Questions

1. 70 year old man with history of poor central vision. Picture of retina on
fundoscopy is shown. What is the diagnosis? Central Macular degeneration.
2. Child with a history of high grade of fever for 4 days, currently has
erythematous skin lesion of cheek. Picture given, What is the diagnosis?
Erythema infectiosum, Parvo B19 infection.
3. 12 year old man with limping of right leg, BMI is >30, X-ray is given, How is
this condition treated? Slipped capital femoral epiphysis, Surgical pinning.
4. Neonate born preterm, presently has subcostal retractions and high
respiratory rate. What is the cause of this condition? ARDS, defect in
surfactant.
5. ABG of a person given who is suffering from Pulmonary embolism. What is
the cause of hypoxia? V:Q mismatch.
6. Similar to 5, ABG of person with CCF following an Acute MI given. What is
the cause of abnormal ABG in this patient? Shunting.
7. H/O 22 year old with sudden fainting spells while playing soccer.
Auscultatory findings of CVS shows ejection systolic murmur which
increases with squatting. ? Diagnosis: HOCM
8. 60 year old with H/O surgical repair of thoracic aortic aneurysm. Currenly
has features of CCF, CVS findings given. It has early diastolic murmur. What
is the diagnosis? Aortic regurgitation.
9. Post MI patient with hypoxia after 5 days, CPK is raised again after initial
decline. What is the cause of the patient’s dypnea? Reinfarction.
10. Patient with H/O orthopedic surgery few days ago, presents with dyspnea
and hemoptysis, there is tenderness in the right calf. H/O hemorrhagic
stroke few months ago. What is the next step in managing this patient?
Venacava filters.
11.H/O surgery for prolactinoma. Currently the patient is delirious. Lab values
shows hypernatremia. What is the next step in management? CDI,
Desmopressin.
12.Child with short limbs, short Lower limb, What is the cause of increased
head circumference? Achondroplasia, Hydrocephalous.
13.Picture of vulva with many vesicles and ulcerated tender lesion in a young
teenager with lymphadenopathy. What is next step in management? HSV
infection. Oral Acyclovir.
14. 15 year old with anemia, Peripheral smear given: Auer Rods. What is the
complication most likely in this patient? AML, DIC.
15.Elderly patient with enlarged non tender LN in left Cervical chain. What is
the next step in management? Lymphoma, excisional biopsy.
16.Child with features suggestive of Down’s syndrome. What is the most like
CVS abnormality in this patient? Endocardial cushion defect.
17.Child with mother who is drug abuser, multiple drugs. The neonate is crying
and yawning, not able to feed. What is the most likely cause? Opiate
withdrawal
18. 6 month old male child with vomiting for past 2 days, current jelly like
blood in stool. What is the diagnosis: Intersusseption.
19. 4 week old with cyanosis relieved with squatting, CVS finding has systolic
ejection murmur in pulmonary region? Diagnosis: TOF
20. Question about VACTERL association. Child has feature suggestive of TEF,
What else would you do for this patient? X-ray of Vertebrae.
21. Female with amenorrhea for 3 months, Beta-hcg >50,000. Expulsion of
grapelike vesicles. What is the next step in management? TV-USG
22.Pregnant in 3rd trimester, decreased fetal movement in last few days. NST
given, Late decelerations. What is the next step in management? CS
23.Similar to 22, but with variable decelerations. What is the most like cause of
the abnormal NST? Cord compression.
24. H/O amenorrhea in a female for a month, presents with bright red blood
per vagina with clots, no FHS heard. Ps examination shows an open cervix,
What would you do next for this patient? Incomplete abortion, DNC.
25. Female with hairy lips and acne, she has high BMI. LH and FSH raised. What
is the best mode of therapy for this patient? PCOS, OCPs.
26.Female with hirsutism, hyponatremia, raised 17-OH progesterone. What is
the diagnosis? CAH
27. Pregnant woman in 3rd trimester with headache, raised BP and proteinuria.
What is the most effective way of lowering BP in this patient? Delivery.
28.Graph showing prolonged 2nd stage of labour with. What is the most likely
cause of this condition? Cephalo-pelvic disproportion.
29. Along with 28, next questions was what will you do next if the fetal head is
engaged. Cervix is fully dilated, contractions are inadequate? Oxytocin.
30. 2 year old with recurrent otitis media and pneumonia as a infant,
examination shows no tonsils. What is most like cause of this patient’s
immunodeficiency? Tyrosine kinase deficiency, Bruton’s X linked disease.
31. Following Q 30, what is the next step in management of this patient?
Measure serum Ig levels.
32. 25 year old male with B/L palpable masses and raised creatinine levels and
the patient has hyperkaemia and is delirious. What is most effective way of
treating this patient? Dialysis.
33.Patient with hypercalcemia but is asymptomatic. What is the most likely
cause? Hyperparathyroidism.
34.Elderly male with back pain, hypercalcemia and raised creatinine. What is
the next step in diagnosing the patient’s condition? SPEP, MM
35.H/O working in shipyard and is also a long time smoker. X ray shows
calcified pleura and slight effusion. What is the next step in confirming the
diagnosis? Mesolthelioma, Pleural biopsy.
36.Young teenager with dyspnea on exertion and exposure to cold. PFT is
normal at this time. What is the next step in diagnosing this condition?
Methacoline challenge test.
37.African American with dyspnea, skin lesion suggestive of EN, X ray given
which shows hilar lymphadenopathy. What is most effective therapy for
this condition? Sarcoidosis, Oral Prednisolone.
38. Male in his 20s with H/O uveitis and currently has back pain, raised CRP.
What is the most likely diagnosis? AS
39. Following 38, what is the most like pattern seen in PFT. List of values for
FEV and FVC given. Choose one which suggests Restrictive lung disease
pattern.
40. Patient with long H/O smoking presents with proximal muscle weakness.
No skin lesions or ptosis. What is the most reliable method of diagnosing
the patient’s disease? Small cell carcinoma, Broncoscopy.
41.Elderly patient with long history of smoking presents with arm pain, right
sided miosis. Diagnosis: Lung cancer.
42.H/O tibial fracture 2 days ago which has been repaired surgically, currently
has loss of sensation and pain in right lower extremity. Pulses are absent
What is the next step in management. MRI angiography, vessel injury.
43. Lot of questions about vaccination during routine visit to physician.
44. Also screening procedures about mammography and colonoscopy.
45. Pap smear shows ASC-US, 3 months later HPV DNA test shows positive
results. What is the next step in management? Colposcopy.
46.Pregnant patient comes for routine prenatal visit. Which vaccine should be
given to this patient. Inflenza vaccine, inactivated .
47. Young male with features of CCF, he had history of URI 1 week ago. What is
most likely organism causing the disease. Myocarditis, Cox-sackie B virus.
48. Preterm labour with contractions before 34 weeks. What would you do for
this patient? Beta-methasone.
49. Adult patient with chest pain, EKG shows ST segment elevation. Which
therapy will significantly lower the patients mortality? Aspirin
50. Adult with epigastric pain for last 3 months, on and off not relieved by PPI
or antacids. What is the next step in management of this patient? Cardiac
stress test.
51.From biostatistics I frequently got questions in each set, some of them
were simple and about pretest and post-test variables.
52.Calculation on False positive Rate: 1 – Specificity
53. Positive Predictive value
54. What will happen if the cut off to a test is decreased from higher to a lower
set point?
55.One abstract with 3 questions. It was about the use of serum Troponin
levels to determine the prognosis of CAD in patients without an ST segment
elevation. The 3rd question was simple and about sensitivity. The other two
were about the research.
56.No Drug ad but there were 2 to 3 questions in which there was RCT done
and I was asked “ When will you decide to stop the study” or “ What is the
most probable bias seen in this research”
57. A doctor is trying to use several different results of studies to decide which
therapy to try in a patient, what type of study is this? – Meta-analysis.
58. How can you practically increase the power of a study which was initially
not significant? Increase the sample size.
59. A lot of questions about ethical issues. A 12 year old child has traumatic
amputation of finger, his parents are not here yet and he is losing a lot of
blood and vitals are unstable. What will you do next? Treat without
consent.
60. An elderly comatose patient who has been ventilated. Son has the health
power of attorney and says continue treatment, daughter thinks the
treatment should be stopped. What should you do next? Continue
treatment.
61. History of trauma of a restrained driver in the front seat, the steering
wheel was bent. Vitals are stable, what will you do next? CT- Scan of
abdomen.
62.History of penetrating trauma to the abdomen following a gun-shot, vitals
are unstable. FAST shows fluid in the abdomen. What will you do next?
Exploratory laparotomy.
63. History of pelvic trauma in adult male, external fixator have been applied,
the patient presents with abdominal pain and has not urinated. Also he has
not had any sensation of fullness of bladder. What is the next step in
management of this patient? CT- Scan of abdomen, bladder injury.
64. Patient on a routine visit has BP 138/88 mm hg. BMI is high. What is the
next step in controlling the BP? Weight reduction
65. One question regarding sequential steps to make a patient stop smoking.
Ask, Advise, Attempt, Assist, Arrange. The answer was to give the patient
nicotine patch, “Assist”
66. Barium swallow showing oesophageal obstruction in a patient who had
dysphagia initially to liquids and now to solids. What is most likely cause?
Adenocarcinoma involving the lower end of Oesophagus.
67. Patient has clinical history suggestive of anterograde amnesia, where is the
lesion most likely located? Hippocampus.
68.Patient with a long history of alcohol abuse has ataxia and nystagmus.
Where is the lesion located? Mammillary bodies.
69.Patient who recently lost a job, currently has low mood, decreased
appetite, anhedonia, decreased energy and sleep. What is the diagnosis of
this patient? Major depressive disorder.
70. A child performs poorly at school and is obsessed with deadlines and
keeping her room clean. She started a new school 6 months ago and
previously had normal relations but now seems detached. What is the
diagnosis? OCD
71. A child has motor and vocal tics in which he calls out profanity to stranger.
What is the common disorder he is likely to have as an adult? OCD
72. A man is socially isolated, doesn’t like having any close personal contacts
and lives alone. What is he suffering from? Schizoid personality disorder.
73. 22 year old man comes to the ER with hallucination, pupils are dilated and
he is mildly dehydrated. What is he most likely intoxicated with?
Amphetamines.
74. Female patient with history of Raynaud’s disease and tapering finger tips,
she also has long history of GERD. What is the next step in diagnosing the
patient’s condition? Ani-centromere antibody
75. A young teen with raised BP, has history of hemoptysis and RBC in the
urine in past few days. What is the most likely diagnosis? Goodpasture’s
disease.
76.A young teen with recurrent sinusitis and lung infections, RBC casts in the
urine. What is the next step in diagnosing the patient’s condition? C-ANCA
77. A patient with history of BPAD , presents with tremors, ataxia and
headache. What is the most like cause of the patient’s presentation?
Lithium intoxication
78. A female in her late 30s has clinical features suggestive of PCOS. What will
you do next for this patient? Endometrial sampling.
79. A female with a H/O simple hysterectomy present with menopausal
symptoms. Which therapy is most appropriate for this patient? Oestrogen
only for initial 25 days of cycle.
80.A patient with history of painless jaundice for 3 months, weight loss,
distended GB. What is the next step in management of this patient? CT
scan of abdomen.
81. Similar to Q. 80 but the patient has increase in conjugated bilirubin >20.
What is the next step in management of this patient? ERCP and stenting to
relieve jaundice.
82.Female patient with epigastric patient, pain exacerbated with eating stake.
Murphy’s sign positive. What is the next step in the management of this
patient? Emergency cholecystectomy within 48 hours.
83. Male patient with long history of UC, currently has pruritis and raised ALP.
What is the most like diagnosis? Primary sclerosing cholangitis.
84. Elderly man with erectile dysfunction, no history of coronary artery
disease, morning tumescence is present. How will you treat this patient’s
impotence? Sidenafil
85. A couple have been trying to conceive for past 2 years, the woman has 1
child from prior marriage. Semen analysis is inconclusive, what is the next
step in evaluating the couple’s infertility? Repeat semen analysis.
86. A female in her 40s who has had 3 children comes for routine check up.
She has regular sexual activity. She does not want any more children. What
mode of contraceptive therapy is most appropriate in this patient? Tubal
ligation.
87. A couple come to you for pre-conceptional counseling, what would you
prescribe to decrease the risk of congenital abnormality in the foetus? Folic
acid.
88. A man in his 30s has a history of Crohn’s disease and had a partial
gastrectomy for a refractory duodenal ulcer 5 years ago. He currently has
anemia with a MCV >110, decreased sensation to vibration in lower limbs,
he is also a vegetarian who drinks oftens. What is most likely cause of the
patient’s anemia? Gastrectomy
89. An elderly patient with history of AMI 2 years ago currently presents with
intermittent chest pain for past 1 week. He is not able to walk without
getting dyspneic. EKG shows no new abnormality. What is the next step in
evaluating the patient’s chest pain? Presantium-Thallium scan as the
patient cannot exercise and there are baseline EKG abnormalities.
90. A patient who has been in a car accident presents to the ER with shortness
of breath and chest pain. He was the restrained driver in the front seat of
the car. Examination shows decreased breath sound on the right side and
distended neck veins. What is the next step in the management of this
patient? Needle decompression of tension pneumothorax.
91. Similar vignette to Q 90 but the patient has low BP, distended JVP, heart
sounds are distant. What is next step in managing the patient’s
hypotension? Peri-cardiocentesis for cardiac tamponade.
92. Patient with clinical features suggestive of CLD, what vaccine would you
give to this patient. Hepatitis A and B vaccine.
93. Patient with leukemia who has been treated with BM transplantation,
currently presents with rash and jaundice, AST, ALT is raised. Which cell
type is responsible for the patient’s condition? GVHD, donor T-
Lymphocytes.
94. Patient with history of seizure taking prophylactic medication has a child
with hirsutism and cleft lip. What medication was the mother most likely
taking? Phenytoin
95. A soldier comes to the Physician with persistent pain in the right lower leg,
not relived by rest. He marches with his company for 3 hours every day. S-
ray shows no abnormalities. What would you do to further for the
management of this patient? Stress fracture of tibia, NSAID, no casting
required.
 96.Elderly patient who presents to the ER with delirium, he has H/O repeated
falls, most recently he fell down in the bathroom 3 weeks ago. Lab values
shows hyponatremia. What is the mechanism of patient’s altered
sensorium. SIADH following a Sub-dural hematoma.
97.Picture of patient with vitiligo affecting the hands. What other disease is
the patient most likely suffering from? Addison’s disease.
98.A 65 year old man with back pain and perineal pain for past 2 months. He
also has dribbling micturition and U/A on prostatic message shows WBC ,
esterase positive.PR shows a tender prostate. How would you treat the
patient’s condition? Acute prostatitis. TMP-SMX for 6 weeks.
99. HIV positive patient with CD4 count of 450, he is not taking any medication at
the time being. What should be done for the patient in his current visit?
Pneumococcal and Infuenza vaccination.
100. HIV positive patient with CD4 count of 150, presents with shortness of
breath, fever. X-ray shows B/L patchy infiltrates. What is the most accurate
method of confirming the etiology of the patient’s condition. Pneumocystis
pneumonia, Broncho-Alveolar Lavage.
101. A family comes to you to seek counseling regarding their 75 year old
grandfather who has Alziemer’s disease. He takes his medications regularly
and is active in his house hold activities. He has stopped going to the mall and
going out of his room. But he interacts with the other members of the family
regularly, although he forgets their names sometimes. They are planning to
take a trip to another state together. Which of the following might exacerbate
the patient’s dementia? Travelling to another state, keep the patient in
familiar surroundings.
102. A 45 year old female presents with a breast lump which is palpable to the
patient and doctor. Mammography shows no significant findings, FNAC is
inconclusive. What will you do next for this patient? Core needle biopsy.
103. A young adult presents to you with new onset of type 1 DM, what
serological test is most likely to positive for this patient? Anti-Glutamic Acid
decarboxilase.
104. What is the most like cause of the patient’s low BP? Elderly receiving
treatment for CCF and presenting with pre-renal failure. Diuretic use.
105. What is the most like cause of the patient’s low BP? Patient with dementia
currently has orthostatic hypotension. Examination shows flat JVP and dry
mucus membrane. Dehydration.
106. What is the most like cause of the patient’s low BP? Patient with H/O URI
week ago, currently has chest pain relieved by propped up position,
examination shows distended JVP and decreased heart sounds.
Echocardiography shows Fluid in pericardial sac. Decreased preload due to
cardiac tamponade
107. A man has a history of getting punched in a bar fight. Currently he has
swelling of his left cheek. X-ray of skull is given. What is the most likely
diagnosis? Orbital fracture.
108. A pregnant patient present to you with burning micturition and supra-pubic
pain. U/A shows plenty of WBC and urine culture is pending. How will you
treat this patient’s condition? Oral Amoxicillin for 10 days.
109. A child presents with drooping of right side of the mouth, he cannot wrinkle
his right forehead. His family went to a field trip a few weeks ago. How will you
treat this patient? Oral penicillin (Doxicycline not used in children)
110. An elderly female presents with B/L swelling and stiffness of fingers which
is worse at the end of the day for the past few weeks. Examination shows
swelling of distal inter-phalangeal signs but not the proximal inter-phalangeal
joints. ESR is not raised. What is the cause of the patient’s joint pain?
Degeneration of the articular joints, osteoarthritis.
111. Female with H/O breast cancer treated with chemotherapy presents with
back pain. SLRT is negative but there is point tenderness of L4 vertebrae. What
is most likely cause of the patient’s backpain? Metastatic carcinoma of breast
causing compression fracture.
112. An elderly homeless man comes to the ER on a cold night with complaints
of abdominal pain. He gives history which is not significant and physical
examination shows no abnormality. The patient demands that he be admitted
to the hospital. What is the diagnosis? Malingering.
113. A chronic opiate abuser comes to a rehabilitation centre. She says that she
wants to kick the habit once and for all. Which therapy is most likely to help
the patient permanently quit her opiate use? Buprenorphine.
114. A female with 4 children comes to you because of involuntary loss of urine
while coughing and sneezing, but there is no bedwetting at night. She also has
fecal incontinence. Picture of perineum is shown with a protruding mass per
vagina. What is the most effective therapy for this patient? Vaginal
hysterectomy with anterior and posterior vaginal wall repair.
115. A man in his 20s comes to you for evaluation of rectal bleed. His mother
died of ovarian carcinoma and sister was treated for endometrial carcinoma. A
colonoscopy is done but shows no polyp but there is an ulcerative mass
present. What is the most likely etiology of the patient’s condition? Defective
DNA repair, Hereditary Non Polyposis colonic carcinoma. (HNPCC)