Professional Documents
Culture Documents
MCQs
60. A female with RA not responding to ibuprofen. What is the best treatment?
A. Increase the dose of ibuprofen
B. Methotrexate
C. Physiotherapy
D. Three NSAIDs for 2 weeks
61. Which of the following to administer to a patient with disseminated intravascular
coagulation?
A. FFP
B. Cryoprecipitate
62. Old male with 3 lesions in the right cortical area and a 4 month history of
headache. The least likely diagnosis is:
A. Primary brain cancer
B. Chronic granulomatous inflammation
63. A case history of mother with history of Sheehan syndrome. All labs show
hypopituitarism. The lesion is most likely at which site?
A. Hypothalamus
B. Pituitary gland
C. Cerebellum
D. Adrenal
64. In the above patient, what will be expected levels of anti-diuretic hormone in the
blood?
A. Increased
B. Decreased
C. Normal
D. Undetectable
65. In the above patient, what will be the cause of lactation failure?
A. Decreased prolactin
66. In the above patient, what will you give first?
A. Thyroxine
B. Cortisol
C. Minerals
D. LH
67. AV dissociation with an MI: all of the following will be administered EXCEPT:
A. Nitrates and β-blocker
B. Heparin
C. Pacemaker
68. An unstable patient with wide-complex tachycardia:
A. Cardioversion
B. Defibrillate
69. A hypertensive with no pedal edema and JVP wnl. On auscultation of chest,
bilateral crackes are heard. How would you manage this patient?
A. Change lisinopril to hydrochlorothiazide
B. Optimize the dose of lisinopril
C. Optimize the dose of thiazide
70. ABGs of COPD patient reveal pH 7.45, pO2 ↓ and pCO2 65 mm Hg. What is the
most likely disorder?
A. Mixed acid-base disorder
71. All of the following are true about atopic asthma EXCEPT:
A. ↑ IgG
72. 8 years old male with mild jaundice:
A. Gilbert syndrome
B. Criggler-Najjar syndrome
C. Dubin-Johnson syndrome
73. Megaloblastic anemia: you will administer all of the following EXCEPT:
A. Folate
B. Vitamin E
C. Vitamin C
D. Vitamin B12
74. Pott’s disease with lytic lesion of disc: appropriate treatment would be:
A. Treat with ATT for 18 months
B. Treat with ATT for 9 months
75. A female patient on ATT for 6 months presenting with CNS signs for 3 days. MRI
shows three lesions in the brain. What is the appropriate management?
A. Continue ATT
B. Add 2 more drugs
C. Stop drugs for 2-3 days
76. A patient in septicemic shock has passed no urine in the past 2 hours. Which of
the following describes the most appropriate course of action?
A. Give dobutamine to increase cardiac output
B. Give dopamine to increase mean arterial pressure
C. Give dopamine to increase splanchnic blood flow leading to increased
kidney perfusion
77. A patient has pneumonia and massive effusion due to infection. Gram staining of
the fluid shows gram positive diplococci. What is the urgent management?
A. IV antibiotic
B. Chest tube
C. Ventilation
78. A diabetic patient with peripheral vascular disease underwent TKR. On 10th post-
operative day, he develops a pulurent discharge with swollen knee joint. The
pathophysiology of this disease includes all of the following EXCEPT:
A. Colonization of nasopharynx by causative agent
B. Defective neutrophil function
C. Ischemia due to peripheral vascular disease
D. Polyneuropathy causing sensory loss
79. A woman with abdominal pain, fever and weight loss. A barium follow-through
shows thickened terminal ileum with ulcers. What is the pathophysiology of
this condition?
A. Caseating granulomas
80. In the above patient, what will you do to confirm your diagnosis?
A. Colonoscopy, ileoscopy + biopsy
B. Tuberculin test
C. Proctoscopy
81. The most appropriate management of the above patient is:
A. Anti-tuberculous therapy
B. Steroids
82. A 68 years old woman suffering from type 2 diabetes mellitus presents with
severe pain and redness over the right leg for the last 2 days and fever for the
last 24 hours. On examination, temperature is 39.4oC. The right leg is swollen
and red from the ankle to the knee joint; also tender to palpation. There are no
other skin lesions. This patient should receive an antibiotic against:
A. Atypical bacteria
B. Gram negative rods
C. Gram negative cocci
D. Gram positive cocci
E. Mycobacteria
83. An ICU patient develops fever, purulent endotracheal secretions and a new chest
X-ray infiltrate. Pending results of cultures sent this morning. Which of the
following is the most appropriate antibiotic regimen at AKU?
A. Vancomycin plus gentamycin
B. Ceftazidime plus gentamycin
C. Vancomycin plus piperacillin-tazobactam
D. Imipenem plus erythromycin
E. Piperacillin-tazobactam plus amikacin
84. In a patient with fever and thrombocytopenia, which of the following features
clinically differentiates between malaria and Crimean-Congo hemorrhagic
fever?
A. Hepatomegaly
B. Splenomegaly
C. Leukopenia
D. Lymphocytosis
E. Abnormal liver enzymes
A 75 years old male diagnosed with Parkinson’s disease had had complaints of
difficulty starting micturition and a weak stream for the past 6 months. Today,
he presented to the ER with complaints of fever (38.6oC) with shaking chills
and pain in the left flank. Rest of the vitals is within normal limits.
85. What would be the most useful investigation to carry out at this stage?
A. D/R of midstream urine
B. D/R of suprapubic aspirate
C. Intravenous pyelography
D. Digital rectal examination
E. Examination of left flank
86. What is the most likely reason for his 6 month long symptoms?
A. Prostatism
B. Stricture formation
C. Neurogenic bladder
D. Glomerulosclerosis
E. Psychosomatic disorder
87. Which, among the following drugs, would you prefer for controlling his
Parkinsonian tremors?
A. Benztropine
B. Bromocriptine
C. Levodopa with carbidopa
D. Selegiline
E. Tolcapone
88. Parkinson’s disease denotes a disappearance of dopaminergic neurons from the:
A. Hippocampus
B. Subthalamus
C. Striatum
D. Substantia nigra pars compacta
E. Substantia nigra pars reticulata
89. Which of the following is FALSE about the combination of levodopa and
carbidopa?
A. It reduces the incidence of hypotension
B. It reduces the incidence of peripheral side-effects
C. It crosses the blood-brain barrier
D. It increases the central availability of dopamine
E. It is administered orally
90. L-dopa is converted to dopamine by the action of:
A. Dopa decarboxylase
B. Dopa aminotransferase
C. Dopa hydroxylase
D. Dopa oxidase
E. Dopa reductase
97. Which of the following is the main reason behind the osteolytic lesions seen in
multiple myeloma?
A. Infiltration by tumor cells
B. Production of self-tolerant immunoglobulins
C. Release of cytokines
D. Secondary hyperparathyroidism
E. Expansion of the marrow
98. Secondary hyperparathyroidism is most often characterized by:
A. High serum calcium, high urinary phosphate
B. Normal serum calcium, high urinary phosphate
C. Normal serum calcium, low urinary phosphate
D. Low serum calcium, high urinary phosphate
E. Low serum calcium, low urinary phosphate
104. An appropriate tissue biopsy of a typical patient with SLE is most likely to
show:
A. Coagulative necrosis
B. Liquefactive necrosis
C. Fat necrosis
D. Fibrinoid necrosis
E. Caseous necrosis
105. The hematologic abnormalities seen in SLE are examples of:
A. Type I hypersensitivity
B. Type II hypersensitivity
C. Type III hypersensitivity
D. Type IV hypersensitivity
E. Type V hypersensitivity
106. Choose the correct statement:
A. Langerhans cells are confined to the CNS
B. Dendritic cells are confined to the CNS
C. Dendritic cells are confined to the skin
D. Dendritic cells are confined to the spleen
E. Langerhans cells are a subset of dendritic cells
A 65 years old diabetic and hypertensive patient has sudden onset of chest
pain of 2 hours duration. He is brought to the emergency room. An ECG done
shows STE in leads I and V2-V4. His creatinine is 6 mg/dl.
128. ST segment elevation in above case is due to:
A. Myocardial infarction
129. Which artery is involved in the above case?
A. Left anterior descending artery
130. Why is morphine administered to the patient?
A. Analgesia
B. Euphoria
131. The best drug for long-term use in this patient is:
A. Aspirin
B. Anti-platelet drugs
132. If renal function is impaired, which drug to use?
A. ACE inhibitor
133. Why renal function is impaired in this patient?
A. Atrophy and scarring of tubules
B. Hyperplasia of glomerular cells
134. Why is the onset of chest pain sudden?
A. Ruptured atherosclerotic plaque
A 28 years old man with a history of passing stools with streaks of blood for
the past 10 years. Now, the bleeding has increased. Lab investigations show
that Hb ↓, neutrophils ↑, K+ ↓, Mg2+ ↓ with microcytic hypochromic anemia.
The patient has been taking loperamide and since last 6 months, his diet
consists of only soup and bread.
135. Why is hemoglobin low in this patient?
A. Chronic loss of blood
136. Why is the patient taking loperamide?
A. Anti-motility drug
137. Why does the patient have hypokalemia and hypomagnesemia?
A. Error in sampling
B. Loss in stool
138. Why do we plan to do colonoscopy?
A. To check for dysplasia
A 35 years old patient had a TB-like disease a few years back with weight loss
and cough. The doctor prescribed him multiple drugs, but, he left them after 1
month. Now, he has come with worsening dyspnea for 1 day. On physical
examination, he has muffled heart sounds, impalpable apex beat and engorged
neck veins. A chest X-ray done in the emergency room shows bilateral diffuse
infiltrates.
142. Where is the problem located in the above case?
A. Pericardium
143. If samples are sent, what type of cells will be seen?
A. Lymphocytes
144. On histopathology, what will you find in the lungs?
A. Epitheloid granulomas
145. What treatment should be given to the above patient?
A. Anti-tuberculous therapy
146. What is the main adverse effect of the above therapy?
A. Hepatotoxicity
A middle-aged lady presents with swollen hands and feet along with
involvement of metacarpophalangeal joints. Recently, she has developed pain
in her right knee with restriction of motion. The knee is tender to touch and
warm. Blood profile reveals neutrophilia and also positive for rheumatoid
factor. Knee aspirate reveals turbid synovial fluid with neutrophils. Specimen
sent for culture grows gram positive cocci which are catalase and coagulase
positive, resistant to methicillin. The patient also has weak left adductor
function and loss of sensation of lateral three-and-a-half fingers in one arm.
147. Which cells are responsible for the formation of rheumatoid factor?
A. B lymphocytes
148. Which antibiotic should be administered to the above patient?
A. Vancomycin
149. For joint pain, you will do all of the following EXCEPT:
A. GABAergic agonist
B. Systemic steroids
C. Intra-articular steroids
150. What is the most likely explanation for her tingling and sensation problems in
her left hand?
A. Carpal tunnel syndrome
65 years old Mrs. Khan, a known hypertensive and diabetic, has hemorrhage
on right side of head, conjunctival redness, proptosis and mydriasis. Her
visual acuity is severely reduced to just perception of light. She also has
swelling from right side of mouth with blackish discharge from the swelling.
151. For this swelling, what diagnostic test would you perform?
A. Kinyoun staining
B. Destroy by KOH and view under microscope
152. We can give all of the following drugs to the above patient EXCEPT:
A. Sulfonylureas
A middle-aged male presents with right upper quadrant pain, sweating and
fever. Ultrasound reveals a single hypoechoic lesion in the liver. The patient
has mild icterus on examination. Lab results reveal ↑ ALT and ↑ total
bilirubin.
153. Why is the patient having pain in right upper quadrant?
A. Stretching of Glisson’s capsule
154. How did the patient contract this infection?
A. Ingestion of cyst
155. How did the infection reach the liver?
A. Portal vein
156. What is the source of bilirubin in this patient?
A. Liver parenchyma
B. RBCs
164. Uncontrolled diabetes mellitus and hypertension in a 55 year old female. You
suspect that hypertension is secondary to Cushing’s syndrome. What test will
you order for this patient?
A. Low-dose dexamethasone suppression test
B. High-dose dexamethasone suppression test
C. 24-hour urinary cortisol
165. A patient with diabetes mellitus well-controlled on glibenclimide until
recently. The patient is obese. What will you do?
A. Start insulin and stop all medications
B. Add another sulfonylurea
C. Add metformin
166. ABGs of a patient show pH of 7.4, pO2 of 76 mm Hg, pCO2 of 54 mm Hg and
HCO3- of 38. What is the most likely underlying disorder?
A. Uncompensated metabolic acidosis
B. Mixed disorder of respiratory acidosis and metabolic alkalosis
167. HMG CoA reductase inhibitors decrease LDL by:
A. Lipoprotein lipase reduction
B. Reducing LDL receptors on cell membranes
C. Increasing LDL receptors on cell membranes
168. In community acquired pneumonia, all are indicators of poor prognosis
EXCEPT:
A. Age > 65 years
B. Confusion
C. Increased urea
D. Dyspnea
E. Elevated temperature
169. In treatment of community acquired pneumonia, we have to first rule out:
A. Legionnaire’s disease
170. A patient has COPD since 2 years and can no longer be controlled by
salbutamol inhaler. What do you do?
A. Corticosteroids orally
B. I/V corticosteroids
C. Corticosteroid inhaler
D. Corticosteroid nebulizer
E. Ipratropium inhaler
171. Acute exacerbation of asthma, PEFR equals 40% of best. What do you do?
A. Give inhaled β-agonist & steroid and admit the patient
B. Do ABGs
C. Get a chest X-ray
D. Give steroids and send home
E. Give antibiotics
172. A patient has asthma for many years. He also has varicose veins, which are
progressively painful and now, he is tender around knee joints. What do you
do?
A. Doppler to rule out DVT
B. Give pain-killers
C. Involve vascular surgery
173. 65 years old female was operated on two weeks back for hip fracture. On
clinical examination, she has RR of 32/min with tachycardia, however, there
is no dyspnea or hypertension. Which of the following is the most useful
investigation to be performed?
A. D-dimer
B. Spiral CT scan of chest
C. Chest X-ray
D. Pulmonary angiography
E. V/Q scan
174. Which one of the following statements is true about bronchogenic carcinoma?
A. 75% small cell, 25% non-small cell
B. Small cell carcinoma causes SIADH
C. Surgery is the best option for small cell carcinoma
D. Sputum cytology is diagnostic
175. A young girl referred to endocrinologist for evaluation of hyperthyroidism
after spontaneous abortion. Which of the following is NOT associated with
hyperthyroidism?
A. Vitiligo
B. SLE
C. Giant cell arteritis
176. A lady with goiter: on physical examination, you would expect to see:
A. Thinning of eyebrows
B. Myxedema
C. Pretibial myxedema
D. Ondiolysis
E. Lethargy
177. A 60 years old male farmer presents with progressive dyspnea. A chest X-ray
is ordered, which reveals bilateral nodular infiltrates. What is the most likely
diagnosis?
A. Cryptogenic fibrosing alveolitis
178. Which of the following is an action of insulin?
A. Increases glycolysis
179. A 25 years old tall lean male with no known comorbids presents to the ER
with sharp right-sided chest pain and decreased breathing sounds on right side.
What is the most likely diagnosis?
A. Tension pneumothorax
180. Which one of the following statements is true?
A. Whispering pectoriloquy is increased over an area of consolidation
181. Does the pattern of chest X-ray findings have any relation to the causative
organism of pneumonia?
A. From a chest X-ray, you cannot tell with certainity the causative agent
for pneumonia
182. In a chest X-ray, you observe mediastinal shift towards the right side. What
could be the most likely explanation?
A. Consolidation on the right side
B. Fibrosis on the right side
C. Collapse on the right side
D. Pnumothorax on the right side
E. Both B & C
183. A patient with diabetes mellitus having urine microalbumin of 180. What
should be the next step?
A. Start him on ACE inhibitor
184. Hormonal assay of a patient with Turner’s syndrome will most likely reveal:
A. Increased FSH and estradiol
B. Low FSH and estradiol
C. Decreased estradiol and increased FSH
185. Insulin does all of the following EXCEPT:
A. Inhibit lipoprotein lipase
186. Asthma is diagnosed by:
A. Improvement of PEFR by ≥15% with bronchodilators
187. In a pregnant female, we will continue all of the following anti-tuberculous
drugs EXCEPT:
A. Isoniazid
B. Rifampicin
C. Pyrazinamide
D. Ethambutol
E. Streptomycin
188. All of the following changes occur in asthma EXCEPT:
A. Increased mucus production
B. Goblet cell hypertrophy
C. Increased secretions
D. Thinning of basement membrane
189. A 61 years old male successfully treated for pneumonia has residual cough
without any fever. What is the most appropriate management plan?
A. Repeat antibiotic course
B. Continue same antibiotics for 20 days
C. Chest X-ray STAT
D. Chest X-ray and follow-up after 3 weeks
190. A patient has hirsutism and you suspect polycystic ovarian syndrome. Which
of the following investigations should be ordered for this patient?
A. Fasting insulin, TSH, pelvic U/S
191. What is the best time to administer antibiotics to a patient undergoing
cholecystectomy for cholelithiasis?
A. 1 hour pre-op
B. 24 hours pre-op
C. Intraoperatively
192. The major support of the uterus is:
A. Broad ligament
B. Infundibular ligament
C. Round ligament
D. Transverse cervical ligament
193. STEMI: ECG shows STE in leads II, III and avF with ST segment depression
in leads I, avL, V1, V2 and V3. The most likely diagnosis is:
A. Inferoposterior MI
194. Which of the following is a bad prognostic sign in febrile seizures?
A. Seizure lasting for more than 1 hour
B. EEG showing abnormal < 8 ms fall
C. Age < 1 year
195. A child with asthma under good control on inhaled steroids, however,
exacerbation occurs after exercise. What is the best advice to give to this
patient?
A. Add long-acting β2-agonist
B. Use short-acting β2-agonist before exercise
196. 10 workers in a grocery shop developed pneumonia with diarrhea, abdominal
pain and vomiting. These workers were exposed to moist environment by
cooling machine for newly arrived material. What is the most likely causative
organism?
A. Legionella pneumophila
197. Drug of choice for the above patients is:
A. Erythromycin
198. A young male from native America presents with a 4 day history of bloody
diarrhea. What is the next step?
A. U/S abdomen
B. Culture and appropriate antibiotics
C. Drink lots of water and reassure
199. A 3 years old child while playing has sudden bouts of cough. He is brought to
the ER with suspected foreign body inhalation. What is the best management
in this case?
A. Chest X-ray and bronchoscopy if history is suspicious
B. Always do bronchoscopy in such a presentation
200. An ECG shows peaked T waves and a prolonged QT interval. Which of the
following two electrolyte disturbances can explain these findings?
A. Hyperkalemia, hypocalcemia
B. Hypokalemia, hypocalcemia
C. Hypokalemia, hypercalcemia
201. A male with left-sided weakness, arm > leg with an irregularly irregular pulse
and defect in lower quadrant of visual field with macular sparing. The most
likely location of this lesion is in the:
A. Parietal lobe
B. Temporal lobe
C. Internal capsule
202. The most likely cause of the above lesion is:
A. Embolic stroke
203. An AIDS patient being treated with zidovudine presents with complaints of
lethargy and weakness. An ECG is ordered, which shows peaked T waves.
What is the most likely cause?
A. Hyperkalemia
B. Zidovudine toxicity
C. Pericarditis
D. Hyperkalemia with inferior wall STEMI
204. A lady with a 2 year history of staghorn calculus. Now, she has presented with
flank pain and tenderness. What is the most likely cause?
A. Renal cortical abscess
B. Pyonephrosis
C. Squamous cell carcinoma of kidney
205. A 65 years old male k/c of prostate CA presents with acute retention of urine.
What is the most likely cause?
A. Radiotherapy of spine
206. A 38 years old male with 1 week history of fever, drowsiness and right
hemiparesis. On examination, he has up-going plantars and has had a seizure.
LP reveals pleocytosis, increased protein and normal glucose. What is the
most likely diagnosis?
A. HSV encephalitis
207. In the above condition, what is the most common site of involvement of the
brain?
A. Frontal lobe
B. Parietal lobe
C. Temporal lobe
D. Occipital lobe
208. What is the investigation of choice for a patient presenting with recurrent
seizures?
A. EEG
B. CT scan
C. MRA
209. A man presents with complaints of unilateral headache, lacrimation, flushing
and rhinorrhea. These symptoms are improved by 100% O2 therapy. What is
the most likely diagnosis?
A. Cluster headache
210. 82 years old male smoker k/c of HTN presents to the ER with chest pain and
extreme shortness of breath after exercise. ECG shows STE in V1-V2 and tall
R waves in V5-V6. What is the most likely diagnosis?
A. Acute myocardial infarction
B. Ischemic cardiomyopathy
C. Aortic stenosis
D. Aortic regurgitation
211. A 28 years old female patient with weight loss, night sweats and colicky
abdominal pain. What should be the most appropriate investigation to order?
A. Colonscopy & ileoscopy with biopsy
212. Which of the following will be most likely seen on histopathology of obtained
specimen for biopsy?
A. Caseating granulomas
213. What is the treatment of choice in the above case?
A. Anti-tuberculous therapy
214. Which of the following is the most lethal complication of Kawasaki disease?
A. Coronary aneurysms
215. Which of the following correctly explains the pathology in lymphocutaneous
fever?
A. Medium vessel vasculitis
216. Which of the following has an association with hepatitis B?
A. Polyarteritis nodosa
217. Which of the following is classically seen in patients with hepatitis C
infection?
A. Type II cryoglobulinemia
218. In the above patient, if a biopsy of a lymph node was taken, one would expect
to see:
A. Leukocytoclastic vasculitis
219. A 70 years old male patient with oligoarthritis, skin lesions and pitted nails
(psoariatic arthritis). An X-ray of the knee joint is likely to show:
A. Pencil-in-cup deformity
220. Which of the following vasculitides has a strong association with smoking?
A. Thrombangitis obliterans (Buerger’s disease)
234. Which of the following skin lesions are classically seen in patients with
dermatomyositis?
A. Gottron’s papules and heliotrope rash
235. Which of the following investigations is required to confirm a diagnosis of
dermatomyositis?
A. Muscle biopsy
236. A 30 years old male presents with a pathologic fracture of his right femur.
During his stay in the hospital, he has an episode of hematemesis. Further
inquiry reveals that he has a long-standing headache and lethargy. What is the
most likely diagnosis?
A. Multiple endocrine neoplasia
[Pathologic fracture PTH hyperplasia; hematemesis gastrinoma;
headache and lethargy pituitary adenoma]
237. The most common cause of death in patients with Paget’s disease is:
A. High output cardiac failure
238. A 5 years old boy with bilateral knee joint swelling. On examination, patellar
tap is positive. On lab investigation, he has an ESR of 90 mm/hr. What is the
best investigation?
A. Synovial fluid aspiration
B. Synovial biopsy
C. Rheumatoid factor
239. How much volume loss should occur before a systolic drop occurs?
A. <15%
B. 15-30%
C. 30-40%
D. >40%
240. An ECG shows regular narrow-complex tachycardia with a heart rate of
300/min. What is the most likely diagnosis?
A. Atrial flutter with a 1:1 block
B. Atrial flutter with a 2:1 block
C. Atrial fibrillation
D. Sinus tachycardia
241. A 15 years old boy k/c of type I diabetes mellitus presents with diabetic
ketoacidosis. He is resuscitated in the ER and managed in hospital. Which of
the following best describes the subsequent management?
A. Continue insulin infusion until the boy starts to eat
B. Discontinue insulin infusion now
242. A baby with right localizing signs had fever for 1 week. Now, he has
generalized tonic-clonic seizures. The isolated organism is likely to
Hemophilus influenzae. Which of the following correctly describes the
condition of this baby?
A. Subdural effusion
B. Febrile seizures
243. Cilnical features of hypercapnia include all of the following EXCEPT:
A. Papilledema
B. Asterixis
C. Clubbing
244. A child had chickenpox 3 days back. He was given Dispirin by parents and
now has presented with nausea, vomiting and lethargy. The most likely
diagnosis is:
A. Reye’s syndrome
245. A known diabetic hypertensive with deranged LFTs, cholesterol 230 mg/dl,
triglycerides 130 mg/dl, HDL 45 mg/dl and family history of MI. Which of
the following drugs should be administered to this patient?
A. Niacin
B. Clofibrate
C. Simvastatin
246. A patient with CML, on chemotherapy, develops dry cough. On chest X-ray,
lower lobar reticular fibrosis is seen. What is the most likely cause?
A. Busulphan
247. A patient had a stroke: hemiplegia with slight dysarthria, no sensory loss and
normal speech. What is the most likely location of the lesion?
A. Frontal cortex
B. Medial leminiscus
C. Internal capsule
D. Cerebellum
248. A patient is on long-term steroid therapy for rheumatoid arthritis. Which of
the following lab values are NOT likely to be seen in this patient?
A. Elevated levels of ACTH
B. Leukocytosis
C. Increased levels of cortisol
A 16 years old male with mental retardation, bleeding gums, fever not
responding to antibiotics, very low platelets, high WBC counts with blasts,
normochromic normocytic anemia, simian crease and HTN:
340. Risk factor for the above disease: (advanced maternal age)
341. Most likely cause of immediate problem: (neoplastic AML/ALL)
342. A 46 years old patient with incontinence, memory deficits and ataxia: (normal
pressure hydrocephalus)
[Remember wacky, wobbly and wet! (dementia, ataxia, urinary incontinence)]
343. A patient with history of anemia, achlorhydia and macrocytosis: (pernicious
anemia)
344. Old female with lower limb paresthesias, weakness, loss of vibration and
position sense in lower limbs. Blood sugar levels are normal. The most likely
diagnosis is (subacute combined degeneration)
345. Ampicillin: (morbilliform rash)
346. Young adult with easy fatiguability, worse in evening: (myasthenia)
347. Pregnant patient with malaria that is chloroquine resistant: (mefloquine)
348. On ECG, S1Q3T3 pattern with RV strain: most appropriate treatment is
(heparin)
349. Hypercalcemia with rash on extremities [erythema nodosum], bilateral hilar
lymphadenopathy: (sarcoidosis)
350. Old male, history of abdominal pain, atrial fibrillation to sinus rhythm, no
localized tenderness on examination: (mesenteric infarct)
351. What will you do in above case? (angiography)
352. HOCMP: murmur decreased with hand-grip and squatting, increases with
Valsalva, exercise and standing
353. Old patient with pancytopenia, BM shows abnormal karyotype on
chromosomes 3 and 7: (myelodysplasia)
354. Iron deficiency anemia with iron resistance: (myelodysplasia)
355. TTP: microangiopathic hemolytic anemia, fever, renal failure, CNS changes, ↑
Cr ↓ Hb ↓ Plt
356. Treatment of above is (plasmapheresis and steroids)
357. Cape like sensory loss on shoulders and back: (syringomelia)
358. Low back pain and leg pain worsening over day and morning, stiffness for 15
minutes: (osteoarthritis)
359. What investigations to do in case of aplastic anemia? (bone marrow
aspiration and trephine biopsy)
360. A patient with chronic AF: (warfarin plus metoprolol)
361. β-lactamase inhibitor added to pencillin to increase sensitivity to
(Pseudomonas)
362. Sinus rhythm after long-term AF: (splanchnic infarct)
363. Parkinson disease with early symptoms: (amantidine)
364. Treatment of a 3 mm microadenoma prolactinoma is (bromocriptine)
365. Solitary thyroid nodule in a patient with some signs of hyperthyroidism: what
test to do next? (FNAC)
366. Antimalarial for Plasmodium falciparum is (artemether plus lumefantrine)
367. Prick from a patient with chronic active hepatitis B: the risk of transmission is
(30%)
368. Prick from a patient with chronic active hepatitis C: the risk of transmission is
(3%)
369. Prick from a patient with AIDS: the risk of transmission is (0.3%)
370. Best indicator of liver functions: (PT)
371. Treatment of amebic liver abscess: (metronidazole)
372. A patient with some infection, got bloody diarrhea after using clindamycin.
What is the most likely organism? (Clostridium difficle)
373. A man with LDL 142 mg/dl, cholesterol 240 mg/dl with no risk factors. What
is the appropriate management? (life style changes)
374. Burns: right arm, whole front of trunk and right leg from knee downwards.
What is the percentage of area burnt? (36%)
375. Snake-bite: (anti-venom)
376. HBsAg positive, HBeAg negative, HBeAb negative and core IgG positive:
(carrier state)
377. A patient with HTN and K+ 6.1: (stop lisinopril, admit and give calcium
gluconate)
378. Second episode of pancreatitis, gall-stone on U/S: (refer to surgeon for
cholecystectomy)
379. Asthmatic, post-menopausal, used HRT but got DVT so stopped it, what to do
for bone health? (alandronate)
380. DKA with pH 7.21: (compensated metabolic acidosis)
381. Which statement is true about type I diabetes mellitus? (related to auto-
immune diseases)
382. A known diabetic hypertensive with CKD and mild proteinuria: (start ACE
inhibitor)
383. A patient k/c of DM, HTN, CKD is undergoing coronary angiography. Which
of the following should be given? (I/V N/S, I/V fluids plus Lasix)
384. Hypercalcemia with poor kidney function: (slow hydration)
385. A man with CKD missed dialysis and developed hyperkalemia with ECG
changes [tall T waves]. What should be first step? (give calcium gluconate,
kayexalate, dialysis)
386. Which of the following is seen in hypokalemia? (U waves)
387. 2 months history of fever, altered mental status and LP shows 88%
lymphocytes with ↓ glucose: (tuberculous meningitis)
388. Hep C reactive, but, PCR negative and LFTs normal: what to do? (repeat
LFTs in 6 months)
389. Which drug decreases mortality in CAD? (aspirin)
390. A patient with anemia, low back pain and proteinuria. Bone scan and bone
marrow given. The most likely diagnosis is (multiple myeloma)
391. Multiple sclerosis: (interferon β1b)
392. Cord compression: (X-ray, MRI)
393. Intermittent diplopia in looking up: (Tensilon test)
394. Thymoma: (mediastinal mass with increasing fatigue throughout day)
395. Cluster headache: (high flow O2)
396. Most common cause of low MCV: (iron deficiency anemia)
397. A patient with chronic blood loss from gut: (iron deficiency anemia)
398. Iron deficiency anemia in old male is supposed to be due to which pathology
unless proven otherwise? (colon CA)
399. A guy went to a friend with rash. His son had it too: (disseminated varicella)
400. Insulin self-injection: (low C-peptide)
401. AML: (CD 13, 33, MPO positive)
402. A known diabetic with UTI due to Pseudomonas: (admit and give I/V
antibiotics)
403. Howel-Jolly bodies: (sickle cell disease)
404. Whipple disease: (oculomasticatory myorhythmias)
405. Organism of whipple disease: (Tropheryma whippeli)
406. Retropharyngeal abscess: (do lateral X-ray)
407. An HIV positive girl has myositis: (zidovudine)
408. Dilated cardiomyopathy: which of the following is NOT useful? (digoxin)
409. Limotrigine adverse effect: (weight gain, alopecia, rash)
410. Increased JVP with tender hepatomegaly and pedal edema: (RVF)
411. Gestational diabetes mellitus: what do you tell her? (improvement will be
seen after 6-8 weeks)
412. Diagnosis of DM: (FBS)
413. PT ↑ aPTT ↑ BT ↔ indicates problem in (common pathway )
414. Angry patient: what is the first thing to do? (verbal)
415. Asthma with eosinophilia and cANCA positive: (Churg-Strauss syndrome)
416. Rash on arms and face, increased in sunlight and day-time, associated with
anemia and arthritis: (SLE)
417. Migraine seizures, LP shows ↑ RBCs and ↑ WBCs: what to do? (EEG, MRI,
contrast-enhanced CT, viral PCR)
418. A smoker taking lithium for bipolar disorder, serum Na+ 120, clubbing
present, urine Osmolarity 350, plasma Osmolarity 260: (SIADH)
419. A guy with pneumonia got better with pencillin but then worsened. The reason
was (pleural empyema / abscess formation)
420. A 3 day history of headache, fever and drowsiness: (meningitis, SAH)
421. 10 day history of diarrhea with small volume of mucoid stools: (Giardia, …)
422. X-ray of patient with RA: (juxta-articular osteopenia)
423. Acute renal failure after taking thiazides for HTN, no cast in urine, 20 WBCs:
(acute interstitial nephritis)
424. Right-sided infarct on ECG: what would you do to confirm? (right-sided
ECG, serial cardiac enzymes)
425. What do you NOT give in right-sided infarct? (nitrates)
426. A diabetic with pedal edema, HbA1c of 6.6: (losartan plus low-salt diet)
427. Obese diabetic with CKD, Cr 1.5 mg/dl, taking metformin and gliclazide.
What to do next? (stop metformin and add insulin)
428. TB patient taking anti-TB drugs, now got pregnant: (continue same drugs)
429. A hypertensive patient on anti-hypertensive drug therapy, however, no
improvement in symptoms. Labs show ↑ Na+ and ↓ K+. What to do? (order
renin and aldosterone levels)
430. A patient with severe asthma, respiratory acidosis on ABGs: what to do?
(intubate and I/V hydrocortisone)
431. Which of the following conditions do NOT increase prolactin?
(hyperparathyroidism)
432. A type I diabetic came with unconsciousness and fever. What to do first?
(blood glucose)
433. An HIV patient with previously treated PCP comes with S1Q3T3 pattern on
ECG: what to do? (order spiral CT scan)
434. Complex partial seizures: (give carbamezapine)
435. Heartburn post-prandial with no comorbids or weight loss: (give trial of
PPIs)
436. A boy on phenytoin has eosinophilia and developed a pruritic rash: (drug
hypersensitivity)
437. DKA: (high anion gap)
438. Newly diagnosed hypertensive in a 45 years old patient. The first anti-
hypertensive to use is (ACE inhibitor)
439. A patient with weight gain, constipation, hair loss and history of angina. Labs
reveal a TSH of 42. What dose of thyroxine to start with? (25 μg)
440. Sudden breathlessness since 3 hours in a chronic smoker: the first
investigation of choice is (CXR)
441. A policeman came with acute painful knee swelling, has history of toe
swellings: (monosodium urate crystals)
442. A 23 years old female with morning stiffness of small joints: what will
confirm the diagnosis? (bony erosions on X-ray)
443. HIV positive patient, test positive twice, what is next step? (Western blotting,
ELISA, CD4 count, viral RNA)
444. A 65 years old patient, diabetic since 10 years, sudden shortness of breath,
crackles at both lung bases, JVP wnl and no hepatosplenomegaly. What is the
diagnosis? (LVF)
445. A 30 years old male with cough and fever got splenectomy done. What is the
mediator of fever? (IL-1)
446. A patient with diabetic gastroparesis: what to give? (domperidone,
metocloperamide)
447. A lady with middle and index finger tingling and reduced pin-prick sensation.
What investigation to order? (nerve conduction studies)
448. Treatment of HSV encephalitis: (acyclovir 10 mg/kg I/V Q8H)
449. Management of chronic hyperkalemia: (kayexalate and diuresis)
450. Hemophilia: (factor VIII deficiency)
451. HS: spherocytes are also seen in (auto-immune hemolytic anemia)
452. Beck’s triad of cardiac tamponade: (jugulovenous distension, hypotension
and muffled heart sounds)
453. Jugulovenous distension in above case is caused by (reduced ventricular
filling)
454. Engorged neck veins in a lady: (SVC syndrome)
455. CSF findings of malaria patient: (↑ pressure ↓ glucose)
456. Abdominal TB, ascitic tap will reveal (lymphocytosis)
457. Patient on diuretics has decreased urine output and not feeling well: (acute
interstitial nephritis)
458. A patient with Boerhaave syndrome: what finding on clinical examination?
(Hamman’s crunch)
459. The reason for above is (pneumomediastinum)
460. A known diabetic and hypertensive with ↑ Cr ↑ BUN. The cause of CRF is
(diabetic nephropathy)
461. A patient with massive UGI bleed: immediate step is (NG)
462. Next step in above patient: (EGD)
463. A patient with aortic dissection: what to do? (rush to OR)
464. A patient with local infiltrating breast CA, nodes are negative, tumor is
positive for estrogen receptors: (give tamoxifen)
465. Obese patient with polycythaemia: (Gäisbock syndrome)
466. Treatment of hereditary spherocytosis: (splenectomy)
467. Treatment of nephrogenic diabetes insipidus: (amiloride)
468. Sickle-cell trait: (HbSA, HbSS, HbSC)
469. Treatment regimen for H. pylori is: (PPI + Klericid + Amoxyl)
470. A young female with WPW syndrome has an unstable heart rate with basal
crackles at both lung bases: (DC cardioversion)
471. An ECG shows tachycardia with a heart rate of 300/min and typical “saw
tooth” pattern: (atrial flutter)
472. ECG showing prolonged PR interval with no dropped beats: (first degree
heart block)
473. ECG shows progressively increasing PR interval followed by a dropped beat:
(Mobitz type I heart block)
474. Most common side effect of phototherapy for neonatal jaundice: (increased
insensible fluid losses)
475. A person with DVT suffered a stroke. What is the most likely explanation?
(paradoxical embolism due to patent foramen ovale)
476. Mononeuritis multiplex is seen in patients with (amyloidosis)
477. In a patient with amyloidosis, echocardiography will most likely reveal
(granular sparkling appearance)
478. What type of cardiomyopathy is seen in patients with amyloidosis?
(restrictive cardiomyopathy)
479. A patient with beaked nose, taut skin around the lips and dysphagia: (CREST
syndrome)
480. A patient with history of prolonged bleeding after delivery and failure to
lactate. Now, she has presented with ↓ FSH, ↓ LH and ↓ TSH. What is the
cause? (pituitary apoplexy)
481. A lady with history of Grave’s disease is currently euthyroid. Now, she has
presented with a palpable thyroid nodule. The best investigation to perform in
this patient is (FNAC)
482. What should be done for relief of pneumothorax? (insert chest tube in 5th
intercostal space anteriorly)
483. Chest tube is inserted at 5th intercostal space to (avoid injury to liver)
484. Safe triangle: (posterior border of pectoralis major, anterior border of
latissimus dorsi, upper border of 5th rib)
485. Most reliable way to find position of chest tube: (chest X-ray)
486. Infant with jitterness: (check serum glucose)
487. A patient with delirium has a history of urinary obstruction. He was
catheterized 2 days back for urinary retention. Now, urine bag is empty. What
will you do now? (I/V fluids and check urine output)
488. A healthy female with leukocyte esterase positive on urine D/R. What to do?
(start antibiotics and follow-up)
489. A 25 years old male carried furniture from one apartment to another. Now,
comes in with severe backache and muscle spasm. What is the appropriate
management? (reassure the patient)
490. A female with polymyalagia rheumatica complains of jaw pain [i.e. jaw
claudication]. What is the most likely cause? (giant cell arteritis)
491. A newborn with cyanosis on first day of life alongwith stridor, wheezing and
suprasternal recession. What is the most likely cause? (obstructed airway,
pneumnonia, cyanotic heart disease)
492. A baby with right middle lobar pneumonia: what drug to treat? (amoxicillin)
493. A patient with PR interval > 0.24 seconds, ↑ ESR and leukocytosis:
(rheumatic fever)
494. A patient has a high-output fistula after surgery for abdominal TB, which
involved resection of ileocecal strictures and end-to-end anastamosis. What is
the appropriate management? (TPN, skin care and antibiotics)
495. A young male with history of bloody diarrhea, weight loss and skin lesions
which turn purple. What is the most likely cause? (ulcerative colitis /
pyoderma gangrenosum)
496. The most reliable clinical sign of acute appendicitis is (rebound tenderness)
497. A patient has gross hematuria with sterile pyuria: (urinary TB)
498. A patient unstable with VT: (100 J defibrillation)
499. The most common dermatophyte infection in Pakistan is (tinea cruris)
500. Definition of anemia during pregnancy according to WHO criteria is (Hb < 11
g/dl)
501. Which of the following is NOT considered a treatment of enteric fever in
children in Pakistan? (ciprofloxacin, ceftriaxone)
502. A stroke patient is hospitalized for 5 days. Now, he has developed left-sided
chest pain and cough: (pulmonary embolism)
503. A patient with end-stage renal disease on peritoneal dialysis. He has
developed abdominal distension, pain and fever. What is the most likely
organism implicated in this case? (Staphylococcus epidermidis)
504. Partially treated meningitis: (CSF pleocytosis)
505. All of the following drugs act by causing hypoglycemia EXCEPT
(metformin)
506. Multiple bleeding points visible on colonoscopy: (ulcerative colitis)
507. ECG shows ↑ R waves in lateral leads and ST depression: (aortic stenosis)
508. Which of the following is NOT hepatotoxic? (ethambutol)
509. Which drug does NOT need adjustment in renal failure? (ethambutol)
510. Following drugs are excreted via biliary route: erythromycin, azithromycin,
doxycycline, ceftriaxone
511. Biliary sludging caused by (ceftriaxone)
512. ECG with PR interval of 0.124 seconds, tall T wave in avR, large R wave and
q wave in V6: (…) [?]
513. On a chest X-ray, air-fluid level can be seen in all of the following EXCEPT:
(hydatid cyst)
514. A 45 years old smoker with cough, chest X-ray shows right lower lobe
collapse with pleural effusion: (CT scan of chest)
515. A 70 years old female patient with long history of steroid use. Now presents
with back pain aggravated for 1 week: (vertebral compression fracture)
516. Bloody diarrhea with friable mucosa: (ulcerative colitis)
517. A 33 years old patient with hypokalemia, BP 90/70 mm Hg and wrinkled skin:
(Addison’s disease)
518. Hyponatremia encountered in hospital settings is most likely due to (excessive
resuscitation)
519. A 9 months old boy brought by mother for complaints of fever, dry cough and
rhinorrhea. Management includes (fluids until resolve)
520. A child with easy bruising, purpura, fever and hepatosplenomegaly. On
examination, he appears pale and her labs reveal Hb of 6.4 g/dl with
pancytopenia: (ALL)
521. 27 years old male with history of missed heart beat; precordial examination is
unremarkable: (PVCs)
522. 47 years old woman with several episodes of severe chest pain: ECG reveals
STE during the episodes; administration of ergonovine during the episodes
exacerbates the pain; the diagnosis is (prinzmetal angina)
523. Most of the hospitalized AIDS patients have which electrolyte abnormality?
(hyponatremia)
524. The most common precipitating factor of epilepsy in adults is (non-
compliance)
APGAR scoring 0 1 2
Appearance All blue Pink with blue limbs All pink
Pulse Absent < 100 bpm ≥ 100 bpm
Grimace None Facial grimace Cry
Activity Flaccid Some flexion Flexed limbs
Respiration Absent Gasping Regular
533. MYOTONIC DYSTROPHY: CTG repeats, distal muscle weakness, males 20-
30 yrs, balding prematurely (spot diagnosis), gonadal atrophy,
cardiomyopathy, DM, anterior/posterior subcapsular stellate cataracts, mental
impairment
534. TEMPORAL ARTERITIS: especially in women, 60+ years, unilateral
headache, raised ESR, loss of vision, association with PMR, diagnose with
temporal artery biopsy and ESR, treat with steroids STAT
537. HYPERTHYROIDISM
CAUSES: Grave’s disease, toxic adenoma, thyroiditis, TSH secreting tumor,
miscellaneous (β-hCG secreting tumor, struma ovarii, amiodarone, T. factitia)
ANTIBODIES: TSI (not available), anti-thyroglobulin & anti-microsomal
(done at AKUH), ANA (non-specfic)
THYROTOXICOSIS: fever, palpitations, restlessness, diarrhea, vomiting
MANAGEMENT OF THYROTOXICOSIS:
IVF + NGT + sedation order TSH, T3, T4, CBC, cultures, U/A
metoprolol 40 mg PO digoxin 1 mg IV over 2 hrs after 4 hrs,
carbimazole 15-25 mg Q6H PO Lugol’s solution 0.3 mLs Q8H PO HC
100 mg IV Q6H (↓ T4 T3) antibiotics if infection fever control with
ice packs, cold baths, panadol
538. HYPOTHYROIDISM
CAUSES: Primary hypothyroidism can be with goiter (Hashimoto’s
thyroiditis, iodine deficiency) or without goiter (amiodarone, surgery,
radiation)
Secondary hypothyroidism can be due to hypothalamic or pituitary causes
HASHIMOTO’S THYROIDISM: patchy lymphocytic infiltrates, auto-
immune etiology, more common in females, Hürthle cells classically seen,
increased risk of lymphoma and Hürthle cell carcinoma
MYXEDEMA COMA:
Signs include decreased ventilation, decreased BP, mental status changes
Precipitated by trauma, infection, stroke, MI, any physiologic stress
Management includes O2 inhalation, IV fluids, T3 5-20 µg IV slowly to
prevent MI, HC 100 mg IV Q8H, treat underlying cause; continue T3 Q4-8H
for 2 days or until improvement occurs, then give T4 50 µg/24 hrs
TREATMENT OF HYPOTHYROIDISM: check TSH 4-6 weekly, give T4 50-
100 μg QD in healthy patients; if history of CAD or advanced age, start with
25 μg Q6H; increase the dose of T4 25 μg every 1-3 weeks until euthyroid
status achieved
549. HEMOLYSIS
EXTRAVASCULAR INTRAVASCULAR
Warm AIHA Cold AIHA
Hypersplenism PNH
Hereditary spherocytosis MAHA
Enzyme defiency anemias (G6PD, PK) Sickle cell
[AIHA=auto-immune hemolytic anemia, PNH=paroxysmal nocturnal
hemoglobinuria, MAHA=microangiopathic hemolytic anemia, PK=pyruvate
kinase]
560. ASCITES
Hemorrhagic due to malignancy or trauma
Chylous due to cirrhosis, malignancy, TB, abdominal surgery, trauma,
pancreatitis, filiariasis
GENITAL DEVELOPMENT
Stage I Preadolescent
Stage II Enlargement of scrotum and testes
Stage IIIIncrease in lenght of penis; reddening of scrotal skin; change in
texture of scrotal skin
Stage IV Enlargement of penis (breadth), darkening of scrotal skin
Stage V Adult genitalia in size and shape
PUBIC HAIR
Stage I Preadolescent
Stage II Sparse, pigmented, downy hair at base of penis and along labia
Stage III Darker, coarser, curled hair; junctions of pubes
Stage IV Hair without distribution of adult type, no hair on thighs
Stage V Distrubtion along medial aspect of thigh
Stage VI Spread up linea alba: “male escutcheon”
1. Hereditary spherocytosis:
a. Folic acid 1 mg/day
b. Treatment of choice: splenectomy
2. Auto-immune hemolytic anemia:
a. Prednisolone 1-2 mg/kg/d in divided doses
b. Transfusion
c. If recurrence on tapering the steroids, do splenectomy
d. Refractory patients to these 2 modalities should be treated with:
i. Rituximab 375 mg/m2 IV weekly for 4 weeks
ii. Danazol 600-800 mg/d (low toxicity; good for long-term use)
iii. Cyclophosphamide, azathioprine, cyclosporine
iv. High-dose IV immunoglobulins (1g q 1-2 d; benefit is short-lived
and treatment expensive)
3. Cold agglutination disease:
a. Symptomatic
b. Alkylating agents like cyclophosphamide
c. Cyclosporine
d. High-dose IV immunoglobulin (temporarily)
e. Rituximab
4. Aplastic anemia:
a. Mild: supportive care; transfuse RBCs and platelets, antibiotics prn
b. Severe: (neutrophils < 500/μL, Plt < 20,000/μL, Retics <1%, bone marrow
cellularity <20%)
i. For young adults <50 yrs, allogenic BMT from HLA matched
siblings
ii. For kids and adults <30 yrs, allogenic BMT using unrelated donor
iii. Adults over age 50 yrs or those without HLA matched siblings,
immunosuppresion with ATG and cyclosporine
iv. Use ATG in combination with steroids to avoid complications of
serum sickness (response usually partial and in 4-12 wks, but,
enough to ensure a transfusion free life)
v. High dose immunosuppression with cyclophosphamide or
refractory cases (cause: may cause pancytopenia)
vi. Androgens (low response rate e.g. oxymetholone)
5. SLE:
a. If benign, supportive care & emotional support
b. Skin lesions: corticosteroids
c. Joint symptoms: NSAIDs, hydroxychloroquine, rest
d. Thrombocytopenia: danazol
e. Corticosteroids indicated for GN, hemolytic anemia, peri/myocarditis,
alveolar hemorrhage, CNS symptoms, TTP
f. For cases resistant to steroids: immunosuppressants like
cyclophosphamide, mycophenolate mofetil, azathioprine
g. Anti-coagulation (warfarin with target INR>3.0) for APS
6. Polycythemia rubra vera:
a. Phlebotomy (weekly) to maintain Hct < 45%
b. Avoid iron supplements
c. Hydroxyurea (only when phlebotomy requirements are high,
thrombocytosis or intractable pruritis; initially myelosuppressive treatment
with alkylating agents was indicated for this, but, this increases the risk of
conversion of this disease to acute leukemia and is now avoided)
7. Myelofibrosis:
a. No specific treatment
b. Transfusion
c. Androgens
d. Allogenic BMT in younger patients
8. CML:
a. DoC is Gleevec® [imatinib mesylate] (inhibitor of tyrosine kinase activity
of bcr-abl gene product)
b. Hydroxyurea if Gleevec® not tolerated
c. α-IFN (toxicity)
d. Curative: allogenic BMT, especially, in patients <60 yrs with HLA
matched siblings
9. AML:
a. Poor prognostic factors: cytogenetics, age > 60 yrs, MPS/MPD, poor
performance
b. For cytogenetics, bone marrow on 10th and 28th days
10. CLL:
a. Smudge cells
b. Can be classified into:
i. SLL (small lymphocytic lymphoma)
ii. Richter’s syndrome i.e. DLBCL (diffuse large B-cell lymphoma)
c. Management:
i. Palliative at stage III/IV with single-agent ± vidarabine
ii. Stage II irradiation of lymphoma
iii. Stage III splenectomy
iv. Steroids for auto-immune hemolytic anemia / idiopathic
thrombocytopenia purpura
d. Fludarabine (new, first-line)
e. Combine with rituximab or cyclophosphamide
f. Chlorambucil (well tolerated)
g. Allogenic BMT
11. ALL:
a. Good prognostic factors: young age, WBC ≤ 30,000, early remission, Ph
negative, T-cell immnophenotype
b. Chemotherapy (daunorubicin, vincristine, prednisone, asparaginase)
c. Allogenic BMT
12. Non-Hodgkin lymphoma:
a. CHOP
13. Hodgkin lymphoma:
a. ABVD
14. ITP:
a. Plasmapheresis
15. Myelodysplastic syndrome:
a. RBC transfusion for anemia
b. G-CSF or GM-CSF for neutropenia
c. Erythropoietin (SC weekly) to reduce transfusion requirement
d. Azacitidine (improves symptoms and time to conversion to acute
leukemia)
e. Allogenic BMT
16. Multiple Myeloma:
a. VAD
b. Autologous stem cell transplant
c. Localized radiotherapy
d. Bisphosphonates
e. Treat hypercalcemia, avoid immobilization and dehydration
SAQs
1. A patient has come with 2 month history of fever, cough and left-sided chest pain.
a. Name the 2 most important abnormalities on this chest X-ray.
i. Left-sided pleural effusion
ii. Fibrotic changes in apical areas
b. What is the most likely underlying disease responsible for the
abnormalities? (Tuberculosis)
2. A patient has 10 years history of episodic cough and wheezing. His complete
blood count showed Hb of 14 g/dl, WBC 20 with 70% neutrophils, 15%
eosinophils, 15% monocytes and no basophils.
a. Describe 2 most obvious abnormalities on the chest X-ray given.
i. Dilated bronchi left upper zone
ii. Cystic bronchiectasis near left perihilar area
iii. Finger-in-glove sign
b. What is the underlying diagnosis? (APBA)
3. A patient was brought to hospital with upper abdominal pain. His blood pressure
was found to 90/50 mm Hg.
a. What abnormalities are visible on the abdominal X-ray?
(pneumoperitoneum)
b. What is the most likely cause for the radiological abnormality? (perforated
duodenal ulcer)
4. A patient was brought to hospital with nausea and vomiting for past several hours.
His BP was found to be 90/50 mm Hg with a postural drop of 20 mm Hg. His
blood chemistry revealed a Cr of 1.2, Na+ 123 and K+ 5.9.
a. Name the three most obvious abnormalities on this chest X-ray.
i. Trachea deviated to left side, bilateral pleural thickening, fibrotic
changes with bullae in left lung
b. What is the underlying disease that could explain the X-ray findings?
(tuberculosis)
c. What is the reason for present illness? (Addison’s secondary to TB)
5. A lady with a past history of lump removed from left breast came with 3 months
complaints of cough and dyspnea on climbing stairs.
a. What abnormality is visible on the chest X-ray? (prominent bilateral
interstitial shadowing with Kerley B lines)
b. What is the underlying disease process? (lymphangitic carcinomatosis)
6. A diabetic lady brought to the ER with 2 hours history of sudden onset of dyspnea
and profuse sweating.
a. Describe the abnormalities on chest X-ray.
i. Diffuse opacification of both lungs due to alveolo-interstitial
shadowing.
ii. Possible cardiomegaly (even allowing AP projection)
b. What is the most likely explanation for abnormality? (Pulmonary edema
due to acute left ventricular failure)
7. SVC obstruction
a. Emergency management
b. Three differentials (lymphoma, bronchogenic CA, sarcoidosis)
c. Three modalities of diagnosis (CT, mediastinoscopy with biopsy)
8. DKA
a. Lab findings
b. Management
c. How much fluid to give and at what rate?
d. What is meant by bolus?
e. What is the dose of insulin?
f. What is the risk of patient dying in the ER?
g. If he dies, what would be the cause of death?
9. SBP with grade-II PSE:
a. Diagnosis
b. Management
10. ABGs of a patient suggestive of asthma:
a. Most likely cause
b. Management
11. CBC of a patient showing hypochromic microcytic anemia:
a. Causes
b. Investigations
12. A 6 years old boy with headache, fever, vomiting and confusion:
a. Most likely diagnosis
b. Common organisms
c. Investigations
d. Drug of choice
e. What is the dose?
13. A patient with tetanic contractions of face muscles:
a. Interpret labs
b. How do you correct Ca2+ for albumin?
c. Effect of acid-base disturbances on ionized Ca2+
d. Management (give 10 mL of 10% calcium gluconate I/V infusion over 30
minutes; repeat as necessary; treat any underlying respiratory alkalosis)
14. Malar rash of SLE:
a. Diagnosis
b. Management
c. Organ involvement
15. A 75 years old patient with myxedema coma:
a. Diagnosis
b. Investigations
c. Management
16. Scleroderma with CREST syndrome:
a. What does CREST stand for?
b. What do each of the above mean?
OSCE
VIVA
1. Chest X-ray:
a. Consolidation (d/d, organisms, management)
b. Pleural effusion (causes, exudates vs. transudate, treatment)
c. Pneumothorax (causes, diagnosis, treatment)
d. Kerley B lines, cardiac failure
e. Coin lesion (d/d, management)
f. Miliary tuberculosis
2. ECG:
a. Ventricular fibrillation (diagnosis, management)
b. Ventricular tachycardia (causes, monomorphic vs. polymorphic)
c. WPW syndrome (pathology, treatment)
3. Causes of renal tubular acidosis
RANDOM FACTS