Free Trial Exam - Palverum Medical Exams

1

A 17-year-old boy is brought to the emergency department by ambulance 30 minutes after the sudden onset of weakness in his legs and upper arms. He explains that he has been under a lot of stress lately preparing for a set of important exams. He had a similar episode 7 months ago the first night after finishing a football tournament with his high school. At the time, the weakness lasted 5 hours and resolved completely without treatment. At follow-up examination 1 week later, the results of a complete blood count, routine serum studies, and an MRI of the brain and spine showed no abnormalities. Medical and family history is otherwise unremarkable. He is not sexually active. He takes no medications and his immunizations are up-to-date. He smokes 2–3 cigarettes daily and does not drink alcohol or use illicit drugs. He is 180 cm (5 ft 11 in) tall and weighs 75 kg (165 lb); BMI is 23 kg/m². Temperature is 36.5°C (97.7°F), pulse is 75/min, respirations are 18/min, and blood pressure is 135/85 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 99%. Muscle strength is 2/5 in the hip flexors and knee extensors, 3/5 in the shoulder abductors, and 4/5 in all other muscle groups. Deep tendon reflexes are 1+ throughout. Sensation is intact. He is oriented to person, place, and time. Examination of the cranial nerves shows no abnormalities. Cardiopulmonary examination shows no other abnormalities. Fingerstick blood glucose concentration is normal. ECG is shown. Which of the following is the most likely diagnosis?

Neurology Neuromuscular Disorders

A. Myasthenia gravis

B. Becker muscular dystrophy

C. Embolic stroke

D. Functional neurological symptom disorder

E. Periodic paralysis

2

Patient Information
Age: 45 years | Gender: M | Site of Care: Office
Chief Concern:
Multiple lesions on chest and lower extremities, progressively increasing in size — not painful or pruritic
History:
HIV diagnosed 7 years ago
Medications: abacavir, dolutegravir, and lamivudine
CD4+ count Skin biopsy
450/mm³ Multiple spindle-shaped cells and lymphocytic infiltrate
A photograph of the lesions is shown. Which of the following is the most appropriate pharmacotherapy?

CD4+ count	Skin biopsy
450/mm³	Multiple spindle-shaped cells and lymphocytic infiltrate

Internal Medicine Infectious Diseases

A. Ganciclovir

B. Nitazoxanide

C. Alpha-interferon

D. Amphotericin B

E. Doxycycline

3

A 28-year-old woman from Tulkarm presents to Al-Isra Hospital after a motor vehicle collision 30 minutes ago. She reports severe neck pain and inability to move her arms or legs. On exam, her blood pressure is 80/50 mmHg, pulse 50/min, and skin is warm and dry. Cervical spine X-ray shows a C5 fracture dislocation. Which of the following features is not expected in this condition?

Orthopedic Surgery Spine Disorders

A. Persistent hypotension unresponsive to fluid resuscitation

B. Tachycardia

C. Diaphoresis above the level of injury

D. Bradycardia may occur because of loss of sympathetic innervation with unopposed vagal activity

4

A 3-day-old male neonate born at Yasser Arafat Governmental Hospital in Salfit is brought by his parents for evaluation of persistent bluish discoloration of the lips and tongue since birth. He was born at term via uncomplicated vaginal delivery, and prenatal ultrasounds were unremarkable. On examination, he is afebrile with a respiratory rate of 50/min, heart rate of 140/min, and oxygen saturation of 82% on room air. Cardiac auscultation reveals a harsh systolic murmur at the left upper sternal border. Chest x-ray shows decreased pulmonary vascular markings. Which of the following is a cause of this patient’s presentation?

Pediatrics Pediatric Cardiology

A. Peripheral vasoconstriction due to cold exposure

B. Low-output congestive heart failure from dilated cardiomyopathy

C. Raynaud phenomenon with digital artery spasm

D. Right-to-left cardiac shunt (cyanotic congenital heart disease)

E. Circulatory shock with distributive vasodilation

5

Tuberculous meningitis CSF findings include:

Neurology Neuroinfectious Diseases

A. Neutrophilic pleocytosis and normal glucose

B. Completely normal CSF

C. Lymphocytic pleocytosis, elevated protein, and low glucose

D. Elevated protein with normal cell count

E. Presence of red blood cells

6

Internuclear ophthalmoplegia in MS results from a lesion in:

Neurology Multiple Sclerosis and Demyelinating Diseases

A. Oculomotor nucleus

B. Abducens nucleus

C. Lateral pons

D. Medial longitudinal fasciculus

E. Visual cortex

7

Superior vena cava obstruction is characterised by:

Emergency Medicine Haematological and Oncological Emergencies

A. Lower limb edema only

B. Chest pain with dyspnoea only

C. Hypertension and headache only

D. Facial and upper limb edema with dilated neck and chest veins

E. Facial edema with fever

8

A 16-year-old boy is brought to the physician by his mother because of a dark red mass on his left thumb. The lesion has rapidly increased in size over the past 2 months. It is not painful, but the lesion bled profusely once when he accidentally bumped his hand on a desk. About 6 months ago, his cat scratched him on the left thumb. He has asthma well controlled with inhaled beclomethasone and albuterol. He is otherwise healthy and receives no other medications. Vital signs are within normal limits. Examination of the left upper extremity shows a solitary 2-cm lesion on the interphalangeal joint of the thumb; a photograph of the lesion is shown. The remainder of the examination shows no abnormalities. Which of the following is the most likely diagnosis?

Dermatology Skin Tumors

A. Cherry hemangioma

B. Pyogenic granuloma

C. Glomus tumor

D. Bacillary angiomatosis

E. Kaposi sarcoma

F. Keloid scar

9

Brown-Sequard syndrome results from:

Neurology Spinal Cord Disorders

A. Hemisection of the spinal cord

B. Anterior spinal artery occlusion

C. Central cord compression

D. Complete cord transection

E. Transverse myelitis

10

Brown-Sequard syndrome from hemisection of the spinal cord causes:

Neurology

A. Ipsilateral loss of proprioception

B. Contralateral loss of proprioception

C. Ipsilateral loss of pain and temperature

D. Contralateral muscle wasting

E. Bilateral paralysis only