Dr. Ahmad Paper

Q1- In Celiac Disease which part of intestine most commonly affected a-Proximal small intestine. b-Distal Small intestine. c-Proximal large intestine. d-distal large intestine. Q2-Known patient of chron’s disease developed sudden severe lower left sided abdominal pain, conctipation & mass palpable in left lower quadrent. Most likely diagnosis. a-Chron’s disease colitis. b-Acute diverticulitus. c-Acute appendicitis. d-Intestinal obstruction. Q3-Patient is going to have elective cystoscopy for mild heamaturia with no other relevant sign symptoms. His urologist ask you about antibiotic prophylaxis . On examination there is murmur of MVP.Whats your opinion abcd-

Augmentin 1 gm PO 1hr before procedure. No antibiotic prophylaxis needed. Clindamycin IV. Vancomycin IV. Only dental and respiratory need prophylaxis

Q4-A patient presented with H/O people whispering about him all the time which no one else here even when he wants not to here, most likely diagnosis. abcd-

Schizophrenia. Mania. Depression. Dementia.

Q5- A patient presented with H/O depression and statement that his ideas can be read by others and even others can put there thinking in his mind denotes to. abcd-

Schizophrenia. Obsessive compulsive disorder. Simple depression. Generalized anxiety disorder.

Q6-Which antipsychotic is least vulnerable for causing Tardev dyskinesia. abcd-

Clozapine. Risperidone. Haloperidol. Chlorpromazine.

Q7-Most common side effect of antipsychotic drugs is. abcd-

Weight gain. Nausea. Vomiting Hypertension.

Q8-A known case of HIV on treatment stable presented with PPD of 12mm induration started on ATT of all 4 major drugs regimen. What you will advise after 1 month followup visit. a- Continue with 4 drugs for 1 more month then INH & Rifampicin for another 4 months. b- Continue with 4 drugs for another 1 month then continue INH for 9months more. c- Continue with 4 drugs for 1 month then INH & Rifampicin for 1 year, d- Continue with 4 drugs for 1 month then INH+Rifampicin for 2 years INH 9 months rifampicin 4 months is right answer Q9-Patient presented with orbital cellulites,fever, supraclavicular lymphadenopathy,hepatomegaly & spleenomegaly. Diagnosis. abcd-

Lymphoma. Hyperthyroidism. Rheumatic fever. Sarcoidosis. A and d both right . For a reed sternberg cell for d hillir lymphdenopathy

Q10-Apatient diagnosed as case of Rheumatoid arthritis has no active complaints except his hand xray shows interphalangeal soft tissue swelling and mild osteopenia. What helps to preserve hand function. a- NSAIDs. b- DMA are not indicated till stage III disease. c- Exercise will not improve or preserve hand function DMA must be in choice methotrexate Q11-An obese patient with knee joint swelling and limited movements with audible crepitus,diagnosed as case of Osteoarthritis which helps most in long term. a- Weight reduction. b- Smoking sessation.

c- NSAIDS. d- Joint replacement Q12-3 year old child got burn injury affecting whole right upper extremity with whole right arm swollen erythematous with blanching on pressure. Have got blisters & some open vesicles too. Whats the grading regarding BSA(body surface area) abcd-

Grade Grade Grade Grade

II burn involving less than 15% of BSA. II burn involving more than 15% BSA. III burn involving less than 15% BSA. III burn involving more than 15% BSA.

Q13-A patient presented with history of burn injuring from boiling oil spillage. He got swollen left arm erythematous and with blanching on pressure, got single blister on left hand. Management abcd-

sterile saline dressing & urgent call to burn consultant. basic Silver sulfa cream, saline dressing and refer to burn consultant. Oral antibiotics and send home.

Q14-In a population study there are 117 new cases of lower respirator tract infection among 1000 subjects. Mean days of disability is 4.6days and mean off job days is 1.7 days. Calculate the disability incidence in above scenario. Q15- 25 years old female with 6wks of newborn child presented with increasing palpitations,SOB,Suffocation,sweating. Diagnosis. abcd-

Post partum thryroiditis. Hashimotos thyroiditis. Sepsis. HTN.

Q16-Picture of thyroid ultrasound showing a simple 1.5*1cm thyroid nodule in right lobe with normal thyroid function and NO other complaint . Management should be. abcd-

reassure its cyst not adenoma. Refer to surgeon for excision. FNAC. Radio iodine uptake scan.

Q17-Picture of normal lung xray, and that of patients xray showing pneumothorax left sided large and one ECG of patient showing ST segment elevation in only inferior leads. Question patient suddenly developed shortness of breath and left sided pain that improves on leaning forward and on expiratrion.

Diagnosis. A- pneumothorax, B- Acute MI ,C-aortic dissection D- oesophagitis. Q18-In diagnosed Hyperthyroid female with H/O Palpitations,HTN,fear,anxiety,sinking and sweating what benefits rapidly to control symptoms. abcd-

Propranolol. Propylthiouracil. Amlodipine. Lisinopril.

Q19- 3 month old baby presented with/O bloody diarrhea which is steeled now lethargy weakness with sunken eyes and signs of dehydration. TLC count 48000 raised what to be given. a- ORS. b- Antibiotics. c- Nothing. Iv fluids is answer Q20-One complete question regarding pseudohypoparathyrodism. Q21-Patient presented after having lunch with sudden nausea,vomiting increasing weakness and nerve paralysis, Diagnosis. abcd-

Botulisim. Tetnus. GB syndrome. Stroke.

Q21-Mother presented with her 9months old baby saying he is following EPI schedule for vaccination on regular basis and his baby is going to have next injection which is due. Whats the vaccine could be. abcde-

BCG. Measles with oral polio. OPV + Hep B. DPT. MMR.

Q22-A lady G4P3 presented with 8wks gestation who got 2 of her babys normal and 1 with downs syndrome wants to have screening regarding current pregnancy of chances of downs syndrome. And given appointment of 2wks later for procedure. Which risk has to be explained in informed consent for procedure to her. a- Unplanned miscarriage.

b- Amniotic membranes rupture c- Neural tube defects. d- Cardiac anomalies. Q23-A female with PAP smear positive for atypical cells of inderminate significance given oestradiol +miconazol cream and repeated after 1 wk but still ATCUS cells what should be done next. abcd-

Colposcopy. Endometrial biopsy. Cone biopsy. Hystrectomy.

Q24-A 65yrs old female with regular followup and have always PAP smear negative what advise should be given to her. a- No need of PAP smear exam Q25-A known case of SLE presented with wheels like lesions with erythematosis and dark coloured pigmented and resolve in 24hrs with new lesions forming. Diagnosis. abcd-

discoid lupus. Urticaria cicatrical. Eczema. Scabies

Q26-. Patient with history of contact lens use for last 5 years presented with watery eyes when ever he goes in bright light what to recommend him. abcd-

To wear dark glasses in sunlight. Saline eye drops 4 times daily. Remove contact lens at night. Nothing.

Q27-Patient with history of flu presented with dark greenish to blackish discharge from the nose. On examination dark black secretions with crusts on turbinates found in nasal cavity. Diagnosis. abcd-

Aspergiloma. Mycosis funcgoids. Influenza. Intra cerebral abcess.

Q28-ONE QUESTION regarding clinical picture of androgenic alopecia. Q29-Patient presented with right upper quadrant pain with nausea vomiting and pain radiating to right shoulder tip. Investigation of choice for acute cholecystitis. Answer is USG abdomen. Q30-A patient with diagnosis of tenia pedis treatment of choice naftifine.

Q31-A person has to visit an area endemic for onchocericosis and have to stay there for 7 days what are the chances for him to acquire the disease. abcd-

None Small risk Medium risk High risk

Q32-A patient with diagnosis of HTN & diabetes ,which medication is beneficial for him to stop progression of diabetic nephropathy. abcd-

Lisinopril Amlodipine. Atenolol. Hydralazine.

Q33-A patient with pale tympanic membrane with progressively decreased hearing from that ear associated vertigo and unsteadiness in walk . diagnosis. Q34- A patient presented with recurrent otitis media and discharge from ruptured tympanic membrane whats the treatment of choice . answer myringoplasty. Q35-A patient diagnosed to be a case of binge eating disorder, Bulemia nervosa whats the treatment that can be effective in her case. abcd-

Congnitive behavioural therapy. Pharmacotherapy. Referred to psychiatrist. Refer to surgeon.

Q36-Reglar exercise cause following effect of BMR. abcd-

It decreases HDL. It increases CRP levels. Sustained exercise increases BMR. Exercise does not effect truncal obesity.

Q37-Female 35 years with H/O amenorrhea for last 9months. On investigations found to have low estradiol levels . Her FSH & LH also measured what could be possible finding about them. ABCD-

Low FSH & LH. Low FSH & High LH. High FSH & LH. High FSH & Low LH.

Q38-A female diagnosed to be iron deficiency anemia on ferrous sulphate oral supplementation which test to detect why inspite of treatment she is still with low Hb.

a- Serum iron & ferritin levels. b- Hb electrophroesis.. c- Peripheral blood film. Q39- A baby is found to have HbA2-30% & HbF-50% whats the disease he is having. abcde-

Sickle cell anemia. Alpha thalasemia. B thalasemia major. B thalasemia minor. B thalasemia trait.

Q40- A known epileptic female got pregnancy ,what to tell her regarding anti epileptic treatment. abcd-

Anti epileptics cause congenital anomalies. Epilepsy itself is a greater risk for fetus. She should stop anti epileptics. She should not to continue her pregnancy.

Q41- An adult who got 1 dose of varecela vaccine about an year back and missed his second dose. What to advise him. a- Get second dose of vaccine. b- Start the course with repeat 1st dose. c- Not needed 2nd dose. Q42-one question about a patient having conjuctivitus with later rash with severe pain on same eyelid . a- HSV conjuctivitus. b- HZ opthalmicus. Q43- A patient with untreated UTI of 14 days duration. Chances of ascending infection. abcd-

0.5%. 5%. 75%. 90%.

Q44-An adoptive child with diagnosed sickle cell disease recently got treated for UTI with antibiotics presented with Temp 37.7F, Pulse 100/min & BP 95/50 .Otherwise non ill looking stable feeling just mild white nasal discharge is there ,what to prescribe. a- Prophylactic penicillin. b- Antihistamine. c- Multivitamin.

d- Asprin 300mg & observation. Q45-A 35years old female presented with progressive hearing loss with H/O same disease of his mother with same presentation in past. Diagnosis Answer otosclerosis. Q46-A child presented with severe respiratory distress cough and high grade fever ,on examination swollen epiglottis whats the best treatment option. abcd-

Urgent tracheostomy. Elective ventilation. Endotracheal intubation. Discharge on oral treatment.

Q47-A female presented with history of calus fracture which is now healed which test to detect bone density. abcd-

Serum calcium. Vitamin D. Dexa scan. Xray pelvis.

Q48-Picture of 3year old child . H/O child presented with otherwise well nourished and with normal reflexes moving all limbs except the head is continuous tilted on right side this developed since birth and increased in intensity. Now when the head moved to right the sternocledomastoid muscle stretch cause severe pain. Diagnosis. ABCD-

Congenital torticolis. erbs paly. Throrasic outlet syndrome. Cervical spondolytis.

Q49-A patient presented with 6hr history of 50 tablets of asprin ingestion. Now nausea vomiting SOB,abdominal pain tachycardia. Most immediate effective treatment. abcde-

Gastric lavage. Activated charcoal. Hemodialysis. Force alkaline dieresis. N acetyl cystine.

Q50- A patient of pre-eclampsia got treated with MgSO4 presented with decreased respiratory effort and drowsiness decreased reflexes toxicity suspected what to give. abcd-

calcium gluconate i/v saline. Atropine. Hydrocortisone.

Q51-A patient presented with H/O asprin ingestion 50 tablets and presented after 6 hrs of ingestion with associated nausea,vomiting,abdominal pain,SOB & tachycardia whats the best immediate treatment. abcd-

Gastric lavage. Activated charcoal. Hemodialysis. Force alkaline dieresis.

Q52-16 year old female presented with H/O worsening tachycardia,exopthalmus,sinking,SOB,sweating,difficult to concentrate in school,sleeplessness & disturbed studies what could you find in physical examination. a- Enlarged thyroid nodule. b- Fever c- Schizophrenia, Q53-A patient presented with H/O ingestion of 4 tablets metformin 500mg what to expect.? abcd-

Hypoglycemia. Hyperglycemia. Lactic acidosis, Metabolic acidosis.

Q54-A female presented with B/L clear nipple discharge with normal periods & no use of contraception. What to check? abcd-

ACTH Prolactin Thyroid hormone. GNRH.

Q55-ONE PICTURE OF A COMPLETE BREAST SELF EXAMINATION GUIDELINES. ASKING Whats needed for self examination. Answer is Mirror is needed which was mentioned in guidelines.

Q56-Patient with fever ,drycough & SOB , on xray upper lobe nodular lesions with fibrosis & congestion & decreased lung volume. What to give to clear asymptomatic contacts. abcd-

BCG Influenza vaccine. Meningococcal vaccine. Hepatitis B vaccine.

Q57-A patient pregnant female 35 years of age with swollen pale lower left leg confirmed to have DVT. What to give her, abcd-

LMWH. Unfractionated heparin. Warfarin, Asprin.

Q58-in Generalized anxiety disorder what relieves symptoms fastly. a- TCA. b- Benzodiazipines. c- Propranolol. Q59-A person otherwise healthy feels sweating and tachycardia when ever he went for dilering speech . abcd-

Agoraphobia. Specific phobia. GAD. Depression.

Q60-A Young female presented with H/O gutring sensation abdominal discomfort sweating and then collapse to groud. Nearby persons got her to nearby facility where her BP,ECG and vitals seems normal. What could be explanation. abcd-

Vasovagal fainting Stroke Myocardial infarction. Hypovolemic shock.

Q61-Patient with somatization disorder treatment should be. abcd-

Pharmacotherapy. More detailed investigations for his mental satisfaction. Referral to medical specialist. Cognitive behavioral therapy.

Q62-Patient with H/O lower back pain, why to ask patient about duration of pain why it’s important for treatment.

abcd-

Location & duration assist in treatment plan & prognosis. To find organic cause. Chronic pain management can be delayed. Acute pain is always of organic cause.

Q63-Patient with H/O CA colon got surgical resection and remains symptom & screening free from CA for about 8years. Now found single lung metastasis .If resection of that metastatic lesion done successfully what will his 5year CA free survival rate would be. abcd-

1% 5% 75% 90%