Q11. You order a PET scan shown below. The radiologist suspects a malignancy. In general, which malignancy is least likely to occur in this location?
a. Adenocarcinoma
b. Squamous cell cancer
c. Large cell cancer
d. Carcinoid
e. Small cell cancer
Tuesday, December 21, 2021
Clinical Case MCQs
Q10. If this was a malignancy in the apex of the lung, what type of arm problem may occur?
A. Swelling of the entire arm
B. Loss of pulses
C. Pain and paresthesias in the middle three fingers
D. Numbness and tingling in the ring and little finger
E. Discoloration of the hand when exposed to cold
Monday, December 20, 2021
Clinical Case MCQs
Q9. You order the blood work. What is the cause of this abnormality in this patient suspected of having a lung malignancy?
a. Bone breakdown
b. Secretion of a parathyroid peptide
c. Renal failure
d. Use of medications
e. Excess production of vitamin D
Clinical case mcqs
Q8. After the CXR is obtained, you order an ECG in the patient with the lung mass. The strip is shown below. You immediately suspect that this patient may have developed?
a. Renal failure
b. Paraneoplastic syndrome
c. Parathyroid adenoma
d. Sarcoidosis
e. Tuberculosis
Clinical Case MCQs
Q6. Based on the below diagram which of the following ganglia is involved in the patient’s eye pathology (horner syndrome)?
Clinical Case MCQs
Q5. When a patient presents with the eye features shown below, what would you ask the patient to determine if the cause if benign or malignant?
A. Do you have any old facial photos?
B. Do you drink alcohol?
C. Does the condition alternate between the eyes?
D. Do you see double?
E. Do you have eye pain?
Sunday, December 19, 2021
Clinical Case MCQs
Q3. In the condition in the previous slide (horner syndrome), which muscle shown below is responsible for the ptosis?
a. Orbicularis oculi
b. Muller’s muscle
c. Levator palpebrae
d. Inferior rectus
Clinical Case MCQs
Q2. While you are examining the patient (see Q1 for history), you are thinking of the differential diagnosis. Which of the following may be helpful in his investigations?
A. Chest x-ray
B. Ophthalmology consult
C. Fundoscopy exam
D. CT brain
E. Arterial blood gas
F. Liver function tests
G. Testing for syphilis
Saturday, December 18, 2021
Clinical Case MCQs
Q1. A 64 yo heavy smoker presents with malaise, fatigue, neck, arm and shoulder discomfort of 3 months duration. Other than a remote appendectomy, his medical history is unremarkable. He has no allergies, no recent travel history and only uses bronchodilators on a PRN basis. As you start to examine him, you note his face. You suspect he has developed?
A. Jaundice
B. Opiate overdose
C. Carotid artery dissection
D. Third nerve palsy
E. Adie pupil
F. Oculosympathetic paresis
Wednesday, December 15, 2021
Clinical case mcqs
Q2. A 20 year old was not wearing a seat belt and was rear ended. He hit his face forcefully with the dashboard and suffered a fracture of the structure shown (see arrow). If there is a leak of clear fluids from his nose, what test will you perform next?
a. Glucose content of the fluids
b. Levels of bence Jones protein
c. Levels of beta2 transferrin
d. Number of WBCs and RBCs
e. Level of albumin
f. pH and microscopic analysis
Clinical Case MCQs
Q1. A 20 year old was not wearing a seat belt and was rear ended. He hit his face forcefully with the dashboard and suffered a fracture of the structure shown (see arrow). In the ED he is found to have leakage of a clear fluid from his nose. What is the structure that has been damaged?
a. Cribriform plate
b. Pterygoid plate
c. Sella turcica
d. Frontal sinus
e. Nasolacrimal duct
f. Pituitary fossa
Tuesday, December 14, 2021
Clinical Case MCQs
Q3. You decide to order imaging studies. What is the ideal study to assess injury to ligament ‘A?’
Clinical Case MCQs
Q2. If you suspect that there is tear of the ligament ‘A’ What test would you do to confirm your diagnosis?
Clinical Case MCQs
Q1. A 17 yo soccer player is seen in the ED after injuring his right knee during soccer. He was trying to kick the ball when he was hit from behind. He heard a popping sound in his knee and immediately fell to he ground. He could not ambulate and had to be transported in a wheelchair. His right knee is swollen and ecchymotic. What is the most likely injured structure?
A
B
C
D
E
F
Friday, December 10, 2021
Clinical Case MCQs
Q5. Another patient with peripheral vascular disease was treated with the agent (sugar polymer) shown below to reduce the risk of DVT. This agent works by inhibiting?
a. Anti-thrombin 3
b. Platelet aggregation
c. Xa factor
d. Factors 5,7,9 and 10
e. Breakdown of plasmin
Clinical case MCQs
Q4. After DVT prophylaxis, the patient returns with complaints of alopecia. He was most likely treated with a drug that acts at which site- see below?
A
B
C
D
Wednesday, December 8, 2021
Clinical Case MCQs
A healthy 69 year-old male who weighs 230 pounds (104kg) with a height of 5 feet and 6 inches (1.7 m) is scheduled to undergo repair of his large incisional hernia and a laparoscopic cholecystectomy at the same time. Based on his BMI, what is the best deep vein thrombosis preventive strategy will you use in him?
A. Early ambulation
B. LMWH and pneumatic compression stockings
C. Compression stockings only
D. Aspirin plus pneumatic compression stockings
E. Pneumatic compression stockings only
Clinical Case MCQs
Q1. A healthy 69 year-old male who weighs 230 pounds (104kg) with a height of 5 feet and 6 inches (1.7 m) is scheduled to undergo repair of his large incisional hernia and a laparoscopic cholecystectomy at the same time. From the formula below, what is his BMI?
Sunday, December 5, 2021
Clinical Case MCQs: Joint pain
Q6. The patient in Q1 with RD has blood work and her results are tabulated in Column B. What would be the next step in her management?
a. Perform bone marrow biopsy
b. Liver biopsy
c. Fecal Guaiac test
d. Ultrasound of the abdomen
e. Transfusion of 2 units of PRBCs
f. Check renal function
Clinical Case MCQs: Joint pain
Q5. Which of the following blood tests is most sensitive for the diagnosis of the condition shown in the image?
a. Anti double stranded DNA
b. Anti Anticentromere antibody
c. Lupus anticoagulant
d. Anti cyclic citrullinated peptide
e. Rheumatoid factor
f. Anti-Smith
Thursday, December 2, 2021
Clinical Case MCQs: Joint pain
Q7. Which of the following antibodies characterizes rheumatoid factor?
A
B
C
D
E
Clinical Case MCQs: Joint pain
Q5. Which of the following blood tests is most sensitive for the diagnosis of the condition shown in the image?
a. Anti double stranded DNA
b. Anti Anticentromere antibody
c. Lupus anticoagulant
d. Anti cyclic citrullinated peptide
e. Rheumatoid factor
f. Anti-Smith
Clinical Case MCQs: Joint pain & fever
Q4. You decide to send blood work in the patient in Q1. Which of the following labs may not be useful in her evaluation?
a. Serology for viral hepatitis
b. ESR
c. CRP
d. Complete blood count
e. Rheumatoid factor
f. Antinuclear antibody assay
Wednesday, December 1, 2021
Clinical Case: Joint pain & fever
Q2. Her sister who has accompanied her also reveals presence of similar symptoms including inability to use her fingers. You quickly notice the sister’s finger deformity which you recognize it to be?
a. Trigger finger
b. Swan neck deformity
c. Boutonniere deformity
d. Mallet finger
e. Jersey finger
Clinical Case: Joint pain & Fever
Q1. A 33 yo Caucasian female presents with chief complaints of pain, fever, and swelling in multiple joints that make it difficult to type, lift or carry any items for the past 7 months. She has been experiencing morning stiffness and even tying shoe laces or buttoning her clothes is difficult. She has not been feeling well for several years and had used OTC medications for pain relief. She denies a rash, and has no allergies. The exam of her hands is shown below. Your immediate impression is that she has?
a. Osteoarthritis
b. Lupus
c. Psoriasis
d. Ankylosing spondylitis
e. Rheumatoid arthritis
f. Lyme disease
g. Sickle cell disease
Tuesday, November 9, 2021
Clinical Case MCQs: Abd Pain
Q3. If this patient was vomiting prior to the onset of abdominal pain, what would you order next?
A. CBC
B. Blood cultures
C. Urinalysis and dipstick
D. Abdominal x-ray
E. Transvaginal ultrasound
F. Perform a pelvic exam
https://youtu.be/7Awe58eMWIY
Clinical Case MCQs: Abd Pain
Q2. This is a male patient who presented with a 18-hour history of vague abdominal pain that started around the umbilicus and later localized to area ‘C.’ If the exam reveals localized tenderness and rebound pain, the next step is?
A. Order CBC
B. Get a bedside ultrasound
C. Order a CT scan
D. Blood cultures
E. Consult with the surgeon
F. Perform a rectal exam
Clinical Case MCQs: Abd Pain
Q1. SB is a 16 yo female who presents to the ED with a 18 hour history of vague abdominal pain. The pain was sudden in onset and colicky in nature. She did take some Tylenol but the pain did not abate. Her past medical history is unremarkable. On exam, her pain has localized to the area ‘C.’ What is the next step in her management?
A. Order CBC
B. Get a bedside ultrasound
C. Urinalysis and dipstick
D. Blood cultures
E. Consult with the surgeon
F. Perform a pelvic exam
Saturday, October 9, 2021
Pharm & Med MCQs
Q12. To reduce the intracranial pressure, you decide to use a sugar-alcohol-based osmotic diuretic. This agent usually acts at what site?
Pharm & Med MCQs
Q11. To reduce the risk of seizures, you start the patient on an anti-seizure drug whose mode of action is shown below. What is one very common adverse effect of this agent?
a. Hallucinations
b. Alopecia
c. Orthostatic hypotension
d. Ototoxicity
e. Gingival overgrowth
f. Halos
Surg & Anat MCQs
Q8. In the ICU the patient is showing signs of Cushing reflex and you are not able to get hold of the radiologist or the neurosurgeon. In the absence of an imaging test, you decide to perform a burr hole at location ‘A.’ Your landmarks will be?
a. 2 cm above and 1 cm anterior to the helix
b. 2 cm anterior and 3 cm above the tragus
c. Half way between the front and back of the skull
d. 2 cm above and 4 cm behind the eye
Thursday, October 7, 2021
Surg & Anat MCQs
Q6. If the herniation occurs at site “D” what one key feature will you note on the physical exam?
A. Diplopia
B. Nystagmus
C. Ipsilateral dilated pupil
D. Contralateral dilated pupil
E. Horner syndrome
F. Deviated tongue
Anat & Surg MCQs
Q4. From the previous slide, if an epidural hematoma causes the most type of herniation, based on the cranial vessel involved where on the homunculus below, will the neurological deficit be most pronounced?
A
B
C
D
E
https://youtu.be/rqK-6wzZ5q8
Surg & Anat MCQs
Q3. With the most common type of herniation following an epidural hematoma (see previous slide), what cranial vessel is most often affected?
Anat & Surg MCQs
Q2. In a patient with herniation at site B from the previous slide what part of the brain will be pushed against the falx cerebri?
Wednesday, October 6, 2021
Sunday, June 13, 2021
Clinical Case MCQs: Dyspnea
Q11. After reviewing the CXR in Q10, the resident ordered a CT scan of the lung in the patient with mitral stenosis (Close up view). You immediately suspect?
a. Interstitial lung disease
b. Kerley B lines
c. Miliary tuberculosis
d. Emphysema
e. Atelectasis
f. Multiple pulmonary emboli
Clinical Case MCQs: Dyspnea
Q10. After admission of the patient, another CXR is obtained. What blood work would you order to confirm the diagnosis based on the CXR?
A. Troponin levels
B. LDH levels
C. BNP levels
D. Creatinine and BUN levels
E. ESR and CRP levels
F. Arterial blood gas
Clinical Case MCQs: Dyspnea
Q8. You order another CXR in the patient with the pandiastolic murmur and the radiologist has entered some markings. After viewing this x-ray you will be concerned for?
A. Endocarditis
B. Stroke
C. Tamponade
D. Heart failure
E. Right heart failure
f. Aneurysm rupture
Clinical Case MCQs Dyspnea
Q6. Based on recent studies, what risk factor is known to be associated with the ECG feature shown below?
a. Smoking
Clinical Case Dyspnea
Q4. Based on the history of palpitations and type of murmur (see below) you expect her ECG to show?
A. Paroxysmal atrial tachycardia
B. Multifocal atrial tachycardia
C. Premature ventricular contractions
D. Atrial fibrillation
E. Ventricular tachycardia
Clinical Case MCQs: Dyspnea
Q3. The patient’s murmur is depicted below. The sound marked by the red arrow is accentuated. What other condition can also the same feature?
a. Prolonged QT interval
b. Short PR interval
c. Hypothyroidism
d. Polycythemia
e. Lack of Vitamin C
f. Hyperkalemia
Clinical Case Dyspnea
Q1. A 40 yo female from Vietnam presents with a 2-month history of anorexia, palpitations, cough and dyspnea. She is unable to lie down at night without getting short of breath. She has no history of allergies and does not use any drugs. She came to the USA 20 years ago and does not remember if she had a throat infection as a child. She is afebrile with stable vitals. On exam, her JVP is elevated and she has rales. The patient has brought over an x-ray done 12 months ago- see below. You want to rule out?
A. Pericardial disease
B. Syphilis
C. Aortic aneurysm
D. Valve disorder
E. Lymphoma
f. Sarcoidosis
Wednesday, June 9, 2021
Clinical Case MCQs: Dyspnea
Q13. While being worked up, the patient’s cardiac monitor reveals the following (See below). What is the next step in his management?
a. Consult with cardiology
b. Observe
c. Administer atropine 0.5 mg IV
d. Use a temporary pacemaker
e. Order troponin levels
Clinical Case MCQs: Dyspnea
Q12. What one common disorder is known to be associated with a ‘decrease’ in the rate in the below test?
a. Hemophilia
b. Lupus
c. Multiple myeloma
d. CO poisoning
e. Sickle cell anemia
f. Lymphoma
g. Pernicious anemia
Clinical Case MCQs: Dyspnea
Q11. The patient in Q1 undergoes the blood test shown below. What ‘prosedimentation’ factor in the blood governs this reaction?
a. Albumin
b. Thrombin
c. Fibrinogen
d. Prostaglandins
e. Bradykinin
f. Complement factor 3
Clinical Case MCQs: Dyspnea
Q10. The patient with mitral stenosis is worked up and his pathology is depicted below in the drawing. What is a common symptom in these patients with the anatomical pathology shown below?
a. Dizziness and syncope
b. Cyanosis
c. Hoarseness
d. Hematemesis
e. Stridor
Clinical Case MCQs: Dyspnea
Q8. Based on the image below, what is the 2nd most affected valve in rheumatic fever?
Clinical Case MCQs: Dyspnea
Q5. You decide to examine the heart. The murmur and sounds during auscultation are shown below. The S1 is accentuated. What does the black arrow represent?
a. Systolic ejection click
b. S3
c. S4
d. Opening snap
e. Signal artifact
f. Split S2
Clinical Case: dyspnea
Q4. You examine the patient’s neck. His JVP tracing is sketched below. What is the cause of this abnormal waveform in a patient with mitral stenosis?
a. Presence of atrial fibrillation
b. Cardiac tamponade
c. Fluid overload
d. Tricuspid regurgitation
e. Forceful atrial contraction
f. Stiff right atrium
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