1601 to 1707 Flashcards
1
Q
- A married 25yo woman presents with 6h hx of abdominal pain located in the LIF. The pain is persistent, of increasing intensity and not radiating first experienced while she was lying down. She feels giddy when she tries to stand erect. The last menstrual period was 6 weeks ago. The radial pulse=130/min and BP=80/40 mmHg. Pelvic US shows free intra-peritoneal fluid. What is the most appropria
A
Ans. The key is B. Immediate laparotomy. [As the patient is in shock it is ruptured ectopic pregnancy. So the next step is immediate laparotomy].
2
Q
- A 40yo man has fallen off a roof. He is shocked and has chest pain. There is a delay between the radial and femoral pulse. His CXR=widening of the mediastinum. What is the single most likely dx? a. Cardiac tamponade b. Diaphragmatic rupture c. Fx ribs d. Tension pneumothorax e. Traumatic rupture of aorta
A
Ans. The key is E. Traumatic rupture of the aorta. [A traumatic aortic disruption is caused by a rapid acceleration (or deceleration) causing a tear in the aorta. Normally this is immediately fatal, but those who survive may show a widened mediastinum on CXR. This can be confirmed with CT scan or angiography of the aorta and requires prompt surgical correction. Stable the haemodynamics and surgica
3
Q
- A 36yo woman presents with swelling in the groin. Exam: swelling is diffuse and soft and lies below the inguinal ligament. It empties with minimal pressure and refills with release. There is a cough impulse and it disappears on lying down. On the calf of the same leg there are varicosities on the medial aspect. What is the most likely dx? a. Varicose vein b. Varicocele c. Saphena varix d. Fe
A
Ans. The key is C. Saphena Varix. [Below inguinal ligament, empties with minimal pressure and refills with release, presence of cough impulse and disappearance on lying down are suggestive of caphena varix supported by presence of varicosity in same leg].
4
Q
- A man presents with a swelling above the groin crease in the abdomen. He has not had any med problems of note. What is the most probable dx? a. Inguinal hernia b. Spigelian hernia c. Testicular tumor d. Epidydimal cyst e. Irreducible hernia
A
Ans. B. Spigelian Hernia. [A Spigelian hernia (or lateral ventral hernia) is a hernia through the spigelian fascia, which is the aponeurotic layer between the rectus abdominis muscle medially, and the semilunar line laterally.
5
Q
- A 70yo man presents with acutely painful, pale paralysed and pulseless left leg. He is noted to have a-fib. What is the most probable dx? a. Intermittent claudication b. Cardiovascular syphilis c. Buerger’s disease d. Chronic limb ischemia e. Acute limb ischemia
A
Ans. The key is E. Acute limb ischemia. [AF may be the cause of thrombus leading to embolic acute limb ischemia].
6
Q
- A 50yo woman complains of several months hx of weakness and difficulty climbing stairs. Exam: fissuring of the skin of her hands. CXR: pulmonary fibrosis. What is the single most likely positive antibody? a. Anti Jo1 b. Anti Scl 70 c. Anti Ro d. Anti dsDNA e. Anti centromere
A
Ans. A. Anti Jo1. [Anticentromere would be present in limited scleroderma and Anti-Scl 70 would be present in diffuse scleroderma. Anti-DSDNA would be positive in SLE, along with Anti-Ro. Anti-Ro is also positive in Sjogren’s syndrome and scleroderma. This is a case of Polymyositis because none of the others would have the muscular weakness that is present in this case. The antibody of choice woul
7
Q
- A 65yo woman complaining of symptoms suggestive of Raynaud’s phenomenon and difficulty in swallowing. Exam: painful lesions on her finger tips and facial telangiectasis. What is the single most likely positive antibody? a. Anti Jo1 b. Anti Scl 70 c. Anti Ro d. Anti ds DNA e. Anti centromere
A
Key: Anti-Centromere (E) Reason: Anti-centromere antibody would be present in CREST syndrome which is also called Limited scleroderma. Features of given case are consistent with CREST syndrome and hence the answer is E. Anti centromere antibody].
8
Q
- A 6yo boy presented about 4h ago with acute severe pain on the testis with the left half slightly higher than the right. Pain was not relieved by any strong analgesic. What is the initial management? a. Give strong analgesic b. IV NS and monitor vital signs c. Reassure d. Immediate surgical referral e. Cover with antibiotics
A
Ans. The key is D. Immediate surgical referral. [Dx torsion of testis]
9
Q
- A 60yo man is brought to the ED in an agitated state. He is lashing out violently. Which drug in low dosage due to its relative lack of autonomic side effects is a drug of choice in the tx of agitation in this pt? a. Haloperidol b. Diazepam c. Fluoxetine d. Clozapine e. Chlorpromazine
A
Ans. The key is A. Haloperidol. It is a wrong key. Correct key is Diazepam. [Haloperidol has autonomic side effects].
10
Q
- A 32yo woman of 40wks gestation attends the antenatal day unit with sudden onset epigastric pain with nausea and vomiting. She is clinically jaundiced. Her biochemistry results show a raised bilirubin, abnormal liver enzymes, high uric acid and hypoglycemia. What’s the most likely dx? a. Acute fatty liver of pregnancy b. Obstetric cholestasis c. Cholecystitis d. HELLP syndrome e. Acute hepat
A
Ans. The key is A. Acute Fatty Liver of Pregnancy. [When jaundice is present in pregnancy, AFLP should be high on the differential. Pain, nausea, vomiting, jaundice, fever with elevated liver enzymes and bilirubin is clinically indicative of AFLP. Also can have elevated INR, TLC and hypoglycaemia.
11
Q
- A 24yo man believes his bowels are blocked and his life is in ruin. What kind of delusion is he suffering from? a. Persecutory b. Factitious c. Guilt d. Nihilistic e. Hypochondriacal
A
Ans. The key is D. Nihilistic. [The man believes his bowels are blocked and his life is ruined is an example of nihilistic delusion].
12
Q
- A 75yo man with declining vision, cornea and pupils are normal, fundus shows obscured margins. What is the single most likely dx? a. Macular degeneration b. HTN retinopathy c. MS d. DM background e. Proliferative DM retinopathy
A
Ans. The key is A. Macular degeneration. [In a 75yrs old man with normal cornea and pupils and papilloedema suggests macular degeneration].
13
Q
- A man under psychiatric tx develops GI distress and tremors. Which drug is most likely to cause these symptoms? a. Lithium b. Diazepam c. Citalopram d. Clozapine e. Imipramine
A
Ans. The key is A. Lithium. [Lithium causes tremor, GI distress (vomiting) along with Diabetes insipidus].
14
Q
- A 24yo man presents with painless hematuria. No other complaint and no abnormality is found on physical exam. What is the most appropriate initial inv which is helpful to get a dx? a. Coag screening b. MSU c. Cystoscopy d. MRI spine e. Abdominal US
A
Ans. The key is E. Abdominal US. [Painless hematuria in a young male without any other findings on history or examination often suggests Polycystic Kidney Disease].
15
Q
- A 29yo woman presents to her GP with troublesome heavy periods. The med tx that she has tried have made little difference. She is known to have large uterine intramural fibroids. You confirm that she is currently trying for more children. Select the most appropriate management for menorrhagia in this pt? a. Danazol b. Endometrial ablation c. Hysterectomy d. Hysteroscopic resection of fibroid
A
Ans. E. Myomectomy. [Chance of subsequent pregnancies is better after myomectomy].
16
Q
- A 30yo schizophrenic female attacks her mother believing that aliens have replaced her with an exact double. What condition is she suffering from? a. Capgras syndrome b. Ganser syndrome c. Todd syndrome d. Fregoli syndrome e. Cotard syndrome
A
Ans. Capgras Syndrome. [Capgras syndrome is an irrational belief that a familiar person or place has been replaced by a duplicate. Ganser syndrome is a fictitious disorder in which a patient deliberately acts as if he has a physical or mental illness when he doesn’t have it. Todd syndrome/Alice In Wonderland syndrome/Lilliputian syndrome is a disorienting neurological condition affecting human per
17
Q
- A 38yo man has just returned from a holiday where he went swimming everyday. For the last few days he has had irritation in both ears. Now his right ear is hot, red, swollen and acutely painful. What is the single most likely dx? a. Foreign body b. Impacted earwax c. OE d. OM e. Perforation of eardrum
A
Ans. C. Otitis Externa. [The swimming history, irritation in both ears and ear being hot, red, swollen and painful indicates inflammation of the external acoustic meatus called Otitis Externa. It isn’t otitis media because of the lack of Tympanic membrane signs].
18
Q
- A healthy 2yo boy is brought to the ED having cut his hand playing in the garden. He has a 2cm clean laceration. He has not received any routine immunizations as his parents are concerned about possible side effects. There are no contraindications to immunizations. What is the single most appropriate follow up inv? a. Courses of DPT vaccine b. Courses of DT c. Single inj of DPT vaccine d. Si
A
Ans. Courses of DPT Vaccine. [The child is unimmunized and has no contraindication to vaccination. Keeping in mind his age, single injections would be useless and would not help the patient. Courses of DPT vaccine would be the best choice in this case].
19
Q
- A 6wk child has hx of frequent vomiting which became worse during the last weeks. He has no fever, recently he has passed stool only once every 2-3d. What inv will you do to confirm the dx? a. Abdominal US b. Barium meal c. Erect XR abdomen d. Feed test e. Reassure
A
Ans. The key is A. Abdominal US. [The age and symptoms points towards pyloric stenosis].
20
Q
- A 30yo woman had an IUCD inserted 8-9m ago. Now on routine follow up the thread is missing. Uterine US showed no IUCD in the uterus. What is the best management? a. Laparoscopy b. Pelvic CT c. Laparotomy d. Pelvic XR
A
Ans. The key is D. Pelvic XR. [Ultrasound should be arranged to locate the device. If ultrasound does not locate the device and there is no definite history of expulsion then abdominal X-ray should be performed to look for an extrauterine device].
21
Q
- A pt comes with weight loss and sleep disturbance has mild depression. He has a hx of MI. What is the single most appropriate tx? a. Diazepam b. ECT c. Imipramine d. Lithium e. Antipsychotics
A
Key: Diazepam
22
Q
- A pt. comes back from India and presents with night sweats and lymphadenopathy. XR: Cavitation. What investigation should be done next? a. CT scan b. AFB stain c. Blood culture d. Bronchoscopy
A
Ans. AFB Stain [The symptoms and arrival from an endemic area for Pulmonary TB suggests the best course of action would be to go for AFB staining via ZN stain].
23
Q
- A 45yo woman has been extensively investigated for a lump she believes to be cancer. She doesn’t think doctors take her seriously and demands another referral. What term best describes her condition? a. Munchausen syndrome b. Munchausen’s by proxy c. Hypochondriasis d. Malingering e. Phobia
A
Ans. The key is C. Hypochondriasis. [Worry about having a serious illness. This debilitating condition is the result of an inaccurate perception of the condition of body or mind despite the absence of an actual medical condition].
24
Q
- A 15yo man presents with bitemporal hemianopia and spade-like hands. What is the definite test to confirm the dx? a. Early morning growth hormone b. Insulin tolerance test c. OGTT with growth hormone measurements d. Random insulin-like growth factor (IGF-1) e. Short ACTH test
A
Ans. The key is C. OGTT with growth hormone measurements. [The bitemporal hemianopia and spade- like hands point towards acromegaly. The best initial test is insulin like growth factors but the definitive test that confirms the diagnosis is OGTT with serial growth hormone measurements].
25
1625. A 22yo man has had an acute, painful, red right eye with blurring of vision for one day. He had a similar episode 1y ago and has had episodic back pain and stiffness relieved by exercise and diclofenac for four years. What is the SINGLE most likely cause of his red eye? a. Chorioretinitis b. Conjunctivitis c. Episcleritis d. Iritis e. Keratitis
Ans. The key is D. Iritis. [The symptoms described are characteristic of ankylosing spondylitis (lower back pain and stiffness which gets better after moving around and taking NSAIDS) the extra articular manifestations of AS is iritis].
26
1626. A 40yo divorced man with bipolar affective disorder attends hospital following an OD of 30 TCA tablets. His new partner has left him and he has stopped taking his medicine and begun drinking heavily. He appears depressed, feels hopeless and is ambivalent about being alive. He is now fit for discharge from the medical ward and acknowledges the benefits of previous tx. What is the SINGLE most
Ans. The key is A. Admission to the psychiatry ward. [To save the patient from another overdose].
27
1627. A healthy baby boy is born at term to a woman who was unwell with confirmed acute hep B during pregnancy. The mother is very concerned that she may have infected the baby with hep B. What SINGLE preventative intervention should be given to the baby? a. Full course of hepatitis B vaccine b. Hepatitis B immunoglobulin alone c. Hepatitis B vaccine and hepatitis B immunoglobulin d. Hepatitis B v
Ans. The key is C. Hepatitis B vaccine and hepatitis B immunoglobulin. [Babies born to mothers infected with hepatitis B have a high risk of acquiring infection, which can be prevented by vaccination at birth. All babies with seropositive mothers should have the full primary course of hepatitis B immunisation and should also have HBIG within 24 hours of birth].
28
1628. A previously well 15yo girl had an acute onset of fever, sweating, bruising and petechiae. A blood count showed: Hgb=63g/L, WBC=1.1mg/L, Neutrophils=0.1, plt=14. No abnormal white cells were seen on the blood film. She was transfused and given IV antibiotics and her condition improved. 3wks later her blood count has returned to a similar picture. What is the SINGLE most likely underlying dx?
Ans. The key is C. Aplastic Anaemia. [The age of the patient and pancytopenic picture give us a clinical diagnosis of Aplastic anemia. Normal WBC morphology rules out ALL, AML and pernicious anaemia while the age rules out CML as a diagnosis].
29
1629. An 83yo woman admitted with a chest infection becomes confused with impaired attention and poor concentration. She is restless and frightened. She is verbally abusive and has perceptual abnormalities. There is no significant prv psychiatric hx. What is the SINGLE most likely dx? a. Delirium b. Drug induced psychosis c. Lewy body dementia d. Multi-infarct dementia e. Psychotic depression
Ans. The key is A. Delirium. [Delirium or Acute Confusional States happen in the elderly in response to stressors like acute infections and this is most likely brought on by the chest infection that has developed].
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1630. A town has a population of 500,000. In a five year period there are 1250 cases of bladder cancer diagnosed at the only hospital. During the same period the occupational health department diagnosed a further 500 cases. What is the annual incidence per million of bladder cancer in this population? a. 2100 b. 1750 c. 1400 d. 700 e. 350
Ans. The key is D. 700.
31
1631. A 28yo woman who has had a prv pulmonary embolism in pregnancy wishes to discuss contraception. She has menorrhagia but is otherwise well. What is the SINGLE most suitable contraceptive method for this patient? a. COCP b. Copper IUCD c. Levonorgestrel intra-uterine system d. Progestogen implant e. POP
Ans. The key is C. Levonorgestrel Intra-Uterine System. [The woman has a history of thromboembolic disease, which essentially contraindicates COCP. LNG-IUS (Mirena) is the hormone releasing device that is most suitable in this patient with thrombophilia and menorrhagia.
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1632. An 8yo girl has had left earache for 2d. The earache subsided about 2h ago with the onset of a purulent discharge which relieved the pain. Her temperature is 39.2C. What is the SINGLE most appropriate antibiotic? a. Amoxicillin b. Ciprofloxacin c. Clindamycin d. Erythromycin e. Flucloxacillin
Ans. The key is A. Amoxicillin. [This is the picture of Acute Otitis Media which has led to tympanic membrane perforation. PO Amoxicillin for 7 days is the treatment of choice]
33
1633. A 38yo man has disturbing thoughts about his house being infected by germs. He is anxious about safety and checks the locks of his doors repeatedly before going to bed. For the last 8wks he has been washing his hands every time he touches the lock, 20-30 times a day. What is the SINGLE most appropriate management? a. Antidepressant b. Antipsychotic c. Anxiolytic d. CBT e. Psychodynamic psych
Reason: This scenario describes a case of OCD for which the best management is CBT followed by SSRIs or TCAs].
34
1634. A 65yo man had closure of colostomy performed 5d ago. He is not systemically unwell. There is a tender, localised fluctuant swelling 4 cm in diameter in the wound. What is the SINGLE most appropriate management? a. Abdominal support b. Antibiotics c. Laparotomy and re-suture wound d. Local exploration of wound e. Observation
Ans. The key is D. Local exploration of wound.
35
1635. A 32yo woman has had a febrile illness and swelling of the small joints of her hands, feet, wrists and knees for two days. She has a maculopapular rash and a few palpable, small cervical lymph nodes. She was previously well. There is no history of relevant travel outside the UK. She has two young children. What is the SINGLE most likely dx? a. Psoriasis b. Reactive arthritis c. Rheumatoid ar
Ans. The key is B. Reactive arthritis. It is a wrong key! Correcct key should be E. SLE.
36
1636. A 16yo girl has had an enlarging mass in the right side of her neck for the last 6wks. She has had no other symptoms. She has a 2 x 2 cm enlarged LN in the anterior triangle of the neck with several smaller associated LN palpable. Oropharyngeal examination shows tonsillar membranes. What is the SINGLE most likely dx? a. Infectious mononucleosis b. Leukaemia c. Lymphoma d. Sarcoidosis e. Tube
Ans. The key is A. Infectious mononucleosis. [Though in infectious mononucleosis lymph nodes are usually seen in posterior triangle but can be seen in whole body including anterior triangle also].
37
1635. A 32yo woman has had a febrile illness and swelling of the small joints of her hands, feet, wrists and knees for two days. She has a maculopapular rash and a few palpable, small cervical lymph Nodes. She was previously well. There is no history of relevant travel outside the UK. She has two young children. What is the SINGLE most likely dx? a. Psoriasis b. Reactive arthritis c. Rheumatoid ar
Ans. The key is B. Reactive Arthritis. [The key is GMC key].
38
1636. A 16yo girl has had an enlarging mass in the right side of her neck for the last 6wks. She has had no other symptoms. She has a 2 x 2 cm enlarged LN in the anterior triangle of the neck with several smaller associated LN palpable. Oropharyngeal examination shows tonsillar membranes. What is the SINGLE most likely dx? a. Infectious mononucleosis b. Leukaemia c. Lymphoma d. Sarcoidosis e. Tube
Ans. The key is A. Infectious Mononucleosis. [Though in infectious mononucleosis lymph nodes are usually seen in posterior triangle but can be seen in whole body including anterior triangle also].
39
1637. A 60yo man has had increasing pain in both buttocks, thighs and calves on walking for three months. He has also recently developed impotence. Femoral and distal pulses are absent in both limbs. What is the SINGLE most likely site of arterial obstruction? a. Aorto iliac b. External iliac c. Femoropopliteal d. Internal iliac e. Tibial
Ans. The key is A. Aorto iliac. [saddle embolus; surgical intervention]. Page 718 OHCM 9th edition. Patient is suufering from leriche’s syndrome. Classic triad of: • Pain and claudication of buttock and thighs (pale cold leg) • Erectile dysfunction from aorto iliac occlusive disease • Absent femoral and distal pulse.
40
1638. A 78yo man has collapsed. He has had a severe headache for 12 hours and had an URTI 3d ago. He has a temp=39.2C, pulse=122bpm, BP=84/60mmHg and RR=34bpm but his chest is clear. He has a GCS=10 and some neck stiffness. He has been started on high-flow oxygen. What is the SINGLE most appropriate immediate management? a. IV antibiotic; CT brain scan b. IV antibiotic; LP c. IV fluids; CT brain s
Ans. The key is D. IV Fluids; IV antibiotic [As his BP is low and has presented with neck stiffness so, IV fluids and V antibiotic should be given, after giving him oxygen].
41
1639. A 16yo boy was brought to hospital in a comatose state having taken methadone belonging to his sister. He was given naloxone and rapidly became alert. Some hours later, he gradually becomes semi- conscious again.What is the SINGLE most likely reason for this patient becoming semi-conscious again in hospital? a. Methadone hepatotoxicity has caused acute liver failure b. Methadone is eliminate
Ans. The key is B. Methadone is eliminated from the body more slowly than naloxone (short t1/2)
42
1640. A 27yo woman who takes the COCP has had painless vaginal spotting and discharge for 3 days. Her last menstrual period, which lasted four days, finished 10 days ago. Her last cervical smear two years ago was normal. Abdominal and vaginal examinations are normal apart from a mild ectropion with contact bleeding. What is the SINGLE most appropriate initial inv? a. Cervical smear b. Colposcopy c
Ans. The key is C. Endocervical swab. [As her cervical smear and examination of abdomen and vagina are normal, next would be to exclude a STD for which Endocervical swab is taken].
43
1641. A 72yo man being investigated for anaemia is booked for a colonoscopy in 24 hours. What is the SINGLE most appropriate management the night before the procedure? a. Bisacodyl tablets b. Glycerine suppository c. Lactulose syrup d. Magnesium citrate (orally) e. Senna tablets
Ans. The key is D. Magnesium Citrate (Orally)
44
1642. A 19yo woman has had progressive bilateral iliac fossa pain and dyspareunia for 3days. She has an offensive vaginal discharge and feels unwell and feverish. Her temp=39C. An initial antimicrobial regimen is commenced. What SINGLE set of organisms are the most appropriate for the antimicrobial regimen to cover? a. Neisseria gonorrhoeae and Candida albicans b. Neisseria gonorrhoeae and Candida
Ans. The key is C. Neisseria gonorrhoeae and Chlamydia trachomatis • Most common antibiotic given for UNCOMPLICATED STDs is azithromycin and it covers gram negative bacteria which are neisseria and chlamydia. • Candida albicans is a fungal infection • Gardnerella is a gram variable bacteria and normal commensal.
45
1643. A 48yo man with renal cancer had radiotherapy for metastatic spinal cord compression at the 11th thoracic vertebra 4wks ago. He has retained sensation but is unable to stand. He has pain in a band around his lower trunk controlled by regular oral morphine. He is distressed by increasingly frequent episodes of painful muscle spasms in his right leg. What is the SINGLE most appropriate managem
Ans. The key is B: Baclofen. [Muscle relaxant].
46
1644. A 4yo girl has had a temp=38.5C for 2days and has not wanted to eat her food. Yesterday she developed a sore throat and small, painful ulcers inside her mouth. Today she has small blisters on the palms of her hands and soles of her feet which are painful but not itchy. What is the SINGLE most likely underlying cause? a. Coxsackie virus b. Herpes simplex virus c. Staphylococcus aureus d. Stre
Ans. The key is A: coxsakie virus Patient is suffering from HFMD (Hand,Foot and Mouth Disease) • HFMD is due to an infection that usually causes a typical illness, including a typical rash. It is most commonly caused by the Coxsackie A16 virus • HFMD most commonly affects children under 10 years of age • This might include a high temperature (fever). After this, a sore throat commonly occurs, quic
47
1645. A 32yo woman has had 3 episodes of slurred speech and 2 episodes of transient weakness of both legs in the past 5yrs. Each episode has resolved in 3m. What is the SINGLE most likely dx? a. Meningioma b. Migraine c. Multiple sclerosis d. Stroke e. Transient ischaemic attack
Ans. The key is C. Multiple sclerosis.
48
1646. An 8yo girl is complying with her asthma treatment of low-dose inhaled corticosteroid prophylaxis and short-acting bronchodilators as required. Her inhaler technique is good. She now has a frequent night cough and mild exercise-induced wheeze. What would be the SINGLE most appropriate change in her treatment? a. Add leukotriene antagonist b. Add oral theophylline c. Add regular long-acting b
Ans. The key is D. Increase dose of inhaled corticosteroid. This is a wrong key. Correct key is C. Add regular long-acting bronchodilator.
49
1647. A 38yo man with longstanding alcohol dependence has vertigo and a tremor every morning. What is the SINGLE most likely dx? a. Anxiety b. Benign positional vertigo c. Cerebellar degeneration d. Optic neuritis e. Temporal lobe epilepsy
Ans. The key is C. Cerebellar degeneration. [chronic alcohol abuse that leads to temporary or permanent cerebellar damage].
50
1648. An 84yo woman with Alzheimer's dementia has recently become incontinent and more confused than usual. What is the SINGLE most likely dx? a. Detrusor overactivity b. Neuropathic bladder c. Nocturnal enuresis d. UTI e. Uterine prolapse
Ans. The key is D. UTI. [In UTI there may be incontinence of urine and confusion].
51
1649. A 4yo boy complains of pain around his right eye. He is unwell, febrile and also suffers from pain on the right side of his face. What is the most probable dx? a. Allergic reaction b. Furuncle c. Folliculitis d. Foreign body e. Periorbital cellulitis
Ans. The key is E. Periorbital cellulitis.
52
1650. A pt presents with irregularly irregular pulse of 162bpm. What drug is most useful initially? a. Amiodarone b. Digoxin c. Bisoprolol d. Warfarin e. Heparin
Ans. The key is C. Bisoprolol (most likely its acute AF and 1st line is verapamil/bisoprolol, 2nd line digoxin/amiodarone)
53
1651. A 59yo man has shown a change in his mood and personality over a 9m period. He has subsequently developed difficulty with memory and conc, and then progressive fidgety movements of his limbs and facial musculature. By the time of medical assessment he has frank choreiform movements and a mini-mental state exam of 21/30. Other exam is normal. He was adopted and therefore no information on his
Ans. The key is A. AD inheritance with anticipation. [Patient is suffering from Huntingtons disease and that is autosomal dominant with anticipation which means a genetic disorder is passed on to the next generation, the symptoms of the genetic disorder become apparent at an earlier age with each generation].
54
1652. A 35yo pt has been dx with schizophrenia. He mimics the doctors and attendants – doing the same physical actions as them. What symptom does this pt have? a. Echopraxia b. Echolalia c. Perseveration d. Apraxia e. Anosognosia
Ans. The key is A. Echopraxia. [Echopraxia is the involuntary repetition or imitation of another person's actions. Similar to echolalia, which is the involuntary repetition of sounds and language. Echopraxia has long been recognized as a core feature of Tourette syndrome, and is considered a complex tic, but it also occurs in autism spectrum disorders, schizophrenia and catatonia].
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1653. A pt has loss of sensation on the tip of her tongue and the inner aspect of the lip. Which nerve is most likely to be involved? a. Vagus nerve b. Glossopharyngeal nerve c. Lingual nerve d. Buccal nerve e. Facial nerve
Ans. The key is C. Lingual Nerve.
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1654. A 51yo woman complains of difficulty swallowing and also reddish dots on her skin. A pic of her hand is seen. What is the most appropriate term for the condition you would expect to see? a. Sclerodactyly b. RA c. Swan neck deformity d. Polydactyly e. Ulnar deformity
Ans. The key is A. sclerodactyly. [Patient is suffering from crest syndrome, sclerodactyly its one of the features].
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1655. A 37yo female working as a healthcare assistant in a nursing home comes to the ED with complaints of severe itching all over her body. On asking she replies that she had applied cream on the body of a resident in the nursing home who had similar itches. What is the mechanism of itching? a. Allergic reaction b. Inflammation of keratinocytes c. Allergic reaction developed due to use of topical
Ans. The key is A. allergic reaction.
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1656. A 65yo pt who had MI 1yr ago now comes to the ED complaining that his neighbor is conspiring against him. When his son is asked, he denies it and also narrates that sometimes his father says that everybody in his office is always talking about him, which is not the case. What is the most appropriate med? a. TCA b. Clozapine c. Olanzapine d. Lorazepam
Ans. The key is C. Olanzapine. [Schizophrenia treated with olanzapine].
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1657. You suspect Cushing's disease in a 50yo woman who has attended clinic with glycosuria, HTN and a suggestive body habitus. Initial inv point you towards a dx of Cushing's disease. Which of the following findings would be against this dx? a. A normal 8am cortisol b. Failure to suppress morning cortisol with dexamethasone c. HTN requiring >2 antihypertensive agents d. Impaired growth hormone re
Key is E: Unilateral adrenal enlargement Cushing’s disease Bilateral adrenal hyperplasia from an ACTH secreting pituitary adenoma. Peak age 30-50 years, male female ratio 1:1 A low dose dexamethasone test leads to no change in plasma cortisol but 8 mg may be enough
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1658. Which finding, on clinical examination of the pulse, suggests a diagnosis of hypertrophic obstructive cardiomyopathy (HOCM)? a. Irregularly irregular pulse suggesting A-fib b. Pulsusalternans c. Pulsusbigeminus d. Pulsusbisferiens e. Pulsusparadoxus
Ans. The key is D. Pulsusbisferiens. [Pulsusbisferiens, is a sign where, onpalpation of the pulse, a double peak per cardiac cycle can be appreciated. Bisferious means striking twice. Classically, it is detected when aortic insufficiency exists in association with aortic stenosis,[1] but may also be found hypertrophic obstructive cardiomyopathy].
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1659. A 60yo male is admitted with a 2d hx of lower abdominal pain and marked vomiting. On examination he has abdominal swelling, guarding and numerous audible bowel sounds. What is the likely dx? a. Gallstone ileus b. Ischemic colitis c. Large bowel obstruction d. Sigmoid volvulus e. Small bowel obstruction
Key is D: sigmoid volvulus [History is not suggestive of ischemic colitis. There are no bowel sounds heard in gallstone ileus. Small bowel obstruction causes central abdominal pain, So given features with lower abdominal pain makes it more likely to be sigmoid volvulus].
62
1660. A 17-year-old boy is diagnosed with scabies. Which of the following statements regarding scabies is correct? a. Is best treated by salicylate emulsion b. It can be spread by a droplet infection c. It causes itchiness in the skin even where there is no obvious lesion to be seen d. It is caused by Staphylococcus aureus e. Typically affects the face
Ans. The key is C. It causes itchiness in the skin even where there is no obvious lesion to be seen.
63
1661. An anemic young man is found to have a macrocytosis of 90%. The most likely cause is? a. Zieve’s syndrome b. Thalassemia minor c. Chronic renal disease d. IDA e. Folate def f. Chronic liver disease g. HUS h. Cytotoxic chemotherapy i. Phenytoin
Ans. The key is E. Folate deficiency. [Zieve's syndrome is an acute metabolic condition that can occur during withdrawal from prolonged alcohol abuse. It is defined byhemolytic anemia (with spur cells and acanthocytes), hyperlipoproteinaemia (excessive blood lipoprotein), jaundice, and abdominal pain. The underlying cause is liver delipidization]
64
1662. An association with HPV is a most characteristic feature of? a. Torus b. Exostosis c. Pleomorphic adenoma d. Verruca vulgaris e. Fibroma f. Epulis fissuratum g. Mucocele h. Pyogenic granuloma i. Parulis j. Ranula
Ans. The key is D. Verruca vulgaris. [It is most commonly associated with warts or verruca vulgaris].
65
1663. For the following type of surgery what is the most likely agent that may cause post-operative infection -- aorto-iliofemoral reconstruction with a Dacron vascular prosthesis? a. Proteus b. E.coli c. Bacteroides fragilis d. Staphylococcus aureus e. Staphylococcus epidermis f. C.perfringens g. Pseudomonas aeruginosa h. Streptococcus fecalis i. Streptococcus pneumonia j. Brucella melitensis
Ans. The key is D. Staphylococcus epidermidis. [Staphylococcus epidermidis is most common cause of infections in prosthesis].
66
1664. A primigravida in the 17th week of her symptomless gestation is found, on US, to have evidence of placental tissue covering the cervical os. By the end of her pregnancy she is likely to develop? a. Placental migration b. Uterine myoma c. Uterine rupture d. Choriocarcinoma e. Chorangioma f. Vasa previa g. Subplacental abruption placenta h. Subchorionic abruption placenta i. Placenta accrete j
Ans. The key is A. Placental migration. [In 90% of pregnancies, an initial low lying placenta will be pulled upwards by the growing uterus and assume a normal position in the upper segment. This phenomenon is referred to as Migration].
67
1665. An elderly lady with COPD has chronic SOB. She is listed for cataract extraction. What is the anaesthetic of choice? a. Facial nerve block b. Bupivacaine infiltration of the peri-orbital skin c. IV midazolam d. Peribulbar acupuncture e. Peribulbar lignocaine infiltration f. Topical xylocaine g. IV alfentanil h. Epidural anesthesia i. General anesthesia j. Retrobulbar xylocaine Inj
Ans. The key is E. Peribulbar lignocaine. [The most used mode of anaesthesia in ophthalmic feild is peribulbar lignocaine].
68
1666. A 55yo chronic alcoholic with known hepatic cirrhosis has been on a heavy bout of alcohol the night before and was brought home by friends after falling several times in the pub. While being taken up the stairs to his bedroom he falls down the flight of 5 steps but sustains no obvious injuiry. His wife calls the ED the next day because she could not rouse him in the morning. He is brought in
Ans. The key is H. Acute subdural hematoma. [Acute subdural hemotoma, typical history of alcholics, falls and usually debilliated or elderly, hepatic cirrhosis increases coagulopathy and chances for bleed].
69
1667. A 58yo man complains of nose disfigurement. He has a hx of facial erythema particularly of the cheeks and nose. Papules and pustules have been erupting at intervals over the last 10yrs. He admits to a moderate regular consumption of alcohol. Exam: noted to have rhinophyma. The most likely dx is? a. Eczema b. Herpes simplex c. Epidermolysis bullosa d. Dermatomyositis e. Tinea versicolor f. Pe
Ans. The key is G. Acne Rosacea. [Acne Rosacea is characterised by recurrent episodes of facial flushing with persistent erythema, telangiectasia, papules and pustules.It is a chronic acneform disorder of the facial pilosebaceous glands with an increased reactivity of capillaries to heat, causing flushing and eventually telangiectasia.Rhinophyma is an enlarged nose associated with rosacea which oc
70
1668. A 60yo man who presented with metastatic adenocarcinoma of unknown source. He developed rapidly progressive weakness of his arms and was found to have a deposit of tumour in his cervical spine. This was emergently treated with radiation. He developed considerable nausea and vomiting during his therapy and at the end of the course began to have bloody vomiting. Following rescusitation with 6
Ans. The key is J. Endoscopy. [Whenever there hemetemesis endoscopy should be carried out immediately if the patients condition allows or it should be delayed till resucitation ,Underlying cause for hemetemesis needs to be sorted out.( High dose radiation is a cause Ulceration and any active bleeders must be treated)].
71
1669. A pt has fine nail pitting, small yellow-brown areas of discoloration in the nailbed involving the nails on both hands. These findings a re commonly associated with? a. Yellow nail syndrome b. Leukonychia c. Onychomycosis d. Lichen planus e. Pellagra f. Thallium toxicity g. Contact dermatitis h. Zinc deficiency i. Hypoalbuminemia j. Psoriasis
Ans. The key is J. Psoriasis. [Characteristic nail changes include pitting, discolouration, subungual hyperkeratosis, crumbling of the nail plate, and onycholysis].
72
1670. A young man develops nonfluent, effortful speech with dysarthria. He is able to undertsand speech. He fails to repeat the sentence. What would you do next? a. XR skull b. Non-contrast CT brain c. Contrast CT brain d. Contrast MRI optic nerves e. 4-vessel cerebral angiogram f. Single vessel cerebral angiogram g. Cerebral angiography h. MRI frontal lobe i. MRI pituitary gland j. MRI temporal l
Ans. The key is H. MRI Frontal lobe. (Brocas area). [Production (Broca's) dysphasia/aphasia - lesions are located in the left pre-central areas. This is a non-fluent or expressive aphasia since there are deficits in speech production, prosody and syntactic comprehension. Patients will typically exhibit slow and halting speech but with good semantic content. Comprehension is usually good. Unlike We
73
1671. A pt being sedated with fentanyl develops severe respiratory depression. This is best reversed using? a. Ethanol b. Naloxone c. Phyostigmine d. Atropine e. Methylene blue f. Diphenhydramine g. Calcium disodium ethylene diamine tetra-acetic acid h. Deferoxamine mesylate i. Flumazenil j. Folic acid
Ans. The key is B. Naloxone. [Opioid Antagonist, reverses the effects of fentanyl, though it has to be administeres for a longer period of time due long half life of fentanyl].
74
1672. A pt presented with the following blood work, MCV: Decreased Serum ferritin: Decreased Total iron binding capacity: Increased Serum iron: Decreased Marrow iron: Absent. What is your dx? a. Thalassemia trait b. Hypoparathyroidism c. Hereditary sideroblastic anemia d. Protein energy malnutrition e. Chronic renal failure f. Anemia of chronic disease g. Acute blood loss h. IDA i. Oral contracept
Ans. The key is H. Iron deficiency Anemia (IDA). [S/S pallor, koilonychia,angular cheilitis, atrophic glossitis, IN marked Anemia ( Cardiac enlargemnet,Flow Murmurs,ankle oedema and heart failure) Inv: FBC : shows microcytic hypochromic anemia, Serum ferrtitin Level reduced, normal 12-15 mcg/L, ( serum ferritin is falsely raised during infections), Anisocytosis and poikilocytosis. Total iron bindi
75
1673. A 20yo prv healthy woman presents with general malaise, severe cough and breathlessness which has not improved with a seven day course of amoxycillin. There is nothing significant to find on examination. The x-ray shows patchy shadowing throughout the lung fields. The blood film shows clumping of red cells with suggestion of cold agglutinins. a. Mycobacterium avium complex b. Coxiella burnet
Ans. The key is H. Mycoplasma pneumonia. [Inability to respond to a seven day course of amoxicillin suggests atypical pneumonia, patchy shadows throughout lung fields and cold agglutination points towards mycoplasma].
76
1674. An 18yo male works in a company where lunches are often catered. One day, the water at the company facility is not working, but they manage to have the lunch anyway. 2wks later, he becomes sick. He develops anorexia, nausea, malaise and jaundice. During the course of the next 4wks, 7 people who shared in the lunch become ill with similar symptoms. After a few wks, each of the 7 people comple
Ans. The key is D. Hepatitis A. [Symptoms of Hepatitis A range from mild nauseas to liver failure (very rare).Spread is normally by the faecal-oral route although there are occasional outbreaks through food sources.Hand washing and good hygiene around food and drink prevent spread of infection.Increasing age is a direct determinant of disease severity].
77
1675. A 35yo 1st time donor suddenly passes out as she is donating blood. Which of the following steps would be least useful in managing this adverse event? a. Ensure donor is adequately hydrated and has not skipped a meal b. Elevating the donor's legs as this is usually due to a vasovagal syncope c. Haemoglobin of the donor meets the minimum requirement for donation d. The donation is usually con
Ans. The key is C. Haemoglobin of the donor meets the minimum requirement for donation. [If syncop then we can continue donation giving simultaneous normal saline to the donor.(option D). Option C. Haemoglobin of the donour meets the minimum requirement for donation [as it is routinely done in every doner prior to donation and therefore this has no impact on syncope!!].
78
1676. An infant is being examined as part of a routine examination. The child can hold its head up and lifts its chest off a table. He has a palmer and rooting reflex as well as a social smile. He is not afraid of strangers. What is the most likely age of this child? a. neonate b. 2 months c. 6 months d. one year e. one and a half years f. two years g. four years h. seven years i. ten years j. fou
Ans. The key is C. 6 months.
79
1677. A mother is concerned because her 1m boy has a swelling in his scrotum. He was born prematurely. On examination the swelling is seen to transilluminate. The likely cause is? a. Lymphogranuloma Venereum b. Testicular Torsion c. Hydrocele d. Epididymitis e. Seminoma f. Mature teratoma g. Varicocele h. Lymphoma i. Orchitis j. Spermatocele
Ans. The key is C. Hydrocele. [Transilluminating scrotal swelling is likely a case of hydrocele. 1-2% neonates present with congenital hydrocele which disappears by 1-2 years].
80
1679. Jean is a 72yo woman with recurrent bowel cancer following a hemi-colectomy 2y ago. She is known to have both local recurrence and liver mets and her pain has been under control on MST 90mg bd. She has had quite severe pain in the RUQ for the past hour despite having taken her normal dose of MST. You find that she has an enlarged liver which is hard and irregular. There is marked localised t
Ans. The key is D. IM diamorphine.
81
1680. Titubation is a feature of disease involving the? a. Cerebellum b. Basal ganglia c. Corpus callosum d. Pons e. Temporal lobe f. Occipital lobe g. Optic chiasma h. 3rd ventricle i. Hypothalamus j. Pituitary gland
Ans. The key is A. Cerebellum [Titubations (head/body nodding) mostly occur due to cerebellar lesions].
82
1681. A 50yo farmer complains of pain in his left arm. Exam: he appears to have a neuropathy affecting isolated nerves in multiple, random areas of his left arm. He also has a palpable purpura and tender nodules on both of his upper and lower limbs. A likely diagnosis is? a. Carpal tunnel syndrome b. Polyarteritis nodosa c. Angina Pectoris d. Gout e. Cellulitis f. Rheumatoid arthritis g. Erysipela
Ans. B. Polyarteritis nodosa. [Presentaion:Peripheral nerves and skin are the most frequently affected tissues. PURPURA, LIVEDOID, SUBCUTANEOUS NODULES and NECROTIC ULCERS. Neurologically, MONONEURITIS MULTIPLEX>...involvemnet of CNS, GIT, kidneys and heart means higher mortality. RENAL INVOLVEMENT: hypertension, Renal failure, GIT:necrosis, perforation. Myalgia].
83
1682. A patient with chronic neutropenia develops a chronic cough. A CXR reveals a cavitating intrapulmonary lesion containing a movable rounded ball lesion. A likely dx is? a. Tuberculosis b. Bronchiectasis c. Cystic fibrosis d. Pulmonary hemosiderosis e. Mitral stenosis f. Aspergillosis g. Wegener’s granulomatosis h. Goodpasture’s syndrome i. Pulmonary embolism j. Non-SCLC
Ans. The key is F. Aspergillosis. [Mostly affects people with reduced immunity, reduced neutrophil count is also predilection for aspergillosis].
84
1683. A mother brings her 1yo infant to her pediatrician. She describes that following a common cold her child's voice has become hoarse and has developed a cough that sounds harsh and brassy and was worse at night. Exam: the child was noted to have trouble drawing air into its lungs between coughs and had trouble drawing air into its lungs. There was visible stridor on inhalation. The cause is mo
Ans: Parainfuenza. [Parainfluenza virus causes croup. A rough barking cough with hoarsness and wheezing, labored breathing, runny nose, fever, cough, decreased appetitie are common features]. Investigation: Viral culture of secretions. Treatment: Symptoatic supportive treatment Antibiotics incase of secondary infection.
85
1684. INR:Normal, APTT:Elevated, Thrombin time:Elevated, Plt count:Normal, Bleeding time: Normal. A likely aetiology is? a. Waldenström's macroglobulinaemia b. Heparin c. Sézary cell leukaemia d. Pelger-Hüet anomaly e. von Willebrand's disease f. Haemophilia g. HIV infection h. DIC i. Acanthocytosis j. Vit K deficiency
Ans: Heparin
86
1685. An infant has diarrhea for 3d with weight loss from 10 kg to 9 kg. Exam: he is noted to have dry mucous membranes, poor skin turgor, markedly decreased urine output, and tachycardia. His BP=normal and compression-release of the nail beds shows satisfactory refilling. Appropriate treatment would include? a. Plasmapheresis and plasma infusion b. 0.5% Normal Saline c. Lactated Ringer's injectio
Ans. The key is C. Lactated Ringer's injection.
87
1686. A 4yo boy has the sudden onset of bone pain. He begins experiencing bleeding of his gums and frequent bloody noses. His mother takes him to his pediatrician. Exam: he is pale and has numerous petechiae over his body, with lymphadenopathy and hepatosplenomegaly. He has WBC=100,000mm and numerous circulating blast cells. He is admitted to the hospital. A bone marrow biopsy=35% blast cells. Whi
Ans. The key is AML. [THIS IS AN ACUTE EMERGENCY IN AML. Leukostatsis causing bone pain. Other s/s are suggestive of AML short Hx, wbc 100000, petechiae, with lymphadenopathy, very high blast cell count and hepatosplenomegaly. Clinically it is very difficult to differentiate between CML and ALL. Lymphocytic means it develops from early (immature) forms of lymphocytes, a type of white blood cell. T
88
1687. A 63yo male has anal canal carcinoma with no evidence of spread to the pelvic wall, pelvic muscles or lymph nodes. This is typically managed by? a. Resection of the sigmoid colon b. Right hemicolectomy c. Left hemicolectomy d. Transverse colectomy e. Internal sphincterotomy f. CT guided drainage g. Diverticulectomy h. Transverse colostomy i. Chemotherapy and radiatherapy j. Abdominal perinea
Ans. The key is I. Chemotherapy and radiotherapy. [This is T1 N0 M0 that is stage 1 cancer. BUT we don’t have tumor size here and sphincter information. However surgery can be avoided To preserve sphincter. Chemo radiation is preferred
89
1688. A 2m baby develops a life-threatening anemia. Blood tests show a normal serum iron, ferritin and TIBC. Hemoglobin electrophoresis reveals a markedly decreased Hemoglobin A content and an increased hemoglobin F content. This baby's anemia is likely to be secondary to? a. Failure of alpha chain production b. Failure of beta chain production c. Deficiency d. Lead poisoning of B12 e. IDA f. Pres
Ans. The key is B. Failure of beta chain production.
90
1689. A 30yo caucasian man presented with a 2wk hx of gradually worsening vision in his left eye. The patient had been seen once by a neurologist 2yrs prv for flashes. At that time a head CT was normal. The patient was lost to follow up with the neurologist, but the flashes had continued for the 2yr period. The patient did not experience visual changes with activity or movement. The patient report
Ans. The key is C. Optic neuritis [Possible diagnosis is MS. Scotoma, 2yr Hx, age race are suggestive except more in females than males].
91
1690. A pregnant woman in an early stage of labour expresses the wish to have pain relief during labour. The anesthetist describes that if the patient wishes he can use medication as a local anesthetic to block the pain sensations of labour. Into which space should the local anaesthetic be normally injected? a. Anterior pararenal space b. Aryepiglottic space c. Vestibule space d. Epidural space e.
Ans. The key is D. Epidural space.
92
1691. A 29yo Afro-Caribbean man presents with a non-productive cough mild aches in the ankles. The symptoms have been present for 2m. His ESR is elevated. Ca: 2.69 mmol/l; PO4 -: 1.20 mmol/l; ALP: 80 iu/L. Serum 25(OH) D: 180 nmol/l Normal values for Calcium: 2.12-2.65mmol/l; Phosphate: 0.8-1.45mmol/l; ALP 30-300iu/L; Serum 25(OH) D: 20-105nmol/l; Urea: 2.5-6.7mmol/l; Creatinine: 70-120μmol/l a. O
Ans. The key is I. Sarcoidosis.
93
1692. A 22yo has had recent chickenpox. He now presents with confusion. He is noted to have low urine output and large petechiae all over his body. CXR: a large patch of consolidation is seen. The management of choice should be : a. Ventilatory support b. Open surgical debridement c. Resection of superficial petechiae with wide margin d. Booster vaccine e. TENS f. Lontophoresis g. Nephrostomy h. O
Ans. The key is J. IV acyclovir.
94
1693. A young girl with a psychiatric hx on med tx is brought to the dermatologist by her mother because of recurrent patchy hair loss. Exam: the hair shafts revealed twisting and fractures. This suggests the following pathology: a. Infection with Trichophyton tonsurans b. Infection with Microsporum canis c. Alopecia areata d. Telogen Effluvium e. Androgenetic Alopecia f. Lichen planus g. Traction
Ans. The key is J. Trichotillomania.
95
1694. Syphilis typically causes a. Lymphogranuloma Venereum b. Testicular Torsion c. Hydrocele d. Epididymitis e. Seminoma f. Mature teratoma g. Varicocele h. Lymphoma i. Orchitis j. Spermatocele
Ans. The key is I. Orchitis.
96
1695. A middle aged woman has severe collapse of the right femoral head requiring replacement. The removed femoral head is sent for pathology and is found to contain enlarged fat cells. The pathologist explains that this is the likely cause of the patient's femoral head collapse. A likely aetiology is a. Septic emboli b. Impaired venous drainage c. Hgb SS disease d. Steroid use e. Alcoholism f. Ga
Ans. The key is F. Gaucher’s disease. [Couldn’t get much reliable info about this question!]
97
1696. A 7yo boy with frequent episodic asthma is on tx with sodium cromoglycate. His physician wants to add a non-steroid preventer. The mother of the boy, a teacher, has just read about a nonsteroidal medication which acts on the mast cells, stopping them from releasing harmful chemicals. Her physician agrees to add this medication to the boy's drug regimen. Which medication is the physician most
Ans. The key is C. Nedochromil Sodium.
98
1697. A 3yo boy is playing with his brother when he falls. He cries immediately and refuses to walk. His mother carries him to hospital. He had a full term NVD with no neonatal complications. His immunisations are up to date. Exam: looks well and well-nourished, no dysmorphic features. He has slight swelling, warmth and discomfort on the lower 1/3 of the left tibia, and refuses to weight bear. AP
Ans. The key is E. Tibial fx. [Toddler's fracture • Undisplaced spiral fractures of the tibial shaft in children under 7 years old often follow minimal trauma and may not be visible on initial X-ray.[8] • Can be difficult to diagnose but should be suspected whenever a child presents with a limp or fails to bear weight on the leg. • Treatment consists of immobilisation for a few weeks to protect th
99
1698. Which one of the following electrocardiographic changes is found in hypercalcaemia? a. Increased QRS interval b. Prolonged Q-T interval c. Short P-R interval d. Short Q-T interval
Ans. The key is D. Short Q-T interval. [Short Q-T interval secondary to a shortened ST segment].
100
1699. An elderly male pt with prior hx of hematemesis is having hx of long term use of aspirin and other drugs, now presents with severe epigastric pain, dysphagia and vomiting. He was connected to vital monitors which were not reassuring. What is the management? a. Oral antacids b. IV PPI c. Oral PPI d. Endoscopy e. Analgesia
Ans. The key is D. Endoscopy. [Long term use of an nsaid predisposes to peptic ulcers. There may cause considerable bleeding leading to shock].
101
1700. A 68yo man presents with bruising and hx of falls. He is found to have a mask-like face, pillrolling tremor and shuffling gait. EEG=normal. Which of the following conditions is he most likely being treated for? a. HTN b. DM c. Psychosis d. TIA e. Complex partial seizure
Ans. The key is C. Psychosis. [Antipsychotics can lead to parkinsonism].
102
1701. A 45yo woman presents with easy fatigability, even on no exertion, chronic headaches and body aches and severe physical and mental exhaustion. She has no underlying conditions and all inv are non- conclusive. What is the most likely dx? a. Somatization b. Chronic fatigure syndrome c. Polymyalgia rheumatic d. GCA e. Depression
Ans. The key is B. Chronic fatigue syndrome. [Chronic fatigue syndrome (CFS) causes persistent fatigue (exhaustion) that affects everyday life and doesn't go away with sleep or rest].
103
1702. A 23yo male presents to his GP 2wks after a RTA concerned about increasing anxiety lethargy and headache. At the time he had a CT brain after banging his head on the steering wheel, which revealed no abnormality. 6m following this episode his symptoms have resolved. What did his original symptoms likely represent? a. Conversion disorder b. PTSD c. Somatization disorder d. GAD e. Post-concuss
Ans. The key is E. Post concussion syndrome. [Post concussion syndrome is a set of symptoms that may continue for weeks, months, or a year or more after a concussion – a minor form of traumatic brain injury].
104
1703. A 34yo man had a 4mm ureteric stone which he passed in urine. This time he presents withh 3cm stone in the right kidney. Single most appropriate treatment? a. No treatment b. ESWL c. Laparotomy d. Observe e. Operative stone removal
Ans. The key is E. Operative stone removal. [Stones < 5mm: pass spontaneously, Inc fluid intake Stones 5mm-1cm /pain not resolving: medical expulsive therapy---> Nifedipine or Tamsulosin(and/or prednisolone) Stones 1cm-2cm: ESWL or Ureteroscopy using dormia basket Stones > 2cm/large/multiple/complex: Percutaneous nephrolithotomy].
105
1704. An 18m girl who has had single UTI is seen in the OPD. She has fever and vomiting but these improved with course of trimethoprim. Subsequently, MCUG showed bilateral vesicoureteric reflux. Single most appropriate mgmt? a. Prophylactic antibiotics b. Reassure c. No treatment d. Ureteric surgery
Ans. The key is D. Ureteric surgery. This is wrong key. Correct key is prophylactic antibiotics. [Usually most of the cases of VUR (even though bilateral) cures with advancing age with antibiotic prophylaxis and only a minority need surgery].
106
1705. A 22yo says she has taken about 40 tabs of paracetamol 3h ago. Her HR=110bpm, BP=110/80mmHg and RR=22bpm. What’s the initial management? a. Activated charcoal b. N-acetyl cysteine c. Gastric lavage d. Wait for 4h paracetamol level
Ans. The key is D. Wait for 4h paracetamol level.
107
1706. A 35yo man skidded on a wet road while riding his motorbike at a speed of 70mph. He has a large hematoma on temporal scalp, some bruises on chest wall and abdomen and a deformed thigh. GCS 11/15. High flow oxygen via mask given. Most immediate radiological inv required during initial resuscitation phase? a. CXR b. CT brain c. CT abdomen d. XR femur
Ans. The key is A. CXR. [CXR may reveal possible chest structure trauma requiring urgent attention which may be life saving while brain lesion need time consuming CT and tx and fracture femur may be managed taking more time].
108
1707. A 4yo baby has a generalized tonic-clonic convulsions and fever of 39C. His mother informs you that this has happened 3-4 times ebfore. What is the most probable dx? a. Febrile convulsion b. Absence seizures c. Epilepsy d. Partial complex seizure
Ans. The key is A. Febrile convulsion.
