Anat, Med & Surg MCQs

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Q1. A 63-year-old male presents with a 12 hour history of severe pain in his
right toe. The toe is swollen, tender to touch and red. The aspiration
microscopy is shown. In which joint is this condition very rare?

a. Knee
b. Elbow
c. Shoulder
d. Wrist
e. Ankle
Q2 Acute flares of this condition are more likely to occur in patients who?

a. Have liver insufficiency

b. Drink excess coffee
c. Have recently been vaccinated
d. Use penicillin
e. Are starving
Q3. If this was a young female receiving a diuretic,
what condition would you want to rule out?
a. Psoriasis
b. Rheumatoid arthritis
c. Lupus
d. Gonorrhea
e. Behcet disease
Q4. A 63-year-old male presents with a 12 hour history of severe pain in his
right toe. The toe is swollen, tender to touch and red. The aspiration
microscopy is shown. Which treatment is unlikely to help this patient?

A. Colchicine
B. Indomethacin
C. Allopurinol
D. Prednisone
Q5. The agent with the mode of action with
black ??? is primarily used to treat?
a. Gout
b. Pseudogout
c. Lesch Nyann syndrome
d. Tumor lysis syndrome
e. Uric acid nephropathy
Q6. The drug with the mode of action shown below is used to treat the
patient in Q1. What common adverse effect will you warn the patient
about?

a. Rash
b. Diarrhea
c. Headaches
d. Neuropathy
e. Tremor
1c,2c,3b,4c,5d,6b
• Gout can be considered a disorder of metabolism that allows uric acid or urate to
accumulate in blood and tissues. When tissues become supersaturated, the urate
salts precipitate, forming monosodium urate crystals. Deposition of these crystals
is most commonly reported in synovium, bone, skin, cartilage, tendon, ligament,
and kidney, but involvement of a range of other musculoskeletal and non-
musculoskeletal tissues also occurs
• Other than the great toe, the most common sites of gouty arthritis are the instep,
ankle, wrist, finger joints, and knee. In early gout, only 1 or 2 joints are usually
involved. Consider the diagnosis in any patient with acute monoarticular arthritis
of any peripheral joint except the glenohumeral joint of the shoulder.
• Vaccination has been associated with increased risk of gout flares. Elevated risk
has been reported with recombinant zoster vaccine and other vaccines, but not
influenza vaccine.
• Allopurinol blocks xanthine oxidase and thus reduces the generation of uric acid.
• Rasburicase (trade names Elitek in the US and Fasturtec in the EU) is a medication
that helps to clear uric acid from the blood. It is a recombinant version of urate
oxidase, an enzyme that metabolizes uric acid to allantoin. Urate oxidase is known
to be present in many mammals but does not naturally occur in humans.
Rasburicase is produced by a genetically modified Saccharomyces cerevisiae
strain.
• Rasburicase is primarily used to treat tumor lysis syndrome. It is administered IV.
• Although colchicine was once the treatment of choice for acute gout, it is now less
commonly used than NSAIDs because of its narrow therapeutic window and risk of
toxicity. To be effective, colchicine therapy is ideally initiated within 36 hours of
onset of the acute attack. When used for acute gout in classic hourly dosing
regimens (no longer recommended), colchicine causes adverse GI effects,
particularly diarrhea and vomiting, in 80% of patients.
Q. A 45-year-old male presents to you with a 6-month history of abdominal pain. He
claims to have intermittent diarrhea, flushing, pruritus and has lost 10lbs in weight. His
urine analysis is shown below. The most likely site of the patient’s tumor location is?

a. Small bowel
b. Appendix
c. Rectum
d. Lung
e. Mediastinum
a
1. 5 HIAA is the metabolic precursor of 5 hydroxytryptamine.
2. Presence of 5–HIAA in the urine is indicative of a carcinoid tumor. The above
patient also has symptoms of a carcinoid syndrome.
3. Carcinoids are rare tumors and are usually most commonly found in the
appendix.
4. They do occur in other sites but at a much lower frequency.
5. When patients present with a carcinoid syndrome, seen in patients with liver
metastases, the primary lesion is most commonly in the ileum.    
Q. The most common type of basal cell
cancer is:
A
B
C
D
E
b
1. The nodular subtype is the most common type of BCC
2. It often presents as a circular, pearly, flesh colored papule
3. This lesion tends to ulcerates as it grows
Q. You have been referred a patient with a basal cell cancer of
the eye. On what part of the eye are these lesions most common?

A
B
C
D
E
c
1. BCC is most common on the lower eyelid, followed by the medial
canthus
Three weeks after a vacation in Panama, a tourist presents with fever, RUQ pain,
diarrhea and general malaise. Workup reveals a collection in the liver which is
aspirated- see below. In his blood work you will typically see an elevation in?

A. Eosinophils
B. Platelets
C. Neutrophils
D. Basophils
E. Monocytes
c
1. Unlike many parasitic disorders, eosinophilia is rare in amebic liver abscess
2. Leukocytosis is common
3. Anemia is also a common finding
4. Jaundice is rare
The liver involvement in amebiasis consists of necrotic abscesses and periportal
inflammation. The abscess contains acellular proteinaceous debris and is
surrounded by a rim of amebic trophozoites invading tissue. The abscess contains a
chocolate-colored fluid that resembles anchovy paste and consists predominantly
of necrotic hepatocytes
Q.A 27 yo smoker presents with painful ulcers on his fingertips. The ulcers have
failed to heal despite all types of treatments. His angiogram is shown below. In
general, which venous disorder is most commonly seen in these patients?

A. Deep vein thrombosis

B. Phlegmasia dolens
C. Migratory thrombophlebitis
D. Superior vena cava thrombosis
E. Spider veins
c
• Thromboangiitis obliterans (TAO), an inflammatory vasculopathy also known as Buerger disease,
is characterized by an inflammatory endarteritis that causes a prothrombotic state and
subsequent vaso-occlusive phenomena. The inflammatory process is initiated within the tunica
intima. It characteristically affects small and medium-sized arteries as well as veins of the upper
and lower extremities. The condition is strongly associated with heavy tobacco use,
• The hallmark angiographic findings in patients with TAO are nonatherosclerotic, segmental
occlusive lesions of the small and medium-sized vessels (eg, digital, palmar, plantar, tibial,
peroneal, radial, and ulnar arteries) with formation of distinctive small collateral vessels around
areas of occlusion, known as corkscrew collaterals
• Superficial thrombophlebitis (often migratory) occurs in almost half of patients with TAO.
Paresthesias (numbness, tingling, burning, hypoesthesia) of the feet and hands and impaired
distal pulses in the presence of normal proximal pulses are usually found in patients with severe
disease. More than 80% of patients present with involvement of three or four limbs
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