301 to 400 Flashcards
1
Q
- A 27yo presents with abdominal pain, bleeding, vomiting and diarrhea. Her LMP was 7wks ago. Exam: abdominal tenderness, BP=90/60mmHg. What is the next appropriate management? a. Immediate laparotomy b. Laparoscopy c. Salpingotomy d. Salpingectomy e. MTX Q. 1. What is the key? Q. 2. What is the diagnosis? Q. 3. Justify the key.
A
Ans. 1. The key is A. Immediate laparotomy. Ans. 2. The diagnosis is ruptured ectopic pregnancy . Ans. 3. In ruptured ectopic pregnancy if there is shock we should go for immediate laparotomy.
2
Q
- A woman presents with complains of abdominal pain, unsteadiness, numbness of lower limb and palpitations. All inv are normal. What is the dx? a. Manchausen b. Somatization c. Hypochondriac d. Bipolar
A
Ans. The key is B. Somatization. [This is multiple, recurrent, medically unexplained symptoms usually starting early in life. Usually patient presents with one symptom at a time. Investigations are normal].
3
Q
- A 34yo African-caribbean man with a hx of sarcoidosis has presented with bilateral kidney stones. What is the most likely cause for this pt’s stones? a. Hypercalcemia b. Hyperuricemia c. Diet d. Recurrent UTIs e. Hyperparathyroidism Q. 1. What is the key? Q. 2. Why this occurs?
A
Ans. 1. The key is A. Hypercalcemia. Ans. 2. Hypercalcemia in sarcoidosis is due to the uncontrolled synthesis of 1,25-dihydroxyvitamin D3 by macrophages. 1,25-dihydroxyvitamin D3 leads to an increased absorption of calcium in the intestine and to an increased resorption of calcium in the bone.
4
Q
- Which of the following is NOT a physiological change during pregnancy? a. Tidal volume 500ml b. RBC vol 1.64L c. Cardiac output 6.5L/min d. Uterus weight 1.1kg e. ESR up by 4x
A
Ans. The key is A. Tidal volume 500 ml.
5
Q
- A 10yo boy presents with nose bleed. What measure should be taken to stop the bleeding? a. Press base of the nose b. Ice packs c. Press soft parts of the nose d. Start tranexemic acid e. IV fluids
A
Ans. The key is C. Press soft parts of the nose.
6
Q
- An MI pt who is already on aspirin no longer smokes and his cholesterol, ECG, echo and BP are normal. Choose the best option for him: a. Give statin b. Give statin+warfarin c. Low cholesterol diet d. Statin+ACEi
A
Ans. The key is D. Statin + ACEi. [Offer all people who have had an acute MI treatment with the following drugs: ACE (angiotensin-converting enzyme) inhibitor dual antiplatelet therapy (aspirin plus a second antiplatelet agent) beta-blocker statin. [2007, amended 2013] [NICE guideline].
7
Q
- A 46yo man is being treated for a pleural effusion. A chest drain has been sited just below the 4th rib in the mid-axillary line on his right side. What single structure is at particular risk of injury? a. Arzygos vein b. Diaphragm c. Intercostal artery d. Internal thoracic artery e. Liver
A
Ans. The key is C. Intercostal artery. [Most vulnerable structure is intercostal nerve, then intercostal artery then intercostals vein. As intercostal nerve is not in option intercostal artery is the answer here].
8
Q
- What advice would you give for the parents of a child with repeated UTI? a. Surgery b. Prophylactic antibiotics c. Increase fluids d. Toilet training e. Laxatives
A
Ans. The given key is A. Surgery. This is a wrong key. Correct option is B. Prophylactic antibiotic.[For repeated UTI prophylactic antibiotic should be given].
9
Q
- A pt presents with complete anuria following prolonged hypotension and shock in a pt who bled profusely from a placental abruption. What is the most probable dx? a. Post viral infection b. Acute papillary necrosis c. Acute cortical necrosis d. HUS e. Renal vein thrombosis Q. 1. What is the key? Q. 2. What is the reason for this?
A
Ans. 1. The key is C. Acute cortical necrosis. Ans. 2. There are 2 reasons for this acute cortical necrosis. i) significant diminished arterial perfusion of the kidneys due to spasm of the feeding artery secondary to profuse bleeding from placental abruption ii) DIC secondary to placental abruption.
10
Q
- An alcoholic 56yo man had ascetic fluid analysis done which was found to be yellow color. What is the most appropriate cause? a. Alcoholic hepatitis b. Decompensated cirrhosis c. TB peritonitis d. Pyogenic peritonitis e. Neoplasm Q. 1. What is the key? Q. 2. How this diagnosis is made?
A
Ans. 1. The key is B. Decompansated cirrhosis. Ans. 2. If the patient experiences serious problems described below his disease has progressed from compensated cirrhosis to decompensated cirrhosis: i) Bleeding varices (internal bleeding) ii) Ascites (fluid in the belly) iii) Encephalopathy (confusion) iv) Jaundice (yellowing of eyes and skin).
11
Q
- A 15yo boy presents with testicular pain for 2days. There is no hx of trauma. Exam: temp=38.5C,right hemi-scrotum tenderness. What is the single most appropriate management? a. Give antibiotics b. Give analgesia c. Reassure d. US scrotum e. Exploratory surgery Q. 1. What is the key? Q. 2. What is the diagnosis? Q. 3. What are the points in favour?
A
Ans. 1. The key is A. Give antibiotics. Ans. 2. The diagnosis is epididymo-orchitis. Ans. 3. Points in favour: i) No history of trauma ii) testicular pain with fever points towards epididymo- orchitis.
12
Q
- A 58yo lady presented with urinary incontinence. She looks anxious for her condition. Urine culture is sterile. Her urodynamic study is normal. What is the next step? a. Antibiotics b. Topical estrogen c. Systemic estrogen d. Duloxetine e. Pelvic floor exercise
A
Ans. The key is E. Pelvic floor exercise.
13
Q
- A 45yo lady came to family planning clinic for contraception advice. She is not keen to be pregnant for the next 3yrs. Her recent US showed multiple small submucosal fibroid. What is the best method of contraception for her? a. Etonogestrol b. COCP c. IUS d. POP e. IUCD
A
Ans. The key is C. IUS. [IUS gives 3-5 yrs long contraception. It also helps to shrink the fibroid].
14
Q
- A child presents with eczema. She was given two creams by the GP – emollient and steroid. What advice would you give her regarding application of the cream? a. Sparingly use both the cream b. First use emollient, then steroid c. Apply steroid then emollient d. Mix emollient & steroid before use e. Emollient at night with steroid
A
Ans. The key is B. First use emollient, then steroid. [emmolient 30 minutes before steroid].
15
Q
- All the following drugs do not cause bronchoconstriction except? a. Atenolol b. Salbutamol c. Salmetrol d. Ipratropium bromide e. Cocaine
A
Ans. The key is A. Atenolol.
16
Q
- A 28 yo female who delivered 6 weeks ago feels sad and has no interest to feeding the baby. She has been eating poorly and having difficulty sleeping. She feels weak throughout the day and has stopped taking the baby out of the house. She also says that the baby has evil eyes. What is the most likely diagnosis? a. Postpartum blues b. Postpaetum depression c. Postpurtum psychosis d. Schizophre
A
17
Q
- A 44yo man presents with periorbital and pedal edema. 24h urine shows 8g of protein/d and serum cholesterol=7mmol/L. Renal biopsy results are awaited. What would be the most likely dx? a. Minimal change disease b. Glomerulonephropathy c. Membranous glomerulonephropathy d. FSGS e. IgA nephropathy f. Mesangiocapillary
A
Ans. The given key is C. Membranous glomerulonephritis. [Some authority claims FSGS as more common cause of nephrotic syndrome].
18
Q
- A 53yo man presents complaining of weight loss, lethargy, increasing abdominal discomfort and gout for the past yr. Exam: spleen palpated 5cm below left costal margin, no fluid wave. CBC: Hgb=10.5g/dL, WBC=200 – 85% neutrophils, plts=100, Na+=140mmol/L, K+ 4mmol/L, creat=151umol/L, urea=7mmol/L. Serum B12 increased. Philadelphia chromosome +ve. What is the most likely dx? a. CML b. CLL c. AML
A
Ans. 1. The key is A. CML. Ans. 2. Points in favour: i) wt loss ii) lethargy iii) abdominal discomfort iv) splenomegaly v) gout [Elevated uric acid and vitamin B12 levels are found in 25% of patients of CML]. A blood picture is suggestive and +ve Philadelphia chromosome is diagnostic.
19
Q
- In a group of cancer pts, 10 died that wasn’t treated while 5 died in the tx group. Which statement is correct? a. Absolute risk =10 b. Relative risk =10 c. Relative risk =5 d. Absolute risk=5 e. Relative risk=2
A
Ans. Given key is E. relative risk = 2. [RR= Number of death in not treated group/number of death in treated group].
20
Q
- A 67yo woman has presented with hard, irregular, poorly defined 5cm lump in her right breast. She has a bruise on the surface and there is no discharge. What is the most likely dx? a. Fibroadenosis b. Fat necrosis c. Fibroadenoma d. Duct ectasia e. Ca breast Q. 1. What is the key? Q. 2. Please justify the key.
A
Ans. 1. The key is B. Fat necrosis. Ans. 2. Fat necrosis usually occurs following trauma or surgery. Given case is a fat necrosis of breast as there is no discharge and there is a bruise indicating prior trauma.
21
Q
- A 67yo female who had undergone a radical mastectomy now comes with the complaint of swelling and redness in her right upper limb. Involvement of which of the following structures explain these symptoms? a. Epitrochlear LN b. Cephalic vein c. Subclavian artery d. Axillary group of LN e. Long thoracic nerve
A
Ans. The key is D. Axillary group of LN. [Axillary clearance compromise lymphatic flow and may results in swelling of upper limb].
22
Q
- A 50yo smoker and heavy drinker presents with complaints of racing heart. A 24h ECG comes out normal. What is your next step in management? a. ECHO b. Reassure c. Stress test
A
Ans. The key is B. Reassure. [Smoking and alcohol excess can cause palpitation without any recognizable arrhythmia and for this no treatment is required].
23
Q
- A 47yo man comes to the GP with a swelling in his left groin which disappears on lying down.The swelling was bluish in color and felt like a bag of worms. He also complains of a mass in the left loin along with hematuria occasionally. What could be the possible dx? a. Left sided RCC b. Varicosity 2nd to liver disease c. Testicular tumor d. UTI e. IVC obstruction Q. 1. What is the key? Q. 2. W
A
Ans. 1. The key is A. Left sided Renal cell carcinoma. Ans. 2. Left sided varicocele. Ans. 3. Most common secondary cause of left sided varicocele is RCC. Newly diagnosed varicocele over the age of 40yrs are very much suggestive of RCC. Varicocele is common on left side as left testicular veins drain to the left renal vein, while the right testicular vein drain directly into IVC.
24
Q
- A man presents with muffled hearing and feeling of pressure in ear with tinnitus and vertigo. He also complains of double vision when looking to the right. What is the most appropriate dx? a. Meniere’s disease b. Acoustic neuroma c. Acute labyrinthytis d. Meningioma e. Otosclerosis Q. 1. What is the key? Q. 2. Justify the key.
A
Ans. 1. The key is B. Acoustic neuroma. Ans. 2. Hearing loss, feeling of pressure in the ear with tinnitus, vertigo and involvement of cranial nerve i.e. right abducent nerve are suggestive of acoustic neuroma.
25
325. In 85% of the population this artery is dominant. What is the single most appropriate option? a. Left ant descending artery b. Coronary sinus c. Circumflex artery d. Left main stem, post descending artery e. Right coronary artery Q. 1. What is the key? Q. 2. Justify the key.
Ans. 1. The key is E. Right coronary artery. Ans. 2. If the posterior discending artery is supplied by the circumflex artery then it is left dominant and if posterior descending artery is supplied by the right coronary artery then it is right dominant. As in 85% of population posterior descending artery is supplied by right coronary artery it is called the dominant that is right coronary artery is
26
326. A 54 yo lady presents with sudden, severe pain in the left half of her skull. She also complains of pain around her jaw. What is the next likely step? a. CT b. MRI c. Fundoscopy d. ESR e. Temporal artery biopsy 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 ESR. Ans. 2. The diagnosis is Giant cell arteritis or temporal arteritis. Ans. 3. Points in favour: i) Age >50yrs ii) Female sex iii) Severe pain in the left half of skull iv) Pain around the jaw (jaw claudication).
27
327. A teenage girl who was ‘fine’ until her boyfriend said he didn’t want the relationship anymore.She took 10 tablets of paracetamol in front of his mother after taking alcohol. What should you do? a. Refer to psychiatry b. Counselling c. GP to sort out family issues d. Return to work to relieve her anger
Ans. The key is A. Refer to psychiatry. [10 tablets of paracetamol is not a life threatening toxic dose and simultaneous drug overdose and alcohol consumption needs psychiatric evaluation].
28
328. A 6yo fell on outstretched hand while playing. He feels tender at the elbow but otherwise well. What is the most likely dx? a. Spiral fx b. Green stick fx c. Compound fx d. Supracondylar fx e. Pulled elbow
Ans. The key is B. Green stick fracture.
29
329. A man has a BP of 160/90mmHg, proteinuria++. KUB US are equally reduced in size with smooth borders and normal pelvic calyceal system. What is the cause of HTN in the pt? a. Chronic glomerulonephritis b. Chronic pyelonephritis c. Bilateral renal artery stenosis d. Essential HTN e. Polycystic kidney
Ans. The key is bilateral renal artery stenosis. This is probably a wrong key. The correct key should be A. Chronic glomerulonephritis. [In bilateral renal artery stenosis BP is very high (much more than 160/90 mmHg].
30
330. A lady presents with abdominal pain, dysuria, dyspareunia and vaginal discharge. What si your next step? a. Laparoscopy b. High vaginal swab c. Hysteroscopy d. Laparotomy e. US
Ans. The key is B. High vaginal swab. [Probable diagnosis is PID].
31
331. An old lady 72yo staying at a nursing home for a few years, a known HTN on reg tx presented with sudden dysphagia while eating with drooling of saliva and req urgent inv. What would be your next step? a. Ba swallow b. Chest CT c. Endoscopy d. Laryngoscopy e. CXR f. Endoscopy with biopsy
Ans. The key is C. Endoscopy. [Probable impacted food bolus (usually meat)which can be visualized and removed with the aid of endoscopy].
32
332. A man presents with outward deviation of his right eye and diplopia. Which nerve is affected? a. Left trochlear b. Left oculomotor c. Right trochlear d. Right abducens e. Right oculomotor
Ans. The given key is B. Left oculomotor! It is wrong key! Answer should be D. Right abducens.
33
333. A 60yo pt who has had a MI a week back presents with dyspnea and pericardial rub. ECG shows ST elevation. CXR: loss of margin at costo-vertebral angle. What is the single most likely cause? a. Cardiac tamponade b. Mitral regurge c. Dressler’s syndrome d. Atrial fib e. Emboli Q. 1. What is the key? Q. 2. Why it is not reinfarction as there is ST elevation?
Ans. 1. The key is C. Dressler’s syndrome. Ans. 2. There is pericardial rub there is pericarditis and in pericarditis there is widespread ST elevation. So the condition is not new MI but Dressler’s syndrome.
34
334. A 12yo girl presented with tics, LOC, no residual sign and no post-ictal phase. EEG abnormality in temporal lobe. The girl had a rapid recovery. What is the most probably dx? a. Generalized tonic-clonic b. Myoclonic d. Atonic seizure e. Febrile convulsion
Ans. The key is C. Partial –> generalized seizure
35
335. A 48yo woman who has been taking medications for asthma for a long time has now presented with decreasing vision. What is the most probable cause for her decrease in vision? a. Inhaled salbutamol b. Inhaled steroids c. Aminophylline d. Beta-blockers e. Oral steroids Q. 1. What is the key? Q. 2. Justify the key.
Ans. 1. The key is E. Oral steroid. Ans. 2. Prolonged steroid use leads to cataract formation.
36
336. A 34yo man after a car crash is in the ED and deteriorating. His GCS has fallen from 13 to 7.What is the most appropriate next step? a. CT b. Burr hole c. MRI d. Intubation e. IV fluids
Ans. The key is D. Intubation. [ABC protocol].
37
337. A pt with alternating swings or episodes from elation and depression had underwent tx and gotten better. What medication needed to be continued so he can stay well? a. Anxiolytics b. Mood stabilizers c. Antidepressants d. Antipsychotics
Ans. The key is B. Mood stabilizers [bipolar disorder treated with mood stabilizers]
38
338. A 40yo male with pre-existing glumerulonephritis having proteinuria and hematuria suddenly deteriorates and presents with oliguria and serum K+=7.8mmol/L, urea=13mmol/L, creat=342mmol/L, GFR=19mL/h. The best management would be? a. Calcium supplement b. Calcium resonate enema 30g c. 10units insulin with 50% dextrose d. Nebulized salbutamol e. 10ml of 10% calcium gluconate f. Hemodialysis urge
Ans. 1. The key is E. 10 ml of 10% calcium gluconate. Ans. 2. To prevent cardiac arrhythmia. [Actually calcium gluconate neither shifts K+ to cells nor reduces serum K+ level that much. It just prevents cardiac arrest or life threatening cardiac arrhythmia and buys time till definitive measures are taken].
39
339. 34yo man was brought to the ED after a RTA. BP=50/0mmHg and chest wall not moving symmetrically, RR=34bpm. What would be initial action? a. IV fluid infusion b. Intubation and ventilation c. CT chest d. Transfer to ITU
Ans. The key is B. Intubation and ventilation [ABC protocol].
40
340. A pt complains of SOB, wheeze, cough and nocturnal waking. He has dry scaly shin with rashes that are itchy. What is the single most likely dx? a. Scabies b. Eczema c. Rheumatism d. Dermatitis e. Psoriasis
Ans. The key is B. Eczema. [Asthma may be associated with atopy].
41
341. A 54yo woman has presented with episodes of abdominal ache, vomiting and postural hypotension. She also has a dark pigmentation of her skin. A dx of Addison’s disease was made. What is the most likely electrolyte abnormality expected in this pt? a. High Na+, Low K+ b. Low Na+, High K+ c. Low Na+, Low K+ d. High Na+, High K+ e. Low Na+, Normal K+
Ans. The key is B. Low Na+, High K+. [ with Addison disease, the sodium, chloride, and carbon dioxide levels are often low, while the potassium level is high].
42
342. An 8yo returned from Spain with severe pain in one ear. Exam: pus in auditory canal, tympanic membrane looks normal. What is the tx option? a. Gentamicin topical b. Amoxicillin PO c. Analgesia d. Amoxicillin IV Q. 1. What is the key? Q. 2. What is the diagnosis?
Ans. 1. The key is A. Gentamycin topical. Ans. 2. Diagnosis is otitis externa.
43
343. A 6wk child is very sick-looking. Bloods: Na+=124, K+=2.8. Dehydrated. What would you choose to resuscitate? a. 0.18% NS + 4% dextrose + 20mmol KCl b. 0.9% NS c. 0.45% NS d. 0.45% NS + 5% dextrose e. 0.45% NS + 5% dextrose + 20 mmol KCl
Ans. The given key is E. But it is wrong key! The correct key is B. 0.9% NS. Explanation: Rsuscitation is mostly done with 0.9% NS or ringers lactate, or hartmans solution. Here is hypokalemia. To treat hypokalaemia the cut off value is below 2.5 mmol/L and absence of anuria during resuscitation.Maintenance is with fluid E.
44
344. A 68yo man gets repeated attacks of LOC and TIA. What is the most likely cause for this? a. Atrial fib b. Mitral stenosis c. Aortic stenosis d. HOCM e. Carotid artery stenosis
Ans. The key is E. Carotid artery stenosis.
45
345. Pt presented with hemoptysis 7d post-tonsillectomy. What is the next step? a. Packing b. Oral antibiotics + discharge c. Admit + IV antibiotics d. Return to theatre and explore e. Ice cream and cold fluids
Ans. The key is C. Admit + IV antibiotic. [infection is a common cause of secondary haemorrhage. Patient should be admitted to observe the course of bleeding and treatment is given with IV antibiotics].
46
346. A child was admitted following a RTA with initial GCS=15. Then during the night the noticed GCS reduced to 13. What is the management? a. Refer to neuro-surgeon b. IV fluids c. Oxygen d. CT brain e. Skull XR
Ans. The key is D. CT brain. [probable intracranial haemorrhage].
47
347. A 57yo woman who is suffering from HTN, presented to the hospital with complaints of recurrent falls when trying to get out of bed or getting up from sitting. She is on some anti-HTN therapy with no other med prbs. What is the cause of her fall? a. CCB b. Vertibrobasiliar insufficiency c. Thiazide d. Hypoglycemia e. Infection
Ans. The key is C. Thiazide. [It causes postural hypotension by volume depletion].
48
348. A 56yo woman with MS presents with drooping of the left side of her lips. She also has loss of sensation over her face, hearing impairment and some in-coordination of her movements. What is the most likely anatomical site affected? a. Cerebellum b. Cerebrum c. Spinal cord d. Brain stem e. Optic nerve
Ans. The key is D. Brain stem. Features of 5, 7, 8th cranial nerve and cerebellum involvement suggestive of brainstem lesion.
49
349. A 68yo male presented with swelling in the lower pole of the parotid gland for the last 10yrs.Exam: firm in consistency. What’s the most probable dx? a. Pleomorphic adenoma b. Adenolymphoma c. Mikulicz’s disease d. Parotiditis e. Frey’s syndrome
Ans. The key is A. Pleomorphic adenoma. [Pleomorphic adenoma (most common) - also called benign mixed tumour: is the most common tumour of the parotid gland and causes over a third of submandibular tumours. They are slow-growing and asymptomatic, having a malignant potentiality].
50
350. A 28yo shipyard worker was admitted for pain in calf while at work which has been increasing over the last 3m. There is no hx of HTN or DM but he is a smoker. Exam: loss of posterior tibial and dorsalis pedis pulsation along with a non-healing ulcer at the base of the right 1st MTP joint. What is the most probably dx? a. Thromboangitis obliterans b. Sciatica c. DVT d. Baker’s cyst e. Embolus
Ans. The key is A. Thromboangitis obliterans. Ans. 2. i) young age ii) smoker iii) pain in cuff iv) loss of posterior tibial and dorsalis pedis pulsation v)non-healing ulcer at the base of the right 1st MTP joint all are suggestive of Buerger’s disease.
51
351. A 35yo lady presents with painful ulcers on her vulva, what is the appropriate inv which will lead to the dx? a. Anti-HSV antibodies b. Dark ground microscopy of the ulcer c. Treponema palladium antibody test d. Rapid plasma regain test e. VDRL
Ans. The key is A. Anti-HSV antibodies. [Genital Herpes may be asymptomatic or may remain dormant for months or even years. When symptoms occur soon after a person is infected, they tend to be severe.They may start as multiple small blisters that eventually break open and produce raw, painful sores that scab and heal over within a few weeks. The blisters and sores may be accompanied by flu-like sy
52
352. A 53yo man presents with a longstanding hx of a 1cm lesion on his arm. It has started bleeding on touch. What is the most likely dx? a. Basal cell carcinoma b. Kaposi’s sarcoma c. Malignant melanoma d. Squamous cell carcinoma e. Kerathoacanthoma
Ans. The key is D. Squamous cell carcinoma. [SSCs Arises in squamous cells. SCCs may occur on all areas of the body including the mucous membranes and genitals, but are most common in areas frequently exposed to the sun, such as the rim of the ear, lower lip, face, balding scalp, neck, hands, arms and legs. SCCs often look like scaly red patches, open sores, elevated growths with a central depress
53
353. A 47yo man with hx of IHD complains of chest pain with SOB on exertion over the past few days.ECG normal, Echo= increased EF and decreased septal wall thickness. What is the most likely dx? a. Dilated CM b. Constrictive pericarditis c. Amyloidosis d. Subacute endocarditis
Ans. The key is A. Dilated CM. [In dilated cardiomyopathy ejection fraction is decreased (but here increased which goes in favour of constrictive pericarditis). On the other hand decreased septal wall thickness favours the diagnosis of dilated cardiomyopathy. So it seems to be a bad recall!!].
54
354. An elderly pt who is known to have DM presents to the hospital with drowsiness, tremors and confusion. What inv should be done to help in further management? a. Blood sugar b. ECG c. Standing and lying BP d. Fasting blood sugar e. CT
Ans. The key is A. Blood sugar.
55
355. A 28yo pregnant woman with polyhydramnios and SOB comes for an anomaly scan at 31 wks.US= absence of gastric bubble. What is the most likely dx? a. Duodenal atresia b. Esophageal atresia c. Gastrochiasis d. Exomphalos e. Diaphragmatic hernia
Ans. The key is B. Oesophageal atresia.
56
356. A 1m boy has been brought to the ED, conscious but with cool peripheries and has HR=222bpm.He has been irritable and feeding poorly for 24h. CXR=borderline enlarged heart with clear lung fields. ECG=regular narrow complex tachycardia, with difficulty identifying p wave. What is the single most appropriate immediate tx? a. Administer fluid bolus b. Administer oxygen c. Oral beta-blockers d. Sy
Ans. 1. The key is D. Synchrnized DC cardioversion. Ans. As the patient is in probable hemodynamic instability (suggested by cool peripheries due to low BP or inadequate CO) so we should go for DC cardioversion. Ans. 3. Probable diagnosis is SVT.
57
357. A 7yo child presented with chronic cough and is also found to be jaundiced on examination.What is the most likely dx? a. Congenital diaphragmatic hernia b. Congenital cystic adenematoid malformation c. Bronchiolitis d. RDS e. Alpha 1 antitrypsin deficiency Q. 1. What is the key? Q. 2. Justify the key.
Ans. 1. The key is E. Alpha 1 antitrypsin deficiency. Ans. 2. Unexplained liver disease with respiratory symptoms are very suggestive of AATD.
58
358. A 35yo construction worker is dx with indirect inguinal hernia. Which statement below best describes it? a. Passes through the superficial inguinal ring only b. Lies above and lateral to the pubic tubercle c. Does not pass through the superficial inguinal ring d. Passes through the deep inguinal ring
Ans. The key is D. Passess through the deep inguinal ring.
59
359. A woman has numerous painful ulcers on her vulva. What is the cause? a. Chlamydia b. Trichomonas c. Gardenella d. HSV e. EBV
Ans. The key is D. HSV.
60
360. A 72 yo man has been on warfarin for 2yrs because of past TIA and stroke. What is the most important complication that we should be careful with? a. Headache b. Osteoporosis c. Ear infection d. Limb ischemia e. Diarrhea
Ans. A. Headache is the correct key. [Headache is the warning sign of hemorrhagic stroke].
61
361. A 55yo man has been admitted for elective herniorraphy. Which among the following can be the reason to delay his surgery? a. Controlled asthma b. Controlled atrial fib c. DVT 2yrs ago d. Diastolic BP 90mmHg e. MI 2 months ago
Ans. The key is E. MI 2 months ago [better go for surgery 6 months post MI as surgery before this has higher mortality rate].
62
362. A 65yo known case of liver ca and metastasis presents with gastric reflux and bloatedness. On bone exam there is osteoporosis. He also has basal consolidation in the left lung. What is the next appropriate step? a. PPI IV b. Alendronate c. IV antibiotics d. Analgesic e. PPI PO
Ans. Here is two key C. IV antibiotics and E. PPI PO. Correct key is C. IV antibiotics. [Pneumonia should be treated first].
63
363. A 66yo man has the following ECG. What is the most appropriate next step in management? a. Metoprolol b. Digoxin c. Carotid sinus massage d. Adenosine e. Amiodarone.
Ans. The key is A. Metoprolol. [P waves are replaced by fibrillatory f-waves. Irregular R-R intervals. Dx atrial fibrillation].
64
364. A 22yo sexually active male came with 2d hx of fever with pain in scrotal area. Exam: scrotal skin is red and tender. What is the most appropriate dx? a. Torsion of testis b. Orchitis c. Inguinal hernia d. Epididymo-orchitis Q. 1. What is the key? Q. 2. How will you differentiate torsion from epididymo-orchitis?
Ans. 1. The key is D. Epididymo-orchitis. Ans 2. In epididymo-orchitis there should be fever, elevation of testes reduces pain (positive prehn sign),In torsion testis lies at a higher level. In torsion urinalysis negative but in epididymo-orchitis it is positive.Epididymo-orchitis usually occurs in sexually active man.
65
365. A man on warfarin posted for hemicolectomy. As the pt is about to undergo surgery. What option is the best for him? a. Continue with warfarin b. Continue with warfarin and add heparin c. Stop warfarin and add aspirin d. Stop warfarin and add heparin e. Stop warfarin
Ans. The key is D. Stop warfarin and add heparin.
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366. A 65yo known alcoholic is brought into hospital with confusion, aggressiveness and ophthalmoplegia. He is treated with diazepoxide. What other drug would you like to prescribe? a. Antibiotics b. Glucose c. IV fluids d. Disulfiram e. Vit B complex
Ans. The key is E. Vitamin B complex.
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367. A 32yo woman has severe right sided abdominal pain radiating into the groin which has lasted for 3h. She is writhering in pain. She has no abdominal signs. What is the most likely cause of her abdominal pain? a. Appendicitis b. Ruptured ectopic pregnancy c. Salpingitis d. Ureteric colic e. Strangulated hernia Q. 1. What is the key? Q. 2. Abdominal pain radiating to groin, at which level of st
Ans. 1. The key is D. Ureteric colic. Ans. 2. It indicate stone at lower ureter. [ i) Pain from upper ureteral stones tends to radiate to the flank and lumbar areas. ii) Midureteral calculi cause pain that radiates anteriorly and caudally. This midureteral pain in particular can easily mimic appendicitis on the right or acute diverticulitis on the left. iii) Distal ureteral stones cause pain that
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368. A 39yo coal miner who smokes, drinks and has a fam hx of bladder cancer is suffering from BPH. The most important risk factor for his bladder carcinoma is? a. Fam hx b. Smoking c. Exposure to coal mine d. BPH Q. 1. What is the key? Q. 2. What are the risk factors for bladder cancer?
Ans. 1. The key is B. smoking. Ans. 2. Risk factors of bladder cancer: i) Smoking ii) Exposure to chemicals used in dye industry iii)Whites are more likely to develop bladder cancer iv) Risk increases with age v) More common in men vi)Chronic bladder irritation and infections (urinary infections, kidney and bladder stones, bladder catheter left in place a long time.) vii) Personal history of bladd
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369. A 34yo woman is referred to the endocrine clinic with a hx of thyrotoxicosis. At her 1st appointment she is found to have a smooth goiter, lid lag and bilateral exophthalmos with puffy eyelids and conjunctival injection. She wants to discuss the tx of her thyroid prb as she is keen to become pregnant. What is the most likely tx you would advise? a. 18m of carbimazole alone b. 18m of PTU alone
Ans. 1. The key is B. 18m of PTU alone. Ans. 2. Other drug option i.e Carbimazole is teratogenic [can cause i) spina bifida ii) cardiovascular malformations, hypospadius etc] if become pregnant. PTU is on the other hand relatively safe in pregnancy.
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370. A child living with his stepfather is brought by the mother with multiple bruises, fever and fractures. What do you suspect? a. NAI b. Malnutrition c. Thrombocytopenia d. HIV
Ans. The key is A. NAI. [H/O living with stepfather, multiple bruises, fever and fractures are suggestive of NAI].
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371. A young man who was held by the police was punched while in custody. He is now cyanosed and unresponsive. What is the 1st thing you would do? a. IV fluids b. Clear airway c. Turn pt and put in recovery position d. Give 100% oxygen e. Intubate and ventilate
Ans. The key is B. Clear airway. [ABC protocol].
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372. A HTN male loses vision in his left eye. The eye shows hand movement and a light shined in the eye is seen as a faint light. Fundus exam: flame shaped hemorrhages. The right eye is normal. What is the cause of this pts unilateral blindness? a. HTN retinopathy b. CRA thrombosis c. CRV thrombosis d. Background retinopathy e. Retinal detachmen
Ans. The key is A. HTN retinopathy [it is a wrong key. Correct key is C. central retinal vein thrombosis].
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373. A mentally retarded child puts a green pea in his ear while eating. The carer confirms this.Otoscopy shows a green colored object in the ear canal. What is the most appropriate single best approach to remove this object? a. By magnet b. Syringing c. Under GA d. By hook e. By instilling olive oil
Ans. The key is Under GA. [Pea is not a magnetic material and hence it cannot be removed by magnet, it will swell up if syringing is attempted, as hook placement is likely with risk of pushing the pea deeper it is not also suitable in a mentally retarded child, and olive oil is not of help in case of pea. So to avoid injury it is better to remove under GA].
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374. A pt presents with longstanding gastric reflux, dysphagia and chest pain. On barium enema, dilation of esophagus with tapering end is noted. He was found with Barrett’s esophagus. He had progressive dysphagia to solids and then liquids. What is the single most appropriate dx? a. Achalasia b. Esophageal spasm c. GERD d. Barrett’s esophagus e. Esophageal carcinoma
Ans. The key is E. Oesophageal carcinoma. [there is dilatation in oesophagus which is seen both in achalasia and carcinoma. Dysphagia to solid initaially is very much suggestive of carcinoma and also barrett’s change is a clue to carcinoma]
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375. A 48yo lady presents with itching, excoriations, redness, bloody discharge and ulceration around her nipple. What is the most likely dx? a. Paget’s disease of the breast b. Fibrocystic dysplasia c. Breast abscess d. Duct papilloma e. Eczema
Ans. The key is A. Paget’s disease of the breast.
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376. Pt with widespread ovarian carcinoma has bowel obstruction and severe colic for 2h and was normal in between severe pain for a few hours. What is the most appropriate management? a. PCA (morphine) b. Spasmolytics c. Palliative colostomy d. Oral morphine e. Laxatives Q. 1. What is the key? Q. 2. Why we should go for this option?
Ans. 1. The key is C. Palliative colostomy. Ans. 2. Cancer or chemotherapy induced obstructions are unlikely to respond to conservative management [NBM, IV fluid, nasogastric suction] and hence only analgesia will not relieve it. So in such cases we have to go for palliative colostomy.
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377. A 70yo man admits to asbestos exposure 20yrs ago and has attempted to quit smoking. He has noted weight loss and hoarseness of voice. Choose the single most likely type of cancer a.w risk factors present. a. Basal cell carcinoma b. Bronchial carcinoma c. Esophageal carcinoma d. Nasopharyngeal carcinoma e. Oral carcinoma Q. 1. What is the key? Q. 2. What are the conditions related to asbestos
Ans. 1. The key is B. Bronchial carcinoma. [Asbestos exposure is a risk factor for lung cancer and also has a synergistic effect with cigarette smoke. Horseness can be from involvement of recurrent laryngeal nerve]. Ans. 2. Conditions related to asbestos exposure: i) Pleural plaques (after a latent period of 20-40 yrs) ii)Pleural thickening iii) Asbestosis (latent period is typically 15-30 yrs) iv
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378. A 32yo woman had progressive decrease in vision over 3yrs. She is now dx as almost blind. What would be the mechanism? a. Cataract b. Glaucoma c. Retinopathy d. Uveitis e. Keratitis Q. 1. What is the key ? Q. 2. Why you made this diagnosis?
Ans. 1. The key is B. Glaucoma. This is wrong key! Correct option is retinopathy. Ans. 2. Cataract is unlikely at this age. Uveitis and iritis doesn’t have such degree of vision loss and iritis and anterior uveitis have pain, redness and photophobia. Open angle glaucoma mostly occurs after the age of 50yrs. Answer should be retinopathy (example retinitis pigmentosa).
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379. A child during operation and immediately after showed glycosuria, but later his urine sugar was normal. Choose the most probable dx. a. Pre-diabetic state b. Normal finding c. Low renal tubular threshold d. DM Q. 1. What is the key? Q. 2. Why glycosuria occurred?
Ans. 1. The key is B. Normal finding. Ans. 2. Stress during operation can cause transient hyperglycemia causing glycosuria secondary to stress induced rise of cortisole which becomes normal after some time.
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380. A pt presented with hx of swelling in the region of the sub-mandibular region, which became more prominent and painful on chewing. He also gave hx of sour taste in the mouth, the area is tender on palpation. Choose the most probable dx? a. Chronic recurrent sialadenitis b. Adenolymphoma c. Mikulicz’s disease d. Adenoid cystic carcinoma e. Sub-mandibular abscess
Ans. The key is A. Chronic recurrent sialadenitis. [pain, swelling, more pain on chewing, tenderness, and submandibular region suggests diagnosis of submandibular chronic recurrent sialadenitis, usually secondary to sialolithiasis or stricture].
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381. ECG of an 80yo pt of ICH shows saw-tooth like waves, QRS complex of 80ms duration, ventricular rate=150/min and regular R-R interval. What is the most porbable dx? a. Atrial fib b. Atrial flutter c. SVT d. Mobitz type1 second degree heart block e. Sinus tachycardia
Ans. The key is B. Atrial flutter. [Saw-tooth like waves, normal QRS complex of 80 ms (normal range 70-100 ms), ventricular rate of 150/min and regular R-R interval is diagnostic of atrial flutter].
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382. A 50 yo woman who was treated for breast cancer 3 yrs ago now presents with increase thirstand confusion. She has become drowsy now. What is the most likely metabolic abnormality? a. Hypercalcemia b. Hyperkalemia c. Hypoglycemia d. Hyperglycemia e. Hypocalcemia Q. 1. What is the key? Q. 2. Justify the key
Ans. 1. The key is A. Hypercalcemia. Ans. 2. Increased thirst, confusion, drowsiness these are features of hypercalcemia. Any solid organ tumour can produce hypercalcemia. Here treated Ca breast is the probable cause of hypercalcemia.
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383. A 29yo woman presents to her GP with a hx of weight loss, heat intolerance, poor conc and palpitations. Which of the following is most likely to be a/w dx of thyroiditis a/w viral infection? a. Bilateral exophthalmos b. Diffuse, smooth goiter c. Reduced uptake on thyroid isotope scan d. Positive thyroid peroxidase antibodies e. Pretibial myxedema Q. 1. What is the key? Q. 2. What is the diagn
Ans. 1. The key is C. Reduced uptake on thyroid isotope scan. Ans. 2. The diagnosis is De Quervain’s or subacute thyroiditis. Ans. 3. Viral or subacute thyroiditis: diagnostic criteria: i) Features of hyperthyroidism present. ii) Pain thyroid, not mentioned. iii) Investigations: high esr (60-100) not mentioned, Reduced uptake of radioactive iodine by the gland.
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384. A lady, post-colostomy closure after 4days comes with fluctuating small swelling in the stoma. What is the management option for her? a. Local exploration b. Exploratory laparotomy c. Open laparotomy d. Reassure
Ans. The key is A. Local exploration.
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385. A 65yo female pt was given tamoxifen, which of the following side effect caused by it will concern you? a. Fluid retention b. Vaginal bleeding c. Loss of apetite d. Headache and dizziness e. Anorgasm Q. 1. What is the key? Q. 2. What is the reason to select this key?
Ans. 1. The key is B. Vaginal bleeding. Ans. 2. Tamoxifen can promote development of endometrial carcinoma. So vaginal bleeding will be of concern for us.
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386. A 39yo man with acute renal failure presents with palpitations. His ECG shows tall tented T waves and wide QRS complex. What is the next best step? a. Dialysis b. IV calcium chloride c. IV insulin w/ dextrose d. Calcium resonium e. Nebulized salbutamol Q. 1. What is the key? Q. 2. What is the diagnosis? Q. 3. What is the significant of tall tented T waves and wide QRS complex?
Ans. 1. The key is B. IV calcium chloride (both IV calcium gluconate or IV calcium chloride can be used when there is ECG changes). Ans. 2. The ECG changes are suggestive of Hyperkalemia. Ans. 3. At potassium level of >5.5mEq/L occurs tall tented T waves and at potassium level >7mEq/L occurs wide QRS complex with bizarre QRS morphology.
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387. A 54yo pt 7 days after a total hip replacement presents with acute onset breathlessness and raised JVP. Which of the following inv will be most helpful in leading to a dx? a. CXR b. CTPA c. V/Q scan d. D-Dimer e. Doppler US of legs Q. 1. What is the key? Q. 2. Justify the key.
Ans. 1. The key is B. CTPA. Ans. 2. The patient has a +ve two level PE Wells score (if it was negative we should do D-Dimer) and there is no renal impairment or history suggestive of allergy to contrast media (if these present we should have go for VQ scan) the investigation of choice is PTCA. NICE guideline.
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388. A 7yo girl has been treated with penicillin after sore throat, fever and cough. Then she develops skin rash and itching. What is the most probable dx? a. Erythema nodosum b. Erythema multiforme c. SJS d. Erythema marginatum e. Erythema gangernosum Q. What is the key? Q. What common drugs causes this to occur?
Ans. 1. The key is B. Erythema multiforme. Ans. 2. Common drugs causing erythma multiforme are: antibiotics (including, sulphonamides, penicillin), anticonvulsants (phenytoin,barbiturates), aspirin, antituberculoids, and allopurinol.
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389. A 60yo man presented with a lump in the left supraclavicular region. His appetite is decreased and he has lost 5kg recently. What is the most probably dx? a. Thyroid carcinoma b. Stomach carcinoma c. Bronchial carcinoma d. Mesothelioma e. Laryngeal carcinoma
Ans. The key is B. Stomach carcinoma. [Mentioned lump in the left supraclavicular region is Vershow’s gland, has long been regarded as strongly indicative of the presence of cancer in the abdomen, specifically gastric cancer].
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390. A 64yo man has presented to the ED with a stroke. CT shows no hemorrhage. ECG shows atrial fib. He has been thrombolysed and he’s awaiting discharge. What prophylactic regimen is best for him? a. Warfarin b. Heparin c. Aspirin d. Statins e. Beta blockers
Ans. The key is A. Warfarine. [Atrial fibrillation: post stroke- following a stroke or TIA warfarine should be given as the anticoagulant of choice. NICE guideline].
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391. A 54yo man after a CVA presents with ataxia, intention tremors and slurred speech. Which part of the brain has been affected by the stroke? a. Inner ear b. Brain stem c. Diencephalon d. Cerebrum e. Cerebellum Q. 1. What is the key? Q. 2. What are the features of the condition?
Ans. 1. The key is E. Cerebellum. Ans. 2. i) Ataxia ii) slurred speech or dysarthria iii) dysdiodokokinesis iv) intention tremor v) nystagmus.
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392. A 57yo man with blood group A complains of symptoms of vomiting, tiredness, weight loss and palpitations. Exam: hepatomegaly, ascites, palpable left supraclavicular mass. What is the most likely dx? a. Gastric carcinoma b. Colorectal carcinoma c. Peptic ulcer disease d. Atrophic gastritic e. Krukenburg tumor
Ans. The key is A. Gastric carcinoma. i) blood group A is associated with gastric cancer ii) vomiting, tiredness, weight loss are general features of gastric cancer iii) palpitation from anemia of cancer iv)hepatomegaly (metastasis) and ascites are late features of gastric cancer. v) palpable left supraclavicular mass- is Vershow’s gland, has long been regarded as strongly indicative of gastric ca
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393. A 21yo girl looking unkempt, agitated, malnourished and nervous came to the hospital asking for painkillers for her abdominal pain. She is sweating, shivering and complains of joint pain. What can be the substance misuse here? a. Alcohol b. Heroin c. Cocaine d. LSD e. Ecstasy
Ans. The key is B. Heroin. [agitation, nervousness, abdominal cramp, sweating, shivering and piloerection, arthralgia these are features of heroin withdrawal].
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394. A child presents with increasing jaundice and pale stools. Choose the most appropriate test? a. US abdomen b. Sweat test c. TFT d. LFT e. Endomyseal antibodies
Ans. The key is A. US abdomen. [This is a picture suggestive of obstructive jaundice. LFT can give clue like much raised bilirubin, AST and ALT not that high and raised alkaline phosphatase but still USG is diagnostic in case of obstructive jaundice].
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395. A 32yo man presents with hearing loss. AC>BC in the right ear after Rhine test. He also complains of tinnitus, vertigo and numbness on same half of his face. What is the most appropriate inv for his condition? a. Audiometry b. CT c. MRI d. Tympanometry e. Weber’s test
Ans. The key is C. MRI. [features are suggestive of acaustic neuroma, so MRI is the preferred option].
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396. A 56 yo lady with lung cancer presents with urinary retention, postural hypotension, diminished reflexes and sluggish pupillary reaction. What is the most likely explanation for her symptoms? a. Paraneoplastic syndrome b. Progression of lung cancer c. Brain metastasis d. Hyponatremia e. Spinal cord compression
Ans. The key is A. Paraneoplastic syndrome. [Features given are well known features of autonomic neuropathy which can be a result of paraneoplastic syndrome].
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397. An old woman having decreased vision can’t see properly at night. She has changed her glasses quite a few times but to no effect. She has normal pupil and cornea. What is the most likely dx? a. Cataract b. Glaucoma c. Retinal detachment d. Iritis e. GCA
Ans. The key is B. Glaucoma. It is a wrong key. Correct key should be A. Cataract. [Age and normal pupil and cornea are suggestive of cataract. If it was glaucoma pupil would be a bit dilated and/or oval in shape].
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398. A pt comes with sudden loss of vision. On fundoscopy the optic disc is normal. What is the underlying pathology? a. Iritis b. Glaucoma c. Vitreous chamber d. Retinal detachment Q. 1. What is the key? Q. 2. What are the causes of sudden painless loss of vision?
Ans. 1. The Key is D. Retinal detachment. Ans. 2. Causes of sudden painless loss of vision: 1. Retinal detachment 2. Vitreous haemorrhage 3. Retinal vein occlusion 4. Retinal artery occlusion 5. Optic neuritis 6. Cerebrovascular accident
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399. A child was woken up from sleep with severe pain in the testis. Exam: tenderness on palpation and only one testis was normal in size and position. What would be your next step? a. Analgesia b. Antibiotics c. Refer urgently to a surgeon d. Reassurance e. Discharge with analgesics
Ans. The key is A. Analgesia. [According to some US sites it is analgesia but no UK site support this!!! So for Plab exam the more acceptable option is C. Refer urgently to a surgeon].
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400. A child suffering from asthma presents with Temp 39C, drooling saliva on to the mother’s lap, and taking oxygen by mask. What sign will indicate that he is deteriorating? a. Intercostal recession b. Diffuse wheeze c. Drowsiness
Ans. Correct key is C. Drowsiness. [Intercostal recession is a sign of severe asthma but it can be seen at a lesser degree as well. So drowsiness is more appropriate answer].
