446. A 37yo man with an ulcer on the medial malleolus. Which of the following LN is involved?

a. External iliac LN e. Iliac LN

b. Pre-aortic LN f. Submental LN
c. Aortic LN g. Submandibular LN
d. Inguinal LN h. Deep cervical LN
447. A pt presents with weight loss of 5kgs despite good appetite. He also complains of palpitations,
sweating and diarrhea. He has a lump in front of his neck which moves on swallowing. What is
the most appropriate dx?
a. Lymphoma
b. TB adenitis
c. Thyroid Ca
d. Goiter
e. Thyroid cyst
448. A 76yo woman has become tired and confused following an influenza like illness. She is also
breathless with signs of consolidation of the left lung base. What is the most likely dx?
a. Drug toxicity
b. Delirium tremens
c. Infection toxicity
d. Hypoglycemia
e. Electrolyte imbalance
449. A young pt is complaining of vertigo whenever she moves sideways on the bed while lying
supine. What would be the most appropriate next step?
a. Head roll test
b. Reassure
c. Advice on posture
d. Carotid Doppler
e. CT
450. A 32yo man has OCD. What is the best tx?
a. CBT
b. SSRI
c. TCA
d. MAO inhibitors
e. Reassure
451. A 65yo woman says she died 3m ago and is very distressed that nobody has buried her. When
she is outdoors, she hears people say that she is evil and needs to be punished. What is the
most likely explanation for her symptoms?
a. Schizophrenia
b. Mania
c. Psychotic depression
d. Hysteria
e. Toxic confusional state
452. A 50yo woman presents following a fall. She reports pain and weakness in her hands for several
months, stiff legs, swallowing difficulties, and has bilateral wasting of the small muscles of her
hands. Reflexes in the upper limbs are absent. Tongue fasciculations are present and both legs
show increased tone, pyramidal weakness and hyper-reflexia with extensor plantars. Pain and
temp sensation are impaired in the upper limbs. What is the most likely dx?
a. MS
b. MND
 c. Syringobulbia
d. Syringomyelia
e. Myasthenia gravis
453. Which of the following formulas is used for calculating fluids for burn pts?
a. 4 x weight(lbs) x area of burn = ml of fluids
b. 4 x weight(kgs) x area of burn = L of fluids
c. 4 x weight(kgs) x area of burn = ml of fluids
d. 4 x weight(lbs) x area of burn = L of fluids
e. 4.5 x weight(kgs) x area of burn = dL of fluids
454. A 65yo male presents with dyspnea and palpitations. Exam: pulse=170bpm, BP=120/80mmHg.
Carotid massage has been done as first instance. What is the next step of the management?
a. Adenosine
b. Amilodipine
c. DC cardioversion
d. Lidocaine
e. Beta blocker
455. A 48yo farmer presented with fever, malaise, cough and SOB. Exam: tachypnea, coarse end-
inspiratory crackles and wheeze throughout, cyanosis. Also complaint severe weight loss. His
CXR shows fluffy nodular shadowing and there is PMN leukocytosis. What is the single most
appropriate dx?
a. Ankylosing spondylitis
b. Churg-strauss syndrome
c. Cryptogenic organizing
d. Extrinsic allergic alveolitis
e. Progressive massive fibrosis
456. A 35yo lady is admitted with pyrexia, weight loss, diarrhea and her skin is lemon yellow in color.
CBC = high MCV. What is the most probably dx?
a. Aplastic anemia
b. Pernicious anemia
c. Leukemia
d. ITP
e. Lymphoma
457. A 72yo woman who had a repair of strangulated femoral hernia 2 days ago becomes noisy,
aggressive and confused. She is febrile, CBC normal apart from raised MCV. What is the most
likely dx?
a. Electrolyte imbalance
b. Delirium tremens
c. Wernicke’s encephalopathy
d. Infection toxicity
e. Hypoglycemia
458. An old lady had UTI and was treated with antibiotics. She then developed diarrhea. What is the
single most likely tx?
a. Co-amoxiclav
b. Piperacillin + tazobactam
c. Ceftriaxone
d. Vancomycin
459. A 56yo man has symptoms of sleep apnea and daytime headaches and somnolence. Spirometry
shows a decreased tidal volume and vital capacity. What is the single most appropriate dx?