Medicine exam 30th Nov 2007
compiled by Umair Khalid
Pulmonology
1. Chest x-ray is shown depicting a central mass. Lab values show hyponatremia and
eukalema. Around 30 years of smoking. Diagnosis?
a. Small cell lung CA Ans
b. Squamous cell lung CA
c. Pulmonary TB
d. Metastatic lung CA
2. FEV1/FVC = 90%. DLCO is reduced. TLC/RV reduced. Diagnosis?
a. Idiopathic pulmonary fibrosis Ans
b. Asthma
c. COPD
3. Auscultation on a patient with IPF (pt is a gardener). What findings
a. Fine end inspiratory crackles Ans
b. Early crackles
c. Wheezes
4. Patient has transudative pleural effusion. Status post breast Ca resection. Most
likely cause of effusion?
a. Hepatic hydrothorax Ans
b. Malignant pleural effusion
5. How would you manage the above patient?
a. Chest tube drainage Ans
6. Smoker since 35 years. Now develops cough and SOB. He has increased
resonance, dull percussion and decreased breath sounds. Whats the cause?
a. Lobar pneumonia Ans
b. Lung cancer
c. Bullous emphysema
7. Hypertension. Pt on ACEI. Now develops cough. Wotcha gonna do?
a. Substitute AREI with ARB.
8. Anti TB dosage for 65 yrs female weighing 63 kg
a. INH: 300 mg Rifampicin 600 mg Ethambutol 1000 mg PZA:2g ans
9. Pateint has asthma. Was on inhaled salbutamol since two years. Now symptoms
worsening. Wotcha gonna do?
a. Add ipratropium bromide inhaled
10. Patient 15 yrs old. Cough and SOB. Diagnosis of asthma confirmed by?
a. Improvement of PEFR by 15% after bronchodilators.
11. How to manage the above patient?
a. Inhaled short acting Beta blocker plus theophylline
b. Inhaled short acting Beta blocker plus montelukast
c. Inhaled short acting Beta blocker plus anticholinergic
d. Inhaled short acting Beta blocker plus steroids
e. Inhaled long acting Beta blocker plus anticholinergic.
12. Acute exacerbation of Asthma. Patient cant even complete [Link] do u
do?
a. Inhaled beta igonists, steroids and admit the pt ans
13. A patient with right sided pain. SOB for 3 hours. Examination revealed left sided
mediastinal shift. Hypotensive. Best way to confirm?
a. CXR ans (coz tension pnemothorax)
b. V/Q scan
14. Patient recovering from hip replacement surgery. Features of pulmonary
embolism. X ray is normal. What is the pathophysiology?
a. Ventilation perfusion mismatch ans
15. Best way to diagnose the condition in above patient?
a. HR CT ans
b. X ray
16. How to manage TB in pregnancy?
a. Continue all anti-TB and stop streptomycin ans
17. 61 yr old male successfully treated for pneumonia, but has residual cough, no
fever. What do you do?
a. repeat antibiotic course
b. continue same antibiotics for 20 days
c. chest xray stat
d. CXR and follow up after 3 weeks ans
18. Which of the following cause of type 1 respiratory failure?
a. Kyphoscoliosis
b. Benzodiazepine overdosage
c. Neuromuscular disorder
d. ARDS
e. Exacerbation of COPD
19. Consequences of hypercapnia in late stage COPD except?
a. Sweating
b. Muscle twitching
c. Tremors
d. cyanosis
Endocrinology
1. Patient with type 1 DM, hyperparathyroidism and adrenal insufficiency
(symptoms were described)
a. PGA 2 ans
b. Graves
c. Hashimoto’s
2. TSH and T4 were given. Mildly deranged. Antimicrosomal antibodies were
positive. Answer?
a. Hashimoto’s thyroiditis
b. De quervan’s thyroditisi
c. Grave’s
3. Postpartum thyrotoxicosis. What drug?
a. Propanolol ans
b. Propyl thyrouracil
c. Methimazole
d. Radiation
e. Surgery
4. Pregancy hyperthyroidism. Drug?
a. Propanolol
b. Propyl thyrouracil ans
c. Methimazole
d. Radiation
e. Surgery
5. 25 yr old female. 3rd trimester. Takes 50 g glucose then after 1 hr her glucose is
142. Next step in management?
a. Diet counseling
b. Do WHO standard OGTT at 1,2 and 3 hrs after 100 g glucose ans
c. Terminate pregnancy
d. Do nothing
e. Tell patient she doesn’t have GDM
6. So wat do u think is the MOA of fibrates?
a. Answer related to Apolipoproteins. (but sadly three options of
apolipoproteins. Answer is the longest option :P which was option D in
my case.
7. Calcium up, phosphates up, PTH up, renal function normal. Diagnosis?
a. Familial hypocalciuric hypercalcemia
b. Primary hyperparathyroidism
c. Secondary hyperparathyroidism
d. Tertiary hyperparathyroidism
e. Vitamin D intoxication
8. Which of the following not associated with prolactinoma?
a. Hypothyroidism
b. Thyrotoxicosis ans
c. Drugs
9. Adrenal mass work up. Incidental finding and pt asymptomatic. What will u do?
a. Do nothing and repeat CT after 6 months ans
b. Check all hormone levels
c. MRI
10. Best way to diagnose Cushing’s
a. 24 hr free urinary cortisol ans
11. pAteints LDL elevated. Best way to treat?
a. Statins ans
12. Type 1 DM Patient presents with an accident and hx of repeated hypoglycemias.
Most common cause for hypoglycemic unawareness?
a. Long duration of diabetes ans
b. Poor glycemic control
c. neuropathy
13. Turner’s syndrome. Hormonal assay will show?
a. Increased FSH, decreased estrogen ans
14. Increased T4. Decreased TSH. Decreased thryglobulin
a. Thyrotoxicosis factitia ans
15. Known case of Type 2 DM. presents with 6th nerve palsy. Explanation
a. Mononeuropathy that resolves on its own in 2-6 weeks.
16. Postural hypotension in DM 2. Cause?
a. Autonomic neuropathy ans
17. Hypogonadism, color blindness and anosmia. Cause?
a. Kallman’s syndrome ans
