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Theme 01

Management of Acute chest pain

Options

A. Calcium channel blocker


B. Morphine
C. Inform the DSO surgery
D. O2, Morphine & anticoagulation
E. IV Fluids
F. Sublingual nitrate
G. Chest drain with underwater seal
H. Heparin
I. Heparin

J. NSAIDS
Instructions

For each of the patient described below choose the single most likely management
from the above list of options. Each option may be used once, more than once or not
at all.

1. A 22 yr old tall teacher complains of sharp chest pain in the chest of 24 hrs
duration. He also complains of shortness of breath.

2. An elderly woman comes to A&E with complains of crushing central chest pain
associated with nausea and sweating. The pain is not relieved by sublingual nitrate.

3. A 32 yr old bartender is taking OC pills. She complains of sudden onset of central


chest pain and dyspnoea. O/E JVP is raised and P2 is loud.

4. A 40 yr old known case of Marfan's syndrome comes to A&E with c/o central chest
pain radiating to the inter-scapular region.

5. A 60 yr old alcoholic complains of profuse bloody vomiting. O/E you find enlarged
irregular liver and free fluid in the abdomen.

Answers

1.G 2.D 3.D 4.C 5.C

Theme 02
Diagnosis of Chest pain

Options

A. Myocardial infarction
B. Aortic dissection
C. Herpes zoster
D. Oesophageal spasm
E. Pneumothorax
F. Lobar pneumonia
G. Fracture Rib
H. Angina pectoris
I. Rupture of oesophagus

J. Amoebic liver abscess


Instructions

For each of the patient described below choose the single most likely diagnosis from the
above list of options. Each option may be used once, more than once or not at all.
6. A 45 yr old known diabetic with h/o dyslipidemia develops acute onset chest pain and
is associated with sweating. The pain subsides after sometime.
7. A 20 yr old man complains of sharp pain in the anterior chest region after his football
match. The pain is localized and there are no associated symptoms.
8. A 30 yr old woman complains of severe pain on the right side of the chest in the 6th
and 7th ICS. A day after onset of the pain she notices small vesicles erupting in that area.
9. A 45 yr old carpenter comes to A&E with complains of severe chest pain on the left
side of the chest. He has a 1-week history of fever and cough with rusty sputum.
10. A 21 yr old female c/o high fever and pain on the right side of the chest. O/E there is
tenderness in the 10th & 11th ICS on the right side.

Answers

6.H 7.G 8.C 9.F 10.J


Theme 03
Management of arrhythmias

Options

A. Amiodarone
B. DC Cardioversion
C. Carotid sinus massage
D. IV lidocaine
E. CPR until defibrillator is available
F. Transvenous pacemaker
G. Surgical ablation
H. Digoxin
I. Verapamil

J. Atropine
Instructions

For each of the patient described below choose the single most likely management from
the above list of options. Each option may be used once, more than once or not at all.
11. A middle-aged woman is found unconscious on the road. When you reach the site,
you find that there is no pulse.
12. A 22 yr old athlete male complains of dyspnoea on exertion. O/E his pulse rate is
40/min. No other abnormality is found.
13. A 34 yr old woman c/o chest pain. ECG shows inverted P waves which appear after
QRS complexes with PR > RP.
14. A 60 yr old man was admitted with acute onset chest pain 2 days ago and was
diagnosed as MI. Now the ECG monitor shows rapid heart rate with QRS duration > 140
ms, left axis deviation and presence of capture beats. He is haemodynamically stable.
15. A young woman taking thyroxine for hypothyroidism presents with palpitations, chest
pain and dyspnoea. ECG shows chaotic activity, Synchronizing DC Cardioversion was
attempted but was unsuccessful.

Answers

11.E 12.J 13.G 14.D 15.A


Theme 04
Investigation of Haemoptysis

Options

A. Sputum cytology
B. 12 lead ECG
C. Anti-glomerular basement antibody
D. Clotting profile
E. Spiral CT scan
F. Heaf test
G. Chest x-ray
H. V/Q scan
I. Bronchography

J. Anti-dsDNA
Instructions

For each of the patient described below choose the single most likely investigation from
the above list of options. Each option may be used once, more than once or not at all.
16. A 45 yr old retired sailor presents with haemoptysis and dyspnoea. Examination
reveals presence of bilateral alveolar infiltrates on chest x-ray and red cell casts on
urinanalysis.
17. An Asian immigrant presents with complaints of low-grade fever, cough and
haemoptysis.
18. A 32 yr old man presents to A&E with high swinging fever, cough with foul smelling
bloody sputum and pleuritic chest pain.
19. A 30 yr old woman on OC pills comes to A&E with severe shortness of breath and
massive haemoptysis. O/E there is calf tenderness.
20. A 24 yr old lady presents to A&E with haemoptysis. She also complains of joint pains
and is noted to have rash on her face. She gives a history of recurrent abortions.
Answers

16.C 17.F 18.G 19.E 20.J


Theme 05
Management of Breathlessness

Options

A. Lobectomy
B. Mastectomy
C. Intercostal drainage
D. Blood transfusion
E. O2, morphine & anticoagulation
F. O2 4 lit/min
G. Chemotherapy
H. Thymectomy
I. Bronchodilator

J. Corticosteroids
Instructions

For each of the patient described below choose the single most likely management from
the above list of options. Each option may be used once, more than once or not at all.
21. A 40 yr old worker c/o shortness of breath. O/E there is mild cyanosis and chest
movements are restricted.
22. A 50 yr old man who underwent total hip replacement 2 days ago now c/o shortness
of breath and generalized lethargy. On auscultation of chest you find a systolic flow
murmur.
23. A middle-aged man comes to A&E with c/o severe crushing central chest pain
radiating to the left arm and not relieved by sublingual nitrate.
24. A 55 yr old man c/o generalized weakness and expresses inability to perform daily
chores. O/E he has ptosis and his reflexes are diminished.
25. A 24 yr old woman complains of shortness of breath on exertion, which is more
marked in winters. She has diffuse bilateral wheeze on auscultation of chest.

Answers

21.F 22.D 23.E 24.H 25.I


Theme 06
Investigation of Gastrointestinal disorders

Options

A. Colonoscopy
B. Barium enema
C. Barium swallow
D. Upper GI Endoscopy
E. CT abdomen
F. Oesophageal manometry
G. CT chest
H. Erect chest x-ray
I. Oesophageal pH testing
J. Motility studies
K. Mesenteric angiography

L. ERCP
Instructions

For each of the patient described below choose the single most likely investigation
from the above list of options. Each option may be used once, more than once or not
at all.

26. A 60 yr old woman complains of difficulty in swallowing solid foods for last 6
months. He also complains of lethargy and loss of weight.

27. A 45 yr old woman suffers from rheumatoid arthritis for last 10 yrs and is on
regular treatment. She now complains of epigastric pain.

28. A 42 yr old woman c/o bloody diarrhea, abdominal pain and weight loss. She
also has nodules over the shin.

29. A 38 yr old man has been on medication for gastric ulcer for last 1 yr. He now
presents to A&E with c/o severe epigastric pain and prostration. His BP is 90/60.

30. An elderly man complains of jaundice and weight loss. Abdominal examination
reveals a palpable gall bladder. He is noted to have crops of tender nodules affecting
the blood vessels throughout the body.

Answers

26.C 27.D 28.A 29.H 30.L

Theme 07
Diagnosis of Jaundice

Options

A. Acute pancreatitis
B. Gall stones
C. Gilbert's syndrome
D. Dubin-Johnson syndrome
E. Carcinoma head of pancreas
F. Hepatitis
G. Haemolysis
H. Drug induced
I. Hepatocellular carcinoma
J. Cirrhosis
K. Cholangiocarcinoma
L. Weil's disease
M. Primary Biliary cirrhosis

N. Acute Cholecystitis
Instructions

For each of the patient described below choose the single most likely diagnosis from
the above list of options. Each option may be used once, more than once or not at
all.

31. A 40 yr old chronic alcoholic comes with c/o yellow discoloration of skin and pain
abdomen. His serum amylase is found to be elevated.

32. A 42 yr old man c/o jaundice. His fasting bilirubin is found to be elevated and
blood film is reported as normal.

33. An elderly man is being investigated for weight loss and jaundice. His blood tests
reveal elevated bilirubin, ALT 110 IU/L, AST 80 IU/L and alpha-fetoprotein 500 IU/L.

34. A middle-aged woman presents with jaundice and marked pruritus. She is found
to have melanotic skin and hepatosplenomegaly.

35. A 50 yr old man presents with c/o jaundice, abdominal pain and fever.
Examination reveals low blood glucose and increased PT. Liver biopsy examination
shows Mallory bodies.

Answers

31.A 32.C 33.I 34.M 35.F


Theme 08
Diagnosis of headache

Options

A. Cluster headache
B. Trigeminal neuralgia
C. Migraine
D. Subarachnoid hemorrhage
E. Temporal arteritis
F. Tension headache
G. Carotid arteritis
H. Vertebro-basilar TIA
I. Herpes zoster
J. Sinusitis
K. Dental abscess
L. Osteomyelitis of mandible
Instructions

For each of the patient described below choose the single most likely diagnosis from
the above list of options. Each option may be used once, more than once or not at
all.
36. A 65 yr old man c/o sudden onset severe occipital headache and vomiting. O/E
you find neck stiffness.
37. A 30 yr old lady c/o recurrent sharp stabbing pains on left side of her face. The
pain occurs while talking and eating food.
38. A 42 yr old woman c/o throbbing headache and pain on combing hair. She also
c/o `curtain falling over her eyes'.
39. A 36 yr old c/o gradual onset of severe headache and is present everyday. He
describes the headache as a tight band around the head.
40. A 40 yr old complains of rapid onset of severe pain around the Right eye, which
is red and watery. Miosis is present is the right eye.

Answers

36.D 37.B 38.E 39.F 40.A


Theme 09
Diagnosis of peripheral neuropathy

Options

A. Carcinoma
B. Drug induced
C. Acute intermittent porphyria
D. Guillian Barre syndrome
E. Lead poisoning
F. Diabetic neuropathy
G. Sub acute combined degeneration of cord
H. Sarcoidosis
I. Polyarteritis nodosa
J. Leprosy

K. Vitamin B1 deficiency
Instructions

For each of the patient described below choose the single most likely diagnosis from
the above list of options. Each option may be used once, more than once or not at
all.

41. A 30 yr old man complains of weakness and paraesthesiae in his legs. He gives a
recent history of upper respiratory tract infection.

42. A 54 yr old woman is found to have peripheral neuropathy. Chest x-ray reveals
bilateral hilar enlargement. She also has raised lesions on her shins.

43. A 46 yr old chronic alcoholic presents with numbness and paraesthesiae in his
feet.

44. A 60 yr old man presents with distal sensory neuropathy in a stocking and glove
distribution. Ankle reflexes are absent.

45. A 50 yr old complains of paraesthesia in lower limbs. He is noted to have


steatorrhoea and angular stomatitis. He is found to have anti-endomysial antibodies.

Answers

41.D 42.H 43.K 44.F 45.G

Theme 10
Evaluation of Confusion

Options

A. Lumbar puncture
B. EEG
C. Arterial blood gases
D. Stool culture
E. Blood culture
F. Liver function tests
G. Chest x-ray
H. CT scan head
I. ECG

J. Toxicology screen
Instructions

For each of the patient described below choose the single most likely investigation from
the above list of options. Each option may be used once, more than once or not at all.
46. A 21 yr old male c/o high fever and confusion. He had a recent ear infection. He is
now found to have rapidly spreading rash on his limbs and a stiff neck.
47. An 18 yr old is witnessed to have collapsed on the street. He is also found to be
incontinent of urine.
48. A 60 yr old complains of dull headache and recent episodes of vomitings. He also has
blurring of vision.
49. A 20 yr old male c/o high fever and altered sensorium.
50. A 68 yr old man complains of chronic cough and haemoptysis. He also complains of
headache and confusion

Answers

46.A 47.B 48.H 49.E 50.G


Theme 11
Diagnosis of Anaemia

Options

A. Iron deficiency anaemia


B. Thalassemia major
C. Pernicious anaemia
D. Vitamin B12 deficiency
E. Folate deficiency
F. Autoimmune haemolytic anaemia
G. Anaemia of chronic disease
H. Paroxysmal nocturnal haemoglobinuria
I. Aplastic anaemia
J. Hereditary spherocytosis
K. Sickle cell anaemia

L. Myelosclerosis
Instructions

For each of the patient described below choose the single most likely diagnosis from the
above list of options. Each option may be used once, more than once or not at all.
51. A 14 yr old girl from Athens is found to be anaemic. Blood film shows microcytic
hypochromic anaemia. There was no response to iron therapy.
52. A 35 yr old woman complains of early morning stiffness of her joints. She is found to
be anaemic.
53. A 10 yr old boy is known epileptic. He now complains of shortness of breath. Blood
examination shows anaemia.
54. A 30 yr old man is being evaluated for anaemia. Blood film shows reticulocytosis, red
cell fragmentation and Heinz bodies.
55. A 60 yr old man is being treated for bronchogenic carcinoma. He is now found to be
anaemic.

Answers

51.B 52.G 53.E 54.J 55.I


Theme 12
Investigation of anaemia

Options

A. Serum B12 levels


B. Urinanalysis
C. Hb electrophoresis
D. Serum folate
E. Coombs' test
F. Ham's test
G. Sickling test
H. ECHO
I. Total serum iron, serum ferritin and TIBC
J. Barium follow through
K. Bone marrow examination

L. Clotting profile
Instructions

For each of the patient described below choose the single most likely investigation from
the above list of options. Each option may be used once, more than once or not at all.
56. A 60 yr old woman underwent hysterectomy 2 days back. She complains of
breathlessness. She is found to have uncontrolled bleeding.
57. A 30 yr old woman with h/o abdominal pain and steatorrhoea. She c/o shortness of
breath and on evaluation she is found to be anaemic.
58. A 20 yr old man from Pakistan presents to A&E with severe shortness of breath. He
has a history of repeated blood transfusions since childhood.
59. A 60 yr old woman is being treated for breast cancer. She has now developed
respiratory infection and is also found to be anaemic.
60. A 40 yr old lady complains of shortness of breath on mild exertion. She gives a
history of menorrhagia.

Answers

56.L 57.A 58.C 59.K 60.I


Theme 13
Investigation of swollen joints

Options

A. Joint aspiration
B. Joint x-ray
C. ESR
D. Blood culture
E. Rheumatoid factor
F. Serum urate levels
G. Anti-nuclear antibodies
H. WBC count
I. Anti-mitochondrial antibodies
J. Barium follow through

K. Anti-endomysial antibodies
Instructions

For each of the patient described below choose the single most likely investigation
from the above list of options. Each option may be used once, more than once or not
at all.
61. A 30 yr old man complains of swelling and pain of right knee joint. He is found to
be febrile and the right knee is hot, swollen and tender.

62. An elderly man complains of chronic joint pain for last 10 years. His left ankle
joint has now swollen. There is no h/o trauma.

63. A 35 yr old woman c/o early morning stiffness of her wrists, knee and elbows.
O/E there is swelling of first metacarpophalangeal joints.

64. A 55 yr old man is being treated for Hodgkin's lymphoma. He has now developed
acutely hot tender swollen left knee. He is apyrexial.

65. A 24 yr old woman c/o rash on her face and upper limbs. She c/o pain in her
wrists and knee joints. O/E she is found to have pericardial rub.

Answers

61.D 62.B 63.E 64.A 65.G

Theme 14
Treatment of Infections

Options

A. Co-amoxiclav
B. Chloramphenicol
C. Flucloxacillin
D. Tetracycline
E. Erythromycin
F. Gentamicin
G. Trimethoprim
H. Vancomycin
I. Metronidazole
J. Rifampicin, Isoniazid & pyrazinamide
K. Benzylpenicillin

L. Cefotaxime
Instructions

For each of the patient described below choose the single most likely treatment from
the above list of options. Each option may be used once, more than once or not at
all.

66. A 35 yr old married woman c/o burning micturition with increased frequency.
She is pyrexial and urinanalysis shows pus cells.

67. An IV drug abuser c/o breathlessness and sharp chest pain. O/E she is found to
have splinter haemorrhages in her nail bed and a systolic murmur is heard on
auscultation.

68. A 30 yr old man c/o chronic cough for last 3 months with a rusty colored sputum.
O/E breath sounds are decreased on left side of the chest and the vocal resonance is
increased in the same area.

69. A 50 yr old man is being treated for pneumonia in ITU for last 1 week. He has
now developed diarrhea.

70. A 10 yr old boy is brought to A&E with high fever and drowsiness. He is noted to
have rash on his limbs. Examination reveals neck rigidity. You are still awaiting the
blood culture report.

Answers

66.G 67.C 68.K 69.I 70.L

Theme 15
Causes of Haematuria

Options

A. Goodpasture's syndrome
B. Bleeding disorder
C. Ureteric calculus
D. Acute pyelonephritis
E. Bladder carcinoma
F. Renal cell carcinoma
G. Acute cystitis
H. Schistosomiasis
I. Acute intermittent porphyria
J. Black water fever
K. Prostate cancer

L. Renal vein thrombosis


Instructions

For each of the patient described below choose the single most likely diagnosis from the
above list of options. Each option may be used once, more than once or not at all.
71. An 18 yr old boy comes to A&E with high-grade fever associated with chills and
rigors. He also complains of passing dark colored urine.
72. A 32 yr old woman is taking OC pills. She comes to A&E with colicky abdominal
pain and vomiting. Urinanalysis reveals red cells and protein. She is also noted to have
weakness in her lower limbs.
73. A 14 yr old girl presents with painless haematuria. She also has cough with blood
stained sputum.
74. A 45 yr old man comes to A&E with left sided colicky abdominal pain radiating to the
scrotum. He is noted to have haematuria.
75. A 55 yr old man complains of painless haematuria. He also complains of difficulty in
free flow of urine. He works in a rubber industry.

Answers

71.J 72.I 73.A 74.C 75.E


Theme 16
Investigation of breast disease

Options

A. Mammography
B. MRI Scan
C. Wide excision biopsy
D. Stereotactic cone biopsy
E. Ultrasound
F. Ductulography
G. FNAC
H. Only clinical examination
I. Tumor markers

J. No further investigation required


Instructions

For each of the patient described below choose the single most likely management from
the above list of options. Each option may be used once, more than once or not at all.
76. A 50 yr old lady underwent a routine mammography-screening programme. It showed
diffuse calcifications. What is the next step?
77. A 28 yr old woman presents to the surgery clinic with diffuse breast swelling that
seems to increase in size during her menses. Physical examination reveals no
abnormality.
78. A 60 yr old presents with lump in the right breast. O/E the swelling is fixed and non-
tender. Skin over the swelling shows puckering. Axillary nodes are palpable.
79. A 25 yr old lady presents with a lump in her left breast. O/E the swelling is soft and
non-tender. Axillary lymph nodes are not palpable.
80. A 32 yr old lady presents with a mass in the upper outer quadrant of her right breast.
O/E the mass is freely mobile and non-tender. Axillary lymph nodes are not palpable.

Answers

76.G 77.E 78.G 79.E 80.A


Theme 17
Management of injured patient

Options
A. X-ray femur
B. Chest drain after needle thoracocentesis
C. CT head
D. Cervical spine immobilization
E. ECG
F. Immediate blood transfusion
G. Splint the leg
H. Transfer to Operation theatre
I. Inform the neurosurgeon
J. Endotracheal intubation
K. IV fluids

L. Skull x-ray
Instructions

For each of the patient described below choose the single most likely management
from the above list of options. Each option may be used once, more than once or not
at all.

81. A 30 yr old man was involved in RTA. He is brought to A&E unconscious. Airway
has been secured and cervical spine immobilized His pupils are irregular and reacting
sluggishly to light. His Glasgow coma scale (GCS) is 9.

82. A 20 yr old motorist was involved in a RTA. He is brought to the A&E conscious.
His left thigh is swollen and tender. His vitals are stable.

83. A 30 yr old man collapsed and fell down on the road. He is brought to A&E
conscious and his vitals are stable. He is drowsy.

84. A 45 yr old man was involved in a RTA. He is brought to A&E conscious and has
multiple injuries on the chest. HE is dyspnoeic.

85. A 30 yr old woman was struck by a speeding car. She is brought to A&E
unconscious with multiple bruises on her abdomen. O/E pulse is 160/min and BP is
70/50 mmHg.

Answers

81.C 82.A 83.L 84.B 85.H

Theme 18
Diagnosis of Vaginal discharge

Options

A. Cervical carcinoma
B. Cervical erosion
C. Candidiasis
D. Gonorrhea
E. Trichomoniasis
F. Syphilis
G. Herpes simplex
H. HIV
I. Chlamydia trachomatis
J. Endometrial carcinoma
K. Bacterial vaginosis

L. Chancroid
Instructions

For each of the patient described below choose the single most likely diagnosis from the
above list of options. Each option may be used once, more than once or not at all.
86. A 24 yr old woman c/o offensive vaginal discharge and burning micturition. She is
noted to have multiple shallow ulcers on her genitalia.
87. A 45 yr old diabetic woman complains of curdy white vaginal discharge associated
with pruritus vulvae.
88. A 40 yr old married woman c/o non-foul smelling discharge. She also c/o post-coital
bleeding.
89. A 32 yr old woman c/o lower abdominal pain and low-grade fever. She confesses to
deep dysparenuia.
90. A 28 yr old lady c/o vaginal discharge and a painless genital ulcer. 2 weeks later she
develops rash on her limbs.

Answers

86.G 87.C 88.B 89.I 90.F


Theme 19
Management of Menopausal symptoms

Options

A. Combined HRT
B. Benzodiazepines
C. Vaginal oestrogen
D. Regular exercise
E. Refer to psychiatrist
F. Vaginal lubricant
G. Oestrogen only HRT
H. Calcium supplements
I. Progesterone only HRT

J. Reassurance
Instructions

For each of the patient described below choose the single most likely management
from the above list of options. Each option may be used once, more than once or not
at all.
91. A 45 yr old woman underwent total abdominal hysterectomy for fibroids. She
now complains of hot flushes and mood swings.

92. A 50 yr old woman attained her menopause 2 yrs back. She complains of painful
sexual intercourse. She gives a family history of breast cancer.

93. A 58 yr old woman attained her menopause 5 yrs back. She now complains of
back pain and pain in legs. She is otherwise healthy.

94. A 60 yr old woman comes to you with complaints of burning micturition. Urine
examination reveals no abnormality.

95. A 45 yr old woman comes with complaints of irregular periods and mood swings.
She has read about postmenopausal osteoporosis in a journal and has come to you
for counselling.

Answers

91.G 92.F 93.H 94.C 95.A

Theme 20
Choice of Contraception

Options

A. OC pills
B. Male condoms
C. Laparoscopic sterilization
D. Depot contraception
E. Vasectomy
F. IUCD
G. Rhythm method
H. Emergency contraception
I. OC pills and male condoms

J. Female condoms
Instructions

For each of the patient described below choose the single most likely preferred method of
contraception from the above list of options. Each option may be used once, more than
once or not at all.
96. A married 30 yr old mother has a history of deep vein thrombosis. She would like to
practice contraception.
97. A young 19 yr old girl has started having sexual relationships. She has come to you
for counselling regarding contraception.
98. A 42 yr old woman with 3 children has a recent history of pelvic inflammatory
disease. She wants to know what is the preferred method of contraception for her?
99. A newly married young woman who has a low IQ wants to postpone her family for
another 2 years.
100. A 28 yr old female comes to you and says that her husband is suffering from HIV
infection. She wants to know what is the best method of contraception for her?

Answers

96.F 97.I 98.C 99.D 100.I


Theme 21
Management of asthma in children

Options

A. Oral bronchodilator
B. Inhaled bronchodilator
C. Inhaled steroids
D. Oral long acting bronchodilator
E. IM Adrenaline
F. Nebulized bronchodilator
G. IV Aminophylline
H. Nebulized steroids
I. Inhaled sodium cromoglycate
J. Pre-exercise bronchodilator
K. Desensitization

L. Ipratropium bromide
Instructions

For each of the patient described below choose the single most likely management from
the above list of options. Each option may be used once, more than once or not at all.
101. A 12 yr old boy comes to medical OP with complaints of shortness of breath and
wheezing whenever he plays football in his school. He is otherwise normal when he is
not playing.
102. A 10 yr old known asthmatic on regular once daily inhaled bronchodilator comes to
review OP with complaints that his symptoms are not under control and that he needs to
use inhaled bronchodilator twice a day. His parents are not willing to use any medication
that contains steroids.
103. A 13 yr old known asthmatic child is brought to A&E with complaints with severe
shortness of breath not controlled by inhaled bronchodilator.
104. A 16 yr old boy complains of shortness of breath. On examination his pulse is 110
and BP 80/60 mmHg. He apparently ate a sandwich that was 3 days old.
105. A 15 yr old chronic asthmatic comes with acute exacerbation of symptoms that are
not relieved by Nebulized salbutamol.

Answers
101.J 102.I 103.F 104.E 105.H
Theme 22
Investigation of fever in children

Options

A. EEG
B. Blood culture
C. Lumbar puncture
D. Urine microscopy and culture
E. Joint aspiration
F. Stool microscopy and culture
G. Chest x-ray
H. Sputum culture
I. ESR
J. Throat swab
K. CT scan head

L. Upper GI Endoscopy
Instructions

For each of the patient described below choose the single most likely investigation from
the above list of options. Each option may be used once, more than once or not at all.
106. An anxious mother brings her 3 yr old child with complaints of high fever and
vomiting since 2 days. She says that the child has been drowsy and irritable.
107. An 11 yr old boy is brought to A&E with high fever and cough for last 4 days. The
cough is productive with foul smelling sputum.
108. A 7 yr old girl is brought with complaints of profuse diarrhea and high fever.
109. A 10 yr old is brought to A&E with complaints of high fever and rapidly appearing
rash on his limbs. On examination you find neck stiffness.
110. A 14 yr old girl is brought with complaints of swollen right knee and low-grade
fever. On examination the right knee is warm, swollen and tender.

Answers

106.B 107.H 108.F 109.C 110.E


Theme 23
Diagnosis of psychiatric illness

Options

A. Schizophrenia
B. Depression
C. Post-traumatic stress disorder
D. Anxiety neurosis
E. Agoraphobia
F. Panic attack
G. Hysteria
H. Munchausen's syndrome
I. Paranoid state
J. Anorexia nervosa
K. Bulimia

L. Obsessive- Compulsive disorder


Instructions

For each of the patient described below choose the single most likely management
from the above list of options. Each option may be used once, more than once or not
at all.

111. A 29 yr old male tells that people are telling him to go and kill the prime
minister. He says that they don't let him think and that they control his thoughts.

112. A young lady is afraid to go out of her house. Whenever she goes out she
rushes back home panicking and closes all the doors and windows.

113. A 45 yr old man comes rushing to your clinic and asks you close your clinic and
go home as he says that the world is going to come to an end.

114. A 35 yr old man does not sleep in the night. He repeatedly gets up and checks
whether all the doors and windows are locked again and again.

115. A 38 yr old man has lost appetite and always sits alone and keeps thinking
about the accident that happened a year ago in which his wife was killed. He is not
regular to his office and avoids socializing.

Answers

111.A 112.E 113.F 114.L 115.C

Theme 24
Diagnosis of red eye

Options

A. Acute conjunctivitis
B. Anterior uveitis
C. Acute glaucoma
D. Subconjunctival hemorrhage
E. Optic neuritis
F. Scleritis
G. Posterior uveitis
H. Retinal haemorrhage
I. Acute Iritis

J. Conjunctival hemorrhage
Instructions
For each of the patient described below choose the single most likely diagnosis from
the above list of options. Each option may be used once, more than once or not at
all.

116. A 25 yr old female bar attendant complains of painful red eye for last 3 days.
On examination you find that the conjunctival vessels are injected and they blanch
on pressure.

117. A 28 yr old male presents with complaints of redness of his right eye. On
examination the sclera is bright red and there is a white rim around the limbus. The
remaining ocular examination is normal.

118. A 34 yr old lady comes with complains of red eye. She also gives history of joint
pains and burning micturition.

119. A 43 yr old man complains of painful red right eye. He is unable to tolerate the
examination light. On examination the iris is injected and the pupil is fixed and
irregular. The eyeball is tense.

120. A middle-aged woman complains of painful right eye. The pain is more on eye
movement and there is also of central vision. She also complains of numbness and
tingling in the limbs.

Answers

116.A 117.D 118.A 119.C 120.E

Theme 25
Diagnosis of Hoarseness

Options

A. Vocal cord nodules


B. Laryngeal nerve palsy
C. Hypothyroidism
D. Epiglottitis
E. Laryngitis
F. Carcinoma larynx
G. Wegener's granulomatosis
H. Angioedema
I. Foreign body

J. Acromegaly
Instructions

For each of the patient described below choose the single most likely diagnosis from
the above list of options. Each option may be used once, more than once or not at
all.
121. A 35 yr old female complains of hoarseness of voice. She also complains of
lethargy, constipation and oligomenorrhea.

122. An 18 yr old male comes to A&E with hoarseness of voice, wheeze and stridor.
He was eating peanuts a while ago. On examination you find swollen lips and tongue.

123. A 25 yr old gives one-week history of hoarseness of voice associated with pain
in the throat while talking. Physical examination reveals no abnormality.

124. A 38 yr old female singer by occupation complaints that she cannot sing
properly as used to earlier. She is worried as she has to give a performance next
week.

125. A 45 yr old woman complains of hoarseness of voice. She underwent sub-total


thyroidectomy last week.

Answers

121.C 122.H 123.E 124.A 125.B

Question 1: Rheumatology

Option List:

Osteoarthritis
Rheumatoid arthritis
Psoriatic arthropathy
SLE
CREST syndrome
Polymyositis
Dermatomyositis
Takayasu's disease
Polyarteritis nodosa
Wegener's granulomatosis

Match each of the following physical signs to the most appropriate


disease in the list above.

A) Telangiectasia confined to the nail folds.

B) Cutaneous calcinosis.
C) 'Squaring' of the base of the thumb.

D) Pitting of the nails.

E) 'Saddle nose' deformity.

F) Absent pulses in one or more limbs (in a young woman).

******** Answers ********

A) Dermatomyositis. B) CREST syndrome. C) Osteoarthritis (deformity


due to subluxation at 1st MCP joint). D) Psoriatic arthropathy.
E) Wegener's granulomatosis (NB: congenital syphilis and
warfarin embryopathy are also causes of a saddle nose
deformity). F) Takayasu's disease.

Question 2: Infectious diseases

Option List:

Treponema pallidum
Rubella virus
Human papilloma virus
Human herpes virus 8
Candida albicans
Epstein-Barr virus
Cytomegalovirus
Coxsackie A virus
Coxsackie B virus

For each of the following cases, select the most likely causative organism
from the above list.

A) Breathless 16 year old boy. Blood pressure 100/70, tachycardia, raised


JVP, muffled heart sounds, lungs clear.

B) White ribbed plaques on the side of the tongue of an HIV +ve male.
Plaques cannot easily be scaped off.
C) White coating of the dorsum of the tongue of an HIV +ve male. Coating
is easily scraped off.

D) 32 year old woman with a maculo-papular rash on the trunk, palms and
soles, and warty lesions on the vulva and around the anus.

E) 11 year old girl with numerous small vesicles on the hands and feet, and
ulcers on the buccal mucosa.

******** Answers ********

A) Coxsackie B virus. The boy has a pericardial effusion. B) Epstein-


Barr virus. The lesion is oral hairy leukoplakia. C) Candida
albicans D) Treponema pallidum. The lady has features of
secondary syphilis. E) Coxsackie A virus. The girl has hand,
foot and mouth disease (this disease has nothing to do with
foot and mouth disease of cattle).

Question 3: Liver disease

Option List:

Hepatitis A
Hepatitis B
Hepatitis C
Haemochromatosis
Wilson's disease
Autoimmune hepatitis
Primary biliary cirrhosis
Sclerosing cholangitis

Match the following 'textbook' descriptions to the most appropriate


disease in the list above.

A) Middle aged woman complaining of pruritis and lethargy. On


examination she had hepatosplenomegaly but no other signs of liver disease.
Liver enzymes raised, particularly alkaline phosphatase and gamma-GT.
Antimitochondrial antibodies present.
B) 13 year old boy with features of a mild acute hepatitis. A tremor was
present, and his school performance had recently deteriorated. Viral and
autoimmune serology was negative.

C) 20 year old man with past history of ulcerative colitis, now presenting
with fatigue, weight loss, pruritis, RUQ pain and intermittent jaundice.

D) 30 year old woman presenting with anorexia, nausea, and fatigue.


Examination revealed palmar erythema and spider naevi. Liver transaminase
enzymes raised. Anti-smooth muscle antibodies present.

E) 42 year old man presenting with weakness, lethargy, impotence, and


arthralgia in the hands and knees. On examination his skin appeared tanned
and hepatomegaly was present.

******** Answers ********

A) Primary biliary cirrhosis. B) Wilson's disease. C) Sclerosing


cholangitis (two-thirds of patients with SC also have UC). D)
Autoimmune hepatitis. E) Haemochromatosis.

Question 4: Dermatology (blisters)

Option List:

Bullous impetigo
Pemphigus vulgaris
Bullous pemphigoid
Dermatitis herpetiformis
Hand, foot and mouth disease
Epidermolysis bullosa
Chicken pox

For each of the following cases, select the most likely diagnosis from the
list above.

A) Neonate with fragile skin that blisters on contact.


B) 70 year old woman with large, tense blisters on the legs. The blisters have
an erythematous base, and some are blood-filled.

C) Young adult with an intensely pruritic vesicular rash on the buttocks,


elbows, knees and shins. On questioning, he admitted to passing offensive
stools.

D) 60 year old woman with flaccid, fragile blisters and erosions on the trunk
and in the mouth.

******** Answers ********

A) Epidermolysis bullosa. B) Bullous pemphigoid. C) Dermatitis


herpetiformis; this is associated with Coeliac disease. D)
Pemphigus vulgaris; this disorder involves the mouth in over
50% of cases.

Question 5: Doctor-patient communication / fun

Option List:

Jaundice
Ruptured aortic aneurysm
Gastroenteritis
Stroke
Impotence
Gonorrhoea
Peripheral oedema
Tuberculosis
Ataxia
Hernia

For each of the following layman's terms, select the most closely
matching medical term from the list above.

A) Dropsy.

B) Rupture.
C) Consumption.

D) Collywobbles.

E) Clap.

******** Answers ********

A) Peripheral oedema. B) Hernia. C) Tuberculosis. D) Gastroenteritis.


E) Gonorrhoea.

Question 6: Endocrinology

Option List:

Water deprivation test


Dexamethasone suppression test
Oral glucose tolerance test
Triple stimulation test
Synacthen test
24 hr urinary vanillylmandelic acid (VMA)
measurement
24 hr urinary 5-hydroxyindoleacetic acid
(5HIAA) measurement

Select the most useful test from the above list for the investigation of
suspected cases of:

A) Phaeochromocytoma.

B) Diabetes mellitus.

C) Diabetes insipidus.

D) Addison's disease.

E) Acromegaly.

******** Answers ********


A) 24 hr urinary VMA measurement (NB: 5HIAA measurement is used
in the investigation of carcinoid syndrome). B) Oral glucose
tolerance test. C) Water deprivation test. D) Synacthen test E)
Oral glucose tolerance test (don't forget that answers can be
duplicated!)

Question 7: Haematology

Option List:

Felty's syndrome
Aplastic anaemia
Hodgkin's disease
Non-Hodgkins lymphoma
Chronic lymphocytic leukaemia
Folate deficiency
Pernicious anaemia
Patterson-Brown-Kelley (Plummer-Vinson)
syndrome
Myelofibrosis

In each of the following cases select the most likely diagnosis from the
list above.

A) 60 year old lady complaining of tiredness, sore tongue, and


numb/tingling feet. Hb=7; MCV=115. She has grey hair and blue eyes!

B) 65 year old well man admitted for hernia repair, found to have raised
lymphocyte count (15 x 10^9 /L).

C) 50 year old woman with lethargy and dysphagia. Oral examination


showed a smooth tongue and angular cheilitis. Hb=8g/dL; MCV=60fL.
Endoscopy revealed proximal oesophageal web.

D) 62 year old woman with longstanding RA found to have splenomegaly.


FBC showed pancytopenia.

******** Answers ********


A) Pernicious anaemia (N.B. folate deficiency does not cause a
neuropathy). B) Chronic lymphocytic leukaemia. C)
Patterson-Brown-Kelly syndrome. D) Felty's syndrome
(classically a triad of RA, splenomegaly and neutropenia).

Question 8: Eponymous diseases and syndromes

Option List:

Berger's disease
Buerger's disease
Peutz-Jegher's syndrome
Osler-Weber-Rendu syndrome
Goodpasture's syndrome
Patau's syndrome
Edwards' syndrome
Leriche's syndrome
Laurence-Moon-Bardet-Biedl syndrome

Which of the above diseases and syndromes are described below?

A) Glomerulonephritis and haemoptysis caused by anti-basement membrane


antibodies.

B) IgA nephropathy, usually triggered by a viral infection.

C) Trisomy 13.

D) Freckles/lentigos in mouth, on lips, and on skin (esp. periorally) PLUS


multiple intestinal hamartomatous polyps that may lead to massive GI
haemorrhage.

E) Inflammation and thrombosis of middle-sized peripheral arteries in male


cigarette smokers.

F) Short stature, obesity, polydactyly, hypogonadism, mental retardation and


retinitis pigmentosa.

******** Answers ********


A) Goodpasture's syndrome B) Berger's disease. C) Patau's syndrome
(N.B. Edwards' syndrome = trisomy 18). D) Peutz-Jegher's
syndrome. E) Buerger's disease (thromboangiitis obliterans).
F) Laurence-Moon-Bardet-Biedl syndrome.

Question 9: Respiratory disease

Option List:

Asthma (non-occupational)
Occupational asthma
Pneumonia
Extrinsic allergic alveolitis
Atelectasis
Pulmonary embolism
Pneumothorax
Sarcoidosis
Inhaled foreign body
Fibrosing alveolitis

For each of the following cases, select the most likely diagnosis from the
above list.

A) 19 year old male smoker with sudden onset of breathlessness and pain in
the left shoulder. On auscultation there were reduced breath sounds in the
left upper zone.

B) 48 year old farmer with dry cough, breathlessness, fever, and a flu-like
feeling that had developed over a period of hours. He reported previous
milder attacks, all occurring after he had been forking hay.

C) 3 year old girl with a 4 hour history of severe cough and wheeze. On
auscultaion there was a monophonic wheeze in the right lung.

D) 60 year old woman, post-cholecystectomy (day 1), with mild tachypnoea,


mild hypoxia, and low-grade fever. On auscultaion breath sounds were
reduced in both lung bases.

******** Answers ********


A) Pneumothorax. B) Extrinsic allergic alveolitis (he has farmer's lung).
C) Inhaled foreign body. D) Atelectasis.

Question 10: Cardiology (ECG)

Option List:

Massive myocardial infarction


Asystole
Atrial fibrillation
SVT with normal conduction
SVT with bundle branch block
Junctional rhythm
Wolff-Parkinson-White syndrome
Ventricular tachycardia
Ventricular fibrillation
Pericarditis
Electromechanical dissociation ('pulseless
electrical activity')

For each ECG description given below, select the most likely
diagnosis/interpretation from the list above.

A) Slightly broadened QRS complexes (2.5 small squares), with initial


slurring of the R wave.

B) Widespread ST-elevation, concave upwards.

C) Bradycardia (43/min) with normal-looking QRS complexes that are


immediately followed by inverted P waves. T waves are normal.

D) Completely flat traces in all leads.

E) Tachycardia (200/min) with broad QRS complexes (3 small squares) in a


patient who has never had an MI. The QRS complexes are morphologically
similar to those on an earlier ECG taken when the patient was in sinus
rhythm.
F) ECG showing sinus tachycardia (140/min) in a non-breathing patient with
absent pulses.

******** Answers ********

A) Wolff-Parkinson-White syndrome. B) Pericarditis. C) Junctional


rhythm. D) Asystole. E) SVT with bundle branch block. F)
Electromechanical dissociation.

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