Thats what FAITH can do

The Number that Never Changes...By: Omar Zarka

He was right; having a good friend for over fifty years is impressive. I was attending a dinner in which a well-respected scholar and professor was being recognized for his accomplishments. Instead of focusing on himself and his journey, he spent his entire speech thanking the numerous individuals that impacted his life. As he reflected on his experience, he said one of the most rewarding gestures he ever received had been from a former student going out of his way to find the professor’s contact information to contact him and thank him for the time and effort he put into his education. I found it peculiar that after several decades of many accomplishments, friends and family, one of the most rewarding gestures the professor received was a thank you.

It’s true though. Sometimes, after trying so hard and going out of our way to help someone, all it takes is two words—thank you—to start the rush of accomplishment and success. In fact, it happens all the time at work and school when we get a pat-on-the-back for the job-well-done on a project or a paper.


I used to ponder on the significance of giving “thanks” to Allah subhanahu wa ta`ala (exalted is He). Clearly there is no benefit to Him, al-Ghani (the One that is free of all needs). Slowly yet surely though, life comes to show that it truly is the thought that counts; at the core, it’s about the very process and not the details. The very act of giving thanks is a humbling comment; a recognition of benefit and respect or even awe. The professor didn’t reminisce on the contents of the thank you, but rather the fact that he was thanked. And notice – the value of the thank you increased because the student was so thankful that he was willing to thank his professor years later, even at the cost of the student’s time and effort. In other words, the fact that his student was so thankful that he thanked him again, was worth more.
We’re so blinded by our own heedlessness and the thick, murky fog of this dunya (the physical Universe) that we readily miss the blessings that surround us. But when we are so fortunate to see some of the things that keep us standing, we don’t have to search for Allah’s contact information. He’s the friend that we’ve known the longest and His number never changes wa alhamdulilLah (and praise be to Allah).

Checkpoints of Faith: Where do you Stand? By Accepted Whispers (Yasmin Mogahed)

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About six months ago, I had just finished praying Fajr (dawn prayer) and decided to recite some Qur’an. Craving attention and appreciation from the right place this time, I remembered reading somewhere that the angels witness morning recitation. I gently flipped through the pages of my Qur’an and started recitation from where I left off but it wasn’t long until I felt my voice crack and eyes blur. I was crying…again! I embraced the Qur’an open and wept silently till the dawn. Exhausted, I carefully placed The Holy Qur’an on the table in front of me, took a deep breath and began recitation again.
“And when the two companies saw one another, the companions of Moses said, ‘Indeed, we are to be overtaken!’ [Moses] said, ‘No! Indeed, with me is my Lord; He will guide me.’” (Qur’an 26:61-62)
I paused and reflected. It wasn’t the first time I had heard this story but like the new dawn, that day, it brought a whole new meaning into my life. Standing in front of the Red Sea, Musa `alayhi as-salam (peace be upon him) had nowhere to go; I too had nowhere to go. But Prophet Musa’s unwavering faith in the face of such great difficulty touched the depths of my heart and I finally realized why Allah subhanahu wa ta`ala (exalted is He) narrates His miracles to us. Prophets were people like us. Allah chose them to deliver His message and through them, the Almighty is enlightening us of how to believe in Him.
Allah (swt) has a plan for us, and sometimes what we are most afraid of is what happens. We find ourselves asking, “Why me?” These emotions of utter despair and hopelessness swamp all aspects of our lives and it becomes almost impossible to keep any hope. Take a moment and reflect. Don’t be afraid, for this is merely a test, a test of your faith. Prophet Musa (as) stood firm in front of the Red Sea and without a doubt believed Allah will make a way, and so He did.
These extraordinary stories from the Qur’an are checkpoints of faith: Where do you and I stand? Al-Mu’min (the Inspirer of faith) unfolds the story of Musa (as), so that we may be inspired and sow seeds of unflinching faith within our hearts. Faith produces miracles, and what was impossible becomes possible.
As I reflected upon the beautiful words of Prophet Musa (as), I wiped my tears and smiled. Humbled, I quickly took the Qur’an in my arms once again. I found peace and tranquility where I had never imagined. I found solace in Allah (swt).
“Don’t look at the Red Sea, look at the One who can split it in two.”—Yasmin Mogahed

Internal Medicine MCQs (part 7)

Part: 7

1. A 45-year old woman underwent a modified radical mastectomy 4 years ago. She was treated for multiple bone metastases with cyclophosphamide, doxorubicin, and fluorouracil for 6 months. She is complaining of exertion on exercise, swelling of the legs, and swelling around eyes in the moming. On examination, she has
bilateral rales in the lungs, S1, S2 audible, S3, S4 gallop present. Her BP is 149/117 mm Hg, PR is 80/min, and RR is 18/min. What is the most likely cause for her cardiac condition?
a) Systolic dysfunction CHF
b) Drug induced cardiac toxicity
c) …

2. Which of the following statements is correct regarding adrenal histoplasmosis:
a) In active disease, calcification is commonly seen
b) Lymphadenopathy is not seen
c) The adrenal glands are usually symmetrically enlarged
d) Adrenal insufficiency is uncommon
Correct answer : c) The adrenal glands are usually symmetrically enlarged
Explanation : Adrenal histoplasmosis

3. Which of the following is not a B cell neoplasm?
a) Hairy cell leukemia
b) Angiocentric lymphoma
c) Mantle cell lymphoma
d) Burkitt’s lymphoma
Correct answer : b) Angiocentric lymphoma (All others are B cell neoplasms)
Read about angiocentric lymphoma here : Angiocentric lymphoma

4. A patient presents with a platelet count of 700 x 10(9)/L with abnormalitites in size, shape and granularity of platelets. WBC count of 12 x 10(9)/L, hemoglobin of 11g/dl and the absence of Philadelphia chromosome. The most likely diagnosis would be:
a) Polycythemia vera
b) Essential thrombocythemia
c) Chromic myeloid leukemika
d) Leukemoid reaction
Correct answer : b) Essential thrombocythemia

5. A 30-year old patient presented with history of jaundice for 10 days. His liver function tests showed bilirubin of 10mg/dl, SGOT/SGPT 1100/1450, serum alkaline phosphatase-240 IU. He was positive for Hbs Ag. What should be the confirmatory test to establish acute hepatitis B infection?
a) IgM Anti HBc antibody
b) HbeAg
c) HBV DNA by PCR
d) Anti HBc antibody
Correct answer : a) IgM Anti HBc antibody

6. The causes of systemic secondary insult to injured brain include all of the following except:
a) Hypercapnia
b) Hypoxaemia
c) Hypotension
d) Hypothemia
Correct answer : d) Hypothemia

7. A 30 year-old male presents with numbness of both lower limbs and right upper limb. Examination reveals pulse 88/minute and BP 160/110 mm of Hg. He also has digital gangrene involving right 2nd and 3rd finger. Urine routine examination is unremarkeable. Microscopic examination shows RBC’s Hemogram and serum
biochemistry is within normal limits. What is the most probable diagnosis?
a) Systemic lupus erythematosus
b) Polyarteritis nodosa
c) Malignant hypertension
d) Chrug-Strauss syndrome
Correct answer : b) Polyarteritis nodosa

8. All of the following are predominant motor neuropathy except:
a) Acute inflammatroy demyelinating polyradiculoneuropathy
b) Porphyric neuropathy
c) Lead intoxication
d) Arsenic intoxication
Correct answer : d) Arsenic intoxication

9. Which test is not useful in a patient with history of syncopal attack
a) Electrophysiological test
b) Table tilt test
c) PET scan
d) Holter monitoring
Correct answer : c) PET scan
Electrophysiological tests look for any defects in the signal generation and conduction in the heart, table tilt test checks for precipitation of syncope when the person is kept at abt 60 degree elevation for abt 20 minutes, Holter monitoring is used to check for any ECG abnormalities in a 24 hour period.
All these tests help in the evaluation of syncope whereas PET scan is …

Internal Medicine MCQs (part 6)

Part: 6

1. All of the following statements regarding primary effusion lymphoma are true except:
A. It generally presents in elderly patients
B. There is often an association with HHV 8
C. The proliferating cells are NK cells
D. Patients are commonly HIV positive

Correct answer :C. The proliferating cells are NK cells
Primary effusion lymphomas are aggressive malignancies that present as serous effusion without any tumour mass.

2. An 18-year-old male presented with acute onset descending paralysis of 3 days duration. There is also a history of blurring of vision for the same duration. On examination, the patient has
quadriparesis with areflexia. Both the pupils are non reactive. The most probable diagnosis is:
a) Poliomyelitis
b) Botulism
c) Diphtheria
d) Porphyria
Correct answer : b) Botulism
The important features of the patient are descending paralysis, blurring of vision and non reactive pupils. Descending paralysis is caused by 3 of the conditions mentioned – polio, botulism, and diphtheria. Diphtheria and botulism can cause ocular symptoms. …

3. Episodic generalized weakness can occur due to all of the following acute electrolyte disturbances, except:
a) Hypokalemia
b) Hypocalcemia
c) Hyponatremia
Correct answer : b) Hypocalcemia
Electrolyte imbalances which result in Episodic generalized weakness:

Hyperkalemia
Hypokalemia
Hypernatremia
Hyponatremia
Hypercalcemia
Hyperphosphatemia
Hypermagnesemia

4. A patient aged 65 years, is diagnosed to have severe aplastic anemia. HLA compatible sibling is available. The best option of treatment is;
a) Anti thymocyte globulin followed by cyclosporine
b) A conventional bone marrow transplantation from the HLA identical sibling
c) A non-myeloablative bone marrow transplantation from the HLA identical sibling
d) Cyclosporine
Correct answer : a) Anti thymocyte globulin followed by cyclosporine
Treatment of choice in an elderly individual with severe aplastic anemia is immunosuppression – Anti thymocyte globulin followed by cyclosporine. Bone marrow transplantation is tried only in young adults.

5. ln acute pulmonary embolism, the most frequent ECG finding is:
a) S1Q3T3 pattern
b) P. pulmonale
c) Sinus tachycardia
d) Right axis deviation
Correct answer : c) Sinus tachycardia
All of the above features may be seen in acute pulmonary embolism, but sinus tachycardia is seen in all cases.

6. A hoursewife ingests a rodenticide white powder accidentally. She is brought to hospital where the examination shows generalized, flaccid paralysis and an irregular pulse. ECG shows multiple ventricular ectopics, generalized changes with ST-T. Serum potassium is 2.5 m Eq/L. The most likely ingested poison is:
a) Barium carbonate
b) Super warfarins
c) Zinc phosphide
d) Aluminium phosphide
Correct answer : a) Barium carbonate
Read more : Features of barium carbonate poisoning

7. The endotoxin of the following gram negative bacteria does not play any part in the pathogenesis of the natural disease:
a) Escherichia coli
b) Klebsiella sp.
c) Vibrio cholerae
d) Pseudomonas aeruginosa
Correct answer : c) Vibrio cholerae
Vibrio cholerae exotoxins are responsible for tis pathogenecity.

8. Salmonella typhi is the causative agent of typhoid fever. The infective dose of S. typhi is:
a) One bacillus
b) 10(8) – 10(10) bacilli
c) 10(2) – 10(5) bacilli
d) 1-10 bacilli
Correct answer : c) 10(2) – 10(5) bacilli (factual question)

9. The single most common cause of pyrexia of unknown origin is:
a) Mycobacterium tuberculosis
b) Samonella typhi
c) Brucella sp.
d) Salmonella paratyphi A
Correct answer : a) Mycobacterium tuberculosis (factual question)

10. “lntestinal angina” is a symptom complex of the following:
a) Postprandial abdominal pain, weight loss, actue mesenteric vessel occlusion
b) Postprandial abdominal pain, weight loss, chronic mesenteric vessel occlusion
c) Preprandial abdominal pain, weight loss, chronic mesenteric vessel occlusion
d) Preprandial abdominal pain, weight gain, acute mesenteric vessel occlusion
Correct answer : b) Postprandial abdominal pain, weight loss, chronic mesenteric vessel occlusion
Intestinal angina is due to chronic mesenteric vein occlusion. It causes abdominal pain, cramping following food intake, weight loss and chronic diarrhoea

Internal Medicine MCQs (part 5)

Part 5:

1. Which of the following is least likely to cause infective endocarditis?
A. Staphylococcus albus
B. Streptococcus faecalis
C. Salmonella typhi
D. Pseudomonas aeruginosa
Correct answer : C. Salmonella typhi
Infective endocarditis is a rare complication of Salmonella typhi infection.

2. Sudden cardiac death may occur in all of the following except:
A. Dilated cardiomyopathy
B. Hypertrophic cardiomyopathy
C. Eisenmengers syndrome
D. Ventricular septal defect
Correct answer : D. Ventricular septal defect
VSD is the best answer among the options given

3. All of the following are true for mitral valve prolapse, except:
A. Transmission may be as an autosomal dominant trait
B. Majority of the cases present with features of mitral regurgitation
C. The value leaflets characteristically show myxomatous degeneration
D. The disease is one of the common cardiovascular manifestations of Marfan’s Syndrome
Correct answer : B. Majority of the cases present with features of mitral regurgitation
Features of Mitral valve prolapse:

Majority of patients are asymptomatic
Some present with non specific chest pain, dyspnoea, fatigue or palpitation
Myxomatous degeneration of heart valves is seen (mostly mitral valve)
Autosomal dominant pattern …

4. All of the following may be seen in patients of cardiac tamponade except:
A. Kussmaul’s sign
B. Pulsus paradoxus
C. Electrical alternans
D. Right ventricular diastolic collapse in echocardiography
Correct answer : A. Kussmaul’s sign
Kussmaul’s sign is seen in constrictive pericarditis.

5. All of the following may occur due to hyperkalemia except:
A. Prolonged PR interval
B. Prolonged QRS interval
C. Prolonged QT interval
D. Ventricular asystole
Correct answer : C. Prolonged QT interval

6. All of the following are risk factors for atherosclerosis except:
A. Increased waist hip ratio
B. Hyperhomocysteinemia
C. Decreased fibrinogen levels
D. Decreased HDL levels
Correct answer : C. Decreased fibrinogen levels
Atherosclerosis risk is increased with increase in fibrinogen levels.

7 .True regarding dengue fever
A. It is both epidemic and endemic
B. Most common arbo virus infection
C. Can survive in ambient temperature
D. Incidence is decreasing in India for past 2-3 decades
E. ??

8. True regarding cardiac tamponade is?
A. Kussumal sign positive
B. Widened mediastinum
C. Steep y descent absent
D. Pulsus alternans
E. Muffled heart sounds
Please contribute to the discussion by posting the answer with references and pointing out any errors in the question!

9. All of the following are major complications of massive transfusion, except:
A. Hypokalemia
B. Hypothermia
C. Hypomagnesemia
D. Hypocalcemia
Correct answer :A. Hypokalemia
Massive transfusions can cause hyperkalemia due to loss of potassium from the transfused red cells.

10. A patient with leukemia on chemotherapy develops acute right lower abdominal pain associated with anemia, thrombocytopenia and leukopenia. Which of following is the clinical diagnosis?
A. Appendictis
B. Leukemic colitis
C. Perforation peritonitis
D. Neutropenic colitis
Correct answer : D. Neutropenic colitis
Acute right lower abdominal pain in an immunocompromised patient after chemotherapy is characteristic of neutropenic colitis.

Internal Medicine MCQs (part 4)

Part 4:

1. In which of the following conditions Splenectomy is not useful?
A. Herediatary spherocytosis
B. Porphyria
C. Thalassemia
D. Sickle cell disease with large spleen
Correct answer : B. Porphyria
Splenectomy has little role in the management of porphyria

2. Renal artery stenosis may occur in all of the following except:
A. Atherosclerosis
B. Fibromuscular dysplasia
C. Takayasu’s arteritis
D. Polyarteritis nodosa
Correct answer : D. Polyarteritis nodosa
Causes of renal artery stenosis:

Atherosclerosis
Giant cell arteritis
Fibromuscular dysplasia
Takayasu arteritis
Tranplant renal artery stenosis
Antiphospholipid antibody syndrome

3. The presence of anti Saccharomyces cerevisae antibody is a surrogate marker of one of the following:
A. Celiac disease
B. Crohn’s disease
C. Ulcerative colitis
D. Tropical sprue
Correct answer : B. Crohn’s disease
Saccharomyces cerevisae antibody positivity:

Chron’s disease – 60-70%
Ulcerative colitis – 10-15%

4. Anticentromere antibodies are most commonly associated with:
A. Diffuse cutaneous systemic sclerosis
B. Mixed connective tissue disease
C. CREST syndrome
D. Polymyositis
Correct answer : C. CREST syndrome
Anticentromere antibodies are seen mostly in those with CREST syndrome. (40-80% patients with CREST syndrome are anticentromere antibody positive)

5. Drug induced lupus can be identified by:
A. Anti histone antibodies
B. Double stranded DNA antibodies
C. Antinuclear antibodies
D. Anti SM antibodies
Correct answer : A. Anti histone antibodies
Anti histone antibodies are present in more than 95% individuals with drug induced lupus.

6. Which of the following is the most common presenting symptom of non cirrhotic portal hypertension?
A. Chronic liver failure
B. Ascites
C. Upper gastrointestinal bleeding
D. Encephalopathy
Correct answer : C. Upper gastrointestinal bleeding
Acute gastrointestinal bleed is the most common presenting symptom of extrahepatic portal hypertension.

7. Which of the following is not a common feature of Anorexia Nervosa?
A. Binge eating
B. Amenorrhoea
C. Self perception of being ‘fat`
D. Under weight
Correct answer : A. Binge eating
Binge eating is a common feature of bulimia. It is rarely seen in anorexia nervosa.

8. Smoking is not a risk factor for development of?
A. Small cell carcinoma
B. Respiratory bronchiolitis
C. Emphysema
D. Bronchiolitis obliterans organizing pneumonia
Correct answer : D. Bronchiolitis obliterans organizing pneumonia
Smoking is a known risk factor for small cell carcinoma, respiratory bronchiolitis and emphysema.

9. Mycotic abscesses are due to:
A. Bacterial infection
B. Fungal infection
C. Viral infection
D. Mixed infection
Correct answer : B. Fungal infection

10. Mycotic aneurysm is an aneurysm infected because of:
A. Fungal infection
B. Blood-borne infection (intravascular)
C. Infection introduced from outside (extravascular)
D. Both intravascular and extravascular infection
Correct answer : D. Both intravascular and extravascular infection
The source of infection in a mycotic aneurysm can be intravascular or extravascular.