Free Trial Exam - Palverum Medical Exams

1

Lightning strike injury is characterised by:

Emergency Medicine Environmental Emergencies

A. Burns only

B. Cardiac arrest only

C. Neurological injury only

D. Cardiac and respiratory arrest, burns, and neurological injury

E. Local pain only

2

A 58-year-old woman from Salfit presents to Yasser Arafat Governmental Hospital with a 3-week history of progressive fatigue, dark urine, and pale stools. She reports intermittent right upper quadrant pain and a 5 kg weight loss. Examination reveals scleral icterus and mild hepatomegaly. Laboratory studies show elevated alkaline phosphatase (480 U/L) and total bilirubin (8.2 mg/dL), with normal transaminases. Which of the following is not a recognized cause of this patient’s presentation?

Internal Medicine Gastroenterology & Hepatology

A. Choledocholithiasis (stone in the common bile duct) causing obstructive jaundice

B. Cholangiocarcinoma causing extrahepatic biliary obstruction

C. Primary sclerosing cholangitis associated with ulcerative colitis leading to biliary strictures

D. Pancreatic head adenocarcinoma causing extrinsic compression of the common bile duct

E. Duodenal peptic ulcer disease causing gastric outlet obstruction without biliary obstruction

3

A 54-year-old man named Ibrahim from Hebron presents to Alia Governmental Hospital with a 6-month history of episodic flushing, watery diarrhea, and occasional wheezing. His blood pressure is 110/70 mmHg, heart rate 98/min, and oxygen saturation 94% on room air. Physical examination reveals a systolic murmur at the left lower sternal border. 24-hour urinary 5-HIAA is markedly elevated. Which of the following sites is most strongly associated with the development of systemic symptoms in a patient with a serotonin-secreting gastrointestinal neuroendocrine tumor?

Internal Medicine Hematology

A. Hepatic tissue

B. Pulmonary parenchyma (pulmonary metastasis without hepatic involvement)

C. Cerebral tissue (brain metastasis alone)

D. Dermal tissue (cutaneous metastasis alone)

E. Osseous tissue (bone metastasis alone)

4

A 45-year-old man from Salfit, Mazen, presents to Yasser Arafat Governmental Hospital with a 3-month history of progressive neck swelling, hoarseness, and unintentional weight loss. He reports no prior thyroid disease but has a family history of "hormonal tumors." On exam, his pulse is 98/min, and a firm, fixed 3 cm nodule is palpated in the right thyroid lobe. Ultrasound reveals a hypoechoic mass with microcalcifications. Which of the following statements regarding thyroid disease is false?

General Surgery Breast & Endocrine Surgery

A. Anaplastic thyroid carcinoma generally has a poor prognosis compared to other thyroid malignancies

B. Medullary thyroid carcinoma is associated with other endocrine neoplasms, particularly in MEN 2 syndromes

C. Follicular thyroid carcinoma carries a worse prognosis than papillary thyroid carcinoma

D. The recurrent laryngeal nerve is a branch of the phrenic nerve

E. Graves disease is an autoimmune disorder caused by thyroid-stimulating immunoglobulins targeting the TSH receptor

5

Serotonin syndrome is characterised by:

Emergency Medicine Psychiatric Emergencies

A. Miosis and respiratory depression

B. Dry mouth, urinary retention, and mydriasis

C. Agitation, hyperthermia, clonus, and hyperreflexia

D. Severe muscle rigidity and hyperthermia without clonus

E. Excessive secretions and bradycardia

6

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

7

Stevens-Johnson syndrome is characterised by:

Emergency Medicine Dermatological and Allergic Emergencies

A. Itchy rash only

B. Localised blisters in one area

C. Skin redness with fever only

D. Painful mucosal erosions and skin detachment caused by a drug

E. Rash with itching and rhinorrhoea

8

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

9

Criteria for weaning from mechanical ventilation include:

Anesthesiology & Critical Care Intensive Care

A. 24 hours of intubation only

B. Normal blood pressure only

C. Absence of fever only

D. Resolution of cause, adequate oxygenation, haemodynamic stability, and adequate consciousness

E. Patient requesting weaning

10

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