1201 to 1300 Flashcards
(100 cards)
1
Q
- A 2wk girl presents with E-coli which is confirmed by urine culture. What is the most appropriate next inv? a. US b. IVU c. CT kidney d. BUE e. MCUG
A
Ans. The key is US. [Infants and children who have had a lower urinary tract infection should undergo ultrasound (within 6 weeks) only if they are younger than 6 months or have had recurrent infections. NICE (Probably to exclude VUR wich is a cause of recurrent UTI)].
2
Q
- A lady from Asia presented with lump in her neck. FNAC has been done and revealed lesions with caseous material in the center surrounded by fibrosis. What is the most probable dx? a. Thyroid carcinoma b. TB lymphadenitis c. Lymphoma d. Inf Mono e. Mesothelioma
A
Ans. The key is B. TB lymphadenitis. [Central caseous necrosis with sourrounded fibrosis is diagnostic of TB lymphadenitis. The most common cellular components seen are epithelioid cell clusters. Lymphocytes and langhans giant cells are also seen].
3
Q
- A 32yo woman has undergone a biopsy for a breast lump. The report says: a well circumscribed lump with clear margins and separated from the surrounding fatty tissue. What is the most appropriate interpretation of this report? a. Fibroadenosis b. Ca Breast c. Mammary abscess d. Fibroadenoma e. Fat necrosis
A
Ans. The key is D. Fibroadenoma. [Fibroadenomas are the most common benign tumor of the female breast. White , well-circumscribed mass is clearly demarcated from the surrounding yellow adipose tissue].
4
Q
- A young boy presented with peri-oral blisters. Some of which are weeping and others are crusted. What is the single most appropriate dx? a. Impetigo b. Varicella zoster c. Shingles d. Scabies e. Herpes simplex
A
Ans. The key is A. Impetigo. [Distribution of varicella zoster is centripetal (more in central area (trunk) and less in limbs and face. On the other hand if blisters are present mainly on face or limbs and/or described as golden, yellow or honey coloured crusts are impetigo].
5
Q
- A 39yo man comes with umbilicated papules on his face. His CD4 count is measured to be 35. What is the single most appropriate option? a. Mycobacterium avium intercellular b. CMV c. Streptokinase d. Toxoplasmosis e. Pneumocystis jerovici f. Moluscum contagiosum
A
Ans. The key is F. Molluscum contagiosum. [CD4 count 35 is too low indicating immunodeficiency where molluscum contagiosum occurs more easily. Umbilicated papules are feature of molluscum contagiosum].
6
Q
- A 45yo man is admitted to ED with excruciating pain in the right leg. Exam: limb is pale and dorsalis pedis and posterior tibial pulses are absent. Pulse=88bpm, irregular and he has apansystolic murmur at apex. What is the most probable dx? a. Thromboangitis Obliterans b. Sciatica c. DVT d. Atherosclerosis e. Embolus
A
Ans. The key is E. Embolus. [Pansystolic murmur at apex indicates mitral regurgitation and irregular pulse indicates AF which can lead to thrombus formation what probably is responsible for this embolus in leg].
7
Q
- An 18yo man has a smooth, tender swelling extending from the ear to the angle of the jaw of sudden onset. Temp=38.5C. What is the single most likely dx? a. Dental caries b. Mumps c. OE d. OM e. Temporomandibular joint pain
A
Ans. The key is B. Mumps. [Here sudden onset and rise of temperature are points indicating the diagnosis of Mumps].
8
Q
- A 6wk baby has a blue mark near coccyx since birth. His mother is worried. What would you do? a. Reassure b. Coag profile c. Karyotyping d. Skeletal survey e. CT
A
Ans. The key is A. Reassure. [This is a benign condition known as “Mongolian spot” or “Mongolian blue”. Mongolian spot refers to a macular blue-gray pigmentation usually on the sacral area of healthy infants. Mongolian spot is usually present at birth or appears within the first weeks of life. Mongolian spot typically disappears spontaneously within 4 years but can persist for life].
9
Q
- A man presents with inoperable carcinoma and back pain. His pain has been well controlled with morphine but he develops vomiting. Morphine was stopped and he was started on metoclopramide and fentanyl patches. He then develops neck stiffness and fever. What is the cause of these symptoms? a. Metoclopramide b. Fentanyl c. Morphine d. Meningitis e. Metastasis
A
Ans. The key is A. Metoclopramide. [Extrapyramidal effects like neck stiffness is common side effect of metoclopramide and also there may occur rise of temperature].
10
Q
- A 51yo man has become increasingly fatigued for the past 10m. PE: no abnormal findings. Labs: Hgb=9.2, Hct=27.9%, MCV=132fl, plt=242, WBC=7.59. Which of the following morphologic findings is most likely to be present on examination of his peripheral blood smear? a. Hypersegmented neutrophils b. Nucleated RBC c. Blasts d. Hypochromic, microcytic RBC e. Schistocytes
A
Ans. No key is given! Probable key is A. Hypersegmented neutrophils. [Only anemia with macrocytosis is with normal examination findings makes Megaloblastic aneamia to be most likely cause where PBF shows hypersegmented neutrophils].
11
Q
- A 9yo girl with weekly abdominal pain and occasional headaches but not a/w vomiting or diarrhea. She maintains a good appetite. Lab: normal. CBC, BUE, etc are normal. Exam: no abnormality as found and the abdomen was soft and non-tender. What would you do for her next? a. US abdomen b. CT thorax c. LFT d. Reassure e. Analgesics
A
Ans. The key is D. Reassure. [Probable case of abdominal migraine a benign condition for which reassurance is appropriate. Abdominal migraine is a form of migraine seen mainly in children. It is most common in children ages five-nine years old, but can occur in adults as well. The diagnostic criteria for abdominal migraine are: A. At least five attacks fulfilling criteria B–D. B. Attacks of abdomi
12
Q
- A 54yo male pt DM with BMI=33 who has been treated using dietary control up till now presents to his GP with a fasting blood sugar of 14mmol/l and creatinine=90mmol/l. Urine shows glycosuria. No other abnormalities are found. What is the best next step in management? a. Biguanide b. Sulfonylurea c. Insulin d. Sugar free diet e. ACEi
A
Ans. The key is A. Biguanide. [Patient is obese type2 diabetic with normal renal function for whom biguanide is the treatment of choice].
13
Q
- What are the side effects of thiazide diuretics? a. Hypocalcemia b. Hyponatremia c. Hypernatremia d. Hyperkalemia
A
Ans. The key is B. Hyponatremia. [Thiazide causes hypercalcemia, hypokalemia and hyponatremia].
14
Q
- A 46yo man who is a heavy drinker is brought to the ED in a drowsy state. He is responding vaguely to questions. Exam: nystagmus and hyperreflexia. MCV=103fl. What is the most likely cause for his cognitive impairment? a. B1 deficiency b. B12 deficiency c. Folate deficiency d. B6 deficiency e. Alcohol withdrawal
A
Ans. The key is A. B1 deficiency. [Presence of confusion and nystagmus indicates Wernicke’s encephalopathy caused by thiamin (vit. B1) deficiency].
15
Q
- A 23yo female presented with a swelling of her neck that moved upwards on protrusion of tongue. What is the next appropriate inv? a. FNAC b. Punch biopsy c. Core biopsy d. MRI neck e. Radioactive thyroid scan
A
Ans. The key is A. FNAC. [The diagnostic investigation is FNAC[Ref: wikipedia]. Then we palpate for thyroid tissue. If absent we do any one of following to confirm the absence of thyroid tissue: ultrasonography, CT scanning, thyroid scanning or MRI. If there is normal thyroid tissue we go for more aggressive Sistrunk’s operation but if there is no normal thyroid tissue [in that case thyroglossal c
16
Q
- A 34yo man from Asia presented with 5m hx of productive cough, night sweats and weight loss. His CXR reveals some shadowing in the left upper zone. What is the single most discriminating inv? a. AFB for sputum b. CXR c. CT d. TFT e. US abdomen
A
Ans. The key is A. Sputum for AFB. [Features are suggestive of PTB for which most discriminating inv. Is Sputum for AFB].
17
Q
- A prv healthy 23yo presented a week hx of bloody diarrhea and abdominal pain with cramps and fever. Exam: tenderness in lower abdomen. What is the most appropriate dx? a. Celiac disease b. Colorectal polyps c. UC d. Laxative abuse e. Gastroenteritis
A
Ans. The key is E. Gastroenteritis. [A short history (one week) of bloody diarrhea, abdominal pain with cramps, fever and tenderness in lower abdomen is indicative of gastroenteritis].
18
Q
- A 10yo boy presents with irritability, sudden onset of pain and discharge from the right ear. Which antibiotic would be the 1st line of tx? a. Amoxicillin b. Ciprofloxacillin c. Flucloxacillin d. Ceftazidime e. Benzyl penicillin
A
Ans. The key is A. Amoxycillin. [For acute suppurative otitis media 1st line antibiotic in UK is Amoxycillin.
19
Q
- A 26yo man strongly believes that every elderly man he meets is his father. Although they look different, he is sure it is father wearing different disguises. What kind of delusions is this man suffering from? a. Delusion of persecution b. Erotomania c. Delusion of grandeur d. Delusion of doubles e. Delusion of reference
A
Ans. The key is D. Delusion of doubles. [The Fregoli delusion, or the delusion of doubles, is a rare disorder in which a person holds a delusional belief that different people are in fact a single person].
20
Q
- A 26yo passed a 4mm stone in his urine. On US a 3mm stone is found in the renal pelvis. What is the single most appropriate management? a. ESWL b. None c. Open Surgery d. Conservative
A
Ans. The key is D. Conservative. [Increased fluid intake is advised].
21
Q
- A 35yo man has had acute pain and swelling below the mandible on the left side for 2h. The swelling occurred after eating a large meal. What is the single most likely dx? a. Laryngocele b. Ranula c. Neck abscess d. Parotid calculus e. Submandibular calculus
A
Ans. The key is E. Submandibular calculus. [Pain and swelling below mandible is due to stone in submandibular salivary gland duct. Pain and swelling increased after large meal as the saliva produced during meal could not come out of the gland due to stone].
22
Q
- A 45yo man has had impaired vision and pain on eye movement in his left eye over the last 5d. He also notes loss of color vision in the same eye. In the left eye, the visual acuity is up to counting fingers. When the pupil is stimulated with light, it dilates. His fundus is normal. What is the single most appropriate clinical dx? a. Acute dacryocystitis b. Acute iritis c. Papillitis d. Retro
A
Ans. The key is D. Retrobulbar neuritis. [Presentation can be described by either optic neuritis or retrobulbar neuritis. In optic neuritis there is disc pallor. As in this case disc is normal it is a case of retrobulbar neuritis].
23
Q
- A 56yo pt has been dx with MS. She presents with a positive Romberg’s test. She also has weakness and loss of sensations in all her 4 limbs. Which site is most likely to be affected? a. Cerebral cortex b. Cerebellum c. Cervical spinal cord d. Thoracic spinal cord e. Brain stem
A
Ans. The key is C. Cervical spinal cord. [Quadriplegia is the feature of cervical cord lesion].
24
Q
- A 58yo man suddenly becomes shocked several days after suffering an acute ant MI. His CXR shows a large globular-shaped heart and clear lung fields. What is the single most likely explanation for the abnormal inv? a. Acute pericarditis b. Cardiac tamponade c. Atrial thrombus d. Left ventricular aneurysm e. Dressler syndrome
A
Ans. The key is B. Cardiac tamponade. [Shock in a post MI patient with globular heart on X-ray and clear lung field indicate Cardiac tamponade]
25
1225. A 56yo alcoholic man who has increased the amount of alcohol he is using wants to attend his daughter’s wedding that is in 2wks. He is now coming to you for help. How would you help him? a. Acamprosate b. Refer to clinical psychologist c. Refer to GP d. Despiramine e. Refer to community mental health support group.
Ans. The key is A. Acamprosate. [If the patient stop alcohol without any supportive treatment there will occur withdrawal symptoms. For the presented situation Acamprosate can help by stopping alcohol without producing withdrawal symtoms (by restoring brain chemical derangement caused by alcohol which is responsible for withdrawal symptoms)].
26
1226. An 80yo woman fell over at her nursing home. XR shows fx of radius with <10degree of dorsal angulation. What is the single most appropriate tx? a. Below elbow full plaster of paris b. Below elbow split plaster of paris c. Closed reduction of fx d. Elasticated support bandage e. Open reduction and internal fixation
Ans. The key is C. Closed reduction of fracture. This is a wrong key! Correct option seems to be A. Below elbow full plaster of paris. [Older people are less likely to go under closed reduction even if the dorsal angulation is not anatomic (like 20 degrees!). Less than 10 degree dorsal angulation does not require even closed reduction].
27
1227. A 16yo girl who is normally fit and well attends her GP complaining of heavy and painful periods. She is requesting tx for these complaints. She denies being sexually active. Select the most appropriate management for her menorrhagia? a. Antifibrinolytics (tranexamic acid) b. COCP c. Endometrial ablation d. IUS progestrogens (mirena) e. NSAIDS (mefenamic acid)
Ans. The key is A. Antifibrinolytics (tranexamic acid). It is a wrong key. Correct answer is E. NSAIDs (mefenamic acid).
28
1228. A 67yo lady with an ulcer on the anal margin. Which is the single most appropriate LN involved? a. External iliac LN b. Pre-aortic LN c. Aortic LN d. Inguinal LN e. Iliac LN
Ans. The key is D. Inguinal LN. [Anal canal below pectinate line is drained into superficial inguinal lymph nodes].
29
1229. A branch of the dominant coronary artery that supplies the inferior portion of the septum. What is the single most appropriate option? a. Septal branches b. Obtuse marginal branches c. Circumflex artery d. Left main stem, post descending artery e. Diagonal branch
Ans. The key is D. Left main stem, post descending artery. [Here no option is satisfactorily correct! By dominant coronary artery we mean that coronary artery which gives of the branch of posterior descending artery. Mostly it is right coronary artery and if there is left coronary dominance, posterior descending artery is the branch of circumflex artery and not direct branch of left main artery. H
30
1230. A 55yo female presented with anemia and dysphagia. There is a feeling of something stuck in the throat. The esophagus can’t be negotiated beyond the crico-pharynx. What is the most probable dx? a. Foreign body b. Plummer vinson syndrome c. Pharyngeal carcinoma d. Barret’s esophagus e. Esophageal carcinoma
Ans. The key is B. Plummer Vinson syndrome. [The picture fits two D/D. 1. Plummer Vinson syndrome 2. Oesophagial carcinoma. Lower oesophagial stricture is more common for Ca. So presenting case is likely a case of Plummer Vinson syndrome. It can be differentiated by the type of anemia. If it is IDA dx is Plummer Vinson syndrome].
31
1231. A pt is on cancer tx with dexamethasone. According to her biochemical results her K+=normal and her Na+=low. What is the dx? a. Addisons b. Dexamethasone side effect c. Dilutional hyponatremia
Ans. The key is C. Dilutional hyponatremia.
32
1232. A diabetic has been prescribed a long acting hypoglycemic in the morning and short acting in the evening. He takes a regular lunch, but has been having hypoglycemic attacks at around 4pm each day. What is the most appropriate intervention? a. Recommend a heavier lunch b. Review morning drug c. Review evening drug d. Review both drug e. Reassure
Ans. The key is B. Review morning drug. [As there is hypoglycemic attacks at evening morning dose needs to be adjusted].
33
1233. A male pt presented with blood and mucus in stool. He has also noticed weight loss but has no hx of altered bowel habits. What is the dx? a. Carcinoma of cecum b. Carcinoma of descending colon c. Carcinoma of sigmoid colon d. Carcinoma of rectum
Ans. The key is A. Carcinoma of cecum.
34
1234. A 22yo man keeps having persistent and intrusive thoughts that he is a dirty thief. No matter what he tries these thoughts keep coming to him. Any attempt to avoid these thoughts leads to serious anxiety. What is the most likely dx? a. Schizophrenia b. OCD c. PTSD d. Mania e. Psychotic depression
Ans. The key is B. OCD. [Though here no obsession or thoughts but no compulsion of activity but there is compulsion of thoughts as well which makes the diagnosis as OCD].
35
1235. A 45yo female comes to the ED while having a generalized tonic clonic seizure and she has having difficulty breathing and is cyanosed. What is the tx option for her? a. Secure airways b. IV diazepam c. IV phenytoin d. Oxygen mask
Ans. A. Secure airways. [Breathing difficulty with cyanosis may indicate saliva, blood, foreign body (as denture), fall back of tongue etc. for which 1st action is to secure airway].
36
1236. A 30yo man is becoming concerned about the safety of his family. He has been checking the locks of the door every hour during the night. He becomes very anxious if his wife tries to stop him. What is the most likely dx? a. Paranoid delusion b. PTSD c. Social phobia d. OCD e. GAD
Ans. The key is D. OCD. [Obsessive compulsive disorder (OCD) is a mental health condition where a person has obsessive thoughts and compulsive activity. An obsession is an unwanted and unpleasant thought, image or urge that repeatedly enters a person's mind, causing feelings of anxiety, disgust or unease. A compulsion is a repetitive behaviour or mental act that someone feels they need to carry ou
37
1237. A 6wk baby has been dx as HIV+ve. Which immunization plan will you opt for him? a. Don’t give any vaccine b. Give all vaccines except live attenuated vaccines c. Give only BCG vaccine d. Give all vaccines except BCG vaccine
Ans. The key is D. Give all vaccines except BCG vaccine. [There are two terms HIV +ve (not immune deficient yet) and AIDS (immune deficient state). In HIV +ve case live attenuated vaccines can be given except BCG and if AIDS all live attenuated vaccines are avoided].
38
1238. A 36yo man has been dx with DI. What electrolyte picture is expected to be seen? a. High serum Na, low serum osmolarity, high urine osmolarity b. Low serum Na, low serum osmolarity, high urine osmolarity c. Low serum Na, high serum osmolarity, high urine osmolarity d. High serum Na, high serum osmolarity, low urine osmolarity e. Normal Na, normal serum osmolarity, normal urine osmolarity
Ans. The key is D. High serum Na, high serum osmolarity, low urine osmolarity
39
1239. The artery that supplies the ant right ventricular wall. What is the single most appropriate option? a. Acute marginal branch b. Left ant descending artery c. Coronary sinus d. Circumflex artery e. Right coronary artery
Ans. The key is A. Acute marginal branch.
40
1240. A 55yo male presents to the ED after an RTA with breathlessness, engorged neck veins and a dull percussion note on the right side of his chest. Exam: pulse=140bpm, BP=80/50mmHg. What is the most likely dx? a. Hemothorax b. Hemopneumothorax c. Tension pneumothorax d. Simple pneumothorax
Ans. The key is B. Hemopneumothorax.
41
1241. A 32yo woman presents with complaints of having low back pain. She is taking analgesics for it. All inv are normal. What will you advice her? a. Bed rest b. Physiotherapy c. Advice to be more active d. Admit
Ans. C. Advice to be more active.
42
1242. A 32yo woman suffers an episode of severe occipital headache with vomiting and LOC. She is brought to the hosp where she is found to be conscious and completely alert. Exam: normal pulse and BP with no abnormal neurological sign. What is the next step in her management? a. Admission for observation b. CT brain c. MRI head d. Reassurance and discharge home e. XR skull
Ans. The key is B. CT brain. [To exclude any possible intracranial bleeding].
43
1243. A 30yo woman is taking tx for asthma. She has a HR=130bpm and peak expiratory flow rate=400. What is the most appropriate management? a. Atenolol b. Digoxin c. Review drugs
Ans. The key is C. Review drugs. [Oral beta agonist frequently causes tachycardia and palpitations].
44
1244. A pt presents with a mask face. He also has gait prbs. Which class of drug is causing this? a. Anti-depressant b. Anti-psychotic c. Anti-HTN
Ans. The key is B. Anty-psychotic. [Anti-psychotics by reducing dopamine can precipitate or induce parkinsonism].
45
1245. A 16yo boy came home from boarding school with a cough. His CXR showed bilateral consolidations. What is the most likely organism which would have caused his symptoms? a. Legionella pneumophilia b. Mycoplasma pneumonia c. Mycobacterium TB d. Pneumocystis jiroveci e. Pseudomonas aeruginosa
Ans. The key is B. Mycoplasma pneumonia. [Mycoplasma is common in military barrack, prison or boarding dwellers].
46
1246. After an MI, a man presents with pansystolic murmur which is radiating to the axilla. What is the dx? a. Tricuspid regurgitation b. Mitral regurgitation c. Aortic stenosis d. Mitral stenosis
Ans. The key is B. Mitral regurgitation. [MI can lead to papillary muscle rupture causing mitral regurgitation].
47
1247. A 34yo labourer developed severe pain in his lower back after lifting a sack of sand. He also complains of shooting pain down his leg. The GP has prescribed him complete bed rest, with painkillers and also scheduled an MRI for him. What is the most likely dx? a. Peripheral vascular disease b. Intervertebral disc prolapse c. Hairline fx of the spine d. Sprain of the back muscles e. Muscle inj
Ans. The key is B. Intervertebral disc prolapse. [Intervertebral disc prolapsed can cause severe back pain following heavy lifting and radiculopathy (pressure on spinal nerve root) can cause this shooting pain which can be demonstrated by MRI spine].
48
1248. A young man returns to his hostel and gets headache and lethargy. Now presents with fever. There are crepitations on the auscultation of lung. What is the most likely organism which would have caused his symptoms? a. Legionella pneumonia b. Mycoplasma c. Staphylococcus d. Streptococcus
Ans. The key is A. Legionella pneumonia. [Legionella is common in hostel, hotel, hospital, nursing home where it spread through their water system, aircondition etc.].
49
1249. A pt is about to undergo surgery. Her Hgb=8.9g/dl and MCV=70. What is the best option for her? a. Inv and postpone the surgery b. Transfuse and proceed with surgery c. Transfuse and defer surgery d. Continue with surgery
Ans. Key is A. Investigation and postpone the surgery. [For elective operation only proceed if Hb% > 10 g/dl. If Hb% < 10 g/dl then defer the operation and investigate first. If Hb% < 8 g/dl also must be transfused. Samson note].
50
1250. A 24yo male presents with discomfort in the groin area and scrotal swelling. Exam: scrotal skin is normal. What would be the next best step? a. Urgent US b. Urgent surgery c. OPD referral d. Antibiotics
Ans. The key is C. OPD referral. [A case of inguinal hernia or hydrocele. In both torsion or epididymo- orchitis scrotal skin will be inflammed (erythematous and oedematous). Should be referred to Surgery OPD].
51
1251. A 22yo girl unhappy about her weight with BMI=22. She likes to have her dinner in an expensive restaurant. She does excessive shopping. K+=3.3. What is the dx? a. Anorexia nervosa b. Bipolar c. OCD d. Bulimia
Ans. The key is D. Bulimia. [BMI 22, even though unhappy, hypokalemia, like to have dinner in an expensive restaurant (probable binge eating) suggest the diagnosis of bulimia]
52
1252. A 59yo pt has been dx with HTN. His BP has been >160/90mmHg on 3 separate occasions. His biochemical profile is as follows: Na+=145mmol/l, K+=6.2mmol/l, creatinine=112umol/l, urea=5.7mmol/l. What is the most appropriate anti-HTN drug for him? a. Amlodipine b. Bendroflumethiazide c. Ramipril d. Lorsartan e. Propranolol
Ans. The key is B. Bendroflumethiazide. [Thiazide reduces Na+ and K+ level. So in this picture of upper normal Na+ with hyperkalemia thiazide seems to be appropriate].
53
1253. A 22yo girl had a fight with her boyfriend and then took 22 tabs of paracetamol. She was commenced on N-acetyl cysteine and she was medically fit to go home the following day. Which of the following does she require? a. OPD referral to relationship counselor b. OPD referral to psychiatrist c. Inpatient referral to psychiatrist d. Inpatient referral to psychologist
Ans. The key is C. Inpatient referral to psychiatrist. [Suicidal ideation is abnormal and if discharged there is chance of repeated suicidal attempts. So inpatient referral to psychiatrist is needed for this patient].
54
1254. A 74yo man presents with sudden onset of with right sided weakness and slurred speech. He also has loss of sensation over the right side of the body and visual field defects. CT shows ischemic stroke. What is the most appropriate management? a. Alteplase b. Streptokinase c. Nimodipine d. Aspirin e. Labetolol
Ans. The key is A. Alteplase. [Patient has acute onset of symptoms and time of onset is also known. So considering window period of 4.5 hours from onset of symptoms can be given alteplase].
55
1255. The artery that runs along the left AV groove. What is the single most appropriate option? a. Left internal mammary artery b. Left anterior descending artery c. Circumflex artery d. Left main stem (LMS) post descending artery e. Diagonal branch
Ans. The key is C. Circumflex artery.
56
1256. A 26yo man presents with painless hematuria. He has no other complaints and on examination no other abnormality is found. What is the most appropriate initial inv to get to a dx? a. Cystoscopy b. Midstream urine for culture c. Abdominal US d. MRI spine e. Coag screening
Ans. The key is C. Abdominal ultrasound. [Abdominal US to exclude polycystic disease, malignancy, tumour, urolithiasis etc].
57
1257. A pt, 50yo smoker and heavy drinker, presents with complaints of racing heart. A 24h EKG comes out normal. What is your next step in management? a. Echo b. Reassure c. Stress test
Ans. The key is B. Reassure. [Racing heart or palpitation is a common phenomenon in alcoholics which is not serious or harmful. So reassure the patient].
58
1258. A 36yo woman came with uterine bleeding. Vaginal US reveals uterine thickness=12mm. what is the most probable dx? a. Cervical ca b. Endometrial ca c. Ovarian ca d. Breast ca e. Vaginal ca
Ans. The key is B. Endometrial Ca. [Actually it is endometrial thickening and in general 12 mm means hyperplasia which may suggest endometrial Ca in this woman].
59
1259. A 30yo woman has PID which was treated with metronidazole and cephalosporin. It is getting worse. What is the next best inv? a. Endocervical swab b. US c. Laparotomy d. High vaginal swab
Ans. The key is B. US. [Probable tubo-ovarian abscess].
60
1260. A pregnant woman had hit her chest 3wks ago. Now she is 24wks pregnant and presents with left upper quadrant mass with dimpling. What is the most probable dx? a. Breast ca b. Carcinoma c. Fibroadenoma d. Fibroadenosis e. Fatty necrosis of breast
Ans. The key is E. Fatty necrosis of the breast.
61
1261. A pregnant pt with Rh –ve who hasn’t been prv sensitized delivers her first baby without any prbs. What would be the latest time to administer anti-sensitization? a. 6h PP b. 24h PP c. 48h PP d. 72h PP e. 5d PP
Ans. The key is D. 72h PP.
62
1262. A 30yo primigravida who is 30wks GA presents to the L&D with absent fetal movements. She also complains of severe headache, heartburn and seeing floaters before her eyes for the last few days. Exam: BP=170/110mmHg, urine protein=++++, rock hard uterus, no visible signs of fetal movements. Choose the single most likely dx? a. Abruption of placenta 2nd pre-eclampsia b. Antepartum hemorrhage c.
Ans. 2 keys A. Abruption of placenta 2nd pre-eclampsia. E. IUFD.
63
1263. A 38yo woman, 10d post partum, presents to her GP with a hx of passing blood clots per vagina since yesterday. Exam: BP=90/40mmHg, pulse=110bpm, temp=38C, uterus tender on palpation and fundus is 2cm above umbilicus, blood clots +++. Choose the single most likely dx? a. Abruption of placenta 2nd preeclampsia b. Concealed hemorrhage c. Primary PPH d. Secondary PPH e. Retained placenta f. Scab
Ans. The key is D. Secondary PPH. [Secondary PPH occurs from 24 hours after delivery. Usually occurs between 5 and 12 days].
64
1264. A 22yo lady who is in her last trimester of pregnancy comes with hx of exposure to a child dx with chicken pox 1d ago. She was investigated and was +ve for varicella antibody. What is the single most appropriate management? a. Give varicella Ig b. Quarantine c. Give varicella vaccination d. Oral acyclovir e. Reassure
Ans. The key is E. Reassure. [If you have antibodies in your blood, this means you have had chickenpox in the past, or have been immunised. No further action is then needed].
65
1265. A 22yo woman who is 20wk pregnant came with pain and bleeding per vagina. Exam: os is not open. What is the single most likely dx? a. Threatened abortion b. Missed abortion c. APH d. Miscarriage e. Inevitable abortion
Ans. The key is A. Threatened abortion.
66
1266. A 32yo lady G1, 28wks GA came to her ANC with a concern about pain relief during labour. She has no medical illnesses and her pregnancy so far has been uncomplicated. She wishes to feel her baby being born but at the same time she wants something to work throughout her labour. What method of pain relief best matches this lady’s request? a. C-section b. Pudendal block c. Entonox d. TENS e. Pe
Ans. The key is C. Entonox. [This is a mixture of oxygen and nitrous oxide gas. Gas and air won't remove all the pain, but it can help to reduce it and make it more bearable].
67
1267. A primipara at fullterm in labor has passed show and the cervix is 3cm dilated. What is the single most appropriate management for her labor? a. Repeat vaginal examination in 4h b. CTG c. IV syntocin drip d. Repeat vaginal examination in 2h e. Induction of labour
Ans. The key is A. Repeat vaginal examination in 4h.
68
1268. A 36yo pregnant woman comes for evaluation with her husband. Her husband has been complaining of morning sickness, easy fatiguability and even intermittent abdominal pain. What is the husband suffering from? a. Ganser syndrome b. Couvade syndrome c. Pseudo-psychosis d. Stockholm syndrome e. Paris syndrome
Ans. The key is B. Couvade syndrome. [Cauvade syndrome, also called sympathetic pregnancy, is a proposed condition in which a partner experiences some of the same symptoms and behavior of an expectant mother].
69
1269. A woman comes to the ED complaining of pain in the right side of the abdomen, she has 7wks amenorrhea. Her pregnancy test is +ve and US scan shows an empty uterus. What is the next step? a. Laparoscopy b. HCG measurements c. US d. Laparotomy e. Culdo-centhesis
Ans. B. HCG measurements. This is a wrong key! Correct key is A. Laparoscopy. [Surgery should be offered to those women who cannot return for follow-up after methotrexate or to those who have any of the following: Significant pain. Adnexal mass ≥35 mm. Fetal heartbeat visible on scan. Serum hCG level ≥5000 IU/L. A laparoscopic approach is preferable. A salpingectomy should be performed, un
70
1270. A 23yo woman who has had several recent partners has experienced post-coital bleeding on gentle contact. What is the single most likely cause of her vaginal discharge? a. Cervical ca b. Cervical ectropion c. CIN d. Chlamydial cervicitis e. Gonococcal cervicitis
Ans. D. Chlamydia cervicitis.
71
1271. A 68yo woman presents with post-coital bleeding following her first episode of sexual intercourse in 10yrs. What is the single most likely cause that has led to post-coital bleeding? a. Endometrial ca b. Atrophic vaginitis c. Endometrial polyp d. Cervical ca e. Cervical ectropion
Ans. The key is B. Atrophic vaginitis.
72
1272. A 28yo woman 8wks GA had PID treated prvly and now comes with vaginal bleeding, rigid abdomen, BP=80/50mmHg, pulse=140bpm. What is the most probable dx? a. Threatened abortion b. Miscarriage c. Missed abortion d. Tubal pregnancy e. Inevitable abortion
Ans. The key is D. Tubal pregnancy. [Previous PUD is a risk factor for tubal pregnancy].
73
1273. A 34yo primigravida who is 16wk GA comes for routine antenatal check up. Her BP=160/100mmHg. She has a hx of repeated childhood UTI. What is the most likely cause of her high BP? a. Essential HTN b. Chronic pyelonephritis c. Acute pyelonephritis d. Pre-eclampsia e. Chronic UTI
Ans. The key is B. Chronnic pyelonephritis. [35% of childhood UTI is associated with VUR and many of them develop renal scarring and chronic pyelonephritis causing hypertension].
74
1274. A 24yo woman has had lower abdominal pain for 12h. She is otherwise well. She is at 10wks GA in a planned pregnany. What is the single most appropriate test to inv the cause of acute abdomen in this lady? a. Abdominal US b. Anti-phospholipid screen c. CBC d. Transvaginal US e. Laparoscopy
Ans. The key is D. Transvaginal US. [D/D: ectopic pregnancy, renal colic, torsion of ovarian cyst, appendicitis etc. Transvaginal US will give better results in case of lower abdominal pain].
75
1275. A pt is at term and in labor, the membranes have ruptured, the liquor contains meconium but the CTG is normal. The cervix is 3cm dilated. What is the single most appropriate action? a. BP monitoring b. CTG c. C-section d. Fetal scalp blood sample e. Internal rotation
Ans. The key is D. Fetal scalp blood sample. This is wrong key. Correct key is CTG. [Till CTG is normal we should not switch to other option but continuing CTG].
76
1276. A pt is at term and labor. The head has been delivered and you suspect shoulder dystocia. What is the single most appropriate action? a. C-section b. Episiotomy c. External rotation d. Fetal scalp blood sample e. Instrumental delivery
Ans. The key is B. Episiotomy.
77
1277. A 29yo female at 28wks GA presents to you with complains of hard stools and constipation for last 2wks. CTG shows fetal tachycardia. What is the single most appropriate tx? a. Oral laxatives b. Fiber diet c. Phosphate enema d. Lactulose e. Reassure
Ans. The key is B. Fiber diet. [Changes to diet and lifestyle are often recommended as the first treatment for constipation. It includes high fiber diet and plenty of fluid, regular exercise etc.].
78
1278. A 16yo girl presents with heavy bleeding. What is the most appropriate initial inv? a. Endometrial sampling b. Transvaginal US c. Hysteroscopy d. Pelvic US e. Exam under anesthesia
Ans. The key is D. Pelvic US. [Pelvic or transvaginal ultrasound are same thing].
79
1279. A woman who is 7wks pregnant presents with excessive and severe vomiting and put on IV fluids and anti-emetic (ondansteron). She is complaining of severe headache and can’t take oralfluids. What is the most appropriate management? a. Termination of pregnancy b. TPN c. Feeds via NGT d. P6 acupressure e. IV hydrocortisone
Ans. The key is A. Termination of pregnancy. This is wrong key. Correct key is E. IV hydrocortisone. [Termination is the last resort! Before it IV hydrocortisone is tried. 1st oral antiemetics if fail perenteral antiemetics if fail iv hydrocortisone. Last resort is termination].
80
1280. A young lady with primary amenorrhea has normal LH, FSH, estradiol and prolactin. Choose the single most likely dx? a. PCOS b. POF c. Absent uterus d. Absent ovaries e. Turner’s syndrome
Ans. The key is C. Absent uterus. [Normal LH, FSH, estradiol and prolactin rule outs PCOS (increased LH,increased FSH, normal oestrogen. LH:FSH ratio is 2:1 or 3:1), POF (in POF, LH & FSH raised, FSH > 20IU/L), Absent ovary will lead to low estradiol, high FSH and LH, Turner’s syndrome: gonadal streaks, as absent ovaries]
81
1281. An obese lady presents with primary amenorrhea. She has high LH, normal FSH and slightly high prolactin levels. Choose the single most likely dx? a. PCOS b. POF c. Hypothyroidism d. Pregnancy e. Primary obesity
Ans. The key is A. PCOS. [High LH, high or normal FSH with slight rise in prolactin levels in an obese lady is suggestive of PCOS].
82
1282. A 38yo lady presents with amenorrhea has very high LH and FSH levels, normal prolactin and low estradiol. Choose the single most likely dx? a. PCOS b. POF c. Hypothyroidism d. Pregnancy e. Menopause
Ans. The key is B. POF. [High LH and FSH, normal prolactin and low estrogen in secondary amenorrhea in a lady under age 40 is highly suggestive of POF].
83
1283. A 77yo publican was admitted for an appendectomy. Post-op he becomes confused, agitated and starts to pick at things. He is then given an IV drug which settles this confusion. Which of the following drugs was given for his confusion? a. Diazepam b. Chlordiazepoxide c. Thiamine d. Vit B
Ans. The key is B. Chlordiazepoxide. [Patient is alcoholic. On admission abstinence from alcohol caused this withdrawal symptom. Agitation, confusion and pick at things are suggestive of delirium tremens which is treated with Chlordiazepoxide].
84
1284. A 65yo lady presents with dyspareunia. What will you give her for her condition? a. HRT b. COCP c. Estrogen gel d. Testosterone gel
Ans. No key is given. Likely key is C. Estrogen gel. [Seems to be atrophic vaginitis for which estrogen gel can be given].
85
1285. A 35yo lady with subserosal fibroid=4cm and submural fibroid=6cm is planning for a child. Which way will you remove the fibroids? a. Laproscopy b. Vaginal myomectomy c. Abdominal myomectomy d. Drugs e. Reassure
Ans. The key is B. Vaginal myomectomy. Probably wrong key! Correct key should be C. Abdominal myomectomy. [Subserosal fibroid is not suitable to treat with vaginal myomectomy. Abdominal myomectomy can deal with both subserosal and submural fibroid].
86
1286. A 32yo presents with heavy blood loss, US: uterine thickness>14mm. What is the best possible management for her? a. COCP b. UAE c. Hysteroscopy myomectomy d. Abdominal myomectomy e. Endometrial ablation
Ans. B. UAE. [COCP will not resolve the case. There is no fibroid so no myomectomy. Endometrial ablation may render the young lady non fertile. So UAE is the only suitable option here].
87
1287. A pt comes with sudden loss of vision. Exam: high BP. Fundoscopy: retina appears swollen. Which blood vessel occlusion is involved? a. Branch RVO b. Branch RAO c. CRAO d. CRVO
Ans. The key is D. CRVO.
88
1288. A 2yo girl has had a temp=39C, poor appetite, abdominal pain and urinary frequency for 3d. What is the single most appropriate inv? a. Catheter specimen of urine for culture b. Clean catch urine specimen for culture c. CBC d. KUB US e. Supra-pubic aspirate of urine for culture
Ans. The key is B. Clean catch specimen of urine for culture.
89
1289. A child with T1DM who is not compliant with meds and eats a lot. He thinks that he is short in his class. He is not happy. What would you do next? a. Refer to psychologist b. Refer to pediatrician c. Refer to GP d. Refer to social services e. Change type of insulin
Ans. The key is A. Refer to psychologist. [Not compliant with medicine, eating a lot, thinking of being short and being unhappy these are psychological issues. So he should be referred to psychologist].
90
1290. An 8yo boy with a BMI=28 was admitted to a surgical ward following a MVC. He was found to have glycosuria. When he recovered from his injury the glycosuria resolved. What is the single most appropriate follow-up inv? a. Fasting blood glucose conc b. Glycosylated hemoglobin - HbA1c c. OGTT d. Random blood glucose conc e. Serum cortisol conc
Ans. The key is A. Fasting blood glucose concentration. [The boy had glycosuria while treating in hospital following a MVC (motor vehical crush). It may be due to stress related cortisol release which later became nil as the boy recovered from trauma. But yet to certain that he is not diabetic fasting blood glucose concentration should be done in follow up visit].
91
1291. At birth, a baby boy at 38wks GA weighs 1.8kgs. He has hepato-splenomegaly and a rash. Blood test show raised level of bilirubin and liver enzymes. What is the most likely dx? a. Galactosemia b. Biliary atresia c. G6PD deficiency d. Rh incompatibility e. Congenital viral infection
Ans. The key is E. Congenital viral infection. [Congenital infections affect the unborn fetus or newborn infant. They are generally caused by viruses that may be picked up by the baby at any time during the pregnancy up through the time of delivery. The more common viruses linked to congenital infections include the Cytomegalovirus (CMV), Herpes, Rubella (German measles), Parvovirus, Varicella (ch
92
1292. A 12yo boy with T1DM has poor long-term control. He is unconscious, hyperventilating and dehydrated. His blood glucose is 28mmol/l. What is the single most imp initial tx? a. Albumin IV b. Bicarbonate IV c. Insulin IV d. Insulin SC e. Saline 0.9% IV
Ans. The key is E. Saline 0.9% IV. [Probable diabetic ketoacidosis. Initial treatment is IV fluid (0.9% saline)].
93
1293. A 30yo woman on OCP presents with dilated tortuous veins crossing her abdomen to join the tributaries to SVC. What is the single most likely cause? a. Intra-abdominal malignancy b. Ovarian cyst c. Fibroids d. Ascites e. DVT
Ans. The key is A. Intra-abdominal malignancy.
94
1294. An 84yo woman with drusen and yellow spots in the center of retina. What is the single most likely dx? a. Macular degeneration b. HTN retinopathy c. MS d. DM background e. Proliferative DM retinopathy
Ans. The key is A. Macular degeneration. [In early disease, the macula shows yellowish-colored subretinal deposits called “drusen”].
95
1295. A pt presents with headache, blurring of vision and acuity loss. On fundoscopy, dots and blots were noted with huge red swollen optic disc. What is the most probable dx? a. CRAO b. Branch RAO c. CRVO d. Optic atrophy
Ans. The key is C. CRVO.
96
1296. A 64yo DM has come for a routine eye check up. Fundoscopy: new vessels all over the retina. What is the most appropriate management? a. Strict sugar control b. Regular eye check ups c. Non urgent referral to specialist d. Laser photocoagulation e. Insulin
Ans. The key is D. Laser photocoagulation. [Neovascularization suggests proliferative diabetic retinopathy which is treated with laser photocoagulation].
97
1297. A 25yo primigravida of 8wk GA presents with severe lower abdominal pain, vaginal bleeding and passage of clots. The internal os is open. What is the most likely dx? a. Appendicitis b. Placental abruption c. Ectopic pregnancy d. Abortion
Ans. The key is abortion. [Up to 24 weeks termination of pregnancy is abortion.
98
1298. A man developed intense pain after using the end of a pencil to scratch his inner ear. He took out the pencil from his ear and realized the end of the pencil with the rubber part is still stuck in his ear. What is the most appropriate management? a. Remove with a hook b. Instill olive oil c. Remove GA d. Remove with magnet instrument e. Do syringing
Ans. The key is A. Remove with a hook. [Place a hook behind the object and pull it out].
99
1299. A 16yo boy presents with acute pain in the right ear and little bleeding from the same ear. He had been in a boxing match and had sustained a blow to the ear. There is little amount of blood in the auditory canal and a small perforation of the eardrum. What is the most appropriate management? a. Admission for parental antibiotics b. Nasal decongestant c. Oral amoxicillin d. OPD review e. Pac
Ans. The key is C. Oral amoxicillin. [Small perforations are usually heal by themselves within 6-8 weeks and doctors often prescribe antibiotics to prevent infections during this healing period].
100
1300. A 45yo man has noticed difficulty hearing on the telephone. He is concerned because his father has been moderately hard of hearing since middle age. BC=normal. An audiogram shows moderate hearing loss in both ears across all frequencies. What is the single most likely dx? a. Acoustic neuroma b. Menieres’ disease c. Noise induced deafness d. Otosclerosis e. Presbyacusis
Ans. The key is D. Otosclerosis. [This patient has conductive hearing loss. So it is not acoustic neuroma. Meniere’s disease has symptoms like vertigo, tinnitus, fullness, along with hearing loss. There is no history of noise pollution not presbycausis as his age is 45. So his deafness fits more with otosclerosis. These are by exclusion. Points in favour of otosclerosis: i) Conducting hearing loss
