A 78 year old man has collapsed. He has had a severe headache for 12 hours and had an upper respiratory tract infection three days ago. He has a temperature of 39.2o C, a pulse of 122 beats/minute, a blood pressure of 84/60 mmHg and a respiratory rate of 34 breaths/minute but his chest is clear. He has a Glasgow Coma Scale score of 10 and some neck stiffness. He has been started on high-flow oxygen.
What is the SINGLE most appropriate immediate management?
A Intravenous antibiotic; computed tomography brain scan
B Intravenous antibiotic; lumbar puncture
C Intravenous fluids; computed tomography brain scan
D Intravenous fluids; intravenous antibiotic
E Intravenous fluids; lumbar puncture
A 32 year old woman has had a febrile illness and swelling of the small joints of her hands, feet, wrists and knees for two days. She has a maculopapular rash and a few palpable, small cervical lymph nodes. She was previously well. There is no history of relevant travel outside the UK. She has two young children.
What is the SINGLE most likely diagnosis?
A Psoriasis
B Reactive arthritis
C Rheumatoid arthritis
D Sarcoidosis
E Systemic lupus erythematosus
A few weeks old child presents with profuse projectile vomiting. What should be the most appopriate initial action for the child?
A. USG
B. Check serum K + level
C. ABG
D. NG tube
E. IV Fluids
A 25yo woman with T1DM has delivered a baby weighing 4.5kg. Her uterus is well contracted.Choose the single most likely predisposing factor for PPH from the options?
a. Atonic uterus
b. Cervical/vaginal trauma
c. Retained POC
d. Large placental site
e. Rupture uterus
An 84 year old woman with Alzheimer’s dementia has recently become incontinent and more confused than usual.
What is the SINGLE most likely diagnosis?
A Detrusor overactivity
B Neuropathic bladder
C Nocturnal enuresis
D Urinary tract infection
E Uterine prolapse
An 18 y/o female with a history of major depression is rushed to A&E after being found on the floor of her bedroom, obtunded. Her father notes that the patient has been treated with an antidepressant for years, although he is unsure what medication she was currently taking. As the physician is speaking with the patient’s father, the patient begins to have convulsions and ultimately passes away. Review of premorbid EKG shows prolonged QT interval. Overdose with which of the following medications is the most likely cause of this patient’s condition?
A. Amitriptyline
B. Sertraline
C. Bupropion
D. Venlafaxine
E. Fluoxetine
Electrolyte disturbance in pyloric stenosis
a.hyperchloremia
b.hyperkalemia
c.hypocalcemia
d.hyponatremia
e.met.acidosis
A 25yo had an LSCS 24h ago for fetal distress. She now complains of intermittent vaginalbleeding. Observations: O2 sat=98% in air, BP=124/82mmHg, pulse=84bpm, temp=37.8C. Themidwife tells you that she had a retained placenta, which required manual removal in the OT.Choose the most appropriate C-Section complication in this case?
a. Retained POC
b. Aspiration pneumonitis
c. Endometritis
d. Uterine rupture
e. DIC
A 25 y/ohad an LSCS 24 hours ago for foetal distress. She now complains of intermittent vaginal bleeding. Observations include saturations 98% in air, blood pressure 124/82 mmHg, pulse 84 beats/min and temperature 37.8C. The midwife tells you that she had a retained placenta, which required manual removal in the operating theatre. Choose the most appropriate post C-Section complication in this case?
A. Retained products of conception
B. Aspiration pneumonitis
C. Endometritis
D. Uterine rupture
E. Disseminated intravascular coagulation
50 year old man presents with headache, fever, and neck stiffness. His heart rate is 50, respiratory rate is 28 and Blood Pressure is 210/110mmHg. What is the single most appropriate treatment?
A. Dexamethasone
B. B-Blocker
C. Adrenaline
D. Mannitol
E. IV fluids
A 22 y/o nulligravid woman had monthly menses without pain until approximately 18 months ago. In the past 18 months, she has noted progressively more painful menses for which
she misses 2 days of work each month. She has no urinary or gastrointestinal symptoms. She has never had sexual intercourse and has had no gynaecologic surgery. The pain is partially relieved by nonsteroidal anti-inflammatory medication. Which of the following is the most likely cause of
her secondary dysmenorrhea?
(A) endometriosis
(B) pelvic infection and adhesions
© pelvic congestion syndrome
(D) cervical stenosis
(E) irritable bowel syndrome
A 48yo woman is admitted to the ED with a productive cough and mod fever. She often has
central chest pain and she regurgitates undigested food most of the time but doesn’t suffer from acid
reflux. These symptoms have been present for the last 3.5m which affects her daily food intake. CXR: air-
fluid level behind a normal sized heart. What is the single most likely dx?
a. Pharyngeal pouch
b. Hiatus hernia
c. Bulbar palsy
d. Achalasia
e. TB
A 56yo man who is hypertensive recently underwent a change in meds. 2days later he
developed wheezing. Which drug can cause this?
a. Atenolol
b. Ramipril
c. Bendroflumethiazide
d. Verapamil
e. Furosemide
An 8yr girl is complying with her asthma Rx of low dose corticosteroid prophylaxis and short acting bronchodilators as required.Her inhaler technique is good.She now has a frequent night cough and mild exercise induced wheeze.What would be the single most appropriate change in her Rx?
a)add leukotriene antagonist
b)add oral theophylline
c)add regular long acting bronchodilator
d)increase dose of inhaled corticosteroid
e)short course of oral corticosteroid
A 29 year old young man complains of recurrent attacks of diarrhoea. He says his stools contain blood and mucus. Sometimes she has low grade fever. What is the most appropriate investigation?
A. Stool culture
B. Plain abdominal x-ray
C. Per rectal examination
D. Barium Enema
A 28yo woman at 34wks GA for her first pregnancy attends antenatal clinic. Her blood results: Hgb=10.6, MCV=95, MCHC=350. What do you do for her?
a. Folate
b. Dextran
c. Ferrous sulphate
d. None e. IV FeSO4
f. Explain this physiologic hemodynamic anemia
g. Blood transfusion
Parents of a 4 year pld child are worrie sincd the child recently started wetting the bed at night again despite being dry for the past 6 months. What advice from the following list options would you give?
A- reassure
B- fluid restriction
C- alarm training
D- desmopressin