The document contains a 30 question multiple choice quiz on various topics in medicine including: - Thyroid gland anatomy and function - Causes of goiter - Features of hyperthyroidism and hypothyroidism - Graves disease - Anemia types and causes (iron deficiency, lead poisoning, B12/folate deficiency) - Lung diseases (COPD, asthma, sarcoidosis) - Liver diseases (hemochromatosis) - Bone and joint diseases (rickets) The bonus question asks about the most important initial step for a male physician conducting a clinical breast exam.

1. MD4 ICM 2 QUIZ
13/4/17

2. Question 1
Concerning the thyroid gland, which of the following is NOT
true?
a) Thyroid function is regulated by the hypothalamic-
pituitarty-thyroid axis
b) The thyroid gland is the smallest pure endocrine gland
c) Controls metabolism, protein synthesis, calcium
homeostasis and the body’s sensitivity to other hormones
d) Located in the neck, below thyroid cartilage

3. Question 2
The predominant effects of the thyroid
hormones are mediated through the action of?
a)Thyroglobulin
b)Triiodthyronine
c)Calcitonin
d)Thyroxine

4. Question 3
A Rastafarian male presents to you with a large non-
tender, midline neck swelling. He is a strict vegetarian and
has prepared his meals without salt for the last 20 years.
What is the most likely diagnosis?
a) Iodine deficiency goiter
b) Sodium deficiency goiter
c) B12 deficiency goiter
d) Submandibular abscess

5. Question 4
A 28 year old male with known hyperthyroidism presents to you in a
delirious state. He is flushed and sweaty, and complains of feeling very
nauseous. His girlfriend relates that he has had a fever and has been
coughing up rusty brown secretions for the last 2 days.
His vitals signs are: T- 104, R- 26, P- 165, BP- 140/80
What is the most likely diagnosis?
a) Food poisoning
b) Thyroid storm
c) Thyrotoxicosis
d) Severe, acute tuberculosis

6. Question 5
All of the following are clinical features of
thyrotoxicosis EXCEPT?
a)Lid retaction or lag
b)Weight loss
c)Diarrhea
d)Loss of lateral portions of the eyebrows

7. Question 6
Which of the following is NOT a clinical feature
of hypothyroidism?
a)Hyper-reflexia
b)Cold intolerance
c)Constipation
d)Dry, course skin with puffy features

8. Question 7
Graves’ Disease
I. Is an autoimmune condition cause by a thyroid-stimulating
immunoglobulin (IgG)
II. Presents with a diffusely enlarged, non-tender goiter with a bruit
III. Is often associated with exophthalmos and pretibial myxedema
IV. Is associated with increased uptake of radioactive iodine
Which of these statements is/are correct?
a) I, III and IV
b) I, III and III
c) Only I and III
d) All of the above

9. Question 8
What laboratory findings will support a clinical
diagnosis of thyrotoxicosis?
a)Elevated T4, suppressed T3 and TSH
b)Elevated T3, suppressed T4 and TSH
c)Elevated T3 and T4, suppressed TSH
d)Elevated T3, T4 and TSH

10. Question 9
A 45 year old woman presents complaining of weight loss
despite eating well. You performed a thyroid exam and
have found a solitary thyroid nodule.
Which of the following is the most appropriate initial step
for evaluating this finding?
a) Subtotal thydriodectomy
b) Ultrasound
c) Radioactive iodine scan
d) Fine needle aspiration biopsy

11. Question 10
“Stones, groans, bones and psychiatric
overtones” is a mnemonic which represent the
clinical features of which of the following?
a)Primary hyperparathyroidism
b)Primary hypoparathyroidism
c)Primary hypothyroidism
d)Primary hyperthyroidism

12. Question 11
24 year old Fred is 8 feet tall. At 9 years, he was 2 feet taller
than his classmates and at 16 years he was12 inches taller
than his father who is 5 feet 9 inches tall.
Which of the following best describes Fred’s condition?
a) Fred has gigantism
b) This condition results from excessive growth hormone
secretion before closure of the epiphysis
c) This condition results from excessive growth hormone
secretion after closure of the epiphysis
d) A and B

13. Question 12
28 year old Suhil is 6 feet 8 inches tall. He is the shortest male
in his family. He has noticed that his wedding band no longer
fits and neither does any of his favorite hats. He recently paid
for special prescription lenses to help with his tunnel vision
and is currently taking 5mg Ramipril tabs twice daily.
What is Suhil’s diagnosis?
a) Hypopituitarism
b) Acromegaly
c) Gigantism
d) Fragile X syndrome

14. Question 13

15. Concerning this picture, which of the following is
false?
a)There is excessive deposition of copper in the
Descemet membrane of the iris
b)This results from an autosomal recessive
condition that affects the ATP7B enzyme
c) Patients often present with fulminant hepatitis
and neurologic symptoms
d)Liver biopsy confirms diagnosis

16. Question 14
A 44 year old miner from Port Kaituma presents complaining
of fatigue and constant headaches. Laboratory tests reveal a
Hb of 7mg/dL and reticulocyte count of 2.4. His LDH and
bilirubin levels are normal. He has had malaria in the past but
has completed his treatment regimen. He is currently using
only Omeprazole and multivitamins.
What is the most likely cause of this patient’s anemia?
a) Iron deficiency
b) Malaria
c) Peptic ulcer disease
d) Colon cancer

17. Question 15
All of the following are causes of microcytic
anemia except?
a)Cooley’s anemia
b)Renal failure
c)Iron deficiency
d)Folate deficiency

18. Question 16
A 5 year old girl with a known history of eating
paint chips off the walls in her old home was found
to have a Hb of 8.
What is the most likely cause of her anemia?
a)Iron deficiency
b)Lead poisoning
c) Folate deficiency
d)B12 deficiency

19. Question 17
A 40 year old male presents to you with bronze colored
skin. He complains of palpitations, joint pains and weight
loss. Physical exam reveals an enlarged liver.
Which of the following is true of this patient’s condition?
a) This is an autosomal recessive disease
b) The cause is excessive accumulation of iron
c) Deferoxamine is a first line treatment
d) All of the above

20. Question 18
Following a viral infection, an 18 year old male presents to you
pale and weak. Laboratory tests reveal the following.
Hb- 7.4 mg/dL
Platelets- 25,000 (Normal- 150,000-450,000)
WBC- 2,500 (Normal- 4,500- 11,000)
What is the most likely diagnosis?
a) HIV infection
b) Sickle cell disease
c) Aplastic anemia
d) Anemia of chronic disease

21. Question 19
Frontal bossing, massive heptosplenomegaly
and severe microcytic, hypochromic anemia is
consistent with which clinical diagnosis?
a)Beta-thalassemia minor
b)Sickle cell anemia
c)G6PD deficiency
d)Beta-thalassemia major

22. Question 19
A 60-year-old man develops numbness of the feet. On
physical examination he has lost proprioception in the lower
extremities and is noticed to have a wide based gait with a
positive Romberg sign. His past medical history includes
hypertension, hypothyroidism, and previous gastrectomy for
gastric cancer.
What is the most likely cause of his symptoms?
a. Folic acid deficiency
b. Vitamin B12 deficiency
c. Vitamin K deficiency
d. Iron deficiency

23. Question 20
Which of the following is a common finding on
peripheral blood smear of patients with vitamin
B12 deficiency?
a)Sideroblasts
b)Microcytic, hypochromic RBCs
c)Heinz bodies
d)Hypersegmented neutrophils

24. Question 21
A 16 year old patient with anorexia nervosa gave birth to a
low birth weight baby boy with a spina bifida malformation.
She was found to be anemic at the start of her pregnancy but
refused to take prenatal supplements and attend antenatal
clinics.
Which of the following is the cause of her baby’s
malformation?
a) Folic acid deficiency
b) B12 deficiency
c) Iron deficiency
d) Thiamine deficiency

25. Question 22
Functional asplenia in sickle cell disease patients
predisposes them to infection with which of the
following?
a)Cytomegalovirus
b)Parvovirus B19
c)Staph. Aureus
d)Encapsulated bacteria

26. Question 23
Which of the following is required to make the clinical
diagnosis of chronic bronchitis?
a) Chronic cough productive of sputum for at least 3
months per year for at least 2 consecutive years
b) Chronic dry cough for at least 3 months per year for at
least 2 consecutive years
c) Wheezing with sputum production for at least 3
months per year for at least 2 consecutive years
d) Chronic cough productive of sputum for at least 1
month per year at least 3 consecutive years

27. Question 24
Which of the following is NOT true of tobacco smoking
and emphysema?
a) Particles from tobacco smoke lead to an increase in
PMNs and macrophages in the lungs
b) Tobacco smoke inhibits alpha-1 antitrypsin leading to
increased protease activity
c) Tar from tobacco results in scarring and fibrosis of lung
tissue resulting in air trapping
d) Tobacco smoke increases free radical production which
results in oxidative damage to lung tissue

28. Question 25
Which of the following represents the spirometric
results seen in obstructive lung disease?
a)Decreased FEV1 and decreased FEV1/FVC ratio
b)Decreased FEV1 and increased FEV1/FVC ratio
c) Increased FEV1 and increased FEV1/FVC ratio
d)Increased FEV1 and decreased FEV1/FVC ratio

29. Question 26
Which of the following represents the spirometric
results seen in restrictive lung disease?
a)Decreased FEV1 and decreased FEV1/FVC ratio
b)Decreased FEV1 and increased FEV1/FVC ratio
c) Increased FEV1 and increased FEV1/FVC ratio
d)Increased FEV1 and decreased FEV1/FVC ratio

30. Question 27
Murali is a Texila student who presents to you complaining of
severe chest tightness. He relates that he was previously in
good health but has just returned from a trip with his friend,
who owns three German Shepherds. He is fully vaccinated
but refers to having frequent night time coughs as a child for
which his mother would give him Asthalin. Lung auscultation
revealed normal findings.
What is the most likely diagnosis?
a) Allergic rhinitis
b) Sarcoidosis
c) Bronchiolitis
d) Asthma

31. Question 28
Which of the following is associated with the
presence of non-caseating granulomatous
disease?
a)Sarcoidosis
b)Histiocytosis X
c)Wegner’s granulomatous
d)Churg-Strauss disease

32. Question 29
The presence of c-antineutrophilic cytoplasmic
antibodies (c-ANCA) is contributive to the
diagnosis of which of the following?
a)Sarcoidosis
b)Histiocytosis X
c)Wegner’s granulomatous
d)Churg-Strauss disease

33. Question 30
The presence of perinuclear antineutrophilic
cytoplasmic antibody (p-ANCA) is contributive to
the diagnosis of which of the following?
a)Sarcoidosis
b)Histiocytosis X
c) Wegner’s granulomatous
d)Churg-Strauss disease

34. Bonus question (Worth 2 points)
For male physicians, what is the most important initial step when preparing to
conduct a clinical breast exam?
a) Ask patient to undress to the waist to ensure adequate exposure
b) Request a female chaperone
c) Ensure that patient is comfortable
d) Informed consent