701 to 800 Flashcards
- A 17yo boy while playing football got a kick and now he is complaining of severe pain and swelling of the left side of his scrotum. What inv is the most appropriate to dx? a. Needle aspiration of scrotum b. US scrotum c. MSU d. Surgical exploration of scrotum e. Urine test for hematuria
Ans. The key is D. Surgcal exploration of scrotum. [This is a case of testicular torsion which needs urgent diagnostic and therapeutic surgical exploration of the scrotum].
- A 50yo man has had hoarseness of voice and drooping eyelid for 2m. a mass is palpable in the right supraclavicular fossa. He smokes 20 cigarettes/day for the last 30yrs. What is the most likely dx? a. Carcinoma larynx b. Carcinoma thyroid c. Carcinoma right bronchus d. Mesothelioma e. Pancoast tumor
Ans. The key is E. Pancoast tumour. [Hoarseness of voice is due to compression of the recurrent laryngeal nerve, ptosis due to compression of the sympathetic ganglion, palpable mass in right supraclavicular fossa due to involvement of the supraclavicular lymph node. History of smoking and given picture indicates the diagnosis of Pancoast tumour].
- An 84yo man got surgical pain which is well controlled by oral morphine 60mg BD. However, now this pt is unable to swallow. What is the most appropriate next step? a. Morphine 60mg state b. Morphine 60mg TDS c. Oxycodone 10mg OD d. Morphine 60mg IV e. Fentanyl patches
Ans. The key is E. Fentanyl patches. [When dose of oral morphine is known and rout should be changed Phentanyl patch is adviced as the fixed dose is known and patch can release the required dose for a given period (when we use patch we can not change the dose). But if the pain control is not optimal we should follow the next step (i.e. parenteral morphine) as per pain ladder. But as no correct dos
- A 19yo man has exercise induced asthma. This has prv been controlled using a salbutamol inhaler as req, but he now gets attacks with exercise. What is the single most appropriate tx? a. Regular salbutamol b. Regular salbutamol and budesonide c. Sodium cromoglycate d. Oral steroid e. Inhaled steroid
Ans. The key is C. Sodium chromoglycate. This is wrong key! Correct key should be E. Inhaled steroid. [Chrommoglycate should be used in exercise induced asthma if inhaled steroid fails].
- A 3yo boy has a sudden onset of fever, vomiting and bilateral face swelling. Few days earlier the GP saw him for bilateral parotid pain and gave analgesics. What is the most appropriate next step? a. Analgesic b. Antibiotic c. Biopsy d. Immediate surgery e. Reassurance
Ans. The key is E. Reassurance. [A case of mumps. Self limiting condition].
- A 75yo man with adenocarcinoma of the prostate which has spread outside the capsule of the gland has ARF. What is the most appropriate next inv? a. MRI spine b. Radionuclide bone scan c. Trans rectal US d. US pelvis e. US KUB
Ans. The key is E. US KUB. [extension beyond capsule may cause obstruction of ureters, causing loin pain, anuria, symptoms of acute kidney injury or chronic kidney disease (here ARF)] ref: patient.info
- A 57yo male presents with sudden onset severe abdominal pain and rigidity against a 4d background of LIF pain and pyrexia. He has no PM/SHx of note and isn’t on any meds. What is the most likely dx? a. Intussusception b. Ischemic colon c. Sigmoid volvulus d. Perforated diverticulum e. Perforated Meckel’s diverticulum
Ans. The key is D. Perforated diverticulum. [Sudden onset, severe abdominal pain, rigidity, left iliac fossa pain and fever are in favour of perforated diverticulum].
- A 46yo woman has weight gain, sensitivity to cold, pulse=50bpm, heart is enlarged with murmur. What is the single most likely dx? a. Hypothyroidism b. Hyperthyroidism c. Cushing’s syndrome d. Addison’s disease11 e. Pheochromocytoma
Ans. The key is A. Hypothyroidism. [The given symptoms are classic presentation of hypothyroidism].
- An alcoholic who has completely given up drinking hears voices. What is the most appropriate tx? a. Olanzapine b. Diazepam c. Acamprosate d. Disulfiram e. Haloperidol
Ans. The key is A. Olanzapine. This is wrong key. Correct key is B. Diazepam. [A case of delirium tremens. Treated with benzodiazepines like chlordiazepoxide or diazepam].
- A 6yo boy has completed an induction course of chemo for ALL. He has an enlarged left scrotum. What is the most appropriate next step? a. Herniotomy b. CT abdomen c. Biopsy d. Immediate surgery e. Reassurance
Ans. The key is B. CT abdomen. This is wrong key. Correct key is C. Biopsy. [Relapse may directly involve testis and excisional biopsy is done to confirm recurrence of leukemia].
- A 32yo miner is rescued after being trapped under a fallwn rock for 4h. After applying a bladder catether, 15-20ml of reddish brown urine was obtained. HR=120bpm, SBP=100mmHg. What would be the next appropriate step? a. Dopamine IV b. Fluid challenge c. Furosemide IV d. 20% Mannitol IV e. Antibiotics
Ans. The key is B. Fluid challenge. [The diagnosis is rhabdomyolysis. So IV fluid is the next appropriate step].
- A 60yo man has had spontaneous painful swelling of his right knee for 3days. 5days prv he had an inguinal hernia repaired as a day case. He takes bendroflumethiazide 2.5mg daily. He is apyrexial. What is the single most appropriate diagnostic inv? a. Blood culture b. CRP c. D-dimer d. XR knee e. Serum uric acid
Ans. The key is E. Serum uric acid. [Thiazide diuretics causes hyperuicemia which can precipitate acute attack of gout].
- A 27yo woman with anxiety and weight loss has tachycardia, tremor and mild proptosis. What single mechanism accounts for her weight loss? a. Deficiency in thyroid hormone b. Increased level of calcitonin c. Increased metabolic rate d. Insulin resistance e. Reduced caloric intake
Ans. The key is C. Increased metabolic rate. [The given features are of thyrotoxicosis in which increased metabolism causes loss of patients weight].
- A man with carcinoma and multiple metastasis presents with intractable nausea and vomiting. He has become drowsy and confused. What is the most appropriate management? a. Dexamethasone IM b. Dexamethasone PO c. Ondansetron IM d. Ondansetron PO e. Morphine oral
Ans. The key is C. Ondensatron IM. [For cancer or chemotherapy induced vomiting ondensatron is the drug of choice. As here vomiting is intractable IM ondensatron should be given not oral].
- A 19yo man presents with weight loss, increasing thirst and increasing frequency of going to the washroom. His father, grandfather and 2 sisters have been dx with DM. What is the most likely type of DM this pt suffers from? a. IDDM b. NIDDM c. LADA d. MODY e. DKA
Ans. The key is D. MODY. [Key features of MODY are: Being diagnosed with diabetes under the age of 25 and having a parent with diabetes, with diabetes in two or more generations].
- A 42yo woman with a PMH of severe headache treated in the ED presents with signs and symptoms of renal failure. She has been seen by her GP for HTN and abdominal pain with OP inv pending. Which inv is most likely to lead to a dx? a. US KUB b. CT brain c. IVU d. Renal artery Doppler e. Renal biopsy
Ans. The key is A. US KUB. [Hypertension, abdominal pain and features of renal failure indicates the diagnosis of ADPKD for which the diagnosis is best made by US KUB].
- In perforation of a post gastric ulcer, where will the fluid accumulate in the peritoneal cavity? a. Left paracolic gutter b. Pelvic cavity c. Lesser sac d. Under the diaphragm e. Right paracolic gutter
Ans. The key is C. Lesser sac.
- A 62yo male is brought to the ED by his daughter because of his persistent lying. He is a known alcoholic and has been admitted recently with delirium tremens. On questioning, he denies any problem with memory. He knows his name and address and states that was at the betting shop this morning, but his daughter interjects calling him a liar explaining that he was at her home. What is the most
Ans. The key is D. Korsakoff psychosis. [In Korsakoff psychosis there is confabulation (a memory disturbance, defined as the production of fabricated, distorted or misinterpreted memories about oneself or the world, without the conscious intention to deceive) which may present like this].
- A 70yo man presented with muscle weakness and inability to climb the stairs. Inv: CPK raised, ESR 15. What is the most likely dx? a. Polymyositis b. Polymyalgia rheumatic c. Reactive arthritis d. RS e. Duchenne’s MD
Ans. The key is A. Polymyositis. [Proximal muscle weakness (inability to climb the stairs) and raised CPK points towards polymyositis].
- A 65yo known alcoholic is brought into the hospital with confusion, aggressiveness and ophthalmoplegia. He is treated with diazepoxide. What other drug would you like to prescribe? a. Antibiotics b. Glucose c. IV fluids d. Disulfiram e. Vit B complex
Ans. The key is E. Vit B complex. [This is a case of Wernicke’s encephalopathy which is treated with Vit B complex].
- A pt suffering from schizophrenia laughs while talking about his father’s death. Which term best describes his condition? a. Depression b. Flat affect c. Emotional liability d. Incongruent affect e. Clang association
Ans. The key is D. Incongruent affect. [Incongruent affect means inappropriate emotional response like loughing hearing a sad news or crying hearing a good news].
- A 72yo man has been on warfarin for 2yrs because of past TIAs and strokes. What is the most imp complication the pt should be careful with? a. Headache b. Osteoporosis c. Ear infection d. Limb ischemia e. Diarrhea
Ans. The key is B. Osteoporosis. It is a wrong key. The correct option is A. Headache. [Headache from intracranial hemorrhage is more important complication about which patient should be careful with (it is more important than osteoporosis)].
- A 24yo woman is afraid to leave her house as whenever she goes out, she tends to have SOB and sweating. She has stopped going out except with her husband. What is the most likely dx? a. Social phobia b. Claustrophobia c. Depression d. Panic disorder e. Agoraphobia
Ans. The key is E. Agoraphobia. [Agoraphobia: Extreme or irrational fear of open or public places].
- A pt on HTN drugs develops hyperkalemia. Which anti-HTN is likely to cause it? a. Ramipril b. Lorsartan c. Thiazide d. Nifedipine e. Furosemide
Ans. The key is A. Ramipril. [Both ramipril and losartan can cause hyperkalemia].
- A young man develops itching worse at night and following bathing. Exam: greysish white linear rash can be seen on the wrist and periumbilical area. What is the dx? a. Scabies b. Polycythemia c. Urticarial d. Atopic eczema e. Lichen planus
Ans. The key is A. Scabies.
- A 40yo lady who has been a smoker since she was a teenager has the following blood result: Hgb=19. What hormone should you check? a. Aldosterone b. Cortisol c. Erythropoietin d. T4 e. TSH
Ans. The key is C. Erythropoetin. [Smoking causes raised carboxyhemoglobin level causing hypoxemia and raised erythropoeitin which leads to raised hemoglobin level (secondary polycythemia)].
- A 25yo man presents with hoarseness of voice. He has swollen vocal cords. His BMI=32 and he smokes 20-25 cigarettes/day. What would you advise him? a. Stop smoking b. Lose weight
Ans. The key is A. Stop smoking.
- A 64yo male was admitted to the medical ward with complaint of diarrhea, abdominal pain and weight loss for few months. Exam: clubbing, perianal skin tags and abdominal tenderness. Colonscopy reveals transmural granulomatous inflammation involving ileocecal junction. He was dx with what? a. CD b. UC c. Bowel cancer d. Gastric cancer e. IBD
Ans. The key is A. CD. [The given picture is typical of Crohn’s disease].
- A pt presents with hemoptysis 7d after tonsillectomy. What is the next step? a. Packing b. Oral antibiotics and discharge c. Admit and IV antibiotics d. Return to OT and explore e. Ice cream and cold fluids
Ans. The key is C. Admit and IV antibiotics. [Secondary hemorrhage can occur from sloughing of tissue from surgical wound following infection].
- A 55yo man presents with HTN. He complains of headache and visual disturbances. He also reports itching after a hot bath and burning sensation in finger and toes. His face is flushed red. PE: mild splenomegaly. Inv: Hgb=20g/dl, WBC=20, plt=500, EPO normal. What is the likely dx? a. Myelofibrosis b. Polycythemia rubra vera c. Essential thrombocythemia d. CML e. CLL
Ans. The key is B. Polycythemia rubra vera. [Raised hemglobin, raised cell counts and normal erythropoeitine along with symptoms of hyperviscosity like headache and associated hypertension are diagnostic of polycythemia rubra vera].
- An old man having T2DM with increased skin tanning, heart failure and having high ferritin (hemochromatosis) level is refusing tx. Where is the first site of cancer? a. Testes b. Adrenal c. Liver d. Pancreas
Ans. The key is C. Liver.
- A 60yo DM lady presents with severe peri-anal pain and swelling. What’s the cause? a. Anal carcinoma b. Anal fissure c. Hemorrhoid d. Anal abscess
Ans. The key is D. Anal abscess.
- A woman is sad, fatigues and she is eating more and also has sleeping disturbance and hears the voice of her husband who died 3yrs ago. What is the dx? a. OCD b. Psychotic depression c. Grieving d. Severe depression
Ans. The key is B. Psychotic depression. [Here features of atypical depression along with hallucination makes the likely diagnosis to be psychotic depression].
- A 40yo teetotaler woman is recovering from a hysterectomy 2days ago. At night she becomes agitated and complains of seeing animals and children walking around the ward. What is the most likely dx? a. Delirium tremens b. Toxic confusional state c. Hysteria d. Mania e. Drug induced personality disorder
Ans. The key is B. Toxic confusional state. [This is not delirium tremens as the womean is teetotaler].
- A woman with a hx of drug abuse and increased alcohol intake, now comes for help and she is concerned about her problem. What is the most appropriate management option? a. Voluntary admission b. Psychiatry team c. Mental health team d. Psychiatry voluntary admission
“Ans. The key is B. Psychiatry team. This is probably a wrong key. Correct option should be C. Mental health team. [Drug abuse and alcohol intake has psychological issue also and mental health team can give broader aspect of support than a psychiatry team. Mental Health Team: ““These can include psychiatrists, psychologists, community psychiatric nurses, social workers, and occupational therapists
- A 28yo woman who is 32 wks pregnant in her 3rd pregnancy is diagnosed as a case of placental abruption. After all the effective measures, she is still bleeding. What is the underlying pathology? a. Clotting factor problem b. Clauser’s syndrome c. Platelet problem d. Succiturate lobe e. Villamentous insertion of placenta
Ans. The key is A. Clotting factor problem.
- An old woman having decreased vision can’t see properly at night. She has changed her glasses quite a few times but with no effect. She has normal pupils and cornea. What is the most likely dx? a. Cataract b. Glaucoma c. Retinal detachment d. Iritis e. GCA
Ans. The key is A. Cataract. [glaucoma may have dilated oval pupil].
- A 53yo man was admitted to the hospital for inv of hemoptysis. 3 days after admission he developed alternating state of consciousness, ataxic gait and some visual problems. What is the most appropriate management of this pt? a. Acamprosate b. Chlordiazepoxide c. Diazepam d. High potent vitamins e. Disulfiram
Ans. The key is D. High potent vitamins. [This is a case of Wernicke’s encephalopathy (as hospital admission prevented him from consuming alcohol) and the treatment for this is high potent vitamins].
- A pt underwent hip surgery. Later he presents with SOB and chest pain. What is the dx? a. Pulmonary embolism b. MI c. Tension pneumothorax d. Fat embolism e. None
Ans. The key is A. Pulmonary embolism.
- A 25yo man presents with hx of breathlessness. A transthoracic echo reveals a patent foramen ovale. What diagnostic inv would you do for a patent foramen ovale? a. Transesophageal echo b. Bubble echo c. Transthoracic echo d. ECG
Ans. The key is B. Bubble echo. [Bubble echo is actually extension of transoesophageal echo in that here additional bubbles are added during transoesophageal echo to get better visualization of foramen ovale].