CK 2021

USMLE Recall Collection

Actual Exam Question

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1. Young girl who went for a walk with her father in some woody garden ..later developed
vesicles that were oozing? Treatment- oral/topical steroids,topical benzylperoxide,topical
antibiotics and few more options..
2. Boy with typical history of atopic dermatitis with rashes over face,trunk ...treatment –same
options as above
3. Elderly with typical history of giant cell arteritis with ESR = 52 MM..treatment- steroids/
carbamazepine...etc
4. Drug advertisement ..3 questions
5. –
6. –
7. Study shown in table..calculate relative risk
8. A long study on drug effectiveness ..asked to interpret the findings
9. What’s wrong in this study ..
10. Man with features of mania, few prior history of depression- diagnosis---most likely bipolar
11. Delirium tremnens—formication. In chronic alcoholic after 2 days of admission.
12. Amphetamine toxicity with sympathetic overdrive features
13. Elderly with htn,dm,hyperlipidemia, osteoarthritis, alzheimer’s everything possible disease
comes with suspicious bruises on abdomen with healing at different stages---elderly abuse
type ko hx
14. A man comes and tells u that his daughter told him that her friend tells that’ her parents
are “useless” and wants to commit suicide ...what should u do at this time 1. Call the
daughter’s friend urself 2. Ask him to call her parents2.call the police yourself immediately
4.. tell him its none of ur business 5.tell him to f**k her!!!!!!!!!!!!!!!!!!!!
15. Patient consumed some pills unknown to anyone..initially respiratory rate was 6 which later
improved to 14 /min ..later she tells she had taken 15 pcm pills ..what do u ..give naloxone
again/give acetylcysteine/do nothing
16. Lithium induced tremors and nephrogenic di
17. Pt with symptoms of dysthymia
18. Tourette syndrome ma adhd
19. Conduct disorder- breaks society rules < 18 yrs old
20. Alzheimers ko patient – when to start donepezil
21. Alzheimers ko ptient daily walk into the garden, daily talking to daughter,daily solving a
mathematical problem,monthly visit to a beach------------what is most likely to create
confusion or worsen her condition
22. Alzheimer’s patient not so severe presentation ..what do u recommend to caregivers –tell
them to assist her in making memory notes/signals
23. Alzheimers patient with almost everything presents with h/o fall fall 2 times ..diagnosed as
osteoarthritis ..what do u recommend to prevent next episode—knee brace/nsaids
24. Personality disorder – ocd
25. What is the study design – case control study
26. Agoraphobia without any other symptoms is social phobia/specific phobia/gad
27. Encopresis in a toilet trained child – 2 long vignettes diagnosis and management
28.
29. Childhood development – 18 months
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30. U suspect that one of your colleague is doing sth wrong about a patient care..what do u do
1. Notify to state medical license board2.tell to the patient the he is doing wrong 3.report to
the hospital anonymous disciplinary council 3.keep quite as u r not sure if ur colleague is
doing wrong or not
31. What’s the best way to prescribe?..1. paracetamol 500.0 mg to be taken by mouth 3 times a
day 2.paracetamol 0.5 ug to be taken by mouth 3 times a day
32. Patient with depression ? now presenting with few psychotic features ..what do u prescribe
at this time – haloperidol
33. Tanner stages of a child given..still not menstruating- reassaurance garne hola jasto lagyo
34. Fetal alcohol syndrome—short palpebral fissure etc but smooth philtrum thiyena
35. Depressive episode
36. 3-4 more questions on biostatistics interpretation of study..
37. –
38. -
39. Sickle cell adolescent under pcm+oxycodone..now complains of increasing pain asks morpine
what do u do ...1.long acting morphine 2. Short acting morphine3. Add more oxycodone
40. Terminal stage Cancer patient asks for pain management ..best way to asses 1.patient
himself2.appearance of patient 3.signs such as facial expressions
41. Young obese female taking isotretinoin ..csf pressure normal and ct scan normal no
hydrocephalus ..has episodic headache(no special features),n/v,blurry vision----dx asked..1.
migraine 2.pseudotumor cerebri 3. Tumor...................
42. Young boy with 1 week history of psychotic symptoms with no history of affect disorder—
brief psychosis
43. Yong female with delusion(that her partner is not trustworthy) ,no hallucination- persistent
delusional disorder
44. Young college boy has problems regarding sleep..plays computer games till 2 am..wakes up
late , often falls asleep during 1st few classes , sleeps till 12 noon during holidays ? diagnosis
1. Circardian rhythm sleep disorder 2.narcolepsy 3. Osa 4.restless leg syndrome
45. Localisation of a site within brain – symptoms given..speech was normal so i ruled out
broca’s and wernicke’s ..
46. A healthy adult comes for routine examination..bp and everything else normal range..what
advise do u give him to maintain his bp? 1.avoid gingko products 2. Regular exercise and
healthy habits?
47. An immunosuppressed man with respiratory problems ---- slide given ..1. aspergillus 2. Pcp
48. A young female with multiple sexual partners with painful lesions and l/n enlargement
..vignette closely referring to herpes but photograph given .it was clearly
folliculitis...organism asked.1. herpes 2. Staph..aureus
49. Elderly man 92 yrs old with photo showing a facial lesion ...what do u do – excision
50. Young female with photo showing oral herpes lesion –confluent and painful ---diagnosis
asked
51. Long vignette of esotropia ..cranial nerve lesion asked --- vi th erve
52. Another vignette –long as it always is --- fundus picture shown ..and then asked what do u
do for diagnosis 1. Slit lamp 2. Goniometry 3.ct scan
53. Vignette describing loss of triceps reflex and reduced sensation over medial 2 fingers..what
is the most likely distribution of defect..c5/c6/c7
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54. Venous ulcer pic on the medial aspect of ankle –diagnosis ?

55. A patient with hypercholesterolemia,dm,htn...presents with rashes over the digits...pic
shown purpuric rash over the dorsum and lateral surface of a toe---- cholesterol embolism?
56. Man treated with tmp/smx ...develops rashes ---- its due to medication side effect.
57. Severe Headache, confusion and some visual problem in a htnsive man ..lp ma no
blood...diagnosis --- intracerebral hmgh
58. Man presents with chest pain , pain on leaning forward and has a rub on auscultation..what
do u do initially..1.cxr 2.ecg
59. Above vignette’s nxt question...on ecg – features of pericarditis ...diagnosis asked
60. AR –murmer..vignette provided some clues
61. asd- murmer; 1 week old child with no cyanosis,fixed wide split
62. Patient had psvt adenosine administered – what may be the complication of
treatment..1.wpw 2.torsades 3.vt 4.vf 5.af
63. What to do in a male patient with no risk factors with ldl levels 165 mg/dl?
64. A child from New Mexico brought to you by his mom ..she tells she removed a tic from her
child’s arm today and she’s sure that the tick wasn’t there yesterday..on examination no
rash ,no symptoms.....what do u do?
65. Osteogenesis imperfect- brittle bones ---collagen defect
66. Slipped capital femoral epiphysis – management- fix it with pins
67. Newborn – female,positive family history with ddh – greatest risk for developing ddh in this
baby?
68. Some invasive procedure performed in the medial thigh ..later develops pulseless
extremities ----most likely cause 1.thrombosis at aortic bifurcation 2. Compartment
syndrome 3.deep vein thrombosis 4. Expansion of hematoma
69. Pain over lower limbs that changes with position(lying supine and lateral) ..slrt –ve 1.lumbar
cord stenosis 2.ivd prolapsed 3. Berguer disease
70. Patient presents with non-productive cough,wheezes etc..cxray shown 1. Asthma 2. Chronic
bronchitis 3.emphysema 4.ild 5.mediastinal lymphoma 6. sarcoidosis
71. Child visited to an African continent few weeks back--- malaria
72. Acute diverticulitis in an elderly resolved after treatment ..then what do u do ?1.advise low
residue diet 2.colonoscopy
73. A bright red well demarcated lesion over the buttock in an infant that was static initially ,
now grows ..... physician tells to the parents it will subside later in life?what is it 1.vascular
overgrowth 2.hemangioma
74. Tension pneumothorax after an acute trauma- easy ..diagnosis asked
75. Marfan syndrome
76. Man with dysphagia to solids and later to liquids ..no improvement on ppi – what do u do-
endoscopy
77. Man with hx suggestive of ureteric stone 3 mm ,now asymptomatic..what is the best advice
for him to prevent recurrence- plenty of fluids
78. Man with epigastric pain especially after fatty meals , also steatorrhea..xray shown;
calcifications on the pancreas—diagnosis : chronic pancreatitis
79. Case of stiffness over sacroiliac joint area, fused vertebra etc---- ankylosing spondylitis
80. Case of female with ulnar deviation of both wrists—rheumatoid arthritis
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81. A child is being started induction therapy for ALL..- what to do : allopurinol+ plenty of
hydration
82. Case of facial paralysis – bell’s palsy
83. Case of dehydration due to repeated vomiting? Estimate sodium,potassium,chloride and
bicarbonate changes
84. Case of dehydration induced acute renal failure..lab parameters changes..Fena, urine
osmolarity,plasma osmolarity
85. Case of anaphylactic shock – changes in svr,co,preload,afterload
86. Hereditary angioedema –
87. Trauma patient – dpl done – blood + :exp laporatomy
88. Cystic fibrosis vignette- sweat chloride
89. Blood in stool + xray abdomen shown with airfluid levels- ischemic bowel
90. Late decelerations on cst- c/s
91. Incomplete abortion
92. Macrosomia- diabetes in mother
93. Muscular strain on lifting some heavy object..advice?
94. Postmenopausal women with thinning of vagina not improved on otc creams what do u
suggest- estrogen cream/ combined ocp/pop
95. Torsion of ovarian cyst- diagnosis ..female with adnexal mass suddenly develops pain???????
96. Case of primigravida with everything goin on normal..- allow spontaneous delivery????????
97. A woman in her 1st trim (6 wks) comes to u asking about the tests to rule out down
syndrome in her child – tell her its too early to do specific tests and do routine pregnancy
tests
98. Cst shown with early decelerations????? What could be the cause--- oligohydramnios?
99. Child with difficulty breathing after birth—hmd
100. Woman doesn’t want any more children – tubal ligation..
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1. A  physician  looks  at  the  full  medical  report  of  all  the  cases  of  a  particular  
disease  in  the  last  one  year.  What  kind  of  study  is  it?  Case  Series  Report  
2. Two/three  calculations  of  sensitivity/specificity  
3. Odds  Ratio  calculation  
4. Recall  bias  
5.  A  21-­‐year-­‐old  woman  comes  for  Pap  Smear.  What  other  test  is  indicated?  
Chlamydia  
6. A   69-­‐year-­‐old   woman   comes   for   routine   follow   up.   What   other   test   is  
indicated?  DEXA  Scan  for  Osteoporosis  
7. A   24-­‐year-­‐old   HIV   positive   case.   What   immunization   other   than  
pneumococcal  vaccine??  Influenza  
8. A  newborn  delivered  by  forceps  has  flattened  occiput,  head  turned  to  the  
right   (with   pain   on   trying   to   move   the   head   to   left)   and   mass   to   the   left   of  
the  neck.  What  is  the  diagnosis??    
9. Tocographic  plot  was  given.  There  was  “early  deceleration”.  Question  was  
about  the  cause  for  the  finding.  Fetal  head  compression  
10. Lots  of  questions  from  ImmunoDeficiency  Chapter  
a. Wiskott  Aldrich  Syndrome.  Dx.  
b. Selective  IgA  deficiency.  Rx:  IVIG  
c. Typical   facies   (wide   spaced   eyes,low   set   ears   and   fish   mouth)   with  
hypocalcemia.  Dx:  DiGeorge  Syndrome.  
d. SCID  
11. A   case   with   features   of   hyperparathyroidism   and   pheochromocytoma.  
What  is  the  most  likely  other  finding??  Raised  calcitonin  level.  
12. Case  of  umbilical  hernia  in  an  infant.  Best  next  step  in  mgmt.  Reassurance  
13. A   case   of   an   adolescent   talking   less   with   parents,   making   poor   eye  
contact,   defying   the   orders   of   parents   etc.   Dx:   Normal   Adolescent  
Behavior  
14. A  psychiatry  case.  A  young  girl  says  she  is  married  to  a  rock-­‐star  and  has  
been   pregnant   with   the   rock-­‐star’s   child.   Pregnancy   test   is   negative.   She  
has  posters  of  the  rock-­‐star  all  over  her  room.  Dx:  confusing  options…  
15. Psychiatry  case.  For  the  past  3  months,  a  young  person  wakes  up  all  night  
to  prevent  worms  coming  out  of  his  body  which  will  rule  over  the  whole  
world.   He   hears   voices   telling   him   to   save   mankind   by   preventing   the  
worms   from   getting   out.   Dx:   confusing…schizophrenia   matrai   milne  
khalko  thyo;  but  only  3  months  duration.    
16. C/o  marfan’s  syndrome.  What  is  the  underlying  defect??  Fibrillin  
17. C/o  oligohydramnios.  Consequence?  Pulmonary  hypoplasia.  
18. C/o  diaphragmatic  hernia.  Consequence?      Pulmonary  hypoplasia.  
19. C/o  ADHD.  Rx:  Methylphenidate  
20. A   surgical   nurse   develops   paronychia.   Culture   shows   Staph.   aureus.   What  
is   the   next   best   step??   Options   like   give   prophylactic   antibiotic   to   all  
patients  who  were  in  her  contact;  take  culture  from  all  patients;  remove  
the  nurse  from  clinical  duty  while  it  heals  etc.  
21. A  girl  for  routine  examination  before  joining  college  where  she  will  live  in  
dormitory.  What  is  the  next  best  step??  Give  meningococcal  vaccine  
22. C/o  a  prisoner  who  comes  with  malingering.  
23. Cystic  fibrosis  with  pneumonia.  Likely  organism?  Pseudomonas  
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24. Vesicles  and  itching  over  neck,  left  wrist  and  proximal  part  of  finger.  Most  
likely  precipitating  cause?  Nickel  
25. Contact  dermatitits.  Underlying  pathophysiology?  T-­‐cell  mediated  HSR  
26. A   patient   on   short   acting   B2-­‐agonist   develops   asthma   symptoms   more  
than   twice   per   week   with   frequent   night   symptoms.   What   is   the   next   best  
drug  to  add  to  the  regimen??  Inhaled  Corticosteroid  
27. A   c/o   pregnancy   given   and   4   USG   screenshot   given.   What   is   the   most  
likely  complication??    
28. ECG  of  inferior  wall  MI.  Next  best  step  of  mgmt.  asked.  
29. ECG   of   atrial   fibrillation   in   an   alcoholic.   What   is   the   underlying   cause?  
Alcohol  
30. 2  Heart  Sounds.  
31. C/o  HOCM.  
32. C/o  Mitral  Valve  Prolapse.  
33. A  c/o  RHF  with  CT  scan  given.  Asked  for  the  underlying  cause.  [maile  CT  
scan  ma  kei  chinina…it  could  have  been  some  pericardial  disease.  Tesaile  
TB  ans  lagaye]  
34. Case   of   Lithium   toxicity.   What   is   the   next   best   step?   Dialysis   (after   all  
dialysis  garnu  parne  THAMEL  formula  ma  L  was  for  lithium]  
35. C/O   watery   diarrhea   followed   by   blood   in   stool   after   eating   hamburger.  
Similar   symptoms   in   friend   who   ate   at   the   same   place.   What   is   the  
underlying  pathophysiology?  
36. Confusing   c/o   cystic   fibrosis.   What   is   the   next   best   step?   Sweat   chloride  
test  
37. C/o  PSGN.  What  is  the  likely  lab  finding?  Low  C3  
38. C/o  HSP.  Rx:  maile  Plasmapheresis  lagaye.  Not  sure.  
39. C/o  epididymitis.  Even  the  cord  was  palpable  which  differentiated  it  from  
torsion  
40.  C/o  hypothyroidism  with  delayed  ankle  reflex.  
41. A   diabetic   pt   presents   with   symptoms   similar   to   DKA   but   all   lab   finding  
are  normal  except  for  high  counts.  Dx.  Infection  
42. C/o  slipped  capital  femoral  epiphysis.  
43. Microscopic  appearance  of  a  bone  tumor.  Dx.  
44. C/o  malar  rash,  mouth  ulcers  and  joint  pain.  Dx:  SLE  
45. C/o  TTP.  Rx:  plasmapheresis  
46. C/o   raised   AFP.   What   is   the   most   likely   disorder   that   will   occur   in   the  
newborn?  Anencephaly  
47.  A  c/o  proximal  muscle  weakness  with  normal  CPK  levels.  Dx:  Myesthenia  
gravis  
48. A  picture  of  skin  lesion  with  history  of  cat  scratch.  Dx:  Bartonella  henselae  
49. A  person  from  Connecticut  develops  lyme  disease.  What  is  the  strongest  
risk  factor  in  the  given  setting??  Location  
50. C/o  scabies  
51. Picture   of   a   skin   lesion   which   occurred   after   hot   oil   spilled   on   his   palm.  
The  lesion  consists  of  red  streak  running  all  the  way  from  the  palms  to  the  
shoulder.  Dx??  
52. Skin.   A   single   lesion   on   the   back   which   is   later   followed   my   numerous  
smaller  lesions  on  the  back.  What  could  have  prevented  the  condition??  
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53. Bluish   discoloration   of   toes   following   angiography.   The   distal   pulses   are  
intact.    Dx:  Athero  emboli  
54. C/o   a   person   with   2   positives   on   CAGE   questionnaire.   What   is   the   next  
best   step??   Options:   chlordiazepoxide   or   disulfiram   or   12-­‐step  
programme.  I  chose  the  third  one.  
55. C/o  hyperprolactinemia.  
56. A   case   of   hyponatremia   on   lab   finding.   Mass   seen   on   lung.   Cause   of  
hyponatremia  asked.  Ectopic  ADH  production  
57. H/o   goiter   in   mother   and   grandmother.   Daughter   has   goiter   with   low  
thyroid  hormones.  Dx:  Iodine  deficiency?  
58. Painless  bleeding  in  third  trimester.  Dx:  Placenta  previa  
59. Hypercalcemia  and  increased  ACE  level.  Dx:  Sarcoidosis  
60. C/o  Sjogren  Syndrome  
61. Raynaud’s  phenomenon.  Rx:  CCB  
62. C/o   Osteoarthritis.   Underlying   pathophysiology   asked.   Destruction   of  
articular  cartilage  
63. An  alcoholic  develops  gout.  Besides  starting  allopurinol,  what  is  the  next  
best  step??  Cessation  of  alcohol  intake  
64. A   man   with   dysphagia   for   solids,   which   later   progressed   to   liquids.   H/o  
weight  loss  but  no  h/o  alcohol  or  smoking.  H/o  gastric  reflux.  Dx:  maile  ta  
Schatzki  ring  lagaye.  
65. H/o   corrosive   ingestion.   Next   step   of   management   after   stabilization?  
Upper  GI  endoscopy  
66. A  patient  presents  with  priapism.  Most  likely  cause?  Trazodone  
67. Pleural   effusion   with   pleural   fluid   and   serum   values   given   which   shows   it  
is  exudative  type.  Cause  asked.  
68. Intraoperative  MI.  What  is  the  best  diagnostic  test?    
69. A  patient  in  loop  diuretics  develops  hearing  loss.  Cause?  Medication  effect  
70. C/o  monoclonal  gammopathy  of  unknown  significance.    
71. C/o  Trichomonas  vaginitis.  Rx:  metronidazole  
72. C/o  ARF  with  urea:creatinine  ratio  of  >20.  Most  likely  cause?  Dehydration  
73. C/o  Bronchiectasis  
74. C/o  Heparin  Induced  Thrombocytopenia.  What  is  the  next  best  step?  Stop  
Heparin.  
75. C/o  rapidly  developing  dementia  with  myoclonus.  Dx:  Cruetzfeldt  Jacobs  
Dz  
76. C/o  ARDS;  different  parameters  of  Mechanical  Ventilation  given  like  Tidal  
Volume,   Rate,   FiO2   etc.   Oxygen   saturation   still   low.   What   will   you   do??  
Increase  PEEP  
77. A  woman  working  in  wool  factory  develops  chest  symptoms  and  on  CXR  
shows   thickening   of   diaphragmatic   thickening.   Her   husband   worked   in  
asbestos   factory.   What   is   the   cause   for   her   condition??   Confusing;  
occupation  ma  tick  ta  lagaye  but  not  sure  how.  
78. Knee  jerk;  root  values?  L4/L5  
79. C/o  shiny,  pearly  lesion  at  tip  of  nose.  Dx:  Basal  cell  carcinoma  
80. C/o  PPH  followed  by  hypopituitarism  ie  Sheehan’s  syndrome.  Underlying  
cause?  Ischemic  Necrosis  
81. A  women  is  on  Lisinopril  and  multiple  other  drugs.  She  tests  positive  on  
Urine  Pregnancy  Test.  What  is  the  next  best  step?  Stop  Lisinopril  
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82. A   person   with   persistently   high   BP   (160-­‐170/100-­‐110)   is   on   two   anti-­‐

HTN   medication:   ACEI   and   Hydrochlorothiazide.   What   is   the   next   best  
step?  Options  like:  substitute  ACEI  with  Loop  diuretic,  Thiazide  with  Loop  
Diuretic,  increase  the  dose  of  Thiazide.  I  picked  the  last  one.  Confusing.  
83. A   woman   with   multiple   family   h/o   breast   carcinoma.   What   is   the   next  
best  step?  Tamoxifen  
84.  C/o  urge  incontinence.  
85. A  woman  with  ASCUS  Pap  Smear?  Repeat  pap-­‐smear  in  3  months  
86. A   case   of   infertility.   Husband   has   a   child   from   previous   marriage.  
Endometrial   biopsy   shows   proliferative   changes.   Hysterosalpingography  
shows  normal  tubes.    Cause  of  infertility?  Anovulation  
87. A   c/o   breast   cancer;   depth,   stage   and   metastasis   given.   They   are   ER  
positive.   What   is   the   most   important   prognostic   factor?   Confused;   maile  
ta  ER  positive  status  vanera  laye.  
88. C/o  FibroAdenoma  
 
 
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1. Venous ulcer ko picture….. venous insufficiency

2. Diarrhea in 3 yr old… day care centre others had similar hx. giardia ko microscopy specimen…
mechanism of diarrhea? Option eutai milne jasto thiynea
3. Hx of multiple fractures osteogenesis imperfecta defect? Collagen
4. Ruptured ectopic ko jasto features in shock…. What to do next? Exlap, laparascopy
5. features presenting like meningitis in a boy living in a dormitory csf findings like viral
meningitis… dx aseptic meningitis, bacterial meningitis, meningoencephalitis
6. IV drug user pt with hep B surface antibody +, core antibody+, hep c antibody +. Which to give?
Hep A Vaccine only, hep A and B vaccine, HBIG
7. Male patient multiple sexual partners urethral thick white discharge. t/t? Ceftriaxone, Azithro
and doxy
8. Scabies ko typical hx. Organism?
9. IE prophylaxis for valvular heart dz patient undergoing endoscopy? None needed, amoxy, vanco
10. Asymptomatic tick bite
11. Anaphylaxis ko case pharynx uvula edema. Next? ET intubation, anti histaminics….
12. Angio edema ko case on anti hypertensives. Which drug most likely? ACEI
13. Allergic rhinitis. Prevention from contact of animal dander from which pt was allergic
14. Brutons agammaglobulinemia
15. Iga deficiency
16. CGD
17. 3 ques research article ( herna pani vaiyena)
18.
19.
20. CAD and risk factors wala dimag ghumaune ques 2-3
21.
22. Hx and ecg suggestive of acute pericarditis
23. Murmur and hx AR
24. Murmur and hx AS (I think)
25. HX and CT head like CDHm, large one. what to do next? Drain
26. Septi arthritis. Along with antibiotics what need to be done? Incision and drainage
27. Thyroid nodule. TSH normal. Next? FNAC
28. FNAC show malignant cells. Next? Total thyroidectomy
29. Graves dz…. Tsh stimulating antibodies
30. Clinical features like asthma….. airway hyperactivity
31. Clinical features like COPD emphysema…. Protease activity increased
32. Methacoline challenge for asthma
33. Bronchiectasis
34. Pneumococcal vaccine for 58 yr old copd patient when to give?
35. Exudative Pleural effusion….chest tube drain
36. Lung abscess. cause?
37. Obstructive sleep apnea
38. Hypoxemia in a trauma patient features and xray likely ARDS
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39. Low back pain ka yeti dherai ques ki dimag kharab banayo
40. Pregnant women with carpel tunnel syndrome? Symptoms due to…. Pregnancy
41. RA patient splenomegaly and lab s/o Felty syndrome
42. RA patient quadriplegic after surgery for something…. C spine subluxation
43. Dermatomyositis
44. Enthesopathy in Ankylosing Spondylitis
45. Uveitis in Ankylosing Spondylitis
46. Osteoporosis ko 1-2 ques, DEXA scan
47. Microcytic anemia
48. Hypersegmented neuthophils, neutopathy.? B12 def
49. HUS… due to toxin
50. Diabetic with lab showing renal insufficiency. Next? Insulin, Metformin, glipizide
51. Bleeding in renal failure? Platlet dysfunction
52. Aantibiotics associated diarrhea… stool for toxin
53. Sigmoid volvulus xray
54. Pseudotumor cerebri … clinical, fundoscopy, csf pressure
55. Pseudotumor cerebri t/t
56. Tourette…. Obscessive compulsive behavior, vocal tics
57. Contrast induced nephrotoxicity prevention with….. prior saline hydration
58. Hyperkalemia with ecg changes…… calcium chloride
59. Stress incontinence
60. Delerium tremens on a post op patient
61. Impetigo- honey colored crust
62. Typical intussusception ko case but it was not in the option….
63. Appendicular abscess
64. Fat embolism
65. Placental abruption
66. Electronic fetal monitoring tracing showing late deceleration. Cause?
67. PTSD
68. Anorexia nervosa
69. Obstructive sleep apnea
70. Sleep walking… stage of sleep?
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Questions
1. 70 year old man with history of poor central vision. Picture of retina on
fundoscopy is shown. What is the diagnosis? Central Macular degeneration.
2. Child with a history of high grade of fever for 4 days, currently has
erythematous skin lesion of cheek. Picture given, What is the diagnosis?
Erythema infectiosum, Parvo B19 infection.
3. 12 year old man with limping of right leg, BMI is >30, X-ray is given, How is
this condition treated? Slipped capital femoral epiphysis, Surgical pinning.
4. Neonate born preterm, presently has subcostal retractions and high
respiratory rate. What is the cause of this condition? ARDS, defect in
surfactant.
5. ABG of a person given who is suffering from Pulmonary embolism. What is
the cause of hypoxia? V:Q mismatch.
6. Similar to 5, ABG of person with CCF following an Acute MI given. What is
the cause of abnormal ABG in this patient? Shunting.
7. H/O 22 year old with sudden fainting spells while playing soccer.
Auscultatory findings of CVS shows ejection systolic murmur which
increases with squatting. ? Diagnosis: HOCM
8. 60 year old with H/O surgical repair of thoracic aortic aneurysm. Currenly
has features of CCF, CVS findings given. It has early diastolic murmur. What
is the diagnosis? Aortic regurgitation.
9. Post MI patient with hypoxia after 5 days, CPK is raised again after initial
decline. What is the cause of the patient’s dypnea? Reinfarction.
10. Patient with H/O orthopedic surgery few days ago, presents with dyspnea
and hemoptysis, there is tenderness in the right calf. H/O hemorrhagic
stroke few months ago. What is the next step in managing this patient?
Venacava filters.
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11.H/O surgery for prolactinoma. Currently the patient is delirious. Lab values
shows hypernatremia. What is the next step in management? CDI,
Desmopressin.
12.Child with short limbs, short Lower limb, What is the cause of increased
head circumference? Achondroplasia, Hydrocephalous.
13.Picture of vulva with many vesicles and ulcerated tender lesion in a young
teenager with lymphadenopathy. What is next step in management? HSV
infection. Oral Acyclovir.
14. 15 year old with anemia, Peripheral smear given: Auer Rods. What is the
complication most likely in this patient? AML, DIC.
15.Elderly patient with enlarged non tender LN in left Cervical chain. What is
the next step in management? Lymphoma, excisional biopsy.
16.Child with features suggestive of Down’s syndrome. What is the most like
CVS abnormality in this patient? Endocardial cushion defect.
17.Child with mother who is drug abuser, multiple drugs. The neonate is crying
and yawning, not able to feed. What is the most likely cause? Opiate
withdrawal
18. 6 month old male child with vomiting for past 2 days, current jelly like
blood in stool. What is the diagnosis: Intersusseption.
19. 4 week old with cyanosis relieved with squatting, CVS finding has systolic
ejection murmur in pulmonary region? Diagnosis: TOF
20. Question about VACTERL association. Child has feature suggestive of TEF,
What else would you do for this patient? X-ray of Vertebrae.
21. Female with amenorrhea for 3 months, Beta-hcg >50,000. Expulsion of
grapelike vesicles. What is the next step in management? TV-USG
22.Pregnant in 3rd trimester, decreased fetal movement in last few days. NST
given, Late decelerations. What is the next step in management? CS
23.Similar to 22, but with variable decelerations. What is the most like cause of
the abnormal NST? Cord compression.
24. H/O amenorrhea in a female for a month, presents with bright red blood
per vagina with clots, no FHS heard. Ps examination shows an open cervix,
What would you do next for this patient? Incomplete abortion, DNC.
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25. Female with hairy lips and acne, she has high BMI. LH and FSH raised. What
is the best mode of therapy for this patient? PCOS, OCPs.
26.Female with hirsutism, hyponatremia, raised 17-OH progesterone. What is
the diagnosis? CAH
27. Pregnant woman in 3rd trimester with headache, raised BP and proteinuria.
What is the most effective way of lowering BP in this patient? Delivery.
28.Graph showing prolonged 2nd stage of labour with. What is the most likely
cause of this condition? Cephalo-pelvic disproportion.
29. Along with 28, next questions was what will you do next if the fetal head is
engaged. Cervix is fully dilated, contractions are inadequate? Oxytocin.
30. 2 year old with recurrent otitis media and pneumonia as a infant,
examination shows no tonsils. What is most like cause of this patient’s
immunodeficiency? Tyrosine kinase deficiency, Bruton’s X linked disease.
31. Following Q 30, what is the next step in management of this patient?
Measure serum Ig levels.
32. 25 year old male with B/L palpable masses and raised creatinine levels and
the patient has hyperkaemia and is delirious. What is most effective way of
treating this patient? Dialysis.
33.Patient with hypercalcemia but is asymptomatic. What is the most likely
cause? Hyperparathyroidism.
34.Elderly male with back pain, hypercalcemia and raised creatinine. What is
the next step in diagnosing the patient’s condition? SPEP, MM
35.H/O working in shipyard and is also a long time smoker. X ray shows
calcified pleura and slight effusion. What is the next step in confirming the
diagnosis? Mesolthelioma, Pleural biopsy.
36.Young teenager with dyspnea on exertion and exposure to cold. PFT is
normal at this time. What is the next step in diagnosing this condition?
Methacoline challenge test.
37.African American with dyspnea, skin lesion suggestive of EN, X ray given
which shows hilar lymphadenopathy. What is most effective therapy for
this condition? Sarcoidosis, Oral Prednisolone.
38. Male in his 20s with H/O uveitis and currently has back pain, raised CRP.
What is the most likely diagnosis? AS
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39. Following 38, what is the most like pattern seen in PFT. List of values for
FEV and FVC given. Choose one which suggests Restrictive lung disease
pattern.
40. Patient with long H/O smoking presents with proximal muscle weakness.
No skin lesions or ptosis. What is the most reliable method of diagnosing
the patient’s disease? Small cell carcinoma, Broncoscopy.
41.Elderly patient with long history of smoking presents with arm pain, right
sided miosis. Diagnosis: Lung cancer.
42.H/O tibial fracture 2 days ago which has been repaired surgically, currently
has loss of sensation and pain in right lower extremity. Pulses are absent
What is the next step in management. MRI angiography, vessel injury.
43. Lot of questions about vaccination during routine visit to physician.
44. Also screening procedures about mammography and colonoscopy.
45. Pap smear shows ASC-US, 3 months later HPV DNA test shows positive
results. What is the next step in management? Colposcopy.
46.Pregnant patient comes for routine prenatal visit. Which vaccine should be
given to this patient. Inflenza vaccine, inactivated .
47. Young male with features of CCF, he had history of URI 1 week ago. What is
most likely organism causing the disease. Myocarditis, Cox-sackie B virus.
48. Preterm labour with contractions before 34 weeks. What would you do for
this patient? Beta-methasone.
49. Adult patient with chest pain, EKG shows ST segment elevation. Which
therapy will significantly lower the patients mortality? Aspirin
50. Adult with epigastric pain for last 3 months, on and off not relieved by PPI
or antacids. What is the next step in management of this patient? Cardiac
stress test.
51.From biostatistics I frequently got questions in each set, some of them
were simple and about pretest and post-test variables.
52.Calculation on False positive Rate: 1 – Specificity
53. Positive Predictive value
54. What will happen if the cut off to a test is decreased from higher to a lower
set point?
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55.One abstract with 3 questions. It was about the use of serum Troponin
levels to determine the prognosis of CAD in patients without an ST segment
elevation. The 3rd question was simple and about sensitivity. The other two
were about the research.
56.No Drug ad but there were 2 to 3 questions in which there was RCT done
and I was asked “ When will you decide to stop the study” or “ What is the
most probable bias seen in this research”
57. A doctor is trying to use several different results of studies to decide which
therapy to try in a patient, what type of study is this? – Meta-analysis.
58. How can you practically increase the power of a study which was initially
not significant? Increase the sample size.
59. A lot of questions about ethical issues. A 12 year old child has traumatic
amputation of finger, his parents are not here yet and he is losing a lot of
blood and vitals are unstable. What will you do next? Treat without
consent.
60. An elderly comatose patient who has been ventilated. Son has the health
power of attorney and says continue treatment, daughter thinks the
treatment should be stopped. What should you do next? Continue
treatment.
61. History of trauma of a restrained driver in the front seat, the steering
wheel was bent. Vitals are stable, what will you do next? CT- Scan of
abdomen.
62.History of penetrating trauma to the abdomen following a gun-shot, vitals
are unstable. FAST shows fluid in the abdomen. What will you do next?
Exploratory laparotomy.
63. History of pelvic trauma in adult male, external fixator have been applied,
the patient presents with abdominal pain and has not urinated. Also he has
not had any sensation of fullness of bladder. What is the next step in
management of this patient? CT- Scan of abdomen, bladder injury.
64. Patient on a routine visit has BP 138/88 mm hg. BMI is high. What is the
next step in controlling the BP? Weight reduction
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65. One question regarding sequential steps to make a patient stop smoking.
Ask, Advise, Attempt, Assist, Arrange. The answer was to give the patient
nicotine patch, “Assist”
66. Barium swallow showing oesophageal obstruction in a patient who had
dysphagia initially to liquids and now to solids. What is most likely cause?
Adenocarcinoma involving the lower end of Oesophagus.
67. Patient has clinical history suggestive of anterograde amnesia, where is the
lesion most likely located? Hippocampus.
68.Patient with a long history of alcohol abuse has ataxia and nystagmus.
Where is the lesion located? Mammillary bodies.
69.Patient who recently lost a job, currently has low mood, decreased
appetite, anhedonia, decreased energy and sleep. What is the diagnosis of
this patient? Major depressive disorder.
70. A child performs poorly at school and is obsessed with deadlines and
keeping her room clean. She started a new school 6 months ago and
previously had normal relations but now seems detached. What is the
diagnosis? OCD
71. A child has motor and vocal tics in which he calls out profanity to stranger.
What is the common disorder he is likely to have as an adult? OCD
72. A man is socially isolated, doesn’t like having any close personal contacts
and lives alone. What is he suffering from? Schizoid personality disorder.
73. 22 year old man comes to the ER with hallucination, pupils are dilated and
he is mildly dehydrated. What is he most likely intoxicated with?
Amphetamines.
74. Female patient with history of Raynaud’s disease and tapering finger tips,
she also has long history of GERD. What is the next step in diagnosing the
patient’s condition? Ani-centromere antibody
75. A young teen with raised BP, has history of hemoptysis and RBC in the
urine in past few days. What is the most likely diagnosis? Goodpasture’s
disease.
76.A young teen with recurrent sinusitis and lung infections, RBC casts in the
urine. What is the next step in diagnosing the patient’s condition? C-ANCA
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77. A patient with history of BPAD , presents with tremors, ataxia and
headache. What is the most like cause of the patient’s presentation?
Lithium intoxication
78. A female in her late 30s has clinical features suggestive of PCOS. What will
you do next for this patient? Endometrial sampling.
79. A female with a H/O simple hysterectomy present with menopausal
symptoms. Which therapy is most appropriate for this patient? Oestrogen
only for initial 25 days of cycle.
80.A patient with history of painless jaundice for 3 months, weight loss,
distended GB. What is the next step in management of this patient? CT
scan of abdomen.
81. Similar to Q. 80 but the patient has increase in conjugated bilirubin >20.
What is the next step in management of this patient? ERCP and stenting to
relieve jaundice.
82.Female patient with epigastric patient, pain exacerbated with eating stake.
Murphy’s sign positive. What is the next step in the management of this
patient? Emergency cholecystectomy within 48 hours.
83. Male patient with long history of UC, currently has pruritis and raised ALP.
What is the most like diagnosis? Primary sclerosing cholangitis.
84. Elderly man with erectile dysfunction, no history of coronary artery
disease, morning tumescence is present. How will you treat this patient’s
impotence? Sidenafil
85. A couple have been trying to conceive for past 2 years, the woman has 1
child from prior marriage. Semen analysis is inconclusive, what is the next
step in evaluating the couple’s infertility? Repeat semen analysis.
86. A female in her 40s who has had 3 children comes for routine check up.
She has regular sexual activity. She does not want any more children. What
mode of contraceptive therapy is most appropriate in this patient? Tubal
ligation.
87. A couple come to you for pre-conceptional counseling, what would you
prescribe to decrease the risk of congenital abnormality in the foetus? Folic
acid.
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88. A man in his 30s has a history of Crohn’s disease and had a partial
gastrectomy for a refractory duodenal ulcer 5 years ago. He currently has
anemia with a MCV >110, decreased sensation to vibration in lower limbs,
he is also a vegetarian who drinks oftens. What is most likely cause of the
patient’s anemia? Gastrectomy
89. An elderly patient with history of AMI 2 years ago currently presents with
intermittent chest pain for past 1 week. He is not able to walk without
getting dyspneic. EKG shows no new abnormality. What is the next step in
evaluating the patient’s chest pain? Presantium-Thallium scan as the
patient cannot exercise and there are baseline EKG abnormalities.
90. A patient who has been in a car accident presents to the ER with shortness
of breath and chest pain. He was the restrained driver in the front seat of
the car. Examination shows decreased breath sound on the right side and
distended neck veins. What is the next step in the management of this
patient? Needle decompression of tension pneumothorax.
91. Similar vignette to Q 90 but the patient has low BP, distended JVP, heart
sounds are distant. What is next step in managing the patient’s
hypotension? Peri-cardiocentesis for cardiac tamponade.
92. Patient with clinical features suggestive of CLD, what vaccine would you
give to this patient. Hepatitis A and B vaccine.
93. Patient with leukemia who has been treated with BM transplantation,
currently presents with rash and jaundice, AST, ALT is raised. Which cell
type is responsible for the patient’s condition? GVHD, donor T-
Lymphocytes.
94. Patient with history of seizure taking prophylactic medication has a child
with hirsutism and cleft lip. What medication was the mother most likely
taking? Phenytoin
95. A soldier comes to the Physician with persistent pain in the right lower leg,
not relived by rest. He marches with his company for 3 hours every day. S-
ray shows no abnormalities. What would you do to further for the
management of this patient? Stress fracture of tibia, NSAID, no casting
required.
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96.Elderly patient who presents to the ER with delirium, he has H/O repeated
falls, most recently he fell down in the bathroom 3 weeks ago. Lab values
shows hyponatremia. What is the mechanism of patient’s altered
sensorium. SIADH following a Sub-dural hematoma.
97.Picture of patient with vitiligo affecting the hands. What other disease is
the patient most likely suffering from? Addison’s disease.
98.A 65 year old man with back pain and perineal pain for past 2 months. He
also has dribbling micturition and U/A on prostatic message shows WBC ,
esterase positive.PR shows a tender prostate. How would you treat the
patient’s condition? Acute prostatitis. TMP-SMX for 6 weeks.
99. HIV positive patient with CD4 count of 450, he is not taking any medication at
the time being. What should be done for the patient in his current visit?
Pneumococcal and Infuenza vaccination.
100. HIV positive patient with CD4 count of 150, presents with shortness of
breath, fever. X-ray shows B/L patchy infiltrates. What is the most accurate
method of confirming the etiology of the patient’s condition. Pneumocystis
pneumonia, Broncho-Alveolar Lavage.
101. A family comes to you to seek counseling regarding their 75 year old
grandfather who has Alziemer’s disease. He takes his medications regularly
and is active in his house hold activities. He has stopped going to the mall and
going out of his room. But he interacts with the other members of the family
regularly, although he forgets their names sometimes. They are planning to
take a trip to another state together. Which of the following might exacerbate
the patient’s dementia? Travelling to another state, keep the patient in
familiar surroundings.
102. A 45 year old female presents with a breast lump which is palpable to the
patient and doctor. Mammography shows no significant findings, FNAC is
inconclusive. What will you do next for this patient? Core needle biopsy.
103. A young adult presents to you with new onset of type 1 DM, what
serological test is most likely to positive for this patient? Anti-Glutamic Acid
decarboxilase.
104. What is the most like cause of the patient’s low BP? Elderly receiving
treatment for CCF and presenting with pre-renal failure. Diuretic use.
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105. What is the most like cause of the patient’s low BP? Patient with dementia
currently has orthostatic hypotension. Examination shows flat JVP and dry
mucus membrane. Dehydration.
106. What is the most like cause of the patient’s low BP? Patient with H/O URI
week ago, currently has chest pain relieved by propped up position,
examination shows distended JVP and decreased heart sounds.
Echocardiography shows Fluid in pericardial sac. Decreased preload due to
cardiac tamponade
107. A man has a history of getting punched in a bar fight. Currently he has
swelling of his left cheek. X-ray of skull is given. What is the most likely
diagnosis? Orbital fracture.
108. A pregnant patient present to you with burning micturition and supra-pubic
pain. U/A shows plenty of WBC and urine culture is pending. How will you
treat this patient’s condition? Oral Amoxicillin for 10 days.
109. A child presents with drooping of right side of the mouth, he cannot wrinkle
his right forehead. His family went to a field trip a few weeks ago. How will you
treat this patient? Oral penicillin (Doxicycline not used in children)
110. An elderly female presents with B/L swelling and stiffness of fingers which
is worse at the end of the day for the past few weeks. Examination shows
swelling of distal inter-phalangeal signs but not the proximal inter-phalangeal
joints. ESR is not raised. What is the cause of the patient’s joint pain?
Degeneration of the articular joints, osteoarthritis.
111. Female with H/O breast cancer treated with chemotherapy presents with
back pain. SLRT is negative but there is point tenderness of L4 vertebrae. What
is most likely cause of the patient’s backpain? Metastatic carcinoma of breast
causing compression fracture.
112. An elderly homeless man comes to the ER on a cold night with complaints
of abdominal pain. He gives history which is not significant and physical
examination shows no abnormality. The patient demands that he be admitted
to the hospital. What is the diagnosis? Malingering.
113. A chronic opiate abuser comes to a rehabilitation centre. She says that she
wants to kick the habit once and for all. Which therapy is most likely to help
the patient permanently quit her opiate use? Buprenorphine.
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114. A female with 4 children comes to you because of involuntary loss of urine
while coughing and sneezing, but there is no bedwetting at night. She also has
fecal incontinence. Picture of perineum is shown with a protruding mass per
vagina. What is the most effective therapy for this patient? Vaginal
hysterectomy with anterior and posterior vaginal wall repair.
115. A man in his 20s comes to you for evaluation of rectal bleed. His mother
died of ovarian carcinoma and sister was treated for endometrial carcinoma. A
colonoscopy is done but shows no polyp but there is an ulcerative mass
present. What is the most likely etiology of the patient’s condition? Defective
DNA repair, Hereditary Non Polyposis colonic carcinoma. (HNPCC)