1. Topic: Amphotericin B Treatment

Correct Answer: E. Dermatophytosis

Explanation: Amphotericin B is a broad-spectrum antifungal agent effective against severe fungal infections such as Cryptococcosis (A), Histoplasmosis (B), Coccidioidomycosis (C), and Aspergillosis (D). These infections often require aggressive treatment due to their potential severity and systemic involvement. Dermatophytosis (E), on the other hand, is typically a superficial fungal infection of the skin, hair, or nails and is usually treated with topical antifungal agents or oral antifungals like terbinafine or itraconazole, not Amphotericin B. Hence, Dermatophytosis (E) is the exception where Amphotericin B is not the treatment of choice.

2. Topic: Enzyme Diagnosis in Acute Myocardial Infarction

Correct Answer: C. CPK (creatine phosphokinase)

Explanation: In the context of acute myocardial infarction (MI), timely diagnosis is crucial. Among the listed enzymes, creatine phosphokinase (CPK) is particularly important because its levels rise within 4-6 hours after the onset of myocardial injury, peaking around 18-24 hours, and returning to normal within 2-3 days. While other enzymes such as aldolase (A), ALAT (B), ASAT (D), and LDH (E) can be elevated in various conditions and offer some diagnostic value, they are less specific or have different kinetics. CPK, specifically the MB isoenzyme (CPK-MB), is most indicative of myocardial injury, making it the most helpful enzyme in diagnosing an acute MI in this patient.

3. Topic: Drug-induced Lupus Erythematosus

Correct Answer: C. Apresoline

Explanation: Apresoline (hydralazine) is known to cause a syndrome similar to systemic lupus erythematosus (SLE), a condition termed drug-induced lupus erythematosus (DILE). This condition is characterized by symptoms such as arthralgia, myalgia, fever, and serositis, which mimic those of idiopathic SLE. While prednisone (A) and ACTH (B) are used in the treatment of autoimmune conditions like SLE, and erythromycin (D) and vancomycin (E) are antibiotics not associated with causing lupus-like syndromes, hydralazine (Apresoline) has a well-documented association with inducing lupus-like symptoms in susceptible individuals.

4. Topic: Pruritus in Dermatological Conditions

Correct Answer: E. Psoriasis

Explanation: While psoriasis can cause itching (pruritus), it is not as commonly or intensely associated with pruritus compared to other conditions listed. Atopic dermatitis (A), scabies (B), flat lichen (C), and dermatitis herpetiformis (D) are all conditions that are characteristically associated with significant pruritus. In psoriasis, the primary features are typically well-demarcated, red, scaly plaques rather than severe itching, distinguishing it from the other conditions where pruritus is a dominant symptom.

5. Topic: Type B (Centrolobular) Emphysema

Correct Answer: E. Hepatomegaly

Explanation: Type B or centrilobular emphysema is characterized by its onset typically around age 40 (A), right heart failure (B) due to chronic hypoxia and pulmonary hypertension, cyanosis (C) caused by poor oxygenation, and plethora (D), which refers to a ruddy complexion due to increased red blood cell production as a response to chronic hypoxia. Hepatomegaly (E), or enlarged liver, is not a direct feature of centrilobular emphysema itself, making it the incorrect statement. The other features are more directly linked to the respiratory and cardiovascular complications of the disease.

6. Topic: Acute Myocardial Infarction (AMI)

Correct Answer: D. It usually responds to nitroglycerin

Explanation: Acute myocardial infarction (AMI) is characterized by pain that can radiate to the jaws (A), has an excruciating intensity (B), and usually responds to morphine (C) for pain relief. However, the pain from AMI often does not respond well to nitroglycerin (D), which is more effective in relieving angina rather than the severe pain of an actual myocardial infarction. This makes statement D the correct answer as the one that is not a characteristic of pain from AMI.

7. Topic: Osteogenic Carcinomas in Adults

Correct Answer: B. Exposure to radiation

Explanation: In adults, osteogenic carcinomas (osteosarcomas) are frequently associated with exposure to radiation (B). This is a significant risk factor, especially in individuals who have undergone radiation therapy for other malignancies. While conditions like neurofibromatosis (A), Paget’s disease (C), fibrous dysplasia of the bone (D), and repeated trauma (E) may have associations with different types of bone abnormalities or other cancers, they are not as commonly linked to the development of osteogenic carcinomas as radiation exposure.

8. Topic: Primary Hyperparathyroidism

Correct Answer: B. Hyperpigmentation

Explanation: Primary hyperparathyroidism frequently leads to symptoms related to hypercalcemia, such as pancreatitis (A) and peptic ulcer (D). However, hyperpigmentation (B) is not typically associated with primary hyperparathyroidism. While personal disorders (C) may arise due to various reasons, they are not directly linked to primary hyperparathyroidism. Hence, hyperpigmentation (B) is the condition incorrectly associated with primary hyperparathyroidism.

9. Topic: Unilateral Pupil Dilation in Trauma

Correct Answer: A. A lesion of the third nerve in the midbrain

Explanation: Unilateral pupil dilation (anisocoria) in the context of trauma typically suggests involvement of the oculomotor nerve (third cranial nerve). 

10. Topic: Symptoms Associated with Subacute Bacterial Endocarditis

Correct Answer: B. The heart murmur

Explanation: Subacute bacterial endocarditis (SBE) typically presents with insidious onset and a range of nonspecific symptoms. 

11. Topic: Rheumatic Fever and ECG Changes

Correct Answer: E. The lengthening of the P-R interval

Explanation: Rheumatic fever commonly affects the heart, particularly the conduction system. The most frequent ECG change observed is the lengthening of the P-R interval (E), indicating first-degree heart block. This is due to inflammation of the heart tissues, particularly the atrioventricular (AV) node. Other changes, such as shortening of the P-R interval (A), sharp T-wave (B), shortening of the Q-T interval (C), or inverted P-wave (D), are not typically associated with rheumatic fever. Thus, lengthening of the P-R interval is the hallmark ECG feature in this condition.

12. Topic: Recurrent Attacks of Confusion and Sweating

Correct Answer: D. Pheochromocytoma

Explanation: Pheochromocytoma is a tumor of the adrenal gland that can cause excessive production of catecholamines, leading to symptoms like recurrent attacks of confusion and sweating, which are common during catecholamine surges. These attacks can occur at any time, including before breakfast. The other conditions listed (A. Duodenal ulcer, B. Epilepsy, C. Islet cell tumor, E. Hyperthyroidism) do not typically present with this specific combination of symptoms in the described pattern. Thus, pheochromocytoma is the most likely diagnosis.

13. Topic: Acute Gastrointestinal Illness After Camping

Correct Answer: B. Staphylococcal food poisoning

Explanation: Staphylococcal food poisoning is characterized by a rapid onset of symptoms, typically within 4-6 hours after consumption of contaminated food. The symptoms include diarrhea, vomiting, and abdominal cramps, as experienced by the students. The other conditions (A. Salmonella food poisoning, C. Shigellosis, D. Botulism) typically have longer incubation periods or different symptom profiles, making Staphylococcal food poisoning the most likely diagnosis in this scenario.

14. Topic: Risk Factors for Colorectal Cancer

Correct Answer: D. Hemangiomas of the hand

Explanation: Risk factors for colorectal cancer include conditions like familial polyposis (B), a genetic condition predisposing to multiple polyps, hemorrhagic rectocolitis (C), a form of inflammatory bowel disease, and a history of certain cancers like breast (A) and ovarian cancer (E). Hemangiomas of the hand (D), being benign vascular tumors, do not increase the risk for colorectal cancer, making this the correct answer.

15. Topic: Prophylaxis for Transient Ischemic Attack

Correct Answer: C. Aspirin

Explanation: Aspirin (C) is widely used as a prophylactic treatment for transient ischemic attacks (TIAs) due to its antiplatelet effects, which help prevent clot formation. Heparin (A) and warfarin (E) are anticoagulants used in different contexts, while Coumadin (B) is another name for warfarin. Vitamin K (D) is used to reverse the effects of anticoagulants, not for prophylaxis. Thus, aspirin is the preferred choice for preventing recurrent TIAs.

16. Topic: Treatment for Urinary Tract Infection (UTI)

Correct Answer: E. Trimethoprim-sulfamethoxazole

Explanation: Trimethoprim-sulfamethoxazole (E) is a first-line treatment for uncomplicated urinary tract infections (UTIs), particularly effective against gram-negative rods like E. coli, commonly implicated in UTIs. Ceftriaxone (A) is typically reserved for more severe infections or hospital settings. Fluconazole (B) treats fungal infections, not bacterial UTIs. Gentamycin (C) is used for severe infections and is not the first choice for uncomplicated UTIs. Metronidazole (D) treats anaerobic bacterial and protozoal infections. Therefore, trimethoprim-sulfamethoxazole is the most appropriate treatment.

17. Topic: Drug-Induced Hemolytic Anemia

Correct Answer: A. Cephalexin

Explanation: Cephalexin (A), a cephalosporin antibiotic, can cause hemolytic anemia, characterized by low hematocrit and the presence of blood in urine, as side effects. The patient’s symptoms of chills and fever can accompany hemolysis. Gentamycin (B), Linezolid (C), Metronidazole (D), and Mupirocin (E) do not commonly cause hemolytic anemia. Thus, cephalexin is the most likely cause of these signs and symptoms in this patient.

18. Topic: Treatment of Heartburn

Correct Answer: D. Omeprazole

Explanation: Omeprazole (D), a proton pump inhibitor, effectively reduces gastric acid production, providing significant relief from heartburn. Bisacodyl (A) is a laxative, Cimetidine (B) is an H2 blocker but less potent than omeprazole, Magnesium hydroxide (C) is an antacid with a short duration of action, and Promethazine (E) is an antiemetic. Thus, omeprazole is the most effective for reducing heartburn symptoms.

19. Topic: Hepatitis B Status

Correct Answer: B. She developed an inappropriate antibody response as a result of an immunosuppressed state

Explanation: The presence of IgM anti-HBc (core antibody) without HBsAg or anti-HBs indicates a recent infection with hepatitis B where the immune response is not typical, possibly due to an immunosuppressed state. The absence of HBsAg rules out active infection (D), and the absence of anti-HBs and IgG anti-HBc suggests she was not vaccinated (A), not cleared of the infection (C), and not uninfected (E).

20. Topic: Clopidogrel Mechanism of Action

Correct Answer: C. It prevents the production of ADP at its receptors on platelets

Explanation: Clopidogrel is an antiplatelet medication that inhibits platelet aggregation by irreversibly blocking the ADP (adenosine diphosphate) receptors on platelets, specifically the P2Y12 receptor. This prevents ADP-induced activation of the glycoprotein IIb/IIIa complex, thereby inhibiting platelet aggregation and reducing the risk of thrombotic events. Options A and B refer to aspirin’s mechanism of action, which involves inhibition of cyclooxygenase and thromboxane A2 production, respectively. Option D relates to glycoprotein IIb/IIIa inhibitors, and option E pertains to the mechanism of action of prostacyclin analogs.

21. Topic: Bronchogenic Cancer

Correct Answer: E. Tracheal metastases are common

Explanation: Bronchogenic cancer, or lung cancer, is characterized by several features: A. Metastasis to other organs may produce the initial symptoms:True. Lung cancer can metastasize early, leading to symptoms related to metastasis sites.B. Insidious onset with cough and localized wheezing: True. Symptoms often develop gradually, starting with a persistent cough and wheezing in localized areas.C. Mediastinal metastases can lead to vena cava obstruction: True. Mediastinal involvement can cause compression of the vena cava, leading to obstruction and related symptoms.D. Horner’s syndrome may be associated with: True. Horner’s syndrome, characterized by ptosis (drooping eyelid), miosis (constricted pupil), and anhidrosis (loss of sweating), can occur due to involvement of sympathetic nerves by tumors.E. Tracheal metastases are common: False. Tracheal metastases are uncommon in bronchogenic cancer. The primary tumor in the lung can invade nearby structures, but metastases to the trachea itself are rare. Therefore, option E is incorrect because tracheal metastases are not a common feature of bronchogenic cancer.

22. Topic: Complications of Subacute Bacterial Endocarditis

Correct Answer: D. All of the above

Explanation: Subacute bacterial endocarditis (SBE) is a condition where bacteria infect the inner lining of the heart chambers or heart valves, typically affecting individuals with pre-existing heart conditions. Complications of SBE can be severe and affect multiple organ systems. 

23. Topic: Carpal Tunnel Syndrome

Correct Answer: E. Carpal tunnel syndrome

Explanation: Carpal tunnel syndrome (CTS) is a common condition caused by compression of the median nerve as it passes through the carpal tunnel in the wrist. Here’s why it is the most likely diagnosis for the described symptoms – Symptoms: Patients typically present with numbness, tingling, and pain in the hand, especially at night or upon waking up. The symptoms often affect the thumb, index, middle fingers, and half of the ring finger – Provocative Maneuver: The Phalen’s maneuver, described as holding the hand in extreme flexion for a short period, reproduces the symptoms of CTS due to increased pressure on the median nerve within the carpal tunnel – Relief by Shaking: Patients may find relief by shaking the hand, which can temporarily alleviate the compression on the median nerve – Diagnosis Confirmation: Clinical diagnosis can be supported by nerve conduction studies (NCS) or electromyography (EMG), which can confirm median nerve entrapment and assess the severity of CTS-Differential Diagnosis: Multiple sclerosis: Typically presents with a variety of neurological symptoms affecting different parts of the body, not localized to the hand. Myasthenia gravis – Presents with muscle weakness and fatigue, not typical for the described symptoms. Acute polyneuropathy – Presents with diffuse neurological symptoms affecting multiple nerves, not typically localized to the median nerve. Ulnar nerve paralysis – Would present with different symptoms related to ulnar nerve distribution, such as weakness or sensory loss in the ulnar nerve innervated areas. Therefore, based on the clinical presentation and the response to provocative maneuvers, the most likely diagnosis in this case is Carpal Tunnel Syndrome (E).

24. Topic: Diagnosis Confirmation for Neurological Symptoms

Correct Answer: B. CT scan of the hand

Explanation: The CT scan of the hand is the most appropriate diagnostic test for confirming the patient’s condition, likely carpal tunnel syndrome, given the symptoms of numbness, pain, and relief with shaking the hand. Blood culture (A) is used for detecting infections, electromyography (C) is used for nerve and muscle disorders but does not confirm anatomical changes, and pneumo-encephalogram (D) is an outdated technique for brain imaging. Therefore, the CT scan provides the necessary detailed imaging of the hand to confirm the diagnosis.

25. Topic: Diagnosis of Hepatobiliary Complications in Ulcerative Colitis

Correct Answer: D. Endoscopic retrograde cholangio-pancreatography

Explanation: Endoscopic retrograde cholangio-pancreatography (ERCP) is the most appropriate diagnostic test for this patient’s condition, as it allows detailed visualization of the biliary and pancreatic ducts, which is crucial for diagnosing conditions like primary sclerosing cholangitis often associated with ulcerative colitis. An abdominal X-ray (A), upper gastrointestinal endoscopy (B), ultrasound (C), and oral cholecystogram (E) do not provide the same level of detail for evaluating the biliary tree and are less effective in diagnosing the specific biliary complications suggested by the symptoms and lab findings.

26. Topic: Diagnosis of Hepatobiliary Symptoms in Ulcerative Colitis

Correct Answer: E. Primary sclerosing cholangitis

Explanation: Primary sclerosing cholangitis (PSC) is a chronic liver disease commonly associated with ulcerative colitis, presenting with symptoms like asthenia, pruritus, jaundice, hepatosplenomegaly, elevated serum alkaline phosphatase, and moderately increased transaminases. Cholecystitis (A) typically presents with acute pain, Budd Chiari Syndrome (B) involves hepatic vein thrombosis, Wilson’s disease (C) is characterized by copper accumulation, and pancreatitis (D) presents with severe abdominal pain. Therefore, PSC is the most likely diagnosis given the patient’s history and symptoms.

27. Topic: Acute Diaphragmatic Pleurisy

Correct Answer: A. From the neck and shoulder

Explanation: Acute diaphragmatic pleurisy affecting the central part of the diaphragm often presents with referred pain to the neck and shoulder area due to irritation of the phrenic nerve, which has cervical roots. Pain in the lateral thorax (B), inter-scapular region (C and D), or all of these areas (E) are not typical for central diaphragmatic pleurisy, making referred pain to the neck and shoulder (A) the correct answer.

28. Topic: Macrocytic Anemia with Neurological Symptoms

Correct Answer: E. None of the above

Explanation: The patient exhibits symptoms of macrocytic anemia with neurological signs, which is indicative of vitamin B12 deficiency. Folic acid (A), ferrous sulfate (B), thiamine chloride (C), and whole blood transfusion (D) do not address the underlying vitamin B12 deficiency. Therefore, none of the options provided will produce the best reticulocytosis response, making E the correct answer. The appropriate treatment would be vitamin B12 supplementation.

29. Topic: Management of Glycosuria and Elevated Fasting Blood Glucose

Correct Answer: A. Reduce weight by dieting

Explanation: The patient has elevated fasting blood glucose levels and glycosuria, indicating early-stage type 2 diabetes or prediabetes. The primary management strategy involves lifestyle modifications, particularly weight reduction through dieting. This can help improve insulin sensitivity and potentially normalize blood glucose levels. Thyroid medication (B) is unnecessary without evidence of thyroid dysfunction. Maintaining the usual diet (C) or taking insulin (D) without addressing diet and weight would not address the underlying issue. Therefore, reducing weight by dieting is the correct management at this stage.

30. Topic: Causes of Death in Patients with Hypertension

Correct Answer: B. From the brain

Explanation: Patients with high blood pressure (hypertension) are at increased risk for various complications, but the most frequent cause of death in these patients is related to cerebrovascular diseases affecting the brain. Hypertension predisposes individuals to conditions such as stroke (hemorrhagic or ischemic), transient ischemic attacks (TIAs), and vascular dementia, all of which are primarily neurological in nature and can lead to fatal outcomes. While hypertension can also affect the heart (A), kidneys (C), lungs (D), and liver (E), the brain-related complications, particularly strokes, are the leading cause of mortality in hypertensive patients. Thus, option B is the correct answer.

31. Topic: Aortic Insufficiency

Correct Answer: B. soft steam jet

Explanation: Aortic insufficiency (aortic regurgitation) typically presents with a diastolic murmur described as a “soft steam jet.” This term captures the high-pitched, blowing quality of the murmur, which is due to the backflow of blood from the aorta into the left ventricle during diastole. While other descriptions such as “gravel with bearing” (A), being heard best lying down (C), or at the apex (D) are not characteristic of aortic insufficiency, the “soft steam jet” accurately reflects the nature of the murmur associated with this condition, making option B the correct answer.

32. Topic: Atrial Fibrillation

Correct Answer: C. atrial flutter with variable ventricular response

Explanation: Atrial fibrillation (AF) is characterized by an irregularly irregular rhythm without distinct P waves, leading to a variable ventricular response. This makes it clinically distinct from atrial flutter with a variable ventricular response, which can present similarly but has organized atrial activity typically seen as “sawtooth” waves on an ECG. Options A, B, and D involve more regular rhythms or specific conduction patterns that are less likely to be confused with the chaotic rhythm of AF, making C the correct answer as it closely mimics the irregularity seen in atrial fibrillation.

33. Topic: Infectious Diarrhea

Correct Answer: A. Campylobacter jejuni

Explanation: Campylobacter jejuni is a gram-negative, oxidase-positive, curved, flagellated rod, which matches the description given. It is a common cause of bacterial gastroenteritis, presenting with symptoms such as diarrhea, abdominal pain, blood, and pus in the stool. The absence of a recent trip does not rule out infection as C. jejuni can be acquired locally, often through contaminated food or water. Options B, C, D, and E are gram-negative bacteria but do not fit the specific characteristics of being oxidase-positive, curved, and flagellated, making A the most likely pathogen.

34. Topic: Urinary Tract Infection (UTI)

Correct Answer: A. Escherichia coli

Explanation: Escherichia coli is the most common causative agent of urinary tract infections, especially in women. It is a gram-negative rod, which fits the description from the gram stain. Symptoms such as urinary frequency, suprapubic pain, and dysuria are typical of a UTI. Other options (B, C, D, E) are either not gram-negative rods or are not typically associated with UTIs, making A the correct answer.

35. Topic: Hypertension Management in COPD

Correct Answer: E. Nadolol

Explanation: Nadolol is a non-selective beta-blocker, which is contraindicated in patients with chronic obstructive pulmonary disease (COPD) due to the risk of bronch

36. Topic: Severe Malaria

Correct Answer: A. Hepatomegaly

Explanation: Severe malaria is characterized by serious complications such as epistaxis (B), digestive hemorrhage (C), and obnubilation (D), which indicate severe systemic involvement. Hepatomegaly (A) can occur in malaria but is not a defining feature of severe malaria, making it the incorrect statement. The focus in severe malaria is on life-threatening symptoms rather than organ enlargement like hepatomegaly.

37. Topic: Mitral Insufficiency (Mitral Regurgitation)

Correct Answer: B. It may be accompanied in some cases by a diastolic rollover

Explanation: Mitral insufficiency is characterized primarily by a systolic murmur (A) due to the backflow of blood from the left ventricle to the left atrium during systole. This murmur can radiate to the back (C). Blood pressure changes (D) are not a typical feature of mitral regurgitation. The major functional sign is exertional dyspnea (E) due to increased pulmonary pressures. However, a diastolic rollover (B) is not commonly associated with mitral insufficiency, making this the incorrect statement. The focus in mitral regurgitation is on systolic murmurs and related symptoms.

38. Topic: Cardiac Tamponade

Correct Answer: D. Inspiratory decrease in systolic blood pressure

Explanation: Cardiac tamponade typically presents with turgidity of the jugular veins (A), a poorly moving cardiac silhouette on imaging (B), signs of pulmonary edema (C), and paradoxical pulse (E). However, an inspiratory decrease in systolic blood pressure (D) is not a characteristic sign of cardiac tamponade, making this the incorrect statement. Cardiac tamponade is primarily identified by its effect on heart movement and pressure, not by changes in systolic blood pressure.

39. Topic: Malabsorption Syndrome in Chronic Diarrhea

Correct Answer: C. Icterus

Explanation: Malabsorption syndrome in chronic diarrhea often presents with symptoms like edema of the lower limbs (A), tetany attacks (B), brittle skin (D), and hematomas at the slightest impact (E), due to deficiencies in essential nutrients. However, icterus (C), which is jaundice, is not typically a feature of malabsorption syndrome, making this the incorrect statement. The focus in malabsorption is on nutrient deficiencies leading to various systemic manifestations, not jaundice.

40. Topic: Newborn Management with HBsAg and HBeAg Positive Mother

Correct Answer: E. Sero-vaccination

Explanation: For a newborn of a mother who is HBsAg and HBeAg positive, the most effective approach to prevent hepatitis B transmission is sero-vaccination (E). This involves the administration of both hepatitis B vaccine and hepatitis B immunoglobulin (HBIG) immediately after birth. This combined approach offers the best protection against the virus. Options like no treatment (A), polyvalent immunoglobulins (B), vaccination alone (C), and specific immunoglobulins (D) do not provide the same level of immediate and long-term protection as sero-vaccination.