1. Topic: Mitral Insufficiency (Mitral Regurgitation) Correct Answer: D. Blood pressure is changed Explanation: Mitral insufficiency primarily affects the heart by causing backflow of blood from the left ventricle to the left atrium during systole. The major functional signs include a systolic murmur (A), potential diastolic rolling in severe cases (B), and sounds that can be heard behind the back due to the nature of the murmur’s radiation (C). Dyspnea (E) is a significant functional sign due to increased pulmonary pressures. However, systemic blood pressure changes (D) are not a direct feature of mitral insufficiency, making this the incorrect statement. Mitral regurgitation focuses on symptoms like dyspnea and characteristic murmurs rather than changes in blood pressure.

2. Topic: Complications of Infective Endocarditis Correct Answer: C. Renal complications such as tubulopathies Explanation: Infective endocarditis is associated with various complications due to septic emboli and immune complex deposition. Atrioventricular conduction disorders (A), heart failure (B), joint complications (D), and cerebral embolisms (E) are well-documented complications of infective endocarditis. Renal complications such as tubulopathies (C), while possible in severe cases due to embolic events or immune-mediated glomerulonephritis, are less commonly associated compared to the other listed complications. Therefore, C is the correct answer as it is less frequently seen in the context of infective endocarditis.

3. Topic: Causes of Lower Extremity Deep Vein Thrombosis (DVT)

Correct Answer: E. High blood pressure

Explanation: Lower extremity deep vein thrombosis (DVT) typically occurs due to Virchow’s triad, which includes factors such as stasis of blood flow, endothelial injury, and hypercoagulability. The risk factors commonly associated with DVT include prolonged bed rest (A), immobilization in plaster (B), and use of birth control pills (C), which can contribute to hypercoagulability. Chronic anemia (D) can lead to hypercoagulability as well due to increased production of clotting factors. High blood pressure (E) is not a known risk factor for lower extremity DVT. While hypertension can contribute to cardiovascular complications, it is not directly linked to the development of DVT. Therefore, E is the correct answer as it does not typically result in lower extremity DVT.

4. Topic: Chest X-ray Features Suggesting Active Tuberculosis

Correct Answer: D. Excavated bi-apical infiltrates

Explanation:

On a standard chest X-ray, features that strongly suggest the possibility of active tuberculosis include excavated bi-apical infiltrates (D). These are characteristic of tuberculosis and indicate cavitation within the lung parenchyma, which is a hallmark feature of active disease. Option A (left lower lobe atelectasis) is less specific for tuberculosis and can occur due to other causes of lung collapse. Option B (firmly circled clear image of the apical segment of the right lower lobe) does not suggest tuberculosis and is not a typical finding. Option C (linear panhilar opacities) are more suggestive of other conditions such as interstitial lung diseases rather than tuberculosis. Option E (reticular aspect of the two fields) typically indicates fibrotic changes and is not specific for active tuberculosis. Therefore, D (excavated bi-apical infiltrates) is the correct answer as it strongly indicates the possibility of active tuberculosis on a chest X-ray.

5. Topic: Chronic Cough and Hemoptysis in a Smoker Correct Answer: E. Bronchopulmonary cancer

Explanation: In a smoker presenting with chronic coughing for several months and hemoptysis (coughing up blood), the primary concern would be bronchopulmonary cancer (E). Smoking is a significant risk factor for lung cancer, and hemoptysis can be a presenting symptom, particularly in cases of bronchogenic carcinoma. While pulmonary tuberculosis (A), pulmonary aspergilloma (B), chronic bronchitis (C), and pulmonary embolism (D) can also cause chronic coughing and, in some cases, hemoptysis, they are less likely in the context of chronic symptoms in a smoker. Lung cancer should be considered first due to the high risk associated with smoking and the presence of hemoptysis. Therefore, E (bronchopulmonary cancer) is the correct answer as the most likely aetiology in this scenario.

6. Topic: Acute Cholecystitis and Common Bile Duct Lithiasis

Correct Answer: E. Pain on scapular irradiation

Explanation: Pain on scapular irradiation (E) is indicative of biliary colic that can be associated with common bile duct lithiasis, where the pain radiates to the right shoulder blade due to diaphragmatic irritation. Other signs like a large blister (A), fever (B), jaundice (C), and pain from the right hypochondrium (D) are common in acute cholecystitis but do not specifically indicate the presence of common bile duct stones. The scapular pain hints at a more extensive biliary involvement

7. Topic: Dilatation of Hepatic Veins Associated with Jaundice

Correct Answer: E. A hepatocarcinoma

Explanation: Hepatocarcinoma (liver cancer) can cause dilatation of the hepatic veins and jaundice due to the tumor obstructing bile ducts and/or blood vessels within the liver. This obstruction leads to a buildup of bile, resulting in jaundice, and impaired blood flow, leading to venous congestion and dilatation. Other conditions like Budd-Chiari syndrome (A), cardiac liver (B), Caroli’s disease (C), and cirrhosis (D) have distinct pathophysiologies that do not directly associate hepatic vein dilatation with jaundice in the same way as hepatocarcinoma does.

8. Topic: Nephrotic Syndrome

Correct Answer: C. A hemorrhagic syndrome

Explanation: Nephrotic syndrome is characterized by a range of features including hypocalcemia (A) due to loss of vitamin D-binding proteins in urine, increased plasma lipoproteins (B) as the liver compensates for protein loss, hydro-sodium retention (D) leading to edema, and functional renal failure (E) due to severe hypoalbuminemia. However, a hemorrhagic syndrome (C) is not typically associated with nephrotic syndrome, making it the incorrect statement.

9. Topic: Pus in Urine

Correct Answer: C. Glomerulonephritis

Explanation: The presence of pus in the urine, known as pyuria, typically suggests an infectious process involving the urinary tract. Causes include renal lithiasis (A), vesico-renal reflux (B), a retained bladder (D), and cystitis (E), all of which can lead to bacterial infections. Glomerulonephritis (C), characterized by inflammation of the glomeruli in the kidneys, typically presents with hematuria and proteinuria rather than pyuria. Therefore, it is the condition least likely associated with the presence of pus in the urine.

10. Topic: Goiter and Hypothyroidism

Correct Answer: B. Autoimmune thyroiditis

Explanation: The association of a goiter with hypothyroidism commonly suggests autoimmune thyroiditis (B), also known as Hashimoto’s thyroiditis. This autoimmune condition leads to chronic inflammation of the thyroid gland, resulting in goiter and subsequent hypothyroidism. Graves’ disease (A) is characterized by hyperthyroidism, not hypothyroidism. Thyroid cancer (C) and Plummer’s adenoma (D) may present with nodules but are not typically associated with hypothyroidism. A hypo-fixing nodule (E) refers to a thyroid nodule that shows reduced uptake on thyroid scans, which is not specific to hypothyroidism but rather a characteristic finding in thyroid imaging.

11. Topic: Acromegaly

Correct Answer: A. Hypertrophy of the extremities

Explanation: Acromegaly is a condition caused by excessive growth hormone (GH) secretion after epiphyseal closure, leading to characteristic features. Hypertrophy of the extremities (A) occurs due to the continued growth of bones and soft tissues. Facial-trunk obesity (B) and facial erythema (C) are not typical features of acromegaly but may occur in other conditions. Osteoporosis (D) and muscle weakness (E) can be associated with acromegaly due to secondary effects on bone and muscle metabolism, but they are not primary diagnostic features.

12. Topic: Diabetic Ketoacidosis (DKA)

Correct Answer: E. None of the following

Explanation: Diabetic ketoacidosis (DKA) is a serious complication of diabetes mellitus characterized by hyperglycemia, ketosis, metabolic acidosis, and dehydration. It can lead to various systemic effects: A pseudo-surgical abdominal syndrome (A) can occur due to abdominal pain and tenderness. Hypovolemic shock (B) can develop due to severe dehydration. Overall dehydration (C) is a hallmark feature of DKA. Hypothermia (D) can occur due to altered thermoregulation and shivering. Therefore, all of the conditions listed can be associated with diabetic acidosis, making the correct answer E, “None of the following.”

13. Topic: Extra-articular Manifestations of Rheumatoid Arthritis

Correct Answer: C. Cauda equina syndrome

Explanation: Rheumatoid arthritis (RA) is known to have various extra-articular manifestations, reflecting its systemic nature. These can include: Splenomegaly (A), due to secondary amyloidosis or involvement in the disease process. Multineuritis (B), referring to peripheral neuropathy which can occur in RA. A serofibrinous pleurisy (D), which involves inflammation of the pleura lining the lungs. Gougerot-Sjogren syndrome (E), an autoimmune condition characterized by dry eyes and dry mouth. Cauda equina syndrome (C), however, is not typically associated with rheumatoid arthritis. It is a condition involving compression of the nerves at the end of the spinal cord, often due to disc herniation or trauma, and is not directly linked to RA. Therefore, the correct answer is C, “Cauda equina syndrome.”

14. Topic: Carpal Tunnel Syndrome

Correct Answer: C. Thumb opposition paresis

Explanation: Carpal tunnel syndrome (CTS) is characterized by compression of the median nerve as it passes through the carpal tunnel in the wrist. The major symptom associated with CTS is thumb opposition paresis, which refers to weakness in the ability to oppose the thumb to the other fingers. This occurs due to impaired function of the median nerve, affecting the muscles responsible for this movement. Thumb adduction paresis: Not typically associated with carpal tunnel syndrome. Thumb flexion paresis: Not a primary symptom of carpal tunnel syndrome. Thumb opposition paresis: This is a hallmark symptom of carpal tunnel syndrome. Interosseous paresis: Interosseous muscles are not commonly affected in CTS. A paresis of the flexion of the index and middle fingers: Not typically a specific symptom of carpal tunnel syndrome. Therefore, option C is correct as it directly describes a characteristic symptom of carpal tunnel syndrome, which is thumb opposition paresis.

15. Topic: Complications of Typhoid Fever

Correct Answer: C. Le Tuphos

Explanation: During typhoid fever, complications can arise due to the dissemination of endotoxins from Salmonella typhi bacteria. “Le Tuphos” (option C) is not a recognized complication of typhoid fever. Instead, complications commonly include: Bradycardia, which occurs due to the effect of endotoxins on the cardiovascular system. Digestive perforations: Can result from severe inflammation and ulceration of the intestinal wall. Splenomegaly: Enlargement of the spleen is a common finding in typhoid fever due to bacterial dissemination. Cardiovascular collapse: Can occur in severe cases due to septic shock induced by endotoxins. Therefore, option C is correct as it does not describe a known complication associated with typhoid fever, unlike the other options which are recognized complications caused by endotoxin flooding in the body.

16. Topic: Influenza Correct Answer: E. Significant lung opacities

Explanation: Common influenza typically presents with symptoms such as cough (A), upper airway catarrh (C), fever (D), and sometimes, significant lung opacities (E) on imaging studies. However, the presence of significant lung opacities (E) suggests a more severe complication or a different respiratory condition rather than typical influenza, making it the incorrect statement in the context of uncomplicated influenza

17. Topic: Cerebral Toxoplasmosis in HIV-positive patients Correct Answer: E. All of the above

Explanation: Cerebral toxoplasmosis, a common opportunistic infection in HIV-positive patients, typically presents with a combination of clinical signs including seizures (A), fever (B), hemiparesis (C), and disorders of consciousness (D). These symptoms collectively suggest the involvement of the central nervous system due to Toxoplasma gondii infection. Therefore, option E is correct as it encompasses all the typical clinical manifestations associated with cerebral toxoplasmosis in HIV-positive individuals.

18. Topic: Chronic Bleeding Anemia Correct Answer: B. A hypochromic microcytic anemia with a low reticulocyte count

Explanation: Chronic bleeding leads to iron deficiency over time, resulting in a hypochromic (reduced hemoglobin content) and microcytic (smaller red blood cells) anemia due to inadequate iron for hemoglobin synthesis. The reticulocyte count tends to be low in this type of anemia because the bone marrow response is insufficient to compensate for ongoing blood loss and iron deficiency. Therefore, option B is correct as it describes the characteristic features of chronic bleeding anaemia.

19. Topic: Multiple Myeloma (Kahler’s Disease) Correct Answer: A. Plasmacytosis

Explanation: In multiple myeloma (Kahler’s disease), there is typically an increase in plasma cells (plasmacytosis) in the bone marrow. These abnormal plasma cells produce monoclonal immunoglobulins (M proteins) that can lead to various clinical manifestations, including bone lesions, renal impairment, and anaemia. Options B, C, and D (eosinophilia, hyperlymphocytosis, neutrophilic polynucleosis) are not typically associated with multiple myeloma. Therefore, option A is correct as it reflects a characteristic feature of the disease.

20. Topic: Transient Ischemic Attack (TIA) in Young Subjects Correct Answer: C. Cardiac embolism

Explanation: In young subjects, transient ischemic attacks (TIAs) are most commonly caused by cardiac embolism. This occurs when a clot or other material from the heart (such as in conditions like atrial fibrillation or valvular heart disease) travels to the brain and temporarily blocks blood flow, leading to transient neurological symptoms. While options B, D, and E (thrombosis of a cerebral artery, embolism of aortic origin, embolism of carotid origin) can also cause TIAs, cardiac embolism is particularly frequent in younger patients due to various cardiac conditions predisposing to clot formation.

21. Topic: Management of Generalized Tonic-Clonic Seizure

Correct Answer: C. As soon as possible lay him on his side and wait for him to return to consciousness

Explanation: During a generalized tonic-clonic seizure, it’s important to ensure the patient’s safety and manage the seizure appropriately. Option C is correct because placing the patient on their side helps prevent aspiration in case of vomiting and allows saliva or any fluids to drain from the mouth. This position also helps maintain an open airway and reduces the risk of injury. Options A (getting valium), B (putting an object in the mouth), D (giving water), and E (taking immediately to the hospital) are incorrect: (A) Administering medication like valium should be done by trained medical personnel if seizures persist or recur. (B) Putting objects in the mouth is not recommended as it can cause injury to the patient’s mouth or teeth and does not prevent swallowing of the tongue. (D) Giving water during a seizure is not recommended as the patient may aspirate it. (E) While hospital evaluation may be necessary if the seizure is prolonged or complicated, immediate transport is not always required for every seizure episode that resolves without complications.

22. Topic: Anxious Patient with Chest Pain and Palpitations

Correct Answer: B. Phaeochromocytoma

Explanation: The patient’s symptoms of chest pain and palpitations, exacerbated by stress and smoking, along with elevated catecholamine levels in the urine, suggest a diagnosis of phaeochromocytoma. This adrenal tumor secretes excess catecholamines, causing episodic symptoms that match the clinical presentation described. Option A (Cushing’s syndrome), Option C (Hyperparathyroidism), Option D (Conn syndrome), and Option E (Malignant hypertension) are not correct: (A) Cushing’s syndrome involves excess cortisol production and typically presents with different symptoms like weight gain and metabolic issues. (C) Hyperparathyroidism is characterized by hypercalcemia-related symptoms, such as fatigue and bone pain. (D) Conn syndrome results in hypertension due to excess aldosterone secretion. (E) Malignant hypertension presents with severe hypertension and end-organ damage signs, not catecholamine-related symptoms. Phaeochromocytoma is the most fitting diagnosis based on the patient’s symptoms and the findings of elevated catecholamine levels.

23. Topic: Acute Left Hemi-thoracic Pain in a 23-year-old Man

Correct Answer: E. Coxsackie virus

Explanation: The patient’s symptoms of acute left hemi-thoracic pain, fever, and pain aggravated by lying down (pleuritic chest pain) are suggestive of pericarditis. Coxsackie virus is a common viral cause of acute pericarditis, presenting with these characteristic symptoms. Options A (Acute articular rheumatism), B (Tuberculosis), C (Herpes simplex virus), and D (Myocardial infarction) are not correct: (A) Acute articular rheumatism typically presents with migratory arthritis and carditis. (B) Tuberculosis can cause pleuritic chest pain but is usually associated with other respiratory symptoms and findings. (C) Herpes simplex virus can cause esophagitis or encephalitis, not typically presenting with isolated pleuritic chest pain. (D) Myocardial infarction presents with chest pain that is not typically worsened by lying down and is associated with ECG changes and cardiac enzyme elevation. Therefore, based on the patient’s symptoms and clinical presentation, the correct answer is E. Coxsackie virus.

24. Topic: Symptoms in a 74-year-old Man Post-Peptic Ulcer Surgery

Correct Answer: E. Afferent loop syndrome

Explanation: The patient’s symptoms of abdominal pain and bloating about 30-40 minutes after eating, associated with nausea and relieved by vomiting, suggest a mechanical obstruction or dysfunction post-peptic ulcer surgery. Afferent loop syndrome occurs due to obstruction or distention of the afferent loop of a Billroth II or Roux-en-Y reconstruction, causing symptoms like pain, bloating, and nausea after meals. Option A (Early dumping syndrome), Option B (Late dumping syndrome), Option C (Gastropathy due to bile reflux), and Option D (Retention of the gastric) are not consistent with the symptoms described: (A) Early dumping syndrome typically presents with cramping, diarrhoea, and palpitations shortly after meals, not relieved by vomiting. (B) Late dumping syndrome manifests with symptoms like hypoglycemia and flushing 1-3 hours after meals, not relieved by vomiting. (C) Gastropathy due to bile reflux may cause epigastric discomfort and nausea but does not typically improve with vomiting. (D) Retention of gastric contents would cause persistent symptoms, not relief upon vomiting. Thus, based on the patient’s symptoms and history of peptic ulcer surgery, the correct answer is E. Afferent loop syndrome.

25. Topic: Methotrexate Mechanism of Action

Correct Answer: B. Di-hydrofolate reductase inhibition

Explanation: Methotrexate exerts its pharmacological effects primarily by inhibiting di-hydrofolate reductase, an enzyme involved in the synthesis of tetrahydrofolate (THF) from di-hydrofolate (DHF). THF is essential for the synthesis of purines and pyrimidines, which are necessary for DNA and RNA synthesis. By inhibiting di-hydrofolate reductase, methotrexate disrupts the production of these nucleic acids, leading to cytotoxic effects and inhibition of cell proliferation, particularly in rapidly dividing cells like those found in leukemia. This mechanism differs from options A, C, D, and E, which describe actions not associated with methotrexate’s mode of action.

26. Topic: Adrenal Insufficiency

Correct Answer: D. Death due to chronic adrenal insufficiency can occur within hours of surgery

Explanation: Adrenal insufficiency, particularly in its chronic form known as Addison’s disease, can lead to acute adrenal crisis if not managed appropriately. During surgery or other stressful events, the body’s demand for cortisol increases, which can overwhelm the adrenal glands if they are unable to produce adequate amounts due to insufficiency. This can result in a life-threatening condition where death can occur rapidly, sometimes within hours if not treated promptly with corticosteroid replacement therapy. Option D correctly identifies the critical nature of acute adrenal crisis in patients with chronic adrenal insufficiency. Options A, B, C, and E are incorrect because Option (A), While corticosteroid replacement is effective in managing adrenal insufficiency, it does not imply that treatment is always easy or straightforward. Option (B) Adrenal insufficiency is more commonly due to autoimmune causes or other primary adrenal gland disorders rather than metastatic cancers. Option (C) Chronic adrenal insufficiency is associated with hypokalemia rather than hyperkalemia. Option (E) While tuberculosis historically was a common cause, today autoimmune disorders are the predominant etiology of adrenal insufficiency in developed countries.

27. Topic: Treatment of Atrial Fibrillation in Heart Failure

Correct Answer: C. Digoxin

Explanation: In a patient with heart failure and atrial fibrillation, controlling the heart rate is crucial to manage symptoms and improve cardiac function. Digoxin is often used in such cases due to its ability to slow the ventricular response rate in atrial fibrillation while also providing positive inotropic effects that can benefit patients with heart failure. It works by inhibiting the sodium-potassium ATPase pump, leading to increased intracellular calcium levels and improved cardiac contractility. This helps to stabilize the heart rate and improve cardiac output in patients with heart failure and atrial fibrillation. Options A, B, D, and E are incorrect because Option (A) Lidocaine (lignocaine) is primarily used for ventricular arrhythmias and not for atrial fibrillation. Option (B) Nifedipine is a calcium channel blocker used for hypertension and angina, not typically for controlling heart rate in atrial fibrillation. Option (D) Mononitrate and isosorbide are nitrate medications used for angina and heart failure symptoms related to ischemic heart disease, not for atrial fibrillation. Option (E) Furosemide is a loop diuretic used for managing fluid overload in heart failure but does not directly affect heart rate control in atrial fibrillation. Therefore, option C (Digoxin) is the correct choice for managing atrial fibrillation in a patient with heart failure.

28. Topic: Syncope in a 76-Year-Old Man

Correct Answer: A. Vaso-vagal syncope

Explanation: Vaso-vagal syncope is a common cause of syncope, especially in situations like standing in a long line where there may be triggers such as emotional stress, pain, or prolonged standing. It typically presents with a sudden loss of consciousness followed by spontaneous recovery, usually within seconds to minutes. Importantly, there is often no loss of bladder or bowel control in vaso-vagal syncope, which helps distinguish it from other causes. Options B, C, D, and E are incorrect because Option (B) Stokes-Adams syndrome (now known as complete heart block) typically presents with syncope due to transient complete atrioventricular (AV) block, leading to a sudden loss of consciousness, often with slow recovery. Option (C) Transient ischemic attack (TIA) presents with neurological deficits that resolve within 24 hours and does not typically cause isolated syncope without other focal neurological symptoms. Option (D) Carotid sinus syncope presents with syncope triggered by pressure on the carotid sinus, such as during shaving or wearing tight collars. Option (E) Hypoglycemia can cause syncope, but in this case, there is no mention of associated symptoms like diaphoresis, palpitations, or confusion, which are typical with hypoglycemic episodes. Therefore, based on the history provided, vaso-vagal syncope (option A) is the most likely cause of the syncope episode described in the 76-year-old man

29. Topic: Neck Masses

Correct Answer: A. Branchial cyst

Explanation: A mass under the anterior border of the sternomastoid muscle in a young patient is most likely a branchial cyst. Branchial cysts are congenital cysts that arise from remnants of the branchial arches during embryonic development. They commonly present as painless, mobile masses in the lateral neck, typically under the anterior border of the sternomastoid muscle. They do not involve the thyroid gland (C), submandibular gland (D), or arise from the thyroglossal duct (E). Cervical adenopathy (B) refers to enlarged lymph nodes in the neck, which would have a different clinical presentation and location compared to a branchial cyst.

30. Topic: Regenerative Anemia

Correct Answer: C. Greater than 120,000/mm3

Explanation: Anemia is classified as regenerative when the reticulocyte count exceeds 120,000/mm3. Reticulocytes are immature red blood cells released by the bone marrow in response to anaemia, indicating active erythropoiesis. Higher counts (A, B, E) suggest significant regenerative capacity but are not the threshold typically used to define regenerative anaemia. Lower counts (D) indicate insufficient bone marrow response, not regenerative anaemia.

31. Topic: Pregnancy-Induced Hypertension (Pre-eclampsia)

Correct Answer: C. Should be controlled by medication

Explanation: Pregnancy-induced hypertension, particularly pre-eclampsia, requires careful monitoring and management, often with medication to prevent complications for both the mother and fetus. It typically does not improve in the third trimester (A), and can lead to lower birth weights rather than higher (B). It does not spare the placenta (D); in fact, it can lead to placental insufficiency. While it does not directly cause maternal renal infection (E), it can lead to renal complications due to hypertension and proteinuria.

32. Topic: Renal Vein Thrombosis

Correct Answer: C. Massive proteinuria

Explanation: Renal vein thrombosis (RVT) can lead to significant disruption of renal function, often presenting with massive proteinuria due to impaired filtration and increased permeability of the glomerular membrane. Leukocyte cylinders (A) and heme granular cylinders (B) are more indicative of renal tubular injury or glomerulonephritis rather than RVT. Urinary findings of a purple color with positive heme testing (D) suggest hematuria, possibly due to trauma or other causes. Specific gravity >1.020 (E) indicates concentrated urine, which can occur in various renal conditions but is not specific to RVT.

33. Topic: Peripheral Neuropathy

Correct Answer: D. Diabetes mellitus

Explanation: Diabetes mellitus is a common cause of peripheral neuropathy, presenting with symmetrical or asymmetrical sensory disturbances, motor weakness, and loss of reflexes in the distal extremities. This neuropathy is often related to chronic hyperglycemia damaging nerve fibers over time. While other conditions like heart disease (A), dermatomyositis (B), hypothyroidism (C), and adrenal insufficiency (E) can contribute to neuropathy, diabetes mellitus is particularly notorious for causing peripheral nerve damage due to its metabolic effects on nerve function and circulation.

34. Topic: Glucagon Function

Correct Answer: A. Promotes glycogenolysis and gluconeogenesis

Explanation: Glucagon plays a crucial role in maintaining blood glucose levels during periods of fasting or hypoglycemia. It promotes glycogenolysis (breakdown of glycogen to glucose) and gluconeogenesis (synthesis of glucose from non-carbohydrate sources), thereby increasing blood glucose levels. This hormonal action helps to counteract hypoglycemia by stimulating the release of glucose from storage sites in the liver and promoting new glucose production. Option B (a carbohydrate in its structure) is incorrect because glucagon is a peptide hormone, not a carbohydrate. Option C (effective in reducing blood sugar levels) is incorrect as glucagon raises blood sugar levels. Option D (antigenically similar to insulin) is incorrect because glucagon and insulin have different structures and functions. Option E (effective in decreasing cyclic adenosine monophosphate in target cells) is incorrect because glucagon increases cyclic adenosine monophosphate levels to initiate its physiological effects.

35. Topic: Diagnosis of a Young Man with Joint Pain, Uveitis, and Ulcers

Correct Answer: A. Behçet’s disease

Explanation: Behçet’s disease is characterized by recurrent episodes of oral and genital ulcers, along with inflammatory manifestations such as uveitis (eye inflammation) and arthritis (joint inflammation). The presence of these symptoms in a young patient, particularly the combination of oral ulcers, genital ulcers, and uveitis, strongly suggests Behçet’s disease. Option B (Reiter’s syndrome) typically presents with arthritis, urethritis, and conjunctivitis but is now classified under reactive arthritis. Option C (Sjögren’s syndrome) primarily involves dry eyes and dry mouth due to autoimmune destruction of the exocrine glands. Option D (Polymyalgia rheumatica) is characterized by proximal muscle pain and stiffness, predominantly affecting older adults. Option E (Relapsing polychondritis) involves recurrent inflammation and destruction of cartilage in various parts of the body.

36. Topic: Clinical Presentation of Endocrine Disorder

Correct Answer: A. Cushing’s syndrome

Explanation: Cushing’s syndrome is characterized by a combination of symptoms including weight gain, hirsutism (excessive hair growth), hypertension, and peripheral edema. These signs are due to excess cortisol production, which also commonly causes features like a rounded face (moon face) and buffalo hump. Option B (Pheochromocytoma) typically presents with episodes of severe hypertension, headaches, palpitations, and sweating, often triggered by stress. Option C (Hyperparathyroidism) usually presents with hypercalcemia, nephrolithiasis, and bone pain, not the symptoms described. Option D (Conn syndrome), or primary hyperaldosteronism, is characterized by hypertension and hypokalemia, not the full symptom complex of Cushing’s. Option E (Renal artery stenosis) can lead to secondary hypertension but is not associated with hirsutism or edema due to excess cortisol.

37. Topic: Management of Refractory Edema

Correct Answer: B. Hydrochlorothiazide

Explanation: In managing refractory edema, especially in patients already on high doses of loop diuretics like furosemide, adding a thiazide diuretic such as hydrochlorothiazide can be beneficial. Thiazide diuretics act on different parts of the kidney than loop diuretics and can enhance diuresis when loop diuretics alone are insufficient. Options like adenoside (A) are not diuretics but may refer to adenosine or adenosine receptor agonists used for other purposes. Furosemide (C) is already being used and adding more orally may not provide additional benefit. Spironolactone (D) is a potassium-sparing diuretic often used in combination with loop diuretics but is not the first choice for additional therapy in refractory cases. Nifedipine (E) is a calcium channel blocker and is not typically used for edema management.

38. Topic: Differential Diagnosis of Symptoms in a 49-year-old Woman

Correct Answer: E. Hypercalcemia

Explanation: Hypercalcemia (option E) can present with symptoms such as polyuria (increased urine output), hematuria (blood in urine), abdominal pain, bone pain, and can also elevate blood pressure. These symptoms collectively suggest an underlying metabolic imbalance related to elevated calcium levels. Option A (Gallbladder stones) typically presents with right upper quadrant pain, not usually associated with the other symptoms mentioned. Option B (Polyarteritis nodosa) is a systemic vasculitis that does not typically cause hypercalcemia or bone pain. Option C (Carcinoma of the pancreas) and Option D (Chronic pancreatitis) may cause abdominal pain but are less likely to present with hematuria, polyuria, or hypertension as prominent features. Hypercalcemia is often associated with malignancy, hyperparathyroidism, or vitamin D toxicity, warranting further investigation to identify the underlying cause.

39. Topic: Diagnosis of a 55-year-old Male Alcoholic with Upper Abdominal Pain

Correct Answer: B. Chronic pancreatitis

Explanation: Chronic pancreatitis (option B) is characterized by severe upper abdominal pain that radiates to the back, loose stools (steatorrhea due to malabsorption), and weight loss. Calcifications can be seen on abdominal imaging, which is a hallmark of chronic pancreatic changes due to repeated inflammation and fibrosis. Option A (Acute pancreatitis) typically presents with sudden onset severe abdominal pain, nausea, vomiting, and elevated pancreatic enzymes. Option C (Gastroesophageal reflux disease) and Option D (Esophagitis) are primarily associated with symptoms related to the upper gastrointestinal tract and are less likely to cause calcifications on X-ray. Option E (Pancreatic carcinoma) can present similarly with pain and weight loss but usually does not have calcifications on imaging unless there is associated chronic pancreatitis. Chronic pancreatitis in an alcoholic patient often requires management of symptoms and addressing nutritional deficiencies due to malabsorption, along with lifestyle modifications to prevent further pancreatic damage.

40. Topic: Complications of Peptic Ulcer

Correct Answer: C. Portal hypertension syndrome

Explanation: Peptic ulcers can lead to several complications, including hemorrhage (A), perforation (B), malignant transformation (D), and duodenal or pyloric stenosis (E). However, portal hypertension syndrome (C) is not typically associated with peptic ulcer disease. Portal hypertension usually results from liver cirrhosis or other liver diseases causing increased resistance to portal blood flow. Peptic ulcers primarily affect the gastrointestinal tract and do not directly lead to portal hypertension.