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Ticket 1
Expand the main groups of rheumatic diseases in old age, their physiological and clinical features
MCQ
1. Which of the following joints findings is most suggestive of an inflammatory, rather than an osteroarthritic cause of jointspain ?
Painful range of motion
Crepitus
Bony articular enlargement
Swelling and warmth
2.A patient presents 12 hours following a Myocardial
infarction. Which of the following enzymes will be
elevated at this period -
Lactate dehydrogenase
Serum glutamate oxaloacetate Transferase
Creatinine phosphokinase
Myoglobin
A 60 year old man with a history of smoking,
hypertension, and chronic exertional angina
develops several daily episodes of chest pain at
rest compatible with cardiac ischemia. The patient
is hospitalized. All the following would be part of
an appropriate management plan except -
Intravenous heparin
Aspirin
Intravenous nitroglycerin
Lidocaine by bolus infusion
4. Complications of streptokinase are -
a) Myocardial rapture b) Joint pain
c) Intracranial bleed d) Parkinsonism
3. Case
Case 1
A 61-year-old man presents to your office with the complaint of cough. The cough
began approximately 3 months prior to this appointment, and it has become more
annoying to the patient. The cough is nonproductive and worse at night and after
exercise. He has had a sedentary lifestyle but recently started an exercise program,
including jogging, and says he is having a much harder time with the exertion. He
just runs out of breath earlier than he used to previously, and he coughs a great
deal. He has not had any fever, blood-tinged sputum, or weight loss. He denies
nasal congestion and headaches. He does not smoke and has no significant medical
history. His examination is notable for a blood pressure of 134/78 mm Hg and
lungs that are clear to auscultation bilaterally, except for an occasional expiratory
wheeze on forced expiration. A chest radiograph is read as normal.
_ What is the most likely diagnosis?
_ How would you confirm the diagnosis?
Ticket 2
Tell the main research methods in cardiology practice in elderly patients and their indication and contraindication
2. MCQ
1. A 65 year old woman presents with generalized
edema, skin ulceration and hypertension. Urine examination shows subnephrotic proteinuria (< 2gm) and microscopic haematuria. Serum complement levels are decreased and she is positive for antihepatitisс antibodies. The likely diagnosis is -
PSGN
Essential mixed cryoglobulinemia
Membrano proliferative glomerulonephritis
Focal segmental glomerulosclerosis
2.Urinalysis shows RBC casts; likely source is -
a) Kidney b) Ureter
Bladder d) Urethra
3. A 62-year-old man with recently diagnosed emphysema presents to your office in November for a routine examination. He has not had any immunizations in more than 10 years. Which of the following immunizations would be the most appropriate for this individual?
A. Tetanus-diphtheria (Td) only
B. Tdap, pneumococcal, and influenza
C. Pneumococcal and influenza
D. Tdap, pneumococcal, influenza, and meningococcal
4. A 69-year-old sedentary man has made an appointment because his best friend died of an MI at age 50. He asks about an exercise and weight loss program. In counseling him, which of the following statements regarding exercise is most accurate?
A. To be beneficial, exercise must be performed everyday.
B. Walking for exercise has not been shown to improve meaningful clinical outcomes.
C. Counseling patients to exercise has not been shown consistently
to increase the number of patients who exercise.
D. Intense exercise offers no health benefit over mild to moderate amounts of exercise.
Case
Case 2
A 65-year-old man comes to an outpatient clinic complaining of low-grade fever
and sore throat, and he receives an injection of intramuscular penicillin for presumed
streptococcal pharyngitis.
Within 20 minutes, he begins to complain of swelling of his face and
difficulty breathing. He looks dyspneic and frightened. His heart rate is 130 bpm,
blood pressure 90/47 mm Hg, and respiratory rate 28 breaths per minute and
shallow. His face and lips are edematous, and he can barely open his eyes because
of swelling. He is wheezing diffusely, and he has multiple raised urticarial lesions
on his skin. An ambulance has been called.
_ What is the most likely diagnosis?
_ What is your next step?
Ticket 3
Describe the clinic in elderly people and complications of AMI
MCQ
A 68-year-old patient of your practice with known COPD has pulmonary function testing showing an FEV1 of 40% predicted has been having frequent exacerbations of his COPD. His SaO2 by pulse oximetry is 91%. Which of the following medication regimens is the most appropriate?
A. Inhaled salmeterol BID and albuterol as needed
B. Oral albuterol daily and inhaled fluticasone BID
C. Inhaled fluticasone BID, inhaled tiotropium BID, and inhaled albuterol as needed
D. Inhaled fluticasone BID, inhaled tiotropium BID, inhaled albuterol as needed, and home oxygen therapy
2. A 69-year-old man is diagnosed with moderately severe (stage II) COPD. He admits to a long history of cigarette smoking and is stillcurrently smoking. In counseling him about the benefits of smokingcessation, which of the following statements is most accurate?
A. By quitting, his pulmonary function will significantly improve.
B. By quitting, his current pulmonary function will be unchanged,
but the rate of pulmonary function decline will slow.
C. By quitting, his pulmonary function currently and rate of decline
are unchanged, but there are cardiovascular benefits.
D. By quitting, his pulmonary function will approach that of a non-
smoker of the same age.
3.Progressive dysphagia is seen in-
a) Carcinoma esophagus b) Globus hystericus
Presbyesophagus d) Achalasia
4.All are used in treatment of Helicobacter pylori, EXCEPT-
Colloid bismuth b) Cisapride
Clarithromycin d) Metronidazole
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