A 5-year-old boy is brought to the ER by his mother. He has fever, cough, lethargy, headache and neck pain. On examination, his temperature is 103.2 F, his neck is rigid and tender and Kernig sign is positive. CSF is clear and significant for glucose 60 mg/dL, protein 80 mg/dL, no bacteria or pus cells and lymphocytes count is 70%.
What is the most likely causative organism?
A- Echovirus
B- Neisseria Meningitidis
C- Streptococcus Bovis
D- Streptococcus Pneumonia
E- Staphylococcus Aureus
A 22 year old patient is brought to hospital Accident &Emergency department department by police a Sunday morning .He had been arrested at an all night party but on the way to police station became agitated & appeared unwell .On on arrival he complains of thirst and nausea & on examination he exhibits large pupils ,hypertension & Global hyper reflexia .He admits to illicit drug use the night before. Which of the following substances is most likely cause of his symptom?
A.Methanol
B.Gammahydroxybutytrate
C.Heroin
D.D-lysergic acid diethylamide
E.Ecstasy(MDMA)
A 55-year-old woman presents to the clinic with a complaint of abnormal uterine bleeding. A biopsy is taken for evaluation of endometrial cancer. At which stage endometrial cancer is often diagnosed?
A- I
B- II
C- III
D- VI
A 20-year old female student represents with a 1-week history of nausea, vomiting and anorexia. She returned 2-weeks ago from a trip to Guatemala. On physical examination, her temperature was 100.3 F, clear chest and she has mild jaundice and a palpable tender liver. Her CBC was normal and her liver function tests are as follows: Serum total bilirubin 3.1 mg/dL. Serum aspartate aminotransferase 1100. Serum alanine aminotransferase 1900. Serum alkaline phosphatase 112.
What is the most likely lab test to confirm your diagnosis?
A- IgM antibody to hepatitis A virus
B- Antibody to hepatitis B surface antigen
C- Antibody to hepatitis C virus
D- DNA for Epstein-Burr virus
E- Serum anti-mitochondrial antibodies
A 25 year-old woman presents to the clinic complaining of general aches for two years. Pain is getting worse over the past 3 months. Every morning, she has stiffness all over her body, which is usually relieved in about 5-10 min. She has no history of trauma or any medical condition. Her BMI is 21 and she has no rash or joint swelling. She has multiple tender points. All laboratory investigations are within normal limits. What is the most appropriate management of this patient?
A-Perform electromyogram (EMG)
B-Perform nerve conduction studies
C-Start duloxetine
D-Start hydrocodone
E-Start prednisone
A 22 year old man is admitted with acute oancreatitis. Despite early improvement his overall condition deteriorates and by the sixth day,he has a high temperature,tachycardia and hypotension. Ct shows non enhanvement of the distal pancreas and peri-pancreatic fluid. Choose single most appropriate movement.
A. Laparotomy and excision of dead tissue
B. Wide debtidement of soft tissue
C. IV catecholamine
D. Oxygen by mask
E. IV corticosteroid
A 60 year old man is brought to the emergency department with a fractired hip. He has been having progressive hearing loss and was recently diagnosed with cardiac failure. Hypercalcemia was noted on his blood test. Single most likely diagnosis?
A. Pagets disease
B. Osteoporosis
C. Osteomalacia
D. Multiple myeloma
E. Spondylosis
A 5 year old girl presents with a 3 day history of fever,cough and runny nose. This is followed by non-blanching pinpoint spots on both legs. Choose the single most useful diagnostic test.
A. Autoantibodies
B. Blood culture
C. Borrelia burgdorferi
D. Glandular fever
E. Liver function test
An 80 year old woman with mild dementia at a nursing home tripped and fell on her hand. Xray revealed a fracture of the distal end of the radius with a 10 degree dorsal angulation. Single best mgmt for her?
A. Closed reduction of fracture
B. Open reduction and internal fixation
C. Above elbow backslab cast
D. Plaster of Paris below elbow
E. Wrist sling
20y/o female presents with recurrent episodes of dyspnoea and productive cough. There is associated colicky abdominal pain. Investigations reveals heavy growth of Pseudomonas aeruginosa
CXR:Tramline and ring shadows .
Your impression ?
a. Bronchiectasis
b. Tuberculosis
c. Cystic Fibrosis
d. Pneumonia
A 26 year old alcoholic man having blunt trauma presented with pain in shoulder ,slight fever,and mediastinal crunch…the cxr showed air in mediastinum,and contrast esophogran showed transmural tears in the lower and middle third of esophagus!! Wat is the most proper diagnosis???
A)boerhaave’s syndrome
B)Mallory Weiss syndrome
C)diffuse esophageal spasm due to trauma
D)none of the above
A 53 yrs old man with type2 diabetes has noticed elevation of his blood glucose level on a new antihypertensive agent he says that his diet and exercise level r unchanged. His HbA1c also deteriorated. Which of the following is responsible.??
A.amlodipine.
B.bendroflumethiazide.
C.irbesortan
D.ramipril
E.rosiglitazone.
A 55 year-old man underwent internal fixation of fractured femur after a motorcar accident and massive bleeding 24 hours ago. He was stable after the surgery and his urine output was normal after he received intravenous fluids. Now he complains of substernal chest pain and shortness of breath. On examination, His temperature is 98.8 F, Pulse is 110/min, blood pressure is 160/100 mmHg and his respiratory rate is 24/min. There is no jugular vein distention. His extremities have established pulses bilaterally and good perfusion. Auscultation reveals harsh systolic murmur across the precordium and crackles on both lung bases. ECG shows sinus tachycardia with delayed precordial transition and no other changes. Laboratory tests including cardiac enzymes are all normal.
What is the most likely diagnosis?
A- Acute myocardial infarction
B- Left bundle branch block (LBBB)
C- Septic shock
D- Hypertrophic cardiomyopathy
E- Pericardial effusion
A 76 year old woman comes to your office for a consultation. Yesterday, she had left hemiparesis for 30 minutes. She thought it was a stroke but now she is completely asymptomatic. She has a history of atrial fibrillation, angina and hypertension. She takes aspirin 81 mg and propranolol 80 mg.
What is your appropriate initial management for this patient?
A- Schedule another appointment whenever she has symptoms
B- Schedule transesophageal echocardiography
C- Schedule carotid duplex ultrasonography
D- Schedule MRI to the brain
E- Obtain CT scan of the head
A 22 year old patient presents with colicky pain which radiates from loin to groin. He complains of
similar episodes in the past. Investigation has been done and 7mm stone was found in the ureter. What is
the most appropriate management for this patient?
A. Per cutaneous nephron-lithotomy
B. Open surgery
C. Ureteroscopy or laser
D. Conservative treatment
E. Extracorporeal shock wave lithotripsy