SLE PROMETRIC, RIYADH AUGUST 2011

1. a. b. c. d.

Patient underwent colectomy. When to do follow- up colonoscopy? 3 months 6 months 9 months 12 months (not sure about answer)

2. 74-year old female patient of Cushing s syndrome, had hip fracture falling off stool, what will you screen for while also treating her fracture: Hyperparathyroidism Osteomyelitis Osteoporosis Osteomalacia 3. Drug table given each with 3-4 drugs, question which group causes hyperuricemia. A B C D (I choose the group which had anti-neoplastics.) 4. Old female patient has pain in hip increased on walking, hip is stiff in morning and throughout the day: Osteomyelitis Osteoporosis Rheumatoid (wrong answer) 5. Very long scenario about middle age man (50 years) with family history of heart disease, active lifestyle, on self induced diet with 50% fat, 35% protein and 15 % carbohydrates, table showing labs, elevated LDL, low HDL, elevated triglycerides and cholesterol, normal RFTs and all other labs. No risk of heart disease Heart disease risk can be avoided by taking statins

Heart disease can be prevented by decreasing calorie intake 6. 9 year old child presented with rapidly developing rash that went into vesicle, pustule, etc phase Varicella (chicken pox)

7. Woman receives Varicella vaccine asks you about getting pregnant. Wait for 1-3 months after getting vaccine to get pregnant.

8. 18 month old patient, parents were treating baby for flu-like illness with fever with increased water intake at home, patient developed generalized tonic-clonic convulsions, presented to you after 1 hour with (description of post-ictal stage). Now baby becomes fully conscious. What is the next most appropriate step? Tepid sponging to reduce fever Give acetaminophen and antipyretics Treat fever, Get MRI done and treat after result (I choose this suspecting Meningococcal Meningitis)

9. Middle aged female patient with history of Stage 2 breast cancer treated successfully, now presents with moderate to severe pain in left leg, not relieved by lying down, pain on extension of leg and walking, O/E Tender region in L3-L4 lower back. No Physical sign of cancer recurrence. Last saw oncologist 2 years back. What is most appropriate scenario: Refer to oncologist Do DEXA Scan Do MRI Hospitalize and do neurology and oncology consultations

10. Maintenance fluid in 22 kg child awaiting surgery: I choose 65 ml/min

11. Baby present with weeping, shiny and crusting lesions around mouth Impetigo.

12. Male patient was advised to undergo Arterial Graft Bypass surgery at other clinic after having episode of pain in leg, now is asymptomatic. Came to you, Non-smoker, elevated cholesterol and early atherosclerotic plaques on some descending aortal branches. What will you advise: Undergo Bypass Grafting Take medication to prevent formation of Arterial plaques To undergo frequent arterial scans to see extent of disease.

13. 1st line class of drugs against Post partum hemorrhage: Uterine Contractile (right answer) Uterine Relaxant 14. Patient recovering from Viral Gastroenteritis, vomiting and diarrhea abated but still having Anorexia. What will you advise: Bananas, Rice cereal and apple juice Chopped pears, yougurt and . Granola, .

15. Patient with idiopathic anovulation. What drug to give: Clomiphene Progesteron LH FSH

16. Description of PCOS. Mechanism of PCOS: Androgen Excess

17. Prostitute with multiple sex partners presents with history of painless vaginal sore which healed and did not leave scar. O/E has generalized lymphadenopathy. What is your diagnosis: Syphilis (my answer) 18. Middle age patient alcoholic with H/O fullness in epigastric region and mild pain, History of nausea and vomiting. Labs: Increased Serum Amylase, Diagnosis: Pancreatic Pseudocyst Pancreatic Cystadenoma Choledochal Cyst Liver Cirrhosis 19. Female patient with wide-open eyes, tremors in hands that do not diminish with intention, What investigation will you do: a. Pituitary Scan b. T4 Levels

20. a. b. c. d.

Which one of these patients with pneumonia will you treat as outdoor patient: 80 Year old with 104 F temperature, BR 24/min PR 126/min, BP 180/110 60 year old with 102 F temperature BR 22/min PR 124/min, BP 160/110 50 year old with 98 F temperature, BR 20/min. HR 110/min, BP 180/110 80 year old with 96 F temperature, BR 18/min, HR 70/min, BP 110/80

21. Child comes from low-socioeconomic neighborhood with c/o Jaundice, you suspect Hepatitis, which one is likely in this child: a. A b. B c. C d. D

22. 15 year old patient comes with history of acute onset nausea, vomiting, yellowish discoloration of skin, What is the most likely diagnosis: a. Hepatitis E b. Other options (no option of hep A)

23. Long scenario of 28 year old male patient with symptoms of Ulcerative Colitis+ anemia related to UC. Sigmoidoscopy revelaed multiple polyps, Biopsy of polyps Carcinoma in situ. What is the most definitive therapy that will be effective in the long-term: a. Correct Anemia b. Left hemicolectomy and Colostomy c. Total Colectomy and Ilectomy d. Removal of all polyps by Colonoscopy

24. Patient came in in coma. Blood sugar levels only 60. What drug has she been using? a. Sulfonylureas (my answer) b. Biguanides c.

25. Female patient came with hypertension, azootemia and GFR of 44. What is her condition due to: a. Pheochromocytoma b. Renal artery stenosis c. Renal Parenchymal Disease d.

26. Patient comes with attack of Strep Throat, had history of previous attack, what is his chance of getting RHD now? a. Nothing, he is immune due to previous infection. b. 100% c. Needs Immunoglobulin to prevent re-infection. d. 50% chance of re-infection.

27. Old scenario for Complete Hydatiform Mole in pregnant patient.

28. Diabetic patient with c/o vaginal secretion, grey- white in color, no smell, adherent to vaginal mucosa, O/E under microscope: Spores. What is the offending organism: a. Candida albicans (my answer) b. Trichomonas Vaginalis c. Syphilis d. Pediculosis pubis

29. Pediatric patient from developing country presented with muscle wasting, weight loss and absent edema. What is the diagnosis: a. Marasmus b. Kwashiorkor c. Muscle wasting syndrome d. 30. a. b. c. d. Old case of Patient whose wife died 2 months back, having signs and symptoms of grief. Dysthymic disorder Depressive illness Bereavement ( my answer) Bipolar disorder

31. Patient with decreased vision, also peripheral vision decreased, using tonometer pressure in right eye 24 mm and left eye 22 m. What is the mechanism: a. Obstruction in trabecular meshwork and ciliary muscle leads to pupillary blockage and drainage of aqueous humor. b. Obstruction at ciliary muscle leads to blockage in drainage of Aqueous Humor. c.

32. Patient with 4 hour history of chest pain. ECG showing patient in V- fib. What is next best step: a. Intravenous Lignocaine b. Intravenous Adenosine c. Implantation of Intracardiac Pacemaker d. Cardioversion

33. Patient with DM and HTN, gradually decreasing vision, Eye Exam shows maculopathy. What is the treatment: a. Pan-retinal photocoagulation b. Photocoagulation of macular area

32. Picture of optic disc. (Looks like this: http://www.revophth.com/content/d/cover_focus/i/1315/c/25316/) What does it show? a. Normal disc b. Cupping of optic disc c. d.

34. Picture of Patients legs (calves) showing maculopapular rash. H/O red rah appearing on extensor surfaces. Rash is tender to palpate but does not blanch on pressure. What is the diagnosis: a. Henoch-Schnolein Purpura b. Polyarteritis nodusa c.

35. Female patient comes with history of periorbital swelling, itching all over body, O/E there is lymphadenopathy. Liver and spleen are enlarged. What is the diagnosis? a. Urticarial b. Angioedema c. Lymphoma (my answer)

36. Picture of base of mouth showing a white patch with sharply-demarcated edges. Patient is male, long- term smoker and chews tobacco, presents with painless lesion in mouth. What is the next most important step: a. Topical Fluconazole b. Biopsy (my answer) c. Wide surgical excision

37. What drug is likely to cause heat-stroke as it inhibits sweating : a. Orphanedrine b. Hyoscamine Sulfate (my answer)

38. CT of Brain picture. Scenario: Patient with sudden severe occipital headache came to emergency. a. Subarachnoid Hemorrhage (my answer) b. Intracerberal Hemorrhage c. Meningitis

39. Patient with severe pain in forehead, over nose and sides of face, also present are shiny blisters on surface of forehead, face and nose. What is the diagnosis: a. Post-herpetic neuralgia b. Varicella c. Herpes Simplex d. Herpes Zoster (my answer)

40. Patient had fly in his eye. On removal of the foreign object what will he need:

a. b. c. d.

Topical corticosteroids Topical Antibiotics Oral corticosteroids Oral Antibiotics

41. Patient complains of discomfort in the eye. There is no discharge. O/E with dye, a dendritic shaped ulcer is seen on the surface of the cornea. What is the diagnosis: a. Keratitis (my answer) b. Uveitis

42. A patient complains of 2 day history of stuck together lashes on waking up. There is mucopurulent discharge. Anterior Chamber, uvea and iris are clear. What is the diagnosis? a. Bacterial Infection b. Viral Infection c. Allergy

43. Patient diagnosed with Gestational Diabetes. Blood sugar levels not controlled by medication, shifted to insulin. What condition is she likely to develop later on in life? a. Hypoglycemic episodes b. Diabetes Type 1 c. Diabetes Type 2 d. Impaired Fasting glucose levels

44. Patient presents with red, peeling rash at back of ears, on limbs and over body. What is the first line treatment? A. Topical steroid B. Oral Steroid C. Oral Antibiotic

45. Patient diagnosed with depressive disorder. You prescribe SSRIs, What will you tell patient about them? a. They will take 3-4 weeks to become effective.

46. Beri-beri disease deficiency due to : Vitamin B1

47. Patient with rheumatic fever after untreated strep infection after many years presented with Mitral regurgitation, the cause of massive regurgitation is dilatation of: a. Rt atrium b. Rt ventricle

c. Lt atrium (my answer) d. Lt ventricle 48. 50-year old accountant, sedentary lifestyle, BMI 30, takes irregular meals; arteries show signs of early atherosclerotic changes. What will you advise? a. No meds necessary b. Prescribe diet of 600 kcal/day and reevaluate in 4 months c. Prescribe over weight diet and reevaluate in 6 months

49. Best intervention for Osteoarthritis: a. Weight training

50. Mechanism of Action of drugs that inhibit Conversion of estriol to estrogen. (I forgot the exact question but it mentioned about ovulation and who inhibits conversion of esterone to estrogen?) Options were: a. Aromatase inhibitors

51. a. b. c.

Patient presents with decreasing visual acuity. What is the best test for distance vision? Newspaper Snellen s Chart (my answer) Refractometer

52. What drug reverses the effect of Benzodiazepines: a. Flumazanil (my answer)