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401. A 12yo boy presents with painful swollen knew after a sudden fall. Which bursais most likely tobe aected?a. Semimembranous bursab. repatellar bursac. retibial bursa

d. Suprapatetaller bursa

Ans. !he key is ". repatellar bursa. # A fall onto the knee can damage the prepatellar bursa. This

usually causes bleeding into the bursa sac causing swellen painful knee. Prepatellar bursitis that is caused by an

injury will usually go away on its own. The body will absorb the blood in the bursa over several weeks, and the bursa

should return to normal. If swelling in the bursa is causing a slow recovery, a needle may be inserted to drain the

blood and speed up the process. There is a slight risk of infection in putting a needle into the bursa].

!". A $1yo man has been referred to the %& with fre'uent episodes ofbreathlessness and chestpain a(w palpitations. )e has a re*ular pulse rate+$0bpm. ,-+sinus rhythm. Whatis the most

appropriate in/ to be done?a. -ardiac enymesb. -c. ,-d. ,choe. 24h ,-

Ans. !he key is ,. 24h ,-.

3ndications of 24 h ambulatory holter monitorin*

• !o e/aluate chest pain not reproduced with e5ercise testin*

• !o e/aluate other si*ns and symptoms that may be heart6related7 such as

fati*ue7 shortness of breath7 diiness7 or faintin*

• !o identify arrhythmias or palpitations

• !o assess risk for future heart6related e/ents in certain conditions7 such as

idiopathic hypertrophic cardiomyopathy7 post6heart attack with weakness of theleft side of the heart7 or Wol6arkinson6White syndrome

• !o assess the function of an implanted pacemaker

• !o determine the eecti/eness of therapy for comple5 arrhythmias

408. A woman d5 with -a "reast presents now with urinary fre'. which part of thebrain is themetastasis spread to?a. "rain stemb. ons

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c. 9edullad. &iencephalone. -erebral corte5

Ans. !he key is &. &iencephalon. #diencephalon is made up of four distinct

components i: the thalamus ii: the subthalamus iii: the hypothalamus and i/: the

epithalamus. Amon* these the hypothalamus has crucial role in causin* urinary

fre'uency;.

404. A man is /ery depressed and miserable after his wife<s death. )e sees no pointin li/in* now thathis wife is not around and apolo*ises for his e5istence. )e refuses any help oered.)is son hasbrou*ht him to the ,&. !he son can<t deal with the father any more. What is themostappropriate ne5t step?a. =oluntary admission to psychiatry ward

b. -ompulsory admission under 9)Ac. efer to social ser/icesd. Alternate housin*e. ,-!

Ans. !he key is ". -ompulsory admission under 9)A. #!his patient is refusin* any

help oered> And his son cannot deal with him anymore> 3n this situation /oluntary

admission to psychiatry ward is not possible and the option of choice is compulsory

admission under 9)A@;.

40. A 81yo man has epista5is 10 days followin* polypectomy. What is the mostlikely d5?

a. Basal infectionb. -oa*ulation disorderc. -arcinoma

Ans. !he key is A. Basal infection. #3nfection is one of the most important cause of

secondary hemorrha*e;.

40$. A woman had an 93. She was breathless and is put on o5y*en mask and !B7her chest pain hasimpro/ed. )er )+40bpm. ,- shows S! ele/ation in leads 37 337 333. What is yourne5t step?a. C9W)

b. Streptokinasec. An*io*raphyd. -ontinue current mana*emente. Bone

Ans. !he key is ". Streptokinase.

40D. A $Dyo male presents with polyuria and nocturia. )is "93+887 urine culture +ne*ati/e for

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nitrates. What is the ne5t d5 in/?a. SAb. Erea7 creat and electrolytesc. 9SE culture and sensiti/ityd. Acid fast urine teste. "lood su*ar

Ans. !he key is ,. "lood su*ar. #A*e at presentation and class1 obesity fa/ours the

dia*nosis of type2 &9;.

40F. A pt from Africa comes with nodular patch on the shin which is reddish brown.What is the mostprobable d5?a. Cupus /ul*arisb. ,rythema nodosumc. yoderma *an*renosumd. ,rythema mar*inatume. Solar keratosis

Ans. !he key is ". ,rythema nodosum. #-auses of erythema nodosum 9%S!

-%99%B -AES,S6 i: streptococcal infection ii: sarcoidosis. %ther causes6

tuberculosis7 mycoplasma pneumonia7 infectious mononucleosis7 dru*s6 sulfa

related dru*7 %-7 oestro*enG "ehcet<s disease7 -&7 E-G lymphoma7 leukemia and

some others;.

40H. A 2Hyo lady came to the ,& with complaints of palpitations that ha/e beenthere for the past 4days and also feelin* warmer than usual. ,5am )+14bpm7 irre*ular rhythm.What is the t5 for

her condition?a. Amiadaroneb. "eta blockersc. Adenosined. =erapamile. Ilecainide

Ans. !he key is ". "eta blockers #the probable arrhythymia is AI secondary to

thyroto5icosis. So to rapid control the symptoms of thyroto5icosis "eta blocker

should be used;.

410. A !2&9 is under*oin* a *astric sur*ery. What is the most appropriate pre6op

mana*ement?a. Start him in 3= insulin and *lucose and JK Lust before sur*eryb. Stop his oral hypo*lycemic on the day of the procesurec. -ontinue re*ular oral hypo*lycemicd. Stop oral hypo*lycemic the pr/ ni*ht and start 3= insulin with *lucose and JKbeforesur*erye. -han*e to short actin* oral hypo*lycemic

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Ans. !he key is &. . Stop oral hypo*lycemic the pr/ ni*ht and start 3= insulin with*lucose and JK beforeSur*ery.

411. A 1Hyo boy is brou*ht by his mother with complaint of lack of interest and no

social interactions.)e has no friends7 he doesn<t talk much7 his only interest is in collectin*cars(/ehicles ha/in*around 2000 toy cars. What is the most appropriate d5?a. "orderline personality disorderb. &epressionc. Schioaecti/e disorderd. Autistic spectrum disorder

Ans. !he key is &. Autistic spectrum disorder.

Autism spectrum disorders aect three dierent areas of a childMs life

• Social interaction

• -ommunication 66 both /erbal and non/erbal

• "eha/iors and interests

3n some children7 a loss of lan*ua*e is the maLor impairment. 3n others7 unusual

beha/iors Nlike spendin* hours linin* up toys: seem to be the dominant factors.

412. A 4yo man who is diabetic and )!B but poorly compliant has chronic S%"7de/elops se/ereS%" and chest pain. ain is sharp7 increased by breathin* and relie/ed by sittin*forward. What

is the sin*le most appropriate d5?a. 93b. ericarditisc. Cun* cancerd. ood pastures syndromee. ro*ressi/e massi/e Obrosis

Ans. !he key is ". ericarditis. #Bature of pain i.e. sharp pain increased by breathin*

and relie/ed by sittin* forward is su**esti/e of pericarditis;.

Bature of pericardial pain the most common symptom is sharp7 stabbin* chest pain

behind the sternum or in the left side of your chest. )owe/er7 some people with

acute pericarditis describe their chest pain as dull7 achy or pressure6like instead7

and of /aryin* intensity.

!he pain of acute pericarditis may radiate to your left shoulder and neck. 3t often

intensiOes when you cou*h7 lie down or inhale deeply. Sittin* up and leanin*

forward can often ease the pain.

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418. A $m boy has been brou*ht to ,& followin* an apneic episode at home. )e isnow completelywell but his parents are an5ious as his cousin died of S3&S at a similar a*e. !heparents ask for*uidance on "CS for a baby of his a*e. What is the sin*le most recommendedtechni'ue for

cardiac compressions?a. All On*ers of both handsb. All On*ers of one handc. )eel of one handd. )eel of both hand

e. 3nde5 and middle On*ertips of one hand

Ans. !he key is ,. 3nde5 and middle On*ertips of one hand.

414. A D0yo man had a ri*ht hemicolectomy for ceacal carcinoma $days a*o. )e

now has abdominaldistension and recurrent /omitin*. )e has not opened his bowels since sur*ery. !here are nobowel sounds. W"-+H7 !emp+8D.8-. What is the sin*le most appropriate ne5tmana*ement?a. Antibiotic therapy 3=b. lycerine suppositoryc. Caparotomyd. B tube suction and 3= Puidse. !B

Ans. !he key is &. B tube suction and 3= Puids. #!he patient has de/eloped

paralytic ileus which should be treated conser/ati/ely;.

21. A $0yo man with a 4y h5 of thirst7 urinary fre' and wei*ht loss presents with adeep painlessulcer on the heel. What is the most appropriate in/?a. Aterio*raphyb. =eno*raphyc. "lood su*ard. "iopsy for mali*nant melanomae. "iopsy for pyoderma

Ans. !he key is -. "lood su*ar. #!he patient probably de/eloped diabetic foot;.

41$. A 1$yo boy presents with rash on his buttocks and e5tensor surface followin* asore throat.What is the most probable d5?a. 9easlesb. "ullous6pemphi*oi*c. ubellad. 3!e. )S

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Ans. !he key is &. 3!. #3t<s probably as wron* key> 3n )S rash typically found in

buttocks7 le*s and feets and may also appear on the arms7 face and trunk. "ut in

3! it mostly occurs in lower le*s. )S usually follow a sorethroat and 3! follow /iral

infection like Pue or E!3. )S is a /asculitis while 3! is deOciency of platelets from

more destruction in spleen which is immune mediated;.

41D. A 84yo man with a white patch on the mar*in of the mid6third of the ton*ue.Which is the sin*lemost appropriate CB in/ol/ed?a. ,5ternal iliac CBb. re6aortic CBc. Aortic CBd. 3n*uinal CBe. 3liac CBf. Submental CB*. Submandibular CBh. &eep cer/ical CB

Ans. !he key is . Submandibular CB.

41F. A 0yo lady presents to ,& with sudden se/ere chest pain radiatin* to bothshoulder andaccompanyin* S%". ,5am cold peripheries and paraparesis. What is the sin*lemost appropriated5?a. 93b. Aortic dissectionc. ulmonary embolismd. ood pastures syndrome

e. 9otor neuron disease

Ans. !he key is ". Aortic dissection. #Esual mana*ement for type A dissection is

sur*ery and for type " is conser/ati/e;.

41H. A 4yo myopic de/elops Pashes of li*ht and then sudden loss of /ision. !hat isthe sin*le mostappropriate t5?a. an retinal photo coa*ulationb. eripheral iridectomyc. Scleral bucklin*d. Spectacles

e. Sur*ical e5traction of lens

Ans. !he key is -. Scleral bucklin*. #3t is a case of retinal detachment with treatment

option of sclera bucklin*;.

420. A 40yo chronic alcoholic who li/es alone7 brou*ht in the ,& ha/in* been foundconfused athome after a fall. )e complains of a headache and *radually worsenin* confusion.What is the

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most likely d5?a. )ead inLuryb. )ypo*lycemiac. ,5tradural hematomad. Subdural hematomae. &elirium

Ans. !he key is &. Subdural hematoma. #subdural hematoma may be acute or

chronic. 3n chronic symptoms may not be apparent for se/eral days or weeks.

Symptoms of subdural hematomas are Puctuatin* le/el of consciousness7 Q

insidious physical or intellectual slowin*7 sleepiness7 headache7 personality chan*e

and unsteadiness. !5. 3rri*ation(e/acuation e.*. /ia barr twist drill and barr hole

craniostomy 1st line. -raniotomy if the clot or*anied 2nd line;.

421. A 4yo man with alcohol dependence has tremor and sweatin* 8days into ahosp admission fora f5 femur. )e is apprehensi/e and fearful. What is the sin*le most appropriate t5?

a. Acamprossateb. -hlordiaepo5idec. Coraepamd. Cofe5idinee. rocyclidine

Ans. !he key is ". -hlordiaepo5ide. #!his is a case of alcohol withdrawal syndrome.

-hlordiaepo5ide when used in alcohol withdrawal it is important not to drink

alcohol while takin* -hlordiaepo5ide.

-hlordiaepo5ide should only be used at the lowest possible dose and for a

ma5imum of up to four weeks. !his will reduce the risks of de/elopin* tolerance7

dependence and withdrawal;.

422. A yo child complains of sore throat and earache. )e is pyre5ial. ,5am tonsilsenlar*ed andhyperemic7 e5udes pus when pressed upon. What is the sin*le most rele/ant d5?a. 39b. Acute follicular tonsillitis

c. Scarlet fe/erd. A*ranulocytosise. Acute %9

Ans. !he key is ". Acute follicular tonsillitis. #Tonsillitis is usually caused by a

viral infection or, less commonly, a bacterial infection. The given case is a

bacterial tonsillitis (probably caused by group A streptococcus). !here are

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four main si*ns that tonsillitis is caused by a bacterial infection rather than a /iral

infection. !hey are

• a hi*h temperature

•

white pus6Olled spots on the tonsils• no cou*h

• swollen and tender lymph nodes N*lands:.

428. A man with a fam h5 of panic disorder is brou*ht to the hosp with palpitations7tremors7sweatin* and muscles ti*htness on 8 occasions in the last $ wks. )e doesn<tcomplain of headache and his " is WBC. What is the sin*le most appropriate lon*6term t5 forhim?

a. &iaepamb. %lanapinec. )aloperidold. Iluo5etine

e. Alpraolam

Ans. !he key is &. Iluo5etine. #ecommended treatment for panic disorder is i: -"!

ii: 9edication NSS3s or !-A:. B3-, recommends a total of se/en to 14 hours of -"!

to be completed within a four month period. !reatment will usually in/ol/e ha/in* a

weekly one to two hour session. When dru* is prescribed usually a SS3 is preferred.

Antidepressants can take two to four weeks before becomin* eecti/e;.

424. A 2Fyo man presents with rapid poundin* in the chest. )e is completelyconscious throu*hout.

!he ,- was taken NS=!:. What is the 1st med to be used to mana*e this condition?a. Amiodaroneb. Adenosinec. Cidocained. =erapamil

e. 9etoprolol

Ans. !he key is ". Adenosine. #9ana*ement of S=! i: /a*al manoeu/res Ncarotid

sinus messa*e7 /alsal/a manoeu/re: transiently increase A=6block7 and unmask the

underlyin* atrial rhythm. 3f unsuccessful then the Orst medicine used in S=! isadenosine7 which causes transient A= block and works by i: transiently slowin*

/entricles to show the underlyin* atrial rhythm ii: cardio/ertin* a Lunctional

tachycardia to sinus rhythm. %)-9;.

42. A $yo woman who is depressed after her husband died of cancer 8m a*o was*i/en

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amitryptaline. )er sleep has impro/ed and she now wants to stop medication butshe stillspeaks about her husband. )ow would you mana*e her?a. -"!b. -ontinue amitryptalinec. sychoanalysis

d. "erea/ement counsellin*

e. Antipsychotic

Ans. !he key is ". -ontinue amitriptyline. #depression is important feature of

berea/ement. atient may pass sleepless ni*hts. As this patients sleep has

impro/ed it indicate he has *ood response to antidepressant and as he still speaks

about her husband there is chance to deterioration of her depression if

antidepressant is stopped. Ior depressi/e episodes antidepressants should be

continued for at least $6H months;.

42$. A $4yo man presents with a h5 of left sided hemiparesis and slurred speech.

)e was absolutelyOne $h after the episode. What is the most appropriate prophylactic re*imen?a. Aspirin 800m* for 2 weeks followed by aspirin Dm*b. Aspirin 800m* for 2 weeks followed by aspirin Dm* and dipyridamole 200m*c. -lopido*rel Dm*d. &ipyridamole 200m*

e. Aspirin 800m* for 2 weeks

Ans. !he key is ". Aspirin 800m* for 2 weeks followed by aspirin Dm* and

dipyridamole 200m*.

42D. A $8yo lady with a "93+82 comes to the ,& with complaints of pi*mentationon her le*s. ,5amdilated /eins could be seen on the lateral side of her ankle. Which of the followin* isin/ol/ed?a. Short saphenous /einb. Con* saphenous /einc. &eep /enous systemd. opliteal /eins

e. Saphano6femoral Lunction

Ans. !he key is A. Short saphenous /ein. #short saphenous /ein tra/els lateral

aspect of ankle while *reat or lon* saphenous /ein tra/els medial aspect of ankle;.

42F. A yo man presents with h5 of wei*ht loss and tenesmus. )e is d5 with rectalcarcinoma.Which risk factors help to de/elop rectal carcinoma e5cept followin*?a. Smokin*b. Iamily h5c. olypd. r/ carcinomae. )i*h fat diet

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f. )i*h Obre diet

Ans. !he key is I. )i*h Obre diet. #e5cept hi*h Ober diet all others are risk factors to

de/elop rectal carcinoma;.

42H. A pt presents with a painful7 sticky red eye with a con*ested conLuncti/a. What

is the mostsuitable t5?a. Antibiotic %b. Antihistamine %c. Antibiotic dropsd. Steroid drops

e. 3"S

Ans. !he key is -. Antibiotic drops. #bacterial conLuncti/itis is treated with antibiotic

drops;.

480. A 4yo woman complains of pain in her hands precipitated by e5posure to thecold weather. She

is breathlessness on walkin*. When she is eatin*7 she can feel food suddenlystickin* to the*ullet. 3t seems to be in the middle of ther esopha*us but she can<t localie e5actlywhere itsticks. 3t is usually relie/ed with a drink of water. -hoose the sin*le most likelycause of dyspha*ia from the options?a. ,sopha*eal carcinomab. Systemic sclerosisc. SC,d. haryn*eal carcinoma

e. lobus hystericusAns. !he key is ". Systemic sclerosis. #aynods phenomena7 pulmonary

in/ol/ement7 oesopha*eal dysmotility are su**esti/e of systemic sclerosis;.

481. A 8yo child brou*ht to the ,& with a swellin* o/er the left arm. showsmultiple callusformation in the ribs. ,5am bruises on childs back. What is the most appropriatene5t step?a. -heck child protection re*isterb. -oa*ulation proOlec. Skeletal sur/eyd. Serum calcium

e. &,A scan

Ans. !he key is -. Skeletal sur/ey. #Skeletal survey is a series of x-ray which is usually used in NAI]. [after

survey should think of childs protection].

482. A 8yo woman has had bruisin* and petechiae for a week. She has also hadrecent menorrha*ia

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but is otherwise well. "lood )*b+11.17 W"-+$.87 lt+14. What is the sin*le mostlikely d5?a. Acute leukemiab. Aplastic anemiac. )3= infectiond. 3!

e. SC,

Ans. !he key is &. 3!. #As the patient is otherwise well acute leukemia7 )3= and SC,

is unlikely. Bormal wbc count e5cludes aplastic anemia. So likely dia*nosis is 3!;.

488. A 80yo man complains of episodes of hearin* music and sometimesthreatenin* /oices within acouple of hours of hea/y drinkin*. What is the most likely d5?a. &elirium tremensb. Wernicke<s encephalopathyc. Jorsako<s psychosis

d. Alcohol hallucinosise. !emporal lobe dysfunction

Ans. !he key is &. Alcoholic hallucinosis. # Alcohol hallucinosis can occur during acute into#ication

or withdrawal. It involves auditory and visual hallucinations, most commonly accusatory or threatening voices.

$ource% &ikipedia].

484. A pt had !3A which he reco/ered from. )e has a h5 of stroke and e5am shows

) in sinus rhythm.

)e is already on aspirin Dm* and anti6)!B dru*s. What other action should betaken?

a. Add clopido*rel onlyb. 3ncrease dose of aspirin to 800m*c. Add warfarind. Add clopido*rel and statin

e. Add statin only

Ans. !he key is &. Add clopido*rel and statin.

48. A 40yo woman suddenly collapsed and died. At the post6mortem autopsy7 itwas found thatthere a bleed from a berry aneurysm from the circle of Willis. 3n which space did thebleedin*occur?

a. Subarachnoidb. Subduralc. ,5tradurald. Subparietal

e. "rain /entricles

Ans. !he key is A. Subarachnoid.

48$. A schiophrenic pt hears people only when he is about to fall asleep. What isthe most likely d5?

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a. )ypnopompic hallucinationsb. )ypono*o*ic hallucinationsc. )ippocampal hallucinationsd. &elirious hallucinations

e. Auditory hallucinations

Ans. !he key is ". )ypno*o*ic hallucinations.

48D. A pt who came from 3ndia presents with cou*h7 fe/er and enlar*ed cer/ical CB.,5am caseatin**ranulomata found in CB. What is the most appropriate d5?a. Cymphomab. !" adenitisc. !hyroid carcinomad. oiter

e. !hyroid cyst

Ans. !he key is ". !" adenitis. #caseatin* *ranulomata are dia*nostic of !";.

48F. A 44yo man comes with h5 of early mornin* headaches and /omitin*. -! brainshows rin*enhancin* lesions. What is the sin*le most appropriate option?a. -9=b. Streptococcusc. !o5oplasmosisd. B)C

e. neumocystis Lero/ii

Ans. !he key is -. !o5oplasmosis.

48H. A D2yo man is found to be not breathin* in the --E with the followin* rhythm.What is the most

likely d5?

a. S=!b. =!c. =Id. Atrial Ob

e. Atrial Putter

Ans. !he key is -. =I.

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440. A $yo man with diRculty in swallowin* presents with an aspirationpneumonia. )e has abo/ine cou*h and fasciculatin* ton*ue. Sometimes as he swallows food it comesback throu*hhis nose. -hoose the sin*le most likely cause of dyspha*ia from the *i/en option?a. "ulbar palsy

b. ,sopha*eal carcinomac. haryn*eal pouchd. seudobulbar palsy

e. Systemic sclerosis

Ans. !he key is A. "ulbar palsy.

441. A 1$yo teena*er was brou*ht to the ,& after bein* stabbed on the upper ri*htside of his back.,rect - re/ealed homo*enous opacity on the lower ri*ht lun*7 trachea wascentrally placed.

What is the most probable e5planation for the Ondin*s?a. neumothora5b. )emothora5c. neumoniad. !ension pneumothora5

e. ,mpyema

Ans. !he key is ". )emothora5. #3n blunt trauma there may be hemo6pneumothora5

but in sharp wound like stabbin* there may occur only hemothora5;.

442. A yo woman complains of retrosternal chest pain and dyspha*ia which is

intermittent andunpredictable. !he food suddenly sticks in the middle of the chest7 but she can clearit with adrink of water and then Onish the meal without any further problem. A barium mealshows acorkscrew esopha*us<. What is the sin*le most likely dyspha*ia?a. ,sopha*eal candidiasisb. ,sopha*eal carcinomac. ,sopha*eal spasmd. haryn*eal pouch

e. lummer6/inson syndrome

Ans. !he key is -. ,sopha*eal spasm. #chest pain7 unpredictable intermittentdyspha*ia and food suddenly sticks in the middle of the chest which can be cleared

with a drink of water indicates uncoordinated irre*ular esopha*eal peristalsis which

is characteristic of esopha*eal spasm> Also cork6screw esopha*us@ seen in barium

swallow is dia*nostic of esopha*eal spasm;.

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448. A 8Fyo female presents with sudden loss of /ision but fundoscopy is normal.She a similarepisode about 1 y a*o which resol/ed completely within 8m. ,5am mild weaknessof ri*htupper limb and e5a**erated rePe5es. What is the sin*le most appropriate t5?a. an retinal photo coa*ulation

b. ilocarpine eye dropsc. -orticosteroidsd. eripheral iridectomy

e. Sur*ical e5traction of lens

Ans. !he key is -. -orticosteroid. #the term rapid loss of /ision is more appropriate

than sudden loss of /ision in multiple sclerosis. emission and relapse of optic

neuritis and focal neurolo*ical symptoms and e5a**erated rePe5es all points

towards multiple sclerosis. !reatment option is corticosteroids;.

444. A 1yo boy presents with a limp and pain in the knee. ,5am le* is e5ternallyrotated and 2cmshorter. !here is limitation of Pe5ion7 abduction and medial rotation. As the hip isPe5ede5ternal rotation is increased. -hoose the most likely d5?a. Tu/enile rheumatoid arthritisb. %s*ood6schlatter diseasec. eacti/e arthritisd. Slipped femoral epiphysis

e. !ransient syno/itis of the hip

Ans. !he key is &. Slipped femoral epiphysis. #!he *i/en presentation is classic for

slipped femoral epiphysis;.

44. A $4yo woman has diRculty mo/in* her ri*ht shoulder on reco/erin* fromsur*ery of theposterior trian*le of her neck. What is the sin*le most appropriate option?a. Accessory ner/eb. lossopharyn*eal ner/ec. )ypo*lossal ner/ed. =a*us ner/e

e. =estibule6cochlear ner/e

Ans. !he key is A. Accessory ner/e.

44$. A 8Dyo man with an ulcer on the medial malleolus. Which of the followin* CB isin/ol/ed?a. ,5ternal iliac CBb. re6aortic CBc. Aortic CBd. 3n*uinal CB

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e. 3liac CBf. Submental CB*. Submandibular CB

h. &eep cer/ical CB

Ans. !he key is &. 3n*uinal CB.

44D. A pt presents with wei*ht loss of k*s despite *ood appetite. )e alsocomplains of palpitations7sweatin* and diarrhea. )e has a lump in front of his neck which mo/es onswallowin*. What isthe most appropriate d5?a. Cymphomab. !" adenitisc. !hyroid -ad. oiter

e. !hyroid cyst

Ans. !he key is &. oiter.

44F. A D$yo woman has become tired and confused followin* an inPuena likeillness. She is alsobreathless with si*ns of consolidation of the left lun* base. What is the most likelyd5?a. &ru* to5icityb. &elirium tremensc. 3nfection to5icityd. )ypo*lycemia

e. ,lectrolyte imbalanceA. !he key is -. 3nfection to5icity. #3nfection to5icity or to5ic shock syndrome is likely

here as precedin* Pue like illness points towards to5in Nenteroto5in type ": from

Staphylococcus aureus;.

44H. A youn* pt is complainin* of /erti*o whene/er she mo/es sideways on the bedwhile lyin*supine. What would be the most appropriate ne5t step?a. )ead roll testb. eassurec. Ad/ice on posture

d. -arotid &oppler

e. -!

Ans. !he key is A. )ead roll test. #this is a case of beni*n paro5ysmal positional

/erti*o@ for which the dia*nosis is made by head roll test;.

40. A 82yo man has %-&. What is the best t5?

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a. -"!b. SS3c. !-Ad. 9A% inhibitors

e. eassure

Ans. !he key is ". SS3. #3t is wron* key> !here is a 9- sample 'uestion with most

appropriate mana*ement bein* -"!. So the correct key is -"!;.

41. A $yo woman says she died 8m a*o and is /ery distressed that nobody hasburied her. Whenshe is outdoors7 she hears people say that she is e/il and needs to be punished.What is themost likely e5planation for her symptoms?a. Schiophreniab. 9aniac. sychotic depressiond. )ysteria

e. !o5ic confusional state

Ans. !he key is -. sychotic depression. #sychotic depression7 also known

as depressi/e psychosis7 is a maLor depressi/e episode that is accompanied

by psychotic symptoms Nhallucinations7 delusions:. 3n this patient nihilistic delusion

fa/ours the dia*nosis of psychotic depression. 3t can occur in the conte5t of bipolar

disorder or maLordepressi/e disorder;.

42. A 0yo woman presents followin* a fall. She reports pain and weakness in herhands for se/eralmonths7 sti le*s7 swallowin* diRculties7 and has bilateral wastin* of the smallmuscles of herhands. ePe5es in the upper limbs are absent. !on*ue fasciculations are presentand both le*sshow increased tone7 pyramidal weakness and hyper6rePe5ia with e5tensor plantars.ain andtemp sensation are impaired in the upper limbs. What is the most likely d5?a. 9Sb. 9B&c. Syrin*obulbiad. Syrin*omyelia

e. 9yasthenia *ra/is

Ans. !he key is -. Syrin*obulbia. #3n 9S there are characteristic relapse and

remission which is absent hereG 3n 9B& there is no sensory deOcitG Syrin*omyelia

doesn<t cause cranial ner/e lesion and in myasthenia there is muscular weakness

without atrophy. )ere the features described well Ots syrin*obulbia;.

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48. Which of the followin* formulas is used for calculatin* Puids for burn pts?a. 4 5 wei*htNlbs: 5 area of burn + ml of Puidsb. 4 5 wei*htNk*s: 5 area of burn + C of Puidsc. 4 5 wei*htNk*s: 5 area of burn + ml of Puidsd. 4 5 wei*htNlbs: 5 area of burn + C of Puids

e. 4. 5 wei*htNk*s: 5 area of burn + dC of Puids

Ans. !he key is -. 4 5 wei*htNk*s: 5 area of burn + ml of Puids.

44. A $yo male presents with dyspnea and palpitations. ,5am pulse+1D0bpm7"+120(F0mm)*.-arotid massa*e has been done as Orst instance. What is the ne5t step of themana*ement?a. Adenosineb. Amlodipinec. &- cardio/ersiond. Cidocainee. "eta blocker

Ans. !he key is A. Adenosine. #!he likely dia*nosis is S=!. 1st

/a*al manoeu/res7 iffails i/ adenosine.U =a*al manoeu/res Ncarotid sinus massa*e7 =alsal/a manoeu/re: transientlyincreaseA= block7 and may unmask an underlyin* atrial rhythm.U 3f unsuccessful7 *i/e adenosine7 which causes transient A= blockG %)-97 H th edition;.

4. A 4Fyo farmer presented with fe/er7 malaise7 cou*h and S%". ,5amtachypnea7 coarse endinspiratorycrackles and wheee throu*hout7 cyanosis. Also complaint se/ere wei*ht loss. )is- shows Puy nodular shadowin* and there is 9B leukocytosis. What is the

sin*le mostappropriate d5?a. Ankylosin* spondylitisb. -hur*6strauss syndromec. -rypto*enic or*aniin*d. ,5trinsic aller*ic al/eolitise. ro*ressi/e massi/e Obrosis

Ans. !he key is &. ,5trinsic aller*ic al/eolitis.

4$. A 8yo lady is admitted with pyre5ia7 wei*ht loss7 diarrhea and her skin is

lemon yellow in color.-"- + hi*h 9-=. What is the most probably d5?a. Aplastic anemiab. ernicious anemiac. Ceukemiad. 3!

e. Cymphoma

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Ans. !he key is ". ernicious anemia. #3t may be *ra/es with pernicious anemia.

Cemon yellow pallor occurs in pernicious anemia. )yperthyroidism may cause

persistently raised body temperature;.

4D. A D2yo woman who had a repair of stran*ulated femoral hernia 2 days a*obecomes noisy7a**ressi/e and confused. She is febrile7 -"- normal apart from raised 9-=. What isthe mostlikely d5?a. ,lectrolyte imbalanceb. &elirium tremensc. Wernicke<s encephalopathyd. 3nfection to5icity

e. )ypo*lycemia

Ans. !he key is ". &elirium tremens. #,lectrolyte imbalance may cause confusion

but not a**ressi/enessG infection to5icity will cause hi*h fe/er7 low "7 rash etc

which is absent here. Abstinance from alcohol in the hospital caused delirium

tremens Nchronic alcoholism is supported by hi*h 9-=: here;.

4F. An old lady had E!3 and was treated with antibiotics. She then de/elopeddiarrhea. What is thesin*le most likely t5?a. -o6amo5icla/b. iperacillin K taobactamc. -eftria5one

d. =ancomycin

Ans. !he key is &. =ancomycin. #seudomembranous colitis is treated with

metronidaole or /ancomycin;.

4H. A $yo man has symptoms of sleep apnea and daytime headaches andsomnolence. Spirometryshows a decreased tidal /olume and /ital capacity. What is the sin*le mostappropriate d5?a. Ankylosin* spondylitisb. -hur*6strauss syndrome

c. ood pasture syndromed. 9otor neuron diseasee. ro*ressi/e massi/e Obrosis

f. Spinal cord compression

Ans. !he key is &. 9otor neuron disease. #in/ol/ement of respiratory muscles in

9B& is associated with poor respiration causin* sleep apnoea;.

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4$0. A yo man presents with mild headache. )e has chan*ed his spectaclesthrice in 1 yr. there ismild cuppin* present in the disc and sickle shaped scotoma present in both eyes.What is thesin*le most appropriate t5?a. an retinal photo coa*ulation

b. ilocarpine eye dropsc. -orticosteroidsd. Scleral bucklin*

e. Anal*esics alone

Ans. !he key is ". ilocarpine. #!his is a case of open an*le *laucoma7 treated with

pilocarpine;.

4$1. A yo woman was found collapsed at home7 paramedics re/i/ed her but inthe ambulance shehad a cardiac arrest and couldn<t be sa/ed. !he paramedic<s report tells that thewoman wasimmobile lately due to hip pain and that they found ulcers on the medial side ofankle. She had&9 and was on anti6diabetics. What is the cause of her death?a. Acute 93b. &JAc. ulmonary embolismd. Acute pericarditis

e. -ardiac tamponade

Ans. !he key is -. ulmonary embolism. #3mmobiliation due to hip pain may

resulted in &=! and later pulmonary embolism;.

4$2. An 1Fyo pre/iously well student is in his 1 st year at uni. )e has been brou*ht tothe ,& in ana*itated7 deluded and disoriented state. What is the most probable reason for hiscondition?a. &ru* to5icityb. &elirium tremensc. 3nfection to5icityd. ,lectrolyte imbalance

e. )ead inLury

Ans. !he key is A. &ru* to5icity. #Voun* a*e and 1 st yr in uni/ersity is likely to point

towards dru* to5icity;.

4$8. A youn* adult presents to the ,& after a motorcycle crash. !he pt has bruisesaround the leftorbital area. -S+187 e5amination notes alcoholic breath. Shortly afterwards7 his-S drops to D.

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What is the sin*le most important initial assessment test?a. 93 brainb. -! brainc. -d. -! an*io brain

e. )ead

Ans. !he key is ". -! brain. #Cikely cause is epidural hematoma;.

4$4. A 80yo female attends %& with a fe/er and dry cou*h. She says that she hadheadache7 myal*iaand Loint pain like one week a*o. ,5am pulse+100bpm7 temp+8D.-. - bilateralpatchyconsolidation. What is the sin*le most likely causati/e or*anism?a. neumococcal pneumoniab. Ce*ionellac. 9ycoplasma

d. Jlebsiellae. -hlamydia pneumonia

Ans. !he key is -. 9ycoplasma. #mycoplasma *i/e Pu6like symptoms and has a

*radual onset plus on c5r shows as bilateral consolidation;.

4$. A 4$yo man is bein* in/esti*ated for indi*estion. TeLunal biopsy showsdeposition of macropha*es containin* AS Neriodic acid6schi: K/e *ranules. What is the mostlikely d5?a. "acterial o/er*rowth

b. -eliac diseasec. !ropical sprued. Whipple<s disease

e. Small bowel lymphoma

Ans. !he key is &. Whipple<s disease. #periodic acid6schi K/e *ranules containin*

macropha*es in LeLuna biopsy is dia*nostic of whipples disease;.

4$$. A 82yo woman of 8Fwks *estation complains of feelin* unwell with fe/er7ri*ors and abdominalpains. !he pain was initially located in the abdomen and was a(w urinary fre' anddysuria. !hepain has now become more *eneralied speciOcally radiatin* to the ri*ht loin. Shesays that shehas felt occasional uterine ti*htenin*. -! is reassurin*. Select the most likely d5?a. Acute fatty li/er of pre*nancyb. Acute pyelonephritisc. oun* li*ament stretchin*d. -holecystitis

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e. E!3

Ans. !he key is ". Acute pyelonephritis. #Ie/er7 ri*or7 abdominal pain a(w fre'uency

and dysurea and radiation to the rt loin su**ests rt sided pyelonephritis;.

4$D. A 82yo pt presents with cer/ical lymphadenopathy and splenome*aly. What isthe sin*le mostappropriate option?a. )emophilusb. Streptococcusc. !o5oplasmosisd. B)C

e. neumocystis Lero/cii

Ans. !he key is &. B)C. # )ere only two points are mentioned6 cer/ical

lymphadenopathy and splenome*aly> !his combination makes B)C as the most

likely cause thouh splenome*aly is a relati/ely uncommon feature of it>>> !hiscombination does not Ot in other options>;

4$F. A $2yo man who was admitted for sur*ery 8days a*o suddenly becomesconfused. )is attn spanis reduced. )e is restless and physically a**ressi/e and picks at his bed sheets.What sin*leaspect of the pt<s h5 reco/ered in his notes is most likely to aid in makin* the d5?a. Alcohol consumptionb. )ead traumac. )5 of an5iety

d. rescribed med

e. %b/ious co*niti/e impairment

Ans. !he key is A. Alcohol consumption. #abstinence from alcohol in the hospital

lead to delirium tremens;.

4$H. A 10yo *irl presents with pallor and features of renal failure. She has hematuriaas well asproteinuria. !he serum urea and creat are ele/ated. !hese symptoms started afteran episode of bloody diarrhea 4days a*o. What is the most probable d5?

a. !!b. )ESc. 3!d. )Se. AI

Ans. !he key is ". )ES. #9ost cases of hemolytic uremic syndrome de/elop in

children after two to 14 days of diarrhea often bloody7 due to infection with a certain

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strain of ,. coli. Ieatures may be i: abdominal pain7 ii: pale skin7 iii: hematuria and

proteinuria7 i/: features of renal failure like6 nausea(/omitin*7 swellin* of face7 hand7

feet or entire body etc. /: ele/ated urea and creatinine etc.;.

4D0. A 40yo woman has had intermittent tension7 diiness and an5iety for4months. ,ach episodeusually resol/es after a few hours. She said she takes alcohol to make her calm. Sheis in a lo/in*relationship and has no probs at work or home. What is the ne5t step in hermana*ement?a. -ollateral infob. -! brainc. -"-d. CI!

e. !I!

Ans. !he key is A. -ollateral info. #Cikely dia*nosis is panic disorder. -ollateral infofrom family7 friends and other peers should be asked to Ond out the cause for her

an5iety;.

4D1. A 4yo 3= dru* abuser is brou*ht into the ,& with complaint of fe/er7 shi/erin*7malaise7 S%"and producti/e cou*h. ,5am temp+8H-7 pulse+110bpm7 "+100(D0mm)*. 3n/-+bilateralca/itatin* bronchopneumonia. What is the sin*le most likely causati/e or*anism?a. 9ycoplasma

b. Staphylococcusc. -hlamydia pneumoniad. seudomonas

e. -

Ans. !he key is ". Staphylococcus. #Amon* the *i/en causes Staphylococcus and

- are reco*nied cause of ca/itatin* pneumonia. !his case is with producti/e

cou*h which *oes more with staphylococcus as - is not producti/e but rather

associated with dry cou*h. &ru* abuse can support both staphylococcus and -;.

4D2. A D1yo woman looks dishe/eled7 unkempt and sad with poor eye contact. She

has recently losther husband. Which of the followin* describes her condition?a. An5ietyb. )allucinationc. 9aniad. )i*h mood

e. Cow mood

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Ans. !he key is ,. Cow mood.

4D8. A $2yo male comes to the complainin* of double /ision while climbin*downstairs. Which of the followin* ner/e is most likely in/ol/ed?a. Abducens ner/eb. !rochlear ner/ec. %culomotor ner/ed. %ptic ner/e

e. !ri*eminal ner/e

Ans. !he key is ". !rochlear ner/e. #oculomotor may cause palsy of inferior rectus7

medial rectus and superior rectus causin* double /ision in multiple *ae> "ut

trochlear in/ol/in* superior obli'ue only causes diplopia in down*ae only. So the

answer is !rochlear ner/e;.

4D4. C1 le/el7 what is the most appropriate landmark?a. 9cburney<s pointb. Stellate *an*lionc. &eep in*uinal rin*d. !ermination of the spinal cord

e. !ranspyloric plane

Ans. !he *i/en key is &. Which is a wron* key. !he correct key is ,. !ranspyloric

plane. #

!he termination of the spinal cord is between C1 and C2 N/ariable between people:.

C1 landmark6 duodenum Orst part7 superior mesenteric artery7 hila of both kidneys7upper border of pancreas7 splenic artery7 pylorus and fundus of *all bladder;.

4D. A 82yo woman presents to the ,& with headache and /omitin*. She wasdecoratin* her ceilin*that mornin* when the headache be*an7 felt mainly occipital with neck pain. Some2hs later shefelt nauseated7 /omited and was unable to walk. She also noticed that her /oice hadaltered. Shetakes no re* meds and has no si*niOcant 9). ,5am acuity7 Oeld and fundi arenormal. She has

upbeat nysta*mus in all directions of *ae with normal facial muscles and ton*uemo/ements.)er u/ulas de/iated to the ri*ht and her speech is slurred. Cimb e5am left armpast6pointin* anddysdiadochokinesis with reduced pin prick sensation in her ri*ht arm and le*.Althou*h power isnormal7 she can<t walk as she feels too unsteady. Where is the most likely site oflesion?

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a. i*ht medial medullab. Ceft medial ponsc. Ceft cerebellar hemisphered. i*ht lateral medulla

e. Ceft lateral medulla

Ans. !he key is Ceft lateral medulla. # There is a loss of pain and temperature sensation on the

contralateral 'opposite( side of the body and ipsilateral 'same( side of the face. There is associated cerebellar

symptoms and other cranial nerve involvement].

)*. A 2Fyo female presents with 1 wk h5 of Laundice and 2d h5 of altered sleeppattern and moods.She was d5 with hypothyroidism for which she is recei/in* thyro5ine. !I! showedincreased !S).!+D0s. What is the most probable d5?a. Acute on chronic li/er failure

b. )yper6acute li/er failurec. Autoimmune hepatitisd. Acute li/er failure

e. &ru* induced hepatitis

Ans. !he key is -. Autoimmune hepatitis. #Autoimmune hepatitis may present as

acute hepatitis7 chronic hepatitis7 or well6established cirrhosis. Autoimmune

hepatitis rarely presents as fulminant hepatic failure. %ne third may present as

acute hepatitis marked by fe/er7 hepatic tenderness and Laundice. Bon speciOc

features are anore5ia7 wei*ht loss and beha/ioural chan*e Nhere altered sleep

pattern and moods:. !here may be coa*ulopathy Nhere !+D0s.: leadin* to

epista5is7 *um bleedin* etc. resence of other autoimmune disease like

hypothyroidism supports the dia*nosis of autoimmune hepatitis;.

)). A yo man has a chronic cou*h and sputum7 ni*ht sweats and wei*ht loss.What is the sin*lemost likely causati/e or*anism?a. -oa*ulase K/e cocci in sputumb. ram 6/e diplococci in sputumc. ram K/e diplococci in sputumd. neumocystis carinii in sputum

e. Sputum stainin* for mycobacterium tuberculosis

Ans. !he key is ,. Sputum stainin* for mycobacterium tuberculosis. #-hronic cou*h

and sputum7 ni*ht sweats and wei*ht loss are classic features of tuberculosis;.

4DF. A 20yo pre*nant 82wks by date presents to the antenatal clinic with h5 ofpainless /a*inal

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bleedin* after intercourse. ,5am (A soft and rela5ed7 uterus+dates7-!+reacti/e. -hoosethe sin*le most likely d5?a. Abruption of placenta 2nd to pre6eclampsiab. Antepartum hemorrha*ec. lacenta pre/ia

d. reterm labor

e. lacenta percreta

Ans. !he key is -. lacenta pre/ia.

4DH. A 80yo man presents to the ,& with diRculty breathin*. )e has returned from3ndia. ,5amthroat re/eals *rey membranes on the tonsils and u/ula. )e has mild pyre5ia. Whatis the sin*lemost rele/ant d5?a. &iphtheria

b. 39c. Acute follicular tonsillitisd. Scarlet fe/er

e. A*ranulocytosis

Ans. !he key is A. &iphtheria. #history of tra/el to india7 *rey membrane in tonsil

and u/ula7 low *rade fe/er7 and dyspnoea support the dia*nosis of diphtheria;.

4F0. A 28yo man comes to the ,& with a h5 of dru* misuse. )e reco*nies that hehas a prb and iswillin* to see a psychiatrist. Which of the followin* terms best describes this

situation?a. Tud*ementb. !hou*ht insertionc. !hou*ht blockd. 9ood

e. 3nsi*ht

Ans. !he key is ,. 3nsi*ht.

#in psychiatry7 the patientMs awareness and understandin* of the ori*ins and meanin

* of his attitudes7 feelin*s7 and beha/ior and of his disturbin* symptoms Nself6

understandin*: is known as insi*ht;.

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