Professional and Linguistic Assessments Board (PLAB) MCQ Part 1

Professional and Linguistic Assessments Board 

(PLAB) MCQ 

Part 1

1. A 65yo man presents with painless hematuria, IVU is normal, prostate is mildly enlarged with mild frequency. What is the most appropriate next step?

1. US Abdomen
2. Flexible cystoscopy
3. MRI
4. Nuclear imaging
5. PSA

Ans. The key is B. Flexible cystoscopy. [Painless hematuria in an elderly (here 65 years old man) indicates carcinoma bladder for which flexible cystoscopy is done.*****here BEP is not advanced to cause hemorrhage. There is mild enlargement of prostate and mild symptoms of prostration and hem- orrhage is unlikely at this initial stage of BEP which makes Bladder cancer as the likely cause of painless hematuria.*****it is also less likely to be prostate cancer as symptoms of prostration are mild (indicates disease is not advanced). Moreover bleeding in cancer prostate is less common].

2. A 74yo smoker presented to his GP with cough and SOB. Exam revealed pigmentation of the oral mucosa and also over the palms and soles. Tests show that he is diabetic and hypokalemic. What is the most probable dx?

1. Pseudocushing syndrome
2. Conns disease
3. Ectopic ACTH
4. Cushings disease
5. Hypothyroidism

Ans. The key is C. Ectopic ACTH. [The patient is smoker and probably developed squamous cell lung cancer which is working as a tumour producing ectopic ACTH causing pigmentation. Resulting raised cortisole is leading to diabetes and hypokalemia (though small cell carcinoma is usual cause but squamous cell carcinoma can produce ectopic ACTH as paraneoplastic syndrome also)].

3. A 44yo woman has lost weight over 12 months. She has also noticed episodes where her heart beats rapidly and strongly. She has a regular pulse rate of 90bpm. Her ECG shows sinus rhythm. What is the most appropriate inv to be done?

1. Thyroid antibodies
2. TFT
3. ECG
4. Echocardiogram
5. Plasma glucose

Ans. The key is B. TFT. [The patient has paroxysmal atrial fibrillation That is why there is no arrhythmia in between attacks. From the given option TFT is the appropriate test as thyrotoxycosis is a leading cause of paroxysmal atrial fibrillation and this ladies weight loss also makes thyrotoxycosis as the probable cause here].

4. A 79yo anorexic male complains of thirst and fatigue. He has symptoms of frequency, urgency and terminal dribbling. His urea and creatinine levels are high. His serum calcium is 1.9 and he is anemic. His BP is 165/95 mmHg. What is the most probable dx?

1. BPH
2. Prostate carcinoma
3. Chronic pyelonephritis
4. Benign nephrosclerosis

Ans. The key is B. Prostate Carcinoma.*****Explanation for Question no. 4:*****first to say in this case (almost all features goes in favour of prostatic carcinoma like- frequency, urgency and terminal dribbling are features of prostatism; Age, anorexia and anaemia are constitutional features of carcinoma prostate and it would be accurate presentation if it was hypercalcaemia. But given calcium level is of hypocalcaemic level and it is the main cause of discrepancy to this question). Renal failure from ureteral obstruction in carcinoma prostate is a common presenta- tion. Thirst is a feature of hypercalcaemia (here may be erroneously calcium level is given in hypocalcaemic level ; probably a bad recall). Prostate biopsy is the confirmatory diagnosis and others like PSA is suggestive.*****there are some suggestion that Renal Failure may be the cause of hypocalcemia.

5. A 64yo man has recently suffered from an MI and is on aspirin, atorvastatin and ramipril. He has been having trouble sleeping and has been losing weight for the past 4 months. He doesn’t feel like doing anything he used to enjoy and has stopped socializing. He says he gets tired easily and can’t concentrate on anything. What is the most appropriate tx?

1. Lofepramine
2. Dosulepin
3. Citalopram
4. Fluoxetine
5. Phenelzine

Ans. The key is C. Citalopram. [Among SSRIs Sertraline is the drug of choice for ischemic heart disease. Next choice is citalopram (as it is of- ten related to torsades de pointes it is not 1st choice). If SSRI cannot be used Mirtazapine is recommended as next antidepressant].

6. A 67yo man after a stroke, presents with left sided ptosis and constricted pupil. He also has loss of pain and temp on the right side of his body and left side of his face. Which part of the brain is most likely affected?

1. Frontal cortex
2. Cerebellum
3. Pons
4. Medulla
5. Parietal cortex

Ans. The key is D. Medulla. [The name of the condition is “Lateral medullary syndrome” [ipsilateral Horner syndrome and contralateral loss of pain and temperature sense].

7. A 60yo man presents with dysphagia and pain on swallowing both solids and liquids. A barium meal shows gross dilatation of the esophagus with a smooth narrowing at the lower end of the esopha- gus. What is the SINGLE most likely cause of dysphagia?

1. Achalasia
2. Myasthenia gravis
3. Esophageal carcinoma
4. Esophageal web
5. Systemic sclerosis

Ans. The key is A. Achalasia. [Dysphagia for both solid and liquid or prominently liquid suggest achalasia where dysphagia to solid suggest stricture. Also gross dilatation of oesophagus with smooth narrowing at lower end is seen in achalasia. In achalasia dysphagia is usually described as progressive].

8. A man undergoes a pneumonectomy. After surgery, invs show hyponatremia. What could be the cause of the biochemical change?

1. Removal of hormonally active tumor
2. Excess dextrose
3. Excess colloid
4. Excessive K+
5. Hemodilution

Ans. The key is A. Removal of harmonically active tumour. [Ectopic ACTH secreting tumour causes hypernatremia and body’s homeo- static mechanism try to lower the level of high sodium and do a lesser degree though sodium remains in hypernatremic level or even it may be normal (this question does not mention any preoperative hyperna- tremia). Removal of that tumour results in negative sodium balance for time being which results hyponatremia while gradually it tends to rise again to normal level].

9. A pregnant lady came with pain in her calf muscle with local rise in temp to the antenatal clinic. What tx should be started?

1. Aspirin
2. LMWH
3. Paracetamol
4. Cocodamol
5. Aspirin and heparin

Ans. The key is B. LMWH. [Injections with low molecular weight heparin (LMWH) are usually used to treat pregnant women with DVT. LMWH is an anticoagulant, which means it prevents the blood clot getting bigger. It does not affect the developing baby ( Ref: nhs. uk)].

10. A 53yo female presents with an acute painful hot knee joint. She is a known case of RA. On examination, the knee is red, tender and swollen. The hamstring muscles are in spasm. Her temp is 38.5C and BP is 120/80mmHg. What is the SINGLE best next inv?

1. Joint aspiration for cytology and culture and sensitivity
2. Joint aspiration for positive birefrengent crystals
3. Joint aspiration for negative birefrengent crystals
4. Blood culture
5. Serum uric acid

Ans. The likely key is A. Joint aspiration for cytology and culture and sensitivity. [Case of septic arthritis. Any chronically arthritic joint is predisposed to infection. Moreover chronic use of steroid in Rh. arthritis is one of the important predisposing factor. In this age group likely organism is Staphylococcus. In younger age group Neisseria gonorrhea is more common].

11. An 80yo man presented with pain in his lower back and hip. He also complains of waking up in the night to go to the washroom and has urgency as well as dribbling. What is the most likely dx?

1. BPH
2. Prostatitis
3. UTI
4. Prostate carcinoma
5. Bladder carcinoma

Ans. The key is D. Prostate carcinoma. [Age, nocturia, urgency and dribbling points towards prostate pathology. Pain of lower back and hip points towards bony metastases from prostate cancer. Blood test for PSA; Prostate biopsy; MRI (if initial biopsy is negative, to decide repeat biopsy).                

Treatment options:                      

1. Active treatment [i) radical prostatectomy ii) radical radiotherapy iii) hormone therapy iv) brachytherapy v) pelvic radiotherapy vi) orchidectomy                    

2. Active surveillance 3. Watchful waiting t4. Palliative care (Source: NICE)].

12. An 18yo female has peri-orbital blisters. Some of them are crust- ed, others secreting pinkish fluid. What is the most likely dx?

1. Shingles
2. Chicken pox
3. Varicella
4. Rubella
5. Measles

Ans. The key is A. Shingles. [Here ophthalmic division of trigeminal nerve is involved. Typically shingles are unilateral].

13. A 29yo lady who is a bank manager is referred by the GP to the medical OPC due to a long hx of tiredness and pain in the joints. An autoimmune screen result showed smooth muscle antibodies positive. What is the most appropriate next inv?

1. ECG
2. TFT
3. LFT
4. Serum glucose
5. Jejunal biopsy

Ans. The key is C. LFT. [A case of autoimmune hepatitis. Autoimmune hepatitis is an uncommon cause of chronic hepatitis which if un-treated can lead to cirrhosis. However with treatment outlook is very good. Smooth muscle antibody is positive in autoimmune hepatitis. Definitive investigation is liver biopsy. Treated with steroid [start with high dose prednisolone]. Azathioprine is commonly added with steroid to reduce its dose as steroid has more side effects than azathioprine].

14. A 5yo with recurrent chest pain, finger clubbing with offensive stool. Choose the single most likely inv?

1. Endomyseal/Alpha glidin antibody
2. Sweat test
3. Barium meal
4. ECG
5. Glucose tolerance test

Ans. The key is B. Sweat test. [Recurrent chest pain from frequent lung infections including pneumonia or bronchitis.”Clubbing” of the fingers is a classic features of Cystic Fibrosis, although not present in many patients. The digestive enzymes are not being produced, food is not adequately digested (malabsorption) and excess fat and protein is lost in the stools, making them bulky, oily, smelly and difficult to flush away].

15. A clinical picture of breast cancer originated from the mammary duct. Biopsy was done and there were neoplastic cells found. Choose the histological picture of the cancer.

1. Neoplastic cells are arranged in small clusters occupying a space between collagen bundles (Seirrhous carcinoma)
2. Spindle cell neoplasms with margins, which infiltrate adjacent structure, fat invaded (Breast sarcoma)
3. Small cells with round nucleus and scant indistinct cytoplasm (Lob- ular carcinoma)

Ans. The key is C. Small cells with round nucleus and scant indistinct cytoplasm (Lobular carcinoma)

16. A 22yo man has a reduced conscious level and a fixed dilated pupil after being involved in a MVC. Choose the single most appropriate option?

1. Facial nerve
2. Oculomotor nerve
3. Olfactory nerve
4. Optic nerve
5. Trigeminal nerve

Ans. The key is B. Oculomotor nerve. [3rd nerve damage can cause fixed dilated pupil].

17. A man with suspected active TB wants to be treated at home. What should be done to prevent the spread of disease?

1. Immediate start of the tx with Anti-TB drugs
2. All family members should be immediately vaccinated with BCG vaccine
3. Patient should be isolated in a negative pressure chamber in his house
4. Universal prevention application protocol

Ans. The key is D. Universal prevention application protocol.

18. A 7yo child is brought to the ED with a 1 day hx of being listless. On examination, the child is drowsy with an extensive non-blanching rash. What advice would you give the parents?

1. All family members need antibiotic therapy
2. Only the mother should be given rifampicin prophylaxis
3. All family members need isolation
4. All family members should be given rifampicin prophylaxis

Ans. The key is D. All family members should be given rifampicin pro- phylaxis. [Meningococcal disease. Diagnosis is done with blood or CSF PCR. Initial prehospital management: Benzyl penicillin or cefotaxime].

19. A 47yo man has a temp of 39C and is delirious. He has developed blisters mainly on his trunk, which appeared a few hours ago. He is well and not on any medications. He last travelled 5 months ago to Italy. Which of the following is the most likely dx?

1. Shingles
2. Chicken pox
3. Pemphigoid
4. Bullous pemphigus

Ans. The key is B. Chicken pox. [Centripetal distribution of blisters favours chickenpox. Adults more commonly develop a more general- ized brain inflammation (“encephalitis”) whose symptoms may include delirium and seizures. Incubation period of chicken-pox is 10-21 days. So this travel history is not significant].

20. A 64yo pt has been having freq episodes of secretory diarrhea, which is extremely watery, with large amounts of mucus. A dx of villous adenoma was made after endoscopy. What electrolyte abnor- mality is most likely in this pt?

1. Hyperkalemia
2. Hypernatremia
3. Hyponatremia
4. Hypokalemia

Ans. Key not given. Correct key is both C and D! [Villous adenoma can cause both hyponatremia and hypokalemia].

21. A pt with an acute gout attack came to the ED. What drug should be given to relieve symptoms?

1. NSAIDs
2. Allopurinol
3. Ibuprofen

Ans. The key is A. NSAIDs. [Oral NSAIDs commenced immediately and continue for 1 – 2 weeks; Colchicine can be effective alternative but is slower to work than NSAIDs. Intra articular corticosteroids are highly effective in acute gouty monoarthritis.

22. A pt was lying down on the operating table in a position with his arms hanging down for 3 hours. Soon after he woke up, he com- plains of numbness and weakness in that hand and has limited wrist movement/wrist drop and sensory loss over dorsum of that hand, weakness of extension of the fingers and loss of sensation at the web of the thumb. What structure is likely to be damaged?

1. Radial nerve
2. Median nerve
3. Ulnar nerve
4. Axillary nerve
5. Suprascapular nerve

Ans. The key is A. Radial nerve. [Here arm hanging down compressing the radial nerve at the spiral groove is the cause of given scenario].

23. A pt who was previously on 120mg slow release oral morphine has had his dose increased to 200mg. He is still in significant pain. He complains of drowsiness and constipation. What is the next step in the management?

1. Increase slow release morphine dose
2. Fentanyl patch
3. Replace morphine with oral hydromorphone
4. Replace morphine with oxycodone
5. Subcutaneous morphine

Ans. The key is D. Replace morphine with oxycodone.

24. A 40yo woman notices increasing lower abdominal distention with little/no pain. On examination, a lobulated cystic mass is felt and it seems to be arising from the pelvis. What is the most appro- priate inv?

1. CA 125
2. CA 153
3. CA 199
4. CEA
5. AFP

Ans. The key is A. CA 125. [Ovarian ca is the likely diagnosis for which tumour marker is CA 125].

25. A resident of a nursing home presented with rashes in his finger webs and also on his abdomen, with complaints of itching which is severe at night. He was dx with scabies. What the best tx for his condition?

1. 0.5% permethrin
2. Doxycycline
3. 5% permethrin
4. Reassure
5. Acyclovir

Ans. The key is C. %5 permethrin. [Scabies outbreaks in nursing homes and cases of crusted scabies may require combination therapy consisting of topical application of permethrin and 2 oral doses of ivermectin at 200 mcg/kg (administered 1 wk apart)].

26. A 34yo alcoholic is found passed out in front of a local pub. The ambulance crew informs you that he was sweating when they found him and there were cans of cider lying empty around him. What is the initial stage of inv?

1. Capillary blood sugar
2. CT head
3. MRI head
4. ABG
5. MCV

Ans. The key is A. Capillary blood sugar. [Alcohol induced hypoglycemia can present as this case].

27. A young boy fell on his outstretched hand and has presented with pain around the elbow. He has absent radial pulse on the affected hand. What is the most likely dx?

1. Dislocated elbow
2. Angulated supracondylar fx
3. Undisplaced fx of radial head
4. Posterior dislocation of shoulder

Ans. The key is B. Angulated supracondyllar fx. [Damage or occlusion of the bracheal artery is the cause of absent radial pulse. Often closed reduction results in restoration of normal anatomy and correction of occlusion of bracheal artery and establishes circulation again but in few instances open reduction is required to fix the occluded artery].

28. A 65yo woman presented with transient arm and leg weakness as well as a sudden loss of vision in the left eye. Her symptoms resolved within the next couple of hours. What is the most appropriate next inv?

1. CT brain
2. Echo
3. Doppler USG
4. Arteriography
5. 24h ECG

Ans. The key is c. [A case of TIA. Probable cause carotid artery atherosclerosis].

29. A man complains of loss of sensation in his little and ring finger. Which nerve is most likely to be involved?

1. Median nerve
2. Ulnar nerve
3. Radial nerve
4. Long thoracic nerve
5. Axillary nerve

Ans. The key is B. Ulner nerve. [Compression of ulner nerve at the elbow, 30. known as cubital tunnel syndrome, causes numbness in the 5th (pinky) finger, along the half (lengthwise) of the 4th (ring) finger closest to the 5th finger, and the back half of the hand over the 5th finger].

30. A young man complains of double vision on seeing to the right. Which nerve is most likely to be involved?

1. Left abducens
2. Right abducens
3. Left trochlear
4. Right trochlear
5. Right oculomotor

Ans. The key is B. Right abducens. [Diplopia on seeing to right indicates right lateral rectus palsy which is supplied by right abducent nerve].

31. A 45yo man keeps having intrusive thoughts about having dirt under the bed. He can’t keep himself from thinking about these thoughts. If he tries to resist, he starts having palpitations. What is the most likely dx?

1. OC personality
2. OCD
3. Schizophrenia
4. Panic disorder
5. Phobia

Ans. The key is B. OCD. [Here patients thoughts are obsession and though no compulsive act is described (like repeated cleansing of dirt) but his nature of thought like inability to resist the thinking or getting palpitation on trying to avoid thinking can be regarded as compulsion of thought. CBT 1st line. SSRIs].

32. A 33yo man presents with an itchy scaly annular rash on his thigh after a walk in the park. Which of the following drugs will treat his condition?

1. Erythromycin
2. Doxycycline
3. Penicillin
4. Amoxicillin

Ans. The key is B. Doxycycline. [Itchy scaly annular rash after a walk in the park indicates erythema migrans caused by the spirochete Borrelia Burgdorferi transmitted by bite of pinhead-sized ixodes ticks leading to lyme disease].

33. A pt with cerebral mets has polyuria and polydipsia. What part of the brain would be affected?

1. Cerebral cortex
2. Cerebellum
3. Diencephalon
4. Pons
5. Medulla

Ans. The key is C. Diencephalon. [Diencephalon is the caudal (posterior) part of the forebrain, containing the epithalamus, thalamus, hypothalamus, and ventral thalamus and the third ventricle. Hypothalamus produce ADH and hens lesion of diencephalon (hypo- thalsamus) may produce cranial diabetes insipidus.

34. A 32yo man presented with painless hematuria. He is hypertensive but the rest of the exam is unremarkable. What is the most likely dx?

1. Polycystic kidneys
2. Ca bladder
3. Ca prostate
4. TTP
5. HUS

Ans. The key is A. Polycystic kidneys. [Painless haematuria at an younger age with hypertension is suggestive of polycystic kidney disease. Renal ultrasound is used to diagnose the condition].

35. A 45yo female complains of pain in the inner side of her right thigh. She was dx with benign ovarian mass on the right. Which nerve is responsible for this pain?

1. Femoral nerve
2. Obturator nerve
3. Iliohypogastric nerve
4. Ovarian branch of splanchic nerve
5. Pudendal nerve

Ans. The key is B. Obturator nerve. [The Obturator nerve is respon- sible for the sensory innervation of the skin of the medial aspect of the thigh].

36. A 37yo lady strongly believes that a famous politician has been sending her flowers every day and is in love with her. However, this is not the case. What is the most likely dx?

1. Erotomania
2. Pyromania
3. Kleptomania
4. Trichotillomania
5. Grandiosity

Ans. 1. The key is A. Erotomania. [Erotomania is a type of delusion in which the affected person believes that another person, usually a stranger, high-status or famous person, is in love with them].*****pyromania is an impulse control disorder in which individuals repeat- edly fail to resist impulses to deliberately start fires, in order to relieve tension or for instant gratification.*****kleptomania is the inability to refrain from the urge to steal items.*****trichotillomania is an impulse disorder characterized by the com- pulsive urge to pull out one’s hair, leading to noticeable hair loss and balding.*****grandiosity refers to an unrealistic sense of superiority.

37. A 3yo child has been brought with facial lacerations. On exam- ination he has some cuts over his right cheek and under the eye. The GCS on initial evaluation is 15. What is the appropriate next inv?

1. Skull XR
2. Facial XR
3. CT scan
4. MRI
5. Observation

Ans. The key is B. Facial X-ray. [Normal GCS makes intracranial lesion less likely. As there is facial injury to exclude any facial bone fracture we can do facial X-ray].

38. A 73yo woman has lymphadenopathy and splenomegaly. She feels well but has had recurrent chest infections recently. Choose the single most likely blood film findings?

1. Atypical lymphocytes
2. Excess of mature lymphocytes
3. Plasma cells
4. Multiple immature granulocytes with blast cells
5. Numerous blast cells

Ans. The key is B. Excess of mature lymphocytes. [Dx is CLL. Age of patient (usually above 50 yrs), lymhadenopathy and splenomegaly, appearance of lymphocytes (mature lymphocytes – but functionally not normal). Repeated chest infection points towards abnormal func- tion of lymphocytes against infection].

39. A lady presents with itching around the breast and greenish foul smelling discharge from the nipple. She had a similar episode before. What is the most likely dx?

1. Duct papilloma
2. Duct ectasia
3. Breast abscess
4. Periductal mastitis
5. Mammary duct fistula

Ans. The key is B. Duct ectasia. [Duct ectasia of the breast or mam- mary duct ectasia or plasma cell mastitis is a condition in which the lactiferous duct becomes blocked or clogged. This is the most com- mon cause of greenish discharge. Mammary duct ectasia can mimic breast cancer. It is a disorder of peri- or post-menopausal age].

40. A young male whose sclera was noted to be yellow by his col- leagues has a hx of taking OTC drugs for some pain. Tests showed raised bilirubin, ALT and AST normal. The provocation test with IV nicotinic acid is positive and produces further rise in the serum bilirubin levels. What is the most likely dx?

1. Acute hepatitis
2. Drug hypersensitivity
3. Gilberts syndrome
4. Acute pancreatitis

Ans. The key is C. Gilbert’s syndrome. [Only bilirubin is increased but not the liver enzymes. Also positive nicotinic acid provocation test is in its favour].

41.A 24yo biker has been rescued after being trapped under rocks for almost 12h. He complains of reddish brown urine. His creatinine is 350umol/L and his urea is 15mmol/L. What is the most imp step in the management of this patient?

1. Dialysis
2. IV NS
3. IV dextrose
4. IV KCl
5. Pain relief

Ans. Key is B. IV NS. [It is a case of rhabdomyolysis which is initially treated with IV NS].

42. A 74yo man who has been a smoker since he was 20 has recently been dx with SCLC. What serum electrolyte picture will confirm the presence of SIADH?

1. High serum Na, low serum osmolarity, high urine osmolarity
2. Low serum Na, low serum osmolarity, high urine osmolarity
3. Low serum Na, high serum osmolarity, high urine osmolarity
4. High serum Na, low serum osmolarity, low urine osmolarity
5. High serum Na, high serum osmolarity, low urine osmolarity

Ans. The key is B. Low serum Na, low serum osmolarity, high urine osmolarity.

43. A man brought into the ED after being stabbed in the chest. Chest is bilaterally clear with muffled heart sounds. BP is 60/nil. Pulse is 120bpm. JVP raised. What is the most likely dx?

1. Pulmonary embolism
2. Cardiac tamponade
3. Pericardial effusion
4. Hemothorax
5. Pneumothorax

Ans. The key is B. Cardiac tamponade. [Chest is clear, so there is no pneumothorax or pleural effusion. Muffled heart sound is due to fluid in pericardial space, low BP from reduced chamber expansion due to pericardial fluid’s pressure and restricted right heart expansion causes raised JVP].

44. A 50yo pt is admitted for elective herniorraphy. Which of the following options will lead to a postponement of the operation?

1. SBP 110mmHg
2. MI 2 months ago
3. Hgb 12g/dl
4. Pain around hernia
5. Abdominal distention

Ans. The key is B. MI 2 months ago. [After MI elective surgery should not be done before 6 months post MI, as operation in earlier than this time has significant increase in mortality].

45. A 32yo woman of 39wks gestation attends the antenatal day unit feeling very unwell with sudden onset of epigastric pain associated with nausea and vomiting. Her temp is 36.7C. Exam: she is found to have RUQ tenderness. Her blood results show mild anemia, low platelets, elevated liver enzymes and hemolysis. What is the most likely dx?

1. Acute fatty liver of pregnancy
2. Acute pyelonephritis
3. Cholecystitis
4. HELLP syndrome
5. Acute hepatitis

Ans. The key is D. HELLP syndrome. [HELLP syndrome is a life-threatening liver disorder thought to be a type of severe pre- eclampsia. It is characterized by Hemolysis (destruction of red blood cells), Elevated Liver enzymes (which indicate liver damage), and Low Platelet count. HELLP is usually related to preeclampsia. The main treatment is to deliver the baby as soon as possible [as early as after 34 weeks if multisystem disease is present].

46. A woman comes with an ulcerated lesion 3 cm in the labia majo- rum. What is the lymphatic drainage of this area?

1. External iliac
2. Superficial inguinal LN
3. Para-aortic
4. Iliac
5. Aortic

Ans. Key is B. Superficial inguinal LN.

47. A man post-cholecystectomy presented with jaundice, fever and dark urine. What is the most diagnostic inv?

1. ERCP
2. USG Abdomen
3. CT Scan
4. MRCP
5. MRI

Ans. The key is A. ERCP [Post operative US will not give good results. We shall not go for ercp first as it has complications like injury and pancreatitis. Acceptable options are CT, MRI and MRCP among which most appropriate is MRCP! But as the Question wants most diagnos- tic it is ERCP (though not practical)!!! The diagnosis here is choledo- colithiasis with cholangitis].

48. A 79yo stumbled and sustained a minor head injury 2 weeks ago. He has become increasingly confused, drowsy and unsteady. He has a GCS of 13. He takes warfarin for Afib. What is the most likely dx?

1. Extradural hemorrhage
2. Cerebellar hemorrhage
3. Epidural hemorrhage
4. Subdural hemorrhage
5. Subarachnoid hemorrhage

Ans. 1. The key is D. Subdural hematoma. [In elderly head injury usu- ally leads to subdural hematoma even if head injury is minor or trivial and extradural hematoma in elderly is extremely uncommon even in more severe head injury. Management: 1st line: Evacuation by barr hole craniostomy. 2nd line: Craniotomy if the clot is organized. Up to 3 weeks burrhole may be possible but longer than this clot is mostly organized and Flap craniotomy is usually required].

49. A 25yo female complains of intermittent pain in her fingers. She describes episodes of numbness and burning of the fingers. She wears gloves whenever she leaves the house. What is the most probable dx?

1. Kawasaki disease
2. Takayasu arteritis
3. Buerger’s disease
4. Embolism
5. Raynaud’s phenomenon

Ans. The key is E. Raynaud’s phenomenon. [Intermittent nature points towards some triggers and wearing of gloves during going out indicates cold weather. Also female sex makes the diagnosis of Raynaud’s phenomenon more likely].

50. A 22yo lady has been unwell for some time. She came to the hospital with complaints of fever and painful vesicles in her left ear. What is the most probable dx?

1. Acne
2. Herpes zoster
3. Chicken pox
4. Insect bite
5. Cellulitis

Ans. The key is B. Herpes Zoster. [This is a case of Herpes zoster oticus and if facial nerve is also involved then it is called Ramsay Hunt syndrome].