MEDICINE - I T&D JUNE - 2021

Paper Discussion
DR. DEEPAK MARWAH
1. A 65-year-old patient of Chronic kidney disease
underwent a kidney transplant in march 2020 and
collapsed suddenly in bathroom. On arrival to
casualty patient was pulseless and no signs of life.
You put the notes as dead on arrival. What could be
possible aetiology that you would explain to
relatives?
a. Hyperacute rejection of kidney
b. Chronic rejection of kidney
c. Cardiovascular etiology
d. Uremic encephalopathy
2. Which is the best investigation for Dysphagia
Lusoria?
a. Oesophageal manometry
b. CTA
c. Double -contrast Barium swallow
d. Aortography
3. 30 year old AIDS positive truck driver is
complaining of odynophagia and cant even drink
water. Upper GI endoscopy was performed and
shows serpiginous ulcers in oesophagus. What is
the diagnosis?
a. Oesophageal Candida
b. Crohn disease of oesophagus
c. Pseudo-achalasia
d. CMV esophagitis
4. A 30 year old patient has been diagnosed with
decompensated alcoholic cirrhosis and gross
abdominal distention. On examination vitals are
stable, normothermic. Per abdomen reveals dilated
veins around umbilicus and fluid thrill. Some marks
are noticed on shoulder. Which of the following is
correct about this patient?
a. High anion gap metabolic acidosis
b. Non chloride responsive metabolic alkalosis
c. Chloride responsive metabolic alkalosis
d. Normal anion gap metabolic acidosis
5. A post thyroid surgery patient is having
complaints of dry mouth with tingling sensation
around lips and finger tips. Which of the following is
next best step for this patient?
a. Reassure the patient, draw blood sample for Potassium levels
b. Reassure the patient and apply BP cuff on arm to check for
carpopedal spasm
c. Give 10 ml of 10% calcium gluconate
d. Give 10ml of 10% calcium chloride
6. A 25 year lady is having complaints of polydipsia
and polyuria with involuntary weight loss. On
General physical examination she is thin built with
stable vitals. Systemic examination is normal. Which
is the next investigation to be prescribed for this
patient?
a. Water deprivation test
b. Water loading test
c. HbA1c
d. Sputum CBNAAT for MTB
7. 25-year-old woman is having recurrent episodes
of diffuse abdominal pain on daily basis which is
relieved by defecation. Her symptoms worsen
during menses but her sleep time is not interrupted
to go to washroom. There is no passage of blood in
stools but she reports diarrhea during the duration
of menses. What is probable diagnosis?
a. Inflammatory bowel disease
b. Irritable bowel syndrome
c. Pseudomembranous colitis
d. Malingering
8. A 30-year-old lady is having tea colour watery
stool for last 6 months. Her colonoscopy show
villous adenoma in transverse colon and is
scheduled for surgery. Which of the following
electrolyte abnormality is expected in this patient?
a. Hypokalemia
b. Hypocalcemia
c. Hypochlorhydria
d. Hypomagnesemia
9. A 60-year-old man collapsed at airport boarding
gate. You are the first responder on the scene and
detect no pulse or breathing efforts. You have
started CPR at ratio of 30:2. Which is the next step?
a. Secure IV line and Give 1mg Adrenaline
b. Attach A.E.D to detect shockable rhythm
c. Intubate the patient/ Advanced airway
d. Transcutaneous pacing
10. Which of the following is correct about renal
tubular acidosis type 4?
a. Involves DCT and occurs due to failure of Na-H antiporter
b. Involves DCT and occurs due to ADH resistance
c. Involves DCT and occurs due to excess activity of Na-K ATPase
pump
d. Involves DCT and occurs due to aldosterone resistance
11. A 60-year-old man collapsed at airport boarding
gate. You are the first responder on the scene and
detect no pulse or breathing efforts. You have
started CPR at ratio of 30:2 and you hear sound of
rib getting fractured. Which is the next step?
a. Wait and assess rib damage and possibility of internal damage
b. Continue CPR
c. Insert Wide bore needle in 2nd intercostal space
d. Defibrillation at 200J for Non-shockable rhythm
12. Which of the following is correct about
Defibrillation?
a. Provides DC shock of 100 joules biphasic
b. Increase in success rate with delay in ROSC
c. Each DC shock is given after completion of CPR for 2minute
d. Worsens prognosis
13. Which is best for management of ECG shown in
rhythm strip of this patient of Diabetic nephropathy
admitted with features of Uraemia.
a. IV Flecainide
b. IV Bretylium
c. IV Amiodarone
d. IV adenosine
14. Comment on possible etiological diagnosis of
this patient with acute abdomen?
a. Boerhaave syndrome
b. Peptic ulcer disease
c. Aortic dissection
d. Stomach Volvulus
15. A 25-year-old previously healthy man presents
with headache, diplopia and nuchal stiffness for 3
days. CSF report of a person shows presence of 25
lymphocytes/ mm3, sugar = 65mg%, protein=80
mg% and increased opening pressure. Which
organism is responsible for this presentation?
a. Cryptococcus
b. Herpes Simplex
c. Mycobacterium Tuberculosis
d. Streptococcus pneumoniae
16. Which of the following is used for intractable
epilepsy?
a. Vagus nerve stimulation
b. Transcranial magnetic stimulation
c. Phototherapy
d. Electroconvulsive therapy
17. What anticonvulsive agent would be MOST
appropriate as first-line therapy for a 21-year-old
woman recently diagnosed with complex partial
seizures?
a. Lamotrigine
b. Carbamazepine
c. Topiramate
d. Phenytoin
18. A 40-year-old female patient presents with
complaint of her waking up to find that she had lost
sensation and motor power in her hand. She woke
up her husband and explained the symptoms and
they have come to your casualty at 4 am. First
differential diagnosis?
a. Transient ischemic attack
b. Neuropraxia
c. MCA territory Stroke
d. Lacunar stroke
19. A 20-year-old boy presents with recurrent
attacks of deep-seated orbital pain. You have
diagnosed him as a case of cluster headache. What
will be the first line management?
a. Sumatriptan
b. Rizatriptan
c. Steroids
d. High flow oxygen
20. Which of the following is shockable rhythm?
a. AV dissociation in complete heart block
b. Sick sinus syndrome
c. Asystole
d. Polymorphic Ventricular tachycardia
21. Which of the following is best site for checking
core temperature of body?
a. Rectum
b. Lower esophagus
c. Tympanic membrane
d. Nostril
22. A 26-year-old man is having treatment with
chemotherapy for Hodgkin's lymphoma. During his
treatment, he has severe vomiting. Which location
in the brain is responsible for his symptoms?
a. Dorsal midbrain
b. Area postrema
c. Ventral pons
d. Thalamus
23. Which of the following is best suited for
confirmation of diagnosis of pseudomembranous
colitis?
a. Stool culture
b. Stool EIA for toxin A and B
c. PCR stool for toxin A and B
d. Stool calprotectin levels
24. A 70-year-old woman has a progressive
neurological disorder resulting in degeneration of
the anterior horn cells throughout her spinal cord
and brainstem. Which of the following abnormal
movements is she most likely to exhibit?
a. Asterixis
b. Chorea
c. Fasciculations
d. Gait Apraxia
25. 85-year-old man presents with a sudden onset
of severe occipital headache and has vomited on
two occasions since the headache began. He also
complains of double vision. His examination
findings are as follows:
Glasgow Coma Scale 15/15
Neck stiffness +++
Comment on where is the likely site of pathology?
a. Anterior communicating artery
b. Posterior communicating artery
c. Lenticulostriate artery
d. P1 Segment of Posterior cerebral artery
26. 70-year-old male who presents with a one-year
history of progressive ataxia, urinary incontinence
and memory loss. What is the most likely diagnosis?
a. Normal pressure hydrocephalus
b. Cerebellar astrocytoma
c. Lewy body dementia
d. Multiple sclerosis
27. Correct about Lumbar puncture procedure is all
except?
a. Done with patient in lateral decubitus position
b. Aspirate once the dura matter is breached with a pop sound
c. Maximum CSF that can be removed safely is about 20 ml
d. Contraindicated in raised I.C.P
28. A known epileptic patient who is non-compliant
is having seizures for past 10 minutes. IV access
could not be obtained. Which medication would
be most suitable to administer at this stage treat the
patient's seizure?
a. Sodium Valproate
b. Levetiracetam
c. Midazolam
d. Lorazepam
29. 30-year-old lady has developed weakness of
both legs 3 days after eating at a sea food
restaurant. She has been having loose watery
stools about 10 times per day and has taken
ORS. On examination she is having flaccid
paraplegia, areflexia with absent plantars. Arm and
truncal examination is normal. Cranial nerves and
high mental function are normal. First differential
diagnosis is?
a. Multiple sclerosis
b. Malingering
c. Gullian barre syndrome
d. Dyselectrolytemia
30. Punched out ulcers in oesophagus are
suggestive of?
a. Eosinophilic esophagitis
b. Reflux esophagitis
c. Herpes oesophagitis
d. Chemical oesophagitis
31. 75-year-old hypertensive patient has developed
a sudden onset left sided facial asymmetry and
inability to use left arm. He was rushed to the
hospital where an urgent NCCT head was
performed after 3 hours of onset of symptoms.
Comment on diagnosis?
a. Right sided intraparenchymal haemorrhage
b. Right sided acute ischemic stroke
c. Right sided intraventricular haemorrhage
d. Right sided cortical venous thrombosis
32. A 40-year-old man is having severe epigastric
pain episodes responding to PPI but recurs when
he does not take PPI. Now he has also developed
diarrhoea with purge rate about 5-6 times per day
for last one month. The Diarrhea is non-responsive
to fasting. UGIE shows a giant duodenal ulcer. What
test should be done next to diagnose the etiology?
a. Breath urea test
b. 72-hour prolonged fasting test
c. Secretin study
d. Small intestinal mucosal biopsy
33. 35-year-old alcoholic comes to you with report
of abnormal Schilling test. You have prescribed
pancreatic supplements to the patient and schilling’
test has become normal. What is the likely aetiology
of abnormal schilling test?
a. Type A gastritis
b. Chronic pancreatitis
c. Whipple disease
d. Bacterial overgrowth syndrome
34. Thrombolysis in a case of acute ischemic stroke
should be done within?
a. 3 hours
b. 4.5 hours
c. 6 hours
d. 12 hours
35. Which of the following condition has muscle
weakness with preserved deep tendon reflexes?
a. Guillain barre syndrome
b. Polio
c. Myasthenia Gravis
d. Lead poisoning
36. A 20-year-old college student complains of
thunderclap headache and nuchal rigidity. What is
best test to confirm the diagnosis?
a. Guarded Lumbar puncture
b. NCCT Head
c. CECT head
d. MRA
37. Which is correct about patient of Acute tubular
necrosis?
a. Low urinary sodium
b. Low osmolality urine
c. > 5 Dysmorphic RBC per HPF
d. High urinary sodium
38. 40-year-old rickshaw puller is admitted due to
multiple episodes of focal seizures occurring on
almost daily basis for last few weeks. His
medication status is not known. NCCT head image
is shown below. What investigation will be best to
establish etiology of lesions?
a. CSF immunoblot for neurocysticercosis antigen
b. CSF ELISA For cryptococcal antigen
c. Beta 1,3 glucan test
d. IgM/IgG titre for toxoplasmosis
39. 35-year-old lady is having complaints of
bilateral ptosis on watching television, chewing
muscle and shoulder girdle weakness. Which test
would be useful for her diagnosis?
a. Anti- Endomysial antibodies
b. Anti- P/Q voltage gated calcium channel antibodies
c. Anti- Ach- receptor antibody titer
d. Anti- synthetase syndrome
40. Metabolic acidosis with hyperkalemia is seen
in?
a. Hyperaldosteronism
b. Vomiting
c. Acute kidney injury
d. Diarrhea with severe dehydration
41. Normal anion gap is seen in?
a. Diarrhea
b. Acute kidney injury
c. Acute tubular necrosis
d. Lactic acidosis type A
42. Which condition has water-melon stomach?
a. Linitis plastica
b. Menetrier’s disease
c. Type A gastritis
d. Gastric antral vascular ectasia
43. A patient of Chronic renal failure has presented
with fatigue. On examination pallor is noted with a
fistula in left hand for recurrent haemodialysis.
Blood urea = 65mg% with serum potassium of 6.5
meq /L. Which of the following is best
recommended is for this patient?
a. Patiromer
b. Calcium gluconate
c. Insulin drip
d. Furosemide drip
44. What is the source of bleeding in Oesophageal
variceal bleed?
a. Left Gastric artery
b. Short gastric artery
c. Coronary veins
d. Azygoz veins
45. Somatostatin is used for treatment of which of
the following conditions?
a. Non-bleeding esophageal varices
b. Gastrinoma
c. G.I.S.T
d. Neuroblastoma
46. Leading cause of death in the haematological
malignancy shown in the slide of a 70-year-old man
with cervical lymphadenopathy with progressive
anemia and petechiae on bilateral ankles is?
a. Infections
b. Bleeding
c. Meningeal and ventricular extension
d. DIC
47. Low serum cobalamin and elevated serum folate
levels are seen in?
a. Acute myeloid leukemia
b. Celiac sprue
c. Bacterial overgrowth syndrome
d. Chronic myeloid leukemia
48. Which is best for diagnosis of small intestinal
mucosal disease?
a. Small bowel Series using barium contrast
b. Urinary D- xylose test
c. Small intestinal mucosal biopsy
d. Breath hydrogen test
49. Normal D-xylose test and normal Schilling test is
a feature of?
a. Chronic pancreatitis
b. Bacterial overgrowth syndrome
c. Celiac disease
d. Intestinal lymphangiectasia
50. Most common extraintestinal manifestation of
Inflammatory bowel disease?
a. Dermatological
b. Rheumatological
c. Metabolic bone disease
d. Hepatobiliary
51. A 30 year old lady with crush injury was
admitted to the casualty. Her urobag shows 100ml
red color urine. ECG is shown below. All are
indicated for this patient except?
a. Hemodialysis
b. Furosemide drip
c. Calcium chloride
d. Magnesium sulfate
52. An unconscious 50-year-old known case of
diabetes mellitus is brought to the ER. His medical
records show he is on warfarin for atrial fibrillation.
Which of the following investigations will not be
done in this patient for work up?
a. Lumbar puncture
b. Random blood sugar
c. NCCT
d. ECG monitoring
53. Schamroth window test is used for evaluation
of?
a. Clubbing
b. Pedal oedema
c. Nephrotic syndrome
d. Pallor
54. Which is a diagnostic feature of CRF?
a. Broad casts in urine
b. Elevated blood urea
c. Proteinuria
d. Bleeding diathesis
55. A 28-year-old man has lenticonus and ESRD. His
maternal uncle also died of similar illness. What is
the diagnosis?
a. ARPKD
b. ADPKD
c. Oxalosis
d. Alport’s syndrome
56. In chronic renal failure there is?
a. Decrease anion gap
b. Normal anion gap
c. Increased anion gap
d. Metabolic alkalosis
57. Which of the following will lead to melena?
a. Haemorrhoids
b. Mallory Weiss syndrome
c. Meckel’s diverticulum
d. Cancer rectum
58. Not a cause of upper GIT bleeding is:
a. Meckel’s diverticulum
b. Mallory Weiss syndrome
c. Gastric antral vascular ectasia
d. Portal hypertension
59. Compare the intestinal biopsy specimen of a 5-
year-old patient before and after diet restriction. All
the true about the condition shown except:
a. Most common complication of celiac sprue is development of
cancer
b. Most sensitive test is anti-Tissue transglutaminase antibody
c. Classic changes in celiac sprue occur in submucosa
d. Associated with dermatitis herpetiformis
60. Patient develops vomiting episodes and extreme
muscle weakness. Cause is?
a. Hypokalemia
b. Hyponatremia
c. Hypophosphatemia
d. Hypomagnesemia
61. Storage temperature of platelets is?
a. - 4 degrees Celsius
b. + 4 degrees Celsius
c. - 20 degrees Celsius
d. + 20-24 degrees Celsius
62. All of the following are the causes of relative
polycythemia except?
a. Dehydration
b. Dengue haemorrhagic fever
c. Gaisbock syndrome
d. High altitude
63. A 30-year-old man says that most nights in last 1
year he lays awake in bed for 2-3 hours before he
falls asleep. His sleep is often interrupted. The next
day he feels tired and forgetful and makes multiple
mistakes in his work. All drugs will be useful for him
except?
a. Flunazepam
b. Zolpidem
c. Ramelton
d. Modafinil
64. Which of the following is not included in triad of
Parkinsonism?
a. Tremors
b. Festinating gait
c. Bradykinesia
d. Cog wheel rigidity
65. Not included in features of vitamin B12
deficiency?
a. Sensory ataxia
b. Rhomberg’s sign positive
c. Apraxia
d. DTR brisk
66. 1st symptom to respond to infusion of thiamine
plus glucose in Wernicke’s encephalopathy?
a. Global confusion
b. Opthalmoplegia
c. Ataxia
d. Confabulation
67. Which of the following drugs will not be useful in
management of this 60-year-old man with
hypertension and right sided face and arm
weakness?
a. Hypertonic saline
b. Labetalol
c. Reteplase
d. Aspirin
68. Not a feature of extrapyramidal lesion?
a. Dystonia
b. Chorea
c. Absent superficial reflexes
d. Normal Deep tendon reflexes
69. Feline oesophagus is seen in?
a. Eosinophilic esophagus
b. Schatzki ring
c. GERD
d. Herpes simplex esophagitis
70. Diffuse esophageal spasm is best diagnosed
by?
a. Endoscopy
b. Manometry
c. Barium swallow
d. CT
71. Which of the following staging is used for
GERD?
a. Ranson
b. Gleason
c. Savary miller
d. Hess Hunter
72. An alcoholic is admitted with severe epigastric
pain for last 6 hours. The pain is radiating to back.
He is admitted and put on NPO with mantainence
IVF, Pantoprazole and tramadol injection. What is
the best test to confirm diagnosis of this patient?
a. UGIE
b. Breath urea test
c. Serum amylase
d. CT abdomen
73. Most common site of tear in Boerhaave
syndrome:
a. Lower end of oesophagus
b. At gastroesophageal junction
c. Upper esophagus
d. Mid oesophagus
74. When will you admit a 60-year-old man with
fever abdominal pain and loose motions for last 4
days and positive rapid antigen test for SARS-COV-
2?
a. Presence of comorbidity like Diabetes mellitus and hypertension
b. RR> 24 and sp02 < 90 % at room air
c. Leucopenia with positive CRP and increased IL-6
d. No need for admission, prescribe Zinc and ivermectin for 3 days