101 to 200

Question 1

101. A 2yo boy fell off his tricycle and hurt his arm. He got up to start crying, but before there was any sound, he went pale, unconscious and rigid. He recovered after 1-2 mins but remained pale. After an hour he was back to normal. His mother says she was afraid he was going to die, and that he had a similar episode 3 months prior after falling down some steps. What single inv is indicated? a.

Answer 1

Ans. 1. The key is D. None. Ans. 2. Diagnosis is breath holding spell.

Question 2

102. A 29yo woman had just delivered a still born vaginally, following a major placental abruption. Choose the single most likely predisposing factor for developing PPH in this lady? a. Retained product b. DIC c. Fibroid uterus d. Uterine infection e. Large placental site Q. 1. What is the key? Q. 2. What are the causes of this condition here?

Answer 2

Ans. 1. The key is B. DIC. Ans. 2. Pregnancy itself is a risk factor for DIC. Placental abruption is a more common cause of DIC.Other causes of pregnancy related DIC are: eclampsia, retention of a dead fetus, amniotic fluid embolism, retained placenta or bacterial sepsis.

Question 3

103. A 28yo woman has delivered with rotational forceps after an 8h labor and 3h second stage.Choose the single most likely predisposing factor for PPH for this pt? a. Atonic uterus b. Cervical/vaginal trauma c. Retained product d. Preterm labor e. Uterine infection

Answer 3

Ans. The key is B. Cervical/vaginal trauma. [complication of forceps delivery].

Question 4

104. A 50yo man has had anterior resection of the rectum for carcinoma. He expressed concerns about control of post-op pain in discussions with the anaesthetist before surgery. What is the best management strategy? a. Oral diclofenac b. Oral codeine c. IM morphine d. IM dihydrocodeine e. Ondansetron oral

Answer 4

Ans. The key is C. IM morphine. [Some post operative pain is severe pain which needs strong opioid analgesic].

Question 5

105. A 73yo male presents with enlarged cervical nodes. He has had recurrent infections over the last year. His conjunctiva is pale. Choose the single cell type you will find on the blood film. a. Granulocyte without blast cells b. Myelofibroblasts c. Plasma cells d. Mature lymphocytes Q. 1. What is the key? Q. 2. What is the diagnosis? Q. 3. What are the points in favour of your diagnosis?

Answer 5

Ans. 1. The key is D. Mature lymphocytes. Ans. 2. The diagnosis is CLL. Ans. 3. It is CLL because of his age (73 yrs), cervical lymphadenpathy, recurrent infections (mature but functionally defective lymphocytes), and pale conjunctiva (anaemia).

Question 6

106. A 45yo lady has 10m hx of SOB. She is found to have irregularly irregular pulse and loud P2 with fixed splitting and ejection systolic murmur in left 2nd ICS. What is the probable dx? a. TOF b. ASD c. VSD d. PDA e. CoA Q. 1. What is the key? Q. 2. What is the diagnosis?

Answer 6

Ans. 1. The key is B. Atrial septal defect. Ans. 2. Diagnosis is ASD with atrial fibrillation. [i) atrial fibrillation = irregularly irregular pulse. ii) ASD =SOB, fixed splitting with loud P2, ESM in pulmonary area]. This picture is typical. One should not misdiagnose SOB, ESM in pulmonary area and loud P2 as pulmonary hypertension (though in elderly this can develop with ASD).

Question 7

107. A 5m baby present with recurrent vomiting. Mother noticed some of the vomitus is blood stained. Choose the single most likely inv? a. Upper GI endoscopy b. Barium meal c. US d. Colonoscopy e. CT abdomen

Answer 7

Ans. The key is A. upper GI endoscopy.

Question 8

108. A 76yo is treated with HTN. He suffers from pain and redness at the MTP joint of his right big toe. Which of the following anti-HTN cause this symptoms? a. Losartan b. Bendroflumethiazide c. Ramipril d. Bisoprolol e. Verapamil Q. 1. What is the key? Q. 2. What is the diagnosis? Q. 3. What is the cause of the disease?

Answer 8

Ans. 1. The key is B. Bendroflumethiazide Ans. 2. Diagnosis is acute gout. Ans. 3. Thiazide diuretics may cause hyperuricemia and thus cause or precipitate gout.

Question 9

109. A 33yo male involved in a street fight presents with bruises and deformity in the upper part of his leg. XR shows fx of the neck of fibula. What is the single most associated nerve injury? a. Sciatic nerve b. Gluteal nerve c. Musculocutaneous nerve d. Lateral peroneal nerve e. Tibial nerve f. Femoral nerve

Answer 9

Ans. The key is D. Lateral peroneal nerve. [Lateral peroneal nerve is other name of superficial peroneal nerve].

Question 10

110. A 35yo man presents with hx of dyspepsia. H.Pylori antibodies are negative. No improvement is seen after 1m of tx. What is the next step? a. Urea breath test b. Gastroscopy c. CT d. MRI Q. 1. What is the key? Q. 2. What may be the D/D here? Q. 3. At this age what are the indications of this procedure?

Answer 10

Ans. 1. Gastroscopy. Ans. 2. Not responding to treatment D/D is: i) Jollinger Elison syndrome ii) Ca stomach Ans. 3. Indications of gastroscopy in a 35 yo man (for man of age <50): i) Acute symptoms with H/O previous episode (PUD) ii) Alarm features [weight loss, anaemia, vomiting, hematemesis and melaena, dysphagia, palpable abdominal mass], fear of cancer, evidence of organic disease.

Question 11

111. A 15yo male has bilateral ankle edema. His BP=110/70mmHg and urinalysis shows protein++++. What is the most likely dx? a. HUS b. IgA nephropathy c. Membranous GN d. Minimal change GN e. Nephrotic syndrome Q. 1. What is the key? Q. 2. What are the points in favour of your diagnosis? Q. What is the treatment?

Answer 11

Ans. 1. The key is D. Minimal change disease. Ans. 2. Points in favour: i) Age 15 ii) Ankle oedema iii) Normotension iv) Heavy proteinuria. Ans. 3. Treatment of choice is steroid (prednisolon). Failure of steroid or frequent relapse (>3) cyclophosphamide.

Question 12

112. A 28yo man has developed a red, raised rash on trunk after playing football. His PMH shows he had childhood asthma. The rash is becoming increasingly itchy. What is the most appropriate tx? a. Oral chlorpheneraime b. Oral amoxicillin c. IM adrenaline d. Nebulized salbutamol e. Histamine Q. What is the key? Q. 2. What is the diagnosis?

Answer 12

Ans. 1. The key is A. Oral chlorpheneramine. Ans. 2. Diagnosis is Atopy (allergy).

Question 13

113. A 72yo man has been advised to have antibiotic prophylaxis for some years now before dental tx. He has never experienced chest pain. Three weeks ago, he noticed breathlessness on exertion and for one week he had orthopnea. His pulse is normal. What is the most probable dx? a. Aortic regurgitation b. Ischemic mitral regurgitation c. Mitral valve prolapse d. Pulmonary stenosis e. Mitral valve s

Answer 13

Ans. The kay is E. Mitral valve stenosis. [Mitral stenosis is the most common valvular complication of rheumatic fever].

Question 14

114. A 37yo woman presents with fatigue. Exam: angular stomatitis, no koilonychea. Choose the single cell type you will find on the blood film. a. Macrocytes b. Microcytes c. Granulocytes wthout blast cells d. Blast cells Q. 1. What is the key? Q. 2. What is the cause here? Q. 3. What are the points in favour of mentioned cause?

Answer 14

Ans. 1. The given key is A. Macrocytes. Ans. 2. The cause here is VIT. B12 or folate deficiency. Ans. 3. Points in favour of Vit. B12 or folate deficiency: i) fatigue (anaemia) ii) angular stomatitis (can be seen in Vit. B12 or folate deficiency) iii) absence of koilonychea is against IDA.

Question 15

115. A 4yo boy with a febrile convulsion lasting eight minutes has been given IV lorazepam to control them. What is the single most likely serious side effect? a. Amnesia b. Anaphylactic shock c. Apnea d. Bronchospasm e. Cardiac arrhythmia

Answer 15

Ans. The key is C. Apnoea. [Respiratory depression may occur following lorazepam administration].

Question 16

116. A 4wk girl has been dx of having breast milk jaundice. She is otherwise well. What is the single most appropriate management? a. Continue breastfeeding b. Exchange transfusion c. Increase fluid intake d. Phototherapy e. Stop breastfeeding Q. 1. What is the key? Q. 2. What is breast milk jaundice? Q. 3. What type of hyperbilirubinemia occurs in breast milk jaundice? Q. 4. What is the cause of

Answer 16

“Ans. 1. The key is A. Continue breast feeding. Ans. 2. If jaundice lasts past the first week of life in a breastfed baby who is otherwise healthy, the condition may be called ““breast milk jaundice.”” Ans. 3. Unconjugated hyperbilirubinaemia. Ans. 4. Cause of breast milk jaundice: factors in a mother’s milk that help a baby absorb bilirubin from the intestine.”

Question 17

117. A 12yo girl when playing in the garden accidentally stepped on a hive and was bitten several times. She has numerous wheals on her body and complains of severe itching. What is the single most appropriate management? a. Oral antihistamine b. IV antihistamine c. IM adrenaline d. Oral ciprofloxacin e. Reassurance

Answer 17

Ans. The given key is C. IM adrenaline which is a wrong key. The correct answer is A. Oral antihistamine.[Intravenous antihistamines are used as an adjunct to epinephrine in the emergency treatment of anaphylaxis and angioedema. Parenteral antihistamine is not recommended in less severe allergic reaction (other than anaphylaxis)]. Followings are the indications of adrenaline in anaphylaxis: 1. Hor

Question 18

118. A term baby born to a 30yo woman of blood group A-ve develops severe jaundice within the first 24h of birth. What is the most likely dx? a. Hereditary spherocytosis b. G6PD c. ABO incompatibility d. Rh incompatibility e. Physiological jaundice

Answer 18

Ans. The key is D. Rh incompatibility.

Question 19

119. A 4yo girl is found to have bounding pulse and continuous machinery murmur. What is the most probable dx? a. TOF b. ASD c. VSD d. PDA e. CoA

Answer 19

Ans. The key is D. PDA. [Continuous mechinary murmur is well known feature of PDA].

Question 20

120. A 12yo child with episodes of sudden bluish discoloration and brief loss of consciousness. Exam: clubbing, central cyanosis, systolic thrill with systolic ejection murmur in 2nd left ICS. What is the most probable dx? a. TOF b. ASD c. VSD d. PDA e. CoA

Answer 20

Ans. The key A. TOF. [TOF usually does not become symptomatic at birth or early infancy and given features (central cyanosis and clubbing with murmur of right ventricular outflow obstruction i.e. ejection systolic murmur in 2nd left ICS) are well known features of TOF]. [Tetralogy of fallot = VSD + Overriding of the aorta + Right ventricular outflow tract obstruction + Right ventricular hypertroph

Question 21

121. An 8yo child who is tall for his age and has a refractory error for which he wears glasses has presented with severe crushing chest pain. What is the most likely dx? a. Fragile X syndrome b. Prader-willi syndrome c. DiGeorge syndrome d. Marfans syndrome Q. 1. What is the key? Q. 2. What is the cause of this severe crushing chest pain? Q. 3. What are the most common cardiac abnormalitis found

Answer 21

Ans. 1. The key is D. Marfans syndrome. Ans. 2. Cause of severe crushing chest pain may be aortic dissection. Ans. 3. Most common cardiac abnormalities in Marfans syndrome are: dilatation of the aorta and mitral regurgitation.

Question 22

122. A 4yo child presents with pain of spontaneous onset in his knee of 2 days duration. He has developed mild fever in the 2nd day. He can walk but has a limp. Exam: painful restriction in the right hip. What is the most probable dx? a. Osteosarcoma b. Septic arthritis c. TB arthritis d. Exostosis e. Osteomyelitis Q. 1. What is the key? Q. 2. What are the points in favour of your diagnosis?

Answer 22

Ans. Given key is E. Osteomyelitis which is a wrong key. The correct answer is B. Septic arthritis. Ans. Points in favour of diagnosis: i) Pain in joints (knee and hip). In osteeomyelitis there is no joint pain but pain in other parts of bone like shaft. ii) Fever iii) Painful restricted movement of joint. NB This controversial question was debated and ultimately settled as septic arthritis by old

Question 23

123. A man with anterior resection and end to end anastomosis done complains of severe pain in the chest and abdominal distension. What is the most appropriate inv likely to review the cause this deterioration? a. XR abdomen b. Exploratory laparoscopy c. CT d. US e. Laparotomy

Answer 23

Ans. The key is E. Laparotomy.

Question 24

124. Pt with hx of alcoholism, ataxic gait, hallucinations and loss of memory. He is given acamprosate. What other drug can you give with this? a. Chlordiazepoxide b. Thiamine c. Diazepam d. Disulfiram e. Haloperido

Answer 24

Ans. The key is B. Thiamine. [These are features of delirium tremens].

Question 25

125. A 35yo male builder presented with sudden onset of severe abdominal pain. He was previously fit and well other than taking ibuprofen for a long term knee injury. On examination he is in severe pain, pulse=110bpm, BP=110/70mmHg and has a rigid abdomen. What is the most likely dx? a. Biliary peritonitis b. Ischemic colon c. Pancreatic necrosis d. Perforated diverticulum e. Perforated peptic ulc

Answer 25

Ans. The key is E. Perforated peptic ulcer. [NSAIDs induced perforation. Points in favour- 1. Prolonged use of NSAIDs, 2. Sudden onset of severe abdominal pain, 3. Rigid abdomen].

Question 26

126. A woman 5 days post-op for bilateral salphingo-oopherectomy and abdominal hysterectomy has developed abdominal pain and vomiting a/w abdominal distension and can’t pass gas. No bowel sounds heard, although well hydrated. What is the most appropriate next step? a. XR abdomen b. Exploratory laparoscopy c. CT d. USG e. Barium enema Q. 1. What is the key? Q. 2. What is the diagnosis? Q. 3. What a

Answer 26

Ans. 1. The key is A. X-ray abdomen. Ans. 2. The diagnosis is paralytic ileas. Ans. 3. Causes of paralytic ileus: i) electrolyte imbalance ii) gastroenteritis iii) appendicitis iv) pancreatitis v) surgical complications vi) certain drugs. Ans. 4. Management of paralytic ileus: i) nil by mouth ii) nasogastric suction to alleviate the distension and remove the obstruction.

Question 27

127. A 30yo man complains of hoarseness of voice. Exam: unilateral immobile vocal cord. What is the most probable dx? a. Graves disease b. Hematoma c. Unilateral recurrent laryngeal nerve injury d. External laryngeal nerve injury e. Tracheomalacia

Answer 27

Ans. The key is C. unilateral recurrent laryngeal nerve injury.

Question 28

128. A 38yo woman has delivered after an induced labor which lasted 26h. choose the single most likely predisposing factor for postpartum hemorrhage? a. Atonic uterus b. Cervical/vaginal trauma c. Rupture uterus d. Fibroid uterus e. Age of mother

Answer 28

Ans. The key is A. Atonic uterus. [Prolonged labour is a risk factor for PPH secondary to atonic uterus].

Question 29

129. A 32yo woman in tears describing constant irritability with her 2 small children and inability to relax. She describes herself as easily startled with poor sleep and disturbed nightmares following a house fire a year ago, while the family slept. What is the single best tx? a. Rassurance b. Relaxation therapy c. Quetiapine d. Lofepramine e. Fluoxetine Q. 1. What is the key Q. 2. What is the di

Answer 29

Ans. 1 The key is E. Fluoxetine. [NICE guidelines suggest that trauma-focussed psychological therapies (CBT or EMDR) should be offered before medication, wherever possible. As these are not in option the best answer here is Fluoxetine (SSRI). At present, there is evidence that EMDR, psychotherapy, behaviour therapy and antidepressants are all effective. There is not enough information for us to sa

Question 30

130. A 22yo woman with longstanding constipation has severe ano-rectal pain on defecation. Rectal exam: impossible due to pain and spasm. What is the most probable dx? a. Anal hematoma b. Anal fissure c. Anal abscess d. Protalgia fugax e. Hemorrhoids

Answer 30

Ans. The key is B. Anal fissure.

Question 31

131. A 20yo student attends the OPD with complaint of breathlessness on and off, cough and sputum. His sleep is disturbed and skin is very dry in flexural areas of the body. Exam: tachypnea, hyperresonant percussion and wheezing on auscultation. What is the most likely dx? a. Extrinsic allergic alveolitis b. Asthma c. Wegener’s granulomatosis d. COPD e. Cystic fibrosis Q. What is the key? Q. What

Answer 31

Ans. The key is B. Asthma. Ans. 2. Diagnostic criteria of asthma: i) Airway hyper-responsiveness to certain stimuli ii) Recurrent variable airflow limitation usually reversible iii) presents as wheezing, breathlessness, chest tightness and cough.

Question 32

132. A pt with thought disorder washes hands 6x each time he uses the toilet. What is the best management? a. Psychodynamic therapy b. CBT c. Antipsychotics d. Refer to dermatology e. Reassure Q. 1. What is the key? Q. 2. What is the diagnosis?

Answer 32

Ans. 1. The key is B. CBT. [For OCD CBT is the 1st treatment of choice and if fails comes drugs]. Ans. 2. The diagnosis is obsessive compulsive disorder.

Question 33

133. A 25yo woman presented to her GP on a routine check up. Upon vaginal exam, she was fine except for finding of cervical ectropion which was painless but mild contact bleeding on touch. What is the next management? a. Endometrial ablation b. Cervical smear (2nd line) c. Colposcopy d. Antibiotics (1st line) e. Vaginal US f. Pack with gauze and leave to dry Q. 1. What is the key? Q. 2. Points in

Answer 33

Ans. The key is D. Antibiotics. This is a wrong key. The correct key is B. Cervical smear. [Before antibiotic we have to take swab]. Ans. 2. Cervical smear is a screaning service which follows its own schedule and can not be done unless it is due or overdue. As the Lady is of 25 years and has ectropion and contact bleeding smear is the best option here as in UK 1st smear is offered at 25 yrs.

Question 34

134. A 32yo had a normal vaginal delivery 10 days ago. Her uterus has involuted normally. Choose the single most likely predisposing factor for PPH? a. Retained product b. DIC c. Uterine infection d. Von Willebrand disease e. Primary PPH Q. 1. What is the key? Q. 2. What type of PPH it would be?

Answer 34

Ans. 1. The key is C. uterine infection. Ans. 2. Secondary PPH

Question 35

135. A 37yo man slipped while he was walking home and fell on his out stretched hand. He complains of pain in the right arm. XR showed fx of the head of radius. What is the single most associated nerve injury? a. Radial nerve b. Musculocutaneous nerve c. Median nerve d. Ulnar nerve Q. 1. What is the key? Q. 2. What is the root value?

Answer 35

Ans. 1. The key is A. Radial nerve. [At wrist, radial nerve injury cause finger drop with a normal wrist and intact sensation]. Ans. 2. Root value of radial nerve: C5,6,7,8 and T1.

Question 36

136. A butcher stabbed accidently his groin. He bled so much that the towel was soaked in blood and BP=80/50mmHg, pulse=130bpm. What % of circulatory blood did he lose? a. <15% b. 15-30% c. 30-40% d. 40-50% e. >50% Q. 1. What is the key? Q. 2. What is the classification of blood loss according to vita sign?

Answer 36

Ans. 1. The key is C. 30-40% Ans. 2. Classification: 1. Class 1 up to 15% of blood volume lost: pulse <100; systolic BP normal; pulse pressure normal; Respiratory rate 14-20; urine output greater than 30 ml/hour. 2. Class 2 15%-30% blood volume lost: pulse 100-120; systolic blood pressure normal; pulse pressure decreased; respiratory rate 20-30; urine output 20-30 ml/hour. 3. Class 3 30%-40% blood

Question 37

137. A 67yo man presents with palpitations. ECG shows an irregular rhythm and HR=140bpm. He is otherwise stable, BP=124/80mmHg. What is the most appropriate management? a. Bisoprolol b. ACEi c. Ramipril d. Digoxin

Answer 37

Ans. The key is A. Bisoprolol. [In acute AF (<48h) if stable rate control by verapamil 40-120mg/8hourly po or bisoprolol 2.5-5mg/d po. In chronic AF (>48h) rate control with beta-blocker or rate limiting CCB; OHCM, 9th edition, page-124].

Question 38

138. A 78yo man is depressed after his wife’s death. He has been neglecting himself. His son found him in a miserable state when he went to visit. The son can’t deal with his father. What is the appropriate management? a. Voluntary admission to psychiatry ward b. Hand over to social worker c. Request son to move in with father d. Send pt to care home

Answer 38

Ans. The key is A. Voluntary admission to psychiatry ward.

Question 39

139. An old alcoholic presents with cough, fever, bilateral cavitating consolidation. What is the most probable cause? a. Gram +ve diplococcic b. Coagulase +ve cocci c. Gram –ve cocci d. AFB e. Coagulase –ve cocci Q. 1. What is the key? Q. 2. What is the organism?

Answer 39

Ans. 1. The key is B. Coagulase +ve cocci. [The picture is of pneumonia and bilateral cavitating consolidation favours staphylococcus as the causative agent]. Ans. 2. Name of organism is Staphylococcus aureus. [Both coagulase positive and coagulase negative cocci are staphylococci. Gram positive diplococcic is pneumococcus and gram negative nisseria, moraxella catarrhalis and hemophilus influenza.

Question 40

140. A 67yo man had successful thrombolysis for an inf MI 1 month ago and was discharged after 5days. He is now readmitted with pulmonary edema. What is the most probable dx? a. Aortic regurgitation b. Ischemic mitral regurgitation c. Mitral valve prolapse d. Pulmonary stenosis e. Rheumatic mitral valve stenosis

Answer 40

Ans. The key is B. Ischaemic mitral regurgitation. [ischaemic mitral regurgitation > raised pulmonary capillary pressure > pulmonary oedema]. [ Inferior myocardial infarction causes left ventricular remodeling, which displaces posterior papillary muscle away from its normal position, leading to ischemic mitral regurgitation].

Question 41

141. A 60yo lady who had stroke 3 years ago now reports having increased dyspnea on exertion and atrial fibrillation. CXR: straight left border on the cardiac silhouette. What is the most probable dx? a. Aortic regurgitation b. Ischemic mitral regurgitation c. Mitral valve prolapse d. Pulmonary stenosis e. Rheumatic mitral valve stenosis Q. 1. What is the key? Q. 2. What are the points in favour o

Answer 41

Ans. 1. The key is E. Rheumatic mitral valve stenosis. Ans. 2. Points in favour: i) Dyspnoea on exertion ii) Straight left border of the cardiac silhouette. To straighten the left heart border it requires underfilling of the left ventricle and aorta which occurs in mitral stenosis. Iii) Atrial fibrillation is a common association.

Question 42

142. A 60yo diabetic complains of pain in thigh and gluteal region on walking up the stairs for the last 6 months. She is a heavy smoker and has ischemic heart disease. What is the most appropriate dx? a. Thromboangitis Obliterans b. Sciatica c. DVT d. Atherosclerosis e. Embolus Q. 1. What is the key? Q. 2. What are the points in favour?

Answer 42

Ans. 1. The key is D. Atherosclerosis. Ans. 2. i) It is not sciatica as sciatica pain is worse when sitting. There may be weakness, numbness, difficulty moving the leg or foot. A constant pain on one side of the rear. A shooting pain that makes it difficult to stand up. ii) It is not DVT as no swelling, warmth or redness of skin are there iii) It is not thromboangitis obliterans as pulses are ok,

Question 43

143. A 3yo child who looks wasted on examination has a hx of diarrhea on and off. The mother describes the stool as bulky, frothy and difficult to flush. What is the single inv most likely to lead to dx? a. Sweat chloride test b. Anti-endomysial antibodies c. LFT d. US abdomen e. TFT Q. 1. What is the key? Q. 2. What is the diagnosis?

Answer 43

Ans. 1. The key is B. Anti-endomysial antibody Ans. 2. The diagnosis is celiac disease. [It is not cystic fibrosis as lung problem is most commonly seen in cystic fibrosis along with GI problem like indigestion].

Question 44

144. A 45yo woman has had severe epigastric and right hypochondrial pain for a few hours. She has a normal CBC, serum ALP is raised, normal transaminase. 3 months ago she had a cholecystectomy done. What is the most appropriate inv? a. US abdomen b. ERCP c. MRCP d. CT abdomen e. Upper GI endoscopy Q. 1. What is the key? Q. 2. What is the diagnosis?

Answer 44

Ans. 1. The key is B. ERCP. It is probably a wrong key and correct key should be C. MRCP. [Post operative US of abdomen does not give good result for hepatobiliary system. ERCP is invasive procedure and it has its considerable complications like cholangitis, injury, pancreatitis etc. Among given options MRCP is most appropriate. We shall go for ERCP after making the dx confirm. For this MRCP is pr

Question 45

145. A 53yo woman presented with pain in the eye, blurry vision and clumsiness for 3 months. She has a hx of difficulty in swallowing and weakness in her right upper limb 2y ago. What is the inv of choice? a. CSF analysis b. EEG c. EMG d. MRI brain e. Visual evoked response test Q. What is the key? Q. What is the diagnosis?

Answer 45

Ans. 1. The key is D. MRI brain. Ans. 2. Diagnosis is multiple sclerosis.

Question 46

146. A 55yo male presents with malaise and tiredness. Exam: spleen approaching RIF, no lymphadenopathy. Choose the single cell type? a. Helmet shaped cell b. Sickle cell c. Granulocyte without blast cells d. Blast cells Q. 1. What is the key? Q. 2. What is the diagnosis? Q. 3. What are the diagnostic features?

Answer 46

Ans. 1. The key is C. Granulocyte without blast cells. Ans. 2. The diagnosis is CML. Ans. 3. Diagnostic features are i) increased number of mature granulocytes ii) huge splenomegaly. [* Helmet shaped cells (or shistocytes) = hemolytic or Microangiopathic hemolytic anemia * Sickle cell = sickle cell anemia * Blast cells (immature cells) = in acute leukemia].

Question 47

147. A 6yo pt comes with easy bruising in different places when she falls. CBC: WBC=25, Hgb=10.9, Plt=45. Her paul bunnel test +ve. What is the most likely dx? a. Glandular fever b. ITP c. Trauma d. NAI e. Septicemia Q. 1. What is the key? Q. 2. What are the lab. Values that suggests the diagnosis here?

Answer 47

Ans. 1. The key is A. Glandular fever. Ans. 2. Suggestive lab. Values: WBC=25 (leucocytosis), Hgb=10.9 (usually patient is not anaemic), Plt=45 (thrombocytopenia-leading to easy bruising), Positive paul bunnel test.

Question 48

148. A 41yo woman who has completed her family, has suffered from extremely heavy periods for many years. No medical tx has worked. She admits that she would rather avoid open surgery. After discussion, you collectively decide on a procedure that wouldn’t require open surgery or GA. Select the most appropriate management for this case. a. Endometrial ablation b. Hysterectomy c. Fibroid resection d

Answer 48

Ans. The key is E. Uterine artery embolization. [Done by interventional radiologist expert in arterial embolization technique. Particles are placed in uterine artery to block circulation to uterine body. No operation or GA is required].

Question 49

149. A girl with hx of allergies visited a friend’s farm. She got stridor, wheeze and erythematous rash. What is the most appropriate tx? a. 0.25ml IM adrenaline b. 0.25ml PO adrenaline c. 0.25ml IV adrenaline d. IV chlorphearamine

Answer 49

Ans. The key is A. 0.25 ml IM adrenaline [Presence of stridor and wheeze are suggestive of anaphilaxis and treatment option is IM adrenaline].

Question 50

150. A 5yo boy is referred to the hospital and seen with his father who is worried that he has been listless. He is not sure why his GP suggested he should come to the ED and is keen to get some tablets and go home. Exam: tired and irritable, swelling around eyes. Renal biopsy: remarkable for podocyte fusion on EM. What is the most probable dx? a. NAI b. Myelodysplastic disease c. HSP d. Membranou

Answer 50

Ans. The key is E. Minimal change glomerulonephritis. [Podocyte fusion on electron microscopy]

Question 51

151. A 6yo boy is brought to the hospital for a 3rd episode of sore throat in 1 month. He is found bleeding from gums and nose and has pale conjunctiva. What’s the single cell type? a. Clumped platelets b. Microcytes c. Granulocyte without blast cells d. Blast cells e. Mature lymphocytes Q. 1. What is the key? Q. 2. What is the diagnosis? Q. 3. What are the points that favour diagnosis?

Answer 51

Ans. 1. The key is D. Blast cells. Ans. 2. The diagnosis is ALL Ans. 3. Points in favour: i) Age-6yrs ii) recurrent infection (sorethroat) due to neutrpenia and abnormal lymphoblasts which cannot protect from infection iii) thrombocytopenia causing gum and nose bleeding. iv) anaemia (pale conjunctiva) due to reduced red cell production from marrow occupation by blast cells. [Here debate came why i

Question 52

152. A 23yo man has been stabbed in the back and has SOB. The trachea is not deviated, he has engorged neck veins and absent breath sounds on the right. What is the most appropriate dx? a. Tension pneumothorax b. Cardiac tamponade c. Simple pneumothorax d. Hemothorax e. Pleural effusion Q. 1. What is the key? Q. 2. What are the point in favour of your answer?

Answer 52

Ans. 1. The key is A. Tension pneumothorax. Ans. 2. Points in favour: i) Stab wound in the back ii) SOB iii) Engorged neck vein iv) Absent breath sound. These features are common for both hemothorax and tension pneumothorax and tracheal deviation is common to both! But chance of tension pneumothorax is more in stab wond and no tracheal deviation is controversial. This is probability of bad recall!

Question 53

153. A 44yo pt comes with right hemiparesis. Exam: left sided ptosis and left dilated pupil. Where is the lesion? a. Cerebral infarct b. Cerebellar infarct c. Medulla oblongata d. Pons e. Midbrain Q. 1. What is the key? Q. 2. What is the name of this condition?

Answer 53

Ans. 1. The key is E. Midbrain. Ans. 2. Weber syndrome [presence of ipsilateral oculomotor nerve palsy and contralateral hemiparesis or hemiplagia].

Question 54

154. A 50yo man has a stab wound to his left anterior chest at the level of the 4th ICS. He has a BP 80mmHg, pulse=130bpm. His neck veins are dilated and his heart sounds are faint. His trachea is central. What is the most appropriate dx? a. Cardiac tamponade b. Diaphragmatic rupture c. Fractured ribs d. Tension pneumothorax e. Traumatic rupture of aorta Q. 1. What is the Key? Q. What are the poin

Answer 54

Ans. 1. The key is Cardiac tempoade. Ans. 2. Points in favour:i) Systolic BP 80 mmHg ii) Pulse 130 bpm iii) Engorged neck vein iv) Faint heart sounds v) Trachea is central.

Question 55

155. A 15yo boy has a soft painless swelling in the left scrotum, blue in color and can be compressed. What is the most appropriate next step? a. Analgesia b. Antibiotic c. Biopsy d. Immediate surgery e. Reassurance Q. 1. What is the key? Q.2. What is the name of this condition?

Answer 55

Ans. 1. The key is E. Reassurance. Ans. 2. Name of the condition is Varicocele.

Question 56

156. A 12yo pt presents with copious diarrhea. Exam: urine output=low, mucous membrane=dry, skin turgor=low. What is the most appropriate initial management? a. Antibiotic b. Antimotility c. Anti-emetic d. Fluid replacement e. Reassurance

Answer 56

Q. 1. What is the key? Q. 2. What is the diagnosis and why? Ans. 1. The key is D. Fluid replacement. Ans. 2. Diagnosis is severe dehydration. Points in favour: i) low urine output ii) dry mucous membrane and iii) low skin turgor.

Question 57

157. A 60yo smoker presents with cramp-like pain in the calves relived by rest and non-healing ulcers.Exam: cold extremities with lack of hair around the ankles, absent distal pulses. What is the most probable dx? a. Intermittent claudication b. Chronic ischemia of the limbs c. Buerger’s disease d. DVT e. DM Q. 1. What is the key? Q. 2. Points that support your diagnosis.

Answer 57

Ans. 1. The key is B. Chronic ischaemia of the limb. Ans. 2. Intermittent claudication is a symptom not diagnosis. It is not buerger’s disease as buerger occur in more younger heavy smoker (before the age of 50yrs), It is not DVT as dvt pain or tenderness is not of an intermittent claudication pattern. Again in DM there is no intermittent claudication.

Question 58

158. An otherwise healthy 13yo boy presents with recurrent episodes of facial and tongue swelling and abdominal pain. His father has had similar episodes. What is the most likely dx? a. C1 esterase deficiency b. HIV c. Mumps d. Sarcoidosis e. Sjogren’s syndrome Q. 1. What is the key? Q. 2. What is the name of this condition? Q. 3. Why it is not acquired?

Answer 58

Ans. 1. The key is A. C1 esterase inhibitor deficiency. Ans. 2. Hereditary angioedema. Ans. 3. Acquired angeoedema usually manifest after the age of 40 yrs.

Question 59

159. A 25yo had an LSCS 24h ago for fetal distress. She now complains of intermittent vaginal bleeding. Observations: O2 sat=98% in air, BP=124/82mmHg, pulse=84bpm, temp=37.8C. The midwife tells you that she had a retained placenta, which required manual removal in the OT. Choose the most appropriate C-Section complication in this case? a. Retained POC b. Aspiration pneumonitis c. Endometritis d.

Answer 59

Ans. 1. The key is C. Endometritis. Ans. 2. More handling of tissue like manual removal of placenta, intermittent vaginal bleeding and raised temperature points toward infective process like endometritis.

Question 60

160. A 30yo woman has brief episodes of severe shooting pain in the rectum. Rectal examination and flexible sigmoidoscopy are normal. What is the most probable dx? a. Anal hematoma b. Anal fissure c. Rectal carcinoma d. Proctalgia fugax e. Piles

Answer 60

Ans. is D. Proctagia fugax [normal rectal examination and flexible sigmoidoscopy excludes other options].

Question 61

161. A 78yo male, DM and HTN, had a fall and since then is unable to walk. He presents with deformity and tenderness over the right hip area. XR=fx of femur neck. What is the single most associated nerve injury? a. Sciatic nerve b. Gluteal nerve c. Lateral peroneal nerve d. Tibial nerve e. Femoral nerve

Answer 61

Ans. The key is A. Sciatic nerve. [Sciatic nerve injury though may occur but may not be very common!]

Question 62

162. A 20yo man has a head on collision in a car. On presentation he is breathless, has chest pain and fx of 5-7th rib. CXR confirms this. What is the most appropriate initial action in this pt? a. Antibiotics b. Analgesia c. O2 by mask d. Physiotherapy e. Refer to surgeon

Answer 62

Ans. The key is C. O2 by mask. [There was debate in this forum that pain relief should be given first which will automatically relieve breathing problem. But others told O2 first]. O2 first is the correct answer!

Question 63

163. A 28yo man with complains of headache and nose bleeds also has pain in the lower limbs on exertion. Exam: radio-femoral delay, cold legs with weak pulse and mild systolic murmur with normal S1S2. What is the most probable dx? a. TOF b. ASD c. VSD d. PDA e. CoA

Answer 63

Ans. The key is coarctation of aorta. [headache and nosebleeds - >hypertension, pain in lower limb on exertion -> as reduced blood supply to leg due to coarctation, radio-femoral delay, cold legs with week pulse, mid-systolic murmur are all features of coarctation of aorta].

Question 64

164. A 23yo male has a tonic clonic seizure whilst at college. His GCS is 12, BP=120/77mmHg, HR=99bpm. What is the most appropriate inv for his condition? a. CT b. MRI c. Serum blood glucose d. Serum drug levels

Answer 64

Ans. The key is C. Serum blood glucose [it is also possible that he may have taken drug, even though first we have to do serum glucose as low blood glucose can be very easily managed and it needs urgent management to save life. If it is excluded then we can look for other causes which may be not fatal in short time as hypoglycaemia].

Question 65

165. A 20yo man complains of recent onset of itching which followed a viral infection. There are numerous wheals of all sizes on his skin particularly after he has scratched it. These can last up to an hour. What is the most probable dx? a. Uremia b. Urticaria c. Psychogenic itching d. Atopic eczema e. Primary biliary cirrhosis

Answer 65

Ans. The key is B. Urticaria.

Question 66

166. A 75yo lady who had mitral valve replacement 13 yrs ago has developed recurrent breathlessness. Her husband has noticed prominent pulsation in her neck. She complains of abdominal pain and ankle swelling. What is the most probable dx? a. Aortic regurgitation b. Mitral regurgitation c. Mitral stenosis d. Tricuspid regurgitation e. Pulmonary stenosis

Answer 66

Ans. The key is D. Tricuspid regurgitation. [Points in favour: i) recurrent breathlessness – if the cause is LV dysfunction, ii) prominent pulsation in the neck – giant v waves, iii) abdominal pain – pain in liver on exertion, ankle swelling; These are features of tricuspid regurgitation.

Question 67

167. A 45yo T1DM had an annual check up. Ophthalmoscopy showed dot and blot hemorrhage + hard exudate and multiple cotton wool spots. What is the next step in management? a. Reassurance and annual screening only b. Urgent referral to ophthalmologist c. Laser therapy d. Non-urgent referral to ophthalmologist e. Nothing can be done

Answer 67

Ans. The key is D. Non-urgent referral to ophthalmologist. [It is pre-proliferative retinopathy so non- urgent referral; If proliferative (with neovascularization) urgent referral].

Question 68

168. A 2m baby who has ambiguous genitalia presents to the ED with vomiting. Labs: Na+=125mmol/L, K+=6mmol/L. What is the most likely dx? a. Fragile X syndrome b. Turners syndrome c. Noonan syndrome d. Congenital adrenal hyperplasia

Answer 68

Q. 1. What is the key? Q. 2. What are the points in favour? Ans. 1. The key is D. Congenital adrenal hyperplasia Ans. 2. Points in favour: i) ambiguous genitalia ii) salt wasting manifested as hyponatremia and hyperkalemia (In mild forms of salt-wasting adrenal hyperplasia, salt wasting may not become apparent until an illness stresses the child). [here hyperkalaemia inspite of vomiting is indicat

Question 69

169. A 40yo man collapsed at home and died. The GPs report says he suffered from T2DM and BMI=35. What is the most likely cause of death? a. MI b. DM c. HF d. PE e. Renal failure

Answer 69

Q. 1. What is the key? Q. 2. Why the patient’s death was unnoticed? Ans. 1. The key is A. MI. Ans. 2. In diabetics MI become painless when the patient develop autonomic neuropathy (till there is no autonomic neuropathy diabetic patients will feel MI pain). In this case the disease was unnoticed as it was a painless attack.

Question 70

170. A 38yo pt presented with tingling, numbness, paraesthesia, resp stridor and involuntary spasm of the upper extremities. She has undergone surgery for thyroid carcinoma a week ago. What is the most likely dx? a. Thyroid storm b. Hyperparathyroidism c. Unilateral recurrent laryngeal nerve injury d. External laryngeal nerve injury e. Hypocalcemia Q. 1. What is the key? Q. 2. What is the cause of

Answer 70

Ans. 1. The key is E. Hypocalcaemia. Ans. 2. Hypocalcaemia may be due to accidental parathyroid gland removal during thyroidectomy. Ans. 3. Laryngospasm is a feature in hypocalcaemia which may cause stridor.

Question 71

171. A 50yo chronic smoker came to OPD with complaint of chronic productive cough, SOB and wheeze. Labs: CBC=increase in PCV. CXR >6ribs seen above the diaphragm in midclavicular line. ABG=pO2 decreased. What is the most likely dx? a. Interstitial lung disease b. Wegener’s granulomatosis c. Ca bronchi d. COPD e. Amyloidosis Q. 1. What is the key? Q. 2. What are the points in favour?

Answer 71

Ans. 1. The key is D. COPD. Ans. 2. Points in favour: i) Age 50 yrs ii) Chronic smoker iii) Chronic productive cough, SOB and Wheeze iv) Raised PCV secondary to chronic hypoxaemia v) Low set diaphragm and widened horizontal ribs vi) Hypoxaemia on ABG.

Question 72

172. A 44yo pt has sudden onset of breathlessness and stridor few minutes after extubation for thyroidectomy. The pat had longstanding goiter for which he had the surgery. What is the most likely dx? a. Thyroid storm b. Hematoma c. Unilateral recurrent laryngeal nerve injury d. External laryngeal nerve injury e. Tracheomalacia

Answer 72

Ans. The key is tracheomalacia. [Prolonged pressure over trachea by goiter is a cause of tracheomalacia following thryroidectomy].

Question 73

173. A 15yo boy presents with generalized edema. His urinalysis reveals protein +++, eGFR =110. What is the most likely dx? a. IgA nephropathy b. Membranous nephropathy c. Minimal change disease d. PSGN e. Lupus nephritis

Answer 73

Ans. The key is C. Minimal change disease. [Points in favour: i) Age 15 yrs ii) Generalized oedema iii) Protein in urine +++ iv) Normal eGFR of 110 (Normal range- 90 to 120 mL/min)].

Question 74

174. A 72yo man is receiving chemotherapy for SCLC. He has his 4th tx 8 days ago. He has a cough with some green sputum but feels well. Temp=37.6C. Chest exam = few coarse crepitations in the right base. HR=92bpm. CBC: Hgb=12.5g/dL, WBC=1.1, Neutrophils=0.6, Plt=89. Sputum, urine and blood culture sent to microbiology. What is the most appropriate management? a. Broad spectrum antibiotics IV b. Br

Answer 74

Ans. 1. The key is A. Broad spectrum antibiotics IV Ans. 2. The diagnosis is lower respiratory tract infection. Ans. 3. GCSF subcutaneously. [it is the treatment of chemotherapy induced leucopenia]

Question 75

175. A 25yo woman with T1DM has delivered a baby weighing 4.5kg. Her uterus is well contracted. Choose the single most likely predisposing factor for PPH from the options? a. Atonic uterus b. Cervical/vaginal trauma c. Retained POC d. Large placental site e. Rupture uterus Q. 1. What is the key? Q. Reason for your answer.

Answer 75

Ans. 1. The key is B. Cervical/vaginal trauma Ans. 2. The baby is a big baby. If patient’s uterus was not well contracted we would fear of atonic uterus! But as uterus is well contracted it is not atonic uterus. Rather most likely cause is trauma dring delivery of this big baby.

Question 76

176. A 23yo lady presents with headache. Exam: photophobia and generalized rash that doesn’t blanch on pressure. What must be done immediately? a. IV benzylpenicillin b. Isolate pt c. Gown and mask d. Blood culture

Answer 76

Ans. The key is A. IV benzylpenicillin.

Question 77

177. A 4yo baby has generalized tonic-clonic seizure and fever of 39C. his mother informs you that this has happened 3-4x before. What is the most likely dx? a. Febrile convulsion b. Absence seizures c. Epilepsy d. Partial complex seizure

Answer 77

Ans: The key is C. Epilepsy. It is wrong key. Correct key should be A. Febrile convulsion. [Points in favour: seizers in presence of high fever. Same previous illness indicate seizers during fever which goes against epilepsy. Though usually febrile convulsion dosen’t tend to recur but it can recur as well. Epilepsy has no relation to fever but is due to pathology in brain].

Question 78

178. A middle aged Asian presents with episodes of fever with rigors and chills for last 1y. Blood film: ring form plasmodium with schaffners dots in RBCs. What is the drug to eradicate this infection? a. Doxycycline b. Mefloquine c. Proguanil d. Quinine e. Artesonate Q. 1. What is the key? Q. 2. What does Shuffner’s dot in RBC indicate?

Answer 78

Ans. 1. The key is B. Mefloquine. Probably wrong key as mefloquine can not eradicate hepatic cycle! Primaquine is the drug that can eradicate hepatic cycle. Ans. 2. Shuffners dot indicates, it is plasmodium ovale or plasmodium vivex infestation.

Question 79

179. A 35yo woman had an uneventful lap chole 18h ago. She has a pulse=108bpm, temp 37.8C. There are signs of reduced air entry at the right base but the CXR doesn’t show an obvious abnormality. What is the most appropriate management strategy? a. Cefuroxime PO b. Ceftriaxone IV c. Chlorpheniramine PO d. Chest physiotherapy e. Reassure Q. 1. What is the key? Q. 2. What is the diagnosis?

Answer 79

Ans. 1. The key is D. Chest physiotherapy. Ans. 2. Atelactasis. [Atelectasis can be seen in chest x-ray but sometimes it becomes undetectable in chest x-ray as we are suspecting in this case].

Question 80

180. A 20yo pop star singer complains of inability to raise the pitch of her voice. She attributes this to the thyroid surgery she underwent a few months back. What is the most likely dx? a. Thyroid storm b. Bilateral recurrent laryngeal nerve injury c. Unilateral recurrent laryngeal nerve injury d. External laryngeal nerve injury e. Thyroid cyst

Answer 80

Ans. The key is D. External laryngeal nerve injury. [External laryngeal nerve functions to tense the vocal cords by activating the cricothyroid muscle, increasing pitch].

Question 81

181. A 28yo woman at 39wk gestation is in labor. She develops abdominal pain and HR=125bpm, BP=100/42mmHg, temp=37.2C and saturation=99%. Exam: lower abdomen is exquisitely tender. CTG=prv normal, now showing reduced variability and late deceleration develops with slow recovery. She has had 1 prv LSCS for a breech baby. Choose the most appropriate CS complication for this lady? a. Endometritis b.

Answer 81

Ans. The key is E. Uterine rupture. [Features of shock, exquisitely tender lower abdomen with abdominal pain, previously normal CTG now becoming non-reassuring and previous history of LSCS makes the diagnosis of uterine rupture].

Question 82

182. An 8m infant presented with FTT and constipation. Exam: large tongue and fam hx of prolonged neonatal jaundice. What is the most likely dx? a. Downs syndrome b. Fragile X syndrome c. Praderwilli syndrome d. DiGeorge syndrome e. Congenital hypothyroidism Q. 1. What is the key? Q. 2. What are the points in favour?

Answer 82

Ans.1. The key is E. Congenital hypothyroidism. Ans. 2. Points in fevour: i) FTT (failure to thrive) ii) constipation iii) macroglossia iv) prolonged neonatal jaundice.

Question 83

183. A 3m infant has presented with recurrent infections. He has abnormal facies and CXR shows absent thymic shadow. What is the most likely dx? a. Downs syndrome b. Fragile X syndrome c. DiGeorge syndrome d. Marfans syndrome Q. 1. What is the key? Q. 2. What are the points in favour?

Answer 83

Ans. 1. The key is C. DiGeorge syndrome. Ans. 2. Points in favour: i) Early age of onset ii) abnormal facies iii) absent thymic shadow on Chest X-ray iv) history of recurrent infection [Infections are common in children due to problems with the immune system’s T-cell-mediated response that in some patients is due to an absent or hypoplastic thymus]. [in newborne can be recognized by convulsions fr

Question 84

184. A 30yo man presents with deep penetrating knife wound. He said he had TT when he left school. What will you do for him now? a. Human Ig only b. Human Ig and TT c. Full course of tetanus vaccine only d. Human Ig and full course of tetanus vaccine e. Antibiotic

Answer 84

Ans.According to UK greenbook correct key is A. Human Ig only.

Question 85

185. A 32yo previously healthy woman has developed pain and swelling of both knees and ankles with nodular rash over her shins. As part of the inv a CXR has been performed. What is the single most likely CXR appearance? a. Apical granuloma b. Bilateral hilar lymphadenopathy c. Lobar consolidation d. Pleural effusion e. Reticular shadowing in the bases Q. 1. What is the key? Q. 2. What is the name

Answer 85

Ans. 1. The key is B. bilateral hilar lymphadenopathy. Ans. 2. The name is Lofgren’s syndrome. It is the triad of i) erythema nodosum ii) bilateral hilar lymphadenopathy iii) arthralgia.

Question 86

186. A neonate’s CXR shows double bubble sign. Exam: low set ears, flat occiput. What is the most likely dx? a. Downs syndrome b. Fragile X syndrome c. Turner’s syndrome d. DiGeorge syndrome Q. 1. What is the key? Q. 2. What double bubble sign indicate?

Answer 86

Ans. 1. The key is A. Down’s syndrome. Ans. 2. Double bubble sign indicate duodenal atresia.

Question 87

187. A 19yo boy complains of itching on the site of insect bite. What is the single most appropriate management? a. Penicillin oral b. Doxycycline oral c. Oral antihistamine d. Oral ciprofloxacin e. Reassurance

Answer 87

Ans. The key is C. Oral antihistamine.

Question 88

188. A man presents with scrotal swelling, the swelling is cystic and is non-tender. It is located in the upper pole of the posterior part of the testis. What is the most likely dx? a. Epididymal cyst b. Testicular ca c. Hydrocele d. Teratoma e. Testicular torsion

Answer 88

Ans. The key is A. Epididymal cyst. [the location of upper pole of the posterior part of testis is the common site for epididymal pathology].

Question 89

189. A young footballer has collapsed during a game. During initial evaluation: RR=14/min, pulse=88bpm, BP=110/70mmHg. He seems to be sweating and muttering some incomprehensible words. What is the most imp next step? a. CT b. MRI c. Blood sugar d. Body temp e. IV fluids

Answer 89

Ans. The key is C. Blood sugar. [Normal vital signs, sweating and collapse during exercise gives suspicion of hypoglycemia which is very easy to treat but fatal if left unrecognized. So most important next step is to check the blood sugar].

Question 90

190. A 45yo waitress complains of pelvic pain which worsens pre-menstrually and on standing and walking. She also complains of post-coital ache. Select the most likely cause leading to her symptoms? a. PID b. Endometritiosis c. Pelvic congestion syndrome d. Adenomyosis e. Premature ovarian failure

Answer 90

Ans. The key is C. Pelvic congestion syndrome. [Women with pelvic congestion syndrome experience a constant pain that may be dull and aching, but is occasionally more acute. The pain is worse at the end of the day and after long periods of standing, and sufferers get relief when they lie down. The pain is worse during or after sexual intercourse, and can be worse just before the onset of the menst

Question 91

191. A 37yo female had a fall with outstretched hand, presented with dinner fork deformity and tenderness over the right arm. What is the single most associated nerve injury? a. Axillary nerve b. Radial nerve c. Musculocutaneous nerve d. Median nerve e. Ulnar nerve

Answer 91

Ans. The key is D. Median nerve. [Median nerve is the nerve injured in Colle’s fracture]

Question 92

192. A mother comes with her 15m child. Which of the following will bother you? a. Shies away from strangers b. Can walk but not run c. Vocabulary consists of only 2 meaningless words d. She can’t make a sentence e. None Q. 1. What is the key? Q. 2. How many words is told clearly by a 15 month old child?

Answer 92

Ans. 1. The key is C. Vocabulary consists of only 2 meaningless words. Ans. 2. At 15 months the child can clearly say 5 words and his first meaningful clear word he says at 12 months.

Question 93

193. A 35yo lady who has been using IUCD for one year now complains of pelvic pain and heavy painful periods. Select the most likely cause leading to her symptoms? a. PID b. Endometriosis c. Adenomyosis d. Fibroids e. Asherman syndrome Q. 1. What is the key? Q. 2. What points favour your diagnosis?

Answer 93

Ans. 1. The key is A. PID. Ans. 2. The given picture may have D/D of PID or fibroid. As IUCD is a risk factor for PID, it is the most likely diagnosis of given picture. Menorrhagia for fibroids are usually painless].

Question 94

194. The dx cells of Hodgkin disease are: a. T-cells b. R-S cells c. B-cells d. Macrophages e. Auer rods

Answer 94

Ans. The key is B. R-S cells. [Diagnostic cell in Hodgkins disease is Reed-Sternberg cells].

Question 95

195. A 16yo girl is admitted after taking a paracetamol OD 4 h ago. She has consumed large amounts of alcohol. Her plasma paracetamol conc is just below the conc that would suggest tx. What should be the tx option for her? a. Refer to psychiatry ward b. Refer to medical ward c. N-acetylcystine d. Serum plasma paracetamol e. No further investigation

Answer 95

Ans. The key is A. Refer to psychiatry ward. [Short term acute alcohol consumption causes enzyme inhibition as in present case and even then paracetamol level is under tx level. So the patients drug level is in safe side but simultaneous drug overdose and alcohol consumption needs psychiatric evaluation and hence the option here is A].

Question 96

196. A 64yo woman has been on HRT for 9yrs. She had regular withdrawal bleeds until 3 yrs ago and since then has been taking a no bleed prep. Recently she noticed a brown vaginal discharge. Choose the single most appropriate initial inv? a. Cervical smear b. High vaginal swab c. TFT d. Transvaginal US Q. 1. What is the key? Q. 2. Why this test will be done?

Answer 96

Ans. 1. The key is D. Transvaginal US. Ans. 2. To determine the endometrial thickness! In a postmenopausal woman with vaginal bleeding, the risk of cancer is approximately 7.3% if her endometrium is thick (> 5 mm) and < 0.07% if her endometrium is thin (≤ 5 mm). In postmenopausal women without vaginal bleeding, the risk of cancer is approximately 6.7% if the endometrium is thick (> 11 mm) and 0.00

Question 97

197. A young girl complains of episodic headaches preceded by fortification spectra. Each episode last for 2-3 days. During headache pt prefers quiet, dark room. What is the tx of choice for acute stage? a. Paracetamol b. Aspirin c. Sumatriptan d. Gabapentin e. Cafergot

Answer 97

Ans. The key is B. Aspirin. This is a wrong key! Correct key is C. Sumatryptan. [Aspirin though 1st line can cause Reye’s syndrome in young girl and that is why Sumatryptan is the better option here].

Question 98

198. A 60yo pt recovering from a surgery for toxic goiter is found to be hypotensive, cyanosed in the the RR. Exam: tense neck. There is blood oozing from the drain. What is the most likely dx? a. Thyroid storm b. Reactionary hemorrhage c. Secondary hemorrhage d. Primary hemorrhage e. Tracheomalacia

Answer 98

Ans. The key is B. Reactionary haemorrhage. [in the recovery room, cyanosis, hypotension, tense neck, woozing of blood from drain; all these goes in favour of reactionary haemorrhage].

Question 99

199. A 33yo man is hit by a car. He loses consciousness but is found to be fine by the paramedics. When awaiting doctors review in the ED he suddenly becomes comatose. What is the most likely dx? a. SAH b. Subdural hemorrhage c. Intracerebral hemorrhage d. Extradural hemorrhage

Answer 99

Ans. The key is D. Extradural haemorrhage. [Age 33 (younger age), considerable head trauma, and lucid interval (present in both extradural and subdural) are the points in favour].

Question 100

200. A 77yo male presents with hx of enuresis and change in behavior. Exam: waddling gait. What is the most likely dx? a. Subdural hemorrhage b. Brain tumor c. Normal pressure hydrocephalus d. Psychotic depression

Answer 100

Ans. The key is C. Normal pressure hydrocephalus. [age (usually occurs in 60s or 70s), loss of bladder control (enuresis), waddling gait and behavior change are all features of normal pressure hydrocephalus].