DR. Mustafa Hokoma (Medicine)

75 year old man has a history of Chronic Lymphocytic Leukemia. He has had treatment with several courses of chemotherapy and has now been admitted to hospital with pneumonia. His past medical history revealed that he had suffered several previous upper respiratory tract infections over the previous six months.
Which of the following components of his immune system is likely to be degcient?
A) complement
b) immunoglobulin G
C) macrophages
D) mast cells
E) T lymphocytes

A 31-year-old woman presents to your clinic complaining of painful arthritis that is worse in the mornings when she wakes up. She was recently evaluated by an ophthalmologist for uveitis in her right eye. A recent laboratory report shows an erythrocyte sedimentation rate of 48 mm/h. Which of the following will be helpful in distinguishing relapsing polychondritis from rheumatoid arthritis (RA)?

A. Arthritis associated with RA is nonerosive.
B. Eye inflammation is absent in relapsing polychondritis.
C. Relapsing polychondritis will not present with vasculitis.
D. Relapsing polychondritis will present with high-titerrheumatoid factor.
E. The arthritis of relapsing polychondritis is asymmetric.

- You are called to the bedside to see a patient with Prinzmetal’s angina who is having chest pain. The pa- tient had a cardiac catheterization 2 days prior showing a 60% stenosis of the right coronary artery with associ- ated spasm during coronary angiogram. The spasm was relieved with nitroglycerin infusion. Which of the fol- lowing additional disorders is the patient most likely to have?A. MigraineB. Peptic ulcer diseaseC. Peripheral vascular disease D. Reactive arthritisE. Rheumatoid arthritis

A 45-year-old man is admitted to the intensive care unit with symptoms of congestive heart failure. He is addicted to he**in and co***ne and uses both drugs daily via injection. His blood cultures have yielded methicillin-sensitive Staphy- lococcus aureus in four of four bottles within 12 h. His vital signs show a blood pressure of 110/40 mmHg and a heart rate of 132 beats/min. There is a IV/VI diastolic murmur heard along the left sternal border. What is the most likely cause of the patient’s murmur?A. Aortic regurgitationB. Aortic stenosisC. Mitral stenosisD. Mitral regurgitationE. Tricuspid regurgitation

- All of the following patients should receive a lipid screening profile except
A. a 16-year-old male with type 1 diabetes
B. a17-year-old female teen who recently began smoking
C. a 23-year-old healthy male who is starting his first job
D. a 48-year-old woman beginning menopause
E. a 62-year-old man with no past medical history

A 45 year old female presents to her GP as she is worried about a tremor in her left hand that is worse when she is doing things. Her mother had a similar tremor. The rest of her examination is unremarkable. How would you manage this woman?

A.Reassure
b. Propranolol
C. Amantadine
D. l Dopa
E. Procyclidine

A 60-year-old lady from Syria presented with rigors and presyncope. No further
history was available. On examination she was febrile at 38.5 °C and flushed.
Her pulse was 120/min. Blood pressure was 120/80 mmHg when lying down and
100/60 mmHg when sitting. Her JVP was not visible and heart sounds were normal.
Her chest was clear. A left paramedian abdominal scar was evident, together with a
tender right flank. There was no neurological abnormality as far as it was possible
to assess.
Hb 13.4 g/dl, white cell count 18.9  109/l, platelets 447  109/l, PT 13 s (normal:
10–12 s), Na 144 mmol/l, K 2.9 mm/l, urea 10.4 mmol/l, creatinine 140mol/l,
chloride 118 mmol/l, bicarbonate 13 mmol/l. No urine was available for analysis.
1. Select the two most likely diagnoses from the following:
a) Diabetic ketoacidosis (DKA)
b) Acute renal failure
c) Right-sided pyelonephritis
d) Malignant bowel perforation with tracking of bowel contents down right
paracolic gutter
e) Ureterosigmoidostomy
f) Type 2 renal tubular acidosis
g) Pancreatitis
h) Haemorrhage into metastatic neuroendocrine tumour

When you deciding whether to initiate anticoagulation for a patient with atrial fibrilation, which of the following factors is least important?
A. Age
B. History of diabetes
C. Mitral stenosis
D. Use of antiarrhythmic medication
E. Hypertension

Where are the most common divers of atrial fibrilation anatomically located?
A. Left atrial appendage
B. Mitral annulus
C. Pulmonary vein or***ce
D. Sinus venosus
E. Sinus node

A clinic patient who has a diagnosis of polycystic kidney disease has been doing research on the internet. She is asymptomatic and has no significant family history. She asks you for screening for intracranial aneurysms. You recommend which of the following?
A. Head CT scan without contrast
B. CT angoigram
C. Cerebral angiogram
D. Magnetic resonance angiogram
E. No furture testing