Q1. A lady presents with itching around the breast and greenish foul smelling discharge from the nipple. She had a similar episode before. What is the most likely diagnosis?
Periductal mastitis
Mammary duct fistula
Duct papilloma
Breast abscess
Duct ectasia
the answer is Duct ectasiaDuct ectasia of the breast or mammary duct ectasia or plasma cell mastitis is a condition in which the lactiferous duct becomes blocked or clogged. This is the most common cause of greenish discharge. Mammary duct ectasia can mimic breast cancer. It is a disorder of peri- or post-menopausal age
Q2. 2hour after an appendectomy, a patient complains of a rapid HR (heart rate) and fever. He says there is also abdominal pain and pain in the shoulder area. What is the first step in the management?
Insert NGT for intestinal decompression
Emergency exploratory laparotomy
Cross match blood
Start IV antibiotics
Maintain IV access and give IV fluids
answer is Maintain IV access and give IV fluids
Q3. A lady with breast cancer has undergone axillary LN clearance. She develops arm swelling after being stung by a bee. What is the most likely mechanism responsible for the swelling?
Hypersensitivity reaction
Fluid retention
Lymphoedema
DVT
Cellulitis
answer is Lymphoedema , compromised lymphatic drainage of arm due to axillary LN clearance. So in any inflammation or swelling, lymph drainage is compromised further giving rise to swelling of limb of that operated side.
Q4. 40 year old patient presents with 50% partial thickness burns. What should be the most appropriate management?
IV fluids calculated from the time of burn
IV fluids calculated from the time of hospital arrival
IV dextrose
No IV fluid
Burns ointment
answer is IV fluids calculated from the time of burn
Q5. 31 yers old man presented with cellulitis and swelling. He was started on flucloxacillin. What other medication do you want to add?
Metronidazole
Vancomycin
Penicillin
Ceftriaxone
Amoxicillin
answer is PenicillinCellulitis is usually caused by staphylococcus and streptococcus. To cover both Flucloxacillin for staphylococcus and Penicillin for streptococci should be prescribed
Q6. A man has reducible bulge below the pubic tubercle, and on occlusion of the deep inguinal ring, cough impulse is present. What is the most likely diagnosis?
Lumbar hernia
Direct inguinal
Indirect inguinal
Spigelian
Femoral hernia
answer is Femoral hernia , below the pubic tubercle is just below the inguinal ligament. On occlusion of deep ring cough impulse is present (means visible) as femoral hernia doesn’t come through deep ring but indirect inguinal hernia
Q7. 66 years old man with anterior resection and end to end anastomosis done complains of severe pain in the chest and abdominal distension. What is the most appropriate investigation to review the cause of this deterioration?
XRay for abdomen
US
Laparotomy
CT
Exploratory laparoscopy
answer is CTAs many anastomotic leak is self-limiting so laparotomy is not done unless indicated otherwise. Definitive diagnosis is made by CT scan
Q8. 31 year old male worker presented with sudden onset of severe abdominal pain. He was previously fit and well other than taking ibuprofen for a long term knee injury. On examination he is in severe pain, pulse 110bpm, BP 110/70mmHg , rigid abdomen. What is the most likely diagnosis?
Biliary peritonitis
Perforated diverticulum
Pancreatic necrosis
Ischemic colon
Perforated peptic ulcer
answer is Perforated peptic ulcer NSAIDs induced perforation. Points in favour- 1. Prolonged use of NSAIDs, 2. Sudden onset of severe abdominal pain, 3. Rigid abdomen
Q9. 66 years old lady 5 days post-operative for bilateral salphingo-oopherectomy and abdominal hysterectomy developed abdominal pain and vomiting with abdominal distension and can’t pass gas. No bowel sounds heard, although well hydrated. What is the most appropriate next step?
Exploratory laparoscopy
CT
U/S
X-ray abdomen
Barium enema
answer is X-ray abdomen,The diagnosis is paralytic ileas. Causes of paralytic ileus:
1- electrolyte imbalance
2- infection (gastroenteritis , appendicitis , pancreatitis)
3- surgical complications
4- certain drugs.
Management of paralytic ileus: nothing by mouth , nasogastric suction to alleviate the distension and remove the obstruction.
Q10. 19 year old woman with longstanding constipation has severe ano-rectal pain on defecation. Rectal examination: impossible due to pain and spasm. What is the most probable diagnosis?
Anal fissure
Anal hematoma
Anal abscess
Hemorrhoids
Protalgia fugax
answer is Anal fissure
Q11. 63 year old smoker presents with cramp-like pain in the calves relived by rest and non-healing ulcers. on examination, cold extremities with lack of hair around the ankles, absent distal pulses. What is the most probable diagnosis?
DM
Buerger’s disease
DVT
Chronic ischemia of the limbs
Intermittent claudication
answer is Chronic ischaemia of the limb,),It is not DVT as dvt pain or tenderness is not of an intermittent claudication pattern,Intermittent claudication is a symptom not diagnosis. It is not buerger’s disease as buerger occur in more younger heavy smoker (before the age of 50yrs),it is not DM because there is no intermittant claudication in DM
Q12. 31 year old woman had an uneventful laparoscopic cholecystectomy 16 hours ago. She has a pulse 109bpm, temperature 37.8C. There is decrease in air entry at the right lung base but the CXR show no obvious abnormality. What is the most appropriate management ?
Reassure
Chlorpheniramine PO
Chest physiotherapy
Ceftriaxone IV
Cefuroxime PO
answer is Chest physiotherapy,Atelectasis can be seen in chest x-ray but sometimes it becomes undetectable as we are suspecting in this case
Q13. 60 year old patient recovering from a surgery for toxic goiter is found to be hypotensive, cyanosed in the the Recovery room,on Exam, tense neck, blood oozing from the drain. What is the most likely dx?
Thyroid storm
Reactionary hemorrhage
Secondary hemorrhage
Primary hemorrhage
Tracheomalacia
answer is Reactionary hemorrhagein the recovery room, cyanosis, hypotension, tense neck, woozing of blood from drain, all these goes in favour of reactionary haemorrhage. "reactionary," hemorrhage that occurs within the first 24 hours after surgery
Q14.50 year old patient presents with right hypochondriac pain. Investigation show a big gallstone. What is the most appropriate management?
Laparoscopic cholecystectomy
Emergency laparotomy
Ursodeoxycholic acid
Low fat diet
Reassure
answer is Laparoscopic cholecystectomy,because the case symptomatic , reassurance not appropriate ,in big stone ursodyoxycholic acid(UDCA) is less effective ,so less invasive procedure preferred so laparoscopic rather than laparotomy
Q15. footballer has been struck in the groin by a kick and presents with severe pain and mild swelling in the scrotum. What is the most appropriate next step?
IV fluids
Exploratory surgery
Doppler
Antibiotics
USG
answer is Exploratory surgery ,To exclude torsion
Q16. 49 year old woman comes with red, swollen and exudating ulcer on the nipple and areola of left breast with palpable lump under the ulcer. What do you think is causing this skin condition?
Inflammatory cells releasing cytokines
Infiltration of the lymphatics by the carcinomatous cells
Infiltration of the malignant skin cells to the breast tissue
answer is Infiltration of the lymphatics by the carcinomatous cells
Q17. 70 year old man, 1hr after hemicolectomy, urine output was 40ml. However, hour after that, no urine seemed to be draining from the catheter. What is the most appropriate next step?
IV furosemide
Check catheter
Dialysis
Blood transfusion
IV fluids
answer is Check catheter
Q18. 71 year old woman has presented with hard, irregular, poorly defined 4cm lump in her left breast. She has a bruise on the surface and there is no discharge. What is the most likely diagnosis?
Ca breast
Duct ectasia
Fibroadenoma
Fat necrosis
Fibroadenosis
answer is Fat necrosis,Fat necrosis usually occurs following trauma or surgery. Given case is a fat necrosis of breast as there is no discharge and there is a bruise indicating prior trauma
Q19. 73 year old female who had undergone a radical mastectomy present now with swelling and redness in her upper left limb. Involvement of which of the following structures explain these symptoms?
Axillary LN
Cephalic vein
Subclavian artery
Long thoracic nerve
Epitrochlear LN
answer is Axillary LN,Axillary clearance compromise lymphatic flow and may results in swelling of upper limb
Q20. 70 year old male presented with swelling in the lower pole of the parotid gland for the last 8 years. Examination show that swelling is firm in consistency,mobile , painless . What’s the most probable diagnosis?
Parotiditis
Adenolymphoma
Mikulicz’s disease
Frey’s syndrome
Pleomorphic adenoma
answer is Pleomorphic adenoma ,Pleomorphic adenoma (most common) - also called benign mixed tumour: is the most common tumour of the parotid gland and causes over a third of submandibular tumours. They are slow-growing and asymptomatic, having a malignant potentiality
Q21. 27 year old shipyard worker was admitted for pain in calf while working which has been increasing over the last 2 months. There is no history of HTN or DM but he is a smoker. Examination show loss of posterior tibial and dorsalis pedis pulsation along with a non-healing ulcer at the base of the left 1st metatarsophalingeal joint. What is the most probably diagnosis?
Spondylosis
Multiple myeloma
Paget’s disease
Thromboangitis obliterans
answer is Thromboangitis obliterans,young age , smoker , pain in cuff, loss of posterior tibial and dorsalis pedis pulsation , non-healing ulcer at the base of the left 1st MTP joint all are suggestive of Buerger’s disease(Thromboangitis obliterans)
Q22. 25 year old construction worker is diagnosed with indirect inguinal hernia. Which statement below best describes it?
Passes through the superficial inguinal ring only
Lies above and lateral to the pubic tubercle
Passess through the deep inguinal ring
Does not pass through the superficial inguinal ring
answer is Passess through the deep inguinal ring
Q23.60 year old man has been admitted for elective herniorraphy. Which among the following can be the reason to delay his surgery?
Diastolic BP 90mmHg
DVT (deep venous thrombosis) 2yrs ago
MI 2 months ago
Controlled asthma
Controlled atrial fibrillation
the answer is MI 2 months ago ,better go for surgery 6 months post MI as surgery before this has higher mortality rate
Q24.man on warfarin posted for hemicolectomy. As the patient is about to undergo surgery. What option is the best for him?
Stop warfarin and add aspirin
Continue with warfarin and add heparin
Stop warfarin
Stop warfarin and add heparin
Continue with warfarin
answer is Stop warfarin and add heparin
Q25. 50 year old lady presents with itching, excoriations, redness, bloody discharge and ulceration around her nipple. What is the most likely diagnosis?
Breast abscess
Fibrocystic dysplasia
Paget’s disease of the breast
Duct papilloma
Eczema
answer is Paget’s disease of the breast.
Q26.Patient with widespread ovarian carcinoma has bowel obstruction and severe colic for 2 hours and was normal in between severe pain for a few hours. What is the most appropriate management?
Oral morphine
Spasmolytics
PCA (morphine)
Laxatives
Palliative colostomy
answer is Palliative colostomy ,Cancer or chemotherapy induced obstructions are unlikely to respond to conservative management (NBM, IV fluid, nasogastric suction) and hence only analgesia will not relieve it. So in such cases we have to go for palliative colostomy
Q27. patient presented with history of swelling in the sub-mandibular region, which became more prominent and painful on chewing. He also gave history of sour taste in the mouth, the area is tender on palpation. what is the most probable diagnosis?
Sub-mandibular abscess
Chronic recurrent sialadenitis
Adenolymphoma
Mikulicz’s disease
Adenoid cystic carcinoma
answer is Chronic recurrent sialadenitis,pain, swelling, more pain on chewing, tenderness, and swelling of submandibular region suggests diagnosis of submandibular chronic recurrent sialadenitis, usually secondary to sialolithiasis or stricture
Q28. 4 days post-colostomy closure lady comes with fluctuating small swelling in the stoma. What is the management option for her?
Reassure
Open laparotomy
Exploratory laparotomy
Local exploration
answer is Local exploration
Q29. type 2 dibetic patient , undergoing a gastric surgery. What is the most appropriate pre-operative management?
Stop oral hypoglycemic drug at night previous to the surgery and start IV insulin with glucose and K+ before Surgery
Change to short acting oral hypoglycemic
Start him in IV insulin and glucose and K+ just before surgery
Stop his oral hypoglycemic on the day of the procedure
Continue regular oral hypoglycemic
answer is Stop oral hypoglycemic drug at night previous to the surgery and start IV insulin with glucose and K+ before Surgery
Q30. 68 year old man had a right hemicolectomy for ceacal carcinoma 6 days ago. present with abdominal distension and recurrent vomiting. He has not opened his bowels since surgery. There are no bowel sounds. WBC=8.5, Temp=37.5C. What is the most appropriate next management?
Laparotomy
NG tube suction and IV fluids
Iv antibiotics
Glycerine suppository
totla parenteral nutrition(TPN)
answer is NG tube suction and IV fluids he patient has developed paralytic ileus which should be treated conservatively
Q31. Which of the following formulas is used for calculating fluids for burn patients?
4 x weight(kgs) x area of burn = ml of fluids
4 x weight(lbs) x area of burn = ml of fluids
4.5 x weight(kgs) x area of burn = dL of fluids
4 x weight(lbs) x area of burn = L of fluids
4 x weight(kgs) x area of burn = L of fluids
answer is 4 x weight(kgs) x area of burn = ml of fluids.
Q32. 50 yrs man underwent emergency splenectomy after a fall from his bicycle. He smokes 6 cigarettes/day. Post-operation, despite mobile, he develops swinging pyrexia and a swollen painful right calf. His CXR shows lung atelectasis and abdominal US demonstrates a small sub-phrenic collection. What is the single most likely risk factor for DVT in this patient?
Immobility
Intraperitoneal hemorrhage
Smoking
Sub-phrenic collection
Splenectomy
answer is Splenectomy,Splenectomized patients have an increased risk of developing deep vein thrombosis and pulmonary embolism
Q33. 50 year old man with previous surgery of cancer of head of pancreas (which has been removed). He has a history of longstanding heartburn. He now comes with rigid tender abdomen, temp 37.7C, BP 90/70mmHg, pulse 120bpm. What is the next step of the investigation?
X-ray abdomen
CT abdomen
US abdomen
MRI abdomen
Endoscopy
answer is X-ray abdomenX-ray abdomen will help diagnosing perforation by showing gas under diaphragm. This is a case of perforated peptic ulcer with the features of shock, abdominal rigidity and raised temperature. Stress from serious disease and operation causes the body to produce higher amounts of acid, which can irritate preexisting ulcers leading to easy perforation
Q34. 67 year old woman has been treated for breast cancer with tamoxifen. What other drug should be added to her treatment regimen?
Calcitonin
Phosphate binders
Bisphosphonates
Vit D
Calcium
answer is Bisphosphonates,bisohosphonates reduce the risk of bone metastasis in cancers and is normally taken as adjuvant therapy in many types of tumours including breast cancer. Plus it prevents bone resorption.
Q35. 5 year old came with full thickness burn. He is crying continuously. What is the next step of management?
Refer to burn unit
Antibiotic
Analgesia
IV fluid stat
Dressing
answer is IV fluid stat, full thickness burn is painless. Child often cry from anxiety for hypoxaemia and hypovolaemia rather than pain. The patient then responds better to oxygen or increased fluid administration rather than to narcotic analgesics.
Q36. 70 year old woman presents to the breast clinic having noticed that she has had a blood stained discharge from the left nipple, with dry skin over the left areola. on exam, blood stained discharge with dry flaky skin noted on the left areola. The nipple was noted to be ulcerated. Wht is the most appropriate investigation?
Stereotactic biopsy
Open biopsy
Punch biopsy
FNAC
MRI
answer is Punch biopsy,As the lesion is on the surface punch biopsy can be well obtained
Q37. woman has offensive yellow discharge from one nipple. She had a history of breast abscess 3 years ago. What is the possible diagnosis?
Breast cancer
Duct ectasia
Duct papilloma
Duct fistula
answer is Duct fistula
Q38. near menopause woman(46yrs) presents with brownish-green and foul smelling discharge from the right nipple, What is the most likely diagnosis?
Duct papilloma
Intra-ductal papilloma
Breast abscess
Duct ectasia
Mammary duct fistula
answer is Duct ectasia Women near menopause are more affected by duct ectasia characterized by brown, green or cheesy discharge. This condition is harmless and tends to clear up without treatment
Q39. 15 year old boy while playing football got a kick and now he is complaining of severe pain and swelling of the left side of his scrotum. What investigation is the most appropriate to diagnose?
US scrotum
MSU(mid-stream urine specimen)
Urine test for hematuria
Surgcal exploration of scrotum
Needle aspiration of scrotum
answer is Surgcal exploration of scrotum This is a case of testicular torsion which needs urgent diagnostic and therapeutic surgical exploration of the scrotum.
Q40. 59 year old male presents with sudden onset severe abdominal pain and rigidity against a 4 days background of left iliac fossa pain and pyrexia. negative past medical or surgical or drug history , What is the most likely diagnosis?
Intussusception
Perforated diverticulum
Ischemic colon
Sigmoid volvulus
Perforated Meckel’s diverticulum
answer is Perforated diverticulum,Sudden onset, severe abdominal pain, rigidity, left iliac fossa pain and fever are in favour of perforated diverticulum.
Q41. 23 year old male smoker is noted to have intense rubor of the feet and absent foot pulse. Examination show amputated right 2nd toe. What is the most probable diagnosis?
Intermittent claudication
Acute limb ischemia
Cardiovascular syphilis
Embolism
Buerger’s disease
answer is Buerger’s disease ,The traditional diagnosis of Buerger's disease is based on 5 criteria (smoking history, onset before the age of 50 years, infrapopliteal arterial occlusive disease, either upper limb involvement or phlebitis migrans, and absence of atherosclerotic risk factors other than smoking). As there is no specific diagnostic test and an absence of positive serologic markers, confident clinical diagnosis should be made only when all these 5 criteria have been fulfilled
Q42.45 year old woman with breast cancer had an extensive removal and LN clearance. She needs an adjunctive treatment. Her mother had cancer when she was 64. Which of the following factors will be against the treatment?
Her age
Family hx
Tumor grading
LN involvement
answer is Her age,Chemotherapy may result in premature ovarian failure
Q43. patient on insulin is booked in for a hernia operation. What is the most appropriate management of insulin?
Give insulin and saline pre-op
Stop insulin for the duration of the op
Give insulin as usual pre-op
Give IV insulin + dextrose + saline pre-operation
answer is Give IV insulin + dextrose + saline pre-operation.
Q44. 25 year old presents with prolonged constipation, blood on side of stool and very painful defecation. PR examination was very painful. What is the single most likely diagnosis?
Ca Colon
crohns disease
ulcerative colitis
Anal fissure
Constipation
answer is Anal fissure.
Q45. 28 year old male has been operated for abdominal trauma and splenectomy was done. On the 3rd post-op day the patient developed acute abdominal pain and distention in the upper abdominal area with hypotension. On insertion of ng tube, 2L of coffee ground fluid was aspirated. What is the most probable diagnosis?
Acute gastric dilatation
Left lower lobe atelectasis
Subphrenic abscess
DVT
Reactionary hemorrhage
answer is Acute gastric dilatation, Acute gastric dilatation may be caused by:Hyperglycaemia, childbirth, abdominal injury, application of a spinal cast, rarely, after abdominal surgery when the stomach is in ileus and drink has been taken too soon. The abdomen is distended and tender, The patient complains of epigastric fullness, nausea, heaviness and heartburn. There is a succussion splash. The accumulation of fluid in the stomach may induce hypovolaemic shock. Reflux of gastric contents may cause an aspiration pneumonia
Q46. 2 hours after an appendectomy, a patient complains of a rapid HR (heart rate) and fever. He says there is also abdominal pain and pain in the shoulder area. What is happening to this patient?
Intra-abdominal bleeding
Anastomotic leak
Sepsis
Intestinal obstruction
answer is Intra-abdominal bleeding
Q47. diabetic man feels hot, painful lump near the anal region. What is the most probable diagnosis?
Anal fissure
Hematoma
Wart
perianal Abscess
External hemorrhoids
answer is perianal Abscess,Diabetic patients are much prone to infection.
Q48. 60 year old lady with type 1 diabetes mellitus for the last 20 year comes with a tender lump near the anal opening. She says she also has a fever. What treatment should she get?
IV antibiotics
culture and sensitivity of aspirate from swelling
Cautery of swelling
Painkillers
incision-drainage + antibiotics
answer is incision-drainage + antibiotics,DDx 1-Perianal abscess 2-Perianal hematoma 3-Thrombosed piles. As infection is common in DM likely case is perianal abscess.
Q49. 65 year old man on dexamethasone underwent surgery. During and after the surgery, his blood glucose was around 306-342md/dL. What will you give the patient?
IV dextrose
IV n/s
Remove dexamethasone
Insulin
Oral hypoglycemic agent
answer is Insulin
Q50. 61 year old man presents with mass in the groin. on exam, mass lies below the midpoint of the inguinal ligament and is pulsatile. What is the most probable diagnosis?
Direct inguinal hernia
Saphenavarix
Femoral hernia
Irreducible hernia
femoral aneurysm
answer is femoral aneurysm Hernia below pubic tubercle (below inguinal ligament) is femoral hernia. But below mid-inguinal point and pulsatile mass is femoral aneurism
Q51. 30 year old manual worker presents with a swelling in the groin. on exam ,mass is found to be just above and lateral to the pubic tubercle. It is reducible. On applying pressure on the internal ring(deep inguinal ring) there is no cough impulse seen. What is the most probable diagnosis?
Direct inguinal hernia
Indirect inguinal hernia
Femoral hernia
Strangulated hernia
Femoral aneurysm
answer is Indirect inguinal hernia Swelling in the groin; mass just above and lateral to the pubic tubercle means inguinal hernia. It is reducible. On applying pressure on the internal ring there is no visible cough impulse; it means the hernia enters through deep ring, and enters scrotum passing through the superficial ring. That means it is indirect inguinal hernia
Q52. 21 year old woman who is 10 weeks pregnant had central abdominal pain for 36 hours. The pain is now colicky. There is no vaginal bleeding. She has vomited once and has had an episode of loosen motion. She looks ill, temp=37.8C and there is rebound tenderness in the RIF. What is the most probable diagnosis?
Uterine fibroid
Ovarian torsion
Salpingitis
pelvic inflammatory disease PID
Appendicitis
answer is Appendicitis ,No vaginal bleeding and pain above pelvis makes pregnancy complication less likely. Loose motion, low grade temperature and positive Mc Burney’s sign makes the diagnosis of appendicitis more probable
Q53. lady developed breast abscess after delivery. What is the most likely organism?
GBS(group B streptococci)
Staphylococcus albus
Streptococcus faecalis
Staphylococcus aureus
Strept. pyogenes
answer is Staphylococcus aureus
Q54. 45 year old woman presents with dysphagia,she is febrile , erythema and middle neck swelling. What is the best management strategy?
IV antibiotics and drainage
incision-drainage
Antipyretics
XR neck
Endoscopic diverticulectomy
answer is IV antibiotics and drainage Neck abscess. Treated with IV antibiotics and drainage
Q55. 58 year old man presents with swelling at the angle of the mandible which is progressively increasing in size for 6 months ,on exam it is mobile. What is the most probable diagnosis?
Tonsillar carcinoma
Mandible tumor
Benign parotid
answer is Benign parotid ,Mandibular tumour or tonsillar carcinoma would not be so mobile after such time period
Q56. 16 year old girl with a lump in her breast ,on Examination, the lump was free and mobile and not attached to the skin. Her mother wants further tests done. What should be the next step?
Reassure and send home
Punch biopsy
US breast
CT
Stereotactic biopsy
answer is US breast Described lump is fibroadenoma. Next investigation is either US breast (for women under 35 yrs) or mammography (for women over 35 yrs).
Q57. lady with a firm smooth breast lump in outer quadrant had a FNAC done. Results showed borderline benign changes. She has family history of breast cancer. What is your next step?
Core biopsy
Genetic testing and counselling
Mammography
US
Punch biopsy
answer is Core biopsy Genetic testing is done for asymptomatic patients in their 30s but given case is symptomatic. If FNAC was not borderline we could withheld core biopsy in favour of genetic councelling and if positive SERMs are given which cause significant reduction in cancer
Q58. 65 year old man had a bowel resection 5 days ago. He is anuric and breathless. His BP=150/110mmHg. He has crackles at both lung bases and sacral edema. Bloods: K+=6.9mmol/l, urea=59mmol/l, creatinine=6.7mgdL. What is the most appropriate immediate management?
5% dextrose infusion
10U insulin, 50ml of 50% dextrose infusion
Dextrose-saline infusion
Calcium resonium enema
Bolus of 20U insulin
answer is 10U insulin, 50ml of 50% dextrose infusion There is renal failure with hyperkalemia. First we have to save heart from arrest or life threatening arrhythmia by shifting K+ into cell. 10U insulin in 50 ml 50% dextrose will help doing this
Q59. 40 year old man presents with acute skin infection in the leg. Diagnosis of cellutitis has been made. What medicines should be prescribed?
Penicillin + Flucloxacillin
Metronidazole + erythromycin
Vancomycin + metronidazole
Ceftriaxone + terbinafine
Ceftriaxone + flucloxacillin
answer is Penicillin + Flucloxacillin ,Cellulitis is usually caused by bacteria, such as staphylococci or streptococci that are commonly present on the skin. So Penicillin + Flucloxacillin should be given
Q60. 60 year old man presented with hot, raised, tender area of skin on his left leg. He is febrile with rigors. you started flucloxacillin, What other medication will you add?
Benzylpenicillin
Ciprofloxacin
Gentamycin
Metronidazole
Ceftriaxone
answer is Benzylpenicillin , Abscess , cellulitis, furuncle these lesions are usually caused by Staphylococcus and streptococcus. So Benzylpenicillin should be added with flucloxacillin to cover streptococcus
Q61. man presented with a purplish swelling at the anal area. It is acutely painful and he complains of constipation for the last 2 months. What is the most appropriate management?
incision and drainage
Incision/Drainage + antibiotics
Reassure
analgesia
Sclerotherapy
answer is Incision/Drainage + antibiotics ,Excision is the method which is done in case of hemorrhoid not incision. This is a case of perianal hematoma which when clotted is treated by incision and left open with excellent result of healing with aids of antibiotics prophylaxis. It occurs in case of constipation. Answer is Incision and drainage + antibiotics. In acute case prior to thrombosis can be treated with evacuation with syringe
Q62. man rescued from a building on fire presented with unconsciousness without any evidence of burns or external injury or soot. What would you do next?
24% oxygen by mask
Hyperbaric oxygen in a hyperbaric chamber
Intubation
100% oxygen inhalation
Refer to specialist unit
answer is 100% oxygen inhalation , In CO poisoning 100% oxygen is the initial management and also there is a role of hyperbaric oxygen in a hyperbaric chamber
Q63. patient after his house fire came with hematemesis with erosion/ulcer of esophagus and on examination there is 55% burn and on endoscopy there is a gastric erosion and soot in the mouth. What is the treatment?
IV PPI
PPI and antibiotic
Tracheal intubation
H. pylori test
PO PPI
answer is Tracheal intubation If a burnt patient gets soots in mouth and-or nose ,tracheal intubation is done. GI ulceration ( oesophageal and gastric ulcers and erosions) due to burns are known as curlings ulcers
Q64. 67 year old woman with history of breast cancer 12 years ago has undergone radical mastectomy and axillary LN removal, she complains now of swollen upper limb 3 weeks after an insect bite. The bite site is better but gross edema is still present. What is the cause?
Allergy
Lymphedema
Filariasis
Breast Ca
answer is Lymphedema As during mastectomy axillary clearance is done, lymphatics on that upper limb is compromised. So there occurs lymphedema
Q65. 65 year old man has a swelling of the left groin which was clinically diagnosed to be indirect inguinal hernia. What is the single feature of the hernia sac that would confirm the diagnosis?
Doesn’t pass through the deep inguinal ring
Comes through femoral ring
Lies below and lateral to the pubic tubercle
Only passes through the superficial inguinal ring
Passes through the deep inguinal ring
answer is Passes through the deep inguinal ring ,Ingunal hernia lies mostly above and medial (occasionally lateral particularly when small) to pubic tubercle. It first enters the inguinal canal through deep inguinal ring and then enters the scrotum through the superficial inguinal ring
Q66. Which of the following conditions requires operative management?
Fournier’s gangrene
Cellulitis
Dyshidrosi
Erysipelas
Lymphangitis
answer is Fournier’s gangrene ,Fournier's gangrene: A horrendous infection of the genitalia that causes severe pain in the genital area (in the penis and scrotum or perineum) and progresses from erythema (redness) to necrosis (death) of tissue. Gangrene can occur within hours
Q67. pregnant woman had hit her chest 3 weeks ago. Now she is 16 weeks pregnant and presents with right upper quadrant mass with dimpling. What is the most probable diagnosis?
Fibroadenosis
Fibroadenoma
Carcinoma
Breast ca
Fatty necrosis of breast
answer is Fatty necrosis of the breast.
Q68. 24 year old male presents with discomfort in the groin area and scrotal swelling. Exam: scrotal skin is normal. What would be the next best step?
Urgent surgery
outpatient referral
Urgent US
Antibiotics
answer is outpatient referral A case of inguinal hernia or hydrocele. In both torsion or epididymo-orchitis scrotal skin will be inflammed (erythematous and oedematous). As the skin is not inflamed the patient should be referred to Surgery OPD(outpatient department)
Q69. patient is about to undergo surgery. Her Hgb=8.9g/dl and MCV=70. What is the best option for her?
Continue with surgery
Investigate and postpone the surgery
Transfuse and proceed with surgery
Transfuse and defer surgery
answer is Investigation and postpone the surgery ,For elective operation only proceed if Hb% > 10 g/dl. If Hb% less than 10 g/dl then defer the operation and investigate first. If Hb% less than 8 g/dl also must be transfused. *Samson note
Q70. 30 year old man has had acute pain and swelling below the mandible on the left side for 2 hours. The swelling occurred after eating a large meal. What is the single most likely diagnosis?
Submandibular calculus
Parotid calculus
Neck abscess
Ranula
Laryngocele
answer is Submandibular calculus ,Pain and swelling below mandible is due to stone in submandibular salivary gland duct. Pain and swelling increased after large meal as the saliva produced during meal could not come out of the gland due to stone
Q71. 19 year old female presented with neck swelling that moved upwards on protrusion of tongue. What is the next appropriate investigation?
Radioactive thyroid scan
MRI neck
Core biopsy
FNAC
Punch biopsy
answer is FNAC ,The diagnostic investigation of thyroglossal cyst is FNAC. Then we palpate for thyroid tissue. If absent we do any one of following to confirm the absence of thyroid tissue: ultrasonography, CT scanning, thyroid scanning or MRI. If there is normal thyroid tissue we go for more aggressive Sistrunk's operation but if there is no normal thyroid tissue (in that case thyroglossal cyst itself may be the only source of thyroid tissue] we do conservative surgery and preserve some portion of cyst with thyroid tissue)
Q72. A 32 year old woman has undergone a biopsy for a breast lump. The report says: a well circumscribed lump with clear margins and separated from the surrounding fatty tissue. What is the most appropriate interpretation of this report?
Fibroadenosis
Fibroadenoma
Ca Breast
Mammary abscess
Fat necrosis
answer is Fibroadenoma ,Fibroadenomas are the most common benign tumor of the female breast. White , well-circumscribed mass is clearly demarcated from the surrounding yellow adipose tissue
Q73. man feels mild discomfort in the anal region and purulent discharge in underpants. What is the most likely diagnosis?
Feacal incontinence
Anal abscess
Fistula in ano
Anal tags
Rectal Ca
answer is Fistula in ano. Abscess is with severe pain which may reduce after it bursts with purulent discharge. But here mild discomfort and purulent discharge favours the diagnosis of fistula
Q74. 30 year old woman has a painless lump in the outer aspect of her right breast. She has had a previous breast lump. Her grandmother had breast cancer at 70 years. on exam, 1 cm smooth, firm, discrete, mobile lump in the other quadrant region of the right breast. What is the single most likely diagnosis?
Breast cyst
Fibroadenoma
Breast abscess
Breast ca
Sebaceous cyst
answer is Fibroadenoma. ,her hx of previous brest lump and now present with a lump of 1 cm size which is smooth, firm (not hard), discrete and mobile (not fixed) suggests fibroadenoma
Q75. 35 year old woman complains of hoarseness of voice 3h after partial thyroidectomy. She had no history of phonation problems before the surgery. What is the single most appropriate investigation?
Bronchoscopy
CT neck
Barium swallow
CXR
Laryngoscopy
answer is Laryngoscopy. Probable diagnosis is recurrent laryngeal nerve palsy
Q76. 55 year old patient recovering from a surgery for toxic goiter is found to be hypotensive, cyanosed in the recovery room. on exam, neck is tense, oozing of blood from the drain. What is the most probable diagnosis?
Reactionary hemorrhage
Secondary hemorrhage
Thyroid storm
Primary hemorrhage
Tracheomalacia
answer is Reactionary hemorrhage , Hemorrhage within 1st 24 hours which usually occurs due to dislodgement of clot or slippage of a ligature
Q78. 40 year old woman has had varicose vein surgery, planned as a day patient. After the operation, she is distressed by repeated retching and vomiting. Her pain is currently well controlled. What is the best management strategy?
Co-codamol
IM morphinea
IV ondansetron
PO ondansetron
Tramadol
answer is IV ondensatron. As there is repeated retching and vomiting patient cannot keep oral medication down. So IV ondansatron should be given
Q79. 90 year old woman is a known smoker. She had an attack of MI 2 years ago,also known to have peripheral vascular disease. She presents with an irreducible herniation over the incision region of a surgery which she underwent in her childhood. What is the most appropriate treatment?
Reassure
Elective herniotomy
Urgent herniorrhaphy
Elective hernioraphy
Truss
answer is Elective hernioraphy. Truss can not be used as hernia is irreducible; urgent herniorrhaphy in strangulation; elective herniotomy- in herniotomy the hernia may recur; only reassure is not an option as irreducibe hernia may become strangulated or may develop intestinal obstruction
Q80. 62 year old man has had ano-rectal pain aggravated by defecation for 3 days. Rectal examination: purple, tender lump at the anal verge. Flexible sigmoidoscopy result: normal rectal mucosa and hard feces. What is the diagnosis?
Anal hematoma
Anal fissure
Rectal ca
Diverticulitis
Angiodysplasia
answer is Anal hematoma.
Q81. 70 year old male undergoes abdominal surgery. On morning, 3 days post-operative, repeat samples confirm serum K+ 7.3mmol/L. His ECG shows broad QRS complexes. Which one of the following can be used as an effective treatment for this pt’s hyperkalemia?
Furosemide IV
Insulin subcutaneously
Calcium chloride IV
Calcium gluconate IV
answer is Calcium gluconate IV Calcium gluconate does not shift potassium into cells or reduce its level but prevents its arrythmogenic effect on heart and buys time till definitive measures are taken
Q82. lady with post ileo-colectomy closure of stoma has a small 4cm swelling around the stoma. What is the most appropriate management of the swelling?
Exploratory laparotomy
Truss
Abdominal binder
Open laparotomy and re-closure
Local exploration of swelling
Laparotomy with mesh repair
answer is Local exploration of swelling
Q83. woman acutely develop SOB (short of breath) in the recovery room and coughing after GA. Auscultation, reduced air entry at the right lung base and diffuse wheeze. Observation: HR=90bpm, BP=110/70mmHg, temp=37.8C and sat=91% in air. Choose among the options which C-section complication has she developed?
Aspiration pneumonitis
Tension pneumothorax
Spontaneous pneumothorax
asthma
Pulmonary embolism
answer is Aspiration pneumonitis. wheeze, reduced air entry at lung base and raised temperature favours the diagnosis of aspiration pneumonitis
Q84. 41 year old woman presents with lump in the groin. on Exam, mass found just below and lateral to the pubic tubercle. There is no cough impulse and it is irreducible. What is the most probable diagnosis?
Saphenavarix
Direct inguinal hernia
Femoral aneurysm
Femoral hernia
Strangulated hernia
answer is Femoral hernia. Mass below and lateral to the pubic tubercle is suggestive of femoral hernia
Q85. lady presents with a swelling below the groin crease that can be reduced. There is no medical history of note. What is the most probable diagnosis?
Epididymal cyst
Testicular tumor
Femoral hernia
Strangulated hernia
Inguinal hernia
answer is Femoral hernia.
Q86. 40 year old man presents with a reducible swelling in the groin, impulse on coughing is present. He has mild dragging pain in the abdomen, otherwise he’s normal. What is the best management strategy?
Urgent herniorrhaphy
Elective herniorrhaphy
Truss
Reassure
Elective herniotomy
answer is Elective herniorrhaphy. Usually before the age of 30, recurrence rate of hernia after herniotomy is much less but after 30 recurrence is high. So Herniotomy is done at the age less than 30. As the presenting case is of 45 yrs we should do herniorrhaphy in this patient
Q87. 29 year old man present with a groin mass after lifting heavy objects. Examination show mass above and medial to the pubic tubercle. It is reducible. On applying pressure on the internal ring, cough impulse is still present. What is the most likely diagnosis?
Femoral hernia
Direct inguinal hernia
Indirect inguinal hernia
Strangulated hernia
Femoral aneurysm
answer is Direct inguinal hernia. on occlusion of deep inguinal ring if cough impulse still present (visible cough impulse) on medial to occluded ring it is direct inguinal hernia
Q88. 40 year old female presents with neck swelling . The swelling has increased in size gradually over the last two years and the patient feels she has breathing difficulty. Examination, mass measures 7cm by 10 cm, soft and not warm to touch. It moves with deglutition(swallowing). Which is the most appropriate management of this mass?
Excision biopsy
Oral propylthiouracil
Oral thyroxine
Partial thyroidectomy
answer is Partial thyroidectomy. Gradually increased swelling in the neck which moves with deglutition is thyroid enlargement and as it is causing pressure symptom like difficulty in breathing a partial thyroidectomy should be performed
Q89. 50 year old worker present with swelling in the left groin. The swelling non-painful and observable in both the erect and recumbent positions. Examination, non-tender irreducible 5 cm mass in the left groin below and on the medial side of the inguinal ligament. Which is the most likely diagnosis in this patient?
direct inguinal hernia
Saphenous vein varicocoele
Femoral hernia
Hydrocoele
answer is Femoral hernia. Sephanous vein varicocele is readily reducible with recumbent position. So presented case is not sephanavarix. Usual location of femoral hernia is below and lateral to pubic tubercle but it is not absolute and it is possible for femoral hernia to present as mass below and medial to pubic tubercle. So the presented case is a case of femoral hernia
Q90. 45 year old woman present to the surgeon with a lump in the right breast. The surgeon observes a 2 cm by 3 cm mass in the left lower quadrant of the breast, no skin changes no discharge from the nipple and the mass has limited mobility . There is no axillary lymph node enlargement. Examination of the left breast and axilla was completely normal. A mammogram report suggests the presence of microcalcifications. Which is the most appropriate next step in the management of this patient?
needle-guided biopsy of the breast
Excision biopsy of the breast
Observation for one year and repeat the mammography
Partial mastectomy
answer is needle-guided biopsy of the breast.
Q91. 40 year old lady presents with swelling in the groin. Examination, swelling is diffuse and soft and lies below the inguinal ligament. It empties with minimal pressure and refills with release. There is a cough impulse and it disappears on lying down. On the calf of the same leg there are varicosities on the medial aspect. What is the most likely diagnosis?
Inguinal hernia
Saphena Varix
Varicose vein
Femoral hernia
Varicocele
answer is Saphena Varix,Below inguinal ligament, empties with minimal pressure and refills with release, presence of cough impulse and disappearance on lying down are suggestive of saphena varix supported by presence of varicosity in same leg
Q92. 33 year old man presents with a swelling above the groin crease in the abdomen. He has negative medical hx of note. What is the most probable dx?
Inguinal hernia
Irreducible hernia
Epidydimal cyst
Testicular tumor
Spigelian Hernia
answer is Spigelian Hernia. Spigelian hernia (or lateral ventral hernia) is a hernia through the spigelian fascia, which is the aponeurotic layer between the rectus abdominis muscle medially, and the semilunar line laterally
Q93. 70 year old man had closure of colostomy performed 4 days ago. He is not systemically unwell. There is a tender, localised fluctuant swelling 5 cm in diameter in the wound. What is the SINGLE most appropriate management?
Local exploration of wound
Abdominal support
Antibiotics
Observation
Laparotomy and re-suture wound
answer is Local exploration of wound..
Q94. 73 year old man being investigated for anaemia is booked for a colonoscopy in 24 hours. What is the SINGLE most appropriate management the night before the procedure?
Lactulose syrup
Glycerine suppository
Bisacodyl tablets
Magnesium Citrate (Orally)
Senna tablets
answer is Magnesium Citrate (Orally).
Q95. 60 year old male is admitted with a 2days history of lower abdominal pain and marked vomiting. On examination he has abdominal swelling, guarding and numerous audible bowel sounds. What is the likely diagnosis?
Small bowel obstruction
sigmoid volvulus
Large bowel obstruction
Ischemic colitis
Gallstone ileus
answer is sigmoid volvulus. History is not suggestive of ischemic colitis. There are no bowel sounds heard in gallstone ileus. Small bowel obstruction causes central abdominal pain, So given features with lower abdominal pain makes it more likely to be sigmoid volvulus
Q96. 24 year old woman presents with a 1 cm small smooth, firm, mobile mass in her left breast. She is very anxious. What is the most appropriate investigation?
Mammography
Mammography and US
US breast
FNAC
answer is US breast. his is fibroadenoma of the breast (breast mouse) for which US of breast is the appropriate investigation and if it reveal a fibrous lump we shall go for FNAC. Another point a doctor should know that for any suspicious breast lesion radiology should must be done before options of biopsy and investigation of choice in radiology is US scan before the age of 35 and mammography after the age of 35. In that term also for this case the investigation of choice is US breast