MCQs of PLAB

A 72yo man has been advised to have antibiotic prophylaxis for some years now before dental tx. He has never experienced chest pain. Three weeks ago, he noticed breathlessness on exertion and for one week he had orthopnea. His pulse is normal. What is the most probable dx?

Aortic regurgitation

Ischemic mitral regurgitation

Mitral valve prolapse

Pulmonary stenosis

Mitral valve stenosis

A 37yo woman presents with fatigue. Exam: angular stomatitis, no koilonychea. Choose the single cell type you will find on the blood film.

Macrocytes

Microcytes

Granulocytes wthout blast cells

Blast cells

A 4yo boy with a febrile convulsion lasting eight minutes has been given IV lorazepam to control them. What is the single most likely serious side effect?

Amnesia

Anaphylactic shock

Apnea

Bronchospasm

Cardiac arrhythmia

A 4wk girl has been dx of having breast milk jaundice. She is otherwise well. What is the single most appropriate management?

Continue breastfeeding

Exchange transfusion

Increase fluid intake

Phototherapy

Stop breastfeeding

A 12yo girl when playing in the garden accidentally stepped on a hive and was bitten several times. She has numerous wheals on her body and complains of severe itching. What is the single most appropriate management?

Oral antihistamine

IV antihistamine

IM adrenaline

Oral ciprofloxacin

Reassurance

A term baby born to a 30yo woman of blood group A-ve develops severe jaundice within the first 24h of birth. What is the most likely dx?

Hereditary spherocytosis

G6PD

ABO incompatibility

Rh incompatibility

Physiological jaundice

A 4yo girl is found to have bounding pulse and continuous machinery murmur. What is the most probable dx?

TOF

ASD

VSD

PDA

CoA

A 12yo child with episodes of sudden bluish discoloration and brief loss of consciousness. Exam: clubbing, central cyanosis, systolic thrill with systolic ejection murmur in 2nd left ICS. What is the most probable dx?

TOF

ASD

VSD

PDA

CoA

An 8yo child who is tall for his age and has a refractory error for which he wears glasses has presented with severe crushing chest pain. What is the most likely dx?

Fragile X syndrome

Prader-willi syndrome

DiGeorge syndrome

Marfans syndrome

A 4yo child presents with pain of spontaneous onset in his knee of 2 days duration. He has developed mild fever in the 2nd day. He can walk but has a limp. Exam: painful restriction in the right hip. What is the most probable dx?

Osteosarcoma

Septic arthritis

TB arthritis

Exostosis

Osteomyelitis

A man with anterior resection and end to end anastomosis done complains of severe pain in the chest and abdominal distension. What is the most appropriate inv likely to review the cause this deterioration?

XR abdomen

Exploratory laparoscopy

CT

US

Laparotomy

Pt with hx of alcoholism, ataxic gait, hallucinations and loss of memory. He is given acamprosate. What other drug can you give with this?

Chlordiazepoxide

Thiamine

Diazepam

Disulfiram

Haloperidol

A 35yo male builder presented with sudden onset of severe abdominal pain. He was previously fit and well other than taking ibuprofen for a long term knee injury. On examination he is in severe pain, pulse=110bpm, BP=110/70mmHg and has a rigid abdomen. What is the most likely dx?

Biliary peritonitis

Ischemic colon

Pancreatic necrosis

Perforated diverticulum

Perforated peptic ulcer

A woman 5 days post-op for bilateral salphingo-oopherectomy and abdominal hysterectomy has developed abdominal pain and vomiting a/w abdominal distension and can’t pass gas. No bowel sounds heard, although well hydrated. What is the most appropriate next step?

XR abdomen

Exploratory laparoscopy

CT

USG

Barium enema

A 30yo man complains of hoarseness of voice. Exam: unilateral immobile vocal cord. What is the most probable dx?

Graves disease

Hematoma

Unilateral recurrent laryngeal nerve injury

External laryngeal nerve injury

Tracheomalacia

A 38yo woman has delivered after an induced labor which lasted 26h. choose the single most likely predisposing factor for postpartum hemorrhage?

Atonic uterus

Cervical/vaginal trauma

Rupture uterus

Fibroid uterus

Age of mother

A 32yo woman in tears describing constant irritability with her 2 small children and inability to relax. She describes herself as easily startled with poor sleep and disturbed nightmares following a house fire a year ago, while the family slept. What is the single best tx?

http://www.webmd.com/mental-health/tc/post-traumatic-stress-disorder–treatment-overview

It has been one year thats why relaxation therapy won’t work and needs medication so the best option will be fluoxetine (SSRI). Tricyclics are no more considered first line therapy in treatment of depression

 

Rassurance

Relaxation therapy

Quetiapine

Lofepramine

Fluoxetine

A 22yo woman with longstanding constipation has severe ano-rectal pain on defecation. Rectal exam: impossible due to pain and spasm. What is the most probable dx?

Anal hematoma

Anal fissure

Anal abscess

Protalgia fugax

Hemorrhoids

A 20yo student attends the OPD with complaint of breathlessness on and off, cough and sputum. His sleep is disturbed and skin is very dry in flexural areas of the body. Exam: tachypnea, hyperresonant percussion and wheezing on auscultation. What is the most likely dx?

Extrinsic allergic alveolitis

Asthma

Wegener’s granulomatosis

COPD

Cystic fibrosis

A pt with thought disorder washes hands 6x each time he uses the toilet. What is the best management?

Psychodynamic therapy

CBT

Antipsychotics

Refer to dermatology

Reassure

A 25yo woman presented to her GP on a routine check up. Upon vaginal exam, she was fine except for finding of cervical ectropion which was painless but mild contact bleeding on touch. What is the next management?

Ectropion is prone to infection.

Endometrial ablation

Cervical smear (2nd line)

Colposcopy

Antibiotics (1st line)

Vaginal US

Pack with gauze and leave to dry

A 32yo had a normal vaginal delivery 10 days ago. Her uterus has involuted normally. Choose the single most likely predisposing factor for PPH?

Normal delivery. Uterus involuted normally. Can’t be A. 
Can’t be DIC, Von Willebrand either. No indications for these
.

Primary PPH is in the first 24 hours.

So it’s C.

Retained product

DIC

Uterine infection

Von Willebrand disease

Primary PPH

A 37yo man slipped while he was walking home and fell on his out stretched hand. He complains of pain in the right arm. XR showed fx of the head of radius. What is the single most associated nerve injury?

Radial nerve

Musculocutaneous nerve

Median nerve

Ulnar nerve

A butcher stabbed accidently his groin. He bled so much that the towel was soaked in blood and BP=80/50mmHg, pulse=130bpm. What % of circulatory blood did he lose?

<15%

15-30%

30-40%

40-50%

>50%

A 67yo man presents with palpitations. ECG shows an irregular rhythm and HR=140bpm. He is otherwise stable, BP=124/80mmHg. What is the most appropriate management?

Bisoprolol

ACEi

Ramipril

Digoxin

A 78yo man is depressed after his wife’s death. He has been neglecting himself. His son found him in a miserable state when he went to visit. The son can’t deal with his father. What is the appropriate management?

Voluntary admission to psychiatry ward

Hand over to social worker

Request son to move in with father

Send pt to care home

Staphylococcus

An old alcoholic presents with cough, fever, bilateral cavitating consolidation. What is the most probable cause?

Gram +ve diplococcic

Coagulase +ve cocci

Gram –ve cocci

AFB

Coagulase –ve cocci

A 67yo man had successful thrombolysis for an inf MI 1 month ago and was discharged after 5days. He is now readmitted with pulmonary edema. What is the most probable dx?

Aortic regurgitation

Ischemic mitral regurgitation

Mitral valve prolapse

Pulmonary stenosis

Rheumatic mitral valve stenosis

A 60yo lady who had stroke 3 years ago now reports having increased dyspnea on exertion and atrial fibrillation. CXR: straight left border on the cardiac silhouette. What is the most probable dx?

MS….LAD….straight Lt.cardiac border

MS…..AF…..Stroke

Aortic regurgitation

Ischemic mitral regurgitation

Mitral valve prolapse

Pulmonary stenosis

Rheumatic mitral valve stenosis

A 60yo diabetic complains of pain in thigh and gluteal region on walking up the stairs for the last 6 months. She is a heavy smoker and has ischemic heart disease. What is the most appropriate dx?

Thromboangitis Obliterans

Sciatica

DVT

Atherosclerosis

Embolus

A 3yo child who looks wasted on examination has a hx of diarrhea on and off. The mother describes the stool as bulky, frothy and difficult to flush. What is the single inv most likely to lead to dx?

Sweat chloride test

Anti-endomysial antibodies

LFT

US abdomen

TFT

A 45yo woman has had severe epigastric and right hypochondrial pain for a few hours. She has a normal CBC, serum ALP is raised, normal transaminase. 3 months ago she had a cholecystectomy done. What is the most appropriate inv?

US abdomen

ERCP

MRCP

CT abdomen

Upper GI endoscopy

A 53yo woman presented with pain in the eye, blurry vision and clumsiness for 3 months. She has a hx of difficulty in swallowing and weakness in her right upper limb 2y ago. What is the inv of choice?

MS

CSF analysis

EEG

EMG

MRI brain

Visual evoked response test

A 55yo male presents with malaise and tiredness. Exam: spleen approaching RIF, no lymphadenopathy. Choose the single cell type?

CML

Helmet shaped cell

Sickle cell

Granulocyte without blast cells

Blast cells

A 6yo pt comes with easy bruising in different places when she falls. CBC: WBC=25, Hgb=10.9, Plt=45. Her paul brunnel test +ve. What is the most likely dx?

Glandular fever

ITP

Trauma

NAI

Septicemia

A 41yo woman who has completed her family, has suffered from extremely heavy periods for many years. No medical tx has worked. She admits that she would rather avoid open surgery. After discussion, you collectively decide on a procedure that wouldn’t require open surgery or GA. Select the most appropriate management for this case.

Endometrial ablation

Hysterectomy

Fibroid resection

Myomectomy

Uterine artery embolization

A girl with hx of allergies visited a friend’s farm. She got stridor, wheeze and erythematous rash. What is the most appropriate tx?

0.25ml IM adrenaline

0.25ml PO adrenaline

0.25ml IM adrenaline

IV chlorphearamine

A 5yo boy is referred to the hospital and seen with his father who is worried that he has been listless. He is not sure why his GP suggested he should come to the ED and is keen to get some tablets and go home. Exam: tired and irritable, swelling around eyes. Renal biopsy: remarkable for podocyte fusion on EM. What is the most probable dx?

NAI

Myelodysplastic disease

HSP

Membranous GN

Minimal change GN

A 6yo boy is brought to the hospital for a 3rd episode of sore throat in 1 month. He is found bleeding from gums and nose and has pale conjunctiva. What’s the single cell type?

Clumped platelets

Microcytes

Granulocyte without blast cells

Blast cells

Mature lymphocytes

A 23yo man has been stabbed in the back and has SOB. The trachea is not deviated, he has engorged neck veins and absent breath sounds on the right. What is the most appropriate dx?

In recent guidelines tracheal deviation and raised JVP are not as essential as it would thought previously.

Acute onset and absence of breath sounds are diagnostic.

Tension pneumothorax

Cardiac tamponade

Simple pneumothorax

Hemothorax

Pleural effusion

Weber’s syndrome:

It is ipsilat. 3rd cranial nerve palsy (occulomotor) + conralat. Hmiplagia due to infarction of one half of the midbrain after occlusion of the paramedian branches of the basilar a.

A 44yo pt comes with right hemiparesis. Exam: left sided ptosis and left dilated pupil. Where is the lesion?

Cerebral infarct

Cerebellar infarct

Medulla oblongata

Pons

Midbrain

A 50yo man has a stab wound to his left anterior chest at the level of the 4th ICS. He has a BP 80mmHg, pulse=130bpm. His neck veins are dilated and his heart sounds are faint. His trachea is central. What is the most appropriate dx?

Cardiac tamponade

Diaphragmatic rupture

Fractured ribs

Tension pneumothorax

Traumatic rupture of aorta

A 15yo boy has a soft painless swelling in the left scrotum, blue in color and can be compressed. What is the most appropriate next step?

Varicocele

Analgesia

Antibiotic

Biopsy

Immediate surgery

Reassurance

A 12yo pt presents with copious diarrhea. Exam: urine output=low, mucous membrane=dry, skin turgor=low. What is the most appropriate initial management?

Antibiotic

Antimotility

Anti-emetic

Fluid replacement

Reassurance

A 60yo smoker presents with cramp-like pain in the calves relived by rest and non-healing ulcers. Exam: cold extremities with lack of hair around the ankles, absent distal pulses. What is the most probable dx?

Intermittent claudication

Chronic ischemia of the limbs

Buerger’s disease

DVT

DM

An otherwise healthy 13yo boy presents with recurrent episodes of facial and tongue swelling and abdominal pain. His father has had similar episodes. What is the most likely dx?

Hereditary  Angio-Oedema

http://www.patient.co.uk/doctor/hereditary-angio-oedema

C1 esterase deficiency

HIV

Mumps

Sarcoidosis

Sjogren’s syndrome

A 25yo had an LSCS 24h ago for fetal distress. She now complains of intermittent vaginal bleeding. Observations: O2 sat=98% in air, BP=124/82mmHg, pulse=84bpm, temp=37.8C. The midwife tells you that she had a retained placenta, which required manual removal in the OT. Choose the most appropriate C-Section complication in this case?

Retained POC

Manual removal has a risk of endometritis.

Aspiration pneumonitis

Endometritis

Uterine rupture

DIC

A 30yo woman has brief episodes of severe shooting pain in the rectum. Rectal examination and flexible sigmoidoscopy are normal. What is the most probable dx?

Anal hematoma

Anal fissure

Rectal carcinoma

Proctalgia fugax

Piles

A 78yo male, DM and HTN, had a fall and since then is unable to walk. He presents with deformity and tenderness over the right hip area. XR=fx of femur neck. What is the single most associated nerve injury?

Sciatic nerve

Gluteal nerve

Lateral peroneal nerve

Tibial nerve

Femoral nerve

A 20yo man has a head on collision in a car. On presentation his is breathless, has chest pain and fx of 5-7th rib. CXR confirms this. What is the most appropriate initial action in this pt?

Antibiotics

Analgesia

O2 by mask

Physiotherapy

Refer to surgeon

A 28yo man with complains of headache and nose bleeds also has pain in the lower limbs on exertion. Exam: radio-femoral delay, cold legs with weak pulse and mild systolic murmur with normal S1S2. What is the most probable dx?

TOF

ASD

VSD

PDA

CoA

A 23yo male has a tonic clonic seizure whilst at college. His GCS is 12, BP=120/77mmHg, HR=99bpm. What is the most appropriate inv for his condition?

serum blood glucose is used as an initial investigation.

 DDx.:  hypoglycaemia or epilepsy or brain tumour

CT

MRI

Serum blood glucose

Serum drug levels

A 20yo man complains of recent onset of itching which followed a viral infection. There are numerous wheals of all sizes on his skin particularly after he has scratched it. These can last up to an hour. What is the most probable dx?

Uremia

Urticaria

Psychogenic itching

Atopic eczema

Primary biliary cirrhosis

A 75yo lady who had mitral valve replacement 13 yrs ago has developed recurrent breathlessness. Her husband has noticed prominent pulsation in her neck. She complains of abdominal pain and ankle swelling. What is the most probable dx?

MVP sx…….IE…….TR

She has a raised JVP, a pulsatile liver causing abd pain and pedal edema (features of TR).

Aortic regurgitation

Mitral regurgitation

Mitral stenosis

Tricuspid regurgitation

Pulmonary stenosis

A 45yo T1DM had an annual check up. Ophthalmoscopy showed dot and blot hemorrhage + hard exudate and multiple cotton wool spots. What is the next step in management?

*Cotton wool spots+hard exudates+venous beading–> Pre proliferative retinopathy–> non urgent referral
*New vessels on iris and /or retina–>
Proliferative retinopathy--> Urgent referral

Reassurance and annual screening only

Urgent referral to ophthalmologist

Laser therapy

Non-urgent referral to ophthalmologist

Nothing can be done

A 2m baby who has ambiguous genitalia presents to the ED with vomiting. Labs: Na+=125mmol/L, K+=6mmol/L. What is the most likely dx?

Fragile X syndrome

Turners syndrome

Noonan syndrome

Congenital adrenal hyperplasia

A 40yo man collapsed at home and died. The GPs report says he suffered from T2DM and BMI=35. What is the most likely cause of death?

MI

DM

HF

PE

Renal failure

A 38yo pt presented with tingling, numbness, paraesthesia, resp stridor and involuntary spasm of the upper extremities. She has undergone surgery for thyroid carcinoma a week ago. What is the most likely dx?

Thyroid storm

Hyperparathyroidism

Unilateral recurrent laryngeal nerve injury

External laryngeal nerve injury

Hypocalcemia

A 50yo chronic smoker came to OPD with complaint of chronic productive cough, SOB and wheeze. Labs: CBC=increase in PCV. CXR >6ribs seen above the diaphragm in midclavicular line. ABG=pO2 decreased. What is the most likely dx?

Interstitial lung disease

Wegener’s granulomatosis

Ca bronchi

COPD

Amyloidosis

A 44yo pt has sudden onset of breathlessness and stridor few minutes after extubation for thyroidectomy. The pat had longstanding goiter for which he had the surgery. What is the most likely dx?

Thyroid storm

Hematoma

Unilateral recurrent laryngeal nerve injury

External laryngeal nerve injury

Tracheomalacia

A 15yo boy presents with generalized edema. His urinalysis reveals protein +++, eGFR =110. What is the most likely dx?

IgA nephropathy

Membranous nephropathy

Minimal change disease

PSGN

Lupus nephritis

A 72yo man is receiving chemotherapy for SCLC. He has his 4th tx 8 days ago. He has a cough with some green sputum but feels well. Temp=37.6C. Chest exam = few coarse crepitations in the right base. HR=92bpm. CBC: Hgb=12.5g/dL, WBC=1.1, Neutrophils=0.6, Plt=89. Sputum, urine and blood culture sent to microbiology. What is the most appropriate management?

Broad spectrum antibiotics IV

Broad spectrum antibiotics PO

GCSF

Postpone tx until bacteriology results available

Reassure and send home

A 25yo woman with T1DM has delivered a baby weighing 4.5kg. Her uterus is well contracted. Choose the single most likely predisposing factor for PPH from the options?

It is not D because uterus is well contracted …arteries will collapse and placental site surface area will also reduce.

Atonic uterus

Cervical/vaginal trauma

Retained POC

Large placental site

Rupture uterus

A 23yo lady presents with headache. Exam: photophobia and generalized rash that doesn’t blanch on pressure. What must be done immediately?

IV benzylpenicillin

Isolate pt

Gown and mask

Blood culture

A 4yo baby has generalized tonic-clonic seizure and fever of 39C. his mother informs you that this has happened 3-4x before. What is the most likely dx?

Febrile convulsion

Absence seizures

Epilepsy

Partial complex seizure

A middle aged Asian presents with episodes of fever with rigors and chills for last 1y. Blood film: ring form plasmodium with schaffners dots in RBCs. What is the drug to eradicate this infection?

Doxycycline

Mefloquine

Proguanil

Quinine

Artesonate

A 35yo woman had an uneventful lap chole 18h ago. She has a pulse=108bpm, temp 37.8C. There are signs of reduced air entry at the right base but the CXR doesn’t show an obvious abnormality. What is the most appropriate management strategy?

Cefuroxime PO

Ceftriaxone IV

Chlorpheniramine PO

Chest physiotherapy

Reassure

A 20yo pop star singer complains of inability to raise the pitch of her voice. She attributes this to the thyroid surgery she underwent a few months back. What is the most likely dx?

Thyroid storm

Bilateral recurrent laryngeal nerve injury

Unilateral recurrent laryngeal nerve injury

External laryngeal nerve injury

Thyroid cyst

A 28yo woman at 39wk gestation is in labor. She develops abdominal pain and HR=125bpm, BP=100/42mmHg, temp=37.2C and saturation=99%. Exam: lower abdomen is exquisitely tender. CTG=prv normal, now showing reduced variability and late deceleration develops with slow recovery. She has had 1 prv LSCS for a breech baby. Choose the most appropriate CS complication for this lady?

Endometritis

UTI

Urinary tract injury

Pleurisy

Uterine rupture

An 8m infant presented with FTT and constipation. Exam: large tongue and fam hx of prolonged neonatal jaundice. What is the most likely dx?

Downs syndrome

Fragile X syndrome

Praderwilli syndrome

DiGeorge syndrome

Congenital hypothyroidism

A 3m infant has presented with recurrent infections. He has abnormal facies and CXR shows absent thymic shadow. What is the most likely dx?

Downs syndrome

Fragile X syndrome

DiGeorge syndrome

Marfans syndrome

A 30yo man presents with deep penetrating knife wound. He said he had TT when he left school. What will you do for him now?

Human Ig only

Human Ig and TT

Full course of tetanus vaccine only

Human Ig and full course of tetanus vaccine

Antibiotic

A 32yo previously healthy woman has developed pain and swelling of both knees and ankles with nodular rash over her shins. As part of the inv a CXR has been performed. What is the single most likely CXR appearance?

Apical granuloma

Bilateral hilar lymphadenopathy

Lobar consolidation

Pleural effusion

Reticular shadowing in the bases

A neonate’s CXR shows double bubble sign. Exam: low set ears, flat occiput. What is the most likely dx?

Downs syndrome

Fragile X syndrome

Turner’s syndrome

DiGeorge syndrome

A 19yo boy complains of itching on the site of insect bite. What is the single most appropriate management?

Penicillin oral

Doxycycline oral

Oral antihistamine

Oral ciprofloxacin

Reassurance

A man presents with scrotal swelling, the swelling is cystic and is non-tender. It is located in the upper pole of the posterior part of the testis. What is the most likely dx?

Epididymal cyst

Testicular ca

Hydrocele

Teratoma

Testicular torsion

A young footballer has collapsed during a game. During initial evaluation: RR=14/min, pulse=88bpm, BP=110/70mmHg. He seems to be sweating and muttering some incomprehensible words. What is the most imp next step?

CT

MRI

Blood sugar

Body temp

IV fluids

A 45yo waitress complains of pelvic pain which worsens pre-menstrually and on standing and walking. She also complains of post-coital ache. Select the most likely cause leading to her symptoms?

PID

Endometritiosis

Pelvic congestion syndrome

Adenomyosis

Premature ovarian failure

A 37yo female had a fall with outstretched hand, presented with dinner fork deformity and tenderness over the right arm. What is the single most associated nerve injury?

Axillary nerve

Radial nerve

Musculocutaneous nerve

Median nerve

Ulnar nerve

A mother comes with her 15m child. Which of the following will bother you?

Shies away from strangers

Can walk but not run

Vocabulary consists of only 2 meaningless words

She can’t make a sentence

None

A 35yo lady who has been using IUCD for one year now complains of pelvic pain and heavy painful periods. Select the most likely cause leading to her symptoms?

PID

Endometriosis

Adenomyosis

Fibroids

Asherman syndrome

The dx cells of Hodgkin disease are:

T-cells

R-S cells

B-cells

Macrophages

Auer rods

A 16yo girl is admitted after taking a paracetamol OD 4 h ago. She has consumed lare amounts of alcohol. Her plasma paracetamol conc is just below the conc that would suggest tx. What should be the tx option for her?

Refer to psychiatry ward

Refer to medical ward

N-acetylcystine

Serum plasma paracetamol

No further investigation

A 64yo woman has been on HRT for 9yrs. She had regular withdrawal bleeds until 3 yrs ago and since then has been taking a no bleed prep. Recently she noticed a brown vaginal discharge. Choose the single most appropriate initial inv?

Cervical smear

High vaginal swab

OHCS/P. 274… about transvaginal uterine US:
“Endometrial cancer is suggested by endometrial thickness >20mm (>5mm if postmenopausal not on hormones), heterogeneous appearance, and hypoechoic areas.”

OHCS/P. 278, about diagnosis of endometrial cancer:
“Uterine ultrasound may be suggestive. The diagnosis is made by uterine sampling”.

 

need to R/O endomet CA. initial inv is D. definitive E

 

 

TFT

Transvaginal US

Endometrial sampling

A young girl complains of episodic headaches preceded by fortification spectra. Each episode last for 2-3 days. During headache pt prefers quiet, dark room. What is the tx of choice for acute stage?

Paracetamol

Aspirin

Sumatriptan

Gabapentin

Cafergot

A 60yo pt recovering from a surgery for toxic goiter is found to be hypotensive, cyanosed in the the RR. Exam: tense neck. There is blood oozing from the drain. What is the most likely dx?

Thyroid storm

Reactionary hemorrhage

Secondary hemorrhage

Primary hemorrhage

Tracheomalacia

A 33yo man is hit by a car. He loses consciousness but is found to be fine by the paramedics. When awaiting doctors review in the ED he suddenly becomes comatose. What is the most likely dx?

SAH

Subdural hemorrhage

Intracerebral hemorrhage

Extradural hemorrhage

Triad of NPH (3W): Wet (Incontinence), wobbly (waddling gait), wacky (odd behavior).

3

 

3

3W

A 77yo male presents with hx of enuresis and change in behavior. Exam: waddling gait. What is the most likely dx?

Subdural hemorrhage

Brain tumor

Normal pressure hydrocephalus

Psychotic depression

A 29yo teacher is involved in a tragic RTA. After that incident, he has been suffering from nightmares and avoided driving on the motorway. He has been dx with PTSD. What is the most appropriate management?

CBT

Diazepam

Citalopram

Dosalepin

Olanzepin

A 5yo child resents with fever. He looks pale. His parents say he always feels tired. On exam: orchidomegaly & splenomegaly. Labs: WBC=1.7, Hgb=7.1, Plt=44. What is the dx?

ALL

CLL

AML

CML

Hodgkins

A 6wk child is brought in with vomiting, constipation and decreased serum K+. What is the dx?

Pyloric stenosis

Duodenal atresia

Hirschsprung disease

Achalasia cardia

Tracheo-esophageal fistula

A 17 yo girl had an episode of seizure. Contraction of muscles started from around the interphalangeal joints, which spread to the muscles of wrist and elbow. Choose possible type of seizure?

Grand mal

Tonic clonic

Myoclonic

Absent

A 46yo man, known case of chronic GN presents to OPD. He feels well. BP = 140/90mmHg. Urine dipstick: protein ++, blood ++ and serum creatinine=106mmol/L. Which medication can prevent the progression of this dx?

ACEi

Diuretics

Cytotoxic meds

Longterm antibiotics

Steroids

A 23 yo girl presented with perioral paresthesia and carpopedal spasm 20 mins after a huge argument with her boyfriend. What is the next step for this pt?

SSRI

Diazepam

Rebreath into a paper bag

Propranolol

Alprazolam

A 25 yo woman has been feeling anxious and nervous for the last few months. She also complains of palpitations and tremors. Her symptoms last for a few minutes and are very hard to control. She tells you that taking alcohol initially helped her relieve her symptoms but now this effect is wearing off and she has her symptoms even after drinking alcohol. What is the dx?

Panic disorder = episodic anxiety.

GAD = persistent anxiety.

Panic disorder

Depression

OCD

Alcohol addiction

GAD

A 2yo child is very naughty. His teacher complains that he is easily distracted. His parents say that he can’t do a particular task for a long time. He sometimes hurts himself and breaks many things. This causes many troubles at home. What is the dx?

ASD

Dyslexia

ADHD

Antisocial personality disorder

Oppositional defiant

A 79 yo lady who is otherwise well recently started abdominal pain. She is afebrile and complains that she passed air bubbles during urination. A urethral catheter showed fecal leakage in the urinary bag. What is the likely pathology?

Diuretics

CD

Rectosigmoid tumor

Large bowel perforation

UC

A 2 month child with diarrhea and vomiting for 6 days is brought in looking lethargic. What is the appropriate initial inv?

BUE

Random blood sugar

CBC

CXR

AXR

A 72 yo man fell while shopping and hurt his knee. His vitals are fine. He speaks in a low voice and is very slow to give answers. What is the most probable dx?

Alzheimers

Vascular demetia

TIA

Pseudo-dementia

Picks dementia

A 47 yo man met with a RTA. He has multiple injuries. Pelvic fx is confirmed. He has not passed urine in the last 4 hrs. What is the next appropriate management for this pt?

Urethral catheter

Suprapubic catheter

IV fluids

IV furosemide

Insulin

A 49 yo pt presents with right hypochondriac pain. Inv show a big gallstone. What is the most appropriate management?

Lap Cholecystectomy

Reassure

Low fat diet

Ursodeoxycholic acid

Emergency laparotomy

In a man who is neglected and alcohol dependent, which high suicidal risk, which factor can increase this risk further?

Alcohol dependence

SSRI

Smoking

Agoraphobia

Court involvement

A 71 yo man presents with coarse tremor. He is on some meds. Which one can be the reason for the tremor?

Lithium

Diazepam

Fluoxetine

Imipramine

Haloperidol

A young woman complains of diarrhea, abdominal cramps and mouth ulcers. AXR shows distended transverse colon with globet cell depletion on rectal biopsy. What is the most probable dx?

CD

UC

Bowel Ca

Bowel obstruction

IBS

After eating a cookie at a garden party, a child began to cough and went blue. The mother also noticed that there were swollen patches on the skin. What is the dx?

Allergic reaction

Aspiration of food

Cyanotic heart disease

Trachea-esophageal fistula

Achalasia cardia

A 70 yo man presents with balance difficulties, vomiting and nausea. Which of the following is the best inv?

MRI cerebellum

CT cerebellum

Skull XR

LP

Blood culture

A 2 yo pt presents with colicky pain which radiates from loin to groin. He complains of similar episodes in the past. Inv has been done and 7mm stone was found in the ureter. What is the most appropriate management?

Percutaneous nephrolithiotomy

Open surgery

Ureterscopy or laser

Conservative tx

ESWL

A footballer has been struck in the groin by a kick and a presents with severe pain and mild swelling in the scrotum. What is the most appropriate next step?

USG

Doppler

Exploratory surgery

IV fluids

Antibiotics

A 47 yo ex-soldier suffers from low mood and anxiety. He can’t forget the images he faces before and has always had flashbacks. He is not able to watch the news because there are usually some reports about war. What is he suffering from?

Depression

PTSD

Panic attack

Agoraphobia

GAD

A 36 yo woman has recently spent a lot of money on buying clothes. She goes out almost every night with her friends. She believes that she knows better than her friends, so she should choose the restaurant for eating out. She gave hx of having low mood at 12 yo. What’s the dx?

Mania

Depression

Bipolar affective disorder

Borderline personality disorder

Dysthymia

A 28 yo female presents with a 3m hx of diarrhea. She complains of abdominal discomfort and passing stool 20x/day. Exam=febrile. Barium enema shows cobblestone mucosa. What is the most likely dx?

Ameoba

Colon Ca

GE

CD

UC

A child is brought in with high grade fever, runny nose and bark-like cough. He is also drooling. What is the most appropriate tx for this child?

Corticosteroids

Paracetamol

Adrenaline nebulizer

IV antibiotics

Intubation under GA

A 78yo lady on warfarin for atrial fibrillation lives in a care home. She presents with hx of progressive confusion for three days. She was also noticed to have bruises on her arms. INR = 7. What is the most probable dx?

Alzheimers

Delirium

Subdural hemorrhage

Vascular dementia

Pick’s dementia

A 28 yo drug user presents to the ED with collapse and anuria. His serum K+ = 7.5mmol/L. CXR = early pulmonary edema. What is the next appropriate management?

Urgent hemodialysis

IV calcium gluconate

IV insulin + dextrose

Furosemide

IV NS 0.9%

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