1101 to 1200 Flashcards
(100 cards)
1
Q
- A lady comes with a missing IUCD thread. Her LMP was 2wks ago. What is the single most appropriate next step in management? a. Abdominal US b. Prescribe contraceptives c. CT d. Serum BHCG e. Vaginal exam
A
Ans. The key is A. Abdominal US. It is wrong key! Correct key is E. Vaginal exam. [LOST THREAD: First confirm the thread is not in position by vaginal examination. If not present ultrasound should be arranged to locate the device. If ultrasound does not locate the device and there is no definite history of expulsion then abdominal X- ray should be performed to look for an extrauterine device.Expul
2
Q
- A 32yo woman presents with hx of lower abdominal pain and vaginal discharge. She had her menses 4wk ago. She has a temp of 38.6C. What is the most suitable dx? a. Acute appendicitis b. Acute PID c. Endometriosis d. Ectopic pregnancy e. UTI
A
Ans. The key is B. Acute PID. [Fever, lower abdominal pain and vaginal discharge are features of PID].
3
Q
- A 40yo female was on COCP which she stopped 6m ago. But she has not had her periods since then. Labs: FSH=22, LH=24, prolactin=700, estradiol=80. What is the most appropriate dx? a. Hypothalamic amenorrhea b. Post pill amenorrhea c. Prolactinoma d. Pregnancy e. Premature ovarian failure
A
Ans. The key is E. Premature ovarian failure. [ FSH and LH are raised in ovarian failure; an FSH level ≥20 IU/l in a woman aged around 40 with secondary amenorrhoea indicates ovarian failure. In POF there is also a mild to moderate rise in prolactin].
4
Q
- A 25yo woman presents with a single lump in the breast and axilla. The lump is mobile and hard in consistency. The US, mammogram and FNA turn out to be normal. What is the most appropriate inv to confirm the dx? a. FNAC b. MRI c. Punch biopsy d. Genetic testing and counselling e. Core biopsy
A
Ans. The key is E. Core biopsy. [The lump is suspicious but US, mammogram and FNA turn out to be normal. So most appropriate investigation to confirm diagnosis is core biopsy. It is often the preferred biopsy method because it is accurate and does not involve surgery].
5
Q
- A 37yo lady stopped taking COCP 18m ago and she had amenorrhea for 12m duration. Labs: FSH=8, LH=7, prolactin=400, estradiol=500. What is the cause? a. Hypothalamic amenorrhea b. PCOS c. Prolactinoma d. Post pill amenorrhea e. POF
A
Ans. The key is D. Post pill amenorrhea. [Post pill amenorrhea= failure to resume menses within 6 months of stopping pill, but she was amenorrheic for 12 months!!].
6
Q
- A lady with a firm smooth breast lump in outer quadrant had a FNAC done. Results showed borderline benign changes. She also has a fam hx of breast cancer. What is the your next? a. Mammography b. US c. Core biopsy d. Genetic testing and counselling e. Punch biopsy
A
Ans. The key is D. Genetic testing and counselling. Probably wrong key! Correct one should be C. Core biopsy. [Genetic testing is done for asymptomatic patients in their 30s and if positive SERMs are given which cause significant reduction in cancer . Since patient has firm breast lump in upper outer quadrant ( most common location for cancer) and FNAC has shown borderline benign changes plus pati
7
Q
- A pt presents with mild dyskaryosis. 1y ago smear was normal. What is the most appropriate next step? a. Cauterization b. Repeat smear c. Swab and culture d. Cone biopsy e. Colposcopy
A
Ans. The key is E. Colposcopy. [In mild dyscariosis colposcopy should be done with HPV test].
8
Q
- An African lady presents with heavy but regular periods. Her uterine size correlates to 14wks pregnancy. What is the most appropriate dx? a. Blood dyscrasia b. Hematoma c. Fibroids d. Adenomyosis e. Incomplete abortion
A
Ans. The key is C. Fibroids. [Regular heavy menstruation in a uterus of 14 wk size is highly suggestive of fibroid].
9
Q
- A 29yo at 38wks GA presents with a 2h hx of constant abdominal pain. She then passes 100ml of blood per vagina. What is the next appropriate inv? a. USS b. CTG c. Clotting screen d. Hgb e. Kleihauer Betke test
A
Ans. The key is A. USS. [Ultrasonogram scan can detect placental abrubtion and fetal heart beat as well. So it is the preferred key over CTG].
10
Q
- A 26yo woman had amenorrhea for 10wks and is pregnant. She experiences hyperemesis. Now she presents with vaginal bleed. Exam: uterus=16wks, closed os. What is the most probable dx? a. Thyrotoxicosis b. Hyperemesis gravidarum c. Twins d. Wrong dates e. Molar pregnancy
A
Ans. The key is E. Molar pregnancy. [In hytaditidiform mole uterus becomes more in size than actual gestational age and due to production of large amount of gonadotrophin by moles patient suffers from severe vomiting i.e. hyperemesis. There also occurs vaginal bleeding].
11
Q
- A pregnant woman of G2, GA 11wks presents with heavy vomiting, headache and reduced urine output. Urine analysis shows ketonuria. Choose the next best step? a. US b. Oral fluid replacement c. Serum BHCG d. Parental anti-emetics e. IV fluids
A
Ans. The key is E. IV fluids. [Hyperemesis gravidarum with oliguria and ketonuria. IV fluid should be started to prevent renal failure].
12
Q
- A pt had inflammatory changes on cervical smear. There is no vaginal discharge, no pelvic pain and no fever. What is the next step? a. Repeat smear in 6m b. Take swab c. Treat with antibiotics d. Colposcopy e. Cone biopsy
A
Ans. The key is B. Take swab. This is a wrong key! Correct key is A. Repeat smear in 6 months. [Ref: Samson notes].
13
Q
- A 37yo infertile lady with 5cm subserosal and 3cm submucosal fibroid is trying to get pregnant. Which is the most suitable option? a.Clomifen therapy b. IVF c. Myomectomy d. Hysterectomy e. IU insemination
A
Ans. The key is C. Myomectomy. [Fibroids are preventing from her being pregnant. So myomectomy is the most suitable option to let her get pregnant].
14
Q
- A young tall man and his wife are trying for babies and present at the infertility clinic. On inv the man has primary infertilitiy and azoopermia. What other inv should be done? a. Testosterone b. LSH c. FSH d. Estradiol e. Karyotyping
A
Ans. The key is E. Karyotyping. [The likely diagnosis is Klinefelter’s syndrome for which Karyotyping should be done to make the diagnosis established].
15
Q
- A woman who is on regular COCP presented to you for advice on what to do as she has to now start to take a course of 7d antibiotics. What would you advice? a. Continue regular COC b. Continue COCP and backup contraception using condoms for 2d c. Continue COCP and backup contraception using condoms for 7d d. Continue COCP and backup contraception using condoms for 2wks
A
Ans. The key is D. Continue COCP and backup contraception using condoms for 2wks. This is wrong key! Correct key should be A. Continue regular COCP. [Before it was thought that antibiotics alter the gut flora and ethinyloestradiol is not conjugated. There is more ethinyloestradiol passed in the stool. So pregnancy and breakthrough bleeding can occur. But later it was established that except for st
16
Q
- A lady presents with hot flashes and other symptoms of menopause. What is the tx option? a. Raloxifen b. HRT c. Bisphosphonate d. COCP e. Topical estrogen
A
Ans. The key is B. HRT
17
Q
- A 28yo woman at 34wks GA for her first pregnancy attends antenatal clinic. Her blood results: Hgb=10.6, MCV=95, MCHC=350. What do you do for her? a. Folate b. Dextran c. Ferrous sulphate d. None e. IV FeSO4 f. Explain this physiologic hemodynamic anemia g. Blood transfusion
A
Ans. The key is F. Explain this physiologic hemodynamic anemia. [According to NICE, cut offs for iron supplements: at booking (8-10 weeks)- if less than 11 at 28 weeks and further- if less than 10.5 if less than these values=> give iron].
18
Q
- A 34yo woman who never had fits or high BP developed fits 6h after delivery of a term healthy child. What is the most likely dx? a. Eclampsia b. Preeclampsia c. Epilepsy d. Pulmonary embolism e. Pregnancy induced HTN
A
Ans. The key is A. Eclampsia. [In eclampsia seizers occurs within 24 hours mostly and majority within 12 hours. Also single seizure doesn’t support epilepsy strongly. So likely answer is A. Eclampsia].
19
Q
- A 30yo lady who already has one child through a prv C-section demands a reversible contraception. She presently experiences heavy and painful periods. What is the most appropriate contraceptive you will recommend for her? a. COCP b. POP c. Implanon d. Danazol e. Mirena f. IUCD
A
Ans. The key is E. Mirena.
20
Q
- A 32yo woman comes with intermenstrual bleeding. Her last cervical smear was 1y ago and was negative. What test would you recommend for her initially? a. Colposcopy b. Cervical smear c. Endocervical swab d. Transvaginal US e. Pelvic CT
A
Ans. The key is B. Cervical smear. This is a wrong key! Correct key is C. Endocervical swab. [Smear can only be done if it is due or overdue, not in any time or not as needed basis].
21
Q
- A 20yo woman has had abdominal pain in the LIF for 6wks duration. Over the past 48h, she has severe abdominal pain and has a fever of 39.1C. Pelvic US shows a complex cystic 7cm mass in the LIF. What is the most likely dx? a. Endometriosis b. Dermoid cyst c. Ovarian ca d. Tubo-ovarian abscess e. Ectopic pregnancy
A
Ans. The key is D. Tubo-ovarian abscess.
22
Q
- A woman is 16wk pregnant and she is worried about abnormal chromosomal anomaly in her child. What is the definitive inv at this stage? a. Amniocentesis b. CVS (Chorionic Villous Sampling) c. Parents karyotyping d. Coomb’s test e. Pre-implantation genetic dx
A
Ans. The key is A. Amniocentesis. [Amniocentesis is done between 14 to 16 weeks of gestation. CVS is done prior to 15 weeks. So the option is A. Amniocentesis].
23
Q
- A 28yo lady with a fam hx of CF comes for genetic counselling and wants the earliest possible dx test for CF for the baby she is planning. She is not in favor of termination. What would you recommend for her? a. CVS (Chorionic Villous Sampling) b. Amniocentesis c. Pre-implantation genetic dx d. Chromosomal karyotyping e. Maternal serum test f. Reassure
A
Ans. C. Pre-implantation genetic dx. [Patient is not yet pregnant but planning for pregnancy. Earliest possible diagnostic test for CF is Pre-implantation genetic dx. Preimplantation genetic diagnosis (PGD) is a procedure used prior to implantation to help identify genetic defects within embryos created through in vitro fertilization to prevent certain diseases or disorders from being passed on to
24
Q
- A 39yo woman in her 36th week GA with acute abdominal pain is rushed for immediate delivery. Her report: BP=110/60mmHg, Hgb=low, bilirubin=22, AST=35, Plt=60, APTT=60, PT=30, Fibrinogen=0.6. What is the cause? a. Pregnancy induced hypertension b. DIC c. HELLP syndrome d. Acute fatty live e. Obstetric cholestasis
A
Ans. The key is B. DIC. [It is not HELLP syndrome as liver enzyme is not elevated. Acute abdominal pain may indicate concealed abruption placenta which may lead to DIC].
25
1125. A 36wk pregnant woman presents with sudden onset of uterine pain and bleeding, uterus is tender, no prv LSCS. What is the most appropriate cause? a. Preeclampsia b. DIC c. Placental abruption d. Placental previa e. Ectopic pregnancy f. Missed abortion g. Ectropion
Ans. The key is C. Placental abruption. [Painful bleeding at 36th week is placental abruption (either revealed or mixed type)].
26
1126. A 28wk pregnant woman presents with uterine bleeding after sexual intercourse. What is the most appropriate cause? a. Preeclampsia b. DIC c. Placental abruption d. Placental previa e. Ectopic pregnancy f. Missed abortion g. Ectropion
Ans. The key is G. Ectropion. [Post coital bleeding can be either placenta previa or cervical ectropion. But as ectropion is commoner in pregnancy so it is the option here].
27
1127. A 6wk pregnant woman presents with abdominal pain. She has prv hx of PID. What is the most likely dx? a. Preeclampsia b. DIC c. Placental abruption d. Placental previa e. Ectopic pregnancy f. Missed abortion g. Ectropion
Ans. The key is E. Ectopic pregnancy. [H/O PID is a recognized cause of ectopic pregnancy. Also pain without bleeding at 6th week support the diagnosis of ectopic pregnancy].
28
1128. A 33wk pregnant woman presents with vaginal bleeding, low Hgb, low plt, increased bilirubin, AST normal, APTT & PT increased. What is the most likely dx? a. Preeclampsia b. DIC c. Placental abruption d. Placental previa e. Ectopic pregnancy f. Missed abortion g. Ectropion
Ans. The key is B. DIC.
29
1129. A 25yo lady at her 28th week GA came for check up. Her BP=160/95mmHg, protein in urine=6g/d. What is the most likely dx? a. Essential HTN b. Gestational HTN c. Chronic HTN d. Preeclampsia
Ans. The key is D. Preeclampsia.
30
1130. A 32yo woman has a hx of spontaneous abortions at 6wks, 12wks, and 20wks. She is now keen to conceive again. Which of the following would you prescribe for the next pregnancy? a. MgSO4 b. Aspirin c. Warfarin d. Mefenemic acid e. Heparin
Ans. The key is B. Aspirin. [Patient of antiphospholipid syndrome had 3 fetal losses and no thromboembolic event and now wants to be pregnant. In such case prophylactic treatment with low dose aspirin is indicated].
31
1131. A 6yo child presents with hx of recurrent jaundice. Between the episodes he is totally fine. Mother gives hx of jaundice being brought about by ongoing infections. What is the most likely dx? a. Hereditary spherocytosis b. G6PD deficiency c. Thalassemia d. Sickle cell disease e. Congenital storage disorder
Ans. The key is B. G6PD deficiency. [There are some precipitating factors of hemolysis causing jaundice in patients with G6PD deficiency among which infection is a recognized one].
32
1132. A 42yo woman who smokes 20 cigarettes/d presents with complains of heavy bleeding and prolonged menstrual period. What is the most appropriate tx for her? a. Tranexemic acid b. COCP c. Mefenemic acid d. IUCD e. Norethisterone
Ans. The key is D. IUCD. This is wrong key. Correct key is A. Tranexemic acid.
33
1133. A 17yo senior school girl with complain of prolonged irregular menstrual period and heavy blood losses. What is the most appropriate tx for her? a. Mefenemic acid b. COCP c. POP d. IUCD e. Mirena
Ans. The key is B. COCP. [In irregular period: COCP except the contraindications for it and in that case POP should be used].
34
1134. A 32yo presents with heavy blood loss, US: uterine thickness>14mm. What is the most appropriate tx for her? a. Mefenemic acid b. COCP c. POP d. IUCD e. IU system (mirena)
Ans. The key is E. IU system (mirena). [Simple endometrial hyperplasia without atypia responds to high- dose progestogens, with repeat histology after three months. This can be effectively delivered by the levonorgestrel intrauterine system (IUS).
35
1135. A 37yo woman presents with heavy bleeding. Inv show subserosal fibroid=4cm and intramural fibroid=6cm. Which is the most appropriate tx? a. UAE b. Abdominal hysterectomy c. Hysteroscopic Myomectomy d. Vaginal Hysterectomy e. Abdominal myomectomy
Ans. The key is E. Abdominal myomectomy. [As patient is young we should go for myomectomy. As hysteroscopic myomectomy is suitable for mainly submucosal fibroids. We should go for Abdominal myomectomy which will deal with both subserosal and intramural fibroids].
36
1136. A woman with sickle cell disease complains of heavy menstrual blood loss. What is the most appropriate tx? a. COCP b. Mirena c. Depot provera d. Copper IUS e. Transdermal patch
Ans. The key is C. Depot provera. [Hormone and barrier methods are all acceptable choices but intrauterine devices are not recommended, as they may be associated with uterine bleeding and infection. Depot contraceptive (Depo-Provera®) is safe and has been found to improve the blood picture and reduce pain crises.
37
1137. A 70yo woman is admitted with diarrhea, vomiting and dehydration. Exam: yellow visual halos in her eyes, ECG=bradycardia. She has a hx of chronic A-fib. Which drug causes the above mentioned side effects? a. Nifedipine b. Ramipril c. Atenolol d. Lithium e. Digoxin
Ans. The key is E. Digoxin. [Digoxin toxicity causes diarrhea, vomiting, dehydration, xanthopsia (yellow halos around light), bradicardia. History of atrial fibrillation is also a clue of digoxin use].
38
1138. A 33yo lady who is a drug addict wants to quit. She says she is ready to stop the drug abuse. She is supported by her friends and family. What drug tx would you give her? a. Benzodiazepines b. Diazipoxide c. Lithium d. Methadone e. Disulfiram
"Ans. The key is D. Methadone. [Methadone is an opioid medication. Methadone reduces withdrawal symptoms in people addicted to heroin or other narcotic drugs without causing the ""high"" associated with the drug addiction and thus used to help a drug addict to quit from drug addiction]."
39
1139. A 50yo lady has been suffering from chronic RA and is on methotraxate and naproxen. Her CBC shows microcytic anemia. What is the most likely cause? a. Anemia of chronic disease b. GI hemorrhage c. Menorrhagia
Ans. The key is B. GI hemorrhage. [Anemia of chronic disease is mostly normocytic and methotrexate causes folate deficiency which may lead to macrocytosis. So for this microcytic anemia NSAIDs induced GI hemorrhage is the most likely cause].
40
1140. A 15yo male noticed swelling on the left knee following a fall while playing. The swelling has not subsided in spite of rest and analgesia. Exam: full knee movement with slight tenderness. He has painless palpable mass in left inguinal region. What is the most probable dx? a. Osteosarcoma b. Ewing’s sarcoma c. Chondrosarcoma d. Lymphangiosarcoma e. Osteodosteoma
Ans. There are two keys i) Osteosarcoma ii) Ewing’s sarcoma. But the likely correct key is probably A. Osteosarcoma. [Both occurs in children and young adults but the occurrence of painful symptom during playing is usually a feature of osteosarcoma. In case of osteosarcoma teenagers who are active in sports often complain of pain in the lower femur, or immediately below the knee. If the tumor is l
41
1141. A 45yo female looking pale has bluish discoloration of hands whenever she goes out in the cold. She has also noticed some reddish spots on her body. She has symmetrical peripheral arthropathy for the last yr. What is the most probable dx? a. RA b. Osteosarcoma c. Limited systemic sclerosis d. Diffuse systemic sclerosis e. Chondrosarcoma
Ans. The key is C. Limited systemic sclerosis. [Raynaud’s phenomena, telangiectasia, sclerodactyly indicates to the dx of CREST syndrome or Limited systemic sclerosis].
42
1142. A 60yo female has pain and stiffness in her right hip joint. Pain is not severe in the morning but increases as the day progresses. She has noticed some nodules in her hands. Inv: Hgb=low. What is the most probable dx? a. RA b. Osteoarthritis c. Gout d. Pseudogout e. Multiple myeloma
Ans. The key is B. Osteoarthritis. [Stiffness and pain of right hip increasing as the day progresses, nodules in hands (Hebarden or Bouchard’s nodes), anemia (probably secondary to prolonged NSAIDs use) indicates osteoarthritis].
43
1143. A 30yo female has chronic diarrhea, mouth ulcers and skin tags. She complains of visual prbs, low back pain and morning stiffness. Inv: ESR & CRP=raised, Hgb=10mg/dl. What is the most probable dx? a. SLE b. Reactive Arthritis c. Gout d. Pseudogout e. Seronegative arthritis
Ans. The key is E. Seronegative arthritis. [Chronic diarrhea, mouth ulcers and skin tags are features of IBD. There is a well known association between IBD and seronegative arthritis (particularly AS). Here low back pain, visual problem, morning stiffness, raised ESR and CRP, low hemoglobin indicates the diagnosis of Seronegative arthritis].
44
1144. A 28yo woman has been on tx for RA for 3yrs. She has gradual loss of vision in both eyes. Her IOP is normal. Red reflex is absent in both eyes. What is the single most likely dx? a. Cataract b. DM retinopathy c. Hypermetropia d. Macular degeneration e. HTN retinopathy
Ans. The key is A. Cataract. [Prolonged use of steroid (here in RA) is a known cause of cataract].
45
1145. An elderly man with recently dx HF has been treated with diuretics. He now develops severe joint pain in his left ankle with swelling and redness. What is single most likely inv? a. XR of bone b. Plasma RF c. Joint fluid uric acid crystals d. ESR
Ans. The key is B. Plasma RF. It is a wrong key. Correct key should be C. Joint fluid uric acid crystals. [Thiazide diuretics may increase uric acid levels in blood causing or precipitating gout and joint fluid may show uric acid crystals].
46
1146. A 60yo lady with a hx of HTN and suffering from RA since the last 10y now presents with hot, swollen and tender knee joint. What inv would you do for her? a. XR b. C&S of joint aspirate c. US d. MRI e. CT
Ans. The key is B. C&S of joint aspirate. [RA itself is a risk factor for joint infection and there are possibilities to increase the chance of septic arthritis with the use of probable steroid which lowers immunity and further facilitates infection of joints for which C&S of joint aspirate should be done].
47
1147. A 34yo man after an RTA was brought to the ED. He has BP=50/0mmHg and chest wall with asymmetrical movement, RR=34bpm. What would be the initial action? a. IV fluid infusion b. Intubation and ventilation c. CT chest d. Transfer to ITU
Ans. The key is B. Intubation and ventilation.
48
1148. A 7yo presented with chronic cough and is also found to be jaundiced on exam. What is the most likely dx? a. Congenital diaphragmatic hernia b. Congenital cystic adenomatoid malformation c. Bronchiolitis d. RDS e. Alpha 1 antitrypsin deficiency
Ans. The key is E. Alpha 1 antitrypsin deficiency. [In those with unexplained liver disease with or without respiratory symptoms should be evaluated for AATD].
49
1149. A 65yo man had a bowel resection 5d ago. He is anuric and breathless. His BP=150/110mmHg. He has crackles at both lung bases and sacral edema. Bloods: K+=6.8mmol/l, urea=58mmol/l, creatinine=600umol/l. What is the single most appropriate immediate management? a. Bolus of 20U insulin b. Calcium resonium enema c. Dextrose-saline infusion d. 5% dextrose infusion e. 10U insulin, 50ml of 50% dext
Ans. The key is E. 10U insulin, 50ml of 50% dextrose infusion. [There is renal failure with hyperkalemia. First we have to save heart from arrest or life threatening arrhythmia by shifting K+ into cell. 10U insulin in 50 ml 50% dextrose will help doing this].
50
1150. A 25yo woman presents with a painful shallow ulcer on the vulva. What inv has to be done? a. HSV antibodies b. Syphilis serology c. Swab for hemophilus ducreyi d. Urine culture e. Blood culture
Ans. The key is C. Swab for hemophilus ducreyi. [Herpes simplex virus causes multiple painful vesicles and syphilis ulcer is painless. As here single painful ulcer probable dx is Chancroid caused by Hemophilus ducreyi].
51
1151. A child was admitted with fever, generalized skin lesion, some of them are weeping lesions and some of them are crusted. What is the most probable dx? a. Varicella b. Impetigo c. Drug reaction d. Contact dermatitis e. Scabies
Ans. The key is B. Impetigo. This is probably a wrong key! Likely correct key should be A. Varicella. [Please consider dx of impetigo if specifically mention honey (or yellow or golden) coloured lesion or distribution described to be on face and limbs predominately. Otherwise consider chickenpox. Though key is impetigo here, it is wrong key. Likely correct option here is varicella].
52
1152. A pt comes with 6m hx of painless bilateral swelling of the face which has been progressively increasing in size. On routine CXR, he is found to have perihilar lymphadenopathy. What is the most probable dx? a. Chronic sialadenitis b. Thyroid adenoma c. Carcinoma of salivary gland d. Adenoid cystic carcinoma e. Mikulicz’s disease
Ans. The key is E. Mikulicz’s disease. [Mikulicz’s disease (MD) is a well-known disorder characterized by enlarged lacrimal and parotid glands caused by infiltration with lymphocytes. When no specific cause is found it is called Mikulicz’s disease; and if secondary to disease like sarcoidosis it is termed as Mikulicz’s syndrome].
53
1153. A woman has widespread metastasis from a carcinoma. She presented with severe back pain. Where do you expect the cancer to be? a. Lungs b. Cervix c. Ovary d. Uterus e. Breast
Ans. The key is E. Breast. [In female breast and lung cancer and in male prostate and lung cancer are most common to metastasize to bone].
54
1154. A 10yo child has got progressive bilateral hearing loss. He has started to increase the TV volume. All other examination is normal. What is the most likely dx? a. Wax b. Foreign body c. Bilateral OM with effusion d. SNHL e. Meningitis due to meningococcus
Ans. The key is C. Bilateral OM with effusion.
55
1155. A child had a patchy rash following tx for sore throat & cervical LN enlargement. Which is the most appropriate antibiotic? a. Ampicillin b. Erythromycin c. Cefuroxime d. Metronidazole e. Tetracycline
Ans. The key is A. Ampicillin. [Infectious mononeucleosis can present with sorethroat and lymphadenothy like tonsillitis and if treated with ampicillin leads to eruption of patchy rashes].
56
1156. A child with a hx of asthma is brought to ED with a cut on knee and sprained on her left wrist. Which is the best analgesic for her? a. Paracetamol b. NSAIDs c. Cocodemol d. Ibuprofen
Ans. The key is A. Paracetamol. [NSAIDs including ibuprofen can precipitate asthma and Cocodamol is also advised to avoid in asthma (due to its codeine content). So paracetamol is the best option here].
57
1157. A 15m baby girl presented to the ED with difficulty in breathing. Exam: she has intercostal recessions and a wheeze. Temp=normal. What is the most likely dx? a. URTI b. Pneumonia c. Bronchiolitis d. RDS e. Alpha 1 antitrypsin deficiency
Ans. The key is C. Bronchiolitis. [Asthma and bronchiolitis has similar sign symptoms. The difference is in pathology. In asthma there is bronchoconstriction but in bronchiolitis there is oedema of the airway wall. In infants and younger children bronchiolitis is commoner than asthma and it is seen that many of the children with bronhiolitis usually followed by asthma].
58
1158. An 8yo boy develops a seizure affecting his right arm, seizure lasts for several mins. He doesn’t remember anything what happened. On his CT: lesion in left hemisphere. What is the most probable dx? a. Epilepsy b. Space occupying lesion c. Dementia d. Huntington’s chorea e. Intracranial HTN
Ans. The key is B. Space occupying lesion. [This is complex partial seizure due to space occupying lesion].
59
1159. A 28yo female presented with complains of difficulties in swallowing liquids only. She also suffers from recurrent chest infection in the past few months. What is the most probable dx? a. Foreign body b. Plummer vinson syndrome c. Achalasia cardia d. Peptic stricture e. Esophageal carcinoma
Ans. The key is C. Achalasia cardia. [Dysphagia to both solid and liquid or mostly to liquid are common feature of achalasia. In achalasia there may occur aspiration due to regurgitation during lying down to sleep which may result recurrent chest infection and cough].
60
1160. Mother having 2 children with CF. What is the risk of getting another baby? a. 1:2 b. 1:8 c. 1:4 d. 1:16 e. 1:1
Ans. The key is C. 1:4. [Cystic fibrosis is an autosomal recessive disease. If both parents are carrier there is 1:4 chance of risk of occurrence of the disease for each child].
61
1161. A 14yo boy has been dx with nephrotic syndrome. 5d later he presents with flank pain, hematuria and fluctuating urea levels. A dx of renal vein thrombosis is made. What is the most likely cause for renal vein thrombosis? a. Protein C deficiency b. Vasculitis c. Loss of antithrombin III d. High estrogen levels e. Stasis
Ans. The key is C. Loss of antithrombin III.
62
1162. A 36yo woman presented with massive bleeding from multiple sites. Lab: fibrin degradation products: +++, plt=30, bleeding time=prolonged, PT=prolonged, APTT=prolonged. What is the most likely dx? a. Hemophilia b. DIC c. ITP d. Factor V leiden e. Warfarin
Ans. The key is B. DIC.
63
1163. A study was done amongst 2 hosp for the equal number of cancer pts. It was noted that hosp A had the higher rate of mortality than hosp B for treated cancer pts. What is the study done here classified as? a. Retrospective b. Observational c. Cohort d. Case study
Ans. The key is C. Cohort study. [A cohort is a group of people who share a common characteristic or experience within a defined period (e.g., are born, are exposed to a drug or vaccine or pollutant, or undergo a certain medical procedure].
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1164. A 17yo girl comes to see her GP after having unprotected sex 2d ago. She asks if her GP can explain to her how this prescribed procedure would work by helping her not to get pregnant. a. It helps to prevent implantation b. It helps in preventing or delaying ovulation c. It causes an early miscarriage d. It releases progesterone and stops ovulation e. It causes local enzymatic reaction
Ans. The key is A. It helps to prevent implantation. Probably key is suggesting IUCD wich helps to prevent implantation and not the pills as both the available pill causes a delay in ovulation. [The time required for the egg to travel to the uterus and implant is usually between 7 and 10 days]. [There are two types of pill: 1. 1.5 mg of levonorgestrel pill. It should be taken within 72 hours (thre
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1165. A 2d baby’s mother is worried about the baby’s hearing. Mother has a hx of conductive hearing loss. What is the most appropriate test? a. Brain stem evoked response b. CT c. Fork test d. MRI e. Reassure
Ans. The key is A. Brain stem evoked response. [A BAER (brainstem auditory evoked response) test can help to diagnose hearing loss and nervous system disorders, especially in newborns, young children, and others who may not be able to participate in a standard hearing test].
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1166. A healthy 8yo boy had antibiotic tx for meningitis. Initially he wasn’t resuscitated. What will be the outcome if he receives full tx? a. He will recover fully to his prv health b. He will have hearing impairment c. He will have brain abscess d. He will have encephalitis
Ans. The key is A. He will recover fully to his prv health.
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1167. A pt presented with jaundice, fever and upper abdominal pain within 24h after removal of gallstone by ERCP. The cholangiography was done and it was patent. What is the possible cause of his complaints? a. Biliary infection b. Acute pancreatitis c. Perforation
Ans. The key is B. Acute pancreatitis. [Though biliary infection is possible but acute pancreatitis is more common complication of ERCP and absence of any obstruction (stone or tumour which helps biliary infection to occur) makes cholangitis less likely].
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1168. A mother presents with her 14m child. He holds furniture and other things to help him stand and walk. He can say ‘mama’ and ‘papa’. He makes eye contact and smiles. He can transfer objects from one hand to another. He responds to his name. what do you interpret from his development? a. Delayed gross motor development b. Delayed fine motor development c. Delayed verbal development d. Normal d
Ans. The key is D. Normal development.
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1169. A young child, 3yo, has presented with vomiting for 3d. Exam: mild-mod dehydration. What is his ABG profile likely to show? a. pH low, PCO2 low b. pH low, PCO2 high c. pH high, PCO2 low d. pH high, PCO2 high
Ans. The key is D. pH high, PCO2 high. [Prolonged vomiting causes loss of H+, Cl- and Na+. There is also hypokalemia. There occur metabolic alkalosis. Compensation for metabolic alkalosis occurs mainly in the lungs, which retain carbon dioxide (CO2) through slower breathing, or hypoventilation (respiratory compensation) leading to high PCO2].
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1170. A 68yo woman has been admitted with poor appetite, weight loss, poor concentration and self neglect for 3wks. She has not been eating or drinking adequately and has rarely left her bed. She is expressive suicidal ideas and is convinced that people are out to kill her. She has been on antidepressant therapy for the past 3m with no improvement. What is the most appropriate tx? a. Anti depressa
Ans. The key is D. ECT. [Patient has symptoms of severe depression with persecutory delusion making the diagnosis of psychotic depression which is treated by ECT].
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1171. A 78yo retired teacher was admitted for a hernioplasty procedure. After the operation he became agitated, aggressive and confused. What is the most appropriate management? a. Diazepam b. Chlordiazepoxide c. Vit B d. Clozapine e. Thiamine
Ans. The key is B. Chlordiazepoxide. [Probable delirium tremens].
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1172. A 25yo girl saw a tragic RTA in which a young boy was killed. The night of the event she couldn’t sleep and the day after she suddenly lost her vision. She was prv fine and there was no hx of medical or psychological prbs. What is the dx? a. Conversion b. Somatization c. PTSD d. Dissociation e. GAD
Ans. The key is A. Conversion reaction. [Conversion reaction is sometimes applied to patients who present with neurological symptoms, such as numbness, blindness, paralysis, or fits, which are not consistent with a well-established organic cause, and which cause significant distress. It is thought that these symptoms arise in response to stressful situations affecting a patient's mental health].
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1173. A 25yo man has been suffering from breathlessness and wheeze for 3m. He has been taking salbutamol 2puffs as required. In the last 2 wks his symptoms have worsened and he has to take salbutamol more frequently during the day time. He also complains of excessive dyspnea at night. What drugs or regimen would you like to add? a. Prednisolone b. Fluticasone + salbutamol inhaled c. Beclomethasone
Ans. The key is C. Beclomethasone inhaled. [Patient was in step 1. As not controlled next step is addition of inhaled corticosteroid].
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1174. A 64yo man who was exposed to asbestos for 40yrs presents with weight loss and chest pain. The dx of mesothelioma has been made. He develops SOB and XR=pleural effusion. What is the most appropriate management? a. Thoracocenthesis b. Chest drain c. Radiation therapy d. Pneumonectomy e. Chemotherapy
Ans. The key is E. Chemotherapy. It is probably a wrong key! Correct key should be A. Thoracocentasis. [As mesothelioma responds very poor to chemotherapy and life expentancy is also very poor Thoracocentasis is the appropriate procedure to improve patients distress (when it becomes more resistant then chest drain)].
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1175. A 72yo presents with polyuria and polydipsia. The fasting blood sugar is 8 and 10mmol/l. BP=130/80mmHg and the level of cholesterol=5.7mmol/l. There is microalbuminuria. What is the single most appropriate next management? a. ACEi and sulfonylurea b. Statin and biguanide c. Statin and glitazone d. Insulin and ACEi e. Statin and ACEi
Ans. The key is E. Statin and ACEI. [1st we shall recommend modification of lifestyle so no diabetic drug now. But for microalbuminuria we shall start ACEI as it is renoprotective and also statin which is recommended as cholesterol is >5mmol/l].
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1176. A 49yo woman presents to the OPD. Her oral glucose test after 2h of glucose intake vs plasma level in 2 different tests are 6mmol/l and 10mmol/l. This situation can be categoraized as a. Impaired glucose tolerance b. Impaired fasting glucose c. T1DM d. T2DM e. Metabolic syndrome
Ans. The key is A. Impaired glucose tolerance. [The WHO defines someone as having pre-diabetes if they have: A fasting blood glucose of less than 7 mmol/L; AND A blood glucose of 7.8 mmol/L or more but less than 11.1mmol/L after a two-hour oral glucose tolerance test].
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1177. A white English man with a past hx of MI is a known HTN and DM. He is currently on aspirin, statin and metformin. What would you add to the tx? a. ACEi b. Diuretic c. Insulin d. Beta blocker e. CCB
Ans. The key is A. ACEI.
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1178. A 57yo man who had MI a few months ago has been having a low mood. A dx of moderate depression has been established. Which medication is the best tx for him? a. SSRI b. TCA c. MAOi d. Benzodiazepam e. Mood stabilizer
Ans. The key is A. SSRI. [Among SSRIs Sertraline is the drug of choice. If SSRI cannot be used Mirtazapine is recommended as next antidepressant].
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1179. A 12yo presents with chest pain. Exam: tachycardia, hypotension, dilated neck veins and the trachea is not centrally placed. What is the next appropriate management? a. Portable XR b. Needle thoracocenthesis c. Chest drainage d. ABG e. CTPA
Ans. The key is B. Needle thoracocentesis. [The case may be either pneumothorax or massive pleural effusion. Thoracocentasis is recommended for both].
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1180. A 7yo child is being inv for TB. His parents don’t agree for taking a BAL. what other sample will show growth of the organism? a. Blood test b. Throat swab c. Gastric washing d. Mantoux test e. CSF
Ans. The key is C. Gastric washing.
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1181. A 51yo man had a MI a few days ago. He developed breathlessness. Echo was done and showed a pansystolic murmur. What can be the cause of this symptom? a. Ruptured papillary muscle b. Acute pericarditis c. Dresslers syndrome d. Malignant VT e. Ventricular aneurysm
Ans. The key is A. Ruptured papillary muscle. [Papillary muscle rupture causes mitral regurgitation causing pancystolic murmur leading to features of heart failure like breathlessness].
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1182. A 61yo man was found with K+=7.5 and ECG with prolong QRS complex. What is the best possible tx option? a. Dialysis b. IV calcium gluconate c. IV insulin and dextrose d. Salbutamol nebulizer e. Loop diuretics
Ans. The key is B. IV calcium gluconate. [In this high level of potassium we have to shift this potassium into cells to reduce plasma level and save heart from arrest or life threatening arrhythmia. For keep the heart safe option of first choice in such emergency is IV calcium gluconate! However it does not shift or reduce potassium level but protects heart from arrhythmia and buy time for definit
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1183. A 38yo man presents with acute infection of skin in the leg. Dx of cellutitis has been made. What meds should be prescribed? a. Penicillin + Flucloxacillin b. Metronidazole + erythromycin c. Vancomycin + metronidazole d. Ceftriaxone + terbinafine e. Ceftriaxone + flucloxacillin
Ans. The key is A. Penicillin + Flucloxacillin. [Cellulitis is usually caused by bacteria, such as staphylococci or streptococci that are commonly present on the skin. So Penicillin + Flucloxacillin should be given].
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1184. A 72yo man presents to the ED with chest pain. The following ECG was taken. What is the most likely dx? a. Anterior MI b. Inferior MI c. Lateral MI d. Posterior MI e. NSTEMI
Ans. The key is E. NSTEMI.
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1185. A 36yo woman has recently spent a lot of money on buying clothes. She goes out almost every night with her friends. She believes that she knows better than her friends, so she should choose the restaurant for eating out with her friends. She gave hx of having low mood at 12y. What is the dx? a. Mania b. Depression c. Bipolar affective disorder d. Borderline personality disorder e. Dysthymia
Ans. The key is C. Bipolar affective disorder. [In bipolar disorder there is depressive disorder alternate with mania and the present case is in manic stage of bipolar disorder].
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1186. A homeless lady presents with cough and fever. She complains of night sweats and weight loss. CXR has been done and shows opacity. What is the next appropriate management? a. AFB b. Mantoux test c. IFN gamma testing d. Bronchoscopy e. CT
Ans. The key is A. AFB. [Cough, fever, night sweat and weight loss are very suggestive of TB. So we should do AFB as her next investigation].
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1187. A 32yo woman presents with malaise fatigue and fever. She complains about weight loss. Exam: malar rash with sparing of nasolabial fold can be seen. What is the most appropriate inv? a. Anti ds DNA b. Anti histone c. Anti centromere d. Anti Jo e. Anti Scl70
Ans. The key is A. Anti ds DNA. [Features are suggestive of SLE. So most appropriate investigation from the given options is A. Anti ds DNA].
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1188. A 75yo man presents with back pain. Inv: plasma cells are found. What is the most probable dx? a. Multiple myeloma b. AS c. Disc prolapse d. Leukemia e. Myelofibrosis
Ans. The key is A. Multiple myeloma. [H/O back pain with presence of plasma cells on inv. Are highly suggestive of Multiple myeloma].
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1189. A 45yo woman presents with complains of abdominal pain and blood in stool. She brings the stool sample from home but has never been able to produce a sample at the hospital. Her urine and blood tests are normal. Exam: multiple scars on the abdomen consistent with laparoscopies and appendectomy. She insists on getting further inv although no abnormalities are found. What is the most likely dx
Ans. The key is E. Munchausen syndrome. [Munchausen syndrome is a psychiatric factitious disorder wherein those affected feign disease, illness, or psychological trauma to draw attention, sympathy, or reassurance to themselves].
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1190. A 36yo woman contacts the police to notify them she was responsible for a recent disastrous flood with loss of lives. What kind of delusions is she suffering from? a. Persecutory b. Poverty c. Guilt d. Nihilistic e. Reference
Ans. The key is C. Delusion of guilt. [Delusions of guilt or sin (self-accusation): This type of delusions involve feeling guilty or remorseful for no valid reason. An example would be someone that believes they were responsible for a war in another country or hurricane damage in another state. In this case, the person believes that they deserve to be punished for their sins and place full blame o
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1191. A 27yo man presents with symptoms characterized by alternating mood swings a/w flight of ideas, elation, over activity and disinhibition, or low mood with lack of energy and social withdrawal. What is the most probable dx? a. Bipolar affective disorder b. Dysthymia c. Mania d. Hypomania e. Cyclothymia
Ans. The key is A. Bipolar affective disorder. [Flight of idea, elation, over activity and disinhibition are features of mania and low mood, lack of energy and social withdrawal are features of depression. Alternating mood swings with depression and mania are chracteristic of Bipolar disorder].
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1192. Healthy parents have 2 children, a child with CF and a healthy child. They want to have another child. What are the chances of that child being a carrier? a. 1:4 b. 1:2 c. 2:3 d. 1:8 e. 1:16
Ans. The key is B. 1:2. [As the parents have a child with cystic fibrosis and they are healthy both of them are carrier. It is an autosomal recessive disease where if both parents are carrier mode of inheritence is as follows: Chance of being healthy child 1:4, Chance of being diseased 1:4 and chance of being carrier 1:2].
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1193. A 64yo man believes a female newscaster is communicating directly with him when she turns a page. What kind of delusions is he suffering from? a. Persecutory b. Control c. Grandeur d. Nihilistic e. Reference
Ans. The key is E. Delusion of reference. [Delusions of reference – A neutral event is believed tohave a special and personal meaning. For example, a person with schizophrenia might believe a billboard or a celebrity is sending a message meant specifically for them].
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1194. A 7yo girl with allergy became acutely unwell while visiting a friend’s house and has been brought immediately to the ED. She is fully conscious but has got stridor, wheeze and erythematous rash. She is receiving oxygen. What is the single immediate management? a. Check airway patency and prepare intubation b. Give 0.25ml in 1000U epinephrine IM c. Give 10mg chlorphearamine IM d. Give 50ml h
Ans. The key is B. Give 0.25ml in 1000U epinephrine IM. [Stridor is one of the indication of IM epinephrine in anaphylaxis].
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1195. A terminally ill pt with metastatic carcinoma presents with dysphagia and difficulty in swallowing. What is the best possible tx? a. Nystatin suspension b. Amphotericin B IV c. PO fluconazole d. Cotrimazole e. Analgesic
Ans. The key is C. PO fluconazole. [Treatment of carcinoma can predispose to development of oesophageal candidiasis which is treated as follows: Oral fluconazole (200 – 400mg) daily for 14 to 21 days (if needed IV fluconazole can also be given].
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1196. A couple attends their GP because of marital problems. The wife states that her husband is having affairs although she has no proof of this. The husband states that she even had him followed by a private detective and this is putting considerable strain on their marriage. What is the most likely dx? a. Fregoli syndrome b. Cotard syndrome c. Mood disorder d. Ekbom syndrome e. Othello syndrome
Ans. The key is E. Othello syndrome. [Othello syndrome is delusion of infidelity (cheating, adultery, or having an affair) of a spouse or partner].
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1197. A 65yo lady who is on thiazide suffers from falls in the morning. What is the cause for her symptoms? a. Orthostatic hypotension b. TIA c. Epilepsy
Ans. The key is A. Orthostatic hypotensin. [Thiazide diuretic is associated with orthostatic hypotension].
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1198. A boy was admitted with partial thickness burn, what is your next step? a. Escharectomy b. Dressing c. Burst blisters d. Local antibiotics e. Refer to burn unit
Ans. The key is E. Refer to burn unit.
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1199. A 28yo man presents with a 2h hx of rapid palpitations. He feels a little light headed but is otherwise well. Exam: pulse=170bpm and regular, BP=100/68mmHg. He has had 2 similar episodes in the past. What is the most likely rhythm disturbance? a. SVT b. VF c. VT d. V-ectopics e. A-fib
Ans. The key is A. SVT. [Palpitation, light headedness with a tachycardia of 170bpm that is regular are most likely a SVT].
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1200. A child has hypothyroidism. What feature is a/w it? a. Microglossia b. Prolonged neonatal jaundice c. Undescended testis d. Anal tag e. Left soft palate
Ans. The key is B. Prolonged neonatal jaundice. [Prolonged neonatal jaundice is a well known feature of hypothyroidism].
