Pleural effusion and lung shadowing (1492/1700)

A retired ship worker has pleural effusion and pleural thickening on right side with bilateral lung shadowing. What would you do to improve his symptoms?

a. Aspiration
b. Chest drain
c. Chemotherapy
d. Diuretic

Space occupying lesion, hyperglycemia (1525/1700)

A 56yo male who presented with epilepsy like symptoms has been dx with an intracranial space occupying lesion. He now complains of thirst and mild dehydration. His blood glucose is also increased. What is the single most appropriate immediate tx?

a. Insulin
b. IV fluids
c. Stop dexamethasone
d. Stop sodium valproate and change to another anti-epileptic

Mass in mediastinum (963/1700)

A 73yo man who was a smoker has quit smoking for the past 3yrs. He now presents with
hoarseness of voice and cough since past 3wks. XR: mass is visible in the mediastinum. What is
the best inv to confirm the dx?

a. Bronchoscopy
b. Thoracoscopy
c. US
d. CT thorax
e. LN biopsy

Cause of fracture (554/1700)

A 72yo man brought to the ED with onset of paraplegia following a trivial fall. He was treated for
prostatic malignancy in the past. What is the single most probable dx?

a. Paget’s disease
b. Osteoporotic fx of vertebre
c. Secondary
d. Multiple myeloma
e. Spondylosis

CT reveals opacity in mediastinum (543/1700)

A 67yo man with hx of weight loss complains of hoarseness of voice. CT reveals opacity in the
right upper mediastinum. He denied any hx of difficulty breathing. What is the single most
appropriate inv?
a. Laryngoscopy
b. Bronchoscopy
c. LN biopsy
d. Bronchoalevolar lavage
e. Barium swallow

Lung cancer histopathology (910/1700)

Pt with a long hx of smoking is now suffering from bronchial ca. histology reveals there are
sheets of large polygonal or giant MNC. What is the most likely dx?
a. Squamous cell ca
b. Small cell ca
c. Adenocarcinoma
d. Large cell ca
e. Oat cell ca

Tamoxifen taken, what to add? (534/1700)

A 64 yo woman has been treated for breast cancer with tamoxifen. What other drug should be
added to her tx regime?
a. Bisphosphonates
b. Calcium
c. Vit D
d. Calcitonin
e. Phosphate binders

Pain control (523/1700)

A man was operated for colorectal ca. His pain is relieved with morphine 60mg bd PO but now
he can’t swallow medications. What will be the next regimen of analgesic administration?
a. Oxycodone
b. Fentanyl patch
c. Morphine 60mg IV/d
d. Morphine 240mg IV/d

Chest infection in lymphoma pt (481/1700)

A pt with hodgkins lymphoma who is under tx develops high fever. His blood results show WBC
<2800 and has a chest infection. Choose the most likely tx?
a. Co-amoxiclav
b. Piperacillin+tazobactam
c. Erythromycin
d. Piperacillin+Co-amoxiclav
e. Penicillin+tazobactam

Mid Third of Tongue white patch - Lymph Node (417/1700)

A 34yo man with a white patch on the margin of the mid-third of the tongue. Which is the single
most appropriate LN involved?

a. External iliac LN
b. Pre-aortic LN
c. Aortic LN
d. Inguinal LN
e. Iliac LN
f. Submental LN
g. Submandibular LN
h. Deep cervical LN

Part of the brain causing Urinary Frequency? (403/1700)

A woman dx with Ca Breast presents now with urinary freq. which part of the brain is the
metastasis spread to?

a. Brain stem
b. Pons
c. Medulla
d. Diencephalon
e. Cerebral cortex

Postural hypotension, diminished reflexes, pupillary response sluggish (396/1700)

A 56 yo lady with lung cancer presents with urinary retention, postural hypotension, diminished
reflexes and sluggish papillary reaction. What is the most likely explanation for her symptoms?
a. Paraneoplastic syndrome
b. Progression of lung cancer
c. Brain metastasis
d. Hyponatremia
e. Spinal cord compression

Supra-clavicular lump (392/1700)

A 57yo man with blood group A complains of symptoms of vomiting, tiredness, weight loss and
palpitations. Exam: hepatomegaly, ascites, palpable left supraclavicular mass. What is the most
likely dx?
a. Gastric carcinoma
b. Colorectal carcinoma
c. Peptic ulcer disease
d. Atrophic gastritic
e. Krukenburg tumor

Supra-clavicular lump (389/1700)

A 60yo man presented with a lump in the left supraclavicular region. His appetite is decreased
and he has lost 5kg recently. What is the most probably dx?

a. Thyroid carcinoma
b. Stomach carcinoma
c. Bronchial carcinoma
d. Mesothelioma
e. Laryngeal carcinoma

Breast cancer patient, confused and thirsty (382/1700)

A 50 yo woman who was treated for breast cancer 3 yrs ago now presents with increase thirst
and confusion. She has become drowsy now. What is the most likely metabolic abnormality?
a. Hypercalcemia
b. Hyperkalemia
c. Hypoglycemia
d. Hyperglycemia
e. Hypocalcemia

Asbestos exposure (377/1700)

A 70yo man admits to asbestos exposure 20yrs ago and has attempted to quit smoking. He has
noted weight loss and hoarseness of voice. Choose the single most likely type of cancer a.w risk
factors present.
a. Basal cell carcinoma
b. Bronchial carcinoma
c. Esophageal carcinoma
d. Nasopharyngeal carcinoma
e. Oral carcinoma

Metastic bowel obstruction (376/1700)

Pt with widespread ovarian carcinoma has bowel obstruction and severe colic for 2h and was
normal in between severe pain for a few hours. What is the most appropriate management?
a. PCA (morphine)
b. Spasmolytics
c. Palliative colostomy
d. Oral morphine
e. Laxatives

Liver cancer, reflux, lung consolidation (362/1700)

A 65yo known case of liver ca and metastasis presents with gastric reflux and bloatedness. On
bone exam there is osteoporosis. He also has basal consolidation in the left lung. What is the
next appropriate step?
a. PPI IV
b. Alendronate
c. IV antibiotics
d. Analgesic
e. PPI PO

Spine tenderness, motor weakness, sensory loss in a cancer pt (1489/1700)

A 73yo woman with skeletal and brain mets from breast ca has worsening low back pain and
blurring of vision. She has weakness of her legs, minimal knee and absent ankle tendon reflexes,
a palpable bladder, a power of 2/5 at the hip, 3/5 at the knee and ankle, and tenderness over
the 2nd lumbar vertebra. There is reduced sensation in the perineum. She has been started on
dexamethasone 16mg daily.What is the single most likely cause of her weakness?
a. Paraneoplastic neuropathy
b. Progression of brain tumor
c. PID at L2/L3
d. Spinal cord compression
e. Steroid induced myopathy

Respiratory infection in a chemo pt (174/1700)

A 72yo man is receiving chemotherapy for SCLC. He had his 4th tx 8 days ago. He has a cough
with some green sputum but feels well. Temp=37.6C. Chest exam = few coarse crepitations in
the right base. HR=92bpm. CBC: Hgb=12.5g/dL, WBC=1.1, Neutrophils=0.6, Plt=89. Sputum,
urine and blood culture sent to microbiology. What is the most appropriate management?
a. Broad spectrum antibiotics IV
b. Broad spectrum antibiotics PO
c. GCSF
d. Postpone tx until bacteriology results available
e. Reassure and send home