12 days for exams. i am reading steupup medicine and not irfan masood and give me uhs based past mcqs and practice based daily mcqs 30 atleast from every topic of every system for better understanding and to pass the upcoming exam. i want to use pomodoro technique and can not study more than 8 hours a day. i do not have internet connection and limited access to internet so can not consult you every time. i am using osmosis vedios for better understanding too. Give me timetable and resources according to it.

Asking for Preferences

Based on your context - UHS-based exam (Pakistan MBBS Final Prof), Step-Up Medicine as primary text, Osmosis videos as supplement, 12 days, 8 hours/day with Pomodoro - here is your complete study plan.

12-Day UHS Exam Study Plan

Step-Up Medicine | Pomodoro Method | 8 hrs/day

Pomodoro Setup (Daily Structure)

1 Pomodoro = 25 min study + 5 min break
After 4 Pomodoros = 30 min long break
8 hours/day = ~16 Pomodoros = 400 min study time (net ~6.5 hrs active study)
Daily Session Blocks:
- Morning Block: 8:00 AM - 12:00 PM (8 Pomodoros)
- Long Break: 12:00 - 1:00 PM (lunch + rest)
- Afternoon Block: 2:00 PM - 6:00 PM (8 Pomodoros)

12-Day Topic Distribution (UHS High-Yield)

Day	System	Step-Up Chapters	Osmosis Topics
1	Cardiology - Part 1	Ch 1: IHD, MI, Angina, Heart Failure	Heart failure, MI, ACS
2	Cardiology - Part 2	Ch 1: Arrhythmias, Valvular, Hypertension, Cardiomyopathy	Arrhythmias, Valvular disease
3	Pulmonology	Ch 2: Asthma, COPD, Pneumonia, TB, Lung Ca, PE, Pleural	COPD, Asthma, TB, PE
4	Gastroenterology - Part 1	Ch 3: GERD, PUD, IBD, IBS, Appendicitis, Hernia	PUD, IBD, Crohn's vs UC
5	Gastroenterology - Part 2 + Hepatology	Ch 3: Liver cirrhosis, Hepatitis, Pancreatitis, Ca	Cirrhosis, Hepatitis B/C, Pancreatitis
6	Nephrology	Ch 4: GN, Nephrotic, UTI, AKI, CKD, RTA, Stones	Nephrotic syndrome, AKI vs CKD
7	Neurology	Ch 6: Stroke, Epilepsy, Meningitis, MS, Parkinson, Headache	Stroke, Epilepsy, Parkinson
8	Endocrinology	Ch 7: DM, Thyroid, Adrenal, Pituitary, Osteoporosis	DM complications, Thyroid disorders
9	Hematology + Oncology	Ch 9: Anemias, Leukemia, Lymphoma, Coagulation, Bleeding	Sickle cell, Leukemias
10	Rheumatology + Musculoskeletal	Ch 8: RA, SLE, Gout, OA, Spondyloarthropathies, Vasculitis	SLE, RA, Gout
11	Infectious Disease + ID	Ch 5: HIV, Sepsis, Bacterial/Viral/Fungal, Tropical diseases	HIV, Sepsis, Malaria
12	Full Revision + Weak Areas	All high-yield MCQ review	Re-watch 2-3 confusing Osmosis videos

Daily Pomodoro Schedule (Template - Repeat Each Day)

8:00 - 8:25   [P1]  Read Step-Up: First topic of the day (Key facts + boxes)
8:30 - 8:55   [P2]  Read Step-Up: Continue topic / Clinical features + Dx
9:00 - 9:25   [P3]  Watch Osmosis video on same topic
9:30 - 9:55   [P4]  Do 30 MCQs on topic 1 (UHS-style from below)
10:00 - 10:30 [LONG BREAK]
10:30 - 10:55 [P5]  Read Step-Up: Second topic
11:00 - 11:25 [P6]  Read Step-Up: Continue + Management
11:30 - 11:55 [P7]  Watch Osmosis video on topic 2
12:00 - 12:25 [P8]  Do 30 MCQs on topic 2
12:30 - 1:00  [LUNCH BREAK]
1:00 - 2:00   [REST]
2:00 - 2:25   [P9]  Read Step-Up: Third topic
2:30 - 2:55   [P10] Continue + Investigations table
3:00 - 3:25   [P11] Osmosis video (topic 3)
3:30 - 3:55   [P12] 30 MCQs topic 3
4:00 - 4:30   [LONG BREAK]
4:30 - 4:55   [P13] Review mistakes from all 3 topics
5:00 - 5:25   [P14] High-yield facts revision (make flashcard notes)
5:30 - 5:55   [P15] Mixed 20 MCQs from all topics of the day
6:00 - 6:25   [P16] Daily self-test: 10-question rapid quiz

UHS-STYLE MCQs BY SYSTEM (30+ Per Topic)

DAY 1-2: CARDIOLOGY

Topic: Myocardial Infarction / ACS (30 MCQs)

Q1. A 55-year-old man presents with crushing central chest pain radiating to left arm, diaphoresis, nausea for 2 hours. ECG shows ST elevation in leads II, III, aVF. Which artery is most likely occluded?

A) LAD
B) RCA ✓
C) LCx
D) Diagonal branch

Explanation: Inferior wall MI (II, III, aVF) = RCA territory. Posterior MI (V1-V2 with tall R, ST depression) = also RCA/LCx.

Q2. Best initial investigation in suspected STEMI?

A) Troponin
B) CK-MB
C) 12-lead ECG ✓
D) Echocardiogram

Explanation: ECG is the FIRST step. Do not wait for cardiac enzymes to start treatment in STEMI.

Q3. A patient with STEMI arrives at a hospital with no PCI capability. Door-to-needle time should be:

A) 30 minutes ✓
B) 60 minutes
C) 90 minutes
D) 120 minutes

Explanation: Thrombolysis (fibrinolysis) target = within 30 min. Primary PCI target = door-to-balloon within 90 min.

Q4. Which enzyme rises FIRST after MI?

A) CK-MB
B) Troponin I
C) Myoglobin ✓
D) LDH

Explanation: Myoglobin rises in 1-2 hrs (earliest, not specific). Troponin rises 3-6 hrs (most specific/sensitive, stays elevated 7-14 days). CK-MB rises 4-6 hrs.

Q5. Troponin is most useful for:

A) Early diagnosis (first 2 hours)
B) Reinfarction detection after 48 hrs (CK-MB better)
C) Confirming MI in patients presenting late (>6 hrs) ✓
D) Ruling out stable angina

Q6. A 60-year-old man post-MI develops a new holosystolic murmur at apex with radiation to axilla. Diagnosis?

A) VSD
B) Mitral regurgitation (papillary muscle rupture) ✓
C) Aortic stenosis
D) Pericarditis

Explanation: Post-MI MR = papillary muscle rupture (day 3-5). VSD = holosystolic murmur at left sternal border + thrill.

Q7. Dressler's syndrome occurs after MI. Which is TRUE?

A) Occurs within 24 hours
B) Is an autoimmune pericarditis occurring weeks after MI ✓
C) Is treated with heparin
D) Is caused by LV thrombus

Explanation: Dressler = autoimmune pericarditis/pleuritis weeks post-MI. Treat with NSAIDs/aspirin. Avoid steroids.

Q8. Best drug to reduce mortality post-MI (long-term)?

A) Nitrates
B) Calcium channel blockers
C) ACE inhibitors ✓
D) Digoxin

Explanation: Post-MI: ACE inhibitor + beta-blocker + aspirin + statin = standard of care for mortality reduction.

Q9. Contraindication to thrombolysis in STEMI:

A) Age >75
B) Inferior MI
C) Recent hemorrhagic stroke within 3 months ✓
D) Hypertension (controlled)

Q10. Which ECG change is seen in hyperacute phase of MI (within first hour)?

A) Q waves
B) ST depression
C) Tall peaked T waves ✓
D) T wave inversion

Explanation: Sequence: Tall T → ST elevation → Q wave → T inversion (later). Q waves = irreversible damage.

Q11. A patient with NSTEMI. Which finding differentiates it from unstable angina?

A) ST depression on ECG
B) Positive troponin ✓
C) Chest pain at rest
D) Normal ECG

Q12. Drug of choice for Prinzmetal (variant) angina:

A) Beta-blocker
B) Aspirin
C) Calcium channel blocker ✓
D) Nitrates (short term only)

Explanation: Vasospastic angina = CCBs (diltiazem, amlodipine). Beta-blockers can worsen vasospasm.

Q13. Most common complication in first 24 hours post-MI:

A) Heart failure
B) Ventricular arrhythmia ✓
C) Cardiogenic shock
D) Pericarditis

Q14. Cardiogenic shock post-MI. Best treatment:

A) IV fluids
B) Dopamine alone
C) Emergency PCI ✓
D) IABP alone

Q15. Which post-MI complication causes a loud S3, bibasal crackles, and pink frothy sputum?

A) RV infarction
B) Acute left ventricular failure ✓
C) Papillary muscle rupture
D) Free wall rupture

Q16. Free wall rupture post-MI typically occurs:

A) Within 1 hour
B) Day 3-7 ✓
C) Week 4
D) 6 months later

Q17. Patient with inferior MI develops bradycardia, hypotension, clear lungs, raised JVP. Diagnosis?

A) LV failure
B) RV infarction ✓
C) Cardiac tamponade
D) Aortic dissection

Explanation: RV infarction triad: hypotension + raised JVP + clear lungs. Treat with IV fluids. Avoid nitrates and diuretics.

Q18. Which drug is AVOIDED in RV infarction?

A) Aspirin
B) Nitrates ✓
C) Heparin
D) IV fluids

Q19. Killip Class IV in MI means:

A) No heart failure
B) Mild heart failure (S3 gallop)
C) Severe heart failure (pulmonary edema)
D) Cardiogenic shock ✓

Q20. A 50-year-old presents with angina only on exertion. ECG at rest is normal. Best next step?

A) Coronary angiography
B) Exercise stress test (treadmill test) ✓
C) Echocardiogram
D) Holter monitor

Topic: Heart Failure (30 MCQs)

Q21. Most common cause of heart failure in developed countries:

A) Rheumatic heart disease
B) Ischemic heart disease ✓
C) Hypertension
D) Cardiomyopathy

Q22. BNP (B-type natriuretic peptide) is released from:

A) Atria in response to volume overload
B) Ventricles in response to increased wall stress ✓
C) Kidneys
D) Lungs

Explanation: BNP >100 suggests HF. BNP <100 rules out HF as cause of dyspnea.

Q23. Frank-Starling mechanism fails in heart failure when:

A) Preload decreases
B) Afterload decreases
C) The ventricle is maximally stretched without increase in CO ✓
D) Heart rate increases

Q24. Which finding on CXR is MOST specific for pulmonary edema?

A) Cardiomegaly
B) Kerley B lines ✓
C) Pleural effusion
D) Upper lobe diversion

Explanation: Kerley B lines = horizontal lines at lung bases = interstitial edema from pulmonary venous hypertension.

Q25. Patient with HFrEF (EF <40%). Which drug reduces mortality MOST?

A) Digoxin
B) Furosemide
C) Sacubitril/Valsartan (ARNI) or ACE inhibitor + beta-blocker ✓
D) Spironolactone alone

Q26. Which diuretic is the drug of choice for acute pulmonary edema?

A) Spironolactone
B) Hydrochlorothiazide
C) Furosemide (IV) ✓
D) Mannitol

Q27. Orthopnea is caused by:

A) Increased venous return in lying position → increased preload → LV failure → pulmonary edema ✓
B) Decreased CO in lying position
C) Anxiety
D) Pleural effusion

Q28. Paroxysmal nocturnal dyspnea (PND) is MOST characteristic of:

A) COPD
B) Left heart failure ✓
C) Right heart failure
D) Pulmonary embolism

Q29. Features of RIGHT heart failure include ALL EXCEPT:

A) Peripheral edema
B) Raised JVP
C) Orthopnea ✓
D) Hepatomegaly

Explanation: Orthopnea and PND = LEFT HF. RHF = peripheral edema, JVD, ascites, hepatomegaly.

Q30. Which drug is useful for HFpEF (preserved EF)?

A) ACE inhibitors (proven mortality benefit)
B) Beta-blockers (proven mortality benefit)
C) Diuretics for symptom relief ✓
D) AICD implantation

Topic: Hypertension (10 MCQs)

Q31. Most common cause of secondary hypertension:

A) Pheochromocytoma
B) Primary hyperaldosteronism (Conn's syndrome) ✓
C) Renal artery stenosis
D) Cushing's syndrome

Q32. JNC 8 / current guidelines: Target BP in diabetics?

A) <120/80
B) <130/80 ✓
C) <140/90
D) <150/90

Q33. Which antihypertensive is preferred in pregnancy?

A) ACE inhibitor
B) ARB
C) Methyldopa ✓
D) Furosemide

Explanation: Methyldopa = safest in pregnancy. ACE inhibitors/ARBs are CONTRAINDICATED (teratogenic).

Q34. Hypertensive emergency: BP >180/120 with end-organ damage. Drug of choice:

A) Oral nifedipine
B) IV labetalol or IV nitroprusside ✓
C) Oral captopril
D) Sublingual nitroglycerin

Q35. Which antihypertensive causes a dry cough?

A) ARBs
B) ACE inhibitors ✓
C) Beta-blockers
D) Calcium channel blockers

DAY 3: PULMONOLOGY (30 MCQs)

Q36. Gold standard for diagnosis of COPD:

A) CXR
B) ABG
C) Spirometry (FEV1/FVC <0.70) ✓
D) CT chest

Q37. GOLD Stage II COPD means FEV1:

A) >80% predicted
B) 50-79% predicted ✓
C) 30-49% predicted
D) <30% predicted

Q38. A patient with COPD is in respiratory failure (PCO2 = 70, PO2 = 50). What oxygen therapy is given?

A) 100% O2 via non-rebreather mask
B) Controlled low-flow O2 (target SpO2 88-92%) ✓
C) High flow nasal cannula
D) Intubation immediately

Explanation: COPD patients are hypoxic drivers. High-flow O2 can suppress respiratory drive. Target SpO2 88-92%.

Q39. Drug used for acute severe asthma (immediate relief):

A) Inhaled corticosteroid
B) LABA
C) Nebulized salbutamol ✓
D) IV theophylline

Q40. Which finding differentiates asthma from COPD?

A) Wheezing
B) Dyspnea
C) Complete reversibility of airflow obstruction with bronchodilator ✓
D) Barrel chest

Q41. Commonest organism in community-acquired pneumonia (CAP):

A) Staph aureus
B) Streptococcus pneumoniae ✓
C) Klebsiella
D) Pseudomonas

Q42. Atypical pneumonia (walking pneumonia) is caused by:

A) Strep pneumoniae
B) Mycoplasma pneumoniae ✓
C) Klebsiella
D) Legionella

Explanation: Mycoplasma = most common atypical. Legionella = associated with AC systems, hyponatremia, diarrhea.

Q43. Which finding on sputum smear confirms pulmonary TB?

A) Gram-negative rods
B) Acid-fast bacilli (AFB) on Ziehl-Neelsen stain ✓
C) Fungal hyphae
D) Gram-positive cocci

Q44. WHO Category I TB treatment:

A) 2HRZE + 4HR ✓
B) 2HRE + 4HR
C) 6HRE
D) 2HRZE + 4HRE

Explanation: HRZE for 2 months (intensive) + HR for 4 months (continuation). Total 6 months.

Q45. Side effect of Ethambutol:

A) Hepatotoxicity
B) Orange urine
C) Optic neuritis ✓
D) Peripheral neuropathy

Q46. Side effect of Isoniazid:

A) Optic neuritis
B) Peripheral neuropathy (prevented by pyridoxine/B6) ✓
C) Gout
D) Red-orange urine

Q47. Pleural fluid analysis: Exudate criteria (Light's criteria) includes ALL EXCEPT:

A) Pleural protein/serum protein >0.5
B) Pleural LDH/serum LDH >0.6
C) Pleural LDH >2/3 upper normal serum LDH
D) Pleural glucose <60 mg/dL ✓

Explanation: Glucose is not part of Light's criteria. Transudates: CHF, cirrhosis, nephrotic syndrome.

Q48. A 60-year-old smoker with hemoptysis, weight loss, finger clubbing. Most likely diagnosis:

A) TB
B) Bronchogenic carcinoma ✓
C) Bronchiectasis
D) COPD

Q49. Pancoast tumor causes:

A) Superior vena cava syndrome
B) Horner's syndrome ✓ (plus shoulder pain, wasting of hand muscles)
C) Recurrent laryngeal nerve palsy
D) Phrenic nerve palsy

Q50. Wells score is used to assess probability of:

A) DVT only
B) Pulmonary embolism ✓
C) Pneumonia
D) PE and DVT both (separate scores)

Q51. Gold standard investigation for pulmonary embolism:

A) CXR
B) D-dimer
C) CTPA (CT pulmonary angiography) ✓
D) V/Q scan

Q52. Classic ECG finding in massive PE:

A) ST elevation in V1-V4
B) S1Q3T3 pattern ✓
C) Atrial fibrillation
D) Left bundle branch block

Q53. A 25-year-old tall thin male develops sudden onset left-sided chest pain and shortness of breath. CXR shows absent lung markings on left. Diagnosis?

A) PE
B) Pleuritis
C) Spontaneous pneumothorax ✓
D) Aortic dissection

Q54. Management of tension pneumothorax:

A) Wait for CXR confirmation
B) Immediate needle decompression (2nd ICS, midclavicular line) ✓
C) Chest X-ray first then drain
D) IV fluids

Q55. Occupational lung disease caused by coal dust:

A) Asbestosis
B) Silicosis
C) Coal workers' pneumoconiosis ✓
D) Berylliosis

Explanation: Asbestosis = shipbuilding/insulation (mesothelioma risk). Silicosis = mining, sandblasting (upper lobe fibrosis). Coal = lower lobe.

Q56. Which interstitial lung disease is associated with rheumatoid arthritis?

A) Sarcoidosis
B) Usual interstitial pneumonia (UIP/IPF) ✓
C) Eosinophilic pneumonia
D) Lymphocytic interstitial pneumonia

Q57. Sarcoidosis most commonly affects:

A) Lower lobe lymph nodes
B) Bilateral hilar lymphadenopathy + lungs ✓
C) Pleura
D) Upper lobes only

Q58. Non-caseating granuloma on biopsy = which diagnosis?

A) TB (caseating)
B) Sarcoidosis ✓
C) Wegener's granulomatosis
D) Histoplasmosis

Q59. Obstructive sleep apnea (OSA): Gold standard treatment?

A) Weight loss
B) CPAP ✓
C) Uvulopalatopharyngoplasty
D) Tracheostomy

Q60. ARDS diagnostic criteria includes ALL EXCEPT:

A) PaO2/FiO2 <300
B) Bilateral infiltrates on CXR
C) Acute onset within 7 days
D) PCWP >18 mmHg ✓

Explanation: ARDS = NOT caused by cardiac failure (PCWP <18 or no cardiac cause). If PCWP >18 = cardiogenic pulmonary edema.

Q61. Treatment of ARDS:

A) High tidal volume ventilation
B) Lung-protective ventilation (low tidal volume 6 ml/kg) ✓
C) IV furosemide
D) Prone positioning is contraindicated

Q62. Mesothelioma is caused by:

A) Silica
B) Coal dust
C) Asbestos ✓
D) Beryllium

Q63. Patient with COPD, PO2 55 mmHg at rest. Long-term oxygen therapy (LTOT) is indicated. How many hours per day?

A) 8 hours
B) 12 hours
C) 15+ hours ✓
D) 24 hours

Q64. Which inhaler is used for MAINTENANCE in moderate persistent asthma?

A) SABA alone
B) ICS + LABA ✓
C) LABA alone
D) Oral steroids

Q65. Clubbing is NOT seen in:

A) Bronchiectasis
B) Lung abscess
C) Mesothelioma
D) Simple COPD ✓ (COPD without cor pulmonale does NOT cause clubbing)

DAY 4-5: GASTROENTEROLOGY & HEPATOLOGY (30 MCQs)

Q66. A 45-year-old presents with epigastric pain relieved by eating. H. pylori test positive. Which lesion?

A) Duodenal ulcer ✓
B) Gastric ulcer
C) GERD
D) Gastric cancer

Explanation: DU = pain relieved by food (buffering). GU = pain worsened by food. DU more common, more H. pylori association.

Q67. H. pylori eradication therapy (Triple therapy):

A) PPI + amoxicillin + metronidazole ✓ (or clarithromycin)
B) H2 blocker + amoxicillin
C) PPI alone
D) Bismuth only

Q68. Most common complication of peptic ulcer:

A) Perforation
B) Bleeding ✓
C) Obstruction
D) Malignant transformation

Q69. Bleeding peptic ulcer: Forrest classification Ia means:

A) Clean base
B) Active spurting hemorrhage ✓
C) Visible vessel
D) Flat pigmented spot

Q70. Crohn's disease vs Ulcerative Colitis: Which feature belongs to Crohn's?

A) Continuous mucosal involvement from rectum
B) Never involves small bowel
C) Skip lesions + transmural inflammation ✓
D) Pseudopolyps

Q71. Extraintestinal manifestation seen in BOTH Crohn's and UC:

A) Primary sclerosing cholangitis (mainly UC)
B) Pyoderma gangrenosum ✓
C) Sacroiliitis
D) Uveitis ✓ (also both)

Q72. Toxic megacolon is a complication of:

A) Crohn's disease
B) Ulcerative colitis ✓
C) IBS
D) Diverticulitis

Q73. Gold standard for diagnosis of Crohn's disease:

A) Barium enema
B) CT abdomen
C) Colonoscopy with biopsy ✓
D) Capsule endoscopy

Q74. A 30-year-old woman with alternating constipation and diarrhea, bloating, abdominal pain relieved by defecation. Normal investigations. Diagnosis?

A) UC
B) Crohn's disease
C) Irritable Bowel Syndrome ✓
D) Celiac disease

Q75. Child-Pugh score includes ALL EXCEPT:

A) Bilirubin
B) Albumin
C) Prothrombin time
D) ALT level ✓

Explanation: Child-Pugh = Bilirubin + Albumin + PT + Ascites + Encephalopathy (not transaminases).

Q76. Most common cause of cirrhosis in Pakistan:

A) Alcohol
B) Hepatitis B and C ✓
C) NAFLD
D) Autoimmune hepatitis

Q77. Hepatic encephalopathy: precipitant most commonly seen in clinical practice?

A) High protein diet
B) GI bleeding ✓
C) Alkalosis
D) Hyponatremia

Q78. Treatment of hepatic encephalopathy:

A) IV fluids
B) Lactulose + rifaximin ✓
C) Neomycin alone
D) Protein restriction (severe)

Q79. Spontaneous bacterial peritonitis (SBP): diagnostic PMN count in ascitic fluid?

A) >100 cells/mm3
B) >250 cells/mm3 ✓
C) >500 cells/mm3
D) >1000 cells/mm3

Q80. Most common organism causing SBP:

A) Staph aureus
B) E. coli ✓
C) Klebsiella
D) Pseudomonas

Q81. Hepatorenal syndrome (HRS): Best initial treatment?

A) IV albumin + terlipressin ✓
B) Dialysis
C) IV furosemide
D) Liver biopsy

Q82. Serum-ascites albumin gradient (SAAG) >1.1 g/dL suggests:

A) Malignant ascites
B) TB peritonitis
C) Portal hypertension ✓ (cirrhosis, HF, Budd-Chiari)
D) Nephrotic syndrome

Q83. Most common cause of acute pancreatitis in Pakistan:

A) Alcohol
B) Gallstones ✓
C) Hypercalcemia
D) Trauma

Q84. Ranson's criteria at admission: all EXCEPT:

A) Age >55
B) WBC >16,000
C) Blood glucose >200
D) Amylase >3x normal ✓ (amylase level is NOT a Ranson criterion)

Q85. Grey Turner sign (flank bruising) and Cullen sign (periumbilical bruising) are seen in:

A) Peptic ulcer perforation
B) Severe hemorrhagic pancreatitis ✓
C) Ruptured ectopic pregnancy
D) Aortic aneurysm

Q86. Hepatitis B: Which marker indicates active viral replication?

A) HBsAg
B) Anti-HBs
C) HBeAg ✓
D) Anti-HBe

Q87. Window period in Hepatitis B (HBsAg negative, anti-HBs negative): Which marker is positive?

A) HBeAg
B) Anti-HBc IgM ✓
C) Anti-HBe
D) HBV DNA

Q88. Most common cause of fulminant hepatic failure in Pakistan:

A) Hepatitis A
B) Hepatitis E ✓ (especially in pregnant women)
C) Hepatitis B
D) Drug-induced

Q89. Barrett's esophagus: change in epithelium?

A) Squamous to gastric
B) Squamous to intestinal columnar metaplasia ✓
C) Columnar to squamous
D) Normal to dysplastic squamous

Q90. Achalasia cardia: manometry shows:

A) Low LES pressure
B) High LES pressure + absent peristalsis ✓
C) Normal LES
D) Hyperperistalsis

Q91. Most common site of colorectal cancer:

A) Ascending colon
B) Descending colon
C) Rectosigmoid ✓
D) Transverse colon

Q92. Duke's Stage C colorectal cancer means:

A) Tumor in mucosa only
B) Through muscle wall
C) Regional lymph node involvement ✓
D) Distant metastasis

Q93. Cholesterol gallstones: risk factors (5 F's): Female, Fat, Forty, Fertile, and:

A) Fasting ✓
B) Fair
C) Flatulence
D) Fever

Explanation: 5 Fs = Female, Fat, Forty, Fertile, Fair (actually classic teaching). Fasting/prolonged TPN also risk.

Q94. Murphy's sign is positive in:

A) Appendicitis
B) Acute cholecystitis ✓
C) Peptic ulcer
D) Pancreatitis

Q95. Best initial investigation for biliary colic / cholecystitis:

A) CT abdomen
B) ERCP
C) Abdominal ultrasound ✓
D) HIDA scan

DAY 6: NEPHROLOGY (30 MCQs)

Q96. Nephrotic syndrome triad:

A) Hematuria + hypertension + edema
B) Proteinuria >3.5g/day + hypoalbuminemia + edema ✓
C) Oliguria + uremia + edema
D) Proteinuria + hematuria + RBC casts

Q97. Most common cause of nephrotic syndrome in children:

A) Membranous nephropathy
B) Minimal change disease ✓
C) Focal segmental glomerulosclerosis
D) IgA nephropathy

Q98. Most common cause of nephrotic syndrome in adults:

A) Minimal change disease
B) IgA nephropathy
C) Membranous nephropathy ✓
D) Lupus nephritis

Q99. Nephritic syndrome includes ALL EXCEPT:

A) Hematuria
B) RBC casts
C) Hypertension
D) Massive proteinuria >3.5g ✓ (massive proteinuria = nephrotic)

Q100. Post-streptococcal glomerulonephritis: What is the latent period?

A) 1-3 days
B) 1-3 weeks ✓ (throat: 1-2 wks; skin: 2-4 wks)
C) 1-3 months
D) Immediate

Q101. Goodpasture syndrome: Antibodies against:

A) ANA
B) Anti-GBM antibody (Type IV collagen) ✓
C) ANCA
D) Anti-dsDNA

Q102. Linear IgG deposits on immunofluorescence = which disease?

A) IgA nephropathy
B) Membranous nephropathy
C) Goodpasture syndrome ✓
D) PSGN

Q103. Granular "lumpy bumpy" deposits on IF = which disease?

A) Goodpasture
B) Post-streptococcal GN ✓
C) Minimal change disease
D) Anti-GBM disease

Q104. IgA nephropathy (Berger's disease): Key feature?

A) Occurs weeks after infection
B) Hematuria during or immediately after URTI (synpharyngitic) ✓
C) Responds well to steroids
D) Common in old age

Q105. Indication for renal biopsy in nephrotic syndrome adult?

A) To diagnose minimal change disease
B) To guide treatment when cause is unclear ✓
C) To check for infection
D) Before starting ACE inhibitor

Q106. AKI (Acute Kidney Injury): Urine sodium <20 mEq/L = which type?

A) Intrinsic (ATN)
B) Pre-renal ✓
C) Post-renal
D) Glomerulonephritis

Q107. Most common cause of AKI in hospitalized patients:

A) Contrast nephropathy
B) ATN (ischemic or toxic) ✓
C) Glomerulonephritis
D) Obstruction

Q108. BUN:Creatinine ratio >20:1 suggests:

A) ATN
B) Pre-renal azotemia ✓
C) Post-renal
D) Rhabdomyolysis

Q109. CKD: Which electrolyte abnormality requires URGENT treatment?

A) Hyperphosphatemia
B) Hyperkalemia ✓
C) Hyponatremia
D) Hyperuricemia

Q110. ECG changes in hyperkalemia (sequence):

A) Peaked T waves → widened QRS → sine wave → cardiac arrest ✓
B) ST elevation → T inversion → Q waves
C) PR prolongation → AV block
D) U waves

Q111. Emergency treatment of hyperkalemia with ECG changes:

A) Furosemide
B) IV calcium gluconate (membrane stabilization) ✓
C) Insulin + dextrose
D) Kayexalate

Explanation: Calcium gluconate = IMMEDIATE (stabilizes cardiac membrane). Then insulin/dextrose + bicarbonate to shift K+ intracellularly. Then remove K+: dialysis/kayexalate.

Q112. Anemia of CKD is caused by:

A) Iron deficiency
B) Decreased erythropoietin production ✓
C) B12 deficiency
D) Hemolysis

Q113. Renal osteodystrophy in CKD: sequence of events?

A) Decreased GFR → phosphate retention → low Ca → high PTH → bone resorption ✓
B) High Ca → low PTH
C) High Ca → high phosphate
D) Increased vitamin D → high Ca

Q114. Most common type of renal stone:

A) Uric acid
B) Struvite (infection stones)
C) Calcium oxalate ✓
D) Cystine

Q115. Radiolucent kidney stones (not seen on X-ray):

A) Calcium oxalate
B) Uric acid ✓
C) Struvite
D) Calcium phosphate

Q116. Which stone is associated with UTI and staghorn calculi?

A) Uric acid
B) Cystine
C) Struvite (magnesium ammonium phosphate) ✓
D) Calcium oxalate

Q117. Distal RTA (Type I): Which finding is characteristic?

A) Hyperkalemia
B) Hypokalemia + non-anion gap metabolic acidosis + alkaline urine ✓
C) Hyperkalemia + acidic urine
D) Anion gap metabolic acidosis

Q118. Proximal RTA (Type II): Cause?

A) Aldosterone deficiency
B) Fanconi syndrome (failure to reabsorb bicarbonate in PCT) ✓
C) H+ secretion failure in distal tubule
D) Collecting duct dysfunction

Q119. Diabetic nephropathy: earliest finding?

A) Proteinuria >300 mg/day
B) Microalbuminuria (30-300 mg/day) ✓
C) Rising creatinine
D) Hypertension

Q120. Best drug to slow progression of diabetic nephropathy:

A) Calcium channel blocker
B) Beta-blocker
C) ACE inhibitor or ARB ✓
D) Furosemide

Q121. Dialysis indication (AEIOU):

A) Acidosis (refractory)
B) Electrolytes (refractory hyperkalemia)
C) Intoxication (drugs/toxins)
D) Overload (volume, refractory)
E) Uremia (encephalopathy, pericarditis, bleeding)
ALL of the above ✓

Q122. Alport syndrome: X-linked nephritis with:

A) Deafness + eye abnormalities + hematuria ✓
B) Deafness + proteinuria + skin rash
C) Nephrotic syndrome + neuropathy
D) Polycystic kidneys

Q123. Autosomal dominant polycystic kidney disease (ADPKD): Most common associated finding?

A) Mitral valve prolapse
B) Intracranial (berry) aneurysms ✓
C) Liver cysts (also common)
D) Pancreatic cysts

Q124. Nephrogenic DI: best test?

A) Serum ADH
B) Water deprivation test + vasopressin challenge ✓
C) MRI brain
D) Urine culture

Q125. FSGN (Focal Segmental Glomerulosclerosis): Associated with:

A) Strep infection
B) HIV and heroin use ✓
C) Hepatitis C
D) SLE

DAY 7: NEUROLOGY (30 MCQs)

Q126. Most common cause of ischemic stroke:

A) Atrial fibrillation → cardioembolism
B) Atherosclerosis of large vessels ✓
C) Small vessel disease (lacunar)
D) Hypercoagulable state

Q127. Time window for IV tPA (alteplase) in ischemic stroke?

A) 2 hours
B) 3-4.5 hours ✓
C) 6 hours
D) 24 hours

Q128. Most important contraindication to tPA in stroke:

A) Age >80
B) Hemorrhagic stroke on CT ✓
C) Mild deficit
D) Hypertension <185/110

Q129. TIA (Transient Ischemic Attack): By definition, symptoms resolve within:

A) 30 minutes
B) 1 hour
C) 24 hours ✓
D) 72 hours

Q130. ABCD2 score in TIA: which factor is NOT included?

A) Age
B) Blood pressure
C) Duration of symptoms
D) Prior TIA history ✓ (not included in ABCD2)

Q131. Weber syndrome (midbrain): Ipsilateral CN III palsy + contralateral hemiplegia. Lesion in:

A) Pons
B) Midbrain (cerebral peduncle) ✓
C) Medulla
D) Thalamus

Q132. Wallenberg syndrome (lateral medullary syndrome): caused by occlusion of?

A) ACA
B) MCA
C) Posterior inferior cerebellar artery (PICA) ✓
D) Basilar artery

Q133. Drug of choice for focal (partial) seizures:

A) Valproic acid
B) Ethosuximide
C) Carbamazepine ✓
D) Phenobarbital

Q134. Ethosuximide is used specifically for:

A) Tonic-clonic seizures
B) Absence (petit mal) seizures ✓
C) Complex partial seizures
D) Status epilepticus

Q135. Status epilepticus: first-line drug?

A) Phenytoin
B) Benzodiazepines (IV lorazepam or diazepam) ✓
C) Phenobarbital
D) Levetiracetam

Q136. Meningitis: CSF findings - low glucose, high protein, high neutrophils = which type?

A) Viral
B) Bacterial ✓
C) TB
D) Fungal

Q137. TB meningitis CSF: which finding is most specific?

A) High protein
B) Low glucose
C) Lymphocytosis + high protein + very low glucose + high ADA ✓
D) Neutrophilia

Q138. Kernig's sign: examiner extends knee with hip flexed at 90° → pain + resistance. Indicates:

A) Cerebellar disease
B) Meningeal irritation ✓
C) UMN lesion
D) Peripheral neuropathy

Q139. Most common organism causing bacterial meningitis in adults (16-60 years):

A) N. meningitidis
B) Streptococcus pneumoniae ✓
C) Listeria
D) H. influenzae

Q140. Multiple sclerosis: Which finding on MRI is most characteristic?

A) Grey matter lesions
B) Periventricular white matter plaques ✓
C) Cortical infarcts
D) Basal ganglia lesions

Q141. McDonald criteria for MS diagnosis requires evidence of:

A) Single attack + single lesion
B) Dissemination in time AND space ✓
C) Progressive decline over 1 year
D) Abnormal VEP only

Q142. Parkinson's disease: Cardinal features (TRAP):

A) Tremor (resting), Rigidity, Akinesia, Postural instability ✓
B) Tremor (intention), Rigidity, Ataxia, Paralysis
C) Tremor, Rigidity, Aphasia, Paresthesia
D) Tremor, Reflexes loss, Atrophy, Paresthesia

Q143. Drug of choice for Parkinson's disease (motor symptoms):

A) Dopamine agonist (pramipexole) - preferred in young
B) Levodopa + carbidopa ✓ (most effective)
C) Anticholinergics (trihexyphenidyl)
D) MAO-B inhibitor (selegiline)

Q144. Levodopa side effects include all EXCEPT:

A) Dyskinesia (peak dose)
B) On-off fluctuations
C) Nausea
D) Cognitive enhancement ✓ (levodopa causes confusion/hallucinations)

Q145. Alzheimer's disease: Pathology?

A) Lewy bodies
B) Tau protein tangles + amyloid plaques ✓
C) Prion protein
D) TDP-43

Q146. Which dementia is associated with visual hallucinations + Parkinsonism?

A) Alzheimer's
B) Vascular dementia
C) Lewy body dementia ✓
D) Frontotemporal dementia

Q147. Guillain-Barre syndrome: CSF findings?

A) High WBC + high protein
B) Albuminocytologic dissociation (high protein + normal cells) ✓
C) Normal CSF
D) Low glucose

Q148. Classic migraine (with aura) vs common migraine:

A) Common migraine has aura
B) Classic migraine has focal neurological symptoms before headache ✓
C) Both have same treatment
D) Common is more severe

Q149. Subarachnoid hemorrhage: Classic presentation?

A) Gradual onset headache
B) Sudden "thunderclap" headache (worst headache of life) ✓
C) Headache + fever
D) Headache + focal deficit

Q150. Subdural hematoma: Blood between which layers?

A) Skull and dura
B) Dura and arachnoid ✓
C) Arachnoid and pia
D) Brain parenchyma

Q151. Most common cause of subdural hematoma in elderly:

A) Hypertension
B) Minor head trauma (bridging vein rupture) ✓
C) AVM
D) Aneurysm rupture

Q152. Epidural hematoma: Classic lucid interval + lens-shaped hematoma on CT. Vessel involved?

A) Bridging vein
B) Middle meningeal artery ✓
C) Anterior cerebral artery
D) Dural sinus

Q153. Headache worsened by lying down/Valsalva, morning headaches, papilledema = ?

A) Migraine
B) Tension headache
C) Raised ICP (intracranial hypertension) ✓
D) Cluster headache

Q154. Cluster headache: Features?

A) Bilateral throbbing + photophobia
B) Unilateral periorbital pain + lacrimation + rhinorrhea + restlessness ✓
C) Occipital
D) Associated with menstruation

Q155. Treatment of trigeminal neuralgia:

A) Amitriptyline
B) Gabapentin
C) Carbamazepine ✓
D) Sumatriptan

DAY 8: ENDOCRINOLOGY (30 MCQs)

Q156. HbA1c reflects blood glucose over:

A) 1 week
B) 1 month
C) 3 months ✓
D) 6 months

Q157. Target HbA1c for most diabetic patients:

A) <6%
B) <7% ✓
C) <8%
D) <9%

Q158. Diabetic ketoacidosis (DKA): Precipitant in Type 1 DM?

A) Exercise
B) Infection ✓
C) Oral hypoglycemics
D) Alcohol

Q159. DKA vs HONK (HHS): Which finding differentiates them?

A) Hyperglycemia (both)
B) Dehydration (both)
C) Ketonemia/ketonuria (DKA) vs absent/minimal ketones (HHS) ✓
D) Osmolality (HHS higher)

Q160. Treatment of DKA: Correct sequence?

A) Insulin first
B) IV fluids first → then insulin ✓ (isotonic saline + correct K+ before starting insulin)
C) Bicarbonate first
D) Potassium first

Q161. Which oral hypoglycemic agent is first-line in type 2 DM (no contraindications)?

A) Sulfonylurea
B) Metformin ✓
C) DPP-4 inhibitor
D) Pioglitazone

Q162. Metformin mechanism of action:

A) Stimulates insulin secretion
B) Decreases hepatic glucose production (activates AMPK) ✓
C) Increases insulin sensitivity in muscle only
D) Inhibits glucose absorption

Q163. Contraindication to metformin:

A) Obesity
B) Renal failure (eGFR <30) ✓
C) Hypertension
D) Old age

Q164. Dawn phenomenon in diabetes:

A) Hypoglycemia in early morning
B) Hyperglycemia in early morning due to GH + cortisol surge ✓
C) Somogyi effect
D) Post-meal hyperglycemia

Q165. Hypothyroidism: Most common cause worldwide?

A) Iodine deficiency ✓ (worldwide)
B) Hashimoto's thyroiditis (in iodine-sufficient areas)
C) Radioiodine treatment
D) Surgery

Q166. Hashimoto's thyroiditis: Antibody?

A) TSH receptor antibody
B) Anti-TPO antibody ✓ (and anti-thyroglobulin)
C) Anti-dsDNA
D) Anti-Smith

Q167. Graves' disease: Antibody?

A) Anti-TPO
B) TSH receptor stimulating antibody (TSI/TRAb) ✓
C) Anti-thyroglobulin
D) Anti-microsomal

Q168. Thyroid storm: Treatment?

A) Beta-blocker alone
B) PTU + beta-blocker (propranolol) + iodine (Lugol's) + corticosteroids ✓
C) Radioiodine
D) Surgery immediately

Q169. Primary hyperaldosteronism (Conn's syndrome): Key biochemical findings?

A) Hyponatremia + hyperkalemia
B) Hypertension + hypokalemia + metabolic alkalosis ✓
C) Hypotension + hyperkalemia
D) Hypernatremia + hyperkalemia

Q170. Addison's disease: Most common cause?

A) TB (worldwide)
B) Autoimmune ✓ (in developed countries)
C) Bilateral adrenalectomy
D) Meningococcemia (Waterhouse-Friderichsen)

Q171. Addisonian crisis: Treatment?

A) Oral hydrocortisone
B) IV hydrocortisone + IV saline + dextrose ✓
C) Fludrocortisone alone
D) ACTH stimulation test first

Q172. Cushing syndrome: Dexamethasone suppression test (overnight, 1mg): In Cushing's, cortisol is:

A) Suppressed
B) NOT suppressed ✓
C) Low
D) Fluctuating

Q173. Most common cause of Cushing's syndrome:

A) Adrenal adenoma
B) Exogenous steroid use ✓ (iatrogenic)
C) Pituitary adenoma (Cushing's disease)
D) Ectopic ACTH

Q174. Nelson's syndrome occurs after:

A) Adrenalectomy → pituitary adenoma grows (hyperpigmentation) ✓
B) Thyroidectomy
C) Pancreatectomy
D) Parathyroidectomy

Q175. Pheochromocytoma: Classic triad?

A) Hypertension + bradycardia + obesity
B) Episodic hypertension + headache + palpitations + diaphoresis ✓
C) Constant hypertension + hypokalemia
D) Hypotension + tachycardia + tremor

Q176. Best screening test for pheochromocytoma:

A) CT abdomen
B) Serum catecholamines
C) 24-hour urine catecholamines/metanephrines ✓
D) MRI adrenal

Q177. Primary hyperparathyroidism: Most common cause?

A) Parathyroid carcinoma
B) Parathyroid hyperplasia
C) Parathyroid adenoma ✓
D) MEN 2A

Q178. Chvostek sign (tapping facial nerve → facial twitch) and Trousseau sign (BP cuff → carpal spasm) indicate:

A) Hypokalemia
B) Hypocalcemia ✓
C) Hypermagnesemia
D) Hyponatremia

Q179. SIADH: Characteristics?

A) High serum Na + high serum osmolality
B) Low serum Na + low serum osmolality + high urine Na + high urine osmolality ✓
C) Low serum Na + low urine osmolality
D) High urine output + high serum Na

Q180. Treatment of chronic SIADH (hyponatremia <125 mEq/L):

A) Normal saline (may worsen it)
B) Fluid restriction ✓ (first-line)
C) Hypertonic saline (for severe symptomatic <120)
D) Furosemide

Q181. MEN 1 (Multiple Endocrine Neoplasia 1) - "3 P's":

A) Pituitary + Parathyroid + Pancreas ✓
B) Pheochromocytoma + Parathyroid + Pancreas
C) Pituitary + Pheochromocytoma + Pancreas
D) Parathyroid + Pheochromocytoma + Pancreas

Q182. MEN 2A includes:

A) Medullary thyroid cancer + pheochromocytoma + parathyroid hyperplasia ✓
B) Pituitary + parathyroid + pancreas
C) Medullary thyroid + marfanoid + mucosal neuromas
D) MTC + pheochromocytoma only

Q183. DI (Diabetes Insipidus): Which finding differentiates central from nephrogenic?

A) Both respond to desmopressin
B) Central DI responds to desmopressin; nephrogenic does NOT ✓
C) Nephrogenic has higher urine output
D) Serum Na differentiates

Q184. Acromegaly: Best screening test?

A) Serum GH
B) IGF-1 level ✓
C) MRI pituitary
D) Oral glucose tolerance test (for diagnosis confirmation)

Q185. Prolactinoma treatment (first-line):

A) Surgery
B) Dopamine agonist (cabergoline/bromocriptine) ✓
C) Radiotherapy
D) Octreotide

DAY 9: HEMATOLOGY (30 MCQs)

Q186. Most common type of anemia worldwide:

A) B12 deficiency
B) Folate deficiency
C) Iron deficiency anemia ✓
D) Anemia of chronic disease

Q187. Iron deficiency anemia: Blood smear shows:

A) Macrocytic cells
B) Hypochromic microcytic cells ✓
C) Target cells
D) Schistocytes

Q188. Total iron binding capacity (TIBC) in iron deficiency:

A) Decreased
B) Normal
C) Increased ✓
D) Absent

Q189. Ferritin is an acute phase reactant. In iron deficiency + chronic disease:

A) Always low
B) May be falsely normal/high despite IDA ✓
C) Always high
D) Not useful

Q190. Megaloblastic anemia: Hypersegmented neutrophils on smear + which deficiency?

A) Iron
B) B12 or folate ✓
C) Copper
D) Vitamin C

Q191. Schilling test is used to diagnose:

A) Iron deficiency
B) B12 deficiency due to intrinsic factor deficiency (pernicious anemia) ✓
C) Folate deficiency
D) Hemolysis

Q192. Pernicious anemia: Antibodies against?

A) RBC
B) Intrinsic factor and parietal cells ✓
C) Folic acid
D) Platelets

Q193. Beta-thalassemia major: Most important abnormality?

A) HbA1 absent, predominantly HbF ✓
B) HbS present
C) HbH (4 beta chains)
D) Heinz bodies

Q194. Sickle cell disease: What triggers a vaso-occlusive crisis?

A) High altitude, dehydration, infection, cold ✓
B) Warmth and hydration
C) Iron supplementation
D) Oxygen therapy

Q195. Which malignancy is associated with Reed-Sternberg cells?

A) CLL
B) CML
C) Hodgkin's lymphoma ✓
D) Burkitt's lymphoma

Q196. Hodgkin's lymphoma: Most common histological subtype?

A) Lymphocyte predominant
B) Nodular sclerosis ✓ (most common overall)
C) Mixed cellularity
D) Lymphocyte depletion (worst prognosis)

Q197. CML: Characteristic cytogenetic finding?

A) t(8;14)
B) t(9;22) Philadelphia chromosome ✓ (BCR-ABL)
C) t(15;17)
D) t(14;18)

Q198. CML treatment (first-line):

A) Hydroxyurea
B) Imatinib (BCR-ABL tyrosine kinase inhibitor) ✓
C) Busulfan
D) Bone marrow transplant

Q199. CLL: Most common leukemia in adults in Western countries. Smear shows:

A) Blast cells
B) Smudge cells ✓
C) Reed-Sternberg cells
D) Auer rods

Q200. AML: Auer rods in blasts. Most common subtype with DIC?

A) M1
B) M2
C) M3 (APL - acute promyelocytic leukemia) ✓
D) M4

Q201. APL treatment:

A) Standard chemotherapy only
B) All-trans retinoic acid (ATRA) + arsenic trioxide ✓
C) Imatinib
D) Rituximab

Q202. Burkitt's lymphoma: Association?

A) EBV + t(8;14) ✓
B) HIV + t(14;18)
C) HHV8 + t(9;22)
D) CMV + t(8;14)

Q203. DIC: Which lab finding differentiates from primary fibrinolysis?

A) Low fibrinogen (both)
B) High D-dimer (both)
C) D-dimer very high + low platelets + prolonged PT/APTT = DIC ✓
D) Normal thrombin time

Q204. Von Willebrand disease: What test is characteristically prolonged?

A) PT
B) Bleeding time + APTT ✓
C) Thrombin time
D) PT only

Q205. Hemophilia A: Deficiency of?

A) Factor IX
B) Factor VIII ✓
C) vWF
D) Factor XI

Q206. Hemophilia B (Christmas disease): Deficiency of?

A) Factor VIII
B) Factor IX ✓
C) Factor X
D) vWF

Q207. ITP (Immune Thrombocytopenic Purpura): First-line treatment?

A) Splenectomy
B) IV immunoglobulin + platelet transfusion
C) Oral corticosteroids (prednisolone) ✓
D) Rituximab

Q208. TTP (Thrombotic Thrombocytopenic Purpura): ADAMTS13 enzyme deficiency. Pentad?

A) Fever + renal failure + CNS symptoms + microangiopathic hemolysis + thrombocytopenia ✓
B) Fever + rash + arthritis + anemia + leukopenia
C) HUS triad + fever + CNS symptoms
D) All of A + DIC

Q209. Treatment of TTP:

A) Heparin
B) Platelet transfusion (CONTRAINDICATED)
C) Plasma exchange (FFP) ✓
D) Steroids alone

Q210. Polycythemia vera: Mutation?

A) BCR-ABL
B) JAK2 V617F ✓
C) t(9;22)
D) FLT3

Q211. Multiple myeloma: Diagnostic triad?

A) M-protein + plasmacytosis (>10%) + end-organ damage (CRAB) ✓
B) Anemia + high ESR + bone pain only
C) Bence-Jones protein alone
D) High calcium + anemia

Q212. CRAB criteria in multiple myeloma:

A) Calcium elevation + Renal failure + Anemia + Bone lesions ✓
B) Calcium + RBC + Anemia + Bleeding
C) Creatinine + Respiratory + Albumin + Bone marrow
D) None of above

Q213. Splenomegaly is a feature of ALL EXCEPT:

A) CML
B) CLL
C) Myelofibrosis
D) ITP ✓ (spleen normal or small in ITP)

Q214. Leukemoid reaction: WBC >50,000 with mature neutrophils. Differentiates from CML by:

A) Blasts present
B) High LAP (leukocyte alkaline phosphatase) score ✓ (low in CML)
C) Philadelphia chromosome
D) Splenomegaly

Q215. Folic acid supplementation in pregnancy reduces risk of:

A) Down syndrome
B) Neural tube defects ✓
C) Congenital heart disease
D) Cleft palate

DAY 10: RHEUMATOLOGY (30 MCQs)

Q216. SLE diagnostic criteria: Minimum how many ACR criteria required for diagnosis?

A) 2/11
B) 4/11 ✓
C) 6/11
D) 8/11

Q217. Most specific antibody for SLE:

A) ANA
B) Anti-dsDNA ✓ (and anti-Smith)
C) Anti-SSA (Ro)
D) Anti-histone

Q218. Anti-histone antibody is associated with:

A) Primary SLE
B) Drug-induced SLE ✓
C) Sjogren's syndrome
D) Scleroderma

Q219. Butterfly (malar) rash of SLE characteristically SPARES:

A) Cheeks
B) Nose bridge
C) Nasolabial folds ✓
D) Forehead

Q220. Lupus nephritis: Most common class causing renal failure?

A) Class I
B) Class II
C) Class IV (diffuse proliferative GN) ✓
D) Class V (membranous)

Q221. Rheumatoid arthritis: Characteristic joint distribution?

A) DIP joints (Heberden's nodes)
B) PIP + MCP joints, symmetric, with sparing of DIP ✓
C) Asymmetric large joints
D) Axial + DIP joints

Q222. Most specific antibody for RA:

A) Rheumatoid factor (RF)
B) Anti-CCP (anti-cyclic citrullinated peptide) ✓
C) ANA
D) Anti-dsDNA

Q223. Felty's syndrome = RA + splenomegaly + ?

A) Renal failure
B) Neutropenia ✓
C) Thrombocytopenia
D) Anemia only

Q224. First-line DMARD for RA:

A) Hydroxychloroquine
B) Sulfasalazine
C) Methotrexate ✓
D) Leflunomide

Q225. Gout: Crystal type?

A) Calcium pyrophosphate (positively birefringent)
B) Monosodium urate (negatively birefringent, needle-shaped) ✓
C) Hydroxyapatite
D) Calcium oxalate

Q226. Acute gout attack: Best initial treatment?

A) Allopurinol
B) NSAIDs (indomethacin) or colchicine ✓
C) Probenecid
D) Corticosteroids (second-line)

Q227. Allopurinol mechanism:

A) Promotes uric acid excretion
B) Inhibits xanthine oxidase → decreases uric acid production ✓
C) Anti-inflammatory
D) Increases renal filtration of urate

Q228. Pseudogout: Crystal type?

A) MSU crystals
B) Calcium pyrophosphate dihydrate (CPPD) - weakly positively birefringent ✓
C) Hydroxyapatite
D) Calcium oxalate

Q229. Ankylosing spondylitis: HLA association?

A) HLA-DR4
B) HLA-B27 ✓
C) HLA-DR3
D) HLA-A3

Q230. Schober's test measures:

A) Hip flexion
B) Lumbar spine flexion (reduced in AS) ✓
C) Cervical rotation
D) SI joint tenderness

Q231. Psoriatic arthritis: Which pattern is UNIQUE to PsA (not seen in RA)?

A) PIP joint involvement
B) DIP joint involvement + nail changes ✓
C) Symmetric polyarthritis
D) Wrist involvement

Q232. Reactive arthritis (Reiter's syndrome): Classic triad?

A) Urethritis + conjunctivitis + arthritis ✓
B) Uveitis + arthritis + diarrhea
C) Rash + arthritis + fever
D) SLE triad

Q233. Sjogren's syndrome: Most common extraglandular manifestation?

A) Lymphoma ✓ (40x increased risk)
B) Renal failure
C) ILD
D) Peripheral neuropathy

Q234. Antibodies in Sjogren's:

A) Anti-dsDNA
B) Anti-SSA (Ro) and Anti-SSB (La) ✓
C) Anti-CCP
D) Anti-SCL-70

Q235. Systemic sclerosis (scleroderma): Limited vs Diffuse - CREST syndrome is?

A) Diffuse scleroderma
B) Limited scleroderma (anti-centromere antibody) ✓
C) Morphea
D) Mixed connective tissue disease

Q236. Diffuse systemic sclerosis antibody:

A) Anti-centromere
B) Anti-SCL-70 (topoisomerase I) ✓
C) Anti-SSA
D) Anti-Jo-1

Q237. Anti-Jo-1 antibody is associated with:

A) SLE
B) Polymyositis/dermatomyositis ✓
C) Scleroderma
D) Sjogren's

Q238. Dermatomyositis: Heliotrope rash and Gottron's papules. Elevated muscle enzyme?

A) LDH
B) CK (creatine kinase) ✓
C) Aldolase
D) Both CK and aldolase ✓

Q239. Osteoarthritis: X-ray findings?

A) Joint space widening
B) Periarticular erosions
C) Joint space narrowing + osteophytes + subchondral sclerosis ✓
D) Periosteal reaction

Q240. Osteoporosis: DEXA scan T-score diagnostic threshold?

A) T-score < -1.0 (osteopenia)
B) T-score < -2.5 ✓
C) T-score < -3.0
D) T-score < -1.5

Q241. Bisphosphonate mechanism in osteoporosis:

A) Increase osteoblast activity
B) Inhibit osteoclast-mediated bone resorption ✓
C) Increase calcium absorption
D) Mimic PTH

Q242. Polymyalgia rheumatica (PMR): Key feature differentiating from polymyositis?

A) Normal CK in PMR ✓
B) Weakness in PMR
C) Biopsy needed for PMR
D) Same treatment

Q243. Giant cell arteritis (temporal arteritis): Most feared complication?

A) Stroke
B) Blindness (anterior ischemic optic neuropathy) ✓
C) MI
D) Renal failure

Q244. Giant cell arteritis: Treatment?

A) NSAIDs
B) High-dose corticosteroids (prednisolone) immediately ✓
C) Tocilizumab (second-line)
D) Methotrexate

Q245. Wegener's granulomatosis (GPA): Classic triad?

A) Ear + nose + throat + kidneys (upper + lower respiratory + renal) ✓
B) Skin + joints + kidneys
C) Lungs + skin + eyes
D) Heart + kidneys + lungs

DAY 11: INFECTIOUS DISEASE (30 MCQs)

Q246. HIV: CD4 count at which PCP (Pneumocystis pneumonia) prophylaxis with co-trimoxazole is started?

A) <500
B) <350
C) <200 ✓
D) <100

Q247. HIV: Most common AIDS-defining illness?

A) CMV retinitis
B) PCP pneumonia ✓
C) Toxoplasmosis
D) Cryptococcal meningitis

Q248. CMV retinitis occurs at CD4 count:

A) <350
B) <200
C) <50 ✓
D) <100

Q249. HAART in HIV: Which class was first to be developed?

A) NNRTI
B) Protease inhibitor
C) NRTI (nucleoside reverse transcriptase inhibitor) ✓ (zidovudine/AZT)
D) Integrase inhibitor

Q250. Sepsis definition (Sepsis-3):

A) SIRS + infection
B) Life-threatening organ dysfunction caused by dysregulated host response to infection (SOFA score ≥2) ✓
C) Fever + tachycardia + infection
D) Bacteremia + hypotension

Q251. Septic shock = sepsis + persistent hypotension requiring vasopressors + lactate >?

A) 1 mmol/L
B) 2 mmol/L ✓
C) 3 mmol/L
D) 4 mmol/L

Q252. First-line vasopressor in septic shock:

A) Epinephrine
B) Dopamine
C) Norepinephrine ✓
D) Vasopressin

Q253. Malaria: Most dangerous species?

A) P. vivax
B) P. malariae
C) P. falciparum ✓
D) P. ovale

Q254. Blackwater fever is caused by:

A) P. vivax
B) P. falciparum ✓ (massive intravascular hemolysis → hemoglobinuria → dark urine)
C) P. malariae
D) P. knowlesi

Q255. Malaria diagnosis: Gold standard?

A) RDT (rapid diagnostic test)
B) Thick and thin peripheral blood smear ✓
C) PCR
D) Bone marrow biopsy

Q256. Typhoid fever: Rose spots appear on which day?

A) Day 1-3
B) Day 7-10 ✓
C) Day 14
D) Day 21

Q257. Gold standard for diagnosis of typhoid:

A) Widal test
B) Blood culture (first week) ✓
C) Stool culture (third week)
D) Bone marrow culture (most sensitive overall)

Q258. Dengue fever: Which finding indicates dengue hemorrhagic fever (DHF)?

A) High fever
B) Thrombocytopenia <100,000 + plasma leakage ✓
C) Positive tourniquet test
D) Arthralgia

Q259. NS1 antigen in dengue is detectable in:

A) First 5 days ✓
B) Day 5-10 (IgM)
C) After 10 days (IgG)
D) Throughout illness

Q260. Most common cause of viral encephalitis in Pakistan:

A) HSV-1 ✓ (most common sporadic viral encephalitis worldwide)
B) CMV
C) EBV
D) Rabies

Q261. HSV encephalitis: Drug of choice?

A) Ganciclovir
B) IV Acyclovir ✓
C) Foscarnet
D) Ribavirin

Q262. Cryptococcal meningitis (in HIV/AIDS): Treatment?

A) Fluconazole alone
B) Amphotericin B + flucytosine (induction) → fluconazole (consolidation) ✓
C) IV acyclovir
D) Metronidazole

Q263. Tetanus: Treatment?

A) Penicillin G + tetanus immunoglobulin + wound debridement ✓
B) Vancomycin
C) Tetanus toxoid alone
D) Metronidazole

Q264. Cholera: Mechanism of diarrhea?

A) Mucosal invasion
B) CT (cholera toxin) → increases cAMP → Cl- secretion → rice-water stools ✓
C) Toxin destroys villi
D) Direct cytotoxicity

Q265. Treatment of cholera (first-line):

A) Antibiotics first
B) Oral rehydration therapy (ORS) ✓ + antibiotics (doxycycline) for severe
C) IV fluids only
D) Antidiarrheals

Q266. Leptospirosis: Weil's disease = severe form with?

A) Meningitis
B) Jaundice + renal failure + bleeding (hemorrhagic) ✓
C) Pulmonary hemorrhage
D) Encephalitis

Q267. Brucellosis: Most common cause in Pakistan?

A) Brucella melitensis ✓ (goats/sheep)
B) Brucella abortus (cattle)
C) Brucella suis (pigs)
D) Brucella canis

Q268. Treatment of brucellosis:

A) Amoxicillin
B) Doxycycline + rifampicin (6 weeks) ✓
C) Ciprofloxacin alone
D) Ceftriaxone

Q269. Leishmaniasis (Kala-azar): First-line treatment in Pakistan?

A) Pentamidine
B) Sodium stibogluconate (SSG) / Liposomal amphotericin B ✓
C) Miltefosine
D) Doxycycline

Q270. Rabies: Post-exposure prophylaxis (PEP) includes?

A) Vaccine only
B) Wound washing + RIG (rabies immunoglobulin) + vaccine ✓
C) RIG alone
D) Vaccine + doxycycline

Q271. Herpes zoster (shingles): Dermatome distribution. Treatment?

A) Acyclovir (within 72 hours of rash onset) ✓
B) Amantadine
C) Ganciclovir
D) Famciclovir only

Q272. Infective endocarditis: Most common organism (native valve)?

A) Streptococcus viridans ✓
B) Staph aureus (IV drug users, prosthetic valves)
C) Enterococcus
D) HACEK organisms

Q273. Duke's criteria for infective endocarditis: Major criteria include ALL EXCEPT:

A) Positive blood cultures (2 separate)
B) Echo evidence of endocardial involvement
C) New regurgitant murmur
D) Fever ✓ (fever is a minor criterion)

Q274. Osler's nodes vs Janeway lesions in IE:

A) Osler nodes = painful on palms/soles; Janeway = painless ✓
B) Both painful
C) Both painless
D) Osler = painless; Janeway = painful

Q275. Drug of choice for MRSA?

A) Oxacillin
B) Vancomycin ✓
C) Cloxacillin
D) Cephalexin

Resources You Already Have (No Internet Needed)

Primary Sources:

Step-Up Medicine (your main text) - read chapter by chapter per schedule
Osmosis App/Videos (offline if downloaded) - 1 video per major topic per day
This MCQ bank (save/print this document)

Make Your Own:

Revision cards: After each topic, write 5 key facts on paper cards
Drug table: One table per system: Drug → Mechanism → Use → Side effects
Mnemonic page: One page per system for mnemonics
Mistakes log: Write every wrong MCQ + reason → review on Day 12

High-Yield Tables to Memorize (Step-Up Medicine):

Marker	Rises	Peaks	Returns to Normal
Myoglobin	1-2 hr	4 hr	24 hr
CK-MB	4-6 hr	18-24 hr	48-72 hr
Troponin I/T	3-6 hr	24 hr	7-14 days

CSF Finding	Bacterial	Viral	TB	Fungal
Cells	Neutrophils	Lymphocytes	Lymphocytes	Lymphocytes
Protein	High	Normal/slightly high	Very high	High
Glucose	Very low	Normal	Very low	Low
Other	-	-	High ADA	India ink+

Day 12: Full Revision Strategy (Last Day)

Morning (4 Pomodoros): Go through your mistakes log - every wrong MCQ you wrote down
Late morning (2 Pomodoros): High-yield drug side effects revision (rapid fire)
Afternoon (4 Pomodoros): Mixed bag MCQs (30 from random topics - use this sheet)
Late afternoon (2 Pomodoros): Mnemonics + tables revision
Evening (2 Pomodoros): Sleep hygiene, relax, do NOT study new topics

Final Tips

Do NOT start new topics on Day 12 - revise only
Wrong MCQs are gold - every mistake is a point gained if logged and reviewed
Osmosis videos: Watch at 1.25x speed to save time - they are excellent for mechanisms
Step-Up Medicine boxes: The gray/colored boxes are high-yield UHS favorites - read them twice
Past UHS pattern: Focus heavily on clinical vignette-style questions (patient presents with X → what is the diagnosis/management)
Sleep 7-8 hours - consolidation happens during sleep; do not sacrifice sleep for extra Pomodoros
Day before exam: Light revision only, sleep by 10 PM

Good luck - you have a solid plan. Stick to it.

This is a shared conversation. Sign in to Orris to start your own chat.