INTERNAL MEDICINE END POSTING EXAM

YEAR 5 BATCH 4 : GROUP 1

1. Acromegaly
TRUE A. Common in adult
TRUE B. Surgery is a mode of treatment
TRUE C. Commonly due to pituitary adenoma
TRUE D. Caused by non-pituitary tumor

2. In nephrotic syndrome, the following is/are true/false

TRUE A. Proteinuria >3gm/day with hypoalbuminemia
FALSE B. Generalised edema is a clinical feature
FALSE C. Hypertension and polyuria
FALSE D. Bilateral renal angle pain
TRUE D. Diabetes mellitus can cause nephrotic syndrome

3. Dengue
TRUE A. By aedes mosquito
TRUE B. Diagnosed by NS1 antigen
TRUE C. Maculopapular rash and lymphadenopathy
TRUE D. Vaccine given in endemic area The U.S. FDA approved Dengvaxia, a vaccine for dengue fever, in
May 2019 for use in dengue-endemic areas.
TRUE E. Bleeding can occur such as epistaxis
4. Finger clubbing is feature of
FALSE A. Chronic bronchitis
TRUE B. Bronchiectasis
TRUE C. Alveolar fibrosis
TRUE D. Primary biliary cirrhosis
FALSE E. Ventricular septal defect
5. Peptic ulcer disease
TRUE A. Duodenal ulcer pain aggravated by hunger, relief by food
TRUE B. Hpylori more significant in peptic ulcer than gastric ulcer
FALSE C. smoking not affect the healing of peptic ulcer disease
TRUE D. Nocturnal pain waking at night
FALSE E. Always complicated by melena & hematemesis

6. Causes of cerebral embolism

FALSE A. Calf vein thrombosis
TRUE B. Atrial fibrillation
TRUE C. Atrial myxoma
TRUE D. Infective endocarditis
TRUE E. Rheumatic fever

7. Cardiogenic shock due to myocardial infarction

TRUE A. Absence of pulmonary edema suggest right ventricular infarction The salient features of RV shock
are RV dysfunction and dilatation accompanied with a high right-atrial pressure, without LV dysfunction and
pulmonary congestion.
FALSE B. Central venous pressure (CVP) best index for left ventricular filling pressure Central venous
pressure, which is a measure of pressure in the vena cava, can be used as an estimation of preload and right
atrial pressure.
TRUE C. Dopamine at low dose increase renal blood flow
TRUE D. High flow oxygen supply indicated
FALSE E. Colloid infusion if oliguria and pulmonary edema.

8. Central chest pain at rest :

TRUE A. Interscapular radiation most probably suggestive aortic dissection Symptoms from an ascending
aortic dissection are classically described as sudden onset of tearing chest pain, often in the interscapular
region and may be associated with syncope, dyspnea, diaphoresis, and weakness
TRUE B. Postural variation most probably suggestive pericarditis Worse when patient is supine, improved
when sitting up or leaning forward
TRUE C. Chest wall tenderness due to musculoskeletal origin
FALSE D. Normal ECG can exclude ischemic heart disease
FALSE E. Relief of pain by nitrates can exclude esophageal causes
9. The following are the recognized causes of hemoptysis
TRUE A. PTB
TRUE B. COPD
FALSE C. Fibrosing alveolitis
TRUE D. Mitral stenosis
TRUE E. Good pasture syndrome

10. Regarding atrial fibrillation

TRUE A. Aspirin alone doesn't reduce risk of stroke
TRUE B. Radial pulse is irregularly irregular
TRUE C. Cardiac output reduce during exercise due to absence of atrial contraction It can decrease cardiac
output due to ineffectual atrial systole and increase pulmonary venous pressure resulting in heart failure.
TRUE C. DC cardioversion is contraindicated during anticoagulant therapy
TRUE D. Maybe cause by alcohol

11. The following infections are transmitted by:

A. PTB
B. Legionellosis
C. Giardiasis
D. Gonococcal
E. Dengue

12. Primary Hypothyroid

TRUE A. Carpal tunnel syndrome
TRUE B. Decreased T4 & TSH High
TRUE C. Cold intolerance
TRUE D. Puffy eyelids
FALSE E. Tachycardia
SBA
2. Which one cause chronic kidney disease except
A. Snake bite
B. DM
C. Obstructive uropathy
D. Malignant hypertension
E. SLE

3. Central cyanosis is feature of all except

4. Diagnose DM

5. Characteristic of cholestatic Jaundice

6. Definition of oliguria
A. <50 ml/day
B. <100 ml/day
C. <200 ml/day
D. <500 ml/day
E. <1000 ml/day

7. Poor prognosis of pneumonia except

8. Character of upper motor lesion

A. Flexion plantar reflex
B. Flaccid muscle tone
C. Fasciculation

9. Hypochromic microcytic anaemia

FALSE A. Folic acid deficiency
TRUE B. Beta thalassemia
FALSE C. Alcoholism
FALSE Hypothyroid normocytic normochromic
FALSE E. Pernicious anaemia
MEQ
A 60y/o man came to ED at 2 am with a crushing central chest pain and shortness of breath for 1 hour. He’s
taken sublingual glyceril trinitrate but it didn’t resolve. On examination, patient was alert, conscious, obese
with a clenching fist on his chest. BP: 160/93mmHg, PR: 102bpm, RR: 24bpm. On auscultation there is bibasal
crepitation, raised JVP, soft S1, normal S2 with gallop rhythm, apex beat palpable at 6th intercostal space and
pansystolic murmur radiated to axilla.

1. Give 3 differential diagnoses

2. List out 4 investigations

3. Interpret ECG
ECG showing an anterolateral STEMI in a 68 year old man with acute onset chest pain since 2 h. Note the ST
segment elevation in anteroseptal and high lateral leads (I, aVL, V1-V3) and reciprocal ST depression in
inferior leads (II, III and aVF). The coronary angiography revealed an ostial occlusion of the left anterior
descending artery.
4. Full diagnosis Anterolateral ST segment elevation myocardial infarction (STEMI)
5. Complication

6. Interpret x-ray
7. State the complications arise from this condition.
8. State acute management.
OSCE 1 Patient with underlying asthma came tachypnoeic
ABG:
pH 7.3
PaO2 (reduced)
PaCO2 (reduced)
HCO3 (normal)
1) Interpret the ABG results
2) Diagnosis
3) Complications
4) Advice you will give

OSCE 2
43 y/o Male, went for routine check-up, deranged LFTs. Virology screening came out as followed:
HBSAg +ve IgG
HBcab +ve
HbeAg +ve
HbsAb -ve
1) Interpret the result, stating the significance of Ab and Ag
2) Most likely diagnosis
3) 3 routes of transmission
4) 2 complications

OSCE 3

Puffy face, coarse dry hairs, weight gain, constipation

1. Diagnosis Primary hypothyroidism in a patient with
Hashimoto's thyroiditis
2. Ix to confirm What to expect in Ix result
Serum TSH - Decreased FT4, Increased TSH
123I radioactive uptake - Evaluates synthetic activity of the
thyroid gland
4. Treatment Resolve with thyroid hormone replacement