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AMC RECALL PAPERS: MEDICINE

2005
GIT: A young medical student, who has started his clinical postings, comes to because his colleagues noticed a yellowish, tinge to his sclera. On examination he is normal except for the yellow sclera. Investigations showed: Total bilirubinElevated Direct bilirubin Elevated Direct bilirubin > (Total Direct bilirubin) Which of the following is most likely? a) Gilberts syndrome b) Haemolytic jaundice c) Ca Pancreas d) Hepatitis e) Carotenemia Ans: Hepatitis In hemolytic jaundice indirect Br is elevated associated with elevated reticulocyte count and Br level rarely goes beyond 4mg/dl unless other pathology is associated. Age is most significant risk factor for pancreatic cancer. In the absence of predisposing conditions, such as familial pancreatic cancer and chronic pancreatitis, pancreatic cancer is unusual in persons younger than 45 years. After age 50 years, the frequency of pancreatic cancer increases linearly (http://emedicine.medscape.com/article/280605-overview). In hepatitis the prodormal phase precedes the icteric phase and there is abrupt onset of fever and vomiting, malaise, headache (JM p.624) and after that icterus appears. Carotenemia is condition caused by excess carotene in the body due to ingestion of vegetables. The yellowish discoloration is distributed un-uniformly in this condition; especially in the palms, soles and nasolabial fold and characteristically sparing the sclera (Harrison p.238). Gilbert Syndrome is characterized by mild unconjugated hyperbilirubinemia where indirect Br is usually below 3mg/dl and uncinjugated (Harrison p.1819).

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CVS: A young man has a syncopal attack while weight lifting. He has had similar episodes twice before. His father died of cardiac disease. What is the most appropriate management? a) Holter monitor b) Echocardiogram c) Stess test d) BP in supine & lying down e) CT scan Ans: Echocardiogram. Hypertrophic cardiomayopathy is 60%cases follow AD inheritance. Dyspnoea, angina, palpiation, pre syncope and syncope can occur (Kaplan p.152) after exercise even in the resting periods also. Sudden death can occur in this condition. Asymmetric left ventricular hypertrophy associated with septal hypertrophy is the features of HOCM (Harrison p.1410). ECG shows left ventricular hypertrophy and pseudo Q wave but Echocardiogram is the best diagnostic modality (Kaplan p.153). Dyspnoea is most common symptom. Systolic ejection murmur, become louder in valsulva, heard best over apex, jerky carotid pulse, double apical pulse.

Echocardiogram of HOCM (http://emedicine.medscape.com/article/152913-overview).

Infection: A 23-years old young lady complaint of lethargy and weakness. She has sore throat and 3 days ago she has returned from JAVA where she suffered from fever recently. Her weakness is due

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to -a) TB b) Tonsillitis c) Post viral fever fatigue d) Infectiuos mononucleosis Ans: Post viral fatigue JM p.803

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Rheumatism: A 29-year old woman, 6 months previously had pleurisy, in the last 2 years mouth ulcers, now develops stiffness and oedema of the wrist and MCP joints; in the morning which disappears afterwards. The most likely cause? a) Rheumatoid arthritis b) Crohns disease c) Ulcerative colitis d) SLE e) Dematomyositis Ans: To diagnose SLE definitely there must be presence of 4 out of 11 criteria among which pleurisy and mouth ulcer is present. In SLE hands, wrist and knee joints are involved (Harrison p.1972) but morning stiffness is a characteristic of RA (Harrison p.1970). In IBD abdominal symptoms should be present and Dermatomyositis occurs commonly in patients more than 50 yrs of age and associated with myelgia, muscle weakness and characteristic rashes on the body (Harrison p.2540). RS: Which of the following most commonly causes pulmonary hypertension & corpulmonale? a) Emphysema b) Bronchiectasis c) Pulmonary embolism d) Pneumothorax e) Foreign body Ans:

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(Oxford p.205)

Drugs: Which of the following is a common side effect of calcium channel blockers? a) Peripheral oedema b) Angio-oedema c) Headache d) Insomnia e) Cough Ans: Peripheral edema. Nausea, constipation, bradycardia, flushing, headache and ankle edema are common side effects (KDT p.530).

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Endo: In diabetic neuropathy you can find each of the following except? a) Bradycardia b) Urine retention c) Impotence d) Diarrhoea at night e) Foot ulcer

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Ans: Bradycardia. Autonomic symptoms may be sudomotor (dry skin due to lack of sweating or excessive sweating in defined areas), pupillary (poor dark adaptation, sensitivity to bright lights), cardiovascular (postural lightheadedness, fainting) (tachycardia and orthostatic hypotension Harrison p.2165), urinary (urgency, incontinence, dribbling) and bladder emptying abnormality (Harrison p.2166), gastrointestinal (diarrhea, constipation, nausea, or vomiting), and sexual (erectile impotence and ejaculatory failure in men, loss of ability to reach sexual climax in women) (http://emedicine.medscape.com/article/1170337-overview). Foot ulcers are major source of morbidity in patients with diabetic disease. Causes of foot ulcers are Neuropathy, PVD and poor infection resistance (Harrison p.2168).

GIT: All of the following are true about duodenal ulcer, except? a) Hunger pain b) Loss of appetite c) Weight gain d) Relapses & remissions e) Relief by antacids Ans: Loss of appetite. Patients with gastric ulcer may present with a wide variety of symptoms, or they may remain completely asymptomatic.

Gastric and duodenal ulcers usually cannot be differentiated based on history alone. Classic gastric ulcer pain is described as pain occurring shortly after meals, for which antacids provide minimal relief. The pain from gastric ulcer is typically located in the epigastrium; however, it can also be perceived in the right upper quadrant and elsewhere. Duodenal ulcer pain often occurs hours after meals and at night. Pain is characteristically relieved with food or antacids (hunger pain). Pain with radiation to the back is suggestive of a posterior penetrating gastric ulcer complicated by pancreatitis. Patients with bleeding gastric ulcers may give a history of hematemesis, melena, or episodes of presyncope. Melena can be intermittent over several days or multiple

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episodes in a single day. Rarely, a briskly bleeding ulcer can present as gross hematochezia (http://emedicine.medscape.com/article/175765-overview). Weight is possible in duodenal ulcer as the person tend to eat more due to hunger pain. Duodenal ulcer pain is mainly due to gastric acid secretion so it is relieved by antacids. Loss of appetite is unlikely DU and in gastric ulcer the person does not loose appetite rather fear food.

Infections: An 18-year-old student presents with jaundice, sore throat and dark urine. There was no hepatitis contact, no IV drug use, and no recent travel history. Bilirubin 80, elevated GammaGT, AST 300, ALT 400 and albumin normal. What is the most likely diagnosis? a) Hepatitis A b) Hepatitis B c) Infectious Mononucleosis d) Cholangitis e) Acute Cholecystits Ans: Infectious mononucleosis (JM p.257). Most specific test: IgM antibody test. Hemat: How would you differentiate between haemolytic anaemia and anaemia of chronic blodd loss? a) Decrease haptoglobin b) Increased reticulocyte count c) Megaloblastosis d) Polychromasia e) Raised ferritin Ans: Hemolytic anemia: increased LDH, decreased Heptoglobin. Chronic blood loss is a cause of Iron deficiency anemia. Decreased S. iron, S. Ferritin and increased S. Transferin (JM p.212). In hemolytic anemia reticulocyte count is raised and S. hepatoglobin is reduced (JM 212).

Electrolytes: A 65-years old presents with confusion. The blood test show serum Na 165, Urine osmolality 205. The most likely diagnosis is? a) SIADH b) Diabetes Mellitus c) Diabetes Insipidus d) Water intoxication e) Renal failure

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Ans: Diabetes Insipidus: Causes of hypernatremia:

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Hypovolemic: Decreased oral intake of water secondary to mental ds, increased water loss due to dieresis, vomiting, diarrhoea and hyperaldosteronism. Hypervolemic: Hypertonic fluid administration, escess salt intake, cushing and conn syndrome. Euvolemic: Diabetes insipidus, skin loss (dj review).

The first step in the diagnostic approach is to estimate the volume status (intravascular volume) of the hypernatremic patient. The associated volume contraction may be mirrored in a low urine Na+ (usually <10 mEq/L). In the hypovolemic patient, a hypertonic urine with a UNa+ <10 mEq/L will point towards extrarenal fluid losses (GI, dermal), whereas an isotonic or hypotonic urine with a UNa+ >20 mEq/L indicates renal fluid loss (diuretics, osmotic diuresis, intrinsic renal disease). In the euvolemic patient with preserved intravascular volume, hypernatremia is most likely due to pure-water losses. In the presence of hypernatremia, urine osmolality normally should be maximally concentrated (>800 mOsm/kg H2 O). Measurement of the urine osmolality will allow differentiation of the following:

Nonrenal causes with appropriately high urine osmolality - Isolated hypodipsia, increased insensible losses Renal water loss indicated by inappropriately low urine osmolality - Diabetes insipidus (often Uosm <300 mOsm/kg H2 O [central, nephrogenic, partial, gestational diabetes insipidus])

To distinguish between central and nephrogenic diabetes insipidus, first obtain a plasma AVP level and then determine the response of the urine osmolality to a dose of AVP (or preferably, the V2-receptor agonist DDAVP). Generally, an increase in urine osmolality of greater than 50% reliably indicates central diabetes insipidus, while an increase of less than 10% indicates nephrogenic diabetes insipidus; responses between 10% and 50% are indeterminate. Hyperosmolar patients with an elevated AVP level have nephrogenic diabetes insipidus; those with central diabetes insipidus will have inadequately low AVP level (http://emedicine.medscape.com/article/241094-diagnosis).

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Hemat: A 70-years old woman presents with a 3-month history of fatigue, generalized lymphadenopathy, and hepatosplenomegaly. What is the most likely diagnosis? a) Hodgkins lymphoma b) Non Hodgkins lymphoma c) Acute lymphocytic leukaemia d) Chronic lymphocytic leukaemia e) Chronic Myeloid leukaemia Ans: Chronic Lymphocytic Leukemia (Kaplan p.183) NHL occurs in individuals of all ages, although the incidence progressively increases with age. The incidence in the 20- to 25-year-old group is 2.5 cases per 100,000 population. By 60 years of age, this rate has increased to 43.7 cases per 100,000, and by 75 years, it has risen to 100 cases per 100,000. The median age of presentation is 55 years. Immunology: Regarding immunology, which of the following is correct? a) Natural killer cells are a subset of T cells b) B cells produce first Ig M and later Ig G c) Ig E is involved in mucosal protection d) Opsonization e) Ans: A and B. Drugs: A 60-years old obese man, on ACE inhibitors for hypertension, Metformin & glibenclamide for diabetes, benzodiazepines & TCAs for depression & insomnia, now complaints of impotence. Which drug is the most likely responsible for the impotence? a) Glibenclamide b) Metformin c) Tricyclic antidepressants d) Benzodiazepine e) ACE inhibitors Ans: D. JM p.1116. Rh: A 30-year old bisexual male, presents with clear urethral discharge, mouth ulcers, arthralgia, fatigue and sausage like fingers. Culture was negative. What is the most likely diagnosis? a) Reiters disease b) Bechets disease c) Ankylosing spondylitis d) SLE

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e) Ans: A. Clear urethral discharge: Non gonococcal urethritis (Chlamydia) Sausage shaped digits are seen in reactive and psoriatic arthritis (Tor Rh p.27, Harrsson p.2014) CNS: A 56-year old man presents confused. He cannot abduct his eyes, there is a slight problem with elevating his eye and nystagmus is present throughout. Most likely diagnosis is? a) Wernickes encephalopathy b) . c) . d) . e) . Ans: Global confusion, ophthalmoplagia and ataxia are seen in warniickes encephalopathy.

Infection: A 23-years old university student has fever, arthralgia, lymphadenopathy & malaise. ALT, AST & GGT are elevated. Peripheral smear shows atypical lymphocytes. The diagnosis is? a) Hepatitis A b) Hepatitis C c) Infectious mononucleosis d) CMV e) ALL Ans: c.

Electrolytes: Hypokalemia occurs in all except? a) Thiazide diuretics b) Pyloric stenosis c) Chronic renal failure d) Laxative abuse e) Hyperaldosteronism Ans: c. Nephrology: A 22 year old man developed haematuria and slight swelling of the face. On examination BP150/80 mmHg, RBC & hyaline casts are present in the urine. Most likely diagnosis? a) Nephrotic syndrome b) Glomerulonephritis c) Pyelonephritis

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d) Ig A nephropathy e) Renal tubular necrosis Ans: B Hematuria.

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Ophthalmology: A 37-years old woman has unilateral exopthalmos. Which of the following is the most likely cause? a) Glaucoma b) Nasophryngeal tumour invading the orbit c) A neoplastic lesion in the lamina cribrosa d) Thyrotoxicosis e) Infection of the frontal sinus f) Maxillary antral tumor Ans: Bilateral causes: * Grave's disease Unilateral causes: * Grave's disease * cavernous sinus thrombosis * pseudotumours of the orbit * carotid-cavernous fistula * tumour (benign, eg dermoid or malignant) * capillary haemangioma * orbital cellulitis * sinus mucocoele

Drugs: All of the following are side effects of prednisolone except? a) Hirsutism b) Lymphopenia c) Leucocytosis d) Osteomalacia e) Weight gain Ans: d.

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GIT: A patient you treated for duodenal ulcer with Helicobacter pylori for 1 week with treiple therapy. He is asymptomatic now. Which of the following is the best follow up? a) Urea breath test b) Endoscopy c) Serology d) Histological examination e) Culture Ans: A.

Infection: A 20-year old man is found to have HIV. What does this indicate? a) He has AIDS now b) He has got lifelong infection & infectivity c) He needs to start pneumocystis carinii prophylaxis d) He requires to start AZT therapy e) He can transmit through saliva now Ans: B. Hematology: A 70-year old woman complaints of fatigue. Blood picture--MCV 118, Hb decreased, WBC decreased, platelets decreased, Hypersegmented polymorphs present. The most likely diagnosis? a) Autoimmune haemolytic anaemia b) Pernicious anaemia c) Anaemia of chronic disease d) Anaemia due to silent gastrointestinal bleeding e) Leukaemia(CML) Ans: B.

Blood gas: A 68 years old man with COPD was brought to your surgery from nursing home by ambulance. On his way to hospital he received O2, 10 L/m by mask. He is still unarousable and his ABG most likely-a) Ph 7.29 PaCO2 65 PaO2 85 b) Ph 7.15 PaCO2 50 PaO2 68 c) Ph 7.25 PaCO2 25 PaO2 100 d) Ph 7.35 PaCO2 40 PaO2 40 e) Ph 7.45 PaCO2 85 PaO2 40 Ans: A.

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Carbon dioxide (CO2) narcosis: A condition of confusion, tremors, convulsions, and possible coma that may occur if blood levels of carbon dioxide increase to 70 mm Hg or higher. Individuals with chronic obstructive pulmonary disease can have CO2 narcosis without these symptoms because they develop a tolerance to elevated CO2. When ventilation is sufficient to maintain a normal oxygen partial pressure in the arteries, the carbon dioxide partial pressure is generally near 40 mm Hg Immunology: A 24-year old female has abdominal pain every week. Sometimes she has face & lip swelling. Her mother and sister also have this. What would you do to establish a diagnosis? *** a) Measure Cl esterase b) Check for food allergies c) Check Pb levels d) Ig A deficiency Ans: A.

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C1 esterase inhibitor is the main regulator in the activation of * complement system * contact system (kallikrein-kinin system) * coagulation cascade, fibrinolytic pathway (to a lesser extent)

CNS: A patient complaints of headache, vomiting & papilloedema. Which of the following is the most likely cause?** a) Giloma of the frontal lobe b) Tumour obstructing the 4th ventricle c) Pituitary tumour d) Ans: B (Deja p.348). CNS/ENT: An elderly patient has acute onset unilateral deafness, tinnitis & vertigo. What is the diagnosis? a) Menieres disease b) Acoustic neuroma

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c) Vestibula neuronitis d) Ans: A. (Torronto ENT p.16)

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Nephrology: A patient has calcium oxalate renal stones. What is the most appropriate managemant? a) Allopurinol b) Alkalinize the urine c) Stop taking food with calcium d) Give calcium Ans: Uric acid stone: Allopurinol Ca oxalate: Rhubab, strawberry, palms and spinach Calcium restricted diet: Reduces urinary calcium It is important to drink plenty of fluid; especially in the summer months or a warm climate (urine output should be kept at > 3 litres per 24 hours). Other prevention measures are directed towards the particular type of urinary tract stone: Calcium stones - reduce calcium intake and avoid vitamin D supplements Oxalate stones - reduce oxalate intake - foods with high oxalate content include chocolate, tea, nuts, beans, spinach, beetroot; reduce intake of citrus fruits (vitamin C) Cystine stones - high fluid intake, alkalinization of urine, D-penicillamine acts as a chelating agent Triple phosphate stones - antibiotics Uric acid stones - allopurinol, urinary alkalinization (GPnotebook)

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Hematology: Heparin therapy is monitored by which of the following tests? a) APTT b) INR c) Bleeding time d) Serum fibrinogen Ans: A. Snake bite: A middle-aged man is brought to your surgery with a history of being bitten by a black snake. On examination there are scratch marks on the lower leg and no other symptoms. What is your management? a) Reassure and send him home b) Excise wound c) Administer antivenin immediately d) Apply Tourniquet e) Observation and antivenoum if necessary Ans: E.

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CVS: Opening snap indicates: a) Mitral valve mobility b) Atrial fibrillation causes disappearance of the opening snap c) Replaces S3 d) Best heard at 2nd right intercostals space e) Remains unaltered despite progression of the disease Ans: A.

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In the healthy heart the mitral and tricuspid valves open silently during diastole, at the end of isovolaemic relaxation. In certain pathological states the AV valves open more rapidly than normal; this results in an audible opening snap. A mitral opening snap is said by some experts to be pathognomonic of mitral stenosis. The intensity of the snap is directly proportional to the area of the fused cusps. The timing of the opening snap is influenced by the atrial pressure (higher the pressure earlier the snap) and the duration of the isovolumic relaxation phase (the shorter the relaxation phase the earlier the opening snap).

Differentiation of the opening snap from P2: This can be achieved by listening to the heart sounds during inspiration: the examiner will hear A2, P2 and the opening snap in quick succession. A mitral opening snap may be caused by:

Mitral stenosis with a mobile valve Rapid mitral flow causes a soft snap e.g. left to right shunts such as a VSD or PDA. Also may occur in severe mitral regurgitation.

A tricuspid opening snap is rare and may be caused by:

tricuspid valve abnormalities e.g. rheumatic stenosis increased tricuspid flow e.g. left to right shunt occuring in an atrial septal defect

http://www.gpnotebook.co.uk/simplepage.cfm?ID=939917320

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Drugs: A man presents with a history of treatment with Sulphasalazine. The least likely complication for the condition he was treated for would be?** a) Pericholangitis b) Iritis c) Erythema nodosum d) Peripheral neuropathy e) Ankylosing Spondylitis Ans: D. Medicine p.183 Skin: In contact dermatitis, which is common? a) Contact with plants b) Can be treated by topical steroids c) Can be treated by oral steroids Ans: JM p.1163

RS: All of the following are present in interstitial fibrosing alveolitis except? a) clubbing is common b) Normal FEV1/FVC does not exclude the diagnosis c) Diffuse expiratory crackles d) Decreased VC Ans: Early inspiratory crackles are seen. JM p.533 Intestitial Fibrosing Alveolitis: Clinical features include:

dyspnoea cyanosis clubbing there may be slightly reduced chest expansion there may be bronchial breathing on auscultation there may be late-inspiratory and paninspiratory crackles heard over the affected lung lobules there may be clinical features of an associated connective tissue disease

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Ix of choice: HRCT (GPnotebook)

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Oncology: A 72-year old man with a history of non-small cell lung cancer now complains of lethargy, constipation and thirst for the past few weeks. What is the most likely problem? a) SIADH b) Ectopic parathormone production from the cancer itself c) Metastasis to the brain d) . e) Ans: B.

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Investigation of choice: Bronchoscopy and biopsy

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CNS: A 64-year-old male complaints of pain behind the right eye, associated with lacrimation, which appears every morning & disappears in the afternoon, for the past 2 weeks. He had similar episodes previously. Which is the prophylactic treatment? ** a) Methysergide b) Ergotamine c) Acetozolamide d) NSAID e) Sumatriptin Ans: Ergotamine. JM p.607 Prevention of the attack - two approaches are generally used, Short-term (transitional) strategy Corticosteroids eg. Prednisolone 60-100mg per day for 25 days, then decreased by 10 mg every 23 days Ergotamine tartrate Greater occipital nerve injections

Long-term (maintenance) strategy these are taken during the entire cluster period + verapamil is first line prophylaxis (80mg tds/qds, but up to 960mg per day may be needed) To avoid therapeutic delay, short-term prednisolone can be added to verapamil. + lithium + methysergide 1-2mg tds may be considered when other treatments fail avoid alcohol and nicotine Hypothalamic deep brain stimulation may be useful in intractable chronic cluster headache GIT: A patient has diarrhoea, fatigue and pallor. Blood picture shows MCV 110. What is the diagnosis? (DAV 642) a) Pernicious anaemia b) Crohns disease c) Gluten-sensitive enteropathy d) Tropical sprue

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Ans: Tropical sprue: History

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TS manifests clinically with a spectrum of signs and symptoms. It may develop in natives or travelers to the tropics, and it may not appear until as long as 10 years after the patient has left there. No definitive marker of TS exists; hence, these claims remain unsubstantiated. Patients may experience the following:

Diarrhea Weight loss Leg swelling Fatigue Fever

Physical

Examination may reveal the following:

Weight loss Dehydration Pallor Oral mucosa changes (glossitis, stomatitis) Edema

Consider specific causes of diarrhea and malabsorption. Consider the diagnosis of TS if the initial history, physical, and laboratory workups are suggestive of mucosal malabsorption. Although TS can manifest as an acute diarrheal illness, the clinical diagnosis is usually not considered until patients present with chronic symptoms. Diarrhea and fat malabsorption may occasionally be difficult to differentiate. Perform a 24- to 72-hour stool test for fat. Total stool fat less than 6-7 g/d excludes steatorrhea; therefore, consider chronic diarrhea.

Laboratory Studies

Clinical presentation, including diarrhea, malabsorption of nutrients, and anemia workup, influences the extent of diagnostic tests. Findings of steatorrhea, mucosal malabsorption of 2 substances (eg, fat, D-xylose), and villous atrophy (demonstrated by means of biopsy) are adequate to make a diagnosis. Response to treatment is considered by some to be the conclusive evidence that confirms the diagnosis. CBC count: This shows megaloblastic anemia associated with reduced folate and vitamin B-12 levels in as many as 60% of patients.

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Blood chemistry test: This includes potassium, calcium, magnesium, phosphate, albumin, cholesterol, and iron studies. Stool collection test

This measures fat content over 72 hours on a diet of 80-100 g of fat. A result of more than 6 g in 24 hours is abnormal (positive for fat malabsorption). Fatty stools are usually observed when the stool fat content is 15 g or more.

D-Xylose absorption test

For this study, 25 g D-xylose is administered orally. In well-hydrated patients with normal renal function, abnormal results (ie, positive for mucosal malabsorption) include a 5-hour urine collection of less than 4 g and a 1-hour serum collection of less than 20 mg/dL.

(Emedicine) RS: A 60-year-old man, who smokes 60 pack per year, presented with shortness of breath, was given 28% oxygen by mask. 30 minutes later, his ABG was PaO2 68, PaCO2 60. What would you do next? a) Stop oxygen and check ABG after 30 minutes b) Continue oxygen until normal PaO2 is reached c) Immediate intubation & ventilation d) Give immediate antibiotic cover against gram negative bacteria e) Start aminotryptillin iv infusion Ans: B. Respiratory failure: PaO2 <60 and PaCO2 >45 Harrison p1595.

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GIT: Which of the following conditions is most likely to become chronic? a) HAV b) HBV c) Hepatitis C virus d) EBV e) Cholecystitis Ans: Hepatitis C. Most common viral hepatitis is Australia: C. JMp628

RS: A young man presents with pleuritic chest pain and cough. On examination there is dullness on percussion and brochial breathing over the right lower zone, posteriorly. Which of the following is the most likely diagnosis? a) Right lower lobe consolidation b) Right lower lobe collapse c) Pleural effusion d) Asthma e) TB cavity

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Ans: A. JM p.529 Infection: Erythema nodosum occurs in all except? a) Steptococcus infection b) Rheumetic fever c) TB d) Leprosy e) SLE Ans: Rh Fever.

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Poisoning: A young man, who had taken some intravenous drug, was found unconscious, with 3 breaths per minute and constricted pupils. Which of the following would be the most appropriate treatment? a) Naloxone b) Atropine c) Scopalamine d) Methadone e) Naltraxone Ans: Naloxone Amyloid can occur in each of the following except? *** a) Rheumatoid arthritis b) TB c) Leprosy d) Chronic active hepatitis e) Multiple myeloma Ans: Leprosy and Chronic active hepatitis

CNS: A 68-years old female presents with a 2-week history of unilateral headache and an ESR 80 mm/hr. The most appropriate treatment is? a) NSAIDs b) Aspirin c) Carbemazepine d) Prednisolone e) Ergotamine Ans: Prednisolone (JM p.)

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2006
Nephrology: A female aged 23 years, presented with proteinuria. There is a previous history of enuresis till 13 years of age. Her sister also had enuresis as a child. The history is suggestive of which of the following?**** a)Chronic glomerulonephritis b) Reflux nephropathy c) Congenital nephritis d) Polycystic kidney disease e) Analgesic nephropathy Ans: Reflux nephropathy Causes of enuresis include: genetic predisposition - about 70% of affected children have a first-degree relative who was enuretic - linkage studies have localised a genetic predisposition to this condition to chromosome 13q urinary tract infection - about 5% of enuretic children have urinary infections, compared with 1% of other children of comparable age. The relationship is not necessarily causal; persistent enuresis may predispose to an ascending infection bladder capacity - may be smaller than normal. Constipation or cystitis also may lead to reduced bladder capacity stress - enuresis sometimes worsens or starts after a stressful event polyuria may be the result of: diabetes mellitus diabetes insipidus chronic renal failure structural urinary tract abnormalities: ectopic ureter ectopia vesicae urethral valves epispadias neurogenic bladder: meningomyelocoele spinal dysraphism spinal cord tumour impaired nighttime arousal due to sleep-disordered breathing medications valproic acid

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clozapine

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Drugs: A patient, who had been taking a particular drug, now presents with haematuria. The drug is most likely? a) Calcium channel blocker b) Digoxin c) Naproxen-NSAID d) . e) Ans: Naproxen. Pyelonephritis Obstruction Sickle cell Tb Cirhosis Analgesics Renal transplant reaction Diabetic Systemic nephritis.

RS: A person presents with alpha antitrypsinogen deficiency. What is the most likely association?** a) One parent has died of emphysema b) Limited to bronchioles c) Uninhibited protease action d) . e) Ans: C. Pan acinar emphysema: Alfa 1 anti trypsin deficiency centriacinar - tissue loss at the centre of the acinus, and greatest in the upper zones. Mild forms may occur in anthracosis, for example in coal miners, and have little or no functional effect. Destructive forms are usually seen in smokers. panacinar - tissue loss throughout the acinus, and greatest in the lung bases. Mild forms may occur with aging; severe forms are typified by alpha-1-antitrypsin deficiency.

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Patterns unusually associated with COAD: paraseptal - bullae occur on the lung fringes. They may rupture to cause a spontaneous pneumothorax. irregular - small, emphysematous foci related to scars, for example, underlying tuberculosis.

Centriacinar (Centrilobular) Emphysema. The distinctive feature of this type of emphysema is the pattern of involvement of the lobules; the central or proximal parts of the acini, formed by respiratory bronchioles, are affected, whereas distal alveoli are spared. Thus, both emphysematous and normal airspaces exist within the same acinus and lobule. The lesions are more common and usually more severe in the upper lobes, particularly in the apical segments. The walls of the emphysematous spaces often contain large amounts of black pigment. Inflammation around bronchi and bronchioles is common. In severe centriacinar emphysema, the distal acinus may be involved, and differentiation from panacinar emphysema becomes difficult. Centriacinar emphysema occurs predominantly in heavy smokers, often in association with chronic bronchitis. Panacinar (Panlobular) Emphysema. In this type, the acini are uniformly enlarged from the level of the respiratory bronchiole to the terminal blind alveoli. The prefix "pan" refers to the entire acinus but not to the entire lung. In contrast to centriacinar emphysema, panacinar emphysema tends to occur more commonly in the lower zones and in the anterior margins of the lung, and it is usually most severe at the bases. This type of emphysema is associated with 1antitrypsin (1-AT) deficiency. Distal Acinar (Paraseptal) Emphysema. In this type, the proximal portion of the acinus is normal, but the distal part is predominantly involved. The emphysema is more striking adjacent to the pleura, along the lobular connective tissue septa, and at the margins of the lobules. It occurs adjacent to areas of fibrosis, scarring, or atelectasis and is usually more severe in the upper half of the lungs. The characteristic findings are of multiple, continuous, enlarged airspaces from less than 0.5 cm to more than 2.0 cm in diameter, sometimes forming cystlike structures. This type of emphysema probably underlies many of the cases of spontaneous pneumothorax in young adults.

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Airspace Enlargement with Fibrosis (Irregular Emphysema).

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Irregular emphysema, so named because the acinus is irregularly involved, is almost invariably associated with scarring. Thus, it may be the most common form of emphysema because careful search of most lungs at autopsy shows one or more scars from a healed inflammatory process. In most instances, these foci of irregular emphysema are asymptomatic and clinically insignificant. (Robbins Pathology)

Endocrine: A 65-year-old man presented with confusion. Laboratory findings showed hypercalcaemia, calciuria, and phosphates within normal limits. Which is the most likely diagnosis? a) Malignancy(osteolytic metastasis) b) Primary hyperparathyroidism c) Idiopathic hypercalcaemia/hypercalciuria d) Pagets disease myeloma Ans:

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CNS: A 28-year old male presents with distal weakness and atrophy of the small muscles of both hands(interossei, lumbricals, thenar & hypothenar). What is the most likely diagnosis? a) Multiple sclerosis b) Bilateral median nerve palsy c) Syringomyelia

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d) Bilateral ulnar nerve palsy e) Brainstem infarction Ans: D.

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CVS: A person with severe aortic stenosis has a systolic gradient of 55 mmHg. What other feature required suggesting the severity? a) LV ejection fraction b) LV end diagnosis pressure c) Cardiac output d) LV hypertrophy e) LV end systolic pressure Ans: D. Severity of AS: 1. 2. 3. 4. 5. 6. Symptoms and signs of LVF Pulse pr Cardiomegaly Paradoxical split S2 LVH with strain Pulmonary congestion

CVS: An elderly man presents to the emergency dept with chest pain. No ECG changes and cardiac enzymes are normal. What is true? a) If ECG is normal he does not have a cardiac problem b) He should have an immediate stress test done c) Intravenous nitrates & heparin are not indicated d) No follow up ECG is required e) Streptokinase is indicated if there are ECG changes Ans: B. A physician may recommend an exercise stress test to: * Diagnose coronary artery disease * Diagnose a possible heart-related cause of symptoms such as chest pain, shortness of breath or lightheadedness * Determine a safe level of exercise * Check the effectiveness of procedures done to improve coronary artery circulation in patients with coronary artery disease * Predict risk of dangerous heart-related conditions such as a heart attack.

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Infection: The most common cause of travellers diarrhoea is? a) Salmonella Typhi b) Shigella c) Enterotoxic E. Coli d) Staphylococcus e) Giardia Lamblia Ans: C. CNS: Taste sensation of the anterior 2/3 of the tongue is carried by which nerve? a) V b) Facial nerve(VII) c) IX d) X e) XII Ans: facial Post Tongue: Glosopharyngeal.

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CNS: Which of the following is least likely to cause facial nerve palsy? a) Skull fracture b) Mastoiditis c) Chronic parotitis d) Parotid tumour e) Acoustic neuroma Ans: C.

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GIT: A patient has massive ascitis and in the fluid malignant cells are found. Which of the following is a possible finding? a) Splenomegaly b) Hepatomegaly c) Supraclavicular swelling d) On digital rectal examination, nodules can be palpated Ans: C. Ca Stomach. Metabolism: The single most reliable test for Haemochromatosis is? a) Red cell mass b) Serum iron c) Serum ferritin d) Serum Transferrin e) Transferrin saturation Ans:

S. transferring satiration S. transferrin saturation: >70% S. ferritin : >250 ug/L.

AR disorders. HHE gene Liver is the first organ involved 90% of cases. Bronze Diabetes: Pancreus Cirrhosis: 10% will convert to carcinoma Heart: Restrictive cardiomyopathy Hypgonadism: loss of libido, testicular atrophy

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Screen First degree relative.

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Mx: Weekly venesection 500 ml until serum iron come to normal then 3 to 4 monthly to keep the S. ferritin level below <100 ug/L. Normal diet, iron restriction not necessary.

The classic tetrad of manifestations resulting from hemochromatosis consists of (1) cirrhosis, (2) diabetes mellitus, (3) hyperpigmentation of the skin, and (4) cardiac failure. Clinical consequences also include hepatocellular carcinoma, impotence, and arthritis.

Infection: In which of the following, is administration of immunoglobin as a prophylaxis not useful? a) Hepatitis A b) Hepatitis B c) Rubella d) Mumps e) Varicella Ans: Hepatitis A Measles doesnt have a carrier.

Hematology: In Von Willebrandts disease you will find: a) Increased platelet count b) Increase bleeding time ( Bleeding time is prolonged, platelets show reduced adhesion and levels of Factor VIII are low ) c) Normal APTT d) . e) Ans: B. RS: 12 years old boy came with severe dyspnoea and afibrile condition. O/E you found R/R40/min, Pulse- 130/min. There is O2 saturation at room air of 85%. WOF will be appropriate-a) Give salbutamol $ hourly at home b) Give salbutamol and aminophyllin 4 hourly at home c) Give him O2 and send him to hospital by an ambulance.

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Ans: C.

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CVS: All the following drugs are proven to decrease the mortality in myocardial infection, except? a) Aspirin b) ACE inhibitors c) Beta blockers d) Nifedipine e) Streptokinase Ans: Nifedipine Mortality reducing: Aspirin B blockers Ace inhibitors Streptokinase

RS: A patient with COPD came in the emergency department with severe dysponea, 28% O2, 8 liter was given by mask. After one hour you did arterial blood gas & you found that PaO2 level was 42 mm Hg, and Pa CO2 level was 68 mm Hg. WOF you will do now? a) Increase O2 inhalation by mask b) Increase I/V fluid c) Repeat arterial blood gas level d) Ask the patient for intubation and ventilation Ans: D. Endocrine: A 50 yrs old lady admitted with Atrial Fibrillation.Blood tests show : a) TSH : decrease (Note:DxThyrotoxicosis b) T3: increase if all decrease, Dx pituitary disease) c) T4: increase Your management will be a) Total thyroidectomy b) Subtotal thyroidectomy c) Radioactive iodine d) Neomercazole(Carbimazole) e) Echo Ans: C. JM p.223

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Presence of graves ophthalmopathy: is a relative contraindication for Radio-active iodine. Pregnancy should be avoided:

CVS: An office clerk with high blood pressure. He is obese and he takes 3-4 cups of coffee everyday. WOF is not correct--a) Consumption of coffee contributes greatly to his BP b) Reducing body weight will help to reduce his BP c) In 90-95% cases no cause is found for BP. d) He should be advised about safe level of drinking alcohol. Ans: A. CNS: A male presents with a sudden onset of vertigo and nausea. During the attack he has deafness. WOF is your diagnosis is -a) Positional vertigo b) Acoustic neuroma c) Labyrinthitis d) Basilar artery infection Ans: C. If there is whistling diagnosis is labyrinthitis, and if whistling is absent Vestibular neuritis.

Skin: Photograph 1: Shows a skin lesion on the forearm. Slightly raised, red plaque, slightly scaly. What is the diagnosis? a) Lichen planus b) Discoid eczema

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c) Squamous cell carcinoma d) Psoriasis e) Contact Dermatits Ans:

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Skin: Photograph 2: Shows a skin lesion, pinkish brown colored lump. The lesion in the picture was found on the forearm of a young male. 2 weeks later he develops pneumonia associated with crepitation through out both lungs.WOF organism is causing this lesiona) Streptococcus pneumonia b) Staphylococcus Aureus c) Mycoplasma Pneumonia d) Pneumocystis carnii e) Mycobacterium Avium Ans:

Skin abscess Trauma: Photograph 3: X-ray showing an open fracture of the fibula & tibia. A young man, after an accident on his motorcycle, presented with 3 cm of bone protruding through the skin of his leg. What is your next line of management? a) Internal fixation of the fracture immediately b) Skin closure of the wound immediately to prevent infection c) Reduce the fracture and apply plaster of paris d) Give tetanus toxoid IM & antibiotics iv e) Debribement is only indicated when the wound is severely contaminated Ans: E. JMp.1375 Good approximation of wound edges minimises scar formation and healing time. Pay special attention to debridement. Avoid deep layers of suture material in a contaminated woundconsider drainage. Inspect all wounds carefully for damage to major structures such as nerves and tendons and for foreign material: shattered glass wounds require careful inspection and perhaps X-ray. high-energy wounds, e.g. motor mowers, are prone to have metallic foreign bodies and associated fractures. Be ready to take X-rays of wounds to look for foreign objects or fractures (compound fractures). Trim jagged or crushed wound edges, especially on the face. All wounds should be closed in layers.

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Avoid leaving dead space. Do not suture an 'old' wound (greater than 8 hours) if it is contaminated with primary closure: leave 4 days before suturing if not infected. Take care in poor healing areas such as backs, necks, calves and knees; and in areas prone to hypertrophic scarring such as over the sternum of the chest and the shoulder. Use atraumatic tissue-handling techniques. Everted edges heal better than inverted edges. Practise minimal handling of wound edges. A suture is too tight when it blanches the skin between the threadit should be loosened. Avoid tension on the wound, especially in fingers, lower leg, foot or palm. The finest scar and best result is obtained by using a large number of fine sutures rather than a fewer thicker sutures more widely spread. Avoid haematoma. Apply a firm pressure dressing when appropriate, especially with swollen skin flConsider appropriate immobilisation for wounds. Many wound failures are due

Infection: Photograph 4: A diabetic man comes to see you. His right leg below his knee is red & shiny. What is the best initial management? a) Penicillin & flucloxalillin b) Metronidazole c) Ampicillin d) Ampicillin & gentamicin e) Ampicillin Ans: Ampi genta and metro Rational prescribing: Diabetes/PVD-lower limb cellulitis: Amoxycillin/clavulanate1st + Metronidazole1st Clindamycin Cephalexin Streptococcus pyogenes (the common cause) 10 Severe benzylpenicillin 1.2 g IV 4 hourly Less severe procaine penicillin 1 g IM 12 hourly or

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phenoxymethyl penicillin 500 mg (o) 6 hourly If penicillin sensitive cephalothin IV or cephalexin 0.5 mg (o) 6 hourly or erythromycin 500 mg (o) 12 hourly

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Staphylococcus aureus 11 file:///C|/McGraw-Hill/gpseries/html/New%20Folder/GP-C60.htm (28 of 31)31/07/2006 12:22:57 AM severe, may be life-threatening flucloxacillin/dicloxacillin 2 g IV 6 hourly less severe flucloxacillin/dicloxacillin 500 mg (o) 6 hourly or cephalexin 500 mg (o) 6 hourly or erythromycin 500 mg (o) 12 hourly

CNS: Photo: Eye and dilated pupil. Ans: Acute angle closure glaucoma Acetazolamide IV and Pilocarpine 4% topical (JMp558)

AMC MEDICINE(2006) Ophthalmology: Man came to you with h/o pain in the eye, also has headache and vomiting. Mxa.Tropical Acetazolamide b.Patch the eye to look for FB cAtropine eye drops d. Topical Pilocarpi Ans: D. RS: Photo: X-ray chest of a 9 months old infant as shown in AMC book(page-119). What is the Dx? Staph. Pneumonia( But most common in this age group is Streptococcus pneumonia) ne ntamicin & metronidaz

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CNS: Photo: CT Scan. A lady complains that she feels her left side of body she feels heavy. She also has paralysis & weakness of left side. WOF is your Dxa. Cerebral Tumour b. Cerebral Haemorrhage c. Cerebral Infarction d. SAH Ans: Electrolytes: ECG: Wide QRS complex and tall T wavea.Hyperkalaemia b.Hypokalaemia c.Hyponatremia Ans: Hyperkalemia CVS: ECG: Inferior Infarction Ans: 2 3 aVF

CVS: ECG: Ventricular Fibrillation Ans: DC Cardioversion. CVS: ECG:Vetricular Ectopic Ans: most common cause of palpiation. CVS: ECG: WPW Syndrome.What is the Rxa.Surgical ablation of the extra circuit b. Radiofrequency ablation of the abnormal tract Ans: B. CNS: A pt. present with ptosis of left eye, left side sensory loss of face. Left side gag reflex was absent, Rt. Sided hemiparesis and incoordination of Rt. Upper and lower limb.Where is the lesion? a.Middle Cerebral Artery

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b.Internal Carotid Artery c. Vertebral Artery d. Multiple Sclerosis e.Post. Cerebral Artery Ans: Vertebral artery. PICA, sup middle and inf lat medullary artery.

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GIT: A baby has jaundice just after delivery. Mother is Rh ve, baby also Rh ve. Coombs Test is ve.What may be the Dx? a.Autoimmune condition b.ABO incompatibility c.Rh incompatibility Ans: Obstetric infections FIRST Inheritence: WOF is X linked Recessive? Haemophilia .

CNS: WOF is a feature of Parkinsonisma..Loss of postural reflex b.Hyperreflexia c.Hypotonia d Wide based gait. Ans: A. CNS: WOF is not a feature of Lacunar Infarct? a.Fascicultion b.Spasticity c.Face weakness(sensory loss of face) d.Difficulty in walking e.Increase Reflexes Ans: LMN lesions are absent: so fasciculations should be absent. Lacunes are small fluid-filled cavities, < 1.5 cm in diameter, which are found in the basal ganglia, the thalamus, the internal capsule, the pons and the cerebral and cerebellar white matter. They

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are the result of infarction secondary to the occlusion of the small penetrating branches of the major intracranial arteries. They are frequently multiple. They are apparent in approximately 25% of strokes. Possible clinical features include: * the patient is likely to be conscious * an infarct in the areas described may cause a pure sensory, pure motor or mixed motor and sensory deficit * sudden onset unilateral cerebellar ataxia, and sudden dysarthria with a clumsy hand are typically caused by by single lacunar infarcts

CNS: A patient who was previously well comes to you with complains of weakness for last 2 weeks, his reflexes in lower limbs are absent though in upper limbs are normal. What will be the CSF findingsa.Elevated protein, elevated glucose, elevated leucocytes b.Elevated protein, normal glucose,leucocytes< 5ml c.Normal protein,normal glucose, leucocytes>5ml d.No ignificant abnormality Ans: B. Infection: All of the following are feature of ROSS RIVER, Except- **** a.Chest pain b.Muscle pain Davidson-107 c.Fever d.Lathergy e.Arthralgia Ans: Chest Pain (JM p.260). WOF is compatible with severe illness:*** a.Increased cortisol, increased THS Dav-552 b.Both cortisone and THs decreased (Seehan synd.) c.Increased cortisol, decreased THS (Cushing Synd. + Hyperthyroidism- worst combination ) d.Decreased cortisol, increased THS e.Normal cortisol, increased THS Ans: C. Cushing Synd. + Hyperthyroidism- worst combination

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Drugs: WOF drugs have strongest negative ionotropic action: a.Digoxin b.Dopamine c.Adenosine d.Deltiazem Ans: D. CCB: Diltiazem Metabolism: In Haemochromatosis, WOF will suggest diagnosis? a.Serum Fe b.Serum Ferritin c.Iron daturation d.Serum transferrin Ans: Serum Transferrin Saturation is best. Serum ferritin is the answer.

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GIT: After screening with faecal blood test WOF is the correct percentage of detection of Duke A1 colonic carcinoma: Scott-323 a.<3% b.15% ( Duke A-tumour confined to bowel wall-survival 90%) c.25% d.50% e.75% Ans:

Which ONE of the following is a mass population screening test which has been demonstrated to reduce cancer mortality significantly? a) annual faecal occult blood testing in the over 50 age group b) annual colposcopy in sexually active women c) annual plasma CA125 in post menopausal women d) annual colonoscopy in siblings of patients with colon cancer e) 2 yearly mammography in women in the 35-45 age group

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Incorrect. The correct answer is (a).

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There have been at least 3 randomised control screening trials conducted which show that faecal occult blood testing every 1-2 years in the over 50 year population reduces the mortality from colorectal cancer by around 20%. Colposcopy is a diagnostic, not a screening test. The appropriate screening test for cancer of the cervix in sexually active women is the Papanicolaou (Pap) smear. Plasma CA125 levels may be raised in asymptomatic women with ovarian cancer but there is not, as yet, any evidence for its benefit as a mass screening measure. Colonoscopy for siblings of patients with colorectal cancer may reduce their mortality, but this is 'selective' screening, by targeting a high-risk group. While mammography in the 50-70 age group has been shown to reduce mortality from breast cancer by around 30%, the benefit for women in the 40-50 age range is quite small, and there is little evidence for benefit in still younger women.

Endocrine: WOF is a feature of Thyrotoxicosis? a.Fine tremor b. Distal myopathy c.Small muscle weakness Ans: A. JM p.294

* Rest tremor o Parkinsons disease * Postural and action tremor o Essential tremor * Exaggerated physiological tremor o Hyperthyroidism o Drug-induced (eg -agonists) o Dystonic tremor * Intention tremor o Cerebellar disorders Infection: A 40 yrs old man comes with short history of malaise and cachaxia when he was on a short trip to Bangkok.His wife thinks he is suffering from jaundice. Now he presents with fever and chills.Blood tests shows: S. Bilirubin- increased, Alk Phos- Much increased, AST-Slightly increased, ALT- Slightly increased.What is the Dx?

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a.Viral Hepatitis b.Cholengitis c.Malaria Ans: Acute Cholangitis.

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Endocrine: A lady comes to you with low BP (100/65), Pulse 120/minute. She complains of pigmentation specially around her breasts.WOF is your Dx: a. SIADH b. Addisons disease c. Hyperaldosteronism (In Oct.05 : Pt. presents with lathergy, mucous membrane pigmentation and K+ : increased, Na+:123 mmol/L(decreased)BP- low and low glucose) Ans: B. Hyperpigmentation and electrolyte disturbance absent in secondary.

hematology: A 54 yr old man has CRF, his MCV is 80-90.It falls even more after treatment with Erythropoietin; when the therapy was stopped he becomes anaemic within two months. His condition is due toa.Fe def. Anaemia b. Vit B12 def. c.Folic acid def. d.Bone marrow fibrosis e.Red Cell atypia Ans: Fe deficiency Anemia.

CVS: WOF is associated with ASDa.Diastolic murmur b.Wide fixed split S2 all muscle weakness. Ans: B. Endocrine: A 34 yr old lady complains of weight loss. She says that she has lost interest in day to day activities, and she feels hot. Her husband says that her wife has become moody & irritable. Her conditions most probably due toa.Hypoythyroidism b.Hyperthyroidism

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Ans: B. Alcoholism: Treatment of Alcohol withdrawl hallucinationa.Diazepam b.Halloperidol Ans: Diazepam (JM p.1251) Ecstasy is very popular in Australia, commonly used by youngs; its properties are similar toa.Cocaine b.LSD c.Methamphetamines d.Diazepam Ans: Methamphetamines. JMp.206

CNS: Treatment of Trigeminal NeuralgiaCarbamezepine Ans: Amytriptyline. Rh: Feature of Temporal Arteritis: Patient with loss of vision which lasted for few minutes.WOF is correct? a.Temporal arteritis b.Lacuner infarct c. Carotid artery stenosis Ans: Carotid artery stenosis JMp842 CNS: A 38 yr old lady with dull contineous headache, could not do her daily work. Most appropriate Ixa.ESR b.USG c.CT Scan Ans: C Endocrine:

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A 35 yr old lady came to ED with twitching of fingers. Investigations done; CT normal. Reassurance given. But after few days she came back again with twitching in hand again. Another CT & USG. Management: Ans: GIT: Patient with ileal resection causing increased INR. WOF is correcta.Non absorption of Vit. K (Normal INR 0.9-1.2) b.Bleeding disorder Ans: Vit K deficiency. Hematology: A patient with INR 2.1: An old man is on Warfarin and now he is discovered with a resectable colon cancer. Management: Stop Warfarin and start low dose Heparin; operate when INR is normal Warfarin should be stopped before 4 days. Clopidogrel should be stopped before:

CNS: A 29 yr old woman developed severe paroxysm of pain in check and lip lasting for about 15-20 minutes. There is loss of sensation in trigeminal nerve area. Most likely Dxa.Tic dorulex b. Trigeminal neuralgia c.Multiple sclerosis d.Migraine without aura Ans: Tic Dolurex and Trigeminal neuralgia same. Ans: CNS: A man presents with sudden onset of Horners syndrome, 9 & 10 nerves palsy and loss of touch and temperarure sensation on the opposite side of the body. Where is the site of lesion? a.Vertebrobasilar artery b.Basilar artery c.middle cerebral artery d.Vertebral artery e.Carotid artery Ans: B.

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CVS: A labourer who is a heavy smoker find difficult to perform his duties and worried about his physical conditions. On examination there is ankle oedema, raised JVP, huge hepatosplenomegaly and ascitis WOF is likely- (May05) a.Cirrhosis b.Costrictive pericarditis due to previous tuberculosis c.SVC obstruction d.Budd Chiari Syndrome Ans: B.

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Constrictive Pericarditis: Signs include:

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* small pulse: o pulsus paradoxus o atrial fibrillation o tachycardia * Kussmaul's sign (a raised JVP with inspiration); dominant y descent and trough * cardiac impulses: barely palpable; characteristic is systolic retraction at the apex * pericardial knock (loud-high pitched S3) following S2 * hepatomegaly * ascites * ankle swelling BuddChiary : There may be an acute presentation with possibly: * vague right upper quadrant abdominal pain * postprandial bloating, nausea and vomiting, and anorexia * tender hepatomegaly * ascites Or, the syndrome may present chronically with possibly: * hepatomegaly * splenomegaly * mild jaundice * ascites * portal hypertension * negative hepatojugular reflex CNS: A 57 yr old lady develops sudden onset of left sided weakness and right eye blindness.This is most likely due toa.Vertebro-basilar insufficy b.Pituitary tumour c.Carotid artery stenosis d.Cerebellar lesion e.Retinal detachment Ans: D.

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RS: Pleural Effusion: Typical presention. Stony dull on percussions, bronchial breath sound above the area, restricted movements on the affected side. Hematology: A pt. was on warfarin, he developed haematemesis and melena. His INR is 10 times normal.WOF should be the management? (Sept.05) a.Fresh plasma infusion b.I/V Fluids c. Oral Vit-K d.Transfuse blood e.Intra muscular Vit-K Ans: FFP Inheritance: A baby with Downs syndrome is born to a couple who definitely refuse to take the child home after failure to convince them.The most appropriate course of action: Arrange temporary foster care All are autosomal recessive , Excepta.Neurofibroblastoma b.Phenylketonuria c.Galactossemia d.Cystic fibrosis e.Sickle cell anaemia Ans: A.

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2007
Hematology: A sudanese boy came to you after administration of Co-timoxazole with the complaints of pallor and increasing darkness of colour of urine. His reticulocyte count was 8%. His Coomb's test was negative, no family history and on electrophoresis Type A hb was detected. What is the Dx? a. Hereditary Spherocytosis b. G6PD def c. Autoimmune HA d. Sickle cell anaemia e. thalassaemia Ans: B. CVS: An old man who suddenly collapsed was unconscious for three minutes following which he recovered fully. 5 ECG rhythm strips given. Which could possibly explain his situation? a. 1st deg. HB b. 2nd deg HB c. VF d. Complete HB e. LBBB Ans: D. Drugs: One ECG which has digitalis effect on it. DX? Drugs: Drug combinations causing anuria: A. Ramipril, NSAID and frusemide B. Simvastatin, NSAID and frusemide C. Ramipril, NSAID and slow IV K+ Ans: NSAIDS, ACEI, Diuertics. RS: A typical CXR of lobar consolidation. What is the org? A. strep pneumonia

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Ans:

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CNS: A man came with ipsilateral horner's syn., cerebellar S/S, dissociated sensory loss. (I could diagnose the case as having lateral medullary syndrome). which artery is involved? A. Ant communicating artery B. Post. cerebral artery C. Post inf. cerebellar artery d. ant. spinal artery Ans: PICA

CNS: What is the mechanism of TIA when there is carotid stenosis? A. Embolim from the artery B, transient spasmodic occlusion of the artery C. Transient hge following increase in carotid artery pressure Ans: A.

RS: Another repeated ques. (and confusing as well!!): Which org does not cause lung abscess" A. Staph aureus B. P. carinii C. M. pneuminiae D. M. TB Ans: B. Endocrine: S/S of thyrotoxicosis: (I read this topic very carefully, but that did not help to avoid confusion in the hall. they are so cheeky!!!) A. coarse tremor B. Wasting of the small muscles of hand C. Narrowing pulse pressure D. widening of pulse pressure Ans: D. Infection:

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CSF reading showed as following: Lymphocyte: 12*10X 6 RBC 256*10X5 Glucose normal prot. increased. The pt had mild neck stiffness. DX? a. TB b. Viral C. SAH Ans: C.

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CNS: A picture of a man protruding his tongue. It showed wasting on the right side. What will be correct for this. A. Left sided lesion and tongue veers to left B. left lesion-tongue veers to right C. right lesion and tongue veers to right D. right lesion and tongue veers to left Ans: C. Emergency: When two rescuers available, what is true regarding CPR? A. 15:2 should be the compression rate B. response should be checked evey 2 min C. chest compression should be on mid chest D. There should be 2.5 cm chest compression each time. Ans: A COPD pt was admintered O2. After sometime he was found unconscious. What could be the blood picture like? A. PaCO2 100 mmHg, PaO2 82mmHg, PH 7.22 B. PaCO2 75 mmHg, PaO2 72mmHg, PH 7.32 C. PaCO2 28 mmHg, PaO2 100mmHg, PH 7.52 D. PaCO2 45 mmHg, PaO2 50mmHg, PH 7.22 Ans:

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SOME OTHER MEDICINE QUESTIONS

Which of the following will decrease the gradient in Hypertrophic cadiomyopathy? a- Digoxin b- Verapamil c- ACE inhibitors d- Prazosin e- Propranolol Which of the following is true regarding aortic stenosis? a- Sudden death is possible b- Gradient of over 50% required surgery c- Angina suggests coexistent coronary artery disease d- Doppler ultrasound is not accurate on diagnosis e- Echocardiography may be used by diagnosis A patient present with headache, prominent supra orbital ridges, prognathism, wide teeth spacing, thick spade like hands, and seborrhoeic, coarse, oily skin. Which of the following is the best investigation to establish a diagnosis? a- Insulin + glucose tests b- X-ray of the pituitary fossa c- Cranial CT scan or MRI scans d- Serum T4+PRL+growth hormone tests e- Oral glucose tolerance tests Ans: Oral glucose load test and suppression of GH (Harrison p.2090). A pregnant lady presents with a widely split S2, cardiomegaly, systolic murmur best heard at pulmonary area, and a diastolic murmur in tricuspid area. Which is the most likely diagnosis? a- Atrial septal defect b- PDA c- VSD d- Pulmonary stenosis e- Aortic stenosis Ans: ASD. Diastolic Murmur due to Functional TR. A 45 yrs old woman about to undergo cholecystectomy has a history of bleeding tendency, increased bleeding time, but a normal platelet count. Which of the following are indicated prior to surgery? a- Vitamin K

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b- Factor VIII concentrates c- Cryoprecipitate d- Fibrinogen e- Fresh frozen plasma Ans: B. vW disease. Which type of bilirubin can cross blood brain barrier? a- Unconjugated b- Conjugated c- Biliary salts Ans: A

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A 28 yrs old female presented with a history of hypertension. Which of the following tests is best for assessing the structure and function of her kidneys? a- IV pyelogram b- Renal ultrasound c- Renal x-ray d- CT scan e- MRI Ans: A. In a paraplegic patient suffering from overflow incontinence, which is the best management? a- Continuous catheterization b- Suprapublic catheterization c- Intermittent self-catheterization d- Suprapublic puncture of bladder e- Permanent cystostomy Ans: C. A patient with bilateral temporal hemianopia. Where is the lesion? a- pituitary fossa b- Optic chiasm c- Parietal lobe d- Temporal lobe e- Optic nerve Ans: B. Management of myocardio infarction with interior, inferior infarction on ECG, first step in management includes:

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a- Heparin, aspirin and nitrites b- Morphine and bete blocker c- Streptokinase d- Observation in ICU Ans: C. Least helpful drug in acute asthma attack is: a- Alupent (Metaprotranol) b- Oral Prednisolone c- Salbutamol inhaler d- Ipitropium bromide e- Sodium chromoglycate Ans: E.

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A patient with congenital spherocytosis soon after splenectomy will have the following in the peripheral blood film. a- Leucocytosis b- Increase plate less count c- Spherocytes d- Decrease survival of RBC Ans: C. Complete tracheal obstruction with right hemi lung collapse: a- Decrease breath sound b- Trachea shift towards the side of the lesion c- Dullness on percussion d- Hyper-resonance on the effective side Ans: B.

Concerning massive plural effusion: a- Trachea shift towards the opposite side of the lesion b- Dullness on percussion c- Diminish breath sound d- Resonance on percussion Ans: A Photosensitivity could be caused by: a- Amiodarone b- Phenytoin

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c- Chlorpromazine d- Digoxin e- Aspirin

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Ans: * phototoxicity - the most common; caused by phenothiazines, amiodarone, thiazides, NSAID's, quinine, tetracyclines, sulphonamides, retinoids, psoralens, fluoroquinolones, griseofulvin, chlorpromazine, prochlorperazine (1) * photoallergy - sulphonamides, phenothiazines, thiazides, pyridoxine, griseofulvin, quinidine, sunscreens, antibacterial agents (1) * lupus erythematous - hydralazine, procainamide, thiazides * pseudoporphyria - frusemide, nalidixic acid, amiodarone, ciprofloxacin, bumetanide, NSAID's * lichen planus - thiazides, quinine * pellagra - isoniazid

The reduction in road crash mortality rates in Australia over the past 15th years is mainly attributable to: a- Health education in media and schools b- Legislative enactments such as seat belts, helmets and alcohol controls c- Improvements in retrieval services, including the use of helicopters d- Improvements in highway design and intersection construction e- Improvements in intensive care and other hospital based services Ans: B. In a 72 yrs old patient with non insulin dependent diabetes mellitus who does not achieve satisfactory glycaemic control with diet the drug of first choice is: a- tolbutamide b- Metformin c- Chlorpropamide d- Glibenclamide e- Gliclazide Ans: B (JM p1323) A 30 yrs old patient presents with severe dandruff and pruritus of the scalp. Scaling also affects his eyelids. The most likely cause is: a- Physiological dandruff b- Psoriasis c- Atopic eczema d- Seborrhoeic dermatitis e- Contact dermatitis

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Ans: D (JM p1164) The ESR not increased in which one of the following conditions: a- Systemic lupus erythematosus b- Multiple myeloma c- Polycythemia Vera d- Disseminated malignancy e- Bacterial infections Ans: C. Sickle Cell anemia.

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A 46 yrs old man suffered his first myocardial infection. Recovery was uneventful. Two days after admission to hospital, the patient fasting blood glucose was 5.8mmol/L (upper limits of normal 6.2mmol/L); a 2 hours postprandial blood glucose was 8.3mmol/L. Four weeks later an oral glucose tolerance test was performed with the following results- fasting 6.5mmol/L, 1hr 9.0mmol/L, 2hr 7.2mmol/L. Blood glucose values in this patient indicate: a- Definite diabetes mellitus b- Possible diabetes mellitus c- Normal tolerance d- Reactive hypoglycemia e- Functional hyperinsulinism Ans: Normal tolerance

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The most common clinical feature of systemic lupus erthematosus is: a- Fever b- Arthritis c- Raynauds phenomenon d- Butterfly facial rash e- Headache Ans: B (Harrison). The clinical features of SLE are necessarily variable as many systems may be involved. Systemic features are almost universal: * fever * malaise * fatigue * weight loss Lymphadenopathy occurs in about half of cases, often in association with hepatomegaly. About one third of patients complain of myalgia and myositis. In women, disease may be exacerbated by menstruation and pregnancy. The approximate frequency of systems involvement is given below: * haematological 95% * joints 95% * cutaneous 80% * pulmonary 65%

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* nervous system 60% * renal 30-55% * gastrointestinal 20% * ocular 15%

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The daughter of a rather confused 78 yrs old woman asks if administration of her mothers drugs could be simplified by taking them with meals. Which one of prescribed drugs should not be taken at meal time? a- Digoxin (Lanoxin) b- Frusemide (Lasix) c- Potassium chloride (Slow K) d- Glibenclamide (Daonil) e- Phenytoin (Dilantin) Ans: A 48 years old man complains of anorexia and tiredness of a few months duration months earlier routine physical examination and urinalysis were normal. Examination at this time shows slight tenderness over the second and third lumber vertebrae. The blood pressure is 120/76 mmHg. Laboratory studies reveal: hemoglobin- 5.0 g/dl Urea - 16mmol/L Urine - protein 4+ - Many hyaline casts -no red cells What is the probable diagnosis? a- Chronic pyelonephritis b- Multiple myeloma c- Gouty nephropathy d- Rapidly progressive glomerulonephritis e- Carcinoma of the prostate with spinal metastases You suspect a 19 yr old man of having infectious mononucleosis. You should be: a- take a throat swab for culture and sensitivity testing b- Order a blood film examination and appropriate immunological tests c- Examination his urine for albumin and cells d- Advised bed rest, fluids and aspirin e- Administer penicillin IM and/or orally A prominent v wave may suggest: a- Atrial flutter with changing block b- Tricuspid incompetence c- Ventricular septal d- Pulmonary e- Pulmonary hypertension

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Which of the following is characteristic of psoriasis? a- Silver scales b- Wickhams striae c- Koebners phenomenon d- Mucosal lesions e- Pruritis The current most commonly prescribed drug in Australia (from the Pharmaceuticals Benefits Scheme) is: a- Salbutamol b- Levonorgestrol and ethinyloestradiol c- Diclofenac sodium d- Amoxycillin e- Diazepam The finding of red cells in the urine indicates: a- the need for radiological investigation of the urinary tract b- The need for urological investigation of the urinary tract c- Damage to renal tubules d- Pyelonephritis e- Glomerular disease A 30 yrs old man consults you, during morning surgery with a two history of weakness, visual disturbance, thirst and polyuria. He has lost 2 kg in weight and yet find that he has 2% glycosuria and ketonuria? Which of the following should you first arrange? a- Micro culture and sensitivity of urine b- Fasting blood glucose estimation c- Oral glucose tolerance test d- Admission to hospital for stabilization Ans: You are requested to visit a 77 yrs old man who is visiting his relatives from inter and who is complaining of back pain following a long motor journey. On arrival 30 minutes later you find that the patient is dead. He had complained of right sided back pain at level of thoracic spine radiating the lower ribs into the epigastrium. Then over a period of 15 minutes he became very pale, short of breath, sweated profusely and diet. His relatives state that he had been in very good health but having treatment for hypertension with Hygroton 25 mg daily (Chlorthalidone). You should: a- ring his local doctor and request him to issue a death certificate b- Issue a death certificate stating that the patient died from myocardial infarction c- Issue a death certificate stating that the patient died from massive pulmonary d- Issue a death certificate stating that the patient died from a reputed aorta

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e- Report the case to the coroner via the police

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When managing a patient in whom the diagnosis of asthma has been made for the first time, it is indicates to the patient that: a- there are two types of asthma, extrinsic and intrinsic b- Asthma usually has an inherited basis c- Asthma can be a chronic or recurring problem d- Immediate improvement can be expected with treatment e- Recent advances have provided a cure for the complaint Susan Smith, aged 35, complains to you of pain in her right hand for the past months. The pain is centered in the palm but radiates up the forearm at time when the palm is bad, the fingers of the right hand seem dead. All her symptoms worse at night and often wake her. They are especially bad premenstrually. Which one of the following tests or features is most likely to assist in youre: a- Froments sign b- Tinels sign c- Finklesteins test d- Claw hand e- Horners syndrome A patient who is treated for the cancer of the breast presents with bone pair that resolves with prasitamol. Bone x-ray shows sclerotic lesions. How Should it: a- temoxiles b- Teraldocyamaciation c- Localized irradiation d- Chemotherapy e- Chemotherapy with radiation In a patient with cardio arrest, what medication should you give first? a- adrenalin b- Lignocaine c- Atropine d- Sodium bicarbonate e- Isoprenaline An 8 yrs old boy was stuns by a bee. He had difficulty breathing and facial oedema. What is the best treatment? a- IV adrenalin b- IV antinistamine c- IV hydrocorlsone d- IV fluids e- SC adrenalin

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In a patient presenting with lacunar infarction the following is true: a- sensory loss only b- Dysphasia c- Can be a result of thromboembolism d- Haemorrhage from the medial cerebral artery e- due to aneurism

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A patient with a dorsal column spinal cord lesion most typically presents with: a- ataxia b- Peripheral neuropathy c- Romberg positive d- Muscle weakness e- absent reflexes A patient with chronic obstructive airways disease was confused and was given 10L/min oxygen in the ambulance. He is now unresponsive. Which is likely result of an ABX taken now? a- PO2 40 PCO2 100 pH 7.35 b- PO2 100 PCO2 10 pH 7.40 c- PO2 60 PCO2 45 pH 7.50 d- PO2 40 PCO2 100 pH 7.15 e- PO2 100 PCO2 60 pH 7.25 (A Type) Which of the following drugs are used in reducing pressure gradient in hypertrophic obst Cardiomyopathy ? a- frusemine b- Digoxin c- Veraparil d- Captopril e- Prazosin (A Type) Which of the following is the best indicator of developing R/heart failure in COAD? a- hypoxia b- Hypercapnea c- Reduced FVC d- Increased JVP e- Liver enlargements (A Type) Which of the following helps in the management of long term asthma? Except: a- ipratropium bromide b- Salbutamol c- Corucsteroids

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d- Sodium chromogivcate e- Epinephrine (A Type) Which of the following can cause hyperkalemia? a- verapamil b- Enalaphril c- Digoxin d- Chlarothiazide e- Amiloride (J Type) Which of the following drugs can potentiate digoxin toxicity? a- cimetidine b- Amiodarone c- Verapamil d- Disopiramide e- B blocker (J Type) Which of the following drugs causes photosensitivity? a- amiodarone b- Phenothiazines c- Sulphonarmide d- Digoxin e- Aspirin (J Type) Which of the following statements are correct? a- left pneumathorax shifts trachea to the right side b- in emphysema you find inspiratory crackling and clubbing of fingers c- in pleural effusion the percussion sound is dull d- in collapse middle lobe moves to the affected side e- in consolidation there is a branchial breath sound

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A man presents with increase thirst constipation and abdominal. He has squamous cell carcinoma of the lung. Which of the following most likely? a- hyperglycaemia b- Mappropriate ADH secretion c- Hypercalcaemia due to parathormone-related peptide d- Hypokalemia e- Secondaries to brain and abdomen A result of 120mmol/l sodium is consistent with: a- Decreased serum osmolality

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b- Decreased total extra cellular body sodium c- Water intoxication d- Inappropriate ADH secretion e- Diabetes insipidus

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How can you differentiate between haemolytic anemia and anemia due to blood loss? a- Decrease in heptoglobin b- Increase in reticulocytes c- Polychromasia d- Decrease in ferritin e- Megalobastosis A patient with 2 days of upper respiratory infection has haematuriaProteinuria and is hypertensive. What is the most likely diagnosis? a IgA nephritis b- Post-streptococcal glomerulonephritis c- Minimal change nephropathy d- Acute pyelonephritis e- Nephrotic syndrome What is NOT true about helicobacter pylori? a- It is associated with gastric carcinoma b- It is associated with gastric lymphoma c- Gastritis d- Gestro-ocsphageal reflux e- Prepyloric ulcers A male patient started on a new medication. He developed breast enlargement. Which drug is the least likely cause/ a- Spironolactone b- Cimetidine c- Digoxin d- Frusemide e- Alpha methyldopa What is compatible with severe illness/ a- Increased cortisol, increased TSH b- Both cortisone and TSH decreased c- Increased cortisol, decreased TSH d- Decreased cortisol, increased TSH e- Normal cortisol, increased TSH Other question with digoxin as the answer. All of these are negative ionotropic. Except: a- propranolol b- Calcium channel blocker

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c- Digoxin d- Guanidine e- Verapmil Regarding angioplasty alone versus stent-insertion, which one is true? a- Decreased rest enosis but no increase in acute complications b- Stents should only be used if angioplasty has failed c- Stents are contraindicated in server multi vessel disease d- Decreased complications but not decreased re-stenosis rate e- Stents are useful in all infarct patients

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Photo of a lesion on the face (see AMCMCQ-book!). Hemi-face covered in naevus flammeus. What is most likely association? a- Epilepsy b- Cerebellar syndrome c- Optic neuritis d- Spasticity e- Hemiplegia Another photo from the AMC book. Boy with 3 truncal lesions +/- one facial one. What is the diagnosis? a- Microspora canis b- Lichen discoid c- Pityriasis rosea d- Psoriasis e- SLE Which of the following is the most common pathology involved in endocarditis? a- Rheumatic fever b- Staphylococcus A 60yrs old male patient has difficulty climbing upstairs. O/E he had wasting of right biceps, diminished biceps jerk, lower limb spasticity, lower limbs reflexes exaggerated and Babinskis sign present, hip flexion weak. What is the most probable diagnosis? a- Cervical disc lesion b- Lumbar canal stenosis c- Motor neuron disease d- Multiple sclerosis e- WPW syndrome A man on anti-hypertension therapy goes for surgery. Discontinuation of which of the following drugs causes serve rebound hypertension during operation? a- Enalapril b- Clonidine c- Methyldopa

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d- Hydralazine e- Verapamil

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After splenectomy for spherocytosis, each of the following is correct except: a- Erythrocyte osmotic fragility will not change b- Erythrocyte life span will be normal c- Anemia will be found Normocytic, normochromic anemia can be found in which of the following diseases? a- Sickle cell anemia b- Vitamin B12 deficiency c- Renal failure d- Liver failure e- Hemolysis A woman complaining of episodes of intense pain over the lower jaw and zygomatic bone lasting for about 2-5 min which has been going for 2 weeks. There are no trigger zones and on examination there is sensory loss on the same side. Which of the following is the most likely diagnosis? a- Multiple sclerosis b- Trigeminal neuralgia c- Migraine d- Facial palsy e- Herpetic neuralgia What is the best way to diagnose giardiasis? a- Duodenal aspirate showing trophozoites b- Fecal microscopy showing ova c- Fecal culture d- Serum immunology e- Villous atrophy A man with multiple episodes of sore throat developed periorbital edema, BP of 160/120, oliguria, which of the following is correct? a- Giving water corrects oliguria b- Hematuria is a prognostic indicator Which of the following is correctly matched? a- Decreased transferrin: in iron deficiency anemia b- Increased transferrin: in hemosiderosis c- Normal transferrin: in Hemachromatosis Which of the following is most implicated in causing pseudo membranous colitis? a- Metronidazole b- Ampicillin

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c- Vancomycin d- Sulphonamides e- Tetracyclines A result of 120mmol/l sodium is consistent with: a- Decreased sodium osmolality b- Decreased total extracellular body Na c- Water intoxication d- Inappropriate ADH secretion e- Diabetes insipidus

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Which of the following is correct regarding myasthenia gravis? a- Some patients do not have anti-cholinergic antibodies b- Anti cholinergic drugs are used for treatment c- Thymectomy is only indicated for thymoma d- Reduced tendon reflexes are characteristic e- Repeated stimulation of peripheral nerve always shows pathological fatigue Eradication of helicobacter pylori is important because: a- It influences relapse b- It reduces complication (incidence of gastric lymphoma) c- It heals quickly d- It decreases local gastritis e- It decreases the cimetidine dosage Which of the following anti-hypertensive drug causes reflex tacycardia? a- Methyldopa b- Hydralazine c- Prazosin d- Verapamil e- Diltiazem Which of the following is true regarding NIDDM? a- The genetic factors are more important that in IDDM b- Abdominal fat is a risk factor c- Oral hypoglycemic agents can cause insulin resistance d- Patients with NIDDM will never?? Insulin e- Patients with gestational diabetes dont go into NIDDM Regarding significant aortic stenosis, which of the following is true? a- If the gradient is>50mmHg, patients needs surgery b- Poor LV function is a contraindication for surgery c- Can cause death d- Chest pain indicates angina pectoris e- Palpable thrill

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A child is presents with long history of unexplained productive cough and wheeze. He is failing to thrive (signs of malobsorbtion). What is your initial investigation? a- Stool exam b- Chest x-ray c- Sweat test d- Blood exam What is true about febrile convulsion? a- It occurs between 6-8 years of age b- Prognosis is not good c- Risk of developing epilepsy is 10% d- Lasts about 15 min. Which of following conditions usually resolves spontaneously? a- Congenital heart block b- Patient ductus in 15 yrs boy c- Atrial septal defect d- Small ventricular septal defect In a child with Kernicterus which abnormality is found in the blood? a- High Unconjugated bilirubin concentration A child is who was well before developed malaise and now he has fever 40c. 3 days ago he falls from tree. Mother noticed that he limped. His thigh is swollen there is an area of pain and tenderness. What is the likely cause? a- Fracture b- Thrombophlebitis c- Ca of bone d- Osteomyelitis A child is presents with sudden onset of high fever. He is unable to drink or swallow. He is stridor. Sever epiglottitis has been diagnosed. What is your management? a- Antibiotics b- Intubations may be required c- Throat should be examined A 76 yrs old man is investigated for a complaint of weakness. The hematological report shows: , Platelets 382*10 MCHC 23%, WBC 12*10 5.6g/100ml, MCV 72u , , Hb ESR 46mm/1 hour. The film shows a marked hypochromia, a moderate, marked polkilocytosis, slight Polychromasia, mature neutrophils, reticulocytes 3% The most likely diagnosis is: a- Megaloblastic anemia

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b- Iron deficiency anemia caused by chronic blood loss c- Chronic renal failure d- Anemia due to folate deficiency e- Thalassaemia minor

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The mortality from the initial blood of a ruptured intracranial aneurysm is about: a- 3-5% b- 5-10% c- 20-35% d- 70-90% e- 95% A 27 yrs old woman in her tenth week of pregnancy was found on a colonles/ml. She was midsteam urine culture to have Ecoil 10 asymptomatic. Which of the following should be considered next? a- Intravenous pyelogram b- Repeat of urine culture and antibiotic therapy if the same organisms are present c- No further investigation d- Investigation after delivery e- Immediate antibiotic therapy Creatinine clearance: a- Is an accurate measure of renal tubular function b- Requires measurement of only the urine creatinine concentration c- Cannot be measured in the nephrotic syndrome d- Approximatles to the glomerular filtration rate e- Measures the total body pool of creatinine A 27 yrs old woman presents with increased frequency of nucturition including nocturia over the recent three weeks. Over this time she has been thirsty and lethargic. Which one of the metabolic derangements is least likely to present in this way? a- Hypokalemia b- Diabetes mellitus c- Antidluretic hormone deficiency d- Hypercalcemia e- Dilantin toxicity Temporal artery has all of the following except: a- Sudden blindness b- Shoulder stiffness c- Increased ESR d- Unilateral throbbing pain e- Microscopic hematuria

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Hypercalcemia can be seen in all of the following except: a- Hyperparathyroidisms b- Chronic calcificans Pancreatitis

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What is absolute contraindication for the use of nicotine patch (Nicorette patch)? a- ? b- ? c- Co morbid heroin use d- Pregnancy Which nerve gives the sensation of the taste of first 2/3 of tongue? a- Facial N. b- Hypoglossal c- Glossopharyngeal d- Trigeminal N. Lithium is best to monitor: a- ? b- Thiazide diuretics will increase c- Measure at 11 pm. d- Measure in urine

Young diabetic patient brought to ER in ketoacidosis. What is important next step in management? a- Rapid insulin (subcutaneous) b- Intravenous sodium chloride (normal 0.9% saline solution) c- Intravenous sodium bicarbonate d- Intravenous 5% dextrose Diabetic man on combined therapy ACE, glibencamid (Daonil), metformin, benzodiazepine and tricyclic antidepressants. Which of the following drugs will have effect on his impotence? a- ACE b- Glibencamide c- Metformin d- Benzodiazepine e- TCA Abattoir worker developed pain, sweating and red urine. What is most likely? a- Brucellosis b- Leptospirosis c- Hepatitis d- Tularaemia

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75yrs man with long standing COPD (H/O 60 pack/year?) has been brought to by ambulance from nursing home. On his way to hospital he received Oxygen 10L/min by mask. On admission he is unarousable and his ABG most likely will be: a- PaO2 85 PaCO2 65 PH 7.15 b- PaO2 68 PaCO2 50 PH 7.45 c- PaO2 100 PaCO2 25 PH 7.25 d- PaO2 40 PaCO2 85 PH 7.45 e- PaO2 60 PaCO2 40 PH 7.35 Which is the most recognized ophthalmic complication of Wemicke encephalopathy? a- B complex deficiency b- Optic nerve neuropathy

Which statement best describe relation between glycaemia control and diabetic retinopathy? a- Strict control of glucose can prevent diabetic retinopathy b- Good control can delay diabetic retinopathy Woman with a prolonged bleeding. Brother and father said she is a bleeder. Most likely is: a- Von Willebrands disease b- Hemophilia A c- Lack of factor IX d- Stuart disease VII nerve palsy least likely occur in: a- Acoustic neuroma b- Chronic parotitis c- Parotid carcinoma Girl with photographic, neck stiffness, (clinical picture of meningitis) What is most appropriate Next step? a- Do LP and give her Ceftriaxone b- Sent her home and review for results c- Do LP and wait for results In Von Willebrandts disease, you will found: a- Increase platelet count b- Increase bleeding time c- Normal aPTT Hepatic toxicity occurs in all except? a- Paracetamol b- Halothane c- NSAIDs

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d- Warfarin e- Chlorpromazine

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In a patient presenting with lacunar infarction, which of the following are true? a- Sensory loss only b- Dysphasia c- Due to an aneurysm d- Haemorrhage from the middle cerebral artery e- ? Thrombo embolism may cause Helicobacteopylori causes all of the following excepts? a- Duodenal ulcer b- Gastritis c- Gastro-oesophageal reflux d- Gastric carcinoma e- Gastric lymphoma A 28 years old male presents with distal weakness and atrophy of the small muscles of both hands (interossei, lumbricals, thenar and hypothenar). What is the most likely diagnosis? a- Multiple sclerosis b- Bilateral median nerve palsy c- Syringomyelia d- Bilateral ulnar nerve palsy e- Brainstem infarction The single most reliable test for hemochromatosis is? a- RE cell mass b- Serum iron c- Serum Ferritin d- Serum tranferrin e- Transferrin saturation A female age 23 yrs, presents with proteinuria. There is a previous history of enuresis till 13 years of age. Her sister also had enuresis as a child. The history is suggestive of which of the following? a- Chromic glomerulonephritis b- Reflux nephropathy c- Congenital nephritis d- Polycystic kidney disease e- Analgesic nephropathy In which of the following, is administration of immunologic as prophylaxis not useful? a- Hepatitis A b- Hepatitis B c- Rubella

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d- Mumps e- Varicella

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A 68 years old female presents with a 2 week history of unilateral headache and an ESR 8omm/hr. The most appropriate treatment is: a- NSAIDs b- Aspirin c- Carbamazepine d- Prednisolone e- Ergotamine Peracetamol poisoning- In the management. W.O.F. is appropriate to prevent: a- IV acetyl cysteine b- Oral acetyl cysteine c- Gestric lavage with charcoal d- Ipecac syrup e- Peritoneal dialysis Patient with chronic WPW syndrome presents with AF. WOF are management: a- Digoxin b- Verapamil c- Cardioversion d- Sotolol e- Disepynamide Metabolism of Digoxin is decreased by: a- Quinidine b- Warfarin c- Verapamil d- Amiodarone e- Ametidine Digoxin intoxication presents with W.O.F. except: a- Hypokalemia b- Patient has yellowish vision c- A.F. can occur

SOME IMPORTANT QUESTIONS:

A 70y old lady has recurrent superficial thrombophlebitis and DVT. She has been treated with anticoagulants, warfarin AND aspirin, but it still occurs. A. She has small cell lung cancer

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B. She has epithelial ovarian carcinoma C. She has mucinous carcinoma of the colon D. Myeloid leukaemia E. Pancreatic cancer

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Ans: E. This is a recurring thrombophlebitis characterised by successive crops of tender nodules in affected blood vessels. Different veins may be affected simultaneously or randomly. It denotes a thrombotic state and is associated with visceral malignancy, especially of the pancreas and lung. The basis is unknown. Thrombophlebitis migrans was first recognised by Trousseau in the diagnosis of his own pancreatic cancer.

A young man has a large, recurrent pneumothorax. What is the treatment? A. Thoracotomy and lobectomy B. Underwater seal drain C. CXR and bed rest D. Chest drain and pleurodesis E. Ans: D. If a patient suffers repeated spontaneous pneumothoraces then a pleurodesis or pleurectomy should be considered. gp notebook