MCQs of PLAB

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?

US Abdomen

Flexible cystoscopy

MRI

Nuclear imaging

PSA

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?

Pseudocushing syndrome

Conns disease

Ectopic ACTH

Cushings disease

Hypothyroidism

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?

Thyroid antibodies

TFT

ECG

Echocardiogram

Plasma glucose

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?

BPH

Prostate carcinoma

Chronic pyelonephritis

Benign nephrosclerosis

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?

Lofepramine

Dosulepin

Citalopram

Fluoxetine

Phenelzine

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?

Frontal cortex

Cerebellum

Pons

Medulla

Parietal cortex

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?

Achalasia

Myasthenia gravis

Esophageal carcinoma

Esophageal web

Systemic sclerosis

A man undergoes a pneumonectomy. After surgery, invs show 0. What could be the cause of the biochemical change?

Removal of hormonally active tumor

Excess dextrose

Excess colloid

Excessive K+

Hemodilution

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

LMWH

Paracetamol

Cocodamol

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

Blood culture

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?

BPH

Prostatitis

UTI

Prostate carcinoma

Bladder carcinoma

An 18yo female has peri-orbital blisters. Some of them are crusted, others secreting pinkish fluid. What is the most likely dx?

Shingles

Chicken pox

Varicella

Rubella

Measles

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?

ECG

Autoimmune hepatitis.

It presents wth polyarthritis in 25% of the cases.

TFT

LFT

Serum glucose

Jejunal biopsy

A 5yo with recurrent chest pain, finger clubbing with offensive stool. Choose the single most likely inv?

Endomyseal/Alpha glidin antibody

Sweat test

Barium meal

ECG

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?

Facial nerve

Oculomotor nerve

Olfactory nerve

Optic nerve

Trigeminal nerve

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?

Shingles

Chicken pox

Pemphigoid

Bullous pemphigus

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?

Hyperkalemia

Hypernatremia

Hyponatremia

Hypokalemia

Hypercalcemia

A pt with an acute gout attack came to the ED. What drug should be given to relieve symptoms?

NSAIDs

Allopurinol

Ibuprofen

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?

Radial nerve

Median nerve

Ulnar nerve

Axillary nerve

Suprascapular nerve

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

Fentanyl patch

Replace morphine with oral hydromorphone

Replace morphine with oxycodone

Subcutaneous morphine

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?

CA 125

CA 153

CA 199

CEA

AFP

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?

0.5% permethrin

Doxycycline

5% permethrin

Reassure

Acyclovir

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

CT head

MRI head

ABG

MCV

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?

Dislocated elbow

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?

CT brain

Echo

Doppler USG

Arteriography

24h ECG

A man complains of loss of sensation in his little and ring finger. Which nerve is most likely to be involved?

Median nerve

Ulnar nerve

Radial nerve

Long thoracic nerve

Axillary 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.

http://emedicine.medscape.com/article/1198383-overview#a0104

A young man complains of double vision on seeing to the right. Which nerve is most likely to be involved?

Left abducens

Right abducens

Left trochlear

Right trochlear

Right oculomotor

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?

OC personality

OCD

Schizophrenia

Panic disorder

Phobia

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?

Erythromycin

Doxycycline

Penicillin

Amoxicillin

A pt with cerebral mets has polyuria and polydipsia. What part of the brain would be affected?

Cerebral cortex

Cerebellum

Diencephalon

Pons

Medulla

A 32yo man presented with painless hematuria. He is hypertensive but the rest of the exam is unremarkable. What is the most likely dx?

Polycystic kidneys

Ca bladder

Ca prostate

TTP

HUS

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?

Femoral nerve

Obturator nerve

Iliohypogastric nerve

Ovarian branch of splanchic nerve

Pudendal 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.

http://www.medicinenet.com/script/main/art.asp?articlekey=11346

 

Erotomania

Pyromania

Kleptomania

Trichotillomania

Grandiosity

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?

Skull XR

Facial XR

CT scan

MRI

Observation

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?

Atypical lymphocytes

Excess of mature lymphocytes

Plasma cells

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?

Duct papilloma

Duct ectasia

Breast abscess

Periductal mastitis

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?

Acute hepatitis

Drug hypersensitivity

Gilberts syndrome

Acute pancreatitis

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?

Dialysis

IV NS

IV dextrose

IV KCl

Pain relief

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?

Pulmonary embolism

Cardiac tamponade

Pericardial effusion

Hemothorax

Pneumothorax

A 50yo pt is admitted for elective herniorraphy. Which of the following options will lead to a postponement of the operation?

SBP <90mmHg

MI 2 months ago

Hgb 12g/dl

Pain around hernia

Abdominal distention

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

Acute pyelonephritis

Cholecystitis

HELLP syndrome

Acute hepatitis

A woman comes with an ulcerated lesion 3 cm in the labia majorum. What is the lymphatic drainage of this area?

External iliac

Superficial inguinal LN

Para-aortic

Iliac

Aortic

A man post-cholecystectomy presented with jaundice, fever and dark urine. What is the most diagnostic inv?

ERCP

USG Abdomen

CT Scan

MRCP

MRI

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?

Extradural hemorrhage

Cerebellar hemorrhage

Epidural hemorrhage

Subdural hemorrhage

Subarachnoid hemorrhage

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?

Kawasaki disease

Takayasu arteritis

Buerger’s disease

Embolism

Raynaud’s phenomenon

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?

Acne

Herpes zoster

Chicken pox

Insect bite

Cellulitis

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?

Acute OM

OM with effusion

Acquired cholesteatoma

Congenital cholesteatoma

Otitis externa

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?

Folic acid

Vit B12

Thiamine

Riboflavin

Pyridoxine

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

Trigger finger

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?

Bronchiolitis

Asthma

Bronchitis

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?

ECG

Echo

24h ECG monitoring

24h BP monitoring

Prv CIN

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:

Renal failure

Pyrexia

Elevated creatinine kinase

Usually occurs after prolonged tx

Tachycardia

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?

Benzodiazepines

Diazipoxide

Lithium

Methadone

Disulfiram

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?

Direct pharynoscopy

Call ENT surgeon

Call anesthesiologist

IV fuilds

Start antibiotics

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.

http://www.patient.co.uk/doctor/brown-sequards-syndrome

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?

Pulmonary embolism

MI

Asthma

Pleural effusion

Pneumothorax

A pt with hepatocellular ca has raised levels of ferritin. What is the most probable cause?

Hemochromatosis

A1 antitrypsin def

Cystic fibrosis

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

Trigeminal neuralgia

Tempero-mandibular joint dysfunction

GCA

Herpes zoster

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?

Foreign body

Plummer vinson syndrome

Pharyngeal puch

Peptic stricture

Esophageal Ca

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

Carotid 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?

Marijuana OD

Cocaine OD

Heroin OD

Alcohol OD

CO poisoning

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?

Oral oxycodone

Oral tramadol

PCA

IV Fentanyl

Diamorphine

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?

Branchial cyst

Parotitis

Pharyngeal pouch

Thyroglossal cyst

Thyroid swelling

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?

Insulin

Naloxone

Methadone

Gastric lavage

Klinefelter’s Syndrome

XXY

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

Chromosomal analysis

Measure of serum gonadotropins

Measure of serum testosterone

Semen analysis

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

http://www.patient.co.uk/doctor/paracetamol-poisoning

Refer to psychologist

Give N-Acetylcysteine

Discharge with psychiatry referral

Liver transplantation

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?

Urethral catheter

Suprapubic catheter

Antibiotics

Condom catheter

Nephrostomy

In CRF, main cause of Vit D deficiency is the failure of:

Vit D absorption in intestines

25 alpha hydroxylation of Vit D

http://www.medscape.com/viewarticle/767843_2

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.

Macular degeneration

Hypertensive retinopathy

Diabetic background

Proliferative diabetic retinopathy

SLE

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?

Bronchial asthma

Cystic fibrosis

Sarcoidosis

Bronchiectasis

Pneumonia

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

Only Ig

Antibiotic

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?

Laparascopy

KUB XR

Pelvic US

Rectal exam

Abdominal US

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?

US Abdomen

ERCP

MRCP

Serum amylase

UGI endoscopy

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?

B2 agonist

Corticosteroid

Diuretic

Theophylline

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

Malabsorption

Increased catabolism

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?

Thought block

Thought insertion

Thought broadcasting

Thought withdrawal

Reference

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?

Laryngeal candidiasis

Infective tonsillitis

Laryngeal edema

Allergic drug reaction

Ludwigs angina

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?

Lymphedema

Cellulitis

Hypersensitivity reaction

DVT

Fluid retention

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

No IVF

IV dextrose stat

Burns ointment

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?

Citalopram

Lofepramine

ECT

Haloperidol

Diazepam

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

       3. Flucloxacillin

3.

 

A man presented with cellulitis and swelling. He was started on flucloxacillin. What other medication do you want to add?

Vancomycin

Penicillin

Metronidazole

Ceftriaxone

Amoxicillin

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?

Ceftriaxone

Penicillin

Gentamicin

Tazobactam

Meropenem

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?

CT

Blood culture

ECG

MRI

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?

Hepatorenal puch

Left paracolic gutter

Subphrenic

Pelvic cavity

Lesser sac

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?

Barrier

IUCD

POP

COCP

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?

GP

Pediatrician

Dietician

Clinical psychologist

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?

Citalopram

Lofepramine

CBT

Chlordiazepoxide

Desensitization

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?

Direct inguinal

Indirect inguinal

Femoral

Spigelian

Lumbar

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.

Pharyngeal pouch

Hiatus hernia

Bulbar palsy

Achalasia

TB

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?

Hypokalemia

Hypocalcemia

Hyperkalemia

Hyponatremia

Hypernatremia

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?

SAH

Brain tumor

Migraine

Cluster headache

Subdural headache

A 35yo man presented with hematuria, abdominal swelling and has a BP of 190/140. What is the most diagnostic inv?

ADPK

Cystoscopy

USG

CT

Renal biopsy

Urine analysis

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?

CT

MRI

IV fluids

Skull XR

Secure airway

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?

IVU

US Abdomen

Cystoscopy

Mid-stream urine for culture

Transrectal US

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?

Glaucoma

Cataract

Macular degeneration

Retinitis pigmentosa

Keratitis

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?

Second stage

First stage

Latent stage

Third stage

Active phase

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?

CT head

EEG

CBC

None

Skeletal survey

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?

Retained product

DIC

Fibroid uterus

Uterine infection

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?

Atonic uterus

Cervical/vaginal trauma

Retained product

Preterm labor

Uterine infection

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?

Oral diclofenac

Oral codeine

IM morphine

IM dihydrocodeine

Ondansetron oral

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

Myelofibroblasts

Plasma cells

Mature lymphocytes

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?

TOF

ASD

VSD

PDA

CoA

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

Barium meal

US

Colonoscopy

CT abdomen

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?

Losartan

Bendroflumethiazide

Ramipril

Bisoprolol

Verapamil

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?

Sciatic nerve

Gluteal nerve

Musculocutaneous nerve

Lateral peroneal nerve

Tibial nerve

Femoral 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

Gastroscopy

CT

MRI

A 15yo male has bilateral ankle edema. His BP=110/70mmHg and urinalysis shows protein++++. What is the most likely dx?

HUS

IgA nephropathy

Membranous GN

Minimal change GN

Nephrotic syndrome

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?

Oral chlorpheneraime

Oral amoxicillin

IM adrenaline

Nebulized salbutamol

Histamine



 

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