https://meditropics.com/?page_id=877&preview=true

Himanshi*

*Post Graduate resident, Department of Medicine, Lady Hardinge Medical College, New Delhi

 

1. A 66-year-old woman on 40 mg prednisolone/day for temporal arteritis was exposed to a confirmed case of influenza A (H1N1). She also had hypertension, asthma and osteoarthritis, for which she took amlodipine, Lisinopril, paracetamol and inhaled salmeterol. She had not yet received her seasonal influenza vaccination. She presented to her doctor 24 hours after the exposure and a choice of prophylaxis with either oral oseltamivir or inhaled zanamivir was considered.

What side effect of zanamivir is she at risk of developing?

 

A. Agitation

B. Bronchospasm

C. Cardiac arrhythmia

D. Guillain–Barré syndrome

E. Reye’s syndrome

2. A 23-year-old man presented to the ER and asked about postexposure prophylaxis for leptospirosis. He had fallen into a canal earlier that day and had been fully submerged. He was taking isotretinoin for acne but was not on any other regular medication. He had no known drug allergies. He had no open grazes and had showered 1 hour after the incident. What is the most appropriate postexposure prophylaxis?

A. Amoxicillin

B. Azithromycin

C. Doxycycline

D. No prophylaxis required.

E. Trimethoprim–sulfamethoxazole

 

 

3. An 8-year-old boy was admitted to a hospital in Malawi with torrential rice water diarrhea. He was from a rural area where there had been a recent outbreak of cholera associated with contaminated drinking water supply. What is the mechanism of action of the cholera toxin?

 

A. ADP ribosylation of Elongation Factor 2

B. ADP ribosylation of inhibitory G proteins

C. ADP ribosylation of stimulatory G proteins

D. Formation of cation-selective pores in cell membranes

E. Zinc-dependent hydrolysis of phosphatidylcholine

 

4. An 18-month-old boy presented with 4 days of sudden onset, severe watery diarrhea, after 2 days of being nonspecifically unwell. He was passing stool approximately 15 times/day. He had vomited for one day, but this then stopped. There was no blood in the stool. He was also noted to have a dry cough and appeared to have coryzal symptoms. He had not had a wet nappy for 24 hours. He had stopped breast feeding at 12 months old. On examination, he was markedly dehydrated, with a temperature of 38.5 °C and a tachycardia. He required aggressive fluid resuscitation. In addition to intravenous fluids or oral rehydration solutions, what agent would improve his outcome?

 

A. Ascorbic acid

B. Cholecalciferol

C. Magnesium

D. Thiamine

E. Zinc

 

5. A 25-year-old primigravida presents at 34/40 with a 1-day history of fevers, rash, dry cough and coryzal symptoms. She had recently moved to the UK and was uncertain of her childhood vaccinations. On examination her temperature is 39 °C, and a generalized maculopapular rash which is coalescent on her trunk. Some small cervical lymph nodes are palpable bilaterally. There are small white spots on the buccal membrane beside her molars. She has bilateral conjunctivitis. She is concerned about the risk to her baby. What are the possible adverse effects that she should be made aware of?

 

A. Cataracts

B. Hydrops fetalis

C. Intrauterine death

D. No increased risk of fetal adverse outcome

E. Sensorineural deafness

 

6. A 24-year-old pregnant woman attended her GP at 14/40 as her 2-year-old daughter had developed a rash and fever consistent with chickenpox that morning. She had been born and brought up in the UK. She was unsure of her varicella immune status. What is the most appropriate management?

 

A. Ask her to re-attend if a rash illness develops.

B. Check her varicella zoster IgG.

C. Give her intramuscular varicella zoster immunoglobulin.

D. Give her varicella zoster vaccine.

E. Reassure her that she is likely to be immune.

 

7. A 21-year-old woman presented to the sexual health clinic with multiple painless lesions over her vulva and perianal area. These were skin-colored, mostly smooth papules of <5 mm, but with a few raised cauliflower-shaped clusters. What human papillomavirus (HPV) type is most likely to have caused this infection?

 

A. HPV-1

B. HPV-6

C. HPV-16

D. HPV-18

E. HPV-45

 

8. An 18-year-old female presented in ER with colicky abdominal pain, diarrhea, vomiting, and frothy urine. She gives a history of knee and ankle joint pains for which she was taking NSAIDS, she also complained of a purpuric rash on buttocks and legs. On examination, her blood pressure was 140/89mmhg, pulse 78/minute, respiratory rate 17/minute. Blood tests reveal elevated creatinine 1.8mg/dL and raised IgA levels. The platelet count was also raised. Biopsy shows increased IgA levels in the mesangium. What is the most likely diagnosis?

 

A. Wegner’s disease

B. Henoch-Schoenlein purpura

C. Polyarteritis nodosa

D. Churg-Strauss

E. Takayasu arteritis

 

9. A 40-year-old female presented to ER with shortness of breath, dry cough, and fatigue. She complained of painful, swollen joints and red eyes sometimes. She has a history of nephrolithiasis. On examination, she has tender axillary lymph nodes and tender patches on her skin. Chest radiograph shows infiltrate. Biopsy reveals non-caseating granulomas. Which of the following is the most likely diagnosis?

 

A. Systemic lupus erythematosus

B. Churg-Strauss

C. Polyarteritis nodosa

D. Tuberculosis

E. Sarcoidosis

 

10. A child with suspected Duchenne muscular dystrophy undergoes a muscle biopsy. Which of the following muscles is most commonly biopsied?

 

A. Deltoid

B. Trapezius

C. Triceps

D. Quadriceps femoris