601 to 700 Flashcards
(100 cards)
1
Q
- A mother presents with her 12m daughter. The child has no meaningful words, is unable to sit unaided and can’t play with her toys. She doesn’t laugh and has poor interaction with her siblings. What is the best management strategy? a. Arrange hearing test b. Assess developmental milestones c. Reassure d. Refer to speech therapist e. MRI brain
A
Ans. The key is B. Assess developmental milestones. [At 12 month one word should be said clearly, in 8 months child can sit independently, smiles at 2 months and plays with toys since early infancy. So she needs to assess developmental milestones].
2
Q
- A pt presents with progressive visual deterioration. Exam: large, multiple cotton wool spots in both eyes. What is the single most likely dx? a. Kaposi’s sarcoma b. Cryptosporidium c. CMV infection d. Pneumocystis carinii infection e. Cryptococcal infection
A
Ans. The key is C. CMV infection. [Large multiple cotton wool spots are seen in early stage of CMV retinitis].
3
Q
- A 53yo had a dental extraction after which he recently had a mitral valve prolapse, high temp of 39C, cardiac failure and new cardiac murmur. What is the single most likely dx? a. Atheroma b. Congenital c. Regeneration d. Infection e. Neoplastic
A
Ans. The key is D. Infection. [Infective endocarditis].
4
Q
- A 12yo boy with a hx of fall on an outstretched hand was brought to the ED with swelling and pain around the elbow. His radial nerve was affected. What is the type of fx? a. Angulated fx b. Epiphyseal fx c. Compound fx d. Spiral fx
A
Ans. The key is D. Spiral fracture. It is wrong key. The correct option should be A. Angulated (supracondylar fracture). [Around 50% interosseous nerve lesions occur in supracondylar fracture whereas 25% shows radial nerve damage. If the fracture is spiral fracture of lower third of humerus it causes nerve damage in 18% almost all of which are radial nerve lesion. However as the fracture is around
5
Q
- A 32yo lady complains that she hears everyone saying that she is an evil person. What type of hallucinations is she suffering from? a. 2nd person auditory hallucinations b. 3rd person auditory hallucinations c. Echo de la pense d. Gedankenlautwerden
A
“Ans. The key is B. 3rd person auditory hallucinations. [Third person hallucinations are auditory hallucinations in which patients hear voices talking about themselves, referring to them in the third person, for example ““he is an evil person””.].”
6
Q
- A 65yo woman had an excision of colonic tumor 3yrs ago. Now she is losing weight and feels lethargic. Exam: pale but no abdominal findings. What is the most appropriate inv? a. CA 125 b. CA 153 c. CA 199 d. CEA e. AFP
A
Ans. The key is D. CEA. [CA 125 = ovarian cancer; CA 153 = cancer breast; CA 199 = pancreatic cancer; CEA = colorectal carcinoma; AFP = hepatocellular carcinoma].
7
Q
- A 46yo African-Caribbean man is found to have BP=160/90mmHg on 3 separate occasions. What is the best initial tx? a. ACEi b. Beta-blockers c. ARBs d. None e. CCB
A
Ans. The key is E. CCB. [If age less than 55 years but Afro-Caribbean origin then CCB].
8
Q
- A 39yo woman will undergo tubal sterilization and she wants to know the failure rate of this type of sterilization. a. 1:50 b. 1:200 c. 1:500 d. 1:1000 e. 1:5000
A
Ans. The key is B. 1:200.
9
Q
- Which of the following reflexes and innervating spinal nerves are correctly paired? a. Anal reflex – S1 b. Ankle jerk – L5 c. Biceps jerk – C7 & C8 d. Knee jerk – L3 & L4 e. Triceps jerk – T1
A
Ans. The key is D. Knee jerk – L3 & L4. [Anal reflex – S2-4; Ankle jerk – S1-2; Biceps jerk – C5-6; Knee jerk– L3-4; Triceps jerk – C7].
10
Q
- A 62yo man with rheumatoid arthritis struck his hand against a door. He subsequently found that although he could extend the interphalangeal joint of his right thumb, the MCP joint of the thumb remained flex. What is the single most likely tendon to have been damaged? a. Extensor carpi ulnaris b. Extensor digitorum c. Extensor indicis d. Extensor pollicis brevis e. Extensor pollicis longus
A
Ans. The key is D. Extensor pollicis brevis. [Action of extensor pollicis brevis = extension of thumb at metacarpophalangeal joint. Extensor pollicis longus = extends the terminal phalanx of the thumb].
11
Q
- A 68yo lady complains of falls to the ground without any warning, maintains consciousness and no confusion. She says this has occurred at number of times. What is the dx? a. Stokes Adams attack b. Hypoglycemia c. Vasovagal syncope d. Drop attacks e. Epilepsy
A
Ans. The key is D. Drop attacks. [Drop attacks are sudden spontaneous falls while standing or walking, with complete recovery in seconds or minutes. There is usually no recognized loss of consciousness, and the event is remembered].
12
Q
- A 50yo man complains of being pursued by the police for a crime he denies committing. He has poor concentration and impaired short-term memory. He admits to drinking large amounts of alcohol for the last 20yrs. What is the most probable dx? a. Dementia b. Hallucination c. Wernicke’s encephalopathy d. Schizophrenia e. Korsakoff psychosis
A
Ans. The key is E. Korsakoff psychosis. [Dementia, i.e. short term memory loss is seen in korsakoff psychosis].
13
Q
- A pt with prv hx of HTN, the membranes have ruptured and the cervix is 3cm dilated. 4h later on examination showed that the cervix was still 3cm dilated. What is the single most appropriate management for her labor? a. Repeat vaginal examination in 4h b. CTG c. C-section d. External rotation e. IV syntocin drip
A
Ans. The key is E. IV syntocinon drip. [There is no progress of labour in 4 hours. Hence syntocinon drip should be given].
14
Q
- A 6yo girl has had 2 short episodes of cough and wheeze over the last 12m. These 2 acute episodes responded quickly to bronchodilator, she has no symptoms or abnormal physical signs. She has slight eczema and her mother has asthma. What is the single most appropriate inv? a. CXR b. Peak flow rate diary c. Pulse oximetry d. Spirometry e. Sweat test
A
Ans. The key is D. Spirometry. [spirometry is the preferred initial test (if available) to assess the presence and severity of airflow obstruction less effort dependent and more repeatable though less applicable in acute severe asthma].
15
Q
- A 45yo man had recently started taking anti-HTN therapy. 6m later his RBS=14mmol/l. Which single drug is most likely to have caused this? a. Amlodipine b. Bendroflumethiazide c. Doxazosin d. Lorsartan e. Ramipril
A
Ans. The key is B. Bendroflumethiazide. [High blood sugar is a well known side effect of bendroflumethiazide].
16
Q
- A 27yo waitress has pelvic pain, dysmenorrhea and increasingly heavy periods. She also complains of dyspareunia. There is generalized pelvic tenderness without peritonism. Pelvic US is normal. What is the most likely dx? a. Endometriosis b. Uterine fibroid c. Pelvic congestion syndrome d. PID e. Tubal pregnancy
A
Ans. The key is C. Pelvic congestion syndrome. [In pelvic congestion syndrome there develops varicose veins in the lower abdomen from prolonged standing (as occurred here in a waitress who remains standing for long) with some pain syndromes like pelvic pain, dysmenorrea, dyspareunia and generalized pelvic tenderness without peritonism. Also there may be associated menorrhagia].
17
Q
- A 14yo girl is clinically obese. She has not started her periods yet and has severe acne. Among her inv, a high insulin level is found. What is the most probable dx? a. Cushing’s syndrome b. Grave’s disease c. Acquired hypothyroidism d. PCOS e. Addison’s disease
A
Ans. The key is D. PCOS. [It is not cushing’s as insulin levels in cushing’s are not usually raised! Here obesity, primary amenorrhea , acne and particularly high level of insulin makes the likely diagnosis to PCOS].
18
Q
- An 18yo girl with primary amenorrhea complains of severe abdominal pain every 4-8weeks which is now getting worse. Exam: lower abdominal mass is felt. What is the most probable dx? a. Ectopic pregnancy b. Ovarian carcinoma c. Hematometrium d. Biliary colic e. Renal carcinoma
A
Ans. The key is C. Hematometrium. [Primary amenorrhea and periodic pain indicate hematometrium either secondary to imperforated hymen or vaginal septum].
19
Q
- A 14yo boy with asthma suddenly developed chest pain and increasing breathlessness during a game of football. When seen in the ED he was not cyanosed. He has reduced breath sounds on the right side. His oxygen saturation is 94% on air. What is the single most appropriate inv? a. Capillary blood gases b. CXR c. CT chest d. Exercise challenge e. MRI chest
A
Ans. The key is B. CXR. [Asthma is a predisposing factor for spontaneous pneumothorax. The presentation indicates pneumothorax for which most appropriate investigation is CXR].
20
Q
- A 36yo woman was recently admitted to a psychiatric ward. She believes that the staff and other pts know exactly what she is thinking all the time. What is the most likely symptom this pt is suffering from? a. Thought insertion b. Thought withdrawal c. Thought block d. Though broadcasting e. Hallucination
A
Ans. The key is D. Thought broadcasting.
21
Q
- A 60yo woman is admitted to the hospital after a fall. She is noted to have poor eye contact. When asked how she is feeling, she admits to feeling low in mood and losing enjoyment in all her usual hobbies. She has also found it difficult to concentrate, feels that she is not good at anything, feels guilty over minor issues and feels very negative about the future. What is the most likely dx?
A
Ans. The key is A. Mild depression. [Mild depression: i)Low mood ii) Anhedonia iii) Guilt iv) Hopelessness v) Worthlessness vi) Inability to concentrate].
22
Q
- A 70yo woman lives in a nursing home following a stroke has developed reddish scaly rash on her trunk. She has many scratch marks on her limbs and trunk with scaling lesions on her hands and feet. What is the single most appropriate initial tx? a. Aqueous cream b. Chlorphenaramine c. Coal tar d. 1% hydrocortisone ointment e. Permethrin
A
Ans. The key is E. Permethrine. [This is a case of scabies and scaly rash denotes the infection of most severe type the crusted or Norwegian scabies. Should be treated with permethrine].
23
Q
- A 16yo boy following a RTA was brought to the ED with a swelling and deformity in his right thigh. Exam: airway is patent and is found to have a pulseless leg. Which structure is involved in this fx? a. Femoral artery b. Posterior tibial artery c. Common peroneal nerve d. Dorsalis pedis
A
Ans. The key is A. Femoral artery.
24
Q
- A man sat cross-legged for about 30mins. After this he was unable to dorsiflex his left foot and had loss of sensation in the web space between the big toe and the 2nd toe. He also has sensory loss on the same side of the foot after 2h. Which of the following was affected? a. Femoral nerve b. Sural nerve c. Peroneal nerve d. Sciatic nerve
A
Ans. The key is C. Peroneal nerve. [Common peroneal nerve winds round the fibular neck at knee joint and when a man sits cross legged for a considerable time pressure exerted on the nerve may cause nerve palsi].
25
625. A 25yo woman is presenting with diarrhea and abdominal bloating over the last 4m. Exam: she has blistering rash over her elbows. Biochemistry: low serum albumin, calcium and folate conc. On jejunal biopsy, there is shortening of the villi and lymphocytosis. What is the most likely dx? a. Celiac disease b. Whipple’s disease c. Crohn’s disease d. Tropical sprue e. Giardiasis f. Cystic fibrosis
Ans. The key is A. Celiac disease. [diarrhea, abdominal bloating, blistering skin rash over elbow (Dermatitis herpetiformis), low serum albumin, calcium and folate conc. Supported by shortening of villi and lymphocytosis on jejuna biopsy is classic presentation of celiac disease].
26
626. A 19yo man presents for the 1st time with a firm and unshakable belief that he is being followed by terrorists who are plotting against him. What is the single best term for this man’s condition? a. Delusion of persecution b. Delusion of grandeur c. Delusion of control d. Delusion of reference e. Delusion of nihilism
Ans. The key is A. Delusion of persecution. [Delusions of persecution refer to false beliefs or perceptions in which a person believes that they are being treated with malicious intent, hostility, or harassment – despite significant evidence to suggest otherwise]
27
627. A 19yo female is brought in by her parents. They are concerned about her BMI which is 12. She is satisfied with it. What is the next step? a. Psychiatric referral for admission b. Family counselling c. Social service d. Start antidepo e. Medical admission
Ans. The key is E. Medical admission. [The diagnosis is anorexia nervosa. At this critical low BMI medical admission is indicated to improve her deficiency states and proper nutrition. ((BMI <15kg/m2, rapid weight loss + evidence of system failure) requires urgent referral to eating disorder unit (EDU), medical unit (MU) or paediatric medical wards].
28
628. A lady who works at a nursing home presents with itching. Exam: linear tracks on the wrist. She says that 2d ago she had come in contact with a nursing home inmate with similar symptoms. What is the mechanism of itching? a. Infection b. Destruction of keratinocytes c. Allergic reaction d. Immunosuppression e. None
Ans. The key is C. Allergic reaction. [The probable diagnosis is scabies in which there is itching due to allergic reaction to mites (Sarcoptes scabii) waste products].
29
629. A teacher had a respiratory infection for which she was prescribed antibiotics. After the antibiotic course when she rejoined school, she lost her voice completely. What is the single most appropriate dx? a. Recurrent laryngeal nerve palsy b. Angioedema c. Laryngeal obstruction by medication d. Laryngitis e. Functional dysphonia/vocal cords
Ans. The key is E. Functional dysphonia/vocal cords. [Functional dysphonia is poor voice quality without any obvious anatomical, neurological or other organic difficulties affecting the larynx or voice box. It is often secondary to viral infection].
30
630. A 43yo lady is admitted with pyrexia, arthropathy, breathlessness and syncope. She was recently dx with pulmonary emboli. There is an early diastolic sound and a mid-diastolic rumble. Her JVP is elevated with prominent a-waves. What is the most likely cause? a. Mitral regurgitation b. Ventricular ectopics c. Pulmonary regurgitation d. Atrial myxoma e. Complete heart block
Ans. The key is D. [Pyrexia, arthropathy, breathlessness, syncope and early diastolic sound and a mid diastolic rumble are known features of atrial myxoma].
31
631. A 28yo man presents with a maculopapular rash over his trunk and palms. He also has numerous mouth ulcers. He had a penile ulcer which healed 2wks ago. What will you do to confirm the dx? a. PCR for treponemal and non-treponemal antibiodies b. Dark ground microscopy from mouth ulcer c. Blood culture for treponema d. Dengue fever
Ans. The key is A. PCR for treponomal and non-treponemal antibodies. [Non treponemal antibody test if positive indicate that there may be syphilis and it is not confirmatory alone. That is why treponemal antibody test should also be done to confirm it. On the other hand resolved disease may show negative treponemal test which is confirmed by positive non-treponemal test].
32
632. A 34yo man complains of arthralgia, abdominal pain and vomiting, a facial rash that is worse in the summer and hematuria. Urea and creatinine are slightly elevated with urinalysis demonstrating red cell casts. PMH is remarkable for childhood eczema. Which inv is most likely to lead to a dx? a. US KUB b. Joint aspiration c. Auto antibodies d. IVU e. Renal biopsy
Ans. The key is C. Auto antibodies. [Likely diagnosis is SLE for which auto antibody (anti ds DNA antibody) should be done].
33
633. A 56yo woman has had severe abdominal pain for 24h radiating to her back and is accompanied by nausea and vomiting. She appears to be tachycardic and in shock. She was found to have gallstones, 2yrs ago. What is the most likely inv to confirm dx? a. US abdomen b. LFT c. Serum lipase d. Angiography e. CT abdomen
Ans. The key is C. Serum lipase. [The likely diagnosis is pancreatitis hence serum lipase].
34
634. A 32yo female with axillary freckles and café au lait spots wants to know the chances of her child also having similar condition. a. 1:2 b. 1:4 c. No genetic link d. 1:16 e. Depends on the genetic make up of the partner
Ans. The key is E. Depends on genetic make up of the partner. [Depends on the make up of the partner, ideally it's 1:2 since it's autosomal dominant with complete penetrance but if the patients spouse also has neurofibromatosis, it raises it to at least 75% with a possible 100%].
35
635. A 40yo man has pain, redness and swelling over the nasal end of his right lower eyelid. The eye is watery with some purulent discharge. The redness extends on to the nasal peri-orbital area and mucoid discharge can be expressed from the lacrimal punctum. What is the single most appropriate clinical dx? a. Acute conjunctivitis b. Acute dacrocystitis c. Acut iritis d. Retrobulbar neuritis e. Sc
Ans. The key is B. Acute dacrocystitis.
36
636. A 60yo lady has severe chest pain. ECG shows changes of inferior wall MI. ECG also shows progressive prolongation of PR interval until a QRS complex is dropped. What is the most probable dx? a. Atrial fibrillation b. VT c. SVT d. Mobitz type I 2nd degree heart block e. Mobitz type II 2nd degree heart block
Ans. The key is D. Mobitz type I 2nd degree heart block. [Inferior MI is frequently associated with conduction defect].
37
637. A 52yo woman speaks rapidly without any pause and ignores interruptions. She doesn’t even pause to take enough breaths. What term best describes this kind of speech? a. Flight of ideas b. Broca’s aphasia c. Wernicke’s aphasia d. Pressure of speech e. Verbal dysphasia
Ans. The key is D. Pressure of speech.
38
638. A 30yo woman has been feeling low and having difficulty in concentrating since her mother passed away 2m ago. She feels lethargic and tends to have breathlessness and tremors from time to time. What is the most likely dx? a. Adjustment disorder b. PTSD c. Panic disorder d. GAD e. Bereavement
Ans. The key is A. Adjustment disorder. [When 2 months passed it is no more normal bereavement but major depression or adjustment disorder].
39
639. A 32yo man on psychiatric medications complains of inability to ejaculate. Which drug is most likely to cause these symptoms? a. Lithium b. Haloperidol c. Chlorpromazine d. Fluoxetine e. Clozapine
Ans. The key is D. Fluoxetine. [SSRIs are frequently associated with delayed ejaculation].
40
640. A 4yo boy is brought by his parents with complains of wetting his bed at night and whenever he gets excited. What would be the most appropriate management for this child? a. Desmopressin b. Oxybutanin c. Behavioural therapy d. Tamsulosin e. Restrict fluid intake
Ans. The key is C. Behavioural therapy. Probably this is wrong option! There is no correct option for this question. [The question is inappropriate. Child is of 4 yrs of age and before 5 yrs only reassurance, no treatment is indicated].
41
641. A 34yo DM pt is undergoing contrast radiography. What measure should be taken to prevent renal damage with contrast dye? a. Reduce contrast dye b. Plenty of fluids c. NSAIDS d. ACEi e. IV dextrose
Ans. The key is B. Plenty of fluids.
42
642. A 75yo woman presents to the breast clinic having noticed that she has had a blood stained discharge from the left nipple, together with dry skin over the left areola. Exam: blood stained discharge with dry flaky skin noted on the left areola. The nipple was noted to be ulcerated. Wht is the most appropriate inv? a. FNAC b. MRI c. Punch biopsy d. Open biopsy e. Stereotactic biopsy
Ans. The key is C. Punch biopsy. [As the lesion is on the surface punch biopsy can be well obtained].
43
643. A 50yo man presents with low mood, poor concentration, anhedonia and insomnia. He has had 2 episodes of increased activity, promiscuity and aggressive behavior in the past. He was arrest 8m ago for trying to rob a bank claiming it as his own. Which drug is most likely to benefit him? a. Haloperidol b. Citalopram c. Desipramine d. Carbamazepine e. Ethosuximide
Ans. The key is D. Carbamazepine. [It is a case of bipolar disorder. Mainstay of treatment is mood stabilizers such as i) Lithium carbonate ii) Anticonvulsant medicines iii) Antipsychotic medicines. So from the given options Carbamazepine is the most appropriate drug].
44
644. A 25yo woman complains of dizziness, nausea, vomiting, visual disturbances and anxiety which keep coming from time to time. Most of the attacks are a/w sudden change in posture. What is the most likely dx? a. Panic disorder b. Carotid sinus syncope c. BPPV d. Vertebrobasilar insufficiency e. Postural hypotension
Ans. The key is C. Benign paroxysmal positional vertigo (BPPV). [Dizziness, nausea, vomiting and nystagmus which keep coming from time to time are common features of BPPV].
45
645. A 56yo man was recently put on anti-HTN meds and recent biochemistry on 2 occasions showed: Na+=132, K+=7.6, Urea=11.3, Creat=112. Which of the following drugs is responsible for this result? a. Amlodipine b. Bendroflumethiazide c. Doxazosin d. Atenolol e. Ramipril
Ans. The key is E. Ramipril. [ACEI and ARB are known to raise the serum potassium level].
46
646. A 46yo woman has offensive yellow discharge from one nipple. She had a hx of breast abscess 3yrs ago. What is the possible dx? a. Duct papilloma b. Duct ectasia c. Duct fistula d. Breast cancer
Ans. The key is C. Duct fistula.
47
647. A 35yo woman undergoing tx for TB presents with malar rash, photosensitivity and hematuria. What is the single most likely positive antibody? a. Anti Ds DNA b. Anti Sm c. Anti Histone d. Anti La e. Anti centromere
Ans. The key is C. Antihistone antibody. [Anti histone antibody is present in 95% cases of drug induced lupus].
48
648. A 6wk child with profuse projectile vomiting. What is the first thing you will do? a. US b. Check serum K+ level c. ABG d. NG tube e. IV fluids
Ans. The key is B. Check serum K+ level. This is a wrong key! Correct key is E. IV fluid. [We shall resuscitate first with normal saline].
49
649. A 55yo woman who attends the clinic has recently been dx with a depressive episode. She complains of unintentionally waking early in the morning, a recent disinterest in sex and a loss of appetite, losing 5kg weight in the last month. She feels that her mood is worse at the beginning of the day. What is the most likely dx for this pt? a. Mild depression b. Moderate depression c. Severe depres
Ans. The key is B. Moderate depression. [Sleep disturbance, disinterest in sex and loss of appetite points towards the diagnosis of moderate depression].
50
650. An employer sent his worker to the ED after having hit his head on a machine. Exam: normal. What is the single most likely inv you would do? a. Skull XR b. CT head c. MRI head d. Reassure
Ans. The key is A. Skull XR. This is wrong key! Correct key should be B. CT head.
51
651. A lady with fam hx of ovarian carcinoma has a pelvis US that fails to reveal any abnormality.What is the single most appropriate inv? a. Pelvic CT b. CA 125 c. CA 153 d. Laparoscopy e. MRI
Ans. The key is B. CA 125. [CA 125 is tumour marker for ovarian tumour].
52
652. A 10yo boy is taken to his GP by his parents with behavioural prbs. He attends a special school due to inappropriate behavior and during the interview with his parents the boy barks at infrequent episodes and shouts expletives. What is the most likely dx? a. Asperger syndrome b. Cotard syndrome c. Rett syndrome d. Ekbom syndrome e. Tourette’s syndrome
Ans. The key is E. Tourette’s syndrome. [Tourete’s syndrome may have motor tics like blinking, facial grimacing, shoulder shrugging. Other complex motor tics may be sniffing, touching objects, hopping, jumping, bending or twisting. It has vocal tics like throat clearing, sniffing, grunting or barking and morecomplex like coprolalia (uttering socially inappropriate words) or echolalia (repeating th
53
653. A 52yo male presents with sudden complete loss of vision from right eye. He also had been complaining of right sided headaches which would come up more on chewing. On fundoscopy, the retina was pale and a cherry red spot could be seen in the macular region. What caused this vision loss? a. CRAO b. CRVO c. Branch RAO d. Branch RVO e. Circumciliary vein occlusion
Ans. The key is A. CRAO. [Pale retina with cherry red spot in macular region is seen in CRAO].
54
654. A 48yo woman presents with left-sided severe headache. She also has a red, watering eye and complains of seeing colored haloes in her vision. What is the most appropriate next step? a. Measure IOP b. Relieve pain with aspirin c. 100% oxygen d. CT e. Relieve pain with sumatriptan
Ans. The key is A. Measure IOP. [Probable case of angle closure glaucoma requiring measurement of IOP to establish the diagnosis].
55
655. A 31yo woman presents with 7-10days following childbirth, with loss of feeling for the child, loss of appetite, sleep disturbance and intrusive and unpleasant thoughts of harming the baby. What is the best tx for this pt? a. Fluoxetine b. Haloperidol c. CBT d. Reassurance e. ECT
Ans. The key is A. Fluoxetine. [The diagnosis is post-partum depression. Treatment is fluoxetine. The mode of treatment may be 1. Drugs like a) Antidepressant b) Antypsychotic or c) Mood stabilizers like lithium. If drug treatment fails then 2. ECT].
56
656. A 56yo male pt presents with intermittent vertigo, tinnitus and hearing loss. What is the best drug tx for this pt? a. Buccal prochlorperazine b. Oral flupenphenazine c. TCA d. Gentamicin patch on the round window e. No med tx available
Ans. The key is A. Buccal prochlorperazine. [Probable case of Menieres disease. Treated with prochlorperazine].
57
657. An 82yo woman has developed painful rash on one side of her forehead and ant scalp. Lesions have also affected her cornea. What is the single most appropriate option? a. Accessory nerve b. Facial nerve c. Olfactory nerve d. Optic nerve e. Trigeminal nerve
Ans. The key is E. Trigeminal nerve. [Probable herpes zoster opthalmicus].
58
658. A 24yo woman presents with episodes of peri-oral tingling and carpo pedal spasms every time she has to give a public talk. This also happens to her before interviews, exams and after arguments. What is the best management strategy for this pt? a. Diazepam b. Rebreathe in a paper bag c. Desensitization d. Buspirone e. Propranolol
Ans. The key is B. Rebreathe in a paper bag. This is wrong key. More correct option is C. Desensitization.[Desensitization is the treatment of choice in long run. For prevention proranalol before expected exposure and if patient presents with an attack then rebreathing in a paperbag to subside her acute problems].
59
659. A 32yo woman P3 of 39wks gestation reports having spontaneous ROM 4days ago. She didn’t attend the delivery suite as she knew that would happen and had already decided on a home birth. Today she feels very hot and sweaty. She thought that she was starting to have labour pains but she describes the pain as more constant. Exam: uterus is tender throughout. Blood tests show raised CRP and WBC. S
Ans. The key is B. Chorioamnionitis. [Prolonged rupture of membrane can lead to chorioamnionitis].
60
660. A 63yo man continues to experience chest pain and has a temp of 37.8C 2 days after an acute MI. His ECG shows widespread ST elevation with upward concavity. What is the single most likely explanation for the abnormal inv? a. Acute pericarditis b. Cardiac tamponade c. Atrial thrombus d. Left ventricular aneurysm e. Dressler syndrome
Ans. The key is A. Acute pericarditis. [Chest pain, raised temperature and ECG findings of widespread ST elevation with upwards concavity is diagnostic of acute pericarditis particularly after MI].
61
661. A 55yo man presents with an ulcer of the scrotum. 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.
62
662. A 35yo woman has butterfly rash on her face and she suffers symmetrical joint pains on knee and elbow, ESR is raised. What is the most discriminative inv for dx? a. Anti DNA antibodies b. Anti Jo1 antibodies c. Anti nuclear antibodies d. Anti centromere antibodies e. Anti la antibodies
Ans. The key is A. Anti DNA antibodies. [Anti DNA antibodies to diagnose SLE].
63
663. Pt had a fight following which he developed bleeding, ringing and hearing loss from one ear. What is the inv of choice? a. CT b. XR skull c. Otoscopy d. MRI vestibule e. Coagulation study
Ans. The key is A. CT. This is a wrong key! Correct key is Otoscopy.
64
664. A 35yo IVDA (Intra Venous Drug Abuser) on penicillin and flucloxacillin for cellulitis now presents with jaundice, pale stools and dark urine. What is the single most likely dx? a. Hep A b. Cholestatic jaundice c. Chronic active hepatitis d. Primary biliary cirrhosis e. Hep B
Ans. The key is B. Cholestatic jaundice. [Flucloxacillin can cause cholestatic jaundice].
65
665. A 79yo woman has been dx with T2DM. Her BMI=22. RBS are 8 and 10mmol/l. Her BP=130/80mmHg. Her fasting cholesterol=5.7mmol/l. She is currently symptom-free but has microalbuminuria. What is the single most appropriate drug management? a. ACEi and glibenclamide b. ACEi and metformin c. Statin and ACEi d. Statin and glibenclamide e. Statin and metformin
Ans. The key is C. Statin and ACEi. [Diabetic patients are advocated statin irrespective of cholesterol levels and diabetic microalbuminuria is best treated by ACEI. As initially we shall give lifestyle advice and no medicine for diabetes even then we shall start with statin and ACEI].
66
666. A 68yo woman is unable to extend the IP joint of her right thumb 7wks following a fx of the right radius. Other finger and thumb movements are normal. What is the single most likely tendon to be damaged? a. Abductor pollicis longus b. Extensor pollicis brevis c. Extensor pollicis longus d. Flexor digitorum profundus e. Flexor pollicis longus
Ans. The key is C. Extensor policis longus. [Full extension of right thumb is achieved by extensor pollicis longus].
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667. A mother presents her 6m son who is vocalizing. She has noticed that he doesn’t respond to loud noises. His motor milestones are normal. What is the best management strategy? a. Arrange hearing test b. Assess development milestones c. Reassure d. Refer to speech therapist e. MRI brain
Ans. The key is A. Arrange hearing test. [Normal motor milestones indicate normal development but unable to respond to loud noise at 6 months may indicate deafness].
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668. A 39yo man presents to the ED with persistent cough, sputum and dyspnea. He gave a hx of smoking 20 cigarettes/d for the last 10 years. Pt was given oxygen in ambulance but he is not improving. What is the next step? a. Prednisolone b. Salbutamol c. Check ABG d. CXR e. ECG
Ans. The key is C. Check ABG. [The patient has COPD and as no improvement with oxygen, next step is to check ABG to give guidance for next treatment plan].
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669. A 66yo woman has been brought to the hospital on a number of occasions with a hx of loss of memory. Her PMH is significant for an MI 6yrs ago. It is noted that she has a step wise decline of her cognitive functions. What is the most likely dx? a. Alzhemiers b. Vascular dementia c. Pick’s dementia d. Huntington’s disease e. Lewy body dementia
Ans. The key is B. Vascular dementia. [Age 65 yrs (vascular dementia is rare at age before 65), history of MI and stepwise decline of cognitive function indicates vasculopathy and hence vascular dementia].
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670. A 55yo man returns for routine follow up 6wks after an MI. He gets breathless when walking uphill. His ECG shows ST elevation in leads V1, V2, V3 and V4. What is the single most likely explanation for the abnormal investigation? a. Heart block b. Right ventricular strain c. Atrial thrombus d. Left ventricular aneurysm e. Dressler’s syndrome
Ans. The key is D. Left ventricular aneurism. [Features of heart failure and persistent ST elevation suggests the dx of left ventricular aneurysm].
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671. A 4m girl has severe FTT (Failure To Thrive) and increasing jaundice which was 1st noticed at 1wk of age. She has an enlarged liver and scratches on her skin. Her parents have been unable to seek medical care. What is the most likely dx? a. Biliary atresia b. G6PD deficiency c. Hep B d. Spherocytosis
Ans. The key is A. Biliary atresia. [Increasing jaundice at this age with failure to thrive, enlarged liver and scratches (itching) indicate cholestatic jaundice likely from biliary atresia].
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672. A 76yo man suddenly collapsed and died. At post mortem exam, a retroperitoneal hematoma due to ruptured aortic aneurysm was noted. What is the most likely underlying cause of the aortic aneurysm? a. Atheroma b. Cystic medial necrosis c. Dissecting aneurysm d. Polyarteritis nodosa e. Syphilis
Ans. The key is A. Atheroma.
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673. A 33yo male came to the hospital with complaint of occasional left sided chest pain that lasts <30mins, following exercise, which relieves upon taking rest. What is the most probable dx? a. Unstable angina b. Decubitus angina c. Stable angina d. Coronary spasm e. MI
Ans. The key is C. Stable angina.
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674. A 42yo overweight smoker comes with heavy periods. A scan reveals a normal uterus. She would like a long term tx with minimal side effects that would offer tx for the menorrhagia and provide contraception. She is unsure whether she would like more children. She is adamant that she doesn’t want surgery as she is terrified of the prospect. Select the best management for her menorrhagia? a. COCP
Ans. The key is C. IU/systemic progesterone. [As patient is smoker, COCP should be avoided. In the given case option C. i.e. mirena is most suitable].
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675. A 10yo male child was brought by his mother complaining that her child watches TV at very high volumes, doesn’t like to play outside and instead has become more sincere with reading. She also says that her son doesn’t respond to her. What do you expect to see on otoscopy? a. Flamingo pink tympanic membrane b. Attic perforation c. Bluish grey tympanic membrane with air fluid levels d. Inflamed
Ans. The key is C. Bluish grey tympanic membrane with air fluid levels. [In glue air there occur conductive deafness so the child watch tv with high volume and does not respond to others for this deafness].
76
676. A lady underwent debulking surgery for ovarian carcinoma. Soon after the surgery she presents with signs of intestinal obstruction. What is the single most appropriate inv? a. Pelvic CT b. CA 125 c. Laparotomy d. Laparoscopy e. Abdominal US
Ans. The key is C. Laparotomy. [In cancer patient obstruction does not respond to medical treatment and hence diagnostic and therapeutic laparotomy is the option of choice].
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677. A 45yo woman undergoing tx for RA for the last 5yrs presents with dizziness, easy fatigabiliy and lack of energy. A blood film shows MCV 106. What could be the most probable reason for her anemia? a. Steroids b. Chronic disease c. NSAIDs d. Methotrexate e. Sulfasalazine
Ans. The key is D. Methotrexate. [Methotrexate leads to folate deficiency anaemia].
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678. A 62yo man who has recently had flu-like illness has woken to find his speech altered. Movement of his eyelids and lips are weak on the right side. Exam: normal. Which anatomical site is most likely to be affected? a. Facial nerve b. Hypoglossal nerve c. Oculomotor nerve d. Trigeminal nerve e. Glossopharyngeal nerve
Ans. The key is A. Facial nerve. [Viral infection is a common cause of facial nerve palsy].
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679. A 5yo girl has had an URTI for 3 days and has been treated with paracetamol by her mother. For the last 12h she has been hot and irritable with severe pain in her right ear. What is the most likely dx? a. Herpes zoster infection b. Impacted ear wax c. Mumps d. OM e. Perforation of eardrum
Ans. The key is D. OM.
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680. A 35yo man has a temp=39C, cough with purulent sputum and right sided chest pain on inspiration. He has herpes labialis. 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. Serology for legionella
Ans. The key is C. Gram +ve diplococcic in sputum. [High temperature, cough with purulent sputum, pleuritic chest pain and herpes labialis are recognized feature of pneumococcal pneumonia (pneumococcus=Gram +ve diplococci].
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681. A 27yo female was brought to the ED by her friend from a movie theatre. She complains of sudden severe pain in the eye followed by vomiting and also was seeing colored halos. She gives a past hx of recurrent headaches which used to resolve spontaneously. Exam: fixed, dilated ovoid pupil seen. What is the first inv? a. CT head b. MRI orbits c. Blood culture and sensitivity d. Toxicology screen
Ans. The key is E. Applanation tonometry. [Darkness can cause dilatation of pupil (which occurred in the darkness of theatre room) which (halfway dilatation) most often precipitate acute attack of angle closure glaucoma and the test to diagnose this is applanation tonometry].
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682. An 82yo male suddenly becomes unconscious and fell down. He recovered completely within minutes. What is the best inv you to to dx the case? a. ECG b. EEG c. Blood glucose level d. CT e. CXR
Ans. The key is A. ECG. [Here sudden unconciuosness without any provocation, which makes arrhythmia the most likely cause; hence we should do ECG].
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683. A child admitted with progressive muscle weakness and frequent falls. What is the most probable dx? a. Duchenne’s MD b. Becker’s MD c. Polymyositis d. Dermatomyositis e. Polymyalgia rheumatic
Ans. The key is A. Duchenne’s MD.
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684. A 56yo man presents to the ED with chest pain. The following ECG was taken. What is the most likely dx? a. Anterior MI b. Inferior MI c. Lateral MI d. Posterior MI e. NSTEMI
Ans. The key is A. Anterior MI. [Here ST elevation in L1, aVL, v2,v3,v4 and v5. So the diagnosis is anteriorMI (as L1 and aVL and v2-v5, anterolateral would be more appropriate description)].
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685. A schizophrenic says: life is unfair. I like fairs. Fairs have food. It must be good. What term describes this pt’s speech? a. Neologism b. Flight of ideas c. Broc1a’s aphasia d. Wernicke’s aphasia e. Clang association
Ans. The key is E. Clang association. [The rhymic use of words as described is known as clanging or clang association often seen in schizophrenia].
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686. A man comes to the ED with hx of pulsatile swelling in the abdomen, he has hx of HTN and exam: pulse=120bpm, BP=70/40mmHg. He is restless and in shock. What emergency management should be done on priority basis? a. Urgent abdominal CT b. Urgent abdominal US c. IV fluids 0.9% NS crystalloids to bring SBP to 90mmHg d. IV fluids 0.9% NS crystalloids to bring SBP to 120mmHg e. Dopamine inj
Ans. The key is C. IV fluids 0.9% NS crystalloids to bring SBP to 90mmHg [Probable ruptured aortic aneurism. Immediate IV normal saline to raise the BP to 90 mmHg to keep the vital organs perfused till definitive measures are taken].
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687. A 5yo boy has cough and swelling at the knee after falling on the ground with rashes on the buttocks which are non-blanching. PT=13, APTT=71, Hgb=11, WBC=8, Plt=200. Choose the most likely dx? a. NAI b. Hemophilia c. HSP d. Osler weber reindu syndrome e. Von-Willebrand disease
Ans. The key is B. Hemophilia. This is a controversial key! Correct key should be E. Von-Willebrand disease. [Likely D/D may be B or C! in von willebrands disease usually there is no hemarthrosis (except in type 3) and in hemophilia no nonblanching rash (there may bruising). isolated rise in APTT is highly suggestive of hemophilia (given case). This is an ill defined question and only likely diagn
88
688. A 45yo woman presents with discharge from the left nipple. The discharge is brownish-green and foul smelling. What is the most likely dx? a. Duct papilloma b. Intra-ductal papilloma c. Duct ectasia d. Mammary duct fistula e. Breast abscess
Ans. The key is C. Duct ectasia. [Women near menopause are more affected by duct ectasia characterized by brown, green or cheesy discharge. This condition is harmless and tends to clear up without treatment].
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689. A 10yo boy presents with generalized swelling. This has been present for 4days and included swollen ankles and puffiness of the face. It started a few days after he had a mild cold with runny nose. His only PMH was eczema. Urine analysis: hematuria, proteinuria 10g/24h, creat 60umol/l and albumin=15g/l. What is the single most likely dx? a. IgA nephropathy b. HSP c. Minimal change nephropathy
Ans. The key is A. IgA nephropathy. [10 yr old boy, history of URTI and hematuria points towards the diagnosis of IgA nephropathy. It may be present with proteinuria and generalized swelling. The important differentiating point from rapidly progressive GN is duration. IgA nephropathy <1o days (usually 4/5 days history of infection but in rapidly progressive GN history of infection for >10 days].
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690. A 28yo man complains of vertigo, nausea and vomiting for more than 30 mins and tinnitus, hearing loss in the left ear. What is the tx for this pt? a. Buccal prochlorperazine (2nd line) b. Metachlorpromide c. Cyclazine (1st line) d. Cotrimazole e. Ondansetron
Ans. The key is C. Cyclizine. More appropriate is A. Buccal prochlorperazine (patient.info). [Both prochlorperazine and cyclizine can be used in Meniere’s disease].
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691. A 16yo girl has been unwell for 5days with malaise, headache and dry cough. She has a few crackles in her chest. Her CXR shows patchy consolidation in the lower lobes. What is the single most likely causative organism? a. Cold agglutinins b. Gram –ve diplococci in sputum c. Gram +ve diplococcic in sputum d. Serology for legionella e. Sputum staining for mycobacterium TB
Ans. The key is A. Cold agglutinins. [Mycoplasma pneumonia, a form of atypical bacterial pneumonia related to cold agglutinin disease].
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692. A child with increasing jaundice and pale stools. Choose the appropriate test: a. Endomyseal antibodies b. Sweat test c. TFT d. LFT e. US
Ans. The key is E. US. [This is obstructive jaundice where US may show dilatation of common bile duct or stones].
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693. A 73yo woman with RA is unable to extend the fingers of her right hand at the MCP joint and IP joints following a fall. What is the single most likely tendon to have been damaged? a. Extensor carpi radialis b. Extensor carpi ulnaris c. Extensor digitorum d. Extensor indicis e. Flexor digitorum profundum
Ans. The key is C. Extensor digitorum. [The extensor digitorum extends the phalanges, then the wrist, and finally the elbow. It acts principally on the proximal phalanges].
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694. You are called to see a 20yo woman 2h post-LSCS. She has not passed urine since her operation. She denied any urinary symptoms preoperatively. Exam: appears unwell, temp=37.5C, BP=94/73mmHg, pulse=116bpm, sat=97%. Her abdomen is distended with tenderness in the left flank and suprapubic region. Bowel sounds are not audible. Choose the most appropriate post Csection complication for this lady?
Ans. The key is B. Urinary tract injury.
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695. A 58yo man has a headache and confusion of 3 days after slipping and hitting his head in the garden. What is the most appropriate initial inv? a. XR skull b. XR face c. CT brain d. MRI brain e. EEG
Ans. The key is C. CT brain. [The likely diagnosis is subdural haematoma for which appropriate initial investigation is CT scan of brain].
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696. A 4yo boy has a cough and arthritis followed by rash on legs which are non-blanching on glass test. No hx of fever. PT=13, APTT=31, Hgb=12, WBC=6.5, Plt=300. What’s the most likely dx? a. Meningitis septicemia b. Hemophilia c. HSP d. ITP e. TTP
Ans. The key is C. HSP. [Usually occurs below 10 yrs of age. The characteristic rash and lab findings matches with HSP].
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697. A 72yo man presents to the ED with chest pain. The following ECG was taken What is the most likely dx? a. Anterior MI b. Inferior MI c. Lateral MI d. Posterior MI e. NSTEMI
Ans. The key is B. Inferior MI. [There is pathological Q wave and mild ST elevation in leads II, III and aVF].
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698. A young man has diarrhea, loss of weight and flatulence for 3 days. What is the most imp tx? a. Metronidazole b. Fluconazole c. Vancomycin d. Amoxicillin
Ans. The key is A. Metronidazole. [An incomplete question!!]
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699. A 6yo child presented with drooling of saliva and severe stridor. He is febrile and sick looking. XR Neck in extension shows a thumb sign. Choose the single most likely dx. a. Croup b. URTI c. Diphtheria d. Acute epiglottitis
Ans. The key is D. Acute epiglottitis. [Drooling of saliva and stridor along with thumb sign in neck X-ray are features of acute epiglottitis].
100
700. A mother presents with her 3yo son who has indistinct nasal speech. He snores at night and has restless sleep. He is tired by day. What is the best management strategy? a. Arrange hearing test b. Assess development milestones c. Refer to ENT surgeon d. Refer to speech therapist e. MRI brain
Ans. The key is C. Refer to ENT surgeon. [Probable enlarged adenoid].
