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a.Gilbert's syndrome b.chronic active hepatitis c.Gaucher's disease d.Galactosaemia e.P rimary biliary cirrhosis f.Alcoholic liver cirrhosis g.wilson's disease h.haemochromatosis i.Cholecystitis j.Hepatic adenoma k.hepatic amoebiasis 1.37 y/o woman presented with generalized pruritis for 5 month .On examination she was tanned and there were spider naevi on her chest.The liver was palpable one finger breadth below the costal margin as well as the tip of the spleen. 2.A 30 y/o woman presented with with anorexia, weight loss lethargy and athralgia for 3 weeks .On examination she was pale and jaundiced .The liver was palpable 2 finger breadth below the costal margin as well as the tip of the apleen.the test result: ALP 150U,AST 875 bilirubin 39, albumin 21g/l, globulin 52 g/l 3.A 32 y/o man presented with haematemesis and shock.On examination there mulpiple surgical scars over both knees ,the right hip and the right hypochondrium.His liver was palpable four fingers breadth below tha costal margin. 1-e as middle age women with pruritis,cirrhosis and hepatomegaly usually have primary biliary cirrhosis 2-are you sure you wrote all the options as I think this is a case of hepatocellular carcinoma 3-f as hematemsis is an evidence of cirrhosis and multiple injuries suggest drunkness and falls 1.primary biliary cirrhosis 2.????????????????? 3.Heamochromatosis(calcium pyrophosphate is deposed asymmetrically in both large and small joints (chondrocalcinosis)leading to an arthropathy.(Kumar and Klark)page 326.It is explain the surgical scars + liver biopsy has been done.

CARDIAC and HYPERTENSION a-alcohol reduction b-b-blockers c-ACE inhibitors d-Stop smoking e-exercise f-digoxin g-frusemide h-thiazides i-cardioversion(?) j-amiodarone k-partial myotomy l-morphin iv m-mannitol n-surgical ablation 53---a pt with HT=160/95 mmhg, he consume 50 U/week management? 54---a pt with HT 200/140 frusemide was given but HT still persists 55---a pt with oedema in the legs who takes frusemide but there is still oedema and dyspnoea 56---in close relatives, death when they are in their 40`ies. In echocardiography of that patient-subarachnoid thickness is found 57---a pt. in his childhood he had some feverish disease and took prednisolone(?) for 6 wks now p/w murmurs, finger swelling(?), subfebril 58--- a pt with crushing chest pain lasting 30 min 59---a pt with narrow complex tachycardia, adenosine has been given, but still there is tachycardianext step?

NEXT STEP IN CARDIO a-Echocardiography b-ambulatory ecg c-rest ecg d-chest x ray e-pacing f-cardiac enzymes g-drug toxicity h-angiogram i-eeg 60---a pt has got cardiac valve diseases for a long time now p/w JVP increase, dyspnoea, oeadema 61---everyday afternoon a pt suffer from 2 hrs chest pain when working 62---Paradoxal pulse(?), QRS amplitude is low in all leads(maybe P2 and JVP is increased) (following a viral inf(?) 63---a pt with lead II,III,aVF-ST elevation, pulse rate: 30/min 64---a young man found dead by his wife on ECG MI was found( maybe dilated pupils no reaction)- next step?

OBS&GYNE a-Chlamidya b-Gonorrhea c-Syphilis d-human papilloma virus 65---a woman with slight jaundice,deep dysparenue,pelvic and hepatic adhesion,fibroids(?) 66---cervical lesion, inflammatory, precancerous(?) or granulomatous a-transvaginal us b-cervical os exam c-laparotomy d-colposcopic examination(?) e-abdominal US f-lupus factor g-fibroid studying(?) 67--- a lady doesn`t have menstruation for 7 wks,p/w vag. bleeding, cervical os is closed 68---a pregnant p/w bleeding, (us by GP :fetus is normal) 69 ---a pt with severe right lower abd. pain, pregnancy test(+), but no fetus in uterus(?) 70---a lady had DVT and 3 times miscarriage at 12, 14 and 13 wks and some fibroid tissue(?) or uterus tenderness 71---a woman p/w termination at 14 wks and at the moment ,at 20 wks, there is miscarriage 72---2 wks after delivery, there is still bleeding and uterus tenderness

a-amoxycillin b-amox+clavulinic acid c-timethoprim d-no sp. treatment e-PCM f-antibitotic against otitis externa 1-7 yr old has rt side ear ache and rhinorrhoea.o/e his rt sided tympanic membrane appears pink in colour 2-4 yr old with rt sided ear ache is examined using otoscopy, it reveals a pink bulging tympanic membrane 3-9 yr old girl with h/o rec. otitis medianow complains of lt sided ear ache, o/e the rt sided tympanic membrane appears scarred,on exam. of left ear pus is seen throughout the ear canal 4-an 8 yr old is noted to have discharge from the lt ear , he has only mild irritation and no significant ear ache, o/e his ext canal is inflamed but tympanic membrane appears normal

a-electrolyte and urate b-lying and sitting BP c-eeg d-ambulatory ecg e-rest ecg f-laparotomy g-urine analysis h-chest x ray i-blood glucose j-ct 12---when a pt. gets up mornings ,falling down and become unconsciousnessmost descriptive invest.? 13---a pt. everyday several times for few wks loss of consciousness without warning(?) and regain his consciousness in 2 min 14---a pt with severe abd. pain radiating to the back, BP:90/50 and still falling down 15---a pt with GCS:3 dilated pupils nonreactant

PSYCH a-acute confusional state b-dementia c-Depression d-Schiophrenia e-posttraumatic stress disorder f-hypomania g-Korsakoff`s synd 16---80yrs old person taking some drugs(?), p/w agitation,disorientation in time and place 17---a high speed car drivingstopped by police.he is still speaking very fast in police station 18---A Kosovian person is always afraid of being killed, fear of a war and p/w agitation and stress 19---a young lady lost his desire for everthing and lost her appetite, she wants to die.

a-tricyclics b-fluexhetine c-councelling d-couple therapy e-marital therapy f-ECT g-psychiatric surgery h-lithium i-carbamazepole 20---a dentist can cope with his work and life but there is lack of confidence 21---A young lady despite on antidepressant treatment, doesn`t eat or drink anything,loss of weight 22---a mother recently delivered a baby. Her first baby died. She is hiding her baby and believed that her husband will kill the baby 23---a pt comes with feeling low and depressive symptoms who had disinhibition,hyperactive, feeling very high before. Antidepressants didn`t help.

DRUGS a-opioid overdose b-opioid withdrawal c-triclics intox

Management of HIV related cases a) Iv ganciclovir b) Emergency esophageal surgery c) Highly active antiretroviral (HAART) therapy d) Adjust Rx e) Oral acyclovir f) Omeprazole+ amox. + metronidazole g) Nystatin gel h) Vit supplements 1. 25 yr homosexual c/o bruises which are brought on by slightest trauma. O/e has oral candidiasis. WBC count: 2.9 X 1,000,000,000 /L 2. A male pt. With HIV presents to STD clinic with Hb 8.9 WBC 1.4 x 1,000,000,000 /L Platelets 19 x 1,000,000,000 /L U & E not done ALP 98 IU /L ALT 45 IU/L 3. A 36 yr journalist , AIDS for 2 yrs. Presents with 3 wk h/o dysphagia, failed to respond tofluconazole. He was on Zidovudine 200 mg tds & dapsone / pyrimethamine for PCP prophylaxis. Endoscopy revealed a single deep ulcer in the lower third of esophagus.

Management of rash a. Isolation/ quaratine b. Reassure c. Acyclovir d. Hydrocotisone cream e. PUVA f. day course of Rifampicin g. Immunize against measeles h. Check anticardiolipin ab Q. A pregnant woman gets transient rash, which disappears. The young woman is otherwise well.

a-amoxicilline b-cotrimaxozole c-anti-tb drugs d-corticosteroids e-clarithromycin 75---a pt with cough , fever,had several influenza inf, CXR-lung lower lobe consolidationtx ? 76--- a pt with known HIV(+) Chest x ray-bilateral diffuse alveolar shadowstx? 77---A pt student is getting fever,diarhhea(?) his friends has similar symptoms-tx? 78--- Pakistani man comes with cough, weight loss, sweating

75-a 76-b 77-d 78-c 77 was looking like inf.diarrhoea for me.. please discuss.

Could you give a hand to clear this question guys? They are so different and confusing as they are? (from 2 different sources)

12.interpretation of renal investigations. a-dialysis, b-iv methyl prednisilone, c-oral azathiopurine, d-adequate i/v fluids, e-i/v glucose and insulin, f-urinary cathetor, g-Ace inhibitor, h-IV PAMIDRONATE) 49.diabetic with mild renal impairment, urea 18 mmol/l,creatinine 350 umol/l,na 138mmol, ca 2.3 mmol, k 7.4 mmol. GLU+INSIL 50.pt with multiple myeloma,urea 18 mmol,creatinine 350 umol,na 142 mmol,k 3.5 mmol,ca 3 mmol -?IV PAMIDRONATE 51.pt with sle urea 18 mmol,creatinine 350umol,urine microscopy contains red cell casts.- IV METHL PREDNISONME 52.rhabdomyolysis patient,urea 18mmol,creatinine 350umol,cpk 2500 iu,k 5.2 - IV HYDRATION 53.male 60 yr with features of urinary tract obstruction.urea and ceratine and k r raised. CATHETER

THEME 41:Next step in management: 1.Insulin and dextrose 2.Dialysis 3.ACE-i 4.Oral azathioprine 5.Fluid challenge[Aggressive treatment with IV fluids] 6.Catheterisation 7.Oral predisolone 187.Patient with diabetes mellitus,moderate renal impairment. Creatinine-350,urea-18,K+7.9,Na+-142. 188.Patient with multiple myeloma.Increased craetinine and urea levels,Normal K+ and Na+ levels,Ca+-3.5 189.Man cannot pass urine.Creatinine-350,Urea-18,Electrolytes -Normal, USG--Dilated bladder and ureters. 190.Man with crush injury[i don't remember the rest of the Q] 191.Acute SLE attack with red cell casts in urine.

ANS...187.Insulin and dextrose or dialysis 188.ACE-i or Azathioprine 189.Catheterization 190.Fluid challenge 191.Oral predisolone 187. i was of opinion that this person shouls go in for dialysis as our ohcm says k+ > 6.5 is urgent indication for dialysis..but some of the opinion that insulin could cause the reentry of potassium..well, give me ur opinion of the same. 188. there is ambiguity in 2 sets if papers..as our ohcm says if pt is symptomatic and ca2+ > 3.5 then we need to give iv pamidronate iv 30ml in saline over 4 hrs. but in the one set of questions its given that ca2+ was 3 and we dont have any info about the patient being symptomatic ..then, i would prefer to the option of treating the underlying cause which in this case is mutilple myeloma . 189. catherization. 190. as u have said its crush syndrome and i agree with ur answer of fluid challenge..but my problem is that whats the fluid of choice to be given..if both saline /mannitol are given.what would u go for ?? i feel mannitol is better but some books prefer saline diuresis. 191. oral prednisolone.. Hi , these questions are the real tough ones .I have a few different answers 1-iv glucose + insulin 2-adequate iv fluids(hypercalcemia) 3-iv methylprednisolone(GN) 4-iv fluids/dialysis? 5-catheter 187- isnt it like the previous question , then the answer should be the same as well, insulin and dextrose 188-ohcm says hydrocortisone for pts with multiple myeloma , so I guess in this case azathioprine is appropriate but not really sure agree with the rest of the answers

1. female child has dark and white patches on her buttokes. her father is black and mother is white. she is brought by her grand mother worried about that. answer: physiological OR non-accidental

2. 6 month female comes with swelling of thigh. x ray show femur fracture. no other h/o trauma. answer: skeleton survey OR child protection conference

3. 9 yr female child comes with parents with h/o bleeding vagina, perineum is red and tender, h/o dysuria too. answer: examination under anaethesia OR child protection conference

1. physiological 2. splint the # 3. examination under Anaesthesia 1-physiological 2-skeletal survey 3-examine under anesthesia

vaginal bleeding a. cervical inspection b. cervical smear c. endocervical swab d. endometrial sampling e. full blood count f. gonadotrophin level g. hysteroscopy h. kleihauer test i. pregnancy test j. thyroid function test k. ultrasound scan 140. a 52 yr old woman has had a history of offensive vaginal discharge and intermittent vaginal bleeding over the past three months. Her last cervical smear was taken four yr ago. 141. a 23 yr old woman has a new sexual partner. She has been on the combined oral contraceptive pill for the last six years. She presents with a two month history of breakthrough bleeding. 140- cervical inspection (I'm expecting a cervical lesion/ ectrpion) 141- hard to decide, could be cervical ectrpion, she's on pill, or infection or even both... inspection+swab I'd say, but there is no such option. 1-could be a carcinoma cervix , since it says smear was done 4 yrs back , is it not always better to repeat a smear again , then in this case the answer would be cervical smear. 140- agree w/ kiran, cld be cervical ca, and since cervical smear was taken 4 yrs ago, then why don't do a cervical smear again 141- cervical ectropion- do a cervical inspection first 140- It may be cervix ca, but ectropion is more common in any case, presents with infection and bleeding. Why not inspection fist? 141- Even the partner change could be a reason for breakthrough bleeding but anyway, I still think erosion should be excluded first esp because she's on OCP.

THEME: management of breast lumps a. mammography b. ductal graphy c. FNAB d. Core biopsy e. Excisional biopsy 1. patient comes with discharge from her nipple. There is no abnormality on mammography 2. old patient. Mass in the right upper lobe of the right breast. It is attached to skin and to the muscles 3. patient with diffuse lumpiness of breasts and a lump on one of them 1. B ductography is helpful as the likely dx is ductectasia 2. C FNAC is the best Ix even for advanced breast Ca. B&L does not mention about excisional bx 3. A Actually all that is needed is reassuarance, but it is safe to do a mammogram.

INFECTION a-toxoplasma gondi b-candidiasis c-CMV(?) d-Syphilis e-chlamidya 73---a pt with known HIV(+) p/w headache and confusion ,some neurological signs(?) 74---young man, lymphadenopathy,fever, dysuria, urethral lesion(?)

a-amoxicilline b-cotrimaxozole c-anti-tb drugs d-corticosteroids e-clarithromycin 75---a pt with cough , fever,had several influenza inf, CXR-lung lower lobe consolidationtx ? 76--- a pt with known HIV(+) Chest x ray-bilateral diffuse alveolar shadowstx? 77---A pt student is getting fever,diarhhea(?) his friends has similar symptoms-tx? 78--- Pakistani man comes with cough, weight loss, sweating

WRIST TRAUMA a-consult immediately to orthopediciant b-correct and put in a cast c-bandage and discharge d-bandage and rewiev in hospital e-x rays f-x rays(including scaphoid wiev) 79---a pt with wrist injury-x-rays have been done, which are normal. There is slight swelling and pain 80---a pt p/w fell on outstretched hand 81---a pt fell on hand p/w swollen and tender wrist, movement are painful. X ray shows effusion(?)

UROLOGY a-abd US b-urine test c-micturation cystogram d-IVP e-mefenamic acid f-frusemide g-thiazides h-gentamycine i-prednisolone(?) j-amoxycilline(?) 82--- a child with a mass on abdominal palpation and haematuria(?) 83--- a congenital anomaly at the entrance of ureters to the bladder 84---a pt with severe loin pain radiating to scrotum 85---an agent which is toxic on renal system

ANSWERS 73-a 74-d 75-a 76-b 77-e 78-c 79-d 80-e 81-f 82-a 83-d 84-e 85-h

a]Do nothing b]FNAC C]TSH D]T3 E]T4 F]Thyroglobulin g]ultrasound h]thyroid scan i]autoantibody titres 1]14 year old girl with diffuse swelling which moves on deglutition 2]35 year old woman with swelling. On thyroid scan, a single nodule is seen 3]50 year old man with an irregular swelling in the front of the neck 4]40 year old woman with a swelling in front of the neck and c/o palpitations and diarrhoea 5]35 year old woman who is on treatment with thyroxin has now come for assessment as to how her treatment has progressed 1. g 2.b 3.h 4.d 5.c

Investigation Of Diarrhea A. Upper gastro esophagoscopy B. Bariun enema C. Thyroid functon tests D. Bone marrow biopsy E. X-ray paranasal sinuses F. Echocardiography G. Sigmondoscopy H. Clostridium difficile toxin titre I. Serum B 12 level J. Karyo typing K. Jejunal biopsy L. Serum Gastrin estimation M. Coomb's test N. None required

1. A 21-year-old man developed maxillary sinusitis and was prescribed Amoxycillin for 10 days. From day 7 he developed bloody diarrhea. 2. A 45-year-old man presents with weight loss, diarrhea and heat intolerance. His sleeping pulse is 96/min and he is afebrile. 3. A 40-year-old man presents with abdominal pain and diarrhea. Endoscopy shows multiple ulcers in the Esophagus and Stomach. 4. A 58-year-old female presents with recurrent jaundice. Her Hb is 8.5 gms% and MCV is 125 fl. 5. A 53-year-old anemic man presents with alternating diarrhea and constipation. He lost 8 lbs in the past 2 months and stool guaiac test is positive. 1h 2c 3l 4i 5g

Abdominal Pain -Next Investigation A. Gastro esophagoscopy B. ERCP C. Oral cholecystography D. Abdominal X ray E. IVU F. Ultrasound abdomen G. Blood glucose H. Laproscopy I. Urine porphyrins J. Echocardiogram K. Chest X ray 1. A 62-year-old man presents with perspiration and dizziness. His BP is 100/70 mm Hg and he complaints of abdominal and back pain. On examination, aortic pulsation is more prominent. 2. A 65-year-old alcoholic presents with recurrent abdominal pain, which is relieved by leaning forward. 3. A 46-year-old obese female complains of recurrent pain under her right lower ribs after eating fatty foods. 4. A 48-year-old patient presents with history of recurrent epigastric pain on lying position. Now his pain becomes constant. 5. A 16-year-old boy complains of right lower abdominal pain, which was initially around umbilicus. He then develops increased frequency of micturition.

1f 2b 3f 4a 5h

Treatment of arrhythmias A. Carotid sinus massage B. Adenosine C. Verapamil D. Sotalol E. Amiodarone F. Digoxin G. Lignocaine H. CaC12 I. Flecainide J. Disopyramide K, Elective DC cardioversion L. Emergency DC version 149. A 30 yr old woman has a 6 month history of palpitations. Her resting ECG shows shortened PR interval and delta waves. Holter momtoring shows evidence of paroxysmal SVT. 150. A 50 yr &ld man was admitted with an acute anterior MI earlier in the day. 2 hrs after thrombolysis with tPA he suddenly complains of feelin^ faint. His pulse is 140/nih and BP 90/40 mmHg. Cardiac monitor shows long run ofVT. 151. A 24 yr old woman presents to casualty complaining of dizziness. Her ECG shows reentrant tachycardia. She had one similar episode in the past which stopped spontaneously and she is on no medication. She is 31 weeks preg nant. 152. A 70 vr old man has collaosed on suraical ward followina a left hemicolectomy. He has a very weak caroUd pulse. His BP is unrecordable. Cardiac monitor shows broad complex tachycardia with a rate of 160/min. 153. A 60 yr old man has chronic renal faiture, which is treated with CAPD. He has a low grade fever and abdominai pain for last 2 days and he has noticed that the dialysate is cloudy after exchange. He suddenly becomes unwell with broad complex tachycardia. His Bf His BP is 80/50 mmHg.

Treatment of cardiac conditions A. Anticoagulation and diQitalizatinn B. GTN C. Propanolol D. Adrenaline E. Lignocaine F. DC cardioversion G. Atropine H. Check digoxin level I. Start dopamine J. IV frusemide K. Carotid sinus massage 134. A 50 yr old man presents with shortness of breath. His pulse is irregularly irregular. The CXR shows cardiomegaly and left atrial enlargement. ECG shows absent P waves. 135. A 60 yr old man is on verapamil for HTN and digoxin for atrial fibrillation. He is listedfor herniorrhaphy. His preoperative ECG shows inverted P wave' tfter QRS complex and a regular rhythm. He is asymptomatic. 136. A 70 yr old pt in ITU suddenty looses consciousness. His ECG shows VT. 137. A 40 yr old man admitted for acute MI suddenly drops his BP to 70/45. He has bilateral rales on auscultation. 138. A 50 yr old man in mj is noted to have paroxysmal SVT on his ECG monitoi

Treatment of cardiac conditions A. 02, morphine and streptokinase B. CABG C. Angioplasty D. Intra aortic ballon angioplasty E. Swan Ganz catheter F. Defibriltlation G. 02, IV frusemide, morphine GTN H. GTN tablet and atenolol I. 6TN and nifedepine 139. A 40 yr old man has severe mitral valve regurgitation and <s unable to maintain an adequate cardiac output. He is awaiting a vdivc icpidcernent. 140. A 50 yr old man presents with dyspnoea and tachycardia. He has bilateral rales on auscultation. He has a history of IHD. CXR shows cardiomegaty and pulmonary oedema. 141. A 60 yr old man canptains of chest pain after jogging. He takes ventolin inhaler for his asthma. ECG shows ST segment depression. 142. A 55 yr old man with frequent episodes of angina now complains that the pain is no longer alleviated by rest or with GTN. Coronary angiogram shows left main stem obstruction. 143. A 60 yr old man comolains of severe excruciatina chest oain at rest. He is diaphoretic and nauseated. The ECG shows y waves and ST elevation in lads II, aVL and I.

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