5000 mcqs

Question 1

Most appropriate is sputum for AFB

Answer 1

first one is igra than c xray if positive than sputum

Question 2

Cxr it should be, active tb. Igra for latent.

Answer 2

Igra is for latent TB. here should do cxr

Question 3

A - Above and lateral to the public tubercle - Strangulated.

16 yr old boy after strenous exercise have 5 cm swelling over inguinal ligament

Answer 3

CT abdomen in stable Abdominal trauma

Question 4

y not ct? we need to look at the extent of the damage and decide wether we will manage it conservatively or not?

Answer 4

pt stable initial USG..if free fluid on USG go for laparotomy…if no free fluid then CT.

Question 4

Hemodynamically stable rules out pneumothorax hemothorax and traumtic aortic injury.
I think go for usg to look for free fluid in abdomen

Answer 4

i was pointing towards spleen/kidney injury, below left ribs contusion and flank pain.

Question 5

Patient come with bleeding give vit k. FFP. To prevent bleeding

Answer 5

INR 4.5-10 with significant bleed. FFP with Vitamin K.

Question 6

salt restriction - frst lifestyle modification for all ascites pts

Answer 6

Delirum tremens

Thiamine infusion should be given before dextrose infusion. racp

Question 7

questionnaire for genetic risk screening first
then go for BRCA Later

first we check her for Risk screening by giving questionnaire then pre test counselling then Refer for gene screening

Answer 7

High risk or possible mutation - refer to family cancer clinic for risk assessment

Question 8

Oral antihistamines and observe

Answer 8

Antihistamine is enough in this case

Question 9

an accident while playing football. he is complaining of left upper quadrant pain
Haemodynamically Stable - CT

Answer 9

pleural effusion can be present in asbestosis.as h/o working in coal mine

Question 10

there is no wt loss so mesotheloma ruled out

Answer 10

Mesothelioma would be ans if there is wt loss and its rare.

Question 11

upper quadrant pain with fever and chills.cause

Probably a case of Amoebic Liver Abcess

Answer 11

fever and ryt iliac fossa pain >abscess

Question 12

In a case of infertility,always do semen analysis first

Answer 12

Diagnosis here is galucoma if timolol and pilocarpine in option will choose that from these options it’s C

Question 13

if both are given which one to prefer? Timolol or pilocarpine?

Answer 13

topical timolol first

Question 14

We always consider insulin first in pregnancy

Answer 14

bulging fontanelle is contraindicated for LP right?

Question 15

Ofcourse if antibiotics is in the option should be chosen
LP is contraindicated in raised ICP
CT has limited role

Answer 15

respect patient’s wish

Question 16

Inverted T wave means PE —-> C

Answer 16

if the bleeding is life threatening we give FFP an PCC together

Question 17

In alcohol aST to alt ratio 2:1

Answer 17

smooth enlarged prostate

Question 18

before adding we have to stop venla

Answer 18

Upon commencing antidepressants, patients with bipolar disorder should be
closely monitored for symptoms of mania, and if these emerge then
antidepressant therapy should be discontinued.Psychoeducation should be provided so that patients, family and friends
can identify early warning signs of mania and/or mixed symptoms RANZAC

Question 19

reason for tachycardia?

fe def anemia

Answer 19

Pt. is already on Aspirin prophylaxis and developed stroke. CEA is recommended in symptomatic stenosis of >50% and asymptomatic stenosis of >70%.

Question 20

Right Carotid endarterectomy

Answer 20

Suspend breast feeding for 24 hour than checkin bilirubin

Question 21

Breas milk

it’s unconjugated

Answer 21

I feel it should be biliary atresia. Immature liver should cause elevation of both conjugated and unconjugated bilirubin

Question 22

Breas milk

it’s unconjugated

Answer 22

I feel it should be biliary atresia. Immature liver should cause elevation of both conjugated and unconjugated bilirubin

Question 23

Breast milk jaundice is Dx by exclusion and most probably prolonged jaundice

Answer 23

If conjugated bilirubin is >10% of total bilirubin from the options given its
Biliary atresia

Question 24

Depends upon age of pt if less than 5 _sodium cromiglycate

If 5 or more -inhaled corticosteroids

Answer 24

already on fluticasone, answer should be D
Reply18h
Ayesha Iqbal
Iqra Fatima dose should be increased

Question 25

(drug induce steroid, statin both ESR,Ck-normal

Poly.Rheu-raise ESR,Ck-normal

Answer 25

ESR,CK normal in drug induced0

Question 26

targetted INR is round about 1.5……If we stop warfarin or giving vit K it will take about 4 days time…..So if emergency Sx give ffp/prothrombin concetrate (B)…if Sx can be delayed above method of stopping or reversing the action of effect of anticoagulant

Answer 26

symptoms of acute abdomen, so we will do intervention ASAP

Question 27

apple core lesion is significant for colon ca here patient having obstructive symptoms so if no options of Prothrombin then we will go with Give FFP, proceed with surgery

Answer 27

its b like if history of snake bite present and even no fangs sign present utill unless always consider snake is poisonus so reffer to tertitory hospital

Question 28

yes dont give entivenom untill collapse aur cardiac arrest inr more than 1.3 opthalmoplegia aur paralysis events

Answer 28

Special clinical features of ALD

Question 29

Cystoscopy to find out gross hematuria cause

Answer 29

Gross hematuria in middle age , go for urine analysis next ct

Question 30

gross haematuria in less than 55 yrs initial UA then CT scan to rule out renal CA..

Answer 30

from these options it’s A

But seems like it’s drug induced bcx no dysmorphic RBCs are there

Question 31

gross hematuria in middle aged ,initial ure then ct to rule out rcc)
Age below 50 do CT scan

Answer 31

investigation for pul. Embolism should be done frst as chest pain and travel h/o are present

Question 32

Always correct vit d before bispoh

Answer 32

First correct vit D, then alendronate

Question 33

depression (risk of suicide very high) compared to pesticide

Answer 33

allergic to pencillin so can’t give ticarcillin

Question 34

Ticarcillin is an extended-spectrum penicillin

Answer 34

Benazathine penicillin G

Question 35

early syphilis-benz penicilin single dose IM, or doxycyline incase of pen allergy. should contact all sexual partners in past 3 month. repeat serology at 3 months, 3 monthly

Answer 35

In PE Gold Standerd CTPA

in Renal insufficient Pt it VQ

Question 36

Next should be B. Best would be V/Q

Answer 36

here they are talking about with 50% stenosis

Question 37

as the pt is asymptomatic.. carotid stenosis just on routine checkup..no TIA or CVA so CVD risk assessment..carotid endarterectomy indicated when stenosis is 75% with symptoms.

Answer 37

Sjogren > mx is supportive
complaint for this pt is dry eyes so
C . artificial eye drop

Question 38

Amox for mild pneumonia in children

Answer 38

yes always we have to exclude hypoxia first

Question 39

Both B & C seem corrext to me…..C more apropriate

Answer 39

Post operative confusion,always think about hypoxia 1st.so pulse oxymetry.ABG should be more appropriate..

Question 40

The most common cause of Postop confusion or coma is hypoxia, followed by electrolytes derangement (hyponatremia, hypernatremia) and blood gas should the initial test, so I think B is best then C. Disorientation/ Coma

Answer 40

Hypoxia is the first thing that has to be suspected when a post-op patient gets confused and disoriented. It may be secondary to sepsis. Check blood gases, provide respiratory support.

Question 41

Delirium tremens (DTs) is very common in the alcoholic whose drinking is suddenly interrupted by surgery. About the second or third PO day they get confused, have hallucinations, and become combative. Intravenous benzodiazepines are the standard therapy for DTs, but
intravenous alcohol (5% in 5% dextrose) is still preferred by some in the surgical community .

Answer 41

Hyponatremia, if quickly induced by liberal administration of sodium-free IV fluids (like D5W) in a postoperative patient with high levels of antidiuretic hormone (ADH; triggered by the response to trauma), will produce confusion, convulsions, and eventually coma and often death (“water intoxication”). Chart review confirms large fluid intake, quick weight gain, and rapidly lowering serum sodium concentration (in a matter of hours). The problem is best prevented by
including sodium in the IV fluids. Once it happens, therapy is controversial and mortality is very high (young women are particularly vulnerable). Most authors use small amounts of hypertonic saline (aliquots of 100 ml of 5%, or 500 ml of 3%), perhaps add osmotic diuretics.
Hypernatremia can also be a source of confusion, lethargy, and potentially coma-if rapidly 👉kaplan surgery

Question 42

yes C here from these options

start on briding therapy bcx we can’t stop warfarin on the whole patient having prothestic valve he is high risk

Answer 42

because warfarin should be stopped 4-5 days before elective surgry

Question 43

By 3yr (36 months) able to kick a ball forcefully

Answer 43

Intrahepatic cholestasis of pregnancy-develop in late pregnancy ,no rash ,worse itching at night,jaundice typically develops 1-4 weeks after onset of pruritus

Question 44

Scabies must have burrows

Pruritus in 3rd trimester goes in favour of cholestasis of pregnancy

Answer 44

zolendronic acid is generally iv

Question 45

The answer is any bisphosphonate iv route

Answer 45

U can have screening fir first trimester but accurate dx will be in 2nd trimester by anniocentsis

Question 46

Diagnosis lichen sclerosus

Answer 46

myocarditis ( a common side effect after covid vaccine) especially in below 50 yrs and younger age groups

Question 47

Troponin can elevated in PE and myocarditis , but according to symptoms, it will be C myocarditis

Answer 47

Myocarditis 💯%

50% patient with vaccine related myocarditis have increased troponin level

Question 48

no fetal heart sounds, so to deliver the dead baby-do amniotomy

Answer 48

Dead baby no fetal heart sound

Question 49

apple core appearance CA colon

Answer 49

Medulloblastoma
Low dose colchine
Vq scan
Prolonged QT
Achlasia

Question 50

WE COUDNT DO BURHOLE WITHOUT CT WHERE YOU WILL OPEN ? A THEN C

Answer 50

A VUR
Reply4d
Arooj Usman
Iv antibiotics then Usg

Question 51

paroxetine contraindicated in pregnancy

Answer 51

why ACEI
Reply5d
Arooj Usman
Ayesha Iqbal they cause angioedema

Question 52

Patient takung ACEI since long withiut any angioneurosis …. & amoxycillin since 2 days &s/s after amoxy angioneuresis appeared …so I will blame Amoxy

Answer 52

Final Answer is E. associated with painful hematura

Question 53

Polymyalgia Rheumatica with Giantcell arteritis.

ESR would be better as next step.

Answer 53

It should be for colposcopy

Question 54

After 5 days niether vaginal not cervical lesions causes bleed and sometimes complete removal of placenta , some decidual part attached with uterus and causes bleed

Answer 54

Cervical laceration

Question 55

salbutamol because its excercise induced asthma, Ref JM 7the edition, still check the latest 8th edition once

Answer 55

Saba is not preventer it’s reliever

Question 56

initially SABA given , if not working than we choose SCG or ICS

Answer 56

they are asking about preventer and in exercise induced we do prefer monteleukast over ICS . As SCG also comes in inhaled form so that we will be our last choice

Question 57

it shuld be sarcidiosis coin like apperaence is due to hypercalcemia leads to calcification which causes coin like asralra are present due to pul htn whixh is present in all others so b

Answer 57

D is very significant side effect after giving opioids .

Question 58

I also want to go with A. But Handbooks says it D.
I heard there was a question in ethics related to this like if patients wants to die we can’t help him or her to die as it’s illegal in Australia but we can give adequate pain killer to patient for reducing pain and it will take the patient to respiratory depression and ultimately to death. Pls correct me if I am wrong

Answer 58

plz send bcq no of that q.. I m thnkng most common problem due to morphine is constipation bt significant problem for medical issue is respiratory depression

Question 59

I can’t find it now. Will share once I get it. That was an etchis question.
However with therapeutic dose it might cause respiratory depression as the patient is immune suppressed

Answer 59

For pain relief we are giving therapeutic dose and therefore less likely to get respi. Depression. Thats why the answer is D

Question 60

no it’s constipation main issue that’s why we have to prescribe laxative with morphine always ,
Respiratory depression will be in toxicity

Answer 60

Here is pus formation so should be bacterial after culture need to be abs..so E

Question 61

B for balanitis
Treatment:
Soaking in warm salt water settles swelling and discomfort.
Barrier or 1% hydrocortisone cream (see also Nappy rash).
Antifungal cream (clotrimazole, miconazole) if candida suspected.
Oral analgesia may be needed.
Topical antibiotic ointments and creams are not efficacious.
Preputial retraction during acute inflammation should not be recommended as this can lead to paraphimosis.

Answer 61

Balanitis is a treatable condition that most commonly happens in uncircumcised males. The main symptoms of balanitis include inflammation and pain on the head of the penis. Treatment often includes Betamethasone antifungal creams, antibiotics, improved personal hygiene and, in some cases, circumcision

Question 62

Anti-dsDNA specificity is high in SLE

Answer 62

Its seems like more anaplastic likely highly agressivve
,2 month short history, large size, recurrent larungeal nerve invasion
Quick growth, invasive, aggressive

Question 63

combination of 3rd gen cephalosporins+azithro is needed to cover resident gonorrhoea even in the absence of Chlamydia

Answer 63

gonorrhoea if not improved usually also has chlamydia too. So add 1gm azithro

Question 64

Emeregence of drug resistance with monotherapy

Answer 64

If symptoms did not improve.. then d..

If improves but again same symptom then reinfection (incubation period is 2-5 days)

Question 65

Thiamine infusion should be given before dextrose infusion. racp

Answer 65

Motor neuron disease

Question 66

Cervical (Compressive) Myelopathy

Answer 66

since patient age less than 55 for CTPA

Question 67

reproductive age group VQ scan I guess

Answer 67

CTPA is Gold standerd.If Renal Failure go fo V/Q

Question 68

V/Q —> patient under 55 highly risk for CPTA scan

Answer 68

Suspected Ca. Prostate. Initial: DRE/PSA - TRUS guided biopsy. MRI indicated in fracture spine d/t mets.

Question 69

intermittent colicky pain after surgery due to obstruction.

Answer 69

diarrhoea. In obstruction it shd be constipation

Question 70

why not pet scan, location of the fracture not given, reason could be distant mets for fracture
Reply5d
Ayesha Iqbal
Iqra Fatima on MRI , mets can be detected

Answer 70

Antibiotics and then endoscopy

Question 71

Octreotide works similar to terlipressin as vasoactive agent. Next is to scope to r/o variceal bleed

Answer 71

next is endoscopy to find out varices

Question 72

salt restriction - frst lifestyle modification for all ascites pts

Answer 72

Most prostates get bigger with age. But as a benign hiperplasia. For this description this mass doesn’t seem clinicaly malignant ( normal constancy; the sulcus is also an anatomic finding.) Not A cause i know it’s already gonna have a higher PSA and doesn’t give any new information. Not B because I’m not thinking in metastasis cause the mass is benign But yes to C because UTI can be a cause of urinary retention.

Question 73

first we do urinalysis and then creatinine and urine cytology is considered in hematuria

Answer 73

i think but would be more confident if urine analysis instead of cytology

Question 74

retention could cause renal impairment

Answer 74

MRI to see soft tissues damage like ligaments or tendon

Question 75

It’s Mri to see if any nerve entrapment

Answer 75

These are the two DD that is regional pain syndrome and also post traumatic chronic wrist pain. since we dont know in this scenario (its just wrist pain mentioned.Could be colles , could be scaphoid) The next step would be to repeat a late xray to evaluate non union before the hand becomes symptomatic with late degenerative changes .Since that was done and showed satisfying union and the patient came with a symptomatic hand, the next step will be to do a mri to check for tendon since in colles fracture there is a problem to look out for tendon damage soft tissue injury and nerve entrapment . .So answer C

Question 76

but if lithium level is mentioned and > 4 then B

Answer 76

Patients with a level 2.5 – 4 mEq/L should have hemodialysis if they have severe symptoms such as neurologic deterioration, hemodynamic instability, acute kidney injury or ventricular arrhythmia.

Question 77

There was another answer throat swab

Answer 77

D dimer?

headache has been reported as a red flag for vaccine induce CVT. but its within days and mentioned as delayed headache.

Question 78

Febeile convulsion -no need anything

Answer 78

Patients presenting with acute neurological ischaemia or amaurosis initial aspirin and the best surgery as in RACGP

Question 79

bcoz risk of transmission to baby less even if symptomatic.do serology once pt is symptomatic

Answer 79

patient is on steriods all others are side effect of steriod except osteomalacia it causes ostepenia and porosis not manalcia

Question 80

long use of steroid avascular necrosis

Answer 80

yes it causes osteoprosis and penia never malacai

Question 81

paroxitene contraindicated in pregnancy

Answer 81

i chose coz veru high level of urea n creatinine anemic and serum calcium low which are the features of acute kidney failure so i chose it plus hugh htn also while prostate no as such clinkcal examination of dre and psa level mentioned

Question 82

anemia. Renal injury. Prostate ca is osteoblastic in nature

Answer 82

advanced age can support prostate Cancer though

Question 83

but age, thirst, fatigue…goes in favor with cancer dont u think

Answer 83

No discharge so csom and cholesteatoma are less likely, also with smoking h/o cancer is possible. I thought nasopharyngeal ca can cause ear pain earlier than CA tongue, coz for aCA tongue to cause ear pain any mass should be large enough to block Eustachian tube. But no mass in the question. Correct me if anyone has a better explanation

Question 84

MC presentation of Ca Tongue is with pain which might be referred to ear. MC presentation of NPC is with cervical lymphadenopathy and Trotters triad.

Answer 84

Ca tongue,reff pain in Ear

Question 85

This is an old Q that I faced many times…….To Ca commonly cause earache ,,one is Nasopharyngeal & another is laryngeal Ca…… reagarding Tongue cancer There are few symptoms in the early stages. In later stages, the cancer may cause pain, a sense of fullness in the throat, difficulty swallowing, the feeling of a lump in the neck or throat, voice changes or ear pain.

Answer 85

Yes In achalasia if you elevate head or even stand up after meal it will more easy to pass food from esophagus to stomach.. Bcz of stretch in esophageal musculatures..

Question 86

C, coz progressive dysphasia frst to solids f/b liquids, smoking h/o,
In achalasia, dysphagia to both solids and liquids present at same time

Answer 86

Progressive dysphagia first to solids than to liquids, h/o wt loss, h/o smoking. Ref:

Question 87

abdoiminal rigidity, pain after meal and hypotension goes in fav of acute pancreatitis though there is no radiation of pain to back

Answer 87

Perforated dudenal ulcer

Question 88

For pain after meal and rigidity for acut abdomin following shock
Pain after meal ‘ perforated pu hav board like rigid abdomen followed by shock

Answer 88

Mesentric ischemia is more appropriate answer since the presentation is acute and minutes after consumption of food. Also, a perforated duodenal ulcer cause generalized rigidity and tenderness which isnt the case here.

Question 89

not b because duodenum pain does not occur after meals. It is hunger pain.

Answer 89

option e I think.. Severe pain(9/10,10/10 etc) out of proportion to examination findings favours option e + although no risk factor for mesenteric ischaemia, old age =>atherosclerosis =>mes ischemia

Question 90

shock like symptoms can occur with both.. But there should be tenderness, rigidity,guarding for perforation plus no hx of duodenal ulcer given

Answer 90

Olanzepine………………………………. MIRTAZEPINE make MDP worse

olanzapine ++ more sedation than risperdone

Question 91

Lateral epicondylitis- no investigation needed at the moment- if theres any restriction in range of motion then we will choose A

Answer 91

tennis elbow, lateral epicondylitis

Question 92

for sure, lateral epicondylitis , no test need

Answer 92

yes i saw an article in which this combination was mentioned and for pre op isotonic saline was mentioed

Question 93

doc why colostomy?
Reply5w
Ajay Deswal
Farhana Sultana its an obstruction so first of all we do hartmans colostomy and keep it open for 2-3 mtnths and treat underlying cause after that we rejoin them

Answer 93

I chose this bcz of intestinal obstruction emergency we so colotmy hartman procedure coz no ise of colnoscopy
Why go for colectomy
Only indication is no gas present below sigmoid junction so site of obstruction at sigmiod just open and release the obstruction no need of colectomy

Question 94

Lichen slerosis is an atropic disorder of skin at older / menopausal age….when affect genitalia causes atrophic changes including valva labia majora… monora may be fused or narrpwing of vaginal opening rendering sex-difficult…here estrogen can be used with or without steroid but in other places mainly steroid is used

Answer 94

what’s the dx

I thought I could be lichen schlerosus so B

Question 95

Less than 25% with symptoms need chest drain

Answer 95

spontaneous : B

traumatic : ICD

Question 96

Incomplete…. Uterine size less than the gestational age plus is open with bleeding

Answer 96

Screening is done by fbs or hba1c

Diagnosed case so Hb1c

Question 97

think in this case it will be Hba1c because she was diagnosed with gestational DB at 32. Now she is 36. There’s no history about previous FU. Hba1c will provide the most accurate information. Thereafter OGTT or Hba1c annually.

Answer 97

Acute flaccid paralysis
Dx Guillain barre syndrome
CSF analysis .

Question 98

Gbs- CSF analysis
Most accurate test for GB Syndrome is NCS/EMG test but the most urgent test to detect impending respiratory failure is PFT (FVC). CSF analysis is a supportive test. Ref: USMLE Master The Boards Step 2 CK.

Answer 98

optic neuritis.. MS

Question 99

Sudden-onset decreased vision and retro-orbital pain in a young female is highly
suggestive of optic neuritis as the most likely diagnosis. For patients with suspected
ON, MRI of the brain is always the most initial investigation to consider. MRI Is highly
sensitive and specific in assessing inflammatory changes in the optic nerves and helps
to rule out structural lesions. In addition, MRI may have a value in predicting future
development of MS in patients presenting with first-time,acute optic neuritis. Patients
with optic neuritis, who also have demyelinating brain lesions on MRI, are more likely
to develop MS in the future. MRI should be considered as the most important initial
investigation for all patients presenting with clinical manifestations of optic neuritis.
However, when it comes to diagnostic accuracy, visual evoked potentials can give a
more sensitive diagnostic yield compared to MRI. In ON, VP can be abnormal when
MRI is negative and inconclusive.Patients with ON or MS will have a delay in latency
with preserved waveforms in conventional VP

Question 100

While, for other choices, Temporal artery biopsy is the definite
diagnostic test for patients with suspected temporal arteritis. Temporal arteritis
presents with scalp tenderness, iaw claudication and vision loss(due to involvement of
the retinal branch). The condition usually occurs in older patients (>50 years). This
patient is young and does not have other features of temporal arteritis; hence,
temporal artery biopsy is not necessary for her. Lumbar puncture (LP) is now used less
frequently and its use is controversial. However, cerebrospinal fluid (CSF)
examination is useful in patients with normal or atypical brain MRI. The typical finding
is the presence of oligoclonal bands (69% of patients with ON). CT scan of the head
has no diagnostic value in patients with suspected ON. In almost 65% of patients, the
pattern of ON is retrobulbar; therefore, no abnormality is noted on fundoscopic
examination. In the remaining 35% of patients with anterior ON (involvement of the
optic nerve head), optic nerve swelling or papillitis can be seen. Other possible
findings in these patients are retinal exudates or peripapillary hemorrhage. Given the
low sensitivity of fundoscopy in ON, it cannot be relied on for diagnosis.

Question 101

MS with deterioration of vision (Optic Neuritis) - IOC is VEPs. Ref:
MRI gold standard

Answer 101

its for optic neuritis

If MRI not confirmed or not in options than go for visual evoked potential

Question 102

we can ask staff member to give injection midazolam if agitated and aggressive. But not to security person and also in Australia taking a patient to security and detention is not allowed generally .

Answer 102

Aggression n threat but no H /O harmful attempt etc therefore he can be attended in the presence of another staff member and if things change, security person can be called. We cannot call security just based on past history.

Question 103

Study is from Effect –> Cause. Effect is EMS. Cause is L-Tryptophan. Study type is Case Control studies which is Retrospective.
So I think it should be C- Exposure Odds Ratio which is the ratio for Case Control Studies.

Answer 103

The odds ratio is the “measure of association” for a case-control study. also used in cohort, case-control and cross-sectional designs,

Question 104

c.case control study.hence odds ratio

Answer 104

She can understand the procedure its benefits and risks
yes I would go with C…17yrs so she can give her medical decisions
she is 17yrs so can give her own medical consent
Mature minor - most probably living with her partner not with her parents now - Gillick competence rule can be applied. Ref:

Question 105

> 35yr+smoker-contraindication to COC

Answer 105

Patch of hair loss n flakes= seborrhic dermatitis= Tinea

Question 106

Aerata = totalis = autoimmune
SLE = no patchy hair loss

Answer 106

Psoriasis= other findings plus shiny silvery scaling with or without hair loss
Psoriasis of scalp is treated with methylprednisolone

Question 107

First reduce displacement, then wound debridement
Assuming pulses are present wound debridement would be next step
laceration of wound so initial step in wound management is wound debridement
greatest importance and initial 5 cause X-ray is must before reduction of a joint

Answer 107

Next calcium vitamin D

Best bisphosphonates

Question 108

This is a case of minimal trauma fracture with osteopenia and the question is asking about the most appropriate mgt (Biphosphonates). However the next step could be measuring the calcium and Vit D levels and start on them first if low. Ref:

Answer 108

Calcium plus Vitamin D if score is - 1.5to - 2.5

Question 109

Many factors need to be considered when placing an osteopenic patient on treatment (T-score: -2.5 to -1). There has been clear data indicating the benefits of placing an osteoporotic patient (T-score:

Answer 109

Septic arthritis untill proven otherwise,so antibiotic

Question 110

I think it as transient synovitis….so going with bed rest…..if it is septic arthritis the temperature will be very high..

Answer 110

Since patient is limping, recent URTI, transient synovitis is more likely, treatment is rest

Question 111

is would be a untill age more than 50 weight loss plus blodd in stool utntill than its achlasia and here is dysphagia of both while in ca oesphagus there will be history of solid first than liquids

Answer 111

Orthostatic Hypotension
Treatment
Conservative
treat the underlying cause
e.g., medication alterations
dietary modification
in the absence of hypertension, the patient should increase fluid and salt intake
Medical
midodrine or fludrocortisone
indication
indicated in patients who do not respond to conservative treatment

Question 112

LEEP = LLETZ

Answer 112

morning stiffness for >30mins and arthritis indicate RA, combined with microcytic anemia, go for steroid

Question 113

breast ca recovered so don’t need to give tamoxifen/ raloxifen anything rather it will increase the chance of thromboembolic events , that’s what I understood.
Post menopausal

Answer 113

Raloxifen will be ideal in this case in presence of vertebral fracture (which can be due to breast cancer mets as well).
Here it is femoral fracture, non vertebral so Alendronate remains the choice.

Question 114

Dear, raloxi has “preventive” properties in breast ca and “protective “ properties confined to vertebrae. So best to use it in patients with high risk for ca breast (not diagnosed and treated) with vertebral T score <2.5
that’s why alendronate.
Best choice in already treated breast ca and Osteoporosis in not only vertebra but also other bone .

Answer 114

According to T scoring _2.5 indicates the need to prescribe alandronate

Question 115

my reasoning is chestpain and ecg pattern is enough for diagnosing MI, irrespective of troponin levels. Here ecg is normal, but symptoms look like mi.so monitor ecg, if ecg changes develops, then do pci immediately

Answer 115

Serial ECG first and repeat Troponin at 3-6 hour interval

Question 116

ECG may be normal in case of NSTEMI.

Answer 116

Methtrexate be stopped at least 3-6 months before conception. Ref:

Question 117

It shuld be c first than folowed by maternal vzig ..!! If mother is postive give vzig plus vaccine to children

Answer 117

Need to check her IgG and IgM status post exposure. If both negative and exposure time <96 hours - give VZIG. Ref: SMA video on immunization.

Question 118

C/F here are s/o - Ac Gastritis to which H. Pylori can be a cause. Also, there are no warnings signs yet

Answer 118

Upper GI endoscopy to rule out PUD

Hallmark point is - epigastric pain increased with alcohol and spicy food intake

Question 119

There will be upper motor neurone signs present (as opposed to the lower signs seen in peripheral nerve compression or cauda equina sydrome), including hypertonia, hyperreflexia*, Babinski’s sign, and clonus (present below the level of the lesion).
*Reflexes tend to be absent at the level of the lesion, as the lower motor neurone within the ventral horn is compressed, so producing a lower motor neurone deficit
Any autonomic involvement is a late stage and therefore carries a worse prognosis. Clinical features include bowel incontinence or constipation or urinary retention

Answer 119

Carbamazepine can cause SIADH

Question 120

Its C along with using a replacement drug.
112 is severe hyponatremia therefore slow correction is required by hypertonic solution until 10-15 mmol is corrected.
Using carBAMazepine together with levothyroxine can decrease the effects of levothyroxine. This can cause fatigue, weight gain, constipation, and low blood pressure.
Meanwhile, lacosamide (LCM), a novel AED which inactivates the sodium channels just like CBZ, is devoid of enzyme‐inducing activity and thus requires no dosage adjustment by plasma drug concentration monitoring. LCM, therefore, is recommended as a first‐line drug to replace when drug induced hyponatremia occurs.

Answer 120

Conduct do not avoid eye contact as/s of autism So ..> A

Question 121

non verbal communication affected in Asperger

In conduct , there will be lot of vandalism , theft , torture

Answer 121

age, fighting behaviour, non attentive,

Question 122

Consultation with other parties partners in Healthcare can be done mostly after patient’s consent

Answer 122

repeat if there was proteinuria and than nxt step is repeat sample her already they hav done splitiing urine protien samole so it means they hav done repeated sample

Question 123

family history or previous history of GDM… Do OGTT asap

Answer 123

family history of diabetes is not high risk but family history of gdm is high risk

Question 124

good surgical debridement before antibiotics

Answer 124

Friedreich’s Ataxia Phenotype

Question 125

0.5 mlof 1:1000 im
Adrenaline 1:1000,solution -dose 0.5ml I m
0.5ml IM

Answer 125

Anaphylactic Shock

Question 126

Superficial femoral artery

Answer 126

incision and drainage with placement of word catheter

C- hot and red swelling, symptomatic

Question 127

she is symptomatic we have to drain it. Marsupilization is for reccurent cases

Answer 127

Pain subsides after rest in OA. Pseudogout can complicate OA. Ref:

Question 128

i think we should treat hot flushes first with transdermal estrogen as it is the more troublesome complaint than vaginal atrophy

Answer 128

hypokalimic hypochloremic metabolic alkalosis diagnosis pyloric stenosis

Question 129

SABA is for exacerbation we will add on steroids if patient not responding to SABA alone here patient already on steroids so we have to step up. Next step will be LTRA

Answer 129

Within 72 hr acyclovir

After 72hr prednisolone

Question 130

Icterus and hemifacial palsy, it seems more of a mass disseminated

Answer 130

Simple Febrile Seizure

Question 131

Mesothelioma??
Reply3w
Ayesha Iqbal
Aliena Franz Jolly pleural thickening

Answer 131

Non-Hodgkin lymphoma (14% of all cancers in transplant recipients) Lung cancer (13% of all cancers in transplant recipients) Liver cancer (9% of all cancers in transplant recipients) Kidney cancer (7% of all cancers in transplant

Question 132

Another issue here is whether IV colloid fluid would be the choice for neurogenic shock?
Reply29w
Wu Jia Xin
Shuang Jiang I would pick crystalloids then colloids

Answer 132

aggressive behaviour. It could be due to psychosis, drug withdrawal or intoxication, psychiatric or medical illness. Sedation is important in this case in order to examine the pt and find the cause

Question 133

Benign intracranial hypertension /pseudo tumor cerebri

Answer 133

LP is Contraindicated in raised ICP, patient has severe papilloedema

Question 134

in case of pseudotumor cerebri,it is required to check opening pressure& is also therapeutic.

Answer 134

MR brain with MR venography
indication preferred initial imaging choice to exclude secondary causes of increased intracranial pressure
Lumbar puncture indication performed after secondary causes of increased intracranial pressure has been excluded on neuroimaging - Question is asking what is the most appropriate initial next inv? I think MRI > LP

Question 135

intracranial HTN due to tetracycline

Answer 135

Antipsychotics are dopamine blockers causing negative symptoms

Question 136

Age>18 Years, Anti-Social Personality Disorder

Answer 136

conduct disorders in childhood now pt has anti social personality disorder

Question 137

C/F most likely S/O Papillary Ca. of Thyroid. Initial TFT - TCG - then USG - FNA. Ref:

Answer 137

MTX, Sulfasalazine, Steroids are used in peripheral arthritis in AS. Ref:
Steroids for extra spinal involvement

Question 138

However, many patients have continued symptoms despite NSAID therapy and are likely to benefit from anti-TNF-α therapy. Patients with AS treated with infliximab (chi- meric human/mouse anti-TNF-α monoclonal antibody), etanercept (soluble p75 TNF-α receptor–IgG fusion protein), adalimumab, or golimumab (human anti-TNF-α monoclonal antibodies, or certoli- zumab pegol [humanized mouse anti-TNF-α monoclonal antibody]) have shown rapid, profound, and sustained reductions in all clinical and laboratory measures of disease activity.
Because of the expense, potentially serious side effects, and unknown long-term effects of these agents, their use should be restricted to patients with a definite diagnosis and active disease (BASDAI ≥4 out of 10 and expert opinion) that is inadequately responsive to therapy with at least two different NSAIDs. Before initiation of anti-TNF therapy, all patients should be tested for tuberculin (TB) reactivity, and reactors (≥5 mm on PPD testing or a positive quantiferon test) should be treated with anti-TB agents. Contraindications include active infection or high risk of infection; malignancy or premalignancy; and history of SLE, multiple sclero- sis, or related autoimmunity. Pregnancy and breast-feeding are no longer considered contraindications if appropriate precautions are taken. Infants exposed to anti-TNF in utero should not be given live vaccines before age 6 months. Continuation beyond 12 weeks of therapy requires either a 50% reduction in BASDAI or absolute reduction of ≥2 out of 10, and favorable expert opinion. Switching to a second anti-TNF agent may be effective, especially if there was a response to the first that was lost rather than primary failure.

Question 139

For most of them answer is sexual abuse

Answer 139

most likely due to microvascular ischemia, recovery is seen in 3-6 months… so mainstay of tt is to observe

Question 140

Aliena Franz Jolly premenstrual headache is absolute

Question 141

close reduction and cast

Answer 141

venous discolouration favours DVT causing venous ulcer or hemosidren deposition we will go for Doppler first