⸻
🫀 Heart Failure MCQs (Hard)
Q26: Which is NOT a cause of heart failure?
A. Hypertension
B. Myocardial infarction
C. Hypothyroidism
D. COPD
✔ Answer: D
⸻
Q27: The most reliable marker of volume overload in HF is:
A. Troponin
B. BNP
C. D-dimer
D. CRP
✔ Answer: B
⸻
Q28: Which drug reduces mortality in HF?
A. Furosemide
B. ACE inhibitors
C. Digoxin
D. Spironolactone only for symptoms
✔ Answer: B
⸻
Q29: Pulmonary edema is most commonly seen in:
A. Right HF
B. Left HF
C. Renal failure
D. Liver cirrhosis
✔ Answer: B
⸻
Q30: In HF, S4 sound indicates:
A. Ventricular dilation
B. Stiff ventricle
C. Valve rupture
D. Pericarditis
✔ Answer: B
⸻
💥 Tamponade MCQs (Hard)
Q31: Which is TRUE about tamponade?
A. Increased LV filling
B. Decreased venous pressure
C. Impaired diastolic filling
D. Increased stroke volume
✔ Answer: C
⸻
Q32: CXR in tamponade typically shows:
A. Cavitation
B. Water bottle heart
C. Hyperinflation
D. Normal lungs always
✔ Answer: B
⸻
Q33: Which condition can mimic tamponade clinically?
A. COPD
B. Tension pneumothorax
C. Asthma
D. MI
✔ Answer: B
⸻
Q34: Kussmaul sign is seen in:
A. Tamponade
B. PE only
C. MI
D. Hypertension
✔ Answer: A
⸻
Q35: First step in unstable tamponade:
A. Diuretics
B. IV fluids + pericardiocentesis
C. Beta blockers
D. Oxygen only
✔ Answer: B
⸻
⚡ Mixed Davidson Traps
Q36: Orthopnea is caused by:
A. Increased venous return when lying flat
B. Decreased preload
C. Bradycardia
D. Valve stenosis
✔ Answer: A
⸻
Q37: Raised JVP is a feature of:
A. Left HF only
B. Right HF and tamponade
C. Asthma
D. COPD only
✔ Answer: B
⸻
Q38: Pulsus paradoxus is most associated with:
A. Aortic stenosis
B. Tamponade
C. MI
D. Hypertension
✔ Answer: B
🫀 Heart Failure MCQs (Hard)
Q26: Which is NOT a cause of heart failure?
A. Hypertension
B. Myocardial infarction
C. Hypothyroidism
D. COPD
✔ Answer: D
⸻
Q27: The most reliable marker of volume overload in HF is:
A. Troponin
B. BNP
C. D-dimer
D. CRP
✔ Answer: B
⸻
Q28: Which drug reduces mortality in HF?
A. Furosemide
B. ACE inhibitors
C. Digoxin
D. Spironolactone only for symptoms
✔ Answer: B
⸻
Q29: Pulmonary edema is most commonly seen in:
A. Right HF
B. Left HF
C. Renal failure
D. Liver cirrhosis
✔ Answer: B
⸻
Q30: In HF, S4 sound indicates:
A. Ventricular dilation
B. Stiff ventricle
C. Valve rupture
D. Pericarditis
✔ Answer: B
⸻
💥 Tamponade MCQs (Hard)
Q31: Which is TRUE about tamponade?
A. Increased LV filling
B. Decreased venous pressure
C. Impaired diastolic filling
D. Increased stroke volume
✔ Answer: C
⸻
Q32: CXR in tamponade typically shows:
A. Cavitation
B. Water bottle heart
C. Hyperinflation
D. Normal lungs always
✔ Answer: B
⸻
Q33: Which condition can mimic tamponade clinically?
A. COPD
B. Tension pneumothorax
C. Asthma
D. MI
✔ Answer: B
⸻
Q34: Kussmaul sign is seen in:
A. Tamponade
B. PE only
C. MI
D. Hypertension
✔ Answer: A
⸻
Q35: First step in unstable tamponade:
A. Diuretics
B. IV fluids + pericardiocentesis
C. Beta blockers
D. Oxygen only
✔ Answer: B
⸻
⚡ Mixed Davidson Traps
Q36: Orthopnea is caused by:
A. Increased venous return when lying flat
B. Decreased preload
C. Bradycardia
D. Valve stenosis
✔ Answer: A
⸻
Q37: Raised JVP is a feature of:
A. Left HF only
B. Right HF and tamponade
C. Asthma
D. COPD only
✔ Answer: B
⸻
Q38: Pulsus paradoxus is most associated with:
A. Aortic stenosis
B. Tamponade
C. MI
D. Hypertension
✔ Answer: B
⸻
🫀 Heart Failure MCQs (Very High Yield)
Q39: Which drug improves symptoms but NOT mortality in HF?
A. ACE inhibitors
B. Beta blockers
C. Furosemide
D. ARNI
✔ Answer: C
⸻
Q40: Most common symptom in left HF:
A. Edema
B. Dyspnea
C. Hepatomegaly
D. Ascites
✔ Answer: B
⸻
Q41: Which is a sign of chronic right HF?
A. Pulmonary edema
B. Raised JVP
C. Orthopnea
D. PND
✔ Answer: B
⸻
Q42: HF with preserved EF is mainly due to:
A. Dilated ventricle
B. Diastolic dysfunction
C. Valve rupture
D. Arrhythmia only
✔ Answer: B
⸻
Q43: Most sensitive marker for HF exacerbation:
A. Troponin
B. BNP
C. CK-MB
D. ESR
✔ Answer: B
⸻
💥 Tamponade MCQs (Very High Yield)
Q44: Which is MOST specific for tamponade?
A. Dyspnea
B. Hypotension
C. Electrical alternans
D. Tachycardia
✔ Answer: C
⸻
Q45: Why does pulsus paradoxus occur?
A. Increased LV contraction
B. Reduced LV filling during inspiration
C. Aortic valve stenosis
D. Increased SVR
✔ Answer: B
⸻
Q46: Which condition increases risk of tamponade after MI?
A. Free wall rupture
B. Atrial fibrillation
C. Mitral stenosis
D. LVH
✔ Answer: A
⸻
Q47: Echo in tamponade shows:
A. LV hypertrophy
B. Pericardial fluid + diastolic collapse
C. Valve calcification
D. Normal heart
✔ Answer: B
⸻
Q48: In tamponade, jugular venous pressure is:
A. Low
B. Normal
C. High
D. Variable only
✔ Answer: C
⸻
⚡ Mixed Exam Killers
Q49: Which finding suggests severe HF?
A. S1 loud
B. S3 gallop
C. Bradycardia
D. Murmur only
✔ Answer: B
⸻
Q50: Most life-threatening complication of HF is:
A. Stroke
B. Cardiogenic shock
C. Anemia
D. Hypertension
✔ Answer: B
🫀 Heart Failure MCQs (Very High Yield)
Q39: Which drug improves symptoms but NOT mortality in HF?
A. ACE inhibitors
B. Beta blockers
C. Furosemide
D. ARNI
✔ Answer: C
⸻
Q40: Most common symptom in left HF:
A. Edema
B. Dyspnea
C. Hepatomegaly
D. Ascites
✔ Answer: B
⸻
Q41: Which is a sign of chronic right HF?
A. Pulmonary edema
B. Raised JVP
C. Orthopnea
D. PND
✔ Answer: B
⸻
Q42: HF with preserved EF is mainly due to:
A. Dilated ventricle
B. Diastolic dysfunction
C. Valve rupture
D. Arrhythmia only
✔ Answer: B
⸻
Q43: Most sensitive marker for HF exacerbation:
A. Troponin
B. BNP
C. CK-MB
D. ESR
✔ Answer: B
⸻
💥 Tamponade MCQs (Very High Yield)
Q44: Which is MOST specific for tamponade?
A. Dyspnea
B. Hypotension
C. Electrical alternans
D. Tachycardia
✔ Answer: C
⸻
Q45: Why does pulsus paradoxus occur?
A. Increased LV contraction
B. Reduced LV filling during inspiration
C. Aortic valve stenosis
D. Increased SVR
✔ Answer: B
⸻
Q46: Which condition increases risk of tamponade after MI?
A. Free wall rupture
B. Atrial fibrillation
C. Mitral stenosis
D. LVH
✔ Answer: A
⸻
Q47: Echo in tamponade shows:
A. LV hypertrophy
B. Pericardial fluid + diastolic collapse
C. Valve calcification
D. Normal heart
✔ Answer: B
⸻
Q48: In tamponade, jugular venous pressure is:
A. Low
B. Normal
C. High
D. Variable only
✔ Answer: C
⸻
⚡ Mixed Exam Killers
Q49: Which finding suggests severe HF?
A. S1 loud
B. S3 gallop
C. Bradycardia
D. Murmur only
✔ Answer: B
⸻
Q50: Most life-threatening complication of HF is:
A. Stroke
B. Cardiogenic shock
C. Anemia
D. Hypertension
✔ Answer: B
1
A 68-year-old man with COPD presents with confusion and tremor. ABG shows:
pH 7.31
PaCO₂ 68 mmHg
HCO₃⁻ 34 mmol/L
Which interpretation is MOST accurate?
A. Acute respiratory acidosis
B. Chronic respiratory acidosis with metabolic compensation
C. Mixed respiratory and metabolic acidosis
D. Metabolic alkalosis with respiratory compensation
E. Normal ABG for COPD
⸻
2
A patient with MI develops sudden hypotension, JVP elevation, and clear lungs. Best diagnosis?
A. LV failure
B. Cardiac tamponade
C. Pulmonary embolism
D. RV infarction
E. Septic shock
⸻
3
Which drug most likely causes metabolic alkalosis with hypokalemia AND hypertension?
A. Furosemide
B. Acetazolamide
C. Spironolactone
D. Amiloride
E. Mannitol
⸻
4
A young woman has hemoptysis, hematuria, and anti-GBM antibodies. Which feature is most specific?
A. Granulomas on biopsy
B. Linear IgG deposition
C. PR3-ANCA positivity
D. Immune complex deposition
E. Hypocomplementemia
⸻
5
Which condition causes low serum iron, low TIBC, high ferritin?
A. Iron deficiency anemia
B. Thalassemia trait
C. Anemia of chronic disease
D. Sideroblastic anemia
E. Acute blood loss
⸻
6
A patient with cirrhosis develops confusion. What is the MOST sensitive early marker of hepatic encephalopathy?
A. Elevated bilirubin
B. Asterixis
C. Increased ammonia
D. Prolonged PT
E. Hypoalbuminemia
⸻
7
Which ECG finding is MOST specific for hyperkalemia?
A. Peaked T waves
B. Short QT
C. Wide QRS with sine wave pattern
D. ST depression
E. U waves
⸻
8
A patient has nephrotic syndrome. Which is MOST likely?
A. RBC casts
B. Hypoalbuminemia + edema
C. High complement levels
D. Hypertension always severe
E. Low urine protein
⸻
9
Which organism is MOST associated with endocarditis in IV drug users?
A. Streptococcus viridans
B. Staphylococcus epidermidis
C. Staphylococcus aureus
D. Enterococcus faecalis
E. HACEK organisms
⸻
10
Which finding differentiates DIC from TTP?
A. Thrombocytopenia
B. Schistocytes
C. Normal PT/PTT
D. Elevated D-dimer
E. Renal failure
A 68-year-old man with COPD presents with confusion and tremor. ABG shows:
pH 7.31
PaCO₂ 68 mmHg
HCO₃⁻ 34 mmol/L
Which interpretation is MOST accurate?
A. Acute respiratory acidosis
B. Chronic respiratory acidosis with metabolic compensation
C. Mixed respiratory and metabolic acidosis
D. Metabolic alkalosis with respiratory compensation
E. Normal ABG for COPD
⸻
2
A patient with MI develops sudden hypotension, JVP elevation, and clear lungs. Best diagnosis?
A. LV failure
B. Cardiac tamponade
C. Pulmonary embolism
D. RV infarction
E. Septic shock
⸻
3
Which drug most likely causes metabolic alkalosis with hypokalemia AND hypertension?
A. Furosemide
B. Acetazolamide
C. Spironolactone
D. Amiloride
E. Mannitol
⸻
4
A young woman has hemoptysis, hematuria, and anti-GBM antibodies. Which feature is most specific?
A. Granulomas on biopsy
B. Linear IgG deposition
C. PR3-ANCA positivity
D. Immune complex deposition
E. Hypocomplementemia
⸻
5
Which condition causes low serum iron, low TIBC, high ferritin?
A. Iron deficiency anemia
B. Thalassemia trait
C. Anemia of chronic disease
D. Sideroblastic anemia
E. Acute blood loss
⸻
6
A patient with cirrhosis develops confusion. What is the MOST sensitive early marker of hepatic encephalopathy?
A. Elevated bilirubin
B. Asterixis
C. Increased ammonia
D. Prolonged PT
E. Hypoalbuminemia
⸻
7
Which ECG finding is MOST specific for hyperkalemia?
A. Peaked T waves
B. Short QT
C. Wide QRS with sine wave pattern
D. ST depression
E. U waves
⸻
8
A patient has nephrotic syndrome. Which is MOST likely?
A. RBC casts
B. Hypoalbuminemia + edema
C. High complement levels
D. Hypertension always severe
E. Low urine protein
⸻
9
Which organism is MOST associated with endocarditis in IV drug users?
A. Streptococcus viridans
B. Staphylococcus epidermidis
C. Staphylococcus aureus
D. Enterococcus faecalis
E. HACEK organisms
⸻
10
Which finding differentiates DIC from TTP?
A. Thrombocytopenia
B. Schistocytes
C. Normal PT/PTT
D. Elevated D-dimer
E. Renal failure
⸻
1
A 64-year-old presents with:
confusion
Na⁺ 112
serum osmolality low
urine osmolality 600
urine Na⁺ 70
clinically euvolemic
After 3% saline, sodium rises to 120 rapidly. Next best step?
A. Continue hypertonic saline
B. Give desmopressin
C. Fluid restriction only
D. Mannitol
E. Stop all treatment
⸻
2
A patient with chest pain has:
ST elevation in II, III, aVF
hypotension
clear lungs
JVP elevated
Best immediate management?
A. Furosemide
B. Nitroglycerin
C. IV fluids
D. Beta blockers
E. Morphine only
⸻
3
A woman has recurrent DVT + miscarriages. Labs show:
prolonged aPTT that does NOT correct with mixing test
Most likely mechanism?
A. Factor VIII deficiency
B. Lupus anticoagulant
C. Vitamin K deficiency
D. Heparin overdose
E. DIC
⸻
4
A COPD patient ABG:
pH 7.36
PaCO₂ 70
HCO₃⁻ 38
Interpretation?
A. Acute respiratory acidosis
B. Chronic respiratory acidosis with compensation
C. Mixed disorder
D. Metabolic alkalosis
E. Normal variant
⸻
5
A patient develops:
hemoptysis
hematuria
rapidly rising creatinine
anti-GBM positive
Best initial treatment?
A. Steroids alone
B. Cyclophosphamide only
C. Plasma exchange + steroids + cyclophosphamide
D. ACE inhibitors
E. Dialysis only
⸻
6
Which condition causes low K+, metabolic alkalosis, hypertension, low renin, low aldosterone?
A. Conn syndrome
B. Liddle syndrome
C. Bartter syndrome
D. Addison disease
E. RTA type 4
⸻
7
A patient has fever, confusion, rigidity, CK 20,000 after antipsychotic use. Best next step?
A. Bromocriptine
B. Haloperidol
C. Continue antipsychotic
D. Lithium
E. Beta blockers
⸻
8
Which ECG finding is MOST dangerous in hyperkalemia?
A. Peaked T waves
B. Prolonged PR
C. Sine wave pattern
D. Flattened P wave
E. U waves
⸻
9
A patient has nephrotic syndrome with:
massive proteinuria
normal BP
normal complement
effacement of podocytes
Most likely?
A. FSGS
B. Minimal change disease
C. Post-strep GN
D. IgA nephropathy
E. RPGN
⸻
10
A patient develops acute pancreatitis. Hypocalcemia mechanism?
A. Renal loss
B. PTH suppression
C. Fat saponification
D. Vit D deficiency
E. Magnesium excess
⸻
11
Which disease gives “strawberry gingival hyperplasia + nephrotic syndrome”?
A. SLE
B. Amyloidosis
C. Diabetes mellitus
D. Wegener granulomatosis
E. Goodpasture
⸻
12
A patient has:
fever
headache
bradycardia
rose spots
Diagnosis?
A. Typhoid fever
B. Brucellosis
C. Malaria
D. Dengue
E. Leptospirosis
⸻
13
Most specific marker for heparin overdose?
A. Platelet drop
B. Prolonged PT
C. Prolonged aPTT
D. High D-dimer
E. Low fibrinogen
⸻
14
A patient after MI develops:
new harsh systolic murmur
shock
pulmonary edema
Diagnosis?
A. Papillary muscle rupture
B. VSD rupture
C. Pericarditis
D. LV aneurysm
E. PE
⸻
15
Which is MOST specific for Addison disease?
A. Hypertension
B. Hypernatremia
C. Hyperkalemia + hyperpigmentation
D. Low cortisol only
E. Low aldosterone only
⸻
✅ Answer Key (No cheating 😈)
B
C
B
B
C
B
A
C
B
C
B
A
C
A
C
1
A 64-year-old presents with:
confusion
Na⁺ 112
serum osmolality low
urine osmolality 600
urine Na⁺ 70
clinically euvolemic
After 3% saline, sodium rises to 120 rapidly. Next best step?
A. Continue hypertonic saline
B. Give desmopressin
C. Fluid restriction only
D. Mannitol
E. Stop all treatment
⸻
2
A patient with chest pain has:
ST elevation in II, III, aVF
hypotension
clear lungs
JVP elevated
Best immediate management?
A. Furosemide
B. Nitroglycerin
C. IV fluids
D. Beta blockers
E. Morphine only
⸻
3
A woman has recurrent DVT + miscarriages. Labs show:
prolonged aPTT that does NOT correct with mixing test
Most likely mechanism?
A. Factor VIII deficiency
B. Lupus anticoagulant
C. Vitamin K deficiency
D. Heparin overdose
E. DIC
⸻
4
A COPD patient ABG:
pH 7.36
PaCO₂ 70
HCO₃⁻ 38
Interpretation?
A. Acute respiratory acidosis
B. Chronic respiratory acidosis with compensation
C. Mixed disorder
D. Metabolic alkalosis
E. Normal variant
⸻
5
A patient develops:
hemoptysis
hematuria
rapidly rising creatinine
anti-GBM positive
Best initial treatment?
A. Steroids alone
B. Cyclophosphamide only
C. Plasma exchange + steroids + cyclophosphamide
D. ACE inhibitors
E. Dialysis only
⸻
6
Which condition causes low K+, metabolic alkalosis, hypertension, low renin, low aldosterone?
A. Conn syndrome
B. Liddle syndrome
C. Bartter syndrome
D. Addison disease
E. RTA type 4
⸻
7
A patient has fever, confusion, rigidity, CK 20,000 after antipsychotic use. Best next step?
A. Bromocriptine
B. Haloperidol
C. Continue antipsychotic
D. Lithium
E. Beta blockers
⸻
8
Which ECG finding is MOST dangerous in hyperkalemia?
A. Peaked T waves
B. Prolonged PR
C. Sine wave pattern
D. Flattened P wave
E. U waves
⸻
9
A patient has nephrotic syndrome with:
massive proteinuria
normal BP
normal complement
effacement of podocytes
Most likely?
A. FSGS
B. Minimal change disease
C. Post-strep GN
D. IgA nephropathy
E. RPGN
⸻
10
A patient develops acute pancreatitis. Hypocalcemia mechanism?
A. Renal loss
B. PTH suppression
C. Fat saponification
D. Vit D deficiency
E. Magnesium excess
⸻
11
Which disease gives “strawberry gingival hyperplasia + nephrotic syndrome”?
A. SLE
B. Amyloidosis
C. Diabetes mellitus
D. Wegener granulomatosis
E. Goodpasture
⸻
12
A patient has:
fever
headache
bradycardia
rose spots
Diagnosis?
A. Typhoid fever
B. Brucellosis
C. Malaria
D. Dengue
E. Leptospirosis
⸻
13
Most specific marker for heparin overdose?
A. Platelet drop
B. Prolonged PT
C. Prolonged aPTT
D. High D-dimer
E. Low fibrinogen
⸻
14
A patient after MI develops:
new harsh systolic murmur
shock
pulmonary edema
Diagnosis?
A. Papillary muscle rupture
B. VSD rupture
C. Pericarditis
D. LV aneurysm
E. PE
⸻
15
Which is MOST specific for Addison disease?
A. Hypertension
B. Hypernatremia
C. Hyperkalemia + hyperpigmentation
D. Low cortisol only
E. Low aldosterone only
⸻
✅ Answer Key (No cheating 😈)
B
C
B
B
C
B
A
C
B
C
B
A
C
A
C
⸻
1
A 58-year-old has:
severe hyponatremia (Na 108)
seizures
serum osmolality low
urine osmolality high
history of small cell lung cancer
Which is BEST next step?
A. Fluid restriction only
B. 3% hypertonic saline slow correction
C. D5W infusion
D. Furosemide alone
E. Tolvaptan immediately
⸻
2
A patient with MI develops:
hypotension
clear lungs
JVP elevated
pulsus paradoxus
Most likely diagnosis?
A. LV failure
B. RV infarction
C. Cardiac tamponade
D. Pulmonary embolism
E. Tension pneumothorax
⸻
3
Which condition gives normal anion gap metabolic acidosis + hypokalemia?
A. Diarrhea
B. DKA
C. Lactic acidosis
D. RTA type 1
E. Renal failure
⸻
4
A patient has:
hemoptysis
glomerulonephritis
c-ANCA positive
Most likely diagnosis?
A. Goodpasture
B. Wegener (GPA)
C. SLE
D. IgA nephropathy
E. Post-strep GN
⸻
5
Which drug causes pulmonary fibrosis + thyroid dysfunction + corneal deposits?
A. Digoxin
B. Amiodarone
C. Procainamide
D. Methotrexate
E. Bleomycin
⸻
6
A patient has:
episodic headache
sweating
hypertension
high urine catecholamines
Best next step before surgery?
A. Start beta blocker only
B. Start alpha blocker first
C. Give diuretics
D. Immediate surgery
E. Calcium channel blocker only
⸻
7
Which ECG pattern is MOST specific for acute pericarditis?
A. ST depression in V1–V3
B. Diffuse ST elevation + PR depression
C. Q waves in inferior leads
D. Tall T waves only
E. T wave inversion localized
⸻
8
A patient develops anemia + low reticulocytes + high ferritin + chronic infection. Diagnosis?
A. Iron deficiency anemia
B. Aplastic anemia
C. Anemia of chronic disease
D. Thalassemia
E. Hemolytic anemia
⸻
9
Which condition causes hypocalcemia + hyperphosphatemia + low PTH?
A. Vit D deficiency
B. CKD
C. Hyperparathyroidism
D. Pseudohypoparathyroidism
E. Rhabdomyolysis
⸻
10
A patient has nephrotic syndrome + renal vein thrombosis risk. Most likely?
A. Minimal change disease
B. FSGS
C. Membranous nephropathy
D. Post-strep GN
E. IgA nephropathy
⸻
11
Which organism causes infective endocarditis on prosthetic valves early (<60 days)?
A. Strep viridans
B. Staph epidermidis
C. Staph aureus
D. Enterococcus
E. HACEK
⸻
12
A patient has:
proximal muscle weakness
rash over knuckles
interstitial lung disease
Diagnosis?
A. SLE
B. Dermatomyositis
C. RA
D. Scleroderma
E. Polymyalgia rheumatica
⸻
13
Which is MOST specific for DIC?
A. Thrombocytopenia
B. Prolonged PT + aPTT
C. High D-dimer
D. Schistocytes
E. Bleeding only
⸻
14
A patient has severe asthma attack. BEST initial treatment?
A. Oral steroids only
B. Beta blockers
C. Nebulized salbutamol + ipratropium
D. Oxygen only
E. Antibiotics
⸻
15
Which condition gives normal AG metabolic acidosis + high urine pH (>5.5)?
A. RTA type 1
B. RTA type 2
C. Diarrhea
D. DKA
E. Salicylate poisoning
⸻
✅ Answer Key
B
C
D
B
B
B
B
C
B
C
B
B
C
C
A
1
A 58-year-old has:
severe hyponatremia (Na 108)
seizures
serum osmolality low
urine osmolality high
history of small cell lung cancer
Which is BEST next step?
A. Fluid restriction only
B. 3% hypertonic saline slow correction
C. D5W infusion
D. Furosemide alone
E. Tolvaptan immediately
⸻
2
A patient with MI develops:
hypotension
clear lungs
JVP elevated
pulsus paradoxus
Most likely diagnosis?
A. LV failure
B. RV infarction
C. Cardiac tamponade
D. Pulmonary embolism
E. Tension pneumothorax
⸻
3
Which condition gives normal anion gap metabolic acidosis + hypokalemia?
A. Diarrhea
B. DKA
C. Lactic acidosis
D. RTA type 1
E. Renal failure
⸻
4
A patient has:
hemoptysis
glomerulonephritis
c-ANCA positive
Most likely diagnosis?
A. Goodpasture
B. Wegener (GPA)
C. SLE
D. IgA nephropathy
E. Post-strep GN
⸻
5
Which drug causes pulmonary fibrosis + thyroid dysfunction + corneal deposits?
A. Digoxin
B. Amiodarone
C. Procainamide
D. Methotrexate
E. Bleomycin
⸻
6
A patient has:
episodic headache
sweating
hypertension
high urine catecholamines
Best next step before surgery?
A. Start beta blocker only
B. Start alpha blocker first
C. Give diuretics
D. Immediate surgery
E. Calcium channel blocker only
⸻
7
Which ECG pattern is MOST specific for acute pericarditis?
A. ST depression in V1–V3
B. Diffuse ST elevation + PR depression
C. Q waves in inferior leads
D. Tall T waves only
E. T wave inversion localized
⸻
8
A patient develops anemia + low reticulocytes + high ferritin + chronic infection. Diagnosis?
A. Iron deficiency anemia
B. Aplastic anemia
C. Anemia of chronic disease
D. Thalassemia
E. Hemolytic anemia
⸻
9
Which condition causes hypocalcemia + hyperphosphatemia + low PTH?
A. Vit D deficiency
B. CKD
C. Hyperparathyroidism
D. Pseudohypoparathyroidism
E. Rhabdomyolysis
⸻
10
A patient has nephrotic syndrome + renal vein thrombosis risk. Most likely?
A. Minimal change disease
B. FSGS
C. Membranous nephropathy
D. Post-strep GN
E. IgA nephropathy
⸻
11
Which organism causes infective endocarditis on prosthetic valves early (<60 days)?
A. Strep viridans
B. Staph epidermidis
C. Staph aureus
D. Enterococcus
E. HACEK
⸻
12
A patient has:
proximal muscle weakness
rash over knuckles
interstitial lung disease
Diagnosis?
A. SLE
B. Dermatomyositis
C. RA
D. Scleroderma
E. Polymyalgia rheumatica
⸻
13
Which is MOST specific for DIC?
A. Thrombocytopenia
B. Prolonged PT + aPTT
C. High D-dimer
D. Schistocytes
E. Bleeding only
⸻
14
A patient has severe asthma attack. BEST initial treatment?
A. Oral steroids only
B. Beta blockers
C. Nebulized salbutamol + ipratropium
D. Oxygen only
E. Antibiotics
⸻
15
Which condition gives normal AG metabolic acidosis + high urine pH (>5.5)?
A. RTA type 1
B. RTA type 2
C. Diarrhea
D. DKA
E. Salicylate poisoning
⸻
✅ Answer Key
B
C
D
B
B
B
B
C
B
C
B
B
C
C
A
⸻
1
A 70-year-old develops confusion after pneumonia. Labs:
Na 114
Serum osmolality low
Urine osmolality 650
Urine Na 80
TSH normal, cortisol normal
After 3% saline, Na rises from 114 → 122 in 6 hours.
What is BEST next step?
A. Continue same rate
B. Stop therapy and give free water (D5W)
C. Give mannitol
D. Start vaptan
E. Observe only
⸻
2
A patient with chest pain:
ST elevation in II, III, aVF
hypotension
clear lungs
JVP elevated
ECG shows ST elevation V1–V4 also
Best explanation?
A. Inferior MI only
B. RV infarction with anterior extension
C. Pericarditis
D. PE
E. LV failure
⸻
3
A patient has:
metabolic acidosis
normal anion gap
urine anion gap positive
hypokalemia
Diagnosis?
A. Diarrhea
B. RTA type 1
C. RTA type 4
D. DKA
E. Lactic acidosis
⸻
4
A 25-year-old:
hematuria
hearing loss
eye abnormalities
family history
Most likely mutation?
A. Type IV collagen
B. Fibrillin
C. Dystrophin
D. CFTR
E. Hemoglobin beta chain
⸻
5
A patient develops:
fever
rigidity
autonomic instability
CK 30,000
on haloperidol
BUT also on lithium.
Most appropriate immediate step?
A. Stop antipsychotic only
B. Dantrolene + bromocriptine
C. Continue lithium
D. Give benzodiazepine only
E. Start antibiotics
⸻
6
Which condition causes low renin + low aldosterone + hyperkalemia + metabolic acidosis?
A. Conn syndrome
B. Liddle syndrome
C. Addison disease
D. RTA type 1
E. Diarrhea
⸻
7
A patient has nephrotic syndrome:
PLA2R positive antibodies
normal complement
Diagnosis?
A. Minimal change disease
B. Membranous nephropathy
C. FSGS
D. Post-strep GN
E. IgA nephropathy
⸻
8
A patient has:
severe HTN
abdominal bruit
unilateral small kidney
Best diagnostic test?
A. Plasma aldosterone
B. Doppler renal artery
C. CT chest
D. Urine catecholamines
E. Renal biopsy
⸻
9
A patient has fever + confusion + low platelets + renal failure. Smear shows schistocytes. PT/PTT normal.
Diagnosis?
A. DIC
B. TTP
C. HUS
D. ITP
E. Leukemia
⸻
10
A COPD patient ABG:
pH 7.28
CO₂ 80
HCO₃⁻ 36
Sudden oxygen therapy worsens CO₂ retention. MAIN mechanism?
A. Loss hypoxic drive
B. Haldane effect
C. V/Q mismatch
D. Respiratory depression
E. Metabolic alkalosis
⸻
11
Which ECG finding is MOST specific for hyperkalemia death risk?
A. Peaked T waves
B. Prolonged PR
C. Sine wave
D. Wide QRS
E. Flattened P wave
⸻
12
A patient with pancreatitis develops hypocalcemia. Mechanism?
A. Renal loss
B. Fat saponification
C. Vit D deficiency
D. PTH suppression
E. Hypermagnesemia
⸻
13
A patient has:
weight loss
tremor
AF
diffuse goiter
high uptake scan
Best long-term treatment?
A. Beta blocker
B. Methimazole
C. Radioiodine
D. Surgery only
E. Steroids
⸻
14
A patient has:
fever
rash
eosinophilia
rising creatinine
recent antibiotics
Diagnosis?
A. Post-strep GN
B. Acute interstitial nephritis
C. RPGN
D. ATN
E. Pyelonephritis
⸻
15
A patient has:
recurrent DVT
miscarriages
prolonged aPTT not corrected by mixing
Most specific antibody?
A. Anti-dsDNA
B. Anti-GBM
C. Anti-cardiolipin
D. Anti-Smith
E. Anti-CCP
⸻
🔥 ANSWERS
B
B
B
A
B
C
B
B
B
C
C
B
C
B
C
1
A 70-year-old develops confusion after pneumonia. Labs:
Na 114
Serum osmolality low
Urine osmolality 650
Urine Na 80
TSH normal, cortisol normal
After 3% saline, Na rises from 114 → 122 in 6 hours.
What is BEST next step?
A. Continue same rate
B. Stop therapy and give free water (D5W)
C. Give mannitol
D. Start vaptan
E. Observe only
⸻
2
A patient with chest pain:
ST elevation in II, III, aVF
hypotension
clear lungs
JVP elevated
ECG shows ST elevation V1–V4 also
Best explanation?
A. Inferior MI only
B. RV infarction with anterior extension
C. Pericarditis
D. PE
E. LV failure
⸻
3
A patient has:
metabolic acidosis
normal anion gap
urine anion gap positive
hypokalemia
Diagnosis?
A. Diarrhea
B. RTA type 1
C. RTA type 4
D. DKA
E. Lactic acidosis
⸻
4
A 25-year-old:
hematuria
hearing loss
eye abnormalities
family history
Most likely mutation?
A. Type IV collagen
B. Fibrillin
C. Dystrophin
D. CFTR
E. Hemoglobin beta chain
⸻
5
A patient develops:
fever
rigidity
autonomic instability
CK 30,000
on haloperidol
BUT also on lithium.
Most appropriate immediate step?
A. Stop antipsychotic only
B. Dantrolene + bromocriptine
C. Continue lithium
D. Give benzodiazepine only
E. Start antibiotics
⸻
6
Which condition causes low renin + low aldosterone + hyperkalemia + metabolic acidosis?
A. Conn syndrome
B. Liddle syndrome
C. Addison disease
D. RTA type 1
E. Diarrhea
⸻
7
A patient has nephrotic syndrome:
PLA2R positive antibodies
normal complement
Diagnosis?
A. Minimal change disease
B. Membranous nephropathy
C. FSGS
D. Post-strep GN
E. IgA nephropathy
⸻
8
A patient has:
severe HTN
abdominal bruit
unilateral small kidney
Best diagnostic test?
A. Plasma aldosterone
B. Doppler renal artery
C. CT chest
D. Urine catecholamines
E. Renal biopsy
⸻
9
A patient has fever + confusion + low platelets + renal failure. Smear shows schistocytes. PT/PTT normal.
Diagnosis?
A. DIC
B. TTP
C. HUS
D. ITP
E. Leukemia
⸻
10
A COPD patient ABG:
pH 7.28
CO₂ 80
HCO₃⁻ 36
Sudden oxygen therapy worsens CO₂ retention. MAIN mechanism?
A. Loss hypoxic drive
B. Haldane effect
C. V/Q mismatch
D. Respiratory depression
E. Metabolic alkalosis
⸻
11
Which ECG finding is MOST specific for hyperkalemia death risk?
A. Peaked T waves
B. Prolonged PR
C. Sine wave
D. Wide QRS
E. Flattened P wave
⸻
12
A patient with pancreatitis develops hypocalcemia. Mechanism?
A. Renal loss
B. Fat saponification
C. Vit D deficiency
D. PTH suppression
E. Hypermagnesemia
⸻
13
A patient has:
weight loss
tremor
AF
diffuse goiter
high uptake scan
Best long-term treatment?
A. Beta blocker
B. Methimazole
C. Radioiodine
D. Surgery only
E. Steroids
⸻
14
A patient has:
fever
rash
eosinophilia
rising creatinine
recent antibiotics
Diagnosis?
A. Post-strep GN
B. Acute interstitial nephritis
C. RPGN
D. ATN
E. Pyelonephritis
⸻
15
A patient has:
recurrent DVT
miscarriages
prolonged aPTT not corrected by mixing
Most specific antibody?
A. Anti-dsDNA
B. Anti-GBM
C. Anti-cardiolipin
D. Anti-Smith
E. Anti-CCP
⸻
🔥 ANSWERS
B
B
B
A
B
C
B
B
B
C
C
B
C
B
C
❤1
الف مبروك لي كل من اخدي الباص
وربي يعوضكم الي ماخدوش الباص اكيد ربي عنده حكمه من الموضوع
وربي يعوضكم الي ماخدوش الباص اكيد ربي عنده حكمه من الموضوع
❤1
الحمد لله كل طلاب الي معايا في الكورس اجتازوه ولله الحمد واخدو الباص ويارب يساعدهم في الكلينك وتمشي امورهم علي خير يارب
❤6👍2
Flashcards: JVP (Jugular Venous Pressure)
Q: What is JVP?
A: Measurement of right atrial pressure by assessing the internal jugular vein.
⸻
Q: Which vein is examined for JVP?
A: Right internal jugular vein.
⸻
Q: Patient position for JVP examination?
A: Semi-recumbent position at 30–45°.
⸻
Q: Why is the right internal jugular vein preferred?
A: It directly reflects right atrial pressure.
⸻
Q: How do you identify JVP?
A: Look for the venous pulsation/meniscus in the neck.
⸻
Q: How is JVP measured?
A: Vertical distance from the top of venous pulsation to the sternal angle (Angle of Louis).
⸻
Q: Normal JVP value?
A: ≤ 3–4 cm above sternal angle.
⸻
Q: High JVP indicates what?
A: Increased right atrial pressure and systemic venous congestion.
⸻
Q: Causes of raised JVP?
A:
Right heart failure
Fluid overload
Tricuspid regurgitation
Cardiac tamponade
Constrictive pericarditis
⸻
Q: JVP vs carotid pulse — key difference?
A:
JVP → not palpable, varies with respiration
Carotid → palpable, single strong pulse
⸻
Q: What is Kussmaul sign?
A: Rise in JVP during inspiration.
⸻
Q: Kussmaul sign occurs in?
A:
Right ventricular infarction
Constrictive pericarditis
Restrictive cardiomyopathy
⸻
Q: Large v waves in JVP suggest?
A: Tricuspid regurgitation.
⸻
Q: Absent a waves in JVP suggest?
A: Atrial fibrillation.
Q: What is JVP?
A: Measurement of right atrial pressure by assessing the internal jugular vein.
⸻
Q: Which vein is examined for JVP?
A: Right internal jugular vein.
⸻
Q: Patient position for JVP examination?
A: Semi-recumbent position at 30–45°.
⸻
Q: Why is the right internal jugular vein preferred?
A: It directly reflects right atrial pressure.
⸻
Q: How do you identify JVP?
A: Look for the venous pulsation/meniscus in the neck.
⸻
Q: How is JVP measured?
A: Vertical distance from the top of venous pulsation to the sternal angle (Angle of Louis).
⸻
Q: Normal JVP value?
A: ≤ 3–4 cm above sternal angle.
⸻
Q: High JVP indicates what?
A: Increased right atrial pressure and systemic venous congestion.
⸻
Q: Causes of raised JVP?
A:
Right heart failure
Fluid overload
Tricuspid regurgitation
Cardiac tamponade
Constrictive pericarditis
⸻
Q: JVP vs carotid pulse — key difference?
A:
JVP → not palpable, varies with respiration
Carotid → palpable, single strong pulse
⸻
Q: What is Kussmaul sign?
A: Rise in JVP during inspiration.
⸻
Q: Kussmaul sign occurs in?
A:
Right ventricular infarction
Constrictive pericarditis
Restrictive cardiomyopathy
⸻
Q: Large v waves in JVP suggest?
A: Tricuspid regurgitation.
⸻
Q: Absent a waves in JVP suggest?
A: Atrial fibrillation.
Q: What is pulse?
A: The palpable arterial pressure wave produced by left ventricular contraction.
⸻
Q: Steps of pulse examination?
A:
Rate
Rhythm
Character
Volume
Equality
Condition of arterial wall
⸻
Pulse Rate
Q: Normal adult pulse rate?
A: 60–100 beats/min.
⸻
Q: Tachycardia is defined as?
A: Pulse rate >100 bpm.
⸻
Q: Bradycardia is defined as?
A: Pulse rate <60 bpm.
⸻
Rhythm
Q: What do you assess in pulse rhythm?
A: Regularity of beats.
⸻
Q: Irregularly irregular pulse suggests?
A: Atrial fibrillation.
⸻
Q: Regularly irregular pulse examples?
A:
Heart block
Premature beats (extrasystoles)
⸻
Character
Q: What is pulse character?
A: The shape and speed of pulse upstroke.
⸻
Q: Collapsing pulse is seen in?
A:
Aortic regurgitation
Patent ductus arteriosus
⸻
Q: Slow rising pulse suggests?
A:
Aortic stenosis
⸻
Q: Pulsus alternans indicates?
A:
Severe left ventricular failure
⸻
Q: Pulsus paradoxus indicates?
A:
Cardiac tamponade
Severe asthma
⸻
Volume
Q: Low volume pulse causes?
A:
Shock
Heart failure
Aortic stenosis
⸻
Q: Bounding pulse causes?
A:
Fever
Anemia
Aortic regurgitation
⸻
Examination Sites
Q: Common site for measuring pulse?
A:
Radial artery
⸻
Q: Why examine both radial pulses?
A:
To detect inequality (e.g., coarctation of aorta, arterial obstruction).
⸻
Q: Radio-radial delay suggests?
A:
Aortic dissection
Subclavian artery obstruction
⸻
Q: Radio-femoral delay suggests?
A:
Coarctation of the aorta
A: The palpable arterial pressure wave produced by left ventricular contraction.
⸻
Q: Steps of pulse examination?
A:
Rate
Rhythm
Character
Volume
Equality
Condition of arterial wall
⸻
Pulse Rate
Q: Normal adult pulse rate?
A: 60–100 beats/min.
⸻
Q: Tachycardia is defined as?
A: Pulse rate >100 bpm.
⸻
Q: Bradycardia is defined as?
A: Pulse rate <60 bpm.
⸻
Rhythm
Q: What do you assess in pulse rhythm?
A: Regularity of beats.
⸻
Q: Irregularly irregular pulse suggests?
A: Atrial fibrillation.
⸻
Q: Regularly irregular pulse examples?
A:
Heart block
Premature beats (extrasystoles)
⸻
Character
Q: What is pulse character?
A: The shape and speed of pulse upstroke.
⸻
Q: Collapsing pulse is seen in?
A:
Aortic regurgitation
Patent ductus arteriosus
⸻
Q: Slow rising pulse suggests?
A:
Aortic stenosis
⸻
Q: Pulsus alternans indicates?
A:
Severe left ventricular failure
⸻
Q: Pulsus paradoxus indicates?
A:
Cardiac tamponade
Severe asthma
⸻
Volume
Q: Low volume pulse causes?
A:
Shock
Heart failure
Aortic stenosis
⸻
Q: Bounding pulse causes?
A:
Fever
Anemia
Aortic regurgitation
⸻
Examination Sites
Q: Common site for measuring pulse?
A:
Radial artery
⸻
Q: Why examine both radial pulses?
A:
To detect inequality (e.g., coarctation of aorta, arterial obstruction).
⸻
Q: Radio-radial delay suggests?
A:
Aortic dissection
Subclavian artery obstruction
⸻
Q: Radio-femoral delay suggests?
A:
Coarctation of the aorta
📢 إعلان لطلبة الباطنة والجراحة
الإعلان موجه للطلبة اللي دخلوا أكثر من امتحان في الباطنة أو الجراحة، وما زالوا ما قدروش يصفّوا المادة رغم المحاولات السابقة.
معانا حتبدأ بطريقة مختلفة من خلال:
✅ تنظيم المنهج وتحديد أهم المواضيع
✅ شرح وتبسيط النقاط الصعبة
✅ ربط المعلومات وتثبيتها
✅ التدريب على أسئلة الامتحانات
✅ متابعة مستمرة وخطة مناسبة لمستواك
✅ التركيز على أسباب التعثر وكيفية تجاوزها
📱 الدراسة أونلاين بالكامل عبر التليجرام
🌍 متاحة لأي طالب داخل ليبيا أو خارجها
المحاولات السابقة ما تعنيش إنك مش قادر… يمكن فقط كنت محتاج طريقة مراجعة وتنظيم مختلفة.
📩 للتسجيل والتواصل عبر التليجرام:
@weamweamweam
الإعلان موجه للطلبة اللي دخلوا أكثر من امتحان في الباطنة أو الجراحة، وما زالوا ما قدروش يصفّوا المادة رغم المحاولات السابقة.
معانا حتبدأ بطريقة مختلفة من خلال:
✅ تنظيم المنهج وتحديد أهم المواضيع
✅ شرح وتبسيط النقاط الصعبة
✅ ربط المعلومات وتثبيتها
✅ التدريب على أسئلة الامتحانات
✅ متابعة مستمرة وخطة مناسبة لمستواك
✅ التركيز على أسباب التعثر وكيفية تجاوزها
📱 الدراسة أونلاين بالكامل عبر التليجرام
🌍 متاحة لأي طالب داخل ليبيا أو خارجها
المحاولات السابقة ما تعنيش إنك مش قادر… يمكن فقط كنت محتاج طريقة مراجعة وتنظيم مختلفة.
📩 للتسجيل والتواصل عبر التليجرام:
@weamweamweam