-SS DNA virus
- Human pathogen is parvo virus B-19
Clinical manifestations
- Erythema infectiosum
fifth disease
Slapped cheek appearance
- Arthropathy
- Transient aplastic crisis in chronic hemolytic disease patient
- In immunodeficient patient it causes chronic anemia with reticulocytopenia
- Fetal infection leading to nonimmunohydrops fetalis
- Hemophagocytic syndrome
Focal segmental glomerulosclerosis - HIV , HBV , Parvo virus , coxsackie
Membrane proliferative glomerulonephritis - HBV , HCV , HIV , CMV , EBV
Diffuse proliferative glomerulonephritis - coxsackie virus
Membranous nephropathy - HBV , HCV
Endocapillary proliferative glomerulonephritis - Measles , Dengue
Mesangioproliferative glomerulonephritis - parvo virus , Mumps
Hemoptysis: Bronchial artery
Duodenal ulcer: Gastroduodenal artery
Gastric ulcer: Left Gastric artery
SDH: Bridging veins
EDH: Middle meningeal artery
Tonsillectomy: Paratonsillar vein
Menstruation: Spiral arteries
Double bleb sign : Appearance of amnion and yolk sac at 5-6 weeks. Embryo lies between amnion and yolk sac
Double bubble sign : Sign of duodenal atresia and other forms of duodenal obstruction.
Double decidua sign : Sign of early normal intrauterine gestation.
Double density sign (cardiac) : Sign of left atrial enlargement when right side of the left atrium pushes into the adjacent lung.
Double density sign (Nucs) : Pattern of uptake that may be seen on bone scans in patients with osteoid osteomas.
Double duct sign : Simultaneous dilatation of the common bile and pancreatic ducts that is generally caused by a tumor in the pancreatic head.
Double PCL sign : MRI sign of a bucket-handle meniscal tear.
Double track sign : :Appearance of hypertrophic pyloric stenosis that may be seen on upper GI series.
Q 1. Which of the following conditions is not associated with sinus bradycardia?
A.Brucellosis
B. Leptospirosis
C.Hypothyroidism
D.Advanced liver disease
E. Typhoid fever
ANSWER. B
Q 2. All of the following are common consequences of congenital heart disease in the adult except
A.Eisenmenger syndrome
B. erythrocytosis
C.infective endocarditis
D.pulmonary hypertension
E. stroke
ANSWER. E
Q 3. Acute hyperkalemia is associated with which of the following electrocardiographic changes?
A.QRS widening
B. Prolongation of the ST segment
C.A decrease in the PR interval
D.Prominent U waves
E. T-wave flattening
ANSWER. A
Q 4. All of the following clinical findings are consistent with severe mitral stenosis except
A.atrial fibrillation
B. opening snap late after S2
C.pulmonary vascular congestion
D.pulsatile liver
E. right-ventricular heave
ANSWER. B
Q 5. A 37-year-old male with Wolff-Parkinson-White syndrome develops a broad-complex irregular tachycardia at a rate of 200 beats per minute. He appears comfortable and has little hemodynamic impairment. Useful treatment at this point might include
A.Digoxin
B. Amiodarone
C.Propranolol
D.Verapamil
E. Direct-current cardioversion
ANSWER. E
Q 6. In African Americans with New York Heart Association class II heart failure, which of the following drug combinations should be added to an angiotensinconverting enzyme inhibitor and beta blocker?
A.Hydralazine/angiotensin receptor blockers
B. Hydrazaline/digoxin
C.Isosorbide dinitrate/angiotensin receptor blockers
D.Isosorbide dinitrate/digoxin
E. Isosorbide dinitrate/hydralazine
ANSWER. E
Q 7. All of the following medications have been shown to worsen heart failure in patients with left ventricular systolic dysfunction except
A.angiotensin receptor blockers
B. calcium channel antagonists
C.nonsteroidal anti-inflammatory drugs (NSAIDs)
D.sotalol
E. thiazolidinediones
ANSWER. A
Q 8. Which of the following is true regarding dose escalation of angiotensin-converting enzyme (ACE) inhibitors and beta blockers in patients newly diagnosed with congestive heart failure?
A.ACE inhibitors should be escalated on a daily basis to maximal tolerated doses, while beta blockers should be gently increased in dose over weeks, as tolerated.
B. Beta blockers should be escalated on a daily basis to maximal tolerated doses, while ACE inhibitors should be gently increased in dose over weeks, as tolerated.
C.Both should be escalated rapidly to maximally tolerated doses.
D.Both should be escalated slowly to maximally tolerated doses.
E. Both should be initiated at full doses
ANSWER. A
Q 9. All of the following findings on echocardiographic assessment of patients with congestive heart failure with preserved ejection fraction are relevant except
A.atrial fibrillation
B. left atrial dilatation
C.left ventricular wall thickness
D.left ventricular diastolic filling as measured by tissue Doppler
E. systolic anterior motion of the mitral valve
ANSWER. E
Q 10. A 28-year-old man with long-standing cardiomyopathy presents with worsening dyspnea. Physical examination reveals a blood pressure of 85/50 mmHg, heat rate of 112 beats/min, elevated jugular venous pressure, positive hepatojugular reflex, quiet S1/S2, apical S3, no pulmonary rales, and 3+ lower extremity edema. Chest radiograph shows no pulmonary edema and a small left-sided pleural effusion. What information does the patient’s pulmonary examination give you in regards to his likely pulmonary capillary wedge pressure?
A.It is likely to be elevated.
B. It is likely to be normal.
C.It is likely to be decreased.
D.No information
ANSWER. D
Q 1. Spontaneous maturation of tumour cells and a more benign clinical course potential is occasionally observed in which of the following neoplasms of childhood?
a) Medullo blastoma
b) Osteogenic sarcoma
c) Nephroblastoma
d) Neuroblastoma
e) Retinoblastoma
ANSWER. D
Q 2. The most common site of carcinoma of the colon is
a) Cecum
b) Ascending colon
c) Transverse colon
d) Splenic flexure
e) recto sigmoid
ANSWER. E
Q 3. The most characterisitc feature of granulation tissue is the
a) Resemblance to a granuloma
b) Growth of fibroblasts and new capillaries
c) Character of the exudate
d) Granular scar that results
e) Presence of monocytes and fibroblasts
ANSWER. B
Q 4. Silicosis is most often complicated by
a) Asthma
b) Carcinoma of lung
c) Mesothelioma
d) Tuberculosis
e) bronchi alveolar carcinoma
ANSWER C
Q 5. Chronic salpingitis is considered to be a significant condition predisposing to
a) Ectopic pregnancy
b) Carcinoma of the cervix
c) Leiomyomata
d) Cystic hyperplasia of the endometrium
e) Choriocarcinoma
ÀNSWER. C
Q 6. Petechiae on pleural and pericardial surfaces and squames in alveoli of an autopsied neonatal infant suggest
a) A transplacentally acquired viral infection
b) Intrauterine anoxia
c) A met plastic epithelial response to oxygen therapy
d) A marked decrease in pulmonary surfactant
e) An inherent clotting defect
ANSWER. B
Q 7. Which of the following statements about alcoholic liver disease is correct?
a) It is rarely associated with fatty change
b) It invariably develops in individuals who consume large amounts of alcohol for more than three months
c) It produces extensive hepatic fibrosis rather than true cirrhosis
d) Mallory bodies and Europhilic infiltrates are morphologic features of the early stages of the disease
e) It is not directly related to toxic effects of alcohol but rather to nutritional disturbances
ANSWER. D
Q 8. All of the following are characterized by geanulomatious inflammation except
a) Sarcoidosis
b) Tuberculosis
c) Histoplasmosis
d) Diphtheria
e) Leprosy
ANSWER. D
Q 9. The principle chemical mediator of enhanced vessel permeability from Europhiles is
a) A cationic protein
b) An acid phosphatase
c) Beta glucuronidase
d) Cholesteryl oleate
e) A mucopolysaccharide
ANSWER. A
Q 1. Which of the following is a veterinary anesthetic with hallucinogenic effects?
a) Cannabis
b) Cocaine
c) Phencyclidine
d) Mescaline
e) MPTP (methylphenyltetrahydropyridine)
ANSWER D
Q 2. Each of the following is an effective antidepressant drug except
a) Lithium
b) Imip ramine
c) Phenelzine
d) Desipramine
e) Chlorpromazine
ANSWER E
Q 3. Methadone is useful in the treatment of heroin dependence because it
a) contains 6-monoacetylmorphine
b) is also semi-synthetic
c) doesn't cross the blood-brain barrier
d) acts on the opioid receptor
e) acts on the glutamate receptor
ANSWER. D
Q 4. Which of the following causes muscle paralysis by sustained depolarisation of the post junctional membrane?
a) Pancuronium
b) Atrac curium
c) Both
d) Neither
ANSWER. D
Q 5. Which of the following drugs has a short elimination half life?
a) Diazepam
b) Oxazepam
c) Both
d) Neither
ANSWER. B
Q 6. Side effects of which of the following may include salivation and sweating?
a) Physostigmine
b) Pyridostigmine
c) Both
d) Neither
ANSWER C
Q 7. The principle route for diazepam glucuronidation is a
a) Mitochondrial enzyme
b) Microsomal enzyme
c) Plasma enzyme
d) Cytosolic enzyme
e) None of the above
ANSWER. B
Q 8. Which of the following is the most serious and dose limiting adverse effect of morphine?
a) Extreme sedation
b) Increased intracranial pressure
c) Decreased respiration
d) Decreased myocardial conductivity
e) Decreased blood pressure
ANSWER. C
Q 9. The amount that a receptor agonist affects the activity of its target receptor is called it
a) functionality
b) interactivity
c) cellularity
d) activity
e) efficacy
ANSWER. E
Q 1. An 86-year-old woman with chronic obstructive pulmonary disease (COPD), congestive heart failure, and insulin-requiring type 2 diabetes mellitus is admitted to the intensive care unit with an exacerbation of her COPD. She is intubated and treated with glucocorticoids and nebulized albuterol. She is also continued on her glargine insulin, aspirin, pravastatin, furosemide, enalapril, and metoprolol. On hospital day 8, parenteral nutrition is begun via catheter in the subclavian vein. Her insulin requirements increase on hospital day 9 due to episodes of hyperglycemia. On hospital day 10, she develops rales and an increasing oxygen requirement. A chest radiograph shows bilateral pulmonary edema. Laboratory data show hypokalemia, hypomagnesemia, and hypophosphatemia and a normal creatinine. Her weight has increased by 3 kg since admission. Urine sodium is <10 meq/dL. All of the following changes in her nutritional regimen will improve her volume status except
A.combination of glucose and fat in the parenteral nutrition mixture
B. decreasing the sodium content of the mixture to <40 meq per day
C.increasing the protein content of the parenteral nutrition mixture
D.reducing the overall glucose content
ANSWER . C
Q 2. A new study has been published showing a benefit of 25 mg/day of vitamin X. The recommended estimated average requirement of vitamin X is 10 mg/day, 2 standard deviations below the amount published in the study. The tolerable upper limit of vitamin X is unknown. Your patient wants to know if it is safe to consume 25 mg/day of vitamin X. Which is the most appropriate answer?
A.Two standard deviations above the estimated average requirement defines the tolerable upper limit.
B. 25 mg/day is probably too much vitamin X in 1 day.
C.25 mg/day is statistically in a safe range of the estimated average requirement.
D.The study was not designed to assess safety and therefore should not influence practice
ANSWER . C
Q 3. An elevation in which of the following hormones is consistent with the effects of anorexia nervosa?
A.Cortisol
B. Gonadotropin-releasing hormone (GnRH)
C.Leptin
D.Thyroxine (T4)
E. Thyroid-stimulating hormone (TSH)
ANSWER. A
Q 4. Which of the following statements regarding anorexia nervosa (AN) and bulimia nervosa (BN) is true?
A.Patients with the purging subtype of BN tend to be heavier than those with the nonpurging subtype.
B. Patients with the restricting subtype of AN are more emotionally labile than those with the purging subtype.
C.Patients with the restricting subtype of AN are more likely to abuse illicit drugs than those with the purging subtype.
D.The mortality of BN is lower than that of AN
ANSWER . D
Q 5. You are seeing a pediatric patient from Djibouti in consultation who was admitted with a constellation of symptoms including diarrhea, alopecia, muscle wasting, depression, and a rash involving the face, extremities, and perineum. The child has hypogonadism and dwarfism. You astutely make the diagnosis of zinc deficiency, and laboratory test confirm this (zinc level <70 µL/dL). What other clinical findings is this patient likely to manifest?
A.Dissecting aortic aneurysm
B. Hypochromic anemia
C.Hypoglycemia
D.Hypopigmented hair
E. Macrocytosis
ANSWER. D
Q 6. You are rotating on a medical trip to impoverished areas of China. You are examining an 8-year-old child whose mother complains of him being clumsy and sickly. He has had many episodes of diarrheal illnesses and pneumonia. His “clumsiness” is most pronounced in the evening when he has to go outside and do his chores. On examination, you notice conjunctival dryness with white patches of keratinized epithelium on the sclera. What is the cause of this child’s symptoms?
A.Autoimmune neutropenia
B. Congenital rubella
C.Spinocerebellar ataxia (SCA) type 1
D.Vitamin A deficiency
E. Vitamin B1 deficiency
ANSWER. D
Q 7. After being stranded alone in the mountains for 8 days, a 26-year-old hiker is brought to the hospital for evaluation of a right femoral neck fracture. He has not had anything to eat or drink for the past 6 days. Vital signs are within normal limits. Weight is 79.5 kg, which is 1.8 kg less than he weighed 6 months ago. Laboratory data show a creatinine of 2.5 mg/dL, blood urea nitrogen of 52 mg/dL, glucose 96 mg/dL, albumin 4.1 mg/dL, chloride 105 meq/L, and ferritin on 173 ng/mL. Which of the following statements is true regarding his risk of malnourishment?
A.He has protein-calorie malnutrition due to the rate of weight loss.
B. He has protein-calorie malnutrition due to his elevated ferritin.
C.He is at risk, but a normal individual can tolerate 7 days of starvation.
D.He is not malnourished because he is not hypoglycemic after 6 days of no food or water
ANSWER. C
Q 8. You are doing rounds in the intensive care unit on an intubated patient who is recovering from a stroke and has diabetic gastroparesis. When suctioning the patient in the morning, she coughs profusely, with thick green secretions. You are concerned about the possibility of aspiration pneumonia. All of the following measures are useful in preventing aspiration pneumonia in an intubated patientexcept
A.combined enteral and parenteral nutrition
B. elevating the head of the bed to 30°
C.physician-directed methods for formula advancement
D.post-ligament of Treitz feeding
ANSWER. C
Q 9. Which of these features represents a critical distinction between anorexia nervosa and bulimia nervosa?
A.Binge eating
B. Electrolyte abnormalities
C.Self-induced vomiting
D.Underweight
ANSWER. D
Q 10. You are counseling a patient who is recovering from long-standing anorexia nervosa (AN). She is a 22-yearold woman who suffered the effects of AN for 8 years with a nadir body mass index of 17 kg/m2 and many laboratory abnormalities during that time. Which of the following characteristics of AN is least likely to improve despite successful lasting treatment of the disorder?
A.Amenorrhea
B. Delayed gastric emptying
C.Lanugo
D.Low bone mass
E. Salivary gland enlargement
ANSWER. D
