Student Date OF Birth Batch No Sait otan-00 ‘Academie Session Subject Exam 2oni-22 Block ll (Renal I, Endocrine and (2210-16) Reprecucton) Marks Total Marks: Marks Obtain Paper Question & Answers Details nginear working Ina factory took into consideration the four factors .eair temperature, velocity, humidity, and mean radiant heat, The resulting indieator is known [Enhanced greenhouse effects responsible for global ‘warming, Many gases contribute to this phenemenen. However, the gts that is mainly responsible for this phenomenon Is: ‘Water waste Is broadly dlvided into two maln types. Complex wastes are those that cannot be decomposed or dissolved by natural agents. They remain on earth for thousands of ‘years without any degradation. Henco, the threat caused by them is also more critical and crucial in polluting the planet. ‘Which among the following is a complex non-biodegradable waste? ‘An engineer working in a factory took into consideration the {our factors ai temperature, velocity humidity, and mean radiant heat. The resulting indleator Is known as: ‘The & hour average sound pressure level In factory was ‘measured by the expert in ergonomics by using a sound level meter. The resut was 40 decibels (ABA). The most appropriate conclusion drawn from this observation is: ‘A member of EPA Environmental Protection Agency was Planning to monitor the air pollution ina cosmopolitan city ‘The most appropriate inditors for this purpose ae: [Enhanced greenhouse effects responsible for global ‘warming, The gas that is mainly respons phenomenon is: ‘RComfort zone 8 Cooling power Comected effective temperature [7] D Elective temperature ‘Ammonia © B Carbon dioxide [7 Carbon Monoxide Dehlerine E Sulu dioxide ‘Rania bones 8 Fecal mater C Insecticides (7 D Leather E Sewage {Comfort zone 8 Cooling power Comected effective temperature [7] D fective temperature E Maximum allowable sweat rate ‘ATs sound will use auditory fatigue The sound levels witin accepted range f (C The sound level is higher han accepted range 1D There isa risk of permanent loss of hearing E The results inconclusive "8 Carbon donde and carbon monoxide ‘8 Hydrocarbon, Ozone & Smoke Lead Oxide & Ammons 1 Poly nuclear Aromatic Hydrocarbon (PAH © E Sulfurcoxide, Nirogen Dioxide, Ozone, Carbon monoxide anc paticulte matter. [T] ammonia © B Catbon dioxide [7 Carbon Monoxide Dehlorine ‘Sulfur dioxide“There are several methods of hospital waste lsposal. The method in which waste can be disposed of by burning! combustion i called ‘A surgeon performed an incision and drainage procedure for an abscess, The abscess was drained, and the drained fuld Is sent fr disposal. According to WHO classification of hospital waste, under which category does ths drained fuld fall? Human papillomavirus (HPV) infection Is the most common exually transmitted infection and can cause skin wats, enital warts, or certain cancers. Of the many different Sirains of HPY, which ofthe following is most likely to cause isble genital warts? HIVIAIDS pationts are at risk of getting opportunistic infection The main reason of this typeof infaction is ‘A 38-year-old man previously in good health suddenly develops severe abdominal pain radiating from the lft ain tothe groin and associated with nausea, perspiration and {requent urination, He is restless, tossing and turing in bed but has no other abnormal findings. What Is the most likely diagnosis? ‘A4T-yearold man presented with flank pains that occur on ‘lth ade for months, He was known hypertensive and on _ntihypertonsive medicines for years. His urine analysis, showed red calls in urine. On physical examination, he had a mass deep in each flank, His laboratory test showed raised BUN that was 48 mia. (normal is 20 mg/dl) and creatinine 's 1.9 mgldL. Complete blood count was normal. What isthe ‘most probable diagnosis? ‘A G-yoar-old child has boon drinking more wator, with more ‘requent urination, forthe past7 months. Urinalysis shows Hof 65 and no proteln, blood, glucose, ketones, WBCs, RECs, or caste. Serum electrolytes are deranged and creatinine is 3.2 mg/dL An ultrasound scan shows bilaterally ‘small kidneys with medullary cysts concentrated atthe cortlcomedullary junction, Which ofthe folowing genes Is ‘most ksly mutatod in this chile? ‘A. year-old man has had right flank pain forthe past 2 ays. Urinalysis shows no blood, protein, or glucose, and microscopic examination ofthe urine shows ne WBCs or RBCs, Abdominal CT scan shows a 7om eccentric lesion of, ‘the upper pole ofthe right kidnay. The lesion is wall circumscribed and cystic witha thin wal and focal hemorrhage, What s the most likely dlagnosia? ‘neineraton 8 Inertzation © Chemical teatment D Microwave radiation ‘infectious (Pharmaceutical D Animal waste E Ratloactive waste AType4 O 8 tweem CType 1 DType 1 E Type 58 ‘AAotieroval drugs that are used to treat AIDS make the persor vulnerable a infection 'B HIV vis interacts with opportunistic micro-organisms and makes ther © C immune systom is weakened by HIV [7] © Kaposi sarcoma thats tumor peculiar o AIDS, destroy lymphocytes ofthe pation E The life syle of AIDS patients is changed making them vulnerable te ‘opportunistic infection ‘A Herpes zoster involving the left lower rb dermatome 8 Left ureteric calls [7] Retopertoneal hemorrhage, 0 Sigmoid dvertcultis forsion ofthe let testicle “RAate pyelonephiis 8 Acute lomerulonephie Chron nal face 1 Polycystic kidney disease [] Renal cel carcinome AvBTS2 BMCKD: CNPHPIf ) DPKD: E PKHD: ‘AAcato pyelonephaiis B Hycronephrosis Renal cal carcnoma © B Simple renal eyst (7 Jrotnelial carcinomahad a fever and sore throat forthe past 3 days, She Is treated with ampicilin and racovers fully In 7 days, Two weeks later, he develops fever and a difus ‘erythematous rash on th trunk and extremities, and notices a slight decrease in urinary output. Urinalysis shows 1+ proteinuria; 1+ hematuria; and no glucose or ketones. Microscopie examination ofthe urine shows RBCs and \WACs, including eosinophils. Whats the most likely cause other disease? ‘A.1Tyear-old boy is involved in a motor vehicle accident in ‘Which he sustains severe blunt trauma tothe extremities and ‘abdomen. Over the next 3 days, he develops ollguria and dark brown urine. The urine dipstick analysis is positive for myoglobin. His serum urea nitrogen level increases to 38 gla. His condition improves after dialysis, but the urine ‘output remains greater than 3 Liday for 1 week before the urea nitrogen returns to normal. What i the most ko iagnosis? ‘Ayoung pationt with generalized edema and proteinuria presents in emergency room. The renal structure most likely damaged is: ‘835 yr old man has frequency of urine with pe Urine, The folowing will indicate defect oftubut hich ofthe following would not results in incr urea concentration 130d blood In a clinical Audit, thas been found that no case of HYPOKALAEMIA has been reported from your lab while the percentage of pationts with hyperkalaemia, and sodlum abnormaiiies is quite reasonable. All your quality checks are ‘within acceptable range. What could be the cause of this ‘anomaly? ‘Ayoars old fomale fs having polyuria (2.5 tres of urine fay). Sho Is nota known patient of dabetes molitus. She has been referred to you for carrying out watr deprivation test torule out dabetes insipidus. Which ofthe following isthe ‘most important parameter to be tested In blood and urine? 66 years old patient with gastroenteritis presents to medical emergency with decreased urine output and AKI, His ‘workup shows hyperkalemia and AKI.ECG shows tlt waves , which ofthe fllowing isthe immediate treatment of hyperkalemia? 1216 years old mal bilatoral lowor limb woakness, power of 05 he reports celebrating his birthday lastnight and reports intake of § ices of cake. his ECG shows prolonged QT interval with u- wave. whieh ofthe following electrolyte is responsible? Patient with history of sudden ons os ‘ADepositon of immune complexes with steplococcal antigens maton of antibodies against glomerular basement membrane CC Hematogenous dissemination of septic embo D Hypersensitivity reaction to ampiciin (7 Renal tubular necrosis ‘AAute pyelonephtis 8 Acute tubular nary © Malignant nephosclerosic Membranousn Renal vein thrombosie 5) ABasement membrane [7] 8 Calyoos © Proximal tubule E Renal pes ‘AFed sp. Gavi of urine Highblood urea level CC High plasma osmolarty [7] D High urinary sodium Hyponatremia ‘ACC 8 Glbeeting 0 Pregnancy Severe dehyratior "XA aul SE equipment 'B Delay in separation of serum [7] Use of expr reagents © Use of qu heparin causing dtr Use of colton tubes containing sodium heparir "REsiimation of Aldosterone B Estimation of BNF C Renal function t 1 Serum and une electrolytes © E Serum and urine osmolality ‘insulin wth derrose B hemodialysis pertoneal alysis © Din calcium gluconate E ventaline nebulizatons ‘Asodur B magnesium Deadlum E potassium [7]12.36 years old wit history of head trauma secondary to road traffic accident presents to ER with polyaypsia, polyuria, he denies extra medications and other comorbid his workup ity. whats the {276 years old female, known case of small cell carcinoma lung, undertretment from oncologist. presented to ER with fit, he denies extra medications and other symptoms ‘emorgoncy Investigations are ordered, serum sodium Is 101, other labs are normal. what the most probable diagnosis? 232 years old patient with body swelling, mala rash, “arthalgla, photosensitivity and alopecia, she on examination has a malar rash, small joint tenderness, pedal edema. on Urineanalysis she has 42 albumin and 63 RBC-casts, the lagnosis of SLE with renal involvement. which ofthe {following isnot a hallmark of nephritic syndrome? 'A23 yrs old lady presented to you in the gynas clinic with ‘the complaints of burning micturation and increased urinary Arequency, What is the most common organism causing Irinary tract infection. Which modality f tst shouldbe the inital investigation of choice after proven urinary traction infection [A258 YEARS OLD BOY PRESENTED WITH FEVER AND [ABDOMINAL PAIN FOR THE LAST 5 DAYS. The mother of the baby was saying thatthe baby eres while passing urine. ‘There is ne jaundice, no pallor. Tho child was having history of constipation. OF patient i having 102 °F, notin distress. No jaundice, The abdomen is soft and non tender and there is no visceromegaly, Which ofthe following investigation wil ‘you do forthe definitive diagnosis. ‘A60 year old male having history of Right loin pain and Aysuria on and off, was diagnosed with amass in the right kidney. On tissue blopsy it was found hypemephroma of Right kidney. What should be the management plan? 'AS5 year old male having history of Right loin pain and dtysuria on and off, was diagnosed witha mass in the right kiney.The most common Renal tumor is ? ‘A,young gel presented to the out patient department is having lft loin paln and dysuria Further Investigations showed left PUJ obstruction with stone, Diagnostic Investigation for PULO ia? ‘A,young giet who underwent ultrasound abdomen for chronic ‘abdominal pain. Right kidney was absent and found attached to lft kidney on loft side, What's the congenital anomall called? ‘Renal diabetes insipidus [7] B nephrogenic dabetesinspidus partial dabetesinspdus D psychogenic plydypsts E suo} ASIADH TT 8 psychogenic polyypsic C thiazde induced hyponate D hypovolamic hyponatremia E hypervolemic hyponatremie hematuria B hypertensior impaired renal functions D nephroterange proteinuria (7 ‘Proteus mirabius Dklebset E Streptococcus ‘RDNA sean B DTPA scar C . Renal utrasonogrophy (T DCT sean of abdomer E.Mcuc "A Special Smear 8 Urine Culture [7 (C Utvasound abdomen 0 Micturatingeystourethvogra Xray KUB "ARU Radical Nephrectomy [ '8 Partial nephrectomy Adjuvant chemotherepy 0 Folow up and montring Moncclonal abodes ‘ROncoeyoma {8 Renal Cell carcinoma [7] C Angiomyoipoms DD Pheeehramacytoma ‘ACT scan B DTPA scan lnvavenous Urogram ‘AHorse shoe kidney B Fused crossed ectopa[ Pelvic Kidney O Rtrenal agenesis E Loft win kidney‘8.35 year old female who is diagnosed incidentally with horse shoe kidneys, Horseshoe kidney is located at? Normal [A225 year old male has raod traffic accident and pr ‘ith a shattered pelvis wth bruising extending to his perineum, nthe ER, he is unable to void There is no blood at ‘the meatus. What are the appropriate next stops In management? nts ‘A patient suffering from urinary tract Infection was started fon a drug that did not achieve any significant systemic levels but accumulated in the urinary bladder and eradicated the local infection, Which of the following isthe most probable drug that fits the above mentioned profile? 'A28 yoar old fomale presents to the medical OPD during the 2nd timester of her pregnancy with burning mietuetion. On Investigations she is found to have urinary tract infection Which ofthe following would be most likely prescribed to this patient? Envetop Shaped crystals are seen in urine on microscopic ‘examination, in which ofthe following poisoning? ‘A.5-year-old elderly man produced only 25m! of urine Inthe past 24 hours, The diagnosis of benign prostatic hyperplasia ‘was made by tho urologist, What isthe cause of acute renal {allure inthis patient? Combined oral contraceptive pills commonly used and comprise of estrogen and progesterone. They are very “effective in preventing pregnancy but also have certain side ‘offocts. One ofthe rare adverse effects of COCPS is ‘According to WHO, many diffrent methods of family planning ate suggested fo couples soaking advice by h professionals, Which method is part of hormon contraception? ° ° ‘ANermal place {8 Higher than normal Lower than norma (7, DPehis E Opposite side rf ther is hematuria obtain act Acaretlly place a Fleys cath ‘ogram 8 obtain a retrograde urethrogram and ct urograr Cobian a retrograde urethrogramit negative,place a foley and obtain & cteystogram [7] (© D place a suprapubic tube and obtain a cystogram ‘RAmoxclin O 8 Cotrimoxazole C Levooxacr DO Nitoturantoin[ E Timethoprin ‘NAmoxiclin [7 C Bonay! Penialir D Ciprofoxacir E Doxycycine ‘Adrsenie 8 Mercury © Oxalle Aid © Phenol Thallum ‘AP re renal 8 Per cena © 0 Post Renal E Ina Glomervat 5) AAny healthy maried couple B A.ouple having a marriage cerfiate CCA couple where the age of wif is between 1 to 49 years [7] DA couple whore the age of husband is between 20 o 60 years Acouple whe the age ofboth husband and wife is between 20 to 6¢ ‘A Cause bith defects £8 Deep vein thrombosis OC Excessive boxy or facial har D infections Pelvic inflammatory dseases ‘ACondor © B intrauterine contraceptive device Subcutaneous implants [7] 1 Tubal igator‘The human body uses carbohydrates in the form of glucose ALung land stores oxcoss glucose inthe form of glycogen. Which, 8 Smal intestine organs) of human body stores glucose inthe form of genie) ‘stores a >) € Liver and museles alyeogen? C D Stomach and muscles E Spleen balanced diet mainly comprises of carbohydrat. A05% proteins. How much percentage of calories is contributed by 1 Bie carbohydrates inthe most of our dets? 30% Das% E70% ‘The mode of obtaining food, growth, anergy repair and ‘ACarbohydrates| maintenance is called nutrition. Which components offood 4 © BPreeine {are called body builders? D Minerals E Fats ‘The mode of obtaining food, growth, anergy, repair and 4 ‘ACarbohyarates ) B Nuttion [7] C Calorie Protein ‘A patient with Bone pains is advised by hs doctor for Stoke supplementation of minerals and vitamins in his diet, But he B Diarthea Is advised that the consumption in axcass of cartain, 1 -. Iinerals and vitamins leads to side effects developing. © Constpatior Excessive intake of calcium in our diet results in, >) 0 Kidney stones [7] E Vergo Which isthe most essential nutrient required for a woman AThiamin during her initial stages of pregnancy for the provention of 1 8 Vitamin ¢ birth defects? © C Foie aca D Vitamin E E Vitamin A [A.2year-old child from a flod-stricken land presented tothe (© Akwashionor Tr closest BHU with symptoms ineluding fatigue, ttabity, cMinoan ‘and lethargy. He had addtional signs of hypoplgmented halt hyperkeratosis, and hyperpigmentation. The child on ‘examination appeared to be stunted with loss of muscle mass and generalized edema, and a large, protuberant belly with a moon face. His medical history confirmed repeated Infections. What isthe probable diagnosis? C Lichen Planus Iodine is a trace element essential to maintain the healthy ALiver growth and development ofthe human body. Which ofthe following body parts is strongly dependent on the trace ‘mineral iodine? c 4 B Thymus (© Thyroid Giand [7 Pineal Gland [A Sosyearcold South Asian male has had type 2 diabetes ‘Ano meltus forthe past S years. His glycosylated hemoglobin, B Race HbA\tc is 7.5% while on metformin 850 mg TDS and glipiaide 5 mg dally, Ho has afarly history of diabetes. Ho is Ethnicity otherwise well but has noticed an increase in his body 0D Family history ‘eight over the past 2 years since he is leading a sedentary — 1 Mestyle. On examination, his temperature is 37C, his blood Pressure is 150/88 mmHg, and his pulss rats 80 por minute. His body mass index is 38 kgim2. Which ofthe following is a modifiable risk factor to curb disease progression in the glven case scenario? © E Sedentarytfestye‘The high-power microscopic appearance of a thyroid nodule shown here Is from a 44-year-old mal. His sorum foo T 4 ‘and TSH levels are normal. No thyroid autoantibodies are detectable inthe serum. This is most consistent with a past history of 'A0.7-cm microadenoma ofthe adenohypophysis is sen by head MRI ina 254/earold formate. Which of the following complications is she most likely to have? Which ofthe following laboratory tests should be per- Period after a subtotal thyroidectomy for a fll eoplasin? Which ofthe following tests should be done first when ‘assessing the functional status ofthe thyroid gland 42 years old female presents to gynae clinic presents with ‘vaginal discharge. Foul smeling discharge was seen on ‘vaginal examination. Gynecologist dacided to do PAP smear Main advantage of PAP cytology smears sto ‘A.2yearold child has had fllure to thrive. The child is short, atures, a protruding tongue, and an hemia. Profound mental retardation ls apparent a ‘the child matures. These findings are best ex-plained by @ lack of ‘A113.yearold female collapses while playing basket ball ‘When brought tothe emergency room, she is obtunded. She has hypotension, tachycardia, and deep, rapidlabored respirations. She has a serum sodium level of 151 mmol, Potassium level of 46 mmol/L, chloride level of 98 mmollL, bicarbonate level of7 mmol, and glucose level of $21 rmgfdl urinalysis reveats no protein, blood, or nitite, but there are 4+ glucose and 4+ ketone levels. The most probable pathologie finding in the pancreas atthe time of her collapse is ‘A.49-yearold male Is feoling fine when he has his blood pressure checked forthe frst time in 20 years. Ho is surprised to find that he hi of 155/95 mm Hg. He has had no serious medical problems and Is taking no medications. Which ofthe following factors ls most likely to be Important in the Initiation ofthis form of hypertension? ‘A{3.yearold man has had watery diarrhea and epigastric pain for the past 3 months. Over-the-counter antacid ‘medications do not relieve the pain. An upper sgastrointostinal endoscopy shows multiple shallow, sharply demarcated ulcers in the duodenum, Hels given ‘omeprazole, Three months later, repeat endoscopy shows ‘thatthe ulcerations are stil present. Which ofthe fllowing “analytes is most likely to be increased in his blood? ADietary iodine deficiency tradition tothe neck [1] Cons mption of goitogens 1D Removal of tumor fom the adranal meds Viral infection “RAmenoshea with galactortea [7] ( BHyperthyroidsn Acromogaly D Cushing disease Synarome of inappropriate antluretc hormone (SIADH) ‘Galonin (© B Thyroid stimulating hormone (TSH) (Parathyroid hormone (PTH © Aatithyroglobuin antibody € Calcium [7] ‘RA total T level £ Total trodathyronine (T3) evel © © Thyrid-simuatng hormone (TSH) level [ 0 Fine needle aspraton E Radloiodine scan [A Detect pre-neoplastic changes to prevent development of malignancy m B Diagnose frank malignancy to institute immediate teatment (© © Diagnose infectons to instute appropriate antibiotic treatment 1 Quickly detect the hormonal status to insite hormonal therapy E Diagnose venereal diseasos ‘ACortso B Insulir Norepinephrine D Somatostatin OE Thyroxine (14) 7, ‘RAmilod replacement of les © CEosinophi inition of islets D Loss of sels of Langerhans [ ‘© AGone defecs in aldosterone metabolar B increased catecholamine secrevon Ineeased production of tal natriuretic factor 1 Renal retention of excess sodium [ Renal atary stenosis ‘© AGastin 8 Glucagon D Somatostatin Vasoactive intestinal peptidehad sever ‘A33.yearold woman h episodes of lighthoadednoss followod by a brief loss of consciousness. (On examination she has no loss of motor or sensory {unction. Imaging studies reveal a 1em lesion in the head of the pancreas. Blood insulin lave are raised. Microscopic ‘examination of the lesion shows infiltrating cell having small rounded nuclei and salt and pepper chromatin, What is the most likely diagnosis? |A a4 yearold man is referred for evaluation of hypertension {and porsistont hypokalemia in spite of taking oral potassium supplements. Blood pressure is 180/110 mmHg. Serum sodium Is 149 mEq/L. (normal 140 to 148 mEajL}; potas 3.3 mEqlL (normal 3.6 to 5.2 mEqlL}. Computed tomos demonstrates a 3cm mass in the right adrenal gland. The most likely diagnosis is? 'A53 fomale subjected to renal transplantation 3 years ago [After the surgery he started glucocorticoids therapy to prevent the rection of transplantation. She came tothe hospital for sereening and the adrenal biopsy was done What's the most Bkely finding that can be observed? ‘A S:yearboy develops secondary sex characteristics, penis, Which ofthe following morphologic features is most aly tobe seen in his adrenal glands ‘A4S-yearold lady with diabetes melltus presents with this Ulcer on her foot. Her posterior tibial pulses are easily fot, but her dsalis pedis pulses are not palpable. Pinprick and vibration perception are absent from the knee down, what is the tke aetiology ofthis ulcer ? ‘A 13¢yoarcld female collapsos while playing basketball ‘When brought tothe emergency room, she is obtunded. She has hypotension, tachycardia, and deep, rapid labored respirations. She has a serum sodium level of 151 mmol, potassium level of 46 mmol, chloride level of 98 mmol, bicarbonate level of7 mmol, and glucose lovel of 521 rmgfdl A urinalysis reveals no protein, blood, or nitrite, but thoro are 4+ glucose and 4 ketone levels what Is the most probable pathologie fading in the pancreas at the time of her collapse? ‘A.6-yearold female has had diabetes mellitus for more than 30 years. She now has decreasing visual acuity. There ino ‘ye pain. Her intraocular pressure is measured as norm: Which ofthe following lesions Is most likely to account for her visual problems? ‘A previously healthy, 36-year-old female has had several "elnting spells” in the past month. During these episodes, she becomes light headed and then collapses, recovering in few minutes, but experiencing diaphoresis and tachycardia, Which ofthe following laboratory results is ‘most likely tobe found during one of these episodes? ‘A46eyearcld woman complains of inereasing fatigue and muscle weakness over the past 6 months. She reports an inabilly to concentrate at work and speaks with a husky volee. The patient denies drug or alcohol abuse. Physical ‘examination reveals cold and clammy skin, coarse and brite alr, boggy face with putty eyells, and peripheral ‘edema. There Is no evidence of golter or exophthalmos. Laboratory studies show reduced serum levels of T3 and T4, Which ofthe following Is the most Ikely underying cause of these signs and symptoms? ° 4 ‘AAoute pancreatitis B Adenocarcinoma cyst bros © Metasatecarcinome Neuroendocrine tumor daison disease © Conn syndrome [7 D Cushing disease E Sipple syndrome AContiel atopy [7 8 Cortical hypertrophy C Difuse hyperplasie D Dysplasie 370 nodular hyperpas ® Anodule in the adrenal cortex composed of zona glomeriosa cells O © Bilateral adrenal cortcal hyperplasia (7 Bilateral adrenal cortical atrophy Ainfesior B Ischaemic C Newepathic DO Neuroschaemic “Ramo replacement of isles Eosinophil inttration of islets D Loss of aes of Langermans [7 E Pancreatic duct obstucor A Cytomegalovinis retnie C Keratomalacie 5) 8 Optic neuritis Proliferative retinopathy [7 ‘A Hypocalcem 8 Hypoglycemia [i C Hypercarbia D Hyperaycom: Ketonuria ‘NAmyoidoss of the tyro B Graves’ dsease €C Hypothyroidism [ Mutnodular gore E Thyroid falioular adanome‘A 20-year-old woman has had difficulty concentrating at ‘Work for the past month, Sho Is constantly geting up and ‘walking around to visit co-workers. She complains thatthe ‘work area is too hot. She seems nervous and often spills her coffe. She has been eating more but has lost 5kg in the past 2 months. On physical examination her temperature Is 37.5°C, pulse 10tIminute, respiratory rate 22/minute, and blood pressure 145/85 mm Hg, Which of the following laboratory findings fs most likey to be prosent inthis woman? ‘A middle-aged man has experienced dlarhes, nervousness, palpitations, and Increased iitabllty forthe past 5 months Proptosis and lid tag are among physical examination ° findings. Which ofthe following laboratory findings is most likely? Congenital adrenal hyperplasia Isa group of autosomal recessive disorders, each characterized by hereditary defects in an enzyme involved in adrenal sterol ° biosynthesis.Name one particular hormone for this condition? 'A4 patient came to Gynae OPD with complaining of irregular heavy vaginal bleeding she is having miscarriage 2 months back after miscarriage complaining of iregular per ‘vaginum bloeding.On por abdominal examination utorus is 0 ‘about 16 weeks size ,on ultrasound grapes like structur ‘mass is present inside uterus.You advise beta HCG What ‘Would be the diagnosis In this patant? ‘832 yoars old lady presented to OPD withthe complaint of chronie vaginal discharge Her pap smear was taken and the result came out tobe inadequate cervical cytology. what is ‘the further management of this patient. 'APS patient with 38 years age came to OPO with complaining of heavy menstrval bleeding from last one Yyearon ultrasound her uterus is normal in size and shape no pathology present ndometrial thickness is Smm patient 0 ‘ants treatment for heavy menstrual bleeding also wants contraception. Her last baby born I 2years What Is the most sultabe option for this patient?” ‘A18 yoars nulliparous obese girl came to Gynae OPD with complaining of eligomenorrhea,seanty flow you advis utrasound.on ultrasound multiple cyst present in right 4 ovary.the is also complaining of hirsutism What would be the cause of oligomenorshea in this patient 'A35 yeras old presented to the OPD witha history of subfertlty of 5 years and heavy menstrual bleeding forthe past 1 yearullrasound shows a 5x5 cm hypoechoic mass 0 Aistorting the uterine cavity what isthe most probable diagnos ‘A772 years old lady present with postmenopausal bleeding lasting for 3 months, she also complains of vaginal bleeding and itching. She had a hysterectomy for some benign 1 consdltion 20 years ago. On elinial examination, there Is ‘excessive vaginal dryness what Is next appropriate stop? ‘A Decreased catecholamines 8 Decreased iodine uptake (Decreased plasma insur 1 Decreased TSH [7 Increased ACTH ‘Alncreased plasma insulin leve B Increased serum T level [ Ineeased serum TSH level D Increased serum cortisol lave E Increased serum cortcatopi lve ‘RAldosterone 8 Cortisol 7 CEstrogen D Glucagon E Thyroid hormone "Roar pregnancy [i 8 Choriocarcinoma C Fibroid uerus © Placental sto tophoblastctumar E Retained products of conceptor ‘A Repeat cervical cytology In $ months [7] Repeat cervical tology in 6 months Repeat cervical eyology in 1 year D No action E Convcalbopsy ‘RCuT inrauterne devioe 8 Mirena cocrs implant E Emergency contraceptive pls ‘A Pelyeyste ovarian syndrome [7 8 Acrenarche © Physiological cause Dobestty E Hirst 8 Fibroid coyst D Endometrial carcinoma Do Nothing 8 Examination under anesthesia D topical estogen E ultrasound pelvis‘Ail 16 years old present with frequent menstrual cycle of 18 days duration t isnot associated with dysmenorthea.Her ‘quality of life fs disturbed with this complaint she has dropped her hemogiobin from 11 gm to 8 gm The next to investigate will be ‘Awoman 22 years old comes tothe OPD with the complaints of fraquent heavy menstrual cycle.She Is PARA 2 and her last baby ie 3 years old.She has this problem 4 years ago ‘hich resolved spontaneously. You examine her with speculum and find some growth protruding from the corvix with an average sizeof 1 em diameter.The probable cause of this Bleeding Is ‘A 24yoar old woman martied for 2 years has not conceived yet Her heights 1.5 m and weight 80 kg with BM of 35.2 ‘She menstruates every 40 - 45 days , the meses last for 23 days with mild flow. She denies dysmenorrhea or yspareuna, Bimanual pelvic examination reveals normal sized ,anteverted mobile on-tender uterus Her husbands semen analysis reports within normal mits. The most likely cause of her subfertity i {A3 years old boy presents to your OPD with chief complaint of short height and constipation On examination the child is having hypotonia,upward slanting palpebral fisures, Flat ‘ace simlan crease and wide space between frst and second, too.What is the most probable diagnosis? ‘8.15 month old child presanted to OPD with right sided ‘emply scrotum. There is bulge in right inguinal region. What is the inital investigation of choice to diagnose undescended tests? ‘403 months old infant presented with right side empty scrotum. On examination: right testis Is palpable in right Inguinal region; A diagnosis of Right undescended testicle (UDT) is made, whats the ideal age of Orchidopexy? 2 years old child with undescended testis, ther Is increas chance of? ‘A 24yoat old obese woman in her 26th week of pregnancy ‘was dlagnosed with gestational dlabetes mellitus aftar positive ghicose tolerance test. She was otherwise healthy, and her past medical history was unremarkable. Dietary ‘management filed to control the blood glucose, and her physician decided to prescribe antidiabetic therapy- Which of the fllowing drugs would be most appropriate forthe patient at tis time? ‘AT year-old boy was brought to the emergency department by his parents because of nausea, vomiting, and persistent ‘abdominal paln secondary tothe fu. Medal history ofthe patient was unremarkable Pertinent serum values on ‘admission were fasting blood glucose 300 mala (70-110 mg/dl), glycosuria 3+, Which ofthe following drugs would be appropriate for this patient? ‘AUtwasound pels [7] © B Thyroid function test Cthrombophile screening D high vaginal swab culture Pap smear ‘Rearicl cancer 8 endometrial cancer conical erosior D nabeshian folie E polp ‘Adnovlaton 7 8 Endometiosi € Tubal blockage 0 Fibroid uterus Pali intammatory dseas ‘RDown syndrome 5) 8 Ture syncrome C Edward syndrome 0 Prader wil syndrome Hypothyroidism 'A Physical examinaton/palpation of inguinal region [ 5) 8 ttasound abdomer C Laparoscopy Dai ‘R69 months [i ‘Testor torsion 8 Testicular tumor CHydrocole D Both @ and b [7] ‘A Giyburide B Insulin [7] (Metformin D Repaginide E Stagliptin 1 Metformin B Migito C Pioglitazone © Regular insln [7] E Rey inde‘A.22yearold woman with type diabetes was brought anncotectous tothe omargerey departments Hor blocs ARatvation of adenosine tiphosphale(ATP}-sensitv K+ iehannels in alucose level was 395 mala (normal 70-110 mld). An target cots Intravenous infusion of insulin was started, and 6 hours later, B Inhibition of glucose transporters in pancreas cll membranes the patont's blood glucose decreased toa nora evel . : ° Which ofthe following molecuiar actions most likely ¢lnibiton of Wve glucokinase contributed tothe therapeutic effect ofthe drug in the © DPhosohorylaton of a tyrosine kinase-tnked receptor ents disorder? pat E Stimulation ofhrmone-sensve lipase ‘A.A year old man with type diabetes started an intensive ‘AHypertensor ‘tharapy to achive atight control of his dabetes. Whichot >) Hypogycomia[T the following complications will the man be at greatest ° : increased risk of experiencing? C Loss of vision © Nephropathy E Weightloss “hat your old wan uth eeyausettcaly euaned typed {OA Bioaks iodide transport into the tyroie syar old man with asymmoticaly enlarged thyro oO sland associated wih elevated loves of T3 and TAs treated g ® Increases hepatic metabolic inactivation of circulating T4 and T3 ‘with propyithiouracil (PTU). Which ofthe following best summarizes the principal mechanism of ation of PTU? nhs protscyes of yma lati thyroidal peroxidase [7] Releases T9 and T4 nt the blood ‘A patient with hypothyroidism following thyroidectomy wil A Levothyroxine requir felong hormone replacement therapy. Which ofthe 4 orally would be most suitable? Cot Protein Thyroid, desiooated ‘A patient prasents in the amargency department with a ‘AGiyburide massive overdose of a drug, The most worrisome signs and B insulr symptoms include excessive cardiac stimulation (severe . + tachycardia, palpitations, angina, ete). The ED physician O C Levothyroxine 1 ‘orders IV administration a P-adrenorgle blocker, saying Prednisone (correctly) tis the only drug ikely to normalize cardiac function quickly and save the patient's Ife, Which ofthe following was the most ikely drug the patant overdosed on? E Propythiourac ‘Apatient witha previously undiagnosed thyroid cancer "Block parenchymal cel receptors for thyroid hormones presents with thyrotoxicosis (thyroid storm). One drug that B Block thyroid hormone release by a direc effect onthe glanc is administered as part of early management, and maybe 1 . Mesaving, Is propranoll. Which of the following best lati thyroid hormone synthesis summarizes why we give this drug, or what we want to do? © D Lessen dangerous cardovascula signs and symptoms of thyroid hormone excess [7 ower TSH levee Inhibition of gonadotropin release in required in a patient for ‘AConcomitant use of antagonists which sheis stated on gonadotropin analogues, Which of, >) 8 Continuous administration [ the following methods of administration would be followed . inthis patent? Gradual increase in dose © Pulsatile acminstrator E Single large dose ‘Atemale of 35 y ‘adiposity, asthania and reduced musclo mass. A few wooks. BM later she presented tothe medical emergency anxiety and ovarian dysfunction, On examination her prolactin levels ‘Were iow. Which ofthe following drugs Is most kely D Somatostatin responsible fr the patient's condition? 2 was reeling somatotopin for © ABromoctpine I 1 € Prolactin E Somatatropir ‘Apostmenopausal woman is a candidate for hormone ‘ARisk of depression replacement therapy as a result of signs of development of © B Rbk of endometrial carcinoma 7 osteoporosis. The doctor decided to add progestrin tothe 4 therapy. Which of the folowing isthe rationale of ation of (Cet ponents rte progestin? Risk of osteoporosis Risk of terine bleeding‘female of 30 years presented tothe medical OPD for a routine checkup during the 2nd trimester of pregnancy. On Investigation the patient was noted to have hypernatremia ‘and edema. Which of the following factors most probably lead tothe patient's condition? ‘Afemale of 26 years presented tothe medical emergency after a miscarriage half an hour ago, She is taken tothe labor room. Which ofthe following willbe used forthe ‘management of this pationt? Fat embolism is caused during criminal abortion dus to: Hyporsenuality in fomales refers to: Superteation means: I vaginal discharge is yllow followed by whitish color after called: ‘The uterus after very resumes its normal size within: Which ofthe following during pregnancy can be hazardous tothe fetus? ‘The softening of lower segment of uterus refers to: ‘Tho fundal height at the lovel of umbilicus roveals the duration of gestation as: © AAelvatio of adosterone [7 8 Gestatona cabetes Increased loves of sur D ketogenesis Physiologie wlme overoae ‘ADesogeste 8 Hycronprogestrone (CMecrany progesterone D Mifepstone E Norethindrone ‘A Cavsing general violence © Causing local violence on abdomen © C eating soapy solun inure cavity 7) D Setinstumentaion E Using abortion stick ‘AFestty 8 Feigaty © impotence © Nymphomania © E Satyasis /AFetzation of wo ova charged curing wo ciferent ovations [T, 8 Baby bom during priate labor Baby bom with congenital anomalies © 0 Fartiization of wo ova brated dvng the same ovation E Tile pregnancy ‘ALochiaakzar 8 Lochi alba © CLochia nies © Lochia rare E Lochiasorose ‘AD weeks O84 wooks C6 weeks [7] De weeks 8.5 wooks ‘Fooling the fla movements & paris 8 Physical examination of abdomen Cc Presence otal cols the ther’ blooe © 2 Radiograph of he ets 7) E Ultrasonography (© ABranon Hid so 8 Chadwick ior Goodets sign 0 Hogar’ sign E Uterine soue © AFive months 8 Four months Seven months 0 Sixmonth [7 These months“The most vital sign of virginity i 1 ‘Cito is small (CO BHymen is intact (C The fourchette& posterior commissure are intact D Vagina isrugose E Vestibule is narton ‘A.Se-yearold Muslim man witha history of type 2 diabetes teks for advice, He lv due to start tasting for Ramadan soon [Awe to subcutaneous biphasic insulin forthe duration of Ramadan ‘and is unsure what he should do with regards to his diabetes 0 18.500 mg a the predawn meal +1000 mg atthe sunset meal medications. He curently takes metformin 500mg tds, What Is the most appropriate advice? © EN change to the mettomin dose 1 1000 mg atthe predawn meal + 500 mg atthe sunset mea! Stop metformin for te duration of Ramadar ‘A 2,/enrold woman has just found out she Is pregnant for ‘ACheck HOATC immediately the second time. Her frst pregnancy was complicated by © B Start matformin and ask the woman to seltonitr glues gestational diabetes Following her fist pragnancy she was 0 told she was no longer dlabetic. What Is the most a. . otopriste mansounent? Do oral glucose tolerance test as soon as possible after booking [ 1 Do oral glucose tolerance test at 16-18 weeks Do oral glucose tolerance tet at 24-28 weeks. [A 30,yearold female i started on carbimazole 20mg bd Total T4 following a diagnosis of Grave's disease, Whats the best 0 BTSHIT biochemical marker to assess her response to treatment? CF ree T4 DESR E Free Ts ‘A 62syearcold man is investigated for hypertenion and A Carcinoid tumour proximal myopathy. On examination he Is noted to have 1 5) 8 Smal col ung cancer [7] ‘abdominal striae, Which one of the following is most sociated with ectopic ACTH secretion? Cardin mysome © Squamous cel lng cancer E Adrenal carcinoma ‘A 54-year-old man with type 2 diabetes mellitus is found on ‘Follow-up ophthaimoscopy in 3 monthe ‘annual review to have new vessel formation atthe optic dis. BAdd aspicin Visual acuity in both ayes isnot affected (6/9). Blood ° pressure is 15S/84mmHg, HbAtc 8.4% What is the most ‘© © Blood pressure contro! Important intervention inthis pationt? D Tight glycaemic conto Laser therapy I ‘A.8.yearold gentleman with longstanding type 2 dlabetes. ‘AMetformin presents tothe acute medical take. Glood tests are 8 Depagifozin [7] ‘demonstrated in the table below. The blood test results are consistent with diabetic ketoacidosis, He has no other past medical history other than type 2 diabetes and obesity. He DAspiin has not had episodes of diabetic ketoacidosis before and does not drink alcohol. His medication history includes ‘aspirin, losartan, metformin, dapaglifiozin and glimepiride. He is allergic to pencil. pH 726 Blood ketones 3.6 mmol. Blood sugar 270 mgldl Which of his medications Is most likely to have contributed to developing diabetic ketoacldosia? C Glimepiide ©) | OE tosartan |A.2Ayearcold female with a history of type 4 dl melitus presents to the Emergency Department with + unit/hour ‘Yoriting and abdominal pain. Fingerpick testing estimates the blood sugar tobe 480mgidl. Arterial blood gases record ‘api of 7.22. On examination the patients dehydrated and 0 6 unt/ hour ‘weighs 0 kg, An Intravenous line is sited and bloods are ent. One lire of 0.9% saline is infused and an intravenous Insulin pump Is set-up. What ate should insulin be intally given? tee © At0 unit hour hour (7‘An obese 48-year-old man presents with lethargy and polydipsia, What isthe minimum HATS that would be Alagnostc of type 2 dlabetes melitus? ‘An 18-year-old gris admitted to the Emergency Department with an episode of sweating and dizziness. Sho Is brought in by her father who has type 2 diabetes mellitus as h worried she may be dlabetle, He describes a number of similar epinodes fr the past wo weeks. Her BM on ‘admission is 36 mg/dl so the fllowing bloods are taken: Plasma glucose 36mg Insulin 15 mg (6-10 male!) Proinsulin 22% (22-24%) C-peptide 0.15 nmol (02-04 mol) What isthe most likely diagnosis? ‘A patients tying to prevent pregnancy by using rhythm method. At which time during a woman's cycle isthe most fertile? Ina normal 28 days menstrual cycle, when would you expect the Li surgete occur "A Cannal use HBAT for agnosis B 6.0% (42 mmolimo €6.3% (45 mmolmot 1 65% (48 mmolina) ‘ADiabetes maltus 8 Insulinom C Nesicoblasosis D Insulin abuse (7 Sulforylurea abuse ADays 15 8 Days 9-16 7] C Days 17-21 D Days 22-28 Days 24-28 REO days 1 11-13 days 614-16 cays 017-19 days E 10-20 days