Medicine MCQs for AMC Part 1 Exam

ByAMC Wise

Question 1001

A 45-year-old male presents to your clinic for a routine check-up. He has no significant medical history and is not taking any medications. On examination, his blood pressure is consistently measured at 160/100 mm Hg on multiple occasions, both at rest and during the visit. He denies any symptoms such as headaches, blurred vision, or chest pain. There is no evidence of end-organ damage on examination, and laboratory tests are within normal limits. What is the most likely diagnosis?

  • A) Mild Hypertension
  • B) Moderate Hypertension
  • C) Severe Hypertension
  • D) Hypertensive Urgency
  • E) Hypertensive Emergency

The correct answer is B) Moderate Hypertension.

Moderate hypertension is defined as systolic blood pressure between 140-159 mm Hg and/or diastolic blood pressure between 90-99 mm Hg, consistently measured on multiple occasions. In this clinical scenario, the patient’s blood pressure measurements consistently fall within this range without symptoms of hypertensive urgency (e.g., severe headache, chest pain) or evidence of end-organ damage.

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Question 1003

A 42-year-old woman presents to her rheumatologist with a complaint of joint pain and stiffness, which has been progressively worsening over the past few months. She notes that her symptoms are most severe in the morning and typically last for more than 30 minutes. On examination, you observe bilateral swelling and tenderness in her wrists and metacarpophalangeal joints. There are also noticeable deformities in her fingers with ulnar deviation. Laboratory tests reveal a positive rheumatoid factor and elevated anti-cyclic citrullinated peptide (anti-CCP) antibodies. What is the most likely diagnosis?

  • A) Osteoarthritis
  • B) Gout
  • C) Systemic lupus erythematosus
  • D) Ankylosing spondylitis
  • E) Rheumatoid arthritis

Answer: E) Rheumatoid arthritis

Explanation: The clinical presentation of this patient is highly suggestive of rheumatoid arthritis (RA). RA is a chronic autoimmune disease that primarily affects the joints. Key features include morning joint stiffness lasting for more than 30 minutes, bilateral joint involvement, and characteristic deformities like ulnar deviation of the fingers. Laboratory findings of a positive rheumatoid factor and elevated anti-cyclic citrullinated peptide (anti-CCP) antibodies further support the diagnosis of RA. Therefore, the most likely diagnosis in this case is rheumatoid arthritis (option E).

Question 1004

A 32-year-old male with a known history of type 1 diabetes mellitus presents to the emergency department with complaints of excessive thirst, frequent urination, abdominal pain, and deep rapid breathing. He mentions that he has missed his insulin injections for the past few days. On examination, he appears dehydrated, with dry mucous membranes and fruity breath. His vital signs show tachycardia and hypotension. Laboratory tests reveal hyperglycemia, ketonemia, and metabolic acidosis. Which of the following is the most likely diagnosis?

  • A) Diabetic ketoacidosis
  • B) Hyperosmolar hyperglycemic state
  • C) Hypoglycemia
  • D) Type 2 diabetes mellitus
  • E) Diabetic nephropathy

Answer: A) Diabetic ketoacidosis

Explanation: The clinical presentation of this patient is consistent with diabetic ketoacidosis (DKA), a serious complication of uncontrolled diabetes, typically seen in type 1 diabetes. Common features of DKA include hyperglycemia, ketonemia, and metabolic acidosis. Patients often exhibit signs of dehydration, such as excessive thirst, frequent urination, and dry mucous membranes. Fruity breath odor is a characteristic finding due to the presence of acetone. It is essential to recognize and treat DKA promptly to correct hyperglycemia and prevent life-threatening complications. Therefore, the most likely diagnosis in this case is diabetic ketoacidosis (option A).

Question 1005

A 60-year-old male presents to a neurologist with complaints of resting tremors, rigidity, and bradykinesia. His family reports that he has been experiencing these symptoms for the past year, and they have progressively worsened. On examination, the patient exhibits a resting tremor, cogwheel rigidity, and a shuffling gait. There is also a masked facies with reduced blinking. Which of the following is the most likely diagnosis?

  • A) Alzheimer’s disease
  • B) Multiple sclerosis
  • C) Parkinson’s disease
  • D) Huntington’s disease
  • E) Amyotrophic lateral sclerosis

Answer: C) Parkinson’s disease

Explanation: The clinical presentation of this patient is characteristic of Parkinson’s disease (PD), a neurodegenerative disorder that primarily affects motor function. Key features of PD include resting tremors, rigidity, bradykinesia (slowness of movement), and a shuffling gait. Patients may also exhibit a masked facies with reduced blinking. These motor symptoms result from the loss of dopamine-producing neurons in the substantia nigra of the brain. While other neurodegenerative conditions may share some symptoms, the combination of resting tremor, cogwheel rigidity, and bradykinesia is highly suggestive of Parkinson’s disease. Therefore, the most likely diagnosis in this case is Parkinson’s disease (option C).

Question 1006

A 30-year-old woman presents with fatigue, pallor, and jaundice. Her medical history reveals a family history of a similar condition. Physical examination shows scleral icterus and hepatosplenomegaly. Laboratory tests indicate a low hemoglobin level, an elevated reticulocyte count, and a positive Coombs test. What is the most likely diagnosis?

  • A) Iron-deficiency anemia
  • B) Vitamin B12 deficiency anemia
  • C) Hemolytic anemia
  • D) Aplastic anemia
  • E) Thalassemia

Answer: C) Hemolytic anemia

Explanation: The clinical presentation of fatigue, pallor, jaundice, hepatosplenomegaly, and laboratory findings such as a low hemoglobin level, elevated reticulocyte count, and positive Coombs test are indicative of hemolytic anemia. Hemolytic anemias are a group of conditions characterized by the premature destruction of red blood cells, leading to anemia. The presentation in this case suggests a hemolytic process, likely due to an underlying genetic or autoimmune cause. Therefore, the most likely diagnosis in this case is hemolytic anemia (option C).

Question 1007

A 45-year-old man presents to his primary care physician with complaints of fatigue, easy bruising, and recurrent nosebleeds over the past several weeks. On physical examination, there are no remarkable findings, except for petechiae and ecchymoses on his skin. Laboratory tests reveal a low red blood cell count, low platelet count, and a high white blood cell count. A bone marrow biopsy is performed, and the results show hypercellularity with increased blast cells. What is the most likely diagnosis?

  • A) Leukemia
  • B) Lymphoma
  • C) Multiple myeloma
  • D) Aplastic anemia
  • E) Hemophilia

Answer: A) Leukemia

Explanation: The clinical presentation of fatigue, easy bruising, recurrent nosebleeds, petechiae, ecchymoses, and the laboratory findings of low red blood cells, low platelets, and high white blood cells are suggestive of leukemia. Leukemia is a cancer of the blood and bone marrow, characterized by the overproduction of abnormal white blood cells. A bone marrow biopsy that reveals hypercellularity with increased blast cells is consistent with acute leukemia. Therefore, the most likely diagnosis in this case is leukemia (option A).

Question 1008

A 28-year-old woman presents to you with a history of fatigue, joint pain, and a butterfly-shaped rash on her face that worsens with sun exposure. She also reports hair loss and oral ulcers. On examination, you note joint tenderness, swelling in her fingers, and a characteristic malar rash on her cheeks. Laboratory tests reveal positive antinuclear antibodies (ANA), anti-dsDNA antibodies, and low complement levels. What is the most likely diagnosis?

  • A) Rheumatoid arthritis
  • B) Sjögren’s syndrome
  • C) Systemic sclerosis (scleroderma)
  • D) Systemic lupus erythematosus
  • E) Psoriatic arthritis

Answer: D) Systemic lupus erythematosus

Explanation: The clinical presentation of this patient, including fatigue, joint pain, a butterfly-shaped rash on the face, hair loss, and oral ulcers, is indicative of systemic lupus erythematosus (SLE). The characteristic malar rash on the cheeks, along with positive antinuclear antibodies (ANA), anti-dsDNA antibodies, and low complement levels, supports the diagnosis of SLE. This autoimmune condition can affect various organ systems, leading to a wide range of symptoms and complications. Therefore, the most likely diagnosis in this case is systemic lupus erythematosus (option D).

Question 1009

A 30-year-old woman presents to you with a history of episodic neurological symptoms, including visual disturbances, weakness in her legs, and difficulty with coordination. She mentions that these episodes tend to come and go over the past few years, with some periods of remission in between. On examination, you find evidence of abnormal reflexes, muscle weakness, and positive findings on an MRI of the central nervous system. Which of the following is the most likely diagnosis?

  • A) Migraine
  • B) Epilepsy
  • C) Myasthenia gravis
  • D) Multiple sclerosis
  • E) Parkinson’s disease

Answer: D) Multiple sclerosis

Explanation: The patient’s clinical history of episodic neurological symptoms, including visual disturbances, weakness in her legs, and difficulty with coordination, is suggestive of multiple sclerosis (MS). MS is a chronic autoimmune disease that affects the central nervous system and is characterized by relapsing and remitting symptoms. Abnormal reflexes, muscle weakness, and findings on central nervous system imaging are consistent with the diagnosis of MS. Therefore, the most likely diagnosis in this case is multiple sclerosis (option D).

Question 1010

A 32-year-old woman presents to you with complaints of chronic abdominal pain, diarrhea, and occasional rectal bleeding. She reports that her symptoms have been ongoing for several months and are not relieved by over-the-counter medications. On examination, you note tenderness in the lower abdomen. Laboratory tests show elevated inflammatory markers. Colonoscopy reveals skip lesions with aphthous ulcers and areas of cobblestone appearance in the colon. What is the most likely diagnosis?

  • A) Irritable bowel syndrome
  • B) Diverticulitis
  • C) Gastroenteritis
  • D) Inflammatory bowel disease
  • E) Celiac disease

Answer: D) Inflammatory bowel disease

Explanation: The patient’s clinical presentation of chronic abdominal pain, diarrhea, and rectal bleeding, along with findings of tenderness in the lower abdomen and elevated inflammatory markers, is highly suggestive of inflammatory bowel disease (IBD). The characteristic skip lesions, aphthous ulcers, and cobblestone appearance seen during colonoscopy are typical features of IBD. IBD includes conditions like Crohn’s disease and ulcerative colitis, which are characterized by chronic inflammation of the gastrointestinal tract. Therefore, the most likely diagnosis in this case is inflammatory bowel disease (option D).

References

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