Question 21

25 year old nurse complaints of dizziness and sweating in the ER. A few days ago she had similar complaints and was adviced to go home from work after stabilizing. She joined work yesterday after leave. This is her third episode of similar complaints. She usually have such complaints whenever she is stressed due to patient overload, and feels better with rest and some juice. Today, her BP is 124/88 mm Hg, pulse is 102/min. She is sweating profusely. The doctor requests for blood chemistry, glucose level, and C- peptide level. The electrolytes levels are as follows, Na 134, K 3.4, Cl 98, Ca 9.2, Mg 2.4, BUN 20, Creat 0.9. Her Glucose level is 54 mg %, and C peptide levels are high. The doctor orders her 5 % Dextrose 100 cc, and she is stabilized subsequently. What is the most likely diagnosis?

A) Factitious disorder
B) Insulinoma
C) Glucagonoma
D) Manchausen Syndrome
E) Hypochondriasis

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Question 20

22 year old male comes to the clinic with complaints of swelling on his back. He says the swelling is cosmetically ugly. It is non tender and has not changed since few years. He also complains of some swelling on his scalp. Occasionally, he has pain in his abdomen, and passes black stools often. Rectal examination is non contributory. Stool shows altered blood. The physician schedules him for a colonoscopy. He is an adopted child of his parents, and does not know anything about his biological parents. On colonoscopy, the physician notes several polyp. What is the most likely diagnosis.

A) Gardener's Syndrome
B) Turcot's Syndrome
C) Diverticulosis
D) HNPCC
E) Colon Ca
F) Angiodysplasia

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Question 19

What vitamin deficiency is linked to the patient's symptoms in question 17?

A) Thiamine
B) Riboflavin
C) Niacin
D) Biotin
E) Cobalamine
F) Folic Acid

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Question 18

The patient in question 17 is stabilized. What cardiac finding is most likely to be present in this patient?

A) Mitral regurgitation
B) Tricuspid regurgitation
C) Aortic Regurgitation
D) Mitral Stenosis
E) Tricuspid Stenosis
F) Aortic Stenosis


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Question 17

A 45 year old Caucasian male is brought to the ER with complaints of breathlessness since few hours. He gives complaints of flushing and dermatitis since few days. Lately, he noticed he gets flushing and increase in number of bowel movements daily which are watery in consistency. He is not able to recall the exact time since the symptoms began. He has a rash around his collar. He vitals are stable except he is breathing heavily. On respiratory examination, he has wheezing all over. He complains of pain in upper abdomen. What is the most likely diagnosis?

A) Vitamin deficiency
B) Food Poisoning
C) Asthmatic attack
D) Serotonin tumor
E) Inflammatory bowel disease.

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