AMC MCQ confusing question collection for discussion

41) Lady on Estrogen/Progestogen combination OCP, now needed to be given Warfarin, the best thing would be:
A) Increase the dose of estrogen and add warfarin
B) Decrease the dose of estrogen and add warfarin
C) Increase the dose of both
D) Give a higher dose of warfarin and same OCP

I couldn’t find any literature about it. I would say if she had a DVT stop OCP. Otherwise with those possible answers my guess is D). Any ideas?

jaundice , poor feeding and lethargy on Day 2 for a neonate

am fairly certain - treat for sepsis first features suggestive of a perinatal infection which can cause all the symptoms mentioned

42) Middle year old man with history of lobar pneumonia treated with adequate antibiotics for 7 days, now complains of persistence of fever and chest pain on cough, diagnosis:
A) Empyema
B) Lung abscess
C) Pneumothorax
D) ?TB

My answer is B. As empyema is rare and it seems to be an infective complication. No History that suggests TB.


43) After thyroidectomy, the lady develops difficulty breathing ( ? stridor) due to obstruction of trachea, the management?
A) Intubate from the recovery bed
B) Surgical explore under GA
C) Release of the stich

I think she needs intubation first and then surgical reopening for most likely bleed as cause. So can’t decide betweem A or B. I guess I would have picked B.

44) The most important factor in the treatment of DKA
A) SQ insulin
B) NS infusion
C) IV insulin
D) IV Potassium
E) Na HCO3

Can’t decide between B and C. I guess insulin deficit caused the problem but dehydration is more life threatening thn hyperglycaemia. So my answer is B).

44) The most important factor in the treatment of DKA
A) SQ insulin
B) NS infusion
C) IV insulin
D) IV Potassium
E) Na HCO3

Treatment of dehydration is the most important thing.
So, B. Usually several liters of saline is expected to administer.

45) 65 year old man with acute knee joint arthritis, and on aspiration, calcium pyrophosphate was identified, the treatment
A) Colchicine
B) Azathioprine
C) Piroxicam
D) Antibiotics
E) Paracetamol

I found this abit confusing. Well so the diagnosis is Pseudogout. The treatment ist 1st NSAID, 2nd intraart. Steroids and if necessary then colchizine. Some textbook suggest to give steroid right away with the aspiration.
Although NSAID usually indomethacine is recommended piroxixam would be an appropriate NSAID.
So my answer is C)
But the therapeutic guidelines say give indomethacine OR colchizine plus paracetamol! And I know in our ED department we usually gave paracetamol first!
What do you guys think?


46) Middle year man with history of acute abdominal pain, similar history earlier on, and physical examination revealed pulsatile epigastric mass, BP borderline, tachycardiac, the immediate management:
A) An urgent vascular surgeon consultation
B) CT chest and abdomen
C) Urgent embolectomy
D) Aortic angiogram
E) ?

I couldn’t decide between A and B. As it depends how stable the patient is. CT would be great and from my experience we have done this first to one of our acute patients. But I guess you shouldn’t delay operation theatre here as he already shows signs of shock (tachycardia).
So my answer would be A). Than they could make the calls anyways…


47) 55 year old man with pruritis, dark urine and right upper quadrant discomfort, on examination cystic mobile mass felt on the right upper quadrant, the possible diagnosis?
A) Ca Head of pancreas
B) Mucoid cyst of gall bladder
C) Acute cholelithiasis
D) Hepatitis
E) Ca gall bladder

This is typical presentation for A) which is my answer.
But what about E)? Could it be the porcelaine gallbladder that we palpate?

48.) Commonest cause for blood stained discharge from the nipple:
A) Ca Breast
B) Duct papilloma
C) Duct ectasia
D) Breast abscess

Can’t decide between A and B. As I think in general benign is always more common but bloody discharge need to be investigated. I guess there are other factors as being uni- or bilateeral and so on but here in this scenario? I guess my answer is B) to be more common.

49) 15 year old girl with primary amenorrhea, her height and breast development and pubic hair are same as the classmates; the most important history would be
A) Periodic abdominal pain
B) Urinary infections
C) When was the growth spurt started

Well, my answer is C). But A) could be possible, thinking of an imperforated hymen, as the other answers are not very satisfying and she is the normal hight. Menarche should be soon after growth spurt in females so this might be imporatnt, and she is 15, where officially prim. Amenorhoea is with 16 yrs, I think.


50) An obese lady who received epidural anaesthesia, who required to give lots of fluid during the anaesthesia and head had to be extended during the surgical procedure, and arm abducted for the IV medications, now complains of radial nerve palsy on that side, the cause

A) Hyper extension of the neck
B) Excessive epidural
C) Excessive fluid administered thru the IV on the affected hand

I would guess A) but just a guess.


51) A Lady who was received epidural pethidine high dose (?Upto 300 mg), in labour, after 10 hours of labur (Occipito posterior) noted to have normal CTG tracings with normal variation has been changed to more wide spred variation and HR down to 90/min, the cause for increasing brady
A) Excessive moulding
B) Higher dose of pethidine depressing baby
C) Cord prolapse
D)

Aa this CTG is typical for cord prolapse my answer is C), despite all the other information here. Don’t know what A means anyways. And I think you can give pethidine up to 300mg in 24hours and 50-100mg every 3 hours, so she should be fine with ít. But maybe not?

45) 65 year old man with acute knee joint arthritis, and on aspiration, calcium pyrophosphate was identified, the treatment
A) Colchicine
B) Azathioprine
C) Piroxicam
D) Antibiotics
E) Paracetamol///////


I found this abit confusing. Well so the diagnosis is Pseudogout. The treatment ist 1st NSAID, 2nd intraart. Steroids and if necessary then colchizine. Some textbook suggest to give steroid right away with the aspiration.
Although NSAID usually indomethacine is recommended piroxixam would be an appropriate NSAID.
So my answer is C)
But the therapeutic guidelines say give indomethacine OR colchizine plus paracetamol! And I know in our ED department we usually gave paracetamol first!
What do you guys think?

Thanks angela for posting the Qs


48.) Commonest cause for blood stained discharge from the nipple:
A) Ca Breast
B) Duct papilloma////
C) Duct ectasia
D) Breast abscess

Can’t decide between A and B. As I think in general benign is always more common but bloody discharge need to be investigated. I guess there are other factors as being uni- or bilateeral and so on but here in this scenario? I guess my answer is B) to be more common.

46) Middle year man with history of acute abdominal pain, similar history earlier on, and physical examination revealed pulsatile epigastric mass, BP borderline, tachycardiac, the immediate management:
A) An urgent vascular surgeon consultation
B) CT chest and abdomen
C) Urgent embolectomy
D) Aortic angiogram
E) ?

I couldn’t decide between A and B. As it depends how stable the patient is. CT would be great and from my experience we have done this first to one of our acute patients. But I guess you shouldn’t delay operation theatre here as he already shows signs of shock (tachycardia).
So my answer would be A). Than they could make the calls anyways…


URGENT SURGICAL TREATMENT IS MY CHOICE. PLEASE COMMENT.

47) 55 year old man with pruritis, dark urine and right upper quadrant discomfort, on examination cystic mobile mass felt on the right upper quadrant, the possible diagnosis?
A) Ca Head of pancreas
B) Mucoid cyst of gall bladder
C) Acute cholelithiasis
D) Hepatitis
E) Ca gall bladder

This is typical presentation for A) which is my answer.
But what about E)? Could it be the porcelaine gallbladder that we palpate?

I AGREE WITH YOUR ANS. I'LL GO WITH A (AS THE PT IS MAN, NO HISTORY OF GALLSTONE OR INFLAMMATION OF GB )

1. a 50 year old man diarrhea bleeding PR with anal fissure most likely Dx
a)ca colon
b)divertivulosis
c)Ulcerative colitis
d)chrons
e)gastroenteritis

Is it Ca colon because fissure would mean he had constipation also?

2 a pt h/o MI and ischemic stroke having abd pain and with fresh bleeding pr
a) angiodysplasia
b) diverticulosis
c)haemorroids
d)duodenal ulcer

Angiodysplasia doesnt cause MI or Stroke then what ? really confused with this one ? :shock:

39) Cause for greenish discharge from one nipple:
A) Duct ectasia////
B) Ductal Papilloma
C) Fat necrosis
D) Breast abscess

My answer is B).
Usually straw like –transparent dischareg but common cause for discharge. Abscess I would think has other sign descriped as erythema and…

The possible answer is ductal papilloma, but is it greenish??

41) Lady on Estrogen/Progestogen combination OCP, now needed to be given Warfarin, the best thing would be:
A) Increase the dose of estrogen and add warfarin
B) Decrease the dose of estrogen and add warfarin
C) Increase the dose of both
D) Give a higher dose of warfarin and same OCP

Estrogen is metabolized in liver, so usually estrogen weaken the effect of warfarin( decrease PT-INR). I would say D is correct, but just my guess.
I will find a literature.

Hi doctor 666, I thought about your questions - here are my answers:

52) A 50 year old man diarrhea bleeding PR with anal fissure most likely Dx
a)ca colon
b)divertivulosis
c)Ulcerative colitis
d)chrons
e)gastroenteritis

My answer would be D) Crohn’s disease. As we have diarrhea which at least to my knowledge is less likely associated with colorectal CA compared to alterted bowel habits with constipation and diarrhea. Also the man is only 50yr and he has the fissure which can be ssociated with Crohns as well as fistulas.

If we just look at the bleed here some causes of LGIB (lower Gi bleed): In most series, diverticulosis accounts for approximately 15 to 55 percent and angiodysplasia for 3 to 37 percent of LGIB.
Angiodysplasia may be the most frequent cause in patients over the age of 65. This
does not apply to subjects under age 50 in whom hemorrhoids are the most common cause of rectal bleeding. Colon cancer is a relatively less common but serious cause of hematochezia.
In a review of seven series that included 1333 patients with acute LGIB, the following bleeding sources were identified:
-Diverticulosis — 33 percent
-Cancers/polyps — 19 percent
-Colitis/ulcers (including Inflammatory bowel disease, infectious, ischemic, and radiation colitis, vasculitis and inflammation of unknown cause) — 18 percent
-Unknown — 16 percent
-Angiodysplasia — 8 percent
-Miscellaneous (postpolypectomy, aortocolonic fistula, stercoral ulcer, anastomotic bleeding) — 8 percent
-Anorectal (hemorrhoids, fissures, and idiopathic rectal ulcers) — 4 percent


53) a pt h/o MI and ischemic stroke having abd pain and with fresh bleeding pr
a) angiodysplasia
b) diverticulosis
c)haemorroids
d)duodenal ulcer

Am not sure, think there is something missing of the story here. First of all the age, than maybe if he is on medications which could cause blees…

Having no more hints and guessing that it is an old fellow with the history I would maybe agree with answer A) angiodysplasia as it might be the most commonest cause of bleed over 65yrs.
Here is what I found in textbooks:
Several conditions have been associated with angiodysplasia. Bleeding from angiodysplasias in patients with aortic stenosis (Heyde's syndrome) has been repeatedly reported but remains controversial. Chronic renal failure has also been associated with angiodysplasia. However, most patients with renal failure have serious comorbid medical conditions such as hypertension and heart failure, which can confound the association. Furthermore, they may be more likely to bleed secondary to platelet dysfunction.

Hi, doctor666 and angelitainca

2 a pt h/o MI and ischemic stroke having abd pain and with fresh bleeding pr
a) angiodysplasia
b) diverticulosis
c)haemorroids
d)duodenal ulcer

h/o meas hospitalize?
If this patient presents fresh gastrointestinal bleeding, after ischemic attack and mycardiac infarction, the answer should be duodenal or gastric ulcer sencondary to massive stress.

How do you think, guys??

Thank you guys

h/o = history of

if anyone gets a better version of the same question please post here

HI, asked another RMO who already passed the AMC last year and works in O&G now for those questions. Here her answers:


3.) Cyclic vulvovaginitis caused by
a. bacterial vaginosis
b. group B streptococcus
c. E coli
d. trichomonas

I'm quite certain its A - Bact Vaginosis.


7.) Menopausal lady with progesterone containing OCP, no bleed for 3 months what would you do initially?
a. USG to determine endometrial thickness
b. endometrial biopsy
c. increase the dosage of progesterone

A - Progesterone causes an increase in endometrium, and the decrease in progesterone causes menstruation. So its quite possible her endomet thickness is increased. Menopausal might mean peri-menopause and not post-menopause so she could still get her period.


8.) Toxic shcok syndrome is most commonly associated with (if this was an actual question then I think I will pass the exam)
a. super absorbent pad
b. endotoxin
c. desquamated rash

Struggle as obvious is a but what about c? C is typical with TSS. And nowadays cause often not menstruation related!
--> agree with you


16. G2 P1 previous C/S because of breech; longitudinal lie vertex presentation position plus one, cervix 5 cm dilated suddenly Hx; which of the following is the most likely cause?

a. placenta praevia
b. uterine rupture
c. amniotic emboli
d. coagulation defect

not sure what the question is asking either. +1 is the station of the baby's head in relation to the mother's ischial spines. 0-ischial spines, +1 means its moved down.


23.) Primi at 26 weeks gestation comes with abdominal pain: which is the best indicator that she will have a preterm delivery:
A) Fetal Fibronectin level in cervix
B) External os open, internal os closed on USG
C) Cervix 3.8cm
D) Effaced cervix

A - fetal fibronectin. cervix 3.8 prob means dilation. you can be 5cm dilated and not in labour so i don't think its C


25.) The least useful investigation to evaluate rhesus Isoimmunisation in a child is:
A) Cord blood group
B) Cord DCT
C) Maternal blood indirect coomb's test
D) Paternal blood grop
E) Kleihaur test

E


39) Cause for greenish discharge from one nipple:
A) Duct ectasia
B) Ductal Papilloma
C) Fat necrosis
D) Breast abscess

A


41) Lady on Estrogen/Progestogen combination OCP, now needed to be given Warfarin, the best thing would be:
A) Increase the dose of estrogen and add warfarin
B) Decrease the dose of estrogen and add warfarin
C) Increase the dose of both
D) Give a higher dose of warfarin and same OCP

oo can't remember if OCPs induce or inhibit liver enzymes. that's the other issue to consider - that you probably need to increase the dose of both if they follow the same metabolic pathway.


48) Commonest cause for blood stained discharge from the nipple:
A) Ca Breast
B) Duct papilloma
C) Duct ectasia
D) Breast abscess

B


49) 15 year old girl with primary amenorrhea, her height and breast development and pubic hair are same as the classmates; the most important history would be
A) Periodic abdominal pain
B) Urinary infections
C) When was the growth spurt started

C


51) A Lady who was received epidural pethidine high dose (?Upto 300 mg), in labour, after 10 hours of labur (Occipito posterior) noted to have normal CTG tracings with normal variation has been changed to more wide spred variation and HR down to 90/min, the cause for increasing brady
A) Excessive moulding
B) Higher dose of pethidine depressing baby
C) Cord prolapse

moulding is caput of the head. its probably C, - cos the other 2 answers don't really explain it

Thanks angelitanca

54.) homeless girl 15 yrs behaviour not good which is best option for her
a. condoms
b. COP
c. IUD
d.depoprovera
e. Norgestron implant
I guess I would say A) as safer sex... but reliable using them and costs...?

55.) homeless girl 15 yr miscocious behaviour which is worst option for her
a. POP
b. COP
c. Sequential oes/proges
d. depo provera
e. implant
Don't know what exaxtly c) stands for... but wouldn't do A) as strict timing.

54.) homeless girl 15 yrs behaviour not good which is best option for her
a. condoms
b. COP
c. IUD////
d.depoprovera
e. Norgestron implant
I guess I would say A) as safer sex... but reliable using them and costs...?
I THINK A IS LESS SAFER THAN C. WHAT DO YOU THINK?

I mean less effective sorry

Luckily the AIPPG is working again. Here some more questions and thought! Hey guys let me also know what you think! Would be very helpful if you would post back some more replies! Thank you!


56.) 16 yr old girl 1o amenorrhoe ht & wt and other features are same as classmates she doesn’t want to get examined which is the most appropriate question to be asked
a. when ur pubic and axillary hair growth started
b. when ur breast development started
c. when was her mother’s menarche started
d. intermittent lower abd pain
Same question as before but a bit more information here. Well this time I am not sure abou the answer. Maybe D) as a start?


57.) 80 yr old complains of sore wrist which happened after an accident on examination peripheral vision loss & small left side pupil, opacity of lens .what will u do most appropriate
a. review driving licence
b. retinal examination
c. urgent CT head
d. check IOP
e. refer for cataract surgery
This one is tricky. As the peripheral vision loss would lead me to glaucoma, the opacity to cataract and the small pupil to infarction or… or maybe you gotta think of the other pupil being dilated and then think of glaucoma again? AM lost.
But my answer is B), as I would do that next and see if I find other clues and then move on. Aslo w should examine the anisokoria to find out which eye is the abnormal one. And I wouldn’t do a super urgent CT as he seems still pretty with it otherwise. If glaucoma is the answer I would do D) but you also have to examine retina then and so B) sounds still a good answer to me.


58.) pt. with transient left hemiplegia with rightside blindness what is the most likely finding u’ll see
A. bruit on left carotid
b. bruit on right carotid
c. cerebral haemmorage on CT
I would say bruits are not often heard although they write about them in every textbook. So my guess would be c)


59.) 40 yr old with recurrent DVT for last 10 years cause?
a. C- protein deficiency
b. Thombo module indeficiency
c. underlying malignancy
d. smoking
My answer is A) Mots common thrombophilia is Faktor V Leiden. Anyone who can tell me what answer b means?


60.) 8wks pregnant with UTI culture done showing E-coli resistant to amoxicillin, cephalosporins, genta,
a. Amoxiclav
b. erythro
c. Penicillin
d. doxycillin
e. ceforoxime
Well depends on the question. If only resisatant to Amoxil I would give Amoxil/clavulan –A). If resistant then actuall I would give D), which can be given in the first 18 weeks of pregn. And is effective for e.coli.


61.) 36 a 42 year old lady comes to u with mass in right upper outer quadrant which is hard and mobile, no pain her mother had Ca breast at age of 65 no one else in the family has history of Ca breast what is the most appropriate step
a. reassure her it is normal finding
b. follow up in 2 weeks
c. Mammogram and reassure if normal
d. FNAC
e. excision
Again confusing from the literature. Not sure between C and D. Radiology guidelines say C) if > 35 yrs. Other literature suggests if definite lump start with D) and if not cyst do C).
I would go for D) as I would like to see the cytology first and she is anyways still young and might not have a well interpretable mammogram.


62). a lady had supraclavicular lymph nodes which is least likely to cause it
a. Breast cancer
b. Ca stomach
c. Ca broncus
d. Ca thyroid
e. melanoma of the arm (of same side to lymph nodes can’t remember Lt or Rt)
I would say E as wouldn’t the axillar LN be enlarged then? Not sure about C as the LN are usually higher than subraclavicular.


63.) a cardiac patient with swelling & pain of knee on aspiration of fluid there was calcium pyrophosphate what is ur initial management for pain
a. steroids
b. indometacin
c. allopurinol
d. colchicine
Usually I would go straight with B) but there are cardiac contraindications which I am not sure. As some literature suggest intraartic. Steroids as first line treatment I would go here with A) if the answer was intraartic.. What do you think from your experience?

58.) pt. with transient left hemiplegia with rightside blindness what is the most likely finding u’ll see
A. bruit on left carotid
b. bruit on right carotid
c. cerebral haemmorage on CT
I would say B. If we choose cerebral hemorrhage, where is a hemorrhage?
Usually, putamen and thalamus hemorrhage do not involve the impariment of vision. How dou you think guys?

45) 65 year old man with acute knee joint arthritis, and on aspiration, calcium pyrophosphate was identified, the treatment
A) Colchicine
B) Azathioprine
C) Piroxicam
D) Antibiotics
E) Paracetamol///////

I choose E. What we should do is to control pain...

63.) a cardiac patient with swelling & pain of knee on aspiration of fluid there was calcium pyrophosphate what is ur initial management for pain
a. steroids
b. indometacin
c. allopurinol
d. colchicine
Usually I would go straight with B) but there are cardiac contraindications which I am not sure. As some literature suggest intraartic. Steroids as first line treatment I would go here with A) if the answer was intraartic.. What do you think from your experience?

I don`t ensure what you what you worry.
We use Aspirin in patients with MI.
I don`t think that you cannot use indometacin.

How do you think?

1.) 36 a 42 year old lady comes to u with mass in right upper outer quadrant which is hard and mobile, no pain her mother had Ca breast at age of 65 no one else in the family has history of Ca breast what is the most appropriate step
a. reassure her it is normal finding
b. follow up in 2 weeks
c. Mammogram and reassure if normal
d. FNAC
e. excision

This family history strongly support potential breast cancer, but risk factors do not effect the decision structure.

Physical exam doesn`t suspect breast cancer, perhaps fibroadenoma.
According to Harrison, lesions that either equivocal or nonsuspicious on PE should be reexamined in 2-4 weeks, during the follicular phase of the menstrual cycle. Days 5-7 of the cycle are the best time for breast exam.

However, , a dominant mass in a postmenopausal woman or a dominant mass that persists through a menstrual cycle in a premenopauasl woman should be aspirated by fine-needle biopsy or reffered to a surgeon.

So, I choose B.

Hi samu,
I just looked NSAIDs up and Indomethacin as well as diclofenac had a special risk with cardiac patients. With increased thrombembolic event risk. (Australian Medicines Handbook)
That and the fact that they wrote "a cardiac" patient made me struggle and I am still not convinced.

madedi2410

hi guest,
can u plz solve these?........

26. Lady G2P1 8( or 18 weeks) with H/O Down’s syndrome baby in previous pregnancy asks you about investigation that accurately will tell this baby’s chance to have Down syndrome.
A-U/S at 18 weeks
B-maternal serum at 18 weeks and U/S
C-villeus biopsy


28. A couple which has been married for 16 years came to you with a complaint of husband having herpes like ulcers on his penis. Woman is OK. Man denies sex outside the marriage. Tests are done and reveal :
Man’s serum: Ig G for HSV1 +ve
IgG for HSV2 +ve
IgM for HSV1 –ve
IgM for HSV2 –ve
Penis ulcer +ve for HSV
Woman’s serum: Ig G for HSV1 +ve
IgG for HSV2 +ve
IgM for HSV1 –ve
IgM for HSV2 –ve
How it should be interpreted?
A-Man got HSV from some one else outside the marriage
B-Man got infection from his wife
C-Man has activation of old infection **
D- They both have out of marriage relationship

1.) 36 a 42 year old lady comes to u with mass in right upper outer quadrant which is hard and mobile, no pain her mother had Ca breast at age of 65 no one else in the family has history of Ca breast what is the most appropriate step
a. reassure her it is normal finding
b. follow up in 2 weeks
c. Mammogram and reassure if normal
d. FNAC
e. excision

Following triple test: clinical-image-FNA I will go for C. 42 yrs (>35yrs old) + mother had breast cancer are put pt at higher risk of cancer. Depend on the result of mammography I may do further test fine needle aspiration-or/& biopsy or follow up.What do you think?

63.) a cardiac patient with swelling & pain of knee on aspiration of fluid there was calcium pyrophosphate what is ur initial management for pain
a. steroids
b. indometacin
c. allopurinol
d. colchicine
Usually I would go straight with B) but there are cardiac contraindications which I am not sure. As some literature suggest intraartic. Steroids as first line treatment I would go here with A) if the answer was intraartic.. What do you think from your experience?

Hi, agree with u that NSAIDs can cause prolonged bleeding time, decreased platelet aggregation, compromised cardiac function but these warning symps are not totally contraindicated. We 're still using low dose NSAIDs with mornitor the bleeding time. If we choose steroid, why don't we choose colchicine?

RPT. 63.) a cardiac patient with swelling & pain of knee on aspiration of fluid there was calcium pyrophosphate what is ur initial management for pain
a. steroids
b. indometacin
c. allopurinol
d. colchicine
I guess you are right, I checked again and as there is really not much written about it in A/E of textbooks I would now choose answer B).


Hi mahedi2410, her eis what I think about your questions:
64.) 26. Lady G2P1 8( or 18 weeks) with H/O Down’s syndrome baby in previous pregnancy asks you about investigation that accurately will tell this baby’s chance to have Down syndrome.
A-U/S at 18 weeks
B-maternal serum at 18 weeks and U/S
C-villeus biopsy
1st choice in 2nd trimester is “second semester quadriple test†= maternal serum. I would actually only do U/S here to confirm gestational age when serum test positive, not to confirm Down syndrome itself. U/S for Down syndrome should be performed in 2st trimester. Villeus biopsy in first trimester if screening positive to confirm diagnosis.


Q from mahedi2410
65) A couple which has been married for 16 years came to you with a complaint of husband having herpes like ulcers on his penis. Woman is OK. Man denies sex outside the marriage. Tests are done and reveal :
Man’s serum: Ig G for HSV1 +ve
IgG for HSV2 +ve
IgM for HSV1 –ve
IgM for HSV2 –ve
Penis ulcer +ve for HSV
Woman’s serum: Ig G for HSV1 +ve
IgG for HSV2 +ve
IgM for HSV1 –ve
IgM for HSV2 –ve
How it should be interpreted?
A-Man got HSV from some one else outside the marriage
B-Man got infection from his wife
C-Man has activation of old infection **
D- They both have out of marriage relationship
My answer here C), too. As only IgG positive, can’t say from whom and when the aquired the inofection from those bloods.



66.) a lady with epigastric pain endoscopy done showing duodenal ulcer urease negative ur treatment
a. i/v omeprazole
b. antibiotics
c ranitidine
d. triple therapy
Just wanted to check with you, we give C) ranitidine first choice, right? What if the answer would be oral PPI? Wold you wather give PPI then or because of costs and in low risk ulcer go with ranitidine?

1.A 35 y old woman develops extremely pruritic, purple, polygonal
papules on her wrists.In association with these skin findings,she is
likely to have:
a. Herpes labial on the lips
b. B. Candidiasis on the vulva
c. Lacy white patches on the buccal mucosa
d. Ulcerations on the conjuctiva
e. Anal fissures

2.The major cause of perinatal death with twin gestation is:
a. Asphyxia during labour
b. Cord prolapse or entanglement
c. Twin-twin transfusion
d. Prematurity
e. Abruptio placenta

3.A 3 day old term infant has episodes of breathing for 10-15
seconds followed by apnea for 5-10 seconds. There are no changes in
skin color or heart rate.Which of the following is the most
appropriate step in management?
a. Administer caffeine
b. Administes theophylline
c. Apply continuous positive airway pressure
d. Provide supplemental oxygen
e. Reassure the parents

4.Which of the foloowing is a correct statement about hemolytic
anemia?
a. The serum bilirubin is a sensitive indicator of hemolysis
b. In cold agglutinin disease, IgM is detected on the red cell
surface
c. In warm auto-immune hemolytic anemia, the indirect Coombs`s
test is positive
d. Oxidant stress hemolysis is characterized by "bite" cells
e. Approximately 5% of patients with CML will have hemolytic
anemia

5.Concerning the use of pneumococcal vaccine for a 6 month old
child with sickle cell disease,which of the following statements is
correct?
a. Vaccine may be used instead of daily penicillin prophylaxis
b. Immunization at 12 months and annually thereafter prevents
mild as well as serious disease
c. Immunization at any time does not help prevent serious
pneumococcal disease
d. Immunization given at 6 monmths of age will prevent serious
pneumoccocal disease
e. Child should receive prompt medical attention for any
fever,regardless of immunization status

6.The patient most likely to develop adenomatous hyperplasia is:
a. A 24 y old on low dose oral contraceptives
b. An obese female with a history of oligoovulation and
infertility
c. A post-menopausal black female with multiple fibroids
d. A 30 y old G3 P3 female with dysfunctional uterine bleeding
e. A 23 y old student with anorexia nervosa

7.A 50 y old woman notes the onset of generalized itching 3 weeks
after starting estrogen therapy. On physical examination, she has
mild hepatomegaly, jaundice and dry eyes. Wjhich of the following is
the mnost specific diagnostic therapy test?
a. Antinuclear antibodies
b. Antimitochondrial antibodies
c. Anticentromere antibodies
d. Antineutrophil antibodies
e. Antismooth muscle antibodies

hi pandai, can you post your answers to the questions, too. Then we can start discussing them! And it would help us all to get your own oppinion and thoughts...

confusing ques...

hi guyz,

107. In the investigation of jaundice, which of the following statements is/are correct?
1- Ultrasound is very accurate in diagnosing stones in the common bile duct
2- Ultrasound imaging can detect large duct obstruction in over 90% of case
3- The CT scan is very accurate in diagnosing gallbladder stones
4- Oral Cholecystography does not help in the diagnosis of the jaundiced patient
MARK:
a- If 1, 2 and 3 are correct
b- If 1 and 3 are correct
c- If 2 and 4 are correct
d- If 4 only is correct
e- If all are correct ////
108. A 20yrs old man is brought to the Casualty Department following a motor vehicle accident. He is hypotensive and unconscious. He has an open fracture of the mandible and a closed fractured tibia. The most probable cause of his hypotension is:
a- The closed head injury
b- The compound mandible fracture
c- The fractured tibia
d- A combination of the above
e- None of the above //////


111. Which of the following statements is/are true for meningloma?
1- Constitute approximately 15% of all primary brain neoplasms
2- Compress put rarely invade brain
3- Most commonly couples the parasagittal site
4- May exhibit metaplastic change as well as characteristic asammoma bodies
Mark:
a- If 1, 2 and 3 are correct
b- If 1 and 3 are correct
c- If 2 and 4 are correct
d- If 4 only is correct
e- If all are correct

112. Concerning aboriginal health in new scuta vales
1- More aboriginal children now die iron infectious disease than 10 years ago
2- Hepatitis B is more common in aborigines than in non aborigines
3- Diabetes is less common among aborigines than among non aborigines
4- Lost aborigines die in the middle years of life (30 to 50 years)
Mark:
a- If 1, 2 and 3 are correct
b- If 1 and 3 are correct
c- If 2 and 4 are correct
d- If 4 only is correct
e- If all are correct
31.05.2007
119. A patient aged 49 years presents with sudden onset of a cold white painful right hand. Which of the following may be relevant?
1- A history of severe catrostarnal chest pain 5 days previously
2- An apical diastolic murmur
3- The presence of atrial fibrillation
4- A temperature of 33 degree Celsius
Mark:
a- If 1, 2 and 3 are correct
b- If 1 and 3 are correct
c- If 2 and 4 are correct
d- If 4 only is correct
e- If all are correct
122. Which of the following statements is/are true of aucocoele of the gall bladder?
1- The gall bladder is distended with watery mucinous fluic
2- It results from obstruction of the cystic duct but not the common bike duct
3- The entrapped bile is reabsorbed with time
4- There is usually no epithelial laming of the wall
Mark:
a- If 1, 2 and 3 are correct
b- If 1 and 3 are correct //////
c- If 2 and 4 are correct
d- If 4 only is correct
e- If all are correct

134. Bronchial adoema:
a- Always benign /////
b- Potential maligancy
c- Can cause obstruction
d- Malignant
e-

One more question from me

67.) 71. 50 yr old pt comes with pain radiating from T8 to right side of the chest with spastic papa paresis most likely cause
a. G-B Syndrome
b. Multiple Sclerosis
c. Spinal cord compression
d. Springomyelia
e. Herpes
I got a bit confused asI would say A) is not spastic, B) he is too old and a man -> anlikely, C) my answer even if the question is not 100% clear where the paresis is, D) thought age more 20-40, arms atrophic paresis and legs spastik? Don't knwo hoe the pain is explaines in T8, E)would perfectly explain the pain but never seen one patient with spastic paresis with herpes, or what do you think?


I will try to answer the other new questions when I find the time to look em up.

confusing ques...

hi guest,could u please give me the ans...

107. In the investigation of jaundice, which of the following statements is/are correct?
1- Ultrasound is very accurate in diagnosing stones in the common bile duct
2- Ultrasound imaging can detect large duct obstruction in over 90% of case
3- The CT scan is very accurate in diagnosing gallbladder stones
4- Oral Cholecystography does not help in the diagnosis of the jaundiced patient
MARK:
a- If 1, 2 and 3 are correct
b- If 1 and 3 are correct
c- If 2 and 4 are correct
d- If 4 only is correct
e- If all are correct ////
108. A 20yrs old man is brought to the Casualty Department following a motor vehicle accident. He is hypotensive and unconscious. He has an open fracture of the mandible and a closed fractured tibia. The most probable cause of his hypotension is:
a- The closed head injury
b- The compound mandible fracture
c- The fractured tibia
d- A combination of the above
e- None of the above //////


111. Which of the following statements is/are true for meningloma?
1- Constitute approximately 15% of all primary brain neoplasms
2- Compress put rarely invade brain
3- Most commonly couples the parasagittal site
4- May exhibit metaplastic change as well as characteristic asammoma bodies
Mark:
a- If 1, 2 and 3 are correct
b- If 1 and 3 are correct
c- If 2 and 4 are correct
d- If 4 only is correct
e- If all are correct

112. Concerning aboriginal health in new scuta vales
1- More aboriginal children now die iron infectious disease than 10 years ago
2- Hepatitis B is more common in aborigines than in non aborigines
3- Diabetes is less common among aborigines than among non aborigines
4- Lost aborigines die in the middle years of life (30 to 50 years)
Mark:
a- If 1, 2 and 3 are correct
b- If 1 and 3 are correct
c- If 2 and 4 are correct
d- If 4 only is correct
e- If all are correct
31.05.2007
119. A patient aged 49 years presents with sudden onset of a cold white painful right hand. Which of the following may be relevant?
1- A history of severe catrostarnal chest pain 5 days previously
2- An apical diastolic murmur
3- The presence of atrial fibrillation
4- A temperature of 33 degree Celsius
Mark:
a- If 1, 2 and 3 are correct
b- If 1 and 3 are correct
c- If 2 and 4 are correct
d- If 4 only is correct
e- If all are correct
122. Which of the following statements is/are true of aucocoele of the gall bladder?
1- The gall bladder is distended with watery mucinous fluic
2- It results from obstruction of the cystic duct but not the common bike duct
3- The entrapped bile is reabsorbed with time
4- There is usually no epithelial laming of the wall
Mark:
a- If 1, 2 and 3 are correct
b- If 1 and 3 are correct //////
c- If 2 and 4 are correct
d- If 4 only is correct
e- If all are correct

134. Bronchial adoema:
a- Always benign /////
b- Potential maligancy
c- Can cause obstruction
d- Malignant
e-

hi mahedi2410
it was me who wrote the first few answers back to you. (21/10/07 7:37) Just forgot to log in. I will try to solve the other questions but am very busy at the moment. Sorry. Maybe some other people will give it a go!
cheers

confusing ques...

thank u angeli for your reply.

68.) pt with h/o rupture membrane 36 hr prior to labour had fever of 38.5 during labour and child is normal at birth with apgar 10 at 5 min after 10 hrs baby presents cynosis respiratory distress, excessive crying.
a. Sepsis
b. TOF
c. PGA
My answer is A) is would fit with the maternal fever and the PROM. But the 10hr post might be a hint for a closing ductus botalli, so I am a bit confused here… what is your opinion.

69.) to give dose of anti –D to mother what is least helpful
a. Kleihauser test
b. Cord test
c. Mother’s ICT
d. Father’s RH
e. Amniotic fluid check
Am still sticking with answer A). But what is that Kleihauer test for then? It shows feto-maternal haemorrhage and the consequence is to give Rh(D)… But in the usual procedure for Rh-incompatibility the kleihauer test is not mentioned. Anyone can explain?

70.). primigravida ICT positive at 12 wks gestational age confirmed with first trimester US at 24wks uterine fundal height appropriate to gestation but at 26 wks fundal height was equal to 34 wks diagnosis
a. foetal hydrops
b. wrong date
c. acute polyhydrominos
d. macrosomia
My answer is a) as ICT was positive… but not sure about answer d).

71.) 82. 24 yr old lady with post coital bleeding most common cause
a. Ca cervix
b. Cervical Ectropion
c. Trichomoniasis
d. cin2
Same question but one more answer possibility. Now actually I would go for c) as cervicitis most commonly causes postcoital bleed. So does ectropian which is common during pregnancy or with hormone changes (the pill). So I am still not 100% sure about the correct answer!

Hi angelina,

I would choose C, because this is the most familiar disease for me.
No, no it is joking.
The reasons are

A is usually with no pain and plegia is ascending from foot.
Sometimes influence of respiratory muscle is crucial for the patient.


B is unlikely, symptom is cleary different, I suppose.

C:Syringomyelia involve
bathyanesthesia,
disorder of autonomic nerve system,
spastic legs and atrophic paresis
disturbance of pyramidal tract
age: 20~40?

E: absolutely, NO.


67.) 71. 50 yr old pt comes with pain radiating from T8 to right side of the chest with spastic papa paresis most likely cause
a. G-B Syndrome
b. Multiple Sclerosis
c. Spinal cord compression
d. Springomyelia
e. Herpes
I got a bit confused asI would say A) is not spastic, B) he is too old and a man -> anlikely, C) my answer even if the question is not 100% clear where the paresis is, D) thought age more 20-40, arms atrophic paresis and legs spastik? Don't knwo hoe the pain is explaines in T8, E)would perfectly explain the pain but never seen one patient with spastic paresis with herpes, or what do you think?

68.) pt with h/o rupture membrane 36 hr prior to labour had fever of 38.5 during labour and child is normal at birth with apgar 10 at 5 min after 10 hrs baby presents cynosis respiratory distress, excessive crying.
a. Sepsis
b. TOF
c. PGA

I choose B.

I suppose, neonate with sepsis cannot cry hard, the sign they cannot cry is very important to find the abnomality in NICU, so I don`t choose A.

C is opposite, TGA(transposition of great arteries) or PDA) patent ductus arteriosus)??
I am not pretty sure these disease, but this story is different from PDA and TGA.

Teralogy of fallot
Because of the severity of pulmonary stenosis, before the closing
ductus arteriosus, L-R shunt provide the flow to lung, but after closing DA,
they need ondomethacin to keep PDA open.

In my opinion, there are some inconsistency, but B is the most realistic, I think.
How do u think, angelina?

Hi Samu,
Thank you! Well, never heard about the not crying but not much NICU experience. Here is what I found in textbook about crying:
"Certain subgroups of patients may not manifest the classic signs and symptoms of bacterial meningitis. Usually in a neonate there is no meningismus or fever, and the only clinical clues to meningitis are listlessness, high-pitched crying, fretfulness, refusal to feed, or irritability"
So I guess can cry with sepsis. But as I said about the ductus in TOF... could be the answer, too. But so far I guess, I would stick with sepsis.

Yes.
Neonate are usually in a bad mood and cry excessively before they are silent. I`ve never read and heard high-pitched crying.
Well, I will find a literature. Thank you.

Furtheremore, my experience in NICU is just 6 week, but 24 hours on call.
It was terrible...

Hi angelitanica,


I just looked NSAIDs up and Indomethacin as well as diclofenac had a special risk with cardiac patients. With increased thrombembolic event risk. (Australian Medicines Handbook)
That and the fact that they wrote "a cardiac" patient made me struggle and I am still not convinced.

I looked for some literature, but there is no statement as you mentioned before in the U.S. and Japan. Thromboembolic event risk would decrease, I suppose.

Cheers,

Most common cause of rupture of extensor pollicis longus?

a) Rheumatoid Arthritis//
b) Tendonitis
c) Tenosynovitis
d) other options not there

80 yr old lady complaining about back pain. She had bent over to pick up her cat and got the pain since then. She also had colon calcer removed when she was 65.

a) aggravation of old case of OA
b) disc prolapse//
c) metastasis from old CA
d) fracture of intervertebral disc

Which of the following is most suggestive of disruption of the deep layers of a post op abdominal wound?

a) persistent pain in wound
b) serosanguinous discharge//
c) persistent abdominal distension
d) gaping in skin after removal of the sutures
e) unexplained fever and tachycardia

A 16 yr old presents with severe headache and rash on her body. She also has profure bleeding from all venepuncture sites. What is the most probable diagnosis?

a) DIC//
b) Thrombocytopenia
c) Henoch Schonlein purpura
d) allergic reaction

feed back pls?

RE Q 62). a lady had supraclavicular lymph nodes which is least likely to cause it
a. Breast cancer
b. Ca stomach
c. Ca broncus
d. Ca thyroid
e. melanoma of the arm (of same side to lymph nodes can’t remember Lt or Rt)
I would say E as wouldn’t the axillar LN be enlarged then? Not sure about C as the LN are usually higher than subraclavicular.

** the question is wrong It was corrected by some one who did this particular paper.
It is Rt supraclavicular Lymph nodes and melanoma of Rt arm
So the answer according to him is B) because ca stomach commonly metastasises to the Lt supraclavicular nodes.

confusing ques...

hi guest,

80 yr old lady complaining about back pain. She had bent over to pick up her cat and got the pain since then. She also had colon calcer removed when she was 65.

a) aggravation of old case of OA
b) disc prolapse
c) metastasis from old CA /////////
d) fracture of intervertebral disc

i think the ans wouldn't be disc prolapse because there is only c/o back pain.but in disc prolapse pain radiates to buttock and thigh.moreover there is h/o colon cancer.so it should be metastasis to vertebral body(especially in elderly).

can u please send my confusing questions' ans.

difference between superfiacial and deep burn ?
deep with more exudate

A farmer comes to the clinic with history of wound caused by a wire. O/E the site is red and tender. Which one of the following Ix can be used to exclude clostridium difficile infection.

a. Biopsy of the muscle
b. aerobic culture
c. anaerobic culture
d. x-ray of the site and looking for subcutaneous emphysema
e. blood culture

plz answer

confusing ques...

A farmer comes to the clinic with history of wound caused by a wire. O/E the site is red and tender. Which one of the following Ix can be used to exclude clostridium difficile infection.

a. Biopsy of the muscle
b. aerobic culture
c. anaerobic culture
d. x-ray of the site and looking for subcutaneous emphysema//////////
e. blood culture

but nobody gives my questions' ans. :!:

A farmer comes to the clinic with history of wound caused by a wire. O/E the site is red and tender. Which one of the following Ix can be used to exclude clostridium difficile infection.

a. Biopsy of the muscle
b. aerobic culture
c. anaerobic culture
d. x-ray of the site and looking for subcutaneous emphysema//////////
e. blood culture

but nobody gives my questions' ans. Exclamation

Hi guys,
I would choose　D。However, even though we cannot detect subcutaneous emphysema, we had better choose antibiotics which cover both aerobic and anerobic bacteria.