Page 1 of 1: IMP MCQ1

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3. You have a 30 years old male patient who says that he cannot hear well. On examination you find that he is deaf in left ear and right (that is exactly they wrote). You ruled out any cause of conductive hearing loss. Write four causes of his deafness.

Clues to the Diagnosis of Sensorineural Hearing Loss
________________________________________
History Physical findings Audiogram Suggested cause of sensorineural hearing loss
Gradual hearing loss, noise exposure, tobacco use Elderly patients with normal tympanic membrane Bilateral, symmetric high-frequency loss Presbycusis
Gradual hearing loss, tinnitus, noise exposure Normal tympanic membrane Bilateral, symmetric loss centered at 4,000 Hz Noise-induced traumatic loss
Rapidly progressive hearing loss, possibly fluctuating, bilateral loss Normal tympanic membrane, with possible vertigo or disequilibrium Any abnormal configuration with poor speech discrimination Autoimmune hearing loss
Sudden unilateral hearing loss, tinnitus, vertigo, head trauma, straining Normal tympanic membrane;vertigo and nystagmus, with positive pneumatic pressure Any unilateral abnormal configuration Perilymph fistula
Sudden, fluctuating, unilateral hearing loss, tinnitus, episodic vertigo Normal tympanic membrane Unilateral low-frequency loss Meniere's disease
Gradual unilateral hearing loss, tinnitus Normal tympanic membrane, possible facial nerve weakness and unsteadiness Any unilateral abnormal configuration Acoustic neuroma

Questions for Evaluating Hearing Loss
________________________________________
When did your hearing loss begin?
Was your hearing loss sudden, or has your hearing slowly been getting worse?
Does your hearing loss involve one or both ears?
Have you been having ringing in your ear, fullness in your ear, dizziness, ear drainage, or ear pain?
Is there a history of hearing loss in your family?
What is your job? What is the noise level in your workplace?
Do you have a history of ear infections, ear injury, or straining to hear?
Do you have a history of stroke, diabetes, or heart disease?
What medicines are you currently taking?
Have you received any intravenous antibiotics, diuretics, salicylates, or chemotherapy?

Otitis media is the most common cause of conductive hearing loss in children
Noise trauma is the most common preventable cause of sensorineural hearing loss.
4. These are the results of a 3 years old boy:
Rinnes: Bone conduction is more in left ear that air conduction
Weber: Lateralized to the left
Audiometry (I am not sure exactly how they frame it)
Rt ear- 10 db
Left – 60 db
Write only one diagnosis
Otitis media is the most common cause of conductive hearing loss in children

13. 3 days after a appendesectomy a 25 years old patient complains of abdominal pain. She has not passed stool since surgery. On examination she has tenderness in right ileac fossa. Bowel sound is decrease.
Q-1 Which one of the following condition can cause this condition? Choose as many as you want to
a. Effect of Anaesthesia
b. Narcotics
c. Inflammation -------------
d. Ischimia
e. Hypokalemia------------- f. Mechanical obstruction--------------
Q-2. After investigation you found out that she has a sponge in left ileac fossa. What will you do? Write four action:
Tell the truth
NBO and Decompress the GIT and correct the electrolyte disturbance if any
Take consent
Take the patient to the operation theater and reomove the sponge under GA
14. You are called to see a 1day old neonate born by normal vaginal delivery at 34 weeks of gestation. Apgar score at birth was 9 and at 5 minutes 9. Write four causes that may lead to the child’s condition
Prematurity
Narcotics
Complicated labour
Disease of the mother

15. A couple comes to infertility clinic for investigation. She is 22 and he is 24. They are having unprotected intercourse for last 6 months. What are the following thing will you do? ( They had a long list)
Reassure
16. A 15 years old comes after overdose of ASA+ Alcohol. After 24 hours she said that it was stupid to attempt suicide and she will never do it again. Choose 6 questions you will ask her to assess suicide risk: a) Does she has a plan for future b) Does she get drunk on alcohol c) Is she happy with her weight d) Does she have a family history of mood disorder e) What are her hobbies f) Does she have family history of suicide
17. You are a young graduate. A flight attendant asked you to check a lady. This lady had her face flushed and swollen. Her legs were swollen too. What will you ask the flight attendant to bring (Write three):

??????????????????????????
18. A 31 years old epileptic patient comes to you for preconception counseling. She is on Carbamazapine and valproic acid. Her last seizure was one year ago. Write three things you will tell her during counseling.
She can be pregnant while taking the antiepliptic medication
There is possible side effect from both on the pregnancy
Keep the lower recommended and effective dose
19. Alcoholic malnourished 42 y male living in abandoned building brought because of some confusion, weakness of his left side, both hand and leg, dropping of his left foot, instability.
Choose tests:
a) screen for Aspirin,
b) PT,
c) drug screen--------------------
d) alcohol ---------------------
e) PTT
f) Bleeding time ----------------

g) Clotting time

f) CT of head, a lot of blood tests…------------------------

20) 30-31 y’s old street-living (or smth like that) male HIV-positive was brought by
his social worker to you at a walk-in clinic. He has a week-long history of urethral
discharge. He is HIVpositive for 5 years and Hep- C positive for 3 years. During last 6
months he was treated 5 times for Gonococcal and Chlamidia infections. He also
had been denounced in these last 3 (or 6) months by 3 women indicating him as a
source of their Chlamidiasis. Your actions: -
a. hospitalize him to treat Gonorrhea and Chlamidiasis
b. denounce the case to the Public Health Officer; ------------------
c. hospitalize him because of his potential danger for the others;---------------
d. serology for HepC and HIV
e. viral charge for HIV and HepC and lymphocytes coun
f. oral treatment for his Chlamidiasis and Gonorrhea
g. IV treatment for his Chlamidiasis and Gonorrhea;
h. Tell the police about him
i. Ask him to use condom-------------------------
j. Take an urethral swab for culture sensitivity---------------------------
k.
21) Young male, runner, was bitten by a stray dog, with no collar. The dog looked
unusually aggressive. The dog bit him and that ran away. The Environmental (or smth like this) service advised him to see a Dr. urgently. He has 3 puncture wounds on his
posterior leg, no inflammation around. He had his tetanus vaccine 3 years ago.
Your immediate management – you have to choose up to 5 from a list: -
a. antirabic
b. immunoglobulin;-------------------
c. -antirabic vaccine; --------------------
d. -tetanus toxoid booster;
e. -notify Public -------------------
f. Health Authority;
g. ask back the Environmental Service about the animal;
h. wash the wound------------------------
i. ATB
j. Spay anti-rabis immumoglobulin in wound--------------------------
k. Stitch the wond
22) 21-day old male with 2-3 days projectile non-bilious vomiting and palpable 3 cm
round formation in epigastrium. Best course of action:
a. pyloromyotomia
b. nasogastric tube ---------------------------
c. antiemetic drug
d. observation
e. Improve nourishment
23) Case with a picture, married woman, 32, abundant watery vaginal malodorous
discharge with moderate vaginal irritation. Picture looks like trichomona. Best
treatment:
a. steroid cream
b. different local ATB
c. metronidazol oral. -------------------------
24) Woman 72, or so, acute left lower abdominal pain for 2 days, nausea, vomiting.
Palpable tenderness, moderate defense in LLQ, fever. There were 4 questions(!),
like immediate tests, immediate treatment. Then they tell you she is better after
few days of non-surgical treatment. Your management at follow-up appointment 3-4
weeks after, tests, definitive treatment. In definitive treatment they ask like
pick up to 5 but there were no so many visibly correct (or expected by them)
options, one were colectomy, there were also colostomy, low fat diet, fiber in
diet, laxatives like mineral oil and smth else, …
25) You are a Dr. in a small rural hospital ER. Male, 52, smoker, documented duodenal
ulcer 2 (or few) years ago, brought with 2 hour chest pain compatible with MI.
Q-1. Your first management, between options:
a) morphine
b) oxygen,
c) beta-blockers
d) aspirin
e) H2-blockers IV
f) fibrinolitic therapy. ------------------------
Q-2. In 2 days he is better but if you are expecting any complications what signs and symptoms you have to be aware of, some 5 or 6 to select from:
a. peripheral edema,
b. lung rales,-----------------
c. elevated jugular pressure
d. pericardial rub --------------------
e. dyspnea, -------------------------
f. Fever
g. Chest pain --------------------
h. Vomitting --------------------------
26) Young male received a hit to his cranium by a baseball stick, initially lost
consciousness shortly, then recovered and almost normal but combative, after that
confused. Options: -epidural hemorrhage
27) Mom brought her 4 years old boy with runny nose, rash all over body. You find some white spot on oral cavity. He has a two years old brother at home. Mom has scheduled a party in two days. What will be your action? Write 3:
Inform the public health
Isolate the baby
Give IV immunogobuline

28) 37 year man came for evaluation of 'SPELLS'---His wife describes that during the each Spell his face flushe, he sweats and grinds teeth. He said that he starts seeing things smaller and then he loses consciousness for 20 seconds. When he wakes up, feels drowsy---
Write upto 4 diagnoses.
Hypertention
Migrain
Glaucoma
Increased intracranial pressure (SOL)

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