Wednesday, March 7, 2012

Answers for Free PLAB, MRCP, USMLE step 1, 2, 3 Test Preparation Questions

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Question 1 Correct Answer C

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Short bowel syndrome is usually the result of surgical resection of the intestines or jejunoileal bypass. The malabsorption is a result of inadequate absorptive surface. Malabsorption of vitamin B12 results in paraesthesias while malabsorption of calcium results in bone pain and carpopedal spasms.


Lactose intolerance results from deficiency of lactose which is a disaccharidase in the mucosal cells of the small intestine which splits the disaccharide lactose into glucose and galactose. Patients complain of borborygni, flatulence, nausea, abdominal cramps, pain, and diarrhea after ingesting lactose containing food like milk. Laboratory investigations reveal that the diarrheal stools are acidic. When the hydrogen breath test is administered, there is elevated hydrogen content in the expired air as the colonic flora digests the unabsorbed lactose. Treatment includes following a lactose-free diet.


Celiac disease is a hereditary disorder caused by gluten intolerance. Gluten is found in wheat, rye, barley, and oats. Patients may be asymptomatic or may present with diarrhea, abdominal discomfort, distention, and steatorrhea in which their stools are pale, malodorous and difficult to flush as they float on the toilet water. They may have anemia from iron and folate deficiency, osteomalacia and bone pains from calcium deficiency, and edema from hypoproteinemia. Laboratory investigations may reveal elevated alkaline phosphatase and prolonged prothrombin time. Diagnosis is confirmed by small intestine mucosal biopsy showing a flat mucosa due to villous atrophy and by subsequent improvement on a gluten-free diet. Specific treatment includes a gluten-free diet.


Tropical sprue is an acquired disease which affects both visitors and natives to tropical areas such as the Caribbean and South India. Its etiology is not known. Patients usually present with diarrhea. They may also complain of weight lossand report that their stools are soft and bulky in steatorrhea. They may also develop deficiencies of folate and cobalamin. Stool microscopy should be done to look for cysts and trophozoites Histological examination of small bowel mucosal biopsy aids in making the diagnosis. Treatment is with tetracycline or oxytetracycline.


Whipples disease, which mainly affects men, is caused by the bacteriumTropheryma whippelii. It is a multisystemic disease which affects the small intestines, joints, brain, heart and eyes. Patients can present with diarrhea, steatorrhea, abdominal pain, weight loss, and joint pains. On examination they may be pale, with lymphadenopathy. Histological examination of small bowel mucosal biopsy reveals PAS positive foamy macrophages. Treatment is with trimethoprim-sulfamethoxazole or chloramphenicol.

Question 2 Correct Answer A

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The clinical picture is suggestive of plant contact dermatitis. Patients usually present with vesicles or bullae with a linear streaky distribution on their hands or legs or other areas of their skin which came into contact with plants such as the poison ivy. Management includes the use of topical steroids such asbetamethasone dipropionate.


Topical antibiotics such as mupirocin are used to treat infective conditions such as impetigo.


Topical antifungals such as clotrimazole cream are used to manage fungal infections such as tinea corporis.


Topical retinoids such as tretinoin and adapalene are used in the management of acne vulgaris.


Topical chemotherapeutic agents such as as 5 Fluorouracil are used in the management of actinic keratosis.

Question 3 Correct Answer C


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Maple bark disease is a Hypersensitivity pneumonitis caused by Cryptostroma corticale that is commonly found in infected maple bark. Symptoms of acute hypersensitivity pneumonitis include cough, dyspnea, fever, and malaise that occur in a previously sensitized person around 6 h after reexposure to the antigen. These symptoms usually clear within a few hours or a few days if there is no further exposure to the antigen. Signs include inspiratory rales.


Malt worker's lung is a Hypersensitivity pneumonitis caused by Aspergillus fumigatus or Aspergillus clavatus that are commonly found in moldy barley and malt.


Farmer's lung is a Hypersensitivity pneumonitis caused by Micropolyspora faeni or Thermoactinomyces vulgaris that are commonly found in moldy hay.


Sequoiosis is a Hypersensitivity pneumonitis caused by Pullularia pullulans or Graphium species that are commonly found in moldy sawdust from redwoods.


Wheat weevil disease is a Hypersensitivity pneumonitis caused by Sitophilus granarius that is commonly found in infested wheat flour.

Question 4 Correct Answer B


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The clinical picture is suggestive of superficial basal cell carcinoma.Patients present with slow growing, reddish, scaly, irregular plaques which can be on their trunk or any other part of the body. These lesions ulcerate and bleed easily. Management includes the use of topical chemotherapeutic agentssuch as 5 Fluorouracil. Other treatment options include surgical excision and cryotherapy. 


Topical immunomodulators such as tacrolimus and pimecrolimus are used in the management of atopic dermatitis.


Topical retinoids such as tretinoin and adapalene are used in the management of acne vulgaris.


Topical emollients such as plain petrolatum are used to manage asteatotic or dry skin conditions such as eczema craquel√©.


Topical antifungals such asclotrimazole cream are used to manage fungal infections such as tinea corporis.

Question 5 Correct Answer A


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In food poisoning caused by Shigella dysenteriae, patients present with bloody diarrhea usually 16 hours after ingesting contaminated foods. They may also be febrile. Common sources of infection include potato salad and raw vegetable salads. A stool examination reveals polymorphonuclear leukocytes without trophozoites. The diagnosis is confirmed by culturing the organism from stool. Management includes rehydration and antibiotics like Ceftriaxone, ciprofloxacin, trimethoprim-sulfamethoxazole or ampicillin.


Metronidazole is used to treat Entamoeba histolytica colitis. Patients usually present with bloody and mucoid diarrhea. Stool examination reveals hematophagous trophozoites and cysts.


Paromomycin and Diloxanide furoate are used to treat asymptomatic Entamoeba histolytica.


Mebendazole is used to treat Ancylostoma americanus and Ancylostoma duodenale infestation. Patients may present with iron deficiency anemia and the ova are visualized in stool microscopy.

Question 6 Correct Answer C


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The clinical picture is suggestive of actinic keratosis. Patients present with multiple papules and plaques with an adherent scale usually on sun exposed areas such as the face, scalp and hands. The skin is usually sun damaged. Management includes the use of topical chemotherapeutic agents such as 5 Fluorouracil.


Topical antifungals such as clotrimazole cream are used to manage fungal infections such as tinea corporis.


Topical steroids such as betamethasone dipropionate are used to manage inflammatory dermatosis responsive to steroids such as lichen planus.


Topical retinoids such as tretinoin and adapalene are used in the management of acne vulgaris.


Topical emollients such as plain petrolatum are used to manage asteatotic or dry skin conditions such as eczema craquel√©.

1 comment:

  1. Hello Dude,

    Short bowel syndrome is a condition in which nutrients are not properly absorbed due to severe intestinal disease or the surgical removal of a large portion of the small intestine. Thanks for sharing it.....

    USMLE Pass Program

    ReplyDelete