1. A paramedic with needle stick injury used on a patient with Hepatitis B positive.

She has
not been vaccinated for Hepatitis B. What would be her presentation in the initial period?

A. HBs Ag positive Anti HBs Ag negative, HBeV negative

B. HBs Ag positive Anti HBs Ag positive HBeV negative

C. HBs Ag negative Anti HBs Ag positive HBeV positive

D. HBsAg positive Anti HBs negative HBeV positive

Correct answer is A: HBs Ag positive Anti Hils Ag negative HBeV negative.

2. Male came with vesicles in forehead to prevent post herpetic neuralgia?

B. Steroids

C. Oral acyclovir and steroids

D. Varicella vaccine

Correct answer is C: Oral acyclovir and steroids

Herpes zoster (commonly referred to as "shingles) and postherpetic neuralgia result from
reactivation of the varicella zoster virus acquired during the primary varicella infection, or
chickenpox Whereas varicella is generally a disease of childhood herpes zoster and post-
herpetic neuralgia become more common with increasing age. Factors that decrease
immune function, such as human immunodeficiency virus infection, chemotherapy
malignancies and chronic corticosteroid use, may also increase the risk of developing
herpes zoster. Reactivation of latent varicella-zoster virus from dorsal root ganglia is
responsible for the classic dermatomal rash and pain that occur with herpes zoster, Burning
pain typically precedes the rash by several days and can persist for several months after the
rash resolves. With postherpetic neuraltia, a complication of herpes zoster, pain may persist
well after resolution of the rash and can be highly debilitating. Herpes zoster is usually
treated with orally administered acyclovir. Other antiviral medications include famciclovir and
valacyclovir. The antiviral medications are most effective when started within 72 hours after
the onset of the rash. The addition of an orally administered corticosteroid can provide
modest benefits in reducing the pain of herpes zoster and the incidence of postherpetic
neuralgia. Ocular involvement in herpes zoster can lead to rare but serious complications
and generally merits referral to an ophthalmologist. Patients with postherpetic neuralgia may
require narcotics for adequate pain control. Tricyclic antidepressants or anticonvulsants,
often given in low dosages, may help to control neuropathic pain, Capsaicin lidocaine
patches and nerve blocks can also be used in selected patients.

https://www.aafp.org/afp/2000/0415/p2437.html,
3. Adult male complain of buttock pain, lower back pain and stiffness specially in early
morning which improve with activity and during day, diagnosis

A. Rheumatoid arthritis

B. Osteoarthritis

C. Anklosing arthritis

Correct answer is C: Anklosing arthritis.

4. Patient comes to the emergency room with weak rapid pulse, what is your next step?

8. Do CPR (2 breaths/30 compressions)

C. Wait until team of resuscitation group comes

Correct answer is C: Wait until team of resuscitation group comes C weak and rapid pulse
does not means cardiac arrest. Once u feel pulse u have to find cause.. CPR 30:2 for
cardiac arrest or no respiration or no pulse palpable so 8 is not option and Not mentioned
about respiration is this scenario so not worth to give 2 breath better wait for expert to come
and decide.

5. Mamography can detect breast lump earlier as compare to breast self examination, how
much earlier mammography can detect?

A. 12months

B. 24months

C. 36months

D. 48 months

Correct answer is B: 24months

A mammogram can show breast lumps up to 2 years before they can be felt. Different tests
help determine if a lump may be cancer....
6. Loss of dorsiflexion and inversion of a foot at ankle is lost in an accident while plantar
flexion is intact. Most common nerve affected?

A. Anterior tibial

B. Posterior tibial

C. Saphenous

D. Sciatic

Correct answer is A: Anterior tibial

The Tibial Nerve is one of the two main muscular branches of the Sciatic Nerve. TheTibial
nerve is the larger terminal branch with root

values of 14, 15, 51, 52, and S3.

The Tibial Nerve provides innervation to the muscles of the lower leg and foot. Specifically:
Triceps Surae (the two headed Gastocnemius and Soleus); Plantaris, Popliteus Tibialis
Posterior: Flexor Digitorum Longus; and Flexor Hallucis Longus muscles. It also has articular
and cutaneous branches.
Terminal Branches

At the foot level just after the heel) the Tibial Nerve divides into the Medial Plantar Nerve
(MPN) and the Lateral Plantar Nerve (LPN). The MPN supplies muscular branches to the big
toe and the two toes next to it, and the LPN the other two toes. The Sural Nerve is a
cutaneous branch of the Tibial nerve that supplies the skin of the legs and feet.
https://www.physio pedia.com/Tibial Nerve.

7. Patient smoker and alcoholic come with difficulty in swallowing and neck mass,
Investigation?

A. Indirect laryngoscopy

B. Neck CT

C. Head CT

D. Biopsy

E. Aspiration

Correct answer is B: Neck CTI

B first Ct neck then further evaluation as needed means FNA or biopsy or scopy depends on
nature of disease.

8. A young man met with head injury with dripping of clear fluids from ear and nose.
Presence of what confirms the fluid to be CSF?

A. Glucose

B. Lactose

C. Proteins

D. Cholesterol.

E. Amino acids

Correct answer is C: Proteins.

9. One of the following is a manifestation of severe hypokalemia?

A. Peaked T wave

B. Wide QRS
C. Absent P wave

D. Seizure
Correct answer is B: Wide QRS

Electrocardiogram[edit]

Hypokalemia leads to characteristic ECG changes (ORS prolongation, ST-segment and T-

wave depression, U-wave formation) (4) The earliest electrocardiographic (ECG) findings,
associated with hypokaiemia, are decreased T wave heigh. Then, ST depressions and T
inversions appear as serum potassium levels reduce further. Due to prolonged repolarization
of ventricular Purkinje fibers, prominent U waves occur (usually seen at V2 and V3 leads),
frequently superimposed upon T waves, therefore producing the appearance of prolonged
QT intervals, when serum potassium levels fall below 3 mEq/L

10. months old boy presented with history of interrupted feeds associated with difficulty in
breathing and sweating for the last 4 months. Physical examination revealed normal
peripheral pulses, hyperactive precordium, normal S1, loud S2 and Pan systolic murmur
grade 3/6 with maximum intensity at the 3rdleft intercostal space parasternally. The MOST
likely diagnosis is:

A. Small PDA (Patent ductus arteriosus).

B. Large ASD (Atrial septal defect).

C. Aortic regurgitation

D. Mitral regurgitation

E. Large VSD (Ventricular septal defect)

Correct answer is E Large VSD (Ventricular septal defect).

11. Diabetic keto acidosis in children, all of the following are true EXCEPT?

A. Do not give K+ till lab results come

B. ECG monitoring is essential

C. If pH <7.0give HCO3

D. Nasogastric tube for semiconscious patient

E. Furosemide for patient with oligouria
Correct answer is E: Furosemide for patient with oligouria.

12. Best sentence to describe specificity of screening test is the population of people who:

A. Are negative of disease, and test is negative

B. Are positive of disease, and test is negative

C. Are positive comparing to total other people

D. Negative disease, positive test

E. Positive disease, negative test

Correct answer is A. Are negative of disease, and test is negative

13. 40 years Woman with cyclic bilateral nodularity in her breast since 6 month, on
examination there is 3 cm tender mobile mass in her breast: what you will do next?

A. FNA with cytology

B. Mammogram

C. Blopsy

D. Follow up for next cycle

Correct answer is B: Mammogram.

14. Hyperprolactinemia associated with all except

A. Pregnancy

B. Acromegaly

C. Oral contraceptive pills

D. Hypothyroidism
Correct answer is C. Oral contraceptive pills

One common cause of hyperprolactinemia is a growth or tumor on the pituitary gland called
a prolactinoma, The tumor produces high levels of prolactin. These turnors can be large or
small and are usually benign, meaning they are not cancerous. Hyperprolactinaemia is the
presence of abnormally high levels of prolactin in the blood. Normal levels are less than 500
ml for women, and less than 450 mil U/L for men,

click below link to see all causes of Hyperprolactenemia

https://en.wikipedia.org/wikinyperprolacunaemi..

15. Most appropiate initial therapy for Postpartum Endometritis

A. Vancomycin&gentamycin

B. Clindamycin&metronidazole

C. Clindamycin&gentamycin

D. Ceftriaxone &azithromycin
Correct answer is C: Clindamycin&gentamycin

C.The prevention of endometritis is important Infection prevention practices, including

avoiding unnecessary caesarean section, appropriate management of prolonged labour,
fewer vaginal examinations during labour, use of good sterile techniques and meticulous
operative procedures during delivery, and providing appropriate prophylactic antibiotics
during caesarean section should be routinely practiced.

FIRST CONTACT (PRIMARY CARE LEVEL)

The diagnosis of endometritis should be considered when a postpartumn woman has febrile
morbidity (oral temperature 738.0°C or on two occasions between day 1-10 after birth)
abdominal pain or foul smelling lochia, Careful physical examination to detect the source of
[8:49 pm, 01/11/2021] Ponnu: infection is crucial. Once endometritis is diagnosed,
appropriate antibiotic treatment should be started. If clindamycin is not available, or not
affordable, the WHO-recommended (1)regimen of ampicillin plus gentamicin plus
metronidazole should be used. If fever is still present 72 hours after treatment, the patient
should be carefully re-evaluated and the diagnosis revised. if complication(s) (such as pelvic
abscess, peritonitis, septic shock, etc.) are suspected the patient should be referred to
higher level of health care immediately.

http://apps.who.int/thi/pregnancy_childbirth/care after childbirthvade/erv.

16. A young boy presented with pain, swelling and redness of right side testes and scrotum.
Sudden onset pain relieved on uplifting the scrotum. What would be the diagnosis?

A. Torsion testes

B. Epididymo-orchitis

C. Inguinal hernia

D. Hydrocele

Correct answer is B: Epididymo-orchitis

According to Prehn's sign. the physical lifting of the testicles relieves the pain of epididymitis
but not pain caused by testicular

torsion Negative Prehn's sign indicates no pain relief with lifting the affected testicle, which
points towards testicular torsion which is a

surgical emergency.

Testicular infections may spread to structures attached to the testicles such as the
epididymis (termed epididymo-orchitis). Testicular

torsion is a medical emergency that can be cured only by a twisting the spermatic cord of the
testicle, usually done by surgery
epididymo-orchitis-cremastric reflex-Normal

testicular torsion-cremastric reflex-abnormal.

17. Celiac disease which not cause it:

A. Rice & corn

B. Oat

C. Wheel

D. Glutenv
Correct answer is A: Rice & corn.

18. 6 months old with cough and wheezy chest .diagnosis is:

A. Asthma

B. Bronchiolitis

C. Pneumonia

D. F.B aspiration
Correct answer is B: Bronchiolitis
B
asthma (after 2 years old)

b) Bronchiolitis (before 2 years old)

c) pneumonia (associated with crypitation)

d) F.B aspiration (sudden wheezing.

19. A 61-year-old woman comes to clinic with a past medical history significant for asthma.
She describes recent increasing difficulty with breathing, particularly with exertion. Review of
systems is positive for nonproductive cough. She denies tobacco use and has been in the
construction business for 28 years. Clincal examination shows clubbing of her fingers. A
chest radiograph demonstrates linear radiodensities at the lung bases and diffuse calcified
pleural plaques. Which of the following is the most likely diagnosis?

A. Hypersensitivity pneumonitis
B. Asbestosis

C. Berylliosis

D. Coal miner disease

E. Silicosis
Correct answer is B: Asbestosis

B-Linear radiodensities at the lung bases, interstitial fibrosis, and calcified pleural plaques
are indicative of prior asbestos exposure. These findings are particularly suspicious given
the patient's long career in construction. Note that signs and symptorns of asbestosis
typically present 15 to 20 years after exposure.

20. A male presented with headache, tinnitus and nausea thinking that he has a brain tumor.
He had just secured a job in a prestigious company and he thinks that he might not meet its
standards. CNS exam, CT,all within normal. What is the Diagnosis?

A. Generalized Anxiety disorder

B. Hypochondriasis

C. Conversion reaction

D. Panic attack

Correct answer is B: Hypochondriasis

Diagnostic criteria for hypochondriasis include the following:

The patient has a preoccupying fear of having a serious disease.

..The preoccupation persists despite appropriate medical evaluation and reassurance.

The belief is not of delusional intensity (as in delusional disorder, somatic type) and is not

--Restricted to a concern about appearance (as in persons with BDD). The preoccupation
causes clinically significant distress or impairment.
The preoccupation lasts for at least 6 months.

The preoccupation is not explained better by another mood, anxiety, or somatoform

disorder....
21. A 53 year old man felt jerking in his left hand which spread to the rest of the body. A few
minutes later he developed a generalized seizure with loss of consciousness. What is the
Investigation of choice is?

A. CT head

B. EEG

C. ECG

D. Carotid USG

E. 24 hours EEG
Correct answer is A: CT head

Seizure-Ruleout stroke or intracranial etiology CT brain plain is first investigation to know

brain pathology…

22. You were working in a clinic with a consultant who prescribed a drug that was
contraindicated to the patient (the patient was allergic to that drug) but you didn't interfere &
assumed that he knows better than you do. Which of the following you have violated:

A. Professional competence

B. Quality of caring patient

C. Honesty

D. Patient relationship

E. Maintaining trust

Correct answer is B: Quality of caring patient.

23. Cervical cancer diagnostic test:

A. Pap smear

B. Punch biopsy
C. Cone biopsy

D. FNAC

Correct answer is C: Cone biopsy

...Cone biopsy

In this procedure, also known as conization, the doctor removes a cone-shaped piece of
tissue from the cervix. The base of the core is formed by the exocervix (outer part of the
cervix), and the point or apex of the cone is from the endocervical canal. The tissue removed
in the cone includes the transformation zone (the border between the exocervix and
endocervix, where cervical pre-cancers and cancers are most likely to start).

A cone biopsy can also be used as a treatment to completely remove many pre cancers and
some very early cancers. Having had a cone biopsy will not prevent most women from
getting pregnant, but if a large amount of tissue has been removed, women may have a
higher risk of giving birth prematurely.

The methods commonly used for cone biopsies are the loop electrosurgical excision
procedure (LEEP), also called the large loop excision

of the transformation zone (LLETZ), and the cold knife cone biopsy.

Loop electrosurgical procedure (LEEP, LLETZ): In this method, the tissue is removed with a
thin wire loop that is heated by electrical current and acts as a scalpel. For this procedure, a
local anesthetic is used, and it can be done in your doctor's office. It takes only about 10
minutes. You might have mild cramping during and after the procedure, and mild-to-
moderate bleeding for several weeks. e Cold knife cone biopsy: This method uses a surgical
scalpel or a laser instead of a heated wire to remove tissue. You will receive anesthesia
during the operation (either a general anesthesia, where you are asleep, or a spinal or
epidural anesthesia, where an injection. into the area around the spinal cord makes you
numb below the waist) and is done in a hospital, but no overnight stay is needed. After e the
procedure, you might have cramping and some bleeding for a few weeks…

24. A patient diagnosed with bronchial carcinoma, came for follow up, the best modality of
follow up

D. Ultrasound
Correct answer is B: CT.

25. Ideal contraceptive for lactating mothers

A. Barrier method

B. Combined OCP

C. Lactational amenorrhea

D. Progesterone only pills

Correct answer is A: Barrier method

25. Ans-A

Methods of Contraception

In choosing a method of contraception, it is important that it not interfere with lactation or

have negative effects on the infant. Norihormonal methods of contraception, such as barrier
methods or the copper intrauterine device (IUD), are the preferred choice for nursing
mothers, because hormones in some contraceptive methods may interfere with lactation,
and the transfer of hormones into milk poses a theoretical risk to the infant.[2] There are
numerous nonhormonal methods available that have no effect on production of milk or on
infant growth and development Methods like the diaphragm, condoms, spermicidal foams
and jellies, and copper IUDS provide
reversible contraception, while vasectomy and tubal ligation are permanent methods…

26. Malaria type with gametocyte cells

A. Plasmodium falciparum

B. P vivax

C. P ovale

D. P malariae

Correct answer is A: Plasmodium falciparum.

27. Which of the following radiological features is a characteristic of miliary tuberculosis:

A. Sparing of the lung apices

B. Pleural effusion
C. Septal lines

D. Absence of glandular enlargement

E. Presence of a small cavity

Correct answer is E: Presence of a small cavity.

28. For close contact with Tuberculosis patients, what do you need to give:

A. Immunoglobulin

B. Anti TB

C. Rifampin

D. INH
Correct answer is D: INH

Tuberculosis (TB) contacts are people who have close contact with patients with infectious
TB. As they are at high risk for infection (and in line with the End TB strategy), TB contacts
should be investigated systematically and actively for TB infection and disease. Such
interventions are called 'tuberculosis contact investigations. They contribute to early
identification of active TB, thus decreasing its severity and reducing transmission of
Mycobacterium tuberculosis to others, and identification of latent TB infection (LTBI), to allow
preventive measures.

Contacts are commonly investigated in high-income countries with low TB burdens and in
settings in which a TB elimination policy i implemented in order to identify persons with early
active TB or who have recently been infected. People identified as infected are then treated
for LTB with isoniazid for at least 6 months (usually 9 months) or with shorter combination
regimens including isoniazid and rifampicin..

29. 70 years old male was brought to the ER with sudden onset of pain in his left lower limb.
The pain was severe with numbness. He had acute myocardial infarction 2 weeks ago and
was discharged 24 hours prior to his presentation. The left leg was cold and pale, right leg
was normal. The most likely diagnosis is:

A. Acute arterial thrombosis

B. Acute arterial embolus

C. Deep venous thrombosis

D. Ruptures disc at L4-5 with radiating pain

E. Dissecting thoraco-abdominal

Correct answer is B: Acute arterial embolus,

30. Patient has neck stiffness, headache and petechial rash. Lumber puncture showed a
high pressure, what would be the cause?

A. Group B strep

B. Neisseria meningitides

C. M.tubecrlosis

D. Staphylococcusaureus

Correct answer is B: Neisseria meningitides.

31. A 5-year-old boy suddenly begins coughing while eating peanuts. He is choking and
gagging. When he is brought to the emergency department, but he is awake and is able to
give his name. On physical examination, his vital signs are stable. On examination of the
chest, inspiratory stridor and intercostal and suprasternal retractions are apparent. Which of
the following is the most appropriate initial step in management?

A. Allow patient to clear foreign object by spontaneous coughing

B. Clear oropharynx with multiple blind sweeps with finger

C. Position patient and perform back blows

D. Stand behind patient and perform abdominal thrusts

E. Perform emergency tracheostomy and take to surgery

Correct answer is A: Allow patient to clear foreign object by spontaneous coughing

Since the patient can cough and breathe, he should be allowed to clear the foreign object
spontaneously, if possible. In the management of foreign object obstruction, if the patient
can cough and breathe, it is best to initially observe and allow spontaneous resolution since
intervention may actually be damaging

32. A 74-year-old woman, who has been followed for the past 25 years for chronic
obstructive pulmonary disease (COPD) comes to the emergency department complaining of
48 hours of temperatures to 38.6 C (101.4 F) and worsening shortness of breath. She has a
chronic productive cough, which has become more copious. On physical examination, she
has rhonchi and increased fremitus in the posterior mid-lung field. A Gram's stain reveals
many epithelial cells and multiple gram-positive and gram-negative organisms; no
neutrophils are seen. Which of the following is the most likely organism causing the
symptoms?

A. Escherichia coli

B. Haemophilusinfluenzae

C. Klebsiellapneumoniae

D. Mycobacterium tuberculosis

E. Mycoplasma pneumoniae

Correct answer is B: Haemophilusinfluenzae

This patient, with a long history of chronic obstructive pulmonary disease (COPD), has
evidence of a community-acquired pneumonia. The common organisms causing
pneumonias in patients with COPD are Streptococcus pneumoniae, Haemophilus
influenzae, and Moraxella catarrhalis.

33. Osteoporosis, which of the following is treatment of osteoporosis?

A. Vitamin D and calcium

B. Bisphosphonate

C. Estrogen replacement therapy

D. Raloxifene
E. Teriperatide

F. All of the above

Correct answer is F: All of the above

Look for an older person, more often a woman, with vertebral fractures leading to loss of
height or wrist fracture. Many are asymptomatic, and fractures are found on routine
screening with bone densitometry, which is recommended for all women above the age of 65

TIPS Osteoporosis gives spontaneous fractures of weight-bearing bones

[9:05 pm, 01/11/2021] Ponnu: Diagnostic Tests The most accurate test is bone densitometry
(DEXA) scanning

The T-score compares bone density with the normal density of a young woman. Osteopenia:
Bone density (T-score) is between 1 and 2.5 standard deviations below normal.
Osteoporosis: T-score more than 2.5 standard deviations below normal. All blood tests are
normal in osteoporosis. Calcium, phosphate, and parathyroid hormone levels are normal.

Treatment

1-Vitamin D and calcium are the best initial therapy.

2-Bisphosphonates (alendronate, risedronate, ibandronate) are used when the T-score is

more than 2.5 standard deviations below

normal. Denosumab (RANKL inhibitor) may be used first-line with bisphosphonates.

3-Estrogen replacement is especially useful in postmenopausal women.

4 Raloxifene is used as a substitute for estrogen in postmenopausal women: it also reduces

the risk of breast cancer and decreases LDL

levels.

5.Teriparatide is an analogue of parathyroid hormone that stimulates new bone matrix

formation.

6 Used as a nasal spray, calcitonin decreases the risk of vertebral fractures.

34. Rheumatoid Arthritis?

A. Destruction in articular cartilage

B. M-F
C. No nodules

D. Any synovial joint

E. HLA DR4
Correct answer is A: Destruction in articular cartilage

A ..Explanations:

a is true plus destruction of bones

bis false the MF is 1:3

c is false Nodules are present in elbows & lungs

d is false because it doesn't affect the dorsal & lumbar spines

e is true but it also affects HLA DR1.

35. Recurrent fourth time 1st trimester pregnancy loss. what is most Likely cause?
A. Anti phospholipid syndrome

B. Chromosomal abnormalities

C. Cervical incompetence

D. Uterine anomaly
Correct answer is B: Chromosomal abnormalities Embryonic chromosomal abnormalities

in couples with recurrent miscarriage, chromosomal abnormalities of the embryo account for
30-57% of further miscarriages:

The risk of miscarriage resulting from chromosomal abnormalities of the embryo increases
with advancing maternal age However it is important to note that as the number of
miscarriages increases, the risk of euploid pregnancy loss increases.

Farbinregpancy inss is defined as the termination of pregnancy before 30 weeks gestation or

with a feral weight of helow 500g
Genetic causes

Most spontaneous miscarriages are caused by an abnormal (aneuploid) karyotype of the

embryo. At least 50% of all first trimester spontaneous abortions (SABS) are cytogenetically
abnormal https://www.roog.org.uk/../documents/guidelines/ptg 17.pdf.

6. Drug contraindicated in Hypertrophic obstructive cardiomyopathy

A. Beta blocker

B. Verapamil
C. Hydralazine
Correct answer is C: Hydralazine

Its hydralazine hocm is worsened by ACE ARB.DIGOXIN. HYDRALAZINE VAL SALVA

MENEOVERND STANDINGG SUDDENLY.TX OF HOCM(HYPERTROPHIC OBSTUCTIVE
CARDIOMYODATHY) IS treated by betablocker verapamil

37. Lynch Syndrome is

A. Autosomal dominent

B. Autosomal recessive
C. None of the above

D. Crohn's disease
Correct answer is A: Autosomal dominent

Lynch syndrome, also known as hereditary non-polyposis colorectal cancer (HNPCO), is a

type of inherited cancer syndrome associated with a genetic predisposition to different
cancer types. In addition, cancers associated with Lynch syndrome are more likely to be
diagnosed at a young age.

Hereditary nonpolyposis colorectal cancer (HNPCC) is the most common form of hereditary
colorectal cancer. It is inherited as an autosomal dominant syndrome as a result of defective
mismatch repair (MMR) proteins. HNPCC, accounts for 2-5% of all colorectal carcinomas,
Over 90% of all colorectal cancers in HNPCC patients demonstrate a higth microsatellite
instability (MSI-H), which means at least 2 or more genes have been mutated in HNPCC
families or atypical HNPCC families,

People who have Lynch syndrome have a significantly increased risk of developing
colorectal cancer. There is also an increased risk of developing other types of cancers, such
as endometrial (uterine), stomach, breast, ovarian, small bowel (intestinal), pancreatic,
prostate, urinary tract, liver, kidney, and bile duct cancers.

https://www.cancer.net/cancer-types/lynch-syndrome.

38. Patient has Hypertension, recurrent attack of gouts 3-4 per year, BUN and creatinine are
high, what is appropriate treatment?

A. Probenecid

B. Allopurinol

Indomethacin

D. None of the above

Correct answer is B: Allopurinol

its a case of chronic hyper uracemia or gout.for prevention or prophylaxis-allopurinol helps

for acute attack NSAIDS is used.
39. Female has burning sensation in vulva, after examination there was vesicle dew drop
and tender and swelling in of the vulva, what is likely diagnosis

A. Herpes simplex

B. Post herpetic virus

C. Wart

Correct answer is A: Herpes simplex

Key facts

The herpes simplex virus or herpes, is categorized into 2 types herpes simplex virus type 1
(HSV-1) and herpes simplex virus type 2 (HSV21.

HSV-1 is mainly transmitted by oral-to-oral contact to cause oral herpes (which can include
symptoms known as "cold sores), but can also

cause genital herpes.

HSV-2 is a sexually transmitted infection that causes genital herpes. Both HSV-1 and HSV-2
infections are lifelong. An estimated 3.7 billion people under age 50 (67%) have HSV-1
infection globally.

An estimnated 417 million people aged 15-49 (11%) worldwide have HSV-2 infection. Most
oral and genital herpes infections are asymptomatic

Symptoms of herpes include painful blisters or ulcers at the site of infection. Herpes
infections are most contagious when symptoms are present but can still be transmitted to
others in the absence of symptoms Infection with HSV-2 increases the risk of acquiring and
transmitting HIV infection. https://www.who.int/news-room/fact-sheets/detail/herpes-simplex-
virus
Treatment

Antiviral medications, such as acyclovir, famciclovir, and valacyclovir, are the most effective
medications available for people infected with

HSV. These can help to reduce the severity and frequency of symptoms, but cannot cure the
infection..

40. Female 55 years has history of breast cancer underwent for operation before several
month.now has bone pain and diagnosed as osteoporosis, best DESCRIPTIVE treatment.

A. Bisphosphonate
B. Vit D supplement (my answer)

C. Regular exercise
Correct answer is A: Bisphosphonate.

41. Drug Induce ovulation:

A. Spironolactone

B. Clomiphene

C. All of the above

D. None of the above

Correct answer is B: Clomiphene

Clomiphene triggers the brain's pituitary gland to secrete an increased amount of follicle
stimulating hormone (PSH) and LH (luteinizing hormone). This action stimulates the growth
of the ovarian follicle arid thus initiates ovulation. During a normal menstrual cycle only one
egg is ovulated…

42. A child presents with maculopapular rash and severe itching. Crops of vesicles were
observed on the back and trunk, some of which were weeping and some crusted. What is
the most likely diagnosis?

A. Rubella virus

B. Cytomegalovirus (CMV)

C. Parvovirus B-19

D. Varicella

E. Morphine

F. Angioplasty

G. Metoprolol

Correct answer is D: Varicella.

43. Patient on treatment for skin rash macules.papules,pustules and vesicles whole the
body.he gave history of malaise, fever and headache one day before the rash,,,which of the
following viral is most likely the cause:

A. Herpessimplex type 6

B. EBV

C. Cytomegalovirus

D. Varicella zoster
Correct answer is D: Varicella zoster.

44. Patient presented with sensation of lump in neck. No dysphagia. No symptoms at all.
Esophageal endoscopy showed no abnormality. Thyroid was normal. What could be the
diagnosis?

A. Esophageal Cancer

B. Pharyngeal diverticula

C. Globus pharyngeus
Correct answer is C: Globus pharyngeus.

45. A 60 years old man presents with a six month history of poor sleep and loss of interest.
He has become forgetful recently and answers most of the questions with "I don't Know".
What is the most likely diagnosis?

A. Bipolar affective disorder

B. Depression

C. Normal Ageing Process

D. Dementia

E. Dyslexia

Correct answer is D: Dementia.

46. 40 years male, come to hospital complain of sharp, central chest pain, exacerbated by
Movement, respiration, lying down with difficulty in breathing, hypotension, bradycardia, & a
lot of thing long scenario the important thing that make diagnosis is the picture:

A. Intubation

B. Thoracotomy

C. Pericardocentesis

Correct answer is C: Pericardocentesis

Pericardial effusion-Chest pain or pressure are common symptoms. A small effusion may be
asymptomatic Larger effusions may cause cardiac tamponade, a life-threatening
complication; signs of impending tamponade include dyspnea, low blood pressure, and
distant heart sounds.

The so-called "water-bottle heart" is a radiographic sign of pericardial effusion, in which the
cardiopericardial silhouette is enlarged and assumes the shape of a flask or water bottle. It
can be associated with dullness to percussion over the left subscapular area due to
compression of the left lung base. This phenomenon is known as Ewart's sign…

47. Patient with flu-like symptoms before 2 days, she's complaining of red eye the most
Common likely Diagnosis:
A. Viral conjunctivitis (my answer)

B. Bacterial conjunctivitis
Correct answer is A: Viral conjunctivitis (my answer).

48. Female complaining of tender, warm, fluctuated, big swelling (signs of abscess) on the
Left shoulder, what to do:

A. Excisional biopsy

B. Incisional biopsy

C. Incisional & Drainage

D. Antibiotic choice
Correct answer is C: Incisional & Drainage.
49. Female aged 40 years came with heavy periods and intermenstrual bleeding, she is not
on OCP or any other drug, not sexually active because her husband travelled one Year ago,
she said the 3 months ago her cycle was regular but changed now, this Features are
suggestive of which of the following:

A. Endometrial cancer

B. Anovulatory cycle

C. Endometritis

Correct answer is B: Anovulatory cycle

The anovulatory cycle is a menstrual cycle characterized by varying degrees of menstrual

intervals and the absence of ovulation and a

luteal phase. In the absence of ovulation, there will be infertility. Normal menstrual bleeding
in the ovulatory cycle is a result of a decline in progesterone due to the demise of the corpus
luteum. It is thus a progesterone withdrawal bleeding. As there is no progesterone in the
anovulatory cycle, bleeding is caused by the inability of estrogen that needs to be present to
stimulate the endometrium in the first place to support a growing endometrium. Anovulatory
bleeding is hence termed estrogen breakthrough bleeding.
Management

Women who do not ovulate and who want to get pregnant need a medical work-up to find
out why they do not ovulate. Drugs are often given to induce ovulation, including oral
medication such as clomiphene or injectable medications. In patients who do not want to get
pregnant anovulation can be managed with the use of cyclic progesterone or progestin
supplementation or use of hormonal contraception…

50. which of the following inherited blood disorders is associated with increased bleeding
time and deficiency of VIIIc:

A. Hemophilia A

B. Hemophilia B

C. Hemophilia C

D. Von willibrand disease

Correct answer is D: Von willibrand disease.

51. A boy who is 11 years old doing well, no complain, participates well in activities, He has
an older brother who died suddenly, which disease the doctor should predict among these
diseases in the future:

A. PDA

B. ASD

C. Hypertrophic cardiomyopathy

D. VSD

Correct answer is C: Hypertrophic cardiomyopathy.

52. A female patient wanted to know when the growth of spine will stop after menarche:

A. 12 months

B. 24 months
Correct answer is B: 24 months.

53. A baby born at 34 weeks with a heart murmur is kept in the incubator for almost 4 weeks.
There is no murmur at discharge. What is the likely cause of this murmur?

A. PDA

B. TOF

C. Aneurysm of sinus of Valsalva

D. Aorto-pulmonary septal defect

E. AVM

Correct answer is A: PDA

pre-term-ductus arteriosus won't close til he reaches maturity.

54. Patient complain of Rt. Hypochondrial pain and fever, he have past History of bloody
diarrhoea and + Ent. Hystoltica in stool. He done aspiration for liver anchovy sauce as result
Diagnosis:

A. Amoebic liver abscess

B. Pyogenic liver abscess

Correct answer is A: Amoebic liver abscess.

55. Patient with mitral valve prolapsed .He will underwent an urology surgery what you will
give him as a prophylaxis.

A. IV vancomycín plus IV gentamicin

B. Oral tetracycline

C. No need to give

D. Penicillin
Correct answer is C: No need to give.

56. Female patient athletic ... 3 month of amenorrhea, physical examination normal lab
investigation FSH, normal LH, normal Prolactine,The diagnosis

A. Ovarian or adrenal failure

B. Pituitary adenoma

C. Hypothalamic amenorrhea

D. Genetic syndrome

Correct answer is C: Hypothalamic amenorrhea.

57. Clinical breast examination all true except?

A. It is an examination by a doctor or nurse who will check both breasts and the lymph nodes
in armpits

B. Recommended every 3 years between 20 & 30

C. Every year after 40

D. All of the above is true

Correct answer is A: It is an examination by a doctor or nurse who will check both breasts
and the lymph nodes in armpits Clinical Breast Exam

It is an examination by a doctor or nurse who will check both breasts and the lymph nodes in
armpits, Recommended every 3 years between 20 & 30 and every year after 40

https://www.indiancanicersociety.org/breast-cancer/index.htmril.

58. which of the following inherited Genes that Increase breast Cancer Risk?

A. BRCA1,BRCA2

B. CA 125

C. HEF gene

D. EGFR mutation

E. All of the above

Correct answer is A: BRCA1 ,BRCA2

Inherited Genes that Increase Cancer Risk

Some gene mutations that increase the risk of breast cancer can be passed from parents to
children. The most well-known gene mutations are BRCA1 and BRCA2. These genes can
greatly increase the risk of breast cancer and other cancers, but they do not make cancer
inevitable

https://www.indiancancersociety.org/breast-cancer/index.html,

59. Which one of these drugs is not available as emergency parenteral tranquilizer in
psychiatric clinics:
A. Haloperidol

B.Risperidone

C. Alprazolam

D. All of the above

Correct answer is B: Risperidone

Risperidone is used to treat certain mental/mood disorders (such as schizophrenia, bipolar

disorder, irritability associated with autistic disorder). This medication can help you to think
clearly and take part in everyday life. Risperidone belongs to a class of drugs called atypical
antipsychotics.

60. 14 year's old girl failed in math exam. Then she had palpitations, tachypnea and
paresthesia. Diagnosis:

A. Hyperventilation syndrome

B. Conversion

C. None of above

Correct answer is A: Hyperventilation syndrome.

61. Patient complaining of pain along median nerve distribution and positive tinel sign
treatment include Casting of both hand in what position

A. Dorsiflexion

B. Plantar flexion

C. Extension

D. Adduction

E. Abduction

Correct answer is A: Dorsiflexion.

62. Child with in toeing and the knee and leg goes inside when he is walking, with W shape
postion while sitting, abnormality is:

A. Metatarsus vareus

B. Metatarsus adductus

C. Medial fernoral torsion

D. Medial tibial torsion

Correct answer is C: Medial femoral torsion..

63. Osterporosis exercise intervention to increase muscle and bone density:

A. High wieght and low reptition

B. Low resistance and conditioning

C. Low resistance and high repetition weight training

Correct answer is C: Low resistance and high repetition weight training.

[9:14 pm, 01/11/2021] Ponnu: 64. Patient presented with ear pain, red bulging tympanic
membrane, apparent vessels, with limited mobility of the tympanic membrane, what the most
likely diagnosis
A. Acute otitis media

B. Tympanic cellulites

C. Mastoditis

Correct answer is A: Acute otitis media.

65. Patient with colored pustules around his mouth, organism show herpes simplex type 1,
what is the treatment:

A. Oral antiviral

B. IV antiviral
C. Supportive
Correct answer is A: Oral antiviral..

66. Young female with BMI 18, fine hair all over body, feeling of she is fat, doesn't eat well
with excessive exercise.

A. Anorexia nervosa

B. Body dysmorphic disorder

C. Bulimia nervosa

Correct answer is A: Anorexia nervosa.

67. Patient went to India, came back complaining of headache, fever only rest examination is
essentially normal.his laboratory report came with positive Flavivirus infection .what's the
cause of this disease?

A. Mosquito

B. Flee

C. Pig

D. Cattle
Correct answer is A: Mosquito

Flavivirus is a genus of viruses in the family Flaviviridae. Most of these viruses are
transmitted by the bite from an infected arthropod (mosquito or tick), and hence are
classified as arboviruses..

68. 3 month's infant with red swelling that increase in size rapidly:

A. Port-wine spot

B. Cavernous haemangioma
Correct answer is B: Cavernous haemangioma.
69. Adolescent complaint of witness syncope when he was standing behind Post Office, It
lasts 4 min what is your diagnosis.

A. Fainting

B. Silent heart attack

C. TIA
Correct answer is A: Fainting.

70. You are called to see a 9.5-pound newborn boy who is jittery 30 minutes after birth. The
pregnancy was complicated by prolonged delivery with shoulder dystocia. Physical exam
reveals a large, plethoric infant who is tremulous. A pansystolic murmur is heard. Which of
the following is the most appropriate diagnostic test?

A. Bilirubin level

B. Blood glucose

C. Galactose level

D. Serum calcium level

E. Serum TSH

Correct answer is B: Blood glucose

8. Blood glucose is the best initial diagnostic exam to evaluate in infants that present large
for gestation, plethora, and jitteriness. This child is most likely born an infant of a diabetic
mother (ODM)

Look for macrosomia (all organs except the brain are enlarged), history of birth trauma, and
cardiac abnormalities (cardiomegaly). The case may not give a history of diabetes in the
mother. Treat with glucose and small, frequent meals

71. Child with iron toxicity several hours ago, investigations show iron conc. 700 mg/dl,
treated with:

A. Gastric lavage

B. Activated charcoal
C. I.V. deferoxamine
Correct answer is C: IV. deferoxamine

Explanation

-Patients with iron toxicity should be treated with IV deferoxime in the following
circumstances:

1) Severe symptoms: altered mental status, hemodynamic instability, persistent vomiting,

diarrhea. 2) High anion gap metabolic acidosis. 3) Serum iron concentration > 500 mcg/dL.
4) Significant number of pills on X-ray..

72. Patient came with painful loss of vision, light avoidance, constricted pupil, ciliary flushing
and cloudy anterior Chamber.

A. Uveitis

B. Acute angle glaucoma

Correct answer is A: Uveitis.

73. Child came with right abdominal mass; he has no iris and undescended testis. what is
the likely diagnosis?

A. Polycystic kidney

B. Nephroblastoma

C. Neurofibromatosis

Correct answer is B: Nephroblastoma

Wilms' tumor is a rare kidney cancer that primarily affects children. Also known as
nephroblastoma, it's the most common cancer of the kidneys in children. Wilms' tumor most
often affects children ages 3 to 4 and becomes much less common after age 5. Aniridia is
the absence of the iris, usually involving both eyes.... Aniridia in some individuals occurs as
part of a syndrome, such as WAGR syndrome (kidney nephroblastoma (Wilms tumour),
genitourinary anomalies and intellectual disability), or Gillespie syndrome (cerebellar

ataxia)..
74 Fatient came with left painful abdominal mass, rebound tenderness, and constipation.
Increased (CRP, ESR) Diagnosis

A Acure diverticulitis

C. Chron's disease

D. Inflammatory bowel syndrome

correct answer is A.Acure diverticulitis

75. Case with hypertensive retinopathy, (in details) patient blood pressure = 180/140
.treatment:

A. Decrease diastolic to 100-110 in 1-2 hrs

B. Decrease diastolic to 80-90 in 1-2 hrs

C. Decrease diastolic to 100-110 in 1-2 days

D. Decrease diastolic to 80-90 in 1-2 days

Correct answer is A: Decrease diastolic to 100-110 in 1-2 hrs.

76. 28 year old man on inhaled short acting bronchodilator and low dose corticosteroid
complains of disturbing cough and wheeze on exercise. He has good inhaler technique and
no known allergens. What is the best modification in his therapy?

A. Oral leukotriene antagonist

B. Inhaled regular long acting bronchodilator

C. Increase dose of inhaled corticosteroid

D. Sodium Chromoglycate

E. Oral corticosteroid

Correct answer is B: Inhaled regular long acting bronchodilator.

77. Patient came to you complaining of lower back pain, you asked him about Duration
because:

A. Short onset is important for biological origin.

B. Location and onset is important for the biological origin

C. Location and onset are important for the outcome

Correct answer is B: Location and onset is important for the biological origin.

78. 24 years old man presented with 4 month history of diarrhea with streaks of blood &
mucous. Ulcerative colitis was confirmed by colonoscopy. The initial therapy for this patient:

A. Oral corticosteroid

B. Azathioprine

C. Infleximabe

D. Aminosalicylic acid

E. Sulfasalazine
Correct answer is A: Oral corticosteroid A once acute symptoms subsides D..

79. Pregnant lady with cardiac disease presented in labor, you'll do all except:

A. Epidural anesthesia

B. Cesarean

C. Diuretic

D. Digitalis

E. Oxygen

Correct answer is B: Cesarean.

80. 50 year's old giving history of (postmenopausal symptoms), hot flushes. Best drug to
reduce these symptom is:
A. Estrogen only

B. Progesterone only

C. Combined pills (estrogen and progesterone)

D. Venlafaxine or Paroxetine or clonidine or HRT if not combined pills,

Correct answer is D: Venlafaxine or Paroxetine or clonidine or HRT if not combined pills…

81. Patient known diabetic with DKA which type of insulin

should be given to DM emergencies:

A. Crystal zinc insulin

B. NPH insulin

C. Lantus insulin

D. Lente insulin

Correct answer is A: Crystal zinc insulin.

82. Patient, medically free came with eye watery discharge, cloudy ant. Chamber with red
conjunctiva, Diagnosis:

A. Keratitis

B. Uveitis

C. Retinitis

D. Corneal laceration

Correct answer is B: Uveitis.

83. Most common cause of raised JVP

A. SVC obstruction
B. Fluid over load
C. Complete heart block

D. Right heart failure

Correct answer is D: Right heart failure.

84. Patient with Reynaud's phenomena he is living with roommate smoker, along scenario
but this is the importance, treatment:

A. Anti-vibrating gloves

B. Keep core body temperature warm in cold

C. Negative smoking is not a trigger of disease

D. Keep hands warm away from cold

Correct answer is B: Keep core body temperature warm in cold.

85. A 50 year's man presented with increased breathlessness at rest. He is currently on

furosemide, digoxin and isosorbide mononitrate. What drug is going to help him?

A. Ramipril

B. Bendroflumethiazide

C. Atenolol

D. Amlodipine

E. Diltiazem
Correct answer is B: Bendroflumethiazide

The key is B. Bendroflumethiazide. [As patient is still in heart failure and pulmonary edema
with the usage of loop diuretic...a thiazide diuretic could be added with loop when response
is inadequate(Refernce:patient.info) this will reduce the volume overload and improve
breathing]...
86. Hypothyroid patient on thyroxin had anorexia, dry cough and dyspnea& left ventricular
dysfunction. She has normal TSH & T4 levels,

with Hyperphosphatemia,hypocalcemia,low PTH(parathyroid Hormone) and low

calcitriol.what is most likely The diagnosis is:

A. Primary hypoparathyroidism

B. Secondary hypoparathyroidism

C. Hypopituitaritism

D. Uncontrolled hyperthyroidism

Correct answer is A: Primary hypoparathyroidism

Hypoparathyroidism is decreased function of the parathyroid glands with underproduction of

parathyroid hormone. This can lead to low levels of calcium in the blood, often causing
cramping and twitching of muscles or tetany (involuntary muscle contraction), and several
other symptoms. The condition can be inherited, but it is also encountered after thyroid or
parathyroid gland surgery, and it can be caused by immune systern-related darnage as well
as a number of rarer causes. The diagnosis is made with blood tests, and other
investigations such as genetic testing depending on the results. The treatment of
hypoparathyroidism is limited by the fact that there is no exact form of the hormone that can
be administered as replacement. However teriparatide, brand name Forteo, a biosimilar
peptide to parathyroid hormone, may be given by injection. Calcium replacement or vitamin
D can ameliorate the symptoms but can increase the risk of kidney stones and chronic
kidney disease.

Treatment

Severe hypocalcaemia, a potentially life threatening condition, is treated as soon as possible

with intravenous calcium (e.g. as calcium gluconate), Generally, a central venous catheter is
recommended, as the calcium can irritate peripheral veins and cause phlebitis. In the event
of a life-threatening attack of low calcium levels or tetany (prolonged muscle contractions),
calcium is administered by intravenous (IV) infusion Precautions are taken to prevent
seizures or larvnx spasms The heart is monitored for abnormal rhythms until the person is
stable. When the life-threatening attack has been controlled, treatment continues with
medicine taken by mouth as often as four times a day.

Long-term treatment of hypoparathyroidism is with vitamin D analogs and calcium

supplementation, but may be ineffective in some due to potential renal damage. The N-
terminal fragment of parathyroid hormone (PTH 1-34) has full biological activity. The use of
pump delivery of synthetic PTH 1-34 provides the closest approach to physiologic PTH
replacement therapy.Injections of recombinant human parathyroid hormone are available as
treatment in those with low blood calcium levels.
https://en.wikipedia.org/wiki/Hypoparathyroidism #Diagnosis.
87. A 26 years male has been operated for abdominal trauma and splenectomy was done.
On the 3rd post-op day the pt developed acute abdominal pain and distention in the upper
abdominal area with hypotension. On insertion of ryles tubes, 2L of coffee ground fluid was
aspirated. What is the most probable diagnosis?
A. Acute gastric dilatation

B. Reactionary hemorrhage

C. Subphrenic abscess

D. DVT

E. Left lower lobe atelectasis

Correct answer is A Acute gastric dilatation.

88. lady came with history of consumption of 15 tablets of INH(Isoniazid). what will be your
mode of action?

A. Pyridoxine

B. Topiramate

C. Naloxone

Correct answer is A: Pyridoxine

A.......... Since isoniazid is increasingly being used to control the spread of tuberculosis,
physicians must be aware of its potentially fatal effects. The ingestion of toxic amounts of
isoniazid causes recurrent seizures, profound metabolic acidosis, coma and even death, In
adults, toxicity can occur with the acute ingestion of as little as 1.5 g of isoniazid. Doses
larger than 30 mg per kg often produce seizures. When ingested in amounts of 80 to 150 mg
per kg or more, isoniazid can be rapidly fatal. The first signs and symptoms of isoniazid
toxicity usually appear 30 minutes to two hours after ingestion and include nausea, vomiting,
slurred speech, dizziness, tachycardia and urinary retention, followed by stupor, coma and
recurrent grand mal seizures. The seizures produced by isoniazid toxicity are often refractory
to anticonvulsant therapy. Given in gram-per-gram amounts of the isoniazid ingested,
pyridoxine (vitamin B6) usually eliminates seizure activity and helps to correct the patient's
metabolic acidosis. Isoniazid toxicity should be suspected in any patient who presents with
refractory seizures and metabolic acidosis. http://www.aafp.org/afp/1998/0215/p749.html.

: 89.3kg full term baby, when should you screen for congenital hypothyroidism?
A. first 12 hours of birth

B. 1-2 days after birth

C. 3-7 days after birth

D. 1 month after birth

E. All of the above time frame is ok

Correct answer is B: 1-2 days after birth

B... From 24-48 hours chances of false positive results are high.ideal time is after 2 days
upto 7 days Ref: American Family Physician.

Screening for congenital hypothyroidism is recommended when a baby is 3 days old.

Testing should be performed before discharge or within 7 days of birth, False-positive TSH
elevations may be found in specimens collected at 24 48 hours after birth, and false negative
results may be found in critically ill newborns or post-transfusion infants. Particular care
should be taken not to miss screening in infants receiving emergency care
https://emedicine.medscape.com/article/919758-workup.

90. Placenta is anterolateral and the examiner was not able to palpate it:

A. Marginal placenta previa

B. Partial placenta previa

C. Low lying placenta previa

D. Complete placenta previa

Correct answer is C: Low lying placenta previa.

91. Which vitamin has a protective effect against colon cancer

A. Vitamin K

B. Vitamin D

C. Folic acid
D. Vitamin C

Correct answer is B: Vitamin D.

Vit D. After following the vitamin D status of 16,818 participants for 12 years, researchers
determined that vitamin D exhibited a strong protective effect against colorectal cancer, with
levels of 32 ng/ml or higher having a 72% risk reduction on colorectal cancer mortality.
Vitamin D & Colorectal Cancer www.hopkinscoloncancercenter.org.

92. Patient pregnant 40 weeks. High BP, irritable exaggerated deep tendon reflexes.
Treatment instituted was methyldopa, beta blocker, hydralazine and MgSo4. Now she
developed dyspnea and chest pain. Her resp. rate 10/min. What is Treatment?

A. 25% D/water

B. IV Soda bicarbonate

C. Diuretics

D. Calcium Gluconate

Correct answer is D Calcium Gluconate

D... ITS LOOKS TO BE ADVERSE EVENT OR TOXICITY OF MGSO4 AND ANTI DOTE IS
CALCIUM GLUCONATE SO D.

: 93. Patient works in a dusty environment had red eyes itching no trauma no mucopurulent
discharge, what to give t relieve his symptoms?

A. Tobramycin eye drop

B. Acyclovir eye drop

C. Trifluridine eye drop

D. Olopatadine eye drop

Correct answer is D: Olopatadine eye drop

D.Olopatadine hydrochloride is an antihistamine (as well as anticholinergic and mast cell
stabilizer), sold as aprescription eye drop (0.2% solution, Pataday (or Patanol 5 in some
countries), manufactured by Alcon). It is used to treat itching associated with allergic
conjunctivitis (eye allergies). Olopatadine hydrochloride 0.1% is sold as Patanol (orOpatanol
in some countries). A decongestant nasal spray formulation is sold as Patanase, which was
approved by the FDA on April 15, 2008.[1] It is also available as an oral tablet in Japan
under the tradename Allelock, manufactured by Kyowa Hakko Kogyo.[2]

It should not be used to treat irritation caused by contact lenses. The usual dose for Patanol
is 1 drop in each affected eye 2 times per day, with 6 to 8 hours between doses.
There is potential for Olopatadine as a treatment modality for steroid repound (red skin
syndrome.

94. Hypertensive patient using sildenafil, in his case it is contraindication to take:

A. Calcium Channel Blockers

B. B blocker

C. Nitrate
D. Diuretics

Correct answer is C: Nitrate

c The US Food and Drug Administration (FDA) has warned against the use of the impotence
drug Viagra by persons taking medications that containnitrates. The FDA's warning was
issued in conjunction with Pfizer, the manufacturer of Viagra (generic name: sildenafil).
Viagra and nitrates both cause the muscles that control the size of blood vessels to relax.
When these muscles relax, the vessels enlarge in diameter and, as a result, blood pressure
drops. When Viagra and nitrates are taken together, the effects are greater than when either
one is used alone. There may be a märked relaxation of the muscles that control the vessels
with a great drop in blood pressure. A drastic drop in blood pressure is detrimental to
patients who have angina pectoris (heart pain), a condition in which a higher blood pressure
is necessary to supply the heart with blood. Lowering the blood pressure decreases the flow
of blood to the heart and can precipitate a heart attack…

: 95. What is the triple test used in the assessment of breast lumps?

A. Breast ultrasound, mammography and fine needle aspiration biopsy

B. Mammography, fine needle aspiration biopsy and plain x ray of the breast looking for
calcification

C. Clinical examination, mammography and fine needle aspiration biopsy

D. Clinical examination, mammography and lumpectomy

E. Clinical examination, mammography and wedge resection of the breast

Correct answer is C: Clinical examination, mammography and fine needle aspiration biopsy.

96. the most important treatment in long survival of COPD is:

A. Oral cortistroid

B. Continues 02 therapy

C. Inhaled steroid

D. Bronchodilator
Correct answer is B: Continues 02 therapy

Oxygen-People with advanced COPD can have low oxygen levels in the blood. This
condition, known as hypoxemia, can occur even if the person does not feel short of breath or
have other symptoms. The oxygen level can be measured with a device placed on the finger
(pulse oximeter) or with a blood test (arterial blood gas). People with hypoxemia may be
placed on oxygen therapy, which can improve survival and quality of
life.http://www.uptodate.com/.../chronic-obstructive-pulmonary....

http://www.uptodate.com/contents/chronic-obstructive-pulmonary-disease-copd treatments
beyond the basics.

97. Patient with normal pressure hydrocephalus. CT brain picture distended ventricles. Initial
treatment?

A. Diuretics

B. Lumber punctures and drains fluid

C. Shunt

Correct answer is B: Lumber punctures and drains fluid

initial treatment B but best is C READ IT

Surgery

Management

Surgical CSF shunting remains the main treatment modality for NPH(NORMAL PRESSURE
HYDROCEPHALUS)). Prior to embarking upon surgical therapy, knowing which patients
may benefit from surgery is necessary. Detailed testing is performed before and after CSF
drainage (eg, baseline neuropsychological evaluation, timed walking test, large-volume
lumbar puncture, external lumbar drainage, CSF infusion testing).

Ideal candidates for shunt surgery would show imaging evidence of ventriculomegaly, as
indicated by a frontal horn ratio exceeding 0,50 on imaging studies...
......http://emedicine.medscape.com/article/1150924 overview.

98. Best method to maintain air way in conscious patient?(reference must)

A. Nasopharyngeal device

B. Oro pharyngeal device

C. Intubation

Correct answer is A: Nasopharyngeal device

A.....conscious or gag reflex present its nasopharyngeal and unconscious or absent gag
reflex its oropharyngeal airway…

99. Which one of the following is another of the so called seronegative forms of arthritis
associated

with HLA B27?

A. Scleroderma

B. Systemic lupus erythematous

C. Sjogrens syndrome
D. Mixed connective tissue disease

E. Psoriatic arthritis

Correct answer is E: Psoriatic arthritis.

100. 38 years female,G3 P3, previous normal deliveries, presented with occasional irregular
bleeding with high FSH, High LH, low Estrogen. what is likely Diagnosis?

A. Turners syndrome

B. Asherman syndrome

C. Sheehan syndrome

D. Premature Ovarian failure

Correct answer is D: Premature Ovarian failure

Both primary and secondary forms of ovarian failure are biochemically characterized by low
levels of gonadal hormones (estrogens and inhibins) and high gonadotropins (LH and FSH)
(hypergonadotropic amenorrhea). Low levels of inhibin B may predict follicular depletion
before the large FSH rise.

Primary ovarian insufficiency-also called premature ovarian failure - occurs when the ovaries
stop functioning normally before age 40. When this happens, your ovaries don't produce
normal amounts of the hormone estrogen or release eggs regularly. This condition often
leads to infertility.
Primary ovarian insufficiency is sometimes confused with premature menopause, but these
conditions aren't the same. Women with primary ovarian insufficiency can have irregular or
occasional periods for years and might even get pregnant. But women with premature
menopause stop having periods and can't become pregnant.

Restoring estrogen levels in women with primary ovarian insufficiency helps prevent some
complications that occur as a result of low

estrogen, such as osteoporosis. https://www.mayoclinic.org/diseases.conditions/premature

ovarian-failure/symptoms-causes/syc-20354683.