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Algeria Medical Residency Contest - independent subject foundations study materials
Algeria Medical Residency Contest - independent subject foundations study resources

Algeria Medical Residency Contest - independent subject foundations practice questions

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Question 1Medical pathology, clinical assessment and body-system reasoning

A 58-year-old man presents with persistent crushing retrosternal chest pain of 2 hours' duration. The ECG shows 3 mm ST-segment elevation in leads II, III, and aVF with reciprocal ST depression in leads I and aVL. Which coronary artery is occluded?

  1. Right coronary artery (RCA) Correct answer.
  2. Left anterior descending artery (LAD)
  3. Left circumflex artery (LCx)
  4. Left main coronary artery

Explanation

ST elevation in leads II, III, and aVF defines acute inferior myocardial infarction. In 85% to 90% of individuals, the inferior wall is supplied by the posterior descending branch of the right coronary artery (right-dominant circulation).

Question 2Medical pathology, clinical assessment and body-system reasoning

In a patient presenting with acute ST-elevation myocardial infarction (STEMI) within 2 hours of symptom onset in a center where primary percutaneous coronary intervention (PCI) cannot be performed within 120 minutes, what is the guideline-directed initial reperfusion strategy?

  1. Immediate intravenous fibrinolytic therapy (tenecteplase or alteplase) Correct answer.
  2. Immediate administration of oral high-dose beta-blockers alone
  3. Urgent transfer for elective coronary artery bypass grafting within 48 hours
  4. Conservative management with intravenous unfractionated heparin and observation

Explanation

When primary PCI cannot be accomplished within 120 minutes of STEMI diagnosis, intravenous fibrinolytic therapy should be administered within 10 minutes of diagnosis (in the absence of contraindications), followed by immediate transfer to a PCI-capable center for rescue or routine post-fibrinolysis angiogram.

Question 3Medical pathology, clinical assessment and body-system reasoning

Which clinical physical examination finding is the hallmark sign of cardiac tamponade, characterized by an exaggerated inspiratory decrease in systolic blood pressure greater than 10 mmHg?

  1. Pulsus paradoxus Correct answer.
  2. Pulsus bisferiens
  3. Kussmaul sign
  4. Water-hammer (Corrigan) pulse

Explanation

Pulsus paradoxus is an abnormally large drop in systolic blood pressure (> 10 mmHg) during quiet inspiration. In cardiac tamponade, ventricular interdependence within a non-compliant pericardial sac causes the inspiratory filling of the right ventricle to bow the interventricular septum leftward, impairing left ventricular stroke volume.

Question 4Medical pathology, clinical assessment and body-system reasoning

Which combination of four drug classes forms the guideline-directed cornerstone of medical therapy (the 'four pillars') for heart failure with reduced ejection fraction (HFrEF)?

  1. ARNI (or ACEi), beta-blocker, MRA (mineralocorticoid receptor antagonist), and SGLT2 inhibitor Correct answer.
  2. Loop diuretic, digoxin, calcium channel blocker, and nitrate
  3. ACE inhibitor, alpha-1 blocker, hydralazine, and amiodarone
  4. Angiotensin receptor blocker, statin, aspirin, and spironolactone

Explanation

Current international and national heart failure guidelines mandate quadruple neurohormonal therapy: 1) Angiotensin receptor-neprilysin inhibitor (ARNI) or ACEi, 2) evidence-based beta-blocker (bisoprolol, carvedilol, metoprolol succinate), 3) Mineralocorticoid receptor antagonist (spironolactone or eplerenone), and 4) SGLT2 inhibitor (dapagliflozin or empagliflozin).

Question 5Medical pathology, clinical assessment and body-system reasoning

Which electrocardiographic finding is characteristic of acute pericarditis during its initial stage (Stage I)?

  1. Diffuse concave-upward ST-segment elevation with PR-segment depression across multiple leads Correct answer.
  2. Convex 'tombstone' ST-segment elevation localized to a single coronary territory
  3. Widespread symmetrical T-wave inversions with pathological Q waves
  4. Shortened PR interval with delta waves and widened QRS complexes

Explanation

Stage I acute pericarditis is characterized by widespread, diffuse, concave-upward (saddle-shaped) ST-segment elevation across precordial and limb leads, accompanied by PR-segment depression (most prominent in leads II, aVF, and V4-V6) and reciprocal ST depression with PR elevation in lead aVR.

Question 6Medical pathology, clinical assessment and body-system reasoning

Which visual adverse effect mandates baseline and periodic visual acuity and color discrimination (red-green) monitoring in patients receiving Ethambutol?

  1. Retrobulbar optic neuritis Correct answer.
  2. Acute closed-angle glaucoma
  3. Posterior subcapsular cataract
  4. Macular pigmentary retinopathy (bull's eye)

Explanation

Ethambutol can cause dose-dependent retrobulbar optic neuritis, presenting with decreased visual acuity, central scotomas, and loss of green-red color discrimination. Patients must be instructed to discontinue the drug immediately if visual symptoms appear.

Question 7Medical pathology, clinical assessment and body-system reasoning

A 62-year-old male smoker presents with progressive exertional dyspnea and chronic productive cough. Spirometry reveals a post-bronchodilator FEV1/FVC ratio of 0.58 and an FEV1 of 65% predicted. What is the diagnosis and GOLD severity grade?

  1. Chronic Obstructive Pulmonary Disease (COPD), GOLD Grade 2 (Moderate) Correct answer.
  2. Asthma with reversible airway obstruction, Step 3
  3. Chronic Obstructive Pulmonary Disease (COPD), GOLD Grade 1 (Mild)
  4. Idiopathic Pulmonary Fibrosis with restrictive defect

Explanation

In the appropriate clinical context, a post-bronchodilator FEV1/FVC ratio < 0.70 establishes persistent airflow obstruction consistent with COPD. GOLD spirometric grades use post-bronchodilator FEV1: >= 80% is grade 1, 50% to < 80% grade 2, 30% to < 50% grade 3, and < 30% grade 4. At 65%, he is grade 2.

Question 8Medical pathology, clinical assessment and body-system reasoning

A 24-year-old asthmatic patient is brought to the emergency department in acute severe distress. Which clinical or arterial blood gas sign indicates impending respiratory muscle exhaustion and life-threatening status asthmaticus?

  1. Silent chest on auscultation and normalization of PaCO2 (pseudonormalization) Correct answer.
  2. Bilateral loud expiratory wheezing with tachypnea of 28 breaths/min
  3. Pulsus paradoxus of 12 mmHg with peak expiratory flow of 55%
  4. Respiratory alkalosis with arterial pH of 7.50 and PaCO2 of 28 mmHg

Explanation

In early acute asthma, hyperventilation causes hypocapnia and respiratory alkalosis. A 'normal' PaCO2 (40 mmHg) or hypercapnia, accompanied by a 'silent chest' (lack of air movement to produce wheezes), indicates severe airflow obstruction, respiratory muscle fatigue, and impending respiratory arrest requiring immediate intubation.

Question 9Medical pathology, clinical assessment and body-system reasoning

Which listed score uses confusion, urea, respiratory rate, blood pressure and age to help assess mortality risk in adult community-acquired pneumonia? Clinical judgment and the actual setting still matter.

  1. CURB-65 score Correct answer.
  2. Wells score
  3. Balthazar score
  4. Child-Pugh score

Explanation

The CURB-65 score stratifies community-acquired pneumonia based on 5 parameters (Confusion, Urea > 7 mmol/L, Respiratory rate >= 30/min, Blood pressure < 90/60 mmHg, Age >= 65). A score of 0-1 suggests outpatient therapy, 2 warrants inpatient admission, and >= 3 indicates severe pneumonia requiring intensive or close inpatient care.

Question 10Medical pathology, clinical assessment and body-system reasoning

A hemodynamically stable patient with suspected acute pulmonary embolism has a high clinical pre-test probability (Wells score = 7). What is the definitive first-line diagnostic imaging test of choice?

  1. Computed tomography pulmonary angiography (CTPA) Correct answer.
  2. Plasma D-dimer ELISA testing
  3. Transthoracic echocardiography alone
  4. Ventilation-perfusion (V/Q) lung scintigraphy without chest radiography

Explanation

In hemodynamically stable patients with a high pre-test probability of pulmonary embolism, CT pulmonary angiography (CTPA) is the primary diagnostic imaging modality of choice. D-dimer testing is not indicated in high-probability patients because a normal result does not safely rule out PE.

Question 11Medical pathology, clinical assessment and body-system reasoning

A 52-year-old male with alcoholic cirrhosis is admitted with massive hematemesis. Initial resuscitation with blood products is begun. What is the immediate pharmacological therapy of choice to reduce portal inflow pressure prior to urgent endoscopy?

  1. Intravenous vasoactive infusion (terlipressin, somatostatin, or octreotide) plus prophylactic ceftriaxone Correct answer.
  2. Immediate oral non-selective beta-blocker (propranolol) monotherapy
  3. Intravenous high-dose furosemide and spironolactone
  4. Intravenous tranexamic acid and vitamin K bolus alone

Explanation

In acute variceal hemorrhage, vasoactive agents (terlipressin, somatostatin, or octreotide) should be started immediately to induce splanchnic vasoconstriction and lower portal pressure. Prophylactic antibiotics (intravenous ceftriaxone) are mandatory to decrease rebleeding, infectious complications, and mortality.

Question 12Medical pathology, clinical assessment and body-system reasoning

Which diagnostic finding in ascitic fluid analysis confirms the diagnosis of Spontaneous Bacterial Peritonitis (SBP) in a cirrhotic patient?

  1. Polymorphonuclear (neutrophil) count >= 250 cells/mm3 Correct answer.
  2. Total white blood cell count >= 100 cells/mm3 with 90% lymphocytes
  3. Serum-ascites albumin gradient (SAAG) < 1.1 g/dL
  4. Lactate dehydrogenase (LDH) level greater than upper limit of normal serum LDH

Explanation

Spontaneous bacterial peritonitis (SBP) is diagnosed when the ascitic fluid absolute neutrophil count (polymorphonuclear leukocytes) is >= 250 cells/mm3 (0.25 x 10^9/L), regardless of culture results, warranting prompt empirical antibiotic therapy (e.g., intravenous cefotaxime).

Question 13Medical pathology, clinical assessment and body-system reasoning

Which highly sensitive and specific serological antibody test is the first-line screening investigation for celiac disease in an individual with normal total serum IgA levels?

  1. Anti-tissue transglutaminase IgA (anti-tTG IgA) Correct answer.
  2. Anti-gliadin IgG antibodies
  3. Anti-Saccharomyces cerevisiae antibodies (ASCA)
  4. Anti-nuclear antibodies (ANA)

Explanation

IgA anti-tissue transglutaminase (anti-tTG IgA) combined with total serum IgA measurement is the recommended first-line serological screening tool for celiac disease, boasting sensitivity and specificity exceeding 95%.

Question 14Medical pathology, clinical assessment and body-system reasoning

Which clinical and endoscopic feature strongly differentiates Crohn's disease from Ulcerative Colitis?

  1. Transmural inflammation with skip lesions ('cobblestone' appearance) and perianal fistulas Correct answer.
  2. Continuous mucosal inflammation restricted strictly to the rectum and colon
  3. Superficial mucosal ulcerations with preservation of the submucosa and muscularis
  4. Absence of non-caseating granulomas on endoscopic mucosal biopsies

Explanation

Crohn's disease features discontinuous 'skip' lesions throughout any part of the GI tract, transmural inflammation, deep fissuring ulcers (cobblestoning), non-caseating granulomas, and a high frequency of perianal fistulas and strictures. Ulcerative colitis features continuous mucosal inflammation limited to the colorectum.

Question 15Medical pathology, clinical assessment and body-system reasoning

According to the KDIGO clinical practice guidelines, what defining criterion confirms the diagnosis of nephrotic syndrome in an adult?

  1. Proteinuria >= 3.5 g/24 hours (or PCR >= 3500 mg/g) and serum albumin < 30 g/L Correct answer.
  2. Proteinuria >= 1.0 g/24 hours with macroscopic hematuria and red cell casts
  3. Serum creatinine doubling within 48 hours and severe hyperkalemia
  4. Hypocomplementemia with low C3 and C4 and sterile pyuria

Explanation

Nephrotic syndrome is defined by massive proteinuria (>= 3.5 g per 24 hours in adults, or spot urine protein/creatinine ratio >= 3500 mg/g), accompanied by profound hypoalbuminemia (< 30 g/L), peripheral edema, and frequently hyperlipidemia.

Question 16Medical pathology, clinical assessment and body-system reasoning

A 6-year-old child presents with sudden facial edema, dark 'coca-cola' colored urine, and hypertension two weeks after an episode of pharyngitis. Serum C3 complement is significantly reduced. What is the most likely diagnosis?

  1. Post-streptococcal acute glomerulonephritis (PSGN) Correct answer.
  2. Minimal change disease (nephrotic syndrome)
  3. IgA nephropathy (Berger disease)
  4. Autosomal dominant polycystic kidney disease

Explanation

Acute post-streptococcal glomerulonephritis (PSGN) typically develops 1 to 3 weeks following group A beta-hemolytic streptococcal pharyngitis (or 3-6 weeks after impetigo). It presents with nephritic syndrome (hematuria, hypertension, oliguria, periorbital edema) and transient hypocomplementemia (low C3).

Question 17Medical pathology, clinical assessment and body-system reasoning

In the emergency management of severe hyperkalemia (serum potassium = 7.2 mmol/L) with peaked T waves and widened QRS complexes on ECG, what is the immediate first-line drug that must be administered intravenously?

  1. 10% Calcium gluconate (or calcium chloride) Correct answer.
  2. Intravenous regular insulin with 10% dextrose
  3. Sodium polystyrene sulfonate (Kayexalate) orally
  4. Intravenous loop diuretic (furosemide) bolus

Explanation

Intravenous calcium gluconate (10 mL of 10% solution over 2-3 minutes) must be given immediately in hyperkalemia with ECG changes. Calcium directly antagonizes potassium's membrane-depolarizing effect, stabilizing the cardiac myocyte resting membrane potential and preventing lethal ventricular arrhythmias.

Question 18Medical pathology, clinical assessment and body-system reasoning

A 21-year-old with type 1 diabetes presents with nausea, vomiting, Kussmaul respirations, and altered mental status. Blood glucose is 420 mg/dL, arterial pH is 7.15, serum bicarbonate is 10 mEq/L, and urine ketones are strongly positive. What is the primary initial fluid resuscitation choice?

  1. 0.9% Isotonic sodium chloride (normal saline) infusion Correct answer.
  2. 5% Dextrose in water (D5W) bolus
  3. 8.4% Sodium bicarbonate intravenous push
  4. Hydroxyethyl starch colloid solution

Explanation

Initial DKA treatment begins with an isotonic crystalloid to restore circulating volume and renal perfusion. Normal saline is an acceptable choice; balanced crystalloids may also be used. The rate is individualized to hemodynamic status, fluid deficit, age, and cardiac or renal comorbidity while potassium is assessed before insulin therapy.

Question 19Medical pathology, clinical assessment and body-system reasoning

A 35-year-old woman presents with weight loss, palpitations, heat intolerance, diffuse painless goiter with an audible vascular bruit, and bilateral proptosis (exophthalmos). Which autoantibody is most specific for this condition?

  1. Thyrotropin receptor autoantibodies (TRAb / TSI) Correct answer.
  2. Anti-thyroid peroxidase antibodies (anti-TPO)
  3. Anti-thyroglobulin antibodies (anti-Tg)
  4. Anti-centromere antibodies

Explanation

Thyrotropin receptor antibodies (TRAb, also known as thyroid-stimulating immunoglobulins [TSI]) bind to and stimulate the TSH receptor, causing autonomous thyroid hormone hypersecretion, diffuse goiter with vascular bruits, and Graves' orbitopathy and pretibial myxedema.

Question 20Medical pathology, clinical assessment and body-system reasoning

Which triad of clinical and laboratory findings classically indicates Acute Adrenal (Addisonian) Crisis in an undiagnosed or non-compliant patient?

  1. Severe refractory hypotension/shock, hyponatremia, and hyperkalemia Correct answer.
  2. Hypertension, hypokalemia, and metabolic alkalosis
  3. Hyperglycemia, hypernatremia, and hypocalcemia
  4. Bradycardia, hypernatremia, and hypokalemia

Explanation

Acute adrenal crisis results from acute glucocorticoid and mineralocorticoid deficiency. Lack of cortisol causes vascular collapse and shock refractory to vasopressors, while aldosterone deficiency causes renal sodium wasting, potassium retention, and metabolic acidosis, producing hyponatremia and hyperkalemia.

Question 21Medical pathology, clinical assessment and body-system reasoning

A 68-year-old man presents with sudden right hemiplegia and expressive aphasia beginning 90 minutes ago. CT shows no hemorrhage, blood pressure is within the thrombolysis limit, and screening finds no contraindication to intravenous thrombolysis. What is the immediate treatment of choice?

  1. Intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA / alteplase) Correct answer.
  2. Intravenous therapeutic unfractionated heparin bolus and infusion
  3. Immediate administration of oral high-dose aspirin (300 mg) and dipyridamole
  4. Aggressive reduction of blood pressure to < 120/80 mmHg with intravenous labetalol

Explanation

An eligible patient with disabling acute ischemic stroke within 4.5 hours of known onset should receive intravenous thrombolysis promptly after hemorrhage and contraindications are excluded. Evaluation for large-vessel occlusion and thrombectomy should proceed without delaying indicated intravenous therapy.

Question 22Medical pathology, clinical assessment and body-system reasoning

Which cerebrospinal fluid (CSF) finding is characteristic of Guillain-Barré syndrome (acute inflammatory demyelinating polyneuropathy) when performed 1 to 2 weeks after symptom onset?

  1. Albuminocytologic dissociation (elevated protein with normal white blood cell count) Correct answer.
  2. Marked pleocytosis (> 500 neutrophils/mm3) with low glucose ratio (< 0.4)
  3. Significant lymphocytic pleocytosis with positive oligoclonal IgG bands
  4. Normal protein concentration with elevated red blood cells and xanthochromia

Explanation

Albuminocytologic dissociation-elevated CSF protein with a normal or only mildly elevated leukocyte count-is the classic finding after the first week of Guillain-Barré syndrome. A marked pleocytosis should prompt investigation for an alternative infectious or inflammatory diagnosis.

Question 23Medical pathology, clinical assessment and body-system reasoning

In the initial medical management of generalized convulsive status epilepticus in adults, what is the first-line intravenous drug of choice that should be administered immediately?

  1. Intravenous lorazepam (or diazepam) Correct answer.
  2. Intravenous phenytoin (or fosphenytoin)
  3. Intravenous levetiracetam bolus
  4. Intravenous propofol general anesthesia

Explanation

The established first-line treatment for status epilepticus (seizures lasting > 5 minutes) is a fast-acting intravenous benzodiazepine: IV lorazepam (0.1 mg/kg) or IV diazepam (0.15-0.2 mg/kg), followed immediately by a second-line non-sedating antiepileptic (phenytoin/fosphenytoin, levetiracetam, or valproate).

Question 24Medical pathology, clinical assessment and body-system reasoning

Which motor feature forms the cardinal asymmetric triad of Parkinson's disease?

  1. Resting tremor, cogwheel rigidity, and bradykinesia Correct answer.
  2. Intention tremor, ataxia, and scanning speech
  3. Chorea, ballismus, and muscular hypotonia
  4. Spastic diplegia, hyperreflexia, and extensor plantar responses

Explanation

Parkinson's disease is clinically diagnosed by its core motor syndrome: bradykinesia (slowness and poverty of movement) combined with at least one of 4-6 Hz pill-rolling resting tremor or lead-pipe/cogwheel rigidity, classically beginning asymmetrically in one limb.

Question 25Medical pathology, clinical assessment and body-system reasoning

A 22-year-old university student presents with acute high fever, photophobia, intense headache, projectile vomiting, and marked neck stiffness (Brudzinski and Kernig signs positive). CSF analysis reveals 2,800 WBC/mm3 with 92% neutrophils, protein of 3.2 g/L, and CSF/blood glucose ratio of 0.18. What is the most likely diagnosis?

  1. Acute purulent bacterial meningitis Correct answer.
  2. Viral (aseptic) meningoencephalitis
  3. Tuberculous meningitis
  4. Cryptococcal meningitis

Explanation

This clinical presentation and CSF analysis (marked neutrophilic pleocytosis > 1,000/mm3, high protein > 1.0-2.0 g/L, and severely depressed CSF/blood glucose ratio < 0.4) are diagnostic of acute purulent bacterial meningitis (most commonly Neisseria meningitidis or Streptococcus pneumoniae).

Question 26Medical pathology, clinical assessment and body-system reasoning

Which diagnostic investigation is the gold standard confirmatory test for Typhoid (Enteric) Fever during the first week of illness prior to widespread antibiotic administration?

  1. Blood culture (Hémoculture) Correct answer.
  2. Widal and Félix serological agglutination test
  3. Stool culture (Coproculture)
  4. Urinary antigen detection test

Explanation

Blood culture is the gold standard for diagnosing Salmonella enterica serotype Typhi during the first septicaemic week of illness, with a sensitivity of 60% to 80%. Stool cultures become positive primarily during the second and third weeks.

Question 27Medical pathology, clinical assessment and body-system reasoning

Which serum autoantibody demonstrates the highest diagnostic specificity (> 95%) for Rheumatoid Arthritis and is an independent predictor of erosive joint disease?

  1. Anti-cyclic citrullinated peptide antibodies (anti-CCP / ACPA) Correct answer.
  2. Rheumatoid factor (RF) IgM
  3. Antinuclear antibodies (ANA)
  4. Anti-double-stranded DNA antibodies (anti-dsDNA)

Explanation

Anti-cyclic citrullinated peptide (anti-CCP) antibodies have a diagnostic specificity of 95% to 98% for rheumatoid arthritis, significantly superior to rheumatoid factor (which can be positive in Sjögren's, hepatitis C, infective endocarditis, and healthy elderly). Anti-CCP correlates strongly with aggressive erosive synovitis.

Question 28Medical pathology, clinical assessment and body-system reasoning

Which listed pair includes highly specific SLE-associated antibodies, with anti-dsDNA sometimes contributing to disease-activity and renal-assessment context? Do not treat every antibody in the pair as the same activity-monitoring test.

  1. Anti-double-stranded DNA (anti-dsDNA) and Anti-Smith (anti-Sm) Correct answer.
  2. Anti-Ro/SSA and Anti-La/SSB
  3. Anti-topoisomerase I (anti-Scl-70)
  4. Anti-histone antibodies alone

Explanation

Anti-dsDNA and anti-Sm are relevant specific SLE-associated antibodies in the appropriate clinical assessment. Anti-dsDNA can contribute to activity and renal-context interpretation, whereas anti-Sm is primarily a diagnostic/classification association and is not treated as a reliable direct activity trend by itself. Neither result replaces the full clinical and laboratory evaluation.

Question 29Medical pathology, clinical assessment and body-system reasoning

A 28-year-old woman presents with severe fatigue, pallor, and pica. Complete blood count shows: Hb 8.2 g/dL, MCV 68 fL, MCH 22 pg, and RDW 18.5%. Serum ferritin is 6 ng/mL. What is the diagnosis?

  1. Iron deficiency anemia (Anémie ferriprive) Correct answer.
  2. Beta-thalassemia trait (minor)
  3. Anemia of chronic disease (inflammation)
  4. Vitamin B12 deficiency (Biermer disease)

Explanation

Microcytic hypochromic anemia (MCV < 80 fL, MCH < 27 pg) with elevated RDW and a serum ferritin < 15-30 ng/mL is unequivocally diagnostic of iron deficiency anemia. Low ferritin reflects exhausted bone marrow iron stores.

Question 30Medical pathology, clinical assessment and body-system reasoning

Which diagnostic finding on peripheral blood smear and bone marrow aspirate confirms the diagnosis of Acute Promyelocytic Leukemia (AML M3) and mandates immediate all-trans retinoic acid (ATRA) therapy to prevent fatal disseminated intravascular coagulation?

  1. Promyelocytes with bundles of Auer rods (faggot cells) harboring t(15;17)(q22;q21) PML-RARA Correct answer.
  2. Myeloblasts with t(8;21) RUNX1-RUNX1T1 and eosinophil precursors
  3. Lymphoblasts expressing CD10, CD19, and terminal deoxynucleotidyl transferase (TdT)
  4. Mature small lymphocytes forming smudge cells (basket cells) expressing CD5 and CD23

Explanation

Acute promyelocytic leukemia (APL, AML-M3) is characterized by abnormal hypergranular promyelocytes containing multiple Auer rods bundled in the cytoplasm ('faggot cells'), driven by the t(15;17) chromosomal translocation generating the PML-RARA fusion oncoprotein. It triggers catastrophic consumption coagulopathy and DIC.

Question 31Medical pathology, clinical assessment and body-system reasoning

Which histopathological finding on lymph node biopsy defines classic Hodgkin Lymphoma?

  1. Reed-Sternberg cells (large binucleated cells with prominent owl-eyed inclusion-like nucleoli) positive for CD15 and CD30 Correct answer.
  2. Sheets of small cleaved follicular center B cells positive for t(14;18) BCL2 translocation
  3. Starry-sky pattern of medium-sized uniform B cells with c-MYC translocation
  4. Diffuse infiltration of large atypical cells positive for CD20 and CD79a

Explanation

Classic Hodgkin lymphoma is histologically defined by the presence of diagnostic Reed-Sternberg cells: giant cells featuring twin nuclei with prominent acidophilic, owl-eye nucleoli, set within a rich non-neoplastic inflammatory background (lymphocytes, histiocytes, eosinophils, plasma cells). The malignant cells express CD30 and CD15.

Question 32Medical pathology, clinical assessment and body-system reasoning

A 9-month-old infant presents with acute vomiting and profuse watery diarrhea for 48 hours. On examination, the infant is lethargic, with sunken anterior fontanelle, dry oral mucosa, cool extremities, and a persistent skin pinch returning in > 2 seconds (pli cutané très persistant). Estimated body weight loss is 12%. According to WHO guidelines, how is this dehydration classified?

  1. Severe dehydration (Déshydratation sévère) Correct answer.
  2. Some (moderate) dehydration
  3. No signs of dehydration (mild)
  4. Hypernatremic dehydration without hypovolemia

Explanation

Under WHO integrated management protocols, lethargy/unconsciousness, sunken eyes/fontanelle, inability to drink, and a skin pinch returning very slowly (> 2 seconds), accompanied by >= 10% weight loss, classify as Severe Dehydration, requiring immediate intravenous fluid resuscitation (Plan C with Ringer's lactate).

Question 33Medical pathology, clinical assessment and body-system reasoning

A 4-month-old infant is admitted during winter with rhinorrhea, low-grade fever, tachypnea (68 breaths/min), intercostal retractions, and bilateral expiratory sibilant rales and fine crackles. What is the most common viral etiology of acute bronchiolitis in this age group?

  1. Respiratory Syncytial Virus (RSV / VRS) Correct answer.
  2. Influenza A virus
  3. Adenovirus
  4. Human Metapneumovirus

Explanation

Respiratory Syncytial Virus (RSV, or virus respiratoire syncytial [VRS]) is responsible for 70% to 80% of all cases of acute bronchiolitis in infants under 12 months of age during seasonal winter epidemics.

Question 34Medical pathology, clinical assessment and body-system reasoning

Which cutaneous lesion is most characteristic of psoriasis vulgaris on clinical examination?

  1. Well-demarcated erythematous plaques covered with silvery-white micaceous scales (Auspitz sign positive) Correct answer.
  2. Target-like 'iris' lesions with concentric rings and central dusky purpura
  3. Pruritic polygonal violaceous flat-topped papules with Wickham striae
  4. Flaccid intraepidermal bullae with positive Nikolsky sign

Explanation

Psoriasis vulgaris classically presents with sharply demarcated, salmon-pink erythematous plaques capped by coarse, silvery-white lamellar scales on extensor surfaces (elbows, knees, scalp, lumbosacral region). Grattage méthodique de Brocq demonstrates the candle-grease sign, pellicle detachment, and pinpoint bleeding points (Auspitz sign).

Question 35Medical pathology, clinical assessment and body-system reasoning

A 30-year-old woman presents with painful, erythematous, warm, non-ulcerative subcutaneous nodules on the anterior shins (tibial crests). Chest X-ray reveals bilateral hilar lymphadenopathy without parenchymal infiltrates. What is the most likely diagnosis?

  1. Löfgren syndrome (acute sarcoidosis with erythema nodosum) Correct answer.
  2. Cutaneous polyarteritis nodosa
  3. Secondary syphilis (syphilides)
  4. Erythema induratum of Bazin

Explanation

The triad of bilateral hilar lymphadenopathy, erythema nodosum, and acute polyarthralgia constitutes Löfgren syndrome, a distinct, benign, self-limiting acute presentation of sarcoidosis that carries an excellent prognosis.

Question 36Medical pathology, clinical assessment and body-system reasoning

Which diagnostic finding confirms Megaloblastic Anemia caused by Vitamin B12 deficiency (Pernicious Anemia / Biermer disease)?

  1. Macrocytosis (MCV > 100 fL), hypersegmented neutrophils, and anti-intrinsic factor antibodies Correct answer.
  2. Microcytosis, elevated serum iron, and ring sideroblasts on Prussian blue stain
  3. Normocytic anemia with elevated reticulocyte count (> 150,000/mm3) and spherocytes
  4. Pancytopenia with hypocellular fat-replaced bone marrow and normal vitamin B12

Explanation

Pernicious anemia (Biermer's disease) is an autoimmune gastritis causing intrinsic factor deficiency. It is characterized by macrocytic megaloblastic anemia (MCV often > 110 fL), hypersegmented neutrophils on blood smear (>= 5 lobes), elevated methylmalonic acid and homocysteine, and specific anti-intrinsic factor antibodies.

Question 37Medical pathology, clinical assessment and body-system reasoning

A 45-year-old woman presents with symmetrical muscle weakness in the proximal lower and upper extremities, elevated serum creatine kinase (CK 4,200 IU/L), and an electromyogram showing myopathic changes. Muscle biopsy confirms endomysial CD8+ cytotoxic T cell infiltration surrounding non-necrotic muscle fibers. What is the diagnosis?

  1. Polymyositis Correct answer.
  2. Dermatomyositis
  3. Inclusion body myositis
  4. Myasthenia gravis

Explanation

Polymyositis is characterized by symmetric proximal muscle weakness, marked CK elevation, and characteristic endomysial mononuclear inflammatory infiltrates consisting predominantly of CD8+ T cells and macrophages directly invading non-necrotic muscle fibers expressing MHC class I antigens.

Question 38Medical pathology, clinical assessment and body-system reasoning

Which diagnostic criterion differentiates Hypertensive Emergency from Hypertensive Urgency in a patient presenting with blood pressure >= 180/120 mmHg?

  1. Presence of acute target-organ damage (e.g., encephalopathy, aortic dissection, pulmonary edema) Correct answer.
  2. The absolute numerical height of the systolic blood pressure above 200 mmHg
  3. Absence of prior history of diagnosed primary essential hypertension
  4. Requirement for oral antihypertensive therapy over 24 to 48 hours

Explanation

Hypertensive emergencies are defined by severely elevated blood pressure (usually > 180/120 mmHg) accompanied by evidence of acute, ongoing target-organ damage (hypertensive encephalopathy, acute coronary syndrome, acute cardiogenic pulmonary edema, aortic dissection, eclampsia, or acute renal failure), mandating immediate intravenous therapy in an ICU.

Question 39Medical pathology, clinical assessment and body-system reasoning

A previously normotensive 32-year-old woman at 28 weeks has blood pressure of 155/95 mmHg, repeated 4 hours later, and dipstick proteinuria of 2+ where quantitative testing is unavailable. Creatinine and platelets are normal. What is the diagnosis?

  1. Preeclampsia (Pré-éclampsie) Correct answer.
  2. Gestational hypertension without proteinuria
  3. Chronic pre-existing essential hypertension
  4. HELLP syndrome

Explanation

Preeclampsia is new-onset hypertension after 20 weeks in a previously normotensive patient plus proteinuria or qualifying end-organ dysfunction. Proteinuria may be documented by >= 300 mg/24 h, a protein/creatinine ratio >= 0.3, or dipstick 2+ only when quantitative methods are unavailable.

Question 40Medical pathology, clinical assessment and body-system reasoning

Which pharmacological agent is the standard drug of choice administered intravenously to prevent and treat convulsive seizures in severe preeclampsia and eclampsia?

  1. Magnesium sulfate (Sulfate de magnésium) Correct answer.
  2. Diazepam infusion
  3. Phenytoin infusion
  4. Sodium valproate bolus

Explanation

Magnesium sulfate is first-line for prevention and treatment of eclamptic seizures and is more effective than phenytoin or diazepam for this purpose. A common regimen uses a 4–6 g loading dose followed by 1–2 g/hour, with clinical monitoring and dose adjustment for renal function and toxicity risk.

Question 41Surgical pathology, anatomy and perioperative reasoning

In a patient presenting with suspected acute appendicitis, which clinical sign is elicited by localized tenderness upon deep palpation in the left iliac fossa that produces sharp referred pain in the right iliac fossa?

  1. Rovsing sign Correct answer.
  2. Blumberg sign
  3. Psoas sign
  4. Obturator sign

Explanation

Rovsing's sign is positive when pressure applied to the left lower quadrant (left iliac fossa) elicits or exacerbates pain in the right lower quadrant, caused by retrodisplacement of colonic gas stretching the inflamed cecum and appendix.

Question 42Surgical pathology, anatomy and perioperative reasoning

What is the classic radiological sign on an erect plain abdominal radiograph (or chest X-ray including diaphragmatic domes) that indicates a perforated gastroduodenal peptic ulcer?

  1. Free subdiaphragmatic crescent of gas (pneumoperitoneum) Correct answer.
  2. Multiple air-fluid levels organized in a stepped staircase pattern (niveaux hydro-aériques)
  3. Coffee-bean sign with an inverted U-shaped dilated loop
  4. Rigler sign with visualization of both sides of the bowel wall without free gas

Explanation

A perforated hollow viscus (most commonly a peptic ulcer of the anterior duodenal bulb or stomach) releases intraluminal gas into the peritoneal cavity, which rises under gravity to form a crescent-shaped radiolucency beneath one or both hemidiaphragms (pneumoperitoneum / croissant gazeux sous-diaphragmatique).

Question 43Surgical pathology, anatomy and perioperative reasoning

Which radiographic and clinical feature reliably distinguishes mechanical obstruction of the small bowel from mechanical obstruction of the large bowel on plain abdominal radiography?

  1. Small bowel: central dilated loops with transverse plicae circulares (valvulae conniventes) traversing the entire luminal diameter Correct answer.
  2. Small bowel: peripheral dilated loops with haustral sacculations that partially indent the lumen
  3. Large bowel: central loops with complete mucosal folds and absence of air in the rectum
  4. Small bowel: massive dilation exceeding 10 cm in diameter with a characteristic coffee-bean shape

Explanation

Small bowel mechanical obstruction features central abdominal dilated loops with valvulae conniventes (plicae circulares) that completely cross the luminal diameter from wall to wall. In contrast, large bowel loops occupy the abdominal periphery and have haustra that only partially indent the lumen.

Question 44Surgical pathology, anatomy and perioperative reasoning

What is the classic Charcot's triad that indicates acute bacterial cholangitis (angiocholite aiguë) secondary to common bile duct gallstone impaction?

  1. Right upper quadrant pain, fever with shaking chills, and jaundice Correct answer.
  2. Left upper quadrant pain, hypotension, and pulsatile mass
  3. Epigastric pain, vomiting, and elevated serum lipase
  4. Fever, right lower quadrant tenderness, and leukopenia

Explanation

Charcot's triad of acute ascending cholangitis comprises biliary colic (right upper quadrant pain), spiking fever with shaking chills, and obstructive jaundice. When accompanied by hypotension/shock and altered mental status, it forms Reynolds' pentad, indicating life-threatening suppurative cholangitis.

Question 45Surgical pathology, anatomy and perioperative reasoning

According to the ultrasonographic Gharbi classification of hepatic hydatid cysts (Kyste hydatique du foie), which type corresponds to a multivesicular cyst with daughter vesicles and 'wheel-spoke' or honeycomb internal architecture?

  1. Gharbi Type III Correct answer.
  2. Gharbi Type I
  3. Gharbi Type II
  4. Gharbi Type V

Explanation

In the Gharbi classification of hepatic hydatid disease: Type I is a pure unilocular fluid collection; Type II is a fluid collection with detached floating germinative membrane (water-lily sign); Type III is a multivesicular cyst with daughter cysts and honeycomb/cartwheel septa; Type IV is a pseudotumoral heterogeneous mass; and Type V is a densely calcified quiescent cyst.

Question 46Surgical pathology, anatomy and perioperative reasoning

What is the most catastrophic immediate systemic complication that can occur if a hydatid cyst accidentally ruptures into the free peritoneal cavity during surgical exploration?

  1. Severe anaphylactic shock and secondary disseminated peritoneal hydatidosis Correct answer.
  2. Acute portal vein thrombosis with Budd-Chiari syndrome
  3. Fulminant hepatic failure from hyperbilirubinemia
  4. Acute hemorrhagic pancreatitis

Explanation

Hydatid fluid contains highly immunogenic parasitic proteins. Spontaneous or iatrogenic rupture into the peritoneal cavity causes massive immediate release of foreign antigen, triggering severe, potentially fatal anaphylactic shock, followed by widespread peritoneal dissemination of viable protoscolices (secondary hydatidosis).

Question 47Surgical pathology, anatomy and perioperative reasoning

According to the revised Atlanta classification of acute pancreatitis, what contrast-enhanced CT finding distinguishes necrotizing pancreatitis from interstitial edematous pancreatitis?

  1. Focal or diffuse areas of non-enhancing pancreatic parenchyma on intravenous contrast CT Correct answer.
  2. Peripancreatic fluid collections with homogeneous, preserved parenchymal enhancement
  3. Presence of calcifications within the main pancreatic duct with parenchymal atrophy
  4. Pancreatic parenchymal enlargement with normal attenuation and no peripancreatic fat stranding

Explanation

On contrast-enhanced CT performed 72 hours after disease onset, non-enhancing areas of the pancreatic parenchyma reflect microvascular thrombosis and tissue necrosis, defining necrotizing pancreatitis. In interstitial edematous pancreatitis, the gland enhances homogeneously throughout.

Question 48Surgical pathology, anatomy and perioperative reasoning

In the Gustilo-Anderson framework, an open tibial fracture follows a high-energy injury with a large soft-tissue wound, but there is adequate local soft-tissue coverage of bone after assessment and no arterial injury requiring repair. Which listed grade matches this supplied coverage pattern?

  1. Type IIIA Correct answer.
  2. Type I
  3. Type II
  4. Type IIIC

Explanation

Gustilo Type IIIA open fractures feature high-energy trauma with extensive soft-tissue laceration (> 10 cm) and severe comminution/periosteal stripping, but adequate soft-tissue coverage of bone is achievable. Type IIIB requires free flap coverage, and IIIC involves an arterial injury requiring surgical repair.

Question 49Surgical pathology, anatomy and perioperative reasoning

Which clinical sign is the earliest, most sensitive, and most reliable symptom of acute compartment syndrome following a closed lower leg fracture?

  1. Severe out-of-proportion pain exacerbated by passive stretching of compartment muscles Correct answer.
  2. Complete absence of distal pedal pulses (pulselessness)
  3. Total cutaneous anesthesia throughout the lower extremity
  4. Gross muscular paralysis and permanent contracture (Volkmann sign)

Explanation

Disproportionately severe, escalating pain that is refractory to analgesia and exacerbated by passive stretching of the muscles within the affected fascial compartment is the earliest and most sensitive sign of compartment syndrome. Pulselessness, pallor, and paralysis are very late signs signifying irreversible ischemic necrosis.

Question 50Surgical pathology, anatomy and perioperative reasoning

What is the classic clinical posture of the lower limb in a patient presenting with an acute displaced intracapsular fracture of the femoral neck?

  1. Shortened lower extremity in external rotation Correct answer.
  2. Lengthened lower extremity in internal rotation and abduction
  3. Shortened lower extremity in marked internal rotation and flexion
  4. Normal extremity length with inability to extend the knee

Explanation

A displaced femoral-neck fracture classically produces a shortened, externally rotated limb because muscular forces act on the disconnected distal fragment. Adduction is not required to identify this pattern.