May 2024

Question 1

Dermatomyositis
Ab ?

Answer 1

Mi-2
(25%)

Question 2

Polymyositis
Ab ?

Answer 2

Jo-1

Question 3

PO iron ?

Answer 3

Iron sulfate

Question 4

Alzheimer’s dz pt. fracture. Rx decision ?

Answer 4

orthopedic surgeon
(not court of protection)

Question 5

Crytococcal meningitis (HIV+)
Rx ?

Answer 5

LP to reduce ICP
(Dexa - wrong answer)

Question 6

Anterior uveitis, 1 cause in Liver disease. ?

Answer 6

HAV (flu-like illness and deep jaundice).
Rx - topical steroids

Question 7

Lupus nephritis Rx ?

Answer 7

change HCQ to mycophenolate mofetil.

Question 8

COPD - assessment for air travel ?

Answer 8

hypoxic challenge test.

Question 9

Aspirin overdose
Rx ?

Answer 9

activated charcoal

Question 10

Hypercalcemia Mx in secondary/tertiary hyperparathyroidism (unfit for surgery) ?

Answer 10

Cinacalcet

Question 11

Diabetic gastroparesis
Rx ?

Answer 11

Domeperidone

Question 12

MS pt, urge incontinence, anti-cholinergic medications make her drowsy. Next step?

Answer 12

Inj Botulism toxin

Question 13

OCD Rx ?

Answer 13

Tab Citanew

Question 14

UTI (old age), CKD, penicillin-allergy. Rx ?

Answer 14

Fosfmycin
Nitrofuratoin (1st choice eGFR > 45)

Question 15

Brugada Syn
type1 vs type2 ECG ?

Answer 15

Coved ST elevation (type1)
2mm saddle ST elevation V2 (type2)

Question 16

Basal cell CA appearance ?
squamous cell CA appearance ?

Answer 16

pearly surface, telangiectasia (basal)
slow growing ulcer (squamous)

Question 17

Becker’s muscular dystrophy
Dx ?

Answer 17

primary proximal myopathy, symptoms worsen in teen age, CK 5times, X-linked (dont affect females), myoglobinuria and cardiomegaly.

Question 18

Duchene. Dx ?

Answer 18

Present in childhood, more severe symptoms earlier, much higher CK level.

Question 19

cluster headache.
prophylaxis ?

Answer 19

PO verapamil.

Question 20

MM Rx ?
Renal imapairment +

Answer 20

cyclo + Dexa + Bortezomib

Question 21

Neurosyphillis Rx ?

Answer 21

Procaine Penicillin + Probenacid
*14 days
(doxy - 3 to 4 weeks, if penicillin allergy)

Question 22

*Imp Diagnostic tests ?
1) EMG/NCG ?
2) Autoimmune profile ?
3) B12 levels
4) Muscle biopsy

Answer 22

1) MND - remember no sensory loss
2) predominant symmetrical proximal muscle weakness
3) Distal muscle weakness + peripheral sensory neuropathy
4) exclude inflammatory muscle condition

Question 23

Benzodiazepam overdose Rx ?

Answer 23

Ventilation
using flumazenil - precipitate seizures (as pt is chronic user of alcohol/TCA).

Question 24

Fomepizol use ?

Answer 24

Rx methanol/ethylene glycol toxicity

Question 25

Metastatic melanoma Rx ?

Answer 25

1) Nivolumab + Ipilimumab (Stage 4/stage 3 when LN can't be resected) 2) Pembrolizumab (stage 3)

Question 26

sarcoidosis Ca++ level ?

Answer 26

Normal (90%)

Question 27

paliative care pt, high BSR Rx ?

Answer 27

Gliclazide (Long acting insulin, if not effective)

Question 28

Chest infection, army barrack, dry cough. Rx ?

Answer 28

Erythro

Question 29

Peripheral neuropathy (chemo agents) ?

Answer 29

Oxaliplatin cisplatin

Question 30

Familial hypercholesterolemia Rx (already on max Rx) ?

Answer 30

Evinacumab

Question 31

Primary Myelofibrosis Dx ?

Answer 31

JAK2 (+) 50% cases Low, Hb, Low PLT, splenomegaly

Question 32

Myelodysplasia Dx ?

Answer 32

JAK (+) in 3% cases low Hb, Low PLT