A 38-year-old m.pdf

A 38-year-old motorcyclist was brought to the emergency room after an RTA. On examination, he was found to have raised JVP with muffled heart sounds. On inspiration, his pulse was fading and his BP was 100/85 mmHg. Select the most appropriate cause of his condition. A. Pneumothorax B. Cardiac tampon...

A 38-year-old motorcyclist was brought to the emergency room after an RTA. On examination, he was found to have raised JVP with muffled heart sounds. On inspiration, his pulse was fading and his BP was 100/85 mmHg. Select the most appropriate cause of his condition. A. Pneumothorax B. Cardiac tamponade C. Diaphragmatic rupture D. Esophageal rupture 2. A 65-year-old man presentswith bleeding per rectum dark red in colour. On examination, his BP was 90/65mmHg and pulse was 100 bpm. Upper Gl endoscopy showed no abnormality. On colonoscopy, dark red blood was revealed. Select the most appropriate next step in investigation. A. Repeat colonoscopy B. Repeat upper Gl endoscopy C. Selective CT angiography D. Redbloodcellscan 3. An anxious 20-year-old man having strong family history of colorectal CA presents with positive fecal occult blood test. Select the most appropriate investigation. A. Upper Gl endoscopy B. Colonoscopy C. Selective angiography D. Red blood cell scan 4. A79-year-old with poor cardiac history and mild renal impairment si admitted with hamatemesis and melena. Duodenal ulcer is found on endoscopy which is actively h otedtofavepassefrshmetena,Seectremostapproprateoptontortreatment. A. Total gastrectomy B. Partial gastrectomy C. Excision of Ulcer D. Oesophago-gastrectomy 5. Amiddle aged man presented with sudden abdominal cramps, vomiting, and obstipation. On examination, high-pitched peristalsiswas auscultated. Supineabdominal X-ray showed small bowel obstruction. What is the most common site for SBO? A. Duodenum B. Jejunum.C lleum D. Colon 6. Apatient present with burning epigastric pain for so long. He was diagnosed with stomach ulcer based on lab investigations. Most common site of stomach ulcer is: A. Greater curvature B. Fundus C. Antrum D. Incisure.1 What is the most common cause of infant mortality? A. Septicemia B. Low birth weight С. Birth asphyxia D. Respiratory distress Internship 2019 263 Effectiveness of an intervention for the eradication of adisease si judged best by: A. Incidence Prevalence С. Absolute risk Relative risk.9 Child after giving DPT vacine cries for 3hours and then stops. What si the most likely reason? A. Reaction to diphtheria B. Reaction to pertussis C. Haematoma formation D. Pain at injection site 10. Apregnant woman on average should gain how much weight in pregnancy? 9 kg B. 7 kg C. 12 kg D. 14kg 1. AlhtefolowingerausefultestsnihtediagnosisfoajundcieEXCEPT: B. HIDAscan C. VI cholangiogram D. Ultrasound 12. Al of the following are causes of prolonged jaundice in a neonate EXCEPT: A. Untreated UTI B. Transesophageal fistula C. Congenital hypothyroidism D. Criggler-Najjar syndrome 13. A 16 years old girl with amenorrhea. Her breast development according to Tanner stages is stage II. Her FSH and HL are slightly reduced with a prolactin of 50. What si the next best step? A. TSH B. Karyotyping C. FSHandLH D. BoneX-ray 14. Apatient with diabetes mellitus has 2+ pedal edema and significant proteinuria. Which of the following tests will predict renal function ni this patient? A. Creatinine clearance B. Serum creatinine C. Urea and electrolytes D. GFR 15. Apatient with uncomplicated diabetes mellitus. Which of the following tests would you order along with RBS in regular visits? A. Urinalysis B. HbA1c C. 24-hour urine collection for protein D. FBS 16. You will administer al of the following to a patient with hepatitis BEXCEPT: A. Lamivudine B. Tenofovir C. Steroids D. Pegylated interferon 17. In which of the following conditions, emergent referral si required? A. Cataract B. Acute angle closure glaucoma C. Diabetic retinopathy D. Chalazion 18. In recurrent diarrhea, you wil do all of the following except: A. Wash vegetables with KMNO4 solution B. Wash hands frequently C. Use boiled drinking water D. Disinfect the floor 19. Which of the following is appropriate for prophylaxis of chloroquine resistant malaria? A. Chlorquine 200mg for 1 week B. Mefloquine 250mg for 1 week C. Proguanil for 1 week D. Atovaquone for 2 weeks 20. Aperson si staying ni an Afghan refugee camp. Which of the following si the least likely to contract? A. Tuberculosis B. Malaria C. Typhoid D. Leishmaniasis 21. A45-year-old woman presents with breast lump and thickened breast skin. What is the suitable investigation? A. Mammogram B. Ultrasound C. Excisional biopsy D. FNAC 22. Administration of warfarin helps in correcting: A. Extrinsic pathway B. Intrinsic pathway C. Prothrombin time D. Fibrinogen 23. A child got measles vaccine at the age of 9 months. The vaccine quality is out of question. The child later on develops measles at the age of 1year. What is the most likely explanation? A. Malnutrition В. Maternal antibody interference.C Vaccine was given subcutaneously D. Child was too young 24. Apatient present with haematemesis, gastric lavagae done but bleeding did not stop. What is the next step in management? A. Octreotide B. Emergency EGD in ER С. Call surgeon D. H2blocker 25. Investigation of choice in staghorn calculi is: A. IVU B. CT abdomen enhanced C. CT plain D. X-ray abdomen 26. Al of the following can cause an increased anion gap except: A. Uremia B. Ethylene glycol C. TypeIRTA D. Lactic acidosis 27. Al of these drugs, following Ml, reduce mortality except: A. Aspirin B. ACE inhibitors C. Beta-blockers D. Lidocaine 28. The most likely mechanism of breathlessness on lying down is: A. Phrenic nerve stimulation B. V/Q mismatch C. Vagus nerve compression D. Lesser chest expansion 29. Asexually active woman cannot present with the following except: A. Malaria B. Dengue C. Leishmaniasis D. Pneumocystis carinii 30. In cor pulmonale, ECG shows following finding: A. Right Atrial Dilatation B. Right ventricular hypertrophy P pulmonale D. U w a v e s 31. In allergic interstitial nephritis, al of the following are true EXCEPT: A. Increased serum creatinine B. Enlarged kidneys C. Sterile pyruia D. No eosinophilia 32. An Afghani male patient presents with fever, tachycardia, and hepatosplenomegaly. What is not likely to have? A. Tuberculosis B. Brucellosis C. Leishmaniasis D. Silicosis 33. 76 years old lady complaining of severe aches and stiffness of shoulder, neck and pelvic girdle muscles for the past 3 months. She presents with increasing headaches and ESR of 90 mm/hr. Most appropriate investigation ni her case is: A. Muscle biopsy B. CT scan of brain.C Temporal artery biopsy. D. Aortic arch arteriogram 34. 2 years old medical student presents with right-sided chest pain and fever for a week. On clinical examination and CXR, a moderate pleural effusion exists. A tap shows exudative picture with protein >5 g/dl, WBC 10,000 with lymphocytic predominance and glucose of 50 g/dl. The most likely diagnosis is: A. Uncomplicated parapneumonic effusion B. Pulmonary infarction C. Tuberculosis D. Empyema 35. A 32-year-old female comes to clinic for the evaluation of shortness of breath a n d palpitations for 3 months. ECG shows A-fib. Patient reports symptoms of weight loss, tremors and anxiety. What is the most likely diagnosis? A. Hyperthyroidism B. Hypothyroidism C. Hypoparathyroidism D. Hyperparathyroidism 36. A 40-year-old lady presented to the pulmonolgy clinic with one-month history of progressive SOB, dry cough, chest fullness, and fever. Clinical examination revealed crackles in left mid-zone and CXR showed evidence of alveolo-nodular infiltrates involving the lingular segment with air bronchogrqms and pericardial effusion. She was diagnosed to have carcinoma of the breast 6 months ago, which was treated with left mastectomy followed by radiotherapy. Her present illness is most likely due to: A. Interstitial lung disease B. Atypical pneumonia C. Radiation pneumonitis D. Lobar pneumonia 37. Mechanism of action of papilledema is: A. Interruption of axonal transport B. Decreased arteriolar supply of optic disc.С Decreased venous drainage of optic disc D. Increased glial tissue at disc 38. Bronchiectasis can be reliably diagnosed by: A. CXR B. Pulmonary function tests С. High-resolution CT scan (HRCT) D. History 39. Atrial fibrillation can be caused by al of the following except: A. Thyrotoxicosis B. Hypertension C. Aortic stenosis D. Ischemic Heart Disease 40. Alcohol intoxication to the liver includes al of the following except: A. Fatty liver Granulomatous hepatitis Cirrhosis D. Hepatocellular carcinoma 41. High anion gap metabolic acidosis si not caused by: A. Lactic acidosis B. Diabetic ketoacidosis C. Diarrhea D. Ethylene glyco! 42. Al of the following features can be found ni sepsis except: A. Multi-organ dysfunction B. Coagulopathy C. Peripheral vasoconstriction D. ARDS 43. Following durgs cannot help ni achieving pain relief post-operatively: A. Morphine and pethidine B. Paracetamol C. Paracetamol and piroxicam D. Codeine 44. After 2 hours of admission, the patient's heart rate drops to 30 bpm due to hypoxia in the territory of: A. LAD B. LCX C. Left internal mammary artery D. Righr coronary artery 45. Female with swollen DIP, PIP joints and both knees with chondrocalcinosis. She has diabetes mellitus as revealed on biochemical labs. What si the most liekly diagnosis? A. Osteoarthritis B. Rheumatoid arthritis C. Hemochromatosis D. Pseudogout 46. A23-year-old female presents with photosensitivity, seizures and headache with a p a s t history of pleuritic chest pain and joint pains. What si the gold standard investigation? A. ANA B. Antids-DNA C. Anti-CCP D. ESR 47. Afemale with facial rash, discoid lesions, proteinuria, and edema for 3months. What is the best screening tool? A. ANA B. Anti ds-DNA C. Anti-CCP D. ESR 48. Ahypertensive female with hypokalemia and normal sodium si on medications for HTN. What is the investigation of choice? A. Serum renin levels after 20mg furosemide B. Serum renin levels C. Saline infusion and aldosterone levels D. Serum electrolytes 49. Apregnant woman delivered her first child via SVD with no complications. She presents with dyspnea post-partum. On examination, she has bilateral rhonchi in mid-chest with a grade 3holosystolic murmur. The most likely diagnosis is: A. Mitral regurgitation B. Mitral stenosis C. CHF D. Cardiomyopathy 50. A32-year-old female comes to the clinic for the evaluation of SOB and palpitations for 3 months. ECG shows atrial fibrillation. She has a positive history of weight loss, tremors, and anxiety. What si the most likely diagnosis? A. Hypothyroidism B. Hyperthyroidism C. Hypercalcemia D. Diabetes mellitus 51. A patient comes with pain on eye movement with rapid central visual change, numbness, tingling, leg weakness, and ataxia. Her symptoms worsen on taking a h o t bath. She was diagnosed having multiple sclerosis. What is the best treatment option? A. Amoxicillin B. Clarithromycin C. Interferon 1beta D. Chlorambucil - 52. A25-year-old male with no known comorbids presents to ER after trauma with sharp right-sided chest pain and decreased breath sounds on right side. What is the likely diagnosis? A. Cardiac tamponade B. Aortic dissection C. Tension pneumothorax D. Pleural effusion §3. Which of the folowing si one of hte actions of insulin? A. Inhibits glycolysis Increases glycolysis Inhibits glucose uptake in skeletal muscles D. Increases proteolysis.4 A60-year-old farmer presents with progressive dyspnoea. CXR shows bilateral nodular infiltrates. What is the most likely diagnosis? A. Cryptogenic fibrosing alveolitis В. Pneumonia C. ILD D. CHF.5 A female delivered her baby few days back and presents with signs an symptoms of hypopituitarism. She was diagnosed having Sheehan's syndrome. The lesion is likely to have in: A. Thalamus B. Hypothalamus C. Pituitary gland D. Cerebrum.6 A female with Rheumatoid arthritis does not respond to ibuprofen. What is the best treatment option? A. Increase the dose of ibuprofen B. Intra-articular steroids C.Methotrexate D. Change NSAID 7. A patient with enteric fever did not respond to ampicillin. What is the next best step? A. Increase the dose B. Add septran DS C. Add folate antagonist D. Send blood sample for culture.3 Important lab finding ni diabetes insipidus is: A. Serumpotassium B. Low urine osmolality C. Low serum osmolality D. High serum calcium.%A patient with swollen painful joint has >50,000 WBCs, >75% neutrophils, blood culture positive in joint aspirate. It also reveals opaque fluid. The treatment of choice is: A. Rest and immobilize joint B. IV antibiotics for 2 weeks C. Oral antibiotics D. Joint drainage. A child comes with perforated ear drum with discharge. Next step is: A. Irrigation B. Normal saline C. D. Topical antibiotics and mopping Mopping only 61. Apatient on prednisolone si predisposed to develop: A. Erosive gastritis B. Gastric ulcer C. Atrophic gastritis D. Gastric CA 62. Most common cause of death in SLE is: A. Renal failure Photosensitivity C. Infections D. Arthritis Answers key 1-B 2-C 3-B 4-C 5-C 6-D 7-B 11-D 12-B 13-A 14-A 15-B 16-C 17-B 21-A 22-A 23-A 24-B 25-B 26-C 27-D 31-D 32-A 33-C 34-C  35-A 36-C 37-A 41-C 42-C 43-A 44-D 45-D 46-B 47-A 51-C 52-C 53-B 54-A 55-C 56-C 57-D 61-B 62-C 10-C 8-A 9-D 20-D 18-A 19-B 28-B 29-D 30-B 38-C 39-C 40-B 48-B 49-A 50-B 58-B 59-B 60-C