MEDICAL

1.A 63 yr old man is admitted with to the cardiology ward with infective endocarditis .Blood culture grow streptococcus bovis .what is the most appropriate investigations given the blood culture findings?

A) Small bowel meal
B) Colonoscopy
C) Cystoscopy
D) Gastroscopy
E) Bronchoscopy .

2.A 56 yr old female presented to her for soft nodules on extensor tendons and corneal arcus .The most appropriate investigations for the diagnosis of underlying disease is

A) BSL +urea
B) BSL + FLP
C) HbA1C
D) Only BSL

3.The most accurate test for Haemochromatosis is
A) liver biopsy and C282Y gene
B) liver biopsy and ferritin level
C) Serum iron and ferritin
D) Serum iron, ferritin and TIBC level .

4.A woman of reproductive age developed venous thrombosis of lower limb . She gave history of taking some tablets regularly .The most likely medication she was taking was ?

A) Antidiabetic medicine
B) OCPS
C) Asprin
D) Thyroxine

5.A 23 yr old patient presented with high grade fever , abdominal pain and rose spots .A diagnosis of Typhoid fever was made. Ceftriaxone was started ,but fever still present after 3 days .what is the most likely drug add to treat this case ?
A) Vancomycin
B) Azithromycin
C) Ciprofloxacin
D) Enoxacin

6.A 53 yr female was brought to the emergency in semicomatosed condition .On physical examination pulse 96/mint. B.P 160/105mmHg temperature 99.6F .Blood sugar level 25mmol/litre .what is the most likely diagnosis

A) Addison disease
B) DKA
C) HONK (Hyperosmolar non ketotic coma)
D) Renal failure
E) Spironlactone therapy .

7.A 67 Yr old male patient a known case of CLD presented with shortness of breath, ascites and drowsiness .Patient is on diuretics .what is the most likely cause of these symptoms ?

A) Furosemide
B) Spironlactone
C) Mannitol
D) Acetazolamide.

8. A 56 yr old male patient present with severe chest pain radiating to left shoulder .On ECG ST elevation present in II.III.AVF. On angiography triple vessel disease .what is the most likely treatment ?
A) PCI
B) CABG
C) Angioplasty (Ballon dilation)
D) SK..

9. A 75 yr old a known case of diabetes and HTN is found to be AF. He reports no history of palpitation or dyspnoea .After discussing treatment options he elects not to be cardioverted .I f the patient remains in chronic atrial fibrillation .What is the most suitable treatment to offer?

A)Asprin
B) Warfarin
C) No anticoagulation
D) Warfarin plus asprin
E) Heparin .

10. The mother of a one and a half year old child gives history of a white reflex from one eye for the past 1 month. On computed tomography scan of the orbit there is calcification seen within the globe. The most likely diagnosis is:
A. Congenital cataract
B. Retinoblastoma
C. Endophtalmitis
D. Coats disease

11. A 10 yr old female presented with one day history of high grade fever and drowsiness .On examination her temperature was 104F and neck rigidity positive .A diagnosis of meningitis was suspected and lumber puncture was performed .The most likely finding in CSF

A) PMN inc, Lymphocyte Inc , Proteins inc
B) PMN inc, Lymphocyte N , Proteins inc
C) PMN inc, Lymphocyte Inc , Proteins N
D) PMN N, Lymphocyte Inc , Proteins inc

12. A 73 yr old woman is reviewed in the pre.op clinic prior to an elective hip replacement .Her past medical history includes polymyalgia Rheumatica and IHD. Screening blood tests are ordered and CBC is reported as follows HB 12.9g/dl , PLT 158*10-9/l, WBC 19.0*10-9/l , neutrophills 4.2*10-9. Lymphocyte 14.1. what is the most likely diagnosis?

A) AML
B) CLL
C) Aplastic anaemia
D) CML
E) ALL.

13. Treatment of choice in lupus nephritis is
A) Cyclosporine
B) Cyclophosphamide
C) Prenisolone
D) Methylprednisolone

14. Regarding mortality of CCF one of the following option is correct?
A) Lisinopril-25-30%
B) Atenolol -25%
C) Asprin 29%
D) All of the above

15. Orthostasis is defined as
A) More than 10 point pulse increase when patient goes from supine to the standing position.
B) > 15 points drop in systolic B.P on a change in position
C) > 10 points drop in systolic B.P on a change in position
D) More than 20 point pulse increase when patient goes from supine to the standing.

16. If patient already taking metformin and sulfonylurea ,yet there is still poor glycemic control then

A) Add Glitazones
B) Switch to Insulin
C) A,B
D) Add Retaglinides

STEP1 Qs 14-09-2014
• classify joints. Formation of shoulder joint. Movements of shoulder joint.
• epithelial lining of respiratory tract. Histology of larynx.
• scenario of TOF followed by a question: describe anatomical defects in Tetralogy of fallot
• names of basal ganglia. Write down a pathway of Parkinson's disease.
• Nervous and humoral mechanisms of BP regulation.
• def hemostasis. Hemophilia.
• etiological classification of anemia.
• def glycogen. Write down glycogen metabolism.
• Def fatty change. Give etiology and pathology of fatty liver.
• def healing and repair. Discuss healing by 1st intention.
• Discuss app. methods of sterilization of surgical instruments and glassware in a hospital.
• Scenario abt a person with recurrent attacks of breathlessness: which type of Ab is expected to be increased? Classify immunity.
• scenario of a person suffering from malaria and doc has prescribed him chloroquine. Give mechanism of action and dose.
• names of beta-lactam drugs. Mechanism of action of penecillins.
• forensic classification of a wound. Discuss features of typical gunshot wound.
• a case of vitriolage has come to u, how will you manage her?
• Non Communicable Disease which are leading cause of immediate death in pakistan. How to control and prevent them?
• Def balanced diet. Discuss macronutrient and micronutrient.
• Indicators of maternal and child health.

Part. 2 Clinical SUBJECTS
1—A 45 yr old woman is investigated for weight gain . She had been unwell for around four months and described a combination of symptoms including depression ,facial male pattern hair growth and reduced libido .During the work up she was found to be hypertensive with a blood pressure of 170/100mmHg .
A) What is the most likely diagnosis ? Cushing syndrome B) Enlist two most important investigations for confirmation ,and which test is most sensitive. Dexametasone, test 24 hr urinary free cirtisol.C) How will you manage this case?

2—A 39 yr old man is admitted to hospital with decompensated liver disease of unknown aetiology .As part of a liver screen the following results are obtained . Anti HBs positive , Anti HBc negative , HBsAg negative .
A) What is this man hepatitis B Status ? Hep B recovery phase B) How will manage hepatic encephalopathy.

3—A 40 yr old woman who is known to be HIV positive is admitted to the emergency department following a seizure . Her partner reports that she has been having headache , night sweats and a poor appetite for the past four weeks . Blood tests and a CT head are arranged CD 4cells 89u/l , CT head single ring enhancing lesion in the right parietal lobe .
A) What is the most likely diagnosis ? B) Enumerate the opportunistic infections of AIDS . C) Describe the treatment of above case ?

4—A 29 yr old man demands a CT scan of his abdomen in clinic .He states it is obvious he has cancer despite previous negative investigations .
A) what is the most likely diagnosis? Manchuhansen syn B)How will you treat above case? And Enlist the complications of TCAs

5—A 23 yr old man presents with a three day history of general malaise and low grade temperature .Yesterday he developed extensive painful ulceration of his mouth and gums . On examination his temperature is 37.4C pulse 84/Mint .and there is submandibular lymphadenopathy .
A) What is the most likely diagnosis? B) How will you manage this case?

6—A 64 yr old woman with type 2 diabetes mellitus presents as she has started to bump into things since the morning . Over the previous two days she had noticed some ‘floating spots in her eyes ‘.Examination reveals she has no vision in her right eye . The red reflex on the right side is difficult to elicit and you are unable to visualize the retina on the right side during fundoscopy . Examination of the left fundus reveals changes consistent with pre-proliferative diabetic retinopathy .
A) What is the most likely diagnosis and justify your diagnosis. Catract B) How will you manage this case?

7—A 35yr old woman presents with a 12 hr history of severe epigastric pain associated with several episodes of vomiting . She drinks 23 units of alcohol per week. She is tender with guarding in the epigastrium .Plain radiography show no evidence of free gas .
A) What is the most likely diagnosis and justify your diagnosis B) How will you investigate above case? C) Treat above case?

8—A 40 yr old man is admitted with a history of 24 hr colicky central abdominal pain and bile stained vomiting . His only past medical history is an appendicectomy when he was 8 . On examination his abdomen is distended ,but there is mild tenderness . Bowel sounds are increased.
A)What is the most likely diagnosis and justify your diagnosis B) Enlist the differential diagnosis ? C) What is the treatment ?
9—A 73 yr old woman presents with a 2 cm lump in the outer quadrant of the right breast The lump does not involve the skin and is mobile . FNAC reveals malignant cells Mammography shows a speculate lesion corresponding to the lump.
A) What is the most likely diagnosis and justify your diagnosis B) What is the investigation ? C) Treatment options in above case ?

10- A 15 yr girl presents with fever , a painful right ear , and deafness from last 6 days .On examination ,the tympanic membrane is full and red ? A) What is the most likely diagnosis and justify your diagnosis B)How will you manage this case?

11—A 2 yr old breast fed male infant is vomiting after each feed. Abdominal X.RAYS demonstrated a double bubble sign .
A) What is the most likely diagnosis and justify your diagnosis B) How will you manage this case?

12—10 days after a premature birth , a mother notices her baby crying excessively and has passed blood and mucus per rectum. The infant is still in the special baby care unit.
A) What is the most likely diagnosis and justify your diagnosis B) How you manage this case?
13—A 31 yr old primi gravid presents at 36 weeks with abdominal discomfort and on examination her abdomen is found to be larger for dates. She is dyspneic and complains of indigestion and claims the abdomen has swollen to this size within a week. USG shows the fetus to be normal.
A) What is the most likely diagnosis and justify your diagnosis? B) How will you manage this case?
14—A 43 yr old woman complains of being unable to conceive for 2 years despite having regular unprotected sex . She complains of sweating all the time , frequent defecation and says this explains her loss in weight in recent weeks . She denied starving herself and says she has a very good appetite ?
A) What is the most likely diagnosis and justify your diagnosis. Hyperthyroidism B) How will you manage infertility in this case?
15 What is biopsychosocial model and enumerate the causes of stress.