Cv of facial pain, nasal discharge, fever. Polyps present in the right side. NBS?

= CT scan

(antibiotics not in option)

CV of 6 weeks child. Fever, cough and bilateral wheeze (similar to bronchiolitis). But, chest xray showed
consolidation consolidation adjoining the right heart border. Dx?

Pneumonia

Bronchiolitis

Ulcer on base of metacarpals. Known case of diabetics. Probe showed ulcer upto the bone. What caused
this?

Inflammation of skin and subcutaneous tissue

Inflammation of skin

Arterial insufficiency

CV of bilateral facial nerve palsy and history of hiking followed by headache and nuchal rigidity. CSF Cells
54 lymphocytic. Next asked?

Borrelia serology

65 years old planned to give rituximab in 1 week. What now?

Give PCV13 now only

11mm PPD and history of travel to Middle east. No symptoms?

Give isoniazid

Cv of multiple non tender ulcers in penis and multiple non tender lymph node.

RPR serology
CV of newborn with small face, single palmar crease, cataracts. Cause asked?

Aneuploidy

Missing chromosome

Intrauterine infection

A military veteran. History of amoxicillin taken 3 weeks back. Now watery diarrhea for 4 days. No blood
in stool. Dx?

C diff

Campylobacter

A man taking prednisolone for long time. Known case of scleroderma. Fever headache for few days.
Total count 12000. CSF cells 545/mm3 glucose 35 protein 65. Gram stain like budding yeast dark red
color . NBS?

Amphotericin

Penicillin

2 months history of diarrhea. Occasionally bloody. History of travel to Mexico. Dx?

Entamoeba

Cv of man persistent lymph nodes more than 4 weeks. 2 cm in diameters. Both in anterior and posterior
chains and left supraclavicular lymph node also present. NBS?

CT abdomen and pelvis

Reassurance

38 week of gestation. No prenatal care. IUD was removed after she was found to be pregnant at 7
months. And she had gonococcal infection as well. She was tested for HIV and found to be positive.
Which is the most important risk factor for being HIV positive?

Gonococcal infection
IUD insertion

No prenatal care

Pregnant at 28 weeks of gestation. 1 hour GCT 120 mg/dl. What to do at this time?

Give TDap

Hepatitis A vaccination in chronic liver disease

Post splenectomy. Which drug should be used?

Drug that inhibits cell wall synthesis enzyme

Recurrent otitis media, pneumonia since 6 months age. What to test?

All IgG, IgM IgA

IgE

Sweat chloride

CV of murmur of AR in media. Complain of severe tearing chest pain radiating to back. BP 140/80. What
to test?

CT angio

CV of tearing chest pain radiating to arm. Cocaine abuser. Which drug to avoid?

Metoprolol

CV of acute chest pain increase with inspiration. Drinks 2 glass of wine daily. Known case of RA. ECG
showed prominent ST elevation. What it the risk factor for this condition?

RA
Alcohol use

(ticked RA. Alcohol use 2 glasses only is insufficient for CAD and symptoms pointed towards pericarditis)

Clear history of STEMI for ½ an hour. Aspirin and clopidogrel give. NBS?

Catheterization

Atorvastatin

CV of acute pulmonary edema. Saturation and symptoms improved with Frusemide. What additional
finding?

Increased BNP

Similar CV. What finding?

Increased preload

Cv of a 17 years old with skin of eyelid- yellowish lesion. Atheletic. Pulse 52. Auscultation extra heart
sound in diastole, no murmurs. What finding need further investigations (heart sound was pointing to
non pathologic S3 in young)?

Skin finding (xanthelasma)

Cv of penetrating chest pain. Bp 100/90. Muffled heart sound. Chest clear. JVP raised. NBS?

Pericardiocentesis

65 years old past smoker. What screening at this time?

USG for abdominal aortic aneurysm

A smoker with left leg peripheral artery disease. NBS?

Smoking cassation
A 17 years old taking OCP. Acute chest pain that increases with inspiration. P02 64. No DVT. Next best
step?

Supplemental oxygen

IV heparin

(ticked supplemental oxygen)

Right carotid artery stenosis. Which visual symptom is likely?

Monocular visual field loss

Cv of a male smoker. Soda drinks 4 drinks per day. BP 144/84. Next recommendation?

Stop soda drinks

BP 170/100. K+ 3.2. NBS?

Pac/PRA

Young male with mediatinal widening and symptoms of SVC syndrome. Decreased saturation with
supine and improved with standing. Cause?

Decreased end tidal partial pressure oxygen when supine

Increased mucus production when supine

Decreased CO2 when supine

Cv of a man taking multiple drugs including amiodarone for long time. Lungs showed bilateral crackles.
Saturation 96%. NBS?

Stop amiodarone

Cv of a female with bilateral hand joint pain. And progressive dysphagia for 3 months. NBS?

ANA
Skin biopsy

UGI endoscopy

CV of a child 2 years in heart failure. Murmur holosystolic?

VSD

CV of child with history of aortic surgery. Mouth down turned. What is deficient?

T cell

Trauma followed by fibular fracture.Tense, tender, Numbness, pain and paralysis. Pulse intact. What to
do besides splinting?

Fasciotomy

Trauma. Blood at tip of meatus. No pelvic fractures. What is associated?

High riding prostate

Cv of hyperthyroidism in a female. What for diagnosis?

TSH rec Ab

1.5 cm thyroid nodule. TSH 1. NBS?

FNA

Cv of thyroid mass and cervical lymph node. Biopsy showed papillary cancer. Rx?

Total thyroidectomy with cervical lymph nodes dissection

Other options were (subtotal thyroidecetomy, lobectomy)

Cv of weight gain and ecchymosis, buffalo hump. MRI 1.5 cm mass. Cause?

ACTH

(other options were CRH…)

Cv of erectile dysfunction. Morning erection only occasionally present. Total Testosterone level 10 (N
10- sth). PRL normal. NBS?

Measure free testosterone level

Calculate free testosterone

Pre prandial and post prandial insulin adjustment. Post break fast and post dinner was high. Patient was
taking NPH BD and aspart TDS. What to do?

Increase dose of pre breakfast and pre dinner aspart

CV of diabetes insipidus after brain surgery. Had to diagnose.

Penetrating chest trauma. Vitals unstable. JVP flat. NBS?

Thoracotomy

CV of CAH. Low bp. Ambiguous genitalia in female child. Cause of symptoms asked?

Decreased aldosterone

Increased 17 OH progesterone

Sarcoidosis.

LN biopsy

CV of shipyard worker. Plaque in pleura.

Asbestosis

Chest xray showed well circumscribed opacity in the lower lung zone laterally obscuring the
costophrenic angle (?loculated empyema). Symptoms of fever cough foul sputum production for 5 days.
Pleural fluid showed high count but glucose 95. Ph not given. NBS?

Chest tube

Continue current regimen

(Ticked chest tube coz empyema has already formed and needs to be drained)

Post op day 4. Complains of low grade fever and cough and sputum production. On day 1 Ng tube was
used for feeding. Wheeze and crackled present in upper lobe. Dx?

Aspiration pneumonia

Aspiration pneumonitis

64 years old.45 pack year smoker left 10 years back. What screening now?

Ct scan for lung cancer

No screening for lung cancer

Cv of an old man with morning stiffness and low back pain. History of eczema. Erythematous lesions in
flexor aspect of elbow and knee (not extensor aspect). Xray showed narrowed disc and osteophytes. Dx?

Osteoarthritis

Psoriatic arthritis

Hypothermia 32 F.

Use heated blankets

An infant sleeps in supine. Mother non smoker. What increases the risk of SIDS?
Use of baby bumper pads

(other options namilne like use of pacifier, sleeping lateral, sleeping together)

Increased aPTT not corrected with mixing. Risk of?

DVT

CV of a diabetic for long time. Xray showed neovascularization. And optic disc cupping. NBS?

Topical pilocarpine

acetazolamide

Laser

PBS showed spherocytes. Splenomegaly present. Coombs positive. Cause of anemia?

Antibody

How to increase the followup spirometry in asthma patinets?

Reminders in patients charts

Low MCV. Low Hb. RDW 18. Dx?

IDA

Splenomegaly. Lymph nodes present. Metamyelocytes, myelocytes elevated. Dx?

CML

Multiple myeloma urine findings?

Protein 1+ WBC few epithelial cells

Old man with splenomegaly. Lymphadenopathy. Anemia. Platelets decreased. TC 25000 L55%. Dx?

CLL

Pregnant woman Rh-. Father Rh+. Now at 28 WOG. NBS?

Give Rhogam

Barium meal xray shown with rat tail appearance. Young age. Dysphagia for solid and liquid at onset.
What for diagnosis?

Manometry

CV of Boerhave syndrome. No procedure was done. Risk factor asked?

Vomiting with retching

Young female with chronic diarrhea. History of thyroid disease. Hb 10. Dx?

Celiac diasease

MCV 110. Erectile dysfunction and peripheral neuropathy type. Cause?

B12

Perioral rash. Taking TPN. Hair loss. Which nutrient to supplement?

Zinc

CV of acute diverticulitis. Fistula between what?

Colon and bladder

Hospitalized patient with multiple issues including heart disease, AF, RA. Complain of bloody diarrhea
since today. Cause?

SMA and IMA junction

Similar CV but acute periumbilical pain. And tenderness. H/o pain after eating. AF+. Cause?

Embolism to mesenteric artery

A polyp 10 mm was removed 3 months back. Biopsy came out to be hyperplastic polyp. When to do
colonoscopy?
10 years

Cirrhosis known case of HEp C. what is recommended?

USG biannually

Case of acute liver failure with AST AlT in the level of thousands. It was mentioned that patient was
taking PCM+ oxycodone. In addition to checking acetaminophen level and viral serology, what to do?

Acetyl cysteine

Upper pain abdomen. Jaundice. Usg showed dilated ducts and 2.5 cm stone in CBD adjacent to ampulla
of Vater and gall bladder wall was not thickened. The patient also had fever. Total count was 15000. Dx
asked?

Cholangitis