health professional for coc preparation

c. Hypochondriasis   Ans. The key is A. Somatization. [Somatization disorder is  patients presenting with any physical symptom and frequent medical visits in spite of negative investigations].   1335. A 26yo man has returned from NY to the UK and noticed weight loss, night sweats, temp=37.5C and cervical lymphadenopathy. He also has splenomegaly. What is the dx? a. TB b. Lymphoma c. Bronchial carcinoma d. Bronchitis   Ans. The key is B. Lymphoma. [Splenomegaly favours lymphoma].   1336. A mother got infected with Hep B during pregnancy. Her child is born and she is worried about the risk of infection to the baby with Hep B. What would you give to the baby? a. Hep B Ig only b. Hep B full vaccine and Ig c. Hep B vaccine only once d. Nothing until immune status is checked e. Hep B vaccine once and Ig   Ans. The key is B. Hepatitis B full vaccine and Ig.   1337. A man suffers from Herpes Zoster affecting his face. Which of the following mucos membrane is to be affected? a. Cheek b. Cornea c. Conjunctiva d. Oropharynx e. Palate   Ans. The key is C. Conjunctiva. [If maxillary or ophthalmic division is not mentioned but only mentions face it means ophthalmic branch more commonly around eye. Herpes zoster ophthalmicus can cause following lesions blepheritis, conjunctivitis, keratitis, anterior uveitis etc. As question wants mucous membrane and among the mentioned lesions only conjunctiva is mucous membrane the answer is conjunctiva].   1338. A 34yo man sustains a fx to shaft of femur after falling from the roof of his house. Exam: distal pulses are not palpable. Which vessel is damaged? a. Femoral artery b. Circumflex femoral artery c. Profundafemoris artery d. Popliteal artery e. Obturator artery f. Dorsalispedis artery   Ans. The key is A. Femoral artery.   1339. A 9yo child doesn’t play with his peers and has collected 200 cars. He doesn’t respond to any criticism. What is the dx? a. Autism b. Personality disorder c. Schizophrenia d. Rett syndrome e. Social anxiety   Ans. The key is A. Autism.   1340. A 63 yo man with vague but persistent pain. On endoscopy: columnar epithelium was found to be pouched into muscularis. What is the dx? a. Adenocarcinoma b. Adenoma c. Peptic ulcer d. H. pylori infection   Ans. The key is A. Adenocarcinoma.   1341. A 24yo man after a head injury presents with difficulty dressing himself, difficulty in writing and inability to differentiate the fingers of his hand. Which part of the brain is most likely to be affected? a. Frontal lobe b. Parietal lobe c. Temporal lobe d. Occipital lobe e. Brainstem   Ans. The key is B. Parietal lobe. [Dressing apraxia, agraphia and finger agnosia are features of parietal lobe lesions].   1342. A 16yo boy in boarding school feels unwell. He developed cough and rash. His CXR showed bilateral consolidations. What is the cause of his symptoms? a. Staph aureus b. Legionella  c. Mycoplasma  d. Streptococcus Ans. The key is C. Mycoplasma. [Rash, bilateral consolidation favours mycoplasma pneumonia. Mycoplasma is common in military barrack, prison or boarding dwellers].   

  1326. A homeless person is found wandering on the street. He had ataxic gait, nystagmus and opthalmoplegia. He looked unkempt and his clothes had a sweaty odour. He had a dry mucous membrane with a BP=118/70mmHg and PR=90bpm. Blood sugar level=8. Alcohol breath test= - ve. What would the most imp initial inv? a. IV insulin b. Vit B complex c. Bolus IV 0.9%NS d. IV dextrose e. Antibiotics   Ans. The key is B. Vit B complex. [This is wernicke’s encephalopathy due to alcohol withdrawal, so Vit B complex should be checked. This occurs mainly due to thiamine deficiency].   1327. A 34yo man has supra-orbital pain and tenderness and developed tenderness over the maxilla. He also has mild fever. What is the single likely cause for these symptoms? a. Acute sinusitis b. GCA c. Trigeminal neuralgia d. Maxillary carcinoma   Ans. The key is A. Acute sinusitis. [There is supraorbital pain in frontal sinusitis and tenderness over maxilla in maxillary sinusitis. Also mild fever may present in acute sinusitis].   1328. A 51yo woman presents with painful tongue and complains of tiredness. She is pale and has angular stomatitis and a smooth red tongue. There is no koilonychea. Choose the single cell type you will find on the blood film. a. Numerous blast cells b. Oval macrocytes c. Spherocytes d. Microcytic hypochromic e. Mexican hat cells f. Erythrocytes Ans. The key is B. oval macrocytes. [Macrocytes are two types, round and oval. Oval macrocytes are seen in megaloblastic anemia which occurs due to Vit B12and/or folic acid deficiency. Glossitis (painful tongue), angular stomatitis and smooth tongue are though characteristic feature of iron deficiency but also known feature of megaloblastic anemia. Absence of koilonychea also favours megaloblastic anemia].   1329. A 24yo woman presents with tingling and twitching of her fingers followed by throbbing unilateral headache. What is the most likely dx? a. Tension headache b. Migraine c. Cluster headache d. TIA e. SAH   Ans. The key is B. Migraine. [The tingling and twitching of her fingers are aura and the migraine is with aura].   1330. A young child dx with chicken pox. Usually goes to day care. What is the most appropriate advice? a. Child should be admitted to hospital straight away b. Isolate the child from parents and siblings at home c. Advice that he can go back to nursery when the rash is crusted over   Ans. The key is C. Advice that he can go back to nursery when the rash is crusted over. [At this stage patient is no more infectious].   1331. A 7yo boy is brought by his mother. There are multiple perioral and forehead vesicles. Some vesicles are crusted and some are not. The face is hot. What is the most likely dx? a. Varicella zoster b. Herpes zoster c. Fungal infection d. Impetigo e. Psoriasis   Ans. The key is B. Herpes zoster.   1332. A 5yo boy is rescued from a burning building and is presented to the ED. He has 5% partial thickness burns over the arms and legs and had soot in the mouth and nose. His breathing has become noisy. What is the single most immediate management? a. Nebulized adrenaline b. Nebulized salmetarol and oxygen c. Needle cricothyrodotomy d. Oropharyngeal airway e. Intubation of airway   Ans. The key is E. Intubation of airway. [Soot in the mouth and nose and noisy breathing occurs in inhalation injury where intubation of the airway is indicated].   1333. A new born baby is borught with pansystolic murmur at sternal border but the baby is not cyanosed. What is the dx? a. VSD b. ASD c. TOF d. PDA   Ans. The key is A. ventricular septal defect. [Pancystolic murmur in sternal border without cyanosis is indicative of VSD].   1334. A woman complaining of diarrhea, abdominal pain and fatigue. All the tests are found to be normal. What is the cause? a. Somatization b. Conversion

b. Prostate ca c. BPH   Ans. The key is A. Hyperensive renal disease. [Small kidneys suggest chronic renal failure and uremia here is the cause of anorexia. As elder he may have associated prostate symptoms from concomitant BPH].   1319. A 55yo woman with breast ca which has spread to lung, liver and bone now presents with increasing constipation, weakness, thirst and anorexia for the past 3d. Her only medication is haloperidol for hiccoughs. Today she is disorientated and has left sided weakness. What is the most likely dx? a. Brain mets b. Hypercalcemia c. Liver failure   Ans. The key is A. Brain mets. [The patient has clinical hypercalcemia, but the neurological features of disorientation and left sided weakness can only be explained with brain metastasis].   1320. A 22yo man presents with a red, hot, swollen, metatarsal phalangeal joint, sarcoilitis and onycholysis. What is the single most likely cause of his condition? a. Gout b. RA c. Reiter’s syndrome d. Psoriatic arthropathy   Ans. The key is D. Psoriatic arthropathy. [Psoriatic arthritis initially can affects the toes very similar to gout. There can be sacroilitis and onycholysis. Ref: patient.info].   1321. Which of the following conditions requires operative management? a. Cellulitis b. Dyshidrosi c. Erysipelas d. Fournier’s gangrene e. Lymphangitis Ans. The key is D. Fournier’s gangrene. [Fournier's gangrene: A horrendous infection of the genitalia that causes severe pain in the genital area (in the penis and scrotum or perineum) and progresses from erythema (redness) to necrosis (death) of tissue. Gangrene can occur within hours].   1322. A 55yo pt presents with collapse and complains of abdominal pain that radiates to the back. An expansile abdominal mass is felt on examination and the pt is in shock. What is the single most likely dx? a. Ruptured aortic aneurysm b. Renal colic c. Trauma d. Endocarditis e. Atheroma   Ans. The key is A. Ruptured aortic aneurysm.   1323. A house-bound 78yo man with severe COPD has had a gradual deterioration over recent months and is now breathless at rest. He is on maximal inhaled medical therapy. Result: pH=7.36, PaCO2=5.9kPa, PaO2=6.9kPa. What is the single most appropriate additional tx? a. Aminophylline PO b. ACEi PO c. Antibiotic PO d. Oxygen e. Steroid PO   Ans. The key is D. Oxygen. [In patients with chronic hypoxaemia, LTOT should usually be prescribed after appropriate assessment, when the PaO2 is consistently at or below 7.3 kPa (55 mm Hg) when breathing air during a period of clinical stability. Clinical stability is defined as the absence of exacerbation of chronic lung disease for the previous five weeks. The level of PaCO2(which may be normal or elevated) does not influence the need for LTOT prescription].   1324. A 79yo man has a swelling of the right groin which was clinically dx to be indirect inguinal hernia. What is the single feature of the hernia sac that would confirm the dx? a. Comes through femoral ring b. Doesn’t pass through the deep inguinal ring c. Lies below and lateral to the pubic tubercle d. Only passes through the superficial inguinal ring e. Passes through the deep inguinal ring   Ans. The key is E. Passes through the deep inguinal ring. [Ingunal hernia lies mostly above and medial (occasionally lateral particularly when small) to pubic tubercle. It first enters the inguinal canal through deep inguinal ring and then enters the scrotum through the superficial inguinal ring].   1325. A 56yo woman with hx of breast cancer 10y ago has undergone radical mastectomy and axillary LN removal, now complains of swollen upper limb 3wks after an insect bite. The bite site is better but gross edema is still present. What is the cause? a. Lymphedema b. Breast Ca c. Allergy d. Filariasis Ans. The key is A. Lymphedema. [As during mastectomy axillary clearance is done, lymphatics on that upper limb is compromised. So there occurs lymphedema].

  1310. A 10yo boy with lower abdominal pain for the last 10d presents with a hx of passing 6-8 loose stools. Temp=38.8C. He is tender in the right lower quadrant and has an anal fistula. Choose the single most likely cause of abdominal pain. a. IBD b. IBS c. Pyelonephritis d. Uretric calculus e. Gastroenteritis Ans. The key is A. IBD. [Likely diagnosis is crohn’s disease which is often associated with perianal fistula formation].   1311. A 28yo woman with hx of drug addiction wants to start a family and have a baby. She would like to stop taking heroin and asked for something to help her stay away from it. What drug tx would you give her? a. Naloxone b. Acamprosate c. Methadone d. Chlordiazepoxide e. Naltrexone Ans. The key is C. Methadone. [Methadone is a powerful synthetic analgesic drug which is similar to morphine in its effects but less sedative and is used as a substitute drug in the treatment of morphine and heroin addiction].   1312. A pt with vesicles in the maxillary divison of trigeminal nerve. Which area of mucus membrane will be involved? a. Palate b. Cheek c. Cornea d. Conjunctiva   Ans. The key is B. Cheek. [It also involve soft palate but not hard palate. So cheek is more complete answer than palate].   1313. A 52yo man presents with visual hallucinations and features of cognitive impairment. What is the most likely dx? a. Frontotemporal dementia b. Lewy body dementia c. Delirium tremens d. Alzheimer’s disease e. Huntington’s disease Ans. The key is B. Lewy body dementia. [Visual hallucinations and cognitive impairment are suggestive of Lewy body dementia. Hallucination is prominent feature of LBD than Alzheimers. Again cognitive impairment goes more with LBD while prominent early memory loss symptom suggests Alzheimer’s].   1314. A 40yo woman who has recently returned from working in the middle east complains of thirst, episode of loin pain, urinary frequency, dysuria and has passed a urinary stone. All inv are normal. She plans to return to the Middle East in a month’s time. What is the single best advice to prevent recurrent stone formation? a. Drink less milk b. High fibre diet c. Increase fluid intake d. Low calcium diet e. Low protein diet   Ans. The key is C. Increased fluid intake. [ Risk factors for renal stones include being overweight, certain foods, some medications, and not drinking enough fluids].   1315. A 32yo man presents with 3d of scrotal pain. Exam: thickening o the left testis and it is hot to touch. What is the most appropriate management? a. Analgesia b. Reassurance c. Antibiotics d. Referral to surgeon   Ans. The key is C. Antibiotics. [scrotal pain of 3 days with thickening of testis which is hot to touch suggests epididymoorchitis, which is treated with antibiotics].   1316. A 34yo woman presents with truncal obesity, easy bruising, hyperglycemia, high BP and depression. Which of the following inv’s will be most helpful in localizing the cause for Cushing’s syndrome? a. Serum cortisol b. 24h urinary cortisol c. Low dose dexamethasone suppression test d. High dose dexamethasone suppression test e. Overnight dexamethasone suppression test Ans. The key is D. High dose dexamethasone suppression test. [High dose dexamethasone suppression test can identify whether pituitary adenoma or ectopic ACTH producing tumour].   1317. A 32yo man develops hematuria 2wks after a sore throat. What is the dx? a. Post infection nephritis b. IgA nephropathy c. Membranous nephritis d. Glomerulonephritis   Ans. The key is A. Post infection nephritis. [Hematuria 2 wks after sorethroat indicate post infection nephritis while hematuria after few days of sorethroat indicate IgA nephropathy].   1318. An elder man who has anorexia, prostate symptoms and HTN. There are small kidneys on US. What is the dx? a. Hypertensive renal disease

1301. The biological parents of a child with CF come to you to know about the chances of their future children with the same disease. What would you say to them? a. There is a 1:4 chance that your future child will have this disease b. All their unaffected children will be carriers of CF c. Nothing can be predicted d. It can 100% dx antenatally Ans. The key is A. There is a 1:4 chance that your future child will have this disease. [It is autosomal recessive disease. As one child is affected both parents are carrier. So in this case next child will be normal in 1:4 case, carrier in 1:2 cases and diseased in 1:4 cases].   1302. A 14yo boy presents with recurrent abdominal pain, malaise and weight loss over 6m. Exam: vague mass is felt in RIF. Colonoscopy shows transmural inflammation and granulomata. What is the most appropriate management? a. Sulfasalazine b. Paracetamol c. Metronidazole d. Ibuprofen Ans. The key is C. Metronidazole. It is a wrong key. Correct key should be A. Sulfasalazine. [Drug of 1st preference is Steroids, then immunosuppressants, then amynosalicylates (such as sulfasalazine). Metronidazole is used if there is infective complications like infected perianal fistula Ref: patient.info].   1303. A 62yo prv shipyard worker complains of breathlessness and chest pain for 6m. He has now developed a large pleural effusion. Which is the single best diagnostic inv? a. ABG b. Bronchoscopy c. CXR d. Pleural biopsy e. Transfer factor   Ans. The key is D. Pleural biopsy. [Shipyard worker is exposed to asbestos and the likely diagnosis here is mesothelioma for which single best investigation is pleural biopsy].   1304. A 67yo man presents with a hx of increasing confusion and drowsiness. He had a fall 2wk ago. CT head reveals a chronic subdural hematoma. What is the best management for this pt? a. Craniotomy b. Burr hole drainage c. Conservative management d. Excision and biopsy   Ans. The key is B. Burr hole drainage.   1305. A 45yo male with epigastric discomfort has been given triple therapy. He has now returned after 4wks of epigastric discomfort. What inv would you do for him? a. ECG b. H.pylori breath test c. Endoscopy and biopsy d. US   Ans. The key is C. Endoscopy and biopsy. This is a wrong key! Correct key is B. H. pylori breath test.     1306. A 13yo boy with umbilical pain for the last 12h presents with anorexia, nausea and has not passed a bowel motion 24h. What is your dx? a. Acute appendicitis b. IBD c. IBS d. Meckel’s diverticulum e. Muscle strain f. Ovarian cysts g. PID h. Psoas hematoma i. Pyelonephritis j. Uretric calculus   Ans. The key is D. Meckel’s diverticulum. [In appendicitis pain shifts to rt iliac fossa].   1307. A 46yo man with tachycardia has the following ECG. What is the most likely dx?  a. SVT b. VT c. Mobitz I heart block d. Atrial fibrillation e. WPW syndrome   Ans. The key is E. WPW syndrome. [Short PR interval and slurred delta wave indicates WPW syndrome].   1308. A 24yo male is admitted with acute severe asthma. Tx is initiated with 100% oxygen, nebulized salbutamol and ipratropium bromide nebulizers and IV hydrocortisone. Despite initial tx there is no improvement. Which is the next step in management? a. IV aminophylline b. IV magnesium sulphate c. IV salbutamol d. IM adrenaline e. IV adrenaline   Ans. The key is B. IV magnesium sulphate.   1309. A 49yo 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, he chokes on food and has become confined to a wheelchair. What is the most likely dx? a. Cerebral tumor b. Myasthenia gravis c. Lambert-Eaton syndrome d. Motor neuron disease e. Cerebro-vascular disease Ans. The key is D. Motor neuron disease. [The picture is of amyotrophic lateral sclerosis with bulbar onset, so it has very bad prognosis].

  1300. A 45yo man has noticed difficulty hearing on the telephone. He is concerned because his father has been moderately hard of hearing since middle age. BC=normal. An audiogram shows moderate hearing loss in both ears across all frequencies. What is the single most likely dx? a. Acoustic neuroma b. Menieres’ disease c. Noise induced deafness d. Otosclerosis e. Presbyacusis   Ans. The key is D. Otosclerosis. [This patient has conductive hearing loss. So it is not acoustic neuroma. Meniere’s disease has symptoms like vertigo, tinnitus, fullness, along with hearing loss. There is no history of noise pollution not presbycausis as his age is 45. So his deafness fits more with otosclerosis. These are by exclusion. Points in favour of otosclerosis: i) Conducting hearing loss. ii) Age of 45 yrs iii) Moderate hearing loss in both ears across all frequencies].

But yet to certain that he is not diabetic fasting blood glucose concentration should be done in follow up visit].   1291. At birth, a baby boy at 38wks GA weighs 1.8kgs. He has hepato-splenomegaly and a rash. Blood test show raised level of bilirubin and liver enzymes. What is the most likely dx? a. Galactosemia b. Biliary atresia c. G6PD deficiency d. Rh incompatibility e. Congenital viral infection   Ans. The key is E. Congenital viral infection. [Congenital infections affect the unborn fetus or newborn infant. They are generally caused by viruses that may be picked up by the baby at any time during the pregnancy up through the time of delivery. The more common viruses linked to congenital infections include the Cytomegalovirus (CMV), Herpes, Rubella (German measles), Parvovirus, Varicella (chickenpox), and Enteroviruses].   1292. A 12yo boy with T1DM has poor long-term control. He is unconscious, hyperventilating and dehydrated. His blood glucose is 28mmol/l. What is the single most imp initial tx? a. Albumin IV b. Bicarbonate IV c. Insulin IV d. Insulin SC e. Saline 0.9% IV   Ans. The key is E. Saline 0.9% IV. [Probable diabetic ketoacidosis. Initial treatment is IV fluid (0.9% saline)].   1293. A 30yo woman on OCP presents with dilated tortuous veins crossing her abdomen to join the tributaries to SVC. What is the single most likely cause? a. Intra-abdominal malignancy b. Ovarian cyst c. Fibroids d. Ascites e. DVT   Ans. The key is A. Intra-abdominal malignancy.   1294. An 84yo woman with drusen and yellow spots in the center of retina. What is the single most likely dx? a. Macular degeneration b. HTN retinopathy c. MS d. DM background e. Proliferative DM retinopathy   Ans. The key is A. Macular degeneration. [In early disease, the macula shows yellowish-colored subretinal deposits called “drusen”].   1295. A pt presents with headache, blurring of vision and acuity loss. On fundoscopy, dots and blots were noted with huge red swollen optic disc. What is the most probable dx? a. CRAO b. Branch RAO c. CRVO d. Optic atrophy   Ans. The key is C. CRVO.   1296. A 64yo DM has come for a routine eye check up. Fundoscopy: new vessels all over the retina. What is the most appropriate management? a. Strict sugar control b. Regular eye check ups c. Non urgent referral to specialist d. Laser photocoagulation e. Insulin   Ans. The key is D. Laser photocoagulation. [Neovascularization suggests proliferative diabetic retinopathy which is treated with laser photocoagulation].   1297. A 25yo primigravida of 8wk GA presents with severe lower abdominal pain, vaginal bleeding and passage of clots. The internal os is open. What is the most likely dx? a. Appendicitis b. Placental abruption c. Ectopic pregnancy d. Abortion   Ans. The key is abortion. [Up to 24 weeks termination of pregnancy is abortion. Ref: patient.info]   1298. A man developed intense pain after using the end of a pencil to scratch his inner ear. He took out the pencil from his ear and realized the end of the pencil with the rubber part is still stuck in his ear. What is the most appropriate management? a. Remove with a hook b. Instill olive oil c. Remove GA d. Remove with magnet instrument e. Do syringing   Ans. The key is A. Remove with a hook. [Place a hook behind the object and pull it out].   1299. A 16yo boy presents with acute pain in the right ear and little bleeding from the same ear. He had been in a boxing match and had sustained a blow to the ear. There is little amount of blood in the auditory canal and a small perforation of the eardrum. What is the most appropriate management? a. Admission for parental antibiotics b. Nasal decongestant c. Oral amoxicillin d. OPD review e. Packing of ear f. Surgical intervention g. Syringing ENT   Ans. The key is C. Oral amoxicillin. [Small perforations are usually heal by themselves within 6-8 weeks and doctors often prescribe antibiotics to prevent infections during this healing period].

  1281. An obese lady presents with primary amenorrhea. She has high LH, normal FSH and slightly high prolactin levels. Choose the single most likely dx? a. PCOS b. POF c. Hypothyroidism d. Pregnancy e. Primary obesity   Ans. The key is A. PCOS. [High LH, high or normal FSH with slight rise in prolactin levels in an obese lady is suggestive of PCOS].   1282. A 38yo lady presents with amenorrhea has very high LH and FSH levels, normal prolactin and low estradiol. Choose the single most likely dx? a. PCOS b. POF c. Hypothyroidism d. Pregnancy e. Menopause   Ans. The key is B. POF. [High LH and FSH, normal prolactin and low estrogen in secondary amenorrhea in a lady under age 40 is highly suggestive of POF].   1283. A 77yo publican was admitted for an appendectomy. Post-op he becomes confused, agitated and starts to pick at things. He is then given an IV drug which settles this confusion. Which of the following drugs was given for his confusion? a. Diazepam b. Chlordiazepoxide c. Thiamine d. Vit B   Ans. The key is B. Chlordiazepoxide. [Patient is alcoholic. On admission abstinence from alcohol caused this withdrawal symptom. Agitation, confusion and pick at things are suggestive of delirium tremens which is treated with Chlordiazepoxide].   1284. A 65yo lady presents with dyspareunia. What will you give her for her condition? a. HRT b. COCP c. Estrogen gel d. Testosterone gel   Ans. No key is given. Likely key is C. Estrogen gel. [Seems to be atrophic vaginitis for which estrogen gel can be given].   1285. A 35yo lady with subserosal fibroid=4cm and submural fibroid=6cm is planning for a child. Which way will you remove the fibroids? a. Laproscopy b. Vaginal myomectomy c. Abdominal myomectomy d. Drugs e. Reassure   Ans. The key is B. Vaginal myomectomy. Probably wrong key! Correct key should be C. Abdominal myomectomy. [Subserosal fibroid is not suitable to treat with vaginal myomectomy. Abdominal myomectomy can deal with both subserosal and submural fibroid].   1286. A 32yo presents with heavy blood loss, US: uterine thickness>14mm. What is the best possible management for her? a. COCP b. UAE c. Hysteroscopy myomectomy d. Abdominal myomectomy e. Endometrial ablation   Ans. B. UAE. [COCP will not resolve the case. There is no fibroid so no myomectomy. Endometrial ablation may render the young lady non fertile. So UAE is the only suitable option here].   1287. A pt comes with sudden loss of vision. Exam: high BP. Fundoscopy: retina appears swollen. Which blood vessel occlusion is involved? a. Branch RVO b. Branch RAO c. CRAO d. CRVO   Ans. The key is D. CRVO.   1288. A 2yo girl has had a temp=39C, poor appetite, abdominal pain and urinary frequency for 3d. What is the single most appropriate inv? a. Catheter specimen of urine for culture b. Clean catch urine specimen for culture c. CBC d. KUB US e. Supra-pubic aspirate of urine for culture   Ans. The key is B. Clean catch specimen of urine for culture.   1289. A child with T1DM who is not compliant with meds and eats a lot. He thinks that he is short in his class. He is not happy. What would you do next? a. Refer to psychologist b. Refer to pediatrician c. Refer to GP d. Refer to social services e. Change type of insulin   Ans. The key is A. Refer to psychologist. [Not compliant with medicine, eating a lot, thinking of being short and being unhappy these are psychological issues. So he should be referred to psychologist].   1290. An 8yo boy with a BMI=28 was admitted to a surgical ward following a MVC. He was found to have glycosuria. When he recovered from his injury the glycosuria resolved. What is the single most appropriate follow-up inv? a. Fasting blood glucose conc b. Glycosylated hemoglobin - HbA1c c. OGTT d. Random blood glucose conc e. Serum cortisol conc   Ans. The key is A. Fasting blood glucose concentration. [The boy had glycosuria while treating in hospital following a MVC (motor vehical crush). It may be due to stress related cortisol release which later became nil as the boy recovered from trauma.

1272. A 28yo woman 8wks GA had PID treated prvly and now comes with vaginal bleeding, rigid abdomen, BP=80/50mmHg, pulse=140bpm. What is the most probable dx? a. Threatened abortion b. Miscarriage c. Missed abortion d. Tubal pregnancy e. Inevitable abortion   Ans. The key is D. Tubal pregnancy. [Previous PUD is a risk factor for tubal pregnancy].   1273. A 34yo primigravida who is 16wk GA comes for routine antenatal check up. Her BP=160/100mmHg. She has a hx of repeated childhood UTI. What is the most likely cause of her high BP? a. Essential HTN b. Chronic pyelonephritis c. Acute pyelonephritis d. Pre-eclampsia e. Chronic UTI   Ans. The key is B. Chronnic pyelonephritis. [35% of childhood UTI is associated with VUR and many of them develop renal scarring and chronic pyelonephritis causing hypertension].   1274. A 24yo woman has had lower abdominal pain for 12h. She is otherwise well. She is at 10wks GA in a planned pregnany. What is the single most appropriate test to inv the cause of acute abdomen in this lady? a. Abdominal US b. Anti-phospholipid screen c. CBC d. Transvaginal US e. Laparoscopy   Ans. The key is D. Transvaginal US. [D/D: ectopic pregnancy, renal colic, torsion of ovarian cyst, appendicitis etc. Transvaginal US will give better results in case of lower abdominal pain].   1275. A pt is at term and in labor, the membranes have ruptured, the liquor contains meconium but the CTG is normal. The cervix is 3cm dilated. What is the single most appropriate action? a. BP monitoring b. CTG c. C-section d. Fetal scalp blood sample e. Internal rotation   Ans. The key is D. Fetal scalp blood sample. This is wrong key. Correct key is CTG. [Till CTG is normal we should not switch to other option but continuing CTG].   1276. A pt is at term and labor. The head has been delivered and you suspect shoulder dystocia. What is the single most appropriate action? a. C-section b. Episiotomy c. External rotation d. Fetal scalp blood sample e. Instrumental delivery   Ans. The key is B. Episiotomy.   1277. A 29yo female at 28wks GA presents to you with complains of hard stools and constipation for last 2wks. CTG shows fetal tachycardia. What is the single most appropriate tx? a. Oral laxatives b. Fiber diet c. Phosphate enema d. Lactulose e. Reassure   Ans. The key is B. Fiber diet. [Changes to diet and lifestyle are often recommended as the first treatment for constipation. It includes high fiber diet and plenty of fluid, regular exercise etc.].   1278. A 16yo girl presents with heavy bleeding. What is the most appropriate initial inv? a. Endometrial sampling b. Transvaginal US c. Hysteroscopy d. Pelvic US e. Exam under anesthesia   Ans. The key is D. Pelvic US. [Pelvic or transvaginal ultrasound are same thing].   1279. A woman who is 7wks pregnant presents with excessive and severe vomiting and put on IV fluids and anti-emetic (ondansteron). She is complaining of severe headache and can’t take oral fluids. What is the most appropriate management? a. Termination of pregnancy b. TPN c. Feeds via NGT d. P6 acupressure e. IV hydrocortisone   Ans. The key is A. Termination of pregnancy. This is wrong key. Correct key is E. IV hydrocortisone. [Termination is the last resort! Before it IV hydrocortisone is tried. 1st oral antiemetics if fail perenteral antiemetics if fail iv hydrocortisone. Last resort is termination].   1280. A young lady with primary amenorrhea has normal LH, FSH, estradiol and prolactin. Choose the single most likely dx? a. PCOS b. POF c. Absent uterus d. Absent ovaries e. Turner’s syndrome   Ans. The key is C. Absent uterus. [Normal LH, FSH, estradiol and prolactin rule outs PCOS (increased LH, increased FSH, normal oestrogen. LH:FSH ratio is 2:1 or 3:1), POF (in POF, LH & FSH raised, FSH > 20 IU/L), Absent ovary will lead to low estradiol, high FSH and LH, Turner’s syndrome: gonadal streaks, as absent ovaries].

b. Concealed hemorrhage c. Primary PPH d. Secondary PPH e. Retained placenta f. Scabies   Ans. The key is D. Secondary PPH. [Secondary PPH occurs from 24 hours after delivery. Usually occurs between 5 and 12 days].   1264. A 22yo lady who is in her last trimester of pregnancy comes with hx of exposure to a child dx with chicken pox 1d ago. She was investigated and was +ve for varicella antibody. What is the single most appropriate management? a. Give varicella Ig b. Quarantine c. Give varicella vaccination d. Oral acyclovir e. Reassure   Ans. The key is E. Reassure. [If you have antibodies in your blood, this means you have had chickenpox in the past, or have been immunised. No further action is then needed].   1265.  A 22yo woman who is 20wk pregnant came with pain and bleeding per vagina. Exam: os is not open. What is the single most likely dx? a. Threatened abortion b. Missed abortion c. APH d. Miscarriage e. Inevitable abortion   Ans. The key is A. Threatened abortion.   1266. A 32yo lady G1, 28wks GA came to her ANC with a concern about pain relief during labour. She has no medical illnesses and her pregnancy so far has been uncomplicated. She wishes to feel her baby being born but at the same time she wants something to work throughout her labour. What method of pain relief best matches this lady’s request? a. C-section b. Pudendal block c. Entonox d. TENS e. Pethidine   Ans. The key is C. Entonox. [This is a mixture of oxygen and nitrous oxide gas. Gas and air won't remove all the pain, but it can help to reduce it and make it more bearable].   1267. A primipara at fullterm in labor has passed show and the cervix is 3cm dilated. What is the single most appropriate management for her labor? a. Repeat vaginal examination in 4h b. CTG c. IV syntocin drip d. Repeat vaginal examination in 2h e. Induction of labour   Ans. The key is A. Repeat vaginal examination in 4h.   1268. A 36yo pregnant woman comes for evaluation with her husband. Her husband has been complaining of morning sickness, easy fatiguability and even intermittent abdominal pain. What is the husband suffering from? a. Ganser syndrome b. Couvade syndrome c. Pseudo-psychosis d. Stockholm syndrome e. Paris syndrome   Ans. The key is B. Couvade syndrome. [Cauvade syndrome, also called sympathetic pregnancy, is a proposed condition in which a partner experiences some of the same symptoms and behavior of an expectant mother].   1269. A woman comes to the ED complaining of pain in the right side of the abdomen, she has 7wks amenorrhea. Her pregnancy test is +ve and US scan shows an empty uterus. What is the next step? a. Laparoscopy b. HCG measurements c. US d. Laparotomy e. Culdo-centhesis   Ans. B. HCG measurements. This is a wrong key! Correct key is A. Laparoscopy. [Surgery should be offered to those women who cannot return for follow-up after methotrexate or to those who have any of the following: ·         Significant pain. ·         Adnexal mass ≥35 mm. ·         Fetal heartbeat visible on scan. ·         Serum hCG level ≥5000 IU/L. A laparoscopic approach is preferable. A salpingectomy should be performed, unless the woman has other risk factors for infertility, in which case a salpingotomy should be undertaken].  [If HCG >6000IU/L and an intrauterine gestational sac is not seen, ectopic pregnancy is very likely, as is the case if HCG 1000–1500IU/L and no sac is seen on transvaginal Ultrasound].   1270. A 23yo woman who has had several recent partners has experienced post-coital bleeding on gentle contact. What is the single most likely cause of her vaginal discharge? a. Cervical ca b. Cervical ectropion c. CIN d. Chlamydial cervicitis e. Gonococcal cervicitis   Ans. D. Chlamydia cervicitis.          1271. A 68yo woman presents with post-coital bleeding following her first episode of sexual intercourse in 10yrs. What is the single most likely cause that has led to post-coital bleeding? a. Endometrial ca b. Atrophic vaginitis c. Endometrial polyp