Documenti di Didattica
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Documenti di Cultura
2 celiac disease-
37 year old woman presents with intermittent episodes of abdominal bloating, abd pain and diarrhea for
several years. She denies any weight loss and all other general physical examination is normal. But she
states that abdominal pain worsens with wheat and eggs. What is the most likely diagnosis?
a. IBS
b. IBD
c. Coeliac disease
4 brucellosis
A man travels from a farm in South America to UK, and presents with lymphadenopathy, night sweats,
fever and splenomegaly. What is the likely diagnosis?
a. Brucellosis
b. TB
c. Lymphoma
d. Coccidiosis
5 observe in surgery
A 8 year old boy falls from his bike hitting his abdomen against the handle. He develops a subcapsular
hematoma as seen on CT. Vital signs are stable. What is the next best management for this?
a. Observe in surgery
b. Reassure
c. Take to the theatre
6 Asperger syndrome
A guy who does satisfactorily computer work in office and has satisfactory grade, but doesnt have
friends and dont make eye contact. He is also awkward on non-verbal conversation..whats the dx?
a. Asperger syndrome
b. Anti-social personality disorder
c. Bipolar disorder
d. Tourette syndrome
7 neglect
A 4 year old admitted with Chest infection weight 8kg (that was below third centile). He gained weight 1
kg in hospital. Then was admitted again with impetigo, weight again reverted to previous weight (loss of
1 kg). This increase and decrease in 1kg occurred yet again after 1 month. What is the most likely
diagnosis?
A) Cystic Fibrosis
B) Celiac
C ) Neglect
D) DM
8 sertaline
A patient with depression, post-MI
9 fluid overload
A patient was given IV fluids and now has the following serum electrolytes value
NA- low
K- normal
cl- normal
What is the likely cause?
10 hyperaldosteronism
11 CTPA
A 3 days post-op patient develops sudden RT chest pain, and breathlessness. What is the investigation of
choice?
12 PTSD
A man who was attacked at a bus station now fears to go out. What is he likely suffering from?
a. GAD
b. PTSD
c. Panic attack
13 paralytic ileus-
A 70yo man had a right hemicolectomy for ceacal carcinoma 6days ago. He now has abdominal
distension and recurrent vomiting. He has not opened his bowels since surgery. There are no
bowel sounds. Temp=37.3C. What is the likely cause of this?
a. anastomotic leak
b. paralytic ileus
14 IV naloxone -
Woman who just had cholestectomy now on opioid Analgesia. Suddenly develops miosis, RR= 6cpm,
reduced chest movements. What is the next best management?
a. IV naloxone
b. Intubate and ventilate
c. CT chest
16 phosphate enema
An 83yo woman who is a resident in a nursing home is admitted to hospital with a 4d hx of
diarrhoea. She has had no weight loss or change in appetite. She has been on analgesics for 3wks
for her back pain. She is in obvious discomfort. On rectal exam: fecal impaction. What is the
single most appropriate immediate management?
a. Codeine phosphate for pain relief
b. High fiber diet
c. Oral laxative
d. Phosphate enema
e. Urinary catheterization
17 pulmonary embolism
A patient who had hip replacement surgery develops sudden breathlessness and chest pain, hemoptysis.
What is the likely diagnosis?
a. Pulmonary embolism
b. Fat embolism
c. DVT
18 CTPA
An immobile patient who had calf tenderness suddenly develops breathlessness, chest pain and
hyperpyrexia. What is the investigation to diagnosis this condition?
a. D-dimer
b. V/Q scan
c. MRI chest
d. CTPA
e. CxR
20 pericarditis
22 vasovagal syncope
A young girl suddenly loses consciousness especially whenever she is asked to make a presentation at
school. What is the likely cause of her syncopal attacks?
a. Vasovagal syncope
b. Long QT syndrome
c
23 siadh
24 Hyponatremia
Man, chronic smoker. Then there's postural drop in BP. Sitting 140/80, lying 110/70. I think, they asked
for electrolyte Imbalance.
a. Hyponatremia
b. Hyperkalemia
25 mirena
26
Woman with mixed (submucous and subserous) fibroids wants contraceptive. which will you give?
a. COCP
b. IUS
c. Implanon
d. Depo
27 laparoscopy
Lady with dysmenorrhea and dysmenorrhagia, has primary infertility for 1 year, Abd uss was normal,
what inv is next?
a. Laparoscopy
b. Laparotomy
c. Hysteroscopy
d. Endometrial biopsy
29 Lymphedema-
A woman who has had mastectomy for breast cancer with some axillary clearance was bitten by an insect
in her RT forearm. The whole limb swells up. What could be the cause of this swelling?
a. cellulitis
b. lymphedema
c.
30 NAI
A 4 month old child weighs 4.1kg. She presents with multiple bruises on her left and right lower leg. Her
left ankle is swollen and she appears irritable. She also has a runny nose. What is the most likely
diagnosis?
a. Hemophilia
b. Thrombocytopenia
c. Non accidental injury
31 NAC
A 22 year old woman is brought in unconscious, said to have ingested 25 tables of PCM 6 hours ago.
What is the next best management?
a. Activated charcoal
b. NAC
c. Serum PCM levels
d. LFTs
32 erythropoietin
A man who smokes presents with fatigue, dizziness and shortness of breath. HCT = 54%, Hb= 178g/dl.
What hormone is most likely responsible for this?
a. Renin
b. Erythropoietin
c. Thyroxin
33 staph aureus
A lactating mother with abscess around the nipple. What is the causative organism?
a. E. coli
b. Staph aureus
c. Streptococcus
d. pneumococcus
35 blood transfusion
A patient presents with Hb = 60g/dl, what is the next step in management?
a. Blood transfusion
b. IV fluids
c. Iron tablets
d. Folic acid
36 anemia of chronic disease
A woman with RA for 30 years presents with tiredness, fatigue, and FBC shows HB (low), MCV (low)
microcytic red cells. She has not being on any medications of recent. No other hx of note. What is the
likely cause of her anemia?
a. Anemia of chronic disease
b. dietary deficiency of iron
c. GI bleeding
38 citalopram
A man who just got married within a year now develops symptoms of anhedonia, sleep disturbance, loss
of interest in sex. What is the treatment? [Moderate depression]
CBT
ECT
citalopram
Olanzapine
39 ABCD2
A patient with TIA and BP= 140/80. What is the best scoring method to assess his risk of future stroke?
a. ABCD2
b. FAST
c. CHADS2
d. Wells score
e. ROCKALL
40 ssri
41 carbamazapine level
A woman with pain on the face has been on medications, and now presents with symptoms of overdose-
horizontal nystagmus, ataxia. What drug level will you check?
Lithium level
Carbamazepine level
Aspirin level
Haloperidol level
42 carbamazapine (anticonvulsant)
Woman with pain in the lower part of her mandible, which drug class will you treat her with?
a. Anticonvulsants
b. Antipsychotics
c. Tricyclic Antidepressants
d. NSAIDS
43 Amitriptyline +/ gabapentin
44 Biliary atresia
A 6-weeks old neonate not breastfed, who suddenly develops jaundice, hepatomegaly, poor weight gain
and pale stools. What is the likely diagnosis?
a. G6PD deficiency
b. Galactosemia
c. Biliary atresia
46 Ulnar nerve
Nerve affectation at the elbow affecting the medial side of the forearm and little and ring fingers,
hypothenar eminence. Which nerve?
a. Ulnar
b. Radial
c. Median
47 emollients- A child has flexural rash in the wrist, neck and elbow. No history of asthma, eczema or hay
fever. What will you give as treatment?
52 bulimia nervosa
A 26 year old woman with BMI=21 who binges on food and then vomits it afterwards because she
believes she is overweight.
a. Bulimia nervosa
b. Anorexia nervosa
c. OCD
55 l5/s1 lesion
Patient with loss of sensation in the medial leg and foot. Which nerve root is involved?
a. L5/S1
b. L1-L2
c. L3/4
d. S2
57 bppv
A 25yo woman complains of dizziness, nausea, vomiting, visual disturbances and anxiety which keep
coming from time to time. Most of the attacks are with sudden change in posture. What is the most likely
dx?
a. Panic disorder
b. Postural hypotension
c. BPPV
d. Vestibular neuritis
59 Dix Hallpike
A 43year old woman presents with severe vertigo on moving her head from side to side whilst sleeping,
and on rising up. What test would you do to confirm the dx?
a. Dix-Hallpike maneuver
b. Rombergs test
c. Trendelenburg test
60 laryngeal candida
A 10yo girl presents with hoarseness of the voice. She is a known case of bronchial asthma and has been
on inhaled steroids for a while. What is the most likely cause of hoarseness?
a. Laryngeal candidiasis
b. Infective tonsillitis
c. Laryngeal edema
d. Allergic drug reaction
e. Ludwigs angina
61 Achilles tendon
A man suddenly feels pain at his Rt ankle joint while undergoing his usual activity, there is a swelling at
the back of his leg. However, he can plantar flex and still bear weight on the foot. What structure is likely
affected?
a. Calcaneofibuar ligament
b. Achilles tendon
c. posterior Tibialis tendon
d. posterior Talofibular ligament
62 closed reduction
Pt with fracture of distal radius ... dorsal angulation >10 degrees . No neurovascular compromise. What is
the appropriate treatment ?
a. arm slab
b. close reduction
c. ORIF
67 campylobacter
A patient who just arrived from travelling now presents with bloody diarrhea, what is the most likely
cause?
a. E coli
b. Giardiasis
c. Campylobacter
69 stress reaction-
A woman who had hyperglycermia post-surgical procedure which resolved/normalized when the blood
sugar was rechecked 1 week after the procedure. What happened?
a. Type 1 DM
b. Type 2 DM
c. Stress reaction
70 syphilis antenatal-
A pregnant woman has had routine antenatal check for Hep and HIV. What other test is routinely
mandatory?
a. Toxoplasmosis
b. CMV
c. Syphilis
d. Rubella
e. Varicella
71 RT Abducent nerve
Patient with diplopia and pain on looking to the right. Which nerve is affected?
a. Rt abducens
b. Lt abducens
c Rt oculomotor
d. Lt oculomotor
73 submandibular calculi
A 35yo man has had acute pain and swelling below the mandible on the left side for 2h. The
swelling occurred after eating a large meal. What is the single most likely dx?
a. Ranula
b. Neck abscess
c. Parotid calculus
d. Submandibular calculus
74 cystoscopy
A 67 year old man with hematuria and proteinuria, frequency, incontinence, what investigation is next
most appropriate?
a. IVU
b. Cystoscopy
c. Abd USS+ KUB
d. Renal biopsy
75 HUS
A girl had diarrhoea, fever with reduced platelets, anemia and then petechial rash about 5 days after. What
is the diagnosis?
a. Hemolytic uremic syndrome
b. HSP
c. Hemophilia
77 inform family and seek help (rx refused) - - - respect his wishes, he showed competence.
79 minimal conscious
Patient with GCS 6 and only responds to painful stimulus. What is the condition?
a. minimally conscious state
b. coma
c. vegetative state
d. locked-in syndrome
80 gastroscopy
54 year old man with dyspepsia and nausea, has features of GI bleeding. What is the next investigation?
a. Gastroscopy
b. Hydrogen breath test
c. Fecal H. pylori test
d. Abd uss
81
32 year old sexually active man with recurring pain in the scrotum that suddenly became severe. On
examination, the RT testis is swollen, higher than the left, and tender. What will you do?
a. give antibiotics
b. reassure
c. Refer to surgical unit
d. Urgent USS
e. give analgesia
83 hyperaldosteronism primary
84 cholangitis
40 year old woman with 2 children presents with jaundice and intermittent RUQ abd pain, passage of dark
urine. What is the likely diagnosis?
a. Ca head of pancreas
b. Hepatitis
c. Biliary colic
d.Acute Cholangitis
86 IV Adenosine
A man who collapsed but now conscious presents with hx of palpitations and chest pain, BP- was normal,
Pulse- 100bpm (normal). What drug will you give him?
a. Synchronous cardioversion
b. IV amiodarone
c. Iv adenosine
d. Beta blocker
e. Digoxin
88 0.9% saline
Hyperemesis gravidarum patientchoice of fluid?
a. Dextrose saline
b. 0.9% N/S
c. No fluid
90 0.45% and dextrose + 20mmol potassium [You add K if value of serum potassium is normal or low.
You dont add K, only if hyperkaelemic.]
Vomiting Child (of about 3 days) needing fluid resuscitation (for moderate dehydration). K= 2.8mmol/L
a. 0.18% N/S with dextrose, no additives
b. 0.18% with dextrose + 20mmol K
c. 0.45% N/S + 5% dextrose, no additives
d. 0.45% N/S + 5% dextrose + 20mmol K
93 ca prostate
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. BPH
b. Prostate carcinoma
c. Chronic pyelonephritis
d. Benign nephrosclerosis
94 ca caecum
Patient with RT iliac fossa mass, weight loss, anemia. What is likely diagnosis?
a. Crohn's
b. CA caecum
c. Ileocecal TB
d. Appendiceal mass
96 schizophrenia
97 mood stabilizers
A man with depression last year, now has sexual disinhibition, excessive spending. Has been on
medications previously. What drug class will you give to maintain his treatment?
a. Mood stabilizers
b. Antipsychotics
c. Antidepressants
d. Anticonvulsants
101 ssri
102 cbt [OCD]
A middle-aged man washes his hand over and over everyday, and is bothered about minute details. Also
has family hx of such. What treatment will you offer him?
a. CBT
b. Olanzapine
c. ECT
103 gardenella
Female with malodorous clear vaginal discharge. pH>4.5. what is the likely causative organism?
Candida
Gardnella
Trichomonas vaginalis
104 CLL
A 65 year old Woman with weight loss, lymphadenopathy and splenomegaly, with blood film showing
mature lymphocytes. What is the diagnosis?
a. CML
b. CLL
c. ALL
d. AML
106 bone marrow biopsy [Visceral leishmaniasis- Low P r/o splenic biopsy.]
A man has just returned from South Africa. Has Hb- low
PT- low
WBC- low
Has splenomegaly and hepatomegaly. He is also bleeding per rectum.
What inv will you do?
a. Bone marrow aspiration
b. Rectal biopsy
c. Splenic biopsy
d. Lymph node biopsy
e. Liver biopsy
107 Haemochromatosis
A 38yo man has had a liver biopsy as part of inv for abnormal LFTs. The pathologist report states:
special stains demonstrate the presence of a very large amount of iron pigment within the
hepatocytes. What single condition is identified by the pathologists report?
a. Alpha 1 antitrypsin deficiency
b. Hemangioma
c. Hemochromatosis
d. Hemosiderosis
e. Wilsons disease
108 Cataract
Woman with gradual reduction in vision of her RT eye over 10 years which was not improved by wearing
glasses. Now has V/A 6/18 in LT eye and hand movements in the RT. What is the diagnosis?
a. Glaucoma
b. Cataract
c. CRVO
d. Retinal detachment
e. Macular degeneration
110 Lymphoma
A 26 year old man travelled from New York to the U.K on business. He had night sweats, T= 37.5C,
cervical lymphadenopathy for 3 weeks. Also had splenomegaly, What is the most likely diagnosis?
Tuberculosis
Lymphoma
Bronchial CA
Bronchitis
113 ITP
116 Change OHA to insulin before surgery?? [Endoscopy, particularly GI endoscopy, requires GI prep.]
A patient with DM is controlled on Gliclazide. He will undergo elective endoscopy. What should be
done regarding diabetic management?
a. Stop oral hypoglycemic drug night before
b. Give insulin, glucose and potassium during procedure
c. change OHA to insulin before the procedure
d. Reduce dose of OHA before the procedure
119 vitamin b complex??? [Arguably the most difficult Q for the day]
An alcoholic man who took a lot of alcohol started hearing voices which were disturbing to him. The
voices have however reduced over the last two weeks since he stopped taking alcohol but have not
disappeared. He comes to you for advice on what to do. He does not want a drug with unpleasant side
effects. What drug will you give him?
a. Acamprosate
b. Disulfiram
c. Chlordiazepoxide
d. Olanzapine
e. Vitamin B complex
120 chlordiazepoxide
123 delay speech milestone Normal [the second Q on developmental milestone too was normal!]
A 14 month old child who walks with support, transfers object from hand to hand, but only babbles. What
is the diagnosis?
a. Normal
b. Delayed speech milestone
c. Delayed Fine motor
d. Delayed Gross motor
126 ssri
A patient with moderate depression symptoms, what will you give to treat?
a. SNRI
b. SSRI
c. TCA
d. ECT
129 fibrinogen-
Pregnant female bleeding continuously pv...what investigation will you do?
A. HCT
B. FBC
C. Fibrinogen levels
D. Chest x-ray
132 ARF/AKI
A girl who had diarrhoea sometimes back, and E coli 0157 was cultured, now presents with raised
creatinine and urea, hematuria and proteinuria. What is happening?
a. AKI
b. Acute Tubular necrosis
134 Picture of lower RT leg and foot with multiple macular erythematous rashes
a. plantar erythema
b. petechial rash
c. lipodermatosclerosis
d. telangiectasia
141 Cushings
Lady with 10 months amenorrhea, hypokaelemia, BMI- 32
PCOS
Cushings
Primary Hyperaldosteronism
Pheochromocytoma
142 NAI
A 76 year old man with dementia who is brought to the ED by his daughter with bruises on his body. No
history of falls. What is the most likely cause of this?
a. SAH
b. NAI
c. Alcohol
d. Stroke
143 CRVO
A woman with sudden loss of vision in her eye. V/A RT eye was 6/36, LT V/A 6/18, no papilledema, but
flame hemorrhages seen in one of the eye. what is the likely diagnosis?
a. Macular degeneration
b. CRVO
c. Diabetic retinopathy
d. CRAO
e. Vitreous hemorrhage
145 child with wheeze, family history of hay fever, diagnostic test Spirometry
151 Sudden headache in a woman, smoker with history of migraine, CT-normal, neurological signs are
normal. What is the next step?
a. Reassure/ do nothing
b. Lumbar puncture
c. MRI
152 Patient with abd pain of sudden onset dies. Autopsy reveals ruptured abd aneurysm, what is the
pathophysiology resulting in this? Atheroma
a. Atheroma
b. Aortic coarctation
c. Dissecting aneurysm
156 Broncholitis
6 month old child with wheeze, intercostal recession
a. bronchiolitis
b. pulmonary dysplasia
159 50 year old, had sore throats for 4 weeks, was given antibiotics- Amoxyl 2 weeks ago and now has a
Unilateral exudating enlarged tonsil
a. squamous cell Ca
b. infectious mononucleosis
160 Calcaneus
A man falls from a height of 8m and lands on his heel with a fracture. What bone is likely to have been
fractured?
a. Talus
b. Calcaneus
c. Navicular
d. Fibular
162 HIV pt with cough, CD4+ =50/mm3, PCP has been ruled out. What drugs should be given?
a. Isoniacid + Rifampicin
b. Amoxyl
c. Steroid
d. Gancyclovir
163 young pt with high BP, haematuria INITIAL investigation (possible APKD)
a. Renal USS
b. Renal biopsy
c. CT abd
d. Mid stream-Urine MCS
169 FSH
Investigation for patient with Azoospermia.
a. Testosterone
b. FSH
c. Estrogen
d. Prolactin
170 Reassure
8 year old girl, with recurrent abdominal pain, everything else is normal
a. reassure
b. Abd uss
c. CT abd
d. urinalysis
172. Interosseous-
After failed attempts at iv assess in a child with severe dehydration, what is the preferred route?
a. Saphenous cut down
b. Interosseous
c. Central line
175 Gastroscopy
A 56 year old man presents with progressive dysphagia to solids, weight loss, and anemia. Which is the
most diagnostic investigation?
a. Esophageal manometry
b. Barium meal
c. gastroscopy
177
A 6 year old child who attends a school is diagnosed with meningococcal meningitis. Who else should
receive rifampicin prophylaxis?
a. Family members and those who came in contact with pt
b. The whole school
c. Nobody
d. All classmates
178 IV Ca gluconate
A patient with multiple pathologies- MI, hypertention, etc, also presents with bradycardia (PR= 40/min),
K= 7.2mmol/L, Ca= low. What is the next step in management?
a. IV Ca gluconate
b. IV Atropine
c. antihypertensives
179 Implanon
Sexually active woman who uses barrier contraceptive (condoms) but does not remember to take pills.
Smokes and has menorrhagia. Now needs contraception for at least 3 years, what is the best contraceptive
for her?
a. COCP
b. Tranexamic acid
c. POP
d. Implanon
e. Diaphragm
181
Patient with jaundice who had test showing IgG hep A is positive...Which other test will be appropriate to
do?
a. Hep A IgM
b. Hep B surface antigen
c. Hep B core antibody
183 Brochiectasis
A 56 year old man with purulent sputum and symptoms of cough and breathlessness, occasional streaks
of blood in his sputum. What is the most likely diagnosis?
a. Bronchitis
b. Bronchiectasis
c. Pneumonia
d. TB
184 Magnesium-
A 17 year old boy suffering an acute exacerbation of asthma has been given nebulized salbutamol and
ipratropium with little improvement. He has also been given 30mg of prednisolone. Which drug will you
add to improve his symptoms?
a. IV hydrocortisone
b. Magnesium
c. Oxygen
185 Methadone-
Patient with cocaine and heroin addiction seeking management for withdrawal symptoms, best drug for
reversal?
a. Naloxone
b. Methadone
c. SSRI
187 SP [Ideally should be Trimethoprim/Septrin, or Pentamidine- but Fansidar can also be used!]
Immunocompromised patient with PCP. What is the treatment of choice?
Sulfadoxine + Pyrimethamine
Steroids
Amphotericin B
Amoxycillin
190 PDA
Machinery murmur in a premature neonate that closed soon after birth.
a. VSD
b. ASD
c. PDA
d. TOF