~MESSI

~ “ When you have dream to chase,

nothing can stop you”.
1) 13-year-old boy came to emergency department with I marked C
Confirm
trauma to thigh while playing football. Incidental yourself!
mass was found, MRI showed mass not involving
bone, artery or nerve. Mass excised and biopsy
showed fibrosarcoma. other medical examination
was normal. Now asking next best step?
A) femoral arteriography
B) CT abdominal and pelvis
C) genetic analysis
D) ECG
2) Combined question part1 (very long CV) A

67-year-old man with history of copd and multiple

other comorbidities comes to office with 6-to-8-
month history of diarrhoea. Stool for ova and parasite
is positive for Giardia and Entamoeba. Stool culture
pending nbs ?
A) hiv testing
B) celiac serology

3) Part2 : hiv testing done which came positive. B

Antiretroviral started asking side effect of therapy?

A) renal failure
B) peripheral neuropathy
C) Stroke

4) Another combined q A

Part 1: 37-year-old patient with ulcerative colitis

diagnosed at age 17 long stem they were asking
when to do colonoscopy for malignancy?
A) colonoscopy Now
5) Part 2 : colonoscopy done and four biopsies taken A

from rectum and sigmoid colon, all four showed high-

grade dysplasia. Next best step?
A) proctocolectomy
6) Randomized control trail for new chemotherapy was I marked
C.
done comparing 5-year survival between new
chemotherapy and standard chemo. Now survival for
new chemo showed RR of 0.26 (CI: 0.23-0.29) and for
standard RR 0.33 (CI: 0.27-0.39). P value significant
for both but confidence interval was overlapping.
Study also compared nausea between these two.
Nausea for new chemo RR: 0.2 and for standard 0.8.
(p was significant and confidence interval was not
overlapping for nausea) q asked what is the main
difference between these two?
A) Standard mortality ratio
B) Death ratio
C) Quality adjusted life years (Qaly)
D) Median survival
7) 56-year-old man with epigastric discomfort came to
office with jaundice. u/s showed dilated ducts and CT
scan showed pancreatic head mass .ercp and stent
placement done along with fine needle aspiration
biopsy. Biopsy was normal, next best step?
A) Eus guided biopsy
B) CEA assay
C) repeat CT scan after 3 month
8) Old age female came to emergency department with All
abdominal bloating and ascites like features, tvus other
showed ovarian mass and cul-de-sac nodularity. Nbs assays
? in
A) Ca-125 option

9) A question where they have done a study. They used I

two groups. One with drug the other with placebo. marked
The drug group reported many side effects and a lot C.
of participants started dropping out of the study.
What would you do next.?
A) decrease dose of drug
 B) decrease frequency at which drug is given .
C) do interim analysis

10 Breast cancer study was done in African and C

Caucasian population . Incidence is high is African
females but not in Caucasian . Prevalence is same in
both population, reason?
A) increased duration of disease in African population
B) high all caused mortality in African female than
Caucasian
C)high case fatality in African females than Caucasian

11 Lethargic child with bilateral subdural hematoma and

retinal haemorrhage, reason ?
A) inflicted trauma
12 A teenager girl brought by mom. Grades dropping, is I
irritable. She cut her hair asymmetrically and dyed marked
them. When interviewed alone she said she doesn’t B.
like th4 changes in her body doesn’t like her name.
She has never felt like a girl. She has talked about it
to parents who dismiss her. She doesn’t like her
friends. Indicating towards gender dysphoria. They
asked what would she develop in future?
A ) Body dysmorphic disorder
B) MDD

13 Mother came with lethargic child . Examination of No

child showed rib bruises , nbs ? skeletal
A) Head CT without contrast survey
or
fundosc
opy in
 options
.
14 22 male come to ER for breathlessness. He is IVDA C
tested +ve for HIV received no care. There are
multiple needle marks on cubital fossa, BP 110/70
Temp 100F RR 24. On exam there are bilateral harsh
breath sound with no egophony or v. fremitus. Xray
show Interstitial infiltrate bilaterally. Rest exam
normal. Most likely org:
a. Staph Aureus
b. Staph Epidermidis
c. Pneumocystis Jero
d. Strep Pneumonia
e. Myco
15 66 female come to physician for abnormal C
involuntary movement limbs and smacking of lips and
face. She has HTN, Osteoarthritis, CHD and GERD tx
with Metazolone, Metoclopramide Amlodipine,
Calcium, Alendronate, Simvastatin and
Acetaminophen. Cause
a. Dec Dopamine in nigral pathway.
b. Absence of Acetylcholine in Mynert Nuclei
c. Chronic Inhibition of Dopamine
d. Increase Dopamine Activity
16 45 female k/c of migraine comes for regular checkup. B
She had BP 150/96 on multiple readings in past and
no change with health style modification for 3
months. Best Drug to prescribe
a. Thiazide
b. Propranolol
c. Captopril
d. Terazosin
1 33 female come with weight gain and fatigue for C
7 3 months. She gain 20lb weight, have
constipation, intolerance to cold weather,
 delayed relaxation phase deep tendon reflex and
fatigue. Thyroid Gland firmly enlarge nontender.
TSH 8. Etiology ?
a) Granulomatous inflammation of Thyroid Gland
b) Fibrosis of T gland
c) Autoimmune distruction of T gland
1 45-year-old schizophrenia patient is brought to I marked C
8 doctor by his friend since he had visual Confirm
hallucination and yelling on the street and other yourself.
things. He was diagnosed schizophrenia when he
has 18 but he was treated then and that’s how he
could finish graduating somehow from high
school. Question
Also had family history of schizo , was asked what
contributes the patient to have good prognosis?
A) age at diagnosis - Later dx is good
B) Family history
C) Education level

1 A
9

fundoscopy was shown and asked which of the

following risk factors could lead to such eye
damage?
A) High hb1ac
B ) hypercholesterolemia
C) High blood pressure
2 a patient has nasal congestion and other allergic
0 symptoms every spring. She take antihistamines
with little relief. She also takes nasal
anticongestion sprays which helps relieve her
symptoms but now symptoms are persistant.You
examine the nose ,it appears boggy and
erythematous-diagnosis?
A)Nasal polyps,
B)rhinitis medica mentosa
c),nasal ulcer.
2 I marked B
1

rectal prolapse image ,pt was embarrassed to get

medical treatment,if she pushes it inside it goes
in,what is the next best step you would do?
A) Manual reduction
B) surgical correction

2 2 cm thyroid lump found on physical A

2 examination of a patient,TSH was normal.next
best step?
A) thyroid ultrasound
B) Biopsy

2 patient who underwent hip procedure. Now here

3 entire lower leg is swollen. They asked you what
has happened to superficial and deep veins?
Superficial veins Deep veins
A) NORMAL OBSTRUCTED
2 Daughter brought her old age mother to office I DID B.
4 visit; her mother was recently diagnosed with
some neurodegenerative disease. Daughter
confronted her saying mother I told you, that you
 have this disease, but mother replied don’t worry
“I am fine”. Daughter is working lady with busy
life schedule, but she is saying I want to live with
my mother. Now asking what would you do?
A) admit her to nursing faculty
B) home nursing care.

25 Patient came to Er with blunt trauma to neck ,

chest and abdomen , bp 116/80 , FAST for chest
and abdominal was normal . After few hour he
developed weakness of right arm and leg,
reason?
A) Blunt carotid injury

26 . 35 year old patient comes to your clinic, she had B

peripartum cardiomyopathy at 34th week of
gestation in her last pregnancy where her EF was
25%. 6 months later, her condition improved and
then her EF was 53 She has DM too. BMI was
24kg/m2 . The patient wants to be pregnant
again, what in this patient is concerning for her to
be pregnant?
a. Maternal Age
b. Left Ventricular Ejection Fraction
c. BMI
27 B

Tinea barbae on face treatment was asked?

A) topical nystatin
B) oral terbinafine
C) topical miconazole
D)topical fluconazole
28 3-month-old with SCID; mother brought her A
because he was exposed to his cousin who had
chicken pox. What would you administer in the
kid?
a. VZIG
b. Varicella vaccine
c. Vaccine plus VZIG
29 Patient had difficulty moving his eye in the A
upward and downward direction in the vertical
axis. Plus symptoms of dementia. Dx?
a. Progressive Supranuclear Palsy
b. Parkinson Disease
c. Lewy Body Dementia
30 Typical scenario of Wiskot Aldrich Syndrome; B
asked the defect in which cell?
a. Neutrophils
b. Lymphocyte
c. Monocytes
31 A kid with history of chronic diarrhea, failure to
thrive, multiple sinopulmonary infections;
maternal uncle had similar history and early
death. Tonsils were not present. Dx?
A) Bruton’s A gamma

32 A pregnant patient at 38 weeks of gestation B

presents to you with headache and visual
symptoms. BP >140/90, Proteinuria positive.
What would you do?
a. Cesarean Section
b. Induction of Labor
c. Manage her HTN
33 Patient cough, smoker for 40 yrs, STABLE ( no I MARKED
confusion) , BP 147/98, his NA is 118 (exactly). C
What is the best next initial step ? Check for
A) Iv 0.9 saline yourself
B) Iv 3% saline
C) Water restriction
34 very long case vignette of Fredrich ataxia, what is A
he going to develop?
a) Cardiomyopathy
b) Diabetes type 1
35 the prophylaxis for dental surgery. The Question B
is, a patient had Aortic valve replacement surgery
years ago . and they tell you on auscultation there
is also MVP systolic murmur(distractor) and she is IF PROSTATIC =
PROPHLYAIX, IF NO= NO
NOT allergic to penicillin and she will do NEED
GINGIVAL cleaning), what is your NS?
A) 3 days PO of ciprofloxacin
B) 1 shot of Amoxicillin the morning of dental
procedure
C) No prophylaxis needed
36 biostat Q calculate PPV and Specifity something D
related to Parkinson. You have to construct the
 2x2 table. They tell you total are 300, 100 had
Parkinson and 200 did not have. Among who had
90 of them tested positive and among of the ones
who did not have 170 tested negative. And
answer choices like that
Specificity PPV was asked?
a) 90 85
b) 75 90
c) 95 75
d) 85 75
37 patient is 60 white lady, she did mammogram 1 C
year ago was normal, she doesn’t smoke, she
doesn’t drink alcohol, she did pap 2 years normal,
menopause at 52, she used OCP from age 25 till
45, Nulligravid, she is not taking hormone
replacement therapy, colonoscopy age 5 years
ago normal , no family history of any cancer.
Question is, which of the following in her history
makes her at lower risk of having ovarian cancer?
A) Age
B) Race
C) Previous OCP use
D) Nulligravid
E) No family Hx of cancer
38 patient marathon runner, he is doing great. On A
urinalysis he had protein +1. They checked in the
morning he had protein/creatinine ratio in urine <
0.4, they checked in afternoon it was 0.7. NS?
a) Reassure
b) renal biopsy
c) Protein electrophoresis

39 Army soldier lady had above knee amputation, B

now that area is painful draining pus, smells bad
and she can’t fit her prosthetic leg due to pain.
 She has NO FEVER, NO SYSTEMIC SYMPTOMS, VT
NORMAL. which of the following is the best way
to target antibiotic treatment ?
a) blood culture
b) Bone biopsy and culture
c) MRI of leg
40 new born female born week 40 has hip dysplasia, A
she was breech and delivered C - section. What is
the risk factor ?
a) inutero presentation
b) Delivery mode
c) Gestational age
D) oligohydramnios
41 Patient Admitted to ER for blunt thoracic trauma; I marked B.
on palpation of sternum there was crepitus. ECG Which most
showed multiple premature ventricular probably is
contractions. Surgery done for sternal fracture right.
now patient was stable and BP NORMAL, but ECG
still showed ventricular contractions. What
should be done?
A) hospitalize and observe for 24 hours
B) hospitalize and serial troponin levels

(PS: no echo in option. Check flow chart of blunt

cardiac injury from google)

42 Patient presents with early morning headaches A

and fatigue. Auscultation – pulmonary
accentuation; has systemic HTN. BMI in 40s or
late 30s (no snoring etc. hx given). Dx?
a. Obstructive Sleep Apnea hypo apnea
syndrome
b. Idiopathic ICH
43 Typical Macular Degeneration scenario –
everything mentioned; wavy door, drusen's on
fundoscopy, central vision defect.
A) macular degeneration
44 32years old lady with family hx of stroke in father A
) and something in mother too. What would you
screen for?
a. Lipid Screening
b. HbA1c Screening
45 A scenario on postoperative atelectasis. A
Management?
a. Incentive spirometry
b. Chest percussions
46 Patient with right sided sensorineural hearing loss Acoustic
and tinnitus Nbs ? neuroma
A) MRI BRAIN

47 patient has cough for 3 months, for the past 3 I marked D

) months he had heart burn with spicy food, and is
worse at night when he lies down. Antacid helps
him. BMI 30. What is the next step in diagnosis?
a) 24 PH monitoring
b) Barium swallow
c) Manometry
d) No further testing needed
48 patient 3 weeks postpartum comes with her C
husband, the husband says that she is saying that
god is talking to her and she should hide the baby
from evil. The husband doesn’t let her hold the
baby and when the baby cries she tells the
husband to shut him up. Ns?
a) Reassure that this Is normal and will go away
b) Follow up in 2 weeks
c) Admit patient involuntary
49 Shipyard worker with asbestosis, probably a mass B
was mentioned too, bilateral facial flushing.
Diagnosis?
a. Asbestosis
b. SVC Syndrome
50 Another q on shipyard worker and asbestosis
patient was also smoking what would happen to
this patient ?
A) bronchogenic carcinoma

51 Long case vignette of hemochromatosis with I marked

arthritis of knee joint Xray shown : A

NEXT STEP ?
A) Transferrin saturation
B) genetic analysis
52 Central venous line related sepsis. Organism?
a. Staphylococcus aureus

53 Weight loss in patients with cystic fibrosis is due to?

a. Decreased pancreatic lipase
54 Long case vignette of cystic fibrosis described now B
asking which of following will decrease mortality in
this patient ?
A) Daily oral antibiotics
B) pulmonary physiotherapy
55 A patient was recently started on acetazolamide,
labs showed normal anion gap metabolic acidosis –
proximal RTA. Mechanism or what has caused it?
A). Drug induced
56 Patient had some trauma, he fell down as such that
the left side of his body hit the ground. He had left
sided flank pain etc. What would you see in this
patient?
A)Hematuria
57 Patient had URI few days ago now presents with
arthritis and nonblanching rash of lower extremities
, pathophysiology ?
A) immune complex deposition
58 Randomized control trial using otic antibiotics for I marked
chronic otitis externa. 1000 patient taken which will D
be randomized to placebo or treatment group but Check
before randomization investigator using otic stain yourself
and only those will be randomized whose tympanic
membrane is stained completely with dye now
asking what is limitation of this study ?
A) increased confounding
B) decrease confounding
C)increase generalizability
D) decrease generalizability
59 Case vignette of pilonidal disease asking
pathogenesis ?
A) cryptoglandular obstruction
B) infection of hair shaft
60 Young female came to ER with waxing and wanning
pain of flank region. ct without contrast ordered ,
fluids and analgesic given . Nbs ?
A) Tamsulosin
61 patient college student age 22, he was getting A and C
B now getting C and D because he is losing tract of
time, he is staying up late and sleeping at night. He
gained weight last 3 months and his BMI is high. He
doesn’t exercise anymore. Dx?
A) Alcohol use
B) Opioid use
C) Marijuana use
D) Cocaine use
62 patient taking SSRI and has fever, confusion, what C
else you expect to see?
a) decreased bowel sounds
b) Miosis
c) Muscle rigidity
d) Hyporeflexia
63 patient had mild pain in RLQ, they did USG and I marked
found a haemorrhagic cyst, NS? A
A) observe and follow up U/S at 6 weeks
B) Laparoscopic cystectomy
C) Hysterectomy
64 C
 picture of xanthoma on elbow, what is the cause?
A) increased HDL
B) Increased Hba1C
C) Increased Triglyceride
65 patient in labour, 41 weeks, had Diabetes during E
pregnancy, baby is coming out, the head coming out
but baby got stuck when cheeks came out. Ns?
a) Apply pressure on mother suprapubic area
b) Rotate baby shoulder 90 degree posteriorly
c) C section
d) Expectant management
e) Reposition mother to hyper flexion of legs
66 patient in labour 39 week, the head of baby coming I marked
out, they put u tracing ( variable deceleration with C
moderate variability) , her amniotic fluid is low. NS?
a) push head back
b) C sec
c) Amnioinfusion
d) Expectant management (there was no
repositioning patient)
67 Case vignette of hyperosmolar hyperglycaemic state I marked
pathophysiology? A
A) increased gluconeogenesis
B) increase lipolysis
68 PATIENT is admitted after MVA, he was transferred B
2 packs of blood, he developed difficulty breathing
and hypotension. (TRALI). next step?
a) Iv fluids
b) Stop transfusion
c) Mechanical ventilation and intubation
69 Patient fell on outstretched hand, fractured her
scaphoid. What will happen to her?
a) Non-union
70 Patient with kidney transplant, few days later his Cr
and Bun are increasing. Major cell responsible?
B) Cytotoxic T cell
C) CD4+ T helper cell

71 Patient 60 female with adenocarcinoma of lung, her I marked

husband had small cell carcinoma, he smokes 40 C
packs, after her husband death they did survey of
her house at that time radon levels were slightly
elevated she doesn’t smoke. Which of the following
predisposed her for the current conditions.?
a) Age
B) Gender
c) Second hand smoking
d) Radon exposure
72 SINGLE Seborrheic dermatitis picture, asking for ns?
A) Reassure

73 Postpartum haemorrhage, patient had HTN. How A

would you manage?
a. Oxytocin
b. Methylergonovine
74 Patient with painful menstruation, age around 20s, with A
systemic symptoms – diarrhoea etc. Dx?
a. Primary Dysmenorrhea
b. Endometriosis

75 Patient during some dental procedure was injected

with local benzocaine. Now developed
methemoglobinemia (had to dx). Mechanism?
A) Cytochrome b5 reductase deficiency leading to
methemoglobinemia
76 Patient with ABO incompability reaction –
transfusion leading to back pain etc. Typical case.
Mechanism?
a. Preformed antibodies against RBC antigens
78 Very long Case vignette with lytic bone lesion Xray
given .
Na levels : 155
Diagnosis ?
A) Langerhans cell histiocytosis
79 Patient on oral steroids for asthma exacerbation
recently, young age; presented with anxiety.
Diagnosis?
a. Medication induced anxiety
80 Scenario on Hyperemesis Gravidarum; Risk factor?
a. Twin Pregnancy
81 15 years old boy, obesity – 34 BMI, acanthosis
nigricans. Reason?
a. Insulin resistance
82 Female with lower abdominal pain partially relieved
with voiding . Cystoscopy showed bladder
haemorrhages and petechia . Diagnosis?
A)interstitial cystitis
83 Female patient came to ER with AMS AbGS AND LABS
GIVEN :
BICARB :14 ( WITH INCREASED ANION GAP )
URINE KETONE +3
URINE GLUCOSE : NORMAL
BLOOD GLUCOSE :120
BLOOD PH :7.43
BLOOD CO2 : 22
DIAGNOSIS ?
A)Salicylate poisoning

84 Pregnant patient at 20 week gestation presents with

signs of cystitis patient . Patient had 6 episodes of uti
last year. Cystitis treated . What to suggest ?
A) postcoital Antibiotics
85 Child with hypertension , palpitation , paleness and A
suprarenal mass . Dx?
A) pheochromocytoma
B) wilm’s HYPERTENSION AND HEMATURIA
86 Young adult with burning urination without discharge A
, sexually active with single partner. also uses
condom NBS ?
A) urine analysis
B) NAAT for chlamydia
87 Female patient initially presents with urge I don’t
incontinence at that time oxybutynin given . Now her remem
postvoid residual volume is 500 next best step ? ber
A) intermittent catheterization other
options
.check
yourself
.
88 Patient with long standing type 1 diabetes on A
enalapril. What should be checked for renal failure ?
A) urine albumin to creatinine ratio
B) serum creatinine
89 16 year old patient with type 1 long standing I
diabetes well controlled with insulin . BMI : 22 marked
HB1AC :6 B
BP: 132/90
What should be done to prevent long term
complication ?
A) increase insulin dose
B ) ADD enalapril
C) caloric restriction
D)lipid profile
90 Patient with tanner stage 4 breast, stage 2 pubic
hairs, left inguinal mass; comes with primary
amenorrhea. Dx?
a. Androgen insensitivity syndrome
b. 5-alpha reductase deficiency
91 Patient with interstitial lung disease, had atrial
fibrillation – on amiodarone and other multiple
drugs. What would you do next?
a. Discontinue Amiodarone
92 A patient with rape – sexual assault, came after 3days
. Contraception ?
a. Oral Levonorgestrel
93 CASE ON ATYPICAL DEPRESSION DX ASKED ?
A)MDD
94 Patient comes with priapism , he is on trazodone.
How would you manage?
a. Shift to Citalopram
95 Patient wants to start a vegan diet. Vitamin b 12 level I marked
C.
:1200 (N:900-1100)
She was concerned about need for screening in
future.
 What should be advised?
A) B12 levels every 6 month
B) B12 and methylmalonic acid annually
C) No screening indicated
96 A patient with HTN. Management?
a. Dietary Approaches to Stop HTN (DASH diet) (no
weight loss in options)
97 Patient with type 2 diabetes and had difficulty losing
weight treatment asked ?
A) metformin
98 patient with Alzheimer's he doesn’t have imbalance, Only
he stops and had difficulty turning while physician by four
his side and had difficulty initiating gait option
type of gait? s
A) Agnostic I
B) Apraxic marke
C) Ataxic d B.
D)Antalgic
99) Saw Serratia in Q, and asked mechanism?
a. Impaired oxidative burst
100) Another q on CGD with same concept .

101) Patient with this rash, I didn’t read the question

details. What else would you find in this patient?
a. Pitting of nails
102) Alcoholic patient with hypokalaemia and
hypocalcaemia. Cause?
a. Decreased Magnesium levels
103) Another q with case vignette of CHF AND
hypocalcaemia signs . Calcium and calcitriol given but
didn't improve nbs ?
A) check magnesium level
104 Hypertension with low potassium level dx ?
A) hyperadosteronism
105 Pregnant patient with symptoms of pyelonephritis A

mechanism of drug used ?

A) cell wall synthesis inhibitor
B) rna polymerase inhibitor
C) translocation inhibitor
D) dna gyrase inhibitor
106 A patient comes with sore throat, he was recently
started on PTU. What is the likely cause of patient’s
sore throat?
a. PTU
107 Patient on chemotherapy developed neutropenia
(shown in labs); developed sepsis or may be asked
what organism infection is the patient at risk for?
a. Pseudomonas
108 Lengthy scenario on RA. Already taking steroids,
) long term treatment?
a. Methotrexate
109 Typical OA scenario but a lengthy one with X-ray
given as well – showing narrowing of joint space.
Management?
a. Quadriceps Strengthening
110 Patient with urge to move legs at night, long details
– restless leg syndrome. What would you check in
this patient?
a. Serum ferritin levels
111 Patient presented to you with symptoms of B
tremulousness and ataxia. During interview, he
seems drowsy, even in between conversation he has
dysarthria and seems to fall asleep. He has had GI
symptoms, myoclonus. BP, RR, temperature normal.
He had been taking anticholinergic, clonazepam and
lithium. What is the cause of patient’s symptoms?
a. Anticholinergic toxicity
b. Lithium toxicity
c. Clonazepam toxicity
112 Typical scenario of peptic ulcer disease in young A
women , how to confirm ?
A) endoscopy
B) stool culture
Pt with exudative pleural effusion – pleural fluid
analysis was given. TGs were 40, Lymphocyte
predominant effusion. Cause?
a. Tuberculosis
b. Chylothorax
114 A lengthy scenario with fixed splitting of S2 and
pulmonary flow murmur. Dx or Cause?
a. Interatrial septal rupture
115 Old patient with palpitation and fatique with ecg A
shown ?

A) 3rd degree heart block

B) WPW
116) Patient came to office with elevated blood pressure ,
four weeks ago she had same blood pressure readings
. She says doc whenever I am at home my blood
pressure is around 116 /80. She appears to be anxious
. Next step?
A) ambulatory bp measurement
117 Patient presents with complain of intermitent A
palpitations ecg was shown , which was normal next
step in diagnosis ?
A) ambulatory ECG
 B) electrophysiologic studies
118 Pt with lesion on nose – a deforming lesion appearing
as if something has bitten the tip of nose – patient
was in military and had been deployed in Middle
Eastern countries. He had inguinal adenopathy. Dx?
a. Leishmaniasis
119 A lengthy question with so many labs - I noticed
Coombs test +ve, cause?
a. Antibody against RBCs
120 Past question – Patient had fever, chills, sense of
impending doom etc. after transfusion. Looked like
haemolytic reaction. Next?
a. Measure free Hb
121 Frontal lobe haemorrhage - a transverse section CT B
scan was given; there was haemorrhage on the medial
side of frontal lobe. Two scans were shown. What
would the patient develop during the period of
recovery?
a. Impulsive Aggression
b. Akinetic Mutism
122 A typical case of Lichen Sclerosis. Rx?
a. Topical Clobetasol

123 Pt taking minocycline and OCPS, she does vaginal B

shaving too. Now she had symptoms of vaginal

candidiasis. A picture of hyphae was also shown. What
is the cause of her symptoms?
a. Vaginal shaving
b. OCPs
 c. Minocycline
124 1 year old child is comes to the hospital for regular C

health visit with his father; the father says, the child
has been a picky eater since last 4 weeks. The house
we used to live in was childproofed but now since a
while (exact duration not mentioned) we have been
staying at his grandmother’s house which is not
childproofed. The grandmother had TB 2y ago, which
was then treated. What would you evaluate this
patient for?
a. Hearing Loss
b. Loss of visual acuity
c. Lead poisoning
d. tb testing
125 Two X-rays given; sudden onset shortness of breath in
a child. It was a repeat question, ?
I marked Foreign Body

126 2 months old new-born with a palpable clunk.

Management?
a. Abduction Harness
127 Long case vignette of graves disease with diffusely
enlarged thyroid ecg also given mechanism?
A) Tsi antibodies
126 Case of hypothyroidism with diffusely enlarged thyroid
pathogenesis ?
A) lymphocytic infiltration

127 Hyperthyroid features with single nodule in thyroid gland ?

Pathogenesis ?
A) increase thyroid hormones production and release
128 Patient with chest pain radiating to jaw , sweating , ecg
showed st elevation in inferior leads .
 Dx ?
A) Myocardial infarction

129 Same case more or less with Ecg given showing

inferior leads elevation
Next best step ?
A) cardiac catheterization

130 Patient had URI one week ago , now present with
signs of heart failure reason ?
A) Myocarditis
131 Pt had some trauma while either cutting tree or he C
was doing something else with the tree; now he
came his right leg was swollen and all, indicating
trauma to femur, he was transfused, stabilized etc.
Now, his PaO2:FiO2 ratio is 350, PCWP is 12, BP:
116/80 CXR showed ‘bilateral infiltrates’. What is
your diagnosis?
a. CHF
b. TRALI
c. Pulmonary Contusion
d. Aspiration Pneumonia
e. Fat Embolism
132 72y old patient with vertigo on waking up when he
lifts head from bed; also occurs during changing sides
when lying on bed. Pt also had SNHL (I believe, it
must be a distractor – age related hearing loss).
Management?
 a. Repositioning manoeuvres
133 Description of child being on a visit to some hiking
place – a picture was shown where a child was shown
one with the shirt up and other naked on side; it had
a very faint circular red rash resembling erythema
migrans. How could it have been prevented?
a. Use of insect repellent DEET
134 36-year-old Patient with case vignette of PCOS came
with complain of vaginal spotting next step ?
A) Endometrial biopsy
135 35 year old lady came with all features of OCPD. I
Huge scenario. They asked what other feature would marke
you see.? d
A) hoarding behaviour C.
B) recurrent suicidal ideation
C) inability to confide in others

136 patient with Duchenne ( they tell you dystrophin is A

absent), what is he going to develop?
A) Heart Failure
B) Amnesia
C) Restrictive lung disease
137 Simple scenario of OCD

138 patient 60 yrs, has hearing loss, they put X ray of leg D
with multiple sclerotic and lytic lesions. . What is
increased?
A) Ca
B) Vit D
C) Calcitonin
D) ALP
139 two cases about OA, with crepitus on movement. A

Next step? A) Quadricep muscle training

B) Track race running
C) Ibuprofen
140 patient has 2 cervices, on USG there are 2 uteruses, B

what is NS?
A) pelvic and abdominal CT
B) Renal USG
C) Karyotype
141 patient 68 years old diabetic can’t drive at night or C

day anymore, he also sees Halos around light

sources. His ocular muscles intact. What is the dx ?
a) macular degeneration
b) Diabetic retinopathy
c) Opacification of lens
142

patient 83 presents with confusion and acute

abdomen signs. reason?
a) twisting of colon
143 patient 14 years old he has bubbles his urine. They C(Minima
l change )
put u a picture of a gallon that has urine and top of it
bubbles. Protein +4, blood none in Urinalysis.

How to confirm?
a) Biopsy
b) US kidneys
 c) 24 hour protein collection
d) microalbumin/creatinine ratio
144 A lady with all the features of vaginismus like can't I marked
B
have sex and has never had a speculum exam but can
insert tampon. NBS?
A) insert vaginal dilator
B) check for the history of sexual trauma
C) physical therapy
145 Features of calcium deficiency , iron deficiency and
peripheral neuropathy
Dx ?
A) celiac disease
146

A picture of bone tumour. Both Xray and biopsy

given. Sunburst pattern seen dx ?
A) osteosarcoma
147 Long case vignette of Copd what to Give ? A

A) inhaled ipratropium
B) inhaled ICS

148 2 year old kid with 4 episodes of otitis media. What to I marked
A.
check at this follow-up?
A) hearing evaluation
B) reassure
149 Starting tnf alpha inhibitor for RA. What to check
before starting.
A) TB
150 50 year old man underwent routine colonoscopy . I marked
A
Polyp was found which was removed ,on biopsy it (review
showed 6mm tubular histology and adenocarcinoma step 3
at upper region of polyp which has not involved stalk uworld
tables
or mucosa . Now asking apart from colonoscopy at 1 for polyp
year what should be done ? manage
A) observation ment )
B) selective colectomy
151 A lady brings her teenage daughter. Long scenario.
Basically her breast development was asymmetric like
one of the breasts was more developed then the
other. NBS?
A) reassure
152 Parents bring their daughter with features hinting
towards Autism spectrum. They asked their future
kids are at increased risk of which other disorder?
A) Autism
153 Drug induced parkinsonism question. Person taking
metoclopramide. Cause of symptoms asked
154 Old guy with severe pain on shoulder such that raising I marked
A
the hand above horizontal caused severe pain. Nsaids
had failed or provided min relief. Next step ?
A) physiotherapy
B) surgery
155 Patient with loss of sensation on medial foot and
medial leg and lossof knee reflex cause ?
A) L4 radiculopathy

156 Mother brought her daughter. Was concerned that

she is using drugs because her cousin of same age was
caught doing drugs. Daughter is fine and has grades in
 As. she doesn’t do drugs. She has tried alcohol but
didn’t like it. What factor may drive her to do drugs?
A) peer pressure
157 Tracheostomy done for some reason for more than 6 I marked
B
weeks. Now Patient presents with inspiratory stridor.
Reason?
A) tracheomalacia
B) Laryngeal stenosis

158 55-year-old patient with hypertension resistant to 3

drugs bp 160/100
All other examination was normal reason?
A) noncompliance
B) renovascular disease
159 Old age patient with creatinine 0.6 . 2 years ago, it Due to
age
was 0.9 next step? related
A) reassure decrease
in muscle
mass.
160 Military man had gunshot wound at C6 SPINAL level and is Only these
four
paralysed below that level with loss of bladder and bowel options.
control (vignette was very long I might be missing some
details. they mentioned further neurological recovery is
difficult now asking what will be your rehabilitative goal for
this patient?
A) provide devices so he can drive.
B) try to achieve bowel and bladder control.
C) Transfer patient from bed to commode
D) Walk without walker
161 70-year-old pt presents with complain of urinary I did A.

hesitancy and difficulty streaming. bp 140/90, No

other medical history. prostate examination was
normal.
PSA level: 5 (N < 4).
Postvoid residual volume: 30
Nbs ?
A) Terazosin therapy
 B) prostate biopsy
162 Pregnancy related changes in total thyroid hormones
level (easy)
...
163 Thyroid removed for some reason now ca level is DUE TO
LOW PTH.
dropping, we gave ca and calcitriol to patient which
normalized the calcium level. What other finding can
be seen?
A) increased urinary ca excretion.
164 Patient had hypercalcemia of malignancy. No
calcitonin
Ca levels: 14.3 in options.
Normal saline given, what other drug should be
added?
A) Zoledronic acid
165 Long case vignette of Cushing syndrome with all A

features given. Pathophysiology?

A) cortisol dysfunction
B) catecholamines dysfunction
166 Schizophrenia patient on risperidone and multiple A

other drugs. On water restriction values given below.

1 hour after at 6
hour
Serum osmo : 270 290

Urine osmo : 107 112

Diagnosis?

A) diabetes insipidus
B) primary polydipsia
C) SIADH
167 4-day old new-born, On feeding he developed severe A
vomiting, diarrhoea and also had seizures. { NO
Blood glucose level : 20mg/dl VON
GERIKE
Enzyme involved? ENZYME
 A) Galactose 1 phosphateuridyl transferase (GALT). IN
B) glucose 6 phosphate dehydrogenase OPTION
)
168 patient 23-year-old, having a party at home, he got B

drunk and went to basement where he has a liquid

for a fog machine . 6 hours later Brought by his
roommate because of vomiting confusion bloody
urine, Urine Analysis shows RBC, blood gases show
anion metabolic acidosis, he has calcium oxalate
stones on imagining. What did he ingest?
a) Methanol
b) Ethylene glycol
c) Isopropyl
D) ethanol
169 60-year-old Japanese, smokes for 40 years, drinks I did C.
Confirm
two glass of martini every night (time not specified). yourself.
has difficulty swallowing and hoarseness. On
laryngoscope we saw ulcerating painless ulcerating
lesion (laryngeal cancer). Beside smoking, what is the
greatest RF of having this condition in this patient ?
A) Age
B) Gender
C) Japanese descent
D) Alcohol
170 Patient presents with all signs of cirrhosis with labs
abnormal next step ?
A) liver ultrasound
171 60-year-old patient admitted to ER with severe I marked B.

Altered mental status, jaundice, raised Pt and INR.

Ast and Alt around 600.
Poor prognostic factor in this patient?
A) AGE
B) Altered mental status
C) liver enzyme levels
172 15-year-old boy presents to ER after being kicked in A
Traumatic
abdomen while playing football. Has severe pancreatitis
epigastric pain that radiates to back. Your Next best
step?
A) serum lipase levels and amylase
B) ct abdomen pelvis
173 30 year old Patient presents to ER with altered
mental status, fever, jaundice and RUQ pain with
raised ALT, AST , AND ALP LEVELS, U/S Showed
dilated CBD.
Fluids and antibiotics given, Nbs ?
A) ERCP
174 Long Scenario like History, past medical history …... A

Military patient presents with complain of watery

diarrhoea for 4 days. he went to Haiti 1 week ago .
Examination: liver 2 cm below the costal margin.
Treatment?
A) ciprofloxacin
B) metronidazole
175 Long case vignette !!!!! (HEPATIC
Patient with cirrhosis and ascites scheduled for liver HYDROT
transplantation in few days . Today came with HORAX)
I did
complain of severe respiratory distress and right chest
sided chest pain. BP: 90/60 . CHEST XRAY GIVEN tube
BELOW. which is
wrong. B
is likely
the
answer.
 Now asking NBS ?
A) CHEST TUBE PLACEMENT
B) THORACENTESIS
C) DIURETICS

176 Patient underwent inguinal hernia surgery few days

ago, now presents with diarrhoea . Organism ?
A) C difficile
178 Present admitted to ER WITH SEVERE BLUNT A
( hepatic
ABDOMINAL TRAUMA . RUQ Tenderness +ve. Laceration)
BP:80/50 . NBS ? fluids first.

A) Iv fluids
B) Abdominal U/S
C) Ct abdomen
179 3-week-old infant with jaundice
Direct raised.
Indirect normal.
Diagnosis?
A) BILIARY ATRESIA
180 Marathon runner with jaundice . (GILBERT)

Total bilirubin: 4
Direct: 0.2
Pathophysiology ?
 A) uridine diphosphate glucuronosyltransferase
181 HIV Patient came with complain of moderate I did B

dysphagia and severe retrosternal pain that worsen

with eating, Oral examination was normal. CD4
COUNT: 150
Most likely organism?
A) candida
B) CMV
182 Old age patient came with complain of progressive
dysphagia and weight loss , 30 year smoking history.
NBS ?
A) endoscopy
183 Patient presents with severe abdominal pain but I did B.

examination was normal.

BICARB: 19
Pulse: irregularly irregular
What to do next?
A) doppler ultrasonography of visceral vessels
B) mesenteric arteriography

184 Simple caustic ingestion scenario , after stabilization

asking Next best step ?
A) endoscopy
185 Very long scenario I did MRI .
Check
40-year-old female with aggressiveness and mood youself.
changes, she had jerking movements in all four limbs.
Examination showed weakness and limb rigidity.
History of depression 10 year ago. No liver findings
given or family history.
What should be done for diagnosis?
A) genetic analysis
B) urine copper excretion
C) MRI
186 Female recently had breakup with her boyfriend and I did A .

was bit upset about that. She says Water in my

boyfriend house seems funny. It's so ridiculous that
my dog doesn't drink that water too
What to check in this patient?
A) blood lead levels
B) blood coniine levels
187 CV of meningitis in child, what complication can occur
?
A) hearing loss
188 15-month child speaks only 1 or 2 words what other
evaluation?
A) hearing evaluation
189 Child with cleft palate , hypocalcaemia what other
finding?
A) T cell deficiency
190 Case vignette on cholesterol emboli after pci , all
features given Dx asked?
A) cholesterol emboli
191 Another simple case of cholesterol embolus with
raised creatinine, these renal findings are due to?
A) Atheroemboli

192 Child fever 101F presents with vesicular rash on hand I did C.
and feet. Mouth picture given. This exact picture!!!!
 What should be done for further evaluation?
A) Tzank smear
B) HSV PCR
C) No further testing indicated

193 REM SLEEP BEHAVIOR DISORDER ALL FEATURES

MENTIONED. DIAGNOSIS WAS ASKED ...
194 13-year-old boy came with father on outpatient visit. C

When interviewed alone he says I have started

masturbating but there is no semen ejection.
NBS?
A) testosterone levels
B) semen analysis
C) reassure
195 68-year-old men with 30-year smoking history, A (AAA)

everything was normal. Now asking what should be

done for prevention of cardiovascular disease?
A) Abdominal Ultrasound
B) ECG
196 55-year-old Female with breast cancer, surgery done.
biopsy show ER+ PR+ and HER2-. therapy targeting
which enzyme should be given?
A) Aromatase inhibitor
197 Young boy came with complain of knee pain. Had I did A

trauma to knee yesterday while playing. On

ultrasound minor effusion in knee is
seen. On examination joint line tenderness positive,
Lachman negative, varus and vulgus test also
negative. Range of motion decreased/painful.
Diagnosis?
A) meniscal tear
B) patellar tendon rupture
198 Patient with long standing diabetes presents with A.
ulcer on second metatarsal with purulent discharge, No bone
bone not visible. biopsy
in
Monofilament test: 5.7 option.
NEXT STEP?
A) MRI FOOT
B) arteriography
C) Ankle brachial index
199 Very Weird Scenario. CHECK
Female had carpel tunnel release surgery few months YOUR
back, now present with swelling from shoulder to SELF.
elbow with burning pain and allodynia. Few other DO
features given. These are due to? NOT
A) I MARKED COMPLEX REGION PAIN SYNDROME. RELAY
(other option didn't match the description) ON
THESE
ANSWE
RS!!
200 Patient admitted to ER with all features of cocaine
toxicity. Now asking if left untreated what will occur
to this patient?
A) elevated and hyperactive mood
B) seizure
C) severe depression
201 Simple case on opioid toxicity with all features.
Diagnosis?
A) heroin
202 13-year-old boy underwent inguinal hernia surgery
repair; during surgery some portion of spermatic cord
was mistakenly removed. Now surgeon saying to
primary care doctor that we should not have to tell
the family, what should be done?
A) tell the surgeon that we should inform the family.
203 What to check before giving statins?
 A) Tsh
204 Pt with Alzheimer's dementia admitted to Er with
severe respiratory failure requiring ventilator. ( living
will) mentioned that no life prolonging measures
should be taken; but his niece was in favour of
ventilation. What should you do?
A) do not ventilate
205 6-year-old female child came with mother on routine I did
evaluation. C.
When interviewed alone she says my father forces
me to touch his “pee pee” . What would you do?
A) Ask further question to know if she is telling the
truth.
B) call the father
C) consult paediatric gynaecologist to check for sexual
abuse.
206 6-year-old child with bone pain, pancytopenia and
lymphadenopathy. Diagnosis?
A) Acute Lymphoblastic leukaemia
207 Old age patient with back pain.
Creatinine:2.1
Hb: 10.2
Next Step?
A) urine and serum protein electrophoresis
209 Old age patient with murmur at 2nd right sternal I marked
B.
border presents with dizziness and chest pain on
exertion. These symptoms are due to?
A) decrease preload
B) ventricular hypertrophy
210 Experimental question!!! I marked B.

5 patients underwent bone biopsy. After few days

they present with;
SYMPTOMS No of patient
• Muffled heart sound 5
 • Raised JVP 3
• Hypotension 5

These are due to?

A) bone marrow emboli
B) Cardiac tamponade

211 Patient with bone fracture developed Sudden

dyspnoea, confusion and petechia .
Diagnosis?
A) Fat embolism
212 Alcoholic patient with confusion , unilateral weakness
of limbs and dilated pupil; diagnosis?
A) Subdural hematoma
213 Patient with motor vehicle accident.

NEXT STEP?
A) CT SCAN OF BRAIN
214 Patient told you she had shrimp allergy, hx of
anaphylaxis, now she wants to eat shrimps despite
being allergic. What would you suggest?
A). Eat shrimps and use Epi kit as needed
215 All features of normal pressure hydrocephalus given
with MRI.
 NEXT STEP?
A) LUMBAR PUNCTURE
216 Patient with severe chest pain and dyspnoea . A

Pulse:110. BP: 110/80

Ct Angio showed emboli involving right upper
segmental artery.
What to do?
A) IV heparin
B) vitamin k antagonist
C) IV thrombolytics
D) embolectomy
217 Child came to office on routine visit. I heard
harsh
BP:80/50 murmur at
(Listen the heart sound) LLB.

Mechanism?
A) interventricular septal defect

218 Patient on dialysis due to chronic kidney disease. Now

presents with bleeding, this is due to?
A) platelet dysfunction
219 Military man came with complain of dyspnoea and crackles
on examination. xray given.

Pattern on PFTS?
FEV1 FEV1/FVCRATIO DLCO TLC
A) down Normal down down

220 Female with multiple seizures and mild limb

weakness. Ct scan given

Necrosis and haemorrhage mentioned in scenario.

What is your diagnosis?
A) Glioblastoma
221 Patients with few episodes of pneumonia, otitis B

media and diarrhoea. These are due decreased?

A) IGM
 B) IGA
C) IGE
222 Old age patient with metastatic breast cancer I marked B.

presents with complain of back pain. One dose of

oxycodone didn’t provide relief: her son asking for
another dose of oxycodone. Nurse administered
another Iv dose of oxycodone after consulting the
doctor. after few hours' patient develops signs of
opioid overdose.
How could this have been prevented?
A) don’t allow son to sit beside mother.
B) Patient controlled analgesia
223 Pregnant patient with preeclampsia what
complication can occur?
A) placenta abruption
224 Pregnant patient G2P1 at 12-week gestation on
routine visit.
She delivered macrosomic baby via c section in
previous pregnancy.
BMI: 34
What should be done at this visit?
A) Oral Glucose tolerance test
225 Female patient with history of breast cancer in
mother at age of 45, breast and ovarian cancer in
sister; what would you advice?
A) BRCA TESTING
226 Patient with History of OSA presents with dyspnoea,
raised jvp, hepatomegaly and right ventricular heave.
What is your diagnosis?
A) COR PULMONALE
227 Women developed severe back pain while lifting
something, not relieved with Naiads. Examination
show bilateral lower limb weakness and bowel and
 bladder dysfunction. Mri showed disc herniation
compressing spinal cord
. Nbs ?
A) lumbar decompression surgery
228 Case of anorexia nervosa in female .
Electrolyte levels asked ?
NA K Cl HCO3
A) 140 2.8 80 28
229 Patient on Proton pump inhibitors presents with
complain of sensory loss of lower limbs and loss of
proprioception. These findings are due to ?
A) Vitamin B12 deficiency
230 Female child with knee pain and morning stiffness for
1 hour daily from 8 weeks. Pathogenesis?
A) Autoimmune inflammation
231 Military man with shortness of breath and epigastric A

tenderness. Respiratory findings are due to?

A) Strongyloidiasis
B) Pseudomonas
C) Giardia
D) Schistosoma Mekongi
232 Very long Vignette :D I did B.

Old age patient with cough, weight loss and night

sweats for two months.
Ct scan given: Air fluid levels in right middle lobe.
NBS?
A) Bronchoscopic biopsy
B) sputum culture for Tb
233 Patient with fever, headache and myalgias.
Examination showed maculopapular rash on bilateral
wrist and ankles. What other history should be
taken?
A) Tick exposure
234 Female patient with vaginal bleeding, amenorrhea B

and lower abdominal pain.

BP: 85/60
TVUS: fluid in posterior cul-de-sac
B HCG: 3500
Next step?
A) Methotrexate
B) Laparotomy
235 Female patient with lower abdominal pain. She took A

mifepristone and misoprostol for abortion. On

Ultrasound foetus is dead.
Mechanism?
A) Progesterone antagonist
B) Alpha 1 agonist
B) Alpha 1 antagonist
236 G2P1 female on routine visit. She received multiple
transfusion in previous pregnancy for some reason;
also administered shot of Anti D in previous
pregnancy. Now on this visit,
ANTI KELL TITERS: 1:200.
This is due to?
A) Previous history of transfusion
237 Patient with history of curettage in previous
pregnancy due postpartum haemorrhage; now
presents with amenorrhea. LH and FSH was normal.
Diagnosis?
A) Ashermen syndrome
238 Pregnant patient developed fever and lower A

abdominal pain after C Section. Antibiotics didn’t

resolve the fever.
Most likely cause?
A) Septic Pelvic thrombophlebitis
B) Endomyometritis

239 Patient received multiple transfusion after trauma. A

 PTT: 42
PT:19
Asymptomatic, cause?
A) DIC
B) Hyperfibrogenemia
240 Female with history of WVF disease. She is undergoing
endometrial biopsy for some reason; what should be given
before biopsy?
A) Desmopressin
241 All features of heart failure given. What would be B

seen on labs ?
A) Low BNP
B) Low urine sodium
242 Patient went on hike in wooded areas. Rash pic
given;

Mediated through which cell?

A) T cell

243 Patient Administered sevoflurane during surgery; he

developed fever, hypertension along with rigidity.
These symptoms are due to?
A) Anaesthetic agent
244 Case vignette of bipolar disorder!!!
Patient insists that she doesn’t want lithium,
carbamazepine or valproate.
What should be given?
A) Aripiprazole
245 6-year-old child with fever, hypotension and other
signs of sepsis. Examination showed splenic
enlargement.
Reason?
A) sickle cell anaemia with sequestration
246 Simple Case of iron poisoning with Xray …..
247 Patient took Ace inhibitors for hypertension.
Creatinine raised after few days.
Cause?
A) renal artery stenosis
248 Patient with night sweats and weight and A

lymphadenopathy.
Xray showing mediastinal mass.
ON LYMPH NODE biopsy: REED STERNBERG CELLS.
NEXT BEST STEP?
A) PET SCAN
B) REBIOPSY LYMPH NODES
249 Pregnant Patient with GBS bacturia at 12-week B

gestation .
Treatment given . Repeat urine culture was normal.
What would you do ?
A) GBS culture at 36 weeks
B) intrapartum Iv penicillin
250 Newly diagnosed asthma. Accurate method to C

monitor progression?
A) Daily spirometry
B) weekly spirometry at office
C) Nocturnal cough and wheeze
251 Patient with dizziness and headache after standing
from sitting position.
BP:110/80
What should be done for further diagnosis?
A) Orthostatic Blood pressure measurement
252 40-year-old female with unilateral breast lump. B
opposite breast examination was normal.
NBS?
A) Mammogram of affected breast
B) Mammogram of bilateral breast
C) biopsy of lump
D) Ultrasound
253 Female patient is taking multiple Antacids. C

What would develop in future?

A) Constipation due to magnesium
B) Hyperphosphatemia due to Aluminium Hydroxide
C) Milk alkali due to Calcium carbonate
254 Patient on amitriptyline, Anticholinergic poisoning
symptoms described.
Due to?
A) Amytriptyline

NOTE
• I Have written these questions in summarized way. The stem
length in Real Exam is long.
• Please Ignore spelling mistakes and grammatical errors.

Best of luck!!!!