Medicine 2015 Nov MCQ & BRQ Review 3

MEDICINE | 2015 NOVEMBER 1
MEDICINE - FINAL MBBS

2015 NOVEMBER | MCQ & BRQ REVIEW
Abstract
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PROUDLY PRESENTS
DISCLAIMER
Due to the spread of Covid 19, all universities were closed until further notice on 13 th
March 2020 & the Final MBBS Examination which was to be commenced from 23 rd
March too was postponed. To control the community transmission, the government
announced island wide curfew from 16th March onwards.
Curfew brought additional time to prepare for the exam but when no one knows when
will it be over, when will universities begin & when is the exam, this extra time
eventually pushed us into a massive pool of idleness. Feelings of uncertainty & chaos
are haunting one’s mind, taking them away from their prime goal of continuing
academics. But there's another group literally called "men", who are always looking for
some relief, enjoyment in their depressed lives & for them, a limit-unknown free time
is like an oasis in an angry desert with 72 super-hot maidens. Prime goal is to enjoy this
idleness until the death notice comes; the exam date.
So the sole purpose of this attempt is to wake us from our ecstasy and push ourselves
back to work or to create a motive to study because sooner or later the exam is
coming. All answers in this review are not 100% accurate. Even the additional
information provided may have some issues (human error can occur even when coping
the same shit from an eBook & pasting it on a word document) & therefore, we are not
taking any responsibility regarding the reliability of the content. Anyone is free to use
this as a guide but do not depend on the answers. Do questions yourself & find
answers yourself. Helping you with your studies is not our concern.
Buwahahahahaa!
#FutureNostalgia
XXXVI | FMUR
Contents
1 – CNS | GBS .......................................................................................................................................... 5
2 – CNS | MG........................................................................................................................................... 6
3 – CVS | Pulse Pressure ......................................................................................................................... 7
4 – CVS | AS............................................................................................................................................. 8
5 – Respiratory | Clinical Signs ................................................................................................................ 9
6 – Respiratory | Pleural Effusions ....................................................................................................... 10
7 - CLCD ................................................................................................................................................. 11
8 – Cirrhosis........................................................................................................................................... 12
9 – Renal nephrology ............................................................................................................................ 13
10 – Metabolic Acidosis ........................................................................................................................ 14
11 – Renal | Polydipsia.......................................................................................................................... 15
12 - AIHA ............................................................................................................................................... 16
13 – Gout............................................................................................................................................... 17
14 – Infections | Antibiotics .................................................................................................................. 18
15 – Infections | Malaria....................................................................................................................... 19
16 – Dermatology | Skin Rashes ........................................................................................................... 20
16 – Dermatology | Skin Rashes ........................................................................................................... 21
17 – Genetics | AD ................................................................................................................................ 22
18 – DM | GLP (Glycogen like peptide) ................................................................................................. 22
19 – Psychiatry | Transient Psychotic Disorders ................................................................................... 23
20 – Psychitry | Delebarate Self Harm .................................................................................................. 24
21 – Emergency | CNS .......................................................................................................................... 25
22 – CNS | NPH ..................................................................................................................................... 25
23 – CNS | Meningitis ........................................................................................................................... 26
24 – CVS | Atrial Fibrillation .................................................................................................................. 26
25 – CVS | HF ........................................................................................................................................ 28
26 – CVS | ACS ...................................................................................................................................... 29
27 – Respiratory | COPD ....................................................................................................................... 30
28 – Respiratory | Chest Infections ...................................................................................................... 31
29 – Respiratory | COPD ....................................................................................................................... 32
30 – Cirrhosis......................................................................................................................................... 33
31 – Hepato-Renal Syndrome ............................................................................................................... 34
32 – Hepatitis ........................................................................................................................................ 35
33 – Hypertension ................................................................................................................................. 36
34 – AKI ................................................................................................................................................. 37
35 - DM.................................................................................................................................................. 38
36 – Thyroid .......................................................................................................................................... 39
37 - DM.................................................................................................................................................. 40
38 – Anaemia ........................................................................................................................................ 40
39 – Infections | Mycoplasma .............................................................................................................. 41
40 – Infective Endocarditis.................................................................................................................... 42
41 – Hospital Acquired Infections ......................................................................................................... 44
42 – Poisoning | Organophosphate ...................................................................................................... 45
43 – PCM Poisoning .............................................................................................................................. 46
44 – Statistics ........................................................................................................................................ 47
45 – Respiratory | Asthma .................................................................................................................... 49
46 – Snake Bite ...................................................................................................................................... 50
47 – Psychiatry | Hypochondriasis........................................................................................................ 51
48 – Psychiatry |Phobia ........................................................................................................................ 52
1 – CNS | GBS
Regarding GBS
a) Type 1 respiratory failure is a feature.
b) Global areflexia is typical.
c) Distal demyelination is a feature.
d) Elevated CSF protein is a feature.
e) Treated with IV methyl prednisolone.
Answers
a) F
b) T
c) T
d) T
e) F
GBS Clinical features

• Areflexia, hyporeflexia
• Flaccid weakness of limbs (Ascending paralysis)
• Bilateral LMN facial palsy
• Type 2 respiratory failure
• Cardiac arrhythmia
• Hyper/hypotension
• Ileus
• Urinary retention
• Investigations –
▪ Nerve conduction studies: slow velocities
▪ CSF analysis: raised protein with no cells
▪ Anti Gm antibodies
• Treatment- plasmaparesis, iv immunoglobulin

• IV methylprednisolone doesn't provide any benefit in GBS
2 – CNS | MG
WOF are true about myasthenia gravis

a) Muscle wasting is a prominent feature.
b) Fluctuating muscle weakness is seen.
c) Heart is not affected.
d) Proximal muscles are mostly affected.
e) Associated with thymic hyperplasia.
Answers
a) F
b) T
c) T (https://pubmed.ncbi.nlm.nih.gov/1099888/ )
d) T
e) T
Myasthenia gravis clinical features

• Fluctuating proximal muscle weakness
• Muscle wasting doesn't occur
• Tendon reflexes are preserved
• Extra-ocular muscles affected first
• Pupils are spared
• Dysphagia
• Dysphonia
• Type 2 respiratory failure can occur
• Associated with thymoma, other autoimmune diseases, SLE, RA
3 – CVS | Pulse Pressure
On examination BP 120/50mmHg recorded in the right upper arm. What are the possibilities?
a) AR
b) MR
c) AS
d) PDA
e) VSD
Answers-
a) T
b) F
c) F - narrow pulse pressure.
d) T
e) F
Explanation-
This patient has wide pulse pressure (systolic pressure -Diastolic pressure) A ‘collapsing’ or ‘water ha
mmer’ pulse - is a large-volume pulse characterized by a short duration with a brisk rise and fall. Thi
s is best appreciated by palpating the radial artery with the palmer aspect of four fingers while eleva
ting the patient’s arm above the level of the heart. A collapsing pulse is characteristic of aortic valvul
ar regurgitation or a persistent ductus arteriosus.
Source- Kumar and Clark’s clinical medicine 8th edition- page 677
4 – CVS | AS
Regarding aortic stenosis

a) Can present with angina
b) ECG may show left ventricular hypertrophy
c) In severe disease there can be narrow pulse pressure
d) Has a thrusting apex
e) Has a loud 2nd heart sound.
Answers-
a) T- In moderately severe cases develop exercise-induced syncope, angina and dyspnea When
symptoms occur, the prognosis is poor
b) T -The ECG shows left ventricular hypertrophy and left atrial delay. A left ventricular ‘strain’
pattern due to ‘pressure overload.
c) T –Sinus rhythm, low volume, slow rising and has narrow pulse pressure.
d) F- The apex beat is not usually displaced because hypertrophy does not produce noticeable c
ardiomegaly. However, the pulsation is sustained and obvious.
e) F- Soft or inaudible aortic second heart sound when the aortic valve becomes immobile
Source- Kumar and Clark’s clinical medicine 8th edition - page-746-747

5 – Respiratory | Clinical Signs
Which is/are correct

a) Tidal percussion is positive in a pneumothorax.
b) Vocal resonance is reduced in a pleural effusion.
c) Cracked pot sign is seen in large lung cavities.
d) Coin sign is seen in a pneumothorax.
e) High pitched bronchial breathing is heard over a consolidation.
A. T positive in pneumothorax, emphysema, Collapse, consolidation, fibrosis pleural thickening.

B. T
C. T Pulmonary cavities. especially at the apex communicating by a narrow orifice with an open
bronchus.
D. T Coin Sound: Transmission of coin tapping sound is increased on the side of tension
pneumothorax. You will hear increased transmission of sound on the side of tension pneumothorax
with a metallic tone to it.
E. T
Tidal Percussion
Percuss down the back until the normal
hyperresonance of the lungs becomes dull over the
diaphragm. Then simply have the patient breath in and
out deeply while continuing to percuss. The sound
should wax and wane.
Pleural effusion (skodaic cracked pot, though

ordinary tympany or hyperresonance is much more
common). Occasional cases of pneumonia when the
consolidation is at its height. Occasional cases of
bronchitis, especially in children. Normal lungs of crying
children during expiration.
Cracked pot sign also A finding of late

hydrocephalus, in which increased intracranial
pressure leads to palpable separation of cranial sutures;
percussion of the skull evokes a ‘jagged’ sound which
has been fancifully likened to sound of a ‘cracked
vessel’.
6 – Respiratory | Pleural Effusions
Exudative pleural effusions are seen in

a) Hypothyroidism
b) Meig syndrome
c) Nephrotic syndrome
d) Pancreatitis
e) Pulmonary infarction.
a) F
b) F
c) F
d) T
e) T
Pancreatisis
If the pancreatic duct disruption occurs posteriorly, an internal fistula may develop between the
pancreatic duct and the pleural space, producing a pleural effusion (PPF) that is usually left-sided. ...
These effusions are generally serosanguinous, hemorrhagic and of exudative type.
Reference - Oxford handbook of clinical medicine

7 - CLCD
Which of the following investigations are correctly matched with their cause for chronic liver cell
disease?
a) Primary biliary cirrhosis – anti ds DNA
b) Auto immune hepatitis – anti smooth muscle antibody
c) Wilsons's disease - 24hr urinary copper excretion
d) Hepatitis B – HepBsAg
e) Hemochromatosis - 24hr hemosiderin excretion
a) F – 2 of 3 to diagnose PBC 1. anti mitochondrial antibodies 2.persistant elevation of serum

alkaline phosphatase 3. Liver biopsy for histology
b) T – type 1 antinuclear(ANA), anti smooth muscles type 2 anti liver/kidney microsomal
(antiLKM) type 3 soluble liver antigen (SLA)
c) T – local investigations : serum ceruloplasmin, Cu concentration, liver function tests, urinary
copper excretion
a. Specialist investigation : gene tracking, liver biopsy for history and liver
copper,copper isotope studies, mutation detection.
d) T
e) F – Transferrin saturation, serum ferritin, liver function tests

8 – Cirrhosis
Causes of cirrhosis,
a) Hepatitis E
b) After acute poisoning of methyl alcohol
c) Asymptomatic gallstones stones without common bile duct obstruction
d) NASH
e) Portal vein thrombosis
a) ?F – hep E does not cause cirrhosis in immunocompetent patients, but causes cirrhosis in
immunosuppressed patients. (Www.ncbi.nlm.gov/pmc/articles/PMC5114516/
b) F – in repeated and excessive alcohol abuse
c) F
d) T
e) T
9 – Renal nephrology
A 35-year-old male presents with haematuria of 1-day duration. He has had a similar episode 1 1/2
years back. He is on treatment for diabetes mellitus. On examination there is no oedema. Blood
pressure is elevated. UFR-RBC 200, pus cells 34, protein nil. No RBC casts and dysmorphic red cells.
Serum creatinine and blood urea normal. Which of the following can be a cause?
a. Post streptococcal glomerulonephritis.

b. UTI
c. Renal cell carcinoma
d. IgA nephropathy
A) F - Casts must be present for diagnosis of nephritic syndrome. Dysmorphic cells is also
indicative of glomerular pathology. Protein is elevated in PSGN. Haematuria without these
features excludes nephritic glomerular condition
B) T - Patient is diabetic so is immunocompromised; therefore susceptible to recurrent UTI

episodes (can explain episode 1.5 years back), it can also present silently as painless
haematuria with pus cells.
C) T/F - Can occur if tumour has superimposed infection top, but it does not have pus cells
normally.
D) F - IgA nephropathy also a nephritic condition. Should have casts. [See Harrison’s 20th edition
whole book]
10 – Metabolic Acidosis
Causes for metabolic acidosis are,

a) Severe vomiting
b) Severe diarrhoea
c) Ketosis
d) Diuretic abuse
e) Acetazolamide therapy
a) F
b) T
c) T
d) T
e) F (or true if acetazolamide can can’t as a diuretic) T
• Metabolic acidosis: This is due to the accumulation of any acid other than carbonic acid, and
there is a primary decrease in the plasma [HCO3−]. It be classified as 1) with normal anion gap
2) with high anion gap or 3) mixed of the previous two.
• Severe vomiting causes GI chloride depletion, leading to metabolic alkalosis
• Diarrhoea causes GI bicarbonate loss, leading to metabolic acidosis with normal anion gap
• Ketosis causes metabolic acidosis with high anion gap, due to production of ketone acids.
• Today’s commonly used diuretics are Chlorotic diuretic has been typically associated with
metabolic alkalosis (see box 9.30)
• Acetazolamide is a carbonic anhydrase inhibitor which causes renal bicarbonate loss. It has a
diuretic type action, but it is typically not used for that purpose
11 – Renal | Polydipsia
Polydipsia is known to occur in

a) SIADH
b) Psychogenic polydipsia
c) Hyperkalaemia
d) CKD
e) Hypokalaemia
a) F - Syndrome of Inappropriate Antidiuretic Hormone cause excess ADH resulting water

retention.
b) T - Psychogenic polydipsia = primary polydipsia. Keep on drinking unnecessarily resulting
reduction of plasma osmolality & diluted urine
c) F - Hyperkalaemia do not cause polydipsia
d) F? - In CKD kidneys not functioning. So water retention can occur.
e) T
• Vasopressin / ADH – cause water

retention via V1 receptors &
vasoconstriction via V2 receptors.
• Vasopressin deficiency cause
diabetes insipidus
• Cranial DI – deficiency due to
hypothalamic involvement
• Nephrogenic DI – receptor
abnormality resulting insensitivity to
vasopressin
• DI characterised by – Polyuria,
nocturia & compensatory polydipsia.
• Commonest are Primary polydipsia &
impairment of renal tubules due to
electrolyte abnormalities like
Hypokalaemia & hypercalcaemia.
• DM also causes osmotic diuresis
cause polydipsia.
Reference – Kumar & Clerk 8th edition page

991-993 thirst axis
12 - AIHA
Regarding warm autoimmune haemolytic anaemia

a) Haemolysis occurs in peripheries
b) Associated with IgM antibodies
c) Caused by Mycoplasma pneumoniae
d) Is usually Coomb’s positive
e) Can be caused by methyl dopa treatment.
a) F – In warm HA haemolysis occur in spleen (in cold both spleen & peripheries)
b) F – IgG (IgM in cold)
c) F - Mycoplasma pneumoniae cause cold HA
d) T
e) T
AIHAs are acquired disorders resulting from increased red cell destruction due to red cell
autoantibodies. Characterized by the presence of a positive direct antiglobulin test.
Warm AIHA
• Common in middle age females.
• Splenomegaly & lymphadenopathy are present.
• Commonest cause – lymphoproliferative disorder.
• A history of blood transfusions and infections, exposure to drugs or vaccination.
• Ix – DAT +, spherocytosis, thrombocytopenia or neutropenia (Evans syndrome)
• Tx – Corticosteroids / prednisolone 1mg/kg, other immunosuppressants (azathioprine,
rituximab), splenectomy, blood transfusions
Cold AIHA
• Cold >>> RBC agglutination in peripheries (acrocyanosis) & complement activation cause
haemolysis.
• Ix – RBC agglutinate @ cold or room temp. False high MCV due to agglutination, DAT+, Cold
agglutinin test elevated.
• Tx – avoid cold, blood transfusion, TX underline cause, anti CD20/rituximab
CMV, EBV
Reference – Kumar & Clerk 8th edition page 398-400

13 – Gout
Regarding Acute Gout,

a) Low dose aspirin lowers uric acid excretion.
b) Uric acid concentration reduces after an acute attack
c) Allopurinol should be given within first week after an acute attack.
d) Common in 1st metatarsophalangeal joint.
e) Responds well to NSAIDs.
Answers (Source- Oxford hand book of Medicine, P550)

A. (?) True
Low dose aspirin increases serum urate level
B. (?)True
In chronic gout urate deposit in pinna, tendons, joints and kidney tissue (as stones)
C. False
Allopurinol is used as a prophylaxis to reduce the acute episodes of Gout
However Alopurinol can trigger an episode of acute gout, so it’s given 3 weeks after an acute
attack with the cover of NSAIDS or Colchicine(if NSAIDs are contraindicated ).
D. True
E. True
In acute episode- high dose of NSAIDs are used.
14 – Infections | Antibiotics
Correctly matched micro-organism with medication,

a) Methycilline sensitive staphylococcus – Cloxacillin
b) Pseudomonas aeruginosa – Co amoxyclav
c) Mycoplasma Pneumoniae – Clarythromycin
d) Plasmodium vivax – Chloroquine
e) Clamydia trachomatis – Doxycycline
Answers. (Sources- Oxford hand book of Medicine, Pub med, FAAP )

A. True
less serious MSSA- 1st Gen Cephalosporins ( Cephalexin )
Clindamycin / Erythromycin / Lincomycin
More serious MSSA- Cloxacillin, Flucloxacillin
B. False
A combination of Amynoglycoside and an Antipseudomonal beta-lactum is used
Amynoglycoside- eg:Tobramycin
Antipseudomonal beta-lactum- Piperacillin, Ticarcillin
C. True
Mycoplasma pneumonia cause moderate pneumonia
Rx- Oral amoxicillin 500mg – 1g tds +

Clarithromycin 500mg bd or Doxycycline 200mg loading dose, then 100mg bd
D. True
E. True
For uncomplicated infections – Oral azithromycin single dose or
Doxycycline 100mg bd for 7 days
in pregnancy – Erythromycin or Amoxycillin
15 – Infections | Malaria
Regarding malaria in Sri Lanka

a) Is currently an endemic disease in Sri Lanka. (F)
b) Vivax malaria is known as tertian malaria. (T)
c) Falciparum malaria can cause nephritic syndrome. (F)
d) Pathology of cerebral malaria is encephalopathy. (?)
e) Artemisinin is the most effective drug. (T)
Answer
a) F
b) T
c) F- P.malariae associated with glomerulonephritis.
d) ?
e) T- Artemisinin based drugs are the most effective treatment for both uncomplicated and
severe infections with P. falciparum in adults and in children.
16 – Dermatology | Skin Rashes
WOF cause a characteristic rash in palms and soles?

a) Secondary syphillis. (T)
b) Herpes simplex virus (T)
c) Condylomata accuminata (F)
d) Keratoderma blenorrhagica (T)
e) Arsenic poisoning (T)
Answer
a) T- Secondary syphillis causes generalized skin rashes involving the whole body including palms
and soles but excluding the face. The rash may take different forms ranging from pink macules,
through coppery papules to frank papules.
b) T- Erythema multiforme is a hypersensitivity rash caused by infections or drugs. Herpes

simplex is the most identifiable cause. Palms and soles may get involved.
c) F- Also known as ano-genital warts caused by HPV.
d) T- The skin of the feet and hands develop painless red and often confluent raised plaques and
pustules histologically similar to pustular psoriasis.
e) T- The first visible symptoms caused by exposure to low arsenic concentrations in drinking-
water are abnormal black-brown skin-pigmentation known as melanosis and hardening
of palms and soles known as keratosis.
16 – Dermatology | Skin Rashes
Rash in palm of hand

a) Mycoplasma.
b) Erythema multiform
c) Herpes simplex
d) Secondary syphilis
e) Granuloma annulare
a) T
b) T
c) T
d) T
e) T
In CAP, extra pulmonary manifestations are common in mycoplasma infections, and they include
include skin rashes. They are commonly found in acral areas including the palms, and can progress to
erythema multiforme and erythema nodosum.
Erythema multiforme is a self-limiting, symmetrical rash characterized by target lesions on the distal
limbs, palms and soles. These are concentric rings of erythema with a dusky centre, which may
occasionally blister. The mucous membranes may be involved, with oro-genital ulceration, erosions
and conjunctivitis – so-called ‘erythema multiforme major’. Erythema multiforme may occasionally
be a recurrent problem, in which case prophylactic acyclovir can be used.
Herpes simplex is the commonest trigger for erythema multiforme

Box 24.28, and figure 31.27 Kumar and Clark 9thed
Secondary syphilis
Between 6 and 10 weeks after the appearance of the primary lesion, constitutional symptoms with
fever, sore throat, malaise and arthralgia may appear due to septicaemia. Widespread skin rash
(present in 75%) is the commonest sign, which can involve the whole body, including the palms and
soles – typically, a non-itchy, maculopapular rash that may have a coppery colour (Fig. 12.9 KC 9th
edition)
Granuloma annulare (GA) is seen most commonly in children and young adults. It is usually
asymptomatic and characterized by clusters of small flesh-coloured or slightly erythematous papules
(with no surface change), which tend to form rings or part of a ring with a dusky centre. They
typically affect the dorsal hands and/or feet. Generalized papular and annular variants also exist. The
cause of GA is unknown; several systemic associations have been proposed but not proven, including
diabetes mellitus and thyroid disease. Palms can be involved in both localised and generalised
variants, but it is rare.
17 – Genetics | AD
Characteristics of autosomal dominant disorders,

a) Abnormal genes from both parents are a prerequisite for the disease.
b) Probability of affecting the siblings will be determined by the affected first child.
c) Abnormal gene is dominant.
d) Who do not have the disease can’t pass to others.
e) Huntingdon’s disease is an example.
a) F – One parent is enough

b) F
c) T
d) T
e) T
18 – DM | GLP (Glycogen like peptide)
Regarding GLP (Glycogen like peptide)

a) It is an incretin a) T
b) Produced by pancreas b) F
c) Increases insulin secretion c) T
d) Metabolized by DPP-4 d) T
e) GLP-1 agonists can be used to treat hypoglycaemia e) F
Regarding question 18
A. GLP-1 is a specific type of incretin released by gut in response to increased glucose levels.
Exenatide and Liraglutide are injectable GLP-1 agonists used as hypoglycaemic agent along
with other hypoglycaemics and insulin. Monotherapy is rarely practiced.
B. Is secreted from gut not pancreas.
C. Incretins account for 60 – 70% of post prandial insulin secretion
D. DDP-4 is a protease which breaks down GLP-1. Its inhibitors include Sitagliptin. Side effects
of DDP-4 inhibitors include GI disturbances and flu like symptoms such as pharyngitis,
rhinorrhoea and headaches.
E. hypoglycaemia is a side effect of GLP-1 agonist which is more prevalent when used with
other hypoglycaemics and insulin. Hypoglycaemia is as low as 5% when used as mono
therapy.
• GLP-1 reduce blood glucose by

1. increasing post prandial insulin secretion
2. Reducing glucagon release
3. Slowing down gastric emptying
4. Enhancing satiety
• Side effects include GI disturbances like diarrhoea, nausea, vomiting, pancreatitis.
• Renal impairment can be caused by reduced absorption of water.
• It is advised to take OCP and antibiotics 1 hour before injecting exenatide.
19 – Psychiatry | Transient Psychotic Disorders
Transient psychotic disorders,

a) Precipitated by stress
b) No need of antipsychotic treatment
c) Resolve within 3 months
d) Appear over 2 weeks
a) T - occur within 2 weeks of stressful event
b) F - Need antipsychotics. Considered psychiatric emergencies. Need hospital admission.

Suicidal risk +
c) T- no more than 3 months
d) T
20 – Psychitry | Delebarate Self Harm
Regarding deliberate self-harm

a) Carried out repeatedly till they die.
b) Commonly done using poisoning and overdosing drugs.
c) Management should involve legal authorities.
d) More common in females
e) Majority do not have a psychiatric illness.
a) F - 1-2% only suicide later
b) T - 90% drug overuse, Self inflicted injuries 5-15%
c) F - No need of legal authorities or psychiatric services in management.
d) T - more in males (but suicide high in female)
e) T- only minority have psychiatric illness - acute stress reaction, adjustment disorder,
personality disorder
DSH –
• 10% of acute medical admissions
• 25% risk of repeating in next year
• Common in young (15-20)
• Most are impulsive
21 – Emergency | CNS
A 49 year old male was found unconscious on road. On arrival his temperature is 370C, BP –
160/90 mmHg, PR-90 bpm. Cardiac auscultation findings are normal. His RR-20/min, lungs clear.
There is no neck stiffness. B/L pupils are 1mm in diameter, poorly reactive to light reflex and
fundus is difficult to examine. B/L lower limb reflexes are normal except B/L plantar responses,
which are extensors.
What is the most likely diagnosis?
a) Snake bite envenomation
b) Organophosphate poisoning
c) Pontine hemorrhage
d) Myasthenic crisis
e) Botulinum toxicity
Answer : C
• Pontine haemorrhage is mainly caused by chronic hypertension.
• It leads to pinpoint pupils, coma
• Causes of pinpoint pupils : 4 P’s
1. Pain killer: opioids/heroin
2. Pontine haemorrhage
3. organoPhosphate
4. Pilocarpine
• OP poisoning – hypotension, rhonchi & crepitation
• Myasthenic crisis causes respiratory muscle weakness
• Botulinum toxin & some neurotoxic envenomation cause fixed dilated pupils
22 – CNS | NPH
A 72 year old male was brought to the medical clinic by his wife. Wife complains that her
husband has forgetfulness and poor concentration during last few months. She also complains
of urinary incontinence and abnormal walk for the last few months. On examination he is
having an unstable gait. His fundal examination is normal.
What is the most possible diagnosis?
a) Lewy body dementia
b) Motor neuron disease
c) Normal pressure hydrocephalus
d) Parkinsonism
e) Alzheimer disease
Answer : C
Mnemonic for normal pressure hydrocephalus – ADI

A – Ataxia
D – Dementia
I – Incontinence
23 – CNS | Meningitis
A 28 year old prisoner was brought to the medical ward with an acute fever episode. His CSF
analysis findings were,
➢ Polymorphs 2
➢ Lymphocytes 48
➢ Protein 458mg/di
➢ Sugar 28mg/dl
➢ RBS 200 mg/dl
What is the most probable diagnosis?
a) Partially treated meningitis
b) Tuberculous meningitis
c) Viral meningoencephalitis
d) Leptospirosis
e) Viral encephalitis
Ans-(B)
Reference- K&C 9th ed. pg.864 / 8th edition pg. 1126
24 – CVS | Atrial Fibrillation
A 55 year old male who is a diagnosed patient with rheumatic heart disease, presented with
drowsiness and fiendishness. On examination he has irregularly irregular pulse, PR-160 bpm, and
BP 70/50 mmHg. What is the most appropriate management for this patient?
a) IV amiodarone
b) IV dobutamine
c) DC cardioversion
d) N/S intravenous infusion
e) IV digoxin
Ans- (C)
• IV Amiodarone 300mg over 30min > 900mg over 24h.
• This patient has got AF, unstable, but conscious, has structural heart disease.
• Patient is unstable if – unconscious, HF features, SBP<90.
25 – CVS | HF
A 60 year old previously well male complained of progressive breathlessness, abdominal

discomfort and swelling of the legs. On examination there was gross ascites, elevated JVP, bi basal
crepitations and an enlarged liver. BP 180/80 mmHg, RR 25/min, PR-36 BPM. On ECG heart rate
was 96bpm. What is the best management option?
a) Digoxin
b) Digoxin+ Furosemide
c) Furosemide
d) Abdominal paracentesis
e) Transthoracic pacemaker
Ans B
• Atrial fibrillation results in pulse deficit.
• In AF rate control is usually achieved by a combination of digoxin, beta-blockers or
nondihydropyridine calcium channel blockers (verapamil or diltiazem). Digoxin
monotherapy may be sufficient for elderly non-ambulant patients.
• Pacemaker implantation can be considered in older patients with poor rate control despite
optimal medical therapy.
• The symptoms and signs of heart failure are: Symptoms:
▪ Exertional dyspnoea
▪ Orthopnoea
▪ Paroxysmal nocturnal dyspnoea
▪ Fatigue.
• Signs:
▪ Cardiomegaly
▪ Third and fourth heart sounds
▪ Elevated JVP
▪ Tachycardia
▪ Hypotension
▪ Bi-basal crackles
▪ Pleural effusion
▪ Peripheral ankle oedema
▪ Ascites
▪ Tender hepatomegaly.
26 – CVS | ACS
A 55 year old male with history of diabetes mellitus and hypertension presented with retrosternal
chest pain. ECG showed 4mm ST elevations In lead V1 to V6. Streptokinase was given after
excluding contraindications. After 2 hours, pain persists and ECG shows 3mm ST elevations. What
is the best management option?
a. Urgent coronary artery bypass grafting
b. Rescue percutaneous coronary interventions
c. Repeat thrombolysis with ateplase
d. Subcutaneous enoxaparin
e. IVGTN
Answer B
• Fibrinolytic agents enhance the breakdown of occlusive thromboses by the activation

of plasminogen to form plasmin. Fibrinolysis is still used if PCI is unavailable.
• In patients who fail to reperfuse by 60–90 minutes, as demonstrated by 50%

resolution of the ST segment elevation, rethrombolysis or referral for rescue coronary
angioplasty is recommended.
Reference K&C 8th ed – read whole book

27 – Respiratory | COPD
A chronic smoker developed cough and progressive sob for 10 years. He presented with exacerbation
of symptoms for 1 week with productive cough. Physician ordered O2 via face mask. What is the O2
percentage you would give via the face mask?
a) A.35%
b) B.45%
c) C.60%
d) D.80%
e) E.100%
Answer A
This patient presents with a COPD exacerbation. In COPD as their respiration driven on respiratory
drive fixed percentage of oxygen given starting from 24-28%
Target saturation- 88-92%
Mx-
• prop up the pt
• Oxygen starting from 24-28% via venturi device
• Nebulize with salbutamol and ipratropium bromide
• Hydrocortisone 200mg iv or prednisolone 40mg stat. Steroid continue for 10- 14d
• Antibiotics
• Failure to respond BiPAP is used.
28 – Respiratory | Chest Infections
A 23 year old man presented with mild fever for 2 weeks. CXR shows right sided pleural effusion.
➢ FBC- wbc 8000
➢ Neutrophil- 60%
➢ Lymphocytes- 40%
➢ Pleural fluid aspiration also showed lymphocytic predominance
Likely diagnosis
a) TB
b) Connective tissue disorder
c) Lymphoma
d) Empyema
e) Parapneumonic effusion.
Answer A
• In parapneumonic effusion and empyema there is neutrophil predominance and swinging

high fever.
• Lymphocyte predominance occur in TB, malignancies and CTD.
• There is leukocytosis in lymphoma.
• And fever for 2 weeks suggests tuberculosis.
29 – Respiratory | COPD
A 65 year old male with cough cold and SOB for 3 years, presented with an acute exacerbation. He
was treated with Salbutamol + O2 nebulization. After 4 hours he developed confusion and
restlessness. What is the most appropriate investigation to find out the cause for his acute
confusional state?
a) FBC
b) CRP
c) CXR
d) CT brain
e) ABG
Answer (E)
• SOB for 3 years- COPD, they are dependent on the hypoxic drive, As this patient is given O2
nebulization Acute Respiratory Failure might have caused hypercarbia and hypoxia.
• Clinical features of Hypercarbia (respiratory acidosis) include confusion, drowsiness,

headache, peripheral vasodilation, tachycardia, bounding pulse, tremor/flaps, papilloedema,
coma
30 – Cirrhosis
A 50 year old patient with cirrhosis presented with variceal bleeding. He was managed with
octreotide and banding. What is the most likely measure to prevent further variceal bleeding?
a) interval banding
b) Oral Proton pump inhibitors
c) interval sclerotherapy
d) Oral nitrates
e) Beta blockers
Answer E
Management of variceal bleeding

1. Initial Acute variceal bleeding Mx
Initial resuscitation, iv access
Iv octreotide bolus or iv Terlipressin with prophylactic iv cephalosporin to prevent SBP
Urgent Endoscopy- banding, sclerotherapy injection or glue injection
Balloon tamponade if all fails
2. Mx of an acute rebleed
Repeat Endoscopy
TIPS or EM surgery
3. Prevention of recurrent/ further variceal bleeding

• Long term measures
▪ Non selective BBs- O Propanalol- B1 action reduce CO, B2 action splanchnic
vasoconstriction all reduce portal inflow
▪ Endoscopic repeated courses of banding
▪ Transjugular portosystemic stent shunts
• Surgical procedures
▪ Shunting, devascularization procedures, liver transplantation
31 – Hepato-Renal Syndrome
What is the best management option for hepato-renal syndrome?

a) Reduce diuretic therapy
b) IV fluid resuscitation with normal saline
c) IV terlipressin
d) Repeated large volume paracentesis
e) IV ceftriaxone
Correct Answer:- C. IV terlipressin

• Hepatorenal syndrome is a functional renal failure occurring in patients with advanced liver
disease caused by intense vasoconstriction of renal arteries.
• There are two types of hepato renal syndrome, type 1 and type 2.
• The type 1 HRS is rapidly progressive and exhibits a very poor prognosis with a 90% 3 month
mortality.
• The type 2 is a more stable less rapidly progressing renal impairment encountered in
patients with advanced liver disease.
• Albumin infusion plus administration of vasoactive drugs such as Terlipressin .5 - 2mg iv
every 4-12 hrs should be considered in the treatment of type I hepatorenal syndrome.
• Vasopressin may be useful in the absence of terlipressin.
Criteria for diagnosis of hepatorenal syndrome
• Advanced liver failure with portal hypertension.
• Serum creatinine concentration >1.5mg/dl or 24 hr creatinine clearance < 40 ml/min.
• Absence of shock, ongoing bacterial infection and fluid loss and no current treatment with
nephrotoxic drugs.
• Absence of sustained improvement in renal function after discontinuation of diuretics and
trial of plasma expansion.
• Absence of proteinurea(500mg/day) or haematuria.
• Absence of ultrasonographic evidence of obstructive uropathy or parenchymal renal disease.
Reference: - “Management of Ascites due to cirrhosis, spontaneous bacterial peritonitis and hepatic
encephalopathy – Clinical Practice Guideline Sri Lanka”, Page 45
32 – Hepatitis
A 3rd year medical student had an accidental prick injury to the hand while taking a blood
sample of a patient, suspected with Hep B infection. What is/are the most appropriate
investigation/s that should be performed subsequently?
a. HBsAg of the patient
b. HBsAg of the student and HIV antibody of the patient
c. HepBsAb of the student and HIV antibody of the patient
d. HBsAg and HIV antibody of the patient
e. HBsAg and HIV antibody in both
Correct Answer :- D. HBsAg and HIV antibody of the patient

• After exposure preferably both source and recipient should be tested for HBV, HCV, HIV.
• When investigating for HBV check for HBs Antigen and anti-HBs from recipient’s sample and
HBs Antigen from source sample if the source is known.
• When investigating for HIV if the source is known test source patient for HIV antibody (after
informed consent).
• If the source is HIV positive / high risk or unknown do baseline HIV testing for recipient after
counseling. If the source is not infected baseline testing or further follow-up of Health Care
Worker may not be necessary.
• When investigating for HCV Check for anti-HCV from source sample (especially from high risk
patients). If positive consider doing HCV PCR. Check for anti-HCV of the recipient as a
baseline investigation.
Reference: - Safety of Health Care Workers and Management of Sharps Injuries,

National G - 52 - Guidelines SLCM. Page 52
33 – Hypertension
A 35 years old male presents to his routine clinic with BL ankle swelling. BP 160/105, PR 78, UFR-
protein ++, RBC 2hpf, S.cr. increased, BU increased, Na+ and K+ normal, GFR 40, USS- increased
cortical echogenicity, normal size kidneys.
What would be the best drug?
a) Methyldopa
b) Nifedipine
c) Captopril
d) Prazosin
e) Sildenafil
Answer D
▪ methyldopa is centrally acting and less potent in a patient with this high a blood pressure
and most of the time reserved for hypertension in pregnancy
▪ nifedipine will be a effective choice in this patient as it has the potential to reduce a BP this
high, but this pt presents with BL ankle swelling which is a known occurrence with CCBs, and
would worsen it
▪ Captopril is renally acting potent enough drug used in early stages of CKD, this pt has a GFR
of 40
▪ prazosin is a newer long acting alpha blocker which has a good enough potency to control
this pts BP should be the answer
▪ Sildenafil although useful in a patient with HTN not used as a therapeutic measure in HTN
Reference; Kumar and Clark 8th edition, pharmacological therapy in HTN,page 783
~pasindu 36th batch
34 – AKI
A 63 years old man admitted to the ward with acute renal failure following an unknown snake
bite. On ex. He was found to have BL basal crepts and UOP was 500/24hours.
What is the best management option?
a. Reduce protein intake <40g

b. Fluid restriction
c. Oral k+ binders
d. Give salbutamol
e. Give oxygen via face mask
Answer B
● With rare exceptions, Na+ and K+ restrictions are appropriate, dietary protein restriction is
controversial
● Aim of mx of acute tubular necrosis is to keep the pt alive handling the complications
until spontaneous recovery of renal function occurs. Seems like the best answer here
● Hyperkalemia is (not mentioned in the que.) is corrected when correcting acidosis with
calcium bicarbonate due to fall of K+ concentration. Ion exchange resins phosphate binders
are another option
● Salbutamol and oxygen give a relief to the patient from Acute pulmonary oedema although
will be less effective if fluid intake continues and fluid overload persists
Reference; Kumar and Clark 8th edition, acute tubular necrosis Mx ,page 612
~pasindu 36th batch
35 - DM
A 72 year old male on oral hypoglycaemics present with fever for 3 days. Examination shows
dehydration and lethargy. Investigation shows RBS 620mg/dl, Na+ 150mmol/l, K+ 5mmol/l, HCO3-
25 mmol/l, Ph 7.35.
What’s the best next step in Management?
a) Soluble insulin 20u IM
b) 0.9% Saline bolus
c) Heparinization
d) Increase oral hypoglycaemic
e) Start mixtard insulin
Answer: (B) 0.9% saline bolus.

• History suggests Hypoglycaemic Hyperosmolar state (on oral hypoglycaemic : Type 2 DM,
• Fever for 3 day: Infection, High Na+ K+ levels : Dehydration)
• First step is to correct hydration with 0.9% Saline
• Then soluble insulin infusion. (3-6 IU/hr ??? Or similar to DKA insulin regime)
• After acute condition settled consider increasing oral hypoglycaemic dosage.
Other information:
• Associate with Type 2DM
• Precipitated by; Infection, MI, Stoke
▪ Conditions leading to Dehydration
• Diagnosed by; Hyperglycaemia >600mg/dl
▪ Hyperosmolarity > 320mOsm/kg
▪ Dehydration
▪ Neurological deficit
▪ No ketoacidosis
• Ix: RBS, Serum Osmolarity, (Blood Culture/ LP, CT bran)
• Mx: Hydrate with 0.9% NaCl
• Neurological assessment and support airway if unconscious
• IV insulin
• Differ from DKA; DKA has; Acidotic breath, Hypokalaemia leading to paralytic ileus
• Neurological deficit rare
Reference: Medscape
36 – Thyroid
A 35 year old female presented with recent onset malaise, tremors and palpitations for 2 weeks
with tenderness of neck.
TSH <0 01mmol/l (0.15-3.5), T4:- 0.35ng/dl, ESR: 44mm/ 1st hour.
What is the most likely diagnosis?
a) Graves disease
b) Thyrotoxic crisis
c) Subacute thyroiditis
d) Toxic MNG
e) Carcinoma of thyroid
Answer: (C) Sub acute thyroiditis.

▪ Tremors, Palpitations, Low TSH, High T4 level suggest thyrotoxicosis.
▪ Neck tenderness more favours Sub acute granulomatous thyroiditis.
Other Information’s:
• Most common cause for painful thyrotoxicosis.
• Aetiology ; Following viral infection (Influenza, Adeno, Coxacie)
• Disease course: (Usually 4-6 wks)
• Stage
1. Hyperthyroid
2. Euthyroid
3. Hypothyroid
4. Euthyroid
• Diagnostic Ix: FNAC
• Mx: Pain: NSAID
• Prednisolone 15mg/day & taper 5mg every 2 weeks
Graves’ disease: Specific signs;

• Exophthalmos
• Limitation to eye movements
• Periorbital and conjunctival oedema
• Pretibial myxoedema
Reference: Medscape
37 - DM
A 55 year old male driver with dm for 10 yr has a past hx of MI and LVF. He is on metformin 500mg
tds and glibenclemide 10mg bd. he presents with worsening nocturia. FBS 320mg /dl. HbA1c >10%
a) Add insulin
b) Low cholesterol
c) Increase metformin
d) Add acarbose
e) Add pioglitazone
Answer A
• Medico nutrient therapy can help but not definitive. pioglitazone is contraindicated in hf
• Increasing metformin dose in hf is not ideal.
• Acarbose will reduce hba1c and post prandial bs. Contraindicated in CRF.
• But best medication to reduce high blood sugar and hba1c in chronic dm is insulin
38 – Anaemia
A 25 year old male presented with hypochromic microcytic anaemia and blood picture with target
cells. Serum ferritin and serum iron level are in upper normal level Hba1c level elevated. what is
diagnosis?
a) Hereditary spherocytosis
b) Sideroblastic anaemia
c) Beta thalassaemia trait
d) Normocytic normochromic anaemia
e) Alpha thalassaemia
Answer B
• Causes for elevated hba1c, hypertriglyceridemia, aplastic anaemia, sideroblastic anaemia,

alcoholism, pregnancy
• Sideroblastic anaemia- hypochromic microcytic anaemia with elevated serum ferritin and fe
and target cells
39 – Infections | Mycoplasma
A 20 year old female is tired and having SOB. She had fever and cough 5 days ago and was treated
with azithromycin 500mg daily.
• Hb-8.3g/dl WBC – 5000 PLT-180000 MCV-99 MCH-28
• Monospot test- negative Reticulocyte count-7% Blood film- Red cell agglutination
What is the diagnosis?
a) G6PD
b) Mycoplasma pneumonia
c) DIC
d) IMN
e) B12 deficiency
• Patient has high retic count suggestive of haemolysis…. B12 deficiency causes low retic count
so it can be eliminated
• G6PD def or DIC dose not cause red cell agglutinations.
• Red cell agglutinations can be seen in both IMN and Mycoplasma infection(due to cold
autoimmune haemolytic anemia)
• Negative Monospot test makes IMN unlikely
Answer is B
Ref- American collage of haematology website & naughty America website

40 – Infective Endocarditis
An 80 year old male presented with 4 weeks history of fever. During last 2 years he had similar
lower urinary tract symptoms. Symptoms disappear after treating with norfloxacilin. But fever
persists. He has hypertension, diabetes and prostatism and is on metformin and prazocin. He has
mild pallor and a splenomegaly. A diagnosis of infective endocarditis is made.
What is the most likely causative organism for infective endorcarditis in this patient?
a. Enterococci
b. Gram negative organism
c. Salmonella
d. Staphylococci
e. Viridans Streptococci
• Out of these organisms enterococci are the ones usually found in the gut and urinary tract
• Enterococci commonly cause UTI and occasionally prostatitis as well.
• Endocarditis usually caused by Enterococci are subacute and not usually associated with
peripheral stigmata
Answer is ‘A’
41 – Hospital Acquired Infections
Which of the following is the best for preventing hospital acquired infections?
a) Give prophylactic antibiotics
b) Vaccination of the hospital workers
c) Proper hand care of hospital workers
d) Early discharge
e) Isolation of the patient
Answer is ‘C’
▪ Handwashing is the single most important procedure for preventing the transmission of
nosocomial infections. (Hospital infection control manual – Sri Lanka college of
microbiologist)
42 – Poisoning | Organophosphate
A 34-year-old farmer was poisoned with organophosphate and he is on treatment with IV

Atropine and Pralidoxime. On the 2nd day he was flushed and agitated. He had dilated pupils, PR-
120bpm, and BP-160mmHg. Which of the following is the best treatment option?
a) IV Fluid
b) Stop pralidoxime
c) Connect to CPAP
d) Stop atropine
e) Give metronidazole
Answer is ‘D’
▪ This patient has developed features (agitation, Flushing, tachycardia, dilated pupils)
suggestive of Atropine toxicity.
▪ Therefore, Atropine infusion should be stopped and wait for 30-60min and restart at a lower
rate.
Clinical features of organophosphate poisoning:

▪ Muscarinic features: excessive salivation, lacrimation, urination, diarrhoea, gastro-intestinal
cramps, emesis, blurred vision, miosis, bradycardia, wheezing
▪ Nicotinic features: fasciculation, paresis or paralysis, hypertension and tachycardia.
▪ Central receptor features: anxiety, confusion, seizures, psychosis and ataxia.
Management
▪ First aid and initial resuscitation.
▪ Medical management includes use of atropine, pralidoxime, and benzodiazepine
▪ Atropine: Physiological antidote at muscarinic receptor. No effects at neuro muscular
junction. It does not cross blood brain barrier. Initial dose of 2mg followed with boluses
every 5 to 10 minutes or as infusion until signs of atropinisation occur. That includes heart
rate more than 80/minute and dilatation of initially constricted pupil
▪ Pralidoxime: Reactivation mainly occurs at neuromuscular junction. It does not cross the
blood brain barrier since it is ionized. Adult dose is 1-2g IV followed by 0.5g/hour infusion.
The side effects of pralidoxime include tachycardia, laryngospasm, muscle rigidity, dizziness,
diplopia, impaired accommodation, headache, hyperventilation, muscle weakness. It is not
safe in
pregnancy and lactation.
Reference: medical emergency book by prof. Weerarathna

43 – PCM Poisoning
An 18 year old girl presented following ingestion of 20 tablets of paracetamol. After 3 hours she
had recurrent episodes of vomiting. Her weight is 45kg. What is the most appropriate
management?
a) Gastric lavage
b) Observe without any interventions
c) Check plasma paracetamol level
d) Give NAC
e) Give methionine
Answer d - give NAC
• Send blood for pcm level asap after 4 hours of ingestion. Plasma level within 4 hours of
ingestion are not reliable as absorption and distribution could continue. plasma level after
15 hours is less reliable.
• If presenting within 2 hours can do gastric lavage if more than 7.5g has been taken. After
gastric lavage give 50g of activated charcoal in 200ml of water.
• if more than 150mg/kg has been taken (in this case pt has taken 10g of pcm which is
exceeding safe dose of 6.75g for her weight)
• So NAC should be started at once and stop if plasma pcm concentration subsequently
indicates that treatment is not required.
Reference - Kumar and Clark 8tg edition page 919 and medical emergency book by
prof.weerarathna(red book) page 252
44 – Statistics
A new diagnosis test was introduced for the disease X. Specificity is 75% and sensitivity is 85%.
Prevalence of the disease X is 5%.how many patients are not diagnosed by the teat among a
population of 1000.?
a) 50
b) 42
c) 8
d) 4
e) 15
Answer - c 8
• Sensitivity is the ability of a test to correctly identify those with the disease.
• Specificity is the ability of the test to correctly identify those without the disease
• prevalence of disease is 5%.
• So in a population of 1000 there are 50 people with disease and 950 without disease.
• Sensitivity (true positives) =85%*50=42
• So the no of people with negative test result but actually have the disease (false negatives) is
around 8 per 1000 population.
people with disease people without disease

test positive 42 237(false positive)
test negative 8(false negative) 713
50 950
45 – Respiratory | Asthma
A 20-year-old girl presented with acute exacerbation of bronchial asthma. Oxygen was given and
was nebulized with salbutamol. But no improvement. Next step in management?
a) Repeat salbutamol
b) CXR
c) CPAP
d) IV aminophylline
e) IV MgSO4
Answer- a/d
46 – Snake Bite
A 55-year-old male presented to the medical ward after being bitten by an unidentified snake. He
was having right leg swelling up to the knee joint and blackish discoloration at ankle joint with an
oozing puncture mark. No other physical signs present. Clotting test is normal. What would be the
immediate decision?
a) Antivenom and surgical referral
b) Surgical referral
c) Limb elevation & antibiotic
d) Antibiotics, antivenom and surgical referral
e) Antibiotics and antivenom
Answer-D
47 – Psychiatry | Hypochondriasis
A 45 year old female presented with abdominal pain of 2 years duration. Examination was
unremarkable. She has undergone several endoscopies, colonoscopies and CT scans which are
normal. Further she expressed that she is in fear of having an intestinal carcinoma. What is the
most probable diagnosis?
a) Depressive disorder
b) OCD
c) Hypochondriasis
d) Anxiety disorder
e) Schizophrenia
Answer- C
Can arrive at the correct answer without looking at the options. Persistent preoccupation with the
possibility of having a serious and progressive physical disorder; such as a malignancy is a feature of
hypochondriasis. Other possibilities are somatization disorder and malingering.
A. Hallmarks of depressive disorder are depressed mood, loss of interest and enjoyment, and
reduced energy leading to increased fatiguability and diminished activity. None of the above
seen in her.
B. OCD has recurrent obsessional thoughts and repetitive behaviors or compulsions. Not seen
here.
C. Correct
D. Patients with anxiety complain of continuous feelings of nervousness, trembling, muscular
tension, sweating, light headedness, palpitations, dizziness.
E. Abnormalities of thought, perception and affect are seen in schizophrenia. This patient has
none of the first rank or second rank symptoms.
Reference – Handbook of clinical psychiatry acknowledgement pg.

48 – Psychiatry |Phobia
A 30 year old accountant seeks medical advice because he worries about an upcoming public
speech to be delivered in front of his colleagues. He always feels uncomfortable in such activities.
Recently he has started to feel that his boss is scrutinizing his work and now he finds it difficult to
sign cheques and other documents in front of others. He knows that his thoughts are not based on
adequate grounds. Now he is avoiding the canteen during lunch and started to take alcohol. What
is the most likely condition he is having?
a) Social phobia
b) Schizophrenia
c) Agoraphobia
d) Alcoholism
e) Panic disorder
Answer – A
Can arrive at the answer without looking at the options. Fear of public speaking, eating in public
places, interacting with people are features of social phobia. Some have anxiety in specific situations
such as signing a cheque when observed, talking on the phone or eating in public places.
Agoraphobia Social phobia

Do not feel anxious about social interactions Anxious about social interactions
Fears being away from home Fears about being negatively evaluated
by others
Anxious about being in situations that are not easily Does not feel anxious in crowded places
escaped- crowds, buss
Fears having a panic attack Fears of embarrassment and
humiliation
Onset 20-30 years Onset mid teens
Alcoholism could be present, but not enough data to arrive at the diagnosis of alcoholism.
In panic disorder there are attacks of severe anxiety which are not restricted to any particular
situation or set of circumstances and are therefore unpredictable. Sudden onset palpitations, chest
pain, choking sensation, dizziness, derealization are features of a panic attack.
Reference- Handbook of clinical psychiatry index

NOTES
NOTES
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MEDICINE - FINAL MBBS

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GBS Clinical features

• Treatment- plasmaparesis, iv immunoglobulin

WOF are true about myasthenia gravis

Myasthenia gravis clinical features

3 – CVS | Pulse Pressure

Regarding aortic stenosis

Source- Kumar and Clark’s clinical medicine 8th edition - page-746-747

5 – Respiratory | Clinical Signs

Which is/are correct

A. T positive in pneumothorax, emphysema, Collapse, consolidation, fibrosis pleural thickening.

Pleural effusion (skodaic cracked pot, though

Cracked pot sign also A finding of late

6 – Respiratory | Pleural Effusions

Exudative pleural effusions are seen in

Reference - Oxford handbook of clinical medicine

a) F – 2 of 3 to diagnose PBC 1. anti mitochondrial antibodies 2.persistant elevation of serum

e) F – Transferrin saturation, serum ferritin, liver function tests

a. Post streptococcal glomerulonephritis.

B) T - Patient is diabetic so is immunocompromised; therefore susceptible to recurrent UTI

Causes for metabolic acidosis are,

Polydipsia is known to occur in

a) F - Syndrome of Inappropriate Antidiuretic Hormone cause excess ADH resulting water

• Vasopressin / ADH – cause water

Reference – Kumar & Clerk 8th edition page

Regarding warm autoimmune haemolytic anaemia

Reference – Kumar & Clerk 8th edition page 398-400

Regarding Acute Gout,

Answers (Source- Oxford hand book of Medicine, P550)

Correctly matched micro-organism with medication,

Answers. (Sources- Oxford hand book of Medicine, Pub med, FAAP )

Rx- Oral amoxicillin 500mg – 1g tds +

Regarding malaria in Sri Lanka

16 – Dermatology | Skin Rashes

WOF cause a characteristic rash in palms and soles?

b) T- Erythema multiforme is a hypersensitivity rash caused by infections or drugs. Herpes

c) F- Also known as ano-genital warts caused by HPV.

16 – Dermatology | Skin Rashes

Rash in palm of hand

Herpes simplex is the commonest trigger for erythema multiforme

Characteristics of autosomal dominant disorders,

a) F – One parent is enough

18 – DM | GLP (Glycogen like peptide)

Regarding GLP (Glycogen like peptide)

• GLP-1 reduce blood glucose by

19 – Psychiatry | Transient Psychotic Disorders

Transient psychotic disorders,

a) T - occur within 2 weeks of stressful event

b) F - Need antipsychotics. Considered psychiatric emergencies. Need hospital admission.

c) T- no more than 3 months

20 – Psychitry | Delebarate Self Harm

Regarding deliberate self-harm

a) F - 1-2% only suicide later

b) T - 90% drug overuse, Self inflicted injuries 5-15%

c) F - No need of legal authorities or psychiatric services in management.

d) T - more in males (but suicide high in female)

Mnemonic for normal pressure hydrocephalus – ADI

Reference- K&C 9th ed. pg.864 / 8th edition pg. 1126

24 – CVS | Atrial Fibrillation

A 60 year old previously well male complained of progressive breathlessness, abdominal

• Fibrinolytic agents enhance the breakdown of occlusive thromboses by the activation

• In patients who fail to reperfuse by 60–90 minutes, as demonstrated by 50%

Medicine 2015 Nov MCQ & BRQ Review 3

Medicine 2015 Nov MCQ & BRQ Review 3