Dr zuhaib khan, peshawar, pakistan.

This is one of the previous papers of DHA exam. I have solved to the best of my Knowledge.

Q1.Pregnant 10 weeks with hypertension and diabetis mellitus. she is on insulin but not
controlled .
O/E
Bp: 150/95
FBS: 190
Urine +3
Managment:
1.ACEi
2.hemodialysis
3.Pregnancy termination
4. IV Mg sulphates
Answer: Pregnancy termination
Explanation: This lady may go into eclampsia if pregnancy not terminated on time. We could
use Mg sulphates but if the patient was in eclampsia.

Q2- Most accurate test to diagnose diabetic nephropathy:

1. US
2. urine microalbuminemia
3. Urine dipstick albumin
4. Urea-creatinine
Answer: urine microalbuminemia
Explanation: Most diagnostic would be 24 hours urinary proteins estimation but it is not in
option.

Tip: Urinary proteins less than 300 mg is not detectable by Urine dipstick.
Q3- A thin patient complaining of cough, wheezes and has upper chest patchy opacities ,he
lives in over crowded town.what should be done for prophylaxsis to he contacts:
1.Himopalus influenza b (Hib)
2.Meningococcal vaccine
3.Brucella
4.Bacillus calmate-guerin
Answer: Bacillus calmate-guerin (BCG)
Explanation: This is a thrid class question.This is typical case of PTB but BCG is done
after birth.BCG is basically for primary prevention.Here option should have included INH.So
we can give INH to the contacts.

Q4- 8 years old Child with leukemia and she is on chemotherapy ,came with fever,apathy
and severely dehydrated. Labs showed:
Na: 140
K: 3.6
Plaltlet count 47,000
Managment:
1.Lumbar puncture
2. Refer to oncology
3. IV ceftriaxone
4. Platlet transfusion
Answer: IV ceftriaxone
Explanation: This child probably has gone into septicemia (DIC),that is comm with
AML3,Promyelocytic leukemia so must be treated with IV Antibiotics. Platelets transfusion is not
warranted as patient is not bleeding actively.So mere platelets transfusion will not relieve her fever and
septicemia.At this amount of platelets as bleeding and subdural spinal hematoma is a chance
So i would not prefer Lumbar Puncture(LP).

Q5- Drug used in rapid relief of anxiety (panic anixiety):

1.Benodiazibine
2.SSRI
3. Barbiturate
4. Busbiron
Answer: Benodiazibine
Q6-Female patient wear glass since 10 years ,she diagnosed recently type 2DM,she
should screen for examination of her eyes :
a) 6 months
b) 12 months
c) 2 years
d) 5 years
Answer: Every year
Q7-patient with cough and hemoptysis and has some joints arthritis.
Renal function(urea -creatinine) are increased.
This condition is due to:
1.Allergy.
2.Inflammatory
3.Auto immune
Answer: Auto immune
Explanation: This is a case of Good Pasture syndrome

Q8-DVT most cause is:

1.Recent Knee surgery
2.Airplaine fly 4 hours
3.Maternal history of DVT
4.Previous history of DVT
Answer: Recent Knee surgery
Q9-Anti TB drug causing hearing loss and tennitis:
1.Ethambutol
2.Pyrizanamide
3.Streptomycin
4.ISoniazide
Answer: Streptomycin

Q10-What is the initial management for a middle age patient newly diagnosed knee
osteoarthritis.
a) Intra-articular corticosteroid.
b) Reduce weight
c) Exercise.
d) Strengthening of quadriceps muscle.
Answer: Reduce weight

Q11-Newborn came with red-lump on left shoulder, increase

in size: 1.Cavernous Hemangioma
2.Milia
3.Port wine
Answer: Cavernous Hemangioma

Q12-picture of hand.Asking what is the appropiate procedure(warts)

1.Tobical ab
2.Oral ab
3.Steroid
4.Cryosurgery
Answer: Cryosrgery

Q13- 8 year old boy weight and hight above 95th centile.His BMI is 30what to do:
1.surgery
2.medication
3.observation for 12 month
4.life style modification
Answer: life style modification
Explanation: This child is obese and it will improve with life style modification.

Q14-Anti TB Drug causing vertigo :

Sterptomycin is the answer.
Q15-diabetic patient complaining of leg ulcer,he started antibiotic but no improvment.The
pulses are present.
Treatment:
1.Surgical debridment
2.Ambutation
3.Hyper baric O2
Answer: Surgical debridment
Explanation: Necrotic debris should be removed to augment the healing and control
infection along with better glycemic control.
Q16-Treatment of anxiety disorder :
1.Alprazolam
2.Flufenazine
3.Haloperidol
Answer: Alprazolam
Tip: Alprazolam is a short acting benzodiazepine used in Anxiety disorder.
Q17-45 years old patient complaining of pain related to meals with some relieve of pain after
taking antiacids.
O/E there is gastric mass 3 cm palpable in the epigastrium.H-Pylori is -ve.All other
examination normal.
What is your diagnosis:
1.Gastric ulcer
2.Gastric cancer
3.Lymphoma
Answer: Gastric cancer
Explanation: When there is mass palpable its always Ca stomach untill unless proven
otherwise.
Tip: I have seen another question like this but they wanted investigation.The answer
for that is Endoscop

Q18-patient treated for bipolardisorder, he is on LITHIUM what is not important:

1.Thyroid function
2.Liver function
3.Pregnancy test
4.Renal function
Answer: Liver function

Q19-old patient with left tender iliac fossa,abdominal rigidity.

Diagnosis:
1.Acute diverticulitis
2.Appendicitis
3.UC
4.Ca colon
Answer: Acute diverticulitis
Tip: Acute diverticulitis is very common in old age and it is usually presented in
left illiac fossa. UC would rather present in middle or young age.
Q20-common cold.what is the common organism:
1.Rhinovirus
2.Cornavirus
3.Respiratory syncityal virus
Answer: Rhinovirus
Q21-why should influnza vaccine be taken annually:
1.Because of virus resistance
2.Due to antigenic drift
Answer: Due to antigenic drift
Q22-pregnant multiprous 41weeks and 2 days of gestation.the cervicx dilated 2cm,the fetus
is mid anterio posterio.Station-2,effacement 50%.How to manage: 1.Oxytocin 2.Rupture of
the membranes 3.Cervical ripinig agent 4.Insert a catheter
Answer: Oxytocin
Q23-patient complaining of sensory neural hearing loss , vertigo, tinnitus and vomiting
Diagnosis:
1.Menier's disease
2.Otosclerosis
3.Otitis media
4.Bengin postional vertigo
Answer: Menier's disease
Q24-A case of painful vesicles. Treatment :
1.Antibiotic
2.Antiviral agent
3.Immunoglobulin
Answer: Antiviral agent

Q25-female patient BMI 16 has fine hair all over the body and has amenorrea and refuse to
eat:
Diagnosis:
1.Anorexia nervousa
2.Bullimia
3.Body dismorphic disorder
Answer: Anorexia nervousa
Q26-HBA1c in diabetic should be:
1.8
2.6
3.7
4.4
Answer: 6
Explanation: The goal is to keep HBA1c less than
6.5
Q27-Asymptomatic patient and said he is an IVdrug abuser.
what is important to investigate:
1.Staph Aureus
2.HIV
3.Viral HB
4.HCV
Answer: HIV
Explanation: Most of the people here too make mistake of clicking HCV but HIV is
more important than HCV as HIV will spread like that and there is no treatment.
HCV has a treatment. IV drug abusers are mostly HIV postive.
Tip: It is a Public hazard.

Q28- A patient complaining of red eye,photophopia,cilliary injection Cloudy anterior chamber:

Diangosis:
1.Uveitis
2.Corneal ulcer
3.Viral conjunctivitis
4.Glaucoma
Answer: Uveitis
Tip: Dont be confuse here with Glaucoma. Cilliary injection is the clue to diagnosis of
Uveitis

Q29-pt complaining of epilepsy and facial twitches on taping the facial area
Parathormone level 8 (high)
Calcium :low
Creatinine: High
Diagnosis:
1.Digeorge syndrome
2.Pseudohypoparathyrodism
3.CRF
4.Osteoporosis
Answer: Pseudohypoparathyrodism
Explanation: Most people are confused that it is CRF but in CRF seum calcium is
usually normal.although initially serum calcium is low. Secondly Epilepsy is the
clue to diagnosis as Pseudohypoparathyroidism is associated with certain
disorders involving the brain and there is resistance to TSH and patients are
usually Hypothyroid not responding to Thyroxine. Creatinine may be high. There
are many types and the most common is Type1,also called Albright renal
Osteodystrophy. Probably this is this one.
This is the most repeated Question in DHA. I was having the same question in my
paper which i will upload soon.

Q30-Pt Known BPH stable on medications(prazocin). on examination prostate was smooth

with no nodularity, He asked for PSA screening.
what will you till him:
a.No need for PSA.
b. order other advanced Investigations (biopsy)
Answer: No need for PSA.
Explanation: Soomth surface and no nodularity clinically excludes Ca prostate so
no need for PSA as false postive reports are there and it will cost and then will
make patient anxiety.

Q31-54 years old patient ,farmer,coming complaining of dry eye,he is smoker for 20 years
and smokes 2 packs/ day.
your recommendation advise him:
a-exercise
b-stop smoking
c-wear sunscreen
Answer: stop smoking

Q32-clinical picture of fever,sore throat and enlarged spleen & liver EBV +ve:
Diagnosis:
Answer: It is Infectious Mononucleosis
Q33-pt hypertensive and diabetic he is on hydrochlorothizize ,but not controlled
Treatment:
1.Double the dose of hydrochlorothizide
2.Add BB
3.Add ACEi
Answer: Add ACEi
Explanation: Best drug in DM type 1. RENAAL studies.
Tip: For type 2 DM the best drug is ARB

Q34-pregnant came with fever and gum bleeding, O/E spleen is palpable 5 cm below left
costal margin, uterus is palpable at the symphsis pubis, platelets count 50,000.
Diagnosis:
a- Gestational thrombocytopenia
b- HEELP syndrome
c- Idiopathic thrombocytopenic purpura
Answer: ITP
Explanation: Another culprit for making mistake in this Q. I have seen mostly they think
that splenomegaly is not the feature of ITP. But remember splenomegaly also doesnt
exclude ITP.HEELP syndrome is characterized by Hemolytic anemia,Elevated liver
enzymes and Low platelets. Here no such things available to establish a diagnosis.
Gestational Thrombocytopenia is a possibilty but that does not present with fever and
splenomegaly.
Tip: ITP is aggravated by infection like in this case Fever is a clue to infection. ITP is
also fales upin Pregnancy.

Q35-pt has a problem in delivering speech in the work,but other wise he is good in working
in his job: Diagnosis:
1.Specific Phobia
2.GAD
3.Depression
4.Social Phobia
5.Performance anxiety
Answer: Performance anxiety

Q36-Pt with HTN presented with edema, azotemia,GFR: 44,

what is the cause of her Kidney diseae:
a) bilateral renal artery stenosis
b) diabetic nephropathy
c) Reflux Uropathy
d) Renal tubular acidosis
Answer: bilateral renal artery stenosis
Q37-female patient complaining of frequency and urgency.
Investigations show few WBS on urinalysis and no bacteria diagnosis:
1.Interstitial cystitis
2.Symptomatic bacturia
3.Pylonephritis
Answer: Interstitial cystitis
Q38-pt complaining of double vision.
Which nerve is invloved:
1.3rd nerve
2.4th nerve
3.6th nerve
4.2nd nerve
Answer: 3rd nerve
Explanation: Dipopia is caused by 3rd nerve damage
Q39-Asthmatic patient .FEV1:85%
What you expect after add short acting Beta Agonists:
1.FEV1 decreases
2.FEV1 increases to 95%
3.No change
Answer: FEV1 increases to 95%
Tip: It may not increase up to 95 % but it will increase so.
Q40-picture of lesion (red margin) with central clearing and flu like
symptoms .
Diagnosis:
1.Teania corporis
2.Lyme disease
3. Urticaria
4. HSP
Answer: Lyme disease
Explanation: It is typical of Erythema migran of Lyme disease caused by tick of
Ixodes.Organism is Borrelia burgdorferi .Usually in camping and hiking.

Q41-What is the most true statement about the benefit of excersice;

1.continuous steady excersice increase Basal metabolic rate
2.Excersice decrease HDL
3.Truncal obesity resistant to excersice
Answer: continuous steady excersice increase Basal metabolic rate
Explanation: Exercise does not decrease HDL rather it increases HDL.
Tip: HDL is a good Cholesterole. Always respect HDL.
Q42-Aman with 2nd and 1st degree burn over his face and neck
Treatment:
1.wash,cover all burns with Silver sulfadiazine,cover with sterile gauze
2.give IV fluid, antibiotic and tetanus toxoid and discharge home with daily dressing
3. cover burn with Silver sulfadiazine, sterile gauze, oral fluid, and discharge home
4. Silver sulfadiazine, sterile gauze, IV fluid and admit to hospital
Answer: cover burn with Silver sulfadiazine, sterile gauze, oral fluid, and discharge
home

Q43-Celiac disease which does not cause it:

a) Rice & corn
b) Oat
c) wheet
d) Gluten
Answer: Rice & corn
Q44: sub dermal implantable contraception:
a- It has low compliance compared to OCP
b- More side effect
c- No local reaction
d-it is associated with thrombotic tendency more than OCP
Answer: it is associated with thrombotic tendency more than OCP

Q45-hypertensive pt using sildenafil , in his case it is contraindication to take :

a.CCB
b.B blocker
c.Nitrate
d.Diuretics
Answer: Nitrate

Q46-child complain of weakness that began in the lower limb then extend up wards ,history
of recent respiratory infection:
Answer is Gian-baree syndrome (GBS)
Q47-6 months boy with fever you should give antipyretic to decrease risk of:
a) Febrile convulsion
b) Epilepsy
Answer: Febrile Convulsion. Very easy Q