IMM – February 2018 – third shift

Cardiology  Pulled stenosis

 MS
1. A young patient with presents with palpitations. ECG  HOCM
showed narrow complex tachycardia. Rx? iv  AR
adenosine  Aortic sclerosis
2. A pregnant lady, has blood pressure 150/90. Which drug 12. Pt with pleuritic chest pain and fever. Heart sounds
can not be given to her  enalapril were distant. Radiology showed enlarged heart
silloutte.
3. Diabetic patient develops HTN, and symptoms of
Next test?
intermittent claudication. Drug to be given ACE
A. Echo
inhibitors or calcium channel blockers
b.ct
4. A 35 yr old woman having syncopal attack. Ejection sys
13. NSTEMI scenario rx  iv heparin + beta blocker +
murmur n echo showed interventricular septum 3.5cm
aspirin
(thickened) or something. Best tx for her?
1. Icd
2. Beta blockers
14. Patient with st elevation inferior wall mi ...thrombolysis
5. Patient complains of dyspnea, ef 47% - diagnosis  was given...after 2hours patient still complaining of
systolic dysfunction severe chest pain ...ecg ST elevation. What is next
best appropriate management for this patient
6. Patient with a – fib , calculate chad2vasc score and tell
treatment? Warfarin
 Rescue pci
7. A man with typical chest pain came to hosp duration 2
hrs. What tests can be done after this 2 hr period that
will help in dx. 15. Pt complains of headache .bp 230/130. Papilledema.
1. Cardiac enzymes chest clear. Next step in rx?
2. Echo A. Iv nitroprusside
3. Ecg
4. Trop t

8. Htn patient started on some antihypertensive drug have 16. Dose of adrenaline in cpr??  1mg every 3 min
low sodium. Likely drug causing hyponatremia 
hydrochlorthiazide

17. Patient presents with recurrent lightheadedness. chest

x-ray and ecg were normal ... Holter monitoring was
9. Pt presents with dyspnea,ECG shows AV dissociation advised what will likely show?
,bp 110/80,HR - 48
A. Svt or wencheback phenomena
 Serial ecg
 Electrophysiology
 Pacemaker
 Echo 18. A patient had asystole 4 mins before your arrival. CPR
 Holter was started before you. On arrival what will you do?
Answer: Iv adrenaline 1mg
10. Bp in upper right arm 150/90 and left leg is 80/40 with
pan systolic murmur best heard at the back of the
chest.
19. Young boy presents with ECG that shows Rbbb and
1. Coarctation of aorta
some ectopics. What disease is he suffering from 
2. Pda
RV arrhythmogenic cardiomyopathy
11. A young male presents with jerky pulse large a wave
JVP ejection systolic in left sternal base pan systolic
apex. likely disease in this patient is?

Dr Abdul Bari Babar

IMM – February 2018 – third shift
20. One strong pulse alternate with one weak pulse in
patient with dyspnea. ECG showed normal rhythm 
pulsus alternans
21. Scenario of rheumatic fever  ASO titer
22. Scenario of rheumatic fever. A skin rash appears on
back that has elevated erythematous margins with
clear center  Erythema marginatum
23. Pregnant lady, severe symptomatic ms valvue area
<1cm2, pressure gradient >15mmhg  rx 
valvulotomy vs PBMC
24. Laborer presented with sudden onset of severe chest
pain, diaphoresis + cold extremities. Likely diagnosis
 MI
25. Young female died after a week of flu like illness.
Autopsy showed large dilated heart. What is the cause
of her disease and death  coxasake virus b
26. Operated for ASD , now presents with fever, eye
examination revealed hemorrhages in retina, 
infective endocarditis
27. Main LAD 50%, RCA 70% stenosed, moderately
severe symptomatic Aortic stenosis. Surgery of choice
in this patient
 Cabg +avr
 CABG
 AVR
28. Patient with fever cough and sharp intermittent chest
pain. Likely diagnosis is:
A. Costochondritis
b. Mi
c. Pulmonary infarction
d. Acute pericarditis
29. Scenario of hocm  SAM (systolic anterior motion)
on echo
30. Patient had all risk factors for atherosclerosis.came
with dysnea.workup done showed EF 20% with
enlarged heart and global hypokinesia. what
investigation should be carried out now  coronary
angiography
(explanation  patient is likely suffering from ischemic
heart disease, that has lead to heart failure. Angiography
will rule out dilated cardiomyopathy, in which case,
Dr Abdul Bari Babar
coronaries would be normal and will give chance to
improve myocardial blood supply)
31. Patient c.o chest pain. Bp 80/40. ECG v -tach. Rx of
choice  cardioversion
Rheumatology
32. Severe headache, in right side of temple. On
examination artery is hard palpable with scalp
tenderness
Ans high dose steroid plus temporal artery biopsy
33. K/c rheumatoid arthritis, now unable to walk, comb hair
or rise from chair, o/e plantars are upgoing  inv
MRI cervical spine
Explanation : likely cause in quest 33 is cervical
myelopathy
34. Urinary hesitancy now presented with backache 
MRI spine
35. K/c rheumatoid arthritis on dmards, now presented with
abnormal lfts. Drug that affect liver is 
methotrexate
36. Patient complains of red eye, burning sensation, x ray
b/l lymphadenopathy, skin rash. Diagnosis 
sarcoidosis
37. Fever + arthritis + pleuritis + abdominal pain 
familial medeternian fever
38. Patient e chronic Rheumatoid arthritis now develops
peri-orbital edema. Most likely the Cause of this
nephrotic syndrome  secondary amyloidosis
Nephrology
39. Cause of anemia in ckd  erythropoietin deficiency
40. Young female, renal artery stenosis is thought to be
cause of htn. What finding is expected on
ctangiography ?
Ans – fibromusuclar dysplasia
41. Scenario of css syndrome patient who developed ckd.
What bone complication is likely to occur 
osteitis fibrosa cystica
42. Pt with low sodium 132 k 6.5 ,drug responsible
amiloride
loop diuretics
IMM – February 2018 – third shift
thiazide
ace
43. Pt had deafness nd hematuria.
Test to do?
A. Renal bx.
44. Ckd patient needs tooth extraction. How to stop
bleeding if desmopressin is unavailable 
conjugated estrogen
45. Flank pain and hematuria..xray normal..us showed
dialted pelvi calyceal system and multiple shadows.
Dx. A) Urate stones
b.cystine stone’
46. Serum sodium 124 meq/l, rbs 700mg/dl. Calculate
corrected sodium for this patient  corrected sodium
134
47. Patient with left flank pain with hematuria
a. Kub
b. Ultrasound abdomen/pelvis
48. Bronchogenic carcinoma case  develops nephrotic
syndrome. Likely histologic GN would be: 
membranous nephropathy
49. In Ckd pt, cause of renal osteodystrophy?
Def of 1, 25 vit D ??
50. Scenario of hus
51. Regarding Pheochromocytoma:
24 hour urinary metanephrines should have been
checked first before operating
52. How to differentiate type 4renal tubular acidosis from
type 2 rta – ans serum potassium
53. Senario of SIADH
A. Urinary na 8
b. Urinary k >30
c. Urinary specific gravity 1005
d. Urinary osmolality >100 mosmol/kg
54. SLE patient developed carcinoma of bladder. Cause of
bladder cancer  cyclophosphamide
55. Sodium rich food??
 cereals
 cane of soup
56. Hyperkalemia scenario. ECG showed tall t wave. What
should be Rx  IV calcium gluconate
Dr Abdul Bari Babar
Pulmonology
57. Asthma patient, complain of severe dyspnea first step
 PEFR
 ABGS
58. Risk factor for emphysema ? Carbon or nicotine
59. Pt with fever n pleuritic cheat pain. Bronchial breathing
in right axilla. Prophylatic treatment must include
coverage for:
 pneumococcal
 staph
60. Tall, slim male developed sudden onset of chest pain
and dyspnea. Likely cause of features 
pneumothorax
61. Tall slim, chest pain and dyspnea, investigation that will
lead to diagnosis  chest x ray
62. A smoker died, his autopsy of bronchi showed
mucosal gland enlargement. Likely underlying
disease???
chronic bronchitis
63. Legionella patient cant take macrolide ?
Levofloxacin vs doxycycline
64. COPD pt having resp acidosis. What treatment would
be most effective
Ans.oxygen inhalation 2-3l/m
65. A presents with cough with bilateral pulmonary
infiltrates on CXR and later developed air fluid level
containing cavity in upper lobe. likely organism
involved ? staphylococcus aureus
66. Pt went to his village after a long time, there he
developed, shortness of breath, wheezing + labs
were leucocytosis with neutrophilia. Likely cause of his
symptoms
ans. Ext allergic alveolitis
Neurology
67. Drug that causes muscle weakness and pain 
simvastatin
68. Patient complains of double vision. One week back he
has history of eye trauma, o/e nasal boil, examination
revealed lateral rectus palsy, and 3rd nerve palsy.
Likely diagnosis would be  cavernous sinus
thrombosis
IMM – February 2018 – third shift

69. Muscle weakness scenario. Potassium 2.4 mmol/l- 82. Nursing home resident + falls + episodic confusion 
familial periodic paralysis subdural hematoma

70. Young lady, ask doctors to tell about medical cause of
fatigue  review her medical records as soon as
possible
71. Collapse after laugh day time sleep and vivid
dreams....
A) narcolepsy
b) absence seizure
72. Patient with features of muscle weakness. Test to
reach diagnosis 
muscle enzyme test
73. Parkinsonism patient with increasing dystonia and
labile blood pressure 
 replace metochloprmide
 treat as multiple system atrophy
74. Fear, gripping nearby objects - temporal lobe
epilepsy
75. Mental retardation + seizures + adenoma sebacicum –
tuberous sclerosis complex
76. An old man in nursing home with headache neck
stiffness fever. All signs of meningoencephalitis. Csf
showed sugar 3.5 mmol protein 0.8g/dl lymphos 70%
neutros 5% gram negative rods on gram stain. Serum
glucose 6mmol. What is the best tx? Apmicillin +
ceftriaxone
83. Lesion of ms will be visualized in ____ on MRI? 
white matter
84. Female 4 hr before she was fine now presented with
middle cerebral infarct on ct with focal deficit. Rx 
iv alteplase
85. Middle age female with lateral gaze palsy,headache
and diplopia,investigation of choice?
1.MRI brain
2.CSF
Exp: features are suggestive of benign intracranial
hypertension
86. A man thinks his wife is unfaithful For 20 years. He is
also a patient of depression for which he takes
fluoxetine. He has suicide potential. Likely diagnosis
is:
 Depression with psychotic features
 Delusional disorder
Infectious diseases
87. Drug that prevent transmission of HIV from mother to
fetus  zidovudine
88. Best test for Diagnosis of h - pylori – c urea breath
test

77. Diplopia, dyarthria. Likely cause is: 89. HSV  recurrent genital lesions
basilar artery infarction
90. Party dinner + patient presented after 24 hr with fever +
78. Pt having right side burning pain after stroke, which abdominal pain + diarrhea  salmonella
lobe involved
91. For prophylaxis of roommate of pt wd meningococal
 Frontal
meningitis
 Temporal
answer: rifampicin + meningococcal vaccine
 Thalamus
tetravalent
79. Patient having loss of vision with macular 92. Polymorphic erupted lesions on skin family history
sparing..Cause?? positive  scabies
Left sided occipital stroke
93. Commonest cause of PUO – TB
80. Common cause of sah
AV malformation 94. Alcoholic smoker presents with cough and sputum,
berry aneurysm hemoptysis weight loss cxr – reticulonodular
HTN shadow..his bronchoscopy and biopsy picture showed
epitheloid cells. What other cells are likely to be
81. Girl wd ascending weakness, power decreased, severe present ??  AFB
resp compromise, gbs. How to monitor her respiratory
function? 95. Man with fever and jaundice ,lfts shows hemolytic
Ans, fev1/ neg inspiratory pressure / vital capacity?? pictures. The likely diagnosis :
plasmodium faclparum

Dr Abdul Bari Babar

IMM – February 2018 – third shift
96. Soldier returning with 3 day history of fever.
Intercellular amoeboid like organism seen with blue
cytoplasm.
 Leishmania
 Trypanosomiasis
 Falciparum
 Babesiosis
97. High grad fever 102f,kernig positive. pulse 90bpm?
 Meningitis
 Malaria
 Enteric fever
98. Fever + maculopapular rash beginning at back of scalp.
Likely diagnostic organism  rubeolla
Expl: measles
Endocrine
99. HLA DR 5 + diffuse goiter  hashimoto’s thyroiditis
100. Obese DM hba1c 8.5  start metformin
101. Gold standard test for diagnosis of acromegaly
Glucose tolerance test – following GH measurement
102. 90kg female with amenorrhoea, hypertension and
hirsuitism  pcos / cushing syndrome
103. Post thyroidectomy, a patient develops tingling and
twitching. What next best management step should be
taken  check ionized calcium
104. Patient DM type 1 having family history positive.
Father died of crf. By what investigation we will assess
his renal involvement.
A. Microalbuminuria
105. Pt develops skin pigmentation..had bl adrenalectomy.
A. Nelson syndrome.
106. Diabetic tennis player collapsed --<> hypoglycemia
107. MCC of recurrent myoglobinuria–mc cardle disease
108. Scenario of conn syndrome
109. Patient with features of carpal tunnel syndrome +
sleepiness  hypothyroidism
110. A patient in his last weeks of life become jaundiced.
Autospy - 3500 gm yellow greasy enlarged liver.
Dr Abdul Bari Babar
Histopathology showed no necrosis. Likely cause of
death 
 Hemochromatosis
 Alcoholism
 Galactosemia
111. Short qt interval: likely cause  calcium 12.4
112. Differentiating point between graves’ disease and
toxic multinodular goiter
a. Myopathy
b. Cardiomyopathy
c. Onycholysis
d. Tachycardia
e. Tremors
113. 56 years old female patient with lower back
pain,family history of breast cancer,calcium phosphate
normal,
what is best initial treatment?????
 Start hrt
 Bisphosphonate+ calcium
 Bisphosphonate only
 Calcium + vitamin D
Gastroenterology
114. Diagnosis of steatorrhea – gold standard test  72
hour fecal test
115. Offensive diarrhea for 6 weeks  giardiasis
116. Patient on clindamycin developed diarrhea. Rx 
vancomycin
117. Male, abdominal pain and lump in right iliac fossa.
Diagnostic test  colonoscopy with biopsy
118. Uc patient presented with jaundice, ercp shows
dilated intrahepatic and extrahepatic ducts with normal
ducts in between. Dx 
ans – primary sclerosing cholangitis
119. Test that would be normal in malabsorption
syndromes 
barium enema
120. Scenario of needle stick injury, hbsag is positive, anti-
hcv, what to do next? Hb core IGM antibody
121. Alcoholic patient develops jaundice, weight loss. Most
specific signs to confirm diagnosis  courvoisier
law
122. Hospitalized old male developed diarrhea .c deficile
toxin positive.diffuse colonic thickening. Is seen on CT
Scan abdomen. What would be seen on
IMM – February 2018 – third shift
histopathology?
Pseudomembranous colitis
123. Abdominal pain + jaundice + dark urine
 Ans biliary colic
124. Young male presented with chorea and abnormal lfts,
rx of choice at this stage of disease  pencillamine
125. Boy with colonic disease in which apc gene is
mutated  familial adenomatous polyposis
126. Pyloric stenosis vomiting metabolic anomoly
1. Hypokalemic alkalosis with alkalinuria
2. Hyperkalemic alkalosis with alkalinuria
3. Hypochloremic alkalosis with aciduria
4. Hyperchloremic acidosis
127. Scenario with recurrent flushing & diarrhrea.
Examination reveals typical findings of mitral
stenosis. Likely diagnosis would be.  carcinoid
syndrome
128. Differentiating test between crohns and ulcerative
colitis.. – serology
129. What goes in favor of ulcerative colitis and not in
crohns.- circumferential involvement
130. Regarding benefit oof 5 asa compounds in uc 
reduce risk of colorectal carcinoma
131. K/c of crohns develops hematuria and flank pain.
Cause?
A. Hyperoxaluria
132. Young male with history of gerd..ogd showed multiple
pyloric ulcers + short qt interval  hypercalcemia
133. Alcoholic male with history of pancreatitis, epigastric
pain which got severe in past two months. C.t
abdomen shows cyst of size 7x8 cm and increased
peritoneal fluid surrounding small gut loops.
1. Pancreatic adenocarcinoma
2. Adenoma pancreas
3. Pancreatic pseudocyst
4. Metastatic ca
134. Cholecystitis scenario.. What is best test to see
obstruction of cystic duct...
1..Ultrasound bilarry tree
1.. Hida scan
Dr Abdul Bari Babar
135. Feeling lump in throat without any difficulty in
swallowing to liquid or solid
globus hystericus
136. Achlasia scenario . diagnostic test  manometry
137. Gerd diagnostic  24hr ph monitoring
138. Emphymatous cholecystitis scenario
139. Most common portosystemic shunt  gastric vein
and esophageal vein
140. Definitive rx of hepto-pulmonary syndrome  liver
transplant
141. Feature that insist you to consider alternative
diagnosis in patient with ibs  weight loss
142. What other condition causes hypergastrinemia apart
from gastrinoma hypochlorydia
143. Iv drug abuser with shoulder pain, o/e normal
shoulder joint, cervical xray normal, with hiccups. 
ct abdomen
144. Patient with a-fib + severe abdominal pain +
thumbprint sign on x ray  ischemic colitis
145. Diet sushi + anemia  diaphlabothrium latum
146. Diagnostic investigation of idiopathic
hemochromatosis
A. Liver biopsy e iron stores
147. Idiopathic hemochromatosis typical findings include –
high iron low tibc
148. Profuse diarrhea. Likely organism?
v.cholera?
149. Medical student, got prick, pt was hbsag+ve & antihcv
+ve, antiHIV -ve... His labs show HbsAb.--> previous
immunization
150. Hostel mates started to have vomiting after 5 hours
staph aureus
151. Trinucleotide repeat disease (CAG) gene expression
 Huntington’s disease
Hematology & oncology
152. Duration of B12 replacement in patient with neurologic
features of B12 deficiency  life long b12
replacment
IMM – February 2018 – third shift

153. Elderly patient with lymphadenopathy and tlc count of

60000 with predominant lymphocytes  CLL

154. A sports man took some drugs than his hb 19.3

hematocrit 58% he is at risk for
 Rhabdomyosarcoma
 HCC
 RCC

155. A Case of snake bite presents to you with diminished

pulse , + raised INR. Best treatment option would be
 FFP + fasciotomy

156. Left leg pain dvt scenario. best diagnostic test

 Doppler
 left leg venography

157. Dialysis patient now developed carpal tunnel features

cause  dialysis related amyloidosis

158. Bleeding scenario with raised aptt and raised bt

ans : was von willibrand disease

159. Scenario of fever + bleeding, blast cells and auer rods

 AML

160. Prgnt lady with low platlets, anemia. Fever. Alt 140 alp
raisd.
Hellp
acute fty liver of pregnacy
intra hepatic choletasis

Toxicology

161. Pesticide scenario. Rx of choice

ans : Pralidoxime

162. Wheat pill scenario

163. Young male had a severe conflict with parents. Now

presented with vomiting. Management options 
urine toxicology screen

Dr Abdul Bari Babar