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BASICSCIENCE

1.

Vertebralarteryisabranchofwhicharteryofthefollowing?Subclavianartery

2.

Whichofthefollowingstatementsregardingthesubclavianveinanditsrelationsiscorrect?\
Anteriorinferiortosubclavianartery
Nearapexoflung

3.

Splenicflexure,sigmoidcolon,untilupperrectumbloodsupply?
InferiormesentericA
SuperiormesentericA

4.

GenetictestingshowedCFTRgenemutationwithabnormalsplicing.WhichpartwillRNAsplicingremove?
Codon
introns
extons

5.

25yearsoldmanpresentedatclinicwithenlargementofbreastandsmallfirmtestes.Noanosmiawasnoted.He
is1.9mtall.LabinvestigationshowedincreaseLHandFSH.Whichisthemostlikelychromosomeabnormality
atthispatient?
46XO
46XX
47XXY
47XYY
Explanation:Klinefeltersyndrome

6.

AfemalepatientwithaFragileXsyndromebrotherwonderingaboutthechancesofbeingacarrierstate?
<1%
100%
50%
25%

7.

Mostlikelymodeofinheritanceoffamilialhypercholesterolemia?Autosomaldominant

8.

Mancomestoclinicwithahistoryofhisfathersufferingfromkidneydiseasewhichwasknowntohavemultiple
cystathiskidney.Whatisthechanceofthismanofsufferingfromthedisease?
100%
50%
33%
25%
0%
Explanation:(pastest)Adultonsetpolycystickidneydiseasehasanautosomaldominantinheritance,hencemany
cliniciansinterchangethemeaningofADPKDasautosomaldominantoradultpolycystickidneydisease.Given
thatthisfatherwillcarryonegeneforthedisorder,hehasa50%chanceofpassingittoanyoffspring.Around
8590%ofptswithADPKDcarryamutationonchromosome16,theremaindercarryingamutationon
chromosome4.Significantrenalfailureusuallydevelopsafterthe4thdecadeoflife.

9.

Centeroftemperatureregulation?Hypothalamus

10. Studyshowsthatwithincreasingagethereisanincreaseinpulsepressure.Whatisthecauseofthis?
Reduceaorticcompliance
Decreasediastolicheartfunction
11. Whichoneofthefollowingfeatureswouldbetypicalofamitochondrialdisorder?
Opticatrophy
Hypercholesterolaemia

Bronchiectasis
Pseudohypoparathyroidism
Spinabifida
12. Whichtumormarkerhavebestprognosticvalueinseminoma?
AFP
BetaHCG
LDH
13. Younggirlwithpasthistoryofhypersensitivitytoeggallergyisnoted.igEtowardseggsiselevated.Whichof
thefollowingvaccinemostlikelytoproduceanallergicreaction?
HepatitisA
Influenza
MMR
Tetanus
Varicella
14. 12weekspregnantwomenwithnovaccinationhistorybeingtested:
VaricellaIgG
()
RubellaIgG
()
WhenshouldMMRvaccinationshouldbegivenatpregnantwomen?
Now
18weekspregnant
24weekspregnant
26weekspregnant
Postpartum
Explanation:WomenfoundtobeseronegativeonantenatalscreeningforrubellashouldbeofferedanMMR
(measles,mumps,rubella)vaccinationfollowingbirthandbeforedischargefromthematernityunitiftheyarein
hospital.
NICEguidelineunderimmunizationsection.
https://www.nice.org.uk/guidance/cg37/chapter/1recommendations
15. Whatwillbebrokendowntoglucoseandfructose?
Maltose
Sucrose
Lactose
Explanation:

16. CytotoxicCD8Tcell?MHCclassI
17. WhichofthefollowingproduceIgE?
Mastcell
Plasmacell
18. WhichofthefollowingisthefunctionofgerminalcenteratLymphnode?
Maturationofdendriticcell
Generatinginflammatoryresponse
Antibodyproduction

19. Patientpresentedwithreccurentbacterialmeningitis.Whatisthedeficientcomplementwhichinvolve
alternativeandclassicalpathway?
C1
C2
C7
MBL

20. Whichistheexplanationofspecificity?
Proportionofthepatientwithoutthediseasewhohavenegativetestresult
Proportionofthepatientwiththediseasewhohavepositivetestresultsensitivity
Patientwithpositivetestresultwhichactuallyhavethedisease(+)predictivevalue
Patietnwithnegativetestresultwhichactuallydoesnthavethedisease
21. (similar)Aresearchercomparedthemeanscoresfornauseaonaratingscalebetweenstandardtherapyanda
newdruginthetreatmentofchemotherapyinducednausea.Whichoneofthefollowingisthemostappropriate
statisticaltest?
Chisquaretest
PairedTtest
logranktest
Pearsoncorrelation
UnpairedTtest
Explanation:(onexamination)Thetwosampleunpairedttestisusedtotestthenullhypothesisthatthetwo
populationscorrespondingtothetworandomsamplesareequal.
22. (Scenariotrialwithgiven2x2table).Whichofthefollowingregardingthestatisticalanalysisshouldbeused?
Chisquare
UnpairedTtest
PairedTtest
Explanation(onexamination) ThedatacouldbeevaluatedusingtheChisquaredtest.Thisdatawouldbeideal
foraChisquaredtest.Itisa2x2contingencytableforwhichthereisaspecialChisquaredformulathatgives
avaluethatcanbelookedupinatablegivingthepvalue.
23. Howshoulddataofbloodpressurebepresentedin?
Forestplot
Scatteredplot
Histogram
Piechart

24. Whichstudycanbepresentedinpiechart?
Age
BP
Height
Ethnicity
weight
25. Astudyofbloodpressurereadingsisdoneonpatientswithchronickidneydisease.Assumingthattheresultsare
normallydistributed,whatpercentageofvaluesliesabovetwostandarddeviationsofthemeanreading?
2.5%
5%
95%
10%

PHARMACOLOGY
26. Patientwhichisundergoinghemodyalisisistakingfluconazoleforhiscandidainfection.Whatisthereasonthat
fluconazoledoseshouldbereduced?
Firstorderkinetics
Longplasmaeliminationhalflife
Highbioavailabilitybyoralrute
Lowplasmaproteinbinding
27. Patientpresentedafterdrinkingfreezer/cooler.Labinvestigationrevealshypocalcemia.Whatisthecauseof
this?
Calciumoxalateformation
Explanation:ethyleneglycolpoisionng
28. PoorprognosisofParacetamoltoxicitycanbemeasuredbywhichofthefollowing?
Creatinin
Bilirubin
ALT

29. Patientwithhepaticencephalopathycomplainofitching.Whatdrugcanbegiven?
Cetrizine
Chlorpheniramine
Dimenhydrinate
Promethazine
30. Whichantibioticinteractswithwarfarin?
Amoxycillin
Coamoxiclav
Claritromycin
Levofloxacin
Vancomycin
31. Whichoneofthefollowingantiepilepticdrugsdoesnothaveimportantdruginteractionswithwarfarin?
Carbamazepine
Lamotrigine
Oxcarbazepine
Phenytoin
Phenobarbital
Explanation:otherdrugisliverenzymeinducerthatmayreducethedoseofwarfarin
32. A65yearoldmanpresentstotheoncologyclinicforreview.Heiscurrentlymanagedwithamultiagent
chemotherapyregimeandcomplainsofpains,predominantlyinhisfeet,withlossofsensation.Onexamination
hehasaperipheralsensoryneuropathyaffectingbothfeet.
Whichofthefollowingagentsismostlikelytohavebeenresponsible?
Cyclophosphamide
Doxorubicin

Methotrexate
Prednisolone
Vincristine
33. A74yearoldpatientwithcongestiveheartfailureisonspironolactone.Whichoneofthefollowingisthe
primarysiteofactionofthisdrug?
Proximalportionoftheproximalconvolutedtubule
ThickascendinglimbofloopofHenle
distalconvolutedtubule
Juxtaglomerularapparatus
Distalsectionoftheproximalcovolutedtubule
Explanation:
Spironolactoneisaspecificpharmacologicantagonistofaldosterone,actingprimarilythroughcompetitive
bindingofreceptorsatthealdosteronedependentsodiumpotassiumexchangesiteinthedistalconvolutedrenal
tubule.
34. Mechanismofactionclindamycin?Inhibitproteinsynthesis
35. Mechanismofactionofverenicline?Nicotinicreceptorpartialagonist
36. Whichdrugcancauseimpairedglucosetolerance?Thiazide
37. PatientisadmittedtoEmergencyDepartmentfollowingsuspectedpeanutallergy.Onexaminationshehasgross
facialandtongueedema.Onauscultationwheezingatbothsideofthechest.Whatshouldimmediatelybegiven?
IVepineprine
IMepinephrine
Dexamethasone
Cetirizine
Explanation:AnaphylaxisIM0.5cc1:1000adrenaline
38. DrugwhichisaffectedwhentakenwithCalciumcarbonate?
Amlodipine
Levothyroxine
NSAID
39. WhatisthemechanismofIvabradine?Inhibitlfcurrent
40. Whatisthemechanismofactionbisacodyl?
Bulkforminglaxative
Stimulantlaxative
Osmoticlaxative
Faecalsoftener
Diarrheainduced
Explanation:

41. Patientpresentedwithswellingoffaceandtongue.Whichofthefollowingdrugmustbestopped?
statin

ACEinhibitor
42. MechanismofACEinhibitorthatcausecough?Decreasedegradationofbradykininproduct
43. Contraindicationbisphosphonatetherapy?Gastric/duodenalulcer
44. Atype2diabeticwasstartedonsitagliptin.Whatisthemechanismofactionofgliptins?
Answer:Dipeptidylpeptidase4inhibitor
45. A35yearoldmanhasalonghistoryofasthma.Heiscomplainingofbreathlessness.Heiscurrentlyon
salbutamol,beclomethasoneinhalersandisnowprescribedMonteleukast.Whatisthemechanismofactionof
monteleukast?
BlocksactionofcysteinylleukotrienereceptorcysLT1
Explantion:Montelukastisaleukotrienereceptorantagonist(LTRA)usedforthemaintenancetreatmentof
asthmaandtorelievesymptomsofseasonalallergies.
46. Patientpresentedwithacneandincreasingfacialhair.Whichofthefollowingisthecauseofthepatient
presentation?
Ciclosporin
Corticosteroid

Kidneytransplantationprincipleandpracticehttps://books.google.com.sg/books?
id=8X2zAQAAQBAJ&pg=PA554&lpg=PA554&dq=hypertrichosis+acne+cyclosporine&source=bl&ots=un4R
hypts&sig=NME0WfPtN1oe
r8IWk9V4gsDq6k&hl=en&sa=X&ved=0ahUKEwjOh_uKq47PAhUHFJQKHSYjDZYQ6AEIMDAD#v=onepa
ge&q=hypertrichosis%20acne%20cyclosporine&f=false
47. RituximabCD20
48. RFosteonecrosisofjawinthispatient?steroid

CARDIOLOGY
49. A29yearoldmancomestotheEmergencydepartmentcomplainingofpleuriticchestpain.Hehasbeen
sufferingfromaflulikeillnessoverthepast3daysandsaysthatthechestpainiscentral,retrosternalandis
relievedbysittingforward.OnexaminationhisBPis125/72mmHg,pulseis75/minandregular.Thereisa
pericardialrub,therearenosignsofleftventricularfailureorconsolidationonauscultationofthechest.
WhatECGchangeswouldyouclassicallyexpectinthissituation?
Tinversion
STelevation,convexupwards
STelevation,concaveupwards
STdepression
Normal12leadECG
Explanation:
Stage 1 widespread STE and PR depression with reciprocal changes in aVR (occurs during the first
two weeks)
Stage 2 normalization of ST changes; generalized T wave flattening (1 to 3 weeks)
Stage 3 Flattened T waves become inverted (3 to several weeks)
Stage 4 ECG returns to normal (several weeks onwards)

50. FamilialhypercholesterolemiaidentifiedLDLgenemutation.Whatismostlikelydefect?
LDLreceptorsynthesis
InabilityLDLtobindwithLDLreceptor
Explanation:
LDLRmutationscanbeclassifiedaccordingtotheeffecttheyhaveonLDLreceptorproteinfunction.TheLDL
receptorproteinisacellsurfacereceptorthatremovesLDLparticlesfromtheplasmabywayofreceptor
mediatedendocytosis.Inclass1mutations,theLDLreceptorproteinisnotsynthesized;inclass2mutations,the
LDLreceptorisnottransportedtotheGolgi;inclass3mutations,theLDLreceptordoesnotproperlybindwith
theLDLparticles;inclass4mutations,boundsurfacereceptorsarenotinternalized;andinclass5mutations,
theinternalizedLDLparticlesarenotreleasedintheendosome.Themajorityofmutationsidentifiedtodateare
class2orclass3mutationsoccurringintheligandbindingandepithelialgrowthfactorprecursorregionsofthe
gene.Class1mutationsarealternativelyreferredtoasnullorreceptornegativemutationsintheliterature,
whereasmutationsfromclasses25aretermedreceptordefective.
(http://aje.oxfordjournals.org/content/160/5/421.full)
51. Middleagedmanpresentedwithprogressivebreathlessness.HisBPwas100/70.Echoshowedsevereleft
ventricularsystolicdysfunction.Whatisthemostlikelyenddiastolicpressureofleftventricle?

10
20
50
70
52. Patientwithacutechestpaindevelopedcompleteheartblock.Hewasdiagnosedhavingacutecoronary
syndrome.Whichofthefollowingarteryisthemostlikelyinvolved?
Rightcoronaryartery
53. 42yearsoldmancollapsedatwork.Hediedbeforetheambulancecouldarrive.Whatisthemostcommoncause
ofsuddendeathatthisageofgroup?
Acutecoronarysyndrome
Brugada
HOCM
Mostarticlestatedaboutcardiacdeathatyoungerthanage40yearsoldwhichisHOCM.Notsureabout42
yearsold.
54. PatientwithPrimaryHypertriglyceridemia.Whichofthefollowingisknowntobethemostcommon
complication?
Pancreatitis
Cardiovascularevents
Elevatedcreatinin
Explanation:notsure???

55. 36weekspregnantwomenpresentedwithsevereretrosternalchestpain.OnexaminationBPatrighthand
110/70andleft106/67.Spo295%.Whichofthefollowingisthemostlikelydiagnosis?
Aorticdissection
Myocardialinfraction
Pulmonaryembolism
SpontaneousPneumothorax
56. WhichoneofthefollowingisassociatedwiththeworstprognosisinHOCM?
Mitralregurgitation
SystolicAnteriorMotionofmitralvalve
Septalwallthicknessgreaterthan3cm
ShortperiodsofAFon72hholter
ShortrunsofSVTon72hholter
57. Whichofthefollowingwouldmostinfluenceyourdecisiontoreferthispatientforaorticvalvereplacement?
aorticgradient50mmhg
PresenceofLVH
Presenceofsymptoms(symptomatic)

Explanation:(pastest)Whileingradienttermshervalvularstenosisisonthecuspoftheseverecategory,
electivevalvereplacementisgenerallynotrecommendedintheabsenceofsymptoms
58. Previoushealthywomenwenttocoronaryangiographyforinvestigation.Duringtheprocedureshehadan
episodeofventricularfibrillationwhichwassuccessfullyresuscitatedbydefibrillator.Coronaryangiography
resultwasnormal.Patientisnowasymptomaticintherecoveryroom.Whichofthefollowingmustbedoneto
preventfurtherattack?
Pacemaker
ICD
Amiodarone
Nothing
59. Patientwithprostheticvalvedevelopedendocarditiscausedbyalphahaemolyticstreptococcus.
Whichofthefollowingantibiotictogive?
Benzylpenicillinandgentamicin
Benzylpenicillinandrifampicin
Vancomycin
60. 67yearsoldCaucasianmanpresenttoclinicforreview.Hishypertensioncantbemanagedwithlifestyle
modificationanddietarymodification.Whichdrugshouldbeinitiated?Amlodipin
61. HypertensivepatientpresentedtoclinicwithsymptomsclassifiedasNYHAclassIII.Onexaminationthereare
basalcrepitationinthelung.TheBPonexaminationis140/90.HeusuallytakesACEi+Betablocker+statin+
aspirin+furosemide.Whichdrugmustbeaddedtohercurrentmedication?
Spironolactone
Furosemide
CCB
Explanation:(pastest)TheEuropeanSocietyofCardiologyrecommendstheadditionofspironolactonefor
improvingthesurvivalofptswhoareinthetransitionfromwellcontrolledclassIItoclassIIIorIVHF.
Diureticsareonlyindicatedifthereisfluidretention.AngiotensinreceptorblockadeinadditiontoACE
inhibitorsisnotrecommendedatthisstage.Digoxinhelpstorelievesymptomstosomeextent,andismore
usefuliftheptisinAF.Similarly,nitratesandhydralazinehelptoimprovesymptomsinptswithclassIIIandIV
HF.MostrecentlyNICEguidelineshavesuggestedaddinganARBinptswithmilder,(classIIIII)HF,and
spironolactoneinptswithsevereHF,toACEinhibitorandblockertherapy
62. Patientfollowingdeliveryofchildpresentedwithbilateralheartfailure.Postpartumcardiomyopathy

DERMATOLOGY
63. 70yearsoldpatientpostrenaltransplantpresentedwithcomplainoflesionatthebackoftheear.On
examinationthereisahyperkeratoticnodule.Whatisthemostlikelydiagnosis?
Squamouscellcarcinoma
Basalcellcarcinoma
Tcelllymphoma
Bcelllymphoma
64. 15yearsoldgirlcomplainwithmultiplelesionatheraxillaandbody.Lesionwasitchy,painless,and
umbilicated.Whatisthenexttreatmentshouldbedone?
Podophylotoxin
Cryotherapy
Waittoresolvespontaneously
Explanation:MolluscumContagiosum
65. A47yearoldladypresentstothedermatologistwithtargetlikelesions.Thecircularlesionshaveacentral
blister.Whichoneofthefollowingisthemostcommoncause?
Herpessimplex
Orf
Staphylococcus
Explanation:
Thelesionsareerythemamultiforme.Thecommonestcauseisquotedtobeherpessimplex,althoughallthe
othersarealsocauses.
66. Patientcomewithcomplainofrecurrentmultipleplaquethatisredanditchy.Thelesionwillappear23hour
anddisappearbyitsown.Patientdonthaveanyhistoryofallergyoffoodandnohistoryofdrugusage.What
shouldbegiventothispatient?
Cetrizine
Prednisolon
Expalantion:chronicidiopathicurticaria
67. Patientpresentederythemarashatbody,arms,legandscalpwithscallinglesion.whichworsenaftertaken
antimalarialmedicine.Healsohadhistoryofrecurrentlesionwithscale.Whichisthemostlikelydiagnosis?
EryhtrodermaPsoriasis
TEN
68. Childrenpatientpresentedwithpainfulblisteringredlesionbothoflimbs,aroundoralcavityandmucosa,which
involvedaround5%ofsurfacebody.Whichisthefollowingthemostlikelycause?
Handfootmouthdisease
TEN
SJS

furtherreadingondxandtreatment:http://cks.nice.org.uk/handfootandmouthdisease#!diagnosissub

ENDOCRINOLOGY
69. 24yearsoldwomencometoclinicwithcomplainofpainlessenlargementathergoiter.Nosymptomsof
thyrotoxicosis.Thyroidhormoneisatnormalrange.Whatinvestigationshouldbedone?
FNAB
CTscan
Followupin3month
70. A17yearsoldgirliscompetingforgymnasticcompetitioncomestoclinicwithcomplainofheadacheand
lethargy.Whichhormoneisconstantinhibition?
Prolactin
GH
Cortisol
ACTH
LH
71. 70yearsoldmancomeswithlowbackandhippain..
Bloodtestreveal:
Calsium2.38
(2.22.6)
Phosphat0.85
(N)
ALP744U/I
(60110)
Whatisthemostappropriatetreatmentforhispain?
Bisphosphonate
Calcitonin
NSAID(naproxen)

http://press.endocrine.org/doi/pdf/10.1210/jc.20142910
72. WomenpresentedtoclinicwithcomplainofGalactorrhea.Shehadbeentakingrisperidonefor18monthsand
alsohistoryofhypothyroidism.
Prolactinlevel2300
Whichisthemostlikelydiagnosis?
Prolactinoma
Druginduced
Hypothyroidism
73. PatientwithDMwithusingdapagliflozinpresentedtoclinic.Thelabinvestigationshowsurineglucose(+).
Whichofthefollowingisthecauseofthislababnormality?
Hyperglycemia
Urinarytractinfection
Druginduced
Explanation:

74. Patientwithhistoryofurinaryretentionpresentedwithdiabeticneuropathy.Whichisthefollowingdrug
shouldbegiven?
Pregabalin
Amytriptilin
75. Asymptomaticpatientcomewithacomplainofsinglethyroidnodule.Onexaminationtherewasnontender
thyroidnodulonpalpation.Thyroidtestwasnormal.Whichisthenextinvestigationshouldbedone?
Isotopescan
USG
Fineneedleaspiration
Evaluatepatientin3month
76. Postpartumwomenpresenttoclinicwithcomplainoftiredness.Onexaminationthereisnothyroidtenderness.
Thyroidprofile:
(2monthsago)hyperthyroidism,(increaseofT4).Andshewastreatedwithsomemedication.
(now)hypothyroidism(increaseTSHwithlowT4)
Whatisthemostlikelydiagnosis?
Postpartumthyroiditis
Druginduced
Hasimotodisease
Explanation:(Pastest)Postpartumthyroiditisisusuallytransient,andcanmanifestashyperthyroidism,
hypothyroidism,orthetwoinsequence.Itisthoughttobeduetochangesintheimmunesystemafterpregnancy
andishistologicallyalymphocyticthyroiditis.Itisusuallyselflimiting.

GASTROENTEROLOGY
77. Patientcomewithcomplainofgotprickedbyanunknownneedle.Whatisthenextthingsheshouldbeadvised?
TreatwithHepBimmunoglobulin
GiveHepBvaccination
Startantiretroviraltreatment
ScreenpatientforHepB,HepC,HIV
78. WhichisthemostlikelyetiologyofHepatocelullarcarcinomaatsoutheastAsian?
Alflatoxin
HepatitisA
HepatitisC
estrogen
Explanation:MostcommonshouldbeHepatitisBwhichisnotatoption.ButanyhowhepatitisCisstilloneof
theleadingcauseatworldwide.
interactionbetweentheextentofexposuretoAFB1andtheincidenceofHCCismultiplicativeormorethan
multiplicative.ChronichepatitisBvirus(HBV)infectionanddietaryexposuretothetoxinarethemajorcauses
ofHCCinthehighriskregionsofthetumor,andarelargelyresponsibleforthestrikinggeographicalvariation
intheincidenceofHCC.Bothriskfactorsaremorecommoninruralthaninurbandwellers.
InhighriskregionsofHBVinfection,theinfectionisusuallyacquiredintheearlyyearsoflife,andthe
exposuretoAFB1beginsevenearlier,thatis,inutero.IthasbeenestimatedthatbyreducingdietaryAFB1
levelstobelowdetectablelimitsineasternAsiaandsubSaharanAfrica,between72,800and98,800newcases
ofHCCcouldbepreventedeachyear http://www.jgld.ro/2013/3/13.pdf
79. Patientpresentedwithcomplainofnonbloodydiarrheaandarthralgia.Weightloss(+).
Jejunalbiopsy:PAS(+)machrophage
Whipplesdisease
80. 30yearsoldfemalewithabdominaldiscomfortandintermittentnonbloodydiarrhea.Therewasmucousin
stools.Herabdominalpainwasrelievedondefecation.SheistakingNSAIDregularyforherheadache.Whichis
themostlikelydiagnosis?
NSAIDSenteropathy
IBS
Chronsdisease
Ulcerativecolitis
81. 87yearsoldmanpainlessjaundicecomplainof6monthpruritusandlethargy.Hislaboratoriumresult:
ANA()
AMA(+)
Whatisthenextinvestigationshouldbedone?
Liverbiopsy
CTabdomen
MRCP
Nothingfurtherneedstobedone
82. Patientpresentedtoclinicwithcomplainofworseningdysphagiaofbothliquidandsolid.Patientalsohad
2kginthelast6month.Chestxrayshowairfluidlevelatmediastinum.Whatisthemostlikelydiagnosis?
Achalasia
Hiatushernia
Malignancy
83. A54yearoldmanpresentswithjointpains,anorexia,diarrhoeaandintermittentfevers.Hehaslostweightover
thepast6months.Onexaminationhehaslymphadenopathy.Investigationsshow:smallbowelbiopsyshows
expandedvilliandperiodicacidSchiff(PAS)positivemacrophages.
Whichofthefollowingisthemostlikelydiagnosis?
Intestinallymphoma
Whipplesdisease

Tropicalsprue
Coeliacdisease
Hepatitis
84. Patientpresentedwithabdominalpainwithdiarrhea.Herstoolwaslooseandnonbloody.
Rectalbiopsy:granulomaatlaminapropiawithinflammatoryinfiltrate
Whichofthefollowingisthemostlikelycause?
Chrondisease
UC
Yersiniapestis

85. 82yearsoldpatientwassuspectedwithinsulinoma.Whichisthenextinvestigationshouldbedone?
72hourprolongfast
Cpeptide
86. Patientwithgiardiasisfoundthestool(),whichinvestigationtoconfirm?
Duodenalbiopsy
GiardiaantibodyigM
Trialofmetronidazole
87. Patientpresentedwithcomplainofnonbloodydiarrhea.HehashistoryofbowelresectionforhisChrons
disease.Whichmechanismisthecauseofhisdiarrhea?
Malabsorbtionofbilesalt
Iritationofbowelduetolipid
Chronsdisease
88. Alcoholicpatientpresentedwithhypocalcemiaandhypokalemia.Whichisthemostlikelycauseofthethis
abnormality?Hypomagnesia
89. Alcoholicpatientwasadmittedafterperiodofstarvation.Hishadlossweight.Hewascommencedonfeeding.
Whichisthecomplicationmostlikelyhappenatthispatient?
Hypophosphatemia

Explanation:refeedingsyndrome(pastest)

HEMATOLOGY
90. WhatisusedtomonitorRivaroxiban?
Fibrinogen
Prothrombintime
Thrombintime
91. Youngfemalepresentwithcomplainoffatigue.Familyhistoryincludehermotherhadspleenectomy.
CBC:decreaseHb
MCV:increased
Peripheralbloodshows:spherocytes.
What'sthebesttreatment?
GivevitaminB12
Folicacid
Notreatment
Explanation:hereditaryspherocytosis.
Folicacidisrequiredtosustainerythropoiesis.PatientswithHSareinstructedtotakesupplementaryfolicacid
forlifeinordertopreventamegaloblasticcrisis.Duringthefirst6yearsoflife,ifpatientshavecompensated
anemia,aregrowingwell,andcankeepupwiththeirpeersinmostactivities,limitingfolicacid
supplementationto1mg/disprudent.
http://emedicine.medscape.com/article/206107treatment
SplenectomyisthedefinitivetreatmentforHS.
92. Patientwastransfusedwithmultiplebloodproductsandivfluidslaterondevelopedsepsis.Whichofthe
followingisthemostlikelyasthecauseofsepsis?
Hartmansolution
Platelets
Redcellconcentrate
Cryoprecipitate
FFP
93. PatientwithsicklecellStraitdiseasewonderingwhatHbherhusbandcarrythatcanmakechildhavedisease?
HemoglobinA
HemoglobinC
HemoglobinF
94. 29yearsoldwomenpresentswithacuterighsidedweakness.Shehadtwospontaneousabortionsinthepast.
ShealsohadhistoryofrecurrentDVT.Examinationrevealedrighthemiparesis.ACTheadscanshowedaleft
middlecerebralarteryterritoryinfarct.Whatisthemostlikelyfindingonechocardiography?
AtrialSeptalDefect
Patentforamenovale
Leftatrialmyxoma

Normalappearance
Explanation:Antiphospholipidsyndrome
95. A62yearoldmanpresentswithworseningbreathlessness,confusionandheadache.Sincethreemonthsago,he
begantohaveprogressiveexertionaldyspnea,achinginthelegs,andpainintheleftarmafter50yards.Upon
investigation,theresultswereobtained:
IgA2.8(0.54.0)g/l
IgG7(5.013.0)g/l
IgM24(0.32.2)g/l
ESR90mm/hr
Whichoneofthefollowingislikelytobeassociated?
Hyperviscosity.
Explanation:waldenstrommacroglobulinemia
96. A42yearoldwomanpresentstotheGPcomplainingofaswellingontheleftsideofherneck.Shehasbeen
sufferingfromnightsweatsandincreasingachesandpainsoverthepastfewmonthswhichshethoughtwere
duetothemenopause,andshehasbeentreatedwithamoxicillinforarecentepisodeofpneumonia.On
examinationsheispyrexialat37.6C,herbloodpressureis110/70mmHgandshehasalargeleft
supraclavicularlymphnode.Shealsohasbluetingedfingertips.
Investigations:
Hb10.4g/dl
Whitecellcount9.8109/l
Platelets182109/l
Na+138mmol/l
K+4.4mmol/l
Creatinine110mol/l
ESR92mm/h
Coldagglutininspositive
Whichoneofthefollowingisthemostlikelydiagnosis?
Bronchialcarcinoma
Hodgkinslymphoma
Mycoplasmapneumonia
NonHodgkinslymphoma
Systemicamyloidosis
97. (Patientwithhistoryofabdominalsurgeryandtreatmentoflongstandinguseofgastricproblems)presentswith
fatigue.Investigation:
macrocyticanemia
Antiparietalantibody(+)
Intrinsicantibody()
Mostlikelydiagnosis?
Bacterialovergrowth
Perniciousanemia
98. PatientwithNHLscenario.Whichdrugisbeneficialforthetreatmentofdisease?CD20
99. 57yrsoldman,whodonatesbloodregularly,recentlywasdeferredfromblooddonation.Heisotherwise
healthywithoutanycomplain.HisLabresultshowsmicrocyticanemia.
What'sthelikelycauseofhisbloodabnormality?
ColonCancer
Gastriccancer
Angiodysplasia
Diverticulitis

INFECTIOUSDISEASE
100.Apatientdevelopeddiarrheaandwasdiagnosedwithclostridiumdifficile.Whichmeasuretodecreaseclostridial
infectionsathospital?
Handwashing
Isolation
101.ScenariowithHIVpatient.WhichofthefollowingisthefirstimmunesystemthatrecognizeHIVvirustoenter
cell?
Dendriticcell
Macrophage
Explanation:HIVentersthebodyandbindstodendriticcells(orangecellswithprojections)whichcarrythe
virustoCD4+Tcellsinlymphoidtissueestablishingtheinfection.

102.68yearsoldpatientwithmeningitisscenario.
Gram(+)diploccocus.Whichofthefollowingisthemostlikelyorganismofcause?
Lesteriamonocytogen
Neisseria
StreptococcusPneumonia
103.PatienttravellingtosouthAmericacomplainofblackspotatthesiteoftickbite,whichlateronhedeveloped
feverandmaculopapularrash.Whichofthefollowingisthemostlikelydiagnosis?
Leishmaniadonovani
Ricketsiaconorri
104.Patientinfectedwithanchylostomaduodenale.Whattreatmentshouldbegiven?
Albendazole
Ivermectine
Piraziquintel
Explanation:Hookwormalbendazole

105.Patientwithdiabetichistorypresentedwithfootulcer.Hisfootswabwastakenandwastreatedwith
flucloxacillin.Swabrevealscandidaalbicans(+).Whatshouldbethenextmanagementinthispatient?
Stayonflucloxacillin
Changetoketokonazole
Addtopicalclotrimazole
Addfluconazole
Addflucytocine

NEPHROLOGY
106.PatientwithhistoryofusinglithiumpresentedwithDiabetesInsipidus.Whichisaffectedcausingthesymptoms
atthispatient?
Aldosterone
Angiotensin
V2receptor
Explanation:(onexamination)

107.Patientwaspresentedwithpolyuriaandthirst.Bloodpressure110/70withposturalBPdrop.Sheisontreatment
oflithiumforherpsychiatricillness
Biochemicalbloodtestingrevealsa
asodiumof152mmol/l
(137144)
Plasmaosmolality299mosmol/l
(275290)
Urineosmolality210mosmol/l
(3501000)
whatisthebestinitialtreatmentforthispatient?
Normalsaline
Dextrose5%
DesmopressincranialDI
Explanation:NephrogenicDIfluidreplacement

(emedicine)
108.PatientcomplainpainlesshematuriacomingbackfromholidayatEgypt.Patientjusthadsorethoratandtreated
withantibiotic.Whatisthemostlikelydiagnosis??
Schistosomiasis
IgAnephropathy
109.Mechanismofkidneyinjurybygentamicin?
110.Manpresentedwithloinpaintothehospital.HewastakingNSAIDSfrom6daysforkneeinjury,on
examinationhehasbilateralkneeeffusion.
Urineshows:protien+,Wbcs+
RFTs:Ureumandcreatininincreased
Diagnosis?
AcuteIschemicNephritis
AcuteTubulointerstitialNecrosis
UrinaryTractInfection
Obstructivenephropathy

NEUROLOGY
111.PatientpresentswithsymptomsofAlzeimer.HerscoreontheMiniMentalStateExaminationwas20of30.
Whatdrugshouldbeprescribed?
Donepezil
112.A75yearoldpatientwithahistoryofdementiadiessuddenlyathome.Apostmortemrevealshertohave
Lewybodydementia.
WhatareLewybodiesmadeupof?
Alphasynuclein
Betaamyloid
LipofuscinRNAinclusionbodies
Tauprotein
113.ApatientwithhistoryofParkinsonwithvisualhallucinationdiseasepresentwithagresion.Whatshouldbethe
treatmentgiven?
Haloperidol
Benzodiazepine
Resperidone
Quetapine

114.Femalepresentedwithbriskreflex,ataxia,ophtalmoplegia,andurinaryincontinence.
Neuromyelitisoptica
Millerfisher
Spinocerebellarlesion
Multiplesclerosis
Cavenosussinusthrombosis
115.Patientpresentedwithdisturbanceofgait.OnexaminationHeisataxictotherightwithhemisensorylossofpain
andtemperatureattherightside.Hehadparalysisofleftpalateandleftfaciallossofpainandtemperature.
Whichofthefollowingisthelesionofthispatient?
LeftPosteriorCerebellarartery
Explanation:Lateralmedullarysyndrome(Wallenberg)

116.Middleagemanpostheadinjuryattendclinicwithhiswife.Hiswifementionednoticinghisaggressive
behaviorandrapidswingingmoods.Healsohadsleepingdisorderandsometimeoutburstofemotionintears.
Onexaminationhewasirritated.Hesurvivedaserioustraumafewyearsagofromroadtrafficaccident.Which
partofbrainismostlikelybeaffected?
Frontallobe
Parietallobe
Temporallobe
Hippocampus
Reticularactivatingsystem
117.Homonymoushemianopia.Brainlesion?Occipitallobe
118.Youngfemalepresentedwithlowbackpainthatincreaseswithforwardbending.Onexaminationtherewas
paresthesiaatinnersideofherrightthigh,medialsideofrightkneetolateralsideofherfoot.Kneereflex
wasabsent.Whichismostlikelyaffected?
L3rootcompression
L4rootcompression
L5rootcompression
Femoralnerve
Obturatornerve

119.46yearoldrighthandedwomanpresentedwithdifficultyreading.ShewasinvestigatedwithaCTbrainwhich
showedrightsidedparietallobeinfarction.Whichofthefollowingislikelytobecontributingtoherreading
difficulty?
Visualinattention
Agraphia
Explanation:

120.A17yearoldgirlcomestotheEmergencyDepartmenthavingsufferedathirdseizureinthepast6months.
Accordingtothemothershehasalwaysbeenclumsyinthemorning,sufferingfromsuddenjerksaffectingher
hands,leadingtofrequentspillageofdrinks.Examinationintheclinic,includingneurologicalstatusis
unremarkableapartfromminorclumsinessholdingapencilandacup.Routinebloodsarenormal.
Whichofthefollowingisthemostlikelycauseoftheseizure?
BenignRolandicepilepsy
Dravetssyndrome
Partialepilepsywithsecondarygeneralisedseizures
Juvenilemyoclonicepilepsy
Psychogenicnonepilepticseizure
121.Howtodiffereniateepilepticseizureandpseudoseizure?
Lateraltonguebite
Urineincontinence

122.Amancollapsedduringalonghaulflight.Beforeboardinghedranksomewineandwasntfeelingwell.Hefelt
hotandnauseated.Helosthisconsciousnessimmediatelyaftertakeoff.andwhenregainedhesawcabincrew
givinghimcolddrink.Itlastedforabout45seconds,duringwhichhewasincontinenceandwasobservedto
havefewjerkymovementsofhisupperlimbs.Whatisthemostlikelydiagnosis?
Vasovagalsyncope
Cardiogenicsyncope
alcoholassociatedsyncope
idiopathicepilepticseizure
nonepilepticseizure
123.Aladypresentedwithtinnitusandvertigo,especiallywhilemovingeyesupanddownandwhilerollingonto
bedtorightside?Whichofthefollowingmostlikelyaffected?
Rightvestibularinvolve
Explanation:BPPV
124.Tourettesyndrome
125.A25yearoldmanexplainsthathehasexperiencedepisodeswhereheisunabletomovejustbeforeonsetof
sleep,andjustafterwaking.Eachtimeitoccursitleaveshimfeelingfrightenedandanxious.Itissometimes
associatedwithvisualdisturbances.
Whatisthemostlikelydiagnosis?
Panicdisorder
Sleepparalysis
Periodicparalysis
Nightterrors
Frontallobeepilepsy

OPHTALMOLOGY
126.Patientpresentedwithgrittyeyesthatfeltbetterafterclosingeyesforawhile.Onexaminationrevealshypopion
(+).Patienthadhistoryofrheumatoidarthritis.Whatisthemostlikelydiagnosis?
Keratitis
Scleritis
Episcleritis
Antuveitis????
Siccasyndrome
127.Diabeticpatientwithproliferativeretinopathy.Management?Laserphotocoagulation
128.Patientpresentwiththecomplainofpainfuleye.Shealsonoticedthathereyewasstickyinthemorning.On
examinationthereissomeinfiltrateonmarginofhereyeandconjunctivalcongestion.Shehashistoryofacne
roscea.Whatisthemostlikelydiagnosis?
Blepharitis
Conjunctivitis
Keratitismarginal
Explanation:(onexamination)
Marginalkeratitisisareasofperipheralcornealinfiltrates/ulcersassociatedwithblepharitis.Itclassically
causesaninfiltratenearthelimbaledgewithanareaofclearcornea.Theremaybelimbalvesselsgrowing
towardsthelesion/s.Itisthoughttobecausedbyahypersensitivityreactiontostaphylococcalexotoxinsfor
Staphylococcusaureuspresentonthelidmarginsinblepharitis.Treatmentinvolvestopicalsteroidsforthe
keratitisandlidhygieneadviceandtopicalantibioticstotreattheunderlyingblepharitis.Inseverecasesoral
doxycyclinecanalsobeused.

PSYCHIATRY
129.48yearoldfemalebelievedthatshehasbreastcancerasaresultofanextramaritalaffairwhichshehavehad10
yearsago.Whatkindofexampleisthisscenario?
Delusionperception
Overvaluedidea
Thoughtdisorder
130.Patientthinksthatherflatisbeingoccupiedbyagentsasofficebasebecauseawhitedogisfollowingher.What
kindofexampleisthisscenario?
Delusionperception
Overvaluedidea
Thoughtdisorder
131.Patientcometoclinicwithcomplainofmultiplepainsymptomsatherbody.Examinationandimagingrevealno
abnormality.Sheishardtoassuretheresnothingwrongwithher.Shehadrecordofseeingdoctorsince
teenager.Onexaminationshelooksagitatedandirritated.Whatisthemostlikelydiagnosis?
Somatizationdisorder
132.Awomanwhohasrecentlyusedcocainepresentstoemergencysayingshecanfeelinsectscrawlingunderher
skin.Whatisthissymptomknownas?
Illusion
Delutionalperception
Halucinations
Explanation:Thisisthesensationoffeelinginsectsintheabsenceofastimulus,andisthereforeahaptic
hallucination.Haptichallucinationscanbeinterpretedinadelusionalwayandcanleadontodelusionalbeliefs
ofinfestation.Thissensationofcrawlinginsectsisalsoknownasthecocainebugandisassociatedwiththe
ingestionofhighdosesofcocaine.Cocaineusecanalsoleadtoanacutetoxicpsychosis,withmarkedagitation,
paranoia,auditoryandvisualhallucinations.(Pastest)
133.Amanwascaughtbypolicefordrivingathighspeedinanarrowroad.Hewastellingthathecomestonoharm
andnoneedtoworrysincehewaspulledbyfourhorsemenfromApocalypse.Policehandedhimoverhospital.
Laterhetoldamedicalstudentathospitalthathetookonetabletofecstasyoneweekago.Whatisthemost
likelycauseofhissymptoms?
Schizophrenia
Druginduced
Alcoholicwithdrawal
Mania
134.Patientcomeswithcomplainof2weekshistoryoffeelingthatotherpeoplearetryingdobadthingtohim.He
havehistoryofdepressionsince6monthagobreakupwithhisgirlfriend.Hestartstodrinkalcoholsince6
weeksagoandadmitusingamphetaminesince3weeksago.Whatisthemostlikelydiagnosisofthispatient?
Alcoholpyschosis
SchizopreniadiagnosisbasedDSMIVTRmustbeminimum1monthsymptom
Druginducedpsychosis
Explanation:Amphetaminesareknowntoleadtodruginducedschizophrenia.(onexamination).
135.17yearsoldmalewithtype1diabetespresentedwithsymptomsofmoderateseveredepressionwhichisnot
respondingtononpharmacologicalapproach.whichofthefollowingdrugisthemostsuitabletoprescribefor
thispatient?
fluoxetine
sertaline
mirtazepine
venflaxadine
escitalopram

RESPIRATORY
136.A66yearoldmanpresentswithshortnessofbreath.Heusedtoworkatindustriesforthepastyearsandsmoke30
ciggaretesaday.Onexamination,hehadsignsofclubbingandfinecrepitationsinthebasesofhischests.Chestx
rayshowsincreasedshadowinginthelowerlobesbilaterally.Thelungshadowingismostlyreticulonodular,a
networkoffinelinesandnodules.Therewaseggshellcalcificationinthelymphnodes.Whatisthelikely
diagnosis?
Asbestosis
Berrylosis
Silicosis
137.PatientwithLungcancerdeveloped.Hypertrophicpulmonaryosteoarthropathy(HPOA),treatment?
zalendronic
138.28yearsoldgirlwithasthmacomestoclinicforreview.Shehasbeentakinginhaledbeclometasone400
microgramsandsalbutamolasrequired.Sheisnowstillhavingbreathlessnessatnightwithcoughing.On
examinationtherewasscatteredwheezethroughoutlungsanddecreasedPEFR.Whichofthefollowingdrugmust
beadded?
Addherbeclometasoneto800mcg
Addsalmeterol
Addmontelucast

139.Patient58yearsoldpresentedtohospitalwithconfusion.Hehashistoryoffeverandcracklesonauscultation.On
examinationvitalsignwasstablewithBP110/70andRR25x/m.Laboratoriumshowelevatedurea>7mmol/l.
Comorbid(+).Whatisthecorrectmanagementforthispatient?
Outpatientantibiotic
dischargepatientwithambulatoryIVantibiotic
admittomedicalward
admittoICU
Explanation:CURB65score2

140.Hemoglobincurveshifttorightinwhichofthecondition?
Decrease2,3diphosphoglycerate
RepsiratoryAcidosis
Methemoglobinuria
Explanation:


141.PatientwithhistoryoflongstandingCOPDpresentedwithacutebreathlessness.Onexaminationtherewas
dullnessanddecreasebreathrightsideofthelungs
HisthoraxXrayshowedcompletepneumothorax
Whichmanagementshouldbedoneinthispatient?
Largeboredrain
Smallboredrain
NeedleAspiration
Observe
Outpatientdischarge
Explanation:BTSguidelines.http://www.sppneumologia.pt/uploads/files/comissoestrabalho/ct%20Tecnicas
%20Endoscopicas/PDF7.pdf

142.PatientwithCOPDpresenttoclinic.Labinvestigationshowspolychytemia(Hb16).Whatisthemostlikely
cause?
Relativepolychytemia
Secondarypolychytemia
Primary/PolychytemiaRubra
143.Whichofthefollowingparaneoplasticsyndromeismostassociatedwithsquamouscellcarcinoma?
Hypercalcemia
Lamberteatonsyndrome
ACTHsecretion
SIADH
144.Manworkingattobaccocompanypresentedwithshortnessofbreath.Heisworkinginatobacco.His
examinationreveals
Transferfactor:reduced
Spirometry:FCV&FEVreduced
Xrayupperlobeshadowing
Diagnosis?
Extrinsicallergicalveollitis
InterstitialPulmonaryFibrosis
Asthma
COPD
Explanation:Restrictivepicture
145.Patientpresentedwithshortnessofbreath.HeadmithistoryofIVdrugabuse.Examinationofthechestwas
normal.
ChestXray:Bilateralinfiltrate

Whichisthenextinvestigationthatshouldbedone?
BAL
Explanation:susp.PCPsecondarytoimmunocompromisedcondition(HIV)
146.WhichofthefollowingismostsensitiveindiagnosingTb?
Sputumcultureandhistology
Chestxray
Tuberculintest

RHEUMATOLOGY/Geriatric
147.A23yearoldwomancomestotheclinicforreview.Sheissufferingfrompainatthebaseofboththumbs.On
examinationthereisthickeningovertheradialstyloidonbothwrists.Flexionofthethumbacrossthepalmand
ulnardeviationatthewristreproducesthepain.Nootherabnormalitiesareidentified.
Whichofthefollowingisthemostlikelydiagnosis?
Carpaltunnelsyndrome
DeQuervainstenosynovitis
Dupuytrenscontracture
Scaphoidosteoarthritis
Ulnarnervecompression
148.WhatisthepathologyofMultiplesclerosis?
Molecularmimicry
Explanation:MostexpertsbelievethatmultiplesclerosisisanautoimmunediseaseinwhichTcellsrecognize
andattackcomponentsoftheaxonalmyelinsheathandotherfeaturesofthecentralnervoussystem,destroying
myelinandtheunderlyingaxon.AlthoughselfreactiveTcellsarepresentintheimmunesystemofpeoplewith
multiplesclerosis,theyarealsofoundinaquiescentstateinperfectlyhealthypeople.Theirpathogenicpotential
isrealizedonlyonacuteactivation,whichcanoccurthroughdifferentmechanisms.RecentworkbyLangand
colleaguesfocusedonmolecularmimicry,oneofthepresumedtriggersofautoimmunity
http://www.directms.org/pdf/MolecularMimicryMS/MolecularMimicryMS.pdf

149.65yearsoldwomenobesewithhistoryofDMtype2presentedforreview.Whichofthefollowingcausefalse
positiveinRheumatoidFactoratthiscase?
Age

Femalegender
Obesity
Diabetesmellitus
Explanation:

150.Whichantibodyislikelytobepositiveinneonatallupus?
AntiJo1
AntidoublestrandedDNA
AntiRo
Anticentromere
ANCA
151.Patientwithbreastcancerwhichisundergoingtreatmentwithanastrazolepresentwithbackpain.Whichofthe
followinginvestigationmustbedone?
DXA(bonedensinometry)
Ctscan
Explanation:Sideeffectofdrugreducedensityofbone(osteoporosis)
152.87yearsoldmanadmittedtohospitalwithahistoryof3fallsinonemonth,anddescribedbyhisattendantas
justwentdown.HewasfoundtohaveUTIandtrimethoprimwasstarted.Afteradmission.Hehadanotherfallin
hospital.Bedsiderailsarealreadyputon.Whatadditionalmeasurewouldbestpreventfurtherfalls?
Indwellingurinarycatheter
Putonbedstraps
Transferpatientintoaquietwelllitroom
IVHalloperidol
OralLorazepam
153.Patientpresentedwithdecreasevisualacuity.Herbloodlabresultwasnormal.Shewasfurtherinvestigatedwith
temporalbiopsyanddiagnosedgiantcellarteritis.Shewasgivencorticosteroidoraltherapyforherdisease.
Aftertreatmentherbloodtestresultwasshownneutrophilia.Whichofthefollowingisthemostlikelycauseof
herbloodchange?
Biopsysiteinfection
Corticosteroidtherapy
Otherinfection
154.40yearsoldpresenttoclinic.ShehadhistoryofRheumatoidArthritissince30yearsoldandasthmasinceshe
was15yearsold.Shehadrecentlytakenibuprofen400mguntilshehadexacerbationthenshestopusingthe
drug.Shehasnthadanyexacerbationforalongperiodoftime.Nowsheisalreadyimprovedbutherjointpain
isworsened.Whatisthenextstepshouldshebetreated?

ContinueIbuprofen
ChangetoCelecoxib
HalfdoseofIbuprofen
DontgiveanyNSAID
155.A30yearoldladypresentedwithjointpainswhichhasbeenpresentfor2yearsbutweregettingmoresevere.
Afterclinicalexamination,bloodtestsandxrays,shehasbeendiagnosedwithrheumatoidarthritis.The
rheumatoidfactorwasnegative.HandXraysshowedosteopeniaandjointerosions.Whichoneofthefollowing
carriesthepoorestprognosticfactor?
HerAge
Insidiousonset
RFnegative
jointerosions
156.Ladycomplainofgeneralizedweaknesswithjointandbackpain.Onexaminationshelooksweakandunableto
getoutofchair.Hermusclepowerwasnormal.TherewereDIPswellingandtenderness.Furtherinvestigation
revealednormalCK.Whatisthemostlikelydiagnosis?
PMR
Psoriaticarthropathy
Rheumatoidarthritis
157.17yearsoldmancometoclinicwithcomplainofbackpainandearlymorningstiffnesswhichgetsbetterduring
theday.Onexaminationtherewasreducedlateralflexion.Whatisthemostlikelydiagnosis?
AnkylosingSpondilitis
158.elderlyladywithfracture,serumcorrectedcalcium:2.2
Serumphosphate:0.8
SerumALP:increased
Parathyroidincreased
Nextinvestigation?
CheckvitaminD?
159.PatientwithRaynauldphenomenonandCRESTsyndromescenario.Whichofthefollowingisthemostlikely
complication?Pulmonaryhypertention
160.Middleagedmanisinvestigatedforfatigueandarthralgia.Healsowasnotedtohavepolyuriaandpolydipsia.
Xrayshowedchondrocalcinosis.Whichofthefindingsisthemostlikelybeincrease?
Ferittin
161.PatientcomplainingofarthritisandBoggywrist.xray:chondrocalcinosis.Whichofthefollowingisthemost
likelydiagnosis?Pseudogout
162.Patientpresentedwithswollenredhottenderjoint.HehashistoryofDMandcongestiveheartfailure.Whatis
thetreatmentthatshouldbeinitiated?
Naproxen
Colchicine
Steroid
Allopurinol