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Mock2 explained by Dr. Khalid SaifullahMock-2. 1. A 38-year-old man with type1 diabetes has been vomiting for 8 hours. He is clinically dehydrated with a blood pressure of 90/60 mmHg. His capillary blood glucose is 18.5mmol/l. What is the single most relevant initial investigation?A.Arterial blood gasesB.Full blood countC.Hemoglobin A/CD.Liver function testsE.Serum urea concentrationAns. The key is A. Arterial blood gases. [Dx is diabetic keto-acidosis. Initial investigation is arterial blood gases which will demonstrate acidosis].Mock-2. 2. A 25-year-old woman has been told that her cervical smear shows mild dyscariosis (CIN 1). She wants to know what she can do to reduce the risk of cervical cancer. She takes the oral contraceptive pill, smokes 20 cigarettes a day and drinks an average of 10 units of alcohol per week. She is slightly overweight but is normotensive. What is the single most important advice to give this woman?A.Avoid tampon useB.Discontinue the oral contraceptive pillC.Lose weightD. Reduce alcohol intakeE.Stop smokingAns. The key is E. Stop smoking. [Smoking: A woman who smokes doubles her risk of cervical cancer].Mock-2. 3. A 62-year-old man who was admitted for minor surgery 3 days ago suddenly becomes confused. His attention span is reduced. He is restless and physically aggressive and picks at his bed sheets. What single aspect of the patient’s history received in his note is most likely to aid in making a diagnosis?Alcohol consumptionHead traumaHistory of anxietyPrescribed medicationObvious cognitive impairmentAns. The key is A. Alcohol consumption. [Dx delirium tremens. As the patientis hospitalized he couldn’t take alcohol for last three days and developed alcohol withdrawal syndrome as delirium tremens. DTs is the most severe manifestation of alcohol withdrawal. It occurs 3-10 days following the last drink. Clinical manifestations include agitation, global confusion, disorientation, hallucinations, fever, hypertension, diaphoresis, and autonomic hyperactivity (tachycardia and hypertension)].Mock-2. 4. A 5-year-old girl who suffered from extensive burns has returned to the general ward after 2 weeks in the intensive care unit (ICU). She has a large hematemesis. Full blood count and coagulation screen are normal.Coagulation screeningComputed tomography scan (CT scan)Barium study of upper GI tractDiscriminate between fetal and maternal blood cells (APT test)EndoscopyAns. The key is C. Barium study of upper GI tract. [In curling ulcer barium study is preferred as endoscopy has risk to cause perforation].Mock-2. 5. A 7-year-old boy has coffee ground vomit and previous unexplained nose bleeds. He is systemically well with no abdominal tenderness. His full blood count is normal. Full blood countCoagulation screen/clotting screenLiver function testsUltrasound scan of abdomenX-ray of abdomenAns. The key is B. Coagulation screen/clotting screen. [Unexplained bleeding tendency in a boy is likely due to bleeding disorder].Mock-2. 6. A 2-week-old boy born with cesarean section because of placental abruption vomits altered blood. He is well hydrated and systemically well.Coagulation screeningComputed tomography scan (CT scan)Barium study of upper GI tractDiscriminate between fetal and maternal blood cells (APT test)EndoscopyAns. The key is D. Discriminate between fetal and maternal blood cells (APT test). [The alkali denaturation test, also known as Apt–Downey test or Apt test, is a medical test used to differentiate fetal or neonatal blood from maternal blood found in a newborn's stool or vomitus].Mock-2. 7. A 4-week-old boy born at home has blood stained vomiting for the first time. He is breast fed and his stools are dark. He is jaundiced and there is blood oozing from his umbilical cord. Full blood countClotting screenLiver function testsUltrasound of the abdomenX-ray of the abdomenAns. The key is B. Clotting screen. [Clotting disorder causing internal bleeding is associated with jaundice and the baby should be screened for clotting disorder]. Mock-2. 8. A 1-year-old boy has had intermittent vomiting since 3 months of age. He is thriving and his vomit occasionally contains blood.Coagulation screeningComputed tomography scanBarium study of upper GI tractDiscriminate between fetal and maternal blood cells (APT test)EndoscopyAns. The key is E. Endoscopy. [Probable pyloric stenosis and there may be erosion as well]. Mock-2. 9. A 30-year-old woman has a painless lump in the outer aspect of her breast. She has had a previous breast lump. Her grandmother had breast cancer at 70 years of age. She has a 1cmX1cm smooth firm discrete mobile lump in the outer quadrant region of her left breast. What is the single most likely diagnosis?Breast abscessBreast carcinomaBreast cystFibroadenomaSebaceous cystAns. The key is D. Fibroadenma. Mock-2. 10. A 38-year-old woman in her 1st pregnancy at 16 weeks gestation is very anxious about the possibility of chromosomal abnormalities in her baby. What is the single best test to give a definitive diagnosis?AmniocentasisChorionic villous samplingMaternal alpha fetoproteinNuchal fold thicknessParental karyotypeAns. The key is A. Amniocentasis. [Amniocentesis is a medical procedure used in prenatal diagnosis of chromosomal abnormalities and fetal infections, and also for sex determination, in which a small amount of amniotic fluid, which contains fetal tissues, is sampled from the amniotic sac surrounding a developing fetus, and then the fetal DNA is examined for genetic abnormalities. The most common reason to have an "amnio" is to determine whether a baby has certain genetic disorders or a chromosomal abnormality, such as Down syndrome. Amniocentesis is performed when a woman is between 14 and 16 weeks gestation. Chorionic villous sampling is usually done at 10 to 13 weeks of gestation]. Mock-2. 11. A 1-year-old boy has been brought to the emergency department with diarrhea and vomiting for 5 days. For the past 24 hours he has been unable to tolerate any fluids. In the last hour he has become drowsy his skin turgor is reduced and his skin is mottled. His eyes are sunken. His heart rate is 180beats/minute and his capillary refill is prolonged. What is the single most appropriate immediate treatment?IV fluid bolus over 20 minutesIV fluid over 24 hoursIV rehydration over 48 hoursNasogastric rehydration over 24 hoursOral rehydration solution over 48 hoursAns. The key is A. IV fluid bolus over 20 minutes. [Severe dehydration, immediate management is bolus IV fluid]. Mock-2. 12. A 25-year-old woman has developed lassitude, breathlessness, purulent sputum and palpitations over a 24 hour period. She has a pulse rate of 88beats/minute. Her electrocardiogram show sinus rhythm. Cardiac enzymesChest X-rayEchocardiogramPlasma glucose concentrationSerum urea and electrolytes concentrationAns. The key is B. [Dx RTI; Chest X-ray should be done]. Mock-2. 13. A 44-year-old woman has lost weight over 12 months. She has also had episodes where her heart beats rapidly and strongly. Her family has noticed that she loses her temper easily. She has a regular pulse rate of 90 beats/minute. Her ECG shows sinus rhythm.Thyroid autoantibodiesThyroid function tests24 hour ambulatory taped electrocardiogram (ECG)Cardiac enzymesChest X-rayAns. The key is B. Thyroid function tests. [Weight loss, palpitations, irritability these are features of hyperthyroidism. So we should go for thyroid function test to demonstrate hyperthyroidism]. Mock-2. 14. A 61 year-old-man has been referred to the outpatients department with frequent episodes of breathlessness and chest pain associated with an irregular heartbeat. He has a regular pulse rate of 60beats/minute. His ECG shows sinus rhythm. Cardiac enzymesElectrocardiogramEchocardiogram24 hour ambulatory taped electrocardiogramSerum urea and electrolytes concentrationAns. The key is D. 24 hour ambulatory taped electrocardiogram. [Possibility of paroxysmal atrial fibrillation where pulse is quiet normal in between attacks. So to demonstrate arrhythmia 24 hour ambulatory taped electrocardiogram should be done]. Mock-2. 15. A 56-year-old woman has woken up 5 times in the last month with a feeling of thumping in her chest. On sitting up for about 2 minutes and taking a few deep breaths, the sensation subsides over a further minute. Her ECG shows sinus rhythm. Cardiac enzymesElectrocardiogram Echocardiogram24 hour ambulatory taped electrocardiogramSerum urea and electrolytes concentrationAns. The key is C. Echocardiogram. [This is orthopnea of heart failure and arrhythmia related to heart failure or overload from venous pooling can cause palpitation or even thumping in chest. As it occurs in night most likely it is orthopnea not due to other aeitiology!! To check the cardiac functional status we should do echocardiography]. Mock-2. 16. An 80-year-old woman has malignant ulcer under 1 cm in diameter on the anterolateral aspect of the left labium major 3cm from the midline. A biopsy shows penetration of the tumour to 1.5mm. What is the most likely site for the lymph node metastasis?Deep inguinal nodesIlieocolic nodesIliac nodesPara-aortic nodesSuperficial inguinal nodes.Ans. The key is E. Superficial inguinal nodes. XMock-2. 17. A 32-year-old woman has had a febrile illness and swelling of the small joints of her hands, feet, wrists and knees for 2 days. She has a maculopapular rash and a few palpable cervical lymph nodes. She was previously well. There is no history of relevant travel overseas. She has 2 young children. What is the most likely diagnosis?PsoriasisReactive arthritisSarcoidosisSystemic Lupus ErythematosisViral arthritisAns. The key is E. Viral arthritis. This is wrong key. Correct key is B. Reactive arthritis. [This is a GMC sample question and GMC given key is B. Reactive arthritis]. XMock-2. 18. A 34-year-old man with multiple sclerosis has taken an overdose of 100 tablets of paracetamol with intent to end his life. He has been brought to the emergency department but is refusing all interventions. What is the single most appropriate next step in the management?Assessment of suicide intentCommence treatment with consentEstablish if patient has a history of mental illnessEvaluate patient’s capacity to refuse treatmentEvaluate the severity of depressionAns. The key is D. Evaluate patient’s capacity to refuse treatment. XMock-2. 19. A 56-year-old man who has been admitted following his first seizure denies a history of weight loss and hemoptysis. Computed tomography scan of the brainEchocardiogramElectrocardiogramElectroencephalogramLiver function testsAns. The key is A. Computed tomography scan of the brain. [1st seizure is not considered as epilepsy so we should not go for EEG for this case and to exclude brain lesion as a cause we can do CT brain]. XMock-2. 20. A 3-year-old boy has 3 episodes of limb jerking. His teacher has noticed that at times he does not concentrate in class. Computed tomography scan of the brainEchocardiogramElectrocardiogramElectroencephalogramLiver function testsAns. The key is D. Electroencephalogram. [Patient has more than 1 episodes of limb jerking which brings epilepsy as a possible cause and hence we shall do D. Electroencephalogram in this patient]. XMock-2. 21. A 45-year-old man travelling alone has been admitted from the airport to the emergency department. He is conscious following a seizure. There are needles and a syringe in his hand luggage. Lumber punctureMidstream urine (MSU) for microscopy, culture and sensitivityPlasma glucose concentrationSerum electrolyte concentration Skull X-rayAns. The key is C. Plasma glucose concentration. [Probable hypoglycemia]. XMock-2. 22. A 50-year-old woman has developed jerking in her left hand, which spread to the rest of her body. A few minutes later, she has a generalized seizure with loss of puted tomography (CT) scan of the brainEchocardiogramElectrocardiogramElectroencephalogramLiver function testsAns. The key is D. Electroencephalogram. [dx partial generalized seizure]. XMock-2. 23. A 46-year-old woman with type 2 diabetes has proteinuria +++, creatinine concentration of 250mmol/l and a serum hemoglobin (Hb) concentration of 16g/ UL. She has a mild ankle oedema and a blood pressure of 145/100mmHg. Her abdominal ultrasound examination shows normal sized kidneys. Urine culture is normal. What is the single most appropriate drug to include in her long-term management?Angiotensin converting enzyme (ACE) inhibitorBeta blockerCalcium channel blockerLoop diureticPotassium spearing diureticAns. The key is C. Calcium channel blocker. This is wrong key. Correct key is D. Loop diuretic. [GP can not prescribe ACEI if serum creatinine is 250mmol/l or high. Ankle oedema may indicate cardiac failure where CCB is contraindicated and even in simple oedema CCB is advised not to give as it worsens oedema. In renal impairment potassium tends to be high hence potassium sparing diuretics is not given. In diabetes beta-blockers can mask the features of hypoglycemia and advised not to prescribe. So only option than remains without any significant restriction is D. Loop diuretic]. XMock-2. 24. A 35-year-old man has had acute pain and swelling below the mandible on the left side for 6 hours. The swelling occurred after eating a large meal. What is the most likely diagnosis?LaryngoceleMumpsNeck abscessParotid abscessSubmandibular calculus Ans. The key is E. Submandibular calculus. [Calculus in duct of submandibular salivary gland causes blockage and retention of saliva in the gland causing raised pressure particularly in case of heavy meals leading to swelling in the gland and pain]. XMock-2. 25. A 40-year-old man presents with jaundice. He became ill with a headache and myalgia 5 days after a fishing trip. He has now noticed red spots on his skin. His wife says his eyes have been red before they turned yellow. What is the most useful diagnostic test?Blood and urine cultureConjugated/unconjugated bilirubinCytomegalovirus serologyHepatitis B serologyPaul-Bunnel test.Ans. The key is E. Paul-Bunnel test. It is a wrong key! Correct key is A. Blood and urine culture. [Likely dx is Weil’s disease and we have to do blood and urine culture to confirm the diagnosis of Weil’s disease]. XMock-2. 26. A 30-year-old woman presents for the first time with a history of heavy menstrual loss lasting 4 days and associated with flooding and passage of clots. What is the initial treatment?Combined oral contraceptiveTranexamic acidGonadotropin releasing hormone (GnRH) analoguesLevonogestrel releasing intrauterine systemMefenamic acidAns. The key is B. Tranexamic acid. [For menorrhagia if there is no contraceptive issue 1st line drug is tranexamic acid (NICE)].Mock-2. 27. A 29-year-old woman is very concerned because she has had very light and infrequent periods for 6 months. Her body mass index (BMI) 35kg/msq. She has a raised serum luteinizing hormone (LH) concentration. What is the initial treatment?NorethisteroneProgesterone suppositoriesTranexamic acidDanazolCombined oral contraceptive pillAns. The key is E. Combined oral contraceptive pill. [The Dx is PCOS. The?contraceptive pill?may be recommended to induce regular periods, or periods may be induced using an?intermittent course of progestogen tablets (which are usually given every three to four months, but can be given monthly)].Mock-2. 28. A 12-year-old girl has primary dysmenorrhea, which prevents her from attending school during her period. Combined oral contraceptiveDanazolGonadotropin releasing hormone (GnRH) analoguesLevonogestrel releasing intrauterine systemMefenamic acidAns. The key is E. Mefenamic acid. Mock-2. 29. A 55-year-old man has weight loss, dyspnea and syncope. He smokes 30 cigarettes a day. He is thin and breathless at rest. His blood pressure on standing is 110/60mmHg and on lying is 140/80mmHg. What is the most appropriate initial investigation in establishing a diagnosis? Chest X-rayEchocardiogramElectrocardiogram (ECG)Pulmonary function tests24 hours taped ECGAns. The key is A. Chest X-ray. [Dx lung cancer. Autonomic neuropathy often presents as orthostatic hypotension. Heavy smoking, personal or family history of cancer can help suggest a link between autonomic symptoms and an underlying malignancy].Mock-2. 30. A 19-year-old man has had fever, neck pain and generalized rash for 12 hours. He is not on any medication. He has a temperature of 39.5 C. He has limitation of neck flexion and no lymphadenopathy. The rash is sparse and mainly on the trunk and looks slightly hemorrhagic and non-blanching on pressure. What is the most likely diagnosis?Henoch-Schonlein purpuraMeaslesIdiopathic thrombocytopenic purpura (ITP)MeningitisChickenpoxAns. The key is D. Meningitis. Mock-2. 31. A 20-year-old woman has nausea, vomiting, fainting and weight loss. She is hypotensive. Investigation results show the following: Sodium129mmol/lPotassium5.2mmol/lUrea12mmol/lGlucose4mmol/lWhat is the most appropriate management?DialysisFluid restrictionInsulin onlyIV 5% glucoseIV normal saline and hydrocortisoneAns. The key is E. IV normal saline and hydrocortisone. [Dx is adrenal insufficiency. So treatment is with IV normal saline and hydrocortisone]. XMock-2. 32. A 6-year-old boy has thirst, weight loss and urinary frequency for a few weeks. Investigation results show:Sodium 148mmol/lPotassium 5.1mmol/lUrea14mmol/lGlucose30mmol/lWhat is the single most appropriate management?IV normal saline and insulinIV normal saline and potassium supplementPlasma expandersDialysisOral potassium chlorideAns. The key is A. IV normal saline and insulin. XMock-2. 33. A 20-year-old man received multiple fractures and crush injuries in motor vehicle collision. 4 days later he has anuria with pulmonary oedema.Investigation results show:Sodium 150mmol/lPotassium 7.2mmol/lUrea 60mmol/lGlucose4.2mmol/lWhat is the single most appropriate management?DialysisFluid restrictionPlasma expandersIV 5% glucoseIV normal saline and hydrocortisoneAns. The key is A. Dialysis. [Dx rhabdomyolysis. As renal shutdown and pulmonary oedema fluid shouldn’t be given. Most appropriate management is dialysis]. XMock-2. 34. A 50-year-old man has been admitted for investigations for breathlessness and weight loss. He has been taking thiazide diuretic for hypertension for 2 years. His blood pressure is 160/100 mmHg and investigation results show:Sodium138 mmol/lPotussium 2.9 mmol/lUrea 5.8 mmol/lGlucose 5.7 mmol/lWhat is the single most appropriate management? IV normal saline and insulinIV normal saline and potassium supplementPlasma expandersDialysisOral potassium chlorideAns. The key is E. Oral potassium chloride. [IV potassium is indicated if potassium levels goes below 2.5 mmol/l. As the given potassium level is 2.9 mmol/l, oral potassium chloride should be given]. XMock-2. 35. An 8-year-old boy has had profuse diarrhea and vomiting due to infective gastroenteritis for 2 days. Investigation results show the following:Sodium 148 mmol/lPotussium 2.2 mmol/lUrea 20 mmol/lGlucose 4.3 mmol/lWhat is the single most appropriate management?IV normal saline and insulinIV normal saline and potassium supplementPlasma expandersDialysisOral potassium chlorideAns. The key is B. IV normal saline and potassium supplement. [As serum potassium level is 2.2 mmol/l IV potassium supplement is indicated]. XMock-2. 36. An 82-year-old man has woken up with incoherent speech. Examination is otherwise normal and his comprehension is good. Where is the lesion located?Broca’s area (frontal cortex)Facial nerveGlossopharyngeal nerveHypoglossal nerveInternal capsuleAns. The key is A. Broca’s area (frontal cortex). [The main characteristic of Broca’s aphasia is that the person is not able to express himself in a fluid way or form complete and articulate sentences, meanwhile, the comprehension is relatively preserved]. XMock-2. 37. An 18-year-old man with type1 diabetes mellitus has been vomiting for the past 8 hours. He is clinically dehydrated with a blood pressure of 90/60 mmHg. His capillary blood glucose is 18.5 mmol/l. What is the single most relevant initial investigation?Arterial blood gasFull blood countLiver function testsHaemoglobinSerum urea concentrationAns. The key is A. Arterial blood gases. [Probable diagnosis is Diabetic ketoacidosis and arterial blood gas will show typical manifestations of metabolic acidosis, low bicarbonate, and low pH (less than 7.3)]. XMock-2. 38. A 52-year-old man who had horseness of voice following thyroid surgery 1 week ago shows no improvement. What is the single most likely diagnosis? Recurrent laryngeal nerve siteHypoglossal nerveBrocha’s aphasiaLaryngitisCerebellumAns. The key is A. Recurrent laryngeal nerve. [During thyroid surgery injury to recurrent laryngeal nerve can lead to horseness of voice]. XMock-2. 39. A 23-year-old man is having difficulty to speak following a stab wound to the right of his neck. On being asked to protrude his tongue, it is deviating to the right. What is the single most important diagnosis? Glossopharyngeal nerveFacial nerveRecurrent pharyngeal nerve Hypoglossal nervePhrenic nerveAns. The key is D. Hypoglossal nerve. [If the damage is to the nerve itself (a lower motor neuron lesion), the tongue will curve toward the damaged side, owing to weakness of the genioglossus muscle of affected side as in given case]. XMock-2. 40. A 62-year-old man has recently had a flue like illness and woke up to find his speech altered. Movement of his eyelids and lips are weak on the right. Examination is otherwise normal. What is the single most likely anatomical site?Internal capsuleFacial nerveThalamusSpinal cord root accessory nerveWernicke’s areaAns. The key is B. Facial nerve. [Viral infection causes facial nerve palsy. Here flue like illness is the source of viral infection to facial nerve]. XMock-2. 41. A 69-year-old woman has had stroke. Her left upper and lower limbs are paralyzed and she is having difficulty speaking. What is the single most likely diagnosis?ThalamusWernicke’s areaInternal capsuleFacial nerveBroca’s areaAns. The key is C. Internal capsule. [Probable lesion is in posterior limb of internal capsule as it causes contralateral hemiparesis or hemiplegia]. XMock-2. 42. A 47-year-old man has a temperature of 39.1 C with delirium. He has developed blisters mainly on his trunk, which appeared a few hours ago. He is well and not on any medication. He travelled 5 months ago to Italy. What is the single most likely diagnosis?Acute pemphigoidAcute viral hemorrhagic feverChicken pox Lyme diseaseShinglesAns. The key is C. Chickenpox. [In elderly encephalitis is commoner in varicella virus infection and the centripetal distribution of the blisters points towards chickenpox. This man with chickenpox has delirium probably due to encephalitis. The travel history is a distractor here]. XMock-2. 43. A 19-year-old man has exercise induced asthma. This has previously been controlled by using a salbutamol inhaler as required but now he gets attacks with exercise. What is the single most appropriate management?Regular salbutamolRegular salbutamol and budesonideSodium cromoglycateOral steroidInhaled steroidAns. The key is C. Sodium cromoglycate. This is a wrong key! Correct key is E. Inhaled steroid. [If exercised induced asthma is not controlled by inhaled salbutamol, then inhaled steroid should be added].XMock-2. 44. A 32-year-old man previously healthy and fit has developed pain and swelling of both knees and ankles with nodular rash over his shins. As part of investigation, a chest x-ray has been performed. What is the single most likely chest x-ray appearance? Apical granulomaBilateral hilar lymphadenopathyLobar consolidationPleural effusionReticular shadow in the basesAns. The key is B. Bilateral hilar lymphadenopathy. [Presented patient is a case of sarcoidosis]. XMock-2. 45. A 35-year-old woman Has had bruises and petechiae for 1 week. She has also had recent menorrhagia but is otherwise normal. Full blood count shows Hb 11.1, WBC 6.3, Platelets 14. What is the single most likely diagnosis?Acute leukemiaAplastic anemiaHIVIdiopathic thrombocytopenic purpuraSLEAns. The key is D. Idiopathic thrombocytopenic purpura. [Petechiae are suggestive of platelet disorder. Here only platelet count is low which supports the diagnosis of ITP. Coagulation profile will show prolonged BT]. XMock-2. 46. A 4-week-old boy has been diagnosed as having breast milk jaundice. What is the most appropriate management?Continue breast feedingExchange transfusionIncrease fluid intakeStop breast feedingPhototherapyAns. The key is A. Continue breast feeding. [Breast milk jaundice is self limiting and mother is advised to continue breast feeding. Rarely is the interruption of breastfeeding an effective treatment for jaundice in a breastfed baby. If a baby's bilirubin levels reach 20 milligrams or above, a recommendation to cease breastfeeding for 24 hours may be used in conjunction with phototherapy. This can usually drop bilirubin levels dramatically]. XMock-2. 47. A 19-year-old woman has had progressive bilateral iliac fossa pain and dyspareunia for 3 days. She has offensive vaginal discharge and feels unwell and feverish. The temperature is 39C. What is the single most appropriate initial investigation?C-reactive proteinEndocervical swabESRFull blood countHigh vaginal swabAns. The key is B. Endocervical swab. [PID is frequently caused by Chlamydia. To test gonorrhea or Chamydia endocervical swab is to be taken. Given case is a probable case of PID]. XMock-2. 48. A 58-year-old woman has breast cancer and has been vomiting for the past 2 days. She has abdominal pain and is disoriented in time and place. She is afebrile. She is on prochloperazine only. Urinalysis is normal. What is the single most likely cause of her symptoms?Acute intestinal obstructionHypercalcemiaHyperglycemiaLiver failureHepatitisAns. The key is B. Hypercalcemia. [(Abdominal pain, nausea, vomiting)=Grones, Still she has no stones (urinalysis normal) and no Bone pain. Psychiatric overtone (not obvious here, only disorientation). We know solid tumours can lead to hypercalcemia and Breast cancer is reason for this hypercalcemia. Pnemonic for hypercalcemia, Stones (renal or biliary), Bones (bone pain), Grones (abdominal pain, nausea and vomiting), Thrones (polyuria), Psychiatric overtones (depression, anxiety, cognitive dysfunction, insomnia, coma). Some or all of these features may present]. XMock-2. 49. A 6-week-old baby girl is found to have a high fever and has white blood cells in a suprapubic aspirate of urine, culture of which has shown pure growth of E. Coli. What is the single most appropriate initial investigation?Intravenous urogramMicturating cystogramNo investigation requiredNuclear medicine renogramUltrasound scan of kidnyesAns. The key is E. Ultrasound scan of kidneys. [This is severe illness (high fever + bacteriurea) and in such case if baby is less than 3 months of age Ultrasound scan is indicated. Ref: ]. XMock-2. 50. A 72 year old white man has a lump on the left side of his nose. It has grown gradually over several months and now is a firm pearly white nodule with a central depression 0.8 cm in diameter. What is the single most likely diagnosis? Basal cell carcinomaIntradermal naevusMalignant melanomaMolluscum contagiosumSquamous cell carcinomaAns. The key is A. Basal cell carcinoma. XMock-2. 51. A 50-year-old man who has been stung by bees many times but the last time he was stung he developed large itchy swelling that lasted up to 72 hours. He now feels well in himself and has no other symptoms. What is the single most appropriate advise?Carry subcutaneous adrenalineTake NSAIDs after bee stingTake steroid after bee stingTake regular anti-histamine tabletsUse antihistamine cream after bee stingAns. The key is E. Use antihistamine cream after bee sting. XMock-2. 52. A 64-year-old man has been brought to the A&E department after being found wandering in the park unsteadily. He is confused and ataxic, has dry mucous membrane and bilateral ophthalmoplegia. He has a history of long acting alcohol abuse. He has a blood pressure of 115/65 mmHg, PR 64 beats/minute, temperature of 36.8C and a capillary blood glucose of 3.5mmol/l. What is the most urgent treatment?Bolus of 50% glucose solutionBolus of lorazepamBolus thiamineInfusion of 0.9% salineInfusion of 5% dextrose solutionAns. The key is C. Bolus thiamine. [The Dx is Wernicke’s encephalopathy which occurs due to alcohol related or other causes of thiamine deficiency. Treatment is with thiamine replacement]. XMock-2. 53. A 35 –year-old man has fallen 10 meters from a ladder and has been brought to the emergency department. He is drowsy and has a swelling on the right parietal area. His GCS score is initially 13 but falls to 9 within an hour. What is the single most appropriate initial step?CT scan of the headIV mannitolMRI scan of the brainSkull X-rayObservationAns. The key is A. CT scan of the head. [Likely diagnosis is extradural hematoma and initial step is A. CT scan of the head]. XMock-2. 54. A 59-year-old man has been admitted for the right hemicolectomy for the carcinoma of the ceacum. 6 months prior to admission he developed a deep venous thrombosis in the left leg. This was complicated by pulmonary embolism and he has been on warfarine since then. What is the single most appropriate pre-operative management?Reduce warfarineIncrease warfarineReplace warfarine with heparineStop warfarineAns. The key is C. Replace warfarine with heparin. XMock-2. 55. A 65-year-old man who smokes has a long-standing history of breathlessness on exertion and productive cough. He has increasing breathlessness, wheeze and fever for 3 days. Arterial blood gas shows; PO2 7.0, PaCO2 6.5, pH 7.3. What is the single most appropriate initial management for this respiratory failure?AminophyllineInvasive ventilationNon-invasive ventilation24% oxygen60% oxygenAns. The key is D. 24% oxygen. This is wrong key! Correct key is C. Non-invasive ventilation. [NIV should be considered in all patients with an acute exacerbation of COPD in whom a respiratory acidosis (PaCO2>6kPa, pH <7.35 ≥7.26) persists despite immediate maximum standard medical treatment on controlled oxygen therapy for no more than one hour]. XMock-2. 56. A 28-year-old Caribbean man has pain and redness over his shin over the anterior surface of his leg. He smokes cigarettes and recently suffered red eyes. Chest x-ray shows enlarged mediastinal lymph nodes and clear fields. What is the most likely diagnosis?PemphigoidPemphigusErythema nodosumRashScabiesAns. The key is C. Erythema nodosum. [This is a case of sarcoidosis and red eye is due to uveitis (the most common ocular manifestation) is one of the extrapulmonary manifestation of sarcoidosis and uveitis is particularly more common in African Americans. Redness over shin is erythema nodosum]. XMock-2. 57. A healthy 2-year-old is brought to A&E with a cut to his hand while playing in the garden. He has a 2 cm clean laceration. He is not received any routine immunization as his parents are concerned about possible side effects. There are no contraindications to immunizations. What is the single most appropriate follow up investigation?Course of diphtheria, pertussis and tetanus vaccineCourse of diphtheria and tetanus Single injection of diphtheria, pertussis and tetanus Single injection of diphtheria and tetanus Single injection of tetanus immunoglobulinAns. The key is A. Course of diphtheria, pertussis and tetanus vaccine. [As the wound is clean immunoglobulin is not necessary]. XMock-2. 58. A 67-year-old man has deteriorating vision in his left eyes. He has long standing chronic obstructive disease and is on multiple drug therapy. What is the single most likely medication responsible?Beta agonistCorticosteroidsDiureticOxygenTheophyllineAns. The key is B. Corticosteroids. [Corticosteroids both systemic and inhaled preparation are known to cause cataract in prolonged use. This is a case of COPD with probable use of corticosteroids]. XMock-2. 59. A 25-year-old woman has had blurred vision, intermittent persthesia and clumsiness of her left arm for the passed three months. The reflexes are brisk in her arm and her optic discs are pale. The single most useful test to confirm the diagnosis?Cerebrospinal fluidEEGElectromyogram (EMG)MRI of the brainVisual evoked responsesAns. The key is D. MRI of the brain. [Given case is a case of Multiple sclerosis. Diagnosis is confirmed by T2 weighted MRI scan of the brain]. XMock-2. 60. An 83-year-old woman who is a resident in a nursing home is admitted to hospital with a 4 day history of diarrhea. She has had no weight loss or change in bowel or appetite. She has been on analgesics for the past 3 weeks for her back pain. She is on obvious discomfort. On rectal examination, she is found to have feacal impaction. What is the single most appropriate management?Codeine phosphate for the painHigh fiber dietOral laxativesPhosphate enemaUrinary catheterizationAns. The key is D. Phosphate enema. [Phosphate enema (currently available as Fleet enema) is widely used to evacuate bowel in feacal impaction]. XMock-2. 61. A 65-year-old man has a productive cough and fever. He has influenza and his temperature is 38.5C. There is reduced air entry and crepitations bilaterally. What is the single most appropriate cause of the pneumonia?Haemophilus influenzaKlebsiellaMycoplasmaStaphylococcus aureusStreptococcus pneumoniaAns. The key is D. Staphylococcus aureus. [History of preceding influenza is a well-known association with Staphylococcus pneumonia]. XMock-2. 62. A 25-year-old woman whose last menstrual period was 12 weeks ago presents with vomiting and increasing right iliac fossa pain of 24 hours duration. Her temperature is 38.C and she is acutely tender in the right iliac lower quadrant. The uterus is just palpable abdominally. What is the single most likely diagnosis?Ectopic pregnancyAcute appendicitis Ruptured ovarian cystSpontaneous abortionHemorrhage into ovarian cystAns. The key is B. Acute appendicitis. XMock-2. 63. A 23-year-old woman whose last menstrual period was 14 weeks ago presents with a history of intermittent acute right iliac fossa pain accompanied by vomiting. She has not had any vaginal bleeding. Her uterus is of normal size. What is the single most appropriate diagnosis. Torsion of the ovarian cystTubo-ovarian abscessRuptured ovarian cystHemorrhage into ovarian cystEctopic pregnancyAns. The key is A. Torsion of the ovarian cyst. [It is not ruptured ovarian cyst as there is no vaginal bleeding also hemorrhagic cyst has vaginal bleeding. In ectopic pregnancy uterus is a bit enlarged, so it is unlikely to be ectopic pregnancy. Abscess will cause fever. So likely diagnosis is A. Torsion of the ovarian cyst]. XMock-2. 64. An 84-year-0ld man has been breathless at rest for several months. His current medication is frusemide, isosorbide nitrate, and digoxin. He is in sinus rhythm with a heart rate of 78b/min and blood pressure of 145/85mmHg. His serum electrolytes and urea are normal. What is the single most appropriate drug to use at this stage?BendroflumethiazideNifedipineRamiprilDonazolNifedipineAns. The key is A. Bendroflumethiazide. [Diuretic resistance is treated with addition of a second diuretic]. XMock-2. 65. A 30-year-old woman has had intense itching of the perineum and between the fingers of her right hand side for 2 weeks. The pruritus is more pronounced in the night after a hot shower. Occasional papulovesicular lesions with excoriation are visible on the perineum. A pelvic examination is normal. What is the single most likely organism to account for this presentation?Enterobius vermicularisHerpes simplexPthius pubisSarcoptes scabeiTrichomonas vaginalisAns. The key is D. Sarcoptes scabei. XMock-2. 66. A 25-year-old lady with 8 weeks amenorrhea presents with 3 days history of right iliac fossa pain and a heavy dark vaginal discharge. On vaginal examination, the uterus is bulky and non-tender. She is acutely tender in the right adnexus. What is the single most likely diagnosis?Ruptured ovarian cystEctopic pregnancySpontaneous abortionTorsion of ovarian cystAppendicitisAns. The key is A. Ruptured ovarian cyst. [Ovarian cyst may cause Irregularity of the menstrual cycle and abnormal vaginal bleeding may occur; the intermenstrual interval may be prolonged, followed by menorrhagia. In case of rupture there is acute unilateral sharp pain with peritoneal sign and dark vaginal discharge or bleeding that is self limiting].Mock-2. 67. A 24-year-old woman with 8 weeks amenorrhea presents with 7 days history of intermittent right iliac fossa pain and scanty vaginal bleeding. An ultrasound scan shows an empty uterus, no visible adnexal masses but excess fluid in the pouch of douglas. What is the single most likely diagnosis?Ruptured ovarian cystEctopic pregnancySpontaneous abortionTorsion of ovarian cystBleeding into corpus luteum Ans. The key is A. Ruptured ovarian cyst. This is wrong key! Correct key is B. Ectopic pregnancy. [Ruptured ovarian cyst causes severe acute pain. The presenting case is leaking ectopic pregnancy which causes slight vaginal bleeding and collection of blood in pouch of douglas]. Mock-2. 68. A 25-year-old woman with 10 weeks history of amenorrhea presents with lower abdominal pain and vaginal bleeding. She is tender across the lower abdomen but otherwise well. On vaginal examination the uterus is bulky and slightly tender. What is the single most likely diagnosis?Spontaneous abortionTorsion of ovarian cystRuptured cystEctopic pregnancyRuptured ovarian cystAns. The key is A. Spontaneous abortion. Mock-2. 69. A 24-year-old woman presents with offensive bloody vaginal discharge. On examination the cervix appears to be ulcerated. What is the single most appropriate investigation?ColposcopyCervical smear and biopsyCervical smearCystoscopyCT scanAns. The key is B. Cervical smear and biopsy. [Biopsy is diagnostic]. [Likely Dx is carcinoma cervix. So Biopsy is the investigation of choice]. XMock-2. 70. A 24-year-old woman presents with post coital bleeding. An abdominal X-ray is normal. Speculum examination is also normal apart from ectopy.ColposcopyCervical smear and biopsyCystoscopyCervical smearCT scanAns. The key is A. Colposcopy. XMock-2. 71. A 64-year-old man with long standing alcohol dependency has been brought to the A&E department after being found wondering in the park unsteadily. He is confused and ataxic, has dry mucous membrane and bilateral ophthalmoplegia. He has a history of longstanding alcohol abuse. He has a blood pressure of 115/85mmHg, PR 64 beats/minute, temperature of 36.8C and a capillary blood glucose of 3.5mmol/l. What is the most urgent treatment? Bolus of 50% glucose solutionBolus of lorazepamBolus thiamineInfusion of 0.9% salineInfusion of 5% dextrose solutionAns. The key is C. Bolus thiamine. [This is a case of Wernicke’s encephalopathy which is treated with replacement of thiamine]. XMock-2. 72. A 4-year-old boy has been brought to the A&E department by ambulance. He has been unwell with a sorethroat for 8 hours. He is sitting on her mother’s knee and is tolerating an oxygen mask but looks unwell. He has constant noisy breathing and is dribbling saliva. His temperature is 39.C. What is the single most appropriate action?Administer IV penicillinCall an anaesthetistExamine the tonsils with a tongue depressorListen to the chestTake blood cultureAns. The key is B. Call an anaesthetist. [This is a case of epiglottitis where anaesthetist should be called for intubation to prevent imminent closure of airway by inflamed enlarged epiglottis]. XMock-2. 73. A 44-year-old man presents with painful erection with curving of the penis. What is the condition?BalanitisPhimosisPriapismPeyrionne diseaseParaphimosisAns. The key is D. Peyronie’s disease. [Peyronie's disease is a form of erectile dysfunction that causes a bend in the penis that can make an erection quite painful. The condition may develop after trauma to the penis, such as bending or hitting]. XMock-2. 74. A 60-year-old woman who has been treated for the carcinoma of the cervix is admitted because of confusion. The GP has done blood test which shows a high urea of 20mmol/l and a normal full blood count. What is the single most appropriate investigation?IVUCystoscopyUltrasound scanMRI pelvisCT scan pelvisAns. The key is C. Ultrasound scan. [There is a well-known association between cervical cancer and renal impairment which increases with those got radiotherapy. Assessment with ultrasound scan is recommended which usually reveal hydronephrosis, hydrocalycosis, hydroureter and parenchymal disease. Uremia may cause confusion in these patients]. XMock-2. 75. A 36-year-old lady has been found to have mild dyscaryosis on ultrasound scan. What is the single most appropriate investigation?Repeat smear in 6 monthsColposcopyCervical biopsyReassureSpeculum examinationAns. The key is B. Colposcopy. XMock-2. 76. A 36-year-old lady has been found to have mild dyscaryosis on ultrasound scan. What is the single most appropriate investigation?Repeat smear in 6 monthsColposcopyCervical biopsyReassureSpeculum examinationAns. The key is B. Colposcopy. XMock-2. 77. A 45-year-old man presents after being hit on the superior part of the knee. What is the single most likely diagnosis?Obturator fossaPrepatellarInfrapatellarSuprapatellarAns. The key is D. Suprapatellar. XMock-2. 78. A 60-year-old lady fell down and cannot rotate her arm externally. Which joint is affected?Humeroscapular jointAcromioclavicular jointHumeroclavicular jointSternoclavicular jointGlomeruloclavicular jointAns. The key is A. Humeroscapular joint. XMock-2. 79. A 60-year-old lady underwent mastectomy with axillary lymphnode clearance. She developed paraesthesia of the inner 3rd of the arm. Which nerve is affected?AxillaryRadialBrachealUlnarMesdianAns. The key is C. Bracheal. XMock-2. 80. A 34-year-old man from Zimbabwe is admitted with abdominal pain to the em,ergency department. An abdominal X-ray reveals bladder calcification. What is the most likely cause?SchistomiasisSarcoidosisLeishmaniasisTuberculosisSchistomiasis hematobiumAns. The key is E. Schistomiasis hematobium. [Schistosoma hematobium causes bladder calcification]. XMock-2. 81. A 74-year-old female presents with headache and neck stiffness to the emergency department. Following a lumber puncture, the patient was started on IV ceftriaxone. CSF culture shows Listeria monocytogens. What is the most appropriate treatment?Add IV amoxicillinChange to IV amoxicillin + GentamicinAdd IV ciprofloxacinAdd IV amoxiclavAns. The key is B. Change to IV amoxicillin + Gentamicin. XMock-2. 82. A 30-year-old woman presents with 6 months history of palpitations. Her ECG shows shortened PR interval and delta waves. Holter monitoring shows paroxysmal SVT. What is the single most appropriate management?Carotid messageVerapamilSotalolAdenosineAmiodaroneAns. The key is D. Adenosine. XMock-2. 83. A 50-year-old man was admitted with an acute myocardial infarction earlier in the day 2 hours after thrombolysis with tPA. He suddenly complains of feeling faint. His PR is 140 b/m and BP is 90/40mmHg. Cardiac monitoring shows long run of SVT. What is the single most appropriate treatment?Carotid messageEmergency DC shockAmiodaroneVerapamilElective cardioversionAns. The key is B. Emergency DC shock. [SVT with hemodynamic instability is treated with emergency DC shock]. XMock-2. 84. A 24-year-old woman presents to the A&E with dizziness. Her ECG shows re-entrant tachycardia. She had a similar episode in the past, which stopped simultaneously. She is not on any medication. What is the single most appropriate management?Carotid messageAdenosineAccessory pathway ablationVerapamilAmiodaroneAns. The key is A. Carotid message. This is wrong key. Correct key is C. Accessory pathway ablation. XMock-2. 85. A 4-year-old boy was diagnosed with UTI, which has later found to be due to E. Coli. What is the most appropriate treatment?TrimethoprimNitrofurantoinAmoxicillinCefalexin Ans. The key is A. Trimethoprim. XMock-2. 86. A 28-year-old lady complaints that she hears everyone saying that she is an evil person. What type of hallucinations she is suffering from? Second person auditory hallucinationsThird person auditory hallucinationsEcho de la penseGredemankessaneAns. The key is B. Third person auditory hallucinations. [Third person auditory hallucinations are auditory hallucinations in which patients hear voices talking about themselves, referring to them in the third person, for example "he is an evil person". This type of auditory hallucination is particularly associated with schizophrenia, but can occur in affective disorders].Mock-2. 87. A 3-week-old girl has been brought to the emergency department. She is lethargic, unwell and not feeding. Her temperature is 38.5C, PR 90b/m and RR 20c/m. Her skin, chest, abdominal, ear and throat examinations are normal. What is the single most appropriate management?Admit for full infection screeningAdmit for full infection screening and start broad-spectrum antibioticAdmit for serial examination and observationDischarge with broad-spectrum antibioticDischarge with oral antipyreticAns. The key is B. Admit for full infection screening and start broad-spectrum antibiotic.Mock-2. 88. A 9-year-old boy has had neck pain and generalized rash for 12 hours. He is not on any medication and has a temperature of 39.5C. He has limitation of neck flexion and no lymphadenopathy. The rash is sparse, mainly on the trunk, looks slightly hemorrhagic and is non blanching on pressure. What is the single most likely diagnosis?Henoch-Schonlein purpuraMeaslesMeningococcal infectionParvovirus B infectionRubellaAns. The key is C. Meningococcal infection.Mock-2. 89. A 4-year-old boy has been bedwetting his bed and the parents are asking for the most appropriate action.Behavioural therapyRestrict fluid 2 to 3 hours before sleepDesmopressin Incontinent pantsNo action requiredAns. The key is B. Restrict fluid 2 to 3 hours before sleep. [1st try self help tips like 1. Restrict fluid before going to bed 2. Regular toilet break at day time. If fails then go for 2nd step, bed-wetting alarm. If fails medicine like desmopressin. Ref: NHS].Mock-2. 90. A 30-year-old lady who works in a pet shop presents with shortness of breath and fever of 38C. What is the most appropriate management?PenicillinAmoxicillinClarithromycinErythromycinTetracyclineAns. The key is E. Tertracycline. [Patient info, GPnotebook says Tetracycline and OHCM says Doxycycline or Clarithromycin].Mock-2. 91. A 40-year-old man is found to have bronchiectasis. What is the most appropriate investigation?Spiral CTHigh resolution CTChest X-rayMRI chestEchocardiographyAns. The key is B. High resolution CT. XMock-2. 92. A-20-year old man with fever and running nose presents with horseness of breath. What is the most appropriate investigation?LaryngoscopeCT chestTSHMRI chestNo investigation requiredAns. The key is E. No investigation required. [Laryngoscopy may be performed at any time, although it is recommended when hoarseness does not resolve within three months of onset or if a serious underlying cause is suspected]. XMock-2. 93. A 70-year-old man who has been smoking for 50 years presents with weight loss and hemoptysis. What is the most appropriate investigation?CT chestMRI chestBronchoscopy and biopsyChest X-rayNo investigation requiredAns. The key is C. Bronhoscopy and biopsy. [Elderly smoker with weight loss and hemoptysis is most likely having bronchogenic carcinoma. Bronchoscopy and biopsy is the most appropriate diagnostic investigation]. XMock-2. 94. A 40-year-old man has undergone detoxification programme. He wants some medication to help him reduce craving?DisulfiramChlordiazepoxideDiazepamThiamineAcamprosateAns. The key is E. Acamprosate. [By reversal of chemical derangement of brain acamprosate reduces craving for alcohol in an alcoholic]. XMock-2. 95. A couple have undergone detoxification programme. They want a medication to help them serve as a deterrent when they take alcohol.A.DisulfiramB.ChlordiazepoxideC.NaltrexoneD.ThiamineE.AcamprosateAns. The key is A. Disulfiram. [Disulfiram acts as a deterrent]. XMock-2. 96. A 45-year-old man has been drinking for the past 48 hours. He presents to the emergency department with aggressive behavior, shaking, tremors and agitation. What is the most appropriate management? DisulfiramChlordiazepoxideNaltrexoneThiamineAcamprosateAns. The key is B. Chlordiazepoxide. XMock-2. 97. A 40-year-old man presents with confusion and constipation. Calcium is 3.4mmol/l. What is the most appropriate treatment?IV sodium chloridePamidronateCalcitoninCalcium resoniumPotassium chlorideAns. The key is B. Pamidronate. [Bisphosphonates inhibit osteoclastic bone resorption and are effective in the treatment of hypercalcemia due to conditions causing increased bone resorption and malignancy-related hypercalcemia]. XMock-2. 98. A 40-year-old man with a history of COPD and a shipyard worker present with pleural effusion. How would you diagnose this fluid?Pleural aspirationCT chestMRI chestChest tube insertionTumour markerAns. The key is A. Pleural aspiration. XMock-2. 99. A 30-year-old man put his hand accidentally in a machine. There is no fracture. What is the most appropriate management?SplintHigh arm sling and rest for 2-3 daysScaphoid castPlaster castAnalgesia onlyAns. The key is B. High arm sling and rest for 2-3 days.Mock-2. 100. A 5-year-old child was found to have Vesico-ureteric reflux. What is true about this condition?Requires prophylactic antibioticMost will require surgeryIn most kidney will be scarred by 5 yearsNo further action is requiredIt is usually asymptomaticAns. The key is B. Most will require surgery. [Maximum get cured by 5 years with prophylactic antibiotics. The minority those reach 5 years without cure usually require surgery]. XMock-2. 101. A 59-year-old man presents with shortness of breath. Chest X-ray shows opacities of the whole left hemi-thorax. What is the most appropriate investigation?CT chestBronchoscopyDiagnostic thoracocentasisMRI chestSputum cultureAns. The key is C. Diagnostic thoracocentasis. [Dx pleural effusion. Inv. Diagnostic thoracocentasis]. XMock-2. 102. A 30-year-old lady stopped OCP 18 months ago. She has amenorrhea for the past 9 months. Pregnancy test is negative. Prolactin is 600. What is the most likely diagnosis?Hypothalamic amenorrheaProlactinomaPCOSEndometriosisPIDAns. The key is B. Prolactinoma. [Post-pill amenorrhea is one which persists at least 6 months following stopping pill. So this is not post pill amenorrhea as there was no amenorrhea at the initial nine months but amenorrhea started after 9 months of period of normal menstruation. It is possible for a developing microprolactinoma to cause such amenorrhea when the level of prolactin reaches 400 mU/L. and when prolactin level rises >5000mU/L we can be certain that there is prolactinoma present unless proven otherwise]. XMock-2. 103. A 70-year-old lady presents with palpitation for the past seven days. Which of the following is the first line drug of choice?AtenololAdenosineAmlodipineDigoxinFlecainideAns. The key is A. Atenolol. [Dx chronic atrial fibrillation. Treatment choice is rate control and anticoagulation. For rate control beta-blocker or rate-limiting Ca+ channel blocker are 1st choice. If beta blocker not tolerated then Ca cannel blockers [rate-limiting such as verapamil or diltiazem] are used as 1st line. Amlodipine is not rate-limiting Ca channel blocker. So from the given option A. Atenolol is 1st line drug of choice]. XMock-2. 104. A 57-year-old man presents with dizziness after an acute upper respiratory tract infection. What is the most likely cause?Meniere’s diseaseVestibular neuritisBenign positional vertigoTIADrug inducedAns. The key is B. Vestibular neuritis. [Viral RTI followed by dizziness is most likely due to vestibular neuritis]. XMock-2. 105. A 40-year-old housewife who has 5 children complains of increasing breathlessness in climbing the stairs. Her period lasts 8-10 days and she loses clots. She smokes 5-7 cigarettes a day. What is the single most appropriate initial investigation?ColposcopyFBCClotting screenCervical smearMRI pelvisAns. The key is B. FBC. [Dx is iron deficiency anemia secondary to menorrhagia. So most appropriate initial investigation is FBC]. XMock-2. 106. A 70-year-old man with temperature of 39.C and cough. What would he check Xray for?PneumothoraxLung cancerMesotheliomaNormalFree gas in the mediastinumAns. The key is D. Normal. [In lung cancer and mesothelioma there is usually low grade fever and other constitutional symptoms like weight loss, anorexia, anemia etc. will be present]. XMock-2. 107. A 45-year-old man 30 year story of smoking presents with shortness of breath. His oxygen is 8, PaCO2 is 7. How much oxygen will you give?100%85%28%24%40%Ans. The key is D. 24%. [This is type 2 respiratory failure where oxygen more than 24% will lower hypoxic drive and respiratory failure will deteriorate further]. XMock-2. 108. 45-year-old man who returned from holyday from spain presents with dry cough and shortness of breath. What is the most appropriate treatment?ClarithromycinErythroycinAmoxicillinBenzylpenicillinTetracyclineAns. The key is A. Clarithromycin. [Travel history gives us the diagnosis of legionella pneumonia and treatment recommended is fluoroquinolone + clarythromycin, Ref: OHCM, 10th edition, page 167]. XMock-2. 109. A 45-year-old man from Africa presents with weight loss dry cough and shortness of breath. What is the most appropriate treatment?Co-trimoxazoleTetracyclineAnti-tuberculous drugsClarithromycineAmoxicillinAns. The key is A. Co-trimoazole. [Both aids and TB are endemic in Africa. So both A. Cotrimoxaole (used in pneumocystis carii pneumonia) and C. Anti-tberculous drugs can be possible answer]. XMock-2. 110. A 45-year-old man believes that his neighbor is using his shower despite the fact that There is no one at home. What is the most likely diagnosis?NihilisticFolie A deuxHypochondrialParanoid delusionDelusion of grandioseAns. The key is D. Paranoid delusion. [A paranoid delusion is the fixed, false belief that one is being harmed or persecuted by a particular person or group of people. Paranoid delusions are known technically as a “persecutory delusion.”] XMock-2. 111. A 30-year-old lady is infertile. What test should you do to prove ovulation?Mid-cycle progesteroneFSHLeutenising hormoneUltrasound scanTestosteroneAns. The key is A. Mid-cycle progesterone. [Mid-luteal cycle progesterone - serum progesterone is tested one week before a period is expected (on day 21 of a 28 day menstrual cycle).The level of progesterone that indicates ovulation is variable. NICE suggest that "..values range from 16 to 28 nmol/l as the lowest limit indicative of ovulation..." (1).For assessment of ovulation for women with a regular menstrual cycle (2)Measure mid-luteal phase progesterone (e.g day 21 of 28 day cycle; day 28 of 35 day cycle):sample should be taken 7 days before the expected period and interpreted when the next period has begun>30 nmol/L is consistent with ovulation and no further biochemical assessment is indicated10-30 nmol/L may require repeat with review of cycle timing<30 nmol/L (confirmed) requires further investigation as for anovulation/oligo-ovulation]. XMock-2. 112. A 30-year-old lady 2 hours into her labour develops fits. Despite treatment with magnesium sulphate she develops another seizure. What is the most appropriate treatment?IV bolus magnesiumIV hydralazineIV labetalolIV methyldopaCaesarean sectionAns. The key is A. IV bolus magnesium. [Magnesium sulfate is used to prevent and treat seizures. Give 4g IV over 5–10min then 1g/h for 24h. Treat further fits with 2g bolus. Ref: OHCS, 10th edition, page 49]. XMock-2. 113. A 60-year-old woan presents with a 1 cm ulcer on his hand which bleeds easily on touch. What is the most appropriate diagnosis?Basal cell carcinomaEczemaSquamous cell carcinomaMelanomaBenign moleAns. The key is C. Squamous cell carcinoma. XMock-2. 114. A 50-year-old man presents with dizziness, which is worse on lying in bed. What is the most appropriate investigation?Tilt testWeber’s testRinnes testDix Hallpike manoeuvreCT headAns. The key is D. Dix Hallpike manoeuvre. [Dx benign positional vertigo. To diagnose we use Dix Hallpike manoeuvre]. XMock-2. 115. A 40-year-old lady presents with clear discharge from a single duct. What is the most appropriate diagnosis?Duct papillomaDuct ectasiaIntraductal papillomaPaget’s diseaseBrest cancerAns. The key is C. Intraductal papilloma. [An?intraductal papilloma?is a benign breast condition.?Intraductal papillomas?are most common in women over 40 and usually develop naturally as the breast ages and changes. breast and nipple diagram.?These are wart-like tumors that grow within the milk?ducts?of the breast. Duct papilloma and intraductal papilloma are synonymus]. Mock-2. 116. A 16-year-old girl who has been to the forest remembers being bitten by an insect and presents with a lesion on her leg. What is the most appropriate treatment?DoxycyclineMetronidazolePenicillinTetracyclineCiprofloxacinAns. The key is A. Doxycycline. [Diagnosis is lime disease after bitten by ticks transmitting borrelia burgdorferi to the patient. The skin lesion is known as erythema migrans. Lyme disease is treated with doxycycline].Mock-2. 117. A 12-year-old boy presents with soiling and he has got a palpable mass in the right lower quadrent. What is the most appropriate management?Enema and laxativeLaxativesEnema onlyHigh fiber dietIncrease water intakeAns is A. Enema and laxative. [If there is impacted feacal matter there may occur soiling due to spilling of some stool. Mass in right lower quadrant also indicates impacted feacal matter. Treated with enema and laxative].Mock-2. 118. A 24-year-old man present with epigastric pain. H. pylori is positive. What is the most appropriate management?EndoscopeUrea breath testTriple therapySerology for H. pyloriUltrasound scanAns. The key is C. Triple therapy. [H. pylori positive in symptomatic patient, start triple therapy. No need further investigation at this point].Mock-2. 119. A 40-year-old man has had epigastric pain. H. pylory was negative. He received omeprazole but still no improvement. What is the most appropriate management.Triple therapyEndoscopyUrea breath testSerology for H. pyloriUltrasound scanAns. The key is B. Endoscopy. [If under 45yrs there is no alarm feature but treatment failed endoscopy is indicated].Mock-2. 120. A 40-year-old man presents with swelling of the leg. Urine examination shows protein +++. What is the most appropriate investigation?Ultrasound of the kidneysRenal biopsyIVUFull blood countImmunocomplexAns. The key is B. Renal biopsy. [In adults most common cause of nephrotic syndrome are focal segmental glomerulosclerosis or membranous nephropathy and some others for which renal biopsy is needed to establish the diagnosis].Mock-2. 121. A 6-year-old child had fractured fibula. He was applied a plaster cast. Later in the night, he develops pain. On examination, the pulses are normal. There is no sensory loss and the limbs are well perfused. What is the most appropriate management?Remove castSplit castFasciotomyIncrease analgesia Repeat X-rayAns. The key is D. Increase analgesia. [As the pulses are normal, no sensory loss and limb is well perfused there is no neurological lesion or vascular compromise. So for pain we should increase analgesia]. XMock-2. 122. A 35-year-old lady who has a family history of ovarian cancer is anxious about getting the cancer. What initial investigation will you do?ColposcopyTransvaginal ultrasound scanCA 125CA 19.9MRI pelvisAns. The key is C. CA 125. [CA 125 is the marker for ovarian cancer]. XMock-2. 123. A 56-yea-rold man was involved in a road traffic accident. His initial GCS was 15/15. 3 hours later his GCS is 8/15. What is the most appropriate investigation? IV mannitolCT headMRI brainDexamethasoneX-ray skullAns. The key is B. CT head. [Possible intracranial hemorrhage for which investigation of choice is CT head]. XMock-2. 124. A 56-year-old man who is a known diabetic presents with microalbuminuria. The BP is 128/85mmHg. What is the most appropriate treatment?AtenololACE inhibitorsCalcium channel blockersDiureticsMetoprololAns. The key is B. ACE inhibitors. [ACE inhibitors are renoprotective particularly in microalbuminuria].Mock-2. 125. A 3-year-old child has been treated for meningitis successfully. The child is about to be discharged from the hospital to home. What is the most appropriate test to do?AudiometryCT brain scanLumber punctureBlood cultureEEGAns. The key is A. Audiometry. [Meningitis is frequently associated with deafness. So before discharge we should do audioetry to rule out this complication]. XMock-2. 126. A 20-year-old tall basket ball player present with sudden chest pain. The trachea is central. He has reduced air entry on the right lung base. What is the most appropriate investigation?ECGChest X-rayCT scanMRI chestEndoscopeAns. The key is B. Chest X-ray. [Dx. Probable pneumothorax. So most appropriate investigation is B. Chest X-ray]. XXMock-2. 127. An 18-year-old woman is bought into the accident and emergency department unconscious. Her respiration is deep and sighing at a rate of 24-breath/minute. Her temperature is 38.5C. Her chest is clear. What single most likely diagnois?PneumoniaUTIPulmonary embolismDiabetic ketoacidosisPericarditisAns. The key is D. Diabetic ketoacidosis. XXMock-2. 128. A 35-year-old woman presents severely breathless to the accident and emergency department. She has signed eyebrows and soot in her mouth and stridor. What single most likely diagnosis?PneumoniaAnaphylaxisLaryngeal oedemaEpiglottitisLaryngeal carcinomaAns. The key is C. Laryngeal oedema. [Signed eyebrow and soot in mouth and stridor indicate inhalation injury resulting in laryngeal oedema from burn]. XXMock-2. 129. A 29-year-old woman presents with right sided chest pain and shortness of breath. Her chest examination is normal apart from a pleural rub in the right mid-zone. Her temperature is 39.C. What single most likely diagnosis?Pulmonary embolisPneumoniaPneuothoraxPulmonary oedemaPericarditisAns. The key is B. Pneumonia. [High temperature, chest pain, breathlessness, pleural rub (pleurisy secondary to infection) all these features are well described in pneumonia]. XXMock-2. 130. A couple’s 3 months old baby died after collapsing and no cause was found. They would like to know how to resuscitate the baby in case of a future occurrence as a preventive measure?Index finger and middle fingerThumb and middle fingerThumb and index fingerOne hand2 handsAns. The key is A. Index finger and middle finger. XXMock-2. 131. A 60-year-old woman was recently diagnosed with breast cancer and presents with thirst, polyuria and constipation. What is the most likely diagnosis?Cerebral metastasisDiabetesHypercalcemiaRhabdomyolysisSpinal cord compressionAns. The key is C. Hypercalcemia. [Any solid organ cancer can cause hypercalcemia with given features as thirst, polyurea and constipation. There are some well known features of hypercalcemia for which mnemonics are used like Stones, Bones, Groans, Moans and Psychic overtones. (Stones: kidney stones; Bones: bone pain and fractures; Groans: anorexia, constipation; Moans: fatigue, myalgia, proximal muscle weakness, joint pain; Psychic Overtones: depression, memory loss, confusion, lethargy, coma)]. XXMock-2. 132. A 64-year old man presents with bloating and abdominal pain. Which of the following is the most appropriate investigation?FBCTFT’sEndomyseal antibodiesLFTFecal blood testAns. The key is C. Endomyseal antibodies. [Symptoms like bloating and abdominal pain are more likely due to celiac disease. So endomyseal antibodies are the most appropriate investigation from given options. Question may arise why not malignancy? There is no altered bowel habit, no anorexia, no anemia to support malignancy]. XXMock-2. 133. A 45-year-old lady presents after her foot was stuck under the motorbike to the emergency department with swelling of the leg. Dorsalis pedis is not felt. He has loss of sensation between the second and big toes. What is the most likely diagnosis?Compartment syndromeArterial ruptureArterial embolusFracture of the footSoft tissue injuryAns. The key is A. Compartment syndrome. [Compartment syndrome occurs when the pressure within?a compartment increases, restricting the blood flow to the area and potentially damaging the muscles and nearby nerves. Here dorsalis pedis pulse is absent and superficial peroneal nerve is involved]. XXMock-2. 134. A 70-year-old man who is on amlodipine and bendroflumethiazide for hypertension present with heart rate of 30b/minute and BP of 140/80mmHg. What is the most appropriate investigation?Ambulatory ECGECGAmbulatory BPEchocardiographySerum drug levelAns. The key is B. ECG. [Probable diagnosis is complete heart block and should be confirmed by ECG]. XXMock-2. 135. A 60-year-old man presents with ankle swelling after being started on new antihypertensives. Which of the following medication is the most likely cause?AmlodipineBendroflumethiazideBisoprololTazosinLisinoprilAns. The key is A. Amlodipine. [Calcium channel blockers are well known cause of oedema (as here caused ankle oedema)]. XXMock-2. 136. A 50-year-old man 3 hours after cholecystectomy has a BP of 60/40mmHg and heart rate of 110b/m. What is the most appropriate immediate treatment?Blood transfusionDiureticsIV fluidsEchocardiographyFurosemideAns. The key is C. IV fluids. [Blood transfusion takes some time so immediately IV fluids are given to combat shock]. XXMock-2. 137. A 70-year-old man presents with right sided weakness and left sided visual loss. Which artery is occluded?Anterior cerebral arteryCarotid arteryPosterior inferior cerebellar arteryMiddle cerebral arteryPosterior cerebral arteryAns. The key is D. Middle cerebral artery. This is a wrong key. Correct key should be B. Caotid artery. [Middle cerebral artery causes contralateral hemianopia not ipsiateral visual loss. Posterior cerebral artery can cause contralateral visual loss with contralateral hemiparesis. But Carotid artery causes ipsilateral visual loss (by occluding ipsilateral ophthalmic artery) with contralateral hemiparesis].Mock-2. 138. A 50-year-old alcoholic man presents with bilateral cavitations and and hemoptysis. What is the most appropriate investigation?CT chestAcid fast bacilliBronchoscopyBlood cultureSputum cultureAns. The key is B. Acid fast bacilli. [Alcoholics are more prone to TB]. XXMock-2. 139. A 7-year-old child is suspected to have a foramen ovale. What is the most appropriate investigation?Bubble echocardiographyTransoesophageal echocardiogramTransthoracic echocardiographyECGCT chestAns. The key is B. Transoesophageal echocardiogram. [Transoesophageal echocardiogram can well delineate foramen ovale which can be more accurately demonstrated by bubble echocardiography. Bubble echocardiography is nothing but extension of transoegophageal echocardiography where bubbles are used to better vision of foramen ovale by passage of bubbles]. XXMock-2. 140. A 20-year-old lady who is not a smoker has been using condom as a means of contraception but would like to change the contraception now. What is the most appropriate contraception?COCPPOP DanazolProgesteroneIUCDAns. The key is A. COCP. XXMock-2. 141. A 30-year-old woman presents with shortness of breath, itching and articarial after playing in the grass in the garden. On examination she has red patches all over her body. Which of the following is the indication of adrenaline?CoughArticariaHorseness of voiceItchingVomitingAns. The key is C. Horseness of voice. [Followings are the indications of adrenaline in anaphylaxis: XMock-2. 142. A previously fit 25-year-old man presents with sudden onset of right sided pleuritic chest pain and fever. His girlfriend is concerned that he has also become confused. What is the single most likely causative organism?Chlamydia psitacciMycoplasmaLegionellaPneumocysti jiroveciHaemophilus influenzaAns. The key is C. Legionella. [Features of pneumonia with confusion suggest legionella pneumonia]. XMock-2. 143. A 19-year-old woman with cystic fibrosis has been well until 24 hours ago when she developed fever, lethargy and breathlessness. What is the single most likely causative organism?Haemophilus influenzaStreptococcusStaphylococcusTuberculosisMycoplasmaAns. The key is A. Haemophilus influenza. [By the age of 18 Pseudomonas becomes the most common organism in rti in cystic fibrosis patient and as it is not in options next comes Haemophilus influenza (If it was in first decade answer would be C)]. XXMock-2. 144. A 50-year-old man presents with a persistent cough for 3 months. He has low grade pyrexia. He has also lost 5kg in weight and has noticed streaks of blood in the sputum. What is the single most likely causative organism?TuberculosisLegionellaPneumocystis jirovecyMycoplasmaStaphylococcusAns. The key is A. Tuberculosis. [Prolonged cough, weight loss, low grade fever and streaks of blood in sputum are classic presentation of tuberculosis]. XXMock-2. 145. A 75-year-old lady underwent total hip replacement. She had severe blood loss during the surgery and also post surgery. She had also developed hyponatremia. Which of the following IV fluid is responsible for this?PlateletsAlbuminCrystalloidsColloidsBloodAns. The key is D. Colloids. [Colloid causes iso-osmolar colloid osmosis and resultant shift in water from the intracellular to the extracellular space can result in dilutional?hyponatremia]. XXMock-2. 146. A 30-year-old lady with history of bee stings present with bee sting on her hand with swelling, itching and shortness of breath. She is a farmer and has been treated successfully. What would you suggest for future management?Adrenaline patchCorticosteroidsAnti-fungalsTopical steroidsIM adrenalineAns. The key is E. IM adrenaline. [Followings are the indications of adrenaline in anaphylaxis: XXMock-2. 147. An 81-year-old woman is brought to the accident and emergency department confused. Over the past three months, she has been complaining of excessive passing of water and weight loss. What is single most appropriate investigation?Serum and urine electrophoresisChest X-rayBlood glucoseUrea and electrolytesCalcium and phosphate levelAns. The key is C. Blood glucose. [Weight loss and polyuria suggest DM]. XXMock-2. 148. An 81-year-old man complaints of general malaise and a chronic backache. He has a history of mild confusion with episodes of marked blurring of vision. An X-ray report shows pepper pot skull. What is the single most appropriate investigation? Full blood countECGSerum electrophoresisThyroid function testsBlood glucoseAns. The key is C. Serum electrophoresis. [Hyperparathyroidism causes pepper pot skull. This is a question with features of multiple myeloma with controversial x-ray findings!! This is clasically seen in hyperparathyroidism, and is occasionally used (inaccurately) to describe the raindrop skull of multiple myeloma]. XXMock-2. 149. What is the test for wobble teeth?Dexa scanNuclear bone medicineSkeletal surveyX-raySerum calciumAns. The key is D. X-ray. XXMock-2. 150. A 40-year-old man is diagnosed with rectal cancer. Which lymph node drainage will it spread to?Para-aorticSuperficial inguinalCommon iliacDeep inguinalInternal iliacAns. The key is E. Internal iliac. XXMock-2. 151. A 40-year-old man is diagnosed with ulcer on his scrotum. Which lymph node will it drain to?Deep inguinalCommon iliacInternal iliacSuperficial inguinalPara-aorticAns. The key is D. Superficial inguinal. XMock-2. 152. A 40-year-old lady who just lost her husband has lost interest in everything. She has low mood and cannot get along with her son. What is the most appropriate management?Detain under mental actVoluntary admission in psychiatry wardECTAdmit to general wardSend to counselling sessionsAns. The key is B. Voluntary admission in psychiatry ward. XMock-2. 153. A 1-year-old child presents with shortness of breath and coryza symptoms. He has barking cough. What is the most likely natural history of this condition?Natural resolutionPersist into adult lifeUnknownAbscess10% chance that it would persist in adult lifeAns. The key is A. Natural resolution. [Dx is croup which usually resolve spontaneously]. XMock-2. 154. An 8-year-old boy with long standing eczema has an intense flare up of this eczema. There is erythema, excoriation and exudates in the flexure. The weeping lesions have not responded to topical betamethason. A skin swab has been taken.Prolonged high dose oral steroidSkin sensitivity testingOral antihistamineEmollient and a short course of 0.1% hydrocortisone (topical)Oral flucloxacillinAns. The key is E. Oral flucloxacillin. [Superadded staphylococcal infection. Should be treated with flucloxacillin].Mock-2. 155. A 50-year-old woman has seborrhoeic eczema affecting the scalp margin and nasolabial folds. Hydrocortisone cream 1% that she purchased from the pharmacy has failed to help. Acyclovir (Oral)EmollientFusidic acid creamBetamethasone 0.1% ointmentKetoconazole creamAns. The key is E. Ketoconazole cream. [Ketoconazole is the treatment of choice for seborrhoeic dermatitis]. XMock-2. 156. A patient presents with skin lesion at the nasolabial fold. It is noted to have rolled edges.Bowens diseaseBasal cell carcinomaLipomaMalignant melanomaKaposis sarcomaAns. The key is B. Basal cell carcinoma. [Commonest site is nasolabial fold. Umbilicated ulcer with rolled/inverted edge (squamous cell carcinoma is everted). Any ulcer which is located above the neck is always basal cell carcinoma until proven otherwise (Ref: Samson notes)]. XMock-2. 157. A pregnant lady presents with pain in the wrist at night and numbness at the thenar eminence and lateral 3 and half fingers. Which nerve is involved?Median nerve at wristMedian nerve at elbowRadial nerve at elbowRadial nerve at wristUlner nerve at wristAns. The key is A. Median nerve at wrist. [Carpal tunnel syndrome is frequently encountered in pregnancy]. XMock-2. 158. A pregnant lady present with UTI. On microscopic urine analysis, E. Coli was detected. What drug should be prescribed to her?TrimethoprimAmoxicillin CiprofloxacinMefenamic acidTetracyclineAns. The key is B. Amoxicillin. [Mefenamic acid is not antibiotic and can cause premature closure of ductus arteriosus in pregnancy. All other given options have adverse effect on fetus except amoxicillin]. XMock-2. 159. A couple have not been able to conceive despite having regular sex for 2 years. The ladies menstrual cycles are regular and of 28 days. 21 days progesterone test shows low level. What is the best treatment for the scenario?BromocryptineClomipheneIVFTestosteroneAns. The key is B. Clomiphene. [In approximately 40% of patients who visit an infertility clinic, anovulation is diagnosed. One of the primary drugs utilized in correcting anovulation is?clomiphene. Please note bromocriptine is used in infertility in case of hyperprolactinemia]. XMock-2. 160. A man comes with pain and swelling in front of the knee. Which bursa might have been involved?Prepatellar bursaSuprapatellar bursaInfrapatellar bursaSemi membranos bursaAns. The key is A. Prepatellar bursa. XMock-2. 161. A 41-year-old woman presents with a rapidly enlarging mass in the neck. She has recently developed stridor and dysphgia. On palpation, the mass is hard and tethered to the skin. What is the single most likely diagnosis?Thyroid adenomaFollicular carcinomaAnaplastic carcinomaHyperthyroidismViral thyroiditisAns. The key is C. Anaplastic carcinoma. [Anaplastic thyroid carcinoma has a rapid course and early dissemination. The most common sites of distant spread include, in descending order the lung, bone and brain. Local invasion of adjacent structures (eg, trachea, esophagus) commonly occurs resulting in stridor and dysphagia. Features like hard mass tethered to the skin and rapid growth also suggests anaplastic thyroid carcinoma]. XMock-2. 162. A 25-year-old woman presence with intolerance to heat and sweating of the hands, she has a smooth, soft thyroid swelling with a bruit. What is the most likely diagnosis?Graves diseaseDrug inducedViral thyroiditisThyroid cancerIodine deficiencyAns. The key is A. Graves disease. XMock-2. 163. A 555-year-old woman presents with increased obesity. On examination, she has central obesity with a round moon face. She is hypertensive and has glycosuria. An ultrasound of her abdomen reveals an enlarged right adrenal gland. The left adrenal gland is normal. What is the single most likely diagnosis?Addison’s diseaseCushing’s diseasePhaeochromocytomaConn’s diseaseCushing’s syndromeAns. The key is E. Cushing’s syndrome. [When cushing’s syndrome is caused by pituitary tumour it is called Cushing’s disease. The given case is Cushing’s syndrome as it is not due to pituitary tumour but from pathology in adrenal gland]. XMock-2. 164. Patient has just had a transurethral prostatic biopsy. What electrolyte imbalance can he develop?HyperkalemiaHyponatremiaHypocalcemiaHypernatremiaHypercalcemiaAns. The key is B. Hyponatremia. [In both prostatatectomy and prostatic biopsy irrigation is given and there occurs absorption of fluids by prostatic venous plexus which leads to dilutional hyponatremia].XMock-2. 165. A man was brought to the A&E department from a shopping mall after collapsing there. He is unconscious and answering questions. His ECG shows irregular rhythm. What is the choice of investigation?CT scanMRI24 hour echocardiogramEchocardiographyAns. The key is D. Echocardiography. [Dx is atrial fibrillation and echocardiography to detect whether there is valvular lesion or thrombus in left atrial appendage (causing TIA) or not]. XMock-2. 166. A 60-year-old man is being treated with cyclophosphamide for fibrosing alveolitis. His hemoglobin (Hb) level is 6.2g/dl with normal red cell parameters, a platelet count of 25 c 10 9/1 and white cell count of 2.0. What is the single most likely diagnosis?Anemia of chronic diseaseAplastic anemiaAcute leukemiaPernicious anemiaBlood transfusionAns. The key is B. Aplastic anemia. [Cyclophosphamide can cause temporary decrease in RBC, WBC and platelets]. XMock-2. 167. A young boy has a painless soft swelling in the right scrotum. It is blue in colour and compressible. What is the best management?Surgical explorationCT abdomenHerniotomyReassuranceAntibioticsAns. The key is D. Reassurance. [Varicocele happen when certain veins in the scrotum become enlarged, due to a malfunction in some of the valves involved in pumping the blood.? Varicoceles normally affect?just one side, usually the left. Treatment is not usually necessary,?unless there is:pain and discomforta low sperm countinfertility?that has continued for at least 2 years and is otherwise unexplainedIn these cases, surgery may be recommended. XMock-2. 168. A 47-year-old man, known to be belligerent heavy drinker, becomes increasingly drowsy over a period of several days. He has previously been well he is rousable but mental state examination reveals considerable cognitive impairment. What is the single most likely diagnosis?Motor neuron diseaseHuntington’s diseaseCreutzfeldt-jacob diseaseSubdural hematomaBenign intracranial diseaseAns. The key is D. Subdural hematoma. XMock-2. 169. A 49-year-old man first presented with increasing difficulty in swallowing several months later he developed weakness in his right foot. Now he can no longer feed himself, chokes on food and has become confined to a wheelchair. What is the single most likely diagnosis?Multi-infarct dementiaAlzheimer’s diseaseBenign intracranial hypertensionNormal pressure hydrocephalousMotor neuron diseaseAns. The key is E. Motor neuron disease. [Clinical picture is consistent with motor neuron disease of progressive bulbar palsy type]. XMock-2. 170. A man has been on treatment for 20 yrs for type 1 diabetes mellitus and now complains of blurring of vision and frequent changes of his reading glasses. Where could be the location of his eye lesion?RetinaChoroidLensIrisCorneaAns. The key is C. Lens. [Diabetes mellitus is a well known metabolic case of cataract]. XMock-2. 171. An adolescent boy comes with a transverse fracture of tibia and is managed conservatively by putting a plaster. Analgesic is already given to him before putting on the plaster. Sometime after putting the plaster, he complains pain in the fractured limb. On examination, pulse, temperature and sensations are normal. What is the most appropriate thing to do next?Cut open the plasterCut open the plaster and reapply after adding more cottonDo an X-ray of the limbGive more analgesics Do open reduction of the fractureAns. The key is D. Give more analgesics. [Pulses are normal and sensations are normal. Temperature is also normal. So no neurovascular lesion and what needed is to give more analgesics]. XMock-2. 172. A woman had a motorcar accident and comes to the A & E with pain and rigidity of the abdomen. Her condition is settled now. What investigation should be done next?CT scan of the abdomenUSGMRIAbdominal X-ray0.9% salinePercutaneous lavageAns. The key is A. CT scan of the abdomen. [We do USG and percutaneous lavage if there is hemodynamic instability. Abdominal X-ray may have some findings including fracture but are not conclusive. CT scan of abdomen is investigation of choice as CT scanning often provides the most detailed images of traumatic pathology and may assist in determination of operative intervention]. XMock-2. 173. An 82-year-old woman is brought to the A&E after a fall at home. ECG and physical examinations are normal. She takes spironolactone for mild oedema, glibenclamide (500mg daily) for type 2 diabetes and uses ibuprofen get for a painful shoulder. What is the single most appropriate management?Medication (sleeping tablets)Review psychotropicReview diabetic medicationReview antihypertensive medicationPrescribe bisphosphonatesAns. The key is C. Review diabetic medication. [probable altered glycemia]. XMock-2. 174. A 82-year-old man presents with unilateral headache, photophobia and sudden reduction in the visual acuity. He has a pale fundus. What is the single most likely diagnosis?Mental state examinationMagnetic resonance imaging of the brainTemporal artery biopsyIntraocular pressureFundoscopyAns. The key is C. Temporal artery biopsy. [Probable giant cell arteritis]. XMock-2. 175. A 64-year-old woman has increased generalized headache, unrelieved by paracetamol. She has difficulty sleeping and says she has lost weight recently. What is the single most diagnostic investigation?ESRCT headTemporal artery biopsyMRI scan of headVisual fieldsAns. The key is B. CT head. [For any tumour or intracranial pathology CT scan is the investigation of choice. MRI is better if features suggest posterior fossa pathology]. XMock-2. 176. A 53-year-old man has severe headaches, worse on lying. You find bilateral papilloedema. What is the single most appropriate investigation?ESREEGCT brainCarotid arteriographySkull X-rayAns. The key is C. CT brain. [Probable brain tumour with raised intracranial pressure]. XMock-2. 177. A 6-year-old boy has eczema. He has been prescribed emollients and corticosteroid. What advice would you give to this patient?Apply both togetherApply after showerApply after shower wait for seconds to dry and apply bothApply corticosteroidsApply both twice a dayAns. The key is C. Apply after shower wait for seconds to dry and apply both. [The options are inappropriate!! When using the two treatments,?apply?the?emollient?first. Wait 10-15 minutes after applying?an?emollient?before?applying?a topical?steroid. That is, the?emollient should be allowed to absorb before a topical?steroid?is applied]. XMock-2. 178. An 8-year-old boy has viral infection. He took a lot of over the counter drugs. His friends noticed that he has yellow sclera. AST, ALT, alkaline phosphatase are all normal. Bilirubin is 31. What is the single most likely diagnosis?Viral hepatitisGallstonesGilbert syndromeDrug toxicityAlcoholic liverAns. The key is D. Drug toxicity. This is a wrong key. Correct key is C. Gilbert syndrome. [In drug toxicity ALT will be much high! In given case liver enzymes are normal and only bilirubin is raised which is feature of Gilbert syndrome].Mock-2. 179. A 30-year-old man is having headaches, fever, neck stiffness and vomiting. What is the single most appropriate antibiotics to give this patient?CeftriaxoneCo-amoxiclavAmoxicillinCiprofloxacin and GentamicinAns. The key is A. Ceftriaxone. [Probable Dx is meningitis and for this the empirical treatment given is ceftriaxone]. XMock-2. 180. An 18-year-old lady with several tiny nodules for 2 days , she has cervical lymphadenopathy and rash on the shin. She has 2 small children. What is the most likely diagnosis?SarcoidosisReactive arthritisRheumatoid arthritisSLEReiter’s syndromeAns. The key is C. Rheumatoid arthritis. This is wrong key. Correct key is A. Sarcoidosis. [Though hilar lymphadenopathy is classic for sarcoidosis generalized or cervical lymphadenopathy is also known feature of sarcoidosis. Erythema nodosum and nodules are also well known features of sarcoidosis]. XMock-2. 181. A 60-year-old woman presents with vaginal bleeding. Her last cervical smear was 3 yrs was normal. What is the single most appropriate investigation?Endometrial samplingCervical smearColposcopyCT scanAns. The key is A. Endometrial sampling. [Post menopausal bleeding is mostly due to endometrial carcinoma]. XMock-2. 182. A 60-year-old lady who is having chronic atrial fibrillation is on warfarin, beta blocker, digoxin and bendroflumethiazide presents with yellow sclera. What is the single most likely cause?DigoxinBendroflumethiazideWarfarinBetablockerAspirinAns. The key is A. Digoxin. [Jaundice?is found among people who take?Digoxin, especially for people who are male, 60+ old , have been taking the drug for < 1 month]. XMock-2. 183. A 45-year-old man who is working an engineering plant. He complaints that his hearing is not good due to noise. What type of deafness is he most likely to have?Unilateral sensory hearing lossBilateral sensoryneuralUnilateral conductive deafnessBilateral conductive deafnessMixed conductive and sensoryneural deafness bilaterallyAns. The key is B. Bilateral sensoryneural.Mock-2. 183. A 30yearold man died after complaining of sudden onset of severe headache. What is the single most likely location of bleeding?IntracerebralExtraduralEpiduralSubarachnoidIntracerebellarAns. The key is D. Subarachnoid. [Sudden onset of severe headache suggest subarachnoid hemorrhage].Mock-2. 184. A 30-year-old lady presents to outpatient clinic complaining of palpitations, feeling of thumping in the chest and a feeling of impending doom the symptoms are so disabling that she cannot cope with it. What is the single most appropriate medication?No medicationSSRIBenzodiazepinesAnti-psychoticsMood stabilizersAns. The key is C. Benzodiazepines. [Panic disorder usually is treated with SSRI but if anxiety is severe as in presenting case with disabling symptoms which she cannot cope with clonazepam (benzodiazepine) is prescribed]. XMock-2. 185. An 80-year-old lady had stroke and she was put on aspirin 75mg once a day. She presents with another TIA. She has been treated successfully and she is now ok. What is the single most appropriate next action?Aspirin and dipiridamoleCopidogrelWarfarinWarfarin and aspirinAns. The key is A. Aspirin and dipiridamole. This is a wrong key. The correct key is B. Clopidogrel. [In older regimen A. Aspirin and dipiridamole was the answer but recently it is changed to B. Clopidogrel]. XMock-2. 186. A 4-year-old man presents with a swelling in the testes. On examination the swelling is smooth and fluctuates. It is located at the posterior upper pole of the left testes. What is the single most appropriate immediate investigation?CT scan testesMRI scan of the testesUSscan of the testesMid stream urineUrethral swabAns. The key is C. USscan of the testes. [Dx epididymal cyst. Investigation of choice is ultrasound scan]. XMock-2. 187. A 30-year-old lady presents to accident and emergencydepartment with shortness of breath, generalized chest pain and feeling as if she will die. You decide to do arterial blood gas. What abnormality will you find in the ABG?High pH, low CO2High pH, normal CO2High O2 and low pHHigh pH and high O2Low pH, low CO2Ans. The key is A. High pH, low CO2. [Dx panic attack. Hyperventilation causes respiratory alkalosis which causes high pH and low CO2 due to CO2 wash out].Mock-2. 188. In a population of 500000, 100 people present with cancer Y, there 1250 cases of cancer Y is registered by death certificate in the last 5 years. The one year survival rate of cancer Y is 0%. What’s the annual incident rate per million?700400200500600Ans. The key is D. 500. This is wrong key. Correct key is 200. [New cases are 100 in year. So new cases in last 5yrs are 500 in half million. So new cases in 1 year is 100 in half million that is 200 in one million]. XMock-2. 189. 76-year-old lady suddenly develops confusion. What is the initial investigation?Blood glucoseBlood cultureCT headMRIUrine cultureAns. The key is A. Blood glucose. [Initial investigation is blood glucose to check any altered glycemia]. XMock=2. 190. 24-year-old man postoperative develops shortness of breath and fever. What’s the most appropriate investigation?CT thoraxChest X rayV/Q scanEchoECGAns. The key is B. Chest X-ray. [Probable atelactesis]. XMock-2. 191. A 60-year-old man with back pain. Creatinine 350, Urea 18, PSA 14.7. The most likely diagnosis?BPHProstate carcinomaBladder carcinomaMultiple myeloaRenal carcinomaAns. The Key is B. Prostate carcinoma. [PSA 14.7 suggests prostate cancer. Prostate cancer causes renal failure by blocking ureters]. XMock-2. 192. A 60-year-old man with back pain. Blood test show creatinine 350, urea 18, PSA 4.5. The most likely diagnosis?BPHProstate carcinomaBladder carcinomaMultiple myeloaRenal carcinomaAns. The key is B. Prostate carcinoma. This is a wrong key. Correct key is D. Multiple myeloma. [PSA is 4.5. So it is not prostate cancer. Probable case of multiple myeloma. In multiple myeloma?accumulation and precipitation of light chains, which form casts in the distal tubules, resulting in?renal?obstruction is the cause of renal failure]. XMock-2. 193. A 5 year boy presents with a bluish mark on his buttocks. Mother wants to know if anything can be done?Clotting screenFull blood countReassureLFTNo investigation requiredAns. The key is C. Reassure. [This is Mongolian blue or Mongolian spot a benign condition for which nothing is needed to done but only reassurance]. XMock-2. 194. A 10-year-old boy presents with purple plaques. He also has proteinuria. What is the most likely cause?InfectionClotting abnormalityVasculitisMalignancyAutoimmune diseaseAns. The key is C. Vasculitis. [Diagnosis of?vasculitis?can be challenging, as symptoms at presentation are often multisystemic. As vessel damage ensues, more specific clinical?features, such as a skin rashes and evidence of organ involvement like nephropathy can be presenting features]. XMock-2. 195. There were 1000 members selected for a double blind placebo controlled study, 503 were taking the placebo and 479 were in the active group. After few weeks 25% of those taking the placebo withdrew compared to 2% of active ones. What is the interpretation of the given data?Chance eventBreakdown in the double blind placebo studyNot possible to interpret the given dataFailure of active drugInitial randomization errorAns. The key is A. Chance event. Mock-2. 196. A 45-year-old man develops ankle oedema, headaches, engorged neck veins. The most likely diagnosis?PericarditisPneumoniaMICOPDVSDAns. The key is A. Pericarditis.Mock-2. 197. A 74-year-old man is found to have bladder cancer. He smoked for several years but stopped smoking 5 yrs ago. Otherwise he is fit and well. What is the most likely risk factor which could have contributed to him developing bladder cancer?SmokingStonesFamily historyDrugsAniline dyeAns. The key is A. Smoking.Mock-2. 198. A housewife develops pain on the anterior inferior part of the knee. What’s the most likely bursa is involved?PrepatellaSuprapatellaInferior patellaLateral patellaMedial patellaAns. The key is A. Prepatella.Mock-2. 199. A 45-year-old man is undergoing laparoscopic Apendicectomy. A port for the camera was inserted halfway between the line connecting the umbilicus and anterior superior iliac spine. Which structure was pierced? Linea albaRectus abdominisAponeurosis of external oblique and internal obliqueInternal muscles and external musclesAns. The key is C. Aponeurosis of external oblique and internal oblique.Mock-2. 200. A woman collapsed and was taken to the hospital. While in the ambulance she complains of pain in the pelvis and on the malleoli. She is diabetic, her weight 122kg and height 162 cm. Shedies in the ambulance. What could have been the cause of her death?PEMISepsisAbdominal aneurysmAns. The key is A. PE. ................
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