MEDICINE PAPER FOR FINAL PROF.2014
Note:
The Bold Option is the Answer of the Question. i.e Question No 1 answer is b.
QUESTION NO1.
A 40 years old woman presents to medical OPD with a three months history of tiredness, weight
loss, and vague abdominal pains, polyuria and polydipsia. Systemic examination is normal except a
Area
/ Topic:_____________________
small mass in front of the neck. Chest X ray normal, RBS 120mg%,
RFTs
& TFTs are normal, Serum
______
calcium 16mg/dl, serum phosphate decreased, alkaline phosphatase 500 IU/liter (normal 20-140).
Ultrasound abdomen shows right renal stones. What is the most likely diagnosis?
a.
b.
c.
d.
e.
Primary hyperparathyroidism
Primary hyperthyroidism
Vitamin D intoxication
Chronic renal failure
Sarcoidosi
QUESTION NO2.
A 35 years old man presents with 7 months history of palpitations and intermittent
diarrhea. He feels restless and hungry and has lost 5 kilos of weight. His heart rate is 120/min and
irregular: BP is 150/70. Examination of the abdomen, nervous system and chest is normal. There is
a swelling in front of his neck. Full blood count, blood sugar and LFTs are normal. Further workup
has confirmed primary hyperthyroidism (increased T3, T4 and decreased TSH). What is the most
common cause of hyperthyroidism?
a.
b.
c.
d.
Multinodular goiter
Toxic adenoma
Graves disease
Thyroiditis
QUESTION NO3:
A 15 years old boy is brought to medical OPD by his mother in drowsy state. He is a known
case of type 1 Diabetes Mellitus. Three days ago he developed productive cough and fever and he
stopped insulin. O/E he is dehydrated, Pulse is 130/min, BP 100/70 mmHg, temperature 104°F. His
breathing is deep and rapid. Crepitations on the right side of the chest. Blood sugar is 500mg/dl,
TLC 16000 with 90% neutrophils, blood urea 60mg/dl and serum creatinine 1.4mg/dl. What is your
most likely diagnosis?
a.
b.
c.
d.
Hyperosmolar non ketotic coma
Hypoglycemic brain injury
Diabetic ketoacidosis
Acute renal failure
QUESTION NO4:
A 45 years old lady has come to the medical OPD with a complaint of increasing fatigue,
somnolence, constipation and body aches. These symptoms have gradually increased over last
two years. Her weight has increased; the menstrual cycle is irregular and has difficulty in hearing.
She looks pale. The skin is dry and the voice is hoarse. The pulse is 59/min and regular. Blood
pressure is 130/80 mmHg. Thyroid function tests confirmed primary hypothyroidism. What is the
most sensitive test for thyroid function?
a.
b.
c.
d.
e.
Thyroid stimulating hormone (TSH)
Radioactive iodine uptake
Antibodies screening test
Thyroid hormones T3, T4
Serum thyroglobulin
QUESTION NO5:
A 42 yrs old female presented with 6 months history of worsening headache with
deteriorating vision in both eyes and polyuria. She is taking treatment for carpel tunnel
syndrome. She has consulted her physician for menstrual irregularities and galactorrhea.
She admitted rapid increase in the size of shoes and tight finger rings. Her BP was 190/110
mmHg and pulse was 82/min. Investigations have confirmed Acromegaly. Which one of
the following is best treatment option for Acromegaly?
a. Trans-sphenoidal surgery
b. GH receptor antagonists
c. Somatostatin analogues
d. Dopamine antagonists
e. Dopamine agonists
QUESTION NO6:
28 years old married lady presented to the medical OPD with the
complaints of weight gain and depression. Examination revealed that she is overweight, BP is
190/100 mmHg. Her skin is thin and there are bruises on the arms and legs. Recently she was
examined by ophthalmologist who found that she had bitemporal hemianopia. The random
blood sugar is 250mg%. You are suspecting Cushing syndrome, which one of the following tests is
the gold standard for confirmation of Dx?
a.
b.
c.
d.
e.
Low dose DM suppression
High dose DM suppression
24 hours urinary cortisol
Serum cortisol levels
Serum ACTH levels
QUESTION NO7:
35 years young man presented with chronic fatigue, lethargy, depression, weight loss and
orthostatic hypotension. His blood pressure is 90/60. Random blood sugar is 90 mg/dl and Serum
sodium 130mEq/l. you have managed this patient well & have confirmed hypocortisolism through
proper investigations. Which one of the following is most common cause of hypocortisolism
(Addison’s disease)?
a.
b.
c.
d.
Sudden withdrawal of steroids
Pituitary gland destruction
Adrenal gland destruction
Adrenal gland tuberculosis
QUESTION NO8:
28 years old married lady presented to the medical OPD with the complaints of
weight gain and depression. Examination revealed that she is overweight, BP is 190/100 mmHg.
Her skin is thin and there are bruises on the arms and legs. The random blood sugar is 250mg%.
You are suspecting hypercortisolism, which one of the following is most common cause of
hypercortisolism?
a.
b.
c.
d.
e.
Autoimmune disease
Exogenous steroids
Pituitary adenoma
Ectopic ACTH focus
Adrenal neoplasm
QUESTION NO9:
A 22 years young man reports with progressive pallor, easy fatigability and lack of
energy for the last 6 months. Eight years ago he was operated after fire arm injury in the right side
of the abdomen, caecum and terminal ileum resected with ileocoloic anastomosis. On
examination, he looks pale; there is no purpura or bruising. Liver and spleen are not enlarged.
Investigations show Hb was 8gm%, MCV 114, RFTs and LFTs normal. Which one of the following is
most likely cause?
a.
b.
c.
d.
Autoimmune hemolytic anemia
Folate deficiency anemia
Iron deficiency anemia
Vitamin B12 deficiency
QUESTION NO10:
60 years male presented with fatigue, weight loss and pain in the left
hypochondrium for the last 6months. On examination there was no lymphadenopathy & he has
huge firm spleen palpable up to the umbilicus (massive splenomegaly). FBC reveals TLC 140000,
Neutrophils= 80%, Lymphocytes=15%, Basophils=5%. Urea, sugar, LFTs & LDH were normal.
Repeated slides for malarial parasites were negative and the portal vein diameter was normal.
What is the most likely diagnosis?
a.
b.
c.
d.
e.
Chronic lymphocytic leukemia
Chronic myeloid leukemia
Iron deficiency anemia
Malignant lymphoma
Multiple myeloma
QUESTION NO11:
A 25 year male was admitted with severe pain all over the chest following
gastroenteritis. The pain was very severe and would response to narcotic analgesic injections. In
the past he had decompression for priapism at the age of ten, ischemic stroke at the age of fifteen
and a vascular necrosis of right femoral head at the age of 20. On examination his temperature is
normal, blood pressure 90/60mmHg, pulse 120, pale, uncomfortable and moaning with pain. His
hemoglobin was 6gm/dl, normal TLC, DLC and platelet count. The mode of inheritance for likely
cause is?
a. Autosomal dominant
b. Autosomal recessive
c. X-linked recessive
d. X-linked dominant
QUESTION NO12:
A sixty years old female with history of auto immune hypothyroidism presented with
weakness. She is also complaining of tingling in her fingers & toes. On examination she is pale and
has loss of vibration and position sense in her feet. Her Hb is 9 gm/dl, TLC, DLC, platelet count,
serum folate, LFTs, RFTs and TFTs normal (taking thyroxin 200 microgram per day). There is no
history of diarrhea or any surgery in the past. Her MCV is 120. Most likely cause for her anemia is?
a.
b.
c.
d.
e.
Autoimmune hemolytic anemia
Anemia of chronic disease
Folate deficiency anemia
Iron deficiency anemia
Pernicious anemia
QUESTION NO13:
A 25 year male was admitted with severe pain all over the chest
following gastroenteritis. The pain was very severe and would response to narcotic analgesic
injections. In the past he had decompression for priapism at the age of ten, ischemic stroke at the
age of fifteen and a vascular necrosis of right femoral head at the age of 20. On examination his
temperature is normal, blood pressure 90/60mmHg, pulse 120, pale, uncomfortable and moaning
with pain. His hemoglobin was 6gm/dl, normal TLC, DLC and platelet count. Which one of the
following tests is used to investigate the cause?
a.
b.
c.
d.
e.
Osmotic fragility test
Metabisulfite test
Schillings test
Coombs test
Hams test
QUESTION NO14:
A 20 years old lady, recently married presents with high grade fever, easy
bruiseability, generalized aches and pains and sore throat. Mother-in-law reports that she had two
episodes of epistaxis and bleeding from gums. She looks pale and toxic. Skin shows purpura and
bruises shins. Pulse 110/min, BP110/80mmHg. Hb 8gm%, Platelets₌ 40,000/mm3 and TLC
₌1500/mm3. You have confirmed Aplastic anemia through bone marrow biopsy. What is the most
common cause of Aplastic anemia?
a.
b.
c.
d.
e.
Cytotoxic drugs
Radiations
Infections
Idiopathic
Thymoma
QUESTION NO15:
A 30 years old lady presents with one year history of easy fatigability,
recurrent weakness of limbs with reversible diplopia, which is worse during the evening time and
better on waking up in the morning. On examination she is hemodynamically stable. On sustained
upward gaze she has decreased frowning of her forehead and develops ptosis. She also has
weakness of her sustained grip. Biochemistry, FBC normal and X-ray chest shows mediastinal
widening. Which of the following will confirm your diagnosis?
a.
b.
c.
d.
Nerve conduction studies
Serum vitamin B12 levels
Electromyography (EMG)
Brain imaging (CT scan)
QUESTION NO16:
A 30 years old lady presents with one year history of easy fatigability,
recurrent weakness of limbs with reversible diplopia, which is worse during the evening time and
better on waking up in the morning. On examination she is hemodynamically stable. On sustained
upward gaze she has decreased frowning of her forehead and develops ptosis. She also has
weakness of her sustained grip. Biochemistry, FBC are normal and X-ray chest shows mediastinal
widening. Which one of the following has strong association with underlying pathology?
a.
b.
c.
d.
Campylobacter jejuni infection
Thymic hyperplasia/Thymoma
Respiratory tract infection
Underlying malignancy
QUESTION NO17:
A 65 years old man presented to your clinic with 2 years history of productive cough of
white sputum and exertional dyspnea for last four months. He is chain smoker for last 35 years.
His echo is normal with ejection friction of 60%, spirometry reveals FEV1/FVC of 50% with
minimal/NO reversibility after 3weeks trial of steroids. Which one is the most likely diagnosis?
a.
b.
c.
d.
e.
Bronchogenic carcinoma
Ischemic heart disease
Asthma exacerbation
Interstitial lung disease
Chronic obstructive pulmonary disease
QUESTION NO18:
A 30 years old lady presents with one year history of easy fatigability, recurrent
weakness of limbs with reversible diplopia, which is worse during the evening time and better on
waking up in the morning. On examination she is hemodynamically stable. On sustained upward
gaze she has decreased frowning of her forehead and develops ptosis. She also has weakness of
her sustained grip. Biochemistry, FBC normal and X-ray chest shows mediastinal widening. Which
of the following is the most your diagnosis?
a.
b.
c.
d.
e.
Guillain-Barre syndrome
Cerebrovascular disease
Myasthenia gravis
Multiple sclerosis
Metastatic cancer
QUESTION NO19:
A 22 years girl had an upper respiratory infection/diarrheal illness about 10 days
back. Now she has developed tingling and weakness in her both lower limbs. Three days later she
developed bladder and bowel incontinence. On examination, the patient has bilateral lower limbs
weakness and loss of reflexes (her knee and ankle jerks are absent bilaterally). FBC, electrolytes,
RFTs and LFTs, X-ray chest and X-rays of lumbar and dorsal spine were normal. What is your most
likely diagnosis?
a.
b.
c.
d.
e.
Guillain-Barre syndrome
Cerebrovascular disease
Myasthenia gravis
Multiple sclerosis
Metastatic cancer
QUESTION NO20:
A 22 years girl had an upper respiratory infection/diarrheal illness about 10 days
back. Now she has developed tingling and weakness in her both lower limbs. Three days later she
developed bladder and bowel incontinence. On examination, the patient has bilateral lower limbs
weakness and loss of reflexes (her knee and ankle jerks are absent bilaterally). FBC, electrolytes,
RFTs and LFTs, X-ray chest and X-rays of lumbar and dorsal spine were normal. Which is
confirmatory test for GBS?
a.
b.
c.
d.
e.
Nerve conduction studies
Serum vitamin B12 levels
Electromyography (EMG)
Brain imaging (CT scan)
LP and CSF analysis
QUESTION NO21:
A 40 years old man brought to emergency department with two days history of high
grade fever, headache, nausea and vomiting. On examination febrile (101F), vitally stable and he is
found to have neck stiffness and photophobia. Rest of the systemic examination is normal.
Investigations showed normal biochemistry, chest x-ray and neutrophilic leukocytosis. What is
your most likely clinical diagnosis?
a.
b.
c.
d.
Subarachnoid hemorrhage
Tuberculous meningitis
Bacterial meningitis
Viral encephalitis
QUESTION NO22:
A 40 years old man brought to emergency department with two days history of
high grade fever, headache, nausea and vomiting. On examination febrile (101F), vitally stable and
he is found to have neck stiffness and photophobia. Rest of the systemic examination is normal.
Investigations showed normal biochemistry, chest x-ray and neutrophilic leukocytosis. Which one
of the following is the investigation of choice to confirm your clinical diagnosis?
a.
b.
c.
d.
Brain imaging
Blood culture
CSF analysis
Blood smear
QUESTION NO23:
A 40 years old man brought to emergency department with two days history of
high grade fever, headache, nausea and vomiting. On examination febrile (101F), vitally stable and
he is found to have neck stiffness and photophobia. Rest of the systemic examination is normal.
Investigations showed normal biochemistry, chest x-ray and neutrophilic leukocytosis. Which one
of the following is most common pathogen responsible for meningitis in adults?
a.
b.
c.
d.
e.
Streptococcus pneumoniae
Neisseria Meningitidis
Staphylococcus aureus
Streptococcus pyogenes
Haemophilus influenza
QUESTION NO24:
A 40 years old man brought to emergency department with two days history of
high grade fever, headache, nausea and vomiting. On examination febrile (101F), vitally stable and
he is found to have neck stiffness and photophobia. Rest of the systemic examination is normal.
Investigations showed normal biochemistry, chest x-ray and neutrophilic leukocytosis. If patient
with meningitis develops a rash, which one of the following is most likely pathogen?
a.
b.
c.
d.
e.
Streptococcus pneumoniae
Staphylococcus aureus
Streptococcus pyogenes
Haemophilus influenza
Neisseria Meningitidis
QUESTION NO25:
A 60 years old gentleman with poorly controlled hypertension presents with
sudden onset severe occipital headache, vomiting and photophobia followed by loss of
consciousness. On examination he is irritable with stiffness of neck with positive kerning’s sign.
Temperature is normal, blood pressure 200/120 and cell counts are normal. What is most likely
clinical diagnosis?
a.
b.
c.
d.
Subarachnoid hemorrhage
Tuberculous meningitis
Bacterial meningitis
Brain abscess/tumors
QUESTION NO26:
A 60 years old gentleman with poorly controlled hypertension presents with
sudden onset severe occipital headache, vomiting and photophobia followed by loss of
consciousness. On examination he is irritable with stiffness of neck with positive kerning’s sign.
Temperature is normal, blood pressure 200/120 and cell counts are normal. What is most likely
cause of this patient illness?
a.
b.
c.
d.
Mycobacterium tuberculosis
Streptococcus pneumoniae
Arteriovenous fistula
Berry aneurysms
QUESTION NO27:
A 40 years old man from poor family from Afghanistan presented with four weeks
history of low grade fever, weight loss, headaches, anorexia and intermittent vomiting. For last
few days he is confused & disoriented. O/E vitally stable, febrile 99F and mild neck stiffness. Rest
of the examination and baseline investigations within normal limits.CSF analysis showed increased
proteins (100mg/dl), decreased sugar (30mg/dl) and increased TLC (2000/mm3) with 90%
lymphocytes. What is your most likely diagnosis?
a.
b.
c.
d.
e.
Subarachnoid hemorrhage
Tuberculous meningitis
Bacterial meningitis
Viral encephalitis
Viral meningitis
QUESTION NO28:
A 32years old woman comes to the emergency department complaining of numbness and
tingling in her right hand for last two days with progressive worsening of symptoms. Three years
back she had an episode of diplopia that lasted for more than 24hours and resolved
spontaneously. O/E increased spasticity in her both lower limbs and hyper-reactive reflexes. What
is your likely diagnosis?
a.
b.
c.
d.
e.
Guillain-Barre syndrome
Cerebrovascular disease
Vitamin B12 deficiency
Myasthenia gravis
Multiple sclerosis
QUESTION NO29:
A 25 years old lady came to the medical OPD with a history of anorexia,
low grade fever, cough and night sweats for the last six months. She has lost five kg of weight. She
looks pale. There is no hepato-splenomegaly or palpable lymph nodes. There are crackles in the
left upper chest. Temperature is 101°F, BP 110/60mm Hg. ESR 95mm at the end of first hour, TLC
9000, neutrophils 70%, lymphocytes 30%. What is the most likely diagnosis?
a.
b.
c.
d.
e.
Interstitial lung disease
Pulmonary tuberculosis
Cystic fibrosis
Bronchiectasis
Pneumonia
QUESTION NO30:
A 25 years old man comes to you with 3 years history of productive cough (greenish
and copious) and fouls smelling breath. For last three days he has hemoptysis, fever and chest
pain with cough. He is very thin, pale, with bilateral clubbing of the fingers and toes. He has coarse
crepitations at the right upper zone. He was successfully treated for pulmonary TB in the past. He
also gives you history of recurrent pneumonias and five times hospitalized for pneumonias. What
is the most likely underlying cause?
a. Interstitial lung disease
b. Pulmonary tuberculosis
c. Bronchogenic carcinoma
d. Bronchiectasis
QUESTION NO31:
A 35 years old female returned from hajj, she had been taking pills to avoid
menstruation. She had a right swollen calf and had been complaining of dyspnea and chest pain.
She collapsed at the airport. At the hospital she was pale and clammy with tachycardia, blood
pressure of 70/40. On examination her JVP was raised, she had a loud P2 at the left sternal border.
Clinical examination revealed clear lung fields. What is the most likely diagnosis?
a.
b.
c.
d.
Pulmonary Thromboembolism
Acute myocardial infarction
Tension Pneumothorax
Left ventricular failure
QUESTION NO32:
A 35 years old female returned from hajj, she had been taking
pills to avoid menstruation. She had a right swollen calf and had been complaining of
dyspnea and chest pain. She collapsed at the airport. At the hospital she was pale and
clammy with tachycardia, blood pressure of 70/40. O/E her JVP was raised, she had a loud
P2 at the left sternal border and clear lung fields. What is the gold standard test to confirm
Dx of Pulmonary Thromboembolism?
a.
b.
c.
d.
e.
Magnetic resonance Imaging
CT pulmonary angiogram
Ventilation perfusion scan
High resolution CT scan
D-dimers assay
QUESTION NO33:
A 25 years old man comes to you with 3 years history of productive cough
(greenish and copious) and fouls smelling breath. He is very thin, pale, with bilateral clubbing of
the fingers and toes. He has coarse crepitations at the right upper zone. He was successfully
treated for pulmonary TB in the past. You suspect bronchiectasis and you order for HRCT. Which of
the following is not a cause of bronchiectasis?
a.
b.
c.
d.
e.
Recurrent pneumonias
Bronchogenic carcinoma
Left ventricular failure
Kartagener syndrome
Cystic fibrosis
QUESTION NO34:
A 25 years old man comes to you with 3 years history of productive cough (greenish and copious)
and fouls smelling breath. He is very thin, pale, with bilateral clubbing of the fingers and toes. He
has coarse crepitations at the right upper zone. He was successfully treated for pulmonary TB in
the past. Recalling causes of clubbing which of the following is not a cause of clubbing.
a. Malignant Mesothelioma
b. Bronchogenic carcinoma
c. Cystic fibrosis
d. COPD/asthma
e. Empyema
QUESTION NO35:
A 19 years old man is brought to casualty department complaining of sudden onset of right
sided chest pain and rapidly progressive breathlessness for the last six hours for the first time in
his life. He is irritable and cyanosed. Pulse is 125/min regular. BP is 70/30. Trachea is displaced
towards left. Hyper-resonant to percussion and breath sounds are absent on the right side. What
is the most likely diagnosis?
a.
b.
c.
d.
e.
Pulmonary thromboembolism
Right sided Pneumothorax
Right sided pleural effusion
Acute asthma exacerbation
Right sided pneumonia
QUESTION NO36:
A 19 years old man is brought to casualty department complaining of sudden
onset of right sided chest pain and rapidly progressive breathlessness for the last six hours for the
first time in his life. He is irritable and cyanosed. Pulse is 125/min regular. BP is 70/30. Trachea
displaced towards left, Hyper-resonant percussion and decreased breath sounds on the right side.
What is the most appropriate first step imaging modality?
a.
b.
c.
d.
e.
Magnetic resonance Imaging
CT pulmonary angiogram
Ventilation perfusion scan
High resolution CT scan
Chest X-ray
QUESTION NO37:
A 66 years old man presented with ON/OFF retrosternal chest pain of 2years.
Each attack lasts for LESS THAN 5 minutes, triggered by stress/exertion and relieved by
rest and nitroglycerine. He is diabetic for last 22years, Hypertensive for last 20years and
smokers for last 18years. Examination and resting ECG normal. What is the most likely
diagnosis?
a.
b.
c.
d.
Myocardial infarction
Unstable angina
Prinzmital angina
Stable angina
QUESTION NO38:
A 50 years old obese man with BMI>35 (otherwise asymptomatic) is referred to you by
general practitioner for his persistently raised BP. You are suspecting secondary hypertension in
this patient. Recalling causes of secondary hypertension, which one of the following list is not the
cause of secondary hypertension.
a. Polycystic kidney disease
b. Pheochromocytoma
c. Cushing syndrome
d. Addison’s disease
e. Hyperthyroidism
QUESTION NO39:
26 years old unmarried man has returned from Hong Kong where he spent two months.
He is complaining of profuse pus from urethra. Systemic examination is normal. He confessed
sexual promiscuity. There is no lymphadenopathy or ulceration. What is the most likely diagnosis
in this case?
a.
b.
c.
d.
HSV-2 infection
Gonorrhea
HIV/AIDs
Syphilis
QUESTION NO40:
A 25 years college student, very fond of eating outside home, presents with a two
weeks history of high grade continuous fever and constipation. O/E he looks toxic, pale and
febrile. Temperature 102°F, he looks moderately dehydrated with centrally coated tongue.
Palpable Soft spleen and rose spot skin rashes on his abdomen and chest. His pulse is 62/min
regular, temperature 102°F, BP 110/70. Neutropenia on FBC repeated MP smears negative. What
is the most diagnostic test for confirmation of Enteric fever?
a.
b.
c.
d.
Typhidot test
Blood culture
Blood smear
Widal test
QUESTION NO41:
A 23 year old man (recently married) presents with a week’s history of fever and sore
throat. He developed a macular rash after taking Ampicillin, prescribed by his general practitioner.
One examination he has enlarged posterior cervical nodes, palatal petechiae and splenomegaly.
What is your diagnosis?
a.
b.
c.
d.
Infectious mononucleosis
Streptococcal pharyngitis
Oral mucocandidiasis
Herpes simplex type2
QUESTION NO42:
A 40 years old woman presented with severe pain epigastrium that radiates to back is
accompanied by nausea and vomiting. Examination revealed Periumbilical bruising and tenderness
in epigastrium. Serum amylase elevated (10 times above the upper limit) which confirms acute
pancreatitis. What is the most common cause of acute pancreatitis in our country?
a.
b.
c.
d.
e.
Abdominal trauma
Thiazide diuretics
Alcohol intake
hypercalcemia
Gall stones
QUESTION NO43:
A 20 years old sexually promiscuous active man, who has frequently travelled
abroad, presents with severe weight loss and chronic watery diarrhea. He also complains of
productive cough and difficulty in swallowing. On examination he is pale and has generalized
painless lymph node enlargement and extensive oral ulcerations. His White cell count is
6000/mm3 with only 4% lymphocytes. What is the most likely diagnosis?
a.
b.
c.
d.
e.
Infectious mononucleosis
Milliary Tuberculosis
Malignant lymphoma
Metastatic cancer
Acquired immune Deficiency syndrome
QUESTION NO44:
A 30 yrs old obese, hypertensive person is admitted to medical ward with one day
History of severe pain and swelling at the base of right toe. O/E the involved joint is tender,
swollen and has overlying red & shiny skin. He has history of similar attacks in the past. This
patient has gout and it is secondary to an ANTIHYPERTENSIVE DRUG. Which one of the following
drugs he is taking for blood pressure control?
a.
b.
c.
d.
e.
Calcium channel blockers
Thiazide diuretics
ACE inhibitors
Loop diuretics
Beta blockers
QUESTION NO45:
A 60 years male presented with fatigue weight loss and pain in the left
hypochondrium for 6months. On examination there was no lymphadenopathy & he has huge firm
spleen palpable up to the umbilicus (massive splenomegaly). Blood smears and bone marrow
biopsy results confirmed your clinical suspicion of CML. Which one of the following is the most
appropriate step in management?
a.
b.
c.
d.
e.
Bone marrow transplantation
Tyrosine kinase inhibitor
Repeated transfusions
Hydroxycarbamide
Beta interferon