Step II MCQ

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