Internal Medicine SEM 1 (2014/2015)

OBA
1. A bartender complained of tea coloured urine and lethargy for the past 1
week and jaundiced for three days. He has no history of fever,
abdominal pain, vomiting and diarrhea. He admitted to have sexual
promiscuity. He has no family history of hepatitis B and C and no known
history of liver failure. He drank alcohol and smokes regularly. On
examination, he had normal temperature, normal pulse rate, and normal
blood pressure.
On investigation of his blood and liver function test.
Blood investigation : normal
Liver function test: ALT and ALP, bilirubin increases.
What are the investigation require for this patient?
A
CT scan
B
Liver biopsy
C
Hepatitis B serology
D
Abdominal ultrasound
E
2. An elderly lady complained of dysuria and frequency in urination for the
past 3 days. She denies any fever and any abdominal pain. She is also
have uncontrolled diabetic and a history of congestive cardiac failure.
On examination, her temperature was normal and her kidney was not
ballotable.
On investigation:
FBC: normal
Urine analysis :
RBC 3+
Protein 1+
What are the diagnosis
A Diabetic nepropathy
B Renal calculi
C Sclerosing Glomerulonephritis
D IgA nephropathy
E UTI
3.

An elderly man complained of 2 month history of arthralgia at the knee

and hands.
It is also accompanied by morning stiffness of duration of 2 hours.
What would be the best diagnostic modality be?

A
B
C
D
E

4
.

A 30 year old lady come with progressive shortness of breath with her
fingers turning blue when expose to cold. She also complains of the skin
tightness and dysphagia.
What would be suitable account for the shortness of breath
A
B
C
D
E

5
.

Anti-dsDNA
Anto scl70
ESR
Hand Radiography
Rheumatoid Factor

Bronchial asthma
Bronchieactasis
Chronic Obstructive Pulmonary Disease
Congestive Cardiac Failure
Pulmonary Fibrosis

A young male admitted to the ward complaining of headaches,

photophobia and purpuric rashes. He denies of any fever, abdominal
pain, cramps or vomiting.
On computerized topography (CT) of the brain shows meningeal
enhancement.
Investigation on his cerebral spinal fluid is done with these results.
Protein : normal
Glucose : Increase
There are present of polymorph
What are the management for this patient
A Acyclovir
B Penicilim
C Metronidazole
D
E

6
.

A 36 year old man complaining of joint paint at the knee for the past 3
month.
He has a history of uncontrolled diabetes mellitus. He had a body mass
index of 30kg/m2.
On examination, he had no fever, his blood pressure was normal, pulse
rate and respiratory rate was normal.
The knee was not tender and not warm.
There crepitation presents on his knee when he move them.

What are the management

A Actrapid
B Knee transplant
C Ice pack
D Painkiller
E Reduce the weight
7
.

An elderly lady with a known history of uncontrolled diabetes

complained of right upper quadrant pain.
On examination, she was febrile with 38O Celcius. Her pulse, respiratory
rate, blood pressure was normal.
On palpitation on the right upper quadrant shows no mass but tender.
Liver function test shows increment in ALP, AST and ALT.
On abdominal ultrasound shows there is multi echoitic mass with an
abcess
What is the management
A Liver biopsy
B Percutaneous drainage
C Intravenous antibiotic
D Acyclovir
E Subcutaneous antibiotic

KFQ
No 1:
46 y/o women presented with lethargy, low and headache especially at
afternoon for 4month. Denied fever, vomit and diarrhea, BP 92/68 (lying),
84/48 (sitting).
Hb
13
Na
135
K
(hyperkalaemia)
Rbs
2.1
Corrected Ca
(hypercalcaemia)
Neutrophil 65%
TWC
normal
Creatinine normal
Urea
normal
1) State 3 abnormalities
2) What is your diagnosis?
3) List 4 relevant investigations
4) State 2 investigations and expected findings

5) List 2 principle managements

No 2:
Pale, jaundice, afebrile, non-alcoholic, positive family history of cancer,
mental altered pass 3days, passing black stool pass 1 week. Physical
examination reveals splenomegaly, soft and non-tender abdomen.
1) 4 clinical sign on peripheral examination
2) Causes of thrombocytopenia
3) Causes of mental altered
4) Causes of melena
5) Investigation & diagnosis
6) 2 principle of management

No 4:
Middle age women presented with intermittent gradually progressive
ptosis especially in the evening. No complain of diplopia. On examination:
bilateral ptosis. Other neurological examination is normal.
1) Diagnosis (3m)
2) I) Bed side test:
II) Diagnosis
3) Other manifestations
4) Pathophysiology
5) Name one drug

OSCE
Q3. Achilles tendon xanthoma

Q4. Plural effusion

1- abnormalities seen in picture
2- three differential diagnosis

Q5. RA
1- abnormalities in picture
2- two Differential Diagnosis
3- two investigation