SELECTION EXAMINATION FOR MD IN GENERAL MEDICINE AND GERIATRIC MEDICINE

OCTOBER 2017 – SINGLE BEST RESPONSE

1. A Diabetic patient with ovarian CA presented to medical ward with abdominal pain, cramps and
diarrhoea after 3rd cycle of chemotherapy. On admission BP 80/50mmHg and lungs were clear. What is
the correct statement?

1. DKA is the most probable diagnosis.

2. IV Clarithromycin & IV Co-amoxiclave should be given empherically.

3. If NS fluid boluses are failed inotropes should be started.

2. 27 yr old boy presented with cough and minimal sputum and fever for 3d. on ex scattered crepts and
rhonchi. Chest x-ray showed bat’s wing appearance. His saturation on admission 96% at rest & reduced
to 92% after 10 min walk. WBC 1.0×103.

What is the useful treatment for him?

1. Cotrimoxazole
2. Clarithromycin + coamoxiclav
3. CPAP
4. Nebulization with salbutamol
5. ART
6. Hydrocortisone

3. A 45 yr old male patient admitted withjoundice abdominal pain and abdominal distention. Ex- ascites
Ix- hypoalbuminamia CT confirms hepatocellular carcinoma. What is the best management?

1. Chemoembolization

2. Liver transplantation

3. Surgical resection

4. chemotheraphy

5. Radiofrequency abalation

4. 17 yr old girl presented with B/L lower limb weakness and reduced UOP. Her ABG as follows.

pH 7.3 bicarbonate 33 potassium 2.8 Mg2+ 0.6 (0.9-1.5) BP 80/50mmHg

What is the probable diagnosis?

 1. Barter’s syndrome
2. Conns syndrome
3. Liddle syndrome
4. Hypokalaemic periodic paralysis
5. Guillain barre syndrome

5. Known patient with ulcerative colitis presented with severe ulcerative colitis presented with bloddy
diarrhoea-10stool/day. PR-108/min, Temp-380CWhat is the best treatment?

a. Azathioprine
b. Prednisolone 40 mg oral
c. Rituximab
d. Antibiotics
e. IV hydrocortisone 100mg 6hly

7. Patient with NASH, BMI-34. What is the most important initial management to reverse long
standing histology?

a. Weight reduction
b. Vitamin E
c. Metformin
d. Smoking cessation
e. Stop alcohol

8. 63 yr old lady with DM & HT presented with paroxysmal atrial fibrillation. She also complained
recurrent palpitation which settled spontaneously. She also had hx of TIA 1 yr back. What would be
the best option for her?

a. Enoxaparin
b. Start Warfarin
c. Lifelong aspirin
d. Clopidogrel + aspirin
e. Watchful waiting

9. A known patient with hypertension , IHD, heart failure(EF-35%) patient presented with SOB and
ankle odema for several days. On Ex BP-130/80mmhg and bi basal crepts. What combination is best
for her?

a. Hydralazine+ nitrate+ ramipril+ digoxin+ spironolactone

b. Frusemide + spironolactone+ ramipril+ digoxin
c. HCT + frusemide + ramipril + digoxin
 d. Frusemide + hydralazine+ramipril+nitrates
e. frusemide+ Asprin + ramipril + ISDN

10. A lady collapsed in the ward after 03 days following knee arthroplasty. 2D ECHO showed dilated
right ventricle. What is the best management?

a. IV Alteplase via IJV vascath

b. IV NS
c. Blood transfusion
d. Filter for left ventricle
e. Filter for IVC

11. A 19 yr old girl presented to medical ward with fever for 3 d. She also had diarrhoea and vomiting.
She also complained mennorhogea lethargy & severe postural giddiness. Her UOP was nil for 6H.
On examination she has cold clammy skin and reduced air entry in right side lung. BP-90/60 lying
and 70/50 standing, PR-122/min, Her WBC-1800, PLT-100000, PCV 58% and Hb 16.7 g/dl. What is
the next step of management?

a. IV Dextran
b. IV Normal saline
c. Blood transfusion
d. Platelet transfusion
e. IV KCl

12. A 30 yr old gentleman presented to medical clinic with high blood pressure, SOB, palpitation severe
flushing diarrhoea & vomiting. Symptoms worsen after ingestion of alcohol and caffeinated drinks.
On examination there is a palpable mass over lumbar region. His CXR showed left apical shadow.
What is the best investigation for diagnose his condition?

a. MRI adrenals
b. CT abdomen
c. CEA
d. Urinary catecholamines
e. 5-HIAA

13. 63 yr old lady presented with back pain for 4 months. She also has constipation polyuria & weight
loss for 2months. In FBC anemia thrombocytopenia and leucopenia, high ESR , high serum calcium
level, high serum creatinine and proteinuria. What is the most possible diagnosis?
 a. Multiple myeloma
b. Non Hodgkin Lymphoma
c. Hyperparathyroidism
d. Sarcoidosis
e. Lung carcinoma
f. TB

14. 19yr old boy presented with macroscopic haematuria and proteinuria three days following
sorethroat. His Serum creatinine is normal. UFR- RBC-+++. UOP was normal. What is the diagnosis?

a. IgA nephropathy
b. PSGN
c. Good Pasteur’s syndrome
d. SLE
e. Wegener’s granulomatosis

15. A 45 yr old labourer who is alcoholic presented with restless behaviour, confusion and tremors of
the hands for 01 day. He has ingested 01 bottle of whisky 03 days back. What is the management
of him?

a. IV Thiamine
b. IV 5% dextrose
c. IV Normal saline
d. IV Metronidazole
e. IM Haloperidol

16. 70 yr old gentleman presented with L/S severe headache, weight loss, loss of appetite for 03
months. His fundoscopic examination was normal. His CT and CSF were also normal. ESR is
108mm/hr. What is the most likely diagnosis?

a. Migraine
b. Cranial Vasculitis
c. TB meningitis
d. Tension headache
e. Raised intracranial pressure
f. Central retinal artery occution

17. Patient presented with Bell’s palsy. What is the following statement is true?
 a. Ipsilateral facial muscle weakness with sparing frontalis
b. Ipsilateral loss of taste of anterior 2/3 of the tongue
c. ptosis
d. Loss of ipsilateral sweating of the face
e. Unilateral hearing loss

18. 50 yr old patient presented withsevere headach. Ct confirms the diagnosis of posterior
communicating artery aneurysm. Appropriate management is,

a. Craniotomy+ Aneurysm clipping

b. Endovascular coiling
c. FFP
d. IV Dexamethasone
e. Conservative management

19. A 68 yr old patient presented with left side weakness after 8h of onst. NCCT brain – no
haemorrhage. on admission her BP = 180/100mmHg. What is the correct management option?

a. Aggressive blood pressure control to prevent further progression

b. Asprin should not be started up to 02 weeks
c. Thrombolysis
d. Tight glycemic control
e. Start ACEI

20. A known patient with depression presented to the medical ward 6hrs following TCA overdose. On
examination he is drowsy. His GCS 12/15 and ABG - metabolic acidosis. What is the immediate
management step?

a. Activated charcoal
b. IV NaHCO3
c. Gastric lavage
d. Ventilation
e. HD

21. A chronic smoker presented to the medical clinic with difficult to getting up from scotting position
and absent reflexes. Weakness improved with repeated stimulation. Chest X ray shows L/S upper
zone lesion. What is the probable diagnosis?

a. LEMS
b. Myasthenia Gravis
c. L/S CVA
 d. Mononeuritis Multiplex
e. Polymyositis

22. A 30 yr old lady presented with giddiness and headache. She also had galactorrhoea and
amenorrhoea . Her serum prolactin level is 1500 (<500) LH &FSH are low , FBS =65mg/dl, Na=-135,
K=-6.8
What is the most probable diagnosis?

a. Prolactin secreting micro adenoma of pituitary

b. Prolactin secreting macro adenoma of pituitary
c. Non-functioning macroadenoma of the pituitary
d. Cortisol secreting pituitary tumor
e. Empty sella syndrome

23. A 56 yr old lady who is on warfarin for prosthetic mitral valve came with PT/ INR =7.3.
She has no bleeding manifestations. What is the management of her?

a. Stop warfarin and R/V with INR

b. Give protamine
c. Give FFP
d. Give IV Vitamin K
e. Half the dose of warfarin

24. 25 years old female with recurrent unilateral visual loss presented to OPD with right face arm leg
weekness. Later MRI scan was done and confirmed multiple scelerosis. Which of the following
treatment will be disease modifying?

a. plasmaparesis
b. IV Immunoglobulin
c. Interferone 1-Beta
d. AZT
e. Corticosteroids

25. 65 yr old lady found to be unconscious bought to the OPD. At OPD she developed seizures which
settled spontaneously. He is a smoker for 20 yrs. ….(SIADH Hx). His Na+ 103, K= 3.5, S.Cr-Normal.
What is the immediate management?
a. Democlocyclin
b. Fluid restriction
c. Hypertonic Saline
d. IV Diazepam
e. IV phenytoin
26. Patient presented with SOB found to have R/S pleural effusion. Pleural fluid aspiration was
haemorrhagic but there were no malignant cells. His CT shows peripheral lung lesion. What is the
next important step in his management?

a. Throcoscopy & Bx
b. CT guides Bx
c. Bronchoscopy & Bx
d. IC tube insertion
e. Watchful waiting

27. 45 yr old female with the past Hx of moderate MS= mild MR admitted with SOB. On ex she had bi
basal crepts. Ecg-Paroximal AF. On admission HR-138/min and reverted to sinus rhythum with the
HR of 98. What is the most appropriate treatment?

a. Warfarin +atenolol +Furusimide

b. Warfarin +digoxin +Furusimide
c. Digoxin +Furusimide +HCT
d. Enalapril +Furusimide +losartan +atenolol
e.

28. Drug which doesn’t reduce potassium?

a. Calcium gluconate
b. Insulin+ Dextose
c. Salbutamol nebulization
d. Dialysis
e. Resin

29. 26 yr old male underwent parathyroid surgery for parathyroid hyperplasia. During surgery his BP
190/110. His father also had surgery for hyperparathyroidism. What is the most appropriate cause
for his high BP during surgery?
a. Hypercalcemia
b. Pheachromocytoma

30. Sings of Ulnar nerve compression at elbow

All the Best from Registrars 2017 Oct