Protein C deficiency An 81-year-old diabe7c presents to the clinic with a recent onset of redness of the skin on the le\ lower extremity. The redness worsens when the leg is in a dependent posi7on. On examina7on, pedal pulses in the le\ leg are diminished. The leg is cold and there is no tenderness on palpita7on. Which of the following is the most likely diagnosis? A. Celluli7s B. Necro7zing fascii7s **C. Arterial insufficiency D. Superficial thrombophlebi7s A 70-year-old man is brought to the clinic with an acute confessional state. On examina7on, he has postural hypotension and dry mucus membranes. Test Result Normal Value Calcium 3.41 2.15-2.62 mol/L Which of the following is the most appropriate ini7al treatment? **A. I.V. 0.9% sodium chloride B. I.V. sodium pamidronate C. Oral prednisolone D. I.V. furosemide A 61-year-old woman has had type 2 diabetes for 12 years. She takes insulin and d smoke. She was recently started on enalapril 10 mg daily for hypertension but coulc it because of a cough (see lab results). Blood pressure 160/95 mmH Heart rate 84 /min Test Result Normal Value Crea7nine 142 44-115 umol/L 24 Urine Analysis: Test Result Normal Values Crea7nine clearance 66 100-140 mL/min 24-hour urine protein 1500 0-150 mg/24 hr Which of the following is the most appropriate therapy? A. Beta blocker B. Thiazide diure7c C. Calcium channel blocker **D. Angiotensin receptor blocker A 70-year-old pa7ent has a sudden onset of pain in the le\ lower limb. The pain is severe and associated with numbness. The pa7ent had an acute myocardial infarc7on 2 weeks before and was discharged 24 hours before this presenta7on. The le\ leg is cold and pale, the right leg is normal. Which of the following is the most likely diagnosis? A. Acute arterial thrombosis **B. Acute arterial embolus C. Deep vein thrombosis D. Dissec7ng aneurysm A pa7ent with atrial fibrilla7on is on warfarin 5 mg daily, the latest IN is 7.0 on rou7ne evalua7on. There is no evidence of abnormal bleeding. Which of the following is the most appropriate ac7on? A. Increase warfarin to 7.5 mg daily B. Decreased warfarin to 2.5 mg daily C. Con7nue with same dose of warfarin **D. Hold warfarin and repeat IN next day A 73-year-old man comes to the Primary Health Care Clinic with severe shortness of breath at night and swelling of the ankles. He has reduced his ac7vity over the past year because of chest pain when he exerts himself. Physical examina7on confirms crackles over both lungs, enlargement of the liver, and pieng edema of the ankles. ECG, cardiac enzymes and blood electrolytes are normal. Blood pressure 140/90 mmHg Heart rate 95 /min Respiratory rate 24 /min Temperature 36.6° C Which of the following is the most appropriate to be included in immediate management? A. Digoxin B. Atenolol **C. Furosemide D. Hydrochlothiazide Page: 10 / 372 - + A 70-year-old man, with no past medical history, presents to the Emergency Department 4 hours a\er the onset of a severe crushing substernal chest pain radia7ng to the neck and le\ arm (see report). Electrocardiography: Significant ST-segment eleva7on in leads I, AVL, V5, and V6. Where is the most likely site of cardiac infarc7on? A. Anterior B. Inferior **C. Lateral D. Posterior A 60-year-old pa7ent presents to the hospital, complaining of a sudden onset of chest pain radia7ng to the back. The blood pressure is low in the le\ arm and the le\ femoral pulse is not palpable (see reports). Chest X-ray: A le\ pleural effusion. ECG: Le\ ventricular hypertrophy. Which of the following is most likely to confirm the diagnosis? A. Echocardiography B. Cardiac isoenzymes **C. Aor7c CT angiography D. Complete blood count A 46-year-old man recovering from an acute myocardial infarc7on 10 days ago. He develops a sharp pain behind the sternum which is made worse by coughing. The pa7ent gets relief when sieng forward. On examina7on, a scratchy superficial sound is heard at the le\ sternal edge, and heart sounds are muffled. There is ascites and a 2 cm raised JVP is confirmed. Which of the following ECG changes would most likely be found? A. Atrial fibrilla7on B. Sinus tachycardia **C. Diffuse ST eleva7on D. Prolonged PR interval A 60-year-old man is admi]ed to the Coronary Care Unit with an acute myocardial infarc7on. His hemodynamic parameters 2 hours later are: Blood pressure 80/50 mHg Heart rate 40 /min Respiratory rate 18 /min Temperature 36.6° C Oxygen satura7on 95% on room air Which of the following would be the appropriate management? **A. IV 0.6 mg atropine sulphate B. Normal saline infusion C. IV isoproterenol D. IV dobutamine A 65-year-old pa7ent presents with 2 hours of chest pain that feels like indiges7on. In the past medical history, hypertension has been diagnosed, but no evidence of myocardial infarc7on or angina. This Emergency Department does not have facili7es for a percutaneous transluminal angioplasty (see report). Blood pressure 170/94 mmH Heart rate 104 /min Respiratory rate 18 /min Temperature 36.6° C Oxygen satura7on 95% on room air ECG: ST segment eleva7on in the anterolateral leads. Which of the following is the most appropriate ini7al interven7on? **A. ASA, streptokinase, nitroglycerine, beta-blockers B. ASA, streptokinase, heparin, beta-blockers C. Nitroglycerin, ASA, heparin, beta-blockers D. ASA, nitroglycerine, beta-blockers Page 11 1 372 a A 60-year-old man presents to the Emergency Department with heavy retrosternal chest discomfort. The discomfort started 3 days earlier as intermi]ent brief episodes which became more frequent and prolonged over the last 24 hours. In the Emergency Department he experienced a similar type of discomfort (5/10 on the pain scale of 1-10) which responded well to sublingual nitroglycerin. serial cardiac enzymes are normal (see report). ECG: An ini7al ECG showed ST segment depression of 0.2 mV in the antero-lateral chest leads, which later normalized completely. Which of the following is the most likely diagnosis? **A. Unstable angina B. Acute pericardi7s C. Myocardial infarc7on D. Acute aor7c dissec7on A 65-year-old woman is brought to the Emergency Department of a ter7ary care hospital with rapid onset shortness of breath and le\ shoulder and arm ache (see image). Blood pressure 100/50 mmHg Heart rate 90 /min Respiratory rate 25 /min Temperature 36.9 °C Which of the following is the most appropriate treatment a\er the ini7al Emergency Department management? A. Low molecular weight Heparin B. Reperfusion with streptokinase C. Thromboly7c therapy with t-PA **D. Primary coronary artery sten7ng A 75-year-old man who has been followed up rou7nely for hypertension and type 2 diabetes mellitus was found to have an irregular pulse which was not found 6 months earlier. In addi7on to hypertension and diabetes, his past history confirms a previous transient ischemic a]ack. He is currently asymptoma7c and is compliant with his medica7ons (see report). ECG: Atrial fibrilla7on at rate of 70 beats per minute. Which of the following is the most appropriate management plan? A. Add digoxin to his current treatment regimen B. Pharmacological cardio-version to sinus rhythm **C. Start an7coagula7on therapy to prevent stroke D. No further step is needed as he is asymptoma7c A 29-year-old woman presents to the Emergency Department complaining of being unable to sleep flat for the last 2 nights due to difficulty in breathing. She has just delivered 1 week earlier. Physical examina7on confirms a laterally displaced apex beat and the presence of a third heart sound. The jugular veins were distended and bilateral lung crackles could be easily heard. Which of the following is the most likely diagnosis? **A. Peripartum cardiomyopathy B. Pulmonary embolism C. Mycordial infarc7on D. Pneumonia A 55-year-old man had a myocardial infarc7on 6 days before. He suddenly develops dyspnoea, cough and frothy sputum. For the first 7me a harsh systolic murmur is heard over the precordium. Which of the following is the most likely cause of this development? A. Ruptured aor7c cusp B. Pulmonary embolism C. Tricuspid regurgita7on **D. Ruptured papillary muscle A 40-year-old man presents to the Emergency Department a\er fain7ng while exercising. He reports past episodes of chest pain, which have occurred both at rest and with exercise. On examina7on of the chest there is I/V systolic ejec7on murmur heard at the le\ sternal border, which does not radiate. The intensity of the murmur increases when the pa7ent bears down or stands up. The lung fields are clear (see report). Blood pressure 125/75 mm Heart rate 110 /min Respiratory rate 18 /min Temperature 36.6° C ECG: Non-specific ST and T wave changes with le\ atrial enlargement. Which of the following is the most likely diagnosis? A. Aor7c stenosis B. Pulmonic stenosis C. Restric7ve cardiomyopathy **D. Hypertrophic cardiomyopathy A 55-year-old man presents to the Emergency Department with con7nuous retrosternal chest pain. An ECG was obtained (see image). Which of the following is the most likely diagnosis? A. Anterior wall ST-eleva7on myocardial infarc7on **B. Inferior wall ST-eleva7on myocardial infarc7on C. Acute coronary syndrome with unstable angina D. Acute Non-ST-eleva7on myocardial infarc7on 35-year-old women comes to the clinic complaining of infer7lity for 3 years. She no7ces excessive breast milk produc7on for 4 months. The physical examina7on is unremarkable (see lab results and report). Blood pressure 130/80 mmHg Heart rate 80 /min Respiratory rate 18 /min Temperature 37.2° C Test Result Normal Values Thyroxine (T4 free) 12.4 8.5 - 15.2 pmol/L Thyroid-S7mula7ng Hormone 1.2 0.4 - 5.0 mU/L Prolac7n 1452 < 870 pmol/L Brain MRI: Well defined pituitary mass about 0.7 cm, which represent an adenoma. Which of the following is the most appropriate treatment? A. Surgery **B. Cabergoline C. Observa7on D. Radiotherapy A 55-year-old woman presents with sudden le\ eye visual loss for 20 minutes. The vision returned to normal a\er this episode. History reveals, she has diabetes mellitus. The physical examina7on is normal. Blood pressure 125/75 mmHg Heart rate 75 /min Respiratory rate 16/min Temperature 37.2° C Which of the following is the most likely diagnosis? A. Mul7ple sclerosis B. Re7nal detachment C. Conversion disorder **D. Transient ischemia a]ack A 60-year-old woman with conges7ve heart failure complains of shortness of breath for 3 months. It is precipitated by daily ac7vity at home. The shortness of breath awakened her several 7mes at night. Her medica7on included fosinopril, carvedilol and furosemide. On examina7on, there is bilateral basilar crepita7on (see report). Echocardiogram: There is dilated le\ ventricular chamber. The le\ ventricular ejec7on fac7on is 30%. Blood pressure 125/80 mmH Heart rate 60 /min Respiratory rate 16 /min Temperature 37.1° C Which of the following drugs is indicated? A. Aspirin B. Amlodipine **C. Spironolactone D. Isosorbide dinitrate A 40-year-old man presents to the clinic complaining of numbness of the feet for 1 month. He was diagnosed with pulmonary tuberculosis 4 months ago. He has been taking isoniazid and rifampin and has 2 months of treatment remaining. He has well controlled diabetes mellitus for the last 3 years. The physical examina7on is normal. Blood pressure 110/70 mmH Heart rate 80 /min Respiratory rate 18 /min Temperature 37.7° C Which of the following drugs should be given? A. Thiamine **B. Pyridoxine C. Vitamin B12 D. Amitriptyline A 30-year-old woman with controlled hypothyroidism comes for follow up. She had been sir thyroxin 175 mcg but the dose was increased 3 months ago to 200 mcg. Physical examina7c is normal (see lab results). Blood pressure 130/80 mmH Heart rate 80 /min Respiratory rate 18 /min Temperature 37.2° C Test Result Normal Values Thyroxine (T4 free) 12.4 8.5-15.2 pmol/L Thyroid-S7mula7ng Hormone 17.2 0.4-5.0 U/L What is the most likely explana7on for these lab findings? A. Small dose B. Ectopic thyroid **C. Poor medica7on adherence D. Secondary hypothyroidism A 45-year-old man was being inves7gated for hypertension. He was prescribed a drug for his lipid disorder but returned 1 week later with intense face flushing a\er taking the tablet prescribed. He was then advised to take a full dose of aspirin 3 7mes daily instead of a low dose once daily. This gave complete relief (see lab results). Tests at first visit Test Result Normal Values Cholesterol (HDL) 0.72