Test Prep MCQS Online Practice Questions and Exam Preparation

Test Prep MCQS Online Questions & Answers

• Question 41:

  A 53-year-old lady presents with hot flash and night sweats. Her LMP was last year. She had Myocardial infarction.

  What is the most appropriate management for her?

  A. Raloxifene
  B. COCP (Combined OCP)
  C. Evening primrose
  D. Clonidine
  E. Estrogen
  D. Clonidine

• Question 42:

  A 32-year-old woman presents with malaise fatigue and fever. She complains about weight loss. Exam: malar nasolabial fold can be seen. What is the most appropriate investigation?

  A. Anti-histone
  B. Anti-centromere
  C. Anti-ds DNA
  D. Anti Jo
  E. Anti Scl70
  C. Anti-ds DNA

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  Features are suggestive of SLE. So most appropriate investigation from the given option DNA.

• Question 43:

  A 74-year-old woman, who has been followed for the past 25 years for chronic obstructive pulmonary disease (COPD) comes to the emergency department complaining of 48 hours of temperatures to 38.6 C (101.4 F) and worsening shortness of breath. She has a chronic productive cough, which has become more copious. On physical examination, she has rhonchi and increased fremitus in the posterior mid-lung field. A Gram's stain reveals many epithelial cells and multiple gram-positive and gram-negative organisms; no neutrophils are seen.

  Which of the following is the most likely organism causing the symptoms?

  A. Escherichia coli
  B. Haemophilus influenzae
  C. Mycobacterium tuberculosis
  D. Mycoplasma pneumonia
  E. Klebsiella Pneumoniae
  B. Haemophilus influenzae

  ---

  The correct answer is B. This patient, with a long history of chronic obstructive pulmonary disease (COPD), has evidence of a community-acquired pneumonia. The common organisms causing pneumonias in patients with COPD are Streptococcus pneumonia, Haemophilus influenzae, and Moraxella catarrhalis

• Question 44:

  A patient who has recently undergone hip fracture repair develops the sudden onset of shortness of breath. His pulse is 110 per minute. The chest is clear to auscultation. Chest x-ray is normal, and the EKG shows sinus tachycardia. ABG shows pH 7.48, pCO2 28, pO2 75.

  What is the next best step in management?

  A. Spiral CT scan
  B. dimers
  C. Heparin
  D. Angiography
  E. Lower extremity Doppler
  C. Heparin

  ---

  When the case so clearly suggests a pulmonary embolus with sudden onset of shortness of breath and clear lungs in a patient with a risk factor, the first thing to do after the chest x-ray.

• Question 45:

  A 67-year-old homeless woman presents to the ED with substernal chest pain that began shortly after vomiting. The patient has a history of alcoholism and has just finished a 3-day binge of vodka. Physical examination reveals a "snap, crackle, and pop" upon palpation around the clavicles.

  What is the most likely diagnosis?

  A. Volvulus
  B. Boerhaave syndrome
  C. Mycocardial infarction
  D. Pancreatitis
  E. Biliary colic
  B. Boerhaave syndrome

  ---

  Boerhaave syndrome is a full-thickness tear of the esophagus secondary to retching. The patient will have a history of severe incessant vomiting, often due to alcoholism. MI is unlikely in this patient given the subcutaneous emphysema. The other choices do not have substernal chest pain. Pancreatitis presents with abdominal pain that radiates to the back upon alcohol intake, not air in the subcutaneous space. Biliary colic has postprandial RUQ pain. Volvulus is malrotation of the colon.

• Question 46:

  Greatest benefit of thrombolysis is when given in Acute MI?

  A. less than 12 hours from onset of pain
  B. Same benefit in A and B
  C. less than 24 hours from onset of pain
  A. less than 12 hours from onset of pain

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  The greatest benefit is less than 12 hours. Very rarely patient gets thrombolytic in 30-60 minutes of chest pain especially in developing country, no resources to transport, and no good medical care nearby, literature shows advantage of thrombolytic after onset of chest pain is greatest by before 12 hours ...for practical purpose earlier is better may be in 30-60 mins, but you gets mortality reduction advantage if thrombolytic taken within 12 hours of chest pain.

• Question 47:

  A 65-year-old woman comes to the emergency department with acute, severe shortness of breath; rales on lung exam; S3 gallop; and orthopnea. Which of the following is the most important step?

  A. ACE inhibitors
  B. Echocardiogram
  C. Oxygen, furosemide, nitrates, and morphine
  D. Digoxin
  C. Oxygen, furosemide, nitrates, and morphine

  ---

  Oxygen, furosemide, nitrates, and morphine are the mainstay of therapy for acute pulmonary edema. Although they are not associated with a concrete mortality benefit, they are the standard of care for pulmonary edema, which is the worst manifestation of CHF. Removing volume from the vascular system and, therefore, the lungs is more important than any form of diagnostic testing. Pulmonary edema is a clinical diagnosis. Shortness of breath, rales, S3, and orthopnea are more important in establishing the diagnosis than any single test.

• Question 48:

  Highest source/cause of increased ACTH in Cushing syndrome: A. Increase ACTH from adrenal

  B. Ectopic source
  C. Increase ACTH from pituitary adenoma
  D. Unknown
  C. Increase ACTH from pituitary adenoma

• Question 49:

  A 75-yearold man has been attending the clinic for lower urinary tract symptoms. His mood is very low and he is unhappy, anxious and unable to sleep. He has been diagnosed with moderate depression. What treatment would you use for this patient?

  A. Amitryptaline
  B. CBT
  C. Citalopram
  D. Dosulepin
  E. Diasepam
  C. Citalopram

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  Mild depression = CBT, Moderate depression = Antidepressant, Severe depression and Ps = ECT, Amitriptyline and Dosulepine causes urinary retention (which is comparatively less in citalopram) so no a patient with lower urinary symptoms. Hence Citalopram is the preferred option.

• Question 50:

  During a basketball match, one of the players suddenly collapsed to the ground with coughing and SOB. What choice?

  A. V/Q
  B. CTPA
  C. MRI
  D. CT scan
  E. CXR
  E. CXR

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  CXR. Likely diagnosis is pneumothorax. So investigation of choice is CXR