ng ovA 65yo man presents w/ painless hematuria, IVU is normal, prostate is mildly enlarged with mild frequency. What is the most appropriate next step?
A 74yo smoker presented to his GP with cough and SOB. Exam revealed pigmentation of the oral mucosa and also over the palms and soles. Tests show that he is diabetic and hypokalemic. What is the most probable dx?
A 44yo woman has lost weight over 12 months. She has also noticed episodes where her heart beats rapidly and strongly. She has a regular pulse rate of 90bpm. Her ECG shows sinus rhythm. What is the most appropriate inv to be done?
A 79yo anorexic male complains of thirst and fatigue. He has symptoms of frequency, urgency and terminal dribbling. His urea and creatinine levels are high. His serum calcium is 1.9 and he is anemic. His BP is 165/95 mmHg. What is the most probable dx?
A 64yo man has recently suffered from a MI and is on aspirin, atorvastatin and ramipril. He has been having trouble sleeping and has been losing weight for the past 4 months. He doesn’t feel like doing anything he used to enjoy and has stopped socializing. He says he gets tired easily and can’t concentrate on anything. What is the most appropriate tx?
A 67yo man after a stroke, presents with left sided prosis and constricted pupil. He also has loss of pain and temp on the right side of his body and left side of his face. Which part of the brain is most likely affected?
A 60yo man presents with dysphagia and pain on swallowing both solids and liquids. A barium meal shows gross dilatation of the esophagus with a smooth narrowing at the lower end of the esophagus. What is the SINGLE most likely cause of dysphagia?
A man undergoes a pneumonectomy. After surgery, invs show 0. What could be the cause of the biochemical change?
Removal of hormonally active tumor
A pregnant lady came with pain in her calf muscle with local rise in temp to the antenatal clinic. What tx should be started?
Aspirin and heparin
A 53yo female presents with an acute painful hot knee joint. She is a known case of RA. On examination, the knee is red, tender and swollen. The hamstring muscles are in spasm. Her temp is 38.5C and BP is 120/80mmHg. What is the SINGLE best next inv?
Joint aspiration for cytology and culture and sensitivity
Joint aspiration for positive birefrengent crystals
Joint aspiration for negative birefrengent crystals
Serum uric acid
An 80yo man presented with pain in his lower back and hip. He also complains of waking up in the night to go to the washroom and has urgency as well as dribbling. What is the most likely dx?
An 18yo female has peri-orbital blisters. Some of them are crusted, others secreting pinkish fluid. What is the most likely dx?
A 29yo lady who is a bank manager is referred by the GP to the medical OPC due to a long hx of tiredness and pain in the joints. An autoimmune screen result showed smooth muscle antibodies positive. What is the most appropriate next inv?
It presents wth polyarthritis in 25% of the cases.
A 5yo with recurrent chest pain, finger clubbing with offensive stool. Choose the single most likely inv?
Endomyseal/Alpha glidin antibody
Glucose tolerance test
A clinical picture of breast cancer originated from the mammary duct. Biopsy was done ad there were neoplastic cells found. Choose the histological picture of the cancer.
Neoplastic cells are arranged in small clusters occupying a space between collagen bundles (Seirrhous carcinoma)
Spindle cell neoplasms with margins, which infiltrate adjacent structure, fat invaded (Breast sarcoma)
Small cells with round nucleus and scant indistinct cytoplasm (Lobular carcinoma)
A 22yo man has a reduced conscious level and a fixed dilated pupil after being involved in a MVC. Choose the single most appropriate option?
A man with suspected active TB wants to be treated at home. What should be done to prevent the spread of disease?
Immediate start of the tx with Anti-TB drugs
All family members should be immediately vaccinated with BCG vaccine
Patient should be isolated in a negative pressure chamber in his house
Universal prevention application protocol
A 7yo child is brought to the ED with a 1 day hx of being listless. On examination, the child is drowsy with an extensive non-blanching rash. What advice would you give the parents?
All family members need antibiotic therapy
Only the mother should be given rifampicin prophylaxis
All family members need isolation
All family members should be given rifampicin prophylaxis
A 47yo man has a temp of 39C and is delirious. He has developed blisters mainly on his trunk, which appeared a few hours ago. He is well and not on any medications. He last travelled 5 months ago to Italy. Which of the following is the most likely dx?
A 64yo pt has been having freq episodes of secretory diarrhea, which is extremely watery, with large amts of mucus. A dx of villous adenoma was made after endoscopy. What electrolyte abnormality is most likely in this pt?
A pt with an acute gout attack came to the ED. What drug should be given to relieve symptoms?
A pt was lying down on the operating table in a position with his arms hanging down for 3 hours. Soon after he woke up, he complains of numbness and weakness in that hand and has limited wrist movement/wrist drop and sensory loss over dorsum of that hand, weakness of extension of the fingers and loss of sensation at the web of the thumb. What structure is likely to be damaged?
|Oxycodone is better than morphine for pain relief with less side effects|
A pt who was previously on 120mg slow release oral morphine has had his dose increased to 200mg. He is still in significant pain. He complains of drowsiness and constipation. What is the next step in the management?
Increase slow release morphine dose
Replace morphine with oral hydromorphone
Replace morphine with oxycodone
A 40yo woman notices increasing lower abdominal distention with little/no pain. On examination, a lobulated cystic mass is felt and it seems to be arising from the pelvis. What is the most appropriate inv?
A resident of a nursing home presented with rashes in his finger webs and also on his abdomen, with complaints of itching which is severe at night. He was dx with scabies. What the best tx for his condition?
A 34yo alcoholic is found passed out in front of a local pub. The ambulance crew informs you that he was sweating when they found him and there were cans of cider lying empty around him. What is the initial stage of inv?
|Alcohol intoxication induces hypoglycemia.|
Capillary blood sugar
A young boy fell on his outstretched hand and has presented with pain around the elbow. He has absent radial pulse on the affected hand. What is the most likely dx?
Angulated supracondylar fx
Undisplaced fx of radial head
Posterior dislocation of shoulder
A 65yo woman presented with transient arm and leg weakness as well as a sudden loss of vision in the left eye. Her symptoms resolved within the next couple of hours. What is the most appropriate next inv?
A man complains of loss of sensation in his little and ring finger. Which nerve is most likely to be involved?
Long thoracic nerve
|6th cranial nerve palsy causes diplpia in the horizontal plane. Only the ipsilateral lateral rectus that is solely innervated by the involved peripheral sixth cranial nerve is affected.
A young man complains of double vision on seeing to the right. Which nerve is most likely to be involved?
A 45yo man keeps having intrusive thoughts about having dirt under the bed. He can’t keep himself from thinking about these thoughts. If he tries to resist, he starts having palpitations. What is the most likely dx?
A 33yo man presents with an itchy scaly annular rash on his thigh after a walk in the park. Which of the following drugs will treat his condition?
A pt with cerebral mets has polyuria and polydipsia. What part of the brain would be affected?
A 32yo man presented with painless hematuria. He is hypertensive but the rest of the exam is unremarkable. What is the most likely dx?
A 45yo female complains of pain in the inner side of her right thigh. She was dx with benign ovarian mass on the right. Which nerve is responsible for this pain?
Ovarian branch of splanchic nerve
A 37yo lady strongly believes that a famous politician has been sending her flowers every day and is in love with her. However, this is not the case. What is the most likely dx?
|The false yet persistent belief that one is loved by a person (often a famous or prominent person). It can be a symptom of schizophrenia or other psychiatric disorders that are characterized by delusional symptoms.
A 3yo child has been brought with facial lacerations. On examination he has some cuts over his right cheek and under the eye. The GCS on initial evaluation is 15. What is the appropriate next inv?
A 73yo woman has lymphadenopathy and splenomegaly. She feels well but has had recurrent chest infections recently. Choose the single most likely blood film findings?
Excess of mature lymphocytes
Multiple immature granulocytes with blast cells
Numerous blast cells
A lady presents with itching around the breast and greenish foul smelling discharge from the nipple. She had a similar episode before. What is the most likely dx?
Mammary duct fistula
A young male whose sclera was noted to be yellow by his colleagues has a hx of taking OTC drugs for some pain. Tests showed raised bilirubin, ALT and AST normal. The provocation test with IV nicotinic acid is positive and produces further rise in the serum bilirubin levels. What is the most likely dx?
A 24yo biker has been rescued after being trapped under rocks for almost 12h. He complains of reddish brown urine. His creatinine is 350umol/L and his urea is 15mmol/L. What is the most imp step in the management of this patient?
A 74yo man who has been a smoker since he was 20 has recently been dx with SCLC. What serum electrolyte picture will confirm the presence of SIADH?
High serum Na, low serum osmolarity, high urine osmolarity
Low serum Na, low serum osmolarity, high urine osmolarity
Low serum Na, high serum osmolarity, high urine osmolarity
High serum Na, low serum osmolarity, low urine osmolarity
High serum Na, high serum osmolarity, low urine osmolarity
A man brought into the ED after being stabbed in the chest. Chest is bilaterally clear with muffled heart sounds. BP is 60/nil. Pulse is 120bpm. JVP raised. What is the most likely dx?
A 50yo pt is admitted for elective herniorraphy. Which of the following options will lead to a postponement of the operation?
MI 2 months ago
Pain around hernia
A 32yo woman of 39wks gestation attends the antenatal day unit feeling very unwell with sudden onset of epigastric pain associated with nausea and vomiting. Her temp is 36.7C. Exam: she is found to have RUQ tenderness. Her blood results show mild anemia, low platelets, elevated liver enzymes and hemolysis. What is the most likely dx?
Acute fatty liver of pregnancy
A woman comes with an ulcerated lesion 3 cm in the labia majorum. What is the lymphatic drainage of this area?
Superficial inguinal LN
A man post-cholecystectomy presented with jaundice, fever and dark urine. What is the most diagnostic inv?
A 79yo stumbled and sustained a minor head injury 2 weeks ago. He has become increasingly confused, drowsy and unsteady. He has a GCS of 13. He takes warfarin for Afib. What is the most likely dx?
A 25yo female complains of intermittent pain in her fingers. She describes episodes of numbness and burning of the fingers. She wears gloves whenever she leaves the house. What is the most probable dx?
A 22yo lady has been unwell for some time. She came to the hospital with complaints of fever and painful vesicles in her left hear. What is the most probable dx?
A 5yo girl had earache and some yellowish foul smelling discharge, perforation at the attic and conductive hearing loss. She has no past hx of any ear infections. What is the most appropriate dx?
OM with effusion
A female with T1DM would like to know about an deficiency of vitamins in pregnancy that can be harmful. A deficiency of which vitamin can lead to teratogenic effects in the child?
A 23yo woman has been having pain at the base of her thumb, the pain is reproduced when lifting her 3 month old baby or changing diapers and also with forceful abduction of the thumb against resistance. What is the likely cause?
Avascular necrosis of scaphoid
De Quervain’s tenosynovitis
A 6m child presents with fever and cough. His mother has rushed him to the ED asking for help. Exam: temp=39C and the child is feeding poorly. Dx?
A 75yo man collapsed while walking in his garden. He recovered fully within 30 mins with BP 110/80 mmHg and regular pulse of 70bpm. He has a systolic murmur on examination. His activities have been reduced lately which he attributes to old age. What is the definitive diagnostic inv that will assist you with his condition?
24h ECG monitoring
24h BP monitoring
A 35yo man with a hx of schizophrenia is brought to the ER by his friends due to drowsiness. On examination he is generally rigid. A dx of neuroleptic malignant syndrome except:
Elevated creatinine kinase
Usually occurs after prolonged tx
A 33yo drug addict wants to quit. She says she is ready to stop the drug abuse. She is supported by her friends and family. What drug tx would you give her?
A 16m child presents with drooling, sore throat and loss of voice. He has fever with a temp of 38.2C. What is your next step towards management?
Call ENT surgeon
A 62yo woman complains of unsteadiness when walking. On examination she has pyramidal weakness of her left lower limb and reduced pain and temp sensation on right leg and right side of trunk up to the umbilicus. Joint position sense is impaired at her left great toe but is normal elsewhere. She has a definite left extensor plantar response and the right plantar response is equivocal. Where is the lesion?
Left cervical cord
Midline mid-thoracic cord
|Brown -Sequards Syndrome
Up to the umbilicus…..T10….Mid thoracic cord
ipsilateral hemiplegia with contralateral pain and temperature sensation deficits.
Right mid-thoracic cord
Left mid-thoracic cord
Left lumbo-sacral plexus
A 26yo man present to ED with increasing SOB on left side and chest pain. He has been a heavy smoker for the past 4 years. He doesn’t have any past med hx. What is the likely dx?
A pt with hepatocellular ca has raised levels of ferritin. What is the most probable cause?
A1 antitrypsin def
A woman has electric pains in her face that start with the jaw and move upwards. Her corneal reflexes are normal. What is the most likely dx?
Atypical face pain
Tempero-mandibular joint dysfunction
A 32yo man presented with slow progressive dysphagia. There is past hx of retro-sternal discomfort and he has been treated with prokinetics and H2 blockers. What is the probably dx?
Plummer vinson syndrome
A 56yo man comes with hx of right sided weakness & left sided visual loss. Where is the occlusion?
|Internal Carotid a occlusion.: Ipsilateral visual loss + contralateral limb weakness.
MCA occlusion: contralateral weakness + contralateral homonymous hemianopia.
Ant meningeal artery
Mid meningeal artery
Mid cerebral artery
Ant cerebral artery
Ant communicating artery
A young college student is found in his dorm unconscious. He has tachyarrhythmia and high fever. He also seems to be bleeding from his nose, which on examination shows a perforated nasal septum. What is the most likely dx?
A 56yo pt whose pain was relieved by oral Morphine, now presents with progressively worsening pain relieved by increasing the dose of oral morphine. However, the pt complains that the increased morphine makes him drowsy and his is unable to carry out his daily activities. What is the next step in his management?
A 30yo man presents with a 5cm neck mass anterior to the sternocleido-mastoid muscle on the left side in its upper third. He states that the swelling has been treated with antibiotics for infection in the past. What’s the most likely cause?
An 18yo man is rushed into the ER by his friends who left him immediately before they could be interviewed by staff. He is semiconscious, RR=8/min, BP=120/70mmHg, pulse=60bpm. He is noted to have needle track marks on his arms and his pupils are small. What is the single best initial tx?
A 30yo man and wife present to the reproductive endocrine clinic because of infertility. The man is tall, has bilateral gynecomastia. Examination of the testes reveals bilateral small, firm testes. Which of the following inv is most helpful in dx?
CT of pituitary
Measure of serum gonadotropins
Measure of serum testosterone
An 18yo female just received her A-Level results and she didn’t get into the university of her choice. She was brought into the ED after ingestion of 24 paracetamol tablets. Exam: confused and tired. Initial management has been done. Inv after 24h: normal CBC, ABG = pH7.1, PT=17s, Bilirubin=4umol/L, creatinine=83umol/L. What is the next step in management?
Observation for another 24h
Refer to psychologist
Discharge with psychiatry referral
A 75yo alcoholic presents with a mass up to umbilicus, urinary dribbling, incontinence, and clothes smelling of ammonia. What is the next step in management?
In CRF, main cause of Vit D deficiency is the failure of:
Vit D absorption in intestines
25 alpha hydroxylation of Vit D
Excess Vit D loss in urine
1 alpha hydroxylation of Vit D
Availability of Vit D precursors
Pt with puffiness of face and rash showing cotton wool spots on fundoscopy. What’s the dx?
|SLE causes nephritic syndrome ,can lead to puffiness and hypertensive retinopathy.|
Proliferative diabetic retinopathy
A 35yo man presents with progressive breathlessness. He gave a hx of polyarthralgia with painful lesions on the shin. CXR: bilateral hilar lymphadenopathy. What’s the most likely dx?
A child presents with clean wound, but he has never been immunized as his parents were worried about it. There is no contraindication to immunization, what is the best management?
Full course of DTP
1 single injection DT
1 single injection DTP
A 65yo HTN man presents with lower abdominal pain and back pain. An expansive abdominal mass is palpated lateral and superior to the umbilicus. What is the single most discriminating inv?
A 55yo man has had severe pain in the right hypochondrium for 24h. The pain comes in waves and is accompanied by nausea. Nothing seems to relieve the pain. He feels hot and sweaty but has normal temp. What is the most appropriate next inv?
A 67yo man has deteriorating vision in his left eye. He has longstanding COPD and is on multiple drug therapy. What single medication is likely to cause this visual deterioration?
A woman who returned from abroad after 3 weeks of holiday complains of severe diarrhea of 3 weeks. She also developed IDA and folic acid def. What condition best describes her situation?
Jejunal villous atrophy
Chronic diarrhea secretions
Increased secretions of acid
A 35yo male is bitterly annoyed with people around him. He thinks that people are putting ideas into his head. What is the single most likely dx?
A 10yo girl presents with hoarseness of the voice. She is a known case of bronchial asthma and has been on oral steroids for a while. What is the most likely cause of hoarseness?
Allergic drug reaction
A lady with breast cancer has undergone axillary LN clearance. She develops arm swelling after being stung by a bee. What is the most likely mechanism responsible for the swelling?
A 34yo pt presents with 50% partial thickness burns. What should be the most appropriate management?
IV fluids calculated from the time of hospital arrival
IV fluids calculated from the time of burn
IV dextrose stat
A 54yo man has recently been dx with moderate depression. He has hx of MI and is suffering from insomnia. What is the drug of choice for him?
|Cellulitis = acute inf. Of the skin and soft tissues.
Cause: B-haemolytic strept. +/- staph.
Rx: 1.Elevate the legs.
2. Benzylpenicillin. If allergic, try Erythromycin
A man presented with cellulitis and swelling. He was started on flucloxacillin. What other medication do you want to add?
A 24yo college student presents with nausea, vomiting, headache, neck stiffness and a fever of 38.4C. What is the most appropriate empirical antibiotic to be started?
A man with prosthetic heart valve underwent hemicolectomy and after some days complains of left hypochondriac pain, fever and has a systolic murmur. What is the next inv to ascertain the cause of HF?
Radioactive thyroid scan
A 45yo man with posterior gastric ulcer presented with severe excruciating pain which subsided after conservative treatment. 10 days later he developed swinging pyrexia. US shows a collection in the peritoneum. What will be the most likely location of the collection?
Left paracolic gutter
A 23yo lady was prescribed with azithromycin 1gm for her chlamydial pelvic infection. She has got a new boyfriend for the last 2 months. She has recently started contraception to avoid conception. Which of the following contraception method will be affected by azithromycin?
An 11yo boy is being checked by the diabetic specialist nurse. His HbA1c was high and he has been skipping meals recently. He has been unhappy at school. Which single member of the clinical team would you refer him to next?
A 35yo man who has served in the army presents with lack of interest in enjoyable activities and feeling low. He doesn’t feel like reading the news or watching movies as he believes there is violence everywhere. What is the most appropriate first line therapy?
A man has reducible bulge below the pubic tubercle, and on occlusion of the deep inguinal ring, cough impulse is present. What is the most likely dx?
A 48yo woman is admitted to ED with a productive cough and moderate fever. She has often central chest pain and regurgitation of undigested food most times but doesn’t suffer from acid reflux. These symptoms have been present for the last 3.5 months which affects both food and drink. A CXR shows an air-fluid level behind a normal sized heart. What is the most likely dx?
|The classical picture of a CXR in achalasia shows a vastly dilated oesophagus behind the heart.|
A 64yo man has been waking up in the middle of the night to go to the bathroom. He also had difficulty in initiating micturition and complains of dribbling. A dx of BPH was made after a transrectal US guided biopsy and the pt was prepared for a TURP. What electrolyte abnormality is highly likely due to this surgery?
A 56yo lady has developed severe right sided headache which worsens whenever she comes to bright light since the last 4 days. She feels nauseated, but doesn’t vomit. What is the most likely dx?
A 35yo man presented with hematuria, abdominal swelling and has a BP of 190/140. What is the most diagnostic inv?
A young man is brought to the ED after a RTA. His GCS on initial evaluation is 6. What ist he most appropriate next step?
A 65yo man presented with frank hematuria. He has no other urinary symptoms. What is the most appropriate next step that will lead to the dx?
Mid-stream urine for culture
A 30yo woman had a gradual decrease of visual acuity since the last 3 years. Now she has a disability due to very low vision. What’s the dx?
A 27yo lady has had an uncomplicated pregnancy so far. She came to the hospital 2h ago after her water broke. The midwife is looking at her now. She has regular contractions. P.V exam revealed 2cm dilated cervix. Vital signs are normal. What stage of labour is she in?
A 2yo boy fell off his tricycle and hurt his arm. He got up to start crying, but before there was any sound, he went pale, unconscious and rigid. He recovered after 1-2 mins but remained pale. After an hour he was back to normal. His mother says she was afraid he was going to die, and that he had a similar episode 3 months prior after falling down some steps. What single inv is indicated?
A 29yo woman had just delivered a still born vaginally, following a major placental abruption. Choose the single most likely predisposing factor for developing PPH in this lady?
Large placental site
A 28yo woman has delivered with rotational forceps after an 8h labor and 3h second stage. Choose the single most likely predisposing factor for PPH for this pt?
A 50yo man has had anterior resection of the rectum for carcinoma. He expressed concerns about control of post-op pain in discussions with the anaesthetist before surgery. What is the best management strategy?
A 73yo male presents with enlarged cervical nodes. He has had recurrent infections over the last year. His conjunctiva is pale. Choose the single cell type you will find on the blood film.
Granulocyte without blast cells
A 45yo lady has 10m hx of SOB. She is found to have irregularly irregular pulse and loud P2 with fixed splitting and ejection systolic murmur in left 2nd ICS. What is the probable dx?
A 5m baby present with recurrent vomiting. Mother noticed some of the vomitus is blood stained. Choose the single most likely inv?
Upper GI endoscopy
A 76yo is treated with HTN. He suffers from pain and redness at the MTP joint of his right big toe. Which of the following anti-HTN cause this symptoms?
A 33yo male involved in a street fight presents with bruises and deformity in the upper part of his leg. XR shows fx of the neck of fibula. What is the single most associated nerve injury?
Lateral peroneal nerve
A 35yo man presents with hx of dyspepsia. H.Pylori antibodies are negative. No improvement is seen after 1m of tx. What is the next step?
Urea breath test
A 15yo male has bilateral ankle edema. His BP=110/70mmHg and urinalysis shows protein++++. What is the most likely dx?
Minimal change GN
A 28yo man has developed a red, raised rash on trunk after playing football. His PMH shows he had childhood asthma. The rash is becoming increasingly itchy. What is the most appropriate tx?