ENRMP question bank of multiple years.pdf
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Aug 12, 2024
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About This Presentation
the question bank of ENRMP
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Question 1
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A 25 year old lady presents with epistaxis and gum
bleeding of 02 weeks duration. Physical examination is
remarkable for scattered petechial rash over the
extremities and trunk. Blood test shows Hgb of 12g/dl
(MCV = 85fL) and platelet of 25 x 103/microL. Liver
function and Coomb's tests are non-revealing.
What is the first line treatment option?
Select one:
a. Plasmapheresis
b. IV immunoglobulin
c. Splenectomy
d. Prednisolone
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A 25 year old lady presents with epistaxis and gum
bleeding of 02 weeks duration. Physical examination is
remarkable for scattered petechial rash over the
extremities and trunk. Blood test shows Hgb of 12g/dl
(MCV = 85fL) and platelet of 25 x 103/microL. Liver
function and Coomb's tests are non-revealing.
What is the first line treatment option?
Select one:
a. Plasmapheresis
b. IV immunoglobulin
c. Splenectomy
d. Prednisolone
Question 2
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Five years old known diabetic child presented with loss
of consciousness of 30 minutes duration early in the
morning but has no fever, vomiting or seizure. He was
adherent to his medication. On objective evaluation he
is comatous with GCS of 10/15 but no other
remarkable findings. You were to determine RBS but it
was not possible for the time being.
What is your immediate next action?
Select one:
a. To give 20ml/kg of normal saline over Ihr.
b. To give anti-meningeal dose of ceftriaxone.
c. To give insulin subcutaneously.
d. To give 2-5ml/kg of 10percent dextrose push.
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SH
Five years old known diabetic child presented with loss
of consciousness of 30 minutes duration early in the
morning but has no fever, vomiting or seizure. He was
adherent to his medication. On objective evaluation he
is comatous with GCS of 10/15 but no other
remarkable findings. You were to determine RBS but it
was not possible for the time being.
What is your immediate next action?
Select one:
a. To give 20ml/kg of normal saline over Ihr.
b. To give anti-meningeal dose of ceftriaxone.
c. To give insulin subcutaneously.
d. To give 2-5ml/kg of 10percent dextrose push.
Question 3
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A 40 years old Gravida IV Para Ill tested positive for
HIV serology on her first perinatal visit. Her CD4 count
is 650cells/mm3. And her HIV RNA is 400copies/mL.
She has 2 previous cesarean sections and planned to
have elective CS for the current delivery and she is
going to have replacement feeding for her neonate.
What is the proper management during the
antepartum period?
Select one:
a. Start HAART, CPT and INH prophylaxis
b. Start HAART , CD4 count and viral load every
month
c. Start HAART, CD4 count and viral load every
‘trimester
d. Start her on HAART and CPT prophylaxis
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A 40 years old Gravida IV Para Ill tested positive for
HIV serology on her first perinatal visit. Her CD4 count
is 650cells/mm3. And her HIV RNA is 400copies/mL.
She has 2 previous cesarean sections and planned to
have elective CS for the current delivery and she is
going to have replacement feeding for her neonate.
What is the proper management during the
antepartum period?
Select one:
a. Start HAART, CPT and INH prophylaxis
b. Start HAART , CD4 count and viral load every
month
c. Start HAART, CD4 count and viral load every
‘trimester
d. Start her on HAART and CPT prophylaxis
Question 4
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A 17 years old female presented with abdominal pain
of 1 day. The abdominal pain was initially periumbilical
and now shifted to the right lower quadrant. It is
worse with coughing and movement. She had two
episodes of non bilious, non bloody vomiting. She
reported recent sex and used condom. She is due to
start her period next week. Physical examination
reveals BP 120/80 mmHg, PR 100 bpm, RR 18 bpm, T
37.9 OC. She has guarding and tenderness over right
lower quadrant of the abdomen. On pelvic
examination she reports tenderness when attempting
to palpate her right adenexia, but no masses and there
was no cervical motion tenderness.
What is the most likely diagnosis?
Select one:
a. Mesenteric adenitis
b. Appendicitis
<. Ovarian tortion
d. Ectopic pregnancy
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A 17 years old female presented with abdominal pain
of 1 day. The abdominal pain was initially periumbilical
and now shifted to the right lower quadrant. It is
worse with coughing and movement. She had two
episodes of non bilious, non bloody vomiting. She
reported recent sex and used condom. She is due to
start her period next week. Physical examination
reveals BP 120/80 mmHg, PR 100 bpm, RR 18 bpm, T
37.9 OC. She has guarding and tenderness over right
lower quadrant of the abdomen. On pelvic
examination she reports tenderness when attempting
to palpate her right adenexia, but no masses and there
was no cervical motion tenderness.
What is the most likely diagnosis?
Select one:
a. Mesenteric adenitis
b. Appendicitis
<. Ovarian tortion
d. Ectopic pregnancy
Question 5
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A-45 years old female patient admitted and treated
with H2 blocker after she presented with severe
epigastric pain and dyspepsia of two months duration,
she also complains melena. Triple therapy was given at
private clinic and H-pylori eradication was confirmed.
What is the next best investigation you would do?
Select one:
a. Upper Gl Endoscopy
b. abdominal u/s
c. Barrium meal
d. colonoscopy
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A-45 years old female patient admitted and treated
with H2 blocker after she presented with severe
epigastric pain and dyspepsia of two months duration,
she also complains melena. Triple therapy was given at
private clinic and H-pylori eradication was confirmed.
What is the next best investigation you would do?
Select one:
a. Upper Gl Endoscopy
b. abdominal u/s
c. Barrium meal
d. colonoscopy
Question 7
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A 3 years old child presented with tachypnea of 2 days
preceded by rhinitis and cough. On physical
examination he has temperature record of 39.30C,
intercostal and subcostal retractions and dullness on
the right chest. Anthropometry is normal. Pleural tap
resulted in cloudy pleural fluid and analysis revealed
50,000 cells (90percent Neutrophils and 8percent
lymphocytes) and gram stain showed positive cocci in
chains.
What is the best way to manage this patient?
Select one:
a. Crystalline penicillin for 3 weeks
b. Potent antibiotics such as vancomycine
c. Oxygen with face mask
d. Chest tube drainage
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A 3 years old child presented with tachypnea of 2 days
preceded by rhinitis and cough. On physical
examination he has temperature record of 39.30C,
intercostal and subcostal retractions and dullness on
the right chest. Anthropometry is normal. Pleural tap
resulted in cloudy pleural fluid and analysis revealed
50,000 cells (90percent Neutrophils and 8percent
lymphocytes) and gram stain showed positive cocci in
chains.
What is the best way to manage this patient?
Select one:
a. Crystalline penicillin for 3 weeks
b. Potent antibiotics such as vancomycine
c. Oxygen with face mask
d. Chest tube drainage
Question 6
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36 years old primigravida woman visited you at your
office for seeking advice about her pregnancy at
gestational age of 10 weeks. Otherwise she has no
chronic medical illness or any compliant.
Which of the following best explains the client's risk?
Select one:
a. She at low risk of having an increased risk of
preterm labor
b. she is at low risk of giving birth by cesarean
section
c. She is at high risk for having a congenitally
anomalous fetus
d. She is at low risk of having an increased risk
of miscarriage
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36 years old primigravida woman visited you at your
office for seeking advice about her pregnancy at
gestational age of 10 weeks. Otherwise she has no
chronic medical illness or any compliant.
Which of the following best explains the client's risk?
Select one:
a. She at low risk of having an increased risk of
preterm labor
b. she is at low risk of giving birth by cesarean
section
c. She is at high risk for having a congenitally
anomalous fetus
d. She is at low risk of having an increased risk
of miscarriage
Question 8
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A 4 years old child was admitted and put on crystalline
penicillin after he presented with cough of 4 days
duration associated with fast breathing and fever. At
admission he had respiratory rate of 50/min, with
inter-costal retraction and relative dullness on the
posterior right lower third chest. After fifty hours of
admission his RR become 48/min, temperature 38.60C
with the same chest finding.
What is your immediate next action?
Select one:
a. Send him for chest X ray
b. Send blood culture
<. Insert chest tube
d. Stop crystalline penicillin and put him on
chloramphenicol
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A 4 years old child was admitted and put on crystalline
penicillin after he presented with cough of 4 days
duration associated with fast breathing and fever. At
admission he had respiratory rate of 50/min, with
inter-costal retraction and relative dullness on the
posterior right lower third chest. After fifty hours of
admission his RR become 48/min, temperature 38.60C
with the same chest finding.
What is your immediate next action?
Select one:
a. Send him for chest X ray
b. Send blood culture
<. Insert chest tube
d. Stop crystalline penicillin and put him on
chloramphenicol
Question 9
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A 70yrs old male patient was operated 5 hours back.
The operation was transevesical prostatectomy. He
was on continuous irrigation but since 30 minute the
urine drainage stopped and the patient developed
severe suprapubic pain.
What is the most likely cause of pain for this patient?
Select one:
a. Displaced urethral catheter
b. Clot obstruction
c. Foreign body
d. Dehiscence of repaired bladder wall
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A 70yrs old male patient was operated 5 hours back.
The operation was transevesical prostatectomy. He
was on continuous irrigation but since 30 minute the
urine drainage stopped and the patient developed
severe suprapubic pain.
What is the most likely cause of pain for this patient?
Select one:
a. Displaced urethral catheter
b. Clot obstruction
c. Foreign body
d. Dehiscence of repaired bladder wall
Question 11
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A 65 year old Para VII woman who has underwent
surgery after diagnosed with pelvic organ prolapse
with anterior and apical defect with POP-Q stage IV.
No urodynamic test was done before the procedure.
After surgery excellent anatomic restoration was
achieved and she is not experiencing any bulge
symptoms.
Which type of urinary incontinence she is likely to
develop?
Select one:
a. Urge incontinence
b. Mixed urinary incontinence
c. Stress urinary incontinence
d. Functional incontinence
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A 65 year old Para VII woman who has underwent
surgery after diagnosed with pelvic organ prolapse
with anterior and apical defect with POP-Q stage IV.
No urodynamic test was done before the procedure.
After surgery excellent anatomic restoration was
achieved and she is not experiencing any bulge
symptoms.
Which type of urinary incontinence she is likely to
develop?
Select one:
a. Urge incontinence
b. Mixed urinary incontinence
c. Stress urinary incontinence
d. Functional incontinence
Question 10
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A 40 years old male a known diabetic patient
presented with the complaint of numbness and
burning sensation of the lower extremity .
Which sensory modality is affected?
Select one:
a. pressure
b. position
c. pains
d. temperature
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A 40 years old male a known diabetic patient
presented with the complaint of numbness and
burning sensation of the lower extremity .
Which sensory modality is affected?
Select one:
a. pressure
b. position
c. pains
d. temperature
Question 12
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In the process of inflammation, all the inflammatory
cells that migrate out of the micro-circulation will die
within hours to a few days. This occurs through various
mechanisms involving the necrotic or apoptotic
pathway of cell death. But there is one exception
which can survive for months in the interstitial tissue.
Which cell has the feature described above?
Select one:
a. Eosinophil
b. Basophil
c. Macrophage
d. Plasma cell
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In the process of inflammation, all the inflammatory
cells that migrate out of the micro-circulation will die
within hours to a few days. This occurs through various
mechanisms involving the necrotic or apoptotic
pathway of cell death. But there is one exception
which can survive for months in the interstitial tissue.
Which cell has the feature described above?
Select one:
a. Eosinophil
b. Basophil
c. Macrophage
d. Plasma cell
Question 13
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A 40 years old male known decompensated CLD
secondary to chronic hepatitis B virus infection was
admitted with the assessment of spontaneous
bacterial peritonitis. After three days of IV diuretics
and IV antibiotics, he started to have insomnia,
behavioral changes like irritability. Physical
examination revealed BP=90/50mmHg, PR=120bpm,
RR=20bpm, T=360C, dry buccal mucosa. The
abdomen swelling is decreasing and has no
tenderness. He was confused and astrexis is positive.
He had negative balance of 2000lit /day urine output
and his Serum electrolyte was within normal range.
What is the possible precipitating factor of his
condition?
Select one:
a. Spontaneous bacterial peritonitis
b. Constipation
c. Hypovolumia
d. High-protein diet
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SH
A 40 years old male known decompensated CLD
secondary to chronic hepatitis B virus infection was
admitted with the assessment of spontaneous
bacterial peritonitis. After three days of IV diuretics
and IV antibiotics, he started to have insomnia,
behavioral changes like irritability. Physical
examination revealed BP=90/50mmHg, PR=120bpm,
RR=20bpm, T=360C, dry buccal mucosa. The
abdomen swelling is decreasing and has no
tenderness. He was confused and astrexis is positive.
He had negative balance of 2000lit /day urine output
and his Serum electrolyte was within normal range.
What is the possible precipitating factor of his
condition?
Select one:
a. Spontaneous bacterial peritonitis
b. Constipation
c. Hypovolumia
d. High-protein diet
Question 14
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A 50 hours old male neonate presented with yellowish
coloration of a body of one day duration but no
irritability. The mother’s blood group is O positive. On
evaluation the baby has icteric sclerae with jaundice up
to the level of the sole. Otherwise there was no other
remarkable finding. Total and direct serum bilirubin
were 23mg/dl 3mg/dl, respectively. Hct was 25mg/di.
What is the most appropriate management?
Select one:
a. Start him on phenobarbital till the serum
bilirubin is < 10mg/dl.
b. Investigate the baby for direct
hyperbilirubinemia.
c. Refer to higher centers for exchange
ransfusion.
d. Start intensive phototherapy with strict
monitoring.
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A 50 hours old male neonate presented with yellowish
coloration of a body of one day duration but no
irritability. The mother’s blood group is O positive. On
evaluation the baby has icteric sclerae with jaundice up
to the level of the sole. Otherwise there was no other
remarkable finding. Total and direct serum bilirubin
were 23mg/dl 3mg/dl, respectively. Hct was 25mg/di.
What is the most appropriate management?
Select one:
a. Start him on phenobarbital till the serum
bilirubin is < 10mg/dl.
b. Investigate the baby for direct
hyperbilirubinemia.
c. Refer to higher centers for exchange
ransfusion.
d. Start intensive phototherapy with strict
monitoring.
Question 15
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A 70 year old male patient was operated for
perforated peptic ulcer disease. P/E on the 2nd post
operative day revealed BP- 140/90mmhg, PR-86bpm
and abdominal examination finding of hypoactive
bowel sounds with urine output of 350ml over 24
hours. Other findings were unremarkable.
Which parentral medication should not be given to
this patient considering the current situation?
Select one:
a. Cimetidine
b. Morphine
c. Potassium chloride
d. Ceftriaxone
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A 70 year old male patient was operated for
perforated peptic ulcer disease. P/E on the 2nd post
operative day revealed BP- 140/90mmhg, PR-86bpm
and abdominal examination finding of hypoactive
bowel sounds with urine output of 350ml over 24
hours. Other findings were unremarkable.
Which parentral medication should not be given to
this patient considering the current situation?
Select one:
a. Cimetidine
b. Morphine
c. Potassium chloride
d. Ceftriaxone
Question 16
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A 19 year old lady is known to have HIV over the past
10 years and she is currently getting TDF/3TC/EFV. She
presents with exertional dyspnea and fatigability.
Physical examination is remarkable for JVP 5cm above
the angle of Louis, murmur of MR, hepatomegaly and
trace peripheral edema. Echocardiography shows
dilated cardiomyopathy with mildly depressed systolic
function.
What is the likely cause of the cardiomyopathy?
Select one:
a. Rheumatic fever
b. Beriberi
c. HIV
d. Thyrotoxicosis
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A 19 year old lady is known to have HIV over the past
10 years and she is currently getting TDF/3TC/EFV. She
presents with exertional dyspnea and fatigability.
Physical examination is remarkable for JVP 5cm above
the angle of Louis, murmur of MR, hepatomegaly and
trace peripheral edema. Echocardiography shows
dilated cardiomyopathy with mildly depressed systolic
function.
What is the likely cause of the cardiomyopathy?
Select one:
a. Rheumatic fever
b. Beriberi
c. HIV
d. Thyrotoxicosis
Question 17
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A 9 months old infant is noted to hold his arms and
legs out straight with occasional crossing-over of the
legs at the ankles. He does not sit unsupported, nor
does he roll over. He was born 12 weeks premature
and was very ill during the neonatal period.
What is the most likely diagnosis?
Select one:
a. Cerebral palsy
b. Mitochondrial Encephalomyopathies
c. Duchenne Muscular Dystrophies
d. Spinal Muscular Atrophies
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A 9 months old infant is noted to hold his arms and
legs out straight with occasional crossing-over of the
legs at the ankles. He does not sit unsupported, nor
does he roll over. He was born 12 weeks premature
and was very ill during the neonatal period.
What is the most likely diagnosis?
Select one:
a. Cerebral palsy
b. Mitochondrial Encephalomyopathies
c. Duchenne Muscular Dystrophies
d. Spinal Muscular Atrophies
Question 18
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A 32 years old male patient presented with oral floor
swelling of 3 years duration and sub mental mass of a
year duration. Up on examination there is bluish
semitransparent cystic swelling which extend to sub
mental area through oral floor.
What is most likely diagnosis in this patient?
Select one:
a. oncocytoma
b. Dermoid cyst
c. Cystic hygroma
d. Plugging ranula
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SH
A 32 years old male patient presented with oral floor
swelling of 3 years duration and sub mental mass of a
year duration. Up on examination there is bluish
semitransparent cystic swelling which extend to sub
mental area through oral floor.
What is most likely diagnosis in this patient?
Select one:
a. oncocytoma
b. Dermoid cyst
c. Cystic hygroma
d. Plugging ranula
Question 19
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A 58 year old Para Ill mother comes to regular OPD
with protruding mass per vagina of 8 years duration.
She usually replaces the mass to urinate. She also has
urinary dribbling. On your inspection of the external
genitalia you observe pinkish mass with patches
hyperpigmentation which has central opening. What
additional physical examination you should to localize
site of defect?
Select one:
a. Bimanual pelvic examination
b. Pessary fitting test
c. Examination with valsalva maneuver
d. Speculum examination
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A 58 year old Para Ill mother comes to regular OPD
with protruding mass per vagina of 8 years duration.
She usually replaces the mass to urinate. She also has
urinary dribbling. On your inspection of the external
genitalia you observe pinkish mass with patches
hyperpigmentation which has central opening. What
additional physical examination you should to localize
site of defect?
Select one:
a. Bimanual pelvic examination
b. Pessary fitting test
c. Examination with valsalva maneuver
d. Speculum examination
Question 20
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A 30 year old primigravida lady comes to the
emergency room and has cardiac arrest. After 3 cycles
of CPR, she has return of spontaneous circulation.
However, she remains unresponsive with fixed and
dilated pupils, absent corneal reflexes and Doll's eye
movement. She is intubated and put on mechanical
ventilator. Her BP 100/70mmHg and PR 88bpm. All her
complete blood count, electrolytes, renal function and
liver function tests are within normal range. You could
not assess drug levels and poison screening. The fetus
is viable with estimated fetal weight of 1.1kg.
Which of the following is the best next step?
Select one:
a. Continue supporting the mother for a few
more weeks
b. Discuss with her family and execute their will
c. Terminate the pregnancy to salvage the baby
d. Discuss with your institution's ethics
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A 30 year old primigravida lady comes to the
emergency room and has cardiac arrest. After 3 cycles
of CPR, she has return of spontaneous circulation.
However, she remains unresponsive with fixed and
dilated pupils, absent corneal reflexes and Doll's eye
movement. She is intubated and put on mechanical
ventilator. Her BP 100/70mmHg and PR 88bpm. All her
complete blood count, electrolytes, renal function and
liver function tests are within normal range. You could
not assess drug levels and poison screening. The fetus
is viable with estimated fetal weight of 1.1kg.
Which of the following is the best next step?
Select one:
a. Continue supporting the mother for a few
more weeks
b. Discuss with her family and execute their will
c. Terminate the pregnancy to salvage the baby
d. Discuss with your institution's ethics
Question 21
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A 25 years old male patient admitted to medical ward
after being diagnosed with AKI. He presented with
generalized body swelling, shortness of breath and
decreased urine output. On physical examination, BP
100/70 mmHg, PR 80 bpm, RR 24bpm, T 36.80C, he
had distant heart sound with pericardial friction rub,
pedal and pretibial edema. Investigation showed
hyperkalemia which was refractory to medical
treatment. Urine output was 300ml/24hrs.
What is the next best management of this patient?
Select one:
a. pericardiocentesis
b. salt restriction
c. hemodialysis
d. chest tube insertion
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A 25 years old male patient admitted to medical ward
after being diagnosed with AKI. He presented with
generalized body swelling, shortness of breath and
decreased urine output. On physical examination, BP
100/70 mmHg, PR 80 bpm, RR 24bpm, T 36.80C, he
had distant heart sound with pericardial friction rub,
pedal and pretibial edema. Investigation showed
hyperkalemia which was refractory to medical
treatment. Urine output was 300ml/24hrs.
What is the next best management of this patient?
Select one:
a. pericardiocentesis
b. salt restriction
c. hemodialysis
d. chest tube insertion
Question 22
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A 27 years old para 4 woman gave birth at home
assisted by traditional birth attendants 4 weeks ago.
She has no history of anti-natal care. She is brought by
her relatives to the OPD after she started to shout,
talks to herself and disturb at home. Prior to the onset
of her symptoms she was sleepless, isolate herself and
lose interest in feeding the infant.
What is the immediate next step in the management
of this patient?
Select one:
a. Educate the family to take the child away
b. Enquire her feeding pattern
c. Start her antipsychotics
d. Enquire the content of hallucinatory voices
content
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A 27 years old para 4 woman gave birth at home
assisted by traditional birth attendants 4 weeks ago.
She has no history of anti-natal care. She is brought by
her relatives to the OPD after she started to shout,
talks to herself and disturb at home. Prior to the onset
of her symptoms she was sleepless, isolate herself and
lose interest in feeding the infant.
What is the immediate next step in the management
of this patient?
Select one:
a. Educate the family to take the child away
b. Enquire her feeding pattern
c. Start her antipsychotics
d. Enquire the content of hallucinatory voices
content
Question 23
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SH
A 7 years old child was diagnosed to have acute
tonsillopharyngits and put on amoxicillin. He came
back with a compliant of lack of response 10 hours
later. You evaluated him and his temperature is 380C
with erythematous tonsils and exudate.
What is the most appropriate next step?
Select one:
a. Put him on intramuscular ceftriaxone
b. Change amoxicillin to erythromycin
c. Change amoxicillin to Augmentin
d. Continue with the same management
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A 7 years old child was diagnosed to have acute
tonsillopharyngits and put on amoxicillin. He came
back with a compliant of lack of response 10 hours
later. You evaluated him and his temperature is 380C
with erythematous tonsils and exudate.
What is the most appropriate next step?
Select one:
a. Put him on intramuscular ceftriaxone
b. Change amoxicillin to erythromycin
c. Change amoxicillin to Augmentin
d. Continue with the same management
Question 24
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A 24 years old male sustained road traffic injury. He
injured his left leg. He was taken to health center and
was referred with posterior gutter. He arrived to your
ER after two hours of the injury. At presentation he has
excruciating pain over the injured leg. On examination
left leg was swollen and distal capillary refill was
sluggish.
What is the next appropriate management?
Select one:
a. Give analgesic
b. X-ray the injured limb
c. Elevate the limb
d. Remove the splint
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A 24 years old male sustained road traffic injury. He
injured his left leg. He was taken to health center and
was referred with posterior gutter. He arrived to your
ER after two hours of the injury. At presentation he has
excruciating pain over the injured leg. On examination
left leg was swollen and distal capillary refill was
sluggish.
What is the next appropriate management?
Select one:
a. Give analgesic
b. X-ray the injured limb
c. Elevate the limb
d. Remove the splint
Question 25
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A 16 years old high school girl, brought by her parents
to OPD, after a fainting attack in the school. Her
parents gave history of shortness of breath,
palpitation, and feeling of dizziness and fear of dying.
She had two previous similar episodes. Medical
evaluation and investigations were normal.
What is the most likely diagnosis?
Select one:
a. Panic disorder
b. Agoraphobia with panic attack
c. Agoraphobia without panic attack
d. Panic attack
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A 16 years old high school girl, brought by her parents
to OPD, after a fainting attack in the school. Her
parents gave history of shortness of breath,
palpitation, and feeling of dizziness and fear of dying.
She had two previous similar episodes. Medical
evaluation and investigations were normal.
What is the most likely diagnosis?
Select one:
a. Panic disorder
b. Agoraphobia with panic attack
c. Agoraphobia without panic attack
d. Panic attack
Question 26
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SH
A 12 month old infant came for routine checkup after
his mother was diagnosed to have smear positive
pulmonary tuberculosis. He is growing well with
normal systemic evaluation.
What is the most appropriate next step?
Select one:
a. Anti-tuberculosis
b. Chest X ray
c. INH prophylaxis
d. Gastric aspirate for gene expert
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SH
A 12 month old infant came for routine checkup after
his mother was diagnosed to have smear positive
pulmonary tuberculosis. He is growing well with
normal systemic evaluation.
What is the most appropriate next step?
Select one:
a. Anti-tuberculosis
b. Chest X ray
c. INH prophylaxis
d. Gastric aspirate for gene expert
Question 27
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A 6 months old prematurely delivered female infant
presented with fast breathing and cough of 3 days
duration associated with feeding interruption. She has
no body swelling or fever. On objective evaluation she
has PR of 155b/min with RR of 55b/min with pale
conjunctivae and non-icteric sclera. There is systolic
murmur at the left 2nd and 3rd inter-costal space and
palmar pallor but no edema.
What investigation do you want to do first?
Select one:
a. Chest X ray
b. Echocardiography
c. Electrocardiography
d. Hematocrit
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A 6 months old prematurely delivered female infant
presented with fast breathing and cough of 3 days
duration associated with feeding interruption. She has
no body swelling or fever. On objective evaluation she
has PR of 155b/min with RR of 55b/min with pale
conjunctivae and non-icteric sclera. There is systolic
murmur at the left 2nd and 3rd inter-costal space and
palmar pallor but no edema.
What investigation do you want to do first?
Select one:
a. Chest X ray
b. Echocardiography
c. Electrocardiography
d. Hematocrit
Question 28
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A 7 years old female patient present with intensely
itchy bullous lesion over the extensor aspect of
extremities of 2 months. On physical exam there are
excoriated plaques and vesicles with scratch marks.
What is the most likely diagnosis?
Select one:
a. Common bullous disease of childhood
b. Dermatitis herpetiformis
c. Allergic reactions
d. Severe atopic eczema
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SH
A 7 years old female patient present with intensely
itchy bullous lesion over the extensor aspect of
extremities of 2 months. On physical exam there are
excoriated plaques and vesicles with scratch marks.
What is the most likely diagnosis?
Select one:
a. Common bullous disease of childhood
b. Dermatitis herpetiformis
c. Allergic reactions
d. Severe atopic eczema
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You are in a swimming pool in one of the hotels.
Clients are informed at the reception that the "Life
Savor’ is going to be late and individuals can only
swim at their own risk. Unfortunately, one of the
clients has just near drowned. He is a young man in
20s. You rescued him from the water. You can feel a
week carotid pulse. Chest is not moving and there is
no air coming through the mouth.
What is the next best measure?
Select one:
a. Start chest compression
b. Bring Automated External Defibrillator and
apply shock
c. Give mouth-to-mouth breathing
d. Flip him over on his abdomen and apply
pressure over the back
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You are in a swimming pool in one of the hotels.
Clients are informed at the reception that the "Life
Savor’ is going to be late and individuals can only
swim at their own risk. Unfortunately, one of the
clients has just near drowned. He is a young man in
20s. You rescued him from the water. You can feel a
week carotid pulse. Chest is not moving and there is
no air coming through the mouth.
What is the next best measure?
Select one:
a. Start chest compression
b. Bring Automated External Defibrillator and
apply shock
c. Give mouth-to-mouth breathing
d. Flip him over on his abdomen and apply
pressure over the back
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A 30 year old female patient underwent resection of
the small bowel and end to end anastamosis with only
45cm length remaining behind for the diagnosis of
gangrenous small bowel secondary to mesenteric
ischemia. Both the ileocecal valve and large bowel
remained intact.
What is the best route of nutritional support in this
patient?
Select one:
a. Total Parentral
b. Nasojejunal
c. Nasogastric
d. Surgical jejunostomy
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A 30 year old female patient underwent resection of
the small bowel and end to end anastamosis with only
45cm length remaining behind for the diagnosis of
gangrenous small bowel secondary to mesenteric
ischemia. Both the ileocecal valve and large bowel
remained intact.
What is the best route of nutritional support in this
patient?
Select one:
a. Total Parentral
b. Nasojejunal
c. Nasogastric
d. Surgical jejunostomy
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A 30 year Para VII woman arrives at emergency OPD
with profuse vaginal bleeding. She delivered at home
before 90 minutes to a 4.1kg male neonate with labor
duration of 7 hours. Placenta and membrane are
delivered spontaneously at home. On your
examination she is hypotensive and tachycardic.
Uterus is 24 week sized and boggy.
What could have best prevented her postpartum
hemorrhage?
Select one:
a. Administration of intramuscular vitamin K
b. Early initiation of breast feeding
c. Active management of third stage of labor
d. Early arrival to the hospital after delivery
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SH
A 30 year Para VII woman arrives at emergency OPD
with profuse vaginal bleeding. She delivered at home
before 90 minutes to a 4.1kg male neonate with labor
duration of 7 hours. Placenta and membrane are
delivered spontaneously at home. On your
examination she is hypotensive and tachycardic.
Uterus is 24 week sized and boggy.
What could have best prevented her postpartum
hemorrhage?
Select one:
a. Administration of intramuscular vitamin K
b. Early initiation of breast feeding
c. Active management of third stage of labor
d. Early arrival to the hospital after delivery
Question 32
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A Gravida Ill Para Il mother comes to emergency OPD
with 7 hours of pushing down sensation and 6 hours
of gush of fluid per vagina. She has stable vital sign.
She has 4 moderate contractions over 10 minutes.
Fetal heart rate is 134beats/minute. Cervix is 8 cm
dilated station -2 with compound presentation of the
fetal head in occipito anterior position and fetal hand
palpated on the right side of the head.
How do you manage labor in this mother?
Select one:
a. Admission and labor augmentation
b. Admission and partograph follow up
c. Manipulating the prolapsed had to revert it
efore admission
d. Cesarean section from EOPD
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A Gravida Ill Para Il mother comes to emergency OPD
with 7 hours of pushing down sensation and 6 hours
of gush of fluid per vagina. She has stable vital sign.
She has 4 moderate contractions over 10 minutes.
Fetal heart rate is 134beats/minute. Cervix is 8 cm
dilated station -2 with compound presentation of the
fetal head in occipito anterior position and fetal hand
palpated on the right side of the head.
How do you manage labor in this mother?
Select one:
a. Admission and labor augmentation
b. Admission and partograph follow up
c. Manipulating the prolapsed had to revert it
efore admission
d. Cesarean section from EOPD
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A 39 years old driver sustained head on collision with a
Sino truck. He sustained pelvic ring injury. CT-scan
showed left side sacral fracture with quadri-rami
fracture. On examination he is unable to dorsoflex the
ankle.
What is the most likely injured nerve root?
Select one:
a. L4
b.L5
c.S1
d. S2
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A 39 years old driver sustained head on collision with a
Sino truck. He sustained pelvic ring injury. CT-scan
showed left side sacral fracture with quadri-rami
fracture. On examination he is unable to dorsoflex the
ankle.
What is the most likely injured nerve root?
Select one:
a. L4
b.L5
c.S1
d. S2
Question 34
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A 56 year male patient presented with lesion over the
sole of the right foot of 08 months duration associated
with pain during walking 8: loss of weight. Two
months back he also noticed a painful swelling over
the right inguinal area which is progressively
increasing in size. On P/E there is a hard 10x8 cm
matted, hard, fixed & tender swelling over the right
inguinal region with an irregularly shaped plaque like
dark lesion over the right sole of the foot. A skin
biopsy was taken from the lesion over the foot.
What would be the biopsy result of this patient?
Select one:
a. Lentigomaligna
b. Basal cell carcinoma
c. Squamous cell carcinoma
d. Acral melanoma
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A 56 year male patient presented with lesion over the
sole of the right foot of 08 months duration associated
with pain during walking 8: loss of weight. Two
months back he also noticed a painful swelling over
the right inguinal area which is progressively
increasing in size. On P/E there is a hard 10x8 cm
matted, hard, fixed & tender swelling over the right
inguinal region with an irregularly shaped plaque like
dark lesion over the right sole of the foot. A skin
biopsy was taken from the lesion over the foot.
What would be the biopsy result of this patient?
Select one:
a. Lentigomaligna
b. Basal cell carcinoma
c. Squamous cell carcinoma
d. Acral melanoma
Question 35
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An anesthesiologist injected 3ml of 2percent lidocaine
into the trachea of a 54 year-old obese male patient
through the crico-thyroid membrane for an awake
intubation.
What nerve will most likely be anesthetized?
Select one:
a. Superior laryngeal nerve
b. Hypoglossal nerve
c. Glossopharyngeal nerve
d. Recurrent laryngeal nerve
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SH
An anesthesiologist injected 3ml of 2percent lidocaine
into the trachea of a 54 year-old obese male patient
through the crico-thyroid membrane for an awake
intubation.
What nerve will most likely be anesthetized?
Select one:
a. Superior laryngeal nerve
b. Hypoglossal nerve
c. Glossopharyngeal nerve
d. Recurrent laryngeal nerve
Question 36
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A 45 year old known hypertensive patient is now
diagnosed to have systolic heart failure with ejection
fraction of 35percent. His BP = 90/60mmHg and PR =
92bpm. He has been on enalapril 10mg po BID and
amlodipine 5mg po daily.
What is the first medication adjustment you want to
make?
Select one:
a. Stop enalapril and amlodipine, consider
digoxin and diuretics
b. Continue enalapril, stop amlodipine, consider
digoxin and diuretics
Cc. Stop enalapril, continue amlodipine, start
digoxin and diuretics
d. Stop enalapril and amlodipine, start digoxin
and diuretics
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A 45 year old known hypertensive patient is now
diagnosed to have systolic heart failure with ejection
fraction of 35percent. His BP = 90/60mmHg and PR =
92bpm. He has been on enalapril 10mg po BID and
amlodipine 5mg po daily.
What is the first medication adjustment you want to
make?
Select one:
a. Stop enalapril and amlodipine, consider
digoxin and diuretics
b. Continue enalapril, stop amlodipine, consider
digoxin and diuretics
Cc. Stop enalapril, continue amlodipine, start
digoxin and diuretics
d. Stop enalapril and amlodipine, start digoxin
and diuretics
Question 37
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A two years old child presented to the hospital after
his family notice abdominal mass while they are
bathing the child. On examination, the child is severely
wasted and hypertensive. There was right flank mass
which extend to midline but didn't cross it. Urine
analysis showed hematuria.
What is the most likely diagnosis?
Select one:
a. Hydronephrosis
b. Retroperitoneal teratoma
c. Neuroblastoma
d. Wilms' tumor
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A two years old child presented to the hospital after
his family notice abdominal mass while they are
bathing the child. On examination, the child is severely
wasted and hypertensive. There was right flank mass
which extend to midline but didn't cross it. Urine
analysis showed hematuria.
What is the most likely diagnosis?
Select one:
a. Hydronephrosis
b. Retroperitoneal teratoma
c. Neuroblastoma
d. Wilms' tumor
Question 38
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You did manual vacuum aspiration for a first trimester
incomplete abortion. The pregnancy was unplanned
and unwanted. For that she went to a local traditional
medicine and given unspecified medication to swallow
4 days back. On arrival she had vaginal bleeding, high
grade fever and foul smelling vaginal discharge. She is
a student and lives with her parents. She has a
boyfriend and wanted to use contraception after the
procedure.
Which contraception method is best to offer the
client?
Select one:
a. IUCD
b. Condom
c. Post pil
d. Injectable
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You did manual vacuum aspiration for a first trimester
incomplete abortion. The pregnancy was unplanned
and unwanted. For that she went to a local traditional
medicine and given unspecified medication to swallow
4 days back. On arrival she had vaginal bleeding, high
grade fever and foul smelling vaginal discharge. She is
a student and lives with her parents. She has a
boyfriend and wanted to use contraception after the
procedure.
Which contraception method is best to offer the
client?
Select one:
a. IUCD
b. Condom
c. Post pil
d. Injectable
Question 39
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SH
A 14 years old adolescent was diagnosed to have
malaria after blood film result showed trophozoite
stage of P. falciparum, and P. vivax.
What is the most appropriate therapy?
Select one:
a. Quinine
b. Coartem
c. Chloroquine with coartem.
d. Quinine with coartem
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A 14 years old adolescent was diagnosed to have
malaria after blood film result showed trophozoite
stage of P. falciparum, and P. vivax.
What is the most appropriate therapy?
Select one:
a. Quinine
b. Coartem
c. Chloroquine with coartem.
d. Quinine with coartem
Question 41
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A 10 years old female child developed generalized
urticaria, laryngeal edema, bronchospasm, and
hypotension following the administration of
benzanthine penicillin for the treatment of
tonsillophayngitis. What will be the first drug to
manage this patient?
Select one:
a. Short acting beta agonist
b. Dexamethason
c. Antihistamine
d. Epinephrine
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SH
A 10 years old female child developed generalized
urticaria, laryngeal edema, bronchospasm, and
hypotension following the administration of
benzanthine penicillin for the treatment of
tonsillophayngitis. What will be the first drug to
manage this patient?
Select one:
a. Short acting beta agonist
b. Dexamethason
c. Antihistamine
d. Epinephrine
Question 40
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You are a physician in primary care and noticed that
many case reports of completed suicide. You made
search on the topic and found many evidences
supporting higher rate of suicide in primary care.
What is the first enquiry the primary care physician
should do to prevent suicide?
Select one:
a. Asking suicidal ideation
b. Asking death thoughts
c. Asking the intent to die
d. Asking plan for suicide
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You are a physician in primary care and noticed that
many case reports of completed suicide. You made
search on the topic and found many evidences
supporting higher rate of suicide in primary care.
What is the first enquiry the primary care physician
should do to prevent suicide?
Select one:
a. Asking suicidal ideation
b. Asking death thoughts
c. Asking the intent to die
d. Asking plan for suicide
Question 43
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A 70 year old man with 15 pack year history of
smoking but who stopped smoking about 5 years ago
presents with cough and weight loss. He has evidence
of left pleural effusion. Chest CT shows left upper lobe
apical mass with left pleural effusion.
What is the best next diagnostic test?
Select one:
a. Fluid Gene Xpert
b. Fluid cytology
c. Pleural biopsy
d. Fluid Adenosine diaminase (ADA)
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A 70 year old man with 15 pack year history of
smoking but who stopped smoking about 5 years ago
presents with cough and weight loss. He has evidence
of left pleural effusion. Chest CT shows left upper lobe
apical mass with left pleural effusion.
What is the best next diagnostic test?
Select one:
a. Fluid Gene Xpert
b. Fluid cytology
c. Pleural biopsy
d. Fluid Adenosine diaminase (ADA)
Question 44
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A 27 years old male patient was told to have gall stone
measuring <4cm. Currently, presented with severe
abdominal pain, nausea, vomiting and low grade fever.
On physical examination, BP=90/60mmHg,
PR=120bpm, RR=20bpm, T=36.50C. Otherwise, there
was no pertinent positive finding. On investigation,
WBC=14,500, Hct=48percent, abdominal U/S -showed
minimal retro-peritoneal fluid collection and gall
bladder is normal, serum lipase was 3x elevated. You
admitted and gave him IV analgesics and ordered him
to be NPO.
What is the next best management of this patient?
Select one:
a. IV prophylactic antibiotics
b. prepare for cholesystectomy
c. IV fluid resuscitation
d. ASA
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A 27 years old male patient was told to have gall stone
measuring <4cm. Currently, presented with severe
abdominal pain, nausea, vomiting and low grade fever.
On physical examination, BP=90/60mmHg,
PR=120bpm, RR=20bpm, T=36.50C. Otherwise, there
was no pertinent positive finding. On investigation,
WBC=14,500, Hct=48percent, abdominal U/S -showed
minimal retro-peritoneal fluid collection and gall
bladder is normal, serum lipase was 3x elevated. You
admitted and gave him IV analgesics and ordered him
to be NPO.
What is the next best management of this patient?
Select one:
a. IV prophylactic antibiotics
b. prepare for cholesystectomy
c. IV fluid resuscitation
d. ASA
Question 45,
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A known diabetic young woman with good sugar
control, presented to your medical OPD for follow up.
She wanted to have a baby and asked your advice on
how to proceed.
When would you recommend her to be screened for
retinopathy?
Select one:
a. Around the time of delivery
b. Before conception
c. At her own convenience
d. After the first trimester
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A known diabetic young woman with good sugar
control, presented to your medical OPD for follow up.
She wanted to have a baby and asked your advice on
how to proceed.
When would you recommend her to be screened for
retinopathy?
Select one:
a. Around the time of delivery
b. Before conception
c. At her own convenience
d. After the first trimester
Question 46
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67 year old female fell from a stair and hit her head
against the ground associated with this she complains
projectile vomiting of 2 episodes. Up on presentation
her GCS was 15/15 and mild abrasion over the
forehead.
What is the next best step in the management of this
patient?
Select one:
a. No imaging is needed.
b. Brain MRI
c. Contrast enhanced CT
d. Non-enhanced head CT
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67 year old female fell from a stair and hit her head
against the ground associated with this she complains
projectile vomiting of 2 episodes. Up on presentation
her GCS was 15/15 and mild abrasion over the
forehead.
What is the next best step in the management of this
patient?
Select one:
a. No imaging is needed.
b. Brain MRI
c. Contrast enhanced CT
d. Non-enhanced head CT
Question 47
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You are managing a nurse with Gene x-pert positive
drug sensitive pulmonary tuberculosis. He comes on
the fourth month of anti-TB initiation. The cough has
almost disappeared and he has gained some weight.
His lab technician colleague did him a repeat Gene x-
pert which is positive. He looks worried that he may
not get cured.
What should you do?
Select one:
a. Check Line Probe Assay
b. Reassure and continue the anti-TB
c. Repeat Gene x-pert as this could be false
positive
d. Send sample for TB culture and sensitivity
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You are managing a nurse with Gene x-pert positive
drug sensitive pulmonary tuberculosis. He comes on
the fourth month of anti-TB initiation. The cough has
almost disappeared and he has gained some weight.
His lab technician colleague did him a repeat Gene x-
pert which is positive. He looks worried that he may
not get cured.
What should you do?
Select one:
a. Check Line Probe Assay
b. Reassure and continue the anti-TB
c. Repeat Gene x-pert as this could be false
positive
d. Send sample for TB culture and sensitivity
Question 48
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SH
A 37 years old male patient sustained road traffic
accident while he was crossing the road. Up on arrival
to ER he was unconscious with GCS of 12/15 V/S PR=
66BPM B/P= 170/90mmHg RR= 32 BPM. On
investigation CXR was unremarkable, ABG shows
paO2=70mmHg PaCO2= 34 mmHg, serum
electrolyte's Na = 134 k= 4.5. CT-scan is unremarkable
What initial measure would you take to improve his
GCS?
Select one:
a. Correct Electrolytes
b. Administer analgesics
c. Hyperventilation
d. Administer antihypertensive medication
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A 37 years old male patient sustained road traffic
accident while he was crossing the road. Up on arrival
to ER he was unconscious with GCS of 12/15 V/S PR=
66BPM B/P= 170/90mmHg RR= 32 BPM. On
investigation CXR was unremarkable, ABG shows
paO2=70mmHg PaCO2= 34 mmHg, serum
electrolyte's Na = 134 k= 4.5. CT-scan is unremarkable
What initial measure would you take to improve his
GCS?
Select one:
a. Correct Electrolytes
b. Administer analgesics
c. Hyperventilation
d. Administer antihypertensive medication
Question 49
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A 55 years old female patient presented with right side
pulsatile tinnitus of 3 years duration. On otoscopic
examination, there was intact tympanic membrane
with vascularized, dome shaped mass mainly
occupying hypotympanum and inferior aspect of
mesotympanum.
What is the most likely diagnosis in this patient?
Select one:
a. Chordoma
b. Squamous cell carcinoma
c. Adenocarcinoma
d. Glomus tumor
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A 55 years old female patient presented with right side
pulsatile tinnitus of 3 years duration. On otoscopic
examination, there was intact tympanic membrane
with vascularized, dome shaped mass mainly
occupying hypotympanum and inferior aspect of
mesotympanum.
What is the most likely diagnosis in this patient?
Select one:
a. Chordoma
b. Squamous cell carcinoma
c. Adenocarcinoma
d. Glomus tumor
Question 50
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A 45 years old man presented with back pain and
lower extremities weakness of one month duration. On
physical exam, he is conscious and alert, with normal
vital signs and clear chest. He has paraparesis with
sensory level at umbilicus.
What investigation is most important to diagnose the
disease?
Select one:
a. Cervical MRI
b. Sacral MRI
c. Thoraco lumbar MRI
d. Upper thoracic CT SCAN
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A 45 years old man presented with back pain and
lower extremities weakness of one month duration. On
physical exam, he is conscious and alert, with normal
vital signs and clear chest. He has paraparesis with
sensory level at umbilicus.
What investigation is most important to diagnose the
disease?
Select one:
a. Cervical MRI
b. Sacral MRI
c. Thoraco lumbar MRI
d. Upper thoracic CT SCAN
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You diagnose preterm labor at gestational age of 34
weeks on a primigravida lady. She is admitted at
cervical dilatation of 5cm. You are planning to follow
fetal heart beat with fetoscope. She had uneventful
ANC and no chronic medical illness.
How frequent should you auscultate the fetal heart
beat during active first stage of labor?
Select one:
a. Every 5 minutes
b. Every 15 minutes
c. Every 30 minutes
d. Every 1 hour
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You diagnose preterm labor at gestational age of 34
weeks on a primigravida lady. She is admitted at
cervical dilatation of 5cm. You are planning to follow
fetal heart beat with fetoscope. She had uneventful
ANC and no chronic medical illness.
How frequent should you auscultate the fetal heart
beat during active first stage of labor?
Select one:
a. Every 5 minutes
b. Every 15 minutes
c. Every 30 minutes
d. Every 1 hour
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A 12 months old infant can request for food and
water, tries to feed himself with spoon and releases
the spoon when asked. He can creep and sit
unsupported. He can wave his hands saying bye and
comes when called.
Which part of his developmental millstone is in
problem?
Select one:
a. Language
b. Fine motor
c. Cognitive
d. Gross motor
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A 12 months old infant can request for food and
water, tries to feed himself with spoon and releases
the spoon when asked. He can creep and sit
unsupported. He can wave his hands saying bye and
comes when called.
Which part of his developmental millstone is in
problem?
Select one:
a. Language
b. Fine motor
c. Cognitive
d. Gross motor
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A 25 year old Para Il mother was admitted with
endomyometritis on her 6th post op day after
cesarean section was done for cord prolapse. She first
present with high grade fever, palpitation, foul
smelling vaginal discharge with bleeding and lower
abdominal pain. Her wound is clean. She is started on
broad spectrum antibiotic and on the third day all her
symptoms improved except her fever persisted and
she has chills.
What is the most likely diagnosis?
Select one:
a. Necrotizing fasci
is
b. Hospital acquired pnemonia
c. Antibiotic resistance
d. Septic thrombophlebitis
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A 25 year old Para Il mother was admitted with
endomyometritis on her 6th post op day after
cesarean section was done for cord prolapse. She first
present with high grade fever, palpitation, foul
smelling vaginal discharge with bleeding and lower
abdominal pain. Her wound is clean. She is started on
broad spectrum antibiotic and on the third day all her
symptoms improved except her fever persisted and
she has chills.
What is the most likely diagnosis?
Select one:
a. Necrotizing fasci
is
b. Hospital acquired pnemonia
c. Antibiotic resistance
d. Septic thrombophlebitis
Question 56
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A 26 years old male patient presented with pain
behind the ear followed by facial deviation to the left
and drooling of saliva of 20 hrs duration. On P/E flat
nasolabial fold, difficult in closing eyes and frauning.no
other pertinent positive findings.
What treatment would you like to initiate?
Select one:
a. carbamazepine
b. amytriptyline
c. predinisolone with acyclovir
d. pethidine
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A 26 years old male patient presented with pain
behind the ear followed by facial deviation to the left
and drooling of saliva of 20 hrs duration. On P/E flat
nasolabial fold, difficult in closing eyes and frauning.no
other pertinent positive findings.
What treatment would you like to initiate?
Select one:
a. carbamazepine
b. amytriptyline
c. predinisolone with acyclovir
d. pethidine
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A child with severe combined primary
immunodeficiency is brought to your clinic for routine
childhood immunization.
What vaccine is contraindicated to this child?
Select one:
a. Measles Vaccine
b. Diphtheria, Tetanus, Pertussis (DTaP) vaccine
c. PCV (pneumococcal) vaccine
d. Hepatitis virus vaccine
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A child with severe combined primary
immunodeficiency is brought to your clinic for routine
childhood immunization.
What vaccine is contraindicated to this child?
Select one:
a. Measles Vaccine
b. Diphtheria, Tetanus, Pertussis (DTaP) vaccine
c. PCV (pneumococcal) vaccine
d. Hepatitis virus vaccine
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A 3-month-old infant presented with a runny nose,
cough, and rapid breathing of 5 days after receiving
his 14-weeks immunizations. On examination he has a
temperature of 380C, a respiratory rate of 60
breathes/minute, and he has a diffuse wheeze.
What is the most likely diagnosis?
Select one:
a. Congenital heart disease
b. Bronchiolitis
c. Myocarditis
d. Severe pneumonia
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A 3-month-old infant presented with a runny nose,
cough, and rapid breathing of 5 days after receiving
his 14-weeks immunizations. On examination he has a
temperature of 380C, a respiratory rate of 60
breathes/minute, and he has a diffuse wheeze.
What is the most likely diagnosis?
Select one:
a. Congenital heart disease
b. Bronchiolitis
c. Myocarditis
d. Severe pneumonia
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A 44 years old farmer came with nodular lesion over
the foot of 5 years which progressively enlarge and
distort the normal biomechanics of the foot. KoH and
culture show fungal elements; on X-ray there are
periosteal erosion and development of new lytic bone
lesions.
Which of the following is not the classical triad of the
disease?
Select one:
a. Tumerification
b. Pain
c. Sinus tracts
d. Grains
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A 44 years old farmer came with nodular lesion over
the foot of 5 years which progressively enlarge and
distort the normal biomechanics of the foot. KoH and
culture show fungal elements; on X-ray there are
periosteal erosion and development of new lytic bone
lesions.
Which of the following is not the classical triad of the
disease?
Select one:
a. Tumerification
b. Pain
c. Sinus tracts
d. Grains
Question 64
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30 year old male presented with coughing up of
blood, shortnesss of breath and chest pain of 1 week.
Associated with this he complains fatigue, nausea,
vomiting and loss of appetite. His laboratory profile
revealed Hct of 34; U/A 10RBCs/HPF ; Serology shows
circulating anti-glomerular basement antibodies.
What will chest X-ray of this patient most likely reveal?
Select one:
a. Bilateral pleural effusion.
b. Bilateral interstitial opacity.
c. Bilateral patchy airspace opacity.
d. Multiple cavitary lesions.
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30 year old male presented with coughing up of
blood, shortnesss of breath and chest pain of 1 week.
Associated with this he complains fatigue, nausea,
vomiting and loss of appetite. His laboratory profile
revealed Hct of 34; U/A 10RBCs/HPF ; Serology shows
circulating anti-glomerular basement antibodies.
What will chest X-ray of this patient most likely reveal?
Select one:
a. Bilateral pleural effusion.
b. Bilateral interstitial opacity.
c. Bilateral patchy airspace opacity.
d. Multiple cavitary lesions.
Question 6S
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A Primigravida lady at gestational age of 27 weeks
presented with crampy lower abdominal pain of 5
hours duration. She has associated passage of watery
fluid. Otherwise she has no bleeding, has no passage
of tissue. On physical examination vital signs are
stable, no abdominal tenderness, cervix is closed and
watery fluid on examining finger appreciated. On
ultrasound examination cardiac activity is negative,
and amniotic fluid is minimal. BPD corresponds to 14
weeks.
What is the diagnosis?
Select one:
a. Inevitable abortion
b. Threatened abortion
c. Incomplete abortion
d. Missed abortion
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A Primigravida lady at gestational age of 27 weeks
presented with crampy lower abdominal pain of 5
hours duration. She has associated passage of watery
fluid. Otherwise she has no bleeding, has no passage
of tissue. On physical examination vital signs are
stable, no abdominal tenderness, cervix is closed and
watery fluid on examining finger appreciated. On
ultrasound examination cardiac activity is negative,
and amniotic fluid is minimal. BPD corresponds to 14
weeks.
What is the diagnosis?
Select one:
a. Inevitable abortion
b. Threatened abortion
c. Incomplete abortion
d. Missed abortion
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A 60 years old known alcohol abuser presents with
right upper quadrant pain. On physical examination he
has a tender hepatomegaly. Lab studies show a
preferential elevation of aspartate transferase; serum
bilirubin levels were within normal range. A liver core
needle biopsy shows fatty changes.
What is the underlying pathogenesis for the above
changes?
Select one:
a. Decreased hydrolysis of fat in adipose tissue
b. Decreased synthesis of VLDL (Very Low
Density Lipoprotein)
c. Increased Beta-oxidation of fatty acids
d. Increased synthesis of glycerol 3 phosphate
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A 60 years old known alcohol abuser presents with
right upper quadrant pain. On physical examination he
has a tender hepatomegaly. Lab studies show a
preferential elevation of aspartate transferase; serum
bilirubin levels were within normal range. A liver core
needle biopsy shows fatty changes.
What is the underlying pathogenesis for the above
changes?
Select one:
a. Decreased hydrolysis of fat in adipose tissue
b. Decreased synthesis of VLDL (Very Low
Density Lipoprotein)
c. Increased Beta-oxidation of fatty acids
d. Increased synthesis of glycerol 3 phosphate
Question 69
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A middle-aged woman presented with malaise,
fatigue, and night sweating. Physical examination
showed dry and red eyes, skin rashes, enlarged joints
and lymph nodes in the cervical region. Chest x-ray
revealed a widened mediastinum. The biopsy report of
lymph node showed non-caseating granuloma with a
range of differential diagnosis.
What is the most likely diagnosis?
Select one:
a. Sarcoidosis
b. Disseminated tuberculosis
c. Systemic lupus erythematosus (SLE)
d. Sjogren's syndrome
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A middle-aged woman presented with malaise,
fatigue, and night sweating. Physical examination
showed dry and red eyes, skin rashes, enlarged joints
and lymph nodes in the cervical region. Chest x-ray
revealed a widened mediastinum. The biopsy report of
lymph node showed non-caseating granuloma with a
range of differential diagnosis.
What is the most likely diagnosis?
Select one:
a. Sarcoidosis
b. Disseminated tuberculosis
c. Systemic lupus erythematosus (SLE)
d. Sjogren's syndrome
Question 70
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A 33 year old man presents from prison with high
grade fever, headache, arthralgia, and myalgia. His
physical examination is remarkable for PR = 126bpm,
BP = 120/80mmHg, RR = 28bpm, To = 39.50€ and
petechial rash scattered over the extremities. Lab
shows WBC = 13,000/mm3, Hgb = 10g/dl, and platelet
= 55,000/mm3. Blood film shows spirochetes. Two
hours after initiation of treatment with penicillin,
patient started having shaking chills and confusion.
Vitals showed PR = 140bpm, BP = 70/40mmHg, RR =
44bpm, and SaO2 = 83percent.
What is the explanation for later finding?
Select one:
a. Septic shock
b. Anaphylactic shock
<. Jarisch-Herxheimer reaction
d. Intracranial bleeding with raised ICP
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A 33 year old man presents from prison with high
grade fever, headache, arthralgia, and myalgia. His
physical examination is remarkable for PR = 126bpm,
BP = 120/80mmHg, RR = 28bpm, To = 39.50€ and
petechial rash scattered over the extremities. Lab
shows WBC = 13,000/mm3, Hgb = 10g/dl, and platelet
= 55,000/mm3. Blood film shows spirochetes. Two
hours after initiation of treatment with penicillin,
patient started having shaking chills and confusion.
Vitals showed PR = 140bpm, BP = 70/40mmHg, RR =
44bpm, and SaO2 = 83percent.
What is the explanation for later finding?
Select one:
a. Septic shock
b. Anaphylactic shock
<. Jarisch-Herxheimer reaction
d. Intracranial bleeding with raised ICP
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A 12 hours old term macrosomic neonate was sent to
NICU for evaluation. The labor and delivery was
uneventful with outcome of 4200gm male neonate
with APGAR of 8 and 9 at first and fifth minutes. On
evaluation he has RR of 50 bpm, red-purple face and
trunk with sustained sucking reflex. On laboratory
investigation, WBC- 20,000cells/mm3 (S6percent
neutrophil), Hgb - 25mg/dl, Pit- 340,000cells/mm3 and
RBS - S6mg/dl.
What is the most next appropriate step?
Select one:
a. Volume to volume exchange transfusion.
b. Hydration with normal saline
c. Partial exchange transfusion
d. Double exchange transfusion
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A 12 hours old term macrosomic neonate was sent to
NICU for evaluation. The labor and delivery was
uneventful with outcome of 4200gm male neonate
with APGAR of 8 and 9 at first and fifth minutes. On
evaluation he has RR of 50 bpm, red-purple face and
trunk with sustained sucking reflex. On laboratory
investigation, WBC- 20,000cells/mm3 (S6percent
neutrophil), Hgb - 25mg/dl, Pit- 340,000cells/mm3 and
RBS - S6mg/dl.
What is the most next appropriate step?
Select one:
a. Volume to volume exchange transfusion.
b. Hydration with normal saline
c. Partial exchange transfusion
d. Double exchange transfusion
Question 54
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A 12 months old infant can request for food and
water, tries to feed himself with spoon and releases
the spoon when asked. He can creep and sit
unsupported. He can wave his hands saying bye and
comes when called.
Which part of his developmental millstone is in
problem?
Select one:
a. Language
b. Fine motor
c. Cognitive
d. Gross motor
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SH
A 12 months old infant can request for food and
water, tries to feed himself with spoon and releases
the spoon when asked. He can creep and sit
unsupported. He can wave his hands saying bye and
comes when called.
Which part of his developmental millstone is in
problem?
Select one:
a. Language
b. Fine motor
c. Cognitive
d. Gross motor
Question 57
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A 4 weeks old neonate presented with 1 week history
of non bilious vomiting that occurs immediately after
feeding. After vomiting he is eager and wants to feed
again. He looks emaciated.
What is the most likely diagnosis of this neonate?
Select one:
a. Inborn error of metabolism
b. Acute gastroenteritis
c. Infantile hypertrophic pyloric stenosis
d. Late onset neonatal sepsis
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A 4 weeks old neonate presented with 1 week history
of non bilious vomiting that occurs immediately after
feeding. After vomiting he is eager and wants to feed
again. He looks emaciated.
What is the most likely diagnosis of this neonate?
Select one:
a. Inborn error of metabolism
b. Acute gastroenteritis
c. Infantile hypertrophic pyloric stenosis
d. Late onset neonatal sepsis
Question 60
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While you are making a round in the labor ward a
midwife consulted you to evaluate one laboring
woman who just came. She reported that on digital
exam she felt a presenting part bounded at one side
by the base of nasal bone but nostrils are not felt. You
did your examination and the finding is similar with
cervix 6 cm dilated. FHB is 130bpm, has 2 contractions
which stays 40 seconds in 10 minutes.
What is the next best management?
Select one:
a. Do augmentation of labor
b. Prepare her for emergency cesarean section
c. Follow fetomaternal condition and labor with
a partograph
d. Do destructive delivery
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While you are making a round in the labor ward a
midwife consulted you to evaluate one laboring
woman who just came. She reported that on digital
exam she felt a presenting part bounded at one side
by the base of nasal bone but nostrils are not felt. You
did your examination and the finding is similar with
cervix 6 cm dilated. FHB is 130bpm, has 2 contractions
which stays 40 seconds in 10 minutes.
What is the next best management?
Select one:
a. Do augmentation of labor
b. Prepare her for emergency cesarean section
c. Follow fetomaternal condition and labor with
a partograph
d. Do destructive delivery
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A 35- year old male patient has presented with neck
and facial swelling. He also complained cough and
shortness of breath. Physical exam revealed BP 100/70
mmHg, PR 80 bpm, RR 26 bpm, T 36.40C . He had
dilated neck veins and visible collateral veins over the
anterior chest. He has cyanosis, edema of the face and
arms. CXR showed mediastinal widening.
What is the most likely diagnosis?
Select one:
a. Aortic dissection
b. Pulmonary thromboembolism
c. Superior venacaval syndrome
d. Cardiac tamponade
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A 35- year old male patient has presented with neck
and facial swelling. He also complained cough and
shortness of breath. Physical exam revealed BP 100/70
mmHg, PR 80 bpm, RR 26 bpm, T 36.40C . He had
dilated neck veins and visible collateral veins over the
anterior chest. He has cyanosis, edema of the face and
arms. CXR showed mediastinal widening.
What is the most likely diagnosis?
Select one:
a. Aortic dissection
b. Pulmonary thromboembolism
c. Superior venacaval syndrome
d. Cardiac tamponade
Question 63
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A 20 years old male patient presented with polyuria,
polydypsia, abdominal pain and vomiting of ingested
matter. On physical exam he is conscious and alert
with BP=90/60, PR=120bpm, RR=24bpm, T=380C, dry
buccal mucosa. On investigation RBS=450ma/dl, urine
ketone is +3 and full of WBC on microscope.
What is the first step in the treatment of this patient?
Select one:
a. Insulin administration
b. fluid administration
c. correction of hypokalemia
d. initiation of antibiotics
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A 20 years old male patient presented with polyuria,
polydypsia, abdominal pain and vomiting of ingested
matter. On physical exam he is conscious and alert
with BP=90/60, PR=120bpm, RR=24bpm, T=380C, dry
buccal mucosa. On investigation RBS=450ma/dl, urine
ketone is +3 and full of WBC on microscope.
What is the first step in the treatment of this patient?
Select one:
a. Insulin administration
b. fluid administration
c. correction of hypokalemia
d. initiation of antibiotics
SS Sa ee
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A 42 yal OG Man COMES tO YOU TaligabıLy ana
palpitation on mild exertion. He underwent
unspecified abdominal surgery 4 years back. He was
also treated for Hook worm two months ago. He has
conjunctival pallor, angular cheilosis and non-icteric
sclerae. His Hgb is 9g/dl (MCV = 120fL). Peripheral
morphology shows macro-ovalocytic RBCs with
hypersegmented neutrophils.
What is the next best management?
Select one:
a. Folic acid plus stool for ova of parasite
b. Folic acid plus vitamin B12
c. Vitamin B12 plus stool for ova of parasite
d. Iron plus mebendazole
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A 42 yal OG Man COMES tO YOU TaligabıLy ana
palpitation on mild exertion. He underwent
unspecified abdominal surgery 4 years back. He was
also treated for Hook worm two months ago. He has
conjunctival pallor, angular cheilosis and non-icteric
sclerae. His Hgb is 9g/dl (MCV = 120fL). Peripheral
morphology shows macro-ovalocytic RBCs with
hypersegmented neutrophils.
What is the next best management?
Select one:
a. Folic acid plus stool for ova of parasite
b. Folic acid plus vitamin B12
c. Vitamin B12 plus stool for ova of parasite
d. Iron plus mebendazole
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A 15 years old male patient was admitted to the burn
unit with a diagnosis of 60percent total body surface
area 2nd degree flame burn. On the first day of
admission he was found to have PR-108bpm & T-
38.2degree C. The other physical findings were
unremarkable. He was investigated with CBC, blood
culture, Urine analysis and Organ function test which
were all normal.
What is the most likely diagnosis of this patient's
current situation?
Select one:
a. Wound site infection
b. Sepsis without organ failure
c. Systemic inflammatory response syndrome
d. Severe sepsis
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A 15 years old male patient was admitted to the burn
unit with a diagnosis of 60percent total body surface
area 2nd degree flame burn. On the first day of
admission he was found to have PR-108bpm & T-
38.2degree C. The other physical findings were
unremarkable. He was investigated with CBC, blood
culture, Urine analysis and Organ function test which
were all normal.
What is the most likely diagnosis of this patient's
current situation?
Select one:
a. Wound site infection
b. Sepsis without organ failure
c. Systemic inflammatory response syndrome
d. Severe sepsis
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A 45 year old man is in your office for consultation of
recent onset general malaise and fatigability. While
walking into your office he suddenly collapsed. You
realized that peripheral pulses are not palpable, apical
impulse is absent, chest is not moving and you do not
feel air coming through the mouth.
What is the next best step?
Select one:
a. Check random blood sugar
b. Start cardiopulmonary resuscitation
c. Transport him to the emergency room
d. Check his pocket for drugs
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A 45 year old man is in your office for consultation of
recent onset general malaise and fatigability. While
walking into your office he suddenly collapsed. You
realized that peripheral pulses are not palpable, apical
impulse is absent, chest is not moving and you do not
feel air coming through the mouth.
What is the next best step?
Select one:
a. Check random blood sugar
b. Start cardiopulmonary resuscitation
c. Transport him to the emergency room
d. Check his pocket for drugs
Question 76
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A 20 year old male patient presented to the outpatient
clinic with a complaint of right upper quadrant
abdominal mass associated with dull aching pain, early
satiety & intermittent vomiting of ingested matter. The
only pertinent finding is on the abdomen which shows
an ill-defined, mildly tender mass over the right upper
quadrant and hepatomegally. Ultrasonography
revealed a big hydatid cyst in the right lobe of liver
with multiple daughter cysts.
What is the best investigative modality to assess
synthetic function of the liver?
Select one:
a. Serum prothrombin time
b. Serum aminotransferases
c. Serum bi
ubin
d. Serum Alkaline phosphatase
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A 20 year old male patient presented to the outpatient
clinic with a complaint of right upper quadrant
abdominal mass associated with dull aching pain, early
satiety & intermittent vomiting of ingested matter. The
only pertinent finding is on the abdomen which shows
an ill-defined, mildly tender mass over the right upper
quadrant and hepatomegally. Ultrasonography
revealed a big hydatid cyst in the right lobe of liver
with multiple daughter cysts.
What is the best investigative modality to assess
synthetic function of the liver?
Select one:
a. Serum prothrombin time
b. Serum aminotransferases
c. Serum bi
ubin
d. Serum Alkaline phosphatase
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A Gravida II Para | mother was admitted to labor ward
with active first stage of labor at a cervical dilatation of
6 cm, O station, and ruptured membrane with left
occipito-transverse fetal position. She had one
previous cesarean scar. She has 4 strong contractions
over 10 minutes. And fetal heart rate ranges between
130 to 158 beats/minute with accelerations. After 90
minute follow up you notice prolonged fetal heart rate
decelerations otherwise maternal vital sign is normal
and no vaginal bleeding.
What is the likely cause of change in fetal heart beat
pattern ?
Select one:
a. Placental abruption
b. Cord compression
c. Second stage of labor
d. Imminent uterine rupture
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A Gravida II Para | mother was admitted to labor ward
with active first stage of labor at a cervical dilatation of
6 cm, O station, and ruptured membrane with left
occipito-transverse fetal position. She had one
previous cesarean scar. She has 4 strong contractions
over 10 minutes. And fetal heart rate ranges between
130 to 158 beats/minute with accelerations. After 90
minute follow up you notice prolonged fetal heart rate
decelerations otherwise maternal vital sign is normal
and no vaginal bleeding.
What is the likely cause of change in fetal heart beat
pattern ?
Select one:
a. Placental abruption
b. Cord compression
c. Second stage of labor
d. Imminent uterine rupture
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A 27 years old female patient with hypothyroidism
came with a compliant of asymptomatic whitening of
the finger tips. On exam there are depigmented
macules and patches over the finger tips and lower lip.
What is the most likely cause of the depigmentation?
Select one:
a. Absence of melanosomes
b. Absence of melanocytes
c. Decrease in functions of melanocytes
d. Decrease in size of melanosomes
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A 27 years old female patient with hypothyroidism
came with a compliant of asymptomatic whitening of
the finger tips. On exam there are depigmented
macules and patches over the finger tips and lower lip.
What is the most likely cause of the depigmentation?
Select one:
a. Absence of melanosomes
b. Absence of melanocytes
c. Decrease in functions of melanocytes
d. Decrease in size of melanosomes
Question 80
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A 52 years old male patient presented with nasal
obstruction of 6 months duration and right side neck
swelling of 2 month duration. The biopsy result
showed undifferentiated nasopharyngeal carcinoma
and CT imaging showed 4x4cm nasopharyngeal mass
with extension to nasal cavity and right side of neck
level 2& 3 with multiple lymphadenopathies.
What is the poor prognostic sign in this patient?
Select one:
a. Size of tumor
b. Neck metastasis
c. Nasal extension
d. Histology type
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A 52 years old male patient presented with nasal
obstruction of 6 months duration and right side neck
swelling of 2 month duration. The biopsy result
showed undifferentiated nasopharyngeal carcinoma
and CT imaging showed 4x4cm nasopharyngeal mass
with extension to nasal cavity and right side of neck
level 2& 3 with multiple lymphadenopathies.
What is the poor prognostic sign in this patient?
Select one:
a. Size of tumor
b. Neck metastasis
c. Nasal extension
d. Histology type
Question 71
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A 5 hours male neonate presented with drooling of
saliva since birth. Additionally, he has cough after each
swallowing of breast milk. NG Tube insertion was tried
it failed go down to stomach. On CXR with NGT
insertion shows coiled NG Tube on the upper chest.
What is the major determinate of poor outcome of this
neonate?
Select one:
a. Aspiration pneumonia
b. Hypothermia
c. Presence of other severe anomalies
d. Hypovolumia
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A 5 hours male neonate presented with drooling of
saliva since birth. Additionally, he has cough after each
swallowing of breast milk. NG Tube insertion was tried
it failed go down to stomach. On CXR with NGT
insertion shows coiled NG Tube on the upper chest.
What is the major determinate of poor outcome of this
neonate?
Select one:
a. Aspiration pneumonia
b. Hypothermia
c. Presence of other severe anomalies
d. Hypovolumia
Question 72
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A young man who was on treatment for schizophrenia
taking phenothiazine for the last 6 months presented
to medical OPD with persistent vomiting of ingested
matter.
What is the most likely medication contraindicated in
this patient?
Select one:
a. Chlorpromazine
b. Metoclopramide
c. Dimenhydrinate
d. Dolasteron
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A young man who was on treatment for schizophrenia
taking phenothiazine for the last 6 months presented
to medical OPD with persistent vomiting of ingested
matter.
What is the most likely medication contraindicated in
this patient?
Select one:
a. Chlorpromazine
b. Metoclopramide
c. Dimenhydrinate
d. Dolasteron
Question 73
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A 14-years old boy sustains injury to his right knee and
developed severe pain and swelling. He subsequently
develops compartment syndrome and required
fasciotomy. His knee radiograph is shown below.
What artery is most likely responsible for the
compartment syndrome?
Select one:
a. Middle geniculate
b. Anterior tibial recurrent
c. Peroneal
d. Posterior tibial
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A 14-years old boy sustains injury to his right knee and
developed severe pain and swelling. He subsequently
develops compartment syndrome and required
fasciotomy. His knee radiograph is shown below.
What artery is most likely responsible for the
compartment syndrome?
Select one:
a. Middle geniculate
b. Anterior tibial recurrent
c. Peroneal
d. Posterior tibial
Question 74
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An 18 year old primigravida lady who started ANC
comes at 36 weeks of gestation. You sent routine
investigation and her CBC result shows Hgb =
6.5gm/dl with microcytic and hypochromic RBCs
otherwise other cell lines are not affected. She has no
symptoms of anemia and her vital sign is in the normal
range and she feels well throughout her pregnancy.
What is the proper management for this patient?
Select one:
a. Therapeutic iron till 3 months post delivery
b. Transfuse whole blood during labor
c. IV iron dextran
d. Packed RBC transfusion
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An 18 year old primigravida lady who started ANC
comes at 36 weeks of gestation. You sent routine
investigation and her CBC result shows Hgb =
6.5gm/dl with microcytic and hypochromic RBCs
otherwise other cell lines are not affected. She has no
symptoms of anemia and her vital sign is in the normal
range and she feels well throughout her pregnancy.
What is the proper management for this patient?
Select one:
a. Therapeutic iron till 3 months post delivery
b. Transfuse whole blood during labor
c. IV iron dextran
d. Packed RBC transfusion
Question 78
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An apparently healthy 15 year old female adolescent
presented with loss of consciousness of 2 hours
duration after she was found in her study room. Her
friends found an unlabeled bottle with a spill of liquid
on the floor. On objective evaluation she is lethargic
with drooling of saliva and labored breathing and
transmitted sound all over the lung fields. She
experienced one episode of vomiting at emergency
and it has garlicky odor. After securing the airway,
breathing and circulation;
What is the next appropriate management?
Select one:
a. Giving syrup of ipecac
b. Starting atropine intravenously
c. Whole-Bowel Irrigation
d. Doing gastric lavage
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An apparently healthy 15 year old female adolescent
presented with loss of consciousness of 2 hours
duration after she was found in her study room. Her
friends found an unlabeled bottle with a spill of liquid
on the floor. On objective evaluation she is lethargic
with drooling of saliva and labored breathing and
transmitted sound all over the lung fields. She
experienced one episode of vomiting at emergency
and it has garlicky odor. After securing the airway,
breathing and circulation;
What is the next appropriate management?
Select one:
a. Giving syrup of ipecac
b. Starting atropine intravenously
c. Whole-Bowel Irrigation
d. Doing gastric lavage
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SAA DAA POE LIE Past 3 TOES
presented with a 5 days history of erosion over the
mucosa and the upper part of the body. On exam
BP=90/60mmHg , RR=32/min , T= 38.90C & PR 120
beats/min ; there are eroded plaques with
hemorrhagic crustations.
What is the most likely cause of the disease?
Select one:
a. Neverapine toxicity
b. Efaverenz toxicity
c. Lamuvidine toxicity
d. Zidovudine toxicity
question
S#
SAA DAA POE LIE Past 3 TOES
presented with a 5 days history of erosion over the
mucosa and the upper part of the body. On exam
BP=90/60mmHg , RR=32/min , T= 38.90C & PR 120
beats/min ; there are eroded plaques with
hemorrhagic crustations.
What is the most likely cause of the disease?
Select one:
a. Neverapine toxicity
b. Efaverenz toxicity
c. Lamuvidine toxicity
d. Zidovudine toxicity
Question 82
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A 24 year old patient came with nasal deviation after
fall down accident in shower of 8 day duration and
claim to have moderate epistaxis at time of accident
which was controlled by manual pressure application.
On physical examination the pertinent finding was
closed displaced right nasal bone fracture involving
mid third.
What is the next best step in management of this
patient?
Select one:
a. Closed reduction
b. Rhinoplasty
ce ET
d. Two view nasal bone x-ray
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A 24 year old patient came with nasal deviation after
fall down accident in shower of 8 day duration and
claim to have moderate epistaxis at time of accident
which was controlled by manual pressure application.
On physical examination the pertinent finding was
closed displaced right nasal bone fracture involving
mid third.
What is the next best step in management of this
patient?
Select one:
a. Closed reduction
b. Rhinoplasty
ce ET
d. Two view nasal bone x-ray
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A45years old came with a complain right chick
swelling of 2years duration. For this complaint he was
admitted and was operated. After 6 hours he noticed
drooping of the right side of a mouth and could not
close mouth.
Through which foramen does the nerve responsible for
this patient's symptom exit the skull?
Select one:
a. Jugular foramen
b. Foramen Ovale
c. IAC
d. Stylomastoid foramen.
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A45years old came with a complain right chick
swelling of 2years duration. For this complaint he was
admitted and was operated. After 6 hours he noticed
drooping of the right side of a mouth and could not
close mouth.
Through which foramen does the nerve responsible for
this patient's symptom exit the skull?
Select one:
a. Jugular foramen
b. Foramen Ovale
c. IAC
d. Stylomastoid foramen.
Question 84
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A para lll lady is diagnosed to have a left ovarian
tumor after she presented with menorrhagia of 3
months. On ultrasound the tumor is 3 by 3 cm mono
locular, the other ovary is ok and there is no ascites
seen.
What is the best next management of this patient?
Select one:
a. Do MRI/CT, tumor markers, chest x -ray
b. Refer her for staging surgery
c. Repeat ultrasound after 3 months
d. ultrasound guided aspiration
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A para lll lady is diagnosed to have a left ovarian
tumor after she presented with menorrhagia of 3
months. On ultrasound the tumor is 3 by 3 cm mono
locular, the other ovary is ok and there is no ascites
seen.
What is the best next management of this patient?
Select one:
a. Do MRI/CT, tumor markers, chest x -ray
b. Refer her for staging surgery
c. Repeat ultrasound after 3 months
d. ultrasound guided aspiration
Question 85
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A 30 year old female patient came to the hospital after
she sustained a flame burn injury inside a small kitchen
while she was cooking. She was removed from the
room by her relatives after that they put out the fire
which caught her clothing. On examination she had
second degree burn of 25percent TBSA involving the
face anterior chest and anterior part of bilateral upper
extremities. She has audible stridor with tachypnea
and oxygen saturation of 7Opercent with atmospheric
air.
What is the best initial step of her management?
Select one:
a. Endotracheal intubation
b. Parentral broad spectrum antibiotics
c. IV corticosteroids
d. Wound debridement
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A 30 year old female patient came to the hospital after
she sustained a flame burn injury inside a small kitchen
while she was cooking. She was removed from the
room by her relatives after that they put out the fire
which caught her clothing. On examination she had
second degree burn of 25percent TBSA involving the
face anterior chest and anterior part of bilateral upper
extremities. She has audible stridor with tachypnea
and oxygen saturation of 7Opercent with atmospheric
air.
What is the best initial step of her management?
Select one:
a. Endotracheal intubation
b. Parentral broad spectrum antibiotics
c. IV corticosteroids
d. Wound debridement
Question 86
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A 34 years old female patient came to regular OPD
with a complaint of generalized body weakness,
malaise and back pain of 3 years duration. Associated
with this he also has constipation and back pain. For
above complaint he was frequently treated with IV
antibiotics. He was admitted 1 year back with the
diagnosis of femoral fracture after he failed from
standing height.
What do you expect in the urine examination of this
patient?
Select one:
a. Low calcium and low phosphate
b. High Calcium and High phosphate
c. Normal calcium and low phosphate
d. Low calcium and high phosphate
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A 34 years old female patient came to regular OPD
with a complaint of generalized body weakness,
malaise and back pain of 3 years duration. Associated
with this he also has constipation and back pain. For
above complaint he was frequently treated with IV
antibiotics. He was admitted 1 year back with the
diagnosis of femoral fracture after he failed from
standing height.
What do you expect in the urine examination of this
patient?
Select one:
a. Low calcium and low phosphate
b. High Calcium and High phosphate
c. Normal calcium and low phosphate
d. Low calcium and high phosphate
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A 44 years old male patient was operated for
gangrenous small bowel volvulus 7 days back and
resection of gangrenous segment and end to end
anastomosis of small bowel was done. On the 6th post
day he developed hospital acquired pneumonia and
was put on Ceftazidime and Cloxacillin. He currently
develop diarrhea which is blood mixed with mucus.
What is the most likely diagnosis?
Select one:
a. Pseudomembranous colitis
b. Anastomotic leak
c. Post operation collection
d. Amebic Dysentery
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A 44 years old male patient was operated for
gangrenous small bowel volvulus 7 days back and
resection of gangrenous segment and end to end
anastomosis of small bowel was done. On the 6th post
day he developed hospital acquired pneumonia and
was put on Ceftazidime and Cloxacillin. He currently
develop diarrhea which is blood mixed with mucus.
What is the most likely diagnosis?
Select one:
a. Pseudomembranous colitis
b. Anastomotic leak
c. Post operation collection
d. Amebic Dysentery
Question 88
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A 22 months old boy presented to your clinic with
complaint of loss of appetite. He is a picky eater,
taking small amount of food but loves milk and drinks
6-8 bottle of whole milk per day. CBC showed WBC
6100, Hgb 6.2mg/dl, HCT 19.8percent, Platelet
715,000, MCV 54 fl/red cell.
What is the most likely diagnosis?
Select one:
a. Iron deficiency anemia
b. Peptic ulcer disease (PUD)
c. Leukemia
d. Lead poisoning
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A 22 months old boy presented to your clinic with
complaint of loss of appetite. He is a picky eater,
taking small amount of food but loves milk and drinks
6-8 bottle of whole milk per day. CBC showed WBC
6100, Hgb 6.2mg/dl, HCT 19.8percent, Platelet
715,000, MCV 54 fl/red cell.
What is the most likely diagnosis?
Select one:
a. Iron deficiency anemia
b. Peptic ulcer disease (PUD)
c. Leukemia
d. Lead poisoning
Question 89
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A 45 years old man presents to the OPD complaining
of a recurrence of a painless mass on his eyelid since 2
months back. He had surgery for the same lesion 6
months back. You performed a repeat surgery and
sent tissue for histopathology.
What histologic feature strongly suggests the
diagnosis of chalazion?
Select one:
a. Presence of keratin pearls
b. Presence of predominantly PMN
inflammatory cells
c. Presence of foreign body giant cells
d. Presence of lipoid tissue
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A 45 years old man presents to the OPD complaining
of a recurrence of a painless mass on his eyelid since 2
months back. He had surgery for the same lesion 6
months back. You performed a repeat surgery and
sent tissue for histopathology.
What histologic feature strongly suggests the
diagnosis of chalazion?
Select one:
a. Presence of keratin pearls
b. Presence of predominantly PMN
inflammatory cells
c. Presence of foreign body giant cells
d. Presence of lipoid tissue
Question 90
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37 years female patient who sustained falling down
accident from 6 meter high building came to ED. Up
on evaluation GCS is 15/15 B/P is unrecordable PR is
feeble RR=28. CVS S1 and S2 well heard no murmur or
gallop. No external source bleeding noticed.
What is the likely source of bleeding in this patient?
Select one:
a. Rib fracture
b. Depressed skull fracture
c. Tibial fracture
d. Pelvic fracture
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37 years female patient who sustained falling down
accident from 6 meter high building came to ED. Up
on evaluation GCS is 15/15 B/P is unrecordable PR is
feeble RR=28. CVS S1 and S2 well heard no murmur or
gallop. No external source bleeding noticed.
What is the likely source of bleeding in this patient?
Select one:
a. Rib fracture
b. Depressed skull fracture
c. Tibial fracture
d. Pelvic fracture
Question 91
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A 40 year old known ovarian tumor patient presents
with right leg swelling of one week duration. Her vitals
are within normal range and she has positive Homan's
sign on the right lower limb. She developed sudden
onset of shortness of breath on her way to the lab and
she is brought back to the emergency without
diagnostic tests. She is breathing on face mask O2 at
10lit/min.
What is the next best diagnostic work up?
Select one:
a. Doppler vascular ultrasound
b. Helical chest CT
c. D-dimer
d. High resolution chest CT
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A 40 year old known ovarian tumor patient presents
with right leg swelling of one week duration. Her vitals
are within normal range and she has positive Homan's
sign on the right lower limb. She developed sudden
onset of shortness of breath on her way to the lab and
she is brought back to the emergency without
diagnostic tests. She is breathing on face mask O2 at
10lit/min.
What is the next best diagnostic work up?
Select one:
a. Doppler vascular ultrasound
b. Helical chest CT
c. D-dimer
d. High resolution chest CT
Question 92
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A 23 years old male patient presented with
generalized body swelling which started from his face
and later involved lower extremity of 3 days duration.
He has decreased urine output. On physical exam, his
BP was 150/80mmHg, PR=80 bpm, RR=20bpm,
T=36.50C, he had pale conjunctiva and pretibial
edema. On investigation, U/A-protein +2, RBC with
RBC casts creatinine was 2.2, after 2 days the creatinine
became 3.5mg/dl.
What is the most likely diagnosis?
Select one:
a. ATN
b. CKD
c. pre-renal azotemia
d. RPGN
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A 23 years old male patient presented with
generalized body swelling which started from his face
and later involved lower extremity of 3 days duration.
He has decreased urine output. On physical exam, his
BP was 150/80mmHg, PR=80 bpm, RR=20bpm,
T=36.50C, he had pale conjunctiva and pretibial
edema. On investigation, U/A-protein +2, RBC with
RBC casts creatinine was 2.2, after 2 days the creatinine
became 3.5mg/dl.
What is the most likely diagnosis?
Select one:
a. ATN
b. CKD
c. pre-renal azotemia
d. RPGN
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A 35 years old male presented with a history of injury
to right eye with a leaf 10 days ago. In the last three
days he developed pain photophobia and redness of
the eye.
What would be the most likely pathology?
Select one:
a. Fungal keratitis
b. Anterior uveitis
c. Corneal abrasion
d. Corneal laceration
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A 35 years old male presented with a history of injury
to right eye with a leaf 10 days ago. In the last three
days he developed pain photophobia and redness of
the eye.
What would be the most likely pathology?
Select one:
a. Fungal keratitis
b. Anterior uveitis
c. Corneal abrasion
d. Corneal laceration
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A 42 year old man presents with fever, confusion and
cough of 05 days duration. He has never received
antibiotics nor has been admitted to health institution
in the last three months. His physical exam reveals BP
80/40mmHg, PR 120bpm, RR 36bpm, To = 38.30€,
SaO2 85percent and crackles over the left upper lobe.
Chest x-ray shows left upper lobe consolidation.
What treatment do you start now?
Select one:
a. High dose cefepime, vancomycin, fluid,
bacteriologic work up & HIV testing
b. Ceftriaxone, azithromycin, fluid and
bacteriologic work up
c. Anti-TB, ceftriaxone, azithromycin, fluid and
bacteriologic work up
d. Meropenem, vancomycin, fluid and
bacteriologic work up
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A 42 year old man presents with fever, confusion and
cough of 05 days duration. He has never received
antibiotics nor has been admitted to health institution
in the last three months. His physical exam reveals BP
80/40mmHg, PR 120bpm, RR 36bpm, To = 38.30€,
SaO2 85percent and crackles over the left upper lobe.
Chest x-ray shows left upper lobe consolidation.
What treatment do you start now?
Select one:
a. High dose cefepime, vancomycin, fluid,
bacteriologic work up & HIV testing
b. Ceftriaxone, azithromycin, fluid and
bacteriologic work up
c. Anti-TB, ceftriaxone, azithromycin, fluid and
bacteriologic work up
d. Meropenem, vancomycin, fluid and
bacteriologic work up
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A 34 years old male patient presented with severe
headache of three days duration. On physical exam
vital signs were normal. Meningeal signs were positive.
LP resulted in hemorrhagic CSF with xanthochromia.
What is the most likely diagnosis?
Select one:
a. Pyogenic meningitis
b. Subarachnoid hemorrhage
c. Chemical meningitis
d. Hypoxic schemic encephalopathy
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A 34 years old male patient presented with severe
headache of three days duration. On physical exam
vital signs were normal. Meningeal signs were positive.
LP resulted in hemorrhagic CSF with xanthochromia.
What is the most likely diagnosis?
Select one:
a. Pyogenic meningitis
b. Subarachnoid hemorrhage
c. Chemical meningitis
d. Hypoxic schemic encephalopathy
Question 96
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A 25 year old male patient presented with cough,
fever, and right pleuritic chest pain of 04 days
duration. Physical exam revealed PR = 110bpm, RR =
26bpm, temperature 38.00€ and evidence of right
pleural effusion. Chest x-ray shows right mid lung zone
homogenous opacity with air bronchogram and
moderate right pleural effusion. Fluid analysis shows
3000cells/microL (Neutrophils = 80percent, L =
20percent), glucose 15mg/di, and protein 4mg/dl.
What is the best management of this case?
Select one:
a. Start antibiotics and drain the fluid
b. Treat as an outpatient with PO antibiotics and
give short appointment
c. Start antibiotics and further investigate the
fluid
d. Start antibiotics and supportive care
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A 25 year old male patient presented with cough,
fever, and right pleuritic chest pain of 04 days
duration. Physical exam revealed PR = 110bpm, RR =
26bpm, temperature 38.00€ and evidence of right
pleural effusion. Chest x-ray shows right mid lung zone
homogenous opacity with air bronchogram and
moderate right pleural effusion. Fluid analysis shows
3000cells/microL (Neutrophils = 80percent, L =
20percent), glucose 15mg/di, and protein 4mg/dl.
What is the best management of this case?
Select one:
a. Start antibiotics and drain the fluid
b. Treat as an outpatient with PO antibiotics and
give short appointment
c. Start antibiotics and further investigate the
fluid
d. Start antibiotics and supportive care
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SH
A 35 years old male patient presented to the
emergency room after sustaining a road traffic
accident. By following the ATLS protocol he was
diagnosed with hemorrhagic shock. The bleeding was
controlled and transfusion with a cross-matched blood
started. Few minutes after the start the patient was
noticed to develop fever associated with severe
hypotension.
What should be the next step in the management of
this patient?
Select one:
a. Give antihistamines and continue transfusion
b. Open another IV line and resuscitate while
continuing transfusion
c. Stop transfusion and notify the blood bank
d. Reassure the patient and give antipyretics
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answered
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question
SH
A 35 years old male patient presented to the
emergency room after sustaining a road traffic
accident. By following the ATLS protocol he was
diagnosed with hemorrhagic shock. The bleeding was
controlled and transfusion with a cross-matched blood
started. Few minutes after the start the patient was
noticed to develop fever associated with severe
hypotension.
What should be the next step in the management of
this patient?
Select one:
a. Give antihistamines and continue transfusion
b. Open another IV line and resuscitate while
continuing transfusion
c. Stop transfusion and notify the blood bank
d. Reassure the patient and give antipyretics
Question 98
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answered
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question
SH
A 42 years old tailor presented, for the first time, to the
medical OPD with a diagnosis of Type 2 DM. He has
multiple lab result of FBS all above 160mg/dl. On
systems review, he has no ocular or visual complaint
and other systems are unremarkable.
When would you recommend this person get his eyes
screened for diabetic complications?
Select one:
a. As soon as possible after diagnosis of DM
b. Five years after diagnosis DM
c. One year after diagnosis of DM
d. Any time he has any ocular or visual
Not yet
answered
Marked out of
1.00
Y Flag
question
SH
A 42 years old tailor presented, for the first time, to the
medical OPD with a diagnosis of Type 2 DM. He has
multiple lab result of FBS all above 160mg/dl. On
systems review, he has no ocular or visual complaint
and other systems are unremarkable.
When would you recommend this person get his eyes
screened for diabetic complications?
Select one:
a. As soon as possible after diagnosis of DM
b. Five years after diagnosis DM
c. One year after diagnosis of DM
d. Any time he has any ocular or visual
Question 99
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answered
Marked out of
1.00
Y Flag
question
SH
A 34 year old Para Ill mother from addis ababa comes
with metromenorrhagia for the past 3 months. Her
pregnancy test is negative. Your trans vaginal
ultrasound shows normal pelvic finding with
endometrial thickness of 10mm.
What additional information you need to know before
you perform endometrial biopsy?
Select one:
a. Her contraceptive use
b. Her BMI
c. Her race
d. Her age at menarche
Not yet
answered
Marked out of
1.00
Y Flag
question
SH
A 34 year old Para Ill mother from addis ababa comes
with metromenorrhagia for the past 3 months. Her
pregnancy test is negative. Your trans vaginal
ultrasound shows normal pelvic finding with
endometrial thickness of 10mm.
What additional information you need to know before
you perform endometrial biopsy?
Select one:
a. Her contraceptive use
b. Her BMI
c. Her race
d. Her age at menarche
Question 100
Not yet
answered
Marked out of
1.00
Y Flag
question
SH
A 45 years old para Il lady presented with non specific
lower abdominal and back pain of 2 years duration.
Otherwise she has no urinary or bowel habit change.
On physical examination the abdomen is soft and 2-3
cm hard nodular mass over the peri-umblical are. On
bimanual examination you appreciated a right adnexal
mass which is mobile and 3 by 4 cm. you ordered
tumor markers and ultrasound to assess its nature.
Which finding is suggestive of malignancy in this
patient?
Select one:
a. Absent solid component on ultrasound
b. Serum CEA level of 0.5 IU/ML
c. Serum CA-125 level of 215IU/ML
d. Absent septation on ultrasound
Not yet
answered
Marked out of
1.00
Y Flag
question
SH
A 45 years old para Il lady presented with non specific
lower abdominal and back pain of 2 years duration.
Otherwise she has no urinary or bowel habit change.
On physical examination the abdomen is soft and 2-3
cm hard nodular mass over the peri-umblical are. On
bimanual examination you appreciated a right adnexal
mass which is mobile and 3 by 4 cm. you ordered
tumor markers and ultrasound to assess its nature.
Which finding is suggestive of malignancy in this
patient?
Select one:
a. Absent solid component on ultrasound
b. Serum CEA level of 0.5 IU/ML
c. Serum CA-125 level of 215IU/ML
d. Absent septation on ultrasound
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