This document contains 95 questions from an actual USMLE exam covering a wide range of medical topics. The questions include clinical vignettes testing diagnosis and management for conditions like dermatitis, giant cell arteritis, bipolar disorder, Alzheimer's disease, depression, personality disorders, cancer pain management, hypertension, pneumonia, and more. They also include questions on biostatistics, medical ethics, prescribing, developmental milestones, and complications of medical procedures.

1. CK 2021
USMLE Recall Collection
Actual Exam Question
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2. 1. Young girl who went for a walk with her father in some woody garden ..later developed
vesicles that were oozing? Treatment- oral/topical steroids,topical benzylperoxide,topical
antibiotics and few more options..
2. Boy with typical history of atopic dermatitis with rashes over face,trunk ...treatment –same
options as above
3. Elderly with typical history of giant cell arteritis with ESR = 52 MM..treatment- steroids/
carbamazepine...etc
4. Drug advertisement ..3 questions
5. –
6. –
7. Study shown in table..calculate relative risk
8. A long study on drug effectiveness ..asked to interpret the findings
9. What’s wrong in this study ..
10. Man with features of mania, few prior history of depression- diagnosis---most likely bipolar
11. Delirium tremnens—formication. In chronic alcoholic after 2 days of admission.
12. Amphetamine toxicity with sympathetic overdrive features
13. Elderly with htn,dm,hyperlipidemia, osteoarthritis, alzheimer’s everything possible disease
comes with suspicious bruises on abdomen with healing at different stages---elderly abuse
type ko hx
14. A man comes and tells u that his daughter told him that her friend tells that’ her parents
are “useless” and wants to commit suicide ...what should u do at this time 1. Call the
daughter’s friend urself 2. Ask him to call her parents2.call the police yourself immediately
4.. tell him its none of ur business 5.tell him to f**k her!!!!!!!!!!!!!!!!!!!!
15. Patient consumed some pills unknown to anyone..initially respiratory rate was 6 which later
improved to 14 /min ..later she tells she had taken 15 pcm pills ..what do u ..give naloxone
again/give acetylcysteine/do nothing
16. Lithium induced tremors and nephrogenic di
17. Pt with symptoms of dysthymia
18. Tourette syndrome ma adhd
19. Conduct disorder- breaks society rules < 18 yrs old
20. Alzheimers ko patient – when to start donepezil
21. Alzheimers ko ptient daily walk into the garden, daily talking to daughter,daily solving a
mathematical problem,monthly visit to a beach------------what is most likely to create
confusion or worsen her condition
22. Alzheimer’s patient not so severe presentation ..what do u recommend to caregivers –tell
them to assist her in making memory notes/signals
23. Alzheimers patient with almost everything presents with h/o fall fall 2 times ..diagnosed as
osteoarthritis ..what do u recommend to prevent next episode—knee brace/nsaids
24. Personality disorder – ocd
25. What is the study design – case control study
26. Agoraphobia without any other symptoms is social phobia/specific phobia/gad
27. Encopresis in a toilet trained child – 2 long vignettes diagnosis and management
28.
29. Childhood development – 18 months
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3. 30. U suspect that one of your colleague is doing sth wrong about a patient care..what do u do
1. Notify to state medical license board2.tell to the patient the he is doing wrong 3.report to
the hospital anonymous disciplinary council 3.keep quite as u r not sure if ur colleague is
doing wrong or not
31. What’s the best way to prescribe?..1. paracetamol 500.0 mg to be taken by mouth 3 times a
day 2.paracetamol 0.5 ug to be taken by mouth 3 times a day
32. Patient with depression ? now presenting with few psychotic features ..what do u prescribe
at this time – haloperidol
33. Tanner stages of a child given..still not menstruating- reassaurance garne hola jasto lagyo
34. Fetal alcohol syndrome—short palpebral fissure etc but smooth philtrum thiyena
35. Depressive episode
36. 3-4 more questions on biostatistics interpretation of study..
37. –
38. -
39. Sickle cell adolescent under pcm+oxycodone..now complains of increasing pain asks morpine
what do u do ...1.long acting morphine 2. Short acting morphine3. Add more oxycodone
40. Terminal stage Cancer patient asks for pain management ..best way to asses 1.patient
himself2.appearance of patient 3.signs such as facial expressions
41. Young obese female taking isotretinoin ..csf pressure normal and ct scan normal no
hydrocephalus ..has episodic headache(no special features),n/v,blurry vision----dx asked..1.
migraine 2.pseudotumor cerebri 3. Tumor...................
42. Young boy with 1 week history of psychotic symptoms with no history of affect disorder—
brief psychosis
43. Yong female with delusion(that her partner is not trustworthy) ,no hallucination- persistent
delusional disorder
44. Young college boy has problems regarding sleep..plays computer games till 2 am..wakes up
late , often falls asleep during 1st
few classes , sleeps till 12 noon during holidays ? diagnosis
1. Circardian rhythm sleep disorder 2.narcolepsy 3. Osa 4.restless leg syndrome
45. Localisation of a site within brain – symptoms given..speech was normal so i ruled out
broca’s and wernicke’s ..
46. A healthy adult comes for routine examination..bp and everything else normal range..what
advise do u give him to maintain his bp? 1.avoid gingko products 2. Regular exercise and
healthy habits?
47. An immunosuppressed man with respiratory problems ---- slide given ..1. aspergillus 2. Pcp
48. A young female with multiple sexual partners with painful lesions and l/n enlargement
..vignette closely referring to herpes but photograph given .it was clearly
folliculitis...organism asked.1. herpes 2. Staph..aureus
49. Elderly man 92 yrs old with photo showing a facial lesion ...what do u do – excision
50. Young female with photo showing oral herpes lesion –confluent and painful ---diagnosis
asked
51. Long vignette of esotropia ..cranial nerve lesion asked --- vi th erve
52. Another vignette –long as it always is --- fundus picture shown ..and then asked what do u
do for diagnosis 1. Slit lamp 2. Goniometry 3.ct scan
53. Vignette describing loss of triceps reflex and reduced sensation over medial 2 fingers..what
is the most likely distribution of defect..c5/c6/c7
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4. 54. Venous ulcer pic on the medial aspect of ankle –diagnosis ?
55. A patient with hypercholesterolemia,dm,htn...presents with rashes over the digits...pic
shown purpuric rash over the dorsum and lateral surface of a toe---- cholesterol embolism?
56. Man treated with tmp/smx ...develops rashes ---- its due to medication side effect.
57. Severe Headache, confusion and some visual problem in a htnsive man ..lp ma no
blood...diagnosis --- intracerebral hmgh
58. Man presents with chest pain , pain on leaning forward and has a rub on auscultation..what
do u do initially..1.cxr 2.ecg
59. Above vignette’s nxt question...on ecg – features of pericarditis ...diagnosis asked
60. AR –murmer..vignette provided some clues
61. asd- murmer; 1 week old child with no cyanosis,fixed wide split
62. Patient had psvt adenosine administered – what may be the complication of
treatment..1.wpw 2.torsades 3.vt 4.vf 5.af
63. What to do in a male patient with no risk factors with ldl levels 165 mg/dl?
64. A child from New Mexico brought to you by his mom ..she tells she removed a tic from her
child’s arm today and she’s sure that the tick wasn’t there yesterday..on examination no
rash ,no symptoms.....what do u do?
65. Osteogenesis imperfect- brittle bones ---collagen defect
66. Slipped capital femoral epiphysis – management- fix it with pins
67. Newborn – female,positive family history with ddh – greatest risk for developing ddh in this
baby?
68. Some invasive procedure performed in the medial thigh ..later develops pulseless
extremities ----most likely cause 1.thrombosis at aortic bifurcation 2. Compartment
syndrome 3.deep vein thrombosis 4. Expansion of hematoma
69. Pain over lower limbs that changes with position(lying supine and lateral) ..slrt –ve 1.lumbar
cord stenosis 2.ivd prolapsed 3. Berguer disease
70. Patient presents with non-productive cough,wheezes etc..cxray shown 1. Asthma 2. Chronic
bronchitis 3.emphysema 4.ild 5.mediastinal lymphoma 6. sarcoidosis
71. Child visited to an African continent few weeks back--- malaria
72. Acute diverticulitis in an elderly resolved after treatment ..then what do u do ?1.advise low
residue diet 2.colonoscopy
73. A bright red well demarcated lesion over the buttock in an infant that was static initially ,
now grows ..... physician tells to the parents it will subside later in life?what is it 1.vascular
overgrowth 2.hemangioma
74. Tension pneumothorax after an acute trauma- easy ..diagnosis asked
75. Marfan syndrome
76. Man with dysphagia to solids and later to liquids ..no improvement on ppi – what do u do-
endoscopy
77. Man with hx suggestive of ureteric stone 3 mm ,now asymptomatic..what is the best advice
for him to prevent recurrence- plenty of fluids
78. Man with epigastric pain especially after fatty meals , also steatorrhea..xray shown;
calcifications on the pancreas—diagnosis : chronic pancreatitis
79. Case of stiffness over sacroiliac joint area, fused vertebra etc---- ankylosing spondylitis
80. Case of female with ulnar deviation of both wrists—rheumatoid arthritis
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5. 81. A child is being started induction therapy for ALL..- what to do : allopurinol+ plenty of
hydration
82. Case of facial paralysis – bell’s palsy
83. Case of dehydration due to repeated vomiting? Estimate sodium,potassium,chloride and
bicarbonate changes
84. Case of dehydration induced acute renal failure..lab parameters changes..Fena, urine
osmolarity,plasma osmolarity
85. Case of anaphylactic shock – changes in svr,co,preload,afterload
86. Hereditary angioedema –
87. Trauma patient – dpl done – blood + :exp laporatomy
88. Cystic fibrosis vignette- sweat chloride
89. Blood in stool + xray abdomen shown with airfluid levels- ischemic bowel
90. Late decelerations on cst- c/s
91. Incomplete abortion
92. Macrosomia- diabetes in mother
93. Muscular strain on lifting some heavy object..advice?
94. Postmenopausal women with thinning of vagina not improved on otc creams what do u
suggest- estrogen cream/ combined ocp/pop
95. Torsion of ovarian cyst- diagnosis ..female with adnexal mass suddenly develops pain???????
96. Case of primigravida with everything goin on normal..- allow spontaneous delivery????????
97. A woman in her 1st
trim (6 wks) comes to u asking about the tests to rule out down
syndrome in her child – tell her its too early to do specific tests and do routine pregnancy
tests
98. Cst shown with early decelerations????? What could be the cause--- oligohydramnios?
99. Child with difficulty breathing after birth—hmd
100. Woman doesn’t want any more children – tubal ligation..
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6. 1. A
physician
looks
at
the
full
medical
report
of
all
the
cases
of
a
particular
disease
in
the
last
one
year.
What
kind
of
study
is
it?
Case
Series
Report
2. Two/three
calculations
of
sensitivity/specificity
3. Odds
Ratio
calculation
4. Recall
bias
5.
A
21-­‐year-­‐old
woman
comes
for
Pap
Smear.
What
other
test
is
indicated?
Chlamydia
6. A
69-­‐year-­‐old
woman
comes
for
routine
follow
up.
What
other
test
is
indicated?
DEXA
Scan
for
Osteoporosis
7. A
24-­‐year-­‐old
HIV
positive
case.
What
immunization
other
than
pneumococcal
vaccine??
Influenza
8. A
newborn
delivered
by
forceps
has
flattened
occiput,
head
turned
to
the
right
(with
pain
on
trying
to
move
the
head
to
left)
and
mass
to
the
left
of
the
neck.
What
is
the
diagnosis??
9. Tocographic
plot
was
given.
There
was
“early
deceleration”.
Question
was
about
the
cause
for
the
finding.
Fetal
head
compression
10. Lots
of
questions
from
ImmunoDeficiency
Chapter
a. Wiskott
Aldrich
Syndrome.
Dx.
b. Selective
IgA
deficiency.
Rx:
IVIG
c. Typical
facies
(wide
spaced
eyes,low
set
ears
and
fish
mouth)
with
hypocalcemia.
Dx:
DiGeorge
Syndrome.
d. SCID
11. A
case
with
features
of
hyperparathyroidism
and
pheochromocytoma.
What
is
the
most
likely
other
finding??
Raised
calcitonin
level.
12. Case
of
umbilical
hernia
in
an
infant.
Best
next
step
in
mgmt.
Reassurance
13. A
case
of
an
adolescent
talking
less
with
parents,
making
poor
eye
contact,
defying
the
orders
of
parents
etc.
Dx:
Normal
Adolescent
Behavior
14. A
psychiatry
case.
A
young
girl
says
she
is
married
to
a
rock-­‐star
and
has
been
pregnant
with
the
rock-­‐star’s
child.
Pregnancy
test
is
negative.
She
has
posters
of
the
rock-­‐star
all
over
her
room.
Dx:
confusing
options…
15. Psychiatry
case.
For
the
past
3
months,
a
young
person
wakes
up
all
night
to
prevent
worms
coming
out
of
his
body
which
will
rule
over
the
whole
world.
He
hears
voices
telling
him
to
save
mankind
by
preventing
the
worms
from
getting
out.
Dx:
confusing…schizophrenia
matrai
milne
khalko
thyo;
but
only
3
months
duration.
16. C/o
marfan’s
syndrome.
What
is
the
underlying
defect??
Fibrillin
17. C/o
oligohydramnios.
Consequence?
Pulmonary
hypoplasia.
18. C/o
diaphragmatic
hernia.
Consequence?
Pulmonary
hypoplasia.
19. C/o
ADHD.
Rx:
Methylphenidate
20. A
surgical
nurse
develops
paronychia.
Culture
shows
Staph.
aureus.
What
is
the
next
best
step??
Options
like
give
prophylactic
antibiotic
to
all
patients
who
were
in
her
contact;
take
culture
from
all
patients;
remove
the
nurse
from
clinical
duty
while
it
heals
etc.
21. A
girl
for
routine
examination
before
joining
college
where
she
will
live
in
dormitory.
What
is
the
next
best
step??
Give
meningococcal
vaccine
22. C/o
a
prisoner
who
comes
with
malingering.
23. Cystic
fibrosis
with
pneumonia.
Likely
organism?
Pseudomonas
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7. 24. Vesicles
and
itching
over
neck,
left
wrist
and
proximal
part
of
finger.
Most
likely
precipitating
cause?
Nickel
25. Contact
dermatitits.
Underlying
pathophysiology?
T-­‐cell
mediated
HSR
26. A
patient
on
short
acting
B2-­‐agonist
develops
asthma
symptoms
more
than
twice
per
week
with
frequent
night
symptoms.
What
is
the
next
best
drug
to
add
to
the
regimen??
Inhaled
Corticosteroid
27. A
c/o
pregnancy
given
and
4
USG
screenshot
given.
What
is
the
most
likely
complication??
28. ECG
of
inferior
wall
MI.
Next
best
step
of
mgmt.
asked.
29. ECG
of
atrial
fibrillation
in
an
alcoholic.
What
is
the
underlying
cause?
Alcohol
30. 2
Heart
Sounds.
31. C/o
HOCM.
32. C/o
Mitral
Valve
Prolapse.
33. A
c/o
RHF
with
CT
scan
given.
Asked
for
the
underlying
cause.
[maile
CT
scan
ma
kei
chinina…it
could
have
been
some
pericardial
disease.
Tesaile
TB
ans
lagaye]
34. Case
of
Lithium
toxicity.
What
is
the
next
best
step?
Dialysis
(after
all
dialysis
garnu
parne
THAMEL
formula
ma
L
was
for
lithium]
35. C/O
watery
diarrhea
followed
by
blood
in
stool
after
eating
hamburger.
Similar
symptoms
in
friend
who
ate
at
the
same
place.
What
is
the
underlying
pathophysiology?
36. Confusing
c/o
cystic
fibrosis.
What
is
the
next
best
step?
Sweat
chloride
test
37. C/o
PSGN.
What
is
the
likely
lab
finding?
Low
C3
38. C/o
HSP.
Rx:
maile
Plasmapheresis
lagaye.
Not
sure.
39. C/o
epididymitis.
Even
the
cord
was
palpable
which
differentiated
it
from
torsion
40.
C/o
hypothyroidism
with
delayed
ankle
reflex.
41. A
diabetic
pt
presents
with
symptoms
similar
to
DKA
but
all
lab
finding
are
normal
except
for
high
counts.
Dx.
Infection
42. C/o
slipped
capital
femoral
epiphysis.
43. Microscopic
appearance
of
a
bone
tumor.
Dx.
44. C/o
malar
rash,
mouth
ulcers
and
joint
pain.
Dx:
SLE
45. C/o
TTP.
Rx:
plasmapheresis
46. C/o
raised
AFP.
What
is
the
most
likely
disorder
that
will
occur
in
the
newborn?
Anencephaly
47.
A
c/o
proximal
muscle
weakness
with
normal
CPK
levels.
Dx:
Myesthenia
gravis
48. A
picture
of
skin
lesion
with
history
of
cat
scratch.
Dx:
Bartonella
henselae
49. A
person
from
Connecticut
develops
lyme
disease.
What
is
the
strongest
risk
factor
in
the
given
setting??
Location
50. C/o
scabies
51. Picture
of
a
skin
lesion
which
occurred
after
hot
oil
spilled
on
his
palm.
The
lesion
consists
of
red
streak
running
all
the
way
from
the
palms
to
the
shoulder.
Dx??
52. Skin.
A
single
lesion
on
the
back
which
is
later
followed
my
numerous
smaller
lesions
on
the
back.
What
could
have
prevented
the
condition??
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8. 53. Bluish
discoloration
of
toes
following
angiography.
The
distal
pulses
are
intact.
Dx:
Athero
emboli
54. C/o
a
person
with
2
positives
on
CAGE
questionnaire.
What
is
the
next
best
step??
Options:
chlordiazepoxide
or
disulfiram
or
12-­‐step
programme.
I
chose
the
third
one.
55. C/o
hyperprolactinemia.
56. A
case
of
hyponatremia
on
lab
finding.
Mass
seen
on
lung.
Cause
of
hyponatremia
asked.
Ectopic
ADH
production
57. H/o
goiter
in
mother
and
grandmother.
Daughter
has
goiter
with
low
thyroid
hormones.
Dx:
Iodine
deficiency?
58. Painless
bleeding
in
third
trimester.
Dx:
Placenta
previa
59. Hypercalcemia
and
increased
ACE
level.
Dx:
Sarcoidosis
60. C/o
Sjogren
Syndrome
61. Raynaud’s
phenomenon.
Rx:
CCB
62. C/o
Osteoarthritis.
Underlying
pathophysiology
asked.
Destruction
of
articular
cartilage
63. An
alcoholic
develops
gout.
Besides
starting
allopurinol,
what
is
the
next
best
step??
Cessation
of
alcohol
intake
64. A
man
with
dysphagia
for
solids,
which
later
progressed
to
liquids.
H/o
weight
loss
but
no
h/o
alcohol
or
smoking.
H/o
gastric
reflux.
Dx:
maile
ta
Schatzki
ring
lagaye.
65. H/o
corrosive
ingestion.
Next
step
of
management
after
stabilization?
Upper
GI
endoscopy
66. A
patient
presents
with
priapism.
Most
likely
cause?
Trazodone
67. Pleural
effusion
with
pleural
fluid
and
serum
values
given
which
shows
it
is
exudative
type.
Cause
asked.
68. Intraoperative
MI.
What
is
the
best
diagnostic
test?
69. A
patient
in
loop
diuretics
develops
hearing
loss.
Cause?
Medication
effect
70. C/o
monoclonal
gammopathy
of
unknown
significance.
71. C/o
Trichomonas
vaginitis.
Rx:
metronidazole
72. C/o
ARF
with
urea:creatinine
ratio
of
>20.
Most
likely
cause?
Dehydration
73. C/o
Bronchiectasis
74. C/o
Heparin
Induced
Thrombocytopenia.
What
is
the
next
best
step?
Stop
Heparin.
75. C/o
rapidly
developing
dementia
with
myoclonus.
Dx:
Cruetzfeldt
Jacobs
Dz
76. C/o
ARDS;
different
parameters
of
Mechanical
Ventilation
given
like
Tidal
Volume,
Rate,
FiO2
etc.
Oxygen
saturation
still
low.
What
will
you
do??
Increase
PEEP
77. A
woman
working
in
wool
factory
develops
chest
symptoms
and
on
CXR
shows
thickening
of
diaphragmatic
thickening.
Her
husband
worked
in
asbestos
factory.
What
is
the
cause
for
her
condition??
Confusing;
occupation
ma
tick
ta
lagaye
but
not
sure
how.
78. Knee
jerk;
root
values?
L4/L5
79. C/o
shiny,
pearly
lesion
at
tip
of
nose.
Dx:
Basal
cell
carcinoma
80. C/o
PPH
followed
by
hypopituitarism
ie
Sheehan’s
syndrome.
Underlying
cause?
Ischemic
Necrosis
81. A
women
is
on
Lisinopril
and
multiple
other
drugs.
She
tests
positive
on
Urine
Pregnancy
Test.
What
is
the
next
best
step?
Stop
Lisinopril
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9. 82. A
person
with
persistently
high
BP
(160-­‐170/100-­‐110)
is
on
two
anti-­‐
HTN
medication:
ACEI
and
Hydrochlorothiazide.
What
is
the
next
best
step?
Options
like:
substitute
ACEI
with
Loop
diuretic,
Thiazide
with
Loop
Diuretic,
increase
the
dose
of
Thiazide.
I
picked
the
last
one.
Confusing.
83. A
woman
with
multiple
family
h/o
breast
carcinoma.
What
is
the
next
best
step?
Tamoxifen
84.
C/o
urge
incontinence.
85. A
woman
with
ASCUS
Pap
Smear?
Repeat
pap-­‐smear
in
3
months
86. A
case
of
infertility.
Husband
has
a
child
from
previous
marriage.
Endometrial
biopsy
shows
proliferative
changes.
Hysterosalpingography
shows
normal
tubes.
Cause
of
infertility?
Anovulation
87. A
c/o
breast
cancer;
depth,
stage
and
metastasis
given.
They
are
ER
positive.
What
is
the
most
important
prognostic
factor?
Confused;
maile
ta
ER
positive
status
vanera
laye.
88. C/o
FibroAdenoma
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10. 1. Venous ulcer ko picture….. venous insufficiency
2. Diarrhea in 3 yr old… day care centre others had similar hx. giardia ko microscopy specimen…
mechanism of diarrhea? Option eutai milne jasto thiynea
3. Hx of multiple fractures osteogenesis imperfecta defect? Collagen
4. Ruptured ectopic ko jasto features in shock…. What to do next? Exlap, laparascopy
5. features presenting like meningitis in a boy living in a dormitory csf findings like viral
meningitis… dx aseptic meningitis, bacterial meningitis, meningoencephalitis
6. IV drug user pt with hep B surface antibody +, core antibody+, hep c antibody +. Which to give?
Hep A Vaccine only, hep A and B vaccine, HBIG
7. Male patient multiple sexual partners urethral thick white discharge. t/t? Ceftriaxone, Azithro
and doxy
8. Scabies ko typical hx. Organism?
9. IE prophylaxis for valvular heart dz patient undergoing endoscopy? None needed, amoxy, vanco
10. Asymptomatic tick bite
11. Anaphylaxis ko case pharynx uvula edema. Next? ET intubation, anti histaminics….
12. Angio edema ko case on anti hypertensives. Which drug most likely? ACEI
13. Allergic rhinitis. Prevention from contact of animal dander from which pt was allergic
14. Brutons agammaglobulinemia
15. Iga deficiency
16. CGD
17. 3 ques research article ( herna pani vaiyena)
18.
19.
20. CAD and risk factors wala dimag ghumaune ques 2-3
21.
22. Hx and ecg suggestive of acute pericarditis
23. Murmur and hx AR
24. Murmur and hx AS (I think)
25. HX and CT head like CDHm, large one. what to do next? Drain
26. Septi arthritis. Along with antibiotics what need to be done? Incision and drainage
27. Thyroid nodule. TSH normal. Next? FNAC
28. FNAC show malignant cells. Next? Total thyroidectomy
29. Graves dz…. Tsh stimulating antibodies
30. Clinical features like asthma….. airway hyperactivity
31. Clinical features like COPD emphysema…. Protease activity increased
32. Methacoline challenge for asthma
33. Bronchiectasis
34. Pneumococcal vaccine for 58 yr old copd patient when to give?
35. Exudative Pleural effusion….chest tube drain
36. Lung abscess. cause?
37. Obstructive sleep apnea
38. Hypoxemia in a trauma patient features and xray likely ARDS
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11. 39. Low back pain ka yeti dherai ques ki dimag kharab banayo
40. Pregnant women with carpel tunnel syndrome? Symptoms due to…. Pregnancy
41. RA patient splenomegaly and lab s/o Felty syndrome
42. RA patient quadriplegic after surgery for something…. C spine subluxation
43. Dermatomyositis
44. Enthesopathy in Ankylosing Spondylitis
45. Uveitis in Ankylosing Spondylitis
46. Osteoporosis ko 1-2 ques, DEXA scan
47. Microcytic anemia
48. Hypersegmented neuthophils, neutopathy.? B12 def
49. HUS… due to toxin
50. Diabetic with lab showing renal insufficiency. Next? Insulin, Metformin, glipizide
51. Bleeding in renal failure? Platlet dysfunction
52. Aantibiotics associated diarrhea… stool for toxin
53. Sigmoid volvulus xray
54. Pseudotumor cerebri … clinical, fundoscopy, csf pressure
55. Pseudotumor cerebri t/t
56. Tourette…. Obscessive compulsive behavior, vocal tics
57. Contrast induced nephrotoxicity prevention with….. prior saline hydration
58. Hyperkalemia with ecg changes…… calcium chloride
59. Stress incontinence
60. Delerium tremens on a post op patient
61. Impetigo- honey colored crust
62. Typical intussusception ko case but it was not in the option….
63. Appendicular abscess
64. Fat embolism
65. Placental abruption
66. Electronic fetal monitoring tracing showing late deceleration. Cause?
67. PTSD
68. Anorexia nervosa
69. Obstructive sleep apnea
70. Sleep walking… stage of sleep?
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12. Questions
1. 70 year old man with history of poor central vision. Picture of retina on
fundoscopy is shown. What is the diagnosis? Central Macular degeneration.
2. Child with a history of high grade of fever for 4 days, currently has
erythematous skin lesion of cheek. Picture given, What is the diagnosis?
Erythema infectiosum, Parvo B19 infection.
3. 12 year old man with limping of right leg, BMI is >30, X-ray is given, How is
this condition treated? Slipped capital femoral epiphysis, Surgical pinning.
4. Neonate born preterm, presently has subcostal retractions and high
respiratory rate. What is the cause of this condition? ARDS, defect in
surfactant.
5. ABG of a person given who is suffering from Pulmonary embolism. What is
the cause of hypoxia? V:Q mismatch.
6. Similar to 5, ABG of person with CCF following an Acute MI given. What is
the cause of abnormal ABG in this patient? Shunting.
7. H/O 22 year old with sudden fainting spells while playing soccer.
Auscultatory findings of CVS shows ejection systolic murmur which
increases with squatting. ? Diagnosis: HOCM
8. 60 year old with H/O surgical repair of thoracic aortic aneurysm. Currenly
has features of CCF, CVS findings given. It has early diastolic murmur. What
is the diagnosis? Aortic regurgitation.
9. Post MI patient with hypoxia after 5 days, CPK is raised again after initial
decline. What is the cause of the patient’s dypnea? Reinfarction.
10. Patient with H/O orthopedic surgery few days ago, presents with dyspnea
and hemoptysis, there is tenderness in the right calf. H/O hemorrhagic
stroke few months ago. What is the next step in managing this patient?
Venacava filters.
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13. 11.H/O surgery for prolactinoma. Currently the patient is delirious. Lab values
shows hypernatremia. What is the next step in management? CDI,
Desmopressin.
12.Child with short limbs, short Lower limb, What is the cause of increased
head circumference? Achondroplasia, Hydrocephalous.
13.Picture of vulva with many vesicles and ulcerated tender lesion in a young
teenager with lymphadenopathy. What is next step in management? HSV
infection. Oral Acyclovir.
14. 15 year old with anemia, Peripheral smear given: Auer Rods. What is the
complication most likely in this patient? AML, DIC.
15.Elderly patient with enlarged non tender LN in left Cervical chain. What is
the next step in management? Lymphoma, excisional biopsy.
16.Child with features suggestive of Down’s syndrome. What is the most like
CVS abnormality in this patient? Endocardial cushion defect.
17.Child with mother who is drug abuser, multiple drugs. The neonate is crying
and yawning, not able to feed. What is the most likely cause? Opiate
withdrawal
18. 6 month old male child with vomiting for past 2 days, current jelly like
blood in stool. What is the diagnosis: Intersusseption.
19. 4 week old with cyanosis relieved with squatting, CVS finding has systolic
ejection murmur in pulmonary region? Diagnosis: TOF
20. Question about VACTERL association. Child has feature suggestive of TEF,
What else would you do for this patient? X-ray of Vertebrae.
21. Female with amenorrhea for 3 months, Beta-hcg >50,000. Expulsion of
grapelike vesicles. What is the next step in management? TV-USG
22.Pregnant in 3rd
trimester, decreased fetal movement in last few days. NST
given, Late decelerations. What is the next step in management? CS
23.Similar to 22, but with variable decelerations. What is the most like cause of
the abnormal NST? Cord compression.
24. H/O amenorrhea in a female for a month, presents with bright red blood
per vagina with clots, no FHS heard. Ps examination shows an open cervix,
What would you do next for this patient? Incomplete abortion, DNC.
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14. 25. Female with hairy lips and acne, she has high BMI. LH and FSH raised. What
is the best mode of therapy for this patient? PCOS, OCPs.
26.Female with hirsutism, hyponatremia, raised 17-OH progesterone. What is
the diagnosis? CAH
27. Pregnant woman in 3rd
trimester with headache, raised BP and proteinuria.
What is the most effective way of lowering BP in this patient? Delivery.
28.Graph showing prolonged 2nd
stage of labour with. What is the most likely
cause of this condition? Cephalo-pelvic disproportion.
29. Along with 28, next questions was what will you do next if the fetal head is
engaged. Cervix is fully dilated, contractions are inadequate? Oxytocin.
30. 2 year old with recurrent otitis media and pneumonia as a infant,
examination shows no tonsils. What is most like cause of this patient’s
immunodeficiency? Tyrosine kinase deficiency, Bruton’s X linked disease.
31. Following Q 30, what is the next step in management of this patient?
Measure serum Ig levels.
32. 25 year old male with B/L palpable masses and raised creatinine levels and
the patient has hyperkaemia and is delirious. What is most effective way of
treating this patient? Dialysis.
33.Patient with hypercalcemia but is asymptomatic. What is the most likely
cause? Hyperparathyroidism.
34.Elderly male with back pain, hypercalcemia and raised creatinine. What is
the next step in diagnosing the patient’s condition? SPEP, MM
35.H/O working in shipyard and is also a long time smoker. X ray shows
calcified pleura and slight effusion. What is the next step in confirming the
diagnosis? Mesolthelioma, Pleural biopsy.
36.Young teenager with dyspnea on exertion and exposure to cold. PFT is
normal at this time. What is the next step in diagnosing this condition?
Methacoline challenge test.
37.African American with dyspnea, skin lesion suggestive of EN, X ray given
which shows hilar lymphadenopathy. What is most effective therapy for
this condition? Sarcoidosis, Oral Prednisolone.
38. Male in his 20s with H/O uveitis and currently has back pain, raised CRP.
What is the most likely diagnosis? AS
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15. 39. Following 38, what is the most like pattern seen in PFT. List of values for
FEV and FVC given. Choose one which suggests Restrictive lung disease
pattern.
40. Patient with long H/O smoking presents with proximal muscle weakness.
No skin lesions or ptosis. What is the most reliable method of diagnosing
the patient’s disease? Small cell carcinoma, Broncoscopy.
41.Elderly patient with long history of smoking presents with arm pain, right
sided miosis. Diagnosis: Lung cancer.
42.H/O tibial fracture 2 days ago which has been repaired surgically, currently
has loss of sensation and pain in right lower extremity. Pulses are absent
What is the next step in management. MRI angiography, vessel injury.
43. Lot of questions about vaccination during routine visit to physician.
44. Also screening procedures about mammography and colonoscopy.
45. Pap smear shows ASC-US, 3 months later HPV DNA test shows positive
results. What is the next step in management? Colposcopy.
46.Pregnant patient comes for routine prenatal visit. Which vaccine should be
given to this patient. Inflenza vaccine, inactivated .
47. Young male with features of CCF, he had history of URI 1 week ago. What is
most likely organism causing the disease. Myocarditis, Cox-sackie B virus.
48. Preterm labour with contractions before 34 weeks. What would you do for
this patient? Beta-methasone.
49. Adult patient with chest pain, EKG shows ST segment elevation. Which
therapy will significantly lower the patients mortality? Aspirin
50. Adult with epigastric pain for last 3 months, on and off not relieved by PPI
or antacids. What is the next step in management of this patient? Cardiac
stress test.
51.From biostatistics I frequently got questions in each set, some of them
were simple and about pretest and post-test variables.
52.Calculation on False positive Rate: 1 – Specificity
53. Positive Predictive value
54. What will happen if the cut off to a test is decreased from higher to a lower
set point?
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16. 55.One abstract with 3 questions. It was about the use of serum Troponin
levels to determine the prognosis of CAD in patients without an ST segment
elevation. The 3rd
question was simple and about sensitivity. The other two
were about the research.
56.No Drug ad but there were 2 to 3 questions in which there was RCT done
and I was asked “ When will you decide to stop the study” or “ What is the
most probable bias seen in this research”
57. A doctor is trying to use several different results of studies to decide which
therapy to try in a patient, what type of study is this? – Meta-analysis.
58. How can you practically increase the power of a study which was initially
not significant? Increase the sample size.
59. A lot of questions about ethical issues. A 12 year old child has traumatic
amputation of finger, his parents are not here yet and he is losing a lot of
blood and vitals are unstable. What will you do next? Treat without
consent.
60. An elderly comatose patient who has been ventilated. Son has the health
power of attorney and says continue treatment, daughter thinks the
treatment should be stopped. What should you do next? Continue
treatment.
61. History of trauma of a restrained driver in the front seat, the steering
wheel was bent. Vitals are stable, what will you do next? CT- Scan of
abdomen.
62.History of penetrating trauma to the abdomen following a gun-shot, vitals
are unstable. FAST shows fluid in the abdomen. What will you do next?
Exploratory laparotomy.
63. History of pelvic trauma in adult male, external fixator have been applied,
the patient presents with abdominal pain and has not urinated. Also he has
not had any sensation of fullness of bladder. What is the next step in
management of this patient? CT- Scan of abdomen, bladder injury.
64. Patient on a routine visit has BP 138/88 mm hg. BMI is high. What is the
next step in controlling the BP? Weight reduction
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17. 65. One question regarding sequential steps to make a patient stop smoking.
Ask, Advise, Attempt, Assist, Arrange. The answer was to give the patient
nicotine patch, “Assist”
66. Barium swallow showing oesophageal obstruction in a patient who had
dysphagia initially to liquids and now to solids. What is most likely cause?
Adenocarcinoma involving the lower end of Oesophagus.
67. Patient has clinical history suggestive of anterograde amnesia, where is the
lesion most likely located? Hippocampus.
68.Patient with a long history of alcohol abuse has ataxia and nystagmus.
Where is the lesion located? Mammillary bodies.
69.Patient who recently lost a job, currently has low mood, decreased
appetite, anhedonia, decreased energy and sleep. What is the diagnosis of
this patient? Major depressive disorder.
70. A child performs poorly at school and is obsessed with deadlines and
keeping her room clean. She started a new school 6 months ago and
previously had normal relations but now seems detached. What is the
diagnosis? OCD
71. A child has motor and vocal tics in which he calls out profanity to stranger.
What is the common disorder he is likely to have as an adult? OCD
72. A man is socially isolated, doesn’t like having any close personal contacts
and lives alone. What is he suffering from? Schizoid personality disorder.
73. 22 year old man comes to the ER with hallucination, pupils are dilated and
he is mildly dehydrated. What is he most likely intoxicated with?
Amphetamines.
74. Female patient with history of Raynaud’s disease and tapering finger tips,
she also has long history of GERD. What is the next step in diagnosing the
patient’s condition? Ani-centromere antibody
75. A young teen with raised BP, has history of hemoptysis and RBC in the
urine in past few days. What is the most likely diagnosis? Goodpasture’s
disease.
76.A young teen with recurrent sinusitis and lung infections, RBC casts in the
urine. What is the next step in diagnosing the patient’s condition? C-ANCA
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18. 77. A patient with history of BPAD , presents with tremors, ataxia and
headache. What is the most like cause of the patient’s presentation?
Lithium intoxication
78. A female in her late 30s has clinical features suggestive of PCOS. What will
you do next for this patient? Endometrial sampling.
79. A female with a H/O simple hysterectomy present with menopausal
symptoms. Which therapy is most appropriate for this patient? Oestrogen
only for initial 25 days of cycle.
80.A patient with history of painless jaundice for 3 months, weight loss,
distended GB. What is the next step in management of this patient? CT
scan of abdomen.
81. Similar to Q. 80 but the patient has increase in conjugated bilirubin >20.
What is the next step in management of this patient? ERCP and stenting to
relieve jaundice.
82.Female patient with epigastric patient, pain exacerbated with eating stake.
Murphy’s sign positive. What is the next step in the management of this
patient? Emergency cholecystectomy within 48 hours.
83. Male patient with long history of UC, currently has pruritis and raised ALP.
What is the most like diagnosis? Primary sclerosing cholangitis.
84. Elderly man with erectile dysfunction, no history of coronary artery
disease, morning tumescence is present. How will you treat this patient’s
impotence? Sidenafil
85. A couple have been trying to conceive for past 2 years, the woman has 1
child from prior marriage. Semen analysis is inconclusive, what is the next
step in evaluating the couple’s infertility? Repeat semen analysis.
86. A female in her 40s who has had 3 children comes for routine check up.
She has regular sexual activity. She does not want any more children. What
mode of contraceptive therapy is most appropriate in this patient? Tubal
ligation.
87. A couple come to you for pre-conceptional counseling, what would you
prescribe to decrease the risk of congenital abnormality in the foetus? Folic
acid.
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19. 88. A man in his 30s has a history of Crohn’s disease and had a partial
gastrectomy for a refractory duodenal ulcer 5 years ago. He currently has
anemia with a MCV >110, decreased sensation to vibration in lower limbs,
he is also a vegetarian who drinks oftens. What is most likely cause of the
patient’s anemia? Gastrectomy
89. An elderly patient with history of AMI 2 years ago currently presents with
intermittent chest pain for past 1 week. He is not able to walk without
getting dyspneic. EKG shows no new abnormality. What is the next step in
evaluating the patient’s chest pain? Presantium-Thallium scan as the
patient cannot exercise and there are baseline EKG abnormalities.
90. A patient who has been in a car accident presents to the ER with shortness
of breath and chest pain. He was the restrained driver in the front seat of
the car. Examination shows decreased breath sound on the right side and
distended neck veins. What is the next step in the management of this
patient? Needle decompression of tension pneumothorax.
91. Similar vignette to Q 90 but the patient has low BP, distended JVP, heart
sounds are distant. What is next step in managing the patient’s
hypotension? Peri-cardiocentesis for cardiac tamponade.
92. Patient with clinical features suggestive of CLD, what vaccine would you
give to this patient. Hepatitis A and B vaccine.
93. Patient with leukemia who has been treated with BM transplantation,
currently presents with rash and jaundice, AST, ALT is raised. Which cell
type is responsible for the patient’s condition? GVHD, donor T-
Lymphocytes.
94. Patient with history of seizure taking prophylactic medication has a child
with hirsutism and cleft lip. What medication was the mother most likely
taking? Phenytoin
95. A soldier comes to the Physician with persistent pain in the right lower leg,
not relived by rest. He marches with his company for 3 hours every day. S-
ray shows no abnormalities. What would you do to further for the
management of this patient? Stress fracture of tibia, NSAID, no casting
required.
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20. 96.Elderly patient who presents to the ER with delirium, he has H/O repeated
falls, most recently he fell down in the bathroom 3 weeks ago. Lab values
shows hyponatremia. What is the mechanism of patient’s altered
sensorium. SIADH following a Sub-dural hematoma.
97.Picture of patient with vitiligo affecting the hands. What other disease is
the patient most likely suffering from? Addison’s disease.
98.A 65 year old man with back pain and perineal pain for past 2 months. He
also has dribbling micturition and U/A on prostatic message shows WBC ,
esterase positive.PR shows a tender prostate. How would you treat the
patient’s condition? Acute prostatitis. TMP-SMX for 6 weeks.
99. HIV positive patient with CD4 count of 450, he is not taking any medication at
the time being. What should be done for the patient in his current visit?
Pneumococcal and Infuenza vaccination.
100. HIV positive patient with CD4 count of 150, presents with shortness of
breath, fever. X-ray shows B/L patchy infiltrates. What is the most accurate
method of confirming the etiology of the patient’s condition. Pneumocystis
pneumonia, Broncho-Alveolar Lavage.
101. A family comes to you to seek counseling regarding their 75 year old
grandfather who has Alziemer’s disease. He takes his medications regularly
and is active in his house hold activities. He has stopped going to the mall and
going out of his room. But he interacts with the other members of the family
regularly, although he forgets their names sometimes. They are planning to
take a trip to another state together. Which of the following might exacerbate
the patient’s dementia? Travelling to another state, keep the patient in
familiar surroundings.
102. A 45 year old female presents with a breast lump which is palpable to the
patient and doctor. Mammography shows no significant findings, FNAC is
inconclusive. What will you do next for this patient? Core needle biopsy.
103. A young adult presents to you with new onset of type 1 DM, what
serological test is most likely to positive for this patient? Anti-Glutamic Acid
decarboxilase.
104. What is the most like cause of the patient’s low BP? Elderly receiving
treatment for CCF and presenting with pre-renal failure. Diuretic use.
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21. 105. What is the most like cause of the patient’s low BP? Patient with dementia
currently has orthostatic hypotension. Examination shows flat JVP and dry
mucus membrane. Dehydration.
106. What is the most like cause of the patient’s low BP? Patient with H/O URI
week ago, currently has chest pain relieved by propped up position,
examination shows distended JVP and decreased heart sounds.
Echocardiography shows Fluid in pericardial sac. Decreased preload due to
cardiac tamponade
107. A man has a history of getting punched in a bar fight. Currently he has
swelling of his left cheek. X-ray of skull is given. What is the most likely
diagnosis? Orbital fracture.
108. A pregnant patient present to you with burning micturition and supra-pubic
pain. U/A shows plenty of WBC and urine culture is pending. How will you
treat this patient’s condition? Oral Amoxicillin for 10 days.
109. A child presents with drooping of right side of the mouth, he cannot wrinkle
his right forehead. His family went to a field trip a few weeks ago. How will you
treat this patient? Oral penicillin (Doxicycline not used in children)
110. An elderly female presents with B/L swelling and stiffness of fingers which
is worse at the end of the day for the past few weeks. Examination shows
swelling of distal inter-phalangeal signs but not the proximal inter-phalangeal
joints. ESR is not raised. What is the cause of the patient’s joint pain?
Degeneration of the articular joints, osteoarthritis.
111. Female with H/O breast cancer treated with chemotherapy presents with
back pain. SLRT is negative but there is point tenderness of L4 vertebrae. What
is most likely cause of the patient’s backpain? Metastatic carcinoma of breast
causing compression fracture.
112. An elderly homeless man comes to the ER on a cold night with complaints
of abdominal pain. He gives history which is not significant and physical
examination shows no abnormality. The patient demands that he be admitted
to the hospital. What is the diagnosis? Malingering.
113. A chronic opiate abuser comes to a rehabilitation centre. She says that she
wants to kick the habit once and for all. Which therapy is most likely to help
the patient permanently quit her opiate use? Buprenorphine.
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22. 114. A female with 4 children comes to you because of involuntary loss of urine
while coughing and sneezing, but there is no bedwetting at night. She also has
fecal incontinence. Picture of perineum is shown with a protruding mass per
vagina. What is the most effective therapy for this patient? Vaginal
hysterectomy with anterior and posterior vaginal wall repair.
115. A man in his 20s comes to you for evaluation of rectal bleed. His mother
died of ovarian carcinoma and sister was treated for endometrial carcinoma. A
colonoscopy is done but shows no polyp but there is an ulcerative mass
present. What is the most likely etiology of the patient’s condition? Defective
DNA repair, Hereditary Non Polyposis colonic carcinoma. (HNPCC)
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