Explanation

(Option C) Glaucoma: Glaucoma is a group of eye conditions characterized by elevated intraocular pressure (IOP) that can cause damage to the optic nerve, leading to vision loss. Acute angle-closure glaucoma presents with sudden, severe eye pain, headache, blurred vision, and halos around lights, which are symptoms consistent with the case described. This condition is a medical emergency that requires immediate attention.

(Option A) Cataract: Cataracts typically cause a gradual, painless clouding of the eye's lens, leading to blurred vision. While they can cause visual disturbances, they don't typically result in acute severe eye pain, headaches, or halos around lights. Furthermore, cataracts do not directly affect intraocular pressure.

(Option B) Uveitis: Uveitis is an inflammation of the uvea, the middle layer of the eye. It can cause eye pain, redness, and blurred vision, but it does not usually lead to acute severe eye pain, elevated intraocular pressure, or halos around lights.

(Option D) Macular degeneration: Macular degeneration affects the macula, the central part of the retina responsible for central vision. It typically leads to gradual central vision loss, distortion, and blurriness. While it can cause visual disturbances, it is not associated with acute severe eye pain, elevated intraocular pressure, or halos around lights.

(Option E) Retinal detachment: While retinal detachment can cause sudden vision changes, it is not commonly associated with acute eye pain, headache, or significant elevation of intraocular pressure.

Subject: Ophthalmology

System/ Title: Visual System

Topic: Glaucoma

Glaucoma

Illustration showing open-angle glaucoma. Intraocular pressure in the back of the eye

Explanation

(Option B) Pulmonary Embolism (PE): PE occurs when a blood clot (usually originating from the leg veins, called deep vein thrombosis or DVT) travels to the lungs, obstructing blood flow in the pulmonary arteries. This can lead to sudden onset dyspnea, tachycardia, and even shock due to decreased oxygenation and cardiac strain. In the given scenario, the presence of sudden onset dyspnea, sinus tachycardia on ECG, and the patient being in shock raises the suspicion of a pulmonary embolism.

(Option A) Acute respiratory distress syndrome (ARDS): ARDS is a severe lung condition characterized by rapid onset of dyspnea, low oxygen levels, and bilateral lung infiltrates on imaging. It can be caused by various factors such as pneumonia, sepsis, trauma, or inhalation of harmful substances. However, in this case, there is no mention of bilateral lung infiltrates on the physical examination or the ECG, making ARDS less likely.

(Option C) Acute Pericarditis: Acute pericarditis is inflammation of the pericardium, the membrane surrounding the heart. It can cause chest pain that worsens with breathing, a pericardial friction rub on physical examination, and characteristic ECG changes such as widespread ST-segment elevation. Since there are no new signs on the physical examination and the ECG shows sinus tachycardia without ST-segment changes, acute pericarditis is less likely.

(Option D) Septicemia: Septicemia, also known as sepsis, is a severe and life-threatening response to an infection that has spread throughout the bloodstream. It can lead to shock and multiple organ dysfunction. While septicemia can cause dyspnea, the information provided in the scenario does not indicate any signs of infection or sepsis.

Subject: Internal Medicine

System: CVS

Topic: Stroke with Dyspnea

Explanation

The abnormalities described in the baby (small abnormal-shaped ear, mandibular hyperplasia, cleft palate, and heart defect) are characteristic features of a group of birth defects known as "retinoic acid embryopathy." Retinoic acid is derived from Vitamin A, and excessive intake of Vitamin A during pregnancy, whether through dietary sources or medication, can lead to these congenital anomalies.

(Option A) Vitamin A: Excessive intake of Vitamin A during pregnancy, especially in the form of retinoids (a type of Vitamin A derivative), can lead to a range of birth defects, including those mentioned in the question. These defects are collectively known as retinoic acid embryopathy.

(Option B) Vitamin C: Vitamin C, also known as ascorbic acid, is generally considered safe during pregnancy and is not associated with the mentioned birth defects. It plays a crucial role in collagen synthesis and overall health, but it does not cause these specific abnormalities.

(Option C) Vitamin D: Vitamin D (Calciferol) is essential for calcium absorption and bone health. While Vitamin D deficiency during pregnancy can have adverse effects, it is not responsible for the specific birth defects mentioned in the question.

(Option D) Vitamin E: Vitamin E (Tocopherol) is an antioxidant that is generally considered safe during pregnancy. It is not known to cause the specific abnormalities described in the baby.

(Option E) Vitamin B3: While Vitamin B3 deficiency (niacin) during pregnancy can lead to birth defects, the described abnormalities are not commonly associated with niacin deficiency.

Subject: Biochemistry

System/ Title: Vitamins

Topic: Vitamin-Induced Birth Defects and Teratology

Teratogenic factors disrupt the normal morphogenesis of the neural crest by acting at different developmental stages during embryogenesis. In humans, these agents are transmitted through the placenta from the mother’s blood and alter the various morphogenetic processes that take place during neural crest formation. After a particular teratogenic agent has passed through the placental barrier, it affects embryonic development at multiple levels including epigenetic dysregulation such as histone modification, DNA methylation, altered transcriptional response, interference with signaling pathways and the production of reactive oxygen species.

Explanation

(Option C) Ischial spine: The ischial spine is a bony projection located on the ischium, which is one of the bones that make up the pelvis. The ischial spine serves as an attachment site for the hamstring muscles, specifically the tendons of the three hamstring muscles: semitendinosus, semimembranosus, and biceps femoris. These muscles originate from the ischial tuberosity, which is located just inferior to the ischial spine. A pulled hamstring, also known as a hamstring strain, occurs when there is an overstretching or tearing of these hamstring muscles or their tendons.

(Option A) Obturator membrane: The obturator membrane is a thin, fibrous sheet that covers the obturator foramen, which is an opening in the hip bone. This membrane serves as an attachment site for various muscles, but it is not directly related to the posterior thigh muscles that are affected in a pulled hamstring.

(Option B) Iliac spine: The iliac spine refers to various bony prominences in the pelvis, such as the anterior superior iliac spine (ASIS) and the posterior superior iliac spine (PSIS). While these bony landmarks provide attachment points for several muscles, they are not associated with the posterior thigh muscles responsible for a pulled hamstring.

(Option D) Sacrum: The sacrum is a triangular bone located at the base of the spine, formed by the fusion of several vertebrae. It provides support for the spine and is an attachment site for various ligaments and muscles. However, it is not specifically related to the attachment of the posterior thigh muscles responsible for a pulled hamstring.

(Option E) Femoral condyle: The femoral condyle is a part of the femur bone in the thigh, but it is not the attachment site for the hamstring muscles. The hamstring muscles primarily attach to the ischial tuberosity.

Subject: Anatomy

System/ Title: Musculoskeletal System

Topic: Hamstring Muscle Attachment

Explanation

(Option A) Situation analysis: This step involves gathering and analyzing information about the current situation and identifying the needs, problems, and opportunities related to the establishment of the hospital in the outskirts of the city. It includes studying the demographics, health indicators, existing healthcare facilities, accessibility, and other relevant factors. The purpose of the situation analysis is to gain a comprehensive understanding of the context in order to make informed decisions during the planning process.

(Option B) Plan formulation: After completing the situation analysis, the next step is plan formulation. This involves developing a strategic plan based on the information gathered during the situation analysis. The plan will outline the goals, objectives, and strategies for establishing the hospital, including aspects such as infrastructure, staffing, medical equipment, and services to be provided. Plan formulation requires careful consideration of various factors, including the available resources, budget constraints, and the needs of the community.

(Option C) Implementation: Once the strategic plan has been formulated, the next step is to implement it. Implementation involves putting the plan into action by mobilizing the necessary resources, initiating construction, hiring staff, procuring medical equipment, and organizing the operational aspects of the hospital. This phase requires effective coordination, communication, and management to ensure a smooth execution of the plan.

(Option D) Evaluation: Evaluation is the final step of the planning cycle. It involves assessing the effectiveness and efficiency of the implemented plan. The evaluation process measures the extent to which the hospital has achieved its intended goals and objectives. It also identifies any shortcomings or areas for improvement. Evaluation helps in making informed decisions for future planning cycles and ensures that the hospital continues to meet the needs of the community effectively.

(Option E) Need Assessment: While need assessment is an important component, it typically falls within the broader scope of situation analysis. Needs assessment involves identifying and prioritizing the specific requirements of the community, and it is often one of the initial steps within the situation analysis phase.

Subject: Ethics, Management & General

System/ Title: Healthcare Management

Topic: Healthcare Planning

Explanation
(Option A) Chronic Pharyngitis: Chronic pharyngitis is the inflammation of the pharynx
(the back of the throat) that lasts for an extended period. It can lead to symptoms such
as hoarseness, difficulty in swallowing, cough, and mild fever, which is consistent with
the patient's presentation. It is often caused by repeated exposure to irritants like
smoking, pollution, or allergies. Frequent infections, such as viral or bacterial infections,
can also contribute to chronic pharyngitis. The symptoms can come and go over time,
leading to recurrent episodes of throat discomfort.
(Option B) Chronic Tonsillitis: Chronic tonsillitis is a condition where the tonsils, which
are located at the back of the throat, remain inflamed and infected for an extended
period. Symptoms include sore throat, difficulty swallowing, and recurrent throat
infections. While this condition can cause similar symptoms to chronic pharyngitis, the
distinguishing feature is the involvement of the tonsils.

(Option C) Enlarged Adenoids: Enlarged adenoids are a common condition in
children, but it can also affect adults. The adenoids are lymphoid tissues located in the
upper part of the throat, behind the nose. When they become enlarged, they can lead to
symptoms like difficulty breathing through the nose, nasal congestion, and sometimes
difficulty swallowing. While the patient's symptoms overlap with enlarged adenoids, it is
less likely to be the diagnosis in a 31-year-old male who gets these symptoms off and
on.
(Option D) Peritonsillar Abscess: A peritonsillar abscess is a collection of pus that
forms near the tonsils, usually as a complication of acute tonsillitis. It can cause severe
throat pain, difficulty swallowing, and fever. While the patient's symptoms do include
fever, the presence of an abscess would typically cause more severe, localized
symptoms such as significant throat pain and swelling on one side of the throat.
(Option E) Laryngopharyngeal Reflux (LPR): LPR, a form of acid reflux affecting the throat, can cause hoarseness and cough. However, it is less likely to present with a mild fever, which makes it less likely.

Subject: ENT
System: Throat
Topic: Oropharyngeal Conditions

Explanation
(Option A) Prolonged latent phase: Prolonged latent phase refers to the early stage of
labor during which the cervix is dilating slowly or not at all, and contractions may be
irregular or not very strong. In this case, the patient has been experiencing regular
contractions for 16 hours but has only reached 2 cm of cervical dilatation, which is
indicative of a prolonged latent phase. This can occur in some women during the early
stages of labor, and it often requires time and patience for the cervix to efface and dilate
further.
(Option B) Obstructed labor: Obstructed labor is a condition where there is an
obstruction preventing the fetus from descending through the birth canal, usually due to
physical factors such as a large baby, an abnormal presentation (e.g., breech), or
maternal pelvic abnormalities. However, the scenario described does not indicate any
signs of obstruction; it primarily suggests a slow progression of labor.
(Option C) Pre-term labor: Pre-term labor refers to labor that occurs before 37 weeks
of gestation. The patient in this scenario is at 40 weeks of gestation, so pre-term labor is
not the correct diagnosis.
(Option D) Normal labor progress: Normal labor progress typically involves the cervix
gradually dilating and effacing, with contractions becoming more regular and stronger.
While the patient's fetal heart rate is reassuring, her slow cervical dilation (2 cm after 16
hours of contractions) suggests that she is experiencing a prolonged latent phase rather
than normal labor progress.
(Option E) Cervical Incompetence: Cervical incompetence usually presents with
painless cervical dilation and is not typically associated with regular contractions and
high fetal station. This option is not the most appropriate diagnosis for the scenario
described.

Subject: Obstetrics and Gynecology
System/ Title: Pregnancy & Childbirth (Labor)
Topic: Labor and Delivery

Explanation
(Option C) Isoniazid: Isoniazid is a first-line anti-tuberculosis drug that can cause
peripheral neuropathy as a side effect. The symptoms of peripheral neuropathy include
pain, tingling, and numbness in the limbs, particularly the hands and feet. This side
effect is more common in patients with pre-existing conditions such as malnutrition,
alcoholism, and diabetes. The risk of developing peripheral neuropathy can also be
reduced by the co-administration of pyridoxine (vitamin B6) with isoniazid.
(Option A) Ethambutol: It is another first-line drug used in the treatment of tuberculosis,
but it is not known to cause peripheral neuropathy. However, it can cause optic neuritis,
which can lead to blurred vision and color blindness.
(Option B) Pyrazinamide: It is also a first-line drug used in the treatment of
tuberculosis. It can cause liver toxicity and joint pain, but it is not known to cause
peripheral neuropathy.
(Option D) Streptomycin: It is a second-line drug used in the treatment of tuberculosis,
and it is not known to cause peripheral neuropathy. However, it can cause hearing loss
and kidney damage.
(Option E) Rifampin: Rifampin is not typically associated with neuropathic symptoms in
the legs.

Subject: Pharmacology
System/ Title: Respiratory System
Topic: Adverse Effects of Anti-tuberculosis Medications

Explanation

(Option A) ASO titre: The ASO titre is a blood test used to detect the presence of
antibodies called anti-streptolysin O in the blood. Streptolysin O is produced by certain
strains of Streptococcus bacteria, which can cause infections such as strep throat. The
ASO titre test is commonly used to diagnose a previous or ongoing streptococcal
infection. Here, the girl had a sore throat a few weeks ago, which may have been
caused by a streptococcal infection. If the ASO titre is elevated, it suggests that the girl
had a recent streptococcal infection, which can lead to complications such as rheumatic
fever.
(Option B) Auto antibodies: Autoantibodies are antibodies that mistakenly target and
attack a person's own tissues or organs. While autoantibodies are important in
diagnosing autoimmune diseases, they are not the most helpful investigation in this
case. The girl's symptoms and history point more towards a possible infectious cause rather than an autoimmune condition.
(Option C) Blood picture and ESR (Erythrocyte Sedimentation Rate): A complete blood picture (CBC) can provide information about the levels of different blood cells, including white blood cells, which can indicate the presence of infection. ESR is a non-specific blood test that measures the rate at which red blood cells settle in a test tube
over time. It can be elevated in conditions associated with inflammation, including
infections. While these tests can provide supportive information, they are not specific for
identifying the cause of the girl's symptoms.
(Option D) X-ray chest PA: An X-ray chest PA (posteroanterior) is a radiological
investigation that primarily evaluates the lungs and heart. It is not directly related to the
girl's symptoms of fever and swollen knee. While a chest X-ray may be useful in some cases, such as suspected lung infections or certain systemic diseases, it is not the most helpful investigation in this specific scenario.

Subject: Pediatrics
System: Infectious Disease
Topic: Post-Streptococcal Complications in Pediatrics

Explanation
(Option C) Necrotizing fasciitis: Necrotizing fasciitis is a rapidly progressing soft tissue
infection characterized by extensive necrosis of the subcutaneous tissue and fascia. It
commonly presents with symptoms such as erythema, edema, severe pain, and
crepitus due to gas production by anaerobic bacteria. This condition is a surgical
emergency requiring prompt diagnosis and aggressive treatment, often including
surgical debridement and antibiotics.
(Option A) Cellulitis: Cellulitis is a bacterial skin infection that affects the deeper layers
of the skin. It typically presents with erythema, warmth, swelling, and tenderness but
does not involve necrosis or gas production. It is usually treated with oral or intravenous
antibiotics depending on the severity.
(Option B) Gas gangrene: Gas gangrene, also known as clostridial myonecrosis, is a
severe and potentially life-threatening infection caused by Clostridium bacteria. It leads
to muscle necrosis and gas production within the tissue, resulting in crepitus. However,
unlike necrotizing fasciitis, gas gangrene primarily affects the muscle tissue rather than
the subcutaneous tissue and fascia.
(Option D) Pyomyositis: Pyomyositis is a bacterial infection of the skeletal muscles,
typically caused by Staphylococcus aureus. It presents with localized muscle pain,
swelling, and sometimes fever. While it can cause tissue necrosis in severe cases, it
does not usually present with the rapid progression and extensive tissue involvement
characteristic of necrotizing fasciitis.
(Option E) Erysipelas: Erysipelas is a superficial bacterial skin infection that affects the
upper dermis and superficial lymphatics. It presents with well-demarcated, raised,
erythematous lesions and is commonly associated with streptococcal bacteria. Unlike
necrotizing fasciitis, it does not involve necrosis of deeper tissue layers or produce gas.
Treatment typically involves antibiotics directed against the causative bacteria.

Subject: Surgery
System: Integumentary System (Dermatology) - Skin
Topic: Soft Tissue Infections (Surgical Site Infections)

Anatomy of skin and soft tissue structures and layers commonly involved with various infectious processes

Skin and soft tissue infections

Explanation
(Option D) Digoxin with diuretic: Digoxin is a medication that can help control heart
rate in patients with atrial fibrillation. It is especially useful in cases where the irregular
heartbeat is causing symptoms like dyspnea. It helps to slow down the heart rate and
improve cardiac output. However, digoxin is not used alone in cases of heart failure; it is
often combined with a diuretic like frusemide to manage fluid overload and reduce strain
on the heart.
(Option A) Injection frusemide: Frusemide, also known as furosemide, is a loop
diuretic used to treat fluid retention (edema) in conditions such as congestive heart

failure. While it can help reduce fluid buildup in the lungs and alleviate dyspnea, it does
not address the underlying issue of atrial fibrillation.
(Option B) ACE Inhibitor: ACE (Angiotensin-Converting Enzyme) inhibitors are
commonly used to treat hypertension and heart failure. While they are beneficial in
some cases, they are not the primary treatment for atrial fibrillation. They may be
prescribed in certain patients with atrial fibrillation who also have coexisting conditions
like hypertension or heart failure.
(Option C) Nitrates: Nitrates, such as nitroglycerin, are vasodilators used primarily to
treat angina (chest pain) and certain heart conditions. They do not have a direct effect
on atrial fibrillation and, therefore, are not the drug of choice for this condition.

Subject: Internal Medicine
System: CVS
Topic: Atrial Fibrillation

Explanation

Neurogenic shock is a type of distributive shock that occurs due to the loss of
sympathetic tone leading to vasodilation and subsequent decreased peripheral vascular
resistance. This condition commonly occurs following spinal cord injury, particularly
cervical spine injury.
(Option E) Hypothermia: Hypothermia is commonly associated with neurogenic shock
due to the loss of sympathetic tone, which impairs the body's ability to regulate
temperature. Vasodilation leads to heat loss from the skin surface, contributing to
hypothermia. The combination of low blood pressure, bradycardia, and hypothermia
characterizes neurogenic shock.
(Option A) Hypoglycemia: Neurogenic shock is not typically associated with
hypoglycemia. In fact, stress response often leads to hyperglycemia rather than
hypoglycemia.
(Option B) Hypernatremia: Neurogenic shock does not typically lead to hypernatremia.
In this condition, there is often fluid loss due to vasodilation, which could potentially lead
to hyponatremia rather than hypernatremia.
(Option C) Metabolic alkalosis: Neurogenic shock is not associated with metabolic
alkalosis. Instead, it can lead to metabolic acidosis due to tissue hypoperfusion and
anaerobic metabolism.
(Option D) Respiratory acidosis: While respiratory complications may occur in spinal
cord injury, respiratory acidosis is not typically a metabolic characteristic associated
specifically with neurogenic shock.
Subject: Surgery
System: Nervous System (Neurosurgery)
Topic: Metabolic Response to Neurogenic Shock in Spinal Cord Injury

Metabolic
Response

Explanation
(Option C) Tetralogy of Fallot (TOF): Tetralogy of Fallot is a congenital heart defect that
involves four distinct abnormalities within the heart's structure. One of the characteristic
features of TOF is the "boot-shaped" heart appearance on X-rays. This is due to the
combination of several structural issues within the heart, including:

1. Ventricular Septal Defect (VSD): This is a hole in the wall that separates the two lower
chambers (ventricles) of the heart. It allows oxygen-rich and oxygen-poor blood to mix,
which can lead to reduced oxygen levels in the body.
2. Pulmonary Stenosis: This refers to the narrowing or constriction of the pulmonary valve
or the pulmonary artery. This narrowing obstructs the flow of blood from the right
ventricle to the lungs, leading to reduced blood flow to the lungs for oxygenation.
3. Right Ventricular Hypertrophy: The right ventricle becomes thicker and more muscular
because of working harder to pump blood against the narrowed pulmonary valve. This
can contribute to the distinctive "boot-shaped" appearance on X-rays.
4. Overriding Aorta: In TOF, the aorta, which is normally connected to the left ventricle, is positioned in such a way that it partially overrides the ventricular septal defect. This
allows oxygen-poor blood from the right ventricle to be pumped into the aorta and
distributed to the body.
(Option A) Atrial Septal Defect (ASD): An ASD is a hole in the wall between the two
upper chambers (atria) of the heart. This would not typically lead to a boot-shaped heart
appearance on X-rays.
(Option B) Transposition of the Great Arteries (TGA): TGA is a condition where the positions of the two main arteries, the aorta and the pulmonary artery, are switched.
This results in two separate circulatory systems—one for oxygen-poor blood and one for
oxygen-rich blood. While TGA can cause significant health issues, it doesn't typically result in a boot-shaped heart appearance on X-rays.
(Option D) Turner Syndrome (Turner's): Turner Syndrome is a genetic disorder that affects females and is caused by the absence or abnormality of one of the X
chromosomes. While it can be associated with certain heart defects, it is not specifically
known for causing a boot-shaped heart appearance on X-rays.

Subject: Pediatrics
System: CVS
Topic: Congenital Heart Disorders

Congenital Heart Disorders are structural and functional abnormalities of the heart that
exist at birth. These conditions result from irregular development during fetal growth and
can impact the heart's chambers, valves, or major blood vessels. These disorders can

vary widely in severity, ranging from minor issues that may not require treatment to
complex and life-threatening conditions. Common examples include Ventricular Septal
Defects (VSDs), Atrial Septal Defects (ASDs), Tetralogy of Fallot, and Transposition of
the Great Arteries.

Explanation
(Option B) X-ray: X-ray is the initial imaging modality of choice for diagnosing
osteoarthritis. It can reveal joint space narrowing, osteophyte (bone spur) formation, and
subchondral sclerosis (hardening of bone beneath the cartilage). These findings are
characteristic of osteoarthritis and can confirm the diagnosis.
(Option A) MRI (Magnetic Resonance Imaging): While MRI provides detailed images
of soft tissues like ligaments, tendons, and cartilage, it is generally not the initial imaging
modality for osteoarthritis diagnosis unless there are suspicions of other concurrent
pathologies such as ligamentous or meniscal tears. It's more useful for assessing soft
tissue injuries and is often used if X-ray results are inconclusive or if there are additional
concerns.
(Option C) Ultrasound: Ultrasound is not typically used as the primary imaging modality
for diagnosing osteoarthritis. It is more useful for evaluating soft tissue structures like
tendons and ligaments. While it may show joint effusion (fluid within the joint) or
synovitis (inflammation of the joint lining), it may not provide the detailed visualization
necessary for confirming osteoarthritis.
(Option D) CT scan (Computed Tomography): CT scans provide detailed images of
bones and can identify bony abnormalities and bone density changes. However, it is not
typically used as the initial imaging modality for diagnosing osteoarthritis unless there
are specific reasons to assess bone architecture in more detail, such as planning for
surgical intervention.
(Option E) Bone scan: Bone scans are not typically used for diagnosing osteoarthritis.
They are more useful for detecting areas of increased bone turnover, such as in cases
of bone metastasis or infection. In the context of chronic knee pain, it is not the most
appropriate imaging modality for confirming osteoarthritis.

Subject: Surgery

System: Orthopedic (Musculoskeletal Trauma)
Topic: Osteoarthritis of the Knee

patient needs

Knee OA features and pathologies with respect to healthy knee

Explanation
(Option C) Brain CT Scan: A CT (computed tomography) scan of the brain is a non-
invasive imaging technique that provides detailed cross-sectional images of the brain's
structure. It's particularly useful in quickly assessing cases of sudden neurological
deficits like the patient's right-sided weakness. It can help identify conditions such as stroke, bleeding, tumors, or other abnormalities that might be causing the symptoms.
Due to its speed and availability in most emergency settings, a brain CT scan is often
the initial investigation of choice for cases like this.

(Option A) Cerebral Angiography: Cerebral angiography involves injecting a contrast
dye into blood vessels to visualize the blood flow in the brain. While it can provide
detailed images of blood vessels, it's an invasive procedure and is not typically used asa first-line investigation for a patient with sudden onset weakness. It's usually reserved for cases where there's suspicion of specific vascular issues, such as an aneurysm or arteriovenous malformation.
(Option B) Analysis of Cerebrospinal Fluid: This involves collecting and analyzing
cerebrospinal fluid (CSF) that surrounds the brain and spinal cord. CSF examination is
more relevant when there's suspicion of infections, bleeding, or certain neurological
conditions. While it can provide valuable diagnostic information, it's not usually the initial
investigation for sudden weakness unless other factors suggest it might be necessary.
(Option D) Fasting Lipid Profile: A fasting lipid profile measures the levels of
cholesterol and triglycerides in the blood. While high lipid levels can contribute to
cardiovascular diseases, they are not the primary concern in a patient presenting with
sudden right-sided body weakness. Lipid profiles are more relevant for assessing heart
health rather than sudden neurological symptoms.
(Option E) Electrocardiogram (ECG): While an ECG is not a direct imaging study of
the brain, it can be relevant in cases of sudden neurological symptoms. Cardioembolic
strokes, for example, can be associated with certain heart conditions. However, for
immediate visualization of potential structural brain abnormalities, a brain CT scan is
generally more informative.

Subject: Internal Medicine
System: Nervous Systemy
Topic: Neurological Emergencies

Explanation
(Option B) Renal cell carcinoma: Renal cell carcinoma is a type of kidney cancer that
often presents with symptoms like hematuria, flank pain, and a solid, enhancing renal
mass on imaging. Smoking is a known risk factor for renal cell carcinoma, which further
supports this diagnosis.
(Option A) Benign prostatic hyperplasia (BPH): BPH is a non-cancerous enlargement
of the prostate gland, which is located in the male urinary system. It can cause urinary
symptoms like difficulty urinating, but it typically does not present with hematuria (blood
in the urine).
(Option C) Bladder cancer: Bladder cancer can also cause hematuria, but it usually
arises in the bladder itself, not in the renal (kidney) tissue. While bladder cancer can
sometimes be seen on imaging studies, it typically presents with different patterns and
characteristics on imaging than renal cell carcinoma.
(Option D) Testicular cancer: Testicular cancer usually presents as a painless mass or
lump in the testicles. It does not typically cause hematuria or have imaging findings in
the kidneys.

Subject: Surgery
System: Renal System (Genitournary)
Topic: Renal Mass with Hematuria

Explanation
(Option A) Complete Blood Count (CBC): This test measures various components of
the blood, including red blood cells, white blood cells, and platelets. In the context of
coagulation status assessment, the CBC provides valuable information such as the
platelet count and hemoglobin level. Platelets are essential for blood clotting, and a low
platelet count (thrombocytopenia) can indicate an increased risk of bleeding during
surgery. Hemoglobin levels are important for assessing an individual's overall blood volume and oxygen-carrying capacity. Abnormalities in hemoglobin levels may affect a patient's ability to tolerate surgery and can also be related to bleeding tendencies.
(Option B) Serum Electrolyte Panel: This test measures the levels of various
electrolytes in the blood, such as sodium, potassium, and calcium. While electrolyte
imbalances can affect various bodily functions, they are not specific indicators of
coagulation status.

(Option C) Liver Function Tests (LFTs): These tests assess the health and function of
the liver by measuring the levels of enzymes and other substances in the blood. While
liver function is important for overall health, LFTs are not direct indicators of coagulation
status. However, the liver does play a role in producing certain proteins necessary for
blood clotting, so severe liver dysfunction can indirectly affect coagulation.
(Option D) Thyroid Function Tests (TFTs): These tests evaluate the function of the
thyroid gland by measuring thyroid hormone levels in the blood. Thyroid function is
unrelated to coagulation status and is typically assessed for different medical purposes,
such as diagnosing thyroid disorders.

Subject: Surgery
Main Topic: Perioperative Care
Sub Topic: Coagulation Status Testing in Surgery

Explanation
(Option A) Anal fissure: An anal fissure is a small tear or cut in the lining of the anal
canal. It is a common cause of painful bleeding per rectum. The pain is usually severe,
and patients may experience discomfort and fear of bowel movements due to the
intensity of pain. Examination would reveal tenderness over the anal region, and
sometimes, a visible tear may be seen. Anal fissures are often caused by the passage
of hard stools and can be acute or chronic.
(Option B) Fistula in ano: A fistula in ano is an abnormal tunnel-like tract that develops between the anal canal or rectum and the skin surrounding the anus. While it can cause pain and bleeding, severe tenderness over the anal region is not typically associated with a fistula. Fistulas often result from an infection near the anus, such as an abscess.
(Option C) Hemorrhoids: Hemorrhoids are swollen and inflamed blood vessels in the
anus and rectum that can cause bleeding, itching, and discomfort. While they can be
painful, the severity of pain described in the case is more indicative of an anal fissure.
Hemorrhoids are generally not associated with severe tenderness on examination.
(Option D) Peri-anal abscess: A peri-anal abscess is a collection of pus in the tissues
surrounding the anus. It can cause pain, swelling, and tenderness in the anal region.
While this condition may lead to painful bleeding per rectum, the severe tenderness on
examination is more characteristic of an anal fissure.

Subject: Internal Medicine
System: GIT
Topic: Anorectal Disorders

Explanation
(Option D) Secondary hemorrhage: Secondary hemorrhage is a known complication
after splenectomy, where there is bleeding from the surgical site after an initially
successful surgery. The symptoms of secondary hemorrhage can include tachycardia,
hypotension, and decreased urine output. This is the most likely issue in this case,
given the patient's history of splenectomy and the presentation of tachycardia,
hypotension, and decreased urine output. The patient should be evaluated and treated
promptly for this condition.
(Option A) Basal atelectasis: This is a condition where there is a collapse or
incomplete inflation of the lungs, typically affecting the lower regions of the lungs. While

atelectasis can cause tachycardia (elevated heart rate), it is unlikely to cause
hypotension (low blood pressure) and decreased urine output, which are the key
findings in this case.
(Option B) Gastric perforation: Gastric perforation is a serious complication that can
occur after abdominal surgery, where there is a hole or tear in the stomach lining,
leading to leakage of stomach contents into the abdominal cavity. While gastric
perforation can cause tachycardia, it typically presents with abdominal pain, tenderness,
and signs of peritonitis (inflammation of the abdominal lining), which are not mentioned.
(Option C) Portal vein thrombosis: Portal vein thrombosis is a blood clot that forms in
the portal vein, which carries blood from the digestive organs to the liver. While portal
vein thrombosis can cause hypotension and decreased urine output, it typically presents
with abdominal pain, jaundice, and gastrointestinal bleeding, which are not mentioned.

Subject: Surgery
System: GIT
Topic: Splenectomy Complication

Explanation
The condition described in the question is consistent with rheumatoid arthritis (RA), an
autoimmune disease that primarily affects the joints. In RA, the immune system
mistakenly attacks the synovium, which is the thin membrane that lines the joints.
(Option E) Synovium: The synovium is the inner layer of the joint capsule, and it
produces synovial fluid, which lubricates and nourishes the joint. In RA, the immune
system targets and attacks the synovium, leading to inflammation, pain, and swelling of
the affected joints.
(Option A) Articular cartilage: Although RA can eventually lead to damage of articular
cartilage, it is not the primary target of the autoimmune reaction in RA. The initial
inflammatory process primarily affects the synovium.
(Option B) Periosteum of bone: The periosteum is the fibrous membrane that covers
the outer surface of bones. While periosteum can be involved in certain conditions, it is
not the primary target in RA.
(Option C) Hyaline cartilage: Hyaline cartilage is a type of cartilage that covers the
ends of bones in joints. While RA can lead to cartilage damage over time, it is not the
primary site of autoimmune attack in RA.

(Option D) Unknown arthritogenic antigen: This option implies that the exact target ofthe autoimmune reaction in RA is unknown. While the precise trigger for the immuneresponse in RA is not fully understood, it is known that the synovium is the primary site of inflammation and damage in this condition.

Subject: Internal Medicine
System: Rheumatology
Topic: Rheumatoid arthritis (RA)

Explanation
(Option C) Ascariasis: Ascariasis is an infection caused by the roundworm Ascaris
lumbricoides, which is common in areas with poor sanitation. The symptoms of
Ascariasis include abdominal pain, diarrhea, general malaise, weakness, and impaired
cognitive and physical development, which are consistent with the symptoms mentioned
in the question.
(Option A) Amoebiasis: This is an infection caused by the protozoan parasite
Entamoeba histolytica. The symptoms include diarrhea, abdominal pain, and fever. It
can lead to severe complications like liver abscesses if left untreated.
(Option B) Ancylostoma duodenale: This is an infection caused by hookworms, which are parasitic worms that live in the small intestine. The symptoms include abdominal pain, anemia, and malnutrition. Hookworms can cause severe damage to the intestinal lining if left untreated.
(Option D) Schistosomiasis: This is an infection caused by parasitic flatworms called
Schistosoma. The symptoms include itching, rash, diarrhea, and abdominal pain. If left
untreated, it can lead to chronic health problems like liver damage and bladder cancer.

Subject: Internal Medicine
System: Infectious Disease
Topic: Parasitic Infections

Explanation
(Option C) Sickle cell disease: Sickle cell disease is an inherited blood disorder that
affects the production of hemoglobin, the protein in red blood cells that carries oxygen
throughout the body. The abnormal hemoglobin can cause red blood cells to become
rigid and form a crescent or sickle shape, which can block blood flow and lead to severe
pain and organ damage. The chest pain in this case may have been due to a sickle cell
crisis, which is a sudden and severe episode of pain caused by the blockage of blood
vessels. Knee pain may also be a symptom of sickle cell disease, as the reduced blood
flow can cause damage to the joints.
(Option A) Gonococcal infections: This is a sexually transmitted infection caused by
the bacterium Neisseria gonorrhoeae. While it can cause joint pain and inflammation, it
is not typically associated with chest pain.
(Option B) Leukemia: This is a cancer of the blood and bone marrow, which can cause
a variety of symptoms depending on the type and severity of the leukemia. Chest pain
and knee pain are not typical symptoms of leukemia, and it is unlikely to improve with IN
fluids and oxygen alone.
(Option D) Systemic lupus erythematosus (SLE): This is an autoimmune disease that can cause a wide range of symptoms, including joint pain, chest pain, and fatigue.
However, it is not typically associated with knee pain, and it would not be expected to
improve quickly with IN fluids and oxygen.

Subject: Internal Medicine
System: Hematology
Topic: Hematological Disorders

Explanation

(Option C) Puerperal pyrexia: As mentioned earlier, puerperal pyrexia is a fever that
occurs after childbirth, usually within the first ten days postpartum. It can have several
causes, including infection of the genital tract, wound infections from episiotomy or
cesarean section, urinary tract infections, or breast infections (mastitis). Given the
patient's symptoms of high-grade fever and foul-smelling vaginal discharge after 24
hours of delivery, puerperal pyrexia is the most probable diagnosis.
(Option A) Chorioamnionitis: Chorioamnionitis is an infection of the fetal membranes
(chorion and amnion) and amniotic fluid. It often occurs during labor and delivery,
especially when there is prolonged rupture of membranes (water breaking) before
delivery. Symptoms include fever, uterine tenderness, foul-smelling vaginal discharge,
and an increased heart rate in the mother. Since the patient has foul-smelling vaginal
discharge and high-grade fever after delivery, chorioamnionitis could be considered as a
possible diagnosis, but it is less likely than puerperal pyrexia in this case.
(Option B) Preterm labor: Preterm labor refers to the onset of labor before 37 weeks of
gestation. In the given scenario, the woman has already delivered vaginally, so preterm
labor is not the correct diagnosis.
(Option D) Pyrexia of unknown origin: Pyrexia of unknown origin (PUO) is a fever of
at least 38.3°C (101°F) that lasts for more than three weeks, and the cause remains
undiagnosed after a thorough evaluation. In this case, the patient's fever is likely relatedto the recent delivery, so PUO is not the appropriate diagnosis.

Subject: ObsGyn
System/ Title: Female Reproductive System
Topic: Postpartum Infection

Explanation

(Option A) CNS ischemic response: The central nervous system (CNS) ischemic
response is a mechanism that operates within minutes to restore blood pressure. When
the body detects a decrease in blood pressure, it triggers vasoconstriction of blood
vessels throughout the body, including the arteries supplying the brain. This
vasoconstriction helps maintain blood flow to vital organs, such as the brain, during
hypovolemia (low blood volume). The CNS ischemic response is an important
immediate compensatory mechanism to restore and maintain blood pressure.
(Option B) Renin Angiotensin system: The renin-angiotensin system is a hormonal
mechanism that regulates blood pressure and fluid balance in the body. It is activated in
response to decreased blood flow or decreased blood pressure. However, the activation

of the renin-angiotensin system typically takes more time (several minutes to hours) to
have a significant effect on blood pressure. Therefore, it is not the primary mechanism
that operates within a minute to restore blood pressure.
(Option C) Reverse stress relaxation: Stress relaxation is a mechanism that occurs in
blood vessels in response to sustained mechanical stress. It involves a decrease in
vascular resistance over time, leading to a gradual decrease in blood pressure. Reverse
stress relaxation refers to the opposite effect, where blood vessels constrict to increase
vascular resistance and restore blood pressure. However, this mechanism is not a
primary response that operates within a minute. It usually occurs over a longer time
frame.
(Option D) Reverse capillary fluid shift: Capillary fluid shift refers to the movement of fluid between the capillaries and surrounding tissues. In the context of hypovolemia,
fluid from the interstitial space may be reabsorbed into the capillaries to increase blood
volume. However, this process is slower and usually takes more time than a minute to
restore blood pressure.
(Option E) Sympathetic nervous system: While the sympathetic nervous system is
involved in the response to hypovolemia, it is not the primary mechanism activated
within the first minute.

Subject: Physiology
System/ Title: CVS
Topic: Compensatory mechanisms for hypovolemia-induced hypotension

Explanation

(Option A) Cholecystitis: Cholecystitis is an inflammation of the gallbladder, usually
caused by a blockage of the cystic duct by gallstones. The pain is typically located in
the right upper quadrant and can be severe. The pain may radiate to the right shoulder
or back. The patient may have fever, nausea, vomiting, and jaundice. The diagnosis is
usually made by ultrasound or CT scan, and treatment involves antibiotics, pain control,
and removal of the gallbladder.
(Option B) Gastritis: Gastritis is inflammation of the stomach lining. It can cause
abdominal pain, nausea, and vomiting, but it is unlikely to cause tenderness in the right
upper quadrant. Gastritis can be caused by infection, alcohol, or certain medications.
(Option C) Hepatitis: Hepatitis is inflammation of the liver, usually caused by a virus. It
can cause abdominal pain, nausea, and fever, but tenderness in the right upper
quadrant is not a typical finding. Hepatitis can also cause jaundice, fatigue, and loss of
appetite.
(Option D) Pancreatitis: Pancreatitis is inflammation of the pancreas, which can cause
abdominal pain, nausea, and vomiting. The pain is typically located in the upper
abdomen and can radiate to the back. Tenderness in the right upper quadrant is not a
typical finding in pancreatitis. Pancreatitis can be caused by alcohol, gallstones, or high
levels of triglycerides. Treatment involves pain control, supportive care, and addressing
the underlying cause.

Subject: Internal Medicine
System: GIT
Topic: Acute Abdominal Pain and Gastrointestinal Disorders