GENERAL MEDICINE

1. A young patient presents with jaundice and his liver function test was abnormal. He also has arthritis. What is the most LIKELY cause?
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Hepatitis A. Hepatitis B. Hepatitis C. Hepatitis E. Infectious mononucleosis.

2. Which of the following viral infection MOST LIKELY become chronic.

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Hepatitis A. Hepatitis B. Hepatitis C. Hepatitis E.

3. What is the cause for increased life expectancy at birth of females than males in Australia?
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Males exercise more than females. Genetic and biological differences. Females seek health care facilities more than males. Males die more in accidents and violence than the females. Employment stress is more for males.

4. A 36 yr old man who is a known ischeamic heart disease patient, complaints of recently increased frequency of chest pain. This episode is prolonged chest pain. Which is TRUE regarding this patient?
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Heparin is not indicated if ECG and enzyme are normal. Thrombolytic therapy is not indicated if ECG is normal. Repeat ECG is not indicated if not associated with pain. Stress test has to be done urgently. Serial enzyme assay has to be done even with chest pain.

5. A 40 yr old man, who is a known hypertensive presents with severe chest pain radiating to the back. His B/P was 180/120. Chest X-ray showed mild cardiomegaly with widening of mediastinum. He also had soft diastolic murmur along the left sternal border. ECG showed acute inferior infarction. What is the appropriate management?
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CTBG. Thrombolys the patient. Give Morphine, Beta-blocker and arrange for Trans oesophageal echocardiography. Give Intravenous heparin.

6. Commonest organism causing spreading cellulites is

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Group A streptococcus. Group B streptococcus. Gram-negative bacilli. Staphylococcus.

7. A 22 yr old man comes with jaundice; on examination he also has cervical lymphadenopathy. His liver function test was SGOT 450. SGPT 400. ALKP 200. GGT Bilirubin

250. 80.

Peripheral blood showed atypical lymphocytes. What is the MOST LIKELY diagnosis?
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Hepatitis A. Hepatitis B. Infectious mononucleosis. Cytomegalo virus. Hepatitis C.

8. What is the causative of Herpes zoster?

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HSV 1. Vareola. HSV 2. Varicella. EBV.

9. A Patient with WPW syndrome has broad complex tachycardia with atrial fibrillation. What is the management?
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Digoxin. Verapamil. DC Cadioversion. Beta-blocker. ACE inhibitors.

10. A 69 Yr old man presents with temporary memory loss and blurring of vision for 10 minutes duration. Where is the lesion?
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Vetebrobasilar insufficiency. Transient global amnesia. Carotid artery stenosis. Dementia.

Middle cerebral artery thrombosis. A 28 yr old female Diabetes patient presented with history of fever and increased frequency of urine. After taking urine for culture she was treated with I.V Ampicilln and Gentamycin subsequently culture report showed E.Coli, which was sensitive to both Gentamycin and Ampicillin. She is still having fever and same urinary symptoms. Blood culture revealed motile E.coli. What would be the most likely cause for her symptoms? In vivo resistance of the organism. Perinephric abscess. Papillary necrosis. Inadequate dosage. Infection somewhere else in the body.

11.

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12.

A 65 yr old man presented with confusion. His plasma sodium was 168-mmol and urine osmolality 205 (50 200) what is the cause for his results? Addisons disease. Compulsive water drinking. Diabetes insipitus. SIADH. Congestive cardiac failure.

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13.
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Which of the following is NOT usually a presentation of Mycoplasma pneumonia. Pleuritic chest pain. Fever. Headache. Severe cough.

14.

A 60 yr old lady, lost ten-kilogram weight over the past 6 months. What is the LEAST LIKELY cause? Depression. Carcinoma of pancreas. Non- insulin dependant diabetes. Hypothyroidism.

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15.

On examination of a 70 yr old lady there was generalized lymphadenopathy and splenomegaly. Her only complaint was abdominal discomfort. What is the MOST LIKELY diagnosis? Acute lymphoblastic leukemia. Acute myeloid leukemia. Hodgkins lymphoma.

a b c

Infectious mononucleosis. Chronic lymphocytic leukemia. 16. All are side effect of corticosteroid EXECPT.
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Hirsuitism. Lymphopenia. Osteomalasia. Leucocytosis. Cushings syndrome.

17.
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Regarding HIV which of the following is correct. Usually develops after two years of infection. Most of the opportunistic infection occurs with generalized lymphadenopathy. Monthly Pentamidine nebulisation reduces the incidence of opportunistic lung infection. Antibodies will develop within a mean period of nine year after infection.

18.
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In a suspected HIV patient, what is the advice you will give? Usually seroconverts within 3 months. Should avoid sexual contact. Chance of transplacental infection is 75%.

19.

Twelve years old school girl suddenly collapsed at school. She was brought by ambulance with dextrose drip 60/ml min. On examination of her, dolls eye reflex were present but she was not responding to painful stimulus. Her vital signs as follows Resp. rate 14/min. Pulse rate 50/min. SaO2 100 %. B/P 180/ 110. (?) If you are working in a tertiary hospital. What is the NEXT step of management?

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Arrange for urgent CT scan. Stop her dextrose infusion and start on saline. Give steroids. Intubate the patient. Neurosurgical reference.

20.

A hypertensive patient present with haematuria (Glomurular nephritis picture) On investigation of urine, which of the following will confirm the diagnosis? Erythrocyte cast. Granular cast.

a b

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Hyaline cast. Proteinuria.

21.
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The diagnosis of chronic renal failure is confirmed by presence of Haematuria. Small size kidney. Hypertention. Proteinuria. Anaemia.

22.

A 48 yr old female, who is a smoker complaints of dyspnoea. She has a past history of exposure to asbestosis ten year ago. On investigation her total lung capacity was 145% of normal expectancy. Diffusion capacity was 25 %. On examination, she had widespread wheeze over lung field. What is the diagnosis? Chronic bronchitis. Emphysema. Asbestosis. Asthma. Carcinoma of bronchus.

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23.

A patient present with dyspnoae .On examination, percussion note was dull on the right lower lobe, and bronchial breath sound heard on the mid zone. What is the most likely cause? Rt. Lower lobe consolidation. Rt. Pleural effusion. Rt. lower lobe collapse. Lt. side pneumothorax.

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24.
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Pulmonary embolism is associated with all of the following EXECPT. Pleural rub. Decrease second heart sound. Bronchial breathing. Syncope. Hemoptysis.

25.
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All of the following indicate severe mitral stenosis EXCEPT. Opening snap. Pre systolic crescendo murmur. Presence of S3. Loud S1.

Atrial fibrillation.

26.

A patient with mitral stenosis with mid diastolic murmur, present with atrial fibrillation and cardiac failure. Which of the following statement is correct regarding his management. No antibiotic prophylaxis before tooth extraction. Wafarin is only indicated if patient has TIA and atrial fibrillation. Mitral valvulolasty has to be done. Captopril should be given.

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27.
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About Keratoacanthoma, which is correct Slow growing tumour with spontaneous resolution. Fast growing tumor with spontaneous resolution. Never undergo spontaneous resolution.

28.
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Which is the correct combination of antibodies with disease. Anti smooth muscle antibody - Primary biliary cirrosis. Anti mitochondrial antibody Chronic active hepatitis. Anti ribonuclear protein Sjogren's syndrome. Anti acetylcholine receptor antibody Myasthenia gravis. Anti nuclear antibody Thyroiditis.

29.

A chronic inflammatory arthritis patient presents with anemia. And investigation showed Hb 10 gms % Sr.Fe 6 (12-15). TIBC less than normal. MCV 80 (80-90) Ferritin820 (very high) Transferrin - Low normal range. What is the MOST LIKELY cause for this patients anemia?

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Anemia of chronic disease. He is probably Iron deficient. Megaloblastic anemia. Hemochromatosis.

30.

A man presents with pain on the right knee for the past two days duration. On aspiration of the knee the fluid was cloudy. Microscopic examination showed polymorphs 500/mm cube. No organism seen. What is the probable diagnosis? Rheumatoid arthritis.

Septic arthritis. Gout. Reiters disease. Ankylosing spondylititis. 31. Anterior uveitis is commonly found in
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Reiters syndrome. Sjogrens syndrome. Ankylosing spondilitis. Rheumatoid arthritis.

32.
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Which of the following is NOT typical of duodenal ulcer? Nocturnal pain. Pain relieved with antacids. Hunger pain. Loss of appetite. Epigastric pain.

33.

A female patient has reflux oesophagitis, not responding to H2 receptor antagonist. She also complaints that her fingers are changing color when immersed in cold water. What is your NEXT step of management? Ranitidine. Fundoplication. Omeprazole. Pneumatic dilatation of esophagus. Octreotide.

a. b.
a b c

34.
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Regarding Paget's disease what is TRUE Hypercalciuria is always present. Alkaline phosphatase is usually elevated. Osteosarcoma is a common complication.

35.
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Which is the LEAST appropriate statement about chronic asthma Will not usually present after fifty years of age. Hypersensitivity to bronchial stimulus.

36.

A 46 yr old female present with pain and proptosis of her left eye. What is the probable diagnosis?

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Cluster headache. Sinusitis. Retro orbital tumor. Temporal arteritis.

37. A lady presents with headache that occurs premenstrual, and the pain starts from the occipital spreads towards the left frontal region. The pain is aggravated on walking and she is irritable, (photophobia) is present. What is the MOST LIKELY cause?
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Tension headache. Premenstrual tension. Migraine without aura. Cluster headache. Temporal arteritis.

38.

A patient presents with fourth attack of gout with pain in the knee joint. What is the management of this patient? Paracetamol. Probenecid. Indomethacin Allopurinol.

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39.
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What is true about heparin-induced thrombocytopenia? Bleeding. Thrombosis. Nuetropenia. Eosophilia.

40.
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All are true regarding hemolytic anemia EXCEPT. Increased Iron absorption. Reduced MCV. Increased urobilinogen.

41.

Which of the following drug will NOT increase the pressure gradient in hypertrophic obstructive cardiomyopathy. Digoxin. ACE inhibitors. Diuretics. Verapamil. Vasodilators. Reduction of hypertension is most important in which of he following

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42.

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Coronary heart disease. Ischemic stroke.

43.

A 65 yrs old man presents with sudden weakness of Lt. Upper limb. He almost recovered completely from it. On examination, you find only mild weakness of the limb. Which is following would be cause for his symptoms? Rt. Sided lacunar infarct. Lt. Sided lacunar infarct. Middle cerebral artery infarct.

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44.
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In polycythemia, which is not commonly found? Reduced amount of Leucocytes. Bleeding. Thrombosis. Increased platelet. Splenomegaly. Which of the following is more suggestive of tuberculous pleural effusion. Increased lymphocytes. Decreased glucose. Increased protein. Severely blood stained.

45.
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46.
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The features of lower motor neuron lesion are. Muscle weakness, wasting, fasciculation, hyper reflexia. Muscle weakness, wasting, hypotonia fasciculation and decreased reflex. Hypotonia, increased muscle mass, fasciculation and decreased reflex. Muscle weakness, rigidity and increased reflex and absent abdominal reflex.

47.

A 58 yr old man accompanied by his wife to the hospital with bruises seen on his head. She complaints that her husband was binge drinking for past one week. On examination he was confused, and had extensor plantar reflex. What is the probable diagnosis? Hepatic encephalopathy. Korsakovs psychosis. Central pontine myelinosis. Subdural hematoma. Dementia.

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48.
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IgA nephropathy what is the usual presentation. Hematuria, rashes over the buttocks and legs. Hypertention, hematuria, sore throat two weeks before. No hypertension, hematuria, history of sore throat two weeks before.

49.
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Lesion in the basal ganglia can cause all of the following features EXCEPT. Dystonia. Ataxia. Akathesia. Dyskinesia. Chorea.

50. A pt. presents with early morning stiffness, which is relieved with activity (h/o Polymyalgia Rheumatica).
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Muscle weakness. Mild synovitis. Fever. Depression.

51.
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Which of the following is NOT a clinical feature of hypothyroidism? Pelvic girdle weakness. Tremor. Small muscle weakness. Palpitation.

52.
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Trigeminal neuralgia can be best treated with which of the following drug Tricyclic anti-deppresants. Phenytoin. Carbamezepine.

53.
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Urinary stones MOST COMMONLY formed in acid urine are. Magnesium ammonium phosphate. Xanthine. Phosphate. Uric acid. Oxalate.

54.

A 64 yr old man complaints of diarrhea for the last three months duration. Which is the LEAST LIKELY cause for his diarrhea. Campylobacter jejuni. Carcinoma of colon. Giardia lamlia. Surreptitious use of laxatives.

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55. In which of the following conditions, hypoxia can be corrected completely by giving 100% oxygen.
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Lung disease. Cyanotic heart disease. Methhaemoglobinemia.

56.
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Regarding tuberculosis, which is true Mantouex test is usually negative in milliary tuberculosis.

57.
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Diabetes mellitus is associated with all of the following EXCEPT. Acromegaly. Prolactin secreting pituitary tumor. Hyperthyroidism. Hemochromatosis. Cushings syndrome.

58.
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Which of the following drug causes hyperkalemia as a side effect Thiazide. Captopril. Beta-blockers.

59.
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Stag horn calculi can be associated with all of the following EXCEPT. Hyperparathyroidism. Hypercalciuria. Prolonged immobilization. Gout. Chronic infection.

60.

A 45 yr old lady presents with palpable lump in her Lt. breast. Which of the following statement is correct regarding her lump? It is considered to be a carcinoma unless proven otherwise.

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61.
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Erythema nodosum occurs in all of the following EXCEPT. Sarcoidosis. Tuberculosis. Yersenia infection.

62.

A picture showing a brown lesion in the arm and forearm, hypo-pigmented areas had no pinprick sensation. What would be the probable diagnosis? Sarcoidosis. Burns. Vitiligo. Leprosy.

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63.

A picture showing crops of lesion over the right eyelid of a 10 yr old child. What would be the probable diagnosis? Skin tag. Warts. Molluscum contagiosum. Nuerofibromatosis.

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