1) A 55-year-old woman with a history of atrial fibrillation is admitted to the emergency department following a syncopal episode. She reports accidentally ingesting twice her daily dose of levothyroxine (synthetic thyroxine) for the past week. Physical exam reveals a heart rate of 140 beats per minute and a fine tremor in her hands. Laboratory results show elevated free T4 levels and normal TSH levels. Which of the following findings is the MOST concerning complication of her thyroxine overdose?
A. Development of Graves' disease
B. Acute kidney injury
C. Electrolyte imbalances
D. Thyroid storm
E. Agranulocytosis
2) The most prevalent type of antibody found in maternal plasma that has role in fetal protection and has long-lasting nature is likely;
a- Immunoglobulin M
b- Immunoglobulin G
c- Immunoglobulin A
d- Immunoglobulin E
e- Immunoglobulin D
3) Among the following oral anticoagulants, which one usually requires a lead-in period with a parenteral anticoagulant (like heparin) for 5-10 days before starting the medication to achieve effective blood thinning (therapeutic anticoagulation)?
A. Dabigatran
B. Edoxaban
C. Apixaban
D. Rivaroxaban
E. Warfarin
4) Identify the well-known culprit bacterium that plays a significant role in the development of dental caries (cavities)?
a- Escherichia coli
b- Streptococcus
c- Streptococcus mutans
d- Listeria monocytogenes
e- Corynebacterium diphtheria
5) The coordinated interaction between the hypothalamus, anterior pituitary, and adrenal cortex results in the production and delivery of the hormone called 'cortisol'. What is expected after this hormone is released in the body?
a- decreased inflammation
b- decreased protein breakdown
c- increased gluconeogenesis
d- increased insulin release
e- both a and c
6) The following is NOT the key characteristic of normal erythrocytes?
a- They contain a protein named hemoglobin that carries oxygen and carbon dioxide
b- Erythrocytes typically have a biconvex disc shape
c- Mature erythrocytes lacks nucleus, mitochondria, and other organelles
d- Erythrocytes are highly flexible, allowing them to deform as they pass through capillaries and other narrow blood vessels without rupturing
e- Erythropoietin, the hormone responsible for the formation of new erythrocytes, is released by the kidneys
7) If a patient has a history of seizures or is at risk of developing them, prescribing which class of antidepressants can be considered as they are likely to have the least effect on seizure threshold compared to other classes of antidepressants?
A) Tricyclic antidepressants (TCAs)
B) Monoamine oxidase inhibitors (MAOIs)
C) Selective serotonin reuptake inhibitors (SSRIs)
D) Serotonin-norepinephrine reuptake inhibitors (SNRIs)
E) Atypical antidepressants
8) What are the characteristic features of Pityriasis Versicolor?
A) Raised, itchy, red patches with central clearing
B) Circular, scaly, erythematous plaques with a central depression
C) Fine, powdery, hypopigmented or hyperpigmented patches on the skin
D) Linear streaks of vesicles on an erythematous base
E) Large, fluid-filled blisters on an erythematous background
9) Which of the following substances is most likely to interfere with the effectiveness of Warfarin (a blood thinner)?
A) Ginkgo
B) Omeprazole
C) St. John's Wort
D) Cranberry juice
E) Levothyroxine
10) What is the alcohol concentration in parts per million (ppm) found in the bloodstream of a reckless driver, if it comprises 0.1% alcohol?
(A) 100 ppm
(B) 1000 ppm
(C) 10 ppm
(D) 250 ppm
(E) 100,000 ppm
12) A 2-year-old child with frequent ear infections is undergoing diagnostic tests to determine the cause. Laboratory results show a significant decrease in serum IgA levels. Which of the following statements is MOST consistent with this finding?
A. The child is likely to have a weakened immune response to respiratory infections
B. The child is more susceptible to allergic reactions
C. The child's body is overproducing antibodies
D. The child's B cells are not functioning properly
E. The child has a severe autoimmune disease
34) A 52-year-old man with a history of some medical condition is prescribed a combination therapy of fenofibrate and nicotinic acid. What is the primary target of this medication combination?
A. Lowering blood pressure
B. Treating vitamin deficiency
C. Reducing blood sugar levels
D. Managing blood clotting disorders
E. Controlling high blood cholesterol
99) What organism is primarily responsible for causing Pityriasis Versicolor?
A) Malassezia furfur
B) Candida albicans
C) Trichophyton rubrum
D) Staphylococcus aureus
E) Streptococcus pyogenes
100) A 72-year-old patient with a history of heart failure arrives at the emergency room with hypertensive crisis. Which of the following medications is LEAST likely to be included in their initial IV infusion for blood pressure control?
A) Labetalol
B) Nicardipine
C) Fenoldopam
D) Hydralazine
E) Nitroglycerin
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Answer Keys
MCQ # - Correct option
1- D
2- b
3- A
4- c
5- e
6- b
7- C
8- C
Explanation:
A) Incorrect. Raised, itchy, red patches with central clearing are more characteristic of conditions like psoriasis or eczema, rather than Pityriasis Versicolor.
B) Incorrect. Circular, scaly, erythematous plaques with a central depression are more indicative of conditions like tinea corporis (ringworm), rather than Pityriasis Versicolor.
C) Correct. Pityriasis Versicolor typically presents as fine, powdery, hypopigmented or hyperpigmented patches on the skin, often in areas of increased sebum production, such as the chest, back, and shoulders.
D) Incorrect. Linear streaks of vesicles on an erythematous base are more characteristic of conditions like contact dermatitis or herpes simplex virus infection.
E) Incorrect. Large, fluid-filled blisters on an erythematous background are more indicative of conditions like bullous pemphigoid or pemphigus vulgaris, rather than Pityriasis Versicolor.
9- C
The answer is: C) St. John's Wort
Here's why:
- Warfarin works by inhibiting vitamin K, which is essential for blood clotting.
- St. John's Wort, an herbal supplement sometimes used for depression, may induce enzymes in the liver that metabolize Warfarin faster. This can potentially reduce the amount of Warfarin available to exert its anticoagulant effect, thereby decreasing its effectiveness.
The other options have a lesser impact on Warfarin:
- A) Ginkgo: While Ginkgo might have some blood-thinning properties, it's not a well-established antagonist of Warfarin.
- B) Omeprazole: This medication used for stomach ulcers might have minor interactions with Warfarin, but it's not a major antagonist.
- D) Cranberry juice: Some studies suggest cranberry juice might interfere with Warfarin's action, although the evidence is not conclusive. It's best to discuss consumption with your doctor.
- E) Levothyroxine: This medication used for hypothyroidism typically doesn't significantly affect Warfarin's action.
10- B
Solution:
To convert the concentration of alcohol from a percentage to parts per million (ppm), you can use the fact that 1% = 10,000 ppm.
Given that the blood of the reckless driver contains 0.1% alcohol, we can calculate the concentration in parts per million as follows:
0.1% alcohol = 0.1 × 10,000 ppm = 1000 ppm
So, the correct answer is (B) 1000 ppm.
12- A
34- E
99- A
Explanation:
A) Correct. Pityriasis Versicolor is primarily caused by the yeast-like fungus Malassezia furfur (also known as Malassezia globosa or Malassezia furfur). It is a normal component of the skin flora but can overgrow under certain conditions, leading to the characteristic skin changes seen in Pityriasis Versicolor.
B) Incorrect. Candida albicans is a yeast species primarily responsible for causing candidiasis, which typically manifests as oral thrush, vaginal yeast infections, or invasive candidiasis, rather than Pityriasis Versicolor.
C) Incorrect. Trichophyton rubrum is a dermatophyte fungus responsible for causing various types of tinea infections, including athlete's foot (tinea pedis) and ringworm (tinea corporis), but not Pityriasis Versicolor.
D) Incorrect. Staphylococcus aureus is a bacterium responsible for various skin infections, such as impetigo, cellulitis, and abscesses, but it is not associated with Pityriasis Versicolor.
E) Incorrect. Streptococcus pyogenes is a bacterium responsible for various infections, including strep throat and skin infections such as impetigo, but it is not associated with Pityriasis Versicolor.
100- D
Explanation:
- Labetalol, Nicardipine, Fenoldopam, and Nitroglycerin are all fast-acting medications used for rapid blood pressure reduction in hypertensive crisis.
- Hydralazine, while effective, can cause reflex tachycardia (increased heart rate) which might not be ideal for someone with a history of heart failure.
- The other options listed are more suitable for initial blood pressure control in this scenario.
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