Medicine Examination (4)

A 45 -year -old patient on hemodialysis has noted that his blood

pressure is difficult to control. He is on regular erythropoietin,
ferrous sulfate, vancomycin, and vitamin D. His blood pressure is
180 / 99 mm Hg. Which of the following is the most likely cause
for the worsening control of his blood pressure?

A. Erythropoietin

B. Ferrous sulfate
C. Vancomycin
D. Vitamin D
E. Uremia

The correct answer is (A) Erythropoietin

The patient most likely has a worsening of his blood pressure due
to erythropoietin.
This is seen in about 33 % of dialysis patients.

A 36 year old asthmatic man on salbutamol 100 mcg inhaler once a day.

Now he is concerned that his symptoms are worsening and his asthma is
not as well controlled. Which single feature from the history would most
support the man's concerns?
 A -Chest tightness is brought on by cold weather.
 B -Having to use the salbutamol inhaler every day.
 C -Most breathless early in the morning.
 D -Walking at night with coughing.
 E -Wheezing is brought on by exercise.

The Answer is (D)

A 17 -year old man has lost 6 kg over the past 2 months.He has been
excessively thirsty .A venous blood sample for glucose was
16 mmol/Which is the single most appropriate next step in management?
 A -24 h capillary glucose diary.
 B -Fasting venous blood glucose
 C -Oral glucose tolerance test(OGT).
 D -Repeat random venous blood glucose.
 E -Start treatment for diabetes.

The Answer is (E)

A twenty year old girl is taking anti tuberculosis treatment. She
presents in eye clinic with out door visual complaints. The most
likely cause of her symptoms is side effect of:
A -Isoniazid.
B - Rifampicin.
C - Ethambutol.
D - Pyrazinamide.
E - Streptomycin

The Answer is (C)

Adverse Reaction of First Line Anti Tuberculosis
Drugs

A patient presents with mild fever and haemoptysis

from Sinjar. Which of the following tests would be
diagnostic of active tuberculosis disease?
A - Heaf test
B -Mantoux test
C -T -cell assay e.g. Quantiferon, ELIspot
D - Sputum or biopsy cultures
E - All of the above

The Answer is (D)

skin sensitivity tests (Heaf, Mantoux) and the
newer T -cell based assays are only useful to
determine latent tuberculosis infection and tell
you nothing about disease activity.

A 28 -year old woman has felt increasingly irritable over the last few

months. She describes herself as "hot and bothered".She is always sweating
and try to cool herself down, she lost 5 kgm in this time. Which single
examination finding is most likely to support the diagnosis?
 A -Dry skin.
 B -Exophthalmos
 C -Hyperpigmented skin folds
 D -Lymphadenopathy.
 E -Malar rash.

The Answer is (B)

A forty year old lady gives history of weight gain and
hoarseness of voice. On examination her pulse is 60 per minute
and skin is pale, coarse and dry. The most important
investigation to find diagnosis in this case is :
A -Adrenocorticotrophin hormone (ACTH).
B -Cortisol level.
C -Gonadotrophin levels.
D -Insulin like growth factor (IGF).
E -T 4 and TSH level.

The Answer is (E)

A 44 -year old man has had hoarseness of voice for the past year with
increased of his shoe size over thepast 3 or 4 years.Which is the single most
appropriate definitive test to support the likely diagnosis?
 A -Insulin growth factor 1 (IGF -1 ).
 B - Oral glucose tolerance test(OGT)with growth hormone.
 C -Random capillary blood glucose.
 D -Random growth hormone
 E -Somtostatin.

The Answer is (B)

An 70 year woman has a history of dry cough for 2 months. She has lost 5 kg of
weight over the 2 months. Her chest X ray shows a left apical shadowing.
Blood tests reveal a raised white cell count of 16 . She has not managed to
cough up any sputum. Which of following tests should be performed?
A. CT scan of the chest
B. Serum ANCA
C. Ultrasound of the chest
D. Kveim test
E. Bronchoscopy
.

The Answer is (E)

A 66 -year old man has had worsening acid reflux over the last 4 months.He
uses salbutamol inhaler for asthma when required but otherwise has no
medical problems.which single additional factor in his history warrant
urgent referral for endoscopy?
 A -Family history of oesophageal cancer.
 B -Progressively worsening shortness of breath.
 C -Smoker of 20 cigarettes per day.
 D -The recent onset of reflux -like symptoms.
 E -Weight gain of half a stone.

The Answer is (D)

 (ALARMS )
Symptoms( Anaemia,Loss of weight,Anorexia,Recent onset
of progressive symptoms,Melaenna or haematemesis and
Swallowing difficulty)

A 26 -year -old woman with a history of a tingling sensation in her

fingers and toes for 2 days and rapidly progressive weakness of
her legs. Deep tendon reflexes are absent. She had an upper
respiratory tract infection 2 weeks ago. The most likely diagnosis
is?
A -Myasthenia gravis
B -Multiple sclerosis
C -Guillain -Barré syndrome
D -Poliomyelitis
E -Tick paralysis

The Answer is (C)

A 66 -year -old woman presented with sudden retrosternal chest
pain with nausea and diaphoresis. She has hypotension, jugular
venous distention, and a murmur of tricuspid regurgitation. An
ECG shows ST -segment elevation in the right precordial leads.
Which of the following is the most likely diagnosis?
A -Constrictive pericarditis
B -Dissecting aortic aneurysm
C -Pericardial tamponade
D -Pulmonary emboli
E - Right ventricular infarction

The Answer is (E)

A 30 -year -old man has had severe colicky right flank pain radiating
into the thigh for 4 hours. He is afebrile. Urinalysis shows RBCs too
numerous to count and no bacteria. Which of the following is the
most likely diagnosis?

A -Acute glomerulonephritis.

B -Bacterial cystitis
C -Benign prostatic hyperplasia
D - Urolithiasis
E -Bladder carcinoma

The Answer is (D)

A 40 year old lady was admitted to hospital with fevers and cough
productive of sputum. Chest X -ray shows diffuse patchy
consolidation around the left lung. She has had a flu like illnes 4
weeks ago, and has a past medical history of asthma. She also
smokes. Which organism is likely to be responsible?
A. Mycoplasma
B. Pseudomonas
C. Klebsiella
D. Staphylococcus
E. Tuberculosis

The Answer is (D) staphylococcus.

Following a viral infection, patients are predisposed to
staphylococcal infection .
The chest XR changes suggest staphlococcus rather than
streptococcus (which would cause lobar consolidation )

A 71 year old man who is a heavy smoker has been brought

into hospital, with a history of cough and breathlessness. He
has a history of COPD which has been managed with home
nebulisers but not oxygen. He was given 60 % oxygen by the
ambulance crew. He appears confused . What should be
done?

A. Stop oxygen

B. Give 24 % oxygen
C. Continue 60 % oxygen
D. Non invasive ventilation
E. Intubation and ventilation
.

The Answer is (B)

The best answers here are either give 24 % oxygen or non invasive
ventilation.
If the patient is not too unwell and is alert, it is safe to turn down the
oxygen to 24 % ( 1 L) and assess the degree of hypoxia and CO 2
retention. With steroids and salbutamol nebulisers, the patient may
improve and not require NIV.
A O 2 of 18 is too high for a patient with COPD, and when patients are
admitted oxygen therapy should be delivered to achieve a O 2 of about
8 -10 on the blood gas.

A 66 -year old man has fallen three times in a day. He is confused and is

responding to things that are not there.
(Bp: 85 / 60 mmhg,Hb: 8.5 gm/dl,MCV 105 fl,INR: 1.7 and
Albumin: 26 gm/dl).His abdomen is tense and distended. Which single most
appropriate course of action?
 A -Abdominal paracentesis.
 B -Packed red cells 2 U.
 C -Propranolol 80 mg.
 D -Spironolactone 100 mg
 E -Lactulose 45 ml.

The Answer is (E)

A forty year old woman gives history of fever for last three
weeks accompanied by dry cough, night sweats and weight
loss. Chest examination is normal. Abdominal examination
reveals hepatosplenomegaly. Chest X -ray shows symmetrically
distributed fine nodules. The most likely diagnosis is:

A -Typhoid.

B -Chronic liver disease.
C -Malaria.
D -Pneumonia.
E - Military tuberculosis

The Answer is (E)

A patient with history of fever, headache and neck
stiffness, normal funduscopy, the most important
investigation is:

A -Magnetic resonance imaging brain.

B -Complete blood counts.
C -Computerized tomography scan brain.
D -Cerebrospinal fluid examination.
E -X -ray skull .

The Answer is (D)

An old patient presented in emergency ward with history of
weakness of right side of body of rapid onset. The most helpful
first line investigation for management of this patient is:
A -Cerebral angiography.
B -Cerebro spinal fluid examination.
C -Computerized tomography scan brain.
D -Fasting lipid profile.
E -Nerve conduction study

The Answer is (C)

A 45 -year old non -smoker woman with no medical problems apart from
difficulty in swallowing for both solids and fluids for the last 18 -months.She
often regurgitates her oral intake and has lost over 5 kgm.Which single
investigation is most likely to support the diagnosis?
 A -Abdominal X -ray.
 B -Chest X -ray
 C -Endoscopic ultrasound scan
 D -Oesophagogastroduodenoscopy(OGD)
 E -Barium swallow.

The Answer is (E)

A 78 -year old man has painfully distended lower abdomen that has
developed over the past 2 days and with anuria .BPH was made, a urinary
cathetar is placed .Which is the single most appropriate course of action?
 A -Abdominal X -ray
 B -Digital rectal examination
 C -IV antibiotics
 D -IV fluids
 E -Ultrasound scan o the kidneys.

The Answer is (D)

A 70 -year old man has had series of heavy epistaxis started yesterday, three
days ago he started antibiotic for urinary tract infection. He has aterial
fibrillation for which he takes warfarin. His INR( 6.4 ).Which single
antibiotics has he been taking?
 A -Amoxicillin
 B -Cephalxin.
 C -Nitrofurantion
 D -Co -amoxiclave.
 E -Trimethoprim

The Answer is (E)

A 17 - year - old boy has had two episodes of severe
anaphylactic shock following bee stings. Which of the
following is the most appropriate intervention?

A. Administration of corticosteroids during

the summer
B. Long -term prophylactic antihistamine therapy
C. Protective clothing
D. Desensitization with bee venom extract
E. Restrict him to the house during the
summer months

The Answer is (D)

55 year old patient had myocardial infarction 6 days ago. He
suddenly develops dyspnoea, cough and frothy sputum.
For the first time a harsh systolic murmur is heard over the
praecordium. This sequence of events might be caused by:

A. Pulmonary embolism

B. Aortic dissection
C. Tricuspid regurgitation
D. Ruptured papillary muscle
E. Ruptured aortic cusp

Answer( D)

Ruptured papillary muscle
Following an MI, ruptured papillary muscle or
interventricular septum is most likely to cause the
combination of pulmonary oedema and new murmur (either
mitral regurgitation or due to VSD).

The nursing staff calls you about 70 year old woman on

regular treatment for chest infection feeling her heart
beating fast and she is anxious ,uncomfortable. Which
single question would be most useful in the immediate
assessment of this patient?
 A -Is the heart beat regular or irregular?
 B -Is she confused?
 C -Is she short of breath?
 D -What is her blood pressure?
 E -What is her temperature?

The Answer is (D)