ecthyma gangreneosum

-*- : )

80. 18
4 V/S BT 36.5 BP80/50 PR120 CBC
Hct 58% WBC2600 N12 L80 M6 E2 B0 plt 35000
Treatment?
a. Dopamine
 b. Cef-3 d. doxy 7
c. NSS loading e. quinine 3
d. Dexamethasone
e. Plt conc 86. 18 Grave’s disease 1
81. 35 white patch
HIV: positive CD4 250 Treatment? ?
a. Oral antifungal + Oral antiretroviral a. NSAIDs
b. Topical antifungal + Oral antiretroviral b.
c. Oral antifungal c.
d. Topical antifungal d.
e. Oral antiretroviral e. PTU
82. Oral hairy leukoplakia fundus 87. 18 3 TSH FT5
Dx? dx?
a. CMV Retinitis a. Simple goiter
83. 10 b. Hashimoto thyroiditis
14 TB LN PE ( ) : c. Grave’s disease
, CXR PPD+ 10 mm BCG scar d. Iodine deficiency
Manage?? e. Subacute thyroiditis
a. INH 9 88. 20 wk T4 T3
b. INH 6 TSH Dx
c. F/U 9 a. Grave’s disease
d. INH + rifampicin 6 mo b. molar preg
e. INH + rifampicin 9 mo c. Gestational Goiter
84. 3wk 2 PE d. Gestational thyrothoxicosis
tonsil 2+ with exudate CBC hct 36% wbc 1000 e. Toxic multinodular goiter
cell/cumm platlet 250000 89. on Glipizide 2 mg Hypoglycemia ,
a. amoxiclav Creatinine rising Management?
b. ceftazidine a. Metformin
c. G-CRF b. Glipizide
d. corticosteroid c. insulin
85. 3 2 90. 60 6
PE: tender at lumbo-
a. sacral spine Lab : Ca 14 Phosphorous 14 BUN 35 Cr
b. 2.5 investigate
c. fansodar 3 a. Parathyroid hormone

NLE_step_2_2011_NCTMS Page 10
 b. PSA stool exam no RBC, no WBC , no
c. U/S KUB parasite
d. MRI spine a. colitis
e. Bone Marrow aspiration b. hyperthyroid
91. 45 2d LFT c. colon CA
increase IX d. Irritable bowel syndrome
a. Abd USG 96. HBsAg –ve HBeAg –ve
b. CT Abd antiHBcIgM +ve antiHBcIgG +ve antiHBsIgG +ve dx?
c. ERCP a. Acute hepatitis B infection
92. b. Asymptomatic HBV carrier
Dx? c. Post immunization
a. G6PD def d. Post infection
b. HBsAg e. Chronic hepatitis B infection
c. HAV 97. 25 1
d. Drug side effect abscess
93. PE : Shifting dullness +ve, Fluid methicillin paracetamol 7
thrill +ve Ascitic fluid : albumin 1.1 , WBC 200 2
(Lymphocyte predominate), exudates serum albumin 1 PTA PE : BT 38.1 c, Difused
2.5 mg/dL erythematous skin rash at trunk and extramities, UA : sp.gr
a. Constrictive pericarditis 1.020 , pH 6.5, Blood 1+, Protein 1+, Glucose –ve,
b. Cirrhosis portal hypertension Ketone –ve, WBC 10-20, RBC 1-5 Diagnosis?
c. Carcinogenic a. UTI
d. SBP b. ATN
94. Case 50 1 c. Analgasic abuse nephropathy
2 wk markedly d. Drug induced interstitial nephropahy
jaundice ,liver 6 cm BRCM impalpable gallbladder e. Post-infectious glomerulonephritis
98. JVD faint heart sound dx?
a. CBD stone a. TB pericarditis
b. HCC b. Heart failure
c. Hilar cholangiocarcinoma c. Infective endocarditis
d. pancreatic head CA 99. 70 U/D : HTN, DLP, DM on HCTZ,
e. Ampullary CA Thiazide, Enalapril, ASA, Simvastatin, Fenofobrate 1
95. 35 3-4 4 6 2

2 tender 2

NLE_step_2_2011_NCTMS Page 11
 PE : normal 104. 82
? orthostatic hypotension
a. ASA
b. Thiazide a. Hypovolemia
c. Enalapril b. AS
d. Fenofibrate c. Coronary disease
e. Simvastatin d. Cardiovascular disease
100. 40 5-10 105. 35 3 d no U/D, on OCP 1
km(30 ) PE: pitting edema Lt. leg, pain on ankle extension Homan
2 BT40 sign positive plan?
PR120 BP160/100 RR30 no focal a. U/S Positive Heparin
neurological deficit Dx? b. U/S Positive d dimer
a. Heat stroke c. d dimer Positive U/S
b. TIA d. d dimer Positive Heparin
c. Acute MI e. Heparin U/S
d. Pulmonary embolism f. LMWH warfarin
e. Intracerebral hemorrhage 106. 30 PE: mild pale,
f. Subdural hematoma moderate jaundice LAB : Hct 25 Hb 8 WBC 8500 plt
101. EKG tall peak T management 250000 polychromasia, microspherocyte
manage
a. Calcium gluconate a. splenectomy
b. insulin+glucose
b. IVIg
c. kalexalate
102. 73 c. corticosteroid
BP 200/110 PR110 RR28 Heart : normal d. blood transfusion
s2 s2 with s3 gallop Ext: pitting edema both leg 107. 60 sepsis
a. Captopril Mildly pale ,Jaundice ,petechiae
b. Digoxin iv CBC : Hct 30% Plt 30,000 PT 30 APTT 60
c. Nitroglycerine iv
103.
COPD a. Liver failure
a. Enalapril b. Factor inhibitor
b. Amlodipine c. ITP
c. Atenolol d. DIC
108. 25 6
1 PE:

NLE_step_2_2011_NCTMS Page 12
 Moderately pale, no jaundice, petechiae both legs CBC: c. Consumptive coagulopathy
Hb 8.5, MCV 90, Reti. Count 0.1%nnWBC 2,500 N10 d. vWB disease
L88 M2 plt 18,000 Dx? e. Chronic liver disease
a. Acute leukemia 112. 30
b. Aplastic anemia PURPURA, ecchymosis CBC: Hb/Hct WBC ,
c. AIHA Platelet30,000 Investigate ?
a. Dengue titer
d. ITP
b. Coomb’s test
e. MDS c. bleeding time
f. TTP d. Anti-HIV
109. 60 mens 2 e. Bone marrow aspirattion
2 wk PE multiple 113. 60 Gastric ulcer S/P
petechiae and ecchymoses Ix Hb 12 Hct 35%,WBC 9000 Gastectomy 10
Plt 200,000, aPTT 76, PT 12 CBC: Hb 6.0,Hct 18, MCV100 WBC
a. Mix coagulogram 4000(N60,L40), Plt. 180000 Mx=?
b. anticardiolipin A6 a. FsSO4
c. Corticosteroid b. Folic acid
d. IV vit K1 c. Vit. B6
e. FFP infusion d. Vit. B12
f. PRC e. PRC
g. Platelet f. Blood transfusion
h. VWF 114. PE :
i. Cryoprecipitating factor moderate pale anicteric sclera no hepatosplenomagaly CBC
j. Lupus coag
: Hb12 WBC N40 L50 E5 plt 250000
110.

a. RBC enzyme defect

a.
b. Antibody to RBC
b.
c. Defect of RBC skeleton
c.
d. RBC sensitivity to complement
d.
115.
e.
(Scaphoid abdomen) heart sound
111. breath sound CXR bowel chest heart
ecchymosis both legs no sign of chronic liver disease
Lab Hb WBC plt 50000 U/D a. congenital diaphragmatic hernia
40 Dx b. pneumonia
a. Factor VIII inh c. pneumothorax
b. Vit K def d. TE fistula

NLE_step_2_2011_NCTMS Page 13
 e. Congenital lung cyst d. CT abdomen
116. 2 e. Reassure advice Follow up at age of 50 because
no risk of CA colon
f. Sigmoidoscopy
a. 120. 12
b. 6 PE: Epigastrium
c. hCG tenderness, liver dullness with Generalized tenderness and
d. LNRH agonist guarding Diagnosis?
e. Orchidopexy a. PU perforation
117. 6 umbilical hernia 3 cm b. Cholecystitis
management c. Pancreatitis
a. Surgery at age of 1 yr 121. 60 melena 2
b. Surgery at age of 4 yr 2 BP
c. Surgery 100/80 fluid resuscitation investigate
d. Surgery ?
e. Surgery a. EGD
118. 60 b. NG lavage
PU 1 c. Colonoscope
pallor, anicteric sclera, abdominal distension, d. Proctoscope
Shifting dullness and fluid thrill positive, no e. CT scan
hepatosplenomagaly, Gastroscope gastric ulcer 3cm at f. Angiography
antrum CA stomach 122. 50
? 2
a. intermittent melena 3
b. Chronic dyspepsia PE : BT = 38.8 C BP = 100/70 mmHg , PR = 110
c. Large ulcer bpm , RR = 26 /min Abdomen : marked distened , Old
d. Location of ulcer surgical scar at middle abdomen , soft , Rt. Lower
e. Shifting dullness and fluid thrill positive quardrant guarding Frequent high pitch bowel
119. 45 sound. Diagnosis…???
a. PU perforate
bowel habit change b. CA colon obstruction
c. Strangulate small intestinal bowel
a. colonoscopy d. Diverticulosis perforate
b. stool occult blood e. Ruptures appendicitis
c. Barium enema f. Perforated cecal diverticulitis

NLE_step_2_2011_NCTMS Page 14
123. 65 16 e. Cystoscopy
PE : BT = 38.3 C , PR = 110 128. 70 T38, impact
bpm , RR = 24 /min , BP = 80/50 mmHg Abdomen feces, suprapubic mass with tenderness, enlarged prostate
: generalized with guarding , Rt. Upper quadrant with rubbery consistency, no neurological deficit
tympanic on percussion ?
a. Broad spectrum antibiotic a. UA, Urine c/s
b. NG tube b. U/S abdomen
c. Rapid NSS c. acute abdomen series
d. Explore lap. d. LP
124. 70 e. CT brain
BE apple core appearance 129. 65 6
a. CA sigmoid colon 1 suprapubic mass prostate
125. 90 U/D
gland enlargement Cr 1.8
admit
a. Furosemide
iv
b. Retain Foley catheter
c. 5 alpha reductase inhibitor
a. iv
d. Cystostomy
b. TPN
e. TURP
c. NG feed
130. 40
d. Gastrostomy feed
UA sp gr 1.015 glucose –ve protein –ve WBC
126. 62
10-20 RBC 50-100 dx
mass introitus
a. Ureteric stone
incontinence
b. Bladder stone
a. stress incontinence
131. (
b. urge incontinence
) Postural drainage
c. overflow incontinence
pneumonitis segment lower lobe
d. continuous incontinence
a. Superior segment
e. detrusor instability
b. Lateral basal segment
127. 30 1 Urine cath
c. Medial basal segment
20 cc. 1 PE : Full
d. Posterior basal segment
bladder , normal prostate Investigation
e. Anterior basal segment
a. Retrograde pyelography
132. 10 BW 60 kg Ht 145 cm
b. U/S KUB
1 DM PE :
c. Plain KUB
acanthosis nigricans at neck axilla and groin with whitish
d. IV pyelography
striae at abdominal wall FBS 95 plan Ix

NLE_step_2_2011_NCTMS Page 15
 a. Polysomnograph e. Platelet
b. Oral glucose tolerance test 137. 4 3
c. Insulin tolerance amoxy
d. Glucagon provocation test BT 38 LN
2 cm BRCM, 2 cm BLCM White patch at
e. Dexamethasone suppression test
tonsil 2 MP rash at extremities Dx?
f. Insulin tolerance a. infectious mononucleosis
133. 8 2 PE BT 38 PR 140 RR b. diphtheria
70 BP 70/50 mod subcostal retraction, fair air entry, c. drug allergy
crepitation both lungs, expiratory wheezing, capillary refill 138. appendiceal rupture
3 sec Mx? ATB PE : Palpable mass at RUQ
a. Adrenaline NB Management?
b. Salbutamol NB a. ATB
c. NSS loading b. Film acute abdominal series
d. ET tube c. Appendectomy
134. 7 ATB d. Explore laparotomy
10 139. PE: BT 37.8 RR 20 white patch at tonsils, cervical
PE : BP70/50 decreased breath sounds at Rt. Lung lymphadenopathy, liver 2 cm BRCM
a. Kawasaki
a.FB aspiration b. DHF
b.Pneumothorax c. Scarlet fever
d. Infectious Mononucleosis
c.Pleural effusion
140.
d.Ruptured mycotic aneurysm
a.
135. U/D Cyanotic CHD 7
BT 37.8 c, Central cyanosis, SEM gr. III/VI LUPSB, no
b.
weakness, BBK-present Lt. leg
a. Brain abscess
c.
b. Bacterial meningitis
c. TB meningitis
d.
d. Chronic subdural hemorrhage
136. 10
e.
141. 12 6 PE :
a. Fluid therapy
Erythematous patches on both cheeks, nose, purplish red
b. FFP
plaque over knuckles area of both hands, muscle power
c. Cryoprecipitate
proximal group grade 3, distal group grade 4
d. PRC

NLE_step_2_2011_NCTMS Page 16
 a. U/A e. molluscum
b. ANA 147. 3
c. Anti dsDNA child abuse
d. Skin biopsy a. Pulmonary edema
e. Electromyelography b. Retinal hemorrhage
142. 7 c. Healed fx clavicle
sodium valproate 600 mg 2 d. Purpura and petichiae
T 37 c, BP 140/90, RR 24, P 148. 5 ER 3 hr PTA
140, pupils 6 mm, sluggish reactive to light BE, DTR 3+, PE: ( )
Absent Barbinski reflex, 6th healed rib fracture Diagnosis?
a. mannitol a. Child abuse
b. Hydralazine 149. 5 3
c. 25% glucose PE
th rd
143. ( ) : BW 15 kg (10 percentile) , Height 90 cm. (< 3
Afebrile, BS+ve Investigate percentile), BP 90/60 mmHg, wide space nipple, cubitus
? vulgus Diagnosis?
a. Stool occult blood a. Hypopituitary
b. Stool for toxin b. Turner’s Syndrome
c. U/S c. Hypoparathyroidism
144. 10 ? d. Acquired hypothyroidism
a. MMR e. Constitutional delayed growth
b. JE 150. 9 7
c. Influenza PE : BT 38.oc, BP 110/70
d. DTP, OPV mmHg R 20/min, P 100/min, limitation of right knee
145. 10 mo 246 movement, mild swelling with marked tenderness at distal
part of right femur Ix?
a. MMR a. CBC
146. 2 3 b. ESR
PE : erythematous scale papule with central punctum c. CRP
hyperpigment + hypopigment macule d. Plain film both knees
dx? e. Bone scan
a. Ecthyma 151. Diag leukemia
b. Eczema
c. Impetigo a.
d. Insevt bite b.

NLE_step_2_2011_NCTMS Page 17
 c. a. ALL
d. b. NHL
152. 10 4 c. Rertinoblastoma
PE. t40 p120 r24 b100/70 d. neuroblastoma
stridor peritonsilar swelling &fluctuation 157. 10 puffy eyelid, pustular
lesion with scab
b. strep gr.A a. nephritic
b. IgA
c. HSP
158. 25 GA 29 wk
153. 1 1 HR 40bpm
apgar
5 cm
a. 0
a.Bleeding disorder b. 1
b.Intestinal Ischemia c. 2
c.Infection d. 3
d.Motility disorder e. 4
154. 14 3 159. 36 . Group A
kg/3 mo PE: BW 38kg Ht 155 FBS 250 TC256 TG180 Group O
HbA1C 8.5 Dx? a. Coombs’ test
a. IFG b. G6PD
b. DM c. Thyroid function test
c. Mixed DLP d. Liver function test
d. Hypertriglyceridemia 160. 2 wk ANC normal
e. hypercholesteralemia labor PE: Heart- Systolic thrill and mid systolic murmur at
155. 3 3 10 left 3rd ICS Diagnosis?
a. TOF
a. IQ b. ASD
b. Denver c. Bicuspid Aortic Valve
c. Hearing d. Coarctation of Aorta
d. learning e. PDA
156. 3 2 PE: mod pale anicteric 161. BW 1,800 g
scleras proptosis both eyes, bilat cervical lymphadenopathy, Cleft lip, Cleft palate PE: HC 30 cm, Systolic murmur,
gum hypertrophy, hepatosplenomegaly dx?

NLE_step_2_2011_NCTMS Page 18
 Omphalocele, polydactyly both hands a. Admit NPO ATB close observe
? b. Emergency explore lap
a. Congenital rubella c. observe clinda 7 d F/U Abd film
b. Triple X Syndrome
c. Turner syndrome d. observe F/U Abd film
d. Trisomy 13 e. emulsified paraffin F/U Abd film
e. Trisomy 18 167. 20 BP 90/70
162. Term 3,000 g NL PR 120 PE : pale fluid
12 hr MB15 Hct 38 PE: mild pale mod jx a. NSS
no hepatosplenimegaly Dx?? b. NSS/2 + NaCO3
a. Breast feeding jaundice c. 5%DNSS
b. G6PD deficiency d. 5%DNSS/2
163. Term 3,100 g BT 37.2 c P e. HESsteril
100/min RR 68/min, no hepatosplenomegaly Hct 40% 168. 8 1
Management? PE : BP 100/70 PR120 full pulse cap refill< 2 sec
a. ET intubation generalized wheal and flare swelling eyelids occasional
b. Septic w/o wheezing
c. 10% Dextrose a. NSS iv load
164. b. Iv chlorpheniramine
eosinophil Dx ? c. Iv hydrocortisone
a. milia d. Adrenaline 1:100 im
b. miliaria rubra e. Salbutamol NB
c. 3.pyoderma 169. 20 GCS
165. newborn BW 4500 g GDM C/S due to CPD E3M6V5 CT brain mild bilateral hemorrhage
active newborn, symmetrical movement, BS 35 mg/dl E3M3V5
Mx? a. CT brain
a. breast feeding b. ET tube
b. infant formula c. Dexamethasone
c. 5% D/W load d. mannitol
d. 10% D/W load 170. 25
e. 50% D/W load
166. 28 4 BP 80/50 PR120 PE : tender and
plain crepitation at lt 9th and 10th ribs Lung : clear Abd :
abdomen ( ) generalized tenderness and guarding with mild rigidity
Mx ?

NLE_step_2_2011_NCTMS Page 19
 a. Ruptured spleen e. NAC
b. Ruptured liver 175. 30 1 hr PTA
c. Ruptured colon PE: Hyperpnea R 30/min,
d. Ruptured duodenum Eyeground- macula edema both eyes, Otherwise-
e. Fracture pelvis unremarkable ABG : pH 7.21 , PaO2 88 mmHg,
171. 22 N/V 2 PE : PCO2 26, HCO3 12, %O2 Sat 98%
RR 32 BP80/60 PR140 drowsiness sunken eye ball dry
lip ER NSS 1000 mL at ward BS 850 Na 129 K a. Cyanide
2.8 Cl 90 HCO3 10 PO43- 4.2 BUN 42 Cr 1.2 b. Paraquat
c. Methanol
a. RI d. Zinc phosphate
b. NSS continue e. Organophosphate
c. Add KCl 176. 3
d. Add KPO4 1-2 cm manage
e. NaHCO3 a. TT
172. 30 DI 3 b. TT+TAT
PE: PR100 BP80/60 marked dry c. Rabies vaccine + ERIG
lips+tongue poor skin turgor dry skin Na160 K 3.3 Cl… d. TT+TAT+Rabies vaccine + ERIG
HCO3-….. 177. 9
a. NSS
b. NSS/2 a. Tetanus toxoid , Rabies vaccine
c. NSS/3 b. Rabies vaccine, Rabies Ig
d. 5%DW 178. 15 1 hr PTA PE :
e. 5%DNSS 2 cm.
173. E3M3V4 lesion 3 2 2
a. C-Spine injury a. Rabies vaccine
b. Cardiac tamponade b. Suture and wound dressing
174. 40 BW 55 kg c. TT Booster dose
Paracetamol 500 mg 30 , PE: d. TT Booster dose & TAT
Unremarkable NG lavage Activated charcoal 179. generalized muscle weakness
30 min. Treatment ?
a. Observe 180. 20
b. Prothrombin time 4 . PE :
c. Paracet level Drowsiness, laceration wound at temporal area, Rt. Eye 4
d. Alkalinize urine

NLE_step_2_2011_NCTMS Page 20
 mm. sluggish react to light, Motor Rt 5/5 Lt 3/5 184. male 75 yr U/D DM, HT, DLP ER
diagnosis 1 hr. PTA
a. Subdural hematoma PE-BT37.8 BP110/70 PR100
b. Epidural hematoma RR24 lung clear aqual BS other normal, oxygen sat 95% ,
c. Intracranial hematoma DTX 40 mg% Tx?
d. Subarachnoid hemorrhage a. NSS load
e. Intracerebral hemorrhage b. Empirical ATB
181. 20 c. Iv glucose push
2 . PTA RR 24/min, hoarseness, forceful d. ET tube
inspiration, retraction of subcostal muscle during e. CT brain emergancy
inspiration, anterior cervical soft tissue swelling & 185. 35
ecchymosis, cervical subcutaneous emphysema, diminish CT brain Rt
air entry both lung Management? 2
a. Oxygen face mask Mx
b. Nasolaryngeal airway a. CT
c. Nasal endotracheal intubation b.
d. Oral endotracheal intubation c.
e. Tracheostomy d. Hadol
182. 10 e. pyridoxine
. ? 186. 65 U/D OA
a. aspiration pneumonia
b. ARDS mild swelling no redness no
c. brain edema tender at medial aspect below patella 2 cm dx?
d. Hypernatrimia a. RA
e. intravascular hemolysis b. Arsenic bursitis
183. 30 c. Prepatellar bursitis
2 2 cm. d. Patella tendinitis
Systemic . e. Flare of OA
187. 3
a. Cobra Tip of rt shoulder
b. Malayan pit viper abduction Dx ?
c. Russel viper a. Supraspinatus tendinitis
d. Malayan krait b. Bicipital tendinitis
e. Green pit viper c. Infraspinatus tendinitis
d. Subscapularis tendinitis

NLE_step_2_2011_NCTMS Page 21
 e. Subcacromial bursitis conjunctiva peripheral injection, Cornea : Clear ,
188. NSAIDs Preauricular lymph node tenderness Manage
PE: Loss of lumbar lordosis a. Warm compression
management? b. Pressure patch
a. NSAIDs c. Artificial tear
b. NSAIDs d. Steroid eyedrop
c. Rehab exercise e. Quinolone eyedrop
189. 50 PE: 193. 45 2
Management ?
a.Colles’ fracture a. Eye irrigation
b.Greenstick fracture b. Steroid eye drop
c.Fracture both bone c. Antibiotic eye drop
d.Wrist dislocation d. Anesthetic eye drop
e.Supracondylar Fracture e. Consult eye shield
190. 10 194. 30
( internal hordeolum?) PE: V/A Rt. Eye 6/36 with pinhole
Treatment? 6/18, ciliary injection, deep AC, keratic precipitate cloudy
a. Warm compression aqueous, mild lens opacity, posterior synechiae
b. Oral ATB
c. Topical steroid a. Refractive error
d. Topical ATB b. Senile cataract
e. electrocautery c. acute uveitis
f. I&D d. Bacterial keratitis
191. 8 1 e. Viral keratoconjunctivitis
f. Anterior uveitis
bilateral conjuctival injection, ciliary injection , preauricular 195. 5
LN
a. 2 a. V/A
b. b. cover/uncover test
c. c. Fundoscopic exam
d. 196. 50
e. topical ATB
f. ciliary injection VA: hand motion , cloudy cornea IOP Rt
192. 22 54 mmHg Lt normal IOP
1 PTA V/A 20/20 2 Sulfa

NLE_step_2_2011_NCTMS Page 22
 a. 100% Glycerine PO 202. Oto: canal
b. 100% Glycerine PO + 1% Atropine eye drop Diag?
c. Azetazolamide a. Otitis externa
d. Azetazolamide + 100% Glycerine PO 203. 15 1 wk
e. Azetazolamide + timolol PE: ~2 cm. anterior neck mass at thyroid level
f. Timolol + 100% Glycerine PO with upward movement on tongue protrude Diagnosis?
197. follicle LN a. Laryngocele
dx? b. Ranular cyst
a. EKC c. Dermoid cyst
b. VKC d. Nodular cyst
c. Allergic conjunctivitis e. Thyroglossal duct cyst
198. 7 Rt eye : 204. 50 3
injected with follicle at lower fornix, Preauricular LN 1 cm
2
a. VA 20/40 and 20/70 with pinhole 2 1 20
b. PE : BP 140/80 mmHg, PR
c. 84/min, RR 20/min, forceful breathing, hoarseness, no
d. palpable neck mass, mild decreased air entry both lungs
e.
199. 40 a. Laryngeal web
6 b. Laryngeal cancer
a. glaucoma c. Laryngeal papilloma
b. cataract d. Intubation granuloma
c. hypermetropia e. Post-operative laryngeal paralysis
d. VF defect f. Vocal cord paralysis
e. Retinal detachment 205. 30
200. 20 1 Otoscopic exam pure tone
audiometry : Rt. threshold 25 dB speech discrimination
100% Lt. threshold 35 dB speech discrimination 25%
a. mastoidectomy
201. RLL Pneumonia + Bullous myringitis common a. Tympanometry
? b. CT temporal lobe
a. S. pneumonia c. Auditory brainstem response
b. Mycoplasma d. Acoustic impedance
c. H. influenza

NLE_step_2_2011_NCTMS Page 23
206. 210.
70 1

a. Carbon monoxide 6
b. Ozone
c. Sulfur dioxide subarachnoid hemorrhage
d. Carbon dioxide bilateral inferior frontal lobes contusion
e. Nitrogen dioxide
207. 20 30%TBSA a. Fall
burn b. Electrocution
2 c. MI
d. Drowning
a. Inhalation injury e. Cerebrovascular accident
b. Acute renal failure 211. scalp
c. Severe electrolyte disturbance laceration wound at temporal area, ,
d. Congestive heart failure open fracture Rt tibia, brushing , abrasion ,
e. Full thickness skin burn rigor mortis , livor
208. 6 mm. a. 6-8 hr.
6 cm. b. tibial fracture
?
a. Intermediate range gun shot c. fracture base of skull
b. Long range gun shot base of skull
c. Contact gun shot 212. base of skull fracture Ix
d. Stab wound a. AP,Lat. Film of skull
209. Underlying Artherosclerosis 213.
CHF
admit 2 wk Bronchopneumonia, Sepsis, Acute a.
renal failure b. C-spine subluxation
? 214.
a. Acute renal failure
b. CHF a.
c. Blunt trauma b.
d. Bronchopneumonia c.
e. Atherosclerosis
f. sepsis

NLE_step_2_2011_NCTMS Page 24
215. 2 wk MRI

dx? a. Agoraphobia
a. MDD b. Hypochodiasis
b. Adjustment disorder c. Somatization disorder
c. Normal grief reaction d. Phobia
d. Dysthymia e. General anxiety disorder
216. 30 220. leukemia admit 2
2

a. prolong separation
a. Alprazolam b. ADHD
b. Haloperidol c. relationship
c. Fluoxetine 221. OCD ?
d. Sodium valproate 222. 20
e. diazepam 2
217. Para 10 6
Resuscitation V/S Sable
a. NAC
2-3 dx? b.
a. Body dysmorphic disorder c.
b. Somatization
c. hypochondriasis d.
218. e.
dx? f.
a. Agoraphobia g.
b. Paranoid personality disorder
c. GAD 223.
d. MDD
219. dx?
CT Brain CT a. OCD
Brain MRI b. Anxiety disorder
c. MDD

NLE_step_2_2011_NCTMS Page 25
224. 23
?
flapping confuse ophthalmoplegia a. alprazolam
a. Alcohol abuse b. midazolam
b. Alcohol dependence c. fluoxetine
c. Alcohol intoxication d. haloperidol
d. Alcoholism 229.
e. Alcohol withdrawal Dx?
f. Wernicke’s encephalopathy a. Sleep deprivation
225. 54 10 b. Delusional disorder
3 BP c. GAD
140/90 mmHg Disorientation to time-place-person EOM d. Narcissistic
Lateral rectus palsy
230. 45
a. Alcohol intoxication
b. Alcohol withdrawal
2 1
c. Delirium tremens
PE
d. Hepatic encephalopathy
agitate when talk about unfaithful wife, oriented to
e. Wernicke’s encephalopathy
time, place and person
226. 35 35 10
a. Paranoid personality disorder
PE : V/S – BP 150/90 mmHg,
b. Obsessive compulsive disorder
Pulse 110 bpm, RR – tachypnea Diagnosis?
c. Delusional disorder
a. Alcohol intoxication
d. Impulsive-Control disorder
b. Alcohol withdrawal
e. Brief Psychotic Disorder
c. Alcohol intoxication
f. Schizoaffective disorder
d. Wernicke’s – Korsakoff syndrome
231. 2
227.
block 3
2-3
?
a. Cocaine
b. Midazolam
a. ADHD
c. Malijuanna
b. Learning disorder
d. Ectasy c. Autism
e. heroine d.
228. 2 e. 2-3
f. Low IQ

NLE_step_2_2011_NCTMS Page 26
232. b. Mercury
c. Arsenic
a. d. Cyanic acid
b. e. Cadmium
c. f. Zn
d. Diazepam iv 236.
e. Calcium gluconate iv a. metal fume fever
233. pill DVT 237.
. 25-45 pill 3
Cd 100

a. selective bias a.
b. surveillance bias b. Nephropathy
c. Flu-like syndrome
d. Hyperpigment
d. e. Peripheral Neuropathy
e. f. Chronic abdominal pain
238. (00.00-8.00)
234. 24
hr a.
a. Glycogen b.
b. Fatty acid c.
c. Protein d.
235. 35 . .
239. 65 hepatitis B

/ a. Pneumococcal
b. Influenza vaccine
a. Lead c. Hepatitis B vaccine

NLE_step_2_2011_NCTMS Page 27