X ray of cardiomegaly young woman sob on exertion what is the best invx to dx

? June 2012 Recall

a. anti ds antibody
b. crp
c. mri

 Multi Para woman presented with Postpartum haemorrhage patient in shock

, blood dose not clot ,what is the most likely cause?
a. Uterine atony
b. Amniotic fluid embolism
female visited you on Monday asking for sick leave because she drank heavily
on Saturday
and Sunday.this is the third Monday .she works as prostitute .she was
diagnosed with
depression and prescribed antidepressant .however she does not take her
antidepressant
regularly. Next step?
Stop drinking
...

issue her ith medical certification

Patient with af, ht high cholesterol level it was long scenario asking about the
best treatment to prevent cva?
a. Aspirin,
b. clopedogril,
c. warfarin
d. Simvastatin
e. Ramipril

Control hypertension

X-ray of bilateral opacities post op dx is atelectasis in addition to physiotherapy

what is the next step patient was hypoxic irritable?? June 2012 Recall
a.antibiotics,
b. iv fluid,
c. lung lavage ,
d.intubation and oxygen therapy

3rd post-op. day with chest pain and dyspnea.Next step?

CXR
CTPA

PE doesnt develop before 5th post op day

92 widowed man presented with chest pat. you resuscitate him , he told you if
something
happen next time do not resuscitate , next step?
Assess his mental competence
Write “do not resuscitate” on the top of his bed

An elderly female with inguinal hernia , scheduled for elective surgery .one
week before surgery
she developed DVT and put on warfarin.Next step?
Postponed operation for 3 months
Operate now
Switch to heparin and operate now
Give FFP
Give Vit. K

Chest blunt trauma due to MVA, paradoxical respiration.both sides #.

Management?
Needle thoracentesis
Intercostal drainage
Intubation followed by intercostal drainage
Positive pressure ventilation

For mild and moderate cases the answer is d

A pat. was on warfarin , undergoes an operation .warfarin stoped before

operation.Now second
day post-op. Next step?
Resume warfarin
Give heparin
a,,it says u cn resume 12 to 24 hours after surgery

ECG of 50 yr lady shows 3 normal beats then 3 Asystole then 3 normal beats
.The Asystole
occurs when you palpate her carotid art. What do you advice her?
DC
Not to massage her carotid art. In the future
B-blocker
Amiodaron
Adinocin

oung man with sudden chest pain, normal B.P., P.R and temp. Normal
Troponin. Next step?
Repeat troponin in 8 hr
Discharge home without follow up
Discharge with F/U after 24 hr in O/P
Admitarrival at the emergency department and may repeat the test at 6 and
12 hours later while others may only measure a single 12 hour post admission
level (to rule out a heart attack

Delayed puberty

Possible causes

 Variation of normal (constitutional delay)

 In females, prolonged high level of physical exertion, e.g. from being an
athlete
 Systemic disease, e.g. Inflammatory bowel disease, chronic renal failure
 Undernutrition e.g. anorexia nervosa, zinc deficiency
 Hypothalamic defects and diseases e.g. Prader-Willi syndrome, Kallmann
syndrome
 Pituitary defects and diseases e.g. hypopituitarism
 Gonadal defects and diseases e.g. Turner syndrome, Klinefelter
syndrome, Testicular failure due to mumps orchitis, Coxsackievirus B,
irradiation, chemotherapy, or trauma. Testicular failure is treated with
testosterone replacement,[2] Ovarian failure.[2]
 Absence or unresponsiveness of target organs e.g. androgen insensitivity
syndrome, mullerian agenesis
  Other hormone deficiencies and imbalances, Endocrine disorders.[3] e.g.
hypothyroidism, Cushing's syndrome
 Cystic fibrosis[4]
 Mutations in FSHB[5]
 Frasier syndrome[6]
 Various forms of congenital adrenal hyperplasia.[3]
 Gonadotropin[clarification needed], a deficiency resulting from a number of
congenital and acquired abnormalities of the central nervous system
 Biedl-Bardet syndrome
 Brain tumors e.g. craniopharyngioma, prolactinoma, germinoma, glioma;
diseases of hypothalamus, irradiation and trauma.

Pediatric endocrinologists are the physicians with the most training and
experience evaluating delayed puberty. A complete medical history, review of
systems, growth pattern, and physical examination will reveal most of the
systemic diseases and conditions capable of arresting development or delaying
puberty, as well as providing clues to some of the recognizable syndromes
affecting the reproductive system.

Since bone maturation is a good indicator of overall physical maturation, an x-

ray of the hand to assess bone age usually reveals whether the child has
reached a stage of physical maturation at which puberty should be occurring.
Visible secondary sexual development usually begins when girls achieve a bone
age of 10.5 to 11 years, and boys achieve a bone age of 11.5 to 12 years.

The most valuable blood tests are the gonadotropins, because elevation
confirms immediately a defect of the gonads or deficiency of the sex steroids.
In many instances, screening tests such as a complete blood count, general
chemistry screens, thyroid tests, and urinalysis may be worthwhile.

More expensive and complicated tests, such as a karyotype or magnetic

resonance imaging of the head, are usually obtained only when specific
evidence suggests they may be useful.

Use of gonadotropin releasing hormone can be of value in the differential

diagnosis.[7]

If a child is healthy but simply late, reassurance and prediction based on the
bone age can be provided. No other intervention is usually necessary. In more
extreme cases of delay, or cases where the delay is more extremely distressing
to the child, a low dose of testosterone or estrogen for a few months may
bring the first reassuring changes of normal puberty.

If the delay is due to systemic disease or undernutrition, the therapeutic

intervention is likely to focus mainly on those conditions.

If it becomes clear that there is a permanent defect of the reproductive

system, treatment usually involves replacement of the appropriate hormones
(testosterone/dihydrotestosterone for boys,[8] estradiol and progesterone for
girls).

Pubertal delay due to gonadotropin deficiency is treated with testosterone

replacement or with HCG [2]

Growth hormone is another option that has been described.[9][10]

Subnormal vitamin A intake is one of the aetiological factors in delayed

pubertal maturation. Supplementation of both vitamin A and iron to normal
constitutionally delayed children with subnormal vitamin A intake is as
efficacious as hormonal therapy in the induction of growth and puberty.[11

An advanced or delayed bone age does not always indicate disease or

"pathologic" growth. Conversely, the bone age may be normal in some
conditions of abnormal growth. Children do not mature at exactly the same
time. Just as there is wide variation among the normal population in age of
losing teeth or experiencing the first menstrual period, the bone age of a
healthy child may be a year or two advanced or delayed.

An advanced bone age is common when a child has had prolonged elevation of
sex steroid levels, as in precocious puberty or congenital adrenal hyperplasia.
The bone age is often marginally advanced with premature adrenarche, when
a child is overweight from a young age or when a child has lipodystrophy. Bone
age may be significantly advanced in genetic overgrowth syndromes, such as
Sotos syndrome, Beckwith-Wiedemann syndrome and Marshall-Smith
syndrome.

Bone maturation is delayed with the variation of normal development termed

Constitutional growth delay, but delay also accompanies growth failure due to
growth hormone deficiency and hypothyroidism.
X-ray of large bowel obstruction…what is the best investigation?
a. Ct scan
b. Colonoscopy
c. Barium enema
d. Fobt

6) A severe mentally retarded 18 yo girl who attends a special school due to

her mental disability came with her guardian. The guardian askes you about
contraception for the girl. What kind of contraception will you advise?
a. IUD
b. microgynom 5
c.BTL
d. hysterectomy
e. condom will protect her from pregnancy and STD
f guardian ship

base on pdf i sent u guys as the pt is sever mental retard and 18 year it ould
be F...if she is under 18 no one can consent for hysterectomy..and if mental
retard is not sever ocp is best method

Elective laparoscopy for a pat. who is known to be an IV drug user.post-op.

there is umbilical
discharge. Blood culture shows Staph.aureus. what is the source of this
infection?
Nasocomial
IV line
Umbilicus

staph aureus rests on skin ,and umbilical discharge means source of

infection is leproscopic wound

‎ yr old child acting strange. Does not want to move out of the family care
7
when they go shopping and he goes to the parties but doesn't stay
overnight out of the house. What of this is most relevant to the history ?
a. 12 months old new brother
b. school record performance
overseas Patient had chest x ray with round opacity. Mantoux test positive
but there is no cough.
triple therapy
monotherapy
review after a period

What is the Best Surgery for Cataract?

A. IOL
B. PHACO

the ideal is day-case surgery using local anasthesia with smal incision
surgery and phacoemulsion+ a lense implant

A 35 weeks pregnant woman presents with vaginal bleeding, but uterus

isn’t tender. BP is 130/80 mmHg, pulse is 86/minute. All of the following will
be your initial steps in management, EXCEPT:
a. blood cross check matching
b. full blood count
c. coagulation factors
d. ultrasound

A.........Bushra Usman Wains here pt is 35 weeks pregnant it means cross

matching has done in her initial antenatal visit other investigations we hav
to do to rule out the cause of p/v bleeding

Old age woman a known case of dementia. Presented with repeated fall.
After admission and treatment. What’s the best next step in decreasing her
falls? June 2012 Recall
a. Close supervision
b. Admission to old care home
c. Donepezil
d. Safe shoes

Elderly woman with H/O Ca. colon presents with lower vertebral
pain.elevated PTH + ALK.PH.
Dx. ?
Multiple myeloma
Malignant met
Disc prolapse
Vertebral

#Hmmm ... Its nt Malignant mets ... In it ca s raised so parathyroid hormone

l b low ... Ths s vertbral fracture sec to probably osteomalacia .. In wich
there is raisee alk phosp n raised pth n low ca ... PTH is high to raise the ca
level4

papillodema in fundoscope. likely cause?

CRAO
CRVO
CRF
diabetic retinopathy
hypertensive retinopathy

ECG of elderly female shows VT .she is hemodynamially stable . Next step?

Amiodaron
DC
Digoxin
Adinocin

tell u the american college f cardiology guidelines.. N american heart

association NICE (UK)..
VT in stable pt wd out any IHD or LV dysfunction .. Lignocaine... N if IHD thn
Amiodarone... N if hemodynamically unstable only thn DC shock

patient presented with biventricular failure. has been taking a lasix and b
blocker. HR 56 with edema. whats the treatment now ?
a. digoxin
b. prozocial
c. NTG patch
d. spironolactone
e. b blocker

Yes seher is rt answer shd hv been ACEI .. Bt herr answer is spironolactone

... If heart rate was greatr thn 60 thn digoxin was answer

Young male presented with pain in loin radiating to groin. Urine exam
showed RBCs +++. Best inv?
 a. Spiral ct
b. Ivp
c. u/s
d. xray
e. cystoscopy

A 97%sensitiv and 96%specific to diagnose ureteric calculi

. How can u diagnose brain death ?

a. CT
b. EEG
c.two practioners should examine the patient
d. coma for long time
e. no automatic breathing or heart rate

 irreversible apnea... E

Queensland fever?
DEngue
Ross rivr fever

A 73 yr old male patient was on levodopa/carbidopa 750 mg/day. His

parkinson systems have been well controlled over a few months but now he
has involuntary oral movements (leaking of lips). management?
a. Add selegeline
b. add benzhexol
c decrease levodopa/carbi
d. increase

First C and after that if still has symptoms then add dopamine agonists

two sisters living togethr, one thinks neighbours tryin to kill her. other is
normal but starts believing like her sis. She is fine when she is awy from her
sis. Dx?
folie e duex
both sisters pschiatric pts

Man is brought to the hospital with with agitation, irritability. He is an

alcoholic. What will you give him
a) Halloparidol
b) Diazepam
cj Olanzipine
d) Thiamine
e) Another short acting BZ cant remember the exact name

‎ 0 yrs old man has chest pain relieved on bending forward, no change in
5
ECG..Cause?
GORD
MI
pericarditis
pleuritis
aortic dissetion

pericarditis can have normal ECG in last stages

Lol its sch a simple question guys n u ppl complicating it ... Pleuritis has no
assoviation wd bending frwrd n it increases wd coughing n inspiration .. N
only LRTI n PE can cause pleurisy usually .. Aoryic dissection hs sharp
stabbing pain wvh hs gt no relation wd poature

A 57 yr old lady develops sudden onset of left sided weakness and right eye
blindness.This is most likely due to-
a.Vertebro-basilar insufficy
b.Pituitary tumour
c.Carotid artery stenosis
d.Cerebellar lesion
e.Retinal detachment
f. rt middle cerebral artery

i think C.. bcz central retinal artery is a branch of carotid artery,. so carotid
artery occulusion on right side will present as ipsilateral blindness and
contralateral weakness of the body.. only confusion is stenosis cant be
sudden , but other options wont give weakness and complete blindness on
opposite sides.. even if vision is effected with weakness , it would be
homonymous type lesions with other options..
A 4 year old child is brought by his mother as he is complaining of pain in
RUQ fro the last 2 years, recently she has noticed mass in RUQ , What is Dx?
a) Neuroblastoma b) hepetoblastoma c)wilms tumor d) HCC

One pt with K/C/O Heavy smoking and COPD presenting with dyspnoea
which is not responding to bronchodyletors , Dx? X ray given with collase
and opacity .N ext investigation?
A) biopsy b) CT scan c) MRI d) USG e) sputum cytology

A man came in with colicky abdominal pain. A renal calculus is seen at the
ureteropelvic
junction measuring 2cm. What is the next step in management?
a. Extracorporal shock wave lithotripsy
b. Percutaneous Nepho lithotomy
c. Basket removal
d. Wait and reassure
e. Nephrectomy

Ureteroscopy
Ureteral stone
Ureterorenoscopy
Renal stones <2 cm
Extracorporeal Shock Wave Lithotripsy (ESWL)
Radiolucent calculi
Renal stones <2 cm
Ureteral stones <1 cm
Percutaneous Nephrolithotomy
Renal stones >2 cm
Proximal ureteral stones >1 cm
Open Surgery Procedures in refractory cases
Anatomic nephrolithotomy
Partial nephrectomy
Illeal ureter

Patients with obstruction of the ureteropelvic junction: Stones can be

removed at the same time as the outflow
abnormality is corrected either with percutaneous endopyelotomy (15-35)
or with open reconstructive surgery.
Transureteral endopyelotomy with Ho:YAG laser endopyelotomy is another
alternative to correct this
abnormality. Incision with an Acucise balloon catheter may also be
considered provided the stones can be
prevented from falling down into the pelvo-ureteral incision

ESWL is especially suitable for stones that are smaller than 2 cm and lodged
in the upper or middle calyx. It is contraindicated in pregnancy, untreatable
bleeding disorders, tightly impacted stones, or in cases of ureteral
obstruction distal to the stone

a 30 yr old man comes with bilt ankle swelling, o/e some skin lesions on
legs, PR interval prolonged on ECG. Rx?
indomethacin
methotrexate
steroid
penicillin

30. Known COPD patient was brought in emergeny with SOB,oxygen was
started and he became more breathless after some time.what ABG’s are
expected?
a. pH 7.2, PO2 80, PCO2 60
b. pH 7.2, PO2 92, PCO2 60
c. pH 7.5, PO2 80, PCO2 60
d. pH 7.5, PO2 92, PCO2 50
e. pH 7.4, PO2 92, PCO2 60

known case of COPD .. given high O2 will develop Respiratory acidosis

A and B are correct
look for O2 . . In COPD pt has o2 at less than 90 normally . .88 is acceptable
for him . . so A is correct
get it
 There are 2 groups and we r trying to study the effect of diabetes in the
population
a) RCT
b) Case control
cj Cohort
...
8) A 4 year old child is brought by his mother as he is complaining of pain in
RUQ fro the last 2 years, recently she has noticed mass in RUQ , What is Dx?
a) Neuroblastoma b) hepetoblastoma c)wilms tumor d) HCC

One pt with K/C/O Heavy smoking and COPD presenting with dyspnoea
which is not responding to bronchodyletors , Dx? X ray given with collase
and opacity .N ext investigation?
A) biopsy b) CT scan c) MRI d) USG e) sputum cytology

middle aged male with h/o recurrent productives presented with fever,
greenish copious amount of sputum n cough. On xray chest : widend
bronchioles present at both lung bases. Next best step in Mx?
a. Amoxicillin n calvulante
b. Ampicilline
c. i/v penicillins......................
d. erythromycin

pt with h/o knee injry while playin football,on that day he developed
effusion, 1 mnth later he came with h/o givin away of knee & episodes of
locking. Dx?
ACL rupture
med meniscal & PCL tear
rupture of MCL & med meniscus

acl + medial menisc

wof is appr. pre operative fluid for appendicectomy?

hartmans
25o ml NS
5 % dextrose
 1 lit NS
20 ml /hr of IV bolus

 ‎ 00) One aborigional girl with injury to ankle . ROM not affected. Having pain
1
at lower broder of tibia. Fever present. Dx?
A) Ankle synovitis B) Osteomylitis

A male presents with a sudden onset of vertigo and nausea. During the
attack he has deafness. WOF is your diagnosis is --
a) Positional vertigo
b) Acoustic neuroma
c) Labyrinthitis
d) Basilar artery

 Pic was given about maile patient aged 65 years with left sided parotid
swelling. He was on medications for DM since 20 years. He had eye
dryness and mouth dryness since 6 years. He was complaining of
agitation, joint pain and fatigue. His BP was 150/80 mmHg. What is the
diagnosis?sjogren
...
46 woman in menopause using tibolon presented with bleeding what is the
most probable cause?
a. Atrophic vaginitis ,
b. side effect of tibolone ,
c. endomat ca,
d. vulvar ca,
e. cx ca

tibolon side effect is not vaginal bleeding or spoting..but tibolon can cause
increased risk of breast,endometrial and ovarian cancer..it improve vaginal
dryness..flushing..there is no increased risk for volvular or cervix cancer

- a man with ht on ramipril 5mg bpr= 130/80 , he is diabetic Hba1c= 7.1,

serum cholesterol = 5 he has heart failure. what is the best next step ?
a. add simvastatin
b. increase ramipril dose
c. add diuretics
 d. add aspirin
e. commence insulin

Simple c frst n thn manage diabetes n cholesterol

A man going to visit Fiji.best vaccine?

A.yellow fever
B.HepatitisA
C.pneumonia
poor recall but question was about the most most important vaccination for
FIJI trip

The accuracy of focus assessment sonography in trauma (a fast scan) is

compromised by all of the following except:
• A Obesity
• B Previous surgery
• C Subcutaneous air
• D Bowel gas
• E Perforation of bowel

 Guys. most common organisms for meningitis???

Age wise Comon organisms are.....In Neonates from 1day to 1 month is
GBS... 2month to 2years is S.Pneum... From 2 yrs to 18 yrs is
Meningococci..above 18 yrs again S.pneum

U r a DRUNK doctor on an airplane .. and someone asked for a doctor for

emergency case… what u will do :
1- Wait for 30 min if no one appear u will appear
2- Till them that u r drunk but u will try to help
3- Go to sleep and forgot about everything

Pediatric endocrinologists are the physicians with the most training and
experience evaluating delayed puberty. A complete medical history, review
of systems, growth pattern, and physical examination will reveal most of
the systemic diseases and conditions capable of arresting development or
delaying puberty, as well as providing clues to some of the recognizable
syndromes affecting the reproductive system.
Since bone maturation is a good indicator of overall physical maturation, an
x-ray of the hand to assess bone age usually reveals whether the child has
reached a stage of physical maturation at which puberty should be
occurring. Visible secondary sexual development usually begins when girls
achieve a bone age of 10.5 to 11 years, and boys achieve a bone age of 11.5
to 12 years.

The most valuable blood tests are the gonadotropins, because elevation
confirms immediately a defect of the gonads or deficiency of the sex
steroids. In many instances, screening tests such as a complete blood count,
general chemistry screens, thyroid tests, and urinalysis may be worthwhile.

More expensive and complicated tests, such as a karyotype or magnetic

resonance imaging of the head, are usually obtained only when specific
evidence suggests they may be useful.

Use of gonadotropin releasing hormone can be of value in the differential

diagnosis

diabetic woman with BMI=30 complains of infertility for last 2 years in spite
of unprotected and regular intercourses. Her periods are irregular. Lab
investigations show increased FSH, slightly increased LH, decreased
oestradiol, her prolactin & thyroid hormones levels are normal. Ultrasound
shows normal ovaries with 4-5 cysts in the right ovary. What will you do to
treat her infertility?
a. Clomiphen citrate
b. Advice to decrease weight
c. Oestradiol therapy
d. IVF with donor ovum
e. Metphormin

it is primary ovarian failure

hemorrhagic shock stage

Stage 1

 Up to 15% blood volume loss (750 mL)[10]

 Compensated by constriction of vascular bed
 Blood pressure maintained
 Normal respiratory rate
 Pallor of the skin
 Stage 2
 Normal mental status[13] to slight anxiety
 Normal capillary refill[13]
 Normal urine output
 15–30% blood volume loss (750–1500 mL)[10]
 Cardiac output cannot be maintained by arterial constriction
 Tachycardia >100bpm
 Increased respiratory rate
 Blood pressure maintained
 Increased diastolic pressure
 Narrow pulse pressure
 Sweating from sympathetic stimulation
 Mildly anxious/Restless
 Delayed capillary refill[13]
 Urine output of 20-30 milliliters/hour[


A pregnant lady was detected to have down's to her child in all tests they
did. At
16 wk usg also it was confirmed. Now patient was again called at 20 wks for
further usg, this ultrasound is for what?
(a) to detect soft symptoms of down syndrome
(b) To detect congenital heart defects

young couple have a child with down's syndrome. They come to u for adivce
on chances for the second child to be Down's?? 1%, 5%, 10%, 40%

A patient aged 35 yrs, comes for advise regarding screening for colon ca. His
maternal aunt was diagnosed with HNPCC. What will you advise?.
a. Sigmoidoscopy
b. Genetic coulcelling
c. Colonoscopy
d. FOBT

AF treatment:

Verapamil

Flecainid

Digoxin

Digoxin controls ventrcl rate but doesnt prevent or terminate AF

attacks....Verapamil z much less effective in restoring cardiac
rythm....Flecainide z used for conversion of AF and maintenance of sinus
rhythm

a pt is found pulseless resuscitation is being done he's been given 10 L of

oxygen while being taken to the hosp .During resuscitation he's been given
150 j 200 j 360 j in hosp ER he's still unconcious .wat is the next step
give another shock of 360 j
give i/v adrenaline

Fit young man presented with severe back pain radiates to his right theigh
and leg. On examination normal reflexes, normal neurological examination.
What will you do?
a. Analgesia and rest for a week
b. X-ray for spine
c. Ct
d. MRI
e. Reassurance

retinoblastoma in a child ,came in with proptosis,

what investigation ?

1. CT orbit
...
2. MRI Brain
3. xray skull

4. U/S orbit

young pt with signs of meningitis initial management?

amox n genta
iv fluids
steroid
LP

a big scenario of dissecting aneurysm.pt was unstable..what is the best

investigation?
a transesophageal echo?
b transthoracis echo
c spiral ct
d ct angiogram

ct angio is best for aourtic rupture in stable pt..in unstable pt with

dissection best is ultrasound fast or TTE

a pt has paralysed bladder wats d Mx?

intermittent catheter
urethral catheter
suprapubic cath

Sphinctorotomy is the best

A man was scratched by a cat and there is a red rash extending from arm to
forearm. no tender lymphadenopathy.
A) Cat scratch
B) Cellulitis

B..if lymphadenopathy..then aAza

Pt from other doctor does not want examin him again:

Examin her in presence other stuff

Arrest an irritable pt because of prevent hurt others

child developed breathing difficulty and became cyanosed in home after 4
days of safe complete vaginal delivery. No murmer. Dx ??
A. TGA
B. Aortic stenosis
C. PDA
D. Hypoplastic left ventricle

Which of the following will decrease the gradient in Hypertrophic

cadiomyopathy?
a- Digoxin
b- Verapamil
c- ACE inhibitors
d- Prazosin
e- Propranolol

Verapamil can reduce the gradient too bt its nt givn in HOCM cz VT is vry
common in JOCM

pt on many medication carbemezapine,thyroxine,develops uti started on

trimethoprim now develops confusion,labs show hyponatremia ,k ,cl nd tsh
normal Mx
stop thyroxine give hypertonic saline
stop cabemezapine give hypertonic saline
stop trimethoprim give N/S
stop thyroxine nd give N/S
stop carbemezapine nd give N/S

A 55- year -old male smoker undergoes a physical examination and

laboratory workup for a life insurance application. history and physical
examination, including rectal examination, are normal. blood count is also
normal, but urinalysis reveals the presence of blood in the urine (>20
RBC/HPF). cystoscopy is negative. abdominal ultrasound reveals a 5 cm
solid mass in the upper pole of left kidney, confirmed by computerized
tomography scan. which one of the following is the most appropriate
management?

1) computarized tomography scan guided percutaneous biopsy

2) retrograde pyelogram
3) repeat computerized tomography scan in 6 months
4) intravenous pyelogram
5) surgical resection

Radiological assessment in the form of CT/MRI of potential lesions is the

definitive test for initial diagnosis of renal malignancy.Increased detection
of small renal masses (SRMs) from more widespread use of sensitive
imaging modalities is creating a new platform for surveillance and
percutaneous biopsy. If CT/MRI demonstrates a malignant renal mass with
no evidence of distant metastatic disease, biopsy is not routinely indicated

A 20 year old man presented with weakness of the left arm. On

examination the left arm is oedematous. His axillary lymph nodes are
enlarged but not tender. He also reported that his pet cat is unwell. What is
the cause?
A) Cellulitis
b) Axillary vein thrombosis
C) Cat Scratch fever

gentamycin+metronidasol:treatment of diabetic foot

A 7 year old girl with nocturia, there is a family history of nocturia. What is the
most appropriate next step?
a. Urine culture
b. Pelvic ultrasound
c. Urine analysis
4 reassurance it is familial

6 yrs girl of a bitch mother now she is living in foster, the carer saw her with
adult sexual behaviour with the other children what is the next step?
a. Psychological assessment ,
b. call her mother and obtain more history,
c. normal behaviour ,
d. hormonal assessment

. A known case of Rheumatoid arthritis who is being treated with

sulphasalazine is now pregnant? How will you manage her?
a. Continue sulphasalazine
b. Replace sulphasalazine with Azithromycin
c. Methotrexate
d. Paracetamol
e. NSAIDS

Middle aged man with a mass infront of the ear,the mass is growing in size
slowly ,there is drowling of saliva from the same side of mouth angle..most
appropriate step in management?

A.intraoral x.ray

B.FNAC

C.Excisional biopsy

D.CT.scan

E.U/S

Salivary glands include major and minor glands. Major salivary glands include
parotid glands that are located in front and below the ears, the submandibular
glands that are under the lower jaw on each side of the neck, and the
sublingual glands that are under the tongue and the floor of mouth area. These
are in pair, one in each side

Of all parotid gland tumors about 80% are benign. The most common benign
tumor of the parotid gland is pleomorphic adenoma (also called benign mixed
tumor) It constitutes approximately 80% of benign salivary gland tumors. The
next most common benign tumor is called Warthin's tumor. This tends to occur
more commonly in older individuals.

Cancerous tumors constitute about 20% of parotid tumors. There are several
varieties of such tumors. However, the most common are called
mucoepidermoid cancer and adenoid cystic cancer. There are several other
kinds that are more rare.
 Same kind of tumors occur in other salivary glands, but with different
distribution. Of note, there are large number of minor salivary glands
throughout the lining of mouth, palate, throat, and even the nose and sinuses.
Therefore salivary gland tumors can occur in any of these areas. They may
even occur in voice box, upper airway of lung (ie trachea and bronchi).

Two tests are most important in determining the nature of the mass. Fine
needle aspiration biopsy and a radiologic imaging which is often a CT scan.
Other imaging or testing may be ordered by the physician selectively. CT or any
other scan does not give the diagnosis. It helps the surgeon to confirm the
exact location of the mass, it's size, whether it is solid or cystic or combination
of the two, whether it is single or multiple, its borders etc. These are useful
information for diagnosis and deciding in further course of management.
Sometimes masses are located outside of the the major salivary glands, but
adjacent to them. Not all masses or bumps of the major salivary gland are
tumors. Benign cysts or obstructive cysts also present as a mass

 Fine needle biopsy does not cause spread of the tumor. It is the established,
standard and safe practice and highly useful in planning care. It may help to
avoid unnecessary major operations when a completely benign and non-
neoplastic (non-tumor) condition is diagnosed

what is the size n site wise treatentod stones in kidnly, pelvi uretric junction,
upper 2/3 rd of urter nad loew 1/3 rd of uerter and bladder? plz write in simple
words
very imp qs..ppl plz discuss this

eswl?
pcnl?
basket?

Treatment Modalities for Renal and Ureteral Calculi

Indicatio
Treatment ns Advantages Limitations Complications
Extracorporeal Radioluc Minimally Requires Ureteral
shock wave ent invasiveOutpati spontaneous obstruction by
 Indicatio
Treatment ns Advantages Limitations Complications
lithotripsy calculiRe ent procedure passage of stone
nal fragmentsLess fragmentsPerine
stones <2 effective in phric hematoma
cmUreter patients with
al stones morbid obesity
<1 cm or hard stones
Ureteroscopy Ureteral DefinitiveOutpa InvasiveCommo Ureteral stricture
stones tient procedure nly requires or injury
postoperative
ureteral stent
Ureterorenosc Renal DefinitiveOutpa May be difficult Ureteral stricture
opy stones <2 tient procedure to clear or injury
cm fragmentsComm
only requires
postoperative
ureteral stent
Percutaneous Renal Definitive Invasive BleedingInjury to
nephrolithoto stones >2 collecting
my cmProxi systemInjury to
mal adjacent
ureteral structures
stones >1
cm
young man is brought in by his girl friend.he was very agitated and his speech
was like "I love you,I love you,you lovely girl,the world is swirl,tibikatu,I do,I do
love you.WOF is most probable diagnosis?
Schizophrenia
Mania
Histrionic personality
Factitious disorder
Schizoaffective disorder

. 35 yr old lady presented to u for breast ca screening as one of her paternal

aunt is dx with BRCA gene n breast ca. What will u advice her?
a. 2 yarely mammography
b. 2 yarely ultrasound
c. Genetic risk screening
d. BRCA gene screening
e. 6 monthly self breast examinations

Both copies of a tumor suppressor gene must be altered or mutated before a

person will develop cancer .....Some individuals who have inherited a germline
BRCA1 or BRCA2 mutation never develop cancer because they never get the
second mutation necessary to knock out the function of the gene and start the
process of tumor formation. This can make the cancer appear to skip
generations in a family, when, in reality, the mutation is present. Persons with
a mutation, regardless of whether they develop cancer, however, have a 50/50
chance to pass the mutation on to the next generation...It is also important to
remember that the BRCA1 and BRCA2 genes are not located on the sex
chromosomes. Therefore, mutations can be inherited from the mother or the
father's side of the family

Ring worm picture of child treatment.

a. Antibiotic
b. Anti viral
c. Betamethasone
d. New name medication

If only one or two lesions exist, topical antifungal therapy is sufficient. You may
be given a prescription for any of the following topical medications:

Imidazoles

Clotrimazole (Lotrimin)
... When using methotrexate for ectopic pregnancy which of the following is
incorrect:
 A An increase in abdominal pain mandates surgical exploration
B The sac must be less than 3.5 cm in diameterf
C Foetal cardiac activity is contra-indication
D The success rate for a single dose is greater than 75%
E Initial HCG levels must be less than 3,00 IU/L

 Most patients experience at least one episode of increased abdominal pain,

which usually occurs 2-3 days after the injection. Increased abdominal pain is
believed to be caused by the separation of the pregnancy from the implanted
site. It can be differentiated from tubal rupture in that it is milder, of limited
duration (lasting 24-48 h), and is not associated with signs of acute abdomen
or hemodynamic instability..................

A bhCG level of greater than 15,000 IU/L, fetal cardiac activity, and free fluid in
the cul-de-sac on US (presumably representing tubal rupture) are
contraindications. Although patients with bhCG levels above 15,000 IU/L and
fetal cardiac activity have been treated successfully with methotrexate, these
patients require much greater surveillance and carry a higher risk of
subsequent operative intervention

Overworked cook came from a party, hyperpyrexia pupil dilated and saying
“spices & herbs coming out of me” otherwise he’s well oriented…. Poisoning?
a. cocaine
b. amphetamine
c. LSD

In the immediate management of Acute Myocardial Infarction.

Which one of the following is FALSE ?

a. Beta blockers and ACE inhibitors must be prescribed within 12 to 24 hours in

the absence of contraindications.
AZADEH AMINI

All the best