801 to 900 Flashcards
(100 cards)
1
Q
- A 78yo gentleman suddenly collapsed. His HR=120bpm, BP=70/40mmHg. Exam: pulsatile mass in abdomen. What is the most appropriate dx? a. Aortic aneurysm b. Mesenteric cyst c. Umbilical hernia
A
Ans. The key is A. Aortic aneurism. [There is features of shock with pulse 120bpm and bp 70/40mmHg and sudden collapse of the patient with pulsatile mass in abdomen makes the likely diagnosis of ruptured aortic aneurism].
2
Q
- A woman prv in good health presents with sudden onset of severe occipital headache and vomiting. Her only physical sign on exam is a stiff neck. Choose the most likely dx. a. Subarachnoid hemorrhage b. Subdural hematoma c. Cerebellar hemorrhage d. Migraine e. Cerebral embolus
A
Ans. The key is A. Subarachnoid hemorrhage. [Sudden onset severe occipital headache and vomiting with stiffness makes the likely diagnosis to be subarachnoid hemorrhage].
3
Q
- A 34yo housemaid presents with headaches in the back of her head for several days and pain on flexing her neck. What is the most likely cause? a. Subdural hemorrhage b. Cervical spondylosis c. Subarachnoid hemorrhage d. Meningitis e. Cluster headache
A
Ans. The key is B. Cervical spondylosis. [Headache in the back of head and pain on flexing neck is early feature of cervical spondylosis which gradually progress to later symptoms like radiculopathies due to root compression in arms and hands]
4
Q
- A 40yo man complains of thirst and lethargy. His BP=140/90mmHg, corrected Ca2+=3.7mmol/l. What is the most appropriate management at this stage? a. IV fluids b. Prednisolone c. IV hydrocortisone d. Calcium prep
A
Ans. The key is A. IV fluids. [Hypercalcemia is treated by IV fluids].
5
Q
- A 75yo man on digoxin develops weakness in the right upper and lower limbs which resolves within a few hours. What is the most definitive inv for this condition? a. Carotid Doppler b. Angiography c. CT head d. Digoxin level
A
Ans. The key is B. Angiography. Probably wrong key! Correct key is C. CT head. [Patient on digoxin means he is being yreated for atrial fibrillation with heart failure and the cause of tia is cardiac in origine! So carotid dopplar or carotid angiography is not the answer. Again for tia investigation of choice is MRI (if not available CT) NICE guideline. So for this question definitove investigatio
6
Q
- A 35yo man presents with balance problems, headache, SNHL and loss of coreneal reflex on the left side. What is the most definitive inv? a. CT scan of internal auditory meatus b. Nuclear imagine of the brain c. MRI of internal auditory meatus d. MRI brain
A
Ans. The key is D. MRI brain. Wrong key! “Most definitive” is MRI internal auditory meatus. [Probable diagnosis is left sided acaustic neuroma. For this most definitive investigation is MRI internal auditory meatus].
7
Q
- A 52yo man has a painful, red, photophobic right eye with slightly blurred vision and watering for 3days. He has had no such episodes in the past. On slit lamp examination there are cells and flare in the ant chamber and pupil is sluggish to react. What is the single most appropriate clinical dx? a. Acute close-angle glaucoma b. Acute conjunctivitis c. Acute dacrocystitis d. Acute iritis e. C
A
Ans. The key is D. acute iritis. [In iritis there is flares and cells in anterior chamber. In iritis pupil may be irregular but in angle closure glaucoma pupil is slightly dilated and oval in shape. In iritis there is no halo around light but in glaucoma there is halo around light].
8
Q
- A 55yo lady with swelling on the abdomen below the umbilicus on the right side. What is the single most appropriate lymph node? 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 D. Inguinal LN.
9
Q
- A 66yo male presents with painful swallowing. What is the most likely dx? a. Nesseria meningitides b. Cryptococcus neoformans c. Candida albicans d. Isospora belli e. Mycobacterium avium
A
Ans. The key is C. Candida albicans. [Oesophageal candidiasis].
10
Q
- A 45yo lady complains of expressable galactorrhea, decreased libido and amenorrhea, weight gain and easy fatigue. Her serum prolactin levels are 1100um/l. what is the likely cause of hyperprolactinemia? a. Hypothyroidism b. Stress c. Pregnancy d. Prolactin secreting pituitary tumor e. PCOS
A
Ans. The key is D. Wrong key. Correct key should be A. Hypothyroidism. [ It is likely to be hypothyroidism because prolactin level in hypothyroidism may be 30-200ng/ml which means 630-4200 mIU/L. Though weight gain can occur but fatigue is not a feature of prolactinoma unless it is a macroadenoma causing suppression of other pituitary hormone! given prolactin level of 1100 IU/L is definitely from
11
Q
- A 42yo female had sudden severe headache and vomiting. She took paracetamol and then collapsed. What is the most likely dx? a. SAH b. Viral encephalitis c. Meningitis d. Anaphylaxis
A
Ans. The key is A. SAH. [Sudden headache, vomiting, collapse are suggestive of SAH].
12
Q
- Parents of a 3m baby are worried about cot death. What advice would you give? a. Lay on the back with feet towards head end b. Lay on the back with feet towards feet end c. Lay on side d. Lay on stomach
A
Ans. The key is B. Lay on the back with feet towards feet end.
13
Q
- A child born at 36wks developed difficulty in breathing with intercoastal recession and nasal flaring. His temp is normal but his mother had PROM 48h ago. What is the most likely inv that will lead to tx? a. Blood culture b. CXR c. Stool culture d. Sputum culture
A
Ans. B. CXR. This is wrong key! Correct key is A. Blood culture. (please see the attachment below where the last line mentions investigations is for sepsis). [Probable diagnosis is Neonatal Pneumonia as there is respiratory signs and history of PROM. In extremes of age pneumonia or sepsis may be with normal temperature or even there may be hypothermia. Here pneumonia is a part of sepsis and invest
14
Q
- A 68yo man has had increasing dysphagia for solid food for 3m and has lost 5kgs in weight. What single inv is most likely to lead to a def dx? a. Barium swallow b. CXR c. CT chest d. Endoscopy and biopsy e. Video-fluoroscopy
A
Ans. The key is D. Endoscopy and biopsy. [Likely cause is malignant stricture for which endoscopic biopsy is the definitive investigation].
15
Q
- A 24yo male was trying to move his wardrobe but it fell on his thigh. It was there for a very long time before someone was able to remove it. When he was seen in ED he had casts in his urine but no RBCs. Other inv showed hypocalcemia and high serum creatinine. What is the cause for his renal failure? a. Acetylcholine b. Myoglobin c. Myotroponin d. Acetyl acetate
A
Ans. The key is B. Myoglobin. [The likely diagnosis is Rhabdomyolysis where renal failure occurs due to myoglobin (myoglobins are released after breakdown of skeletal muscles)].
16
Q
- Anatomical structure to be pierced during surgery midline port during gallstone removal. a. External iliac muscle b. Cricoid cartilage c. Linea alba d. Rectus sheath muscle e. Duramater f. 1st tracheal cartilage g. Conjoined tendon h. Intercostal muscles
A
Ans. The key is C. Linea alba.
17
Q
- A 48yo man has continuous ant chest pain which is worse on inspiration and has temp of 37.5C since 4wks after a MI. His ESR=45mm/h. 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
A
The key is E. Dressler syndrome. [Dressler syndrome usually occurring two to five weeks after the initial event but it can be delayed for as long as three months. It is characterised by pleuritic chest pain, low- grade fever and pericarditis].
18
Q
- An 8yo child swallowed 12 tablets of paracetamol 4h ago. Serum paracetamol levels when tested were at critical level. What would you do next? a. Activated charcoal b. IV N-acetylcysteine c. Gastric lavage d. Observation only
A
Ans. The key is B. IV N-acetylcystine. [As 4 hour paracetol level is at critical level start IV N-acetyltine at once]. Manaement of paracetamol poisoning: GI decontamination is recommended in those presenting <4h after OD. Activated charcoal 1g/kg (max 50g) is the treatment of choice, reducing serum levels more than gastric lavage and limiting liver injury. • Glucose, U&E, LFT, INR, ABG, FBC, HCO3
19
Q
- A pt dx with DVT is taking warfarin. What is his cut off INR limit? a. <1 b. 1-2 c. 2-3 d. 3-4
A
Ans. The key is C. 2-3. [This range is appropriate for the prophylaxis or treatment of venous thromboembolism and reduction of the risk of systemic embolism for people with atrial fibrillation and valvular heart disease].
20
Q
- Inserting a drain in the mid-axillary line. What is the single most appropriate anatomical structure? a. External iliac muscle b. Linea alba c. Rectus sheath muscle d. Conjoined tendon e. Intercostal muscles
A
Ans. The key is E. Intercostal muscles.
21
Q
- A 29yo man presents with hx of cough, weight loss and night sweats. Exam: pansystolic murmur. What is the most appropriate dx of underlying cause? a. Malaria b. HSP c. HIV d. Dengue fever
A
Ans. The key is C. HIV. [Though not mentioned IV drug abusers may have tricuspid regurgitation causing pansystolic murmur and HIV also very common in this group].
22
Q
- A 15yo boy presents with recurrent breathlessness and wheeze especially after exercise. What is the most diagnostic inv? a. CXR b. Lung function test c. PEFR d. CT scan
A
Ans. The key is B. Lung function test. [Assessment of severity of airflow obstruction can diagnose asthma and COPD].
23
Q
- A 34yo man was walking along the country side when an insect bit him. After which he started to complain of an annular rash spreading upwards. a. Penicillin PO b. Doxycycline PO c. Flucloxacillin PO d. Gentamicin PO e. Ciprofloxacin PO f. Antihistamine PO g. Antihistamine IV h. Corticosteroid IV i. Corticosteroid IM j. Adrenaline IM k. Adrenaline IV l. Atropine IV m. Reassurance
A
Ans. The key is B. Doxycycline PO. [Described rash is erythema migrans which is characteristic skin lesion seen in lyme disease. Lyme disease is treated with Doxycycline].
24
Q
- A 60yo man was brought in by his wife complaining of ataxia, urinary incontinence and erectile dysfunction. He also complains of rigidity and slowing of movement with a pill rolling tremor of the hands. What is the likely dx? a. Parkinson’s disease b. Idiopathic parkinson’s disease c. Shy-drager syndrome d. Huntington’s disease
A
Ans. The key is C. Shy-drager syndrome. [Shy-drager syndrome is characterized by parkinsonism (rigidity, slowing of movement with hand tremors) plus a more pronounced failure of the autonomic nervous system (urinary incontinence and erectile dysfunction) and there may also cerebellar sign like ataxia be present]. [Please note the discrepancy of this question (may be a bad recall) that classic pill
25
825. A 67yo man being managed for a malignancy develops neutropenic fever. He has been commenced on Ticarcillin, Tazobactam and Gentamicin. He has also recently commenced on Meropenem but on the 3rd day his temp still remains >39C. 2 blood tests and urine cultures show no organism. Inv: Hgb=104g/dl, WBC=<0.5, Plt=15. What will you do next? a. Continue IV antibiotics and add oral antifungals b. Con
Ans. The key is B. Continue antibiotics and add IV antifungals. [If judicial antibiotic fail to control fever next step is to add antifungal agents].
26
826. A young girl who is known to have T1DM presented with drowsiness and deep breathing. Her sugar level=20. Her BP=120/80mmHg and her mucous membranes are dry. What would be the next appropriate step? a. Serum urea b. Blood culture c. CT d. HbA1c e. ABG
Ans. The key is E ABG. [Likely diagnosis is DKA where ABG is done to demonstrate acidosis].
27
827. Removal of a glioma, which single most appropriate anatomical structure will be pierced? a. Cricoid cartilage b. Rectus sheath muscle c. Duramater d. Conjoined tendon e. Intercostal muscles
Ans. The key is C. Duramater.
28
828. A child is not breathing and intubation failed. At what anatomical site should the incision be made? a. External iliac muscle b. Cricoid cartilage c. Linea alba d. Rectus sheath muscle e. Duramater f. 1st tracheal cartilage g. Conjoined tendon h. Intercostal muscles
Ans. The key is B. Cricoid cartilage. [Incision for tracheostomy is done which goes down from cricoids cartilage].
29
829. A 10yo child who presented with fx of the radius which was treated with a plaster cast, complains of pain. Exam: limb is swollen but warm and well perfused, pulses are present. What should you do next? a. Send for repeat XR b. Remove cast c. Replace cast with more padding d. Give analgesic
Ans. Key is D. Give analgesic.
30
830. A 32yo man has been to Thailand and returned with cervical lymphadenopathy and fever. What is he most likely suffering from? a. HIV b. EBV c. Typhoid d. Measles
Ans. The key is B. EBV. [Cervical lymphadenopathy mentioned in question which occurs in EBV infection. In ARS (acute retroviral syndrome) or primary HIV infection there is generalized lymphadenopathy].
31
831. A 6yo child presents with edema and mild proteinuria. No hematuria. What is the most likely dx? a. PSGN b. Membranous GN c. Minimal change GN d. RPGN
Ans. The key is C. Minimal change GN. [Minimal change GN is usually seen in young children. It presents as edema and proteinuria].
32
832. An 80yo woman suffering from RA presents with severe epigastric pain and vomiting. She also complains of shoulder tip pain. What is the single most discriminatory inv? a. US Abdomen b. Sigmoidoscopy c. Colonscopy d. Barium meal e. Upper GI endoscopy f. Erect CXR
Ans. The key is F. Erect CXR. [Elderly patient with RA is usually on NSAIDs which may lead to perforated peptic ulcer which presents as severe epigastric pain, vomiting and shoulder tip pain. Diagnosis is made by seeing free gas shadow under the diaphragm on erect CXR].
33
833. A 44yo man went on holiday to Sudan 5wks ago. He now presents with red urine and fever. Exam: hepatomegaly. What is the most likely dx? a. Malaria b. Brucellosis c. Leptospirosis d. Schistosomiasis
Ans. The key is D. Schistosomiasis. [Holyday in Sudan, hematuria, fever and hepatomegaly goes most with Schistosomiasis amongst the given option].
34
834. A 32yo homosexual comes with hx of weight loss. Fundoscopy reveals retinal hemorrhages. What is the single most appropriate option? a. Mycobacterium avium b. CMV c. Hemophilus influenze d. NHL e. Pneumocystic jerovici
Ans. The key is B. CMV. [Weight loss in a homosexual is likely to be due to AIDS and CMV retinopathy with retinal hemorrhage is a recognized association].
35
835. A 30yo man comes with hx of early morning back pain and stiffness. Exam: red eyes. What is the single most appropriate option? a. Iris b. Ciliary body c. Cornea d. Conjunctivitis e. Sclera
Ans. The key is A. Iris. [Young man with early morning back pain and stiffness is suggestive of seronegative arthritis likely ankylosing spondylitis where iritis is a common association].
36
836. A 70yo woman with longstanding anxiety is seen in the OPD. She complains of her heart skipping a beat quite often. This particularly occurs when she is trying to get to sleep. The palpitations are never sustained. What is the most likely rhythm disturbance? a. SVT b. VF c. VT d. V-ectopics e. A-fib
Ans. The key is D. V-ectopics. [From the given options the most likely answer is V-ectopics. If it occurs in a normal heart though symptomatic it is benign in nature but if it is secondary to heart disease like MI it may precipitate to more life threatening arrhythmia like ventricular fibrillation].
37
837. A 17yo has acute pain around his right eye, pain on one side of his face and ear ache too. What is the single most dx? a. Ear wax b. Ear foreign body c. Dental abscess d. Cellulitis e. Herpes zoster
Ans. The key is E. Herpes zoster. [It seems to be herpes zoster of the trigeminal nerve. Onset is acute, unilateral distribution favours herpes zoster]
38
838. A 12yo boy presented with itching in his hands. Exam: skin is dry and red. His mother is asthmatic and older brother has hay fever. What is the single most likely causative factor? a. Dermatitis herpitiformis b. Scabies c. Eczema d. Uremia e. Drug induced
Ans. The key is C. Eczema. [Itchy lesion and family history of asthma and hay fever in 1st degree relatives favours the diagnosis of eczema]
39
839. A 45yo man presented with pruritic purple papules on the flexor surface of his wrist and some white lacy markings on his buccal mucosa. What is the single most likely causative factor? a. ALL b. Lymphoma c. Polycythemia d. IDA e. Lichen planus
Ans. The key is E. Lichen planus. [White lacy pattern of lesion is characteristic of lichen planus].
40
840. A known DM was admitted with sudden LOC. What is the initial inv? a. CT scan b. RBS c. MRI d. ECG e. ABG
Ans. The key is B. RBS. [In unconsciousness in diabetics, first hypoglycemia should be excluded by doing RBS].
41
841. A 36yo lady comes with hx of early morning stiffness of her small joints and with red and painful eye. What is the single most appropriate option? a. Iris b. Ciliary body c. Cornea d. Conjunctivitis e. Sclera f. Lichen planus
Ans. The key is E. Sclera. [Ocular manifestation of rheumatoid arthritis is scleritis (red, painfull eye)].
42
842. A 23yo man comes with 2d hx of sticky greenish discharge from the eyes with redness. What is the single most appropriate option? a. Iris b. Ciliary body c. Cornea d. Conjunctivitis e. Sclera
Ans. The key is D. conjunctivitis. [Bacterial conjunctivitis can cause sticky greenish discharge].
43
843. A pt was admitted with erectile dysfunction, reduced facial hair and galactorrhea. What is the most probable dx? a. Hyperprolactinemia b. Cushing’s syndrome c. Pheochromocytoma d. Hyperthyroidism e. Hypoparathyroidism
Ans. The key is A. Hyperprolactinemia.
44
844. A 32yo man has been repeatedly admitted to hospital for what was described as anxiety or panic attacks and palpitations. On occasions he is found to be tremulous and hypertensive. A persistent weight loss is noted. What is the most probable dx? a. Hyperthyroidism b. Panic attacks c. Pheochromocytoma d. Cushing’s disease e. GAD
Ans. The key is C. Pheochromocytoma.
45
845. A 35yo man with T1DM is dehydrated with BP of 90/50mmHg. What is the single most appropriate initial inv? a. ABG b. CBC c. HbA1c d. LFT e. Serum Urea
Ans. The key is A. ABG. [Dehydration with low BP points towards probable DKA. So from the given options ABG is the best response].
46
846. In OGTT what is the glucose venous plasma level 2h after glucose intake which indicates impaired glucose tolerance? a. >11.1mmol/l b. Between 7.8-11.0mmol/l c. Between 8.0-10.9mmol/l d. Between 10.0-11.0mmol/l e. Between 7.1-11.0mmol/l
Ans. The key is B. Between 7.8-11.0mmol/l.
47
847. A young man who has no PMH presented with jaundice, low Hgb, retics 8% and other indices WNL but occasional spherocytes were seen on blood film. What is the single most appropriate inv? a. G6PD enzyme assay b. Direct coombs test c. Repeat blood film d. Indirect coombs test e. BMA
Ans. The key is B. Direct Coombs test. [The direct Coombs test, is used to determine whether the cause of hemolytic anemia, is due to antibodies attached to RBCs which are seen in autoimmune-related hemolytic anemia].
48
848. A 22yo man came to the hosp after an injury in his hand while playing basketball. Exam: avulsion of extensor tendon from the distal phalanx. What is the single most probable deformity? a. Dinner fork deformity b. Game keeper thumb c. Mallet finger d. Gun-stock deformity e. Garden spade deformi
Ans. The key is C. Mallet finger. [A finger that bends down at the end joint and cannot be straightened is called a mallet finger. It is caused by an injury to the extensor tendon that straightens (extends) the finger. A splint worn day and night for 6-8 weeks will cure the problem in most cases].
49
849. A 28yo man is inv for recurrent lower back pain. A dx of AS is suspected. Which of the following inv is most useful? a. ESR b. XR sacro-iliac joints c. HLA B27 d. XR thoracic spine e. CT lumbar spine
Ans. The key is B. XR sacro-iliac joints. [x-ray sacroiliac joint shows fusion of both SI joints and thin, symmetrical syndesmophytes bridging the intervertebral disc spaces].
50
850. A 4yo girl is taken by her mother to the ED and complains of feeling unwell, urinary urgency and temp=39C. What is the single next best inv? a. Catheter catch of urine b. Clean catch of urine c. US d. IVU e. Suprapubic catch of urine
Ans. The key is B. Clean catch of urine. [The clinical features described are consistent with urinary tract infection for which clean catch of urine is the next best investigation.
51
851. A 2yo girl presents with a 4d hx of fever that started with a cough. Her RR=45bpm, sat=94%, temp=38.9C, capillary refill time=1s. There are crepitations at the left base on auscultation. Urine shows negative dipstick. What is the single inv most likely to lead to dx? a. Blood for C&S b. ESR c. CXR d. Urine for C&S e. CSF analysis
Ans. The key is C. CXR. [The features are consistent with RTI (probable pneumonia) for which CXR is the investigation of choice].
52
852. A 3yo girl presents with fever for 2d. She is drowsy and had a seizure causing twitching of the right side of the body for 4mins. Her RR=30bpm, sat=90%, temp=38.9C, capillary refill time=2s. Urine negative on dipstick. What is the single inv most likely to lead to dx? a. Blood for C&S b. ESR c. CXR d. Urine for C&S e. CSF analysis
Ans. The key is E. CSF analysis. [It is really very difficult to differentiate between encephalitis and meningitis. Encephalitis is mostly viral and in UK herpes simplex virus is the main cause. Meningitis also has a viral predominance though less than encephalitis. Because encephalitis involves infection of the brain itself, symptoms of altered brain function--like confusion or decreased alertnes
53
853. A 6m boy is admitted with persistent irritability. He is lethargic and is not feeding as well as usual. His RR=30bpm, sat=97%, temp=38.0C, capillary refill time=2s. Urine reveals leucocytes on dipstick. What is the single inv most likely to lead to dx? a. Blood for C&S b. ESR c. CXR d. Urine for C&S e. CSF analysis
Ans. The key is D. Urine for culture and sensitivity. [Dipstick test if show leucocytes or nitrites is suggestive of UTI. So to confirm it we should do urine C&S].
54
854. A 3yo boy presents with a 1d hx of being unwell. He appears shocked and has 3h old rash made up of urticarial and purpural spots. His RR=30bpm, sat=94%, temp=39C, capillary refill time=1s. Urine is clean on dipstick. What is the single inv most likely to lead to dx? a. Blood for C&S b. ESR c. CXR d. Urine for C&S e. CSF analysis
Ans. The key is A. Blood for C&S. [Likely diagnosis is septicemia for which Blood culture is the investigation of choice].
55
855. A child is dx with VUR. What would you tell his parents? a. Requires antibiotic prophylaxis b. Most will require surgery c. Most will have kidney scarring by 5yo d. Nothing can be done e. Reassure
Ans. The key is B. Most will require surgery. This is wrong key! Correct key is A. Require antibiotic prophylaxis. [Practically it is established that majority of VUR will cure with time with prophylactic antibiotics and need no surgery! Only a minority needs surgery].
56
856. A 2yo child presents with severe vomiting. Exam: mass felt in abdomen. What inv is most appropriate? a. US b. XR c. CT d. CBC
Ans. The key is A. US. [The question is incomplete and is not suitable for further discussion with such little info].
57
857. A 13yo girl complains of a 2d hx of hoarseness of voice a/w dry cough. She feels feverish. On direct laryngoscopy, her vocal cords are grossly edematous. What is the single most appropriate inv? a. None req b. Sputum for AFB c. Laryngoscopy d. Bronchoscopy e. XR cervical spine
Ans. The key is A. None required. [Dx is laryngitis].
58
858. A 7yo girl is brought by her mother with bright red staining of her underpants. She also gives a hx that her daughter recently started taking horse riding lessons. What is the single most appropriate next action? a. Local exam b. Exam under GA c. Continue regular child care d. Inform child protection services e. Coag profile
Ans. The key is B. Exam under GA.
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859. A 7d baby whose birth weight was 3.5kg and now is 3kg. What is the most appropriate next step? a. Check child protection register b. Nutritional assessment c. Skeletal survey d. Continue regular child care e. Inform police
Ans. The key is D. Continue regular child care. [In 1st week the baby loose some weight then start gain weight again. It is normal. So the option is continue regular child care].
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860. A 6yo child fell on his nose 2d ago. His parents have now brought him with difficulty in breathing. Exam: fever, nasal bones are straight. What is the single most likely dx? a. Nasal polyp b. Septal hematoma c. Septal abscess d. Deviated nasal septum e. Fx nose
Ans. The key is C. Septal abscess. This is wrong key! Correct key is C. septal hematoma. [Septal abscess takes a bit more time and a considerable portion of caseof septal hematoma is associated with fever].
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861. A 12yo pt came to the OPD with complains of fever, malaise, weight loss, anorexia and productive cough. Exam: temp=39C, pulse=100bpm. His mother says that he has a hx of recurrent chest infections and he is not thriving well. What is the single most likely causative organism? a. Pneumococcal pneumonia b. Staphylococcus c. Mycobacterium TB d. Pseudomonas e. PCP
Ans. The key is D. Pseudomonas. [Here the likely diagnosis is cystic fibrosis in which RTI due to pseudomonas is a very common association].
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862. A 3yo child brought by his mother. Exam: bruises on the buttocks. Mother also gives hx of runny nose 2wks ago. What is the single most appropriate next action? a. Check child protection register b. Coag profile c. Skeletal survey d. Continue regular child care e. Inform police
Ans. The key is B. Coagulation profile. [Likely diagnosis is HSP in which coagulation profile will show significant increase in D-dimer concentration. An activation of coagulation including hyperfibrinolysis secondary to the endothelial damage is a typical feature of the common types of HSP].
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863. A 4yo is brought to the ED by ambulance. His mother reports that he has been unwell with a sore throat for 8h. He is sitting on his mother’s knee and is tolerating an oxygen mask but looks unwell. He has constant noisy breathing and he is drooling saliva. His temp=39C. What is the most imp dx? a. Acute asthma b. Bronchiolitis c. Croup d. Epiglottitis e. Tonsillitis
Ans. The key is D. Epiglottitis.
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864. A pt with terminal cancer is being treated with chemo develops tingling and numbness of the fingertips of both arms. What is the single most likely cause of the symptoms? a. Bone mets to cervical vertebrae b. Post-chemo neuropathy c. Hyponatremia d. Hypocalcemia
Ans. The key is B. Post-chemo neuropathy.
65
865. An 80yo man has a permanent catheter. Catheter specimen urine found lots of e-coli. What is the single most appropriate management as he wants to attend his daughter’s wedding next week? a. Change the catheter b. Prolonged antibiotics c. Bladder wash d. Repeat MSU after wedding e. Reassure
Ans. The key is A. Change the catheter.
66
866. A 35yo male typist who suffered a scaphoid fx was treated with a scaphoid cast. After 2wks when the cast was removed for a review XR, it was found that he had problems in moving the thumb, index and middle fingers. What would you suggest as the management for the recent prb? a. Release of flexor retinaculum b. Release of common flexor sheath c. Release of palmar sheath d. Ulnar nerve release
Ans. The key is A. Release of flexor retinaculum. [Now case of carpal tunnel syndrome (median nerve compression)].
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867. A pt on insulin is booked in for a hernia operation. What is the most appropriate management of insulin? a. Give insulin and saline pre-op b. Stop insulin for the duration of the op c. Give IV insulin + dextrose + saline pre-op d. Give insulin as usual pre-op e. None
Ans. The key is C. Give IV insulin + dextrose + saline pre-op.
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868. A 35yo male who recently had an appendicectomy has got severe pain in his right big toe. Joint is red and swollen. He consumes 30 units of alcohol/week. What is the most probable dx? a. Rhabdomyosarcoma b. Osteoarthritis c. Gout d. Pseudogout e. Arthritis
Ans. The key is C. Gout. [Alcoholic drinks can raise the level of uric acid in the blood].
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869. A 25yo male who recently noticed change in his shoe size, he is also constipated, has a preference to hot weather, his skin is dry, has severe pain in wrist joint. Joint is red and swollen. What is the most probable dx? a. Chondro-sarcoma b. Lipo-sarcoma c. Gout d. Pseudogout e. Ankylosing spondylitis
Ans. The key is D. Pseudogout. [Hypothyroidism (change of shoe size due to myxedema (or pedal oedema can be seen in hypothyroidism) , other features of constipation, cold intolerance, dry skin are well known features of hypothyroidism.) has well recognized association with pseudogout].
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870. A 45yo woman had her visual acuity checked at her local optician. 12h later she presents to the ED with severe pain and redness in her eye. What is the single most appropriate option? a. Iris b. Ciliary body c. Ant chamber d. Post chamber e. Cornea
Ans. The key is C. [In acute angle closure glaucoma half-dilated pupil is the most likely position which precipitates an acute attack as the trabecular meshworks are mostly closed by peripheral anterior synechia of peripheral iris in this position. And mild illuminated darkened room like of an optician (also use of mydriatics accelerates this) or opera (cinema hall) are culprit to make this! As th
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871. A 75yo man who has DM and HTN experiences acute monocular blindness which resolves after 1h. What is the most likely dx? a. GCA b. Optic neuritis c. Lacunar infarct d. Pontine hemorrhage e. Amaurosis fugax
Ans. The key is E. Amourosis fugax.
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872. A 26yo presents with prolonged constipation, blood on side of stool and very painful defecation. PR exam: very painful. What is the single most likely dx? a. Ca Colon b. UC c. CD d. Anal fissure e. Constipation
Ans. The key is D. Anal fissure.
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873. A 35yo man with painless left testicular enlargement for the past 6m which is increasing in size and 3x larger than the right side. There is no tenderness or redness. What is the most likely dx? a. Testicular tumor b. Hydrocele c. Epididymal cyst d. Epididymo-orchitis e. Reassure
Ans. The key is A. Testicular tumour. Doubtful key!! May be Hydrocele.
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874. A middle aged man who has had a hx of chronic sinusitis, nasal obstruction and blood stained nasal discharge. He now presents with cheek swelling, epiphora, ptosis, diplopia, maxillary pain. What is the single most likely dx? a. Nasopharyngeal ca b. Pharyngeal ca c. Sinus squamous cell ca d. Squamous cell laryngeal ca e. Hypopharyngeal tumor
Ans. The key is C. Sinus squamous cell ca.
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875. A 60yo man with a long hx of smoking and alcohol presents with nasal obstruction, epistaxis, diplopia, otalgia and conductive deafness. What is the single most likely dx? a. Nasopharyngeal ca b. Pharyngeal ca c. Sinus squamous cell ca d. Squamous cell laryngeal ca e. Hypopharyngeal tumor
Ans. The key is A. Nasopharyngeal ca. [Nasal obstruction, epistaxis are features with cranial nerve palsy diplopia due to 6th nerve, (also 5th and 12th cranial nerves are frequently affected. otalgia and conductive deafness from local extension as mentioned can occur].
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876. A 60yo is on tx for IHD, HTN and hyperlipidemia. During the night he complains of wheeze and SOB. Which of the following meds is responsible for that? a. Amlodipine b. Atenolol c. Ramipril d. Simvastatin e. Bendroflumethiazide
Ans. The key is B. Atenolol. [Asthma can be precipitated by beta blockers].
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877. A 15yo boy who complains of pain in his leg which has settled with aspirin. What is the most probable dx? a. Leomyosarcoma b. Liposarcoma c. Painful hip d. Exostosis e. Osteod osteoma
Ans. The key is E. Osteoid osteoma. [Younger age of onset and relieved with aspirin favours the diagnosis of osteoid osteoma].
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878. A 20yo fit man suddenly developed severe lower back pain as getting up from bed. What is the single most probable dx? a. Paget’s disease b. Multiple myeloma c. PID d. AS e. Spondylosis
Ans. The key is C. PID [Prolapsed Intervertebral Disc]. [Sudden onset of lower back pain and felt more during forward bending or similar movement like getting up from bed favours the diagnosis of PID].
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879. A 60yo man brought to the ED with fx hip, he is deaf and has bilateral pedal edema. What is the single most probable dx? a. Paget’s disease b. Osteoporotic fx vertebra c. Secondary d. Multiple myeloma e. Spondylosis
Ans. The key is A. Paget’s disease. [H/O deafness and evidence of heartfailure like pedal edema favours the diagnosis of Paget’s disease].
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880. An 80yo lady presents wih pain on left 6th rib for a week. It is non-tender on examination. What is your most likely dx? a. Herpes zoster b. Costochondritis c. Bone degeneration d. Thoracic vertebra compression
Ans. The key is C. Bone degeneration.
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881. A 68yo DM, HTN with a 45pack/year smoking hx, has left sided chest pain increased with breathing. Exam: myosis on left side and wasting of small muscles of left hand. What is the single most appropriate dx? a. Costochondritis b. Lung cancer c. Good pasture’s syndrome d. MND e. Progressive massive fibrosis
Ans. The key is B. Lung cancer. [Smoking history, chest sign and Horner’s syndrome points towards lung cancer (probable pancoast tumour)].
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882. A 34yo man had a cold 2d back. He now presents with right sided facial pain. What is the single most likely dx? a. Maxillary sinus b. Ethmoid sinus c. Septal hematoma d. Septal abscess e. Allergic rhinitis
Ans. The key is A. Maxillary sinus. [Probably maxillary sinusitis was intended to say].
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883. A 29yo man with hx of asthma comes with post nasal discharge and bilateral painless nasal blockage. What is the single most likely dx? a. Nasal polyp b. Septal hematoma c. Septal abscess d. Atopic rhinitis e. Allergic rhinitis
Ans. The key is A. Nasal polyp.
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884. A 24yo man has been found unconscious in an alleyway with a RR=6bpm and HR=60bpm. His pupils are constricted. What is the best tx? a. Methadone b. Naloxone c. Naltrexone d. Thiamine e. Glucose
Ans. The key is B. Naloxone. [Respiratory depression and miosis points towards opiates poisoning for which antidote naloxone is given]
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885. A 23yo female presents with back pain and early morning stiffness, also complaining of eye problem and her sister has a similar condition. What is the single most probable dx? a. Paget’s disease b. PID c. Myofacial pain d. AS e. Spondylosis
Ans. The key is D. AS [Back pain with early morning stiffness and uveitis points towards the diagnosis of ankylosing spondylitis].
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886. A 63yo female with a hx of osteoporosis suddenly falls on her outstretched hand while shopping. XR shows fx at distal radius with backward shift of the distal fragment. What is the single most probable deformity? a. Dinner fork deformity b. Coxavara c. Mallet finger d. Cubitus valgus e. Garden spade deformity
Ans. The key is A. Dinner fork deformity.
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887. A 60yo man presents with severe colicky pain from his right flank radiating to his groin. His urinalysis reveals trace blood cells. What is the single most discrimatory inv? a. US abdomen b. XR KUB c. Colonoscopy d. Upper GI endoscopy e. Laproscopy
Ans. The key is A. US abdomen. [Features are of ureteric colic. X-ray KUB may miss radiolucent stones so US abdomen is the discriminatory inv].
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888. A 45yo man has been admitted for an elective hernia surgery. 3d later he presents with agitation, sweating, aggressiveness, and complains of seeing snakes on the hosp wall. Chlordiazepoxide has been started for this pt. What is the most appropriate next step? a. Diazepam b. Acamprosate c. Disulfiram d. Thiamine
Ans. The key is D. Thiamine. [Dx is delirium tremens. So following chlordiazepoxide thiamine is the appropriate next step].
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889. A woman with a prv hx of pain at the left wrist following a fall 4m ago for which she didn’t seek any tx now presented with pain in the same wrist below the thumb and the pain is aggravated whenever she holds her baby. What is the cause? a. Fx radial head b. Scaphoid fx c. Carpal tunnel syndrome d. Colles fx e. Ulnar fx
Ans. The key is B. Scaphoid frature.
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890. A 29yo man was involved in an RTA. He presents with distended neck veins, clear breath sounds and a trachea which is in the midline. His RR=34bpm, BP=60/0mmHg. What is the most likely dx? a. Simple pneumothorax b. Tension pneumothorax c. Cardiac tamponade d. Pericarditis
Ans. The key is C. Cardiac tamponade. [Distended neck vein, clear breath sound and no tracheal shift and BP of 60/0 points towards cardiac tamponade].
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891. An elderly woman is found anemia. As part of her exam, she had a barium enema which reveals a mass lesion in the ascending colon. What is the single most appropriate dx? a. Sigmoid volvulus b. Anal fissure c. Sigmoid carcinoma d. Cecal carcinoma e. Diverticular disease
Ans. The key is D. Cecal carcinoma. [Mass in assending colon and anaemia makes cecal carcinoma the likely diagnosis from the given options].
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892. A 55yo male after gastrectomy developed anemia. His MCV=106fl. Exam: loss of proprioception and vibration sense. What is the most likely dx? a. IDA b. Folate def c. Vit B12 def d. Anemia of chronic disease
Ans. The key is C. Vit B12 def. [gastrectomy –> deficiency of intrinsic factor –> Vitamin B12 def. leading to macrocytic anemia and resulting subacute combined degeneration of cord causing loss of proprioception and loss of vibration sense].
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893. A 26yo male has been operated for abdominal trauma and splenectomy was done. On the 3rd post-op day the pt developed acute abdominal pain and distention in the upper abdominal area with hypotension. On insertion of ryles tubes, 2L of coffee ground fluid was aspirated. What is the most probable dx? a. Acute gastric dilatation b. Reactionary hemorrhage c. Subphrenic abscess d. DVT e. Left lower
Ans. The key is A. Acute gastric dilatation. [Acute gastric dilatation may be caused by: Hyperglycaemia, childbirth, abdominal injury, application of a spinal cast, rarely, after abdominal surgery when the stomach is in ileus and drink has been taken too soon. The abdomen is distended and tender. The patient complains of epigastric fullness, nausea, heaviness and heartburn. There is a succussion s
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894. A 50yo man presented with increased breathlessness at rest. He is currently on furosemide, digoxin and isosorbide mononitrate. What drug is going to help him? a. Ramipril b. Bendroflumethiazide c. Atenolol d. Amlodipine e. Diltiazem
Ans. The key is B. Bendroflumethiazide. [This is a case of diuretic resistance. Heart failure represents the most common clinical situation in which diuretic resistance is observed. In mild CHF, diuretic resistance is not commonly encountered, as long as renal function is preserved. However, in moderate and severe CHF patients, diuretic resistance occurs more frequently and often becomes a clinica
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895. A 31yo man underwent an operation where his hand was hanging outside the table. After the operation he had wrist drop and sensory loss over the dorsum of his hand. Which nerve was injured? a. Radial b. Ulnar c. Median d. Axillary e. Brachial
Ans. The key is A. Radial. [As the man’s hand was hanging outside the ot table there was pressure on radial nerve at arm level which is similar lesion of Saturday night palsy].
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896. What is the mode of spread of chicken pox? a. Airborne b. Close contact c. Fecal-oral d. Blood e. Vector
Ans. The key is A. Airborne.
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897. A 64yo man presents with ipsilateral vertigo, tinnitus and left side hearing loss. Exam: Renne test +ve and Weber’s lateralizes to the right ear. What is the most appropriate inv? a. CT b. MRI brain c. XR d. Audiometry e. None f. Caloric testing
Ans. The key is B. MRI brain. [Rinne positive, so it is not conductive deafness. Again we know if weber lateralize to deaf ear it is conductive and lateralized away from deaf ear then it is sensoryneural. So here there is sensoryneural hearing loss in left ear. So the most appropriate investigation is MRI brain. Why not CT? As auditory involvement including acoustic neuroma is better visualized by
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898. A 67yo man presents to the ED with pain in his left groin. He suddenly collapses and his is not able to move or lift his leg. He is on alendronate. What is the dx? a. Fx of neck of femur b. Post hip dislocation c. Fx of shaft of femur d. Pelvic base fx e. Peripheral vascular disease
Ans. The key is A. Fx neck of femur. [Use of alendronate indicates osteoporosis where fracture neck of femur is more common].
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899. A young male met with an RTA and is suspected to have a femur fx. His BP is 90/60mmHg. What is the next immediate action? a. XR b. IV fluids c. Put leg splint d. Send bloods for inv e. US
Ans. The key is C. Put leg splint. [Still patient is hemodynamically stable and leg splinting takes (Thomas splint) 10-15 minutes. This will improve alignment and stop the ongoing loss which is usually alarming. Some argue for ABC protocol but as the case is stable we can go for splinting first].
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900. A 70yo pt presents with cough and SOB. He stopped smoking cigarettes 2yrs ago but has a 50yr smoking hx before quitting. CXR=consolidation and bilateral bihilar lymphadenopathy. What is the best inv for this pt? a. LN biopsy b. Pleural fluid cytology c. CT d. MRI e. US
Ans. The key is A. LN biopsy. [likely diagnosis is lung cancer, so best investigation for this is LN biopsy].
