(Single Best Answer) Question 171: A 50 year old male patient, an alcoholic and smoker presents with a 3 hour history of severe retrosternal chest pain and increasing shortness of breath. He started having this pain while eating, which was constant and radiated to the back and interscapular region. He was a known hypertensive. On, examination, he was cold and clammy with a heart rate of 130/min, and a BP of 80/40 mmHg, JVP was normal. All peripheral pulses were present and equal. Breath sounds were decreased at the left lung base and chest x-ray showed left pleural effusion. What is the most likely diagnosis ?
A) Acute aortic dissection B) Acute myocardial infarction C) Rupture of the oesophagus D) Acute pulmonary embolism Answer (Select an option above to get the answer):
(Single Best Answer) Question 172: A 50 year old chronic alcoholic male agricultural worker presented with high grade fever of one week duration with spells of chills and rigor. Examination of the respiratory system revealed bilateral crepitations with scattered rhonchi. Multiple subcutaneous nodules were found on the extensor surface of the left forearm, arm and left leg. Direct microscopy of the pus aspirated from the skin nodule revealed plenty of Gram negative bacilli with bipolar staining. Culture revealed distinct rough corrugated grey-white colonies on Blood Agar. The organisms were motile and oxidase positive. The most likely diagnosis is ?
A) Plague B) Melioidosis C) Bartonellosis D) Actinomycosis Answer (Select an option above to get the answer):
(Single Best Answer) Question 173: A 45 years old hypertensive male patient presented in the casualty with two hours history of sudden onset of severe headache associated wit nausea and vomiting. On clinical examination the patient had neck stiffness and right sided ptosis. Rest of the neurological examination was normal. What is the clinical diagnosis ?
A) Hypertensive brain haemorrhage B) Migraine C) Aneurysmal subarachnoid haemorrhage D) Arteriovenous malformation haemorrhage Answer (Select an option above to get the answer):
(Single Best Answer) Question 174: A 45 year old male had multiple hypoaesthetic mildly erythematous large plaques with elevated margins on trunk and extremitites. His ulnar and lateral popliteal nerves on both sides were enlarged. The most probable diagnosis is ?
A) Lepromatous leprosy B) Borderline leprosy C) Borderline tuberculoid leprosy D) Borderline lepromatous leprosy Answer (Select an option above to get the answer):
(Single Best Answer) Question 175: A 45 year old female patient presents with symptoms of easy bruisability and frequent headaches. Physical examination shows moderate splenomegaly. Blood counts show a normal leucocyte count and a platelet count of 1000 X 103 /cu mm. the leucocyte alkaline phosphatase score is normal. Which one of the following is the drug of choice for the treatment of this patient ?
A) Hydroxyurea B) Radioactive phosphorus C) Anagrelide D) Interferon alpha Answer (Select an option above to get the answer):
(Single Best Answer) Question 176: A 45 year old coal mine worker presents with cutaneous nodules, joint pain and occasional cough and dyspnoea. His chest radiograph shows multiple small (1-4cms) nodules in bilateral lung fields. Some of the nodules show cavitation and specks of calcification. Most likely these features are diagnostic of ?
A) Sjogrens syndrome B) Caplan's syndrome C) Silicosis D) Wegener's granulomatosis Answer (Select an option above to get the answer):
(Single Best Answer) Question 177: A 41 year old male patient presented with recurrent episodes of bloody diarrhoea for 5 years. Despite regular treatment with adequate doses of sulfasalazine, he has had several exacerbations of his disease and required several weeks of steroids for the control of flares. What should be the next line of treatment for him ?
A) Methotrexate B) Azathioprine C) Cyclosporine D) Cyclophosphamide Answer (Select an option above to get the answer):
(Single Best Answer) Question 178: A 40 years old tailor complains of pain, numbness and weakness of the right hand for the last three months. On examination, there is hypoesthesia and atrophy of thenar eminence. Which one of the following nerves is likely to be involved ?
A) Ulnar B) Radial C) Axillary D) Median Answer (Select an option above to get the answer):
(Single Best Answer) Question 179: A 40 years old man underwent kidney transplantation for end stage renal disease. Two months after transplantation, he developed fever and features suggestive of bilateral diffuse interstitial pneumonia. Which one of the following is the most likely etiological agent ?
A) Herpes simplex virus B) Cytomegalovirus C) Epstein - Barr virus D) Varicella Zoster virus Answer (Select an option above to get the answer):
(Single Best Answer) Question 180: A 40 year old patient has undergone an open cholecystectomy. The procedure was reported as uneventful by the operating surgeon. She has 100 ml of bile output from the drain kept in the gall bladder bed on the first post operative day. On examination she is afebrile and anicteric. The abdomen is soft and bowel sounds are normally heard. As an attending physician, what should be your best possible advice ?
A) Order an urgent endoscopic retrograde cholangiography and biliary stenting B) Urgent laparotomy C) Order an urgent hepatic iminodiacetic acid scintigraphy (HIDA) D) Clinical observation Answer (Select an option above to get the answer):