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
A 55-year-old man with congestive heart failure on multiple treatments came to the clinic for
follow up. The physician discussed with him the importance of compliance and the effect of the
treatments on his life. Which of the following medications is associated with reduced mortality
rate in congestive heart failure?
A. Digoxin therapy
B. Diuretic therapies
C. anticoagulation therapies
**D. Angiotensin-converting enzyme (ACE) inhibitors
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 60-year-old diabe7c pa7ent presents for follow-up. Currently, the pa7ent takes mejormin that
maintains fas7ng blood glucose levels lower than 5.5 mol/L with HbA1c level of 5.8%. Physical
examina7on is normal, including a lower extremity neurologic examina7on. The pa7ent has
regular eye exams that show no signs of re7nopathy.
Blood pressure 149/90 mmH (three readings) Heart rate 76 /min
Respiratory rate 18 /min
Temperature 36.6° C
Which of the following is the most appropriate management?
A. No change in therapy
**B. Add ACE inhibitor
C. Add beta-blocker
D. Add sulfonylurea
A 60-year-old pa7ent presents to the hospital, complaining of a sudden onset of chest pain
radiating to the back. The blood pressure is low in the lef t arm and the lef t femoral pulse is not
palpable (see reports).
Chest X-ray: A left pleural effusion.
ECG:Lef t ventricular hypertrophy.
Which of the following is most likely to confirm the diagnosis?
A. Echocardiography
B. Cardiac isoenzymes
,**C. Aortic CT angiography
D. Complete blood count
COMMON:
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
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 45-year-old pa7ent presents to the clinic with a 3-month history of stumbling, weak grip,
dysphagia, and generalised weakness, and also had 2 episodes of aspira7on pneumonia in the
last 2 months. Examina7on confirms brisk reflexes, spas7c muscles, and fascicula7on of tongue
and thigh.
Which of the following is the most likely diagnosis?
A. Mononeuropathy
B. Myasthenia gravis
,C. Myasthenic syndrome
**D. Motor neuron disease
A 66-year-old woman has recently been found to have high blood pressure. She had a
cholecystectomy 15 years ago and has osteoarthri7s in the knees for which she uses ibuprofen
(see lab results).
Blood pressure 160/95 mmH
Heart rate 84 /min
Test Result Normal Values
Crea7nine 138 44-115 mol/L
Sodium 142 134-146 mmol/L
Potassium 2.9 3.5-5.1 mmol/L
Chloride 100 97-108 mmol/L
Bicarbonate 31 21-28 mmol/L
Which of the following is the most likely Diagnosis?
A. Essen7al hypertension
B. Pheochromocytoma
**C. Primary hyperaldosteronism
D. NSAIDs induced hypertension
A 30-year-old man comes to the Outpa7ent Clinic because of the recent development of marked
peripheral edema. He has no significant past medical history. On examina7on, he has 4+
edema of the lower extremi7es (see lab results and reports).
Blood pressure 105/80 mmHg
Test Result Normal Values Albumin 18 34-56 g/L
Urea 5 2.8-8.9 mmol/L Crea7nine 85 44-115 mol/L Dips7ck analysis: 4+ proteins.
Urinalysis:
Oval fat bodies, and some hyaline casts and occasional RBCs. Which of the following is the most
likely diagnosis?
**A. Inters77al nephri7s
B. Nephri7c syndrome
C. Nephro7c syndrome
D. Ischemic nephropathy
A 29-year-old woman is diagnosed with rapidly progressive glomerulonephri7s. Which of the
following pathological changes is characteris7c of this diagnosis?
A. Dilated proximal tubules with inflamma7on
**B. Crescent forma7on within Bowman's space
C. IgA deposi7on in glomerular capillaries
D. Fat globules in urine sediment
A young man comes into the clinic with intermi]ent haemoptysis for 2 months, associated with
some blood in his urine. He is a non-smoker and was previously in excellent health. He also
, describes a weight gain of 20 kg over the past 3 weeks, with "puffy eyes" in the morning. He has
an elevated serum crea7nine concentra7on (see report).
Lung Biopsy:
Serum immunoglobulin on basement membranes.
Which of the following is the most likely diagnosis?
A. Acute myocardial infarc7on
**B. Goodpasture syndrome
C. DiGeorge syndrome
D. Graves' disease
In which of the following condi7ons is inters77al pneumoni7s a characteris7c histopathologic
finding?
**A. Viral pneumonia
B. Lobar pneumonia
C. Bronchopneumonia
D. Secondary tuberculosis
A 53-year-old woman presents to the Outpa7ent Department. She has been unwell for 6
months with arthralgia, fever, weight loss and more recently has developed pleuri7c chest pains.
She also has synovi7s of the small joints of the hands. There were no rashes or nail fold infarcts.
Heart sounds are normal (see lab results and reports).
Blood pressure 110/70 mmHg Heart rate 70 /min Respiratory rate 18/min
Test Result Normal Values
Hb 89 120-160 g/L
WBC 3.2 4-10.5 x 109/L
Platelets count 99 150-400 × 109/L
Neutrophils 80 40-60%
Lymphocytes 17 20-40 %
MCV 90 80-95 f1
C-reac7ve pep7de 99 <8.2 mg/L
ESR 56 3-15 mm/h
Cloeng 7me 7 5-10 min
Ferri7n 920 22-340 pg/L
ANA 1:320 =1:40
Pulmonary Angiography CT:
Confirms a small le\ pleural effusion. There is no consolida7on, pulmonary embolus and no
lymphadenopathy.
ECG:
Sinus tachycardia.
Which of the following the most likely diagnosis?
A. Infec7ve endocardi7s
B. Adult-onset s7ll's disease
**C. Systemic lupus erythematosus
D. Rheumatoid arthri7s with vasculi7s
heart failure?
A. Digitalis
B. Enalapril
**C. Furosemide
D. Procainamide
A 55-year-old man with congestive heart failure on multiple treatments came to the clinic for
follow up. The physician discussed with him the importance of compliance and the effect of the
treatments on his life. Which of the following medications is associated with reduced mortality
rate in congestive heart failure?
A. Digoxin therapy
B. Diuretic therapies
C. anticoagulation therapies
**D. Angiotensin-converting enzyme (ACE) inhibitors
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 60-year-old diabe7c pa7ent presents for follow-up. Currently, the pa7ent takes mejormin that
maintains fas7ng blood glucose levels lower than 5.5 mol/L with HbA1c level of 5.8%. Physical
examina7on is normal, including a lower extremity neurologic examina7on. The pa7ent has
regular eye exams that show no signs of re7nopathy.
Blood pressure 149/90 mmH (three readings) Heart rate 76 /min
Respiratory rate 18 /min
Temperature 36.6° C
Which of the following is the most appropriate management?
A. No change in therapy
**B. Add ACE inhibitor
C. Add beta-blocker
D. Add sulfonylurea
A 60-year-old pa7ent presents to the hospital, complaining of a sudden onset of chest pain
radiating to the back. The blood pressure is low in the lef t arm and the lef t femoral pulse is not
palpable (see reports).
Chest X-ray: A left pleural effusion.
ECG:Lef t ventricular hypertrophy.
Which of the following is most likely to confirm the diagnosis?
A. Echocardiography
B. Cardiac isoenzymes
,**C. Aortic CT angiography
D. Complete blood count
COMMON:
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
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 45-year-old pa7ent presents to the clinic with a 3-month history of stumbling, weak grip,
dysphagia, and generalised weakness, and also had 2 episodes of aspira7on pneumonia in the
last 2 months. Examina7on confirms brisk reflexes, spas7c muscles, and fascicula7on of tongue
and thigh.
Which of the following is the most likely diagnosis?
A. Mononeuropathy
B. Myasthenia gravis
,C. Myasthenic syndrome
**D. Motor neuron disease
A 66-year-old woman has recently been found to have high blood pressure. She had a
cholecystectomy 15 years ago and has osteoarthri7s in the knees for which she uses ibuprofen
(see lab results).
Blood pressure 160/95 mmH
Heart rate 84 /min
Test Result Normal Values
Crea7nine 138 44-115 mol/L
Sodium 142 134-146 mmol/L
Potassium 2.9 3.5-5.1 mmol/L
Chloride 100 97-108 mmol/L
Bicarbonate 31 21-28 mmol/L
Which of the following is the most likely Diagnosis?
A. Essen7al hypertension
B. Pheochromocytoma
**C. Primary hyperaldosteronism
D. NSAIDs induced hypertension
A 30-year-old man comes to the Outpa7ent Clinic because of the recent development of marked
peripheral edema. He has no significant past medical history. On examina7on, he has 4+
edema of the lower extremi7es (see lab results and reports).
Blood pressure 105/80 mmHg
Test Result Normal Values Albumin 18 34-56 g/L
Urea 5 2.8-8.9 mmol/L Crea7nine 85 44-115 mol/L Dips7ck analysis: 4+ proteins.
Urinalysis:
Oval fat bodies, and some hyaline casts and occasional RBCs. Which of the following is the most
likely diagnosis?
**A. Inters77al nephri7s
B. Nephri7c syndrome
C. Nephro7c syndrome
D. Ischemic nephropathy
A 29-year-old woman is diagnosed with rapidly progressive glomerulonephri7s. Which of the
following pathological changes is characteris7c of this diagnosis?
A. Dilated proximal tubules with inflamma7on
**B. Crescent forma7on within Bowman's space
C. IgA deposi7on in glomerular capillaries
D. Fat globules in urine sediment
A young man comes into the clinic with intermi]ent haemoptysis for 2 months, associated with
some blood in his urine. He is a non-smoker and was previously in excellent health. He also
, describes a weight gain of 20 kg over the past 3 weeks, with "puffy eyes" in the morning. He has
an elevated serum crea7nine concentra7on (see report).
Lung Biopsy:
Serum immunoglobulin on basement membranes.
Which of the following is the most likely diagnosis?
A. Acute myocardial infarc7on
**B. Goodpasture syndrome
C. DiGeorge syndrome
D. Graves' disease
In which of the following condi7ons is inters77al pneumoni7s a characteris7c histopathologic
finding?
**A. Viral pneumonia
B. Lobar pneumonia
C. Bronchopneumonia
D. Secondary tuberculosis
A 53-year-old woman presents to the Outpa7ent Department. She has been unwell for 6
months with arthralgia, fever, weight loss and more recently has developed pleuri7c chest pains.
She also has synovi7s of the small joints of the hands. There were no rashes or nail fold infarcts.
Heart sounds are normal (see lab results and reports).
Blood pressure 110/70 mmHg Heart rate 70 /min Respiratory rate 18/min
Test Result Normal Values
Hb 89 120-160 g/L
WBC 3.2 4-10.5 x 109/L
Platelets count 99 150-400 × 109/L
Neutrophils 80 40-60%
Lymphocytes 17 20-40 %
MCV 90 80-95 f1
C-reac7ve pep7de 99 <8.2 mg/L
ESR 56 3-15 mm/h
Cloeng 7me 7 5-10 min
Ferri7n 920 22-340 pg/L
ANA 1:320 =1:40
Pulmonary Angiography CT:
Confirms a small le\ pleural effusion. There is no consolida7on, pulmonary embolus and no
lymphadenopathy.
ECG:
Sinus tachycardia.
Which of the following the most likely diagnosis?
A. Infec7ve endocardi7s
B. Adult-onset s7ll's disease
**C. Systemic lupus erythematosus
D. Rheumatoid arthri7s with vasculi7s
