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Question 1
A patient recovering from bacterial meningitis is found to have progressive hearing loss. What is the most common complication of meningitis?
- Sensorineural hearing loss
- Communicating hydrocephalus
- Cerebral palsy
- Focal neurologic deficits
Question 2
In iron deficiency anemia, the reticulocyte count is typically elevated.
- True
- False
Question 3
How do oral contraceptive pills increase the risk of deep vein thrombosis?
- Estrogen decreases protein S levels
- Progestin increases antithrombin activity
- Estrogen increases platelet production by the bone marrow
- Progestin causes endothelial fibrinoid necrosis
Question 4
The strongest predisposing factor for both ischemic and hemorrhagic stroke is ______.
Fill in the blank
Question 5
Which test is the confirmatory test of choice for hereditary spherocytosis?
- Eosin-5-maleimide (EMA) binding test
- Osmotic fragility test
- Direct Coombs test
- Hemoglobin electrophoresis
Question 6
A patient on digoxin presents with ventricular fibrillation, hyperkalemia, and altered mental status. What is the appropriate treatment?
- Digoxin-specific antibody Fab fragments
- Calcium chloride infusion
- Higher-dose digoxin to stabilize the rhythm
- Furosemide to lower serum potassium
Question 7
In patients older than 65 years, bioprosthetic heart valves are generally preferred over mechanical valves because valve degeneration is slower and long-term anticoagulation is not required.
- True
- False
Question 8
A patient's acne has not improved with topical retinoids, benzoyl peroxide, and topical antibiotics. What is the next step?
- Add oral antibiotics
- Start isotretinoin immediately
- Stop all topical therapy and observe
- Switch to a topical antihistamine
Question 9
Which carcinoma is most strongly associated with Epstein-Barr virus?
- Nasopharyngeal carcinoma
- Oropharyngeal carcinoma of the tonsil
- Laryngeal squamous cell carcinoma
- Esophageal adenocarcinoma
Question 10
How is polycythemia vera initially managed?
- Therapeutic phlebotomy plus low-dose aspirin
- Hydroxyurea alone
- Therapeutic phlebotomy plus full-dose warfarin
- Observation without intervention
Question 11
Which antihypertensive class is first-line for African American patients with hypertension and no other compelling indication?
- Thiazide diuretics
- Angiotensin-converting enzyme inhibitors
- Beta blockers
- Aldosterone antagonists
Question 12
What is the most common cause of death in patients with chronic kidney disease?
- Cardiovascular disease
- Infection
- Gastrointestinal bleeding
- Malignant hypertension
Question 13
Cardiovascular disease is the leading cause of death in patients with chronic kidney disease.
- True
- False
Question 14
A patient has epistaxis, petechiae, and ecchymoses with large platelets and a normal platelet count. Which disorder is most likely?
- Bernard-Soulier syndrome
- Glanzmann thrombasthenia
- Immune thrombocytopenia (ITP)
- Von Willebrand disease
Question 15
Deficiency of which platelet receptor causes Glanzmann thrombasthenia?
- Glycoprotein IIb/IIIa (fibrinogen receptor)
- Glycoprotein Ib/IX/V (von Willebrand factor receptor)
- Glycoprotein Ia/IIa (collagen receptor)
- P-selectin
Question 16
Which test confirms the diagnosis of leukemia?
Fill in the blank
Question 17
A patient with membranous nephropathy suddenly develops bilateral flank pain, gross hematuria, elevated lactate dehydrogenase, acute kidney injury, and bilateral renal enlargement. What is the most likely diagnosis?
- Bilateral acute renal vein thrombosis
- Bilateral acute renal artery thrombosis
- Acute tubular necrosis
- Acute pyelonephritis
Question 18
Which imaging study is preferred to confirm renal vein thrombosis in a patient with acute kidney injury?
- Magnetic resonance venography
- Computed tomography angiography
- Renal ultrasound
- Intravenous pyelography
Question 19
In the ristocetin cofactor assay, ristocetin induces platelet aggregation by activating von Willebrand factor to bind which platelet receptor?
- Glycoprotein Ib
- Glycoprotein IIb/IIIa
- Glycoprotein Ia/IIa
- P2Y12 receptor
Question 20
Failure of platelet aggregation after ristocetin is added is seen in von Willebrand disease and Bernard-Soulier syndrome.
- True
- False
Question 21
A young adult presents with a nonproductive cough, bibasilar crackles, and hemolytic anemia. Which infection best explains this presentation?
- Mycoplasma pneumoniae
- Streptococcus pneumoniae
- Legionella pneumophila
- Mycobacterium tuberculosis
Question 22
Which anticonvulsants are considered safe for use during pregnancy?
- Lamotrigine and levetiracetam
- Valproate and phenytoin
- Carbamazepine and phenobarbital
- Topiramate and valproate
Question 23
A patient who lives in a basement develops erythrocytosis during the winter. What is the most likely mechanism?
- Chronic carbon monoxide poisoning causing chronic cerebral hypoxia and increased erythropoietin production
- Polycythemia vera with autonomous red blood cell production
- Obstructive sleep apnea causing nocturnal hypoxemia
- Erythropoietin-secreting renal cell carcinoma
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