1301 to 1400 Flashcards
(100 cards)
1
Q
- The biological parents of a child with CF come to you to know about the chances of their future children with the same disease. What would you say to them? a. There is a 1:4 chance that your future child will have this disease b. All their unaffected children will be carriers of CF c. Nothing can be predicted d. It can 100% dx antenatally
A
Ans. The key is A. There is a 1:4 chance that your future child will have this disease. [It is autosomal recessive disease. As one child is affected both parents are carrier. So in this case next child will be normal in 1:4 case, carrier in 1:2 cases and diseased in 1:4 cases].
2
Q
- A 14yo boy presents with recurrent abdominal pain, malaise and weight loss over 6m. Exam: vague mass is felt in RIF. Colonoscopy shows transmural inflammation and granulomata. What is the most appropriate management? a. Sulfasalazine b. Paracetamol c. Metronidazole d. Ibuprofen
A
Ans. The key is C. Metronidazole. It is a wrong key. Correct key should be A. Sulfasalazine. [Drug of 1st preference is Steroids, then immunosuppressants, then amynosalicylates (such as sulfasalazine). Metronidazole is used if there is infective complications like infected perianal fistula
3
Q
- A 62yo prv shipyard worker complains of breathlessness and chest pain for 6m. He has now developed a large pleural effusion. Which is the single best diagnostic inv? a. ABG b. Bronchoscopy c. CXR d. Pleural biopsy e. Transfer factor
A
Ans. The key is D. Pleural biopsy. [Shipyard worker is exposed to asbestos and the likely diagnosis here is mesothelioma for which single best investigation is pleural biopsy].
4
Q
- A 67yo man presents with a hx of increasing confusion and drowsiness. He had a fall 2wk ago. CT head reveals a chronic subdural hematoma. What is the best management for this pt? a. Craniotomy b. Burr hole drainage c. Conservative management d. Excision and biopsy
A
Ans. The key is B. Burr hole drainage.
5
Q
- A 45yo male with epigastric discomfort has been given triple therapy. He has now returned after 4wks of epigastric discomfort. What inv would you do for him? a. ECG b. H.pylori breath test c. Endoscopy and biopsy d. US
A
Ans. The key is C. Endoscopy and biopsy. This is a wrong key! Correct key is B. H. pylori breath test.
6
Q
- A 13yo boy with umbilical pain for the last 12h presents with anorexia, nausea and has not passed a bowel motion 24h. What is your dx? a. Acute appendicitis b. IBD c. IBS d. Meckel’s diverticulum e. Muscle strain f. Ovarian cysts g. PID h. Psoas hematoma i. Pyelonephritis j. Uretric calculus
A
Ans. The key is D. Meckel’s diverticulum. [In appendicitis pain shifts to rt iliac fossa].
7
Q
- A 46yo man with tachycardia has the following ECG. What is the most likely dx? a. SVT b. VT c. Mobitz I heart block d. Atrial fibrillation e. WPW syndrome
A
Ans. The key is E. WPW syndrome. [Short PR interval and slurred delta wave indicates WPW syndrome].
8
Q
- A 24yo male is admitted with acute severe asthma. Tx is initiated with 100% oxygen, nebulized salbutamol and ipratropium bromide nebulizers and IV hydrocortisone. Despite initial tx there is no improvement. Which is the next step in management? a. IV aminophylline b. IV magnesium sulphate c. IV salbutamol d. IM adrenaline e. IV adrenaline
A
Ans. The key is B. IV magnesium sulphate.
9
Q
- A 49yo man first presented with increasing difficulty in swallowing. Several months later he developed weakness in his right foot. Now he can no longer feed himself, he chokes on food and has become confined to a wheelchair. What is the most likely dx? a. Cerebral tumor b. Myasthenia gravis c. Lambert-Eaton syndrome d. Motor neuron disease e. Cerebro-vascular disease
A
Ans. The key is D. Motor neuron disease. [The picture is of amyotrophic lateral sclerosis with bulbar onset, so it has very bad prognosis].
10
Q
- A 10yo boy with lower abdominal pain for the last 10d presents with a hx of passing 6-8 loose stools. Temp=38.8C. He is tender in the right lower quadrant and has an anal fistula. Choose the single most likely cause of abdominal pain. a. IBD b. IBS c. Pyelonephritis d. Uretric calculus e. Gastroenteritis
A
Ans. The key is A. IBD. [Likely diagnosis is crohn’s disease which is often associated with perianal fistula formation].
11
Q
- A 28yo woman with hx of drug addiction wants to start a family and have a baby. She would like to stop taking heroin and asked for something to help her stay away from it. What drug tx would you give her? a. Naloxone b. Acamprosate c. Methadone d. Chlordiazepoxide e. Naltrexone
A
Ans. The key is C. Methadone. [Methadone is a powerful synthetic analgesic drug which is similar to morphine in its effects but less sedative and is used as a substitute drug in the treatment of morphine and heroin addiction].
12
Q
- A pt with vesicles in the maxillary divison of trigeminal nerve. Which area of mucus membrane will be involved? a. Palate b. Cheek c. Cornea d. Conjunctiva
A
Ans. The key is B. Cheek. [It also involve soft palate but not hard palate. So cheek is more complete answer than palate. Conjuctiva is more affected in ophthalmic division of trigeminal nerve].
13
Q
- A 52yo man presents with visual hallucinations and features of cognitive impairment. What is the most likely dx? a. Frontotemporal dementia b. Lewy body dementia c. Delirium tremens d. Alzheimer’s disease e. Huntington’s disease
A
Ans. The key is B. Lewy body dementia. [Visual hallucinations and cognitive impairment are suggestive of Lewy body dementia. Hallucination is prominent feature of LBD than Alzheimers. Again cognitive impairment goes more with LBD while prominent early memory loss symptom suggests Alzheimer’s].
14
Q
- A 40yo woman who has recently returned from working in the middle east complains of thirst, episode of loin pain, urinary frequency, dysuria and has passed a urinary stone. All inv are normal. She plans to return to the Middle East in a month’s time. What is the single best advice to prevent recurrent stone formation? a. Drink less milk b. High fibre diet c. Increase fluid intake d. Low calc
A
Ans. The key is C. Increased fluid intake. [ Risk factors for renal stones include being overweight, certain foods, some medications, and not drinking enough fluids].
15
Q
- A 32yo man presents with 3d of scrotal pain. Exam: thickening o the left testis and it is hot to touch. What is the most appropriate management? a. Analgesia b. Reassurance c. Antibiotics d. Referral to surgeon
A
Ans. The key is C. Antibiotics. [scrotal pain of 3 days with thickening of testis which is hot to touch suggests epididymoorchitis, which is treated with antibiotics].
16
Q
- A 34yo woman presents with truncal obesity, easy bruising, hyperglycemia, high BP and depression. Which of the following inv’s will be most helpful in localizing the cause for Cushing’s syndrome? a. Serum cortisol b. 24h urinary cortisol c. Low dose dexamethasone suppression test d. High dose dexamethasone suppression test e. Overnight dexamethasone suppression test
A
Ans. The key is D. High dose dexamethasone suppression test. [High dose dexamethasone suppression test can identify whether pituitary adenoma or ectopic ACTH producing tumour].
17
Q
- A 32yo man develops hematuria 2wks after a sore throat. What is the dx? a. Post infection nephritis b. IgA nephropathy c. Membranous nephritis d. Glomerulonephritis
A
Ans. The key is A. Post infection nephritis. [Hematuria 2 wks after sorethroat indicate post infection nephritis while hematuria after few days of sorethroat indicate IgA nephropathy].
18
Q
- An elder man who has anorexia, prostate symptoms and HTN. There are small kidneys on US. What is the dx? a. Hypertensive renal disease b. Prostate ca c. BPH
A
Ans. The key is A. Hyperensive renal disease. [Small kidneys suggest chronic renal failure and uremia here is the cause of anorexia. As elder he may have associated prostate symptoms from concomitant BPH].
19
Q
- A 55yo woman with breast ca which has spread to lung, liver and bone now presents with increasing constipation, weakness, thirst and anorexia for the past 3d. Her only medication is haloperidol for hiccoughs. Today she is disorientated and has left sided weakness. What is the most likely dx? a. Brain mets b. Hypercalcemia c. Liver failure
A
Ans. The key is A. Brain mets. [The patient has clinical hypercalcemia, but the neurological features of disorientation and left sided weakness can only be explained with brain metastasis].
20
Q
- A 22yo man presents with a red, hot, swollen, metatarsal phalangeal joint, sarcoilitis and onycholysis. What is the single most likely cause of his condition? a. Gout b. RA c. Reiter’s syndrome d. Psoriatic arthropathy
A
Ans. The key is D. Psoriatic arthropathy. [Psoriatic arthritis initially can affects the toes very similar to gout. There can be sacroilitis and onycholysis.
21
Q
- Which of the following conditions requires operative management? a. Cellulitis b. Dyshidrosi c. Erysipelas d. Fournier’s gangrene e. Lymphangitis
A
Ans. The key is D. Fournier’s gangrene. [Fournier’s gangrene: A horrendous infection of the genitalia that causes severe pain in the genital area (in the penis and scrotum or perineum) and progresses from erythema (redness) to necrosis (death) of tissue. Gangrene can occur within hours].
22
Q
- A 55yo pt presents with collapse and complains of abdominal pain that radiates to the back. An expansile abdominal mass is felt on examination and the pt is in shock. What is the single most likely dx? a. Ruptured aortic aneurysm b. Renal colic c. Trauma d. Endocarditis e. Atheroma
A
Ans. The key is A. Ruptured aortic aneurysm.
23
Q
- A house-bound 78yo man with severe COPD has had a gradual deterioration over recent months and is now breathless at rest. He is on maximal inhaled medical therapy. Result: pH=7.36, PaCO2=5.9kPa, PaO2=6.9kPa. What is the single most appropriate additional tx? a. Aminophylline PO b. ACEi PO c. Antibiotic PO d. Oxygen e. Steroid PO
A
Ans. The key is D. Oxygen. [In patients with chronic hypoxaemia, LTOT should usually be prescribed after appropriate assessment, when the PaO2 is consistently at or below 7.3 kPa (55 mm Hg) when breathing air during a period of clinical stability. Clinical stability is defined as the absence of exacerbation of chronic lung disease for the previous five weeks. The level of PaCO2(which may be normal
24
Q
- A 79yo man has a swelling of the right groin which was clinically dx to be indirect inguinal hernia. What is the single feature of the hernia sac that would confirm the dx? a. Comes through femoral ring b. Doesn’t pass through the deep inguinal ring c. Lies below and lateral to the pubic tubercle d. Only passes through the superficial inguinal ring e. Passes through the deep inguinal ring
A
Ans. The key is E. Passes through the deep inguinal ring. [Ingunal hernia lies mostly above and medial (occasionally lateral particularly when small) to pubic tubercle. It first enters the inguinal canal through deep inguinal ring and then enters the scrotum through the superficial inguinal ring].
25
1325. A 56yo woman with hx of breast cancer 10y ago has undergone radical mastectomy and axillary LN removal, now complains of swollen upper limb 3wks after an insect bite. The bite site is better but gross edema is still present. What is the cause? a. Lymphedema b. Breast Ca c. Allergy d. Filariasis
Ans. The key is A. Lymphedema. [As during mastectomy axillary clearance is done, lymphatics on that upper limb is compromised. So there occurs lymphedema].
26
1326. A homeless person is found wandering on the street. He had ataxic gait, nystagmus and opthalmoplegia. He looked unkempt and his clothes had a sweaty odour. He had a dry mucous membrane with a BP=118/70mmHg and PR=90bpm. Blood sugar level=8. Alcohol breath test= - ve. What would the most imp initial inv? a. IV insulin b. Vit B complex c. Bolus IV 0.9%NS d. IV dextrose e. Antibiotics
Ans. The key is B. Vit B complex. [This is wernicke’s encephalopathy due to alcohol withdrawal, so Vit B complex should be checked. This occurs mainly due to thiamine deficiency].
27
1327. A 34yo man has supra-orbital pain and tenderness and developed tenderness over the maxilla. He also has mild fever. What is the single likely cause for these symptoms? a. Acute sinusitis b. GCA c. Trigeminal neuralgia d. Maxillary carcinoma
Ans. The key is A. Acute sinusitis. [There is supraorbital pain in frontal sinusitis and tenderness over maxilla in maxillary sinusitis. Also mild fever may present in acute sinusitis].
28
1328. A 51yo woman presents with painful tongue and complains of tiredness. She is pale and has angular stomatitis and a smooth red tongue. There is no koilonychea. Choose the single cell type you will find on the blood film. a. Numerous blast cells b. Oval macrocytes c. Spherocytes d. Microcytic hypochromic e. Mexican hat cells f. Erythrocytes
Ans. The key is B. oval macrocytes. [Macrocytes are two types, round and oval. Oval macrocytes are seen in megaloblastic anemia which occurs due to Vit B12and/or folic acid deficiency. Glossitis (painful tongue), angular stomatitis and smooth tongue are though characteristic feature of iron deficiency but also known feature of megaloblastic anemia. Absence of koilonychea also favours megaloblastic
29
1329. A 24yo woman presents with tingling and twitching of her fingers followed by throbbing unilateral headache. What is the most likely dx? a. Tension headache b. Migraine c. Cluster headache d. TIA e. SAH
Ans. The key is B. Migraine. [The tingling and twitching of her fingers are aura and the migraine is with aura].
30
1330. A young child dx with chicken pox. Usually goes to day care. What is the most appropriate advice? a. Child should be admitted to hospital straight away b. Isolate the child from parents and siblings at home c. Advice that he can go back to nursery when the rash is crusted over
Ans. The key is C. Advice that he can go back to nursery when the rash is crusted over. [At this stage patient is no more infectious].
31
1331. A 7yo boy is brought by his mother. There are multiple perioral and forehead vesicles. Some vesicles are crusted and some are not. The face is hot. What is the most likely dx? a. Varicella zoster b. Herpes zoster c. Fungal infection d. Impetigo e. Psoriasis
Ans. The key is B. Herpes zoster.
32
1332. A 5yo boy is rescued from a burning building and is presented to the ED. He has 5% partial thickness burns over the arms and legs and had soot in the mouth and nose. His breathing has become noisy. What is the single most immediate management? a. Nebulized adrenaline b. Nebulized salmetarol and oxygen c. Needle cricothyrodotomy d. Oropharyngeal airway e. Intubation of airway
Ans. The key is E. Intubation of airway. [Soot in the mouth and nose and noisy breathing occurs in inhalation injury where intubation of the airway is indicated].
33
1333. A new born baby is borught with pansystolic murmur at sternal border but the baby is not cyanosed. What is the dx? a. VSD b. ASD c. TOF d. PDA
Ans. The key is A. ventricular septal defect. [Pancystolic murmur in sternal border without cyanosis is indicative of VSD].
34
1334. A woman complaining of diarrhea, abdominal pain and fatigue. All the tests are found to be normal. What is the cause? a. Somatization b. Conversion c. Hypochondriasis
Ans. The key is A. Somatization. [Somatization disorder is patients presenting with any physical symptom and frequent medical visits in spite of negative investigations].
35
1335. A 26yo man has returned from NY to the UK and noticed weight loss, night sweats, temp=37.5C and cervical lymphadenopathy. He also has splenomegaly. What is the dx? a. TB b. Lymphoma c. Bronchial carcinoma d. Bronchitis
Ans. The key is B. Lymphoma. [Splenomegaly favours lymphoma].
36
1336. A mother got infected with Hep B during pregnancy. Her child is born and she is worried about the risk of infection to the baby with Hep B. What would you give to the baby? a. Hep B Ig only b. Hep B full vaccine and Ig c. Hep B vaccine only once d. Nothing until immune status is checked e. Hep B vaccine once and Ig
Ans. The key is B. Hepatitis B full vaccine and Ig.
37
1337. A man suffers from Herpes Zoster affecting his face. Which of the following mucos membrane is to be affected? a. Cheek b. Cornea c. Conjunctiva d. Oropharynx e. Palate
Ans. The key is C. Conjunctiva. [If maxillary or ophthalmic division is not mentioned but only mentions face it means ophthalmic branch more commonly around eye. Herpes zoster ophthalmicus can cause following lesions blepheritis, conjunctivitis, keratitis, anterior uveitis etc. As question wants mucous membrane and among the mentioned lesions only conjunctiva is mucous membrane the answer is conju
38
1338. A 34yo man sustains a fx to shaft of femur after falling from the roof of his house. Exam: distal pulses are not palpable. Which vessel is damaged? a. Femoral artery b. Circumflex femoral artery c. Profundafemoris artery d. Popliteal artery e. Obturator artery f. Dorsalispedis artery
Ans. The key is A. Femoral artery.
39
1339. A 9yo child doesn’t play with his peers and has collected 200 cars. He doesn’t respond to any criticism. What is the dx? a. Autism b. Personality disorder c. Schizophrenia d. Rett syndrome e. Social anxiety
Ans. The key is A. Autism.
40
1340. A 63 yo man with vague but persistent pain. On endoscopy: columnar epithelium was found to be pouched into muscularis. What is the dx? a. Adenocarcinoma b. Adenoma c. Peptic ulcer d. H. pylori infection
Ans. The key is A. Adenocarcinoma.
41
1341. A 24yo man after a head injury presents with difficulty dressing himself, difficulty in writing and inability to differentiate the fingers of his hand. Which part of the brain is most likely to be affected? a. Frontal lobe b. Parietal lobe c. Temporal lobe d. Occipital lobe e. Brainstem
Ans. The key is B. Parietal lobe. [Dressing apraxia, agraphia and finger agnosia are features of parietal lobe lesions].
42
1342. A 16yo boy in boarding school feels unwell. He developed cough and rash. His CXR showed bilateral consolidations. What is the cause of his symptoms? a. Staph aureus b. Legionella c. Mycoplasma d. Streptococcus
Ans. The key is C. Mycoplasma. [Rash, bilateral consolidation favours mycoplasma pneumonia. Mycoplasma is common in military barrack, prison or boarding dwellers].
43
1343. A 10yo boy is brought to the ED 10h after injury to the foot. It was punctured with a metal spike that passed through his shoe. What is the next best step? a. Ig b. Ig and vaccine c. Vaccine only d. Clean the wound e. Antibiotics
Ans. The key is D. Clean the wond. [“NEXT” best step is clean the wound].
44
1344. A 56yo male presents with persistent watery diarrhea. What is the most likely dx? a. Treponema pallidum b. Nesseria meningitides c. Cryptosporidium d. Staph aureus e. Pseudomonas aeruginosa
Ans. The key is C. Cryptosporidium.
45
1345. A 2yo girl has frequency, urgency and burning micturition. She has some supra pubic tenderness. Which one of the following is the most appropriate initial inv? a. Supra pubic aspiration of urine for C&S b. Clean catch of urine for C&S c. USG d. IVU e. MCUG
Ans. The key is B. Clean catch of urine for C&S. [The features are consistent with lower UTI for which clean catch of urine for c&s should be done].
46
1346. An 89yo man presents with carcinoma of posterior oropharynx. Which is the single most appropriate LN involved? a. Pre-aortic LN b. Aortic LN c. Submental LN d. Submandibular LN e. Deep cervical LN
Ans. The key is E. Deep cervical LN.
47
1347. A young boy presented to the OPD 12wks after renal transplantation with fever and pain in lower abdomen. Renal functions were deranged. Renal biopsy showed immune cell infiltrate and tubular damage. What is the most probable dx? a. Pyelonephritis b. Chronic graft rejection c. Acute rejection d. Drug toxicity e. Graft vs host disease
Ans. The key is C. Acute rejection. [Acute rejection usually occurs in the first few months after transplant, but may occur up to a year after transplant. Features presented are typical of acute graft rejection].
48
1348. A 56yo lady presents with a pathological fx of T11 vertebra. There is found to be an underlying metastatic lesion. What is her most common primary ca? a. Lung b. Breast c. Uterine d. Brain
Ans. The key is B. Breast. [In female breast and lung cancer and in male prostate and lung cancer are most common to metastasize to bone].
49
1349. A 6m infant has breast milk jaundice. He is otherwise feeding well and is not dehydrated. What would his LFTs look like? a. Total bilirubin:40, conjugated bilirubin<5% b. Total bilirubin:300, conjugated bilirubin 85% c. Total bilirubin:500, conjugated bilirubin>85% d. Total bilirubin:400, conjugated bilirubin<85%
Ans. The key is A. Total bilirubin:40, conjugated bilirubin<5%. [Brest milk jaundice is characterized by indirect hyperbilirubinemia].
50
1350. A 29yo man took a tour of Japan and also travelled to other parts of Asia, developed fever, petechie and rash on his body. He didn’t take malaria prophylaxis prior to travel. What is the most likely dx? a. Malaria b. HSP c. HIV d. Dengue fever e. ITP
Ans. The key is D. Dengue fever.
51
1351. A 4yo boy ingested his grandmother’s medicine and has developed dilated pupil. What is the cause? a. Amitryptiline b. Paracetamol c. Iron d. Digoxin
Ans. The key is A. Amitryptiline. [TCA causes mydriasis]
52
1352. A 46yo male presents with confusion and drowsiness. What is the most likely dx? a. Cryptococcus neoformans b. Toxoplasma gondii c. HSV d. CMV e. Candida albicans
Ans. The key is A. Cryptococcus neoformans. [The key is doubtful as Toxoplasmosis is most common cns lesion in AIDS].
53
1353. A child has developed rash after the tx of penicillin. What will be the cause of rash? a. Drug reaction b. Kawasaki c. Inf Mono
Ans. The key is A. Drug reaction.
54
1354. A child comes with recurrent joint pain, multiple bruises, swollen ankle and unable to move his legs. What is the inv of choice? a. ESR b. RF c. Clotting factors
Ans. The key is C. Clotting factors. [Probable diagnosis is hemarthrosis with the disease hemophilia].
55
1355. A 66yo man has renal colic. He has also presented with acute onset pain in his knee in the past. What is the single most likely cause for renal failure? a. SLE associated GN b. Hypercalcemia c. HTN d. Hyperuricemia e. Hyperoxaluria
Ans. The key is D. hyperuricemia. [Knee pain is due to gout and renal colic may occur from uric acid stone (urate stone)].
56
1356. A boy with a hx of recurrent swollen tender joints on both knees and elbows and not able to participate in sports. What is the inv of choice to dx? a. RF/ASO titre b. Clotting factor c. ESR
Ans. The key is B. Clotting factor. [Haemarthrosis causing disability].
57
1357. A 26yo man is referred for gastroscopy because of a hx of several months of dyspepsia. He has routine bloods checked and is found to have a serum calcium level=3.2mmol/l with a venous bicarbonate level of 33mmol/l. Renal and LFT are both ormal. CXR is normal. What is the most likely cause of his hypercalcemia? a. Melanoma b. Metastatic malignancy c. Milk alkali syndrome d. Primary hyperparat
Ans. The key is C. Milk alkali syndrome. [In medicine, milk-alkali syndrome is characterized by high blood calcium caused by taking in too much calcium and absorbable alkali; common sources of calcium and alkali are dietary supplements taken to prevent osteoporosis and antacids. If untreated, milk-alkali syndrome may lead to kidney failure or death].
58
1358. A 3yo boy presents with difficulty in walking and skin lesions. What is the most likely causative agent? a. Strep pyogenes b. Rubella virus c. Parvovirus d. Papovirus e. Paramyxovirus
Ans. The key is C. Parvovirus. [Sometimes there may occur arthropathy for which children gets difficulty to walk. There occurs macular morbiliform rash in parvovirus infection following disappearance of rash of the cheeks].
59
1359. A pt after his house fire came with hematemesis with erosion/ulcer of esophagus and on examination there is 55% burn and on endoscopy there is a stomach/gastric erosion and soot in the mouth. What is the tx? a. PO PPI b. IV PPI c. PPI and antibiotic d. H. pylori test e. Tracheal intubation
Ans. The key is E. Tracheal intubation. [If a burnt patient gets soots in mouth and /or nose tracheal intubation is done. GI ulceration (here oesophageal and gastric ulcers and erosions) due tu burns are known as curlings ulcers].
60
1360. A 40yo man complains of severe colicky loin pain that radiates to his scrotum. He is noted to have microscopic hematuria. No masses are palpated. What is the single most likely cause? a. Acute cystitis b. Bladder ca c. Renal vein thrombosis d. Acute pyelonephritis e. Ureteric calculus
Ans. The key is E. Ureteric calculus. [In ureteric stone there is radiation of pain from loin to groin or scrotum. There also occurs hematuria].
61
1361. A 55yo man is having slow growing ascites. When we tap the peritoneal fluid the protein is <25 and it is clear and yellow. What could be the origin for ascites? a. Budd-Chiari b. Gastrinoma c. Hepatoma d. TB e. Pancreatitis
Ans. The key is A. Budd-Chiari syndrome. [In gastrinoma there is no ascites! In hepatoma there will be exudative ascites as in TB and pancreatitis. Budd-Chiary syndrome causes transudative ascites and the likely option here].
62
1362. A 7yo boy presents with his mother to GP surgery. His mother describes he had presented this since 3wks ago. He had not experienced any trauma. No other symptoms a/w the condition. Exam: non tender swollen ankles bilaterally. There is no rash or lesion. He is otherwise well. Which single test would be the best as an initial assessment? a. Plasma electrolytes b. Albumin c. Total serum protein
Ans. The key is B. Albumin. [Likely cause of ankle oedema from hypoalbuminema].
63
1363. In lyme disease, which complication is most likely to lead to collapse? a. Dilated CM b. AV block c. Mild encephalitis d. Meningitis e. Myocarditis
Ans. The key is B. AV block.
64
1364. A 30yo pt came to the OPD with complaint of breathlessness and dry cough. He has lost 5kgs in 2m. He is an IV drug abuser. Inv: CXR=bilateral interstitial shadowing. What is the single most likely causative organism? a. Klebsiella b. TB c. Chlamydia pneumonia d. PCP e. Chlamydia psitacci
Ans. The key is D. PCP. [IV drug abuser, weight loss, breathlessness and dry cough with interstitial shadowing indicate PCP pneumonia in an AIDS patient].
65
1365. A 27yo female who had a RTA 7m back now complaints of attacks of sudden onset rotational vertigo which comes on with sharp movements of the head and neck. Which of the following would be most helpful? a. Caloric testing b. Hallpikes maneuver c. Gutenbergers test d. Meniere’s test e. Otoscopy
Ans. The key is B. Hallpikes maneuver. [Vertigo which comes on with sharp movement of the head and neck points towards the diagnosis of benign positional vertigo which can be demonstrated by Hallpikes maneuver].
66
1366. A man rescued from a building on fire presented with unconsciousness without any evidence of burns or external injury or soot. What would you do next? a. 100% oxyen inhalation b. 24% oxygen by mask c. Hyperbaric oxygen in a hyperbaric chamber d. Intubation e. Refer to specialist unit
Ans. The key is A. 100% oxygen inhalation. [In CO poisoning 100% oxygen is the initial management and also there is a role of hyperbaric oxygen in a hyperbaric chamber].
67
1367. A pt has had 1 ep of depression and 2 eps of mania over the last year and now presents with depression. He is on anti-depressants. What additional pharmacological tx would now act as a prophylaxis for his condition? a. Antidepressants b. Antipsychotics c. Mood stabilizers d. No additions req
Ans. The key is C. Mood stabilizers. [Antidepressant alone can lead to manic attack and to prevent this a mood stabilizer is required].
68
1368. A man presented with a purplish swelling at the anal area. It is acutely painful and he complains of constipation for the last 2m. What is the most appropriate management? a. I&D b. I&D + antibiotics c. Reassure d. Analgesia e. Sclerotherapy
Ans. The key is B. I&D + antibiotics.
69
1369. A pt came to the ED after he had banged his car quite a few times on reversing. He was complaining of seeing double while he tried to look back during the process of reversing the car, he also complains of double vision on looking at an outward gaze. Which nerve is involved? a. Abducent nerve b. Trochlear nerve c. Oculomotor nerve d. Optic nerve e. Trigeminal nerve
Ans. The key is A. Abducent nerve. [Lateral rectus palsy].
70
1370. A pt had a stroke. Now, there is left sided weakness and right side facial numbness. CT shows ischemic stroke. Which one would you prescribe? a. Alteplase b. Aspirin c. Clopidogrel d. Heparin e. Warfarin
Ans. The key is A. Alteplase. [Some say CT detects ischaemic stroke beyond window period which is not correct and it is able to detect stroke much earlier and hence it’s place is there in the treatment with alteplase].
71
1371. A young boy presents with fever and cough. His father was dx with TB a week ago. The parents don’t want him to have a BAL under anesthesia. Which other samples can be taken for dx? a. Urine b. Blood c. CSF d. Gastric washing e. Sweat
Ans. The key is D. Gastric washing. [A young boy is able to cough up sputum unless it is dry cough where suspected TB is diagnosed by broncho-alveolar-lavage (BAL). As in dry cough TB bacteria contaminate saliva and goes to stomach with swallowed contaminated saliva Gastric-washing can bring out bacteria and detected thereby. So gastric-washing is an alternative to BAL in dry cough].
72
1372. A 50yo man came to the hosp a few months after he had a MI. Exam: everything normal, S1 and S2 were heard on auscultation, but there is a new pan-sytolic murmur. What is the most appropriate inv of choice? a. ECG b. 24h ECG c. Echo d. CXR e. CT
Ans. The key is C. Echo. [To rule out any valvular lesion (following papillary muscle rupture) or septal lesion].
73
1373. A 73yo stroke pt has been on aspirin for 2yrs. He now presents with epigastric pain and is asking for a tx. What is the most appropriate management? a. Laparotomy b. NSAIDs c. Omeprazole d. Morphine e. Tramadol
Ans. The key is C. Omeprazole.
74
1374. A 2yo girl is brought to the ED by her mother. The child is screaming that there is something in her ear and she appears agitated. Exam: a plastic bead is seen inside the ear. What is the best method of removal? a. Forceps b. Hook c. Under general anesthesia d. Syringing e. Magnet
Ans. The key is C. Under general anaesthesia.
75
1375. During antenatal visits, the following tests are routinely offered to all pregnant mothers apart from HIV and Hep B? a. Rubella and syphilis b. Syphilis and toxoplasmosis c. Hep C & thalassemia d. CMV and rubella e. Sickle cell anemia and Hep
Ans. The key is A. Rubella and syphilis
76
1376. A 32yo male complains of tremors everytime he tends to use his muscles and when he is pointing at objects. No complaints at rest. His father complained of similar problems. What is the most probable dx? a. Parkinsonism b. Lithium toxicity c. Thyrotoxicosis d. Benign essential tremor
Ans. The key is D. benign essential tremor. [In benign essential tremor there is no rest tremor but tremor occurs during movement of the affected limb].
77
1377. A 40yo woman with breast cancer has back pain which keep her awake at night. She blames it on a gym session she had 2wks ago. She now has difficulty in climbing stairs. There is tenderness over the right thoracic spine. She has diminished fine touch and temp sensation in her right foot. What is the single most appropriate inv? a. Bone density scan b. CT head c. MRI spine d. Nuclear bone scan
Ans. The key is C. MRI spine. [There is neurological deficit so to exclude spinal involvement MRI is the single most appropriate investigation].
78
1378. A pregnant lady at her 39wk GA present with eclampsia. Soon after her arrival in the labour suit, IV MgSO4 and IV hydralazine has been prescribed. The pt then develops another fit in the hosp and maintenance dose of MgSO4 has been started. What is your next step in management? a. Mg SO4 bolus b. Delivery of baby c. MgSO4 loading dose d. Diazepam
Ans. The key is A. MgSO4 bolus.
79
1379. A man suffering from Influenza A since 5d ago. CXR: pneumonia. What organism is responsible for pneumonia in this pt? a. Hemophilius influenze b. Klebsiella c. Staphylococcus aureus d. Streptococcus pneumonia e. Pseudomonas
Ans. The key is C. Staphylococcus aureus. [Post flue pneumonia is usually caused by staphylococcus aureus].
80
1380. A pt admitted due to repeated attacks of pancreatitis presents with dementia and loss of proprioception in the legs. What is the most appropriate tx? a. Thiamine b. Pyridoxine c. Cobolamin d. Lipase e. Antibiotics
Ans. The key is C. Cobalamin. [Pancreatic insufficiency can lead to malabsorption and B12 (cobalamin) deficiency. Dementia and diminished vibratory sensation and proprioception in the lower extremities were the most common objective findings of cobalamin deficiency].
81
1381. A man after MI presented with sudden breathlessness and dyspnea. Exam: scattered pansystolic murmur all over the precordium. What is the next inv that will lead to dx? a. ECG b. Echo c. CT d. Blood culture e. CXR
Ans. The key is B. echo. [Sudden breathlessness and dyspnea suggest mitral regurgitation secondary to papillary muscle rupture but on the otherhand pansystolic murmur all over the precordium suggest VSD! However in either case required investigation is echo].
82
1382. During a laparoscopic procedure, a trochar is inserted halfway between the umbilicus and the ant superior iliac spine. What are the structures most likely to be pierced? a. Rectus sheath b. Linea alba c. External oblique aponeurosis d. Internal oblique and transverse abdominal e. Both C and D
Ans. The key is D. Internal oblique and transversus abdominis.
83
1383. A pt, a small child presented with URTI and later developed fever, earache and tympanic membrane is dull. What is the likely dx? a. OM b. OE c. Glue ear d. Perforation of the tympanic membrane e. Referred ear ache
Ans. The key is A. OM. [Fever, earache and dull tympanic membrane following urti are pointing the diagnosis of acute otitis media].
84
1384. A 72yo male who is a regular smoker has come to the ED with complaints of loss of weight and loss of appetite. He also complains of odynophagia. Exam: actively bleeding ulcer on right tonsil. What is the most appropriate dx? a. Tonsillar ca b. Vincent’s angina c. Irritant ingestion d. Paracoccidiodmycosis e. Herpes simplex infection
Ans. The key is A. Tonsillar ca.
85
1385. A pt with regular episodes of SNHL, vertigo and tinnitus lasting >30min. Neurological exam=normal. What is the likely dx? a. Meniere’s disease b. Acoustic neuroma c. Otosclerosis d. Benign positional vertigo e. Labrynthitis
Ans. The key is A. Meniere’s disease. [SNHL vertigo andtinnitus lasting 30 minutes are consistent with Meniers disease. Here attacks are episodic that is symptoms resolves but hearing loss is progressive. In acoustic neuroma hearing loss is not episodic. Otosclerosis also not episodic and conductive type. Benign positional vertigo, no hearing loss and vertigo with sharp posture change. Unilateral
86
1386. A pt with celiac disease from birth, now as an adult presented with some abdominal symptoms. The biopsy shows infiltration of the gastric epithelium by lymphocytes. What is the most likely dx? a. Lymphoma b. Diverticular disease c. Lynch syndrome d. Gastric TB e. Peritoneal tumor
Ans. The key is A. Lymphoma. [Coeliac disease leads to an increased risk of both adenocarcinoma and lymphoma of gut].
87
1387. A 55yo man presented with hot, raised, tender area of skin on his right leg. He is febrile with rigors. He has been started on flucloxacillin. What other meds will you add? a. Ciprofloxacin b. Gentamicin c. Metronidazole d. Benzylpenicillin e. Ceftriaxone
Ans. The key is D. Benzylpenicillin. [Abscess, cellulitis, furuncle these lesions are usually caused by Staphylococcus and streptococcus. So Benzylpenicillin should be added with flucloxacillin to cover streptococcus].
88
1388. A 65yo man has incurable bronchial cancer. He is unable to cough up his secretions. This is leading to a distressing cough. Which of the following drugs is most likely to help him? a. Scopolamine b. Xanomeline c. Aceclidine d. Pilocarpine e. Cevimiline
Ans. The key is A. Scopolamine. [Any secretory condition of lung is reduced and improved with scopolamine].
89
1389. A pt presented after eating a seafood dish at a local restaurant. He complains of difficulty in breathing. His speech is slurred and his BP=85/55mmHg. What would be the most appropriate next step? a. IV adrenaline b. IM adrenaline c. SC adrenaline d. PO chlorpheniramine e. IV chlorpheniramin
Ans. The key is B. IM adrenaline. [Patient is getting anaphylactic shock with difficulty of breathing and slurred speech (probably from tongue swelling) which are indications of IM adrenaline].
90
1390. A 7yo boy presents with proptosis and periorbital edema. What is the immediate action that needs to be taken? a. IV morphine and immediate ophthalmoscopy b. IV morphine c. Observation only
Ans. The key is A. IV morphine and immediate ophthalmoscopy.
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1391. A schizophrenic man complains that he can hear voices talking about him and telling him to end his life by cutting his throat. He only hears them when he wakes up from sleep and not at other times. What type of hallucinations is he having? a. Somatic b. Kinesthetic c. Hypnogogic d. Hypnopompic e. Lilliputian
Ans. The key is D. Hypnapompic hallucination. [Hallucinations during going for sleep is hypnagogic and hallucinations during wake up from sleep is hypnapompic hallucinations].
92
1392. A 28yo woman complains of hearing strange voices in her bedroom as she is falling asleep in the night. She says there is no one in the room except her. On evaluation she has no other problems. What is she suffering from? a. Delusion of persecution b. Cotard syndrome c. Hypnogogic hallucinations d. Lilliputian hallucinations e. Schizophrenia
Ans. The key is C. Hypnagogic hallucinations. [Hallucinations during going for sleep is hypnagogic and hallucinations during wake up from sleep is hypnapompic hallucinations].
93
1393. A 32yo man on psychiatric meds presents with coarse tremors and diarrhea. What is the most likely alt to the drug causing the prb? a. Lithium b. Diazepam c. Haloperidol d. Valproate e. Citalopram
Ans. The key is D. Valproate. [Diarrhea and coarse tremors are well known side effects of valproate].
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1394. A man is brought to the ED after he was stabbed in the chest. Chest is clear bilaterally with muffled heart sounds. BP=60/0mmHg, pulse=120bpm, JVP is raised. What is the most probable dx? a. Pulmonary embolism b. Cardiac tamponade c. Pericardial effusion d. Hemothorax e. Pneumothorax
Ans. The key is B. Cardiac tamponade. [Lungs clear bilaterally excludes effusion and pneumothorax. Muffled heart sound and low bp with raised jvp points towards the diagnosis of cardiac tamponade].
95
1395. A 64yo alcoholic who has been dx with liver cirrhosis presents with a massive ascites. What is the mechanism of fluid accumulation in a pt with liver disease? a. Cirrhosis b. Portal HTN c. Hypoalbuminemia d. Liver failure e. Hepatic encephalopathy
Ans. The key is C. Hypoalbuminemia. [Mechanism of fluid accumulation (in general, not only ascites is hypoalbuminaemia].
96
1396. A 38yo man presented to ED with severe pain in upper abdomen. He has already taken course of triple therapy and now had elective endoscopy 2d ago. He is in shock. What is the most probable dx? a. Ca esophagus b. Barret’s esophagus c. Mediastinitis d. Ca stomach
Ans. The key is C. Mediastinitis.
97
1397. A 68yo man who is a known case of liver cirrhosis has developed ascites. What is the mechanism for the development of ascites? a. Portal HTN b. Hypoalbuminemia c. Congestive heart failure d. Liver failure
Ans. The key is A. Portal hypertension. [Development of ascites is more due to portal hypertension in a patient with liver disease].
98
1398. A man feels mild discomfort in the anal region and purulent discharge in underpants. What is the most likely dx? a. Feacal incontinence b. Anal abscess c. Fistula in ano d. Anal tags e. Rectal Ca
Ans. The key is C. Fistula in ano. [Abscess is with severe pain which may reduce after it bursts with purulent discharge. But here mild discomfort and purulent discharge favours the diagnosis of fistula].
99
1399. A 38yo female presents with difficult in looking upward and on examination she was found to have lid lag as well. She also complains of her heart racing at times. Which test will help in dx? a. Tensilon test b. 24h ECG c. TFT d. Schimmer test e. Young Helmholtz ophthalmoscopy
Ans. The key is C. TFT. [Difficulty in looking upwards is due to superior rectus or inferior oblique palsy and palsy of one or more extra-ocular muscle can occur in thyrotoxicosis which is known as Ballett’s sign. There is lid lag in thyrotoxicosis and racing heart is due to paroxysmal atrial fibrillation caused by hyperthyroidism].
100
1400. A young anxious mother of a 10m boy comes to you and requests a test for CF. What is the most appropriate inv? a. Sweat test b. Heel prick test c. Breath test d. CXR
Ans. The key is A. Sweat test. [The sweat test measures the concentration of chloride that is excreted in sweat. It is used to screen for cystic fibrosis (CF). Due to defective chloride channels, the concentration of chloride in sweat is elevated in individuals with cystic fibrosis].
