2006D September AMC MCQ Recall Questions

1- A 62 yr old man presents with tiredness ,weight loss,anemia and fatigability. What is
the Ix you will do first?
a.Barium meal
b.Sigmoidoscopy
c.Colonoscopy
d.Fecal occult blood test

2- A young man comes to you with epigastric pain.His wife is pregnant and he is “on
edge”.AOF would support you inference that he is an alcoholic,EXCEPT-
a.Attempt to cut down in the past
b.Anger on enquiry
c.Guilty about drinking
d.Eye opener
e.Two bottle of light beer/day

3- A 35 yr old school teacher came to you with a H/O difficulty to fall asleep, irritability
7 anxiety. When he goes to bed all minor mistakes in the day came to his mind &
argues with those in himself. These thought are intrusive & gives him much distress
though he knows these thoughts are irrational. He tries to get rid of them but unable
to do that. He is perfectionist and wants to be done in the way he likes. Which of the
following drugs would be the most beneficial to him ?
a, Benzodiazepines
b, Non benzodiazepine hypotic
c, SSRI
d, Atypical anti psychotics
e, Anti psychotic/anti depressant

4-A young man has a syncopal attack while weight lifting. He has had similar episodes
twice before. His father died of cardiac disease. What is the most appropriate
management?
a) Holter monitor
b) Echocardiogram
c) Stess test
d) BP in supine & lying down
e) CT scan

5-A 70-years old woman presents with a 3-month history of fatigue, generalized
lymphadenopathy, and hepatosplenomegaly. What is the most likely diagnosis?

a) Hodgkin’s lymphoma
b) Non Hodgkin’s lymphoma
c) Acute lymphocytic leukaemia
d) Chronic lymphocytic leukaemia
e) Chronic Myeloid leukaemia

6-A patient has calcium oxalate renal stones. What is the most appropriate
managemant?
a) Allopurinol
b) Alkalinize the urine
c) Stop taking food with calcium
d) Give calcium

7-A female aged 23 years, presented with proteinuria. There is a previous history of
enuresis till 13 years of age. Her sister also had enuresis as a child. The history is
suggestive of which of the following?

a) Chronic glomerulonephritis
b) Reflux nephropathy
c) Congenital nephritis
d) Polycystic kidney disease
e) Analgesic nephropathy

8-A 65-year-old man presented with confusion. Laboratory findings showed

hypercalcaemia, calciuria, and phosphates within normal limits. Which is the most
likely diagnosis?

a) Malignancy(osteolytic metastasis)
b) Primary hyperparathyroidism
c) Idiopathic hypercalcaemia/hypercalciuria
d) Pagets disease myeloma

9-A 64-years old man presents with profuse bright red bleeding per rectum. What is
the most like cause?

a) Ca colon
b) Polyp
c) Diverticulosis
d) Duodenal ulcer
e) Haemorrhoids

10-A diabetic patient with an ulcer at the head of the 2nd metatarsal on the sole of the
foot. Which of the following would be the most likely cause?

a) Macrovasclar disease
b) neuropathy
c) Infection
d) Varicose venis
e) Hyperglycaemia

11-The most common cause of diarrhoea in bedridden elderly patients is?

a) Ca colon
b) Crohn’s disease
c) Ulserative colitis
d) Diverticulosis
e) Faecal impaction

12-What is the most important aspect in managemant of an open fracture OF tibia and
fibula?
a) Antibiotics
b) Intenal fixation
c) Debridement
d) Tetanus toxoid
e) Immobilisation
13- A middle aged female complaints of morning diarrhoea and cramps. On
examination there are no remarkable findings. Which is the most likely diagnosis?

a) Irritable bowel disease

b) Ca Colon
c) Crohns disease
d) Ulcerative colitis
e) Inflammatory bowel disease

14-A 5 month old baby unwell for a week is noticed by his parents to have episodes of
leaning forward and shaking his arms. His parents are concerned, because he is not
responding as he used to. What is the likely cause?

a) Infantile spasm
b) Febrile seizures
c) Breath holding spells
d) Infantile myoclonic seizures
e) Petit mal epilepsy

15 A 2 month old child has strawberry naevus on its face. What is the most
appropriate management?

a) Cryotherapy
b) Lase therapy
c) Observation
d) Injection of a sclerosing agent
e) Simple excision

16- A child has tenderness & pain at upper tibia of the left leg and swelling of the knee
which is warm. He is febrile(39 degrees Celsius) and gets pain at 30 degrees flexion.
What is your diagnosis?

a) Osteomyelitis
b) Osteosarcoma
c) Septic arthritis
d) Fracture tibia
e) Irritable hip (Transient synovitis)

17- A 20-year-old female presents to you with amenorrhoea. On ultrasound, a

cyst(1.8 x 1.3 x 1.0 cm) is found on the right overy. What is the most appropriate
management?

a) Laproscopy to find cytology

b) Repeat ultrasound in 4 weeks time
c) Do nothing
d) OCP
e) Oophorectomy

18- A female, 17 weeks pregnant, has acute right iliac fossa pain. Which of the
following is the least likely cause of the pain?

a) Pyelonephritis
b) Red degeneration of a fibroid
c) Ectopic pregnancy
d) Acute appendicitis
e) Torsion of an ovarian cyst

19- Multiple red inflamed lesions with discharege in auxilla of left groin. What is the
diagnosis

a) pyelenodeal sinus
a) infected epidermoid cyst
a) suppurative hydradenitis

20- . A 17 year old girl who had a seizure with loss of consciousness for 1 minute. She
says that for 1 year she has been experiencing 'jerks' in her hands. What is the
treatment?

a) phenitonin
a) carbamazepine
a) gabapentin
a) itho suxximide
a) sodium valporate

21- 39. A couple who wanted advice regarding contraception using rhythm method.
Her period in one year varied between 26 and 29 days. What stage do you advise
abstinence? (recall qu)

a) 8-19 days
a) 10-19 days
a) 12-19 days
a) 6-16 days
a) 4-21 days

22- Without a previous history of any operation what is the most common cause of
small bowel obstruction?

a) hiatus hernia
a) groin hernia
a) sigmoid volvulos
a) gall stone illeus
23- A baby born at term. Normal appearance. 6 hours after birth develops tachypnea
and cyanosis and was corrected with 45% O2. What is the diagnosis?

a) transient tachypnia of infant

a) merconium aspiration
a) hyaline membrane disease

24- Patient with right sides sciatica and lower limb pain. He was hospitalized and given
narcotic analgesia and bed rest. After 8 hours he cannot pass urine. What is the
reason?

a) narcotic analgesic side effect

a) prostetic bladder outflow obstruction
a) central cord disc prolapse

25- A 12 year old girl with anorexia. Has lost 5kg over last few months. She has
abdominal distension and offensive stool The diagnosis is:

a) giardia
a) Chrohns disease
a) Amoebiec parasite

26- Child was at birthday party. Came to hospital with sudden onset of wheeze on one
side. What do you do?

a) inspiratory and expiratory x-ray

a) bronchoscopy
a) allergy test
27-Woman after 3 days of laparotomic operation during shower became cyanosed,
tachypnoec, breathless. Dx
a) Myocardial Infarction.
b)Pulmonary embolism
c)Vasodilatation due to hot shower

28 In a patient with a loss of dorsiflexion and eversion but has intact inversion, plantar
flexion, ankle and knew reflex. WOF nerves is injured
a) L4
a) L5
a) Sciatic nerve
a) common peroneal nerve

46 yr old pt presented e decreased vision specially in reading books

a- myopia
b- presbiopia
c- cataract
d- hypermetropia
30- A 20 year old female with a lump in anterior aspect of sternocleidomastoid muscle,
at the border of lower and middle third. What's the best management?
a) brachial cyst
31- Patient with a lump in suprasternal notch, which moves up and down with
swallowing. What is the diagnosis?
a) Thyroid nodule
b) Thyroglossal cyst
c) Branchial cyst
32- claudication of bottuck, thinght and calf
a- aortic-iliac artery
b- femoral artery
c- popliteal artery

33- picture of a lesion(kerato acanthoma) what is the Rx

a- local Ex
b- wide local Ex
c- observation

44- young man after MVA presented with dyspnea, mild brusis on chest wall and mild
cynosis ,no obvious chest injury, BP 70/50 and subcutaneous emphysema.
a- esophagea laceration
b- hemothorax
c- pneumothorax

45- pt presented e the painfull loss of vision, conjuntival injection, dilated pupil
a- cataract
b- glucoma
c- conjuntivitis

46- most common site coarctaton of aorta Dx

a- radial pulse
b- delayed or absent femoral pulses
c- systolic murmur in lleft sternum
d- notching of ribs on chest X-ray

47- 28 yr old women 2 month after delivery feel pain in intercourse , not on initial
period but on deep penile penetration
a- neglected small tear after delivery
b- candidiasis
c- endometriosis
d-
(question similar to this one )
48- pt presented e weakness of hands upper arm and hyper reflexia of lower limbs
a- cuada equina synd
b- lumbar dics herniation
c- spinal cord compression

48- nipple with bloody discharge and retraction

a- pagets dis
b- duct carcinoma
c- duct papilloma

50- newborn developed mild jaundice after 96 hrs of birth lasted for 2 – 3 wks indirect
bilirubinemia
a- hemolysis
b- neonatal hepatitis
c- spherocytosis
d- breast feeding

51- inc prolactin level pt was receiving antipsychotic drug therapy

a- micro adenoma
b- due to antipsychotic
c-

52- Pt 42 yr e pain epigastric pain nausea , vomiting (known to have duodenal ulcer)
a- dudenal ulcer
b- panceratitis
c- cholangitis

53- . WOF is true regarding a 2cm kidney stone in the pelvis seen in KUB
examination.:
a. trans-cutaneous ………
b. exracorporal litotrypsy
c. Lithotripsy
d. Open surgery

54- 6 year old child comes to you with up rolling if eyes, neck stiffness, protruded
tongue, rigid body and face tilted to one side. Had vomiting and was being treated by
the GP. What is the cause?

a. Huntington's chorea
b. Epilepsy
c. Reaction to metoclopramide
d. Gastritis

55- . A lady had a MVA 6 months before. Now she presents with pain in her Rt. Arm
and hand with disturbed sensation. Her biceps and triceps jerks are normal. Muscle
power is 6/6 in biceps and 6/5 in triceps respectively. Other tests were normal, What
could be the cause of her situation?
a) Spinal cord injury
b) FRACTURE in the cervical vertebra
c) Multiple sclerosis
d) Intervertebral disc protrusion
e) Spinal artery thrombosis

56- Male arrived to the ED with a history of vomiting & diarrhea , dehydration.What is
the best management?
a]5%glucose IV
b]50%glucose
c]0.9%sodium
d]hartman

57- how to diagnose glomerulonepritis? FINDINGS IN THE URINE

a- RBC
B- WBC
C- PROTEINURIA

58- Management of stage CIN-II of cervix

a- conisation
b- hystrectomy
c- radiotherapy
d- laser therapy
e- observation

59- young man with mouth ulcer, conjunctivitis, purulent urethral discharge, negative
rheumatoid factor?
a- reiter’s syndrome
b- SLE
c- rheumatoid arthritis

60- picture on anthology book page 54, a boy had a trauma (picture in the top) ACUTE
ANA HAEMATOMA, what is the management
a- analgesia
b- excise and drain the haematoma under anaesthesia.

61- picture on anthology book page 55, ANAL FISTULA,

62- in patient with urine osmolality increased, plasma osmolality decreased, what do u
find as laboratory:

a- Na decreased, urea decreased

b- Na decreased , urea increased
c- Na increased, urea decreased
d- Na increased, urea increased

63- achalasia

64- picture from anthology book page 210 right picture, SUBUNGUAL HAEMATOMA,

65-66 two questions for the picture from anthology book page 294 , right picture ,
chronic deep venous insufficiency.

67- picture of lipoma on the back of the neck.

a- do nothing

68- most commonly injured organ in blunt abdominal trauma

a- spleen
b- liver
c- small intestine

69- picture with white granuloma in pelvis and kidney

a- tuberculous
 70- senior resident in a hospitalhave a relation with his patient and you are the
supervisor, what do u do?
a- court
b- talk to patient
c- talk to the resident

71- 59 yr male presents with reduced tsh,t3 and t4 normal. what should b avoided
a.medication containing iodine
b.beta blocker
c.digoxin
d.steroids

72- 1.which of the following does not mimic secondary syphilis

a.pityriasis rosea
b.atopic eeeczema
c.tinea corporis
d. viral warts

2006C July AMC MCQ Recall Questions

1. patient with bipolar and intolerance to lithium, what treatment to give
2. picture with melanoma
3. picture with SCC
4. picture of Venous insufficiency and SKIN discoloration
5. what analgesia to give prior shoulder dislocation manipulation
6. ECG with anteroseptal MI
7. ECG with RBBB
8. ECG with AF
9. patient with hypokalaemia, hyonatraemia and increase bicarbonates, he is on frusemide,
ramipril, omeprazole. Which drug is responsible for above changes
10. questions with prevalence and incidence of a disease
11. Cancer patient on panadeine forte and NSAIDs now poor pain control, Unable to sleep and
very anxious what to add on his treatment. Amitrypatline
12. 82 year old lady previous fit and healthy and an UNCOMPLICATED appendicectomy now
presents with abdominal pain and distension of few days duration. XRAY provided with
distension of the whole colon. Whats the diagnosis?
13. patient with bowel resection and chronic diarrhea ?what treatment
14. a question of PE
15. a question of pneumothorax
16. Whats the commonest cause of bleeding in a post menoasual women
17. a woman with CIN II what action should be taken
18. a patient with pulmonary oedema post MI ?treament
19. a patient suffered an MI 4 weeks ago. Now presents with a second episode of biliary colic
?action
20. a patient with AS and first degree block with bradycardia ?cause of his collapse
21. a question of bitemporal hemianopia where is the lesion
22. Another question of Bitemporal hemianopia and pituitary adenoma
23. a question of a lacunar infarction
24. a question of infantile epilepsy
25. How to distinguish a third nerve palsy secondary to DM
26. a very stupid question: A patient who has a Psych disorder(I cant remember which one)
and lives with sister who is normal, believes that the neighbors are plotting against them. The
<<healthy>> sister believes her sister when she is at home but when goes away from home
the delusion is disappearing. Whats the syndrome
27. patient with dislocated finger, XRAY given ?action
28. a question of hydroponics marihuana
29. Premature rupture of membranes what to do
30. premature baby with sepsis
31. which condition is not related to malignancy: HIV, CMV, EBV
32. breast cyst given on mammogram ?action
33. a question of thyroglossal cyst
34. a patient undergone thyroidectomy, few hours later develos stridor and SOB ?action
35. a tricky question with a child with polyneuropathy
36. a question about most frequent psych presentation in primary care
37. Lithium toxicity
38. a patient with first degree block and bradycardia on digoxin ?verapamil etc what to do?
39. commonest organism in a child and OTITIS media
40. A question of IgA nephropathy
41. signs of a third nerve lesion given ?which part of the third nerve affected, ?right ?left
42. a question of temporal arteritis
43. a question of a scaphoid #
44. a question of supracondilar#
45. what you will not do in a first infertility consultation of a couple
46. treatment of POS
47. Diagnosis of POS
48. billing method contraception what to do
49. what is the best physical sign to diagnose DVT of the lower limb
50. subclavian steel syndrome
51. risk of having a child with cleft palate
52. a question of postpartum psychosis
53. a patient with UC and now developed cholangitis
54. commonest cause of PR bleeding in a child
55. SKIN prick test in a patient treated for anaphylaxis
56. child treated for asthma attack with salbutamol nebs with no effect ?next step
57. treating HTN what risk is proven to be improved
58. exercise induced asthma, what to do
59. retinal detachment immediate management
60. A child with pulmonary plethora on CXR………VSD
61. a chilld with diagnosis of acyanotic heart disease missed in the hospital prior discharge,
what was the cause for the missed diagnosis?
62. Mullerian duct question
63. how to differentiate renal cause from other causes of oliguria

2006A March AMC MCQ Recall Questions

1. Woman occasional finding on abdo CT, 1.5 cm adrenal tumor, no physical symptoms. What
is the best management?

a. Surgical removal
b. Repeat CT in 6 months

2. A farmer comes to the clinic with history of wound caused by a wire. O/E the site is red and
tender. Which one of the following Ix can be used to exclude clostridium difficile infection.

a. Biopsy of the muscle

b. aerobic culture
c. anaerobic culture
d. x-ray of the site and looking for subcutaneous emphysema
e. blood culture

3. A young man comes back from Thailand with purulent urethral discharge and dysuria. After
treating him for chlamydia what else should u give him.

a. IM ceftriaxone
b. Oral ampicillin
c. Oral roxythromycin

4. A middle aged lady with acute onset of jaundice and fever. O/E you can feel a mass in RUQ
which moves up and down with breathing. Whats the most probable cause?

a. gall bladder malignancy

b. CBD stone
c. liver abscess
d. gallstone in gallbladder

5. A young guy comes with mild jaundice and unspecific symptoms. On imaging evaluations
you find liver granulomas. They are most likely associated with -

a. sarcoidosis
b. candidiasis
c. liver amyloidosis
d. crohn's dis.

6. A patient with unilateral miosis and ptosis. Which one is the most likely cause?

a. lung Ca (ONLY IF IT IS APICAL LOBE)

b. fracture of base of the skull

7. A lady who has been admitted for pneumonia has been found to have AF. In the lab data,
TSH is normal, T4 is marginally raised but T3 is normal. Whats the best management?

a. carbimazole
b. radioimaging
c. recheck TFT one month later

8. A young man is presented with short stature and increased skin elasticity. Which of the
following is the most likely to be associated with this condition?

a. lens dislocation
b. aortic regurgitation
c. mental retardation

9. A man with HT, Hx of smoking and alcohol abuse complains of the onset of palpitations
since 4 hrs. PR 250. After carotid massage his pulse rate decreases. His most like ECG
a. Atrial flutter
b. Mobitz1
c. Torsades de Pointes
d. AF ( alcohol - the most common cause in men less than 60 years)

10. An 80 yr.old lady with normal kidney function (lab data given) has AF and is 45 kg. You
put her on digoxin 0.25mg bd. After 14 days she has nausea and vomiting. Like cause -

a. gastric ca
b. gastric ulcer
c. brain infarct
d. previous unknown renal impairment ( DIGITALIS TOXICITY)

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A 50 year old woman who had a CT scan abdomen. CT shows 1.5cm mass on the R) adrenal
gland. Non symptomatic, no electrolyte imbalance. No hormonal imbalance. What do you do
next?

a) do MRI
a) PET scan
a) Biopsy
a) Repeat CT in 6 months
a) Ultrasound
well i guess the answer is repeat ct in 6 months Small adrenal adenomas ( < 2 cm) usually are
nonfunctional, produce no symptoms, and require no special treatment but should be kept
under observation for growth or development of secretory function.
http://www.merck.com/mrkshared/CVMHighLight?file=/mrkshared/m
manual/section2/chapter9/9e.jsp%3Fregion%3Dmerckcom&word=adr
enal&word=disorders&domain=www.merck.com#hl_anchor
Nonfunctional Adrenal Masses
Space-occupying lesions of the adrenal glands that have no hormonal activity.

Adrenal adenomas, detected by abdominal CT or MRI, are the most common of these masses.
In newborns, spontaneous adrenal hemorrhage may produce large adrenal masses, simulating
neuroblastoma or Wilms' tumor. In adults, bilateral massive adrenal hemorrhage may result
from thromboembolic disease or coagulopathy. Benign adrenal cysts are observed in the
elderly and may be due to cystic degeneration, vascular accidents, bacterial infections, or
parasitic infestations (Echinococcus). The adrenals may become infected with tuberculosis
organisms via the bloodstream, causing adrenal masses. Rare nonfunctional adrenal
carcinoma produces a diffuse and infiltrating retroperitoneal process. The most common
nonfunctioning adrenal mass in adults is an adenoma (55%), followed by metastatic tumors
(30%). Cysts and lipomas make up most of the remainder.

Symptoms, Signs, and Treatment

Nonfunctional adrenal masses are usually found incidentally during tests conducted for other
reasons. With any adrenal mass, adrenal insufficiency is rarely observed unless both glands
are involved. Small adrenal adenomas ( < 2 cm) usually are nonfunctional, produce no
symptoms, and require no special treatment but should be kept under observation for growth
or development of secretory function. If metastatic disease is a possibility, fine-needle biopsy
can be diagnostic. If the tumor is solid, of adrenal origin, and > 6 cm, it should be excised,
because biopsy cannot always distinguish benign from malignant tumors. The major signs of
bilateral massive adrenal hemorrhage are abdominal pain, falling Hct, signs of acute adrenal
failure, and presence of suprarenal masses on CT or MRI. Tuberculosis of the adrenals may
cause calcification and adrenal insufficiency (Addison's disease). Nonfunctional adrenal
carcinoma usually manifests as metastatic disease and is not amenable to surgery, though
mitotane may afford chemotherapeutic control when used in association with supportive
exogenous corticosteroids.

Evaluation of Asymptomatic Adrenal Masses

With abdominal CT scanning, many incidental adrenal masses (so-called incidentalomas) are
discovered. This is not surprising, since 10 to 20% of subjects at autopsy have adrenocortical
adenomas. The first step in evaluating such patients is to determine whether the tumor is
functioning by means of appropriate screening tests, e.g., measurement of 24-h urine
catecholamines and metabolites and serum potassium and assessment of adrenal cortical
function by dexamethasone-suppression testing. However, 90% of incidentalomas are
nonfunctioning. If an extraadrenal malignancy is present, there is a 30 to 50% chance that the
adrenal tumor is a metastasis. If the primary tumor is being treated and there are no other
metastases, it is prudent to obtain a fine-needle aspirate of the adrenal mass to establish the
diagnosis. In the absence of a known malignancy the next step is unclear. The probability of
adrenal carcinoma is <0.01%, the vast majority of adrenal masses being benign adenomas.
Features suggestive of malignancy include large size (a size > 4 to 6 cm suggests carcinoma);
irregular margins; and inhomogeneity, soft tissue calcifications visible on CT (Fig. 321- , and
findings characteristic of malignancy on a chemical-shift MRI image. If surgery is not
performed, a repeat CT scan should be obtained in 3 to 6 months. Fine-needle aspiration is
not useful to distinguish between benign and malignant primary adrenal tumors
(http://www.accessmedicine.com/content.aspx?aID=98598&searchStr=adrenal+mass#98598
)

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question 8 is ehlers danlos syndrome and is associated with aortic regurgitation with
dissection.

Ehlers-Danos syndrome is a group of inherited disorders characterized by excessive looseness

(laxity) of the joints, hyperelastic skin that is fragile and bruises easily, and/or easily damaged
blood vessels. The syndrome sometimes involves rupture of internal organs. There are six
major types that are characterized by distinctive features.

Causes, incidence, and risk factors

Ehlers-Danlos syndrome (EDS) can occur in different forms -- involving blood vessels, skin,
and/or joints -- with a variety of different genetic defects as their cause. A variety of genetic
mutations cause abnormality in collagen. Collagen provides structure and strength to
connective tissue in skin, bone, blood vessels, and internal organs.

Different forms of EDS have different modes of inheritance. Family history is a risk factor in
some cases.

Incidence is 1 in 400,000 in the USA.

Symptoms

Joint dislocation or subluxation

Joint pain
Increased joint mobility, joints popping, early arthritis
Double-jointedness, flat feet
Easily damaged, bruised, and stretchy skin
Very soft and velvety skin
Easy scarring and poor wound healing
Premature rupture of membranes at birth
Visual difficulties
Signs and tests

Examination by the health care provider may show:

Excess joint laxity and joint hypermobility

Soft, thin, or hyperextensible skin
Mitral valve prolapse
Periodontitis
Signs of platelet aggregation failure (platelets do not clump together properly)
Rupture of intestines, uterus, or eyeball (seen only in vascular EDS, which is rare)
Deformed cornea
Tests:

Collagen typing (performed on a skin biopsy sample)

Collagen gene mutation testing
Lysyl hydroxylase or oxidase activity
Echocardiogram (heart ultrasound)
Treatment

There is no specific cure for Ehlers-Danlos syndrome, so individual problems and symptoms
must be evaluated and cared for appropriately. Frequently, physical therapy or evaluation by a
physician specializing in rehabilitation medicine is needed

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