1 Flashcards
1
Q
Q183504-Child present with fever, neck stiffness, anterior frontanellae full , lymphocytes 5400cumm(n <5) , glucose is normal ,no organism on gram stain, meningitis like scenario
A. Intravenous phenytoin B. Rectal diazepam C. Intramuscular morphine D. Oral paracetamol E. Intravenous dexamethasone (exact option
A
تشخیص 👈 مننژیت ویرال
زمانیکه عامل مننژیت مشخص نیست دگزا بهتره همزمان یا قبل از انتی بیوتیک شروع بشه ولی اگه در دسترس نیست نباید برای تجویز انتی بیوتیک صبر کنیم. (دگزا بمدت ۴ روز داده میشه)
تنها مننژیت هایی که نیاز به دگزامتازون دارند: هموفیلوس و پنوموکوک است. بنابراین وقتی عامل مشخص شد و اینها نبودند دگزا قطع میشه
دگزا سن زیر دو ماه داده نمیشه
در برخورد با مننژیت ویرال همه اقدامات اولیه انجام میشه( اکسیژن تراپی و IV، شروع هیدریشن، بلاد کالچر، lp و شروع درمان) اما وقتی نتیجه مشخص شد درمانها قطع میشه و فقط درمان علامتی انجام میشه (بغیر از مننژیت هرپسی که درمان اسیکلوویر)
ویژگی های csf نرمال: پروتئین زیر ۰.۴ و قند بزرگتر مساوی ۲.۵ میلی مول و سلول زیر ۵ تا لفنوسیت (مونوسیت صفر)
ویژگی csf ویرال: پروتئین ممکنه کمی افزایش یافته باشه ولی زیر یک، لنفوسیت سلول غالب، قند نرمال
2
Q
2096) Q183114-Diarrhoea for 1mth what will u do for initial treatment?
A. Octreotide
B. Prednisolone
C. Loperamide
D. Cholestyramine
A
اسهال مزمن:
جواب C
توضیح دیگه؟؟
3
Q
Q10253-A patient on Amisulpride(some antipsychotic) 800mg well controlled now after developing psychotic and hypomanic feature 2 years ago. (some other thing just forgot). Which one of following suggests poor prognosis of this patient?
A. Past self harm
B. High dose of Antipsycotics
C. lost job in 06 months
D. Other option also relavant cant remember at this moment
A
Ans: C
4
Q
Q182394- On interview. Asking about the appetite. Patient told “That is concern with food. Food which does not comes from moon, moon made of cheese. But I came her by bus”. Which of the following will have in this patient?
A. Depression B. Dissociation C. Disorganized behavior D. Delusion E. Depersonalization
A
Ans: C
Dissociation is a mental process that causes a lack of connection in a person’s thoughts, memory and sense of identity. Dissociation seems to fall on a continuum of severity. Mild dissociation would be like daydreaming, getting “lost” in a book, or when you are driving down a familiar stretch of road and realize that you do not remember the last several miles. A severe and more chronic form of dissociation is seen in the disorder Dissociative Identity Disorder, once called Multiple Personality Disorder, and other Dissociative Disorders.
Depersonalization is a harmless, but often very troubling, mental state characterized by a disruption in one’s self-perception and awareness. The sufferer’s thoughts, emotions and actions feel detached, unreal or foreign, as if they are not a part of oneself.
Depersonalization, as well as derealization (the feeling that the external world is unreal), is the most prominent symptom in dissociative disorders, such as dissociative identity disorder (previously known as multiple personality disorder). Depersonalization may also occur as a result of extreme anxiety, panic, sleep deprivation, other mental disorders and certain types of drug use or withdrawal. In some patients, for example, long-term use of benzodiazepines can induce chronic depersonalization and perceptual disturbances. Withdrawal from benzodiazepines can result in the same.
5
Q
Q10291-Floppy child recall , normal development than hevy breathing, not eating, diminished all limb reflexes
a) Prader Willy
b) Early pulsy
c) Boutulism
d) Myotrophic sclerosis ( something like that)
A
Answer: SMA ( spinal muscular atrophy)
6
Q
Q182405-17 girl has dyspareunia, worry about endometriosis because sister has infertility because of this. Examination: nodule on ligament on vaginal palpationand some other description, what is important to diagnose endometriosis:
A.nodule on uterosacral ligament,
B.dyspareunia,
C.menorrhagia,
D.family history
A
Ans: A
اندومتریوز
علایم: از علل دیس منوره ثانویه
روش تشخیص قطعی: لاپاراتومی
درمان دارویی: خط اول cocp
7
Q
Q91030-A couple came to you they r in relationship with each other from last 4 yrs now they are planning for pregnancy what will you check in female partner
a) Rubella
b) CMV
c) Parvovirus
d) Toxopalasmo
e) Varicalla
A
Ans: A
مراقبت های قبل بارداری
بررسی سابقه واکسیناسیون برای روبلا، هپاتیت و واریسلا
افرادیکه جهت دریافت واکسن مراجعه کردند در خصوص احتمال بارداری سوال میپرسیم
بعد از دادن واکسن mmr نباید تا ۲۸ روز باردار شوند، اما اگه بارداری رخ داد اطمینان دهی میکنیم
واکسن هایی که توصیه میشه: mmr، واریسلا به انهایی که سابقه ابتلا و واکسیناسیون ندارند، انفولانزا(during بارداری توصیه میشود) و dTpa
ساپلمنت اسید فولیک 👈از یک ماه قبل تا پایان ماه سوم با دوز ۰/۵
دوز بالا(۵): ۱- مصرف داروی انتی کانوالژانت ۲- دیابت مزمن (نه gdm) ۳- سابقه اختلال NT در فرزند قبلی یا فامیلی هیستوری مثبت ۴- کمبود ۵متیل تتراهیدروفولات ۵-bmi بالای ۳۰ ۶- ریسک سوجذب(مثلا سلیاک، ibd)
ید👈 دربارداری و شیردهی ۱۵۰ میکروگرم روزانه
کنترل وزن
کنترل عفونت ها:
توکسوپلاسموز👈 avoid cat litter, garden soil, raw meat, شستن میوه و سبزی، مصرف نکردن شیر غیرپاستوریزه
8
Q
Q9936-Young boy developed pain in the right knee .. mild progressive marked swelling .. no other systemic symptoms as I recall Blood results given .. anemia .. low platelets .. normal WBCs . What is your diagnosis
a. Juvenile rheumatoid arthritis
b. Acute leukemia
c. Apalstic anemia
d. SLE
e. Other irrelevant options
A
Open
A?
9
Q
Q9937-Which of the following is notconsidered an extra-articularmanifestation of Rheumatoid Arthritis?
a) Osteoperosis
b) Peripheral neuropathy
c) Cutaneous nodules
d) Pericardial effusions
e) Hepatomegaly
A
Ans: E
بهترین درمان MTX
عارضه متوترکسات: هپاتیت
متوترکسات در نارسایی کلیه ممنوع است
10
Q
Q11079- You are intern. Patient wishes you to witness her will in the presence of lawyer.
What should you do?
- Witness the will
- Refuse to witness(ans)
- Ask surgical register if he can do it
- Seek legal advice
A
Ans: C?
11
Q
Q9250- An *18 year** old girl suddenly lost her weight about 10 kg. Reduction in school performance or grades. What appropriate thing will you ask in the history to make a diagnosis
a. Apparent loss of appetite
b. Feelings of guilt
c. Feelings of inferiority
d. Premorbid personality
e. Suicidal ideation
A
Ans: C
🔴آنورکسی نروزا :
بیشترین میزان مرگ و میر و خودکشی را در تمام بیماری های روانپزشکی دارد.
معمولا خانم های جوان
سن شروع معمولا ۱۳تا ۲۵ سالگی است.
علت نامشخص
⚪️کرایتریاهای تشخیصی:
• ترس شدیدی به افزایش وزن با وجود اینکه under weight
•ارزیابی نامناسب از وزن و شکل بدن خوش دارد
•وقتی بهش میگی چاقه کاملا ریفیوز میکنه
•در خانم های پست منارک ممکنه دچار آمنوره در حداقل ۳سیکل متوالی بشه
⚪️دو تایپ:
۱:Restrictive type:
زیاد غذا نمیخوره که به دنبالش رفتار جبرانی داشته باشه
۲:Bing eating/purging type:
شخص زیاد غذا میخوره و به دنبالش رفتار جبرانی مثل تحریک به استفراغ و … داره.
⚪️علائم روحی و روانی:
افت عملكرد در كارهاى روزانه زندگى،تغییر رفتار در غذا خوردن،غذا خوردن پنهانی،تغییر انتخاب غذا(مثلا یکدفعه تصمیم میگیرن وگن یا وجترین بشن)
اینسایت پایین،کاهش تمرکز،مود پایین، self esteem پایین،خود كم بينى (feeling of inferiority )، احساس ترس ،عصبانيت،ناراحتى و عدم اعتماد و سعى در مخفى كردن اين احساسات،رفتار و تفكرات OCD روى وزن
⚪️علائم فيزيكى:
❗️تاخير رشد و تاخير بلوغ،كاشكسى،گونه هاى فرو رفته
❗️آمنوره(تا سه سيكل متوالى منس نشه) يا منس هاى ارگولار به علت ديسفانكشن هيپوتالاموس و سو تغذيه
❗️تحليل بافت پستان به خاطر مسائل هورمونى كه كاهش پيدا ميكنند
❗️آریتمی به علت اختلالات الکترولیتی و،هارت فیلر و
prolonged QT interval
❗️برادى كاردى واز بين رفتن عضلات قلب، آريتمى و مرگ ناگهانى
❗️ناخن و موهاى شكننده به علت سوتغذيه،خشکی پوست و مو
❗️ادم پریفرال، انکل ادم،هايپركراتوز،هيپوتنشن ارتواستاتيك،دهيدريشن،هيپوترمى(به علت كاهش بافت چربى)،
هيپوگليسمى،موهاى لانوگو(موهاى نازك سفيد روى پش، بازوها،و صورت)،تو سرما نميلرزن،
❗️كاهش وزن به علت گرسنگى كه خودشون به خودشون تحميل ميكنن نه كاهش اشتها،البته به دنبال افسردگى كه دارن كاهش اشتها هم پيدا ميكنند
❗️استئوپروز(اين بيماران حتى بعد بهبود همچنان در معرض استئوپروز هستند به همين خاطر بعد بهبود توصيه به رفتن زير آفتاب و انجام BMD ميشوند.)
❗️كاهش تحمل برخى غذا ها مثلا lactose intolerance آلرژى ناگهانى به برخى غذاها،
❗️ سنگ كليه و Chronic renal impairment
❗️مشكلات گاسترواينتستينال(يبوست و اسهال درد جنراليزه شكم،ديستنشن شكم، پرولاپس ركتوم، پانكراتيت، پارگى ازوفاگوس)
❗️افزايش كلسترول،لكوپنى،ترومبوسيتوپنى،آنمى نرموكروم نورموسيتيك،آنزيم هاى كبدى غير نرمال
❗️هايپرتروفى پاروتيد
❗️ خرابى دندان ها،التهاب لثه،کنژوکتیویت
❗️کاهش LH, FSH, TSH و استرادیول
❗️ناباروری
❗️در صورت بارداری بچه های با وزن پایین، پره مچور، و مالفورماسیون های جنینی وافزایش میزان سقط
12
Q
Q183287- A child 7 years old came with fever 38.7 looks tiered and lethargic and he ha grunting on examination his chest is clear what is the diagnosis??
A.Epiglottis
B.Croup
C.Broncholitis
D.Pneumonia
A
Ans: D
یه سوال هم هست که با همین شرح حال جرم شایعش رو پرسیده که میشه پنوموکوک
13
Q
Q11291-12 week old pregnant lady was brought to the emergency department with vomiting, abdominal pain and severe bleeding for the past 4 hours. She also had 2 fainting attacks. Her blood pressure is 80/40.She was normal till before this episode and USG at 11 weeks showed normal nuchal translucency. Which is the most likely diagnosis?
a. Incomplete abortion
b. Complete abortion
c. Abruption placenta
d. Ectopic pregnancy rupture
e. Hydatidiform mole
A
Ans: A
14
Q
Q183175-ECG of 72 y old man with history of dm and htn on metformin and hypertensive drugs.no history of stroke and hf irregular pulse the rate:80 .ecg shows af bp:135/80.rx?
- methoprolol
- warfarin
- digoxin
- asa
A
PR normal
Chads 2 👉 warfarin
15
Q
Q183574- Child (3-4 year) with fever 39C and history of cough unwell for 3 days. I think he has wheeze but minimal lung signs on exam. CXR given. Asked which investigation wud u do for further assisting in diagnosis?
a. pneumococcal PCR
b. pleural aspirate
c. blood culture
d. FBC
A
Ans?
16
Q
Q9244- male with hemoptysis and melaena,UGI endoscopy and colonoscopy done no finding what next:
- tagged rbc
- capsule endoscopy
- CT angio
- TECHNETIUM scan
A
Ans: b
چرا مکل نه؟
چون مکل معمولا خونریزی حاد میده
17
Q
Q182500-18 year old male with blood mixed with stool. stool culture negative. Upper GI endoscopy and Colonoscopy showed nothing. Most appropriate next?
a) Ct angiogram
b) X ray abdomen
c) Capsule endoscopy
d) repeat colonoscopy
A
Ans: C
خونریزی فعال و انستیبل کاتتر انژیو
خونریزی فعال انژیو
18
Q
Q182472- a case of chronic liver disease presented with ascites and low albumin level. What is the next appropriate management
a. lactulose
b. albumin infusion
c. salt and fluid restriction
d. spironolactone and frusemide
A
Ans: salt restriction
19
Q
Q183512-A 49 year old female presented with progressive back pain. She has a history of Breast Ca (and Sx done at her 35yr age) and lumbar osteoarthritis. What of the following clinical features will help you decide the investigation (MRI) to do?
A. Past history of breast Ca
B. Back pain without trauma
C. Past history of vertebral osteoarthritis
D. High blood pressure
E. Radicular Pain radiating to the buttock
A
Ans:A
20
Q
Q183538- 64 yr old man with low back pain. No symptoms of prostate. Crushed vertebrae t10 L1 seen on bone scan with increased uptake. Labs were given
ESR increased more than 100
Ca level was normal. What will u do to know underlying cause
A.bone marrow exam
B.PSA
C.PET scan
D.MRI spine
A
Ans:A
21
Q
Q11265- Patient is taking methotrexate, prednisolone and celecoxib for RA. Lab results show pancytopenia with high esr (67). Management?
a. Increased prednisone
b. HCQ
c. Folic acid
d. Folinic acid
e. Cease celecoxib (not sure)
A
Ans: D
22
Q
Q183530- old age lady with polymyalgia rhematica.on oral mpain killers like codeine paracetamol with dose given.one of her friend who had end stage cancer and was on morphine gave her morphine and she was using it.now friend has died.now lady has come for prescription of morphine.what will u do
a. give her prescription
b. refuse her request
c. report her drug seeking behaviour
d. increse the dose of her oral analgesics
A
Ans:C
23
Q
Q11103-42yo woman who smokes 20 cigarettes/d presents with complains of heavy bleeding and prolonged menstrual period. What is the most appropriate tx for her?
a. Tranexemic acid
b. COCP
c. Mefenemic acid
d. IUCD
A
Ans: Mirena?
24
Q
Q183212- 18 month baby. Diarrhea for 6 weeks. Stool tests normal. First copious watery diarrhea now undigested food particles in stool. What to do-
Gluten free diet
lactose free diet
reduce red meat in diet
continue same diet
A
Ans:B
25
Q183195-A schizophrenic patient admitted involuntary. He wanted to sue hospital against his admission. He believes that God wants to swim across Pacific Ocean. And he says other ppl in his religion have same belief. What's most important justifying his continuing involuntary admission?
A. Loss of his insight
B. His belief at risk
C. Fixity of his belief
D. Presence of positive psychiatric behavior
Ans:A
26
Q182114- Medical student, care for a under supervision, report me that he published medical information about a patient on facebook, what you do?
A. Nothing, it's not your responsibility
B. Talk to him that his action is wrong
C. Tell the supervisor
D. Ask him to remove it from Facebook
C
27
Q11200-Post op patient, agitated, trying to get out of bed, removing all IV infusion, all vitals normal except SaO2 is 86% in room air. After giving oxygen by face mask, what is next:
a. Droperidol
b. Blood glucose level
c. CT
d. Intubate
e. IV antibiotics
A
28
Q182356- hutchinson's freckle on face for the past 6 years, size is increasing now, next step of management?
A. Local excision.
B. Excision with a 2 cm margin.
C. Fluorouracil cream
D Review in 12 months
A
29
Q9103- Sarcoidosis xray with 3yrs dyspnea, 12months loin pain, 24hours hematuria…what inv have to do NEXT?
a) xCT chest
b) Serum ACE
c) USG of abdomen
d) urine r/m/e
e) cystoscopy
C
30
Q183186-15 years old girl, came with (fever, sore throat, swollen neck glands) Otherwise no medical illness, not on any medications, no travel history. Asking (something like) what symptom will actually tell you the definite diagnosis?
A. Diffuse pharyngitis
b. Temperature 38.5
c. Swelling of ankle
d. splenomegaly
Ans:
افتراق از فارنژیت باکتریال 👈 D
افتراق از cmv و سایر 👈A
31
Q182609- Old woman diagnosis as Schiz & taking Venlafaxine. Now ,she become confused, day time sleeping & reduced concentration.. What test will u do ?
```
A.Ur & Cr
B.Electrolytes
C.FBS
D.LFT
E.Urine C&S
```
Ans: B
کلا ازعوارض ونلا که خیلی باید حواسمون باشه افزایش فشارخون هست که درشروع درمان وطی درمان باید چک بشه اما علامتدار شدن اگر به صورت کانفیوژن باشه هیپوناترمی عاملش هست. معمولا سوال علایم رو میگه
Uncommon adverse effects of SSRIs and TCAs
SSRI
Extrapyramidal effects – acute dystonia, akathisia and Parkinsonism
• Neuropsychiatric syndromes – mania, frontal lobe syndrome
• Bradycardia
• Seizures
• Symptomatic hyponatremia
• Hepatotoxicity
• Prolonged bleeding time
• Granulocytopenia
• Serotonin syndrome
بیشترین تداخل با وارفارین 👈 فلووکستین و فلووکسامین
کمترین تداخل👈سیتالوپرام و سرترالین
```
TCAs
Extrapyramidal effects – acute dystonia, akathisia and Parkinsonism
• Neuropsychiatric syndromes – mania, frontal lobe syndrome
• Bradycardia
• Seizures
• Symptomatic hyponatremia
• Hepatotoxicity
• Prolonged bleeding time
• Granulocytopenia
• Serotonin syndrome
```
32
Q10087-patient was brought to emergency room after a fight causing a stab with a knife in the chest. patient BP is normal but his O2sat is mildly decreased he is calm , he only has mild dyspnea , on examination he has dullness to percussion , decreased air entry on left side with trachea deviated to the side of the injury ( not the opposite ).what should you do ?
a. Give O2
b. Chest tube
c. Thoracocentesis
d. IV fluids
e. Just cover the wound and send him home
اگه چاقو سمت چپ و فضای بین دنده ای ۴ و ۵ باشه که احتمال اسیب قلب وجود داره قدم بعدی در صورت استیبل بودن بیمار 👈 فست
اگه سمت مقابل باشه و بیمار استیبل باشه👈 اول CT
33
Q11324- A man with dyspnea and SOB, taking metformin and rosiglitazone for diabetes, amiodarone for recurrent ventricular tachyarrhythmias, enalapril and metoprolol. Which drug may have caused these symptoms?
```
A. Amiodarone
B. Metformin
C. Rosiglitazone
D. Enalapril
E. Metoprolol
```
در این سوال باید به علایم همراه دقت کنی
امیودارون دو نوع فیبروز ریوی میده: نوع حاد و مزمن
امیودارون با acei 👈 هایپرکالمی و نارسایی کلیه
تداخل آمیودارون با:
✅استاتین: افزایش ریسک میوپاتی
✅وارفارين: خونریزی شدید
✅پریندوپریل(ACE): پولموناری توکسیسیتی
رزیگلیتازون تشدید HF میکنه
34
Q188460-Which of the following medication is contraindicated in Acute pulmonary edema with ejection fraction 25% ?
1. Sitagliptin
2. Metformin
3. Exenatide
4. Rosiglitazone
5. Glyburide.
Ans: D
35
```
Q10202- Patient with CHF taking B-blocker , furosemide , perindopril , K supplement , Metformin for DM , started Amiodarone due to arrythmic problems , now complain of lightheadedness and palpitation & feeling like syncope. Potassium level was given about 6.5 and other lab values were within normal range
A.Metformin & amiodarone
B.Metformin & K supplement
C.Frusemide & Perindopril
D.Frusemide & Metformin
E. Amiodarone +Perindopril
```
Ans:E
36
Q183552- PIC if hands with rash.patient was started on amiodarone 2 weeks back and this rash developed on face and hands for 1 week.rash gets aggravated when he goes to sun .what is the cause.
a. phototoxicity
b. pseudoporphyria
Pseudoporphyria is clinically characterized by increased skin fragility; erythema; and the appearance of tense bullae and erosions on sun-exposed skin , which are identical to those seen in patients with porphyria cutanea tarda
However, a clinical pearl that may prove helpful in differentiating between pseudoporphyria and porphyria cutanea tarda is that the classic features of hypertrichosis, hyperpigmentation, and sclerodermoid changes found with porphyria cutanea tarda are unusual with pseudoporphyria.
37
ضايعه پوستي به دنبال اميودارون
١- fix drug eruption
٢-اريتم مولتي فرم
٣- سودوپورفيري
Ans: C
توجه کنید که توی این استم اشاره ای نشده که قبلا هم بیمار همین مشکل رو داشته یا خیر، برا همین تشخیص fixed drug eruption یه ذره غیر منطقی میاد، با توجه به اینکه باید تکرار ضایعات اتفاق بیفته
طبق مد اسکیپ فقط اریتم مولتی فرم و سودو پورفیری ذکر شده برای آمیودارون
38
Q182514- a pt came for advice as her mother has fracture of hip due to osteoporosis. Pt ask for proplylactic treatment as she is at risk of having osteoporosis ,works long hours your next step in her investigation?
a) serum ca and phosphate level
b) vit d level
c) xray
d) bone scan
اگه خانم بالای ۶۰ و اقای بالای ۵۰ باشه چون سابقه مینیمال تروما فرکچر در خانواده داره جز گروه Increased risk حساب میشه و باید BMX واسش انجام بشه
اگه سنش کمتر باشه و در ریسک کمبود ویتامین دی باشه(زیاد در معرض نور قرار نگیره) 👈 چک ویتامین D
39
Q9058-A patient developed a diarrhoea after a eurotrip. Diarrhoea was not bloody and he lost weight. What is most likely causative agent?
```
A. Campilobacter
B. Giardia
C. Staphylococcus
D. Salmonella
E. Shigella
```
Ans: B
📍Diarrhoea
✅Giardiasis
Inf of small intestin/oral_feacal +contaminated drink & food
most common symptom
diarrhoea➕stomach cramps➕ bloating➕nausea➕loose and pale greasy stools➕ fatigue➕ weight loss.
First sign➡️3-25d(7d)➡️recover in 4-6 w
Tx➡️metronidazol ➕drink plently of fluid
No isolation➡️only personal hygiene
✅ShigellOSIS (bacillary dysentery)
Spreading➡️Faecal-oral
Dx➡️S/C
Tx➡️ciprofloxacin(in not self limiting inf)
@Hadis65
40
Q9975- A old man present with new onset of diarrhoea for 3 months and weight loss. Complains for difficulty in getting up from chair and walking up the start.
A-campylobacter jejuni infection
B-coeliac disease
C-polymyositis
D-thyroxicosis
Ans:D
41
Q182185- 4 yr old boy increase vomiting and( not sure abd distension include or not ) child is alert and responding , Ivx shows metabolic acidosis , next step in management ?
a. Oral rehydration fluid
b. Abdominal ultrasound
Answer: IV fluid rehydration
42
Q183061- A 40 yr old woman with known social phobia , now comes with her brother for the assesemt. Whenever she goes out, She feels anxious,palptiations. she has a plan to attend her cousin wedding ceremony next week. She sleeps well and at home she enjoys gardening n painting.
What is your approproate tx for her?
```
A.Temazepam
B.Olanzapine
C.Venlafaxine
D.Citalopram
E.Propanolol
```
Ans:E
43
Q11283-The patient comes with morning stiffness of both wrists for 1 to 2 hours and both wrists pain. (not mention other joint pain). Now patient is concern and comes with this wrist joint pain. Her lab results as follow.
Hb reduced MCV 77 fL (lower than given normal value) ESR 75 mm/hr (SURE for both values of MCV & ESR)
A. NSAIDs
B. Prednisolone
C. Hydroxychloroquine
D. Methotrexate
E. Etanercept
D
RF +. Anti CCP +
```
درمان ra:
ضد درد انتخابی پاراستامول با دوز ماکزیمم
مکمل امگا ۳
بصورت کوتاه مدت NSAID
چویس درمانی 👈 DMARD یعنی متوترکسات، دو تا سه ماه برای شروع اثر دارو زمان میبره، کورتون سیستمیک در همین زمانی که منتظر شروع اثر دارو هستیم بصورت کوتاه مدت استفاده میشه
```
44
Q183054- previously healthy woman came for AN 38 wk gestation with 1L blood loss. Low lying placenta seen during 18 week care and failed to follow up n USG check.
On exam: bp 100/70, Hb - slightly low.
Which further process will help u for dx?
```
Pain with bleeding
Uterus TENSENESS
Absence fetal heart sound
Uterine contraction
High head
```
placenta previa باعث مال پرزنتاسیون جنین می شد، چون جفت پایین بود، درنتیجه بچه بالاتر میرفت مثلا عرضی قرار میگرفت
45
Q9634- 40 yrs old woman with menorrhagia and hysteroscopy. She had a dilatation and curettage three months ago Which of the following is the best management plan a, nortestosterone
b. levonorgestrel iucd
c continuous methylprogesterone
این سوال صرفا جهت نمونه
که گفته d&c انجام شده
در مورد این سوال ابهامات زیاد بوده و این عدم قاطعیت مورتا در تعیین درمان choise هم مشکل ساز هست.
ببینید این خانم در سن ۴۰ سالگی هست و اگر ایشون رو normal population فرض کنیم احتمالا ovulatory هست. البته میشه این فرضیه رو هم مطرح کرد که با این سابقه ی منوراژی و کورتاژ و هیستروسکوپی شاید anovulatory هم باشه.
✅ اگر خونریزی رو حاد در نظر بگیریم:
ترانکزامیک اسید (IV or Oral )
اگر جواب نداد یا نبود norethisterone یا مدروکسی پروژسترون استات که تجویز هر دو دارو به شکل continuos نیست پس گزینه a مطرحه.
✅ درمان heavy menorrhagia هم کورتاژ و هیستروسکوپی (که انجام شده در این کیس) و بعد Norethisterone با دوز بالاست که باز هم گزینه a رو برای ما مطرح میکنه.
✅ اگر خونریزی رو مزمن در نظر بگیریم:
✳️ سیکل Ovulatory:
پروژسترون خوراکی به شکل سیکلیک + ترانکزامیک اسید
```
✳️ سیکل anovulatory:
مهارکننده های پروستاگلندین به شکل سیکلیک، یا یکی از اینها:
ضد بارداری های خوراکی
داروهای آنتی فیبینولایتیک
میرنا
```
46
Q9633- 24yrs old with dysmenorrhoea and menorrhagia asked to do investigation but she insist she wants medication
a. mefenamic acid
b. tranexamic acid
c. ocp
d. iucd
A
47
Q11399- Adult man came with malaise and nausea, examination showed jaundice. History of acute bronchitis treated with augmentin 3 weeks ago . What to do :
A. Give ursodeoxycholic acid
B. Give N-acethylcyctine
Drug-induced hepatitis
🔸بیمار بعد از مصرف Co-Amoxiclave دچار هپاتیت و کلستاز دارویی شده است که معمولا Alp و 5 آلفا نوکلئوتیداز و گاما گلوتامیل ترانسفراز هم بالا میروند که نشان دهنده انسداد در مسیر صفراوی می باشد.
🔸اقدام بعدی انجام سونوگرافی و mri و Ercp می باشد که در مواقع دارویی دیلاتاسیون مجاری صفراوی گزارش نخواهد شد.
🔸طبق مطالب Co-Amoxiclave جز داروهایی هستش که کلستاز دارویی ایجاد میکنه و با توجه مطالب بالا Ursodeoxycholic acid جریان صفراوی رو بهتر میکنه، یه چیزی یادتون باشه در کلستاز دارویی اتساع مجاری صفراوی نداریم.
✅شایعترین علل جاندیس بترتیب: هپاتیت ویرال,سنگ صفراوی,کنسر پانکراس, سیروز ,پانکراتیت و داروها هستند
✅هپاتوتوکسیسیته کو اموکسی کلاو بسیار نادره و اگه اتفاق بیفته خودبخود بهبود پیدا میکنه اورسودیوکسی کولیک اسید موجب افزایش موارد برگشت به نرمال میشه
✅بریم سایر گزینه ها: ان استیل سیستئین در پیشگیری از هپاتوتوکسیسیته پاراستامول استفاده میشه, کورتیکوسترویید در هپاتیت دارویی نقشی نداره شارکول هم در درمان برخی مسمومیتهای دارویی بکار میره در کو اموکسی کلاو کاربرد نداره
48
```
Q183053- 40 yr fit n healthy woman came to OPD with incrasing jaundice, itchy skin n dark color urine for a week otherwise no symptoms. On exam: she is obviously jaundice and scratch marks present.
4 weeks ago, she has URTI and treated with Amoxil-calvulonic acid, no other history of hospitalization and no medication hisrory.
Lab value
ALP 410
BIL 80
AST 150
ALT 180
GGT increased
USG: biliary USG IS NORMAL.
what is your management for the patient?
A.Activated charcoal
B.Observation
C.N acetyl cysteine
D.Prednisolone
E.Ursodeoxycholic acid (UDCA)
```
E
49
```
Q11062- patient comes to you from Japan 🇯🇵, she believes that her bowels have exploded after a volcanic explosion...she was treated with trifluoperazine before in the past and she responded well but later lost contact with the doctor.. later she stopped taking the drug because she was having some motor problems and stiffness,what is most appropriate next treatment?
A)quetiapine
B)trifluoperazine
C)haloperidol
D)clozapine
```
A
50
Q182222- Female 50 years works as a cleaner,complain of can’t tolerate coldness when come out from bed since 2 months,terminated from job as she was not in work and disorganised,what you will find her as a symptom?pulse 56/min
a) Rigidity
b) Disdiadochookinesia
c) Delayed reflex syndrome
e) RD- fundoscope
Hypothyroidism
| C
51
Q11367- Guy just found out he had Huntington’s disease 1 month ago, brought in by police for driving under alcohol influence , now he insiders on being discharged home as its lambing season , what to do :
A. Allow discharge and outpatient detoxification
B. Admit and detoxification
C. Refer to Huntington’s support group
B
برخورد با مسمومیت با الکل
دو ماده شایع متانول و اتیلن گلیکول
⛳️مصرف همزمان اتانول همراه با متانول و اتیلن گلیکول اثر پروتکتیو داره
⛳️پرزنتیشن👈 دپرشن cns، رتینال توکسیسیتی در متانول، علایم gi و کاهش فشار خون و ...
بررسی ها👈 الکترولیت، سطح کلسیم در مسمومیت با اتیلن گلیکول، سطح سرمی هردو، گپ اسمولار
درمان👈 شارکول فعال نقشی نداره(بخاطر سرعت جذب بالا) ، درمان انتی دوتال با الکل دهیدروژناز: اتانول با ان جی یا ای وی و فومپزیل ای وی
در مسمومیت با اتانول 👈 فولات
در مسمومیت با اتیلن گلیکول👈 پیریدوکسین یا تیامین
♦️دیس شارژ در صورت سطح سرمی کمتر از ۲۰
♦️اندیکاسیون دیالیز 👈 سطح سرمی بیش از ۵۰ و عدم دسترسی به فومپزیل، سابقه مصرف زیاد، اسیدوز متابولیک، نارسایی کلیه
52
Q10142- Old man complaints of dyspnoea, orthopnoea. History of DM + and take metformin, atorvastatin, aspirin ,etc. JVP 3cm , bilateral basal crepts +, CXR is given (interpret as left heart failure). What is the most appropriate next step to confirm the diagnosis?
a. CTPA
b. Serum electrolytes and creatinine
c. ECG
d. Troponin
e. BNP
E
53
Q182626-4 yrs child comes with high fever. He is v toxic. Soft inspiratory stridor. No cough. Chest clear. What is the causative organism
A)RSV
B) H influenza
C) influenza virus
D) strep pneumoniae
D
برونشیولیت که سن شایعش زیر ۱۲ ماه و عاملش RSV
درمان کلی برونشیولیت👈 IV مایع درمانی + اکسیژن
کروپ هم عاملش ویرال هست، سرفه دمی barking همراه با استریدور و علایم URTI تب معمولا پایین و تب بالای ۳۹ نادره، در نوع شدیدش بخاطر خستگی عضلانی سرفه دیده نمیشه و بیمار شواهد هیپوکسی و خستگی تنفسی داره
درمان کروپ:
خفیف(که فقط سرفه داره +- استریدور)👈 سرپایی، بچه رو ریلکس نگه دارن
متوسط (سرفه + افزایش تلاش تنفسی یعنی تراکئال تاگ و ...+ استریدور) 👈 بستری، کورتون خوراکی، اگه جواب نداد نبولایزر آدرنالین
شدید( کاهش سرفه + شواهد هیپوکسی + بی صدا شدن قفسه سینه ) 👈 بستری در ICU، اکسیژن، ادرنالین استنشاقی تا دوبار، دگزامتازون iv که بعدتر خوراکی میشه، اگه به سمت نارسایی تنفسی میره باید انتوبه بشه
هموفیلوس انفولانزا عامل اپی گلوتیت حاد است، تظاهرش بچه بی حال و ارومی که تمایل داره بشینه و دراز نمیکشه، گردنش رو حرکت نمیده، با چشمهاش دنبال میکنه، صدای ارام با soft stridor بازدمی داره، سرفه نداره، دهان باز و درولینگ و دیسفاژی داره و از خوردن امتناع میکنه، درمانش سفتریاکسون ۵ روز
شایعترین عامل پنومونی در شیرخواران ویرال است، در در بچه های زیر ۵ سال پنومونی های باکتریال و شایعترین اونها پنوموکوک است که تظاهر تاکی پنه و گرانتینگ بازدمی است، ممکنه معاینه چست یافته ای نداشته باشه یا یافته فوکال داشته باشه. در نوع ویرال ویزینگ و کراکل منتشر سمع میشه.
54
82010-Intern concern about needle injury. All cases in the hospital were manage correctly with no big problem. Now there is accreditation and the intern was asked about this issue. What the intern should answer:
A.Give info about the protocol of management
B.Leave the answer to higher officer
C.Tell a case that he knows
D.Say that this will not be a problem
A
55
Q10137-A man present with unable to sit as he is pacing whenever sit down. Last night, he was injected with depot Zuclopenthixol decanoate. What to give?
1. Physostigmine
2. Benztropine
3. Diazepam
4. Methyl phenidate
Akathisia: Urge to move
درمان کوتاه مدت : بنزودیازپین خوراکی یا بتابلاکر خوراکی (بتابلاکر در اسم و بیماری عروق محیطی و بعضی هارت فیلر ها کنتراندیکه است)
درمان: کاهش دوز تا زمان رفع علایم یا تغییر انتی سایکوتیک به نسل دوم
هیستوری: اگر علایم ریجیدیتی و پارکینسونیسم هم داشت جواب ارجح بنزتروپین است
56
183581- After a night party a girl comes to the ER in the morning with a high fever of 40c, agitated, decreased consciousness level, muscle rigidity, tremor. What will be the best initial step in management?
a. I/V infusion
b. Cool blanket and ice pack
c. I/V Diazepam
d. Dantrolene Sodium
```
A
Serotonin syndrome
Triad:
Neuromuscular
Autonomic
CNS
```
سندروم سروتونين از عوارض مرگبار مصرف همزمان ssri و سایر داروهای سروتونرژیک با داروهايي نظير انتي دپرسان ها، اپيوئيدها خصوصا ترامادول، ضد تهوع ها، ليتيوم، سلژيلين و ... است.
♦️ حداقل سه مورد از علائم سندرم سروتونین باید وجود داشته باشد شامل:
۱-تغییرات منتال استیتوس یا تغييرات رفتاري نظير آژيتيشن،گيجي، هيپومانيا، تشنج
۲- تغییر در تون عضلانی نظير ترمور، ميوكلونوس، هيپررفلكسي،لرز
۳- ناپایداری اتونوم نظير افزايش يا كاهش فشار خون، تب، تاكي كاردي، اسهال
```
♦️ درمان شامل:
۱- بستری در آی سی یو
۲- قطع داروها
۳- هیدراسیون IV
۴- کنترل دما ، ضربان، فشار خون ، برون ده ادرار
۵- خنک کردن بدن با کیسه یخ یا اسپری آب
۶- در صورت نیاز پارالیز و ونتیلاسیون
۷- بنزوديازپين ها ممکن است برای کنترل تشنج و هیپراکتیویتی عضلانی استفاده شود
۸- درمان دارویی فشار خون نیاز نیست
```
ممکن است نیاز به سیپروهپتادین برای سندرم متوسط و خفیف باشد . یا کلرپرومازین و پروپرانولول .
57
Q10297- daughter brings father complaining of increased breathlessness and cough last few days or 2 weeks i forgot. known case of HTN and heart failure, on multiple drugs. smoker. o/e bilat basal crackles.
xray given ( bilat patchy infiltrates, no cardiomegaly, and heart borders were very poorly defined) Dx asked?
a) acute lvf
b) lung ca
c) acute on chronic bronchitis
d) pulm fibrosis
A
58
Q183582- Pt comes with H/O of unilateral temporal side headache for last 4 hours. He didn’t experience such type of headache before. He is also complaining of mild neck pain of same side. Pain is not subsiding by taking regular pain killers. Pic of the pt is given below. What will be the next step in management?
a. CT head
b. ESR
c. Temporal artery biopsy
d. CXR
e. Visual evoke potential test
سردرد شدید یکطرفه + هورنر + درد گردن
دایسکشن کاروتید
تشخیص MRA
نبود cta
نبود انژیو
اموروزیس فوگاکس: از دست دادن موقت و بدون درد بینایی
59
Q184214-man has all the enzyme increased . AST
هپاتيت بي در فاز اكيوتش آنزيما بالا ميرن ولي هيچ ربطي به بيلي روبين نداره مگر اينكه مزمن بشه و كبد سيروز بشه و بعدش با زردي بياد و اون موقع كه كبد سيروز هست انزيمها بالا نيستن
هپاتيت سي هم همينطور از اولش مزمنه و رايز آنزيم رو اصلا نداره و فقط در مراحل انتهاييش كه مريض سيروز شد زردي ميگيره
سي ام وي رو هم كه تاحالا مشنيدم
هپاتيت آ هميشه فقط اكيوت هست و پترن كلستاتيك ميده
60
```
Q9740-58yr old man returned from Thailand after 2 weeks holiday with his wife. Now presents with fever, malaise, pain in the right upper quadrant. His lab findings were given with a big list of all the FBE, LFTs, etc. Almost all his LFTs raised. GGT was very high. Whats the diagnosis?
a. Hepatitis A
b. Cholangitis
c. Liver abscess
d. Acute pancreatitis
e. Cholecystitis
```
?
61
Q188018- Lady 18 weeks gestation and previous DVT presents with sudden dyspnoea and sob.What's the initial investigation in this patient?
```
A-D dimer
B-VQ SCAN
C-ECG
D-CTPA
E-DOPPLER US
```
B
62
Q183585- A primigravida lady 32 weeks of gestation smokes 30 cigarettes per day comes to your clinic with the complaints of mild pedal edema and SOB.On examination lung is clear, O2 saturation is 90%. What will be your next step of management?
a. V/Q ratio
b. CXR
c. ECG
d. ECHO
e. CTPA
B
63
Q184403- Depersonalization and derealization occur in :
a. Depression
b. Schizo
c. Ocd
d. mania
e. all of the above
E
64
Q184100- 32 year old history historectomy and oophorectomy for menorrhagia has -2.8 Z score for bone marrow. Besides giving calcium, what to give?
a) Vit D
b) Calcitrol
c) Estrogen
d) Estrogen and progesterone
e) Bisphosphonate-Alendronate
C
65
```
Q184079-Post op incarcerated hernia 1st day aggitation stem fever sob O2 sat 88% xray given after o2 what initial step.xray had patches! What initial
A.IV antibiotics
B.Heparin
C.Thrombolysis
D.Droperidol
```
D
66
Q10273- A 42 year-old secretary has lost her job because, due to her perfectionism and excessive attention to trivial details, she could never finish an assignment on time. She writes innumerable lists of things to be done and follows rules scrupulously. She consistently annoys friends and family members with her lack of flexibility remarks. What is the best treatment for her?
1) Psychodynamic Psychotherapy
2) Olanzapine
3) Venlafaxine
4) CBT
5) Exposure & response Therapy
?
67
Q183252- lady comes with belief with her head full of worm.some alien want to change gene of rice and wheat to all world.previously treated with respi,olanzapine,quitiapine.partially controlled symptom.now?
A.Clozapine
B.Aripipirazole
C.Ziprasidone
A
| قوی ترین
68
Q183541- pic of ringworm on face of a girl(the one given in annotated).wht is the treatment a.mupirocin
b. acyclovir
c. betnovate
d. another brand name (I cant remember)seems like antiviral no antifungal in options
درمان: topical antifungal
| Canesten
69
Q183536- a lady with sign symptoms of Parkinson disease.she had just resting tremors no other symptoms.what is best mng at this stage
a. benzhexol
b. selegiline
c. propranolol
d. diazeopam
?
70
Q183532- .a girl with signs and symptoms of depression.what in history will lead you to dx
a. difficulty going to sleep
b. difficulty staying awake
c. early morning wake up and cant go back to sleep
C
71
Q182017-Case of acute cholecystitis booked for Elective Lap Chole then before operation patient has sweating, pale and hypotension 90/40, temp 37.8 With abdominal tenderness & guarding, no palpable mass, what will help you to reach Dx.
A.Lipase
B.LFT
C.Coagulation profile
D.CBC
A
72
Q182468- Recall on mass on the left side of scrotum, cannot get above the mass. Asking for management
A) usg
B) surgical exploration
C) Orchidectomy
D) FNAC
A
73
Q184488-which of the following statement is incorrect regarding Guillain-Barre syndrome?
A.IVIGs are the treatment of choice
B.Plasma exchange is the first line treatment
C.Neuropathic pain is commonly seen during the illness
D.Steroids have no role in treatment E.Neuropathic pain is responsive to TCAs
C
```
ضعف عضلانی قرینه معمولا شروع از دیستال همراه با ارفلکسی، پارستزی
معمولا درد ندارند
تشخیص LP و NCV
منیجمنت 👈 چک FVC
درمان IVIG و پلاسمافرز
کورتون جایگاهی نداره
```
74
Q183195-A schizophrenic patient admitted involuntary. He wanted to sue hospital against his admission. He believes that God wants to swim across Pacific Ocean. And he says other ppl in his religion have same belief. What's most important justifying his continuing involuntary admission?
A. Loss of his insight
B. His belief at risk
C. Fixity of his belief
D. Presence of positive psychiatric behavior
A
75
Q9247- Patient on medications for HTN. she feels dizzy when get out of the bed.. happenining for a while.. she also had some falls. BP 160/100 Has AF. Next Ix
```
A echo
B xray
C holter monitoring
D 24 hour BP monitoring
E check BP again in supine
```
E
76
Q183518-A student thinks that he has brain tumor. The final exam is near and he gets more tired, headache and stressed due to tumor. All neuro exam and CT are normal. After CBT, he still think he has brain tumor. What is the diagnosis?
a. Hypochondriasis
b. Somatisation disorder
c. Conversion disorder
d. Factitious disorder
A
77
Q182110- Xray given (joint space is a bit narrow , may be little displacement) Football player , can’t stand , painful ankle joint movement , ask diagnosis ?
A.Fibula fracture
B.Fibula fracture with fracture articular surface of tibia
C.Fibula fracture with fracture articular surface of tibia & joint displacement
D.Fibula fracture with joint displacement
E.Fibular fracture with ? mortise
E
78
Q11018- pt had generalized tonic clonic seizures & he is also on warfarin & other drugs.What to give??
```
A.Amiodarone
B.sodium valproate
C.carbemazepine
D.phenytoin
E.topiramate
```
B
79
Q183568- Patient recently diagnosed with Huntingtons Disease, he has been drinking, and acting erratic. The police have brought him to ED as he was caught drink driving. What is your best next management?
a. Detoxification in ER
b. To refer him to Huntington support group
c. To send to drug and alcohol clinic
d. Admit and detoxify
D
80
Q182158- a child 10 yr old refuses to go to school . he developed frequent touching of his face and raise his arm above his head and crawl his hand on the ground, he can supreess doing those thing s but developed anxiety if he suppress those things . his classmates make fun of him coz of those behaviours and his teacher also annoyed,what to give
a. Temazepam
b. Mirtazapine
c. Risperidone
d. Quitiapine
C
81
Q183013- Pregnant women 28 th weeks,oral glucose tolerace test 8.7g(normal-8.5 gm) what to do?
a) dietician
b) start metformin
c) start insulin
d) do hba1c
A
82
Q11108- One ecg,looks normal to me,patient on ramipril , presented after syncope ,lab value was given,sodium normal,potassium 5.5,asked about next management?
a. insulin and glucose
b. haemodialysis
c. rectal resonium
d. Cease ramipril
e. Calcium carbonate IV
D
| ?
83
Q11255-a man works on a farm of another area brought by police for breaking a window with brick.he said he remember nothing except loss of his job from his farm.dx
1. depersonalization
2. automatism
3. dissociative fuge
4. derealization
5. conversion
C
84
Q182087-Patient put facebook status for you that u did not treat them well and no one should get treatment from you what will u do ?
a. Ignore
b. Ask patient to come to you and discuss this with you
c. Inform defence manager
d. Write to ask him to remove add
e. Write all treatment you provided under same post
C
85
Q184484-A pregnant lady came to you with multiple bruises in her thigh as a result of husband abuse.
What’s the next step in management?
```
A. Provide an immediate shelter
B. Confront the husband
C. Call the police
D. Take pictures for reporting
E. Arrange couple meeting
```
A
اگه بیمار رضایت داره و با کانسنت بیمار اول documentation یعنیD و قدم بعدی A
86
Q182584- Pt with features of hyperthyroidism with TSH low and a swelling in the neck. what other investigation helps to know the CAUSE of the problem
A. T3 T4
B. Increase uptake in the radioscan
C. Peroxidase enzyme
A
در برخی تیروتوکسیکوزها ما افزایش جذب نداریم
87
Q182404-several ppl in a city has abdominal pain,watery eyes;nausea, vomiting. There is a recent work with open coal seam. What to do next?
1. Inform health authority
2. Inform environmental protection authority
3. check CBC,blood biochemistry lead n iron levels i think
C
۱- نمونه گیری و آزمایشات
۲- آموزش
۳- در صورت مثبت بودن اطلاع به سیستم بهداشتی
سوالات مسمومیت با سرب
سطح نرمال کمتر از ۰/۴۸
۰/۴۸ تا ۲/۱۷ میلی مول (در ۲۰ ضرب کن میشه گرم) آموزش
بیشتر از ۲.۱۷ شلاتور
مسمومیت با سرب روی کبد کمترین اثر رو میذاره
88
Q182520- 72 years old Man come with low back pain. On investigating X ray, found L4-L5 compressed fracture. Many lab investigations: low Hb around 85 , mild leukocytosis , ESR 108, What will you do to know the cause of fracture ?
A. PSA
B. Bone marrow examination
C. MRI spine
D. Spine X ray
B
89
Q9440- scenario of a man was in confined place rushed by ambulance to the hospital .? emergency now ask how to give o2 .
A.2l nasal .
B. 6l Ventura mask
C.only give if spo2 less than 90
D.immediatly enter him into hyperbaric oxygen room
E.continous high flow o2mask
Ans: E
اکسیژن تراپی:
💡بیمار هایپوکسیک با o2sat زیر ۹۰٪ 👈 اکسیژن ۱۰۰٪ با نازال کانولا ۲-۶ لیتر یا ماسک ساده ۵-۱۰ لیتر
💡بیمار هایپوکسیک با o2sat زیر ۸۵٪ 👈 اکسیژن ۱۰۰٪ با ماسک hudson رزرویور ۱۰-۱۵ لیتر
💡بیمار هایپوکسیک در ریسک هایپرکاپنه (نارسایی تنفسی تایپ ۲) 👈 اکسیژن ۲۸٪ با ماسک ونتوری
📞بیماران در ریسک هایپرکاپنه:
1. بیماری انسدادی ریه: اسم، برونشکتازی، copd
2. کیفواسکلیوز شدید یا AS
3. سیگاری heavy
4. اپنه خواب شدید
5. چاقی با bmi بالای ۴۰
6. بیماری های عضلانی که ضعف عضلات تنفسی میده
7. اوردوز اپیویید، بنزودیازپین و ...
♦️ بیماری که به سمت نارسایی تنفسی میره، یعنی PCO2 بالای داره 👈 CPAP
♦️ برای بیمار ترومایی همیشه اکسیژن میذاریم
♦️ حتما به اونایی که دیسترس دارن با ماسک میدیم حالا بسته به مقدار اکسیژن که میخوایم بدیم ماسکش رو انتخاب میکنیم
♦️ در مسمومیت با منوکسید کربن همیشه اکسیژن میدیم، اگه شرایط زیر رو داشت هایپرباریک و اگه نداشت اکسیژن high flow نرمال
۱- بیهوشی در صحنه یا در بیمارستان
۲- کانفیوژن و اختلال فوکال نورولوژیک(بجز تاری دید) یا اختلال سایکولوژیک
۳- اختلال کاردیووسکولار مثلا شواهد ایسکمی در ای کی جی
۴- عدم پاسخ به درمان اولیه
۵- سطح Cohb بالای ۲۵ و بالای ۲۰ در خانم باردار
90
Q183390-diabetic person with peripheral neuropathy presents with 1cm ulcer on the fifth toe. there is swelling and redness also yellow exudate extending onto the dorsum of the foot. he is on metformin. blood levels checked glucose hba1c>7.6 management
a. amputation
b. iv abc
c. insulin
?
91
Q183463- A 6 years old boy contact with a chicken pox friend in school, he is neither vaccinated nor infected previously, first step of mx
a. check serology
b. immunoglobulin
Ans: vaccination
92
Q183451-A medical student under the university supervision in your unit uploaded a paients documents in Facebook, a social worker seen this and inform you what you will do?
A. this is not your responsibility
B. Warn the medical student
C. Inform the hospital manager
D. Inform to the supervisor
E. Ask the social worker to talk to the student
D
93
Q183450-Appropriate step in designing a cohort study regarding the Psychological changes in the group affected by bush fire
A. Select a proper random numbers
B. design a proper efficient followup
C. Design a control group
B
94
Q183193-Pt compliant of abd distension, constipation, weight loss of 4kg ,mass extending from pelvic region to umbilicus which is freely move and not attach to underlying structure.
In VE , mass is felt separated from uterus,a little beside right midline abdomen no other finding, asking management?
A. GIST
B. Retroperitoneal sarcoma
C. Endometrial cancer
D. Ovarian cancer
E. Leiomyoma
D
95
Q183186-15 years old girl, came with (fever, sore throat, swollen neck glands) Otherwise no medical illness, not on any medications, no travel history. Asking (something like) what symptom will actually tell you the definite diagnosis?
A. Diffuse pharyngitis
b. Temperature 38.5
c. Swelling of ankle
d. splenomegaly
```
تشخیص افتراقی های
Typical EBV syndrome:
...HIV
...CMV
...toxo
```
✅در بین اینها diffuse tonsillitis. در EBV هست
ولی اسپلنومگالی هم در ebv و هم در cmv تا 50% وجود دارد
✅از نظر بالینی در ebv. تونسیلیت منتشر 85% و اسپلنومگالی 50% است
✅ اگر تابلو بیماری ebv syndrome بود تونسیلیت افتراق دهنده است
ولی اگر افتراق از تونسیلیت استرپتوکوکی مد نظر بود اسپلنومگالی افتراق دهنده است
96
Q183254- african come for refugee health check up.malaria neg two days prior coming here.mentioned eosinophilia.but no fever mentioned.what most app next inv u will do?
A.Stool for ova,parasites
B.Schistosomiasis serology
C.Check malaria again
به زمان مراجعه و نوع تست مالاریا که میگه تکرار بشه دقت کن
شیستوزومیازیس
- سابقه شنا در هیستوری مهمه👈 حداقل یک دقیقه
- منطقه اندمیک: افریقا، laos،
- اسمیر مالاریا و تست رپید ۳ نوبت با فاصله ۱۲-۲۴ ساعت باید تکرار بشه
- بین اکسپوژر و تخمک گذاری فاصله ۳۰-۶۰ روزه 👈 بنابراین بررسی مدفوع در این بازه زمانی بی فایده است
- سروکانورشن هم بطور میانگین ۲۶ روز زمان میبره
- بررسی سروکانورژن و مدفوع بطور پریودیک سه تا ۶ ماه بعد از اکسپوژر
- 👈 بنابراین تشخیص از طریق رد سایر تشخیصها
97
Q182463- which is correct about myasthenia gravis?
A) it is diagnosed by MRI or CT
B) It is associated with small cell carcinoma
C) it is associated with autoimmune thyroiditis
Thymoma
| C
98
Q182165-23 yr old lady came with weakness on all limbs but especially at lower limbs,diminished reflex ( not sure ) tingling sensation at foot, no other sensory symptoms . HB reduced MCV – 100 ( normal 80- 100 ) WBC, platelet – normal B12 level- reduced Likely cause ?
a. Pernicious anamia
A
کمبود B12:
* شیوع ۱۵٪ در افراد مسن
* سن زیر ۴۰ سال توجه به انمی پرنشیوز
* منبع: گوشت، ماهی، محصولات لبنی ، تخم مرغ
* ذخایر بدن تا ۴ سال کافی هستن
* جذب از طریق فاکتور داخلی (که در معده ساخته میشه) در ترمینال ایلئوم
* علل مهم کمبود:
- کمبود غذایی(وجترین ها فقط تخم مرغ و محصولات لبنی و وگان ها مکمل غذایی)
- اختلال جذب:
1. معده👈کمبود فاکتور داخلی : آنمی پرنشیوز، پست گاسترکتومی
2. ترمینال ایلئوم👈 رزکشن ایلئوم، بیماری کرون، رشد بیش از حد باکتری ها، سلیاک و ...
3. عفونت اچ پیلوری
- افزایش نیاز : هایپوتیروئیدیسم
- افزایش دفع : الکلیسم
- افزایش تخریب : دوزهای بالای ویتامین C
- دارویی: اچ۲ اگونیست، ppi، متفورمین، ocp،
-
* علایم:
- جنرال👈زبان lemon tinge، گلوسیت(زبان دردناک گوشتی)، pale بودن، کاهش اشتها و کاهش وزن، خستگی، ضعف جنرال و سایر علایم آنمی
- نوروسایکتریک👈 بیقراری، تحریک پذیری، دپرشن، سایکوز، دمانس
- نورولوژیکال👈 پارستزی، نوروپاتی محیطی، تندرنس عضلانی و
علایم درگیری ستون خلفی نخاع:
علایم حسی و لور موتور نورون
و
علایم درگیری راه کورتیکواسپاینال: علایم حرکتی و آپرموتور نورون
(subacute combined degeneration of the spinal cord)
شامل:
اختلال پوزیشن و ویبریشن( معمولا علایم اولیه) سپس اتاکسی، ضعف و سفتی عضلات
تریاد کلاسیک: پلنتار اکستنسور(UMN) + نبود رفلکس زانو(LMN) + نبود رفلکس مچ(LMN)
حس درد و حرارت نرمال
✅ علایم نورولوژیکال کمبود B12 ممکنه در نبود آنمی رخ بده، بنابراین درصورت وجود علایم، چک سطح b12 انجام میشه
✅ دمانس ناشی از آن در صورت درمان طی ۲ سال اول برگشت پذیره
✅آنمی پرنشیوز: بدنبال گاستریت اتروفیک اتوایمیون/همراهی با سایر بیماری های اتوایمیون: تیرویید، ادیسون، هایپوپارا، سلیاک و.../ افزایش ریسک کنسر معده
📍بررسی ها:
کاهش هموگلوبین
افزایش MCV
کاهش سطح سرمی B12
رتیکولوسیت نرمال یا کاهش یافته
پلی مورف هایپرسگمنت
تست شیلینگ👈 بررسی سطح B12 لیبل شده قبل و بعد از تزریق فاکتور داخلی
تست مثبت: افزایش جذب بعد از تزریق فاکتور داخلی 👈 آنمی پرنشیوز
تستهای اختصاصی آنمی پرنشیوز: آنتی بادی ضد پریتال سل (در ۹۰٪ موارد)، انتی بادی ضد فاکتور داخلی(اختصاصی تر ولی حساسیت کمتر)
📍درمان:
رفع علت زمینه ای
اگه بعلت malabsorption باشه درمان تزریقی لازمه👈 هیدروکسی کوبالامین یک میلی گرم روزانه و
طول مدت درمان متفاوته
درمان نگهدارنده هر سه ماه یک میلی گرم
اگه بعلت کمبود تغذیه ای است👈 درمان خوراکی
✅ malaise طی دو روز بعد از شروع درمان بهبود پیدا میکنه، رتیک کانت باد از ۷ روز با پیک میرسه و اهن سرم ممکنه طی یک دو روز اول کاهش پیدا کنه
✅ افزایش هموگلوبولین ۱۰g/ week
✅ با شروع درمان و افزایش هموتوپویزیس ممکنه افزایش نیاز به آهن داشته باشیم
✅ بهبود علایم نوروپاتی معمولا طی ۶-۳ ماه ولی علایم نخاعی مقاوم تر هستن
99
Q9557- Patient underwent Conization for abnormal pap smear 2-3 days back. Now presents with fever 39, pain lower abdomen and tenderness. What’s the most appropriate place to take a swab?
a. Blood culture
b. Endocervical swab
c. High vaginal swab
d. Low vaginal swab
e. Endometrial (don’t remember this one exactly)
B
درمان انتی بیوتیکی
درمان:
در شروع درمان هر نوع IUD و ... باید خارج بشه
سکس پارتنر برای گنوره و کلامیدیا درمان بشه
📍فرم سکچوالی:
- فرم خفیف تا متوسط👈 درمان سرپایی: ازیترومایسین تک دوز + داکسی سایکلین + مترونیدازول + سفتریاکسون تک دوز عضلانی(در صورت شک به گنوره)، بمدت ۱۴ روز
- فرم شدید👈 ازیترومایسین وریدی+ سفتریاکسون وریدی+ مترونیدازول وریدی ، تا زمان بهبود کلینیکال قابل توجه سپس ۱۴ روز درمان خوراکی
📍فرم نان سکچوالی:
- خفیف تا متوسط👈 آموکسی/کلاوونات یا داکسی سایکلین + مترونیدازول بمدت ۲-۴ هفته
- شدید👈 آموکسی/آمپی وریدی+ جنتامایسین وریدی یک تا سه دوز + مترونیدازول وریدی
📍اکتینومایکوزیس:
آموکسی + مترونیدازول
100
Q183136-The pregnant woman comes with her husband due to (some pain or injury, I forgot). When asked the history the wife said that she got those injuries herself from fall. When asked further the woman seems withdrawn and anxious. On examination there’s also injuries on the vulva area. What would you do first for this condition?
1. Confront the husband about the injuries.
2. Admit her immediately
3. Ask her to come alone again
4. Tell husband to be gentle with her
B
101
Q186700- A 65-year-old schizophrenic patient needs coronary angiography because of suspected myocardial infarction. Cardiologist explained the procedure to the patient who did no understand the procedure. Who can give the consent on behalf of the patient
1. The patient’s relative (guardianship court)
2. Mental health tribunal (can give consent only for mental illness)
3. The patient
4. The court
مریض کامپیتنت نیست.
اگر از قبل تعیین شده که برای تصمیمات مدیکال این مریض چه کسی تصمیم می گیره، ما حرف اون آدم رو گوش می دیم. مثلا اگر برادر مریض وکیل امور پزشکی این مریض باشه، با یه تماس قضیه حل میشه. البته اگر این وکیل در best interest مریض تصمیم نگیره و مثلا بگه ولش کنین بمیره در حالی که با آنژیو بشه به راحتی قضیه رو بدون ریسک بالا ردیف کرد موکول میشه به گاردینشیپ کورت. در خصوص چیزی که اورژانسیه و نمیشه صبر کرد تا گاردینشیپ کورت تشکیل بشه، دکتر می تونه برای مریض غیر کامپیتنت و در best interest بیمار درمان مناسب رو حتی بر خلاف نظر وکیلش انجام بده. منتها باید آماده دادگاه بازی بعدش باشه و دادگاه هم به نفع دکتر رای خواهد داد. این قضیه وقتی فرق می کنه که مریض به شخصه و در زمانی که کامپیتنت بوده، پلن درمانی مشخصی رو (مثل سی پی آر یا اینتوبه شدن) رو اعلام کنه که مورد قبولش نیست و حاظره بمیره ولی اون پلن مشخص انجام نشه. به این میگن advanced care directive یا advance care plannin.
با این اوصاف اگر تا حالا گیجتون نکردم، بزارین ساده بگم:
تریبونال منتال هلت هیچ نقشی در تصمیمات پزشکی و غیر از منتال هلت مریض نداره. تریبونال کارش بررسی اینوالنتری بودن مریض برای درمان منتال هلته. پس این گزینه درست نیست.
خود بیمار هم کامپیتنت نیست، پس این گزینه هم غلطه.
کورت می تونه جواب درست باشه، ولی برای آنژیو وقت طلاست و نمیشه منتظرش شد و این گزینه هم غلطه.
تنها گزینه این سوال همون همراه مریضه. ایشالا که ایشون بگن آنژیو بشه. ولی اگر گفتن نشه و دلیل مشخص نداشت و صرفا حال کرده مریضش بمیره، دکتر می تونه over-ride بکنه و در best inerest مریض تصمیم بگیره و تا به حال هم دادگاهی چنین موردی رو به ضرر دکتر رای نداده.
102
Q91034- ECT scenario, pt unable to eat and severe melancholic depression. Came with his wife who is willing to go for any treatment for him. What to do?
a) ECT approval from mental health tribunal
b) ECT approval under duty of care
c) ECT approval e consent from wife
d) ECT approval e consent of two doctors
A
103
Q183089- Gout scenario, now presents with acute symptoms. Lab results show urate level little increase and creatinine is 1.8 (Normal 0.6 – 1.2) not mention renal failure just give creatinine value. What to give?
A. Prednisolone
B. Codeine
C. Naproxen
D. Allopurinol
E. Colchicine
A
104
Q184087- 74 yrs old male has metastatic prostate cancer ,he is taking morphine for pain relieve and self-prescribed cannabis but recently they arenot working and he is complaining of insomnia and agitation ,what will be better for him:
a. sleep hygiene
b. motivational therapy
c. supportive psychotherapy
d. interpersonal therapy
e. visual photo therapy
C
105
Q9624- 58yrs old man, drag left foot, reflexes on left lower limb are increased, planter flexion & dorsiflexion are 4/5, weak ankle movements, equivocal plantar reflex, upper limb and face are normal exam.Lesion site
a. Common perineal nerve
b. Cervical spinal cord
c. L5,S1 nerve root
d. Cerebral cortex
e. Brain Stem
```
گزینه a، نوروپاتی محیطی هست
گزینه b ،درگیری دستها باید داشته باشد
گزینه c رفلکسهای افزایش یافته نمی دهد.
گزینهd ,به نظر جواب بهتریست.
گزینه e, درگیری بولبار می دهد مثل دیزآرتری دیسفاژی و ...
```
106
Q9103- Sarcoidosis xray with 3yrs dyspnea, 12months loin pain, 24hours hematuria…what inv have to do NEXT? FINAL PLEASE...
a) xCT chest
b) Serum ACE
c) USG of abdomen
d) urine r/m/e
e) cystoscopy
C?
107
Q10500- X ray limbo sacral spine lateral view describing reduced bone density with multiple anterior wedging of L2, 3 and 4 vertebral bodies.
Patient is 75 years, having mild back pain with recent severe localized abdominal pain. Blood test revealed mild anemia. Raised ESR. Calcium level is normal.
Diagnosis?
a. Multiple Myeloma
b. Metastasis from prostate
c. Osteoporosis fracture
A
108
Q10327- woman presented with painless hematuria, after doing urine analysis and culture what will you order
a. CT scan
b. u/s of kidney, ureter and bladder
c. cystoscopy
d. IVP
A
109
Q9525-14 year old girl BMI 32 has striae and pigmentation on her neck and axillary region. She is very lethargic. Grandmother was diabetic . She has amennorhea. Stria on abdomen. Diagnosis
a.Cushing
b.Metabolic-
C-PCOS
d.Hypothyroidism
?
110
Q182113- 52 year old man, severe headache since 6 hours right side of head and neck. No past medical history, no fever, ptosis in right eye.
```
A. CT brain
B. Slit lamp
C. ICA Doppler
D. MRI brain
E. Fundoscopy
```
E
MRA
CTA
Angio
111
Q184123- Regarding unilateral undescended testis, which of the following is most commonly associated?
a) Malignancy
b) Varicocele
c) Ingiunal hernia(Indirect)
d) Hydrocele
e) Torsion of the testis
C
112
Q184372- A lady was in Operation for hours and stayed in lithotomy position ( mentioned exactly) After that she suffered of foot drop where the lesion ??
A.S 1
B.neck of fibula
C.L 5
B
113
Q183588- Pt has chest pain for 4 hours, now relieve 4/10. He is taking ramipril atovastatin aspirin , now no murmur , no dyspnea , BP normal. What should be the next step after giving O2..
a. Morphine
b. Clopidogrel
c. Thrombolytics
d. Nitroglycerine
e. Frusemide
B
114
Q184379- Old patient with ischiorectal abscess, has this problem recurrent many times, what s the cause?
A. Anal fistula
B. Diverticular disease
C.crohn
D. Diabetic
E. Immunodeficiency disorder
A?
115
Q184386- old pt with hamaturia ,increase urea ,creatine ,arthralgia,foot drop,what will lead u
to dx:
a. Sural nerve biopsy
b. Renal biopsy
c. ANCA
A
116
Q9013-A young girl 15 yrs,collapsed at exercise,her father had HOCM,after ECG and ECHO,U found no abnormality, next step ?
A- holter monitoring
B- stress echo
C- repeat ECHO after 3 month
B
117
Q9004-A man comes to you follwing an episode of rectal bleeding which has stopped spontaneously. You are planning to do colonoscopy. He had a drug eluting stent placed 2 montgs ago and was started on clopidogrel and Aspirin.
Which of the following is the appropriate mode of action?
A. Stop clopidogrel and do colonscopy
B.Stop clop for 7 days, give LMWH and do colonoscopy
C.continue clop and do colonoscopy D.postpone colonoscopy
C
118
Q10284- Orbital cellulitis scenario, what invg to find causative organism?
a) eye swab
b) blood culture
c) CT brain
B
119
Q9313- One year old boy has repeatedly respiratory infections,he was brought to de GP cos of ear discharge,last month he had swollen tonsils diagnosis?
A- sinositis
B-tonsilitis
C-Pneumonia
D immune deficiency
B
120
Q9165-yo alcoholic and smoker complains of a 2 cm painless lump on the left tonsil. No other signs and symptoms described. What is the most likely dx?
a. Squamous cell carcinoma
b. nasopharyngeal cancer
c. body/aneurism on the carotid artery
d. mts from some place
e. non-Hodgkin lymphoma
A
121
Q184312- 55 yr male complaint of severe headache on left side and also neck pain on at same side. He never suffered on this pain before. The pain didn’t suppress with painkillers. He has history of 2-3 glass of wine, 20 pack year smoking. Photo is given ( I see ptosis and constricted pupil on the left side). Eye examination is normal and vision is unimpaired. What investigation to get to dx?
A. CXR
B. CT of head
C. Slit lamp examination
D. Carotid doppler USG
E. MR angiography
E
122
Q183137-ECG now comes with AF, hypertension and DM. Comes with palpitation. BP 140/90, PR 68/min. he’s taking losartan, metformin and other drugs for his conditions. What would you give him for his condition???
1. Warfarin
2. Metoprolol
3. ACEI
A
123
Q183221- a girl came with two months history of recurrent visual problems. Seeing flash lights ( moving lights ) for 10 minutes . sometimes suffer from global headache worse on exertion what’s the possible cause ?
A.Occipital lobe tumor
B.Migraine with aura
C.Focal epilepsy
D.Optic neuritis
B
124
Q9592- Female worrried about baby : how to prevent from sudden infant death sundromea.
a. Sleep with baby
b. keep baby in supine position
B
125
Q184175- woman want to be pregnant on Na valproate for epilepsy, well controlled what to do
a. dec the dose of Na valp
b. change to phynetoin Na
c. stop the medication as she became good
d. leave her on the same dose of Na valp
Change to lithium
126
Q182519- past history of dvt pt on UFH perioopertively n switch to lmw heparin after 5 days undergone rt hip surgery develop dvt after 10 days that what to do In investigation only platelets r decreased
A- ffps
B- vit k
C- cease heparin and switch to other anticoagulant
D- platelets infusion
HIT
| قطع هپارین
127
Q9698- A pregnant lady with multiple gallstones came to a GP. He advised her cholecystectomy after delivery. Why?
a. risk of Ca gallbladder
b. increased risk of CHOLESTATIC jaundice in next pregnancy
c. increased risk of Ca pancreas
d. increased risk for primary biliary cirrhosis
B
128
Q184142-Patient I forget the scenario but he has loss of planter flexion and inversion, also loss of ankle jerk, but he has intact dorsiflexion and eversion. Knee jerk normal. Which nerve injury?
A-sciatic
B-tibial
C-common peroneal
B
129
Q9777- A man is brought to the ER after brawl hit to the side of left eye. On examination, you have found an orbital floor fracture. Which of the following is the accurate predictor of this diagnosis?
A. Sub conjunctival haemorrhage
B. inability to open his mouth
C. loss of sensation of his cheek
D. decreased visual acuity
C?
130
Q182547. An infant who was delivered prematurely at 28 wks with birth weight of 1100 gms. After delivery he was intubated and kept in a ventilator for 3 days, now the baby present with spastic paresis in his lower limbs. Cause?
a. prematurity
b. RDS
c. intrapartum hypoxia
d. low birth weight
A
131
Q91043. Patient will h/o DM and HTN hurt her wrist when she crashed into a parked car. On examination there was significant peripheral vision loss which she was unaware of. Next appropriate step :
a. Check Intraocular pressure
b. CT head
B
132
Q182615. you are a doctor in rural hospital in north Australia and a patient comes after 30 mints was bitten by a brown snake in his left ankle , the patient has no symptoms , and there were simple scratches over the skin of the ankle with no marks of the snake teeth , the tertiary hospital is 150 km far away , what is the urgent next step to do:
A- Call for helicopter ambulance to the tertiary hospital to be supervised
B- Give anti- venom ampoule now and another ampoule after symptoms appear
C- Tell the patient to go home as no tooth bits remarks and no symptoms
D- Urgent apply for a tourniquet in the upper part of left thigh
A
اون pdf و عکسایی که‌گذاشتم گایدلاین انتقال هوایی استرالیاست که اصلا در مورد کنترا اندیکاسیون snake bite هیچی نگفته و عوضش گفته هرچی سریعتر زنگ بزنید به ما بیایم و با خودمون انتی ونوم و کیت تشخیص بیاریم و بعد از تست کردن مریضو با خودمون ببریم
یه نکته دیگه که باید حواسمون باشه در مارگزیدگی اولین اقدام بانداژ سفت روی محل گاز مار هست(حواسمون باشه تورنیکه کنتراندیکه هست)،بانداژ باید به اندازه ای سفت باشه که جلوی جریان خونو نگیره و باید اندام یا محل زخمی کاملا با آتل یا یه چیز مشابه بی حرکت بشه تا ونوم توی خون مریض پخش نشه و بانداژ باید در محل باقی بمونه تا زمانی که آنتی ونوم آماده تزریق باشه و قبل از اون نباید باز بشه
و در اخر اینکه اگه مریض علامت دار بود باید بهش انتی ونوم بزنیم همون اول اینم اندیکاسیوناش👇👇👇
قطعی: inr مختل، سابقه کلاپس و تشنج و ایست قلبی، شواهد افتالموپلژی و پتوز
نسبی: علایم سیستمیک مثل درد شکمی و تهوع، Ptt ابنورمال، لکوسیتوز و Ck بالای هزار
133
Q184079. Post op incarcerated hernia 1st day aggitation stem fever sob O2 sat 88% xray given after o2 what initial step.xray had patches! What initial (xray had patches here)
IV antibiotics
Heparin
Thrombolysis
Droperidol
D
134
Q9955. 25 yr old female complain of Raynaud's phenomenon in cold,also having edema of bl feet,,bibasal crepitation on lung bases ,heart on CXR silhute appearance .ana+, ENA neg..cz
a. primary Raynaud's
b. cold agglitonin antibody
c. sle
d. limited sclerosis
Scleroderma
135
Q9943- rash on face &hand.pain in both hands . RF =14 (normal less than 14 ) , ANA =1/574 ( normal less than 7, ) rest of labs were all normal what will you find in xray on hands ?
a. chondrocalcinosis
b. periarticular erosions
c. punched out markings
d. periarticular osteope
The most common radiographs in SLE show periarticular osteopenia and soft-tissue swelling without erosions.
136
Q185500. A patient who is going to do surgery for varicose veins in next 3 weeks. He has been taking clopidrogrel for cardiac stenting for 4 months. What is the most appropriate management?
a. Reassess need for surgery
b. Do surgery now
c. Change clopidrogrel to LMWH before surgery
d. Stop clopidrogrel and do surgery
e. Change clopidrogrel to warfarin before surgery
A
137
=dTPجواب .4.Tetanus immunoglobulin + Tetanus toxoid
5.Diptheria toxoid +whole cell pertussis +Tetanus toxoid (DPT) booster
توی اینها Q91040. 14yrs old boy,One of your long term patient since birth,presents to you at your surgery after Dog bite at home,when he was playing with it , accidentally fell over the animal and provoked it. O/E There were Two deep puncture wounds. No deep structural injury.His last immunisation for tetanus was at 4 yrs of age according to his File.You advise him to get the wounds cleaned and apply non-Adherent , absorbent plaster by the Office nurse and give him prophylactic antibiotics for 5 days. As the bytes are deep puncture wounds you decided to give him tetanus injections as well.
Which one is the BEST vaccination?.
1.DTPa(Diptheria,Tetanus,Pertussis acellular)
2.Tetanus Toxins
3.Adult Tetanus and Diptheria Toxoid
4.Tetanus immunoglobulin + Tetanus toxoid
5.Diptheria toxoid +whole cell pertussis +Tetanus toxoid (DPT) booster
dTp
138
Q183200. Patient went intramedullary wire fixation for tibia fracture..pain exaggerated on passive dorsiflexion of his big toe..what management should proceed?
A.review after weeks
B.put on more analgesic
C.leg elevation
D.4th option forgot may b invx like X ray E.stabilize with plaster cast
Fasciotomy
| Comprtment syndrome
139
Q184213. 9 years old girl had enuresis . what to do next?
A) DMSA
b) cystoscopy and urodyanamics c)nothing
U/A, U/C
| اگه نبود یورودینامیک
140
Q11097- Pt has problems in outside right eye and inside in left eye visual field where is the problem
1) Left parietal
2) Right parietal
3) Left visual cortex
4) Left optic radiation
C
141
Q182537- Pain in the buttocks&posterior thigh&deadly leg pain after walking 100 m on normal floor &20 m on unequal land well felt pedal pulsation next
a.doppler legs
b.ct angio
C.mri lumbosacral
d.x.ray
A
142
Q182578- A patient has pneumonia. His hip muscles become weak. CT shows a spinal stenosis. He is on statins.
and multiple other drugs. On examination knee jerk is absent, lower limb power is 3/6, absent dorsalis pedis pulses and sensation over thigh is loss. Next investigation?
```
A) Mri
b) Xray
C) Arterial duplex
D) CK
E) LP
```
با سی بستن
143
Q184113- Which of the following most closely represents the role of risk managernent in the hospital
A . To ensure proper ethical management of patients
B. To ensure proper clinical care of patients
C. To act as a patient advocated..
D To minimize the legal risk to the hospital from litigation
B
144
Q9508- Woman has regular menses for 4-6 wk interval, pain on left iliac fossa for 3 days, aggravated while urination, her lmp was 9 days back, she had similar episode 4 wks back, which lasted for 3 days, cause?
a. Ovulation
b. complicated ovarian cyst
c. dysmenorrhea
d. Early PID
اگه 9 روز از اول سیکل گذشته باشه اندومتریوز
اگه 9 روز از اتمام خونریزی گذشته باشه اوولیشن
کیست کامپلیکه معمولا تکرار نمیشه هر ماه
```
بله،
با این خصوصیات:
یک خانم نسبتا جوان
سیکلهای منظم
درد در میانه های سیکل
تکرار شونده
تقریبا و یا حتما بدون هیچ علامت همراه دیگه.....
میشه میتل اشمرز
```
روز نهم از "پایان خونریزی"،
بله میشه
145
Q9045- An alcoholic, very agitated , rushed to the emergency department with many complaints, claiming if he is not attended to immediately he will jump in front of a car. What will you check first?
a) Alcohol level
b) magnesium level
c) serum electrolytes (Na+ and K+).
C
146
Q186427- homeless with paranoid ideation and prosecutory delusions threat he will through himself infront of train if not admit him Mx
A. admit to psychiatry ward
B.forcedcaustidy
C.through clinical examination
A
147
Q186426- Woman with marital problem with husband , feeling lonely , financial issue, do not have time to go out with husband , feeling depressed, what next?
A.Send to gyneacologist
B.Send to psychiatrist
C.Ask to appointment with husband
D.Send to marriage counseling
C
148
Q186429- 84 years woman wants to going to ‘alp mountains walking tour ‘ in Europe needs your confirmation for travel Mmse 24/30 .what to do
```
a- No permission
b- Call family
c- Call travel agent
d- Admit to hospital
e-Doing physical exam
```
E
149
Q184081- flial chest Trauma to chest by MVA and flail chest and open chest wound ,important step to be done at scene(accident site)
A-Morphine IV
B_pressure by gauze to close the wound
C_chest tube
D_chest strapping
B
150
Q186295- Female admitted, overdosed on indapamid , was admitted and not able to sleep despite benzodiazepam . Now nurse found her staring at the ceiling and other times agitated. Cause?
A. Dementia
B. Delirium
C. Depression
D. Catatonia
B
151
Q185053- 70-year-old man with extremely severe parkinsonism comes by ambulance to the emergency department secondary to psychosis and confusion developing at home. He is maintained on levodopa/carbidopa, ropinirole, and tolcapone.
What is the most appropriate next step in management?
a. Stop levodopa/carbidopa
b. Start clozapine
c. Stop ropinirole
d. Stop tolcapone
e. Start haloperidol
Ropinirole : dopamin agonist
C
```
چند نکته در مورد داروهای آگونیست دوپامین :بعضی انواع این داروها عبارتند از:
آپوکینون (آپومورفین)Apokinon
بروموکریپتین Bromocriptine
پرگولید Pergolide
لیزوراید Lisuride
پرامی پکسول (میراپکس یا سیفرول یا پکسولا) Pramipexol (Sifrol)
کابرگولین Cabergoline
روپینیرول (رکیپ) Ropinirol (Requip)
روتیگوتین Rotigotine
```
این داروها در مقایسه با لوودوپا توهم و هذیان بیشتری را باعث می شوند.
داروهای مقلد دوپامین وقتی به تنهایی بکار می روند احتمال دیس کینزی را کمتر میکنند ولی اگر به همراه لوودوپا مصرف شوند دیس کینزی تشدید می شود. به همین علت برخی پزشکان ترجیح میدهند در بیماران زیر ۷۰ سال تا زمانی که بیمار به داروهای مقلد دوپامین پاسخ مناسب میدهد این داروها را به تنهایی تجویز کنند ولی پس از ۷۰ سالگی بعلت بیشتر بودن عوارض این داروها (بخصوص توهم و هذیان و افت عملکردهای شناختی) در افراد مسن، لوودوپا را ترجیح می دهند.
152
Q11321- bipolar patient on lithium and controlled, now has tremor of hand mild at rest, increasing with activity
A. lithium level
B.. Change to valproic acid
C.. Add propranolol
D.. add benztropine
A
153
Q183237- A man complaint of ‘ feeling something in his body ‘ and anxiety. BP160/- .No other features of
```
A.hyperthyroidism given.
B.Give beta blockers
C.Investigate for pheochromocytoma
D.Investigate for hyperthyroidism
E.Arrange psychiatric counseling
```
C
154
Q185540- 2.Young boy is brought to the rural hospital ER after trauma to the head. He was in a motor vehicle accident. After that he developed extreme unconsciousness with GCS of 6/15. You have intubated the patient. The Neurosurgery unit is 3 hours from the rural ER. What is the next appropriate plan for this patient?
a. Transfer to neurosurgery unit
b. Do a ct scan
c. Burr hole
d. Craniectomy
C
155
Q185539- 1.A young boy is brought to you in the rural ER. Neurosurgery unit is 1 hours away. Earlier today he was hit during football where he lost consciousness and fell to the ground. A few minutes he regained his consciousness and walked out of the field. His family brought him to you complaining that he has developed headache after the incident. His GCS is 10/15. What is the next plan for him?
a. Do a ct scan
b. Transfer to neurosurgery unit
c. Hyperventilation and mannitol infusion
d. Burr hole
e. Craniectomy
C
156
6- 2 yrs went to some country 6 months ago, penile ulcer, healed in one week, now generalized lymphadenopathy, rash on trunk and limbs young homosexual male dx?
a. HSV
b. HIV
c. treponema pallidum
C
157
```
7️⃣
Q186169- Wife brings Ptx (husband) with worsening Parksonism syx(marked bradykinesia,rigidity,lack of self empathy and agitation) presenting with auditory and visual hallucinations comes to you for advice.Ptx is currently on carba and levodopa 75mg with little to no improvement for more than a year nowWhats the appropriate next step
a-Donezpil
b-Quietapine
c-Haloperidol
d-Increase Levodopa
e-Pramipexole
```
توضیحات استاد صالحی عزیز ریکال q186169
همراهی علایم سایکوز و پارکینسون
مهم ترین داشتن پارکینسون و بوجود آمدن علایم سایکوز بدنبال پارکینسون که یا ناشی از دلیریوم است یا ناشی از عوارض دارویی و یا ناشی از ایجاد دمانس روی پارکینسون سوار شده و علایم سایکوز از همراهان دمانس است.
مورد دیگر دمانس لوی بادی پایه اصلی بیماری سایکوز است و علایم پارکینسون اضافه شده ضایعه در نقاط مختلف وجود دارد.
🚨برای تفکیک لوی بادی از علایم سایکوزی که بدنبال پارکینسون بوجود می آید:
- بیمار لوی بادی علایم روانشناختی اش قبل یا همزمان با علایم پارکینسون بوجود اومده پس یعنی مشکل سایکوز بیمار اولیه است و نه ثانویه به بیماری پارکینسون و توهم بینایی هم حتمن باید وجود داشته باشد ولی 🔑باز به این معنی نیست که توهم دیگه ایی وجود نداشته باشد...
🌺اینکه شایعترین توهم بینایی یا شنوایی هست به این معنی نیست که نباید توهم دیگه ایی باشد
در مورد این مریض چندتا نکته قابل ذکر است:
۱. بیمار یکساله روی لوودوپا هست یعنی داروی لوودوپای بیمار دوزش زیاد نشده و داروی جدیدی اضافه نشده و شرایط جدیدی برای بیمار ایجاد نشده از نظر درمانی
سوال داره میگه این مریض دوز داروش زیاد نشده
👌چیز جدیدی اضافه نشده که شما تصور کنید سایکوز بیمار ناشی از داروهای ضدپارکینسونش هست
بلکه دوز داروهای ضدپارکینسونش خیلی پایینه ۷۵ میلی گرم هست و یکساله ثابت هست
۲. بیمار علایم توهمی را جدیدا پیدا کرده
👌پس چیزی نیست که از قبل داشته باشه یعنی قبل پارکینسون نداشته و اتفاق جدیدی است برای بیمار...پس لوی بادی هم نیست
اما اینکه ایا دمانس ناشی از پارکینسون داره یا دلیریوم ناشی از پارکینسون داره باید اطلاعات سوال را دید
۳. نکته بعدی اینکه بیمار علایم مصرف یکساله دارو علایم پارکینسون بدتر شده و این نکته خیلی مهمی است
حتی اگر مریض دمانس بدنبال پارکینسون داشته باشه اولین قدمی که بر می داریم کنترل تشدید علایم پارکینسون هست پس وقتی میگه نکست یا فرست استپ چی هست اولین قدم ضایعه ارگانیک را اول درمان و دادن انتی سایکوتیک به بیمار که در مورد بیمار باید داروی لوودوپا افزایش بدهیم و مطالعات که در مورد علایم بیماران با پارکینسون و دمانس انجام شده و همین طور راجع به بیمارانی که لوی بادی دارند که علایم پارکینسون و سایکوز دارند در تمام موارد استفاده از لوودوپا علایم پارکینسون رو بهتر کرده هر چند ممکنه روی علایم دمانس بیمار تاثیری چندانی نداشته باشد
با توجه به این قضیه لوودوپا افزایشش قطعیه ولی قدم بعدی استفاده از کویتایپین هست نه قدم اول!
اگر به این نتیجه رسیدید که سایکوز بیمار ناشی از اضافه شدن داروهای انتی پارکینسون هست مثلا همین بیمار اگر داروش کم بوده و دوز دارو رو افزایش میدید در حال بالا بردن فارغ ازینکه آیا پارکینسون بهتر شد یا نه علایم سایکوز پیدا کرد این ناشی از داروهای انتی پارکینسون است و باید طبق سیری کم کنیم داروها را....
1⃣اول کم کردن انتی کولی نرژیک ها
(چون مریض پارکینسون خیلی مستعد دلیریوم انتی کولی نرژیک هست و دلیریوم هم علایم سایکوز می دهد)
2⃣قدم بعدی داروهای دوپامینرژیک مریض را باید کم کنیم و از بین این ها پرامی پکسول یا روپی نیرول، آمانتادین مهم ترین داروهای دوپامینرژیک هستند
3⃣قدم آخر کم کردن لوودوپا هست یعنی لوودوپا را حتی نگه میداریم
اگر حتی سایکوز بیمار ناشی از این مصرف داروهاست لوودوپا اخرین دارو هست که قطع میشه چون ممکنه شرایط پارکینسون بیمار بدتر باشد.
حال مریض بد است و تشدید شده پس قطعا لوودوپا کم نمیشه بلکه اضافه هم میشه ولی بعدا بهش کویتایپین اضافه می شود.
⛔️هالوپیریدول از انجا که مشکوک به دلیریوم بودین طبیعتا نمی دهمیم به بیماری که پارکینسون داره❌
158
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Q184196-18 years old with single painless ulcer. rpr positive with 1:64 titre. what is immediate management?
A.im penicillin,
B.notify public health,
C.perform contact tracing,
D.do other std screening
```
A
159
Q182164- Women underwent total hysterectomy and bilateral oophorectomy , her sister has ovarian cancer . when to give HRT ?
a. Before operation
b. Immediately after operation
c. Only after symptoms of menopause arise
B
160
Q184249- women with 2 years after Filshie clip sterilization. Regular cycle with menorrhagia +, At this cycle, bleeding for 10 days with few clots. Pap smear normal 12 months ago. Initial investigation(exact options)?
a) pap smear
b) Full blood count
c) ultrasound
d) Thyroid function test
e) Endometrial Biopsy
B?
161
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Q1902237- Woman with history of LSCS and flishie clip sterilization came with menorrhagia for few cycles and now she has vaginal bleeding from 10 days ago what to do?
A) D&C
B) Mirena
C) Remove flishie clip
(No usg in options)
```
?
162
Q186497- Your female patient calls you, says husband is getting aggressive and violent. She is hiding in bathroom while calling you and you can hear husband shouting in background, what will be your initial appropriate advise?
a. Ask her to go to women’s shelter
b. Encourage her call the police immediately
A
163
Q184135- Arab woman who doesn’t speak English with 16. weeks pregnancy, was referred by the midwife for which she suspects her mental condition. The woman seems irritable, worried(or anxious) about the people around and she’s uncomfortable when her husband is not around. She is also irritated with her 2 children. What condition in her history will be present to lead you to diagnose this patient? (looks like prodromal symptoms)
1. Panic attacks
2. Paranoid personality disorder
3. Family member with schizophrenia
4. History of trauma
C
164
Q185337- A woman comes to your clinic. She was controlled with zuclopenthixoldepo. She has taken oral olanzapine and respiradone which is not controlled for her symptoms due to poor compliance.Now she presents with dyskinesia, muscle rigidity and severe extrapyramidal side effects.What will you do for ur management?
A.change to respiradone depov
B.continue same treatment and give benztropine
C.change to quetipine
D.continue zuclopenthixol depo for 3 days and change to respiradone depov
A
این بیمار که بعلت عدم قبول داروی خوراکی رسپریدون و کلوزاپین برای وی داروی آنتی سایکوتیک تیپیک تزریقی zuclopenthixol شروع شده که بعد از مدتی عوارض پارکینسونیسم و اکستراپیرامیدال شدید داده، پس راه حل تغییر به داروی آتیپیک می باشد و آنهم طولانی اثر ، که رسپریدن آتیپیک طولانی اثر با عوارض اکستراپیرامیدال کمتر می باشد.
درست هست که کویتیاپین اتیپیک با عوارض اکستراپیرامیدال کمتر از رسپیریدون می باشد ولی بیمار مصرف نخواهد کرد
اما چند نکته:
همزمان با شروع رسپیریدون طولانی اثر باید آنتی سایکوتیک خوراکی شروع شود تا سه هفته، زیرا در سه هفته اول رسپریدون طولانی اثر دوز خونی ایجاد نمی کند و از هفته چهارم دوز خونی درمانی دارد، در این بیمار که zuclopenthixol تزریقی میگیرد دوز آن تا سه هفته جوابگوی بیمار هست.
نکته بعدی اینکه zuclopenthixol دوفرم تزریقی دارد.
فرم Deconate که با فاصله هر سه هفته تزریق می شود
فرم acetae که 2 تا 3 روز به پیک خونی میرسد و در سایکوز حاد در بيمارستان استفاده می شود.
بیمار ما فرم Deconate رو مصرف میکرده است
165
Q10281-12-year-old male presents with acute onset of inability to walk and severe pain in the groin, thigh, and knee. There is no signs of fever He is and appears nontoxic but is obviously distressed. Examination shows an externally rotated thigh and apparent limb shortening. What is the MOST likely diagnosis?
A) Osteosarcoma
B) Slipped capital femoral epiphysis
C) Septic arthritis of the hip
D) Toxic tenosynovitis of the hip
E) Osgood-Schlatter s disease
B
166
Q10207- New Ethics: You are working in a busy emergency department and there were rush of patients at once while still there were other serious patients in the emergency. Your department head is on hospital meeting & you are one of the junior doctor at that period. Which of the following patient will be your next priority.
1) Patient aggressive & abusive with multiple laceration & psychotic behaviour
2) Case of acute poisoning with frothing from mouth
3) Case of severe chest pain with syncope
4) MVA with severe bleeding all from the head
5) Burn patient with 36% burn in surface area
B
167
Q10206- New ethics: A child with severe asthma was brought to emergency hospital by ambulance. When measured the SP02 level very low, the patient was very dyspnoeic with gasping , comatose, silent chest. The oxygen cylinder in ambulance not working. Child went to apnea.The parents were distressed and aggressive and asked for compensation.
1) The hospital manager will be responsible and face criminal case
2) No court case but hospital has to pay compensation
3) The doctor is responsible to investigate the case & report parent
4) Its just an accident. So nobody responsible
5) The ambulance driver will have to attend civil court
جواب اول می تونه درست باشه ولی تقصیر منیجر نیست. مسئولیتش اینه که رسیدگی کنه به مشکل.
جواب دوم غلطه
جواب سوم می تونه درست باشه چون دکتر وظیفه اطلاع رسانی به والدین رو داره ولی وظیفه تحقیق نداره. تحقیق یا همون investigation به عهده مدیر بیمارستانه.
گزینه چهار غلطه
گزینه پنج غلطه چون الزاما راننده به دادگاه نخواهد رفت.
168
Q186248- Patient had history of pancreatitis. Some time ago .now presented with distension tenderness visible vessels percussion positive 37.5 temp liver enzymes raised, confused and slightly drowsy. Dx
1. Bud chiari
2. Pancreatitis
3. Alcoholic cirhosis
4. Spontaneous bacterial peritonitis
B
169
Q184421- 50 year old man present with hypertension with asthma and reflux nephropathy. lab inv were given. There was high urea,high creatinine and proteinuria 900 mg/day. What is the choice of anti HTN?
1. amlodipine
2. losartan
3. perindropil
4. indapamide
5. metoprolol.
B
170
Q11220- 14 months can transfer ball bet 2 hands, days monosyllables, can walk independently, mother thinks there is delay
1. No delay
2. Gross Motor delay
3. Fine motor delay
4. Speech delay
D
171
Q183258- 30 yr female,exercise 100 push ups everyday,spend 4hr everyday in gym,hourly check mirror,changes clothes everyday 2-3times.
A.Ocd
B.Anorexia nervosa
C.BODY DISMORPHIC
D.Excessive exercise syndrome E.Chronic fatigue syn
C
172
Q183256- girl has hematuria,hemoptysis,progressive distress for 2 months.ix lead you to dx?
A.ace
b.anti gbm antibody
c.ct chest
B
173
Q183544- traveller came back from Africa.have fever(not very high)with tender splenomegaly.no gi symptoms.hb is 8 g/dl (12-15g/gl).malaria test 3 days before he left was negative.(no history of taking prophylaxix or net using or any h/o bathing in lake…as in previous recalls).what to do next
a. repeat malarial serology
b. schistosomiasis serology
c. Entamebae histolytica
d. giardiasis
A
174
Q185286- PT came with pain on the lateral side of little finger,how to mx?
A. Rest & elevation
B. Fix with nail
C. K wire insertion
C
175
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70)Q11331- A 75 years old man presents to you with blurring of vision over few hours. He said there was no pain or any other symptom before or along with the vision loss. On examination his vision was markedly reduced, and there was decreased pupillary reflex. Which of the following will lead you to diagnosis of his condition.
A. Fundoscopy
B. ESR
C. MRI
D. CT head
E.Carotid Doppler
```
A
این ارتریت تمپورال نیست
انسداد امبولیک شریان رتین بدون درد فرد دچار کاهش بینایی میشه و رفلکس مردمک نداره که خیلی مهمه در افتراق این کیس از اموروزیس فوگاکس
176
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Q188306- A man presented for a sick but presented with ataxia with alcoholic fetor asking
most important investigation to do
a. ct scan of brain
b. LFT
c. INR
d. fasting blood sugar
e. full blood exam
```
B
خب مريض به اورژانس مراجعه نكرده
اومده گواهي استعلاجي بگيره انگار
پس به نظر مياد يه پروسه مزمن داشته باشه نه يه چيز حاد مثل مسموميت با الكل، تازه تو گزينه چهارم هم گفته قند ناشتا، پس اون گزينه كلا رد ميشه
از اونجايي هم كه گفته مريض بوي گند الكل ميده پس با يه كيس الكليسم مزمن روبه رو هستيم انگار
خب مرض الكلي اي داريم كه تو معاينه كشف كرديم كه اتاكسي داره
خب اره به نظرم همون بررسي سيروز الكلي خوب باشه
ولي اگه تو گزينه ها چك تيامين يا MRI برين داشت من به اونا هم شك ميكردم به خاطر سندروم ورنيكه كورساكوف
177
Q185285- Woman came with complaining of excessive bleeding during her period.She also lost her weight in last few months, has 2/3 kids (forgot)telling that her relation with her husband is not going well,not going for vacation for long time, having some financial crisis ans renting house.what to do next?
A. Send her to psychiatrist
B. Advice her to go for vacation
C. Send her to gynaecologist
D. Tell her to bring husband next time
C
178
Q11278- An 18-yrs old girl is referred after having threatened suicide on Facebook. She has unstable relationships, keeps in touch with friends close and ends them in a violent way after argument. She has past history of self-harm (wrist-cutting) and has attempted times of overdose on paracetamol after argument with her parents. What in her history will you need to find for your diagnosis? (exact options)
```
A. Prenatal exposure to alcohol
B. Past history of early sexual abuse
C. Bullying
D. Death of a family member
E. Parental separation
```
B
179
Q183263- A worried mother come with children to have antibiotic for meningitis.as boy visited child care where a girl dx as meningitis from mon –Wednesday.but that child visit just on Friday.what to do?fever of child not mentioned.
a. Inform her about sign symptom of disease
b. Send her to imergency department
c. Give antibiotic
A
180
Q185361- Scenario of woman with melody stuck in her mind. She can't get rid of it and is causing her to be distressed and making her distracted. What will help you in diagnosis?
A)Level of insight
B)Mood
C)Suicidal idea
A
181
Q185125- ECG : SVT. Asking for predisposing factor??
?
182
Q185168- Foot drop with intact foot inversion, decreased ankle reflex
A-Sciatic nerve
B-common peroneal nerv
B
183
Q184019- Alcoholic pt present with foul smelling cough, high fever with rigor. xray was given and it showed opacity in middle zone with air fluid level,after giving flucloxacilin what next
a) transpleural drainage
b) waterseal drainage
c) aspiration
d) CT chest
D
184
Q11341- Old lady 67 years admitted for knee replacement surgery.prior to sugery used to take 1-2 standard drinks of red wine everyday.she was on carbamazapine atorvastatin,ramipril and ibuprofen.third day she developd agitation,tremors and restlessnes.whats the cause?
A.serotinin syndrome
B.alcohol withdrawl
C.benzodiazapine withdrawl
D.psychosis
C
185
Q11091- A man present with inflammatory joint painin multiple areas.he also has renal failure.which of the following is contraindicated in theis man?
```
A.Metotherextae.
B.Hydroxychloroqine.
C.Sulfasalazine.
D.Azathioperene.
E.Etanercept
```
A
186
Q182603-A 30-year-old lady at 36-weeks of pregnancy presents with blood pressure 140/95 mmHg, proteinuria, headache and mild upper abdominal pain. What is the most appropriate management?
a. Give magnesium sulphate
b. Observe until full term
c. Full bed rest
d. Follow up in 1 week
e. Immediate vaginal delivery
A
187
Q182601- ECG of a 60 yr man show ? Atrial flutter 4:1 , with HT & DM , pt has no complaint of dyspnea.. Mx ?
a. Add Metoprolol
b. Add aspilet
c. Add warfarin
d. DC cardiovertion
C
188
Q11235- 3 DAYS AFTER LAPAROSCOPIC PROCEDURE PATIENT HAD SPIKE OF FEVER,DYSPNOEA & RED SWELLING & MILD DISCHARGE OF UMBILICUS.CULTURE OBLOOD,SPUTUM & UMBILICAL DISCHARGE ALL SHOW STAPHYLLOCOCCUS AUREUS.WHAT IS THE SOURCE OF THIS PROBLEM NOW:
1. RESPIRATORY TRACT
2. UMBILICUS
3. IV CANNULA SITE
B
189
Q186373- 83 year old patient, living alone was asking help for her will. She always visit her GP and buy her gifts. What should be her action?
A) Assess testament capacity
B) Help her with the will
C) tell her that her daughter can be beneficiaries
D) forgot
A
190
Q9031- A 50 year old man who suffers from rheumatoid arthritis and who has been treated with prednisolone for 3 years develops peripheral neuropathy of the lower extremities. This neuropathy is most likely due to?
A. arsenic poisoning
B. thiamine deficiency
C. development of necrotising arteritis
D. ruptured intervertebral disc
E. Vit b12 deficiency
C
191
Q11018-pt had generalized tonic clonic seizures & he is also on warfarin & other drugs.What to give? A. Amiodarone
B. sodium valproate
C. carbamazepine
D. phenytoin
E. topiramat
B
192
Q182578-A patient has pneumonia. His hip muscles become weak. CT shows a spinal stenosis. He is on statins and multiple other drugs. On examination knee jerk is absent, lower limb power is 3/6, absent dorsalis pedis pulses and sensation over thigh is loss. Next investigation?
A) Mri
b) Xray.
C) Arterial duplex
D) CK
E) LP
A?
193
Q186149- Scenario with HF, raised JBP, fullness on lung percussion. On digoxin, thiazides all lots of other medication. ECG was there with HF. Asked what to do next. Digoxin level was 1.5 (normal was 2.5)
A. Increase digoxin dose
B. Stop all medications and review after 3days
C. Increase thiazide
C
در مورد af جديد در بيمار hf
اول كنترل ريت مهم است كه ميتونه باعث de compensated hf بشه و بيمار رو تو ادم ريه ببره
بعد از كنترل ريت مثل af در بيماران عادي براي كنترل ريت و انتي كواگولان تراپي اقدام ميشه
اون انقباض دهليزي كه در af از بين ميره در برونده قلبي بيماران نارسايي قلبي نقش داره و به همين علت بسياري از بيماران hf از كنترل ريتم هم سود ميبرند
والا خانم دكتر منم فكر كنم اشتباه تايپي باشه
- لابد منظورش Af بوده
- به نظرم جواب اضافه كردن دوز تيازيد باشه
- چون مريض اورلود مايع داره
- مريضو نميشه سه روز تو پولمونارى ادم ول كرد
194
Q185433- HRT risk per year; which is correct
a) Breast CA 10% increase per year
b) Gall stones 2% decrease per year
c) Heart disease 1% increase per year
A
195
Q182499- patient was sent on a stress leave after employer finds him using cocaine. The patient admits ,using cocaine and also has memory impairment, agitation and is also irritable, what is the next step
a. urine drug screen
b. collateral history from employer
c. history of sexual abuse
d. past history of drug use
🌺🌺بزرگترین ریسک فاکتور اوردوز کوکائین 👈مصرف با سایر داروهاست
مثلا در مصرف با داروهای سداتیو ...به نظر میرسد اثرات تحریکی کوک کم است ...فرد بیشتر مصرف میکند تا حد مسمومیت 👈👈 سطح سایر داروها باید بررسی شود
🌺مصرف کوک + الکل 👈cocaethylen ... بسیار خطرناک
🌺مصرف کوک + هروئین 👈speedball ...بسیار کشنده
196
Q186219- A patient has surgery and on 10th post op day she developed dyspnea & agitated, he being a heavy drinker and a smoker. What is the next appropriate thing to do?
A. ABG
B. Chest Xray
C. Blood alcohol
D. CTPA
E. Ultrasound
A
197
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Q186205- Mother 41+ 3 days with no abnormality. Previous child born by LSCS due to obstruction of labor. Bishop score 2.
A. Induction with prostaglandin
B.Induction with ARM
C. LSCS
D. Admission for fetel examination
E. CTG after 1 week
```
C
198
Q186252- Old man with urinary incontinence. Not severe but it causes a problem when he goes out. First step of Mx?
a. Pelvic floor exercise
b. Bladder train
c. Prazosin
d. Anticholinergic agen
B
199
Q11241- A 35year woman working in machinery factory came many times for sick certificate for Mondays, now came again for sick certificate. she is taking 8 standard drinks on Saturday Sunday nights , she has a complain of headache nausea on Monday mornings. She wants to get rid of her habit , what is ur best step of management?
a. Arrange comprehensive counselling programme
b. Advise to take two standard drinks daily c.Advise to change her work d.Give her a chart that alcohol is injurious for health
A
200
Q185243- Lady wanting to conceive….she has regular 24 day cycle…presenting on 17th day….what hormone to check for her today
a. FSH
b. LH
c. Progestrone
C
معیار تخمک گذاری،اندازه گیری پروژسترون سرم یک هفته مانده به شروع سیکل بعدی ست،درواقع روز اندازه گیری به طول سیکل وابسته ست
201
Q185398- Child with low mcv, low hb presents with blood in urine. his urea n creatinine is normal. he has a bp of 60/50 smthbg like that. what is the cause..
a. glomerulonephritis
b. nephritic syndrom
c. hemorrhagic cystitis
C
202
Q185145- A lady came in abdominal pain. Hx of cholecystectomy and prostetic valve for which she is on warfarin. INR 5. BP 120/80, HR 80. CT scan given.
Looks like distented bladded with irregular border
a. Suprapubic chateter
b. Urinary chateter
c. IV VitK
B
درسته كه مريض وارفارين ميخوره ولي تاحالا كه علامتي مبتني بر خونريزي نداشته پس ويتامين كا نميديم تازه دريچه مصنوعيم داره --- چون وارفارين ميخوره سوپراپيوبيكشم نميكنيم چون خونريزي ميده-- ميمونه فولي عادي
اينكه لبه هاي مثانه در سي تي نامنظم ذكر شده ايا خونريزى تو مثانه بوده طراح سوال ميدونه!
اين اى ان ار طبق اين جدول پايين تو مصرف وارفارين اگه باشه و اگه خونريزى نباشه نوشته وارفارين قطع شه و اى ان ار ٢٤ ساعت بعد چك بشه... من به هر حال فكر كنم گزينه مفقوده داريم... اين كه فولى هم زده شه احتمال تروماتيزه كردن مجراى ادرارى با اين اى ان ار هست! به نظرم .حالا باز نظر جمع؟
203
Q185032- 55 yr old man presents with three week history of nausea & vomiting! Initially clear fluid, later indigested food particles! Last 3 months, he suffered from abdominal pain radiating to back! Most likely Dx
a. Ca head of pancreas…
b. Chronic DU
c. Ca duodenum
d. Ca body of stomach
e. Linitis plastic
B
204
Q185505- 10yr old child presented with maculopapular rash & recently recovered from common cold. Lab inv shows – Hb – 8.6 (SURE) WBC – 7 (SURE) Plt – 35 (SURE)
A. Bone marrow aspirate
B. Epstein Barr serology
C. Coagulation study
D. Platelet function test
E. Urine microscopy and culture
A
205
Q185395- man had multiple lesions of basal cell ca. what is the factor indicating prognosis?
a. histopathology typ
b. depth of lesins
c. size of lesions
d. malignant cells present at the resected margins of the lesions
D
Depth تو ملانوما مهمه
بيزال سل كارسينوما اصلا اهل متاستاز دادن نيست واز بيسمنت رد نميشه
206
Q185239- Lady bents over to pick cat…experiences severe LBA…has h/o beast ca…what is the diagnosis
a. Veretebral bone fracture
b. Mets from breast ca
?
207
Q185241- Lady presenting with forgetfulness….she doesn’t seem to rem where she has kept her personal belongings…she seems distressed when gp offered to examine her and declined examination…what will you find in history?
a. Suspiciousness
b. Hoarding
B?
208
Q185004- An 11-month-old African American boy has a hematocrit of 24% on a screening laboratory done at his well-child checkup. Further testing demonstrates: hemoglobin 7.8 g/dL; hematocrit 22.9%; leukocyte count 12,200/μL with 39% neutrophils, 6% bands, 55% lymphocytes; hypochromia on smear; free erythrocyte protoporphyrin (FEP) 114 μg/dL; lead level 6 μg/dL whole blood; platelet count 175,000/μL; reticulocyte count 0.2%; sickle-cell preparation negative; stool guaiac-negative; and mean corpuscular volume (MCV) 64 fL. Which of the following is the most appropriate recommendation?
a. Blood transfusion
b. Oral ferrous sulfate
c. Intramuscular iron dextran
d. An iron-fortified cereal
e. Calcium EDTA
B
209
Q9463- A young teenager slept on chair last night while watching TV.Now complains of pain and numbness in hand. Weakness of wrist flextion and elbow extension ans anesthesia in the region of deltoid.Refexes are normal.Which nerve is involved?
a.Ulnar b
.Radial
c.Median
d.Posterior interosseus nerve
B
210
Q9920- Old woman with urgency and nocturia for a long time. Now having incontinence for like a month. She also has bilateral knee OA. What is the best management for her?
A. Fluid restriction at night
B. Install a commode in her bedroom.
C. Oxybutynin
D. Paracetamol
B
211
Q184142- Patient I forget the scenario but he has loss of planter flexion and inversion, also loss of ankle jerk, but he has intact dorsiflexion and eversion. Knee jerk normal. Which nerve injury?
A-sciatic B-tibial C-common peronea
B
| پرونئال: اورژن و دورسی فلکشن یبیال: اینورژن و پالنتار فلکشن
212
Q186093- That lady presented with meningitis.her Child had rash and fever few days back resolved.ladys CSF protein 0.45, glucose 3.5, cells- Monocytes. Cause?
A. HSV
B. Enterovirus
C. Meningococcus
B
213
Q185417- Post op after op on antrum ...complaint of severe pain on right shoulder tip and dysnoea ,Chest normal on examination.Investigation of choice ?
a. Ddimer
b. Usg abdomen
c. Echo
d. Troponin
?
214
```
Q186491- Pregnant with genital herpes,what test to identify it is new or recurrent infection??
A.get a swab one of wart for PCR
B.sample of wart for pcr
C.review her serology status in week
D.send a sample for serology today
```
B
215
Q10222- An alcoholic man presents with severe epigastric pain, after bouts of projectile vomiting associated with dysphagia. 6 months ago he had a gastric ligation done . What is the next line of management?
```
A.Reduce fluid from band
B.Barium swallow
C.CT abdomen
D.Urgent laparotomy
E. Echocardiogram
```
A
سلام مجدد بچه ها من الگوريتماي كتاب بارياتريك رو ديدم الان اسكرين شات ميكنم توي اين مريضا اول فشار باند رو كم ميكنيم بعد بيمار رو تصوير برداري كه بهترينش عكسهاي شكم با كنتراست و بعد در صورت شك به پوچ با ليك ناشي از اروزيون داشتيم سي تي ميكنيم
يعني نكست همون الف
در صورتيكه علايم صفاقي يا پريتوان داشته باشه اولين اقداممون سي تي
يكي از عوارض خود باند بلاخص در طولاني مدت ارزويون جانكشن گاستروازوفاژيال توسط بانده و ميتونه هم پريتونيت و هم پريتونيت مخفي بخاطر چاق بودن اين بيماران و هم كلكشن ايجاد كنه بنابرين خيلي مهمه كه استم به ما چي ميگه تا در موردش تصميم بگيريم ولي در همه اينا براي بررسي لول باند و اسليپيج يا عدمش اولين روش تشخيصي خود عكس ساده با كنتراسته و در فاز حاد شك به فشار بالاي باند و يا ايجاد پوچ شديد همون عكس با كنتراسته
216
Q10211- Picture of thrombosed anal veins with no bleeding ask for treatment
A. Glyerltrynitrate gel
B. Hemorrhoidectomy
C. Incision
D. Incision and drainage
E. Sclerotherapy
D
217
Q186157- Best screening method should be
a. High sensitivity
b. High specificity
c. High PPV
d. High NPV
A
218
Q183125- mother brought his young child who presented with four lesions on his right face. She tried antiseptic but the ulcers like lesions showed no improvement. What is your most appropriate treatment? ( ring picture left cheek of Handbook )
A.mupirocin (bactroban)
B.topical hydrocortisone
C.topical acyclovir
D.topical idoxuridine
No option for clotrimazole
A
219
Q10514- A 25 years old soccer player got injured in his knee during a game. Initially there was pain that subsided after hours. After some days effusions started to expand. Finally when the swelling settled he feels sometimes his knee is locking in full extension and sometimes his leg gives away. What is the diagnosis?
A. Only ant cruciate ligament injury -
B. Med meniscus injury -
C. lateral collateral ligament injury
D. Medial collateral ligament injury and medial meniscus injury
B
220
Q186687- Football player suddenly feel acute moderate pain in his rt knee while playing after hours the pain subsides but effusion expanded after some day when the swelling and pain settled sometimes he felt his leg is giving away some time his knee is locked , Dx?
a. Med meninscial injury
b. Fracture patella
c. Med meninscial and medial cruciate ligament injure
d. Ant cruciate ligament injury
A
221
Q91033- a 10 yr old child had seizure at home.after that he became unconscious and remain.he was brought to ed via ambulance.blood glucose 2.wat will u give
a. im glucagon
b. iv dextrose
c. iv glucagon
d. iv normal saline
اگه ای وی داره b
222
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Q9274- 52 y/o female has 1y amenorrhea, 2 years ago pap smear was normal but 4 years ago pap smear was cervical wart, she has had sexual contact after 1 year, during sex, she had not any discomfort or pain. After that she developed 24 hour vaginal bleeding. Cause?
A. vaginal atrophy
B. cancer cervix
C. cancer endometr
D. relapse of condyloma
D. menstrual cycle
```
B?
223
Q187613- 26year old female, with hair on face and hands, with irregular periods 3-4 times a year, What will you investigate
A.Testosterone
B.Magnesium
C.Fsh
D.LH
c
امنوره ثانویه
اولین بررسی ها tsh،fsh،prl
224
Q183577- Child got superficial abrasions and lacerations after falling in garden
bed..he has h.o 2 DTPa vaccines..most appropriate step after cleaning the wound?
A)give tentnus toxoid n topical antibiotic cream
B)give tetnus toxoid and oral penicillin
C)give tetanus toxoid n immunoglobulins
D)DTPa and booster in 2 months
E)DTPa and immunoglobulins
E
225
Q9523-Salmonella outbreak has been declared in the community. A girl presents to you with watery diarrhea for 3 days. What is the best test out of the following to diagnose her condition?
a. Blood culture
b. Urine culture
c. Stool culture
d. Throat swab
A
226
Q187328- pregnant woman at 12 weeks gestation presents with heavy bleeding had an ultrasound Nuchal translucency at 11 weeks Abdomen rigidity, tenderness. Maternal hypotension and tachycardia. Asking diagnosis
a. incomplete abortion
b. threatened Abortion
c. Ectopic pregnancy
d. Placenta previa
e. molar pregnancy
A
227
Q11312- A 6 month old child came with recurrent upper respiratory infection. The immunization history reveals that the child has received his hepatitis B vaccination at his birth and no further immunization history at 2 and 4 month of age due to recurrent upper respiratory infection. Now the child has fever 37.8 and clear nasal discharge. What is your management regarding immunization?
A. Give hepatitis B immunization and institute catch up schedule
B. Give hepatitis B immunization and recommence standard schedule
C. Investigate underlying cause of URTI
D. Give hepatitis B immunization after fever subside
E. Give hepatitis B immunization at now
B
228
```
Q10494- Old man, back pain one week ago while working in the garden, now came with point tenderness, low grade fever, what is the likely dx
A. Discitis
B.herniation
C.sepsis
D.vertebral fracture
```
A
سلام خدمت دوستان
در مورد این سوال
در discitis معمولا در بالغین بدنبال جراحی دیسک یا تروما میتونه ایجاد بشه
و در اطفال فرم خودبخود شایعتر هست (انتقال از طریق خون)
اما فرم خودبخود میتونه در بالغین با دیابت یا مشکل ایمنی هم دیده بشه اما شایع نیست
علائمش میتونه درد خفیف یا شدید موضعی باشه
و تب اکثرا خفیف هست
به نظر من با این گزینه ها همون discitis رو باید انتخاب کرد هرچند خیلی شایع نیست
چون تو شکستگی تب نداریم و حالا اگر بدنبال بدخیمی یا استئومیلیت شکستگی بخواد ایجاد بشه دلیل نداره که همزمان یا بعد از شکستگی تب بده
قبل از شکستگی هم بعیده که یه فرد مسن با تب و بیحالی بره کار سنگین بکنه
229
Q182621- A patient presented with macroscopic hematuria. 6 months back he diagnosed as c-ANCA positive vasculitis causing hematuria and started on Prednisolone and Cysclophosphamide. The RBCs on examination are 20% dysmorphic and 80% normal, what is the most appropriate next step?
a. Repeat renal biopsy
b. Stop cyclophosphamide
c. CT abdomen
d. Renal USG
e. Cystoscop
E
230
Q186359- Woman with loss of vision. She asked her next 10 years progression of multiple sclerosis?
A. 10%
B. 20%
C. 70%
D. 90%
E. 30%
A or C
231
Q187467- 1 year old child diagnosed with bacterial meningitis was admitted to hospital. Blood culture taken and iv ceftriaxone started. after 1 day of admission child had a seizure of <1 min duration. long labs were given sodium and bicarbonate low. all others were in normal range. what is the cause of seizure?
a. SIADH
b. dehydration
c. adrenal failure
C
232
Q186608- 24 months old baby brought by his parents for development assessment. What should he have achieved?
A. Can pronounce 2 personal pronouns
B. Know family name
C. Know 4 colours
A
233
Q186197- A 16 year old female presents with Sickle cell anaemia and heavy menstrual bleeding. What is the best treatment of choice?
A. Combined Oral Contraceptive Pill (COCP)
B. Inj Depoprovera
C. Mirena
D. IUCD
E. Implanon
C
234
Q185483- Pt on paracetamol controlled analgesia for fracture on fantanyl for 24hrs Complains of persistent nausea but not severe pain from last 12 hrs wat to do?
A.Reduce fentanyl dose
B.Change to oral tramadol+metochlopramide
C.Change to morphine
D.Give metochlopramide and continue same dose of fentanyl
B
فنتانیل و مورفین هر دو high potent هستند
وقتی درد کنترل شده میتونیم سراغ باقی گزینه ها بریم
تو گزینه سی برای تهوع درمانی ذکر نشده
235
Q185373- 36.hep b infected pregnanat woman at 26 weeks(not sure what age of gestation was). what to do next
A. giv hep b vaccine to mother and baby as soon as baby isborn
B. giv imunoglobulin now and hep c vaccine after baby is born
C. d.giv both hep b vaccine and immunoglobulin now
C
236
Q187406- parents come with 22 m old child concern abt speech;parents speak hindi at home;baby has only 4 discernible words,no comprehensible sentence;baby was very active but little eye contact,throw all toys given to him;what will be ur app mx besdie hearing and visual assessment?
a. reassure parents its nrml to lag in language for the child as different language at home
b. refer for muldicsiplinary developmental assay
c. others I forgot but not relevant
B
237
```
Q187595- 3 cm mass in left lobe thyroid without any invation to lymph node. It says papillary ca in stem.
A.Total thyroidetomy
B.Lobectomy
C.Radio iodine ablation
D.Ablation with thyroidectomy
```
A
238
```
Q9476- old woman presented with c/o lathergy and fatigue. CBC shows hypochromic and microcytic anemia no h/o abdominal pain or altered bowel habits or bleeding per rectum. What you will advice next?
A) Serum ferritin
b)fecal occult blood
c) hb electrophoresis
d)colonoscopy
```
A
239
Q185092- A 28 yrs old lady presented with flight of ideas,pressure of speech and delusions and four months pregnant.How to treat her?(old recall)
a. Lithium Carbonate
b. Na Valproate
c. Clozapine
d. Some Benzodiazepines
e. Carbamazepine
?
240
```
Q83002- A boy with ADHD was initially treated with methylphenidate after 6 months how do you adjust the dose of treatment
A. Assess the level of hyperactivity
B. Side effects
C. Reduced symptoms
D. Improved lifestyle
E. Good grades in school
```
E
241
Q186556- Couple came with primary infertility for 2 years with regular sexual intercourse the female examination was normal and his tests are normal , you found that the husband has a small testis what investigation you will order?
A. U/S
B.Testosterone level
C.Prolactin levels
D. Karyotyping
B
242
Q10278- 22 year-old primigravida complains of headaches, restlessness, sweating, and tachycardia. She is 16 week pregnant and her blood pressure is 180/110 mmHg.
What is the best investigation for her?
a. Exploratory laparotomy
b. Mesenteric angiography
c. Head CT scan
d. Abdominal CT scan
MRI
| Abd US
243
Q9215-patient came at 12 weeks labs showed rh antibodies in her blood.this is her 2nd pregnancy what to do?
a. do blood group of her spouse
b. monitor level of antibody
c. give her anti d now
d. do fetal usg
e. terminate pregnancy
بر اساس صحبت هاي استاد نصيري عزيز
مادري داريم كه در ويزيت سه ماهه اول آنتي بادي گروه هاي خونيش مثبت شده
الان چيزي كه مهمه (١) بايد ببينيم آيا تيتراژ افزايش يابنده و significant هست يا خير؟؟
(٢) اگر بود ببينيم آيا دارد روي جنين اثر ميذاره يا خير؟ كه در اينجا لازمه ژنوتيپ جنين را پيداكنيم (البته زماني آنتي ژن جنين را چك ميكنيم كه مطمئن باشيم آنتي بادي هاي مادر به سطح significant رسيده باشد كه بتونه برروي جنين تاثير داشته باشد)
(٣) اگر دارد بر جنين اثر ميذاره الان مداخلات درمانيمون براي جنين چيه؟ (براساس داپلر شريان مغزي مياني middle cerebral artery و بر اساس آن كم خوني جديد را حدس ميزنند و در صورت لزوم ترانسفيوژن داخل رحمي انجام ميشود
پس خصوصا در رفرنس هاي جديدتر دانستن اينكه بدونيم اين مثبت بودن از كجا اومده تاثيري در مداخلات ما در اين بارداري نميكنه اگر چه ميتونه بر پلن ما براي بارداري ها ديگر تاثير داشته باشد
لطفا به ويس ها دقيق گوش بديد حتي اگر پدر منفي باشه باز ما بايد بررسي كنيم چون ممكن است مادر از source هاي ديگر مثبت شده باشد
و جالبه كه در بعضی منابع برای ممالک آزاد گفتند دنبال چک پدر نرويد،چه کاریه ،شاید اصلا بابای بچه این نباشه،اون وقت داستان میشه🤫
بنابراين بر اين اساس گزينه بي صحيح تر به نظر ميرسد
244
Q182535- 58yr od male pt, since six month watery diarrhea mucus or blood ,with 3 kg weight loss.presented with a hx of increasing difficulty to stand from sitting And walk upstairs. What is the cause?
a. Thyrotoxicosis
b. IBD-alt diarrhoea and constipation
c. celiec
d. campylobacter jujeni
e. bowel cancer
B
245
Q10290- 8 mo old baby, parents concerned not babbling yet. Appears to respond well to sounds on examination. MX?
A .tell its normal variant
B .review in 6 mo
C. arrange speech pathologist referral
D. ENT consult
C
246
Q186302- teratogenic for fetus in pregnant lady?
A. cocaine
B. heroin
C. amphetamine
D. methamphetamine
E. Flouxetine
A
247
Q185370- a 3yos parents bring her because of recurrent infections. what is the first test that needs to b done
a. iron studies
b. folate
c. serum ferritin
A or c?
248
Q185381- girl with swelling of neck at the angle of the jaw since a few weeks. a month ago she had
a tonsilitis treated with antibiotics. she has no lymphadenopathy.
A. what is next step
B. review in week
C. fine needle biopsy
D. ebv serology
D
اينا رو كه بحث كردم بر اساس اون الگوريتما اگه از اول با علايم سيستميك اومدن و بعد لنفادنوپاتي مقاوم ميشه اي بي وي بررسيش دو تا شيش هفته بعد
اگر فقط ايزوليتد لنفادنوپاتي بر اساس ار سي اچ ترايال درمان
در صورت عدم درمان بين شيش تا هشت هفته بيوپسي
اين دوتا سوال هم كه جفتشون يك بيماري همراه داشتن بنظرم اي بي وي
249
Q186589- Child treated for tonsillitis still has 3cm lump under mandible angle. Painless. No lymphendopathy, no fever, otherwise well.
a) Aspirate biopsy
b) Ultrasound
c) EBV serology
d) CT head and neck
C
250
Q185394- studnt came back frm india persistant fever. showerd with bucket of water frm nearby lake.also drinking water proper sterilized and clean. malaria tested twice.all meds taken including antimalarials and vaccinations.
A. looks for other disease
B. do thick thin filn now
C. do another rapid malaria test
D. also smthng abt malaria
B
251
Q186188- A locum at private gp service finds patient record incomplete and some orders about patient treatment are not followed what you should do?
A. Maintain records and patient call up system
B. Ask consultants when they return
C. Urge patients to go to some other doctor
2 more options
A??
252
Q184238- 2y.o. Boy vomits after feeding, cries, lost 200g in previous week. Blood analysis shows metabolic alkalosis. What is the investigation?
A) CT
B) Barium enema
C) Ultrasonography
D) Endoscopy
C
.شكمى و سونوگرافى انجام میشھ در سوال بالامھمترین مسالھ اى كھ میخواد مطرح كنھ اینتوساسپشن ھست كھ نكست استپ ایكس رى
)داره با وجود اینكھ خودش آلكالوتیكھ براى حفظ پتاسیم ایجاد میكنھ كھ با متابولیك آلكالوزیس ھمراھھ،پارادوكسیكال آلكالوریا ھم Projectile vomitingبشھ، ممكنھ در مواردى كھ مادر در حاملگى دارو ھایي مخصوصا اریترومایسین مصرف كند ایجاد
توضیح ھیپرتروفیك پیلوریك استنوزیس )سن شایع ھیپرتروفیك پیلوریك استنوزیس ۲تا ٦ھفتگى ھست،
بچھ با این سن امكان نداره كھ ھیپرتروفیك پیلوریك استنوزیس باشھ
253
Q186198-Wife brings Ptx (husband) with worsening Parksonism syx(marked
bradykinesia,rigidity,lack of self empathy and agitation) presenting with auditory
and visual hallucinations comes to you for advice.Ptx is currently on carba and
levodopa 75mg with little to no improvement for more than a year nowWhats the
appropriate next step?
A.Donezpil
B.Quietapine
C.Haloperidol
D.Increase Levodopa
E.Pramipexole
D
254
Q187291- A 18 year old boy with schizophrenia not responding to medications needs ECT. He gave you consent in written form. The boy is living with
parents.What is the next step?
A. Take consent from parent
B. Do ECT
C. Obtain consent from mental health tribunal
D. Obtain the second opinion
B
255
Q11425- A patient has come in with a fracture of the femur. He is a known schizophrenic, on medication and his schizophrenia is well under control. He refuses to be taken to the operation theatre for surgery. Which of these ethical principles is most appropriate here?
a. Informed consent
b. Utilisation of health resources
c. (?) (the end is determined "utilisation")
d. Autonomy
با توجه به تاكيد سوال بر روي اين كه اسكيزوفرني مريض كنترل شده است يعني ميخواد بگه مريض كامپتنته
جواب اتونومي بيمار.
گزينه D
256
Q10411- Pt hears a popping sound in ear before that mild vertigo the nystagmus and then fall down now have rt horner syndrome and right ear total sensory neural hearing loss(SNHL). Probable cause?
a. Acoustic neuroma
b. Acute labyrinths
c .Meningioma
d. Meinners disease
e. Basilar infarction
شروع ناگهانی و حضور سندرم هورنر این یعنی دایسکشن ورتبرال یا بازیلر
E
257
Q187340-An 18 year old girl presents with epistaxis, malaise and tiredness for months. no other symptoms . Hb is 8.5, microcytic hypochromic picture. INR is 1.5. Calcium is 1.9. What is next most appropriate to reach diagnosis?
a. Hb electrophoresis
b. serum electrolytes
c. Iron studies
d. anti glidian antibods
e. stool culture
D
258
Q186517- Woman comes to see a male physician. She need to get pelvic examination but she is reluctant to get it done from male doctor, what should be your appropriate action?
a) Ask her if presence of female nurse would help
b) Ask her to come when female physician available
c) Send her to some another physician
d) Others irrelevant
A?
259
Q182195- Melanoma patients did surgery now asking u about giving advice of his 5 and 3 years of old child is there any risk factors?
a) don’t go out 10 am and 3 pm
b) apply suncream when going out in the sun
c) remove the dysplastic nevus
B
260
Q185101- Young female schizophrenic patient in psychiatric ward suffers ulcer in right arm, you where informed by the nurse that the patient will not accept any intervention for this ulcer. What will be your action ?
A call her parents for consent
B obtain medical board power order to treat the patient
C refer to surgical team
D take a swab
E neglect the ulcer
?
261
Q185564- A patient presented with swelling in parotid region from three months, which has sometimes dull pain while eating. Patient had history of dry eyes. FNAC shows maglinant cells. What next step?
A- Biopsy
B- Sialography
C- CT head and neck
D-MRI head and neck
C
262
Q184427- Woman with headache,tachycardia,chest pain has history of hypertension and also has history of schizophrenia for which doctor put clozapine on..which is the most appro invx to check for her?
A.clozapine level
B.troponin
C.chest xray
D.TSH
E.FBC
B
263
Q9598- child with history of asthma and he was aknown case of nut allergy, both parents are smoker, develop wheeze , hoarseness of voice and other chest symptoms relieved by salbutamol. What is the most likely preventive measure for such subsequent episode?
A-avoid all type of nuts in foods
B-prevent exposure to passive smoking from parents
C-remove all carpets from house
D-remove cats and dogs
B
264
Q182278- woman with forgetfulness, doesn't concentrate to work ,burning her hands during cooking , once went to a place and realize she don’t know why she is here , what in MMSE u will find about the affect of mood?
A. Lability
B. flatness
c. blunting
d. blandness
A
265
Q9005- A child with nephrotic syndrome treated with steroid, developed hypertension , diffuse abd pain and vomiting for 1 week ,Afebrile-
A acute pancreatitis
B acute pyelonephritis
C renal artery stenosis
C
266
Q187304- a male with h/o orchiectomy came with infertility complain . semen
exam shows 1 million sperm count, what next investigation
a. karyotyping
b. FSH LH
c. chromosome deletion test
d. Testosterone
B
267
Q187480- A man comes to GP, says the next door had people who are going go kill him. So he is carrying a knife, which he gives to you when asked for it, but you have a feeling that he possesses more weapons by his history. He is not aggressive and complies with you. The police have been contacted already. What to do?
a. Inform the neighbors
b. Call the neighbors to verify and ask more history
c. Refer to specialist for psy consultation
C
268
Q91001- pt collapsed at work, colleagues say limb movement for 1-2 min… then confused till now. but follows command.
A.eeg
B.mri
C.ct
C
269
Q187475- Patient presents with abdominal pain and a discharging sinus. Has undergone many operations in the USA (for crohn’s disease as far as I can remember) But the patient does not know the specifications of surgeries and refuses to allow you access to medical records from USA. (Pic given, this is the closest I could find, there was also a yellowish discharge )
a. Factitious disorder
b. Somatostatin disorder
c. Malingering
A
270
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Q9252- 70 yrs lady has previous 2 times H/o vertebra # or something like this and now again with the same issue..all her vitD,Ca, Albumin all level ok, she is on raloxifene 25 mg, what to do now
A.continue current treatment
B. increase Raloxifene dose to 50 mg
c.stop raloxifene and start Alendronate
D. continue raloxi and add Alendronate
E. once weekly injection
```
?
271
Q187538-Gynecomastia photo, young man, bilateral parotid swelling, came to you for scrotal swelling. You can get above the swelling, alcoholic, smoker. What is the diagnosis?
A-Teratoma
B-Ledwig cell tumour
C-Alcoholic liver disease
B
272
Q186153- 45 yrs old man with no family history of prostate cancer comes for screening advice and counselling . He insist he wants a DRE.
A digital rectal exam showed a normal sized prostate with normal non nodular sulci. What is the next important step
A. Reassurance
B. PSA after 2 weeks
C .TRUS
D. Abdominal usg
B
273
Q184393- A child previously treated Viral Infection for 1 wk.now come with petechiae on trunk & arm,non blanchable.
Lab
Hb -low
plt -normal
no mention abt WBC , RBC count
A .Bone marrow aspiration
B. Epstein barr serology
C. coagulation test
D. platelet Function test
E.urine RE
E
هنوخ
274
Q185500- A patient who is going to do surgery for varicose veins in next 3 weeks. He has been taking
clopidrogrel for cardiac stenting for 4 months. What is the most appropriate management?
a. Reassess need for surgery
b. Do surgery now
c. Change clopidrogrel to LMWH before surgery
d. Stop clopidrogrel and do surgery
A
275
Q185376- known woman with alzheimers getting difficult for family to manage. they bring her to the nursing home. she stays a few days after which she started going outside from the main gates everyday. wont listen to anything she is told. what is next step in mangmnt
a. talk to the family
b. change medication
c add to her medication
d.send her to hospital
A
276
Q186249- 15 years Boy previously a good student now present with agitation , violent , admit to occasional marijuana use, multiple needle marks on forearm but don’t want to talk about it.
a) Respiridone
b) Paroxetin
c) Methylphenidite
B
277
Q183305- Woman controlled on na valproate. Planning pregnancy . Ur advice ?
A.Inc valproate
B.Dec valproate
C.Stop valproate
D.Continue same
C?
278
Q184419- Child with systolic murmur on left sternal border and no cyanosis feature, involve whole precordium, Dx-
a. ASD
b. VSD
c. TGA
d. TOF
e. Physiological
B
279
Q186616- A young man comes with weak shoulder abduction, and elbow extension, loss of sensation over deltoid, cause?
a. C5 nerve palsy
b. Brachial plexus injury
c. C7 nerve injury
d. Carpal tunnel syndrome
B
280
Q11332- A 56 years old woman is admitted for an elective surgery. She has been taking antithyroid medicine since 7 years and carbamazepine since 3 weeks. On admission you discover a UTI and started her on Trimethoprim. On third day she becomes very lethargic and labs show low sodium. What is the next best step?
A. Cease Trimethoprim and and give normal saline
B. Cease Carbamazepine and fluid restriction
C. Cease Trimethoprim and fluid restriction
D. Cease Carbemazepine and give hypertonic saline
E. Cease both Trimethoprim and Carbemezepine
D
281
Q182207- Asbestos exposed man came for advice. During work workers do not use mask, but they are exposed to asbestos during renovation. He is worried about asbestos related cancer, what is your advice:??
A. Refer to respiratory specialist
B. Do nothing
C. Inform government to take some legislation
D. Repeated Xray for the next 5years
E. Inform asbestos has very low risk for cancer
A
282
Q185011- 23 year old woman, choatic anxious agigated, multiple wrist lacerations. This happens post breakup with boyfriend. Admitted. Shouts on nurses. Found with inflated bp apparatus around neck. Cause?
A. Passive agression
B. Acting out
C. Schizophrenia
D. Genuine attempt of suicide
B
283
Q183509- 32 yr old asymptomatic woman present with 25 mm swelling in her right lower thyroid lobe which was found incidentally in CT scan for the whiplash injury..after taking fnab there was(pssamomma bodies) and what management??
a.-review with USG next 6 mths
b-review with thyroid function tests next 6 mths
c-radio iodine scan
d-right lower lobe lumpectomy
e-total lumpectomy
E
284
Q182034- mother come with 12 months old infant with increase head size from 25 percentile at birth to 75 percentile now and on examination child hypotonic what will you do next??
a. CT SCAN head
b. check CMV infection
c. TSH
D. head ultrasound
e Rubella test
A
285
Q10512- ECG bradycardia with hyperacute T wave only one strip….Middle age pt c/o light headach and syncopal attack 3 episode in one month, bp 100/60 0r 90/60 ??he is on multiple drugs.which drug comination will be tha cause of his problem? Actually confusing scenario not that simple….
A.Amlodipin +Aspirin
B.frusimide+Aspirin
C.Amlodipin+Amiodaron
B
286
Q10488- which combination making muscle weakness without tenderness ?
A. ramipril and HCT
B. amiloride and Ramipril
C. celecoxib and HCT
B
287
سوال چهل و سوم
Q10454- E CG-SVT with WPW.Next invextigation?
a.Troponin
b.Echo
B??
288
Q184463- ECG of NSTEMI given. Chest pain started 2 hours back. Now pain 4/10. taking ramipril atovastatin aspirin
No dypnoea, murmur. What should be given now?
a. Thrombolysis
b. aspirin,
c. GTN,
d. clopidogrel,
e. metoprolol
D
289
Q186235- Man whose hand deeply injured by screw driver , 5 weeks ago, he found supercial laceration and give diphtheria tetanus toxoid , now , the hand is swollen and painful. What to do beside antibiotics?
a) Elevation
b) Aspiration
c) Tetanus toxoid
d) Tetanus immunoglobulin only
e) Dpt
B
290
Q186234- Woman with CCF , taking digoxin and perindopril regularly. Long list of lab result given. ECG show pulmonary congestion(given) and she has progressive dyspnea
a) Add furusemide
b) Add
c) Cease digoxin and give K+ supplement
d) Cease perindopril and give K+ supplement
e) Urgent rhymthm inversion?
اگه هایپوکالمی داشت c
| اگه فقط ادم ریه A
291
Q185092- A 28 yrs old lady presented with flight of ideas,pressure of speech and delusions and four months pregnant.How to treat her?(old recall)
a. Lithium Carbonate
b. Na Valproate
c. Clozapine
d. Some Benzodiazepines
e. Carbamazepine
?
292
```
Q9093- Young pt. With BMI 29 had a small boil on his arm, he admits drinking 3 to 4 soft drinks everyday . Increased urine frequency.
-Blood glucose 19
-Hba1c 11
Mx?
A. Metformin
B. Insulin pump
C. Insulin gargline
D. Gleclazide
E. Another oral Hypoglycemic
```
C
293
Q91029- 75 year old lady with severe stress incontinence. She manages to accidentally urinate 10 times during the day and cant make it to the bathroom. She is annoyed by this. Urodynamic studies confirm detrusor instability. What is the best treatment option?
A. Pelvic floor muscle exercise
B. Anticholinergic
C. Retropubic suspension
D. Anterior colporrhaphy
B
294
Q182326- Non healing ulcer, old patient, seen by a community nurse twice a week, needs doctor,what to do?
A.involve the family
B.visit hospital
C.swab to be taken
B
295
Q185414- Patient had amenorrhoea for past 12 months and wants to conceive. H/0 previous irregular menstruation with 5-6 times per year. Further hormonal details were given
LH and FSH low, some other hormones mentioned all normal.
What will help you with the diagnosis?
A. MRI to diagnose pituitary atrophy
B. Estrogen and Progesterone levels
C. Thyroid investigations
C
296
Q187589- A man with rheumatoid arthritis, HTN is on thiazide, enalapril, chloroquine and diclofenac is feeling lethargic, short of breath since a few months. He looks pale, his heart rate is 80bpm. BP was normal. Lab values were given. Hemoglobin was low, MCV marginally low, leucocytes low, platelets low. Cause?
A. Chloroquine
B. Thiazide
C. Enalapril
D. Diclofenac
A
297
Q9462- A patient came in with weakness of wrist and finger extension. Tendon reflexes were normal. No other abnormalities noted. Where is the lesion?
a. Anterior interosseus nerve
b. Median nerve
c. Ulnar nerve at the elbow
d. Radial nerve
e. Posterior interosseus nerve
D
298
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Q9945- A 35 year old man acutely complained of Right knee pain and swelling right after playing golf. Arthrocentesis done revealing 25 mL of brown pigmented fluid aspirated. What is the diagnosis? A. Rheumatoid arthritis
B. Gout
C. Osteoarthritis
D. Pigmented villonodular synovitis
E. Hemochromatosis Achondrosis
```
D
299
Q186139- A 60yrs of age man was found fallen on bathroom floor with dizziness but was conscious with a history of poor stream urine and difficulty in micturition and brought by his wife to ER.He has a history of HTN and DM..his BP is 165/85 and pulse is irregular.ECG showed AF.what investigation will you do as next most appropriate?
A.blood glucose
B.troponin
C.holter monitoring
D.echo
B
| چون هوشیار است الف رد میشه. نکست : تروپونین . بست: هولتر مانیتورینگ
300
Q187618- Pregnant woman come with HSV infection. What investigation will you do to differentiate this is primary or secondary infection?
A) HSV Ig M now
B) Do HSV culture from HSV lesion
C) Do HSV PCR from HSV lesion
D) Review her HSV immune status from the blood taken at 12 week of gestation
E) Do HSV type specific from the blood taken now
C
301
Q188033- A 8 year old child with persistent night pain in his left legs , on examination there was no restriction in active movement and no swelling or tenderness what is the most appropriate next step?
A-X-ray left hip
B-ultrasound
C-bone scan
D-bone marrow examination
E-Reassure
A
ضایعات مفصلی حرکات اکتیو و پاسیو محدود میشھ و در خارج مفصلی فقط اکتیو
302
Q182580-A 13-year-old girl presents to your clinic asking for termination of pregnancy. Three weeks ago she participates in a party where she is coerced to have unwanted sex with a stranger. Yesterday, using a home pregnancy test, she realised that she is pregnant. She is a school girl and lives with her parents. Which one of the following is the most appropriate next step in management?
A. Inform the Child Protection Service.
B. Inform her parents of the event.
C. Terminate the pregnancy.
D. Inform the police.
E. Inform the Sexual Assault Services.
A
303
Q188446-in which of these presentations of bowel disease is infliximab most beneficial?
A. fulminent colitis
B. crohn's with fistulas
C. ulcerative colitis resistant to Rx
B
304
Q188146- 14 years old boy begin soiling his pants his mother was concerned before 4 month he suffered from abdominal pain and diarrhea but she doesn't know if associated with weight loss??
A -constipation with soiling
B -sexual abuse
A
305
Q188143- 32 weeks pregnant lady's child got varicella. Was tested earlier to have no immunity against varicella. What to do now? (No option for check ig)
A.Do u/s
b. Give zoster Ig
c. Give Acyclovir
d. Give Varicella Zoster vaccine
B
306
Q186309- 72 year female come for routine check up. Her mother develop colon cancer at the age of 65 years. She doesn’t have any bowel symptoms and haven’t done any screening test before. She want to know her risk?
a) Colposcopy 2 yrly
b) 5 yrly cervical cancer screening
c) 5 yearly colon cancer screening.
d) mammogram year
e) no screening needed
B
307
Q182598- A 64 year old man presents to hospital with his first epileptic seizure whilst sat reading a newspaper at home. Drug history – Nil clinical examination reveals the following: •Temp 371•BP 182/102 •O2 Sats 99% Air •GCS 15/15 •Finger prick blood glucose 3.9 mmol/l •No Jaundice, Anaemia, Clubbing, Cyanosis, Lymphadenopathy •CVS,RESP,GI: (-) Neurological examination: including cranial nerves and Fundoscopy (-)His blood tests show the following: His chest X-ray shows a ill defined lesion in the left mid zone. What is the most likely aetiology of his seizure?
a. Brain Metastases
b. Hypercalcemia
c. Syndrome of inappropriate ADH secretion (SIADH)
d. Hyponatraemia not caused by SIADH
e. Idiopathic epilepsy
C
308
Q183304- Man depressed as wife have affair. Dr started him on Sert now with delayed ejaculation.
A.Dec sert
B.Inc sert
C.Withdraw sert
D.Switch to fluoxetine No option of reassure
A
309
Q188548-4 year old child difficulty in swallowing for 2 days . not willing to eat solid food but only drink milk repeatedly .no cough mentioned. His brother had asthma. On examination child is well and normal examination. What to do now?
A) x ray neck chest and abdomen
B) Salbutamol
C) barium swallow
Endoscopy
310
Q185357- A lady presented with pneumonia symptoms. She is oriented and stable. GP suggests her admission to hospital. She refused and ask for medications. What will you do?
A) Involuntary admission under Mental Health Tributary
B) Prescribe medications
C)Counsel her why admission is necessary
D) Counsel her family to persuade her for admission
E) Get Colleague’s suggestion for admission
C
311
Q9153
- Man chronic smoker. He smokes 20 cigarettes a day and drinks 8-10 strandard drinks of alcohol. Now presents with increasing dyspnea. On cardiac examination no notable finding. Chest examination shows hyperresonant lung percussion and some crackles on both lung bases. O2 saturation is 85%. Otherwise the patient is not in distress. What next to do ? (chest xray is given – no notable findings)- Acute exacerbation of COPD
a. Give him salbutamol
b. prescribe him beta blockers
c. Do ABGS
d. Do a ct chest
C
312
Q10492- A case of chronic back pain in an old man with radiating pain and tenderness at L5 disc, He has problems passing urine when lying down, but can void urine easily on standing. Which of the following symptoms indicate a need for an urgent MRI?
a. urine problems
b. radiculopathy
c. chronic back pain
d. disc herniation
A
313
Q184162- Patient returned from travel to overseas was taking tetracyclin proohylaxis for malaria regularly; 23 days after her return she had bloody diarrhea for 2 days. O/E she has slight tenderness in the left lower abdomen T 37.5 other than that all normal. Blood culture, stool exam normal. Ask about the cause
a. pseudomembranous colitis
b. giardia
c. E H
d. Sigella
A
Clostridium difficile causes the most severe cases of antibiotic-associated diarrhoea. Infection can occur at any time during, or for some months after, a course of antibiotics. Exposure to broad-spectrum antibiotics such as cephalosporins, quinolones and lincosamides is an important risk factor for C. difficile infection. C. difficile infection can also follow treatment with cancer chemotherapy, and occasionally occurs spontaneously. The use of proton pump inhibitors is an additional significant risk factor for C. difficile infection. Outbreaks of hypervirulent strains (including PCR ribotype 027 and 078) have been reported worldwide including in Australia. Some outbreaks of these hypervirulent strains have been associated with broad-spectrum quinolone use (eg moxifloxacin). Control of hospital antibiotic use and infection control measures (additional contact precautions) have reduced nosocomial spread, particularly in outbreaks. Diagnosis The diagnosis of Clostridium difficile infection should be based on either: colonoscopy or histopathology results that demonstrate pseudomembranous colitis microbiological evidence of C. difficile toxin, or toxin-producing C. difficile, in stools, in a patient who has signs and symptoms of C. difficile infection in the absence of another cause. Many different approaches are used in the laboratory diagnosis of C. difficile infection but the optimal testing strategy has not been established. A variety of microbiological tests are used, often in combination. Tests to detect C. difficile: C. difficile glutamate dehydrogenase (GDH) (common antigen) detection is sensitive but not specific, and is a useful screening test as part of a multistep algorithm. C. difficile culture alone (ie without isolate toxin testing) is of limited clinical value. 11/18 Tests to detect C. difficile toxin:
Cell cytotoxicity neutralisation assay (CCNA) is technically demanding and slow, but sensitive and specific. Toxigenic culture (ie C. difficile culture with isolate toxin testing) is slow, but sensitive and specific. Enzyme immunoassays (EIAs) to detect C. difficile toxins A and B have high specificity but low sensitivity, and should not be used as a stand-alone test. Nucleic acid amplification tests (NAAT) (eg polymerase chain reaction [PCR]) for C. difficile toxin genes have high sensitivity and specificity. Perform testing for C. difficile or its toxins on unformed stool only, unless the patient has ileus. Do not repeat testing during the same episode of diarrhoea, or test for cure. Asymptomatic colonisation is common in young children (younger than 2 years), so testing should not be routinely performed in this group. Treatment Discontinue implicated antibiotics unless there is a strong rationale for continuing; in up to 25% of patients symptom resolution follows, and the likelihood of relapse is reduced. If antibiotics cannot be discontinued, seek expert advice. For mild to moderate disease, use: metronidazole 400 mg (child: 10 mg/kg up to 400 mg) orally or via nasogastric tube, 8-hourly for 10 days. Metronidazole can be given IV in patients who cannot tolerate the oral formulation (see dose below). 9 Seek expert advice for all patients with severe disease (eg white cell count more than 15 × 10 /L, severe abdominal pain, elevated serum creatinine, elevated serum lactate, low serum albumin, high fever, or organ dysfunction). In patients with severe disease, use: vancomycin 125 mg (child: 5 mg/kg up to 125 mg) orally or via nasogastric tube, 6hourly for 10 days [Note 2 ]. Intravenous vancomycin is not effective against C. difficile infection due to inadequate penetration of the drug into the lumen of the colon. There is evidence that fidaxomicin is associated with lower rates of recurrence compared to vancomycin, but data for its use in severe disease are lacking and it is currently expensive. In complicated cases (eg hypotension or shock, ileus, megacolon), in addition to oral or nasogastric vancomycin, use: 12/18 metronidazole 500 mg (child: 12.5 mg/kg up to 500 mg) IV, 8-hourly for 10 days.
Metronidazole can be given IV in patients who cannot tolerate the oral formulation (see dose below). 9 Seek expert advice for all patients with severe disease (eg white cell count more than 15 × 10 /L, severe abdominal pain, elevated serum creatinine, elevated serum lactate, low serum albumin, high fever, or organ dysfunction). In patients with severe disease, use: vancomycin 125 mg (child: 5 mg/kg up to 125 mg) orally or via nasogastric tube, 6hourly for 10 days [Note 2 ]. Intravenous vancomycin is not effective against C. difficile infection due to inadequate penetration of the drug into the lumen of the colon. There is evidence that fidaxomicin is associated with lower rates of recurrence compared to vancomycin, but data for its use in severe disease are lacking and it is currently expensive. In complicated cases (eg hypotension or shock, ileus, megacolon), in addition to oral or nasogastric vancomycin, use: 12/18 metronidazole 500 mg (child: 12.5 mg/kg up to 500 mg) IV, 8-hourly for 10 days.
In severe infection associated with ileus, vancomycin can be administered as a retention enema (500 mg in 100 mL sodium chloride 0.9% rectally, 6-hourly) in addition to oral or nasogastric vancomycin and IV metronidazole. Early surgical referral is indicated in patients with severe disease, because outcomes are poor after organ dysfunction is established. Patients with severe disease may require a colectomy to survive, especially if toxic megacolon develops. Repeat microbiological testing for C. difficile is only indicated in symptomatic patients; tests often remain positive for over a month, even after effective therapy, so repeat testing is not generally indicated within this time. Recurrent disease can be a problem—seek expert advice. Referral to a specialist should be considered after two or more episodes of confirmed C. difficile infection. Repeat treatment (with metronidazole or, for severe relapsing disease, vancomycin) is usually successful. Various regimens (eg pulsed dosing or dose tapering of vancomycin) have been used, but there is limited evidence for their efficacy. Other antibiotics that have been used successfully include bacitracin (given orally) [Note 3 ], rifaximin [Note 4 ], sodium fusidate, tigecycline and nitazoxanide [Note 5 ]. Faecal microbiota transplantation (FMT) ('stool transplant') appears to be useful for intractable recurrent disease. There are considerable logistical issues to consider (including consent, donor screening, processing, dosing, and method and route of administration) and few reports of its use for acute severe disease. However, FMT is increasingly being undertaken at specialist centres—seek expert advice. Note 2: Injectable vancomycin can be given orally or via nasogastric tube, as an alternative to oral capsules. Dissolve 500 mg of vancomycin powder in 10 mL of water, measure the appropriate dose (eg 125 mg = 2.5 mL), and give orally or via nasogastric tube. Flavouring syrups can be added before administration to improve palatability. Note 3: A commercial preparation of oral bacitracin is not available, so it must be prepared extemporaneously. Note 4: At the time of writing, rifaximin is not approved by the Australian Therapeutic Goods Administration (TGA) for this indication. See the TGA website [URL information. . ] for current Note 5: Nitazoxanide is not registered for use in Australia but is available via the Special
314
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Q188557-child 7 years old came with fever 38.7 looks tired and lethargic and has grunting on examination his chest is clear what is the diagnosis??
A-Epiglotitis
B-Croup
C-Broncholitis
D-Pneumonia
```
D
315
Q184410- 9 months old infant with deformed occipito temporal region of skull and prominent frontal region, what to do?
a. Change sleeping position
b. CT
c. Ultrasound
d. MRI
e. Resaaure
A
316
exaggerate reflex of lower extremity. He was born gestation age 26 weeks. At delivery he was given gentamycin and dexamethasone for respiratory. Cause of his current symptoms?
A.Gentamycin toxicity
B.Antenatal infection
C.Preterm delivery
D.Antenatal hypoxia
C
317
Q188186-Pharmaceutical company approaches u with results of comparison between 2 drugs for hyper cholesterolrmia, wat is d important question u wil ask
A- wether same dose of dugs wer used
B- wether 2 grp s contained d same no of people
C- how did u equalise d dietary factors
C
318
Q184078-Chest pain 12 hrs pain reduced 4/10 on ecg st depression o2 given nxt
a. Morphine
b. GTN
c. Heparin
d. Thrombolysis
C
319
Q186417- 6 month-old baby girl. Preterm 32 weeks-old born. Come to routine follow up. mother concerns about her weight.Follow up weights : Birth:1760 gr ; 1 month:2.2 kg ; 2 months: 3 something ; 3 months:smt ; 4 months: smt ; 5 months:smt ;6 months:6 kg
According the growth chart what should you say to mother ?
A.Her growth is slow but not delayed
B.Her growth is delayed
C.Her growth is between normal range
C
320
Q186219- A patient has surgery and on 10th post op day she developed dyspnea & agitated, he being a heavy drinker and a smoker. What is the next appropriate thing to do?
A. ABG
B. Chest Xray
C. Blood alcohol
D. CTPA
E. Ultrasound
A or B
321
Q11103-42yo woman who smokes 20 cigarettes/d presents with complains of heavy bleeding and prolonged menstrual period. What is the most appropriate tx for her?
a. Tranexemic acid
b. COCP
c. Mefenemic acid
d. IUCD
e. Norethisterone
این سوال خیلی تکرار شده :
گزینه دوم ( cocp ) بعلت مصرف سیگار و سن بالای 35 👈 ممنوع
گزینه چهارم ( IUCD ) بعلت خونریزی 👈ممنوع
اختلاف بین گزینه a و e بوده :
1. اندیکاسیون tranexemic acid در 👈خونریزی حاد و شدید
2. اندیکاسیون mirena ( گزینه e ) 👈در خونریزی های شدید و طولانی که منجر به آنمی میشود
بیمار با شکایت پریودهای شدید و طولانی مراجعه کرده و الان خونریزی نداره و بهترین جواب E
🌺🌺البته در ماههای اخیر با a بسته شده با این استدلال که الان خونریزی شدید داره ولی بهترین جواب اوایل مطرح شدن سوال داده شد !
تصمیم گیری با استم کامل 🔥🔥🔥🔥
322
Q10180-12 yrs old school girl suddenly collapsed at school.she was brought by ambulane with dextose drip 60/ml min.on exam dolls eye reflex were present but she was not responding to painful stimulus.her vitals signs were as follows: > R/R 12/min > PR 50/min > SaO2 100% > bp 180/110(?) > if you are working in a tertiary hospital.What is the Next step of management?
A) Arrange for urgent CT Scan
B)S top her dextrose infusion and start on saline
C)Give Steriods
D)Intubate the patient
E)Nuerosurgical Reference
D
323
Q11120- Family moved city to town where low fluoride water there, asking best advise
a. Low fluoride toothpaste ... upto 3 yrs
b. high flouride toothpaste .... from 3 yrs onwards
c. fluoride tablet
?
324
Q9593- 33 year of woman who had done TAH and BSO, t score femur -2.5 and vertebra -1.5, what to give
1. oestrogen therapy
2. oestrogen and progesterone
3. vit D and Ca
4. alendronate
A
325
Q185036-lady on carbimazole for thyroid, now going to be pregnant.what to do?
a. continue carbimazole
b. stop carbimazole
c. decrease the dose
توي سه ماه اول عوض میکنیم و ptu شروع میکنیم ، از تریمیستر دوم دوباره تغییر میدیم به کربیمازول
326
```
Q185502- Nearly like this picture
Man present with 12 hours history of abdominal pain & distension. On examination, pain around the umbilicus, bowel sounds are increased, rectum empty. What is the most likely diagnosis?
a. Intussusception
b. Sigmoid volvulus
c. Ca caecum
d. Appendicitis
e. Perforation
```
A
327
Q185317- family of an old lady with dementia complaints you about they can no longer taking care of her. She awaked early in the morning and go through the drawers and garbage. Often accuse the family as thieves. What is the management?
A-urgently arrange for the nursing home care
B-arrange community nurse to see them
C-admit the patient
Mmse?
328
Q185160- A young female sex worker present for normal check-up and on lab test you found she has gonorrhoea.Besides treating her, what next will you do?
1. Trace contacts of her past one year
2. Ask her to avoid sex
3. Trace contacts of her for past 6 months
4. Trace contacts of her for past 2 months
5. Inform health department
5
329
Q186670- A 48 years old man complains of anorexia and tiredness of a few months duration months earlier routine physical examination and urinanalysis were normal.examination at this time shows slight tenderness over the second & third lumbar vertebrae.The blood pressure is 120/76 mmHg. Laboratory studies reveal: HB=5.0 g/dl, Urea=16mmol/l, Urine:pro=4+, many hyaline casts no red cells. what is the probable diagnosis?
a) chronic pyelonephritis
b) multiple myeloma
c) gouty nephropathy
d) rapidly progressive glomerulonephritis
e) carcinoma of the prostate with spinal metastases
B
330
Q186324- year-old female comes to your office after multiple episodes of unexplained"swellings"during last couple of months.The swellings were non-pitting,non-pruritic and affecting her face,arms and legs.
About 3 months ago,she had an admission to emergency department because she was unable to breath and she was given diphenhydraminate and steroids to relieve her symptoms.
About a month ago she had appendectomy because of severe abdominal pain.
Which of the following investigations is most helpful in diagnosis of this condition?
a. C1 and C4 levels(hereditary angioedema)
b. C1q level
c. Tryptase level
d. Alkaline phosphatase level
e. Serum Immunoglobulin levels
?
331
Q10043-32 year old man who is a smoker and takes cannabis was on depot ziprasidone and lithium and well controlled on it is now thinking of not taking the medications due to akathisia. What will you tell him?
a. If you do not take medications, you will relapse within 2 years.
b. Akathisia is rapidly abolished by benztropine.
c. Akathisia is not caused by these medicines
d. Tobacco and cannabis cause akathisia and stopping these will revert akathisia
بعد از دوماه اکاتاژیای شما برطرف میشه
| اگه این گزینه نبود a
332
Q10148-pt on aspirin, metoprolol, prindopril, indopamide, & mixtard insulin. Suddenly fell and collapsed. On presentation had BP 90/80, RBS of 5.5. I was stuck on this one. Asking what drug caused this? Options were:
a. Insulin
b. Aspirin
c. Metoprolol
d. Pendropril-Indopamide
D
333
Q10269- young man with dizziness and fainting attack during exercise in school but otherwise normal during the day , no family history of such findings. What is the most relevant to see on examination?
```
A-Heart rate less than 50
B- BP 90/50
C-Continuous machinery murmur (Patent ductus arteriosus)
D-Systolic murmur on right upper sternum
E-Presence of S3 murmur
```
D
334
```
Q182093- A 45 year-old male presented with a self-limiting seizure in the emergency department. He is known to have epilepsy which is well controlled with carbamazepine for last 12 months. Blood test don't show any abnormality and there is no obvious cause of the seizure identified. The patient is keen to know for how much time he isn't allowed to drive?
A. 4 weeks
B. 3 months
C. 6 months
D. 12 months
E. 3 years
```
B?
335
Q183286- Pt came with swelling in the leg , duplex was done showed DVT he was started on enoxaparine(1mg/kg) and warfarine 5 mg after 5 days the pain in his leg increased his INR 1.7 , what is the next appropriate step?
A.Change warfarine to enoximab
B.Increase warfarine
C.Change enoxaparine to IV heparin
D.Repeat US
D?
336
Q10045- Hyperkalemia ECG in pt with many medication which interaction cause this ecg:
A.amlodipine and amiodaron
B.amiodarone and aspirin
C.aspirin and fruesamide
D.amlopdepine and frusemide
C
337
Q188013- old man 60 years old who is a heavy smoker for 40 years comes to you with a swelling in the tonsillar region,O/E there is a mass in the tonsillar pouch,what is your diagnosis ?
a. Nasopharyngeal cancer
b. Lipoma
c. lymphoma
d. laryngeal cancer
e. metastatic spread
C?
| scc
338
Q183497-CT scan of diverticulitis in elderly woman with scenario of fever, LIF pain, mild leukocytosis, history of constipation and peri colic abscess found. Most appropriate next treatment?(CT given)
A.Broad spectrum antibiotics with gut rest
B. Prednisolone
C. CT guided drainage
D. Laparoscopic surgery
E. sigmoid resection
A
339
Q187179- Woman has left groin mass. No trouble for her. On examination, discrete, tender, smooth surface 3cm mass is felt just below and lateral to pubic tubercle. Which is appropriate?
a. Abdominal USG
b. CT abd and pelvis
c. Surgical exploration
d. Fine needle aspiration
e. Core biopsy
C
340
Q188068- Old px underwent surgery of femur fracture, 7 days after had dyspnea and confusion. On auscultation, there is crepitation in right lower lobe.
A.PE
B. fat embolism
C. pneumonia
D. aspiration syndrome
A
341
Q185341- Human bite recall. 35 years old man went to pub, where a woman bite him, totally unknown and she went away. 2 cm lesion, bleeding continues, teeth mark, he is fully tetanus immunized 3 years ago. What to do now?
A-suture and review in 24 hours
B-hep B vaccine and immunoglobulin
C-zidovudin
D-flucloxacillin
E-Aziathromycin
D
342
Q9922-Patient BMI 32. Everything normal. Amenorrhoea for 12 month. Previously irregular (5-6 times yr). Now came for infertility Fsh 2 (normal <3) LH normal Prolactin 450 ( upto 700) TSH Normal range Oestradiol normal range What inv to confirm
a. S.testosterone
b. usg
c. CT scan
d. Endometrial biopsy
B
343
Q11387-48 years old woman last menstruation was 8 month ago come with vaginal bleeding. what is the most common cause?
a) endometrial cancer
b) cervical cancer
c) vaginal atrophy
d) follicular activation
e) cervical glandular hyperplasia
D
344
Q182589- 1 year old child diagnosed with bacterial meningitis was admitted to hospital.blood culture taken and iv ceftriaxone started.after 1 day of admission child had a seizure of <1 min duration.long labs were given sodium and bicarbonate low.all others were in normal range.what is the cause of seizure?
a. SIADH
b. dehydration
c. adrenal failure
توجھ بفرمایید کھ سیژر خودش باعث کاھش مختصر بیکربنات می شود .
این کیس siadh ھست کھ در بیماران مننژیتی و التھاب مننژ بعلت افزایش ترشح adh بروز میکنھ .
بود و فقط یک سیژر زیر یک دقیقھ تظاھر آن نیست و اگر فرض بر سندرم waterhouse frderichshen و خونریزی آدرنال باشھ ، پتاسیم بالا و گلوکوز پایین ومریض خیلی بدحال خواھد
ضمنا عدد پتاسیم ھم نداده
و این بیشتر ھیپوناترمي ایزووالیومیك اس اي دي اچ
چون ادرنال اینسافیشنسي یك بیماري خیلي خیلي فولمینانت تره
من باشم بین الف و سي بازھم با این استم الف میزنم
یك تشنج گذرا داشتھ
شیشم بیمار درد شكم نداره
پنجم الان چھ كلوي دیگھ بھ نفع ادرنال اینسافیشنسي داریم
چھارم توي اكثر عفونتھا بلاخص گرم منفي ھا ممكنھ ھیپوناترمي داشتھ باشیم
سوم اینكھ توي ھر عفونت باكتیك اسیدمي و بیس اكسس منفي دیده میشھ
دوم اینكھ شرایط عمومي بیمار بد نیست اونقدري كھ بخواد ادرنال اینسافیشنسي باشھ
یكي اینكھ الان مننژیتھ نھ مننگوككسمي
345
Q9045- An alcoholic, very agitated, rushed to the emergency department with many complaints, claiming if he is not attended to immediately he will jump in front of a car. What will you check first?
a) Alcohol level
b) magnesium level
c) serum electrolytes (Na+ and K+)
C
346
Q10026-6th post partum day, presents with seizure GTCS, no previous episode or h/o seizure.3 episodes after reaching ER controlled with Midazolam. next
a. Magnesium
b. phenytoin
c. phenobarbitone
d. valproate
A
347
Q11196- Young man, with hereditary spherocytosis (AD), asking how many of his siblings will be affected:
a. 50% of all siblings
b. 25% of all male
c. 25% of all siblings
d. 50% of all male
e. None
A
348
Q183531- boy 7 yr old with recurrent abscesses.each time staph aureus positive.low weight and height acc to age.o/e pharyngitis gingivitis and multiple scabs of abscesses.what is helpful in diagnosing the underlying cause.
a. lymphocyte count
b. neutrophil function
c. complement level
d. antibody level
B
349
Q187610- 60 yr lady with pain controlled on regular opioid analgesics come for a new prescription.2 weeks ago u gave her a prescription of 2 month but she now comes and says the pharmacist made a mistake in dispensing the drugs.pharmacist denied any mistake in dispensing.what will u do?
A.precribe her 2 weeks opioid
B.ask the pharmacist any record of dispensing
C.document the discrepancy between women and pharmacist saying
D.report abt women's telling lie
C
350
Q186111- 2 yrs old Child with irritability, fever 39.8 chills ,abdominal pain,. on examination looks unwell resp rate 30 heart rate 120, treatment?
a) oral amoxillin
b) oral roxithromycin
c) iv penicillin
d) iv flucloxacillin
A or c
| استفراغ
351
Q185456- Pregnant woman 39 weeks , no fetal movement , CTG pic given- normal.....what to do Next
A)Reassure and ask her to come after 24 hour
B)Induction of labour
C)C section
D)Reassure and ask her to come in the next visit
E)Admit and do further investigation
D
352
Q91044- The picture of prolapsed hemorrhoids asking most common presentation:
a. Painful defecation with bleeding
b. Painful defecation without bleeding
c. Painless defecation with bleeding
A or c
353
Q188152-A 72 yrs old woman presents with confusion and O/E she was found to be afebrile and nothing abnormal was detected. She has an ulcer on the lower part of her leg, which has been treated by the community nurse for several months. What will assist in the diagnosis?
a. Urine test
b. Swab of the wound
c. Blood culture
d. CT scan
e. Lumbar puncture
?
354
Q187184-DM patient with injury to left index finger prior 2 days. Which indicate deep tendon involvement?
1. Clear vesicle on finger tip
2. Pain on extensor tendon sheath
3. Flexion posture of finger
4. Pain on passive flexion of left index finger
5. Fusiform formation of finger
Semi flexion
| C
355
Q183219- Family history of father and paternal aunt died at 50 years of age. Patient complaint of wide based gait and verbal dysfunction. What is your next management?
A.Genetic counseling
B.Lumbar puncture
C.Serum cooper and ceruloplasmin
D.MRI
E.CT head
D?
356
Q184114- A young man has a syncopal attack while weight lifting. He has had similar episodes twice before. His father died of cardiac disease. What is the most appropriate management?
a) Holter monitor
b) Echocardiogram
c) Stess test
d) BP in supine & lying down
e) CT scan
براي تشخیص hcom اول اکو ، اگه اون چیزي نشون نداد بعد استرس اکو)استرس تست
357
Q187203- Women taking trifluoperazine (1st generation antipsychotic) feels like volcanic eruption in her stomach lost contact with psych.stop drug dt movement disorders asking rx
a. triflouperazine
b. haloperidol
c. quetapine
d. clozapine
C
358
Q187242-A 45 yr old lady smoker and htn uses ocps for many years, BP 150/90mmHg now comes re prescription and well controlled on her menorrhagia and also says doesn't want to conceive. Don’t want to change cause it has been good for her menorrhagia. What advice now?
Nearly exact scenario
A. provided that she stop smoking then can give ocps
B. Use implanon
C. Use copper iud
D. Use progestrogen only pill
E. Use condoms +ocps
D
359
Q187245- Scandinavian female 35years BMI 30 (consumption of snus+ can develop DM type2) for first antenatal check-up . What will you do?
a. OGTT as soon as possible
b. OGTT @ 24-28 weeks
A
360
Q195526-A man was brought by his wife who had complained of sudden onset of tongue swelling. He is a known diabetic treated with metformin and chlorpropramide, hypercholesterolemia given simvastatin and hypertension for which he takes ramipril. His GP prescribed him amoxicillin 2 days ago for a URTI. On examination, tongue is swollen. He has difficulty speaking and points to his tongue. Wheezing can be heard on auscultation. Which of the following drugs is responsible for the patient’s presentation?
A. Metformin
B. Chlorpropramide
C. Simvastatin
D. Amoxicillin
E.
Ramipril
E
361
```
Q186280- your in a rural area and 4 cases of trachoma come to you then you find out extra 20 how can you treat acute indexes ? Apart from hand washing , what will u give?
b-oral azithromycin
c-doxycyclin
d-don’t do anything
e-penicillin
```
```
درمان تراخم ⬅️SAFE
S= surgical
A= antibiotic ( Azithromycin)
F= facial cleanliness
E= enviromental health
```
362
Q188127- Old man came with his wife.she complains that he gets confused
sometimes and has stopped reading news paper.He still drives, sometimes at
night .mmse 26/30 .what are you gonna do about it?
a- Cease driving at night
b- Repeat mmse after 3 months
c- MRi of brain
d- advice to do more mental and physical activities
e. assess him for treatable demential conditions.
E
363
Q188196-3 years old male presented with VF cardiac arrest.first shoch delivered on artival in ED after 2 min CPR done.still in VF.what is the most appropriate step?
A.feel for presence or absence of pulse
B.give adrenaline 1ml 1:1000 i/v
C.deliver a second shock 200 j
C
364
Q185355- A lady present to you and she tells that God tell her `Fast 40 days and time so that World War end .She is orientated and decline her to test other function. What is your first line of management?
A) Zuclopenthixol
B) Diazepam
C)Quatiapine
D) Risperidone Consta
E) Clozapine
تو اين سوال گزينه اول و چهارم تزريقي هستن گزينه دوم بي ربطه گزينه چهارم هم در موارد مقاوم ميديم
365
Q187353- Female 39 weeks pregnant came with lower abd pain for few hour which have become more intense over few hours. Which of following represents that labour has started
a. inc no of contractions
b. inc frequency of contractions
c. inc severity of pain
d. repture of membranes
e. dilation of cervix
E
366
Q11357- CT abdomen with symptom of weight loss and dark urine with abdomen fullness and she had heart failure with EF 20% . What is the next step :
A. Open cholecystectomy
B. Whipple’s procedure
C. Percutanrous transhepatic cholangiography
D. ERCP
D
367
Q10430-Short term dementia mmse given 24 something . Wants to change will . Daughter says it would be illegal to do so
A. She can change her will
B. She can't
C. Refer for neuropsychiatric review
D.Ask lawyer
C
368
Q10494- Old man, back pain one week ago while working in the garden, now came with point tenderness, low grade fever, what is the likely dx
A.Discitis
B.herniation
C.sepsis
D.vertebral fracture
A
369
Q188045- Pt BP 110/50 mmHg, on exam a pulsatile abdominal mass felt in midline, with severe pain radiating to back. Most appropriate next?
a) Urgent laprotomy
b) USG
c) CT
d) Aortogram
e) NS
C
370
Q186493- woman is planning to do the IVF..she is well controlled on lithium..she takes 1000mg of lithium per day.what to do now?
1. reduce the dose
2. cease lithium
3. check the blood lithium level
Pros and cons
371
Q186095- A 60 y.o. man develops lightheadedness and palpitations. He has hx of thyroid disease and well-controlled heart failure. He is on thyroxine, ACEI, diuretic. ECG is given – clearly showed AFib. What is the next step?
a. Cease thyroxine
b. Start digoxine
c. Start b-blocker
d. Start verapamil
B
372
Q188269-A boy is brought in by the father to see you because he has become very inattentive in school with falling grades. He is said to have been having recurrent bilateral ear discharge for some months back. On examination, boy was sitting calmly and in attentive he had bilateral hearing loss with findings of ear examination as below What is the next step in management of this child?
A-Ciprofloxacin ear drop
B-Tympanic membrane grafting
C-Hearing aid
بسته به عکس
373
Q182326-Non healing ulcer, old patient, seen by a community nurse twice a week, needs doctor, what to do –
A.involve the family,
B.visit hospital,
C.swab to be taken
?
374
Q10359-Patient conceived after IVF at is at 22 week gestation, PPROM, going to deliver in one hour. You are a GP at rural area. Patient’s husband is anxious. Weight of baby is 270 g. What is your next step in management?
a) Prepare for active resus
b) Refer
c) No active resus
C
375
Q187616- 76 year old female is on warfarin for Atrial fibrillation. She presented with second episode of TIA. What is the most appropriate initial investigation you will do next?
A- Echo
B- 24 hour Echo
C- MRI brain
D- Carotid Angiography
E- CT brain
C
376
Q186515- Patient TFT given: TSH on higher side, T3- low, what next investigation to do?
a) MRI brain
b) Thyroid antibodies
c) Thyroid scan
d) USG neck
A
377
Q188418-Patient on fluoxetin for depression and nifedipin we for htn.one month ago Fluoxetine vwas decrease. Now palpitation and sinus tachycardia. Bp 135/ 75.cause
```
A)Drug interactions
B)Niphidipine
C)Fluxetin toxicity
D)Neuroleptic malignant syndrome
E)booster at 6 month
```
CBC + SSRI
hypotension bradycardia
A
فلوكسيتين از طريق مهار كبدي/ روده اي انزيم CYP3A4 باعث افزايش سطح خوني و اثر نيفيديپين ميگردد.به همين دليل در همزماني مصرف اين در دارو باهم دوز كمتري از نيفيديبين تجويز ميگردد.
در حال حاضر كه دوز فلوكسيتين كاهش يافته، بايد دوز نيفيديپين رو افزايش بديم.
گزينه A به علت تغيير همزمان فعاليت يك كمپلكس انزيمي با دو دارو گزينه صحيح هست.
♦️ سندروم نورولپتيك بدخيم هم سندرومي هست با علايم ريجيديتي، تب، ناپايداري اتونوم،تغيير سطح هوشياري و... كه بيشتر در مصرف انتي سايكوتيك هاي اتيپيك و كلوزاپين ديده ميشود.
378
Q10396- A child got hit on the head in school. Was brought to the ER with increasingly deteriorating consciousness. I think the GCS was 8 or less. Don’t remember. The parents are a few minutes away. What to do as the next step?
a) Wait for the parents
b) Take consent from the teacher
c) IV mannitol
d) IV dexa
e) Urgent CT scan
E
379
Q184267-A 25 year old man from local correlation facility and the police brought him as a request for checking him up . He complained of with abdominal pain n tenderness for a day. He has many tattoos on his body and poor dentation(SURE) (No other history provided) What is your dx?
(A CXR is given with some radio-opaque curvy lines which seem to be hairs, and a straight radiopaque line likely to be needle was seen.)
a. Factitious disorder
b. Schizophreniform
c. Developmental instability
d. Eating disorder
e. Schizophrenia
A
380
Q183299- Recall of man with fever n swollen knee join on aspiration rhomboid crystals with GRAM POSITIVE COCCI
A.IV ceftrioxne
B.Colchicine
C.Prednisolone
D.Arthroscopic washout/debridement
D
381
```
Q186585- 5o y old woman complain pain in mid thoracic region + weakness of legs progressing over 2 past months O/E found spastic paraparesis Dx
1-multiple sclerosis
2-tabes dorsalis
3-motor neuron disease
4-spinal cord compression
5-parasagital meningioma
```
D
382
Q185425- A community service person contacted you to check on an old woman living alone. Upon entering, you find out that she managed her
home poorly with messy living room and dirty sinks. She's disheveled in her bedroom. She called you by her daughter name at first. Then, she shouted you to get out and leave her alone. Then she suddenly attacks you. What is your immediate response?
A. Leave
B. Call police
C. Restraint her
D. Sedate her
E. Go to lawyer
A
383
Q186425- a 47 y/o man presented with palpitations and found to be in AF with increased rate. Reverted spontaneously to sinus rhythm but this is her third episode in last 2 years. Echo norml. BP: 152/88 . first line prophylaxis:
```
A. bisoprolol
B. verapamil
C. ramipril
D. digoxin
E. amiodarone
```
A
384
Q188005- Michael is a 60 years old man with history of TI a year ago and controlled hypertension and DM. Three months ago, he had an episode of DVT and has been warfarnized since then. He has been recently diagnosed with cholecystitis after stabilization with fluid and antibiotics he will have his elective surgery in 5 days, what will be your plan of management of warfarin pre operatively?
A- Change to heparin until two days before surgery then check INR
B- Cease warfarin today until the day of surgery
C- Measure the INR, if it’s less than 5 continue warfarin
D- Cease warfarin and change to LMWH from the 4th day until the 12 hours
before surgery
E- Cease warfarin and change to heparin now
D
385
Q188026- A case with genital ulcer with h/o multipartner and signs of meningitis.on CSF raised glucose,polymorph nuclear cells predomonantly.which organism is responsible for this?
1. HSV-rbc
2. HIV
3. pneumococcus
4. meningococcus
5. treponema pallidum
5
386
Q189051-ECG with bradycardia and prolong QT or sth like that, In scenario patient came with chest pain for 15 min and relieve by rest. Troponin normal. Pulse – normal and regular. BP normal. What to do next?
1. repeat troponin
2. echo
3. coronary angiography
4. repeat ecg
D
ECG 0 1 6
Troponin 0 6 12
387
Q182462- which of the following regarding antidepressant therapy is correct?
A) Patient with no improvement after 2 weeks should stop and receive another drug
B) patients unresponsive after 6 wks, treatment should be altered
C) if no improvement after 6 weeks, depression is unlikely to be the cause
B
388
Q187434-a company want to do a study regrding effectiveness of a drug.what will be null hypothesis of this study?
a. no change in efficacy between two drug
b. signiificant dif in efficacy if p value >.05
c. signiificant diff in efficacy if p vaue
A
389
Q188548-4 year old child difficulty in swallowing for 2 days . not willing to eat solid food but only drink milk repeatedly.no cough mentioned. His brother had asthma. On examination child is well and normal examination. What to do now?
x ray neck chest and abdomen
Salbutamol
barium swallow
Endoscopy
390
```
Q188050- Pt had recurrent episodes of renal calculi proved to be calcium oxalate, this time coming with hematuria. what's ur management
A. Thiazide
B. Low salt diet
C. Allopurinol
D. Spironolactone
E. Low calcium diet
F.cxr
```
A
391
Q187195- 3 children from day care center Dx with HepA. What to do to prevent?
A- Test all kitchen staffs with hepA IgM
B- Quarantine all children with fever
C- External catering service
D- HepA vaccine to all HepA non-immunized children and staffs
E- Close day care center for 14days
D
392
Q11021- That recall of child with testicular swelling. The exact scenario was child with acute scrotal pain and swelling. On examination both testes were separately palpable and non tender. Swelling and redness also over the penis. What is the most likely diagnosis?
a. Torsion of testis
b. Epididymo-orchitis
c. Strangulated incarcerated hernia
d. Hydrocoele
e. Idiopathic scrotal edema
E
393
```
Q187609- A 46 years female presented with lower abdominal pain for 2 days. Her last menstrual cycle was normal n three weeks ago. On examination there is mild tenderness n fullness in right adenexa. Usg shows cystic mass of 10 cm in right ovary whats the diagnosis??
A. Krukunberg tumor
B. Luteal cyst
C. Serous cystadenoma
D. Cystoadenosarcoma
E. Mucinous cyst
```
C
تومورKrukunberg متاستاز به تخمدان از سیستم گوارشی بیمار ما علامت گوارشی ندارد
کیست لوتال معمولا زیر ۵سانت (رفرنس اوزی) اگر عارضه دار شود علامت میدهد مثل مصرف انتی کواگولان یا مشکل انعقادی
کیست serous cystadenoma کیست مولتی لوکولار حاوی مایع سن ۳۵ تا ۵۵ سال شایعترین کیست اپیتلیومی
تودهCystoadenosarcuma علامت دیگر مثل کاهش وزن و اسیت نگفته ودر کل مریض خوبه
کیست mucinois سایز بزرگ هستند بیمار جوانتر است مثلاً ۳۰ ساله و lobulated مولتی لوکولار است و حاوی موسین
394
Q187179- Woman has left groin mass. No trouble for her. On examination, discrete, tender, smooth surface 3cm mass is felt just below and lateral to pubic tubercle. Which is appropriate?
A- Abdominal USG
B- CT abd and pelvis
C- Surgical exploration
D- Fine needle aspiration
E-Core biopsy
C
395
Q187243-A 23 year old lady presents to you asking for advice regarding the need for Chlamydia screening. Her last year pap smear was normal but now she wants to check for STD screening. Reason for chlamydia screening
A. It can be asymptomatic.
B. It causes infertility.
C. Her partner could be asymptomatic.
D. She does not need the test
A
396
Q187324-young girl Came with menorrhagia. Absent from work because of menses pain & heavy flow. From history & exam, cannot find cause. You ordered several lab investigations but she insists to give medication. Her cycles were regular
A- OCP
B- Oestrogen patches
C- Mefenamic acid during period
D- tranexamic acid during period
C
397
Q11103-42yo woman who smokes 20 cigarettes/d presents with complains of heavy bleeding and prolonged menstrual period. What is the most appropriate tx for her?
a. Tranexemic acid
b. COCP
c. Mefenemic acid
d. IUCD
e. Norethisterone
?
398
Q187185- A man is brought for assessment following car accident. His car is rear-ended at traffic light spot. Although air bag is not activated, he complaint of chest pain, breathing difficulty and dizziness. On examination, he is agitated, flushed and palpitation. PR 110/min. PB 135/80 mmHg. Breath sound normal and other physical examinations are normal. What next?
A- Blood alcohol
B- Blood glucose
C- CXR
D- Echo
C
399
Q187328-pregnant woman at 12 weeks gestation presents with heavy bleeding had an ultrasound Nuchal translucency at 11 weeks Abdomen rigidity, tenderness. Maternal hypotension and tachycardia. Asking diagnosis
a. incomplete abortion
b. threatened Abortion
c. Ectopic pregnancy
d. Placenta previa
e. molar pregnancy
A
400
Q183095- Indigenous child with chronic suppurative otitis media presents with chronic ear discharge. Ear swab done showed existence of pseudomonas aeruginosa organisms. After ear toileting what will u do?
A. Oral Amoxicillin
B. Oral Augmentin
C. Ciprofloxacin ear drop
D. Paramycetin with steroid ear drops
E. Hearing aids
C
401
Q187256-What is the most important indicator in finding health risk of obesity?
A. BMI
B. Waist Circumference
C. Waist hip ratio
D. skin fold thickness
C
402
Q187203- Women taking trifluoperazine (1st generation antipsychotic) feels like volcanic eruption in her stomach lost contact with psych.stop drug dt movement disorders asking rx
a. triflouperazine
b. haloperidol
c. quetapine
d. clozapine
C
⭐️⭐️⭐️⭐️⭐️
بطور خلاصه:
آنتی سایکوتیک های نسل اول مثل: تری فلوپرازین، پیموزاید، پرفنازین و... عوارض اکستراپیرامیدال (دیستونی حاد، پارکینسونیسم، دیسکنزی تاخیری) بیشتر دارن..
نسل دومی ها مثل: رسپریدون، کوییتاپین، آریپیرازول و... اکستراپیرامیدال کمتر دارن ولی باعث افزایش قند، چربی و وزن میشن
403
Q189232-65 yr old man with nocturia and long hx of dribbling urine problems for 3 months with median sulcus palpable smooth prostate ,On examination ,2 fingers above the pubic symphysis what next
A. Urine cytology
B. PSA
C. Bladder scan
D. CT scan abdomen
E. serum creatinine
E
404
Q189229- A mother came with her two children. Mother's brother has haemochromatosis. What screening test advice would you offer?
A.Screen only mother
B. Screen mother and kids
C. Ask her to come with her husband
D. Screen only the children
A
405
Q11429- A male child get HS ( hereditary spherocytosis). What is the chance of his siblings getting the same condition?
```
A. 50% of all siblings will get it
B. 25% of all siblings will get it
C. 25% of male siblings will get it.
D. No one will get it
```
A
406
Q186720- a child 10 yr old refuses to go to school . he developed frequent touching of his face and raise his arm above his head and crawl his hand on the around. he can supress doing those things but developed anxiety if he suppress those things . his classmates make fun of him coz of those behaviours and his teacher also annoy,what is the diagnosis?
a) asperger disease
b) ADHD
c) complex motor tic disease
d) Tourette syndrome
C
407
Q184036-pt of crohns disese was on sulfasalzine prednisonlone,azathioprine labs given neutrophils and wbc low hb low, cause
A.Sulfasalazine
B.predniosonlne
C.azathioprine
C
408
Q9956- child presents with rash on eyelids and muscles pain symmetrically
a. dermatomyositis
b. polymyositis
c. polymyalgia rheumatica
d. sle
A
پلی میوزیت:
* میوپاتی التهابی ایدیوپاتیک
* شروع تدریجی علایم طی ۳-۶ ماه
* پیک سنی: ۶۰-۴۰ سال
📍علایم:
* جنرال👈 خشکی صبحگاهی، خستگی، انورکسی، کاهش وزن، پدیده رینود(در صورت همراهی با سایر بیماری های بافت همبند)
* ضعف عضلانی پروگزیمال قرینه با شروع تدریجی👈 سختی در بالا و پایین رفتن از پله، شانه زدن و .../ سختی نگه داشتن سر/ ممکنه در طی روز falctuation داشته باشه
* درد علامت بارزی نیست(۵۰٪)
* درگیری عضلات ازوفاژیال و لارنژیال👈 دیسفاژی و اسپیریشن
* ارترالژی ممکنه وجود داشته باشه(۵۰٪)، حتی قبل از تظاهرات عضلانی
* درگیری عضلات کمربند لگنی بارزتر از قسمت فوقانی بدن
* درگیری قلبی👈 پریکاردیت، کاردیومیوپاتی
* درگیری عضلات تنفسی👈 exertional dyspnea
📍معاینه:
* سنسوری نرمال
* ضعف عضلات پروگزیمال که گاهی در لمس تندر هستند ولی معمولا بدون درد
* رفلکس ها نرمال(مگر در بیماری خیلی پیشرفته که عضلات اتروفی شده اند)
📍بررسی ها:
* لکوسیتوز در ۵۰٪
* افزایش ESR,CRP در ۵۰٪
* میوگلوبینوری
* RF مثبت در ۵۰٪
* اتوانتی بادی ها👈Jo1
* افزایش CK 👈 به اندازه ۵۰-۵ برابر نرمال(همراه با LDH و AST)
* غیرطبیعی بودن EMG در ۹۰٪ بیماران(فیبریلاسیون)
* بیوپسی عضلانی 👈 جهت رد سایر بیماری های عضلانی
*
✅به بدخیمی های همراه توجه شود(پارانئوپلاستیک) 👈 ریه، تخمدان، پانکراس و روده
📍درمان:
* خط اول: کورتیکواستروئید معمولا ۴-۸ هفته
* داروهای ایمونوساپرسیو
درماتومیوزیت:
* تظاهرات پوستی هم دارد:
- راش heliotrope-colored photosensitivity روی فورهد، گونه ها و پلکها همراه با ادم پره اربیتال
- راش روی سطح پشتی دستها (پاپول گوترون) و اریتم nail fold
- راش روی زانو
- راش ماکولر روی شانه ها و پشت 👈 shawl sign
- کلسیفیکاسیون زیرجلدی
* بیوپسی از پوست هم میتوان گرفت
نکات:
شروع تدریجی ضعف 👈 به نفع میوپاتی
شروع حاد 👈 میوپاتی ناشی از دارو یا متابولیک ، نوروپاتی
درد در استراحت و تندرنس در لمس👈 میوپاتی، کمبود b12
409
Q187409-GP working at a remote aboriginal increasing.what will u do do reduce incidence of STD?
a. tv campaign
b. lecture in community health centreregarding effect of STI community where STD
c. arrange community wide progamme directed well behavior and knowledge
d. educate school age child
e. arrange peer education for aboriginal male
C
410
Q188053- A patient on Warfarin for AF came with rectal bleeding, INR 9, hypotension and tachycardia. Initial management:
A. Give Vitamin K
B. Give FFP
C. Cease warfarin
D. Give platelet
B
411
Q184198-New Q of 16 old boy who his grades fall because he doesn't pay attention to lectures and he do some Skitch drowning instead of studing , he had fight with one of his colleagues and when you interviewed him he couldn't make eye contact with you and was unable to explain his condition , he denied taking Alcohol or non prescribed medications
A Asperger
B Dysthemia
C bound alcohol and drug
D Conduct
E Schiz
E
412
Q183549- old lady with htn d.m on lots of drugs.now came with increased drowsiness and loss of appetite. Given lots of labs Cbc,rfts,tfts,lfts Ca phosphorus level. Everything was normal except urea and creatinine it was high
a. iv normal saline
b. hemodialysis
c. ca gluconate
d. resonium
A
413
Q186104-
violence and crime are rising due to alcohol use following drought and financial breaks in a town. You are asked as a gp to devise a plan. Which one is the most approptiate?
a. Involve the police
b. Limit alcoho retails
c. Design pamphlets about alcohol harms
d. Set up an organizatiob for financial and psychosocial support
C
414
Q188442-.Urologist and RMO did surgery of urethral operation. Urologist suggest a drug that is not prescribed by hospital for this patient. As a RMO what to do next?
A.tell pharmacist to discuss with urologist
B.you as a RMO discuss with urologist
B
415
Q188310-A 14 year old girl who lives with her family has come to you for contraception as she is going to be sexually active in the near future. She doesn’t want her parents to be aware of this. What will u do?
A. Give her contraception
B. Ask her about the identity and age of her sex partner
C. Tell her that she needs parents’ permission
D. Inform her parents despite her objection
E. Give her contraception and Tell her to ask her partner to use condom.
B
416
Q11052-34 year old female. married for 10 years. complains of insomnia .she also has anxiety and irritability especially before onset of periods which have been particularly heavy in the past few cycles. She is worried that her reduced libido is affecting her relation with her husband. However she enjoys time in office and around friends. what is the best pharmacological approach?
a. Primrose oil daily
b. Sertraline 100 mg
c. bendrofluazide
d. COCP without pill free week
e. POP
D
417
Q187089-Non-Australian patient admitted for #femur & ribs after car accident. He was driving a stolen car, which turned over while being chased by police, someone is killed in the accident. He is aggressive, argumentative, demanding to smoke. Later, threatens that he will assault staff, discharge himself & will go to his embassy & complain about inappropriate behavior of hospital. What will you do according to his last action?
a) Discharge immediately to police custody
b) Refer to nearest medical ward with correctional facility
c) insist rather he use nicotine patch
d) Tell the embassy about his expired temporary visa
e) allow him to smoke in smokers room safely away from other patients
C
418
Q187707-Woman with depression (explain about her depression history ) now we want to do ECT for her as a treatment . We explain for her about ECT and she accepts it ..What should be explain for her about ECT?
A) ECT is a modern technique
B)Don’t read about ECT in internet and social media because they have a bias (exactly use bias)
C) ECT is the only way of your treatment
D)ECT is good way on the base of clinical trial
D
419
Q9252- 70 yrs lady has previous 2 times H/o vertebra # or something like this and now again with the same issue..all her vitD,Ca, Albumin all level ok, she is on raloxifene 25 mg, what to do now
A.continue current treatment
B. increase Raloxifene dose to 50 mg
c.stop raloxifene and start Alendronate
D. continue raloxi and add Alendronate
E. once weekly injection
?
420
Q188437-an aboriginal mom came 4 immunization.don't eye contact,want to leave home quickly.........
a. observe mood in next visit
b. inform child protecttion
c. send a nurse 4 home visit
d. contact local aboriginal authority
E. ask her to bring a family member next time.
E
421
Q9028-3 year old child, pain ,limping..on examination tenderness onknee,, No definite swelling,no fever..next
step(Hb: low..Plt..low..Esr:high)
A: aspiration of knee
B: xray of knee
C:bone scan
D:bone marrow examination
E: FBE
اگه دو رده پایینه بررسی لام خون محیطی و bm
422
Q11246-Young man who is previously healthy , also a marijuana user was brought to ER. He is v active now and said he has been attack by Underground gangsters and police is also following him. His friends said he has seen many times using amphetamine at parties. Which one of the following is imp risk factor?
1) Cardiotoxicity from amphetamine use
2) Gangsters are after him
3) Police
4) co morbid drug abuse
A or D
423
Q182175-Patient presented with dyspnea on exertion and shortness of breath. She was on digoxin and ramipril and frusemide. She failed to take the drug for 3 days because she was on a trip. There is bilateral basal crepitations and leg edema up to knee. JVP is raised. What is your most appropriate investigation?
A. Check digoxin level
B. Echocardiogram
C. Electrocardiogram
D. Serum urea and creatinine
E. Troponin
B
424
Q184421- 50 year old man present with hypertension with asthma and reflux nephropathy. lab inv were given. There was high urea,high creatinine and proteinuria 900 mg/day. What is the choice of anti HTN?
1. amlodipine
2. losartan
3. perindropil
4. indapamide
5. metoprolol
B
425
Q9587- ecg ventricular ectopics , of 65years old man on hypertensive treatment &history of MI 3yrs ago ,now all examination is normal except of soft blowing precordial murmur on the left border of sternum .. what to do ?
a. cease metaprolol
b. cease metaprolol & commence verapamil
c. add warfarin ??
B or C سام
426
Q186281- 40 years old man complain from persistent abnormal thoughts that’s making him washing his hands at least 10 times after touching the key or door.he is on SSRI but want to try non pharmacological therapy to help him get rid of this thoughts
Teach him how to avoid touching the doors or key
Explain him that this thoughts is normal to relieve his anxiety
Refer him to insight oriented psychotherapy
Have psychological evaluation
Cbt
427
Q188193-U r on duty of conducting interviews of doctor for a certain post in hospital, u come to kno dat one of ur colleagues is assessing d medical reports of applicants, wat s ur immediate action
A-Tel doctor it s not correct
B- inform ur superior
C- inform ApRAH
B
428
Q10359-Patient conceived after IVF at is at 22 week gestation, PPROM, going to deliver in one hour. You are a GP at rural area. Patient’s husband is anxious. Weight of baby is 270 g. What is your next step in management?
a) Prepare for active resus
b) Refer
c) No active resus
C
429
```
Q187616- year old female is on warfarin for Atrial fibrillation. She presented with second episode of TIA. What is the most appropriate initial investigation you will do next?
A- Echo
B- 24 hour Echo
C- MRI brain
D- Carotid Angiography
E- CT brain
```
C
430
Q186515- Patient TFT given: TSH on higher side, T3- low, what next investigation to do?
a) MRI brain
b) Thyroid antibodies
c) Thyroid scan
d) USG neck
B
431
Q188058- Pregnant young women with DM type 1, comes with vomiting and ketones ++, Hba1c 16%. What to do?
A. Infusion of dextrose and insulin
B. Insulin 10 unit
C. Cek ketones in urine
D. IV saline 1L in 12 hours ( yes twelve hours)
B?
432
Q188418-Patient on fluxetin for depression and nifedipinwe for htn.one month ago Fluoxetine vwas decrease. Now palpitation and sinus tachycardia. Bp 135/ 75.cause
```
A)Drug interactions
B)Niphidipine
C)Fluxetin toxicity
D)Neuroleptic malignant syndrome
E)booster at 6 month
```
A
433
Q183299- Recall of man with fever n swollen knee join on aspiration rhomboid crystals with GRAM POSITIVE COCCI
A.IV ceftrioxne
B.Colchicine
C.Prednisolone
D.Arthroscopic washout/debridement
D
434
Q184439- Woman after vaginal delivery. 2700gm baby. Previous c section. Ergometrine given,placenta delivered through cord traction. Now PPH. Cause?
A. Uerine atony
B. Uterine inversion
C. Uterine rupture
B
435
```
Q186585- 5o y old woman complain pain in mid thoracic region + weakness of legs progressing over 2 past months O/E found spastic paraparesis Dx
1-multiple sclerosis
2-tabes dorsalis
3-motor neuron disease
4-spinal cord compression
5-parasagital meningioma
```
D
436
Q186425- a 47 y/o man presented with palpitation and found to be in AF with increased rate. Reverted spontaneously to sinus rhythm but this is her third episode in last 2 years. Echo norml. BP: 152/88 . first line prophylaxis:
a-bisoprolol
b-verapamil
c-ramipril
d-digoxin
e-amiodarone
A
🌺در مورد این سوال چند تا نکته هست که توجه کنید
1. بیمار یک lone AF هست در یک فرد جوان .یعنی اکو شده و structural heart disease نداشته و CAD و .. هم نداشته
2. پاروکسیسمال AF هست یعنی کمتر از 24 ساعت خودبخود سینوس شده ولی حملات تکرار شونده هست پس باید ساپرس بشه
3. در بیمار پاروکسیسمال AF هم از نظر تصمیم برای آنتی کواگولان تراپی مثل بیمار AF پایدار برخورد میکنیم ...چادز وسک و...
4. آمیودارون داروی بسیار خوبی برای convert کردن ریتم و نگه داشتن در ریتم سینوسی هست ولی بعلت عوارض زیاد هیچ وقت خط اول برای طولانی مدت نیست مگر بیمار اندیکاسیون خاصی داشته باشه یا کنتراندیکاسیون سایر داروهایی مثل سوتالول یا فلکائینید ..
توی این اسلاید ... حتی وقتی بیمار AF داره و تصمیم گرفتیم ریتم رو کانورت کنیم زمانیکه structural HD نداره , آمیودارون خط اول نیست ..
و جز داروهایی که برای convertion بکار میره اینجا هم بتابلاکرها رو نام برده ...و یکی از بهترین بتابلاکرها برای این هدف بیزوپرولول هست
🌺توی این سوال برای پروفیلاکسی اولا باید فشار بیمار خوب کنترل بشه و شروع بتابلاکر برای نگه داشتن در ریتم سینوس و چه دارویی بهتر از بیزوپرولول که هم فشارش رو خوب کنترل میکنه و هم با هدف کنترل و پایدار نگه داشتن ریت و ریتم ..
🌺به نظر من برای یک بیمار 47 ساله با پاروکسیسمال AF بدترین کار این هست که first line آمیودارون شروع کنیم..
برای این بیمار عوارض af کمتر از آمیودارون است 😉
437
Q188005- Michael is a 60 years old man with history of TI a year ago and controlled hypertension and DM. Three months ago, he had an episode of DVT and has been warfarnized since then. He has been recently diagnosed with cholecystitis after stabilization with fluid and antibiotics he will have his elective surgery in 5 days, what will be your plan of management of warfarin pre operatively?
A- Change to heparin until two days before surgery then check INR
B- Cease warfarin today until the day of surgery
C- Measure the INR, if it’s less than 5 continue warfarin
D- Cease warfarin and change to LMWH from the 4th day until the 12 hours
before surgery
E- Cease warfarin and change to heparin now
D
438
Q184488-which of the following statement is incorrect regarding Guillain-Barre syndrome?
A.IVIGs are the treatment of choice
B.Plasma exchange is the first line treatment
C.Neuropathic pain is commonly seen during the illness
D.Steroids have no role in treatment E.Neuropathic pain is responsive to TCAs.
C
439
Q184068-Gbs stem.how to monitor respiration.
A.FEV
B.FVC
C.Monitor chest expansion
B
440
Q188026- A case with genital ulcer with h/o multipartner and signs of meningitis.on CSF raised glucose,polymorph nuclear cells predomonantly.which organism is responsible for this?
1. HSV-rbc
2. HIV
3. pneumococcus
4. meningococcus
5. treponema pallidum
5
441
Q188034- 9 year old patient was brought to you due to headache and frequent vomiting for the past few days. On examination, you noticed patient walking with head tilted to right, nodules palpated on the right side of her neck. Neck was stiff. Limping gait was also observed. what is your INITIAL investigation?
A. ct scan
B. Neck ultrasound
C. Lumbar puncture
D. Blood culture
E. Chest xray
A
442
Q187350-Old aged male with bp, 170/80, Then on recheckin 140/80 Description was there (on exam of fundus of eye there was AV Nipping) Wat u do?
A- review after one week (chk bp)
B- 24 hr bp monitoring
C-Reassure
Drug
443
Q182462- which of the following regarding antidepressant therapy is correct?
A) Patient with no improvement after 2 weeks should stop and receive another drug
B) patients unresponsive after 6 wks, treatment should be altered
C) if no improvement after 6 weeks, depression is unlikely to be the cause
B
444
```
Q186203- 50 years old lady , asking about mammography . her sister recently diagnosed with breast cancer
A. Reliability of mammogram
B. Specificity of mammogram
C. False positive mammogram
D. dont remember other options
#surg
```
A
445
Q186214- Man with surgery for clerk 1 metastatic melanoma , excise about 2mm margin of normal cell.
Malignant cell is around 1.5mm. He doesn’t have any other symptoms. Mx?
a-Regular observation
b-Axillary LN biopsy
B
446
Q186566- Man from Somalia comes to you with soiling. On examination you notice a fistulous tract. Which of the following is the most likely cause?
A) Crohn’s
b) Ulcerative Colitis
C) Schistosomiasis
D) Perianal Abscess
D
447
Q10204- Stress incontinence recall of elderly with failed pelvic floor exercise therapy with rectocele but no cystocele. She feels awkward for attending the functions.
a) Weighted vaginal cones (I choose this)
b) Culposuspension
c) Imipramine
d) Pelvic UTZ
e) Kegel exercise
B
448
Q9035- pt has colles fracture treated 2 months ago. Her xray at follow up at 6 weeks was normal. Now c/o pain and tingling sensetions at the site of fracture what u will do next?
1. repeat xray
2. Mri to see ligaments
3 exercises
4. analgesia
5. brace
D
449
Q10522- An old lady giving history of deteriorating hand writing for long period, on exam. no pincer grip, numbiness in little and ring finger, normal flexors of hand and wrist, investigation:
A.xr of wrist
B.xr spine
C.MRI brain
?
450
Q91003- 16 years old girl with BMI 13 and has anorexia nervosa refuse having tubal feeding, in which only one circumstance you can introduce tubal feeding involuntarily against her wishes?
A-agreement from health ethic committee
B-agreement of the medical director of the hospital
C-agreement from 2 psychiatric doctors
D-from her guardianship power or something
E –consent from parents
C
451
```
Q10525- 40yr man, numbness of 4th& 5th fingers, weak thumb& index opposition, loss of princer grasp, flexion of wrist and fingers are normal. What is the most likely site ?
A- Cervical neck lesion
B- Carpal tunnel nerve entrapment
C- brachial plexus
D- Nerve entrapment elbow
E- Cervical region
```
D
452
```
Q91048- A man with psychiatric problems, he was on risperidone, sertraline and??. Now he's well controlled, no more command hallucinations, no more Suicidal ideas. What to do now?
A. CT Brian
B. MRI Brian
C. Measure sertraline
D. Measure risperidone
E. ECG
```
E
سرترالین با ریسپریدون آریتمی میده
453
Q187536-Child with only 2 vaccination history fell on garden bed with superficial lacerations and tears.
A-Dpt and booster after 2 months
B-Tetnus toxoid nd Ig
C-Dpt and Ig
D- tetanus toxoid and topical antibiotics
C
454
Q183047- A woman works at a part-time job (OFFICE CLEANER), and complaints of early morning headache, frontal & bilateral, dull in character, varying in intensity, she takes paracetamol & ibuprofen, which only cause relief for 2-3 hours. What is the cause?
A. Drug rebound headache
B. Migraine
C. Tension headache
D. Cerebral tumor
E. Pre-menstrual headache
A
455
Q184416- 30 year indigenous lady presented with sob and cough since weeks. o/e temp 37.8, PR, RR, BP, saturation all are within normal limits, mitral stenosis with bilateral basal crepts. X-ray given with features like bilateral symmetrical upper lobe infiltrates (X-ray seems like bilateral apical rounded oapcity but not too high at the apex). Diagnosis?
A. Left ventricular failure
B. pulmonary hypertension
C. rheumatic fever
D. Peumocystis pneumonia
E. TB
B
456
Q186465- An old man who had transurethral resection of prostate for BPH brought by his wife with complaint of aggression and inappropriate behavior at home. What point in history is most important for immediate management?
A. History of hurting animals
B. History of interpersonal relation problems
C. Ideas of self harm
D. Worsening of symptoms at night
D
457
```
Q11337- A man known case of Alzheimers is on donezepil and memantine. Since one month the aged care staff have noticed a change in his behavior. He tries to kiss and fondle nurses while bathing and has been seen sitting in front of nursing station masturbating. What is the cause of his changed behavior?
A. Worsening Alzheimers
B. Side effect of Donezepil
C Side effect of Memantine
D. Lesion in the frontal lobe
```
A
458
Q189110-A professional young cyclist guy ,falling on wrist ,presented with a picture similar to below one.management?
1) plate and screw
2) compression screw
3) long cast
4) bandaging
B
459
Q189273-Young man after a quarrel had a fracture of floor of eye what is the most consistent symptom with that?
a-Conjunctivalhaemorrhage
b-loss of visual activity
c-anaesthesia around the cheek
d-Cant open the mouth completely
e- Epistaxis
C
460
Q185350- old patient who drinks about 10-12 standard drinks per day ,underwent some surgery. on 3rd post op day he developed agitation ,O2 saturation 88%. what next ?
1-blood alcohol
2-blood glucose
3-CTPA
4-Chest X-ray
D
461
Q186448- A man how has migrated from Sudan 6 weeks ago has perianal fistula at the posterior aspect, low situated. What is the most likely cause?
A. Whipworm
B. Crohn’s disease
C. Perianal abscess
C
462
Q187260-43 years man known case of COOPD with 20 cigarettes per day since 18 years of age. Tried to stop 4 times during last year. smoke 5 mins after wake up. Have strong family history of smoking. What factor is important indicator to stop smoking ?
A- Family history
B- Duration of smoking
C- History of cessation
D- First time smoking for the day
E- Something about medical condition may be??
D
463
Q188551-You want to know the Hep HepCpositive mother. How to investigate?
A- Antibody of baby at birth
B- Antibody of baby at 18 months
C- Antibody of baby at 12 months
B
464
Q182376-child had history of nocturnal enuresis.. child came with hematuria 2 days after upper respiratory tract infection. The child is then recovered and came to follow up after 2 weeks and the urinalysis shows non glomerular RBC +. What is the appropriate investigation?
1. Urine cytology
2. Serum electrolytes and creantinine
3. Renal USG
4. Doppler renal vein
5 Dmsa
C
465
Q185343- 3 years old child with macular generalized rash with cracked lips oral mucosa involved bleeding from hand feet genitalia Labs thrombocytosis And leucocytosis Most appropriate asked—
Echo
Blood culture
Urine culture and pcr
A
466
Q188439-.Preg lady anti natal visit with anemia Hb 9 Mcv low from range , taking multivitamins already what adv :
A-Iron infusion
B-Green leafy vegetable
C-Hb electrophoresis
C
| Iron studies
467
Q186085- Adult man has headache,palpitation,sweating high BP 160/100 and a feeling of "something bad about to happen". What is your next step?
A. Investigate for pheochromocytoma
B. Thyroid function tests
C. Give beta-blockers
A
468
Q189118-a 38 y/o male farmer presented for managing his superficial leg ulcer.what apportunistic screening test do you do after managing his ulcer?
1) depression
2) testis cancer
3) recreational drug
4) hyperlipidemia
5) farming poisons
A
469
Q189380-a couple come to you for fertility consultation. the man has RA and is taking MTX and HCQ. which of the following is the best advice?
1. continue both drugs
2. cease MTX and continue HCQ
3. continues MTX and cease HCQ
4. cease both drugs and start Adalimumab
5. cease both drugs and start leflunomide
B
470
Q183308- Young woman fall of a horse broken tibia fibula n small pneumothorax on xray (which isnot given) now transfer via air ambulance .ox sats 98%. Whats the app step before transfering
A.Needle thoracocentesis
B.Needle spiration with underwater seal
C.Oxygen by face mask
D.Cont positive pressure ventilation
B
471
Q186256- Woman patient has been booking late afternoon bookings for .. months. She feels lonely and later become attracted to the doctor. One week later , she called the hospital for home visit for tonsillitis. What will be ur advice?
a) Visit her home with surgery staff member
b) Explain her that she will not be seen by that doctor anymore
c) Tell her to come to emergency depertment
d) Ask her to call other medical services
B
472
Q10229- A 52 years old lady came with complaint of loose motion for 2 years her condition improved after gluten free diet . what will u do next?
a) trial of strict gluten free diet
b) anti tissue transglutaminase
c) Jejunal biopsy
D. Stool culture
E. Urine sweat test
B
473
Q184188-80 years old women in a seperated ward,nurse says she found masturbating herself frequently..what to do?-
a) involve social worker ,
b) tell her it is not good,
c) send her in a 4 patient room in ward,
d) tell nurse pt needs privacy
D
474
Q186637- a 28 y/o male presents with distal weakness and atrophy of the small muscles of both hands ( interossel, lumbricals, thenar & hypothenar). What is the most likely diagnosis?
a. muscle sclerosis
b. bilateral median nerve palsy
c. syringomyelia
d. bilateral ulnar nerve palsy
e. brain stem infarction
C
475
Q186367- You have a patient with Alzheimer disease, you gave him restrictions in driving that he can only drive in the morning but you saw him driving at night time 10pm (stem question said the doctor is CONFIDENT that he is her patient). What will be your action?
a. Notify Licensing driving authority about the incident without informing the patient
b. Schedule a consultation with the patient and ask about he incidence
c. Other irrelevant
B
476
Q186657- 45yr old man who is hypertensive and just treated for his helicobacter pylori with triple therapy. Now comes with urine protein and hematuria with 2 cysts in right kidney & 3 cysts in left kidney. Diagnosis?
a) PKD
b) IgA Nephropathy
c) Nephrotic syndrome
d) Acute Interstitial Nephritis
e) Phaechromocytoma
D
477
Q189330-Couple comes for infertility treatment, man cryptorchidism, only 1M sperm count. What inv to do first
a. fsh, lh
b. karyotyping
c. utz
d. testosterone
A
478
Q184475- Pt smoker for 20 years, enlarged tonsils, on exam 1*1.5 mass in tonsillar fossa. Most probable Dx?
a) Mets from CA
b) SCC
c) Lymphoma
d) Nasopharyngeal CA
B
479
Q184002- acute pancreatitis scenario.patient with sudden epigastric pain. when will u do ct abdomen-
a. 2nd day of admission
b. 3rd day of admission
c. now
d. when clinical condition deteriorates
D
480
Q9980- Image of bilateral gynecomastia, more on the left side. Male, 54 years, heavy drinker, 2 to 3 liters per day. He is having diffuse abdominal distension and bilateral parotid swelling and hand tremor. He is also having small Testicular swelling. Diagnosis?
a. Malignant teratoma
b. Hepatic liver disease
c. Leydig cell tumour
d. Colon cancer
C
481
Q189424-waldenstrom paitent with pneumonia and started ampicillin and azithromycin after next day he developed rash over abdomen ( picture is given small pustules type rash all over present not looking like rash) Ask what next investigation
A- corton
B- skin culture
C- biopsy
if skin lesions
D- blood test for fungal
C
| درمان کورتون
482
Q186315- There was a picture of man who has a lump on his anterior triangle of neck, fine needle aspiration biopsy shows malignant cells which one of the imaging leads to diagnosis?
A-X ray of head and neck
B-Ct of head and neck
C-MRI of head and neck
B
483
Q188453-Ecg of wpw syndrome.old patient 280 hr.bp normal?
A-Verapamil
B-Adenosine
C-Amiodatone.
Wide qrs : amiodarone
Narrow qrs: adenosine
Irregular(AF): procainamide
484
Q9386- A sudanese boy had sex with his girlfriend. after a few days he found urethral discharge from his penis. He has other sexual partners . what specimen will help you make a diagnosis of the STI-
a. 1st catch urine PCR
b. Mid stream urine pcr
c. urine culture
d. Urethral swab gram stain and culture
A
485
Q188165-Young male complaining of pain in groin after lifting a heavy object. By exam no Lump but US revealed 1cm defect in inguinal ring with fat herniation. But No visible lump. What to do next?
a- open laparotomy mesh
b- laparoscopic repair
c- check again if lump appears
C
486
Q11318-42 years woman brought to you by her friends who wasn’t go out much for 10 years and stay in home. But she was enjoying doing gardening, staying at home. What in history will help you to treat her?
A. School refusal
B. Night terror
C. Alcohol consume
D. Substance abuse (don’t remember if this option given or not)
E. Her orientation
A
487
Q188461-man said to his friend that recently he became hypervigilant and something funny is going around him he feels. He comes to u and said that something very peculiar is going to happen with him ?
A-Prodromal schizophrenia
B-Schizotypal personality
C-delusion
A
488
```
Q189160-A young girl is brought to you by her parents who explain that their daughter has been having headaches, fever, chills, nausea and vomiting. Upon examination, you notice she is drowsy and neck is stiff. What is your management in making a diagnosis?
A. ABG
B. CT scan
C. LP
D. Abdominal US
E. EKG
```
C
489
Q189472-old lady living alone ,her son has been taking care of her health issues, when u examine her mmse is 12,her son was involved in her all of her decisions since a year ago, when you ask about her issues she denies any forgetfulness and tells that she does not want to talk anything abt it, what is your next step?
A-ask d son to wait outside and interview her alone
B- arrange nursing home care for her
C-ask son to deal with her financial affairs
D.arrange nurse home visit
E.advise son to go to the court to take the power of attorny
A
490
Q189270-45 yrs old man with no family history of prostate cancer comes for screening advice and counselling . He insist he wants a DRE.A digital rectal exam showed a normal sized prostate with normal non nodular sulci. What is the next important step?
A. Counsel him and return if any symptom
B. PSA
C .TRUS
D. Abdominal usg
E. Genetic counselling
A
491
Q186125- Patient with pain and swelling at the meta tarsopharyngeal joint of right big toe . She has hypertension and is on ACEI and frusemide. Urate level- ↑ Creatinine level - 1.9 (0.6-1.2mg/dl) What is most appropriate drug to treat her condition?
A. Colchicine
B. Allopurinol
C. Aspirin
D. Diclofenac
E. Predisolone
E
492
Q186287- One ECG, seemed normal. 50-60 yr old lady presented with difficulty climbing stairs due to dyspnea and weakness. No JVP raised, mild edema. She's hypertensive on acei/indapamide since 5 yrs. Bp 135/85, pulse 84 regular.And her lungs were hyperinflated on cxr with low breath sounds at both bases. What investigation next?
A) TSH
B)STRESs ecg
C) v/q scan
D)serum brain natriuretic peptide
E) troponin
D
493
Q186382- Pregnant patient with increased BP 145/90 blurring of vision third sign which will alert you
a. tenderness at left costal margin
b. bilateral hand edema
c. presence of 5 jerks of clonus at ankle
d. Rise of BP to 150/90 in next 30 mins
C
494
Q184246-A 35 year old woman presented for screening because of a history of diabetes in her mother. She is otherwise fine. Her BMI is normal. All investigations were normal. What will you do?
a. RBS every 2 years
b. OGTT every 2 years
c. Observe till age 45, then 3 yearly blood sugar
d. FBS now
e. every 3 years
E
Fbs or hba1c
از ۴۰ سال
495
Q189259-27 years old come with green brown nipple discharge . On examination ,no palpable mass and discharge is expressed from 3 opening of nipple.What is the most appropriate test to get diagnosis?
A.biopsy of nipple
B.ductogram
C.FNAC of nipple
D.USG
E.mammogram
D
496
Q188191-Lady who was an athelet now presenting with muscle weakness, recurrent falls and inability to walk without support,recent history of divorce frm an abusive husband, she is supporting her mother by working so hard, diagnosis
A- adjustment disorder
V- MDD
C- conversion disorder
D-somatisation
C
497
Q186173- Chronic COPD patient want to quit smoking he has tried 4 times previously but feels restless and agitated what is the strongest indication for start of nicotine therapy?
a-His withdrawal symptoms
b-His duration of disease
c-Family history of smoking
d-Obesity
A
498
Q189248_old age pt with vomiting and abdominal distention and passing flatus last 12hours undermarkable history of surgery or other disease asking about Dx?
A.small bowel obstraction
B.large bowel obstraction
C.pseudo obstraction
D.volvulus
C
499
Q186517- Woman comes to see a male physician. She need to get pelvic examination but she is reluctant to get it done from male doctor, what should be your appropriate action?
a) Ask her if presence of female nurse would help
b) Ask her to come when female physician available
c) Send her to some another physician
d) Others irrelevant
C
500
Q184299-18yr girl started getting a boyfriend, go in to have sexual intercourse soon, h/o some ovarian cancer in 2nd degree relatives. (very complicated question). what to do?
A. start regular screening
B. wait till 2 years
C. give HPV vaccine
D. talk with partner about safe sex
C
501
Q188562-2 year old child. Respiratory rate 30. Heart rate 120. Fever 39.7. one day history of fever, vomiting, abdominal pain. On examination mild abdominal tenderness but no rigidity. Chest xray is given ( looks like pneumonia). Which of the following is the most appropriate initial antibiotic?
a. Amoxicillin
b. Roxithromycin
c. Augmentin oral
d. IV penicillin
e. IV flucloxacillin
D
502
Q182639-Pregnant lady at 16 weeks comes to you for check up. She is hepatitis C positive. What will you check next?
A.HCV PCR
B.Chlamydia
A
503
Q189049-Multiple sclerosis scenario …Young female with pain behind left eye for one year followed by blurring of vision initially 6/7.5 for coth eyes then 6/30 for left eye , rt eye normal.Which inv to order?
a. MRI
b. VEP
c. biopsy of temporal artery
d. LP
A
504
Q188332-50 years old female with amenorrhea and multiple hot flushes (10 per day). She has history of mastectomy after history of breast cancer. The specimen was hormonal receptor negative. Most appropriate treatment?
A. Combined HRT
B. Estrogen only
C. Paroxetine
D. Some kind of herbal therapy ”can’t remember its name”
C
505
Q187299-Melancholic depressed patient with suicidal attempt. Can't give consent for ECT.what next :
a. Take a second opinion from another doctor who knows him or has seen him
b. Mental health tribunal
c. From wife
d. duty of care
B
506
Q186700- A 65-year-old schizophrenic patient needs coronary angiography because of suspected myocardial infarction. Cardiologist explained the procedure to the patient who did no understand the procedure. Who can give the consent on behalf of the patient
1. The patient’s relative (guardianship court)
2. Mental health tribunal (can give consent only for mental illness)
3. The patient
4. The court
A
507
Q188268-A wife brought his husband who was not eating and drinking anything with severe melancholic depression.H/O self harm for 3times,likes wrist injury,Neck injury.Now Suggests for ECT,but patient rufusing for ECT.His MMSE is good.What will you do next?
A-ECT approval from mental health tribunal-victoria guidelines
B-ECT approval under duty of care
C-ECT approval with consent from wife
D-ECT approval with consent of two doctors
A
508
Q189204-You are a working as a doctor and just withdraw blood from a patient who is suspected of HIV. Unexpectedly, you stab yourself with the needle and the nurse sees it. What is your management?
A. Wash hands with soap
B. Give patient reassurance you are fine
C. Administer gammaglobulin
D. Go to hemodialysis
E. Administer antiretroviral
A
509
Q188072- You have selected a community people to give PCV7 and people
are vaccinated and some are not vaccinated; the graph given below
A. Patient are resistant to vaccine
B. Vaccine is not working
C. Vaccine serology
D. Vaccination is non specification
Serotype Conversion
510
Q187171-Lady presents at 14 weeks gestation. Her first baby was 4.4kg, delivered by ventouse and complicates by shoulder dystocia. What will you investigate in this pregnancy?
A. Urinary glucose every antenatal visit
B. Glucose tolerance now
C. Fasting blood sugar
B
511
Q9622- An old lady who gets beaten up by his drug addict son best advice to keep her safe
a. tell her that u have to inform the police
b. urge her to go to the police
c. tell her to go to the refuge center
d. tell her its her right to inform the police
C
512
Q10025-Post renal transplant (1 yr ago),now presents with headaches, significant loss of weight, night sweats CSF erythrocytes ++, elevated mononuclear cells elevated, proteins elevated,glucose reduced.Next step in mx?
a. ZN stain
b. HIV
c. analysis of bacterial antigens
A
513
Q186310- Women with UTI and she suffer from significant persistent pain. She is also depressed, insomnia , low mood, etc. Mx?
a) Tramadol
b) Diazepam
c) Citalopram
d) Diclofenac
C
514
Q9109- Female post partum depression taking paroxetine since 2 years. Symptoms are well controlled. Wants to conceive again. What next?
a. cease paroxetine now
b. cease when pregnant
c. continue paroxetine and add citalopram now
d. when pregnant
e. continue paroxetine
A
515
Q188047- 35 y.o man treated with cephalexin for sore throat, 6 days later presents with rash
A. Delayed type 4 hypersensitivity
B. SJS
C. TEN
D. Post streptococcal psoriatic gutattae
A
516
Q187354-pt dying with ca pancreas in a ruralhospital. From last few days he has sever pain and nausea, he is being given 50 mg morphine and iv fluids. But his condition not improving, his consciousness is also Fluctuating. Mx
a. inc dose of morphine
b. stop iv fluids
c. add diazepam
d. add fentanyl patch
```
A?
Stop morphine (pca)?
```
517
Q183538- 64 yr old man with low back pain. No symptoms of prostate. Crushed vertebrae t10 L1 seen on bone scan with increased uptake. Labs were given ESR increased more than 100
Ca level was normal. What will u do to know underlying cause
A.bone marrow exam
B.PSA
C.PET scan
D.MRI spine
A
518
Q185142 -Boy, pain in the leg after fall during football game. Pain leg and medially rotated with thigh held up. What injury.
b. medial meniscus
c. ACL
d. PLC
A
519
Q189234-5-year-old child presents after sustaining lacerated wounds on leg, received 2 doses of dtp at 2 and 4 months. What to give now after wound management?
A.TT and antibiotics
B.TT and Ig
C.DTPa and booster after 2 months
D.DTPa and IG
D
520
Q187314-A lady came with progressive dizziness, worsening abdominal cramps, vomiting and diarrhea. 10 days ago she had taken a prescription from the psychiatrist for a condition she described as “very happy” “very energetic.” Most likely cause for current presentation?
A. Gastroenteritis
B. Lithium toxicity
B
521
Q187431- image like this. 55yr male, smoker, h/o surgery for ca oesophagus; swelling in the lateral neck from 3 weeks,non tender, smooth, soft, free from overlying skin. Oropharyngeal examination normal.whts Dx?
a. branchial cyst
b. pleomorphic adenoma of parotid c.submandibular duct stone
d. metastasis
D
522
Q187195- 3 children from day care center Dx with HepA. What to do to prevent?
A- Test all kitchen staffs with hepA IgM
B- Quarantine all children with fever
C- External catering service
D- HepA vaccine to all HepA non-immunized children and staffs
E- Close day care center for 14days
D
523
Q185355- A lady present to you and she tells that God tell her `Fast 40 days and time so that World War end ‘.She is orientated and decline her to test other function. What is your first line of management?
```
A) Zuclopenthixol
B) Diazepam
C) Quatiapine
D) RisperidoneConsta
E) Clozapine
```
C
524
Q188127- Old man came with his wife.she complains that he gets confused sometimes and has stopped reading news paper.He still drives, sometimes at night .mmse 26/30 .what are you gonna do about it?
a. Cease driving at night
b. Repeat mmse after 3 months
c. MRi of brain
d. advice to do more mental and physical activities
e. assess him for treatable demential conditions.
?
525
Q186194- a patient presents with 3 months history of nausea and epigastric discomfort he has icteric sclera he consumes 50-60 grams of Alcohol. Lab investigations were given all liver enzymes including total and conjugated bilirubin were raised and serum lipase was also raised on Usg there was dilatation of intrahepatic channels not extrahepatic no other abnormality what you will do?
a-ERCP
b-CT abdomen
c-MRCP
d-Endoscopic ultrasound
B
526
Q186691- a 45 y/o farmer is in financial debts due to the severe drought and is blaming the government for the current problem. He is planning to kill himself so that his family can benefit from his insurance. Which of the following defence mechanism is he using?
a. denial
b. projection
c. rationalisation
d. displacement
D
527
Q9909- Business man got bankrupt, many financial problems, complaining of late insomnia, lack of pleasure, loss 15 kg from his weight through 3 months, any many other symptoms of depression, his family concern about him and the patient refused to take any medication as he doesn’t believe he is sick, he admit he is tired and exhausted but not depressed, what’s this called?
A Denial
B Reaction formation
C Depersonalisation
D Rationalisation
A
528
Q188128- A farmer not doing well, had recent losses, cant eat or sleep. He wants to commit sucide and end it all .He is not accepting that he is depressed and says that its just because of his financial problems that he is feeling like this. What does it reflect? (the scenario pointed him towards being very depressed and he was in denial.)
a) Denial
b)Rationalisation
C)suprresion
B
529
Q184084- Man with nocturia n urinary frequency n dribbling. mass above the pubic symphysis DRE showed enlarged prostate with palpable median sulcus palpable.what is the most appropriate next step?
```
A-trans rectal ultrasound
B-PSA
C-bladder scan
D-CT
E-urine cytology
```
B or C?
530
Q1810296-what of the following is the most consistent finding of orbital floor fracture:
A-vertical diplpoia
B-horizontal diplopia
C-inability to open the jaw
D-loss of sensation on the ipsilateral cheek
A
531
Q1810345-Tsh normal ,, serum thyroxin increase ,, pulse of the pt 62 ,, complaints of tiredness ,,, no other abnormality ,,,asking next appropriTe inx——
A-Thyroid autoab
B-Thyroid usg
C-Mri brain
D-Raioisotope
C
532
Q1810402-Post opt pt oliguria wz indwelling catheter.fever 38.5.There was generalized abdominal pain. Most appropriate mx?
A. Abd xray
B. blood culture
C. S electrolyte and creatinine
D. abd usg
D
533
Q184281-Female patient with RA she takes ibuprofen and methotrexate to control her disease for 5 years. Recently patient complains of some symptoms (jaundice), and her labs are given.
protein - 9 (6-8) slight increased
albumin- 5 (3.5-5.5) normal
ALT - >100 (7-56) Liver enzymes >100 in my exam question
AST - >100 (10-40)
GGT - >100 (0-30)
What is the cause of her symptoms?
A- Methotrexate induced hepatitis
B- ibuprofen induced hepatitis
C- Autoimmune hepatitis
D- Viral
A
534
Q186128- old patient found unconscious at home brought by son to emergency department . the patient was taking tablets methadone, oxycodone , busprione.had naloxone at ambulance. patient has constricted pupil on examination.what drug assay you will do for management?
A-methadone
B-oxycodone
C. cocaine
d.paracetamol
D
535
Q187184- DM patient with injury to left index finger prior 2 days. Which indicate deep tendon involvement?
1. Clear vesicle on finger tip
2. Pain on extensor tendon sheath
3. Flexion posture of finger
4. Pain on passive flexion of left index finger
5. Fusiform formation of finger
C
536
Q183064- The patient has 8 months history of joint pain in the wrist and the ankle and minimal pain in other joints but now the patient comes with morning stiffness of both wrists for 1 to 2 hours. Her lab results as follow.
Hb reduced
MCV slightly reduced (nearly below lower margin level) ESR 70 (sure for this level)
```
A. NSAIDs
B. Prednisolone
C. Hydroxychloroquine
D. Methotrexate
E. Etarnarcept
```
D
537
Q187610- 60 yr lady with pain controlled on regular opioid analgesics come for a new prescription.2 weeks ago u gave her a prescription of 2 month but she now comes and says the pharmacist made a mistake in dispensing the drugs.pharmacist denied any mistake in dispensing.what will u do?
A.precribe her 2 weeks opioid
B.ask the pharmacist any record of dispensing
C.document the discrepancy between women and pharmacist saying
D.report abt women's telling lie
E.another one I forgot
C
538
Q187169-Patient presents to you who has kept a knife for his protection. He submits the knife for security check but he is evasive about keeping other weapons and refuses to allow you to talk to his psychiatrist. What’s your next step?
A. Ask his relative about his mental history
B. Ask to neighbor about his history
C. Ask police about the case
D. Override his refusal and talk to psychiatrist anyway
C
539
Q184409- old patient with decrease in vision from past few months .vision s 6/18 on right side and 6/12 on left and on correction with pinhole is 6/9 on both sides .What is the cause fr this condition?
a. Retinal degeneration
b. Glaucoma
c. Cataract
d. refractive error
e. presbyopia
C
540
Q185349- 18 m Child crying and waking up at night everytime mother give fruit juice .Ur advice
A.add milk thickener to bottle
B.give cows milk
C.give water.
D.give bottle milk
A
541
Q185295- a 10 yr old child had seizure at home.after that he became unconscious and remain. he was brought to ed via ambulance. blood glucose 2.wat will u give
a. im glucagon
b. iv glucagon َ◌
c. im dextrose
d. phenytoin
e. diazepam
A
normal random blood glucose range:
children 3.5 – 5.5 mmol/L
neonate 2.9 – 7 mmoll/L
542
Q189198-Woman around 30-35 years of age attends for Pap smear, Her previous smears are all normal. She doesn’t have sexual activity in last two years. What’s the reason of testing chlamydia in her?
A. chlamydia is asymptomatic
B. chlamydia can cause infertility
C. Both partners could be asymptomatic
D. No need for screening
D
543
Q188068- Old px underwent surgery of femur fracture, 7 days after had dyspnea and confusion. On auscultation, there is crepitation in right lower lobe.
A. PE
B. fat embolism
C. pneumonia
D. aspiration syndrome
A
544
Q188013- old man 60 years old who is a heavy smoker for 40 years comes to you with a swelling in the tonsillar region,O/E there is a mass in the tonsillar pouch,what is your diagnosis ?
a. Nasopharyngeal cancer
b. Lipoma
c. lymphoma
d. laryngeal cancer
e. metastatic spread
First SCC then C
545
Q10508-Pregnant lady , 26 weeks , with genital hsv2 , painful ulcers can't urinate ,Treat with ?
a. Oral acyclovir
b. Oral famciclovir
c. Topical acyclovir
d. Iv acyclovir
e. Iv famciclovir
بارداری
اسیکلوویر
والاسیکلوویر
546
Q187157-9 months old child with URTI. He didn’t receive vaccines after 6 months when developed thigh swelling after receiving vaccine injections. Now presents with URTI and low grade fever. Advice about immunization schedule?
A. Re-commence primary immunization schedule
B. Give missing vaccines today
C. Give missing vaccines today and repeat after one month
D. Give missing vaccine today except pertussis and review in one month
E. After URTI resolves
B
547
Q9593- 33 year of woman who had done TAH and BSO, t score femur -2.5 and vertebra -1.5, what to give
1. oestrogen therapy
2. oestrogen and progesterone
3. vit D and Ca
4. alendronate
A
548
Q10180-12 yrs old school girl suddenly collapsed at school.she was brought by ambulane with dextose drip 60/ml min.on exam dolls eye reflex were present but she was not responding to painful stimulus.her vitals signs were as follows: > R/R 12/min > PR 50/min > SaO2 100% > bp 180/110(?) > if you are working in a tertiary hospital.What is the Next step of management?
A) Arrange for urgent CT Scan
B)S top her dextrose infusion and start on saline
C)Give Steriods
D)Intubate the patient
E)Nuerosurgical Reference
D
549
Q188352- SIDS.Two consequent deaths of children in a family at 5 months and 4 months.most important thing to be asked.
1. Extended family history of SIDS
2. Immunisation history of kids
3. Parental age
4. Ethnicity
C
550
Q184410- 9 months old infant with deformed occipito temporal region of skull and prominent frontal region, what to do?
a. Change sleeping position
b. CT
c. Ultrasound
d. MRI
e. Resaaure
S
551
Q185126- 82 years old women known case of gout, renal failure and HTN. Scenario of having acute gouty attack. What's the next management?
1. allopurinol
2. colchicine
3. paracetamol
4. codeine
5. naproxen
B
کنترا اندیکاسیون انسید:
Peptic ulcer,gastritis,GERD which has not been treated effectively,CHF, significant renal failure( cr>200 mmol/lit)
552
Q9006- hyperkalemia ,patient on ramipril , presented with lethargy about immediate management?
a. insulin and glucose
b. haemodialysis
c. rectal resonium
d. Cease ramipril
e. Calcium gluconate
E
553
Q1810354- A fifty year old man who had a syn operated recently. His ECG is given. It has sinus rhythm. What to do next?
A- coronary angiography
B-holter monitoring
A
554
Q9110-Lady pregnant, wants to know if there are any vaccinations they should get?
a) DTP to the entire family
b) DTP to the father alone
c) DTP to only those at risk
d) No vaccination
A
555
Q182453- ECG showing atrial fibrillation , asking for management?
A) metoprolol
B) hydrochlorothiazide
C) vagal manoeuvre
D) Methyldopa
A
556
Q187267-Lead level is 3.8 what to do ?
A-Hemodislysis
B-Activated charcol
Chelator
557
Q189445- patient about 60 yrs, feels sharp pain in his chest. He feels better when bending forward. ECG changes almost in all leads. What ur treatment?
A)Semi sitting position
B) NSAIDS
C) TNG
D) O2 therapy
E) PCI
B
558
Q1810056-child with croup scenario, 38 fever and coryza, harsh cough, respiratory stridor on rest using collateral muscles
A. Prednisolone oral
B. IV prednisolone
C.Humidified oxyg
A
559
Q1810034- middle age female gravida 8 delivered her baby vaginally after 2 hours her pulse was 100 b/m and BP was 80/50 and she lost approx 500ml of blood vaginally. What is the cause?
A) uterine atony
B) uterine rupture
C) vaginal laceration
D) pocs
B
560
Q1810251-a history of middle aged woman with diplopia when looking to the left side and his right eye turned outward and downward.where is the pathology of right eye?
A.6th nerve palsy
B. Brain stem
C. CORTEX
D.Posterior communicating artery aneurysm
D
561
Q188042- CTG showed reduced baseline variability and variable deceleration (CTG was not given). The mother had 4 cm cervical dilation within 14 hours .Pethidine was given to her 3 times .Fetal head was in the left occiput posterior. What is the cause of the CTG abnormality?
a) prolonged labour
b) elevated resting uterine pressure due to incoordinate uterine action
c) molding of fetal head
d) sedative drugs
D
562
Q9605- Female who has schizophrenia, and was on olanzapine 10 mg, she has very good progression of
her symptoms now complaining of 10 kg increase of her weight, best to do:
a. Decrease olanzapine
b. Change to Ziprasidone
c. Increase olanzapine
d. Change to clozapine
e. Continue olanzapine
B
563
```
Q185374- old pt known diabetic. he is taking metformin and a secretagog. when tested for followup, his hbaic is 12 and blood sugar markedly elevated.
what is the cause?
a.insulin dependant dm
b.insulin resistance has increased
c.there is insulin deficiency
```
ابتدای تشخیص دیابت تیپ دو insulin resistance هستش اما بعد از تشخیص و در طی درمان با دارو سلولهای پانکراس سازنده ی انسولین تدریجا از بین میرن و زمانی که بیمار دیگه به داروهای اورال جواب نمیده یعنی با توجه به تخریب سلولها حالت insulin deficiency ایجاد شده
ابتدا b سپس c
564
Q185338- Picture of external thrombosed pile. What is the clinical finding?
A-pain + bleeding while defecation
B-pain + bleeding not related to defecation
C-no pain + bleeding while defecation
D-no pain + bleeding not related to defecation
E-pain but no bleeding
E
565
Q1810112-Same question on spironolactone- 45 yr old male started on spironolactone and ace inhibitor and a few more medications for lhf develops b/l breast enlargement and pain what is the cause(no part on cancer )
A-Spironolactone
B-Ace
A
داروهاي عامل ژنیکوماستی: استروییدها، متیل دوپا، سایمتیدین، ماریجوانا، اسپیرینولاکتون
566
```
Q182501-renal tumour lower lobe of kidney 1cm, 58 yrs old woman asymptomatic on accidentally ultrasound finding
A. Biopsy
B. Total nephrectomy
C. Partial nephrectomy
D. Counselling
E. Observation and reassurance
```
C
567
```
Q187219 -Numbness in little and ring fingers and pincer grip weakness. Triceps jerk loss.
A- Nerve root compression
B- MS
C- Spinal stenosis
D- Cervical lesion
```
A
568
Q1810271-PAP smear report: intermediate risk, HPV(not 16,18:mentioned) positive and LSIL present. What do to next?
a) PAP smear after 12 months
b) Colposcopy within 3 months
c) HPV after 12 months
d) Co_test after 12 months (LBS + HPV test)
e) Liquid based cytology after 12 months .
C
569
Q1810369- Almost similar pic but it was on medial malleolus with pus in it, pt was diabetic, was on metformin, his glycemic control was good for last few years but now it’s not in control. What will you do next, after taken swab culture? No duration was mentioned
A. Xray
B. Mri
C. Blood sugar
D. Swab from ulcer
A
570
Q9249- Lady complains of pain while urinating she had menstrual period 8 days ago and experienced this kinda pain 4weeks ago
a. Ectopic
b. Complicated
c. ovarian cyst
d. Endometriosis
?
571
Q1811240- Lady on venlafaxine overdose after separation with her husband. She is depressed or down? (dont remember the exact word). One year ago she was prescribed venlafaxine (not sure what for). What will you do next? (this q was a little different from the usual recall)
a. increase the dose of venlafaxine
b. decrease the dose of venlafaxine
c. mirtazipine
d. clozapine
C
572
Q1810090-A 38 yo aboriginal lady, with no fh for diabetes, BMI 22, BP 125/75, wof is best advice for screening:
1. 2 yrly ogtt
2. Annaul ogtt
3. Annaul fbs
4. Annaul AUDSRISK
5. Screening not indicated till 45 yo
D
573
Q189339-Post op, hyponatremia, SIADH scenario asking for diagnostic inv
a. serum osmolality
b. urine osmolality
c. serum electrolytes
A
574
Q187722- 4 years old child with enuresis and FH + , When he was 2 years old ....toilet training ...but never he was dry in night ....but he is dry at day .....now enuresis increase about 4 to 5 times a weak
Initial management ?
A) limited liquid
B) AVDDP
C) put alarm for him
Reassure
575
```
Q184451- mother has a dizygotic twins with schizophrenia what is the change she develops it
a- None
b- 9 or 10%
c- 20 %
d- 50%
e- 100 %
```
B
576
Q10259- A post marketing drug surveillance study of a new heart failure therapy to the market was carried out on 10,000 subjects who had completed clinical trials. Which one of the following most accurately reflects the information generated from such a study?
a) Adverse events profile
b) comparative therapeutics efficacy
c) cost benefits trial
d) cost effectiveness
e) Drug potency
D
577
Q10518- Man suddenly got back pain and admitted hospital got oxycodone.which findings will be most significant for you to do an imaging?
1. Urinary retention
2. Positive tinel test
3. increased planter reflex ans UMNL
4. tenderness on sacroilliac region
A
578
Q1810328-Patient complains of dyspnoea and weakness. Long-term smoking history +, JVP (3cm), pheipheral oedema +. (There were 1 or 2 more respiratory symptoms).
ECG given — I didn’t see ischemic changes, R waves in lead V5-V6 tall (4 big squares) but in V1 S wave was only about 2big square tall.
a. Exercise stress test (exact option)
b. BNP
c. Troponin
D. echo
B
579
Q188520-A 16day old baby (not sure about age but the child was few days old) comes with fever, lethargic, feeds poorly. Frontanelles were soft. Rash present in trunk. Blood and urine examination normal . Blood taken for culture. What’s next ?
A- LP
B- Urine culture
C- electrolyte
D- ABGs
A or ct?
580
Q182067- Patient comes back from Thailand with hx of having sex with multiple prostitutes. After one week presents with lymphadenopathy, mild pharyngeal erythema, splenomegaly, sore throat Atypical lymphocytes present. Monospot test negative. What is the most likely diagnosis?
a) HIV
b) EBV
c) CMV
A
581
Q1810100-30 yrs old present with melaena,to find out the cause there is endoscopy and colonoscopy done but nothing is conclusive,what should be done now??
a) red cell radioactive scan
b) sigmoidoscopy
c) capsule endoscopy
d) MRI
C
582
Q189470-A three year old girl with a history of cough for 1 month and fever from 3 days.a cxr was done and on it streaky patches were seen in lower region of the left lung. Whats the most appropriate next step?
A.mantoux
B.igra
C.bronchoscopy
D.sweat test
C
583
Q189144-wht symptom will u find most commonly in hereditary hypercholestrolemia?
a. Cornea arcus
b. Tendon xanthoma
c. orbital xanthoma
d. hepatomegaly
A
زیر ۴۵ الف
بالای ۴۵ ب
شیوع بیشتر الف
اختصاصی تر ب
584
Q1810230-man depressed as wife has affair. Dr started him on Sert now with delayed ejaculation.
```
A. Add Diazepam
B.Inc sert
C.Withdraw sert
D.Switch to fluoxetine
E. Add sildenafil
```
E
585
Q1810249-an old man complains of back pain. a lateral xray of thoraolumbr spine was given.what do
a. psa
b. colonoscoy
c. Abdominal CTSCAN
Dexa
586
Q1810419-Showing a distension.nausea.since 3
CT.abdomibal
cross
section
and
c/o
Abdominal
bloating
wks or something.options were
A.gastrointestinal stromal tumour
B.Renal ca
C.pancreatitis
D.pancreatic pseudocyst
D
587
Q9702- gp refrred a pregnant for cholecystectomy ..rationale for his decision
A. She will be able to eat normal during pregnancy
B. Increase chance of stone complications during pregnancy
C.increase chance of cholestatic jaundice
d.increase chance of fatty liver of pregnancy
B
588
Q187755- Pt had kidney transplant from cadaver.No urine output till the 7th post operative day ,requiring dialysis.What is the cause?
Acute rejection
Blocked catheter
Ureteric obstruction
Donor venous thrombosis
ATN
| نبود A
589
Q185352- ECG – ST elevation in V1, V2, V3, no arrhythmia detected Patient has history of chest pain 2 hour ago , symptom relieved and now pain 4/10. He is on atorvastatin and aspirin. On admission, given oxygen. Most appropriate next step in management?
A. Nitrate
B. Metoprolol
C. Morphine
D. Clopidrogrel
E. Thrombolysis
D
590
Q1810038-A case of myasthenia gravis with diplopia and muscle weakness. What is the initial investigation to do?
Tensilon test
Nerve conduction study
EMG
A
591
Q10223- A 32 year old woman presented with bilateral joint swellings of her proximal interphalangeal joints associated with a 45 minutes period of early morning stiffness of joints. She has obvious rheumatoid nodules and a high rheumatoid factor assay. She got raynoud phenomenon treated with nifedipine. Rhematoid positive, ds DNA positive but negative CCP. Which of the following is the best long term management?
a. infliximab
b. sulfasalazine
c. methotrexate
d. prednisolone
e. Hydroxychloroquin
E
592
Q186653- 6 week old baby, still jaundiced. since day 4. breast feeding well. dark urine, clay stool. Total bilirubin 200 (N <20), direct 130. dx?
1. congenital hypothyroidism,
2. gilbert,
3. breast milk,
4. congenital biliary atresia
D
593
Q11325- A man on sertraline 100 mg daily bcoz his wife left him for another guy. now complains about erectile dysfunction. What do u do as a physician ?
```
A. cease sertraline
B. change to another drug in the same group
C. tell him to bring his wife
D. talk to his wife
e.reassure him
```
B?
594
Q11277- Old lady presented few other features were given with narrow introitus . Biopsy showed lichen sclerosis management.
A.0.5% steroid
B.oestrogen cream
A
595
Q9942- management of SLE long term :
a) immunosuppressive plus anti coags
b) immunosuppressive plus anti platelets
c) immunosuppressive plus antibiotics
d) anti coags plus anti platelets
B
596
Q189309-A mother of a toddler presents to her GP with Headache and mild neck-stiffness. Her child had an URTI with rash one week ago, but has now recovered. What is the most likely causative organism?
A. Influenza
B. Enterovirus
C. Herpes virus
D. Pneumococcal
B
597
Q10290- 8 mo old baby, parents concerned not babbling yet. Appears to respond well to sounds on examination. MX?
a) tell its normal variant
b) review in 6 mo
c) arrange speech pathologist referral
d) ENT consult
C
598
Q184232-A woman comes to you for referral to ENT specialist because she has vague pain behind her ears for a long time. She has consulted with many doctors. She became frustrated and angry while explaining you about lengthy investigations and examinations she had to undergo and said “I am so sick of doctors telling me it is all in my head”. What is your next step in management?
a) Reassure
b) MRI brain
c) Refer her to ENT specialist
d) Prescribe antidepressant
e) Collateral history
E
599
Q183574- Child (3-4 year) with fever 39C and history of cough unwell for 3 days. I think he has wheeze but minimal lung signs on exam. CXR given. Asked which investigation wud u do for further assisting in diagnosis?
a. pneumococcal PCR
b. pleural aspirate
c. blood culture
d. FBC
C?
600
```
165) Q10100) A 6 month old boy had runny nose for 3 days. Cough for one day and today is coming with restless breathing. He has been vomiting intermittently for 2days and fed poorly today.
His temp 37.4. Pr 160, RR 70, he has wheezy chest and retraction and inspiratory tug.
Next
A) CXR
B)Rsv immunofloruscence
C) blood gases
D) blood culture
E) blood glucose
```
E
601
Q1810301-15 yr old lady presented to you for breast CA screening as one of her paternal aunt is with Breast and ovarian ca. What will u advice her?
A.2 yarely mammography
B.2 yarely ultrasound
C. conduct Genetic risk assesment
D. order BRCA1 gene mutation
E. 6 monthly self breast examinations
C
602
Q188303-schizoaffective disorder on risperidone, and lithium. Went to party n took alcohol, cocaine n ecstasy Now presenting with hyperreflexia, tremors, irritability, drowsiness, agitation, temp 37.8, bp 150/?Wat nxt investigation
A-Alcohol level,
B-drug screen,
C-lithium level,
D-ck level
D
603
Q10044- ECG of hypokalemia.Patient in digoxin,furosemide,amlodipine (and some other drugs.Which drug is the cause of this presentation?
a) Amlpodipine and Amiadarone
b) Furosemide and amlodipine
c) furosemide and amiadarone
C
604
Q10512- ECG bradycardia with hyperacute T wave only one strip….Middle age pt c/o light headach and syncopal attack 3 episode in one month, bp 100/60 0r 90/60 ??he is on multiple drugs.which drug comination will be tha cause of his problem? Actually confusing scenario not that simple….
A.Amlodipin +Aspirin
B.frusimide+Aspirin
C.Amlodipin+Amiodaron
B
605
Q1810235-78yo women pancreatic cancer with recurrent bile duct obstruction from Pancreatic tumour. Previously inserted a stent in the common bile duct but obstructive symptoms occurred again; jaundice, conj bilirubin etc. wat to do?
a) Palliative biliary bypass,
b) percutaneous hepatic drainage?
c) ERCP with stent change
C
اگر امکان سرجري بود که اول پرکوتانه بعد سرجري
علائم استیبل و مزمن : ercp
علائم حاد : پرکوتانه و بعد استیبل شدن استنت
606
Q185484-Colles fracture recall but with different opons xray at 6 week followup was normal and now pt having mild pain and tingling sensations what to do
```
A. Xray again
B. splint for few days more
C. occupational therapy to check on him
D.exercise analgesics
E. MRI to see ligament
```
D
607
Q185576- What is the most common cause for recurrent ano rectal abscesses in elderly
a. Diverticulosis
b. Ano rectal fistula
c. Crohn’s disease
d. Ulcerative colitis
B
608
Q186503- 9 months old child presented with abdominal distension, elder sibling had h/o RTI few days back. Abdominal xray- paucity of air in right quadrant. What is the most appropriate treatment?
a) Air enema
b) Iv antibiotics
c) Others I forgot
A
609
Q9768-2 yr old with haematuria and hypertension.history of recurrent nephrotic syndrome ( thrice in the last 18 months). Symptoms unresponsive to steroids. Diagnosis?
```
A) Iga nephropathy
B) PSGN
C) vesivoureteral reflux
D) Family history of kidney disease
E) flank non tender mass
```
FSGS
| C
610
Q186198-Wife brings Ptx (husband) with worsening Parksonism syx(marked
bradykinesia,rigidity,lack of self empathy and agitation) presenting with auditory
and visual hallucinations comes to you for advice.Ptx is currently on carba and
levodopa 75mg with little to no improvement for more than a year nowWhats the
appropriate next step?
A.Donezpil
B.Quietapine
C.Haloperidol
D.Increase Levodopa
E.Pramipexole
D
611
Q183480- Given right eye picture(the whole eye reden, no discharge) patient come with severe pain in eye,injected and loss of visual and pupil is not react to light
a. prenisolone
b. timolol
c. chloramphenicol
d. surgery
B
-
-
درمان لانگ ترم : ایریدوتومی پریفرال
درمان اورژانسی: استازولامید
iv
،
قطره پیلوکارپین، قطره تیمولول
612
Q1810094-pt had 130/80 BP, total cholesterol 5.4 , fbs -5.2 ,waist circumference 92 cm What is the significant risk factor for cardiovascular disease?
a) Cholesterol
b) Waist circumference
c) bp
d) fbs
A
613
Q11370- Baby with a picture of cleft lip which was diagnosed at 18 weeks by ultrasound scan and what should should be told to parents regarding further management .
1) ask patients to terminate pregnancy before 22 weeks
2) amniocentesis
3) just advice to continue pregnancy as there is no other complications
B
614
```
Q10019-Female patient old age came to ER by sudden chest pain when they are preparing to make ECG they found that ( give picture with redness and swelling of RT Breast) diagnosis
A. invasive Breast carcinoma
B. cystosarcoma phylloides
C. chronic Breast abscess
D. intraductal carcinoma
```
A
615
Q185458- Boy feels shy at school because he speaks like…I I I I…, feel …ccooooll. During talk his eyes blinking several times. His friend teasing him. Ask what the diagnosis.
A Autism
B Asperger
C Stuttering
C
616
Q10142- Old man complaints of dyspnoea, orthopnoea. History of DM + and take metformin,
atorvastatin, aspirin ,etc. JVP 3cm , bilateral basal crepts +, CXR is given (interpret as left heart failure). What is the most appropriate next step to confirm the diagnosis?
a.CTPA
b.Serum electrolytes and creatinine
c.ECG
d.Troponin
e.BNP
Next ECG
| Diagnostic BNP
617
```
Q189211-Mother takes 9 mon old irritable baby with a bile stain vomiting and diarrhea to see her local GP. She says the baby was doing fine until today when the baby kept vomiting up food.US shows shadows in right upper quadrant. What next to do?
A. Urine culture
B. Stool culture
C. Air enema
D. Laparotomy
E. Laparoscopy
```
C
618
Q9050-Patient on antithyroid and now euthyroid want to conceive
A. continue carbimazole
B. replace carbimazole with propranolol
C. stop carbimazole
D. give iodine
اگر هم یوتیرویید باشه قطع میکنیم در طول حاملگی ببینیم جی میشه ، یکم هایپر هم عیبی نداره
از تریمستر دوم به بعد میتونه بره رو کربیمازول
اگر باردار هست و تو تریمستر اوله باید ptu استفاده کنه و باید انزیم هاي کبدي مادر مدام چک بشن به دلیل هپاتیت دارویی
اگر میخواد باردار بشه و هیپرتیرویید هست ما با ید رادیو اکتیو درمانش میکنیم و تا سه ماه باید صبر کنه و باردار نشه.
619
Q188004- 25 year old on OCP with post coital bleeding, last pap 18 months ago was normal. what next
```
A. Assure
B. Colposcopy
C. Repeat Pap
D. Do Thin Prep
E. Check for HPV
```
D?
620
Q182503- enlarged gall bladder with multiple stones, found dilated bile duct and stone obstruction in common bile duct, patient developed toxic shock, what to do after fluid resuscitation?
a. laparotomy cholecystectomy
b. laproscopic bile duct explore
C. percutaneous bile drainage
d. endoscopic duct drainage
C or D
621
Q182541- a man returns from sudan with 1 month history of shortness of breath and unproductive cough. Chest X-ray was given which showed rt sided lung fibrosis with trachea deviated to the rt side. what is the next appropriate management?
a. amoxicillin
b. isoniazid
c. doxycycline
d. isoniazid, rifampicin ethambutol and pyrazinamide
e. admission in isolation
E
622
Q184096- 15 y/o boy with history of sudden outburst of anger who is currently in a special school is now at the verge of expulsion. What would be the best drug management for this case?
```
A. Sodium Valproate
B. Risperidone
C. Olanzapine
D. Haloperidol
E. Carbamazepine
```
B
623
Q186204- Woman fall on outstretched hand at the back door of her house. Her xray on 6 weeks post fracture heal finely. She came to follow up on 8 week post fracture only show mild intermittent pain. Mx?
a) Repeat xray wrist
b) Sling for better stability?
c) CT
d) Arrange occupational therapy for back door safety
D?
624
Q10262- Indian student, 2 mths dysuria, hematuria, frequency. All urine test normal except RBCs and pus in urine. Urine culture (-). Dx?
a) Cystoscopy
b) Renal biopsy
c) Urogram
d) Repeat urinalysis
e) Chlamydia PCR
A
625
Q9354- Young boy after a episode of Severe bout cough developed chest pain , after 12hrs he went to ED,it revealed 15% pneumthorax, where the gave him morphine after analgesia . What initial management you will do
A. Reassurance
B. Admit and review in 24 hrs
C. Aspirate and review
D. Chest tube insertion with water seal
E. Similar option to chest tube insertion
C
626
Q9604- schizo lady 78 YO, admitted for smoething or presented idk, diagnosed with cancer of caecum. surgeon said only way to tx is to operate(in more sophiticated way). lady's MMSE: 20/30. same details given. bt one of her daughter wanted to ask u if it is fair to operate on this mentally something patient! but u have talked to the pt about the condition & she said yes to operate. wt to do?
a. as pt not able to give consent dnt operate
b. call fr family meeting with sergeon
c. pt has give consent ,go for sx
d. listen to daughter n not do sx as she has the attorny or smthing
e. listen to spouse
B
627
Q182509- picture of submandibular gland sewlling in old man,it was slow growing for last 12 moths, overlying skin is free, no pain, u have done FNAC & found malignant cell, what will u do next??
a. usg
b. ct neck
c. mri neck
d. sialogram
B
628
Q9165-yo alcoholic and smoker complains of a 2 cm painless lump on the left tonsil. No other signs and symptoms described. What is the most likely dx?
a. Squamous cell carcinoma
b. nasopharyngeal cancer
c. body/aneurism on the carotid artery
d. mts from some place
e. non-Hodgkin lymphoma
A
629
Q9262-year old male occational usage of metamphatamine.. daily usage of marijuana and unexplained scars in forarm. Treat with psychotherapy but failed.what to do next
a. Diazepam
b. Respiridone
c. Methyphenidate
d. Fluoxetine
e. Naloxone
B?
630
Q187567-33 yrs old womwn came e wth insomnia and she been diagnosed e with ovarian cancer e metastasis now she is tearful and wants to end it all .what is ur initial management
a. Mirtazapine
b. temazepam
c. send her to chaplain something like that
d. refere her fr euthanasia
Access suicidal risk
631
Q183333-What’s the most prognostic factor in calculating 5 year CVD risk?
a- Bmi
b- Waist circumference
c- Hypercholesterolemia
d- Hypertension
WHR
ولی دقت کن اگه توی cvd
Most prognostic factor:
1 waist/hip ratio
2 waist circumference
632
Q11206-Family with a newborn baby moved to a small village in rural Australia, father called up GP to inform wife sad all the time, low mood, crying but taking good care of baby, cannot get her to the hospital as he is busy with new work, what next:
a. Make a home visit
b. Send a social worker to check on woman
c. Insist husband to get the woman & baby to clinic
d. Admit the woman, baby can be with dad
A
633
Q185501- 35 year old lady come with rash and color change in winter of hands. This is previously improved by nifedipine.Lab shows
ANA 1/640
Anti dsDNA (+)
Anti CCP (-)
RF (+)
SURE inv
What is the most appropriate treatment?
a. Prednisolone
b. Hydroxychloroquine
c. Methotrexate
d. Naproxen
e. Azathioprine
B
634
Q186151- Ecg of V.fib. Defib done but still no change. What next?
A. Continue CPr for 2 mi
B. Repeat defib
A
635
Q185346- Pic of sle rash face and arthritis and recurrent mouth ulcers for 6 months. ANA and Anti dsDna positive. Long term management?
a. Methotrexate
b. Hydroxychloroquine
c. Cyclosporin
B
636
Q186588- absolute Contraindication for COCP:
a) Inherited hereditary thrombophilia
b) Hep A 3 years back
c) Family history for breast cancer
d) Family history of endometrial cancer Like
A
637
```
Q182533- young man presented with dizziness. ECG was given which showed sinus bradycardia with heart rate of 35/min .treatment
A.atropine
B.pacemaker
C.amiodarone
D.diltiazem
```
A or b
638
Q9557- Patient underwent Conization for abnormal pap smear 2-3 days back. Now presents with fever 39, pain lower abdomen and tenderness. What’s the most appropriate place to take a swab?
a. Blood culture
b. Endocervical swab
c. High vaginal swab
B
639
Q1810083-A lady, she is on medication for HTN and hypercholesterolemia, she is saying that she has been taking the drugs regularly and hasn’t visited the doctor for 8 months, but when u check u realise that she was supposed to finish d medications 2 months back, her mmse is 24 with impairment in recall. What is ur next step??
A.Tell her that she need to b assisted by a practice nurse
B. Talk to her familly without letting her know
C. Ask her nominate a familly member to get more information
D. Do more examination
E. Ask the pharmacist for further information
E
640
Q187279-The government implemented streptococcal vaccine for 7 different strains in 2000. In the following years, the vaccinated serotypes have decreased and the non-vaccinated cases have increased. Why is the case?
a. Vaccine resistance
b. Antigen drift
c. serotype conversion
C
641
Q187492-Despite increased no of patients covered under cervical cancer screenin (from68% to 85% now). There is no decrease in cervical cancer incidence. What is the cause?
a) Screening test is not specific
b) Cervical cancer has very rapid course
c) Treatment not adequate
d) women with highest risk weren't screened
D
642
Q1810287-Pt BP 80/50 mmHg, PR : 110 .on exam a pulsatile abdominal mass felt in midline, with sudden severe pain radiating to back. Most appropriate next?
a) Urgent laprotomy
b) FAST
c) CT
d) Aortogram
B
643
Q1810266-Lady comes with complaints of intermittent LIF pain more during urination, from 3 days ago she had similar pains 4weeks back .her period finished 9 days ago …what is the diagnosis
a. Endometriosis
b. ovulation
B
644
Q187187-years old come with left scrotal pain which wakes him up at night. No fever, malaise and discharge. On examination, right scrotum and content is normal. Left scrotum tender, redness, swollen. Cremasteric test is positive. Pain is reduced initially when left scrotum is elevated. What invx?
A- Urine C&S
B- Chlamydia PCR
C- Scrotal USG
D- Needle aspiration
داپلر
| نبود b
645
```
Q186420- A teenager 16 years plays football &active in sports. He has hx of asthma and on fluticasone. What - is the cause of Gynaecomastia?
a) Anabolic/ steroids use
b) fluticasone inhaler
C) idiopathic
D)pubertal
E) Reassurance
```
C
اگر استروئید آنابولیک مصرف میکرده: گزینه الف، در غیر این صورت گزینه سی
646
Q185394- student came back from India with persistent fever. Showered with bucket of water from nearby lake. Also drinking water proper sterilized and clean. Malaria tested twice. All meds taken including antimalarial and vaccinations.
A. look for other disease
B. do thick thin filn now
c. do another rapid malaria test
d. also something abt malaria
B
647
Q183424- qestion showing ph acidic, nornal bicarbonate and elevated serum co2 levelz asking whats happening
a. metabolic acidosis and resp acidososis.
b. metabolic acidosis without compensation
c. metavolic acidosis with compensation.
d. respiratory acidosis with compensation
e. resp wo compensation.
E
648
Q10309- woman 7 weeks amennorhoea, vaginal bleeding episode. obese so pelvic examination difficult, home preg test was positive, USG shows no gestational sac in uterus, no fluid in pouch of douglas, cant exactly remember but there was an apparant follicular ovarian cyst/corpus luteal cyst . how to manage?
a. serial beta hcg,
b. ultrasound review in 2 weeks,
c. repeat pelvic examination in 2 weeks,
d. laparoscopy
A
649
Q185371- 25yo nulliparous woman at 6 weeks amenorrhea. her regular cycles are of 4 to 5 weeks. she had a home pregnancy test which was positive. presents with bleed per vaginum and abdominal pain. what investigation needs to b done
a. serial b hcg
b. urine pregnancy test
c. serum hcg levels
d. ultrasound
D
650
Q10347- An ECG came with Atrial fibrillation. It was very prominent. The patient came with complains of palpitation. Heart rate was I think in 70s. He was hypertensive. Asking for treatment?
a) Digoxin
b) Beta blockers
c) Adenosine
d) Amiadrone
No calcium channel blocker in options
B
651
Q182055-Heart block ECG on Enalapril, diltiazem 40 mg, Digoxin( within normal level).
A. Stop all & monitor ECG for 3 days
B. Add propranolol
C. Reduce diltiazem
D. DC shock
بیماری گه بلوک قلبی در ECG که انالاپریل دیلتیازم و دیگوکسین استفاده میکنه
با توجه به رفرنسها هر سه دارو میتونن بلوک قلبی در عوارضشون بدهند پس در قدم اول قطع داروها و مانیتورینگ منطقی به نظر میاد
جواب: A
652
Q10202- Patient with CHF taking B-blocker , furosemide , perindopril , K supplement , Metformin for DM , started Amiodarone due to arrythmic problems , now complain of lightheadedness and palpitation & feeling like syncope. Potassium level was given about 6.5 and other lab values were within normal range
A.Metformin & amiodarone
B.Metformin & K supplement
C.Frusemide & Perindopril
D.Frusemide & Metformin
E. Amiodarone +Perindopril
E
653
Q182040- Infliximab, what test will u advise?
A. CMV
B. TB
B
654
Q9488- 8 years child affected with common cold most of the 12 months but more in winter season. O/E no lymp node enlargement. Wt investigation u do?
a. x-ray nasal sinus
b. ct
c. skin prick test
d. IgE level
C
655
Q10060- what is most common cause of hepatoma
A. Alcoholic liver disease
B. Hemochromatosis
C. Hepatocellular carcinoma
D. Hep A
E. Hep B
E
| Hep b c
656
Q10092- 65 year old lady nulliparous comes with painless bleed from the breast, her cousin had breast Cancer, very short stem. what is the diagnosis?
A. Intraductal papilloma
B. Ductal ectasia
C. Invasive cancer
D. Paget disease
A
657
Q185055-In australia,almost every year there are several indication of bush fire.usually it is caused by young people and teenagers.which of the following is true?
A.Juvenile pyromania is the main cause of fires in australia
B.it is due to accidental fire caused by youngster who get scard after the fire starts to spread uncontrollably and then run away.
C.it has no serious consequences
D.youngsters like to ignite and play with fire
E.it is done to hide crimes
A
658
Q11177- lady with 4 cm dilatatation of cervix came to hospital.on examination cervix was 5 cm dilated, fetal head at ischial spine,LOT position and ctg was of early deceleration.what to do now
a. immediate delivery
b. fetal scalp sampling
c. continuous ctg
d. tocolytics
C
659
Q10525- 40yr man, numbness of 4 th & 5th fingers, weak thumb & index opposition, loss of princer grasp, flexion of wrist and fingers are normal. What is the most likely site ?
A- Cervical neck lesion
B- Carpal tunnel nerve entrapment
C- brachial plexus
D- Nerve entrapment elbow ans
E- Cervical region
D
660
Q188487- MAN WITH BELLS PALSY FEATUTRES ( DROOPY R FACE CANT OPEN RIGHT EYE .FRONTALIS MUSCLE WEAK?
A. CT
B. MRI
C. NERVE CONDUCTION
D NO FURTHER INVEST
E. SWALLOWING TEST BY SPEECH PATHOLOGIST
D
661
Q184446- Risk of endometrial cancer-
a. smoking
b. obesity
c. cyclical HRT,
d. alcohol
e. cervical dysplasia
B
662
PDA-
جPS-
بASD-
الفVSD-
همراهWIDE FIXED P2+RBBB مراجعه کرده است تشخیص شما چیست؟ یك پسر ده ساله با عفونتهاي مکرر تنفسی فوقانی و تحتانی و سوفل سیستولیک دو/ششم در LSB و سوفل مید دیاستولیک به
B
663
Q10024-polypharmacy digoxin ,spironolactone, presents with nausea abd pain, digoxin levels normal ,K- 6.5 with ecg tall T waves, asking cause?
a. digxin toxicity
b. hyperkalemia
A
664
Q188066- Old woman, post femoral surgery develops painless distention. Xray of huge dilated bowels. Initial tx.
A. Nasogastric aspiration and IV fluid
B. Rectal flatus tube
C. Colonic compression
A
| سپس b
665
Q186415- 68years old man who is living alone, taking perindropil, B blocker diuretics for CCF, Elderly care service visit him once 2 weeks for medical checkup. He walks every day for 30 min and does his own shopping. What is the greatest risk factor for fall in this man?
a. health care service visit him not frequent enough
b. taking more than three drugs
c. living alone
d. health care service being too far away from him
B
666
Q9044-Male patient with bleeding per rectum and examination internal hemorrhoid. Most common associted features
A Painful swelling on defecation
b. Mucus discharge
c. feeling of lump
d. nocturnal perineal pain
B
ترشح و تحریک پری آنال در تمام انواع هموروییدهای داخلی دیده می شود و شایع است .
ولی احساس توده فقط در نوع پرولاپس دیده می شود .
در متن سوال حرفی از پرولاپس نزده و فقط خونریزی اطراف مقعد که در معاینه بیشتر پی به همورویید داخلی برده است .
اگر پرولاپس شده بود بدون معاینه در نگاه هم دیده میشد
667
Q188565-Middle aged woman with pain in right thigh worse at night n morning. But gets better after 10 mins of walk. Hx of bilateral knee OA. Next Investigation?
a. X ray right hip
b. Bone scan
c. X ray lumbosacral spine
D. MRI
E. Doppler Usg
A or c?
668
Q188208-ovarian ca diagnosed , where is primary site?
A-breast
B-colon
C-stomach
D-kidneys
B
669
Q1810086-A 75 y.o man with fever,cough, rigor...had chronic cough with greenish yellow sputum for 3 years, and persistent bilateral basal crepitation, now in his cxr has left lower lobe consolidation, what is the most app treatment option for him:
1. Oral rohxithromycin
2. Oral amoxi..calavulant
3. IV flucloxacilin
4. IV ticarcilin-pipracilin
5. IV meropenem
B
670
Q187741- 53 year old man complained of chest pain radiating to his jaw for 30 minutes. Upon arriving in the ER. Vital signs stable, normal ecg pattern, normal troponin I and CKMB levels. Patient was immediately relieved upon giving Isosorbide Dinitrate. What’s the next management.
A. Send and reassure patient home with ISDN sublingual sprays
B. Repeat troponin I every 30 minutes for the next 2 hours
C. Check ECG every hour for changes in patterns
D. Chest X ray
E. Refer for PCI
C
671
Q188103-. 25 years oldboy, back pain and stiffening.xray given.He is been taking pcm and pcm/codein for the pain but it is not working anymore. On exam, loss of lordosis. Tx?
A/ indomethacin
b/ sulfalazine
c/ MTX
d/ physiotherapy
e/Infliximab
A
672
Q183549- old lady with htn dm on lots of drugs. now came with increased drowsiness and loss of appetite. Given lots of labs Cbc,rfts,tfts,lfts Ca phosphorus level. Everything was normal except urea and creatinine it was high
a. iv normal saline
b. hemodialysis
c. ca gluconate
d. resonium
A
```
هایپرکالمی مقاوم به درمان
اورلود مایع
اسیدوز مقاوم
انسفالوپاتی اورمیک
پریکاردیت و پلوریت اورمیک
سم زدایی
```
673
Q188043- Case of old woman with iron deficiency anemia, no symptoms no complain, cause?
A. Carcinoma of caecum
B. Carcinoma of.....
C. Carcinoma of stomach
D. nutritional deficiency
A
674
Q11021- A patient with prostate ca T3b N0M0. Mx
A.Radical prostactemy
B.orchidectomy
C.Radiation
D. Androgen deprivation
C
675
Q9070-A 2 year old patient has been having progressive cough, fever and wheezing for the past 2 weeks. On examination patient has tracheal tug, subcostal retractions, RR 40, o2 sat 88% clear breath sounds. What will confirm your diagnosis?
```
A. Chest xray
B. Pulmonary function test
C. Improvement with initial use of salbutamol
D. Blood C/S
E. Cbc
```
C
676
```
Q1811155- 2 year old child with respiratory symptoms with o2 sat 88% (not sure). What finding will confirm the diagnosis?
A- history of Atopy in parents
B- history of Atopy in the child himself
C- improved symptoms with salbutamol
D- chest x ray
E- spirometery
```
C
677
Q186650- woman presents with 12 hr history of painful abdominal cramps and bloody diarrhoea. passed
stool abt 10 times. causative organism?
1. salmonella enteritidis,
2. enterotoxigenic e coli,
3. giardia,
4. norwalk virus
A
678
Q10336-Scenario of woman with melody stick in her mind. She can't get rid of it and being distracted and distressed. What help you in diagnosis?
a) Level of insight
b) Mood
c) Suicide idea
A?
679
Q186253- Men 35 years with history of difficulty in micturition for 2 years. Difficult to start and dribbling at the end of micturition.
a) BPH
b) Bladder stone
c) Urethral stricture
d) Urethral valve
e) Cancer (not sure)
C
680
Q11460- An old woman came to the ED with vulval erythema and vaginal pain. She had some symptoms of candidiasis which was confirmed by labs. How will you treat this woman?
a) Oral Nystatin
b) Oral Fluconazole
c) HRT
d) Topical estrogen
e) Oral Clotrimazole
B
681
Q11036- A lady concerned that her partner has hep C .what prevention
A.use condoms
B. Dont share razors & blades
B
682
Q188463-pic of old lady with painful swelling infront of tragus with redness.Cause?
a) duct stenosis
b) duct stone
c) coxakie virus
d) poor oral hygiene
e) parotid duct Ca.
d
Parotitis
Acute bacterial suppurative parotitis is caused most commonly by Staphylococcus aureus and mixed oral aerobes and/or anaerobes
often occurs in the setting of debilitation, dehydration, and poor oral hygiene, particularly among elderly postoperative patients.
CLINICAL MANIFESTATIONS — Suppurative parotitis is characterized by the sudden onset of firm, erythematous swelling of the pre- and postauricular areas that extends to the angle of the mandible. This is associated with exquisite local pain and tenderness with complaints of trismus and dysphagia. Systemic findings of high fevers, chills, and marked toxicity are generally present.
On examination, a fluctuant quality is generally not appreciated because of the dense parotid fascia that overlies the gland.
Ultrasound is our preferred initial imaging modality for suspected suppurative or obstructive parotitis, since it is particularly useful for detecting stones in the duct or parenchyma and for differentiating between obstructive and nonobstructive sialadenitis.
TREATMENT — Treatment of suppurative parotitis includes hydration and intravenous antibiotics
683
Q188022- You are a junior doctor. A 16 year old girl comes with abdominal pain. She does not allow you to touch her abdomen. You call Surgery consultant who criticize you and tell you to call the gynaecology consultant. What to do?
1. Re-examine patient
2. Call Gynaecology consultant
3. Do pregnancy test
C
684
Q10304 -newborn good apgar scores. later becomes jittery. blood glucose < 2mmol. Mx?
a. IV glucose
b. IV glucagon
c. IM glucagon
A
685
Q1810080-A 66 yo woman, with sharp chest pain aggrevated on rotating, difficulty in standing from sitting on chair, unsteadiness in walking, and on examination there was no tenderness or fracture on chest wall, just weekness in lower limbs and increase knee and ankle reflexes bilaterally, wof is the most app next in her management to reach dx:
1. Serum protein electrephoresis
2. chest xray
3. ct spine
C
686
Q189197-aA man had been on anti-Parkinson drug for 9 years. Recently, his wife complains of psychosis and was prescribed 10mg Haloperidol. After two weeks, wife complains of abnormal movement and inability to feed himself. What to do next.
A) decrease dose of anti-Parkinson drug.
B) increase dose of anti-Parkinson drug
C) decrease dose of Haloperidol
D) increase dose of Haloperidol
E) continue same treatmen
C
687
Q9564- A man presents to your clinic. His BMI is in the overweight range. He is a smoker. He occasionally uses cocaine and cannabis. Which of the following is the biggest risk factor for CAD in this patient?
A. Obesity
B. Cannabis
C. Age
D. Cocaine
E)tobacco
E
688
Q186284- Mother came with meningitis. Child had history of fever and generalized lymphadenopathy and rash last day.. On CSF monocytes, glucose 3.5(2-4.5 normal), no RBCS, protein>45 (or 0.45...i couldn't get the exact value).Most probable cause?
a-Meningococcus
b-Echovirus
B
689
Q186557 - mother came with 14 month old baby ,she says she is not developing like his sister.She rolled at 6 months, sit with walk,but can say only ba ba.Can pick small things and shifts from hand to hand,plays peek a boo. Auditory and visual examination are normal.what is the problem?
a-No developmental delay
b-Gross motor
c- fine motor
d- language delay
D
690
Q9385- renal tumour lower lobe of kidney 5cm, 62 yrs old woman asymptomatic on accidentally ultrasound finding what you will do next?
A. Biopsy-as old pt
B. Total nephrectomy
C. Partial nephrectomy
d. Observation and reassurance
C
<1 cm 👉👉 F/U
1-7cm 👉👉 Partial nephrectomy
>7cm 👉👉 Total nephrectomy
منیج توده هاي تصادفی کلیه:
691
Q91049- Lady took 120 tablets of PCM, who presented with fx of encephalopathy
a. Liver transplant;
b. continue N-acetyl;
c. low benzodiapines & low Antipsychotics
A
Liver failure with increased inr
Acidosis
Hepatic encephalopathy
افزایش cr و BUN
کرایتریاهاي شدت مسمومیت با پاراستامول که باید پیوند کبد انجام بدیم، شامل:
692
Q9207-swelling to infront of ear, no tender, non fluctuant swelling at front of tragus, skin over swelling is mobile
A- USD
B- CT
C- MRI
D- Bx
E- FNAC
B
693
Q1810150-32 year old woman, smoker, BMI 45, with her mother recently diagnosed as breast cancer at 60 year age,worried if she got breast cancer and asking advice, what is your most appropriate action?
A-stop smoking
B-breast self-examination
C-annual mammography with 6 monthly clinical review
D-Reduce weight
E-ultrasound and mammography now
B?
694
Q185503- Patient with parkinsonism like features , history of taking resperidone and now visual hallucination.His cognitive function is impaired. (Not given fluctuation). What is the most likely diagnosis?
a. Dementia
b. Lewy body dementia
c. Drug interaction
d. Cerebral infarct
B
695
Q188353- Aboriginal child with acute otitis media
1. amoxicillin
2. amoxicillin/clavulante
3. ciprofloaxacin
A
696
Q1810427 -Adult female taking carbamazepine.came for ocp prescription.wat to do.provided symptomatocaly stable.
A.increase carba and give low dose ocp
B.decrease carba and give high dose ocp
C.cease carba and give ocp.
D.continue same dose carba and add ocp
D
697
Q1810418-Girl with no history of purpura and petechiae.
Presented with bruises over left thigh and buttocks.asking next investigation.
A.von wilibrand
B.factor 9
C.protien c and s
D.bleeding time
D
698
Q186491- Pregnant with genital herpes,what test to identify it is new or recurrent infection??
A.get a swab one of wart for PCR
B.sample of wart for pcr
C.review her serology status in week
D.send a sample for serology today
E.Igm
D
699
Q11421-A 48-year-old woman notices a whitish discharge from her left nipple when she was drying her breast after a shower. She has 3 children, the youngest, 2 years old, and has been breast-feeding all of them within a range of 9-12 months after birth. What is the management?
a. Give bromocriptine
b. Give oestrogen/progesterone pills
c. Give progesterone (? Unsure whether this was the actual option)
d. Avoid breast stimulation
D
700
Q9791- scenario of a lady who become agitated and confused at shopping center for 1-2 mins. She has h/o same attacks . and during attack she stares blankly, doesn’t respond to any command followed by conusion. Sometime during conversation with relatives it happens and she doesn’t follow the conversation. What is ur dx?
a) Panic attack
b) GAD
C) Complex partial seizures
d)PTSD
C
701
Q188334- a patient presents with 3 months history of nausea and epigastric discomfort he has icteric sclera he consumes 50-60 grams of Alcohol. Lab investigations were given all liver enzymes including total and conjugated bilirubin were raised and serum lipase was also raised on Usg there was dilatation of intrahepatic channels not extrahepatic no other abnormality what you will do?(in ca pancreas both extra intra pancreatic duct will be dilated)
A-ERCP
B-CT abdomen
C-MRCP
D-Ena
E-CTPA
Next b
| Best c
702
Q189123- 17 years old boy come with Gingival inflammation and swelling with submandibular lymph nodes enlargement,soft,tender. next step?
A)CT head
B)OPG
C)gingival swab
Refer
703
Q187642- Lady presents with mild temperature and redness of breast left….non fluctuant area +….what to do after giving antibiotics
a. Breast feed from left breast first
b. Express and discard
c. Aspirate
A
704
Q184439- Woman after vaginal delivery. 2700gm baby. Previous c section. Ergometrine given,placenta delivered through cord traction. Now PPH. Cause?
A. Uerine atony
B. Uterine inversion
C. Uterine rupture
B
705
Q188313- Overdose of amitryptylline ( not mentioned how long ago) now drowsiness and hypotensive and Wide QRS in ECG. what is yr next management?
1. oral activated charcoal
3. hemodialysis
3. gastric lavage
4. Intubation and IV sodium bicarbonate
5. something like cardioversion
D
706
Q189252-A middle age woman comes for Pap smear test. Her last 6 mth pap smear result is LSIL. She also wants to take HPV vaccine, What is the app action?
A. Give vaccine now
B. Should not give vaccine
C. Vaccinate according to her Pap smear result
D. vaccinate according to HPV serology result
E. Vaccinate according to HPV PCR result
A
707
Q1810398-Long term complication of prostate surgery
A. Impotence
B. Retrograde ejaculation
C. Urinary incontinence
Radical : erection
| Trans urethra: ejaculation
708
Q185089-76 year old woman comes with a month of lethargy and occasional diarrhoea for a month. She has no other comorbidity. BP 140/85, HR –normal She had FBE and routine tests checked 3 months ago. All were within normal range. What is the initial investigation?
A. FBC
B. C X-ray
C. Colonoscopy
D. Thyroid function
A
709
Q10030- on combined OCP, presents now with scenario of migraine with aura asking what is appropriate
a. continue cocp
b. its contraindicated
c. review if has another episode
B
710
Q183161- ecg shows block and patient presented with light headness asking what is next
A.beta blocker
b.digoxin
C.holter
D.echo
D
بعدم اکو تا اختلال استراکچرال رد بشه
با توجه به اینکه تو ECG بلاك داره دیگه هالتر کمک بیشتري نمیکنه و اگه علامتداره پیس
711
Q183550- scenario of a kid who presented with DKA.what is the most likely complication of management of this condition
a. hyperkalemia
b. hypokalemia
c. cerebral edema
?
712
Q187032- A homeless man comes to emergency department, agitated and insist to admit him and threatening that he will jump in front of a car if you will not fulfill his wish. He has been taking low price beer for 2 cans for the past 2 weeks. What is your next step?
a. Mental health Act (something like that)
b. Dislouse
c. Give him IV Glucose
d. Give him IV thiamine
e. Give him Diazepam.
D
713
Q10495- old patient came with acute back pain,x-ray shows two fractured vertebrae, on bone scan only these two vertebrae were positive, lab results show: all wrere within normal range except the ESR was high, what is the next most important investigation:
1. bone marrow examination.
2. PSA.
3. LP
4. MRI
A
714
```
#internal
Q183538- 64 yr old man with low back pain. No symptoms of prostate. Crushed vertebrae t10 L1 seen on bone scan with increased uptake. Labs were given
ESR increased more than 100
Ca level was normal. What will u do to know underlying cause
A.bone marrow exam
B.PSA
C.PET scan
D.MRI spine
```
A
715
Q183538- 64 yr old man with low back pain. No symptoms of prostate. Crushed vertebrae t10 L1 seen on bone scan with increased uptake. Labs were given
ESR increased more than 100
Ca level was normal. What will u do to know underlying cause
A.bone marrow exam
B.PSA
C.PET scan
D.MRI spine
A
716
```
Q10496- Anthology vertebral fracture picture with 40 years lady with sudden severe pain radiation to thigh and toe with no neurological deficit next investigation
A. Spine Xray
B. MRI of lumbo sacral region ans
C. Bed rest
D. Analgesia
E. Continue activity
```
D
717
Q10518- Man suddenly got back pain and admitted hospital got oxycodone.which findings will be most significant for you to do an imaging?
1. Urinary retention
2. Positive tinel test
3. increased planter reflex ans UMNL
4. tenderness on sacroilliac region
A
718
Q10520- 46 yrs old man got back pain during gardening about one months ago,now came to unbcoz pain is continuing,there is no numbness,u give him analgenic,now whats next??
a. xray
b. mri
c. ct scan
d. usg
e. bed rest
A
719
Q10232- Old man with back pain. Xray given which shows collapse of L4 or L3 as well as osteopenic bones. Lumbosacral xray was done. Which of the following is the next best step?
a. MRI
b. PSA
c. DEXA
d. Bed rest
C
720
Q9278-man with back pain after gardening with sharp pain at buttocks down to heel. what is expected in exam?
a. pain in outer thigh
b. pain in inner thigh
c. decrease in knee extension power
d. decreased knee reflex
e. decreased ankle reflex
E
| درگیری سیاتیک
721
```
Q9364-40 yr old lady with back pain at L4 level with severe shooting pain to leg after analgesia
what next
A. Observation
B. X-ray lumbosacral
C. CT lumbosacral
D. MRI lumbosacral
-No continue activity/rest in option
```
A
722
Q11041- Old lady with back pain after bending.she is on furesemide & thiazide.asking cause??
A.compression fracture
B.metastasis
C.disc prolapse
A
723
Q11242-A 40 year female had a history of breast ca which is treated at 24 year age . She has history of osteoarthritis of hand,fingers and knees, now presented with back pain in L3-L4 region. On exam there is tenderness too.Which one of following is your initial step of management ?
A.ESR
B.bone densitometry
C.MRI spine
C?
724
Q9685- Elderly woman with H/O Ca. colon presents with lower vertebral pain elevated PTH + ALK.PH. Dx.?
1. Multiple myeloma
2. Malignant met
3. Disc prolapse
4. Vertebral #??? No elevated PTH
?
متاستاز کانسر کولون به استخوان شایع نیست
باعث افزایش کلسیم و افت pth میشه
725
Q81077 -old man fell from height pain radiating to buttocks. Management
A. MRI lumbar spine
B. Bed rest
C. Contine activity
Xray
726
X ray limbo sacral spine lateral view describing reduced bone density with multiple
anterior wedging of L2, 3 and 4 vertebral bodies. Patient is 75 years, having mild back pain with
recent severe localized abdominal pain. Blood test revealed mild anemia. Raised ESR. Calcium
level is normal. Diagnosis?
Multiple Myeloma
Metastasis from prostate
Osteoporosis fracture
A
727
Q83017. Old man with back pain. Xray given which shows collapse of L4 or L3 as well as osteopenic bones. Lumbosacral xray was done. Which of the following is the next best step?
a. MRI
b. PSA
c. DEXA
d. Bed rest
C
728
```
Q10420-34 year old female come to ask about breast screening ,as her mother was Diagnosed with breast Ca at age 60
a-refer to breast screening
b-reassure
c-annual clinical exam
d-Moniter breast for any change
```
D
729
Q10423-23 yr girl with positive family history mother had ca breSt 40yrs n girl hving breast swelling in upper quadrent 4 cm and smooth outlines everything apart from swelling s normal no node involve ...diagnosis
a. Fibrocystic ds
b. Fibroadenoma
c. Lobular ca
بیماری فیبروکیستیک:
سن ۳۰-۵۰ /مرتبط با هورمون/ تورم، درد و تندرنس که قبل از منس تشدید میشه و معمولا بعد از پریود بهتر میشه/ یک یا دوطرفه/ ممکنه ترشح نیپل(عمدتا خاکستری و شفاف، گاهی خونی) دیده بشه/ اقدامات: اطمینان بخشی، اگر کیست قابل لمس وجود داشت 👈 FNA، اگه diffuse lumpiness و سن بالای ۴۰👈 ماموگرافی
فیبروادنوما:
شایع در دهه ۲۰/ توده محکم، صاف و متحرک که معمولا در یک چهارم فوقانی خارجی قرار داره/ هر ۱۲ ماه اندازه دو برابر میشه/ اقدامات: سونوگرافی + FNA (سن بالاتر همراه با ماموگرافی، اندیکاسیونهای بیوپسی اسکیژن: ۱- توده بزرگ بالای ۳-۴ سانت ۲-ادامه افزایش اندازه ۳-نتیجه مشکوک اسپیراسیون ۴-سن بالای ۴۰ سال
730
Q10549-
| اسپری فلوتیکازون مصرف می کند - الان از هر دو طرف سینه شیر میاید - چه کنیم؟
Check prl
731
Q11414-A woman with history of multiple vulva ulcer of herpes type, she has a boyfriend. What advice to give ?
A.Advice use of condom
B.Abstain from sex during flare of vesicles
C.Use of anti viral on patient
D.Use of antiviral on boyfriend
?
732
Q11500- یه عکس dimple sign گذاشته بود
گفته بود کدوم یکی موجبش هست
infiltrative carcinoma
ductal carcinoma incitu
A
733
```
Q83062.pic of mollucum contqgiusum what is most appropriate?
a-wash beed?! in hot water
b-avoid swimming in public hot pool
c-antibiotic
d-other unrelated drugs
```
B?
734
```
Q10431- A pregnant woman with bleeding pv has blood group 0-ve, how will you assess anti D dose?
A. Feto-maternal hemorrhage
B. Assesment of anti D ig
C. Coombs test
D. USG
E kell test
```
A?
735
Q81044 - Patient presents with cough productive of blood stained sputum. He has been having ankle pains and painful wrist. Urine microscopy showed wbc casts. What is the diagnosis?
a) Systemic lupus erythromatosis
b) Bronchial cancer
c) Wegner’s granulomatiosis
d) Renal cell carcinoma
C
وگنر
امروزه گرانولوماتوزيس با پلي آنژيتيس ناميده⬅️واسكوليت نادر با علت ناشناختست
ترياد كلاسيك⬅️URT گرانولوما➕فلتينگ پولمونري شادو(ندول)➕گلومرولونفريتيس
تسخيص⬅️ضعف➕علايم دستگاه تنفس فوقاني مثل(رينوره➕سينوزيت)➕علايم دستگاه تنفس تحتاني(سرفه➕ويز ➕ديس پنه)
چست ايكس ري⬅️ندول متعدد ➕كاويتاسيون
c-ANCA➡️تست تشخيصي مفيد ولي غير اختصاصي
تست تشخيصي قطعي⬅️بيوپسي(معمولا بايوپسي باز ريه)
پروگنوز بهتر⬅️تشخيص زودتر➕سيكلوفسفاميد
736
```
Hny:
❓❓❓
Q9771-A 29 year old construction worker was brought to Emergency department with pain abdomen Associated with vomiting. He mentioned that he is relieved of pain intermittently and he noted that the pain is radiating from lower abdomen to scrotum .On examination his temp was 37°C and abdomen was soft with normal bowel sounds .urine dip test was positive and urine ph was 5.8.The next logical step in diagnosis of this case is ;
A. FAST
B. Ultrasound abdomen
C. Non contrast CT abdomen
D. Contrast CT abdomen
E. IVP
```
C
737
```
Q11021- A patient with prostate ca T3b N0M0. Mx
A.Radical prostactemy
B.orchidectomy
C.Radiation
D. Androgen deprivation
```
C
738
Q10038-45 yrs old varicocoele scenario asking for next
a. no investigation
b. usg scrotum
B
739
```
Q81047 - A 20 y old boy had not sex with any one till now becouse he embarrassed about his small penis.what you dou?
Reassure that is nl in some people
Exam the penis size
Check testestron level
Lh/fsh level
Cbt
```
Length 12-18
Circumference 8-12
B
740
Q9891 اقای مسنی که جدید دیزوری و فرکونسیش بیشتر شده مراجعه کرده . بک پین هم داره.در آزمایشاتش psa=10 در ادرار wbc و rbc داشت و hb=12. تشخیص؟
a. Bph
b. Cancer prostat
c. Uti
C
741
Q82079. old pt 85 yr old presented with a long list of investigations having dysuria urgency and
frequency and back pain his labs show urine complete pus and psa was 10 what is ur most likely
diagnosis?
A) BPH
B)CA prostate
C)UTI
D) CA bladde
C
742
Q82196. 84 yrs lady renal tumour lower lobe of kidney 1cm, asymptomatic on accidentally
ultrasound finding. she also had a drug eluting stent 4 months ago and she is on Asprin and
clopidogrel. whats next appropriate management?
A. Biopsy
B. Total nephrectomy
C. Partial nephrectomy
D. Counselling
E. Observation and reassurance
C
743
Q10078- Post carotid endarterectomy pt went home after 7 days came back with audible stridor and severe dyspnea, what will u do after u raise his bed feet?
A) immediate Intubation
B) O2
C) Remove suture
D) Send to back to OR and surgery immediately
C
744
```
Q10081-22-year-old male pretend with right knee pain while jogging, and relieved by rest, on exam knee movement is normal and no limitations to joint mobility, no fever, no swelling, no deformity, x ray is normal too. Dx?
A. Stress Lateral epicondyle fracture
B. Lateral meniscus injury
C. Patellar femoral pain syndrome
D. Septic arthritis
E. Osteoarthritis
```
C
745
```
سوال 7️⃣
Q10092- 65 year old lady nulliparous comes with painless bleed from the breast, her cousin had breast Cancer, very short stem. what is the diagnosis?
A. Intraductal papilloma
B. Ductal ectasia
C. Invasive cancer
D. Paget disease
```
A
746
Q10098- A Zenker diverticulum X-ray with barium swallow. Mx.
Stapling
747
Q10115- a young man had a street fight duing which he hit his head on road , but he could get up & get into argument again.but after few minutes he collapsed.in ER he could not open his eyes,withdraw to pain &confuse conversation .whats next most appropriate?
1-CT scan
2-intubate
3-burr hole
B
748
Q10119- old man h/o smoking , alcoholism.presented with dyspnea.O/E plethoric face, engorged neck veins.what is most appropriate investigation? (sorry don’t remember full scenario)
1- Xray chest
2-ECHO
3-CT CHEST
C?
749
```
Q10153- Pt scheduled for lap chole. how will u start his antibiotics..
1- Commence at the time of surgery
2- Commence 2 days b4 surgery
3- 1 day before and 3 days after
4- discharge with 10 days
```
A
Ab at time of anesthesia
750
Q10164- Inguinal hernia. What will lead u to go for urgent surgery?
A. Swelling
B. Pain
C. Irreducibility
C
751
Q10169- A 30 years old man bitten by a brown snake comes after 30 mins. He has a 5 cm linear scratch mark on leg, no sign of puncture. Seems well. He and his friends couldnt find the snake. What to do
A. Reassure that as he has no puncture mark he can go home
B. Remove the skin around scratch mark n put a high bandage
C. Give him one ampule of brown snake antivenom and one if symptoms develop
D. Send him via ambulance to a base hospital 150 km away for observation
?
752
Q10451-Man with trauma ear now developed swelling.Next?
a-Incision and drainage
b-Compression and review.
A
753
Q10458- A man with swelling in front of tragus…on left side ..angle of mouth moving less than
right ..limited mobility of swelling..Pic given is exactly same as in HB q 2.002
a.Adenoid CA parotid
A
754
Q10479- History of Breast CA.. OPERATED ….comes with back pain …..what Ix ……?
lumaber spine
Mri
755
Q10484- XRAY ABD…small ( size not given )ureteric calculus….asking Rx
a. ESWL
b. Cystourethroscopic lithotripsy
c. pcnl
?
756
Q9216- A 30 years old woman comes to your clinic asking you for the best contraception for her. She doesn’t smoke, and she has negative family and personal history of breast cancer. But she has one episode of DVT few months ago, what will be your best contraception advice for her:
A- Use condoms
B- Use natural methods of contraception
C- Use low dose combined oral contraceptive pills
D- Use progesterone only pills
E- Intra uterine contraceptive device
E مسی
757
Q9146-Measles outbreak recall—
a. give Ig to unvaccinated staff and children
B. exclude all unvaccinated
C. exclude all wz fever
D. take all the infection control measures
E. wash hands/ there was no give vaccine or exclude the sick ones
A
758
Q183134-Pregnant lady comes at 18 weeks of gestation for palpitations and lethargy. Her others physical examinations are all normal. Her cardiovascular examination is also normal. Her TSH level is 5.1 (upper limit 4.0). What investigation would you do in this patient?
1. Do TSH again
2. Check serum T4
3. Antithyroid antibodies
Drug
759
Q182427- 14 year old with ADHD. Refusing to take medicines since few months. Agressive. About to be expell from school
A. Respa depot
B. Tell parents to insure adherence
3. Send state appointed nurse
4. Tell parents child has right to refuse meds
A?
760
Q183350-32 weeks gravid woman , come with acute abd pain , she was suffering from cold and after repeated coughing got the abd pain , fetal hr 145 , dx?(no any bleeding mention)
A. rectus sheath divarification
B. placental abruption
C. vasa previa
D. placenta previa
E. rectus muscle haematoma
E
761
```
Q11485-Patient from Iraq. Gives history of dry cough.No fever not hemoptysis. You notice pan systolic murmur at
apex. Chest x ray given. Diagnosis?
a.Tb
b.Mycoplasma Pneumonia
c.Rheumatic fever
d.Ca.Bronchus
#internal
```
C
762
Q188207-45 year old soldier from Iraq has persistent dry cough for 2 weeks. O/E his chest is clear. But he has a systolic murmur at the apex. A CXR is given I couldn’t see anything on it. Whats the diagnosis?
a) pulmonary
b) lung ca no murmur
c) sarcoidosis
d) pneumonia
A
763
Q182256-women elderly has both legs pitting edema and groin swelling what to do in diagnosis,
A.echo,
B.pelvic ultrasound
C.pulmonary angiography
A
764
1811224- post operative (cancer colon) with good hydration with long lab:
Na-decrease / S.Osmolarity-increase / U.osmolarity-decrease
A) hypertonic saline
B) normal saline
C) restrict fluid to 1 and half litte
B
765
Q1811241- 26 year old lady came with complain of post coital bleeding thrice. Her previous pap smear was done 3 months back which was normal. Asking about investigation.
A. Repeat pap
B. Chlamydia PCR
C. Colposcopy
D. Thick and thin smear
C
766
Q183074- Kawasaki case: child with fever, conjunctivitis, rash, lymphadenopathy, treatment asked
a. Ivig
b. high dose aspirin
c. , echo
A
| اندیکاسیون های کورتیکواستروئید
767
Q9260-Patient with h/o chest pain 2 months ago..bp is 170/90...cholesterol is 8.5...smoker 30 pack year history.Which one is the most important factor for major cardiac event within 2 years?
a. BP
b. Cholesterol
c. Angina
d. Smoking
B
768
؟Q182233- 17 year boy is having fights in school he is agitated and doesn't want to talk for his problem goes out then comes back into the clinic he is not making eye contact whats the cause
اگر طول مدت علائم بیش از یک هفته و اختلال عملکرد واضح—«سایکوز میتوان در نظر گرفت
دکتر مهرداد :شک بهfirst episode of psychosis
769
Q187401-29 yrs old woman complains of weight loss and lethargy and malaise, she noticed passing more frequent urine in day about 8 times and 2 times in the midnight.. Investigations revealed HbA1c 11.9, Fbs 9.8 mmol. What will be the best initial treatment ?
A metformin
B insulin glargine
C Gliclazide
D insulin pump
B
770
Q182514- a pt came for advice as her mother has fracture of hip due to osteoporosis. Pt ask for proplylactic treatment as she is at risk of having osteoporosis ,works long hours your next step in her investigation?
a) serum ca and phosphate level
b) vit d level
c) xray
d) bone scan
بسته به سن
اگه بالای ۶۰ سال باشه 👈 دگزا
اگه کمتر باشه توصیه به انجام ورزش و تغذیه مناسب و افتاب و ...
771
Q189306-A 48-year-old farmer smokes 40 cigarettes a day. He goes to the GP because he has bilateral pain in his buttocks and the backs of his thighs after walking 100m on a smooth surface and 25m on an incline or rough ground. Dorsalis pedis pulses are bilaterally palpable. Which images will assist diagnosis?
A. Spine MRI
B. CT
C. Duplex Doppler
D. Pelvic Angiogram
داپلر نیاز داره تا abi مشخص بشه ولی تشخیص قطعی با انژیو
772
Q185330- Patient taking tramadol for pain. She now take mirtazapine for depression. Most common SE?
1. hyperreflexia
2. Ataxia
3. Diplopia
4. Hypotonia
5. Muscle weakness
A
773
Q185387- cystocele in multigravid woman.with frequncy urge incontinence and stress incontinance a few times. no dysuria. investigation to diagnose?
a. cystoscopy
b. usg pelvis
c. urine culture
d. ivp
e. micturating somethng gram
C
774
Q182598- A 64 year old man presents to hospital with his first epileptic seizure whilst sat reading a newspaper at home. Drug history – Nil clinical examination reveals the following: •Temp 371•BP 182/102 •O2 Sats 99% Air •GCS 15/15 •Finger prick blood glucose 3.9 mmol/l •No Jaundice, Anaemia, Clubbing, Cyanosis, Lymphadenopathy •CVS,RESP,GI: (-) Neurological examination: including cranial nerves and Fundoscopy (-)His blood tests show the following: His chest X-ray shows a ill defined lesion in the left mid zone.
What is the most likely aetiology of his seizure?
a. Brain Metastases
b. Hypercalcemia
c. Syndrome of inappropriate ADH secretion (SIADH)
d. Hyponatraemia not caused by SIADH
e. Idiopathic epilepsy
C
اسمولالیته خون کمتر از ۲۹۰ است
سندرم پارانئوپلاستیک در کنسر ریه
775
Q182061- Asbestos exposed man came for advice. During work workers do not use mask, but they are exposed to asbestos during renovation. He is worried about asbestos related cancer, what is your advice:
A. Refer to respiratory specialist
B. Repeated Xray for the next 5years
C. Inform government to take some legislation
D. Do nothing
E. Inform asbestos has very low risk for ca
A?
776
Q182657-COPD patient comess with history of weight loss with facial congestiom and prominent ceinsnin neck. On exam no breath sound in left upper lobe..What is cause of symptoms
A) Lung CA
B)SVC obstruction
درگیري شبکه بازویی است. پان کوست بیشتر در small cell کارسینوما می بینیم درد منتشر شونده در بازو توصیف کلاسیک تومور پان کوست براثر
صورت برافروخته و عروق برجسته صورت و چشمهاي محتقن همه از علایم svc هستند
فوقانی ریه میگویند. تومور قله ریه در مجراي ورودي )inlet( فوقانی قفسه سینه میباشد. به این تومورها، تومورهاي پانکوست یا تومورهاي شیار اولین و دومین تنه اعصاب سینهاي، سندروم هورنر و ضعف و آتروفی عضلات دست میشود و بطور شایع به علت توسعه موضعی سندروم پانکوست مجموعهاي از علائم و نشانههاي اختصاصی است که شامل درد شانه و بازو در مسیر تنه هشتم اعصاب گردنی و
777
Q187422- man with dyspnea for 3yr,now comes with 1mnth loin pain and 24 hour haematurai.what will be nxt appro inv.lots of lab.Hb reduced,ESR raised,ca raised.xray close to this
a. anti GBM AB
b. ACE level
c. parathyroid hormone level
B
همونace level اقدام ابتدایی initial بخواد می تونیم pth براي رد هاپیر پارا بخوایم در هیپرکلسمی ولی اگر most appropriate بخواد ،
داشته باشه تظاهرات مربوط به هیپرکلسمی هست. اینا همه موید سارکویدوز هست ، و در هیپر پاراي اولیه این تظاهرات نیست و هایپرپاراي اولیه اغلب تظاهرات نداره ولی اگرم این سوالات با این مشخصات ، تنگی نفس پیشرونده ) درگیري ریوي ( و درگیري کلیوي ، درد شکم ، افزایش esr و hb پایین ،
778
Q182222- Female 50 years works as a cleaner,complain of can’t tolerate coldness when come out from bed since 2 months,terminated from job as she was not in work and disorganised,what you will find her as a symptom?pulse 56/min
a) Rigidity
b) Disdiadochookinesia
c) Delayed reflex syndrome
C
779
Q11323-40 years old man dix with colon ca. noted many polys on colonoscopy initially, then dx with colon ca. mom and two sisters have uterine ca. what hereditary illness does he have?
A. Lynch (HNPCC)
B. FAP
C. Gardners
D. Turcots
E. Peutz-Jegher syndrome
A
| AD
780
Q11321- bipolar patient on lithium and controlled, now has tremor of hand mild at rest, increasing with activity
A ..lithium level
B.. Change to valproic acid
C.. Add propranolol
D.. add benztropine
A
781
Q182541- a man returns from sudan with 1 month history of shortness of breath and unproductive cough. Chest X-ray was given which showed rt sided lung fibrosis with trachea deviated to the rt side. what is the next appropriate management?
a. amoxicillin
b. isoniazid
c. doxycycline
d. isoniazid, rifampicin ethambutol and pyrazinamide
e. admission in isolation
E
782
Q10262- Indian student, 2 mths dysuria, hematuria, frequency. All urine test normal except RBCs and pus in urine. Urine culture (-). Dx?
a) Cystoscopy
b) Renal biopsy
c) Urogram
d) Repeat urinalysis
e) Chlamydia PCR
نكست خواست ال پي بست خواستemg
783
Q185456- Pregnant woman 39 weeks , no fetal movement , CTG pic given- normal.....what to do Next :
A)Reassure and ask her to come after 24 hour
B)Induction of labour
C)C section
D)Reassure and ask her to come in the next visit
E)Admit and do further investigation
#obs
D
784
Q182534- a man presented with central chest pain of 4 hrs duration. ECG was given which st elevation in v2-v4.what is the next appropriate management after giving aspirin?
a. troponin I now and after 8 hrs
b. subcutaneous heparin
c. intravenous heparin
d. coronary angiogram.
D
785
Q184003- Lady 75 years old has HTN, DM, well controlled on drugs. She has an episode of chest pain during walking for 15 mins which is relived after rest. Her current medications include ramipril, metformin, metoprolol. Now the b.p is 130/85, Heart rate is 54bpm. Which of the following inveatigations will you consider next?
a. Serum Troponin
b. Thalium scan
c. Holter monitoring
d. CT angiogram
A
786
Q183161- ecg shows block and patient presented with light headness asking what is next
A. beta blocker
b. digoxin
C. holter
D. echo
Complete heart block
موج p داریم، یک شکل و منظم
موج QRS یک شکل و منظم
اما این دوتا هیچ ربطی به هم ندارن
Mobitz 2
حذف ناگهانی QRS، موج QRS پهن و بزرگتر از ۳ مربع
این دوتا اگه باشن 👈 pace
1st garde
اگه علامتدار باشه، اتروپین و در صورت عدم پاسخ پیس میکر
علامتدار: دیزینس، تنگی نفس، چست پین
787
Q183199- Woman with headache,tachycardia,chest pain has history of hypertension and also has history of schizophrenia for which doctor put clozapine on..which is the most appro invx to check for her?
A.clozapine level
B.troponin
C.chest xray
D.TSH
E.FBC
B
788
Q188204-RA case for 10 years,with c/o sudden pain for last 2 days in the following two fingers that turned black. Which investigation will lead to diagnosis?
a. Anticardiolipin Antibody
b. ANA
c. ANCA
d. Anti-dsDNA
e. Anti topoisomerase
C
789
Q183224- A patient who has rheumatoid arthritis had history of DVT last 3 year ago. Now he came with black fingers . what is the investigation to find the underlying cause?
A- ANCA
B- Anticardiolipin
C- ANA
D- Anti ds DNA
B
790
Q183206- Day 7 post renal transplant , no urine output . Planned for dialysis , what is the cause ?
a. Acute rejection
b. Obstruction
c. Acute tubular necrosis
d. Donors graft thrombosis
e. Graft failure
C
791
Q183211- Lady on well controlled antidepressant , took husband’s tramadol for her back pain . Now complaining palpitation , flushed . Asking what other symptom is important/ differentiate ( something like that )
a. hyperreflexia
b. Ataxia
c. Diplopia
d. Hypotonia
e. Muscle weakness
A
792
Q183190-Prostate cancer, gleason score 7, T3 N0 M1 , involving seminal vesicle and and features of metastasis to the lumbar, bone is seen on MRI that was taken, what is your next treatment?
a. orchidopexy ……orchidectomy
b. radical prostatectomy
c. external beam radiotherapy
d. Androgen therapy
A
793
Q186289- A driver from interstate has moved to your locality recently and is stable on lithium for past 20 years How do you monitor?
a-check lithium every 3 months
b-check lithium every 6 months
c-check lithium every 1 year
C?
794
Q186266- Scenario a man who is suffering from epigastric pain after eating food with his friend in a restaurant . Who had the same problem and allergy when he ate a carrot cake. What's the cause of his problem now?
a) carrot
b ) penut
c) dietary produces.
d) gluten
e) glutamiase
B
795
Q185448- diverticulitis scenario. Ct was given. What next
a. antibiotic and bowel rest
b. surgical exploration
c. colonoscopy
d. laparoscopy and proceed
A
796
Q185448- diverticulitis scenario. Ct was given. What next
a. antibiotic and bowel rest
b. surgical exploration
c. colonoscopy
d. laparoscopy and proceed
A
797
Q186225- Doctor after night shift from emergency department went to bar. He found his colleagues there and some are having illicit drugs. They have to go to hospital for duty 2 hours later. What will u do?
a) Report to director of emergency department
b) Tell directly to those colleagues
c) Leave and said nothing
d) Inform APHRA
A
798
Q188343 - Woman with a history of hysterectomy and DVT. Now complaining of hot flushes and insomnia. SSRI was not helpful in relieving symptoms..What will you give her?
A. Oral low dose estradiol
B. Transdermal estradiol
C. Progesterone only pills
D. HRT
E. Clonidine
B
799
Q189370-Locals of one area affected by coal seam. Physical examination- WNL. What will be your most appropriate action?
a. Inform public health unit
b. Educate about environmental risk
c. Inform local authority
d. Some tests
B
800
```
Q185301- One medical student is studying relationship between amelgam n dementia what type of study?
A. case control
B. cohort
C. cross sectional
D. RCT
E. Observational study
```
A
801
Q1811027- Old lady with recurrent chest infections as a child Now presents with rusty coloured sputum afebrile bilateral crepts
A-Bnp
B-Sputum culture
C-Echo
B
802
Q183355-pat lost his driver license because of drinking, lived alone , divorce, present to the emergency as agitated , on examination you found Nystagmus, hyperreflexia and ataxia ( exactly), what the important thing to check?
A blood alcohol
B liver enzymes
C ct head
No option for thiamin
C
803
Q183401- middle aged man.presents with retrosternal chest pain that wakes him in the middle of the night. he says he has experienced this type of pain before. when he used to walk aftr having a meal. he thinks its the same pain that woke him at night. what do u do.
a. gastroscopy
b. upper gi endo
c. echocardiography
d. exercise tolerance test
D
804
Q184463- ECG of NSTEMI given. Chest pain started 2 hours back. Now pain 4/10. taking ramipril atovastatin aspirin . No dypnoea, murmur. What should be given now?
a. Thrombolysis
b. aspirin,
c. GTN,
d. clopidogrel,
metoprolol
D
805
Q182200- Patient surgery done for sig volvulus 6 yrs ago.now xray given c/o distension,central abdominal pain.whats most appropriate management?
a. gastrographin enema
b. repeat enema 2-3 hrs
c. send to ot
d. pass NG and ileo-jejunic tube
D
806
Q188559-old man with abdominal distension and pain since 3 days and history of constipation since a month. He has been on diclofenac for back pain. No Xray given Cause?
a. pseudoobstruction
b. CA sigmoid
c. Sigmoid volvulus
A or b
807
Q188335-5 yr old boy with cough from 12 months before was on salbutamol and also taking oral prednisolone, he has an eczema history, both parents are smokers. Which one is the best medicine for prevention used in inhalation mode?
A Monteleukast
B Cromoglycate
C Salbutamol
D Fluticasone
E salmeterol
D
808
Q189155-74 year old man comes to you complaining of losing conscious. He has never had this problem only when he finishes sexual intercourse. It usually occurs for few minutes when he is at the bathroom. He says he does not have any problems after he returns to bed. What is your dx?
A. Cardiac failure
B. Ischemic heart disease
C. Vasovagal syncope
D. Postural hypotension
E. TIA
C
809
Q10018-Patient presented with diplopia for 1 day. On examination there was diplopia on the right eye when
looking towards the right side. his glucose is normal. ECG has occasional verntricular ectopics. Whats
the most appropriate management.
A. Warfarin
B. Peridropnil
c. Metformin
d. Observation
?
810
Q10024-polypharmacy digoxin ,spironolactone, presents with nausea abd pain, digoxin levels -normal ,K- 6.5 with ecg tall T waves asking cause
a. digxin toxicity
b. hyperkalemia
A
811
Q189199-Young female was overweight and lost 30kg. Since then, she has been very selective about eating and feels guilty after eating. When asked to step on the scale, she becomes teary and says she takes laxatives to ‘clean her bowel’. She also says she will exercise after work. What is the dx:
a. Body dysmorphic disorder
b. Anorexia Nervosa
c. Obsessive compulsive disorder
d. bulimia
e. She is fond of exercising
D
812
Q11331- A 75 years old man presents to you with blurring of vision over few hours. He said there was no pain or any other symptom before or along with the vision loss. On examination his vision was markedly reduced, and there was decreased pupillary reflex. Which of the following will lead you to diagnosis of his condition.
A. Fundoscopy
B. ESR
C. MRI
D. CT head
E.Carotid Doppler
B
813
Q189051-ECG with bradycardia and prolong QT or sth like that, In scenario patient came with chest pain for 15 min and relieve by rest. Troponin normal. Pulse – normal and regular. BP normal. What to do next?
1. repeat troponin
2. echo
3. coronary angiography
4. repeat ecg
D
814
Q186140- A hypertensive and diabetic presented with histories of numbness, nausea and sweating. He developed dizziness while urinating.Pulse is irregular and ECG shows atrial fibrillation. Other things said. Diagnosis asked
a. Myocardial infarction
b. Micturition syncope
c. Vasovagal syncope
A
815
Q186139- A 60yrs of age man was found fallen on bathroom floor with dizziness but was conscious with a history of poor stream urine and difficulty in micturition and brought by his wife to ER.He has a history of HTN and DM..his BP is 165/85 and pulse is irregular.ECG showed AF.what investigation will you do as next most appropriate?
A.blood glucose
B.troponin
C.holter monitoring
D.echo
B
816
Q189196-Old lady with history of appendicectomy & cholecystectomy presented with 3 wk history of abd pain, distension. xray shows dilated ascending colon, transverse colon & descending colon, no air. Abd is soft tender. Rectum is empty.
A- Sigmoid volvulous?
B- Adhesive IO
C- CA Sigmoid
C
817
Q1810414-Pregnant woman at 39 weeks came with complaint of single episode of vaginal bleeding. Every examination was normal except for tender uterus but no contractions. Fetal heart rate is 144bpm.
What is the diagnosis?
a) Placenta abruption
b) placenta preavia
c) normal labor
A
818
Q1810010-pregnant female diagnosed with hydatid mole pregnancy with very high B hcg after D&C her bhcg dropped to normal , 4 weeks ( ONLY 4 ) later she back to you with high Bhcg again , what would be the cause of this
A -recurrence of the hydatid mole
B – Normal pregnancy
C - endometriosis
B?
819
Q184040- ct scan solitary neoplastic mass in cirhottic liver only descrption no ct was there
Classic CT findings of HCC include a hypervascular pattern with arterial enhancement and rapid washout during the portal venous phase
Other characteristics that support the diagnosis of HCC include visualization of a tumor capsule, demonstration of an internal mosaic resulting from variable attenuation within the tumor, and portal vein branch invasion
820
Q188281-Young boy, accident with slipped fall during skiing. Very marked swollen elbow, very painful. On examination, absent peripheral pulses, numbness cold and clammy. At emergency department, what is your next step of management?
A. Ulnar nerve decompression
B. Reduction
C. Refer to OT
D. Simple analgesic-then x ray,then rx based on the type of
E. X ray
C
821
Q182505- Parents of a 6 yr old boy complain that their son is overactive, not cooperative with other children at school & sometimes displayed destructive behaviour. He does not like to follow rules. But when kept alone, was found to be playing happily with toys and other children. WOF is correct in his Dx?
a. It is a normal variant
b. ADHD
c. Autism
d. Poor parenting
e. Oppositional defiant disorder
B
822
Q185356- 80 year old women at a hospital, taking risperidone. she asked the stuff daily to open the back door coz she wants to measure the yard fence .The stuff have to collect her belongings to prevent her from leaving , her son has power of Anthony. What should you advise to the stuff? Exact scenario
a. Ask the staff to lock the back door ( exact )
b. Inform her son
c. Increase the dose of risperidone
d. Return her belongings
B
823
Q184148- Diabetic man on olanzapine taking to control his symptoms for last 2 years, notice increase wt what to do ?
a. decrease olanzapine
b. change to other drug
c. stop it as he feel good now
B
824
Q184174- Patient truck driver was on phynetoin Na for epilepsy, not well controlled, his doctor changed his medication to carbamazepine which worked well asking when he can drive again
a. after 6 months
b. after 12 months
c. after 2 years
d. now
e. he can’t drive any more
E
825
Q184295- 55 y lady gave up her university studies to pursue career in alternative medicine. Doesnt have close friends, fights with neighbours but enjoys company of individuals to whom she reads future from the cards. What is the diagnosis?
A) Shizotypal disorder
B) Borderline personality disorder
C) Dependant
D) Bipolar disorder
A
826
Q182435- 9 mn old irritable screaming bile stain vomiting and diarrhea. Her sister is suffering frm gastroenteretitis.usg shows shadows in right upper quadrant.what next to do?
A. Air enema
B.urine culture
C.stool culture
D.observe
A
827
Q184209-16 yr girl come for check up , what opportunistic screening will u do ? (No option for HTN & chlamydia)
a) skin cancer
b) Scoliosis
c) Diabetes
d) Breast screening
e) Lung cancer
A
828
Q9009-child 6 YEARS old with history of asthma presented with upper respiratory tract infection , urine examination showed very high serum glucose and ketonuria of 2+. what is the most appropriate test to follow up this child?
A-HbA1C
B-serum creatinine and electrolyte
C-FBS
D-OGTT .
E-Blood gases
A
829
Q1811194- 40 y /lady admitted to hospital for severe upper abdominal pain 4 days ago. No similar previous history mentioned. what is the next management? (pic more severe than this around umbilicus) One picture with? blood stained or erythematous vesicles in clusters present along t 10 dermatome around umbilicus with on blackish spot in the lesion.
1. oral acycloviri/v acyclovir
2. continued analgesia
3. i/v hydrocortisone
4. oral prednisolone
A
830
Q9734- In emergency department man presents with severe upper abdominal pain and shock.abd rigid.what is the cause.
a. Acute pancreatitis
b. Perforated duodenal ulcer
c. Perforated peptic ulcer
d. Cholestasis
B
831
Q188033- A 8 year old child with persistent night pain in his left legs , on examination there was no restriction in active movement and no swelling or tenderness what is the most appropriate next step?
A-X-ray left hip
B-ultrasound
C-bone scan
D-bone marrow examination
E-Reassure
A
832
Q184025- a lady had DVT 10 yrs ago after a femur fracture. now she is pregnant and wants to know what she can do ?
a-heparin prophylaxis antenatally
b-compression stockings after 20weeks
c-post natal heparin for 3 mnth
B
833
Q185150- Pt with attack of MI, u started heparin and 12 hrs later abdominal swelling developed, u suspect hematoma, what to do
A. Stop heparin
A
834
Q187561-A case of suspecting acute coronary syndrome with bp 160/90. What will you give?
A. Clopidogrel
B. Enoxaparin
C. Aspirin
D. Oxygen via nasal cannula
E. Metoprolol
C
835
Q91025- Woman with photo of hemi facial palsy(looks like bells palsy) and icterous sclera.has discharge and pain from ear starting befor the facial palsy (no diarrhoea) What next?
1. acyclovir
2. ct
3. prednisolon
4. Antibiotic
5. Analgesic
A/C
836
Q187408-mother concerned abt 15yr old daughter recent change in bhvr,stopped studying,became vegetarian,take long shower at night.what in history will lead to dx?
a. her though that neighbours are influencing her concentration
b. h/o marijuana abuse at her high school
c. she changed her sub from law to mdcn last yr
d. she had salmonella enteritis 3 mnth back
A
837
Q184457- Most striking feature when interviewing a pt wit thought disorder?
a) You experience pressure in pt's talk and have difficulty in keeping up with the pt's flow of ideas
b) Pt withdraws to the extent that you have difficulty maintaining contact
c) Pt is forgetful and has difficulty remembering what he/she is talking about
d) You cannot quite grasp the meaning of some of the pt's statements.
e) It is as though a pane of glass is between you and the patient
D
838
Q9472- Man with urinary retention mass above the pubic symphysis DRE showed enlarged prostate with palpable median sulcus palpable Catheter inserted what is the most appropriate next step?
A-trans rectal ultrasound
B-PSA
C-MRI
D-CT
E-urine culture
E
839
Q10223- A 32 year old woman presented with bilateral joint swellings of her proximal interphalangeal joints associated with a 45 minutes period of early morning stiffness of joints. She has obvious rheumatoid nodules and a high rheumatoid factor assay. She got raynoud phenomenon treated with nifedipine. Rhematoid positive, ds DNA positive but negative CCP. Which of the following is the best long term management?
a. infliximab
b. sulfasalazine
c. methotrexate
d. prednisolone
e. Hydroxychloroquin
E
840
Q11103-42yo woman who smokes 20 cigarettes/d presents with complains of heavy bleeding and prolonged menstrual period. What is the most appropriate tx for her?
a. Tranexemic acid
b. COCP
c. Mefenemic acid
d. IUCD
e. Norethisterone
این سوال خیلی تکرار شده :
گزینه دوم ( cocp ) بعلت مصرف سیگار و سن بالای 35 👈 ممنوع
گزینه چهارم ( IUCD ) بعلت خونریزی 👈ممنوع
اختلاف بین گزینه a و e بوده :
1. اندیکاسیون tranexemic acid در 👈خونریزی حاد و شدید
2. اندیکاسیون mirena ( گزینه e ) 👈در خونریزی های شدید و طولانی که منجر به آنمی میشود
بیمار با شکایت پریودهای شدید و طولانی مراجعه کرده و الان خونریزی نداره و بهترین جواب E
🌺🌺البته در ماههای اخیر با a بسته شده با این استدلال که الان خونریزی شدید داره ولی بهترین جواب اوایل مطرح شدن سوال داده شد !
تصمیم گیری با استم کامل 🔥🔥🔥🔥
841
Q182261-17 year old boy says he has to count till 20 other wise her mom will be killed, they has a minor accident 3 months ago, boy is keeping himself into the room most of the time saying he is hearing the voices but couldn't recognise it, whats the diagnosis,
A.OCD,
B.sever depression,
C.shezophreniform diso
C
استم دیگه هم داره که گفته یک هفته قبل(۴۴۳۳) که اونجا brief psychosis مطرح میشه
842
Q185422- Distorted body image is found in all except:
a. Acromegaly
b. Hypochondriasis
c. Limb amputation
d. Anorexia nervosa
e. Non dominant paritial lobe lesion
B
843
Q189206-A man was taken to you from prison after being aggressive and threatening to kill himself. He is convicted and currently serving time for trying to kill his parents because he thinks they have been replaced by double. Upon reviewing the h/x, you realize the man has been diagnosed with schizophrenia as a child and given dexamethasone. The warden calls and asks for your next step in management. What do you do?
A. Send the man back to prison
B. Administer anti-psychotics and send the man away
C. Release the man from custody
D. Send to prison hospital
E. Send to local psych unit
E
844
Q9934- Well controlled Rheumatoid arthritis with indomethacin presents with knee swelling tenderness.After arthrocentesis what is the next
a. See for uric acid crystals in microscopy
b. Increase the dose of indomethacin
c. Blood culture
A
845
```
Q187638- a Malaysian student,uni student ,his gf went back to attend dad’s funeral now this guy become restless ,irritable and cant sleep and complains that his gf taling behind his back
Dx?
A-Suspicious cannabis
B-Grief reaction
C-Panic psychosis
D-Reactive psychosis
E-Onset of schizo
```
D
846
Q9944- A boy with joint pains. ANA +ve (can’t remember the no) RF –ve. What’s the long term complications?
a. Cardiomyopathy
b. Uveitis
c. Small bowel ulceration
B
847
```
Q182405-17 girl has dyspareunia, worry about endometriosis because sister has infertility because of this. Examination: nodule on ligament on vaginal palpationand some other description, what is important to diagnose endometriosis:
A.nodule on uterosacral ligament,
B.dyspareunia,
C.menorrhagia,
D.family history
```
A
848
Q1810106-54yr man post op complain of abdominal pain , nausea , vomiting , BP 110/70 , pulse 85/min , eye was mildly icteric ,alcohol 50-60ml everyday , liver palpable 3cm non tender, ESR 54 ,GGT 236 , ALP increase ,TB 54 , CB 50 , rest all enzyme normal.What next ?
A) Aniti mitrochondrial antibody
B)Hep B & C serolgy
c) serum urea & creat
D) Ultrasound
D
849
```
Q183344- yr old male patient complaint of fatigue, tiredness, mild confusion. He has history of hypertension, DM, hypercholestrolaemia, hypothyroid. He take metformin, perindopril/ indapamide, atorvastatin,thyroxine … other P/E is normal.
Lab result
Na- 125( n=135-145)
Other K, bicarb, - normal
TSH- 0.3 (n= 0.4-2.5)
Cause of confusion?
A. Metformin
B. Indapimide
C. Atorvastatin
D. Perindopril
E. Thyroxine
```
🌺باید توی استم سوال ببینیم :
...اگر هیپوولمیک بود 👈 علت اینداپامید ( بعلت هیپوناترمی ناشی از کاهش حجم)
....اگر یوولمیک بود 👈 SIADH ناشی از ACEI
این سوال با b بسته شده
ولی چون اشاره ای به هیپوولمی نشده و گفته معاینه نرمال بوده من با D موافقم 🔥🔥🔥🔥🔥🔥
Ans : B or D
بسته به یافته های ph/e
850
Q9045- An alcoholic, very agitated, rushed to the emergency department with many complaints, claiming if he is not attended to immediately he will jump in front of a car. What will you check first?
a) Alcohol level
b) magnesium level
c) serum electrolytes (Na+ and K+)
C
851
Q11263- 10 minutes weakness of right side of body with some speech trouble. Return to normal with no carotid bruit and blurring of vision. What it could be?
a. Lacunar infarct
b. Vertebro basilar
c. ischaemia caotid artery
d. hypoglycemia
e. hyperglycemia
C
852
Q185038-neonate found apnea in sleeping brought by parents to ER no HR apnea with no bruises his death is pronounced next
A.Mention on his death paper as cot death(sids)
B.Inform child protection cervice
C.Refer him to forensic autopsy
D.Call the coroner
E.Arrange funeral for neonate instead of parents
C
Q1902245
یه خانم ۲۵ ساله که با بیمارستان تماس گرفته و ابراز میکنه بعد از درد شکم یه جنین مرده دفع کرده در ۱۲ هفتگی
واژه stillbirth تو استم ذکر شده که شامل این تعریف یعنی وضع حمل قبل از ۲۰ هفته نمیشه البته
در هر صورت نگران هست و کمک میخواد از ما که چکار باید انجام بده
سقط در استرالیا قانونی هست در صورتیکه پزشک در نظرش گرفته باشه به خواست خانم باردار بخاطر اینکه سلامت جسمی یا روحیش ممکنه به مخاطره بیفته و البته مسائل اقتصادی و اجتماعی اونها هم موقع تصمیم گیری در نظر گرفته میشه
تا ۲۰ هفته و حتی ۲۴ هفته (بسته به هر state تفاوتهایی هست)
البته بعد از اون دیگه با نظر دو پزشک
و سقط در غیر این صورت unlawful هست
در مورد این سوال که stillborn گزارش شده
باید به coroner اطلاع داده بشه و اون بررسی میکنه و ممکنه اتوپسی انجام بده ولی وقتی مشخص بشه stillborn هست دیگه رسیدگیش با اونها نیست(پس اطلاع میدیم)
در ادامه یه الگوریتم گذاشتم که برخورد با مرگ جنین هست که در هر صورت قدم اول به نظر اطلاع به coroner هست ولی موارد سقط نیاز به گواهی فوت ندارند
حالا مواردی که باید به coroner اطلاع داده بشه:
۱.مرگهای مرتبط با مراقبتهای پزشکی( ناشی از اونها و یا ناشی از فقدان اونها)
۲.مرگهای غیرطبیعی یا ناشی از violent
3.Death in care:
الف)افراد ناتوان در مراکز نگهداری
ب)بچه هایی که در انتظار adoption هستند
پ)افرادی که علی رغم میلشون بر اساس mental health act از درمان براساس دستور دادگاه محروم بودند
۴.مرگی که علتش مشخص نباشه
۵.مرگ در شرایط مشکوک
۶.مرگ در بازداشتگاه نتیجه اقدام پلیس
۷.هویت جسد مشخص نباشد
853
Q182287- A few weeks baby found dead in her cot ,she wasn’t cyanotic or any other distress , when parents brought she already expired by than .what u do?
a. notify Coronal
b. order forensic autopsy
c. complete a death certificate stating as SID case
A
854
Q185415- 34 an old lady came with her son living in home after seeing a specialist who dx mild dementia nd advised donepzil. She dont want to take medicine also her son saying she is coping good what to do
A ask her son to ensure she will take medicine
B. Explain her to take medicine if she want to stay at home
C. Admit nursing home
D. respect her wish
D
855
2⃣
```
Q189221-A man presenting with abd pain and distension for 3days, constipation for 2 days. Vital sign stable apart from and distended with sluggish bowel sound. Abd Xray given(shows Small bowel obstruction) After 2days, gave IV antibiotics and nasogastric aspiration. Not relieved symptom. What is next management?
A. continue the same treatment
B. IV N/S and hydrate
C. colonoscopy
D. Surgical
E. Nasal flatus tube
```
D
درمان small bowel obstruction :
1. Iv fluid
2. Monitoring urine output
3. NG tube
4. AB iv
5. Anti emetics
6. Analgesia
در صورت عدم پاسخ به درمان conservative 👈 جراحی
856
Q1810083-A lady, she is on medication for HTN and hypercholesterolemia, she is saying that she has been taking the drugs regularly and hasn’t visited the doctor for 8 months, but when u check u realise that she was supposed to finish d medications 2 months back, her mmse is 24 with impairment in recall. What is ur next step??
A.Tell her that she need to b assisted by a practice nurse
B. Talk to her familly without letting her know
C. Ask her nominate a familly member to get more information
D. Do more examination
E. Ask the pharmacist for further information
بچه ها A
| من E اگه منظورش چک دارو باشه
857
Q188506-35 years old man comes with sudden severe pain in abdomen and hematuria.Ct abdomen was done which is shown below.Most appropriate mx?
a. Wait and see
b. ESWL for less than 1o
c. PCNL
d. Ureteroscopic laser lithotripsy for greater than 10mm
e. basket extraction
!
858
```
Q188056- 35year old man married with 1 kid, presents with arthralgia, fever 38.9, splenomegaly for 2 weeks. Nothing about lymphadenopathy. FBC normocytic normochromic anemia. (I forgot but there was something abound blood shows atypical lymphocytes?) What is diagnosis?
A. SLE
B. HIV
C. CMV
D. Hodgkin lymphoma
E. Acute .... leukemia
(No EBV option like in old recalls)
```
C
859
Q188107- A 32 yrs old man present with new onset of diarrhoea for 3 months and weight loss. Complains for difficulty in getting up from chair and climbing up stairs. dx?
a. campylobacter jejuni infection
b. coeliac disease
c. IBD
d. thyroxicosis
این سوال با استم های تقریبا مشابه تکرار شده و این سوال با همین استم تقریبا با همه گزینه ها بسته شده و اما :
بیمار جوان + اسهال غیر خونی + ضعف عضلانی
گزینه 1 👈 با توجه به اینکه کامپیلوباکتر اسهال خونی میده رد میشه
گزینه 2 👈اسهال غیر خونی + کاهش وزن و ضعف عضلانی ناشی از کمبود vit b12 با سلیاک قابل توجیه است
گزینه 3 👈 هرچند IBD هم بعلت کمبود vit b12 میتواند ضعف عضلانی داشته باشد ولی معمولا با اسهال خونی میاد و درد شکم و .. پس با این استم خیلی مطرح نیست
گزینه d 👈 تیروتوکسیکوز میتواند منجر به اسهال مزمن شود ولی اینکه فقط با اسهال و بدون سایر علائم باشد معمولا در سنین بالا مطرح است ولی این بیمار جوان است
جواب با این استم : گزینه b
🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥
860
```
Q188056- 35year old man married with 1 kid, presents with arthralgia, fever 38.9, splenomegaly for 2 weeks. Nothing about lymphadenopathy. FBC normocytic normochromic anemia. (I forgot but there was something abound blood shows atypical lymphocytes?) What is diagnosis?
A. SLE
B. HIV
C. CMV
D. Hodgkin lymphoma
E. Acute .... leukemia
(No EBV option like in old recalls)
```
C
```
در mononucleosis like syndrome:
🌺عدم وجود LAP 👈به نفع CMV
🌺عدم وجود هپاتومگالی و اسپلنومگالی 👈به نفع HIV
🌺وجود هپاتومگالی 👈اول CMV ....بعد EBV
🌺راش 👈به نفع HIV
```
861
```
Q9190- adult girl with bilateral pneumonia , O2 saturation 85% , alert .. how to give oxygen ?
A) nasal 100 % O2 2L
B)Ventuse
C) Cpap
D) intubation , ppv
```
مشابه این سوال رو این ماه داشتیم ( Q1902267)
در مورد این استم :
با توجه به اینکه سابقه بیماری ریوی ذکر نشده و بیمار بطور حاد دچار هیپوکسی شده 👈سمت راست الگوریتم
با توجه به اینکه o2sat : 85% 👈 ستون دوم
و با توجه به اینکه دیسترس تنفسی در استم ذکر نشده 👈 دادن اکسیژن از طریق نازال کانولا امکانپذیر است با دوز 2-4 lit
🌺🌺در کسی که دچار دیسترس تنفسی بدنبال هیپوکسی شده 👈 نازال کانولا نباید استفاده بشه ❌
چون مقدار زیاد اکسیژن باعث دپرشن تنفسی میشه و باید از ماسک با رزرور استفاده بشه
862
Q10201- An old man with congestive heart failure and hypothyroidism. On levothyroxine, digoxin, and other medications came with light headedness and palpitations. His HB was 140 regular. The ECG picture was given very close to the below one. Wt should you do:
1 Cease thyroxine (reduces tachycardia)
2 . Stop digoxin (reduces tachycardia)
3. Decrease digoxin
4 . Add metoprolol
5. Cease both drug
D
863
Q182486-Case scenario of lumbar spinal compression with paresthesia on the plantar and lateral aspect of the foot.ask wts most specific sign for it
A.urinary incontinence
B.absent knee reflex
C.leg pain
d. absent ankle reflex
D
864
Q184103- A lady came with her daughter to your office . she said that her 8 year old daughter doesn't play with her friends and her social relation with others is poor since 2 months ago and she is annoyed from the older students . mother is divorced from her father years ago and is in a new relation with a young man since 3 months ago. what is your next management?
A-refer to Child protection service
B-arrange a consultation with psychologist/psychiatrist for her
C- talk to the mother without girl
D- arrange a meeting with her biological parents
#etic
@Elahem6765
سلام دوستان،
چند تا نکته تو این سوال هست.
یکی اینکه این بچه در مدرسه مشکل داره. جنس مشکلات از نوع مشکل با دوستان قدیمیه و همینطور بچه دیگه اجتماعی نیست.
دوم رابطه جدید بین مادر و پارتنر جدید.
سوم اینکه اشاره ای به موارد چایلد ابیوز منجمله وجود کبودی و ... نشده.
چهارم قرابت زمانی مشکلات مدرسه و تغییرات در منزله.
کلا و در نه در خصوص این کیس، شایعترین مشکل عدم انطباق با تغییرات در خانه خواهد بود.
مهمترین نکته سوال هم این خواهد بود که شما چایلد ابیوز رو میس نکرده باشین. البته از نظر احتمال و میزان شیوع، این مورد اصلا به شیوع مشکلات انطباقی با تغییرات خونه نمیرسه.
با همه اطلاعات سوال هیچ سرنخ و یافته واضحی برای چایلد ابیوز وجود نداره. بنابراین من توصیه نمی کنم بدون داشتن هیچ سرنخی، شما چایلد پروتکشن رو فعال کنید.
شرح حال بیشتر خیلی کمک کننده خواهد بود، بنابراین، گزینه دوم و سوم منطقی هستند. گزینه چهارم کمتر منطقیه چون ممکنه به راحتی عملی نباشه.
حالا به خواسته سوال دقت کنیم:
سوال از قدم بعدی پرسیده. برای شرح حال بیشتر، گزینه سوم می تونه در همون جلسه اطلاعات بیشتری رو فراهم کنه. بنابراین من این گزینه رو انتخاب می کنم.
بعد از این قدم، تکلیف من مشخص خواهد شد تا ببینم آیا گزینه های دوم و چهارم مناسب هستند یا نه.
ولی در اولین قدم، شرح حال بیشتر گرفتن از مادر می تونه بسیار کمک کننده باشه.
865
Q9702- gp refrred a pregnant lady in first trimester for cholecystectomy for gall stones..rationale for his decision
A. She will be able to eat normal during pregnancy
B. Increase chance of stone complications dueing pregnancy
C.increase chance of cholestatic jaundice
d.increase chance of fatty liver of pregnancy
E.more pregnancy complications with gall stones
B
866
Q11097- Pt has problems in outside right eye and insight in left eye visual firld where is the problem.
1) Ieft parietal
2) Right parietal
3) Left visual cortex
4) Left optic radiation
C
867
Q1811204- h/o rash after penicillin injection..asked what next antibiotic?
A) cephalaxin
B) ciprofloxacin
C) roxithrtomycin
D) ticarcillin
راش بدون تب واکنش تاخیری هست و نیازی به پرهیز دارویی نداره
راش همراه با تب اما از نوع الرژیک حساب میشه و نباید مجددا تجویز بشه
B
868
```
Q188344- 45 female, laproscopic cholecystectomy before 6 months. now elevated ALT, aspartet aminotrans., cholesterol.. Abdo pain and dyspepsia. Most appropriate Investigation?
A-contrast CT abdo and chest
B-ercp with manometry
C-mrcp
D-oral cholecystogram
```
#surg
C
869
Q184135- Arab woman who doesn’t speak English with 16. weeks pregnancy, was referred by the mid-wife for which she suspects her mental condition. The woman seems irritable, worried(or anxious) about the people around and she’s uncomfortable when her husband is not around. She is also irritated with her 2 children. What condition in her history will be present to lead you to diagnose this patient? (looks like prodromal symptoms)
1. Panic attacks
2. Paranoid personality disorder
3. Family member with schizophrenia
4. History of trauma
C
870
Q188252-case scinario of 5 years old child with sudden attack of seizure and faint. His
parents mentioned that he is still wet his bed and try to take more attention from
them and the parent were watching TV when he had the attack infront of them
during their watch what is the most imp history u ask will help u to reach the diagnose:
A-Is it the first attack
B-about cynosis during the attack
C-family history of seizure (centrotemporal spike) benighted
```
مساله ای که مقالات خیلی تاکید کرده بودند
طول مدت حمله
باز بودن چشم
ناله و گریه کردن حین حمله
دفعات مکرر حمله بدون پاسخ به درمان معمول تشنج
گاز گرفتن گوشه زبان
مشکل اخیر در خانواده و مدرسه
نکته خیلی مهم: سابقه sexual یا فیزیکال ابیوز
```
تنها راه تشخیص قطعی هم گفته vEEG
یعنی با ویدئو ۴۸ ساعته EEG بگیرند از بیمار
871
Q9018-When interviewing a patient she replies “moon is blue,blue is cheese, I am elephant, treat me like a queen, tied roped and chained marshall”. What is this?
A- tangentiality
B- derailment
C- circumstantiality
D- Dissociation
E- bereavemen
B
در derailment مریض کم کم از خط خارج میشه و بین دو جمله ارتباط وجود داره
در tangential افکار مماسی داریم
در flight of idea بیمار بر اساس تجانس و قافیه حرف می زنه .
در word salad کلمات هر جمله هم به هم ربطی ندارن.
در loosening of association هیچ جمله اي به جمله بعد ربطی نداره البته هر جمله از لحاظ دستوري درسته.
... , My food is cheese, cheese is in the moon, I live in moon
در circumstantiality که همون حاشیه پردازیه بیمار به معاینه کننده اطلاعات اضافی میده که معمولا در بیماران وسواسی دیده میشه.
در blocking بیمار چند دقیقه راجع به یک مساله حرف می زنه و بعد ناگهانی موضوع صحبتو عوض می کنه
872
Q184083- Old age female ,heavy smoker ,complaining of painless lump in her neck by examination you found a lump supraclavicular, Subcutaneous.What will lead to diagnosis?
A.Bronchoscope
B.Gasteroscope
C.MRI neck
D.Mammography
E.FNAC
E
873
Q9910- Pic of left hand who didn't have distal phalanges in all fingers, petechial rash on foot dorsum has cough dyspnea loud P2 along the rt-sternal border. asking about the cause
a. Pulmonary HTN
b. Bronchiectasis
c. Chronic asthma
d. interestial lung disease
e. Emphysema
A
در نوع diffuse مهمترین عارضه : کریزکلیه
limited cutanesus Sclerodermia مهمترین عارضه : pulmonary HTN
874
Q188475-A 15 yr old student attends the OPD with complaint of breathlessness on and off, cough and sputum. His sleep is disturbed and skin is very dry in flexural areas of the body. Exam: tachypnea, hyper resonant percussion and wheezing on auscultation. What is the most likely dx?
a. Extrinsic allergic alveolitis
b. B. Asthma
c. Wegener’s granulomatosis
d. COPD
e. Cystic fibrosis
B
سلام مجدد
خوب تشخیص بین الف و ب هست چون e که به این صورت حاد نمیاد و داستان های خودش رو داره و بیشتر به صورت حملات برونشمتاتیک و عفونت های مکرر میاد که بحثش طولانیه
EAA or HP
یه بیماری هست که برا تشخیصش باید کرایتریاهای رادیوکرافی و BAL و تماس با انتی ژن و ..... پر بشه و همینطور با علایم اسم و یه خشکی دست یا حتی سابقه آلرژی که نمیشه تشخیص داد
پس فقط استم تشخیص اول ماست و COPD هم که لااقل 10 سال سابقه سیگار کشیدن رو میخواد
در ضمن خیلی از اسمی ها اتوپی هم دارن و مستعد به آلرژی هم هستم
تا یادم نرفته در HP سابقه تماس مهمه مثلا در استم میگه طوطی یا پرنده داره ویا تو نونوایی کار میکنه .....
875
Q182476- 68 yrs old with ca prostate with MI with drug eluting stent. Gleason score 7. Treatment
A-androgen deprivation theray
B-radical prostatectomy
C-b/l orchidectomy
D-external beam radiotherapy
E-continue surveillance
B or d
876
```
Q9362- DM 1 pt after a penetrating injury developed swelling of ring finger, it was tender esp on flexor side pt had problem with extension of the finger ... What to do next
A. IV cephalothin(exact wording)
B. Iv flucoxacillin
C. Surgical exploration
D.Iv cephalothin with physiotherapy
E. Iv flucoxacillin with physiotherapy
```
C?
877
Q182434- 7 days old with jaundice started on 4th day of delivery with total bilirubin 240 & conjugated 6,(yes it was 6 )blood groups were same of baby & mother..
asking cause?
```
A. Hemolytic
B. Biliary atresia
C. Breast Milk Jaundice
D. Abo incompatibility
E. rh incompatibility
```
C
878
Q187351-Pt came with back pain & tenderness in L4 L5 region.. On gistory it was found that he used to be ivdrug abuser & there was history of hap c
asked inv?
A-cxr
B-Mri
C-Ct scan
B
879
Q182410- child with fever drowsiness n cold extremities
Rash was mentioned asking treatment
A.Iv cefatholin
B.Iv gentamicin
C.Oral penicillin
D.Oral roxithro was there
A
880
Q188090-58 year old woman after lifting some heavy thing , develops pain in the right buttock and tenderness in her back at L4-5, has difficulty and restrictions of movement in extension and flexion and rotations , what will you do next?
A- Lumber corset
B-Analgesic
C- bed rest
D- referral to orthopedics
E- keep active
B
881
Q9044-Male patient with bleeding per rectum and examination internal hemorrhoid. Most common associted features
A Painful swelling on defecation
b. Mucus discharge
c. feeling of lump
d. nocturnal perineal pain
B
882
Q91044- The picture of prolapsed hemorrhoids asking most common presentation:
a. Painful defecation with bleeding
b. Painful defecation without bleeding
c. Painless defecation with bleeding
A
883
Q189447- patient has Sigmoid volvulus. He has not attended in hospital on time because he lives far away.
Which one indicates that Colon has been infarcted?
A) Local tenderness at the side of volvulus
B) Couldn’t be managed with fatus rectal tube
C) Dilatation more than 10 cm proximal to it
C
884
Q9774-A patient with rheumatoid arthritis got a flare up and doctor wants to administer
azathioprine. which screening test should be done before starting this drug?
a) Tb Gold test
b) Thiopurine methyltransferase
C. Anti Acetylcholine inhibitors
D. Complements assay.
E. Anti gliadin IgA
B
885
Q1810287-Pt BP 80/50 mmHg, PR : 110 .on exam a pulsatile abdominal mass felt in midline, with sudden severe pain radiating to back. Most appropriate next?
a) Urgent laprotomy
b) FAST
c) CT
d) Aortogram
B
886
```
Q186092- A woman comes to psychiatrist who is referred by GP, telling that GP doctors ‘treat him like a nut’. ‘All doctors stick together’. she has h/o charged to doctor at court.
A) Borderline
B) Antisocial
C) Narcissistic
D) Passive aggressive
E) paranoid
```
E
887
Q187484- Child has diarrhea +_____for 4 days, mother doesn't mind until the child develops a limp and stops walking, then she brings the child to you. Pain and tenderness in left hip. No fever. Diagnosis?
a. transient tenosynovitis
b. Septic arthritis
c. Slipped femoral capital epiphysis
A
888
Q11261- pt with chest pain radiate to the back with sweating &pallor. BP 170/100. CT shows aortic dissection about 4cm distally from left subclavian artery what is the most appropriate next mx.
```
A.iv nitruptusside
B.iv labetalol
C.iv verapamil
D.endovascular repair
E.thoracotomy and graft repai
```
B
889
Q188428-a woman with secondary infertility after 3years birth of her child. Mid cycle sex and regular cycle. Cause?
A short luteal phase
B sperm antibodies
C sperm abnormality
D tubal damages
```
woman with child 3 yrs ago cannot concieve , no contraceptives, regular cycles, mid cycle sex,, cause
Abn sperm count
Tubal damage
Long leutialphace
Bad timing of sex
```
خوب دوستان اين سوال هم بسيار چالش برانگيز بوده و با جواب هاي متفاوتي بسته شده و سوال بسيار ناقص هست ، اولا هيچ اطلاعي از همسر نداده و به همين دليل من فرض كردم همسر سالم هست و گزينه سي را رد ميكنم
و گزينه ب يعني اسپرم انتي بادي را هم رد ميكنم چون بسيار نادر هست .
از طرفي نميدونم كه زايمان قبلي سزارين بوده يا نه و يا ايا سابقه PID داره يا نه و ايا به رحم در زايمان قبلي اسيب وارد شده يا نه و نميدونم طول دوره پريودها چند روزه بوده
ولي به طور كلي
اگر سيكل ٣٥ روزه و يا ٢١ روزه باشه جواب bad timing است
و اگر سيكل ٢٨ روزه بوده : هم ميتونه مشكل اسيب توبول و هم لوتيال فاز كوتاه باشه.
لوتيال فاز كوتاه اجازه نداده تخمك در رحم ايمپلنت بشه و علايم ديگر مثل لكه بيني هم ميده كه در سوال ما نداره پس گزينه الف را رد ميكنم.
از طرفي مشكل اسيب توبول شايعتر هست و مسوول ٢٠-٢٥درصد از علل اينفرتيليتي هست و بسياري از موارد به دليل يه سالپنژيت و يا STD بدون علامت و پنهان إيجاد ميشود
پس منطقي ترين جواب اين سوال اسيب توبولار يعني گزينه D ميباشد
890
Q184114- A young man has a syncopal attack while weight lifting. He has had similar episodes twice before. His father died of cardiac disease. What is the most appropriate management?
a) Holter monitor
b) Echocardiogram
c) Stess test
d) BP in supine & lying down
e) CT scan
B
891
Q182506- pic of a very big & severly ulcerated leg ulcer with h/o dm pt with non healing ulcer(yes they mentioned in the scenario that it’s a non healing ulcer),her dm was well controlled previously.swab taken from ulcer done & antibiotic was given already,so whats most appropriate next step??
a. mri
b. xray
c. swab culture
d. blood sugar
e. duplex Doppler
B
892
Q9754- A mom brings her 6 weeks child to your clinic as he recently starts to vomit out the milk he’s drinking with no bilious. He’s been developing well until last week when he stopped gaining weight. On examination there is no abdominal pain and no palpable masses. What do you think is the diagnosis:
```
A- Gastroesophageal reflux continue to thrive
B- Pyloric stenosis
C- Urinary tract infection
D- Intestinal obstruction
E- Duodenal atresia
```
B
893
Q184198-New Q of 16 old boy who his grades fall because he doesn't pay attention to lectures and he do some Skitch drowning instead of studing , he had fight with one of his colleagues and when you interviewed him he couldn't make eye contact with you and was unable to explain his condition , he denied taking Alcohol or non prescribed medications
1. A Asperger
2. B Dysthemia
3. C bound alcohol and drug
4. D Conduct
5. E Schiz
5
894
Q183580- A 26 yrs autistic boy with mood disorder. He loves to stay alone. His relatives brings him to you, During interview he gets agitated and goes out of the room. After a while he comes again in the room. What will be the best pharmacological Rx?
a. Sodium valproate
b. Lithium
c. Sertraline
d. Resperidone
e. Olanzapine
D
895
```
Q182542- 45 yrs old male presents with crackles and wheeze at the base of both lungs. He has a history of MI and HTN. Chest –ray was given . diagnosis asked
a. lt heart failure
b. COPD
c. asthma
d. pulmonary embolism
e. pneumonia
```
A
تو این سوال یک اقای ۴۵ساله رو داریم که تو معاینه کراکل دوطرفه در بیس ریه داره و متاسفانه با توجه به اینکه تصویری از این سوال نداریم با توجه به هیستوری بیمار یعنیMI و HTN به نظر بهترین گزینه ای که بتونه bibasal crackles رو در این مریض توجیه کنه گزینه اول یعنی HF باشه.
من توضیح مختصری در مورد ویژگی های cxr در HFرو اینجا اوردم
Chest x-ray findings include pleural effusions, cardiomegaly (enlargement of the cardiac silhouette), Kerley B lines(horizontal lines in the periphery of the lower posterior lung fields), upper lobe pulmonary venous congestion and interstitial edema.
✏️Additional causes
Although not as common, bibasilar crackles may also be present if you have chronic obstructive pulmonary disease (COPD) or asthma.
همونطور که خوندید کراکل دوطرفه بازیلار در بیماری های ابستراکتیو مزمن هم ممکنه وجود داشته باشه ولی خیلی شایع نیست و توی سوال ما هم اشاره ای به سابقه سیگار و اسم نشده😉
896
Q189213-A man comes to the ED after indulging several alcohol beverages. On exam, you notice there is increased swelling on the abdomen with jaundice and abdominal distention. The patient is in severe pain and you can palpate the liver. What is your diagnosis? (Pic is given)
A. Budd Chiari
B. Acute pancreatitis
C. Alcohol induced cirrhosis
D. Hepatomegaly
E. Splenomegaly
B
897
Q182527- pancytopenia due to methotrexate (with underlying RA) What to give
a) folic acid
b) folinic acid
B
898
Q9703- A patient presented with upper abdominal pain, fever, and vomiting. Ultrasound revealed thickened wall of the gall bladder and gallbladder stones. You commenced antibiotics but condition got worse with sign of peritonitis. What to do?
a. Cholecstostomy
b. ERCP
c. Cholecystectomy
d. Whipples
B or C?
899
Q10293- Female came with symptoms fever myalgia, rash,, 1week ago, went camping in Queensland, got bitten by tick, bite site got red and tick was removed. o/e axillary lymphadenopathy , black scab at bite site,etc. Dx?
A. Lyme disease
B. Scrub typhus
C. Q fever
D. ross river fever
A
یه مقایسه بکنید اینها رو
Lyme
گزش کنه، تب و میالژی و آرتریت و erythema migrans داره(شکل ضایعه)
Scrub typhus
علائمش تب و سردرد و میالژی و راش ماکولوپاپولر موقتی و لنفادنوپاتی رجیونال و جنرالیزه و اسکار سیاه در محل گزش داره تنها مشکلش اینه که با مایت منتقل میشه نه کنه
Q fever
علائمش تب و لرز و میالژی و سردرد و سرفه خشک هست و با انواع و اقسام جانوران میتونه منتقل بشه بیشتر مال کارکنان کشتارگاهاست یا کسی که در تماس با دام و محصولات دامه
Rose River
علائمش تب و راش و پلی آرترالژی هست جواب سوال ما نیست چون با پشه منتقل میشه
Dengue
هم از طریق پشه منتقل میشه و علایمش سردردودرد پشت چشم و بی اشتهایی واستفراغ و راش پوستی در تنه و دست و پا و بندرت خونریزی از بینی و دهان و علایم تحریک مننژ هست و جواب سوال ما نیست
Queensland tick typhus
علائمش دقیقا عین اسکراب تیفوسه فقط خفیف تر (تب، سردرد، میالژی، لنفادنوپاتی، اسکار سیاه محل گزش) و با گزش کنه هم منتقل میشه .من فکر میکنم جواب باید این باشه🤔🤔🤔🤔
900
Q182519- past history of dvt pt on UFH periopertively n switch to lmw heparin after 5 days undergone rt hip surgery develop dvt after 10 days that what to do-(In investigation only platelets are decreased)
A- ffps
B- vit k
C- cease heparin and switch to other anticoagulant
D- platelets infusion
C
وارفارین تا زمانیکه Plt count بالای ۱۵۰ نشه شروع نمیشه
داروی انتی کواگولانی که شروع میشه👈 مهارکننده مستقیم ترومبین : اگاتروبان
901
Q189123- 17 years old boy come with Gingival inflammation and swelling with submandibular lymph nodes enlargement,soft,tender. next step?
A)CT head
B)OPG
C)gingival swab
B
902
Q186712- Alcoholic patient now became agitated came to hospital. He's uncontrollable by security. Treatment?
A. I/M haloperidol
B. Thiamine
C. I/V diazepam
D. I/V midazolam.
A
903
Q184428- a patient presents after RTA with a 6 cm laceration in the anterior part of tibia. His tibia seemed grossly deformed and distal pulsations were intact(SURE à not absent). What is the next appropriate management/
a. debridement
b. tetanus toxoid
c. bone reduction
d. antibiotics
C
904
Q187292- Heart failure case man with AF on Ramipril, metoprolol, digoxin. Went on trip for 2 weeks and stopped his medication. Now with bilateral edema up to knee in legs. And ankle swellings Lungs is clear. And the patient is not dyspneic, in addition to CXR and ECG, what is next most appropriate invx?
A. Serum creatinine and electrolyte
B. Echo
C. Arterial blood gas
D. Troponin
E. Check digoxin level
A
بدون دیسپنه و بدون ارتوپنه، قدم بعد چک کراتینین
در صورت ارتوپنه و دیسپنه، قدم بعد اکو
905
Q185500- A patient who is going to do surgery for varicose veins in next 3 weeks. He has been taking
clopidrogrel for cardiac stenting for 4 months. What is the most appropriate management?
a. Reassess need for surgery
b. Do surgery now
c. Change clopidrogrel to LMWH before surgery
d. Stop clopidrogrel and do surgery
e. Change clopidrogrel to warfarin before surgery
A
906
Q1811272- A 42yo man with complaints of fever, caugh and foul smelling sputum, the patient is a heavy alcohol drinker. His CXR reveals a round like lesion containing fluid in his Rt mid zone, antibiotic in commenced, what next? (The CXR and the size of lesion was not given)
A) broncoscopy
B) plueral drain
درمان ابسه ريه انتي بيوتيك هست.و در ٨٠-٩٠٪ موارد درمان إنتي بيوتيكي موفقيت اميزه. حالا اين سوال إنتي بيوتيك رو داده و احتمالا خوب نشده (ولي ريكالر يادش رفته اين جمله رو اضافه كنه)
توي اين شرايط كه درمان إنتي بيوتيك شكست ميخوره ، درناژ ميكنيم
اول AB و بعد ct برای تعیین سایز و بعد درناژ ( اگر بالای 6cm بود از اول درناژ و اگر کمتر بود بعد از ۶ هفته)
ترانس پلورال درناژ
اسپيراسيون واسه ابسه ريه جواب نميده
كلا ابسه ها رو درناژ ميكنن
كيست ها رو اسپيره ميكنن
توي اين سوال هم البته عكسشو من نديدم ولي خب پلورال درين و برنوكو ميتونن هردو جواب باشن ولي خب اگر در محيط باشه بهترين كار ترانس پلورال درين هست نه پلورال و اگر نزديك برونكوس باشه مثلا توي عكس در نزديكي مدياستن باشه بهترين كار همون برنوكوست البته ابسه هايي كه برونش راه دارن و معمولا با برونكوسكوپي ميشه تخليه كرد علايم خلط ريويشون تابو تر هست
907
Q184480-You are in emergency department, you see patient with electric shock, he is alert, his pulse is regular, ECG normal, the inlet was on the left hand, and the exit on the RT shoulder, what is your management?
a. Discharge him home, and if he has chest pain to com to the hospital.
b. Do cardiac enzymes, if normal discharge him.
c. Admit him in intensive care.
d. Call cardiologist on call.
A
در برق گرفتگی دو تا از عواملی که در شدت ضایعه موثرن ولتاژ و جریان هستن طبق سایتهای اوزی ولتاژ بالا یعنی 1000< و پایین یعنی 1000>
حالا در اپروچ به برق گرفتگی از همه باید ekg گرفته بشه اگه بیشتر از یه اسیب جزئی پوستی باشه باید cbc , ck , u/a انجام بشه اگه ولتاژ پایین باشه و ekg نرمال باشه و سابقه loc و اریتمی و آسیب دیگه ای که بخاطرش بخواد بستری بشه نداشته باشه میتونیم مرخصش کنیم
908
Q188306- A man presented for a sick certificate but presented with ataxia with alcoholic fetor asking
most important investigation to do
a. ct scan of brain
b. LFT
c. INR
d. fasting blood sugar
e. full blood exam
B
909
Q184323- 72 yr female,sudden vertigo,nystagmus,tinnitus & deafness in left ear.one sided body weekness. dx?
1. Walenberg sydnrome (Lateral medullary syndrome)
2. lateral pontine syndrome
3. Acustic neuroma
4. Meningioma
5. Minneirs disease
6. Labyrinthitis
B
910
Q187603- 43 year old man is brought to er as he is in the police custody alredy after attacking to some one and now presented with agitated and poor cooperative and when asked question doesnot reply. Blood alchol level done its around 63 mml (.2%) what is most appropriate management?
A-Keep in er until he is respond to and capable of giving history
B-Give im haloperidol
C-Call to social worker
D-Call to specialthing like that
A
911
Q182595- A 44-year-old psychology professor with a chronic history of rheumatoid arthritis presents for a follow-up
examination. She is currently taking prednisone and infliximab, a regimen that has successfully stabilized her
condition. Physical examination reveals no significant changes. Toward the end of the visit, she mentions that
she would like to try acupuncture as an adjunct treatment in addition to the medications she is currently taking What is the most appropriate response to her request?
A. "I'm sorry, but I am not very familiar with acupuncture and am reluctant to combine the two therapies."
B. "I hope you are aware that acupuncture has its limitations."
C. "If you want to try acupuncture, I cannot continue serving as your physician."
D. "Why do you want to try acupuncture?"
E. "How can an educated woman
D
912
Q9769-4 years old boy with hematuria, proteinuria and hypertension now who initially responded to steroids. Diagnosis?
A- PSGN
B- Minimal change disease
C- FSGN
D- Anti GBM disease
C
913
Q184384- complaining of pain in his right arm with pain in different joints. On examination he appears to have motor neuropathy affecting his right arm, with foot drop and skin lesions in different parts of his body. On investigation you found hamaturia ,increase urea and creatinine. What will you do to confirm the diagnosis?
A- Sural nerve biopsy
B- Renal biopsy
C- ANCA
D- Anti dsDNA
A
914
Q184450- 5-year-old has progressively increasing pallor since birth and hepatosplenomegaly. Which of the following is the most relevant investigation for achieving diagnosis
a) Hb electrophoresis
b) Peripheral smear examination
c) Osmotic fragility test
d) Bone marrow examination
این سوال در توتال بین a و c شک بوده . تالاسمی ماژور که تابلو شدیدتری داره و تالاسمی مینور هم تابلو ضعیفتر . تالاسمی الفا هم تشخیص دقیق با الکتروفورز داده نمیشه . میمونه تالاسمی بتا اینترمدیت که میتونه این تابلو رو بده ولی معمولا بعد از ۴_۵ ماهگی که ساخت هموگلوبین بتا تکمیل میشه شروع به علامت دار شدن میشه نه از بدو تولد .
اسفروسیتوز معمولا اسپلنومگالی میده نه هپاتواسپلنومگالی و ایکتر هم معموله . ضمنا تستی که اخیرا برای تشخیصش گرفته میشه E5M test هست و اسموتیک فراژیلیتی قدیمیه .
سیکل سل انمی با ایکتر، حملات درد در نقاط مختلف ، عفونت مکرر ...همراهه ولی خب مدل ضعیف هم داره . البته تا ۵ سالگی معمولا اتواسپلنکتومی اتفاق افتاده و دیگه هپاتواسپلنومگالی بعیده .
کنسر های خونی معمولا از بدو تولد نیستن و تابلو ی شدیدتری دارن .
انمی فقر اهن هم از بدو تولد نمیتونه باشه. و کمتر هپاتواسپلنومگالی میده.
بین اینها شخصا با تالاسمی بتا اینترمدیت موافقم و جواب a ولی چون قطعی نشده باز میذاریم شاید بعدا سوال دقیق ترش اومد.
دوستان ... برای این سوال که با تشخیص اسفروسیتوز با سی بستیم .. من هر جا رو نگا میکنم واسه اسفروسیتوز هپاتومگالی پیدا نمیکنم
اینترمدیا یه چیزیه بین تالاسمی ماژور و مینور ، نه مثل ماژور شدید که سریع بچه رو از بین ببره و failer to thrive کنه نه مثل مینور بی علامته
915
Q186631- after screening with faecal blood test WOF is the correct perrcentage of detection of Duke A1 colonic carcinoma: Scott-323
a. <3%
b. 15%(Duke A tumour confined to bowel wall survival 90%)
c. 25%
d. 50%
e. 75%
D
916
Q186624- pjotograoh 2: shows a skin lesion, pinkish brown colored lump. The lesion in the picture was found on the forearm of a young male. 2 weeks later he develops pneumonia associated with crepitation through out both lungs. WOF organism is causing this lesion?
a. strep pneumonia
b. staph aureus
c. mycoplasma pneumonia
d. pneumonia carnil
e. mycobacterium avium
?
917
Q186636- apaitient has massive ascitis and in the fluid malignant cells are found, which of the folloing is a possible finding?
a. splenomegaly
b. hepatomegaly
c. supraclavicular swelling
d. on digital rectal examination, nodules can be palpated
?
918
Q186638- a 65 y/o man presented with confusion. Laboratory findings showed hypercalcemia, calciuria, and phosphate within normal limits. Which is the most likely diagnosis?
a. malignancy (osteolitic metastasis)
b. parimary hyperparathyroisim
c. idiopathic hypercalcemia / hypercalciuria
d. pagets disease myeloma
?
919
Q186642- a paitient has diarrhoea, fatigue and pallor, blood picture shows MCV 110, what is the diagnosis? (DAV-642)
a. pernicious anemia
b. crohn disease
c. gluten sensitive enteropathy
d. tropical sprue
?
920
Q186670- A 48 years old man complains of anorexia and tiredness of a few months duration months earlier routine physical examination and urinanalysis were normal.examination at this time shows slight tenderness over the second & third lumbar vertebrae.The blood pressure is 120/76 mmHg. Laboratory studies reveal:
HB=5.0 g/dl, Urea=16mmol/l, Urine:pro=4+, many hyaline casts no red cells.
what is the probable diagnosis?
a)chronic pyelonephritis
b)multiple myeloma
c)gouty nephropathy
d)rapidly progressive glomerulonephritis
e)carcinoma of the prostate with spinal metastases
?
921
Q186676- which of the following will decrease the gradient in hypertrophic cardiomyopathy?
a. digoxin
b. verapamil
c. ace inh
d. prazosin
e. propranolol
?
922
```
Q186693- 18 year old came for routine screening for insurance,,,,,and dipstick showed RBC+ on complete urine analyiss.....it was like this RBC 1+ PROTEIN NEGATIVE... analysis confirmed blood cells of glomerular origin:
a .thin basement membrane dise
ae b: alport syndrome
c: nephrotic syndrome:
d:PSGN
```
A
923
Q182014-Father with Huntington chorea, daughter carrier, she wants to check her 10year-old daughter?
1. Don’t do genetic testing
2. Counselling the 10-year-old daughter
3. Do the test for the 10-year-old daughter with her mother
4. Do genetic test for the daughter
5. Genetic counselling
?
924
Q189168-Man comes to psychiatrist for medical evaluation from court. His examination are all normal. He has history of criminal record for assault, theft and larceny. After counselling section, he confided to the doctor that he wants to kill his ex-partner. What is your next step?
a) Warn his ex-partner about it
b) Send him for forensic assessment
c) 3-4 continuous counselling session with him
d) invite his ex-partner for a session
e) call police
E
925
Q187655- A 54 year man presented with epigastric pain and vomiting and nausea for 12 hour duration.he has had this pain on and off for last 3 month with loss of appetite and weight loss. Further more he is chronic alcoholic otherwise not significant history on examination his sclera is mild ecteric . ther is intrahepatic dilation only no intra hepaitic or extra hepatic bile duct obstruction .lab values given . whats most appropriate next?
Bilirubin 54
Alp 88
Ast
Ggt 155
Lipase 300
Normal values given can compare with given values
A-Ct abdomen
B-Ercp
C-Mri abdomen
D-Endoscopic view
E-Uss
A
926
Q186197- A 16 year old female presents with Sickle cell anaemia and heavy menstrual bleeding. What is the best treatment of choice?
A. Combined Oral Contraceptive Pill (COCP)
B. Inj Depoprovera
C. Mirena
D. IUCD
E. Implanon
C
927
Q184155- Woman married to a man known to have hepatis C positive, she came to know what increase risk of transmission of hep C the most to her
a. unprotected sex
b. use his tooth brush and his razor blades
c. eat together
B
928
Q182588- ALL pt on cyclophosphamide. you prescribe imipenim and azithromycin, he develops maculopapular rash. what test do u perform?
a. CMV test
b. skin allergy test
c. immunofluoresence of the skin lesion
d. BM biopsy
A
929
Q182175-Patient presented with dyspnea on exertion and shortness of breath. She was on digoxin and ramipril and frusemide. She failed to take the drug for 3 days because she was on a trip. There is bilateral basal crepitations and leg edema up to knee. JVP is raised. What is your most appropriate investigation?
A. Check digoxin level
B. Echocardiogram
C. Electrocardiogram
D. Serum urea and creatinine
E. Troponin
Next: ECG & CXR
Best: Echo
930
Q185032-55 yr old man presents with three week history of nausea & vomiting! Initially clear fluid, later indigested food parcles! Last 3 months, he suffered from abdominal pain radiang to back! Most likely Dx
1. Ca head of pancreas
2. Chronic DU
3. Ca duodenum
4. Ca body of stomach
5. Linitis plastica
B
931
Q182095- Which of the following clinical feature is helpful to differentiate Lewy body dementia from Alzheimer's disease?
A. Parkinsonism
B. Persistent short term memory loss
C. Deterioration of social skills
D. Taking longer to do routine tasks
E. Forgetting well-known people or places
A
932
Q184093- Patient with mania on lithium for the last 2 years and was controlled on it. She is planning pregnancy and wants your advice?
A. Stop Lithium
B. Decrease Lithium
C. Check Blood Lithium Levels
D. Start Quetiapine
E. Counsel her about the pros and cons of lithium therapy during pregnancy
E
933
Q187404-6mth child with wheezing, fever, tracheal tug, sub costal recession,
nasal discharge. What will you do to make Dx
A- CXR
B- Sputum Cx
C- Blood Cx
D- Nasopharyngeal as pirates for PCR
D
934
Q11116- Boy having a fight in a pub ,he has a bruise on his ear – what to do . Options
a. Needle aspiration
b. I&D
c. Compression
d. Observation
e. NSAIDS
A
935
Q182278- woman with forgetfulness, doesn't concentrate to work ,burning her hands during cooking , once went to a place and realize she don’t know why she is here , what in MMSE u will find about the affect of mood?
A. Lability
B. flatness
c. blunting
d. blandness
A
936
Q9991-21 yr old boy comes with mom, mom says he is keeping himself isolated for 18 months, taking marijuana since one year, now having something delusion i forgot. Dx
A) Drug induced psychosis
B) Schizophrenia
C) Schizophrniform disorder
A
937
Q189101-Patient with cellulitis leg , treated with cefazolin , and got relieved but 3 days later fever develop with rash , In the future , which drug will be safe ?
A . Cefazolin -1st line cephalosporin
B . No cephalosporin
C , neither penicillin nor cephalosporin
D , Any cephalosporin except cefazolin
C
کلا حساسیت به انتی بیوتیک ها به سه دسته تقسیم میشه :
۱) IgE mediated immediate:
که نوع سریع هستند و بلافاصله و در طی یک ساعت بعد تزریق انتی بیوتیک خودشون رو به شکل کهیر ، آنژیوادم ، برونکواسپاسم و آنافیلاکسی نشون میدند، آنافیلاکسی بیشتر خودشو با انتی بیوتیک های تزریقی نشون میده و وقتی یک نفر سابقه ی حساسیت تیپ یک به دارویی رو داره یعنی باید از استفاده از ان دارو پرهیز کند
۲)IgE independent reaction :
اینا تقریبا مثل دسته ی اول هستند، مثل red man synd در ونکو که باید انتی هیستامین بگیرن و مجددا با ریت اهسته میشه برای بیمار شروع کرد
۳)delayed reaction :
اینا خودشون رو به صورت راش چند روز بعد تزریق دارو نشون میدند و وقتی که این اتفاق میافته ۱۰۰٪ نمیتونیم بگیم که در اینده بازم این اتفاق میافته پس کنتر اندیکه مصرف نمیشن
🔔🔔این دسته سوم چند نوع خطرناک دارن که باید حواسمون بهشون باشه :
🌸 serum sickness like reaction
که به صورت تب ، پروتین اوری ، راش واسکولیتی و ارتریت یا ارترالژی و علایم فلو لایک خودشو نشون میده که بیشتر در مصرف cefaclor دیده میشه و سولفانامید ها هم میتونن تریگر باشن براش
🌸🌸 dress syndrom
که به صورت تب ، ائوزینوفیلی ،هپاتیک فیلر و راش خودشو نشون میده
🌸🌸🌸SJS or TEN
که درگیری پوستی و مخاطی بسیار زیادی داره و بیشتر در سولفانامید ها و نویراپین دیده میشه که کنترا اندیکه مصرف دارو هست
❇️❇️حساسیت سفالوسپورین ها به خاطر زنجیره بتالاکتامی که دارن میتونه شبیه به پنی سیلین ها باشه که اونم به صورت حساسیت های سریع و تاخیری دیده میشه ، گفته شده که در حساسیت به سفالوسپورین ها خیلی نادر هست که به یک دسته ی دارویی تعمیم داده بشه و معمولا فقط حساسیت به همون دارو ی خاص هست
خب برسیم به منیجمنت این حساسیت ها که توی جدولی که براتون گذاشتم نوشته اگر حساسیت به پنی سیلین تاخیری باشه و از نوع سیستمیک نباشه باید الترناتیو مثل سفالوسپورین های دیگر وانتی بیوتیک بدون چرخه بتالاکتام داده بشه اما اگر حساسیت سیستمیک داده بشه نباید پنی سیلین و سفالوسپورین ها و کارباپنم داده بشه
خب حالا برسیم به سوال ما گفته که بعد چند روز حساسیت به صورت ♦️راش ♦️همراه با ♦️تب ♦️داده ! پس بیمار در دسته تاخیری قرار میگیره که در دسته ی تاخیری فقط راش داشتیم و اگر باقی علایم بهش اضافه بشه مثل تب ،برای بیمار سیستمیک بودن مطرح میشه ! حالا اگر واکنش فقط به صورت راش بود میتونستیم دارو رو ندیم و از باقی سفالوسپورین ها استفاده کنیم یعنی گزینه دی ، اما این بیمار همراه با راش تب هم داره ! که به نظر من با باقی علایمش که نداریم میتونه توی یکی از سه دسته ی مهم واکنش تاخیری ها قرار بگیره و در این صورت نه پنی سیلین و نه سفالوسپورین و نه کارباپنم نمیتونه بگیره که گزینه سه مطرح میشه و به نظر من اینجا جواب گزینه سه هست
938
Q182609- Old woman diagnosis as Schiz & taking Venlafaxine. Now ,she become confused, day time sleeping & reduced concentration.. What test will u do ?
A.Ur & Cr
B.Electrolytes
C.FBS
D.LFT
E.Urine C&S
B
939
Q182115- Female 50 year old, menopaused 1 year ago, work a receptionist, asking about her osteoporosis risk, as her mom (85years) has osteoporosis and hip fracture, what to advice?
A. Ca screening
B. 25 hydroxy vit D screening
C. Bone scan by Xray
DEXA
940
Q11337- A man known case of Alzheimers is on donezepil and memantine. Since one month the aged care staff have noticed a change in his behavior. He tries to kiss and fondle nurses while bathing and has been seen sitting in front of nursing station masturbating. What is the cause of his changed behavior?
A. Worsening Alzheimers
B. Side effect of Donezepil
C Side effect of Memantine
D. Lesion in the frontal lobe
A
941
Q187605- 14 year old girl came to GP , living with parents.started sexual activity.asking for contraception.dont want you to inform her parents.whats the first thig you will do?
1-call parents & tell them
2-prescribe OCP
3-ask age & identity of her partner
4-give her OCP & advice partner to use condoms
C
زیر 16 و با خانوادست و شک دارین به مچور بودنش: سن پارتنر در کنار تجویز ocp باید بررسی بشه
زیر 16 و مستقل: تجویز
بالاي 16: تجویز
942
Q186205- Mother 41+ 3 days with no abnormality. Previous child born by LSCS due to obstruction of labor. Bishop score 2.
A. Induction with prostaglandin
B.Induction with ARM
C. LSCS
D. Admission for fetel examination
E. CTG after 1 week
C
943
Q189452- A lady in her 37 weeks of Pregnancy has severe pain in her right upper quadrant and is worsening. She has vomited several times. Her bp is 100/60 and pulse is 90. Otherwise she is well,
What to do?
A) Laparoscopy
B) Laparatomy
C) wait till her delivery
D) giving pain killer
B
944
Q11435. adult with long history of dysphagia , more after certain types of food lasting for few days , also history of asthma, endoscopy done: multiple constrictions , diagnosis:
a- eosinophilic esophagitis
b- achalasia
c- ca esophagus
A
945
Q9557- Patient underwent Conization for abnormal pap smear 2-3 days back. Now presents with fever 39, pain lower abdomen and tenderness. What’s the most appropriate place to take a swab?
a. Blood culture
b. Endocervical swab
c. High vaginal swab
d. Low vaginal swab
e. Endometrial (don’t remember this one exactly)
B
946
Q188249-Risk factor for dvt after knee surgery
A-BMI 36
B-Varicose vein
c- history of cancer in her mother
A
947
Q188364- . lady presented with pain and tenderness supraorbital was diagnosed to have sinusitis, she has fever and then she developed neck stiffness, LP revealed polymorphonucleocytes .what is the diagnosis :
A. Frontal sinusitis
B. Meningeococcal meningitis
C. Pneumococcal meningitis
D. Stretococal meningitis - Gram+ve diplococci
C
948
Q187362-A 74 year old male was brought in by the police for workup. He was taken in custody due to murder of his 70 year old wife, whom he was married to for 55 years. There were multiple head injuries on the wife. Which one of the following is the likely cause that led to this event?
A) his wife had metastatic breast cancer
B) he was overly preoccupied with her whereabouts lately
C) they had many separations during their marriage
D ) she was financially independent
B
949
Q184473- A 35y woman presented with clear discharge from breast. Her small kid is 5y old. In the examination there is no lump in the breast with presser of nipple clear discharge is obviously detected. Dx:
a. Benign duct papilloma
b. Intraductal carcinoma in-situ
c. Mammary duct ectasia
d. Paget disease
A
950
Q184474- A 42 year old woman presented with breast lump which is diagnosed as intra-ductal carcinoma. What is your next step in management?
a) Core biopsy
b) Hook wire excision
c) USG
B
951
Q10308- woman h/o recurrent genital herpes, last episode 8 months ago. Best way to prevent transmission to partner?
a. avoid sex when lesions,
b. tell partner always use condom,
c. prophylactic antiviral partner,
d. prophylactic antiviral for woman
A or B?
952
Q186700- A 65-year-old schizophrenic patient needs coronary angiography because of suspected myocardial infarction. Cardiologist explained the procedure to the patient who did no understand the procedure. Who can give the consent on behalf of the patient
1. The patient’s relative (guardianship court)
2. Mental health tribunal (can give consent only for mental illness)
3. The patient
4. The court
A
مریض کامپیتنت نیست.
اگر از قبل تعیین شده که برای تصمیمات مدیکال این مریض چه کسی تصمیم می گیره، ما حرف اون آدم رو گوش می دیم. مثلا اگر برادر مریض وکیل امور پزشکی این مریض باشه، با یه تماس قضیه حل میشه. البته اگر این وکیل در best interest مریض تصمیم نگیره و مثلا بگه ولش کنین بمیره در حالی که با آنژیو بشه به راحتی قضیه رو بدون ریسک بالا ردیف کرد موکول میشه به گاردینشیپ کورت. در خصوص چیزی که اورژانسیه و نمیشه صبر کرد تا گاردینشیپ کورت تشکیل بشه، دکتر می تونه برای مریض غیر کامپیتنت و در best interest بیمار درمان مناسب رو حتی بر خلاف نظر وکیلش انجام بده. منتها باید آماده دادگاه بازی بعدش باشه و دادگاه هم به نفع دکتر رای خواهد داد. این قضیه وقتی فرق می کنه که مریض به شخصه و در زمانی که کامپیتنت بوده، پلن درمانی مشخصی رو (مثل سی پی آر یا اینتوبه شدن) رو اعلام کنه که مورد قبولش نیست و حاظره بمیره ولی اون پلن مشخص انجام نشه. به این میگن advanced care directive یا advance care plannin.
با این اوصاف اگر تا حالا گیجتون نکردم، بزارین ساده بگم:
تریبونال منتال هلت هیچ نقشی در تصمیمات پزشکی و غیر از منتال هلت مریض نداره. تریبونال کارش بررسی اینوالنتری بودن مریض برای درمان منتال هلته. پس این گزینه درست نیست.
خود بیمار هم کامپیتنت نیست، پس این گزینه هم غلطه.
کورت می تونه جواب درست باشه، ولی برای آنژیو وقت طلاست و نمیشه منتظرش شد و این گزینه هم غلطه.
تنها گزینه این سوال همون همراه مریضه. ایشالا که ایشون بگن آنژیو بشه. ولی اگر گفتن نشه و دلیل مشخص نداشت و صرفا حال کرده مریضش بمیره، دکتر می تونه over-ride بکنه و در best inerest مریض تصمیم بگیره و تا به حال هم دادگاهی چنین موردی رو به ضرر دکتر رای نداده.
953
Q184196-18 years old with single painless ulcer. rpr positive with 1:64 titre. what is immediate management?
A.im penicillin,
B.notify public health,
C.perform contact tracing,
D.do other std screening
A
954
Q1810379-Mother has twins’ wants to breastfeed for contraception and she only wants to get pregnant after that. What would be the factor that increases her risk for conception
A. Period like discharge
B. Unliateral mastitis
C. Multiple sex a week
D. One twin doesnt breast feed
E.Twins only breastfed at night
E
955
Q186637- a 28 y/o male presents with distal weakness and atrophy of the small muscles of both hands ( interossel, lumbricals, thenar & hypothenar). What is the most likely diagnosis?
a. muscle sclerosis
b. bilateral median nerve palsy
c. syringomyelia
d. bilateral ulnar nerve palsy
e. brain stem infarction
C
956
Q185090. The recall on FNAC of the biggest of thyroid nodes, which showed blood, colloid and follicular cells. The nodes are non-toxic. What to do next?
a. Repeat FNAC
b Core Biopsy
c. Partial thyroidectomy
A
957
Q186154- post op agitation on 3rd day in a pt who drink 4-6 cans of beer everyday. smokes 20 packs of cigarettes everyday. Pt tries to remove his Iv line cause?
a-Alcohol withdrwal
b-drug reaction
c-psychosis d)dementia
A
958
Q189134- 47Patient on warfarin.. had PR bleeding. InR 9. Whats most appropiate next tx?
A -whole blood tx
B -packed cell tx
C- ffp tx
D -vit k
E -cease warfarin
C
959
Q10278- 22 year-old primigravida complains of headaches, restlessness, sweating, and tachycardia. She is 16 week pregnant and her blood pressure is 180/110 mmHg.
What is the best investigation for her?
a. Exploratory laparotomy
b. Mesenteric angiography
c. Head CT scan
d. Abdominal CT scan
e. Abdominal ultrasonogram
E
960
Q1810402-Post opt pt oliguria wz indwelling catheter.fever 38.5.There was generalized abdominal pain. Most appropriate mx?
A. Abd xray
B. blood culture
C. S electrolyte and creatinine
D. abd usg
D
961
Q186169- Wife brings Ptx (husband) with worsening Parksonism syx(marked bradykinesia,rigidity,lack of self empathy and agitation) presenting with auditory and visual hallucinations comes to you for advice.Ptx is currently on carba and levodopa 75mg with little to no improvement for more than a year nowWhats the appropriate next step
```
a-Donezpil
b-Quietapine
c-Haloperidol
d-Increase Levodopa
e-Pramipexole
```
D
962
Q186169- Wife brings Ptx (husband) with worsening Parksonism syx(marked bradykinesia,rigidity,lack of self empathy and agitation) presenting with auditory and visual hallucinations comes to you for advice.Ptx is currently on carba and levodopa 75mg with little to no improvement for more than a year nowWhats the appropriate next step
a-Donezpil
b-Quietapine
c-Haloperidol
d-Increase Levodopa
e-Pramipexole
B
963
Q183296- Mother brings her 18months old child. Gov is not supplying flourinated water. She’s worried about dental health if child. What will u advice
A.Fluorine supplement tablets
B.High fluoridated toothpaste
C.Low flourinated toothpaste
A?
964
Q10488- which combination making muscle weakness without tenderness ?
A. ramipril and HCT
B. amiloride and Ramipril
C. celecoxib and HCT
B
965
Q187331-case of a patient present with foul smelling cough, high fever with rigor, xray done found cavity with air fluid level,after giving antibiotic what is the most app step
A- Trans pleural drainage
B- Water seal drainage
C- Needle aspiration
D-Blood culture
A
اول CT
966
Q189351-28 yr female postcoital bleeding on two separate occasions... Pap smear normal 2 months
ago...what next
a-Hpv serology
b-Chlamydia pcr
c-Pap smear
d-Thin film pap smear
B
967
Q189252-A middle age woman comes for Pap smear test. Her last 6 mth pap smear result is LSIL. She also wants to take HPV vaccine, What is the app action?
A. Give vaccine now
B. Should not give vaccine
C. Vaccinate according to her Pap smear result
D. vaccinate according to HPV serology result
E. Vaccinate according to HPV PCR result
A
968
Q184415- 40 years old man complain from persistent abnormal thoughts that’s making him washing his hands at least 10 times after touching the key or door.he is on SSRI but want to try non pharmacological therapy to help him get rid of this thoughts
Teach him how to avoid touching the doors or key
Tell him that this thoughts is normal to relieve his anxiety
Refer him to neuropsychologist unit
Refer him to insight psychotherapy
teach him about exposure and therapy
Exposure
969
Q1811109- 32 weeks pregnant woman with previous minor bleeding, presents with a breech presentation. Which of the following is the management?
A- EVC now
B- ECV at 37 weeks
C- C.S at 35 weeks
D- C.S at 39 weeks
E- Vaginal breech delivery
B
970
Q11514-Long lab tests of Hereditory Spherocytosis .Child had URTI. Pallor, no jaundice. Retics count 6% (increase), low HB, low platelets. On exam child had pansystolic murmur at left sterna border. Cause asked?
A.Parvovirus
B.Hep A
C.ITP
D. Subacute infective endocarditis
E.Folate deficiency
A
971
```
Q189092-Elderly patient presents with 10 minutes loss of vision and weakness of one half of the face. How will you investigate?
A-Carotid doppler
B-Echo
C-Mri
D-Ct
```
D
972
Q187572-38 yrs old asking for COCP, she smokes 15 cigarettes, has family history of ovarian n breast cancer, she also has history of premenstrual headaches what is most likely a contraindication/reason for not prescribing COCP to her
A-Her history of premenstrual headaches
B-family of ovarian cancer
C-Family ho breast cancer
D-Age
E-Smoking
E
973
Q1810366- A patient had a subclavian catheter for a few weeks. She now has signs of SVC syndrome. What do you do next?
A-venography
B-doppler ultrasound
B
974
Q1811251- A man presents with claudication before 100 meters, and 20 meter uphill, bilateral lower limb reflexes were reduced and all the lower limb pulses were normal, pain in buttock while walking, No ABI, what is best diagnostic method?
A) Doppler ultrasound
B) MRI
C) hip xray
D) digital subtraction angiography
(And another question asking next step)
D
975
Q11200-Post op patient, agitated, trying to get out of bed, removing all IV infusion, all vitals normal except SaO2 is 86% in room air. After giving oxygen by face mask, what is next:
a. Droperidol
b. Blood glucose level
c. CT
d. Intubate
e. IV antibiotics
A
976
Q1811299- A old patient came to ED by his sister on examination he was confuse and loss of muscle force in on side CT scan done what is your diagnosis
A) Cerebral ischemia
B) ICH
C) Brain tumor
D) SDH
E) SAH
C
977
Q9523-Salmonella outbreak has been declared in the community. A girl presents to you with watery diarrhea for 3 days. What is the best test out of the following to diagnose her condition?
a. Blood culture
b. Urine culture
c. Stool culture
d. Throat swab
A
978
Q186393- A woman presents with painless vaginal bleeding since last night. Her LMP was 8 weeks ago. Her urine pregnancy test at home was positive 3 weeks ago. Examination findings suggest 12 week pregnancy. Cervix is closed. No pain or tenderness. What should be done now?
```
A. Blood bHCG titer
B. Trans-vaginal sono
C. Full blood examination
D. Review in 2 weeks
E. Recheck urine pregnancy test
```
?
979
Q182503- enlarged gall bladder with multiple stones, found dilated bile duct and stone obstruction in common bile duct, patient developed toxic shock, what to do after fluid resuscitation?
a. laparotomy cholecystectomy
b. laproscopic bile duct explore
C. percutaneous bile drainage
d. endoscopic duct drainage
D
980
Q9524-Middle age man WITH pain in buttock and thigh during 100 m walk on ground. He can walk 20 m uphill but his femoral pulses are not palpable however his dorsalis pedis is palpable. which appropriate investigation will you request
A. Arterial Doppler
B. Digital subtraction arteriography
C. CT angiogram
d. femoral ultrasound scan
A
| اول ABI
981
Q185371- 25yo nulliparous woman at 6 weeks amenorrhea. her regular cycles are of 4 to 5 weeks. she had a home pregnancy test which was positive. presents with bleed per vaginum and abdominal pain. what investigation needs to b done
a. serial b hcg
b. urine pregnancy test
c. serum hcg levels
d. ultrasound
D
982
```
Q183329-man with two day history of left testicular pain and erythema with prominent veins. Diagnosis?
A- Varicocele
B- Epidimitis
C-Hydrocele
D- Orchitis
```
B
خب سوال از آقایی میگه(نگفته چند ساله)با شرح حال دو روزه از درد بیضه چپ و قرمزی و عروق برجسته تشخیص چی هست؟
سوال خیلی ناقص هست اما در همین حد گزینه ها:
■اولا با یه پروسه حاد روبرو هستیم،طبق مورتاگ سه تشخیص افتراقی اصلی اسکروتوم حاد عبارتند از:
۱.تورشن بیضه
۲.تورشن اپندیج بیضه
۳.اپیدیدیم ارکیت حاد
و در ادامه میگه با شیوع کمتر، احتمال هماتوم و هیدروسل حاد رو داریم.
■پس تا اینجا واریکوسل چون یه پروسه حاد داریم رد میشه،هیدروسل حاد چون شیوع کمتری داره رد میشه میرسیم به مهم ترین که تورشن هست(تو گزینه ها نداریم و البته در تورشن پروسه ای حاد تر از دو روزه داریم ) و بعد از اون اپیدیدیم ارکیت.
■در مورد ارکیت حاد به تنهایی،همیشه در اثر اوریون داریم،و با وجود واکسیناسیون نسبتا نادر هستش.
■ اپیدیدیمیت(البته اغلب همراهش ارکیت داریم) می مونه که اغلب به علت پاتوژن های منتقله از راه جنسی در آقایون جوون و پاتوژن های مجرای ادراری در افراد مسن تر دیده میشه.به درد دو روزه عنوان شده در صورت سوال میخوره،تورم و قرمزی و تندرنس داره.
بهترین جواب:
Ans:B
983
Q182039- Cecal carcinoma presentation
A. Change in bowel habit
B. Weakness & lethargy
B
984
Q189336-65 yr old man present with three weeks history of headache & vomiting. He has history of Clark 1 melanoma and surgery 3 years ago. On examination, temperature 37.3 & no other abnormal findings. CT given. What is the most likely diagnosis? Exact scenario the image was similar to this but the lesion was rounder, with the surrounding enhancement.
a. Brain abscess
b. Melanoma metastasis
c. Glioma
d. Cerebral infarct
e. Tuberculous meningitis
C
985
Q189295-A young woman presents to you at 26 weeks of gestation. This morning she lost fluid from her vagina and is worried she has compromised the pregnancy. She had an antenatal bleed several weeks ago, and sex with her partner last night. On speculum examination you see a significant amount of straw-coloured fluid. What is the most likely diagnosis?
A. A product of the haemorrhage
B. Fluids from sex
C. PROM – amniotic fluid
C
986
Q1811223- HSP scenario with leg photo, develop rash in buttock and leg, next investigation
A) abdominal USG
B) urinary phase-contrast microscopy
C) blood culture
D) CXR
B
987
Q182323- Ovarian cancer screening question – friend was diagnosed with ovarian cancer, wants to be screened, you examine her but is normal, what advise do you give her –
A.ultrasound,
B.reassure,
C.tell her that there is no screening for ovarian cancer
C
988
9️⃣
Q182602- A young adult male who is in excellent health comes with palpitation after 15km of running. 5 Strips of ECG was given (no SVT given)
a) Ventricular ectopics / PVC
b) Atrial Fibrillation
c) Complete Heart Block
d) Ventricular Tachycardia
e) Atrial flutter
A
| احتمالا همون cpvt
989
Q186153- 45 yrs old man with no family history of prostate cancer comes for screening advice and counselling . He insist he wants a DRE. A digital rectal exam showed a normal sized prostate with normal non nodular sulci. What is the next important step?
A. Reassurance
B. PSA after 2 weeks
C .TRUS
D. Abdominal usg
A or b?
990
Q183357-A Patient presented with fatigue, when you examined him, you found dropping of the Right eye with constricted right pupil,
which Investigation you do to reach diagnosis
A.MRI brain
B.Bronchoscopy
C.Chest X-ray
C
991
Q1811232- 52years old around menopause, taking HRT for 2 years. no other features. what risk ?
a. Stroke
b. VT
c. Breast cancer
B
992
Q182055-Heart block ECG on Enalapril, diltiazem 40 mg, Digoxin( within normal level).
A. Stop all & monitor ECG for 3 days
B. Add propranolol
C. Reduce diltiazem
D. DC shock
A
بیماری که بلوک قلبی در ECG که انالاپریل دیلتیازم و دیگوکسین استفاده میکنه
با توجه به رفرنسها هر سه دارو میتونن بلوک قلبی در عوارضشون بدهند پس در قدم اول قطع داروها و مانیتورینگ منطقی به نظر میاد
جواب: A
993
Q91011-A lady comes with sudden severe headache subsiding after 2 hour + vomiting. Normal ct scan. No fever but neck stiffness present. No trauma history. Cause?
a. Acute cerebral haemorrhage
b. Sub arachnoid haemorrhage
c. Atypical migraine
d. Temporal arteritis
B?
994
Q184248-Lady with 24 hours of muscle weakness and tingling sensation +, weakness more in lower limbs, no other sensory loss, no other symptoms mentioned
a) acute inflammatory polymyopathy
b) multiple myeloma
c) myastinia gravis
A
میلیت وسیع گردنی بده تا اینو ایجاد کنه و درگیري حسی در اون صورت خیلی زیاده اگر ام اس باشه که اندامهاي تحتانی رو گرفته باشه خوب ناشی از میلیت هست و سطح حسی هم انتظار داریم ام اس باید ي نورولوژیست: با شروع حاد و درگیري بیشتر اندام تحتانی a بیشتر مطرحه،
995
Q9216- A 30 years old woman comes to your clinic asking you for the best contraception for her. She doesn’t smoke, and she has negative family and personal history of breast cancer. But she has one episode of DVT few months ago, what will be your best contraception advice for her:
A- Use condoms
B- Use natural methods of contraception
C- Use low dose combined oral contraceptive pills
D- Use progesterone only pills
E- Intra uterine contraceptive device
E
Q9216
بيمار خانم ٣٠ ساله اي است كه سيگاري نيست و سابقه شخصي وخانوادگي برست كانسر هم ندارد ولي بيمار سابقه DVT چند ماه قبل را ذكر مي كند
🌺 با توجه به سابقه DVT مصرف COC براي بيمار منع مصرف دارد.
🌺natural contraception هم اصلا كنتراسپشن مناسبي نيست.
🌺كاندوم براي جلوگيري از STD مناسب است ولي احتمال فيلر آن بالاست
🌺 در مورتاگ گفته شده استpop با افزايش ريسك vte ارتباطي ندارد ولي در بعضي از رفرانسها دكر شده است اگر فردي ريسك فاكتورهاي ديگري براي DVT داشته باشد ممكن است با مصرف pop ريسك ها را افزايش دهد.
🌺 در افراد با سابقه DVT بهترين كانتراسپشن iud است.بهترين IUD كه در اين بيماران استفاده ميشودغيرهورموني(مسي )مي باشد.
🌺در مورتا ذكر شده است iud در خانمهاي nuli parous هم استفاده مي شود.
جواب: E
996
Q1811277- A young lady ,overweight with oligomenorhea ,she has menstruation every4-5 months, her hormonal assays:
LH:6.3 / FSH:2.3 / TSH:3.6 / Prolactin: Normal range
What to do to confirm diagnosis:
A) Check testosterone
B) Pelvic sono
C) Check progesterone
A
997
```
Q188038- 24 years old aboriginal male with lack of interest in normal life and is having visual hallucination watching his ancestors he is saying my mother died last month but it is not the case and mother died year ago, also has sucidal thought what is most likely diagnosis?
A. Personality Disorder
B. Depression with unresolved grief
C. Depression with psychosis
D. Schizophrenia
E. major Depression
```
C
998
Q188133- 18 yr old girl presents with malaise, tiredness for mnths.. on labs, hb 8, microcytic hypochromic, inr 1.5, calcium 1.9..... what’s the inv to reach the diagnosis. (Many labs were given)
1. hb electrophoresis
2. antigliadin antibodies
3. iron studies
4. serum electrolytes
B
999
Q186216- A 6 years old boy contact with a chicken pox friend in school, he is neither vaccinated nor infected previously, first step of mx
a. check serology
b. immunoglobulin
c. give vaccine to the child
C
1000
Q1811065- Scenario patient diabetic hypertensive with ulcer above medial malleoulus ,hx of dvt. Cause?
a) Chronic limb ischemia
b) chronic venous stasis
c) Diabetic neuropathy
B
1001
Q186273- 14 month baby who has history of roll over on 4 month, sitting without support from 8 month , claps hand, plays peak a boo, now has started walking without support, moves things from one hand to other , babbling but no words...
a-normal development
b-Gross motor delay
c-Fine motor delay
d-Social delay
e-Speech delay
E
1002
Q9169-30-year-old lady presents at your clinic at 26 weeks of gestation.She is worried as she came in contact with a child having chicken pox 24 hours ago.You checked her pre-pregnancy IgG level for chicken pox which was negative. She missed to get vaccinated for chicken pox before pregnancy. She has no symptoms otherwise.
What is next best step in her management?
a. Check IgM level
b. Give vaccine for chicken pox
c. Check IgG level
d. Give varicella zoster immunuglobulins
e. No action needed as she is asymptomatic
D
1003
Q186158- HPV during pregnancy ?
a-Can give
b-Give after delivery
c-Give if antibody negative
B
1004
Q187003-50 y.o. woman complains of loss of interest in life, she is tearful. She also admits of cutting herself.
In the conversation she mentions that life is not worth living. (You cannot clearly understand if she is suicidal or not). After treating caring her wounds on the wrist, what is the management?
a. Start sertraline
b. Contact local mental health crisis team c. Involuntary admission
d. Organise regular follow up
B
1005
Q187006-a nurse,smell like alcohol in early morning,when u ask her she denies drinking alcohol,what next
a. test her alcohol level,
b. report to nurse head
c. report to nurse board
d. fire her
e. write it down in documents
B
1006
Q187007-a boy,with suicidal thoughts,u admit him voluntary,father comes and asks you to let his son go with him
a. don’t talk with the father and don’t tell him about his son’s suicidal attempt due to confidentiality
b. tell him about his son’s suicidal tendancy
c. let the son go with father
B
1007
Q187008-pt not giving previous consultation fee , now presenting with sore throat
a. refer to local hospital
b. ask for consultation fee first
c. see him in between patients.
d. If emergency : see between pts . If not : refer
Treat him & send him bill
1008
Q187009-A woman 40 yrs, known alcoholic and a smoker , a mother of two girls aged 6 and 4 visits your clinic for headache and requests a leave certificate. She is very tearful and depressed, says she lost all her money by gambling .Now states she has no money to provide for her children. What would be the first thing you need to do ?
a. Call the Police
b. Arrange for financial support
c. Call child protection services
d. Arrange for immediate admission Psychotherapy
C
1009
Q187010-A nursing staff in you ward smells of alcohol every morning when she comes for duty. How will deal with this situation ?
a. Inform hospital administration
b. Inform nursing board
c. Talk to her
d. Check her blood alcohol level
e. Inform nursing head
C
1010
Q187011-A man 25 yrs had one episode of seizure. He experienced having muscle jerks in his right arm few months ago. He asks you advise regarding driving ?
a. Can drive after 6 months
b. Can drive after 3 months
c. Can drive after 12 months
d. Can drive after 24 months
C
1011
Q187012-pregnant woman on 12 weeks ask u to do her abortion but ur beleives are against abortion and the baby is in good health and alive what to do?
a-refer her to another collegue who has the same point of view b-refer her to ethical service in the hospital
c-refer her to the hospital for further care
d-tell her that the baby will die if u leave him
A
| اگه بدحال بود c
1012
```
Q187013-a man on oxicodone for chronic pain come to u saying that he has taking heroin to control pain now want to u to write him a script of heroin what to do
a-check urine level of oxicodone
b-write him oxicodone
c-tell him to continue taking heroin
d-ask the medical indemnity
```
D
گزینه آخر گزینه خوبیه. ولی جواب اینه که ما هرویین تجویز نمی کنیم!
اندازه گیری سطح ادراری فقط می تونه کمک کنه که بدونیم آیا دارو رو مصرف می کنه یا نه.
راستش بین گزینه ها من نمی تونم چیزی رو انتخاب کنم. شاید پرسیدن از ایندمنیتی بهترین کار باشه.
1013
Q187014-old women from nusing home pt with femur fracture.morphine prescribed.pt severely drowsy. She had given a prior written form stating that she doesn’t want to be taken in hospital if severe illness occurs.what to do?
a. prescribe regular analgesia
b. arrange family meeting
خوب گفته اگر حالش بد شد نمی خواد بره بیمارستان، ولی الان حالش بد نیست. الان بیش از حد مورفین گرفته. و بیماریش هم ترمینال نیست.
پس با خانواده صحبت می کنیم تا قدم بعدی مشخص بشه. ولی فعلا مورفینش باید قطع بشه.
1014
Q187015-driver who carries pt to nursing home developed grand mal seizure recently.no previous history.wat should u do?
a. inform empmoyer
b. inform license authority
c. tell him not to drive upto 6 months
#اخلاق
Can not drive for 5 years
| Patient should Report to DLA
1015
Q187019-Pt with seizures on carbamazepine,controlled on phenytoin for last three months.how long he can't drive?
a. three months
b. six months
c. one year
d. 2 years
e. never drive
C
1016
Q187020-A young lady with bruises on face and history of abuse by her husband.she says don’t tell anyone as she doesn’t want to leave her husband. next step?
a. inform police
b. call to husband
c. do nothing
d. counsel her regarding domestic violence
D
1017
Pregnant lady came with his husband for antepartum Hge ..you noticed bruises on her vulva and other signs of abuse...what to do?
A)call the police
B)talk to the husband about his relationship with his wife
C)talk to the wife alone
```
Pregnant woman comes for antenatal visit and says her husband beats her and is careful not to leave any bruises ……..
Call police
Admit the woman
Tell her to call the police
Talk to her husband
No option about shelter
```
20 year old primigravida at 30 weeks came for ANC has bruises all over her face. She says her husband beat her. What do you do?
a) Inform child support
b) Inform police
c) Inform social welfare
d) Take pictures of bruises
سوال اول:
کیس خشونت خانوادگیه. با خانم تنها صحبت می کنید. افزایش آگاهی وظیفه شماست و اگر خواست می تونه خودش به پلیس زنگ بزنه. شما وقتی به پلیس زنگ می زنی که جان بیمار در اون لحظه در خطر باشه.
سوال دوم:
از بین گزینه های موجود تشویقش به پلیس زنگ زدن مناسب هست. بستری برای وقتیه که احتمال خشونت با آسیب جدی و مرگ در صورت برگشت به خانه وجود داشته باشه.
سوال سوم:
بین گزینه ها داکیومنت کردن عکسها بهترینه. قبل از زایمان به چایلد پروتکشن کاری نداریم. پلیس رو هم بیمار زنگ می زنه مگر اینکه متن سوال حاکی از این باشه که جراحات خیلی شدیده و مثلا همسرش بیرون مطب منتظر هست که دوباره حمله کنه. سوشیال وافیر هم کاری نخواهد کرد.
کلا افزایش آگاهی و اطمینان از ایمنی شرح وظیفه جی پی هست. وقتی امنیت نسبی وجود داره، فقط افزایش آگاهی مد نظر خواهد بود.
1018
Q187025-young boy had fight with his girl friend and he has said that ‘I will kill my self’. Now he is in hospital and he is angry with nurse and said to nurse ‘I will kill you’.After a while said He wants to go home & apologized for his deeds. What should be done now?
a. Permit him to going home freely with his girl friend
b. Permit him to going home but coming for follow-up
c. No permission
d. Call police
#اخلاق
C
| Admission
1019
14. 22-Student misses exam and comes to you for medical certificate as he claims he was ill that day but looks normal today on examination, what will you do?
a. Decline as you cannot confirm the dx
b. Decline as she couldn’t come on exam day
c. Accept and give medical certificate
d. Give Certificate and mention that she claims she was ill that day
D
1020
Q187027-Old man with bony metastasis from prostrate cancer is brought by son who found him collapsed in garden shed. He is on perindropil, statin, bisoprolol,codeine. He had drunk all of his tablets so he would never wake up so as to be out of misery with pain. He’s given 2 shots of morphine but still is in pain.He’s now demanding to go home. What do you do ?
a. Send him home with paracetomol
b. Send him home with his usual medicine
c. Arrange him for palliative care
d. Send social worker home
#اخلاق
C
1021
Q187028-Lady is breast cancer with bone pain. Investigation done. Son called you and NOT to tell his mom if result is bad. What to do next?
a. Family come in for appointment without mother
b. You insist you only talk to patient.
c. Ask son to come in with mother in next appointment
d. Ask son to make appointment to discuss further
#اخلاق
B
1022
Q187029-Child with appendicitis with peritonitis, but the child is confused and doctor worried that the patient could not give consent. Parent’s not available only sister present and she is on the way to hospital. From whom do u take consent
a. Proceed surgery without consent
b. Consent from sister
c. Consent from the patient
d. Consent from on-duty medical administrator
e. Consent from two medical doctors
A
1023
Q184001- A 12-year-old girl presents with severe right lower-quadrant abdominal pain and marked tenderness and is found to have acute appendicitis. The child is at a sleep- away camp . You are not able to locate her parents .They are not at home and you can - not reach them on the cell phone . The camp counselor and the director of the camp bring in the child.
What should you do?
a. Do not do the surgery without parental consent.
b. Ask the camp counselor or director for consent.
c. Ask the patient for consent.
d. Perform the appendectomy.
e. Give intravenous antibiotics alone..
D
1024
Q187030-A woman thinks that she has weak heart since birth.she lives with her daughter.a few days ago she developed chest pain after hearing the news of her daughters marriage.her daughter is planning to move with her husband in a different town.O/E no abnormality was found.troponin was within normal limit.which condition will reveal the womans dx
a. H/O separation from her own mother during childhood
b. Chest pain after hearing her daughters marriage
c. othee irrelevant option
A
1025
Q187031-Old agitated alcoholic man , came in shouting , says he has been drinking cheap street wine and thrown away food from garbage can ,next ?
a. iv glucose
b. thiamine
c. diazepam
d. droperidol
C?
1026
Q187033-A GP with HIV recently got a job offer as surgeon…he don’t want to inform the new employer
a. Inform the employer
b. Inform the surgical cousil
c. Advice him to take universal precatuions Inform board
C
1027
Q187034-A one week old neonate developed severe jaundice and mother is quite concerned about the long term risk of severe hyperbilirubinemia.
Which of the following is not a possible consequence of kernicterus in this baby?
a. Hearing deficit
b. Athetoid cerebral palsy
c. Paralysis of upward gaze
d. Hypothyroidism
e. Dental dysplasia
D
```
Complications
Choreoathetoid cerebral palsy
Hearing loss
Gaze abnormality especially upward gaze
Dental enamel dysplasia
```
1028
Q187035-a lady with spina bifida came to clinic at 8 week gestation , worried that the
infant will have similar problem but didn’t take AN care before and no folic acid
prior next management?
a. Folic acid now till 20 week of pregnancy
b. Reassure
c. Usg at 12 week
```
High risk:
Previous baby with NTD
Familial history +
Chronic DM in mother
Anti-epileptic drugs
Obesity
Malabsorption
```
Folic acid 5 mg daily
از یک ماه قبل از بارداری تا پایان ماه سوم
سونوگرافی ستون فقرات جنین ۱۶-۱۸ هفته
نظر متخصص زنان در مورد سوال مشابه:
▪️در اين سوال با توجه به سابقه ي اسپينا بيفيدا در مادر ، بايد دوز ٥ ميلي گرم اسيد فوليك از يك ماه قبل از بارداري تا سه ماه بعد تجويز كرد
▪️يكي از روش هاي تشخيصي براي اسپينا بيفيدا ، سونوگرافي انومالي در🍒١٨-٢٠ هفته🍒 هست
```
▪️منبع RCH ، در موارد هاي ريسك بايد ٥ ميلي گرم فوليك اسيد تجويز كرد :
١-سابقه ي اسپينا بيفيدا در پدر و مادر
٢- سابقه ي فرزند قبلي مبتلا
٣-مصرف داروهاي ضد صرع
٤-مادر با سابقه ي ديابت
```
▪️الفا فيتو پروتيين يك تست voluntary و optional براي بررسي ريسك نقايص لوله عصبي است ، اما تست تشخيصي محسوب نميشود.زمان انجام آن ۱۵ تا ۱۸ هفته هست .
▪️در اين سوال گزينه ي دوم كه غلط است
گزينه ي سوم كه براي تشخيص اسپينا بيفيدا سن حاملگي ١٠ هفته مناسب نيست و سونوگرافي هدفمند براي بررسي انومالي جنيني در ١٨-٢٠ هفته انجام ميشود
بنظر گزينه ي اول صحيح تر از بقيه به نظر ميرسد
1029
Q187036-Picture of unilateral ptosis + miosis of old age man complains from severe unilateral headache and this is the first time he experience this type of headache what is the investigation that can help you in the DX....?
a. Doplex US of the carotid artery
b. CT brain
MRA
CTA
Doppler
بچه این سوال و استم ناقصه
ولی به طور کلی که نگاه کنیم این به دایسکشن میخوره و duplex sonography و بهتر از اون MRA میتونه جواب باشه.
از طرف دیگه تاکید طراح روی اینکه "this is the first time he experience this type of headache " میتونه علامتی برای SAH باشه. دقت کنید SAH در مراحل اولیه سردرد لوکال در محلی که خون ریزی شروع شده میده و بعد سردرد ژنرالیزه میشه. اماااااا
چیزی که باید حواسمون باشه اینه که در SAH علایم چشمی ما مربوط به فلج عصب 3 هست و در نتیجه همون طور که در عکس گذاشتم پتوز و میدریاز خواهیم داشت و نه پتوز و میوز.
1030
Q187037-A patient presented with a unilateral scrotal swelling suspected to be a varicocele. Which of the clinical
findings will help in making the diagnosis?
a. Clearly palpable spermatic cord
b. There is associated trans-illumination
c. There is no trans-illumination
d. There is fullness in the posterior part of the testis with an impalpable cord
A
1031
سوالات مشابه
Q9224-64 years old man with PSA 1.5 , after ? time PSA becomes 3.0 (n<4.0). On DRE, prostate
is enlarged and regular. On USG-guided biopsy of 12 slides only 1 locus pathology showed
adenocarcinoma of Gleason 4 stage. What is the management?
A.radical prostatectomy 🎯
B.continued surveillance(Active Surveillance)
C.transurethral prostatectomy
D.radiotherapy
E.EBRT
این بنده خدا فقط 64 سالشه پس امید به زندگی بالاست. حالا دابلینگ پی. اس.ای داره و هم گلیسونش 4 شده پس میره برای رادیکال پروستاتکتومی
```
Q186372- A man aged 64 yr. his psa is 3.8ng now.last year it was 2 or 1.8.he did 12 biopsies this time and one showed a focus of adenocarcinoma and gleason score 4 . management asked? a.
A) radical prostatectomy 🎯
B) external beam radiotherapy
C) orchidectomy
D) continued surveillance
```
با همون استدلال قبل میشه A
Q182492-60 year old man on DRE prostate is normal, first psa was 1.5 then PSA is 3.2 (n<4.0) On USG-guided biopsy 1 locus pathology showed adenocarcinoma of Gleason 4 stage. What is the management?
a) radical prostatectomy 🎯
b) continue surveillance
c. transurethral prostatectomy
d. EBRT
بارم همون استدلال قبل
```
Q184423- A man aged 68 years. his psa is 3.8ng now. last 2 year(sure) it was 1.5.he did 12 biopsies this time and one showed a focus of adenocarcinoma and Gleason score 4. he had operation for cardiac stent placement 18 months back & on antiplatelet since then. What is the management for this man?
A) radical prostatectomy
B) external beam radiotherapy
C) orchidectomy
D) continued surveillance
```
خب این یکم داستانش فرق کرد. این مریض الان یک ریسک فاکتور پیدا کرده ولی خب استنت رو 18ماه قبل گذاشته و به نظر میاد بتونیم به گزینه 1 فکر کنیم هنوز چون سنشم پایینه.
```
Q185545-Old male with prostate cancer T3N0M1 invasion in seminal vesicle and lumbar vertebra
asked Mx?
A. Bilateral orchidectomy
B. External beam radiotherapy
C. Androgen deprivation therapy 🎯
D. Active surveillance
```
این متاستاز پیدا کرده پس میریم سراغ درمان ضد آندروژن
Q182069- 50 yr old patient diagnosed with prostate cancer gleason score 7 stage tb3 NoMo
Asking tt
A.Radical prostatectomy
B.Androgen ablation
C,Ebr 🎯
D.Orchidectomy
اینجا لایف اکسپکتنسی بالاست. تومور زده خارج کپسول و سمینال وزیکول درگیر شده اما هنوز متاستاز نداده پس رادیوتراپی می کنیم.
Q185191-scenario of prostate cancer T3N0M1
a.ebrt
b.radical prostatectomy
c.active surveillance
d.androgen deprivation therapy
اینجا متاستاز داریم باید یک درمانی بکنیم که هرجای بدن متاستاز داریم پوشش بده پس میریم سراغ درمان های آنتی آندروژن
Answers
1032
Infliximab
Azaitopurine
Allopurinol
Corticosteroid
TB
Thiopurine methyltransferase
HGPRT
Strangilus
1033
Q187073-یکی از کارکنان کادر بهداشتی بیمارستان که دچار هپاتیت C شده، خطرات احتمالی انتقال بیماری به وی کامل توضیح داده شده، اما وی همچنان پروسیجرهای خطرناک را بدون رعایت نکات ایمنی برای بیماران انجام میدهد. اقدام لازم؟
الف) هشدار دادن مجدد خطرات
ب) بدلیل رعایت کانفیدنشیالیتی نباید اقدامی انجام بدهیم
ج) اخراج کردن فرد
د) اطلاع به سوپروایزر
#اخلاق
#عفونی
د
1034
```
Q187077-خانمی که در حاملگی قبلی بچه 4400 گرم به دنیا اورده وبچه دچار دیستوشی شانه و مدریت براکیال پلکسوس پارالایز شده . در این حاملگی برای جلوگیری از بروز مجدد چه کاری انجام بدهیم ؟
الف) چک قند در هر ویزیت انته ناتال
ب)OGT در هفته 24 تا 28 حاملگی
ج) پلویک سیتیمتری
د) گروس اسکن در هفته 36 حاملگی
سزارین در گزینه ها نبود
#زنان
```
OGTT در اولین ویزیت
سابقه دیستوشی اندیکاسیون سزارین نیست
🤰 Shoulder dystocia
▫️یک اورژانس مامایی است
▫️عدم خروج شانه پس از خروج سر
▫️عمدتا غیر قابل پیش بینی
▫️دست کم ٥٠ درصد موارد بدون هیچ عامل خطری
▫️ارزش اخباری تک تک عوامل خطر و حتی مجموع آنها کمتر از ١٠ درصد
⬜️ عوامل خطر پیش از زایمان
▫️سابقه دیستوشی شانه
▫️♦️ماکروزومی
مهم ترین عامل خطر،البته PPV پایین دارد.
▫️دیابت مادر
احتمال دیستوشی شانه در نوزاد مادر دیابتی ٢ تا ٤ برابر بيشتر از نوزادی با همان وزن از مادر غیردیابتی ست
▫️چاقی مادر
عمدتا بخاطر ارتباطش با دیابت و ماکروزومی مهم است
▫️بارداری گذشته از موعد
بعلت ارتباطش با وزن جنین میتواند مؤثر باشد
```
⬜️ عوامل حین زایمان
▫️مرحله اول طول کشیده
▫️مرحله دوم طولانی
▫️القای زایمان
▫️زایمان ابزاری
▫️بارداری گذشته از موعد
```
🤰 shoulder dystocia
Macrosomia (LGA)
⁉️ در چه مواردی به آن شک کنیم:
👈ارتفاع رحم (SFH) بالای صدک ٩٠
👈سابقه تولد نوزاد LGA صرف نظر از تعداد بارداری ها
👈وزن تخمین زده شده در سونوگرافی بالای صدک ٩٠
♦️در تعریف RANZCOG ماکروزومی به وزن بالای ٤٥٠٠ اطلاق میشود♦️
🔶 اندازه گیری سریال SFH
🔸روش غربالگری مفید برای ارزیابی رشد؛ توصیه شده است.
🔸فاقد دقت کافی در زنان چاق
🔶 سونوگرافی
🔸روش استاندارد تعیین ماکروزومی
🔸صددرصد قابل اعتماد "نیست"
🔸تعداد زیادی از جنین های ماکروزوم دچار دیستوشی شانه "نمیشوند"
🔸 اندکسهای بیومتریک HC, FL , AC بیشترین ارزش اخباری را در ارزیابی جنین LGA در مادر غیردیابتی دارند.
⁉️القای زایمان صرفا بعلت ماکروزومی توصیه "نمیشود"
⁉️ انجام سزارین انتخابی صرفا بعلت LGA نیز توصیه "نمیشود"
⁉️جنین های درشت تر بیشتر مستعد آسیبهای "پایدار" شبکه براکیال هستند.
♦️ باردارانی که در آنها شک به ماکروزومی وجود دارد باید پیش از زایمان تحت مشاوره با مامای ارشد و یا نهایتا متخصص زنان قرار بگیرند.
1035
Q11108- One ecg,looks normal to me,patient on ramipril , presented after syncope ,lab value was given,sodium normal,potassium 5.5,asked about next management?
a. insulin and glucose
b. haemodialysis
c. rectal resonium
d. Cease ramipril
e. Calcium carbonate IV
Q182108-ECG pic was given (I think it is normal , HR 75/min , no features of hyperkalaemia) , Pt come with syncope,🎀 K 5.5🎀, other electrolytes normal
a. Cease ACEI
b. Calcium carbonate
c. Glucose and insulin
d. Resonium A
e. Pacemaker
Cease ramipril
اما در مورد این سوال هایپرکالمی:
اول از همه باید بدونیم دو اقدام مهم داریم: یک نیاز به اقدام اورژانسی هست یا نه
در مورد اقدام اورژانسی گایدلاین های مختلف نظر متفاوتی دارن اما RCH و یکی دو تا رفرنس دیگه اوزی اینطور گفتن:
بیمار علامت دار (فلج یا ضعف عضلانی) یا تغییرات نواری یا بیمار انستیببل یا پتاسیم بالای 7 (بعضی منابع بالای 6.5)
دقت کنید تو RCH هم ستون سمت چپ رو کلا جدا قرار داده. در این موارد دیگه با کلسیم گلوکونات شروع میکنیم.
اما در مورد بیماری که احتمالا به صورت تصادفی متوجه پتاسیم بالا شدیم اگه های ریسک نباشه (که اگه باشه باز با کلسیم گلوکونات) باید با قطع داروی مسبب اش شروع کنیم و بعد ارزیابی و ادامه
بقیه اش هم که تو الگوریتم RCH هست
و اگه بین 6 تا 7 باشه علاوه بر نبولایزر سالبوتامول باید گلوکز و انسولین هم تجویز بشه که سریعتر پایین بیاد
1036
Q187080-بیمار با شرح حال ایسکمی مزانتر که دچار رکتوراژی شده است اقدام بعدی شما چیست ؟
الف) سی تی آنژیو
#جراحی
A
1037
```
Q187081- بیماری به شما مراجعه کرده با شرح حال اسهال ابکی غیر خونی و اخیرا هم مسافرت بوده ؟
الف)سالمونلا
ب) ژیاردیا
ج)E.COLI
#داخلی
```
ج
Diarrhea:
Most common cause of bloody diarrhea….campylobacter
Second most common cause of bloody diarrhea…shigella
Most common cause of traveler diarrhea….E-coli
Most common cause of diarrhea in pediatrics…viral
Most common virus causing diarrhea in kids……rotavirus
Diarrhea followed by weakness and areflexia…GBS
Diarrhea followed by renal impairement….HUS
Bloody diarrhea followed by RUQ pain….ameba
Diarrhea after camping…..Giardia
Chronic bloody diarrhea in young male…..IBD
Diarrhea after long term antibiotics....clostridium difficile
Antibiotic causing clostridium difficle….clindamycin
TTT of clostridium difficile ….metronidazole or vancomycin
Diarrhea after eggs or chicken…..salmonella
Diarrhea just hours after meal…..staph toxin
Diarrhea in bed ridden with constipation...fecal impaction
Main ttt of diarrhea…..fluid
TTT of traveler diarrhea…..fluid only
TTT of staph toxin…..fluid only
TTT of shigella or campylobacter….antibiotics
TTT of ameba or giardia….metronidazole
1038
Q187082-خانم 23 ساله با اسهال طول کشیده و هموگلوبین 9 مراجعه کرده است .IgA کاهش یافته و آنتی گلایدین آنتی بادی منفی می باشد .اقدام لازم ؟
الف)SMALL BOWEL BIOPSY
#داخلی
A
1039
Q187083-فرد چاق 68 ساله با درد RUQمراجعه کرده که درد از 18 ساعت قبل شروع شده است ، بیمار تهوع و استفراغ دارد و درد بیمار با دم تشدید می شود در سونوگرافی بیمار سنگهای متعدد در کیسه صفرا مشاهده شده بیمار تحت درمان با سفتریاکسون و مدتی بهتر شده و مجددا با درد شدید و تب سی و هشت و نیم درجه مراجعه کرده است و مشکوک به پریتونیت هستیم .اقدام بعدی شما چیست ؟
کوله سیستکتومی
کوله سیستوستومی
ERCP
?
1040
```
Q187090-A person from a rural area rang you and told you that he has recently moved to rural area with his wife and 6 weeks old son.The wife is behaving abnormally and doesn't want to come out of the house.She is taking too much care of the baby and doesn't want to leave.He cannot go to work because if this as he doesn't have any other social.support.What should you do?
a)Visit him at his house
#اخلاق
```
A
1041
Q185305- A man with depression on venlafaxine for 4 weeks. He is now well controlled. But sometimes he see dark shadow when he is about going to sleep. How to management?
A-he should be on anti-psychotic
B-tell him normal people also see dark shadow
C-he should change anti-depressant
D-he should cease venlafaxine #depression
B
1042
Q11377-14 year old boy does not sleep well, always alone in his room with his toys, he counts
to 20 if not he will think that his mother will die, this all happened after a road accident.
- ADHD
-OCD
-asperger
-CDD
-PTSD
Acute stress disorder
طی ۴ هفته بعد از حادثه تروماتیک
```
PTSD
علایم بیش از یک ماه طول بکشه
اکیوت زیر ۳ ماه طول میکشه
کرونیک بیشتر مساوی ۳ ماه
شروع تاخیری ۶ ماه بعد
```
1043
Q187103-خانم الکلی که روز شنبه مراجعه کرده اما میگوید امروز یکشنبه است اما تاریخ ماه را درست میگوید! اظهار میکند که دیگر الکل مصرف نمیکند. در حال حاضر روی برنامه ترک الکل است. کدامیک به قطعی شدن تشخیص کمک میکند؟
A, gait
B, tremor
علائم ترک الکل:
```
اژیته
ترمور واضح
تعریق
بی خوابی
تشنج
```
دلیریوم ترمنس:
```
ممکنه با عفونت و تروما تظاهر پیدا کنه
بین یک تا پنج روز بعداز قطع مصرف
اژیته
گیجی disorientation
کاهش سطح هوشیاری
ترمور شدید
توهم بینایی
تعریق ، تاکیکاردی
علایم دهیدراسیون
```
1044
Q187101-پسر ۱۴ ساله موقع فوتبال ضربه خورده درد درLUQ, علائم حیاتی و سونو نرمال...درد داره...اقدام بعدی?
الف)لاپاراتومی
ب)CXR
ج)CT
A
حواسشون به مالاریا باشه
منگوکوک و پنوموکوک هر ۵ سال
هموفیلوس انفولانزا یکبار
انفولانزا سالانه
لانگ ترم پنی سیلین (اموکسی روزانه)
1045
Q187107-خانمی با آمنوره از ۷ هفته قبل مراجعه کرده، تست حاملگی ادراری مثبت کزارش شده، در حال حاضر درد شکم دارد. در سونوگرافی ساک حاملگی در رحم رویت نشد، کورپوس لوتئوم دیده میشود.
A, quantitative Beta HCG
A
حاملگی خارج از رحم
```
*حدود یک درصد حاملگی ها
»پارگی EP میتونه سریع اتفاق بیفته و‌مرگبار باشه به دلیل خونریزی داخل پریتوئن
»دهه سوم زندگی شایعتر
یک سوم موارد شکم اول هستن
بیماران درخطر:
سابقه قبلی حاملگی خارج از رحم
سابقه عفونت لگن
جراحی شکمی قبلی
عمل بستن لوله
داشتن IUCD
انجام IVF
```
» علائم :
درد شکم ، خونریزی واژینال،
موارد پارگی: درد شدید، کلاپس گردش خون یا شوک
»تشخیص:
تست ادرار حاملگی
تیتر BHCG
اگه تیتر بیشتر از ۱۰۰۰ باشه باید ساک حاملکی در سونوی واژینال دیده بشه،
اگه کمتر از ۱۰۰۰ باشه باید دو روز بعد دوباره چک بشه تا مشخص بشه که روند افزایش نرمال داره یا نه
» سونوی واژینال
»لاپاروسکوپی
1046
```
Q187108-خانمی با machinery operator job, سه هفته هست که روز دوشنبه با سردرد و حالت تهوع مراجعه میکند. یکشنبه شب ها مصرف زیاد الکل دارد. در حال حاضر نگران میزان مصرف الکل خود میباشد.
الف) تجویز دیازپام
ب) توضیح در مورد مضرات الکل
ج)توصیه به کاهش ساعت کاری
د) برنامه ترک گروهی(نامطمئن؟)
```
B
1047
#زنان
Q187115-2 monthe amenorrhoea, pregnancy, uterus 3 cm above the pubic
symphysis, what is the most likely diagnosis
A-polyhydroamnios
B-molar pregnancy
C-twin pregnancy
D-wrong date
B
A,C بیشترین رشد سه ماه سوم
1048
سوال اصلی:
Picture of a palm fascia thickening and fibrosis with skin puckering associated with the ring finger and litter finger flexion with unability to extent the finger , (Dupuytren’s contracture) . Which of the following is the least common cause?
a. Farm worker
b. Chronic infection
c. Vibrating tool damage
d. Smoker
e. alcoholism
این سوال کم اهمیت ترین علتو خواسته و جوابش میشه b
بیماری زمینه ژنتیکی اتوزومال دومینانت داره و تمام مواردِ الکل، سیگار، کار باوسایلی که ویبره دارند، کار زیاد با دست، دیابت، سیروز کبدی، COPD ، تروما، برخی داروها مثه فنی‌توئین تو این بیماری ریسک فاکتور محسوب میشن
1049
```
Q187143-
سوال کیک هویج
فرد با دوستش رستوران کیک هویج خورده بود بعد با علایم آنستیبل و شوک اومده بود اورژانس فشار ۸۰/ ۵۰ و پالس ریت ۱۱۰ تا و سابقه این حملات رو قبلن داشته و در اورژانس براش آنتی هیستامین و آدرنالین و هیدروکورتیزون زده بودن حالش خوب شده بهترین توصیه برای منیجمنت آینده
۱. پردنیزولون اورال
۲. آنتی هیستامین
۳. تست حساسیت پوستی
۴. Prevent consumption of simillar material
۵. Auto-injectable adrenaline Amp ans
```
۵
| فردی که دچار حملات آنافیلاکتیک میشه مهم ترین کار در منیجمنت آینده اش همین گزینه هست که ریکال نشده بود
1050
Q187147-
خانم ۵۰ ساله که ۱۰ روز قبل توتال ابدومینال هیسترکتومی شده
عین جمله
Profuse continous watery slightly bloody vaginal discharge
داشته ولی مشکل در یورینیشن نداشته است علت:
۱. گرانولیشن تیشو
۲. فیستول اورتروواژینال #زنان
2
دكتر سام
عوارض هيستركتومى ابدومينال:
١-عوارض مربوط به بافت هاى نزديك به آن مثل حالب
٢-عوارض مربوط به بافت هاى قدامى و خلفى كه در قدامى مثانه قرار گرفته
پروفيوز كانتينيوس واترى ديس چارج در اثر تروماى مثانه و ايجاد فيستول اورتروواژينال به وجود امده به احتمال زياد.
در واقع يك urinary incontinence مى باشد.
گرانوليشن تيشو، ديس چارج پروفيوز واترى ايجاد نمى كند . گرانوليشن تيشو در صورت عفونى بودن ديس چارجش به صورت اگزوداتيو و غليظ بوده و در صورت غير عفونى بودن،سروزى مى باشد.
1051
Q187151-
فردی تحت درمان کاربامازپین که اخیرا به علت یو تی آی تری متوپریم دریافت میکرده و در آزمایشات سدیم ۱۱۵ هست و کانفیوژن داره
۱. قطع کاربامازپین با سالین هیپرتونیک
۲. کاربامازپین و محدودیت مایع
۳. قطع تری متوپریم و نرمال سالین
گزینه قطع کاربامازپین و محدودیت مایع نداشت #نورولوژی
A
1052
Q187177-patient presented with decompensated liver disease with decreased serum albumin(2 ) wt to give
a. lactulose
b. spironolactone+furosemide
c. fluid restriction+sodium restriction
d. concentrated albumin
C
Sanaz MCQ 📝:
طبق مطالب بالا، درمان آسیت به ترتیب شامل موارد زیر هست:
🍄محدودیت نمک.
🍄دیورتیک که گزینه ارجح اسپیرینولاکتون هست و در صورت لزوم لازیکس اضافه میشه.
🍄در مورد آسیتهای رفرکتوری یا تنس پاراسنتز انجام میشه.
🍄در صورتی که حجم پاراسنتز انجام شده بیش از ۵ لیتر باشه، انفوزیون آلبومین صورت میگیره.
1053
Q187159-14 year old boy was controled on respiridone for ADHD now since one year he stopped and refuse to take Mx and become problematic in school what will be your next initial step...
1-depot respire JM-1050
2- refer for psychotic mx.
3-change to another drug
4-talk with mother to talk with him
5-talk with boy about benifits if Mx and danger of stopping it.
5
1054
Q187160-Young boy developed pain in right knee.mild progressive marked swelling.no other systemic stmptoms.blood results anemia,low platelets,normal wbc.diagnosis?
A.juvenile rheumatoid arthritis
B.acute leukemia.
A
1055
Q187161-How can a fibroid best be described?
a) Benign growth of fibroblasts
b) Benign growth of skeletal muscles
c) Benign growth of smooth muscles
d) Cancerous growth of fibroblast
e) Cancerous growth of smooth muscles
C
1056
```
Q187162-Image of Case of diabetus and unstable vitals with image of scrotal gangrene what is most apropiate
next mx.
1. Debridment
2. AB
3. Control sugar
4. Supportive Mx #جراحی
```
A
1057
```
Q187168-a man came to psy doc for dippression followed by incident,wife having new boyfrnd,doc prescribed sertraline,2wks aftr treatment he developd problem on ejaculation,what to do next--decrease sertraline
A.add sedanafil
B.withdrawl sertraline
C.change to fluoxetine
No option for decrease sertraline
```
B?
1058
Q187186- Woman present with back pain after lifting heavy objects at work. She has lifted these boxes before and there is no previous injury. When ask about degree, she said 4/10. Pain not radiating to another site. She is worrying that she might lose her job because of the pain and said one of her friends who got back pain has retrenched. Which one of the followings cause chronic pain syndrome?
a) Being woman
b) No radicular pain
c) Pain 4/10
d) No previous injury
e) Anxiety about employment #ارتوپدی
E?
1059
```
Q187194- Heart failure case man with AF on Ramipril, metoprolol, digoxin. Went on trip for 2 weeks and stopped his medication. Now with bilateral edema up to knee in legs. And ankle swellings Lungs is clear. And the patient is not dyspneic, in addition to CXR and ECG, what is next most appropriate invx?
A. Serum creatinine and electrolyte
B. Echo
C. Arterial blood gas
D. Troponin
#قلب
```
نظر خانم دکتر انصاری متخصص قلب:
بيمار كيس شناخته شده hf و af است و باز با قطع داروها و با علايم ادم پاها اومده.خوب اكو فكر نميكنم در اين بيمار اطلاعات اضافي بهمون بده و اتفاق خاصي هم تو اين سه هفته براش نيفتاده كه مثلا ef عوض شده باشه يا تابلوي اكو بيمار تغيير كنه. به نظرم براي رد تشخيص افتراقي اختلال عملكرد كليوي اينجا چك cr و الكتروليتها جواب بهتريست
جواب a
1060
Q187195- 3 children from day care center Dx with HepA. What to do to prevent?
A- Test all kitchen staffs with hepA IgM
B- Quarantine all children with fever
C- External catering service
D- HepA vaccine to all HepA non-immunized children and staffs
E- Close day care center for 14days
#عفونی
D
1061
```
✍️✍️✍️
2352)
Q183371-16 yo patient with psychosis had symptoms controlled by risperidone. tells about embarassing milk leak from her breasts at school.managemnt?
A.reduce dose
B. Increase dose
C rpelace drug with clonazapine
D. Rrplace with quetiapine
e. Stop drug
#psycho
```
A or E?
1062
Q187207-45-year-old man presented with headache and episodic palpitation, anxiety and feeling of something funny is going inside him. His blood pressure is 150/-mmHg. What is the next appropriate step?
A. thyroid function test
B. test for pheochromocytoma
C. refer for psychological counseling
B
مورتاگ
فئوکروموسایتوما
تشخیص: series of three 24 h free cathcolamines VMA
Abdominal ct or mri
درمان:excise tomour,cover with alpha and beta blocker
1063
```
Q187220-Woman not able to move her right side voluntarily come to ED after her husband was taken to hospital for some emergency condition. She lives with her husband only. Same thing happened 12 months ago and get better spontaneously within 24hrs. on examination, motor and sensory are all normal. Dx?
A- Malingering
B- Transient cerebral ischemia
C- Conversion disorder
D- MND #روانپزشکی #نورولوژی
```
C
1064
#قلب
Q187264-ECG picture looked ok...nothing particularly abnormal except some p
wave inversion in multiple leads. Elderly lady with worsening dyspnea especially
when climbing up the stairs for three weeks. On
examination equal bilateral air entry, hyperinflation
of chest with decreased entry at bases, mild pedal
edema. Investigation?
A. Troponin
B. Stress test
C. BNP
C
1065
Q187268-Picture: showing thrombosed external haemorrhoids for 1 days with
perianal pain with h/o of constipation, what is the management?
a. Incision under local anaesthetics
b. Haemorrhoidectomy
c. Drainage abscess
d. Give antibiotics
A
1066
```
Q187275-student posted interesting case on his facebook profile from the
hospital. What to do?
A. Inform uni student supervisor
B. Inform hospital administrator
C. Ask him to take it of
D. Contact facebook
```
A
1067
```
#قلب
Q187278-Ecg of atrial fibrillation with heart rate high n low bp. Metaprolol given
but heart rate still high. Next step.
1. Verapamil
2. Flecanaide (medical cardioversion)
3. Electrical cardioversion
```
C?
1068
#اخلاق
Q187287-An elderly woman presents to your GP practice for check up. You have
noticed some bruises on her arms and legs. When you talked to her she said that
her son-in law sometimes goes out of control and beats her. What is your duty?
1. Encourage her to call the police
2. Take consent to involve social worker
3. Take consent to involve the police
4. Call the police without her consent
5. Organise family meeting
A?
1069
#اخلاق
Q187289-There is a surgeon always shouting to the staff or others. It’s happened
several times. The staffs get upset and some crying until left the operation room
during operation. You are intern, what you should do:
a-talk to surgeon,
b-talk to anaesthetist,
c-raise the problem at the intern meeting,
d-report to director of clinical training
D
1070
```
Q187288-Female patient with bilateral non pitting edema up to groins.
inv??
A.duplex both legs
B.ct scan abd & pelvis
C.echo
D.surgical exploration
```
B?
ادم non pitting شک به عواملی هست که انسداد لنف داده برای همین سی تی شکم و لگن رو انتخاب میکنیم
1071
Q187294-Pregnant lady came for assessment. She has previous history of pregnancy losses at 18 and 20 weeks of
gestation. Both births were still born after
intrauterine fetal death and required
induction of labor to deliver. What is the most
likely causes?
A. Chromosomal abnormalities
B. Cervical insufficiency
C. Maternal lupus antibody
C
1072
#اخلاق
Q187295-A 65-year-old, one of your colleague, is disoriented. You noticed that he
is cognitive impaired. One day before starting consultation you talked to him and
asked him did he need help for his problem? He became agitated and starts his
consultation again.What will you do?
1. Ask receptionist not send patients to him
2. Ask one of your psychiatric consultant to see him
3. Inform the medical board
4. Inform his family members and ask them to take him to doctor
C?
1073
#اخلاق
Q187297-81 year old patient you have managed for 10 years told you the next
time she needs intervention or resuscitation don't do anything. her MMSE at that
time was 29/30.
She became sick and came to hospital and it was life-threatening. You decide to
do nothing. Her daughter yelled on you and asked to treat her. What will you do?
a.Treat the patient
b.Tell the family (arrange a meeting with the family)
c. ask for court order
d. call your superior
B
| بیمار رو درمان میکنیم ولی cpr نمیکنیم
1074
```
Q187301- long hx of constipation,patient on many drugs for parkinsonism and now constipation,vomitting and pain ?
a. small bowel series
b. supine abdominal xray
c. gastrografin follow through
d. CT with oral contrast
```
```
#intern
#جراحی
```
B
1075
```
Q187376-29 yrs old woman complains of weight loss and lethargy and malaise, she noticed passing more frequent urine in day about 8 times and 2 times in the midnight.. Investigations revealed HbA1c 11.9, Fbs 9.8 mmol. What will be the best initial treatment ?
A metformin
B insulin glargine
C Gliclazide
D insulin pump
```
B
1076
```
Q187311-a lady had some abdominal surgery ( forgot the name of surgery), after 3 days had fever, abdomen is soft, but some redness around the umbilicus, fine crepts, cultures from umbilicus, blood and nasopharynx all grew staph aureus.whats the source of staph
A. IV
B. nosocomial
C. umbilicus
D. nasopharynx
E. skin
```
بینی یا پوست یا پورت نافی
1077
```
Q187334-120..14 y. old girl.. Hx of wt loss...BMI 15..when asked about any interest ,she said why should I? what sholud this entire world mean? what is the most relevent to her Dx.?
A. fatigue
B. sleep dist.
C.moving around with friends
D. feeling of inferiority
E.idea of guilt
```
D
1078
Q187315 -A 14 year old comes to you with a 3 month history of loose stools associated with abdominal pain. On physical examination, she is noticed to have anal excoriations. No anaemia / passage of blood in stools. History of pin worm infestation at the age of 3 present for which she was treated. Her ESR is 70. The most likely diagnosis is ?
a. Crohn’s disease
b. Giardiasis
c. Campylobacter
d. Clostridium perfringens
e. Pseudomembranous colitis
A or b
1079
Q187341-Woman with 2 years after Filshie clip sterilization. Regular cycle with menorrhagia +, At this cycle, bleeding for 10 days with few clots. Paps smear normal 12 months ago. Initial investigation? (exact option)
a) Pap smear
b) Full blood count
c) Ultrasound
d) Thyroid function test
e) Endometrial Biopsy
B or C
1080
```
Q187342-woman after removal of central venous line lady developed facial swelling and swelling around the neck. What’s the most appropriate investigation?
a. CT chest
b. CT neck angiogram
c. Chest x-ray
d. Echo
(no option for neck USG Doppler)
```
#جراحی
B
1081
Q187347-pregnant at 30 wks come to the emergency with right upper quadrant abdominal pain for 4 hrs but she develop that pain one hour after eating hamburger sandwich ,blood pressure was140/95,
Pulse normal, 37.3c ,no bleeding , which one lead you to the dx?
A obstetric us
B bladder us
C refer to specialist
D gall bladder us
E Urine Study
B or E
1082
Q71044. 32 weeks gravida came to you she had pain for 4 hour in rt upper quandrant .she was well till 1 hour after eating a hamburger.all examinations are normal only bp145/95.what will you do next?
a) ct abdomen
b) laparatomy
c) obstetric usg
d) urinary creatine/protein ratio
D
1083
```
Q187349-28 yr lady returned from asia with some skin lesion and tenosynovitis in left forearm ..complain pain and swollen left knee..vital stable..asking diagnosis
1 -post viral arthritis
2 -gonococcal ar
3 -reactive ar
4 -streptococcal ar
```
C?
1084
```
Q187354-pt dying with ca pancreas in a ruralhospital. From last few days he has sever pain and nausea, he is being given 50 mg morphine and iv fluids. But his condition not improving, his consciousness is also
Fluctuating. Mx
a.inc dose of morphine
b. stop iv fluids
c.add diazepam
d. add fentanyl patch
#داخلی
#گوارش
```
افزایش دوز انفوزیون روزانه مورفین بهترین کار هست .
قطع کردن مایعات دریافتی سودی به حال مریض نداره و بیمار رو دهیدره میکنه .
پچ ترنس درمال فنتانیل در بیماران end stage بکار نمی بریم .
دیازپام هم اثر ضد درد نداره
خوب در این سوال بیمار اند استیجی رو داریم که دچار درد شدید و تهوع و فلکچویشن در هوشیاریش شده معلوم نیست که آیا بیمار قبلا روی اپیویید بوده و دردش کنترل بوده و الان دردش شدید شده (breakthrough pain) یا نه
بیمار 50 میلی مورفین گرفته و مایع درمانی شده اما جواب نداده
حالا مسئله ی اصلی اینه که آیا علت تهوع و دلیریوم اش رو درد شدیدش در نظر بگیریم یا مورفین
خوب من اومدم با رد گزینه رفتم جلو چون بیمار درد شدید داره و به اصطلاح دردش stable نشده پس از فنتانیل پچ نمیتونیم استفاده کنیم دیازپام هم که دلیریومش رو بدتر میکنه
در رابطه با مایع درمانی اتفاقا یکی از علل دلیریوم میتونه دهیدریشن باشه و هم چنین در مواردی که توکسیستی اپیویید اتفاق بیافته اولین کار مایع درمانیه پس قطع کردن اون وضع بیمار رو بهتر نمیکنه
پس میمونه گزینه a
من فکر میکنم بیشتر علائمش بخاطر کنترل نبودن دردش هست چون الان دوز خیلی بالایی از مورفین رو هم نمیگیره در نتیجه بنظرم بهترین کار افزایش دوز مورفین باشه
1085
```
Q187360-Young woman came in for prenatal visit in her first trimester. She asked which type of food she should avoid (didn’t say which trimester) ?
A) soft cheese
B) Trimmed Salmon
C) caffeine
#زنان
```
A
1086
Q187363-65 year old pt was admitted in the hospital due to respiratory and cardiac failure. His chief complaint was dyspnea. He was started on furosemide, ace inhib , inhaled albuterol which relieved his symptoms, which of the following medications on discharge will reduce his symptoms in the long term?
A) inhaled ipratropium
B) prednisolone
C ) digoxin
A
درمان اصلی در بیماران HF که هم در کاهش مورتالیتی و هم کاهش موربیدیتی و symptoms موثر هستند ACEi , BB , aldostrone antagonist میباشد که در همه بیماران HF (حتی اگر علایم نداشته باشد ) باید شروع شود و در صورت تحمل و نداشتن کنتراندیکاسیون دوز up titrate شود ( به ترتیب ACE i و سپس BB و آنتاگونیست آلدوسترون )
و اما در بیماران علامتدار اگر با سه داروی فوق علایم کنترل نشد شروع دیگوکسین و دیورتیک ( بخصوص در صورت داشتن congestion ریوی ) کمک کننده هست و بعد از بهبودی میتوان دوز این دو دارو را کم و حتی قطع کرد
در بیماران copd موثرترین راه جهت کاهش عود علایم و کنترل طولانی مدت قطع سیگار , اکسیژن تراپی long term در بیماران هیپوکسیک , واکسیناسیون آنفولانزا و پنوموکوک و جلوگیری از exacerbation هست .موکولیتیک ممکن هست موثر باشد .
درمان با پردنیزولون در بیماران severe COPD بخصوص در دوره تشدید علایم شروع میشود و سپس taper dose و نهایتا قطع خواهد شد بنابراین در درمان long term جایگاهی ندارد
درمان با برونکودیلاتور ها در بیماران علامتدار : شروع با برونکودیلاتور کوتاه اثر و در صورت عدم بهبود علائم شروع برونکودیلاتور طولانی اثر .هر چند LABAs و LAMAs در کنترل long term علایم و کاهش بستری بیمارستانی موثر هست ولی evidence قوی برای ادامه طولانی مدت دارو وجود ندارد
این بیمار هم HF و هم respiratory failure دارد بنابراین بهترین درمان برای کاهش عود علایم از نظر نارسایی قلب دادن ACEi , bb و آنتاگونیست آلدوسترون است و از نظر نارسایی تنفسی ایپروتروپیوم میتواند موثر باشد ولی کنترل cardiac failure موثرتر هست. به نظر جواب این سوال گزینه مفقوده هست ولی در بین این سه گزینه قطعا جواب a صحیح تر است
1087
```
Q187368-Middle age man complians of abdominal pain and chest pain 24 hours post gastrectomy operation due to a gastric carcinoma.
Whats the most appropriate next step?
A) iv fluxacillin
B) iv cephalosporin + gentamicin
C) metronidazole
D) abg
```
D?
هرچند معتقدم اين سوال يك چيزي توش ميس ريكال شده ولي با رد گزينه سه گزينه شامل انتي بيوتيك و يك گزينه شامل اي بي جي هست و يك نكته ديگه اينكه مهمترين عارضه سيستميك كانسر استوماك چيه ؟
هايپركواگيبيليتي كه بهش ميگن سندرم تروسو
]
خب بيمار پست اپ عمل شكم براي كانسر استوماك
بصورت ناگهاني درد سينه پيدا كرده يحتمل بايد بفكر امبولي ريه هم جزو تشخيصهاي افتراقيش بايم
هم چست پين ميده
هم تاكي پنه ميده
هم تنگي نفس ميده
يكي ديگه از مسايلي كه مد نظر قرار بديد اينه كه بعد از گاستركتومي بيمار توي بيست و چهار ساعت اول پي او نميشه
و چون نميشه بيمار اگر ليك اناستوموز كنه معمولا كانتنت گوارشي خودشه نن غذا
بنابرين ديرتر سمپتوماتيك ميشه
و اگرم بشه شدتش كمه
بهرحال با استم ناقص نميشه قضاوت كرد ولي با شك به امبولي و حتي پري اپريتيو ام اي تو اين گزينه هاي ناقص اي بي جي
اگر اي كي جي داشت اونو بزنيد
اگر چست بود نكستش بزنيد
1088
Q187369- Man brought to hospital after throwing brick at windows he said last thing he
remembers is leaving work from rural farm
a.Dissociative fugue
b.Factitious disorder.
c.Malingering
D. Automatism
A
1089
```
Q187371-Young Guy was brought in after a soccer accident. On exam there is pain with medical rotation of the leg with the high fixed. There was no mention of immediate swelling or effusion following trauma!
WHat is the most likely cause?
A) acl
B) pcl
C) medical meniscus
D) lateral meniscus
```
D
1090
#داخلی
Q187389-A 70 year old man comes in with complaint of right foot pain. He has
bilateral reduced doral pedis pulses and positive buerger in right foot. Which of
the following sigs is the reason for the nocturnal pain?
A) reduced bilateral pulses
B) positive buerger sign
B
1091
#اخلاق
Q187400-Anaphylactic patient in ed. Rmo gave 1mg adrenaline iv. And nurse has
it ready and is about to give. Wat to do?
A)Ignore
B) tell the dr and nurse abt it
C) tell nurse to give im
B or c?
1092
```
Q186302- Most teratogenic for fetus in pregnant lady?
A) cocaine
B) heroin
C) amphetamine
D) methamphetamine
E) Flouxetine
```
A
1093
```
Q1902301- Pregnant pt, last trimester. Which will cause more harm ?
A. Diazepam
B. Fluxetiene
C. Amphetamine
D. Marijuana
E. Morphine
```
C
1094
Q187470- Man, known case of angina. Came to obtain his usual prescription from you. He said he is alright apart from, frequent attacks of angina. He is on statins, ACEi , aspirin. BMI 30, smokesheavily. He recently got divorced and eats from outside most of the time. What to do next?
a. Increase statin
b. Increase acei
c. Asses motivation to modify risk factor
d. Arrange a ECG stress test
D
اگه گزینه ی افزایش دارو ها یا اد کردن بتابلاکر و نیترات تو گزینه ها نبود یا آنژیو نبود با همین استرس تست میبندیم
🍄🍄 تعريف unstable angina كه در مورد بيمار اين سوال صادق است
Definition of unstable angina
Throughout this guideline, unstable angina is defined as having three possible presentations:
```
1. symptoms of angina at rest (usually prolonged >20 minutes);
2. new onset (≤2 months) exertional angina of at least Canadian Cardio- vascular Society Classification class III in severity;
3. or recent (≤2 months) acceleration of angina as reflected by an increase in severity of at least one CCSC class to at least CCSC class III.
```
In most, but not all, of these patients, symptoms will be caused by significant coronary heart disease (CHD). Variant angina, non-Q-wave myocardial infarction (MI), and post-MI (>24 hours) angina are part of the spectrum of unstable angina.
1095
```
Q187475- Patient presents with abdominal pain and a discharging sinus. Has undergone many operations in the USA (for crohn’s disease as far as I can remember) But the patient does not know the specifications of surgeries and refuses to allow you access to medical records from USA. (Pic given, this is the closest I could find, there was also a yellowish discharge )
a. Factitious disorder
b. Somatostatin disorder
c. Malingering
#روان
```
A
1096
```
Q187497-
در فرد دیابتی که مشکوک به هموکروماتوز هستیم، اولین اقدام تشخیصی چیست؟
1.iron
2.ferritin
3.TIBC
4.FBS
#internal
```
B
1097
Q187512-
خانمی با آمنوره از هفته قبل مراجعه کرده است، آزمایش ادرار حاملگی در منزل مثبت شده و اکنون با دل درد مراجعه کرده، در سونوگرافی ساک حاملگی رویت نشد و کورپوس لوتئوم دیده میشود، اقدام مناسب؟
۱.چک مکرر bhcg
تو racgp گفته از چهارهفته و سه روز میتونیم ساک حاملگی رو با سونوی واژینال ببینیم با فرض اینکه منس ها رگولار بوده باشند
hcg discriminatory zone =1500-2000
یعنی بالاتر از این مقادیر انتظار داریم ساک حاملگی رو با سونوی واژینال ببینیم
اگر hcg کمتر از این بود برای تعیین تکلیف از بتای سریال استفاده میکنیم که تا شش الی هفت هفته انتظار داریم در ۴۸ ساعت ۶۶ درصد اضافه بشه( حدود دوبرابر)
1098
18 months old child with difficulty in climbing satirs…he also had h/o of a delay when he started standing…he has proximal muscle weakness….what to check?
a) CK
b) ESR
c) Muscle biopsy
d) MRI
e) Hip joint X-ray
Next cpk
Best muscle biopsy
اين case دوشن هست
اختلال ژنتيكي ارثي،توي ١-٣سالگي مشكل بالارفتن از پله دارن ك بتدريج پيشرفت ميكنه
تشخيصش بابيوپسي
1099
```
Q187527-
Pregnant woman, vegetarian with DM and bmi:29 ; all exam is normal take folic acid what else??
1.Zinc
2.Iron
3.Oil fish
#gyn #زنان
```
B
1100
Q187530- According to USG @ 19 weeks the EDD is 25th Jan .According to USG @ 36 weeks EDD is 30th Jan. Most reliable?
a. EDD should be confirmed between 20th -30th January
b. Day estimated at 19weeks by USG
c. Day estimated by LMP
C
در مورد این سؤال
اولویت تعیین سن بارداری:
١- براساس LMP
٢- در صورت نامطمئن بودن LMP و یا فراموشی آن، براساس CRL در سونوگرافي سه ماهه اول
٣- در صورت نداشتن LMP و یا نبود سونوگرافي سه ماهه اول مطمئن، براساس BPD تا سن ١٨ هفتگی
1101
```
Q187558-A case of diaphragmatic hernia forsurgery. Old h/o DVT. Asked for DVT prohylaxis .
a. Enoxaparin before surgery till discharge.
b Enoxaparin after surgery for 10 days
#surg #جراحی
```
B
1102
```
Q187559-82 year old lady had a hx of smoking 24 pack a year, now 10 kg wt loss hx, on physical ex only anorexia present and left sided supraclavicular LN found. On chest and abd CT done, nothing spesific. what is the cause?
a)ca lung
b)ca stomach
c)ca colon
d)ca breast
#internal #خون #ریه
```
B
1103
```
Q187563-Boy coming for asthma he had previous asthma and peanut allergy and has horse cat and dog at home.his brither also has asthma . asked which should b removed first.
A-Peanut
B-Cat and dog
C-Carpet
D-Asthma
#internal #داخلی
```
A
1104
```
Q187564-Patient with rheumatoid arthritis is doing well with treatment. Suddenly he has necrosis of
fingers in both hands (picture was given) . Which investigation is necessary to reach diagnosis?
a) Anti Cardiolipine
b) ANA
c) Anti dna
d) Anti LUPUS
e) ANCA
#internal #روماتو
```
Ena
| نبود anca
1105
```
Q187587-a child 8months has 3 days history of diarrhea rota virus was diagnosed now diarrhea resolved,,,baby started wd formula and solid food...now again has 10days history of diarrhea what dietary advice u will give
1-low lactose
2-cow milk
3-hypoallergic milk
#اطفال
```
A
1106
Q187588-Old pt with known bilateral chronic osteoarthritis, develop parasthesia and numbness in the lateral side of leg below knee condition worse at night and improve after walking for 10 min, wt is the important thing to examine in this pt
A- Straight legs raising test
B -Any tenderness in lateral condyle
C- Any loss of sensation in the lateral side of leg
#نورولوژی #ارتوپدی
B
1107
Q187589-A man with rheumatoid arthritis, HTN is on thiazide, enalapril, chloroquine and diclofenac is feeling lethargic, short of breath since a few months. He looks pale, his heart rate is 80bpm. BP was normal. Lab values were given. Hemoglobin was low, MCV marginally low, leucocytes low, platelets low. Cause?
a. Chloroquine
b. Thiazide
c. Enalapril
d. Diclofenac
A
شایعترین عارصه‌ی تیازیدها هیپوکالمی است و بعد هم متابولیسم اسیدوزیس و دهیدره شدن
انالاپریل با سبکی سر، ضعف و سرفه‌ی خشک
دیکلوفناک با دیس پپسی و درد و تهوع
کلروکین با تاری دید، تهوع و استفراع، دردهای شکمی...و کوتاهی نفس و به ندرت تغییرات خونی
1108
```
Q187592-62 years old male patient with K/C/O DM and HTN presents to the ED with sudden onset of crampy abdominal pain in the lower abdomen. On history you find out that he has ongoing diarrhea and intermittent hematochezia for the last month with no travel or outside food ingestion history His GP has done stool MCS/OCP/PCR and routine blood tests which were negative. O/E his abdomen is tender in pubic area with no guarding and rigidity. His regular medications would be Perindopril, Metformin, Aspirin and Vit D.
118.What is the most likely diagnosis?
A-Diverticular disease
B-Angiodysplasia
C-Ischemic colitis
D-Infectious diarrhea
Answer with explanation please
#داخلی
```
C
1109
```
Q187600-A 42year old male presented with ischemic stroke and has been on low dose (100 mg daily) aspirin., he developed major depression, and you decided to start him on an antidepressant. wof is the best choice of antidepressant ?
a. Sertraline
b. Escitalopram
c. Amitriptylin
d. Fluoxetine
e. Venalfaxine
#روانپزشکی
```
C
1110
```
Q187629- Women on phenytoin wants contraception for 2 yrs only
A- implanon
B- depo medroxy
C -pop
D-iucd
E- mirena
#زنان
```
E
1111
Q187646- Most common Child abuse ??
A-Physical
B-Sex abuse
C-Neglect
```
#روانپزشکی
#اخلاق
```
Emotional abuse
1112
```
Q187652- 40 yr old pt. travel history , present with bloody diarrhea for 10 days along with Left iliac fossa pain . most appropriate inv ?
a) CT chest
b) CT abdomen
c) Colonoscopy
#داخلى
```
B
1113
Young man coming with bloody diarrhea after trip to thailand. Few weeks later he developed rt sided hypochondrial pain, jaundice and vomiting. Ct abdomen showed the following picture….diagnosis?
a) HIV
b) ulcerative colitis
c) amoebiasis
d) shigelosis
#infect
C
1114
```
Q187653-50 years female , with fracture vertebrae. Hypochromic microcystic anemia . ferritin decrease with angular stomatitis and thin skin with pigmentation clubbibg... normal bowel habit and normal stool consistency. She also have clubbing..next
a. small bowe biopsy
b. colonoscopy
c. b12 level
D. bone marrow scan
e. bone marrow biopsy
```
A
1115
```
Q187679-3 year old child came with asthma attack every month for last 12 mo, he takes inhaled salbutamol. What to use for prevention
A-Inhaled salbutamol
B-Inhaled fluticasone
C-Inhaled salbutamol/fluticasone
D-SCG
```
D?
1116
Q187685- 70 years old lady started forgetting recently. When she speaks she got confused, difficulty to utter words. She even forgets and leave her stove open. Which part of the CNS affected?
A. Parieto-occipital
B. Medial temporal
C. Orbito- fronta
#nuro #نورولوژی
B
1117
```
Q187694-Old man with minimal fracture then he does bone scan and it shows absorption
Hgb low
Plt high
WBC normal
Ca normal
Next investigation
A) bone marrow
B) psa
C) thyroid function
```
A?
1118
Q187725- Hx of trauma to head, man unconscious and on oxygen..... Asking what next to give-
a) IV dexamethasone
b) IV 20% mannitol
c) CT scan
#نورولوژی
C
1119
Q187726- Mother proved to have cmv acute infs by having cmv igm + in her 28 th week of gestation , what to do next :
a-terminate the pregnancy
b-check fetal blood for cmv igm
c-check if the mother has cmv igm in her first antenatal visists or not .
d Repeat the serolog
#اطفال #زنان #عفونی
D
1120
```
Q187738-supracondylar fracture X ray given, patient controlled analgesia given but he still has pain, next step of management?
A.reduction
B. Ulnar nerve decompression
C. Add analgesics
D. Send to OT
```
#ارتوپدی
D
1121
Q187739- 55 yr old male on clopidogrel with H/O drug eluting stent insertion 1 wk earlier came to your hospital for the fracture of femur operation. What is your advice to this patient?
a) Pospone surgery for about 12 month and then do op
b) immediate platelet transfusion and do surgical procedure
c) give FFP and do surgery now
d) discontinue clopidogrel and do surgery
e) do surgery immediately
#جراحی #خون
D?
در مورد جراحی های غیر قلبی الکتیو بعد از pci که میدونید در مورد BMS حداقل زمان 4 الی 6 هفته هست ولی اگر امکان داشته باشه بهتر هست جراحی. رو تا 3 ماه عقب بندازیم .
در مورد DES بهترین زمان جراحی الکتیو بعد از 12 ماه هست ولی با استنتهای نسل جدید حتی تا 6 ماه و گاهی 3 ماه ( در حد مطالعه و موارد خاص ) باید جراحی با تاخیر انجام بشه .در واقع قطع کلوپیدوگرل در زمانهایی که گفته شد safe تر هست
اما در مورد جراحی اورژانسی تصمیم گیری بر اساس ریسک bleeding جراحی و ریسک استنت ترومبوز و خطر mi یا مرگ که بر اساس زمان pci , نوع استنت , رگی که pci شده متفاوت هست و تصمیم گیری سخت هست .
اگر ریسک خونریزی بالا باشه ( چند جراحی high risk مشخص شده ) حتی اگر ریسک استنت ترومبوز بالا باشه شما مجبور هستید کلوپیدوگرل رو قطع کنید
در مواردی که ریسک خونریزی حین جراحی بالا نیست ولی ریسک استنت ترومبوز بالا هست قطعا دارو ادامه پیدا میکنه .
در مورد این سوال ریسک استنت ترومبوز با توجه به زمانی که از pci گذشته خیلی بالاست و همینطور جراحی فمور هم جز جراحی هایی هست که حداقل 500 سی سی خونریزی داره و طبق رفرنسهای ارتوپدی حداقل 7 تا 10 روز باید کلوپیدوگرل قطع بشه و جراحی هم با توجه به سن بیمار نهایتا ا لی 2 هفته میشه عقب انداخت
اگر در استم شرایط همودینامیک unstable ذکر کنه که نشاندهنده این باشه که بیمار خونریزی داره قطعا گزینه e جواب هست
ولی اگر علائم همودینامیک ناپایدار نداشته باشه من خودم با توجه به اینکه این جراحی در لیست جراحی های high risk مشخص شده نیست گزینه d رو انتخاب میکنم ( احتمالا هم جراح توجه نمیکنه و قطع میکنه😉 )
گزینه b و c که قطعا غلطه چون اثری نداره
1122
Q187740- Middle aged male on addiction therapy by methadone. He was watched by a social worker agitated and with pin point pupil yesterday. What’s your management?
A. Do clinical examination before giving today’s dose
B. Refer to police
C. Refuse to give him the dose.
D. Don’t give the dose until after drug screening test
#روانپزشکی
A
1123
```
Q187745-22 year-old primigravida complains of headaches, restlessness, sweating, and tachycardia. She is 16 week pregnant and her blood pressure is 180/110 mmHg.
What is the best investigation for her?
a. Exploratory laparotomy
b. Mesenteric angiography
c. Head CT scan
d. Abdominal CT scan
e. Abdominal ultrasonogram
```
#زنان
E
در استم سوال حتما یا نکست رو خواسته که جواب میشه سونوگرافی یا بست رو خواسته که احتمالا گزینه چهار mri بوده که جواب اون میشه.در هیچ رفرنسی من ct در بارداری جهت تشخیص فئوکروموسیتوما ندیدم
1124
Q187751-a woman came to your office with her 8 year old girl and ask your advice about HPV vaccine . what will you do ?
a. give her now
b. advice after 10 years of age
c. needs to get it while he enters to college
d. need it when she begins her sexual relationship
B
1125
```
Q187753-Pt is on low dose OCP, complaining of breakthrough bleeding, what to give…
a. increase estrogen…
b. increase progesterone…
c. advice high dose of both…
#زنان
```
Breakthrough bleeding on COCs management:
✅ Exclude underlying causes (e.g. chlamydia, pregnancy, missed pills, malabsorption, diarrhoea or vomiting, concurrent medications)
✅ Increase oestrogen if taking a pill with 20mcg EE to a maximum of 35mcg EE
✅ Change progestogen if already taking a pill with 30 or 35 mcg EE
✅Consider vaginal ring
early or midcycle : increase estrogen
late: increase progestrone or change type of progestron
