MCQ Year51st posting phase 2010/2011

1. Regarding aortic stenosis, which is/are true:a. Patient is encouraged to participate in strenuous fitness programb. Nitrate is the cornerstone treatment for anginac. B-blocker is for anginad. Antibiotic prophylaxis for infective endocarditis is not essentiale. Valve replacement is recommended in severe aortic stenosis even if patient is

asymptomatic

2. The following is/are true regarding AEBA:a. Hyperkalemia is a complication of beta 2 agonistb. Loading dose of IV aminophyilline is indicated in the initial management of AEBAc. IV hydrocortisone is as effective as oral prednisoloned. 100% oxygen can be given to type 2 respiratory failure

3. Regarding PTBa. Military TB- positive sputum smearb. Positive sputum smear indicate high infectivityc. Mantoux test is negative in patient who has HIV with low CD4 countd. HIV patient requires 18 month duration of treatmente. Primary TB usually asymptomatic

4. Organism known to cause infective endocarditisa. Staphylococcal aureusb. Streptococcus viridansc. Staphylococcal epidermidisd. Enterococcus faecalise. Bacillus cereus

5. Esophageal varicesa. Complication of liver cirrhosisb. Alpha blocker to reduce recurrence of bleedingc. Portosystemic shunt is the treatment of choice with recurrent bleedingd. Urgent sclerotherapy is the treatment of choicee. Known to occur in patient without liver disease

6. Antibiotics for Burkholderia pseudomallei:a. Doxycyclineb. Merapenemc. Ampicillind. Ceftazidimee. Chloramphenicol

7. Clinical features of normal pressure hydrocephalusa. Ataxic gaitb. Papilloedemac. Normal CT braind. Mental retardation

e. Urinary incontinence

8. Regarding rheumatoid arthritisa. Caplan’s syndromeb. Distal interphalangeal joint is more affected than PIPc. asymmetrical arthritisd. pericarditise. splenomegaly

9. Wernicke’s enchephalopathya. clinical feature ataxia, gaze palsyb. treatment is IV thiaminec. commonest cause is viral infectiond. a/w confubulatione. can induce hepatorenal syndrome

10. In RPGNa. crescent formation is a finding in renal biopsyb. raised serum complement is known to occurc. c-ANCA is positive in Wegener’s granulomatosisd. Pauci immune is known to occur in SLEe. UFEME shows isomorphic RBC

11. Regarding CKDa. is a risk factor for cardiovascular d/sb. is the commonest cause of chronic glomerulus nephritisc. biopsy glomerulus sclerosisd. persistence proteinuria regardless of GFR normal, it is diagnostice. abnormal GFR more than 1 year is diagnostic

12. The following associations is/are corecta. osteoarthritis – nail dystrophyb. rheumatoid arthritis – keratoderma blenorrhagicac. SLE – butterfly rashd. scleroderma – microstomiae. ankylosing spondylitis – ant. Uveitis

13. 23 years old malay lady p/w ITP. Which is/are true?a. splenomegaly is a common featureb. a/w lymphomac. plt transfusion is a mainstay routine Rxd. BM will show ↑ megakaryocytese. splenectomy should be preceded with pnemococcal vaccination

14. Local side-effect of the long term use of topical corticosteroids include:a. Basal cell carcinomab. Increased hair growthc. Purpurad. Thickening of the dermis

e. Acne

15. Regarding acute lymphoblastic leukaemia (ALL)a. If it occurs in adult life the prognosis is goodb. The prognosis is worse in malesc. Meningeal involvement is commond. Null-ALL is the commonest typee. Lymphadenopathy is common

OBA Year 51st posting phase 2010/2011

1. 17, Malay girl came with worsening palpitation, periodic paralysis of the lower limb, short attention span and easily irritated.On examination, patient is agitated, thin body built, moist hand, fine tremor, diffuse soft goiter which is non tender.BP : 100/60Pulse rate : 120 bpmWhat is the best treatment?

a) Carbimazoleb) Propanololc) Propylthiouracild) Digoxine) Radioiodine therapy

2. 72, malay male with a known case of hypertension, present with right hemiparesis. On examination,BP : 180/100 mmHgPR : 100+, regularRBS : 11.2 mmol/LPositive expressive dysphasia, xanthelasma, thickening of Achilles tendon, right hemiparesis and positive Babinski response.CT : Hypodense lesion.What is the next investigation to come to the diagnosis?

a) ECG- 12 leadb) Fasting blood sugarc) Lipid profiled) Echocardiograme) Thyroid function test

3. 24/Female presented with multiple joint pain and significant loss of weight.On examination patient is pale, alopecia and left wrist tenderness. The MOST appropriate investigation to diagnose would be:

a) ANAb) anti-dsDNAc) ESR

d) FBPe) X-Ray Left wrist

5. A young women p/w multiple bruises over her body. O/e revealed lethargy, tachycardia, BP slightly low, and high grade fever. What is the urgent management?

a) Fluidb) Antibioticsc) Blood transfusiond) Platelet transfusion e) Do FBC (not sure)

6. 25 years old female p/w polydypsia. It was a/w amenorrhea. O/e she appeared not dehydrated, BP of 130/90 mmHg, weight circumference of 90 cm and BMI of 34 kg/m2.Investigations revealed FBS of 10, HbA1c of 8.5, LDL of 3.4 and triglicerides of x. What is the most appropriate management for her?

a) advice exerciseb) advice weight lossc) start her on anti hypertensive agentd) start anti lipide) start oral metformin

7. 25 years old gentleman, k/c/o PTB p/w confusion. O/e BP was 100/60 mmHg (lying), 80/40 mmHg (sitting), temperature 38.5ᴼC.Investigations revealed RBS of 2.4 and urea of 8.4. What is the most appropriate management?

a) IV dextrose 50% bolusb) IV hydrocortisonec) Rehydrationd) Start broad spectrum antibiotice) Start noradrenaline infusion

8. Elderly gentleman who is a k/c/o HPT and chronic smoker p/w no active complaint in a routine medical check-up. Physical examination revealed high BP, high PR, raised JVP, bibasal crepitaion, and bilateral pedal oedema. Which drug can reduce the risk of mortality of this patient?

a) aspirinb) bisoprololc) digoxind) perindoprile) spironolactone

9. 45 years old gentleman, active smoker with h/o travelling c/o sudden onset of SOB with pleuritic chest pain.

O/e BP was 100/60 mmHg, PR was 110 bpm, SPO2 was 89% under room air. Unilateral leg swelling was noted. What is the most appropriate investigation for diagnosis?

a) 12-lead ECGb) ABGc) CXRd) D-dimera) E) US-doppler

10. 60 years old lady p/w polyuria and polydypsia. She also complaint of intermittent abdominal pain and haematuria. What is the most appropriate investigation? (?multiple myeloma)

a) ?b) renal profilec) ?d) serum protein electrophoresise) serum Benjonce protein

OSCE Year51st posting phase 2010/2011

1. 17 years old malay girl from village was brought to the hospital with complaint of lethargy for 2 weeks duration

[Picture of koilonichia]

a. Describe the nail changesb. 2 others abnormalities expectedc. Explain 2 other differential diagnosis

2. An elderly lady with known case of IHD

[ECG of complete heart block]

a. Describe 3 abnormalities in the ECGb. Diagnosis

3. A 60 years old female with end-stage renal failure

[CXR which shows ostopenic bones]

a. Describe the abnormalitiesb. What is the most likely diagnosisc. Give one investigation to confirm the diagnosis

4. 25 years old male, an intravenous drug user presented with fever and drowsiness of 3 days duration

[Contrasted CT-scan of the brain, axial slice with rim enhancing lesion]

a. Describe the abnormalitiesb. Give two differential diagnoses

5. Rest station