1501 to 1600

Question 1

1501. A 23yo man is having difficulty in speaking following a stab wound to the right of his neck. On being asked to protude his tongue, the tip deviated to the right. Which anatomical site is most likely to be affected? a. Facial nerve b. Hypoglossal nerve c. Vagus nerve d. Trigeminal nerve e. Glossopharyngeal nerve

Answer 1

Ans. The key is B. Hypoglossal nerve. [In hypoglossal nerve palsy the tongue will be curved toward the damaged side, combined with the presence of fasciculations or atrophy].

Question 2

1502. A girl presents with signs of hyperventilation. What is the most likely ABG derangement? a. pH increased, PCO2 increased b. pH decreased, PCO2 increased c. pH increased, PCO2 decreased d. pH decreased, PCO2 decreased

Answer 2

Ans. The key is A. pH increased, PCO2 increased. This is a wrong key. Correct key should be C. pH increased, PCO2 decreased.

Question 3

1503. A pt presents with skin pigmentation, diarrhea, vomiting, abdominal pain and postural hypotension. What electrolyte abnormality is likely to occur? a. Na+=130, K+=6.5 b. Na+=130, K+=2.5 c. Na+=13, K+=6.0 d. Na+=140, K+=8 e. Na+=130, K+=1.5

Answer 3

Ans. The key is A. Na+=130, K+=6.5. [In Addison’s disease there is low Na+, low Cl-, low CO2 and raised K+].

Question 4

1504. A 10yo boy develops nasal bleeding. What is the best way to stop the bleeding from the nose? a. Pressure over base of the nose b. Ice packs c. Pressure over the soft tissues d. Nasal packing e. Surgery

Answer 4

Ans. The key is C. Pressure over the soft tissues.

Question 5

1505. A pt came to the hosp with a complaint of severe chest pain lasting for >1h. Following ECG test, pt revealed to have ST depression. He was already on aspirin. What is the most specific tx for this pt? a. GTN b. Simvastatin c. Clopidogrel d. BB e. LMWH

Answer 5

Ans. The key is B. Simvastatin. It is a wrong key. Correct key should be LMWH. [Specific treatment means treatment particularly adapted to the special disease being treated. LMWH is vital to prevent further events or deterioration and seems to be the most specific drug in the given scenario].

Question 6

1506. A 69yo woman presents with a sudden onset of weakness of her right arm and leg. She is known to be hypertensive. There has been no headache, LOC, visual, speech or sensory symptoms. Exam: BP=180/90mmHg, pulse=100 and regular heart sounds, no carotid bruit. Higher mental function tests are normal. No apraxia or neglect. Speech, swallowing and sensation are normal. There are no visual field de

Answer 6

Ans. The key is B. Lacunar stroke. [Weakness of right arm and leg. So lesion is on left side. Hence C,D and E can not be the option. Also no AF or carotid artery disease and features are very much consistent with lacunar infarct].

Question 7

1507. A 34yo man has an intermittent epigastric pain for 3wks. It is worse by food but helped by some tablets he obtained from the pharmacy. He had a similar episode 3yrs ago and his doctor gave him a course of 3 types of tablets at the time. What is the most appropriate next inv? a. Abdomen US b. Barium meal c. Serum H.Pylori antibodies d. C13 urea breath test e. Upper GI endoscopy

Answer 7

Ans. The key is D. C13 urea breath test. [Patient was allright for 3yrs after eradication therapy. Now symptoms again may indicate recurrence of H. Pylori infection which can be demonstrated by C13 urea breath test. Serum antibody persist (IgG) for long and not reliable for recheck].

Question 8

1508. A girl with sickle cell anemia has painful bleeding and vaso-occlusive crisis during her periods. What is the best possible management for this pt? a. COCP b. Tranexamic acid c. Copper IUS d. UAE e. Depot provera

Answer 8

Ans. The key is E. Depot provera. [Hormone and barrier methods are all acceptable choices but intrauterine devices are not recommended, as they may be associated with uterine bleeding and infection. Depot contraceptive (Depo-Provera®) is safe and has been found to improve the blood picture and reduce pain crises].

Question 9

1509. A 70yo pt comes with swelling in the parotid region for the last 10y. Exam: gland is soft and cystic. Choose the most probable dx? a. Pleomorphic adenoma b. Carcinoma of the salivary glands c. Mikulicz’s disease d. Adenoid cystic carcinoma e. Parotid duct stones

Answer 9

Ans. The key is D. Adenoid cystic carcinoma. [Pleomorphic adenoma is firm in consistency not soft and cystic. Also adenoid cystic carcinoma progresses slowly and 15 year cervival is 40%].

Question 10

1510. A 74yo man has been admitted unconscious with no hx. He has a GCS=6 and a dilated left puil which becomes insensitive to light. What is the single most likely dx? a. Extradural hematoma b. Meningitis c. Opioid OD d. Pontine hemorrhage e. SAH

Answer 10

Ans. The key is E. SAH. [Extradural hematoma is very rare in elderly and there occurs lucid interval;Features are not consistent with meningitis. Opioid and pontine hemorrhage causes myosis. So likely dx here is SAH].

Question 11

1511. A 27yo man presents to the ED with 2d hx of severe headache and pyrexia (38.9C). CT: petechial hemorrhage in the temporal and inf frontal lobes. What is the most likely dx? a. Brain abscess b. Meningococcal meningitis c. Cerebral malaria d. Herpes simplex encephalitis e. New variant CID

Answer 11

Ans. The key is D. Herpes simplex encephalitis. [Petechial hemorrhage in the temporal and inferior frontal lobes are characteristic of Herpes simplex encephalitis].

Question 12

1512. A 44yo woman with memory loss, poor concentration and inability to recognize household projects. She has right-handed involuntary writhing movement. There is strong fam hx of similar complain. What is the single most likely dx? a. Pic’s dementia b. Wilson’s disease c. Huntington’s disease d. HIV associated dementia e. Fronto-temporal dementia

Answer 12

Ans. The key is C. Huntington’s disease. [A person with Huntington’s disease may appear to have a lack of drive, initiative and concentration. Involuntary jerking or writhing movements (chorea). Typical presentation is between 35-55 yrs].

Question 13

1513. A 54yo man has collapsed suddenly following a headache. He has hypertension and takes warfarin for prosthetic heart valve. GCS=4 and dilated left pupil. What is the single most likely dx? a. Ant circulation stroke b. Post circulation stroke c. Intracerebral hemorrhage d. Intracerebellar hemorrhage e. Pontine hemorrhage.

Answer 13

Ans. The key is C. Intracerebral hemorrhage. [Headache, collapse, and warfarine use makes the dx of intracerebral hemorrhage most likely. “Pointers to bleeding (unreliable!): Meningism, severe headache, and coma within hours.” OHCM].

Question 14

1514. A 5wk breast fed baby whose birth weight was 3.5kg and is now 4.5kg is thriving well but is deeply jaundiced. What is the most likely dx? a. Galactosemia b. Breast milk jaundice c. Thalassemia d. Sickle cell disease e. Congenital storage disorder

Answer 14

Ans. The key is B. Breast milk jaundice. [Breast milk jaundice is a type of neonatal jaundice associated with breastfeeding. It is characterized by indirect hyperbilirubinemia, presents in the first or second week of life, and can persist for as long as 12 weeks before spontaneous resolution. There is normal thrive and weight gain. In galactosemia there will be lethargy, vomiting, diarrhea and fai

Question 15

1515. A 71yo man with no prv immediate hx is brought to the ED by his wife who says he has become progressively more forgetful, tends to lose his temper and is emotionally labile. There is no hx of infectious disease or trauma. What’s the single most likely dx? a. Pic’s dementia b. Fronto-temporal dementia c. Huntington’s disease d. Alzheimer’s disease e. Vascular dementia

Answer 15

Ans. The key is D. Alzheimer’s disease. [Pic’s dementia and fronto-temporal dementia are similar in some way (first personality change then dementia) but in pic’s there is odd social behavior like violating etiquettes and says vulgar. In huntington’s disease there is changes in personality, cognition and physical skills at the age of 35-45yrs and there is chorea. In vascular dementia there is mult

Question 16

1516. A 38yo woman with hemophilia who received several blood transfusions a few years ago presents with irritability and increasing memory deficit. She is unable to speak properly. He is on anti-TB tx. What is the single most likely dx? a. Creutzfeldt Jacob disease b. Drug toxicity c. Vascular dementia d. HIV associated dementia e. Space occupying lesion

Answer 16

Ans. The key is D. HIV associated dementia. [Blood transfision is the clue for HIV transmission. Immunodeiciency is also responsible for TB].

Question 17

1517. An 18yo girl has menorrhagia and dysmenorrhea and requires contraception. What drug will you give her? a. COCP b. Mirena coil c. Copper T d. UAE e. Depo provera

Answer 17

Ans. The key is A. COCP. It is a wrong key. Correct key should be B. Mirena coil.

Question 18

1518. A pt of tuberculous abscess with the hx of prv abscess drainage presented with fever and tenderness between L2/L3 vertebra. Which is the best inv for this pt? a. XR b. CT c. US d. MRI e. Blood culture

Answer 18

Ans. The key is D. MRI. [Vertebral collapse from TB infection is better seen on MRI].

Question 19

1519. A 4yo child presents with repeated chest infections. He has yellow discoloration of sclera and the mother gives a hx of diarrhea as well. What is the single inv most likely to lead to a dx? a. Sweat chloride test b. Anti-endomysial antiboides c. LFT d. Jejunal biopsy e. TFT

Answer 19

Ans. The key is A. Sweat chloride test. [Repeated chest infections, and jaundice suggests dx of cystic fibrosis. In the hepatobiliary system which is damaged in about 25 to 30% of the cystic fibrosis patients, malfunctioning secretion can cause liver disease and gall stones, leading to pain and jaundice. For cystic fibrosis sweat chloride test can be done].

Question 20

1520. An 82yo woman has been admitted from a nursing home with dense hemiplegia and homonymous hemianopia. She is dysphasic. What vessel is most likely to be involved? a. Ant cerebral artery b. Mid cerebral artery c. Post cerebral artery d. Internal carotid artery e. Post inf cerebellar artery

Answer 20

Ans. The key is B. Mid cerebral artery. [Hemiplegia, homonymous hemianopia, dysphasia these are common features of mid cerebral artery stroke].

Question 21

1521. A pt is dx with SIADH. Choose the appropriate biochemical change. a. Plasma Na+ decrease and urine osmolarity increase b. Plasma Na+ decrease and urine osmolarity decrease c. Plasma Na+ increase and urine osmolarity decrease d. Plasma Na+ increase and urine osmolarity increase

Answer 21

Ans. The key is A. Plasma Na+ decrease and urine osmolarity increase.

Question 22

1522. A newborn that is electively intubated at birth and is due for surgery 48h after birth. The condition was suspected on antenatal US on CXR. What is the most likely dx? a. CF b. Congenital diaphragmatic hernia c. Congenital cystic adenomatoid malformation d. RDS e. Alpha 1 antitrypsin deficiency

Answer 22

Ans. The key is B. Congenital diaphragmatic hernia.

Question 23

1523. A 63yo male undergoes abdominal surgery. On Monday morning, 3d post-op, repeat samples confirm serum K+=7.1mmol/l. His ECG shows broad QRS complexes. Which one of the following can be used as an effective tx for this pt’s hyperkalemia? a. Calcium chloride IV b. Calcium gluconate IV c. Insulin subcutaneously d. Furosemide IV

Answer 23

Ans. The key is B. Calcium gluconate IV. [Calcium gluconate does not shift potassium into cells or reduce its level but prevents its arrythmogenic effect on heart and buys time till definitive measures are taken].

Question 24

1524. A 25yo man attended in urological OPD has single testis. He was inv and other testis was located in the abdomen. What is the best management plan for this pt? a. Short trial of HCG b. Orchidectomy c. Orchidopexy d. Reassurance e. IV testosterone

Answer 24

Ans. The key is C. Orchidectomy. [Ectopic testis is prone to develop testicular cancer and therefore it should be surgically removed].

Question 25

1525. A 56yo male who presented with epilepsy like symptoms has been dx with an intracranial space occupying lesion. He now complains of thirst and mild dehydration. His blood glucose is also increased. What is the single most appropriate immediate tx? a. Insulin b. IV fluids c. Stop dexamethasone d. Stop sodium valproate and change to another anti-epileptic

Answer 25

Ans. The key is B. IV fluids. It is wrong key. Correct key should be A. Insulin. [Hyperglycemia is not a feature of ICSOL per se but indicates dexamethasone therapy. For dexamethasone induced hyperglycemia lose insulin is the treatment. So answer should be A. insulin. Also for mild dehydration IV fluid is not indicated. IV fluid is not indicated even in moderate dehydration. It is only indicated i

Question 26

1526. A mother brings her newborn to the hosp concerned about a blue patch on the buttocks. The newborn is of mixed race and was delivered normally. What is the most appropriate management? a. Reassurance b. CBC c. XR d. Plt count

Answer 26

Ans. The key is A. Reassurance. [The diagnosis is mongolian blue or spot. Mongolian spot refers to a macular blue-gray pigmentation usually on the sacral area of healthy infants. Mongolian spot is usually present at birth or appears within the first weeks of life. Mongolian spot typically disappears spontaneously within 4 years but can persist for life. It is a benign condition requiring no interv

Question 27

1527. The ECG of a 65yo shows absent P waves, narrow QRS complex, ventricular rate of 120bpm and irregular R-R interval. What is the most probable dx? a. A-fib b. A-flutter c. SVT d. Mobitz type 1 2nd degree heart block e. Sinus tachycardia

Answer 27

Ans. The key ia A. Atrial fibrillation. [In A-fibrillation fibrillatory f waves replaces p waves and R – R interval are irregular].

Question 28

1528. The ECG of an 80yo pt of IHD shows sawtooth like waves, QRS complex of 80ms, ventricular rate of 150bpm and regular R-R interval. What is the most probable dx? a. A-fib b. A-flutter c. SVT d. Mobitz type 1 2nd degree heart block e. Sinus tachycardia

Answer 28

Ans. The key is B. Atrial flutter. [Sawtoothlike waves and regular R-R interval are diagnostic of atrial flutter].

Question 29

1529. A man brings his wife into the ED after finding her unconscious at home. He says at breakfast time she had complained of sudden severe headache. What is the most appropriate inv? a. MRI b. XR c. CT brain d. Carotid Doppler

Answer 29

Ans. The key is C. CT brain. [Probable SAH. Among the given option most appropriate is CT brain].

Question 30

1530. A 68yo lady with T2DM. Which drug should be prescribed? a. Biguanides b. Sulphonyl urea c. Insulin d. Lifestyle modifications

Answer 30

Ans. The key is A. Biguanide. [This is an incomplete question and BMI is needed to decide whether biguanide or sulphonylurea be prescribed].

Question 31

1531. In a laparoscopic mesh repair for hernia, when the trochar is inserted at midpoint between umbilicus and ischial spine. What structure will be pierced? a. Linea alba b. Rectus muscle c. Conjoint tendon d. External and internal oblique muscles e. Inguinal ligament

Answer 31

Ans. The key is D. External and internal oblique muscles.

Question 32

1532. A 48yo man has intermittent left sided lower abdominal pain and feels generally unwell. He has lost his appetite and has lost weight. Temp=38.3C and he has BP=190/100mmHg. What is the single inv most likely to lead to dx”? a. Colonoscopy b. Endomysial antibodies c. Fasting serum glucose conc d. TFT e. US abdomen

Answer 32

Ans. The key is E. US abdomen. [Probable diagnosis is diverticulitis and preferred investigation from given list is US abdomen].

Question 33

1533. A man with DM comes to the ED after he collapsed at home. His GCS=10. What should be the next initial inv for this man? a. Capillary blood sugar b. MRI head c. CT head d. Serum electrolytes

Answer 33

Ans. The key is A. Capillary blood sugar. [It may be either hypoglycemic or hyperglycemic coma which can be detected by checking capillary blood sugar].

Question 34

1534. A 60yo DM pt presented with easy fatigability, weakness and numbness of hands and swollen feet. Exam: pedal edema, sensory neuropathy and palpable liver and spleen. Urine: proteinuria. US abdomen: enlarged kidney. Renal biopsy: amorphous homogenous substance that stained red with congo-red. What is the dx? a. DM retinopathy b. Sarcoidosis c. Wilms tumor d. Amyloidosis e. Glycogen storage dis

Answer 34

Ans. The key is D. Amyloidosis [Amyloidosis is a common cause of organomegaly. Also in diabetic nephropathy kidneys may be enlarged].

Question 35

1535. A 75yo man has urinary symptoms of hesitancy, frequency and nocturia. Rectal exam: large hard prostate. What is the most appropriate inv? a. CA 125 b. CA 153 c. CA 199 d. CEA e. PSA

Answer 35

Ans. The key is E. PSA. [Urinary symptoms and hard prostate on PR suggests prostatic cancer for which PSA should be done].

Question 36

1536. A child suffering from CF developed pneumonia. Which organism is responsible for this pneumonia? a. H. influenza b. Klebsiella c. S. aureus d. S. pneumonia e. Pseudomonas

Answer 36

Ans. The key is E. Pseudomonas.

Question 37

1537. An obese woman with hx of migraine presented with heavy bleeding during menstruation which is painful and needs contraception too. What is the best possible management for this pt? a. COCP b. Mirena coil c. Copper T d. UAE e. Depo provera

Answer 37

Ans. The key is B. Mirena coil.

Question 38

1538. A 2yo fell on outstretched hand on playground. He presents with pain on base of the thumb. XR=no fx. What is the single most likely dx? a. Colles fx b. Head of radius c. Mellet finger d. Scaphoid fx e. No fx

Answer 38

Ans. The key is D. Scaphoid fx. [Scaphoid fracture is often missed in initial x-ray].

Question 39

1539. A pt was admitted with increased frequency of passing urine, increased thirst, weakness and muscle cramps. What is the most probable dx? a. Conn’s syndrome b. Cushing’s syndrome c. Pheochromocytoma d. Hyperthyroidism e. Hypoparathyroidism

Answer 39

Ans. The key is A. Conn’s syndrome. [There is hypokalemia in Conn’s syndrome. Increased frequency of passing urine and increased thirst are from nephrogenic DI resulted from hypokalemia and hypokalemia also causes weakness and muscle cramps].

Question 40

1540. A 69yo male presented with sudden onset of dysphagia. He is neither able to swallow liquid nor solid, he recently had a denture fitting. What is the most probable dx? a. Foreign body b. Plummer vinson syndrome c. Achalasia cardia d. Esophageal rupture e. Esophageal ca 1

Answer 40

Ans. The key is A. Foreign body. [Sudden onset of dysphagia to both liquid and solid and recent history of fitting denture suggests foreign body (denture) in oesophagus].

Question 41

1541. A 62yo man with chronic schizophrenia presents with a mask like face and involuntary pill rolling movement in both hands. He complains of chronic cough and forgetfulness. He is on long term antipsychotic meds. What is the single most likely dx? a. Shy drager syndrome b. Parkinsonism c. Huntington’s chorea d. Tardive dyskinesia e. Akathisia

Answer 41

Ans. The key is B. Parkinsonism. [Antypsychotic drugs can cause parkinsonism].

Question 42

1542. A 34yo female presented with vomiting preceded by an occipital headache of acute onset. Exam: conscious and alert with photophobia but no neck stiffness. CT: normal. What is the most appropriate further management? a. CT brain with contrast b. Repeat CT brain in 24h c. CSF exam d. Cerebral angio e. MRI brain

Answer 42

Ans. The key is C. CSF exam. [Probable subarachnoid hemorrhage. CT may not show any abnormality in early stage in some instances and in that case we shall do CSF examination 12 hours later to see xanthochromia].

Question 43

1543. A lady with post ileo-colectomy closure of stoma has a small 4cm swelling around the stoma. What is the most appropriate management of the swelling? a. Local exploration of swelling b. Exploratory laparotomy c. Open laparotomy and re-closure d. Abdominal binder e. Truss f. Laparotomy with mesh repair

Answer 43

Ans. The key is A. Local exploration of swelling.

Question 44

1544. A 64yo woman has been brought by her son for psychiatric evaluation. She says that she has stopped living with her husband because she is convinced it is someone else posing to be him. What kind of delusions is she suffering from? a. Delusion of reference b. Delusion of control c. Delusion of guilt d. Delusion of persecution e. Delusion of doubles

Answer 44

Ans. The key is B. Delusion of control. This is a wrong key! The correct key is E. Delusion of doubles. [Delusion of control is a false belief that another person, group of people, or external force controls one’s general thoughts, feelings, impulses, or behavior. The delusion of doubles, is a rare disorder in which a person holds a delusional belief that different people are in fact a single pers

Question 45

1545. A 19yo man with known hx of OM presents with headache, lethargy, sweating and shivering. What is the single most likely dx? a. Furuncle b. Meningitis c. Myringitis d. Nasopharyngeal tumor e. OM

Answer 45

Ans. The key is B. Meningitis. [OM often can be a cause of intracranial extension leading to cerebral abscess or meningitis].

Question 46

1546. A 46yo woman has gained weight. She has sensitivity to cold. Her pulse = regular at 50bpm and heart=enlarged. What is the single most likely underlying mechanism for this condition a. Autoimmune b. Degenerative c. Congenital d. Infective e. Nutritional

Answer 46

Ans. The key is E. Nutritional. This is a wrong key. Correct key is Autoimmune hypothyroidism. [The most common cause of hypothyroidism in UK is autoimmune hypothyroidism. In developing countries it is often nutritional (iodine deficiency).The diagnosis is autoimmune hypothyroidism (in hypothyroidism heart is often gets enlarged)].

Question 47

1547. A 70yo man presents with a punched out ulcer between his toes. He is a heavy drinker and smoker. Exam: ulcer is yellow and the foot turns red when dangling off the bed. What is the single most likely dx? a. Arterial ischemia ulcer b. Malignancy c. Neuropathic ulcer d. Pressure ulcer e. Venous stasis ulcer

Answer 47

Ans. The key is A. Arterial ischemic ulcer.

Question 48

1548. A 65yo woman complains of a painful discharging ulcer above her ankle on the inner side of her left lower leg. Exam: the base of the ulcer is red and covered by a yellow fibrous tissue. The border is irregular. The skin is tight. What is the single most likely dx? a. Arterial ischemia ulcer b. Malignancy c. Neuropathic ulcer d. Pressure ulcer e. Venous stasis ulcer

Answer 48

Ans. The key is E. Venous stasis ulcer. [Some people with venous insufficiency develop stasis dermatitis. Blood pools in the veins of the lower leg. Fluid and blood cells leak out of the veins into the skin. It is usually seen above ankle and inner side of leg]

Question 49

1549. A 55yo woman suffered from an acute MI 5d ago. While she was in the hosp the pt developed features of pulmonary edema and heart failure. What is the most probable cause of her present condition? a. VSD b. Ruptured papillary muscle c. Pericarditis d. A-fib e. Re-infarction

Answer 49

Ans. The key is B. Ruptured papillary muscle. [Post MI rupture of papillary muscl is responsible for valve failure (mitral regurgitation) causing pulmonary oedema and heart failure].

Question 50

1550. A 76yo woman presents with deep stroke 6h ago. What would the immediate tx be? a. Aspirin 75mg b. Aspirin 300mg c. Streptokinase d. IV heparin e. Dipyridamole 200mg

Answer 50

Ans. The key is B. Aspirin 300mg.

Question 51

1551. A 19yo man accuses his friend of making his right arm swing out at a stranger. What is the best term to describe his condition? a. Control b. Persecution c. Guilt d. Reference e. Grandeur

Answer 51

Ans. The key is A. Control. [Delusion of control is a false belief that another person, group of people, or external force controls one’s general thoughts, feelings, impulses, or behavior].

Question 52

1552. A 26yo man with hx of hereditary hemorrhagic telengectasia is planning to start a family. What is the mode of inheritance? a. AD with incomplete penetrance b. Autosomal co-dominant c. AR with incomplete penetrance d. AD e. AR

Answer 52

Ans. The key is D. AD [Hereditary hemorrhagic telangiectasia is of autosomal dominant mode of inheritance].

Question 53

1553. A 50yo man with a known hx of stroke is unable to get out of his house because he can’t find where the door is. He refuses help from his wife and says he is not blind. What is the single most likely defect? a. Paracentral scotoma b. Tunnel vision c. Total blindness d. Central scotoma e. Cortical blindness

Answer 53

Ans. The key is E. Cortical blindness. [Cortical blindness is the total or partial loss of vision in a normal- appearing eye caused by damage to the brain’s occipital cortex. Rarely, a patient with acquired cortical blindness may have little or no insight that they have lost vision, a phenomenon known as Anton– Babinski syndrome].

Question 54

1554. An elderly lady presents with confusion. She is apyrexial but complains of dysuria for 2d duration. What is the def dx inv? a. Blood culture b. Urine nitrates c. CT head d. ECG e. IVU

Answer 54

Ans. The key is B. Urine nitrates. [Dysurea is suggestive of uti. UTI also can lead to confusion. Urine nitrates if positive is diagnostic of UTI].

Question 55

1555. A 40yo woman on chemotherapy for metastatic breast carcinoma now presents with painful swallowing. Exam: she has white plaques on top of friable mucosa in her mouth and more seen on esophagoscopy. What is the most effective tx for this pt? a. Antispasmodic b. H2 blocker c. Antibiotics d. Antifungals e. I&D

Answer 55

Ans. The key is D. Antifungal. [Features are consistent with oesophageal candidiasis which is treated with Oral fluconazole (200-400 mg daily) or IV fluconazole for 14-21 days].

Question 56

1556. A 43yo woman has suffered with heavy periods for many years and has tried many medical tx without success. She is constantly flooding and at times can’t leave her house due to heavy bleeding. She has completed her family of 5 children and her last blood test showed Hgb=8.9g/dl. She feels that she can’t cope with the bleeding anymore and her husband is asking for a tx that can guarantee succe

Answer 56

Ans. The key is B. Hysterectomy. [As family is complete hysterectomy is the best option to stop bleeding and it also helps not to get endometrial carcinoma].

Question 57

1557. A man on antipsychotic meds develops features of retinitis pigmentosa. Which drug is most likely to cause these symptoms? a. Thioridazine b. Haloperidol c. Chlorpromazine d. Risperidone

Answer 57

Ans. The key is A. Thioridazine. [Thioridazine and other antipsychotics (neuroleptics, dopaminergic antagonists) can cause degenerative retinopathies with histological, electrophysiological and symptomatological features similar to those of primary retinitis pigmentosa].

Question 58

1558. Pt with low Hgb, MCV=76, angular stomatitis, red tongue, and koilonichea. What is the most probable dx? a. Folate def b. B12 def c. Iron def d. Vit E def e. Hemolytic anemia

Answer 58

Ans. The key is C. Iron deficiency anemia. [Low MCV, angular stomatitis, red tongue and koilonichea are characteristic of iron deficiency anemia].

Question 59

1559. A pt with sudden severe eye pain, red eye, visual blurring, acuity of only finger counting, nausea, vomiting with a shallow ant chamber that is hazy on shining a torch. What is the dx? a. CRVO b. Acute closed angle glaucoma c. Uveitis d. Iritis e. Open angle glaucoma

Answer 59

Ans. The key is E. Open angle glaucoma. This is a wrong key! The correct key is B. Acute closed angle glaucoma. [Sudden severe eye pain, red eye, visual blurring, acuity of only finger counting, nausea, vomiting, shallow anterior chamber that is hazy on shining torch are all classic presentation of acute closed angle glaucoma].

Question 60

1560. A pt who works in a pet shop has temp=37.5C, dyspnea, chest pain and cough. CXR: patchy consolidation. What is the most suitable tx? a. Amoxicillin b. Tetracyclin c. Erythromycin d. Clarithromycin e. Penicillin

Answer 60

Ans. The key is A. Amoxicillin. This is a wrong key! Correct key is D. Clarithromycin. [OHCM, 9th edition].

Question 61

1561. A 50yo man complains of dysphagia after eating bread. Barium swallow reveals a lower esophageal ring. What is the most appropriate tx? a. Reassurance b. Antispasmodics c. Dilatation of the LES d. Endoscopic diverticulectomy e. I&D

Answer 61

Ans. The key is C. Dilatation of the LES.

Question 62

1562. A 48yo nulliparous woman feels tired all the time. Her periods are regular but have always lasted for at least 10d. Choose the single most appropriate intial inv? a. High vaginal swab b. Serum Hgb conc c. TFT d. None e. Abdominal US

Answer 62

Ans. The key is B. Serum Hb conc. [Feeling tired all the time and prolonged period suggest anemia. So serum Hb should be done initially].

Question 63

1563. A man got his hand caught in machinery at work. The fingers are swollen but the XR shows no fx. What is the most appropriate management? a. Splint b. Put in plaster c. Broad arm sling for 1wk d. Elevate in high sling for 2d e. Neighbor strapping

Answer 63

Ans. The key is D. Elevate in high sling for 2d. [Extravasetion of blood caused this swelling along with inflammation for which best option is elevate in high sling for 2d which will help improve symptom by gravitational shift of fluid from hand].

Question 64

1564. A 39yo woman presents with symptoms recurring annually characterized by depressed mood, being socially withdrawn hypersomnia, lack of enjoyment in life, last for several months. What is the most likely dx? a. Seasonal Affective Disorder b. Mod depression c. Dysthymia d. GAD e. Bipolar disorder

Answer 64

Ans. The key is A. Seasonal Affective Disorder. [Depression associated with late autumn and winter and thought to be caused by a lack of light].

Question 65

1565. A 75yo man presents with ARF. He has been troubled by recurrent epistaxis but over the last 3wks he reports to have coughed up blood too. What is the single most likely positive antibody? a. P ANCA b. C ANCA c. Anti Ro d. Anti DS DNA e. Anti centromere

Answer 65

Ans. The key is B. C ANCA. [ARF and recurrent epistaxis and hemoptysis suggests Wegener’s granulomatosis for which C ANCA is most specific].

Question 66

1566. A woman is admitted to the hosp for elective abdominal hysterectomy. 2m ago she was dx with DVT and pulmonary embolism and was started on warfarin. What is the most appropriate preop measure you will take on this occasion? a. Continue warfarin b. Stop warfarin c. Stop warfarin and start heparin d. Increase warfarin dose e. Add heparin

Answer 66

Ans. The key is C. Stop warfarin and start heparin.

Question 67

1567. This condition affects middle aged women more than men and is characterized by low mood, early morning waking, loss of libido, tiredness and suicidal intention last for at least 2wks. What is the most probable dx? a. Bipolar affective disorder b. Dysthymia c. Major depressive disorder d. Schizoaffective disorder e. Recurrent brief depression

Answer 67

Ans. The key is C. Major depressive disorder. [Given case is severe depression (major depressive disorder). Mild depression: i)Low mood ii) Anhedonia iii) Guilt iv) Hopelessness v) Worthlessness vi) Inability to concentrate. Tx CBT Moderate depression: Features of mild + vii) Poor sleep viii) Poor Appetite ix) Poor libido x) Easy fatiguability. Tx Antidepressants Severe depression: Features of mod

Question 68

1568. A 10yo boy has fallen from a tree and injured his right chest. He has pain and difficulty breathing. He is tachypenic and tender with an area of paradoxical chest wall movement on the right side. What is the single most likely dx? a. Diaphragmatic rupture b. Flial chest c. Fx ribs d. Hemothorax e. Tension pneumothorax

Answer 68

Ans. The key is B. Flial chest. [In flial chest multiple adjacent ribs are broken in multiple places, separating a segment, so a part of the chest wall moves independently. Pain, difficulty breathing, tachypnea and tender area of chest wall movement suggest flial chest].

Question 69

1569. A 37yo woman had an elective LSCS 1d ago. You are called to see her as she becomes SOB with left sided chest pain and a cough. She has had 3 children, 2 born by LSCS. Exam: she has reduced air entry at left lung base. Her observations include sat=92% on air, BP=105/84mmHg, pulse=120bpm, temp=37.2C. Choose among the options which C-section complications has she developed? a. Aspiration pneumo

Answer 69

Ans. The key is D. Pulmonary embolism. [Absence of wheeze and near normal temperature makes aspiration as unlikely diagnosis and favours the diagnosis of pulmonary embolism].

Question 70

1570. A pt presents with increasing retrosternal pain and dysphagia for both solids and liquids over 18m but denies weight loss. Chest is clear. What is the most likely dx? a. Achalasia b. Pharyngeal carcinoma c. Esophageal spasm d. Esophageal stricture

Answer 70

Ans. The key is C. Esophageal spasm. This is a wrong key. Correct key should be A. Achalasia. [Dyspagia for both solids and liquids or dysphagia to mostly liquids are features of Achalasia. Increasing dysphagia is characteristic of achalasia (Esophagial spasm does not cause progressive but intermittent dysphagia].

Question 71

1571. A 70yo man presents with a fluctuant swelling of the scrotum which feels like worms when he is standing but regresses when he lies down. What is the most probable dx? a. Varicocele b. Hematocele c. Testicular ca d. Epidydimal cyst e. Saphena varix

Answer 71

Ans. The key is A. Varicocele. [Fluctuant swelling of the scrotum which feels like worms are suggestive of varicocele].

Question 72

1572. A 52yo woman has had a swelling in the neck, hoarseness and stridor-both inspiratory and expiratory for 2m. What is the most probable dx? a. Ca larynx b. Ca thyroid c. Vocal chord nodules d. Ca bronchus e. Thyrotoxicosis

Answer 72

Ans. The key is B. Ca thyroid. [There isno features of hyperthyroidism. So it is not thyrotoxicosis but Ca thyroid].

Question 73

1573. A woman became acutely SOB in the recovery bay and is coughing after GA. Auscultation: reduced air entry at the right lung base and diffuse wheeze. Observation: HR=88bpm, BP=112/76mmHg, temp=37.8C and sat=91% in air. Choose among the options which C-section complication has she developed? a. Aspiration pneumonitis b. Spontaneous pneumothorax c. Endometritis d. Pulmonary embolism e. Tension p

Answer 73

Ans. The key is A. Aspiration pneumonitis. [Diffuse wheeze and raised temperature favours the diagnosis of aspiration pneumonitis].

Question 74

1574. A 23yo female presents with paresthesias and loss of distal pulses in her arms. She is noted to be hypertensive. She describes feeling unwell a month prior with fever and night sweats. What is the most probable dx? a. Kawasaki disease b. Takayasu arteritis c. Buerger’s disease d. Embolism e. Raynaud’s phenomenon

Answer 74

Ans. The key is B. Takayasu arteritis [Takayasu arteritis is a granulomatous inflammation of the aorta and its major branches. Criteria: 1.Age of 40 years or younger at disease onset 2.Claudication of the extremities 3.Decreased pulsation of 1 or both brachial arteries 4.Difference of at least 10 mm Hg in systolic blood pressure between arms 5.Bruit over 1 or both subclavian arteries or the abdomi

Question 75

1575. A 35yo woman presents with mass in the groin. Exam: mass found just below and lateral to the pubic tubercle. There is no cough impulse and it is irreducible. What is the most probable dx? a. Direct inguinal hernia b. Strangulated hernia c. Femoral hernia d. Saphenavarix e. Femoral aneurysm

Answer 75

Ans. The key is C. Femoral hernia. [Mass below and lateral to the pubic tubercle is suggestive of femoral hernia].

Question 76

1576. A 30yo woman has injured her left lower chest in a RTA. She has BP=80/50mmHg, pulse=120bpm. Auscultation of chest=bowel sounds present. What is the single most likely dx? a. Diaphragmatic rupture b. Flail chest c. Fx ribs d. Ruptured esophagus e. Tension pneumothorax

Answer 76

Ans. The key is A. Diaphragmatic rupture. [Bowel sound present on auscultation of chest following RTA causing lower chest injury is suggestive of diaphragmatic rupture].

Question 77

1577. A lady presents with a swelling below the groin crease that can be reduced. There is no med hx of note. What is the most probable dx? a. Inguinal hernia b. Strangulated hernia c. Testicular tumor d. Epidydimal cyst e. Femoral hernia

Answer 77

Ans. The key is E. Femoral hernia.

Question 78

1578. A 32yo woman of 38wks GA attends the antenatal day unit with pain in the suprapubic area that radiates to the upper thighs and perineum. It is worse on walking. Her urine dipstick showed a trace of protein but no white cells, nitrates or blood. What’s the most likely dx? a. Braxton hicks contractions b. Round ligament stretching c. Symphasis pubis dysfunction d. Labor e. Complicated femoral

Answer 78

Ans. The key is C. Symphysis pubis dysfunction. [Symptoms can include: pain over the pubic bone at the front in the centre pain across one or both sides of lower back pain in the area between vagina and anus (perineum). Pain can also radiate to thighs. Cause: stiffness of pelvic joints or the joints moving unevenly at either the back or front of pelvis during pregnancy. Physiotherapy is helpful].

Question 79

1579. A 45yo mechanic presents with a reducible swelling in the groin, impulse on coughing is present. He has mild dragging pain in the abdomen, otherwise he’s normal. What is the best management strategy? a. Truss b. Elective herniorrhaphy c. Urgent herniorrhaphy d. Elective herniotomy e. Reassure

Answer 79

Ans. The key is D. Elective herniotomy. This is wrong key! Correct key is B. [Elective herniorrhaphy. [elective herniotomy is done in young children preferably at 3-6 months of age. Presenting case should be treated by elective herniorrhaphy. Herniotomy = only resection of sac; Herniorrhaphy = resection of sac + repair of posterior wall of inguinal canal; Hernioplasty = resection of sac + posterio

Question 80

1580. A 25yo man present with a mass in the groin after heavy lifting. Exam: mass is found just above and medial to the pubic tubercle. It is reducible. On applying pressure on the internal ring, cough impulse is still present. What is the most likely dx? a. Direct inguinal hernia b. Indirect inguinal hernia c. Femoral hernia d. Strangulated hernia e. Femoral aneurysm

Answer 80

Ans. The key is A. Direct inguinalhernia. [On occlusion of deep inguinal ring if cough impulse still palpable (actually more appropriate is visible) on medial to occluded ring it is direct inguinal hernia]. {Cough impulse negative means after occluding deep ring there will be no visible cough impulse and positive means there will be visible cough impulse. Negative cough impulse=indirect hernia; po

Question 81

1581. A 35yo woman presents with a swelling in the neck. The swelling has increased in size gradually over the last two years and the patient feels she has difficulty with breathing. Exam: mass measures 8cm by 10 cm, soft and not warm to touch. It moves with deglutition. Which is the most appropriate management of this mass? a. Partial thyroidectomy b. Oral thyroxine c. Oral propylthiouracil d. Ex

Answer 81

Ans. The key is A. Partial thyroidectomy. [Gradually increased swelling in the neck which moves with deglutition is thyroid enlargement and as it is causing pressure symptom like difficulty in breathing a partial thyroidectomy should be performed].

Question 82

1582. A 46yo laborer reports swelling in the right groin. The non-painful swelling is observable in both the erect and the recumbent positions. Exam: non-tender irreducible 4 cm mass in the right groin below and on the medial side of the inguinal ligament. Which is the most likely dx in this pt? a. Indirect inguinal hernia b. Femoral hernia c. Saphenous vein varicocoele d. Hydrocoele

Answer 82

Ans. The key is C. Saphenous vein varicocele. This is a wrong key! Correct key is B. Femoral hernia. [Sephanous vein varicocele is readily reducible with recumbent position and reducible. So presented case is not sephanavarix. Usual location of femoral hernia is below and lateral to pubic tubercle but it is not absolute and it is possible for femoral hernia to present as mass below and medial to p

Question 83

1583. A camel rider sustained a kick to the lateral side of his right leg just below the knee caused by the camel stick. The site is slightly bruised and tender to touch. During physical examination, he is unable to either dorsiflex or evert the foot. There is loss of sensation over the front and outer half of the leg and dorsum of the foot. If these observations are the result of damage to a nerv

Answer 83

Ans. The key is B. Peroneal. [Inability of dorsiflex and foot eversion with sensory loss over front and outer half of leg and dorsum of foot are seen in peroneal nerve injury].

Question 84

1584. A 46yo woman presents with sudden episode of abdominal pain which started about 2h ago. The pain is located in the epigastrium and radiates to her back. She has vomited twice since the onset of attack. The pain is made worse by lying flat on her back and she is more comfortable sitting up and bending forwards. She was informed of the presence of gallstones in her gall bladder four weeks earl

Answer 84

Ans. The key is B. Serum amylase. [Epigastric pain radiating to back, worse on lying flat and comfort on bending forward are classic presentation of acute pancreatitis in which serum amylase is increased].

Question 85

1585. A 75yo Japanese woman reports repeated episodes of vomiting of undigested food mixed with blood. She has lost 5 kgs in weight over the last one month. Clinical exam: shows a frail woman with mild conjuctival palor. Exam: non-tender slightly mobile mass in the epigastric region. Which is the most likely dx? a. Colon cancer b. Gastric cancer c. Gall bladder cancer d. Oesophageal cancer

Answer 85

Ans. The key is B. Gastric cancer. [Non-tender mass in epigastrium, conjunctival pallor (anemia), weight loss, vomiting of undigested food mixed with blood due to pyloric obstruction by cancer mass and particularly Japanese (highest incidence of gastric cancer due to taking smoked fish) are almost diagnostic of gastric cancer].

Question 86

1586. A 45yo man, known to be chronically addicted to alcohol, presents in the ED and reports two episodes of vomiting fresh bright red blood in the previous 6h. He estimated the volume blood vomited at each bout to be more than 500mls. Clinical exam: the radial pulse=120/min, BP=90/60mmHg. There is no mass or tenderness in the epigastrium. The liver is palpable for 3 cm below the costal margin an

Answer 86

Ans. The key is D. Uppergastrointestinal endoscopy. [The likely diagnosis is bleeding oesophageal varices which should be diagnosed by endoscopy and if needed stappling can be done with endoscope].

Question 87

1587. A 42yo woman reports to the surgeon that she is worried about a lump that she feels the right breast. The surgeon observes a 2 cm by 3 cm mass in the right lower quadrant of the breast. There are no associated skin changes and the mass has limited mobility. There is no discharge from the nipple. There is no axillary lymph node enlargement. Examination of the left breast and axilla was comple

Answer 87

Ans. The key is B. A needle-guided biopsy of the breast.

Question 88

1588. A 45yo man presents with a mass on the right side of the face. The mass was first observed three months ago but has recently become visibly larger. He feels pain over the mass and is unable to blow a whistle. Clinical examination shows that the mass is likely to be the parotid gland. An oral examination shows a foul smelling discharge from the duct of the gland and gentle probing shows that

Answer 88

Ans. The key is C. Facial nerve palsy. [Due to malignant infiltration].

Question 89

1589. A 6yo boy presents with jaundice following treatment with sulphathiazole. Investigations suggest that the jaundice is due to haemolysis caused by G6DP deficiency. Which is true regarding etiology of G6DP deficiency? a. Inherited as autosomal dominant condition b. Inherited as sex-linked dominant condition c. Inherited as sex-linked recessive condition d. Results from auto-antibodies to red c

Answer 89

Ans. The key is C. Inherited as sex-linked recessive condition.

Question 90

1590. A 5yo previously healthy child has a 1-day history of severe pain in the throat, breathing difficulties and fever. On examination you find an anxious, septic-looking child with drooling of saliva and stridor. Which is the most appropriate initial management? a. Intubation under general anaesthesia b. Insertion of nasogastric tube c. Fluid resuscitation and antibiotics IV d. Anteroposterior &

Answer 90

Ans. The key is A. Intubation under general anesthesia. [Acute epiglottitis. Should intubate to save from closure of airway].

Question 91

1591. A 6yo boy has been noticed to have problems with co-ordinating his voluntary movements over the last two years. He has a waddling gait and needs to support himself on his hands when rising from the floor. He has larger calves than other boys but he runs more slowly. Which is the most likely dx? a. Myotonia b. Myasthenia gravis c. Duchenne muscular dystrophy d. Muscular atrophy

Answer 91

Ans. The key is C. Duchenne muscular dystrophy. [The child having difficulty with walking, running, jumping and climbing stairs. Walking may look different with a ‘waddling’ type of walk. The boy may be late in starting to walk (although many children without DMD also walk late). When you pick the child up, you may feel as if he ‘slips through your hands’, due to looseness of the muscles around th

Question 92

1592. A previously healthy, 10m female child presents to your clinic with a 1-day history of high fever, runny nose and conjunctivitis. The child looks unwell and is irritable. Exam: child’s oropharynx shows that it is inflammed and there are small white spots on the oral mucosa. Which is the most likely dx? a. Kawasaki disease b. Parvovirus infection c. Herpes zoster d. Measles

Answer 92

Ans. The key is D. Measles. [Koplick’s spots are characteristic of measles].

Question 93

1593. A 3d term, breast-fed infant is brought by the mother who reports that the child has not been active and not feeding well. She also notices jaundice, which was not present at birth and is increasing. Exam: the temp=35.4°C, and the liver is palpable 2 cm below the costal margin. Which is the most likely dx? a. Rhesus isoimmunisation b. Inadequate breast milk c. Congenital biliary tract obstru

Answer 93

Ans. The key is D. Sepsis. [Not active, not feeding well, increasing new onset jaundice and hypothermia are suggestive of neonatal sepsis].

Question 94

1594. A 65yo woman with DM, HTN and normal kidney function underwent a total right hip replacement. She had massive haemorrhage during the operation and was given 8 units of packed RBC. The blood pressure dropped to 60/40 mm Hg for about two hours before it was corrected with blood transfusion. Two days after the surgery the serum creatinine level rose to 4.2 mg/dl (normal <1.5 mg/dl), BUN was 50

Answer 94

Ans. The key is C. Acute tubular necrosis. [Hypotension even for some minutes or few hours can readily lead to acute tubular necrosis which is evident here by uremia and further supported by brown granular cast in the urine sediment].

Question 95

1595. A 78yo pt is diagnosed with metastatic lung cancer; there is no cure for his condition. His son tells the physician that in the case of a diagnosis of cancer, the physician must not tell his father. He wishes that his father does not suffer any psychological distress caused by the knowledge of a terminal diagnosis. Which one of the following ethical principles supports the son’s request? a.

Answer 95

Ans. The key is D. Non-maleficence. [Nonmaleficence means non-harming or inflicting the least harm possible to reach a beneficial outcome. Harm and its effects are considerations and part of the ethical decision-making process in the NICU. Short-term and long-term harm, though unintentional, often accompany life-saving treatment in the NICU.

Question 96

1596. A 23yo single male was brought to Emergency exhausted and frightened. His father tells you that his son, who was previously healthy, had, for no apparent reason, a sudden attack of fear, dizziness, sweating, palpitations and the feeling that his heart is going to stop beating. The symptoms started to decrease gradually after about 10 minutes. Which is the most likely dx? a. Panic attack b. D

Answer 96

Ans. The key is A. Panic attack. [a sudden feeling of acute and disabling anxiety; often fear of death]

Question 97

1597. A 30yo woman, G2P1, at 37 weeks gestation mentions that her 3-year-old son has just developed chickenpox. She is not certain whether she has had the disease herself. Which is the next step in management? a. Administration of varicella-zoster immune globulin IM b. Measurement of varicella IgM level c. Acyclovir tablets orally d. Measurement of varicella IgG level

Answer 97

Ans. The key is D. Measurement of varicella IgG level. [If previous infection is doubtful do varicella IgG level].

Question 98

1598. A 24yo primigravida presents to the ED with a history of 8-week amenorrhoea followed by heavy vaginal bleeding and severe, crampy abdominal pain. Exam: HR=110/min and BP=120/80mmHg. The uterus is bulky. The cervix is dilated and there is active bleeding from the cervical os, but no tissue has been expelled. Which of the following is the most likely dx? a. Inevitable abortion b. Threatened Ab

Answer 98

Ans. The key is A. Inevitable abortion. [when os is closed threatened and when os is opened inevitable abortion (No tissue has been expelled)].

Question 99

1599. A 46yo woman comes for a routine gynaecological visit. On pelvic examination, a 1-cm red, granular lesion is noted on the posterior cervical lip, which is firm and bleeds on contact. Which is the next best step for establishing a dx? a. Cervical cytological smear b. Punch biopsy c. Transvaginal ultrasound d. Colposcopy

Answer 99

Ans. The key is B. Punch biopsy.

Question 100

1600. A 31yo woman, G5P4, who has amenorrhoea for 12 weeks and a positive pregnancy test presents to the ED with vaginal bleeding. Symphysial-fundal height measurement corresponds to 22 weeks gestation. Ultrasound examination reveals bilateral cystic masses. No fetal parts are seen during the examination. The cervix is closed. Which is the most likely dx? a. Tubal pregnancy b. Endometriosis c. Hyd

Answer 100

Ans. The key is C. Hydatidiform mole. [In molar pregnancy uterus is more enlarged than gestational age and on US no fetal part but cystic masses are seen].