1 :

Hint : 💊 Steroids = bone loss

Correct Answers:

  • The patient has severe asthma and requires frequent therapy with oral steroids.


Rationale :

🔷 Chronic oral steroid use is one of the strongest risk factors for osteoporosis because it accelerates bone resorption and decreases bone formation.

🔷 Supplements like calcium and multivitamins are protective, not harmful.

🔷 NSAIDs may cause GI issues but do not significantly increase osteoporosis risk.

🔷 HRT usually protects bone density, though it has other risks (e.g., clotting, breast cancer).


Distractor Analysis :

Rationale for Incorrect Options to be Available Soon

2 :

Hint : 🌬️ Non-selective beta-blockers + asthma = bronchospasm risk

Correct Answers:

  • reactive airway disease (asthma)


Rationale :

🔷 Propranolol is a non-selective beta-blocker, meaning it blocks both β1 receptors in the heart and β2 receptors in the lungs.

🔷 Blocking β2 receptors can cause bronchoconstriction, which is dangerous and potentially life-threatening for patients with asthma or COPD.

🔷 Propranolol is commonly used after MI and in CAD, as it reduces cardiac workload, so those are not contraindications.

🔷 PUD is not a primary contraindication for propranolol, although beta-blockers can mask symptoms of hypoglycemia and must be used with caution in some cases.

🔷 Therefore, the major concern is a history of reactive airway disease (asthma).


Distractor Analysis :

Rationale for Incorrect Options to be Available Soon

3 :

Hint : ❤️ Relax vessels → more blood flow → erection

Correct Answers:

  • It causes smooth muscle relaxation and increased penile blood flow


Rationale :

🔷 Sildenafil citrate (Viagra) is a phosphodiesterase type-5 (PDE-5) inhibitor.

🔷 It works by blocking PDE-5, which increases cGMP levels, leading to smooth muscle relaxation in the corpus cavernosum.

🔷 Relaxed smooth muscle allows more arterial blood flow into the penis, producing and maintaining an erection.

🔷 It does not act on seminal vesicles, nor does it cause vasoconstriction or sustained contraction.

🔷 Its action depends on sexual stimulation—it does not automatically cause erections without arousal.


Distractor Analysis :

Rationale for Incorrect Options to be Available Soon

4 :

Hint : 🎀 More estrogen exposure = higher breast cancer risk

Correct Answers:

  • Family history of breast cancer
  • Nulliparity (never given birth)
  • Use of hormonal replacement therapy


Rationale :

🔷 Family history (especially first-degree relatives with breast cancer or BRCA mutations) significantly increases risk.

🔷 Nulliparity (never having given birth) means longer lifetime exposure to estrogen, raising breast cancer risk.

🔷 Hormone replacement therapy (HRT), especially combined estrogen-progesterone, increases risk due to prolonged hormone exposure.

🔷 Breastfeeding is actually protective, as it lowers lifetime estrogen exposure.

🔷 Early menopause shortens estrogen exposure and therefore reduces risk (whereas late menopause increases it)


Distractor Analysis :

Rationale for Incorrect Options to be Available Soon

5 :

Hint : 💉 Crisis = fluids + O₂ + strong opioid now

Correct Answers:

  • Initiate PCA for hydromorphone administration


Rationale :

🔵 In vaso-occlusive sickle cell crisis, immediate opioid analgesia is a priority alongside IV fluids/O₂ already started.

🔵 PCA hydromorphone provides rapid, titratable control for severe pain (9/10), reducing stress-mediated sickling.

🔵 Incentive spirometry is helpful to prevent ACS, but pain control comes first to enable participation.

🔵 Empiric amoxicillin is not routine for a URI (often viral) without bacterial signs—treat infection per evaluation.

🔵 Adrenergic decongestants do not address the life-threatening pathophysiology of crisis pain/hypoxia.


Distractor Analysis :

Rationale for Incorrect Options to be Available Soon

6 :

Hint : 👁️High IOP = think glaucoma

Correct Answers:

  • Glaucoma


Rationale :

🟣 Increased intraocular pressure (IOP) is the hallmark of glaucoma.

🟣 Chronic elevation in IOP damages the optic nerve, risking irreversible vision loss.

🟣 Macular/ocular degeneration involves central vision loss, not IOP elevation.

🟣 Diplopia (double vision) and nystagmus are neurologic/ocular motor findings, not primary IOP issues.

🟣 Early detection and IOP-lowering therapy (prostaglandins, beta-blockers) preserve vision.


Distractor Analysis :

Rationale for Incorrect Options to be Available Soon

7 :

Hint : 🧠 CNS myelin loss = MS

Correct Answers:

  • disseminated demyelination of nerve fibers in the CNS.


Rationale :

🟢 Multiple sclerosis features immune-mediated demyelination in brain and spinal cord.

🟢 Demyelination causes conduction block → weakness, fatigue, sensory/visual changes (e.g., optic neuritis).

🟢 Not due to dopamine depletion (Parkinson disease).

🟢 Not due to neurofibrillary tangles (Alzheimer disease).

🟢 Not due to low acetylcholine at NMJ (myasthenia gravis).


Distractor Analysis :

Rationale for Incorrect Options to be Available Soon

8 :

Hint : 🧪 PSA screens, doesn’t diagnose

Correct Answers:

  • None of the above


Rationale :

🔷 PSA (Prostate-Specific Antigen) is a blood test used as a screening tool for prostate cancer risk, but it is not diagnostic.

🔷 An elevated PSA does not confirm cancer—it can be elevated in BPH, prostatitis, aging, or after procedures.

🔷 PSA is not a measure of prostate volume, though higher prostate size may contribute to higher PSA levels.

🔷 Screening usually starts around age 50–55 for men at average risk, and earlier (age 40–45) only for high-risk groups (e.g., African American men, strong family history).

🔷 A negative PSA test does not increase BPH risk; it just indicates no significant antigen elevation at the time.


Distractor Analysis :

Rationale for Incorrect Options to be Available Soon

9 :

Hint : 📉 HF hallmark = low EF

Correct Answers:

  • decrease left ventricular ejection fraction


Rationale :

🔴 The hallmark of left-sided systolic HF is reduced LVEF (pump failure).

🔴 Hypertension/afterload is a cause/risk, not the hallmark finding.

🔴 Valvular disease and prior MI are etiologies, not defining features.

🔴 Low LVEF leads to pulmonary congestion (dyspnea, crackles, orthopnea).

🔴 Guides therapy: ACEi /ARNI, beta-blocker, MRA, SGLT2i, diuretics.


Distractor Analysis :

Rationale for Incorrect Options to be Available Soon

10 :

Hint : ⚡TN pain → carbamazepine

Correct Answers:

  • carbamazepine


Rationale :

🟡 Carbamazepine is first-line for trigeminal neuralgia (stabilizes inactivated Na⁺ channels).

🟡 Provides superior relief of paroxysmal lancinating facial pain.

🟡 Valproic acid/phenytoin/phenobarbital are not first-line for TN pain.

🟡 Monitor for bone marrow suppression, hyponatremia, drug interactions.

🟡 Consider oxcarbazepine if intolerance occurs.


Distractor Analysis :

Rationale for Incorrect Options to be Available Soon

Total Questions: 10

Choose Different Exam !