MEDICINE

LUMIERE SEM 5
1. Q: 45 year old come with renal colic pain. Xray detected no abnormalities. KUB
sonography shows 6mm stone at left renal pelvis. What is the possible type of stone?

A.Calcium oxalate
B.Uric acid
C.Hydroxyapatite
2. Q: A 35 y/o woman presented to the clinic with multiple joint deformities involving both
hands and noted to have ulnar deviation at the wrist. What is the most likely diagnosis?

A. Rheumatoid arthritis
B. Septic arthritis
C. Gouty arthritis
3. Q: An 70 years old man comes with complain of lesion on the face. The lesion has pearly
border and telangiectasia on the center of the lesion. What is the possible prognosis?

A. Squamous cell carcinoma

B. Basal cell carcinoma
C. Melanoma

LUMIERE SEM 6
1. A 50 y/o male with chronic Hepatitis B and liver cirrhosis admit to emergency
due to hematemesis.
Best class medication?
A. Vasopressin antagonists.
B. Proton pump inhibitors.
C. H2 receptors antagonists.
2. 10 y/o boy presented with dry skin and lichenification at flexure of elbow and
knee, which is the most important information for diagnosis?
A. Personal H/O asthma
B. Severe itch
C. Family H/O skin disease
3. A 50 year old man presented with a 4 day history of fever, cough with productive
greenish sputum. Chest radiograph showed left pleural effusion and a diagnostic
pleural tapping done.

Pleural fluid investigation useful in determine course of management

A. Biochemistry profile
B. Cytology
C. Culture and sensitivity
4. 17y/o female. Progressive lethargy and pale.
 Hb : 7.6 (low)
MCV : 50fL(low)
MCL : 21pg (low)
TWBC : normal
Plt : 200 x 10^9 /L (normal)
A) IDA
B) Thalassemia
C) Sideroblastic anemia

LUMIERE SEM 9

No Soalan Pilihan jawapan

.

1 A 42 y/o man noticed change of voice and increased in his shoe a. Thyroid function test
size over the past 2 years. Physical examination revealed b. Random growth
enlarged extremities and bitemporal hemianopia. hormone
c. Insulin-like growth
Which of the following is the most appropriate investigation? hormone [IGF-1]

2 A 30 year old female complained of 3 months history of A. Carbimazol

palpitation, heat intolerance and irritability. Physical examination B. Propranolol
revealed tachycardia, hand tremors and excessive sweating. C. Lugols iodine

Which is best treatment for immediate relief of her symptoms?

3 A 50 year old diabetic was admitted with fever and lethargy. His A. Subcutaneous basal
blood glucose was 28mmol/L with positive urine ketones. bolus insulin
B. IV antibiotic
Which of the following is the most important treatment at this C. IV saline
stage?

4 30 y/o male on treatment for renal tubular acidosis (distal type) A. Serum calcium
present with progressive generalized weakness last 2 days. B. Serum potassium
Which following electrolytes must affected his condition? C. Serum magnesium

5 46 years old male with no previous medical illness complaint of A. Post streptococcal
passing blood in urine 2 day prior presentation. He has h/o sore glomerulornephritis
throat and low grade fever a day prior that. No h/o sandy urine B. IgA nephropathy
C. pyelonephritis
What is the most likely diagnosis

6 A 65 y/o man on regular hemodialysis since the last 5 years ℅ A. Tertiary

generalised bone pain and body itchiness. Blood ix hyperparathyroidism
Ca : 1.7 mmol/L (2.2-2.6) B. Secondary
PO4 : 3 mmol/L (1.13-1.77) hyperparathyroidism
ALP : 200 IU/L (less than 140) C. Primary
Which of the following likely to describe his condition? hyperparathyroidism

7 40-year old man, with dyspepsia. Upper GI endoscopy revealed a. H. pylori serology
gastritis and positive H. pylori. Eradication treatment is started. b. Urea breath test
 Best investigation to measure H.pylori eradication. c. Repeat upper GI
endoscopy

8 52 y/o male with previous history of CLD presented with A. Ranitidine

haematemesis. Urgent upper GI endoscopy revealed large B. Pantoprazole
esophageal varices with evidence of recent bleeding as well as C. Octreotide
portal hypertensive gastropathy

Most appropriate IV medication?

9 50-year-old male came with worsening jaundice & abdominal A. Liver function test
mass. He is a known case of chronic hepatitis B with liver B. Alpha-fetoprotein
cirrhosis & portal hypertension. What is the test to support the C. Carcinoembryonic
diagnosis? antigen

10 30 y/o female pt was refered to you for further management of A. HbcAg

chronic hepatitis B infection. Although she was asymptomatic, B. HbeAg
her liver transaminase were elevated twice the normal upper limit C. Hbv dna

Which is the following is the best test to assist in determining if

she need anti viral

11 A 45 years old woman with severe mitral stenosis developed A. Throat Swab
fever for 2 weeks after a dental extraction B. Six time blood test
within 24 hours
Which of the following is the most appropriate investigation C. Anti Streptolysin O
Test (ASOT)

13 A 65 year old male, smoker presented with sudden severe chest A. Full blood count to
pain that woke him up. Examination showed unequal blood detect leukocytosis
pressure over bilateral arms. ECG was not conclusive. Chest B. CT scan of thorax
radiograph showed large heart and widened mediastinum. with contrast
C. Report ECG half an
Which of the following is the best investigation for him? hour apart

14 A 39 y/o lady presented with fever, multiple joint pain and facial A. NSAIDS
rashes since 6 weeks. On PE, there is raised edematous facial B. Oral Prednisolone
rash, palatal ulcers and bilateral wrist synovitis. C. Cyclophosphamide

What is the best immediate treatment?

15 A 70 y/o man with end stage renal failure presented with 2 days a. Gouty arthritis
h/o painful swelling at first metatarsal of his left toe associated b. Septic arthritis
with fever. c. Reactive arthritis

Which of the following is the most likely diagnosis?

16 19 y/o young lady came with complain of fever and headache A. Moraxella menigitis
since 3 days. OE , kernig’s sign was positive and CSF culture B. meningicoccal
reveals gram negative diplococci. menigitis
C. Streptococcus
Which is the most likely diagnosis? menigitis

19 A 60 years old man, hypertension, presented with sudden onset A. Alteplase

left sided hemiparesis and slurred speech since 8 months ago. B. Aspirin
 Examination revealed left UMN 7th cranialnerve and left C. Labetolol
hemiplegia with motor grade 0/5. His blood pressure was
190/110mmhg. CT brain showed hypodensity over right corona
radiata.
Whis is the most appropriate treatment?

20 a 30 y/o lady presented with recurrent severe headeche since her a. Sumatriptan
teenager year. It was unilateral associated with photophobia and b. O2 therapy
phonophobia lasted for hour to day. Neurological exam was c. Opiod
normal

Best treatment

22 34 year old male presented with bilateral lower limb weakness A. Acute
and numbness since 1 week. Examination revealed bilateral Transversemyelitis
lower limb weakness with power ⅗. Stoking? type/level loss of B. Gullian barre
sensation. He had history of diarrhea 2 weeks prior. What is the syndrome
most likely diagnosis C. Hyperkalemia with
myopathy/neuropath
y

23 A 34 year old male presented with massive para-aortic nodal A. Acute pulmonary
mass and hepatosplenomegaly. He was diagnosed with Burkitt embolism
Lymphoma. He was started on multiagent chemotherapy. On 2nd B. Hyperurecemic
day of treatment, he developed breathlessness and urine output nephropathy
was 200mls/24hr. RR- 28/min, PR- 90bpm, BP- 130/70mmHg. C. Sepsis

What’s the cause?

26 A. Iv. Corticosteroids
30 year old male came with shortness of breath. He has a history B. Nebulizer B-agonist
of rhinitus & eczema. On examination, there is decreased with oxygen
bilateral air entry into his lungs. What is the most appropriate C. MDI B-agonist &
treatment? anticholinergic

27 A 60 year old man a smoker presented with fever and cough A. Upper lobe
since 3 months. It was associated with night sweat destruction
B. Upper lobe
Which of the following CXR finding that is likely to be presented casseation
in this patient C. Upper lobe mass

28 A 15 year old boy was brought from his hostel to the emergency A. Blood culture
room with complaints of fever, cough and breathlessness since 3 B. Throat swab
days prior. Examination revealed RR 28/min, lung examination C. Mycoplasma
was clear. Chest X-ray showed minimal perihilar reticular serology
changes. Sputum gram-stain was -ve.

Which of the following is the most appropriate diagnostic

investigation?

29 A 25 year old man presented with mild itch lesion on back and A. Azole topical cream
shoulder for the past 1 year. On examination, he had or shampoo
hypopigmented macular scaly skin lesions. Skin scraping reveals B. Selenium sulfide
fungal hyphae in typical “spaghetti and meatball” pattern. He was lotion
treated with several topical creams and lotion, initially cleared but C. Zinc pyrithione
 recurred. shampoo

Which of the following is the best treatment for him?

30 60 y/o man with osteoarthritis of right knee since 5 years A. Knee X-ray
presented with a history of low grade fever and painful swollen B. Knee joint aspiration
right knee. He has history of using low dose oral corticosteroids for culture
for lung disease. C. Blood culture

What is the diagnostic investigation?

Case Question

A 38-year old lady presented with 4 weeks colicky 1. Give 3 differential diagnosis.
abdominal pain in the paraumbilical and 2. State 4 further history to support the
suprapubic areas. There are no radiation or differential diagnosis.
relation with food consumption. This was followed 3. Give 3 investigations to support diagnosis
by 2 weeks history of alternating diarrhoea and and its reason.
constipation, where constipation is more
prominent with abdominal pain. It is associated
with per rectal bleed and foul-smelling perianal
discharge. She denied history of analgesics
usage. Stool occult blood test is positive.

LUMIERE SEM 10

No. Soalan Pilihan jawapan

1 20 year old man was brought by family due to recurrent A. IV Lorazepam

episodes of generalized tonic clonic seizures lasting for 5 B. Intubation
minutes each time. On examination, he was drowsy but C. IV Phenytoin
was able to move all limbs. He fitted again in the
emergency room during the examination. SpO2 was
97%. Blood investigations were normal.

What is the best immediate treatment?

2 A 60 Year old male with hypertension, presented with A. Aspirin

sudden onset of left sided body weakness for 8hours B. IV Labetolol
duration. C. rTPA

Examination revealed conscious and alert.

Patient blood pressure 180/100mmHg, pulse rate 90bpm
with irregularly irregular rhythm.

His power was 0/5 over left upper and lower limb. Brain
CT shows hypodensity over patient right parieto
temporal region.

Which of the following is the treatment of choice?

3 A 24 year old lady presented with fever for 5 days, A. Electroencephalogra
followed by headache and seizure. On examination she m
was drowsy and febrile. There was presence of neck B. Lumbar puncture
rigidity, bilateral hyperreflexia and ankle clonus. Non- C. MRI brain
contrast CT brain was normal.

What is the next investigation of choice?

4 A 50 year-old man with pulmonary tuberculous was A. Hydrocephalus

started on four types of anti tuberculous drugs. He B. Peripheral
presented again after 2 months with progressive neuropathy
numbness over both feet. On examination, he had C. Transverse myelitis
normal tone and power but reduce ankle jerk bilaterally
and downgoing plantar response. Sensory examination
revealed reduced sensation to pinprick from distal toes
up to ankle bilaterally.

Which of the following complications had occurred?

5 A 28 y/o male, came with fever for 1 week, A. Peripheral smear for
headache,myalgias. O/E , temp 38.1’c, looked malarial parasite
dehydrated, conjunctival suffusion and tender palpation B. Mononuclear
over B/L para spinal, thigh, and calf muscle. agglutination test,
FBC : wcc : 12.2, Platelet : 63X10^3 MAT test
Urea : 18 mmol/L C. NS-1
Creatinine : 220mmol/L
Hct : 46%
AST: 255 IU/L
ALT : 206 IU/L
ALP: 197 IU/L
Total bilirubin: 66g/L

What is the next choice of investigation?

6 60 years old smoker was admitted with acute chest pain. A. Fibrates
Physical examination reveals normal. ECG shows ST B. Niacin
depression in inferior leads. Serum troponin shows C. Statins
abnormal.His fasting blood glucose and serum
triglycerides is elevated.

Which drugs is recommended to control his lipid level ?

7 A 30 years old lady, rapid increase weight, multiple A. CT adrenal

bruises on her abdominal. B. Low dose
On examination, she was obese, pinkish abdominal dexamethasone
striae and high blood pressure. Serum cortisol increase. suppression test
C. High dose
What is the most appropriate initial investigations? dexamethasone test

8 A 24 y/o lady presented with recurrent epigastric pain A. H. Pylori serology

 which worsened at night. Clinical examination revealed B. Stool for H. Pylori
only mild tenderness over epigastric region. Ultrasound antigen
abdomen was normal. She was planned for Helicobacter C. Urea Breath test
Pylori evaluation.

Which of the following is the most accurate test for the

presence of Helicobacter Pylori?

9 50 y/o male with long standing liver cirrhosis presented A. Abdominal

with SOB. OE the BP was normal, but patient was paracentesis
tachypneoa, massive ascites was noted. B. Albumin infusion
Which of the following is the highest priority intervention? C. High dose frusemide

10 30y/o man with IBD started on three medication A. azathioprine

simulteously. Patient was noted to have leucopenia after B. Mesalazine
1 month therapy. C. Prednisolone

What medication likely cause?

11 A 29 y/o man presented with 2 days history of swelling at A. Allopurinol

1st metatarsal of his left toe associated with fever. It was B. Colchicine
noted after taking seafoods. C. Prednisolone

Which of the following is the immediate drug of choice?

12 35 years old male presented with multiple joint pain at A. Reactive Arthritis
bilateral wrist and ankle with right knee since 2 weeks. B. Rheumatoid Arthritis
It was associated with early morning stiffness. A week C. SLE
prior, he has a history of fever with multiple mouth ulcer.

What is the most likely diagnosis?

13 A 39 years old lady presented with bluish discoloration of A. Anti centromere

fingers, shortness of breath on exertion and difficulty in antibody
swallowing for past 6 weeks. Physical examination B. Anti nuclear antibody
revealed disclosed taut skin, macrosomia & digital ulcers C. Anti Ro antibody
at finger tips. Respiratory system revealed fine
crepitations.

What is the most important investigation to confirm

diagnosis ?

14 66 years old man, T2DM, and CKD presented with A. Blood pH 7.29 [<7.1]
nausea and vomiting for 1 week. B. Presence of
You suspected he is having acute on chronic kidney pericardial rub
failure. C. Serum K+ 5.3
mmol/L [>6.5]
What are the indications for urgent hemodialysis?

15 A 65 years old man with end stage renal disease on A. Primary

 regular hemodialysis for 5 years, presented with hyperparathyroidism
generalized bone pain and body itchiness. He was not B. Secondary
compliant to his phosphate binder. hyperparathyroidism
Blood investigations showed: C. Tertiary
Calcium 1.7 mmol/L (2.2-2.6) hyperparathyroidism
Phosphate - 3 mmol/L (1.13-1.77)
Alkaline phosphatase 200 IU/L (< 140)
Which of the following complications describe his
condition?

16 60 year old man with underlying diabetes mellitus and A. Amlodipine

hypertension has started treatment for increased blood B. Prazosin
pressure. Upon review of the renal function test, serum C. Ramipril
creatinine was elevated from 110µmol/L to 200µmol/L.

What medication is the most likely cause?

17 A 36 year old female had mitral valve replacement for A. Maintain the warfarin
mitral stenosis and currently on warfarin therapy at 3mg treatment at current
daily. She c/o gum bleeding for the last 2 days. dose
B. Reduce warfarin to
O/E revealed, there was minimal bleeding around the 2mg daily
buccal mucosa. No other sites of bleeding noted. Her C. Stop warfarin
INR was 2.3

Which of the following is the most appropriate

management strategy?

18 A 22 year old lady. Underlying thalassemia developed A. Acute febrile non-

fever while undergoing packed red cell transfusion for hemolytic transfusion
symptomatic anemia. Upon examination, she was pale reaction
and jaundice with temperature 40 degree. Her BP was B. Acute hemolytic
120/60mmHg and Pr 100bpm. Lung and abdominal transfusion reaction
examination normal. C. Acute septic reaction

Which is likely complication?

20 40 y/o man with T2DM presented with acute confusion A. DKA

preceded by 3 day of fever. on examination reveal B. HHS
drowsy, dehydrated. C. uncontrolled DM
Blood glucose : 30mmol/L
Sodium bicarbonate 10mmol/L
what is the most diabetic complication ?

21 A 28 years old man, came for contact screening for A. Reassurance

tuberculosis as his wife was diagnosed with pulmonary B. Start anti Tb
tuberculosis. C. Start isoniazid
He was asymptomatic. prophylaxis therapy
 Mantoux test = 22cm, with normal chest X-ray.

What is the best management?

23 A 50y/o man presented with left sided body weakness. A. Acute Pulmonary
After 3 days in the ward he developed sudden onset Embolism
respiratory distress. On examination, his RR was 36/min, B. Aspiration
BP 80/50mmhg, PR 120/min and Temp 37C. Lung Pneumonia
examination showed equal breath sound with no added C. Septic Shock
sound. Muscle power of left sided limb was 0/5 and left
leg was swollen.

Which of the following complication had occurred?

24 30 y/o man presented with sudden onset of SOB and A. Insert chest tube at
pleuritic chest pain. O/E, his RR was 32/min and he was right safety triangle
unable to complete sentences. His trachea was deviated B. Insert large bore
to left side and there was hyperresonance on right side cannula at 2nd right
of his chest. He had sudden cardiorespiratory arrest and intercostal space
was resuscitated. midclavicular line
C. Positive pressure
What is the best immediate management step? ventilation

25 60 y/o smoker with COPD, presented with fever and A. Beta-lactam and
cough with yellowish sputum for 5 days. O/E, he is macrolide
febrile with RR 28, SpO2 of 95%. Lung examination [Azithromycin]
showed bronchial breath sound over left middle zone. B. Beta-lactam and
metronidazole
Which antibiotic combination is drug of choice? C. Beta-lactam and
beta-lactamase
inhibitor [Augmentin
– Amoxicillin +
Clavulanate]

26 15 y/o boy presented with elbow and wrist pain 2 weeks A. Infective
prior, which was resolving. A week later, he developed Endocarditis
unilateral knee and ankle pain, associated with fever. He B. Rheumatic Carditis
had multiple pink color, ring-like lesion on his back. CVS C. Staphylococcus
examination revealed a diastolic murmur over left sternal septic arthritis
edge.

Which of the following most likely diagnosis?

27 A 45 years old, male, a smoker presented with chest A. IV heparin infusion

pain, which was very severe that woke him up. BP B. IV tenecteplase
160/90 mmHg, JVP 6 cm and bilateral lungs crepitation. C. Subcutaneous
ECG shows left bundle branch block. He was started fondaparinux
with dual anti-platelet. Which is the specific treatment?

Dx: Acute MI with Acute left ventricular failure

28 A 60 years old man presented with breathlessness for 1 A. Air bronchogram –
week, bilateral leg swelling, and orthopnea. Since 2 days Lobar pneumoniae
ago, he develops cough with pink frothy sputum. B. Bronchial wall
On examination: Bilateral lung fine crepitations, JVP 7 thickening – Cystic
cm, pitting sacral edema. fibrosis
Chest X-ray revealed abnormality C. Upper lobe diversion
– Acute pulmonary
What is the compatible findings on Chest X-ray? edema

29 A 70 years old man presented with a lesion on his A. Basal cell carcinoma
cheek. The lesion had a raised pearly border and there B. Melanoma
was telangiectasia on the surface of the lesion. C. Squamous cell
carcinoma
Which of the following is the most likely diagnosis?

30 44y/o,Male,smoker presented with chronic cough and A. Ask the patient as

loss of weight of 10kg for 2 months. Examination showed how much he knows
a cachexic patient with mass lesion over upper lobe of about his condition.
left lung. Biopsy result showed Adenocarcinoma of lung. B. Explain regarding the
You need to deliver the bad news to the patient. diseases and
(Breaking bad news) treatment options
available.
What is the first step after established the rapport with C. Disclosed the biopsy
the patient? result and his
prognosis.

Case Question

A 50 years old man presented with dyspnea 1) 3 differential diagnosis.

on exertion for 4 weeks. The symptom - Congestive heart failure
improved upon resting. - COPD
He smokes 1 pack/day for the past 4 years. - Asthma
He had a history of hypertension and type 2
DM for the past 5 years and was on regular 2) 4 additional history to support your
follow up at local clinic. differential diagnosis.
- SOB only lying flat, during sleep
- Chest pain
- Family history of asthma
- Productive cough with yellowish sputum

3) 3 specific investigation to confirm

diagnosis and reasons.
- ECG
- Chest x-ray
- PEFR

XANTHRON SEM 5

NO. SOALAN JAWAPAN

1. A 45 years old gentleman complaining of fever, cough A. Chlamydia

pneumoniae
with productive greenish sputum. He just returned from
B. Legionella
cruise holiday and some of his cruise members also had pneumophila
similar complaint. C. Mycoplasma
What is the most likely organism? pneumoniae

2. A 50 years old man presented with a 4 days history of A. Biochemistry

fever, cough with productive greenish sputum. A chest profile
radiograph showed left pleural effusion. A diagnostic
B. Culture and
pleural tap was done.
sensitivity
What is the most likely investigation will
determine the chest tube insertion? C. Cytology

3. An intravenous drug user is presented with fever and A. Streptococcus

yellowish sputum. Two from his 3 blood culture grew viridans
gram positive cocci organism. B. Streptococcus
What is the most likely organism? pneumonia
C. Staphylococcus
aureus

4. A 56 years old man presented with acute left knee A. Arthrocentesis

swelling for 2 days duration with fever. Which is the most
 important diagnostic investigation? B. Blood culture

C. Knee X-ray

5. 60 years old man with hypertension presented with A. Dysarthria

sudden onset of imbalance while walking in straight line.
B. Positive Romberg’s
Examination reveals presence of intention tremor and
test
impairment of rapid alternating movement of right upper
limb C. Pronator drift
Which of the following clinical sign is most likely to
be present?

6. 30 years old man complaint of polydipsia, polyphagia and A. Deficiency of anti-

polyuria. On examination, he is obese with skin diuretic hormone
hyperpigmentation at neck and axilla area. Other (ADH)
systemic examination is normal.
B. Osmotic diuresis
What is the explanation of polyuria?
C. Resistance of ADH

7. A 27 years old gentleman presented with fever for 8 days A. Malaria infection
associated with headache, arthralgia and myalgia. He has
B. Typhoid fever
just come back from orang asli settlement in Gua Musang.
At presentation, he was conscious, alert but lethargic. C. Dengue fever
Temperature 39.5°C, BP 100/60 mmHg, PR 130 bpm.
Systemic examinations were unremarkable.

Blood test:
Hb : 10 mg/dL
WBC : 13 X 10^9
Platelet count : 56
HCT : 30%
Urea : 15
Creatinine : 210
Bilirubin : 400
Indirect bilirubin : 300
AST : 250
ALT : 230
 What is the most likely diagnosis?

8. A 45 years old man with end stage renal failure presented A. Calcium level
with syncope and lethargy. Which of the following
B. Haemoglobin level
investigation is indicated?
C. Magnesium level

9. 45 years old smoker presented with gradual onset of A. Barium swallow

dysphagia to both solid and fluid for past 1 year. He also
B. Oesophageal
complained of weight loss of 10 kg. he was previously
manometry
well. On examination, he was cachexic. Otherwise,
systemic examination was unremarkable. C. Esophagogastroduo
Which is the most important initial investigation? denoscopy

10. A 60 years old man was treated for severe pneumonia. A. Campylobacter
After being on intravenous antibiotics for 2 weeks, he jejuni
began to pass blood stained loose stools. Which of the
B. Clostridium difficile
following organism would be the cause?
C. E. coli

11. A 30 years old gentleman presented with blurring of A. Ethambutol

vision for the past 2 weeks. He is currently on treatment
B. Isoniazid
for his pulmonary tuberculosis.
C. Rifampicin
What possible drug is the cause for his blurring of
vision?

XANTHRON SEM 6

1. A 55 years old woman who has poorly controlled DM complaint of productive cough
with greenish sputum and fever.
Which of the following is the most likely organism involved?

Chlamydophila pneumoniae

Legionella pneumophila
 Pseudomonas aeruginosa

2. A 50 years old male smoker presented with fever, productive cough with greenish
sputum for 4 days. Chest X-ray showed left pleural effusion. A diagnostic pleural tap was
done.
What is the most likely investigation will determine the chest tube insertion?

Biochemistry profile

Cytology

Culture and sensitivity

3. A 25 years old woman with severe mitral stenosis develop fever for 1 week after dental
scaling. There is new pansystolic murmur at apical area.
Which of the following is most likely diagnosis?

Acute heart failure

Acute rheumatic fever

Infective endocarditis

4. A 17 years old thin girl with recurrent sore throat presented with palpitations, shortness
of breath and painful left knee and right ankle.
Which is most likely diagnosis?

Acute rheumatic fever

Infective endocarditis

SLE

5. A 36 years old obese man presented with painful erythematous and swollen metatarsal-
phalangeal joint of the right big toe for 2 days after large consumption of seafood.
Which of the following is the best management plan?

Colchicine

Paracetamol

Tramadol
6. A 50 years old man with hypertension and diabetes mellitus presented with sudden
onset of drowsiness and right sided body weakness. His BP is 180/100mmHg.
Which of the following is the immediate investigation to be done?

Brain CT scan

Blood glucose

ECG

7. A 40 years old diabetic male, an active smoker admitted with retrosternal chest pain
which radiate to the left arm. He was noted to have high triglyceride, low HDL and
fasting blood sugar 11mmol/L.
Which of the following is more likely reason for abnormal lipid value?

Poor compliance to statin therapy

Poor glycaemic control

Smoking

8. A 28 years old gentleman presented with fever for 2 months associated with
intermittent crampy abdominal pain loose stool. He also noticed multiple red spots over
his upper chest and the back. Clinically, the patient looks lethargic, temperature 39.3°,
BP 110/90 mmHg, PR 110bpm. On examination, abdomen was soft, mildly tender with
no peritonism. There were maculopapular rash present all over the upper trunk. There is
no calf tenderness. FBC showed Hb 13.5gm/dL, WCC 4.1 and platelet 86.
 Which of the following is the most likely diagnosis?

Cholera

Dysentery

Typhoid fever

9. A 17 years old lady presented with progressive lethargy. She was found to be pale.
Examination of other system was unremarkable. Her initial blood count showed the
following.

Investigations
TWBC : 9 X 10^9
Hb : 7.5g/dL
MCV : 60 fl
MCH : 20 pg
Platelet : 200 X 10^9

Which of the following is the most likely diagnosis?

Autoimmune haemolytic anaemia

Iron deficiency anaemia

Megaloblastic anaemia

10. A 45 years old man came to the OPD with complaint of nausea, vomiting and also left
flank pain for 3 days prior to presentations. He has also complained of reduced urine
output along with blood stained urine. His 2 elder brothers are receiving monthly
haemodialysis. On examination, he is pale with sallow appearance. He has developed
bilateral pedal ankle oedema extended to his knees. His BP was 170/90 mmHg, PR 90
bpm. Per abdomen examination revealed bilateral ballotable kidney.

Investigations
Urea : 30mmol/L
Creatinine : 850Umol/L
Hb : 7g/dL

Which is the most probable diagnosis?

 Renal cell carcinoma

Autosomal dominant polycystic kidney disease

Autosomal recessive polycystic kidney disease

11. A 45 years old smoker presented with gradual onset of dysphagia to both solid and fluid
for the past 1 year. He also complained of weight loss of 10 kg. He was previously well.
On examination, he was cachexic. Otherwise, systemic examination was unremarkable.
Which of the following is the most important initial investigation?

Barium swallow

Oesophageal manometry

Esophagogastroduodenoscopy

ODDITYX SEM 5

1. 19 yo gentleman admitted to a&e because of sudden sob. While waiting to be

admitted, he developed pleuritic chest pain. What investigation should be done to
confirm his new complaint?

A. Ct pulmonary angiography
B. Cxr (/)
C. Ecg

2. A 30y/o non smoker presented with recurrent h/o pneumonia for the past 1
month. He is currently admitted with recurrent fever and cough. On examination, there
was finger clubbing and stony dullness at the midlower of the right lung. What is the
most likely diagnosis?

A. Bronchial carcinoma
B. Empyema
C. Pulmonary tuberculosis

3. A 45 yo lady non smoker presented with intermittent haemoptysisbamd dyspnoea on

exertion for past 1 week. She does not has any fever, loss weight or loss appetite. She
had past medical history of childhood rheumatic fever
Which of the following is the most likely diagnosis
A. Infective endocarditis
B. Mitral stenosis
Pulmonary embolism
4. 50 y/o man to A&E w severe sudden onset occipital headache, nasuea, vomiting,
nexk stiffness, photophobia. o/e, he has lt sided hemiparesis.
most appropriate initial step of managemanet
A. Ct brain
B. Lp
C. serve aspirin

5. A 27 year-old army presented with intermittent fever for 8 days. He just returned
from a training in a jungle. On examination, he was conscious but lethargic. There was
hepatosplenomegaly noted. Blood incestigation revealed hemolytic anemia.

Most likely diagnosis

A. Leptospirosis
B. Malaria infection
C. Scrub typhus

6. 50 year old man with end stage renal failure presented with few episodes of
syncope disease, reduced exercise tolerance, easily fatigue. O/E, he is pale and
shallow looking. Most appropiate investigation?

A. FBC

B. Renal fx test

C. Liver fx test

7. A 68 overweight lady currently on hormone replacemnet therapy for osteosclerosis ,

present with swelling of left leg for 3 days . Has history of left neck femur fracture 1
month ago. Cause ?

A hormone replacemnet therapy

B overweight
C immobilisation

8. A 65 y/o man, active smoker presented with dysphagia and weight loss over 3
months. Clinically, he was cachexic and dehydrated.

Most important diagnostic investigation

A. Barium swallow
B. Chest X-ray
C. Oesophagogastroduodenoscopy

9. A 65 years old gentleman with diabetes mellitus is recently diagnosed to have

hypertension. He is started on a new medication to control his BP. On examination, his
glycemic control has worsened after the introduction of this anti-hypertensive drug.
Which of the following is the most likely prescribed drug?
A. Amlodipine
B. Chlorothiazide
C. Ramipil

10. 67 y/o man treated for severe pneumonia. After being on IV antibiotics for 2 weeks
he began to pass blood-stained loose stool.

Which is most likely causative agent?

A. C jejuni
B. Clostridium dofficile – antibiotic induced diarrhea
C. E. coli

11. A 30 year old gentleman presented with blurring of vision for past 2 weeks. He is
currently on treatment for his pulmonary TB. What possible drugs is the cause of
blurring of vision?

A. Ethambutol – causing optic neuritis

B. Isoniazid

C. rifampicin