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SMLE - Interne
| Question | Answer | |
|---|---|---|
| A 55-year-old man with exertional chest pain relieved by rest. Diagnosis? | A. Unstable angina | B. Stable angina | C. NSTEMI | D. STEMI | B. Stable angina pectoris |
| A 58-year-old man with chest pain at rest, no ST elevation, troponin negative. Diagnosis? | A. Stable angina | B. Unstable angina | C. NSTEMI | D. Pericarditis | B. Unstable angina |
| A 60-year-old man with chest pain, ST depression, troponin positive. Diagnosis? | A. Stable angina | B. NSTEMI | C. STEMI | D. Prinzmetal angina | B. Non-ST elevation myocardial infarction |
| A 59-year-old man with ST elevation in II, III, aVF. Diagnosis? | A. Anterior MI | B. Lateral MI | C. Inferior MI | D. Posterior MI | C. Inferior wall myocardial infarction |
| A 62-year-old man with chest pain, hypotension, JVD, clear lungs. Diagnosis? | A. LV infarct | B. RV infarct | C. Pulmonary embolism | D. Pericarditis | B. Right ventricular infarction |
| A 55-year-old man with chest pain radiating to arm, sweating, elevated troponin. Management? | A. Aspirin + clopidogrel | B. Morphine + oxygen | C. Beta-blocker | D. All | D. All of the above (MONA-B) |
| A 60-year-old post-MI patient — drug proven to improve survival? | A. ACE inhibitor | |
| A 57-year-old with MI complicated by pulmonary edema. Treatment? | A. Furosemide + morphine | B. Beta-blocker | C. IV fluid | D. Digoxin | A. IV furosemide and morphine |
| A 58-year-old with MI — contraindication to beta-blockers? | A. Bradycardia | B. Hypertension | C. Diabetes | D. Smoking | A. Bradycardia or heart block |
| A 70-year-old hypertensive patient with ankle edema due to medication. Drug? | A. Amlodipine | B. Losartan | C. Atenolol | D. Enalapril | A. Calcium channel blocker (Amlodipine) |
| A 50-year-old with hypertension, dry cough, started on ACE inhibitor. Alternative drug? | A. ARB | B. Beta-blocker | C. Diuretic | D. CCB | A. Angiotensin receptor blocker (ARB) |
| A 65-year-old diabetic with hypertension and proteinuria. Preferred drug? | A. ACE inhibitor | B. Beta-blocker | C. Diuretic | D. CCB | A. ACE inhibitor |
| A 70-year-old with isolated systolic hypertension. Best treatment? | A. Thiazide diuretic | B. Beta-blocker | C. ACE inhibitor | D. CCB | D. Calcium channel blocker |
| A 60-year-old with malignant hypertension. Drug of choice? | A. Nitroprusside | B. Hydralazine | C. Captopril | D. Labetalol | A. IV nitroprusside |
| A 55-year-old with pulsus paradoxus, JVD, muffled heart sounds. Diagnosis? | A. Pericardial effusion | B. Cardiac tamponade | C. Constrictive pericarditis | D. RV infarct | B. Cardiac tamponade |
| A 45-year-old man with chest pain relieved by leaning forward, diffuse ST elevation. Diagnosis? | A. MI | B. Pericarditis | C. PE | D. GERD | B. Acute pericarditis |
| A 60-year-old man with Kussmaul sign, pericardial knock, JVP elevation. Diagnosis? | A. Cardiac tamponade | B. Constrictive pericarditis | C. RV failure | D. PE | B. Constrictive pericarditis |
| A 70-year-old man with severe tearing chest pain radiating to back, unequal BP in arms. Diagnosis? | A. MI | B. Aortic dissection | C. PE | D. Tamponade | B. Aortic dissection |
| A 65-year-old smoker with chronic cough, sputum, cyanosis. Diagnosis? | A. Chronic bronchitis | B. Emphysema | C. Asthma | D. Bronchiectasis | A. Chronic bronchitis |
| A 60-year-old with barrel chest, pursed-lip breathing, hyperinflated lungs. Diagnosis? | A. Emphysema | B. Asthma | C. Chronic bronchitis | D. Bronchiectasis | A. Emphysema |
| A 45-year-old man with episodic wheeze, cough, reversible obstruction. Diagnosis? | A. Asthma | B. COPD | C. Bronchiectasis | D. PE | A. Bronchial asthma |
| A 30-year-old asthmatic using β2-agonist daily with symptoms at night. Next step? | A. Add inhaled corticosteroid | B. Add theophylline | C. Add LABA | D. Stop treatment | A. Add inhaled corticosteroid |
| A 55-year-old man with COPD, chronic hypercapnia. Oxygen therapy caution? | A. May suppress respiratory drive | B. Causes acidosis | C. Irrelevant | D. None | A. Can depress hypoxic drive |
| A 60-year-old chronic smoker with weight loss and clubbing. Diagnosis? | A. Bronchogenic carcinoma | B. COPD | C. TB | D. Bronchiectasis | A. Lung cancer |
| A 45-year-old with hemoptysis, night sweats, weight loss, apical infiltrates. Diagnosis? | A. TB | B. Pneumonia | C. Cancer | D. Abscess | A. Pulmonary tuberculosis |
| A 35-year-old with productive cough, fever, rusty sputum. Diagnosis? | A. Pneumococcal pneumonia | B. Atypical pneumonia | C. TB | D. Bronchitis | A. Streptococcus pneumoniae infection |
| A 28-year-old with cough, myalgia, diffuse infiltrates, cold agglutinins positive. Diagnosis? | A. Mycoplasma pneumonia | B. Viral pneumonia | C. TB | D. Chlamydia | A. Atypical (Mycoplasma) pneumonia |
| A 30-year-old with pneumonia and diarrhea, hyponatremia. Organism? | A. Legionella | B. Strep pneumo | C. Klebsiella | D. Mycoplasma | A. Legionella pneumophila |
| A 40-year-old alcoholic with cavitating pneumonia in upper lobe. Organism? | A. Klebsiella | B. Staph | C. TB | D. Pseudomonas | A. Klebsiella pneumoniae |
| A 50-year-old man with sudden pleuritic pain, dyspnea, tachycardia, D-dimer positive. Diagnosis? | A. PE | B. Pneumonia | C. MI | D. COPD | A. Pulmonary embolism |
| A 45-year-old with DVT and SOB, CT shows saddle embolus. Treatment? | A. Heparin | B. Warfarin | C. Thrombolysis | D. Oxygen | C. Thrombolysis (massive PE) |
| A 60-year-old man with pleural effusion, exudate, high LDH. Diagnosis? | A. TB effusion | B. CHF | C. Cirrhosis | D. Nephrotic | A. Tuberculous exudative effusion |
| A 40-year-old woman with dry cough, bilateral hilar lymphadenopathy. Diagnosis? | A. Sarcoidosis | B. TB | C. Lymphoma | D. COPD | A. Sarcoidosis |
| A 50-year-old man with hematuria, hemoptysis, anti-GBM antibodies. Diagnosis? | A. Goodpasture | B. Wegener | C. PAN | D. SLE | A. Goodpasture syndrome |
| A 60-year-old man with nasal ulcer, hematuria, c-ANCA positive. Diagnosis? | A. Wegener granulomatosis | B. PAN | C. SLE | D. Goodpasture | A. Granulomatosis with polyangiitis (Wegener’s) |
| A 40-year-old man with HTN, uveitis, erythema nodosum, bilateral hilar lymphadenopathy. Diagnosis? | A. Sarcoidosis | B. TB | C. RA | D. SLE | A. Sarcoidosis |
| A 35-year-old with hemoptysis, cavitating lesion, c-ANCA positive. Diagnosis? | A. Wegener | B. TB | C. Cancer | D. Goodpasture | A. Granulomatosis with polyangiitis |
| A 45-year-old man with chronic cough, hemoptysis, clubbing, purulent sputum. Diagnosis? | A. Bronchiectasis | B. TB | C. Cancer | D. COPD | A. Bronchiectasis |
| A 50-year-old man with polyuria, polydipsia, fasting glucose 160 mg/dL. Diagnosis? | A. Type 1 DM | B. Type 2 DM | C. Diabetes insipidus | D. Stress hyperglycemia | B. Type 2 diabetes mellitus |
| A 25-year-old man with polyuria, polydipsia, weight loss, ketones in urine. Diagnosis? | A. Type 1 DM | B. Type 2 DM | C. DI | D. Cushing | A. Type 1 diabetes mellitus |
| A 40-year-old diabetic with fruity breath, Kussmaul breathing. Diagnosis? | A. DKA | B. HONK | C. Lactic acidosis | D. Hypoglycemia | A. Diabetic ketoacidosis |
| A 60-year-old diabetic with hyperosmolar coma, no ketones. Diagnosis? | A. DKA | B. HONK | C. Lactic acidosis | D. Hypoglycemia | B. Hyperosmolar nonketotic coma |
| A 55-year-old diabetic with HbA1c 9%. Indicates? | A. Poor control | B. Good control | C. Normal | D. Hypoglycemia | A. Poor glycemic control |
| A 40-year-old diabetic with microalbuminuria. Next step? | A. ACE inhibitor | B. Loop diuretic | C. ARB | D. Both A and C | A. Start ACE inhibitor therapy |
| A 60-year-old diabetic with neuropathy and absent ankle reflexes. Diagnosis? | A. Peripheral neuropathy | B. Myopathy | C. Nephropathy | D. Retinopathy | A. Diabetic peripheral neuropathy |
| A 55-year-old man with retinopathy and nephropathy. Type of diabetes complication? | A. Microvascular | B. Macrovascular | C. Acute | D. None | A. Microvascular complication |
| A 50-year-old diabetic with MI and stroke. Type of complication? | A. Microvascular | B. Macrovascular | C. Neuropathic | D. None | B. Macrovascular complication |
| A 45-year-old with hypoglycemia, high insulin, low C-peptide. Cause? | A. Exogenous insulin | B. Insulinoma | C. Sulfonylurea | D. Addison | A. Exogenous insulin use |
| A 40-year-old with fasting hypoglycemia, high insulin and C-peptide. Diagnosis? | A. Insulinoma | B. Addison | C. Factitious | D. GH tumor | A. Insulinoma |
| A 35-year-old woman with palpitations, weight loss, tremor, heat intolerance. Diagnosis? | A. Hypothyroidism | B. Thyrotoxicosis | C. Pheochromocytoma | D. Anxiety | B. Hyperthyroidism (thyrotoxicosis) |
| A 30-year-old woman with exophthalmos and pretibial myxedema. Diagnosis? | A. Graves disease | B. Toxic adenoma | C. Hashimoto | D. Thyroiditis | A. Graves disease |
| A 45-year-old woman with weight gain, cold intolerance, dry skin. Diagnosis? | A. Hypothyroidism | B. Hyperthyroidism | C. Cushing | D. Addison | A. Hypothyroidism |
| A 50-year-old woman with painless goiter and hypothyroidism. Diagnosis? | A. Hashimoto | B. Graves | C. De Quervain | D. Subacute thyroiditis | A. Hashimoto thyroiditis |
| A 40-year-old man with painful thyroid enlargement following viral infection. Diagnosis? | A. De Quervain | B. Graves | C. Hashimoto | D. Riedel | A. Subacute granulomatous (De Quervain) thyroiditis |
| A 55-year-old woman with hard woody thyroid, fixed to trachea. Diagnosis? | A. Riedel thyroiditis | B. Hashimoto | C. Graves | D. De Quervain | A. Riedel thyroiditis |
| A 45-year-old woman with thyroid nodule, cold on scan. Next step? | A. FNAC | B. Observe | C. Radioiodine | D. Surgery | A. Fine-needle aspiration cytology |
| A 60-year-old woman with thyroid nodule, amyloid on biopsy, calcitonin elevated. Diagnosis? | A. Medullary carcinoma | B. Papillary | C. Follicular | D. Anaplastic | A. Medullary thyroid carcinoma |
| A 40-year-old woman with thyroid cancer and psammoma bodies. Diagnosis? | A. Papillary | B. Follicular | C. Medullary | D. Anaplastic | A. Papillary thyroid carcinoma |
| A 50-year-old woman with thyroid cancer invading capsule, hematogenous spread. Diagnosis? | A. Follicular carcinoma | B. Papillary | C. Medullary | D. Anaplastic | A. Follicular carcinoma |
| A 70-year-old with rapidly enlarging thyroid, compressive symptoms. Diagnosis? | A. Anaplastic carcinoma | B. Medullary | C. Papillary | D. Hashimoto | A. Anaplastic carcinoma of thyroid |
| A 45-year-old with fatigue, weight gain, hypotension, hyponatremia, hyperkalemia. Diagnosis? | A. Addison | B. Cushing | C. Conn | D. SIADH | A. Addison’s disease (primary adrenal insufficiency) |
| A 35-year-old woman with truncal obesity, moon face, striae, HTN. Diagnosis? | A. Cushing | B. Addison | C. Conn | D. PCOS | A. Cushing syndrome |
| A 40-year-old woman with Cushing syndrome. Best screening test? | A. Overnight dexamethasone suppression | B. ACTH level | C. Cortisol AM | D. CT adrenals | A. Low-dose dexamethasone suppression test |
| A 45-year-old man with HTN, hypokalemia, metabolic alkalosis. Diagnosis? | A. Conn syndrome | B. Addison | C. Cushing | D. Pheochromocytoma | A. Primary hyperaldosteronism (Conn syndrome) |
| A 50-year-old man with episodic headache, sweating, palpitations, HTN. Diagnosis? | A. Pheochromocytoma | B. Cushing | C. Thyrotoxicosis | D. Anxiety | A. Pheochromocytoma |
| A 45-year-old woman with MEN 2A. Tumors involved? | A. Medullary thyroid + Pheo + Parathyroid | B. Pituitary + Pancreas + PTH | C. Pheo + Insulinoma + GH | D. Adrenal + Pancreas | A. Medullary thyroid carcinoma, pheochromocytoma, hyperparathyroidism |
| A 60-year-old man with galactorrhea and low libido. Diagnosis? | A. Prolactinoma | B. GH adenoma | C. ACTH tumor | D. Cushing | A. Pituitary prolactinoma |
| A 40-year-old man with large hands, jaw, high GH. Diagnosis? | A. Acromegaly | B. Gigantism | C. Cushing | D. Prolactinoma | A. Acromegaly |
| A 42-year-old with acromegaly. Screening test? | A. IGF-1 level | B. GH after glucose | C. MRI | D. TSH | A. Elevated IGF-1 |
| A 45-year-old with central obesity, purple striae, HTN, high cortisol, low ACTH. Diagnosis? | A. Adrenal adenoma | B. Cushing disease | C. Ectopic ACTH | D. Steroid use | A. Adrenal adenoma (ACTH-independent Cushing) |
| A 60-year-old woman with confusion, Na+ 118, osmolality low. Diagnosis? | A. SIADH | B. DI | C. Addison | D. Cushing | A. Syndrome of inappropriate ADH secretion |
| A 30-year-old man with polyuria, polydipsia, hypernatremia, urine osmolality low. Diagnosis? | A. DI | B. DM | C. SIADH | D. Cushing | A. Diabetes insipidus |
| A 25-year-old woman with amenorrhea, galactorrhea, visual field defect. Diagnosis? | A. Prolactinoma | B. Craniopharyngioma | C. Cushing | D. GH tumor | A. Pituitary prolactinoma |
| A 45-year-old man with hyperpigmentation, hypotension, hyperkalemia. Diagnosis? | A. Addison | B. Cushing | C. Conn | D. SIADH | A. Addison’s disease |
| A 55-year-old man with proximal weakness, hypokalemia, metabolic alkalosis. Diagnosis? | A. Conn | B. Addison | C. Cushing | D. Pheochromocytoma | A. Primary hyperaldosteronism |
| A 40-year-old woman with HTN, episodic headache, sweating. Diagnosis? | A. Pheochromocytoma | B. Cushing | C. Conn | D. Addison | A. Pheochromocytoma |
| A 30-year-old woman with polyuria, low urine osmolality, normal glucose. Diagnosis? | A. Diabetes insipidus | B. DM | C. SIADH | D. Addison | A. Diabetes insipidus |
| A 60-year-old man with edema, proteinuria, hypoalbuminemia. Diagnosis? | A. Nephrotic syndrome | B. Nephritic syndrome | C. Glomerulonephritis | D. CKD | A. Nephrotic syndrome |
| A 55-year-old man with periorbital edema, frothy urine, hyperlipidemia. Diagnosis? | A. Minimal change | B. FSGS | C. Membranous nephropathy | D. Diabetic nephropathy | C. Membranous nephropathy |
| A 45-year-old woman with SLE, proteinuria, RBC casts. Diagnosis? | A. Lupus nephritis | B. PSGN | C. FSGS | D. Amyloidosis | A. Lupus nephritis |
| A 35-year-old man with hematuria, cola-colored urine, post-sore throat. Diagnosis? | A. PSGN | B. IgA nephropathy | C. MPGN | D. Lupus | A. Post-streptococcal glomerulonephritis |
| A 25-year-old with recurrent hematuria, after URI, normal complement. Diagnosis? | A. IgA nephropathy | B. PSGN | C. Lupus | D. HSP | A. IgA nephropathy (Berger disease) |
| A 40-year-old man with nephrotic range proteinuria and Congo red positivity. Diagnosis? | A. Amyloidosis | B. FSGS | C. Membranous | D. MPGN | A. Renal amyloidosis |
| A 55-year-old diabetic with progressive renal failure, proteinuria. Diagnosis? | A. Diabetic nephropathy | B. Amyloidosis | C. PSGN | D. FSGS | A. Diabetic nephropathy |
| A 65-year-old hypertensive with small shrunken kidneys. Diagnosis? | A. Chronic kidney disease | B. Acute renal failure | C. Nephrotic syndrome | D. Amyloidosis | A. Chronic kidney disease |
| A 70-year-old man with CKD. Common cause of death? | A. Cardiovascular disease | B. Uremia | C. Anemia | D. Hyperkalemia | A. Cardiovascular complications |
| A 45-year-old man with hematuria, flank pain, palpable mass. Diagnosis? | A. RCC | B. PKD | C. Pyelonephritis | D. Stone | A. Renal cell carcinoma |
| A 50-year-old man with painless hematuria, smoker. Diagnosis? | A. Bladder carcinoma | B. RCC | C. Stone | D. Cystitis | A. Transitional cell carcinoma (bladder cancer) |
| A 55-year-old man with hematuria, flank pain, family history of kidney cysts. Diagnosis? | A. ADPKD | B. ARPKD | C. RCC | D. Hydronephrosis | A. Autosomal dominant polycystic kidney disease |
| A 60-year-old woman with acute renal failure, low urine Na+, high BUN/Cr. Diagnosis? | A. Prerenal | B. Intrinsic | C. Postrenal | D. CKD | A. Prerenal azotemia |
| A 50-year-old with muddy brown casts, BUN/Cr <15. Diagnosis? | A. ATN | B. Prerenal | C. Postrenal | D. CKD | A. Acute tubular necrosis |
| A 40-year-old with eosinophilia, rash, recent antibiotic use. Diagnosis? | A. Interstitial nephritis | B. ATN | C. Glomerulonephritis | D. Rhabdomyolysis | A. Drug-induced interstitial nephritis |
| A 65-year-old man with flank pain, hematuria, stone on X-ray. Type? | A. Calcium oxalate | B. Uric acid | C. Cystine | D. Struvite | A. Calcium oxalate stone |
| A 45-year-old woman with recurrent UTI and staghorn calculi. Stone type? | A. Struvite | B. Uric acid | C. Calcium | D. Cystine | A. Struvite (magnesium ammonium phosphate) stones |
| A 50-year-old man with gout, radiolucent renal stones. Type? | A. Uric acid | B. Calcium | C. Struvite | D. Cystine | A. Uric acid stones |
| A 60-year-old with polyuria, polydipsia, high calcium, bone pain, renal stones. Diagnosis? | A. Hyperparathyroidism | B. Sarcoidosis | C. Malignancy | D. Vit D toxicity | A. Primary hyperparathyroidism |
| A 55-year-old man with fatigue, bone pain, fractures, normal calcium, low phosphate, high ALP. Diagnosis? | A. Osteomalacia | B. Osteoporosis | C. Paget | D. HyperPTH | A. Osteomalacia |
| A 70-year-old man with bone pain, elevated ALP, normal calcium, mosaic bone pattern. Diagnosis? | A. Paget disease | B. Osteoporosis | C. Osteomalacia | D. Metastasis | A. Paget’s disease of bone |
| A 65-year-old woman with chronic joint pain, Heberden nodes. Diagnosis? | A. OA | B. RA | C. Gout | D. Pseudogout | A. Osteoarthritis |
| A 40-year-old woman with morning stiffness >1 hr, small joints, RF positive. Diagnosis? | A. Rheumatoid arthritis | B. OA | C. Gout | D. SLE | A. Rheumatoid arthritis |
| A 35-year-old woman with malar rash, photosensitivity, proteinuria. Diagnosis? | A. SLE | B. RA | C. Dermatomyositis | D. Vasculitis | A. Systemic lupus erythematosus |
| A 45-year-old woman with dry eyes, dry mouth, parotid enlargement. Diagnosis? | A. Sjögren syndrome | B. SLE | C. RA | D. Dermatomyositis | A. Sjögren syndrome |
| A 40-year-old woman with proximal muscle weakness, heliotrope rash, Gottron papules. Diagnosis? | A. Dermatomyositis | B. Polymyositis | C. SLE | D. RA | A. Dermatomyositis |
| A 50-year-old with proximal muscle weakness, no rash, elevated CK. Diagnosis? | A. Polymyositis | B. Dermatomyositis | C. SLE | D. Myasthenia | A. Polymyositis |
| A 55-year-old with dysphagia, sclerodactyly, telangiectasia. Diagnosis? | A. Systemic sclerosis | B. Dermatomyositis | C. SLE | D. RA | A. Systemic sclerosis (CREST syndrome) |
| A 60-year-old man with recurrent oral ulcers, genital ulcers, uveitis. Diagnosis? | A. Behçet disease | B. SLE | C. RA | D. Vasculitis | A. Behçet syndrome |
| A 25-year-old man with back pain, morning stiffness, HLA-B27 positive. Diagnosis? | A. Ankylosing spondylitis | B. RA | C. OA | D. Psoriatic arthritis | A. Ankylosing spondylitis |
| A 35-year-old man with urethritis, conjunctivitis, arthritis. Diagnosis? | A. Reactive arthritis | B. Gout | C. SLE | D. RA | A. Reactive arthritis (Reiter syndrome) |
| A 40-year-old man with acute monoarthritis, needle-shaped crystals, negative birefringence. Diagnosis? | A. Gout | B. Pseudogout | C. Septic arthritis | D. RA | A. Gout |
| A 60-year-old with knee pain, rhomboid crystals, positive birefringence. Diagnosis? | A. Pseudogout | B. Gout | C. OA | D. RA | A. Calcium pyrophosphate deposition (pseudogout) |
| A 50-year-old woman with Raynaud’s phenomenon, anti-centromere antibodies. Diagnosis? | A. Limited scleroderma | B. Diffuse sclerosis | C. SLE | D. CREST | A. CREST (limited scleroderma) |
| A 40-year-old woman with dysphagia, skin thickening, anti-Scl-70 positive. Diagnosis? | A. Diffuse scleroderma | B. CREST | C. Dermatomyositis | D. RA | A. Diffuse systemic sclerosis |
| A 60-year-old man with fever, weight loss, purpura, neuropathy, HBV+. Diagnosis? | A. Polyarteritis nodosa | B. Wegener | C. HSP | D. SLE | A. Polyarteritis nodosa |
| A 12-year-old with purpura, arthralgia, abdominal pain, hematuria. Diagnosis? | A. HSP | B. SLE | C. PAN | D. ITP | A. Henoch–Schönlein purpura |
| A 40-year-old woman with hematuria, hemoptysis, anti-GBM positive. Diagnosis? | A. Goodpasture | B. Wegener | C. PAN | D. SLE | A. Goodpasture syndrome |
| A 55-year-old with asthma, eosinophilia, neuropathy. Diagnosis? | A. Churg–Strauss | B. Wegener | C. PAN | D. SLE | A. Eosinophilic granulomatosis with polyangiitis |
| A 45-year-old woman with fatigue, pruritus, high ALP, antimitochondrial antibody. Diagnosis? | A. PBC | B. PSC | C. Cirrhosis | D. Hepatitis | A. Primary biliary cholangitis |
| A 40-year-old man with UC and beaded intrahepatic ducts. Diagnosis? | A. PSC | B. PBC | C. Cirrhosis | D. Cholangiocarcinoma | A. Primary sclerosing cholangitis |
| A 50-year-old alcoholic with hepatomegaly, AST > ALT. Diagnosis? | A. Alcoholic hepatitis | B. Viral hepatitis | C. Cirrhosis | D. NASH | A. Alcoholic hepatitis |
| A 45-year-old man with chronic HBV and cirrhosis, AFP elevated. Diagnosis? | A. HCC | B. Cholangiocarcinoma | C. PSC | D. Adenoma | A. Hepatocellular carcinoma |
| A 60-year-old with painless jaundice, palpable gallbladder. Diagnosis? | A. Carcinoma head of pancreas | B. Cholangiocarcinoma | C. Gallstones | D. PSC | A. Carcinoma of pancreas (Courvoisier sign) |
| A 45-year-old man with head injury, brief loss of consciousness, lucid interval, then coma. Diagnosis? | A. Epidural hematoma | B. Subdural | C. SAH | D. Contusion | A. Epidural hematoma |
| A 60-year-old with gradual headache, confusion, after minor trauma. Diagnosis? | A. Chronic subdural hematoma | B. Epidural | C. SAH | D. Contusion | A. Chronic subdural hematoma |
| A 35-year-old with sudden severe headache, neck stiffness, photophobia. Diagnosis? | A. Subarachnoid hemorrhage | B. Meningitis | C. Migraine | D. ICH | A. Subarachnoid hemorrhage |
| A 50-year-old man with hypertension, sudden hemiplegia, coma. Diagnosis? | A. Intracerebral hemorrhage | B. SAH | C. Stroke infarct | D. Tumor | A. Hypertensive intracerebral hemorrhage |
| A 65-year-old with sudden right-sided weakness, aphasia, carotid bruit. Diagnosis? | A. Ischemic stroke | B. Hemorrhage | C. SAH | D. TIA | A. Ischemic stroke |
| A 70-year-old man with stroke, BP 160/90, glucose 110. Next step? | A. CT brain | B. MRI | C. Thrombolysis | D. Aspirin immediately | A. CT brain before thrombolysis |
| A 65-year-old with stroke, CT shows no bleed, within 2 hours. Management? | A. IV tPA | B. Aspirin | C. Heparin | D. Observe | A. Thrombolysis with IV tPA |
| A 70-year-old with stroke 8 hours ago. Management? | A. Aspirin | B. Thrombolysis | C. Surgery | D. Observe | A. Antiplatelet (aspirin) |
| A 60-year-old man with facial droop, drooling, forehead spared. Diagnosis? | A. Stroke | B. Bell’s palsy | C. Myasthenia | D. Guillain-Barré | A. Upper motor neuron facial palsy (stroke) |
| A 35-year-old woman with sudden facial weakness, cannot close eye, taste loss. Diagnosis? | A. Bell’s palsy | B. Stroke | C. Myasthenia | D. GBS | A. Lower motor neuron facial palsy (Bell’s) |
| A 25-year-old with ascending weakness after viral illness. Diagnosis? | A. Guillain-Barré syndrome | B. Myasthenia | C. Polio | D. Transverse myelitis | A. Guillain-Barré syndrome |
| A 30-year-old with double vision, fatigability, improves with rest. Diagnosis? | A. Myasthenia gravis | B. Lambert-Eaton | C. GBS | D. MS | A. Myasthenia gravis |
| A 28-year-old woman with diplopia, fatigue, thymic mass. Diagnosis? | A. Myasthenia gravis | B. MS | C. GBS | D. Thyroid eye disease | A. Myasthenia gravis with thymoma |
| A 40-year-old woman with optic neuritis, internuclear ophthalmoplegia, relapsing symptoms. Diagnosis? | A. Multiple sclerosis | B. GBS | C. MG | D. CVA | A. Multiple sclerosis |
| A 35-year-old man with tremor at rest, rigidity, bradykinesia. Diagnosis? | A. Parkinson disease | B. Huntington | C. Wilson | D. Essential tremor | A. Parkinson disease |
| A 40-year-old woman with intention tremor, worsens on action, improves with rest. Diagnosis? | A. Essential tremor | B. Parkinson | C. Wilson | D. Dystonia | A. Essential tremor |
| A 20-year-old man with tremor, rigidity, KF rings, low ceruloplasmin. Diagnosis? | A. Wilson disease | B. Parkinson | C. Hepatitis | D. ALS | A. Wilson’s disease |
| A 60-year-old with progressive memory loss, disorientation, apraxia. Diagnosis? | A. Alzheimer’s | B. Parkinson | C. Vascular dementia | D. Depression | A. Alzheimer’s disease |
| A 65-year-old hypertensive with stepwise memory decline. Diagnosis? | A. Vascular dementia | B. Alzheimer’s | C. Lewy body | D. Parkinson | A. Vascular dementia |
| A 70-year-old with visual hallucinations, fluctuating cognition, Parkinsonism. Diagnosis? | A. Lewy body dementia | B. Alzheimer’s | C. Vascular | D. Frontotemporal | A. Dementia with Lewy bodies |
| A 55-year-old with personality change, disinhibition, preserved memory. Diagnosis? | A. Frontotemporal dementia | B. Alzheimer’s | C. Vascular | D. Lewy | A. Frontotemporal dementia |
| A 40-year-old man with choreiform movements, family history. Diagnosis? | A. Huntington disease | B. Wilson | C. Parkinson | D. MS | A. Huntington’s chorea |
| A 60-year-old man with sudden vision loss, temple tenderness, high ESR. Diagnosis? | A. Temporal arteritis | B. Optic neuritis | C. Glaucoma | D. Migraine | A. Giant cell arteritis |
| A 35-year-old with severe unilateral periorbital headache, lacrimation, rhinorrhea. Diagnosis? | A. Cluster headache | B. Migraine | C. Tension | D. Sinusitis | A. Cluster headache |
| A 25-year-old woman with unilateral throbbing headache, photophobia, aura. Diagnosis? | A. Migraine | B. Cluster | C. Tension | D. SAH | A. Migraine |
| A 30-year-old woman with bilateral band-like headache, stress-related. Diagnosis? | A. Tension headache | B. Migraine | C. Cluster | D. Neuralgia | A. Tension-type headache |
| A 50-year-old with facial pain triggered by touch, lasts seconds. Diagnosis? | A. Trigeminal neuralgia | B. Cluster | C. Migraine | D. TMJ disorder | A. Trigeminal neuralgia |
| A 25-year-old with seizure, EEG 3-Hz spike-and-wave. Diagnosis? | A. Absence seizure | B. Tonic-clonic | C. Myoclonic | D. Focal | A. Absence seizure |
| A 20-year-old with generalized tonic-clonic seizure. First-line therapy? | A. Valproate | B. Phenytoin | C. Levetiracetam | D. Diazepam | A. Sodium valproate |
| A 30-year-old with focal seizure, temporal lobe aura. Drug of choice? | A. Carbamazepine | B. Valproate | C. Diazepam | D. Ethosuximide | A. Carbamazepine |
| A 28-year-old woman with absence seizure. Drug of choice? | A. Ethosuximide | B. Valproate | C. Carbamazepine | D. Phenytoin | A. Ethosuximide |
| A 35-year-old epileptic woman on valproate, pregnant. Risk? | A. Neural tube defect | B. Cleft palate | C. Cardiac defect | D. Hydrocephalus | A. Neural tube defects (spina bifida) |
| A 60-year-old hypertensive with right hemiparesis, expressive aphasia. Vessel? | A. Left MCA | B. Right MCA | C. ACA | D. PCA | A. Left middle cerebral artery infarct |
| A 55-year-old man with left leg weakness, urinary incontinence. Vessel? | A. ACA | B. MCA | C. PCA | D. Basilar | A. Anterior cerebral artery infarct |
| A 50-year-old with visual field defect, occipital lobe infarct. Vessel? | A. PCA | B. MCA | C. ACA | D. Basilar | A. Posterior cerebral artery infarct |
| A 65-year-old with vertigo, diplopia, ataxia, crossed signs. Diagnosis? | A. Brainstem stroke | B. MS | C. Vestibular neuritis | D. Migraine | A. Brainstem stroke |
| A 25-year-old man with trauma, flaccid paralysis below injury, absent reflexes. Diagnosis? | A. Spinal shock | B. Cord transection | C. GBS | D. Hemisection | A. Spinal shock |
| A 30-year-old with ipsilateral motor loss, contralateral pain loss. Diagnosis? | A. Brown-Sequard | B. Cord transection | C. Anterior syndrome | D. Central | A. Brown-Sequard syndrome |
| A 70-year-old man with postural tremor, cogwheel rigidity, shuffling gait. Diagnosis? | A. Parkinson disease | B. Wilson | C. Essential tremor | D. Huntington | A. Parkinson disease |
| A 55-year-old man with weakness of all four limbs, UMN signs, no sensory loss. Diagnosis? | A. ALS | B. MS | C. GBS | D. Myasthenia | A. Amyotrophic lateral sclerosis |
| A 35-year-old woman with optic neuritis, paresthesia, relapsing course. Diagnosis? | A. Multiple sclerosis | B. Myasthenia | C. GBS | D. SLE | A. Multiple sclerosis |
| A 40-year-old man with proximal weakness, small-cell lung cancer. Diagnosis? | A. Lambert-Eaton syndrome | B. Myasthenia | C. GBS | D. ALS | A. Lambert–Eaton myasthenic syndrome |
| A 70-year-old man with resting tremor, rigidity, shuffling gait. Diagnosis? | A. Parkinson disease | B. Essential tremor | C. Huntington | D. Wilson | A. Parkinson disease |
| A 30-year-old woman with hand tremor when holding a cup, relieved by alcohol. Diagnosis? | A. Essential tremor | B. Parkinson | C. Wilson | D. Dystonia | A. Essential tremor |
| A 20-year-old man with chorea, KF rings, psychiatric changes. Diagnosis? | A. Wilson disease | B. Huntington | C. Parkinson | D. Sydenham | A. Wilson disease |
| A 45-year-old woman with pain and stiffness in shoulder, ESR high. Diagnosis? | A. Polymyalgia rheumatica | B. RA | C. Osteoarthritis | D. SLE | A. Polymyalgia rheumatica |
| A 70-year-old woman with headache, jaw claudication, tender temporal artery. Diagnosis? | A. Temporal arteritis | B. Polymyalgia | C. Migraine | D. RA | A. Giant cell arteritis |
| A 30-year-old man with fatigue, pallor, glossitis, neurologic signs. Diagnosis? | A. B12 deficiency | B. Folate | C. Iron | D. Thalassemia | A. Vitamin B12 deficiency anemia |
| A 40-year-old vegetarian with macrocytosis, hypersegmented neutrophils. Diagnosis? | A. Megaloblastic anemia | B. Iron deficiency | C. Sideroblastic | D. Hemolytic | A. Megaloblastic anemia (B12/Folate) |
| A 60-year-old man with pallor, koilonychia, microcytosis. Diagnosis? | A. Iron deficiency anemia | B. Thalassemia | C. Anemia of chronic disease | D. Sideroblastic | A. Iron deficiency anemia |
| A 25-year-old woman with menorrhagia, low Hb, low MCV, high TIBC. Diagnosis? | A. Iron deficiency anemia | B. Thalassemia | C. Chronic disease | D. Hemolytic | A. Iron deficiency anemia |
| A 30-year-old man with microcytosis, target cells, normal iron. Diagnosis? | A. Thalassemia | B. Iron deficiency | C. Sideroblastic | D. Chronic disease | A. Thalassemia trait |
| A 50-year-old with fatigue, weight loss, splenomegaly, basophilia, t(9;22). Diagnosis? | A. CML | B. AML | C. CLL | D. Polycythemia vera | A. Chronic myeloid leukemia |
| A 70-year-old man with lymphocytosis, smudge cells, generalized lymphadenopathy. Diagnosis? | A. CLL | B. CML | C. AML | D. NHL | A. Chronic lymphocytic leukemia |
| A 40-year-old man with blasts, Auer rods, DIC. Diagnosis? | A. AML | B. ALL | C. CML | D. CLL | A. Acute myeloid leukemia (M3 variant) |
| A 5-year-old child with lymphoblasts, bone pain, hepatosplenomegaly. Diagnosis? | A. ALL | B. AML | C. CML | D. Lymphoma | A. Acute lymphoblastic leukemia |
| A 30-year-old man with painless lymphadenopathy, Reed–Sternberg cells. Diagnosis? | A. Hodgkin lymphoma | B. NHL | C. Leukemia | D. TB | A. Hodgkin lymphoma |
| A 50-year-old man with painless lymphadenopathy, B symptoms, multiple nodes. Diagnosis? | A. Non-Hodgkin lymphoma | B. Hodgkin | C. CLL | D. TB | A. Non-Hodgkin lymphoma |
| A 60-year-old man with bone pain, anemia, renal failure, lytic lesions. Diagnosis? | A. Multiple myeloma | B. Lymphoma | C. Osteoporosis | D. Paget | A. Multiple myeloma |
| A 55-year-old man with recurrent infections, M spike on electrophoresis. Diagnosis? | A. Multiple myeloma | B. MGUS | C. Waldenström | D. Lymphoma | A. Multiple myeloma |
| A 65-year-old man with hyperviscosity, IgM monoclonal spike. Diagnosis? | A. Waldenström macroglobulinemia | B. MM | C. MGUS | D. Lymphoma | A. Waldenström macroglobulinemia |
| A 40-year-old man with easy bruising, petechiae, low platelets, normal PT/PTT. Diagnosis? | A. ITP | B. DIC | C. TTP | D. Hemophilia | A. Immune thrombocytopenic purpura |
| A 35-year-old woman with fever, anemia, thrombocytopenia, renal failure, neuro signs. Diagnosis? | A. TTP | B. HUS | C. DIC | D. ITP | A. Thrombotic thrombocytopenic purpura |
| A 5-year-old child post-diarrhea with anemia, thrombocytopenia, renal failure. Diagnosis? | A. HUS | B. TTP | C. DIC | D. ITP | A. Hemolytic uremic syndrome |
| A 55-year-old with sepsis, bleeding, low platelets, high PT/aPTT. Diagnosis? | A. DIC | B. ITP | C. TTP | D. HUS | A. Disseminated intravascular coagulation |
| A 60-year-old man with splenomegaly, high Hb, low EPO, pruritus after hot bath. Diagnosis? | A. Polycythemia vera | B. Secondary polycythemia | C. CML | D. PV deficiency | A. Polycythemia vera |
| A 50-year-old man with fatigue, pruritus, high eosinophils, high ALP. Diagnosis? | A. Myeloproliferative disorder | B. Lymphoma | C. CML | D. Allergic reaction | A. Chronic myeloproliferative disease |
| A 30-year-old woman with migratory thrombophlebitis and pancreatic cancer. Diagnosis? | A. Trousseau syndrome | B. DVT | C. Factor V Leiden | D. DIC | A. Trousseau’s migratory thrombophlebitis |
| A 45-year-old man with recurrent DVT, normal PT/PTT. Cause? | A. Factor V Leiden | B. Protein C deficiency | C. Antithrombin deficiency | D. All | D. All of the above thrombophilias |
| A 60-year-old man with anemia, high ferritin, low TIBC, chronic disease. Diagnosis? | A. Anemia of chronic disease | B. Iron deficiency | C. Thalassemia | D. Sideroblastic | A. Anemia of chronic disease |
| A 55-year-old with bone pain, punched-out skull lesions. Diagnosis? | A. Multiple myeloma | B. Metastasis | C. Osteosarcoma | D. Paget | A. Multiple myeloma |
| A 50-year-old woman with hypercalcemia, low phosphate, high PTH. Diagnosis? | A. Primary hyperparathyroidism | B. Secondary | C. Tertiary | D. Malignancy | A. Primary hyperparathyroidism |
| A 60-year-old man with hypercalcemia, low PTH. Cause? | A. Malignancy | B. Primary HPT | C. Tertiary | D. Vit D | A. Malignancy-associated hypercalcemia |
| A 40-year-old woman with fatigue, low calcium, high phosphate, low PTH. Diagnosis? | A. Hypoparathyroidism | B. Vitamin D deficiency | C. CKD | D. Pseudohypoparathyroidism | A. Hypoparathyroidism |
| A 45-year-old man with hypertension, low potassium, high aldosterone. Diagnosis? | A. Conn | B. Addison | C. Cushing | D. Pheochromocytoma | A. Conn syndrome |
| A 50-year-old man with paroxysmal hypertension, palpitations, headache. Diagnosis? | A. Pheochromocytoma | B. Cushing | C. Conn | D. Addison | A. Pheochromocytoma |
| A 35-year-old woman with generalized hyperpigmentation, hypotension, low cortisol. Diagnosis? | A. Addison | B. Cushing | C. Conn | D. SIADH | A. Addison’s disease |
| A 30-year-old man with obesity, striae, moon face, truncal fat. Diagnosis? | A. Cushing | B. Addison | C. Hypothyroidism | D. Conn | A. Cushing syndrome |
| A 40-year-old man with hypertension, truncal obesity, buffalo hump. Diagnosis? | A. Cushing | B. Conn | C. Addison | D. Pheochromocytoma | A. Cushing syndrome |
| A 50-year-old man with polyuria, low urine osmolality, high Na+. Diagnosis? | A. Diabetes insipidus | B. SIADH | C. DM | D. Addison | A. Diabetes insipidus |
| A 45-year-old woman with hyponatremia, low serum osmolality, concentrated urine. Diagnosis? | A. SIADH | B. DI | C. Addison | D. Hypothyroidism | A. Syndrome of inappropriate ADH secretion |
| A 55-year-old man with chest pain relieved by rest, normal ECG. Diagnosis? | A. Stable angina | B. Unstable angina | C. NSTEMI | D. STEMI | A. Stable angina |
| A 58-year-old man with chest pain at rest, ST depression, normal troponin. Diagnosis? | A. Unstable angina | B. NSTEMI | C. STEMI | D. Prinzmetal | A. Unstable angina |
| A 60-year-old man with ST elevation in anterior leads, chest pain 2 hours. Management? | A. Thrombolysis | B. Aspirin | C. PCI | D. All | D. All (PCI preferred if <12h) |
| A 65-year-old with inferior MI, hypotension, clear lungs. Diagnosis? | A. RV infarction | B. LV failure | C. Tamponade | D. Shock | A. Right ventricular infarction |
| A 50-year-old post-MI, harsh systolic murmur at apex radiating to axilla. Diagnosis? | A. MR | B. TR | C. VSD | D. AS | A. Papillary muscle rupture → Mitral regurgitation |
| A 60-year-old man with chest pain, pericardial rub, diffuse ST elevation. Diagnosis? | A. Pericarditis | B. MI | C. PE | D. Angina | A. Acute pericarditis |
| A 55-year-old man with BP 180/120, papilledema. Diagnosis? | A. Hypertensive emergency | B. Urgency | C. Crisis | D. Normal | A. Hypertensive emergency |
| A 60-year-old man with tearing chest pain radiating to back, unequal pulses. Diagnosis? | A. Aortic dissection | B. MI | C. PE | D. Tamponade | A. Aortic dissection |
| A 65-year-old man with chronic cough, sputum 3 months/year for 2 years. Diagnosis? | A. Chronic bronchitis | B. Emphysema | C. Asthma | D. TB | A. Chronic bronchitis |
| A 50-year-old smoker with progressive dyspnea, barrel chest, decreased breath sounds. Diagnosis? | A. Emphysema | B. COPD | C. Asthma | D. Bronchiectasis | A. Emphysema |
| A 45-year-old with episodic wheezing, cough, reversible obstruction. Diagnosis? | A. Asthma | B. COPD | C. Bronchiectasis | D. PE | A. Asthma |
| A 35-year-old woman with nonproductive cough, bilateral hilar lymphadenopathy. Diagnosis? | A. Sarcoidosis | B. TB | C. Lymphoma | D. COPD | A. Sarcoidosis |
| A 40-year-old man with hematuria, hemoptysis, anti-GBM antibody. Diagnosis? | A. Goodpasture | B. Wegener | C. PAN | D. SLE | A. Goodpasture syndrome |
| A 50-year-old with nasal ulcers, sinusitis, renal failure, c-ANCA positive. Diagnosis? | A. Wegener granulomatosis | B. PAN | C. Churg-Strauss | D. TB | A. Granulomatosis with polyangiitis |
| A 45-year-old asthmatic with eosinophilia and vasculitis. Diagnosis? | A. Churg-Strauss | B. PAN | C. Wegener | D. Goodpasture | A. Eosinophilic granulomatosis (Churg-Strauss) |
| A 60-year-old man with chronic cough, foul sputum, clubbing. Diagnosis? | A. Bronchiectasis | B. COPD | C. Asthma | D. TB | A. Bronchiectasis |
| A 50-year-old man with acute dyspnea, tachycardia, pleuritic pain, D-dimer high. Diagnosis? | A. PE | B. Pneumonia | C. MI | D. COPD | A. Pulmonary embolism |
| A 65-year-old with sudden dyspnea after long flight, clear lungs. Diagnosis? | A. PE | B. Pneumothorax | C. MI | D. Asthma | A. Pulmonary embolism |
| A 70-year-old man with orthopnea, basal crackles, S3 gallop. Diagnosis? | A. Left heart failure | B. Right HF | C. COPD | D. PE | A. Left-sided heart failure |
| A 60-year-old man with peripheral edema, hepatomegaly, JVP raised. Diagnosis? | A. Right heart failure | B. Left HF | C. Tamponade | D. Cirrhosis | A. Right-sided heart failure |
| A 65-year-old man with syncope, angina, ejection murmur radiating to carotids. Diagnosis? | A. Aortic stenosis | B. MR | C. AS | D. TR | A. Aortic stenosis |
| A 55-year-old with early diastolic murmur, wide pulse pressure, head bobbing. Diagnosis? | A. Aortic regurgitation | B. MS | C. MR | D. TR | A. Aortic regurgitation |
| A 45-year-old with diastolic murmur at apex, opening snap. Diagnosis? | A. Mitral stenosis | B. Aortic regurgitation | C. MR | D. TR | A. Mitral stenosis |
| A 60-year-old with pansystolic murmur radiating to axilla. Diagnosis? | A. MR | B. TR | C. VSD | D. AS | A. Mitral regurgitation |
| A 50-year-old with pansystolic murmur increasing on inspiration. Diagnosis? | A. Tricuspid regurgitation | B. MR | C. VSD | D. AS | A. Tricuspid regurgitation |
| A 30-year-old with fixed split S2, pulmonary flow murmur. Diagnosis? | A. ASD | B. VSD | C. PDA | D. TOF | A. Atrial septal defect |
| A 5-year-old with harsh pansystolic murmur at LLSB. Diagnosis? | A. VSD | B. ASD | C. PDA | D. TOF | A. Ventricular septal defect |
| A 10-year-old with continuous machinery murmur. Diagnosis? | A. PDA | B. ASD | C. VSD | D. TOF | A. Patent ductus arteriosus |
| A 3-year-old with cyanosis, clubbing, squatting episodes. Diagnosis? | A. Tetralogy of Fallot | B. TGA | C. VSD | D. PDA | A. Tetralogy of Fallot |
| A 60-year-old hypertensive with flash pulmonary edema. Drug? | A. Furosemide | B. ACE inhibitor | C. Beta-blocker | D. CCB | A. IV furosemide |
| A 55-year-old with systolic heart failure. Drug improving survival? | A. ACE inhibitor | B. Beta-blocker | C. Spironolactone | D. All | D. All of the above |
| A 60-year-old man with AF, irregularly irregular pulse. Initial management? | A. Rate control + anticoagulate | B. Shock | C. Rhythm convert | D. Observe | A. Rate control with beta-blocker and anticoagulation |
| A 65-year-old with AF, INR 1.5, on warfarin. Target INR? | A. 2–3 | B. 1–2 | C. 3–4 | D. <1 | A. 2–3 |
| A 55-year-old with paroxysmal SVT. Acute management? | A. Vagal + adenosine | B. Amiodarone | C. Beta-blocker | D. DC shock | A. Vagal maneuvers + IV adenosine |
| A 60-year-old man with wide complex tachycardia, stable BP. Management? | A. Amiodarone | B. Adenosine | C. Shock | D. Beta-blocker | A. IV amiodarone |
| A 70-year-old with VT, pulse absent. Next step? | A. Defibrillation | B. CPR | C. Amiodarone | D. Lidocaine | A. Immediate defibrillation |
| A 65-year-old man with sudden chest pain, tachypnea, ECG shows S1Q3T3. Diagnosis? | A. Pulmonary embolism | B. MI | C. Pneumothorax | D. Aortic dissection | A. Acute pulmonary embolism |
| A 55-year-old man with chronic productive cough, cyanosis, overweight. Diagnosis? | A. Chronic bronchitis | B. Emphysema | C. Asthma | D. Bronchiectasis | A. Blue bloater – chronic bronchitis |
| A 65-year-old with thin build, dyspnea, minimal cough, hyperinflated lungs. Diagnosis? | A. Emphysema | B. Bronchitis | C. Asthma | D. TB | A. Pink puffer – emphysema |
| A 30-year-old woman with dry cough, erythema nodosum, hilar lymphadenopathy. Diagnosis? | A. Sarcoidosis | B. TB | C. Lymphoma | D. COPD | A. Sarcoidosis |
| A 50-year-old with cough, weight loss, hemoptysis, apical infiltrate. Diagnosis? | A. Pulmonary TB | B. Lung cancer | C. Bronchiectasis | D. Pneumonia | A. Pulmonary tuberculosis |
| A 40-year-old man with chronic cough, sputum, clubbing, coarse crepitations. Diagnosis? | A. Bronchiectasis | B. COPD | C. TB | D. Pneumonia | A. Bronchiectasis |
| A 25-year-old with pleuritic chest pain, tall thin male, sudden dyspnea. Diagnosis? | A. Spontaneous pneumothorax | B. PE | C. Asthma | D. Pneumonia | A. Primary spontaneous pneumothorax |
| A 60-year-old with dullness, decreased breath sounds, stony percussion. Diagnosis? | A. Pleural effusion | B. Pneumothorax | C. Consolidation | D. Collapse | A. Pleural effusion |
| A 65-year-old man with bronchial carcinoma, pleural effusion. Fluid type? | A. Exudate | B. Transudate | C. Chylous | D. Empyema | A. Exudative pleural effusion |
| A 50-year-old woman with frothy sputum, orthopnea, basal crepitations. Diagnosis? | A. Pulmonary edema | B. Pneumonia | C. COPD | D. Asthma | A. Pulmonary edema (heart failure) |
| A 60-year-old with basal crackles, JVP raised, ankle edema. Diagnosis? | A. Congestive heart failure | B. COPD | C. Cirrhosis | D. PE | A. Congestive heart failure |
| A 65-year-old man with sudden dyspnea, hypotension, muffled heart sounds. Diagnosis? | A. Cardiac tamponade | B. PE | C. Pneumothorax | D. MI | A. Cardiac tamponade |
| A 70-year-old with orthopnea, S3, bilateral basal crepitations. Diagnosis? | A. LV failure | B. RV failure | C. COPD | D. PE | A. Left ventricular failure |
| A 60-year-old man with ankle edema, ascites, raised JVP. Diagnosis? | A. RV failure | B. LV failure | C. Cirrhosis | D. Nephrotic | A. Right-sided heart failure |
| A 45-year-old woman with systolic murmur, radiating to axilla. Diagnosis? | A. Mitral regurgitation | B. Aortic stenosis | C. MR | D. TR | A. Mitral regurgitation |
| A 50-year-old man with diastolic murmur, opening snap. Diagnosis? | A. Mitral stenosis | B. Aortic regurgitation | C. TR | D. MR | A. Mitral stenosis |
| A 55-year-old with ejection systolic murmur radiating to carotids. Diagnosis? | A. Aortic stenosis | B. MR | C. TR | D. ASD | A. Aortic stenosis |
| A 60-year-old man with early diastolic murmur, collapsing pulse. Diagnosis? | A. Aortic regurgitation | B. MS | C. MR | D. TR | A. Aortic regurgitation |
| A 50-year-old man with pansystolic murmur increasing with inspiration. Diagnosis? | A. Tricuspid regurgitation | B. MR | C. VSD | D. ASD | A. Tricuspid regurgitation |
| A 30-year-old woman with fixed split S2, pulmonary murmur. Diagnosis? | A. ASD | B. VSD | C. PDA | D. TOF | A. Atrial septal defect |
| A 5-year-old with harsh pansystolic murmur, LLSB. Diagnosis? | A. VSD | B. ASD | C. PDA | D. TOF | A. Ventricular septal defect |
| A 10-year-old with continuous machinery murmur. Diagnosis? | A. PDA | B. ASD | C. VSD | D. TOF | A. Patent ductus arteriosus |
| A 3-year-old cyanotic child, squatting relieves dyspnea. Diagnosis? | A. TOF | B. TGA | C. VSD | D. PDA | A. Tetralogy of Fallot |
| A 65-year-old hypertensive with renal bruit. Cause? | A. Renal artery stenosis | B. PCKD | C. Nephrotic | D. CKD | A. Renal artery stenosis |
| A 60-year-old with flank mass, hematuria, polycythemia. Diagnosis? | A. RCC | B. PKD | C. Pyelonephritis | D. Stone | A. Renal cell carcinoma |
| A 55-year-old diabetic with high creatinine, proteinuria. Diagnosis? | A. Diabetic nephropathy | B. Nephritic | C. FSGS | D. Amyloidosis | A. Diabetic nephropathy |
| A 40-year-old woman with butterfly rash, oral ulcers, arthritis, proteinuria. Diagnosis? | A. SLE | B. RA | C. Dermatomyositis | D. PAN | A. Systemic lupus erythematosus |
| A 35-year-old woman with dry mouth, dry eyes. Diagnosis? | A. Sjögren syndrome | B. SLE | C. RA | D. CREST | A. Sjögren syndrome |
| A 25-year-old man with back pain, morning stiffness, improved with exercise. Diagnosis? | A. Ankylosing spondylitis | B. RA | C. OA | D. Gout | A. Ankylosing spondylitis |
| A 40-year-old man with acute big toe pain, needle-shaped crystals. Diagnosis? | A. Gout | B. Pseudogout | C. OA | D. RA | A. Gout (monosodium urate) |
| A 60-year-old woman with knee pain, rhomboid crystals, positive birefringence. Diagnosis? | A. Pseudogout | B. Gout | C. RA | D. OA | A. Pseudogout (CPPD) |
| A 50-year-old with proximal weakness, heliotrope rash, Gottron papules. Diagnosis? | A. Dermatomyositis | B. Polymyositis | C. SLE | D. RA | A. Dermatomyositis |
| A 45-year-old with proximal weakness, no rash, high CK. Diagnosis? | A. Polymyositis | B. Dermatomyositis | C. RA | D. Myasthenia | A. Polymyositis |
| A 55-year-old woman with Raynaud’s, sclerodactyly, telangiectasia. Diagnosis? | A. Systemic sclerosis | B. Dermatomyositis | C. SLE | D. RA | A. Limited scleroderma (CREST) |
| A 45-year-old man with cough, hemoptysis, anti-GBM antibodies. Diagnosis? | A. Goodpasture | B. Wegener | C. PAN | D. SLE | A. Goodpasture syndrome |
| A 40-year-old man with chronic cough, weight loss, apical cavity. Diagnosis? | A. TB | B. Cancer | C. Bronchiectasis | D. Sarcoidosis | A. Pulmonary tuberculosis |
| A 55-year-old with fever, productive cough, rusty sputum. Diagnosis? | A. Pneumococcal pneumonia | B. Klebsiella | C. TB | D. Legionella | A. Streptococcus pneumoniae infection |
| A 45-year-old alcoholic with upper lobe cavitating pneumonia. Diagnosis? | A. Klebsiella | B. Staph | C. Pseudomonas | D. TB | A. Klebsiella pneumonia |
| A 50-year-old man with fever, hyponatremia, pneumonia. Organism? | A. Legionella | B. Strep | C. Klebsiella | D. Mycoplasma | A. Legionella pneumophila |
| A 30-year-old man with cough, myalgia, patchy infiltrate, cold agglutinins. Organism? | A. Mycoplasma | B. Chlamydia | C. Legionella | D. Pneumococcus | A. Mycoplasma pneumoniae |
| A 40-year-old with recurrent sinusitis, hematuria, c-ANCA positive. Diagnosis? | A. Wegener | B. PAN | C. Goodpasture | D. SLE | A. Granulomatosis with polyangiitis (Wegener) |
| A 35-year-old woman with pleuritic chest pain, pericardial rub, diffuse ST elevation. Diagnosis? | A. Pericarditis | B. MI | C. PE | D. Angina | A. Acute pericarditis |
| A 60-year-old with ejection systolic murmur radiating to carotid. Diagnosis? | A. Aortic stenosis | B. MR | C. TR | D. ASD | A. Aortic stenosis |
| A 45-year-old woman with early diastolic murmur, collapsing pulse. Diagnosis? | A. Aortic regurgitation | B. MS | C. MR | D. TR | A. Aortic regurgitation |
| A 30-year-old woman with diastolic murmur, opening snap. Diagnosis? | A. Mitral stenosis | B. Aortic regurgitation | C. MR | D. TR | A. Mitral stenosis |
| A 60-year-old man with pansystolic murmur radiating to axilla. Diagnosis? | A. MR | B. TR | C. VSD | D. AS | A. Mitral regurgitation |
| A 40-year-old with pansystolic murmur increasing on inspiration. Diagnosis? | A. TR | B. MR | C. VSD | D. ASD | A. Tricuspid regurgitation |
| A 60-year-old man with chest pain, fever, pericardial rub, diffuse ST elevation. Diagnosis? | A. Pericarditis | B. MI | C. PE | D. Angina | A. Acute pericarditis |
| A 55-year-old man with chest pain, ST elevation, hypotension, clear lungs. Diagnosis? | A. RV infarction | B. LV failure | C. PE | D. Tamponade | A. Right ventricular infarction |
| A 65-year-old with tearing chest pain radiating to back, unequal BP in arms. Diagnosis? | A. Aortic dissection | B. MI | C. PE | D. Tamponade | A. Aortic dissection |
| A 70-year-old man with chronic cough, sputum, cyanosis. Diagnosis? | A. Chronic bronchitis | B. Emphysema | C. Asthma | D. TB | A. Chronic bronchitis |
| A 50-year-old man with barrel chest, dyspnea, pursed-lip breathing. Diagnosis? | A. Emphysema | B. COPD | C. Bronchiectasis | D. Asthma | A. Emphysema |
| A 30-year-old woman with nonproductive cough, bilateral hilar lymphadenopathy. Diagnosis? | A. Sarcoidosis | B. TB | C. Lymphoma | D. COPD | A. Sarcoidosis |
| A 40-year-old man with hemoptysis, weight loss, cavitary lesion upper lobe. Diagnosis? | A. TB | B. Cancer | C. Bronchiectasis | D. Pneumonia | A. Pulmonary tuberculosis |
| A 50-year-old with fever, rusty sputum, lobar consolidation. Diagnosis? | A. Pneumococcal pneumonia | B. Klebsiella | C. TB | D. Legionella | A. Streptococcus pneumoniae |
| A 45-year-old alcoholic with upper lobe pneumonia, currant jelly sputum. Diagnosis? | A. Klebsiella | B. Staph | C. TB | D. Pneumococcus | A. Klebsiella pneumoniae |
| A 60-year-old with fever, diarrhea, hyponatremia, pneumonia. Organism? | A. Legionella | B. Pneumococcus | C. Mycoplasma | D. Klebsiella | A. Legionella pneumophila |
| A 25-year-old with dry cough, patchy infiltrates, cold agglutinins positive. Diagnosis? | A. Mycoplasma pneumonia | B. Chlamydia | C. Legionella | D. TB | A. Mycoplasma pneumoniae |
| A 50-year-old with recurrent hematuria, hemoptysis, c-ANCA positive. Diagnosis? | A. Wegener | B. Goodpasture | C. PAN | D. SLE | A. Granulomatosis with polyangiitis (Wegener) |
| A 45-year-old man with asthma, eosinophilia, neuropathy. Diagnosis? | A. Churg–Strauss | B. Wegener | C. PAN | D. Goodpasture | A. Eosinophilic granulomatosis (Churg–Strauss) |
| A 60-year-old man with peripheral edema, JVP raised, hepatomegaly. Diagnosis? | A. Right heart failure | B. Left heart failure | C. Cirrhosis | D. PE | A. Right-sided heart failure |
| A 65-year-old with orthopnea, S3 gallop, basal crackles. Diagnosis? | A. Left heart failure | B. Right heart failure | C. COPD | D. PE | A. Left-sided heart failure |
| A 70-year-old with severe dyspnea, frothy sputum, crackles. Diagnosis? | A. Pulmonary edema | B. COPD | C. Pneumonia | D. PE | A. Pulmonary edema |
| A 60-year-old with fixed split S2, pulmonary murmur. Diagnosis? | A. ASD | B. VSD | C. PDA | D. TOF | A. Atrial septal defect |
| A 50-year-old with continuous machinery murmur. Diagnosis? | A. PDA | B. ASD | C. VSD | D. TOF | A. Patent ductus arteriosus |
| A 5-year-old child with cyanosis, clubbing, squatting episodes. Diagnosis? | A. Tetralogy of Fallot | B. TGA | C. VSD | D. PDA | A. Tetralogy of Fallot |
| A 45-year-old with syncope, angina, ejection murmur radiating to carotid. Diagnosis? | A. Aortic stenosis | B. MR | C. MS | D. TR | A. Aortic stenosis |
| A 60-year-old man with early diastolic murmur, wide pulse pressure. Diagnosis? | A. Aortic regurgitation | B. MS | C. MR | D. TR | A. Aortic regurgitation |
| A 40-year-old woman with diastolic murmur at apex, opening snap. Diagnosis? | A. Mitral stenosis | B. MR | C. AR | D. TR | A. Mitral stenosis |
| A 55-year-old with pansystolic murmur radiating to axilla. Diagnosis? | A. MR | B. TR | C. VSD | D. AS | A. Mitral regurgitation |
| A 50-year-old man with pansystolic murmur increasing with inspiration. Diagnosis? | A. TR | B. MR | C. VSD | D. ASD | A. Tricuspid regurgitation |
| A 60-year-old with fatigue, pallor, glossitis, neuropathy. Diagnosis? | A. B12 deficiency | B. Folate deficiency | C. Iron deficiency | D. Sideroblastic | A. Vitamin B12 deficiency |
| A 35-year-old vegetarian with macrocytosis, hypersegmented neutrophils. Diagnosis? | A. Megaloblastic anemia | B. Iron deficiency | C. Thalassemia | D. Chronic disease | A. Megaloblastic anemia |
| A 45-year-old woman with menorrhagia, low Hb, microcytosis, high TIBC. Diagnosis? | A. Iron deficiency anemia | B. Thalassemia | C. Chronic disease | D. Hemolytic | A. Iron deficiency anemia |
| A 55-year-old man with weight loss, splenomegaly, basophilia, t(9;22). Diagnosis? | A. CML | B. AML | C. CLL | D. PV | A. Chronic myeloid leukemia |
| A 70-year-old man with lymphocytosis, smudge cells. Diagnosis? | A. CLL | B. CML | C. AML | D. ALL | A. Chronic lymphocytic leukemia |
| A 50-year-old man with anemia, bone pain, lytic lesions, M spike. Diagnosis? | A. Multiple myeloma | B. Lymphoma | C. Metastasis | D. Leukemia | A. Multiple myeloma |
| A 60-year-old man with hyperviscosity, IgM spike. Diagnosis? | A. Waldenström macroglobulinemia | B. MM | C. MGUS | D. Lymphoma | A. Waldenström macroglobulinemia |
| A 40-year-old man with fever, anemia, thrombocytopenia, renal failure, neuro signs. Diagnosis? | A. TTP | B. HUS | C. DIC | D. ITP | A. Thrombotic thrombocytopenic purpura |
| A 5-year-old child with anemia, thrombocytopenia, renal failure after diarrhea. Diagnosis? | A. HUS | B. TTP | C. DIC | D. ITP | A. Hemolytic uremic syndrome |
| A 60-year-old with sepsis, low platelets, prolonged PT/aPTT. Diagnosis? | A. DIC | B. ITP | C. TTP | D. HUS | A. Disseminated intravascular coagulation |
| A 55-year-old with pruritus after hot bath, high Hb, low EPO. Diagnosis? | A. Polycythemia vera | B. Secondary polycythemia | C. CML | D. PV deficiency | A. Polycythemia vera |
| A 65-year-old with anemia, high ferritin, low TIBC. Diagnosis? | A. Anemia of chronic disease | B. Iron deficiency | C. Thalassemia | D. Sideroblastic | A. Anemia of chronic disease |
| A 45-year-old man with recurrent DVT, normal PT/PTT. Cause? | A. Factor V Leiden | B. Protein C deficiency | C. Antithrombin III deficiency | D. All | D. All (inherited thrombophilias) |
| A 60-year-old man with chest pain radiating to jaw and arm, relieved by rest. Diagnosis? | A. Unstable angina | B. Stable angina | C. NSTEMI | D. STEMI | B. Stable angina |
| A 58-year-old man with chest pain at rest, normal ECG, troponin negative. Diagnosis? | A. Unstable angina | B. NSTEMI | C. STEMI | D. Prinzmetal | A. Unstable angina |
| A 60-year-old with ST elevation in V1–V4 and raised troponin. Diagnosis? | A. Anterior MI | B. Inferior MI | C. Posterior MI | D. Lateral MI | A. Anterior wall STEMI |
| A 65-year-old with ST elevation in II, III, aVF. Diagnosis? | A. Anterior MI | B. Inferior MI | C. Lateral MI | D. Posterior MI | B. Inferior wall STEMI |
| A 60-year-old post-MI patient develops pansystolic murmur at apex. Diagnosis? | A. Papillary muscle rupture | B. VSD | C. MR | D. TR | A. Papillary muscle rupture causing acute MR |
| A 55-year-old man with ST-depression in V2–V3, tall R waves in V1. Diagnosis? | A. Posterior MI | B. Anterior MI | C. Lateral MI | D. Inferior MI | A. Posterior wall MI |
| A 60-year-old with crushing chest pain, hypotension, JVP elevated, clear lungs. Diagnosis? | A. RV infarction | B. LV failure | C. Tamponade | D. PE | A. Right ventricular infarction |
| A 55-year-old man with systolic murmur radiating to carotids. Diagnosis? | A. Aortic stenosis | B. Mitral regurgitation | C. VSD | D. ASD | A. Aortic stenosis |
| A 60-year-old with early diastolic murmur and wide pulse pressure. Diagnosis? | A. Aortic regurgitation | B. MS | C. MR | D. TR | A. Aortic regurgitation |
| A 45-year-old woman with mid-diastolic murmur, opening snap at apex. Diagnosis? | A. Mitral stenosis | B. AR | C. MR | D. TR | A. Mitral stenosis |
| A 50-year-old with pansystolic murmur radiating to axilla. Diagnosis? | A. MR | B. TR | C. VSD | D. AS | A. Mitral regurgitation |
| A 55-year-old man with murmur increasing on inspiration. Diagnosis? | A. Tricuspid regurgitation | B. MR | C. AS | D. VSD | A. Tricuspid regurgitation |
| A 25-year-old with continuous machinery murmur. Diagnosis? | A. PDA | B. ASD | C. VSD | D. TOF | A. Patent ductus arteriosus |
| A 5-year-old with harsh pansystolic murmur LLSB. Diagnosis? | A. VSD | B. ASD | C. PDA | D. TOF | A. Ventricular septal defect |
| A 30-year-old woman with fixed split S2, pulmonary flow murmur. Diagnosis? | A. ASD | B. VSD | C. PDA | D. TOF | A. Atrial septal defect |
| A 3-year-old child with cyanosis, clubbing, squatting relief. Diagnosis? | A. TOF | B. TGA | C. VSD | D. PDA | A. Tetralogy of Fallot |
| A 40-year-old man with systolic BP 180, diastolic 120, papilledema. Diagnosis? | A. Hypertensive emergency | B. Urgency | C. Crisis | D. Stable HTN | A. Hypertensive emergency |
| A 65-year-old with tearing chest pain radiating to back, unequal pulses. Diagnosis? | A. Aortic dissection | B. MI | C. PE | D. Tamponade | A. Aortic dissection |
| A 55-year-old man with chronic cough, sputum for >3 months in 2 years. Diagnosis? | A. Chronic bronchitis | B. Emphysema | C. Asthma | D. Bronchiectasis | A. Chronic bronchitis |
| A 60-year-old smoker with dyspnea, barrel chest, pursed-lip breathing. Diagnosis? | A. Emphysema | B. COPD | C. Asthma | D. Bronchiectasis | A. Emphysema |
| A 40-year-old man with episodic wheeze and reversible airflow obstruction. Diagnosis? | A. Asthma | B. COPD | C. Bronchiectasis | D. PE | A. Asthma |
| A 60-year-old man with foul purulent sputum, clubbing. Diagnosis? | A. Bronchiectasis | B. COPD | C. Asthma | D. TB | A. Bronchiectasis |
| A 45-year-old man with hemoptysis, night sweats, weight loss. Diagnosis? | A. TB | B. Cancer | C. Pneumonia | D. Abscess | A. Pulmonary tuberculosis |
| A 35-year-old with pneumonia, hyponatremia, diarrhea. Organism? | A. Legionella | B. Strep pneumo | C. Klebsiella | D. Mycoplasma | A. Legionella pneumophila |
| A 25-year-old with dry cough, patchy infiltrates, cold agglutinins. Diagnosis? | A. Mycoplasma pneumonia | B. Chlamydia | C. Legionella | D. Viral | A. Mycoplasma pneumoniae |
| A 60-year-old with pleuritic pain, dyspnea, tachycardia, D-dimer high. Diagnosis? | A. PE | B. Pneumonia | C. MI | D. Asthma | A. Pulmonary embolism |
| A 65-year-old man with chronic cough, weight loss, clubbing, mass on X-ray. Diagnosis? | A. Bronchogenic carcinoma | B. TB | C. COPD | D. Bronchiectasis | A. Lung cancer |
| A 40-year-old man with dry cough, bilateral hilar lymphadenopathy. Diagnosis? | A. Sarcoidosis | B. TB | C. Lymphoma | D. COPD | A. Sarcoidosis |
| A 60-year-old man with hematuria, hemoptysis, anti-GBM positive. Diagnosis? | A. Goodpasture | B. Wegener | C. PAN | D. SLE | A. Goodpasture syndrome |
| A 45-year-old man with sinusitis, hematuria, c-ANCA positive. Diagnosis? | A. Wegener granulomatosis | B. PAN | C. Goodpasture | D. SLE | A. Granulomatosis with polyangiitis (Wegener) |
| A 50-year-old man with HTN, proteinuria, edema. Diagnosis? | A. Chronic renal disease | B. Nephrotic | C. Nephritic | D. AKI | A. Chronic kidney disease |
| A 35-year-old man post-sore throat, cola-colored urine, edema. Diagnosis? | A. PSGN | B. IgA nephropathy | C. Lupus | D. Diabetic | A. Post-streptococcal glomerulonephritis |
| A 25-year-old with recurrent hematuria after URI, normal complement. Diagnosis? | A. IgA nephropathy | B. PSGN | C. Lupus | D. HSP | A. IgA nephropathy (Berger) |
| A 55-year-old diabetic with proteinuria, retinopathy, CKD. Diagnosis? | A. Diabetic nephropathy | B. Amyloidosis | C. FSGS | D. Lupus | A. Diabetic nephropathy |
| A 50-year-old man with hematuria, flank mass, polycythemia. Diagnosis? | A. RCC | B. PKD | C. Stone | D. Pyelonephritis | A. Renal cell carcinoma |
| A 60-year-old man with smoking history, painless hematuria. Diagnosis? | A. Bladder cancer | B. RCC | C. Stone | D. Infection | A. Transitional cell carcinoma of bladder |
| A 40-year-old woman with malar rash, arthritis, proteinuria. Diagnosis? | A. SLE | B. RA | C. Dermatomyositis | D. PAN | A. Systemic lupus erythematosus |
| A 45-year-old woman with dry mouth, dry eyes, parotid swelling. Diagnosis? | A. Sjögren | B. SLE | C. RA | D. Dermatomyositis | A. Sjögren syndrome |
| A 30-year-old woman with heliotrope rash, Gottron papules, proximal weakness. Diagnosis? | A. Dermatomyositis | B. Polymyositis | C. SLE | D. RA | A. Dermatomyositis |
| A 45-year-old woman with proximal muscle weakness, no rash, ↑ CK. Diagnosis? | A. Polymyositis | B. Dermatomyositis | C. RA | D. SLE | A. Polymyositis |
| A 40-year-old with Raynaud’s, sclerodactyly, telangiectasia. Diagnosis? | A. Systemic sclerosis | B. Dermatomyositis | C. SLE | D. RA | A. Limited systemic sclerosis (CREST) |
| A 30-year-old man with urethritis, conjunctivitis, arthritis. Diagnosis? | A. Reactive arthritis | B. RA | C. AS | D. SLE | A. Reiter syndrome (Reactive arthritis) |
| A 25-year-old man with back pain, morning stiffness, HLA-B27 positive. Diagnosis? | A. Ankylosing spondylitis | B. RA | C. OA | D. Gout | A. Ankylosing spondylitis |
| A 40-year-old with big-toe pain, needle-shaped crystals, negative birefringence. Diagnosis? | A. Gout | B. Pseudogout | C. RA | D. OA | A. Gout |
| A 60-year-old with knee pain, rhomboid crystals, positive birefringence. Diagnosis? | A. Pseudogout | B. Gout | C. RA | D. OA | A. Calcium pyrophosphate deposition disease (Pseudogout) |
| A 60-year-old man with anemia, bone pain, and lytic skull lesions. Diagnosis? | A. Multiple myeloma | B. Metastasis | C. Osteoporosis | D. Paget | A. Multiple myeloma |
| A 65-year-old with recurrent infections, M-spike on electrophoresis. Diagnosis? | A. Multiple myeloma | B. MGUS | C. Waldenström | D. Lymphoma | A. Multiple myeloma |
| A 70-year-old man with lymphocytosis, smudge cells. Diagnosis? | A. CLL | B. CML | C. AML | D. ALL | A. Chronic lymphocytic leukemia |
| A 50-year-old with basophilia, splenomegaly, t(9;22). Diagnosis? | A. CML | B. AML | C. CLL | D. PV | A. Chronic myeloid leukemia |
| A 5-year-old child with anemia, bone pain, hepatosplenomegaly. Diagnosis? | A. ALL | B. AML | C. CML | D. Lymphoma | A. Acute lymphoblastic leukemia |
| A 40-year-old man with blasts and Auer rods. Diagnosis? | A. AML | B. ALL | C. CML | D. CLL | A. Acute myeloid leukemia |
| A 35-year-old man with painless lymphadenopathy, Reed–Sternberg cells. Diagnosis? | A. Hodgkin lymphoma | B. NHL | C. CLL | D. TB | A. Hodgkin lymphoma |
| A 55-year-old man with B-symptoms and multiple nodes. Diagnosis? | A. Non-Hodgkin lymphoma | B. Hodgkin | C. CLL | D. TB | A. Non-Hodgkin lymphoma |
| A 60-year-old with anemia, renal failure, hypercalcemia. Diagnosis? | A. Multiple myeloma | B. MGUS | C. Lymphoma | D. CML | A. Multiple myeloma |
| A 65-year-old with IgM spike, hyperviscosity. Diagnosis? | A. Waldenström macroglobulinemia | B. MM | C. MGUS | D. Lymphoma | A. Waldenström macroglobulinemia |
| A 40-year-old woman with petechiae, low platelets, normal PT/PTT. Diagnosis? | A. ITP | B. TTP | C. DIC | D. HUS | A. Immune thrombocytopenic purpura |
| A 35-year-old with fever, anemia, thrombocytopenia, renal failure, neurologic symptoms. Diagnosis? | A. TTP | B. HUS | C. DIC | D. ITP | A. Thrombotic thrombocytopenic purpura |
| A 5-year-old post-diarrhea child with anemia, thrombocytopenia, renal failure. Diagnosis? | A. HUS | B. TTP | C. DIC | D. ITP | A. Hemolytic uremic syndrome |
| A 60-year-old septic patient with bleeding, prolonged PT/aPTT. Diagnosis? | A. DIC | B. TTP | C. HUS | D. ITP | A. Disseminated intravascular coagulation |
| A 55-year-old man with pruritus after hot bath, Hct ↑, EPO ↓. Diagnosis? | A. Polycythemia vera | B. Secondary polycythemia | C. CML | D. PV deficiency | A. Polycythemia vera |
| A 45-year-old with migratory thrombophlebitis and pancreatic mass. Diagnosis? | A. Trousseau syndrome | B. DVT | C. Factor V Leiden | D. DIC | A. Trousseau’s migratory thrombophlebitis |
| A 60-year-old with DVT and normal PT/PTT. Likely cause? | A. Factor V Leiden | B. Protein C deficiency | C. Antithrombin III deficiency | D. All | D. Inherited thrombophilia |
| A 40-year-old with microcytosis, target cells, normal iron. Diagnosis? | A. Thalassemia | B. IDA | C. Sideroblastic | D. ACD | A. Thalassemia trait |
| A 30-year-old woman with menorrhagia, low Hb, high TIBC. Diagnosis? | A. Iron deficiency anemia | B. Thalassemia | C. ACD | D. Hemolytic | A. Iron deficiency anemia |
| A 50-year-old vegetarian with macrocytosis, hypersegmented neutrophils. Diagnosis? | A. Megaloblastic anemia | B. IDA | C. ACD | D. Thalassemia | A. Megaloblastic anemia (B12/folate deficiency) |
| A 60-year-old man with pallor, glossitis, paresthesia. Diagnosis? | A. B12 deficiency | B. Folate | C. Iron | D. Chronic disease | A. Vitamin B12 deficiency |
| A 55-year-old man with fatigue, weight loss, hepatosplenomegaly, Hb ↑. Diagnosis? | A. Myelofibrosis | B. CML | C. PV | D. Leukemia | A. Myeloproliferative disorder (PV/myelofibrosis variant) |
| A 40-year-old woman with polyuria, polydipsia, fasting glucose > 126 mg/dL. Diagnosis? | A. Type 2 DM | B. Type 1 DM | C. DI | D. Stress hyperglycemia | A. Type 2 diabetes mellitus |
| A 20-year-old with polyuria, weight loss, ketones in urine. Diagnosis? | A. Type 1 DM | B. Type 2 DM | C. DI | D. Cushing | A. Type 1 diabetes mellitus |
| A 50-year-old diabetic with polyuria, polydipsia, glucose 600, no ketones. Diagnosis? | A. HONK | B. DKA | C. Lactic acidosis | D. Hypoglycemia | A. Hyperosmolar non-ketotic coma |
| A 25-year-old type 1 diabetic with fruity breath, Kussmaul breathing. Diagnosis? | A. DKA | B. HONK | C. Lactic acidosis | D. Uremia | A. Diabetic ketoacidosis |
| A 55-year-old with HbA1c 9%. Interpretation? | A. Poor control | B. Good control | C. Normal | D. Low | A. Poor glycemic control |
| A 50-year-old diabetic with microalbuminuria. Next step? | A. ACE inhibitor | B. ARB | C. Loop diuretic | D. CCB | A. Start ACE inhibitor |
| A 60-year-old diabetic with absent ankle reflexes. Diagnosis? | A. Peripheral neuropathy | B. Nephropathy | C. Retinopathy | D. Myopathy | A. Diabetic peripheral neuropathy |
| A 55-year-old with retinopathy and nephropathy. Type of complication? | A. Microvascular | B. Macrovascular | C. Neuropathic | D. None | A. Microvascular |
| A 60-year-old with MI and stroke. Complication type? | A. Macrovascular | B. Microvascular | C. Acute | D. Neuropathic | A. Macrovascular |
| A 45-year-old with hypoglycemia, ↑ insulin, ↓ C-peptide. Diagnosis? | A. Exogenous insulin use | B. Insulinoma | C. Sulfonylurea | D. Addison | A. Exogenous insulin administration |
| A 40-year-old with ↑ insulin and C-peptide during hypoglycemia. Diagnosis? | A. Insulinoma | B. Addison | C. Factitious | D. GH tumor | A. Pancreatic insulinoma |
| A 30-year-old woman with weight loss, heat intolerance, tremor, palpitations. Diagnosis? | A. Hyperthyroidism | B. Hypothyroidism | C. Anxiety | D. Pheochromocytoma | A. Hyperthyroidism |
| A 28-year-old with exophthalmos, pretibial myxedema. Diagnosis? | A. Graves disease | B. Hashimoto | C. Thyroiditis | D. Toxic adenoma | A. Graves disease |
| A 45-year-old woman with cold intolerance, weight gain, dry skin. Diagnosis? | A. Hypothyroidism | B. Cushing | C. Addison | D. PCOS | A. Primary hypothyroidism |
| A 50-year-old with painful thyroid post-viral infection. Diagnosis? | A. De Quervain thyroiditis | B. Graves | C. Hashimoto | D. Riedel | A. Subacute (De Quervain) thyroiditis |
| A 55-year-old woman with hard woody thyroid fixed to trachea. Diagnosis? | A. Riedel thyroiditis | B. Hashimoto | C. Graves | D. De Quervain | A. Riedel thyroiditis |
| A 45-year-old woman with painless goiter and hypothyroidism. Diagnosis? | A. Hashimoto | B. Graves | C. Subacute | D. Riedel | A. Hashimoto thyroiditis |
| A 40-year-old woman with solitary thyroid nodule, cold on scan. Next step? | A. FNAC | B. Observe | C. Surgery | D. Radioiodine | A. Fine-needle aspiration cytology |
| A 50-year-old woman with thyroid nodule, calcitonin elevated. Diagnosis? | A. Medullary carcinoma | B. Papillary | C. Follicular | D. Anaplastic | A. Medullary thyroid carcinoma |
| A 40-year-old with papillary structures and psammoma bodies. Diagnosis? | A. Papillary carcinoma | B. Follicular | C. Medullary | D. Anaplastic | A. Papillary thyroid carcinoma |
| A 55-year-old with solitary thyroid nodule, capsular invasion, hematogenous spread. Diagnosis? | A. Follicular carcinoma | B. Papillary | C. Medullary | D. Anaplastic | A. Follicular carcinoma |
| A 70-year-old with rapidly enlarging thyroid, compressive symptoms. Diagnosis? | A. Anaplastic carcinoma | B. Medullary | C. Papillary | D. Follicular | A. Anaplastic carcinoma |
| A 45-year-old woman with fatigue, weight gain, hypotension, hyperpigmentation. Diagnosis? | A. Addison disease | B. Cushing | C. Conn | D. SIADH | A. Primary adrenal insufficiency (Addison’s disease) |
| A 35-year-old woman with moon face, truncal obesity, striae, HTN. Diagnosis? | A. Cushing syndrome | B. Addison | C. Conn | D. PCOS | A. Cushing syndrome |
| A 40-year-old man with HTN, hypokalemia, metabolic alkalosis. Diagnosis? | A. Conn syndrome | B. Addison | C. Cushing | D. Pheochromocytoma | A. Primary hyperaldosteronism (Conn’s) |
| A 50-year-old man with episodic headache, sweating, palpitations, HTN. Diagnosis? | A. Pheochromocytoma | B. Cushing | C. Conn | D. Addison | A. Pheochromocytoma |
| A 45-year-old woman with MEN 2A. Involved tumors? | A. Medullary thyroid + Pheo + Parathyroid | B. Pituitary + Pancreas + PTH | C. Pheo + GH | D. Adrenal + Pancreas | A. Medullary thyroid carcinoma, pheochromocytoma, and hyperparathyroidism |
| A 60-year-old woman with confusion, Na 118, osmolality low, concentrated urine. Diagnosis? | A. SIADH | B. DI | C. Addison | D. Cushing | A. Syndrome of inappropriate ADH secretion |
| A 30-year-old man with polyuria, polydipsia, hypernatremia, dilute urine. Diagnosis? | A. Diabetes insipidus | B. SIADH | C. DM | D. Addison | A. Central diabetes insipidus |
| A 40-year-old man with fatigue, weakness, hyperkalemia, low cortisol. Diagnosis? | A. Addison disease | B. Conn | C. Cushing | D. SIADH | A. Addison’s disease |
| A 35-year-old woman with truncal obesity, HTN, purple striae. Diagnosis? | A. Cushing | B. Addison | C. Conn | D. PCOS | A. Cushing syndrome |
| A 50-year-old woman with central obesity, buffalo hump, high cortisol, low ACTH. Diagnosis? | A. Adrenal adenoma | B. Cushing disease | C. Ectopic ACTH | D. Steroid use | A. Adrenal adenoma (ACTH-independent Cushing) |
| A 60-year-old man with galactorrhea, low libido. Diagnosis? | A. Prolactinoma | B. GH tumor | C. ACTH adenoma | D. Cushing | A. Pituitary prolactinoma |
| A 40-year-old man with large hands, jaw enlargement, elevated IGF-1. Diagnosis? | A. Acromegaly | B. Gigantism | C. Cushing | D. GH deficiency | A. Acromegaly |
| A 45-year-old woman with central obesity, amenorrhea, HTN, glucose intolerance. Diagnosis? | A. Cushing syndrome | B. PCOS | C. Addison | D. Conn | A. Cushing syndrome |
| A 30-year-old woman with amenorrhea, galactorrhea, visual field defect. Diagnosis? | A. Prolactinoma | B. Craniopharyngioma | C. Cushing | D. GH tumor | A. Pituitary microadenoma (Prolactinoma) |
| A 35-year-old man with polyuria, dilute urine, hypernatremia. Diagnosis? | A. Diabetes insipidus | B. SIADH | C. DM | D. Addison | A. Diabetes insipidus |
| A 50-year-old man with high calcium, low phosphate, high PTH. Diagnosis? | A. Primary hyperparathyroidism | B. Secondary | C. Tertiary | D. Malignancy | A. Primary hyperparathyroidism |
| A 60-year-old man with hypercalcemia, low PTH. Cause? | A. Malignancy | B. Primary HPT | C. Tertiary | D. Vit D | A. Hypercalcemia of malignancy |
| A 40-year-old with fatigue, low calcium, high phosphate, low PTH. Diagnosis? | A. Hypoparathyroidism | B. Vit D deficiency | C. CKD | D. Pseudohypoparathyroidism | A. Hypoparathyroidism |
| A 55-year-old man with proximal weakness, hypokalemia, metabolic alkalosis. Diagnosis? | A. Conn | B. Addison | C. Cushing | D. Pheo | A. Primary hyperaldosteronism |
| A 35-year-old woman with hypertension, episodic headache, sweating. Diagnosis? | A. Pheochromocytoma | B. Conn | C. Cushing | D. Addison | A. Pheochromocytoma |
| A 45-year-old woman with hot flashes, FSH high, LH high, estrogen low. Diagnosis? | A. Menopause | B. PCOS | C. POF | D. Hypothyroid | A. Natural menopause |
| A 25-year-old woman with amenorrhea, galactorrhea, normal TSH. Diagnosis? | A. Prolactinoma | B. Sheehan | C. PCOS | D. Hypothyroid | A. Pituitary prolactinoma |
| A 28-year-old woman with obesity, hirsutism, irregular menses. Diagnosis? | A. PCOS | B. Cushing | C. CAH | D. Hypothyroidism | A. Polycystic ovary syndrome |
| A 30-year-old with amenorrhea, normal estrogen, normal FSH, normal LH. Diagnosis? | A. Hypothalamic amenorrhea | B. PCOS | C. Premature ovarian failure | D. Sheehan | A. Hypothalamic amenorrhea |
| A 35-year-old woman with hot flashes, premature amenorrhea, high FSH. Diagnosis? | A. Premature ovarian failure | B. Menopause | C. PCOS | D. Sheehan | A. Premature ovarian insufficiency |
| A 50-year-old woman with vaginal dryness, dyspareunia, hot flashes. Diagnosis? | A. Menopause | B. Hypothyroidism | C. PCOS | D. Sheehan | A. Menopause |
| A 45-year-old man with weight gain, central obesity, glucose intolerance. Diagnosis? | A. Metabolic syndrome | B. Cushing | C. Hypothyroidism | D. PCOS | A. Metabolic syndrome |
| A 60-year-old man with obesity, glucose intolerance, dyslipidemia, HTN. Diagnosis? | A. Metabolic syndrome | B. DM | C. Obesity | D. Hypothyroid | A. Metabolic syndrome (Syndrome X) |
| A 40-year-old man with BMI 33, OSA, HTN. Diagnosis? | A. Obesity hypoventilation | B. OSA | C. COPD | D. Restrictive | A. Obesity hypoventilation (Pickwickian syndrome) |
| A 50-year-old with excessive daytime sleepiness, loud snoring. Diagnosis? | A. Obstructive sleep apnea | B. Obesity hypoventilation | C. COPD | D. CHF | A. Obstructive sleep apnea |
| A 65-year-old man with bradykinesia, tremor, rigidity. Diagnosis? | A. Parkinson’s disease | B. Wilson | C. Essential tremor | D. Huntington | A. Parkinson disease |
| A 25-year-old with ascending paralysis post viral infection. Diagnosis? | A. Guillain–Barré syndrome | B. Myasthenia | C. MS | D. Polio | A. Guillain–Barré syndrome |
| A 30-year-old woman with diplopia, weakness, thymic mass. Diagnosis? | A. Myasthenia gravis | B. Lambert–Eaton | C. GBS | D. MS | A. Myasthenia gravis with thymoma |
| A 35-year-old woman with relapsing visual loss, paresthesia. Diagnosis? | A. Multiple sclerosis | B. GBS | C. MG | D. CVA | A. Multiple sclerosis |
| A 40-year-old man with tremor at rest, shuffling gait. Diagnosis? | A. Parkinson disease | B. Huntington | C. Essential tremor | D. Wilson | A. Parkinson disease |
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