401 to 500 Flashcards
(100 cards)
1
Q
- A 12yo boy presents with painful swollen knew after a sudden fall. Which bursa is most likely to be affected? a. Semimembranous bursa b. Prepatellar bursa c. Pretibial bursa d. Suprapatetaller bursa
A
Ans. The key is B. Prepatellar bursa. [A fall onto the knee can damage the prepatellar bursa. This usually causes bleeding into the bursa sac causing swellen painful knee. Prepatellar bursitis that is caused by an injury will usually go away on its own. The body will absorb the blood in the bursa over several weeks, and the bursa should return to normal. If swelling in the bursa is causing a slow
2
Q
- A 61yo man has been referred to the OPD with frequent episodes of breathlessness and chest pain a/w palpitations. He has a regular pulse rate=60bpm. ECG=sinus rhythm. What is the most appropriate inv to be done? a. Cardiac enzymes b. CXR c. ECG d. Echo e. 24h ECG
A
Ans. The key is E. 24h ECG. Indications of 24 h ambulatory holter monitoring: To evaluate chest pain not reproduced with exercise testing To evaluate other signs and symptoms that may be heart-related, such as fatigue, shortness of breath, dizziness, or fainting To identify arrhythmias or palpitations To assess risk for future heart-related events in certain conditions, such as idiopathic
3
Q
- A woman dx with Ca Breast presents now with urinary freq. which part of the brain is the metastasis spread to? a. Brain stem b. Pons c. Medulla d. Diencephalon e. Cerebral cortex
A
Ans. The key is D. Diencephalon. [diencephalon is made up of four distinct components: i) the thalamus ii) the subthalamus iii) the hypothalamus and iv) the epithalamus. Among these the hypothalamus has crucial role in causing urinary frequency].
4
Q
- A man is very depressed and miserable after his wife’s death. He sees no point in living now that his wife is not around and apologises for his existence. He refuses any help offered. His son has brought him to the ED. The son can’t deal with the father any more. What is the most appropriate next step? a. Voluntary admission to psychiatry ward b. Compulsory admission under MHA c. Refer to soc
A
Ans. The key is B. Compulsory admission under MHA. [This patient is refusing any help offered! And his son cannot deal with him anymore! In this situation voluntary admission to psychiatry ward is not possible and the option of choice is “compulsory admission under MHA”. The point here is the man has felt himself in danger by self neglect].
5
Q
- A 31yo man has epistaxis 10 days following polypectomy. What is the most likely dx? a. Nasal infection b. Coagulation disorder c. Carcinoma
A
Ans. The key is A. Nasal infection. [Infection is one of the most important cause of secondary hemorrhage].
6
Q
- A woman had an MI. She was breathless and is put on oxygen mask and GTN, her chest pain has improved. Her HR=40bpm. ECG shows ST elevation in leads I, II, III. What is your next step? a. LMWH b. Streptokinase c. Angiography d. Continue current management e. None
A
Ans.Correct key is C. Angiography.
7
Q
- A 67yo male presents with polyuria and nocturia. His BMI=33, urine culture = negative for nitrates. What is the next dx inv? a. PSA b. Urea, creat and electrolytes c. MSU culture and sensitivity d. Acid fast urine test e. Blood sugar
A
Ans. The key is E. Blood sugar. [Age at presentation and class1 obesity favours the diagnosis of type2 DM].
8
Q
- A pt from Africa comes with nodular patch on the shin which is reddish brown. What is the most probable dx? a. Lupus vulgaris b. Erythema nodosum c. Pyoderma gangrenosum d. Erythema marginatum e. Solar keratosis
A
Ans. The key is B. Erythema nodosum. [Causes of erythema nodosum: MOST COMMON CAUSES- i)streptococcal infection ii) sarcoidosis. Other causes- tuberculosis, mycoplasma pneumonia, infectious mononucleosis, drugs- sulfa related drug, OCP, oestrogen; Behcet’s disease, CD, UC; lymphoma, leukemia and some others].
9
Q
- A 29yo lady came to the ED with complaints of palpitations that have been there for the past 4 days and also feeling warmer than usual. Exam: HR=154bpm, irregular rhythm. What is the tx for her condition? a. Amiadarone b. Beta blockers c. Adenosine d. Verapamil e. Flecainide
A
Ans. The key is B. Beta blockers [the probable arrhythymia is AF secondary to thyrotoxicosis. So to rapid control the symptoms of thyrotoxicosis Beta blocker should be used which will improve the arrythmia].
10
Q
- A T2DM is undergoing a gastric surgery. What is the most appropriate pre-op management? a. Start him in IV insulin and glucose and K+ just before surgery b. Stop his oral hypoglycemic on the day of the procedure c. Continue regular oral hypoglycemic d. Stop oral hypoglycemic the prv night and start IV insulin with glucose and K+ before surgery e. Change to short acting oral hypoglycemic
A
Ans. The key is D. Stop oral hypoglycemic the prv night and start IV insulin with glucose and K+ before Surgery.
11
Q
- A 19yo boy is brought by his mother with complaint of lack of interest and no social interactions. He has no friends, he doesn’t talk much, his only interest is in collecting cars/vehicles having around 2000 toy cars. What is the most appropriate dx? a. Borderline personality disorder b. Depression c. Schizoaffective disorder d. Autistic spectrum disorder
A
Ans. The key is D. Autistic spectrum disorder. Autism spectrum disorders affect three different areas of a child’s life: Social interaction Communication – both verbal and nonverbal Behaviors and interests In some children, a loss of language is the major impairment. In others, unusual behaviors (like spending hours lining up toys) seem to be the dominant factors.
12
Q
- A 45yo man who is diabetic and HTN but poorly compliant has chronic SOB, develops severe SOB and chest pain. Pain is sharp, increased by breathing and relieved by sitting forward. What is the single most appropriate dx? a. MI b. Pericarditis c. Lung cancer d. Good pastures syndrome e. Progressive massive fibrosis
A
Ans. The key is B. Pericarditis. [Nature of pain i.e. sharp pain increased by breathing and relieved by sitting forward is suggestive of pericarditis]. Nature of pericardial pain: the most common symptom is sharp, stabbing chest pain behind the sternum or in the left side of your chest. However, some people with acute pericarditis describe their chest pain as dull, achy or pressure-like instead, a
13
Q
- A 6m boy has been brought to ED following an apneic episode at home. He is now completely well but his parents are anxious as his cousin died of SIDS (Sudden Infant Death Syndrome) at a similar age. The parents ask for guidance on BLS for a baby of his age. What is the single most recommended technique for cardiac compressions? a. All fingers of both hands b. All fingers of one hand c. Heel o
A
Ans. The key is E. Index and middle fingertips of one hand.
14
Q
- A 70yo man had a right hemicolectomy for ceacal carcinoma 6days ago. He now has abdominal distension and recurrent vomiting. He has not opened his bowels since surgery. There are no bowel sounds. WBC=9, Temp=37.3C. What is the single most appropriate next management? a. Antibiotic therapy IV b. Glycerine suppository c. Laparotomy d. NG tube suction and IV fluids e. TPN
A
Ans. The key is D. NG tube suction and IV fluids. [The patient has developed paralytic ileus which should be treated conservatively].
15
Q
- A 60yo man with a 4y hx of thirst, urinary freq and weight loss presents with a deep painless ulcer on the heel. What is the most appropriate inv? a. Ateriography b. Venography c. Blood sugar d. Biopsy for malignant melanoma e. Biopsy for pyoderma
A
Ans. The key is C. Blood sugar. [The patient probably developed diabetic foot].
16
Q
- A 16yo boy presents with rash on his buttocks and extensor surface following a sore throat. What is the most probable dx? a. Measles b. Bullous-pemphigoig c. Rubella d. ITP e. HSP
A
Ans. The key is D. ITP. It’s probably a wrong key! The correct key should be E. HSP. [In HSP rash typically found in buttocks, legs and feets and may also appear on the arms, face and trunk. But in ITP it mostly occurs in lower legs. HSP usually follow a sorethroat and ITP follow viral infection like flue or URTI. HSP is a vasculitis while ITP is deficiency of platelets from more destruction in sp
17
Q
- A 34yo man with a white patch on the margin of the mid-third of the tongue. Which is the single most appropriate LN involved? a. External iliac LN b. Pre-aortic LN c. Aortic LN d. Inguinal LN e. Iliac LN f. Submental LN g. Submandibular LN h. Deep cervical LN
A
Ans. The key is G. Submandibular LN.
18
Q
- A 50yo lady presents to ED with sudden severe chest pain radiating to both shoulder and accompanying SOB. Exam: cold peripheries and paraparesis. What is the single most appropriate dx? a. MI b. Aortic dissection c. Pulmonary embolism d. Good pastures syndrome e. Motor neuron disease
A
Ans. The key is B. Aortic dissection. [Cold peripheries due to reduced blood flow to dista parts of dissection and reduced perfusion of nerves resulted in paraparesis. Usual management for type A dissection is surgery and for type B is conservative].
19
Q
- A 54yo myopic develops flashes of light and then sudden loss of vision. That is the single most appropriate tx? a. Pan retinal photo coagulation b. Peripheral iridectomy c. Scleral buckling d. Spectacles e. Surgical extraction of lens
A
Ans. The key is C. Scleral buckling. [It is a case of retinal detachment with treatment option of scleral buckling].
20
Q
- A 40yo chronic alcoholic who lives alone, brought in the ED having been found confused at home after a fall. He complains of a headache and gradually worsening confusion. What is the most likely dx? a. Head injury b. Hypoglycemia c. Extradural hematoma d. Subdural hematoma e. Delirium
A
Ans. The key is D. Subdural hematoma. [subdural hematoma may be acute or chronic. In chronic symptoms may not be apparent for several days or weeks. Symptoms of subdural hematomas are: fluctuating level of consciousness, ± insidious physical or intellectual slowing, sleepiness, headache, personality change and unsteadiness. Tx. Irrigation/evacuation e.g. via barr twist drill and barr hole craniost
21
Q
- A 54yo man with alcohol dependence has tremor and sweating 3days into a hosp admission for a fx femur. He is apprehensive and fearful. What is the single most appropriate tx? a. Acamprossate b. Chlordiazepoxide c. Lorazepam d. Lofexidine e. Procyclidine
A
Ans. The key is B. Chlordiazepoxide. C. Lorazepam is also correct key! [Dx alcohol withdrawal symptom. According to NICE 1st line treatment is oral lorazepam and if symptom persists or oral medication is declined, give parenteral lorazepam, haloperidol or olanzapine. According to OHCM 1st line treatment is chlordiazepoxide. Chlordiazepoxide should only be used at the lowest possible dose and for a
22
Q
- A 5yo child complains of sore throat and earache. He is pyrexial. Exam: tonsils enlarged and hyperemic, exudes pus when pressed upon. What is the single most relevant dx? a. IM b. Acute follicular tonsillitis c. Scarlet fever d. Agranulocytosis e. Acute OM
A
Ans. The key is B. Acute follicular tonsillitis. [Tonsillitis is usually caused by a viral infection or, less commonly, a bacterial infection. The given case is a bacterial tonsillitis (probably caused by group A streptococcus). There are four main signs that tonsillitis is caused by a bacterial infection rather than a viral infection. They are: a high temperature white pus-filled spots on the
23
Q
- A man with a fam hx of panic disorder is brought to the hosp with palpitations, tremors, sweating and muscles tightness on 3 occasions in the last 6 wks. He doesn’t complain of headache and his BP is WNL. What is the single most appropriate long-term tx for him? a. Diazepam b. Olanzapine c. Haloperidol d. Fluoxetine e. Alprazolam
A
Ans. The key is D. Fluoxetine. [Recommended treatment for panic disorder is i) CBT ii) Medication (SSRIs or TCA). NICE recommends a total of seven to 14 hours of CBT to be completed within a four month period. Treatment will usually involve having a weekly one to two hour session. When drug is prescribed usually a SSRI is preferred. Antidepressants can take two to four weeks before becoming effect
24
Q
- A 28yo man presents with rapid pounding in the chest. He is completely conscious throughout. The ECG was taken (SVT). What is the 1st med to be used to manage this condition? a. Amiodarone b. Adenosine c. Lidocaine d. Verapamil e. Metoprolol
A
Ans. The key is B. Adenosine. [Management of SVT: i) vagal manoeuvres (carotid sinus message, valsalva manoeuvre) transiently increase AV-block, and unmask the underlying atrial rhythm. If unsuccessful then the first medicine used in SVT is adenosine, which causes transient AV block and works by i)transiently slowing ventricles to show the underlying atrial rhythm ii) cardioverting a junctional ta
25
425. A 56yo woman who is depressed after her husband died of cancer 3m ago was given amitryptaline. Her sleep has improved and she now wants to stop medication but she still speaks about her husband. How would you manage her? a. CBT b. Continue amitryptaline c. Psychoanalysis d. Bereavement counselling e. Antipsychotic
Ans. The key is B. Continue amitriptyline. [depression is important feature of bereavement. Patient may pass sleepless nights. As this patients sleep has improved it indicate she has good response to antidepressant and as she still speaks about her husband there is chance to deterioration of her depression if antidepressant is stopped. For depressive episodes antidepressants should be continued fo
26
426. A 64yo man presents with a hx of left sided hemiparesis and slurred speech. He was absolutely fine 6h after the episode. What is the most appropriate prophylactic regimen? a. Aspirin 300mg for 2 weeks followed by aspirin 75mg b. Aspirin 300mg for 2 weeks followed by aspirin 75mg and dipyridamole 200mg c. Clopidogrel 75mg d. Dipyridamole 200mg e. Aspirin 300mg for 2 weeks
Ans. The key is B. Aspirin 300mg for 2 weeks followed by aspirin 75mg and dipyridamole 200mg. It is wrong key! Current recommended secondary prophylaxis is C. Clopidogrel 75mg.
27
427. A 63yo lady with a BMI=32 comes to the ED with complaints of pigmentation on her legs. Exam: dilated veins could be seen on the lateral side of her ankle. Which of the following is involved? a. Short saphenous vein b. Long saphenous vein c. Deep venous system d. Popliteal veins e. Saphano-femoral junction
Ans. The key is A. Short saphenous vein. [short saphenous vein travels lateral aspect of ankle while great or long saphenous vein travels medial aspect of ankle].
28
428. A 55yo man presents with hx of weight loss and tenesmus. He is dx with rectal carcinoma. Which risk factors help to develop rectal carcinoma except following? a. Smoking b. Family hx c. Polyp d. Prv carcinoma e. High fat diet f. High fibre diet
Ans. The key is F. High fibre diet. [except high fiber diet all others are risk factors to develop rectal carcinoma].
29
429. A pt presents with a painful, sticky red eye with a congested conjunctiva. What is the most suitable tx? a. Antibiotic PO b. Antihistamine PO c. Antibiotic drops d. Steroid drops e. IBS
Ans. The key is C. Antibiotic drops. [bacterial conjunctivitis is treated with antibiotic drops].
30
430. A 45yo woman complains of pain in her hands precipitated by exposure to the cold weather. She has breathlessness on walking. When she is eating, she can feel food suddenly sticking to the gullet. It seems to be in the middle of the esophagus but she can’t localize exactly where it sticks. It is usually relieved with a drink of water. Choose the single most likely cause of dysphagia from the o
Ans. The key is B. Systemic sclerosis. [Raynods phenomena, pulmonary involvement, oesophageal dysmotility are suggestive of systemic sclerosis].
31
431. A 3yo child brought to the ED with a swelling over the left arm. XR shows multiple callus formation in the ribs. Exam: bruises on childs back. What is the most appropriate next step? a. Check child protection register b. Coagulation profile c. Skeletal survey d. Serum calcium e. DEXA scan
Ans. The key is C. Skeletal survey. [Skeletal survey is a series of x-ray which is usually used in NAI]. [after survey should think of childs protection].
32
432. A 35yo woman has had bruising and petechiae for a week. She has also had recent menorrhagia but is otherwise well. Blood: Hgb=11.1, WBC=6.3, Plt=14. What is the single most likely dx? a. Acute leukemia b. Aplastic anemia c. HIV infection d. ITP e. SLE
Ans. The key is D. ITP. [As the patient is otherwise well acute leukemia, HIV and SLE is unlikely. Normal wbc count excludes aplastic anemia. So likely diagnosis is ITP].
33
433. A 30yo man complains of episodes of hearing music and sometimes threatening voices within a couple of hours of heavy drinking. What is the most likely dx? a. Delirium tremens b. Wernicke’s encephalopathy c. Korsakoff’s psychosis d. Alcohol hallucinosis e. Temporal lobe dysfunction
Ans. The key is D. Alcoholic hallucinosis. [Alcohol hallucinosis can occur during acute intoxication or withdrawal. It involves auditory and visual hallucinations, most commonly accusatory or threatening voices. Source: Wikipedia].
34
434. A pt had TIA which he recovered from. He has a hx of stroke and exam shows HR in sinus rhythm. He is already on aspirin 75mg and anti-HTN drugs. What other action should be taken? a. Add clopidogrel only b. Increase dose of aspirin to 300mg c. Add warfarin d. Add clopidogrel and statin e. Add statin only
Ans. The key is D. Add clopidogrel and statin. This is wrong key! Correct key should be E. Add statin only. [He who is already on aspirin need no change in aspirin dose. Clopidogrel is now drug of choice for secondary prevention in TIA but if someone is already on aspirin he should continue it as same dose and should be considered to shift to clopidogrel in next few visits. So for given case corre
35
435. A 40yo woman suddenly collapsed and died. At the post-mortem autopsy, it was found that there a bleed from a berry aneurysm from the circle of Willis. In which space did the bleeding occur? a. Subarachnoid b. Subdural c. Extradural d. Subparietal e. Brain ventricles
Ans. The key is A. Subarachnoid.
36
436. A schizophrenic pt hears people only when he is about to fall asleep. What is the most likely dx? a. Hypnopompic hallucinations b. Hyponogogic hallucinations c. Hippocampal hallucinations d. Delirious hallucinations e. Auditory hallucinations
Ans. The key is B. Hypnogogic hallucinations.
37
437. A pt who came from India presents with cough, fever and enlarged cervical LN. Exam: caseating granulomata found in LN. What is the most appropriate dx? a. Lymphoma b. TB adenitis c. Thyroid carcinoma d. Goiter e. Thyroid cyst
Ans. The key is B. TB adenitis. [caseating granulomata are diagnostic of TB].
38
438. A 44yo man comes with hx of early morning headaches and vomiting. CT brain shows ring enhancing lesions. What is the single most appropriate option? a. CMV b. Streptococcus c. Toxoplasmosis d. NHL e. Pneumocystis jerovii
Ans. The key is C. Toxoplasmosi
39
439. A 72yo man is found to be not breathing in the CCU with the following rhythm. What is the most likely dx? a. SVT b. VT c. VF d. Atrial fib e. Atrial flutter
Ans. The key is C. VF.
40
440. A 65yo man with difficulty in swallowing presents with an aspiration pneumonia. He has a bovine cough and fasciculating tongue. Sometimes as he swallows food it comes back through his nose. Choose the single most likely cause of dysphagia from the given option? a. Bulbar palsy b. Esophageal carcinoma c. Pharyngeal pouch d. Pseudobulbar palsy e. Systemic sclerosis
Ans. The key is A. Bulbar palsy. [Dysphagia, nasal regurgitation, fasciculating tongue these are featuresof bulbar palsi due to lower motor neuronal lesion of IX-XII nerves].
41
441. A 16yo teenager was brought to the ED after being stabbed on the upper right side of his back. Erect CXR revealed homogenous opacity on the lower right lung, trachea was centrally placed. What is the most probable explanation for the XR findings? a. Pneumothorax b. Hemothorax c. Pneumonia d. Tension pneumothorax e. Empyema
Ans. The key is B. Hemothorax. [In blunt trauma there may be hemo-pneumothorax but in sharp wound like stabbing there may occur only hemothorax].
42
442. A 55yo woman complains of retrosternal chest pain and dysphagia which is intermittent and unpredictable. The food suddenly sticks in the middle of the chest, but she can clear it with a drink of water and then finish the meal without any further problem. A barium meal shows a ‘corkscrew esophagus’. What is the single most likely dysphagia? a. Esophageal candidiasis b. Esophageal carcinoma c.
Ans. The key is C. Esophageal spasm. [chest pain, unpredictable intermittent dysphagia and food suddenly sticks in the middle of the chest which can be cleared with a drink of water indicates uncoordinated irregular esophageal peristalsis which is characteristic of esophageal spasm! Also “cork-screw esophagus” seen in barium swallow is diagnostic of esophageal spasm].
43
443. A 38yo female presents with sudden loss of vision but fundoscopy is normal. She a similar episode about 1 y ago which resolved completely within 3m. Exam: mild weakness of right upper limb and exaggerated reflexes. What is the single most appropriate tx? a. Pan retinal photo coagulation b. Pilocarpine eye drops c. Corticosteroids d. Peripheral iridectomy e. Surgical extraction of lens
Ans. The key is C. Corticosteroid. [Sudden loss of vision, remission and relapse of optic neuritis and focal neurological symptoms and exaggerated reflexes all points towards multiple sclerosis. Treatment option is corticosteroids].
44
444. A 15yo boy presents with a limp and pain in the knee. Exam: leg is externally rotated and 2cm shorter. There is limitation of flexion, abduction and medial rotation. As the hip is flexed external rotation is increased. Choose the most likely dx? a. Juvenile rheumatoid arthritis b. Osgood-schlatter disease c. Reactive arthritis d. Slipped femoral epiphysis e. Transient synovitis of the hip
Ans. The key is D. Slipped femoral epiphysis. [The given presentation is classic for slipped femoral epiphysis].
45
445. A 64yo woman has difficulty moving her right shoulder on recovering from surgery of the posterior triangle of her neck. What is the single most appropriate option? a. Accessory nerve b. Glossopharyngeal nerve c. Hypoglossal nerve d. Vagus nerve e. Vestibule-cochlear nerve
Ans. The key is A. Accessory nerve. [Accessory nerve lesion causes weakness of the trapezius muscle and can produce a drooping shoulder, winged scapula, and a weakness of forward elevation of the shoulder].
46
446. A 37yo man with an ulcer on the medial malleolus. Which of the following LN is involved? a. External iliac LN b. Pre-aortic LN c. Aortic LN d. Inguinal LN e. Iliac LN f. Submental LN g. Submandibular LN h. Deep cervical LN
Ans. The key is D. Inguinal LN.
47
447. A pt presents with weight loss of 5kgs despite good appetite. He also complains of palpitations, sweating and diarrhea. He has a lump in front of his neck which moves on swallowing. What is the most appropriate dx? a. Lymphoma b. TB adenitis c. Thyroid Ca d. Goiter e. Thyroid cyst
Ans. The key is D. Goiter.
48
448. A 76yo woman has become tired and confused following an influenza like illness. She is also breathless with signs of consolidation of the left lung base. What is the most likely dx? a. Drug toxicity b. Delirium tremens c. Infection toxicity d. Hypoglycemia e. Electrolyte imbalance
A. The key is C. Infection toxicity. [Infection toxicity or toxic shock syndrome is likely here as preceding flue like illness points towards toxin (enterotoxin type B) from Staphylococcus aureus].
49
449. A young pt is complaining of vertigo whenever she moves sideways on the bed while lying supine. What would be the most appropriate next step? a. Head roll test b. Reassure c. Advice on posture d. Carotid Doppler e. CT
Ans. The key is A. Head roll test. [this is a case of “benign paroxysmal positional vertigo” for which the diagnosis is made by head roll test].
50
450. A 32yo man has OCD. What is the best tx? a. CBT b. SSRI c. TCA d. MAO inhibitors e. Reassure
Ans. The key is B. SSRI. [It is wrong key! There is a GMC sample question with most appropriate management being CBT. So the correct key is CBT].
51
451. A 65yo woman says she died 3m ago and is very distressed that nobody has buried her. When she is outdoors, she hears people say that she is evil and needs to be punished. What is the most likely explanation for her symptoms? a. Schizophrenia b. Mania c. Psychotic depression d. Hysteria e. Toxic confusional state
Ans. The key is C. Psychotic depression. [Psychotic depression, also known as depressive psychosis, is a major depressive episode that is accompanied by psychotic symptoms (hallucinations, delusions). In this patient nihilistic delusion favours the diagnosis of psychotic depression. It can occur in the context of bipolar disorder or majordepressive disorder].
52
452. A 50yo woman presents following a fall. She reports pain and weakness in her hands for several months, stiff legs, swallowing difficulties, and has bilateral wasting of the small muscles of her hands. Reflexes in the upper limbs are absent. Tongue fasciculations are present and both legs show increased tone, pyramidal weakness and hyper-reflexia with extensor plantars. Pain and temp sensation
Ans. The key is C. Syringobulbia. [In MS there are characteristic relapse and remission which is absent here; In MND there is no sensory deficit; Syringomyelia doesn’t cause cranial nerve lesion and in myasthenia there is muscular weakness without atrophy. Here the features described well fits with syringobulbia].
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453. Which of the following formulas is used for calculating fluids for burn pts? a. 4 x weight(lbs) x area of burn = ml of fluids b. 4 x weight(kgs) x area of burn = L of fluids c. 4 x weight(kgs) x area of burn = ml of fluids d. 4 x weight(lbs) x area of burn = L of fluids e. 4.5 x weight(kgs) x area of burn = dL of fluids
Ans. The key is C. 4 x weight(kgs) x area of burn = ml of fluids.
54
454. A 65yo male presents with dyspnea and palpitations. Exam: pulse=170bpm, BP=120/80mmHg. Carotid massage has been done as first instance. What is the next step of the management? a. Adenosine b. Amlodipine c. DC cardioversion d. Lidocaine e. Beta blocker
Ans. The key is A. Adenosine. [The likely diagnosis is SVT. 1st vagal manoeuvres, if fails iv adenosine. • Vagal manoeuvres (carotid sinus massage, Valsalva manoeuvre) transiently increase AV block, and may unmask an underlying atrial rhythm. • If unsuccessful, give adenosine, which causes transient AV block; OHCM, 9th edition].
55
455. A 48yo farmer presented with fever, malaise, cough and SOB. Exam: tachypnea, coarse endinspiratory crackles and wheeze throughout, cyanosis. Also complaint severe weight loss. His CXR shows fluffy nodular shadowing and there is PMN leukocytosis. What is the single most appropriate dx? a. Ankylosing spondylitis b. Churg-strauss syndrome c. Cryptogenic organizing d. Extrinsic allergic alveoliti
Ans. The key is D. Extrinsic allergic alveolitis.
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456. A 35yo lady is admitted with pyrexia, weight loss, diarrhea and her skin is lemon yellow in color. CBC = high MCV. What is the most probably dx? a. Aplastic anemia b. Pernicious anemia c. Leukemia d. ITP e. Lymphoma
Ans. The key is B. Pernicious anemia. [It may be graves with pernicious anemia. Lemon yellow pallor occurs in pernicious anemia. Hyperthyroidism may cause persistently raised body temperature. Both are autoimmune disease which favours this association].
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457. A 72yo woman who had a repair of strangulated femoral hernia 2 days ago becomes noisy, aggressive and confused. She is febrile, CBC normal apart from raised MCV. What is the most likely dx? a. Electrolyte imbalance b. Delirium tremens c. Wernicke’s encephalopathy d. Infection toxicity e. Hypoglycemia
Ans. The key is B. Delirium tremens. [Electrolyte imbalance may cause confusion but not aggressiveness; infection toxicity will cause high fever, low BP, rash etc which are absent here (fever here is hyperthermia of delirium tremens). Abstinance from alcohol in the hospital caused delirium tremens (chronic alcoholism is supported by high MCV) here].
58
458. An old lady had UTI and was treated with antibiotics. She then developed diarrhea. What is the single most likely tx? a. Co-amoxiclav b. Piperacillin + tazobactam c. Ceftriaxone d. Vancomycin
Ans. The key is D. Vancomycin. [Pseudomembranous colitis is treated with metronidazole or vancomycin].
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459. A 56yo man has symptoms of sleep apnea and daytime headaches and somnolence. Spirometry shows a decreased tidal volume and vital capacity. What is the single most appropriate dx? a. Ankylosing spondylitis b. Churg-strauss syndrome c. Good pasture syndrome d. Motor neuron disease e. Progressive massive fibrosis f. Spinal cord compression
Ans. The key is D. Motor neuron disease. [involvement of respiratory muscles in MND is associated with poor respiration causing sleep apnoea].
60
460. A 55yo man presents with mild headache. He has changed his spectacles thrice in 1 yr. there is mild cupping present in the disc and sickle shaped scotoma present in both eyes. What is the single most appropriate tx? a. Pan retinal photo coagulation b. Pilocarpine eye drops c. Corticosteroids d. Scleral buckling e. Analgesics alone
Ans. The key is B. Pilocarpine. [This is a case of open angle glaucoma, treatment is with pilocarpine].
61
461. A 55yo woman was found collapsed at home, paramedics revived her but in the ambulance she had a cardiac arrest and couldn’t be saved. The paramedic’s report tells that the woman was immobile lately due to hip pain and that they found ulcers on the medial side of ankle. She had DM and was on anti-diabetics. What is the cause of her death? a. Acute MI b. DKA c. Pulmonary embolism d. Acute peric
Ans. The key is C. Pulmonary embolism. [Immobilization due to hip pain may resulted in DVT and later pulmonary embolism].
62
462. An 18yo previously well student is in his 1st year at uni. He has been brought to the ED in an agitated, deluded and disoriented state. What is the most probable reason for his condition? a. Drug toxicity b. Delirium tremens c. Infection toxicity d. Electrolyte imbalance e. Head injury
Ans. The key is A. Drug toxicity. [Young age and 1st yr in university is likely to point towards drug toxicity].
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463. A young adult presents to the ED after a motorcycle crash. The pt has bruises around the left orbital area. GCS=13, examination notes alcoholic breath. Shortly afterwards, his GCS drops to 7. What is the single most important initial assessment test? a. MRI brain b. CT brain c. CXR d. CT angio brain e. Head XR
Ans. The key is B. CT brain. [Likely cause is epidural hematoma].
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464. A 30yo female attends OPD with a fever and dry cough. She says that she had headache, myalgia and joint pain like one week ago. Exam: pulse=100bpm, temp=37.5C. CXR: bilateral patchy consolidation. What is the single most likely causative organism? a. Pneumococcal pneumonia b. Legionella c. Mycoplasma d. Klebsiella e. Chlamydia pneumonia
Ans. The key is C. Mycoplasma.
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465. A 46yo man is being investigated for indigestion. Jejunal biopsy shows deposition of macrophages containing PAS (Periodic acid-schiff) +ve granules. What is the most likely dx? a. Bacterial overgrowth b. Celiac disease c. Tropical sprue d. Whipple’s disease e. Small bowel lymphoma
Ans. The key is D. Whipple’s disease. [periodic acid-schiff +ve granules containing macrophages in jejunal biopsy is diagnostic of whipples disease].
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466. A 32yo woman of 38wks gestation complains of feeling unwell with fever, rigors and abdominal pains. The pain was initially located in the abdomen and was a/w urinary freq and dysuria. The pain has now become more generalized specifically radiating to the right loin. She says that she has felt occasional uterine tightening. CTG is reassuring. Select the most likely dx? a. Acute fatty liver of
Ans. The key is B. Acute pyelonephritis. [Fever, rigor, abdominal pain a/w frequency, dysurea and radiation to the rt loin suggests rt sided pyelonephritis].
67
467. A 32yo pt presents with cervical lymphadenopathy and splenomegaly. What is the single most appropriate option? a. Hemophilus b. Streptococcus c. Toxoplasmosis d. NHL e. Pneumocystis jerovcii
Ans. The key is D. NHL. [ Here only two points are mentioned- cervical lymphadenopathy and splenomegaly! This combination makes NHL as the most likely cause thouh splenomegaly is a relatively uncommon feature of it!!! This combination does not fit in other options!]
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468. A 62yo man who was admitted for surgery 3days ago suddenly becomes confused. His attn span is reduced. He is restless and physically aggressive and picks at his bed sheets. What single aspect of the pt’s hx recovered in his notes is most likely to aid in making the dx? a. Alcohol consumption b. Head trauma c. Hx of anxiety d. Prescribed med e. Obvious cognitive impairment
Ans. The key is A. Alcohol consumption. [abstinence from alcohol in the hospital lead to delirium tremens].
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469. A 10yo girl presents with pallor and features of renal failure. She has hematuria as well as proteinuria. The serum urea and creat are elevated. These symptoms started after an episode of bloody diarrhea 4days ago. What is the most probable dx? a. TTP b. HUS c. ITP d. HSP e. ARF
Ans. The key is B. HUS. [Most cases of hemolytic uremic syndrome develop in children after two to 14 days of diarrhea often bloody, due to infection with a certain strain of E. coli. Features may be i)abdominal pain, ii) pale skin, iii) hematuria and proteinuria, iv) features of renal failure like- nausea/vomiting, swelling of face, hand, feet or entire body etc. v) elevated urea and creatinine et
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470. A 40yo woman has had intermittent tension, dizziness and anxiety for 4months. Each episode usually resolves after a few hours. She said she takes alcohol to make her calm. She is in a loving relationship and has no probs at work or home. What is the next step in her management? a. Collateral info b. CT brain c. CBC d. LFT e. TFT
Ans. The key is A. Collateral info. [Likely diagnosis is panic disorder. Collateral info from family, friends and other peers should be asked to find out the cause for her anxiety].
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471. A 45yo IV drug abuser is brought into the ED with complaint of fever, shivering, malaise, SOB and productive cough. Exam: temp=39C, pulse=110bpm, BP=100/70mmHg. Inv: CXR=bilateral cavitating bronchopneumonia. What is the single most likely causative organism? a. Mycoplasma b. Staphylococcus c. Chlamydia pneumonia d. Pseudomonas e. PCP
Ans. The key is B. Staphylococcus. [Among the given causes Staphylococcus and PCP are recognized cause of cavitating pneumonia. This case is with productive cough which goes more with staphylococcus as PCP is not productive but rather associated with dry cough. Drug abuse can support both staphylococcus and PCP].
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472. A 71yo woman looks disheveled, unkempt and sad with poor eye contact. She has recently lost her husband. Which of the following describes her condition? a. Anxiety b. Hallucination c. Mania d. High mood e. Low mood
Ans. The key is E. Low mood.
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473. A 62yo male comes to the GP complaining of double vision while climbing downstairs. Which of the following nerve is most likely involved? a. Abducens nerve b. Trochlear nerve c. Oculomotor nerve d. Optic nerve e. Trigeminal nerve
Ans. The key is B. Trochlear nerve. [oculomotor may cause palsy of inferior rectus, medial rectus and superior rectus causing double vision in multiple gaze! But trochlear involving superior oblique only causes diplopia in downgaze only. So the answer is Trochlear nerve].
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474. L1 level, what is the most appropriate landmark? a. Mcburney’s point b. Stellate ganglion c. Deep inguinal ring d. Termination of the spinal cord e. Transpyloric plane
Ans. The given key is D. Which is a wrong key. The correct key is E. Transpyloric plane. [The termination of the spinal cord is between L1 and L2 (variable between people). L1 landmark- duodenum first part, superior mesenteric artery, hila of both kidneys, upper border of pancreas, splenic artery, pylorus and fundus of gall bladder].
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475. A 32yo woman presents to the ED with headache and vomiting. She was decorating her ceiling that morning when the headache began, felt mainly occipital with neck pain. Some 2hs later she felt nauseated, vomited and was unable to walk. She also noticed that her voice had altered. She takes no reg meds and has no significant PMH. Exam: acuity, field and fundi are normal. She has upbeat nystagmus
Ans. The key is Left lateral medulla. [ There is a loss of pain and temperature sensation on the contralateral (opposite) side of the body and ipsilateral (same) side of the face. There is associated cerebellar symptoms and other cranial nerve involvement. The condition is known as Lateral Medullary Syndrome].
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476. A 28yo female presents with 1 wk hx of jaundice and 2d hx of altered sleep pattern and moods.She was dx with hypothyroidism for which she is receiving thyroxine. TFT showed increased TSH.PT=70s. What is the most probable dx? a. Acute on chronic liver failure b. Hyper-acute liver failure c. Autoimmune hepatitis d. Acute liver failure e. Drug induced hepatitis
Ans. The key is C. Autoimmune hepatitis. [Autoimmune hepatitis may present as acute hepatitis, chronic hepatitis, or well-established cirrhosis. Autoimmune hepatitis rarely presents as fulminant hepatic failure. One third may present as acute hepatitis marked by fever, hepatic tenderness and jaundice. Non specific features are anorexia, weight loss and behavioural change (here altered sleep patter
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477. A 55yo man has a chronic cough and sputum, night sweats and weight loss. What is the single most likely causative organism? a. Coagulase +ve cocci in sputum b. Gram -ve diplococci in sputum c. Gram +ve diplococci in sputum d. Pneumocystis carinii in sputum e. Sputum staining for mycobacterium tuberculosis
Ans. The key is E. Sputum staining for mycobacterium tuberculosis. [Chronic cough and sputum, night sweats and weight loss are classic features of tuberculosis].
78
478. A 20yo pregnant 32wks by date presents to the antenatal clinic with hx of painless vaginal bleeding after intercourse. Exam: P/A – soft and relaxed, uterus=dates, CTG=reactive. Choose the single most likely dx? a. Abruption of placenta 2nd to pre-eclampsia b. Antepartum hemorrhage c. Placenta previa d. Preterm labor e. Placenta percreta
Ans. The key is C. Placenta previa.
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479. A 30yo man presents to the ED with difficulty breathing. He has returned from India. Exam: throat reveals grey membranes on the tonsils and uvula. He has mild pyrexia. What is the single most relevant dx? a. Diphtheria b. IM c. Acute follicular tonsillitis d. Scarlet fever e. Agranulocytosis
Ans. The key is A. Diphtheria. [history of travel to india, grey membrane in tonsil and uvula, low grade fever, and dyspnoea support the diagnosis of diphtheria].
80
480. A 23yo man comes to the ED with a hx of drug misuse. He recognizes that he has a prb and is willing to see a psychiatrist. Which of the following terms best describes this situation? a. Judgement b. Thought insertion c. Thought block d. Mood e. Insight
Ans. The key is E. Insight. [in psychiatry, the patient's awareness and understanding of the origins and meaning of his attitudes, feelings, and behavior and of his disturbing symptoms (self-understanding) is known as insight].
81
481. A pt with hodgkins lymphoma who is under tx develops high fever. His blood results show WBC <2800 and has a chest infection. Choose the most likely tx? a. Co-amoxiclav b. Piperacillin+tazobactam c. Erythromycin d. Piperacillin+Co-amoxiclav e. Penicillin+tazobactam
Ans. The key is B. Piperacillin+tazobactam. [Here patients WBC is <2800, i.e. patient has leucopenia (probable neutropenia). Piperacillin/Tazobactam may be used in the management of neutropenic patients with fever suspected to be due to a bacterial infection as in patient with postchemotherapy neutropenia. Even febrile neutropenia can be seen in patients with cancer perse!].
82
482. A 25yo woman presents with urinary freq, dysuria and fever. Urine microscopy shows 20-50 RBC and 10-20 WBC in each field. What is the most probable dx? a. Schistosmiasis b. Kidney trauma c. Ureteric calculus d. Bladder calculi e. Cystitis
Ans. The key is E. Cystitis. [Hematuria and significant WBC in urine (>10 per HPF) makes cystitis the most likely diagnosis].
83
483. A 65yo presents with dyspareunia after sex. She in menopause. She complains of bleeding after sex. What is the most probably dx? a. Cervical ca b. Endometrial ca c. Ovarian ca d. Breast ca e. Vaginal ca
Ans. The key is B. Endometrial carcinoma. [Any post menopausal bleeding if associated with pain lower abdomen (may be even in the form of dyspareunia) is endometrial carcinoma unless proven otherwise. (even painless vaginal bleeding in post menopausal women is highly suspicious!)].
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484. A 45yo man underwent an emergency splenectomy following a fall from his bicycle. He smokes 5 cigarettes/day. Post-op, despite mobile, he develops swinging pyrexia and a swollen painful left calf. His CXR shows lung atelectasis and abdominal U demonstrates a small sub-[phrenic collection. What is the single most likely risk factor for DVT in this pt? a. Immobility b. Intraperitoneal hemorrhage
Ans. The key is D. Splenectomy. [Splenectomized patients have an increased risk of developing deep vein thrombosis and pulmonary embolism].
85
485. A 6m baby had LOC after which he had jerky movement of hands and feet. What is the most probable dx? a. Infantile spasm b. Absence c. Partial simple seizure d. Atonic seizure e. Partial complex
Ans. The given key is A. Infantile spasm which is a wrong key! Correct key is E. Partial complex. [In partial simple seizer there is no LOC (loss of consciousness). Infantile spasm though may be associated with occasional LOC but its nature is more generalized rather than the focal nature described here. So the likely option is E. Partial complex seizure].
86
486. A 24yo primigravida who is 30wk pregnant presents to the labor ward with a hx of constant abdominal pain for the last few hours. She also gives a hx of having lost a cupful of fresh blood per vagina before the pain started. Abdominal exam: irritable uterus, CTG=reactive. Choose the single most likely dx? a. Abruption of placenta 2nd to pre-eclampsia b. Antepartum hemorrhage c. Placenta previa
Ans. The key is B. Antepartum hemorrhage. [Though presentation indicates abruption placenta but abrutio placenta 2nd to pre-eclumpsia can’t be the option as no features are suggestive of pre-eclumpsia here. So better option is B. Antepartum hemorrhage which also includes abruption placenta. Only bleeding cannot indicate whether it is concealed, mixed or revealed].
87
487. A 62yo lady presents with right sided headache and loss of vision. What is the single most inv? a. ESR b. BUE c. CT head d. XR orbit e. IOP
Ans. The key is A. ESR. [Elderly (age 62), rt sided headache and loss of vision are suggestive of temporal arteritis where elevated ESR is highly suggestive of this diagnosis].
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488. A 24yo man asks his GP for a sick note from work. He says that feels down, is lethargic and has stopped enjoying playing the piccolo (his main hobby). He was admitted to the psychiatry ward last year following an episode of overspending, promiscuity and distractibility. What is the most probable dx? a. Psychosis b. Cyclothymia c. Bipolar affective disorder d. Seasonal affective disorder
Ans. The key is C. Bipolar affective disorder. [presently patient has depression and previous features of mania makes the diagnosis of bipolar affective disorder likely].
89
489. A 42yo female who is obese comes with severe upper abdominal pain with a temp=37.8C. She has 5 children. What is the most probable dx? a. Ectopic pregnancy b. Ovarian torsion c. Hepatitis d. Biliary colic e. Cholecystitis
Ans. The key is cholecystitis. [Fat, female, fare, forty and fertile are the pneumonic for cholecystitis! Here the presentation of severe upper abdominal pain with fever along with the pneumonic features points towards the diagnosis of cholecystitis].
90
490. A child has just recovered from meningitis. What inv will you do before discharge? a. CT scan b. EEG c. Blood culture d. Repeat LP e. Hearing test
Ans. The key is E. Hearing test. [deafness is a common complication of meningitis, so hearing test is suggested before discharge].
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491. A primiparous woman with no prv infection with herpes zoster is 18wk pregnant. She had recent contact with a young 21yo pt having widespread chicken pox. What is the most suitable management for the pregnant lady? a. Acyclovir PO b. Acyclovir IV +IVIG c. Acyclovir IV d. Reassure e. IVIG
Ans. The key is E. IVIg. [If the pregnant woman is not immune to VZV and she has had a significant exposure, she should be offered varicella-zoster immunoglobulin (VZIG) as soon as possible. VZIG is effective when given up to 10 days after contact (in the case of continuous exposures, this is defined as 10 days from the appearance of the rash in the index case). RCOG guideline].
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492. A 40yo woman presents to the GP with low mood. Of note, she has an increased appetite and has gone up 2 dress sizes. She also complains that she can’t get out of bed until the afternoon. What is the most likely dx? a. Pseudo depression b. Moderate depression c. Severe depression d. Dysthymia e. Atypical depression
Ans. The key is E. Atypical depression. [Atypical depression is a subtype of major depression or dysthymic disorder that involves several specific symptoms, including increased appetite or weight gain, sleepiness or excessive sleep, marked fatigue or weakness, moods that are strongly reactive to environmental circumstances, and feeling extremely sensitive to rejection].
93
493. An 8yo boy is clinically obese. As a baby he was floppy and difficult to feed. He now has learning difficulties and is constantly eating despite measures by his parents to hide food out of reach. What is the most probable dx? a. Cushing’s syndrome b. Congenital hypothyroidism c. Prader Willi syndrome d. Lawrence moon biedel syndrome e. Down’s syndrome
Ans. The key is C. Prader Willi syndrome. [Prader Willi syndrome rare congenital disorder characterized by learning difficulties, growth abnormalities, and obsessive eating, caused especially by the absence of certain genes normally present on the copy of chromosome 15 inherited from the father].
94
494. A 20yo lady is suffering from fever and loss of appetite. She has been dx with toxoplasmosis. What is the tx? a. Pyrimethamine b. Pyrimethamine + sulfadiazine c. Clindamycin d. Spiramycin e. Trimethoprim + sulfamethoxazole
Ans. The key is B. Pyrimethamine + sulfadiazine. [If the eye is involved, or if immunocompromized, tx option is pyrimethamine + sulfadiazine OHCM 9th edition, page 404].
95
495. A 68yo woman has a sudden onset of pain and loss of hearing in her left ear and unsteadiness when walking. There are small lesions visible on her palate and left external auditory meatus. What is the single most likely dx? a. Acute mastoiditis b. Cholesteatoma c. Herpes zoster infection d. Oropharyngeal malignancy e. OM with infusion
Ans. The key is C. Herpes zoster infection. [Herpes zoster oticus (Ramsay Hunt syndrome) occurs when latent varicalla zoster virus reactivates in the geniculate ganglion of the 7th cranial nerve. Symptoms: Painful vesicular rash on the auditory canal ± on drum, pinna, tongue, palate or iris with ipsilateral facial palsy, loss of taste, vertigo, tinnitus, deafness, dry mouth and eyes. OHCM 9th edit
96
496. A 45yo woman has been dx with GCA and is being treated with steroids. What is the other drug that can be added to this? a. ACEi b. Beta blockers c. Aspirin d. Interferons e. IVIG
Ans. The key is C. Aspirin [Low dose aspirin is increasingly being recommended for people with a history of giant cell arteritis. It has been found to be effective in preventing complications of giant cell arteritis, such as heart attacks or stroke (nhs.uk)].
97
497. A 17yo man has acute pain and earache on the right side of his face. Temp=38.4C and has extensive pre-auricular swelling on the right, tender on palpation bilaterally. What is the single most likely dx? a. Acute mastoiditis b. Acute otitis externa c. Acute OM d. Mumps e. OM with effusion
Ans. The key is D. Mumps. [C/F: prodromal malaise, increased temperature, painful parotid swelling, becoming bilateral in 70%. OHCS 9th edition, page 142].
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498. An ECG of an elderly lady who collapsed in the ED shows rapid ventricular rate of 220bpm, QRS=140ms. What is the most probable dx? a. Atrial fibrillation b. VT c. SVT d. Mobitz type1 2nd degree heart block e. Sinus tachycardia
Ans. The key is B. Ventricular tachycardia. [Dx: i) history (if IHD/MI likelihood of a ventricular arrhythmia is > 95%), ii) 12 lead ECG, and iii) lack of response to IV adenosine). ECG findings in favour of VT: Positive QRS concordance in chest leads Marked left axis deviation AV dissociation (occurs in 25%) or 2:1 or 3:1 AV block Fusion beats or capture beats OHCM 9th edition, page 816].
99
499. A pt presents with purple papular lesions on his face and upper trunk measuring 1-2 cm across. They aren’t painful or itchy. What is the single most likely dx? a. Kaposi’s sarcoma b. Hairy leukoplakia c. Cryptosporidium d. CMV infection e. Cryptococcal infection
Ans. The key is A. Kaposis sarcoma. [It is a spindle-cell tumour derived from capillary endothelial cells or from fibrous tissue, caused by human herpes virus. It presents as purple papules (½ to 1 cm) or plaques on skin and mucosa (any organ). It metastasizes to nodes. OHCM 9th edition, page 716].
100
500. A 6yo boy is clinically obese, his BMI >95th centile. He has no other medical prbs, examination is unremarkable. His mother says that she has tried everything to help him lose weight. What is the most probable dx? a. Cushing’s syndrome b. Congenital hypothyroidism c. Down’s syndrome d. Lawrence moon biedel syndrome e. Primary obesity
Ans. The key is E. Primary obesity.
