Nash Qbank

Q.1. Which of the following is the most objective method for identifying high-risk patients for peri- operative morbidity and mortality?

A:

Metabolic equivalent tasks

B:

Revised cardiac risk index of lee

C:

Cardiopulmonary exercise testing

D:

American society of anaesthesiologist scoring

Q.2. A 5-year-old girl is found to have a loud pan-systolic murmur at the lower left sternal border. Which of the following is the most likely diagnosis?

A:

Atrial septal defect

B:

Patent ductus arteriosus

C:

Ventricular septal defect

D:

Pulmonary valve stenosis

Q.3. A 2-month -old boy presents to the Paediatric Emergency Department with coughing, wheezing and rapid breathing for the last 2 days. The infant was bor at 38 weeks’ gestation; his birth weight is 3.5 kg and now weighs 5.2 kg. He had developed a runny nose, iritability and difficulties feeding without having to pause several times. His 3-year-old brother has a cold with fever and cough. Physical examination shows a prolonged expiratory time, nasal flaring and subcostal retractions. Cardiac auscultation results are normal and the spleen and liver are of normal size for the child's age. Blood pressure 86/58 mmHg Heart rate 146 /min Respiratory rate 56 /min Temperature 38.6° C Oxygen saturation 96% on room air Which of the following is the most appropriate next step in making a definitive diagnosis?

A:

Chest X-ray

B:

Throat swap

C:

Bronchoscpoy

D:

Nasopharyngeal aspirate

Q.4. A 5-year-old childis brought to the clinic with a febrile iiness with a cough and separate imegularly shaped (blotchy) rashes. He has not had any routine vaccinations. On physical examination, there is enlarged tender cervical lymph nodes. There are also erythematous. maculopapular rashes behind the ear, face and neck and to a lesser extent on the trunk. Which of the following is the most likely diagnosis?

A:

Chickenpox

B:

Measles

C:

Mumps

D:

Rubella

Q.5. A 12-year-old boy is brought to the Primary Health Care Clinic with knee pain for the past 3 weeks. The pain increases when he runs, jumps and climbs stairs. He plays basketball and football at school and has no history of injury or trauma. Physical examination is normal except for mild edema over the tibial tuberosity. Which of the following is the most likely diagnosis?

A:

Septic arthritis

B:

Patellar dislocation

C:

Osgood-schiater disease

D:

lliotibial band friction syndrome

Q.6. Which of the following criteria is utilized to diagnose hypertension in a 12-year-old gin?

A:

Blood pressure >120/80 mmHg

B:

Blood pressure >140/90 mmHg

C:

>90th percentile for the age and sex

D:

>95th percentile for the age and sex

Q.7. A patient received a severe blow on the inferolateral side of the left knee joint while playing football. Radiographic examination confirmed a fracture of the head and neck of the fibula. Which of the following nerves is most vulnerable for damaged?

A:

Tibial

B:

Deep peroneal

C:

Common peroneal

D:

Superficial peroneal

Q.8. A 4-year-old girl presents to the clinic for the 4-6-year vaccinations. She has steroid-dependent nephrotic syndrome. She has been on daily steroids 2 mg/kg/day for the last 6 weeks. Examination reveals cushingoid facies and abdominal striae. Which of the following is the best approach for immunizations?

A:

Defer live vaccines untill off steroid 1 month

B:

Give immunoglobulins instead of vaccines

C:

Decrease the dose of live vaccines

D:

Give all vaccinations as scheduled

Q.9. A 27-year-old pianist with a known carpal tunnel syndrome, experiences difficulty in finger | movements. | Which of the following muscles is most likely paralyzed?

A:

Thenar muscles

B:

Dorsal interossei

C:

Palmar interossei

D:

Medial two lumbricals

Q.10. An 8-year-old girl with presents with sore a throat and a temperature of 38°C. History reveals, she has not received any childhood immunization. A clinical examination confirms a severely swollen and edematous neck region with enlarged cervical lymph nodes. Her pharynx is erythematous with bleeding spots when a swab is taken for culture. An inspiratory stridor is noted upon auscultation of the lungs. Which of the following is the most likely diagnosis?

A:

Streptococcal pharyngitis

B:

Diphtheria

C:

Pertussis

D:

Thrush

Q.11. A 1-year-old child with high fever, poor feeding and inactivity has not urinated for 4 hours. On examination, there is a generalized petechial rash and the extremities are cold. Blood pressure 74/40 mmHg Heart rate 180 /min Respiratory rate 34 /min Temperature 37.4" C rectal Which of the following is the most likely diagnosis?

A:

Septic shock

B:

Renal failure

C:

Acute myocarditis

D:

Idiopathic thrombocytopenic purpura

Q.12. A 36-year-old man has unilateral mild pain in the neck which radiates to the right interscapular and shoulder regions. The pain is followed by sharp, electric shock-like pain, which goes down the arm with numbness, weakness and loss of tendon reflexes. i Which of the following is the most likely diagnosis?

A:

Whiplash injury

B:

Cervical disc prolapse

C:

Rotator cuff tendonitis

D:

Polymyalgia rheumatica

Q.13. A 1-year-old girl presents to the Paediatrics Emergency Department at night with episodes of oud coughing and refusal to feed. There is a history of upper airway infection with nasal congestion and sneezing over the last week. She has not received any routine immunizations. During the physical examination, there are repetitive violent fits of a hacking cough that are followed by forceful, high-pitched inhalations accompanied by facial cyanosis. Between attacks, the girl appears exhausted and apathetic. Heart rate 150 /min Respiratory rate 60 /min Temperature 36.6° C Oxygen saturation 92% on room air Which of the following diagnostic tests would be most appropriate?

A:

Nasopharyngeal swabbing

B:

Sweat chloride test

C:

Chest radiography

D:

Serologic testing

Q.14. A 28-year-old sustained motorcycle accident. Examination confirmed a deep laceration atthe posterior aspect of the left calf, about 15 cm long and 5 cm deep. Which of the following nerves is most likely injured?

A:

Tibial nerve

B:

Sciatic nerve

C:

Common fibular nerve

D:

Superficial fibular nerve

Q.15. A 16-year-old asymptomatic boy presents for a sports participation physical examination. He is asthmatic since the age of 4 years and uses albuterol on rare occasion, which gives rapid and complete relief. Which of the following questions is best to ask to evaluate whether the current control is satisfactory?

A:

"Are you able to keep up with your teammates?"

B:

"Are you using your inhaler more frequently?"

C:

"Are you coughing during meals?"

D:

"Are you coughing at night?"

Q.16. A 25-year-old man presents to the hospital with an open fracture of his right leg, after a motor bike accident on a farm. Later he develops severe pain, necrosis and blue discoloration of the skin, and apparently there is gas in the deep tissues of the leg. ; Which of the following is the most likely causing agent?

A:

Actinomyces israeli

B:

Staphylococcus aureus

C:

Clostridium perfringens

D:

Mycobacterium ulcerans

Q.17. A 3-year-old boy presents to the Paediatric Emergency Department with fever, headache and generalized muscular pain over the last 24 hours. The child appears sleepy and irritable. There are several spots on the buttocks and legs. Physical examination confirms stiffness of the neck. After performing a lumbar puncture, an intravenous infusion of penicillin G is started. The parents also report that the child's 6-year-old brother had been in close contact with this boy and ask how best to look after him (see image and report). Blood pressure 90/55 mmHg Heart rate 120 /min Respiratory rate 38 /min Temperature 39° C Oxygen saturation 95% on room air CSF analysis: Elevated cell count and Gram negative diplococeic. What would be the best management for the older brother?

A:

Hospital admission and monitoring

B:

Intravenous penicillin G

C:

Active immunization

D:

Oral rifampicin

Q.18. Which of the following Is characteristic of the cardia auscultation of child with an atrial septal defect ?

A:

S3 gallop

B:

Fixed, widely split S2

C:

Continuous murmur

D:

Systolic ejection click

Q.19. A 12-month-old boy presents to the Paediatric Emergency Department in the early morning hours with nasal congestion and a barking cough and 3 days history of a mild airway infection. Physical examination shows suprasternal retractions and nasal flaring. The back of the throat is reddened. Lung fields are clear on auscultation. The inhalation of nebulized epinephrine temporarily improves the symptoms. Heart rate 110 /min Respiratory rate 30 /min Temperature 38.5° C Oxygen saturation 94% on room air Which of the following is the most appropriate next step in management?

A:

Steroids

B:

Antibiotics

C:

Antihistamine

D:

Bronchodilators

Q.20. A 45-year-old is presented following poly-trauma. He requires intubation to protect airway obstruction. After resuscitation and management, he is transferred to ICU. Which of the following is the most appropriate method to clear the cervical spine?

A:

CT scan

B:

Clinical judgement

C:

MRI of cervical spine

D:

AP and Lateral view cervical spine x-ray

Q.21. A 9-year-old girl is brought to the Emergency Department with abnormal movements and a recent history of tea-coloured urine. Her parents described a preceding skin eruption. On examination, the child looks unwell, and unresponsive and lower limb swelling is noted (see lab results). Blood pressure 155/105 mmHg Heart rate 110 /min Respiratory rate 25 min Temperature 37.4° C Test Result Normal Values Hb 78 112-165 gL Platelets count 165 150-400 x 109/L Blood urea nitrogen 13.1 1.8 10 6.4 mmol Creatinine 101 27-88 pmollL Complement C3 0.5 0.7-1.5 glL Which of the following is the most likely diagnosis?

A:

Post streptococcal glomerulonephritis

B:

Hemolytic uremic syndrome.

C:

Henoch-schonleinpurpura

D:

Acute renal failure

Q.22. An 80-year-old woman presents with a history of bilateral leg pain and numbness, preventing her from walking more than 50 meters for over 2 years. Her symptoms are worse when going downhill. On the other hand, she can walk further if she bent forward on a walker or if she is. going uphill. When she reaches the limit, her leg pain stops her from going any further. Physical examination showed a forward stooped gait. Spine and neurological examination were normal. Both pedal pulses are present. Which of the following is the most likely diagnosis?

A:

Lumbar spinal stenosis

B:

Lumbar discogenic pain

C:

Peripheral vascular disease

D:

Lumbosacral spondylolisthesis

Q.23. A 25-year-old woman presents with a 6-hour history of lower abdominal pain associated with nausea and 1 episode of vomiting. Examination confirms minimal tenderness in the suprapubic and left liac fossa region. Urine dipstick and pregnancy tests are normal (see lab results). Blood pressure 110/70 mmHg Heart rate 76 /min Temperature 36.6 °C Test Result Normal Values Hb 110 130-170 g/L (Male) 120-160 g/L (Female) WBC 94.5105 x 1091 Neutrophils 50 40-60% Which of the following is the most appropriate management?

A:

US abdomen

B:

Abdominal X ray

C:

Diagnostic laparoscopy

D:

Discharge on oral analgesics

Q.24. Which of the following is the most frequent agent causing acute bronchiolitis?

A:

Adenovirus

B:

Parainfiuenza

C:

Mycoplasma pneumonia

D:

Respiratory syncytial virus

Q.25. A 25-year-old obese patient complained of numbness and tingling of the little and ring fingers on the left hand. The patient said that the symptoms are worse when the hands are raised. The elevated arm stress test is positive on the leftthe Which of the following is the most likely diagnosis?

A:

Carpal tunnel syndrome

B:

Thoracic outlet syndrome

C:

Chronic shoulder subluxation

D:

Ulnar artery thrombophlebitis

Q.26. A 30-year-old woman underwent endoscopic sinus biopsy of soft tissue mass at the roof of left maxillary sinus. After recovery, the patient experienced numbness and paraesthesia in her left lower eyelid and upper lip. Which of the following is the most likely affected nerve?

A:

External nasal

B:

Infratrochiear

C:

Infraorbital

D:

Mandibular

Q.27. A 3-year-old alert and oriented girl presents to the Paediatric Emergency Department at 2 a.m. with breathing difficulties and a brassy, barking cough. There is inspiratory stridor at rest and a hoarse voice. The girl has been suffering from a viral upper airway infection for the past week. A physical examination shows moderate chest wall retractions. On auscultation, there is decreased air entry. The extremities and buccal membranes appear pink and moist. Heart rate 180 /min Respiratory rate 60 /min Temperature 39.9° C rectal Oxygen saturation 93% on room air Which of the following is the most appropriate management?

A:

Broad-spectrum antibiotic treatment

B:

Nebulized epinephrine and oral steroids

C:

Inhalation with salbutamol and budenoside

D:

Cough suppression with codeine hydrochloride

Q.28. A 24-year-old man came to the hospital with pain, swelling and difficulty in moving the arm. Examination shows he has humeral fracture (see report) X-ray: The fracture was at the level of the surgical neck. Which of the following nerves was most likely injured?

A:

Ulnar

B:

Radial

C:

Axillary

D:

Median

Q.29. A 3-year-old child is a known asthmatic who usually has 1 acute exacerbation each month. The acute symptoms are relieved by nebulizer therapy at the Emergency Department or the nearby health centre. Which of the following should be included in the daily management?

A:

Slow-release theophylline

B:

Sodium cromoglycate

C:

Inhaled budesonide

D:

Oral steroids

Q.30. A 45-year-old woman complains of dysphagia to liquids, retrostemnal pain on swallowing and regurgitation of food. Which of the following has the highest diagnostic value?

A:

Barium swallow

B:

CT with contrast

C:

Upper gastrointestinal endoscopy

D:

Lower oesophageal sphincter manometry

Q.31. A 10-year-old boy is diagnosed with acute rheumatic fever with cardiac involvement. For how many years is theumatic fever prophylaxis recommended for this child?

A:

1

B:

5

C:

10

D:

15

Q.32. A 5-year-old child has a 1-day history of cola-coloured urine with red blood cell casts. 2 weeks ago, the child had culture-positive streptococcal tonsils. A diagnosis acute post- streptococcal glomerulonephritis is suspected. Which of the following is the best clinical evidence to support the diagnosis?

A:

Mildly elevated blood creatinine

B:

Negative antinuclear antibody

C:

Positive streptozyme test

D:

Low C3

Q.33. A 3-year-old girl presents to the Paediatric Emergency Department at night with a barking, dry cough and laboured breathing. There is a 3-day history of nasal obstruction and cough that had worsened over the last 2 hours. The child appears anxious and cries with a hoarse voice. There is a sharp, high-pitched sound on inspiration. Physical examination confirms indrawing of the chest wall and a reddened throat. A single treatment with nebuiized epinephrine results in a quick improvement of the airway symptoms. 30 minutes after the inhalation the coughing and the breathing difficulties reappear. Which of the following is the next step in management?

A:

Observation in clinic

B:

Intravenous steroid

C:

Oxygen administration

D:

Repeat epinephrine inhalation

Q.34. A 3-year-old boy fell on his outstretched hand while playing in the yard. On examination, there is tenderness and swelling of the forearm, which seemed to be abnormally curved (see image). Which of the following is the most appropriate management?

A:

Perform a CT scan of the forearm

B:

Rest, ice compression and elevation

C:

Administer paracetamol and discharge

D:

Reduce the fracture and cast the forearm

Q.35. A 6-year-old girl presents with ear pain and swelling of the pinna. She had returned the previous day from swimming camp and developed these complains 1 day before. On examination, she has significant pain when moving the pinna and a foul smelling discharge from the ear canal. Which of the following is the most appropriate management?

A:

Oral amoxicillin

B:

Oral cefuroxime

C:

Topical neomycin

D:

Topical dexametasone

Q.36. A 14-year-old-boy presents for a routine paediatrics exam. There is no history of any major illness. Physical examination confirms an irregular pulse with no | other abnormal findings (see image). Blood pressure 115/70 mmHg Heart rate 80 /min Respiratory rate 20 /min Temperature 36.8° C Oxygen saturation 85% on room air Height 175 cm (> 90th percentile Weight 45 kg (25th percentile) Which of the following is most likely prognosis?

A:

Syncopal episodes

B:

Need of pacemaker

C:

Normal development

D:

Myocardial infarction

Q.37. A 30-year-old patient presents with history of pain and swelling of the right knee (see lab results). Aspirate of knee Test Result Normal Values Colour Yellow Clear Appearance Opaque Transparent Viscosity Variable High WBC 15.2 < 200 /ml PMNs 80% < 25% Mucin clot Poor Good Which of the following is the most likely diagnosis?

A:

Gouty arthritis

B:

Septic arthritis

C:

Rheumatic arthritis

D:

Pseudogout arthritis

Q.38. A 10-year-old boy is admitted to the hospital due to acute exacerbation of asthma. He is currently medicated with montelukast once daily and has last been seen by his primary care physician over 6 months ago. He reports daily episodes of dry cough and wheezing that are exacerbated by exercise. After admission, his symptoms stabilized with the administration of inhaled albuterol. Which of the following the most appropriate long-term maintenance therapy?

A:

Oral steroids once daily, plus a long-acting beta-2 agonist as needed

B:

Inhaled corticosteroid twice-daily, plus a short acting beta-2 agonist as needed

C:

Inhaled long-acting beta-2 agonist, plus a short acting beta-2 agonist as needed

D:

Leukotriene receptor antagonist once daily plus a short acting beta-2 agonist as needed

Q.39. An army soldier comes to Outpatient Clinic complaining of painful fla feet after several years of service, which included thousands kilometres of marching in the desert. The pain was acute in the medial aspect of his sole. Which of the following structures is the most likely strained?

A:

Tendon achilles

B:

Spring ligament

C:

Flexor retinaculum

D:

Extensor retinaculum

Q.40. A 65-year-old man presents with a 72-hour history of severe pain in epigastrium radiating to his back with associated nausea and 2 episodes of vomiting. History confirms that he is a known case of cholelithiasis. Abdominal examination confirms generalized tendemess in abdomen. US guided aspiration of the intra-abdominal uid grows E.coli (see ab results). Blood pressure 100/70 mmHg Heart rate 110 /min Respiratory rate 22 /min Temperature 38.6 °C Test Result Normal Values Amylase 576 24-151 IUL Lipase 300 0-160 IU/L C-reactive peptide 135 <8.2 mg/L What is the most likely explanation for the bacterial growth?

A:

Bowel perforation

B:

Bacterial translocation

C:

Haematogenous spread

D:

Exogenous contamination

Q.41. A 45-year-old man had transurethral catheterization before going for a long surgical procedure. Postoperatively he developed haematuria and a urethral injury is suspected. Which of the following is most likely injured part of urethera?

A:

Penile

B:

Prostatic

C:

Membranous

D:

Middle spongy

Q.42. A 19-year-old felt on an outstretched hand while playing football. Examination confirmed tendemess over the anatomic snuff box. Which of the following is the most suspected fracture?

A:

Colles

B:

Cuboid

C:

Scaphoid

D:

Hook of hamate

Q.43. A 25-year-old man is brought to the Emergency Room after a motor vehicle accident. Examination shows, he has a severed nerve in the right upper limb, resulting in a loss of adduction of all the digits of the right hand. Which of the following is the most likely affected nerve?

A:

Ulnar

B:

Median

C:

Musculocutaneous

D:

Upper subscapular

Q.44. A 50-year-old woman comes to the clinic with numbness in the lower part of the ear, lower face, and upper neck. History reveals, she underwent a lateral neck dissection. Examination shows. loss of sensation over both surfaces of the lower part of the pinna and skin overlying the angle of the mandible on the same side of the operation. Which of the following nerves is most likely injured?

A:

Third occipital

B:

Great auricular

C:

Lesser occipital

D:

Greater occipital

Q.45. A 70-year-old, non-smoking man presents with increased urinary frequency, especially at night. The patient feels that the bladder is not fully empty after voiding, and the urine stream has slightly diminished. The patient's high blood pressure is well controlled with a calcium channel blocker. There is no associated fever, weight loss, haematuria, or pain with voiding. The digital rectal examination was significant for a moderate enlargement of the prostate, but is otherwise normal. Results of urinalysis and kidney function tests were normal (see lab result). Test Result Normal Value PSA antigen 1 <4 ng/ml Which of the following is the most appropriate initial management?

A:

Cystoscopy

B:

Open prostatectomy

C:

Alpha-blocker therapy

D:

Transurethral Resection Prostatectomy

Q.46. A 60-year-old man presents to the clinic with pain in the left flank, weight loss, and haematuria. Examination confirms a firm mass in the lumbar region. Blood pressure 158/98 mmHg Heart rate 76 /min Respiratory rate 18 /min Temperature 36.6° C Which of the following imaging is the most diagnostic?

A:

MRI

B:

CTscan

C:

Ultrasound

D:

Radionuclide scan

Q.47. An 11-month-old child presents with failure to thrive, frequent large volumes of urine, excessive thirst, and 3 episodes of dehydration not associated with vomiting or diarrhoea. Several boys in his family showed similar symptoms. Which of the following is the most likely diagnosis?

A:

Diabetes mellitus

B:

Diabetes insipidus

C:

Water intoxication

D:

Nephrotic syndrome

Q.48. A 40-year-old man comes to the clinic with pain in the lower back, and blood in the urine. IVP shows a non-opagque filing defects in the renal pelvis. Ultrasound revealed dense echoes and acoustic shadowing. Which of the following is the most likely diagnosis?

A:

Tumour

B:

Blood clot

C:

Uric acid stone

D:

Sloughed renal papilla

Q.49. A 1-year-old child is brought to the clinic with a high fever, cough and respiratory distress for 3 days. On auscultation of the chest, there are generalised fine crackles (see report). Chest X-ray: Showed puffy infiltrates with ill-defined margins throughout both lung fields. Which of the following is the most likely diagnosis?

A:

Bronchopneumonia

B:

Acute epiglotitis

C:

Bronchiactasis

D:

Cystic fibrosis

Q.50. A 53-year-old man presents to the hospital with fever and pain in the right knee for 2 days. On physical examination, the right knee was swollen and red with a limited range of motion. A knee Joint aspiration was performed. Then, the patient started empirically on Cloxacilin. Onday3 | after admission, a further report was received (see reports), Gram stain showed numerous white biood cells and gram positive cocci in clusters. Bacteriology (3 days later): Staphylococcus aureus that was resistant to cefoxitin. Which of the following is the most appropriate action?

A:

Add gentamicin

B:

Start vancomycin

C:

Continue cloxacilin

D:

Arthroscopic washout

Q.51. A 6-year-old girl presents to the Emergency Department with a history of feeling unwell and tiredness over the last 10 hours. On examination, she looks pale, had a palpable liver and her spleen was 6 cm below the costal margin (see lab results). Blood pressure 93/55 mmHg Heart rate 169 /min Respiratory rate 28 /min Temperature 37.5° C Test Result Normal Values Hb 58 112-165 gL Platelet count 98 150-400 x 109/L Sickle cell screen Positive Which of the following is the most useful investigation?

A:

Bone marrow aspiration

B:

Abdominal ultrasound

C:

Antinuclear antibody

D:

Reticulocyte count

Q.52. A 41-year-old ‘woman developed atrophy of the thenar eminence, but the sensation over it is intact. Which of the following nerves is the most likely damaged?

A:

Ulnar

B:

Radial

C:

Axillary

D:

Median

Q.53. A 65-year-old woman comes to the Outpatient Clinic complaining of pain in her left hand and fingers from typing on the keyboard for a while. Investigations reveal insufficient blood flow into the ~~ | superficial palmar arch Occlusion of which of the following arteries is the most likely cause?

A:

Ulnar

B:

Radial

C:

Anterior interosseous

D:

Posterior interosseous

Q.54. Which of the following is the most appropriate strategy to avoid air bag injury in children under the age of 12 years?

A:

Restrain in back seats.

B:

Restrain in front seats

C:

Rear facing in front seats

D:

Booster seats in front seats

Q.55. A 1-year-old girl presents to the Paediatrics Emergency Department at night with episodes of loud cough and refusal to feed. There is a history of upper airway infection with nasal congestion and sneezing over the last week. She has not received any routine immunizations. During the physical examination, there are repetitive violent fits of a hacking cough that are followed by forceful, high-pitched inhalations and accompanied by facial cyanosis. Between attacks the girl appeared exhausted and apathetic. Heart rate 150 /min Respiratory rate 60 /min Temperature 36.6° C Oxygen saturation 92% on room air Which of the following is the most likely cause?

A:

Bordetella pertussis

B:

Respiratory syncytial virus

C:

Streptococcus pneumonia

D:

Haemophilus influenza type B

Q.56. A 48-year-old man who is a smoker for the last 20 years, had a routine exam (see lab result and report) Test Result Normal Value Calcium 3.1 2.15-2.62 mmol/L Chest X-ray. 4 cm diameter left hilar mass. Which of the following is the most likely diagnosis?

A:

Metastatic carcinoma

B:

Adenocarcinoma of lung

C:

Advanced bronchiectasis

D:

Squamous cell carcinoma of lung

Q.57. A 25-year-old man presents with a 6-month history of heartburn. The pain becomes worse at night after lying down. On lifting weight, he experiences a biter taste in mouth. Which of the following is the most likely diagnosis?

A:

Esophagitis

B:

Acute gastritis

C:

Boerhaave's syndrome

D:

Perforated peptic ulcer

Q.58. During physical examination of a child, the physician asks the patient to face the wall, bend forward and let the arms hang down unsupported. What does this test screen for?

A:

Scoliosis

B:

Sexual abuse

C:

Rectal prolapse

D:

Leg length symmetry

Q.59. A patient presented after a blunt injury over the left leg. Examination confirmed a sensory loss on adjacent sides of the great and second toes, and impaired dorsiflexion of the foot. Which of the following nerves is most likely injured?

A:

Sural

B:

Saphenous

C:

Deep peroneal

D:

Posterior tibial

Q.60. A 25-year-old woman presents with a longstanding history of lower abdominal and right hypochondrial pain. Diagnostic laparoscopy confirms pelvic and perihepatic adhesions. Which of the following is most likely responsible?

A:

Ecoli

B:

Chlamydia

C:

Bacteroides

D:

D. Streptococci

Q.61. A 52-year-old woman sipped and fell, she complained of being unable fo extend her leg athe knee joint. Which of the following muscles is most likely paralyzed?

A:

Sartorius

B:

Biceps femoris

C:

Semitendinosus

D:

Quadriceps femoris

Q.62. A 20-year-old man comes to the clinic complaining of a knee pain. History reveals he received a | severe blow on the inferolateral side of the left knee joint while playing football. Radiographic : ‘examination revealed a fracture of the head and neck of the fibula. ; Which of the following nerves is the most likely to be damaged?

A:

Tibial

B:

Deep peroneal

C:

Common peroneal

D:

Superficial peroneal

Q.63. A patient presented with an infected wound at the forehead. Which of the following lymph nodes will most likely enlarged?

A:

Mastoid

B:

Submental

C:

Submandibular

D:

Superficial parotid

Q.64. A 1-year-old boy is seen on a routine examination. He has had vertically transmitted HIV infection and now has a low T-cell count. Which of the following vaccines would be contraindicated?

A:

Varicella

B:

Hepatitis B

C:

Pneumococcal

D:

Dipheteria, Tetanus, acellular Pertusis

Q.65. Which of the following patients with congenital heart disease would be expected to exhibit cyanosis?

A:

6-year-old girl with coarctation of the aorta

B:

18-month-old boy with a muscular VSD

C:

Term newbom with truncus arteriosus

D:

10-year-old boy with a congenital ASD

Q.66. An 82-year-old man presents to the clinic with Inability to urinate. The patient complains of severe pain and bloating in the lower abdomen, painful and urgent need to urinate. Which of the following is the most appropriate management?

A:

Semi-urgent prostatectomy

B:

Antibiotic for a urinary infection

C:

Foley catheterisation and culture urine

D:

Cystoscopy and Transurethral Resection Prostatectomy

Q.67. A 26-year-old man is brought to the Emergency Room after sustaining a bullet injury to his arm Examination shows his median nerve was damaged. Which of the following is the most likely clinical finding?

A:

Ape hand

B:

Claw hand

C:

Wrist drop

D:

Waiter's tip hand

Q.68. A 1-year-old girl is brought to the Paediatric Emergency Department in the early morning with breathing difficulties. She has a dry cough that sounds like the barking of a sea lion and gets worse when she is crying. Every time the infant breathes in, there is a high-pitched sound. There is also a 4-day history of a mild upper airway infection. Blood pressure 80/65 mmHg Heart rate 120 /min Respiratory rate 40 /min Temperature 38.5° C Which of the following is the most appropriate way to establish the diagnosis?

A:

Chest X-ray

B:

Spirometry

C:

Pharyngeal swab

D:

Clinical examination

Q.69. Which of the following findings in a newborn requires immediate treatment?

A:

An erupted tooth

B:

Breast enlargement

C:

Shallow sacral dimple

D:

Absent femoral impulses

Q.70. A 40-year-old man patient comes to the clinic after developing hoarseness of the voice and aspiration when drinking fluids. History reveals, he underwent thyroidectomy surgery 2 weeks prior to these symptoms. Which of the following is the most likely damaged laryngeal nerve?

A:

External

B:

Internal

C:

Superior

D:

Recurrent

Q.71. An 8-year-old boy complained of pain in his right hip and was unable to walk, associated with high fever for the last five days. physical examination confirmed that the active and passive range of motion of the hip was painful and restricted. Pelvic and hip X-rays were normal. Ultrasound of the hip showed a right hip fluid collection (see lab results). Blood pressure 120/65 mmHg Heart rate 110 /min Respiratory rate 22 /min Temperature 39.2° C Test Result Normal Values Hb 125 112-165 glL Platelets count 210 150-400 x 109/L WBC 9.84.5-10.5 x 1091L ESR 78 2-10 mmh C-reactive peptide 2.0 0-0.5 mg/d Which of the following is the most appropriate next step in management?

A:

Hip MRI

B:

Bone scan

C:

Hip CT scan

D:

Hip aspiration

Q.72. A 35-year-old man is brought to the Emergency Room after a road traffic accident. X-ray shows a displaced fracture of the mid shaft of the humerus. Which of the following is the most likely clinical complication?

A:

Wrist drop

B:

Claw hand

C:

Waiters tip hand

D:

Klumpke's paralysis

Q.73. A 7-month-old presents with low-grade fever and a dry cough for the last 3 days. On examination, there is wheezing over both lung fields (see report) Heart Rate 127 /min Respiratory Rate 47 /min Temperature 38.9° C Chest X-ray: Hyperinflation and some infilrate. Which of the following is the most likely diagnosis?

A:

Asthma

B:

Sinusitis

C:

Influenza

D:

Bronchiolitis

Q.74. A 30-year-old patient presents with recurrent urinary tract infections, polyuria, and electrolyte imbalance (see report). Ultrasound Bilaterally enlarged kidneys with multiple, variably-sized and thin-walled cysts distributed throughout the renal parenchyma. Which of the following is the most likely diagnosis?

A:

Carcinoma bladder

B:

Renal calcul disease

C:

Medullary sponge kidney

D:

Polycystic kidney disease

Q.75. A 5-year-old boy is evaluated for generalized swelling of the face, abdomen and extremities over the past 3 weeks. The mother does not report any significant past medical problems and there is no history of fever or sore throat. There is no shortness of breath or cough. On examination, he appears comfortable and has significant oedema of his face and lower extremities. The child will be started on a low sodium diet (see lab results). Temperature 37.1°C Heart rate 88/min Blood pressure 100/60 mmHg Respiratory rate 16/min Serum Test Results Normal Value Serum albumin 25 36-52 lL Urinalysis Result Normal Values Proteins 3+ 0 Erythrocytes 0 0-2 per high power field 24 Urine Analysis Rests Normal Value 24 hr urine protein 140 0.8-14 mg/dl Which of the following should be recommended in addition to the diet?

A:

Furosemide

B:

Renal biopsy

C:

Corticosteroid trial

D:

Admit and start dialysis

Q.76. An infant bom to a 36-year-old mother presents with poor feeding, sweating over the forehead, and repeated chest infections. The child has an upward slant of the eyes, delayed mile stones, short stubby fingers, ciinodactyly of the litle finger, and a single transverse palmer crease. The child is in respiratory distress. Blood pressure 65/45 mmHg Heart rate 120 /min Respiratory rate 45 /min Temperature 36.8° C Which of the following is the most likely cardiac anomaly?

A:

Tetralogy of fallot

B:

Patent ductus arteriosus

C:

Endocardial cushion defect

D:

Transposition of great arteries

Q.77. A 12-year-old boy comes to the clinic with multiple painful swollen joints with reduced range of motion. Examination shows multiple non-tender subcutaneous nodules. Which of the following would most probably confirm the diagnosis?

A:

Elevated ESR

B:

Positive blood culture

C:

High C-reactive protein

D:

Elevated anistreptolysin O titer

Q.78. A 24-year-old woman comes to the clinic after noticing a lump in her breast. Examination shows, a firm, painless, and freely movable 3 cm mass in the left breast. The mass has grown slowly over the past year and does not change during the menstrual cycle. Which of the following is the most likely diagnosis?

A:

A Fat cyst

B:

Fibroadenoma

C:

Fibro-cystic changes

D:

Intraductal papilloma

Q.79. A 13-year-old boy with sickle cell disease, presents with severe unilateral hip pain, which has developed over the past few weeks. Which of the following is the most likely diagnosis?

A:

Avascular necrosis

B:

Rheumatic fever

C:

Psoriatic arthritis

D:

Still's disease

Q.80. A 3-year-old child was a admitted to the hospital to initiate antibiotic treatment for pneumonia. She has long history of sinusitis and lower respiratory tract infections. During the current admission, she underwent fibre optic bronchoscopy with sputum collection, and both Pseudomonas aeruginosa and Burkholderia cepacia were isolated. Which of the following is the most likely diagnosis?

A:

Asthma

B:

Cystic fibrosis

C:

Primary ciliary dyskinesia

D:

Alpha 1-Antitrypsin deficiency

Q.81. A 5-week-old baby is brought to the clinic with low-grade fever and difficulty breathing. Her parents report that she had 2 episodes in which she appeared to have stopped breathing. Physical examination confirms subcostal retraction with inspiration and diffuse bilateral wheeze. Temperature 37.9 °C Heart Rate 130 /min Respiratory Rate 55 /min Oxygen saturation 90% Which of the following is the most appropriate treatment?

A:

Inhaled corticosteroids

B:

Ventiatory management

C:

Broad spectrum antibiotics

D:

Supportive care and hydration

Q.82. A 3-year-old boy presents to the Paediatric Emergency Department with fever, headache and generalized muscular pain over the last 24 hours. The child appears sleepy and irritable. There are several spots on the buttocks and legs. Physical examination confirms stiffness of the neck. After performing a lumbar puncture, an intravenous infusion of penicillin G is started (see image, lab result and report) Blood pressure 90/55 mmHg Heart rate 120 /min Respiratory rate 38 /min Temperature 39° C Oxygen saturation 95% on room air Test Result Normal Value WBC 25 4.5-10.5 x 109/L CSF Culture: Gram negative diplococcic. Which of the following is the most likely late complication?

A:

Ataxia

B:

Seizures

C:

Deafness

D:

Cranial nerve palsy

Q.83. Which of the following is a component of the Tetralogy of Fallot?

A:

Ventricular septal defect

B:

Left ventricular hypertrophy

C:

Atrial septal defect

D:

Tricuspid stenosis

Q.84. A 2-day-old baby is brought to the hospital because of reluctance to feed and seizures since last | night. On examination, the baby weighed 3 kg, is inactive and has a generalized increased tone. A cerebral spinal fluid sample was obtained (see lab results). Test Result Normal Values Gross appearance Clear Clear and colourless Glucose 3.5 2.8-5 mmol/L. ; Total protein 0.22 0.22-0.33 g/L Cells 10 Up to 30/pL Which of the following is the most likely diagnosis?

A:

Neonatal sepsis

B:

Neonatal tetanus

C:

Pyogenic meningitis

D:

Hypoxic- ischemic encephalopathy

Q.85. A 35-year-old man patient comes to the clinic with a painless uicer on his penis. History reveals, he had unprotected sexual encounter 3 weeks ago. Examination shows that the lesion has a clean base with sharp margins, and there are non-tender palpable regional lymph nodes. Which of the following is the most likely diagnosis?

A:

Syphilis

B:

Chancroid

C:

Gonorhoea

D:

Granuloma inguinale

Q.86. A 45-year-old is brought to the Emergency Department following a high-speed motor vehicle accident. Examination confirms seat belt sign (see report). CT - Chance fracture of lumbar vertebrae. Which of the following is the most likely finding on an abdominal CT?

A:

Injury to vena cava

B:

Stomach perforation

C:

Duodenal perforation

D:

Isolated jejunal blow out

Q.87. A 70-year-old man presents with urinary incontinence. The patient's bladder is palpably distended after voiding. The patient stated that he voids frequently, although he has difficulty initiating the urine stream. Which of the following is the most likely type of incontinence?

A:

Urge

B:

Stress

C:

Reflex

D:

Overflow

Q.88. A 16-year-old patient comes to the clinic because he is unable to bring the fork to his mouth to feed himself. History reveals the patient had a closed head injury in a motor vehicle accident 10 days ago. Which of the following is the most ikely involved area?

A:

Cerebellum

B:

Parietal lobe

C:

Occipital lobe

D:

Temporal lobe

Q.89. A 2-year-old child who refuses to walk since the day before, presents to the clinic. The parent states that the child was playing and tripped over a toy. While falling, the right leg was caughtin the toy and twisted. Since then, the child has wanted to be carried. The past medical history is ; normal and immunizations are current. Which of the following is the most likely diagnosis?

A:

Spiral fracture of the right tibia

B:

Spiral fracture of the right femur

C:

Softtissue swelling of the right ankle

D:

Chip fracture of the proximal right tibia

Q.90. A 13-year-old boy presents for a physical check-up. He has had normal growth and development and has been able to do the usual activities for his age without difficulty. His older brother had had a sudden cardiac death while walking to work. The boy's examination is normal. Which of the following must be excluded?

A:

Bicuspid aortic valve

B:

Patent ductus arteriosus

C:

Ventricular septal defect

D:

Hypertrophic cardiomyopathy

Q.91. A 85-year-old patient is admitted for elective ventral hemia repair. He is diabetic and hypertensive for 10 years. Examination confirms raised JVP, bilateral basal crepitation on chest auscultation, and pedal edema. What is the most appropriate next step in management?

A:

Open repair as scheduled

B:

Laparoscopic repair as schedueled

C:

Surgery after optimization at a later date

D:

No surgery unless presents with obstruction

Q.92. A 24-year-old was running and suddenly experienced severe left leg pain. The patient was limping because of the pain, which is relieved by passive stretching. Which of the following is the most commonly involved muscle?

A:

Soleus

B:

Gastrocnemius

C:

Tibialis posterior

D:

Peroneous longus

Q.93. A 55-year-old is admitted for an elective laparoscopic cholecystectomy. He is diabetic and hypertensive for 5 years. History confirms a recent admission in Intensive Care Unit for anterior wall MI 6 weeks ago. What is the most appropriate management?

A:

Open cholecystectomy during this admission

B:

Laparoscopic cholecystectomy after 6 months.

C:

Laparoscopic Cholecystectomy during this admission

D:

Per-cutaneous cholecystostomy during this admission

Q.94. A 74-year-old man is referred to the thoracic surgeon with dysphagia of solid food for six weeks ‘which marked weight loss for 2 months. Oesophageal endoscopy shows a stenotic mass in the mid oesophagus (see report). Chest X-ray: Normal. Which of the following is the most likely diagnosis?

A:

Lymphoma

B:

Adenocarcinoma

C:

Squamous cell carcinoma

D:

Extension from neuroendocrine cancer

Q.95. A 12-year-old overweight boy complains of severe left hip pain after minor trauma. He cannot bear his weight on the left leg. The boy denied any history of fever. Physical examination confirmed that the left lower leg was externally rotated and the range of motion of the left hip joint is restricted and painful. Laboratory results were normal (see image) Which of the following is the most likely diagnosis?

A:

Septic arthritis

B:

Femoral neck fracture

C:

Slipped capital femoral epiphysis

D:

Developmental dysplasia of the hip

Q.96. A 9-month-old infant has a congenital heart lesion but the parents do not know the specific diagnosis. On examination, it was found that the infant has central and peripheral cyanosis. Which of the following is the most likely diagnosis?

A:

Patent ductus arteriosus

B:

Coarctation of the aorta

C:

Tetralogy of fallot

D:

Atrial septal defect

Q.97. Which of the following ECG abnormalities is an expected finding in ostium secundum atrial septal defect?

A:

Delta waves

B:

Left axis deviation

C:

Right bundle branch block

D:

Left ventricular hypertrophy

Q.98. An 80-year-old man presents with dull aching pain in the loins (see lab results and report). Test Result Normal Values Creatinine 280 44-115 pmol/L. Urea 12.5 2.75-7.4 mmol/L Ultrasound abdomen: Bilateral hydronephrosis. Which of the following is the most likely diagnosis?

A:

Stricture of urethral meatus

B:

Prostatic enlargement

C:

Neoplasm of bladder

D:

Pelvic cancer

Q.99. A 2-year-old child presents to the clinic with chalky discoloration on both sides of the teeth. The child sleeps with the milk bottle in his mouth. On examination, there are opaque discolorations on the backside of the central maxillary incisors and the first molars. Which of the following is the most likely diagnosis?

A:

Herpetic gingivostomatitis

B:

Nursing bottle caries

C:

Gingival hyperplasia

D:

Congenital syphilis

Q.100. Which of the following has the greatest risk of developing endocarditis in patients with congenital heart disease?

A:

Patent ductus arteriosus

B:

Ventricular septal defect

C:

Atrial septal defect

D:

Tetralogy of fallot

Q.101. A 9-year-old presents with weakness, fatigue, and hypertension in upper limbs. Examination confirms delayed pulses in lower extremities. Which of the following is the most likely aetiology?

A:

Atrial septal defect

B:

Mitral valve prolapse

C:

Coarctation of the aorta

D:

Ventricular septal defect

Q.102. A 26-year-old professional football player is brought to the Emergency Room after being hiton | the lateral side of the left knee. The knee is buckled, and the patient is in severe pain. On ; examination, there was a swelling over the medial aspect of the left knee. There was laxity when valgus stress test was performed on the knee. Both the Lachman test and McMurray fest were negative. Which of the following is the most likely type of injury?

A:

Lateral meniscus tear

B:

Medial meniscus tear

C:

Lateral collateral ligament sprain

D:

Medial collateral ligament sprain

Q.103. A 2-year-old is brought to the clinic with a sore throat and high-grade fever for 5 days. On examination, he is febrile and mildly dehydrated. The pharynx and tonsillar area is congested along with inflammation of the mouth and lips associated with gingivitis. Lesions in the mouth and lips appear as whitish-yellow plaques with an erythematous base. Which of the following is the most likely cause?

A:

Adenovirus

B:

Coxsackie virus

C:

Herpes simplex virus

D:

Epstein-barr virus

Q.104. A 5-year-old boy presents with a sore throat and refusal to eat. The mother reported that the child has had an increased temperature for the last 3 days. Several children who attended the same play group have developed similar symptoms. Physical examination shows spots and blisters on the palms of both hands as well as on the buttocks. There are small ulcers on the palate (see image). Heart rate 110 /min Respiratory rate 30 /min Temperature 38.6° C Which of the following additional physical findings is most likely to have?

A:

Spots on the soles

B:

Swollen tonsils

C:

Scratch marks

D:

Diarthoea

Q.105. A 10-year-old boy presents to the Paediatric Clinic with a skin rash. The parents report that the ‘symptoms had started with a single red spot over a small scratch and have spread over the last 4 days. There are several lesions on the cheeks, the trunk and the upper limbs. Physical examination confirms swollen lymph nodes in the arm pits and groins (see image). Blood pressure 100/65 mmHg Heart rate 80 /min Respiratory rate 24 /min Temperature 37.4° C Which of the following is the most likely diagnosis?

A:

Impetigo

B:

Candidiasis

C:

Herpes simplex

D:

Dermatitis herpetiformis

Q.106. A 65-year-old male comes to the clinic with a mild intermittent urinary flow reduction. Rectal examination, urinalysis and prostate specific antigen studies are normal (see report). Ultrasound prostate: Enlarged median lobe. Which of the following is the best way to investigate?

A:

Annual renal function monitoring

B:

Periodic PSA measurement

C:

Beta-blocker therapy

D:

Cystoscopy

Q.107. An 18-month-old child is brought to the Emergency Department with fever, irritability and refusal to move the left lower extremity. Physical examination confirms a swollen, erythematous knee ; with resistance to passive mobilization. Which of the following would be the single most important test?

A:

Blood culture

B:

X-ray of the knee

C:

Complete blood count

D:

Examination of joint fluid

Q.108. ‘A 6-month-old girl presents with difficulty feeding and the parents report that her skin becomes bluish during feeding and crying. Cardiac auscultation reveals a harsh systolic ejection murmur and a loud, single S2. Which of the following is the most likely diagnosis?

A:

Aortic stenosis

B:

Tetralogy of fallot

C:

Ventricular septal defect

D:

Transposition of the great arteries

Q.109. A 23-year-old athlete presented with foot pain while standing and walking. On physical exam, there was significant tendemess on the midiine plantar surface of the foot. The patient denied any history of trauma. Which of the following is the most likely diagnosis?

A:

Hallux valgus

B:

Hallux rigidus

C:

Plantar fasciitis

D:

Tarsal tunnel syndrome

Q.110. Which of the following congenital heart diseases is associated with the lowest risk of infective endocarditis?

A:

Patent ductus arteriosus

B:

Ventricular septal disease

C:

Subvalvular aortic stenosis (discrete)

D:

Atrial septal defect (ostium secundum)

Q.111. An 8-month-old child presents to the Paediatric Emergency Department in the early morning hours. He has laboured breathing and a barking cough that becomes worse when crying. There is a 2-day history of nasal congestion and dry cough. Physical examination confirms nasal faring and a reddened throat. There is also a harsh, high-pitched sound when the child breathes in. Auscultation over the lung fields is normal. The boy is anxious and cries with a hoarse voice. Heart rate 110 /min Respiratory rate 30 /min Temperature 39° C Oxygen saturation 94% on room air Which of the following is the most likely cause?

A:

Viral

B:

Allergy

C:

Bacterial

D:

Foreign body

Q.112. A 22-month-old boy presents to the Emergency Department with a sudden onset of respiratory distress during a family picnic. He is afebrile and has otherwise been well. Physical examination demonstrates unilateral wheezing in the right hemithorax. Which of the following is the most likely to be seen in his chest X-ray?

A:

Pneumothorax on the right side

B:

Consolidation of the right lower lobe

C:

Lower lobe collapse on the right side

D:

Hyperinflation of the right lung with mediastinal shift to the left

Q.113. A 30-year-old man was hit by a car. He was brought to the Emergency Department within 1 hour, and cleared by the trauma team. He was found to have an isolated injury to his left leg. An examination revealed tenderness over the shin and abrasions with a small 6ozing wound. IV. antibiotics and tetanus prophylaxis were started (see images). Which of the following is the most appropriate next step?

A:

Discharge from emergency department with above knee cast

B:

Urgent surgical debridement and intramedullary nailing

C:

Closed reduction followed by external fixation

D:

Discharge on oral antibiotic for 3 days

Q.114. A 10-year-old boy presents to the Paediatric Clinic with a skin rash. The parents report that the symptoms had started with a single red spot over a small scratch and have spread over the last 4 days. There are several lesions on the cheeks, the trunk and the upper limbs. Physical ‘examination confirms swollen lymph nodes in the arm pits and groins (see image). Blood pressure 100/65 mmHg Heart rate 80 /min Respiratory rate 24 /min Temperature 37.4° C Which of the following is the most appropriate treatment?

A:

Steroids

B:

Acyclovir

C:

Antibiotics

D:

Antiseptics

Q.115. A 14-year-old boy presents to the clinic complaining of "brown urine” for the past 3 days. 2 weeks ago, he had 2 days of fever and a sore throat, but he improved spontaneously and has been well ever since. On physical examination, only periorbital edema is noted (see lab results). Blood pressure 136/92 mmHg Heart rate 98 /min Respiratory rate 28 /min Temperature 37 * C Urinalysis Result Normal Values Specific gravity 1.035 1001-1030 Proteins ++ Absent Blood ++ Absent Which of the following is the most likely diagnosis?

A:

IgA nephropathy

B:

Acute pyelonephritis

C:

Hemolytic-uremic syndrome

D:

Post-streptococcal glomerulonephritis

Q.116. A 30-year-old patient presents to the clinic with a pelvic fracture, due to blunt trauma. A retrograde urethrography demonstrates disruption of the membranous urethra. Which of the following is the most appropriate first step in management?

A:

Perineal repair

B:

Retropubic repair

C:

Suprapubic catheter

D:

Transurethral catheter

Q.117. Which of the following represents the main treatment for symptomatic acute rheumatic fever?

A:

Intravenous ampicillin every 6 hours

B:

High dose oral acetyl salicylic acid

C:

Daily intravenous hydrocortisone

D:

Monthly intramuscular penicillin

Q.118. An 18-month-old infant presents to the Paediatric Outpatient Ciinic for evaluation of delay in walking. It was observed that there is widening of the lower ends of long bones (see lab results). : Height 78 cm Weight 10 Kg Test Result Normal Values Calcium total 8.1 2.2-2.7 mmol/L Phosphate 2.1 1.3-2.3 mmol/L Alkaline phosphatase 1020 100-320 UL : Which of the following is the most likely cause?

A:

Hypophosphatesia

B:

Renal osteodystrophy

C:

Vitamin D deficient rickets

D:

Familial hypophosphatemic rickets

Q.119. A 42-year-old woman gives a history of recurrent fractures and the passage of stones in the urine preceded by renal colic. Family history and a clinical examination were normal (see lab results and report). Test Result Normal Values Calcium 2.60 2.15-2.62 mmoliL. Albumin 41 34-56 gL Phosphate 1.1 0.82-1.51 mmol/L Parathyroid hormone 402 1.1-5.3 pmol/L Plain X-ray abdomen: Multiple radio-opaque shadows in the renal area. Which of the following is the most appropriate investigation?

A:

Sestamibi scan

B:

Alakiine phosphatase

C:

24-hour urine calcium

D:

Intravenous pyelogram

Q.120. A 5-year-old child presents to the Emergency Department with a 4-day history of malaise, poor oral intake, diarrhoea, and decreased urine output. Physical examination confirms a tachycardia, xerostomia and sunken eyes (see lab results). Test Results Normal Values Blood urea nitrogen 14.9 1.8 to 6.4 mmol Creatinine 180 27-62 mollL Potassium 5.5 3.5-5.1 mmol/L. Bicarbonate 14 21-28 mmol/L Which of the following is the most appropriate management?

A:

Dialysis

B:

Diuretics

C:

Normal saline

D:

NaHCO3 solution

Q.121. ‘A 25-year-old is brought to the Emergency Department after being rescued from a burning building. Examination confirms a slightly confused patient with singed facial and nasal hair. Which of the following is the most appropriate next step in management?

A:

Elective intubation

B:

Observation in ICU

C:

Avoid medico-legal issues

D:

Advice on pain management

Q.122. A 3-year-old child presents to the Emergency Department with a history of bloody diarrhoea and oliguria. The parents report that the child had started a fever, vomiting, diarrhoea and abdominal pain 7 days before, shortly after they ate at a fast-food restaurant. On physical examination, the child appears ill and in distress. She is also pale and lethargic (see ab results). Test Results Normal Values Hb 83 112-165 g/L WBC 2245-105 x 109/L Platelets count 50 150-400 x 109 /L Urinalysis Results Normal Values Proteins + Absent Erythrocytes 10 0-2 per high power field Which of the following is the most appropriate management strategy?

A:

Steroids

B:

Antibiotics

C:

Supportive care

D:

Watchful waiting at home

Q.123. A 58-year-old healthy patient has a six-month history of central lower back pain. The pain is present on awakening, and without treatment, resolves after about 30 minutes. Acetaminophen seemed to help it resolve sooner. Morning examination showed mild paraspinal muscle spasm with no neurological changes (see report). MRI Lumbar: Mild lumbar spinal stenosis. Which of the following is the most appropriate management?

A:

Biofeedback

B:

Physical therapy

C:

Lumbar laminectomy

D:

Epidural steroid injection

Q.124. A 6-year-old boy presents for his routine preschool check-up. The cardiovascular examination reveals a systolic murmur grade Ill, with no thrill located at the lower sternal border, itis vibratory in character and accentuated when the boy is in a supine position. Which of the following is the most likely diagnosis?

A:

Still murmur

B:

Aortic stenosis

C:

Atrial septal defect

D:

Ventricular septal defect

Q.125. A 55-year-old man presents with sudden, severe and constant pain in his epigastrium for the past 2 hours. History confirms that he has been on medication for joint pain for the last 2 years. Examination confirms a very sick patient with sunken eyes. Abdomen is tender and rigid to palpation. Which of the following is the most likely diagnosis?

A:

Esophagitis

B:

Acute gastritis

C:

Perforated peptic ulcer

D:

Perforated peptic ulcer

Q.126. A 6-month-old boy presents to the paediatrician with a loud barking cough and a rectal temperature of 38° C. The parents report a cold for the last 3 days that worsens at night. The : coughing is aggravated with crying and there is a high-pitched, rasping sound on inhalation. Physical examination confirms a reddened throat and a nasal obstruction (see report). Chest X-ray: Normal. Which of the following is the most likely cause?

A:

Parainfluenza virus

B:

Mycoplasma pneumonia

C:

Respiratory syncytial virus

D:

Haemophilus influenza type B

Q.127. A 21-year-old patient presents with an abnormal left testicle. On examination, the area adjacent 10 the left testicle feels like a bag of worms, which gets larger with a valsalva maneuver. Which of the following is the most likely diagnosis?

A:

Hydrocele

B:

Varicocele

C:

Spermatocele

D:

Leftinguinal hernia

Q.128. A 75-year-old man presents to the Outpatient Department, complaining of back pain and increasing difficulty with passing urine (see lab results). Test Result Normal Values Prostate-specific antigen 84 0-4 pg/L Alkaline phosphatase 410 39-117 IU/L Albumin 41 34-56 g/L Gamma glutamyltransferase 19 6 to 37 IU/L Which of the following is the most likely diagnosis?

A:

Prostatitis

B:

Prostatic cancer

C:

Urinary bladder cancer

D:

Benign prostate hyperplasia

Q.129. An 8-year-old boy presents to the Emergency Department after a fall on his left forearm. On examination, there was swelling and a deformity with a 1 cm wound on the volar aspect of his forearm (see image). Which of the following is the first step in management?

A:

Closed reduction and below elbow cast

B:

Closed reduction and above elbow cast

C:

Discharge the patient with oral antibiotic

D:

Surgical debridement, irrigation, and fixation

Q.130. An infant girl, born to a 24-year-old woman, diagnosed clinically as Down's syndrome. The mother asked about the risk in any future pregnancy. Which of the following is the appropriate investigation to determine this risk?

A:

Karyotyping for this infant

B:

Amniocentesis in next pregnancy

C:

Ultrasound during next pregnancy

D:

Karyotyping for this infant and mother

Q.131. A 10-day-old full-term boy presents with abdominal distension for 1 week. It is associated with greenish vomiting and difficulty in passing stool. His stools are loose in constancy. On per-rectal examination, the rectum is empty and he passed a large amount of stool and gases after the figure was removed (image given). Which of the following is the most likely diagnosis?

A:

Pyloric stenosis

B:

Intussusception

C:

Incarcerated hernia

D:

Hirschsprung's disease

Q.132. Which of the following echocardiographic findings is consistent with the diagnosis of acute rheumatic fever?

A:

Mitral valve stenosis

B:

Aortic valve stenosis

C:

Mitral valve regurgitation

D:

Pulmonary valve regurgitation

Q.133. A 56-year-old multiparous patient on oral oestrogen, complains of painless urine incontinence when coughing, sneezing, or laughing for 1 year. On examination, there was mild vaginal atrophy and constrictor muscle laxity. Urinary incontinence is demonstrated in the fithotomy ~~ position with Valsalva manoeuvre (see report). Urinalysis: Normal Which of the following would be the recommended management?

A:

Beta blocker

B:

Kegel exercises

C:

Periurethral bulking

D:

Post-coital antibiotics

Q.134. Which of the following is a known side effect of beclomethasone use in children?

A:

Intraocular hypertension

B:

Excitable behaviour

C:

Sleep disturbance

D:

Growth retardation

Q.135. A 45-year-old man was brought to the Emergency Department after a motor vehicle accident with severe pain in his left arm. X-rays confirmed left humeral and ulnar fractures. After an open reduction and internal fixation, the patient was unable to extend his forearm, wrist and Which of the following is the most likely damaged?

A:

Ulnar nerve at the medial epicondyle

B:

Median nerve at the cuboidal fossa

C:

The radial nerve above the spiral grove

D:

Median nerve at the lateral epicondyle

Q.136. As a part of physical examination to evaluate the lower limb function of a football player, the physician asked him to stand on his tiptoes. Which of the following nerves was the physician testing?

A:

Tibial

B:

Femoral

C:

Deep fibular

D:

Superficial fibular

Q.137. A 26-year-old man complained of pain in his buttocks, lower back and stiffness which improved after moving around and doing exercises. The patient had similar complaints a year ago. Which of the following is the most likely diagnosis?

A:

Hyperuricemia

B:

Psoriatic arthritis

C:

Reactive arthritis

D:

Ankylosing spondylitis

Q.138. A 23-year-old patient presented to the Emergency Department with pain in his finger that was caused by a hyperextension injury. An acute pain in the right second finger developed instantly. On examination, the patient cannot flex the distal phalanx of the right second finger, and has tenderness and swelling over the volar aspect of the distal phalanx of that finger. The patient also complained of pain and tendemess at the paim. Which of the following Is the most likely resulted injury?

A:

Rupture of the flexor profundus tendon

B:

Rupture of the flexor superficialis tendon

C:

Extra-articular fracture of the distal phalanx

D:

Intra-articular fracture of the middle phalanx

Q.139. Which of the following are most consistent with the diagnosis of acute rheumatic fever?

A:

Fever, Roth spots and ischemic stroke

B:

Malar facial rash, joint aches and fever

C:

Chorea and multiple painful joint swelling

D:

Fever, cough and purulent sputum production

Q.140. An 18-month-old child is brought to the clinic with mild atopic eczema. The parents report that he woke up last night with stridor and a barking cough. There are no preceding or associated upper respiratory tract infection symptoms. The symptoms resolved spontaneously a few hours later. It is the second episode of this nature over the past 6 months. Which of the following is the most likely diagnosis?

A:

Acute epiglottitis

B:

Bronchial asthma

C:

Spasmodic croup

D:

Angioneurotic edema

Q.141. A 3-year-old girl presents to the Paediatric Emergency Department in the early morning hours with a barking cough, that worsens with crying. There is a history of mild cough and temperatures around 38° C (rectal) over the last 3 days. Physical examination confirms an inflamed throat and mild suprasternal retractions. Blood pressure 95/65 mmHg Heart rate 90 /min Respiratory rate 34 /min Temperature 39.3° C Which of the following is the most likely at auscultatory finding?

A:

Crepitation

B:

Wheezing

C:

Stridor

D:

Gasp

Q.142. A 50-year-old man presents with a long-standing history of indigestion and epigastric discomfort. He has poor appetite and has lost 10 kg recently. Examination confirms wasting of facial muscles, palpable supraclavicular lymph nodes and dull epigastric mass. Which of the following is the most likely diagnosis?

A:

Liver metastasis

B:

Chronic peptic ulcer

C:

Stomach carcinoma

D:

Chronic pancreatitis

Q.143. A 73-year-old man recently underwent radical prostatectomy. 2 months later, investigation revealed metastatic spread of cancer cells. ‘Which of the following is the first site for venous spread?

A:

Bone

B:

Lungs

C:

Brain

D:

Skull

Q.144. A 2-year-old boy is brought to the clinic with a large left-sided abdominal mass. IV pyelogram shows, the mass appears to arise from the left kidney and distort and displace the collecting system (see report). Chest X-ray: Multiple pulmonary nodules. Which of the following is the most likely diagnosis?

A:

Wilm's tumour

B:

Neuroblastoma

C:

Rhabdomyosarcoma

D:

Non-Hodgkin lymphoma

Q.145. An 8-year-old girl is referred to the paediatric nephrologist for increasing lethargy and extremely puffy eyelids for a week. Urine analysis showed 4+ proteins but glucose, red blood cells and ketones were absent. Which of the following is the most ikely diagnosis?

A:

Membrano-proliferative glomerulonephritis

B:

Focal segmental glomerulosclerosis

C:

Minimal change disease

D:

Bergers disease

Q.146. A 4-year-old boy presents to the Paediatric Emergency Department at 3 a.m. with a barking cough and mild respiratory distress. The parents report that he had an airway infection over the last 2 days that had suddenly worsened. The boy appears iitable. Physical examination confirms an inspiratory stridor. The child speaks with a hoarse voice. Blood pressure 90/65 mmHg Heart rate 110 /min Respiratory rate 30 /min Temperature 38° C Oxygen saturation 92% on oom air Which additional finding would be cause for concem?

A:

Tachypnea

B:

Nasal flaring

C:

Expiratory stridor

D:

Bluish coloured lips

Q.147. An 8-year-old sickle cell child arrives at the Emergency Department in respiratory distress. Over the previous 3 days, the child has become progressively tired and pale (see lab result) Test Result Normal Value Hb 31 112-165 gl. Which of the following is the most likely cause?

A:

Cytomegalovirus

B:

Parvovirus B19

C:

Coxsackie A16

D:

Echovirus 11

Q.148. A 20-month-old child is brought to the Emergency Department due to respiratory distress with stridor and fever. Her parents mentioned that 2 days ago she started rhinorrhoea and mild cough with progressive worsening of the cough that is now “barky” Which of the following is the most likely diagnosis?

A:

Tracheomalacia

B:

Tracheal foreign body

C:

Laryngotracheobronchitis

D:

Acute infectious laryngitis

Q.149. Which of the following syndromes is associated with coarctation of the aorta?

A:

Down

B:

Tumer

C:

Edward

D:

Patau

Q.150. A child is brought to the clinic with chronic proteinuria renal disease and hypertension. The parents are concerned about progression to end-stage renal disease. Which of the following drugs would be most useful in preventing this progression?

A:

Enalapril

B:

Clonidine

C:

Propanolol

D:

Amlodipine

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MOCK TEST 10

Q.1. Which of the following is the most objective method for identifying high-risk patients for peri- operative morbidity and mortality?

Q.2. A 5-year-old girl is found to have a loud pan-systolic murmur at the lower left sternal border. Which of the following is the most likely diagnosis?

Q.6. Which of the following criteria is utilized to diagnose hypertension in a 12-year-old gin?

Q.7. A patient received a severe blow on the inferolateral side of the left knee joint while playing football. Radiographic examination confirmed a fracture of the head and neck of the fibula. Which of the following nerves is most vulnerable for damaged?

Q.9. A 27-year-old pianist with a known carpal tunnel syndrome, experiences difficulty in finger | movements. | Which of the following muscles is most likely paralyzed?

Q.14. A 28-year-old sustained motorcycle accident. Examination confirmed a deep laceration atthe posterior aspect of the left calf, about 15 cm long and 5 cm deep. Which of the following nerves is most likely injured?

Q.18. Which of the following Is characteristic of the cardia auscultation of child with an atrial septal defect ?

Q.20. A 45-year-old is presented following poly-trauma. He requires intubation to protect airway obstruction. After resuscitation and management, he is transferred to ICU. Which of the following is the most appropriate method to clear the cervical spine?

Q.24. Which of the following is the most frequent agent causing acute bronchiolitis?

Q.25. A 25-year-old obese patient complained of numbness and tingling of the little and ring fingers on the left hand. The patient said that the symptoms are worse when the hands are raised. The elevated arm stress test is positive on the leftthe Which of the following is the most likely diagnosis?

Q.26. A 30-year-old woman underwent endoscopic sinus biopsy of soft tissue mass at the roof of left maxillary sinus. After recovery, the patient experienced numbness and paraesthesia in her left lower eyelid and upper lip. Which of the following is the most likely affected nerve?

Q.28. A 24-year-old man came to the hospital with pain, swelling and difficulty in moving the arm. Examination shows he has humeral fracture (see report) X-ray: The fracture was at the level of the surgical neck. Which of the following nerves was most likely injured?

Q.29. A 3-year-old child is a known asthmatic who usually has 1 acute exacerbation each month. The acute symptoms are relieved by nebulizer therapy at the Emergency Department or the nearby health centre. Which of the following should be included in the daily management?

Q.30. A 45-year-old woman complains of dysphagia to liquids, retrostemnal pain on swallowing and regurgitation of food. Which of the following has the highest diagnostic value?

Q.31. A 10-year-old boy is diagnosed with acute rheumatic fever with cardiac involvement. For how many years is theumatic fever prophylaxis recommended for this child?

Q.34. A 3-year-old boy fell on his outstretched hand while playing in the yard. On examination, there is tenderness and swelling of the forearm, which seemed to be abnormally curved (see image). Which of the following is the most appropriate management?

Q.39. An army soldier comes to Outpatient Clinic complaining of painful fla feet after several years of service, which included thousands kilometres of marching in the desert. The pain was acute in the medial aspect of his sole. Which of the following structures is the most likely strained?

Q.41. A 45-year-old man had transurethral catheterization before going for a long surgical procedure. Postoperatively he developed haematuria and a urethral injury is suspected. Which of the following is most likely injured part of urethera?

Q.42. A 19-year-old felt on an outstretched hand while playing football. Examination confirmed tendemess over the anatomic snuff box. Which of the following is the most suspected fracture?

Q.43. A 25-year-old man is brought to the Emergency Room after a motor vehicle accident. Examination shows, he has a severed nerve in the right upper limb, resulting in a loss of adduction of all the digits of the right hand. Which of the following is the most likely affected nerve?

Q.47. An 11-month-old child presents with failure to thrive, frequent large volumes of urine, excessive thirst, and 3 episodes of dehydration not associated with vomiting or diarrhoea. Several boys in his family showed similar symptoms. Which of the following is the most likely diagnosis?

Q.48. A 40-year-old man comes to the clinic with pain in the lower back, and blood in the urine. IVP shows a non-opagque filing defects in the renal pelvis. Ultrasound revealed dense echoes and acoustic shadowing. Which of the following is the most likely diagnosis?

Q.52. A 41-year-old ‘woman developed atrophy of the thenar eminence, but the sensation over it is intact. Which of the following nerves is the most likely damaged?

Q.54. Which of the following is the most appropriate strategy to avoid air bag injury in children under the age of 12 years?

Q.56. A 48-year-old man who is a smoker for the last 20 years, had a routine exam (see lab result and report) Test Result Normal Value Calcium 3.1 2.15-2.62 mmol/L Chest X-ray. 4 cm diameter left hilar mass. Which of the following is the most likely diagnosis?

Q.57. A 25-year-old man presents with a 6-month history of heartburn. The pain becomes worse at night after lying down. On lifting weight, he experiences a biter taste in mouth. Which of the following is the most likely diagnosis?

Q.58. During physical examination of a child, the physician asks the patient to face the wall, bend forward and let the arms hang down unsupported. What does this test screen for?

Q.59. A patient presented after a blunt injury over the left leg. Examination confirmed a sensory loss on adjacent sides of the great and second toes, and impaired dorsiflexion of the foot. Which of the following nerves is most likely injured?

Q.60. A 25-year-old woman presents with a longstanding history of lower abdominal and right hypochondrial pain. Diagnostic laparoscopy confirms pelvic and perihepatic adhesions. Which of the following is most likely responsible?

Q.61. A 52-year-old woman sipped and fell, she complained of being unable fo extend her leg athe knee joint. Which of the following muscles is most likely paralyzed?

Q.63. A patient presented with an infected wound at the forehead. Which of the following lymph nodes will most likely enlarged?

Q.64. A 1-year-old boy is seen on a routine examination. He has had vertically transmitted HIV infection and now has a low T-cell count. Which of the following vaccines would be contraindicated?

Q.65. Which of the following patients with congenital heart disease would be expected to exhibit cyanosis?

Q.66. An 82-year-old man presents to the clinic with Inability to urinate. The patient complains of severe pain and bloating in the lower abdomen, painful and urgent need to urinate. Which of the following is the most appropriate management?

Q.67. A 26-year-old man is brought to the Emergency Room after sustaining a bullet injury to his arm Examination shows his median nerve was damaged. Which of the following is the most likely clinical finding?

Q.69. Which of the following findings in a newborn requires immediate treatment?

Q.70. A 40-year-old man patient comes to the clinic after developing hoarseness of the voice and aspiration when drinking fluids. History reveals, he underwent thyroidectomy surgery 2 weeks prior to these symptoms. Which of the following is the most likely damaged laryngeal nerve?

Q.72. A 35-year-old man is brought to the Emergency Room after a road traffic accident. X-ray shows a displaced fracture of the mid shaft of the humerus. Which of the following is the most likely clinical complication?

Q.77. A 12-year-old boy comes to the clinic with multiple painful swollen joints with reduced range of motion. Examination shows multiple non-tender subcutaneous nodules. Which of the following would most probably confirm the diagnosis?

Q.79. A 13-year-old boy with sickle cell disease, presents with severe unilateral hip pain, which has developed over the past few weeks. Which of the following is the most likely diagnosis?

Q.83. Which of the following is a component of the Tetralogy of Fallot?

Q.86. A 45-year-old is brought to the Emergency Department following a high-speed motor vehicle accident. Examination confirms seat belt sign (see report). CT - Chance fracture of lumbar vertebrae. Which of the following is the most likely finding on an abdominal CT?

Q.87. A 70-year-old man presents with urinary incontinence. The patient's bladder is palpably distended after voiding. The patient stated that he voids frequently, although he has difficulty initiating the urine stream. Which of the following is the most likely type of incontinence?

Q.88. A 16-year-old patient comes to the clinic because he is unable to bring the fork to his mouth to feed himself. History reveals the patient had a closed head injury in a motor vehicle accident 10 days ago. Which of the following is the most ikely involved area?

Q.91. A 85-year-old patient is admitted for elective ventral hemia repair. He is diabetic and hypertensive for 10 years. Examination confirms raised JVP, bilateral basal crepitation on chest auscultation, and pedal edema. What is the most appropriate next step in management?

Q.92. A 24-year-old was running and suddenly experienced severe left leg pain. The patient was limping because of the pain, which is relieved by passive stretching. Which of the following is the most commonly involved muscle?

Q.93. A 55-year-old is admitted for an elective laparoscopic cholecystectomy. He is diabetic and hypertensive for 5 years. History confirms a recent admission in Intensive Care Unit for anterior wall MI 6 weeks ago. What is the most appropriate management?

Q.94. A 74-year-old man is referred to the thoracic surgeon with dysphagia of solid food for six weeks ‘which marked weight loss for 2 months. Oesophageal endoscopy shows a stenotic mass in the mid oesophagus (see report). Chest X-ray: Normal. Which of the following is the most likely diagnosis?

Q.96. A 9-month-old infant has a congenital heart lesion but the parents do not know the specific diagnosis. On examination, it was found that the infant has central and peripheral cyanosis. Which of the following is the most likely diagnosis?

Q.97. Which of the following ECG abnormalities is an expected finding in ostium secundum atrial septal defect?

Q.98. An 80-year-old man presents with dull aching pain in the loins (see lab results and report). Test Result Normal Values Creatinine 280 44-115 pmol/L. Urea 12.5 2.75-7.4 mmol/L Ultrasound abdomen: Bilateral hydronephrosis. Which of the following is the most likely diagnosis?

Q.100. Which of the following has the greatest risk of developing endocarditis in patients with congenital heart disease?

Q.101. A 9-year-old presents with weakness, fatigue, and hypertension in upper limbs. Examination confirms delayed pulses in lower extremities. Which of the following is the most likely aetiology?

Q.106. A 65-year-old male comes to the clinic with a mild intermittent urinary flow reduction. Rectal examination, urinalysis and prostate specific antigen studies are normal (see report). Ultrasound prostate: Enlarged median lobe. Which of the following is the best way to investigate?

Q.108. ‘A 6-month-old girl presents with difficulty feeding and the parents report that her skin becomes bluish during feeding and crying. Cardiac auscultation reveals a harsh systolic ejection murmur and a loud, single S2. Which of the following is the most likely diagnosis?

Q.109. A 23-year-old athlete presented with foot pain while standing and walking. On physical exam, there was significant tendemess on the midiine plantar surface of the foot. The patient denied any history of trauma. Which of the following is the most likely diagnosis?

Q.110. Which of the following congenital heart diseases is associated with the lowest risk of infective endocarditis?

Q.116. A 30-year-old patient presents to the clinic with a pelvic fracture, due to blunt trauma. A retrograde urethrography demonstrates disruption of the membranous urethra. Which of the following is the most appropriate first step in management?

Q.117. Which of the following represents the main treatment for symptomatic acute rheumatic fever?

Q.121. ‘A 25-year-old is brought to the Emergency Department after being rescued from a burning building. Examination confirms a slightly confused patient with singed facial and nasal hair. Which of the following is the most appropriate next step in management?

Q.127. A 21-year-old patient presents with an abnormal left testicle. On examination, the area adjacent 10 the left testicle feels like a bag of worms, which gets larger with a valsalva maneuver. Which of the following is the most likely diagnosis?

Q.129. An 8-year-old boy presents to the Emergency Department after a fall on his left forearm. On examination, there was swelling and a deformity with a 1 cm wound on the volar aspect of his forearm (see image). Which of the following is the first step in management?

Q.130. An infant girl, born to a 24-year-old woman, diagnosed clinically as Down's syndrome. The mother asked about the risk in any future pregnancy. Which of the following is the appropriate investigation to determine this risk?

Q.132. Which of the following echocardiographic findings is consistent with the diagnosis of acute rheumatic fever?

Q.134. Which of the following is a known side effect of beclomethasone use in children?

Q.136. As a part of physical examination to evaluate the lower limb function of a football player, the physician asked him to stand on his tiptoes. Which of the following nerves was the physician testing?

Q.137. A 26-year-old man complained of pain in his buttocks, lower back and stiffness which improved after moving around and doing exercises. The patient had similar complaints a year ago. Which of the following is the most likely diagnosis?

Q.139. Which of the following are most consistent with the diagnosis of acute rheumatic fever?

Q.143. A 73-year-old man recently underwent radical prostatectomy. 2 months later, investigation revealed metastatic spread of cancer cells. ‘Which of the following is the first site for venous spread?

Q.145. An 8-year-old girl is referred to the paediatric nephrologist for increasing lethargy and extremely puffy eyelids for a week. Urine analysis showed 4+ proteins but glucose, red blood cells and ketones were absent. Which of the following is the most ikely diagnosis?