PGMI KPK entrance test (FCPS-II induction): format, syllabus and merit

Answer: D — Calcium gluconate intravenously

This is severe hyperkalaemia (7.2 mEq/L) with ECG changes, and the point tested is the order of treatment. Once the ECG is affected the immediate danger is a fatal arrhythmia, so the first drug must protect the myocardium rather than lower potassium; the slow irregular pulse adds urgency. Intravenous calcium gluconate, 30 mL of 10% over 10 minutes with cardiac monitoring (or 10 mL of 10% calcium chloride), stabilises the cardiac membrane within minutes; it does not lower potassium and its effect lasts only 30 to 60 minutes, so it is repeated if the ECG does not improve. Insulin with glucose is the most effective potassium-shifting treatment and follows immediately, but takes 15 to 30 minutes to work. Nebulised salbutamol is an additional shifting agent with a similar delay. Emergency haemodialysis is the definitive treatment in this patient but cannot be started within minutes. Sodium polystyrene sulfonate acts over hours and has no role in the emergency.

Answer: C — Urgent surgical excision of the mass

This is a left atrial myxoma, the commonest primary cardiac tumour, arising here from the fossa ovalis. The three classic consequences are present: obstruction, as the mass prolapses through the mitral orifice in diastole causing breathlessness, presyncope and the mobile tumour plop; embolism, producing the two transient ischaemic events; and constitutional upset. Because a fragment may embolise to the brain at any moment and the mass can occlude the valve and cause sudden death, it is excised surgically within days, not electively. Anticoagulation does not prevent embolisation of friable tissue and leaves the obstruction untreated. Thrombolysis is aimed at thrombus and risks catastrophic haemorrhage in a resolved neurological event. Percutaneous coronary intervention addresses a disease not present. Watching for six months exposes her to a preventable stroke.

Answer: C — High anion gap metabolic acidosis

This is diabetic ketoacidosis, testing whether an anion gap is calculated rather than pH read alone. Sodium minus chloride and bicarbonate gives 132-95-12, an anion gap of 25, far above normal 8-12, from unmeasured beta-hydroxybutyrate and acetoacetate from unopposed lipolysis in insulin deficiency: a high anion gap metabolic acidosis. Calling it compensated is wrong because pH remains acidaemic at 7.20; compensation never restores a normal pH. Uncompensated is also wrong, since Winter's formula predicts a PaCO2 of about 26 mmHg and the measured 25 shows appropriate respiratory compensation, the Kussmaul breathing seen here. There is no mixed disorder, as the respiratory response is as expected. Respiratory alkalosis is a primary hyperventilation, not compensatory.

Answer: B — Obtain a court order for chemotherapy

✅ Correct: Obtain a court order for chemotherapy

When parents refuse potentially life-saving treatment for a child, clinicians should seek legal intervention to protect the child's welfare rather than simply accept refusal.

❌ Why the others are wrong

A: Parental authority has limits when refusal places a child at serious risk.

C: Proceeding without appropriate legal authority may breach parental/legal rights.

D: Supportive treatment alone leaves a potentially curable serious condition untreated.

E: Transferring care to avoid the issue does not protect the child's interests.

Answer: B — Power

✅ Correct: Power

Power is a study's ability to detect an association that genuinely exists — the probability of rejecting a false null hypothesis. It equals 1 − beta.

It is driven by sample size, the size of the true effect, the outcome's variability and the chosen alpha. An underpowered study that reports "no association" has shown nothing.

❌ Why the others are wrong

Precision — how tightly an estimate is reproduced, reflected in confidence interval width; a study can be precise about the wrong thing.

Confidence — the confidence level (typically 95%) attached to an interval estimate, not the ability to detect an effect.

Significance — the alpha threshold at which a result is called statistically significant; controls false positives, not detection of true effects.