JCAT Past Past Paper 4

10cm white fluffy mass on the side of the tongue?

12 years old girl was brought to hospital with high grade fever, rash and swelling of multiple joints of hands and feet. On auscultation of the heart she had changing murmurs as well. There was history of pharyngitis 2 weeks prior to this episode. The organism most likely responsible is?

13 year old child having fever, cold, cervical lymphadenopathy ,petechiae with purpural rash and hepatosplenomegaly.What investigation will be diagnostic?

30 week baby, is born preterm, which of the following is the most common complication:

1st line management in polycythemia rubra vera Is?

A 30-year-old lady with confirmed intralobular carcinoma of the breast comes for a follow-up visit. You want to determine the multicentricity of the disease. Which of the following tests will you use?

30 years old female, has difficulty in swallowing for a year, symptoms have now worsened, no weight loss or hematemesis is there, she has no such past medical history, what can be the problem?

35 years old lady presented with high grade fever with rigors and chills and right upper quadrant abdominal pain. O/E there was localized tenderness even on superficial palpation and  mass was palpable in the right hypochondrium. What is the possible clinical diagnosis?

45 years old gentleman c/o pain in calf muscles after walking some distance, Which is relieved   after taking rest but reappears on resuming his walk. This is a typical feature of?

40 years old male asking for day case surgery of inguinal hernia but surgeon refused because of which of the following

50 year old women with a past surgical history of two c-sections, a total abdominal  hysterectomy and bilateral salphingo-oophorectomy comes to the ER with nausea, vomiting, and abdominal distention with increasing peri-umbilical pain over 48  hours. Air-fluid levels are observed on X-ray in the small bowel. What is your first step in management?

50 years old lady presented with acute onset of right hypochondrial pain. Murphy’s sign was positive. Which hormone is responsible for causing pain in this lady?

50 years old male k/c of peptic ulcer disease presented with multiple episodes of  hematemesis. He was vitally unstable with a BP of 90/50 mm Hg and pulse of 115/m. After initial resuscitation what step should be done?

60 yrs old female with features of abdominal pain, distension and vomiting. On ultrasound there was non-specific characterless distended loops visible. What is diagnosis?

60 year old chronic smoker with progressive hoarseness over 3 months, what will you suspect?

65 male with lymphocytes on smear and enlarged spleen, what is possible diagnosis?

7 year old girl, present to your complaint. Her mother has noticed that she is not been eating  well and has lost some weight. Today her mother noticed something red protruding from her anal  area.You diagnose her with rectal prolapse. What is the cause?

70 years old patient admitted with acute MI. On post admission day 4 he developed severe abdominal pain and there mild distention of the abdomen and mild tenderness with pain out of proportion. Sluggish bowel sounds were present. Lactate levels were raised. What is your diagnosis?

In a well-child visit, an 8-year-old girl with no symptoms except for an episode of scalp itching two weeks ago that was treated by over-the-counter shampoo is found to have posterior cervical lymphadenopathy. What could be the possible cause of this finding?

A 10 year old child comes to you with his right ear displaced anteriorly, redness and swelling ?in preauricular area associated with severe tenderness. The area is hard and indurated but  does not compress when pressed. He has fever and is inconsolable. What is your treatment plan?

A 40 year old male, operated for parotid adenoma presents with complaints of redness and  sweating while eating food. He notices the symptoms even while thinking of food .The condition is referred to as:

A 40 year old man keeps coming to you  with  complaints of having colorectal carcinoma despite having  a normal colonoscopy  and negative  FOB.He is currently going through a divorce.He complains of blood in his stool and has once  tried  putting ketchup in his rectum before coming to you. What is the diagnosis?

A 40 year old woman comes to the clinic with complaints of photophobia and decreased tear production. She has dry mouth and vaginal dryness that has caused dyspareunia and knee  pain upon walking. What is the likely diagnosis?

A 40-year-old female comes with a lump in her breast She has no family history of breast cancer, she has three children aged 3, 6 and 10. She is an avid tennis player. She noticed the lump a week ago after she developed breast pain in the area this was following her youngest child screaming and crying and she was trying to calm him down. What is your diagnosis?

A 50 year old gentleman knows a case of hepatitis related CLD presented with hematemesis after initial fluid resuscitation. What next step in treatment should be given to control bleeding until  endoscopy is arranged?

A 50 years old man presented with left sided hemiparesis which resolved after 7 hrs. On  examination the right sided carotid bruit was positive. What should be  done next?

A 50 years old man presented with progressively increasing mass in the left parotid gland. He underwent a parotidectomy for that. After a few days he started experiencing deviation of  angle of left corner of mouth. Damage to which nerve resulted in this outcome?

A 50 years old man presented with right sided hemiparesis. Carotid bruit was positive.    Which investigation should be performed?

A 50 years old man who had a history of epigastric pain off and on 2-3 hrs. after food intake, presented to ER with very sharp unbearable epigastric pain. Tenderness was also positive. There was no associated history of hematemesis or melena. What is the likely diagnosis?

A 54-year-old man is admitted to the emergency department He has taken more than 50 digoxin tablets (0.25 mg each), ingesting them about 2 hours before admission. His pulse is 54 b/min, and the ECG shows third-degree heart block. Which of the following is the most important therapy to initiate in this patient?

A 54-year-old woman is being treated for an atrial arrhythmia. She complains of headache, dizziness and tinnitus. Which of the following antiarrhythmic drugs is the most likely cause of these symptoms?

A 54-year-old woman had a myocardial infarction. Which of the following would be appropriate prophylactic antiarrhythmic pharmacotherapy?

A 55 years old lady presented with mass in the supero-lateral quadrant of breast along with swelling of the axillary tail. Mammography revealed diffuse suspicious microcalcifications. What should be the next step of management?

A 56-year-old woman complains of chest pain following any sustained exercise. She is diagnosed with atherosclerotic angina. She is prescribed sublingual nitroglycerin for treatment of acute chest pain. Which of the following adverse effects is likely to be experienced by this patient?

A 56-year-old woman complains of chest pain following any sustained exercise. She is diagnosed with atherosclerotic angina. She is prescribed sublingual nitroglycerin for treatment of acute chest pain. Which of the following adverse effects of sublingual nitroglycerin can be prevented by atenolol?

A 58 years old mother of 5 presents with breakthrough bleeding. She refuses endometrial biopsy due to fear of further bleeding. What can be the other non-invasive investigation done in this setting?

Which medication is most likely responsible for the signs and symptoms observed in a 58-year-old woman being treated for chronic suppression of ventricular arrhythmia, including fatigue, a resting heart rate that is 10 bpm lower than her previous rate, and cool and clammy skin, along with laboratory test results indicating low thyroxine and elevated thyroid-stimulating hormone levels?

A 6 weeks old child presents to you with cough and rhonchi and decreased activity. The mother is extremely worried. She says that he had an eye infection treated with topical antibiotics around 2 weeks after birth. What is the likely causative organism in this child?

A 6 year old girl is brought by her mother who noticed a fleshy grape-like cluster extruding from her vagina. What is the diagnosis?

A 6-month-old child with abdominal swelling no other symptom.

A child triples his birth weight by what age?

A child with a swollen jaw that shows an ulcerated and fungating type of lesion from interior Sindh comes to you. You take a biopsy of the lesion and under the microscope you find a starry sky appearance. What virus is likely associated with your diagnosis?

A child with abdominal pain is suspected of having intussusception, which of the following is true?

A clinical situation in which immune system or a therapy failed to eliminate all the Plasmodium spp infected erythrocytes and numbers of Plasmodium spp in RBCs begin to increase again with subsequent clinical symptoms is called.

A construction worker was brought to Emergency after he fell from a building with multiple injuries. Suddenly he stopped breathing. Percussion note was hyper resonant on right side and trachea was deviated to the left. What should be the best treatment option?

A couple presented in OPD with H/O infertility for 2 years. Semen analysis of  husband was done. What according to WHO criteria is normal sperm count?

A cricket player gets hit on hand; which structure can get damaged in an anatomical snuff  box injury?

A diabetic elderly man with micro and macrovascular complications developed foot ulcers having purulent discharge. Pus was sent for culture. The organism grown in culture shows  swarming motility. This is a feature of which of the following?

A diagnosed case of COPD presented to you with hepatomegaly pitting edema in both feet that is gradual in onset, what is the most probable cause?

A drug causes orthostatic hypotension in an elderly gentleman. What is the mechanism of action of this drug?

A female has come to you repeatedly over the year with the complaint that she has palpitations and feels dizzy when this occurs.She has no anxiety or depression and all her tests have come back negative.What is your diagnosis?

A female having asymptomatic mole on right foot since childhood now presented with ulceration. Next step in management is?

A final year student discusses a new patient with the consultant orders to get Carcinoembryonic antigen (CEA) done. What is the consultant checking for?

A first year medical student has a sudden mild icterus one week before his final professional part 1 exam. This occurred once  before when he played football as a child and has never participated in sports since then. What is likely diagnosis?

A fluid sent from the ward and its protein level comes out to be 3.77g/dl and it readily coagulates in the container. What is it?

A house officer attempts to maintain a central line through subclavian approach he does it successfully. Ten minutes later patient complains of SOB, her O2 sats are dropping and trachea is deviating to the opposite side of CVP line. What is the next best step?

A hamartoma is a?

A hypertensive is well controlled on monotherapy however he feels that sometimes after meals his blood pressure tends to go a little higher. What advise will you give him?

A male athlete comes to you in the clinic. He says he has recently felt pain in his wrist and tapping it produces tingling in his middle and index finger and sometimes a sharp shooting pain. You have him press his palms together tightly which reproduces the pain. What is the nerve

involved?

A male patient presented with swelling in the groin area which was non tender and   fluctuant. Transillumination was positive. What is the diagnosis?

A patient has been gaining weight and has abdominal striae alongside a peculiar hump on his  neck, he has been on homeopathic medication for 2 years for his asthma,what does he have?

A patient has come to you four times in 6 weeks with Complaints of heart disease.You have run a whole battery of tests and reassure him yet again that he is okay. What is the diagnosis?

A patient has uncompensated lactic acidosis.Which of the following will you find in his lab work?

A patient has unstable tachyarrhythmia without a pulse:

A patient is brought to the ward after a total thyroidectomy. 2 Hours later his drain output suddenly increases and becomes hemorrhagic. His blood pressure falls to 90/60 and he is tachycardic and tachypneic. He starts becoming confused. How would you Classify this Hemorrhage?

A patient is undergoing hemiglossectomy and you have to counsel him about the risk of nerve damage. Which nerve might be damaged during this procedure?

A patient of chronic renal failure has ABGs pH 7.23,PC02 = 23.Bicarb 12. What is the interpretation?

A patient presents in OPD with vertical diplopia on downward gaze. You suspect damage to a nerve supplying an extraocular muscle, which nerve would you look for?

A patient presents to you will a platelet count of 20, she is bleeding profusely per vaginally, her blood pressure in 80/50, heart rate 140 and respiratory’ rate is 35. She has rales in bilateral chest. She has a history of viral infection two years ago when she developed high grade fever and mild bleeding from her gums. What is y our diagnosis?

A patient presents to you with CO poisoning. The liver enzymes are increased. Hepatocyte damage occurs due to which of the following processes?

A patient presents with vaginal and gum bleeds, her platelet count is 20,000. She has high grade fever and peri- orbital pain. Her heart rate is 120 and BP is 80/60. What is diagnosis?

A patient reaches emergency following a road traffic accident. He cannot flex his right forearm. Which nerve damage is causing this?

A patient started on ATT complains of numbness of feet after a few weeks, which drug is most likely to have caused it:

What is the most probable cause of decreased urine output, hematuria, and abdominal pain in a patient who has undergone a total abdominal hysterectomy?

A patient undergoing hemodialysis complains of shortness of breath, apprehension; his lung bases are clear but JVP is raised and heart sounds are muffled, what can be the most probable cause?

A patient with a bony lesion that causes severe pain at night when lying down and relieved by ibuprofen, what is the diagnosis?

A patient with chronic hepatitis C, Cirrhosis and massive ascites comes to you with fever,  malaise and abdominal pain. You take a fluid sample of his ascites and are suspecting a bacteria has transmigrated and caused this. What is the likely pathogen involved?

A patient with CKD comes to you with tachycardia, tachypnea and 100/60 blood pressure. His labs come back showing hyperkalemia. What is your first step in management?

A patient with Clinically Significant Macular Edema (CSME) was treated with macular grid photocoagulation. After 3 months the Optical Coherence Tomography (OCT) showed persistent vitreoretinal traction. What is the next line of management?

A patient with febrile neutropenia following chemotherapy presents to you with Shortness of breath.Which antibiotic regimen will you start empirically?

A type I diabetic is diagnosed with oral candidiasis, which medication would you choose?

A young  athlete presented with c/o rash around his mouth, seborrheic dermatitis and hair fall. He gave a history of taking raw eggs as a diet. Which nutritional deficiency can cause his symptoms?

A young boy cries a lot at night and is inconsolable for a few hours after he goes to sleep.  He seems to try to remove something from his anus and insists it is hurting him. During the day  he is fine. What could be the likely cause?

A young boy fell on his right side from bike during an RTA. He had numbness over his dorsal surface of thumb and finger and was unable to extend his arm. X-ray PA and  lateral views   showed fracture of right mid­ shaft of  humerus. The damaged nerve is?

A young boy fell on out stretched hand while playing cricket. O/E there was pain on  movement at wrist joint with tenderness at base of thumb the likely cause is:

A young boy presented with nasal airway obstruction leading to snoring and mouth   breathing. O/E there were b/1 grape like swellings in his middle meatus of nose. What is he suffering from?

A young boy presents to you with no bowel sounds, profuse greenish coloured vomitting, tachycardia, a tense and tender abdomen. What is your first management plan?

A young boy presents to you with recurrent eczema,recurrent sinusitis and diarrhea and a history of bleeding after circumcision.What is your diagnosis?

A young boy with asthma has been using his inhalers regularly. He comes for a follow up visit and you notice a white, cheesy layer on his buccal mucosa. What would have caused this?

A young child presented with fever, coryza and pain in right ear for 2 days. O/E his tympanic  membrane was red and bulging. Most common organism responsible for his symptoms is?

A young college student presented with bloody diarrhea, urgency, abdominal pain (left sided), fever and nocturnal diarrhea, he says that he was on vacation with his friends and smoking reduced his symptoms. What is the likely diagnosis?

A young female diagnosed case of aplastic anemia presented with pain right hypochondrium. Ultrasound showed multiple gallstones. Which type of gallstones can be seen?

A young female lawyer is quite anxious, she presents in the outpatient department with a history of weight loss, alternative diarrhea and constipation, what is likely diagnosis?

A young female presented with  c/o small volume loose stools with evacuation preceded by urgency. She also complained of increased amount of bloating and mucorrhea. There were no other constitutional symptoms and all her investigations were normal. What is the likely diagnosis?

A young female presented with an asymptomatic nodule in front of her right sternocleidomastoid muscle. It did not move with swallowing. FNAC of the nodule showed  thyroid tissue in it. What is the diagnosis?

A young female who is a known case of pulmonary tuberculosis has been taking her medications for the last 3 months. Due to non­ affording status she did not take one medicine. She currently has numbness        and tingling in her fingers. What medication did she not take?

A young female with menorrhagia and easy bruising comes to you for checkup, her PT, APTT are normal, but she has isolated thrombocytopenia her exam is unremarkable. What is the likely diagnosis?

A young girl of 23 years of age presented with abdominal pain, menorrhagia, and 18 weeks size mass in hypogastrium. What can be the diagnosis

A young girl presented with nausea, vomiting and RHC pain for 3 days. She was deeply jaundiced and her LFTs were deranged. She was well oriented in time and place and there were no other complaints. What is the likely diagnosis?

A young girl presented with severe RIF pain. Rebound tenderness was positive. Laparotomy was done as a suspected case of acute appendicitis but on examination her right fallopian tube   was inflamed. What should the surgeon do?