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MCQ RECALL PAPER - OCTOBER 2001

1. a. b. c. 2. a. b. 3. a. b. c. 4. a. b. c. d. e. 5. a. b. c. 6. a. b. c. 7. a. A lady with different marriage problems and problems with husband etc had never gone on holidays: advise them to go for holiday suffering from depression* refer them to marriage counsellor? Tourettes Syndrome: tics begin at age 21 years always starts below 18 years* The antidote to opioids: Nalaxone* charcoal . 32 year old lady with mastalgia. Conservative treatment failed next step: bromoceptine danazol* clomephane progesterone

Which of the following indicate ovarian tumour rather than ascites: dull laterally, tympanic anteriorly dull anteriorly, tympanic laterally* shifting dullness Dj vu found in: frontal lobe lesion brain stem infarct temporal lobe lesion Cause of pneumonia in AIDS: pneumocystis carnii b. One of the following is a Calcium channel blocker: One of the immature defences: Projection*

8. 9. a.

10. a. b. 11. a. b.

Picture of hands: rheumatoid arthritis* leprosy Diagram (picture of a lesion on a child): Strawberry naevus* Psoriasis 15: Picture skin lesion: cellulitis* If the first child in a family has phenylketonuria, what are the chances of the second child having the same disease? 1 in 3 1 in 2 1 in 4* 2 in 4

a. 16. a. b. c. d. e.

a. b. 18. 19. a. b.

17. What is the cause of recurrent sticky eye? Lacrimal duct block*

The most common maternal cause of child developmental delay: Iron deficiency occurs in all except: thalassemia minor

20. a. b. c. 21. a. b. 22. a. b. c. 23.

A male infant with breast development: abnormal precocious puberty normal in infant* All the following are side effects of steroid therapy except: decrease WBC count increase WBC count* The cause of paralysis of only one limb is: front lobe infarct thalamic infarct lacunar infarct* All the following are indicators of thrombolytic therapy except:

a. b. 24.

ECG showing ST elevation ECG normal (no changes)* What you will get with otoscelerosis : a) normal tympanic membrane b) usually ruptured tympanic membrane c) non-functioning eustachian tube. A 23-year old man returned from Bali with watery diarrhoea (no blood). On physical examination, he is normal. Which organism is the most likely cause? giardia rota virus toxicogenic E.coli cholera. A seven-week old baby is brought to you by his mother. His mother complains that he has been vomiting intermittently since birth. On examination, you find no abnormalities except some weight loss. What is your probably diagnosis? UTI Pyloric stenosis Phenylketonuria DI. Genetic transmission of phenylketonuria, which of the following is correct: one in two regardless of sex one is four regardless of sex female will be affected and male will be carrier male will be affected and female will be carrier. Question about SIADH A child is brought to you with a fever. On examination you find neck rigidity, protein is 1.2, sugar is normal and lymphocyte is 50x10. What is your probable diagnosis? tuberculosis echo virus bacterial meningitis typhoid rhino virus Which carcinoma does not metastasise into the brain? lung liver kidney prostate testes.

25. a) b) c) d) 26.

a) b) c) d) 27. a) b) c) d) 27a. 27b a) b) c) d) e) 28. a) b) c) d) e)

29. a) b) c) d) 30.

A patient after a motor traffic accident with a pelvic fracture. Five days after successful resuscitation, he develops severe dyspnoea. What is your initial management? oxygen inhalation I/V Heparin intubation and ventilation intensive antibiotic therapy. A patient with COPD came into the Emergency Department with severe dyspnoea, 28% O2 8L given by mask. After one hour, you did arterial blood gases and found that PO 2 level was 42mm of Hg, PCO2 was 68mm of Hg. What will you do next? a) increase O2 inhalation by mask b) ask the patient for intubation and ventilation c) increase I/V fluid repeat arterial blood gas level after one hour. Undescended testes is related to: torsion of the testes spermatogenesis will be perfect if the operation is done before 3 years of age developmental delay of the child acute epididymitis. One ECG tracing. What is your diagnosis? WPW syndrome inferior MI complete heart block normal tracing anterior MI. You will get erythema nosodum in all the following conditions, except: sarcoidosis bacterial myocardial infarction tuberculosis yersinia rheumatic fever. A chest X-Ray of a child shows consolidation in the left side. What is your probable diagnosis? streptococci pneumonia mycoplasma pneumonia tuberculous pneumonia aspergillus pneumonia viral pneumonia. A 22-year old woman comes to you with secondary amenorrhoea. On examination you find LH:FSH ratio increase. What is your diagnosis?

a) 31. a) b) c) d) 32. a) b) c) d) e) 33. a) b) c) d) e) 34. a) b) c) d) e) 35.

a) b) c) d) e) 36. a) b) c) d) e) 37. a) b) c) d) e) 38.

PCO primary ovarian failure non-functioning UT endometriosis valvo-vaginitis. How does Microgynon 30 work? in the hypothalamus in the pituitary gland in the ovaries in the Uterus on both ovaries and Uterus. In a patient with acute severe excruciating abdominal pain, which of the following is least likely: acute MI rupture of aortic aneurism acute appendicitis renal colic mesenteric artery occlusion.

For Wernickes encephalopathy, what is the appropriate treatment? a) I/V thiamine followed by glucose b) oral glucose only c) I/V glucose. After a splenectomy, you will get all the following except: a) persistent anaemia b) normal RBC life span. Neuropathy ulcer in the metatarsal of the foot. What is the most common cause of this type of ulcer? a) diabetic neuropathy b) ischaemic ulcer. All of the following cause facial nerve palsy, except: chronic parotitis cancer of the parotid gland fracture at the base of the skull mastoiditis fracture of the mandible.

39.

40.

41. a) b) c) d) e) 42.

After peritonial fluid aspiration, you get malignant cells in the fluid. Which of the following is the most reliable sign in this condition? a) palpable lymph node in P/R examination

b) supraclavicular lymph node palpable.

43.

With ventricular tachycardia, which of the following sign is the successful resuscitation: a) pupillary reaction to light b) ECG. The following statements about a panic attack are all true, except: precipitating factor should be avoided 20% occur in the general population it is more likely to occur in females than males preceded by sweating and hyper-ventilation. A primigravida womans height is 150cm. At 38 weeks gestation she is in labour. On pelvic examination, you think that the pelvis is apparently reduced but the cervix is fully effaced and 4cm dilated. The baby is in the longitudinal position and head is at 0 station. What is your management plan: trial of labour X-Ray pelvimetry start I/V oxytocin immediate caesarean section wait and see. Which one of the following conditions is most related to colonic carcinoma: melanosis coli ulcerative colitis colon irradiation diverticulosis. (A picture of a big goiter). What is your diagnosis? multinodular goiter Graves disease diffuse goiter thyroid carcinoma. A child can babble, laugh when he looks in the mirror, can roll over and can sit without support with an arched back. He can also walk with support. Which of the following is the most consistent with his developmental age? 6 years 3 months 7 months 9 months 12 months.

44. a) b) c) d) 45.

a) b) c) d) e) 46. a) b) c) d) 47. a) b) c) d) 48.

a) b) c) d) e)

49. a) b) c) d) e) 50.

A pregnant woman presents to you at 38 weeks gestation with 1000ml of blood loss and lower abdominal pain. Which of the following is not indicative of abruptio placenta? foetus dead uterus tense and distended foetal head is high up BP is 180/110 Normal pulse rate.

All of the following can cause sever hypokalaemia, except: a) pyloric stenosis b) chronic renal failure c) Conns disease (primary hyperaldosteronism). In a bed-ridden patient, what is the most common cause of diarrhoea? diverticulitis fecal impaction ischaemic colitis ulcerative colitis.

51. a) b) c) d) 52.

With a diabetic ulcer, what is your appropriate Rx: a) Amoxicillin + penicillin b) Ampicillin + Gentamycin + Metronidazol. c) Flucloxacillin + Gentamycin d) Ampicillin + Cloxacillin. What is the most common cause of bleeding from the nipple? intraductal papilloma ductal carcinoma Pagets disease mastitis. 54. A child comes to you with a minor, cleaned, contaminated wound but he doesnt have any history of previous immunisation. What is your management plan: Tetanus immunoglobulin TT DTP just clean the wound local antibiotic.

53. a) b) c) d)

a) b) c) d) e) 55.

What is the cause of unilateral exopthalmos? a) maxillary antral tumour b) thyrotoxicosis (Graves disease) c) simple goiter.

56. After a difficult catheterisation, blood pressure suddenly decreases. What would be your diagnosis? a) internal haemorrhage b) septicaemia c) pylonephritis. 57. a) b) c) d) 58. a) b) c) d) e) 59. a) b) c) d) 60. a) b) c) d) e) 61. What is the absolute contradiction of OCP? focal migraine varicose vein smoking mild hypertension. After the first delivery in a twin pregnancy, you will do all of the following in the second delivery, except: external podalic version check the fetal lie check the bleeding check the fetal heart sound check the vaginal laceration/s. How would you treat a bee sting? I/M adrenalin I/V hydrocortisone I/V fluid I/V antibiotic. Which vitamin will be deficient in a breast-fed baby: vitamin A vitamin K vitamin D vitamin B12 vitamin E. An eight (8) year old obese boy presents to you. On examination, his weight is 48kg, which is more than the 98th percentile and his height is 140cm, which is more than the 90th percentile. Otherwise all normal. Which of the following is correct in relation to this boy? advanced bone age increased blood sugar level primary hyperaldesteronism thyroitoxicosis hypothyroidism.

a) b) c) d) e)

62.

a) b) c) d) e)

A 35-year old lady nullipara wishes to conceive, but has fibroid uterus, bleeding 60ml, Hb level is 90g/l, O/E ut is boggy to the level of the umbilicus. What is your management? correct the anaemia the myomectomy suppression of the fibroid by GnRH analogue for 3 months the myomectomy hysterectomy hysterectomy & oophorectomy observe 6 months the myomectomy 67. Infective endocarditis: what is the most common organism? staphylococcus aureus streptococci viridans streptococci fecalis coxiella viruses A patient came to you with severe chest pain ECG done but it is normal. What is your management? Thrombolytic therapy should not be given if ECG is normal discharge the patient for going home I/V heparin and nitrates are contraindicated exercise test is to be done immediately ECG should not be repeated unless pain once again A 22 year old man came to you complaining of snake bite 2 hours before. O/E there is abrasion in the leg otherwise normal. What is your management? give antivenom observe for 24 hours give an incision and let bleed for 5 minutes clean the wound and give bandage and let him go do nothing A 22 months-old child came to you with respiratory distress, unilateral wheeze. Previously he was well. What is your management? measure O2 level do an x-ray chest inspiratory and expiratory give antibiotic give bronchodilator A bisexual man diarrhoea for one month, has mouth ulcers, artharalgia, one joint of hand is painful; 2nd toe pain, ulcers on palms and soles. What is the diagnosis? Reiters disease Behcets disease AIDS syphilis

a) b) c) d) e) 68. a) b) c) d) e) 69. a) b) c) d) e) 70. a) b) c) d) 71. a) b) c) d)

e) reactive arthritis 72. a) b) c) d) e) 73. a) b) c) d) 74. Retinal neovascularization: glaucoma retinal V thrombosis malignant melanoma hypertension Diabetes mellitus 23 year-old girl has abdominal colic, 2 weeks back she had viral infection, perpural rash. Most probable diagnosis is: ITP Ischaemic colitis Henoch-schonlein purpura glandular fever

What differentiates between haemolytic and iron deficiency anaemia? a) polycythaemia b) polychromasia c) normal platelet count Oxytocin: is secreted from ant pituitary acts by enzyme oxynase causes contraction of various involuntary muscles like ut & breast causes contraction of ut only Progesterone can cause AOF expect: mild hypertension amenorrhoea after 3rd injection infertility may occur up to 6 months after stopping breakthrough bleeding

75. a) b) c) d) 76. a) b) c) d) 77.

In a 65 year-old woman having ovarian tumour and endometrial hyperplasia WOF is correct? a) fibroma b) granulosa cell tumour c) teratoma A 50 year-old woman came to you with complaint of slight vaginal bleeding. She also complains that she has amoenorrhoea for 11 months. What is your diagnosis? endometrial carcinoma ca. cervix oestrogenic stimulation of the ovary vaginal atrophy

78. a) b) c) d)

e) cervical polyp 79. A woman 16 weeks pregnant having hypertension 110/95mm of Hg. proteinurea +++ mild oedema. What is your diagnosis? a) preclampsia b) renal hypertension c) glomerulonephritis 30 year old cystic fibrosis with chest pain treated with nebulised tobramycin th./ DM, recent weight loss, steathhorrea. Correct management? decreased carbohydrated diet and stabilising glycaemic contro pancreatic enzyme continue nebulised tobramycin for another 3 weeks chest physiotherapy Difficult breathing after penicillin for U.R.T.I has generalised urticaria and blood pressure 90mm Mg. Correct management? IV I.M adrenalin 1:10,000 S.C adrenalin 1:1000 I.V. pneumothorax airway assessment 500ml IV colloid Each is important host defence against bacterial meningitis: IgA ciliary activity mucosal epithelium complement IgM Factor least likely to affect prognosis of breast ca: tumour size oestrogen receptor status menopause involvement of axillary lymph node percent 8 cell in s-phase Nephrotic Syndrome commonly caused by EXCEPT? post glomerulonephritis result decrease in plasma volume plasma cholesterol normal but HDL result in renal salt wasting 37 year-old man with depression presents to emergency, drowsy and aggressive. He has taken a bottle of doxepin and scotch together. Important management include:

80. a) b) c) d) 81. a) b) c) d) e) 82. a) b) c) d) e) 83. a) b) c) d) e) 84. a) b) c) d) 85.

a) b) c) d) e) 86.

admin for ECG monitoring for 4 hours serial doses of charcoal orally do serum paracetamol as the only drug screen as the patient is conscious significant T.C.A. overdose can be ruled out alkalisation of urine will aid excretion of doxepine, and will protect against arrhythmia A fifteen year-old girl presents with fever and painful left forearm two days after her cat had clawed the arm. There is regional lymph adenopathy present and temperature is 39oC. Which of the following statement is true? the implicated bacterium E.coli most suffer of cat fever are >60 complication may include involvement liver, spleen, central nervous system, bowel and skin ampicillin and cephalosporin are inadequate therapy lympadenopathy in the field of drainage is invariable A 71 year-old woman presents with crushing chestpain, a ECG shown. She is pale and diaphoretic, peripheral vein. The most likely cause of the hypotension is? chordae rupture causing acute mitral regurgitation S.B.E. right ventricular myocardial infarction second degree AV Block pericardial tamponade Insulin resistance is a complication of on-going insulin therapy requiring increasing doses. Which of the following is the most common cause? anti-insulin antibody switching from procine to human insulin obesity* the somoguy effect non-compliance Condition that are associated with Lichen planus includes all of the following with the exception of? primary billiary chirrhosis graft versus host disease chronic active hepatitis amalgam in dental fillings chronic myeloid leukemia*

a) b) c) d) e) 87. a) b) c) d) e) 88. a) b) c) d) e) 89. a) b) c) d) e) 90.

Lipid lowering drugs are a complex group of drugs with a spectrum of side effects. Which of the following indication is correct? a) gemfibrozol is indicated for hypercholesterolaemia b) simvastatin is effective for hypertrigliceridemia c) fish oils are suite for treating hypercholesterolaemia

d) fluvastatin is effective for combined hypercholesterolaemia and hypertrigliceridaemia* e) individual without coronary heart disease with LDL-cholesterol lever > 4.5 mmol/l should not receive such drugs because of side effect profiles 91. a) b) c) d) e) 92. Which of the statement concerns infantile spasm is correct? age of onset is usually 18 months they occur less frequent with physical activity ECG is usually normal developmental milestone are unaffected aetiology is frequently idiopathic* A girl infant is brought to your rooms for investigation of abdominal pain manifested by colic and progressive constipation. Other siblings are well. Which of the following is LEAST likely to be implicated? lead poisoning hypo thyroidism hirsprung disease hypocalcaemia* infantile botulism Louis, a 5 year-old boy is brought to you for testing his free lead level, which is significantly elevated. His physical and locomotor examination is completely normal. On questioning, the parents state that they have recently moved to an old terrace. The initial most appropriate management would be to? commence decontamination of the house commence a chelating agent commence d-penicillamine for 2-6 months check the free erthrocyte protoporphyrin* check the urinary excretion of lead after administration of calcium EDTA Alf, a 74 year-old man recently admitted for management of respiratory failure asks about home-oxygen. The following are criteria for long-term continuous oxygen therapy except: PaO2 <55mmHg O2 saturation <88% treating the Hypoxia associated with the sleep apnoea if the patient has mental impairment oxygen should be withheld for safety reasons congestive heart failure with intractable angina All of the following statements about inflammatory bowel disease are true except: pseudopolyps developing in ulcerative colitis do not become malignant development of fistula between bowel and skin or bladder suggests granulomatous bowel disease, such as a regional enteritis severe hypotension with fever, leucocytocis and abdominal distention suggests development of toxic megacolon which usually requires immediate surgery

a) b) c) d) e) 93.

a) b) c) d) e) 94.

a) b) c) d) e) 95. a) b) c)

d) e) 96.

occult bleeding occurs in both ulcerative colitis and regional enteritis but gross bleeding is more characteristic of ulcerative colitis metronidazole may help to control acute diarrhoea in crohns disease Jose, 6 months-old boy is referred back to you by the local hospital where he has presented several times over three months due to a series of falls at home. The question of non-accidental injury (child abuse) has been raised. Your initial assessment would include: developmental milestone assessment a skeletal survey with radiograph of AP CXR, AP Pelvis AP views of extremities, AP lateral views of skull confrontation of prompt referral to a paediatrician funduscopy William, 13 year-old presents several times over 10 days with a facial abscess that has not responded to local drainage and oral cephalexin. The next appropriate action would include: commence flucloxacillin check the blood sugar admit for IV penicillin and flucloxacillin check full blood count question the boy about side effect of cephalexin to assess compliance The management of jaundice patient for 9 days in a 12 day old would include? phototherapy with reassurance to the parent investigation with full blood count, reticulocyte and coombs test cessation of breast feeding work up for bacterial infection exchange transfusion Which of the following is a valid reason for hospitalising a psych patient: suicidal threat underlying medical problem when personality is the underlying problem to improve compliance to treatment to adjust psychiatric treatment Petechia seen on the following except? ITP platelet dysfunction due to aspirin overdose chronic liver disease chronic renal failure hypersplenism

a) b) c) d) e) 97.

a) b) c) d) e) 98. a) b) c) d) e) 99. a) b) c) d) e) 100. a) b) c) d) e)

101.

Screening program is part of medical practice following an accepted procedure in medical practice: a) perform rectal exam for prostatomegaly b) prostate specific antigen c) annual breast examination by general practice 35 year-old man, fever, myalgia, arthralgia, photophobia, dry cough for 5 days. Antibotic given 3 days ago, now this patient develops mouth ulcer, erythematosis, macular papular rash. Full blood count: infectious mononucleosis HIV CMV gonococal infection rubella Assessment of breast lump in 35 year-old woman on a month self-examination: medical examination mammography then re-assure if it not suspicious diagnosis of impapable lesion is best by open biopsy mammography to be checked by radiologist B/c mammography not ideal screening under 50 refer to a surgeon initially USG (real time) With respect to standard clinical standards except waiting time relative to triage scale hysterectomy in women younger than 35 years attending for CME paint in general practice turn around time for serum kit request for emergency anastomotic break down rates in colorectal surgery Upper quadrant abdominal pain in someone who denies drinking alcohol intake: Anti Hbc Igm Hbe Ag Hbs Ag Anti HCV AST 620 ALP 170 ALT 303 Tot bil 37 GGT 3000 Most appropriate course of action: refer for liver biopsy check AFP evaluated alcohol intake prefer serology for HBV DNA

102.

a) b) c) d) e) 103. a) b) c) d) e) 104. a) b) c) d) e) 105.

a) b) c) d) 106.

4 months-old baby temperature 39.2oC 10 minute prolonged seizure. Immediate management is? a) cerebral CT

b) c) d) e) 107. a) b) c) d) e) 108. a) b) c) d) e) 109. a) b) c) d) e) 109. a) b) c) d) e) 110.

lumbar puncture following CT urinalysis and bacteriology use rectal diazepam advice that febrile convulsion is benign and no medical interference Neonatal sepsis most commonly associated with: A B streptococus haemolyticus E coli group B B strep group D stret S aureus Intusucception: most frequent cause of intestinal obstruction blood stool are invariable woman increased than men abdominal mass 20% (actually 60-90% cases) non operative movements are seldom successful 43 year-old man admit ICU for head injury, early evening hour, He has indwelling catheter in situ: Na + 132. K+ 3.4 cl*10 MCOs*20 His low urine output due to: pain thiazide diuretic pneumonia delirium tremens head trauma 19 year-old man with genital ulcer presents for reviewing 24 hours following onset dysuria, pruritus. Otherwise well. The following are applicable: immediate acyclovir, it will decrease likelihood of recurrence doxycycline should be considered P24 Ag test should be performed urethral swab for gonorrhoea HSV is implicated Most common cause of infective endocarditis:

111. Cause of Travellers diarrhoea a) E. Coli 112. In Haemochromatosis there is: a) transferrin b) transferrin 113. Indication of spleenectomy blood picture given

a) ITP 114. Opening snap in MS proves: a) mobility of valves 115. Most common site of undescended testis a) inguinal canal 116. Which one does NOT cause facial N palsy: a) parotitis b) parotid cancer deep lobe 117. Mucosal ulcer + genital ulcer + lymphadenopathy a) syphilis b) SLE 118. A child with jittery cause

119. Third heart sound (S3) normal: a) young children 120. Opening snap indicates: a) mobility of valve with MS 121. Sudden syncope cause

122. Severe pain abd all causes EXCEPT: a) Acute appendicitis 122. Inferior infarction shown: a) leed II, III and aVF 123. Premorbid condition for schizophrenia a) idea of reference 124. Man with trauma hospitalised after 3 days agitated. Cause: a) alcohol withdrawal 125. Main cause of recurrent abortion? a) cervical incompetence 126. In chronic pain management a) regulate dose 127. LH/FSH ratio is reversed with

a) PCO 128. Vaginal greenish, smelly, secretion in all except: a) Ca endometrium 129. Treatment with progestrone causes:

130. Oxytocin help with all except: a) production of milk b) secretion of milk 130. Commonest cause of bleeding PR in elderly a) ca rectum b) piles 131. Backpain and abd pain + BP: a) ruptured aortic aneurysm 132. Cause of infective endocorditis a) strepto viridans (30- ) 133. pCo2 etc = COAD a) O2 and then do ABG 134. Tension pneumothorax Rx: a) needle into thorax 135. Resp failure + cor-pulmonale a) emphyseme (Davidson 326) 136. Proverb cognitive testing and mental test for: a) delusion b) dementia 137. Lady with lower limbs paralysis in a wheel chair: a) refer to psychiatrist b) refer to physio c) refer to ortho 138. Low platelet count a) intracranial haemorrhage 139. Bone metastasis mostly from: a) prostate cancer b) breast cancer

140. Radio nuclear conf: a) thyroid 141. Normal anion gap?

142. Tumour marker CA125 in: a) ovarian cancer 142. In hydatid disease following will be raised: a) B-hCG 143. VWB syndrome measure:

144. Best test for heparin: a) INR b) APTT 144. All are hepatotoxic drugs except:

145. Rx for Wernicks Encephalopathy: a) thiamine 145. Desputeryns contractive which is correct? a) Palmar aponeurosis fibrosis 146. Two days after surgery calf pain a) angiography b) doppler u/s 147. 148. 149. 150. 151. 152. 153. 154. 155. 156. 157. 158. 159. 160. Horner syndrome may be present in: Carcinoma lung Tics occurs in: TIA = Ant. Carotid Artery block Frontal lobe meningioma poisoning small pupil + something = antidote Naloxone low platelets = Intracranial Haemorrhage All give brain mets.:. except from prostate swelling hernia in child disappears Rx= surgery Erysipelas Rx = penicillin high JVP = TR confirmatory diagnosis of MI = clinical history hemorrhoids pt gets a) no pain b) pain Rh-ve mother - ? Rx Narscicist personality disorder definition

161. 162. 163. 164. 165. 166. 167. 168. 169. 170. 171. 172. 173. 174. 175. 176. 177. 178. 179. 180. 181. 182. 183. 184. 185. 186. 187. 188. 189. 190. 191. 192. 193. 194. 195. 196. 197. 198. 199. 200. 201. 202. 203. 204. 205.

short height in children all causes except: Rx of Wernickes Encephalopathy Diagnosis of ovarian cyst panic disorder treatment cirrhosis with palmar erythema = Ascitis pituitary adenoma Rx=Bromocryptin Pneumonia lower (Rt) lobe HIV Ab in blood appears when ? very small cyst in ovary Rx= call after 4 wks for USG Rheumtic fever Rx = Sarcoidosis diagnosis = Seborrhic dermatosis mainly found onfiltered= exposed surfaces Acute cholecystitis Vertebro basillar insufficiency presentation = Anaemia of chronic illness = blood picture Post traumatic stress disorder = diagnosis Asthma at least 2 Q Green paste like nipple discharge diagnosis= Anorexia Nervosa most common =tachycardia.. Hep B = becomes chronic VWB disease Dementia definition Duodenal Ulcer = no anorexia Ectopic pregnancy,pain abdomen, 17 wks all except: UTI in child Fibrosing allergic alveolitis Obesity and height test GTT Glomerulonephritis main cause = Carpal tunnel syndrome common in = pregnancy DM autonomic neuropathy= tachycardia DM ulcer = neuropathy Osteolytic malignant hypercalcaemia Normal anion gap disease D/D= renal tubular acidosis Syncope diagnostic description Oedema leg Nephrotic syndrome children Retro orbital pain in 10 yr child main cause = Posterior fossa tumour in children most common one is = Aspirin induced gastritis present as= Mycoplasma pneumonia description given Jaundice ? difference in obstructive & haemolytic Post menopausal bleed most coomon cause= Ca endometrium Adrenogenital syndrome ? Definition of fistula ACE inhibitor S/E

206. 207. 208. 209. 210. 211. 212. 213. 214. 215. 216. 217. 218. 219. 220. 221. a)

TCA S/E = impotence ischaemic colitis case given Age 7 months = developmental picture Inguinal hernia to differentiate direct or indirect Rx for mastalgia= danazol APH Abruption placenta all except = BP-180/110 Colles Fracture Pic Infected sebaceous cyst -pic strepto pneumonia in child pic tinea scalp pic multinodular goitre pic supply ant 2/3 of tongue = facial nerve Nasopharyngeal cancer Rx = radiation uncomplicated piles = no pain thought disorder definition conversion reaction case given. 222. Hyponogagic hallucination occurs in normal people before falling asleep 223. Breast cancer all are precipitating (risk) factors except: artificial menopause history of breast cancer in mother and sister breast cancer in other breast history of cancer in uterine body first child after the age of 35 years

a) b) c) d) e)

224. Metastatis to brain,all primary site are except: a) prostate 225. Febrile convulsion a) occurs in 6 months to 4 yrs of age 226. 12 weeks pregnant woman with the 14 wks size uterus with P/V bleeding the most important aspect in follow up: a) B-HCGT measurement weekly for 1 month b) contraceptive for 6 months c) CT scan of lungs and brain In uncomplicated mucosal haemorrhoid, which of the following does not occur: pruritus fresh blood per rectum something coming down per rectum pain the anal region mucous discharge

227. a) b) c) d) e)

228. a) b) c) d) 229.

Anti D immunoglobulin should be given to a negative mother in which of the situation: child born having B+ve blood group must be given within 24 hours of delivery one dose given in 2nd trimester the chance of immune reaction in mother to be given to all mother with o-ve blood group

4 yrs old child with early morning headache, which is progressive for the last 6 wks vomiting a) posterior fossa tumour b) 230. A pt presented with vomiting, papilloedema, blurring of vision diagnosis: a) Cerebral infarct b) vertebrobasilar infarct

231. a) b) c) d) e)

25 years old man c/o fever, cough (nonproductive) for 3 wks, CXR shown bilateral diffuse patchy infettrates diagnosis is? pneumocystis carni mycoplasma strept pneumonae klebiella pneumonia staphylococcul pneumonia 232. A young man presenting with low grade fever, malaise, weakness (generalised) CXR bilateral hilar lymphadenopathy M. tuberculosis

233.

a) b) c) d) 230. a) b) c) d) e)

A man 30 years of age presented with pleuritic chest pain with fever of 38.8 c o/e Rt lower lung field in full on percussion, bad breath round with bronchial breath round over the dull area of the back side of right chest. Dx in: Rt pleural effusion Rt sided consolidation (lower lobe) Rt lower lobe collapse lung car All of the following can happen in ulcerative colitis except: Erythema nodosum pericholangitis peripheral neuropathy episcleritis seronegative arthritis

231. Erythema nodosum does not occur in: a) streptococcal infection b) rheumatic fever c) sarcoidosis

d) yersenia infection e) fungal infection 232. An infant with diarrhoea which of the following is the cause in convulsions: a) serum sodium 156 mmol/L b) serum sodium 126 mmol/L c) potassium d) HCO3

233. a) b) c) d) 234. a) b) c) d) e) 235. a) b) c) d) e) 236. a) b) c) d) e)

67 year-old man developed abdominal pain, bloody diarrhoea. Exam shows pulse 108/m; BP-90/50 mm g crepitation in lung base, P/R shows blood in the rectum: diverticular disease Ca colon mesentric artery occlusion haemorrhoid Carpal tunnel syndrome in pregnancy, which one of the following is the correct response: diuretic treatment surgical intervention splinting of the hand in mid extension position immediate termination of pregnancy ACE inhibitor Which one of the following is not found in autonomic neuropathy in a diabetic patient? urinary retention urinary frequency bradycardia constipation nocturnal diarrhoea A 6 year-old child has fever 40oC. CXR showing (Picture given) Rt lower lobe consolidation: H influence S pneumonae viral mycoplasma pneumonae

237. Causes of hypokalemia except: a) pyloric b) hyperaldosteronism

c) CRP d) chronic use of purgatives 238. Causes of proteinuria except: Rhematoid arthritis Diabetes mellitus Definition of fistula 243. D & C is most appropriate in before stating normal therapy for menoochigie cervical incompetence in 10% cases diagnosis and evaluation of postcoital bleeding indicated for post menopausal bleeding a woman with mastalgia that has failed to respond to other conservative measure, the appropriate therapy would be: medroxy porgesterone danazol stilbesterol bromcroptine diethyl estradiol Which of the following is indicated for primary dysmerocibvrea except: paracetamol bromocriptine mefenamic acid OCP indomethacin A 35 year old lady with galactorrhea has a pituitary adenoma which is in 3mm of optic chaisma had a prolactin level of 2500 U/L. Which of the following is the most appropriate initial management: transfrontal surgery transphenoidal surgery bromcriptine danazol Regarding oxytocin secreted from amt pituitary has antidiuretic effect is a steroid hormone formed by the enzyme oxytocinase stimulates all involuntary muscles

239.

a) b) c) d) 240. a) b) c) d) e) 241. a) b) c) d) e) 242.

a) b) c) d) 243. a) b) c) d) e)

244. a) b) c) d) 245.

Causes of acute pancreatitis except: mumps alcohol cholelithiasis islets all tumour Tourette disorder 246. Impotence causing drug: gilibenclamide metformin TCA benzodiazepine Ace inhibitor (70 year old man taking Glibeaclemide with Mefforman for diabetes. Also taking ACE inhibitor for TCA with benzo and TCA for depression) Dj vu is found in which of the following? temporal lobe lesion frontal lobe lesion occipital lobe lesion brain stem infarct 28 year old man presenting with a right inguinoncrotal swelling Dx: direct inguinal hernia hydrocele varicocele testicular tumour spermatocide

a) b) c) d) e)

246. a) b) c) d) 247. a) b) c) d) e) 248.

A mother brought her 1 year old child with the c/o of a swelling which she noticed 2 days ago but now there is no swelling on examination. The most appropriate action would be: a) referral for surgical intervention In fat embolism which of the following is true? peteche in the upper half peteche in the whole body peteche in the dependent part peteche in the palm and sole peteche in the lower part of the body

249. a) b) c) d) e)

250. Hepatotoxic drug except a) chlorpromazine

b) c) d) e) 251. a) b) c) d) 252. a) b) c) d) 253. a) b) c) d) 254.

paracetamol OGP halothane warfarin Diabetic patient with ulcer over the 3rd metatarsal head, wof in the course microvasular disease neuropathy ill fitting shoe infection Hereditary sphescocytosis, wof does not occur after splenectomy except: osmatic fragility anaemia persistence normal life span of RBC presence of spherocytes in PBF 29 year old man with 6 months h/o crampy abd pain, mucoid stool after food, specially after breakfast, incomplete passage of bowel, his weight was normal. Dx is? ca rectum ca colon LBS Chronic amoebiasis 68 year old man with vomiting, passage of food particles and vomitus. appetite, ed weight loss. He has a h/o duodenal ulcer 8 years back which was treated with cimetidine, currently he takes aspirin for pain. Dx in: gastric & duo ulcer gastritis ca oesophagus ca cardia A picture of multinodular goitre A picture of a kin lesion (malignant) on the domain of the hand A picture of colles # A picture of scalp (T.capitiol Alopecia areata) 17 weeks gestation with rt illiac fossa pain except: red degeneration of fibroid acute appendicitis UT1 Ectopic pregnancy ?

a) b) c) d) 255. 256. 257. 258. 259. a) b) c) d) e)

260. a) b) c) d) e) 261. a) b) c) d) 262. a) b) c) d) 263. a) b) c) d) e) 264.

Newborn with cataract, jaundice, two of his brothers/sisters had same problem. Diagnosis? rubella embryopathy galactomaemia glaucoma (congenital) toxoplasmosis CMV infection Newborn baby of 1 week is found in the cot with cyanosis tachypnea. There was no palpable murmur, pulse palpable. Diagnosis is? TOF hypoplastic left heart PDA tramparition of great vessel with USD Amniocentesis of 16 weeks. All of the following can be diagnosed except? Downs cystic fibrosis spina bifida TOF First step of management of a asphyxiated newborn: O2 by face mask pharyngeal aspiration endotracheal intubation I/V glucose naloxone 9 days old neonate with vomiting, dehydration. Invest Na 120 mmol/L K 7.7 mmol/L M63 30 mmol/L Diagnosis: congenital hypothyroidism neonatal diabetes pyloric stenosis congenital adrenal hypoplasia WOF is not caused by Hi Pylori: gastric cancer duodenal ulcer gastric-oesophageal reflux antra cancer gastritis

a) b) c) d) 265. a) b) c) d) e)

266. a) b) c) d) 266.

a) b) c) d) e)

A patient had been treated with anti H. pylori regimen. Which of the following is the proper test to evaluate effectiveness of proper therapy? serology urea broth test biopsy serum gastrin A 30 year old man was brought to the emergency dept with depressed respiration, pin pointed pupil. Only history is taking a I/V unknown drug. What is the right measure to reverse his acute condition? atropine physostigmine naloxone naltraxone thiamine

267. a) b) c) d) e) 268. a) b) c) d) e) 269. a) b) c) d) e) 270.

In the resuscitation procedure of a patient with cardiac arrhythmia with arrest, wof is the right thing to assess the response to Rx? femoral pulse radial pulse skin circulation size and reaction of pupil urinary output In wof ca. colon is most likely to develop: diverticulitis Crohns ulcerative colitis ischaemic colitis radiation introitus

Least likely to happen in anorexia nervosa: amenorrhoea bradycardia lanugo hair flight of idea denial A man of 35 years always think himself someone special, grandiose ideas, self shameless attitude about his honour: a) obsessive compulsive personality disorder b) histrionic personality disorder c) narcissistic personality disorder

d) borderline personality disorder 271. Panic attack without agoraphobia?

272. a) b) c) d) e) 273. a) b) c) d) e) 274.

In fibrosing alveolitis, wof is not true: clubbing inspiratory crackles mild hypoxemia normal FEV, 1 FVC ratio excludes diagnosis restrictive lung function A man with bilateral wasting of the small muscles of the hand: multiple sclerosis GB syndrome cervical spondylitis cervical rib syringomyelia

A new born baby after delivery by mid forceps was unable to move height hand diagnosis: a) brain haemorrhage b) Erbs palsy c) cephalohaematoma

275. A patient treated with heparin, wof do you check to monitor therapy? a) APTT b) INR c) Prothrombin time 276. A patient with von willbrands disease has been bleeding profusely. Which test do you perform? a) APTT b) Bleeding time c) INR A female patient with dysuria, frequency of urine, fever was found to have leucexytes 100/HPF with ecoli of 100,000/ml and treated with antibiotics. After treatment repeat urine shoed normal report: IVU cystoscopy MCV repeat c/s of urine treat in future if only develop symptoms

277.

a) b) c) d) e)

278. a) b) c) d) e) 279. a) b) c) d)

Pseudodementia: schizophrenia depression conversion disorder alcohol drugs A 28 year old female has the h/o enuresis up to the age of 13 years. Now developed BP of 140/90 mm of Hg. Her two sisters had these type of problems: reflux nephropathy horseshoe kidney post streptococcal x.n congenital nephritis 280. Short stature is associated with wof except: CAH Precocial puberty obesity A 7 year-old boy often completing immunisation developed progressive weakness with loss of reflexes. Diagnosis: G B syndrome poliomyelitis encephalitis subdual haematoma A 65 year-old lady occasionally develops unilateral weakness of the body with unilocular loss of union. Diagnosis: vertebrobasilar insufficiency carotid artery stenosis brain stem infarct Wernkes extradural haematoma WOF becomes chronic: hepatitis A hepatitis B hepatitis C hepatitis D In wof disease, amylodosis is not associated: rheumatoid arthritis chr active hepatitis tuberculosis leprosy

a) b) c) 281. a) b) c) d) 282. a) b) c) d) e) 283. a) b) c) d) 284. a) b) c) d)

e) gluocoma

285.

An old lady of 70 years developed lethargy, confusion, constipation for the last 4 months. Before that period she was alright. Investigations revealed: s.calcium 2.88 mmol/L s.phosphate N urinary calcium - N primary hyperparathyroidism osteolytic bone lesion idiopathic hypercalcemia Pagets disease 286. A child with ankle oedema, puffy face, wof does not occur? (protenuria +++ ) lipid is inversely proportional to albumin focal and regimental glomerulsclerosis response to steroid in 90% cases penicillin prophylaxis A 50 year-old patient is on treatment with hydro chloro-thiazide with B blocker for 10 years. He is obese and recently developed polyuria with thirst. RBS was 17 mmol/L with no ketonuria. WOF action would be appropriate? GTT withdrawal of drugs with review weight reduction insulin sulphonyluria An elderly patient (hypertensive) developed atrial fibrillation, transephogphageal echo showed echogenic shadow is found in the atrium. Wof action would be appropriate? aspirin warfarin cardioversion BP

a) b) c) d)

a) b) c) d) 286.

a) b) c) d) e) 287. a) b) c) d)

287. a) b) c) d) e) 288.

Wof does not longevity in M1 patients: streptokinase aspirin ACE inhibitor B blockers nifedipine In which of the following situations, gamma globulin does not work:

a) b) c) d) e)

varicella mumps hepatitis A hepatitis B rabies

289. Aim of surgical Rx in morbid obesity (except) a) length of satiety centre b) reduce calorie intake c) banal metabolic rate 290. A pregnant lady at 16 weeks of pregnancy develops proteinuria (+++), proteinuria, BP 140/95 mm of Hg. Wof might be the case: a) pre-eclampsia b) pre-existing renal disease Hutchisons melanoic freckle not true: irregular margin irregular surface elderly people occurs in underclothing area A young man when lifting in last 2 occasions developed syncope. His father died suddenly with same problem. wof test most useful: .. angiography ECG supine with resting BP measurement CXR A woman taking injectable progesterone. wof is not side effect? mid HTN irregular menstruation depression weight gain Pseudo-dementia Haemolysis with acute blood picture Anion gap Pseudodementia Mammography

291. a) b) c) d) 292. a) b) c) d) e) 293. a) b) c) d) 294. 295. 296. 297. 298.