.

Body dysmorphic concern is present in all except :

A. Hypochondriasis
B. Amputated leg
C. BDD
D. Anorexia nervosa
E. Non dominant parietal lobe lesion

A man 25 years took some Drug for gastritis 2 days ago since then he's been experiencing upward rolling of eyes(
PT IS CONSCIOUS) he went to party took MDMA n had a fit. Now he's conscious and alright . Only complains of
that upward rolling . Cause : 2) Oculogyric crises

89 year old male with constipation for months. on examination, ab is soft.no mass. rectal examination : empty rectum.
what is the appropriate management?
-lactulose
-fleet enema
-colonoscopy
parents concerned 2 years old child not toilet trained. able to walk at 12 months. everthing normal but wont interact n
cries when u try to examine.
whats d dx
-asperger
-autism
-normal

pic of a hyperpigmented leg given.

ask what is it u will ask in history?
-severe melacosis
-smoking 40 pack years
-history fracture lower tibia/ fibula
1- .Post MI after 4 years came to your clinic for follow up visit, the patient is doing well. Still on diet and regular exercise with
complete normal lab work provided. He is on ace and aspirin only

reinforce diet and exercise

stop aspirin
add statin
complete in regular follow up
till him he don't need any more follow up
2- Adult patient is under dexamphetamine(SPEED) treatment. If stops TTT abruptly which could be the symptoms

Aggressive
Anhadenia
Auditory hallucinations
Paraanoia
Homicidal ideation

1- Mesenteric ischaemia…most important identifying point-

atrial fibrillation
,bloody diarrhoea,
abdominal pain

One man wid polycystic kidney disease on annual review wat investigationn to detect the lower urinary trct obstructuon
Cystoscopy
Abd ct
Contrast ct
Usg
Retrograde pyelography…

1. Patient on carbamazepine, we want to add lamotrigine and increased it when we can stop? 1-2 weeks , dec
carba then start other drug-1 wk add 2 nd wk continue 3 rd wk stop
15 gal came by herself doenst want to tell her Parents has been feeling low no suicidal thoughts .. No interest in stidies .. Mangembet
Cbt
Female adolescent group (ans )
Relaxationtherapy
Fluoxetine
Mirta
In venlafaxine wat wud monitor to increase the drug BP, creatinine clearance
Similar old scenario: Pt, T-37, mild neck stiffness,3 wk headache. Lp reveals:
PMN 1*10^6(0)
Mononuclear cells 20*10^6(1-2)
Protein: Increased
Glucose:Decreased.What’s the most likely organism:
A.Echovirus
B.Listeria Monocytogens
C.Mycoplasma Pneumoniae
D.Mycobacterium Tuberculosis
E.Cryptococcus monocytogens
baby dev delay 12 months

-cant stand unsupport,

cant understand no...
boy 23 yr comes for colon ca screan, father dx at 35 and paternal uncle at 40( fobt 2 yearly)

BMI 14 in female, excessive exercise, you will do all inv, except ?

A- ECG
B- Electrolyte
C- Gonadotropin
D- LFT
E- Bone Density
If asked which baseline not be done dexa

Menopause on HRT, Initial beneficial effect ?

A- Insomnia
B- Depression
C- Cognitive function & Dementia

Old age female with IHD on thyroxine, 75 mcg

 Lab showed hypothyroidism, highTSH and low T3 and T4
What is next?
Increase thyroxine to 100
Keep the same dose
Decrease thyroxine
Q. In australia almost every year there are sevral indication of bush fire usually it is usually by young people which of
the following is true ?
A. Junenil pyromania
B. Due to accidant fire caused fire by yongster who get scard after the fire start to speed uncontrolled
C. It has serious consequences
D. Yongsters like to ingnite and play with fire
E. It is done to hide crimes

Q. pyromania is seen mostly in youth generation. What leads them to do this?

1) to show heroism
2) childhood instinct to fire and fire fighting objects
3) as a display of revenge and anger

.wife brings husband with strange behaviour , recently thrown out of job
and he makes silly jokes and dresses badly etc what will help in
detereming the cause
A- minus 7 test
B-copying pentagon intersection
C-disorientation to time
D-verbal fluency test
IF VERBAL FLUENCY NOT IN OPTION CHOOSE SERIAL 7

A young girl comes with history of diarrhea , no blood. There is perianal

excoriation. What will lead you to diagnosis?
a) small intestine biopsy
b) biopsy shows flat atRopHy of intestine
c) biopsy shows granumatous
) Case of polycystic kidney disease on annual follow up presented with
hematuria and GFR 20 asking what of the following would help you to
find if there is lower urinary tract obstruction
a.renal us
b. CT abdomen (not pelvis)
c. IVP
d. retrograde urethrogram (Not in option as mentioned above)
e. another test with contrast
RETROGRADE URETHROGRAM> CT PELVIS > RENAL USG
.pt has spinal stenosis and on statin,now comes with hip muscle weakenss
wht to do
CPK
Doppler
MRI
X ray abdomen for adult male picture of toxic megacolon, rectal tube inserted, no
improvement
What is next
Colonoscopic decompression
Surgery
NGT insertion
Male patient after tranurethral resection of prostate, became pallor and hypotensive
Give Blood
IV fluid 1 liter over 1 hour
Iv fluid 1 liter over 2 hours
Another recall of COPD patient with ABG of PO2 60, PCO 58, HCO3 32
What is the cause of his low conscious level
Hypercapnia
Hypoxia

Boy was watching tv then attack of convulsion what to ask ?

A. First attack
B. Hx of cynosis during attack
C. Family Hx of convulsion

A previously well 3year old boy brought into ED by his father. Pt had seizure & fainting. Scenario sounded like
breath holding spells. What history/findings most helpful in diagnosis?
A. cyanosis
B. Seizure/ involuntary movements
C. no neurological deficit.
D. drowsiness post seizure
E. urinary incontinence/dribbling of saliv

years old man who’s working in real estate. He used to dress well but
recently he looked in bad shape, shouted on customers and fired from his
job. What’s the cause?
A. Depression
B. Schizophrenia
C. Bipolar
D. Borderline personality disorder
E. Fronto-temporal dementia
which antibiotic combination is nephrotoxic:

a.gentamicin plus chloramphenicol

b.gentamicin plus cephalothin
c.gentamicin plus cloxacillin
d.tetracycline plus erythromycin

years old man has headache and is accusing neighbors as they use
insecticide excessively. He mentioned he had frequent trouble with them
as they are very noisy.he changed his living place two times before as he
was unlucky with his neighbors
Thinking that they hate him and want to harm him .other persecution
thinking was there.
a delusion
 b.depression
c. schizophrenia
d. Paranoid personality disorder

4 yr old child . Developmental mile stones that should b achieve at this

age
Stand on one leg for 5 sec
2 wheeled cycle
Toilet trained at night

4 years child asking milestone taht should be attended in order to reassure the
mother A-Riding two wheel bicycle
B-Managing toilet at night
C-Wearing clothes by himself
D-Riding two vehicle bicycle
E-Draw figure

What is considered a serious dangerous delay in a 4year child .

Cant cloth himself/ can't dress without supervision
Can't draw a face
Cant ride a two wheels bicycle
Cant stabilized on one foot for five second
ANS B

At what age a child would be able to build a tower of 3-4 blocks?

A) 12 months
😎 18 months
C) 24 months
D) 15 months
ANS C
 surgery Mass lump that moves with swallowing up and down asked for investigation:
a- FNAC
b-ultrasound
c-x-ray
d.MRI
a. CT

pic of old lady with painful swelling infront of tragus with redness.cause 1.duct stenosis
2.duct stone
3.coxakie virus
 4.poor oral hygiene

5yr pt on multiple drugs metoprolol, aspirin, hydrochlorothiazide present to Ed with drowsiness

ABG shows pH acidic pco2 22 base excess -15..... Hco3 not given blood glucose high which
drug is responsible for this condition
Aspirin
Metoprolol
Hydrochlorthiazide
OLD lady came with fracture (I think vertebral) everything normal except LOW vit. D
--Alendronate
--oral calcitriol

56. years old female with body mass index 23, complaining of tiredness and laziness at work.
She had menstruation at age of 12 and menses are regular. She has dark
 pigmentation on back of her neck and axilla and abdominal striae. Her grandmother has type
2 DM. diagnosis?
A- Cushing disease
B- Addisson disease
C- Hypothyroidism
D- PCO
E- Metabolic syndrome
C section done – baby normal. Now abd. Pain, fever 39c, which antibiotic to choose? A.
Vancomycin+gentamycin+metronidazole
B. Ceftriazone+gentamycin

Patient on antipsychotic,,, developed DM after 12 months. ,,, next

Lfts
Tfts
Urea electrolyte
Fasting lipid profile

Patient on multiple drugs ,,, all cell line depressed cause

Metoprolol
Thiazides
Perindoprl

cardio 68 year old lady in nursing home brought with history of fall while gardening, she takes perindopril, indapamide,
metformin, metoprolol, aspirin, statins. Pulse = 50/min, BP= 90/60, sugar = 6.2 mmol cause of fall?

A. Indapamide + perindopril
Metformin
Metoprolol
2 others

#rheumato Q.SLE scenario,young female with rash on face and joint pain wrist and hand
Hb bit low
ANA positive
DSDNA more than 25
RF factor positive but very mild
What are x ray Finding
1.periosteal osteopenia
2.periosteal sclerosis
3.punched out leisons
#april 19
Over 80% of SLE patients have symmetric, nonerosive, nondeforming polyarthritis affecting the small joints of the hands, wrists,
knees, and shoulders (,2). Approximately 10% will have irreversible deformities and ulnar drift at the metacarpophalangeal joints as
well as swan neck and boutonniere deformity (Jaccoud syndrome) (,2). On radiographs of the hands, pericapsular soft-tissue edema
represents synovitis around small joints, and juxtaarticular osteoporosis is seen, appearing similar to rheumatoid arthritis. It is often
difficult to distinguish between these two disease processes because they can occur simultaneously in some individuals, with erosive
arthritis being a feature of both entities. In such cases, the other diagnostic criteria for SLE will help determine which entity is
predominant (,2).

In the wrist, carpal instability is seen in 15% of SLE patients (,2,,35). This condition manifests as increased distance (>3 mm) between
the scaphoid bone and the lunate or other carpal bones. Instability of the wrist can be demonstrated with radiographs obtained with the
wrist in radioulnar deviation (,2).
.. 39w pregnant female during labour the meconium passed and CTG 149 fhr,no accelration,no deceleration, variablty 15
....what u will do next

A-Fetal scalp sample, coz the chance of Hypoxia is 10%

B-Fetal scalp sample ,coz the chance of hypoxia is 50%
C-Fetal scalp sample ,coz the chance of hypoxia is 75%
D-Cs urgent
E-No abnormalities, close monitoring till delivery

5-25 variability is reassuring

<5 low variability
absent variability is NON REASSURING

Patient h/o fracture. One day before surgery, confused and abusing everyone. What will help u in diagnosis?
A. Paranoid
B. Fluctuating level of consciousness
C. Delusion
Patient h/o fracture. One d

ay before surger There was a question on treatment od optioc neuritis-

A--immunoglobulin
B-iv methylpred
C-cyclophosphamide
D-azio
y, confused and abusing everyone. What will help u in diagnosis? A. Paranoid B. Fluctuating
level of consciousness C. Delus on 4 months old exclusiveky breast fed baby waking up
frequentky at night crying, askin for what to do:
A-start solid feeds
B-start bottle feed at night when awake,
C-consol baby
D-use persifire?
Ion

A 25 year old woman, arrested once for shoplifting, now says 'i am forever
depressed' my friebds let me down, she also has self harm behaviour. What
management to give:
A-drama therapy,
B-aversive behaviour therapy,
C-diathec therapy,
E-exposure response
Baby waking up a lot at night but tbis time baby 6 moths . What to do -----i
chose introduce solid feeds-rice cereals
a 15 months child who is totally on cows milk with iron def. what to do ?
a. dec milk
b. iron supplements
c. introduce solids

Ebdoscopy photo of oesophagus..metaplasia. pt on 20mg omeorazole. What to do.

------Chose increase omprazole dose

gynae Yasmin – containing drosperinon and ethynyl estradaiol - is now released for usage in Australia
, wt makes it be prefered by women ?
a. It causes weight loss rather than weight gain
b. It contains low estrogen and progesterone
c. It causes less spotting even at the very beginning of the treatment
d. It has a failure rate less than other OCPs
e. It has a protective effect against cervical cance

neuro There was a straight forwad case of gullien barre ascending oaralysis asking
diahnosis
Nerve conduction is diagnostic
Lp is initial

year old child comes with

constipation.. (not since
from birth) and rectal
prolapse,,
Weight n height for age is
normal. Growing well.
Unremarkable
examination.. what in
history will lead u to
diagnosis..??
A. His recent stool pattern
B. mother’s brother has
cystic fibrosis
C. His sister treated for
hookworm
D. Family history of
Crohn’s disease
A 19 yrs old gal had traveled to thailand she had several episodes of sore throat

while there . On presenting with fatigue malaise. On examination mascular pains no other

abnormalities. Diagnosis:

infective mononucleosis ,

post viral fatigue syndrome

infection 18 y/o Chinese student, 1st year university. Complains of diarrhoea for
the last 3w, 3-4 x/24h. Felt fine before arriving in Australia. Important
University exams next week. PE normal.
1- smooth muscle relaxant
2- metronidazole
3 – Ciprofloxacin
#git Scenario of IBS.Exam is in coming week.What is appropriate for this patient?
Anti
Depressants
Smooth muscle relaxant
Reduce fat inet

21 y.o man (BMI 27), smokes and drinks, first visit to a GP.
Screening to offer him today:
1 - Skin cancer
2 - Testicular
3 – Lipids profile
4 – Blood pressure (not sure if this was an option) 5
- Diabetes

65 y/o man c/o fatigue and weight loss. Haematuria and dysuria (2 episodes).
Urinalysis blood and pus. Dx?
1- renal tuberculosis
2- bladder ca
3- nephrolithiasis
A young patient will undergo urgent surgery. He refers severe bleeding after
a dental procedure. It’s found out he has Von Willebrand disease. What to
do:
1 - Platelets transfusion
2 - Factor VII
3 - Factor VIII

Old man admitted in the hospital because of pneumonia, but during his stay he
fractured his femur after a fall. Of the bed. The surgery to fix it went well and he is
recovering well.
However, he is getting increasingly and argumentative with staff, he blames them for
letting he falls. Management:
1 – Trial with antidepressants
 2 – Diazepam
3 - Risperidone

y/o boy fell from gym equipment at school with the head first. Reported brief loss of conscience, he
remembers and describes how it happened. 1 episode of vomiting. Small swelling on scalp. No neurological
finding. Fully alert now.
1- Discharge home
2- 4 hours neurological observation and discharge if no neurological signs present
3-admit to the hospital for neurological assessment
4- CT

8 weeks pregnant with auto limited vaginal bleeding, what warrants urgent surgical
Referral
1 -crampy abdominal pain
2 - Shoulder tip pain

Photo with a red mass, apparently thrombosed, on the edge of the anus. The
scenario was: Young lady constipated because of the use of Panadeine, she
noted slight rectal bleeding and it aches.
1 - Internal prolapsed haemorrhoids
2 - Perianal hematoma
3- pilonidal cyst
5 – Perianal abscess
6
Perianal hematoma/thrombosed external hemorrhoid> pain withouth bleed

External thrombosed = pain only

Internal hemo> painless bleed

Internal prolapsed hemo> painful bleed

For 1st to 3rd its band ligation

For 4th deg its hemorrhoidectomy

And for perianal hematoma within 24 hrs Aspiration

And after 24 hrs IND

AND after 5 days leave them alone

renal Scenario of a patient with signs and symptoms of Calculi in the ureter,
which was confirmed by CT. What would Indicate surgical treatment
1 - Several pain for 48h
 2 - Size 0,5 mm
3 - Haematuria
4 - High fever and tenderness in the flank

Very fit young man. Painful Lump in the groin after 15km run. On physical
examination it’s mild tender, has no cough impulse.
1 - Inflamed lymph node
2 - Femoral hernia
3 - Inguinal indirect hernia

eye Fundoscopy with red cherry spot (I believe it was CRAO).

Old lady with High blood pressure and DM type 2 presenting with unilateral
amaurosis. CT scan without contrast and carotid doppler were normal. Management
1- Hyperbaric O2
2- acetazolamide
3- timolol
4- massage
5- Crao> if presents within 30 min > massage nd refer
6- Crao if presents after 30 min > then iv acetazolmide and then refer

25 years woman, pregnant, 16 weeks, is concerned about Down Syndrome after

talking to a friend. She has no personal or family history. Pregnancy uneventful so
far. First antenatal visit at 8 weeks everything alright. What to do now?
1- PAAP test
2- USG
3- Review consultation at 20 weeks
4- Amniocentesis
5- MS-AFP

Young man, 27 y.o., smokes 15 cigarettes/year, drinks 10g alcohol day, cocaine and

marijuana socially, comes with chest pain, ECG reveal ST elevation on lateral wall.
Which

one lead to his MI

A- alcohol
 B- Marijuana
C- smoke
D- cocaine

15 y/o involved with drugs, not going to school, behaving badly. Mother comes in.
The options were:
1 - call the police
2 - talk to the school
3 - contact child protection service. (All the options were about contacting some sort
of authority)
paeds paeds female 8 yrs with forearm fracture , urine dipstick done after managing fa fr in
the evening ++, on followup dipstick repeated few days later in the morning and was
negative, diagnosis:

6 a- due to her trauma

7 b- orthostatic prtnuria

8 nephritic

. 6 year-old girl had a fracture of forearm after falling down from tree. During the follow up
of her fracture in the afternoon, there is a presence of protein in the urine. 3 days later,
there is no urine in her morning sample of urine. What is the cause? (I was really confused
which one to choose cuz the follow up for fracture usually is in 2week, and they provide
the exact time of the day like “afternoon” and “in the morning” which leads more to
orthostatic proteinuria)

a) Orthostatic proteinuria

b) Response of body to the injury

Transient proteinuria, which is associated with fever, vigorous exercise, or exposure to

extreme cold, is distinguished from orthostatic proteinuria as abnormal protein excretion
resolves when the underlying condition is no longer present.
Persistent proteinuria is differentiated from orthostatic proteinuria by elevated protein
excretion in urine samples collected in both the recumbent and upright positions. It is a
marker for renal parenchymal disease (eg, glomerular disease and interstitial nephritis) and
can be associated with chronic kidney disease. It is important to distinguish persistent
proteinuria from orthostatic proteinuria, as further evaluation is required to determine the
underlying etiology in individuals with persistent proteinuria. (See "Evaluation of
proteinuria in children", section on 'Approach to the child with proteinuria' and "Assessment
of urinary protein excretion and evaluation of isolated non-nephrotic proteinuria in adults",
section on 'Persistent isolated proteinuria' .)
Orthostatic proteinuria is a benign condition and does not affect renal function. Over time,
proteinuria resolves spontaneously in most patients. (See 'Prognosis' above.)
For individuals with orthostatic proteinuria, we recommend no further initial evaluation or
intervention ( Grade 1C ). Although the long-term prognosis is excellent, we suggest
periodic monitoring of protein excretion of the individual while in a recumbent position
 (eg, first morning void) to reconfirm the diagnosis of orthostatic proteinuria in those who
continue to have daytime proteinuria ( Grade 2C ). (See 'Management and follow

Pics of epigastric hernia, man lying down.how to test to reach diagnosis?

Palpate while coughing
Examine while standing (no cough)
Examine while legs raised
Ankle swelling, afebrile, stiffness for an hour relieved by walk ,Xray show
periarticular osteopenia and narrow space, other foot joint is normal. What is the
diagnosis?
A-osteoarthritis
B-Rheumatoid arthritis
C-sle
D-septic arthritis

resp Man brought to the ED after he sustained accident, Labs shows multiple rib fractures.
Most appropriate management to the patient?
Endotracheal Intubation
Chest tube Insertion
Elevation of the head
Tracheostomy
First thing to do is pain management

Caucasian Female had vacation from China with history of sore throat. Came to you with
fatigue and mild lymphadenopathy.

Infectious Mononucleosis
Mycobacterium Tuberculosis
Influenza
Hodgkins Lymphoma

Chronic alcoholic but stopped alcohol intake 6 months back presents with painless neck
spasm and spasm when he extends his right arm. All examination normal. The spasms
come frequently without any trigger during the day.

Chorea
Dystonia
Alcohol withdrawal
Delirium tremens
Parkinsons
Treatment is with purified botulinum A toxin in to affected muscle repeated in 3 to 6 months
Head circumference chart of 12 month baby with frequent vomiting not relieving evenon
th
thickeners sinch a few months. Head size on 98 percentile now.

Investigation to do Ct
Barium meal Endscopy
If usg in option choose that

Primi mother 39weeks admitted with contractions vaginal examination reveal is 5 CM cervix fully
effaced and in four hours vaginal examination same finding with cephalic presentation occipito
transverse position and heart rate of baby 140.. what will be your next step

Ventouse delivery Lscs

Fetal blood sampling

Oxytocin
Review in 4 hours again

#gynobs
Primi in labour, cx fully
effaced, 5 cm dilated, head
cephalic presentation, with
membranes ruptured. After 4
hours cx still 5cm dilatedno
progress in labour. No fetal
distress. Next step?
A. Wait and observe for next 4
hrs
B. Start oxytocin drip
C. Imediate cs
D. Fetal scalp monitoring
E. Antibiotics

Baby with jaundice in 24 hours of birth. Mother is rh negative and O blood group. Baby is rh
negative but A blood group. Reason of jaundice

Abo incompatibility

Rh incompatibility

Breast milk jaundice

Physiological jaundice

77 year old man come with progressive back pain and wakes up at night due to pain
examination point tenderness in lumbar region. Cause asked (no history of trauma. No history
of weight loss. No history of previous chemo or radio or previous malignancy. This was the
only info in the question)

Body mets Osteoporotic fracture Slipped disc

Bee sting to a child 20 minutes ago and the child collapsed. Now wheeze and rr 28
per minute. Next

Adrenaline
Hydrocortisone
Nebulization
salbutamol

Bee sting scenario to a child. Collapsed and presented with stridor and edema on sting
site.. Next
Adrenaline
Hydrocort Nebulization
Oxygen by mask
Nebulizer salbutamol

Picture of cellulitis of leg.. Patient has history of melanoma on the same leg and dvt on the
same leg 20 years ago and now Asking most appropriate next management

Pressure bandage and immobilization

Flucloxillin
Duplex usg
Biopsy and histology
Blood culture

Stable patient and SVT ecg asking most appropriate next step
Adenosine
Amiodarone
Vagal manouvre

26 year old Patient comes after 2 weeks of lmp with mid abdominal pain. On cocps. Had sex
with three men in last two months. Mild tenderness on palpation of low abdomen and adnexal
mass. What investigation next

Pregnancy test
Chlamydia pcr
Urine analysis

25 year old confronts about having sex with unknown man last night after binge drinking.
She took the morning pill and Now asking for advice

Hep B test
Pregnancy test
Chlamydia test
Reassure
Aboriginal mum came for vaccine of her 2month child .She didn’t hold child during
immunization and refused to hold was given. She didn’t talk and look up during it. What
about her this behaviour

a. Cultural issue
b. Poor parenting
cInform CPA
dYou will go to visit home
eSend a social worker to her home

aborginal lady came for child vaccination,no eye contact,not holding baby
during vaccination,want to leave immediately.
a) refer this mother to psychiatrist
call a family member of her when next visit
other options can’t remember

Single mother comes with her son who has secondary enuresis. She is evasive with
the details and asks doctor to give any medicine which will stop this as she is tired
of the laundry she has to do. She says the boy is active and plays around a lot. OK
examination of the boy
, he has bruises on back and legs and mother explains that those are from the play
ground.
What will u ask mother
If mother was abused as a child Her
employment status
Financial condition

25 year old Patient has headache which is bi frontal and come for four to five
days a week and lasts three to four hours. She is on pop and Paracetamol.
Paracetamol gives only little relief. Next

Methysergide

Cease pop

Relaxation technique

Ergotamine

Xray of colles fracture asking cast position

Ans Partial flexionwrist and Full pronation ulnar deviated hand

First movement to be lost in degenerative bone disease

Flexion
Extension
Rotation
Abduction
Adduction
Internal rotation> extension> abduction>adduction>flexion>external rotation

Only usg is enough to rule it out uti

Less than one
Usg negative tou do mcug
Acute retention/Post op Anuria-catheter
Only oliguria=Bladder scan
Oliguria +catheter =S. electrolyte and
creatinine
Oliguria+catheter+fever=culture
And when zero volume (anuria) with catheter then catheter-flush

Child started on respirodone. What’s the initial side effect

Weight gain
Night sedation
Liver toxicity
8year old going for appendicectomy asking for appropriate fluid to start
Dextrose
Saline
Saline and dextrose

Homeless man wandering and brought to emergency room. Mmse 10 on 25 and he was
sleeping between examination. He smells of alcohol and he is malnourished. Alcohol levels
are 0. Asking Immediate management

Dextrose
Thiamine
Ct
)
Ans Thiamine oxygen nalaoxone glucose(TONG)

Old patient with copd and now consents for dnr (DONOT RESUSCITATE)but family asks
you to do everything possible to make her better. Patients mmse is 27. What to do as her
doctor

Assure family that you will do everything to save her Deny the patients
request Call family meeting
Call court
Respect his wish

Girl presents with father. Her teachers at school reveals that she has been inacting sex with
boys in playground. Showing explicit photographs to her friends at school. What do you look
in her history

Sexual abuse
Precocious puberty
Normal child behavior

child presented with diarrhea and stool for Rita virus positive and resolved. Mother
gave
normal feeds.after 3/4 days again had profuse diarrhea noticed perianal excoriation
What modification u advise
1.low lactose
2.soya based milk(not given to <6 month old )

Child presented with fever and productive cough all chest examination chest X-ray blood esr
normal. What will you further order for investigation
HRCT

Bronchoalveolar larvage
 3year child mother admitted following febrile convulsion what advice
you will give regarding her long term prognosis
She will not avoid of developing high
temperature 2. This condition will not develop
into convulsions
3.usual course of the disease is resolving after 6 years
3.
NOTE
50 % chance of recurrent febrile seizure

3% chance of epilepsy in future

man presented with right side hemiparesis and aphasia symptoms developed 5hours
before.
CT says infarction what is the management
Aspirin
tpa
other management options
Young woman has history of pleurisy in past has arthritis and morning
stiffness resolved over day had recurrent oral ulcers too
Diagnosis
1.RA
2.gout
3.SLE

you have involved your patient for a new trial study on antihypertensives
for six months after three months her blood pressure normal and she want
to exit from the study what will be your action
1.allow her to terminate from the study
2.inform relevant pharmaceutical company who carry out this

Diabetes mellitus 1 yrly eye and urine and lipids

3 monthly bmi, bp, , hbaic

You are planning to start palcitaxsal andCISPLATIN for a cancer

patient which long term side effect you should discuss with the patient
1.rash
2.neuropathy

pt of crohns disese was on sulfasalzine prednisonlone,azathioprine labs given neutrophils and

wbc low hb low, cause
Sulfasalazine
Azthioprine
Baby born by Lscs found limbic severely cyanosed HR 40 no respiration what is
APGAR score

Girl had recurrent abdominal pain and angioedema of face and lips family history in
mother and brother what investigation you will do
Allergy test
C1esterase inhibitor level

18 y/o girl experienced recurrent abdominal pain for the past past few
weeks. Occasionaly has tongue or lip swelling. Whats the investigation to
confirm
diagnosis?
A) skin allergytest
B ) C1 esterase deficiency
C) serum imunoglobulin assay

Patient has underwent carotid endarterectomy 6 days back and now developed difficult to
breath spontaneously came to Ed..on admission severely laboured and harsh stridor what is
ur next step?
O2
Endotracheal incubation
Cricothyroidectomy

A patient on maintenance dialysis develops hyperkalaemia, ECG shows complete heart

block. Serum K 7.9 mmol/L which one of the following measures should be taken
immediately?
Dialysis
IV Calcium Gluconate
Temporary cardiac pacing
IV Insulin with Dextrose
Sulbutamol inhaler

27 yrs old female with history of DVT due to femur fracture last 2yrs ago,ask about
contracrption?
OCP
POP
Depo 3 mthly
Diaphragm
e) Levonogestral IUCD
MVA,asking emergency blood transfusion for massive bleeding
same blood group with well matched
same blood group with not well matched
O Rh negative ,whole blood
O Rh negative ,packed cells
O Rh positive blood group

68 yrs old woman is generally well comes to you because of she feels more tired
,night sweats and back pain for 10 days.X ray show no lytic lesion.BM exam shows 15% of
plasma cells.Mx?
a) prednisolone and mephalan
b)another BM exam one yr
later
c)annual X ray
 .30 wks pregnant lady complaint of severe frontal headache for 12 hrs.On abd
exam,No tenderness and FHS is 140/min.BP-80/50 and pulse is 100/min.Next
appropriate mx?
USG abd
CTG
c)MRI
brain
d)LP
e) blood culture
18.yrs old pt complaint of amenorrhoea for 12 mths with previous h/o of irregular mens
5-6 times per year.She is on thyroxine for hypothyroid for 2 yrs.No other special
c/o.Next important invx?
TSH
MRI pituitary
FSH/LH
CT abd
e)serum progesterone

wks pregnant lady with vaginal d/c,No contraction.FHS is 140/min.On speculum exam,
no pooling,no discharge,os is closed.How will u decide whether she needs referral to
tertiary centre
Fibronectin

24.-yrs old pt complaint of wheezing, rash and facial redness after exercise.He ate egg
and salad 2 hrs b4 and take diclofenac for aching pain 6hrs b4.He has no previous h/o of
asthma and hay fever.Causes?
Exercise
Egg
Diclofenac
9 yrs old pt with painful knee.On exam,knee normal,hip joint tender,limited
m/m,synovialfluid effusion 8mm,temp-38.Next step?
Aspiration of hip joint
Immobilization
IV a/b
Physiotherapy

Scenario of Diabetic foot ulcer(1cm) on dorsum of foot with serous yellow discharge for 1
week.Temp-38.5.What is next mx after WD?
MRI foot
Oral amoxicillin / caluvulinic acid
IV Ticarcillin/ clauvunate
d0 X ray foot

75 yrs old man c/o of abdominal pain and constipation.On exam, abdomen is tender and
slightly distended and rebound tenderness +. Abd X ray shows large bowel
obstruction.Next invx?
CT abdomen
Colonoscopy
Barium enema
USG abdomen
MRI abdomen

Mild or asymptomatic hypercalcemia: total calcium < 12 mg/dL (< 3 mmol/L) or ionized calcium <
8 mg/dL (< 2 mmol/L)
Encourage adequate oral hydration
Reduced dietary intake of calcium
Avoidance of thiazide diuretics, lithium, high-calcium diet

Moderate hypercalcemia: total calcium between 12–14 mg/dl (3–3.5 mmol/L)

Asymptomatic: same treatment as for mild hypercalcemia (see above)
Symptomatic: same treatment as described above for severe hypercalcemia (see below)
Severe or symptomatic hypercalcemia: total calcium > 14 mg/dL (> 3.5 mmol/L) or ionized
calcium > 12 mg/dL (> 3 mmol/L)
IV hydration with isotonic saline
Loop diuretics (with monitoring of serum potassium!) in patients with renal insufficiency or heart
failure to avoid volume overload (Loop diuretics increase the renal excretion of calcium but also
prevent volume overload in at-risk patients.)

Bisphosphonates (e.g., zoledronic acid, pamidronate), in cases of excessive bone resorption

(e.g., hypercalcemia of malignancy, immobilization)
Calcitonin

Dialysis in severe cases or renal failure: > 18 mg/dL (> 4.5 mmol/L)

Loop diuretics Lose calcium → Discontinue them in hypocalcemia!

Thiazide diuretics are calcium sparing → Discontinue them in hypercalcemia!

Children with OCD first line line exposure and response prevention therapy WE give
fluvoxamine
For depression in children fluoxetine
For huntington paroxetine
OCD compulsion and obsession BOTH URGES

OCPD OBSSESSION URGE

MOOD
A CT ANGIOGRAPHY

Carotid doppler is done TIA (Temporary vision loss, contralateral

body paralysis)
 enlarged gall bladder with multiple stones, found dilated bile duct and stone obstruction
in common bile duct, patient developed toxic shock, what to do after fluid
resuscitation?
a. laparotomy cholecystectomy
b. laparoscopic bile duct explores
c. percutaneous bile drainage
ERCP
e. MRCP
young female c/o of lightheadness and loss of conscious for few seconds after long satnding
history.On exam,BP-80/50,PR normal,Blood glucose –noraml,ECG-NAD.what is most
appropriate treatment?

Pacemaker
increased intake of salt and water

Stress ECG test

42 year man with difficulty initiating urine n dribbling at end he says he empties bladder
completely he doesn’t has to wake up at night to void urine; cause
BPH
b. Ca prostate
c. urethral stricture
d. ca bladder
.Child after bee sting, presents with urticaria on legs, severe pruritus and vital
signs stable.No other signs and symptoms.Mx?
IM adrenaline
Oral promethazine
IV promethazine
Topical steroids
IV steroids
A medical condition is present absolute risk is 8 out of 100 in one population. Relative risk
is 25 %. What? is NNT
50
100
200
10
.H/o of submandibular L/N enlargement.On biopsy shows malignant cells.Ask primary site?
Posterior nasal canal
Tongue
Submandibular salivary gland
buccal mucosa
59.mother brought his young child who presented with four lesions on his right face.
She tried antiseptic but the ulcers like lesions showed no improvement. What is your
most appropriate treatment?
A. mupirocin (bactroban)
B. topical hydrocortisone
C. topical acyclovir
D. topical idoxuridine
.Mother who brings her 15 yrs old son,she worries about skin cancer.Asked risk factor of
cancer?
Sunburn more than tan
positive family history of melanoma
Exposure to UV at childhood
Presence of atypical nevous

7yrs girl with intermittent abdominal pain. Urine microscopy showed WBC 20 (<50) and
Culture showed E.coli growth of 1x10*5 / mL . Most appropriate next step?
Oral ciprofloxacin
Nitrofurantoin
Nitrofurantoin
cefazolin
D. No treatment needed
In less than 1 month iv antibiotics are advisable
Trimethoprim>cephalexin>cotrimoxazole >amoxicluvanate

Scenario of patient with colorectal carcinoma. Hemicolectomy was done with removalof 4 out
of 26 LNs !!
the most appropriate next
Chemotherapy
Chemo-radio therapy
Complete colectomy
. Patient travel to endemic malaria known falciparum with history of
depression. Prophylaxis?
a) Doxycycline
Choloroquine
Choloroquine + proguani
Mefloquine
.16 years old girl comes for HPV vaccination and want to do HPV serology
before vaccination. Ur advice?
A HPV serology is not advisable
B HPV serology is readily available
C. HPV serology is the best test for previous natural infection
Man presents with MVA with CT scan & CSF findings was normal. There was no neck rigidity &
unconsciousness present. What can you do next?

Carotid Endarterectomy B Cerebral

Angiography
C Follow up
D Nothing to do

1st Metatarsal Joint Swell. Asked Dx?

A Gout
B Pseudogout
C Rheumatoid arthritis
CXR shows anterior dislocation of Left shoulder. What happen?

A-Loss of sensation over outer aspect of upper arm

B- Loss of sensation over medial aspect of upper arm
C- Loss of sensation over lateral aspect of forearm
D- Loss of sensation over medial aspect of forearm
E- Loss of sensation over the shoulder joint
Man complaints several things. But on exam doctors found nothing. Then go to ENT Department. Still not
disease found. Dx?

A Hypochondriasis
Somatoform disorder
C Borderline
D Malingering
Factitious
19 ECG of 60 years man. Atrial flutter seen with HTN & DM. Pt. Unstable. What to do next?

Metoprolol
B Warfarin
C DC Cardioversion
D Temporary Pacemaker

21 Now a days Common Psychological disease in Australia?

Dementia
B Depression
C Schizophrenia
D Suicide

Patient Presented with Glaucoma within 3 hours. There was no H/O Glaucoma in previous. What to do
next?

Oral Timolol

B IV steroids
\C Drop Pilocarpine
D Icepacks
E Oral Acetazolamide

24 ECG of Complete heart block. Rx options?

A Atropine
Permanent pacemaker C Temp.
Pacemaker
Answer
What is the most common cause of Profuse Bright red Bleeding in Adult. Dx?

Diverticulitis
B Anal fissure
C Intussusception
D Chrons disease

Asked Rx of Salmomella?

Metronidazole
B Ciprofloxacin
C Azithromycin
Answer Cipro

Man naked in road yeilling loudly into the road & tell Love you baby. Asked Dx?
Depression
Schizophrenia
C Borderline

Mom comes with baby in ER. Multiple Bruises in head. But mom's complaint about weakness. What to do next?

Report child protective service

B Treat this patient

Pregnant woman in 3rd trimester presents with RUQ quadrant pain. On examination there is tenderness. She also claims to
have vomited a day before. While under observation she develops rebound tenderness and increased WBCS. What the next
appropriate step?

IV antibiotics
USG of the Right Hypochondrium
Laparoscopy
Laparotomy

PROM transfer to teritory hospital. pregnancy 24wk.clear fluid. No contraction. She is 50km away from hospital. Next
app mx?

Tocolytic
Betamethasone therapy
Refer to nearest hospital
Speculum exam
Answer B

A middle age female gravida 8 delivered her baby vaginally after 2 hours her pulse was 100 b/m and BP was 80/50 and she
lost apporx 500 ml of blood vaginally. What is the cause?

Uterine atony
Uterine Rupture

A previously healthy 25-year-old basketball player came in due to swelling of the right limb for 1 week. On examination, his
right arm including his hand and forearm are dusky, swollen and edematous. He has non-tender axillary lymphadenopathy.
He noticed that his pet cat is also unwell. What is the most likely diagnosis?

Cellulitis
Cat-scratch disease
Subclavian vein thrombosis
Cervical rib
Baby 8 months coming with hypotonia and poor developmental milestones,noted
to have downwards slanting palpabrle fissure,a flat occiput,open anterior
frontanelle,single transverse palmar crease.what invx to do?
A. CT
B. USG
C. Thyroid function test
ANS C

#paeds Developmental milestone question: 37 or 39 month

( 3years and above old can’t remember, what should he be able to do?
A) kick a ball
😎 ride a bicycle
C) speak full proper sentences
D) can draw a face
ANS A
C AT 4 YEARS

3years old climb stairs nd can kick ball

PAEDS Premature baby 12 mo. Old cannot sit un supported , what to ask in history?
A) When started Prone to supine
😎 Sibling mile stone
C) Neonatal jaundice duration
D) Birth asphyxia related history

. An11 months boy, cant sit unsupported, 10th percentile for corrected age. Delivered at 32 wks for maternal placental
abruption. Was in NICU for 5 wks..reason for delayed dev?..
a. due to 8 wks prematurity
b.Duchene muscular dystrophy
c. cerebral palsY
ANS A

a child brought by mother at 18 months she says baby start rolling over at 5 months sitting at 7 to 8 months standing and
walking at 12 months nd so nd now babbling but no proper words. Her audiometry is normal. Baby respond to voices and
growth is also normal. What is ur advice to mother?
a) Normal growth
b) Delayed speech
c) Delayed milestones
ANS B

probability probability of schizo in dizygotic twin:

a. nil
 b.
10
%
c.
20
%
d.
40
%
B

Diabetic pt with 3-month ulcer, pulses not palpable, X-ray done erosion showing, what ll dofor next for
management:
A-Ulcer swab
B-MRI
C-Leg ultrasound for arteries

A Weird twisted PCM scenario : 21 yr old male, Stable , Height:170 cm Wt: 60 Kg, took 14 or 16(not sure) PCM
tablets of 500 mg, present at your place after 10 hours .. what is your most appropriate next step ?
a) PCMlevel
b) N-AcetylCystine

c) Charcoal
d) Reassure

A man presents with inflammatory joint pain in multiple areas. He also has renal failure.
Which of the following is contraindicated in this man?
a. Methotrexate
b. Hydroxychloroquine
c. Sulfasalazine
d. Azathioprine
e. Etanercept
weakness of the right side of the body for 10 min
A. Hypoglycemia
B. Hyperglycemia
C. Carotidstenosis
D. Vertebro- basilarischemia
E. Lacunar
F. ischemia

6 years old boy presented to the ER due to asthma

attack. He had 6 puffs of salbutamol and not improved
wheezing
a. Addsalmeterol
b. Salbutamol in 20 minsinterval
 c. Ipratropiumnebulization
6 years old boy presented to the ER due to asthma attack. He had 6 puffs of salbutamol and
he improved but still has wheezing and speaks in words
a. Addsalmeterol
b. More 12 puffs ofsalbutamol
c. Ipratropiumnebulization
d. Oralprednisolone
e. Hydrocortisoneiv

78 year old lady complains of fatigue and weight loss 5 kgs in the past couple of months. She
also has occasional loose bowel movement. Bp normal heart, rate 58. Rest of the labs normal.
What could be the cause of her presentation?
A. Occultmalignancy
B. Hyperthyroidism
C. Iron deficiencyanemia
D. Hypothyroidism
2) Woman with pain in her wrist fingers and other small joints. Has a history of scaly rash on her elbows
previously treated. What initial
3) investigation
A-ANA
B-B- CCP
C- Xray
D- MRI

9) Elderly man around 65 presents with severe chest pain radiating to the back. Ecg
normal. Pain not relieved with nitrates. Bp was highi think. Rest all normal. What is the
next appropriateinvestigation?
A-Transesophageal echo( hb 3.070)
B-Transthoracic echo
C-Ct angiogram
D-Troponin
E-Ecg repeat

first degree heart block ecg with potassium 5.5 ( normal level was upto 4.9) in the question.
A-Calciumcarbonate
B-Resonium
C-Insulin glucose
D-Stop Ramipril
E-Pacemaker

woman with subtotal thyroidectomy ,in post op room , 12 hrs may b , got difficulty beathing
,stridor, drain tube collection is few, what to immediately?
a. Remove deep musclesuture
b. Remove skinstaples
c. Intubation
d. Oxygen viamask
 27 yr obese with acne and hirsutism asking for OCPs, she has regular migraine headaches
with scotoma at times. What to prescribe her for contraception?
A--Ethinyl estradiol and drosperinone
B--Erhinyl estradiol and cyproterone
C--3 monthly dmpa
D--Barrier methods(hb 3.226)
E--Ethinyl estradiol and norgestrel
IF ASKed for pill and has migraine with scotoma then give pop

24 weeks pregnant with c/o, watery vaginal discharge, uterus lax, no contractions, fetal heart 140, what is the next
most. Important step in management
A--Refer to tertiary care
B--Admit and observe
C--Tocolytics
D--Dexamethasone
E--Per speculum exam(initial to dx pprom)

26 weeks pregnant with draining liquor, NO uterine contracrions, fetal heart positive, os
closed. After examination what is the next most appropriate step?

A--Refer to tertiary care

B--Refer to secondary care
C--Admit and observe
D--Discharge with oral antibiotics
E--Tocolytics

If in option Give steroids if she is <34 weeks pregnant and antibiotibs and refer to tertiary hospital
28 weeks pregnant with draining liquor, apparent contractions, fetal heart positive, os closed
after dexamethasone next step
A--Tocolytics
B--Antibiotics
C--Refer
D--Steroid

60 yr old women Post colectomy day 5 on 60ml ns and 30mcg potassium drip
Labs
Na 110
K 2.6
Urea9

Asking nexr management step

A--Give hypertonic saline
B--Give calcium chloride
 C--Increase saline infusion
D--Change to hartmansolution

9 weeks pregnant with UTI, symptomatic, Culture shows E. coli, Resistant to amoxycillin,
Cephalosporins. What togive?
A--Trimethoprim
B--Augmentin
C--Gentamicin
D--Metronidazole
E--Ciprofloxacin

Pt with nail injury 6 weeks ago, asking mangent

A-- Excision biospy
B-1cm margn excision
C—Debrdemet

Pt with insomnia, weight loss, anhedonia, hallucinations. Past hx of treatment for depression.
What to give
A-- Quetiapine
B-- Mirtazapine
C-- Duloxetine
D-- Altrazolam

68 yr Women brought by son with inc falls and ataxia, vitals normal. No loss of memory
mentioned
Urinary incontinence present
Ct with dilated ventricles, minimal cortical atrophy
Dx
A-- Normal pressure hydroceph
B--Alzheimer
C-- Lwy body

Scenario old lady come with memory loss, recurrent history of fall and urinary incontinence.
Asking diagnosis.
a. Normal pressurehydrocephalus
b. EDH
c. SAH
d. SDH
e. Alzheime

Another scenario with dribling of urine, frequency throughout the day, incomplete urination.
Wakes up Twice in the night
Best inv
A-- Ascending pylogram
B-- Ct abdomen
C-- Cystoscopy
D-- No option for urine analysis
 25 yr old lady has dizygotic twins with schizophrenia, what is her chance of having
schizophrenia
A-1
B-10
C-20
D-50
E-100

Pt with sudden loss of hearing in left ear, otoscopy. Revealed wax in both externalauditory canal, further exam non tender firm irregular
mass in submandibular region. What will u examine further to reach todx

A-- Examine tongue

B-- Examine larynx
C-- Rhinoscopy
D-- Maxillary sinus
CT E-- Repeat otoscopy

Acute migraine attack tx

A-- Sumitriptan(1stparacetamol and antiemitic)
B-- Propanolol
C-- Ergotamine
ANS PARACETAMOL ANS ANTIEMETIC IF NOT IN OPTIONS THEN SUMITRIPTAN
70 yr old lady, post MI admitted in ward, receiving Rx, suddenly becomes agitated, shouts,
nurses assist her to avoid falls, what is she at greatest risk of?
A-- Falls
B-- Repeat MI
C-- Stroke

One photo of amputated 1st toe, with ulcer bed with redness and yellow granulation tissue, pt
diabetic, .dorsalis pedis artery palpable. Asking dx
A-- Thromboangitis(if said smoker)
B-- Small vessel obstruction
C-- Femoral artery thrombosis
D-- Popliteal artery thrombosis

Loss of calculation, speak, few other functions like that, pt right handed,
Unable to write. Lesion?
A-- Left temporal
B-- Left
parietal(dominant

Visit to Thailand 1mnth back, there the pt had diarhea and resolved
Now presented with mild epigastric pain, vitals normal, fever 37.8, ct scan revealed
A-- Amoebic abscess
B-- Hydatid cyst
C-- Hepatocellular ca
Needle prick to nurse. Pt is admitted with thoracic herpes zoster, he is hiv antibody positive,
Hbsag neg, hbsab positive, hbsab positive, she bled the wound and washed with water, whats
next
A-- Give her hep b immunoglobulin
B-- Lamivudine
C-- Zudovudine(JM 1454)
D-- Acyclovir
E—Antibiotics
Known source start zidovudine within 2 hours for 28 days
Unknown source take blood sample of pt and doctor for hiv hepb hepC , commence hepb vaccination if not
vaccinated

questions about sallmonella typhi, 1, 16 yr old working student got diarhea and salmonella,
there is an endemic these days and many students are affected, what is the most imp inthe
history of the boy?
A--Regular hand washin
gB--His part timejob
C--His schoolname
D--Est fruits and vegetables

2. 25 y/o old works in a restaurant and got diarhea, salmonella diagnosed. What is
themost imp toadvise
A--Inform restaurant about salmonella
B-
-Dont go to job until diarhea settles

Rural doctor wants to make study about the relation between admission to hospital with
rotavirus infection and birth weight , what’s appropriate ?
a. RCT
b. Casecontrol
c. Cross sectional
d. Cohort
e. Caseseries

30 yr female come from prison having shingles what is the next management?
A look for partner screening
B check for immune status

13.A man with inflammatory joint pain in multiple areas.renal failure present.which drug is
ok?
a.methotrexate
b
.Hydroxychloroquinec
.Sulfasalazined
.azathioprine
e.etanercept

Gynae q was there where 6 weeks amenorrhea now spotting and the home based beta hcg
positive and no pain and us shows 12 mm thickness of the endometrium and corpus luteum
visible rest no fluid in cul de sac asking cause
A-Ectopic
B-False positive beta hcg
C-Rest options were not correct

Aortic rupture x Ray given wide mediastinum. Options were that of

A-Diaphragm rupture
B- Aortic rupture
A. Haemthorax

Post colectomy hartman pouch recall but age was very old 85 year and get confused on 3rd
day no respiratory disetress Cause
A-electrolytes
B-Urine culture
C-Pulse oximetry

Acne + wt gain
A lithium
B risperidone
C lithium + resperidone
1) you noticed a nurse in your practice came in with smell of alcohol and slurred of speech
in the morning. You confront the nurse but she strongly denies it. Whats your next step?
2) A)terminate heremployment
B)document her behavior
C)the nurse’s practitioner
D)inform the nursing board

3) a woman came to refill her cocp. On further questioning, she occasionally has
headache ass with photophobia. Whats the next appropriatemanagement?
A) continue prescribecocp
b) tell the patient to come in for review if the headcahe present again
C) tell patient cocp is contraindicated in her condition

2) A wife complained that her husband has become forgetful. He doesnt enjoy his past
hobbies anymore due to minor stroke 2 years ago. Currently her husband having
difficultyto manage their financial. Whats the likel
3) diagnosis?
A) vasculardementia
b) alzheimer
C) fronto temporaldementia
D) lewy bodydementia

4) 3o y/o woman 32 weeks pregnant presented with fever, RUQ abdominal pain, jaundice.
she just came back from Kenya 2 weeks ago. Whats the complication to her fetus in
viewof hercondition?
A) hydropfetalis
B ) hepatosplenomegaly
C) stillbirth
D) low birthweight

42 year old pt ,post colectomy day 5 with wound oozing of yellowish foul smelling discharge and fever,T-
38 , what antibiotic to choose ?
A.IV Augmentin
B.Vancomycin
C.Ceftrixone+Genta
D.Metronidazole

Pt post colectomy day 5 with wound oozing of fecal materiat and fever, long scenario Asking antibiotic to
add
B--Flucoxacillin

C—Metronidazole
D--Vancomycin
 27 year old female who had abortion at 8 weekend , did D&C and come back with highe grade fever and
lower abd pain … what will u give ?
A-IV Ceftriaxone
B-Oral Azithromycin
C-Oral Augmentin
D-Oral Doxy plus Oral Metronidazole
Puerperal fever
Amoxy/potassium cluv
+
Metronidazole
A 10-month-old girl presents to ED with a two week history of coryza symptoms, and her
mother has become worried as she seems to be struggling for breath and wheezy. On
examination, the infant looks well but there are some intercostal and subcostal recessions, a
respiratory rate of 35 and a widespread expiratory wheeze on auscultation. You suspect she
has bronchiolitis. Which of these management options would not be considered appropriate
infants with bronchiolitis?
a) Bronchodilators
b) Palivizumab
c) Oxygen
d) Nasogastricfeeds
e) Nebulisedadrenaline

A women with colectomy 12 hours earlier, now symptoms of small bowel obstruction, one
groin has tender swelling without cough impulses next?
A-Observe
B- Explore surgery C-
Gutrest
D- AB
EXPRESSIVE LANGUAGE DISORDER
Children with an expressive language disorder (developmental expressive aphasia) fail to develop the use
of speech at the usual age. These children have normal intelligence, normal hearing, good emotional
relationships and normal articulation skills. The primary deficit appears to be a brain dysfunction that
results in an inability to translate ideas into speech. Comprehension of speech is appropriate to the age of
the child. These children may use gestures to supplement their limited verbal expression. While a late
bloomer will eventually develop normal speech, the child with an expressive language disorder will not do
so without intervention.13 It is sometimes difficult, if not impossible, to distinguish at an early age a late
bloomer from a child with an expressive language disorder. Maturation delay, however, is a much more
common cause of speech delay than is expressive language disorder, which accounts for only a small
percentage of cases. A child with expressive language disorder is at risk for language-based learning
disabilities (dyslexia). Because this disorder is not self-correcting, active intervention is necessary

RECEPTIVE APHASIA
A deficit in the comprehension of spoken language is the primary problem in receptive aphasia; production
difficulties and speech delay stem from this disability. Children with receptive aphasia show normal
responses to nonverbal auditory stimuli. Their parents often describe such children as “not listening” rather
than “not hearing.” The speech of these children is not only delayed but also sparse, agrammatic and
indistinct in articulation.18 Most children with receptive aphasia gradually acquire a language of their own,
understood only by those who are familiar with them.
Ethics Patient came with sweating pain in abdomen and light bleeding 6 week of pregnancy
 she didn’t allow her abdominal exam because it was tender you call the surgical resident and
he scolds you about not doing the Abdominal exam and tells you to call Gynecological
registerar patient has BP of 100/90 or 90/60 I can’t remember exactly all other vitals are
normal what will you do next
A call gyneregisterar
Give IV fluids
Call your surgical resident again
Can’t remem
Ethics Vietnam travel pt not wiling for others except yellow fever vaccine what to do
A report to immi dept
B document it medical report
C don’t treat the pt

what is the best method to collect data in hcv prevalence

data on new case
data of treating case
data from 5yrs health department

There was old man in nursing home where he hot diarrhea and incontinance for the last
4days what is the nostapproprirtae next atep u will do for mx
Rigid Sigmoidoscopy
Colonsocopy
Ct abdomen plus pelvis
Rectal exam
Fecal impaction confirm with rectal examination nad xray
Treat with oral or osmotic laxatives (8sachets of macrogol 3350 for 3days with or without rectal
suppositories or fleet enema microlax

Uterine prolapse ... which ligment weakness

A-Broad ligament
B-Round ligment
C-Uterosacral ligament
48 year old came with infertility who had 2 children ( 9 years of age and 6 years of age ) from
her previous relationship and he is with her new relationship who is 52 year old , he never
had children before , what is the reason for infertility?
1. Female ove r 40
2. Male Over50
3. Oligospermia

One university contact u to do a research about vit c efficacy in the population

A-Case control
B-Cohort
C-Double blinded
D-Randomization
 27 year old female came with hx of DVT and migraine headache but not having attack over 1
year had ectopic pregnancy 6 months ago came for contraceptive advice , what to give??

A-OCP
B-POP
C-Depo 3 monthly
D-Condom
E-Ethenylestradiol

52 year old male came to your office worrying about Ca Prostate because his friend was
diagnosed with Ca prostate but he doens't have any urinary symptoms. What will you do?
a. Take the blood forPSA
b. Tell him to come back if any symptomsdevelop
c. Tell him there is no screening test forprostate
d. Do DRE
e. TransrectalUSG

If discussion of pros and cons in option first choose that

1) 30y/o, 26 weeks pregnant, pprom confirmed by speculum, VE: os

3cm, effaced Contraction 1 every 10 minute. Whats the next step?
A) IVSalbutamol
B) oralbethamesone
C) IV syntocinon
D) D)IVantibioti

2) A man brought in to Ed by police on a shopping cart. He yelled that he knows this is

prison. Claimed that sees the painting into the wall. Whats the likelydiagnosis?
A) delusional
disorder
B) B )delirium
C) schizophrenia

3) ECG of AF(,most probably ecg of svt ) 20 y/o male presented with feel a little faint. No
chest pain. No sob. Whats the appropriate next
4) step?
A) Amiadarone
b) digoxin
C) vasovagalmaneuvre
D) dccardioversion
E) beta blockers
5) contro 10 yrs boy presents with bony tenderness behind ear, ear discharge, fever, neutrophils count
increases.. most appropriate investigation??
A. Bloodculture
B. Dischargeexamination
C. CT head{mastoditis}

Parvo virus igm igg came positive, pregnant women asking for next
A-Usg
B-Recheck after 2 weeks

Papua new Guinea travel after 3 weeks develeops

dirrahoea
A-Salmonella
B-Travellersdiarrhoea
C-Giardia

26 year old female , has dialysis 3 times a week , she is good and decent with the ward
nurses, shouts and speaks rudely with dialysis nurses, wts the defence mechanism ?
a. Acting out
b. Splitting
c. Regression
d. Denial
e. Repression

A lady came with diarrhoea, weight loss, and some other features. Low Hb, MCV 110.
Diagnosis
a. perniciousanaemia
b. Gluten sensitiveenteropathy

Old couple travelled to western australia. Pt in coma, gcs very low, High temp
, Had few mosquito bites while there.. asking cause?
A.Australian encephalitis
B.Malaria
C.DengueD.
Ross river
2 yrs old child suddenly enters his parents room at night , they found him confused so they
rush to the ED … by exam all is nomal … what to do next ?? very weird Qs
- EEG
- CTbrain
- Drugscreen
 - Glucose tolerancetest

1. Xray given with left sided opacity,,, patient have complains of bilateral thigh weakness
2. and tenderness

1. EMG
2. Ctchest

68 y/o woman ,, complain of purulent green brown vaginal discharge,,, she is sexually active
A. Endometrialcancer
B, chlamydiatrachomatis
1. Pregnant lady with vaginal discharge,,, no contractions ,, is closed ,,, how will udecide
whether she need
2. referral
1. Fetalfibronectin
2. Speculumexam
3. Prerequisite of testing of fetal fibronectin
4. gestation 22 35weeks
5. Cervical dilation <3cm
Membrane intact
Sickle cell trait patient ,,,, after long flight developed severe generalized bone and joint pain
,, what next
A enoxaparin
Boxygen
C analgesia

. Child lived in different foster cares ,,, now come to gp clinic and hugs doctor and then he
got injury in clinic and then hugs parents and then hit them and repeat hitting and hugging ,,,
diagnosis

1. Reactive .dettachment disorder ....

2 adhd
3 autism
9. Pregnant lady 19 weeks ,,,, take cares of child who is diagnosed with glandular fever,,ebv
im ,,, whatnext
A reassure
B amniocentesis
C anti body testing
Come when symptoms develop is better option

19. Post partum woman asking husband to keep watching her so that she don’t throw
20. the baby

A overvalued idea
B delusion
 ANS
OBSESSION

21. Osteoporosis risk

factor Asmoking
B menopause before 35 years

Mary is an attendant at a local accommodation centre and has an intensive itchy rash on her
wrists and arms that has been present for the past few days. She has recently bought a watch
and wonders if this is the cause of the problem. The most likely Dx?
A) popularurticaria
B) Tinea
C) Contact
dermatitis
D) eczema
E) Scabies
ANS E
Patient had kidney transplant from cadaver. No urine output till the 7th
D.USG abd

Ans-- Doppler
Woman 39 wk pregnant, came with heavy bleeding 1000 ml, tender
uterus,fetal heart sounds not heared by Doppler, after resuscitation next

step ?
A- CS
B- USG
C-amniotomy( Baby dead

Pregnant 40 w don’t feel fetal movement, ctg normal,not convinced by results, cervix dilated 2cm , head at 1 ,cm
below ischial spine

A-amniotomy

B- syntocinon

C-CS
D-review In 24 hrs

ECG of Af , patient has family history of stroke , he has hypertention what will
?reduce the risk of stroke
Warfarin
Statin
Ramipril

24 year man with painful swollen testis , for 2 days , on exam ,

tender swollen
? spermatic chord , fever + ,, asked investigation and
proper management
Urine
Surgical exploration
Chlamydia pcr

Woman with prev episodes of crush fracture, on risedronate. It was stated that patient has used prednisone, but
came to you with another episode of fracture. What appropriate mgt?
1. Change to alendronate
2. Change to IV zolendronic acid
3. Give strontium

4. Give raloxifene

Woman with h/o steroid use & previous fracture, taking Risedronate 35mg, has recurrent vertebral fracture in last
3 months, what next
a.stop risedronate and change to IV zolendronic acid
b.Change to alendronate

c.Continue Risedronate

d.Stop Risedronate

2.Very Old lady with coxa vera.which of the following will help her in walking?
a-walking stick
b-strap
c-brace used in sport

10.Then another scfe case, what inv to choose

11. Ultrasound
12hip xray,
13.mri,

14yo girl, pregnant disclosed to you that the father is her uncle, she said don’t tell parents. what next to do:

inform child protection don’t tell parents

Incomplete case of OSA: man brought by wife, because wife concerned that his husband sometimes sleep at the
lights (cant remember if man here is with other comorbids). What to do?

Check hba1c
Report to driving authority
22. Case of chronic schizophrenia, regular medication (depot antipsychotic) and good compliance.
On his ffup you saw pigmented lesion on his face and u assessed to be melanoma. U advise that it should be
excised but he refused saying it will heal on its own. next appropriate step

1.explain to him what is melanoma and excision

2do cognitive test
3do capacity to decide something
4. Refer for psych assessment

6. increase dose
man with case of eosinophilic esophagitis but asking best treatment?
A. esomepraszole
B. budesonide
c. helicobacter pylori antibiotics

36.child, family hx of travel child played in the sand during trip, now came home vaginal bloody yellowish
discharge? Asking reason for the finding

a. Sexual abuse
b. Monilia
c. Gardnerella vaginitis
Sandbox vaginitis—Fb, not in option then A
Obese depressed middle age woman with signs of excessive hair growth. What to check:
a.tsh
b.LH
3.testosterone
4. cortisol

43.3 times hx of miscarriage at 6 wks gestation, pregnancy is always confirmed with bhcg. What’s the cause?

APAS
Chromosomal translocation?

30 y-old lady, infertility for 2 years, tsh, lh normal , with history of apendicectomy 12 years back. Undergo
Laparoscopy, Dx?

a.PCOS
b endometriosis
c.Tubal occlusion
d.Adhesions
e.Uterine fibroids

A lady has history of PID and endometriosis of the uterosacral ligament surgery
done 4 years ago and she had chlamydia infection treated 2 years ago which of the
following will lead to future infertility
Surgery
Chlamydia
PID
Endometriosis

Ans-C
Chlamydia>Gonorrhoea

Treatment?
a. Amoxicillin
b. Drain
c. Surgery

Im procain pencillin or clindamycin + aspiration nd drainage

scenario of peritonsilar abscess with uvula devited suddenly in the er
get severly distressded with severe stridor management
intubation
incion and drainage of abcess

asking for what determines prognosis ?

a. Diameter
b. Thickness/depth
c. Color
Incidental finding in abdominal CT,upper right kidney mass 1 cm.
Asymptomatic , What to do
A. Percutaneous biopsy

B. Repeat CT scan after 6 months

C. MRI

D. Renal artery angiography

Left nephrectomy
1cm if partial nephrectomy if not in option then active survellience
2,3,4 ,5 mass partial nephrectomy if not in option then biopsy

Patient from nursing care was brought in the ER because of agitation at

night, upon waiting to the doctor fell asleep but after 4 hours the doctor
came and become agitated, violent. On Physical exam, extensive
bruising on arms-
thrombophilia
vwd
elder abuse
HSP case

Man 32 y-old asking for ca colon screening , his father die at 44 y-old from
colon ca
No screen need
Fob every 2 years
Colonoscopy now
Genetic counsuling
no screen at now... from 50 yrs or 10 yrs younger of the age of family member
diagnosed
so, for him, 34yrs, as his father died at 44yrs from colon

Infection student came back frm india persistant fever. showerd with
bucket of water frm nearby lake.also drinking water proper sterilized and
clean. malaria tested twice.all meds taken including antimalarials and
vaccinations.0
• looks for other disease
• b.do thick thin filn now
• do another rapid malaria test
• also smthng abt malaria

18 months baby went 2 month back with her parents to India . Now with
cough, no other symptoms,. Vacination complete. Physical exam normal. .
Asking for agent ?

Neisseria T

Pstreptocco

Influenza

Pertrusis

Mycoplasma

Male came from Thailand 2 months ago .. presenting now with marked
confusion and marked lymphadenopathy more at the axillary and inguinal
groups (may be mild hepatosplenomegaly .. not sure) .. CT showed
bilateral periventricular lesions (no details mentioned) .. what inv to do
next
Test for HIV
Test for IMN
Test for Malaria
MRI of the brain
1.56 years old woman, h/o menopause, was on HRT for last 4 years, no
menstrual bleeding for last 6 months----
A. Cease HRT
B. Continue HRT
3.One person went to Angola, Malaria prophylaxis was given, now presents
with high fever, two malaria test negative, what to do now……

A. Malaria check peak of fever

B. Another thick and thin film.

C. 22years female presents with nausea, pain in right iliac fossa, increased
urinary frequency, no h/o amenorrhoea, Temperature 37.8 F……
• Urine analysis
• Ultrasonogram
,,
7. 27 years old Known case of Asthma, was on Budesonide, blood test
reveals increased Neutrophil, Increased WBC, cause of neutrophilia----
A. Hereditary
B. Budesonide
C. Bronchitis
8. 4 Years old children, urine analysis showed Protein-Trace, Haematuria 1+, After
1 week, urine examination normal, what is the cause of the previous
urinary presentation…..
A. Nephrotic Syndrome,
B. AGN
C. Benign haematuria
9. Farmer with f/o meningitis, CSF findings are TC-820/cc, Monocytes-
70%, Polymorph-30%, Cytology showed Gm +ve Rod……
A. Brucellosis
B. Pneumococcus
C. Listeria..
If large >>anthrax
 If small>> listeria

Plumber presents with progressive dyspnoea, X ray shows Interstitial

infiltration, FEV1 50%, FVC 70%, No improvement on Salbutamol….
A. Steroid
B. CT chest
C. plueral biopsy
D. FEV1+FVC BOTH DEC IN RESTRICTIVE RATIO
INCREASED
E. FEV1 DECREASE FVC NORMAL IN OBSTRUCTIVE

Case of incarcerated hernia, patient was agitated after surgery, could not
memorize the PO day, BP less than 70mm Hg, SpO2 86%, X ray Hazy……
A. haloperidol
B. Intubation
C. Ceftriaxone

18. 20 years male, known case of Type 1 DM, now not going to university,
no social life, went to sleep at night, lethargic, what to check….
A. Mental state examination
B. Thyroid
18.Photophobia, mucopurulent discharge, On Fluroscent examination
shows corneal infiltrate….
A. Chloramphenicol
B. Specialist referral

28. Pain on tibial tubercle----traction apophysitis Osgood schlatters-

traction, asking for treatment------Conservative

Old patient with iloischial abscess, has this problem recurrent many times. On
examination there is no abnormal feature. what s the cause?
A. Anal fistula
B. Diverticular disease
C. Crohns disease
D. Diabetic
E. Immunodeficiency disorder
Man from Somalia comes to you with soiling. On examination you notice a
fistulous tract. Which of the following is the most likely cause?
Crohn’s
Ulcerative Colitis
C) Schistosomiasis
D) Perianal Abscess
Others findings of Internal haemorrhoids----
Mucus
loose stool

Right eye diplopia, dilated pupil, Frontal headache, cause----

PICA
MS
Mid Brain Infarct
6th Nerve Palsy
Hepatitis B statistic question. Core antibody +ve 60, Surface antigen +ve
7, only surface antigen 12, options were---
300
325
75
50
1. 39 wks preg lady with pain abd on the right side. Nothing mentioned
about the fetus, admitted to hospital, next day pain gets worse,
fever increases, wbc 21 000. What to do?
2. a.lapascopy

b. laparotomy
usg--- Appendicitis
d.iv antibiotics
e.forgot
2. 41 + preg woman, with prev hx of lscs for NPOL. Now comes to
check ?
3. a. admit to see fetus
b. elective lscs
c ctg in next visit
c. induction with prostaglandin
lady had DVT 10 yrs ago after a femur fracture. now she is pregnant and wants to
know what she can do ?
a-heparin prophylaxis antenatally
b-compression stockings after 20weeks
c-post natal heparin for 3 mnths

Past dvt hx> postnataprophylaxia only

But past dvt in pregnancy or while on ocp > Both ante and postnatal prophylaxis

3. 39 wks lady complains no fetal movement for 36 hours , ctg pic given (2
accelarations, I could see) . what to do?
a. tell her to come in next
visit
b. induction of labour
c. usg d.
forgot

5. Other many ecgs, I don’t remember now, I thought I would come back to
those questions again, so flagged them, but couldn’t come again (no time )
6. man with mass infront of ear, eye movement affected, what to dofor diagnosis?
a. ct head
b mri head
c. usg
d. fnac

Pt with painless slowly growing mass in front of the left ear,can not close his eye
completely.initial ix
1.USG
2.FNAC
3.CT

15) Scenario of mass in front of ear with dripping of saliva. most appropriate
next? a- CT
b- FNAC
c- U/S
d- Excision

58 year old man with painless slow growing mass in front of his left ear. He can't
close his eyes properly. It is firm and seems to be fixed to the underlying muscle.
What is most appropriate next?
Usg
CT scan head and neck
Laryngoscopy
X ray
Fnac
initially for parotid swelling-- USG
if any sign of FN impairment—Initial CT
16. picture of one blue fallopian tube, no adhesions seen. Lady with 12 months
amenorrhoea , wants to concive. Hx of appectectomy in childhood. Husb semen
study normal, wife hormonal study normal. What is the cause of infertility?
a. hydrosalphix

c. adhesions
19. woman with amenorrhoea12 months, all reports , like fsh , lh normal
except, tsh 0.04 (slightly low)Cause?
a.pcos
b. premature ovarian failure
c. primary hypothyroidism (yes, hypo they
said)
d. pituitary adenoma.

Gambling is very popular in Australia. What do you think the reason

which influence in this condition?
A Melbourne Cup
B Easy access to gambling
C teen age/ adolescent think that gambling is good for socialise
marijuana is illegal and not culturally accepted

39 wks pregnant female cervical dilation 2 cm for past 36 hrs.primigravida.

ctg ultasound normal.pt not satisfied still worried what to do.
a. amniotomy
b.csection
c.reassure and wait
d.administer prostaglandin
old lady known case of breast cracinoma .previously oprated for it.labs given showed
hypercalcemia. asking diagnosis
a. hypercalcemia of malignancy
b.hyperparathyroidism

A patient with adhesive capsulitis took time off work but now his employers are telling him to return to
work. You examine the patient and his range of movements are better now but the patient is still
saying that he cannot go back to work as it will aggravate the pain further. What will be your next
appropriate step as his GP?
Arrange Vocational counseling of the patient
Arrange functional assessment
Tell the patient he has to go back to work
Speak to his employers and tell them that cannot return
Post cataract surgery, patient develops red eye, photophobia, blurred vision, pain.
Diagnosis.
 A) Hypopyon
B Hyphaema
C. Acute Iritis
D. Glaucoma
25 years old male has progressive dysphagia for the past 3 months, more with solids
than liquids. He also has intermittent reflux symptoms. He also has allergy and
asthma for which he takes salbutamol and is well controlled. What the diagnosis?
A) Achlasia
B) Eosinophilic esophagitis
C) Peptic stricture
D) Pharyngeal pouch
E) a man concerned with his counting rituals, is on d verge of expulsion frm his
job due to
F)
G) his lateness and impaired work performance. Along with relaxation
technqiues,
H) what is
I) the next appropriate management?
J) A- exposure and response prevention
K) B- citalopram--- OCPD
L) C- olanzapine
M) D- diazepam
A patient has taken lots of tablets of venlafaxine. Was on depression treatment. One
year back she was given psychotherapy as she was irritable (shouting at coworkers)
and anxious. After stabilization of the patient what next to add
A. Lorazepam
B. Risperidone
C. Mirtazapine
D. Sodium valproate

A patient has taken lots of tablets of venlafaxine. Was on depression treatment. One
year back she was given psychotherapy as she had problem at work (shout at her
coworkers). She cant relax at home after work. After stabilization of the patient, what
should be added? (no mention of insomnia…it revealed pt is anxious)
Lorazepam
b.respiridone
C. Mirtazapine
D.Haloperidol
E. sodium valproate

A woman presents to the ED with epigastric pain and history of vomiting 3 times,
streaked with blood. She admits to drinking 10 cans of beer last night after which she
started vomiting. On examination her abdomen is soft, no guarding or rigidity but there
is tenderness in the epigastric. After the examination, she vomits again. Vomit contains
blood. Which one of the following the next appropriate step in the management of this
patient.
Esomeprazole
Gastroscopy
Odansetron
LFTs
Abdominal Ulrasound
mostly in alcoholic pts usually self limiting definite dx by esophagoscopy
Dx Mallory Weiss syndrome severe bout of cough nd vomting blood appears in
vomitus
Appendicitis in pregnancy first USG to exclude any other cause, if normal
then diagnostic laparoscopy.If we dx appendicitis then laparoscopic
appendectomy ( all trimester can do)
If perforated then laparotomy

Free perforation —
A free perforation can cause intraperitoneal dissemination of pus and
fecal material. These patients are typically quite ill and may be septic; they
are at increased risk of preterm labor and delivery and fetal loss [ 62,63].
Urgent laparotomy is necessary for appendectomy with irrigation and
drainage of the peritoneal cavity.
A child with ADHD. Well controlled with methylphenidate. The parents say that
the medication has significant improved his symptoms but are concerned as
the child has loss of appetite. You find that the child is with normal height and
weight but the growth has slowed. Next step?

a)Stop methylphenidate
B)Only give methylphenidate during
school days
C) Add multivitamins

16 years old has hx of heavy menstrual bleeding. No dysmenorrhea. One

time during her menstrual periods, she fainted due to the heavy bleeding
and was taken to ED . What the next appropriate step?

a) Mirena
b) Hysteroscopy and D+C(gold standard most appropriate )
c) OCP
d) POP
e) Coagulation screen

A young girl tries marijuana for the first time. In the following week she
exhibits paranoid behavior. She thinks she is being followed. She feels
agitated. Sister has history of schizophrenic illness
. What is the next most appropriate step in the management of this
patient? (cant recall the rest of the symptoms but basically the girl was
showing changed behaviour, mood changes, suspicious and claims to
have only smoked marijuana only one time)
A) Physical examination
B) MSSE
C) MSE
D) Urine drug screen
A mother comes to you with her child who has been sick since 3 days. She
is asking for a medical certificate as she has missed work for the previous
3 days while taking care of the child, and therefore needs to explain her
leave of absence to her employer. You examine the child and conclude
that he does have signs and symptoms suggestive of a mild URTI. What
will you do?

Refuse to give the certificate as retrospective dating is not allowed

Give her the certificate that’s dated today but covers/explains the
previous 3 days as well
Give her a certificate that’s only for today
Don’t give her the certificate because the child isn’t that sick

A 50 years old man says he has to take atleast 3 temazepam to

sleep ...otherwise he is unable to fall asleep without it. He feels anxious and agitated
during the day if he doesn’t use Temazepam. He says he cannot find work but spend
his time fixing old motorbikes. Whats the dx?

a) benzodiazepine Use disorder

b) MDD
c) Adjustment disorder
d) Circadian sleep-wake rhythm disorder

A teenager girl with history of excessive exercise and workout. She weighed 27kg
before. Now she binge eats but then purges and does excessive exercise. Her current
weight is 32kg. Ht is 162cm. Age was 16 years. What will you find in examination?
a)tachycardia

b)ankle edema AN

c)vitiligo
d)hyperthermia

A woman has history of chronic mood disorder and eating disorder. She is fine now but
presents to you saying she usually skips breakfast and then has large lunch…but then
feels guilty during the day for eating such a large meal. She denies any mood
symptoms. What the most appropriate dietary advice for her?
A) Tell her to start keeping a mood diary
B) Have a balanced diet and healthy lifestyle
C) Eat small regular meals during the day
D) Have a large breakfast

You prescribe Olanzapine to a woman. When she goes to buy this medication at the
pharmacy, the pharmacist says to her that this drug can cause diabetes. So the woman
calls you and tells you about what the pharmacist said, and says she wants to stop the
medication now because her mother died of complications of diabetes. What will you
do?

A) Arrange an early review with her to discuss further about the adverse effects
B) Advice her that she will need to be changed to another antipsychotic
C) Report the pharmacist to some Board for acting beyond his expertise
D) Call the pharmacist and tell him he shouldn’t have said that (something along
these lines. Don’t remember exactly)

A 42 year-old secretary has lost her job because, due to her perfectionism and
excessive attention to trivial details, she could never finish an assignment on time. She
writes innumerable lists of things to be done and follows rules scrupulously. She
consistently annoys friends and family members with her lack of flexibility remarks.
What is the best treatment for her?
Ocpd diagnosis
1) Psychodynamic Psychotherapy /psychoanalytic
2) Olanzapine
3) Venlafaxine
4) CBT-2nd
5) Exposure & response Therapy- OCD

woman is perfectionist.had a miscarriage 3 months back.since then she

is moderately (mentioned)depressed. she is concerned about her work
and don’t want medication as it will affect her work. what's most
appropriate for her-
a.cbt
b.interpersonal therapy
c. ssri
d.diazepam
A pregnant woman comes at 41 weeks and 3 days. Antenatal Hx is
normal. Her last delivery was by CS due to failure of progression of
labour. CTG done is normal. What is the most appropriate next step?
A-Elective CS
B-Amniotomy
C-Admit her for fetal monitoring
D-Repeat CTG

Cadaver renal transplant recall. No urine output till 7th day requiring dialysis. No pain.
No fever. What is the cause?
A.Acute rejection
B.Blocked catheter
C.Ureteric obstruction
D.Donor venous thrombosis
E.Acute tubular necrosis

45 years old man with scrotal swelling. He has had this swelling for 2 years. It becomes
prominent when he is standing or straining. Collapses when he lies down. Initially it did
not cause any problems but now the man complains of dragging discomfort towards the
end of the day. What will you do next?

a) Suggest him supportive underwear

b) Scrotal ultrasound
c) Surgical exploration
d) Doppler ultrasound
e) Tumor markers

 Post partum psychosis.....first step- olanzapine

6 yr old girl with hereditary spherocytosis came with marked pallor and palpable spleen,
history of URTI last week lasting for 3-4 days . HB – reduced (more than 8.5) WBC –
normal Platelet

– normal Retic count – 6 %

a. adeno virus
b. cytomegalovirus
c. parvo virus
d.epstain bar virus
e.cosakie virus

pallor patient with picture of microcytic anemia MCV low Serum ferritin normal

A) HB electerophoressis

Vit B12 levels

B) folate levels
• A high school student went to the summer camp with his friends. He developed
diarrhea and dysuria and urine RE given with RBC++. What’s your diagnosis?

• A. HUS .

Acute pyelonephritis
C. Acute interstitial nephritis

• H/o diarrhea,camping>>>>HUS

• H/o URTI+PLATELETS+NON BLANCHIG RASH>>>>HSP

 BZd withdrawal
 Intoxication= inappropriate sexual or aggressive behavior ,impairment
in memory or concentration 
Withdrawal=autonomic activity tremors insomnia seziures anxiety treat with
benzo 




• Breath holding spell – ixwasn’t sure..
• .eeg
• ecg
• iron studies
• ca vit D
• CT brain

 Prednisolone – adrenal insuff had hypoglycemia and postural

hypotn and hypona and hyperkalemia 
Appendicitis
 pic with guarding and rigidity next step...
Laparoscopy
iv antibiotics
• Old man admitted for delirium and fell fracture femur treated 16 weeks
discharged needs a ramp doesn’t want to pay for and doesn’t want to shift to
old age home-

• admit for few more days

• transfer to old age home

• apologise or explain that sometimes unfortunate incidents happen

Male started having problems at work wen was asked to work in a team ..feels
like they don’t do the job well so does it all himself and not good enough coz
no time...wat will be seen to diagnose this personality type..
.went with social isolation...
Other option was argumentative ...
Narcissit
38 yrs,15 smoker ,premenstrual headache,F/H/O breast

carcionoma,most important contraindication of OCP

AGE

SMOKING

premenstrual headache

F/H/O breast carcionoma

.A woman gave a birth to a full term baby weighing only 2000 gm with head
circumference at 1st percentile, hepatomegaly and mixed severe jaundice, he
has deeply pigmented retina on fundoscopic examination , and bilateral basal
crackles in the lung, wts the causing organism ?
a. CMV
b. Toxoplasma
c. Leisteria
d. Herpes Zooster
e. Rubella

A very agitated schizophrenic patient was there, and the doctors admit him
involuntarily.. what’s the reason of involuntary admission?
Non-maleficence
Harm reduction
salmonella food poisoning outbreak 2 days girl with negative stool culture what to do
next?
a.serology
. b.urine culture
c.stool culture
d.blood culture

5)One population, mean systolic BP is 115 and SD is 15 so what will be range of 95%
population’s BP?
a)100 to 130
b)85 to 145

young man brought to ED after brawl in bar in which he hit someone. He is alcoholic,
take multiple drugs and aggressive. What in history will you to know if he has
personality disorder?
a. Childhood sexual abuse
b. H/o cruelty to animals in adolescence
c. Drug and alcohol dependence

d. H/o of hitting partner one week back

e. H/o depression in mother

A patient with rheumatoid arthritis got a flare up and doctor wants to administer
azathioprine. which screening test should be done before starting this drug?
a) Tb Gold test
b) Thiopurine methyltransferase
C. Anti Acetylcholine inhibitors

Postmenopausal Woman with h/o gastric ulcer with hypertension, BMD showes T score
-2.5 in both vertebra and neck of femur, Ca and Vit D level was normal, asking for
treatment?
a)Strontium
b)Alendronate
c)HRT
d)Vitamine D
e)Calcium

An old man with pain in different joints, aspiration done and revealed positive rhomboid.
Patient disclosed that he is C/O from impotence. Diagnosis

A-Reactive arthritis
B-Rheumatoid arthritis
C-Hemochromatosis
D-SLE

old man with nocturia and long hx of dribbling urine problems for 12
months with median sulcus palpable with enlarged smooth prostate what
next appropriate?
A. Urine cytology
B. PSA
C. Bladder scan
D. CT scan abdomen
E. serum creatinine
39) A man returned from Asia. Now complains intermittent fever with chills and
rigor. He said that he used mosquito net during sleep at night. He has mild
spleenomegaly with thrombocytopenia.
Rapid Malaria Rest (98% sensitive and 96% specific) is negative. Now what to
do?
a. Repeat the test
b. Thick and thin film
c. Draw blood when fever is at peak and test again d.
Test for other infectious disease
e. Test for TB

Man with severe depression treated with venlafaxine now presented with
agitation pressured speech euphoria and mania ask what next appropriate thing to
do
a. add sodium valproate.
B. add clozapine
c. add olanzapine
d. Withdraw venlafaxine
e. add risperidone
Lady overdosed of venlafaxine prescribed for her. She was irritable at work and
insomniac. Her mood is euphoric now. What should be given after recovery from
overdose?
A. sodium valproate
mirtazapine
risperidone
oestrogen patch
ola if in option then
choose that
62) 22 year old female , BMI 32, smoker, on OCP, grandmother had breast ca at
age 63 . Asks her risk of getting breast ca. What will you advise?
a. Change to low dose estrogen
b. Stop smoking
c. Lose weight
d. Mammography
e. Regular breast self-exam

39 week pregnancy patient came with blood loss of 100ml, uterus tender,
continuous monitoring going on, suddenly fetal heart sound not heard even with
doppler, next step in management?
a) Amiotomy
b) C-section
c) Synto drip
d) Vaginal PG

32yr old female with diagnosis of Multiple sclerosis pt with optic neuritis
symptoms. Whats the risk of rcurrrence of neurological symptoms in next 10
years
A. 10%
B. 30%
C. 50%
D. 70%
E. 90%
F.
old
G. man in ed pulsating mass in abdomen. He is in
severe pain. bp 100/60. Everything is prepared for surgery and blood for
cross-
matching is taken.
H. Next step?
I. A- fast Ultrasound
J. B-Aortography
K. C-IM Morphine
L. D-No option for CT

Woman with premenstrual symptoms affecting her marriage and daily life. She
was depressed. Her husband is also annoyed but she can go out and enjoy with
friends.
What is the
best treatment option available?
Sertraline
Evening primrose oil
interpersonal
coc pill without pill free interval
HRT

Man brought by police, who was shouting in street, and walking naked, what is
the best medication to start treatment for this patient?
A-clozapine
b-quietapine
c-amisulpride
d-resperidone
e- olanzapine
a case of chronic liver disease presented with ascites and low albumin level.
What is the next appropriate management/
a. lactulose
b. albumin infusion
c. salt and fluid restriction
d. spironolactone and frusemide
55-yeor-old man presents with a six-month history of increasing
dysphagio for solid food. He has a previous history, going back over
many yeors, of gastro- oesophogeal reflux. He has managed his reflux
with antacids but, since the dysphagia started, his reflux has not been so
troublesome. Which one of the following is the most likely diagnosis?
A. Corcinoma of the oesophagus.
B. Achalasio of the oesophagus.
C. Peptic oesophogeal stricture.
D. Poraoesophageal hernia.
E. Ulcerative oesophagitis.

13-Woman with premenstrual symptoms affecting her marriage and daily life.
HER BLEEDING IS HEAVY. Her husband is also annoyed but she can go out
and enjoy with friends. What is the best treatment option available?
1. Sertraline
2. Evening primrose oil
3. interpersonal
4. coc pill without pill free interval
14 years old girl lives with family has now become sexually active comes to
you for
contraception advice and tells you not to inform her parents. What will u do?
A. Give her prescription of contraception
B. Ask her about identity and age of her sex partner
C. Tell her she needs parents’ permission
D. Inform parents
E. Tell her to use condom to her partner

Patient came from brazil one month ago , now both wife and husband come to you
wife want to conceive but concern about Zika virus , not doing yet sex after
coming back . Your advice ?
1- Zika virus not transmitted through sex
2- use condom
3- Do zika virus serology
4- Reassure , you are not infected

X-ray picture with compression of one vertebrae. Old lady complain of her
backache. What is your immediate action?
a. Bed rest
b. Back bandage.
C. Vit D
D. Calcium supplements
E, biphospgonate
3-month (6 month??) boy normal until 6 week of age. Now, hypotonia in all
four limb, feeding difficult, can’t control head. Sometimes he smile.
a) Early cerebral palsy
b) Botulism paralysis
c) SMA
d) Prader willi
e)
162 jm
Another que with similar scnerio, girl drank petrol and arrived hospital.. what
will happen in the patient? (Asking diagnosis)
a. Chemical pneumonitis

Lady old think worm in plate in rest home A

Purée diet
B resperidine 0.5 mg mixed with dinner …………….ans

Sudden infant sudden syndrome

Cot death
how to prevent
2Baby in separate room
3No smoking …………ans
4No pet

Woman 39 wk pregnant, came with heavy bleeding 1000 ml, tender uterus,fetal
heart
sounds not heared by Doppler, after resuscitation next step ?
A- CS
B- USG
C-amniotomy

ECG of Af , patient has family history of stroke , he has hypertention what will
?reduce the risk of stroke
Warfarin
Statin
Ramipril

then 13 yo pregnant with her 19yo bf, urine preg test negative, whats the next
important thing to do:
Give emergency contraception
Counsel about the use of contraception
Report to child protection
11. Status epilepticus child scenario mgt
Give rectal diaz
Give rectal pcm
lady diabetic, sudden onset of facial weakness, with icteric sclera, ear
discharge (but no mention of vesicles) what to do
Famciclovir,
Mri
Prednisone (Ds Bells palsy)

18. then another case for me its clear bell’s palsy. But asking what investigation to
do?
Ct scan
Mri
No test needed
A woman develops erthymetaous tender swelling on her left breast after
delivering 1 week..she tries to breastfeed but was unable.. Treatment
options were
1.Procaine penicillin
2:Fluxocillin
3: ampicillin
Vancomycin
Erythromycin
Child with intermittent abdominal pain between attacks he is ok, attacks
usually last couple of hours and subside, this time he came with the same pain
on RUQ and also a mass ,pain lasted 12 h this time, no fever .dx
Hepatoblastoma
Neuroblastoma
Wilms
Pyelonephritis

4year old boy with a 2 year history of vomiting and abdominal pain, now
presents with abdominal pain and a right upper quadrant mass, what's the most
likely diagnosis?
A. Wilm's tumour.
B.Neuroblastoma.
C.Hepatoblastoma.
D.PUJ obstruction.

pt with abdominal pain he is 4 years old , pain reccurent for last 2 years , last
attack was in left flank inv:
A.us during attack
B. micturating cystogram
C.erect and supine xray
D. small intestine meal and follow
E. electrolytes and urea , creatinine

Young boy with intermittent pain in flank and radiating to thigh for two years,
now pain is continuos with vomiting, a mass felt below left hypochondrium, dx
a.Wilms tumour
b.Nephroblastoma
c.Ureteropelvic junction obstruction

- neuroblastoma is painful, pt ll not even let u examine, but age of

occurrence btw 6m to 2yrd
 All can be painful ,Nd puj is tender
Wilms and neuroblastima nontender and have no vomiting
Ecg of svt, young patient collapsed suddenly at school during class, awakened after 1
minute, taken by ambulance to the ER vitals: bp 140/80; HR 76, RR 18, ecg done in
ER shows narrow complex SVT, what is the initial management ?
A atropine
B Adenosine
C carotid sinus massage
D Cardioversion
E defibrillation
SVT ECG elderly man with palpitations asking managemt a)
carotid sinus
b) iv adenosine

young female came to you with her father. father says she is anxious heart
rate increasd. forgets things and nervous. headache dizziness. she has to appear
in court in two days fir charges of shop lift (stole bags or cosmetics forgot)
A-- Factitious disorder
B-- Panic attack
Malingering

.Amenorrhea 12 month ago after miscarriage which was managed

conservatively, now intermittent abdominal pain , 12 months abodimnal
discomfort what to do to reach diagnosis ?
1- Laporoscopy
2- Hysterosalpingography
3- Vaginal US
man in ward due to delirium of Copd exacerbation and agitated and fall and got
femur fracture after the treatment he need expensive home management but he
don’t want to pay pills and shouting and says she will go for court because ur
neglency causing my fracture what you will do
a. control her anger and excuse to him
b. give respridone
3.tell him mistakes can be occur
27 years old come with green brown nipple discharge . On
examination ,no palpable mass and discharge is expressed from 3
opening of nipple.What is the diagnosis
1.cancer
 2.mastitis
3.fibrioytocis
4.duct ectasia
Woman known with polymyalgia rheumatica and has prednisone 10 mg daily,
antihypertensive medication for HTN and metformin for DM, she feels dizzy
and unwell as she went overseas a didn’t take medication at all. Labs .
Glu 4.0,
Na 125,
K 5.0 diagnosis??
A) Adrenal insufficiency
Indapamide
B) metformin
C) lisinopril

Pt with visual field defect left eye outer side right eye inner side where is damage
A Rt. optic n.
B Rt optic tract
C Lt. optic n.
D optic chaisma
E right cortex
Optic tract
Optic radiation
Visual cortex (occipital lobe )
Recent flight, DM2, fever with swollen and tender calf, no other criteria for Wells:
A--D-dimer
B--Venous US
C--blood culture.
Femur is primary site for dexa scan

Pt known case of ulcerative colitis presented with fever, left sided abdominal pain,
leukocytosis.no guarding or distention. x ray was given. asking management
A-- Laprotomy
B-- IV hydration. Antibiotic npo
Answer b (dx diverticulitis

Scenario of gallbladder stone alongwith cbd dilation 14 mm with stones. askng managemt
a) laprozcopic cholecystectomy
b) endoscopic decompressiom
Answer B

CT abdomen scan an elderly woman with heart failure and FE 20% has raised ALP, ALT,GGT but bilirubin is normal,
she has pruritus and and has lost 4 kg in 3 months, what is the most appropriate management:
a) ERCP
b) percutaneous cholangiogram drainage
c) cholecystectomy
d) can’t remember
Answer B

Ans c 2ndA

male with hx of cholycystectomy and previous acute pancreatitis now

with epigastic fullness and mass .,, ct showed 10 cm pseudodcyst in post wall
of stomach
a. ERCP
b. PERcutaneous drainage
c. endoscopic gastrostomy

enlarged gall bladder with multiple stones, found dilated bile duct and stone obstruction in
common bile duct, patient developed toxic shock, what to do after fluid resuscitation?
a. laparotomy cholecystectomy
b. laparoscopic bile duct explores
c. percutaneous bile drainage
d.endoscopic decompression
Answer C PTC.

ans B
Ans B

Ans A
The parotid, submandibular, and sublingual glands are the largest salivary glands. These glands may swell
repeatedly and often bilaterally (sialadenosis), but are also subject to acute inflammation that is predominantly
unilateral (sialadenitis). Diseases that commonly cause sialadenitis include: Sjögren syndrome (chronic
immunologic sialadenitis), Heerfordt syndrome, and mumps (epidemic parotitis). Sialadenosis and sialadenitis
primarily affect the parotid gland. However, stones in the salivary ducts (sialolithiasis) mainly form in the
submandibular gland because of its ascending salivary duct.
Salivary gland tumors manifest mainly in the parotid. Painless and progressive swelling of the gland is the cardinal
symptom of benign as well as malignant tumors, while facial palsy is considered a criterion for malignancy.
Generally, the smaller the gland, the greater the chance that the tumor is malignant. Clinical examination and
ultrasound play the biggest role in diagnosis. For all parotid tumors, the preferred treatment is parotidectomy with
retention of the facial nerve. A resection of the facial nerve is indicated only if it is infiltrated by the tumor.
Postoperative radiation therapy may benefit patients with malignant tumors.

ANS B

Ans B
ANS B
Ans C
Answer PTSD
Answer should be malingering; but out of these the answer is PTSD related to h/o of childhood abuse.

ANS D

ApoE4 isoform is major risk factor for cvd such as coronary heart disease stroke and arrhythmias
ApoE2 has dual effect adverse and beneficial effect on cvd
ANS A

ANS AA
If ABG in option then choose ABG
If Q mentions fever (fever will indicate Atelactasis) then choose Xray.
If Q mentions- fever, ABG, X-ray- ABG
If no fever then SUCE

ANS C

ANS A
Ans C

ANS A
ANS B

ANS D

Cbt is treatment of choice for pyromania

They are fascinated by fire and fire equipment
ANS C
ANS RESPIREDONE

ANS A
ANS B

ANS IS B
 ANS E

ANS C
Ans A

Low fluorinated <5 years of age

Ans B
Ans B

B repeat fnac

A 25 years old man came to OPD with complaint of pregressive difficulty in walking .HE had a waddling gait and
had difficulty in raising from squatting position .
The enzyme most likely raised in this position would be
A.Alkaline phosphatase
B.CK-MB
C. CPK
D.SGOT
E.Trop-T
Ans-C
Increase risk of cholestasis

Ans A

Abnorml personality since childhood.no friends.always lived alone.now problems at work.asking treatment
Diazepam
SSRI
Olanzapine
Ans- B
I think in personality disorders mainly we give psychotherapy. Nd ssri or antipsychotic it depends on
their symptoms
Contrast nephropathy treat with iv hydration

pt with post nasal drip.how u manage?

a.oral antihistamine at night
b.pseudoafidrine spray at night
c.diphenhydramine spray at night
d.nasal spray when attack

Ans-C CT head, If fontanelle open then usg

Ans D
But better option to choose is partial nephrectomy

Pmc overdose
Ans C ANS B ANS A
Ans-3
THESE DRUGS CAUSE DEHYDRATION AND HYPONATREMIA

HYPOTHERMIA
Hyponatremia
Liver toxicity
ICB

Posted 25 years old mom, came to your clinic with her 8 months old child named Ali. They are new immigrants
from Egypt. Regarding Ali’s polio vaccine what will be your decision if you knew that Ali took 3 doses of oral polio
vaccine back in Egypt:
A- No need for further vaccines as he completed his polio schedule
B- You will give him one dose of injected polio vaccine—updated in Aus, now IPV
C- You will give him an oral booster vaccine
D- You will ask the mother to bring back her child when he will be one year old to assess his need for a booster
E- Start new polio vaccine schedule with him
Ans- B

Recall of Somalian child who received oral polio Now he came to your facility and you only have injectable vaccine
?
A. No more vaccination needed.
B. He should take oral booster.
C. Continue with the injectable vaccine.
Pregnant lady contacted with CMV affected person. Her blood results came are CMV IgM. Next important step
1- terminate pregnancy
2- check her past history previous serology
3- repeat serology ( IgM and IgG) in the next 2 weeks.
4- give antiviral Tx
A G2P1 came at 12 weeks of pregnancy for the second time. The first visit was at 4 weeks of pregnancy, now in
her lab tests: CMV IgM (+). What is the appropriate management?
a. Check her previous sample for Ig G and Ig M
b. Do amniocentesis
c. Do blood test again for Ig G
d. USG in 18 weeks
ANS-A serology
32 year old woman came in her second pregnancy asking about wt to do now as she has had postpartum
psychosis in her last pregnancy.
a) Review her late in pregnancy
b) Start prophylactic dose of antidepressants
c) Start her on antipsychotics now
d) Do abortion as she is not allowed to get pregnant anymore
e) Start antipsychotics after delivary
A pregnant lady G2 P1 comes for antenatal visit at 8 weeks gestation. She is concerned that she had the history of
postpartum psychosis after the delivery of her first child. What should you advise her?
a. Give prophylactic antipsychotics now
b. Give antipsychotics in her second trimester
c. Give antipsychotics in her third trimester
d. Advise her to come with her husband in the third trimester
start her on antipsychotic after delivery is a better option

PSyChOPsychiatric disorders are increasing in Australia. Based on community studies, which of the
following psychiatric disorder is of recent increase (or the most common)
? A) Bipolar mania disorder

B)Obsessive compulsive disorder

C) Schizophrenia
D) Anxiety disorders
Q.Which of the following conditions is the COMMONEST anxiety disorder encountered in general
practice?
a)Generalised anxiety disorder
b)Phobic disorder
c)Obsessive compulsive disorder
d)Panic disorder
e)Post-traumatic stress disorder
Only rash>cholestrol emboli
Rash plus deranged RFT> drug induced nephritis
Only deranged RFT post pci> Contrast nephropathy its mostly non oliguric

Px with known asthma woke up at 4am with noisy breathing. She had sore throat few days ago. At
present, she has fever and abnormal breath sounds. No mention of wheeze.

A. Aspiration

B. Acute As Px with loin pain dysuria. urine culture showed Ecoli tx w antibiotics for 4 days. However px
is still with symptoms. What to do next aside from blood culture?
A. CT abdomen

B. Ultrasound of bladder

C. Urine culture

A carpet layer consulted due to painful knees after work. What is next appropriate inv

A. Plain X ray of knee

B. Ultrasound of knee
C. MRI of knee

A carpet layer consulted due to painful knees after work. What is the appropriate dx tool?

A. Plain X ray of knee

B. Ultrasound of knee

C. MRI of knee

Stone at neck of gall bladder elderly pt, stent placed , mybe very ill surgery prohibited

A. Percutaneous cholecystectomy (cholecystostomy

B. Cholecystectomy

ANS c

C hild 6 yrs old... Came to u after 2 weeks of Whooping cough.. What will u do??

A. Give antibiotics, tell him to go school

B. Exclusion

C. Booster vaccine and exclusion

D. Give antibiotics and exclusion

Ans A

Ans C MAYBE CATATONIA

ANS A

Ans D
Ans B

SEMINOMA Always orchidectomy and radiotherapy

Early NSeminoma only orchidectomy plus active survelliance Late one orchidectomy plus chemo

Ans D
Ans B

ANS A

Ans A SSRI DX OCD

ANS C

ANS 0.5CM
Ans C

Ans D
Ans C
Ans A

A A
Ans B ANS A
Ansc ansA

Most lethal pancreas and lung

LEAST LETHAL PROSTATE AND TESTICULAR

Ans C ANS A
ANS B ANS LOW BIRTH WEIGHT

Ans C ansA
Ans C

Ans A

ANS B
ANS A

15. An elderly woman with RA, 15 years on steroids by mouth. Pneumonia developed (by X-ray) of light to
moderate severity. they ask what else, except for antibiotics, I need to give her. Of the options I remember
only IV
ANS IV STEROIDS

Young female, primigravida came at 38 weeks pregnancy. LOP fetus position. Head is not engaged. What is
the cause?
A. Contracted pelvis
B. LOP position
C. Placenta previa
D. Cephalo-pelvic disproportion
ANS A
A girl of 10 years old, feels bad for a couple of days - tiredness, weakness, oliguria (urine is very dark), but not
ORZ, pressure 160/100, there are many red blood cells in the urine and there are proteins. ask Treatment
after pressure reduction
A. Low-salt and low protein die
t B. Little salt, many carbohydrates and many proteins.
AT . steroids
G. Furosemide
ANS A
ALWAYS FIRST CONTROL BP WITH DIURETIC AND ACEI THEN
LOW PROT LOW SALT HIGH CARB DIET
Summary - Nephritic- low protein low salt high carb diet..And we give furo and Acei to control HTN.. Nd in
Nephrotic low fluid low salt , high protein

Mom brought the child tk he can not climb the stairs (somewhere around 4 years old). The boy has weakness
of the lower limbs and lacks reflexes like ankle. his mother also has no reflexes and high arched foot. They
ask what to do next A. Muscle Biopsy
B.nerve conduction study
B. Electromyography
ANS EMG
For charcot mrie diagnostic test is emg

A student without symptoms, experiencing that a pulse at rest - 45. ECG data in my opinion
is normal. ask what's next
A. Soothe that everything is fine
B. electrolytes check
V. Holter and something else

man with a history of drug abuse presents to you. He says he hasn’t used any drugs for the
past 2 years. He has recently become easily agitated, irritable and has lost interest. He also
experienced episodes of explosive anger. He mentions to you that he’s been charged with
minor assault. Which of the following is most likely?
A Antisocial personality disorder
B Malingering
C Recurrent drug abuse
D Trying to get a medical certificate to show in court
B

A picture of a clinical balanitis in a boy, a little white pus is released, a skin like partially retractable and there
is redness. Ask for treatment
A. Steroids locally
B. Antibiotics locally
ANS B??

10month old male baby brought by mother with complaint of meatal yellow discharge and she noticed that
prepuce is partially retractable over glans. How will you treat?
a.Topical mupirocin
b.oral antibiotics
c. topical steroids
ANS A

Question about the aunt (a couple of days after some kind of operation, but according to the scenario, I
understood that the operation is not important) that collapsed in the hospital. They ask what should be done
after CPR is started and respiratory paths are prepared and it is already breathing from ambu bag.
A. Ecg
B. Defibrillator
B. Chest X-ray
G. Adrenaline give
The girl collapsed during the sport, in the ambulance she was pumped out. her father died
young (sudden death). It is now stable. Ask what's important the following –
ECG –
X-ray –
echo -
a couple of hours after a difficult procedure for removing stricture in the urethra in a man - pallor, weakness,
sweating (and there was something else, maybe the temperature, the answer is correct. –
gram-negative sepsis,
internal hemmorrage,
shock)
68. girl on sertalina asks if she can Ecstasy –
ecstasy is contraindicated –
they are synergists
ANS FOR 1ST GRAM NEG SEPSIS HB 3.18
SECOND>SYNERGISM
The guy with the newly diagnosed shizoy doesn’t want someone knew about it. And it
seems that it’s some thoughts. –
notify your friend
- call the police –
to promise the guy that info is confidential
ANS C
66. 11-13 years old girl with abdominal pain last couple of weeks or days. Inspection -
norms. Urine - WBC 20, Crop, 10 * 5 E Coli. asking –
do not treat –
iv / in antibiotics –
oral antibiotics
ANS C

. woman 42 after an uncomplicated miscarriage, could not get pregnant for a long time before this
pregnancy. Ask the following –
COC for 6 months
- fertility medicines
- assisted reproduction
- adoption
-ICF
-intracorporal fertilization
Ans c

64. Uncompliant man with dialysis (End stage renal disease). After the last dialysis, 5 days have passed, he
acted with shortness of breath and something else (maybe swelling)
- give furosemide
- to make an X-ray –
put in dialysis

. boy, 4-5 years old, with growing pains in the lower limbs (without signs of inflammation,, without
lameness, in the morning and in the afternoon - normal, wakes up at night from pain). Ask how to treat
- no way
- aspirin
- NPVS
– paracetamol
ANS D
57. most common cause of perianal fistula
- perianal abscess
- crohn
- ulcerative colitis

The homeless drunk agitated and with signs of alcohol intoxication, came to the hospital and said that the
last month had been drinking cheap swill and was eating out of the garbage. before that he was often
treated for alcohol inoculation. What to give before / in glucose?
– thiamine
– haloperid

a little girl doesn’t get acclimatized at school, doesn’t like when someone breaks her routine, constantly
arranges her dolls in a row, she has no friends, but she doesn’t care Like language and development are
normal. the diagnosis?
- autism
- Asperger
- shiz
-Retts syndrome
-OCD

ANS B

aunt vegetarian low NV, low MCV and MCH, ferritin 6. (8-300)
- thalassemia
- dietary deficiency

The guy after torsion of the testicle (long ago operated). now this testicle is bigger than the other. ask what
to do with it.
a. Calm and let go
b. Usg
c. Testicular oncology markers
d. selfexamination
Ans B

mother brought her daughter 17 or 16 years. There is no menstruation and she is short, and her breasts are
normal, her hair is puberty. vaginal examination did not give hold.
- ovarian dysgenesis
- Mullerian agenesis
-Turner syndrome
-hypohonodism

A young Aboriginal girl is very worried about her mother’s death, says that she hears
voices, says that perfume is involved, and this other family has cursed her mother.
- Ask an Aboriginal Specialist for advice.
- Put her in a psychiatric hospital
- Something of the type to inform the society to protect something

. Baby up to a year from Sudan. Mom complains that he is whiny, restless, eats badly. in the analyzes - Hb -
90, vitamin D somewhere 16 and alkaline phosphatase -1500. Ask what causes his symptoms. 29.
ANS VIT D
a girl of 7 years old, covered with bruises and petechial rash, no bleeding. platelet count - 5.
enlarged Lymphnode on the neck (1 cm). HB and leukocytes are normal. ask for treatment
(there were no steroids in the answers)
- no
- thrombosis
- Immunoglobulin
- HT 31.
The fetus has hydrops. they ask what should be done to find out the reason.
- Fetal blood test
- Amniocentesis
- Maternal blood coombs test
Ans C
Ans C

ANS D
ANS B
ANS D ANS C

ANS A

ANS NEB ADRENALINE

ANS C EMBOLECTOMY
 57 ACEI 56 A 55A 54A
53 C
ANS B

ANS B
ANS B

ANS B ANS A
4 yr Child mom brings her with complain of genetilia problem. U examined and found labia majora
fusion. whats ur next step
A. Examine under anesthesia

B. Topical steroids

C. Topical estrogen

D. Review in 4 months

ANS D

You are a dentist and want to relationship between mercury amalgam and dementia. You take two groups
of people one with dementia and one with mercury amalgam. What this type of study called?
a. Cross-sectional

b. Randomized controlled trial

c. Case-control

d. Cohort

e. RCT

- Young adult hit his lt eye with squash ball apart from headache which resolved with paracetamol. In
second day developed slightly decrease in visual acuity in the affected eye. Anterior chamber is clear all
other examination are normal. What is dx
A) vitreous he

B) В)retinal

detachment

C) retinal artery thrombosis

D) hyphema

E) cerebral hge

ANS B

- 2 during breast feeding 2mnth old baby cryng flexing leg scratching mother’s breast. He is gaining
weight normally. Not sleeping at night. dx
Infant colic

Pyloric stenosis

Insufficient milk production

silent reflux
ANS A
Child present with fever, neck stiffness, anterior frontanellae full , lymphocytes 5400cumm(n <5) ,
glucose is normal ,no organism on gram stain, meningitis like scenario

A. Intravenous phenytoin

B. Rectal diazepam

C. Intramuscular morphine

D. Oral paracetamol

E. Intravenous dexamethasone

- Salmonella outbreak has been declared in the community. A girl presents to you with watery diarrhea
for 3 days. What is the best test out of the following to diagnose her condition?

a. Blood culture

b. Urine culture

c. Stool culture

d. Throat swab

ANS C
A patient came to your office, 40 weeks pregnant and complaining that she did not feel fetal
movement since 36 hours. Bishop score2, Vaginal examination, cervix 2 cm, bony part of fetal head
1 cm below ischial spine. CTG normal, but the patient is not convinced and very worry about the
baby.
A-Elective CS
B-Amniotomy
3-Admission and observation.
4-Take juice and repeat CTG
5-Follow up in next appointment
Pregnant 40 w don’t feel fetal movement, cog normal, not convinced by results, cervix dilated
2cm , head at 1 cm below ischial spine,
A-amniotomy

B- syntocinon

C-CS

D-review In 24 hrs
ORTHO 16 yr boy playing football, pain in knee, on examination swelling & tenderness over tibial
tubercle , Dx?

A-traction apophysitis( ans)

B - tendinitis

C- capsulitis

ANS A

Pt with severe back pain, urinary incontinence, has h/o basal cell carcinoma, removed before many
years,cannot urinate while lying flat, but can urinate only on standing, what indicate immediate
imaging?

A- h/o BCC

B- positional urinary retention

ANS b

YOUNG WOMAN home pregnancy test positive, LMP 8 wks ago, now abdominal pain& light bleeding,
next?

A-USG

B-qualitative Bhcg

C-pelvic examin

17 y old male, mva, he is walking & ok, but has lt shoulder pain , no neck pain,has LUQ tenderness, BP
110/60 what’s next?
A- CT abdomen

B- IV cannula(if bp unstable then choose first iv line or fluids )

C- USG

female with headache and hearing loss but on examination nothing she has legal problems diagnosis

a.Factitious disorder

b.Migraine

c.Borderline personality disorder

C. malingering

- Small child morning red eye , ear swelling, itchy, afebrile , playing
1- Allergic ,
2- Erysipeales
3- Otits extern

Male infertility history of operated cryptoorchidism with seminal analysis shows low no and poor motility
of sperms what next to help in management
FSh lh

Testosterone

Karyotype

If man comes with complain of infertility first thing to do is semen analysis if analysis already done then
do fsh

Male with mass above the testis felt separated from the testis painless reaching to inguinal canal with
no impulse on cough
Hernia

Varicocele

Epidydmal cyst

Hydrocele

Amenorrhea 12 month ago after miscarriage which was managed conservatively, now intermittent
abdominal pain , what to do to reach diagnosis ?
1- Laporoscopy
2- Hysterosalpingography
3- Vaginal uS

Small child irritable , high fever, abd pain , vomting , by ausultaiton decrease intestinal peristalsis
decrase, abd distended , unwell , xray distended bowel most appropriate to reach diagnosis ..

1- Intusscuption
2- Ultrasound
3- Air enema
4- Ct

Female detoriation of vision with loss of pupillary refelex direct and intact indirect Picture of fundoscopy
??
1- central retinal artery occulation
2- optic neuritis(both loss )
Case of nephrotic syndrom now developed abd pain.. Tenderness with decrease in GFR

1- Renal artery thrombosis. .

2- Renal vein thrombosis
Patient has neck pain after injury of the neck , he cant extend or rotate then neck , neck flxion is
normal what will clarify the diagnosis
1- Right pain on exention of the neck
2- Pain on lateral roation
3- Tenderness on neck extenstion

Patient with fever 38 …previously for a major operation , dr gave him G/A..now with back pain , swelling,
tenderness , and red area in the back , discharging fluid from the back , also having problem with
urination , DX, ?
1- Spinal chord compression
2- Epiduarl abcess
3- Side effects from G.A
64 yrd with pain left side of the head , pain increase on the right when he lie down on the left side ,
previously treated from jaw pain . Investigaiton??
1- Esr
2- HLA b27
3- Blood culture

Old patient with leg pain which increase after 200 meter walking , he cant move his leg, pain become
worse at night , what sign make the diagnosis

1- Tenderness on greater trochanter

2- Pain on internal rotation

Patient came with deadly leg pain , he can walk 200 meter, then pain increase after walk in plain and
incline area, palpable pulse, what is the best Ix ?

1- Doppler ,

2- MRi lumbo-sacral

3- Straight leg raise test

Man going to get fired from job because of not finishing his job, he said he want to make the job perfectly
, what history will make the diagnosis ,
 1- History of self harm
2- History of lateness

psych Family with a newborn baby moved to a small village in rural Australia, father called up GP to inform
wife sad all the time, low mood, crying but taking good care of baby, cannot get her to the hospital as he
is busy with new work, what next:
A. Make a home visit
B. Send a social worker to check on woman
C. Insist husband to get the woman & baby to clinic
D. Admit the woman, baby can be with dad
E. Wait for the husband to call back again
Ans A

infectionA nurse while disposing a syringe basket in a ward known to have

Hepatitis C patients accidentally pricks her self . In addition to testing herself for HIV what else should
she do?
A) Immediate test for HCV antibodies
b) Periodic test upto 6 months for HCV antibodies
C) HCV level after 48 hours
D) Begin treatment with Ribaverin + something else HSV in
pregnancy

neuro Gbs stem.how to monitor respiration.

X FEV
X FVC
Monitor chest expansion

Old man with DM,HTN, Drink 1 beer daily. Has difficult of R hip abduction n internal
rotation .Gets his pain after walking.
Noted to have forearm bruises as well

Cause asked
A)AVascular necrosis
B)Chronic hip septic arthritis
C)Thigh hematoma
Etc

An 89 year old male comes to you complaining that he is having pain in his groin for the past few weeks.
He is finding it more and more difficult to go and meet his lady friend, so he started using a cane, and
taking paracetamol. Even then pain did not improve. On examination, you note tenderness in bilateral
groin area. What is your diagnosis
A Avascular necrosis of femur
B Fracture of neck of femur
C Osteoporosis
infection young had history of fever 40 degree and arthralgia bodyache from 5 days with history of
travel to combodia
Examination shows platelets 3000000 and elevated urea ..he has bilateral conjunctivitis and red rash
over the body..
What the diagnosis??

Malaria

Hepatitis A

Staphyloccos scalded skin syndrom

Dengue fever

neuro lady develops severe occipital headache plus she also has a hx of pkd and migraine, her ct comes
normal and physical and neurological exam what should be the next step in ix to lead to dx?

a. Mri

b. Ct angiogram

c. Lp

ans C Pkd associated with berry aneurysm

CT scan > LP

#renal 22yo boy comes with mild abdominal pain and painless hematuria, family h/o uncle died of
cerebral hemorrhage. What is the diagnosis?
20. PKD
21. renal contusion

22. AIN

renal Old man with her wife. He was disoriented and confused. He was diarrhea for 24 hrs. He also had
history of prostectomy 1 week ago and catheterization for it. He was give IV fluids yesterday in local hosp.
His conscious level improved. Now he comes with urine output of 20 ml/hr and his RFTs r normal...What
to do now?
A) give bolus of IV saline

IV furosemide

encourage oral rehydration

catheter flush

: shows an acute perianal haematoma. A 27 yrs old female, a basketball player, presented with
perianal pain over 10 hours, what is the management?
a. Incision under local anaesthetics

b. Haemorrhoidectomy under GA

c. Drainage abscess

d. Give antibiotics

e. Haemorrhoidectomy under LA
showing thrombosed external haemorrhoids for 1 days with perianal pain with h/o of constipation, what
is the management?
a. Incision under local anaesthetics

F. Haemorrhoidectomy

G. Drainage abscess

H. Give antibiotics

U NEED TO CHECK TUBERCULIN TEST BEFORE STARTING INFLIXIMAB OR HEP B

BEFORE STARTING AS ITS ANTI TNF AND IT CAN REACTIVATE THESE DISEASES

contro 9 weeks pregnant with uti, symptomatic

Culture shows ecoli

Resistant to amoxycillin

Cephalosporins
What to give?

Trimethoprim

Augmentin

Gentamicin

Metronidazole

Ciprofloxacin

First line in pregnancy is cephalexin

Then Nitrofurantoin and 3rd line augmentin

Trimetho contraindicated in first trim

diabetic foot is admitted in hosp. For 1 wk ulcer is about 1cm not healed after wound debriment but
has discharge that is yellow in colour. What to do next?

MRI

Oral amoxy/clav.acid

IV ticarcillin/clav acid

greenish discharge then ticarcillin

Old lady has no stress incontinence but has urge incontinence and bed wet at night. she has mild
rectocele. inv?
-urine dipstick and culture

-urodynamic study

-cystoscopy
#psych 6) Ballet dancer ankle fracture, have inferior complexity, vomit forcefully. You treated her
ankle. What’s next?
FBC

S. electrolyte

Mg.
10. The leg with venous ulcers under crust DVT in the past.

Tx a)Warfarin activity dressings.

Elevation + hydrogel + compression stocking

ortho 17) Superficial femoral artery claudication. What sign you will find?

a) Thigh numbness

b) Ankle jerk, sole plantar???

c) Knee jerk

d) Calf pain of leg

e) Ankle jerk loss

#surgery Most common site of thigh claudication

A. Aortoiliac artery(external or common )

B. Superficial femoral artery

C. Profunda femoris artery

D internal iliac artery

E. Popliteal artery

What is the most common site affected leading to intermittent claudication?

a. Popliteal artery

b. Internal ileac artery

c. Superficial femoral

d. Profunda femoris artery

patient with depression and psychosis, treatment?

a) SSRI

b)Antipsychotic

f) SSRI+ antipsychotic

g) Sedatives.
 h) 7 mnths old child with mother came that he is continually bleeding from mouth since
yesterday after he struck his head in table.you notice old bruises on forhead nd legs cause

i) Hemophilia
j)
k) ITP

l) Vwd

m) Non accidental
n)

surgery Man with dental problem with gingivitis and fever before opening of mouth and no Gerd or
anything what to do next
Dentist referral

Give antibiotic
Give analgesia

Aspirate

X ray to exclude abscess

Thyroglossal cyst in a lady. Swelling moves with protrusion of tongue. Asked for long term
complication...
A no change of left untreated

B change to malignancy

C compression of trachea

Infection>tracheal compression>malignancy

The most common complications of thyroglossal duct cysts are infection with the possibility for abscess
formation, spontaneous rupture, and formation of a secondary sinus tract. A Sistrunk procedure
mistakenly performed for thyroid ectopia that removes thyroid tissue can

cause hypothyroidism. The cysts can compress the trachea and lead to respiratory distress, especially if
they are rapidly expanding (although this is not common). Carcinoma is the most feared complication,
occurring in about 1% of all cases, with papillary carcinoma accounting for 85-92% of malignancies and
follicular carcinoma accounting for the rest. Most patients who develop carcinoma tend to present at a
later age. Cancer in a thyroglossal duct cyst seems to be more common in females than in males. The
diagnosis of carcinoma arising in a thyroglossal duct cyst is typically made postoperatively by
histology.[4,5]#endo

Swelling in the anterior neck:

a) Tongue protrusion
b) Swallow your spit

24) Picture given, maculopapular rash in the hand, foot, genitalia.

Rx?

Topical steroid
Antiviral

Its painkillers and hydration and hygeine

exclusion until blisters dry

surgery Prostate cancer, gleason score 7, T3 N0 M1 ,involving seminal vesicle and and features of
metastasis to the lumbar, bone is seen on MRI that was taken, what is your next treatment?

a.orchidopexy

b.radicalprostectomy

c.external beam radiotherapy

d.Androgen therapy

A patient with prostate ca T3b N0M0. Mx

A.Radical prostactemy

B.orchidectomy

C.Radiation

D. Androgen deprivation

#posted #surgery Prostate cancer with T3N0M1 with metastasis to lumbar vertebrae. Treatment

-androgen deprivation therapy

-radical prostatectomy

-b/l orchidectomy

-external beam radiotherapy

psych
 Olanzapine with weight gain. Want to substitute:

a) Risperidone

Chloram

Zipra > lurasidon> aripraz

Female who has shizophrenia , and was on olanzapine 10 mg , she has very good progression of her
symptoms now complaining of 10 kg increase of her weight , best to do :

Decrease olanzapine

Change olanzapine to Ziprasidone

Increase olanzapine

Add respiredone

Continue olanzapine

psych Patient on olanzapine and clonazepam complains about weight gain of 15kgs, but well
controlled schizophrenia. Patient is happy about the well control.
A. Replace olanzapine with risperidone

B. Sibuteramine

C. Orlistat

D. Cease clonazepam

Olanzapine, clozapine, risperidone causes significant weight gain.. while ziprasidone,

haloperidol, lurasidone cause the least weight gain..

Suspected HIV. Accidentally pricked.

a) Take blood from both patient and doctor

b) Start anti retroviral therapy for doctor

A sudanese boy had sex with his girlfriend. after a few days he found urethral discharge from his
penis. He has other sexual partners. what specimen will help you make a diagnosis of the STI

a.1st catch urine PCR

b. Mid stream urine pcr

c. first stream urine microscopy and culture

d. Urethral swab gram stain and culture

e. mid-stream urine microscopy and culture

Young girl with menorrhagia regular cycle passing clots on 1st 2 days with heavy bleeding what initial
investigation
A. FBC

B. pelvic

USG

C. hysteroscopy

27 years old Known case of Asthma, was on Budesonide, blood test reveals increased Neutrophil,
Increased WBC, cause of neutrophilia----
A. Hereditary

B. Budesonide

C. Bronchitis

Corticosteroids decrease eosinophils and lymphocytes but increase Neutrophil....

git X-ray showing distended bowel I think small bowel obstruction? patient vomiting, abdominal distension
present for 3 days??? (no acute presentation and no pain mention in my exam question) Rectal exam
normal. Patient had AF. Next step?

A. Endoscopy or colonoscopy (forgot)

B. microlax enema

C. ct scan

D. air enema

E. nasogastric tube insertion

If they ask inv then ct scan

psych Husband brought his wife to the doctor complaining that she is not behaving as usual . She
forgets things and has few falls as usual, the woman was mumbling something and her expressions
were flat Husband also said that she would fall asleep suddenly any where . What is the diagnosis?

a)Alzheimer's dementia

b)Lewy body dementia

c)Fronto_temporal dementia
d)Senile dementia

e) schizophrenia

Wife brings Ptx (husband) with worsening Parksonism syx(marked bradykinesia,rigidity,lack of self
empathy and agitation) presenting with auditory and visual hallucinations comes to you for advice.Ptx is
currently on carba and levodopa 75mg with little to no improvement for more than a year nowWhats the
appropriate next step
Donezpil

Quietapine

C.Haloperidol

D.Increase Levodopa

E.Pramipexole

Which of the following help in differentiating Parkinson disease dementia from Lewy body dementia?
postural instability

tremor

cognitive changes

differentiating from LBD FROM PARKINSON DISEASE IS VUSUAL HALLUCINATION

You review a 65-year-old man who is currently taking antipsychotic medication. His carers have

noticed that his movements have been very slow over the past few weeks. Which one of the following
would suggest a diagnosis of Parkinson's disease rather than drug-induced parkinsonism?

A.Rigidity

B.Masked face

C.Bilateral symptom

D. Flexed posture

E Restlessness of arms and legs

D.
The question is asking how you can distinguish Parkinson’s disease from drug induced . I think there is
something missing .. if the question would be how can you diagnose drug induced Parkinsonism from
Parkinson’s disease then it would be c which is bilateral

symmetrical symptoms .
Apart from that other options are all related to idiopathic Parkinson’s disease .

Freezing more in PD

Tremor more in DIP

B/L DIP

U/L PD

Good reaponse to therapy PD

Delayed response DIP

Acute onset >DIP

Slow onset PD

#gynae #obs Pregnant female 18 weeks pregnancy .. presenting with sudden severe headache .. mild
bluuring of vision .. drowsness .. exam revealed normal abdomen .. no uterine tenderness .. HTN don’t
remember the exact number .. you take blood sample for lab
.. what to do next

Abd. US (not pregnancy)

Fundus exam

CT brain (sure not MRI)

Urine culrure and sensitivity

gynae 16 year old female presents with Sickle cell anaemia and heavy menstrual bleeding. What is the
best treatment of choice?
A. Combined Oral Contraceptive Pill (COCP)

B. Inj Depoprovera

C. Mirena

D. IUCD

Implanon

gynae 27 year old female came with history of DVT and migraine headache but not having attack over 1
year had ectopic pregnancy 6 months ago came for contraceptive advice , what to give ?

A-OCP

B-POP

C-Depo 3 monthly

D-Condom

E-Ethenylestradiol+ ( something don’t

surgery man with swelling in the groin area of about 2 cm dilated , blood chemistry with heamturia
came to you with severe pain ! What to do first
Urine culture

Usg

Ct

Surgical exploration

Contrast Ct
49-patient aged 42-43 (xray done), presented with low back pain. What will you do next?

A)PCM+codeine

B)Morphine

C)Spinal X ray
30-40 year old with back/hip pain after waking up in the morning with stiffness. Initially the pain was only
left sided. He started exercising and that relieved the pain. Today, he woke up and is suffering from b/l
pain and morning stiffness. What is your diagnosis?

A)MS

B) AS

3) RA

4) Disc prolapse

B) AS

Pic ( enlarged and bluish fallopian tube ) female h/o of appendectomy 10 or 5 years ago , want to
conceive all investigations are normal What is the reason ?
A- adhesion

B- hydrosalpinx
surgery A female underwent chemotherapy via subclavian vein catheter, after 2 days or something
c/o facial swelling, asking investigation
CT neck

Subclavian venography

Postpartum Mother saying cannot look after the baby anymore treating not sleeping etc

Moved to rural recently Husband says he is very anxious n helpless n seek ur help Most related answers
were

Involuntary admission to hospital of Wife

Do a home visit

Do a home visit

What would be the indication for ERCP in a women with h/o cholecystitus to be taken up for
laparoscopic cholecystectomy?
A.dilated bile duct >7mm

B.small gallstones

C.thickened gall bladder

If obstructive j, choose
28yrs old lady had 2 times lost pregnant at 26 and 28 wks pregnancy with fetal death in utero. Asking
cause?
A.Intrauterine infection

B.chromosomal abnormality.

C.PE

. D.cervical incompetence

E.maternal lupus antibiotics

26 yes old presenting with pain at LIF, fever, vomiting, menstruation 3 wks back regular. No dysuira,
abd-guarding, but no rebound tenderness, T-37.6'C, BP-110/70mmHg, PR-80/min.beta HCG-neg,
Irina lush so normal. What is cause?
A.acute pyelonephritis.

B.ovarian toursion.

C.Epiploic appenandgitis

D infracted fibroid

45 yes old man, 2 yrs H/O dysphagia, a few days worsening difficulty of swelling liquid and solid.
Endoscopic done inflammatory changes and is given 3 wks esomeprazole 20mg BD. What is most
appropriate management?
A.increase dose of esomeprazole
B change to pantoprazole

. C.oral methyl perennial lone

Fluticasone

A young patient with asthma history complains of intermittent dysphagia on esomeprazole

40mg for a few months, now asking management?
a. Change to pantoprazole

b. Increase dose of esomeprazole

c. Fluticasone
22yrs old man, 6wks nail infection at Lt big toe, already antibiotics. given picture. Asking appropriate
management?
A.antibiotics for 1wks
. B.antifungal

. C.radical excision at nail bed

. D.wide edge incision at nail bed.

Indication of embolectmy except?

A.loss of sensation at lower limb

B.decrease temperature.

C.erythema

Flexion of shoulder only possible till 90degrees, abduction till 70degreee and external rotation 0
degree. What is the cause?
A) rotator cuff tear

B)adhesive capsulitis

C)acromial injury

D)tumor.

Ans B

- 60-year- old, Cholecystitis post op Lap – developed swelling in the umbilicus and pain after 4 days of
surgery. What is the cause ?

a) Nosocomial

b)Anerobic Gut

c)From the urinary tract

d)From the iv line

e)from umbilicus

paeds 14 month baby who has history of roll over on 4 month, sitting without support from 8 month ,
claps hand, plays peak a boo, now has started walking without support, moves things from one hand to
other , babbling but no words...
normal development

Gross motor delay

Fine motor delay

Social delay

Speech delay

psych Parents coming to u complaining that their 8 years old child performs everything slowly difficult to
be awaken and prepared to school in the morning . They have to repeat each order several times and
sometimes they wonder if he can understand. Grades of reading are at 2 SD less . He avoids eye contact
and seems not interested in having new friends no language delay mentioned

Autism

Aspergers

ADHD

Specific language delay

Receptive and expressive language delay

Boy with no language delay. Parents says that sometimes he act like he can’t understand what other
says. He often make jokes which he dnt realise ppl get hurt. Dx
autism

Asperger

ADHD

Pt has bilateral knee osteoarthritis...now comes with pain in lateral side of one thigh. Inv?

Xray hip

Xray lumbosacral spine

Xray thoracic spine

Bone scan

Middle aged woman with pain in right thigh worse at night n morning. But gets better after 10 mins of
walk. Hx of bilateral knee OA. Next Investigation?
a. X ray right hip

b. Bone scan

c. X ray lumbosacral spine

D. MRI

Doppler Usg

6x4 cm anorectal swelling (ischiorectal region) with pelvic dysplasia can’t walk. What to do?

Aspirate
Antibiotic of different type.

Incision & drainage then wound packing ( anorectal,perianal abscess, ischirectal ,perirectal )

Treatment of Vaginal Watery Discharge in a girl of 20 years who recently had Sexual Intercourse. No
pain during sex. No other STI previously.

a. Azithromycin

b. Doxycycline

c. Metronidazole

d. Azithromycin & Doxyciline+ Metronidazole for 5 days.

gynae 32 year old woman has increasing white vaginal discharge. She is 7 weeks pregnant.

Her Chlamydia swab is positive. All other tests are normal. What is the single most

appropriate treatment?

Amoxicillin

Clindamycin

Doxicycline

Erythromycin

Metronidazole

Photophobia, mucopurulent discharge, On Fluroscent examination shows corneal infiltrate….

Chloramphenicol

Specialist referral

#gynae 5) Female with moderate rectocele but no cystocele. Urinary problem. Next??

a) Urine C/S

b) USG

CT Ureteric stone at upper part of calix of renal pelvis.size 2cm.no features of

hydronephrosis.most appropriate treatment?
ESWL

PCNL
18 WEEKS PREGNANT Patient with flank pain that radiates into the groin. Abd CT found 2cm stone
in upper pole of the kidney. What to do?
A. extracorporeal shock wave lithotripsy

B. Wait to pass it by himself

C. Alfa blockator and wait(tamsulosin&alfuzosin can also be used )

D. Shock wave lithotripsy

E. psnl

Renal stones in pregnancy mostly Mx is conserVative like increased hydration and analgesia and alpha
blockers
If very bothersome then surgery can be last resort

PCLN ESWL THIAZIDES ALLOPURINOL ALL ARE C/I IN PREGNANCY

renal Patient-severe lower groin pain, haematuria, usg urinary tract shows no problem. Dx?

nephrocalculi

2)pyelonephritis

appendix 4)GB

old man with nocturia and long hx of dribbling urine problems for 12 months with median sulcus
palpable with enlarged smooth prostate what next appropriate?

A. Urine cytology

3. PSA

4. Bladder scan

5. CT scan abdomen

6. serum creatinine

prostate Man with nocturia n urinary frequency n dribbling. mass above the pubic symphysis DRE
showed enlarged prostate with palpable median sulcus palpable.what is the most appropriate next step?
a)Urine cytology

PSA

Serum creatinine
CT

urine cytology

but if urine analysis and culture in option we can choose that

60-64yrz man with dec. Urine frequency,prostate enlarged

Next inv.

A.PSa

B.urine culture

C.cystourethrogram

D.bladder scan

If increase frequency we can suspect infection then ll do urine analysis and culture Here dec

frequency suspecting obstruction

Pregnant 10 wks, takes alcohol,ecstasy, cocain,Smoking. What is most danger for her?

1.Alcohol

2.Ecstasy

3.Cocain

4.Smoking

Opiates CI in pregnancy except meperidine

paeds A 2-day old newborn is found to be irritable, crying all the time and sleeping very less. On
examination he has
increased muscle tone, hyperactive deep tendon reflexes and exaggerated Moro reflex. Mother
has been taking
methadone daily until day of delivery. There is on electrolyte abnormality reported on routine
investigations.
What is your next course of action?

a. Give naloxone

b. Give morphine

c. Start 5 percent dextrose infusion

d. Give oral paracetamol

e. Admit in intensive care unit for ten days

Pregnant pt, last trimester. Which will cause more harm ?

A. Diazepam

B. Fluxetiene

C. Amphetamine

D. Marijuana

E morphine

poisoning Wierd twisted PCM scenario : 21 yr old male, Stable , Height:170 cm Wt: 60 Kg, took 14 or
16(not sure) PCM tablets of 500 mg, present at your place after 10 hours .. what is your most appropriate
next step ?
a) PCM level

b) N-Acetyl Cystine

c) Charcoal

d) Reassure

drug Fluoxetine interaction with warfarin

1) Hyperkalaemia

2) New drug commence

3) Drug interaction

drug Patient on fluxetin for depression and nifedipin we for htn.one month ago Fluoxetine was decrease.
Now palpitation and sinus tachycardia. Bp 135/ 75.

Drug interactions

Niphidipine

Fluxetin toxicity
Neuroleptic malignant syndrome

patient on fluxetine for depression and nifedipine for htn. one month ago fluxetine dose was increased,
now pilpitations, and sinus tachycardia, bp 135/75 cause:
a- drug interaction

b- nifidepine

c- fluxetine toxicity
young female came for OCP, has typical history of migraine (migrane with aura)!

A) POP!

give contraception after detailed medical examination!

C) barrier contraceptive!

Which ONE of the following is first line contraceptive choice for women with epilepsy using enzyme-
inducing anti-epileptic drugs?
a. Combined oral contraceptive pills with low dose estrogen

Levonorgestrel-releasing intrauterine contraceptive device

Barrier methods

Progestin only pills

Combined oral contraceptive pills with high dose estrogen

epilepsy, DMPA and IUD are the choices. OCP is not recommended. But if pts wants OCP, then you
can prescribe with higher oestrogen.
A man who has had a bilateral orchidopexy presents to your clinic. He is asymptomatic and has no
family history of testicular cancer. He is worried about developing testicular cancer. What is the FIRST
step:
A. No intervention required

B. Ultrasound

C. Biopsy inguinal approach

D. Biopsy scrotal approach

E. Tumour markers

pregnant 18 week hepatitis c antibodies positive next

a.terminate

b.pcr
c.repeat

It is recommended that individuals who are HCV positive have a PCR test for HCV RNA and liver
function tests, as the risk of perinatal transmission is dependent on the presence of HCV RNA. The
PCR detects the presence or absence of the virus in the blood, the viral load in the blood and the
genotype. Liver function tests should be performed at the time of checking HCV RNA status. As HIV co
- infection increases the risk of transmission, HIV status should be ascertained if not already performed.

Indian couple come to doctor with 3 months old baby who has hx of 1 month cough What organism

caused this ?

a)Micoplasm pneumonia.

B ) M. Tuberculo

Septic Child pale, drink cows milk a lot .otherwise normal but blood Hb - 6.5 MCV decreased. What's
management?
a. Rbc transfusion

b. I.V. iron

c. I.M Ferrous
Pregnant 37-38wks , signs of jaundice, no fever, tenderness in RUO, slight redness, BP ,pulse
everything normal.

Biliary colic

Cholecystitis

Cholangitis

Gastroenteritis

A pregnant lady with multiple gallstones came to a GP. He advised her cholecystectomy after delivery.
Why?
a. risk of Ca gallbladder

b. increased risk of CHOLESTATIC jaundice in next pregnancy c.

increased risk of Ca pancreas

d. increased risk for primary biliary cirrhosis

. a 4 years old child with intermittent pain in the abdomen with vomiting which been for 12 months on
examination it s all normal what will lead u to diagnosis
a-erect and supine xray

b-barium enema

c-us during the attack

d-gadtrographin and follow through

Baby 18months Hb 6, WBC moderately dec,. nothing else given. What to give?

1) Oral Fe

2) IV iron

3) IM iron

4) Folic acid

5) Vit B12

6) Transfusion of RBC

A woman delivered a preterm baby in her 2 nd pregnancy with 3100gm weight. Apgar at 1 st min is 6 and
at 5 th min is 9. Over the next few hours he develops grunting and
Tachypnea and subcoastal recession. He was started on o2 at 4 hours of age. What is the most
likely
cause?

Birth asphyxia

Meconium aspiration

Tension pneumothorax

Transient tachypnea of newborn

Hyaline membrane disease

Rds preterm

TTN term
Meconium aspiration post term

7yrs diabetic man blood glucose increased, BMI-32, hba1c 11 he already on metformin.
Gliclazide,
anti HTN, and statin. What to give now?

1) Increase metformin dose

2) Commence rosiglitazone

3) Insulin

4) Surgery to decrease BMI

alcoholic patient with reduced visual acuity and MMSE is 28. What is the basis to assess this
patient further?
A)reflexes reduced
presence of tremor

visual acuity
an old lady presented to you with early diastolic murmur at apex, mid systolic murmur at right
parasternal side and diastolic murmur at left sternum. What is the lesion?

A)MR
B)AR
C)MS
D)TR

cardio An old lady presents with exertional dyspnea.On chest auscultation you have found
mid-systolic murmur along with diastolic murmur.What is the prominent lesion of her heart?

A.AS

B. MS

C. TR

CHF

E.AR
Old man presents with confusion (no ascites), asterixis-

Uraemic

encephalopathy,

Patient present with decompensated liver failure with decreased serum albumin,
ascites. Flapping tremor What is the most appropriate next step?
A-IV albumin
B-spironolactone and frusemide
C-fluid and sodium restriction
D-Lactulose

Decompensated liver failure+Encephalopathy----> Lactulose

Ascites, low albumin----> salt & fluid restriction
tense Ascites, abd pain, fever---> paracentesis Without

fever, mild ascites, cirrhosis feature---> paracentesis

ascites no fever and no abd symptoms lfts

#ortho ques of hand pain, weakness and tingling of index and middle finger. what
other symtoms to diagnose? a. hypo thenar weakness
b. flexor of finger weakness
c.palmar fascia thickening
d. Epl tendon

surgery Old lady with painful swelling infront of tragus with redness. Cause?
63) Duct stenosis
64) Duct stone
65) Coxakie virus
66) Poor oral hygiene
67) Parotid duct Ca

cause poor oral hygiene dx

duct stone

Adult female taking carbamazepine.came for ocp prescription.wat to do.provided

symptomatocaly stable.
A.increase carba and give low dose ocp
B.decrease carba and give high dose ocp
C.cease carba and give ocp.
D.continue same dose carba and add ocp

Patient has attempted IVF since the last 2 months, the results of her BHCG are not in as yet,
she is on ACEI for HTN. what will be your next action?
A)Chnahe ACEI to methyldopa now
B)Increase ACEI level in pregnancy
C)continue ACEI till pregnancy
D)Add another drug to ACEI once pregnant
# A young medical student, who has started his clinical postings, comes to because his
colleagues noticed a yellowish, tinge to his sclera. On examination he is normal except for the
yellow sclera. Investigations showed: Total bilirubin—Elevated Direct bilirubin – Elevated Direct
bilirubin > (Total – Direct bilirubin) Which of the following is most likely?

a) Gilbert’s syndrome
b) Haemolytic jaundice
c) Ca Pancreas
d) Hepatitis
e) Carotenemia
with indirect its gilbert
with direct hepatitis

gynae Lady presenting with chest pain.O/E her face shows bruises

and lips have cuts. Which system examination reveals diagnosis

a. CVS
b. Endocrine
c. Musculoskeletal
d. Peripheral nerve
After knee replacement PE, shouting at everyone and compliment
physiotherapist divorce:
a) Delusion
b) Delirium

c)bpd4

External rotation >> adhesive capsulitis Internal

rotation >>rotator cuff and acromia

A 60-year old man presented with history of vomiting for 3 days. Vomit is clear in colour with
identifiable food colour.
A few years ago he was treated with ranitidine.
Over the last 6 months he has been having intermittent epigastric pain, for which he has
been taking aspirin.
He also last 5 kg weight in recent few months.
What is the most likely diagnosis?
a. Chronic duodenal ulcer disease
b.
c. b. Pancreatic cancer
d.
e. c. Cancer of the stomach
f.
g. d. Urinary tract infection
h.
i. e. Drug-induced gastritis
j.

e) post op has alrwXy been given heparin for 10 days. What will you give now?

A)Warfarin for 6 mknths

warfarin for 6 weeks
C)heparin for 6 months
D)heparin for 6 weeks
f) At first if patient is on Warfarin ,stop it 2-3 days prior to srgery> Start
Heparin....leave it for 10 days even after surgery> THen again Start Warfarin ....>
Leave it for around 6 months .....Thats it.

A man who is a smoker, 15 cigarettes per day for last 10 years, complaining of epigastric pain
which is colicky in nature, now presenting with an acute abdominal pain. On examination
succession splash is positive. Most likely diagnosis???
a) Gastric CA

b) peptic ulcer

M. esophageal perforation

duodenal perforations
25 year old lady previously on sertraline controlled on medicines, she stopped 5 weeks
gestation
N.
when came to know that she is pregnant. Now came with mood problems on 20
weeks. She is
O.
P. asking if she needs to start sertraline or if there is any other medicine available
Q.
R. A. recommence sertraline
S.
T. B. Start olanzapine
U.
C. Explain benefits and side effects of sertraline and olanzapine
V. D. No medicine
W.
X. E. Refer for psychoth
A 36yr old woman comes to the emergency dept. because of severe headache that

woke her from sleep 6 hours ago, and was not relieved by aspirin or acetaminophen.

She also noticed that she has neck stiffness and

that it hurts during neck extension and flexion. She was recently diagnosed of
Hodgkin's disease. Her temp is 39, BP is 130/80mmhg, Pulse 75, respirations is
17/m. Physical exam shows nuchal rigidity,

fundoscopy exam shows bilateral optic disc swelling.

She appears lethargic has eye tenderness with

movement, mild photosensitivity. After obtaining blood

cultures, next step?

A. Order CT scan

B. IV ceftriaxone
C. MRI angiogram of head
D. MRI of the head
E. Perform lumbar puncture

92 year old woman admitted to hospital,, said if got cardiac arrest do not resuccitate

a) discuss her decision with her family

b) assess her mental statuts
c ) write do not recussitate on her bed

Ans- safe sex with condoms (best – not to share razor, blazor)
Ans- safe sex with condoms (best – not to share

razor, blazor)
MANAGEMENT

Initial resuscitation — Initial management of the patient with a TCA overdose centers around securing the
patient's airway, breathing, and circulation. TCA poisoned patients are frequently moribund and require
intubation for airway protection and ventilation. Supplemental oxygen should be administered as needed.
A summary table to facilitate the emergent management of TCA overdose is provided ( table 1 )

Additional therapy consists primarily of the following:

Isotonic saline to address hypotension.Sodium bicarbonate to address other cardiovascular

toxicities.Alpha adrenergic vasopressors (such as norepinephrine or neosynephrine) to address
hypotension refractory to aggressive fluid resuscitation and bicarbonate infusion.

Although TCAs possess some anticholinergic properties, cardiac toxicity is most prominent. Physostigmine may
worsen cardiac function and is associated with cardiac arrest in the setting of TCA overdose; physostigmine
should not be given if a TCA ingestion is known or suspected [ 29 ]. The role of physostigmine in
anticholinergic overdose is discussed separately. (See "Anticholinergic poisoning" .)

Sodium bicarbonate — Treatment with hypertonic sodium bicarbonate is warranted in patients with TCA
poisoning who develop widening of the QRS interval >100 msec or a ventricular arrhythmia. Most patients
with TCA-induced QRS interval prolongation respond to bicarbonate therapy

Ans C

ANS C

HEPERTENSIVE HEART DISEASE AND CORONARY HEART DISEASE MOST COMMON CAUSE
OBSERVE

A lady came to the ED with whitish discharge. She had some symptoms of candidiasis which was confirmed by
labs. How will you treat this woman?

Oral Nystatin

Oral Fluconazole

HRT

Topical estrogen
Oral Clotrimazole
Female with recurrent candidiasis 4 times in last 6 months. Clotrimazole vaginal cream helped controlling
the symptoms last 3 times. …white palque… What is the most appropriate next step?

a. Oral Nystatin

b. vaginal nystatin

c. fluconazole

Answer c

26 yrs pregnant lady with genital ulcers with pain. Confined with HSV type2. What is the most appropriate
management?

A. Oral amoxicillin

B.oral gemcyclovir.

C.oral metronidazole

#Respiratory a man returns from sudan with 1-month history of shortness of breath and unproductive cough.
Chest –ray was given which showed rt sided lung fibrosis with trachea deviated to the rt side. what is the next
appropriate management?

a. amoxicillin

b. isoniazid

c. doxycycline

d. isoniazid, rifampicin ethambutol and pyrazinamide

e. admission in isolation
Patient brought by wife.wife complains that she is tired of his habit of collecting rubbish.he denies
any problem by saying I have lots of property and bank balance and 3 residence..wife says bitterly
that they r all filled with rubbish.what is the most appropriate pharmacological approach?

a. Venlafaxine
b. .b.cbt

Answer A.
But SSRI better choice

Pregnant 28 week gestation, with sudden gush of fluid - straw color - What is the immediate step to be done ?
 A- Speculum
B- B- Cortisone

Speculum

2-pediculosis on hair of child in school ( tx )

Permethrin
- CT pic ( RIGHT Upper quadrant abdominal pain for 3 hours then subsided) with left renal distortion
What is the diagnosis

A- Hydate cysts

B- Gall bladder stones (My Answer)

C- Ca pancrease

D- Renal cell carcinoma

Gall stone

pt accidentally discovered 1cm stone in kidney , calcium in urine HIGH , urate in blood High What is the ttt ?

1- allopurinol 2- ESWL

ESWL

Answer 2. ESWL
ANS A
diabetic female on Ramipril 5mg , Bp: 150/80 , sligh increase in cholesterol, what decreases risk of stroke as her
brother had stroke ?

A- increase ramipril

B- statin

Increase ramipril

12- layer female had miscarriage, weight loss, loss of interest with husband, bad sleep, she is unwilling for
medications to avoid addiction in question mentioned moderate to sever depression .. what is most suitable?

A- SSRI

B- CBT

C- Psychotherapy

CBT

11. The woman is planned for a hernia operation however suddenly one week before the op develops DVT and was
prescribed warfarin. What to do?, postpone the op.
 If elective reassess the need for surgery. If decided for surgery stop warferrin 4 days before surgery and
give heparin since she has DVT.

If emergency give FFP and then do surgery

Male with features of cld has moderate asities and edema on both side upto knees wht is intial appropriate
management

1. Salt nd fluid restrictions(ox 260)

2. Spironolactone ndfrusemide

3. Lactulose

. 32yr old female with diagnosis of Multiple sclerosis pt with optic neuritis symptoms. Whats the risk of
rcurrrence of neurological symptoms in next 10 years

A. 10%

B. 30%

C. 50%

D. 70%

E. 90%

Answer D
3. Pt came in emergency with dysnpea and ascites you started furosemide and prednisolone. Now he
complaint of vomiting and abdominal pain.
4. Acute pancreatitis
SBP

Pt complain of history or rash all over his body when u were about to start the amoxycillin for some infection.
What things is important for you to know in the history to decide a allergy to drug

A. Timing of rash

B. Size of rash covered

C. Associated symptoms of itching etc

Pt involuntarly admited in emergency for alcohol and drug overdose. Later Gets agitated and threat to complaint
to medical head against his admission. In history His wife recently left saying due to emotiinal abuse. He is a
successful enterpreneur blah blah..dx?

A. Bipolar disorder

B. Borderline personality

C. Paranoid

Narcissist personality

10. 25 yr old male with vt ecg bp 80/60mmhg next thing to do

11. A. Amiodrone

B. Adenosine

Carotid

massage

D. Dc

cardiovers

ion

1. Analgesics (1st line)

2. Antiviral oral (within 72 hours of onset of vesicle)

couple comes to the GP clinic for infertility treatment. All investigations of wife was normal. Husband is on
medications for arthralgia. What will be your advice?

a. continue methotrexate and hydrochloroquinone(HCQ)

b. cease methotrexate and continue HCQ.

c. cease both drugs

d. continue methotrexate and stop HCQ

There was a new drug cant remember

-pancreatitis patient what to do immediately. Chose pain relief

21. after colonoctomy operation the patient was on 2 L NS input with 700 ml from the driange (sure) and 500
ml urine (sure) and 2 L output , long labs given with only hypokalemia what to give

A - 1 NS Litre + 2 L dexterose 5% + 10 mmol K+

B - 2 NS litre + 1 L dexterose 5% + 10 mmol K+

C - 2 NS Litre + 2 Litre Dexterose 5% + 50 mmol K+

D - 3 NS Litre + 2 Litre Dexterose 5% + 50 mmol k+

E- 3 NS litre + 3 Litre dexterose 5% + 50 mmol

 Consider gonococcal conjunctivitis if severe purulent discharge with conjunctival and lid
oedema. Perform an urgent gram stain and contact ophthalmology þ may need septic
work up and systemic Ceftriaxone 50 mg/kg/dose (2g) iv 12H.
 Gonococcal- 1 weekiv ceftriaxone (speticemia)
 Chlamydia – 2 weeks orally azithroimycin

Patient on olanzapine and clonazepam complains about weight gain of 15kgs, but well controlled
schizophrenia. Patient is happy about the well control.

A. Replace olanzapine with risperidone

B. Sibuteramine

C. Orlistat

D. Cease clonazepam

E refer dietitian

woman came with central abdominal pain radiating to back, lower abdomen tenderness present.
Liver function tests
are normal. Serum amylase, Lipase normal. Asking diagnosis?
a. Pancreatitis
b. cholangitis
C.aortic Aneurysm
D. mesenteric ischemia

35 years old woman came after delivery of a child. Breastfeeding. Want to conceive after 1 year.
Which contraceptive is best for her?
a. POP both options safe
b. IUD

Gp want to research STD in an area

A. inform the pt

B. protocol follow

35 yrsfemale,visual problem from last 1 year,left eye 6/12 & right eye ??pale optic disc,no
cupping,afferent pupillary reflex absent,DX?

a. DM

b.glaucoma

no optic neuritis/MS in options

A patient on Amisulpride(some antipsychotic) 800mg well controlled now after developing

psychotic and hypomanic feature 2 years ago. (some other thing just forgot). Which one of
following suggests poor prognosis of this patient?
A. Past self harm
B. High dose of Antipsycotics
C. lost job in 06 months

….fetal heart rate was plotted on partograph ,,it was 120 b/min then dropped to 70 b/min.per
vaginal bleeding was nill, ARM was done,syntocinon was given what was the cause of this
condition:
a)placenta previa
b)vasa previa
c)amniotic fluid embolism
d)umbilical cord prolapse

Pregnant lady with full term baby at delivery, what CTG expected to show if with cord prolapse
presentation?
A. early decelerations
B. late decelerations
C. variable deceleration
Ans.c
Woman with 2 episodes of ecclampsia and CTG shows bradycardia of 90 bpm. Wha will cause
the bradycardia
a) Maternal hypoxia
b) cord prolapse
c) uterine contractions on the head

Man came after chlamydial arthritis......got sulphasalazine....and now is having high fever,
painful mouth ulcer,on exam swollen gum and ulcer on gum and buccaneers mucosa found...

Lab showing neutropenia cause asked

1.sulphasalazine toxicity

2.Herpetic stomatitis

AnsA
34 years female...mother got breast cancer at 60 years...now anxious...advice

1.reassure

2.recomnend self breast examination

3. Look and feel for her breast

Ans.c

Picture of Dupuytrens contracture and normal blood glucose next step

1. Physiotherapy

2. Remove flexor retina column

3. Steroid injection in tendon

A scenario of patient that was recently discharged from hospital from CCU for fainting attacks and they
added to him Amiodarone. He’s DM, HTN, IHD, Af on many medications ACEi, Glebenclamide, Nitrates,
Warfarin.

Then he developed acute painful thigh swelling, what to check for him?

A. INR

B. US

C. MRI

D. LAB Investigation
A Kid presented by a flu like symptoms (Fatigue, Fever, Lack of appetite, Sore throat), enlarged cervical
LNs and pharyngeal ulcers, so what’s the causative organism?

A. Infectious mononucleosis

B. EBV

C. Adenovirus

Influenza virus

A scenario of Lithium toxicity, the patient came with disturbed level of conscious, the level was given
(Cannot recall) what’s the treatment?

A. Dialysis

B. Activated charcoal

a junior doctor in foreign country did crime history..choices are

A inform immigration of the country

B infrom Australia practioners regulations

C inform his medical defence agency

D inform hospital medical board

E take document for future

man living with his father alone at home . has a complain of seeing ghost of his father in his bedroom
every night, when he move his hand or do something then ghost disappears and does nothing with him.
his father died 6 months ago. What is the imp reason to reach diagnosis?

a. delusion

b. He takes 760ml alcohol daily night

c. He had strong relation with his father

young man whose father died 6 months ago. He’s seeing the ghost of his father at home which appears
and disappears without talking to him. He presents to you asking for advice. Most appropriate
management asked.

- give him leaflet about process of natural grief

- reassure him that this is normal process of grief

- diazepam
- ssri

19 yrs old school girl say`I feel like I m going to the whole bottle of paracetmol,everythings seems
nonsense to me`…she say she has been felt like this after her favourite physic teachers resign.also has
history of sex abuse by his elder brother.what to give

A respiredone

B haloperidol

C quetiapine

D velanfexine

E clozapine

a lady taking multiple drugs like for UTI and also another one infection….drugs r
gentamicin,amoxicillin,aminoglycosiderenal function is normal and she is well and all lab investigation is
normal except for K+ is 6.3 .what the cause

A delayed serum separation(sure for this)

B amoxicillin

C gentamicin

Daminoglycoside

the old man in nursing care is annoying his roommate and seeing soldiers.what help the dx?

A PTSD history

B previous visual impairment

C previous cognitive condition

D list of medication

9.old woman with 3 months ago had angioplasty of femoral artery and she had long standing history of
goiter .now she complaint of 5kg wt loss with normal appetite and increased tiredaness

Lab inx 3 months ago was including tsh glucose LFT TG cholesterol (all r non fasting blood chemistry).All
normal except TSH is low (like 0.01 or 0.1)...glucose was 7.2

So what investigation now is most appropriate for next dx for presenting condition?

A tsh

B OGTT

C LFT
d. t3 t4

12 week pregnant lady is coming for goiter …besides tsh what next important inx?

A t3

B t4

C thyroid peroxidase antibody

D FNAC

54 lady came for pap smear and all are fine ..but has slight heavy period…what next important? Already
given iron therapy.whats next ??

A iron studies

B monogram

C colonoscopy

D usg

E CT

22 yr old lady coming for breast cancer..usg done all normal…no family history… no mass…breast r all
fine.what next?

A reassure and no follow up

B rs and 6 month fu

C rs and 12 month fu

D mammogram

E self breast examination

16a man with BMI 36 and BP around 140 /90 and TG LDL cholesterol all raised ,liver function all normal
except ALT(not sure ALT or AST but sure is not lipase )200….what is the dx.

A pancreatic insufficiency

B chronic liver disease

C metabolic syndrome jm 192

D cushing

E hypothyroid

. 17 yr old girls complaints of dypareunia 3 months age after she started sexual activity.had history of
painful menstruation since 11yr.on ve there is mass extending from just above hymen remnant upto
cervix os on the right side.she didn’t use any contraception method.no fever.what dx?

A bartholin abscess(posterior nd midline)

B woffrian duct cyst(lateral wall)

C right side ectopic pregnancy

D acute pelvic infection

30 yr old lady with well controlled on sertraline 50 mg.but complaint of abd pain ..what is the next
mangnagemetn

A stop the drug immediately

B change the drug immediately

C taper to 25 mg and then four day free…then start another one

D taper to 25 mg together with low dose of another drug and then stop setralin in four days with
continue of another drugs (yes exactly loing like this)

Two groups are being studied for risk reduction for some disease with aspirin use. Tables are given as
follows. Aspirin used aspirin not used Got dis Used aspirin Not used aspirin

Got disease 10 20

Disease free 990 980

ease 10 20 Disease free 990 980 Calculate NNT for this?

a. 10

b. 100

c. 1000

A 32 yo, G1P0 has presented to you in labor. She has had a uneventful antenatal history. And she has no
underlying medical illnesses. Her cervix is 4cm. Her contractions are constant at 5 mins apart. You found
meconium stained liqor. CTG given of late deceleration.

What is the next best step?

a) Send for EM C-Section

b) Fetal blood pH

c) Continuous CTG monitoring

d) Check on her in a few hours

Young boy is brought to the rural hospital ER after trauma to the head. He was in a motor vehicle
accident. After that he developed extreme unconsciousness with GCS of 6/15. You have intubated the
patient. The Neurosurgery unit is 3 hours from the rural ER. What is the next appropriate plan for this
patient?

a. Transfer to neurosurgery unit

b. Do a ct scan

c. Burr hole

d. Craniectomy

. One new question of thyroid with proptosis and diplopia from 24 hrs Old hyperthyroid pt but dint take
rx

Carbimazole

Iodine

Prednisoline

4th option was irrelevant

Pregnant woman at 34 weeks gestation presented at 32 weeks for antenatal care where her first USG
was done. Everything was normal. She has returned today with complaint that someone had told her
she looks small. What will you do to confirm with her that her progress is normal?

a) Repeat abdominal USG

b) symphysio-fundal height of 34cm at 35 weeks

c) examine her on next visit

d) If fundal height has been shown continuous linear growth, not to worry
young woman, had menorrhagia and dysmenorrhea, D&C done, amenorrhea for 6 mth, wat what is
the most appropriate Investigation?
1) Hysteroscopy
2) Laparoscopy
3) Ultrasound

Laproscopy pic of woman with PID given. She has done tubal insufflation test also.wat is the most likely
associated findngs?((( most associated findings thy asked)))

-dyspareunia

-infertility

-pain

-discharge

A pt on sodium valporate and quietapine, now changes his doctor. What will you check before
commencing treatment?
a.valproate blood level

b. quetiapine blood level

c.ecg

CA breast with metastasis to thigh, management of pain??

1- NSAID- 1st line then opioids then radiation …jm pg85

2- S C morphine

3- tamoxifen

4- radiation

Initially nsaid > opiod

Best radiation

Case of one week tiredness and last day developed diarrhea, patient is on pendopril and furosemide
serum Na+ decreased, K + normal, others are normal what is cause:

a.SIADH

b.Furosmide

c.diarrhea

A.indapamide

yr old lady recently divorced from second marriage. She had problems with first husband who left
her after 4 year of marriage. She occationally go to gambling,(some other bad things). She feels better
when she is at home with her mother and currently she is living with her mother.

A.Antisocial Personality Disorder

B.Borderline Personality Disorder

C.Bipolar Personality Disorder

D.Dependent Personality Disorder

70+ year old man on Ramipril 5mg for hypertension. On Examination Bp- 150/?, pulse – normal
Cholesterol 6.?(normal range given around 2). Rest investigation with in normal limit. Which one will
reduce his risk of stroke?

A. Low dose
B. Aspirin
B. Clopid
C. Increase Ramipril

D. Atova
E.warfarin
child with history of asthma and he was aknown case of nut allergy, both parents are smoker, develop
wheeze , hoarseness of voice and other chest symptoms relieved by salbutamol. What is the most likely
preventive measure for such subsequent episode?
A-avoid all type of nuts in foods
B-prevent exposure to passive smoking from parents
C-remove all carpets from house
D-remove cats and dogs

Psoriasis pic on the buttock of a man for 6 weeks. What is the most appropriate plan?
a. apply coal tar
b. Emollient creams
c. Topical triamconolone
d. Ketoconazole

Picture showing red patches of rashes in legs psoriasis??? Treatment

a) prednisolone(topical fine) (didn’t remember it was given oral prednisolone or just prednisolone)

b) calcipotriol cream

c) antifungal

Psoriasis rash on whole legs since 6 mons trtmnt

Uv therapy

Calcipotriol

Predsinolone

A 3yr old with complain of anorexia and diarrhoea for the past 2days and fever. On examination Temp
39, tenderness and guarding in Left iliac fossa. What is diagnosis

Mesenteric adenitis-jm 341

Appendicitis

Giardiasis

Amoebic dysentery

Student misses exam and comes to you for medical certificate as he claims he was ill that day but looks
normal today on examination, what will you do?
a. Decline as you cannot confirm the dx

b. Decline as she couldn’t come on exam day

c. Accept and give medical certificate

d. Give Certificate and mention that she claims she was ill that day

Case of TIA(weakness for one hour) previous angiography for coronary aretery and 50% bilateral carotid
stenosis, o/e normal sinus rhythm, what to do next:

a.clopidogril

b.carotid endarctomy

c.warfarin

Old recalls of CSF analysis and raised monocytes and RBCs with neck stiffness and vomiting what to do
to him until u make dx:

a.aciclovir

b.analgesics and follow up

c.antibiotics

. 14 hrs ago male was addmited after vomiting and severe abdominal pain following binge drinking ..
now aggtited .security staff are trying to control him . next

a) iv diazepam

b) im haloperidol

c) im midazolam

Young lady in 26wks of pregnancy came with PROM, cervix closed and baby is okay. There is no
contractions. There wer a hospital at 50km and other tertiary hospital at 150km. After giving antibiotic
and glucocorticoids, what should you do next ??

a) send her home

b) send her to primary hospital 50km away

c) send her to tertiary hospital 150km away

d) give tocolytic

A 34 years old primigravida in the 3rd trimester came to u in ur clinic with headache and high BP
150/100mmhg dipstick shows protein+++, during consultation she developed a tonic colonic seizure and
collapsed with loss of consciousness, next step immediately?
A) give iv mgso4 (2nd line)

B) intubate and ventilate

C) immediate cs with delivery of the baby

15 years old girl presented with amenorrhea, she told you that she is same tall of her peers in the class
and same body but they menstruate, what you will ask her to help you in diagnosis

a. When she got breast bud

b. When she got pubic hair

c. Does she has cycle pain

d. Does she has accelerated growth

pt with history of travel just returned from thailand, now shortness of breath, left chest pain, temp
normal, and pain increases with cough and inspiration…almost similar above question but here no
history of fever.what is possible diagnosis?

a- peumonia

b- pulmonary embolism

c- acute pericarditis

d- myocardial infarctio

. patient after thyroidectomy perioral tingling sensation and irritability asking about cause ?

Ca: low normal K: low normal 3.5 Hco3=35 (increased) what is the most likely cause?

A. tetany

b. hypokalaemia

c. Anxiety

D Hypocalcaemia

Female 40 years u prescriped her codeine for her back pain, and now tell u that she started Heroin as it
helped more to decrease her pain

A) Measure urine drug level bfore future prescription of Codeine

B) Don’t give her codeine

C) Refer her to drug and alcohol rehabilitation

Post partum hemorrhage of 500 ml, stable vital signs, uterus well palpalble but bend to the Left

A) Uterus inversion

B) Uterine Rupture ( if vitals unstable)

C) broad ligament hematoma

. Colles fracture photo, how u do the cast?

A) Below the elbow with semi flexion(full pronation and ulnar deviation )

B) Below the elbow with semi extension

C) Above the elbow with complete extension

Young girl making no eye contact and irritable , poor attention at school, what investigation from mom
can help u diagnose

Recent study reports from school

Parental relationship

Appetite, mood and sleep

Man suspecting his neighbours of spying on him and filming his relations with his wife, plice also
involved, what is the most concerning factor

Previous psychiatric admission

Has a liscenced gun and pistol

Same attitude with previos neighbours

Family mental disease hx

A roaming person brought by police with confusion and hallucinations, blood alcohol level zero,
probable cause

A. Alcohol abuse

B. Drug abuse

C. Alcohol withdrawal
. trachoma in child and doctor founf around 20 other members of family infected too, what to give to
index cases

oral doxycyc

azithromyc dropd

No option in recall for right answer oral azithromycin

Or choose topical tetracycline if u see an option

A young woman has two black spots on her lower limb with no change for last one year

What is it

A. Benign junctional naevus

B. HSP purpura

C. Seborrhic keratosis

Pregnant Women,Varicella serology positive at 8wks of gestation.Now 10wks of gestation,exposedto

chicken pox.What to do?

A.Reassure

B.VZIG

C.Varicella vaccine

D.Varicella Serology

MVA scenario of young male who was sitting beside the driver before ann accident, he has transient
unconsciousness but he decriped what happened and 0knew where he is, BP 70/40 then measure again
after resuscitation was the same 70/40 what is next?

a) FAST USG

b) CT abdomen

c) Laparotomy

d) Request blood products

20yr boy after an MVA is brought by his mother to the ER. He has sustained a head injury. He is drowsy.
He refuses any treatment for him whereas the mother tells you to treat him as required. Which of the
following symptoms in the boy will alert you to immediately treat the boy?

a. Sudden deterioration in the level consciousness

b. Impaired decision making capacity

21 year old girl with phobia of dogs.her boyfriend has a German Shepard.she comes to u n wants to
overcome her phobia.best advise

1.buy a small pet dog

2.see pictures of dogs

3.self hypnosis

4.keep a diary

a woman came in labour, Cx dilatation was 3cm soft and fully effaced, fetal HR normal, station at Ischial
spine. After 4 hours, now 6cm dilated, station below ischial spine and FHR normal.. what to do

a) Observe and review again

b) Oxytocin infusion

c) Forcep delivery

)Nocturnal enuresis in a chilld going for camp and doesn't want to urinate like he does at home, how will
you help

A bed alarm

B desmopressin

C imipramine

D will resolve itself

pt was stable after mi had thigh Hematoma enoxaparin and clopirodgel taken asked how ill u manage
next

a.compress haematoma

b. stop enoxaparin clopidogrel

c. inject anti thrombin in thigh

d. give ffp

post operative of angioplasty, stent with clopidogrel releasing. The patient complains of painful quickly
expanding buldge in the loin groin region what to do next

inject thrombin at the site

give ffp
vit k infusion

immediate explorative surger

A patient may be 46 yrs old with low appetite.. BP- 104/70 , pulse 56 . what is your next step of
management ?

a. Thyroid ultrasound

b. thyroid autoantibodies

c. thyroid uptake scan

d. thyroxine 50 microgram

. 53 yrs old came for advice brother colon cancer dx at 63 . she had not seen dr for 5 years. what will u
do? Male or female???

a. colonoscopy

b. pap smear ans

c. chlymidia testing

mother brought her 4 year old child for her language problem. she started saying mum n dad at 12 13
months of life. she has a collection of 50 words in her vocabulary and she speaks 2 words sentences. she
can wear dress herself. plays well. whats likely problem?

a. autism

b. asperger

c. language disorder

d. rett syndrome

e. Normal child

A 46 year old man came for URTI he has fasting glucose of 6.1 . OgTT done showed 6.7. what next to do

a. repeat OGTT after 18 months

b. Fasting glucose yearly

c. check fasting glucose 3 yearly ans

d. advise HbA1c

e. ogtt yearly

old lady with tinnitus. renne webber tests normal. what wud you do?

a. audiometry

b. tympanometry
c. nerve conduction studies

39 month child.what should he be able to do?

A) kick a ball

ride a bicycle

C) speak full proper sentences

D) can draw a face

30 months child able to do

A. Kick ball

B. Dress himself

C. Say 4 words

A case of lateral epicondylitis. Treatment?

Lateral epicondylectomy

Immobilization of the fingers

Analgesic

Sling below elbow

Brace at the elbow

If brace below not in option choose anlgesics

Old male presented by hypoglycemia 2.6

1 iv dextrose 50ml 50%

2 iv dextrose 25ml 50%

3 iv dextrose 50ml 25%

4 im glucagon

endometritis scenario with fever . 4 days after deliver. what to give with amoxicillin ?

a. add metrondazole

b. add gentamicin

c. add maybe benzyl penicillin not sure. i chose metronidazole

Child Limping Pain in knee

a. Examine hip ans

b. Xray hip

Xray knee

Middle aged male on addiction therapy by methadone. He was watched by a social worker agitated and
with pin point pupil yesterday. What’s your management?

A. Do clinical examination before giving today’s dose.

B. Refer to police

C. Refuse to give him the dose.

D. Don’t give the dose until after drug screening test

Patient was on methadone program. Quit it 2 months ago. Now comes with restlessness and dilated
pupils. He is drowsy but arousable. Whats next step?

a. give him naloxone and review after 24 hrs

b. start methadone

c. hospitalize him

A woman comes to your clinic. She was prescribed trifluphenazine for her condition. She says she went
on a trip and forgot to take her medicine with her.She also says that she occasionally forgets taking her
medicines. But this time she did not take it for 3 weeks because of her trip. Now she presents with
voices in her head. What will you consider giving to this woman?

a. Continue trifluphenzine

b. Respa Depot?

c. Olanzapine

d. Discontinue trifluphenazine

patient come with swelling in the neck 3 days /3 weeks ago ( didn’t mention in which area of the neck ,
didn’t mention about tongue protrusion ) exactly saying has only swelling with fluctuation , soft ,no
other feature on examination. what Dx?

A. Epidermoid cyst

B. Thyroglossal cyst

C. Thyroid cyst?
D. ? LN

E. ? Thyroid nodule

A couple comes to you with 2 young children and are having maritial difficulty. The women starts
arguing with husband and then asks him to leave. After husband leaves she say "I feel like killing myself
and my children" and after a moment says "Sorry, I was just kidding, I love my children" and asks you
not to tell this to his husband. What will you do?

A. Tell the husband

B. Tell the police she wants to kill the children

C. Inform the Family and Child protection services

D. Respect the confidentiality of the patient

. What are least expected effects of lead toxicity?

A. IQ deterioration

B. Opthalmic abnormalities

C. Hb decrease

D. Forgot options

Thyroid storm - It is characterized by a high fever (often above 40 °C/104 °F), fast and often irregular
heart beat, vomiting, diarrhea, and agitation. Inorganic iodide (ideally potassium iodide and not Lugol's
iodine[citation needed]) and antithyroid drugs (propylthiouracil or methimazole) are used to reduce the
release of thyroid hormone from the gland, and beta blockers (e.g. propranolol) to reduce the effect of
circulating thyroid hormone on end organs.[1][3] Corticosteroids, like dexamethasone, are used to
prevent peripheral conversion of T4 to T3. In high fever, temperature control is achieved with
paracetamol/acetaminophen, frequent fluid replacement, mechanical ventilation and corticosteroids

25 year old female who is otherwise fine says she is getting married. Her father, grandfather paternal
and uncle had a blood condition in which their rbc were not normal. What is the risk of her developing
the disease after marriage?

A. 25% of her male children

B. 25% of both male and female children

C.50% of her male children

D. 50% of all children

E. No risk of development
She hs no risk of developing disease , herself carrier , her children 50% normal, 25 male child affected,
25 ?% female carrier

A 50 year old women had a mitral valve replacement surgery after rheumatic infection. After 24 hours
she starts developing a swelling in the femoral region which is increasing in size every hour, the swelling
is pulsatile on palpation. What would be your immediate next step?

A. Perform USG

B. Perform CT angio

C. Put pressure on the swelling

D. MRI

E. Forgot

Pseudoaneurysm

A child with IDDM collapses at his school in the playground. The most appropriate first action would be:

a. Assess his neurological status

b. Do a glycaemia test

c. Iv glucose

d. Test the urine for ketones

Insulin injection

45 years woman previous on carbamazepine ,thyroidectomy done and now presents with swelling and
soreness of pharynx,dx

a) viral pharyngitis

B)thyrotoxisis

C)tonsillitis

Lithium toxicity (level=3.0) question with low BP 85/50. What to do? N/S; hemodialysis

50 y man on lithium he is on his regular dose got out to work in 39c day and his wife gave history of
alchol abuse past few days he is presented now with ataxia and tremors cause ?

1- lithium toxicity -.

2-sun stroke---

3- alchol withdrawl
Patient was taking lithium and respiridone, came with acne and weight gain, cause,

a. respiridone

b. lithium

combine

Pt with mania on lithium for the last 2 yrs and controlled on it. She is planning pregnancy and wants
your advice?

a. stop lithium

b. decrease lithium

c. do blood lithium levels

d. start queteipine

e. counsel her about the pros and cons of lithium therapy during pregnancy

A lady on lithium well controlled previously now poor compliance drug levels low ,,,and hypomania
What to give

Lithium

Carbamezapine

Depot

Sodium valproate

Olanzapine

A 24-year od male presented with elevated mood, pressured speech, agitation and flight of ideas over
last 2 weeks. He is cooperative otherwise. There is no history of drug abuse in the past. Which one of
the following is the drug of choice in this situation?

a. Sodium valproate

b. Carbamazepine

c. Lithium

d. Quetiapine

e. Haloperidol
14 years male patient on psycho stimulant medication for ADHD and her parents complained from his
non compliance to the medication and his abnormal behavior in the school ....

Send nurse to insure his compliance

Tell the parents to obligate him to the medication

Give him depot

Give him respridone

Talk w the patient about the +ve &-ve effect of his medication

School boy non compliant for ADHD medicine, grades drop, what to do?

a.Ask school for support,

b.let the boy decide about the medication

c.supervise parents

d, talk to the boy,

14 year old with ADHD. Refusing to take medicines since few months. Agressive. About to be expell from
school

A. Respa depot

B. Tell parents to insure adherence

3. Send state appointed nurse

4. Tell parents child has right to refuse med

CHILD WITH ASTHMA HISTORY SIMILER TO OLD RECALL ON SABA 4 HRLY, AND ORAL PREDNISOLONE TAKING SABA
FOR AS A EXERSISE PREVENTER,LONG SENARIO ASKING FOR MANAGEMENT FOR ONGOING SYPMTOMS?

A. SABA ( if ongoing symptoms )

B. ORAL PREDNISOLON
C. CICLESONIDE
D. BUDESONIDE/(if SABA already has been taken)
Salbutamol+ lowdose ics…if symptoms are still not contro the add LABA

1. adult male with pic of U/s-there is complex mass, swelling of scrotum,what to do

a.biopsy
 b.CEA
c.alpha feto protein
d.surgery.
Mother comes with 10 months infant with height 45 head size 25th at birth then now increase to
75 percentile now .. On examination child is mild hypotonic with open anterior fontanelle ,other
examination normal,feeding well, what to do??
Ct head
b. Check cmv
C.tsh
D. Usg head

. female , pg 18 wks , sudden frontal headache, bp 80/60, pulse 90, on exam: confused and
drowsy, heart normal what inv:
A.Mri
B.Us
C. Echo
D.CTG
. young pt 2weaks pain in shoulder with limited abduction and flexion of shoulder after lifting
of heavy things …what is the initial Mx?
a- paracetmol
b-MRI
c- intrarticular Cortisone injection
resolve in 30mnths

. pyloric stenosis pic from anthology. Pt uop 50ml/hr asking what to give with iv fluid in 24 hours?
a.20mmol kcl
b. 50 mmmol kcl
c. more than 50 mmol kcl
d. no kcl required!

. 60 yr male pt with 2 days ho intense photophobia with blurring of vision. .vision also
reduced on left side asking diagnosis?
A.conjuctivits
B.gluacoma
C.keratitis
old recall old man found collapsed in garden with temp 33.4 + hypothyroidism + heart block
asking cause of collapse?
--hypothermia
hypothyroidism
first steroids then levothyroxine
A 44 year old man comes because he is concerned about his health. His father had diabetes at 56.? Next?
A) OGTT 2 yearly…..
6 monthly RBS
C) FBS yearly(ans)
d) fbs every 3 years

A child is cyanotic, apex beat on left axillary line, loud murmur on the left sternal border.
a) ASD
b) VSD
c) TOF(ans)
d) TGA
A girl comes to you cz she has some abdominal pain and diarrhea and asks you for certificate for her illness but she
is ok now..she has been in the emergency 3,4 times before for suicidal attempts.what is your diagnosis?
a.malingering
b.borderline
c. schizoph

Q.5 An 18 year old case Anorexia Nervosa, which of the following will u find?
A) Tachycardia
Low grade pyrexia
C) Delayed relaxation phase of ankle jerk
D) Shivering in a cool environment
E) Loss Of breast development(ans)

- Patient with hypothyroidism . Ischemic heart disease and hypertension on levothyroxine 150 mcg daily she
developed signs of hyperthyroidism and labs confirmed it so they decreased her dose to 100 mcg today , when
should you follow up TSH level ?
• twice daily
• after 1 day
• after 7 days
• after 2 weeks
• after 4 weeks(ans)

schizo p.t on antipscychtc have weight gain, most is the next investigation?
a. TSH
b. FBS
c. Lipid profile(ans)

Pic of frost bite in great toe after camping trip Wat to do

Resurrance it's just frost bite
Remove the toe
Review in 4 weeks (
Remove only the nail

30 years old lady came to you because of 8 weeks ago her marriage was broken, 1 year ago she was referred for
psychotherapy from work (Shouting at colleagues) . After finishing her work she cant able to relax at home. What is
the diagnosis?
A) Bipolar-II with depression
Cyclothymic disorder
C) GAD
D) Major depression
E) Borderline personality disorder(ans)

woman her pap smear didn’t show abnormal cells but the endocervical cells were absent. Her previous pap
was normal
what would you do?
Reassure that no test are required any more(ans) ( though it is not full stem)
b. repeat pap smear now
ideally repeat after 6 to 8 weeks

most common feature of calcular Cholecystitis:

1 filling defect
2 intrahepatic biliary dilatation
3 thickned wall (ans)
4 fluid inside the bladder
 Young man 30-35 yo complains on 2 years history of problem with finish his urination. He states it's feels like
smth in urethra. And after finishing void he still feels his bladder is not empty. No fever, no pain. Just
incomplete voiding. What is the best investigation in his case?
1- ct
2- mri
3- cystoscopy
4- uretroscopy(??)

young man has difficulty with initiating urination and drippling sometimes how to initially diagnose?
a) venous pyelography
b) transrectal sonography(ans)
c) CT
d) MRI...

Urethral stricture
49.What the most common cause of infection of gall bladder?
A. staphyloauriu
S
b.E Coli(ans)

Famous recall of young couple with infertity, regular menses, mid cycle sex. Cause of infertility?
A- Tubal abnormalities
B- Short luteal phase
C- Sperm antibodies
D- Bad timing
Answer: A

Old patient with macroscopic hematuria ,cystoscopy done but no finding was mentioned, also has
intermittent loin pain wch radiate to groin ,next most apropriate investigation ==>
2.c.t abdomino pelvis
Mass in anterior leg, firm regular, attached to gastrocnemius muscle, most appropriate inv ?
A. MRI
B. U/S
C. CT
D. Biopsy
24 yr female had 2 babies before, amenorrhea 2 years, all normal hormones (prolactin,
testosterone,FSH,LH) , estrogen 70, US 3-4 multiple cyst, Dx ?
A. PCOS
B. Hypothalamic dysfn.
C. Pituitary Adenoma
D. POF

22 year female, seprated from boyfriend 6 weeks, now loose wt. , lazy at work, not good sleep,
anxiety attacks & stress ?
A. FLuoxetine
B. Female adolscence group
C. Start CBT- Either Adjustment disorder or Depression, treatment has to be started with C.

. Boy when sleep on his back stridor, otherwise ok, stressed tachypnea and cyanosis?
A. Foreign body inhalation
B. Epiglotittis
C. Broncholitis
D. Trachiomalacia

24 female amenorrhea 12 months, pain during sex, on examination uterus size normal, all
examin. normal, what will you suspect?
A. Pregnancy
B. Endometriosis

. Travelling to endemic typhoid, took vaccine already, what to advice ?

A. Wash hands
B. Avoid all fruits n veg.
C. Bottled water

Old male present with constipation, have ca with bone metastasis, took 20mg morphine for
pain last week, Inv ?
A. Morphine level
B. Abd Xray
C. Serum Ca.

Male AF, whitish lesion in Ct brain ?

A. Echo initial(Af pt with infarct go for echo)
B. CT Angio best
C. MRI

Rupture membrane & meconium, baby PR 144 bpm ,v iriability 5 , no decelartion, no

accelaration ?
A. Normal
B. Abnormal & need sampling
Case of chronic limb ischemia : 100m claudication & *it go away at rest, on examination bruits
on femoral artery. ?
A. Angioplasty
B. Femoral bypass graft
C. Intensive walking program

2 yr old have pertussis, have 5 month sister, after Rx ?

A. DPTa for sister
B. DPTa for adult of unknown hx of vacc.
C. Erythromycin
D. Parents & Grandparents Vaccine

Pic of Baby born with mass in testes &Transillumination test +ve ---> Hydrocele

23 yr female, palpable spleen, pic of pancytopenia, rash on her legs Dx ?

A. SLE
B. ITP
C. HSP

40 yr female tonsilitis, took amoxicillin, after 3 weeks she devloped purpuric rash, not
blenching, painful joint, fever ?
A. Hypersensitivity vasculitis
B. HSP
C. I.Mononucleosis

17 male ate pizza, had diarrhea, sub .conjuctivits, hematuria, fever, what to do to dx ?
--> stool culture(HUS)

. female don't want to eat because she think her bowel are rotten, she is dehydrated ?
A. NS until urine output 2ml/kg/hr
B. D5 1L/hr
C. 1/5 NS/ 4hr
D. NS until urine output 1ml/kg/hr
CT given (Ischemic stroke), Old female, Rt side hemiplegia, dysarthia came after 1 hour from
symptom, best Mx ?
A. rtPA
B. Clopidogrel & Aspirin
C. Clopidogrel
D. Warfarin

24 female, sudden loss of conscious attacks, at bed time she have visual and auditory halluc. ,
weakness in rt. side ?
A. Rt. temporal lobe
B. Lt. temporal lobe
C. Partial lobe
D.LEFT Occipital lobe

53. Acalculia, agraphia, dysathria, weakness on the left side

A. Medulloblastoma in Rt. partial lobee
B. Medulloblastoma in Lt. partial lobe
C. Cerebellar tumor

54. Female on haloperidol for a while , now devlop EPS, cogwheel rigidity, repetative fall, what
is most imp sign to confirm dx ?
A. Dysdiadochokinesia
B. Bradykinesia
C. Sialorrhea

5 Male, MMSE 18, HTN & IHD ?

A. Memantine(HEARTBLOCK )
B. Rivastigmine
Male 70 yr want to do check up for insurance , Plasma Protien Increase, s.albumin 3 (n: 3.5-5.5)
, No symptoms ? (what to do next)
A. Serum immunoglobulin
B. Plasma Protein Electrophoresis
C. Bone Marrow Biopsy

Young boy have asperger on sertaline , now irritability , cause ?

A. S/E of sertaline
B. Asperger Itself

F TREATED ALREADY NO DRUG MENTIONED THEN NORMAL TEENAGE BHVR

8 yr boy, fever 39, Hx of tonsilitis 1 week ago, Now fever n rash, toxic looks pale
1. Blood culture
2. AmoxI
SCARLET FEVER APPROPRIATE OPTION IS THROAT CULTURE
Peripheral vascualar disease & heavy smoker, S.Cholesterol 7.5 (increase), BP increase and
diabetic, after advice to stop smoking, what will decrease peripheral vascular dsz ?
A- BP control
B- Control Cholesterol
C- Control DM
Middle age man , ↑↑ ca, his father 75 yr have ca ↑↑ but didnt take Rx, PTH ↑↑, what is your
Inv ?
A. Urinary ca
B Parath. Scan
Familial hypocalcuric hypercalcemiaAD (ca sensory receptor mutation )
24 URINARY CA best ,
Tx benign no treatment
Nd counselling the family
No complications

- mother her child will have chemotherapy and he is completely vaccinated coming to GP want to know what
vaccines she should take to protect her son ?

A- Hepatitis A

B- hepatitis B

C- influenza

D- varicella
 varicella is live we can't give live vaccine during treatment

Child has leukaemia going to start chemo immuninaztion upto date what in mother to check

a. hep b

b. /influenza

c. /vericella

d. /mumps

/hep A

man wondering in the shopping ,mall whole day ,peoples house door to door,sometimes raising his hands and
stand or seat aimlessly,dx
1.hepatic pathology
2.schizophrenia
3.manic

Pt hemoptysis and cough afebrile for 3 years with infilterate lower zone and x ray wierd
A-lobar pneumoia
B-bronchiactesis
C-chronic bronchitis(cough with white sputum )
D-lung abcess

Pt with alcohol bing and liver impairment

A- diazepam
B-lorazepam

Pt not comfortable in sex wth husband, ttt by clotrimazole but now recurent white discharge ,on exam redness on
genital area with small ulcer
A-herpes pcr
B- vdrl
C-vaginal swap
41 year old lady with increasing dyspareunia and burning sensation in vagina not responding to clotrimazole came
to you. On examination you found redness of vulva with a painless small ulcer on labia. What to do next?
A) VDRL
Vaginal Cytology
C) Vaginal swab for bacterial culture
D) PCR for Herpes simplex
Pt with mouth ukcer, arthlagia, stiffeness of hand
A-sle
B-sarcoidosis
C-rh.arthritis
Osteoarthritis

Pt leave her job with depression symptom and say i dont want to live ,with alot of suicide attempt
A-dilectal therapy
B-drama therapy
C-aversive behavior modification

Genital warts in preg. Lady after cryotherapy increased

A-aldara cream
B-surgical excision of labia
C- surgical excision ofbwart by diathermy
No optionfor leave it until delivery or again cryotherapy
mother of a complain that he has lack of concentration in study, his teacher say he is not attending the school
regularly but leaving home for school everyday.his result is below average and he become aggresive to his younger
brother for 1 yr after his parent's seperation. cause?
school phobia,
truancy,
drug abuse,
seperation anxiety,

A young man comes for routine medical check up for insurance . All examinations are normal but urine dipstick
protein 1+ but no hematuria. What is your next appropriate management?
1) 24 hour urinary protein
2) serum electrolytes and urea creatinine
3) repeat urine check in early morning
4) Intavenous pyelography
5) CT abdomen

5.Girl experiences anxiety when goes out in meetings with strange people . Has stress at work cuz of work load.
Next ?
A. Propranolol before going to meetings
B. Relaxation therapy
C. Psychotherapy

8.A school teacher comes with difficulty to initiate sleep every night. He says whenever he goes to sleep he feels
he might have done something wrong so he starts recalling each n every moment of his day. And after he has
recalled his day completely m realised that he has not done any wrong, then only he gets happy n satisfied n sleep
. It takes almost 1 -2 hours each day. T/t asked.
A. Antidepressants
B. Antipsychotics
C. Ssri
D. Antidepressants+ something E. Bzd

Female delivered a baby 3800gm at 37 weeks without any complications. Placenta out after 5 mins, syntocinon
given. After 30 mins of deliver, 1000ml of bleeding vidin10 mins. Dx ?
A. Birth canal lacerations
B. Atony

.Which of the following has worse prognosis?

A. Hodgkins
B. Non hodgkins
C. Metastatic ca breast
D. Ca testis

.Most common complication after pancreatitis .

A. Pseudo cyst
B. Renal failure(earliest if asked)

pic of eye with many lesions in the upper lid only (not vesicles as i see)
1-herpes
2-bacterial infection
3-skin tags
pt with multiple joint pain , did aspiration showed positive rhomboid , also patient have impotence . What is the
diagnosis?

A- reactivate arthritis

B- hemochromatosis
Arthritis plus chronic scaly rash on elbows n knees ?

Sle

/rheumatoid

/psoriatic arthritis

/ reactive arthritis?

Psoiatic arthrities

/ Pt with deadly pain at buttocks increased on walking more on climbing all pulses are palpable
/
/ A- MRI lumbosacral.. Ans
/
/ B- Ct spine
/
/ C- Doppler
/
/ D- Ct angio
/
/ MRI
/ 26- pregnant 28 weeks, bleeding 1000ml, uterus tender , can’t feel fetal parts , hypotension,
tachycardia, what to do next after resuscitation?
/
/ A- C.S
/
/ B- Aminotomy
/
/ C- Ultrasound
/ - 16 week pregnant with proteinuria high BP ask Dx
/
/ A- Preeclampsia
 /
/ B- Renal cause of proteinuria.. Ans
/
/ Renal cause of proteinuria
/ patient on methotrexate and prednisone now with pancytopenia and ulcers dx
methotrexate toxicity ttt >> folinic acid
/

- 5th generation Australian with cough for 3 weeks NO Fever and chest is clear , afraid from infecting son ?

A- pertussis serology

B- chest x- ray

C- mycoplasma serology
- hereditary spherocytosis with decreased reticulocytes ,, cause ?

Parvovirus
patient on carbamazepine Na:112 and confused ?

Stop carbamazepine and give hypertonic saline

Stop carbamazepine and give hypertonic saline

38- 16 year female came for urti what opportunistic screening to do A-

D Depression
BPD

pregnant lady(G1)come to u with family h/o of mother with DVT at 50age, her sister has h/o abortion.during
antenatal period what inx will be most benefit for her current pregnancy??
FBE
Thrombophilia screen
Antiphospholipid Ab
Coagulation profile

patient with chest trauma +open flail chest what to do at accident scene
A. Opioid analgesic
B.chest tube
C. Mouth to mouth resuscitation
D. Cover open chest wound with a dressing

Which study to do to find causality between HTN and MI?

a. Case control
b. Cohort
c. Cross sectional
d. Randomised control trial
e. Case series
pregnant in first trim. Her last pap 6 months normal but no endocervical cells ..what to do
A)repeat pap now
B)repeat in two weeks
C)repeat in 18 months

Pt with hx of hemicoloctomy for sigmoid volvulus presented with moderate to sever abdominal pain on the right
side with distention, x ray was typical for cecal volvulus whats mot app treatment

-colonoscopy
baruim enema
-immediate surgery
Gastrograffin swallow
Small intestine serial film

femal pt. with infertility for 3 yrs , midcycle sex, 1 child before, semen 15 million,60%,40% ,tube problem in 1 side
only, normal hormones level, with mild pain during sex, wht is the cause of her inferti;lity
a. Semen abn.
b. Tube abn.
c. Endometriosis—pain during sex.. ( sanjana says )
d. Ovulation problem

patient with polycystic kidney disease his GFR is 20 ,,, he is on rimapril ,metformin,statin,aspirin …… went outside
country then after 2 years he returned to his doctor his investigation was just the same GFR 20
WHICH DRUG SHOULD BE STOPPED NOW ??
A-RIMAPRIL
B-ASPIRIN
C-STATIN
D-METFORMIN

Female diagnosed with cancer daughter came for BRCA 1

,whom she can pass her outcome
A-Life insurance company
B- Superannuation fund.
C-First degree relative
Ctg showed reduced baseline variability and variable deceleration (ctg not given)
the mother had 4 cm cervical dilation within 14 hours , pethidine was given to her 3 times I guess
the fetal head is in the left occiput posterior. What is the cause of ctg abnormality
a. prolonged labour
b. sedative drugs
c.elevated resting uterine pressure
d. molding of fetal head
Question about ctg in low risk pregnancy
assessment of fetal previous oxygenation
assessment of fetal oxygenation now
is superior to intermittent fetal auscultation
CTG monitoring can sometimes lead to medical interventions which are not necessarily needed

60 years old man feels pain when he walks only two blocks and stops to rest after that. He has a recent history of
left buttock and back of thigh pain, but he has three month history of ischaemia in left leg and foot. A bruit is
present over femoral artery and His limb is pulseless and cold. Next step?
A- Thrombolytic
B- Angioplasty
C- Bypass surgery
D- Walking program
E- Nefidepine

Child - 2yrs old Harsh Cough, stridor Temp 38 degrees cel

Admitted at 11 pm
What do u administer first.
A- prednisolone IV
B- adrenaline neb
C-salbutamol neb
D-oral steroid

\\

GIT Post esophagectomy, left lower chest pain after 5 or 7 days, asking most appropriate inv to reach diagnosis.

1. Oral contrast study

2. CXR

A female pt with chest tightness and SOB for 2 days, she received chemotherapy for ovarian ca ( paclitexil
and cisplatin) asking inv.

Ecg

Ctpa

5. dimer

Doppler

76 years old lady with hypertension ( on treatment) concerned about her risk of stroke, because recently her
brother got stroke. She has AF as well.

What can decrease her risk of stroke?

1. Low dose aspirin

2. Warfarin
3. Statin is
4. Poisoning 3 people live in a room. they hv a old gas stove. now come with drowsiness dx-
5.
6. 1.NO2 poisoning
 7.
8.
9. 2.CO poisoning.
10.
11.
12. 2.CO poisoning
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24. Answer D (at first )

A child was in a room where in the adjacent room was a fire, he has breathlessness and confusion. no burns ,
he did not come into contact with the fire. There is soot in his mouth. What to do?

Intubation – laryngeal edema

If the man had a Card for non-transfusion then-we can give non blood volume expanders

7. A resident reports to you that a psychologist from the hospital asks him to write a prescription because he
doesn’t have time to go to a GP, what should you do?
1. Report to head doctor.
Remind resident about confidentiality between him and the psychologist

Post partum patient complaining of easy fatiguability lathergy breast feeding. Blood picture given, hb low Mcv low
.Next inv?
A. Iron deficiency anaemia
B. Folate deficiency
C. Pernicious anaemia