1. A 46 years old lady, with no known medical illness.
1 months history of taking
slimming pills, presented with 3 days history of fever and rash.
other FBD- normal
eosinophil high
urea and creatinine raised
other RP normal
1) what other investigation you would like to do
2) what investigation to confirm and what will be the fidings?
3) what is your diagnosis?
4)
5) what is your management?
2. A 36 years old male, presented with high grade fever and headache. have history of
multiple sexual partner. no focal neurological deficit, CT normal, no neck stiffness.
Papiloedema bilaterally on fundoscopy. Lumbar puncture show High pressure lumbar
puncture >40mmHg.
1)what is your dx?
2)differential diagnosis?
3)what investigation you want to do and give reasons?
4)
5)how do you want to manage this patient?
3.
1. 75 years old male, chronic smoker (25 packs year) presented with progressive
shortness of breath and cough for 2 months. He had history of hemoptysis 2 weeks prior
to admission. He also had loss of appetite and loss of weight (5kg within 2 months).
On examination, the patient was cachexic and he had hoarseness of voice.
FBC & RP: Normal.
High Calcium level
CXR: Opacity on left upper lobe
a) What is the provisional diagnosis of his patient?
b) What is the abnormality on the chest x ray?
CXR picture was given showing left apical heterogenous opacities with blunting of left
cardiophrenic and costophrenic angle)
c) What causes of hypercalcaemia in this patient? Give 2 causes:
d) Investigations that you would like to do to confirm diagnosis?
e) Explain the causes of hoarseness of voice in this patient?
4.
42 years old lady with DM type 2, dyslipidaemia, hypertension presented with complaint
of 2 months retrosternal chest pain, dizziness and presyncopal attack. On further
questioning, patient complained of depression and weight gain. She on atenolol,
amlodipine, metformin and simvastatin.
On examination, patient has dry skin, coarse facial and bilateral non pitting edema?
ECG: Showed complete heart block
a) What is the name abnormality described in ECG?
b) List the 2 causes of ECG abnormality for this lady?
c) What are the investigations that will aid you in the diagnosis?
d) What are the management options to improve her condition? (2marks)
5.
A 56 year old male with history of diabetes and hypertension was currently on 1
antihypertensive. Noted BP to be not controlled on follow up. Urine examination was
noted to have microalbuminuria. RP was done noted creatinine of 150 mmol/l a
fundoscopy was done. (diebatic retinopathy pic)
a) what is the diagnosis
b) state 4 findings that is present in the fundoscopy finding
Perindopril was added on top of his current hypertension. The patient later presented to
the hospital noted creatinine level increased to 300 mmol/l
c) what caused the worsening creatinine level
d) what other investigation that you would like to do in this patient
e) How would you manage this patient
mcq
1) Acute exacerbation of COPD
a. irreversible on peak flow meter
b. main treatment is steroid
c. involve of easinophil
d. x ingat
e. x ingat
4. regarding life threatening asthma
A) Expected Peak exploratory flow rate is < 30%
B) intravenous corticosteroid had an immediate effect
C) absence of rhonchi and breath sound is the reassuring sign
D) hypercapnia is the indication for intubation
E)
5. A 56 years old woman, known case of systemic hypertension for 5 years came with
dyspnea associated with cough and bilateral pedal edema. Chest X-Ray shows pulmonary
congestion. Echocardiography reveals ventricular hypertrophy with preserved left
ventricular systolic function. Which of these drugs will improve her symptom?
A. Digoxin
B. Diuretics
C. ACE-inhibitor
D. Beta blocker
E. Calcium channel blocker
6. 55 year old gentleman presented with chest discomfort. The pain occured at rest,
heavy, radiated to the jaw lasted for 20 minutes and not relieved by sublingual GTN. Vital
signs are normal. ECG showed ST isoelectric and T depression at I aVL V5 and V6. Trop T
is 0.15 (0.02-0.1)
A. Most probable diagnosis is unstable angina
B. Immediate streptokinase is needed
C. involvement of anterior wall
D. Aspiriin need to be given
E. ow molecular weight heparin need to be given
8.following is/are adverse prognosis of acute pancreatitis
a. age >55y.o
b. corrected serum Ca >2
c. serum albumin
d. blood urea is 16
e. blood sugar level >10 mmol/L
10. The following is / are the causes of an intracranial space occupying lesion in HIV +
patient
A. toxoplamsa gondii T
B. Mycobacterium TB T
C. Cryptococcus Neoformans T
D. Pneumocystis Carinii (involve lungs) F
E. Progressive multifocal leucoenecphalopathy T
12 62 years old lady was admitted with a 3 weeks history of lethargy and constipation.
Her blood results are as follow: Hb: 9.8, MCV:84, corrected Calcium: 3.1, albumin: 33,
urea: 7.5, creatinine: 155.... which of following investigation can aid diagnosis?
a) ferritin
b) parathyroid hormone level
c) chest X-ray
d) urine of Bence Jones protein
e) skull X-ray
15. Causes of obesity
a) Cushing's syndrome
b) PCOS
c) Prader willi syndrome
d) Hypothyroid
e)Gastric ca.
16. regarding multiple sclerosis
a. it is demylinated process of peripheral nervous system
b. optic neuritis is a features
c. in csf examination, oligoclonal band is a features
d. multiple plaque are seen neri periventricular ib brain MRI
e. immunoglobulin is a treatment option
18) Middle aged lady presented with ConstipationTFT : Tsh high, t4 low
A) Initiation of tx lead to myocardial ischaemia
B) pretibial myxedema
C) hypernatremia
D) a/w anti thyroid peroxidase
E) m m m
21) In autoimmune hemolytic anaemia :
a) negative coomb test exclude the diagnosis
b) paroxysmal nocturnal hemoglobinuria is due to autoantibody formation
c) hemosiderinuria is due to intravascular hemolysis
d)
e) anti-D is one of the treatment option
23. 36 years old man came with 1 week history of fever and progressively worsening
shortness of breath. chest Xray shows right pleural effusion.
a. chest tube is inserted if pH > 7.45
b. pleural LDH :serum LDH > 0.5 indicate exudate
c. PTB likely cause caseating granuloma in pleural fluid
d. empyema thoracis is a complication f pneumonia
e. aspiration is a must in all cases of pleural effusion
25) 18 years old girl was referred for RBBB on ECG.
possible cases of RBBB?
a. normal variant
b.pulmonary embolism
c.cor pulmonale
d.ASD
e.corrected VSD
