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1. Yount pt presented with 3rd epissode of meningitis in last 4 years + following deficiencies is most likely cause >> C5 complement.
2. Known Alcoholic steatohepatitis pt presented with abdominal swelling and grade 2 ascites + Blood test: Low Na+, K+: 4.1 mmol/l + Most appropriate way to treat the pt’s ascites >> Spironolactone.
3. Known COPD and chain smoker pt presented with progressive drowsiness, nausea, vomiting, cough + On exam: Coarse crackles + CXR: LT hilar mass with lymphadenopathy + Ca++: 3.2 mmol/l + Most likely cause of pt’s symptoms >> Increased parathyroid hormone-related peptide.
4. Pt presented with fx of meningism, purulent sputum, LT base consolidation + CSF: Gram-positive diplococci + Most appropriate intervention >> Ceftriaxone and vancomycin (The causative organism was Streptococci pneumonia)
5. 46 yrs pt was brought to Emergency Department following 40 × 50 mg amitriptyline overdose + Low bP, LoW GCS + CG: Short run VT, QRS 115 ms + Blood Test: Bicarbonate: 17 mmol/l + Most appropriate nest step >> Sodibicarbonate.
6. 24-year-old pt presented with H/O diarrhea following a visit to holiday in Portugal + diarrhea was self-limited on each occasion + Most likely organism >> E. coli.
7. Elderly pt presented with a known case of severe hyponatremia (Na+: 108 mmol/l) and now underwent correction with 1.8% saline + Nurses noticed: that he now appears unable to move his limbs and suspect that pt might be suffering from osmotic demyelination + likely initial cause of osmotic demyelination >> Astrocyte apoptosis.
7. Middle-aged lady presented with progressive fatigue and itching + on exam: Xenthelesma, scratch mark, 2 finger breadth hepatomegaly + Autoantibody most likely to be found in this pt >> Anti-mitochondrial Ab. (Dx: Primary Biliary cirrhosis)
10. Known CKD, IHD, Past H/O of recovery from sepsis presented with fever after Haemodialysis episode following hemodialysis + Blood test: WBC raised, CRP: 73 mg/l + Most likely cause of pt’s fever >> Staphylococcus epidermidis.
11. Pt with known Sjogren syndrome presented with 2 cm smooth swelling at the angle of the Left side of the jaw but the orifice of the parotid gland of the left side looks normal + most likely diagnosis >> parotid gland stone.
12. Known Type 1 DM pt underwent pan-retinal photocoagulation + Pt most likely complain of >> Impaired Night vision.
13. 20 yr pt came to the hematology department for a routine test and blood test: Neutrophils which have bi-lobed nuclei + other physical and Lab test is normal + Most likely dx >> Hereditary pledger -Huet anomaly
14. Young lady presented with pain during intercourse, dysuria, mucopurulent discharge + NAAT: Chlamydia is positive + Most appropriate intervention >> Doxycycline.
15. 49 yrs Alcoholic pt presented with a photosensitive erythematous rash with bullae + on the exam: skin is fragile, increased pigmentation & hypertrichosis + Enzyme is most likely to be deficient in this pt >> Uroporphyrinogen decarboxylase. (Dx: Porphyria Cutaneous Tarda)
16. Middle age known DM pt presented with abnormal liver function + On exam: he is tanned, presence of spider naevi, hepatomegaly + Knee X-ray: Bilateral chondrocalcinosis + Most likely cause of pt’s knee pain >>Pyrophosphate arthropathy. ( Dx: Haemochromatosis)
17. Mode of action of Digoxin >> inhibits the Sodium-potassium exchange pumps.
18. Reason behind transfusing irradiated blood >> Prevent graft vs host disease.
19. 36 ys lady presented with H/O Fourth 2nd trimester miscarriages, intermittent joint pain + Blood test: Low Hb, Low Platelet, ANA antibody (+), Most appropriate next investigation >> Anti-phospholipid antibody.
20. 34 yrs pt presented with 100 ml hemoptysis, nagging cough, SOB following flu-like illness + on exam : BP: 155/90 mmHg, Inspiratory crackle in both lung fields + lab test: Cr: 425 micromol/l, Raised ESR + Autoantibody is most likely to be found in this pt >> Anti-glomerular basement membrane.
21. A Young Obese pt presented with a severe headache worse in the morning and late in the evening + vision greys out when strains to pass stool + Bilateral papilloedema + CT brain normal + Most appropriate initial therapy >> Acetazolamide ( Dx: Primary intracranial hypertension).
22. Young pt with H/O bilateral lens dislocation and shoulder dislocation presented with tearing chest pain + 20-mmHg BP difference in 2 hands, ECG: inferolateral T wave inversion + Most likely dx >> Aortic dissection. (Dx: Marfan syndrome)
23. Pt presented with Rt shoulder weakness following bike accident + forty hours later got excruciating pain worsened by movement, not relieved by medication + on exam: marked weakness of the supraspinatus, infraspinatus, serratus anterior, and deltoid muscles + Most likely Dx >> Brachial neuritis.
24. Young lady presented with small joint polyarthritis affecting her fingers, wrist, ankle, and feet for the last 8 weeks + Lab test: RF: positive, Anti-CCP antibody positive + Most appropriate long-term intervention >> Methotrexate ( Dx: Rheumatoid arthritis).
25. 39 yrs pt presented in the GI clinic with severe epigastric pain + endoscopy showed: multiple gastric and duodenal ulcers and Gastrin elevated significantly + Most likely site of any tumor producing gastrin >> Pancreas.
26. Mode of action of Apremelast >> Phosphodiesterase -4 inhibitor.
27. Elderly known smoker retired plumber present with a progressive SOB, dry cough + inspiratory crackles, Pathy bilateral shadow and pleural plaque + Intervention likely to have the greatest impact on prognosis >> Smoking cessation (Dx: Asbestosia)
28. 42 yrs Alcoholic presented with H/O several tooth loose, gum disease + On exam: Araea of petechiall hemmorrhage + Most likely vitamin deficiency >> Vitamin-c.
29. Pt with known NYHA class 2 heart failure started Celecoxib for severe arthritic pain of knee + Most concerned side effect of celecoxib here >> Worsening cardiac failure.
30. Pathophysiology best fit of hemoptysis in bronchiectasis >> Capillary engorgement.
31. Elderly pt came for a follow-up following starting Risedone following a Lt Colle’s fracture + Most important risk factor for osteonecrosis of the jaw as a result of bisphosphonate treatment >> Dental Caries.
32. Pt known COPD has continued to deteriorate despite taking rescue prednisolone + despite nebulization wheeze on auscultation + Blood tests: pH: 7.31; P(CO2): high ; p(O2) low + Most appropriate next step >> Non-Invasive ventilation.
33. Pt known to have CRT-P present with the complaints, device has fired three times in the course of the day + A decision is made to pass a magnet over the device + How does the magnet work in this situation >> Turns off the defibrillator portion of the device.
34. Which Anti-TB ( quadruple therapy) is the most potent CYP450 enzyme inducer >> Rifampicin
35. Young pt presented with SOB on exercise and central chest pain during inspiration following the viral flu 2 weeks ago + ECG: widespread Concave ST -segment elevation + Most likely dx >> Effusive pericarditis.
36. 24 yrs pt known user of nitrous oxide canister present with unable to walk + on the exam: the presence of spasticity, clonus, hyperreflexia, upgoing plantar + most likely finding may have >> Impaired proprioception.
37. 24 yrs lady presents with the feeling out of control, pins and needles, RR: 35 br/min, pleuritic chest pain and oxygen saturation: 95% + H/O similar episode earlier in a night club + Most likely dx >> Panic disorder.
38. 48 yr woman presented with dizziness and nausea that lasted for 20-30 seconds, which resolved if the head was kept still + on exam: no tinnitus, tympanic membrane normal + Most appropriate next step >> Hallpike maneuver (dx: Benign paroxysmal positional vertigo).
39. Pt with known colon Ca present with fever following last cycle chemo received 3 weeks ago through indwelling line + blood test: Low WBC count, Low neutrophil count + Most likely causative organism >> Staphylococcus aureus.
40. 24 yrs pt presented with disturbance of vision and Lt sided eye pain + on exam: Left relative afferent pupillary defect, oedematous Left optic disc + what other feature would you expect to find >> Loss of color vision
41. 34 yr pt presented with stress incontinence following vaginal birth + fundamental feature of stress incontinence >> Increased abdominal pressure.
42. 49 yrs known Stage-4 CKD pt presented with iron deficiency anemia + Most likely contributor to the pt’s iron deficiency anemia >> Increased hepcidin.
43. An elderly woman presented with extreme fatigue, nausea, and swollen ankle following taking ibuprofen for 2-3 weeks on exam: swollen ankles, Erythematous rash over the upper part of body + Blood test: raised eosinophil, raised creatinine + Most likely Dx >> Acute interstitial nephritis.
44. A 45-year-old pt visited a Blood donation center wishing to donate blood + the following precluded the pt from donating blood >> Receiving a platelet transfusion in 2001.
45. Young pt presented with left wrist, left ankle pain, Conjunctivitis, dysuria following Spain travel + Most likely Dx >> Reactive arthritis.
46. Food has the highest glycemic index >> White rice.
47. 40 40-year-old lady presented with Photosensitive rash, joint pain, haematuria, proteinuria + Most likely to be found on jnvestigation >> Low C3 level.
48. 48 yrs presented with accidental adrenaline injection + on the exam: Thumb is cold, there is no distal capillary refill + Most appropriate initial intervention >> Topical application of Nitroglycerine.
49. A young 18 yr lady brought by her mother with H/O generalized tonic Clonic seizure + Clumsiness in the morning + sudden jerk on her upper limbs + Mother has H/O epilepsy + Most appropriate intervention >> Levetiracetam (Dx: Juvenile myoclonic Epilepsy)
50. Known case of Acute myeloid leukemia admitted for induction chemotherapy + Most appropriate prophylaxis against acute renal impairment >> Rasburicase.
51. A young pt known to have ADPKD presented with a heart murmur and intermittent palpitation + On exam: A late systolic murmur loudest at the apex + Most likely Dx >> Mitral valve prolapse.
52. Elderly pt underwent Lt hemiarthroplasty 2 days back and presented with confusion, pulled out his IV line, trying to bite nursing staff + 0n exam: Lt lower lobe pneumonia + Most appropriate intervention >> Haloperiod (Dx: Acute confusional State)
53. Known HIV pt poorly compliant to Anteretrovital therapy + On exam: 145/9p mmHg, Pitting oedema jn both lower limbs + Test: Rasied Cr, Urine: (Protein 3+, Blood negative) + Most appropriate intervention >> Highly active Anteretroviral therapy. (Dx: HIV Induced nephropathy)
54. Elderly pt presented with diarrhea, palpitations, and flushing, wt loss + on the exam: pan systolic murmur loudest in the tricuspid area + Lab test: Low HB, Low K+, Most useful investigation >> Urinary 5-Hydroxyindoleacetic acid (Dx: Carcinoid syndrome)
55. 19-year-old pt presented with cerebral venous thrombosis + family history of an inherited affinity hemoglobin ( Hb Variant) + Most likely finding >> Elevated Haemtocrit.
56. Elderly pt presented with fluctuating confusion, bumping into things on his Left hand + GCS: 13, on exam: Left-sided sensory inattention and extensive Bruising due to frequent falls + Most likely cause of pt’s confusion >> Subdural hematoma.
A >> Aged Person
A >> H/O Alcoholism
A >> Use of Anticoagulant/sign of over anticoagulation in the form of a bruise.
57. Elderly pt taking 120 mg of morphine for controlling pain of metastatic Breast Ca + Most appropriate initial dose of morphine slow-release tablets >> 60 mg twice daily.
58. Most useful score to assess a stroke pt’s independence >> Barthel index.
59. 55 yrs pt presented with ejection systolic murmur, and fever following a recent dental procedure + on the exam: Wt loss, ejection systolic murmur at the aortic area, Splinter haemmorrhage affecting fingernails + Most suggestive feature of bacterial endocarditis >> Fever.
60. A young female pt presents with weakness in her leg following the recent death of her father + on the exam: The Neurological exam was normal but when trying to lift her left leg, she appears to slowly the ground rather than dropping suddenly + Most likely Dx >> Conversion disorder.
61. Apart from cervical cancer, others cancer mostly associated with HPV 16 >> Oropharyngeal, anal cancer, and penile cancer in males.
62. 34 yr lady presented with weight loss, palpitations, and anxiety + On exam: 1.5 cm nodule on palpation of the left side of the thyroid + Lab text: TSH low, Free T4 is high + Most likely dx >> Toxic thyroid Adenoma.
63. 29 yr pt presented with severe spasms of the neck, fixed gaze + neck is twisted and unable to straighten + all of this happened following metoclopramide + Most appropriate intervention >> Benztropine.
64. Pt with known T1 DM presented with collapse, nausea, vomiting + H/O recurrent hypoglycemia, postural drop of 25 mmHg on standing + Blood test shows: Low Na+, Borderline high K+; Most useful investigation >> Synacthen test (Dx: Adrenal insufficiency)
65. Eldely known CKD pt came for a routine check-up. Blood test: K+: 6.4 mmol/l +an emergency ECG was arranged + feature on ECG signifies the highest risk if cardiac arrest >> QT prolongation.
66. Erythematous rash affecting both cheeks with telangiectasia with a number of papules affecting Nasolabial folds + fails to respond to topical metronidazole and topical azelaic acid + Most appropriate next step >> Oral doxycycline. (Dx; Acne rosacea).
67. Elderly known aortic stenosis pt presented with Iron deficiency anemia + 2 colonoscopy and endoscopy shows: normal + still SOB and reduced Exercise tolerance + Most likely cause of pt’s iron deficiency anemia >> Small bowel angiodysplasia (Dx: Heyde syndrome)
68. Human Leukocyte antigen associated with psoriasis >> HLA-B27
69. Elderly pt presented with sudden onset dizziness, nausea, vomiting, and ataxia + on the exam, the presence of Nystagmus, Loss of sensation affecting the Right-hand side of his face and Left-hand side of the body + Artery most likely to have been occluded >> Posterior inferior cerebellar artery (Dx: Lateral Medullary syndrome)
70. 38-year-old man known Alcoholic pt presented with a paracetamol overdose following the loss of his job + Which factors are associated with an increased suicide risk >> Alcohol abuse
72. 12 weeks pregnant lady present with hypertension + on exam: BP: 150/91 mmHg + ECG: LVH by voltage criteria + Most appropriate jntervention for this pt’s BP >> Labetalol.
73. 4o yrs man known to have asthma presented with night cough despite taking inhaled beclomethasone 200 micrograms twice daily + taking omeprazole for reflux esophagitis + BMI: 35 kg/M2 + Most appropriate next step in therapy >> omeprazole. (Dx: GERD)
74. Retired boilermaker present with Lt-sided pleural effusion + pleural fluid met Light’s criteria ( exudative) + Most likely cause of pt’s pleural effusion >> Malignancy (Dx: Mesothelioma)
75. The most important method to reduce the spread of C. difficile >> Soap and water handwashing.
76. 56 yrs yr pt presented with weight gain, hypertension, new-onset type 2 DM + on the exam: BP: 155/o0 mmHg, acne over his face and upper chest + BMI: 36kg/M2 + fasting Blood sugar: 9.1 mmol/l + Most useful next investigation >> 24 -hours urinary free cortisol. (Dx: Cushing syndrome).
78. 12 weeks pg lady contacted her niece last day who has developed chicken pox + she can’t remember having had chicken pox herself + Most appropriate next step >> Varicella zoster testing.
79. 20 yr pt came to know colonoscopy report which showed: more than 20 polyps with high-grade dysplasia + Has F/H/O familial adenomatous polyposis with identified APC mutation most appropriate plan for pt’s treatment >> Proctocolectomy with stapled ileal pouch-anal anastomosis.
80. A 19-year-old lady presented with LT breast cancer + According to her: her sister has breast ca, her father has prostate cancer; uncle’s diet from pancreatic acncer + mutation is most likely to be found in the family >> BRCA-2.
81. 24 yr pt presented with hives like rash, stridor, and tongue swelling + on exam: BP: 90/60 mmHg, HR: 125 bpm + Tx started with fluid loading, hydrocortisone, and IM adrenaline + Most appropriate next step >> Serum tryptase. (Dx is: Anaphylasix)
82. 19 yr known to have anorexia nervosa presented with NG feeding + On exam: BMI: 16 kg/m2 + After few hours she develops hypotensive and Left ventricular failure + Most likely cause of pt’s symptoms >> Hypophosphatemia (Dx: Refeeding syndrome)
83. Elderly pt presented with abdominal pain, distention, and confusion + On exam: HR: 132 bpm, irregular + blood test: Lactate is significantly elevated 4.9 mmol/l (0.5- 2.2 mmol/l) + Most common site of lesion of this pt’s presentation >> Splenic Flexure. (Dx: Ischaemic Colitis)
84. Olanzepine was started for schizophrenia + Most frequent side-effect of olanzepine >> Weight gain.
85. 34 yr pt presented with Lt severe tiredness, erectile dysfunction, and postural drop + on the exam: Bitemporal hemianopia + Test: Low Na+, Low TSH, high Prolactin level + MRI: 2 cm pituitary adenoma with optic chiasma pressure + Most appropriate intervention >> Surgical resection (Dx: Non-functioning adenoma)
85. Pt is known to have Acute promyelocytic leukemia + Most appropriate initial intervention >> All-trans retinoic acid.
86. A children’s day carer presented with anal itching at night + she said, she found something wriggling that looked like a piece of cotton + Most likely cause of pt’s symptoms >> Enterobius vermicularis.
87. Young pt presented following 3rd days of postpartum, she has been crying a lot over the day, and feels useless + otherwise she was well + Most likely Dx >> Baby Blues.
88. 19 yrs boy presented with the complaint that he failed to enter into puberty + On exam: 188 cm tall, with very sparse pubic axillary hair + B/L small testes + test: Low testosterone high FSH + Most likely Dx >> Klinefeter syndrome.
89. Drug causes Steven-Johnson syndrome:
90. 73 yr pt presented with lightheadedness with H/O frequent falls + On exam: BP: 135/70 mmHg with a 22 mmHg postural drop + which medication would discontinue first >> Doxazocin.
91. A 25-year-old pt with known Ulcerative colitis presented with an ulcerated lesion with a necrotic center + his UC is maintained with mesalazine + Most appropriate intervention >> Oral steroid. (Dx: Pyoderma gangrenosum)
92. 54 yrs known DM and IHD( Old inferior MI) is on metformin, dapagliflozjn, sitagliptin + BMI: 35 kg/M2 + Lab test: Cr: 123 miromole/l + HbA1c: 59 mmol/l + Most appropriate next step >> Switch sitagliptin for semaglutide.
94. 74-year-old pt known to have end-stage-bronchial carcinoma and expected to die within a few hours + on the exam: unconscious, excess respiratory secretion precipitating bouts of coughing + Most appropriate next step >> Hyoscine.
95. 45 yr lady presented with tiredness all day, double vision at the end of the day, fatigable ptosis + CXR: Smooth mass in the upper half of the chest in the junction heart and great vessels + Most likely cause of its abnormal chest X-ray >> Thymoma.
96. 45 yrs lady presented with dry cough, recurrent small volume hemoptysis + uveitis, rash at both shins + SCATTERED crackles + CXR: B/L hilar Lymphadenopathy + Most likely dx >> Sarcoidosis.
97. 42 yrs man Non-smoker presented with SOB on exertion + Chest is normal + BMI: 35 kg/M2 + Most likely abnormal test >> Expiratory reserve volume.
98. 3o yr pt presented with 3rd episode of renal colic which is calcium oxalate stone + Most appropriate prophylaxis against further episodes of renal colic >> Hydrochlorothiazide.
99. 19 yr boy presented with the H/O frequent fall + On the exam: Low BP (95/65 mmHg, Tiredness, muscle cramps) + BMI: 21 kg/m2 + Lab test: low K+; high HCO3- + Most likely cause of pt’s symptoms >> Sodium-potasium-Chloride cotransporter mutation. (Dx: Bartter syndrome)
100. 19 yrs old boy presented with pitting edema of both lower limbs and had H/O 2 same episode which was responded to steroid + Urinary:(Protein 3+, Blood negative) + Most appropriate next investigation >> First-morning void urinary Albumjn: creatinine ratio. (Dx: Minimal change glomerulonephritis)
