1 Flashcards
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
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
2096) Q183114-Diarrhoea for 1mth what will u do for initial treatment?
A. Octreotide
B. Prednisolone
C. Loperamide
D. Cholestyramine
اسهال مزمن:
جواب C
توضیح دیگه؟؟
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
Ans: C
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
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.
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)
Answer: SMA ( spinal muscular atrophy)
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
Ans: A
اندومتریوز
علایم: از علل دیس منوره ثانویه
روش تشخیص قطعی: لاپاراتومی
درمان دارویی: خط اول cocp
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
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
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
Open
A?
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
Ans: E
بهترین درمان MTX
عارضه متوترکسات: هپاتیت
متوترکسات در نارسایی کلیه ممنوع است
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
Ans: C?
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
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
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
Ans: D
یه سوال هم هست که با همین شرح حال جرم شایعش رو پرسیده که میشه پنوموکوک
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
Ans: A
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
PR normal
Chads 2 👉 warfarin
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
Ans?
Q9244- male with hemoptysis and melaena,UGI endoscopy and colonoscopy done no finding what next:
- tagged rbc
- capsule endoscopy
- CT angio
- TECHNETIUM scan
Ans: b
چرا مکل نه؟
چون مکل معمولا خونریزی حاد میده
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
Ans: C
خونریزی فعال و انستیبل کاتتر انژیو
خونریزی فعال انژیو
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
Ans: salt restriction
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
Ans:A
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
Ans:A
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)
Ans: D
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
Ans:C
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
Ans: Mirena?
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
Ans:B
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
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
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
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
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
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
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
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
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
Q188460-Which of the following medication is contraindicated in Acute pulmonary edema with ejection fraction 25% ?
- Sitagliptin
- Metformin
- Exenatide
- Rosiglitazone
- Glyburide.
Ans: D
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
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.
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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.
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
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?
- Physostigmine
- Benztropine
- Diazepam
- 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
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 .
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
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
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
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
?
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
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
Q184403- Depersonalization and derealization occur in :
a. Depression
b. Schizo
c. Ocd
d. mania
e. all of the above
E
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
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
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
?
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
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
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
?
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
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
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
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
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
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
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
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
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
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
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
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
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
?
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
- depersonalization
- automatism
- dissociative fuge
- derealization
- conversion
C
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
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
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
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?
- Inform health authority
- Inform environmental protection authority
- 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
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
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:
- بیماری انسدادی ریه: اسم، برونشکتازی، copd
- کیفواسکلیوز شدید یا AS
- سیگاری heavy
- اپنه خواب شدید
- چاقی با bmi بالای ۴۰
- بیماری های عضلانی که ضعف عضلات تنفسی میده
- 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
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
?
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
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
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
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
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
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
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
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
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
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?
- Confront the husband about the injuries.
- Admit her immediately
- Ask her to come alone again
- Tell husband to be gentle with her
B
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
- The patient’s relative (guardianship court)
- Mental health tribunal (can give consent only for mental illness)
- The patient
- 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.
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
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
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
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 ...
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?
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
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
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
?
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
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
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
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
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?
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
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
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
Q10284- Orbital cellulitis scenario, what invg to find causative organism?
a) eye swab
b) blood culture
c) CT brain
B
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
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
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
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???
- Warfarin
- Metoprolol
- ACEI
A
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
Q9592- Female worrried about baby : how to prevent from sudden infant death sundromea.
a. Sleep with baby
b. keep baby in supine position
B
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
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
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
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
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?
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
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
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
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
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
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.
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
=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
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
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
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
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
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
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
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
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
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
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
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
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
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
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.
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
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
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
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
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
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❌
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
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
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?
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)
?
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
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)
- Panic attacks
- Paranoid personality disorder
- Family member with schizophrenia
- History of trauma
C
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
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
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
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.
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
- Bud chiari
- Pancreatitis
- Alcoholic cirhosis
- Spontaneous bacterial peritonitis
B
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?
- amlodipine
- losartan
- perindropil
- indapamide
- metoprolol.
B
Q11220- 14 months can transfer ball bet 2 hands, days monosyllables, can walk independently, mother thinks there is delay
- No delay
- Gross Motor delay
- Fine motor delay
- Speech delay
D
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
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
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
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
✍✍✍ 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
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
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
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
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
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
Q185125- ECG : SVT. Asking for predisposing factor??
?
Q185168- Foot drop with intact foot inversion, decreased ankle reflex
A-Sciatic nerve
B-common peroneal nerv
B
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
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
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
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
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
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:
- RESPIRATORY TRACT
- UMBILICUS
- IV CANNULA SITE
B
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
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
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
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?
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
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
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
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
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
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
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
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
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
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؟
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
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
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
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
?
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?
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
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
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
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
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
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
?
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
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
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
Q186157- Best screening method should be
a. High sensitivity
b. High specificity
c. High PPV
d. High NPV
A
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
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
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
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
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?
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
?
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
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
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
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
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
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
Q186302- teratogenic for fetus in pregnant lady?
A. cocaine
B. heroin
C. amphetamine
D. methamphetamine
E. Flouxetine
A
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?
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
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
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
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??
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
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
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
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
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
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
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?
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
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
?
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
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
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
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
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
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
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
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
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
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
?
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
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
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
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
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
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
Q183305- Woman controlled on na valproate. Planning pregnancy . Ur advice ?
A.Inc valproate
B.Dec valproate
C.Stop valproate
D.Continue same
C?
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
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
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
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
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
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
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
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
Q10488- which combination making muscle weakness without tenderness ?
A. ramipril and HCT
B. amiloride and Ramipril
C. celecoxib and HCT
B
سوال چهل و سوم
Q10454- E CG-SVT with WPW.Next invextigation?
a.Troponin
b.Echo
B??
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
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
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
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
?
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
- 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 🔥🔥🔥🔥
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
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
?
Q9593- 33 year of woman who had done TAH and BSO, t score femur -2.5 and vertebra -1.5, what to give
- oestrogen therapy
- oestrogen and progesterone
- vit D and Ca
- alendronate
A
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
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
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?
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?
- Trace contacts of her past one year
- Ask her to avoid sex
- Trace contacts of her for past 6 months
- Trace contacts of her for past 2 months
- Inform health department
5
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
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
?
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
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
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
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?
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?
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
?
Q187184-DM patient with injury to left index finger prior 2 days. Which indicate deep tendon involvement?
- Clear vesicle on finger tip
- Pain on extensor tendon sheath
- Flexion posture of finger
- Pain on passive flexion of left index finger
- Fusiform formation of finger
Semi flexion
C
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?
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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?
- reduce the dose
- cease lithium
- check the blood lithium level
Pros and cons
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
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
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
?
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
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
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
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.
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
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
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
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
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
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
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
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?
- HSV-rbc
- HIV
- pneumococcus
- meningococcus
- treponema pallidum
5
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?
- repeat troponin
- echo
- coronary angiography
- repeat ecg
D
ECG 0 1 6
Troponin 0 6 12
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
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
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
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
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
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
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
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
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
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
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
?
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
?
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
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
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
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
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?
- amlodipine
- losartan
- perindropil
- indapamide
- metoprolol
B
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
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
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
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
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
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
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?
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
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
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
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
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
- بیمار یک lone AF هست در یک فرد جوان .یعنی اکو شده و structural heart disease نداشته و CAD و .. هم نداشته
- پاروکسیسمال AF هست یعنی کمتر از 24 ساعت خودبخود سینوس شده ولی حملات تکرار شونده هست پس باید ساپرس بشه
- در بیمار پاروکسیسمال AF هم از نظر تصمیم برای آنتی کواگولان تراپی مثل بیمار AF پایدار برخورد میکنیم …چادز وسک و…
- 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 😉
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
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
Q184068-Gbs stem.how to monitor respiration.
A.FEV
B.FVC
C.Monitor chest expansion
B
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?
- HSV-rbc
- HIV
- pneumococcus
- meningococcus
- treponema pallidum
5
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
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
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
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
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
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
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
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?
- repeat xray
- Mri to see ligaments
3 exercises
- analgesia
- brace
D
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
?
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
