Académique Documents
Professionnel Documents
Culture Documents
2005
GIT:
A young medical student, who has started his clinical postings, comes to because his
colleagues noticed a yellowish, tinge to his sclera. On examination he is normal except for the
yellow sclera. Investigations showed:
Total bilirubinElevated
Direct bilirubin Elevated
Direct bilirubin > (Total Direct bilirubin)
Ans: Hepatitis
In hemolytic jaundice indirect Br is elevated associated with elevated reticulocyte count and Br
level rarely goes beyond 4mg/dl unless other pathology is associated.
Age is most significant risk factor for pancreatic cancer. In the absence of predisposing
conditions, such as familial pancreatic cancer and chronic pancreatitis, pancreatic cancer is
unusual in persons younger than 45 years. After age 50 years, the frequency of pancreatic
cancer increases linearly (http://emedicine.medscape.com/article/280605-overview).
In hepatitis the prodormal phase precedes the icteric phase and there is abrupt onset of fever
and vomiting, malaise, headache (JM p.624) and after that icterus appears.
Carotenemia is condition caused by excess carotene in the body due to ingestion of vegetables.
The yellowish discoloration is distributed un-uniformly in this condition; especially in the palms,
soles and nasolabial fold and characteristically sparing the sclera (Harrison p.238).
Gilbert Syndrome is characterized by mild unconjugated hyperbilirubinemia where indirect Br is
usually below 3mg/dl and uncinjugated (Harrison p.1819).
2|Page ps
CVS:
A young man has a syncopal attack while weight lifting. He has had similar episodes twice
before. His father died of cardiac disease. What is the most appropriate management?
a) Holter monitor
b) Echocardiogram
c) Stess test
d) BP in supine & lying down
e) CT scan
Ans: Echocardiogram.
Hypertrophic cardiomayopathy is 60%cases follow AD inheritance. Dyspnoea, angina, palpiation,
pre syncope and syncope can occur (Kaplan p.152) after exercise even in the resting periods
also. Sudden death can occur in this condition. Asymmetric left ventricular hypertrophy
associated with septal hypertrophy is the features of HOCM (Harrison p.1410). ECG shows left
ventricular hypertrophy and pseudo Q wave but Echocardiogram is the best diagnostic modality
(Kaplan p.153).
Dyspnoea is most common symptom.
Systolic ejection murmur, become louder in valsulva, heard best over apex, jerky carotid pulse,
double apical pulse.
Infection:
A 23-years old young lady complaint of lethargy and weakness. She has sore throat and 3 days
ago she has returned from JAVA where she suffered from fever recently. Her weakness is due
3|Page ps
to --
a) TB
b) Tonsillitis
c) Post viral fever fatigue
d) Infectiuos mononucleosis
Rheumatism:
A 29-year old woman, 6 months previously had pleurisy, in the last 2 years mouth ulcers, now
develops stiffness and oedema of the wrist and MCP joints; in the morning which disappears
afterwards. The most likely cause?
a) Rheumatoid arthritis
b) Crohns disease
c) Ulcerative colitis
d) SLE
e) Dematomyositis
Ans: To diagnose SLE definitely there must be presence of 4 out of 11 criteria among which
pleurisy and mouth ulcer is present. In SLE hands, wrist and knee joints are involved (Harrison
p.1972) but morning stiffness is a characteristic of RA (Harrison p.1970). In IBD abdominal
symptoms should be present and Dermatomyositis occurs commonly in patients more than 50
yrs of age and associated with myelgia, muscle weakness and characteristic rashes on the body
(Harrison p.2540).
RS:
Which of the following most commonly causes pulmonary hypertension & corpulmonale?
a) Emphysema
b) Bronchiectasis
c) Pulmonary embolism
d) Pneumothorax
e) Foreign body
Ans:
4|Page ps
(Oxford p.205)
Drugs:
Which of the following is a common side effect of calcium channel blockers?
a) Peripheral oedema
b) Angio-oedema
c) Headache
d) Insomnia
e) Cough
Endo:
In diabetic neuropathy you can find each of the following except?
a) Bradycardia
b) Urine retention
c) Impotence
d) Diarrhoea at night
e) Foot ulcer
Ans: Bradycardia.
Autonomic symptoms may be sudomotor (dry skin due to lack of sweating or excessive sweating
in defined areas), pupillary (poor dark adaptation, sensitivity to bright lights), cardiovascular
(postural lightheadedness, fainting) (tachycardia and orthostatic hypotension Harrison
p.2165), urinary (urgency, incontinence, dribbling) and bladder emptying abnormality (Harrison
p.2166), gastrointestinal (diarrhea, constipation, nausea, or vomiting), and sexual (erectile
impotence and ejaculatory failure in men, loss of ability to reach sexual climax in women)
(http://emedicine.medscape.com/article/1170337-overview). Foot ulcers are major source of
morbidity in patients with diabetic disease. Causes of foot ulcers are Neuropathy, PVD and poor
infection resistance (Harrison p.2168).
GIT:
All of the following are true about duodenal ulcer, except?
a) Hunger pain
b) Loss of appetite
c) Weight gain
d) Relapses & remissions
e) Relief by antacids
Patients with gastric ulcer may present with a wide variety of symptoms, or they may remain
completely asymptomatic.
Gastric and duodenal ulcers usually cannot be differentiated based on history alone.
Classic gastric ulcer pain is described as pain occurring shortly after meals, for which
antacids provide minimal relief.
The pain from gastric ulcer is typically located in the epigastrium; however, it can also be
perceived in the right upper quadrant and elsewhere.
Duodenal ulcer pain often occurs hours after meals and at night. Pain is
characteristically relieved with food or antacids (hunger pain).
Pain with radiation to the back is suggestive of a posterior penetrating gastric ulcer
complicated by pancreatitis.
Patients with bleeding gastric ulcers may give a history of hematemesis, melena, or
episodes of presyncope. Melena can be intermittent over several days or multiple
6|Page ps
episodes in a single day. Rarely, a briskly bleeding ulcer can present as gross
hematochezia (http://emedicine.medscape.com/article/175765-overview).
Weight is possible in duodenal ulcer as the person tend to eat more due to hunger pain.
Duodenal ulcer pain is mainly due to gastric acid secretion so it is relieved by antacids. Loss of
appetite is unlikely DU and in gastric ulcer the person does not loose appetite rather fear food.
Infections:
An 18-year-old student presents with jaundice, sore throat and dark urine. There was no
hepatitis contact, no IV drug use, and no recent travel history. Bilirubin 80, elevated Gamma-
GT, AST 300, ALT 400 and albumin normal. What is the most likely diagnosis?
a) Hepatitis A
b) Hepatitis B
c) Infectious Mononucleosis
d) Cholangitis
e) Acute Cholecystits
Hemat:
How would you differentiate between haemolytic anaemia and anaemia of chronic blodd
loss?
a) Decrease haptoglobin
b) Increased reticulocyte count
c) Megaloblastosis
d) Polychromasia
e) Raised ferritin
Electrolytes:
A 65-years old presents with confusion. The blood test show serum Na 165, Urine osmolality
205. The most likely diagnosis is?
a) SIADH
b) Diabetes Mellitus
c) Diabetes Insipidus
d) Water intoxication
e) Renal failure
7|Page ps
Causes of hypernatremia:
Hypovolemic:
Decreased oral intake of water secondary to mental ds, increased water loss due to dieresis,
vomiting, diarrhoea and hyperaldosteronism.
Hypervolemic:
Hypertonic fluid administration, escess salt intake, cushing and conn syndrome.
Euvolemic:
The first step in the diagnostic approach is to estimate the volume status (intravascular volume)
of the hypernatremic patient. The associated volume contraction may be mirrored in a low urine
Na+ (usually <10 mEq/L).
In the hypovolemic patient, a hypertonic urine with a UNa+ <10 mEq/L will point towards
extrarenal fluid losses (GI, dermal), whereas an isotonic or hypotonic urine with a UNa+ >20
mEq/L indicates renal fluid loss (diuretics, osmotic diuresis, intrinsic renal disease).
In the euvolemic patient with preserved intravascular volume, hypernatremia is most likely due
to pure-water losses. In the presence of hypernatremia, urine osmolality normally should be
maximally concentrated (>800 mOsm/kg H2 O). Measurement of the urine osmolality will allow
differentiation of the following:
To distinguish between central and nephrogenic diabetes insipidus, first obtain a plasma AVP
level and then determine the response of the urine osmolality to a dose of AVP (or preferably,
the V2-receptor agonist DDAVP).
Generally, an increase in urine osmolality of greater than 50% reliably indicates central
diabetes insipidus, while an increase of less than 10% indicates nephrogenic diabetes
insipidus; responses between 10% and 50% are indeterminate.
Hyperosmolar patients with an elevated AVP level have nephrogenic diabetes insipidus; those
with central diabetes insipidus will have inadequately low AVP level
(http://emedicine.medscape.com/article/241094-diagnosis).
8|Page ps
Hemat:
A 70-years old woman presents with a 3-month history of fatigue, generalized
lymphadenopathy, and hepatosplenomegaly. What is the most likely diagnosis?
a) Hodgkins lymphoma
b) Non Hodgkins lymphoma
c) Acute lymphocytic leukaemia
d) Chronic lymphocytic leukaemia
e) Chronic Myeloid leukaemia
NHL occurs in individuals of all ages, although the incidence progressively increases with age.
The incidence in the 20- to 25-year-old group is 2.5 cases per 100,000 population. By 60 years of
age, this rate has increased to 43.7 cases per 100,000, and by 75 years, it has risen to 100 cases
per 100,000. The median age of presentation is 55 years.
Immunology:
Regarding immunology, which of the following is correct?
a) Natural killer cells are a subset of T cells
b) B cells produce first Ig M and later Ig G
c) Ig E is involved in mucosal protection
d) Opsonization
e)
Ans: A and B.
Drugs:
A 60-years old obese man, on ACE inhibitors for hypertension, Metformin & glibenclamide for
diabetes, benzodiazepines & TCAs for depression & insomnia, now complaints of impotence.
Which drug is the most likely responsible for the impotence?
a) Glibenclamide
b) Metformin
c) Tricyclic antidepressants
d) Benzodiazepine
e) ACE inhibitors
Ans: D.
JM p.1116.
Rh:
A 30-year old bisexual male, presents with clear urethral discharge, mouth ulcers, arthralgia,
fatigue and sausage like fingers. Culture was negative. What is the most likely diagnosis?
a) Reiters disease
b) Bechets disease
c) Ankylosing spondylitis
d) SLE
9|Page ps
e)
Ans: A.
Clear urethral discharge: Non gonococcal urethritis (Chlamydia)
Sausage shaped digits are seen in reactive and psoriatic arthritis (Tor Rh p.27, Harrsson p.2014)
CNS:
A 56-year old man presents confused. He cannot abduct his eyes, there is a slight problem
with elevating his eye and nystagmus is present throughout. Most likely diagnosis is?
a) Wernickes encephalopathy
b) .
c) .
d) .
e) .
Ans:
Global confusion, ophthalmoplagia and ataxia are seen in warniickes encephalopathy.
Infection:
A 23-years old university student has fever, arthralgia, lymphadenopathy & malaise. ALT, AST
& GGT are elevated. Peripheral smear shows atypical lymphocytes. The diagnosis is?
a) Hepatitis A
b) Hepatitis C
c) Infectious mononucleosis
d) CMV
e) ALL
Ans: c.
Electrolytes:
Hypokalemia occurs in all except?
a) Thiazide diuretics
b) Pyloric stenosis
c) Chronic renal failure
d) Laxative abuse
e) Hyperaldosteronism
Ans: c.
Nephrology:
A 22 year old man developed haematuria and slight swelling of the face. On examination BP-
150/80 mmHg, RBC & hyaline casts are present in the urine. Most likely diagnosis?
a) Nephrotic syndrome
b) Glomerulonephritis
c) Pyelonephritis
10 | P a g e ps
d) Ig A nephropathy
e) Renal tubular necrosis
Ans: B
Hematuria.
Ophthalmology:
A 37-years old woman has unilateral exopthalmos. Which of the following is the most likely
cause?
a) Glaucoma
b) Nasophryngeal tumour invading the orbit
c) A neoplastic lesion in the lamina cribrosa
d) Thyrotoxicosis
e) Infection of the frontal sinus
f) Maxillary antral tumor
Ans:
Bilateral causes:
* Grave's disease
Unilateral causes:
* Grave's disease
* cavernous sinus thrombosis
* pseudotumours of the orbit
* carotid-cavernous fistula
* tumour (benign, eg dermoid or malignant)
* capillary haemangioma
* orbital cellulitis
* sinus mucocoele
Drugs:
All of the following are side effects of prednisolone except?
a) Hirsutism
b) Lymphopenia
c) Leucocytosis
d) Osteomalacia
e) Weight gain
Ans: d.
11 | P a g e ps
GIT:
A patient you treated for duodenal ulcer with Helicobacter pylori for 1 week with treiple
therapy. He is asymptomatic now. Which of the following is the best follow up?
a) Urea breath test
b) Endoscopy
c) Serology
d) Histological examination
e) Culture
Ans: A.
Infection:
A 20-year old man is found to have HIV. What does this indicate?
a) He has AIDS now
b) He has got lifelong infection & infectivity
c) He needs to start pneumocystis carinii prophylaxis
d) He requires to start AZT therapy
e) He can transmit through saliva now
Ans: B.
Hematology:
A 70-year old woman complaints of fatigue. Blood picture---
MCV 118, Hb decreased, WBC decreased, platelets decreased, Hypersegmented polymorphs
present. The most likely diagnosis?
a) Autoimmune haemolytic anaemia
b) Pernicious anaemia
c) Anaemia of chronic disease
d) Anaemia due to silent gastrointestinal bleeding
e) Leukaemia(CML)
Ans: B.
Blood gas:
A 68 years old man with COPD was brought to your surgery from nursing home by
ambulance. On his way to hospital he received O2, 10 L/m by mask. He is still unarousable and
his ABG most likely--
a) Ph 7.29 PaCO2 65 PaO2 85
b) Ph 7.15 PaCO2 50 PaO2 68
c) Ph 7.25 PaCO2 25 PaO2 100
d) Ph 7.35 PaCO2 40 PaO2 40
e) Ph 7.45 PaCO2 85 PaO2 40
Ans: A.
12 | P a g e ps
Immunology:
A 24-year old female has abdominal pain every week. Sometimes she has face & lip swelling.
Her mother and sister also have this. What would you do to establish a diagnosis? ***
a) Measure Cl esterase
b) Check for food allergies
c) Check Pb levels
d) Ig A deficiency
Ans: A.
13 | P a g e ps
C1 esterase inhibitor is
the main regulator in the
activation of
* complement system
* contact system
(kallikrein-kinin system)
* coagulation cascade,
fibrinolytic pathway (to a
lesser extent)
CNS:
A patient complaints of headache, vomiting & papilloedema. Which of the following is the
most likely cause?**
a) Giloma of the frontal lobe
b) Tumour obstructing the 4th ventricle
c) Pituitary tumour
d)
CNS/ENT:
An elderly patient has acute onset unilateral deafness, tinnitis & vertigo. What is the
diagnosis?
a) Menieres disease
b) Acoustic neuroma
14 | P a g e ps
c) Vestibula neuronitis
d)
Nephrology:
A patient has calcium oxalate renal stones. What is the most appropriate managemant?
a) Allopurinol
b) Alkalinize the urine
c) Stop taking food with calcium
d) Give calcium
Ans:
Uric acid stone: Allopurinol
Ca oxalate: Rhubab, strawberry, palms and spinach
Calcium restricted diet: Reduces urinary calcium
It is important to drink plenty of fluid; especially in the summer months or a warm climate
(urine output should be kept at > 3 litres per 24 hours).
Other prevention measures are directed towards the particular type of urinary tract stone:
Hematology:
Heparin therapy is monitored by which of the following tests?
a) APTT
b) INR
c) Bleeding time
d) Serum fibrinogen
Ans: A.
Snake bite:
A middle-aged man is brought to your surgery with a history of being bitten by a black snake.
On examination there are scratch marks on the lower leg and no other symptoms. What is
your management?
a) Reassure and send him home
b) Excise wound
c) Administer antivenin immediately
d) Apply Tourniquet
e) Observation and antivenoum if necessary
Ans: E.
16 | P a g e ps
CVS:
Opening snap indicates:
a) Mitral valve mobility
b) Atrial fibrillation causes disappearance of the opening snap
c) Replaces S3
d) Best heard at 2nd right intercostals space
e) Remains unaltered despite progression of the disease
Ans: A.
In the healthy heart the mitral and tricuspid valves open silently during diastole, at the
end of isovolaemic relaxation. In certain pathological states the AV valves open more
rapidly than normal; this results in an audible opening snap.
This can be achieved by listening to the heart sounds during inspiration: the examiner
will hear A2, P2 and the opening snap in quick succession.
http://www.gpnotebook.co.uk/simplepage.cfm?ID=939917320
17 | P a g e ps
Drugs:
A man presents with a history of treatment with Sulphasalazine. The least likely complication
for the condition he was treated for would be?**
a) Pericholangitis
b) Iritis
c) Erythema nodosum
d) Peripheral neuropathy
e) Ankylosing Spondylitis
Ans: D.
Medicine p.183
Skin:
In contact dermatitis, which is common?
a) Contact with plants
b) Can be treated by topical steroids
c) Can be treated by oral steroids
Ans:
JM p.1163
RS:
All of the following are present in interstitial fibrosing alveolitis except?
a) clubbing is common
b) Normal FEV1/FVC does not exclude the diagnosis
c) Diffuse expiratory crackles
d) Decreased VC
dyspnoea
cyanosis
clubbing
there may be slightly reduced chest expansion
there may be bronchial breathing
on auscultation there may be late-inspiratory and paninspiratory crackles heard over the
affected lung lobules
there may be clinical features of an associated connective tissue disease
18 | P a g e ps
Oncology:
A 72-year old man with a history of non-small cell lung cancer now complains of lethargy,
constipation and thirst for the past few weeks. What is the most likely problem?
a) SIADH
b) Ectopic parathormone production from the cancer itself
c) Metastasis to the brain
d) .
e)
Ans: B.
19 | P a g e ps
CNS:
A 64-year-old male complaints of pain behind the right eye, associated with lacrimation,
which appears every morning & disappears in the afternoon, for the past 2 weeks. He had
similar episodes previously. Which is the prophylactic treatment? **
a) Methysergide
b) Ergotamine
c) Acetozolamide
d) NSAID
e) Sumatriptin
GIT:
A patient has diarrhoea, fatigue and pallor. Blood picture shows MCV 110. What is the
diagnosis? (DAV 642)
a) Pernicious anaemia
b) Crohns disease
c) Gluten-sensitive enteropathy
d) Tropical sprue
20 | P a g e ps
History
TS manifests clinically with a spectrum of signs and symptoms. It may develop in natives
or travelers to the tropics, and it may not appear until as long as 10 years after the
patient has left there. No definitive marker of TS exists; hence, these claims remain
unsubstantiated. Patients may experience the following:
Diarrhea
Weight loss
Leg swelling
Fatigue
Fever
Physical
Weight loss
Dehydration
Pallor
Oral mucosa changes (glossitis, stomatitis)
Edema
Laboratory Studies
(Emedicine)
RS:
A 60-year-old man, who smokes 60 pack per year, presented with shortness of breath, was
given 28% oxygen by mask. 30 minutes later, his ABG was PaO2 68, PaCO2 60. What would
you do next?
a) Stop oxygen and check ABG after 30 minutes
b) Continue oxygen until normal PaO2 is reached
c) Immediate intubation & ventilation
d) Give immediate antibiotic cover against gram negative bacteria
e) Start aminotryptillin iv infusion
Ans: B.
Respiratory failure: PaO2 <60 and PaCO2 >45 Harrison p1595.
22 | P a g e ps
GIT:
Which of the following conditions is most likely to become chronic?
a) HAV
b) HBV
c) Hepatitis C virus
d) EBV
e) Cholecystitis
Ans: Hepatitis C.
Most common viral hepatitis is Australia: C. JMp628
RS:
A young man presents with pleuritic chest pain and cough. On examination there is dullness
on percussion and brochial breathing over the right lower zone, posteriorly. Which of the
following is the most likely diagnosis?
a) Right lower lobe consolidation
b) Right lower lobe collapse
c) Pleural effusion
d) Asthma
e) TB cavity
23 | P a g e ps
Ans: A. JM p.529
Infection:
Erythema nodosum occurs in all except?
a) Steptococcus infection
b) Rheumetic fever
c) TB
d) Leprosy
e) SLE
Ans: Rh Fever.
Poisoning:
A young man, who had taken some intravenous drug, was found unconscious, with 3 breaths
per minute and constricted pupils. Which of the following would be the most appropriate
treatment?
a) Naloxone
b) Atropine
c) Scopalamine
d) Methadone
e) Naltraxone
Ans: Naloxone
CNS:
A 68-years old female presents with a 2-week history of unilateral headache and an ESR 80
mm/hr. The most appropriate treatment is?
a) NSAIDs
b) Aspirin
c) Carbemazepine
d) Prednisolone
e) Ergotamine
2006
Nephrology:
A female aged 23 years, presented with proteinuria. There is a previous history of enuresis till
13 years of age. Her sister also had enuresis as a child. The history is suggestive of which of the
following?****
a)Chronic glomerulonephritis
b) Reflux nephropathy
c) Congenital nephritis
d) Polycystic kidney disease
e) Analgesic nephropathy
genetic predisposition - about 70% of affected children have a first-degree relative who was
enuretic - linkage studies have localised a genetic predisposition to this condition to
chromosome 13q
urinary tract infection - about 5% of enuretic children have urinary infections, compared
with 1% of other children of comparable age. The relationship is not necessarily causal;
persistent enuresis may predispose to an ascending infection
bladder capacity - may be smaller than normal. Constipation or cystitis also may lead to
reduced bladder capacity
stress - enuresis sometimes worsens or starts after a stressful event
polyuria may be the result of:
diabetes mellitus
diabetes insipidus
chronic renal failure
structural urinary tract abnormalities:
ectopic ureter
ectopia vesicae
urethral valves
epispadias
neurogenic bladder:
meningomyelocoele
spinal dysraphism
spinal cord tumour
impaired nighttime arousal due to sleep-disordered breathing
medications
valproic acid
25 | P a g e ps
clozapine
Drugs:
A patient, who had been taking a particular drug, now presents with haematuria. The drug is
most likely?
a) Calcium channel blocker
b) Digoxin
c) Naproxen-NSAID
d) .
e)
Ans: Naproxen.
Pyelonephritis
Obstruction
Sickle cell
Tb
Cirhosis
Analgesics
Renal transplant reaction
Diabetic
Systemic nephritis.
RS:
A person presents with alpha antitrypsinogen deficiency. What is the most likely
association?**
a) One parent has died of emphysema
b) Limited to bronchioles
c) Uninhibited protease action
d) .
e)
Ans: C.
Pan acinar emphysema: Alfa 1 anti trypsin deficiency
centriacinar - tissue loss at the centre of the acinus, and greatest in the upper zones. Mild
forms may occur in anthracosis, for example in coal miners, and have little or no functional
effect. Destructive forms are usually seen in smokers.
panacinar - tissue loss throughout the acinus, and greatest in the lung bases. Mild forms
may occur with aging; severe forms are typified by alpha-1-antitrypsin deficiency.
26 | P a g e ps
paraseptal - bullae occur on the lung fringes. They may rupture to cause a spontaneous
pneumothorax.
The distinctive feature of this type of emphysema is the pattern of involvement of the
lobules; the central or proximal parts of the acini, formed by respiratory bronchioles, are
affected, whereas distal alveoli are spared. Thus, both emphysematous and normal
airspaces exist within the same acinus and lobule. The lesions are more common and
usually more severe in the upper lobes, particularly in the apical segments. The walls of
the emphysematous spaces often contain large amounts of black pigment. Inflammation
around bronchi and bronchioles is common. In severe centriacinar emphysema, the
distal acinus may be involved, and differentiation from panacinar emphysema becomes
difficult. Centriacinar emphysema occurs predominantly in heavy smokers, often in
association with chronic bronchitis.
In this type, the acini are uniformly enlarged from the level of the respiratory bronchiole
to the terminal blind alveoli. The prefix "pan" refers to the entire acinus but not to the
entire lung. In contrast to centriacinar emphysema, panacinar emphysema tends to
occur more commonly in the lower zones and in the anterior margins of the lung, and it
is usually most severe at the bases. This type of emphysema is associated with 1-
antitrypsin (1-AT) deficiency.
In this type, the proximal portion of the acinus is normal, but the distal part is
predominantly involved. The emphysema is more striking adjacent to the pleura, along
the lobular connective tissue septa, and at the margins of the lobules. It occurs adjacent
to areas of fibrosis, scarring, or atelectasis and is usually more severe in the upper half
of the lungs. The characteristic findings are of multiple, continuous, enlarged airspaces
from less than 0.5 cm to more than 2.0 cm in diameter, sometimes forming cystlike
structures. This type of emphysema probably underlies many of the cases of
spontaneous pneumothorax in young adults.
27 | P a g e ps
Endocrine:
A 65-year-old man presented with confusion. Laboratory findings showed hypercalcaemia,
calciuria, and phosphates within normal limits. Which is the most likely diagnosis?
a) Malignancy(osteolytic metastasis)
b) Primary hyperparathyroidism
c) Idiopathic hypercalcaemia/hypercalciuria
d) Pagets disease myeloma
Ans:
28 | P a g e ps
CNS:
A 28-year old male presents with distal weakness and atrophy of the small muscles of
both hands(interossei, lumbricals, thenar & hypothenar). What is the most likely diagnosis?
a) Multiple sclerosis
b) Bilateral median nerve palsy
c) Syringomyelia
29 | P a g e ps
Ans: D.
CVS:
A person with severe aortic stenosis has a systolic gradient of 55 mmHg. What other feature
required suggesting the severity?
a) LV ejection fraction
b) LV end diagnosis pressure
c) Cardiac output
d) LV hypertrophy
e) LV end systolic pressure
Ans: D.
Severity of AS:
1. Symptoms and signs of LVF
2. Pulse pr
3. Cardiomegaly
4. Paradoxical split S2
5. LVH with strain
6. Pulmonary congestion
CVS:
An elderly man presents to the emergency dept with chest pain. No ECG changes and cardiac
enzymes are normal. What is true?
a) If ECG is normal he does not have a cardiac problem
b) He should have an immediate stress test done
c) Intravenous nitrates & heparin are not indicated
d) No follow up ECG is required
e) Streptokinase is indicated if there are ECG changes
Ans: B.
Infection:
The most common cause of travellers diarrhoea is?
a) Salmonella Typhi
b) Shigella
c) Enterotoxic E. Coli
d) Staphylococcus
e) Giardia Lamblia
Ans: C.
CNS:
Taste sensation of the anterior 2/3 of the tongue is carried by which nerve?
a) V
b) Facial nerve(VII)
c) IX
d) X
e) XII
Ans: facial
Post Tongue: Glosopharyngeal.
31 | P a g e ps
CNS:
Which of the following is least likely to cause facial nerve palsy?
a) Skull fracture
b) Mastoiditis
c) Chronic parotitis
d) Parotid tumour
e) Acoustic neuroma
Ans: C.
GIT:
A patient has massive ascitis and in the fluid malignant cells are found. Which of the following
is a possible finding?
a) Splenomegaly
b) Hepatomegaly
c) Supraclavicular swelling
d) On digital rectal examination, nodules can be palpated
Ans: C.
Ca Stomach.
Metabolism:
The single most reliable test for Haemochromatosis is?
a) Red cell mass
b) Serum iron
c) Serum ferritin
d) Serum Transferrin
e) Transferrin saturation
Ans:
S. transferring satiration
S. transferrin saturation: >70%
S. ferritin : >250 ug/L.
AR disorders.
HHE gene
Mx: Weekly venesection 500 ml until serum iron come to normal then 3 to 4 monthly to
keep the S. ferritin level below <100 ug/L.
The classic tetrad of manifestations resulting from hemochromatosis consists of (1) cirrhosis, (2)
diabetes mellitus, (3) hyperpigmentation of the skin, and (4) cardiac failure. Clinical
consequences also include hepatocellular carcinoma, impotence, and arthritis.
Infection:
In which of the following, is administration of immunoglobin as a prophylaxis not useful?
a) Hepatitis A
b) Hepatitis B
c) Rubella
d) Mumps
e) Varicella
Ans: Hepatitis A
Measles doesnt have a carrier.
Hematology:
In Von Willebrandts disease you will find:
a) Increased platelet count
b) Increase bleeding time ( Bleeding time is prolonged, platelets show reduced adhesion and
levels of Factor VIII are low )
c) Normal APTT
d) .
e)
Ans: B.
RS:
12 years old boy came with severe dyspnoea and afibrile condition. O/E you found R/R-
40/min, Pulse- 130/min. There is O2 saturation at room air of 85%. WOF will be appropriate--
a) Give salbutamol $ hourly at home
b) Give salbutamol and aminophyllin 4 hourly at home
c) Give him O2 and send him to hospital by an ambulance.
33 | P a g e ps
Ans: C.
CVS:
All the following drugs are proven to decrease the mortality in myocardial infection, except?
a) Aspirin
b) ACE inhibitors
c) Beta blockers
d) Nifedipine
e) Streptokinase
Ans: Nifedipine
Mortality reducing:
Aspirin
B blockers
Ace inhibitors
Streptokinase
RS:
A patient with COPD came in the emergency department with severe dysponea, 28% O2, 8
liter was given by mask. After one hour you did arterial blood gas & you found that PaO2 level
was 42 mm Hg, and Pa CO2 level was 68 mm Hg. WOF you will do now?
a) Increase O2 inhalation by mask
b) Increase I/V fluid
c) Repeat arterial blood gas level
d) Ask the patient for intubation and ventilation
Ans: D.
Endocrine:
A 50 yrs old lady admitted with Atrial Fibrillation.Blood tests show :
a) TSH : decrease (Note:DxThyrotoxicosis
b) T3: increase if all decrease, Dx pituitary disease)
c) T4: increase
Your management will be
a) Total thyroidectomy
b) Subtotal thyroidectomy
c) Radioactive iodine
d) Neomercazole(Carbimazole)
e) Echo
Ans: C.
JM p.223
34 | P a g e ps
CVS:
An office clerk with high blood pressure. He is obese and he takes 3-4 cups of coffee everyday.
WOF is not correct---
a) Consumption of coffee contributes greatly to his BP
b) Reducing body weight will help to reduce his BP
c) In 90-95% cases no cause is found for BP.
d) He should be advised about safe level of drinking alcohol.
Ans: A.
CNS:
A male presents with a sudden onset of vertigo and nausea. During the attack he has
deafness. WOF is your diagnosis is --
a) Positional vertigo
b) Acoustic neuroma
c) Labyrinthitis
d) Basilar artery infection
Ans: C.
Skin:
Photograph 1: Shows a skin lesion on the forearm. Slightly raised, red plaque, slightly scaly.
What is the diagnosis?
a) Lichen planus
b) Discoid eczema
35 | P a g e ps
Ans:
Skin:
Photograph 2: Shows a skin lesion, pinkish brown colored lump. The lesion in the picture was
found on the forearm of a young male. 2 weeks later he develops pneumonia associated with
crepitation through out both lungs.WOF organism is causing this lesion-
a) Streptococcus pneumonia
b) Staphylococcus Aureus
c) Mycoplasma Pneumonia
d) Pneumocystis carnii
e) Mycobacterium Avium
Ans:
Skin abscess
Trauma:
Photograph 3: X-ray showing an open fracture of the fibula & tibia. A young man, after an
accident on his motorcycle, presented with 3 cm of bone protruding through the skin of his
leg. What is your next line of management?
a) Internal fixation of the fracture immediately
b) Skin closure of the wound immediately to prevent infection
c) Reduce the fracture and apply plaster of paris
d) Give tetanus toxoid IM & antibiotics iv
e) Debribement is only indicated when the wound is severely contaminated
Ans: E.
JMp.1375
Good approximation of wound edges minimises scar formation and healing time.
Pay special attention to debridement.
Avoid deep layers of suture material in a contaminated woundconsider drainage.
Inspect all wounds carefully for damage to major structures such as nerves and tendons and
for foreign material:
shattered glass wounds require careful inspection and perhaps X-ray.
high-energy wounds, e.g. motor mowers, are prone to have metallic foreign bodies
and associated fractures.
Be ready to take X-rays of wounds to look for foreign objects or fractures (compound
fractures).
Trim jagged or crushed wound edges, especially on the face.
All wounds should be closed in layers.
36 | P a g e ps
Infection:
Photograph 4: A diabetic man comes to see you. His right leg below his knee is red & shiny.
What is the best initial management?
a) Penicillin & flucloxalillin
b) Metronidazole
c) Ampicillin
d) Ampicillin & gentamicin
e) Ampicillin
Rational prescribing:
Clindamycin
Cephalexin
Staphylococcus aureus 11
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12:22:57 AM
CNS:
Photo: Eye and dilated pupil.
AMC MEDICINE(2006)
Ophthalmology:
Man came to you with h/o pain in the eye, also has headache and vomiting. Mx-
a.Tropical Acetazolamide
b.Patch the eye to look for FB
cAtropine eye drops
d. Topical Pilocarpi
Ans: D.
RS:
Photo: X-ray chest of a 9 months old infant as shown in AMC book(page-119). What is the Dx?
Staph. Pneumonia( But most common in this age group is Streptococcus pneumonia) ne
ntamicin & metronidaz
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CNS:
Photo: CT Scan. A lady complains that she feels her left side of body she feels heavy. She also
has paralysis & weakness of left side. WOF is your Dx-
a. Cerebral Tumour
b. Cerebral Haemorrhage
c. Cerebral Infarction
d. SAH
Ans:
Electrolytes:
ECG: Wide QRS complex and tall T wave-
a.Hyperkalaemia
b.Hypokalaemia
c.Hyponatremia
Ans: Hyperkalemia
CVS:
ECG: Inferior Infarction
Ans: 2 3 aVF
CVS:
ECG: Ventricular Fibrillation
Ans: DC Cardioversion.
CVS:
ECG:Vetricular Ectopic
CVS:
ECG: WPW Syndrome.What is the Rx-
a.Surgical ablation of the extra circuit
b. Radiofrequency ablation of the abnormal tract
Ans: B.
CNS:
A pt. present with ptosis of left eye, left side sensory loss of face. Left side gag reflex was
absent, Rt. Sided hemiparesis and incoordination of Rt. Upper and lower limb.Where is the
lesion?
a.Middle Cerebral Artery
39 | P a g e ps
GIT:
A baby has jaundice just after delivery. Mother is Rh ve, baby also Rh ve. Coombs Test is
ve.What may be the Dx?
a.Autoimmune condition
b.ABO incompatibility
c.Rh incompatibility
Inheritence:
WOF is X linked Recessive?
Haemophilia .
CNS:
WOF is a feature of Parkinsonism-
a..Loss of postural reflex
b.Hyperreflexia
c.Hypotonia
d Wide based gait.
Ans: A.
CNS:
WOF is not a feature of Lacunar Infarct?
a.Fascicultion
b.Spasticity
c.Face weakness(sensory loss of face)
d.Difficulty in walking
e.Increase Reflexes
Lacunes are small fluid-filled cavities, < 1.5 cm in diameter, which are found in the basal ganglia,
the thalamus, the internal capsule, the pons and the cerebral and cerebellar white matter. They
40 | P a g e ps
are the result of infarction secondary to the occlusion of the small penetrating branches of the
major intracranial arteries. They are frequently multiple.
CNS:
A patient who was previously well comes to you with complains of weakness for last 2 weeks,
his reflexes in lower limbs are absent though in upper limbs are normal. What will be the CSF
findings-
a.Elevated protein, elevated glucose, elevated leucocytes
b.Elevated protein, normal glucose,leucocytes< 5ml
c.Normal protein,normal glucose, leucocytes>5ml
d.No ignificant abnormality
Ans: B.
Infection:
All of the following are feature of ROSS RIVER, Except- ****
a.Chest pain
b.Muscle pain Davidson-107
c.Fever
d.Lathergy
e.Arthralgia
Ans: C.
Cushing Synd. + Hyperthyroidism- worst combination
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Drugs:
WOF drugs have strongest negative ionotropic action:
a.Digoxin
b.Dopamine
c.Adenosine
d.Deltiazem
Ans: D.
CCB: Diltiazem
Metabolism:
In Haemochromatosis, WOF will suggest diagnosis?
a.Serum Fe
b.Serum Ferritin
c.Iron daturation
d.Serum transferrin
GIT:
After screening with faecal blood test WOF is the correct percentage of detection of Duke A1
colonic carcinoma: Scott-323
a.<3%
b.15% ( Duke A-tumour confined to bowel wall-survival 90%)
c.25%
d.50%
e.75%
Ans:
Which ONE of the following is a mass population screening test which has been
demonstrated to reduce cancer mortality significantly?
Incorrect.
There have been at least 3 randomised control screening trials conducted which
show that faecal occult blood testing every 1-2 years in the over 50 year population
reduces the mortality from colorectal cancer by around 20%.
Colposcopy is a diagnostic, not a screening test.
The appropriate screening test for cancer of the cervix in sexually active women is the
Papanicolaou (Pap) smear. Plasma CA125
levels may be raised in asymptomatic women with ovarian cancer but there is not, as yet, any
evidence for its benefit as a mass screening measure. Colonoscopy for
siblings of patients with colorectal cancer may reduce their mortality, but this is
'selective' screening, by targeting a high-risk group.
While mammography in the 50-70 age group has been shown to reduce mortality
from breast cancer by around 30%, the benefit for women in the 40-50 age range is
quite small, and there is little evidence for benefit in still younger women.
Endocrine:
WOF is a feature of Thyrotoxicosis?
a.Fine tremor
b. Distal myopathy
c.Small muscle weakness
Ans: A. JM p.294
* Rest tremor
o Parkinsons disease
* Postural and action tremor
o Essential tremor
* Exaggerated physiological tremor
o Hyperthyroidism
o Drug-induced (eg -agonists)
o Dystonic tremor
* Intention tremor
o Cerebellar disorders
Infection:
A 40 yrs old man comes with short history of malaise and cachaxia when he was on a short
trip to Bangkok.His wife thinks he is suffering from jaundice. Now he presents with fever and
chills.Blood tests shows: S. Bilirubin- increased, Alk Phos- Much increased, AST-Slightly
increased, ALT- Slightly increased.What is the Dx?
43 | P a g e ps
a.Viral Hepatitis
b.Cholengitis
c.Malaria
Endocrine:
A lady comes to you with low BP (100/65), Pulse 120/minute. She complains of pigmentation
specially around her breasts.WOF is your Dx:
a. SIADH
b. Addisons disease
c. Hyperaldosteronism
(In Oct.05 : Pt. presents with lathergy, mucous membrane pigmentation and K+ : increased,
Na+:123 mmol/L(decreased)BP- low and low glucose)
Ans: B.
Hyperpigmentation and electrolyte disturbance absent in secondary.
hematology:
A 54 yr old man has CRF, his MCV is 80-90.It falls even more after treatment with
Erythropoietin; when the therapy was stopped he becomes anaemic within two months. His
condition is due to-
a.Fe def. Anaemia
b. Vit B12 def.
c.Folic acid def.
d.Bone marrow fibrosis
e.Red Cell atypia
CVS:
WOF is associated with ASD-
a.Diastolic murmur
b.Wide fixed split S2 all muscle weakness.
Ans: B.
Endocrine:
A 34 yr old lady complains of weight loss. She says that she has lost interest in day to day
activities, and she feels hot. Her husband says that her wife has become moody & irritable.
Her conditions most probably due to-
a.Hypoythyroidism
b.Hyperthyroidism
44 | P a g e ps
Ans: B.
Alcoholism:
Treatment of Alcohol withdrawl hallucination-
a.Diazepam
b.Halloperidol
Ecstasy is very popular in Australia, commonly used by youngs; its properties are similar to-
a.Cocaine
b.LSD
c.Methamphetamines
d.Diazepam
CNS:
Treatment of Trigeminal Neuralgia-
Carbamezepine
Ans: Amytriptyline.
Rh:
Feature of Temporal Arteritis: Patient with loss of vision which lasted for few minutes.WOF is
correct?
a.Temporal arteritis
b.Lacuner infarct
c. Carotid artery stenosis
CNS:
A 38 yr old lady with dull contineous headache, could not do her daily work. Most appropriate
Ix-
a.ESR
b.USG
c.CT Scan
Ans: C
Endocrine:
45 | P a g e ps
Ans:
GIT:
Patient with ileal resection causing increased INR. WOF is correct-
a.Non absorption of Vit. K (Normal INR 0.9-1.2)
b.Bleeding disorder
Hematology:
A patient with INR 2.1: An old man is on Warfarin and now he is discovered with a resectable
colon cancer. Management:
Stop Warfarin and start low dose Heparin; operate when INR is normal
Warfarin should be stopped before 4 days.
Clopidogrel should be stopped before:
CNS:
A 29 yr old woman developed severe paroxysm of pain in check and lip lasting for about 15-20
minutes. There is loss of sensation in trigeminal nerve area. Most likely Dx-
a.Tic dorulex
b. Trigeminal neuralgia
c.Multiple sclerosis
d.Migraine without aura
Ans:
CNS:
A man presents with sudden onset of Horners syndrome, 9 & 10 nerves palsy and loss of
touch and temperarure sensation on the opposite side of the body. Where is the site of
lesion?
a.Vertebrobasilar artery
b.Basilar artery
c.middle cerebral artery
d.Vertebral artery
e.Carotid artery
Ans: B.
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CVS:
A labourer who is a heavy smoker find difficult to perform his duties and worried about his
physical conditions. On examination there is ankle oedema, raised JVP, huge hepato-
splenomegaly and ascitis WOF is likely- (May05)
a.Cirrhosis
b.Costrictive pericarditis due to previous tuberculosis
c.SVC obstruction
d.Budd Chiari Syndrome
Ans: B.
47 | P a g e ps
Constrictive Pericarditis:
Signs include:
* small pulse:
o pulsus paradoxus
o atrial fibrillation
o tachycardia
* Kussmaul's sign (a raised JVP with inspiration); dominant y descent and trough
* cardiac impulses: barely palpable; characteristic is systolic retraction at the apex
* pericardial knock (loud-high pitched S3) following S2
* hepatomegaly
* ascites
* ankle swelling
BuddChiary :
* hepatomegaly
* splenomegaly
* mild jaundice
* ascites
* portal hypertension
* negative hepatojugular reflex
CNS:
A 57 yr old lady develops sudden onset of left sided weakness and right eye blindness.This is
most likely due to-
a.Vertebro-basilar insufficy
b.Pituitary tumour
c.Carotid artery stenosis
d.Cerebellar lesion
e.Retinal detachment
Ans: D.
48 | P a g e ps
RS:
Pleural Effusion: Typical presention. Stony dull on percussions, bronchial breath sound above
the area, restricted movements on the affected side.
Hematology:
A pt. was on warfarin, he developed haematemesis and melena. His INR is 10 times
normal.WOF should be the management? (Sept.05)
a.Fresh plasma infusion
b.I/V Fluids
c. Oral Vit-K
d.Transfuse blood
e.Intra muscular Vit-K
Ans: FFP
Inheritance:
A baby with Downs syndrome is born to a couple who definitely refuse to take the child home
after failure to convince them.The most appropriate course of action:
Arrange temporary foster care
Ans: A.
49 | P a g e ps
2007
Hematology:
A sudanese boy came to you after administration of Co-timoxazole with the complaints of
pallor and increasing darkness of colour of urine. His reticulocyte count was 8%. His Coomb's
test was negative, no family history and on electrophoresis Type A hb was detected. What is
the Dx?
a. Hereditary Spherocytosis
b. G6PD def
c. Autoimmune HA
d. Sickle cell anaemia
e. thalassaemia
Ans: B.
CVS:
An old man who suddenly collapsed was unconscious for three minutes following which he
recovered fully. 5 ECG rhythm strips given. Which could possibly explain his situation?
a. 1st deg. HB
b. 2nd deg HB
c. VF
d. Complete HB
e. LBBB
Ans: D.
Drugs:
One ECG which has digitalis effect on it. DX?
Drugs:
Drug combinations causing anuria:
A. Ramipril, NSAID and frusemide
B. Simvastatin, NSAID and frusemide
C. Ramipril, NSAID and slow IV K+
RS:
A typical CXR of lobar consolidation. What is the org?
A. strep pneumonia
50 | P a g e ps
Ans:
CNS:
A man came with ipsilateral horner's syn., cerebellar S/S, dissociated sensory loss. (I could
diagnose the case as having lateral medullary syndrome). which artery is involved?
A. Ant communicating artery
B. Post. cerebral artery
C. Post inf. cerebellar artery
d. ant. spinal artery
Ans: PICA
CNS:
What is the mechanism of TIA when there is carotid stenosis?
A. Embolim from the artery
B, transient spasmodic occlusion of the artery
C. Transient hge following increase in carotid artery pressure
Ans: A.
RS:
Another repeated ques. (and confusing as well!!): Which org does not cause lung abscess"
A. Staph aureus
B. P. carinii
C. M. pneuminiae
D. M. TB
Ans: B.
Endocrine:
S/S of thyrotoxicosis: (I read this topic very carefully, but that did not help to avoid confusion in
the hall. they are so cheeky!!!)
A. coarse tremor
B. Wasting of the small muscles of hand
C. Narrowing pulse pressure
D. widening of pulse pressure
Ans: D.
Infection:
51 | P a g e ps
Ans: C.
CNS:
A picture of a man protruding his tongue. It showed wasting on the right side. What will be
correct for this.
A. Left sided lesion and tongue veers to left
B. left lesion-tongue veers to right
C. right lesion and tongue veers to right
D. right lesion and tongue veers to left
Ans: C.
Emergency:
When two rescuers available, what is true regarding CPR?
A. 15:2 should be the compression rate
B. response should be checked evey 2 min
C. chest compression should be on mid chest
D. There should be 2.5 cm chest compression each time.
Ans:
A COPD pt was admintered O2. After sometime he was found unconscious. What could be the
blood picture like?
A. PaCO2 100 mmHg, PaO2 82mmHg, PH 7.22
B. PaCO2 75 mmHg, PaO2 72mmHg, PH 7.32
C. PaCO2 28 mmHg, PaO2 100mmHg, PH 7.52
D. PaCO2 45 mmHg, PaO2 50mmHg, PH 7.22
Ans:
52 | P a g e ps
A patient present with headache, prominent supra orbital ridges, prognathism, wide teeth
spacing, thick spade like hands, and seborrhoeic, coarse, oily skin. Which of the following is
the best investigation to establish a diagnosis?
a- Insulin + glucose tests
b- X-ray of the pituitary fossa
c- Cranial CT scan or MRI scans
d- Serum T4+PRL+growth hormone tests
e- Oral glucose tolerance tests
A pregnant lady presents with a widely split S2, cardiomegaly, systolic murmur best heard at
pulmonary area, and a diastolic murmur in tricuspid area. Which is the most likely diagnosis?
a- Atrial septal defect
b- PDA
c- VSD
d- Pulmonary stenosis
e- Aortic stenosis
Ans: ASD.
Diastolic Murmur due to Functional TR.
A 45 yrs old woman about to undergo cholecystectomy has a history of bleeding tendency,
increased bleeding time, but a normal platelet count. Which of the following are indicated
prior to surgery?
a- Vitamin K
53 | P a g e ps
Ans: B.
vW disease.
Ans: A
A 28 yrs old female presented with a history of hypertension. Which of the following tests is
best for assessing the structure and function of her kidneys?
a- IV pyelogram
b- Renal ultrasound
c- Renal x-ray
d- CT scan
e- MRI
Ans: A.
In a paraplegic patient suffering from overflow incontinence, which is the best management?
a- Continuous catheterization
b- Suprapublic catheterization
c- Intermittent self-catheterization
d- Suprapublic puncture of bladder
e- Permanent cystostomy
Ans: C.
Ans: B.
Management of myocardio infarction with interior, inferior infarction on ECG, first step in
management includes:
54 | P a g e ps
Ans: C.
Ans: E.
A patient with congenital spherocytosis soon after splenectomy will have the following in the
peripheral blood film.
a- Leucocytosis
b- Increase plate less count
c- Spherocytes
d- Decrease survival of RBC
Ans: C.
Ans: B.
Ans: A
c- Chlorpromazine
d- Digoxin
e- Aspirin
Ans:
* phototoxicity - the most common; caused by phenothiazines, amiodarone, thiazides,
NSAID's, quinine, tetracyclines, sulphonamides, retinoids, psoralens, fluoroquinolones,
griseofulvin, chlorpromazine, prochlorperazine (1)
* photoallergy - sulphonamides, phenothiazines, thiazides, pyridoxine, griseofulvin, quinidine,
sunscreens, antibacterial agents (1)
* lupus erythematous - hydralazine, procainamide, thiazides
* pseudoporphyria - frusemide, nalidixic acid, amiodarone, ciprofloxacin, bumetanide, NSAID's
* lichen planus - thiazides, quinine
* pellagra - isoniazid
The reduction in road crash mortality rates in Australia over the past 15th years is mainly
attributable to:
a- Health education in media and schools
b- Legislative enactments such as seat belts, helmets and alcohol controls
c- Improvements in retrieval services, including the use of helicopters
d- Improvements in highway design and intersection construction
e- Improvements in intensive care and other hospital based services
Ans: B.
In a 72 yrs old patient with non insulin dependent diabetes mellitus who does not achieve
satisfactory glycaemic control with diet the drug of first choice is:
a- tolbutamide
b- Metformin
c- Chlorpropamide
d- Glibenclamide
e- Gliclazide
A 30 yrs old patient presents with severe dandruff and pruritus of the scalp. Scaling also
affects his eyelids. The most likely cause is:
a- Physiological dandruff
b- Psoriasis
c- Atopic eczema
d- Seborrhoeic dermatitis
e- Contact dermatitis
56 | P a g e ps
Ans: C.
Sickle Cell anemia.
A 46 yrs old man suffered his first myocardial infection. Recovery was uneventful. Two days
after admission to hospital, the patient fasting blood glucose was 5.8mmol/L (upper limits of
normal 6.2mmol/L); a 2 hours postprandial blood glucose was 8.3mmol/L. Four weeks later an
oral glucose tolerance test was performed with the following results- fasting 6.5mmol/L, 1hr
9.0mmol/L, 2hr 7.2mmol/L. Blood glucose values in this patient indicate:
a- Definite diabetes mellitus
b- Possible diabetes mellitus
c- Normal tolerance
d- Reactive hypoglycemia
e- Functional hyperinsulinism
Ans: B (Harrison).
The clinical features of SLE are necessarily variable as many systems may be involved.
* fever
* malaise
* fatigue
* weight loss
Lymphadenopathy occurs in about half of cases, often in association with hepatomegaly. About
one third of patients complain of myalgia and myositis. In women, disease may be exacerbated
by menstruation and pregnancy.
* haematological 95%
* joints 95%
* cutaneous 80%
* pulmonary 65%
58 | P a g e ps
The daughter of a rather confused 78 yrs old woman asks if administration of her mothers
drugs could be simplified by taking them with meals. Which one of prescribed drugs should
not be taken at meal time?
a- Digoxin (Lanoxin)
b- Frusemide (Lasix)
c- Potassium chloride (Slow K)
d- Glibenclamide (Daonil)
e- Phenytoin (Dilantin)
Ans:
A 48 years old man complains of anorexia and tiredness of a few months duration months
earlier routine physical examination and urinalysis were normal. Examination at this time
shows slight tenderness over the second and third lumber vertebrae. The blood pressure is
120/76 mmHg.
Laboratory studies reveal: hemoglobin- 5.0 g/dl
Urea - 16mmol/L
Urine - protein 4+
- Many hyaline casts
-no red cells
What is the probable diagnosis?
a- Chronic pyelonephritis
b- Multiple myeloma
c- Gouty nephropathy
d- Rapidly progressive glomerulonephritis
e- Carcinoma of the prostate with spinal metastases
You suspect a 19 yr old man of having infectious mononucleosis. You should be:
a- take a throat swab for culture and sensitivity testing
b- Order a blood film examination and appropriate immunological tests
c- Examination his urine for albumin and cells
d- Advised bed rest, fluids and aspirin
e- Administer penicillin IM and/or orally
The current most commonly prescribed drug in Australia (from the Pharmaceuticals Benefits
Scheme) is:
a- Salbutamol
b- Levonorgestrol and ethinyloestradiol
c- Diclofenac sodium
d- Amoxycillin
e- Diazepam
A 30 yrs old man consults you, during morning surgery with a two history of weakness, visual
disturbance, thirst and polyuria. He has lost 2 kg in weight and yet find that he has 2%
glycosuria and ketonuria?
Which of the following should you first arrange?
a- Micro culture and sensitivity of urine
b- Fasting blood glucose estimation
c- Oral glucose tolerance test
d- Admission to hospital for stabilization
Ans:
You are requested to visit a 77 yrs old man who is visiting his relatives from inter and who is
complaining of back pain following a long motor journey. On arrival 30 minutes later you find
that the patient is dead. He had complained of right sided back pain at level of thoracic spine
radiating the lower ribs into the epigastrium. Then over a period of 15 minutes he became very
pale, short of breath, sweated profusely and diet. His relatives state that he had been in very
good health but having treatment for hypertension with Hygroton 25 mg daily (Chlorthalidone).
You should:
a- ring his local doctor and request him to issue a death certificate
b- Issue a death certificate stating that the patient died from myocardial infarction
c- Issue a death certificate stating that the patient died from massive pulmonary
d- Issue a death certificate stating that the patient died from a reputed aorta
60 | P a g e ps
When managing a patient in whom the diagnosis of asthma has been made for the first time, it
is indicates to the patient that:
a- there are two types of asthma, extrinsic and intrinsic
b- Asthma usually has an inherited basis
c- Asthma can be a chronic or recurring problem
d- Immediate improvement can be expected with treatment
e- Recent advances have provided a cure for the complaint
Susan Smith, aged 35, complains to you of pain in her right hand for the past months. The pain is
centered in the palm but radiates up the forearm at time when the palm is bad, the fingers of
the right hand seem dead. All her symptoms worse at night and often wake her. They are
especially bad premenstrually. Which one of the following tests or features is most likely to
assist in youre:
a- Froments sign
b- Tinels sign
c- Finklesteins test
d- Claw hand
e- Horners syndrome
A patient who is treated for the cancer of the breast presents with bone pair that resolves with
prasitamol. Bone x-ray shows sclerotic lesions. How
Should it:
a- temoxiles
b- Teraldocyamaciation
c- Localized irradiation
d- Chemotherapy
e- Chemotherapy with radiation
In a patient with cardio arrest, what medication should you give first?
a- adrenalin
b- Lignocaine
c- Atropine
d- Sodium bicarbonate
e- Isoprenaline
An 8 yrs old boy was stuns by a bee. He had difficulty breathing and facial oedema. What is the
best treatment?
a- IV adrenalin
b- IV antinistamine
c- IV hydrocorlsone
d- IV fluids
e- SC adrenalin
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A patient with a dorsal column spinal cord lesion most typically presents with:
a- ataxia
b- Peripheral neuropathy
c- Romberg positive
d- Muscle weakness
e- absent reflexes
A patient with chronic obstructive airways disease was confused and was given 10L/min oxygen
in the ambulance. He is now unresponsive.
Which is likely result of an ABX taken now?
a- PO2 40 PCO2 100 pH 7.35
b- PO2 100 PCO2 10 pH 7.40
c- PO2 60 PCO2 45 pH 7.50
d- PO2 40 PCO2 100 pH 7.15
e- PO2 100 PCO2 60 pH 7.25
(A Type)
Which of the following drugs are used in reducing pressure gradient in hypertrophic obst Cardio-
myopathy ?
a- frusemine
b- Digoxin
c- Veraparil
d- Captopril
e- Prazosin
(A Type)
Which of the following is the best indicator of developing R/heart failure in COAD?
a- hypoxia
b- Hypercapnea
c- Reduced FVC
d- Increased JVP
e- Liver enlargements
(A Type)
Which of the following helps in the management of long term asthma? Except:
a- ipratropium bromide
b- Salbutamol
c- Corucsteroids
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d- Sodium chromogivcate
e- Epinephrine
(A Type)
Which of the following can cause hyperkalemia?
a- verapamil
b- Enalaphril
c- Digoxin
d- Chlarothiazide
e- Amiloride
(J Type)
Which of the following drugs can potentiate digoxin toxicity?
a- cimetidine
b- Amiodarone
c- Verapamil
d- Disopiramide
e- B blocker
(J Type)
Which of the following drugs causes photosensitivity?
a- amiodarone
b- Phenothiazines
c- Sulphonarmide
d- Digoxin
e- Aspirin
(J Type)
Which of the following statements are correct?
a- left pneumathorax shifts trachea to the right side
b- in emphysema you find inspiratory crackling and clubbing of fingers
c- in pleural effusion the percussion sound is dull
d- in collapse middle lobe moves to the affected side
e- in consolidation there is a branchial breath sound
A man presents with increase thirst constipation and abdominal. He has squamous cell
carcinoma of the lung. Which of the following most likely?
a- hyperglycaemia
b- Mappropriate ADH secretion
c- Hypercalcaemia due to parathormone-related peptide
d- Hypokalemia
e- Secondaries to brain and abdomen
How can you differentiate between haemolytic anemia and anemia due to blood loss?
a- Decrease in heptoglobin
b- Increase in reticulocytes
c- Polychromasia
d- Decrease in ferritin
e- Megalobastosis
A male patient started on a new medication. He developed breast enlargement. Which drug is
the least likely cause/
a- Spironolactone
b- Cimetidine
c- Digoxin
d- Frusemide
e- Alpha methyldopa
Other question with digoxin as the answer. All of these are negative ionotropic. Except:
a- propranolol
b- Calcium channel blocker
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c- Digoxin
d- Guanidine
e- Verapmil
Photo of a lesion on the face (see AMCMCQ-book!). Hemi-face covered in naevus flammeus.
What is most likely association?
a- Epilepsy
b- Cerebellar syndrome
c- Optic neuritis
d- Spasticity
e- Hemiplegia
Another photo from the AMC book. Boy with 3 truncal lesions +/- one facial one. What is the
diagnosis?
a- Microspora canis
b- Lichen discoid
c- Pityriasis rosea
d- Psoriasis
e- SLE
A 60yrs old male patient has difficulty climbing upstairs. O/E he had wasting of right biceps,
diminished biceps jerk, lower limb spasticity, lower limbs reflexes exaggerated and Babinskis
sign present, hip flexion weak. What is the most probable diagnosis?
a- Cervical disc lesion
b- Lumbar canal stenosis
c- Motor neuron disease
d- Multiple sclerosis
e- WPW syndrome
A man on anti-hypertension therapy goes for surgery. Discontinuation of which of the following
drugs causes serve rebound hypertension during operation?
a- Enalapril
b- Clonidine
c- Methyldopa
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d- Hydralazine
e- Verapamil
A woman complaining of episodes of intense pain over the lower jaw and zygomatic bone
lasting for about 2-5 min which has been going for 2 weeks.
There are no trigger zones and on examination there is sensory loss on the same side. Which of
the following is the most likely diagnosis?
a- Multiple sclerosis
b- Trigeminal neuralgia
c- Migraine
d- Facial palsy
e- Herpetic neuralgia
A man with multiple episodes of sore throat developed periorbital edema, BP of 160/120,
oliguria, which of the following is correct?
a- Giving water corrects oliguria
b- Hematuria is a prognostic indicator
c- Vancomycin
d- Sulphonamides
e- Tetracyclines
A child is presents with long history of unexplained productive cough and wheeze. He is failing
to thrive (signs of malobsorbtion). What is your initial investigation?
a- Stool exam
b- Chest x-ray
c- Sweat test
d- Blood exam
A child is who was well before developed malaise and now he has fever 40c. 3 days ago he falls
from tree. Mother noticed that he limped. His thigh is swollen there is an area of pain and
tenderness. What is the likely cause?
a- Fracture
b- Thrombophlebitis
c- Ca of bone
d- Osteomyelitis
A child is presents with sudden onset of high fever. He is unable to drink or swallow. He is
stridor. Sever epiglottitis has been diagnosed. What is your management?
a- Antibiotics
b- Intubations may be required
c- Throat should be examined
A 76 yrs old man is investigated for a complaint of weakness. The hematological report shows:
,, Platelets 382*10, MCHC 23%, WBC 12*10Hb 5.6g/100ml, MCV 72u
ESR 46mm/1 hour.
The film shows a marked hypochromia, a moderate, marked polkilocytosis, slight Polychromasia,
mature neutrophils, reticulocytes 3%
The mortality from the initial blood of a ruptured intracranial aneurysm is about:
a- 3-5%
b- 5-10%
c- 20-35%
d- 70-90%
e- 95%
A 27 yrs old woman in her tenth week of pregnancy was found on a colonles/ml. She wasmid-
steam urine culture to have Ecoil 10 asymptomatic. Which of the following should be considered
next?
a- Intravenous pyelogram
b- Repeat of urine culture and antibiotic therapy if the same organisms are present
c- No further investigation
d- Investigation after delivery
e- Immediate antibiotic therapy
Creatinine clearance:
a- Is an accurate measure of renal tubular function
b- Requires measurement of only the urine creatinine concentration
c- Cannot be measured in the nephrotic syndrome
d- Approximatles to the glomerular filtration rate
e- Measures the total body pool of creatinine
A 27 yrs old woman presents with increased frequency of nucturition including nocturia over the
recent three weeks. Over this time she has been thirsty and lethargic. Which one of the
metabolic derangements is least likely to present in this way?
a- Hypokalemia
b- Diabetes mellitus
c- Antidluretic hormone deficiency
d- Hypercalcemia
e- Dilantin toxicity
What is absolute contraindication for the use of nicotine patch (Nicorette patch)?
a- ?
b- ?
c- Co morbid heroin use
d- Pregnancy
Which nerve gives the sensation of the taste of first 2/3 of tongue?
a- Facial N.
b- Hypoglossal
c- Glossopharyngeal
d- Trigeminal N.
Diabetic man on combined therapy ACE, glibencamid (Daonil), metformin, benzodiazepine and
tricyclic antidepressants. Which of the following drugs will have effect on his impotence?
a- ACE
b- Glibencamide
c- Metformin
d- Benzodiazepine
e- TCA
Abattoir worker developed pain, sweating and red urine. What is most likely?
a- Brucellosis
b- Leptospirosis
c- Hepatitis
d- Tularaemia
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75yrs man with long standing COPD (H/O 60 pack/year?) has been brought to by ambulance
from nursing home. On his way to hospital he received Oxygen 10L/min by mask. On admission
he is unarousable and his ABG most likely will be:
a- PaO2 85 PaCO2 65 PH 7.15
b- PaO2 68 PaCO2 50 PH 7.45
c- PaO2 100 PaCO2 25 PH 7.25
d- PaO2 40 PaCO2 85 PH 7.45
e- PaO2 60 PaCO2 40 PH 7.35
Which statement best describe relation between glycaemia control and diabetic retinopathy?
a- Strict control of glucose can prevent diabetic retinopathy
b- Good control can delay diabetic retinopathy
Woman with a prolonged bleeding. Brother and father said she is a bleeder. Most likely is:
a- Von Willebrands disease
b- Hemophilia A
c- Lack of factor IX
d- Stuart disease
d- Warfarin
e- Chlorpromazine
In a patient presenting with lacunar infarction, which of the following are true?
a- Sensory loss only
b- Dysphasia
c- Due to an aneurysm
d- Haemorrhage from the middle cerebral artery
e- ? Thrombo embolism may cause
A 28 years old male presents with distal weakness and atrophy of the small muscles of both
hands (interossei, lumbricals, thenar and hypothenar). What is the most likely diagnosis?
a- Multiple sclerosis
b- Bilateral median nerve palsy
c- Syringomyelia
d- Bilateral ulnar nerve palsy
e- Brainstem infarction
A female age 23 yrs, presents with proteinuria. There is a previous history of enuresis till 13
years of age. Her sister also had enuresis as a child. The history is suggestive of which of the
following?
a- Chromic glomerulonephritis
b- Reflux nephropathy
c- Congenital nephritis
d- Polycystic kidney disease
e- Analgesic nephropathy
d- Mumps
e- Varicella
A 68 years old female presents with a 2 week history of unilateral headache and an ESR
8omm/hr. The most appropriate treatment is:
a- NSAIDs
b- Aspirin
c- Carbamazepine
d- Prednisolone
e- Ergotamine
A 70y old lady has recurrent superficial thrombophlebitis and DVT. She has been
treated with anticoagulants, warfarin AND aspirin, but it still occurs.
A. She has small cell lung cancer
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Ans: E.
This is a recurring thrombophlebitis characterised by successive crops of tender nodules in
affected blood vessels. Different veins may be affected simultaneously or randomly. It denotes a
thrombotic state and is associated with visceral malignancy, especially of the pancreas and lung.
The basis is unknown.
Thrombophlebitis migrans was first recognised by Trousseau in the diagnosis of his own
pancreatic cancer.
Ans: D.
If a patient suffers repeated spontaneous pneumothoraces then a pleurodesis or pleurectomy
should be considered.
gp notebook