1401 to 1500 Flashcards
- A 22yo Greek man presents with rapid anemia and jaundice following tx of malaria. He is noted to have Heinx bodies. Choose the single most likely cause from the given options? a. G6PD deficiency b. Anemia of chronic disease c. Pernicious anemia d. IDA e. Vit B12 deficiency
Ans. The key is A. G6PD deficiency. [G6PD (glucose-6-phosphate dehydrogenase) deficiency exacerbated by administration of oxidant drugs (e.g., primaquine, dapsone, quinidine) can also result in Heinz bodies].
- A 65yo has terminal cancer and his pain is relieved by a fentanyl patch but he now complains of shooting pain in his arm. Which of the following will add to his pain relief? a. Gabapentin b. Radiotherapy c. Amitryptiline d. Morphine
Ans. The key is A. Gabapentin. [Shooting in the arm indicates neuropathic pain for which both amytriptiline and gabapentin can be used].
- A 45yo male alcoholic presents after a large hematemesis. He has some spider naevi on his chest, BP=100/76mmHg, pulse=110bpm. He has a swollen abdomen with shifting dullness. a. Gastric ca b. Mallory-weiss tear c. Esophageal ca d. Esophageal varices e. Esophagitis f. Peptic ulceration
Ans. The key is D. Esophgeal varices. [Spider nevi and ascites suggest advanced liver disease. Here in alcoholic middle aged man having large hematemesis with above mentioned features are very suggestive of bleeding from esophageal varices secondary to portal hypertension in liver cirrhosis].
- A 23yo woman presents with a 1cm small smooth, firm, mobile mass in her left breast. She is very anxious. What is the most appropriate inv? a. Mammography b. US breast c. FNAC d. Mammography and US
Ans. The key is B. US breast. [This is fibroadenoma of the breast (breast mouse) for which US of breast is the appropriate investigation and if it reveal a fibrous lump we shall go for FNAC. Another point a doctor should know that for any suspicious breast lesion radiology should must be done before options of biopsy and investigation of choice in radiology is US scan before the age of 35 and mamm
- A pt was admitted with abdominal pain, diarrhea, pigmented palmar creases and buccal mucosa. What is the most probable dx? a. Addison’s disease b. Cushing syndrome c. Pheochromocytoma d. Hyperthyroidism e. Hypoparathyroidism
Ans. The key is A. Addison’s disease. [Abdominal pain, diarrhea, pigmented palmar creases and buccal mucosa are well known features of addisons disease].
- A 36yo pt came with diarrhea, bleeding, weight loss and fistula. What is the single most likely dx? a. Colorectal ca b. Celiac disease c. CD d. UC e. IBS
Ans. The key is C. CD. [Bloody diarrhea can occur in both CD & UC. Also weight loss is common! but fistula formation is unique feature of CD].
- A 45yo man has undergone detox and now wants a drug to stop him from craving alcohol. What med would be that drug of choice? a. Disulfiram b. Acamprosate c. Thiamine d. Naloxone e. Diazepam
Ans. The key is B. Acamprosate. [Disulfirum is a deterrent which does not reduce craving. Acramposate by restoring deranged brain chemical reduces craving].
- A 68yo man awoke to find that he is unable to close his left eye and dribbling saliva from the left angle of his mouth. What is the single most appropriate option? a. Facial nerve b. Glossopharyngeal nerve c. Hypoglossal nerve d. Optic nerve e. Vagus nerve
Ans. The key is A. Facial nerve. [Features are suggestive of left sided facial nerve palsy].
- A 19yo female dx with trichomonas vaginalis. LMP was 10d ago. What is the best antibiotic tx? a. Erythromycin b. Vancomycin c. Metronidazole d. Penicillin e. Clarithromycin f. Doxycycline g. Fluconazole h. Clotrimazole
Ans. The key is C. Metronidazole.
- A 35yo man has been given a dx of allergic rhinitis and asthma. Exam: peripheral neuropathy with tingling and numbness in a ‘glove and stocking’ distribution. Skin elsions are present in the form of tender subcutaneous nodules. The pt is responding well to corticosteroids. What is the single most appropriate dx? a. AS b. Churg-strauss syndrome c. Crytogenic organizing d. Extrinsic allergic a
Ans. The key is B. Churg-strauss syndrome. [The American College of Rheumatology has identified six criteria for the diagnosis of CSS:[3] • Asthma (wheezing, expiratory rhonchi). • Eosinophilia of more than 10% in peripheral blood. • Paranasal sinusitis. • Pulmonary infiltrates (may be transient). • Histological confirmation of vasculitis with extravascular eosinophils. • Mononeuritis multiplex or
- A 28yo woman comes with sudden onset vomiting and pain per abdomen. Exam: mobile swelling in the right iliac fossa. What is the most probable dx? a. Ectopic pregnancy b. Tubo-ovarian abscess c. Acute appendicitis d. Ovarian torsion e. Diverticulitis
Ans. The key is D. [As there is no history of amenorrhea ectopic pregnancy is less likely. So dx is possible ovarian torsion].
- A 68yo man on tx for an irregular heart beat comes to the ED. He has palpitations for the last 3h. Exam: pulse=regular, 154bpm. Carotid sinus massage settled his pulse down to 80bpm. What is the most likely rhythm disturbance? a. SVT b. V-fib c. VT d. V-ectopics e. A-fib
Ans. The key is A. SVT. [Regular tachycardia responding to vagal maneuver is likely SVT].
- A 43yo man with a hx of hospital admissions talk about various topics, moving from one loosely connected topic to another. What is the most likely dx? a. Psychosis b. Mania c. Schizophrenia d. Pressured speech e. Verbal diarrhea
Ans. The key is B. Mania. [Flight of idea is common in mania].
- An 18yo girl presents with rash on her trunk, abdominal pain, arthritis, proteinuria and hematuria. What is the most probable dx? a. TTP b. ITP c. HSP d. HUS e. Measles
Ans. The key is C. HSP. [Henoch-Schönlein purpura (HSP) is an acute immunoglobulin A (IgA)–mediated disorder characterized by a generalized vasculitis involving the small vessels of the skin, the gastrointestinal (GI) tract, the kidneys, the joints, and, rarely, the lungs and the central nervous system (CNS). Rash on trunk, abdominal pain, arthritis, proteinuria and hematuria are well known featur
- A pt is on loop diuretics. What effect do loop diuretics produce? a. Low Na+, low K+ b. Low Na+, normal K+ c. Normal Na+, normal K+ d. High Na+, low K+ e. High Na+, high K+
Ans. The key is A. Low Na+, Low K+. [Loop diuretics causes hyponatremia and hypokalemia].
- A 6yo girl is being investigated for renal failure. She is found to have a congenital abnormality of the insertion of the ureters into the urinary bladder. What is the single most likely cause for renal failure in this pt? a. SLE b. PKD c. Wilm’s tumor d. Acute tubular necrosis e. Reflux nephropathy
Ans. The key is E. Reflux nephropathy. [Reflux nephropathy is kidney damage (nephropathy) due to urine flowing backward (reflux) from the bladder toward the kidneys; the latter is called vesicoureteral reflux (VUR)].
- A 76yo man is in the CCU 2d after an acute MI. He tells you that he had an episode of rapid pounding in the chest lasting for about 2mins. He remains conscious throughout. What is the most likely rhythm? a. SVT b. VF c. VT d. V-ectopics e. A-fib
Ans. The key is C. VT. It is wrong key. Correct key should be D. V-ectopics.
- A 49yo man comes with hx of cough and SOB. His CD4 count is measured as 350. CXR shows lobar consolidation. What is the single most appropriate option? a. Mycobacterium avium intercellular b. CMV c. Streptococcus d. Toxoplasmosis e. Pneumocystis jerovici
Ans. The key is C. Streptococcus. [Features are consistent with lobar pneumonia].
- A 32yo woman with prv hx of PID now presents with severe abdominal pain. Her LMP was 8wks ago. What is the most probable dx? a. Ectopic pregnancy b. Ovarian torsion c. Hematometrium d. Chronic PID e. Cholecystitis
Ans. The key is A. Ectopic pregnancy. [PID is a risk factor for ectopic pregnancy].
- A 25yo who is 38wks pregnant presents to the labour ward with a hx of fewer fetal movements than usual during the evening. She also says that abdominal contractions are coming every few minutes and she is having a blood stained show per vagina for the last few minutes. Exam: cervix is fully affaced, 9cm dilated, cephalic presentation and station is +1. Choose the single most likely dx? a. AP
Ans. The key is C. Labour. [Abdominal contractions coming every few minutes, having blood stained show per vagina, fully effaced cervix with dilatation of 9 cm, cephalic presentation and station +1 suggests that the patient is in labour].
- A 30yo woman has a painless lump in the outer aspect of her left breast. She has had a prv breast lump. Her grandmother had breast cancer at 70yrs. She has a 1cm smooth, firm, discrete, mobile lump in the other quadrant region of the left breast. What is the single most likely dx? a. Breast abscess b. Breast carcinoma c. Breast cyst d. Fibro-adenoma e. Sebaceous cyst
Ans. D. Fibroadenoma. [H/O previous brest lump and presently with a lump of 1 cm size which is smooth, firm (not hard), discrete and mobile (not fixed) suggests fibro-adenoma].
- A 38yo woman is in the ED following an OD of her meds. She doesn’t need med tx for the OD. She says she wishes to be discharged. What is the single most appropriate management? a. Community psychiatric nurse visit b. Psychiatric OPD review the next day c. Prescribe anti-depressants d. Admission under the mental health act e. Discharge and allow to go home
Ans. The key is D. Admission under the mental health act. [There is every chance of repeat over dose. So she should be admitted under mental health act].
- A 63yo male presents after having had a seizure. Exam: alert and oriented. Exam: inattention on the left side and hyperreflexia of the arm. What is the most probable dx? a. Cerebral tumor b. Pituitary adenoma c. Cerebellar abscess d. Huntington’s chorea e. Parkinsonism
Ans. The key is A. Cerebral tumour.
- A 70yo lady on Raloxifene for osteoporosis has recently to the UK from Australia. She now presents with severe chest pain, SOB and suddenly collapsed in the ED. What is the single most appropriate dx? a. MI b. Aortic dissection c. Pulmonary embolism d. Costochondritis e. Pneumothorax
Ans. The key is C. Pulmonary embolism. [Prolonged air travel is a risk factor for pulmonary embolism].
- A 35yo woman complains of hoarseness of voice 3h after partial thyroidectomy. She had no hx of phonation probs before the surgery. What is the single most appropriate inv? a. Laryngoscopy b. Bronchoscopy c. CT neck d. CXR e. Barium swallow
Ans. The key is A. Laryngoscopy. [Probable diagnosis is recurrent laryngeal nerve palsy].
- A 40yo pt came to OPD with complaint of fever, pleuritic chest pain, productive cough and painful vesicles around the lips. Exam: temp=38C. He has a hx of splenectomy last yr. What is the single most likely causative organism? a. Pneumococcal pneumonia b. Staphylococcus c. Klebsiella d. Streptococcus e. Chlamydia psitacci
Ans. The key is A. Pneumococcal pneumonia. [painful vesicles around the lips is well known association of pneumococcal pneumonia. Also pleuritic chest pain and productive cough are present in pneumococcal pneumonia].
- A 37yo male pt who recently returned back to UK from UAE attends the OPD with complaint of dry cough, breathlessness and anorexia. According to him he had flu like symptoms a week ago. He is slightly confused. Inv: lymphopenia & decreased Na+. CXR: bi-basal consolidation. What is the single most likely causative organism? a. Legionella b. Chlamydia pneumonia c. PCP d. Viral pneumonia e. Chla
Ans. The key is A. Legionella. [H/O travel (staying in AC and watersystem of hotel), lymphopenia, decreased Na+, bi-basal consolidation are well known features of legionnaires disease].
- A 20yo student came to the OPD with complains of headache, malaise, dry cough, joint pain and vomiting. Exam: temp=39C. CXR: patchy consolidation. What is the single most likely causative organism? a. Pneumococcal pneumonia b. Mycoplasma c. Klebsiella d. Streptococcus e. PCP
Ans. The key is B. Mycoplasma.
- A 45yo man presented to his GP with vague symptoms of headache, proximal muscle weakness and nocturia. Test results show him to be severely HTN (230/130mmHg) and hypokalemic. What is the most probable dx? a. Addison’s disease b. Conn’s disease c. Familial hyperaldosteronism d. Cushing’s disease e. Cushing’s syndrome
Ans. The key is B. Conn’s disease. [High BP is often the only presentation of Conn’s syndrome. Loss of K+ in urine leads to hypokalemia which in turn causes muscle weakness and polyuria particularly nocturia].
- A man says his insides are rotting and nobody has buried him. Which term best describes his condition? a. Delusion of nihilism b. Delusion of guilt c. Delusion of persecution d. Incongruent affect e. Clang association
Ans. The key is A. Delusion of nihilism.
- A man with chronic cough presents with copious purulent sputum. What is the single most dx? a. Bronchitis b. Bronchiectasis c. COPD d. Pneumonia e. Emphysema
Ans. The key is B. Bronchiectasis.
- A 32yo man working in a shipyard comes with SOB. Exam: dullness on left side of the chest, pain in left side of chest, pleuritic rub and crackles been heard on the same side. What is the single most likely dx? a. Pericarditis b. Pleurisy c. Pleural effusion d. CCF e. TB
Ans. The key is C. Pleural effusion. [Shipyard worker are exposed to asbestos and presenting case has developed mesothelioma causing pleura thickening and pleural effusion. Though it is usual that in pleural effusion pleural rub reduces or becomes absent but it is also possible to get pleural rub even in pleural effusion and the like diagnosis is pleural effusion here].
- A 67yo female presents with balance prbs. Exam: nystagmus on left lateral gaze, a loss of the left corneal reflex and reduced hearing in the left ear. What is the most likely dx? a. Meniere’s disease b. Acoustic neuroma c. Cerebral abscess d. Pituitary tumor e. Gentamicin
Ans. The key is B. Acoustic neuroma. [nystagmus, loss of corneal reflex, hearing loss, balance problem are well known feature of acoustic neuroma].
- A 22yo man reports a 2d hx of hoarseness of voice. He denies any weight loss but he has been smoking for 4yrs. What is the single most appropriate inv? a. None b. Laryngoscopy c. Bronchoscopy d. BAL e. CXR
Ans. The key is B. Laryngoscopy. It is a wrong key! Correct key is A. None. [If horseness is of >3 weeks in man >50 yrs and smoker and heavy drinker to rule out cancer do CXR and\or laryngoscopy- NICE guideline].
- A 34yo IVDA (intravenous drug addict) presents with a 4m hx of productive cough. He has lost 10kgs. What is the single most appropriate inv? a. Sputum for AFB b. Laryngoscopy c. Bronchoscopy d. CT neck e. CXR
Ans. The key is A. Sputum for AFB. [In IVDA immunity becomes low and easily gets infected with TB].
- A 25yo pt came to the OPD with complaint of fever, malaise, breathlessness, cough and anorexia. His gf has got similar symptoms. He had hx of sore throat and ear discharge a month ago. What is the single most likely causative organism? a. Legionella b. Mycoplasma c. Chlamydia pneumonia d. PCP e. Chlamydia psitacci
Ans. The key is C. Chlamydia pneumonia.
- A 72yo male presents with acute confusion. He has been in the hosp for 2wks having been treated for a DVT. The nurses have noticed that he became increasingly drowsy. Exam: small scalp laceration, a GCS of 8 and bilateral up-going plantar response. a. Infection toxicity b. Delirium tremens c. Extradural hematoma d. Subdural hematoma e. Electrolyte imbalance
Ans. The key is D. Subdural hematoma. [Even trivial head trauma can lead to subdural hematoma. Presence of small scalp laceration, confusion and becoming increasingly drowsy Glasgow coma scale of 8 are suggestive of subdural hematoma].
- A 50yo DM pt came to the OPD with complaint of fever, muscle ache, dry cough and anorexia. Inv: CXR=upper lobe cavitation. What is the single most likely causative organism? a. Legionella b. Mycoplasma c. Staphylococcus d. Klebsiella e. Streptococcus
Ans. The key is D. Klebsiella. [Upper lobe cavitation favours Klebsiella pneumonia. Also it is well known that staphylococcal and klebsiella pneumonia are more common in DM than normal person].
- A 20yo man complains that all his movements are being watched. Sometimes he feels as though his actions are being controlled by his radio. At other times he is aware of voices describing what he is doing. What is the most probable dx? a. Mania b. Drug induced psychosis c. Delusion of control d. Schizophrenia e. Korsakoff psychosis
Ans. The key is D. Schizophrenia.
- A 35yo is agitated and euphoric. He claims to be helping the prime minister with economic policy, although this is not true when checked. What is the most likely dx? a. Mania b. Schizophrenia c. Hypomania d. Drug induced personality disorder e. Delusion of grandeur
Ans. The key is E. Delusion of grandeur. Key is wrong! Correct key should be mania. [Agitated, euphoric and delusion of grandiosity makes the likely dx to be “Mania”. Agitation and euphoria are not feature of delusion of grandiosity but mania].
- A 20yo student who recently visited Asia came to the OPD with complains of low grade fever, night sweats, anorexia and productive cough. Inv: CXR=cavitatory lesions in upper lobes. What is the single most likelt causative organism? a. Mycoplasma b. Klebsiella c. TB d. PCP
Ans. The key is C. TB. [Low grade fever, night sweats, anorexia, dry (initially) or productive cough, and upper lobe cavitary lesions are highly suggestive of TB].
- A 35yo man with T1DM is dehydrated with BP=90/50mmHg. What is the single most appropriate initial inv? a. ABG b. CBC c. HbA1c d. LFT e. BUE
Ans. The key is A. ABG. [The likely dx is DKA. Among the given options ABG is the most appropriate inv. To demonstrate acidosis].
- A 45yo woman presents with pruritis. Exam: skin pigmentation. Inv: raised ALP and presence of anti-mitochondrial antibodies. What is the single most likely dx? a. Psoriasis b. Scabies c. Atopic eczema d. Dermatitis herpetiformis e. Hyperthyroidism f. Primary biliary cirrhosis
Ans. The key is F. Primary biliary cirrhosis. [Pruritus, skin pigmentation (increased amounts of melanin, widely dispersed throughout both epidermis and dermis), raised ALP, and presence of AMA are diagnostic of primary biliary cirrhosis].
- A 60yo man complains of tiredness, lethargy and itching that is severe after a hot bath. He also has nocturia, polyuria and nausea and vomiting. Exam: pallor, pigmentation and generalized edema. What is the single most likely dx? a. Hyperthyroidism b. Lichen planus c. Lymphoma d. Eczema e. Liver failure f. CRF
Ans. The key is F. CRF. [Given picture is typical of CRF].
- A 30yo man complains of vague pain in the loin with BP=140/90mmHg. He is found to have proteinuria and hematuria. What is the inv to confirm the dx? a. Abdominal US b. ANCA c. ANA d. Urine microscopy and culture e. Stool culture
Ans. The key is A. Abdominal US. [The likely dx is ADPKD for which US is diagnostic investigation].
- A 54yo man comes with sudden onset of palpitations and breathlessness. His HR=164bpm. What is the single most appropriate tx in the acute phase? a. Adenosine b. Metaprolol c. Verapamil d. Amiodarone
Ans. The key is A. Adenosine. [Common arrhythmias we encounter are AF, SVT, VT in exams. Here no suggestive feature for AF and SVT is the commonest presentation as in described case. So first we shall give adenosine to establish the diagnosis].
- A 29yo woman has developed an itchy scaly rash particularly over her wrist with fine white streaks overlying the lesion. Her nails have ridges and her buccal mucosa is lined with a lacy white pattern. What is the single most likely dx? a. Psoriasis b. Scabies c. Urtericaria d. Dermatitis herpetiformis e. Hyperthyroidism f. Lichen planus
Ans. The key is F. Lichen planus. [“Lacy white pattern” is used as a diagnostic description of lichenplanus].
- The artery that runs in the ant inter-ventricular groove. What is the single most appropriate option? a. Acute marginal branch b. Left ant descending artery c. Coronary sinus d. Circumflex artery e. Right coronary artery
Ans. The key is B. Left ant descending artery
- Which virus is transmitted by the fecal-oral route? a. Hep C b. Coxsackie virus c. Dengue d. None of the above
Ans. The key is B. Coxsackie virus.
- A 40yo woman presented with generalized itching and tiredness for few months. She gave a hx of heavy menstrual periods. Exam: pallor. What is the single most likely causative factor? a. IDA b. Lichen planus c. Dermatitis herpitiformis d. Eczema e. Uremia
Ans. The key is A. IDA. [IDA is one of the cause of pruritus. Heavy periods, pallor and tiredness further supports the diagnosis].
- A 7yo child presents with lesions on the trunk. Exam: some lesions are weeping and others are crusted with a red base. What is the causative organism? a. Herpes simplex b. Varicella zoster c. Rubella virus d. Herpes zoster
Ans. The key is B. Varicella zoster.
- An 87yo woman with a hx of HTN has acute breathlessness. She has a RR=32bpm, widespread lung crackles, pulse=120bpm, BP=160/90mmHg and elevated venous pressure. Her peripheral O2 sat=85%. What is the single most appropriate initial management? a. IV antibiotics b. IV furosemide c. Nitrate infusion d. Neb. Salbutamol e. 100% oxygen
Ans. The key is E. 100% oxygen. [Most appropriate initial management is E. 100% oxygen.Oxygen saturation is low. So we have to give oxygen initially].
- A 25yo man presented with painless cervical lymphadenopathy with lethargy, night sweats and itching. What is the single most likely causative factor? a. Lymphoma b. Polycythemia c. IDA d. Uremia e. Drug induced
Ans. The key is A. Lymphoma. [Cervical lymphadenopathy, lethargy, night sweats and itching are well known features of lymphoma].
- A 25yo male presents with fever and pain in the right lower thigh of 1m duration. Exam: lower third of his thigh is red, hot and tender. The XR showed new bone formation. What is the most probable dx? a. Osteosarcomoa b. Ewing’s sarcoma c. Tuberculus arthritis d. Exotosis e. Fibrosarcoma
Ans. The key is B. Ewing’s sarcoma.
- A 76yo man presents with sore throat, local irritation by hot food, dysphagia and a sensation of a lump in his throat. He has a 20y hx of smoking. What is the single most likely dx? a. Nasopharyngeal ca b. Pharyngeal ca c. Sinus squamous cell ca d. Squamous cell laryngeal ca e. Hypopharyngeal ca
Ans. The key is B. Pharyngeal Ca.
- A 42yo female who is obese comes with severe upper abdominal pain and right shoulder tip pain with a temp=37.8C. She has 5 children. What is the most probable dx? a. ERCP b. LFT c. Serum amylase d. MRCP e. US abdomen
Ans. The key is US abdomen. [5 “f”. Fat, female, fair, fourty, fertile = cholecystitis].
- A 37yo laborer comes with hx of redness of left eye with foreign body sensation in the same eye. What is the single most appropriate option? a. Ciliary body b. Sclera c. Conjunctivitis d. Cornea e. Iris
Ans. The key is D. Cornea. [Redness with foreign body sensation of eye in a labourer are most likely due to foreign body in cornea].
- An 11yo boy came to the hospital with pain after falling off his bicycle. XR= fx at distal radius with forward angulations. What is the single most probable dx? a. Dinner fork deformity b. Cubitus valgus c. Gun stock deformity d. Garden spade deformity e. Genu valgus
Ans. The key is D. Garden spade deformity.
- A middle aged man with a lump in front of his neck which moves up while he’s swallowing. US shows a mass replacing the left lobe of thyroid. And spread to the sternocleidomastoid and adjacent muscles. What is the most probable dx? a. Thyroid ca b. Pharyngeal pouch c. Bronchus ca d. Thyroid cyst e. Larynx ca
Ans. The key is A. Thyroid Ca.
- A 28yo male complains of severe pain while trying to grasp any object. It started since he participated in skiing and had a fall and caught his thumb in the matting. Exam: rupture of the ulnar collateral ligament of MCP joint of the thumb. What is the single most probable deformity? a. Dinner fork deformity b. Game keeper thumb c. Mallet finger d. Gun stock deformity e. Garden spade deformit
Ans. The key is B. Game keeper thumb. [Gamekeeper’s thumb is an insufficiency of the ulnar collateral ligament (UCL) of the metacarpophalangeal (MCP) joint of the thumb].
- A 25yo male had an injury to the knee while playing football. XR=condylar fx of tibia. What is the single most probable deformity? a. Dinner fork deformity b. Gibbus c. Cubitus valgus d. Garden spade deformity e. Genu valgus
Ans. The key is E. Genu valgus.
- A 50yo man presents with itching after hot shower with dizziness, chest pain after exercise. Exam: splenomegaly. What is the single most likely causative factor? a. ALL b. Lymphoma c. Polycythemia d. Scabies e. Eczema
Ans. The key is C. Polycythemia. [Itching after hot shower; dizziness and angina due to hyperviscosity and splenomegaly are well known features of polycythemia].
- A man presented with carcinoma of the bladder and has been working in factories. He wants to know what dye has caused it. What is the single most likely cause? a. Aniline b. Asbestos c. Latex d. Silica
Ans. The key is A. Aniline. [Aniline dye is a well known cause of bladder cancer].
- A 62yo man presents with left sided hearing loss and tinnitus. He also complains of vomiting and headache. Exam: papilledema and SNHL in the left ear. What is the single most likely dx? a. Meningioma b. Nasopharyngeal ca c. Acoustic neuroma d. Pharyngeal ca e. Meniere’s disease
Ans. The key is C. Acoustic neuroma. [SNHL, tinnitus, papilledema (raised intracranial pressure) are suggestive of acoustic neuroma].
- A HIV +ve 55yo man presents with painless lymphadenopathy, fever, night sweats and weight loss. What is the most probable dx? a. Hodgkin’s lymphoma b. NHL c. ALL d. AML e. CML
Ans. The key is B. NHL. [NHL is more likely diagnosis in AIDS or immunodeficient state].
- A 22yo man says that he can hear the voice of his deceased uncle telling him that he is being spied on. The pt is distressed by this becoming low in mood and anxious and has not left the house for 2wks. He is starting to drink increasing quantities of alcohol. He is noticed to have thought-block and passivity phenomena. What is the single most suitable med to treat his symptom? a. Diazepam b
Ans. The key is E. Olanzapine. [Auditory hallucination, social withdrawal, thought block are features of schizophrenia. So olanzapine is the drug to be prescribed from the given option].
- A middle aged Asian presents with episodes of fever with rigors and chills for last 1yr. Blood film: ring form of plasmodium with schuffners dots in RBCs. What is the drug to eradicate this infection? a. Doxycycline b. Mefloquine c. Proguanil d. Quinine e. Artesunate
Ans. The key is B. Mefloquine which is a wrong key! None of the given option is correct!! [Shuffners dot indicate either vivax or ovale infection and the hepatic cycle only can be eradicated by primaquine. So none of the given drugs are the option!! It is a bad recall].
- A 50yo man presents with flight of ideas which are rambling and disinhibited. He is distractable, confused and overactive. What is the most likely dx? a. Dementia b. Mania c. Schizophrenia d. Psychosis e. Acute confusional state
Ans. The key is B. Mania. [Flight of ideas, dysinhibition, distractibility, confusion and overactivity are features of mania].
- A pt presents with a lid lag, bulging eyes, opthalmoplegia and thyroid bruit. What inv will you do? a. TFT b. Eye sight c. Tensilon test d. US e. FNAC
Ans. The key is TFT. [TFT should be done. Why not FNAC? Thyrotoxicosis is benign and not malignant].
- A 30yo lady complaining of right ear deafness with decreased corneal reflex and past pointing. Acoustic analysis shows SNHL. What is the next most appropriate inv to do? a. CT brain b. CT acoustic canal c. MRI brain d. MRI acoustic canal e. PET brain
Ans. The key is MRI brain. This is wrong key! Correct key is D. MRI acoustic canal.
- A 29yo woman who returned from Egypt 2wks ago now presents with difficulty in breathing, chest pain, cough and purulent sputum with an episode of blood staining. She is on COCPs. What is the most likely dx? a. Pulmonary embolism b. Pneumonia c. Lung abscess d. Pneumothorax e. Pulmonary edema
Ans. The key is B. Pneumonia. [Purulent sputum is the clincher to differentiate pneumonia from pulmonary embolism here].
- A 60yo pt recovering from a surgery for toxic goiter is found to be hypotensive, cyanosed in the recovery room. Exam: neck is tense. There is oozing of blood from the drain. What is the most probable dx? a. Thyroid storm b. Reactionary hemorrhage c. Secondary hemorrhage d. Primary hemorrhage e. Tracheomalacia
Ans. No key is given. Correct key is B. Reactionary hemorrhage. [Hemorrhage within 1st 24 hours which usually occurs due to dislodgement of clot or slippage of a ligature].
- A 40yo woman has had varicose vein surgery, planned as a day pt. After the op, she is distressed by repeated retching and vomiting. Her pain is currently well controlled. What is the best management strategy? a. Tramadol b. Co-codamol c. IM morphine d. IV ondansetron e. PO ondansetron
Ans. The key is D. IV ondensatron. [As there is repeated retching and vomiting pt. cannot keep oral medication down. So IV ondansatron].
- A pt with renal failure has serum K+=7.5, raised creatinine and broad complex tachycardia. What is the most appropriate management? a. Calcium gluconate b. Sodium bicarbonate c. Dialysis d. Furosemide e. Sotalol
Ans. The key is A. Calcium gluconate. [Calcium gluconate don’t shift K+ to cell or reduce potassium level but it prevents arrythmogenic action of raised K+ till definitive measure is taken].
- An 18yo lady in her 30th wk of pregnancy is brought to the hospital in an altered sensorium. She is taking slow, shallow breaths and her breath has a fruity smell. An ABG: pH=7.20, urine ketones: +ve. What is the most probable dx? a. HONK b. DKA c. HELLP syndrome d. PIH e. GDM
Ans. The key is B. DKA. [Shallow breath and fruity smell with acidosis in ABG and positive ketone body in urine suggests the diagnosis of DKA].
- A 26yo man presented with abdomen distension and pain. His stools have been mucoid and sometimes blood stained. What is the most appropriate inv? a. Stool C&S b. Gastroscopy c. IgG tissue transglutaminase d. Barium meal e. Jejunal biopsy
Ans. The key is D. Barium meal. [Probable diagnosis is Crohn’s disease. Can be demonstrated by barium meal].
- An 83yo elderly woman presented in the ED with cough, fever and sneezing. Tx was given but she became confused and again presented with above said symptoms. What is the cause of her condition? a. Aspiration due to confusion b. Alveolar damage due to drugs c. Drug toxicity d. Pneumothorax
Ans. The key is A. Aspiration due to confusion.
- A 37yo man presents with some raised lesions on the shin. He came with cough and also complains of arthralgia. Exam: bilateral hilar lymphadenopathy and erythema nodosum is present. What is the single most likely cause? a. CD b. UC c. Sarcoidosis d. Streptococcal infection e. TB
Ans. The key is B. UC. It is a wrong key! Correct key is C. Sarcoidosis. [Cough, arthralgia, bilateral hilar lymphadenopathy and erythema nodosum are suggestive of sarcoidosis].
- A young lady with cervical ectropion bleeds on touch. What is the most appropriate next inv? a. Transvaginal US b. Cervical smear c. Punch biopsy d. Serum estradiol e. Colposcopy
Ans. B. Cervical smear. Wrong key! Correct key is E. colposcopy.[Screening test cervical smear is only done in scheduled time and not in on demand basis. So if it is scheduled now then it can be the option otherwise Colposcopy should be the key!! This is definitely an incomplete question].
- A 28yo man with recent onset of dyspepsia after eating spicy food and alcohol consumption. H. pylori fecal antigen was negative. He returns after 1m with similar symptoms despite being given omeprazole 40mg. What is the single best initial inv? a. Hydrogen breath test b. Gastroscopy c. Barium meal d. None
Ans. The key is B. Gastroscopy.
- A 35yo woman who usually has 4 days mid-cycle bleeding, had her period 10d ago. She has now presented with spots of blood. Her smear was normal 6m ago. Exam: cervical ectropion which doesn’t bleed on touch. What would you do? a. Cervical smear b. Endocervical swab c. US guided biopsy d. Laparotomy e. Transvaginal US f. Punch biopsy g. Serum estradiol h. Colposcopy
Ans. The key is A. Cervical smear. Wrong key! Correct key is colposcopy! [Cervical smear can only be done on scheduled time and not in on need basis. In such case if investigation is needed colposcopy can be done].
- A 7yo boy presents with epistaxis of 2h duration. The bleeding has been controlled. Inv: Plts=210, PT=13, APTT=42, bleeding time=normal. Which of the following is the most likely dx? a. Hemophilia b. Von willebrand disease c. ITP d. Vit K deficiency e. Liver disease f. Anatomical defect
Ans. The key is F. Anatomical defect.
- A pregnant woman returns from Sudan, now presenting with intermittent fever, rigor and seizures. What is the dx? a. TB b. Malaria c. Meningitis d. Lyme disease
Ans. The key is B. Malaria. [Intermittent fever is seen in malaria. In meningitis fever is not intermittent].
- A pt is unresponsive and cyanosed. What is the most definitive 1st step in management? a. Chest compressions b. Check airway c. Call 999 d. Mouth to mouth e. Recovery position
Ans. The key is B. Check airway.
- A man was bitten by a drug addict and comes to the hosp with a wound. What inv should be undertaken? a. Hep C b. Lyme disease c. Hep B d. Syphilis e. Hep A
Ans. The key is C. Hepatitis B.
- An 18yo woman says that she can’t walk around as she is very big for that room. What is the most likely hallucination? a. Extracampine visual hallucinations b. Liliputian visual hallucinations c. Alice in wonderland syndrome d. Hypnagogic hallucinations
Ans. The key is B. Lilliputian visual hallucination. [B. Liliputian visual hallucinations and C. Alice in wonderland syndrome are same].
- A middle aged lady presented with fever, altered sensorium, bleeding gums and jaundice. Labs: deranged renal function tests, normal PT/APTT, fragmented RBCs and low plts. What’s the most likely dx? a. Cholesterol emboli b. HUS c. TTP d. Hepatorenal syndrome e. Sepsis
Ans. The key is C. TTP. [Fever and altered sensorium suggest the diagnosis of TTP].
- A child came to the ED with severe asthma and not responding to salbutamol nebulizer and vomiting many times. What is the most appropriate management? a. Salmetrol b. Montelukast c. Prednisolone d. Budesonide inhaler e. Oxygen f. IV salbutamol
Ans. The key is A. Salmeterol which is a wrong key!! The correct option is F. IV salbutamol. [In acute attack there is no place for salmeterol. In the given case most appropriate management is IV salbutamol].
- A 73yo woman with skeletal and brain mets from breast ca has worsening low back pain and blurring of vision. She has weakness of her legs, minimal knee and absent ankle tendon reflexes, a palpable bladder, a power of 2/5 at the hip, 3/5 at the knee and ankle, and tenderness over the 2nd lumbar vertebra. There is reduced sensation in the perineum. She has been started on dexamethasone 16mg da
Ans. No key is given! The likely correct option is D. Spinal cord compression. [Brain metastasis induced cerebral oedema can explain blurring of vision secondary to raised intracranial pressure. Rest of the features including weakness can well explain spinal cord compression].
- A 78yo woman presents with unilateral headache and pain on chewing. ESR=70mm/hr. She is on oral steroids. What is the appropriate additional therapy? a. Bisphosphonates b. HRT c. ACEi d. IFN e. IV steroids
Ans. The key is A. Bisphosphonates. [Oral steroid can lead to decrease in bone mineral density. To overcome this Bisphosphonate can be administered].
- A 48yo woman is admitted to the ED with a productive cough and mod fever. She often has central chest pain and she regurgitates undigested food most of the time but doesn’t suffer from acid reflux. These symptoms have been present for the last 3.5m which affects her daily food intake. CXR: air- fluid level behind a normal sized heart. What is the single most likely dx? a. Pharyngeal pouch b.
Ans. 1. The key is B. Hiatus hernia. This is a wrong key. Correct key should be D. Achalasia. Ans. 2. Points in favour: Aspiration pneumonia due to retained food and fluid in oesophagus. In achalasia usually there is no acid reflux. Dysphagia for both food and drink. Air-fluid level behind heart. Why it is not hiatus hernia? Ans. Differentiating point:-i) In hiatus hernia usually you will get asso
- A retired ship worker has pleural effusion and pleural thickening on right side with bilateral lung shadowing. What would you do to improve his symptoms? a. Aspiration b. Chest drain c. Chemotherapy d. Diuretic
Ans. The key is C. Chemotherapy. It is a wrong key! Correct key is B. Chest drain. [Respond to chemotherapy and life expectancy is poor in mesothelioma. To improve symptoms chest drain should be undertaken].
- An 88yo woman is a known smoker. She had an attack of MI 2y back and is known to have peripheral vascular disease. She presents with an irreducible herniation over the incision region of a surgery which she underwent in her childhood. What is the most appropriate tx? a. Truss b. Elective herniorrhaphy c. Urgent herniorrhaphy d. Elective herniotomy e. Reassure
Ans. The key is B. Elective hernioraphy. [Truss can not be used as hernia is irreducible; urgent herniorrhaphy in strangulation; elective herniotomy- in herniotomy the hernia will not subside or recur; only reassure is not an option as irreducibe hernia may become strangulated or may develop intestinal obstruction].
- A 72yo woman who is taking loop diuretics for left ventricular failure. She now is suffering from palpitations and muscle weakness. What is the electrolyte imbalance found? a. Na+=130mmol/L, K+=2.5mmol/L b. Na+=130mmol/L, K+=5.5mmol/L c. Na+=140mmol/L, K+=4.5mmol/L d. Na+=150mmol/L, K+=3.5mmol/L e. None
Ans. The key is A. Na+=130mmol/L, K+=2.5mmol/L. [Loop diuretics causes hyponatremia and hypokalemia].
- A young woman who is a marathon runner comes with secondary amenorrhea. Inv: normal LH, FSH and estradiol, prolactin=600. What is the most likely dx? a. Hypothalamic amenorrhea b. Pregnancy c. PCOS d. Prolactinoma e. Anorexia
Ans. The key is D. Prolactinoma. It is a wrong key. Correct key is A. Hypothalamic amenorrhea. [Generally in hypothalamic amenorrhea there is slight low level of LH, FSH and Oestrogen and mild elavation of prolactin].
- A 4yo child comes with a sprain in his foot. Hx reveals that the child has had recurrent admissions to the hosp due to severe asthma. What is the most appropriate analgesic? a. Diclofenac sodium b. Ibuprofen c. Paracetamol d. Codeine
Ans. The key is C. Paracetamol.
- A 34yo pregnant woman, 38wk GA is in labor. She had a long 1st stage and troublesome 2nd stage, has delivered a baby. After her placenta was delivered she had a convulsion. What is the most probable management? a. MgSO4 IV b. Diazepam IV c. IV fluid d. Hydralazine IV e. Anti-epileptic
Ans. The key is A. MgSO4 IV. [Eclampsia, tx is IV MgSO4].
- A 23yo woman presents with offensive vaginal discharge. Vaginal pH=4.5. What is the most likely organism? a. Gardenella b. Trichomonas c. Candida d. Mycoplasma
Ans. The key is A. Gardenella.
- A 62yo man has had ano-rectal pain aggravated by defecation for 3d. Rectal exam: purple, tender lump at the anal verge. Flexible aigmoidoscopy: normal rectal mucosa and hard feces. What is the best management strategy? a. Anal hematoma b. Anal fissure c. Rectal ca d. Diverticulitis e. Angiodysplasia
Ans. The key is A. Anal hematoma.
- A 43yo presents with severe vertigo on moving sidewards whilst sleeping. What test would you do to confirm the dx? a. Hallpikes maneovure b. Romberg’s test c. Trendelenburg test d. Heel-shin test
Ans. The key is A. Hallpike maneovure. [Hallpike maneovure is the preferred method to detect benign positional vertigo].
