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1. A 30-yr-old woman has pain and stiffness in her hands, wrists, elbows, knees and ankles. There is
swelling of her MCP joints bilaterally. On physical examination, her temperature is 38 °C (100.4
°F). Examination of the joints reveals thickening and tenderness of the metacarpophalangeal
joints and proximal interphalangeal joints bilaterally. Both wrists lack complete flexion and
extension and are warm to the touch. Choose the most likely diagnostic antibody for Rheumatoid
arthritis from the below list of options.
A. Antimicrosomal antibody
B. Antireticulin antibody
C. Anti-dsDNA
D. P-ANCA antibody
E. Rheumatoid factor
ANSWER: E
2. A 73-yr-old fit farmer presents with pain on weight bearing and restricted movements of the right
hip. Choose the most likely diagnosis from the below list of options.
A. Ankylosing spondylitis
B. Erythema nodosum
C. Osteoarthritis
D. Gout
E. Psoriatic arthritis
ANSWER: C
3. An elderly man started frusemide 2-weeks ago and now presents with a red, hot, swollen first
metatarsal phalangeal joint. Choose the most likely diagnosis from the below list of options.
A. Ankylosing spondylitis
B. Joint sepsis
C. Osteoarthritis
D. Gout
E. Psoriatic arthritis
ANSWER: D
4. A 41-yr-old woman has pain and stiffness in her hands, wrists, elbows, knees and ankles. There is
swelling of her MCP joints bilaterally. On physical examination, her temperature is 38 °C (100.4
°F). Examination of the joints reveals thickening and tenderness of the metacarpophalangeal
joints and proximal interphalangeal joints bilaterally. Both wrists lack complete flexion and
extension and are warm to the touch. Choose the most likely diagnosis from the below list of
options. Drug of choice for patient with rheumatoid artritis
A. Methotrexate
B. NSAIDs
C. Hydroxychloroquine sulphate
D. Sulphasalazine
E. D-penicillamine
ANSWER: A
5. A 53-yr-old woman complains of redness, swelling and stiffness in the distal interphalangeal
joints of her hands, but has no other joint complaints. Choose the most likely diagnosis from the
below list of options.
A. Gout
B. Still's disease
C. Pseudogout
D. Rheumatoid arthritis
E. Osteoarthritis
ANSWER: E
6. A 50-yr-old woman complains of stiffness in her fingers worse at the end of the day. The DIP
joints and the first metacarpophalangeal joints are affected. Choose the most likely diagnosis
from the below list of options.
A.
B.
C.
D.
E.
Osteoarthritis
Rheumatoid arthritis
Psoriatic arthropathy
Haemochromatosis
Gonococcal arthritis
ANSWER: A
7. A 70-yr-old woman complains of arthritis in the fingers and big toe. On examination she has bony
swellings of the first carpometacarpal joint and the distal interphalangeal joints and has an
affected metatarsophalangeal joint. Choose the most likely diagnosis from the below list of
options.
A. Rheumatoid arthritis
B. Hyperparathyroidism
C. Psoriatic arthropathy
D. Osteoarthritis
E. Haemochromatosis
ANSWER: D
8. An elderly man presents with a red, warm swollen metatarsophalangeal joint following a right
total hip replacement operation. Choose the most likely diagnosis from the below list of options.
A. Ankylosing spondylitis
B. Reactive arthritis
C. Osteoarthritis
D. Acute Gouty arthritis
E. Psoriatic arthritis
ANSWER: D
9. A 60-yr-old alcoholic man presents with a hot swollen first metatarsophalangeal joint and a lesion
on the rim of the left pinna. Choose the investigation for diagnosis from the below list of options.
A. HLA-B27
B. Synovial fluid analysis
C. X-ray
D. Anti-dsDNA antibody
E. Rheumatoid factor
ANSWER: B
10. A 65-yr-old man has started chemotherapy for lymphoma. He has developed a painful swollen
hot right knee. He is apyrexial. Choose the most likely changes from the below list of options.
A. High ESR
B. Erosions on X-ray
C. Positive blood culture
D. Positive rheumatoid factor
E. Urate crystals on joint aspirate
ANSWER: A
11. A 50-year-old male is evaluated because of pain in the right inguinal area, lower back, and hands.
The inguinal pain worsens as he walks, and all pain increases as the day progresses. On physical
examination, internal rotation of the right hip elicits the groin pain. The second, third, and fourth
metacarpophalangeal joints are swollen, warm, and tender to pressure. Radiographs show severe
osteoarthritis in the right hip. Which of the following is the best test to confirm the diagnosis?
A. Rheumatoid factor
B. HLA-B27
C. Serum iron and iron-binding capacity
D. Fasting plasma glucose
E. Serum uric acid
ANSWER: C
12. A 67-year-old woman has had four or five episodes of joint pain and swelling, lasting 3 to 8 days,
involving the right knee and left elbow. She is asymptomatic between attacks, and sulindac, 200
mg twice daily, has usually relieved the symptoms. Her most recent episode was 3 months ago.
On physical examination, none of her joints is swollen or tender, but there is marked crepitus on
extension of the knee. She also has a positive bulge sign over the left knee and pain on full
extension of the left elbow. Which one of the following tests would confirm the diagnosis?
A. Arthrocentesis of the knee and laboratory analysis of the synovial fluid
B. Measurement of serum uric acid
C. Measurement of serum rheumatoid factor
D. Radiograph of the knee
E. MRI of the knee with gadolinium contrast
ANSWER: A
13. A 72-year-old retired lawyer is evaluated because of swelling of his right knee. He has mild
osteoarthritis and stays active swimming and playing tennis and golf. On physical examination,
he has an effusion in the right knee. At a point in the mid-thigh (measured from the superior
border of the patella), the right thigh is 4 cm smaller in diameter than the left. There is crepitus
with right knee flexion. The knee is not warm. Which of the following is the best next step in the
management of this patient?
A. Order radiographs of both knees and treat the patient with ibuprofen.
B. Order radiographs of the right hip and right knee.
C. Aspirate the joint fluid in the right knee and refer the patient for physical therapy.
D. Aspirate the joint fluid in the right knee and obtain blood cultures.
E. Treat the patient with celecoxib, and advise him to stay off his feet for 48 hours.
ANSWER: C
14. A 64-year-old woman presents with a 1-year history of pain in her thumbs. A focused
examination reveals squaring at the base of both first digits, worse on the right, and pain on
pressure over the first carpal metacarpal joints. She also has nontender bony overgrowth at the
distal interphalangeal joints. The patient says that her mother had “the same fingers” and she
worries that she will become crippled. Choose the most likely diagnosis from the below list of
options.
A. Ankylosing spondylitis
B. Rheumatoid arthritis
C. Osteoarthritis
D. Gout
E. Psoriatic arthritis
ANSWER: C
15. A 65-year-old woman presents with a 1-year history of pain in her thumbs. A focused
examination reveals squaring at the base of both first digits, worse on the right, and pain on
pressure over the first carpal metacarpal joints. She also has nontender bony overgrowth at the
distal interphalangeal joints. On physical examination, there is crepitus on passive motion of the
left knee, which has a slight varus (“bow leg”) deformity. Her feet turn out slightly, and the heels
are in valgus. Which of the following changes will reveal X-ray examination?
A. Erosions
B. Subluxations
C. Osteophytes
D. Osteoporosis
E. Ankylosis
ANSWER: C
16. A 73-yr-old fit farmer presents with pain on weight bearing and restricted movements of the right
hip. Choose the most likely X-ray changes from the below List of options.
A. Cystic changes and lytic lesions
B. Joint spaces are narrowed with reactive subchondral sclerosis, osteophytes
C. Periarticular osteopenia, marginal erosions
D. acroosteolysis
E. Fluffy bone periostitis and erosions at the interphalangeal joints
ANSWER: B
17. A 60-year-old woman is evaluated because of a 1-year history of bilateral knee pain and low back
pain. She has some stiffness for approximately 15 minutes when she awakens in the morning, and
during the afternoon her pain is worse. As she describes her pain, she slides her hand down the
anterior thigh to her knee on the right to show where the pain is most severe. On physical
examination, she has slight swelling and tenderness to pressure of the distal interphalangeal joints
2-5 on both hands. All the joints are brought through full range of motion without pain. There is
slight crepitus with motion of the right knee. Which of the following treatment do use?
A. methotrexat
B. intra-articular injection of sodium hyaluronate
C. probenecid
D. colchicine
E. allopurinol.
ANSWER: B
18. A 68-year-old woman has had four or five episodes of joint pain and swelling, lasting 3 to 8 days,
involving the right knee and left elbow. She is asymptomatic between attacks, and sulindac, 200
mg twice daily, has usually relieved the symptoms. Her most recent episode was 4 months ago.
On physical examination, none of her joints is swollen or tender, but there is marked crepitus on
extension of the knee. She also has a positive bulge sign over the left knee and pain on full
extension of the left elbow. Which one of the following tests would confirm the diagnosis?
A. Measurement of uric acid
B. Arthrocentesis of the knee and laboratory analysis of the synovial fluid
C. Measurement of serum rheumatoid factor
D. Radiograph of the knee
E. MRI of the knee with gadolinium contrast
ANSWER: B
19. A 51-yr-old woman complains of stiffness in her fingers worse at the end of the day. The DIP
joints and the first metacarpophalangeal joints are affected. Choose the most likely diagnosis
from the below list of options.
A. Rheumatoid arthritis
B. Psoriatic arthropathy
C. Osteoarthritis
D. Haemochromatosis
E. Gonococcal arthritis
ANSWER: C
20. A 65-yr-old man has started chemotherapy for lymphoma. He has developed a painful swollen
hot right knee. He is apyrexial. Choose the most likely diagnosis from the below list of options.
A. Urate crystals on joint aspirate
B. High ESR
C. Erosions on X-ray
D. Positive blood culture
E. Positive rheumatoid factor
ANSWER: A
21. A 57-year-old woman has had five episodes of joint pain and swelling, lasting 3 to 8 days,
involving the right knee and left elbow. She is asymptomatic between attacks, and sulindac, 200
mg twice daily, has usually relieved the symptoms. Her most recent episode was 4 months ago.
Classical picture of exacerbation of the arthritis includes all of the following except
A. Excruciating and sudden pain
B. Low-grade fever may also be present
C. Overgrowth at the distal interphalangeal joints
D. Warmness
E. Redness
ANSWER: D
22. A 55-year-old man presented to the clinic with a nodule on his elbow. He reported that the nodule
had been bothering him for 3 years and had steadily increased in size recently. Further
questioning revealed a history of repeated attacks of acute joint pain. The physical examination
revealed a rounded, subcutaneous nodule over the elbow, which was tender and rubbery to the
touch. The examination was also notable for a subcutaneous nodule at the left metatarsalphalangeal joint and left metacarpal-phalangeal joint, as well as evidence of arthritis involving
both hands. Which of the following changes will reveal X-ray examination?
A. Erosions
B. Subluxations
C. Osteophytes
D. Osteoporosis
E. "punched-out" lytic lesion
ANSWER: E
23. A 59-year-old man presented to the clinic with a nodule on his elbow. He reported that the nodule
had been bothering him for 2 years and had steadily increased in size recently. Further
questioning revealed a history of repeated attacks of acute joint pain. The physical examination
revealed a rounded, subcutaneous nodule over the elbow, which was tender and rubbery to the
touch. The examination was also notable for a subcutaneous nodule at the left metatarsalphalangeal joint and left metacarpal-phalangeal joint, as well as evidence of arthritis involving
both hands. Which of the following is characteristic of the arthritis?
A. Depositions of monosodium urate monohydrate crystals within the periarticular soft tissues
B. Overgrowth of bones within joints
C. Autoimmune synovitis
D. Osteoporosis
E. Rheumatoid nodules over joints
ANSWER: A
24. A 60-year-old man presented to the clinic with a nodule on his elbow. He reported that the nodule
had been bothering him for 4 years and had steadily increased in size recently. Further
questioning revealed a history of repeated attacks of acute joint pain. The physical examination
revealed a rounded, subcutaneous nodule over the elbow, which was tender and rubbery to the
touch. The examination was also notable for a subcutaneous nodule at the left metatarsalphalangeal joint and left metacarpal-phalangeal joint, as well as evidence of arthritis involving
both hands. Which of the following medications is indicated for the treatment of chronic arthritis?
A. allopurinol
B. colchicine
C. corticosteroids
D. indomethacin
E. ibuprofen
ANSWER: A
25. 79 y/o male with foot pain and swelling for many years. There are "punched out" articular
erosions with overhanging cortex and associated soft tissue masses. Serum uric acid was
markedly elevated. Choose the most likely diagnosis from the below list of options.
A. Ankylosing spondylitis
B. Rheumatoid arthritis
C. Osteoarthritis
D. Chronic Gouty arthritis
E. Psoriatic arthritis
ANSWER: D
26. 53-year-old male with foot pain and swelling for many years. There are "punched out" articular
erosions with overhanging cortex and associated soft tissue masses consistent with tophaceous
gout and gouty arthritis. Choose the most likely changes from the below list of options.
A. Urate crystals on joint aspirate
B. High ESR
C. Erosions on X-ray
D. Positive blood culture
E. Positive rheumatoid factor
ANSWER: A
27. 59 y/o male with foot pain and swelling for many years. There are "punched out" articular
erosions with overhanging cortex and associated soft tissue masses. Serum uric acid was
markedly elevated. Which of the following medications is indicated for the treatment of chronic
arthritis?
A. allopurinol
B. colchicine
C. corticosteroids
D. indomethacin
E. ibuprofen
ANSWER: A
28. 49 y/o male with foot pain and swelling for many years. There are "punched out" articular
erosions with overhanging cortex and associated soft tissue masses. Serum uric acid was
markedly elevated. Which of the following medications is indicated for the treatment of
exacerbation of arthritis?
A. allopurinol
B. colchicine
C. corticosteroids
D. indomethacin
E. ibuprofen
ANSWER: B
29. 55 male with swelling and pain of his fingers. Patient also with similar complaints regarding his
great toe of the left foot. Soft tissue swelling with subtle soft tissue nodules primarily of the 2nd
and 3rd digits. Erosions with overhanging edges at the distal aspects of the proximal phalanges of
the 2nd and 3rd digits and metatarsophalangeal joints. Choose the most likely diagnosis from the
below list of options.
A. Ankylosing spondylitis
B. Chronic Gouty arthritis
C. Rheumatoid arthritis
D. Osteoarthritis
E. Psoriatic arthritis
ANSWER: B
30. 57 yo male with swelling and pain of his fingers. Patient also with similar complaints regarding
his great toe of the left foot. Soft tissue swelling with subtle soft tissue nodules primarily of the
2nd and 3rd digits. Erosions with overhanging edges at the distal aspects of the proximal
phalanges of the 2nd and 3rd digits and metatarsophalangeal joints. Which of the following
medications is indicated for the treatment of chronic arthritis?
A. colchicine
B. corticosteroids
C. indomethacin
D. allopurinol
E. Ibuprofen
ANSWER: D
31. 28-year-old patient, presents with complaints of tightness of fingers. There is also history of
dysphagia. Which of the following is the probable diagnosis:
A.
B.
C.
D.
E.
Dermatomyositis
Scleroderma
Rheumatoid arthritis
Polyarteritis nodosa
SLE
ANSWER: B
32. 59 yo male with swelling and pain of his fingers. Patient also with similar complaints regarding
his great toe of the left foot. Soft tissue swelling with subtle soft tissue nodules primarily of the
2nd and 3rd digits. Erosions with overhanging edges at the distal aspects of the proximal
phalanges of the 2nd and 3rd digits and metatarsophalangeal joints. Which of the following
medications is indicated for the treatment of exacerbation of arthritis?
A. allopurinol
B. corticosteroids
C. colchicine
D. indomethacin
E. ibuprofen
ANSWER: C
33. 57 yo male with swelling and pain of his fingers. Patient also with similar complaints regarding
his great toe of the left foot. Soft tissue swelling with subtle soft tissue nodules primarily of the
2nd and 3rd digits. Erosions with overhanging edges at the distal aspects of the proximal
phalanges of the 2nd and 3rd digits and metatarsophalangeal joints. Which of the following
medications is contraindicated for the treatment of exacerbation of arthritis?
A. corticosteroids
B. colchicine
C. indomethacin
D. ibuprofen
E. allopurinol
ANSWER: E
34. A 32-year-old woman is evaluated because of a 5-year history of Raynaud’s phenomenon and
thickened skin over the fingers, small patches of calcinosis on the distal fingers and dorsum of
one hand. She reports mild dyspnea when she climbs stairs. She takes a proton pump inhibitor for
reflux esophagitis. Physical examination reveals sclerodactyly, with one digital tip ulcer, minimal
calcinosis. Lung and heart examination, and radiograph are normal. Results of routine laboratory
tests are normal, including renal function. Echocardiogram suggests mild right ventricular
diastolic dysfunction. The diffusing capacity for carbon monoxide (DLCO) is 44% of normal.
Within the next 5 years, she is at high risk for developing which of the following?
A. Fine, dry crackles indicative of pulmonary fibrosis
B. Renovascular hypertension with hyperreninemia
C. Sclerodermatous changes on the forearms and face
D. Pulmonary hypertension
E. Esophageal varices
ANSWER: D
35. A 35-year-old woman is evaluated because of a 5-year history of Raynaud’s phenomenon and
thickened skin over the fingers, small patches of calcinosis on the distal fingers and dorsum of
one hand. She reports mild dyspnea when she climbs stairs. She takes a proton pump inhibitor for
reflux esophagitis. Physical examination reveals sclerodactyly, with one digital tip ulcer, minimal
calcinosis, and two telangiectasias on her face. Which of the following is the probable diagnosis:
A. Dermatomyositis
B. Scleroderma
C. Rheumatoid arthritis
D. Polyarteritis nodosa
E. SLE
ANSWER: B
36.
What substances are reabsorbed in renal tubules completely?
A. Aminoacids
B. Creatinine
C. Sodium
D. Potassium
E. Chlorum
ANSWER: A
37.
In case of acute poststreptococcal glomerulonephritisthe most appropriate treatment is
A. Corticosteroids
B. Cytotoxics
C. Antibiotics, symptomatic treatment
D. Memranostabilisation therapy
E. Plasmapheresis
ANSWER: C
38.
Nephrotic syndrome may occur in morphological case of
A. minimal change disease
B. Mesangiocapillary glomerulonephritis
C. Membranous nephropathe
D. Mesangioproliferative glomerulonephritis
E. All of them
ANSWER: E
39.
What is the definition of oliguria?
A. Oliguria is <600 ml of urine per 24
B. Oliguria is <400 ml of urine per 24
C. Oliguria is <800 ml of urine per 24 hours
D. Oliguria is is less than 100 ml urine per 24 hours
E. Oliguria is <500 ml of urine per 24
ANSWER: B
40.
What is the definition of anuria?
A. anuria is less than 500 ml urine per 24 hours
B. anuria is less than 400 ml urine per 24 hours
C. anuria is less than 300 ml urine per 24 hours
D. anuria is less than 200 ml urine per 24 hours
E. anuria is less than 100 ml urine per 24 hours
ANSWER: E
41.
The kidney functions are:
A. Maintains of fluid load in body
B. Maintains of constant osmotic pressure plasma
C. Maintains of constant electrolyte balance
D. Maintains of blood acidity
E. All of them
ANSWER: E
42.
Normal levels of Glomerular filtration rate (GFR) are
A. 140-190 ml/min
B. 90-120 ml/min
C. 60-90 ml/min
D. 30-60 ml/min
E. 90-190 ml/min
ANSWER: B
43.
Processes of ultrafiltration in kidneys are stopped when systemic arterial blood
pressure is;
A. 140 -160 mm Hg
B. 120 -140 mm Hg
C. 90 -100 mm Hg
D. 70 -80 mm Hg
E. <60 mm Hg
ANSWER: E
44.
Normal sizes of kidneys in adults are
A. 10-12 сm х 5-6 сm х 3-4 сm
B. 15-16 сm х 7-8 сm х 5-6 сm
C. 7-8 сm х 3-4 сm х 2-3 сm
D. 5-7 сm х 2-4 сm х 1-3 сm
E. 18-22 сm х 8-10 сm х 6-7 сm
ANSWER: A
45.
Acute nephritic syndrome is characterized by sudden onset of all of following except:
A. acute renal failure ;
B. oliguria (<400 mL of urine per day);
C. hematuria;
D. hypertension;
E. Proteinuria more3.5 g per 24 h.
ANSWER: E
46.
What are indications for dialysis in the setting of renal failure?
A. Fluid overload
B. Refractory hyperkalemia
C. BUN > 130
D. Pericardial friction rub
E. All of them
ANSWER: E
47.
The nephrotic syndrome is a clinical complex characterized by a number of renal and
extrarenal features, the most prominent of which are:
A. proteinuria of >3.5 g (per 24 h);
B. hypoalbuminemia;
C. edema;
D. hyperlipidemia;
E. all of them.
ANSWER: E
48.
Triad of symptoms of acute glomerulonephritis
A. hematuria, edema, hypertension
B. pyuria, bacteriuria, hypertension
C. haematuria, bacteriuria, swelling
D. Pyuria, cylindruria, swelling
E. Pyuria, edema, swelling
ANSWER: A
49.
Bacteriuria is observed at
A. urolithiasis
B. acute glomerulonephritis
C. acute pyelonephritis
D. chronic glomerulonephritis
E. diabetes mellitus
ANSWER: C
50.
Episodes of intense pain radiating along the ureter to the inguinal region is observed
at:
A. glomerulonephritis
B. pyelonephritis
C. cystitis
D. urolithiasis
E. None of them
ANSWER: D
51.
In chronic renal failure in a diet restricted
A. proteins
B. vitamines
C. fats
D. carbohydrates
E. All of the above
ANSWER: A
52.
In case of nephrotic syndrome in diabetic nephropathy with ESRD the most
appropriate treatment is
A. Corticosteroids
B. Cytotoxics
C. symptomatic treatment
D. Memranostabilisotion therapy
E. Renal replacement therapy
ANSWER: Е
53.
The mechanisms of proteinuria are except ?
A. Overflow of elevated normal or abnormal serum proteins
B. Decreased reabsorption of normal filtered proteins
C. Increased glomerular permeability
D. Changes in renal hemodyndamics
E. Hypercoagubility
ANSWER: Е
54.
Which drugs should not be used in pregnancy.
A. Fluoroquinolones;
B. Phospomycine;
C. Aminoglucosides;
D. macrocrystalline nitrofurantoin;
E. amoxicillin
ANSWER: A
55. What is an autosomal dominant disease characterized by bilateral enlargement of kidneys
secondary to multiple large cysts. Patients present with hematuria, pain, hypertension, and
progressive renal failure. What is this disease?
A. Adult polycystic kidney disease
B. Diabetic nephropathy
C. Alport’s syndrome
D. Goodpasture’s syndrome
E. Primary amuloidosis
ANSWER: A
56. A 24- year-old patient with a history of preceding streptococcal infection complains of malaise,
headache, anorexia, subfebrile fever. On exam, mild generalized edema, BP of 150/90 mm Hg, HR of
100/min, RR of 20/min, the urinalysis showed increased protein, red cell casts and hyaline casts.
What is your diagnosis?
A. Bacterial endocarditis
B. Essential hypertension
C. Rheumatic fever
D. Acute pyelonephritis
E. Acute glomerulonephritis
ANSWER: E
57. A 18 year old guy gets ampicillin for treatment of acute respiratory illness complicated by acute
bronchitis. On the 5th day of treatment symptoms of intoxication increased, mild oedema on face,
pain in the joints appeard. On the skin of the trunk papular rash came out. Blood pressure: 140/90
mm Hg Throughout the day he singled out 210 ml of urine (fluid was 2000 ml). The blood test:
creatinine 0.24 mmol / l, urea 11.8 mmol / L, potassium 3.8 mmol / l, sodium 125 mmol / liter. The
urine test: proteinuria 0.99 g / l, erythrocyturia, eosinophilic leukocyturia. The relative density of
urine during the day ranged from 1002 to 1010. Urine culture for sterility gave no growth. What is
the most likely diagnosis?
A. Acute pyelonephritis
B. Acute interstitial nephritis
C. Acute glomerulonephritis with nephritic syndrome
D. Acute glomerulonephritis with nephrotic syndrome
E. Dysmetabolic nephropathy
ANSWER: B
58. Patient M., 19 years old, was taken to hospital in serious condition with complaints of general
weakness, thirst, dry mouth, dull headaches. The first time he felt himself bad a year ago, when blood
pressure began to rise (180/110 mmHg) Treatment was not regular. His well-being became worse a
few days ago. During examination: face puffiness, pale skin and mucous membranes, muscle
twitching. Tongue was covered with gray bloom, bleeding gums. There was mild oedema on the
shins. Pulse is 94 in 1 minute, rhythmic, tense. BP 175/120 mm Hg. Art. The first tone over the top of
the heart is weakened; the second is stronger above the aorta. In the lower parts of lungs breathing is
hard. The liver acts 2 cm from the edge of the rib arch, it is a little condensed, sensitive during
palpation. Blood tests: er. - 2.2 h1012 / l Hb - 82 g / l, ESR-26 mm / hour. Urine test: some density
1.016 protein, 1.35 g / l, leukocytes 6 n / s, erythrocytes. - densely cover the field of vision, single
hyaline cylinders. What is your diagnosis?
A. Pyelonephritis
B. Glomerulonephritis
C. Nephrolithiasis
D. Focal nephritis
E. Amyloidosis
ANSWER: B
59. A 53-year-old man presented to his general practitioner with a right inguinal hernia. He had a 6year history of hypertension that had been initially treated with atenolol but he had neither visited a
doctor nor taken any medication for 3 years. There was no other significant medical history. He
smoked 30 cigarettes per day. On examination, his blood pressure was 176/96 mmHg, his heart
sounds were normal and his chest was clear. The abdomen was normal. Fundoscopy revealed
bilateral dot haemorrhages, microaneurysms and hard exudates. Urinalysis showed protein 4+, blood
2+. Investigations serum creatinine 176 .mol/L (60–110) fasting plasma glucose 16.7 mmol/L (3.0–
6.0) urinary albumin:creatinine ratio 287 mg/mmol (<2.5) ultrasound scan of kidneys normal
appearances, left kidney 10.4 cm, right kidney 11.2 cm What is the most likely diagnosis?
A. diabetic nephropathy
B. focal and segmental glomerulosclerosis
C. hypertensive nephropathy
D. idiopathic membranous nephropathy
E. ischaemic nephropathy
ANSWER: A
60. A 68 year old male diagnosed with nephrotic syndrome receives steroid therapy without benefit.
His investigations show an albumin of 20 g/L (37 - 49), Total cholesterol of 12 mmol/l, dipstick
urinanalysis reveals +++ protein and a renal biopsy shows focal segmental glomerulosclerosis. Which
one of the following is most likely to preserve renal function?
A. dietary salt restriction
B. low dietary protein intake
C. ramipril
D. simvastatin
E. warfarin
ANSWER: C
61. 50-A 25 year old woman who is 20 weeks pregnant is diagnosed with pyelonephritis. She had
suffered recurrent urinary infections since childhood and her family history reveals that her mother
had a history of hypertension and had been told she had a kidney problem. Examination was normal
and Urea and Creatinine were both normal What is the most likely diagnosis?
A. autosomal dominant polycystic kidney disease
B. bladder outlet obstruction
C. normal physiological urinary stasis of pregnancy
D. reflux nephropathy
E. renal stone disease
ANSWER: D
62. A 60 year old male is noted to have macroglossia, hepatomegaly and has waxy papules in the
eyelids, neck and groin. He complains of symptoms of carpal tunnel syndrome. He has now
developed oedema and is found to have nephrotic syndrome. What is the most likely diagnosis?
A. Amyloidosis
B. Glomerulonephritis
C. Minimal change disease
D. Scleroderma
E. Hypercholesterolaemia
ANSWER: A
63. A 30-year-old woman with fatigue, arthralgia, alopecia, and weight loss for 4 months presents to
her primary care physician after going to the beach and developing a red rash on her face. The rash
initially developed over the bridge of her nose and later spread to her cheeks but spared the nasolabial
fold. Urine dipstick analysis demonstrates 2+ protein, microscopic urinalysis reveals dysmorphic
erythrocytes and cellular casts, and a 24-hour urine collection reveals 1500 mg of protein. Renal
biopsy is performed, which demonstrates increased mesangial, epithelial, endothelial, and
inflammatory cells involving more than 70% of glomeruli. What is this patient’s diagnosis?
A. Proliferative glomerulonephritis
B. Azotemia
C. Acute Tubular Necrosis
D. CRF
E. Uremia
ANSWER: A
64. A 55-year-old man comes to the emergency department with pain on urination, fever and chills.
He also complains of perineal and suprapubic tenderness as well as dysuria and hesitancy. His
allergies include codeine, sulfonamides, and quinidine. Temperature is 38.5 C (101.3 F), blood
pressure is 132/90 mm Hg, pulse is 88/min, and respirations are 18/min. Abdominal examination is
remarkable for suprapubic tenderness. Digital rectal examination demonstrates a swollen, boggy, and
exquisitely painful prostate gland. Laboratory studies show a leukocyte count of 11,500/mm3,
creatinine of 0.9 mg/dL, and blood urea nitrogen of 16 mg/dL. A urinalysis shows too numerous to
count white blood cells and Gram-negative rods. The most appropriate treatment for this patient is
A. amoxicillin/clavulanate 875 mg by mouth twice daily for 14 days
B. ceftriaxone 1 gram intravenously daily for 5 days
C. ciprofloxacin 500 mg by mouth twice daily for 14 days
D. clindamycin 300 mg 4 times daily for 10 days
E. trimethoprim-sulfamethoxazole 1 double strength tablet twice daily for 14 days
ANSWER: C
65. A 45-year-old woman who has had slowly progressive renal failure begins to complain of
increasing numbness and prickling sensations in her legs. Examination reveals loss of pinprick and
vibration sensation below the knees, absent ankle jerks, and impaired pinprick sensation in the hands.
Serum creatinine concentration, checked during her most recent clinic visit, is 0,790 mmol/L (8.9
mg/dL). The woman's physician should now recommend
A. a therapeutic trial of phenytoin
B. a therapeutic trial of pyridoxine (vitamin B6)
C. a therapeutic trial of cyanocobalamin (vitamin B12)
D. initiation of renal replacement therapy
E. neurologic referral for nerve conduction studies
ANSWER: D
66. A 29-year-old woman is critically ill. The illness was manifested by oliguria, edema, severe
headache. Pasternatsky’s sigh is negative in both sides. On lab exam, WBC of 10.000/mcL; on
urinalysis protein of 1,6g/L, erythrocyturia. Your preliminary diagnosis.
A. Acute pyelonephritis
B. Acute glomerulonephritis
C. Cancer of the kidney
D. Urolithiasis
E. Chronic glomerulonephritis
ANSWER: A
67. A 39-year-old black man presents for hypertension discovered during a pre-employment
examination. He is healthy but has a family history of hypertension in both parents and two siblings.
He has no history of cardiovascular disease and does not use tobacco, alcohol, or recreational drugs.
He is taking no medications. The patient appears well. Height is 173 cm (68), body weight is 78 kg
(172 Ib), and blood pressure is 160/1 02 mm Hg seated and standing. The physical examination is
otherwise normal. A complete blood count and electrolyte panel are normal. The serum creatinine
concentration is 1 .8 mg/dL, and urinalysis reveals 2+ proteinuria. Which is the most appropriate
antihypertensive therapy for this patient?
A. Intensive lifestyle modification
B. Angiotensin-converting enzyme inhibitor
C. Diuretic
D. Nondihydropyridine calcium channel blocker
E. None of them
ANSWER: B
67. All the following features favor ventricular tachycardia as the cause of broad-complex
tachycardia, EXCEPT:
A. QRS duration with right bundle branch block morphology (RBBB) is greater than 140 ms, and
greater than 160 ms with left LBBB morphology
B. LAD with RBBB morphology, extreme LAD (northwest axis) with LBBB morphology
C. AV dissociation
D. Response to carotid sinus massage
E. Concordance of the QRS pattern in all precordial leads (i.e., all positive or all negative
deflections)
ANSWER: D
68. Which of the following will most likely respond to verapamil?
A. RVOT tachycardia
B. Idiopathic LV tachycardia
C. Bundle branch re-entry tachycardia
D. ARVD ventricular tachycardia
E. All of the above
ANSWER: B
69. The most common type of arrhythmia in WPW syndrome is....
A. Ventricular tachycardia
B. Ventricular fibrillation
C. Ventricular premature complexes
D. Atrial ectopics
E. AV re-entry tachycardia
ANSWER: E
70. Use of echocardiogram in the assessment of AF:
A. It is not necessary to perform a TTE in patients with AF
B. TEE is always needed to allow better assessment of the MV and LA
C. TTE should be performed at baseline to diagnose associated structural/functional heart disease
D. TTE is necessary to determine stroke risk stratification for thromboprophylaxis in all patients
E. When TTE is technically difficult, MRI is needed to exclude cardiac abnormalities
ANSWER: C
71. Which is the preferred initial treatment strategy for rate control in AF patients?
A. Digoxin
B. Beta-blockers or rate limiting CCB
C. Combination therapy of beta-blockers and rate-limiting CCB’s
D. Amiodarone
E. Combination therapy of digoxin and beta-blockers
ANSWER: B
72. Which option is better in regard to cardioversion?
A. Synchronised DC shock to restore sinus rhythm
B. Amiodarone in all patients to restore sinus rhythm
C. Flecainide in patients with IHD to maintain sinus rhythm
D. Digoxin to restore sinus rhythm
E. Propaphenone to restore sinus rhythm in HCMP patients
ANSWER: A
73. Regarding antithrombotic treatment in AF:
A. Patients with asymptomatic AF have less risk of embolism than symptomatic patients
B. Patients with atrial flutter do not need antithrombotic treatment due to the low risk of
embolism of this arrhythmia
C. Warfarin is the best option in patients with high risk of thromboembolism
D. Aspirin has a similar effect in stroke reduction to placebo
E. Paroxysmal AF has the lowest risk of embolism
ANSWER: C
74. Sudden cardiac death in patients >35 years old is most commonly associated with:
A. Hypertrophic cardiomyopathy
B. Coronary artery disease
C. Congenital long QT syndrome
D. Long QT syndrome secondary to various medications
E. arrhythymogenic RV cardiomyopathy
ANSWER: B
75. Congenital long QT syndrome can lead to
A. Complete heart block
B. Polymorphic ventricular tachycardia
C. Acute myocardial infarction
D. Recurrent supraventricular tachycardia
E. All of the above
ANSWER: B
76. Bundle branch re-entry ventricular tachycardia is most commonly associated with:
A. Enhanced automaticity in the right bundle
B. Enhanced automaticity in the left bundle
C. Supranormal conduction in the His bundle
D. Abnormally slow conduction in the His bundle
E. All of the above
ANSWER: D
77. All of the following are ECG manifestations of Wolff-Parkinson-White syndrome
EXCEPT
A. Narrow QRS
B. Initial slurred QRS upstroke
C. Short PQ interval
D. Normal QT interval
E. All of the above
ANSWER: A
78. The initial manifestations of WPW syndrome may include which of the following?
A. Atrial fibrillation
B. AV re-entry tachycardia
C. Ventricular fibrillation
D. Wide-QRS tachycardia
E. All of the above
ANSWER: E
79. The presence of an r prime in V1 during narrow-QRS tachycardia is suggestive of...
A. AV re-entry
B. AV node re-entry
C. Rate-dependent BBB
D. Atrial tachycardia
E. Atrial fibrillation
ANSWER: B
80. Ventricular ectopic beats (VEBs) occurring in apparently normal hearts are:
A. Associated with a bad prognosis
B. Never frequent or complex
C. Less frequent with increasing age
D. May be associated with symptoms of “missed beats”
E. Always symptomatic
ANSWER: D
81. In patients with ventricular ectopic beats:
A. Caffeine restriction always reduces symptoms
B. High caffeine intake should always be discouraged in symptomatic patients
C. There is good evidence that reducing caffeine intake reduces ectopics
D. Hypertension has no association with frequency of ectopic beats
E. LVH is not associated with increased frequency of ectopics
ANSWER: B
82. Regarding ventricular ectopics and exercise:
A. Ectopics are usually benign if they are supressed on exercise
B. Exercise-induced VEBs are not associated with adverse prognosis
C. RVOT ectopics are usually supressed on exercise
D. Ectopics induced on recovery after exercise are benign
E. All of the above
ANSWER: A
83. An idiopathic left ventricular tachycardia (VT) shows the following...
A. Typical LBBB morphology
B. LAD and RBBB morphology
C. Associated with a high risk of sudden cardiac death and almost always requires ICD therapy
D. Never responds to verapamil
E. All of the above
ANSWER: B
84. Wenckebach phenomenon is defined as...
A. Progressive shortening of PR interval till a beat is dropped
B. Progressive lengthening of PR interval till a beat is dropped
C. Irregular heart rate and PVC’s
D. Shortened QT intervals
E. Slurred QRS complex
ANSWER: B
85. Giant a waves in JVP (“cannon” waves) are seen in
A. Sinus bradycardia
B. Atrial fibrillation
C. First-degree AV-block
D. Complete heart block
E. Atrial ectopic
ANSWER: D
86. All of the following findings are suggestive of LVH except:
A. (S in V1 + R in V5 or V6) > 35 mm
B. R in aVL > 11 mm
C. R in aVF > 20 mm
D. (R in I + S in III) > 25 mm
E. R in aVR > 8 mm
ANSWER: E
87. All of the following findings are suggestive of RVH except:
A. R in V1=7 mm (15 mm with RBBB)
B. (R in V1 + S in V5 or V6) > 10 mm
C. R < S in V6
D. R or R’ in V1
E. S in V3 + R in aVL > 28 mm (20 mm for women)
ANSWER: E
88. When present, each of the following heart sounds occurs shortly after S2 EXCEPT:
A. Opening snap
B. Third heart sound
C. Ejection clic
D. Tumor plop
E. Pericardial knock
ANSWER: C
89. Each of the following statements regarding splitting of the second heart sound is true
EXCEPT:
A. Severe pulmonic valvular stenosis is associated with a softened P2
B. Delayed closure of the pulmonic valve with inspiration contributes to physiologic splitting of
S2
C. Fixed splitting of S2 is the auscultatory hallmark of an ostium secundum atrial septal defect
D. Paradoxical splitting of S2 is expected in patients with a right ventricular electronically paced
rhythm
E. Right bundle branch block is associated with paradoxical splitting of S2
ANSWER: E
90. The timing of an "innocent" murmur is usually:
A. Early systolic
B. Presystolic
C. Midsystolic
D. Holosystolic
E. Early diastolic
ANSWER: C
91. Which of the following pairs of medical conditions and antihypertensive medications
would be incorrect to use in a patient with essential hypertension?
A. Beta-blocker and a history of myocardial infarction
B. Alpha-blocker and prostatic hypertrophy
C. Thiazide diuretic and gout
D. Amlodipine and heart failure
E. ACE-inhibitor and diabetes mellitus
ANSWER: C
92. Thiazide diuretics can contribute to each of the following metabolic effects EXCEPT:
A. Hypomagnesemia
B. Hypouricemia
C. Hypercalcemia
D. Hypercholesterolemia
E. Hyponatremia
ANSWER: B
93. Which of the following statements regarding prevention of stroke is correct?
A. Treatment of systolic hypertension does not decrease the risk of stroke in patients older than
age 60
B. Hypertension should not be a target of secondary prevention after an ischemic stroke because
elevated BP is desirable to maintain adequate cerebral perfusion
C. Treatment with HMG-CoA reductase inhibitors reduces the risk of recurrent stroke
D. The combination of aspirin and clopidogrel is superior to aspirin alone for prevention of
recurrent stroke
E. None of the above
ANSWER: C
94. You see a diabetic patient presents with BP readings that are 155/95 or higher. All of the
following statements about the treatment of this patient's hypertension are correct EXCEPT:
A. Pharmacologic blocade of the renin-angiotensin system reduces the risk of both microvascular
and macrovascular events
B. Aggressive BP control reduces cardiovascular events more in diabetics than in nondiabetics
C. Calcium channel blockers show no benefit in reducing cardiovascular events
D. The goal BP for this patient is <130/80 mmHg
E. All the above statements are correct
ANSWER: C
95. Which of the following antihypertensive agents is a known cause of autoimmune hemolytic
anemia?
A. Metoprolol
B. Methyldopa
C. Captopril
D. Losartan
E. Monoxidine
ANSWER: B
96. All of the following characteristics are typical of hypertensive crisis EXCEPT:
A. Diastolic BP >120 mmHg
B. Retinal hemorrhages
C. Constriction of cerebral arterioles with decreased vascular permeability
D. Proteinuria
E. Microangiopathic hemolytic anemia
ANSWER: C
97.
Which of the following pairs of medical conditions and antihypertensive medications
would be INCORRECT to use in a patient with essential hypertension?
A. Beta-blocker and a history of myocardial infarction
B. Alpha-blocker and prostatic hypertrophy
C. Thiazide diuretic and gout
D. Amlodipine and heart failure
E. ACE-inhibitor and diabetes mellitus
ANSWER: C
98. Which of the following statements regarding antihypertensive agents and atrial fibrillation
(AF) is TRUE?
A. Losartan has been shown to decrease new-onset AF more effectively than atenolol
B. Valsartan has been shown to decrease new-onset AF more effectively than amlodipine
C. Atenolol has been shown to decrease new-onset AF more effectively than captopril
D. Nifedipine has been shown to decrease new-onset AF more effectively than diltiazem
E. All of the above are false
ANSWER: A
99.
Which lifestyle change has been shown to produce the biggest reduction in systolic blood
pressure?
A. 10-kg weight loss
B. Dietary sodium reduction
C. Moderation of alcohol consumption
D. Change to a vegetarian diet
E. Magnesium supplement
ANSWER: A
100. Which of these statements is true regarding renin-angiotensin system-blocking agents?
A. Less effective when combined with a diuretic than when used alone
B. More effective in patients of African descent than in white patients
C. Preserve kidney function in addition to lowering blood pressure
D. Are the first-line antihypertensive medications in pregnancy
E. All of the above
ANSWER: C