PYQ Test & Discussion
MEDICINE
By - Dr. Santhosh Patil
A woman in her early forties was taking analgesics regularly for headaches for the past
6 months. The intensity of headache increased in severity for the last 3 days and
reduced when she stopped taking the analgesic. Likely diagnosis is?
Acute 12
A. Cluster headache Doc-Oxygen
B. Tension headache DOC-NSAIDS
C. Chronic migraine DOC-Triptans
D. Medication overuse headache
MICK RHD
A known case of mitral stenosis presented with breathlessness and chest pain in her
early twenties. On examination, the pulse was irregularly irregular. On
echocardiography, no thrombus was found. Best agent to prevent future thrombotic
events is?
"A
A. Dabigatran fibrillation
s
used risk of
B. Aspirin 150mg Doc for Strok 2 .
anticoagula Decision about
anticoagula
2
C. Oral warfarin I RID
is based on CHA2DSVASC
metallic
E pts
prosthetic Score
D. Aspirin + Clopidogrel values
without
antiway
~
directly
Start
looking & CASAS if A fib ii) occurs
HCM
in >
-
i) Rheumatic valvular heart dis
iii) PreviousStroke ITIA .
Patients presenting with a mid diastolic murmur and JVP showing prominent a-waves,
most likely diagnosis is?
i
IL -
Prominent a
A. Tricuspid stenosis >
- Mid diastolic (5 I Tricuspid
stenosis
Murmux --
ii) RV H
diastolic
B. Mitral stenosis * >
-
Mid
iii) PS
muxmux
C. Mitral regurgitation X >
- Pan systolicmumU = Canon 'al
AX dissociation
D. Tricuspid regurgitation >
-
Pansystolic murmur
9) AX blocks
b) XT /V . ib
A chronic alcoholic patient presented with abdominal distension, swelling of legs and
reduced urine output. Serum creatinine was 1.6 mg/dL. What is the next line of
management in this patient?
Asis] Dec . cirrhosis of liver a
Hepatorenal syndrome
.
A. Methylprednisolone
feclic
L
B. Heparin Can be hepatitis
used for Terlipressiv
Autoimmune Hepatitis is preferred
C. Torsemide over octreotide
Avoid in MRS pts
D. Octreotide plus albumin
causes
-
DOC
for MRS
I
Splanchnic vasoconstriction
I
&
A 72-year-old man was brought in with complaints of cough with yellowish sputum. On
* X
examination, RR- 20/min, BP-110/70 mmHg, not confused and hemodynamically
stable. Lab reports showed urea levels of 44 mg/dL. What is the next best step in the
- -
management of this patient? &
is : A P
A. Give antibiotics and send the patient home
Decision about
-
B. Consider admission in a non-ICU setting Vs OP R,
admission
based on
C. Admit to ICU with invasive mechanical ventilation CISRB-65
PSI
D. Admit to ICU without mechanical ventilation ↓
Prefered
0-1-OP R
,
IP 12
2 -
3
>
- ICU
Diurnal variation
↓
A 29-year-old man complained about excessive fatigue by the end of the day that
improved with rest. History of ptosis, difficulty in speech and swallowing was also
mentioned. Most likely diagnosis is?
A. Myasthenia gravis hallmark of
NM) disorders
B. Duchenne muscular dystrophy
MG :
EDD
C. Lambert-Eaton syndrome
weakness maximal
by
LEMS :
weakness maximal in
D. Systemic lupus erythematosus the
morning
Trousseau sign
Carpo-pedal spasm was developed in a woman suffering with hysteria when she was
hyperventilating. What could be the likely cause for this?
It
ypocalcemia
sis :
-ysterical hypeentilation
A. Respiratory alkalosis Hypaventilation
↓
B. Metabolic alkalosis CO2 wash out
Respiratory
& Alkalosis
C. Respiratory acidosis
Shift of
Cat2 from Extracellular
D. Metabolic acidosis to intracellular
circuit ↓
R - Closed o
breathing e bag
Hypocalcemia
.
A woman is admitted due to persistent vomiting and is a known case of diabetic.
History of consuming outside food was given. On evaluation, blood pressure is 90/60
mmHg. Her arterial blood gas (ABG) report shows the following findings. What is the
cause of her ABG findings?
pH- 7.52 huh
- (N) pl
HCO3-30 meq/L
PaCO2-20 mmHg . 35
7 7 45
- .
< 7 35 > 7 45
NA.123 mEq/L
.
- -
K- 3.2 mEq/L Acidosis Alkalosis
Cl-67 mEq/L
A. Diabetic ketoacidosis X
-
B. Septic shock -> Lactic
acidosis
- C. Persistent vomiting
D. Renal tubular acidosis X
-
A chronic renal failure patient who was on dialysis brought to the casualty when he
collapsed suddenly .On examination, labored breathing was noticed. ECG shows tall
tented T waves. Most likely acid-base imbalance that can be seen in this patient?
MIK Acid base disin CKD
Hyperkalemia acidosis
Metabolic
A. pH-7.4, HCO3-27 mEq/L, pCO2-40 mmHg
B. pH-7.14, pCO2-20 mm Hg, HCO3-34 mEq/L
C. pH-7.54, HCO3-27 mEq/L, pCO2-34 mm Hg
D. pH-7.14, pCO2-20 mm Hg, HCO3-5 mEq/L
-
Sclerosis -
A woman presented with the feeling of tightness on her face and numbness of her
fingertips. The antinuclear antibody (ANA) is found to be positive and
I
immunofluorescence shows the nucleolar pattern. What is the likely diagnosis?
A. Rheumatoid arthritis Ray hand's
Phenomenon
B. Sjogren’s syndrome
IK death
C. Systemic lupus erythematosus > ILD
in SSC >
-> PAH
D. Systemic sclerosis
A woman in her mid forties, who has a known case of hypertension, was brought to the
emergency room with loss of consciousness, chest pain, and diaphoresis. Bilateral
pulses were un-equal and she was grossly unstable. ECG showed nonspecific ST-T
changes. What is the next best investigation?
A. MRI
Asis-Dissection of
- aorta
B. Cardiac enzymes L
IOC >
-
CT angio
&
Alt-
Transesophageal
>
C. Transoesophageal echocardiography
echo
D. X ray -
CT EE)
A patient presents with a seizure. On evaluation, urine osmolality is 1000 mOsm/Kg
and serum osmolality is 270 mOsm/Kg. Expected electrolyte abnormality can be?
(N) serum
osmolality = 250-294
mOsmo/IL .
A. Hyponatremia
B. Hypernatremia
S . osmo = 2 (Nat)
+
C. Hyperkalemia
(N) Nat-135-145mmol/L .
D. Hypokalemia
Clinical presentation with feeble femoral pulses associated with upper-limb blood
- -
pressure of 186/90 mmHg and chest X-ray showing enlarged intercostal arteries, what
is the likely diagnosis?
rib
notaling
A. Bicuspid aortic valve
Asis-Coarctation of
B. Atrial septal defect aorta
C. Coarctation of aorta
D. Patent ductus arteriosus
supplies lat wall.
A circumflex artery bypass was performed on a patient who is a known case of
-
atherosclerosis . Stent placement was successful. He was already taking lisinopril,
-
verapamil, and metoprolol. Now which drug should be added?
- -
TAPng
IHD
>
A. PDE 5 inhibitor
-
& 1yr
Antiplatelet S
tiplatelets
-
&
B. P2Y12 receptor blocker clopidogrel ~
-blockers
-
~
ACEi(ARBs ~
C. Direct oral anticoagulant Nitrates
T
~
-
-
P2412
D. PDE 3 inhibitor I
Present as
↑ Episodic N E
palpitations
All of the following statements are true regarding pheochromocytoma except?
Temors secreting
catecholamines
Adrenaline/
A. Propranolol is given initially to manage hypertension noradrenaline
dopamine)
B. Surgical excision is the definitive treatment
Definitive 1 =
Surgery .
C. Diagnosed by urine VMA & catecholamines DOC
↑ referred Inv for screening ! Antihypertensive : -
x blockers
Urine MNINMN -
D. Can present as hypertension alone and sometimes with vomiting and pain (started
abdomen
- - - -
- -
first)
-
↓
B-blockers
Later
What should be the first-line of treatment for the patients diagnosed with giant cell
-
arteritis presenting with headache, jaw claudication, polymyalgia rheumatica, and
mononeuritis multiplex?
12-6
against
MAb
A. Tocilizumab
2nd line
B. Steroids agents
C. Abatacept >
CTLA-Eg
-
D. Aspirin >
-
Add on
R
↓ is chemic events
A 49-year-old man presented with a history of recurrent retrosternal chest pain with
--
each episode lasting for 3-5 min and subsiding with sublingual nitrate. ECG shows left
- -
-
-
ventricular hypertrophy and flat T-wave. He is a known case of hypertension, diabetes
- - - - -
mellitus, hypercholesterolemia currently on aspirin, atenolol, metformin, and
- - --
lovastatin. What is the next best step in management?
-
:
A. Increase the dose of beta blocker Unstable Angina
For UANSTEMI *
Angina at rest
-
B. Injection enoxaparin
-- -
Angina not relieved
by
rest/nitrates <5 mins
.
C. Add clopidogrel
Asis :
Stable Angina
control -blockers/
D. IV glyceryl trinitrate infusion Symptom
>
↑
-
->
CBs/nitrates
for HANSTEME
STEMI
·
Prevention of MACE- > Antiplatelets
stating
A known case of diabetic who is non-compliant with medication presented with
-
vomiting and abdominal pain. On examination, she was dehydrated. RBS 500 mg/dL
- - - -
and ketone bodies were 2+ on dipstick. Next line of management is:
-
Asis : DKA
A. Intravenous fluids with long -acting insulin
Aug fluid
B. Intravenous fluids GL
.
deficit >
-
C. Intravenous fluids with regular insulin
D. Intravenous insulin
The fluid analysis of cerebrospinal fluid (CSF) specimen showed mononuclear cytosis,
elevated proteins, low sugars and the microscopic picture is as below. Most likely
etiology is:
Pyogenis/bast
Tubercular
meningitis
meningitis
A. Chemical meningitis
B. Aseptic meningitis
C. Bacterial meningitis
D. Tuberculous meningitis
I
Cob well
In retro positive patients who are on highly active antiretroviral therapy, the parameter
used to monitor treatment efficacy is:
NACO/WHO
guidelines
A. CD4+T cell count
AART >
rec
for all
pts
.
B. p24 antigen
C. Viral load
D. Viral serotype
-
What is the drug of choice for acute management for unilateral headache associated
with nausea, photophobia, and phonophobia in female patients?
Tension type - BIL
Seasonality/Autonomiche
·
Migraine
A. Sumatriptan Alcohol
Y
precipitates
m> F
·
Aura Cluster
B. Flunarizine UIL
pref
Photophobia SUNC/SUNA
Her
C
·
Phonophobia Paroxysmal Hemicrania >
Excellent
C. Propranolol -
-
·
Nameal response
vomiting
to INDOMETA
for
D. Topiramate Llasting
Cutaneous
seconds
touch-precipitates
-
CN .
e
preventive R of migraine ·
A patient was brought by relatives with sudden onset breathlessness. He is a known
case of hypertension who is non-compliant with medication. On chest X-ray, the picture
-
is as shown below. Next line of management is:
Hi presenting
A. Nebulization with salbutamol accele
-
pulm
.
&
B. Intravenous nitroglycerine
edema
LVF
C. Intravenous salbutamol heart
Acute
failure)
D. Oxygen and antibiotics
A woman in her thirties presented with fever associated with night sweating. On
-
examination, ptosis and bilateral facial nerve palsy was found. Investigations showed
- -
leukocytosis and bilateral hilar lymphadenopathy. Most likely diagnosis is?
- - - -
- - -
A. Hypersensitive pneumonitis is of Sarcoidosis
B. Tuberculosis i) R/o Tb
C. Lymphoma
affected ii) 5 .
Ped
ACE
MI ii) Biopsy do of non-creating
- LungsK granulomas of affected
D. Sarcoidosis
und tupus organs
or sarcoidosis
specific
n pernio nuclear
imaging (Pand/Lamb a,a
A CT scan of a woman who is 37 years old, presented with fever, breathlessness, and
cough with expectoration is as shown below. Most likely diagnosis is?
A. Pleural effusion
B. Mediastinal mass
C. Consolidation with air bronchogram
D. Diaphragmatic hernia
chogran
See radiological
consolidation
finding for
A patient who ingested ten tablets of paracetamol was brought to ED. He has
developed oliguria and liver function tests show deranged values. Which of the
following can be used in the management of this condition?
A. Ursodeoxycholic acid
B. Dopamine Decision to use NAC
is based on S .
pct
C. N- acetylcysteine levels plotted on a
graph >
-
mack Mathew
D. Furosemide
-
Nomogram
An MRI scan of a non-pregnant female with complaints of galactorrhea, revealed a
large pituitary tumor and who is not willing for
S surgery, which of the following is the
best drug for treatment?
rancy
in
Pref . Asis-Prolactinoma
A. Bromocriptine Cabergoline ↓
R of
S choice
Regardl e s
o
pered
& themo
B. Promethazine
Pro choice pamineConists .
size
C. Octreotide
D. Clozapine
The jugular venous pressure (JVP) findings in patients presenting with an irregularly
- -
irregular pulse of 120/minute and a pulse deficit of 20 is:
- - -
Fib
Asis : A
- Pulse deficit =
HR-Culerate
A. Absent a wave ↓
Asculta Palpation
B. Absent p wave
(N) PD < 10/min
C. Cannon a wave
MICK for
> 10/min -
A .
fib
.
D. Raised JVP with normal waveform
Y
A chronic liver disease patient presented with abdominal distension, jaundice, and
-
pruritus. Ascitic fluid analysis revealed neutrophil count >650 per cubic mm. What is
the most likely diagnosis?
Ascitic fluid
A. Intestinal obstruction PON count)
250/mm3
B. Malignant ascites
C. Tubercular ascites
D. Spontaneous bacterial peritonitis
DOC
/C organism
S - Intestinal I7
E Co)i
.
-
Ceftriaxone
--
bacteria .
A patient presented with yellowish discoloration of skin and sclera. On evaluation,
bilirubin and alkaline phosphatase levels are elevated. Remaining liver enzymes are in
- - -
normal range. What is the likely diagnosis?
S
Obstruction
A. Hepatic jaundice
B. Hemolytic jaundice -value
C. Obstructive jaundice
D. Prehepatic jaundice
A male patient presented with weakness. Drug history of diuretics intake is present.
ECG showed flat T waves and prominent U waves. What is the most likely diagnosis?
A. Hyperkalemia
B. Hypokalemia
C. Hypomagnesemia
D. Hypernatremia
A patient was brought to the emergency department. The arterial blood gas report is
as follows: pH, 7.3; pCO2, 79mm Hg; and HCO3, 39 meq/L. Which of the following is the
most likely diagnosis?
A. Respiratory acidosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis
All of the following are seen in MEN 2B syndrome except:
A. Parathyroid adenoma
B. Megacolon
C. Mucosal neuroma
D. Marfanoid habitus
A known case of a coronary artery disease patient was brought with chest pain and
palpitations. ECG is as shown below. Next line of management is?
A. Oral metoprolol
B. Intravenous amiodarone
C. Oral amiodarone
D. Intravenous metoprolol
Multidrug-resistant (MDR) tuberculosis shows resistance to which of the following
drugs?
A. Isoniazid and rifampicin
B. Fluoroquinolones
C. Isoniazid, rifampicin, and fluoroquinolone
D. Isoniazid, rifampicin, and kanamycin
A patient presented with fever, jaundice, and malaise. Based on the serology reports
given below, most likely diagnosis is?
Anti-HBc (IgM): Positive
HBsAg: Positive
Anti-HBs: Negative
Anti-HCV antibodies: Negative
A. Acute hepatitis C
B. Acute hepatitis B
C. Chronic hepatitis B
D. Chronic hepatitis C
Accidentally a child swallowed 10-20 ferrous sulfate tablets and was brought to the
emergency department. Arterial blood gas revealed acidosis. Following can be used in
the management of this condition?
A. Deferoxamine
B. Activated charcoal
C. Dimercaprol
D. Penicillamine
A farmer was brought to the emergency with a history of OP poisoning, managed with
atropine and pralidoxime. After a few days, he developed a high fever. The likely cause
would be:
A. Side effect of pralidoxime
B. Atropine Overdose
C. Symptoms of organo-phosphorus poisoning
D. Aspiration pneumonia
A lady noticed that her husband was being unable to express emotions. He also had
tremors and slowness of gait. The possible site of lesion would be:
A. Cerebellum
B. Basal ganglia
C. Hippocampus
D. Premotor cortex
A patient presented with chest pain radiating to the interscapular area. The BP in the
left arm was 180/100 mmHg and in the right arm, 120/90 mmHg. The chest X-ray
revealed mediastinal widening. The most probable diagnosis would be:
A. Aortic dissection
B. Esophageal stricture
C. Pulmonary embolism
D. Foreign body in trachea
From the image given below, identify the murmur depicted:
A. MR
B. AS
C. PR
D. TS
What will be the role of tPA in the management of myocardial infarction?
A. Fibrinolysis
B. Inhibit platelet aggregation
C. Inhibit thrombin
D. None of the above
A patient, who was on treatment for hypertension, developed hyperkalemia. The ECG
has been depicted below. Which of the following drugs can cause this side effect?
A. Spironolactone
B. Hydrochlorothiazide
C. Metoprolol
D. None of the above
A resident of Delhi had fever for 5 days, platelets were 20,000/cu.mm, WBC counts <
3000 and there were bleeding episodes with increased BT and petechiae. The most
likely diagnosis would be:
A. Scrub Typhus
B. Dengue
C. Malaria
D. Typhoid
An elderly male presented with prior MI and ventricular tachyarrhythmia treated for 4
years with medications. He had a dry cough, dyspnea and fatigue for the past 3 to 4
months. He also developed hypothyroidism. The drug responsible for this condition
would be:
A. Amiodarone
B. Lisinopril
C. Metoprolol
D. Furosemide
A 50-year-old male, a chronic smoker, presented with pain in the right arm. On
examination, ptosis was noted. The chest X-ray revealed an image as depicted below.
The most likely diagnosis would be:
A. Pancoast tumour
B. Cervical radiculopathy
C. Brachial plexus injury
D. Carpal tunnel syndrome
