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Tricuspid 28. A 35-year-old HIV patient with odynophagia, white esophageal plaques. Organism? A. Candida B. HSV C. CMV D. EBV 29. A 50-year-old man with fever, cough, rusty sputum, lobar consolidation. Likely organism? A. Pneumococcus B. Klebsiella C. Legionella D. Mycoplasma 30. A 35-year-old woman with dysmenorrhea, menorrhagia. USG: bulky globular uterus. Diagnosis? A. Adenomyosis B. Fibroid C. Endometriosis D. Endometrial ca 31. A 28-year-old traveler with watery diarrhea, hypokalemia, Vibrio culture positive. Pathogenesis? A. Endotoxin B. Heat-stable toxin C. Enterotoxin (↑cAMP) D. Neurotoxin 32. A 22-year-old with pancytopenia, smear: LD bodies in macrophages. Vector? A. Tick B. Sandfly C. Tsetse fly D. Mosquito 33. A 60-year-old with lymphocytosis, smudge cells on smear. Diagnosis? A. ALL B. AML C. CLL D. CML 34. A 7-year-old with dark urine, edema post-sore throat. Biopsy: hypercellular glomeruli, subepithelial humps. Diagnosis? A. IgA nephropathy B. MPGN C. Post-strep GN D. RPGN 35. A 35-year-old man with chronic diarrhea, PAS-positive macrophages in biopsy. Diagnosis? A. Crohn’s B. Whipple’s disease C. UC D. Celiac 36. A 65-year-old with pneumonia after hotel stay, diarrhea, hyponatremia. Organism? A. H. influenzae B. Klebsiella C. Legionella D. Mycoplasma 37. A 3-year-old boy with bow legs, wrist widening, rachitic rosary. Diagnosis? A. DMD B. Becker MD C. SMA D. Rickets 38. A 30-year-old man with urethritis, conjunctivitis, arthritis, HLA-B27 positive. Diagnosis? A. RA B. Reactive arthritis C. SLE D. Gout 39. A 70-year-old smoker with hilar mass, hypercalcemia. Diagnosis? A. Adenocarcinoma B. Small cell ca C. Squamous cell ca D. Large cell ca 40. A 28-year-old woman with infertility, chocolate ovarian cyst. Diagnosis? A. Fibroid B. Adenomyosis C. Endometriosis D. PCOS 41. A 6-year-old with fever, drooling, muffled voice, neck swelling. Likely? A. Epiglottitis B. Croup C. Retropharyngeal abscess D. FB aspiration 42. A 45-year-old with irregular cycles, infertility, high TSH. Likely? A. PCOS B. Hyperprolactinemia C. Hypothyroidism D. Premature ovarian failure 43. A 55-year-old with painless hematuria. Biopsy: transitional cell carcinoma. Risk factor? A. Smoking B. Schistosoma C. Cyclophosphamide D. Radiation 44. A 26-year-old at 12 weeks expels products, os closed. Diagnosis? A. Threatened abortion B. Inevitable abortion C. Missed abortion D. Complete abortion 45. A 65-year-old with melena, prolonged PT, antibiotics use. Cause? A. Hemophilia A B. Hemophilia B C. vWD D. Vit K deficiency 46. A 32-year-old in labor with uterine rupture: painful bleeding, fetal parts palpable. Diagnosis? A. Abruption B. Placenta previa C. Vasa previa D. Uterine rupture 47. A 2-year-old with RSV bronchiolitis, wheeze, distress. Diagnosis? A. Croup B. Epiglottitis C. Asthma D. Bronchiolitis 48. A 30-year-old woman with endometriotic cyst. Best fertility-preserving treatment? A. OCPs B. GnRH agonist C. Laparoscopic cystectomy D. Danazol 49. A 6-year-old with isolated thrombocytopenia, purpura. Diagnosis? A. HSP B. SLE C. PSGN D. ITP 50. A 28-year-old in labor with shoulder dystocia. Next step? A. McRoberts maneuver B. Fundal pressure C. Emergency CS D. Forceps delivery

1. A 55-year-old man with painless hematuria, smoker. Cystoscopy shows papillary growth. Next investigation? A. Biopsy of lesion B. Urine cytology C. CT urography D. IVP 2. A 40-year-old woman with fatigue, glossitis, macrocytic anemia. Peripheral smear: hypersegmented neutrophils. Deficiency? A. Vitamin B12 B. Iron C. Folate D. Copper 3. A 50-year-old man with chest pain, ST elevation in II, III, aVF. Culprit artery? A. LAD B. RCA C. LCX D. Left main 4. A 35-year-old woman with watery diarrhea after antibiotics. Colonoscopy: pseudomembranes. Organism? A. Salmonella B. Shigella C. E. coli D. Clostridium difficile 5. A 65-year-old diabetic with fever, chills, rose spots. Blood culture: Gram-negative bacilli. Diagnosis? A. Malaria B. Typhoid C. Dengue D. Leptospirosis 6. A 6-year-old boy with recurrent pneumonia, steatorrhea, growth retardation. Sweat chloride: 75 mmol/L. Diagnosis? A. Cystic fibrosis B. Asthma C. Bronchiectasis D. Alpha-1 AT deficiency 7. A 28-year-old primigravida develops PPH, uterus flabby. First step? A. Uterine massage + oxytocin B. Uterine artery ligation C. B-Lynch suture D. Hysterectomy 8. A 35-year-old man with cavitary lung lesion, branching filaments, weakly acid-fast. Organism? A. Actinomyces B. Nocardia C. TB D. Klebsiella 9. A 30-year-old woman with irregular cycles, hirsutism, infertility. USG: polycystic ovaries. First-line drug? A. OCPs B. Clomiphene C. Metformin D. Letrozole 10. A 40-year-old alcoholic with aspiration pneumonia. Sputum: red currant jelly. Organism? A. Pneumococcus B. Klebsiella C. Staph aureus D. Pseudomonas 11. A 25-year-old pregnant woman at 10 weeks bleeding. USG: snowstorm, no fetus. Diagnosis? A. Complete mole B. Partial mole C. Missed abortion D. Blighted ovum 12. A 3-year-old with pallor, hepatosplenomegaly. Hb electrophoresis: ↑HbF. Diagnosis? A. Beta thalassemia major B. Iron deficiency C. Sideroblastic anemia D. Lead poisoning 13. A 32-year-old woman with Pap smear HSIL. Next step? A. Colposcopy + biopsy B. HPV test C. Repeat Pap D. Hysterectomy 14. A 2-year-old boy with fever, stridor, drooling, toxic appearance. X-ray: thumb sign. Diagnosis? A. Croup B. Epiglottitis C. Foreign body D. Asthma 15. A 28-year-old infertile woman, HSG shows T-shaped uterus. Etiology? A. Congenital anomaly B. Asherman syndrome C. DES exposure D. Endometriosis 16. A 12-year-old girl with short stature, webbed neck, streak ovaries. Diagnosis? A. Turner syndrome B. Klinefelter C. Noonan D. Mullerian agenesis 17. A 30-year-old at 20 weeks with severe vomiting, dehydration, ketonuria. Diagnosis? A. Hyperemesis gravidarum B. Morning sickness C. Gastritis D. Gastroenteritis 18. A 7-year-old nephrotic syndrome patient develops sudden dyspnea. Likely complication? A. Pneumonia B. Pleural effusion C. Pulmonary embolism D. Pericarditis 19. A 35-year-old woman with menorrhagia, infertility, USG: intramural uterine mass. Likely? A. PCOS B. Endometriosis C. Dermoid cyst D. Fibroid 20. A 4-year-old boy with fever, conjunctivitis, cracked lips, LAD. Likely? A. Kawasaki disease B. Scarlet fever C. Measles D. Diphtheria 21. A 28-year-old with PROM at 36 weeks, no contractions. Next step? A. Immediate delivery B. Antibiotics + steroids C. Tocolysis D. Observation 22. A 5-year-old boy with recurrent UTIs, hydronephrosis, dilated ureters. Cause? A. VUR B. Posterior urethral valves C. Neurogenic bladder D. Stone 23. A 24-year-old with amenorrhea, absent uterus, normal ovaries. Diagnosis? A. Turner B. Mullerian agenesis C. Asherman syndrome D. PCOS 24. A 6-year-old with palpable purpura, arthritis, hematuria. Biopsy: IgA deposits. Diagnosis? A. HSP B. SLE C. Rheumatic fever D. Kawasaki 25. A 60-year-old ICU patient on antibiotics develops candidemia. DOC? A. Fluconazole B. Amphotericin B C. Voriconazole D. Caspofungin 26. A 55-year-old with hemoptysis, c-ANCA positive, granulomas. Diagnosis? A. Goodpasture B. Wegener’s (GPA) C. Sarcoidosis D. TB 27. A 28-year-old IV drug user with fever, murmur. Blood cultures: S. aureus. Most likely valve? A. Mitral B. Aortic C. Pulmonary D.

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1. A — Aspirin: First drug in STEMI, antiplatelet improves survival. 2. A — ACE inhibitors: Slow progression of diabetic nephropathy. 3. B — Ischemic stroke: Sudden deficit, CT normal initially. 4. D — Wernicke’s encephalopathy: Thiamine deficiency in alcoholics. 5. B — Ceftriaxone: DOC for typhoid fever in most areas. 6. A — Propranolol: Contraindicated in asthma (bronchospasm). 7. A — PT/INR: Used to monitor warfarin therapy. 8. B — Valproate: Causes weight gain, hepatotoxicity, teratogenic. 9. C — Behçet’s disease: Oral/genital ulcers, uveitis, HLA-B51. 10. B — Klebsiella: Aspiration pneumonia, red currant jelly sputum. 11. A — aPTT: Monitors unfractionated heparin. 12. A — Hydroxyurea: Increases HbF, reduces sickle crises. 13. A — Amiodarone: Avoided in congenital long QT (prolongs QT). 14. B — Levodopa + carbidopa: DOC for Parkinson’s. 15. C — Aspergillus: Fungus ball in post-TB cavity. 16. A — NSTEMI: ST depression + ↑troponins. 17. A — Atropine: Blocks muscarinic effects of OP poisoning. 18. C — Vibrio cholerae: Enterotoxin ↑cAMP → watery diarrhea. 19. C — Nephrotoxicity: Aminoglycosides damage proximal tubules. 20. A — Kawasaki disease: Fever, mucositis, LAD, coronary risk. 21. B — Prednisolone: DOC in Bell’s palsy. 22. B — Legionella: Pneumonia + hyponatremia + diarrhea. 23. B — Treponema pallidum: Syphilitic chancre. 24. C — HSP: IgA-mediated vasculitis, purpura, arthritis, renal. 25. D — Caspofungin: Best drug for invasive candidemia in ICU. 26. C — Wegener’s/GPA: Necrotizing granulomas, c-ANCA positive. 27. D — Tricuspid valve: IVDU endocarditis, S. aureus. 28. B — Candida: HIV esophagitis, white plaques. 29. A — Streptococcus pneumoniae: MCC lobar pneumonia, rusty sputum. 30. A — Adenomyosis: Globular uterus, dysmenorrhea, menorrhagia. 31. C — Sandfly vector: Kala-azar due to Leishmania donovani. 32. C — CLL: Smudge cells, elderly, lymphocytosis. 33. C — Post-strep GN: Lumpy-bumpy deposits, low complement. 34. C — Whipple’s disease: PAS-positive macrophages in lamina propria. 35. C — Legionella: Pneumonia + diarrhea + hyponatremia. 36. B — Rickets: Bow legs, rachitic rosary, widened wrists. 37. D — Folate deficiency: Macrocytosis, glossitis, hypersegmented neutrophils. 38. B — Reactive arthritis: Urethritis + conjunctivitis + arthritis. 39. B — Squamous cell carcinoma: Lung cancer causing hypercalcemia (PTHrP). 40. C — Endometriosis: Chocolate cyst, infertility, pelvic pain. 41. D — Retropharyngeal abscess: Toxic child, muffled voice. 42. C — Hypothyroidism: Irregular cycles, infertility, ↑TSH. 43. D — Schistosoma: Risk factor for bladder carcinoma. 44. D — Complete abortion: Expulsion of products, os closed. 45. D — Vitamin K deficiency: Prolonged PT after antibiotics. 46. D — Uterine rupture: Painful bleed, fetal parts palpable. 47. D — Bronchiolitis: RSV infection, wheeze in infants. 48. C — Laparoscopic cystectomy: Fertility-sparing for endometrioma. 49. D — ITP: Isolated thrombocytopenia, purpura, normal smear. 50. D — Forceps delivery: For shoulder dystocia if maneuvers fail.

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A 50-year-old man with fever, cough, rusty sputum, lobar consolidation. Organism? A. Pneumococcus B. Klebsiella C. Legionella D. Mycoplasma 30. A 35-year-old woman with dysmenorrhea, menorrhagia. USG: globular uterus. Diagnosis? A. Adenomyosis B. Fibroid C. Endometriosis D. Carcinoma 31. A 30-year-old with kala-azar, pancytopenia, fever. Vector? A. Tick B. Sandfly C. Mosquito D. Tsetse fly 32. A 60-year-old man with smudge cells, lymphocytosis. Diagnosis? A. ALL B. AML C. CLL D. CML 33. A 7-year-old boy with edema, cola urine after sore throat. Biopsy: hypercellular glomeruli. Likely? A. IgA nephropathy B. MPGN C. Post-strep GN D. RPGN 34. A 35-year-old man with chronic diarrhea, PAS-positive macrophages in biopsy. Likely? A. Crohn’s B. Whipple’s disease C. UC D. Celiac 35. A 65-year-old with pneumonia, diarrhea, confusion, hyponatremia. Organism? A. H. influenzae B. Klebsiella C. Legionella D. Mycoplasma 36. A 3-year-old boy with bow legs, rachitic rosary, widened wrists. Diagnosis? A. Duchenne MD B. Rickets C. SMA D. Becker MD 37. A 28-year-old with fatigue, glossitis, anemia. Smear: macrocytosis, hypersegmented neutrophils. Likely? A. Iron deficiency B. B12 deficiency C. Folate deficiency D. Hemolysis 38. A 30-year-old with urethritis, conjunctivitis, arthritis, HLA-B27 positive. Likely? A. RA B. Reactive arthritis C. SLE D. Gout 39. A 70-year-old smoker with hilar mass, hypercalcemia. Likely carcinoma? A. Adenocarcinoma B. Squamous cell carcinoma C. Small cell carcinoma D. Large cell carcinoma 40. A 30-year-old woman with infertility, chocolate ovarian cyst. Likely? A. Fibroid B. Adenomyosis C. Endometriosis D. PCOS 41. A 6-year-old boy with fever, muffled voice, drooling, neck stiffness. Likely? A. Epiglottitis B. Croup C. Retropharyngeal abscess D. Foreign body 42. A 45-year-old woman with irregular cycles, infertility, high TSH. Likely? A. PCOS B. Hyperprolactinemia C. Hypothyroidism D. Ovarian failure 43. A 60-year-old man with painless hematuria. Risk factor for bladder carcinoma? A. Smoking B. Schistosoma C. Cyclophosphamide D. Radiation 44. A 28-year-old at 12 weeks expels products, os closed. Diagnosis? A. Threatened abortion B. Inevitable abortion C. Missed abortion D. Complete abortion 45. A 65-year-old man on antibiotics with melena, prolonged PT. Likely? A. Hemophilia A B. Hemophilia B C. vWD D. Vit K deficiency 46. A 32-year-old in labor with painful bleed, fetal parts palpable, absent FHS. Diagnosis? A. Abruption B. Placenta previa C. Vasa previa D. Uterine rupture 47. A 2-year-old with RSV infection, wheeze, distress. Diagnosis? A. Croup B. Epiglottitis C. Asthma D. Bronchiolitis 48. A 30-year-old woman with endometriotic cyst. Best fertility-preserving treatment? A. OCPs B. GnRH agonist C. Laparoscopic cystectomy D. Danazol 49. A 6-year-old with isolated thrombocytopenia, purpura. Diagnosis? A. HSP B. SLE C. PSGN D. ITP 50. A 28-year-old in labor with shoulder dystocia. Next step? A. McRoberts maneuver B. Fundal pressure C. Emergency CS D. Forceps delivery

1. A 55-year-old man with chest pain, ECG: ST elevation in anterior leads. First drug to be given? A. Aspirin B. Clopidogrel C. Heparin D. Streptokinase 2. A 45-year-old hypertensive with diabetes and CKD. Which drug slows nephropathy? A. ACE inhibitors B. Beta-blockers C. Thiazides D. CCB 3. A 60-year-old man with sudden right hemiplegia, slurred speech. CT brain normal. Likely cause? A. Hemorrhage B. Ischemic stroke C. TIA D. Tumor 4. A 40-year-old man with chronic alcohol use develops confusion, ophthalmoplegia, ataxia. Cause? A. Hypoglycemia B. Thiamine deficiency C. B12 deficiency D. Wernicke’s encephalopathy 5. A 25-year-old with fever, chills, rose spots on abdomen. Blood culture: Salmonella typhi. Best drug? A. Azithromycin B. Ceftriaxone C. Ciprofloxacin D. Doxycycline 6. A 30-year-old man with asthma and HTN. Which antihypertensive is contraindicated? A. Propranolol B. Amlodipine C. Enalapril D. Prazosin 7. A 60-year-old man with atrial fibrillation is started on warfarin. Which test is monitored? A. PT/INR B. aPTT C. Platelet count D. Bleeding time 8. A 20-year-old woman with generalized seizures. Drug causing weight gain, hepatotoxicity? A. Phenytoin B. Valproate C. Carbamazepine D. Ethosuximide 9. A 28-year-old woman with recurrent oral ulcers, genital ulcers, uveitis. HLA-B51 positive. Likely? A. SLE B. Crohn’s C. Behçet’s disease D. Sarcoidosis 10. A 40-year-old alcoholic with aspiration pneumonia. Sputum: red currant jelly. Organism? A. Pneumococcus B. Klebsiella C. Staph aureus D. Pseudomonas 11. A 35-year-old man with DVT is on heparin. Which test monitors therapy? A. aPTT B. PT C. INR D. Bleeding time 12. A 30-year-old man with sickle cell anemia has recurrent painful crises. Which drug reduces them? A. Hydroxyurea B. Folic acid C. Iron D. B12 13. A 45-year-old woman with long QT syndrome. Which drug is avoided? A. Amiodarone B. Metoprolol C. Digoxin D. Atenolol 14. A 60-year-old with Parkinson’s disease develops tremor and rigidity. DOC? A. Amantadine B. Levodopa + carbidopa C. Bromocriptine D. Selegiline 15. A 35-year-old man with fungus ball in lung cavity after TB. Likely organism? A. Candida B. Aspergillus C. Cryptococcus D. Nocardia 16. A 55-year-old man with chest pain, ST depression, positive troponin. Diagnosis? A. NSTEMI B. STEMI C. Unstable angina D. Stable angina 17. A 25-year-old man with organophosphate poisoning, miosis, fasciculations. Antidote? A. Atropine B. Pralidoxime C. Diazepam D. Neostigmine 18. A 30-year-old with watery diarrhea after travel. Stool culture: Vibrio cholerae. Mechanism? A. Endotoxin B. Heat-labile toxin C. Enterotoxin ↑cAMP D. Neurotoxin 19. A 60-year-old man on gentamicin develops rising creatinine. Mechanism? A. Hepatotoxicity B. Ototoxicity C. Nephrotoxicity D. Neurotoxicity 20. A 35-year-old man with fever, conjunctivitis, cracked lips, LAD. Diagnosis? A. Kawasaki disease B. Scarlet fever C. Measles D. Diphtheria 21. A 28-year-old woman with sudden weakness of face, Bell’s palsy. Best initial drug? A. Acyclovir B. Prednisolone C. Ceftriaxone D. Amoxicillin 22. A 50-year-old man with pneumonia, hyponatremia, diarrhea after hotel stay. Organism? A. Pneumococcus B. Legionella C. Klebsiella D. Mycoplasma 23. A 30-year-old with painless penile ulcer, non-tender lymph nodes. Organism? A. H. ducreyi B. T. pallidum C. Chlamydia D. Klebsiella 24. A 6-year-old with palpable purpura, arthritis, hematuria. IgA deposition. Likely? A. SLE B. HSP C. Rheumatic fever D. ITP 25. A 60-year-old man with ICU stay develops sepsis with Candida. Best drug? A. Fluconazole B. Amphotericin B C. Caspofungin D. Voriconazole 26. A 55-year-old with hemoptysis, sinusitis, c-ANCA positive. Diagnosis? A. Goodpasture’s B. GPA (Wegener’s) C. Sarcoidosis D. TB 27. A 25-year-old IV drug user with fever, murmur. Blood culture: S. aureus. Valve? A. Mitral B. Aortic C. Pulmonary D. Tricuspid 28. A 30-year-old HIV patient with odynophagia, white plaques in esophagus. Organism? A. Candida B. HSV C. CMV D. EBV 29.

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Answers ✅ 1. C ✅ Reduced oxygen carrying capacity → ischemia worsens in IDA + MI. 2. C ✅ In anemia, CO demand ↑ → worsens MS symptoms. 3. B ✅ PV: high Hb, low EPO, HTN, splenomegaly. 4. A ✅ INR 6 + bleed → FFP best immediate. 5. B ✅ Sickle trait + HCM = arrhythmia/sudden death risk ↑. 6. C ✅ AF + thrombocytosis → highest risk thromboembolism. 7. B ✅ Sickle cell + chest pain + infiltrates = Acute chest syndrome. 8. B ✅ B12 deficiency correction improves O2 delivery → angina relief. 9. C ✅ Hemolysis due to prosthetic valve (mechanical destruction). 10. B ✅ Myelofibrosis: tear drops, nucleated RBCs, fibrosis. 11. A ✅ PV with hyperviscosity worsens arrhythmias in long QT. 12. B ✅ Angina worsens due to reduced O2 delivery. 13. C ✅ Severe anemia + tachycardia → urgent transfusion. 14. A ✅ HIT → paradoxical thrombosis despite low platelets. 15. B ✅ CML = BCR-ABL mutation. 16. A ✅ Clopidogrel → drug-induced immune thrombocytopenia. 17. C ✅ Severe anemia worsens LVOT obstruction via ↓ O2 delivery. 18. B ✅ COPD + hypoxia + high EPO = secondary polycythemia. 19. A ✅ Corrects on mixing study = Vit K dependent factor deficiency. 20. C ✅ Stroke despite therapeutic INR = embolus despite anticoag. 21. C ✅ Severe anemia → high-output heart failure. 22. C ✅ B12 corrects anemia + arrhythmias. 23. A ✅ Sickling = rigid RBC membranes → vaso-occlusion. 24. A ✅ Prosthetic valve → mechanical destruction of RBCs. 25. B ✅ >20% blasts = AML. 26. A ✅ PV: ↑Hb, ↑WBC, ↑platelets, JAK2 mutation. 27. B ✅ Anemia → high flow states → functional murmurs. 28. A ✅ Zidovudine causes marrow suppression → aplastic picture. 29. A ✅ Aspirin/clopidogrel cause platelet dysfunction (not count drop). 30. B ✅ Hyperviscosity in cyanotic heart disease → stroke risk. 31. A ✅ HIT = IgG antibodies against PF4-heparin. 32. B ✅ Severe anemia → mid-diastolic flow murmur. 33. C ✅ Marathon dehydration → relative polycythemia. 34. A ✅ GI bleed with INR 4.5 → Vit K + PCC/FFP. 35. A ✅ Sickle disease → chronic hemolysis. 36. B ✅ PV = JAK2 mutation. 37. A ✅ Very high platelets → ET → MI risk ↑. 38. A ✅ Auer rods → AML. 39. A ✅ Shear stress degrades vWF multimers in AS. 40. A ✅ LMWH is anticoagulant of choice in pregnancy with prosthetic valve. 41. A ✅ Hyperviscosity due to polycythemia → stroke. 42. A ✅ Flow murmur in severe anemia. 43. A ✅ IDA → decreased myocardial O2 delivery. 44. C ✅ Dual antiplatelets (both) cause ICH. 45. A ✅ Repeated transfusions → secondary hemochromatosis. 46. A ✅ ACEIs rarely cause hemolysis (immune). 47. D ✅ Protein C deficiency = venous + arterial thrombosis. 48. A ✅ RCC → paraneoplastic ↑EPO → secondary polycythemia. 49. A ✅ Severe anemia → bounding pulse, hyperdynamic circulation. 50. A ✅ Myelofibrosis often progresses to AML.

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38. A 40-year-old man with cardiomyopathy. BM biopsy: blasts with Auer rods. Hb 7 g/dL, WBC 50k. Diagnosis? A. AML B. ALL C. CML D. Myelofibrosis 39. A 60-year-old male with aortic stenosis, develops acquired vWD, mucosal bleeds. Mechanism? A. High shear stress degrading vWF B. Platelet destruction C. Marrow failure D. Factor VII deficiency 40. A 28-year-old woman with prosthetic mitral valve on warfarin. Gets pregnant. What anticoagulant preferred? A. LMWH B. Heparin C. NOAC D. Continue warfarin 41. A 20-year-old with cyanotic heart disease, recurrent strokes. Hb 20 g/dL. Mechanism? A. Polycythemia-induced hyperviscosity B. Iron deficiency C. Low platelets D. Coagulopathy 42. A 55-year-old man with angina. Hb 7 g/dL, smear: hypochromic cells. Which murmur most likely? A. Flow murmur B. Aortic stenosis C. Mitral regurgitation D. PDA 43. A 35-year-old woman with fatigue, spoon nails, exertional angina. Hb 5 g/dL, ferritin ↓. Pathophysiology? A. Decreased myocardial O2 delivery B. LV hypertrophy C. Coronary spasm D. Arrhythmia 44. A 50-year-old post-MI patient on dual antiplatelets. Develops intracranial hemorrhage. Platelets normal. Which drug causes? A. Aspirin B. Clopidogrel C. Both D. Warfarin 45. A 28-year-old sickle cell patient with repeated transfusions, dyspnea, cardiac hypertrophy. Ferritin very high. Complication? A. Secondary hemochromatosis B. Marrow suppression C. Leukemia D. Renal failure 46. A 65-year-old hypertensive with heart failure. On ACEI. Develops anemia with high retics. Likely cause? A. Hemolysis due to ACEI B. Marrow suppression C. Iron deficiency D. Aplastic anemia 47. A 35-year-old male with recurrent DVT, family history +. Tests: Protein C deficiency. Risk in CVS? A. MI B. Stroke C. Pulmonary embolism D. All of the above 48. A 55-year-old smoker with hematuria. Hb 19 g/dL, Hct 65%, EPO ↑. Likely cause? A. RCC B. PV C. COPD D. High altitude 49. A 25-year-old with exertional dyspnea, flow murmur. Hb 5 g/dL. Which sign most likely? A. Bounding pulse B. Narrow pulse pressure C. Hypotension D. Pulsus paradoxus 50. A 70-year-old man with anemia, splenomegaly, tear drop cells. BM biopsy: fibrosis. Likely outcome? A. Progression to AML B. Spontaneous cure C. Regression D. CML

18. A 55-year-old smoker with COPD presents with polycythemia, Hb 20 g/dL, Hct 65%. O2 sat 86%. EPO ↑. Most likely diagnosis? A. Polycythemia vera B. Secondary polycythemia C. Relative polycythemia D. Myelofibrosis 19. A 25-year-old man with recurrent epistaxis, gingival bleeding. Platelets 3 lakh/µL, prolonged PT & aPTT. Mixing study corrects PT. Which deficiency? A. Vitamin K deficiency B. Hemophilia A C. Hemophilia B D. Factor VII deficiency 20. A 70-year-old with atrial fibrillation on warfarin. INR 2.8. Develops ischemic stroke. Which mechanism best explains event? A. Subtherapeutic INR B. Hypercoagulable state C. Embolus despite anticoagulation D. Aspirin resistance 21. A 30-year-old woman with exertional palpitations, fatigue. Hb 5 g/dL, microcytosis. ECG: sinus tachy. Echo: high cardiac output state. What is the anemia effect? A. Decreased preload B. Decreased afterload C. High-output heart failure D. Low-output heart failure 22. A 40-year-old alcoholic presents with megaloblastic anemia, Hb 6 g/dL, macro-ovalocytes. ECG: sinus tachy, occasional PVCs. Which supplement corrects both anemia & arrhythmia? A. Iron B. Folic acid C. Vit B12 D. Pyridoxine 23. A 20-year-old man with sickle cell disease, chest pain & priapism. ECG: sinus tachycardia. Which mechanism explains recurrent vaso-occlusion? A. Increased RBC membrane rigidity B. Decreased MCV C. Splenic sequestration D. Low HbA2 24. A 45-year-old man post-MI develops fever, murmur, splinter hemorrhages. Hb 9 g/dL, high retics, schistocytes. Mechanism of anemia? A. Mechanical destruction B. Nutritional deficiency C. Immune mediated D. Decreased production 25. A 70-year-old man with angina. Hb 8 g/dL. Bone marrow: >20% blasts. Likely diagnosis? A. CML B. AML C. Myelodysplasia D. Myelofibrosis 26. A 50-year-old male with long QT syndrome. Hb 19 g/dL, WBC 14,000, platelets 7 lakh. Which is most likely? A. PV B. Secondary polycythemia C. Myelofibrosis D. CML 27. A 32-year-old female with exertional palpitations. Hb 8 g/dL, low ferritin. Echo: flow murmur at left sternal border. Cause of murmur? A. Valvular stenosis B. Anemia-induced flow murmur C. Congenital shunt D. Prosthetic valve 28. A 40-year-old HIV patient on zidovudine. Develops pallor, exertional dyspnea. Hb 6 g/dL, low retics. Likely mechanism? A. Marrow suppression B. Hemolysis C. Iron deficiency D. Vit B12 deficiency 29. A 60-year-old diabetic on aspirin & clopidogrel presents with hematuria. Platelets 2.5 lakh/µL, PT/aPTT normal. Cause of bleeding? A. Platelet dysfunction B. Thrombocytopenia C. DIC D. Vit K deficiency 30. A 25-year-old male with cyanotic heart disease. Hb 22 g/dL, Hct 70%, EPO ↑. Main risk? A. MI B. Stroke C. Infective endocarditis D. Arrhythmia 31. A 45-year-old man with unstable angina on unfractionated heparin. After 5 days, platelets drop 50%. Mechanism? A. IgG to PF4-heparin complex B. Direct platelet destruction C. Bone marrow suppression D. Complement activation 32. A 70-year-old hypertensive with LVH, angina. Hb 7 g/dL, microcytosis. Most likely murmur? A. Systolic ejection murmur B. Mid-diastolic flow murmur C. Holosystolic murmur D. Continuous murmur 33. A 25-year-old male with chest pain post marathon. Hb 20 g/dL, Hct 65%. EPO normal. Likely diagnosis? A. PV B. Secondary polycythemia C. Relative polycythemia D. Myelofibrosis 34. A 55-year-old man with prosthetic valve on warfarin. Develops GI bleed. INR 4.5. Management? A. Vit K + PCC B. Stop warfarin only C. Platelet transfusion D. Aspirin 35. A 30-year-old sickle cell patient with exertional dyspnea. Hb 6 g/dL, retics high, indirect bilirubin ↑. Likely cause? A. Hemolysis B. Marrow suppression C. IDA D. B12 deficiency 36. A 60-year-old man with fatigue, pruritus post hot shower, splenomegaly. Hb 19 g/dL, Hct 65%, EPO low. Likely mutation? A. BCR-ABL B. JAK2 C. CALR D. MPL 37. A 25-year-old man with severe chest pain, ST elevation. Platelets 8 lakh/µL. Which disorder? A. ET B. PV C. CML D. DIC