RAPID REVISION v2.

CHILDHOOD INFECTION

BLOCK 1

1. NOBODY CHARLES
2. EXPLORE FEB
3. BONES
1. A study was done in a group of mice regarding the effect of a drug in coronary artery disease.
Before the study was concluded, mice died due to certain reasons. Now the same study was
conducted in a set of post meno pausal women with the following outcome obtained.

No of years risk of CAD

<1 1

2 years 1.12( CI 0.8-1.2)

4 years 1.18( CI 0.9- 1.5)

5 years and more 1.3( CI1.2-1.7)

What does the result demonstrate?

a. Biological plausibility
b. Dose response relationship
c. Inverse causality
d. Temporality was not in option

2. Couple comes for the Periconceptional counselling. Parents are concerned for their
second child to have Downs syndrome. They already have a daughter with DOWN
syndrome. Now they want to be sure if their future baby will have downs syndrome but
they will not terminate the pregnancy. What test will you do?
a. Chorionic villous sampling at 12th week
b. Amniocentesis at 14 week

c. quadraple screen

d. estriol in 10 weeks

nowhere mentioned if the couple wants to know the test early

3. A patient develops single erythematous pruritic and painful 7 mm rash over the neck while he
was gardening in a rose garden 1 day before. the lesion was painful and erythematous. Picture
was not given, description only
a. contact dermatitis
b. Sporothrix
c. insect bite
 4. Patient had allergy with treated in an urgent care for a urinary tract infection with TMP SMX. She
had some similar episode for which she was treated by Emergency physician doctor few months
back. Now she come to her PCP and ask about, is her allergy listed on EMR. Physician look at
EMR and could not find it. What should be the physician’s response to the patient regarding her
allergy condition?

a. Remind the physician about allergy every time you see them

b. Wear allergy band with the name of drug that she is allergic to.

c. Encourage the patient to report the emergency physician to state medical board

d. Report the urgent physician to state medical board

5. A 20s female came to your OPD because she thinks she has genital herpes. She further adds she has
been seeing a gynecologist from past few years. She says “we had a good understanding and were
comfortable with each other and you know things happened on and on”. I think I contracted Herpes
from him. The gynecologist is still her physician. On examination the patient has candida but not herpes.
Which statement is true regarding this condition?

a. The gynecologist has breached his profession conduct

b. The patient is fabricating a story

c. Since both are consenting adults, this should not be a problem

d. Since both are adults, both are equally responsible for harming patient physician relationship

e. The physician should have immediately terminated the relationship once they have started dating.

6. A 25 years young nurse came to the office for HME. She tells the doctor that she has been
fatigued all the time and she tells that the fatigue might be related to her working as a nurse.
She does not smoke and is a mutually monogamous relationship with her husband. She does not
use ilicit drugs and drinks alcohol occasionally. Last visit was a year ago. On examination she has
a fixed split of S2 and there is a flow murmur at the LUSB. She has been having the murmur since
childhood and has had no problem regarding it. What investigation will you do regarding her
condition?
a. ECG
b. ECHO
c. Hemoglobin
d. HIV serology

7. A 40 years young female nurse comes with a complain of jaw tenderness for the past few
months.
 She started her jaw pain when an aggressive patient punched her and had a hairline fracture 3
years back. She had a few days off during that time and got some employment benefit. Since
then her pain has been persistent ad had some distress with it. Her work history was sound
before the incident. On examination, she had an exquisite tenderness on her jaw. She rates her
pain 8 out of 10 on examination. X ray shows no lesions and a completely healed mandible. She
seems quite distressed regarding her inability to continue her job as a nurse. Diagnosis asked:
A. Somatic symptom disorder pain predominant
B. Malingering
C. Factitious disorder.

8. A 40s male comes with persistently elevated blood glucose level for the past 5 days. He has a history
of COPD was treated for acute exacerbation in the ER 5 days back where the doctor prescribed him with
oral prednisolone for 7 days. He was under inhalational Ipratropium, Inhalational fluticasone and oral
prednisolone. Vitals are within normal limit. Now his symptoms are resolved and is stable. He is a known
case of DM under glyburide and metformin. Blood glucose comes out to be 300 mg/dl. What is your is
most appropriate next step in management?

a. Start LABA

b. Start insulin

c. Stop prednisolone

d. Start IV fluid

9. DCIS vignette explains, initially calcification seen on mammography, then biopsy done and biopsy
feature explained not crossing the basement membrane. Family history is negative. Lesion was present
in left breast and right breast is clear on imaging.

a. Lumpectomy

b. Radical Mastectomy

c. Radical Mastectomy with Lymph node sampling

d. B/L mastectomy with SLNB

no u/l mastectomy and SLNB in option, both options had b/l radical mastectomy

10. 30s Female comes with the complaints of intermittent unilateral bloody discharge from nipple. The
mass stains her undergarments O/E- no mass could be palpated. Family history is non contributable.
What investigation is done to confirm the diagnosis?

a. CXR

b. Mammography
c. Breast MRI

d. Ductography

Biopsy was not in option

11. 6 year young child. Has an ovoid shaped lesion few centimeters below umbilicus at the belt line.
Mother has tried emollients, OTC hydrocortisone and isopropyl alcohol cream. The lesion has not
improved. Diagnosis: picture was not given the lesion was described only.

a. Contact dermatitis

b. Fungal infection

c. Nummular eczema

d. Psoriasis

12. A man in his 50s came with a lesion in his cheek. The Lesion was 2*0.5 cm ovoid, flat, non-scaly, with
the smooth, regular border. History of sun exposure as well. Diagnosis:

a. Seborrheic keratosis
B. Lentigo maligna
[Link]
d. Actinic Keratosis

13. 26 Y/O Female came for HME. She was a IV drug user from 17 to 19 years old. Now she is married
and is in a mutually monogamous relationship with 1 male partner. No complains at present. HIV testing
done one year ago was negative. On examination, liver span was 6 cm and spleen tip was palpable 3 cm
from the LLQ.

Labs shows: Hb: 14

Ferritin: 480

Platelet: 120000

ALP: 130

ALT/AST : 40s

What will you do to confirm the diagnosis

a. Hepatitis C testing

b. Bone marrow biopsy

c. Phlebotomy
d. CT A+P

e. USG was not in option

[Link] American with a diagnosed case of HTN was under hydrochlorthiazide and his BP
was not under control. BP: 150/ 95. His serum Creatinine was 1.3. What will you add next?
a. Losartan
b. metoprolol
c. amlodipine
d. hydralazine (I am not quite sure about this)

15. A female with a history of migraine came to PCP because her symptoms were not
adequately controlled. She is asking for referral to a neurologist. The insurance company
had a policy of giving incentives to the doctors if they are able to manage the symptoms on
their own and do not send the referral. What should the neurologist do?
a. referral to the neurologist
b. Reassure her that he can manage the symptoms on his own
c. Do not send her to the neurologist and offer her a new set of investigations
d. Do not send her to the neurologist, but do not take the incentive from the insurance
company.

16.A female in her 40s came to F/U for a case of HTN. She used to measure her BP in church
which was between 115-125 mmHg SBP and 70-75 mm Hg DSBP. She is under 4
antihypertensive drugs, HCTZ, losartan, Amlodipine and spironolactone. Her office BP was
162/98 mm Hg and 155/95 mm Hg. What will you do now? (these values are exact)
a. ABPM
b. Add another antihypertensive
c. Renal doppler USG
d. Renal scintography

17. A early 30s pregnant female came to the HME for her regular checkup. She is a triathlon
runner and is a vegetarian, and is current taking pregnancy multivitamins. What nutritional
counselling should you advise her?
a. Ask her to continue the same regimen
b. Add a meat protein supplementation
c. Limit her physical activity
d. Add Ca and vitamin D

[Link] had melanoma for which excisional biopsy was done, later showed that the depth
involved was 0.7mm. NBS:
a. Excision with 1-cm margin only
b. Sentinel LN biopsy only
c. Axillary LN biopsy
d. Nothing required
[Link], MVA case. Patient was placed on spinal board, cervical collar was applied. Patient
had a laceration over forehead, and left humerus with no active bleeding. Leg laceration was
deep but had not involved bone. Patient says that he has no pain over cervical spine. Patient
was a heavy drinker and he was drinking just before driving before the accident occurred.
BP-100/70mmHg. NBS in management:
a. CT cervical spine
b. Xray pelvis
c. Xray left knee
d. X ray femur

[Link] has increasing difficulty to see, tunnel vision was also mentioned. He had more
difficulty at night and had better vision during the day time. Rest of the examination was
normal. On examination peripheral vision was poor. Diagnosis:
a. Cataract
b. Glaucoma
c. ARMD
d. Vitamin A deficiency

21. A early 20s female who having coarse facial hairs, nodulocystic acne came to the
physician with those problems. Menses were not regular. BMI was on the normal. What is
the appropriate treatment for her?
a. Spironolactone
b. Norethindrone/Ethinyl estradiol
c. Flutamide

[Link] female presents to the emergency department with severe groin pain radiating to
the loin. CT scan showed 1 mm (not cm) ureteric stone. She was managed in the ER with Iv
fluids. Apart from IV fluids, what will be the next appropriate step?’
a. oral NSAID (not on discharge, nothing mentioned)
b. F/U in PCP if pain persist
c. some irreverent options were there, I’m sure you’ll exclude them all

23. A women in her 30s presented to the PCP with complains of weakness on her right hand
for few days. Sensation over the right hands had also decreased. Few months ago she had an
episode of foot drop which resolved on its own.( this thing was super hidden in the vignette)
Power was 3/5 of her hand muscles. What will be your appropriate next step?
a. wrist splint
b. NCS of the Upper extremities
c. Nothing at the moment
d. MRI
 24. One HOPI with a female having purging type behavior and feeling of remorse and
running few miles after having food. She restricts herself with food for a day or two after
having food. On examination, parotid enlargement and callus present. Serum amylase was
Increases. The last line of CV mentions that she has a BMI of 18.3. what is the diagnosis?
a. Bullemia Nervosa
b. Anorexia Nervosa
c. Binge eating behavior

25. A patient developed tingling and numbness of his lateral and dorsum of his right foot. The symptom
started when he stand from squatting position after repairing his car brake for 2 hour. On examination,
he has sensory loss over the lateral aspect of left leg and dorsum of foot. Weakness in dorsiflexion +nt .
Patellar and ankle reflexes were 2+. Bowel and bladder function were normal. Patient is having the
problem for the past 3 weeks and patient is having low back pain for the same time. How do you confirm
your diagnosis

a. X ray lumbar spine

b. MRI Lumbar spine

c. NCS

d. Muscle biopsy

26. An old lady comes with increasing nausea and epigastric pain for 24 hours. She has history of fatigue
for 1 week. She underwent uncomplicated total knee replacement for her right hip. She has stated
treadmill exercise a week back with no complains of hip joint. She is a known case of DM under
medication, she was under metformin and atenolol. Her wound was normal. What is the next
appropriate step you do in this condition?

a. ABG
b. ECG
c. TFT
d. Blood glucose monitoring
e. chest x-ray

27. A lady has had migraine for 1 year, and she was having her regular medicine and her symptoms were
under control. For last 1 month, she has an increased intensity of pain with visual auras and associated
with throbbing headache for which she is taking Naproxen thrice a day, but her pain is still there. She is
having her problem almost daily. Doctor examines her, and on eye examination with torchlight, she is
uncomfortable due to photophobia. What is the NBS in management for her.

a. MRI brain

b. Stop Acetaminophen
c. Start sumatriptan.

d. Recommend her psychotherapy

28. A daughter brings an 80-year-old lady for some cognitive disorder issues. Her daughter
says something then mother says ‘I am actually doing fine and she just want to make you
think that I cannot take care of myself. My daughter just wants all my money “. what will be
your best response: -
a. Send the daughter out of the room and just rely on the patient’s history
b. Ask the patient if it is okay to have her daughter in the room to contribute to the history
c. Tell them to resolve their issues at home
d. Examine mother alone in absence of daughter.

29. 7 years kid, brought by her father. Doctor noticed that the child’s foot while standing
looked flat and slightly pronated with heel slightly valgus but both medial longitudinal arch
looks normal when the foot is hung. On further examination it is noted that the whole
weight of the body is transmitted to medial axis instead of lateral axis. NBS:
a. AP and lateral X ray of foot on standing position
b. AP and lateral X ray of foot on sitting position
c. Nothing is required

30. Sequential
A. Patient had stroke features- weakness of left side of the body, there was no sensory
involvement. He came to the ER within 30 mins of presentation. On examination, Babinsky
sign positive on left side. Dysarthria and muscle power was 3/5 on upper and lower
extremities. Patient consumes only 3-4 oz alcohol per week. H/o HTN current BP-150s/90s.
Patient under anti-HTN medication lisinopril.
1. which of the following is the good prognostic factor in patients condition?
i. Isolated motor symptoms
ii. Age
2. Patient was given IV alteplase and his motor symptoms resolved within minutes. He has
no symptoms now. How do you prevent the recurrence of similar events in future?
i. Complete abstinence from alcohol
ii. Increase the dose of lisinopril
iii. add amlodipine to the regimen
B.
1. Patient presented to the ER with ground-coffee emesis for which management with blood
transfusion and other conservative measures were done. He is a known case of liver
cirrhosis. Hb- 5.7, BP 90/60, HR increased. Now on examination he has bilateral lung
crackles. Which of the following is the next best step in management?
i. IV furosemide
ii. Transfuse one more pint of PRBC
iii. IV antibiotics

2. IV furosemide was given. He was managed conservatively and his condition began to
improve. An UGI endoscopy was performed 3 days later(as I remember) which revealed non-
bleeding gastric varices which was then treated. On examination, BP 120/80, HR 86 oxygen
saturation of 96-97% with 2L oxygen via nasal canula. Which of the following is the NBS in
management?
i. Initiate continuous infusion of octreotide
ii. Therapy with clarithromycin + omeprazole+ amoxicillin
iii. Continued observation only

31. HOPI:
A 7 years old boy is brought by his parents with complain of fever and sore throat. The fever
was relieved by ibuprofen, however it has not completely resolved it yet. Initially fever was
101.7 and now its 100.2. On examination there was an erythematous tonsils without
exudates. There is no cough and rhinorrhea. An erythematous rash was present in the axilla
and the anterior cervical lymphadenopathy was enlarged and tender. Streptococcal Antigen
test was negative. What will be the next appropriate step in the management?
a. Continue supportive measures only
b. Throat culture
c. Heterophile antibody testing
d. Nothing required at the moment
32.14 years old girl came to the office with h/o amenorhoea since 8 months maybe. Came to
know that she is pregnant from home pregnancy test. She wants to continue pregnancy. Her
BMI is normal. She has a sister at home who has a 2 year old child , both of them are
healthy. She now asks what complications can occur in my scenario?
a. Chromosomal abnormalities
b. Preterm labor
c. Nothing
d. GDM

33. 12 years old boy with a history of allergic rhinitis taking intranasal fluticasone as required
came in the month of July. His last visit was 1 year ago and had taken all the necessary
vaccinations up to last year. His sexual maturity score was 2 and has not started his sexual
activities yet. What vaccine will you recommend at this time?
a. Pneumococcal
B. HPV
C. Influenza
d. Varicella zoster
no meningococcal in option

34. A middle aged man, smoker complains of sudden onset severe chest pain radiating to
back. His vitals were stable and BP was on the higher side. ECG was given which is depicted
as below

I inferred it as anterior wall MI and now the question asks what will be the appropriate
NBSIM?
a. CT Angiography
b. Coronary cathetherization
c. Serum troponin
d. CXR
35. A heart sound given where the patient came in for routine HME to apply for
insurance. Everything was normal regarding his clinical examination. I inferred a diastolic
sound heard in RUSB and LLSB, found it more prominent on LLSB.
[Link]
[Link]
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36. A Mexican woman came to the ER with complain of diffuse abdominal pain. She had
a history of appendectomy some 20 years ago and now on examination abdomen was
distended to the level of umbilicus. Her BP was high and diffuse tenderness was present
in the abdomen. Her urine output was 50 ml in the past 2 hours. What will be the
appropriate next step in management?
a. Foleys catheterization
b. 0.9% NS
[Link] USG
d. Ex. Laparotomy

37.60 years female, known case of comes to the PCP with a complain of telling that she
have decreased in height from 5.8 to 5.6 feet , sleep has reduced from 7 hours to 5.5
hours, some kind of low mood. She is concerned about her sleep but her apetite is
normal. She seemed to be forgetting about some past things. Patient currently on
Alendronate and calcium. Her thought process are congurent Advice to the patient?
a It seems normal for your age.
b. SSRI
c. Zolpidem

38. 35-year male, everything ok, except for his HBA1C being 7. Fasting blood sugar was
around 200
NBS –
[Link]
[Link] diet
I could not deduce anything out of it and sadly metformin was not in option

39. 13 y/o girl k/c/o graves’ disease with ophthalmopathy on propylthiouracil,

nonadherent to her treatment now presents with T=101, BP-raised, tachycardia,
pupillary dilatation, diarrhea, tremors of her hands.
NBS
a Propranolol
[Link]
 c. Antibiotics

40. A girl of sophomore year came to vacation to her home, she is a diagnosed case of
ADHD under stimulants. She came to a physician for the first time asking him to write a
prescription of amphetamines that she had lost to pack up while she was coming home.
She used to get her medicine from school health facility which is miles away. She used to
take a few pills of her friend while has to study for a long time. The physician has been a
primary physician of the girl’s mother for which she was very grateful for her. The
physician is hesitant to prescribe her medicine and the girl got very angry at him and
started shouting at him. “Do you think I am an addict? Why does everyone treat me in
this way?” What would be the appropriate response of the physician?
a. Do not prescribe her medicine
b. send her to the emergency department
c. Prescribe her amphetamine for a month
d. Prescribe her a low potent stimulant for some time
e. Tell her mother regarding here drug seeking behavior

41. A female on 41 plus ½ weeks period of gestation comes with a history of labor. Fetal
head station is +2, cervix is 50% effaced plus 8 cm dilated. CTG shows variable
deceleration. What will be the next appropriate step?
a. Steroids
b. C/S immediately
c. MgSO4
d. No intervention needed at this time
somewhat similar picture, nadir was less than 30 sec

43. A man with positive APC mutation came with his 13 years old daughter for genetic testing. Test was
positive for APC in daughter too. NBS?

a. Colectomy now

b. Colonoscopy now
c. Colonoscopy starting at 40 yrs

44. A female with a swelling in anterior neck for some time came to PCP for regular check up. Her
T3/T4/TSH were in the reference range. RAIU was done and it came out to be normal. What will you
recommend now?

a. repeat TFT in two weeks

b. repeat RAIU only in 1

c. repeat TFT only in 1 year

d. repeat all investigations in 1 year

[Link] obese man with BMI of > 40 came for a routine health check up. His GFR came to be 15
ml/min/m2. What will be the next appropriate step in management?

a. Prepare him for Bariatric Surgery

b. Intraperitoneal dialysis

c. SV catheter for dialysis

d. Surgical preparation for Hemodialysis

46.A boy has a difficulty in ambulating. His brother has a similar history and is now wheelchair bound.
Sister has no anomalies. His serum creatinine value is elevated and Gower sign is well explained. Calf
pseudo hypertrophy is also present. What will you see in the muscle biopsy?( dystropin pos neg not
mentioned)

a. Myonecrosis and endomysial fibrosis

b. dystropin negative in Immunohisto staining

47. Two intern doctors are practicing an ICU round for the patient who are being admitted there. What
should the doctors look first to know the status of admitted patient?

a. ICU progression chart of the patients

b. feeding status of the patient

c. Output from drain site

d. Nursing care plan for the patient

48.A battalion was about to be deployed to some region. An army commander comes to the physician
for asking about preventing their soldiers from chikungunya.
a. Ask them to use insect repellant cream and net

b. Hand washing

c. Do not train near clean stagnant water

49. A hospital administration came to find out that a influenza vaccination rate was >90% in children of
age <2 years and significantly low in adolescent age group. They came to know that the vaccination rate
was quite higher in the summer/spring season and low in other seasons. The hospital describes the
demographics of population and many things. I could not find anything regarding the cause of not doing
the immunizations( Basically I Thought that it was hinting towards pareto chart). Which of the following
best describes the things the hospital is trying to interpret?

a. Run Chart

b. Pareto Chart

c. Fish bone diagram

50 A guy presents with heaviness around his scrotum. On examination a firm non-tender mass is present
on the testis. Apart from doing the STI screening in the boy what is the next appropriate step in
management?

a. Usg scrotum

b. CT scan

c. Biopsy

[Link] lesion of vulva, caesarean advised to prevent what in baby?

a. Encephalitis

b. Hearing loss

c. Conjunctivitis

52. Male with a history of travel to Mexico a month back has a watery diarrhea for the past new days.
Fever and significant weight loss is negative. He also had an episode of pyelonephritis for which he was
treated with cefazolin. What is the cause of diarrhea in this patient?

a. Giardia

b. C. difficale

53. Nurses felt that doctors are not maintaining hand hygiene. Some educational campaign team is
formed. A team from a hospital infection control started a survey on PPE and handwashing too. They
have been randomly distributing some survey to healthcare workers too. They found compliance for
handwashing and PPE to be 90 and 92% among the 500 subjects being surveyed. The results did not
came as the nurses complained. What’s the problem here.

a Interrater reliability

b Intra rater reliability

c Observer bias

d Measurement bias

e Health worker Effect

54 MSM boy with flat topped lesion in the perianal region, which don’t bleed on touch. How do you
treat the case?

a. Cryotherapy
C lata
b. Intralesional steroid

[Link] penicillin

55.A baby in utero features explained. Currently mother is at 32nd week of gestation. Previous reports of
USG at 28 weeks and at 32 weeks are of following

At 28 weeks At 32 weeks

Head Circumference= corresponded to 28 weeks Head circumference corresponds to 32

weeks

BPD = corresponded to 28 weeks BPD = corresponded to 32 weeks

Abdominal Circumference = corresponded to 28 weeks Abdominal Circumference = corresponded

28 weeks

femur length= corresponded to 28 weeks femur length= corresponded to 31 weeks

What is the reason for the above findings?

a. Intrauterine infection
b. Constitutional delay
c. Uteroplacental Insufficiency
d. Congenital defect

56. A patient came with the history of SOB and chest pain. CXR shows left sided pleural effusion. A
resident comes for thoracocentesis and while placing the needle there was no fluid coming out of the
chest. The resident realizes an mistake has been made and he put the needle on the right side. He
discloses the error to the patient. Which of the following can help prevent repeating such mistakes in
future?

a. Do an RCA regarding the event

b. Perform a preprocedural time out

c. resident must perform the procedure under supervision

57. A girl of Muslim tradition falls from her bicycle while riding on a sunny day. She is wearing a hijab and
a skirt. She is pregnant and when enquired she says that she is on her fasting as per her religion. Now
will you proceed your discussion.

a. Ask her what is meant by fasting in her religion.

b. call her chaplain and ask if she can waive her fasting during the pregnancy

c. admit her and feed her involuntarily

58. Adolescent male has left the college 8 months back, starts losing interest in other things, but has
developed this weird interest in, aerospace. Has his room filled with structures built with aluminum foil,
parents are worried and when they ask him, he says “it’s not important”. He sometimes smokes
marijuana. He also mumbles on his own when he is alone. He is disheveled and unkempt . What is the
diagnosis?

a. OCD

b. Substance abuse disorder

c. Schizophrenia

d. MDD with psychotic features

59. One middle-aged man, was driving as usual, used to waive the guard every time he leaves the office.
But then at that very moment he meets with an accident, a car hit his car from the side and now he
suspects that the guard has something to do in his accident. Suspects that the guard is the reason for his
accident. He was brought by his wife. His goals are right and has no other problem. Mood and affect are
congruent. Asked diagnosis:

a. Delusional disorder

b. Schizophrenia

c. Mania
60. A man with significant features of depression has came to a psychiatrist. SIGECAPS criteria fulfilled.
He has lost a significant weight approx.. 6.8 kg in a short span of time. Which of the following drug will
be appropriate?

a. Alprazolam

b. Aripiprazole

c. Buspirone

c. Mirtazapine

d. Olanzapine

61. An old physician who is also one of the senior partner in the hospital comes late, doesn’t fill chart on
time, doesn’t return his pagers. The staff manager who is also one of the business partner of the hospital
comes to know about it and inform this issue to you (junior physician). The staff manager continues,
“Today he even forgot where he is and what date it is.” What is the role of junior physician in this
scenario?

a. Refer to employee service program.

b. Report to Chief Medical Officer

c. Ask the staff manager to keep track of his activities and observe.

d. Ask the staff manager to make a file of his actions till date

e. Tell the senior physician to take a retirement

62. A women in her 40s came to the physician with a history of being unable to sleep because she was
unable to sleep because she hears a sound for the past 1 week. The sound is constantly telling her that
the world is suffering and you are here doing nothing. She started having these problems for the past 8
months and the condition has worsened now. Due to the sound she no longer enjoys shopping that she
used to do previously. She started isolating herself and did not go to the social activities with her friend
that she previously used to do She had a flat affect and was tearful during the interview. She was talking
normally for some time and then was easily distracted with the sound. She had thought about her death
but has no suicidal ideation. What is the mostly diagnosis?

A. Schizophrenia

B. MDD with psychotic features

Super confused between these two options, I found only 3/9 criteria of MDD, had I gotten I more I would
have gone with b. went with a eventually.
[Link] features with LUTS given. 71 years young male. DRE: smooth and non-nodular prostate.
Urinalysis normal mentioned. What will you do next for diagnosis?

a. PSA

b. Transrectal USG

c. Biopsy

d. No investigations required

I went with PSA on this one, the earlier day while in the discussion, our friend told us that they had a
vignette of man in their 80s had PSA done. So 1 marks plus minus bhandai I went with a.

64. A young female presented to the ER with altered mental status and signs of meningismus. Had
petechial- pustular rashes on lower limbs. She deteriorated rapidly within an hour. Systolic BP was found
to be 70 mm of Hg. In addition to fluids and antibiotics, what is the physician’s next step?

a. Give steroids.

b. Place her in a hyperbaric chamber

c. VP shunt?

65 . A man plans to go on a trip to Equador, wants to take prophylaxis for traveller’s diarrhea. What
would you prescribe: This guy actually asked the doctor what he should take in case if develops a
diarrhea. I guess that is not prophylaxis at all.

a. Amoxicillin

b. Nitrofurantion

c. Ciprofloxacin

d. Fosfomycin

66. a patient came to the physician and found that his serum creatnine level which was sent a month ago
was found to be high and both the patient and physician were unknown about it. The lab had some EMR
but it did not synced with the EMR of the patient. Now, in addition to repeating his creatnine value, what
should be done?

a. RCA

b. Interface EMR should be adjusted between lab and clinic

c. FMEA
[Link] with both vocal and motor tics. He has this shrugging and clearing throat habits. Being
problematic for some time. He swipes his hand over his forehead repeatedly during examination.

What will be the most likely fate of the patients condition?

a. Will progressively worsen with age

b. Will progressively improve with age
c. ADHD
d. OCD( not ODD)

68. . A girl from Guatemala visits to doctor. She has tremor like, involuntary, irregular aimless movement
of extremities. Patient had recently immigrated to the states around 2 months [Link] has history
of sore throat few months back but resolved without medication. Rapid streptococcal antigen test was
negative. Deep tendon reflex was normal. Patient had hypotonia of his fingers and things slipped off his
fingers while he was trying to hold some objects. Now ask what investigation you will perform on this
patient:

[Link]

[Link]

[Link]

d. CT head

69. RRR calculation to be done

In gist CER: 0.25

Case event rate: 0.21

Ans: easy one

70. A female was sexually assaulted by male in party. The boy compelled her for vaginal penetration and
ejaculated inside her vagina. There were lacerations around the thigh area as well. Along with
emergency contraceptive What will be the appropriate prophylaxis for her?

a. Ceftriaxone + azithromycin

b. Zidovudine(AZT)

c. Gentamycin plus doxycycline

71. Patient has pain around the hip and tenderness on lateral aspect of the hip. Pain gets worse while
lying on same side. He is on oral naproxen but pain is still there. What will be your next
pharmacotherapy?

a. Inj. Triamcinolone in Bursa

b. Inj ketorolac

c. Oral steroid

72. Female patient is a known case of MDD. She landed up in emergency after ingestion 14 tab of
fluoxetine and 16 tab of acetaminophen. She is known case of MDD under Fluoxetine and Lorazepam as
needed. Her boyfriend was called but could not be contacted. She has history of 40 times ER visit for
similar suicide attempts His PCP says psychiatrist didn’t provided her With Lorazepam for that’s why she
did this act. She also has mark of healed incision on her wrist. Last line says, what else will you do for this
suicidal behavior. –

a. Gradually taper the dose of Lorazepam

b Psychodynamic Psychotherapy

c Dialectical Behavioral Therapy

[Link] has severe vomiting. Features of bowel obstruction is explained. Dry mucous membrane and
capillary refill time was 5 sec. Patient also has mild fever approx. 100.6, BP 100/ x

. Lab: BUN- 45 Creatinine- 2.1 Asked about the cause of the investigation finding:

a. Acute renal insufficiency

b. Intravascular hypovolemia

c. Bacterial translocation

[Link] has food left in abdomen and delayed gastric emptying in nuclear gastric-emptying test. X-ray
given with mild distention but no air fluid level.

Now what will be expected to be increased in this patient:

a. HbA1c

b. Gastrin
c. GLP-1

d. GIP

we discussed regarding the findings that incretins might be increased, however both were there and I
went with b.

75. Asked about the treatment of diabetic gastroparesis

a. metoclopramide

b. Ondansetron

76. 5. Child from some rural area has features of malnutrition. He has a distended abdomen and hair is
easily pluckable. What will be the following finding?

Albumin Insulin

Normal increase

Normal decrease

Increase decrease

Decrease decrease

77. Patient underwent some GI surgery few years back and now presents with bone and muscle pain; His
blood calcium level was 8.x.

PTH urinary Ca intestinal absorption of PO4

inc dec dec

78. . Venous ulcer : I didn’t even read the question.
a. bacterial culture

b. surgical debridement

c. unna boot

d. Revascularization

e. amputation

79. Patient comes for HME, drinks 4 beers a day, 4 times a week while he travels during his work.

His TG2:80

HDL-60

LDL 170

Mild hepatomegaly on examination.

Cause for the labs

a. Alcohol

[Link] Steatosis

80. One CV of bipolar basically asking management of acute mania. Patient is very agitated when trying
to examine. NBS in management

a. valproate

b. Risperidone

c. Lithium

ditto question in amboss, have a look please

81. Patient is on central venous catheter on her neck. She is being administered chemotherapy for her
breast cancer. The cateter has been there for four months She then developed fever and some systemic
signs of infection. On examination, there is tenderness and erythema at the catheter site. Organism
could be:

a. Streptococcus pneumoniae

b. Pseudomonas aeruginosa

c. Staphylococcus aureus

d. candida

82. 4-month-old boy had intermittent abdominal pain and some other infections, full jargon in the
vignette. He is a case of leukemia and is planned for chemotherapy.

Normal including labs except uric acid which was 14.2.

What will be the NBS in management?

a allopurinol therapy

b. some antibiotics

c. colchicine

no IVF in option

83. A 40 male known case of COPD under oral steroid for 7 days after AE of COPD was brought to you by
her wife because of abnormal behavior for 5 days (may be just 2 days after initiating steroid) He has
developed abnormally high interest in sexual activities and always wants to try something new. She also
asks her wife to make trip to different cities for dinner and again come back. he has started buying things
which is not required in the home. Diagnosis
a. steroid induced mania

b. Bipolar

c. Acute stress disorder

84. A case of acute on chronic pancreatitis. A female came with the history of severe epigastric pain
radiating to the back for 4 hours. On examination epigastric tenderness present. She was a chronic
alcoholic and used to have constant pain previously.

Amylase level: 290

ALP was slightly raised

X ray of abdomen given showing calcification in the pancreas.

NBS 1. CT scan

2. IV fluid

3. MRCP

85. 24-year-old with sinusitis and recurrent ear infection presents to the clinic. She has such kind of
infection since childhood. She says, I get more infection than whosoever I have seen till now. Diagnosis
asked –

A CVID

b Rhinosinusitis

c nasal polyp

[Link]’s granulomatosis
86. A case COPD with the X ray given. Now the question asks what is decreased in this patient?

a. DLCO
b. TLC
c. Residual volume

87. Another case of COPD and the patient was had frequent exacerbations. He was under ICS and
albuterol PRN. He is concerned about the potential frequent exacerbations. His O2 saturation is 92% at
the moment. What do you add in this regimen?

a. salmeterol

b. azithromycin

c. Prednisolone

d. Oxygen therapy

88. Pregnant female of 14 WOG comes with a complains of increase SOB and frequent nighttime
awakenings for the past two weeks. She is a known case of Asthma and is under albuterol SOS. She
smokes daily with some good amount of cigerattes per day. She has been using increased frequencies
of albuterol for some time.

a. Oral prednisolone

b. oral theophylline

c. oral montelukast
d. chromylyn sodium

smoking cessation and LABA were not in option.

89. A man had recently undergone a above knee amputation surgery a few weeks ago. O/E mild
erythema of the amputation stump was present. He uses wheel chair for ambulation. The physician is
planning for the rehabilitation. The rehabilitation should focus on which aspect of the patient condition?

a. Strength and balance exercise

b. wound care

c. Nutritional management

90. A middle aged man was trying to put on gloves when he had a stinging sensation of bite of brown
recluse spider which was discovered while removing the gloves. He visited the PCP with severe pain and
swelling of the area. What will be the most appropriate step in management?

a. antivenin

[Link]

[Link] pharmacotherapy is indicated at this time

[Link]

[Link] : A patient with a known case of ? RA had a steroid injection in his DIP joint of little finger 8
weeks back. O/E there is a fluctuant swollen and tender DIP joint with limited mobility.

The patient was afebrile and other examination was normal.

What is the appropriate next step in management?

a. Arthrocentesis
b. CBC and blood culture
c. Serum uric acid
d. Amputation

92. patient with difficulty in achieving erection for the past few months. He is a known case of DM
and HTN under metformin and lisinopril. Dorsalis pedis pulses were palpable but vibration and
proprioception was lost in B/L lower extremities. Cause of difficulty in erection?

[Link] instability

b. aortoiliac occlusion

[Link] side effect

93. A case of obesity hypoventilation syndrome with accentuated S2 in an obese individual. The
greatest risk the patient will be at is?

a. cerebrovascular disease

b. cardiovascular disease

c. Erectile dysfunction

94. A case of secondary hemochromatosis with typical hyperpigmentation, DM and joint pain

Asked about the values

Ferritin Transferrin saturation iron inc inc inc

95. A postpartum female who recently underwent a normal vaginal delivery had severe pain and
swelling on her lower limb. On examination, she had an erythematous swelling, leg was purple in
color. Distal pulses were palpable. USG: large thrombus extending above knee. NBSIM?

a. LMWH

b. Thrombolysis

c. Streptokinase in femoral vein

96. Patient with multiple antihypertensives presented with symptoms of swelling of lower limb for
some time. O/E B/L lower extremity edema was present on lower limb. Protein was 3+( not 4+ as
previously written). Serum Creatinine was deranged. Cause?

a. Ibuprofen

b. losartan

c. amlodipine

[Link] transfusion in a patient showed signs of hemolytic reaction like dark urine and
hypotension. Apart from using a second identifier for the verification of patient identity what could
have prevented the transfusion reaction?

a. cross matching the patient blood with the transfused blood

b. Usuage of leucoreduced blood

c. pre transfusion administration of steroids

98.A case of MRSA was identified at a hospital in a patient who recently underwent an
appendectomy. IT was found that the nurse who has been taking care of patient was also taking care
of another patient in postop ward with a diagnosed case of MRSA. Which of the following
precautions would have prevented the development of in this patient?

a. contact precautions for all patients in postop ward for the first 48 hours of surgery

b. health care providers should have used alcohol and chlorhexidine based sanitizers

c. all the individuals visiting the postop ward should have worn gown and gloves

99. the most accurate test is?

a.A

b.B

c. C

d. D

e. E

100. Patient was treated for pneumonia. Came to ER with some sick features. Fever 102 degree
Fahrenheit. BNP was raised and x ray was given, Pao2 and Fio2 was not given.
CXR did not have blunting of CP angle.

[Link] failure

b. ARDS

101. A 12 yrs young boy has bilateral cheek swelling, high fever. He is brought by his mother who
was then counselled about the importance of vaccination which she was not accepting. Doctor’s
counselling should involve which of the following complication of this condition?

a. Orchitis

b. Encephalitis
more than 10 yrs ma A
c. Hearing loss less ma B

d. No complication (not in option)

102. 1 day old newborn, APGAR was 8 and 9. Mentioned that has uncle and father too in the family
with MEN. O/E child has multiple mucosal swellings. Asked diagnosis

a. MEN1

b. MEN2a

c. MEN2b

d. Tuberous sclerosis
103. A female patient complains with pain over foot. the patient is an avid runner. O/E patient has
tenderness over lateral part of her foot. Her lateral part of her shoes is worn out. Calcaneal squeeze
test was negative. Diagnosis:

a. Morton neuroma

b. Plantar fasciitis

c. Achilles tendinitis

d. Stress fracture of calcaneal

e. Stress fracture of metatarsal ( not mentioned which one)

104. Vignette of descending aortic aneurysm, the picture was clear. The vignette also mentions that
The pulses in the leg are not compromised and all other organ system is normal. BP 190/90 mmHG.

a. oral propranolol

b. Iv nitroprusside

c. endovascular graft

d. Thoracotomy

(be open minded in such questions, I was thinking of going with endovascular graft in case there is
an peripheral organ compromise, however there wasn’t any)

105. Patient has history of abortion few months back. She didn’t seek for care then. Now cames with
nausea and vomiting. Uterus 12 wks of size and B-hcg increased to 1,00,000. She has vesicle like
mass PV, USG also shows cystic elements. The next appropriate action?

a. Laparotomy

b. D & C

c. Mtx

d. Repeat B-Hcg in 48 hours

106. Patient has midsystolic click with late systolic murmur grade 3/6. He says that he used to take
prophylaxis in the prior dental procudres. The prophylaxis given for dental procedure in this patient
will protect against what.

a. Strep mitis.
b. Staph epidermidis
c. Strep bovis
d. d. No prophylaxis needed at this time
107. one ecg diven in a man who drinks alcohol heavilt with all the features of Heart Failure given
and had to diagnose that it’s a case of heart failure.

108. One man with colorectal carcinoma resected 3 years back had a normal CEA value at 4 months
back. The patient had a mass in lungs identified by the CT scan of chest. Mass was single and was
near the colon. What is the next appropriate investigation in this patient?

a. repeat CEA level

b. FNAC of mass

c. Ct Abdomen and pelvis

d. colonoscopy

rest are the usual suspects. The guy in the dressing room is still shy, that poor boys’ uncle died and
he had no part in their, the teratoma is still 7 cm and has not grown in size and undergone torsion
and the SCID boy is still receiving VZIG. I hope the rat who was still running in trademill in step 1 has
gained some muscle mass, and the young boy who had giardiasis should know by now that wild
berries did not cause giardiasis but the lake water did.

THANK YOU EVERYONE

ABSTRACT

1.H2-PPI

1. Reduce confounding.
2. Low, High
3. More prospective studies needed.

2. CHILDHOOD INFECTION PREDICTOR

This was the systematic review published in 2010 in Lancet, but table was there which was key to two
answers. In the abstract text , prevaence of sepsis varied in different study from 0.55% - 45%. Heading is
same but don’t follow the inner content
 Parameters +likelihood -ve likelihood
Parental concern
Poor perfusion 38

Three step test 0.04

4. What best predicts the disease- capillary refill >5 sec

5. Why physician is less confident to use this study based on data- Prevalence rate varied a lot
6. What excludes the disease- Three step test

SEQUENTIAL

7. IV furosemide
8. Observation

SEQUENTIAL

9. Isolated motor symptom

10. Increase dose of Losartan

This was U/L infarct

In 2nd part of the Q, they explain that CT was normal, but MRI showed this sort of MRI picture of
infarct in basal ganglia in one side, pt has BP more then 140/90
HOPI: All are two page long, skim and scan the pertinent system of examination of chief complaints

11. Persistent hypokalemia- Check magnesium levels

12. Index finger septic arthritis- Arthrotomy

13. 2 hrs. after deep diving, only maxillary pain, all other system normal – Barotrauma

14. Heart Failure on Chlorthalidone, on discharge- ARB

15. Anorexia Nervosa, BMI 18.3, patient is a purging kind of anorexic, we have to search this BMI in
the physical examination.

16. Patient resides in some institutionalized facility and had some infection for which initially
ceftriaxone is given then cefixime, now he presents with

NBS- stop cefixime.

17. Kid with sore throat, lymphadenopathy, other features , In last line says Strep rapid test -, NBS
- Throat culture
PICTURE BASED Q:
18. CTG variable deceleration- cord compression

19. CTG of early and variable deceleration at 42 weeks of gestation with all parameters looking
normal= Expectant management

20. ALL with lymphoblast, vignette says hand and other bone pains with lytic lesion on bone and
shotty lymph nodes in cervical region, Gaucher’s also in option.
21. Paget’s disease left hip = increase ALP

22. Horse Shoe kidney Ct scan= Ureteropelvic obstruction

23. Venous ulcer – Unna boot

24. Sigmoid volvulus- detorsion

somewhat vague
25. Intussusception of 2-month-old child- I felt they were trying to show small bowel obstruction,
pic was sort of below.

26. ECG II, III, AVF, S4= coronary angiography

27. Old person- twice history of syncopal episode in a long vignette

Some treatment is given and again ecg done, now individual multiple pieces of ECG leads given,
couldn’t make out, what they are trying to show

Just a depiction, its also in black and white

Marked= pacemaker (felt like Wenckebach’s, but difficult)

28. Alcoholic patient, S3, BNP raised, ECG given, looked normal or I couldn’t find pathology, marked
something related to heart failure.

29. Xray chest with constitutional symptom explained in CV= Hodgkin Lymphoma to diagnose

arrow is not there, some this sort of picture.

30. Xray showing left Ilium fracture, with high riding prostate and blood in a meatus= Retrograde
urethrography to mark

31. ROC curve to mark A= Q mentioned accuracy somewhere but not that clear statement
32. Obese women with multiple surgery for incisional hernia has now sore over the lowest part of
her belly, risk in 6 months= Enterocutaneous fistula

Bigger than this and lifted by hand, blue area has ulcer on it

33. Triglyceride =40 in last= Tuberculosis

34. Some atraumatic scenario with Rt sided pleural effusion= Thoracocentesis

35. Paget’s skull CT, also explains similar lesion in tibia, history of prostate cancer treatment also
mentioned= ALP activity

Arrows not there, somewhat similar to this

36. Treated for pneumonia, presented to Emergency with sick features after 2 days; Pao2, Fio2 not
mentioned, Xray given= ARDS

37. Occupational history, morning productive sputum for some time, x-ray of asbestosis given, what
will you see on BAL= Asbestos bodies

Somewhat like this with plaque to assume at anterolateral chest more then pure lateral and
inferior chest.
38. Similar picture of Asbestosis again – forgot what was asked, might be spirometry parameter.

39. Right sided lung cancer with SVC syndrome features like facial flushing explained= SVC
syndrome

Not this much clear picture and tumor not so close to hilum.
40. Descending aortic dissection= propranolol

Clearer picture then this

41. 45Y/ Male, Emphysema clue given, family history of father died and cirrhosis features like spider
angiomata explained= Alfa 1 antitrypsin deficiency

More darker and clearer than this

42. COPD features explained, asked the spirometric parameter= Decreased DLCO

43. Seborrheic dermatitis of kid to diagnose.

Similar but whole face with head was depicted with lesions are similar to above over scalp as
well as face
44. Some postoperative patient with Tachycardia and SOB, ECG was not that clear,I could appreciate
S1 and Q3 but T3 couldn’t be appreciated= marked pulmonary embolism- below ecg picture for
your review, somewhat might be similar

45. Acanthosis Nigricans, what is seen= decreased HDL

 46. Strongyloidiasis larva shown, eosinophilia also there = Ivermectin

Somewhat similar, less curved then this, more transparent but coloured with content inside this larvae
visible

47. Scabies- contact precaution

48. Herpes lesion of vulva, caesarean advised to prevent against what in baby = Encephalitis

49. Patient in chemotherapy (has to infer), developed 10/10 pain = Herpes Zoster to diagnose

A zoomed photo like this

50. Rheumatoid arthritis features explained, what decrease progression= Methotrexate

Not a classic x-ray but has shown lytic erosion over distal radius and vignette helps.

51. Cardiac myxoma gross picture with diastolic rumble production on auscultation and all
described, asked the origin of the mass shown= Mesenchymal
52. Contact dermatitis= Advice to keep away from weedy plant

53. Similar question as above but gets 2-3 cm patch in neck while rose gardening, no other features
described, no photo = confused between insect bite versus weed.

54. Baby with ovoid round lesion at beltline. Mother tried emollient, Hydrocortisone and isopropyl
alcohol but didn’t work= contact dermatitis versus fungal

55. Lesion in face with regular margin, ovoid, slowly increasing in size, worked in outdoors for long =
lentigo maligna versus seborrheic keratosis

56. Foreign body to mark.

57. Akinetic mutism

58. Vignette describing pneumonia with x-ray not fully lobar but hazy on Right lower lobe= IV
levofloxacin

Somewhat similar to this

59. Suddenly found brown spider while wearing gloves; and hand picture with lesion on the thumb
shown= Nothing required, antivenin, debridement

Picture like this but hand is slightly darker then this and little bit less erythema

60. Leishmaniasis
61. I felt like Acute on chronic pancreatitis for the below x-ray, His vitals were deranged though
enzymes were not that high I guess, patient has severe pain and presented to casualty. NBS in
management= CT scan versus IV normal saline. Kindly check.

There is calcification, but not so much as in this x-ray, no doubt it is chronic pancreatitis but
Acute on chronic??

62. Female, menorrhagia, BP on higher side 160/85, pulse=115, Abdominal distension up to

umbilicus, Mexican American. In emergency urine output 50 ml in 2 hours. Don’t remember
other thing and couldn’t reach the diagnosis. NBS
-Foleys
-USG
-0.9 % N/S

63. Female IV drug abuser in the past, around 10 yr back; currently doesn’t take drugs and is in
monogamous relationship, Everything normal except Ferritin approx. 300. Next to do?
- Hepatitis C
- Other forgot.
64. 60 years female, known case of osteoporosis with complain of I have decreased in height from
5.8 to 5.6 something, sleep has reduced from 7 hours to 5.5 hours, some kind of low mood but
no SIGECAPS. Patient currently on Alendronate and calcium. Long vignette but recollected these
key points. Advice to the patient?
- It seems normal for your age. [Kindly see analytically for such question]
- Other forgot.

65. 35-year male, everything ok, except for his HBA1C being 7. NBS
- Insulin
- ADA diet

66. Measured BP at church it was 130/80, 126/70. Patient currently is on four antihypertensive. In
clinic BP=150 s /80s. Her labs report is normal said in last line. NBS
- USG Doppler
- Ambulatory BP monitoring

67. Girl, 9 y/o, known case of graves’ disease with ophthalmopathy on propylthiouracil, non-
adherent to her treatment now presents with T=100, BP-raised, tachycardia, pupillary dilatation,
diarrhea??, tremors of her hands. NBS
- Propranolol
- Steroid

68. Diffuse goiter. All investigation done and everything is normal.

- F/U in 1 year

69. Multiple sclerosis vignette given in vague way of remitting relapsing motor and sensory features
, sometime upper limb, and sometime lower limb. NBS
- MRI

70. Pregnant patient already on Albuterol 4 times a day, presented to emergency I guess with
features of SOB and wheeze, vitals stable. What to give on discharge I guess
- Oral Montelukast
- IV steroid
- Iv Theophylline
71. COPD patient already on domiciliary oxygen therapy, on LAMA and SABA , currently SPO2 was
not that bad but question toward exacerbation and what to add, I guess
-Oral Azithro
- Oral Steroid
- LABA

72. Abdominal bruit, Resistant hypertension= Duplex Renal USG

73. Pregnant, training for Triathlon. In addition to advising nutrition and folic acid, what advice to
give.
- Limit the physical activity.
- Advice for meat-based protein.

74. Patient recently underwent amputation of one limb around 5 days back. His wound is clean and
dry with mild redness and edema. Now his rehabilitation care will be advised on basis of what
parameter?
- Balance and strength exercise.
- Wound care.

75. Patient had allergy with Amoxicillin previously and was taken to emergency, second episode also
described in middle of the vignette. Now she come to her PCP and ask about, is her allergy listed
on EMR. Physician look at EMR and couldn’t find it. As a physician what advice should you give
to the patient to do regarding this (bit dicey statement at last)
- Report the emergency physician.
- Report the 2nd physician.
- Wear the allergy band all the time.
- Remind the clinician she approaches while she goes for consultation about the allergy she
has [I inferred, please check, different words are there for sure]

76. Patient comes for HME, drinks 4 beers a day. His TG around 280, HDL-60. Everything else
normal. Cause for the labs
- Alcohol
- Hepatic Steatosis
77. Young female has sore on throat, There is an anterior neck swelling with mass, which is tender.
NBS
- Rapid strep test?
- TFT
- Throat c/s

78. Patient is hypertensive and has other comorbidities as well like osteoarthritis. On labs his
creatinine is 2.1 and urine protein is 4+. Cause?
-Ibuprofen
-Losartan

79. Sickle cell disease patient with known case of asthma presented to emergency with chest pain
which is severe and there is associated SOB.
- Acute chest syndrome
- Exacerbation of asthma

80. HIV patient- has to infer from cryptococcal meningitis and other features; is at risk for which
cancer??
- Hodgkin Lymphoma
- Angiosarcoma
- Others forgot.

81. Some step-up treatment of Crohn’s disease scenario. The medication, which will be now
prescribed will acts on which mediator.
- TNF alfa
- TGF beta

82. Patient has some kind of RTA and now presents with collar applied on the neck. She deteriorates
suddenly and then developed features of stroke. Cause
- Carotid artery injury
- Forgot

83. Mother has noticed a year back that her son is sensitive to sun, while they went to beach.
Recently similar episode happened and baby on examination has freckles on different part of
the body. I think some features of neurocognitive delay slightly is explained. Likely diagnosis
-Xeroderma pigmentosum
-sunburn
- Noonan syndrome
84. Mother is concerned of the brown tan in a baby, which is increasing in numbers recently. Likely
diagnosis.
-Neurofibromatosis
- Tuberous sclerosis

85. BMI> 40, written in vignette.

Labs given- urea=65 urea/creat value are arbitrary guesses
Creatinine=5.5
Egfr= 15

- Preparation for dialysis line something

86. Some clinical trial discussed in the vignette, father wants adolescent child to participate but boy
knows and understand and won’t like to take part in it. As a physician what will you do?
-Tell father that they should not proceed with the trial

87. Long scenario with girl with ADHD, she also has a brother and mother and lot of junk in middle.
She visits a doctor and says she has lost her medicines and , she would like him to prescribe her
stimulant drug she is taking. When doctor denied , she becomes aggressive “ Do you think I am
an addict” sort of. As a physician, what should you do?
- Prescribe her stimulant for few days.
- Prescribe her non stimulant meds instead of stimulant.
- Other forgot.
dont pescribe her?

88. 36-year female with left breast mobile mass. NBS

- USG left breast.
- MRI breast
- Biopsy
- No mammography

89. Girl with features of Rhinitis explained. She is on medicine for a week but still not working. On
examination, Nasal mucosa is pale.
- Rhinitis medicamentosa
- Allergic Rhinitis
 90. Liver disease scenario with lot of alcohol intake. Forgot.
- GGT

91. Kid with 15 mm PPD, recent contact with the relative from India who is an active case of TB, x-
ray done and it was normal. NBS.
- Isoniazid
- HRZE

92. PE scenario, some surgical process done, I think duodenal perforation repair, and now patient
present with pain at surgical site , SOB, Tachy, inc RR, some x-ray features also explained. NBS
- CT Chest

Heart sound [All three HS are guesses]

93. VSD

94. TR – Nothing given in CV, listened at the area, and guessed.

95. S3 gallop- vignette also toward heart failure= Heart failure

96. 60 yrs. old had 2 adenomatous polyps for which he had undergone polypectomy. Colonoscopy
done 2 years back was normal. Smoker, quit 10 yrs. ago, h/o 30 pack years. He is also a MSM on
monogamous relationship.
Now what screening to be done:

a. Colonoscopy now
b. CT scan chest [ I think b, c both can be done; don’t know what they were trying to ask]
c. RPR
d. USG abdomen

dont do anything

97. A male patient has significant history of weight loss. On abdominal examination, huge mass was
palpated in Left flank. There was further clue hinting towards RCC like pain abdomen, hematuria.
No investigation done. Now what to be done for diagnosis:
a. CT scan Abdomen
98. Patient has food left in abdomen and delayed gastric emptying in nuclear gastric-emptying test.
X-ray given with mild distention but no air fluid level. Now what will be expected to be increased in this
patient:
a. HbA1c
b. Gastrin

? Normal x-ray was given.

99. Another similar case but this time patient was already diagnosed with diabetes mellitus type 2.
Treatment asked:
a. Metoclopramide

100. Patient has severe vomiting. Features of bowel obstruction is explained. Dry mucous membrane
and capillary refill time was 5 sec. I think pt also has mild fever approx. 100, BP on lower side but not
unstable.
Lab:
BUN- 40
Creatinine- 2.5

Asked about the cause of the investigation finding:

a. Acute renal insufficiency
b. Intravascular hypovolemia
c. Bacterial translocation
101. A child from Guatemala visits to doctor. He has tremor like, involuntary, irregular aimless
movement of extremities. Deep tendon reflex was normal. Patient has history of sore throat few months
back but resolved without medication. Rapid streptococcal antigen test was negative. Now ask what
investigation you will perform on this patient:

-ECHOCARDIOGRAPHY

102. A female was raped 3 days back. She presented to doctor with abrasion around thigh and bruising
in her cheek. After preliminary management, what will you offer for contraception.

- Oral LNG

103. Patient has DM, pigmented skin, joint pain and other features of hemochromatosis.
Up/down

Iron Transferrin saturation ferritin

104. Girl has a history of menorrhagia. Whenever she gets common cold, she also has episodes of nasal
bleeding. Her other family members also have similar issues, I guess

PT aPTT platelets

Normal Inc Normal

105. Child from some rural area has features of malnutrition. He has a distended abdomen and hair is
easily pluckable. What will be the following finding?

Albumin Insulin

106. Patient has undergone Trans-sphenoidal surgery. Has feature of dry mouth.

S. sodium serum osmolarity urine osmolarity

150 308 80
107. Patient underwent some GI surgery few years back and now presents with bone and muscle pain;
His blood calcium level is also on the lower side.

PTH urinary Ca intestinal absorption of PO4

108. Another question on vitamin D deficiency. What to measure for the confirmation of diagnosis:
a. 1,25 –(OH) vitamin D
b. 25-(OH) vitamin D

109. There is a scenario of diarrhea in the patient

PH -7.35
HCO3 – 14
PCo2 -27

a. Metabolic acidosis
b. Metabolic alkalosis
c. Respiratory alkalosis
d. Respiratory acidosis

110. Travelers diarrhea prophylaxis was asked, pt was most probably planning for travel to Equador.
a. Ciprofloxacin
b. Azithromycin

111. Paget’s disease of breast was explained as an eczematous lesion involving nipple areola complex
. What to do for diagnosis:
a. Biopsy of breast

112. A 34-year patient with u/l bleeding from nipple and other features s/o intraductal papilloma. Most
confirmatory test for the diagnosis

-Ductography
-Mammography
-Ultrasonography
113. A young female comes with sudden onset severe pain in LLQ. She has h/o intermittent
abdominal pain. On examination tenderness in LLQ with guarding and rigidity. Basically all
features of ovarian torsion explained. Now what investigation would you do to confirm the
diagnosis?
a. Transabdominal usg with Doppler

114. A young 19 yrs girl is having lower abdominal pain. Pain starts 2-3 days before menses and relieved
after menses. She has pain during deep penetration intercourse with her boyfriend. On examination
there is tenderness on puborectalis muscle. NBS.
a. Laparoscopy
b. Leuprolide therapy
c. Physical Therapy
No analgesic/ OCP in option

115. An army female comes with complain of pain in lateral aspect of foot. She has to run long
distance during some combat training. Tearing of lateral aspect of shoes. There is point tenderness on
the lateral aspect of the foot. Cause?
a. Stress fracture of 1st 2nd metatarsal
b. Navicular fracture
c. Cuboid fracture
d. Stress fracture of lateral metatarsal
e. Morton neuroma

116. Patient had difficulty in extension of ring and little finger of hand. On examination, there is cord
like thickening and nodules in the palmer aspect of hand. Diagnosis:
a. Dupuytren’s contracture

117. 35. Patient on ciprofloxacin. ECG shows polymorphic tachycardia. Patient is managed at the
hospital. What will you expect in the ECG?
Long QT
Narrow QRS

118. 7cm ovarian cyst, teratoma said in the Q- laparoscopy

119. Ectopic pregnancy with fluid in POD, Beta HCG- 3400, cysts explained in each ovary, with one
explained as a complex, Bp on lower side with tachy- laparotomy
120. Female with multiple sexual partners, currently on monogamous relationship with past h/o
chlamydia which was treated. She had her LMP 6 weeks back. She had a vaginal spotting a week back.
She presented with sudden onset Lower abd pain, BP= 100/60. HR=112, Beta hcg=2000. Hematocrit=
25%. NBS in management.
- Laparoscopy
- Serial Beta hcg monitoring for 2 days??

121. MSH2 positive. Colectomy already done. What do you suggest- hysterectomy now

122. Newly born child, APGAR and all described. In the last line, he has large tongue with few mucosal
lesion. Family h/o thyroid cancer. Association:
a. MEN1
b. MEN type 2a
c. MEN type 2b

123. A old man was brought by daughter with h/o lost in neighborhood few times and hearing aid. He
was restricted for driving by daughter. He was upset. When asked by doctor he said everything
is fine. On examination 0 recall out of 3. Suggestion
a. Let him drive with hearing aid.
b. Let him drive only when someone is available to accompany him.
c. Don’t let him drive in any circumstances.

124. 23 yr old boy is curious about the genetic test to find out if he has Huntington or not. Parent has
h/o Huntington disease. As a physician, what do you recommend.
a. Genetic testing
b. This is not appropriate age.
c. Refer for genetic counselling.

125. A battalion was about to be deployed to some region. An army commander comes to physician
seeking help on how to prevent their soldiers from chikungunya. As a physician what would your advice.
a. Ask them to use mosquito repellant cream and nets.

126. A girl of certain tradition falls from her bicycle while riding on a sunny day. She is wearing a hijab
and a skirt. She is pregnant and when enquired she says that she is on her fasting as per her religion.
Now will you proceed your discussion.
a. Ask her what is meant by fasting in her religion.
127. A child has h/o URTI. He has multiple petechiae with only thrombocytopenia. Asked what will be
the course of this disease
a. Resolve on its own after 3 months

128. A patient has recurrent h/o syncope. Parameters fulfilling the orthostatic hypotension is given in
the CV, diastolic fall below 10 in standing. He was under multiple drugs including HCTZ for hypertension.
His blood glucose is normal-98 . Cause asked?
a. HCTZ
b. Aspirin
c. Statin

129. A pregnant lady comes with painless rash. she is allergic to penicillin.

RPR, FTA Abs positive.

Treatment asked??
a. No treatment needed.
b. Desensitization of penicillin
c. Intravenous ceftriaxone
d. Doxycycline

130. A young patient has a history of weakness of upper as well as lower limbs. There is similar history in
other family members too. He is dystrophin gene +. what will you see in biopsy of muscle of this
patient?
a. Myonecrosis with fibrosis
b. Dystrophin negative immunohistochemistry

131. Patient has history of abortion few months back. She didn’t seek for care then. Now cames with
nausea and vomiting. Uterus 12 wks of size and B-hcg increased to 1,00,000. She has vesicle like mass
PV, USG also shows cystic elements.
Your appropriate action?
a. Laparotomy
b. D & C
c. Mtx
d. Repeat B-Hcg

132. A young guy with watery diarrhea for 10 days. He has signification weight loss nearly 5 kg. FOBT
negative. CRP/ESR raised in labs. NBS for diagnosis?
a. Colonoscopy with biopsy
b. Colonic enterography
c. Capsule endoscopy
133. A female came with vaginal bleeding. On imaging she has isointense mass of 1x 2cm, 4x5 cm and
1x3cm. complication she can have in her pregnancy?

a. Malpresentation

134. A guy presents with heaviness around his scrotum. On examination a firm non-tender mass is
present on the testis. NBS
a. Usg scrotum
b. CT scan
c. Biopsy

135. A pregnant female has following serology

1st trimester 2nd trimester
Rubella IgG +ve +ve
Toxoplasma IgG +ve +ve
CMV IgG -ve +ve

Complication the baby can develop.

a. Hearing loss
b. Hydrocephalous
c. Cataract

136. Meningitis scenario. The baby is even started the treatment and steroid?? too. Asked about what
most common complication is baby protected from
a. Hearing loss

137. Tunnel shaped vision said in the cv, also described loss of peripheral vision= Glaucoma

138. Wavy door in early part of cv, fundoscopy - drusen in description seen said in last part of cv = ARMD

139. Sore throat and infection described, Low WBC count described, pt on antithyroid- Propylthiouracil.

140. COPY PASTE in EMR= Long vignette, skim, and mark

141. Fever 104, RUQ pain and increase bilirubin slightly, Labs were not that bad but clinical feature
helps, stone is also seen lodged at the distal CBD and ampulla
-Cholangitis
- Biliary colic
142. Kawasaki disease, 4 days of fever and 4 criteria met. NBS to diagnose.
-Echocardiography
- CRP

143. Patient had vaccination against HPV. Now asked prevent from what??
a. Wart
b. Nasopharyngeal cancer
c. Oropharyngeal cancer
d. Skin cancer

144. Patient has 0.7 mm melanoma. Treatment??

-Excision with 1 cm margin

more than 1 cm ca vane sentinal node biopsy
- Sentinel node biopsy
- Excision with >2cm margin

145. A hospital director noticed changes in trend of influenza cases over several months. He wants to
do presentation regarding this report of 3 months. Which chart should he use to represent this data?
a. Pareto
b. Run chart
c. Fishbone diagram

146. Drug X had adverse event 10% vs Placebo 14%. NNT?

a. 10
b. 25
c. 125
d. 15

147. RRR calculation asked. It was bit tricky. 4 values were given, 2 in decimals example 0.21 and 0.17.
Other two values in percentage like 18% and 13 %. But at last, asked in a tricky way about RRR
calculation for values in decimals. I calculated it as 16.

148. A burn patient was brought to ED. He was initially managed with IV fluids and all. He developed
pain in extremity with decrease pulse and examination showed circumferential constriction of limb at
the burn area of limb. NBS in management
a. Fasciotomy
b. Escharotomy
c. Limp amputation
149. A female was sexually assaulted by male in party. Along with emergency contraceptive NBS
a. Ceftriaxone + azithromycin (This was only plausible option in this set)
b. Send her home.

150. Dry mouth & mydriasis =tolterodine. Female is on multiple medications, among which one is
tolterodine. Aske the cause of dry mouth.

151. A man with positive APC mutation came with his 12 years old son for genetic testing. Test was
positive for APC in son. NBS?
a. Colectomy now
b. Colonoscopy now
c. Colonoscopy at 40

152. Patient has pain around the hip and tenderness on lateral aspect of the hip. Pain gets worse while
lying on same side. He is on NSAID but pain is still there. NBS in management?
a. Inj Triamcinolone in bursa
b. Inj ketorolac
c. Narcotics

153. There is a history of accidental gun injury by his brother on his hand. He underwent surgery and
shrapnel was removed and all. After some duration he presented with complain of severe pain, edema
and hair changes. It is also stated that he has decreased ROM of elbow and stiff of nearby joint .
Diagnosis?
a. CRPS

154. Breast was biopsied. Result says normal prostatic tissue. 3 pathologists has already confirmed that
it’s a prostate tissue? What should the first physician do.
a. Confirm from another pathologist.
b. Say nothing to patient.
c. Find the root cause.
155.

From the above flowchart, which task should be improvised.

Option E has highest SD/Mean, other forgot.

156. Lady has an ovarian carcinoma with end stage and DNR signed= can do Surgery and Chemotherapy

157. Patient drowsy before surgery for nephrolithiasis due to overdose of morphine . Physician came for
consent. NBS
a. Take consent from husband
b. Proceed without consent
c. Postpone surgery

158. Child came with bone pain with lamellar bone mass said in the CV
- Ewing’s sarcoma
- Osteoid Osteoma

159. Kid has papillomatous lesions over vocal cord said in the CV. NBS
a. Remove larynx.
b. Surgical excision
c. Observation

160. Patient sustains RTA and then undergoes splenectomy. what to give on discharge.
- penicillin
- No vaccine in option
161. Patient has midsystolic click with late systolic murmur grade 3/6. The prophylaxis given for dental
procedure in this patient will protect against what.
a. Strep mitis.
d. No prophylaxis needed.

162. Lithium toxicity- drowsy in the interview, diarrhea as a chief complaint

163. Vignette of a kid with previous history of femur fixation with external fixator, debridement done
with 1.5 cm bone excision. MRI shows edema in marrow and surrounding soft tissues. What should be
done for long term disability prevention.
- Early Range of motion Exercises

164. Priapism= Switch Trazodone to Escitalopram

165. Old person with bradykinesia, labile mood, orthostasis, cognitive issues and is not able to look up
and down
- Progressive Supranuclear palsy

166. Mother brings her daughter as a “late bloomer”. On examination Breast Tanner 4 and pubic hair
Tanner 2. There is a blind vaginal pouch. Diagnosis
- Androgen Sensitivity Syndrome

167. Child with retinal hemorrhage and subdural hematoma- Inflicted trauma.

168. Mother left her child with home aid and later discovered in baby some trauma and features of child
abuse= Call CPS

169. Elderly person presents with red swelling and erythema on medial aspect of arm= Adult protective
services

170. Old person with some past history of hearing issues have features of vertigo while getting up from
the bed for 15 sec, which then resolves. Today at the clinic Dix Hallpike maneuver is done (described) ,
which showed nystagmus and confirmed the diagnosis. What should be done further for treatment of
this patient.
- Repositioning Maneuver
- Meclizine

171. 32-year-old female. Father had a stroke. She is a smoker= Lipid screening
172. Old age person has back pain and then describes about radiation of pain too in middle of vignette,
but it gets better on leaning forward= Spinal stenosis

173. Grandma home= Check lead level

174. Capillary Lead level done= Check venous lead level

175. Teething baby, benzocaine applied, blue = Methemoglobinemia due to cytochrome B5 reductase
deficiency

176. ADHD child described problems at home and school. What investigation
- Lead level
- EEG

177. Adult with tingling in hands, diarrhea, anemia, calcium decreased (?7.8) = IgA-TTG celiac

178. 2 days after coronary Angio, reticular rash in abdomen. Inc creat=3, urea=30, urinalysis- RBC=3
- Cholesterol emboli
- Contrast Induced

179. Hospitalized, I think cholecystectomy also done. Mexico travel history few weeks back. Now
presented with diarrhea, labs also given
- Clostridium difficle usually foul smelling and watery diarrhea

180. Pt known case of CKD has SOB, nausea, anorexia, creat 10, urea 110, felt like uremic component is
creating some issue. Bicarb 15, pt on oral frusemide, some crackles but not in distress.
- Hemodialysis
- IV frusemide

181. Nurses felt that doctors are not maintaining hand hygiene. Some educational campaign team is
formed. Hospital infectious team? Started survey on PPE and handwashing too. They have been
randomly distributing some survey to healthcare workers too. They found compliance for handwashing
and PPE to be 90 and 92% among the 500 subjects being surveyed. I inferred that instead of nurse telling
less compliance, how come values came out to be so high. What’s the problem here.
- Interrater reliability
-Intra rater reliability
- Observer bias
- Measurement bias hawthorne effect vayo
- Health worker Effect
182. Serratia and staph in italics. How to confirm diagnosis?
- Measurement of Reactive oxygen burst defect

183. Parents are concerned for their second child to have Downs syndrome. Confirmatory test for that
can be ?
- Chorionic villous sampling at 12th weeks
- Amniocentesis at 14th week

184. A person is being transferred from Greece via plane for the limb injury he has sustained in some
RTA. He also takes cocaine 2-3 times a month. Lots of story in middle. Then lots of features of Infective
endocarditis described, then describes new murmur being heard in tricuspid area. Last line says blood
culture shown growth of Gram negative diplococci. NBS
- IV ceftriaxone
-IV Ertapenem

185. 5-week child vomits the formula feed, as it was fed, then he gets hungry. Baby is fine and not much
other finding described. NBS
- USG abdomen

186. Egg allergy described. Mother is concerned about vaccination of MMR.

- Scheduled vaccination can be done

187. Trans female on testosterone and lots of other story. What should she be counselled about?
- Reactive erythrocytosis

188. Features of chrons disease described in a fancy way. Pts chief complaint is Right sided loin to groin
type of pain, even urinalysis with stone features explained?? Cause
- Fat Malabsorption

189. 1 yr old baby from Honduras is now in America. Child was weaned at 6 months with lots of different
food he eats described. What to test.
-Iron level
- Vitamin D level

190. Kid from Honduras with features of lymphadenopathy, hepatosplenomegaly and white patch in
mouth is now in USA. When scraped, the tongue patch is scrapable. Diagnosis.
- HIV
191. Postpartum patient with features of DVT described in left lower limb, not severe enough to be
called phlegmasia cerulae dolens. DVT diagnosed said in the CV. NBS
- Heparin

192. 10 minutes after transfusion, patient developed SOB, B/L lung infiltrates. I couldn’t figure out lots
of systemic systems and even rash. Kindly check for vitals and all- couldn’t remember.

- TRALI
- Anaphylaxis

193. Cholecystectomy done. 1 cm GB carcinoma found not extending beyond ant wall of GB. NBS.
- Nothing to be done
- Liver bed resection
- other don’t remember

194. Young boy with lots of features of vocal and motor tics explained. Tail question is not fate but exact
wordings forgot.
- Improve with age
-ADHD Associated with adhd and OCD
- ODD fate sodhyo vane improve with age

195. Female patient is a known case of MDD. She landed up in emergency after ingestion of lots of
lorazepam and sertraline tablets. Lots of story in middle. His PCP says psychiatrist didn’t provided her
the certain medicine she desired for that’s why she did this act. She also has mark of healed incision on
her wrist. Last line says, other then medical therapy and all, what else she will be requiring in near
future.
- Dialectical Behavioral Therapy

196. Child with recurrent infections. 2 maternal uncles has also died. Child has no tonsils on
examination.
- Adenosine deaminase deficiency
- SCID
- X-linked Agammaglobulinemia

197. 24-year-old with sinusitis and? ear infection presents to the clinic. She has such kind of infection
since childhood. She says, I get more infection than whosoever I have seen till now. Not much other
detail explained, I guess. Diagnosis asked.
- Nasal Polyposis
- ? CVID
- other option don’t remember
198. Army man has a habit of tucking shirt and cleans his house very often. Some ego dystonic features
explained like, he gets upset if things are not done. Then story starts of his wife who died 6 months back
and then he cries when talked about her. Long vignette
- OCD
- ? Grief reaction

199. A 45 y/o women came to the office with h/o irregular menstruation for past 6-8 months. Typical
features of Premenopausal symptoms not clearly mentioned. She is on IUD contraception. She is
sexually active with her husband. No other active complaints. Vitals are stable. Pelvic examination shows
IUD strings and no abnormalities. All other physical examination were noncontributory.
Urine b-hcg test is negative. What to do at this visit?
-Serum b-hcg
- TFT
- Do nothing

200. A 14-year-old girl came to the OPD with mother. She has no complaints. Her mother is worried
because she has been sexually active with her boyfriend and doesn't use any kind of contraceptives. She
wants advice regarding long term and effective contraceptive for her daughter. In this question, girl is a
known case of migraine with auras. What will you give?
-OCPS
-Levo -IUD
-Some patches
-Condoms

201. 14-year-old girl came to the office with h/o amenorrhea since few months. Came to know that she
is pregnant from home pregnancy test. Now asks what she might be at risk of?
-Preterm pregnancy
-Chromosomal abnormalities
-Nothing

202. A young kid presents with bilateral swelling around the jaw since few days, some typical features of
B/L parotitis described. No history of trauma, any aggravating or relieving factors. Vitals Stable. Other
physical examination normal. What can be complication due to this condition?
A) Orchitis
B) Hearing loss

203. There is a vignette describing OSA in adult- features like snoring daytime sleepiness described.
What will be he at risk of?
- Cardiovascular complication
- Don’t remember
204. History of breast cancer in past described, which was treated. Some features relating to recurred
type also? Then there is a description of increased JVP, decreased BP. Forgot the chief complaint- might
be SOB. NBS
- ECHO
-Pericardiocentesis

205. A man while cutting tree accidently cuts his leg, he is operated at hospital and multiple fluids
around 20 pints in total infused. After 18 hrs there is B/L infiltrates in chest. Left ventricular end diastolic
pressure= 12, Pao2/Fio2= 350. Diagnosis
- Fat Embolism
- Lung contusion

206. Features of acute transfusion reaction described within hours. Other then checking the name of the
patient, what else should have been done?
- Blood group details and name should have been matched. (Somewhat like this)

207. Two rooms in hospital with two patients having same last name. During transfer of the patient for
surgery wrong patient has been transferred and wrong surgery is done. What could have prevented this
error while transfer of the patient?
- Two patient identifier if has been used.
- Others forgot

208. After transfusion of few pints of blood, patient developed a sense of impending doom. What to do
now?
- Call blood bank to check something
- Check free hemoglobin

209. 19 years old military boy presented with features of fever and myalgia. He recently, few weeks back
got his flu shots. He is taking paracetamol. What else to be done.
- Nothing to be done
-Oseltamivir

210. MSM boy with flat topped lesion in the perianal region, which don’t bleed on touch?? But systemic
feature of secondary syphilis not described. Treatment
- Cryotherapy
- Intralesional steroid
- IV penicillin
211. A baby in utero features explained. Currently mother is at 32nd week of gestation. Previous reports
of USG at three different visits up to 28 weeks corresponded to the same weeks size of Head
Circumference, Arm Circumference and femur length?. Now at 32nd week.
Head circumference corresponds to 32 weeks
Abdominal circumference corresponds to 28 weeks
What is the reason.

- Intrauterine infection
- Constitutional delay
- Uteroplacental Insufficiency
- Congenital defect

212. 38th weeks of gestation, presents with severe frontal headache, BP- high (don’t remember value)

- Induction.

213. Vignette focus a lot on boy gaining weight, then mentions grades dropping, marijuana using. Again,
describe about he is gaining weight a lot. What’s the problem here.
- Cannabis use disorder

214. Patient is a known opioid user and now presents with cellulitis like feature in left upper limb. With
lots of effort vein could be accessed. She also has pupillary dilatation, she is yawning, other autonomic
symptoms of withdrawal described. Next best step in management.
- Methadone
- No Buprenorphine in option

215. Kid is frantically brought by his mother after he ingested a coin sized 1cm x 4mm which is in
stomach now (this might be the size calculated after x-ray ). Next best step.
- Immediate surgical consultation
-Measure lead level
- Follow up with your PCP in next 2-3 days

216. There is a submandibular pain in the patient when he eats, now swelling has also been seen and
palpation also reveals same. I think no fever.
- Sialadenitis
- Calculus of submandibular duct
217. Old age person comes with a concern that he is not getting orgasms and he is not able to ejaculate.
Then there is a description of peripheral neuropathy, and orthostasis. He is a diabetic. His peripheral
pulses are normal. What is the likely cause?
- Aortoiliac obstruction
-Peripheral Autonomic dysfunction

218. There is some issues in reporting of patient reports between Laboratory and clinic. The patient
reports were usually faxed. One patient with deranged creatinine value got late his reports notified/
found late like after 1 month. What could be the solution of this issue.
- Interface of EMR should be adjusted for Laboratory and clinic
- Others don’t remember

219. POP up in EMR as a forcing function

220. COPY PASTE EMR

221. Patient underwent surgery of femoral neck decompression and fibular strut grafting for the
osteonecrosis treatment. The fibular graft site seemed to have some 2cm square lesion which rapidly
turned into 6 cm square lesion(forgot the characteristics, but inferred Necrotizing fasciitis). Next best
step.
- Debridement
- Other forgot

222. 19-year-old sexually active girl recently underwent chlamydia testing. What next?
- Do it again next year

223. Trembling hand while doing OT

- Stop him

224. 25 WOG with no prior history of Diabetes mellitus underwent Glucose challenge test and OGTT.
GCT- high. OGTT results are.
1 hr- high
2 hr- Normal
3 hr- high
What is the risk in the fetus.
- Large size baby
- VSD
- Spinal dysraphism
225. Female with increased hair in the upper lips and body presents to the doctor. She is amenorrheic,
obese, and has menstrual irregularities. Treatment.

- Ethindrone + Ethinyl estradiol [ Might be slightly different, but it was OCP]

- Metformin
- spironolactone

226. Boggy uterus- Oxytocin

227. Patient has a precipitous delivery with heavy bleeding, she is asthmatic, she received oxytocin.
What to do now.
- Carboprost
- Pelvic examination for cervical and vaginal laceration
- other don’t remember

228. Female presented with greenish foul-smelling vaginal discharge. On examination, some punctate
lesions are also visible in cervix. Gram stain is done but couldn’t see any organism. What could be the
cause.
- Gardnerella vaginalis
- Chlamydia Trachomatis
- Neisseria Gonorrhea
- Candida albicans

229. 11 year old vaccination- I went for HPV, don’t remember the story.

230. Vignette looked like Munchausen by proxy for kid where mother don’t want to discharge her kid
even after kid is fine and treated in the hospital.
- Call CPS and keep child in hospital

231. Alcoholic, eye dilated on one side, paralyzed on other side

- subdural hematoma

232. HBA1C – 7.5, BP= 138/80, Microalbumin=600. Most important risk of progression of renal disease
in this patient.
- Blood pressure
- HBA1c
- Microalbumin
233. Malingering- Hairline Jaw fracture years back, nurse by profession, now complaints of severe pain
on palpation and has to leave her work due to it. Secondary gain not explained but other options like
somatic symptom disorder, PTSD could not be ruled in.

234. 7 years kid, brought by her father. Doctor noticed that the child’s foot while standing looked flat
and slightly pronated with heel slightly valgus but arch looks normal when the foot is hung. NBS:
a. AP and lateral Xray foot and ankle while standing
b. AP and lateral Xray foot and ankle while sitting
c. Nothing

235. Down’s syndrome age 3.5 years kid with otitis media ,3 episodes in last 18 months. Now presents
with symptoms of acute otitis media with fever of 101. On pneumatic otoscopy – left tympanic
membrane is pale and immobile, right TM is mobile and looks normal. NBS:
a. Amoxycillin
b. Tympanostomy

236. One middle-aged man, was driving as usual, and must wave to a school guard bye-bye. But then at
that very moment he meets with an accident (some car hit his car from the side) and now he suspects
that the guard has something to do in his accident. Suspects that the guard is the reason for his
accident. He was brought by his wife. His goals are right and has no other problem. Asked diagnosis:
a. Delusional disorder
b. Schizophrenia
c. Mania

237. A man SIGECAPS fulfilled, one concern was not gaining weight. Which of the following drug will be
appropriate?
a. Lorazepam
b. Buspirone
c. Mirtazapine
d. Olanzapine

238. Adolescent male has left the college 8 months back, starts losing interest in other things, but has
developed this weird interest in, aerospace . Has his room filled with structures built with aluminum foil,
parents are worried and when they ask him, he says “it’s not important”. He sometimes smokes
marijuana. He also mumbles on his own when he is alone. Asked diagnosis.
a. OCD
b. Substance abuse disorder
c. Schizophrenia
d. MDD with psychotic features
239. 50s/M, has COPD. Had an exacerbation episode and doctor prescribed steroids for 7 days. He
comes on day 5, brought by his wife. He started buying expensive things “which they did not need”,
spending more, bought things for wife, planned trips etc. So, his wife brought him because this was not
the usual husband she had. Asked diagnosis:
a. Substance abuse
b. Steroid-induced mania

240. Patient complains of issue in left foot. It started a month back when he sat on his toes with his knee
flexed and did some work for an hour. He also had low back pain at that incidence. On examination, he
has loss of sensation over the lateral aspect of left leg and dorsum of foot. Weakness in dorsiflexion and
foot drop features of left side. Patellar and ankle reflexes were 2+. Bowel and bladder function were
normal. How do you confirm your diagnosis:
a. LS spine Xray
b. MRI LS spine [ I inferred PIVD leading to L5 root compression with left sided foot drop]
c. Nerve conduction studies
if spine tenderness go for MRI
d. Muscle biopsy

241. Male, MVA case. Patient was placed on spinal board; cervical collar was applied. Patient had a
laceration over forehead, and left knee, no active bleeding. Knee laceration was deep but had not
involved bone. Patient was a heavy drinker, and he was drinking just before driving before the accident
occurred. NBS in management:
a. CT cervical spine
b. Xray pelvis
c. Xray left knee.

242. An old physician who is also one of the senior partner in the hospital comes late, doesn’t fill chart
on time, doesn’t return his pagers. The staff manager who is also one of the business partner of the
hospital comes to know about it and inform this issue to you (junior physician). The staff manager
continues, “Today he even forgot where he is and what date it is.” What should you (junior physician do
in this scenario):
a. Refer to employee service program.
b. Report to Chief Medical Officer
c. Ask the staff manager to keep track of his activities and observe.
d. Ask the staff manager to make a file of his actions till date.

243. BPH features with LUTS given. 71 years old guy. Urinalysis normal mentioned. What is the next best
step in diagnosis.
a. PSA
b. Transrectal USG
c. Biopsy
d. No investigations required.
244. A young female presented to the ER with altered mental status and signs of meningism’s. Had
petechial- pustular rashes on lower limbs. She deteriorated rapidly within an hour. Systolic BP was
palpated to be 70 mm of Hg. In addition to fluids and antibiotics, what is the physician’s next step?
a. Give steroids.
b. Place her in a hyperbaric chamber

245. A man presents with pain in multiple sites of the body i.e., shoulder, ribs, other areas. On prostate
examination- it is nodular and hard with features of malignancy. NBS
- Radionuclide Bone Scan
- PET Scan

246. One question was about vaginal discharge. Mentioned whitish vaginal discharge and pruritus. O/E
whitish vaginal and cervical discharge with vaginal erythema mentioned. Next best step in management.
a. Oral fluconazole
b. Oral metronidazole
c. Wet mount of the discharge

247. 40s female with fatigue for 6 months more in the afternoon. BP high. Lab: hypokalemia, metabolic
alkalosis. Not mention about any bruit.

a. Renal artery stenosis

b. Primary Hyperaldosteronism
c. Phaeochromocytoma

248. 27 yrs. medical student going Sub Sahara recently got hep B vaccine. Now what vaccine is
recommended for her before going to visit Africa: -
a. Give Hep A vaccine.

249. One CV of bipolar basically asking management of acute mania. Patient is very agitated when
trying to examine. NBS in management
a. Lamotrigine
b. Risperidone
c. Lithium
250. 2 month old baby examination is done where there is click heard while examining the hip. USG is
being done and while pushing the usg probe for examination there is relocation of hip anteriorly [ These
points are given in slightly complex way] NBS in management- Pavlik harness

251. Child has a history of sore throat and fever few weeks back and now his urine is red in color. Other
features pointing toward PSGN is given. What kind of hypersensitivity reaction is this?
a. Type I
b. Type II
c. Type III
d. Type IV

252. Patient is on central venous catheter on her neck. She is being administered some medication
(most probably some chemo via it). She then developed fever and some systemic signs of infection. On
examination, there is tenderness and? erythema at the catheter site. Organism could be:
a. Streptococcus pneumoniae
b. Pseudomonas aeruginosa
c. Staphylococcus aureus

253. Daughter brings an 80-year-old lady for some cognitive disorder issues. Her daughter says
something then mother says ‘My daughter only wants my money ,I am actually doing fine’.
what will be your best response:
-Just rely on the daughter’s history
-Just rely on the old lady's history
-Tell them to resolve their issues at home
-Ask the old lady if her daughter can sit though the interview
- Examine mother alone in absence of daughter

254. A lady has had migraine for 1 year, and she was doing ok for time being. For last 1 month, she has
an increased intensity of pain with auras and typical feature of migraine for which she is taking
acetaminophen thrice a day, but her pain is still there. Doctor examines her, and on eye examination
with torchlight, she is uncomfortable due to photophobia. What is the NBS in management for her.
-MRI brain
-Stop Acetaminophen
-Start sumatriptan.
-Recommend her psychotherapy.

255. 4-month-old boy had intermittent abdominal pain and some features linking toward malignancy or
leukemia is there and everything else was normal including labs except uric acid which was 14.2. What
will be the NBS in management?
-Start allopurinol therapy
- No IV fluid in option
256. Shellfish allergy, but she wants to eat shellfish.
a. Eat shellfish but carry epi pen.
b. Give diphenhydramine.

257. MRSA case was found in post op case and few days later it was also found in another patient in
another ward. Long vignette. What could have prevented this?

a. Contact precaution for all patient in Post op for 48 hours

b. Ask anyone who visits post op ward to wear gown and gloves.
c. Use of alcohol-based sanitizers before and after exposure to patient

258. OA: quadriceps strengthening exercise

259. A middle aged lady had a very large mass on the abdomen, She also has nausea and other
symptoms. On USG? it was continuous with the uterine cavity. I inferred it as a big tumor. NBS
-Hysterectomy with B/L salpingo-oophorectomy
-CT scan of the Abd and pelvis
-Do regular pap smear No use or biopsy in option other option were not valid

260. A lady with CA 125 elevated was worried and saw some study about elevated CA 125 with adnexal
mass. The lady has no adnexal mass. As a physician what will you recommend to her?
- This cannot be applied to her as she has no mass

261. Primary dysmenorrhea to diagnose- She has pain 2 day prior and 2 days after menses. It is also
associated with nausea, vomiting and some diarrhea in those episodes.

262. Girl is about to get graduated from the university and now planning to join working in some firm.
She is worried, how she is going to make it out. She feels anxious and have panic type symptoms while
giving presentations and is worried about it happening again and people making fun of her. During those
episodes of anxiousness, she has also felt “out of the body” (something like this). This has been her
problem ever since she was in middle school. She is fine with colleagues and enjoys time with them.
Diagnosis:
- Social Phobia
- Dissociative disorder
- Panic Disorder
263. An elderly lady presents with slight difficulty in breathing and getting tired? She underwent Total
Knee Replacement 6 weeks back, She was doing her treadmill and other stuffs and was fine until
recently she developed these issues (slightly vague, I inferred couldn’t fulfilled criteria of PE or other
serious issues). She is a diabetic. What will you do?
- Blood glucose measurement
- ECG
- Chest X-Ray

264. Lady husband died 6 months/1 year back. At that time she drank a litre of vodka and then was
drinking a bit afterward too. She has been admitted once for this issue too. Then She joined Alcoholic
Anonymous group and was doing fine. I think, now she has left it now. Whenever she recalls about her
husband, she grabs a beer. If she does not undergo treatment, what is the likely complication she can
develop.
- Alcohol induced depression Alohol use disorder
- Suicidality?

265. Female wants to hurt baby and SIGECAPS also fulfilled= MDD with psychosis

266. Physician will get incentive if not referred but patient is having continuous pain of migraine not
resolved by any means.
- Refer to Neurologist

267. DCIS vignette explains, initially calcification seen on mammography, then biopsy done and biopsy
feature explains not crossing a basement membrane, Rx-
- Lumpectomy
-Radical Mastectomy
-Radical Mastectomy with Lymph node sampling

268. Patient has hypertension and 50% carotid stenosis, Aspirin is started, what to add- Lisinopril. This
might be the HOPI.

269. Kidney transplant 4 months back on treatment. Pt complaints of graft site tenderness but no fever.
What is the most appropriate step?
- Biopsy

270. Thalassemia trait- Patient is on iron supplements. Look at labs. MCV and RBC count

271. A kid with ADHD is tall, has gynecomastia, he is shy to change at the changing room, what to do for
diagnosis- karyotyping
273. A vignette explains the whooping cough scenario in a kid and has asked the treatment
- Azithromycin

274. Vitamin B12 deficiency scenario- Peripheral neuropathy (LMN features though,
vibration/proprioception loss, forgot)

275. Recurrent pneumothorax scenario, 2nd visit for pneumothaorax. Xray shows 50% pneumothoraces.
NBS:
- Tube thoracostomy
- Needle thoracostomy?
- Pleurodesis
1. 15yrs/F with h/o heavy bleeding during menstruation,menses-regular,menarche-12yrs,o/e-
pallor and she also has h/o nasal bleeding whenever she gets common cold.(No family h/o)

PT aPTT Platelets

2. 27yrs/F came for routine HME. On auscultation-Bruit heard over right kidney,creatinine-1.
NBS?(BP-Not given)
[Link]
[Link] fat diet
[Link] protein diet
[Link] scintigraphy
[Link] duplex USG

3. 17yrs/F with ADHD under amphetamine on her summer vacation(Hostel far from home).
She visits a doctor and says she has forgotten her medicine at hostel and now she would like
him to prescribe her the medicine,she has been taking. When doctor denied , she becomes
aggressive “ Do you think I am an addict” . As a physician, what should you do?
a. Prescribe her stimulant for few days.
b. Prescribe her less potent stimulant.
c. Do not give anything

4. Female with increased hair in the upper lips and body presents to the doctor. She is
amenorrheic, obese, and has menstrual irregularities. Treatment?
[Link]/Ethinyl estradiol
[Link]
[Link]

5. 19yrs/F comes to ER with 4-5 days history of chest pain that radiates to shoulder [Link]
took over the counter ibuprofen and had some [Link] doesnot smoke or take illicit
[Link]-Diffuse T wave [Link]?
[Link] virus
[Link]
[Link]

6. Lady husband died 6 months back. At that time she drank a litre of vodka and then was
drinking a bit afterward too. She has been admitted once for this issue too. Then She joined 12
step support group and was doing fine. I think, now she has left [Link] she recalls about
her husband, she grabs a beer(mero ma she thinks of having a beer thyo not grab) . If she does
not undergo treatment, what is the likely complication she can develop?
[Link] induced depression
[Link] of symptoms

7.A female was raped 3 days [Link] presented to doctor with abrasion around thigh and
bruising in her [Link] preliminary management,what will you offer for contraception?
[Link] IUD
[Link] LNG

8. 28-year-old woman gets sinusitis and pneumonia every year since childhood.O/e- B/l cervical
LN [Link]?
a. CVID
b. Nasal polyposis
c. Wegener's granulomatosis
d. Lymphoma
e. Allergic rhinitis

9.A patient presents with jaw pain for 3 months,aggravated on eating food.O/E-Submandibular
gland swelling (+).Diagnosis ?
[Link] sialadenitis
[Link] duct calculus

10.A 60yrs/M with h/o colon Ca had colectomy done 5 years [Link] chest and CEA level 6
months back shows no [Link] he presents with dry cough for few [Link] x-
ray,a small round mass is found in hilar region of the left lung,NBS?
[Link] CEA level [Link] abdomen + pelvis [Link] chest

11. CV of vitamin D deficiency. What to measure for the confirmation of diagnosis:

a. 1,25 –(OH) vitamin D
b. 25-(OH) vitamin D

12 . A pregnant patient at around 14-18 WOG with history of asthma using albuterol
around 4-5 times per day. She continues to smoke despite her condition. No any
pregnancy related symptomatology present. Her asthma has not been under control
recently. Now question asks what to add futher?
a. Intra nasal cromolyn
b. Oral methylprednisolone
c. Oral Montelukast
d. Increse the dose of albuterol

13. CV of a 3 month postpartum female has recently resumed sexual intercourse but
complains of dyspareunia and also some urinary problems. On examination there is
 Grade II cystocele. The couple also have plan to have a baby within a year or so. The
patient is already doing Kegels exercise for about 2 months with minimal benefit. Now
what else to do for management?
a. Anterior colporrhaphy
b. Physical exercise therapy

[Link] has food left in abdomen and delayed gastric emptying in nuclear gastric-emptying test.X-
ray given with mild distention but no air fluid level. Now what will be expected to be increased in this
patient:
a. HbA1c
b. Gastrin

[Link] army female comes with complain of pain over lateral aspect of [Link] has to run long
distance during some combat [Link] of lateral aspect of [Link] is point tenderness on
the lateral aspect of the [Link]?

a. Stress fracture of 1st 2nd metatarsal

b. Navicular fracture
c. Cuboid fracture
d. Stress fracture of lateral metatarsal
e. Morton neuroma

16. A young patient has a history of weakness of upper as well as lower limbs. There is similar history in
other family members too. He is dystrophin gene +. what will you see in biopsy of muscle of this
patient?
a. Myonecrosis with fibrosis
b. Dystrophin negative immunohistochemistry

17. A young guy with watery diarrhea for 10 days. He has signification weight loss nearly 5 kg. FOBT
negative. CRP/ESR raised in labs. NBS for diagnosis?
a. Colonoscopy with biopsy
b. Colonic enterography
c. Capsule endoscopy

18. Picture of an ulcer on the distal leg shown and Asked next best step in management :
a. IV heparin
 b. Unna boot
c. ABI

19. One middle age man, was driving as usual, and has to wave to a school guard bye-bye. But then
at that very moment he meets with an accident (some car hit his car from the side) and now he
suspects that the guard has something to do in his accident. Suspects that the guard is the
reason for his accident. He was brought by his wife. His goals are right, and has no other
problem. Asked diagnosis:
a. Delusional disorder
b. Schizophrenia
c. Mania

20. A CV of around 31years female at around 38 WOG presents with ROM and cord
prolapse with cord palpated on the vagina. The contractions are adequate. Cervix fully
effaced at 10cm with head station +2(2 nai thyo). Fetal heart rate is on the normal side. How
do you manage the case?
a. Forceps delivery
b. Push the cord back
c. Cesarean section

21. A man SIGECAPS fulfilled ,concern was not gaining weight. Which of the following drug will
be appropriate ?
a. Bupropion
b. Mirtazapine
c. Sertraline

22. CT scan given mass in Right lobeof liver,homogenousin appearance,fever +ve,in addition
to aspiration what will bedone?
a . Cefalexin+metronidazole
b. Albendazole

23. 5-6yearskid,brought by her [Link] has noticed that the child’s foot looked flat
while standing but is okaywhen the foot is [Link]
a. Xray foot while standing
b. Xray foot while sitting
[Link]

24. Transgender male, currently under testosterone therapy, patient is satisfied with the effects.
Planned for surgery after 1.5-2years. Someone in family mother/aunt has carcinoma
endometrium or breast (forgot) at age 49years. NBS
a. Hysterectomy now
b. Check erythrocytosis
25. 14-15y/M came after a fall injury over his leg. No external wound. CV mentions there is a mass
in the diaphysis and has lamellated appearance. Asked diagnosis
a. Osteosarcoma
b. Ewings sarcoma

26.68Yrs/M, Patient had stroke features- weakness of left side of the body, no sensory
involvement. Patient consumes only3-4 oz alcohol per week. H/o HTN, current BP-
140/90s. patient under anti-HTN meds(lisionpril). What is the best
prognostic factor for this patient:-
a. Isolated motor symptoms
b. Age

b. Which of the following would be most appropriate for this patient for better long
term outcome?
a. Complete abstinence from alcohol
b. Increase the doseof lisinopril
[Link] diet

27. Patient has increasing difficulty to see, described as tunnel vision. Clear lens.
Diagnosis?
a. Cataract
b. Glaucoma
c. ARMD

28. Male, MVA case. Patient was placed on spinal board, cervical collar was applied. Patient had a
laceration over forehead, and left knee, no active bleeding. Knee laceration was deep but had
not involved bone. Patient has no pain over cervical spine. BP-100/60mmHg. What will you do
to diagnose?
a. CT cervical spine
b. Xray pelvis
c. Xray left knee

29. A man plans to go on a trip, wants to take prophylaxis for traveller’s diarrhea. What would you
prescribe:
a. Amoxicillin
b. Ciprofloxacin
d. Fosfomycin

30. Nurses felt that doctors are not maintaining hand hygiene. Some educational campaign team is
formed. Hospital infectious team? Started survey on PPE and handwashing too. They have been
randomly distributing some survey to healthcare workers too. They found compliance for
handwashing and PPE to be 90 and 92% among the 500 subjects being surveyed. I inferred that instead
of nurse telling less compliance, how come values came out to be so high. What’s the problem here.
[Link] reliability
[Link] rater reliability
[Link] bias
d. Measurement bias
[Link] worker Effect

31. Female with multiple sexual partners, currently on monogamous relationship with past h/o
chlamydia which was treated. She had her LMP 6 weeks back. She had a vaginal spotting a week back.
She presented with sudden onset Lower abd pain, BP= 100/60. HR=112, Beta hcg=2000. Hematocrit=
25%. NBS in management?.
a. Laparoscopy
[Link] Beta hcg level in 2 days

32. Patient underwent some GI surgery few years back and now presents with bone and muscle pain;
His blood calcium level is also on the lower side.
PTH Urinary Ca Intestinal absorption of PO4

33. 20s/F present with pain,erythema and scanty discharge from nipple.H/o nipple [Link] fever and
f luctuation.

[Link]

[Link]

[Link]

[Link]

a.H2 Vs PPI

[Link] infection

Maximum Qsns from Explore and Eva set…Thankyou All!!