This is The Answers of Mock Exam 5

Reference:

From the files of (Studying for SLE Together) a face book group
2012
(Miscellaneous Part)

Q1. A man came with bruising & increase time of bleeding with factor
8 deficiency :
a) Haemophilia A
b) Von Willebrand disease
Hemophilia A is clotting factor VIII deficiency & is the most common form,
Hemophilia B is factor IX deficiency. It is a Recessive X-linked disorders

Q2. An old man 65 years with Hemoglobin= 9, you will:

a) Assess Iron levels
b) Assess LDH
c) Arrange for endoscopy
Anemia is a common sign of colon cancer in elderly

Q3. In aspirin overdose :

a) Liver enzyme will peak within 3-4 hr
b) first signs include peripheral neuropathy and loss of reflexes
c) 150 mg/kg of aspirin will not result in aspirin toxicity
The early signs and symptoms of aspirin overdose include impaired hearing
and ringing in the ears. Other early signs of aspirin poisoning include
lightheadedness, breathing rapidly, double vision, vomiting, fever and
dehydration
The acutely toxic dose of aspirin is generally considered greater than 150 mg
per kg of body mass. Moderate toxicity occurs at doses up to 300 mg/kg,
severe toxicity occurs between 300 - 500 mg/kg

Q4. Man who is having severe vomiting and diarrhea and now
developed leg cramps after receiving 3 liters of dextrose, he is having:
a) Hypokalemia
b) hyponatremia
c) hyperkalemia
d) hypernatremia
K+ is secreted in stool, as he is having a diarrhea he will lose a huge amount
of K+, also muscle cramp is a symptom of Hypokalemia

Q5. Man who received blood transfusion back in 1975 developed

jaundice most likely has:
a) Hepatitis A
b) Hepatitis C
c) Hepatitis D
d) Hepatitis E
e) Autoimmune hepatitis

Q6. Best method to prevent plague is:

a) Hand wash
b) Kill rodent
c) spray pesticide
d) give prophylactic AB
Plague is a deadly infectious disease that is caused by the enterobacteria
Yersinia pestis. carried by rodents mostly rats

Q7. Patient come to ER with constricted pupil and respiratory

compromise you will suspect:
a) Opiates like morphine
b) Cocaine
c) Ectasy
Certain drugs cause constriction of the pupils, such as alcohol and
opioids
Other drugs, such as atropine, mescaline, psilocybin mushrooms, cocaine and
amphetamines may cause pupil dilation

Q8. Management of somatization

a) Multiple phone call
b) Multiple clinic appointments
c) Refer to pain clinic
d) Antidepressant
Cognitive Behavioral Therapy is the best established treatment for a variety
of somatoform disorders including somatization disorder

Q9. A lot of bacteria produce toxins which are harmful. Which one of
the following is useful?
a) Botulism
b) Tetanus
c) Diphtheria
d) Staph aureus

Q10. Organophosphorus poisoning, what is the antidote?

a) Atropine
b) Physostigmine
c) Neostigmine
d) Pilocarpine
e) Endrophonium

Q11. Patient using haloperidol, developed rigidity (dystonia)

treatment :
a) Antihistamine and anticholinergic
Haloperidol is a dopamine antagonist used in psychosis
Side effects : Extrapyramidal side effects, Dystonia, Tremors, Dry mouth,
Depression

Q12. High risk factor in CLL :

a) Age

b) Smoking
c) History of breast ca
d) History of radiation
Risk factors: 1) Age. Most people diagnosed with chronic lymphocytic
leukemia are over 60. 2) Sex. Men are more likely than are women to develop
chronic lymphocytic leukemia. 3) Race. Whites are more likely to develop
chronic lymphocytic leukemia than are people of other races. 4) Family
history of blood and bone marrow cancers. A family history of chronic
lymphocytic leukemia or other blood and bone marrow cancers may increase
your risk. 5) Exposure to chemicals. Certain herbicides and insecticides

Q13. A 60 years old male was refer to you after stabilization,

investigation show Hgb 8.5 g/l, hect. 64% , RBC 7.8 , WBC 15.3 &
Platelet 570, Diagnosis :
a) Iron deficency Anemia
b) Hemoglobinopathy
c) CLL
d) 2ry polycythemia

Q14. A 24 years old patient. Came for check up after a promiscuous

relation 1 month ago, he was clinically unremarkable, VDRL: 1/128, he
was allergic to penicillin other line of management is:
a) Ampicillin
b) Amoxicillin
c) Trimethoprim
d) Doxycyclin
Venereal Disease Research Laboratory [ VDRL ] test is a serological screening
for syphilis that is also used to assess response to therapy, to detect CNS
involvement, and as an aid in the diagnosis of congenital syphilis
The first choice for uncomplicated syphilis is a single dose of
intramuscular penicillin G or a single dose of oral azithromycin. Doxycycline
and tetracycline are alternative

Q15. Cellulitis in children most common causes:

a) Group A streptococcus
b) Staphylococcal aureus
Staphylococcus aureus is the most common bacteria that cause cellulitis.
Group A Streptococcus is the next most common bacteria that cause
cellulitis. A form of rather superficial cellulitis caused by strep bacteria is called
erysipelas; it is characterized by spreading hot, bright red circumscribed area
on the skin with a sharp raised border. The so-called "flesh-eating bacteria" are,
in fact, also a strain of strep which can -- in severe cases -- destroy tissue
almost as fast as surgeons can cut it out.

Q16. Patient with Hodgkins lymphoma and red strunberg cell in

pathology and there is eosinophil lymphocyte in blood so pathological
classification is:
a) Mixed-cellularity subtype
b) Nodular sclerosis subtype of Hodgkin's lymphoma
Classical Hodgkin's lymphoma can be subclassified into 4 Pathologic
subtypes based upon

Reed-Sternberg cell morphology and the composition of the reactive cell

infiltrate seen in the lymph node biopsy specimen the cell composition around
the Reed-Sternberg cells
Name
Description Nodular sclerosing CHL Is the most common subtype and is
composed of large tumor nodules showing scattered lacunar classical RS
cells set in a background of reactive lymphocytes, eosinophils and plasma
cells with varying degrees of collagen fibrosis/sclerosis.
Mixed-cellularity subtype
Is a common subtype and is composed of numerous classic RS cells admixed
with numerous inflammatory cells including lymphocytes, histiocytes,
eosinophils, and plasma cells, without sclerosis. This type is most often
associated with EBV infection and may be confused with the early, so-called
'cellular' phase of nodular sclerosing CHL Lymphocyte-rich or Lymphocytic
predominance Is a rare subtype, show many features which may cause
diagnostic confusion with nodular lymphocyte predominant B-cell NonHodgkin's Lymphoma (B-NHL). This form also has the most favorable
prognosis
Lymphocyte depleted
Is a rare subtype, composed of large numbers of often pleomorphic RS
cells with only few reactive lymphocytes which may easily be confused with
diffuse large cell lymphoma

Q17. Therapeutic range of INR [In presence of Anticoagulant]

a) 2.5-3.5
b) 2.0-3.0 But normal range in absence if Anticoagulant is 1.8-1.2

Q18. Patient had arthritis in two large joints & pansystolic murmur
carditis Hx of URTI, the most important next step:
a) ESR
b) ASO titre
c) Blood culture
The diagnosis of Rheumatic fever can be made when two of the major
Modified Jones criteria, or one major criterion plus two minor criteria, are
present along with evidence of streptococcal infection: elevated or rising
Antistreptolysin ASO titre or DNAase

Q19. Patient with gunshot and part of his bowel spillage out and you
decide to give him antibiotic for Bacteroid fragilis, so what you will
give?
a) Amoxicillin
b) Clindamycin Sure
c) Erythromycin
d) Doxycycline
e) Gentamicin

Q20. Treatment of peritonitis the organism is Bacteroid fragilis

a) Clindamycin
b) Mitronidazole
c) Carbapenem
B. fragilis is involved in 90% of anaerobic peritoneal infections

B. fragilis is susceptible to metronidazole, carbapenems, tigecycline, betalactam/beta-lactamase inhibitor combinations (e.g., Unasyn, Zosyn), and
certain antimicrobials of the cephamycin class, including cefoxitin
Clindamycin is no longer recommended as the first-line agent for B. fragilis
due to emerging high-level resistance

Q21. Patient with high output fistula, for which TPN was ordered ,
after 2 hours of the central venous catheterization, the patient
become comatose and unresponsive , what is the most likely cause ?
a) Septic shock
b) Electrolytes imbalance
c) Delayed response of blood mismatch
d) Hypoglycemia
e) Hypernatremia
Enterocutaneous fistula is an abnormal communication between the small or
large bowel & the skin.
It is a complication that is usually seen following surgery on the small or large
bowel
Low-output fistula(< 200 mL/day), moderate-output fistula (200-500), highoutput fistula ( > 500 mL/day )

Q22. What is most sensitive indicator for factitious fever?

a) Pulse rate
Factitious fever: Fever produced artificially by a patient. This is done by
artificially heating the thermometer or by self-administered pyrogenic
substances. An artificial fever may be suspected if the pulse rate is much less
than expected for the degree of fever noted. This diagnosis should be
considered in all patients in whom there is no other plausible explanation for
the fever. Patients who pretend to have fevers may have serious psychiatric
problems.

Q23. Healthy patient with family history of DM type 2, the most

factors that increase chance of DM are:
a) HTN and Obesity
b) Smoking and Obesity
c) Pregnancy and HTN
d) Pregnancy and Smoking

Q24. In diabetic retinopathy, most related factors:

a) HTN and obesity
b) HTN and smoking
c) Smoking and obesity
The risk factors that increase diabetic retinopathy background are:
1) HTN
2) Poor glucose control or long case D.M
3) Raised level of fat ( cholesterol)
4) Renal disease
5) Pregnancy (but not in diabetes caused by pregnancy)

Q25. Patient with blood group A had blood transfusion group B , the
best statement that describe the result is
a) type IV hypersensitivity
b) inflammatory reaction
c) Type II hypersensitivity