RECALLS – AUG 2021 (FOCUS WHATS APP GROUP VERSION)

DISCLAIMER : FIRST 140 Q – are sure right answers.

If you want to add/modify first 140Q, ping this mail id.
Remaining questions doesn’t have a proper reference to
state a single answer.
Mail id : Vkarumannan@gmail.com

1. Ankle clonus – Gastronemius

2. Bevacicumab – Anti-VEGF
3. INDAPAMIDE – Acts at DCT
4. Cinacalcet – allosteric Calcimimetic at calcium receptors.
5. Repeated muscle contraction, making it better – LEMS – Anti-VGCC
6. Systolic murmur reaching axilla – Papillary muscle rupture
7. Bicalutamide – Androgen Receptor blocker
8. Fabry disease -XLR
9. Grave’s – TSH antibody
10.Person couldn’t believe he doesn’t have cancer irrespective of all the
tests are normal – Delusion

11.Which supports it’s due to UGI Bleed – Increased UREA value

12.Black color of the venous ulcer Is due to – Haemosidderin
13.Thailand man with retro-orbital pain, 3 malarial slides are negative for
MP, macular rash, only lab investigation was ALT elevated – DENGUE
14.B/l hilar lymphadenopathy with increased calcium – Sarcoidosis
15.MOA Metformin – Increased Insulin sensitivity
16.What is the abnormal ECG among the options- all were normal variants –
LBBB abnormal
17.Cervical carcinoma – HPV
18.B/L involvement – cervical radiculopathy
19.ADPKD – USG
20.Pancrearic cancer 19-9
21.Dental pt with ASD closure – No prophylaxis is needed ( recent
guidelines )
22.A smoker presented with Horner’s syndrome initial investigation – CXR
23.Reactive arthritis scenario – B27
24.GTN should not be used for a prolonged period – due to development of
Tolerance.
25.Monoclonal antibody is Humanised – to reduce immunogenicity
26.Acidosis with nephrocalcinosis – Distal Renal tubular acidosis
27.A man presented with bleeding PR, proctoscopy was done – internal
haemorrhaides – next step – Flexible sigmoidoscopy
28.An old lady with urinary incontinence while laughing and sneezing, what
is initial management – Pelvic floor exercises
29.A man with seizure history for 4 years, he closes his eyes for 5-15 min
when episode occurs, If he is being disturbed limb jerking occurs, once
the episode is over he behaves normally – Malingering
30.Anaemia with clumping of red cells in microscopy – next test – Direct
Globulin test to identify AIHA.

31.An elderly man with worsening vision, O/E both fundus had yellow spots
– ARMD
32.Women presented with 4 lower limb ulcers, otherwise normal , red in
color, no cause/ clue was there – Pyoderma gangrenosum ( cause it’s
idiopathic in 50% cases)
33.Scotoma is due to – Optic nerve
34.Worse outcome in pregnancy – PAH
35.A man making noise – typica history of toureette syndrome
36.Rapid worsening with myoclonic jerks – CJD
37.Visual hallucination – Dementia with lewy bodies
38.Wide gait with confusion and incontinenece – NPH
39.Chondrocalcinosis – pseudogout
40.Teeth staining hypokalemia and BMI 21 – Bulimia nervosa
41.Rash on sun exposed areas – PCT
42.Leishmania – Sandfly
43.IgE produced by plasma cells
44.Ankle oedema – diltiazem
45.White spot in the mucosa – measels
46.Vaccination for s.pneumonea and H. inf – due to hyposplenism
47.Tuner – coarctation of aorta
48.Increased pulse pressure – due to compliance of the aorta.
49.A patient with hypoxia with peripheral edema – LTOT
50.Intermittent facial flushing- angioedema – perindopril

51.LMWH – activate anti-thrombin 3/ inhibition of factor x

52.Ileocolectomy – cholestyramine is to be added
53.Rhyming voice with doctor – mania
54.Glucokinase in skeletal muscle and brain acts in a different way due to –
Different affinity
55.Pregnant women with lumps and axillary freckles – NF1
56.Acute tonsiliits followed by rash – Guttate psoriasis
57.Single ring enhancing lesion – Toxoplasma
58.Overdose with wide QRS – Amitryptiline
59.Rheumatoid arthritis – Ulnar deviation of MC joint
60.DKA treated while waking up cloudy vision- due to change in refraction
of the lens
61.Larger pupil – Adie’s tonic pupil
62.Calf hypertrophy – Becker’s muscular dystrophy
63.Becker – the functional protein is still produced
64.Elder with short-term memory loss – Donepezil
65.Buttock pain and tingling sensation in the leg – pyriformis syndrome
66.CMV – Vangancilcovir
67.IV cefotaxime – SBP
68.Alport syndrome – SNHL
69.Gram negative diplococci – Azithromycin given already thinking of
chlymydia, what to add – Ceftriaxone.
70.Cat – B. hensele

71.Omeprazole and esmoprazole – enantiomers

72.Morphine breakthrough dose 1/6 – 10 mg
73.Right diaphgrm is injured – phrenic nerve
74.6 months after myasthenia low mood – depressive disorder
75.FEV1 Improved with salbutamol – asthma
76.Neisseia meningitidis infection – C5-C9 ( C7 was in the option )
77.APML with t(15,17) – good prognosis – PM
78.Melanoma – vertical thickness
79.Hep c – cryoglobulins
80.Isolated neutropenia – seen in high altitude no treatment necessary
(benign ethnic neutropenia)
81.MEN 1 – insulinoma
82.Autosomal Dominant/Biventricular enlargement - HOCM
83.SLE in a young woman – hydroxychloroquine
84.Hyperkalemia – IV ca gluconate
85.Ketone source – lipolysis
86.Terminal cancer – midazolam
87.Aortic dissection – labetalol
88.COPD stable patient with reduced po2 and high pco2 room air 84%
something – since patient is not acutely ill – preferred 28% venturi mask
( if acutely ill – reservoir mask with 15L/min)
89.Pleural plaques – mesothelioma
90.Long QT – Magnesium iv

91.Hyperphagia and small testes obesity – prader willi syndrome

92.Palliative care – SC glycopyrronium
93.E-Smoking and and lung cancer – odd’s ratio
94.Specificity- probability of negative results when they don’t have the
disease
95.PICA
96.Peroxisome – very long chain fatty acids
97.Foot touching the ground with waddling gait – G.maximus.
98.Stat Q asked about mean cholesterol or something parametric data –
paired test
99.Recurrent meniigitis – HSV
100. After 150j shock, what should be done for a VT – In a monitored
situation, 3 successive shocks with same joules, if outside shock then cpr
should be started Ref: PM.
101. Rectal biopsy with crypt abscess and depletion of goblet cells –
Ulcerative colitis.
102. CKD patient and rediced kidney size in USG, Renal Imaging – DTPA
scan ( contrast is contraindicated in ckd Patients)
103. A patient presented with confusion, fever and low platelet counts
– TTP (RA)
104. Scleroderma complication – Malabsorbtion
105. Restless leg syndrome – Ropinirole
106. ALS – Riluzole
107. Diabetic nephropathy involved part is – Glomerulus
108. Dicrotic Notch – Aortic valve closure
109. Reduced Hb and normal ferritin – anaemia of chronic disease
110. Morning stiffness and pain resolves after 3 hrs – AS

111. Sjogren’s syndrome with RTA which part of nephron is involved –

Distal Nephron
112. Rugby player presented with progressive weakness of limbs over 6
months, with bladder retention he was playing rugby before that. MCV
was increased – vit B12 deficiency
113. ECG coorelates with something – LBBB
114. Facioscapulohumeral muscular dystrophy
115. Bone marrow suppression or Hypersplenism – alcoholic, reduced
count of RBC, WBC and Thrombocyte. (Reference from Harrison- BOTH )
116. Confirmatory for Acromegaly – OGTT
117. Lacunar Infarct – CADASIL – AD
118. A person with obesity, Hypertension and DM – drug to be given
which gives weight loss also – Exenatide
119. Molluscum – self-limiting condition
120. Measuring pneumothorax according to BTS – from hilum
121. Future risk of Completing the suicide, risk is – previous planning
(RA)
122. Difference in limb blood pressure – Takayasu arteritis
123. Bronchiectasis – to prevent exacerbations –postural drainage
124. Procyclidine MOA – Anti-cholinergic ( anti-muscarnic )
125. Increased Creatinine clearance depends on – muscle mass
126. Seizure, licking lips and pulling shirt – Temporal lobe epilepsy
127. If buprenorphine is added with morphie – reduced analgesia
128. A lady with CF and husband is the confirmed carrier, affected child
– 50%
129. Tube drainage is required if the ph is less than 7.2 ( Guidelines are
in emedicine )
130. Trimethoprim, how it affects creatinine – Inhibits the tubular
secretion.(RA)

131. Insulin is a transmembrane receptor

132. C. difficle infection prevention – soap and water
133. Cannon ball metastasis – secondary to renal ( kidney )
134. Iv drug user with fine granular lesions in both lungs, D/D military
TB and PCP – Bronchoalveolar lavage.
135. Enteropathic arthirits – sure answer
136. ARDS – protein rich pulmonary edema
137. Golfer presented with Reddish macular rash present over scalp
and back of the neck – Actinic keratosis
138. Female hirsute immigrated to UK, with primary amenorrhea and
virilization first to test.initial test - Serum testosterone or confirmatory -
17-OH ( answer is CAH non-classic )
139. Polycythemia vera with elevated WBC cells and Increased
platelets – JAK2
140. Gout with peptic ulcer on omeprazole – colchicine
141. Proximal joint swelling/ peri-articular osteopenia RA factor
positive – RA
142. After 2 months common among IVD users – STAPH AUREUS. PM
attached.
143. Charcot’s neuropathy
144. Cryptosporodiasis a women presented again after 2 days of bowel
motions, stool examination is cysts of cystospora– is largely supportive (
Nitazoxanide is licensed in UK for immunocompetent patients ) – PM.
145. Staus epilepticus – first line is IV lorazepam, Q was patient had 3
seizure at Emergency areat, while examining also he was having one, for
established seizure or ongoing one IV phenytoin/ phenobarbital – (RA)
146. Testicular cancer – B HCG /LDH
147. PICA/ Vertebral artery?????
148. Tobacco factory – upper lobe fibrosis – EAA
149. A Lady waiting for a bus, dizziness occurs with no Loss of
consciousness, it happened previously also – intervention – Postural
hypotension –( NICE recommends measuring BP again standing from a
seated position or supine after 1 min of standing)
150. Nocturnal hypoventilation – long term effect – reduced FVC/Inc
HCO3
151. Future Mortality prevention – clopidogrel
152. PBC next investigation – MRCP
153. A women with menorrhagia, constipation and hyperprolactinoma,
on risperidone– primary hypothyroidism
154. A lady presented to the diabetic clinic with profuse sweating,
while talking her speech is slurred what is the appropriate management
– IM glucagan ( since it’s a diabetic clinic and glucagon is available, if it’s
roadside – chocolate/juice would be the best answer – Not sure though )
155. Discarded Needle stick injury/ had booster dose 4 years back –
reassure OR HIV PEP??( tetanusvaccine and Ig – isn’t required <10 yrs if
dose received <10 years as per guidelines.)
156. Fragility fracture – osteoporosis risk – previous fragility fracture
OR family history of fragility hip #??Low BMI is the risk for fragility #, not
High BMI, NICE guideline is attached
157. Adrenal insufficiency – one Q with lowest hormonal parameters
158. When a drug can’t be removed by dialysis – high protein bounding
159. Paracetamol tablet overdose , presented after 3 days with
confusion worst prognosis – Increase in PT>> PH less than 7.3 (RA)
160. Diabetic/ subcutaneous tender swelling – necrobiosis lipidica/EN?
161. Girl with trust issues/ trust no one – paranoid
schizo/Shizoaffective?
162. TM joint pain aggrevated in cold and chewing – Temporal
neuralgia or TMJ ??
163. Strongedt indication to isolate in a room – AFB in sputum, urine ,
CSF and AFB in discharging neck sinus.??
164. Axillary lymph node – breast cancer
165. Hodgkin’s lymphoma – bad prognostic sign – night sweats, WBC
cells more than 15,000 cells??
166. ECG Axis was asked -90 degree.
167. Blood transfusion minimum to re-check for HbA1C – 1 month or 3
month??
168. Jaundice with dilated gall stones/no pyrexia, next intervention is-
Cholecystectomy or MRCP or ERCP??
169. Cervical lymph node of 1.5 cm and increased WBC count – CLL
Immunophenotyping/Node biopsy ??
170. Menorrhagia women – VWD??

171. Iv methylprednisolone or immunoglobulin – GBS

172. Stat Q2,
173. Stat Q3
174. Periarticular osteopenia – Dexa scan??
175. Avascular necrosis – full range of movement with one side
restriction??
176. Another genetic Q 1 in 4. Maternal uncle were positive
something??
177. Cyclophosphamide acts via T Cells/Macrophage ( One of these has
to be the answer)
?? cyclophosphamide eradicates large implanted GL261 gliomas by
activating antitumor Cd8+ T-cell responses and immune memory OR
Macrophage.
178. MOA steroids in asthma – anti-inflmmatory?? Option? B receptor
activation?
179. Malar rash ANA POSITIVE anti-ds negative, antibody? Jo1, anti
smith RNAP??
180. Natalizumab induced PML. How to monitor annually – Jc virus
titre, MRI brain ( Mri brain seems clinically feasible ) open to
discussion??
181. MOA – endothelin, in a a ptient given Bosentan increase
resistence
182. A UTI patient on co-amoxiclav, causes of hypernatremia? Due to
reduced water intake? Or reduced Nacl absorption.
183. Bloody diarrhea, returning from Africa, fellow camp members
were also affected- Entameba or shigella???
184. TP53 gene – cell cycle arrest/tumour suppressor/telomere ??
185. Family members were morbidly obese >40 BMI, - due to polygenic
cause/ due to single genetic disorder??
186. Q from neurology – left sided uvula or tongue deviation ( not sure
whether uvula or tongue )ataxia and c/l weakness – options were Rt Sup
cerebellear, lt sup cerebellar, rt inf cerebellar, lt inf cerebellar and AICA
187. Severe MS in pregnancy – Increase herat rate
188. Fecal calprotectin – 2 or 1 Question??
189. Patient taking Thiazide diuretic, developed diarrhea and AKI 1.
DRUG INDUCED/DEHYDRATION??
190. Yersinia

191. Drug induced psychosis – Break up between BF and GF

192. Kallman
193. Gfr 33/Diabetic and protenuria – ACEI
194. Nodular sclerosing – LN biopsy
195. Intention to treat analysis
196. Recurrent facial rashes which disappears, while examination no
rash – Malingering/ Allergic contact dermatitis????
197. Montreal cognitive assessment chart/ frontal lobe assessment to
be done on?
198. Telescoping of fingers – Psoriatic arthritis
199. TTP – Plasma Exchange.

All the best for the results, pray for the best to happen. -J