Medicine McQ Workbook PDF

1 1. 30 year old female presents with multiple episodes (>10) of episodic headache for past 4 years. It usually involves one half of the face and is associated with nausea and vomiting. There is no aura. Most likely diagnosis? a) Migraine b) Cluster headache c) Angle closure...

1 1. 30 year old female presents with multiple episodes (>10) of episodic headache for past 4 years. It usually involves one half of the face and is associated with nausea and vomiting. There is no aura. Most likely diagnosis? a) Migraine b) Cluster headache c) Angle closure glaucoma d) Temporal arteritis 2. A 45 year old male patient presented in casualty with a 2 hour history of sudden, severe headache associated with nausea and vomiting. He has neck stiffness but the rest of neurological examination is normal. What is the clinical diagnosis? a) Hypertensive cerebral bleed b) Migraine c) Subarachnoid hemorrhage d) Hemorrhage associated with A – V malformation 3. A patient being evaluated for aphasia is unable to name objects properly. However, his speech is effortless but with frequent errors in choice of words. Rest of neurological examination is normal. Damage in which area of brain results in this type of aphasia? a) Posterior temporal and parietal lobes, dominant hemisphere b) Frontal and parietal lobes, dominant hemisphere c) Prefrontal and frontal lobes, dominant hemisphere d) Posterior parietal and temporal lobes, non dominant hemisphere 4. Which of the following is NOT a feature of upper motor neuron paralysis? a) Flaccid paralysis b) Hyperactive stretch reflexes c) Spasticity d) Muscular incoordination 5. Which among the following is not a usual feature of right middle cerebral artery infarct? a) Aphasia b) Hemiparesis c) Facial weakness d) Dysarthria 6. Which of the following sensations is lost on same side in Brown Sequard syndrome? a) Pain b) Touch c) Proprioception d) Temperature 7. A 80 year old female presents with progressive loss of memory, difficulty in recalling names, difficulty in speech and inability to perform desired tasks. Which pathological feature is likely to be present? a) Beta amyloid b) Lewy body c) Cermaidase d) Pick’s bodies 8. A patient presents with headache and nuchal rigidity. CSF analysis reveal clear fluid with normal protein and glucose levels. Cell count is 50 lymphocytes/cu.mm with lymphocytic predominance. What is the probable diagnosis? 2 a) Bacterial meningitis b) Viral meningitis c) TB meningitis d) Cryptococcal meningitis 9. A 60 year old man presents with sudden onset right sides hemiparesis for the last 3 hours. BP at admission is 200/100 mm Hg. NCCT head is shown below. All of the following are indicated in the management except? a. Thrombolysis b. Control of hypertension c. Mannitol d. Elective hyperventilatiomn 10. A 60 year old patient is diagnosed with acute ischemic stroke and advised thrombolysis with alteplase. His weight is 90 Kg. How much should be the initial dose of alteplase to be given to the patient? a. 8 mg b. 10 mg c. 12 mg d. 15 mg 11. Which of the following is the most common cause of neurological deterioration in a case of subarachnoid bleed? a) Rebleeding b) Vasospasm c) Embolism d) Hydrocephalus 12. 50 year old female presents with pain, numbness and impaired sensation over half of face along with ataxia, nystagmus, dysphagia and hoarseness of voice. His pain and thermal sensations over the opposite half are impaired. Horner’s syndrome is present. Likely cause is thrombosis of which vessel? a) AICA b) Basilar artery c) Vertebral artery d) Pontine vessels 3 13. A young male develops fever, followed by headache, confusional state, focal seizures and right hemiparesis. MRI performed shows bilateral frontotemporal hyper intense lesion. Most likely diagnosis? a) Acute pyogenic meningitis b) Herpes simplex encephalitis c) Neurocysticercosis d) Ischemic stroke 14. A patient presented with right sided hemiplegia while on warfarin. What should be the initial investigation to be done? a) Serum troponin I levels b) EEG c) Non contrast CT scan d) MRI brain 15. All of the following are true about Weber’s syndrome except? a) Ipsilateral oculomotor nerve palsy b) Diplopia c) Contralateral hemiplegia d) Ipsilateral facial nerve palsy 16. ABCD2 scoring includes all of the following parameters except? a) Age b) History of stroke c) Hypertension d) Diabetes mellitus 16. A 50 year old woman develops sudden onset facial deviation with slurring of speech and inability to use right arm for last few minutes. The features began to reduce spontaneously and got completely resolved in next 48 hours. She has mid diastolic murmur on auscultation in left side of heart with irregular rhythm. Diagnosis? a) TIA b) Thrombo embolic stroke c) Cardioembolic stroke d) Pulmonary embolism 4 1. 30 year old female presents with multiple episodes (>10) of episodic headache for past 4 years. It usually involves one half of the face and is associated with nausea and vomiting. There is no aura. Most likely diagnosis? ~ a) Migraine : Non classical 5 - 4 -2 - 1 b) Cluster headache c) Angle closure glaucoma d) Temporal arteritis 2. A 45 year old male patient presented in casualty with a 2 hour history of sudden, severe headache associated with nausea and vomiting. He has neck stiffness but the rest of ~ neurological examination is normal. What is the clinical diagnosis? en a) Hypertensive cerebral bleed Fever b) Migraine Rupture Berry ↓ c) Subarachnoid hemorrhage -Cause : aneurysm SAH d) Hemorrhage associated with A – V malformation WERNICKE'S word Salad Fluent ↳ - > - 3. A patient being evaluated for aphasia is unable to name objects properly. However, his speech is effortless but with frequent errors in choice of words. Rest of neurological examination is normal. Damage in which area of brain results in this type of aphasia? a) Posterior temporal and parietal lobes, dominant hemisphere - b) Frontal and parietal lobes, dominant hemisphere * c) Prefrontal and frontal lobes, dominant hemisphere d) Posterior parietal and temporal lobes, non dominant hemisphere 4. Which of the following is NOT a feature of upper motor neuron paralysis? umN a) Flaccid paralysis : LMN ② tee ↓ b) Hyperactive stretch reflexes c) Spasticity spasticity d) Muscular incoordination O tane 5. Which among the following is not a usual feature ofO right middle cerebral artery infarct? a) Aphasia 3> McA = McA b) Hemiparesis c) Facial weakness d) Dysarthria 6. Which of the following sensations is lost on same side in Brown Sequard syndrome? a) Pain b) Touch(fine/crude ipsatural : Dosal c) Proprioception column d) Temperature - Amnesia 7. A 80 year old female presents with progressive loss of memory, difficulty in recalling names, ANOMIA Aphasia Apraxia difficulty in speech and inability to perform desired tasks. Which pathological feature is likely to be present? a) Beta amyloid Alzheimer b) Lewy body c) Cermaidase d) Pick’s bodies 8. A patient presents with headache and nuchal rigidity. CSF analysis reveal clear fluid with normal protein and glucose levels. Cell count is 50 lymphocytes/cu.mm with lymphocytic predominance. What is the probable diagnosis? 5 a) Bacterial meningitis b) Viral meningitis c) TB meningitis d) Cryptococcal meningitis HT weakness 9. A 60 year old man presents with sudden onset right sides hemiparesis for the last 3 hours. BP at admission is 200/100 mm Hg. NCCT head is shown below. All of the following are indicated in the management except? - emchagic 8 - ischemical a. Thrombolysis ~ b. Control of hypertension c. Mannitol d. Elective hyperventilatiomn · JICT 10. A 60 year old patient is diagnosed with acute ischemic stroke and advised thrombolysis with alteplase. His weight is 90 Kg. How much should be the initial dose of alteplase to be k given to the patient? a. 8 mg > 0 9 mg -. 0 9x90 =. D b. 10 mg c. 12 mg d. 15 mg #. reg 11. Which of the following is the most common cause of neurological deterioration in a case of subarachnoid bleed? a) Rebleeding MODIPINE) b) Vasospasm c) Embolism (prevent : d) Hydrocephalus oss sensation-face 12. 50 year old female presents with pain, numbness and impaired sensation over half of face # I, along with ataxia, nystagmus, dysphagia and hoarseness of voice. His pain and thermal - sensations over the opposite half are impaired. Horner’s syndrome is present. Likely cause is thrombosis of which vessel? a) AICA spioltalamic b) Basilar artery WALLENBERG c) Vertebral artery d) Pontine vessels PICA Vertebral A 6 CNS infection : ENCEPHALITIS Most likely diagnosis? - a) Acute pyogenic meningitis b) Herpes simplex encephalitis HSV-1. 13. A young male develops fever, followed by headache, confusional state, focal seizures and right hemiparesis. MRI performed shows bilateral frontotemporal hyper intense lesion. c) Neurocysticercosis bleed d) Ischemic stroke - -O 14. A patient presented with right sided hemiplegia while on warfarin. What should be the initial investigation to be done? a) Serum troponin I levels hemontagic stoke. b) EEG c) Non contrast CT scan d) MRI brain 15. All of the following are true about Weber’s syndrome except? a) Ipsilateral oculomotor nerve palsy ~ BRAIN babit b) Diplopia c) Contralateral hemiplegia d) Ipsilateral facial nerve palsy 16. ABCD2 scoring includes all of the following parameters except? a) Age b) History of stroke c) Hypertension TIA Estroke d) Diabetes mellitus 16. A 50 year old woman develops sudden onset facial deviation with slurring of speech and inability to use right arm for last few minutes. ↓ The features began to reduce spontaneously - - and got completely resolved in next 48 hours. She has mid diastolic murmur on auscultation - in left side of heart with irregular rhythm. Diagnosis? a) TIA b) Thrombo embolic stroke TA c) Cardioembolic stroke d) Pulmonary embolism S - -embolism. 7 Respiratory system: 1. A patient during evaluation has decreased vital capacity and decreased total lung volume. What is the most probable diagnosis among the following ? a) Bronchiectasis b) Interstitial lung disease c) Cystic fibrosis d) Asthma 2. In an asthmatic patient which of the following pulmonary functions would show the greater improvement on inhaling a bronchodilator - a) Tidal volume b)FEV1 c) FEF(25-75) d)FVC 3. Which one of the following distinguishes ARDS from cardiogenic pulmonary oedema ? a) Normal Pao2 b) Normal pulmonary arterial pressure c) Normal arterial-alveolar gradient d) Normal Paco2 4. A 28 year female, has diarrhea, confusion, high grade fever with bilateral consolidation on x ray.The probable causative organism is a) Legionella b) Neisseria meningitidis c) Streptococcus pneumoniae d) H. influenzae 5. A patient develops fracture of the shaft of femur. On day 3, he develops respiratory distress and decrease SPO2 and petechiae. Probable diagnosis is? a. Hypostatic pneumonia b. Hemolytic pneumonia c. Crush syndrome d. Fat embolism 6.Mesothelioma is most commonly associated with? a. Asbestosis b. Silicosis c. Anthracosis 8 d. Coal workers pneumoconiosis 7. Treatment of choice in a patient of acute pulmonary embolism with right ventricular hypokinesia and compromised cardiac output is? a) Thrombolytic agent b) Low molecular weight heparin c) Warfarin d) IVC filters 9. A 30 year old man presents with complaints of 2 days of fever, malaise,cough and green sputum production. He has no significant past medical history. He is alert with a temperature of 39.2°C, respiratory rate 28 breaths/min, blood pressure 110/70 mmHg, heart rate 105 beats/min, SpO2 on room air is 94%. White blood cell (WBC) count is 15,500/μL. Chest X ray shows consolidation in the right lower lobe. Which of the following is the most appropriate antibiotic therapy for this patient? a) Azithromycin b) Ceftriaxone c) Fluconazole d) Piperacillin/tazobactam 10. A 60 year old man, a known hypertensive, is being evaluated for 1-hour history of chest pain and dyspnea. The patient had been hospitalized 1 week ago for colectomy (of colon carcinoma). On examination, he is afebrile, the blood pressure is 110/60 mm Hg, the pulse rate is 120/min, the respiration rate is 24/min. Oxygen saturation is 88% in room which improves to 97% with 4L of O2. Breath sounds are normal. Chest X ray is normal. Which of the following tests should be done for a definitive diagnosis? a) Assay for plasma D-dimer b) CT pulmonary angiography c) Lower extremity ultrasonography d) Ventilation perfusion scan 11. All are true about aspirin sensitive asthma except? a) Nasal polyposis b) Treatment with inhaled corticosteroids c) Rhinosinusitis d) Increased prostaglandins 9 12. True statements about emphysema include all of the following except? a) Cyanosis b) Barrel shaped chest c) Associated with smoking d) Type 1 respiratory failure 13. A patient presents with sudden onset breathlessness after a subclavian vein cannulation. On examination, breath sounds are absent on left side while chest is hyper resonant on percussion on the same side. Likely diagnosis? A. Malposition of cannula B. Iatrogenic pneumothorax C. Spontaneous pneumothorax D. Pleural effusion 14. A 65 year old chronic smoker presents with complaints of Hemoptysis. His chest x ray appears to be normal. Next best investigation? A. Bronchscopy B. HRCT C. Sputum cytology D. Spirometry 15. An elderly male was admitted for pneumonia and treated with i.v antibiotics for 3 weeks. He presents 5 days after discharge from hospital with diarrhea and gripping abdominal pain. Which of the following drug is likely to benefit this patient? A. Amoxicillin B. Vancomycin C. Metronidazole D. Levofloxacin 16. Which of the following is the cardinal feature of ARDS? A. Diffuse alveolar damage B. Hypoxemia C. Surfactant deficiency D. Hypocapnia 17. Low glucose in pleural effusion is seen in all except: a) Rheumatoid arthritis b) Empyema c) Malignant pleural effusion 10 d) Dressler’s syndrome 18. Investigation of choice to distinguish between COPD with emphysema and bronchial asthma is? a) Allergy test to pollens b) Non reversible air flow obstruction c) Chest X-ray d) Arterial blood gas analysis 11 Respiratory system: Restrictive 1. A patient during evaluation has decreased vital capacity and decreased total lung volume. What is the most probable diagnosis among the following ? a) Bronchiectasis b) Interstitial lung disease c) Cystic fibrosis d) Asthma Reversible 2. In an asthmatic patient which of the following pulmonary functions would show the greater improvement on inhaling a bronchodilator - num a) Tidal volume b)FEV1 ⑧ 9-12 % c) FEF(25-75) d)FVC 3. Which one of the following distinguishes ARDS from cardiogenic pulmonary radiogen oedema ? a) Normal Pao2 o b) Normal pulmonary arterial pressure c) Normal arterial-alveolar gradient d) Normal Paco2 - 4. A 28 year female, has diarrhea, confusion, high grade fever with bilateral consolidation on x ray.The probable causative organism is 4 Pneumonia a) Legionella : Contaminated Ac (small b) Neisseria meningitidis outbreaks) c) Streptococcus pneumoniae d) H. influenzae 5. A patient develops fracture of the shaft of femur. On day 3, he develops respiratory distress and decrease SPO2 and petechiae. Probable diagnosis is? a. Hypostatic pneumonia b. Hemolytic pneumonia c. Crush syndrome d. Fat embolism 6.Mesothelioma is most commonly associated with? a. Asbestosis b. Silicosis c. Anthracosis  12 d. Coal workers pneumoconiosis MASSIVE : UNSTABLE Lactivity7. Treatment of choice in a patient of acute pulmonary embolism with right ventricular hypokinesia and compromised cardiac output is? re m a) Thrombolytic agent b) Low molecular weight heparin c) Warfarin d) IVC filters 9. A 30 year old man presents with complaints of 2 days of fever, malaise,cough and green sputum production. He has no significant past medical - - history. He is alert with a temperature of 39.2°C, respiratory rate 28 breaths/min, ~ blood pressure 110/70 mmHg, heart rate 105 beats/min, SpO2 on room air is 94%. White blood cell (WBC) count is 15,500/μL. Chest X ray shows $90/60 consolidation in the right lower lobe. Which of the following is the most appropriate antibiotic therapy for this patient? LINEUMONIA a) Azithromycin -65- = 0 b) Ceftriaxone 0 00 o c) Fluconazole d) Piperacillin/tazobactam ⑭SOPr cral antibiotics 10. A 60 year old man, a known hypertensive, is being evaluated for 1-hour history of chest - immobilization pain and dyspnea. The patient had been hospitalized 1 week ago for colectomy - (of colon carcinoma). # On examination, he is afebrile, the blood pressure is 110/60 mm Hg, the pulse Low Spoz ⑨rate is 120/min, the respiration rate is 24/min. Oxygen saturation is 88% in room which improves to 97% with 4L of O2. Breath sounds are normal. Chest X ray is normal. ↓ # Which of the following tests should be done for a definitive diagnosis? PE a) Assay for plasma D-dimer b) CT pulmonary angiography c) Lower extremity ultrasonography d) Ventilation perfusion scan ② Cox intrinsic 11. All are true about aspirin sensitive asthma except? a) Nasal polyposis trad b) Treatment with inhaled corticosteroids SAMIR's c) Rhinosinusitis d) Increased prostaglandins - ①  13 12. True statements about emphysema include all of the following except? a) Cyanosis Chronic : bunchitis b) Barrel shaped chest c) Associated with smoking d) Type 1 respiratory failure 13. A patient presents with sudden onset breathlessness after a subclavian vein cannulation. On examination, breath sounds are absent on left side while chest is hyper resonant on percussion on the same side. Likely diagnosis? A. Malposition of cannula B. Iatrogenic pneumothorax Pneumoltarax C. Spontaneous pneumothorax D. Pleural effusion 14. A 65 year old chronic smoker presents with complaints of Hemoptysis. His Initial chest A. : x ray appears to be normal. Next best investigation? Bronchscopy B. HRCT C. Sputum cytology D. Spirometry 15. An elderly male was admitted for pneumonia and treated with i.v antibiotics for 3 weeks. He presents 5 days after discharge from hospital with diarrhea and gripping abdominal pain. Which of the following drug is likely to benefit GIT this patient? disorde A. Amoxicillin B. Vancomycin Antibiotic associated C. Metronidazole PSEUDOMEMRANous colitic D. Levofloxacin Primary C. difficle 16. Which of the following is the cardinal feature of ARDS? A. Diffuse alveolar damage - B. Hypoxemia C. Surfactant deficiency D. Hypocapnia 17. Low glucose in pleural effusion is seen in all except: a) Rheumatoid arthritis /b) Empyema -ve exudate c) Malignant pleural effusion  14 d) Dressler’s syndrome 18. Investigation of choice to distinguish between COPD with emphysema and reversive bronchial asthma is? a) Allergy test to pollens b) Non reversible air flow obstruction c) Chest X-ray d) Arterial blood gas analysis 15 1. Austin Flint murmur is commonly mistaken for murmur of? a) Mitral regurgitation b) Pulmonary regurgitation c) Tricuspid stenosis d) Mitral stenosis 2. Which of the following is correct about WPW syndrome? a) Short PJ interval b) Broad QRS interval c) Tall tented T waves d) Prolonged PR interval 3. A patient presented with distended neck veins that increase on inspiration. On further examination, regular pulse is noticed which tends to disappear with deep inspiration. There is no parasternal heave or murmur. S3 heart sound is present. Likely diagnosis? a) Tricuspid stenosis b) Aortic regurgitation c) Constrictive pericarditis d) Acute exacerbation of COPD 4. Condition presenting with high pitched pansystolic murmur radiating from apex of heart to axilla with soft S1? a) Mitral stenosis b) Aortic stenosis c) Mitral regurgitation d) Aortic regurgitation 5. A patient complains of palpitations. On examination, irregularly irregular pulse is present and ECG shows absent P wave. Likely diagnosis? a) Atrial fibrillation b) PSVT c) Ventricular tachycardia d) Ventricular fibrillation 6. A patient with previous history of MI 3 years ago now presents with gradually increasing shortness of breath while climbing the stairs. On examination, S3 gallop is noted. Likely diagnosis? a) Chronic Pericarditis b) LV aneurysm c) Congestive cardiac failure d) Pulmonary embolism 7. True regarding duration of secondary prophylaxis for a 6 year old child with carditis? a) Life long b) Till the child is 18 years old c) For next 5 years d) Till the child is 25 years old 16 8. A 30 year old patient with rheumatic heart disease presents with fever for the last 2 weeks. On physical examination, the following finding is noted and the 2nd picture reveals the ophthalmoscopic finding. Which additional finding can be present in this patient? a) Ascites b) Splenomegaly c) Caput medusae d) Renal artery bruit 9. A 25 year old female has non exertional chest pain. On auscultation, she had multiple non ejection clicks. Investigation of choice? a) Serum troponin levels b) Chest x ray c) Echocardiography d) ECG 10. Comment on your diagnosis based on the ECG given: a. Hyponatremia b. Pericarditis c. Pulmonary embolism d. Hyperkalemia 11. A patient had undergone prosthetic valve replacement and he developed endocarditis 8 months later. Organism responsible commonly is? a) Staphylococcus aureus b) Streptococcus viridans c)Staphylococcus epidermidis d) HACEK 17 12. Beck’s triad include all of the following except? a) Hypotension b) Jugular vein distension c) Silent heart d) Kussmaul’s breathing 18 Severe AR - 1. Austin Flint murmur is commonly mistaken for murmur of? a) Mitral regurgitation b) Pulmonary regurgitation c) Tricuspid stenosis 8 d) Mitral stenosis - 2. Which of the following is correct about WPW syndrome? a) Short PJ interval ⑧ b) Broad QRS interval c) Tall tented T waves d) Prolonged PR interval Knosman's 3. A patient presented with distended neck veins that increase on inspiration. On further examination, regular pulse is noticed which tends to disappear with deep inspiration. There is no parasternal heave or murmur. S3 heart sound is present. Likely diagnosis? ( a) Tricuspid stenosis ? pubus b) Aortic regurgitation c) Constrictive pericarditis Paradoxe d) Acute exacerbation of COPD 4. Condition presenting with high pitched pansystolic murmur radiating from apex of heart to - axilla with soft S1? = a) Mitral stenosis (also in USD : Not b) Aortic stenosis radiating c) Mitral regurgitation- d) Aortic regurgitation 5. A patient complains of palpitations. On examination, irregularly irregular pulse is present and ECG shows absent P wave. Likely diagnosis? a) Atrial fibrillation - >f wave b) PSVT > - c) Ventricular tachycardia d) Ventricular fibrillation merged in ORS ; regular complication : CCF 6. A patient with previous history of MI 3 years ago now presents with gradually increasing - shortness of breath while climbing the stairs. On examination, S3 gallop is noted. Likely G diagnosis? + a) Chronic Pericarditis dyspnea b) LV aneurysm cardiac c) Congestive cardiac failure A d) Pulmonary embolism 7. True regarding duration of secondary prophylaxis for a 6 year old child with carditis? a) Life long b) Till the child is 18 years old c) For next 5 years next 10 yr d) Till the child is 25 years old (2) will 2542 (longer 19 8. A 30 year old patient with rheumatic heart disease presents with fever for the last 2 weeks. On physical examination, the following finding is noted and the 2nd picture reveals the ophthalmoscopic finding. Which additional finding can be present in this patient? - Fever - Rolli Spot Endocarditis #fective a) Ascites b) Splenomegaly c) Caput medusae Janeway d) Renal artery bruit ~ 9. A 25 year old female has non exertional chest pain. On auscultation, she had multiple non # ejection clicks. Investigation of choice? MVP a) Serum troponin levels b) Chest x ray c) Echocardiography d) ECG 10. Comment on your diagnosis based on the ECG given: inted a. Hyponatremia b. Pericarditis c. Pulmonary embolism d. Hyperkalemia 11. A patient had undergone prosthetic valve replacement and he developed endocarditis 8 months later. Organism responsible commonly is? a) Staphylococcus aureus b) Streptococcus viridans - Late c)Staphylococcus epidermidis d) HACEK 20 : Fendi -put un Fat 12. Beck’s triad include all of the following except? a) Hypotension - ~ b) Jugular vein distension c) Silent heart- muffed heart sound banks/Apps A : d) Kussmaul’s breathing &: Acidosis Lan ly related to topic - discussio ~s