2022 Flashcards
LOW LEVEL Of PAPP - A
Evaluation of Growth Screening
white thicky creamy cheese vaginal discharge
itchy, soreness and redness
colour white curd like discharge
Candida Albicans
Yellow green vaginal discharge
strawberry appearance of the vagina
Trichomonas
gray watery profuse vaginal discharge
foul smelling
wet mount test positive positive clue cell
Bacterial vaginosis
Yellow green
thick mucupurulent
SIGNS of PID
Cervicitis
cervical motion tenderness
PID
Colles Farcture
How will you apply the cast
FUDP
Flexion
Ulnar Deviation
Pronation
or Flexion and below elbow
eye trauma and reduce vision.
dx?
Lens dislocation
A 25 yo female
Patient took rubella vaccine 2 weeks ago, 1 week before her period
She missed her periods and now is pregnant . What will you do?
Rubella Serology
5.1 cm stone at Uteropelvic junction
What to do?
ESWL
Extracorporeal Shock Wave Lithotripsy
Best way to prevent Trachoma in a community?
Handwash
Studying a case if food poisoning that happened one week ago in a marriage. Appropriate study?
Cohort
Abdominal Plain Xray normal small bowel filled with gas, asked investigations?
Colonoscopy
0.2 ABI and patient smokes 40 cigarette a day. What to do next?
CT arteriogram
When to intubate?
GCS below 8
Rhinorrhea, CSF+ , Periorbital hematoma
What to do next?
CT Scan
5yo with asthma attack and was given inhaled Salbutamol and symptoms were relieved/ Now he is discharged. What to give to prevent future attacks?
Fluticasone(ICS)
Admitted and discharged shortly
Asthma attacks
Oral prednisolone must during discharge
best way to prevent exercise induced asthma
SABA
32.-3.6 cm aortic aneurysm increase in 2 years. When do you screen?
Every 2 years
Floaters and flashes
Retinal Detachment
Hematuria and hemoptysis
What is the inital Diagnosis?
Urine Culture
DHematuria and hemoptysis
What is the confirmatory Diagnosis?
anti-GBM antibodies
hematuria associated with sensorineural deafness and eye disorders
it progress to renal failure
Alport Sydnrome
if patient with asthma doesnt present symptom
LABA
Severe asthma:
A. nocturnal asthma more than 1 per week
B. symptoms most day
C. Multiple ED visits
SABA prn and
LABA with ICS
add
Ipratropium bromide (Nebuliser)
or
Oral Prednisolone
History of duodenal ulcer
H pylori in biopsy
Triple Therapy
MTX and pred long term no remission
Now wants to get pregnant
Change to SULFA
DRUGS OF CHOICE FOR RA in pregnancy: CASH
Cyclosporine
Azathioprine
Sulfasalazine
Hydroxychloroquine
develops fever, malaise, sore throat and dry cough, hacking cough
diffuse rales and rhonchi
What is the diagnosis?
S. pneumoniae
Atypical pneumionaie
Alcoholics
lungs abscess
organism?
Kleibsiella pneumoniae
COPD
organism?
Haemophilus influenzae
Recent viral infection
org?
Staphylococcus aureus
poor dentition
aspiration
organism?
Anaerobes
Young, healthy patients
pneumonia
org?
Mycoplasma pneumoniae
haorseness
pneumonia
org?
Chlamydia pneumoniae
contaminated water sourdes
air conditioning
ventilation systems
pneumoniae
org?
Legionella
Birds
pneumoniae
org?
Chlamydia Psitacci
1st year pneumoniae
BEL
beta Hemolytic
E coli
Listeria
animals at the time of giving birth
veterinarians
farmers
pneumonia
org?
Coxiella burnetii
Right Upper lobe collapse
Pancoast tumor history
asking diagnosis
Pemberton Sign
SVC obstruction
Horner’s Syndrome
outpouching that occurs at the junction of the lower part of the throat and upper portion of the esophagus
the poucg forms because the muscle that divides the throat from the esophagus the cricopharyngeal CP muscle, fails to relax during swallowing
Zenker’s diverticulum
keratin pearls and intercellular bridges
hilar mass arising from bronchgus
Squamous cell Carcinoma
Genetic test for cystic fibrosis
Sweat Chloride Test
88 yo woman slipped and hit her head on the tub
now confused and only knows her name not the date and where she is at
diagnosis?
Subdural hematoma
bridging veins - most commonly affected vessel
next best step and initial diagnosing test ? - CT scan without contrast - classic finding - crescent shaped hematoma
most appropriate therapy - immediate surgical evaluation and hematoma evacuation thourgh either a burr hole or craniotomy
intermittent stream and difficult in voiding, soft DR with moderately enlarge, painless hematuria. What to do next?
Urinalysis
if it is painless, always initial is Urinalysis then followed by
if >55 yo, macroscopic - Cystoscopy
if >35 yo. macroscopic - CT abdomen
if >55 yo, microscopic - USG or Cytoscopy
if >30 yo, microscopic - USG or Cytoscopy
if it is painful, initial is still urinalysis then followed by
if >40 yo - Xray to confirm then Spiral CT scan
A premenstrual 47 yo
fatigue, breast tenderness and bloating
pills alleviated PMS symptoms except for depression and emotionals
What is the next step?
Fluoxetine 20mg or Sertraline 50 mg in the morning for 14 days before the anticipated period
post menopausal symptoms
- Hot flush
old man with voiding difficulties,
prostate DRE done
and its normal
what’s next step?
Day to day activities
A man with HTN and COPD, cramps in the calf muscles upon walking one block
diminised popliteal and pedal pulses
what medication should be used to avoid ?
ACEIs
Choice of antihypertensive in different situations
- with Asthma?
CCBs
Diuretics
Beta Blockers, ACEIs - is contraindicated
Choice of antihypertensive in different situations
- in Pregnancy?
if there is emergency - Beta Blockers ( Labetalol BP 150/)
Essential Hypertension ( random visits then increased BP) - Methyldopa
Choice of antihypertensive in different situations
- in Renal Artery Stenosis?
Unilateral - ACEIs
or Bilateral - Diuretics (ACEIs is contraindicated)
Choice of antihypertensive in different situations
- Chronic Kidney Disease?
ACEIS
ARBs
Choice of antihypertensive in different situations
- Post dialysis ?
CCBS
Beta Blockers
ACEIs
Cannot give Diuretics - there is already too much fluid
Choice of antihypertensive in different situations
- Acute Renal Failure
in case of congestion - DIURETICS
is stable case - BETA BLOCKERS
Choice of antihypertensive in different situations
- End stage Renal Disease?
Transplantation
Man with urinary retention mass above the pubic symphysis
DRE shows enlarged prostate with palpable median sulcus
catheter inserted what is the most appropriate step?
Trans Rectal Ultrasound Guided biopsy
woman with cardiac artery stenting, debelops episodes of transient visual loss to her left eye. Vision returns within 30 minutes. 10 of these within the past 3 months. Symptoms?
Retinal Vein Thrombosis
40yo male patient with RA, on Methotrexate and Hydroxycholorquine, planning to start family. What is your advice?
A. Stop Methotrexate and continue Hydroxychloroquine
a 32 yo woman came with greenish vaginal discharge. She had an implanon 3 years ago. She lives with her female sexual partner. A diagnosis of bacterial vaginosis was made and she was given Metronidazole. What else will you do?
Treat her partner
A 5 day infant - mild puruelnt eye discharge
mild cursted yellowish discharge in both eyes without a prominent swelling and inflammation of eyelids
org?
Gonorrhea
neonatal eye discharge
first day
Chenical Irritation
neonatal eye discharge
1st week
Gonorrhea
neonatal eye discharge
1- 2 wks
Chlamydia
tx: Azithromycin 20 mg/kg orally for 3 days
female first trimester. trying to stop smoking. How will you help?
Nicotine Patch
Man working in garden fell and rubbed his face on grass vision blurring, no pain, no conjunctivitis. What is the next investigation?
Fluorescien
28 yo female positive for HPV 16, 18 and negative for 16 and 18
Cervical screen 6-12 months
10 cm cyst two months after pancreatic, middle age patient comes with epigastric pain, a cyst is exactly posterior stomach, best managed asled?
Endoscopic Gastrostomy
up to 40 % of pseudocyst resolve without intervention
Pseudocysts smaller than 6 cm - usually disappears without intervention
if it is larger than 6 cm with symp, > 6 wks - surgically drained
less than 6cm without symp - careful observation with periodic CT scan
Xray of slipped Capitofemoral joint of a 14 year old boy with BMI 30. What will you do?
Pinning of joint
A young patient has got often light headedness
normal CXR
ECG normal
Holter monitor reveals ventricular ectopic
Plain echo
45 from Sri Lanka with painless haematuria. probable dx?
UTI
Female with gestational diabetes fx,
normal OGTT at 8 wks
What to do?
24-28 wks
7 days post op patient with dyspnea and breathlessness
Most appropriate investigation?
Since he is post op Patient then answer is CTPA
CTG of primigravida given, FHR at 120 bpm What to do?
FHR is normal so continue Fetal heart monitoring
if there is late decelerations then scalp ph sampling then put mother in left lateral position then second give O2 and third if hypo - give synto and do monitor CTG every 4 hrs.
An old age patient with cataract had improve vision after surgery, in post op day 4 he had painful eye and blurred vision. What is the diagnosis?
A. Conjunctivitis
B. Uveitis
C. Suture infection and Abscess
D. Hypopyon
E. Acute Glaucoma
C. Suture infection and Abscess
A ball hitting the eye leading to floaters and vision loss asking cause?
Retinal Detachment
The five F
Fall of vision
Flashes of light
Floaters in the vitreous
Fundus findings
Field changes
Baby 17 days old with jaundice
Normal weight gain
Stools and urine also normal
What can be the cause?
A. Biliary atresia
B. Breast Milk jaundice
C. ABO incompatibility
B. Breast Milk jaundice
ABO incompatibility - is a first day jaundice so within 24 hrs but this baby is 17 days old
While Biliary atresia - will have obstructive features such as dark urine and pale stool.
Covid Positive 6 days symptoms
88% saturation
after oxygen treatment
A. Ceftriaxone
B. Amoxiclav
C. Remdesivir
D. Prednisolone
D. Prednisolone
Case of temporal lobe epilepsy in a lady asking about which step will help you to make diagnosis?
A, Video EEG - never the first line
B. History from the witness
C. CT head
D. ECG
E, Carotid message
B. History from the witness
What is the first line investigation for seizure?
Electrolytes
recurrent time - glucose
patient went to Jakarta but did not visit rural area only city and hotel. Fever, malaise and rash. What is the investigation?
Dengue Ns1
What are the complications of Malaria?
CHAPLIN
Cerebral Malaria or Coma
Hypoglycemia
Anaemia
Pulmonary edema
Lactic Acidosis
Infections
Necrosis of Renal tubules
Gastrointestinal symptoms, hepatomegaly, neurasthenia, cholangitis. cholecystitis
Dx?
It is a common infection of dogs and other fish -eating carnivores (reservoir final hosts) in China, Korea, Republic of Kora and Vietnam, Cambodia and Taiwan
Clonorchiasis
Transmission is tru undercooked fish
bilary tract inflammation - pigmented gallstones associated with cholangiocarcinoma
Clonorchis sinensis
Tx: Praziquantel
Short Intubation and Long intubation
D
Cambodia
Cholangitis
Liver Abscess
India
Enteric
patient went to Thailand
fever malaise hepatosplenomegaly
DX
HIV
other diseases:
Pneumonia
STD
Chikunguniya
Viral Hepatitis
Measles
Anthrax
Ricketssiae
Old female patient is abusing alcohol
laboratory test to confirm this
A. MCV
B. ALT
C. MCH
D. AST
A. MCV
Which of the ff abnormalities not associated with long QT segment?
A. Hypokalaemia
B. Hypocalcaemia
C. Hypomagnesemia
D. Hyponatremia
E. Bradycardia
D. Hyponatremia
A boy with ADHD was initially treated with methylprhenidate after 6 month how do you adjust the dose?
A. Assess the level of hyperacitivity
B. Side effects
C. Reduced Symptoms
D. Improve lifestyle
E. Good grades in school
A. Assess the level of hyperacitivity
Alcohol withdrawal synmptoms
Delirium Tremens
Tx:
Tx for Adjustment disorder
Psychodynamic therapy
Tx for OCD
Exposure and Response Therapy
Tx for Tourettes Syndrome
Habit Reversal therapy
Tx for ASD
Behavioural modification program
tx for Persistent depressive disorder
Insight Oriented Psycotherapy
Tx for grief
Supportive Therapy
Tx for ODD
Family therapy
TX for Kleptomania
Insight Oriented Therapy
Tx for Separation Anxiety DIsorder
CBT and Psychotherapy
TX for ADHD
Behavioural Therapy
Tx for Specific Phobia
Systematic Desensitization and Exposure therapy
Tx for all dissociative disorders
Psychotherapy
tx for Anger management
CBT or anger management therapy
Divorded parents
Child lives with father, complains abdominal pain O/e normal. Tx?
A. COgnitive therapy
b. Behavioural therapy
C. Fluoxetine
D. Amitriptylline
b. Behavioural therapy
tx for alcoholics + agitated
B2
Tx for alcoholic + psychosis
Haloperidol
nonalcoholic + agitated
Nonalcoholic + psychosis
TX; Haloperidol
Teen boy falling grades
Plays video games all day
knows that video games is affecting his studies
Wants a career in video games
dx?
A. Normal adolescent behaviour
B. Drug addiction
C. ADHD
D. ODD
A. Normal adolescent behaviour
Patient stopped eating for 2 days. Says she has no gut. Patient does not want ECT
A. Give ECT on the ground of patient no care no consent needed
B. mental Health ribunal
C. COnsent of husband
B. mental Health ribunal
Patient lawyer wants his medical records as he is going to appear in the court. What do you do?
A. give him the records
B. Tell him need court order
C. Need to do forensic assessment before giving records
B. Tell him need court order
All of the following can cause Serotonin Sydnrome except:
A. Haloperidol
B. L tryptophan
C. Clonazepam
D. Meclobemide
E. Dectromorphan
C. Clonazepam
Pt hit the eye by a ball
orbital floor fracture
A. Diplopia upward and outward
gaze
B. Diplopia on downward gaze
C. Pain on opening mouth
A. Diplopia upward and outward
gaze
Features of Orbital FLoor fracture
decreased visual acuity
binocular vertical diplopia
eyelid swelling
ipsilateral hyperaesthesia
Enopthlamos is a late feature that can be seen after edema settles.
horizontal diplopia and chewing
Zygomatic Fracture
Specific feature of orbital floor fracture
ipsilateral hyperaesthesia
most common feature of orbital floor fracture
vertical diplopia
cluster of autonomic, motor and mental status changes resulting from excess 5-HT
Serotonin Syndrome
tx: Cyproheptadine
Asymptomatic with 30% pneumothorax
Intercostal tube with large bore catheter
<25% collapse with no symptoms - observe
<25% collpase with symptoms - Drain
>25% collapse - usually drain
Symptoms and Management in Serotonin Syndrome
mediastinal shifting
Tension Pneumothorax
tx: Needle throcostomy
newly diagnosed ankylosing spondylitis treatment asde from physiotherapy?
A. Naproxen
B. TNF inhibitors
C. Paracetamol
D. morphine
A. Naproxen
If NSaids Failed what is the second line management for Ankylosing Spondylitis?
Etenercept
Adalimumab
Infliximab
What is the accurate method to diagnose Ankylosing spondylitis?
biomarker for AS - HLAB27
MRI
Acute Tophous gout treatment?
Prednisolone
Prophylaxis of a flare of gout
Cochicine 0.5 mg daily or bid
or Predinisolone 6mg daily
or NSAID eg Diclofemac 25-50 mg up to 200 mg/daily
60 lady joint pain with Heberden’s nodes. How to diagnose?
Osteoarthritis
- Xray
- ESR and CRP is not raised. coz it is non-inflammatory
polarized light microscopy
positive birefringence
Pseudogout
polarized light microscopy
negative birefringence
Gout
Tx of Gout with Renal problem
Corticosteroids
if its not in the choice
low dose colchicine
How to treat Seborrheic Keratoses?
freezing them with liquid nitrogen or cryotheraphy
, or electrocuatery or laser resurfacing or Ablative laser
4yo child with sudden onset of fever, resp distress, drooling, soft inspiratory stridor. Diagnosis?
A. Croup
B. Epiglottitis
C. Bronchiolitis
B. Epiglottitis
81yo 3 month progressive constipation
Pain for 5 days
Xray is given
A. sigmoid Volvulus
B. Colon Cancer
A. sigmoid Volvulus
more common in older men and has sudden and severe onset
4months runny nose - low grade fever and family members got infected
wheezing, cough. cause?
A. RSV - bronchiolitis
B. Pertussis
C, Influenza
A. RSV**
Bronchiolitis is for less than 1 month old
Initial investigation for bronchiolitis and pertussis?
Nasopharyngeal Swab
boggy swelling of knee. Clicking sound. Inv?
A. Xray
B. MRI
C. Arthrocentesis
B. MRI
Dx - ACL tear
Croup, what org?
Parainfluenza
Adenovirus
Influenza
Old patient, bilateral shoulder and hip pain. Lab given ESR raised, Ck normal
Treatment?
A. Prednisolone
B. Paracetamol
A. Prednisolone
myopathy
CK and ESR both elevated
Polymyositis
myopathy
ESR and CK both normal
Drug induced - steroids - statin
myopathy
ESR is raised and CK is normal
Polymyalgia Rheumatica
Long standing angioedema can be associated with what medications?
ACEIs
Age > 50
new headache - throbbing, unilateral
diplopia
polymyalgia rheumatica
loss of pulsation of temporal artery
jaw claudication
temporal artery 5cm is diagnostic
Temporal Arteritis
fatigue / malaise + headache + jaw claudication
Temporal Arteritis
Inv for temporal arteritis
ESR is elevated
C-reactie protein elevated
mild anaemia 0r normochromic normocytic
Thyroid operation done
After sometime develop difficulty breathing
management?
A. Intubation
B. Open the sutures
B. Open the sutures
Right Homonymous hemianopia
with macular sparing
where is the lesion?
Left Occipital cortex
Epigastric hernia on linea alba commonly contains what?
Extraperitoneal Fat
Collegue is HIV positive doesnt want to reveal the condition and continues to practice what to do?
Report to APHRA
patient that takes medications for RA well controlled
Ibuprofen, Sulfasalazine, prednisolone, cyclosporine suddenly feeling tiredness and elevated platelets and abnormal labs
Ibuprofen
Female patient hx of syncope. ECG normal, bp sitting and lying same and normal. What is next?
Holter to rule out cardiac arrythmias
dx: Fatigue + dizziness +/- Syncope = Cardiac Arrythmias
Patient gf came to pick up prescription for insulin?
Confirm over the phone
Patient suicidal. Involuntarily admitted. Dad lives with him comes later and asks for what happened?
A. Tell father
B. Don’t tell father because of confidentiality
B. Don’t tell father because of confidentiality
Foster mother wants to return girl child as she was doing unusual sexual behavior with other kids
A. Inform child protection
B. Arrange another foster home
C. Get psychiatric evaluation
D. Chase collateral information about the family structure
E. Notify hospital admission
C. Get psychiatric evaluation
Down’s patient ear pain. Carer says patient has intermenstrual bleeding. She doesn’t want you to allow to examine her and just wants to discuss about the ear pain? What will you do?
A. Examine her under GA
B. Ask her about the knowledge of intermentstrual bleeding
C. Arrange for ultrasound
B. Ask her about the knowledge of intermentstrual bleeding
38 wks, amniotomy meconium stained, CTG is normal. What is next?
STOP CTG
Child healthy, playful, no bruise anywhere, mild urti. Mother young very sickly, bruise on both hands, lives on uncle’s basement and eats leftover, coffee, beer and cigarettes. What to do?
A. Child protection
B. Child health services
C. Emergency shelter service
C. Emergency shelter service
female bruising all over. Says bf abuses. What to do?
A. Photograph
B. Encourage to report
C. Arrange shelter
C. Arrange shelter
Protect first
Allopurinol dosage
50 - 300 mg
Picture of heberden nodes. Which condition causes this?
Celiac Disease
Hyperkalemia
Previous 1 week h/o headache, fever. Now came with h/o dark urine, jaundice, hepatomegaly, splenomegaly. Sexual partner is well. What is the diagnosis?
EBV
34wks pregnant patient, came with complaints of itching
What is the diagnosis
Cholestasis of Pregnancy
presents in the last trimester with symptoms of fulminant hepatitis - jaundice, vomitinh, abdominal pain, headache and possibly coma
Acute Fatty Liver of pregnancy
40 yo male with visible hematuria. Kidneys palpable. No pain symtoms what is the diagnosis?
Polycystic Kidney Disease
palpable kidneys
Good pasture disease. Investigation to confirm the diagnosis?
A. Antibuclear antibody
B. Anti basement membrane antibody
B. Anti basement membrane antibody
Anti-GBM antibody
tx for GBM - plasmapheresis and immunossuppression
the defect is in the alpha 3 subunit of type IV collagen
DXT: failure to thrive + chronic cough + loose bowel actions
Cystic Fibrosis
dx: Sweat chloride test
Picture of prolapsed hemorrhoids. What is the appropriate management?
Rubber Band ligation
tx for ADHD
Methylphenidate
vulva itchiness that doent respond to two course Itraconazole
White lesion on examination
mgt?
Lichen Sclerosus
Ans- Bethamethasone (steroid) cream
A woman came to you with infertility, she also has hirsutism. What will be your next investigation?
PCOS
- FSH/LH (same with infertility cases - always check this one out first)
During routine check up, adrenal mass is seen in CT and MRI, but no symptoms and all well. What will you do?
A. CT in 6 months
B. Percutaneous biopsy
C. Tumor resection
A. CT in 6 months
Middle aged man, comes with lower back pain, radiating to the right thigh, leg pain, hard to walk, difficulty with everyday activities. H/o urine incontinence, O/e verterbal local tenderness. Which one of these condition is more consistent with spinal cord compression?
A, Urine incontinence
B. Leg pain
C. Impaired ankle jerk
D. Vertebral local tenderness
E. Lower back pain
D. Vertebral local tenderness
Women concerned about ovarian cancer, because her Grandma got one. She is on COCP. What will you do next?
A. Continue COCP
B. Increase the dose
C. Decrease the dose
D. CHange POP
E. Condoms
A. Continue COCP
A woman came for OCP, mother and sister have recent DVT. What will you advice
A, Thrombophilia Test
B. Low dose COCP
C. High dose estrogen COCP
E. POP
E. POP
32 yo woman, came with amenorrhea for 12 mos, no sexual activity since 1 yr ago. best inv?
Beta-HCG
always exclude pregnancy first
mother with car accident, bruises in abdomen by seatbelt, condition is good, fetal heart sound auscultation is good, What is next?
Admit and hospitalize
5 year old child leg pain during night but well at daytime, normal well development. What is the next step?
Reassure
Dx; Growing pains
an old lady fell on her shoulder 6 wks ago
sustained no fractures
now returns with the swelling and mottling on her shoulder and proximal area of her arm
complains of hypersthesia and extends from arm to mid-forearm
Normal doppler sonogram
Diagnosis?
CRPS
Complex Regional Pain Syndrome
Young man after jogging and going up slopes pain in lateral aspect of knee tenderness in 30 degree knee flexion in lateral distal femur what is the diagnosis?
A. Iliotibial band syndrome
B. Lateral meniscus
C. Stress Fracture of Lateral condyle of femur
Ilotibial Band Syndrome
Young lady with epilepsy for which she was on phenytoin. She wants contraceptive for 2 years. What is best for her?
A. COCP with 30 ug ethinyl estradiol
B. POP
C. Copper IUCD
D. Implanon
C. Copper IUCD
Symmetrical arthralgia in small joints of both hands.
ANA, ENA (anti roSSA), RF and dsDNA positive
Anti CCP negative
What is the diagnosis?
SLE
Patient in cardiac care unit for MI 2 days ago
PCI done
Now ECG of 3rd degree heart blocl
What to do?
A. transcutaneous pacemaker
B. Permanent pacemaker
B. Permanent pacemaker
Patient presenting with diarrhea, generalized arthralgia, rash on lower extremities since 2 days. Treated for sore throat with Amoxiccillin 7 days before. What is tyhe cause?
HSP
char by tetrad of palpable petechial rash or purpuric rash, arthralgia/ arthritis, abdominal pain and nephritis
IgA Vasculitis (HSP_
17 yo boy admitted for some leg fracture. Asked nurse to give morphine. Now the boy is complaining of severe pain. Found out nurse decided that he doesnt need morphine so gave him PCM. What will you do?
A. Notify AHPRA
B. Incident report
C. notify the hospital administrator
D. Discuss the issue in nursing head meeting
B. Incident report
if patient has breath sounds decrease on left upper side of the back and Xray shows opacity in the left upper lobe. What is next?
CT chest
Assistant of specialist came to you complaining of work overload. Distressed because of that. Specialist is your friend so what will you do?
A. Declare conflict of interest
B. Tell specialist about this
C. Tell her its okay
D. Ask her to find new GP
A. Declare conflict of interest
Z
equivalent amount of radiation in Xray
400
55yo has diplopia for 1 day R eye
Glucose is normal
ECG shows occasional ventricular ectopic
Management?
Observation
A man presents with pansystolic murmur which is radiating to the axilla
What is the diagnosis?
MR
MR. Pan napunta sa axilla
Mitral Regurgitation
B is correct
PVT - cannot stop the heart from poundingA
B Stop patient’s metoprolol
65 yo man digoxin with HF and basal crepitation came with SOB in emergency pedal edema
Management?
A. Furosemide
A. TEE
A. TEE
young, basketball player, swollen arm, edematous, mild discoloration, tender
o/e small lymph nodes are palpable but not tender
cat is unwell
A. Cat scratch disease
B. Cellulitis
C. Axillary vein thrombosis
C. Axillary vein thrombosis
(vs catscratch - with fever)
Athlete + fever for few days + lymphadenopathy usually painful + animal / cat sick + limb swelling
Cat Scatch disease
swelling in the arm with pain high in the axilla
seen in people working above their head, such as painters and basketballers.
it is an emergency requiring antithrombotic therapy.
Subclavian or Axillary Vein thrombosis
68 yo hip fracture, comes for third day with SOB with chest tightness
What is your probable diagnosis?
A. Fat Embolism
B. Pulmonary Embolism
C. MI
D. Cardiac Tamponade
A. Fat Embolism
It occurs within 24-48 hrs after trauma but thromboembolism is uncommon before 5 days after immobilization.
Hampton’s hump
Wedge opacity
Pulmonary Embolism
`28yo diagnosed with HOCM and now is worried if her 10 years old child has the same. ECG echo normal what next?
A. Stress Echo
B. ECG echo in 2-3 years
C. repeat Echo
B. ECG echo in 2-3 years
Melanoma in the eye (on eyelid) treatment
A. send plastic surgeon
B. Observation
A. send plastic surgeon
What will you do for follow - up with Melanoma
A. Chest CT
B. Mammography
C. LFT
D. Brain CT
Chest CT
An 28 alcohol male patient agitated brought to the hospital glucose is 4. Qhat is the immediate thing you will do in the ER before definitive treatment?
A. IV glucose
B. IV thiamine
A. IV glucose
Adult, agitation, woman, alcoholic
A. Blood Glucose
B. Look for Oral Diazepam
C. Haloperidol IM
C. Haloperidol IM
Four years snakebite (black snake) boy is alert plus conscious. First step at site
A. Immobilize plus pressure
B. Do nothing
C. tourniquet
A. Immobilize plus pressure
diabetic ketoacidosis in 19 yo , glucose 22 mmol.
A. IV fluids
B. Insulin
C. KCL
A. IV fluids
What does the comatose patient needs
water
sodium
(3L normal saline)
Potassium (KCL)
Insulin
Diaphragmatic rupture
what to diagnose?
Abdominal CT scan
Diarrhea with HCO3 = 8 (N 24). What will you add to the IV fluid?
A. NaHCO3
B. Fluid restriction
A. NaHCO3
All of the ff can cause serotonin Sydnrome except?
Clonazepam
bloody diaarrhea, and o n Sulfasalazine now came with red rash on leg picture of
Erythema Nodosum
CT is given - adeno, chronic calcification pancreatitits, woman
3 glasses of wine intake, weight loss
dx?
Pancreatic carcinoma
colicky abdominal pain and anorexia for 7 days
2 days with diarrhea
tenderness all over the abdomen with guarding
temp 39
diagnosis?
Perforated appendicitis
Acute tophous gout treatment?
Allopurinol
Abdominal ultrasound - focal hepatic lesion
abdominal ct scan - enhaving focal mass suring the arteril phase with rapid washout during the portal venous phase
diagnosis?
Liver cancer
fever and petechial rash
diagnosis is meningitis
What is the next step in the management?
A. Blood Cultures
B, Intravenous access
C. Lumbar puncture
D. Intravenous ceftriaxone
E. Intravenous Benzoyl Penicillin
B, Intravenous access
Vietnam travel - What prophytlaxis is required?
A. Doxycycline
B. Ampicillin
A. Doxycycline
Salmonella travel advice?
A. TRSD Vaccine
B. Doxycycline
C. Avoid street food
D. Drink Bottle water
C. Avoid street food
boggy swelllling at the knee, clicking sound
ACL
dx: MRI
Why do you notify Salmonella
A. To research
B. To prevent spread
B. To prevent spread
Typhoid travel advise
best suggestion
A. Vaccine
B. Personal hygiene
A. Vaccine
70 male, recent travel to asia, now confused, neighbors brought to ED
axillary and lymph node enlargement. What test will you do
A. HIV
B. Syphilis serology
A. HIV
Varicella Zoster
PCR
Cellulitis red swollen hand
antibiotic?
IV Fluctox
27yof, breast mass 0.5 cm, painless, no swelling, , nontender and firm. aunt had breast ca age 65
USG
A young woman with pap smear results: LSIL and HPV test was negative for none 16 and 18. Management?
54 yo, asymptomatic man, comes concerned with colon cancer, father has colon cancer at 67. What can he do for cancer screening?
FOBT now
patient is in hospital for cholecystectomy
tachycardis + increased BP + chest pain + dyspnea + ECG ST segment depression
management?
Cath Lab
sputum fever, CXR lower lobe consolidation
Probable cause?
Streptococcus Pneumoniae
54yo F, with stress incontinence
What is next?
Urine analysis
A young man with mass in the lft testis separated from the testicle, painless, mass is compressible, nontender and can be felt soft and firm. What is your diagnosis?
A. Varicocele
B. Epididymal cyst
C. Inguinal hernia
D. Non seminomal testis cancer
E. Seminomal testis cancer
Inguinal hernia
bulge above the umbilical. mass located above the umbilical, painful, does not get smaller by lying down and does not disappear
dx?
Epigastric hernia
yellowish greenish offensive discharge
thin and foamy + vaginal itching
dx?
Trichomonas
which indicates severe infectivity with Hepatitis B?
HbeAg
A young man has come complains of epigastric pain. Pain gets worse after eating, urease test positive. management?
D. PPI + Amoxiciillin + Clarithromycin
nuchal translucency
Oligohydramnios
HX of intermittent acute right iliac pain by vomting
no vaginal bleeding
LMP 12 wks ago
dx?
Ruptured Ovarian Cyst
inv: TVS
RX: reassurance - sinple cyst ,$cm
why not torsion? - very ill patient, severe cramping
mobile mass in abdomen - laparoscopy
amenorrhea + abdominal pain + vaginal bleed
urinary b-hcg test can be negative
Ectopic pregnancy
most approp treatment for umbilical hernia?
Mesh Repair
left leg and hip muscle weakness
and weakness of left hand
fasciculation in lower limb and left lower limb hyperreflexia, weakness of ankle joint. what is most likely the site involved?
Cervical spine
A man concerned of Prostate cancer. PR is done and normal. What is next?
PSA after 2 weeks pf performing DRE
PSA every 2 yrs from 50-69 - men at average risk of prostate cancer
A man prescribed oxycodone for lumbar pain, recentlu because of severe pain he took heroin what is next?
A. Reduce oxycodone
B. Switch to Tramadol
C. Check Oxycodone level
A. Reduce oxycodone
(it is less potent 6 x than heroin)
Abdominal pain
elderly
sudden onset
Sigmoid Volvulus
most common affected site leading to intermittent claudication
Superficial femoral Artery
pregenancy, 18 wks, TSH - low
palpitations, lethargy, ecg ectopic beats whats next?
Free T4
- Primary Hyperthyroidism
-
38 male with epigastric discomfort
increased with alcohol and spicy food. No weight loss. What to do next?
A. CT abdomen
B. Upper GI endoscopy
C. Urea breath test
D. fecal occult blood
C. Urea breath test
39 pt with Warfarin, INR 9 with bleeding
What to do?
STOP WARFARIN
Stop the offending drug first
15 yo, bilateral, exaggerated reflex, ataxia, joint position all gone
Friedrichs Ataxia
Back pain what features in the history make you think of doing more investigations?
Reflex
Fever
Pain Radiation
Local tenderness
Fever
1+ proteinuria on routine health check
No other abnormalities
A. Repeat Urinalysis
B. 245hr Urinary Protein
C. Urine culture
A. Repeat Urinalysis
Child have psychotic problem started Risperidone what should be suspected in the consequence?
RISPERIDONE = WEIGHT GAIN
endoscopy shows a narrow ring in esophagus in biopsy
treatment?
Budesonide
tx for EoE
infertility, female with prolactin level 5500 taken Paracetamol and Esomeprazole. What is the cause?
Pituitary Adenoma
> 4000 - Pituitary Tumour
< 4000 - Drugs
Lurias test- frontal lobe test, unable to perform dementia symptoms also mentioned, what investiagtion to help the diagnosis?
A. Serum Vitamin B12
B. Blood Alcohol
C. Urine Drug screen
D. No option of CT
A. Serum Vitamin B12
GBS scenario with CSF - albuminocytological dissociation, most approp test for diagnosis?
A. Nerve conduction studies
B. EMG
C. MRI brain
D. MRI spine
A. Nerve conduction studies
consequence of RISPERIDONE
Gynecomastia or
Weight gain
athlete, h/o multiple neck injuries, diarrhea 2 wks ago, difficulty in extending wrist and elbow, numbness in posterior aspect of lower third of arm. Nerve and nerve root asked
C6-C7
man with h/o criminal records now h/o insomnia, agitated, recently charged with minor assault
A. Oral Olanzapine
b. IM Diazepam
C. IV Phenytoin
D. IV morphine
b. IM Diazepam
earache and droopy face
episodes of viral illness in the past
difficulty closing his R eye and has a right sided facial droop
Right otoscopy shows crusted eruptions in the External auditory Meatus
What is the cause?
A. Drug induced allergic reaction
B. Fungal infection of external canal
C. Reactivation of herpes zoster virus
C. Reactivation of herpes zoster virus
Treatment of gout when allopurinol didnt work
Febuxostat
fixed semi-dilated pupil
tx?
Pilocarpine
dx: Acute Angle Closure Glaucoma
Persistent diarrhea more than 2-3 days
Metronidazole
child limping and difficulty in walking
no fever
Perthes is in children 4-8 yo
Pt with complains of multiple symptoms but no records for that even after search
Diagnosis?
Factitious disorder
HLAB27 positive with back ache
on methotrexate and hydroxycholoroquine
What to do?
Cease Methotrexate
rash on abdomen in 18 months old child with previous fever
Herpes 6
Antibiotic to give post splenectomy
Amoxicillin
Acute limb ischemia what is the next step?
Heparin
Rash on abdomen in 18 months old child with previous fever
Herpes 6
Post splenectomy
tx?
Amoxicillin for 2 years
Typical drussen
Intravitreal Becavizumab
Sjogrens
anti ro +
dry eyes
tx?
Naproxen
Molar Pregnancy
Hydatid form
Orbital floor fracture
Diplopia
What is the late feature for the Orbital Floor Fracture
Enopthlamos
redness and swellling just anterior to the neck
Mgt?
Regular Sialogogues
Foot deformity with a high arch (pes cavus)
Invrted champagne bottles
Diagnosis?
Charcot Marie Tooth Syndrome
Clear discharge from urethra and dysuria
mgt?
Azithromycin
Initial management for hyperemesis gravidarum
IV fluids
Abdominal distention which electrolyte can cause
Calcium
History of hoarding what to look?
Social Anxiety
swelling and redness in scrotal 36-72 hours
Testicular Torsion
USG of testis showing hypoechoic area
Next step
Afp
USG - Beta-HCG- AFP
But afp if theres no other ans
swelling i the testicular region
swelling not tense
transilluminate
next step?
Defer surgery for 1 yr
Hydrocoele - dx
pain in lateral epicondyle
difficulty in flexing the wrist
what is next?
Inj Corticosteroids
post appendectomy 3 years ago
dyspareunia
Pelvic Adhesions
Patient stable on Clonzapine BMI 41
What is next
Aripiprazole
Eosinophilia means
New growth for parasites
A
Preg 6 wk with intense itching what is advice
HCC post partum screen
tx for atropic vagina
Estrogen Cream
Tx for meningcoccal meningitis
antibiotic of choice for 5 yo
Ceftriaxone
What drug to stop in hyponatremia
HCThiazide
Upper abdominal pain + worse after eating and at night
GERD
What is the physical examination finding of Polycythemia vera
Splenomegaly
What is the most common cause of death in peole with Polycythemia vera
Thrombosis
Diplopia + arthralgia + hematuria + hemoptysis + HT
Good pasture Disease
White band ring
floater increasing
Vitreous hemorrhage
For Asthma,
spo2> 92
What to give?
Steroids
For Asthma,
if spo2 <92
What to give?
Ipratropium then steroids
What is the treatment for Lichen Sclerosis
Clobetasol
bilateral mastalgia and bilateral nipple discharge with greenish yellow staining
Mammary duct ectasia
pregnancy and itching
Cholestasis
confused and restless after day 2 abdmonail surgery and hiatus hernial repair
Electrolyte imbalance
Diabetic foot ulcer treatment
toileting the wound
protreinuria, hematuria,
2 days of sore throat
(1-4days)
IgA Nephropathy
protreinuria, hematuria,
2 wks of sore throat
(1-2 wks)
PSGN
Basilar skull nfracture
Racoon eyes, CSF leaking
What to do next?
Oral Gatric tube
Fertility
Sulfasalazine
Body pain
Test are all normal
tx?
Amitriptyllline
post op day 5
painless distention of abdomen
rectal examination unremarkable
Small bowel distentoon
nxt?
NG tube and decompression
Joint pain
tenosynovitis
swollen joints
vesicular eruptions in arms
Gonococcal athritis
erectile dysfunction
enlarged tongue
widening of joint spaces, low testosterone and hyperglycemia
What is the diagnosis?
Acromegaly
intense photophobia, painful red eye but pupils reacting normally what is the diagnosis
?
Keratitis
flattened deltoid
Ac dislocation
2 yo, blood in stools, abdominal pain
Meckel’s diverticulum
premature ejaculation but no problem with erection
SSRI
edema and pain in the lower extremity
loss of pulse
diuplex of the leg is negative
what is next?
CT angio
multiple, dilated loops of small bowel
post cholecystectomy
site of anatomic obstruction?
Jejunum
HUntington disease chances of offspring to get the disease
50%
Site of reflux in GERD and location of hiatal hernias
Transposition point between stratified swquamous and columnar
Gastroesophageal junction
distal portion of the stomach
site of the hypertrophic pyloric stenosis
obstruction leads to the gastric outlet obstruction
Gastric antrum / pylorus
Site of small bowel obstruction
prior abdominal surgery
Duoedenum / jejunum/ ileum
Transition between small bowel and large bowl
site of intussusception and gallstone ileus
Ileocecal junction
Watershed blood supply
Splenic flexure : SMA (artery of Drummond) and IMA (left colic supply)
Rectosigmoid junction: IMA (sigmoid and internal iliac (superior rectal) supply
Splenic flexure and Rectosigmoid junction
older males
acquired weakness of transversalis fascia
within the hesselbachs triangle (medial to inferior epigastric vessels)
Direct Inguinal Hernia
young males
incomplete obliteration of processus vaginalis
lateral to inferior epigastric vessels through deep and superficial inguinal ring
Indirect Inguinal Hernia
Highest risk of incarceration
Femoral Hernia
AST 500 U/L , ALT 510 U/L
positive smooth muscle antibodies
Autoimmune hepatitis
elevated alkaline phosphatase
anti-mitochondrial antibody
Primary Biliary Cholangitis
(IgM)
- middle aged women
p-ANCA antibody
asso with ulcerative colitis “onion-skin
appearance of bile ducts, beads on a string
Primary Sclerosing cholangitis
RUQ pain, fever, jaundice
gallstone obstructing common bile duct
history of cholelithiasis
Acute Cholangitis
CAG repeat
Huntingtons disease
weakness in facial muscle, frontalis having swallowing difficulties coughs when he tries to drink water
Bell’s Palsy
Postpartum mother with heavy vaginal bleeding
Amoxicillin
10 month, rep distress, exp and insp wheezing, intercostal recession
Nasopharyngeal swab
sign of intestinal ischaemia
A fib
Patient wsith subarachnoid what willl you add for long term management
Nimodipine
Boy with head trauma playing foot ball fainted for some seconds, became drosy and unconscious
CT Scan
feels detached from the environment
Take collateral history from relatives who have seen her
PCOS scenario what to expect in the lab
High free androgen index or free testosterone
patient had MI and is on aspiring for 10 years and doppler shows 60% stenosis in both sides in the Right and Left carotids
What’s next?
Endarterectomy
back pain
labs raised ALP 500
cause?
Paget’s disease
vertigo, nausea, nystagmus and ataxia with no hearing impairment
diagnosis?
Vestibular neuritis
swelling 2cm in non tender below the inguinal ligament medial to the femoral artery
pain increases upon internal rotation and hyperflexion of the hip.
cause of the pain?
Femoral Hernia
left sided chest pain, no spine tenderness, no skin changes but pain on upon trunk rotation and numbness over the bilateral lower limbs and ankle reflex loss
Anterior Cord compression
hypertensive medication that should be avoided in bilateral renal artery stenosis and is useful in diabetic patients
ACE inhibitors
Hypertensive medication that can treat nephrogenic diabetes insipidus, icreases lithium concentrations
side effects: gout, hypercalcemia, hyponatremia
Inhibits the Na/Cl cotransporter in DCT
Thiazide Diuretics
Inhinits calcium channels in vascular amooth muscle
helpful in treating Raynaud syndrome
causing orthostasis and lower extremity edema
Dihydropyridine calcium Channel blockers
blocks AT11 receptor
side effects: hyperkalemia and Acute kidney injury
its avoids the ACEI cough
Angiotensin II receptor blockers
Man eating in restaurant and has severe allergy involving SOB, resp distress
tx?
Adrenaline
prebious cs secondary to obstructed labout came with labor pains at term, at 2nd stage loss 1.5 L of blood, abdomen soft and tender
Uterine Aton
Abdominal pain.irregular pulse
next?
Xray followed by CT
- Mesenteric Ischemia
slow growing persistent red scaly patch on areas of skin exposed to the sun
Bowen disease
Patient has dysmenorrhea, no improvement with NSAIDs and COCPS
USG then Laparoscopy
history of back pain, renal involvement, increased calcium and increased phosphorus
What is the next inv?
Serum electrophoresis
female with hair loss, alopecia, rash and pancytopenia and thrombosis present, which antibody to order?
Anti Cardiolipin
enlarged testis, transillumination test is negative
What is the next step?
USG of the testis
male patient with history of travel comes with a long pain and fever and jauncie. fluid given
stones in the gallbladder and ducts
Next immediate management?
Endoscopic decompression of the Bile ducts
48 female mother had breast cancer at 60, father had colon cancer at 70, brother is diabetic
what to order?
FBS is correct
RTA (major) + internal bleeding + INR (INR < 5 patient is quite stable)
+ Vital BP 80’60
+ mgt?
Stop Warfarin and give FFP and Do immediate surgery
rape victim is irritable and have flashbacks
Dx?
PTSD
How would calculi in gallbladder look on USG
Single FIlling defect
female patient hsuband dies a year ago, she develops insomina, tiredness , weight loss and irritability for the last 3 months
Dx?
Pathological Grief
Patient is given with sertraline
pain in abdomen, psychotic symptoms improves what to do?
Decrease the dose
Alcoholic patient third day post op, confused and agitated
What to do
Haloperidol IM
child 5 months weaned from breast milk to cows milk presents with altered bowel habits
what is the cause?
Cow milk protein allergy
45yo f, colonoscopy and endoscopy normal, blood transfusion is required 2 units per day to maintain Hb of 9 gm/ dl
What will you do?
Capsule Endoscopy
Pt accidentally taken Warfarin and now INR - 7 what to do next?
Cease Warfarin
Molluscum contagiousum
Advice?
Avoid taking bath
pain, tenderness to palpation to malleoulus
intolerance to weight bearing
Xray
transillumination test, upper pole discomfort with compressible mass
Dx?
Inguinal Hernia
PSA > 20, Irregular DRE, bone metastasis and back pain
What is the treatment to be given?
Radiotherapy - EBRT
A mom has a kid 2 yrs with pertussis and has a 2 wk old baby. they are against vaccination
What you will do?
Isolate the baby at home
Pt with COPD, had recurrent admission, most impt to reduce the recurrence of hospitalization?
Long term use of O2 at home
Indication for an operation in a lady with neck swelling that becomes larger and has bleeding from it
Dysphagia
A lady with swelling looks like parotid swelling. What is the investigation needed?
Ultrasound
A lady with greenish discharge from the breast
next inv?
Breast ultrasound
A man with prostate cancer and back pain
Lumbosacral xray shown
What is the best therapy to improve the pain?
Androgen Deprivation Therapy
cause of pneumonia in a 1 year old
RSV
starting dose of Allopurinol
50mg
PCOS scenario
What is the cancer that you need to check?
Endometrial cancer
claudication pain while sleeping , history of ACS
tips to toes pain
Peripheral Artery Disease
Fundsocopy given blood clot bigger than 7 figure as in mirror
Central visual loss and straight lines wavy
initial Investigation?
Amsler Grid
10 mm nodular lesion on the cheek
been present for the past 12 months and now started increasing
Management???
Excision
3 yo milestone
copy circle
Diminished breath sound / tracheal deviation
dullness on percussion
What next?
Large bore Chest Tube
