Internal Medicine 10 MCQs - 1

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1. Why patients with factor V Leiden mutation are at higher risk for venous thrombosis during pregnancy or after surgery?

This mutation is associated with an antibody to protein S.

This mutation is associated with an antibody to protein C.

Platelets aggregate abnormally.

Inability of protein C to cleave factor V.

2. Which of the following is likely to be a neoplasm of T-lymphocyte lineage?

Mycosis fungoides.

Chronic lymphocytic leukemia

Follicular lymphomas.

Burkitt's lymphoma

3. A 55 years old man complains of numbness in both legs and progressive inability to walk over the past 2 months. Physical examination is normal except for a decrease perception of light touch and pain in the lower extremities as well as bilateral leg weakness. There is no sensory level. Laboratory workup is remarkable for a hematocrit of 30 % and elevated total protein. Serum protein electrophoresis reveals an M spike. The etiology of this patient’s weakness is most likely.

Necrosis of central nervous system gray and white matter.

Inflammation of dorsal root ganglia.

Tumor elaborated immunoglobulin that is reacting with myelin components.

Loss of cerebellar Purkinje cells.

4. A 28-year-old man presents with chest pain. Chest x-ray show a large mediastinal mass. Abdominal CT reveals periaortic lymphadenopathy. Physical examination, including examination of testes, is negative. Mediastinoscopic biopsy reveals poorly differentiated carcinoma. Which of the following laboratory tests would be most likely to be positive?

CA- 125.

Beta human chorionic gonadotropin.

Prostate specific antigen.

Carcinoembryonic antigen.

5. A 38-year-old premenopausal woman has a 3 cm mass in her left breast. Breast biopsy reveals infiltrating ductal carcinoma, and a left modified radical mastectomy is performed. The pathology report states that the primary tumor is estrogen receptor positive and that 4 of 28 lymph nodes identified are involved with tumor. Chest x-ray, bone scan, liver scan, and blood chemistries are all normal. The most appropriate next step in the management of this patient would be.

Antiestrogen therapy.

Bilateral oophorectomy.

Post-operative radiation therapy to the left chest wall and axilla.

Appropriate combination chemotherapy.

6. A 45-year-old woman with long standing rheumatoid arthritis is diagnosed as having ‘anemia of chronic disease’. The predominant mechanism causing this type of anemia in persons with chronic inflammatory disorder is

Intravascular hemolysis.

Defective porphyrin synthesis.

Impaired incorporation of iron into porphyrin.

Impaired transfer of reticuloendothelial storage iron to marrow erythroid precursors.

7. A 29-year-old woman is brought to accident and emergency after suffering from a seizure at work witnessed by a colleague. She reports the patient has been unwell for the past week with the headaches and nasal congestion, but reused any sick leave. The patient has a temperature of 38.3 oC. A swollen bulging eye and ipsilateral gaze palsy. The most likely diagnosis is

Cavernous sinus thrombosis.

Giant cell arteritis.

Duane syndrome.

Cerebral abscess.

8. A 17-year-old boy is rushed to accident and emergency after breathing difficulties in a restaurant. The parents report the patient feeling unwell after eating a cake containing nuts. The patient has swollen lips and tongue and an audible wheeze is heard. The most appropriate first line treatment is

0.05 mg intravenous adrenaline.

100 mg intravenous hydrocortisone.

20 mg intravenous chlorphenamine.

0.5 mg intramuscular adrenaline.

9. A 57-year-old woman complains of headache and weakness on the right side of her body. The headache is normally worst first thing in the morning and is particularly painful on her left-hand side. The weakness has occurred very gradually over several weeks and is most noticeable when lifting objects. On examination, her temperature is 38.5 oC. She has recently had a left ear infection which is not causing any pain now. The most likely diagnosis is

Subdural hemorrhage.

Otitis media.

Cerebral abscess.

Mollaret’s meningitis.

10. Persons with polycythemia vera and a hematocrit more than 45% are most likely to display which of the following?

Hypocellular bone marrow.

Decreased carotid blood flow.

Increased levels of urinary erythropoietin.

Increased bone marrow iron stores.

Internal Medicine 10 MCQs – 1

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