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Mary melad 18 april recall 1- pregnant lady with hypertension about 170/100 with unilateral renal artery stenosis what will you give?a.ACEIb.b.blockerc.methyldopa 2.meningitis scenerio,lymphocyte increase,rbc 200 ,protein n,mx?a.analgesic and observeb.supportivec.do mrid.ceftriaxone 3- A 50 y.o. patient after knee replacement. On the 4th POD the develops chest pain and dyspnea. ABG: pO2 90 (N 95-100 mm)p CO2 31 (N 35-45)HCO3 21 (N 22-28)pH 7.32 (N 7.35-7.45)What is the next step in management?a. Oxygen by Hudson maskb. CTPA PULMONARY EMBOLISM 4- . Pt. after doing gastric bypass surgery . now complaint of lightheadedness , diarrhea , bloating 30 min. after meal , this picture is due to ?A) Hypoglycemia late dumping diarrhea abd crampsB) hypovolemiaC) vagal stimulation 5- A man presents to your clinic. His BMI is in the overweight range. He is a smoker. He occasionally uses cocaine and cannabis. Which of the following is the biggest risk factor for CAD in this patient?ObesityCannabisAgeCocaine e-Tobacco6- A 45 yrs. old woman came with a painful mass in breast. What is the most likely dx?Dermoid cystCarcinomaFibroadenomaBreast cyst7- 9 yr old boy is brought thru ambulance as he fell down from gymnastic equipment at school. had one vomiting, no LOC, remebers the fall. on exam a slight swelling over forehead. GCS 15/15.what will u do??D/c with head trauma assessment sheetCTobserve fpr 4 hrsobserve for 24 hrs 8- Mamogram of a breast …. an old women with normal breast examination.She had a history of trauma on chest 10 years ago with brusing in the breast ?What will u do?a.reassureb.Percutaneous core biopsyc.FNACd.repeat mamo after 6 months9- VT very bad only guess by scenario given in 4 yr old child asking mx Immese face in cold water Iv adenosine Iv verapamilAtenolol10- Patient is on multiple medications. Blood count shown – Hb low, MCV 70. What is the cause?a. Aspirinb. Diclofenac c. Chloroquine11- U/S breast given, 25-year-old woman with mass in the right upper quadrant. What is the next best management ?a)fibroadenomab)breast cystc)breast cancer12- Thyroglossal cyst scenario with a pic same picture as Hb Asking for next investigation…UsgCt neckX rayfnac13- An elderly man comes to you with complains of increasing pain in his leg. He was able to walk up to 200 meters but now is developing pain in his right leg and the distance he covers has shortened. Now he can walk only short distances. He has history of smoking and consuming alcohol occasionally. His ABI was done which showed .8 and .2 ( Cant remember which leg what). What is the next step in management?A) Doppler USGB) Walking exerciseC) CompressionD) Angiography14- . a pt admitted in psychiartric ward for 10 days.he is treated with some antipsychotic n diazepam good now bt for the last 4 days he become agitated n go to other ward n mess all the things with some urinary incontinence.no other urinary symptoms.what is the dx?a.benzo toxicity b.relapse of pyschosisc.UTI15- One child was brought to you drowsy wit high grade fever and rash over body. Asked what immediate next Send to hospital immed Give im penicillin Maintain IV line Take blood cultures16- middle aged female with signs and symptoms of heart failure , lower limb edema and pulmonary crackles with shortness of breath , presented to you while on ECG the following reading was there (to me looked normal rythm at the start -there is slight elevation of the ST not sure- FOLLOWED by a period of Asystoly or no pulse and after that the rythm restored again)during this period of asystoly the patient was normal and stable with no increased signs BP 120/84 what should be done next A)continue monitoring B) give amiodarone C)give lidocaine17- A 24year old man confined with a friend came mentioning " funny business is going around" ( same in inverted comma) he said he has been followed and something will happened with him after his some promotion & award. What is the example of his comments?a) prodormal schezob) passivity phenomenonc) idea of referenced) delusional disorder18- . 25yr female,can’t ride of melody of a popular musical band.she is distructed by their melody.after relaxation what is the next appropriate step (ocd)Exposure and desensitizationSsriTca19- sign of pyloric stenosis due to duodenal ulcerVomiting after 1 hour Vomiting immediately after eatingVomiting after 2 hours20- . Patient with colon cancer, age 45, father at 57 with colon cancer and one cousin/relative at 65. Came for screening,he did fobt and was negative and still he want to be screened what will be your management?a.FOBT 2 yearlyb. colonoscopy yearlyc.colonoscopy 2 yearly d.ceae.rectal examination21. 64 years old man with rusty coloured sputum with cough and pleuritic chest pain ..patient not distressed and oxygen saturation 92%..treatment asked??a..doxycycllineb.amoxycyclline /clavulanatec.cefotaximed.ceftriaxone22. Sjogren’s Syndrome scenario. Asked imm appropriate Mx?a. Sialographyb. Biopsy of Salivary Gland23- A 4 yr child wid fever 39, cough n breathlessness,nasal flaring.a)iv bezylpenicillinb)flucloxacillinc)adrenaline24-pt on sertraline,developed diarrhea n abd pain,next?a-switch 2 snrib-switch 2 another ssric-switch to tca25- A pharmaceutical company has done a study to compare the efficacyof two drugs that reduce blood cholesterol. Each group receives one ofthe drugs. What is the most important question you should considerregarding validity of this study ?a. Whether both groups receives the efficient dose of drugs?b. In Which country they have done the study?c. Which journal has published it?26.RA case for 10 years,with c/o sudden pain for last 2 days in thefollowing two fingers that turned black (exactly following picture:Anthology book p.291). Which investigation will lead to diagnosis?a. Anticardiolipin Antibody b. ANAc. ANCAd. Anti-dsDNAe. Anti topoisomerase27- Patient with renal failure , uremia and increase creatinine, with PTh= 11 and phosphate very increased ,calcium normal upper limit what to doParathyroidectomyphosphate restricted diet c)ca supplementation 28- persistant proteinuria in a child..what to do?appropriate something 12 hr urinary protein estimation serum creatint and urinary creatinine ratio29- - CT of brain hage. patient present with blood pressure 180/100 with heart rate of 85 or 90 ,his oxygen saturation is 93% and breathing spontaniously .. his glass comma scale is 10 which of the following should be done next A) intubation B) lower blood pressure C) give mannitol D) keep observing and do nothing now30- A 50 year old heavy alcoholic man came with ascitis, enlarged liver 4 cm below costal margin , his abdomen is tender and his temp. is 37.9 c his blood pressure is 100/60 which of the following is best treatment for current problem ? SPONTENEOUS bacterial PeritonitisIV metronindazole + amoxicillin IV metronindazole + amoxicillin + gentamycin Paracentesis Oral amox. Clax.IV albumin31- Child 4yr with 2 day prodromal then harsh cough fever 39 nasal flaring, tracheal tug,intercostal recession o2 sat 80% treatment a)nebulized salbutamol, b)nebulized bedosinuoed c),im adrenaline croupd), iv benzyl penicilline)iv fluxaacillin32- OCD case. SSRI prescribed, partial response. Patient would like to try some non-medicament therapy. What is you advice?a. refer him for long-term insight-oriented psychotherapyb. advise him that compulsions are the form of anxiety reduction behaviour33- Question about a junior doctor being asked to witness the will for a patient who was disorientated. A) Witness the willB) Do not witness the will34- a young boy in hospital for some emergency operation.he is suspected to be confused by doctor.he has only sister..no parents available.doc calls sister,she is on her way.now what to doask boy for consentask medical administration for consentno need for consent and proceed to surgery 35- Old age female had a will not to admit her when she is terminally ill , today she fall & had # femur , she became very drowsy after morhine inj. , what to do now ?A)Operate her FractureB)arrange family meetingC) admit herD) Refer to Emergency departmentE) Refer to Palliative care unit36- Indigenous mother with her baby comes for vaccination , she looks afraid & silent , no eye contact & go out rapidly after finishA) Call child abuse authorityB) send nurse to home visitC) try to evaluate herbehavior next visitd) tell her to bring a family member next time37. 3 yr indigenous child with profuse yellow colour ear discharge , nasal yellow greenish discharge , inflamed tympanic membrane , enlarged inflamed tonsils what is the next step ?A) Soframycin ear dropsB) oral amoxicillinC) Ear toiletD) oral steroidE) Oral Amoxicillin-Clavulinic acid38. Teacher in kinder garten 10 wk pregnant , recently knows that one of the children have rubella what is next step ?A) Exclude child & reassure herB) terminate the pregnancy before wk 13c) do Igg & Igmd) tell her to come when symptoms appear39. 69 yrs female with vaginal discharge noticed on her panty. PCR shows gonorrhea , pt. said she didn’t have any sexual activity last 10 years , what is the best next ?A) repeat PCRB) give ceftriaxone single doseC) Give azithromycine single doseD) DO hysteroscopy e)counsel about treatment40- 13 years old living alone came with h/o unwanted intercourse last night what willl u do next a)sexual assult serviceb)child protectionc)inform parentsd)inform police41- A middle aged Australian woman,multipara, c/o inability to control her bladder past 3 months. She is afebrile. Coughing , sneezing and laughing causes dribbling of urine.How do you define the exact cause of her incontinence?Urine AnalysisUrine C&SUrodynamic StudiesVoiding Cystourethrogram42- interstate?truck driver?got insomnia with tremors,palpitations and wt loss for last 3 months.wts next invx1)tsh2)urinary drug screening 43- A pt smoker plus occupational asbestos exposure as well.. Has?pleural plaques?& hyperinflation or CXR. Now dysopnea. What will u do??A.CTB.bronchoscopyC. Sputum examD. Per cutaneous biopsy44- 1 pt diabetic on polypharmacy :warfarin , betablocker ,furosemide…temperature 37.8 pulse 60 thigh red swollen tenderCellulitis-DVT –hematoma45- Female patient had a long operation in lithotomy position , which muscle could be affected ?a. Flexor hallucis longus b. Flexor hallucis brevis c. Extensor hallucis longus d. Bicepcs femoris e. Soleus46- 36 ECG of myocardial infarction at metropolitan hospital …Management ??Coronary angiographyrTPA (streptokinase )Troponin levels examination47- ) Fundoscopy was done. Patient has DM, Hypertension. Now come for vision loss painless for 3 hours. CRAO ?Ocular messageIV acetazolamideTopical pilocarpineTimololThanks for every one in gold star keep supporting me special thanxx to omaiqa waqas .drmehmet.drjan.dr mina pray for me to pass thanxx ................
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