EMSTREX 23/02/19

No. Questions Answers

1 The best way to measure the temperature o Rectal
o Tympanic
o Axillary
o Oral
2 One patient has abdominal pain , vomiting and o Amyand hernia
constipation for about 12 hours , past surgical o Maydls hernia
history of laparoscopic gastric bypass 18 months o Small intestine adhesion
back ; AXR showed multiple air fluid level, what o Richter hernia
could be the cause ? o Petersen hernia

3 Scenario of a trisomy explained in a child. Stating o 18

rocker bottom feet with clenched fists & small o 13
head. o 21
Picture was given. which trisomy? o Turner

4 Calculate the GCS 12

5 Patient presented with right sided facial Broca’s area
weakness and inability to express himself , with
loss of sensation over the big toe , picture of
brain areas was provided , choose the possible
affected area ?
6 Patient post MI , the most common possible o Arrhythmia
complication o Myocardial rupture
7 A picture of neurotransmitters was provided , o Atropine is Ach antagonist
asking about the pre ganglionic Ach receptor , o Neurotransmitters will be
what is the common feature between all the recycled
neurotransmitters ?

8 Jvp waves were given along with a scenario of Extra large a wave
cirrhosis and varices as well, which of the feature
of the wave was the cause for pulmonary stenosis
, keeping chronic high right atrial pressure in
mind,

9 Newly married lady , wants contraception , but o IUCD

she forget frequently , what is the most suitable o Diaphragm
contraceptive method you can give ? o Condom
o OCP
10 One child with uti. What will most likely o Renal and bladder US in
determine the probably of hypertension in one week
future. o Doppler ultrasound in one
month
o DMSA
o Voiding MCUG
o IVP
11 USG chest was provided , with IVC dilated and o Thrombolytic therapy
low BP , WHAT IS THE NEXT STEP

12 Patient presented with hematemesis , low BP , o GIVE 1 L of fluid

USG Chest was provided , with IVC collapsed and o Put some Cather
low BP , what is the next best step ? o Give blood transfusion

13 man working in a cupboard/wardrobe furniture o Hard sawdust

making shop...has slight cough and nose irritation o Organic paint stripper
which resolves on the weekend...now patient
has cracks on hands and feet

14 Lumber section was provided , with questioning Dorsal column system

about which site is responsible for proprioception
and awareness of joint position
15 Patient presented with sudden onset of SOB , o Pulmonary edema
USG lung showed the following , what is the o Pneumothorax
possible cause ? o Pneumonia
16 Lady with irregular periods each 55 days , wants o PCOS
to have kids , and hip circumference of about 88 o Androgen insensitivity
cm , Frerriman Gallway score = 14 o Testicular fertilization
17 Patient , pulseless , ECG shows ventricular o Epinephrine
tachycardia o Amiodarone
o lidocaine
o magnesium

18 Patient with parkinsonism , scheduled for brain o Substansia nigra compacta

stimulation therapy , which side of brain will be o Substansia nigra reticularis
affected ? o Caudate
o Putamen
19 Picture of CT, choose which one contains Choose whatever applicable
intraventricular hemorrhage

20 Old patient with chest symptoms for month then o STEMI

resolved. Troponin negative. ECG given. o NSTEMI
 o Unstable angina
o Non cardiac cause

But in the exam Q wave was there

21 Endoscopy showed ulcer , what to give , Melena o IV infusion pantoprazole
was present o H.Pylori eradication

22 34 years old diabetic lady, non compliant , o DKA

presented with history of pneumonia after that o Hyperosmolar coma
she developed abdominal pain and vomiting and o Hypoglycemia
lost consciousness , POCT was 34 without
mentioning the unit ( i.e. mg/dl or mmol/l )
23 Lady presented abdominal pain , treated by IV o ERCP
fluids and antibiotics was given , USG showed o MRCP
multiple stones in CBD and single stone in the gall o CT abdomen
bladder , what is the next step ? o Cholecystectomy
24 In a chemical factory , you have 1 scientists and o Initiate x-ray program
chemistry specialist who is handling a dangerous yearly
chemical substance , what can you do to decrease o Give gloves and masks
their exposure ? o Automated cabinet
o Proper handling of the
chemical substance
25 Patient presented with abdominal pain , she / he o Hypoparathyroidism
is taking vit D tablets and exposing to sun o Vit D toxicity
excessively , her/his labs : now her ionised and o Hypothyroidism
 total calcium are high and low PTH ,vitamin D > o Thyroid adenoma
400 , what is the cause ?
26 Question of man with DM felt that a curtain fell o Retinal artery embolism
on his eye but then it got better , what is the o Retinal detachment
diagnosis ?
27 What feature is not present in HTN fundoscopy ? Micro aneurysm
28 Pregnant lady at 32 weeks , with high BP , not o Pre eclampsia
checked before , now she have fundoscopic o Chronic hypertension
changes with proteinurea + 2 , what is the cause ?
29 Pregnant lady already hypertensive on
medications
30 One patient has galactorrhea , amenorrhea and o Super sensitivity of
nausea and vomiting and Parkinson like dopamine receptors
symptoms , due to some drug , that drug work in o Block the receptor for
which mechanism dopamine
31 What drug increase the risk of digoxin toxicity ? o Furosemide
o Cholecystramine
o Losartan
o Ace inhibitor

32 Patient presented with multiple fundal gastric o Histamine

polyps and increased level of chymotrypsin , o Gastrin
what substance will be increased in blood ? o Somatostatin
o CCK
33 Lady with heavy bleeding USS showed o Laparoscopic
submucosal fibroid measured 4*4 cm , now have myomectomy
bleeding , what is the best management ? o Hysteroscopic
myomectomy
o Observation with iron
supplement
o Hysterectomy
34 Lady have dysmenorrhea and infertility , Laparoscopy
diagnosed as endometriosis , what is the best
management ?
35 Lady was having heavy period , she did D&C ,
now lighter period , what is the cause ?
36 Lady didn’t feel her abdomen Nilistic delusions
37 Young lady had an arguement with her parents o Schizophrenia
over rejection of marrige proposal... suddenly o Conversion disorder
went blank and couldn’t move her limbs

38 Patient with alcohol withdrawal , what to give ? Chlorodiazpoxide

39 Patient with alcohol withdrawal what thing , Tachycardia
most predictive sign of alcohol toxicity ?
40 College student cant stop thinking about cursing Obsessions
other colleges in the college
41 Patient have depression before, now starts BIPOLAR
experience mania like symptoms, what is the
diagnosis ?
42 Man brought son to ER with panic attack
43 young man wants to quit his job as a medical o Simple phobia
representative because he is shy and cant present o Social phobia
infront of doctors and has skipped previous 3 o Panic disorder
seminars

44 USG Gyn showed small centric collection and o Give MTX

bilateral complex adnexal mass with bleeding and o Expectant management
abdominal pain what is the management o laparotomy /scopy
Bhcg was 200 now 700 o Evacuation
o misoprostol

45 Which anti HTN doesn’t cause dyslipidemia ? ACEi

46 One lady with B HCG measures 200000 what is Hydatiform mole
the most likely diagnosis ?
47 Someone fell from the bicycle X ray of wrist o 1st metacarpal fracture
showed hair line fracture of the distal radius , o 2 nd metacarpal fracture
o Radial fracture
o Scaphoid fracture
48 Lady with fluctuant mass in the introitus Bartholin abscess
49 Patient with headache bilateral frontal and vision Pituitary adenoma
problem
50 Elderly male had a community acquired o legionella
pneumonia , culture streptococcus positive , o Chlamydia
started antibiotics; situation worsened. o Pseudomonas
cavitation on x ray o Staph aureus

what was the organism?

51 40 years lady , agitated and anxious , family said o Opioid toxicity
that she is depressed and recently quite her job o Sympathomimetic drug
and divorced , Has 7mm eyes And diaphoretic toxi city
skin what is the cause ? o Cholinergic
o Anticholinergic drug
52 RTA , supra pubic tenderness Suprapubic catheter
53 Patient with ascending weakness, arefflexia of GBS
patella and ankle , history of bloody diarrhea
before , with LP showing 8 lymphocytes and
158mg proteins
54 Case of lady with progressive weakness through NMJ disease
out the day , proximal weakness , intact sensation
, what is pathophysiology of this condition ?
55 female patient how develops weakness in the jaw o Neck ultrasound
and blurred vision specially at the end of the day, o Brain MRI
 Asking about the best initial test o Chest CT
o Echo
o CSF
56 Patient with coronary vasospasm (atypical angina o Diltiazem
vasospastic), how prevent that ? o Propranolol
o Nitrates
57 There was also cystic fibrosis question....lady who o 100%
is pregnant came to know the gender is female o 75%
what are the chances of baby getting CF o 50%
o 25%
58 45 yo Patient who develops in only 1 day o Anterior spinal cord
hemiplegia in his lower limbs power 2/5, syndrome
arreflexia, Babinski negative, what is the most o Spinal cord compression
likely cause ? o Infection
o Tumor
o MND
59 Lady under haloperidol treatment , her husband o Over dose
brought her to ER with fever of 40 degrees , o Allergic reaction
tachycardiac , hypotension o Neuroleptic malignant
syndrome
60 Female ,5wk amenorrhea with abdominal pain o ectopic pregnancy
and vaginal bleeding, uterus, B HCG 200-300 , o Hydatidiform mole
examination showed enlarged uterus , USG bulky o Threatened abortion
uterus with centric collection and adnexal mass o Pregnancy of unknown
location
61 patient has nose bleed recurrent epistaxis and o CT chest
headache , Upon exertion and headache and he o check for factor 8 and 9
has lower limb pain after exercise and weak o Xray
peripheral pulses as well, and the choices o Echo
included : o ECG
62 RTA with flail chest dull distended abdomen, Laparotomy
patient intubated and saturation improved, equal
air entry , next management
63 Which drug is not tocolytic : .oxytocin

64 Man with drooping of right eye and cant frown o Right facial n
and no sweat o Left facial n
 Which nerve involved o Right sympathetic chain
o Left sympathetic chain
o
Right Oculomotor n

65 One 72. Year old patient has tremor , coarse , o Parkinson

relieved by wine , doesn’t stop with action . o Normal for his age
Include the head . What is the cause ? o Essential

66 12 yr old , pneumonia like moderately severe o Discharge him

symptoms started with antibiotics. Chest xray o Admit in ICU for
shows pleural effusion (image given) observation
The baby was vitally unstable and desaturation o Surgical consult for chest
air tube insertion
What is the next beat step? o Chest CT
o Oxygen

67 1. Scenario of measles. Ques was what will help o Vit A

in mortality or morbidity? o Vit C
o Rabivirn
o IG
68 Lady with multiple cut wounds on her hand borderline personality
disorder
69 Mother with excessive worring about her kids in GAD
school
70 football player , His bp was 140/85 , What to do o Should we call him next
next week to measure his BP
o Should we not call at all
o Should we conduct other
test
71 One was 68 year old male diagnosed as age
pneumonia. Main reason to treat him as
inpatient
72 Lady with excessive investigations to rule out HIV hypochondriasis
despite doctor reassurance
73 Risk factor for Downs syndrome Increased mother age >40
74 Patient with productive cough , yellowish sputum o TB
, fever for 3 weeks , now become blood tinged , o Malignancy
weight loss 2 kgs
75 Man from sudan with pain in the end of the DeQuvrian
thumb of right hand
76 Question of mass in the vermis Medulloblastoma

77 Question of blue cells seen Ewing sarcoma

78 Depression and cardiac disease o fluoxetine
o TCA
79 Patient with neck pain in work Proper positioning
80 One with hypothyroidism symptoms amenorhea. o B HCG
Next best? o TSH
81 Old lady have long term history of constipation , Perforated diverticulitis
now had pain in the left lower abdomen , rigid
abdomen ,
82 RTA and was given 500 ml in ambulance ,what is don’t give epinephrine
the one bedside maneuver you shouldn’t do? because it will reduce the
tissue perfusion
83 White frothy vaginal discharge , Ph 5.8 and o Candida
inflammation was present too Acidic ph , H/o o Trichomonas
Burning & itching
84 chest infection and coughing with no product o RSV
What is the most likely organism o Strep pneumonia

85 pt came post appendectomy with fever and pain pelvic abscess.

near illiac fossa
86 a lactating lady with 4×4 cm fluid filled cyst in her o I And D
inner right breast o Antibiotics

87 lady with upper and lower limbs weakness. aspirin

.incoherent speech but got better after 2 hours,
what to give to prevent recurrent episodes ?
88 Patient with weakness in lower and upper limbs o Cerebral tumor
and in speech and other .intact sensation o Motor neuron disease
o Anterior column system
 o Spinal stenosis
89 Twin pregnancy lady wz hyperemesis o hypokalemia
gravidarum.. Which electrolyte affected? o hyponatremia
90 Which side of heart failure doesn’t lead to lower o Left sided heart failure
limb edema but lead to pulmonary edema , what o Compensated HF
is the cause o Right sided heart failure
o Biventricular HF
91 Medications to be avoided in hyperkalemia Spironolactone
92 Patient with central abdominal pain , radiating to o Mesenteric lymphadenitis
the right side of the abdomen , with pain in DRE , o Appendicitis pelvic
no raise in WBCs or Neurotrophilia , no rebound o Renal colic
o Diverticulitis
93 Man with back pain and decrease lordosis , works Work as tolerated
in police
94 Patient with displaced supra condylar humeral ORIF
fracture
95 Mother with breast cancer , refused biopsy and Beneficence
treatment , the doctor counselled her son
96 Child with abdominal pain and red jelly stool and Intersusseption
sausage shape mass in the abdomen
97 Patient who’s grandfather has hemophilia , which Female gender
thing in this patient will protect her from getting
hemophilia
98 Patient on TB medications , what vitamin must be B6 Pyridoxine
given
99 Patient Had IDA what lab result would be MCV < 80
expected in him?
100 What is the red flag for a patient with back pain Urinary symptoms

101 Young obese boy with pain in the hip radiate to Slipped capital femoral head
the knee , xray was provided
102 Patient who is exposed to chlorine while cleaning o PFT after 1 week
the swimming pool , already PFT was done , o N95 mask
what to do for him next ? o Give him PFM
o Avoid coming to work
103 Lady presented with dizziness and headache , o Sinus bradycardia
ECG was provided o 3rd degree heart block

104 man working in small space or something like o CO intoxication

that complaining of dizziness weakness I don’t o Relating with paint
remember if headache too , what is the cause of
his symptoms ?
105 Child with fever and rash and low BP , what is the o IV fluids
next step ? o Antibiotics
106 Patient is working in noisy environment , what is Yearly audiometry
your recommendations ?
107 Most common cause for secondary bone cancer o Skin cancer
o Lung cancer
o Bone cancer
108 You want to do a chemical survey on a factory to o Do questionnaire
detect the degree of hazards caused by this o Assess the material
chemical , what is the best way to do that o Check the ventilation
o Interview the workers
109 Lady presented with urine incontinence mostly o Stress incontinence
on coughing and sneezing , awakes her up in the o Urge incontinence
night 2 times , what is the most likely diagnosis ? o Total incontinence
110 Farmer presented with excessive lacrimation , Organophosphorus poisoning
increase salivation and diarrhea with miosis what
is the most likely diagnosis ?
111 Pregnant lady presented to ER after RTA , she FAST
have pneumothorax and thoracotomy ,what to
do for her
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