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Year : 2022  |  Volume : 12  |  Issue : 2  |  Page : 95-96

Medical quiz

Assistant Professor, Department of Medicine, Assam Medical College and Hospital, Dibrugarh, Assam, India

Date of Web Publication23-Nov-2022

Correspondence Address:
Dr. Dibyajyoti Borah
Department of Medicine, Assam Medical College and Hospital, Dibrugarh, Assam
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2278-8239.361832

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How to cite this article:
Borah D. Medical quiz. Assam J Intern Med 2022;12:95-6

How to cite this URL:
Borah D. Medical quiz. Assam J Intern Med [serial online] 2022 [cited 2023 Mar 22];12:95-6. Available from: http://www.ajimedicine.com/text.asp?2022/12/2/95/361832

Q1. A 78-year-old female is seen in the clinic with complaints of urinary incontinence for several months. She finds that she is unable to hold her urine at random times throughout the day; this is not related to coughing or sneezing. The leakage is preceded by an intense need to empty the bladder. She has no pain associated with these episodes, though she finds them very distressing. The patient is otherwise independent in the activities of daily living, with continued ability to cook and clean for herself. Which of the following statements is true?

  1. The abrupt onset of similar symptoms should prompt cystoscopy.

  2. First-line therapy for this condition consists of desmopressin.

  3. Indwelling catheters are rarely indicated for this disorder.

  4. Referral to a genitourinary surgeon is indicated for surgical correction.

  5. Urodynamic testing must be performed before the prescription of antispasmodic medications.

Q2. A 64-year-old man with primary light chain amyloidosis develops orthostatic symptoms despite maintaining adequate oral intake. He also notes early satiety, with bloating and vomiting if he eats too rapidly. To combat this, he has decreased the size of his meals but eats twice as frequently during the day, with some positive effect. What is the most likely explanation for his gastrointestinal symptoms?

  1. Diverticulosis

  2. Gastric cancer

  3. Gastroparesis

  4. Irritable bowel syndrome E. Small-bowel obstruction

Q3. A 38-year-old man with multiple sclerosis develops acute flaccid weakness in his left arm and left leg. Physical examination reveals normal sensorium, normal cranial nerve function, 1/5 strength in his left upper extremity, 0/5 strength in his left lower extremity, impaired proprioception in his left leg, intact proprioception in his right leg, decreased pain and temperature sensation in his right arm and leg, and normal light touch/pain and temperature sensation in his right leg. Where is his causative lesion most likely to be?

  1. Cervical nerve roots

  2. High cervical spinal cord

  3. Medulla

  4. Pons

  5. Right cortical hemisphere

Q4. A 35-year-old male is seen in the clinic for evaluation of infertility. He has never fathered any children, and after 2 years of unprotected intercourse his wife has not achieved pregnancy. Sperm analysis shows a normal number of sperm, but they are immotile. Past medical history is notable for recurrent sinopulmonary infections, and the patient recently was told that he has bronchiectasis. Chest radiography is likely to show which of the following?

  1. Bihilar lymphadenopathy

  2. Bilateral upper lobe infiltrates

  3. Normal findings

  4. Situs inversus

  5. Water balloon–shaped heart

Q5. A 19-year-old normal nonsmoking female has a moderately severe pulmonary embolism while on oral contraceptive pills. Which of the following is the most likely predisposing factor?

  1. Abnormal factor V

  2. Abnormal protein C

  3. Diminished protein C level

  4. Diminished protein S level

  5. Diminished antithrombin III level

Q6. A 28-year-old woman with HIV on antiretroviral therapy complains of abdominal pain in the emergency department. Laboratory data show a creatinine of 3.2 mg/dL; her baseline creatinine is 1.0 mg/dL. Urinalysis shows large numbers of white blood cells and red blood cells without epithelial cells, leukocyte esterase, or nitrites. Which test is indicated to diagnose the cause of her acute renal failure?

  1. Acid-fast stain of the urine

  2. Anti-GBM (glomerular base membrane) antibodies

  3. Renal angiogram

  4. Renal ultrasound E. Urine electrolytes

Q7. A 57-year-old man is admitted to the hospital for dehydration and confusion. In the emergency department he complained of excessive thirst and he was found to have a serum sodium of 162 meq/L and a newly elevated creatinine of 2.2 mg/dL. After receiving IV fluid, his sensorium clears and the patient relays to you that he drinks large amounts of fluid each day and makes about 2 L of urine each day. He has noticed that his urine output has no relation to the amount of fluid he drinks. His sodium remains elevated at 150 meq/L, and his urine osmolality returns at 80 mosmol/kg. After careful water restriction, you administer 10 µg of desmopressin intranasally and remeasure his urine osmolality. The osmolality is now 94 mosmol/kg. What is the most likely cause of his hypernatremia?

  1. Chronic hyperventilation

  2. Diabetes insipidus

  3. Excessive solute intake

  4. Gastrointestinal losses

  5. Surreptitious use of diuretics

Q8. A patient with a history of Sjögren’s syndrome has the following laboratory findings: plasma sodium 139 meq/L, chloride 112 meq/L, bicarbonate 15 meq/L, and potassium 3.0 meq/L; urine studies show a pH of 6.0, sodium of 15 meq/L, potassium of 10 meq/L, and chloride of 12 meq/L. The most likely diagnosis is

  1. type I renal tubular acidosis (RTA)

  2. type II RTA

  3. type III RTA

  4. type IV RTA

  5. chronic diarrhea

Q9. A 16-year-old woman had visited your clinic 1 month ago with jaundice, vomiting, malaise, and anorexia. Two other family members were ill with similar symptoms. Based on viral serologies, including a positive anti-hepatitis A virus (HAV) IgM, a diagnosis of hepatitis A was made. The patient was treated conservatively, and 1 week after first presenting, she appeared to have made a full recovery. She returns to your clinic today complaining of the same symptoms she had 1 month ago. She is jaundiced, and an initial panel of laboratory tests returns elevated transaminases. Which of the following offers the best explanation of what has occurred in this patient?

  1. Co-infection with hepatitis C

  2. Hepatitis A recurrence

  3. Inappropriate treatment of initial infection

  4. Incorrect initial diagnosis; this patient likely has hepatitis B

  5. Relapsing hepatitis

Q10. A 34-year-old male reports “yellow eyes” for the last 2 days during a routine employment examination. He states that since his early twenties he has had similar episodes of yellow eyes lasting 2 to 4 days. He denies nausea, abdominal pain, dark urine, light-colored stools, pruritus, or weight loss. He has not sought prior medical attention because of finances, lack of symptoms, and the predictable resolution of the yellow eyes. He takes a multivitamin and some herbal medications. On examination he is mildly obese. He is icteric. There are no stigmata of chronic liver disease. The patient’s abdomen is soft and nontender, and there is no organomegaly. Laboratory examinations are normal except for a total bilirubin of 3 mg/dL. Direct bilirubin is 0.2 mg/dL. AST, ALT, and alkaline phosphatase are normal. Hematocrit, lactate dehydrogenase (LDH), and haptoglobin are normal. Which of the following is the most likely diagnosis?

  1. Crigler-Najjar syndrome type 1

  2. Cholelithiasis

  3. Dubin-Johnson syndrome

  4. Gilbert’s syndrome

  5. Medication-induced hemolysis

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