1. Topic: Causes of Acute Mitral Regurgitation

Correct Answer: B. Hypertrophic and obstructive cardiomyopathy

Explanation: Acute mitral regurgitation is commonly caused by conditions that suddenly damage the mitral valve or its supporting structures, such as chordae tendineae rupture (rope breakage), trauma, bacterial endocarditis, or myocardial infarction. Hypertrophic and obstructive cardiomyopathy, while it can lead to chronic mitral regurgitation due to obstruction and abnormal valve motion, is not a typical cause of acute mitral regurgitation.

2. Topic: Complications of Osler’s Endocarditis on Mitral Prolapse

Correct Answer: A. Multiple pulmonary septic embolisms

Explanation: Osler’s endocarditis, particularly when associated with mitral valve prolapse, can lead to complications such as right hemiplegia with aphasia due to embolic strokes, microscopic hematuria from emboli to the kidneys, lumbar spondylitis, and acute limb ischemia from arterial emboli. However, multiple pulmonary septic embolisms are more commonly associated with right-sided endocarditis rather than mitral prolapse, making option A the correct exception.

3. Topic: Signs of Cardiac Tamponade

Correct Answer: C. Signs of pulmonary edema

Explanation: Cardiac tamponade is characterized by signs such as jugular venous distension (turgor of the jugular veins), a slightly mobile cardiac silhouette on fluoroscopy, a paradoxical pulse (pulse paradox), and a decrease in systolic blood pressure during inspiration. These are all indicative of the increased pressure on the heart and restricted cardiac filling. Signs of pulmonary edema, however, are not typically associated with cardiac tamponade and are more related to left heart failure, making option C the correct exception.

4. Topic: Medications in Congestive Heart Failure

Correct Answer: C. Beta blockers

Explanation: While beta blockers are generally beneficial in managing chronic heart failure, they are strictly contraindicated in acute decompensated heart failure because they can reduce cardiac output and worsen symptoms. Other medications listed, such as digitalics, nitro derivatives, diuretics, and prazosin, are commonly used in managing congestive heart failure, especially during acute episodes.

5. Topic: Malignant Arterial Hypertension

Correct Answer: A. Stage 2 fundus

Explanation: Malignant arterial hypertension is a severe form of hypertension characterized by very high diastolic blood pressure (often above 130 mmHg), signs of left ventricular failure, significant neurosensory disturbances, and renal insufficiency. However, it is associated with Stage 4 hypertensive retinopathy (not Stage 2), which includes papilledema, hemorrhages, and exudates.

6. Topic: Risk Factors for Digoxin Toxicity

Correct Answer: C. Hyperthyroidism

Explanation: Digoxin toxicity is more likely in conditions such as kidney failure, very advanced heart failure, hyperkalemia, and hypercalcemia because these conditions affect digoxin’s metabolism and its effects on the heart. However, hyperthyroidism typically increases the metabolism of digoxin, potentially reducing its effect, rather than increasing the risk of toxicity.

7. Topic: Paraneoplastic Syndromes in Bronchial Cancer

Correct Answer: E. Enophthalmos

Explanation: Paraneoplastic syndromes commonly associated with bronchial cancer include Schwartz-Bartter syndrome (SIADH), digital clubbing, Cushing’s syndrome, and hypercalcemia. These syndromes result from the ectopic production of hormones or cytokines by the tumor. Enophthalmos, which refers to the posterior displacement of the eye within the orbit, is not typically associated with bronchial cancer and is not a paraneoplastic syndrome.

8. Topic: Diagnosis of Chronic Bronchitis

Correct Answer: A. Through interrogation

Explanation: Chronic bronchitis is primarily diagnosed based on clinical history, which involves questioning the patient (interrogation). The diagnosis is typically established when a patient reports a productive cough lasting for at least three months in two consecutive years. Although additional tests like respiratory functional exploration or imaging may help assess the extent of lung damage, the initial diagnosis hinges on the patient’s history.

9. Topic: Complications of Bronchial Dilations

Correct Answer: D. Cystic fibrosis

Explanation: Cystic fibrosis is a genetic disorder that leads to bronchiectasis (bronchial dilations) but is not a complication of bronchial dilations. The other options, such as lung abscess, hemoptysis, purulent pleurisy, and chronic cor pulmonale, are recognized complications that can arise from bronchial dilations.

10. Topic: Pre-capillary Pulmonary Arterial Hypertension

Correct Answer: A. Vasoconstriction due to hypoxia

Explanation: Pre-capillary pulmonary arterial hypertension in the context of chronic respiratory failure is primarily associated with vasoconstriction due to hypoxia. Hypoxia causes the pulmonary arteries to constrict, leading to increased pulmonary arterial pressure. The other options do not directly explain the mechanism behind pre-capillary pulmonary hypertension in this context.

11. Topic: Diffuse Interstitial Pulmonary Fibrosis

Correct Answer: C. Left cancer

Explanation: Diffuse interstitial pulmonary fibrosis is characterized by clinical signs such as clubbing, dyspnea, weight loss, and crackles. However, “left cancer” is not associated with this condition. The clinical manifestations of diffuse interstitial pulmonary fibrosis are related to lung fibrosis and its effects, rather than to malignancies.

12. Topic: Hemoptysis in a Former Tuberculosis Patient

Correct Answer: E. Bronchial candidiasis

Explanation: In a former tuberculosis patient experiencing hemoptysis, the following conditions are relevant: bronchial cancer, recurrence of pulmonary tuberculosis, parascaricidal dilatation of the bronchi, and aspergillosis as a sequel of tuberculosis. Bronchial candidiasis is not a common condition associated with hemoptysis in this context.

13. Topic: Gastroesophageal Reflux

Correct Answer: A. It is secondary to retrograde esophageal contractions

Explanation: Gastroesophageal reflux disease (GERD) is primarily related to the incompetence of the lower esophageal sphincter, not retrograde esophageal contractions. It can occur with or without hiatal hernia, is often marked by heartburn, may present as pseudoanginal pain, and is associated with lower esophageal sphincter incontinence.

14. Topic: Pyloric Stenosis in Young Adults

Correct Answer: C. Hypertrophy of the pylorus

Explanation: In young adults, the most common cause of a clinical syndrome resembling pyloric stenosis is hypertrophy of the pylorus. Gastric cancer, duodenal ulcer, and gastric ulcers are less commonly associated with this syndrome in this age group.

15. Topic: Assessment of Upper Gastrointestinal Hemorrhage

Correct Answer: C. The number of units of blood and fluids infused for hemodynamic maintenance

Explanation: The most precise criterion for assessing the importance of an upper gastrointestinal hemorrhage is the number of units of blood and fluids infused for hemodynamic maintenance. This measure provides a direct indication of the volume of blood lost and the extent of resuscitation required. Other options such as hematocrit, the volume of blood aspirated, drop in blood pressure, and initial central venous pressure are important but less directly related to quantifying the blood loss and necessary intervention.

16. Topic: Epigastric Pain Diagnosis

Correct Answer: A. Ulcerative pain

Explanation: Epigastric pain that is rhythmic, cramp-like, and occurs during the day without late postprandial irradiation is most suggestive of ulcerative pain. This type of pain is often associated with peptic ulcers, where the discomfort tends to follow a specific pattern and can be relieved by food or antacids. Other conditions like gastritis, gastroesophageal reflux, acute hemorrhagic pancreatitis, and hepatic colic have different pain characteristics or associated symptoms.

17. Topic: Diarrhea Due to Malabsorption

Correct Answer: A. Significant weight loss

Explanation: Diarrhea due to malabsorption is often associated with significant weight loss because the body is unable to absorb essential nutrients effectively, leading to malnutrition. While steatorrhea (fatty stools) can also indicate malabsorption, significant weight loss is a more direct and prominent sign of the condition. Mucous and bloody diarrhea are more typical of inflammatory or infectious causes, and stool weight at 150g/d is generally not indicative of malabsorption, as it is more relevant to osmotic or secretory types of diarrhea.

18. Topic: Isolated Functional Colonopathy

Correct Answer: B. Weight loss

Explanation: Isolated functional colonopathy, such as irritable bowel syndrome (IBS), typically presents with symptoms like abdominal pain, constipation, diarrhea, and postprandial bloating. Weight loss is not a common feature of functional colonopathy and often suggests other underlying issues or conditions.

19. Topic: Acute Pancreatitis

Correct Answer: B. Cholelithiasis

Explanation: Cholelithiasis (gallstones) is one of the most common causes of acute pancreatitis. While alcohol is also a significant cause, gallstones are more frequently associated with acute episodes. Other factors such as obesity, clofibrate use, and hyperparathyroidism are less common causes.

20. Topic: Nephrotic Syndrome

Correct Answer: C. An increase in serum gammaglobulins

Explanation: Nephrotic syndrome typically features hypoalbuminemia, hypercholesterolemia, a risk of thrombosis, and often a low urinary sodium concentration. However, an increase in serum gammaglobulins is not a typical feature of nephrotic syndrome; instead, it is often characterized by hypoglobulinemia due to protein loss in the urine.

21. Topic: Nephritic Syndrome

Correct Answer: B. Hypo protidemia less than 60g per liter

Explanation: Nephritic syndrome is characterized by hypertension, hematuria with cylindruria, edema, and persistent proteinuria. However, hypo protidemia (specifically less than 60g/L) is more commonly associated with nephrotic syndrome rather than nephritic syndrome.

22. Topic: Uric Acid Stone Dissolution

Correct Answer: B. An alkaline urinary pH

Explanation: Dissolving a uric acid stone requires an alkaline urinary pH. Uric acid stones form in acidic urine, so alkalinizing the urine helps to dissolve these stones by increasing their solubility.

23. Topic: Acute Prostatitis

Correct Answer: D. A hard and stony prostatitis

Explanation: Acute prostatitis typically presents with painful prostatitis, acute urinary retention, urinary burns, and a high fever. A “hard and stony” prostate is more characteristic of chronic prostatitis or prostate cancer, not acute prostatitis.

24. Topic: Pyuria (Pus in the Urine)

Correct Answer: C. Glomerulonephritis

Explanation: Pus in the urine (pyuria) is commonly associated with infections or conditions like renal lithiasis, vesico-renal reflux, a retained bladder, or cystitis. Glomerulonephritis, however, is primarily an inflammation of the glomeruli and typically presents with hematuria (blood in the urine) rather than pyuria.

25. Topic: Contraindications for Biguanides in Diabetes Mellitus

Correct Answer: B. Kidney failure

Explanation: Biguanides, such as metformin, are contraindicated in patients with kidney failure due to the increased risk of lactic acidosis, a serious and potentially life-threatening condition. Obesity, insulin-dependent diabetes, angina, and peripheral neuropathy do not directly contraindicate the use of biguanides.

26. Topic: Complications of Type 4 Hypertriglyceridemia

Correct Answer: B. Acute pancreatitis

Explanation: Type 4 hypertriglyceridemia, characterized by elevated triglyceride levels, can lead to acute pancreatitis, a serious and potentially life-threatening condition. While atheroma, hypertension, obesity, and gout are associated with lipid disorders, they are not specific complications of Type 4 hypertriglyceridemia like acute pancreatitis.

27. Topic: Clinical Signs of Acromegaly

Correct Answer: D. Prognathism of the lower jaw

Explanation: The most suggestive clinical sign of acromegaly is prognathism of the lower jaw, which refers to the abnormal protrusion of the lower jaw. This feature is a hallmark of acromegaly due to excessive growth hormone, leading to characteristic facial changes. Swelling of the fingers, weight gain, hair loss, and exophthalmos may be present but are not as specific to acromegaly as prognathism.

28. Topic: Biochemical Parameters Indicative of Conn’s Adenoma

Correct Answer: B. Hypokalemia

Explanation: Hypokalemia is a key biochemical parameter that suggests the presence of a Conn’s adenoma (primary hyperaldosteronism) in a hypertensive patient. Conn’s adenoma leads to excessive secretion of aldosterone, causing the kidneys to retain sodium (leading to hypernatremia) and excrete potassium, resulting in hypokalemia. The other options are less specific or unrelated to Conn’s adenoma.

29. Topic: Erysipelas

Correct Answer: E. It has a gradual, non-painful onset

Explanation: Erysipelas typically presents with a sudden onset of symptoms, including pain, redness, and swelling in the affected area. The condition is often painful, and the rapid progression of symptoms contradicts the idea of a gradual, non-painful onset, making option E the incorrect statement among the provided options.

30. Topic: Candida Infections

Correct Answer: C. Ringworm of the scalp

Explanation: Candida species are responsible for infections such as vaginitis, thrush, black hairy tongue, and intertrigo. However, ringworm of the scalp (tinea capitis) is caused by dermatophytes like Trichophyton or Microsporum, not by Candida. Thus, option C is the correct answer.

31. Topic: Paget’s Disease

Correct Answer: E. Osteonecrosis

Explanation: Paget’s disease is a bone disorder that can lead to complications such as deafness, heart failure, headaches, and hip disease due to abnormal bone growth and deformation. However, osteonecrosis (bone death due to poor blood supply) is not a typical complication of Paget’s disease. Thus, option E is the correct answer.

32. Topic: Acute Gout in Chronic Renal Failure

Correct Answer: C. Colchicine

Explanation: For an acute attack of gout, especially in patients with chronic renal failure, colchicine is often used as it effectively reduces inflammation during an acute attack. Aspirin and phenylbutazone are not recommended due to their potential to worsen kidney function or interact adversely with renal conditions. Benzobromarone and allopurinol are used for chronic management and prevention of gout but are not suitable for treating acute attacks. Thus, option C is the most appropriate choice.

33. Topic: Diagnosis of Syphilitic Chancre

Correct Answer: E. Nelson’s test

Explanation: For diagnosing a syphilitic chancre, useful tests include ultramicroscopic examination (A) to visualize the spirochetes, the VDRL (B) for initial screening, TPHA (C) for confirmation of syphilis, and immunofluorescence (D) for detecting Treponema pallidum. Nelson’s test (E), which is not typically used for diagnosing syphilis, is therefore the least relevant in this context.

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34. Topic: Persistent Salmonella Carrier After Typhoid Fever

Correct Answer: B. Cholelithiasis

Explanation: Salmonella Typh 1 can persist in the gallbladder of patients, leading to chronic carriage. Therefore, cholelithiasis (B) is a common finding as the bacteria may reside in the gallbladder and contribute to the formation of gallstones. Splenic abscess (A), stomach ulcer (C), Meckel’s diverticulum (D), and appendicular abscess (E) are not typically associated with persistent Salmonella carriage after typhoid fever.

35. Topic: Tetanus Prevention in a Vaccinated Individual

Correct Answer: D. A toxoid booster

Explanation: In individuals who are adequately vaccinated but who have not received a tetanus booster in the past 10 years, a single booster of the tetanus toxoid (D) is recommended. The initial vaccination at age 19 and the booster at 20 should provide long-term immunity, but routine boosters every 10 years are necessary to maintain protection. The human tetanus immunoglobulin (B, E) is only used in unvaccinated individuals or those with unknown vaccination status presenting with high-risk wounds. Two toxoid injections (C) are not required for someone with a recent vaccination history.

36. Topic: Antibiotic for Gas Gangrene

Correct Answer: C. Penicillin G

Explanation: Gas gangrene, typically caused by Clostridium species, is effectively treated with Penicillin G (C), which targets these anaerobic bacteria. Gentamycin (A) and Cotrimoxazole (D) are not primarily effective against Clostridia. Colistin (B) is used for Gram-negative infections, and Nalidixic acid (E) is used for urinary tract infections, making them unsuitable for gas gangrene.

37. Topic: Diagnosis of Cerebral Toxoplasmosis in HIV-Infected Patients

Correct Answer: D. Meningeal stiffness

Explanation:

Cerebral toxoplasmosis in HIV-infected patients is characterized by symptoms such as convulsive seizures (A), fever (B), hemiparesis (C), and altered consciousness (E). Meningeal stiffness (D), typically associated with meningitis, is not a common feature of cerebral toxoplasmosis. The presentation of this condition usually does not include meningeal signs but rather neurological deficits and systemic symptoms.

38. Topic: Blood Findings in Myeloma (Kahler’s Disease)

Correct Answer: E. None of the above

Explanation:

In the typical form of myeloma, or Kahler’s disease, blood findings typically include abnormalities such as monoclonal gammopathy, increased levels of paraproteins (M proteins), and anemia, but not the specific options listed. Plasma cells may be found in the bone marrow (A), but they are not typically seen in blood in significant numbers. Eosinophilia (B), hyperlymphocytosis (C), and neutrophilic polynucleosis (D) are not characteristic of myeloma. Therefore, the answer is that none of these findings are typically observed in the blood of a patient with myeloma.

39. Topic: Hemopathies and Splenomegaly

Correct Answer: B. Chronic myeloid leukemia

Explanation: Chronic myeloid leukemia (B) is commonly associated with splenomegaly due to the accumulation of abnormal leukocytes in the spleen. Biermer’s disease (A), also known as pernicious anemia, does not typically cause splenomegaly. Kahler’s disease (C) and hemophilia (D) are not characteristically associated with splenomegaly, and latrogenic agranulocytosis (E) involves a decreased white blood cell count but not necessarily splenomegaly.

40. Topic: Thrombocytopenia in Hepatic Cirrhosis

Correct Answer: D. Hypersplenism

Explanation: In hepatic cirrhosis with signs of portal hypertension, thrombocytopenia (low platelet count) is commonly due to hypersplenism (D), where the spleen is enlarged and sequesters platelets, leading to a reduced number in circulation. Bone marrow failure (A) is less likely given the normal D-dimer levels and absence of signs of bleeding. Disseminated intravascular coagulation (DIC) (B) typically shows elevated D-dimer levels, not low. Immunological destruction (C) and consumption at the level of esophageal varices (E) are less common causes in this context.