201 to 300 Flashcards
1
Q
- A 29yo teacher is involved in a tragic RTA. After that incident, he has been suffering from nightmares and avoided driving on the motorway. He has been dx with PTSD. What is the most appropriate management? a. CBT b. Diazepam c. Citalopram d. Dosalepin e. Olanzepin
A
Ans. The key is A. CBT. [CBT is the treatment of choice in PTSD].
2
Q
- A 5yo child presents with fever. He looks pale. His parents say he always feels tired. On exam: orchidomegaly & splenomegaly. Labs: WBC=1.7, Hgb=7.1, Plt=44. What is the dx? a. ALL b. CLL c. AML d. CML e. Hodgkins
A
Ans. The key is A. ALL. [normally in ALL CBC shows raised WBC, low RBC and low platelet; but it is also possible to all cell lines to be depressed, as is the presented case].
3
Q
- A 6wk child is brought in with vomiting, constipation and decreased serum K+. What is the dx? a. Pyloric stenosis b. Duodenal atresia c. Hirschsprung disease d. Achalasia cardia e. Tracheo-esophageal fistula
A
Ans. The key is A. Pyloric stenosis. [why not duodenal atresia? Pyloric stenosis is much more commoner than duodenal atresia; in duodenal atresia the vomitus should contain bile, which is not the case in pyloric stenosis].
4
Q
- A 17 yo girl had an episode of seizure. Contraction of muscles started from around the interphalangeal joints, which spread to the muscles of wrist and elbow. Choose possible type of seizure? a. Grand mal b. Tonic clonic c. Myoclonic d. Absent
A
Ans. The key is C. Myoclonic. [seizers associated with contraction of specific muscle group is seen in myoclonic seizers].
5
Q
- 46yo man, known case of chronic GN presents to OPD. He feels well. BP = 140/90mmHg. Urine dipstick: protein ++, blood ++ and serum creatinine=106mmol/L. Which medication can prevent the progression of this dx? a. ACEi b. Diuretics c. Cytotoxic meds d. Longterm antibiotics e. Steroids
A
Ans. The key is A. ACEI. [renal impairment is delayed by ACEI].
6
Q
- A 23 yo girl presented with perioral paresthesia and carpopedal spasm 20 mins after a huge argument with her boyfriend. What is the next step for this pt? a. SSRI b. Diazepam c. Rebreath into a paper bag d. Propranolol e. Alprazolam Q. 1. What is the key? Q. 2. What is the likely diagnosis?
A
Ans. 1. The key is C. Rebreathing in paper bag. [hyperventilation causes CO2 washout and respiratory alkalosis. If you continue breathing and rebreathing in paper bag it will allow CO2 concentration to rise in paper bag and as you rebreath this again and again you will regain some washed out CO2 and thus relief to this alkalosis]. Ans. 2. The girl may have anxiety disorder when it precipitates lea
7
Q
- A 25 yo woman has been feeling anxious and nervous for the last few months. She also complains of palpitations and tremors. Her symptoms last for a few minutes and are very hard to control. She tells you that taking alcohol initially helped her relieve her symptoms but now this effect is wearing off and she has her symptoms even after drinking alcohol. What is the dx? a. Panic disorder b. Dep
A
Ans. The key is A. Panic disorder.
8
Q
- A 2yo child is very naughty. His teacher complains that he is easily distracted. His parents say that he can’t do a particular task for a long time. He sometimes hurts himself and breaks many things. This causes many troubles at home. What is the dx? a. ASD b. Dyslexia c. ADHD d. Antisocial personality disorder e. Oppositional defiant
A
Ans. The key is C. ADHD (Attention deficit hyperreactive disorder).
9
Q
- A 79 yo lady who is otherwise well recently started abdominal pain. She is afebrile and complains that she passed air bubbles during urination. A urethral catheter showed fecal leakage in the urinary bag. What is the likely pathology? a. Diuretics b. CD c. Rectosigmoid tumor d. Large bowel perforation e. UC
A
Ans. The key is B. CD. [debate came that Crohn’s disease cannot occur in 79 yrs but this is not the case! “Crohn’s disease can occur at any age, but is most frequently diagnosed in people ages 15 - 35. About 10% of patients are children under age 18”. .So I think it can occur in this age also and the feature like fistula is a common association of CD].
10
Q
- A 2 month child with diarrhea and vomiting for 6 days is brought in looking lethargic. What is the appropriate initial inv? a. BUE b. Random blood sugar c. CBC d. CXR e. AXR
A
Ans. The key is A. BUE. [Electrolyte imbalance should be checked in this baby presenting with diarrhea and vomiting for considerable time].
11
Q
- A 72 yo man fell while shopping and hurt his knee. His vitals are fine. He speaks in a low voice and is very slow to give answers. What is the most probable dx? a. Alzheimers b. Vascular demetia c. TIA d. Pseudo-dementia e. Picks dementia
A
Ans. The key is A. Alzheimers
12
Q
- A 47 yo man met with a RTA. He has multiple injuries. Pelvic fx is confirmed. He has not passed urine in the last 4 hrs. What is the next appropriate management for this pt? a. Urethral catheter b. Suprapubic catheter c. IV fluids d. IV furosemide e. Insulin Q. 1. What is the key? Q. 2. What is the reason of this management?
A
Ans. 1. The key is B. Suprapubic catheter. Ans. 2. In pelvic fracture there is chance of urethral rupture and hence displacement of urethral catheter while try to place it.
13
Q
- A 49 yo pt presents with right hypochondriac pain. Inv show a big gallstone. What is the most appropriate management? a. Lap Cholecystectomy b. Reassure c. Low fat diet d. Ursodeoxycholic acid e. Emergency laparotomy Q. 1. What is the key? Q. 2. Points in favour?
A
Ans. 1. The key is A. Lap Cholecystectomy. Ans. 2. i) as symptomatic only reassurence is not appropriate ii) as big stone ursodyoxycholic acid is less effective iii) less invasiv is preferred so laparoscopic rather than laparotomy.
14
Q
- In a man who is neglected and alcohol dependent, whith high suicidal risk, which factor can increase this risk further? a. Alcohol dependence b. SSRI c. S]moking d. Agoraphobia e. Court involvement
A
Ans. The key is A. Alcohol dependence. This is wrong key!! Correct key should be B. SSRI. [He is already alcohol dependent. So further (additional) risk factor is SSRI (SSRI has well known risk of developing suicidal ideation].
15
Q
- A 71 yo man presents with coarse tremor. He is on some meds. Which one can be the reason for the tremor? a. Lithium b. Diazepam c. Fluoxetine d. Imipramine e. Haloperidol
A
Ans. The key is A. Lithium. Actually in therapeutic dose lithium causes fine tremor but in toxic dose it causes coarse tremor. So the probable answer is lithium.
16
Q
- A young woman complains of diarrhea, abdominal cramps and mouth ulcers. AXR shows distended transverse colon with globet cell depletion on rectal biopsy. What is the most probable dx? a. CD b. UC c. Bowel Ca d. Bowel obstruction e. IBS Q. 1. What is the key? Q. 2. What are points in favour?
A
Ans. 1. The key is B. UC. Ans. 2. In UC there is goblet cell depletion and less mucous production in contrast with CD where there may be goblet cell hyperplasia and mucous secretion is not reduced. Please note aphthous ulcer can develop in both CD and UC.
17
Q
- After eating a cookie at a garden party, a child began to cough and went blue. The mother also noticed that there were swollen patches on the skin. What is the dx? a. Allergic reaction b. Aspiration of food c. Cyanotic heart disease d. Trachea-esophageal fistula e. Achalasia cardia
A
Ans. The key is A. Allergic reaction.
18
Q
- A 70 yo man presents with balance difficulties, vomiting and nausea. Which of the following is the best inv? a. MRI cerebellum b. CT cerebellum c. Skull XR d. LP e. Blood culture
A
Ans. The key is A. MRI cerebellum. [Balance difficulties, vomitin and nausea suggests cerebellar lesion. In posterior fossa lesion MRI is preferred].
19
Q
- A 2 yo pt presents with colicky pain which radiates from loin to groin. He complains of similar episodes in the past. Inv has been done and 7mm stone was found in the ureter. What is the most appropriate management? a. Percutaneous nephrolithiotomy b. Open surgery c. Ureteroscopy or laser d. Conservative tx e. ESWL Q. 1. What is the key? Q. 2. What treatments are recommended for different siz
A
Ans. 1. The key is E. ESWL. Probably a wrong key! The correct key is C. Ureteroscopy or laser. [For 6-16 mm stone in pediatric group ureteroscopy is the treatment of choice. So answer here is C. Ureteroscopy or laser]. Ans. 2. Stones < 5mm: pass spontaneously, Increase fluid intake. Stones 5mm-10mm /pain not resolving: medical expulsive therapy—> Nifedipine or Tamsulosin(and/or prednisolone). St
20
Q
- A footballer has been struck in the groin by a kick and a presents with severe pain and mild swelling in the scrotum. What is the most appropriate next step? a. USG b. Doppler c. Exploratory surgery d. IV fluids e. Antibiotics
A
Ans. The key is C. Exploratory surgery. [To exclude torsion].
21
Q
- A 47 yo ex-soldier suffers from low mood and anxiety. He can’t forget the images he faces before and has always had flashbacks. He is not able to watch the news because there are usually some reports about war. What is he suffering from? a. Depression b. PTSD c. Panic attack d. Agoraphobia e. GAD
A
Ans. The key is B. PTSD. [repeated flashbacks and tendency to avoid the thoughts of stressor is diagnostic of PTSD].
22
Q
- A 36 yo 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. She gave hx of having low mood at 12 yo. What’s the dx? a. Mania b. Depression c. Bipolar affective disorder d. Borderline personality disorder e. Dysthymia
A
Ans. The key is C. Bipolar affective disorder. [Initial depressive episode (may be befor a long) followed by mania is bipolar affective disorder].
23
Q
- A 28 yo female presents with a 3m hx of diarrhea. She complains of abdominal discomfort and passing stool 20x/day. Exam=febrile. Barium enema shows cobblestone mucosa. What is the most likely dx? a. Ameoba b. Colon Ca c. GE d. CD e. UC
A
Ans. The key is D. CD. [Hx of diarrhea, abdominal discomfort, and patient being febrile indicate gut inflammation and cobblestone appearance on barium enema is suggestive of CD].
24
Q
- A child is brought in with high grade fever, runny nose and bark-like cough. He is also drooling. What is the most appropriate tx for this child? a. Corticosteroids b. Paracetamol c. Adrenaline nebulizer d. IV antibiotics e. Intubation under GA
A
Ans. The key is E. Intubation under GA. This is a wrong key! In epiglottitis there is no cough and bark like cough is diagnostic of croup! So the correct key should be a. Corticosteroids. [high fever, bark-like cough in a child suggest croup which is treated with corticosteroids. Drooling is sign of epiglottritis but some authority say it occasionally can be present in croup though not usual].
25
225. A 78yo lady on warfarin for atrial fibrillation lives in a care home. She presents with hx of progressive confusion for three days. She was also noticed to have bruises on her arms. INR = 7. What is the most probable dx? a. Alzheimers b. Delirium c. Subdural hemorrhage d. Vascular dementia e. Pick’s dementia
Ans. The key is C. Subdural haemorrhage. [Age 78 yrs, living in a care home where unnoticed trivial injury is possible (like fall), warfarine and high INR is potential risk factor of subdural haemorrhage suggested by bruises on arms also].
26
226. A 28 yo drug user presents to the ED with collapse and anuria. His serum K+ = 7.5mmol/L. CXR = early pulmonary edema. What is the next appropriate management? a. Urgent hemodialysis b. IV calcium gluconate c. IV insulin + dextrose d. Furosemide e. IV NS 0.9%
Ans. The key is B. IV calcium gluconate. [IV calcium gluconate is given to protect the heart from lethal arrhythmia or cardiac arrest from high potassium level and used to buy time while definitive management is being taken. Actually calcium gluconate don’t lower the potassium level that much but protect the heart from arrhythmia].
27
227. A 32 yo woman suffers an episode of severe occipital headache with vomiting and loss of consciousness. She is brought to the hospital where she is found to be conscious and completely alert. Exam: normal pulse & BP. No abnormal neurological signs. What is the next step in management? a. Admission for observation b. CT brain c. MRI head d. Reassurance and discharge e. XR skull
Ans. The key is B. CT brain. [basilar migraine can cause severe headache and LOC. But there occurs no neurological deficit and on recovering from unconsciousness becomes completely alert. But to diagnose basilar migraine there should at least history of two migraine attacks with aura. As here diagnostic criteria of basilar migraine is not fulfilled we can not discharge the patient without neuroima
28
228. A 25 yo woman was brought to the ED by her boyfriend. She has many superficial lacerations on her forearm. She is so distressed and constantly says her boyfriend is going to end the relationship. She denies trying to end her life. What is the most likely dx? a. Acute psychosis b. Severe depression c. Psychotic depression d. Borderline personality disorder e. Schizophrenia
Ans. The key is D. Borderline personality disorder. [ Borderline personality disorder: Act impulsively and develop intense but short-lived emotional attachment to others. They are usually attention seekers but not suicidal].
29
229. A young woman was brought to the hospital. On exam she has low temperature and tremor. She says when she closes her eyes, she can see colors. What drug has been used? a. Amphetamines b. LSD c. Cocaine d. Heroine e. Ecstasy
Ans. The key is B. LSD.
30
230. A lady comes in severe liver disease and hematemesis. Her INR is >10. What should she be given? a. FFP b. Steroids c. Whole blood d. IV fluids e. Vit K
Ans. The key is A. FFP.
31
231. After eating a cookie at a garden party, a child began to cough and went blue. The mother also noticed that there were swollen patches on the skin. What is the initial management? a. OTC antihistamine b. Oxygen c. Bronchodilators d. Epinephrine IM e. Nebulized epinephrine
Ans. The key is D. Epinephrine IM [anaphylaxis with partially blocked airway].
32
232. A 63 yo female is noted to have left pupil irresponsive to light and is dilated. What is the most probably dx? a. Pontine hemorrhage b. Subdural hemorrhage c. Cerebellar hemorrhage d. Extradural hemorrhage e. Subarachnoid hemorrhage
Ans. The key is D. Extradural hemorrhage. This is a wrong key! Correct key is B. Subdural hemorrhage.
33
233. A 28yo business executive presents at the GP asking for some help because she has been arguing with her boyfriend frequently. She is worried about her weight, and she thinks she may be fat. She has been on a diet and lost 7 kgs in the last 2 months on purpose. She is eating less. She used to do a lot of exercise. Now she says she’s feeling down, has some insomnia and feels tired and without e
Ans. The key is B. Bipolar disorder. [Now she is depressed but before hypomanic which makes the likely dx of bipolar disorder].
34
234. A woman brought her husband saying she wants the ‘thing’ on his forehead removed. The husband is refusing tx saying it improves his thinking. What is the most appropriate next step? a. Assess his mental capacity to refuse tx b. Remove lesion c. Refer to ED d. Mini-mental state exam e. Refuse surgery and send pt back
Ans. The key is A. Assess his mental capacity to refuse treatment.
35
235. A 37 yo man who has many convictions and has been imprisoned many times has a hx of many unsuccessful relationships. He has 2 boys but doesn’t contact them. What is the most probable dx? a. Borderline personality disorder b. Schizophrenia c. Avoidant personality disorder d. Histrionic personality disorder e. Antisocial behavior disorder
Ans. Ans. The key is E. Antisocial behavior disorder. [Antisocial personality disorder is a particularly challenging type of personality disorder, characterised by impulsive, irresponsible and often criminal behavior].
36
236. A 60 yo man has a pathological rib fx. He also complains of recurrent infection. BMA is done. Labs: Ca2+ = 3.9mmol/L and ALP = 127u/L. what type of cell would be found in abdundance in the marrow smear? a. Plasma cell b. Myeloid cell c. Bence-jones protein d. Megakaryocytes e. Reticulocytes Q. 1. What is the key. Q. 2. What is the diagnosis? Q. What are the points in favour of diagnosis?
Ans. 1. The key is A. Plasma cell. Ans. 2. The diagnosis of multiple myeloma. Ans. 3. Points in favour: i) age 60 yrs ii) pathological rib fracture (from metastases) iii) recurrent infection (due to B cell dysfunction (manifested as hypogammaglobulinemia), numerical and functional abnormalities of T cells, and dysfunction of natural killer cells), iv) raised calcium level.
37
237. A child presents with blue marks on the sclera, short stature and heart murmur. What is the dx? a. Osteogenesis imperfect b. Hypopituitarism c. VSD d. Achondrogenesis e. Dwarfism
Ans. The key is A. Osteogenesis imperfecta.
38
238. A 5month child can’t speak but makes sounds. She can hold things with palm, not fingers. Can’t sit independently but can hold her hand and sit when propped up against pillows. How’s the childs development? a. Normal b. Delayed speech c. Delayed sitting d. Delayed motor development
Ans. The key is A. normal
39
239. A 27 yo woman has hit her neck in an RTA without complains of tingling or motor loss. What is the next most appropriate inv? a. MRI b. XR c. CT cervical d. Diagonal XR
Ans. The key is B. X-ray. [As there is no neurological deficit we can exclude any fracture by x-ray first]. [Diagonal x ray means ,oblique view of cervical spine. By this view we can assess facet joint arthopathy. This doesn't related to RTA].
40
240. A young female who has many superficial lacerations was brought into the ED by her boyfriend for superficially lashing her upper arm. She is adamant and screaming that she is not suicidal but scared her boyfriend wants to leave her. What is the dx? a. Acute psychosis b. Severe depression c. Obsessive d. Bipolar e. Borderline personality f. Schizophrenia
Ans. The key is acute psychosis. Probably this is wrong key! Correct key should be E. Borderline personality disorder. [Borderline personality disorder (BPD), also known as emotionally unstable personality disorder, is a long term pattern of abnormal behavior characterized by unstable relationships with other people, unstable sense of self, and unstable emotions.[3][4] There is often an extreme fe
41
241. A 22yo woman was brought by her boyfriend with multiple superficial lacerations. There are scars of old cuts on her forearms. She is distressed because he wants to end the relationship. She denies suicide. What is the most likely dx? a. Acute psychosis b. Borderline personality disorder c. Severe depression d. Schizoid personality e. Psychotic depression
Ans. The key is B. Borderline personality. [Borderline personality disorder (BPD), also known as emotionally unstable personality disorder, is a long term pattern of abnormal behavior characterized by unstable relationships with other people, unstable sense of self, and unstable emotions.[3][4] There is often an extreme fear of abandonment, frequent dangerous behavior, a feeling of emptiness, and
42
242. A 31yo single man lives with his mother. He usually drives to work. He always thinks when the traffic lights change, his mother is calling him, so he drives back home. What is the dx? a. OCD b. GAD c. Schizophrenia d. Bipolar e. Cyclothymia
Ans. The key is C. Schizophrenia. [ delusion of reference - he thinks that the changing traffic lights aregiving message to him].
43
243. A 56yo woman is known case of pernicious anemia. She refuses to take hydroxycobalamin IM as she is needle shy. She asks for oral medication. Why will oral meds be not effective? a. Intrinsic factor def b. Malabsorption c. Irritated gastric mucosa d. Lack of gastric acidity
Ans. The key is A. Intrinsic factor def. [Vitamin B12 cannot be absorbed without intrinsic factor].
44
244. An 11m baby had an apnea event. The parents are worried that if something like this happens in the future, how they are to deal. Advise them about infant CPR. a. Index and middle finger compression b. Compression with palm of one hand c. Compression with palm of two hands d. Compression with rescue breaths 30:2 e. Compression with rescue breaths 15:2
Ans. The key is A. Index and middle finger compression.
45
245. A teacher brings in a child who says she fell down after hitting a table. On probing further, you decide that it was most probably an absence seizure. What led you to this dx? a. The child had not eaten since morning b. The child suddenly went blank and there was up-rolling of eyes c. The child started moving his fingers uncontrollably before he fell d. The child’s body became rigid and then
Ans. The key is B. The child suddenly went blank and there was up-rolling of eyes.
46
246. A man has discharge from his left ear after a fight. Where is the discharge coming from? a. CSF b. Inner ear c. Outer ear d. Brain
Ans. The key is A. CSF. [probable fracture base of skull].
47
247. A 40 yo manic depressive is noted to have high serum levels of lithium and profound hypokalemia. His GP had started him on anti-HTNs. Choose the single most likely cause? a. Verapamil b. Amiodarone c. Ranitidine d. Lithium e. Thiazide
Ans. The key is E. Thiazide. [Thiazide was prescribed for Hpt and when lithium was prescribed its level increased due to thiazide and thiazide also caused hypokalemia resulting the given picture].
48
248. A 74yo man presents with weakness in his arm and leg from which he recovered within a few days and short term memory loss. He has an extensor plantar response. He has similar episodes 2 years ago and became unable to identify objects and to make proper judgment. What is the most appropriate dx? a. Alcoholic dementia b. Pick’s dementia c. Huntington’s disease d. Alzheimer’s disease e. Vascular
Ans. The key is E. Vascular dementia. [hemiparesis, memory impairment, extensor planter reflex, inability to identify objects, poor judgment are features of strokes and thus vascular dementia].
49
249. A nurse comes to you saying that she has recently developed the habit of washing her hands after every 15-20 mins. She is unable to conc on her work and takes longer than before to finish tasks as she must constantly wash her hands. What is the most appropriate management? a. CBT b. SSRI c. ECT d. Antipsychotics e. Desensitization Q. 1. What is the key? Q. 2. What is the diagnosis?
Ans. 1. The key is A. CBT. Ans. 2. The diagnosis is OCD.
50
250. A 61yo man underwent a surgery in which ileal resection had been done. He complains of fatigue, headache, and heart racing. Labs: MCV=108fL, Hgb=8.9g/dL. What is the most likely dx? a. Vit B12 def b. Iron def c. Folate def d. Hemolytic anemia e. Anemia of chronic disease Q. 1. What is the key? Q. 2. What are the points in favour?
Ans. 1. The key is Vit. B12 deficiency. Ans. 2. Vit B12 is absorbed mostly in ileum. [As ileal resection is done B12 is not absorbed leading to megaloblastic anaemia].
51
251. A 7yo is brought by his mother who says that he was well at birth but has been suffering from repeated chest and GI infections since then. She also says that he is not growing well for this age. What is the likely condition of this child? a. CF b. SCID c. Primary Tcell immunodeficiency d. Primary Bcell immunodeficiency e. Malabsorption Q. 1. What is the key? Q. 2. What are the points in favou
Ans. 1. The key is A. cystic fibrosis. Ans. 2. CF involved in production of sweat, respiratory mucous, digestive fluid and mucous. These secretion becomes thick than normal predisposing to lung and GI infections since birth.
52
252. A 3yo child has a high temp for 4 days and he had not seen a doctor. Then mother notices rashes on buccal mucosa and some around the mouth. What is the most appropriate dx? a. Measles b. Roseola infectiosum c. Rubella d. Chicken pox e. Impetigo
Ans. The key is B. Roseola infectiosum. It is a wrong key! The correct key should be A. Measles! [As the rash developed after 4 days fever the dx is measles!].
53
253. A 70yo lady presents with fever for 3d and confusion. There is no significant PMH. What is the most probable dx? a. Delirium b. Hypoglycemia c. Alzheimers d. DKA
Ans. The key is A. Delirium. Delirium is an acute confusional state and declined cognitive function which involves changes in arousal (hyperactive, hypoactive or mixed), perceptual deficits, altered sleep-wake cycle, and psychotic features such as hallucinations and delusions.
54
254. An obese mother suffers from OSAS. Which of the following inv is best for her? a. ABG b. Overnight pulse-oximetry c. Polysomnography d. EEG
Ans. The key is B. Overnight pulse-oxymetry. [It is already a diagnosed case of OSAS. So no need for reconfirmation with polysomnography. If like to know the current status or monitor overnight pulse oxymetry is good].
55
255. A 28yo business man came to the sexual clinic. He was worried that he has HIV infection. 3 HIV tests were done and all the results are negative. After a few months, he comes back again and claims that he has HIV. What is the dx? a. Somatization b. Hypochondriac c. Mancheusens d. OCD e. Schizophrenia
Ans. The key is B. Hypochondriac. [Worry about having a serious illness].
56
256. A 6wk child presents with progressive cyanosis, poor feeding, tachypnea over the first 2 wks of life and holosystolic murmur. What is the most appropriate condition? a. ASD b. VSD c. Tricuspid atresia d. PDA e. TOF Q. 1. What is the key? Q. 2. What are the points in favour?
Ans. 1. The key is E. Tetralogy of Fallot. It is a wrong key!! Correct answer is C. tricuspid atresia. Ans. 2. Points in favour: i) tachypnoea over first 2 wks of life ii)progressive cyanosis iii) poor feeding iv) holosystolic murmur of VSD.
57
257. A 29yo woman who was dx to have migraine presents with severe onset of occipital headache. She lost her consciousness. CT=normal. Neurological exam=normal. What is the most appropriate management? a. Repeat CT b. MRI c. LP d. XR e. No inv required Q. 1. What is the key? Q. 2. What is the diagnosis? Q. 3. What are the points in favour
Ans. 1. The key is E. No investigation required. Ans. 2. The diagnosis is basilar migraine. Ans. 3. Points in favour i) history of migraine ii) severe occipital headache iii) LOC iv) CT normal v) neurological examination is normal.
58
258. A 19yo man has been happier and more positive than usual, with more energy than he has ever felt before for no particular reason. He has been getting more work done at the office today andhas been socializing with his friends as usual. What is the most likely dx? a. Atypical depression b. Marked depression c. Bipolar syndrome d. Psychosis e. Hypomania Q. 1. What is the key? Q. 2. What are the
Ans. 1. The key is E. Hypomania. Ans. 2. i) elevated mood ii) more energy than before iii) getting more work done at the office (loss of inhibition). These features are common for both mania and hypomania!! Then why it is not mania? It is not mania as in mania you will get psychotic symptoms like i) delusion of grandeur ii) auditory hallucinations, which are absent here!
59
259. A 35yo female attempts suicide 10x. There is no hx of psychiatric problems and all neurological exams are normal. What is the best tx? a. Problem focused tx b. CBT c. Antipsychotic d. Antidepressant e. ECT
Ans. The key is A. Problem focused tx. [patient is not psychotic and with normal neurology! So she may getting some problem in family life, finance, job or somewhere like this which she is not able to cope with and that is leading to her suicidal thoughts].
60
260. A 57yo man presents with weight loss, tiredness, fever and abdominal discomfort. Exam: spleen palpable up to the umbilicus. Labs: WBC=127, Hgb=8.7, Plt=138. What is the most likely dx? a. CML b. AML c. CLL d. AML e. Polycythemia Q. 1. What is the key? Q. 2. Why it is so diagnosed?
Ans. 1. The key is A. CML. Ans. 2. Points in favour of CML: i) Age 57 years ii) weight loss iii) abdominal discomfort iv) anaemia v) fever vi) marked splenomegaly.
61
261. A baby born at 34 weeks with a heart murmur is kept in the incubator for almost 4 weeks. There is no murmur at discharge. What is the likely cause of this murmur? a. PDA b. TOF c. Aneurysm of sinus of Valsalva d. Aorto-pulmonary septal defect e. AVM Q. 1. What is the key? Q. 2. Why it was present in this baby? Q. If it is present after birth what is the management?
Ans. 1. The key is A. PDA. Ans. 2. As it is more common in premature baby! Ans. 3. Management: to keep the duct open until after surgical repair.
62
262. A 6yo girl who has previously been well presented with a hx of tonic-clonic seizures lasting 4mins. Her mother brought her to the hospital and she appeared well. She is afebrile and didn’t lose consciousness during the episode of seizure. She has no neurologic deficit. What is the most appropriate inv for her? a. ABG b. Serum electrolytes c. ECG d. Blood glucose Q. 1. What is the key? Q. 2. W
Ans. 1. The key is B. Serum electrolyte. Ans. 2. In epilepsy patient becomes unconscious. The child has no previous illness and she was conscious during the episode of seizure. So electrolyte imbalance may be the cause.
63
263. A 60yo woman was found by her son. She was confused and had urinary incontinence. She has recovered fully after 6h with no neurological complaints. What is the most likely dx? a. Stroke b. Vestibular insufficiency c. TIA d. Intracranial hemorrhage
Ans. The key is C. TIA.
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264. A 34yo woman presents 3 weeks after childbirth. She has had very low mood and has been suffering from lack of sleep. She also has thought of harming her little baby. What is the most appropriate management for this pt? a. ECT b. CBT c. IV haloperidol d. Paroxethine e. Amitryptiline Q. 1. What is the key? Q. 2. What is the diagnosis? Q. 3. What are the points in favour of your diagnosis?
Ans. 1. The key is A. ECT. This is a wrong key. Correct key is B. CBT. Ans. 2. The diagnosis is post purtum depression (thinking of harming baby is not psychosis but depression and attempt or action to harm baby is psychosis). Ans. 3. Points in favour: i) onset 3 weeks after childbirth ii) Depressive symptoms (very low mood, insomnia) iii) thought of harming her little baby but no attempt or actio
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265. A 65yo woman presents with headache. She also complains of dizziness and tinnitus. She has Recently realized she has visual problems. There is hx of burning sensation in fingers and toes. On exam: splenomegaly, itchy after hot bath. Labs: RBC=87, Hgb=31.9, Plt=796. What is the dx? a. CML b. CLL c. Polycythemia vera d. Myelofibrosis e. NHL Q. 1. What is the key? Q. 2. What are the points in fa
Ans. 1. The key is C. Polycythemia vera. Ans. 2. Points in favour: i) hyperviscosity symptoms (headache, dizziness, tinnitus, visual problem) ii)pruritus, typically after a hot bath, iii)splenomegaly iv) RBC=87, Hb=31.9, Plt=796.
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266. A 29yo male brought to ED in unconscious state. There is no significant past hx. Which of the following should be done as the initial inv? a. CT b. Blood glucose c. ABG d. MRI e. CBC
Ans. The key is B. Blood glucose.
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267. A 45yo woman comes with red, swollen and exudating ulcer on the nipple and areola of right breast with palpable lump under the ulcer. What do you think is causing this skin condition? a. Inflammatory cells releasing cytokines b. Infiltration of the lymphatics by the carcinomatous cells c. Infiltration of the malignant skin cells to the breast tissue
Ans. The key is B. Infiltration of the lymphatics by the carcinomatous cells.
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268. A 20yo young lady comes to the GP for advice regarding cervical ca. she is worried as her mother past away because of this. She would like to know what is the best method of contraception in her case? a. POP b. Barrier method c. IUCD d. COCP e. IUS
Ans. The key is A. POP. Probably wrong key! Correct key should be B. Barrier method! [spermatozoa itself acts as a carcinogen!!! So barrier method is the best protection from the given option!!].
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269. A 66yo man, an hour after hemicolectomy has an urine output of 40ml. However, an hour after that, no urine seemed to be draining from the catheter. What is the most appropriate next step? a. IV fluids b. Blood transfusion c. Dialysis d. IV furosemide e. Check catheter
Ans. The key is E. Check catheter
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270. A 24yo pt presented with anaphylactic shock. What would be the dose of adrenaline? a. 0.5ml of 1:1000 b. 0.5ml of 1:10000 c. 1ml of 1:500 d. 5ml of 1:1000 e. 0.05ml of 1:100
Ans the key is A. o.5 ml of 1:1000. [in cardiac arrest 1 ml of 1:1000 iv].
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271. A 44yo woman complains of heavy bleeding per vagina. Transvaginal US was done and normal. Which of the following would be the most appropriate inv for her? a. Hysterectomy b. Endometrial biopsy c. CBC d. High vaginal swab e. Coagulation profile
Ans. The key is E. Coagulation profile. [Transvaginal US is normal i.e. no endometrial hyperplasia, no fibroid or obvious cause for heavy bleeding was found. So now most appropriate investigation should be coagfulation profile].
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272. A 60yo woman presented to OPD with dysphagia. No hx of weight loss or heartburn. No change in bowel habits. While doing endoscopy there is some difficulty passing through the LES, but no other abnormality is noted. What is the single most useful inv? a. CXR b. MRI c. Esophageal biopsy d. Esophageal manometry e. Abdominal XR Q. 1. What is the key? Q. 2. What is the diagnosis? Q. 3. What is the
Ans. 1. The key is D. Oesophageal manometry. Ans. 2. Achalasia cardia Ans. 3. i) Oral medication: Nitrates or CCB ii) Balloon dilatation of the spincter iii) Oesophagomyotomy.
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273. A 24yo woman presents with deep dyspareunia and severe pain in every cycle. What is the initial inv? a. Laparoscopy b. Pelvic US c. Hysteroscopy d. Vaginal Swab Q. 1. What is the key? Q. 2. What is the likely diagnosis? Q. 3 What is the treatment?
Ans. 1. The key is B. Pelvic US. Ans. 2. The likely diagnosis is endometriosis. Ans. 3. Treatment: There is no cure for endometriosis, but a number of treatments may improve symptoms. This may include pain medication [NSAIDs such as naproxen], hormonal treatments [COCP, or mirena], or surgery [Surgical removal of endometriosis when other measures fail].
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274. A 38yo woman, 10d postpartum presents to the GP with hx of passing blood clots per vagina since yesterday. Exam: BP=90/40mmhg, pulse=110bpm, temp=38C, uterus tender on palpation and fundus 2cm above umbilicus, blood clots +++. Choose the single most likely dx/ a. Abruption of placenta 2nd to pre-eclampsia b. Concealed hemorrhage c. Primary PPH d. Secondary PPH e. Retained placenta f. Scabies
Ans. 1. The key is D. Secondary PPH. Ans. 2. Secondary PPH: Secondary PPH is defined as abnormal or excessive bleeding from the birth canal between 24 hours and 12 weeks postnatally.
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275. A 32yo female with 3 prv 1st trimester miscarriages is dx with antiphospholipid syndrome. Anticardiolipin antibodies +ve. She is now 18wks pregnant. What would be the most appropriate management? a. Aspirin b. Aspirin & warfarin c. Aspirin & heparin d. Heparin only e. Warfarin only
Ans. The key is C. Aspirin & heparin.
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276. A 23yo presents with vomiting, nausea and dizziness. She says her menstrual period has been delayed 4 weeks as she was stressed recently. There are no symptoms present. What is the next appropriate management? a. Refer to OP psychiatry b. Refer to OP ENT c. CT brain d. Dipstick for B-hCG e. MRI brain Q. 1. What is the key? Q. 2. What is the likely diagnosis?
Ans. 1. The key is D. Dipstick for B-hCG. Ans. 2. Likely diagnosis is pregnancy. [Features like vomiting, nausea and dizziness are consistent with early pregnancy supported by delayed menstruation].
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277. A 16yo girl came to the sexual clinic. She complains of painful and heavy bleeding. She says she doesn’t a regular cycle. What is the most appropriate management? a. Mini pill b. Combined pill c. IUS d. Anti-prostoglandins e. Anti-fibrinolytics
Ans. The key is B. Combined pill.
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278. A 36yo man walks into a bank and demands money claiming he owns the bank. On being denied, he goes to the police station to report this. What kind of delusions is he suffering from? a. Delusion of reference b. Delusion of control c. Delusion of guilt d. Delusion of persecution e. Delusion of grandeur
Ans. The key is E. Delusion of grandeur.
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279. Which method of contraception can cause the risk of ectopic pregnancy? a. COCP b. IUCD c. Mirena d. POP
Ans. The key is B. IUCD.
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280. A woman has pernicious anemia. She has been prescribed parenteral vitamin B12 tx but she is needle phobic. Why is oral tx not preferred for this pt? a. IM B12 is absorbed more b. Intrinsic factor deficiency affects oral B12 utilization c. IM B12 acts faster d. IM B12 needs lower dosage e. Pernicious anemia has swallowing difficulties
Ans. The key is B. Intrinsic factor deficiency affects oral B12 utilization.
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281. An old man comes to the doctor complaining that a part of this body is rotten and he wants it removed. What is the most likely dx? a. Guilt b. Hypochondriasis c. Munchausen’s d. Nihilism e. Capgras syndrome
Ans. The key is D. Nihilism. [nihilism (medical term is nihilistic delusion): parts of the body do not exist or are dead] Guilt: an emotion that occurs when a person feels that they have violated a moral standard. Hypochondriasis: worry about having a serious illness. Munchausen’s: a psychiatric factitious disorder wherein those affected feign disease, illness, or psychological trauma to draw atte
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82. A 31yo woman who is 32weeks pregnant attends the antenatal clinic. Labs: Hgb=10.7, MCV=91. What is the most appropriate management for this pt? a. Folate supplement b. Ferrous sulphate 200mg/d PO c. Iron dextran d. No tx req
Ans. The key is D. No tx required. [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].
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283. A 47yo man who is a chronic alcoholic with established liver damage, has been brought to the hospital after an episode of heavy drinking. His is not able to walk straight and is complaining of double vision and is shouting obscenities and expletives. What is the most likely dx? a. Korsakoff psychosis b. Delirium tremens c. Wernickes encephalopathy d. Tourettes syndrome e. Alcohol dependence
Ans. The key is C. Wernicke’s encephalopathy. triad of i) ophthalmoplegia, ii) ataxia iii) confusion.
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284. A 32yo woman of 39wks gestation attends the antenatal day unit feeling very unwell with sudden onset of epigastric pain a/w nausea and vomiting. Temp 36.7C. Exam: RUQ tenderness. Bloods: mild anemia, low plts, elevated LFT and hemolysis. What is the most likely dx? a. Acute fatty liver of pregnancy b. Acute pyelonephritis c. Cholecystitis d. HELLP syndrome e. Acute hepatitis
Ans. The key is D. HELLP syndrome. [H=hemolysis, EL=elevated liver enzyme, LP=low platelet count].
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285. A 57yo woman presents with dysuria, frequency and urinary incontinence. She complains of dyspareunia. Urine culture has been done and is sterile. What is the most appropriate step? a. Oral antibiotics b. Topical antibiotics c. Topical estrogen d. Oral estrogen e. Oral antibiotics and topical estrogen
Ans. The key is C. Topical estrogen. [There may be UTI like symptoms and dyspareunia in atrophic vaginitis for which topical oestrogen can be used]
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286. A pt came to the ED with severe lower abdominal pain. Vitals: BP=125/85mmHg, Temp=38.9C. Exam: abdomen rigid, very uncomfortable during par vaginal. She gave a past hx of PID 3 years ago which was successfully treated with antibiotics. What is the appropriate inv? a. US b. Abdomen XR c. CT d. High vaginal e. Endocervical swab
Ans. The key is A. US. [Patient had previous PID. Current symptoms of severe cervical motion tenderness with significant rise of temperature is very much suggestive of pelvic abscess].
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287. A pregnant woman with longterm hx of osteoarthritis came to the antenatal clinic with complaints of restricted joint movement and severe pain in her affected joints. What is the choice of drug? a. Paracetamol b. Steroid c. NSAID d. Paracetamol+dihydrocoiene e. Pethadine
Ans. The key is A. Paracetamol.
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288. A 24yo 18wk pregnant lady presents with pain in her lower abdomen for the last 24h. She had painless vaginal bleeding. Exam: abdomen is tender, os is closed. What is the most probable dx? a. Threatened miscarriage b. Inevitable miscarriage c. Incomplete miscarriage d. Missed miscarriage e. Spontaneous miscarriage
Ans. The key is A. Threatened miscarriage. [gestational age 18 weeks, lower abdominal pain, tender abdomen, closed os and painless vaginal bleeding indicates threatened abortion].
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289. A 2yo child playing in the garden had a clean cut. She didn’t have any vaccinations. Also, there is no contraindication to vaccinations. Parents were worried about the vaccine side effects. What will you give? a. Clean the wound and dress it b. Give TT only c. Give DPT only d. Give DPT and tetanus Ig e. Give complete DPT vaccine course
Ans. The key is E. Give complete DPT vaccine course.
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290. A 32yo female who has had 3 prv miscarriages in the 1st trimester now comes with vaginal bleeding at 8wks. US reveals a viable fetus. What would be the most appropriate definitive management? a. Admit b. Aspirin c. Bed rest 2 weeks d. Cervical cerclage e. No tx
Ans. The key is B. Aspirin. [Early miscarriage is more common in antiphospholipid syndrome and treated with heparin or aspirin when become pregnant].
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291. A 6yo girl started wetting herself up to 6x/day. What is the most appropriate tx? a. Sleep alarms b. Desmopressin c. Reassure d. Behavior training e. Imipramine
Ans. The given key is B. Desmopressin. This is wrong key! Correct key is D. Behavior training. [behavior training seems to be more appropriate. Desmopressin is given for short term relief generally and after alarm bells fail to control symptoms, it is used in children above 7 yrs whereas given case is of a child of 6 yrs].
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292. A 27yo 34wk pregnant lady presents with headache, epigastric pain and vomiting. Exam: pulse=115, BP=145/95mmHg, proteinuria ++. She complains of visual disturbance. What is the best medication for the tx of the BP? a. 4g MgSO4 in 100ml 0.9%NS in 5mins b. 2g MgSO4 IV bolus c. 5mg hydralazine IV d. Methyldopa 500mg/8h PO e. No tx
Ans. The given key is A. 4g MgSO4 in 100ml 0.9%NS in 5mins. It is a wrong key. Correct key is E. No tx. [Here, question specifically asked for tx of BP. In case of BP of 145/95 mmHg no treatment for BP is needed. Ref: NICE guideline].
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293. A 24yo lady who is 37wk pregnant was brought to the ED. Her husband says a few hours ago she complained of headache, visual disturbance and abdominal pain. On arrival at the ED she has a fit. What is the next appropriate management for this pt? a. 4g MgSO4 in 100ml 0.9%NS in 5mins b. 2g MgSO4 IV bolus c. 2g MgSO4 in 500ml NS in 1h d. 4g MgSO4 IV bolus e. 10mg diazepam in 500ml 0.9%NS in 1h
Ans. The key is A. 4g MgSO4 in 100ml 0.9%NS in 5mins [NICE]. [Dx is eclumpsia].
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294. What is the pathological change in Barret’s esophagitis? a. Squamous to columnar epithelium b. Columnar to squamous epithelium c. Dysplasia d. Metaplasia e. Hyperplasia
Ans. The key is A. Squamous to columner epithelium.
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295. A 34yo male presents with hx of headache presents with ataxia, nystagmus and vertigo. Where is the site of the lesion? a. Auditory canal b. 8th CN c. Cerebellum d. Cerebral hemisphere e. Brain stem
Ans. The key is C. Cerebellum. [Features described are consistent with cerebellar lesion].
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296. A 24yo girl comes to the woman sexual clinic and seeks advice for contraception. She is on sodium valproate. a. She can’t use COCP b. She can use COCP with extra precaution c. She can use COCP if anticonvulsant is changed to carbamezapin. d. She can use COCP with estrogen 50ug and progesterone higher dose e. She can use COCP
Ans. The key is E. She can use COCP. [sodium valproate has no effect on COCP].
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297. A 27yo lady came to the ED 10 days ago with fever, suprapubic tenderness and vaginal discharge. PID was dx. She has been on the antibiotics for the last 10days. She presents again with lower abdominal pain. Temp=39.5C. what is the most appropriate next management? a. Vaginal swab b. Endocervical swab c. US d. Abdominal XR e. Laparoscopy
Ans. The key is C. US. [Initial presentation was of PID. But recurrance of symptoms suggests resistantcondition like abscess formation].
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298. An 18yo man complains of fatigue and dyspnea, he has left parasternal heave and systolic thrill with a harsh pan-systolic murmur at left parasternal edge. What is the most probable dx? a. TOF b. ASD c. VSD d. PDA e. TGA
Ans. The key is C. VSD.
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299. A young girl presenting with fever, headache, vomiting, neck stiffness and photophobia. She has no rashes. What is the most appropriate test to confirm dx? a. Blood culture b. Blood glucose c. LP d. CXR e. CT
Ans. The key is C. LP. [case of meningitis. LP will confirm the diagnosis].
100
300. A 65yo HTN man wakes up in the morning with slurred speech, weakness of the left half of his body and drooling. Which part of the brain is affected? a. Left parietal lobe b. Right internal capsule c. Right midbrain d. Left frontal lobe
Ans. The key is B. Right internal capsule. [As symptoms are on left side lesion is on right side of the brain. So answer should be either b) right internal capsule or c) right midbrain. If it was midbraine there would have cranial nerve involvement. On the other hand given picture is very much consistent with lacunar infarction of internal capsule!]
