901 to 1000 Flashcards
(100 cards)
1
Q
- A 27yo pt met with a RTA. While the NGT is passing, bowel sounds are heard in the chest. CXR shows NGT curled. What is the dx? a. Diaphragm rupture b. Aortic rupture c. Splenic rupture d. Bowel rupture e. Liver rupture
A
Ans. The key is A. Diaphramatic rupture.
2
Q
- A 62yo man dx with T2DM with BMI=33. Lifestyle modifications have failed to control blood sugar. Labs: urea=3.6mmol/l, creatinine=89mmol/l. what is the next appropriate management? a. Biguanide b. Sulfonylurea c. Insulin d. Glitazone e. Sulfonylurea receptor binder
A
Ans. The key is A. Biguanide. [Patient is obese type 2 diabetic. So biguanide is the tx of choice].
3
Q
- A pt presents with progressive dyspnea. He complains of cough, wheeze and a table spoonful of mucopurulent sputum for the last 18m. Spirometry has been done. FEV1/FVC=2.3/3.6. After taking salbutamol, the ratio=2.4/3.7. What is the most likely dx? a. Chronic bronchitis b. Asthma c. Bronchiectasis d. Lung fibrosis e. Sarcoidosis
A
Ans. The key is A. Chronic bronchitis. [Progressive dyspnoea, wheeze productive cough and the result of spirometry (prebronchodilator FEV1/FVC ratio of 64% and postbronchodilator FEV1/FVC ratio of 65%] points towards the diagnosis of chronic bronchitis. Some may think of bronchiectasis! But in bronchiectasis there is copious purulent sputums (as cup full of sputum not table spoon full!!!)].
4
Q
- A 62yo man presents with cough, breathlessness and wheeze. 24% O2, salbutamol and hydrocortisone were given. The symptoms haven’t improved and so nebulized bronchodilator was repeated and IV aminophylline was given. ABG: pH=7.31, RR=32. What is the next appropriate management? a. Nasal IPPV b. Intubation and ventilation c. LABA d. Toxapram e. Amoxicillin PO
A
Ans. The key is A. Nasal IPPV. [Here given case is COPD has following indications of Nasal IPPV i) Tachypnea (>24 breaths/min) and ii) Hypercapnic respiratory acidosis (pH range 7.10-7.35)].
5
Q
- A young girl returns from holidays in Spain. She complains of discharge from her ear and complains of tragal tenderness. Exam: tympanic membance normal. Aural toilet has been done. What is the next appropriate med? a. Antibiotic PO b. Antibiotic IV c. Steroid PO d. Steroid drop e. Antibiotic drop with steroid
A
Ans. The key is E. Antibiotic drop with steroid. [Discharge from ear and tragal tenderness are features of otitis externa. Key treatment is aural toileting. Drop advised is Sofradex (Framycetin + dexamethasone)
6
Q
- A 23yo man sprained his right ankle 6wks ago while playing football. He was tx with a below knew walking cast. On removal of the cast, the pt noted to have right foot drop. He has weakness of extensors of the ankle and toes and diminished pin prick sensation over the dorsum of the foot. The ankle jerk is present and plantar reflex is flexor. What is the most likely cause of the foot drop? a.
A
Ans. The key is A. Compression of common peronial nerve. [Foot drop, weakness of extensors of the ankle and toes and diminished pin prick sensation over the dorsum is sugestive of compression of common peroneal nerve].
7
Q
- A young man was knocked down during a fight in the waiting room of the ED. He is now unconscious and unresponsive. What is the 1st thing you would do? a. Turn pt and put in recovery position b. Put airway c. Endotracheal intubation d. Assess GCS e. Start CPR
A
Ans. The key is B. Put airway. [ABC protocol].
8
Q
- A 52yo man underwent a hemicolectomy. After a few days he complains of left ventricular pain and fever. ECHO has been done and shows a systolic murmur. What is the next appropriate inv? a. CT b. US c. CXR d. Blood culture e. LFT
A
Ans. The key is D. Blood culture. [Dx a case of infective endocarditis. Therefore the next appropriate investigation is blood culture].
9
Q
- A 19yo man has exercised induced asthma and is using a salbutamol inhaler as req and beclamethasone 400ug BD. He complains that he has to wake up at night for his inhaler. What is the single most appropriate tx? a. Beclo b. Regular salbutamol and budesonide c. Sodium cromoglycate d. Oral steroid e. Inhaled steroid
A
Ans. The key is C. Sodium cromoglycate. [the patients current complaint is nocturnal asthma for which next step is long acting beta blocker!! This question is probably a bad recall].
10
Q
- Pt with a long hx of smoking is now suffering from bronchial ca. histology reveals there are sheets of large polygonal or giant MNC. What is the most likely dx? a. Squamous cell ca b. Small cell ca c. Adenocarcinoma d. Large cell ca e. Oat cell ca
A
“Ans. No key is given!! Correct answer is D. Large cell ca. [Large cell carcinoma is, by definition, a poorly differentiated malignant epithelial tumor. It consists of sheets or nests of large polygonal or giant multinuclear cells and probably represents SCC .””]”
11
Q
- A 27yo man presents with chest pain and respiratory distress. Exam: tachycardia, hypotension and neck vein distension. Trachea is deviated to the left side, breathing sounds on right side are absent and diminished on left side. What is the next appropriate management? a. CXR b. Right side aspiration (16G) c. Left side aspiration (16G) d. Right side drain with a small tube (12F) e. Left side d
A
Ans. The key is B. Right side aspiration (16G). [The features described is diagnostic of right sided tension pneumothorax. Next appropriate management is To remove the air, insert a large-bore (14–16G) needle with a syringe, partially filled with 0.9% saline, into the 2nd intercostal interspace in the midclavicular line on the side of the suspected pneumothorax. Remove plunger to allow the trapped
12
Q
- A 16wk pregnant pt who was exposed to a child with chicken pox came to GP for help. She was tested –ve for varicella antibody. What is the next most imp step in management? a. Reassurance b. Ig c. Ig + vaccine d. Vaccine only e. Acyclovir
A
Ans. The key is B. Ig. [If you are pregnant, come contact with chicken pox case, found antibody negative on blood test you have to take injection Ig. Ref: patient.info].
13
Q
- A 68yo woman dx with T2DM and BMI=33. Lab: GFR=29, urea=13, creatinine=390mmol/L. what is the next appropriate management? a. Biguanide b. Sulfonylurea c. Insulin d. Glitazone e. Sulfonylurea receptor binder
A
Ans. The key is C. insulin. [Insulin is devoid of significant side effect than Glitazones (like fluid retention). In renal failure there is reduced GFR and some fluid retention. It is not desirable that glitazone to cause more fluid retention by causing oedema. The oral agents that are thought to be relatively safe in patients with nondialysis CKD include short-acting sulfonylureas (eg, glipizide)
14
Q
- A 5yo boy was brought to GP with high temp and many vesicles on his back. What is the most appropriate management? a. Topic acyclovir b. Oral acyclovir c. Oral antibiotics d. Topical steroids e. None
A
Ans. The key is E. None. [A case of chickenpox. None of the given treatment is used in chickenpox. Symptomatic treatment like, acetaminophen if fever, antihistamine and calamine lotion is given].
15
Q
- A woman came with the complaint of pain in her right arm when she abducts it. She has recently moved to a new house. There is no hx of trauma. Wht is the likely cause of her pain? a. Rupture of the long head of biceps b. Sprain of the acromio-clavicular ligament c. Tendinitis of the abductor sheat d. Supraspinatus tendinitis e. Shoulder dislocation
A
Ans. The key is D. Supraspinatus tendinitis. [Tendinitis and partial tears in the supraspinatus tendon causes a ‘painful arc’ since as the person elevates his arm sideways, the tendon begins to impinge under the acromion throught the middle part of the arc, and this is usually relieved as the arm reaches 180 degrees (vertical)].
16
Q
- An 83yo man with longstanding COPD has become progressively breathless over the last 2yrs. He is on salbutamol, ipratropium, salmetarol, beclomethasone and theophylline. His FEV1<30%. What is the next appropriate management? a. Lung transplant b. Trial of CPAP c. Trial of non-invasive ventilation d. Assessment for long term O2 therapy e. Short course of O2 therapy
A
Ans. The key is D. Assessment for long term O2 therapy. [Patient is progressively breathless with present FEV1 of <30%. So his respiratory deterioration indicates progressive respiratory failure for which he should be assessed for long term O2 therapy. Long-term oxygen therapy (LTOT) for more than 15 h/day improved mortality and morbidity in a well-defined group of patients with chronic obstructiv
17
Q
- A 49yo man complains of fullness in his left ear, recurrent vomiting and tinnitus. What is the most appropriate med? a. Buccal prochlorperazine b. Oral chlorpheniramine c. Oral flupenphenazine d. Buccal midazolam e. IV rantidine
A
Ans. The key is A. Buccal prochlorperazine. [Meniere’s disease Dilatation of the endolymphatic spaces of the membranous labyrinth causes vertigo for ~12h with prostration, nausea/vomiting, a feeling of fullness in the ear; uni- or bilateral tinnitus, sensorineural deafness (eg fluctuating). Attacks occur in clusters (<20/month). Cause: A mystery! Electrocochleography; endolymphatic space MRI. Proc
18
Q
- A man had a soft mass on his mandible. Mass is freely mobile and has started growing progressively over the past 6m. The mass still moves freely. What is the best inv for this pt? a. FNAC b. CT c. XR d. MRI e. ESR
A
Ans. The key is A. FNAC.
19
Q
- A 63yo man has been brought to the hosp after collapsing during a wedding. His ECG is below. What is the most likely dx? a. VT b. A-fib c. VF d. A-flutter e. SVT
A
Ans. The key is C. VF. [QRS complex is chaotic, wide, bizarre and irregular which is characteristic of ventricular fivrillation].
20
Q
- A 75yo war veteran complains of loss of appetite and says he has lost weight over the past few months. He says that he has passed some blood in his urine, however, he had no pain. A recent report shows that PSA >5.5ng/ml. how will you manage this pt? a. Radical prostatectomy b. TURP c. Cryosurgery d. Brachytherapy e. Irradiation
A
Ans. The key is A. Radical prostatectomy. This answer is controversial. [Though PSA is a bit higher than normal it is not confirmatory of carcinoma! But loss of appetite and weight loss are highly suggestive of cancer in this 75yrs old man. Active Surveillance is offered first for Low Gleason score. esp at age of 75. and any other treatment depending on extension of tumor will be offered after exc
21
Q
- A 19yo boy comes to the ED with pain, swelling and tenderness 2cm distal to Lister’s tubercle of radius. Exam: proximal pressure on the extended thumb and index finger is painful. XR: no fx. What is the next appropriate management for the pt? a. Immobilization with cast b. Repeat XR c. MRI d. Surgery e. None
A
Ans. The key is A. Immobilization with cast. This is wrong key! Correct key is C. MRI. [Imaging: Request a dedicated ‘scaphoid’ series. If –ve, and fracture is suspected MRI has been shown to be sensitive and cost-eff ective. CT is an alternative. If neither is available, cast and re-x-ray in 2 weeks. Ref: OHCS, 9th edition, page-744].
22
Q
- A 71yo man with a hx of 50yrs of smoking presents with cough, hemoptysis, dyspnea and chest pain. He also has anorexia and weight loss. The dx of lung cancer has been stabilized. Which electrolyte abnormality can be seen? a. Hyperkalemia b. Hypocalcemia c. Hyponatremia d. Hypernatremia e. Hypomagnesemia
A
Ans. The key is C. Hyponatremia. [Likely diagnosis is squamous cell lung cancer (as the patient is smoker) causing SIADH and resulting hyponatremia].
23
Q
- A 56yo man who is hypertensive recently underwent a change in meds. 2days later he developed wheezing. Which drug can cause this? a. Atenolol b. Ramipril c. Bendroflumethiazide d. Verapamil e. Furosemide
A
Ans. The key is A. Atenolol. [Beta blockers can precipitate asthma attacks].
24
Q
- A 33yo man has a temp=38.5C, cough and chest pain on the right side on inspiration. He also has purulent sputum. What is the most likely organism to cause pneumonia in this pt? a. Gram +ve diplococcic b. Coagulase +ve cocci c. PCP cold agglutinins d. AFB e. Gram –ve diplococcic
A
Ans. The key is C. PCP cold agglutinins. It is wrong key! Correct key should be A. Gram +ve diplococci. [It is a case of community acquired pneumonia caused by streptococcus pneumoniae].
25
925. A young man’s arm was caught in a machine. XR showed no fx but arm is very swollen. What is the best tx? a. Plaster cast b. Wide splint with upward position c. Analgesics d. Antibiotics e. Tetanus prophylaxis
Ans. The key is B. Wide splint with upward position. [If the limb is kept hanging it will aggravate the swelling as fluid shifts to dependant part. Here wide splint with upward position will help the accumulated blood or fluid to move down and will improve the swelling].
26
926. A child was brought in to ED by his parents for taking his grand-dad’s meds. There is an extra systole in the ECG. Which drug was taken? a. Digoxin b. Amitryptiline c. Atenolol d. Ramipril e. Bendroflumethiazide
Ans. The key is A. Digoxin. [Both digoxin and amitryptiline can cause extrasystole].
27
927. A 5yo child came from Ghana 6wks ago. 2d ago he developed fever, vomiting and neck stiffness. He had taken malaria prophylaxis and had no rash. What is the dx? a. Cerebral abscess b. Cerebral malaria c. Meningococcal meningitis d. SAH e. Cerebral tumor f. Pneumonia
Ans. The key is B. Cerebral malaria. [Incubation period of malaria is 7 – 30 days. Malaria prophylaxis cannot give confirmed protection and there is often failure of prophylaxis. Fever, vomiting, neck stiffness are consistent with cerebral malaria].
28
928. A HTN pt on bendroflumethiazide 2.5mg/d has come for his routine checkup. Exam: BP=145/85mmHg. Lab: K+=5.9, Na+=137. What is the most appropriate management for this pt? a. Stop meds b. Continue same dose c. Increase the dose d. Decrease the dose e. Repeat the blood test
Ans. The key is E. Repeat the blood test. [Bendroflumethiazide causes hyponatremia and hypokalemia. But the findings are opposite which is probably error of test. Hence blood test should be repeated to confirm the level of potassium and sodium].
29
929. A 65yo man presents with significant weight loss and complains of cough, SOB and chest pain. Exam: left pupil constricted, drooping of left eyelid. What is the most likely dx? a. Pancoast tumor b. Thoracic outlet syndrome c. Cervical rib d. Pneumonia e. Bronchogenic ca
Ans. The key is A. Pancoast tumor. [Pancoast tumour is the apical lung cancer that is associated with destructive lesions of the thoracic inlet and involvement of the brachial plexus and cervical sympathetic nerves (the stellate ganglion) leading to horner’s syndrome].
30
930. A 4yo boy presents with fever, sore throat and lymphadenopathy. The dx of tonsillitis has been made. He had 3 episodes last yr. What is the most appropriate management for this pt? a. Tonsillectomy b. Paracetamol/ibuprofen c. Oral penicillin V d. IV penicillin e. None
Ans. The key is B. Paracetamol/ibuprofen. [Explanation: Drugs: Antipyretic analgesics such as paracetamol and ibuprofen are of value. For most patients, antibiotics have little effect on the duration of the condition or the severity of symptoms. The National Institute for Health and Care Excellence (NICE) suggests that indications for antibiotics include:[1] Features of marked systemic upset
31
931. A pt had passed a 4mm stone in his urine. He has a 3mm stone in the renal pelvis found on US. What is the management? a. ESWL b. None c. Dormier basket d. Surgery e. PCNL
Ans. The key is B. None. [Stones less than 5 mm in diameter pass spontaneously in up to 80% of people. Stones between 5 mm and 10 mm in diameter pass spontaneously in about 50% of people. Stones larger than 1 cm in diameter usually require intervention (urgent intervention is required if complete obstruction or infection is present). Two thirds of stones that pass spontaneously will do so
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932. A 4yo boy presents with fever, severe ear ache, vomiting and anorexia. He also has mod tonsillitis. Exam: tympanic membrane bulging. He came to the GP a few days ago and was dx with URTI. What is the most appropriate dx? a. OE b. Acute OM c. Serous otitis d. Chronic suppurative OM e. Mastoiditis
Ans. The key is B. Acute OM. [High fever, severe earache, vomiting, bulging tympanic membrane and H/O associated URTI is highly suggestive of acute OM].
33
933. A 3yo girl presents with complains of sudden right facial weakness and numbness and pain around her ear. There are no symptoms. What is the most appropriate dx? a. SAH b. Bell’s palsy c. Stroke d. TIA e. Subdural hemorrhage
Ans. The key is B. Bell’s palsy.
34
934. A 6yo boy fell in the playground and has been holding his forearm complaining of pain. Exam: no sign of deformity or swelling. However, there is minimal tenderness on exam. What is the dx? a. Fx mid radius b. Fx mid ulnar c. Fx neck of humerus d. Fx shaft of humerus e. Green stick fx of distal radius
Ans. The key is E. Green stick fx of distal radius.
35
935. A 62yo man has been smoking about 15 cigarettes/day for 45yrs, and has been working as a builder since he was 24yo. He presents with chest pain, SOB, weight loss. CXR shows bilateral fibrosis and left side pleural effusion. What is the best inv that will lead to dx? a. CXR b. Pleural fluid aspiration of cytology c. MRI d. Pleural biopsy e. CT
Ans. The key is D. Pleural biopsy. [There is asbestos exposure in builders and associated smoking greatly increases the possibility of developing mesothelioma and the given presentation is typical of mesothelioma. Best investigation is pleural biopsy].
36
936. During a basketball match, one of the players suddenly collapsed to the ground with coughing and SOB. What is the inv of choice? a. CXR b. CT c. MRI d. V/Q scan e. CTPA
Ans. The key is A. CXR. [Likely diagnosis is pneumothorax. So investigation of choice is CXR].
37
937. A 57yo man having HTN on oral anti-HTN. However, he is finding it difficult to mobilize as he feels dizzy whenever he tries to get up. What is the most appropriate inv for him? a. Ambulatory BP b. ECG c. MRI d. CXR e. CT
Ans. The key is A. Ambulatory BP. [Ambulatory BP to document low BP as cause of presenting symptom. The case seems to be of postural hypotension and low BP as a result of given anti hypertensive].
38
938. A 33yo female complains of diplopia on upright gaze. Exam: ptosis can be seen. There are no other complains or any significant PMH. What is the most appropriate inv for him? a. Ophthalmoscopy b. Visual field test c. TFT d. CT e. Checking red reflex
Ans. The key is E. Checking red reflex. This is a wrong key. Right key should be D. CT. [A case of 3rd nerve palsy. So to delineate the cause CT should be done].
39
939. A tall rugby player was hit in the chest by a player of the opponent team. He developed breathlessness and his face went blue and purple. You have been called to look at him, how will you manage him? a. Insert a needle in the 2nd ICS in the mid-clavicular line b. Insert a needle in the 5th ICS in the mid-axillary line c. Intubate the pt d. Start CPR e. Give oxygen
Ans. The key is E. give oxygen. [1. The patient went blue and purple!! It is due to catch up of breath and it is not cyanosis by pneumothorax as cyanosis of pneumothorax takes time to develop and considered as a late feature. Immediate feature is chest pain, tachycardia, tachypnea etc. 2. There are no immediate feature mentioned according to which we can say pneumothorax is the diagnosis. 3. Colla
40
940. A young woman fell and hit her knee. Exam: valgus test +ve. What ligament was most probably injured? a. Ant cruciate b. Medial collateral c. Lateral collateral d. Post cruciate e. Meniscus
Ans. The key is B. Medial collateral. [The valgus stress test involves placing the leg into extension, with one hand placed as a pivot on the knee. With the other hand placed upon the foot applying an abducting force, an attempt is then made to force the leg at the knee into valgus. If the knee is seen to open up on the medial side, this is indicative of medial collateral ligament damage].
41
941. A 75yo man comes in complaining of difficulty in passing urine, poor stream and dribbling at the end of voiding and anorexia. US shows bilateral hydronephrosis. What is the cause of these findings? a. BPH b. Renal stones c. Bladder stones d. Prostatic ca e. UTI
Ans. The key is D. Prostatic ca. [Elderly patient of 75yrs with obstructive symptoms of lower urinary tract, bilateral hydronephrosis all can occur in BPH or ca prostate. Anorexia is clincher here. It is a feature of carcinoma rather than BPH].
42
942. 2h after an appendectomy, a pt complains of a rapid HR and fever. He says there is also abdominal pain and pain in the shoulder area. What is happening to this pt? a. Intra-abdominal bleeding b. Anastomotic leak c. Sepsis d. Intestinal obstruction
Ans. The key is A. Intra-abdominal bleeding.
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943. A 50yo man presents with the complaints of recurrent UTI and occasional blood in the urine. Some unusual cells have been seen in urine on routine exam. Which os the following inv would you like to carry out now? a. Cystoscopy b. Urine C&S c. XR KUB d. US e. CBC
Ans. The key is D. US. It is wrong key! Correct key is A. Cystoscopy. [Likely diagnosis is bladder cancer. Occasional blood in urine and unusual cells (suggestive of malignant cells) suggests the diagnosis. It is also true that in bladder cancer there occurs frequent uti like symptoms].
44
944. A 28yo drug user presents to ED collapsed and anuria. His serum K+=7.5mmol/l. CXR shows early pulmonary edema. What is the next appropriate management for this pt? a. Urgent hemodialysis b. IV calcium gluconate c. IV insulin + dextrose d. Furosemide e. IV 0.9% NS
Ans. The key is B. IV calcium gluconate. [In severe hyperkalemia IV calcium gluconate is given to protect the heart from cardiac arrest or life-threatening arrhythmias till definitive treatments are arranged].
45
945. DM man feels hot, painful lump near the anal region. What is the most probable dx? a. Anal fissure b. Abscess c. Hematoma d. Wart e. External hemorrhoids
Ans. The key is B. Abscess. [DM patients are much prone to infection].
46
946. A 65yo lady with T1DM for the last 20y comes with a tender lump near the anal opening. She says she also has a fever. What tx should she get? a. I&D + antibiotics b. IV antibiotics c. C&S of aspirate from swelling d. Painkillers e. Cautery of swelling
Ans. The key is A. I&D + antibiotics.
47
947. An 80yo DM lady presents with redness and swelling over her right foot. It is tender to touch, warm and glossy. What are the complications this pt might develop? a. Meningitis b. Sepsis c. Ulcer d. Gangrene
Ans. The key is D. Gangrene.
48
948. After surgery a pt’s left leg has become swollen and tender. The diameter of the calf has increased and passive movements cause pain. What is the most probable dx? a. DVT b. Lymphedema c. Peripheral vascular disease d. Hematoma e. Superficial thrombophlebitis
Ans. The key is A. DVT. [Swelling, tenderness and enlarged calf diameter are features of DVT supported by positive Homan’s test (pain on passive movement)].
49
949. 2h after an appendectomy, a pt complains of a rapid HR and fever. He says there is also abdominal pain and pain in the shoulder area. What is the first step in the management? a. Maintain IV access and give IV fluids b. Start IV antibiotics c. Insert NGT for intestinal decompression d. Cross match blood e. Emergency exploratory laparotomy
Ans. The key is A. Maintain IV access and give IV fluids. [Features given are of internal bleeding! So maintain iv access and giving iv fluid is the first step in management of this patient].
50
950. A pregnant woman presents with knee pain on movements. The pain becomes worse at the end of the day. Radiology shows decreased joint space. Labs: CRP=12. What is the 1st line med? a. Paracetamol b. NSAIDs c. Oral steroid d. Intra articular steroid e. DMARDs
Ans. The key is A. Paracetamol. [Pain on movement, pain worse at end of day and decreased joint space are characteristic of osteoarthritis supported by no significant raise in inflammatory marker (CRP=12). 1st line medicine is paracetamol].
51
951. A 68yo man presents with muscle weakness. He is not able to climb stairs. He also complains of mild breathlessness. He says that he sometimes feels difficulty in swallowing food. Labs: ALP=216, AST=49, ALT=43, CK=417, ESR=16. What is the most likely dx? a. Polymyositis b. Polymyalgia rheumatic c. Muscular dystrophy d. Esophageal carcinoma e. Osteoarthritis
Ans. The key is A. Polymyositis. [Proxymal myopathy (not able to climb stairs), mild breathlessness (involvement of thoracic muscles or interstitial lung disease), dysphagia due to involvement of the oropharyngeal striated muscles and upper oesophagus)and raised CK suggests the diagnosis of Polymyositis].
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952. A 67yo builder presents with a persistent nodular lesion on upper part of pinna with some telangiectasia around the lesion. What is the dx? a. Basal cell b. Squamous cell c. Keratocanthoma d. Actinic keratosis e. Bowens disease
Ans. The key is A. Basal cell ca. [Any ulcer which is located above the neck is always basal cell carcinoma until proven otherwise. Source: SAMSON notes].
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953. A 68yo pt wakes up with slurred speech and right sided weakness. CT shows cerebral infarct. What is the most appropriate tx? a. Aspirin b. Alteplase c. Warfarin d. Clopidogrel e. Dipyridamole
Ans. The key is B. Alteplase. It is a wrong key! The correct key is A. Aspirin. [The window period to administer alteplase is 4.5 hours. If we cannot certain this period we cannot proceed for alteplase].
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954. A 73yo man who is recovering from surgery on the left carotid artery in his neck. He has slurred speech. On protusion of his tongue, the tip deviated to the left. What is the single most appropriate option? a. Accessory nerve b. Facial nerve c. Glossopharyngeal nerve d. Hypoglossal nerve e. Vagus nerve
Ans. The key is D. Hypoglossal nerve. [Testing function of the nerve is performed by asked the subject to stick their tongue straight out. If there is a loss of innervation to one side, the tongue will curve toward the affected side, due to unopposed action of the opposite genioglossus muscle. If this is the result of alower motor neuron lesion, the tongue will be curved toward the damaged side, c
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955. A 24yo woman known to be suffering from panic disorder presents to the hospital with tingling and numbness in her fingers. ABG: pH=7.52, PCO2=2.2kPa, PO2=11kPa, Bicarb=20. What is the most likely condition? a. Acute metabolic alkalosis b. Acute resp alkalosis c. Compensated resp alkalosis d. Compensated metabolic acidosis e. Acute metabolic acidosis
Ans. The key is B. Acute respiratory alkalosis. [In panic attack there occurs hyperventilation which causes washout of CO2 and leads to acute respiratory alkalosis resulting in raised pH >7.45 (here 7.52), low PCO2 (here 2.2 kPa) with compensatory decrease in HCO3 (here 20meq/l)].
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956. A 65yo man on dexamethasone underwent surgery. During and after the surgery, his blood glucose was around 17-19mmol/l. What will you give the pt? a. Insulin b. Oral hypoglycemic c. Remove dexamethasone d. IV Saline e. IX dextrose
Ans. The key is D. IV saline. [It is estimated that adults secrete 75-150mg of cortisol in response to major surgery and 50mg a day for minor surgery, and secretion parallels duration and extent of surgery Patients undergoing a surgical procedure or responding to stress, trauma, or an acute illness will exhibit an increase in adrenal cortisol production up to 6-fold normal levels. However, in pati
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957. A 61yo man who had stroke 2y ago is on aspirin. He has RA but suffers from pain and can’t tolerate it. He is taking senna for constipation. What is the best med to relieve his pain? a. DMARDs b. Ibuprofen c. Co-codamol d. Paracetamol
Ans. The key is B. Ibuprofen. [DMARDs are not painkillers but prevents disease progression in long term. Paracetamol is not enough to control severe pain. Co-codamol will cause constipation. Patient is already taking laxative! So Co-codamol is not the option. Excluding other Ibuprofen seems to be the best option].
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958. A young child was brought by his mother to the OPD complaining that he raised the vol of the TV and didn’t respond to her when she called him. Exam: tympanic membrane was dull greyish and no shadow of handle of malleus. What is the most probable dx? a. Chronic OM b. Acute OM c. Secretory OM d. Otitis externa e. Cholesteatoma
Ans. The key is C. Secretory OM.
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959. A 48yo woman always socially withdrawn has stopped going out of the house. She is afraid to socialize because she fears that people will criticize her. What is the most probable dx? a. Agoraphobia b. PTSD c. Social anxiety d. OCD e. GAD
Ans. The key is C. Social anxiety. [Social anxiety disorder is a type of complex phobia. This type of phobia has a disruptive or disabling impact on a person's life. It can severely affect a person's confidence and self-esteem, interfere with relationships and impair performance at work or school].
60
960. Post gastric ulcer got perforated leading to bleeding involving the gastro-duodenal artery. Where would fluid accumulate in the cavity? a. Left paracolic gutter b. Pelvic cavity c. First part of duodenum d. Under the diaphragm e. Retroperitoneal
Ans. D. Under the diaphragm. [Correct option probably A. Left paracolic gutter].
61
961. A 4yo boy presents with recurrent episodes of self limiting spontaneous bleeding. Coag test: PT normal, bleeding time normal, APTT prolonged, Factor VIII decreased. His father and uncle suffer from a similar illness. What is the most likely dx? a. Hemophilia A b. Hemophilia B c. Von willebrand’s disease d. ITP e. TTP
Ans. The key is A. Hemophilia A. [Prolonged APTT and decreased factor VIII points towards the diagnosis of Hemophilia A].
62
962. A 53yo lady presents with hot flash and night sweats. Her LMP was last year. She had MI recently. What is the most appropriate management for her? a. Raloxifene b. Estrogen c. COCP d. Evening primrose e. Clonidine
Ans. The key is C. COCP. [COCP has very little effect in stroke or MI and hence can be used to treat post menopausal symptoms in those patients].
63
963. A 73yo man who was a smoker has quit smoking for the past 3yrs. He now presents with hoarseness of voice and cough since past 3wks. XR: mass is visible in the mediastinum. What is the best inv to confirm the dx? a. Bronchoscopy b. Thoracoscopy c. US d. CT thorax e. LN biopsy
Ans. The key is E. LN biopsy.
64
964. A 52yo man known DM presents to ED with sudden onset of pain in the left loin and hematuria. Inv: 8mm stone in left lower ureter. Nifedipine with steroids was prescribed as initial tx with supportive therapy. He returned complaining of worsening pain, vomiting with passing of 2 stones. Renal function tests indicate impending ARF. How will you manage this pt? a. Continue same tx b. Start alpha
Ans. The key is E. Percutaneous nephrostomy. [Percutaneous nephrostomy, or nephropyelostomy, is an interventional procedure that is used mainly in the decompression of the renal collecting system. Percutaneous nephrostomy catheter placement has been the primary option for the temporary drainage of an obstructed collecting system. Here impending ARF indicates obstructive uropathy].
65
965. A lady who is alcohol dependent wants to quit but wants someone to encourage her. What would you do? a. Medication b. Refer to social services c. Refer to psychology d. CBT
Ans. The key is B. Refer to social services.
66
966. A young girl presented to OBGYN assessment unit with lower abdominal pain and per vaginal bleeding after a hx of hysterosalpingograph as a part of her infertility tx. Observation: BP=90/50mmHg, pulse=120bpm, exam revealed rigid abdomen. What is the most appropriate next inv? a. CT b. XR erect and supine c. US abdomen d. Coag profile e. CXR
Ans. The key is C. US abdomen. [Likely cause of bleeding and shock is ruptured fallopian tube for which appropriate next investigation is US abdomen].
67
967. A 21yo woman who is on COCP had to take azithromycin. What should be advised for her contraception? a. Using 7d condoms after antibiotics and avoid pill free break b. Using 14d condoms after antibiotics and avoid pill free break c. Using 7d condoms after antibiotics d. No extra precaution e. Using 14d condoms after antibiotics
Ans. The key is D. No extra precaution. [Before it was thought that antibiotics like azithromycin inhibits the enzyme and reduce the efficacy of COCP. But later it was established that practically no significant changes occur and so no need of any extra precaution].
68
968. A 60yo woman presented with radial fx and had a colle’s fx and supracondylar fx in the past. What inv is req to detect her possibility of having the same prb later? a. Dexa scan b. MRI c. Nuclear bone scan d. CT e. Bone biopsy
Ans. The key is A. Dexa scan. [The likely cause of these multiple fracture is osteoporosis (post menopausal women) for which we should do Dexa scan to establish the diagnosis].
69
969. A 43yo woman presents with low mood, loss of libido, sleep disturbance, tiredness, palpitation, chest discomfort, irritability and recurrent worries. What is the most likely dx? a. Seasonal Affective Disorder b. Mod depression c. Dysthymia d. GAD e. Bipolar disorder
Ans. The key is B. Moderate depression. [Mild depression: i)Low mood ii) Anhedonia iii) Guilt iv)Hopelessness v) Worthlessness vi) Inability to concentrate. Tx CBT Moderate depression: Features of mild +vii) Poor sleep viii) Poor Appetite ix) Poor libido x) Easy fatiguability. Tx Antidepressants Severe depression: Features of moderate +xi) Suicidal intensions. Tx ECT].
70
970. Which of the following is true for tamoxifen? a. Increased incidence of endometrial carcinoma b. Increased risk of breast ca c. Increased risk of osteoporosis d. Increased risk of ovarian ca
Ans. The key is A. Increased incidence of endometrial carcinoma.
71
971. A 45yo male complains of tremors in hands. Exam: tremors are absent at rest but present when arms are held outstretched and persist on movement. What is the most probable dx? a. Parkinsonism b. Benign essential tremor c. Cerebellar disease d. Liver failure e. Stroke
Ans. The key is B. Benign essential tremor. [Tremors absent at rest and present on outstretched hand and persist on movement are benign essential tremor].
72
972. Pregnant lady had her antenatal screening for HIV and Hep B. what more antenatal inf should she be screened for? a. Rubella and syphilis b. Toxoplasma and rubella c. Syphilis toxoplasma d. Hep C & E e. Hep A & C
Ans. The key is A. Rubella and syphilis.
73
973. A young man has been found in the park, drunk and brought to the ED by ambulance. He recently lost his job and got divorced. He thinks nurses are plotting against him. What is the most likely dx? a. Schizoid personality b. Borderline personality c. Schizophrenia d. Psychotic depression e. Paranoid
Ans. The key is E. Paranoid personality disorder. [Patients disease (Paranoid personality disorder) is responsible for his divorce and loss of job. Suspiciousness to wife is reason for divorce].
74
974. An elderly man who used to work in the shipyard industry presented with cough and SOB few weeks to months. He was given salbutamol nebulization and antibiotics and admitted to the ward. He died 3d later. CT: patchy infiltrates, pleural thickening and pleural effusion. Why is this a coroner’s case? a. Pt got wrong dx or management b. Pt died soon after admission c. Death could be due to occupa
Ans. The key is C. Death could be due to occupational illness.
75
975. A 26yo lady came with abdominal pain, vaginal discharge and low grade fever. What is the most likely dx? a. HELLP syndrome b. Acute PID c. Ectopic pregnancy d. Appendicitis
Ans. The key is B. Acute PID.
76
976. A new screening test has been devised to detect early stages of prostate ca. However, the test tends to dx a lot of ppl with no cancer, although they do have cancer as dx by other standard tests. What is this flaw called? a. False +ve b. True +ve c. False –ve d. True –ve e. Poor specificity
Ans. The key is C. False negative.
77
977. A 26yo political refugee has sought asylum in the UK and complains of poor conc. He keeps getting thoughts of his family whom he saw killed in a political coup. He is unable to sleep and feels hopeless about his survival. Because of this he is afraid to go out. What is the most likely dx? a. Acute stress disorder b. PTSD c. Social phobia d. OCD e. GAD
Ans. The key is B. PTSD. [Keep getting thoughts of his family disaster, insomnia, to avoid similar circumstances he is avoiding going out these are suggestive of PTSD].
78
978. A 2yo boy presented with gradual swelling of feet and poor feeding. He has gained weight and has dark urine. What is the single most appropriate inv? a. Serum albumin (2nd) b. 24h urinary protein (1st) c. Serum calcium d. BUE e. Serum glucose
Ans. The key is B. 24 hr urinary protein. [A case of nephritic syndrome. So the single most appropriate investigation from the given options is 24 hour urinary protein].
79
979. A 26yo lady presents with high fever, lower abdominal pain and purulent vaginal discharge. She looks very unwell. What is the most appropriate management? a. Tetracycline 250mg QD b. Doxycycline 100mg BD and metronidazole 400mg BD c. IV Ceftriaxone 2g with doxycycline 100mg d. IV ceftriaxone 2g with doxycycline 500mg e. Ofloxacin 400mg BD and metronidazole 400mg BD
Ans. The key is C. IV Ceftriaxone 2g with doxycycline 100mg. [The disease is severe needing inpatient management with IV Ceftriaxone 2g + IV doxycycline 100 mg (as Iv doxycycline is not licensed to use in uk probably oral doxycycline is given).
80
980. A 39wk pregnanct woman came to labor suite 3d after an obstructed labour presents with pain and swelling of one leg. Exam: leg has blue mottling and is cold. What is the dx? a. DVT b. Post phlebitis syndrome c. Embolus d. Varicose vein e. Herpes gladiatorum
Ans. The key is C. Embolus.
81
981. An 8yo boy has his tonsils and adenoids removed. On the 7th post-op day, he comes back to the ED with hemoptysis and fever. What is the most appropriate management? a. Admit for IV antibiotics b. Prescribe oral antibiotics and discharge c. Packing d. Surgery e. Reassurance
Ans. The key is A. Admit for IV antibiotic. [Most secondary hemorrhage occurs due to infection which erodes a vessel. So patient should be admitted for IV antibiotics].
82
982. A 50yo female had swelling in her ankles. She is a known alcoholic. Now she presented with breathlessness and palpitations. What is the most likely cause of her condition? a. VT b. SVT c. A-flutter d. A-fib e. V-ectopics
Ans. The key is D. Atrial fibrillation. [Ankle swelling suggests alcoholic cardiomyopathy and alcoholism is also a well known cause of atrial fibrillation].
83
983. A young boy has acute scrotal pain for a few hours. Exam: one testis is very painful to touch. He had this kind of pain before but it was mild and resolved itself within 30mins. What would you do next? a. Urgent exploration b. US c. Antibiotics d. IV fluids e. Doppler US
Ans. The key is A. Urgent exploration. [As sudden onset of severe pain likely diagnosis is torsion of testis. (infection takes a more prolonged course). Next step is urgent exploration].
84
984. An 8wk pregnant woman presents with persistent vomiting and weight loss. Exam: HR=110bpm. Dehydration was corrected with NS infusion and K+. The condition didn’t improve so IM cyclizine was given. She is still vomiting. What is the next appropriate management? a. IV fluids b. IV antiemetics c. IV steroids d. Terminate pregnancy e. Thiamine
Ans. The key is C. IV Steroid. [Steroids may be used in patient's of hyperemesis gravidarum refractory to standard therapy].
85
985. A 28yo lady presents with dyspareunia and dysmenorrhea. She is very obese. She now wants reversible contraceptive method. Which of the following will be most suitable for her? a. Mirena b. COCP c. POP d. Copper T e. Barrier method
Ans. The key is A. Mirena.
86
986. A young lady who is 28wks pregnant presents with vaginal bleeding. She has lost about 200ml of blood. Exam: uterus is tender. Resuscitation has been done. What is the most imp inv to establish the dx? a. US b. CT c. D-dimer d. Clotting profile e. None
Ans. The key is A. US. [Antepartum hemorrhage. Most important investigation to establish the dx is US].
87
987. A 14yo girl presents with primary amenorrhea and a short stature. What is the most likely dx? a. Down’s syndrome b. Klinefeltner’s syndrome c. Turner’s syndrome d. Fragile X syndrome e. Normal finding
Ans. The key is C. Turner’s syndrome. [Down’s syndrome and Fragile x syndrome don’t have primary amenorrhea. Klienfelters syndrome patients are tall males. So the likely diagnosis is Turner’s syndrome].
88
988. A 32yo woman wants reversible form of contraception. She has one child delivered by emergency C-section. She also suffers from migraine and heavy periods. What is the most suitable form of contraception for this lady? a. COCP b. Mini pill c. IUCD d. Barrier method e. Abstinence
Ans. The key is C. IUCD. It is wrong key! Correct key is b. Mini pill. [IUCD causes increased bleeding. In migraine we cannot give COCP. So for contraception best option from the given ones are b. Mini pill though it does not improve menorrhagia].
89
989. A 45yo known hypertensive man presents with hematuria, proteinuria and edema. What is the definitive dx test for him? a. Urine protein b. Renal biopsy c. Renal function test d. Urine microscopy e. Serum protein
Ans. The key is B. Renal biopsy. [In nephritic syndrome glomerulus is affected. So renal biopsy is the definitive diagnostic test].
90
990. A 47yo man presents with proteinuria+, BP=160/95mmHg, small kidneys that have smooth renal pelvis. What is the most probable dx? a. GN b. Chronic pyelonephritis c. Unilateral renal artery stenosis d. Multiple myeloma e. ARF
Ans. The key is A. GN. [In chr. Pyelonephritis US will demonstrate renal scarring and urinalysis will demonstrate pyuria which are absent here. In renal artery stenosis there will be considerable difference in kidney size from one another which is not found here. Here likely diagnosis is GN].
91
991. You are the HO in the hospital and the lab report of a pt shows glucose=4mmol/l, K+=5.2mmol/l, Na+129mmol/l. what is the most appropriate management? a. NS 0.9% b. NS 0.45% c. NS 0.9% and insulin d. Insulin e. Dextrose
Ans. The key is A. NS 0.9% [Here there is significant hyponatremia with mild hyperkalemia. Glucose is in lower normal level. Insulin can shift K+ in cells but this mild hyperkalemia does not need this treatment at this level. More over in lower blood glucose insulin may cause hypoglycemia. So the best management option is A. NS 0.9% which will correct the electrolyte imbalance (including K+ level
92
992. A 27yo man presents with abdominal pain. He says his urine is dark. Exam: BP=160/105mmHg. What is the most appropriate inv? a. US b. Renal biopsy c. CT d. Urine protein e. Urine microscopy
Ans. The key is A. US. [Abdominal pain, Dark urine (hematuria) and hypertension suggests ADPKD. The sensitivity of ultrasonography for ADPKD1 is 99% for at-risk patients older than 20 years].
93
993. A 12m child with AIDS is due for his MMR vaccination. What is the single most appropriate action? a. Defer immunization for 2wks b. Don’t give vaccine c. Give half dose of vaccine d. Give paracetamol with future doses of the same vaccine e. Proceed with standard immunization schedule
Ans. The key is B. Don’t give vaccine. [MMR is live attenuated vaccine which should be avoided in AIDS]. [*** Please note!! In similar question where asked about HIV positive child’s vaccination and the answer was give all vaccines except BCG!! HIV positive is not in a immunodeficient state and can receive live attenuated vaccines (except BCG), where as child with AIDS means he has criteria of imm
94
994. A young man presents with sudden, severe pain and swelling in the scrotum. Exam: one testis seems higher than the other. What is the most probable dx? a. Varicocele b. Hematocele c. Testicular tumor d. Epidiymo-orchitis e. Testicular torsion
Ans. The key is E. Testicular torsion. [Sudden severe pain, scrotal swelling and higher position of the affected testis is diagnostic of testicular torsion. You may get further support from examining cremesteric reflex which is absent in testicular torsion!!].
95
995. A 24yo male involved in RTA with XR: fx neck of humerus. What is the single most associated nerve injury? a. Axillary nerve b. Radial nerve c. Median nerve d. Ulnar nerve
Ans. The key is A. Axillary nerve.
96
996. A 64yo man complains of increasing SOB and cough for the past 18m. He coughs up a Tbsp of mucopurulent sputum with occasional specks of blood. What is the most likely underlying cause? a. Acute bronchitis b. Bronchiectasis c. Chronic bronchitis d. Lung cancer e. Pneumonia
Ans. The key is C. Chronic bronchitis. [There may be specks of blood in sputum in both bronchiectasis , acute and chronic bronchitis. Duration of disease is 18 months, so it is not acute bronchitis. Again only one tablespoonful sputum does not justify the term copious sputum of bronhiectasis in which sputum will be much more like cup-full in amount. So it is chronic bronchitis].
97
997. A 55yo man who is hypertensive suddenly lost his vision. The retina is pale and fovea appears as a bright cherry red spot. What is the single most appropriate tx? a. Pan retinal photocoagulation b. Corticosteroids c. Scleral buckling d. Surgical extraction of lens e. Pressure over eyeball
Ans. The key is E. Pressure over eyeball. [In central retinal artery occlusion (CRAO) retina becomes pale and fovea becomes cherry red. Hypertension is a major cause of CRAO. Apply direct pressure for 5-15 seconds, then release. Repeat several times. Ocular massage can dislodge the embolus to a point further down the arterial circulation and improve retinal perfusion].
98
998. A 32yo man with schizophrenia and a hx of violence and distressing auditory hallucinations was admitted to the ward with aggressive behavior and has already smashed his room. He is refusing any oral meds. What is the single most appropriate injection? a. Flupenthixol b. Fluphenazine c. Haloperidol d. Paraldehyde e. Risperidone
Ans. The key is C. Haloperidol. [If oral preparation was asked we could give risperidone but in question asked injectable preparation. Injection Risperidone is a depot preparation the action of which takes few days to start. So in acute case it is not suitable; hence from the given options haloperidol is the best choice].
99
999. A 65yo man complains of hematuria, frequency, hesistancy and nocturia. He reports that on certain occasions he finds it difficult to control the urge to pass urine. Urine microscopy confirms the presence of blood but no other features. What is the most porbable dx? a. BPH b. Bladder ca c. Prostatic ca d. Pyelonephritis e. Prostatitis
Ans. There are two keys A. BPH and C. Prostatic carcinoma. [There are no constitutional features of carcinoma. Bleeding is more common in BPH and occurs in a minority of cases and much less common in prostatic carcinoma. Features given are of prostatism only which favours the diagnosis of BPH].
100
1000. A 60yo man presents with mass in the groin. Exam: mass lies below the midpoint of the inguinal ligament and is pulsatile. What is the most probable dx? a. Direct inguinal hernia b. Saphenavarix c. Femoral hernia d. Irreducible hernia e. Femoral aneurysm
Ans. The key is C. Femoral hernia. Controversial key! May be femoral aneurism . [Hernia below pubic tubercle (below inguinal ligament) is femoral hernia. But below mid-inguinal point and pulsatile mass may be femoral aneurism as well!!].
