Ethics:

MURPHY to
1) women had mamo last year and calcifications suggesting cancerous features was seen
but she wasnt informed of her results by her prior physician! She gets a mamo again now,
which is normal! She also enquires of her previous mamo results which is available with

TIE
you and you are wondering why she didnt get a biopsy by her previous physician? NB
reply?
- tell patient about this latent error
- ask pt to schedule visit with her prior physician and ask him regarding the results
- i will discuss with ur prior physician and get back to you.
2 -←valproate drug induced pancreatitis in a 15yr old child! ( V GET SSMMAASHEDD)

grid
3- chlamydial conjunctivitis in a 15 day old neonate. (Qid 3758)
4- alcoholic dilated cardiomyopathy diagnosis by either BNP or cardiac MRI (no echo in
option) – should be - Cardiac MRI.

⇐
5- herpes zoster near temporal area- complication can be? Keratitis or encephalitis?
6- dementia with eye findings mentioned! I did progressive supranuclear palsy

wog:&
Progressive supranuclear palsy:
• stiff and broad-based gait, with a tendency to have
their knees and trunk extended (as opposed to the
flexed posture of idiopathic Parkinson disease), and

war
arms slightly abducted
• ophthalmoplegia is the hallmark of PSP, but it may
take as long as ten years to develop. The average is
three to four years. Vertical saccades
• Bradykinesia with marked micrographia is a primary
feature of parkinsonism in PSP, all types. Rigidity in
patients with PSP is usually more apparent in axial
than limb muscles, especially the neck and upper
trunk. It can be demonstrated on examination by
resistance to passive movement of the neck
• frontal lobe dysfunction. The patients manifest
impaired abstract thought, decreased verbal fluency,
motor perseveration, and frontal behavioral
disturbances
• insomnia
https://t.me/usmle_recalls_updated
 • Lack of response to levodopa
7- 18 month old child with undescended testis at a scheduled visit? Ur next best step?
- inform mother that neonate physical development is incomplete and require further
evaluation
- karyotype
a s
- orchiopexy wala operation i
8- testicular cancer biggest risk factor is cryptorchidism
9- women with virilization features. Hormones to be measured? I marked DHEAS and
-
testosterone.
Other options were DHEAS and androstenodione, etc
10- calculate PPV 75% and specificity 85% (From a stem in which following data was
given:
Total 300 pt
100 had disease
200 did not. (control group)
A test gave positive result in ___ diseased pt and ___ control group pt
so TP and FP is given. Total diseased and nondiseased are given. Calculate rest
11- buspirone- partial serotonin agonist
12- CLL (smudge cells given in stem) monoclonal lymphocytic proliferation.
13- diabetic neuropathy infected ulcer? Cause? neuropathy or polymicrobial (should be
neuropathy)
14- brachial plexus pic shown with C5 marked as being damaged! - effect? I marked
failure of arm abduction.
15- for dental cleaning- no prophylaxis required
Another question in which dental cleaning with h/o prosthetic valve (she was penicillin
allergic) so I chose clindamycin (not sure if its corrct)
Other options were Pip Taz, etc
16- candida infection risk factor is antibiotics
17- pt having pain and stiffness in fingers (confusing one with RA) then give. About
brown pigmentation of skin and glucose 160mg. What will u do to diagnose? iron (Qid
2880)
18- Rx for obsessive compulsive personality disorder? I marked CBT.
19- there was a 2 question continuation case of COPD with the first answer being give
oxygen first. It was correct and then the pt developed CO2 narcosis (oxygen dilated
airways, what is caused? I marked Ventilation perfusion mismatch
20- ecg seemed like long QT interval so i marked ion channel defect
21- there were qs with stem mentioning similar issues for maternal uncle and answers
were regarding hemophilia and Chronic granulomatous disease.
22- wiskot aldrich syndrome with classic triad in the stem
23- multiple myeloma ka bhe ek case tha.
24- ovarian cancer treatment! I think i marked platinum plus taxanes(after
cytoreduction)! Dekh lena
25- intraductal papilloma diagnosis? Ductogram or mammogram?
26- svc syndrome case
27- cholecystitis case with equivocal findings on U/S. NBS- HIDA scan
28- B/L facial nerve and abduscent nerve palsy with sensorimotor findings- tumor
location? Brain, spinal cord, brainstem (i marked)
https://t.me/usmle_recalls_updated Mr. Murphy

USMLE RECALLS
2020

~Best wishes to you in this long tiring USMLE journey.

God bless you!
P.S. Keep me in your prayers, whoever is reading this!
 https://t.me/usmle_recalls_updated

Q No. Question Stem Possible

Answer
01. Combined Question A
Part 1. A scenario on acute diverticulitis leading to abscess. Pt was
given antibiotics – metronidazole and ciprofloxacin, in the end they
mentioned CT findings where the major clue to note was
pneumoperitoneum . Q asked what you would do next.
a. Exploratory Laparotomy I
b. Percutaneous drainage of abscess

02. Part 2. Exploratory Laparotomy done, and patient was started on A

÷
above antibiotics in addition to gentamicin . Pt s kidney function
declined 2-3 days later, I guess. Now they asked the reason for this
decline? Urine output was normal somewhat ~ 800ml/24hrs but the
creatinine was rising!
a. Drug induced tubular dysfunction
b. Contrast induced nephrotoxicity

03. Another Combined Q C

Part 1. Patient presented with myalgia, headache, body ache and
Presents
mowspot
other general symptoms. He was sexually active with multiple
.

partners.
Labs: HIV ELISA –ve, Monospot Test –ve, Rapid Influenza test – like
ve
You treated the patient symptomatically with fluids and
acetaminophen and he got better. Later, he came with tender
cervical lymphadenopathy. Now what would you do?
a. Oseltamivir therapy
b. Amantadine therapy

d. HIV Elisa again Estates

c. HIV viral load (PCR)
hone
e. Don t recall
PPL
04. Part 2. I can t recall what the other question asked, but it was if PCP Alo give
something related to treatment or further management. They got the
viral load and count. Pts CD4 count was in 400s (N>500); high
viral load was mentioned too. What next? Todo Goo Itis top coma 450 ,
a. TMP-SMX Prophylaxis ( 20 o ,

b. Some other prophylaxis

c. I chose the option related to treatment (can t clearly recall) ART
05. A pregnant patient with HIV count in 11,000s. How would you
decrease the transmission risk? A
a. Cesarean section

head 71000 @
f- Viral Kung
→ Do C- Section
delivery
.
06. A question on PSGN – Patient had pharyngitis 2 weeks ago and C
now came with glomerulonephritis; C3 was decreased. The patient (Doubtful!)
had a rash on the shoulder – it was typical impetigo rash. They
asked about management?
pscgrvsobservahontx
if persisted Mf
a. IV Steroids -

b. Oral Steroids Antibiotic also

.

c. Oral antibiotics
#
[I couldn t understand what management they were asking for
whether to treat PSGN or the rash. PSGN is managed
symptomatically and I couldn t find such reliable option to go with.
I marked oral antibiotics just to treat the rash (topical mupirocin not
in options). Confirm this question!]

07. Description of child being on a visit to some hiking place – a (Dx – Lyme
picture was shown where a child was shown one with the shirt up Disease)
and other naked on side; it had a very faint circular red rash
resembling erythema migrans. How could it have been prevented?
a. Use of insect repellant DEET

08. 72y old patient with vertigo on waking up when he lifts head from ( (Dx - BPPV)
bed; also occurs during changing sides when lying on bed. Pt also
had SNHL (I believe, it must be a distractor – age related hearing
loss). Management?
a. Repositioning maneuvers

09. Calculation on Specificity and PPV (85% and 75%)

10. A study compared drug X vs Placebo. Intention to treat analysis B

applied. A table was given and the question was to tell the number
of sample population in the study.
a. 212
b. 312
c. 882
d. 776

11. During a flight, a patient had symptoms resembling those of

vascular air embolism. Patient was a deep sea diver and he had a
 them

gle fpmhdtcaf.Deah.im
* Have
diving session 4h before he got into the flight. The doctor on board
is managing the patient. He administered the patient oxygen;
besides this what should be done?
a. Emergency landing to treat the patient s condition

The answer does sound wrong, but I couldn t find a reasonable

option there. Look into it!

12. A 70y old patient has malaise, low grade fever and other A
nonspecific symptoms. Myalgia and rhinorrhea –ve; the patient
asked what would be the prognosis or how would the disease
follow? Influenza
a. It will develop into myalgias and rhinorrhea requiring
antiviral therapy
b. It will resolve spontaneously in 2 to 3 weeks

pgunfoltrahun
13. Pt had some trauma while either cutting tree or he was doing C

ARDS something else with the tree; now he came his right leg was
swollen and all, indicating trauma to femur, he was transfused,
stabilized etc. Now, his PaO2:FiO2 ratio is 350, PCWP is 12, CXR
was
22 I
pa0zlF0u
showed bilateral infiltrates (interstitial word wasn t mentioned).

ARDS
What is your diagnosis? (I don t remember what symptoms were -
"
mentioned)

< 300 ✓
a. CHF
b. TRALI without hours B/c !ontm°
c. Pulmonary Contusion pym
get
✓
- d. Aspiration Pneumonia
e. Fat Embolism

14. Pt has a thyroid nodule in the left lobe of thyroid gland; cervical B
lymph nodes of the left side were also involved. Biopsy showed
papillary thyroid carcinoma. How would you manage?
a. Partial thyroidectomy
b. Total thyroidectomy with resection of involved lymph
nodes
surgery
15. A case on sepsis. It was a lengthy scenario to understand and label C is the
it as sepsis. Besides fluids and antibiotics, what would you answer.
administer? (I did it
a. Dobutamine wrong!)
b. Dopamine
c. Norepinephrine
d. Milrinone

16. 4 hour old newborn, what vaccination would you administer?

 a. Hepatitis B ✓
17. A patient with this picture shown – when he moves his arms like A (somewhat
this he has pain in the neck region within the site of brachial similar
plexus; some motor or sensory loss in the hands and extremities wording)
was mentioned too. How would you manage?
a. Anterior scalene muscle release at the insertion site
-

b. Sternocleidomastoid insertion site

something
c. Costocervical angle manipulation
d. Sternoclavicular angle
manipulation

18. Patient had pain in anterior knee or around the knee on prolonged B
Schaller
sitting; resisted extension reproduced the pain and patellar
compression test was positive too. Dx? tubercle as Osgood
a. Patellar tendonitis Pair on tibial
b. Patellofemoral Syndrome
afterlong sitting ,
Runner , , E
19. 2 months old newborn with a palpable clunk. Management?
a. Abduction Harness i DD lol

20. 2-3 months old newborn with a palpable clunk. How would you
diagnose?
a. Ultrasonography of Hip Joint DD H da

21. Two X-rays given; sudden onset shortness of breath in a child. It

was a repeat question, I marked Foreign Body

22. 1 year old child is comes to the hospital for regular health visit with C
his father; the father says, the child has been a picky eater since last 1979
4 weeks. The house we used to live in was childproofed but now
since a while (exact duration not mentioned) we have been staying
at his grandmother s house which is not childproofed. The

Inured
grandmother had TB 2y ago, which was then treated. What would
you evaluate this patient for?

:
a. Hearing Loss
b. Loss of visual acuity
c. Lead poisoning
°
?
chuff µ
pheon
 d. Tuberculosis

23. Pt taking minocycline and OCPS, she does vaginal shaving too. B
Now she had symptoms of vaginal candidiasis. A picture of hyphae
was also shown. What is the cause of her symptoms?
§
a. Vaginal shaving
b. OCPs
c. Minocycline

24. A typical case of Lichen Sclerosis. Rx?

Dx Bx-

a. Topical Clobetasol

25. A case with somewhat similar picture. I diagnosed it as Lichen

sclerosis. What else can the patient have?
a. Loss of vulvar architecture

26. Frontal lobe hemorrhage - a transverse section CT scan was given; A

there was hemorrhage on the medial side of frontal lobe. Two scans
were shown. What would the patient develop during the period of
recovery?
a. Impulsive Aggression
Textural
b. Akinetic Mutism

27. Patient was an IVDU, had MRSA cultures positive, and placed on B
IV daptomycin. Now he has aortic regurgitation murmur
mentioned. Echo was done and it showed large vegetation on aortic
valve and paravalvular fluid collection. What would you do?
→
a. Gentamicin Therapy
b. Surgical Replacement of valve →
-
Abscess
28. Past question – Patient had fever, chills, sense of impending doom
-

etc. after transfusion. Looked like hemolytic reaction. Next?

a. Measure free Hb
contact blood bank W .

29. A lengthy question with so many labs - I noticed Coombs test +ve,
cause?
 a. Antibodies against RBCs

30. Graft reaction – when the graft was connected the patient suddenly
-
developed symptoms. Mechanism? acute
a. Preformed antibodies against graft antigens
Hyper
31. Abstract: Role of Bronchoscopy and CT scan in patient with
Hemoptysis with CXR negative:
The first question asked how this study applies to this patient.
- Patient met the inclusion criteria (and there was some relevant
option to this so I chose that. (Option C in real exam!)
-

nd
32. The 2 question was on calculating the sensitivity if CT scan:
My answer: 24/25
(the table was drawn in the abstract – TP were 24 and FN were 1 in
the CT Scan line so I chose 24/25)

33. The 3rd question was about why one thing (e.g., CT) is better than A - (100%
the other (e.g., bronchoscopy) – I don t exactly remember now sure on this
what were they favoring in question. one – I gave
✓ a. It has low negative likelihood ratio my 4 minutes
b. It has low positive likelihood ratio to the
c. It has low specificity question, you
d. It has low true negatives can trust me)
I calculated PLR, Specificity and was able to rule out option B and
C; D was easily ruled out too.

34. Abstract: Comparison of Co s milk s Formula milk:

First Question: Why does this study doesn t apply to this patient?
- The study was based in Finland so I opted for an option that said
something like not a representative population sample (more like
generalizability thing)

35. 2nd Question: Mother was asking what should she do if she is
unable to breastfeed her child?
- The study didn t mention anything about breastfeeding so I chose
an option that said you breastfeed your child preferably and if you
can t then use formula milk instead of cow s milk.
(the study had concluded that formula milk is better than cow s
milk)
- Can t recall the 3rd question from abstract
36. A case of infant with cystic fibrosis – mother mentioned that the A
child tastes salty when mother kisses her. What test would you do
next?
a. Pilocarpine stimulated sweat iontophoresis
-

b. CFTR mutation testing in Cl Channel

Sweated
*
best test
 c. CFTR mutation testing in Na Channel
d. 2 other options related to F508

37. 12 year old girl comes with this rash on her face. She had worked C – cutaneous
in farms with his uncle in the anthrax
past few weeks. The organism
causing the disease belongs to
which class of organisms?
a. Gram positive coccus
b. Gram negative coccus
✓c. Gram positive rod
d. Gram negative rod
e. Acid fast bacillus

38. A patient came with epigastric abdominal pain since a few days; he C
has had no diarrhea or related symptoms. Labs showed eosinophilia
-

and so many other things mentioned. Organism causing this

belongs to which genus?
a. Cryptosporidium

0139€
b. Cyclospora
c. Stronyloides .→
d. Giardia
e. Entamoeba

39. Patient with cutaneous serpiginous rash initially, has pulmonary A

symptoms now. Liver span was 7-8cm, spleen was palpable 2cm
below the costal cartilage. Hb down. Labs showed increased
eosinophils. Organism?
a. Visceral larva migrans -
to to Cara
b. Blastocystis hominis

40. Pt with lesion on nose – a deforming

lesion appearing as if something has bitten
the tip of nose – patient was in military
and had been deployed in Middle Eastern
countries. He had inguinal adenopathy.
Dx?
a. Leshmaniasis
41. Patient with this lesion; asks what can I My dx -
expect from the disease or how would it Seborrheic
progress? keratosis
a. It self resolves spontaneously

42. Patient with this lesion on face with a biopsy picture. Dx? B

a. SCC
b. BCC

43. Patient with venous stasis ulcer; arterial pulses etc. was all normal. B
Management?

←
a. Venous Bypass Grafting
b. Medical Compressive Dressing
c. Arterial Bypass Grafting

44. A typical scenario of aortic dissection – management? A

a. Labetalol
b. Hydralazine
(all other drugs were in option)

45. Stab wound just to the left of sternum, X-ray give: heart contours =A
enlarged. BP: 88/? Next step? (don t remember rest of the scenario)
a. Echocardiography B
b. Thoracotomy
46. A patient with abdominal pain and other symptoms resembling
ruptured abdominal aortic aneurysm along with this CT scan; the
aneurysm was larger than the one here. Dx?
A

a. Abdominal Aortic Aneurysm – my answer

-
b. Superior Mesenteric Artery something

47. A kid with bilious vomiting and bleeding per rectum (I couldn t
relate why he had bleeding PR); Next step?
a. X-ray Abdomen

T
48. A lengthy scenario with fixed splitting of S2 and pulmonary flow
murmur. Dx or Cause?
a. Interatrial septal rupture

49. Within 2 days of MI, patient presents with symptoms resembling Confirm
cardiogenic shock or heart failure. Audio had a holosystolic yourself!
murmur. The confusing options for me were:
-

OE-z.IT?npex,wmrwurmaailla !
a. New Membranous VSD
b. Papillary Muscle Rupture

50. A long question just like we write presenting complaint, hx of B

presenting complaint, comorbid etc. all the details.
Complaint: Abdominal Pain. Initially bearable, has been severe
now.
Examination: High Fever, Rash on the left lower side of abdomen,
BP: 160/95.
-
-
,

Comorbid: Diabetes Mellitus

Dx?
a. Erysipelas
b. Necrotizing fasciitis
=

51. Patient was in severe pain following trauma. His BP was 150s/?
Reason of increased BP?
 a. Pain induced sympathetic activation
a
52. Patient had features of myocardial ischemia, symptoms were
mainly induced by any stressful situation not otherwise. Dx?
a. Stress induced cardiomyopathy Broken
Syndrome
53. Patient with hx of rash recently which resolved on its own, it was
like erythema migrans rash. Now he had facial nerve palsy
bilaterally and other systemic symptoms. He had hx of recent
camping. How would you diagnose?
a. Lyme Serology
-
54. A child with pleural effusion with X-ray given. Next step?
a. Thoracentesis -

if > Icc
55. Pt with exudative pleural effusion – pleural fluid analysis was A
given. TGs were 40, Lymphocyte predominant effusion. Cause?
a. Tuberculosis
b. Chylothorax T G> HO
-

56. Child with sudden choking while eating peanuts. Mother performed B
a maneuver and tried to help the child throw out peanuts. He was
then playful and all good. Examination still showed right lower
lobe wheezing. X-rays were given PA and Lateral views – seemed
normal. Next step?
a. Decubitus X-rays
b. Rigid Bronchoscopy
-

57. A student had a TST of 3mm; recently his bus driver was
diagnosed with TB. He wanted to get a TST done again, which now
showed 16mm induration. CXR was done, which was negative.
Next?
-
.

a. 9 months of INH therapy

58. A patient had multiple painful genital ulcers with dysuria as well. A
Most likely organism?
a. HSV2
b. H. ducreyi Red ulcer base
c. Syphilis
.

59. Patient had a history of recurrent boils; axilla was shown – there Confirm
were sinus tract formed with pussy drainage from them; I couldn t yourself!
be sure if it was hidradenitis supprativa . The question asked
mechanism of infection?
a. Apocrine gland duct obstruction
A-
 b. Secondary infection of sebaceous cyst

60. Patient with symptoms of urethritis; yellow colored discharge. Probably B

-
Examination showed vaginal and sub-epithelial cervical petechiae;
cervical motion tenderness –ve. What would you do next?
a. Culture
b. Wet mount Trio hormones
-

61. An alcoholic found at a roadside; CXR showed left lower lobe

infiltrates or something. It was hinting toward aspiration
pneumonia. Organism?
a. Anaerobes + Aerobes

62. 35 year old patient comes to your clinic, she had peripartum
cardiomyopathy at 34th week of gestation in her last pregnancy
x
A

where her EF was 25%. 6 months later, her condition improved and
then her EF was >50% (it was normal, not exactly remember how
much). She has DM too. BMI was 24kg/m2. The patient wants to
be pregnant again, what in this patient is concerning for her to be
pregnant? ✓
a. Maternal Age
b. Left Ventricular Ejection Fraction ✓
EF
c. BMI

63. 3 year old with SCID; mother brought her because he was exposed A
to his cousin who had chicken pox. What would you administer in
the kid?
a. OVZIG
b. Varicella vaccine
c. Vaccine plus VZIG

64. Typical scenario of Wiskot Aldrich Syndrome; asked the defect in B

which cell?

smallplatelets
a. Neutrophils
b. Lymphocytes
-
c. Monocytes

65. Patient had difficulty moving his eye in the upward and downward A
direction in the vertical axis. Plus symptoms of dementia. Dx?
a. Progressive Supranuclear Palsy ✓
b. Parkinson Disease
c. Lewy Body Dementia

66. A kid with history of chronic diarrhea, failure to thrive, multiple

sinopulmonary infections; maternal uncle had similar history and
early death. Tonsils were not present. Dx?

↳
Typical
 a. X linked Agammaglobulinemia
(multiple options related to immunodeficiencies)

67. 72 year old patient with Alzheimer s dementia, he had a good I marked B,
appetite; ate a well-balanced diet and completely healthy otherwise, but it can be
homebound as well. What vitamin deficiency would be expected? option D as
a. A the best
b. B12 answer!
c. C
d. D

=
e. E

68. A pregnant patient at 38 weeks of gestation presents to you with B

headache and visual symptoms. BP >140/90, Proteinuria positive. (Similar to
What would you do? UWSA2)
a. Cesarean Section
b. Induction of Labor
c. Manage her HTN

69. Patient had a seizure disorder which was controlled on B

Levetiracetam; patient was I guess concerned for neural tube
defects. How would you manage?
a. Switch the patient to Carbamazepine → SCAD
b. #Continue the patient on Levetiracetam
c. Switch the patient to Valproate

70. A neonate had neural tube defects – it was defined some way; Only answer
Mechanism was asked? that seemed
a. Methylene THF reductase deficiency reasonable

*
-

71. Patient was started on olanzapine for schizophrenia. His C

schizophrenia was well controlled, on the follow up visit patient s
labs showed metabolic abnormalities (related to side effects of
olanzapine). Patient insisted not to alter the dose of olanzapine, he
said, “after a long while, I have started feeling better and I insist
you to not alter the medication dosages despite the side effects .
How would you manage?
a. Increase the dose of Olanzapine
b. Decrease the dose of Olanzapine
c. Shift the patient from Olanzapine to Quetiapine
-
d. Continue the patient on Olanzapine
e. Discontinue Olanzapine

72. Patient was started on Lithium carbonate for some reason. What
would you find increased in this patient?
 a. Serum Calcium wats on parathyroid
73. Patient presented to you with symptoms of tremulousness and B
ataxia. During interview, he seems drowsy, even in between
conversation he has dysarthria and seems to fall asleep. He has had
GI symptoms, myoclonus. BP, RR, temperature normal. He had
been taking anticholinergic, clonazepam and lithium. What is the
cause of patient s symptoms?
a. Anticholinergic toxicity
b. Lithium toxicity
c. -Clonazepam toxicity

74. Patient with multiple symptoms that I

don t recall now. X-ray showed
bilateral hilar and para-tracheal
lymphadenopathy. Dx?
a. Sarcoidosis

75. Scenario of Idiopathic pulmonary fibrosis. What else would you

find in this patient or what would be the X-ray findings?
a. Bilateral reticulonodular opacities on CXR

76. Patient with a recent history of travel to Mexico. Now presents with E. coli is the
watery diarrhea. What is the most likely organism? MCC of
a. E. coli traveler s
diarrhea
77. Patient with a recent history of watery diarrhea leading to bloody Dx - HUS
diarrhea later managed with fluids and all, now presents with
anemia, thrombocytopenia and elevated creatinine. Mechanism of
these symptoms?
a. Toxin mediated

78. A lady presented with urinary frequency and urgency, suprapubic C-

discomfort/pain, no comorbidity, non-pregnant. She is uncomplicated
nitrofurantoin allergic or resistant. What would you do next? cystitis needs
a. Urine Culture treatment
b. Fluoroquinolones Rx without
c. TMP-SMX Rx culture

79. A scenario on small bowel obstruction – previous hx of surgery,

increased bowel sounds etc. X-ray showed air-fluid levels. Next?

unstable -
Surgical
observe
stable
-
 a. Small Bowel follow through (Upper GI Series) &
(I don t think there was an option of tube decompression or
anything related, but better check)
T

80. Male patient presented with abdominal pain radiating to back, A (patient had
presentation similar to acute pancreatitis. He used to have 14 normal
drinks/week. US showed gallstones present in gallbladder. alcohol
Amylase, Lipases were elevated. Cause of pancreatitis? consumption)
a. Biliary
b. Alcohol

81. Patient with anemia,TRBCs in 6 millions, ferritin normal, Hb down.

Dx?
a. Beta thalassemia trait

82. Patient with urge to move legs at night, long details – restless leg
syndrome. What would you check in this patient?
a. Serum ferritin levels cheek
forFe def
Pramifseaok
.

(no option related to Uremia or CKD)

Rc .

83. Typical OA scenario but a lengthy one with X-ray given as well –
showing narrowing of joint space. Management?
a. Quadriceps Strengthening

84. Lengthy scenario on RA. Already taking steroids, long term

treatment?
a. Methotrexate

85. Patient with symptoms related to A

muscle weakness – proximal (muscle
myopathy; picture of rash on hand was biopsy is not

papules
.

given. What is confirmatory for in options)

diagnosis in this patient?
a.- Anti-synthetase , Minsk Gotrans
b. Anti-dsDNA

T.aiyu.DE?dsmyobufpjp?
86. Pt with myopathy related symptoms – can t stand from chair with < Duchenne
his arms hold against chest; cataracts etc. mentioned too. What is Muscular
the most common cause of death in these patients? Dystrophy
a. Cardiomyopathy/CHF Scenario
87. Patient on chemotherapy developed neutropenia (shown in labs);
developed sepsis or may be asked what organism infection is the
patient at risk for?
a. Pseudomonas
-

88. Patient with ovarian cancer, exploratory laparotomy, debulking A

surgery done. What would you do next?
a. Chemotherapy ✓
b. Radiotherapy

89. Patient with endometrial cancer – biopsy showed atypical high Probably B is
grade hyperplasia; undergone total hysterectomy, comes a week or the best
some days later for follow-up, everything is fine. How would you answer; I
manage the patient further? marked C, had
a. No follow-up indicated no
b. Radiotherapy – probably this is the answer! knowledge!

-218
c. Chemotherapy – I marked this, had no knowledge!

90. A patient comes with sore throat, he was recently started on PTU.
What is the likely cause of patient s sore throat?
a. PTU

91. A pregnant lady – had no prenatal care, membranes ruptured for 1- I thought of
2 days, delivered the baby. What is the neonate at risk for in the early onset
next month (or week may be?)? neonatal
a. Sepsis
hours sepsis due to
GBS!
92. Pregnant lady came to you with vaginal bleeding after a recent I marked A,
intercourse, probably 37th/38th week of gestation. Per speculum but confirm it
examination showed vaginal bleeding. Patient was since C
hemodynamically unstable, probably FHR was 100/min. What confused me
-
would you do next? (no TVUS in
-
a. Cesarean section options)!
b. Vaginal delivery
c. Transabdominal US

93. Patient with right ovarian mass, left adnexal tenderness with I diagnosed it
something mentioned on US that seemed like ectopic pregnancy in as ruptured
the left adnexa, free-fluid positive. Next step? ectopic
a. Laparoscopy
94. A patient with recent abdominal trauma and now present with A
uterine tenderness, vaginal bleeding (indicating abruptio placenta),
CTG showed late decelerations. US showed breech presentation.
Next?
a. Cesarean delivery
 b. Induction of labor

95. Patient with recent sepsis hx, cultures grew Staph. B

Epidermidis/MRSA. Now he presented with high grade fever, joint
pain, inability to bear weight – septic arthritis presentation. What
would you do next?
a. Antibiotics
b. Joint Aspiration

96. Patient presented 1 week ago when US showed absent fetal activity B
(or pregnancy test was positive), now she presents with hx of
vaginal bleeding, she has passed large clots. Examination showed
closed cervix. Beta-hcg is positive. What is the dx?
a. Incomplete abortion
b. Complete abortion
c. Threatened abortion
d. Missed abortion
e. Septic abortion

97. Recent trauma – patient on ventilator, 5 days later developed A

pneumonia. What organisms would you cover?
T a. Pseudomonas and MRSA coverage
b. Streptococcus pyogenes and some other organism coverage
c. Klebsiella and Legionella coverage

98. An 8-10 years old obese child – growth chart showed sudden Not sure!
increase in BMI reaching 97th percentile. Patient had features of
supravalvular aortic stenosis murmur on auscultation – it was
-
'
'
i
defined. What would put the patient at risk for cardiovascular
complications?
a. Auscultation findings I

b. Findings on growth chart

99. Scenario on rhinitis - not sure vasomotor or allergic. Rx? B

a. Oral Loratadine
✓ b. Intranasal fluticasone
Agonist
-

c. Intranasal oxymetazoline
*
100. Patient in late 20s or early 30s, presented with symptoms of
hyperandrogenism. 17-hydroxyprogesterone levels were normal,
but when ACTH stimulation done, 17-OH PG levels raised too
much. Family hx positive. What enzyme deficiency?
a. 21-alpha hydroxylase

101. Hypertension plus low potassium. Dx?

 a. Hyperaldosteronism

102. Alcoholic patient with hypokalemia and hypocalcemia. Cause?

a. Decreased Magnesium levels

103. Patient with multiple sexual partners, age in 40s. Patient had all his I marked B
childhood vaccinations done, but has not seen doctor or had any because of
other vaccination later in life. Recently he had TdaP 5years ago. sexual hx
What vaccination would you administer? mainly, no
a. TdaP other
b. Hepatitis B indication or
-
c. Pneumococcus risk factors
d. Meningococcus

104. 65years old patient, we had to administer pneumococcal A

vaccination. How would you administer?
a. PCV13 now – my answer
b. PCV 13 now and 6 months later
and multiple other PCV related options

105. Patient with this rash, I didn t

read the question details. What
else would you find in this
patient?
a. Pitting of nails

106. A study was done – matching was described like age, sex
controlled group take. It is done to control what?
a. Confounding

107. There was another study where researchers weren t accepting the B
study because some of the patients were very old aged, some were
diabetic, some had end stage disease like it was obvious that the
study is confounded and not controlled for such factors. How can
you improve this study now? Like what analysis can improve study
results?
a. Matching
b. Stratification

108. A question on Anaphylaxis. Rx?

a. Epinephrine Injection
 109. Patient told you she had shrimp allergy, hx of anaphylaxis, now she
wants to eat shrimps despite being allergic. What would you
suggest?
a. Eat shrimps and use Epi kit as needed

pk%7f.fi
110. Patient with a history of recent weight gain, fatigue. TSH value too C

tV¥
high; T3, T4 down. Bilateral nipple discharge – galactorrhea.
Prolactin slightly increased around 60s. How would you manage
→
patrie
-

this patient?
a. Trans-sphenoidal surgery
b. Bromocriptine
c. Levothyroxine

111. Saw Serratia in Q, and asked mechanism?

a. Impaired oxidative burst

=
112. Parents brought their 15y old son, has started coming home late,
started hanging out more with friends late at night, they have
observed his eyes seemed red a few times. His grades have fallen,
new friends. Dx?
a. Chronic Inhalant Abuse
(No other abuse option, no option of normal adolescence)

113. Renal bruit, HTN. Next?

a. Magnetic Resonance Angiogram (MRA)
(no US in options)

114. Scenario on acute pericarditis – typical, with ECG as well. Rx?

a. Ibuprofen

115. Pt in 30s or 20s – mobile, rubbery, non-tender mass in upper outer A

quadrant of breast. Dx?
a. Fibroadenoma
b. Breast cyst

116. Patient below 30s with breast mass. What would you do next? A
a. Ultrasound
b. Mammogram

117. Patient above 40s (don t remember exact age), breast mass, no I chose A,
other hx. Mammography findings showed – multiple papillary learn to
calcifications. Dx? differentiate
a. DCIS from B!
calcified apt
-

b. Fat necrosis→
c. Sclerosing adenosis
118. Patient had a pap smear – ASCUS positive, HPV testing positive A
and then underwent colposcopy findings: it was defined as if it
is not invading basement membrane, it was either CIN2 or CIN3.
Next?
a. LEEP (or Cervical conization)
b. Total Hysterectomy
c. Radical Hysterectomy

119. ECG of PSVT just like in UW, had to diagnose. Other options were QId:4920
WPW, Ventricular tachycardia, Atrial fibrillation etc.

120. Another ECG – Irregularly irregular pulse pattern of atrial B

fibrillation noted on ECG. This patient is at increased risk for?
a. Syncope
b. Cerebral ischemia
c. Coronary Artery Disease
d. CHF

121. A patient with HTN. Management?

a. Dietary Approaches to Stop HTN (DASH diet)
(no weight loss in options)
-

122. A patient with HTN, increased BMI, exercises once a week. B

Management?
a. Decrease Alcohol intake
b. Increase exercise duration

=
c. Decrease K+ in diet

123. 8years old child with nocturnal enuresis, he was toilet trained at age B
3. Daytime dryness, but nighttime urination problem.
Management?
a. Imipramine Rx
b. Motivational therapy

124. Patient comes with priapism (explained in words), he is on

trazodone. How would you manage?
a. Shift to Citalopram

125. Patient recently took certain cough medications (name wasn t

mentioned). He was on SSRI already. Presented with dilated pupil,
hyperthermia, hyperreflexia etc. Dx?
a. Serotonin Syndrome
 126. Patient with this picture given. There was no
Management? (My Dx – Tinea option which
capitis, didn t read the case) said to give

for capitis
a. Oral Griseofulvin to the oral rx to the
patient and contacts patient and

oral b. Topical Selenium Sulfide to topical to

only
wonks
the patient and contacts
c. Oral Griseofulvin to the
patient only
contacts, so I
went with C

FooFeast
d. Topical Selenium sulfide to
the patient and Oral
e. Griseofulvin to the contacts

127. A 13y old patient used to exercise a lot (not into other sports, but C–
used to exercise only), his HR was down (around 50s; likely 54), Xanthalesmas
examination showed yellowish papules on the eyelids above and -

below. S3 positive. Which of the features warrants further

evaluation?
a. Pulse
b. Auscultation findings

*
c. Skin Findings

128. A patient with sickle cell disease came with presentation of I marked B,
gallstones leading to acute cholecystitis. Next? but I am
a. Oral antibiotics and fluids etc. doubtful.
b. Cholecystectomy Confirm
(no delayed or urgent thing mentioned or within 72h) yourself!

129. Patient with elevated lipids – TGs were below 500 and LDL above A

treatTfoulgif71000
190. Rx?
a. Statin
b. Fibrates

130. Case on Aortic Stenosis with murmur described or heard on

Auscultation.

131. Typical scenario on OCD – patient had cleanliness related

obsessions, used to wash hands multiple times; even in the clinic he
has used sanitizer multiple times, hand excoriations seen on
examination.

132. Patient with criteria meeting for MDD. She had symptoms since A
more than 2 years. Although 5 of SIGECAPS was defined, but she
said she has had no difficulty continuing her job – school teacher.
Dx?
a. Persistent Depressive (Dysthymic) Disorder
 b. Major Depressive Disorder

133. Patient with ADHD, now having motor tics since last week or two B
weeks. 2 years ago, he has had similar episode which resolved on
its own. No vocal tics. Dx?
a. Impulse control disorder
b. Chronic tic disorder
(Tourette not in options)

134. A patient with rape – sexual assault, came after 4 days (I guess).
Contraception?
a. Oral Levonorgestrel

135. Patient had recent sex 4h ago, pregnancy test negative, hx of

thromboembolism; wants contraception.
a. Copper IUD

136. Patient with early pregnancy loss – placental infarcts found on A

examination of placenta. Platelets down. PT, PTT wasn t given.
She would have antibody against?
a. Cardiolipin
b. AutoIgG antibody

137. Patient with interstitial

- lung disease, had atrial fibrillation – on
amiodarone and other multiple drugs. What would you do next?
a. Discontinue Amiodarone
-

138. 12 months old child is brought to your office by mother who I chose B.
complains that she is unable to retract the child s penile foreskin. Confirm
On examination, the skin is retractable easily and there is no yourself!
discharge or lesion under the skin. What would you tell the mother?
a. Recommend elective circumcision
b. Reassure the mother that the child s penis is normal

139. Patient presents with early morning headaches and fatigue. A

Auscultation – pulmonary accentuation; has systemic HTN. BMI in
40s or late 30s (no snoring etc. hx given). Dx?
a. Obstructive Sleep Apnea
b. Idiopathic ICH

140. Patient on tetracycline plus other medications and raised ICP signs

gifted
- papilledema. CT scan was negative. Next?
a. ↳MRI
=
a
(I don t remember if LP was in options, so just make sure .

yourself!)
wt loss auto land de
, go
141. Patient going for mountain climbing, on the day of ascent, he
developed pulmonary symptoms resembling high altitude
pulmonary edema. Rx?
a. Acetazolamide

142. Another question on prevention of high altitude pulmonary edema. A

Patient on ascent developed pulmonary symptoms, his other friend
came via flight directly, and he doesn t have these symptoms. What
should the patient have done to prevent HAPE?
a. Acetazolamide on the day of ascent
-
b. 3 months of cardiovascular endurance training

143. A patient had HTN, he was recently started on NSAIDs. What B

could be the reason of elevated BP? (It was a tough scenario, I
could only make this sense out of it)
a. Decreased renal endothelin production
b. Decreased renal prostaglandins production
c. Increased renal endothelin production
d. Increased renal prostaglandins production
(2 other options were similarly increased/decreased renal
production of X?)

144. A 3years child is overheard by parents who is telling his friend that I chose C
his sister touches or manipulates his genitals. They bring their son
to the doctor, parents get embarrassed and tell the doctor about the
incident and that their daughter (who is 15years old) says she does
because her brother likes and enjoys it. Listening to this, the boy
starts crying and says, he doesn t like it at all and that she does it
forcibly. Parents are embarrassed of this act and ask the physician
not to report this incident and they are willing to get involved in a
family therapy. What should the physician do?
a. Defer reporting until family therapy is complete
b. Interview the parents alone
c. Interview the daughter alone
d. Report the incident to CPS

145. Patient with mass in front of ear (in parotid gland); fine needle I chose B,
biopsy showed cystadenoma. No LAD. What would you do next? unsure!
a. Observe
b. Superficial Parotidectomy
c. Head and Neck CT Scan

146. Velocardiofacial defects – palate, cardiac and face defects. Cause?

a. 22q11. Deletion
 147. Patient has palatal fusion defect i.e. cleft palate; bifid uvula. Patient I chose A
is at risk for?
a. Speech Problems
-

b. Valvular Defect

148. Case on Hyperthyroidism. Rx? I chose C –

a. Propylthiouracil confusing!
b. Methimazole
c. Propanolol

149. Case on alpha-1 antitrypsin deficiency – patient had emphysema,

family hx of liver cirrhosis. X-ray was a little weird as if there was
a diaphragmatic hernia but luckily no such option.

150. Patient with multinodular goiter, has symptoms of

hyperthyroidism. Rx?
a. Sodium Iodide I131
(No PTU, Methimazole or Thyroidectomy in options. Couldn t
relate any other answer)

151. Patient with nephrolithiasis – calcium oxalate stone on analysis. I chose A

Lengthy scenario; Labs: Calcium 11.2mg/dl. What is the indication
-

of parathyroidectomy in this patient?↳ Not

a. Nephrolithiasis
bad
-

b. Serum Calcium levels

152. Patient had TB, now he had hemorrhagic adrenals bilaterally. What A
test would be abnormal in this patient?
a. ACTH stimulation test
b. Dexamethasone suppression test

153. Typical PCOS scenario. What would you do next?

a. Ultrasound of Ovaries
(there was no option of treatment)

154. A male patient with gynecomastia and infertility. What would you B
check in this patient?
a. Estrogen levels NY
b. Testosterone levels

155. Patient with tanner stage 4 breast, stage 2 pubic hairs, left inguinal A
- mass; comes with primary
-
amenorrhea. Dx?
a. Androgen insensitivity syndrome
b. 5-alpha reductase deficiency
156. 13 years old girl presents with primary amenorrhea, breast and
pubic hair are stage 2. What would you do next?
Secondary Sea characters
the
a. Reassurance and follow-up
.

157. 15 years old boy, obesity – 34 BMI, acanthosis nigricans. Reason?

a. Insulin resistance

158. A diabetic patient with early satiety, vomiting etc. What would you
do?
a. Gastric
-
emptying test
(Diabetic gastroparesis probably)

159. Similar early satiety, sometimes patient has hypoglycemia an hour

after meals; at other times his fasting glucose levels range from
200-400mg/dl. Patient had diarrhea as well. Dx?
a. Diabetic Gastroparesis

160. Diabetes mellitus scenario – patient had foot ulcer, pulses weak or
absent. Long standing DM. Paresthesia etc. were positive too. What
else would you see in this patient?
a. Abnormal monofilament test confirmatory
161. Patient in 60s comes to the doctor, tells the doctor unless my A
husband initiates sex I don t even feel a need for it. Even during
sex, I don t actually enjoy it like I used to do. She says during our
visit to Europe, we didn t have sex. Dx?
a. Sexual arousal disorder
b. Sexual orgasmic disorder
c. Sexual aversion disorder

162. Patient with mature cystic teratoma. What would you do next?
a. Laparoscopy

163. A patient belonging to US military comes with his wife due to

issues regarding fertility. Wife is completely normal, has child
from other person. Husband s semen analysis was abnormal. What
can be the issue?
a. Left sided varicocele

164. Patient around 30s (<35years) comes to the hospital due to fertility It was like
issues – she had multiple sexual partners; she says, she has been give her
trying to conceive since last 6 months, she and her husband have knowledge of
regular time to time sex but not able to conceive yet. Everything when do you
else is normal, she has no hx of any serious disease. What would label a patient
you recommend? infertile – 12
months of no
 a. Reassure the patient and tell her about conception duration conception
etc. with regular
sex and age
<35

165. Patient with secondary amenorrhea; previously she had an abortion, A

underwent D&C. Post D&C, she had mild bleeding for a few days.
Now she presents 6 months later, and has not resumed her menses.
How would you diagnose or what would you do?
a. Sonohysterogram Asher war
b. CT scan
(No hysteroscopy or any better option in answers)

166. Patient with headaches, palpitations, pallor, BP – 185/? On A

abdominal examination, no masses palpable. What can you
consider the most likely reason?
a. Pheochromocytoma
b. Renal Artery Stenosis → Ace
-
I
167. A girl presents with axillary/inguinal freckling, café au lait spots as B
well. She has a small nodule on areola at the side of nipple which is (as per NF1)
lighter in color than areola. Why is this occurring in this patient?
a. Estrogen mediated
b. Tumor suppressor gene mutation
meat
168. Leukocytes in 100,000; 40% metamyelocytes. Mechanism of this? Puedo Lib
Baggy
a. 9;22 translocation (though it should be more myelocytes,
.

but there was no leukemoid reaction related option) *

169. A patient had sick sinus syndrome, he was administered B – Confirm
EPINEPHRINE (or NE). yourself!

Before 15 minutes after

Bradycardiac Bradycardiac
Episode Episode
Leukocyte count 14000 18000

Neutrophils 60% 70%

Bands 0% 2% (exact!)
Lymphocytes 30% 25% (estimate!)

⇐emarginate
What is the reason/mechanism of this?
a. De-margination of adhered pool

bands !
b. Release of pool from bone-marrow
c. Release of pool from spleen
cells are
170. Typical Macular Degeneration scenario – everything mentioned;
wavy door, drusens on fundoscopy, central vision defect.
Everything literally!

171. Scenario on Hyperemesis Gravidarum; Risk factor?

MAB Hey
Btpneg, cheerio
a. Twin Pregnancy CA,
- l HM ,
172. A scenario on OHS – can t recall details.

173. Patient on oral steroids for asthma exacerbation recently, young

=
age; presented with anxiety. Diagnosis?
a. Medication induced anxiety

174. Patient has moderate persistent asthma (mentioned in scenario); B - unsure

SABA use every day every 3-4hours, was already on daily low
dose ICS. Still patient has symptoms. How would you further
manage the patient?
a. Continue on the same therapy
b. -Increase the dose of ICS
c. Add oral steroids

175. Patient had oral cavity mass – smoker and alcoholic, ill-fitting A
dentures. In addition to smoking, what is the other risk factor for
HNSCC?
a. Alcohol
b. Dentures/Hygiene

176. 32years old lady with family hx of stroke in father and something A
in mother too. What would you screen for?
a. Lipid Screening
b. HbA1c Screening lipid 35
D.M
45 -

177. A scenario on postoperative atelectasis. Management? A

a. Incentive spirometry
b. Chest percussions

178. Typical scenario on Fibromyalgia. Tender points described. Rx? A

a. TCA
b. Steroids
(Other first line options for Rx not in the options)

x
179. A scenario on MDD. Patient is concerned for weight gain regarding I chose C, but
therapy. They also mention that patient says, I have had episodes it can be D. I

-
where I binged too much and vomited . Management?
a. SSRI – probably Sertraline
b. Mirtazapine
am unsure!

I .
 c. Bupropion
d. Imipramine

180. Pneumothorax Case – patient had hx of prior spontaneous I chose A - (A

pneumothorax secondary to asthma. He is in asthma exacerbation little mixed
now, we managed the patient s exacerbation with drugs and his and tough
PaO2 deranged. X-ray showed pneumothorax. Patient has hx of scenario)
COPD too. Asked the mechanism/reason of pneumothorax?
a. Apical Bleb Rupture
b. Collagen related some option

181. A patient with unilateral signs and symptoms – UMN signs, mainly I chose A
motor symptoms; Hoffman sign was positive (but no related thing).
How would you further evaluate?
a. CT scan of Brain
b.→ EMG No GBS
(No spine related option; it was a weird question)

182. Alcoholic with Subdural hematoma – typical scenario

183. Patient with a 6 week hx of back pain; paraspinal tenderness I chose A

positive. Was on some therapy and NSAIDs already that didn t
help. What would you do now?
a. Recommend exercise therapy
-
b. MRI Spine (no spinal signs)
c. Bed Rest

184. Child abuse scenario. Bilateral retinal hemorrhages and subdural

hemorrhage as well. Dx?
a. EInflicted trauma
-

185. Patient with sudden loss of consciousness after trauma for some
minutes and then regained consciousness, he was all good and was-

moved to ambulance. During the transfer to ambulance, his

condition deteriorated, was obtunded etc. On examination, eyes
.

closed; when left eyelid picked up, his eye was down and out. Pupil
2mm on right and 4mm on left. Dx?
a. Left sided Epidural Hematoma
-

186. Typical Gout Scenario – Negatively birefringent crystals, patient

on thiazides. Dx GWC
187.
⇐ Hyper
Patient presented with ear discharge, fever, TM ruptured etc. Dx as
acute otitis media. Rx?
a. Oral amoxicillin
188. Patient with acute otitis media leading to acute mastoiditis. What I chose A –
would you do next? confirm
a. CT Scan Brain
-
yourself!
b. Drain/Fluid Aspiration

189. Patient with right sided sensorineural hearing loss and other right
sided CNVIII symptoms. Pt can t feel sensations on the right half

5,78 confession
of the face. Dx?
a. Right sided Acoustic Neuroma

190. A scenario on either Crohn s disease or Ulcerative colitis. NBS?

a. Colonoscopy – my answer

191. Patient with lumbosacral radiculopathy, straight leg raise test

positive at 30 degrees flexion unilaterally, paraspinal tenderness
defined – lateral to bone. Management?
a. Laminectomy
¥ b. MRI spine NSAIDS
!
c. Some Brace
(I didn t mark either of these options – can t recall what I chose)

192. A young patient 15years age with back pain. Cobb angle > 10
-
degrees. Reason of back pain?
a. Adolescent idiopathic scoliosis – I am very doubtful!
(don t remember other options now)

193. Patient with proximal muscle myopathy, raised CK – diagnosed it

as Polymyositis. Mechanism/Pathophysiology?
a. Cytotoxic T cell mediated muscle damage
CDS
-

194. Patient with hearing loss, increased hat size, bone pain etc.
Elevated ALP. Dx?
a. Paget s Disease - typical scenario

195. Patient with above more or less similar presentation. X-ray of

Femur given – highly sclerotic. What else would you see in this
patient?

*
a. Increased ALP
-

196. A patient with recently diagnosed diabetes mellitus (some weeks

300mg/24hr. What is the cause?

-

ago). He is a known hypertensive. He now has proteinuria – around x

A (confirm
yourself!)

A
a.
-
Nephrosclerosis
b. Glomerulosclerosis

-
197. Patient with a known MVP, he is going for gingivectomy or UWSA1 Q.
gingival manipulation. Antibiotic prophylaxis?
a. No antibiotic prophylaxis

198. A young patient with this x-ray, I chose A

diagnosed it as osteosarcoma. What this
patient is at risk for?
a. Lung metastasis – my answer
-

b. Neuropathy (as in nerve damage

secondary to tumor)

- Weird question!! (No option

related to limb length
discrepancy)

199. A 7 year old child with recent URTI, Hb 3g/dl, Hemoglobinuria. A

Dx?
a. G6PD Deficiency
b. Hereditary Spherocytosis
-

c. Pyruvate Kinase Deficiency

200. Patient with neurologic symptoms with raised MCV. Dx?

a. B12 deficiency

=
201. A patient with sickle cell disease comes to the physician with
severe pain crisis, had similar previous episodes which he managed
with acetaminophen and oxycodone etc. (some other opioids) but
I chose B

since last 5 days he is out of his prescription and the episode is

severe this time. What would the physician tell the patient?
a. Don t worry, saline only would help you with pain crisis
b. Prescribe the patient what he wants

of
(there was no option related to checking and confirming from
data base)
c.

202. Patient was taking opioids for certain reason and now came to ask
for more, I don t remember further details.
a. Check drug database before prescribing the patient
(somewhat similar option)

203. Patient with recent procedure leading to bleeding, family history of

bleeding disorder or similar episodes – multiple members affected.
Dx?
a. Platelet adhesion defect (dx it as von Willebrand disease)

204. Patient with low platelet count and megakaryocytes on smear. Dx? A
 a. ITP
b. TTP

205. Patient with ABO incompability reaction – transfusion leading to

back pain etc. Typical case. Mechanism?
a. Preformed antibodies against RBC antigens Hemolytic
206. Patient given vancomycin – reaction developed, red man syndrome

÷
was described; flushing etc. This is mediated by:
a. Histamine release

207. Patient during some dental procedure was injected with local
benzocaine. Now developed methemoglobinemia (had to dx).
Mechanism?
a. Cytochrome b5 reductase deficiency leading to

*
methemoglobinemia

208. Patient was being prepared for surgery; midazolam, fentanyl and C
topical benzocaine used. RR around 12-15, PaO2 decreased, O2
-
saturation decreased (not sure exactly), HR around 120bpm; had

ohelhttbscausedbybenzdh
something in hands – probably cyanosis. Dx? "

WIFE a. Midazolam toxicity

b. Fentanyl toxicity
c. Benzocaine toxicity
d. Vasovagal reaction

209. Shipyard worker with asbestosis, probably a mass was mentioned B

too, bilateral facial flushing. Diagnosis?
a. Asbestosis
b. SVC Syndrome
-

210. Patient with some occupation (related to asbestos exposure), Picture is

pleural plaques and all. Typical scenario. Dx? similar to the
one in
NBME17,
Step1

a. Asbestosis

211. Another Q on SVC Syndrome too!

212. Central venous line related sepsis. Organism?
a. Staphylococcus aureus
(Coagulase negative staphylococcus – S. epi in not in options!)

213. Weight loss in patients with cystic fibrosis is due to?

a. Decreased pancreatic lipase
214. Patient with adult onset asthma – cough, metallic taste in mouth.
What will you find?
a. Decreased LES tone

215. 58years old patient with a recent episode of food impaction, solid
food stuck for a little while. Later with water, food passed. What
Barium first
would you do?
a. Esophageal endoscopy swallow
(No pain or odynophagia! I don t remember if barium swallow
is an option.)

216. Patient with flat facial profile (midface hypoplasia), single palmar
crease, epicanthal folds and bilateral cataracts. Dx?
a. Trisomy 21

217. Patient with Crohn s disease, what will he develop later?

a. Fistula

218. Patient with fluctuant tenderness mass on rectal exam, finger

placed posterolaterally or just laterally. Dx?
a. Perirectal abscess

219. Patient with vomiting, abdominal distension. Hx of surgery long

ago. Hyperactive bowel sounds. Mechanism?
a. Extrinsic compression of bowel
~

adheshious
'

220. Patient non-alcoholic, obese – 34 or 38 BMI, no other risk factors;

liver pathology. Dx?
AST t ALT
A
Ll
a. Nonalcoholic steatohepatitis
b. Cirrhosis

221. Supraclavicular lymph node enlarged around 3 cm; how would you
further evaluate this patient?
a. CT Chest, Abdomen and Pelvis – my answer

gets
222. Patient severely alcoholic, he presented with early satiety (don t
✓
recall further options). What would you do next?
a
boot
go.w.fr
a. EGD
i

b. CT Abdomen
 (I was confused if it s pancreatic or gastric cancer – can t recall
anymore)

223. Patient with severe vomiting, labs?

pH HCO3 X?
?
Don t remember what x was, but it was the only option relating
where there was increased pH and HCO3 both.

224. Patient with asthma exacerbation. What is the cause of hypoxemia A

in patient with asthma?
a. V/Q mismatch
b. Hypoventilation

225. Patient was taking multiple drugs – Senna, I noticed. Colonoscopy

showed melanotic mucosa. Dx?
a. Laxative Abuse

femoral
226. Patient with a mass below inguinal ligament, presented with
features of small bowel obstruction. Next?
a. Surgery – my answer

BERT
227. Gunshot wound to abdomen, exit and entry site noted. Patient is I chose A, not
hemodynamically stable, BP normal. What would you do next? sure of the
a. CT Abdomen + answer!
b. Abdominal US
(don t know if laparotomy is option there!)

228. A pregnant lady with right sided pain, just to the site of enlarged
uterus; rebound tenderness etc. and other symptoms related to
appendicitis. Dx?
a. Appendicitis

229. Patient with elevated BP on an office visit – 145/88; how would the
physician further assess or evaluate the patient. Patient was
otherwise completely normal. To decrease the risk of stroke in this
patient, what would the physician do?
a. Repeat BP measurement on the next visit

230. A patient with unilateral headache, especially pain behind the eye;
diagnosed it as cluster headache. What else would you find in this
patient?
- Faster
A

-
a. Normal visual acuity -

Og
b. Papilledema
231. Patient given antipsychotic – he developed acute dystonia. Drug
used to dystonia works via what mechanism?
a. Antimuscarinic
232. A patient was recently started on acetazolamide, labs showed
-

normal anion gap metabolic acidosis – proximal RTA. Mechanism

or what has caused it?
a. Drug induced

233. A scenario on SIADH/Primary polydipsia, wasn t really obvious.

Patient had hyponatremia around 120s, asymptomatic. What would
you do next?
Kuo Gineltypwhoacsahue
Symptomatic
a. Water Restriction →
or
234. Patient had some trauma, he fell down as such that the left side of
his body hit the ground. He had left sided flank pain etc. What
would you see in this patient?
a. Hematuria

235. A soldier had some trauma in a bomb blast. He had splenic injury
and so underwent splenectomy. Now he is advised to be on certain
antibiotic for prevention of some complication. What is the
mechanism of action of antibiotic required?
a. Cell wall synthesis inhibitor
←
(Penicillin used post-splenectomy to prevent sepsis)

236. Patient had urge incontinence, lengthy scenario. Rx? B

a. Intermittent catheterization
✓ b. Tolterodine therapy

237. Patient had started NSAIDs recently, and now labs showed RBCs B
in urine, RBC cast, WBCs in urine - 2% eosinophils in urine,
increased creatinine; probably had fever too. No typical rash (as we
have studied). Dx?
a. Acute Tubular Necrosis
b. Acute Interstitial Nephritis

238. Patient with week of gestation in 30s, present with elevated BP,
urine dipstick showed proteinuria. Next step in diagnosis?
a. 24hrs urine protein

239. Post-traumatic stress disorder – patient had sleep issues, used to

have some sleep medications. Can t recall anything else. Rx?
a. SSRI
CBT '←exbosW9 Nightmare → pnazoesini
X
240. Patient with nephrolithiasis, 3mm stone. How would you treat this A (option C in
patient, hydration etc. was being done already? exam)
 a. Citrate
b. Tamsulosin ✓
241. Irregularly enlarged uterus, heavy menstruation. Dx? Fibroids
a. Myometrial smooth muscle proliferation

242. Patient with painful menstruation, age around 20s, with systemic A
symptoms – diarrhea etc. Dx?
a. Primary Dysmenorrhea
b. Endometriosis

WITTYspite
243. Postpartum hemorrhage, patient had HTN. How would you A
manage?
a. Oxytocin ✓ Iwa , IBP ,
b. Methylergonovine Is
244. Patient had leakage of urine with coughing, weightlifting etc. A
Patient has her first delivery which was converted to cesarean due
to prolonged labor. The second pregnancy was managed with
elective cesarean. Risk factor for this patient s condition?

:
a. Multiple Pregnancies
b. Weightlifting

245. Auscultation findings – S4. Patient had a little unclear presentation. I chose A
a. Myocardial Infarction
b. Pulmonary Embolism

246. A 20 year old boy is diagnosed with schizophrenia, started on I chose A –

treatment with risperidone. Family wants to get involved in because male,
patient s management and are good with undergoing family early age are
therapy. They ask the physician, “What should we expect from our poor
son s condition? What should the physician tell? prognostic
a. Schizophrenia is a chronic illness which would last in your factors!
son
b. Your son would develop 2-3 episodes before becoming

*
completely normal

247. Patient comes to the physician for evaluation prior to getting

-
A – a little
pregnant. What would you evaluate the patient for? doubtful
a. Varicella though
b. Hepatitis B .
c. Influenza
(All other options were related to the vaccines which we can
administer even during pregnancy)

248. Patient comes to the physician with hx of 2nd trimester preterm I chose B
deliveries; first delivered child had cerebral palsy, second one had
 some other disease. During the second pregnancy, she was given
IM Progesterone but even then the pregnancy ended in a labor next
week at 25/26 week. Now this patient is pregnant at some 15th
week of gestation or more may be. How would you manage this
patient?
a. IM Progesterone at 16-26 weeks of gestation -
b. Hospitalize the patient → No
(Cerclage wasn t in options, but I am not sure about bed rest)

249. 17 year old girl comes for routine screening evaluation before I chose B
going to some sports playing within the US. What vaccine would
you administer?
a. HPV
b. Meningococcus
c. Pneumococcus

:
250. Patient on levodopa-carbidopa, developed visual hallucinations.
Rx?
a. Quetiapine
(No option on dose alteration)

251. Patient with migraine, doctor is telling her that he would keep her B
on propanolol therapy; patient suggests that my friend has migraine
attacks and she is using topiramate therapy and her results are
better, you start me on topiramate therapy instead. Doctor tells her
that the upfront costs are higher for topiramate compared to
propanolol i.e. propanolol is cost effective and I prefer prescribing
this. What ethical principle is doctor applying here?
a. Autonomy
b. Beneficence
c. Non maleficence
d. Double Effect
e. Justice

252. A patient had painful intercourse and came for evaluation, imaging
showed septate uterus. What can the patient expect?
a. Normal Fertility
(No other option related to pregnancy related complications,
only this made sense)

253. Adolescent drug abuse related scenario – I marked get a urine drug i

screening

254. Patient with pancreatic cancer; she presented with confusion and
altered mental status. Multiple lytic lesions were seen in femur.
What is the reason for patient s CNS symptoms?
 a. Brain Metastasis
b. Hypercalcemia B
-

255. Medical director has noticed a physician coming late since few I chose B
days, her colleagues have questioned her decisions a few times
these days. The director is friends with the physician s spouse. The
physician was previously working very fine and had remarkable
achievements. What should he do?
a. Tell her spouse about her work issues
b. Report the physician to impaired physician program
c. Ask the physician to get a urine drug screening

256. A patient was recently diagnosed with myocardial infarction, now B

he has major depressive disorder.
a. He will die soon
b. His quality of life will be affected

257. A patient comes to physician with pain in his legs when he I chose A
exercises for like 20-30 minutes, everything else is fine. How
would you manage the patient?
a. Ask the patient to continue exercise program
b. Cilostazol

NOTE:
I have tried to mention in a summarized way whatever I understood from the question stem. The
real length is good enough, more or less similar to how you see the questions in UWorld!
Some Suggestions:
a. When doing sequence questions (the combined ones), don t submit the question initially.
Do it later when you re done with rest of the block so that even if gets wrong, you can
have time to console yourself during the break. I submitted one and it went wrong, it took
me 3-4 minutes to get myself out from the fact that I have made a mistake in the easiest
question. So it s better to solve them for later.
b. Look for abstract questions – see which block contains 38 questions, it is the block where
you ll have abstract questions. This way you ll be ready that your next block has abstract
and eat anything you need to energize yourself during the break accordingly.
c. It is NOT an easy exam, UW does cover most of the stuff but you will be tricked with
options. So if that happens with you, I guess that s fine. Just know this and make yourself
able to deal with the stress and you will be good. If there is anything you need to do
besides UW, I would suggest FA Step1. Basics are also covered in CK exam so if you are
someone who is not in touch with FA from longer, just quickly see through FA.

DO YOUR BEST and LEAVE THE REST ON GOD!! THANK YOU!!

 rd
29- one eye ptosis due to 3 CN compression (PCA Aneurysm) ​Qid 16119
30- Epitrochlear nodes, axillary nodes, cat exposure=> bartonella
31- RTA II lesion (proximal) decreased PO4, Mg+2, decreased cl., decreased Ca
(Fanconi)
32- Pulmonary embolism in a woman, she did not had much risk factors just 1 or 2, but
she had S1Q3T3 on ECG with SOB and low O2 sat. I did P.E
33- Calcaneal Stress fracture- tender points in foot laterally & medially in a runner
34- Carpal tunnel syndrome- splinting failed= continue splinting and add intraarticular
steroids.
35- llachman positive ACL with xray given: I marked Medial OA with chronic ACL
36- B/L foot medial (as in clubfoot) while walking. They were prolly knock knees, they
asked mother is concerned about monitoring, how will u monitor?
I did no surveillance required
• Xray AP and lateral supine
• Xray AP and lateral standing
• MRI
37- DDH ortolani +ve : Pevlic harness (Hip abduction harness)
38- Rotator cuff tear: weakness of abduction and overhead activities after a trauma
39- End of life care. Autonomy. Prefer patient wishes
40- Pt had progressive claudication (radiating burning and tingling). But It doesn’t occur
on cycle exercise machine (cause bent down prolly) ABI was 0.9 so it confused me but I
still marked Spinal stenosis
41- obese with 40+ BMI, what will happen to FEV1, FEV1/FVC, DLCO
42- mild smoker with COPD and Liver Function abnormalities: alpha antitrypsin
43- young girl with exercise induced SOB: for diagnosis? No options of methacholine
challenge test, I did Spirometry
44- smoker, chornic cough with white sputum, barrel shaped chest on chest xray,
spirometry showing obstructive profile, NBS? I did DLCO
Other options were methacholine challenge test etc
45- a person with height of 6’ 5 having sharp pain in chest, murmur was given (diastolic
in axilla, aortic area) it was marfan with aortic dissection causing AR
46- VSD with thrill causing pronounced second component of S2 (accentuation)
47- A very long stem with unnecessary details (dysphagia, muscle weakness here and
there) with eye symptoms at night and glare. Cause of eye symptoms? Opacities of lens
48- AMD with yellow spots in posterior retina, with distortion of vision
49- trichomoniasis with its wet mount and increased pH with discharge
50- new onset RA: methotrexate
51- sunburn in a child, he went somewhere to enjoy, after that whole body mildly red, he
had underwear mark on his groin.
52- secondary hyperparathyroidism due to vitamin D deficiency. This question came in
like a history (like complaint, pasthistory, drug history, occupational history) she was
using too much sunscreens cause she was afraid of cancer after recent diagnosis of BCC
in her uncle or sth. Labs were given of 2 HPTH.
53- coombs positive intravascular hemolysis labs (LDH increased) cause? IgG
54- TRALI after 4platelet, 5 RBC tranfusions
55- PRBC given after pt starts having bleeding from every possible hole :D
I did transfusion reactions, other options were not feeling right :p
56- 18 year old boy for routine examination. Screen for? Lipid profile, chlamydia,
gonorrhea
1 more question on lipid profile screening
57- SKT1 mutation what to do? Esophagoduodenoscopy
58- Risperidone given, what to monitor? Lipid profile and fasting glucose
59- bipolar pt stable on risperidone, now pregnant, stopped risperidone on her own,
symptoms came back (she started buying 5000$ worth of things online to get ready for
the baby), what to give? Restart risperidone
other options were start lithium, do CBT, etc.
60- Pt had flu like symptoms then developed sharp pain. Murmur was given. That was so
hard (pericardial friction rub thi I think). I did pericardial effusion.
61- why pneumonia happened after PPSV23? Options were like immunity weaned off,
etc.
62- simple graves disease with faltu ECG with all symptoms of graves. Reason? TSI
63- patient had labs of congenital hypothyroidism, repeat labs after few weeks still TSH
st
high T4 low, he is developing okay till 1 week of life. what to do? I did start
levothyroxine
Other options were like followup few weeks later, etc.
64- a nurse transferred MRSA from one pt to another. How could this be prevented? Pt
was post op (not in ICU)
Options were
hand sanitizing before and after pt encounter
gown and cap before entering room
mask for face
isolation
65- nursing home guy had flu like symptoms, now cardiac tamponade, other pt at nursing
home also had similar flu symptoms. What to do?
isolate others in nursing home, etc
66- posterior communicating artery aneurysm causing CN III symptoms
67- pt with Chiasmal tumor on MRI: how will u monitor its progression? I did visual
field
68- Pregnant pt with CKD and currently smoking. she developed preclampsia, they asked
what causes symptoms of preclampsia?
Answer was systemic endothelial dysfunction
69- patient after severe trauma. Ct was given. He had cerebral contusions in frontal lobe
what will he experience in following days?
Anterograde amnesia
Receptive (Wernicke) aphasia
aggression
akinetic mutism
70- 14yo got pregnant. Risk in this pregnancy? I did preterm labor, other option was
chrosomomal anomaly
71- 42 ½ weeks gestation, CTG with 2 variable decellerations, NBS?
72- CTG with late decelerations. What Is it showing? Placental insufficiency
73- Systolic Murmur that gets loud with Valsalva and standing up, improves with lying
down and squatting. Bhoojo tou janein hum tumko manein.
HCM
74- hard questions. 1 on tension pneumothorax, 1 on cardiac tamponade: both had only
subtle changes. Tension pneumo wala had stab wound 3cm lateral to left sternal border
75- retinal hemorrhage in a child with bilateral subdural hemorrhage. Cause?
Faltu options just directly go for : ABUSE (inflicted injury sth)
76- 2 on wiskott Aldrich, 1 confusing one on bruton (very little details so understand
well), 1 easy question on CGD
77- 38yo f there was question in which mammograph revealed just calcification there was
no mass. No history of breast implants
Options were MRI, biopsy, ultrasound
78- bilateral vestibular shwannoma in a pt with NF2
79- pt had nonprogressive hearing loss, also having 20-30sec position related vertigo. It
was BPPV do maneuvers to treat
80- herpangina: erythematous pharynx without exudate and vesicles on tongue and soft
palate: only supportive treatment

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