1. For nocturnal enuresis how long you will give desmopressin?

1-2 months () 2-3 months 3-6 months 6-9 months 1-2 weeks

2. A lady is allergic to lidocaine; she is going to have a vulval biopsy. What will you give? Topical preparation of prilocaine and lidocaine () Prilocaie infiltration Infiltration of Bupivacaine No anesthesia

3. Which of the following is NOT a complication of abruption placenta? () Pulmonary embolism Vaginal bleeding leading to shock Renal failure Extravasation of blood into myometrium DIC

4. A child 3 years old came to ER with H/O bleeding per rectum since 2 hours ago. She bleed 300ml of blood, she was healthy before that and she arrived to the ER she had an about 200ml of bleeding. O/E

abdomen soft, no mass palpable. What is the most appropriate investigation? Ultrasound Lower GI endoscopy () Technetium 99 scan Ba enema

5. A lady one year after delivery presents with amenorrhea even though she chose not to breast feed her baby. She had PPH and curetting done during delivery. You gave her estrogen-progesterone but no withdrawal bleeding. What is your diagnosis? Sheehan syndrome () Asherman syndrome Premature ovarian failure

6. Similar scenario. But here she had PPH and curetting was not done. She had withdrawal bleeding when estrogen-progesterone given. What is your diagnosis? () Sheehan syndrome Premature ovarian failure Asherman syndrome.

7. An epileptic man getting phenytoin 400 mg but his epilepsy is not controlled. What are you going to do? () Increase the dose

8. What is the prevalence of anxiety disorders in children? 2% () 5% 10% 15%

9. Picture of rectal prolapse in a child. Which of the following is true about cystic fibrosis? Affected parents common () Parents may have sub-clinical disease Antenatal diagnosis may be possible.

10. Question on nerve injury, a man cannot touch his index finger with thumb, sensations over palm is normal and no other abnormality. Which nerve was injured? Ulnar nerve Median nerve Radial nerve () Anterior interosseous nerve Axillary nerve.

11. Which of the following is unlikely to be due to child abuse? Fouchette tear Hymen tear

 Condyloma Chalmydia infection Vulval hematoma

12. A 2 years old child with fever, continuous tonic-clonic seizures for 15 minutes what will you give? () IV Lorazepam IV phenobarbitone Paraldehyde Ethosuccimide

13. A 14 year old boy, his height on 5th centile, weight on 50th centile and the bone age is delayed. What is the first investigation Growth hormone assay Karyotyping () Testosterone

14. A 7 years old boy brought to you by the parents. His height on 5th centile, he is doing well at school. Parents are of normal height. Which of these investigations will you do first? () Bone age Skeletal survey Karyotyping Hormonal assay

15. Which of the following is most likely to be Ectopic pregnancy? 7 weeks amenorrhea with vaginal spotting 7 weeks amenorrhea with IUD 12 weeks amenorrhea with right lower quadrant pain 5 weeks amenorrhea with menstrual like cramps.

16. Which is the most common cancer in Canada in men(excluding skin cancer) Lung () Prostate Colon Liver Brain

17. Which of the following first appears in ARDS? () Low PO2 High PCO2 with Low po2

18. Which of the following is not seen in AIDS related complex? Lymphadenopathy Cardiomegaly () Splenomegaly

19. A lady 65 years taking -blocker for hypertension. She complains of fatigue and decreased sleep, the doctor prescribed imipramine.

Physical exam normal. What is the most likely cause? Chronic fatigue syndrome () Due to the effect of drugs Hypothyroidism

20. Tricyclic overdose. Patient develops arrhythmia. What will you give? () Sodium bicarbonate I/V

21. How do you monitor Tricyclic overdose? () ECG

22. A patient with heart rate186 with wide QRS complex. How will you differentiate SVT from ventricular arrhythmia? Fusion beat Capture beat () Delta wave.

23. Same question (Options different) Fusion beat Capture beat () Regularity / Irregularity rhythm SVT=Regular

24. How will you differentiate maxillary fracture from zygomatic fracture? Malocclusion

() ?Diplopia

25. A lady with 6 months of amenorrhea, pregnancy test positive. She felt fetal movements 2 months back. O/E fundal height-27 cm. What is the approximate gestational age Type one answer 26 -28 weeks

26. A patient with chronic AF on long term warfarin treatment. PT- 5.9 What will you do? Cryoprecipitate FFP Platelet transfusion

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04-19-2013, 01:31 PM #2

Neha Gupta Neha Gupta is offline Junior Member -------------------------------------------------------------------------------Join Date:Oct 2012Posts:7,000

27. A patient known alcoholic came to ER with bleeding esophageal varices. Hemodynamically he is stabilized. What is your next most appropriate management? IV octreotide () Gastroscopy Senstaken tube

28. A child is brought to the ER by his parents with H/O diarrhea and vomiting for 3 days, last episode of vomiting was 12 hours ago and loose stools 4 times in last 24 hours. O/E pulse=100/mt BP=100/60, oral mucosa mildly dry and eyes mildly sunken. No other abnormalities. What is the management? He was tolerating oral clear fluids.(part B Q)- choose 2 Oral electrolyte solution Oral clear fluids Admit Send him home IV normal saline D5W

29. A child has ingested cleaning liquid with lye. Which of the following is NOT done? IV fluids () NG tube Chest X ray Endoscopy Endtrachial tube

30. An 85 year old man living in nursing home complaints of obstipation for the last 3 days. He was apparently healthy before that. What is the most common cause? Cancer colon

() Fecal impaction

31. A man conducted a cohort study about social support on health outcome. Here social support is? Determinant Commodity () ?Confounding factor.

32. An asymptomatic lady, Pap smear negative, Chlamydia and HPV negative. On examination cervix shows pink squamous epithelium and inner to that red columnar epithelium around the os. What is your further action? Pap smear after 3 months Laser coagulation () Do nothing Biopsy

33. A man complaint of thickening .etc (suggestive of fungal infection) of toe nails... How will you treat? () Oral terbinafine for 3 months Oral itraconazole for 12 months Oral grieseofulvin for 9 months Topical miconazole for 3 months

34. Lady complaints of pain in the right upper quadrant for the last 24

hours. Tc- 13000, amylase 800, Alk.po4ase=160, sGPT=56, sGOT=60, s.bilirubin normal. What is your diagnosis Acute cholecystitis () Acute pancreatitis Acute hepatitis Choledocholithiasis

35. Spontaneous rupture of extensor tendon of thumb occurs in () Rheumatoid arthritis de quervains disease

36. A 28 years old lady has weight gain, fatigue etc. (features suggestive of hypothyroidism) for the last 2 years. O/E there is irregular rubbery enlargement of thyroid. TSH is 9.1 what is your next step? () Give her eltroxin Do radio active iodine uptake scan FNAC Do T4 U/S

37. An aboriginal man living on reserve goes to a physician. Who is going to pay for his visit? () ?Federal government Provincial government Some aboriginal organization(forgot the name)

38. Which of the following is true about Canada health act? Health insurance is Portable to all provinces and regions Accessible to all When goes to another province the host province temporarily take care of the cost

39. Which of the following organization is for the best interest of physicians? Canadian medical association MCC

40. A man is in the ER with fracture of femur and comminuted fracture of tibia which is reduced and taken care of. Which all complications can occur? Part B Q () ? Fat embolism Compartmental syndrome Atrophy of quadriceps knee joint stiffness Decubitus ulcer

41. What is the standard treatment in tourette syndrome? () Haloperidol family therapy Individual psychotherapy

 Behavior therapy

42. A pregnant lady is going to a vacation in? African country. Which of the following is not true? Hepatitis A vaccine can be give Hepatitis B vaccine can be given () Chloroquine prophylaxis is contraindicated

43. Which of the following is NOT a feature of vaginal foreign body? Dyspareunia Foul smelling vaginal discharge () Fever Vaginal bleeding Abdominal pain

44. A pregnant lady at 37 weeks date confirmed by first trimester scan, fundal height 31 cm. U/S done shows decreased liquor and estimated fetal weight 2000 gram. What is your next action? BPP twice per week Repeat scan after 24 hours () Admit her and plan for induction of labor Send her home. Contraction stress test ( I am not sure whether this option was there or not)

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04-19-2013, 01:33 PM #3

Neha Gupta Neha Gupta is offline Junior Member -------------------------------------------------------------------------------Join Date:Oct 2012Posts:7,000

A 28-year-old medical student returns from Kenya after a 6 week elective. Two weeks later she complains of fever, rigors, malaise and headache occurring daily for the past four days What physical findings would you specifically look for? Select up to three. Arthritis Papilledema Ascites Pallor Crackles Petechiae Cullen's sign Lymphadenopathy Erythema chronicum migrans Meningismus Erythema nodosum Roth spots Hepatomegaly Scleral icterus Hypotension Splenomegaly Osier's nodes Systolic ejection murmur Palmar erythema Wheezes

What laboratory investigations would you order? Select up to five. Abdominal ultrasound HTV serology Blood cultures LDH Chest x-ray Liver function tests CD4 cell count Lyme serology Cold agglutinins Malaria serology Creatinine PPD

CT scan head Platelets EEG Serology for dengue fever Hemoglobin Stool cultures Hepatitis A serology Stool for ova and parasites Hepatitis B surface antigen Thick smear for malaria Heterophile antibodies White blood cell count

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04-20-2013, 01:10 PM #4

Neha Gupta Neha Gupta is offline Junior Member -------------------------------------------------------------------------------Join Date:Oct 2012Posts:7,000

CASE 3 A 40-year-old man is admitted to the Emergency Department with a history of chest pain of sudden onset while playing basketball with his young children.

What diagnoses would you consider at this point? List up to two. 1. 2.

CASE 3: With respect to your diagnosis, what elements in the history would you inquire about? Select up to six. Chronic headaches and takes aspirin regularly Consumes 12 beers daily Family history of chest disease

Family history of diabetes Had dental extraction 2 months ago Hemoptysis Hemorrhoids History of brr ichiectasis History of hypertension History of smoking On a low salt diet Pain worse on breathing Post-prandial abdominal pain Productive cough of recent onset Radiation down the arms Radiation into the jaw Recurrent nosebleeds Shortness of breath Stool is black in colour Stool is pale in

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04-20-2013, 01:11 PM #5

Neha Gupta Neha Gupta is offline Junior Member -------------------------------------------------------------------------------Join Date:Oct 2012Posts:7,000

CASE 4: An 84-year-old female is brought to the Emergency Department by her daughter

who states that her mother has not been herself over the past three days. Further questioning reveals that the mother has been less attentive than usual and more withdrawn, her conversation is often rambling and she has not been sleeping well. Prior to this, she functioned very well.

What diagnoses would you consider at this time? List up to two: 1. 2.

What additional aspects of history would be most important to know? Select up to four: Alcohol intake Complete psychiatric history Family history of Alzheimer's disease Financial status History of fever History of incontinence History of Osteoarthritis History of Parkinson's disease History of previous CVA Immunization status Marital status Medication history Occupational history Pattern of symptoms over the course of the day, eg. fluctuations

Presence of hallucinations Previous history of depression Previous seizure disorder Previous surgery Recent travel Smoking history

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04-20-2013, 01:13 PM #6

Neha Gupta Neha Gupta is offline Junior Member -------------------------------------------------------------------------------Join Date:Oct 2012Posts:7,000

CASE 4: The interview confirms the daughter's description of the mother. Physical exam reveals: BP 120/80 supine and 100/70 sitting, RR=22, P=104, T=38.7C. JVP is at the sternal angle. Respiratory exam reveals dullness, increased tactile fremitus, crackles and bronchial breath sounds all in the left base. Heart sounds are normal. The abdominal exam is normal. CNS exam does not reveal any focal findings. What would you include in your initial investigations? Select up to four: ALT Electrolytes AST HIV test Blood cultures MRI of head B12 Protein electrophoresis CBC PT and PTT Chest x-ray RBC folate

CPK SPECT scan CT Scan of Head TSH Drug screen Urea and creatinine EEG VDRL

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04-20-2013, 01:14 PM #7

Neha Gupta Neha Gupta is offline Junior Member -------------------------------------------------------------------------------Join Date:Oct 2012Posts:7,000

An 84-year-old female is brought to the Emergency Department by her daughter who states that her mother has not been herself over the past three days. Further questioning reveals that the mother has been less attentive than usual and more withdrawn, her conversation is often rambling and she has not been sleeping well. Prior to this, she functioned very well.

What diagnoses would you consider at this time? List up to two: 1. B12 deficiency 2. Delirium due to infection

What additional aspects of history would be most important to know? Select up to four:

1.Alcohol intake 2. History of fever

3. Pattern of symptoms over the course of the day, eg. fluctuations 4. Previous seizure disorder

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04-20-2013, 01:16 PM #8

Neha Gupta Neha Gupta is offline Junior Member

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Q. A 39 year old male with no fixed address is brought to the emergency department by ambulance after having a witnessed generalized tonic-clonic seizure of short duration. He is known to have a history of alcohol abuse in the past. On examination, he is noted to be drowsy with tachycardia and no focal neurological deficits.

What are the most likely possible etiologies of a seizure in this patient? list up to four. 1. 2. 3. 4.

Which diagnostic tests would be most useful to determine the etiology of this patient's seizure? Select up to five. Abdominal ultrasound EKG Abdominal X-Ray ESR Arterial blood gases Glucose ASA level Liver function tests

CBC Lumbar puncture Chest X-ray Protein Creatinine PT/PTT CT head Serumethanol, methanol, ethylene glycol level Drug screen for street drugs Skull X-Ray Electrolytes Urea Urinalysis

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04-20-2013, 01:20 PM #9

Neha Gupta Neha Gupta is offline Junior Member -------------------------------------------------------------------------------Join Date:Oct 2012Posts:7,000

Q. A 36-year-old Gravida I, Para O is seen at 36 week gestational age, complaining of swelling of her hands and feet as well as gastric pain, all of recent onset. Her blood pressure taken in the left lateral position is 150/95 (previous it was 120/70).

With respect to plausible diagnosis, what elements of history would you enquire about? Select up to five. Alcohol intake Headache Allergies History of birth control pill use Blurred vision History of infertility Constipation History of urinary tract infection Deepening of voice Number of sexual partners Dysmenorrhea Previous history of PID

Dyspareunia Previous dilatation and curettage Family history of ovarian cancer Scotoma Fetal movement Smoking Fever Weight gain

With respect to investigations, which of the following may be helpful in establishing the diagnosis? Select up to six. Amniocentesis LH Amylase Liver enzyme CBC (including platelets) Lumbar puncture Chest x-ray PA flat Obstetrical ultrasound Creatinine PT/PTT CT scan of head Thyroxine bindy globulin ECG Urinary calcium ESR Urinary protein Free cortisol Urinary sodium FSH

What is the most likely diagnosis in this patient? List one.

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04-20-2013, 02:16 PM #10

Neha Gupta Neha Gupta is offline Junior Member -------------------------------------------------------------------------------Join Date:Oct 2012Posts:7,000

At his four month well baby visit, an infant boy is noted to be bright and alert but generally hypotonic. The baby lies naturally in the frog leg position, has poor head control and his deep reflexes cannot be elicited. > > Which of the following would you include in the > differential dg? Select up to five > > 1. aminoaciduria > 2. astrocytoma > 3. cerebral palsy > 4. Charcot-Marie-Tooth disease > 5. Duchenne's muscular dystrophy > 6. Hyperkalemic periodic paralysis > 7. Hypopituitarism > 8. Hypothyroidism > 9. infant botulism > 10. lead poisoning > 11. metachromatic leukodystrophy > 12. mucopolysaccharidosis > 13. myastenia gravis > 14. Nemaline myopathy > 15. sepsis > 16. spinal muscular atrophy (Werdnig-Hoffman disease) > > The most appropriate investigations would include > which of the folowing? select up to four

> > 1. aryl sulphatase > 2. creatinine kinase > 3. CT of head > 4. ECG > 5. EMG > 6. fasting blood sugar > 7. MRI of head > 8. muscle biopsy > 9. nerve biopsy > 10. nerve conduction > 11. serum aminoacidsserum carnitine > 12. serum potassium > 13. serum pyruvate > 14. urinary reducing substances > 15. urine screen for mucopolysaccharides

Q. A 73 year-old woman presents at the Emergency Department with injuries and other signs suggesting that her husband is abusing her. The patient feels dependent on her husband, since he is her primary caregiver. Consequently, she asks the physician who treats her not to report her husband to the authorities.

How should this situation be handled 1-Since the woman is not a minor, the principle of confidentiality outweighs other considerations; the husband must not be reported at this point

2-Law requires that the case be reported, but if it's possible to refer the woman to other services, this may benefit her more 3-Without witnesses supporting the claim that the woman is being abused, referring the case to legal authorities would be futile 4-In an older individual, it is relatively easy to mistake injuries due to accidents for injuries due to abuse; thus, this should not be treated as an abuse case 5-The woman should be admitted to the inpatient psychiatric unit for her protection.

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04-22-2013, 03:00 PM #12

Neha Gupta Neha Gupta is offline Junior Member -------------------------------------------------------------------------------Join Date:Oct 2012Posts:7,000

Q. A 63 year-old woman has metastatic breast cancer. Admitted to the hospital on account of weakness and dehydration and weakness, her prognosis is not good, and no more effective treatment options are available. Therefore, palliative chemotherapy is being considered. At the same time, the nutrition team has concerns about the patient's cachexia. Total parenteral nutrition (TPN) is recommended. Which of the following is most accurate? 1-Since total parenteral nutrition (TPN) has no major drawbacks, there is no reason not to move forward with it 2-TPN would prolong the patient's suffering necessarily. Thus, it should not be included in the care 3-Since TPN has certain risks, not including it in the palliative care should be considered 4-There is no reason to proceed with any treatment other than pain management 5-TPN is essential to this patient's management

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04-22-2013, 03:01 PM #13

Neha Gupta Neha Gupta is offline Junior Member -------------------------------------------------------------------------------Join Date:Oct 2012Posts:7,000

Q. A clinical trial is conducted to compare the efficacy of two different antibiotics in the outpatient treatment of uncomplicated pneumonia. Drug A is found to cure the disease in 90% of the cases, while drug B cures the disease in 70% of cases. After further statistical analysis however, this difference is NOT found to be statistically significant, with a P value of greater than 0.05.

What can be done to increase the statistical significance of the clinical trial data set?

1-Add a third drug, drug C, to the trial protocol 2-Compare the costs of drugs A and B 3-Compare the number of days of treatment required for drugs A and B 4-Begin a new identical study and collect an entirely new data set 5-Increase the number of patients enrolled in the study

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04-22-2013, 03:02 PM #14

Neha Gupta Neha Gupta is offline Junior Member -------------------------------------------------------------------------------Join Date:Oct 2012Posts:7,000

These are some questions. Please answer them with your explanation. .

1.A psychiatrist planned a randomized clinical trial of a new drug. She expected a success rate of 60%. A 15% difference in the success rates is the minimum which she regards as having clinical importance. She needs to enroll about 150 patients for the difference to be significant at a p value < 0.05. Unfortunately, she could only recruit 100 patients. Although the success rate was close to the expected, the p value was greater than 0.05. The psychiatrist can conclude that the new drug is of no value. there is no difference between the old and new drugs. she has confused clinical and statistical significance in her trial design.

the trial has failed to demonstrate that the new drug is superior. the results justify the use of the new drug routinely.

2. A 67-year-old man presents with a painless right groin mass. He first noticed it a month ago and it seems to have grown slightly since. History includes a coronary balloon angioplasty 3 months ago. On physical examination, the mass is hard, fixed, and slightly pulsatile. Which one of the following would confirm the diagnosis? Angiography Computed tomography scan Open biopsy Needle biopsy Ultrasound

3. A 55-year-old male patient with suspect tuberculosis requires diagnostic bronchoscopy. Which one of the following statements about informed consent is most appropriate? An experienced nurse may explain the procedure and sign the consent form. The consent must include information regarding all side-effects of the procedure. The interview with the patient must be conducted by the physician who will carry out the procedure or by another equally competent physician. No consent is required since diagnostic studies for suspect tuberculosis may be ordered under public health legislation if necessary. The consent form must be signed by a witness other than the physician.

4.A 47-year-old man has been training to run a marathon. After a long run, he develops mild pain and swelling in his left knee. Examination shows a mild joint effusion and a soft tissue mass in the popliteal fossa. Ultrasound confirms that he has a Baker's cyst. Which one of the following is the best treatment for this condition? Cyst aspiration and compression. Surgical excision of the cyst. Intra-articular steroids.

Arthroscopic debridement. Rest, compression and anti-inflammatory medication.

5.Which one of the following features differentiates posttraumatic stress disorder from adjustment disorder? The presence of autonomic symptoms. The presence of sadness. The severity of the precipitating stressor. Co-morbid anxiety with irritability. The absence of concomitant disease.

6.A 45-year-old woman was involved in a motor vehicle collision. She was not restrained. She complains of severe hip pain, and her hip is held in flexion and adduction. What is her most likely injury? Pelvic fracture. Femoral neck fracture. Psoas muscle disruption. Posterior hip dislocation. Sacro-iliac joint disruption.

7.A 26-year-old nurse with a previously negative tuberculin skin test is found to have a positive reaction to purified protein derivative (PPD) 3 months after having been exposed, in hospital, to a patient with active tuberculosis. The nurse is asymptomatic and a chest x-ray shows no abnormality. Which one of the following would be the correct management at this time? Isoniazid and ethambutol for 12 months. Sputum or gastric washings for tuberculosis cultures and initiate therapy only if these prove positive. X-rays of the chest every 3 months and initiate treatment should a pulmonary infiltrate develop. Isoniazid and ethambutol until sputum or gastric wash cultures are reported negative in 8 weeks. Isoniazid for 6 months.

8. A 62-year-old asymptomatic man who received radiation treatment for acne during adolescence is seen for evaluation of his thyroid gland. On examination, the thyroid gland is non-tender and normal in size. A 2 cm nodule is palpable. There is no lymphadenopathy. Which one of the following courses of action is most appropriate? Fine-needle aspiration biopsy. Radioiodine thyroid scan. Ultrasound and reassessment in 6 months. Hemithyroidectomy. Determination of serum thyroid-stimulating hormone.

9.A 21-year-old man is involved in a motorcycle collision. On arrival in the Emergency Department, he is noted to have no movement of his legs, no sensation in his legs and loss of rectal tone. Which one of the following may be beneficial? High dose steroids High dose antihistamines Opioid antagonists Revascularization of the spinal cord Spinal cord cooling

10.Patients should be instructed to avoid foods with a high tyramine content when taking which one of the following drugs? Fluoxetine. Desipramine. Phenelzine. Moclobemide. Nortriptyline.

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04-22-2013, 03:03 PM #15

Neha Gupta Neha Gupta is offline Junior Member -------------------------------------------------------------------------------Join Date:Oct 2012Posts:7,000

11.A 62-year-old morbidly obese male with type 2 diabetes mellitus is being started on metformin. Which of the following is the most common drug adverse effect affecting compliance? Diarrhea Weight gain Fatigue Headache Edema

12.A 32-year-old woman presents to the emergency complaining of feeling anxious, short of breath, nauseated and dizzy. She is sweaty and complains of feeling "pins and needles" in her hands. Upon questioning, she describes the room as spinning. She is certain that something terrible is happening to her "like a heart attack." Which one of the following symptoms should alert you to a medical condition presenting as a panic attack? Fear of dying Paresthesias Diaphoresis Dyspnea Vertigo

13. A 65-year-old woman, who is otherwise well, has disabling rheumatoid arthritis. You elect to treat her with the nonsteroidal anti-inflammatory agent (NSAID) ibuprofen in an attempt to reduce the inflammatory response and pain she suffers. Which one of the following side effects of NSAIDs is most likely to develop in this patient? Thrombocytopenia. Duodenal ulcer. Congestive heart failure.

Gastritis. Acute renal failure.

14. A 7-year-old boy with a past history of chronic kidney disease due to posterior urethral valves diagnosed at birth presents to the Emergency Department with a 48-hour history of diarrhea and vomiting. He weighs 30 kg and his height is 130 cm. Examination reveals a pale child with cool hands and feet and a prolonged capillary refill time. Laboratory results showed: Sodium 134 mmol/L Potassium 5.2 mmol/L Bicarbonate 19 mmol/L Creatinine 170 mol/L Urea 17.5 mmol/L Which one of the following would be the most appropriate to order as an intravenous bolus to treat this acute illness? 600 mL of 5% dextrose 0.45% saline. 400 mL of 0.9% saline. 150 mL of 0.2% saline with 10 mmol/L KCl. 500 mL of 0.45% saline. 300 mL of 0.2% saline with 20 mmol/L KCl.

15.Compared with control subjects, patients with major depression generally show frequent REM periods and decreased density. decreased REM latency and decreased stage 4 sleep. shortened REM time and decreased stage 2 sleep. shortened REM time and no change in stage 4 sleep. increased rapid eye movement (REM) latency and increased stage 2 sleep.

16. A 39-year-old woman presents to your office and requests the birth control pill. She has used oral contraceptives in the past with no problems. She is healthy and does not take any medications. Her mother had breast cancer. Before prescribing the pill, which one of the following interventions would be most appropriate? Review her past Papanicolaou smears for abnormalities. Order a mammogram. Draw blood for a lipid profile.

Assess her smoking status. Do a urine pregnancy test.

17. Four weeks ago, a 42-year-old woman presented to your office having already started taking St. John's Wort 300 mg 3 times a day as recommended by her naturopath. She had a two-month history of feeling sad and distant from her family, crying spells when alone and difficulty falling asleep. She continued to work part time. Although she continued to take St. John's Wort 300 mg TID, she now reports that she feels more distracted, has sleepless nights and more frequent crying spells. She is not suicidal. In addition to regular follow up, which one of the following is the most appropriate management plan? Stop St. John's Wort and begin venlafaxine (Effexor XR) 75 mg QAM, after a wash out period. Continue St. John's Wort at the current dose and add paroxetine (Paxil) 20 mg OD. Increase the dose of St. John's Wort to 600 mg TID. Add Omega-3 5 g/day to the current dose of St. John's Wort. Add Lithium 600 mg daily to augment her current dose of St. John's Wort.

18.A woman, gravida 2, para 1, consults at 10 weeks of gestation. In obtaining her history, which of the following is the most important risk factor for preterm delivery? She has a history of anorexia nervosa. Her first baby was born at 34 weeks. She was treated for Chlamydia 6 months ago. She works as a sales person in a department store. She is 36 years old.

19.An 11-year-old child is brought unconscious to the Emergency Department. You diagnose a ketoacidotic coma due to undiagnosed diabetes. You want to start insulin treatment but the parents refuse, stating that their beliefs prohibit the use of non-human derived hormones. Which one of the following is the most appropriate action? Obtain a supporting opinion from a medical colleague to initiate treatment. Ask the child protection agency to act as a mediator between you and the parents.

Initiate volume repletion and make sure the child is comfortable. Initiate insulin treatment since you judge it necessary. Obtain a court order before initiating insulin treatment.

20.Five years ago, you completely removed a malignant melanoma on a middle-aged woman. She was disease-free on follow-up. Today, she presents with her husband who complains that she has been irritable, depressed, demanding and uncooperative. She looks vague and answers questions slowly. Brief general examination is within normal limits. Which one of the following management steps is the most appropriate? Obtain a drug and alcohol screen. Start a therapeutic trial of antidepressants. Order a complete blood count and blood chemistry. Order a computed tomography scan of the head. Refer the patient to a counselor.

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04-24-2013, 01:50 PM #16

Partha Sarkar Partha Sarkar is offline Junior Member -------------------------------------------------------------------------------Join Date:Oct 2012Posts:5,093

Q. A retrospective cohort study is conducted to evaluate the relationship between cigarette smoking and bladder cancer in men. In the study, 48 out of 10,000 smokers and 24 out of 20,000 non-smokers develop bladder cancer. The risk difference is: 0.25. 4. 36. 24. 0.0036.

Q. A 19-year-old primigravida woman presents for her first prenatal visit at 12 weeks' gestation. She is generally healthy. She has a history of frequent urinary tract infections as a child. Which one of the following is most appropriate? Cystoscopy. Prophylactic antibiotics. 24-hour urine for creatinine clearance. Urine culture. Renal ultrasound.

Q. A previously healthy seven year old boy complaints of pains in his legs and shoulders associated with a loss of appetite and listlessness. Over the next few days he develops a cough and increasing shortness of breath. On examination he is found to be alert but mildly dyspnoeic. He is afebrile, the respiratory rate is 60 per minute and the apex rate is 130 per minute. Air entry is good but crackles are heard in both bases. The precordium is normodynamic. Heart sounds are normal and no murmur is detected. No rub is heard. The liver is felt 4 cm below the costal margin. CASE 8: QUESTION 18 Which of the following would be included in the differential diagnosis? Select up to two.

* Coxsackie myocarditis ** Viral pneumonia (how about this one?)

Q. 9 year boy came with his grandfather said that the child cry a lot and did not sleep well, his school performance is good, his mother was admitted for overdose antidepressant, his grandfather asked you to prescribe antidepressant for the boy

a. you will prescribe ttt b. you will not prescribe ttt as his mother is his decision maker is not present c. you will not prescribe ttt as he may take over dose as his mother d. you will not prescribe ttt as his condition did not need ttt.

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04-24-2013, 01:52 PM #17

Partha Sarkar Partha Sarkar is offline Junior Member -------------------------------------------------------------------------------Join Date:Oct 2012Posts:5,093

Q. An 11-year-old girl, who is a Jehovah's Witness, is in need of a bowel resection for ulcerative colitis. Her hemoglobin is 53 g/L (normal value 120-160 g/L). The family is refusing to allow her any blood products. Which one of the following is the most appropriate next step? a.Transfer her care to another hospital. b.Book her for surgery without any blood transfusion. c.Treat her nonoperatively. d.Arrange to make her a ward of the court and give her a blood transfusion. e.Ignore the patient's family's wishes and give her a blood transfusion.

The courts are clear on this issue. An adult has the right to refuse any life saving measures as long as he is competent to make the decision. However, they cannot make the decision for their child. In this case, a child is severely anemic and would receive a blood transfusion irrespective of the parent's wishes. In general, going to the courts is never the right answer. Answer is E.

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04-24-2013, 01:52 PM #18

Partha Sarkar Partha Sarkar is offline Junior Member -------------------------------------------------------------------------------Join Date:Oct 2012Posts:5,093

Aboriginal patients seeking sick note, who should pay?

1. Patient 2. Federal govt. 3. provincial govt 4.Some aboriginal organization

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04-24-2013, 01:53 PM #19

Partha Sarkar Partha Sarkar is offline Junior Member -------------------------------------------------------------------------------Join Date:Oct 2012Posts:5,093

Question: 1

Passive immunization is most often used to prevent

1) diphtheria.

2) typhoid.

3) rabies.

4) meningococcal meningitis.

5) tuberculosis

2 Which one of the following drugs can be safely administered to patients taking phenelzine?

1) methyldopa

2) lithium carbonate

3) pseudoephedrine

4) methylphenidate

5) meperidine

Question: 3

A 25-year-old man presents to your office with a 2-week history of intermittent bright red blood per rectum. He is otherwise well. From this history alone, the most likely diagnosis is:

1) anal fissure

2) ulcerative colitis

3) multiple polyposis coli

4) hemorrhoids

5) rectal carcinoma

Question: 4

A 68-year-old man develops acute renal failure after surgery for ruptured aortic aneurysm. He refuses dialysis. Psychiatric consultation reveals him to be fully alert and oriented, cognitively intact, and not psychotic or clinically depressed. He says he is refusing dialysis because he has "lived a full life" and does not want to be "tied to a machine, even if this means I'll die." The psychiatrist should tell the man's internist that the man

1) is temporarily incompetent to decide on treatment, so treatment should be started.

2) is competent to decide on treatment, but his refusal should be overruled because of the existence of a medical emergency.

3) his refusal of dialysis must be respected because he is competent to decide on treatment.

4) is behaving in a self-destructive manner, so he should be committed for treatment against his will.

5) shows no evidence of a major psychiatric illness but assessment of competency is required.

Question: 5

A 23-year-old sexually active woman presents with fever, pain and effusion in her left knee, as well as scattered erythematous papular lesions on the fingers, toes and extremities. Which one of the following is the most likely diagnosis?

1) secondary syphilis

2) disseminated lymphogranuloma venereum

3) Reiter's syndrome

4) disseminated gonococcemia

5) herpes simplex virus type 1 (HSV-1) infection

Question: 7

A 3-year-old girl is admitted to hospital because of generalized petechiae. The blood count shows anemia and neutropenia. The best initial diagnostic step is to order

1) anti-platelet antibodies.

2) a reticulocyte count.

3) an osmotic fragility test.

4) a bone marrow biopsy.

5) antinuclear antibodies.

After surgical incision of an abscess situated in the right posterior triangle of the neck, the patient could no longer raise her right hand above her head to brush her hair. Which one of the following nerves is most likely injured in this patient?

1) long thoracic nerve

2) spinal accessory nerve

3) suprascapular nerve

4) dorsal scapular nerve

5) nerve to subclavius

Question: 9

A voluntary exercise program was offered to the male employees of a large company. After its introduction, the rates of ischemic heart disease (IHD) events were compared between those who volunteered for the program and those who did not. These events were determined by regular voluntary checkups, including comprehensive cardiovascular investigation. The group that exercised had a lower rate of IHD. The main reason to reject the conclusion that exercise is protective against IHD is

1) selection bias could have occurred.

2) confounding could have occurred related to the size of the company.

3) measurement bias could have occurred.

4) Hawthorne effect could have occurred.

5) results are not generalizable.

Question: 10

An 8-year-old boy is admitted with a diagnosis of acute renal failure. The serum potassium level is 7.0 mmol/L. Which one of the following is most likely to be observed on the electrocardiogram?

1) increased P wave amplitude

2) ST segment elevation

3) increased T wave amplitude

4) increased R wave

5) absent Q waves

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04-24-2013, 01:54 PM #20

Partha Sarkar Partha Sarkar is offline Junior Member -------------------------------------------------------------------------------Join Date:Oct 2012Posts:5,093

Question: 11

A 20-year-old man with abrupt onset of hematuria and proteinuria, accompanied by azotemia and salt and water retention, most likely has which one of the following?

1) nephrotic syndrome

2) multiple myeloma

3) diabetic nephropathy

4) nephrolithiasis

5) acute glomerulonephritis

A 30-year-old female presents to her physician's office for an increase in fatigue over the last 2 months. On physical examination, the physician notes delayed capillary refill in the nailbeds and a pale appearance of the inner lining of the eyelids. A peripheral smear reveals hypochromic erythrocytes. Which one of the following tests would be most useful in confirming the probable diagnosis?

1) serum ferritin and total iron-binding capacity (TIBC)

2) schilling's test

3) glucose 6-phosphate dehydrogenase assay

4) hemoglobin electrophoresis

5) serum folate and cobalamin (vitamin B12)

Question: 13

A 23-year-old woman in her first trimester of pregnancy is diagnosed as having deep venous thrombosis in her right lower extremity. Which one of the following is the most appropriate therapy?

1) warfarin

2) heparin

3) clopidogrel

4) dipyridamole

5) streptokinase

Question: 14

A 51-year-old man suffered a myocardial infarction 2 years ago. He has been well since. His non-fasting cholesterol level is 6.4 mmol/L. Which one of the following is the next step in his management?

1) no further action

2) obtain a total cholesterol after a 12-hour fast

3) obtain a lipid profile (cholesterol, triglycerides and HDL cholesterol) after a 12-hour fast

4) initiate a cholesterol-lowering diet

5) obtain a lipoprotein electrophoresis

Question: 15

In a 5-year-old girl with leg edema and apparent congestive heart failure, which one of the following would be most effective in inducing rapid therapeutic diuresis?

1) digoxin

2) furosemide

3) thiazides

4) spironolactone

5) mannitol

Q. A 14-year-old boy is seen in the Emergency Department with painless gross hematuria and left-sided abdominal pain. His uncle died of a brain hemorrhage at age 58. Which one of the following is the most likely diagnosis? Nephrolithiasis. Urinary tract infection. Polycystic kidney disease. Renal contusion. Acute glomerulonephritis.

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04-26-2013, 02:04 PM #22

Partha Sarkar Partha Sarkar is offline Junior Member -------------------------------------------------------------------------------Join Date:Oct 2012Posts:5,093

Q. A competent 63-year-old woman with amyotrophic lateral sclerosis (Lou Gehrig disease) has written an advance directive stating that tube feeding is not acceptable. She has now suffered a stroke and cannot communicate or swallow. Her neurological condition is stable, and she is referred to the nutritional support team. Which one of the following should they do? Insert a central line for parenteral alimentation. Insert a nasogastric tube for nutrition. Recommend that she have compassionate terminal care. Suggest a referral to a surgeon for consideration of a gastrostomy. Suggest that she have small regular amounts of liquids by mouth.

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04-26-2013, 02:09 PM #23

Partha Sarkar Partha Sarkar is offline Junior Member -------------------------------------------------------------------------------Join Date:Oct 2012Posts:5,093

Q. In Canada, the age-standardized male incidence rate decreased from 1993 through 2000 for which one of the following cancers? Melanoma. Colorectal. Thyroid. Non-Hodgkin's lymphoma Lung

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04-26-2013, 02:13 PM #24

Partha Sarkar Partha Sarkar is offline Junior Member -------------------------------------------------------------------------------Join Date:Oct 2012Posts:5,093

Q. A previously healthy 2-year-old boy presents to your walk in clinic with a 3-day history of non-bloody, non-bilious vomiting followed by a 5-day history of non-bloody watery diarrhea. Today the diarrhea is bloody, and he is not wetting his diapers. He attended a family picnic 10 days prior. His physical examination reveals a quiet child with a heart rate of 100/minute and a blood pressure of 120/80 mm Hg. His mouth is moist, his eyes are not sunken, and his skin turgor is normal. The rest of his examination is completely normal. Which one of the following is the most important next step in investigation for this patient? Air contrast enema Supine and upright abdominal radiographs Abdominal ultrasound Complete blood count and creatinine Coagulation screen

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04-26-2013, 02:16 PM #25

Partha Sarkar Partha Sarkar is offline Junior Member -------------------------------------------------------------------------------Join Date:Oct 2012Posts:5,093

Q. A very active 75-year-old man who has had a previous appendectomy and open cholecystectomy presents to the Emergency Department with a 3-week history of crampy lower abdominal pain with distention and obstipation. Physical examination shows a distended abdomen with mild diffuse tenderness. Rectal examination is normal. Abdominal x-rays show dilated loops of ascending, transverse and descending colon, with no gas in the rectum. Which one of the following is the most likely diagnosis? Sigmoid colon volvulus. Fecal impaction. Adhesive large bowel obstruction. Diverticulitis. Carcinoma of the sigmoid colon.

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04-26-2013, 02:19 PM #26

Partha Sarkar Partha Sarkar is offline Junior Member -------------------------------------------------------------------------------Join Date:Oct 2012Posts:5,093

Q. A 75-year-old woman presents with a 1-year history of cognitive impairment with periodic confusion and delirium-like episodes of unclear etiology. She has frequent visual hallucinations and over the last month had 2 episodes of syncope. The only findings on physical exam are mild rigidity and loss of associated arm movement while walking. ECG and Holter monitoring are normal. Which one of the following classes of medications will be most important to avoid in this patient? Selective Serotonin Re-uptake Inhibitor antidepressants. Mood stabilizers. Cholinesterase inhibitors. Benzodiazepines.

Anti psychotics.

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04-29-2013, 02:22 PM #27

Partha Sarkar Partha Sarkar is offline Junior Member --------------------------------------------------------------------------------

Join Date:Oct 2012Posts:5,093

Q. 29 years old female otherwise healthy on oral ocp present t the er with worsening RUQ pain ct scan show 6.5 adenoma in the left lobe of the liver 1- surgical resection 2- stop ocp 3- serial ct scan 4- systemic chemotherapy 5- intraarterial embolization of the hepatic adenoma

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04-29-2013, 02:23 PM #28

Partha Sarkar Partha Sarkar is offline Junior Member -------------------------------------------------------------------------------Join Date:Oct 2012Posts:5,093

Patients should stop using oral contraceptives or anabolic steroids. This allows for regression in the size of the majority of the tumors. Complete resolution is atypical. The risk of malignant transformation remains even after the contraceptive or steroid use has been discontinued.

Due to the increased risk of spontaneous life-threatening hemorrhage and the possible malignant transformation associated with larger-size tumors or in patients with GSD, elective surgical resection is considered for all lesions greater than 5 cm in diameter.

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04-29-2013, 02:24 PM #29

Partha Sarkar Partha Sarkar is offline Junior Member -------------------------------------------------------------------------------Join Date:Oct 2012Posts:5,093

Q. You are the doctor covering the newborn nursery, when a new baby is brought in from the delivery room. The baby was born full term, there were no complications at the time of delivery, and the baby appears well now. The Apgar scores were 9 at 1 minute and 9 at 5 minutes. You review the mother's prenatal history and discover that she had a vaginal swab positive for group B Streptococcus. Upon further review of the records, you note that the mother received one dose of ampicillin three hours prior to delivery, had rupture of membranes for 5 hours, and did not have a fever. The most appropriate initial management of this baby is A. close observation only B. complete blood count with differential C. complete blood count with differential and blood culture D. complete blood count with differential, blood culture, and lumbar puncture E. complete blood count with differential, blood culture, lumbar puncture, and chest x-ray

I would do Close observation only. The patient is fine, the mother is fine. I mean there was a risk of GBS sepsis but it is not 100% if mom is GBS +. Its more like 10-20% risk. If baby is fine, just watch for bad things to happen otherwise he would be fine.

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04-29-2013, 02:25 PM #30

Partha Sarkar Partha Sarkar is offline Junior Member -------------------------------------------------------------------------------Join Date:Oct 2012Posts:5,093

Q. A 39-year-old man comes to your office for a routine annual examination. He has no current medical issues and takes only one multivitamin daily. His father and a brother died respectively of myocardial infarctions at ages 56 and 51. The patient reports smoking one pack of cigarettes per day for the previous 21 years, drinking social ethanol, but denies any illicit substance abuse. His last fasting cholesterol level is 219 mg/dL. Concerning his risk of smoking related-mortality, the most accurate statement is: A. By quitting, his risk of cancer is eliminated after 10 years B. By quitting, his risk of myocardial infarction is halved at one year C. Cessation decreases symptoms of COPD but does not reduce mortality D. Switching to low yield cigarettes improves health outcome E. Quitting before age 50 decreases the risk of death over the next 15 years by 100%

Questions of May 2009 :

- pt . with WPW syndrome developed rapid irregular arrhythmia diagnostic of AF , what is the best management ?

a) digitalis b)verapmil c) cardioversion

2-pt with irregular ht rate and ECG typical of AF and rate of 96 / min what is the best management to decrease the long term complication ?

a) longterm anticoagulation b) digitalis

3- pt. with abdominal aneurysm 4cm what is the appropriate management ? a)refer him to surgeon for urgent surgical intervention b)Do MRI c) repeat U/S after 3-6 m

4-pt with intermittent claudication and peripheral ischemia in the calf ms what is the site of obstruction : a)superfiscial femoral Artery b) popliteal A. c) deep femoral

6-pt with moderately severe HTN and cong. heart failure what is the best ttt ? a) CCB + BB b) ACE inhib + diuretics c) BB+ACE inhibit d ) CCB + diuretics

7 female pt with a lap. Cholecystectomy 1 d ago .on the next day she developed Temp 37.8 C ,dyspnea and O/E : dulleness on percussion with coarse crept . on both lung bases what is the next diagnostic step to reveal diagnosis : a) C x-ray b) V/ P scan c) ABG

8-male pt 52 y old with acute retrosternal chest pain , sweating ,what is the best management to confirm the diagnosis ? a) Cx-ray b) echocardiography c) ABG

9- female pt with outward shift apex ,pulsations in the pericordium ,systolic murmer in the pulmonary area ,fixed wide splitting of S2 ,x-ray show dilatation of the pulmonary artery and its branches :

a) ASD b) VSD c) PS

10- pt with grade 2/6 systolic murmer over the aortic area and fixed splitting of S2 and murmer transmitted to the interscapular area a) AS b) VSD

11- pt admitted to the emergency with multiple rib fractures and pulmonary contusi-ons ,although there was no head injury he was irritable and resteless , what is the best appropriate management a) CT scan b) O2 c) sedate with morphine d )

12-pt with non small lung cancer after he knows he refused to get irradiation as a ttt of his cancer what is your appropriate management ? a) explain the condition to his family b) do what you that is the best

13 pt with COPD developed yellow green sputum what is the best antibiotic Given : a) penicillin b) norfloxcacillin c) cefotriaxon

14-the organism responsible for toxic shock syndrome is a) staph aureus b) stept.pyogens

15-pt with renal failure which of the following antibiotic is contraindicated :

a) penicillin b) Doxacyclin c) septra d) erythromycin

16- old pt with anurea and vomiting and developed when catheterization small amount of dark urine . what is the cause of anurea

a) dehydration b) stone c)

17- 22y old pt developed sore throat after 2 days he developed dark urine with red cell cast and proteinurea +2 ,antisterptolysin O titre is ve and remains ve after 3 weeks .what is the most likely diagnosis : a) mem GN b) IGA nepropathy c) post-strept.GN

18-58 y old pt taking erythropoietin for anemia resulting from renal failure and his HB improved from 90 to 112 then dropped again to 96 what is the possible cause : a) folate def. b)iron def. c)

19- 12 m old infant ,his mother brought him because she felt hard mass in the lt mass in the lt upper epigastric area with blood in urine : a) polycystic kidney b) willims tumer c)

20 picture of pt ,fair skin and blue eyes and pig. Skin lesion : a)pigmented nevus b) malignant melanoma

21-picture of old age female with bad odor coming from her chest . on exposure there is lesion on her breast : a) infiltrating carcinoma of breast b)Paget dis of the breast c) fungal infection

22-female pt with breast lump ,her mammography and U/S were unremarkable what is the next appropriate management :

a) fine needle biopsy b) excision biobsy c) CT scan

23-female pt having a breast lump and worried about being a cancer what would be be the next appropriate management :

a) reassure the pt that there is no risk of malignancy b) rescheduale mamography c) consider being malignant untill prove otherwise

24-male pt with intermittent bleeding / rectum for 2 days and after last defecation there is bleed in toilet and soaking toilet paper with string sensation in the perineum , what is the diagnosis ? a) external thrombosed piles b) acute anal fissure c) int thrombosed piles d) cancer rectum

25-42 y old male pt presented with difficulty in initiation of micturation ,able to evacuate and post-micturation drippling ,what is the diagnosis a)stricture urethra b)BPH c)

26- Swelling at the lat .border of rectus ms a) lipoma b)

27- Female pt 17 y old after cooleys fracture and cast what is the most predictable For development of volkmans ischemic contracture ? a)painful extension of fingers b) absent radial pulse

28- Female pt with valgus deformity in the lt knee ,foot deviation to the lt and Difficulty in internal rotation of the hip ?

29-Which of the following dis linked with ant. uveitis ? a)A.S b)Reiters c) R.A.

30-Baby delivered difficulty by forceps ,after delivery the baby cant move his Lt arm which is maintained beside him . What is the expected lesion ? a)Erbs palsy (brachial plex injury ) b) fascial n .injury

31-female pt has suprapubic tenderness urgency incontinence ,what is the probable diagnosis : a) ch. Interstitial cystitis b) dynamic dysfunction of the bladder

32- female pt ater operation for endometriosis developed urinary incontinence when Standing or walking which will be the most appropriate investigation : a) laparoscopy b)IVP c) mythelen blue inject in the vagina

33-Female pt developed painless progressive jaundice ,puritis O/E there is palpable G.Bladder. What is the most appropriate diagnosis : a)cholithiasis b)pancreatic cancer c) liver dis

34-male pt. with lt lower illiac fossa pain radiating to lt groin with painful difficult micturation ,what is the most appropriate investigation : a)U/S b) cystoscopy c)

35- pt is G 1 and now is in her 39th week and discovered to have tranverse lie . what is the next management : a)external version b)CS

36- female pt preg. In 32th week hypertensive 170/110 and proteinurea +2 hyperreflexia ,headache . what is the best management : a)BB b) start Mg sulphate c) send home and reassurance

37-Female pt 30 y old obese ,nuliparous now she is preg. But dont remember her LMP and she reported having irregular cycles .she has been last seen 5m for her Pap smear . what is the next step : a) do pap smear b) repeat HCG levels

38-pts with dysmenorrahea and dyspaeunia ,what is the definite diagnosis ?

a)|U/S b) laparoscopy

39-pt with unilat bloody discharge from the nipple ,this consistent with the dia-gnosis of :

a)duct carcinoma in situ b) infiltrative duct carcinoma c)

40-pt G1 in her 8 weeks wants to terminate preg. And her cervix is long and closed What would you use

a) intraamniotic injection of oxytocin b) vaginal supp of PG c) intraamniotic saline

41-Pt G1 in her 16 th week of preg ,she asked for induction of abortion ,what would you use :

a) methotrexate b) misoprostol

42- Pt now in delivery and her 1st stage of labour progress normally for the first 5 h. And now the cervix is dilated 5cm then gush of blood through the vagina .what Would be the cause : a)placenta previa b)placenta accrete c) chorioamnionitis

43-Pt 28 y old diabetic on glybride recently and planning to conception what Would be true regarding her glycemic control : a) continue on glybride b) shift to insulin c) stop glybride because hypoglycemiattacks common in 1st T of preg. d)

44-14 yold girl has 3 w of vaginal bleed and she has irrig cycles and amenorrehea before her HB now is 82 g% but her pulse and BP is normal .what is the best appropriate management : a) give 2 units packed RBCs b) exclude pelvic and vaginal causes of bleeding by pelvic U/ S c)consult hematologist to exclude causes of coagulopathy

45-Pt with repeated abortion in her 1st T of preg .What would be the management to guard against occurrence of abortion : a) Circulage b) IU progesterone

46- Pt with repeated abortion now she is preg in her 8th w (T1) .What would be the next step to diagnose the cause : a)Karyotyping b) antiphospholipid testing c)

47-Pt with amenorrehea her gonadotrophinslow normal ,prolactin N. and S.oestrogen is low .What would be the diagnosis : a) 1ry ovarian failure b) premature menaupose c) hypothalamic disorder d) pituitary adenoma

48-Pt with headache ,HTN,RT red eye what is the next step : a)U/S b)CTscan c) tonometry

49-Female pt. came to your office after eye trauma by ball ,after you ve examined you found only red eye .What would be the most important cause to refer her to ophalmologist : a)corneal abrasion or erosion b)conjuntival inject c)

50- Worker came to your office after trauma by metallic bar inj to his eye .What Would be the next management : a) CT scan B) MRI c) x-ray

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04-29-2013, 02:27 PM #32

Partha Sarkar Partha Sarkar is offline Junior Member -------------------------------------------------------------------------------Join Date:Oct 2012Posts:5,093

People with WPW who are experiencing tachydysrhythmias may require synchronized electrical cardioversion if they are demonstrating severe signs or symptoms (for example, low blood pressure or lethargy with altered mental status). If they are relatively stable, pharmacologic treatment may be used. People with atrial fibrillation and rapid ventricular response are often treated with amiodarone[11] or procainamide[12] to stabilize their heart rate. Procainamide, amiodarone, and cardioversion are now accepted treatments for conversion of tachycardia found with WPW.[13] AV node blockers should be avoided in atrial fibrillation and atrial flutter with WPW or history of it; this includes adenosine, diltiazem, verapamil, other calcium channel blockers and beta blockers.[14] They can exacerbate the syndrome by blocking the heart's normal electrical pathway (therefore favoring transmission through the pre-excitation pathway). People with symptomatic narrow-QRS-complex tachycardias may be cardioverted.

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04-29-2013, 02:28 PM #33

Partha Sarkar Partha Sarkar is offline Junior Member -------------------------------------------------------------------------------Join Date:Oct 2012Posts:5,093

Q Female 55 y with bleeding about one cup per day. she does not take hormone replacement therapy, what is the common cause of this bleeding?

a. endometrial cancer b. atrophic vaginitis c. cervical polyp d. cancer cervix

(CDM)- a father brought his son due to fatigue and tiredness, his eats a lot of junk food, in lab data they gave Hb: 100, PLT: 200 *10 (12 fold) WBC: 16*10(12 fold) Write the characterization of this lab data, Write your DDx

Q-TRUCK DRIVER with cataract vision 20/80 Donot want to go for surgery ,because of financial constraint. What you will do - inform motor vehicle authorities -inform employer - refer to Eye Sp for Further workup

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04-29-2013, 02:29 PM #34

Partha Sarkar Partha Sarkar is offline Junior Member -------------------------------------------------------------------------------Join Date:Oct 2012Posts:5,093

Q. A 28-year-old housewife presents with a 12-week history of intermittent episodes of slightly raised, itchy, pink, skin lesions on her trunk and limbs. She is not aware of any associated symptoms or precipitating factors. The process resolves completely and spontaneously over 24 hours. Which one of the following is the most appropriate statement about testing for the etiology of this process? 1.Skin tests will identify contact allergens. 2. An elimination diet will identify offending foods. 3.A skin biopsy will identify urticarial vasculitis. 4.An antinuclear antibody is often positive. 5. Blood tests usually fail to identify specific causes.

Q. A 35-year-old woman presents with severe, upper abdominal pain associated with nausea and vomiting. Examination shows guarding and rebound of both right and left upper quadrants. Her pulse is 120/minute, and her blood pressure is 90/60 mm hg. Her blood work includes a white blood cell count of 25x109/L and an amylase of 2000 U/L. Which one of the following is the most likely cause of this woman's shock?

Loss of whole blood into the peritoneal cavity Sepsis resulting from Gram-negative bacterial growth in necrotic pancreatic tissue Deleterious effects of trypsin and other toxic products on cardiac function Disseminated intravascular coagulation Loss of fluid into the retroperitoneal space

Q. female complaining of recurrent colicky pain in the right upper quadrant and postprandial distension. there were multiple stones in gall bladder and it was removed. she felt some relive after the OP with disappearance of symptomes, but few days later, she experience recurrence of symptoms, what is the cause ?

a, gall stones were not the cause of the patient symptoms b. development of mucocele c. recurrence of stones again d. there was a stone left in the common bile duct

Q. Disclosures made by patients to their doctors ate : Privileged Confidential Contractual

Fiduciary Sacrosanct