54 y/o female, dizzy and nauseous for 1 day. Prior to this, she had 3 days of epigastric pain and vomiting. She has type 2 diabetes and had a pituitary tumour excised 20 years previously for which she remains on steroid replacement therapy. She is pale. Her abdomen is soft with epigastric tenderness. Digital rectal examination: Tar-like liquid stool in the rectum.
Which is the single most likely diagnosis?
A Angiodysplasia
B Diverticulitis
C Gastric carcinoma
D Mallory–Weiss tear
E Perforated gastric ulcer
Man who has motor neuron disease and is wheelchair bound, finds it difficult to swallow food- both liquids and solids. What would be the best option to provide nutrition?
A. Gastrostomy
B. Fine bore NG tube
C. Parenteral nutrition
D. Give steroids and continue oral nutrition
A 67 yr old lady presents with nausea , vomiting and diarrhoea for 3 days . She has atrial fibrillation and on digoxin . What is the single most likely diagnosis ?
A. Clostridium difficile
B. Digoxin
C. Gastroenteritis
D. IBD
E. Colonic cancer
A 12yo boy with a hx of fall on an outstretched hand was brought to the ED with swelling and
pain around the elbow. His radial nerve was affected. What is the type of fx?
a. Angulated fx
b. Epiphyseal fx
c. Compound fx
d. Spiral fx
A 55 year old male patient had TIA which he recovered from. He has a history of stroke and upon examination his heart rate was in sinus rhythm. He is already on aspirin 75mg and anti-hypertensive drugs. What other action should be taken?
A. Add Clopidogrel only
B. Increase the doses of aspirin to 300mg
C. Add Warfarin
D. Add Clopidogrel and Statins
E. Add Statins only
artery that runs in left AV groove is?
A left anterior descending
B circumflex
C LMS post descending artery
A 32yo woman presents to the ED with headache and vomiting. She was decorating her ceiling
that morning when the headache began, felt mainly occipital with neck pain. Some 2hs later she
felt nauseated, vomited and was unable to walk. She also noticed that her voice had altered. She
takes no reg meds and has no significant PMH. Exam: acuity, field and fundi are normal. She has
upbeat nystagmus in all directions of gaze with normal facial muscles and tongue movements.
Her uvulas deviated to the right and her speech is slurred. Limb exam: left arm past-pointing and
dysdiadochokinesis with reduced pin prick sensation in her right arm and leg. Although power is normal, she can’t walk as she feels too unsteady. Where is the most likely site of lesion?
a. Right medial medulla
b. Left medial pons
c. Left cerebellar hemisphere
d. Right lateral medulla
e. Left lateral medulla
A 30yo man presents to the ED with difficulty breathing. He has returned from India. Exam:
throat reveals grey membranes on the tonsils and uvula. He has mild pyrexia. What is the single
most relevant dx?
a. Diphtheria
b. IM
c. Acute follicular tonsillitis
d. Scarlet fever
e. Agranulocytosis
A 33 year old female complains of diplopia on upright gaze. On examination ptosis can be seen. There are no other complains or any significant past medical history. What is the most appropriate investigation for this patient?
A. Ophthalmoscopy
B. Visual field test
C.Thyroid function test
D. CT scan
E. Checking red reflex
25 yr old man lives in larkana (pakistan) has comes to ER with 5 day hx of diarhae and abdominal pain ,pain z colicy and severe asociated with nause but no vomiting.diarhhae z watery but since yesterday it become bloody he has no hx of travel his temp is 98 F b.p 120/80 pulse z 102/min which of the fallowing is most likelt etiology ?
A.E coli
B.staphy areus
C.rota virus
D.clostridum perfringens
E.clostridium deficle
Patient has flat mood and sad, what is the best question physician can ask to know whether patient depressed or not?
A-Are you depressed
B-Did you feel worthless
C-Do you have idea of self injury
D-Do you have sleep disturbances
An 88yo woman is a known smoker. She had an attack of MI 2y back and is known to have peripheral vascular disease. She presents with an irreducible herniation over the incision region of a surgery which she underwent in her childhood. What is the most appropriate tx?
a. Truss
b. Elective herniorrhaphy
c. Urgent herniorrhaphy
d. Elective herniotomy
e. Reassure
- A 48yo man has intermittent left sided lower abdominal pain and feels generally unwell. He has lost his appetite and has lost weight. Temp=38.3C and he has BP=190/100mmHg. What is the single inv most likely to lead to dx?
a. Colonoscopy
b. Endomysial antibodies
c. Fasting serum glucose conc
d. TFT
e. US abdomen
A patient who just arrived from travelling now presents with bloody diarrhea,
what is the most likely cause?
a. E coli
b. Giardiasis
c. Campylobacter
d.rota virus
A mother brings her baby to the hospital complaining that the baby has stridor only upon breast-feeding. On examination, omega shaped cartilage was seen in the neck. What is the most probable diagnosis?
A. Laryngomalacia
B. Bronchiolitis
C. Croup
D. Epiglotitis
E. Tracheo oesophageal fistula
Radiosensitive testicular cancer:
A-Yolk sac
B-Seminoma
C-Choriocarcinoma
D-All of the above
A! 64 year old man complains of increasing shortness of breath and cough for the!
past 18 months. He coughs up a tablespoon of muco6purulent sputum with occasional
specks of blood. What is the most likely underlying cause?
a. Acute bronchitis
b. Bronchiectasis
c. Chronic bronchitis
d. Lung! cancer
e. Pneumonia