OBA

1. A man came in with seizure, most likely due to drug. However, which of the following is least likely to cause
seizure?
A. Antipsychotic
B. Tricyclic antidepressant
C. Sedative hypnotics
D. Tramadol
E. Pethidine

2. Death by asphyxiation – which of the following is most likely to be true?

A. Ppl who try to suffocate you by compressing your nose and mouth causes asphyxiation of internal airway
B. Death by hanging is due to asphyxiation
C. The fracture of hyoid bone and cricoid cartilage occurs in death by hanging
D. Manual strangulation is method of suicidal intention

3. The most important rationale for cancer screening.

A. Cheap test.
B. Cancer detected early.
C. High demand from public.
D. Early positive cases live longer.
E. Non invasive screening test

4. A 35 year old lady who just delivered her first child the day before suddenly noticed swelling and tenderness of the
left breast. What is the most likely diagnosis?
A. Carcinoma breas
tB. Breast engorgement
C. Breast abscess
D. Mastitis
E. Fibrocystic breast/ Fibroadenoma

6. A girl with tiredness and anaemia but normal full blood count and menstruation. what other micronutrient to give
beside iron? ( is this the Q with vegetarian?)
A. Folic acid
B. vitamin b12
C. Vitamin c
D. Vitamin k
E. vitamin b6

7. 45 years old man presented with pain and bleeding on defaecation for the past two days. He has constipation for
the past few days. He is otherwise well. Diagnosis?
A. Anal fissure
B. Carcinoma of rectum
C. Diverticulitis
D. Haemorrhoid
E. Ulcerative colitis

11. 23 yr old male recently returned from overseas trip presents with dysuria and urethral discharge. Which is the
most likely organism?
A. Chlamydia trachomatis
B. E coli
C. Neisseria gonnorhoea
D. Klebsiella spp
E.Ureaplama urealyticum

12. A 28 year old man was newly diagnosed with hypertension. What clinical examination do you do to test for
coarctation of aorta?
A. Carotid bruit
B. Radio-radial delay
C. Radio-femoral delay
D. Collapsing pulse
E. Renal bruit

13. A 50 year old woman who was diagnosed hypertensive and given antihypertensives developed a dry cough a
week later. Which of the following medications is likely given to her?
A. ACE inhibitor
B. Calcium channel Blocker
C. Beta Blocker
D. Diuretics
E. Angiotensin Receptor Blockers

16. 65 year old male, presented with lower vague abdominal pain , with alternating diarrhea and constipation, and
( vomiting? ), what best investigation can be made?
A. Colonoscope
B. CT abdomen
C. Proctoscope

20. A study on whether yellow sputum correlates with bacterial infection. Out of 100 patients with yellow sputum with
respect to the figures below, how many of them have bacterial infection?
Sensitivity = 43%
Specificity = 74%
Positive predictive value = 16%
Negative predictive value = 12%
A.12
B.16
C.43
D.74
E.100 (not sure)

21. People with no gout, drink soft drinks. Follow up 20 years later to see whether they develop gout.
A. Cohort study
B. Randomised controlled trial
C. Cross sectional study
D. Case control study
E. Systemic Review

24. A 35 years old gardener presented with right elbow pain for one week. the pain is reproducible by extending his
wrist against resistance with an extended arm. What is the most likely diagnosis?

A. Biceps Tendonitis (Patients typically complain of achy anterior shoulder pain, which is exacerbated by lifting or
elevated pushing or pulling. A typical complaint is pain with overhead activity or with lifting heavy objects.)

B. Tennis elbow pain lateral epicondyle

C. Golfers Elbow
D. Olecranon Bursitis
E. Osteoathritis

29. 65 year old Diabetic Man presented with 1 week duration of increasing pain, swelling, and redness on his right
knee. Two weeks ago, he had an elective athroscopy. His pulse rate is 110bpm, temperature is 38 degrees celcius.
What is his diagnosis?
A. Infected Baker's cyst.
B. Acute OA
C. Acute Gout
D. Septic Athritis
E. Osteomyelitis.

33. 30 year old male, presented with high grade fever, vomiting and headache. Test done: Flex neck towards chest,
what do you anticipate in this examination? (brudzinski sign)
A. Severe pain at back
B. Severe Pain at hamstring
C. Involuntary Flexion of hip
D. Hyperextension of Knee

34. 20y/o girl presented with palpitation and worsening SOB, what of the murmurs below suggest a ASD?
A. Fixed splitting S2
B. reversed splitting S2
C. Loud S1
D. Muffled Heart sound
E. retrostenal ??? sorry forgot pls help
Ans - A
35. presented with SOB, bilateral crepitation,bilateral leg oedema ?(sry dont really remember) pulse 110bpm,
irregularly irregular, what's the most likely jvp.
A. large 'a' wave
B. large 'v' wave
C. cannon 'a' wave (ventricular tachy)
D. evelated JVP with normal waveform
E. abesent 'a' wave (AF)

41. A 45 year old lady diagnosed with hypertension presented with episodic weakness. She has no family history of
hypertension. Examination shows normal fundus and no renovascular bruit. Urea 4.6, Potassium: 2.4, Sodium: 142.
Venous blood gas showed metabolic alkalosis. What
A. Conn’s syndrome
B. Hypertension treated with diuretics

43. 54 yr old woman presents with sudden onset of chest pain. Her only risk factor is dyslipidemia. ECG was done and
it showed ST elevation. She was given GTN and aspirin and ecg was repeated and it was normal. What is the most
likely diagnosis?
A.Prinzmetal angina
B. STEMI
C.Non STEMI
D.Unstable angina

46. A patient of 'forgotten age' presented with consistent raised unconjugated bilirubin level despite having otherwise
normal liver function test and renal profile etc. (otherwise normal)..He did not suffer from any clinical symptoms and
signs.
Answer is Gilbert's syndrome.

48. A 21-year-old lady complained of drinking 4L water at day time and passing urine 5 times at night for one month.
She recently consulted psychiatrist for depression. Physical findings were non attributable. Urine dipstix no ketones
and glucose.
a. central DI
b. DM
c. hypercalcemia
d. hypokalemia
e. psychogenic polydypsia

50. A 49 year old man with known alcoholic liver disease. Admitted 2 days ago. Now presenting. Sweating, shaking,
tachycardia and febrile. He believes he sees spiders crawling across the ceiling.
A) alcoholic hepatitis
B) alcoholic intoxication
C) delirium tremens
D) encephalitis
E) korsakoff psychosis

51. A 68 year-old man with chronic hep b infection presented with 1month weight loss n right upper quadrant
discomfort. On examination, he had ascites and mass at right hypochondriac region. What is the most likely
diagnosis?
A. Cholangiocarcinoma
B. Liver cirrhosis
C. Coinfection with hep d
D. Hepatocellular carcinoma
E. Reactivation of hep b

53. 50 year old male with macrocytic anaemia,bone aspiration revealed megaloblastic bone marrow. What is the most
likely cause?
A. Alcohol
B. Azathioprin
C. B12 deficiency
D. Iron Deficiency
E. Thalassemia trait

54. A 24 yr old man presented with headache, high grade fever and neck stiffness. He has no previous history of head
injury. CSF aspirate shows high CSF pressure, low glucose, pleomocytosis (neutrophilia), High protein. What is the
most likely diagnosis
A. Aseptic Meningitis
B. Bacterial Meningitis
C. Subdural hematoma
D.Tuberculous Meningitis
E. Viral Meningitis

56. A 21 year-old man presented with confusion. Examination revealed hypersalivation, hyperlacrimation and miosis.
The patient was also tachycardic and bp was high. What is the possible causes of poison?
A. Aspirin
B. Opiate
C. Organochlorine
D. Organophosphate
E. Paracetamol

57. Patient admitted for acute exacerbation of COPD. what investigation to do on admission?
A. Arterial blood gas
B. Full blood count
C. Spirometry
D. Sputum culture

E. (forgotten)

60. A 60 year-old woman with hypertension was treated with ACE-inhibitor. 2 weeks later, her baseline eGFR dropped
by 35%. Serum potassium increased from 4.6 to 5.9. What is your management?
A. Reduce the dosage of ACE-inhibitor
B. Stop the ACE-inhibitor
C. Refer for dialysis
D. Start furosemide
E. Convert to angiotension receptor inhibitor

61. In chronic renal disease, with BP: 135/85mmHg, what's the choice of anti-hypertensive?
A. ACE-inhibitor
B. ARB
C. CCB
D. Calcium supplement
E. Diuretics

62. 33 years old female presented with 2 months of low grade fever, night sweats, malaise, painless cervical
lymphadenopathy. Cervical lymph node biopsy: Large cells with bilobed spectacle shape nucleus along with large and
small lymphocytes and bands of fibrosis.
A. Burkitt lymphoma
B. Cat Scratch Disease
C. Hodgkin Lymphoma
D. Infectious Mononucleosis
E. Tuberculous lymphadenopathy

63. A 25 years old female, with a swelling in anterior midline of the neck, that goes up upon deglutition and protrusion
of tongue, what is the swelling most likely to be
A. Thyroglossal cyst
B. Branchial cyst

64. 58 years old man, two years history of lower abdominal pain, weight loss. He is diagnosed with lower rectal
cancer. Which is a feature of low rectal ca?
A. Palpable mass in lower abdomen
B. Passing of blood in stool
C. Passing of mucus in stool
D. Incomplete evacuation of stool
E.

65. 65 yr old male is on treatment for BPH and has dysuria and intermittent difficulty in passing urine. What
complications are likely to cause these symptoms.
A. Prostatitis
B. Cystitis
C. Bladder CA
D. Bladder diverticulum

67. 45-year-old man presented with painless swelling in the right iliac fossa. On examination, the mass was hard and
immobile. Right scrotum was found to be empty. What was the most likely diagnosis?
A. Abscess from caecal diverticulitis
B. Appendicular mass
C. Caecal Ca
D. Lymphoma
E. Ca of undescended right testis

68. A foreign worker took Nsaid for his joint pain and rashes. He developed sudden episode of abdominal pain. Which
one of the following investigation is the best suitable for him?
A. ECG
b. Erect CXR
C. Urgent endoscopy
D. Abdominal Xray

69. A 62-year-old man has irregular bowel habit for almost a year and recently complains of lower abdominal
discomfort. The attending doctor could not decide if it is a colorectal cancer or diverticular disease of the large bowel.
Which of the investigations is the least likely to confirm either of the diagnosis?
A. Barium enema
B. Colonoscopy
C. CT Scan of abdomen and pelvis
D. Diagnostic laparoscopy
E. Serum CEA

70. a 21 years old girl who is sexually active came with lower abdominal pain. which is the least relevant
investigation?
A. Abdominal ultrasound
B. FBC
C. Abdominal imaging
D. Urine FEME
E. UPT

71. Female, headache, febrile, neck stiffness.

A cryptococcus meningitis
B tuberculous meningitis
C transient ischemic attack

72. A 22-year-old male presented with right groin swelling that appears after coughing and descending into his
scrotum.
A. Direct inguinal hernia
B. Femoral hernia
C. Indirect inguinal hernia
D. Obturator hernia
E. Spigelian hernia

73. 19 year-old male had a knife stab into the area below right ingunal ligament. There was profuse bleeding and he
was in shock. What would you do as first line measure to stop the bleeding
A. Compression
B. Tourniquet at right thigh
C. Clamp and ligate
D.
E. Blood transfusion

75. A 35 year-old lady admitted for elective laparoscopic cholecystectomy. How would you classify the surgical
wound?
A. Class I: Clean
B. Class II: Clean-Contaminated
C. Class III: Contaminated
D. Class IV: Dirty
E. None of the above

78. 45 year old man presented with sudden onset of severe epigastric pain which spreads to all over the abdomen .
What is the most useful clinical sign to differentiate between perforated peptic ulcer disease and acute pancreatitis ?
A. Abdominal movement with respiration
B. guarding
C. Obliterated liver dullness
D. Rebound tenderness
E. Shifting dullness
81. 45 year old woman with 4 day of left iliac fossa pain. PR: 100b/m. BP: 130/80. T: 38. Tender mass is palpable in
left iliac fossa. What is most likely diagnosis.
A: Bladder stone
B: Colon carcinoma
C: Diverticulitis
D: Iliac artery aneurysm

84. Most likely feature of varicocele

A. Disappear upon lying down
B. Feel like bag of worms
C. Reducible
D. Right sided
E. Transillumunation

85. A 54-year old man presents with repeated vomiting for past three days
Which of the following clinical features is suggestive of pyloric stenosis?
A. A long history of recurrent epigastric pain
B. A palpable mass in epigastrium
C. Loss of appetite
D. Pallor
E. Recent loss of weight

86. A 64 year-old man presents with a swelling over the anterior aspect of his neck. The swelling is hard in
consistency. Malignancy of the thyroid gland is suspected. Which of the following is the most likely:
A. Anaplastic
B. Papillary
C. Lymphoma
D. Medullary
E. Follicular

90. Motorcylist accident. Hypotension and dyspnoiec. Right lung was hyperresonant and absent breath sound. Neck
vein engorged.
A. Cardiac temponade
B. Haemothorax
C. Lung contusion
D. Simple pneumothorax
E. Tension penumothorax

Chiew Lui: These are some questions that I remember with unknown question numbers, but some very incomplete >.<
Those who remember, please feel free to edit it. Thanks a lot ^_^

#. Rheumatoid arthritis man presented with nocturnal eye pain, red eye, visual acuity 6/12.
A. Anterior Uveitis
B. Episceritis
C. Conjuntivitis
D. Scleritis

#. Mother of 8 week pregnant. Which is not necessary?

A. ABO Rh blood
B. Fasting blood glucose
C. Haemoglobin
D. HIV
E. Urinalysis

#. Young man post appendisectomy. Have fever despite of prophylactic antibiotic

A. Atelectasis & Pneumonia
B. Surgical wound infection
C. DVT
D. UTI

#. After thyroidectomy, pin and needles at “forgotten where”. Investigate:

A. Serum TSH
B. Serum T3 and T4
C. Serum calcitonin
D. Serum calcium
# . Diabetic lorry driver with transient loss of vision (last for few minutes) while resting at rest station
A. TIA
B. Diabetic retinopathy
C. Hypogylcemia
D. Postural hypotension

#. Rhomboid-shaped crsystal whic is weakly positive birefringence in polarised light

A. Calcium pyrophosphate dehydrate arthropathy
B. Gout
C. Osteoarthritis
D. Rhematoid arthritis

#. Ankle joint: Tender & warm. Afebrile.

A. Gout
B. Septic arthritis
C. Osteoarthritis
D. Osteomyelitis
E. Rhematoid arthritis

#. Proximal myopathy with bla bla bla

A. Muscle
B. Peripheral nerve
C. Dorsal root
D. Ventral root

#. Foreign worker with night sweat, fever, cough with cervical lymphadenopathy. X ray shows cavitation
A. Pulmonary tuberculosis
B. Lymphoma
C. Infectious mononucleosis

#. Fever with productive cough. What is the expected findings?

A. Decrease vocal fremitus with dull percussion
B. Decrease vocal fremitus with hyperresonance percussion
C. Increase vocal fremitus with dull percussion
D. Increase vocal fremitus with hyperresonance percussion

#. Diabetic Mellitus
A. Discoid rash
B. Necrobiosis lipoidica

#. Adult polycystic kidney disease. Investigation:

A. Abdominal USG
B. Abdominal X-ray

#. Differentiating anal fissure & haemorrhoid

A. Painful defecation
B. Blood splattered in toilet bowl

# Urine analysis most favouring UTI

A. Positie nitrites
B. Positive leukocyte esterase
C. Positive red blood cell
D. Specific gravity decrease
E. Positive glucose

#. Haematuria and weight loss

A. Renal cell carcinoma
B. Bladder tumour

EMQ
Ears: Otitis Externa, Wax, Foreign body, Acoustic Neuroma, Acute suppurative otitis media, Chronic otitis media,
Cholesteatoma, Barotrauma, otitis externa, acute otitis media with effusion (serous), chronic otitis media (effusion),
otosclerosis
1. 30 year old man, After swimming-complaints: deafness after swimming barotrauma
2. Child, pulling-ear sign, autoscope see darkness, cannot visualise tympanic membrane foreign body
 3. Old man, with 1 year history of Deafness on both ears, right side more than left, deafness more pronouced in
nosiy background, rinne negative, weber lateralise to right.otosclerosis
4. Discharge: Pus. Otoscope Examination:Attic perforation, Grey matter in the ear Acute suppurative otitis media
5. Something on pain on pulling the ear otitis externa

Muscle weakness: Syringomyelia, Guillain-Barré syndrome, Tranverse myelitis (lupus), Pott's spine, multiple myeloma
1. Progressive muscle weakness for past 4 days. Now on ventilator Guillain-Barre Syndrome
2. Muscle weakness Syringomyelia
3. A patient with SLE symptoms: arthritis, rash Transverse myelitis
4. Old man, pallor, back pain Multiple myeloma (CRAB- hypercalcemia, renal insufficiency, anemia, bone pain)
5. HIV positive with night sweats, weight loss, paraplegia, limb weakness pott spine

Headache: Cluster, Tension, Migraine, Meningitis, Encephalitis, sinusitis, Subdural hematoma, Subarachnoid
hemorrhage, Giant cell arteritis
1. Sudden headache neck stiffness Meningtis
2. Businesswoman feels like a tight bandage around the head Tension
3. Headache with photophobia and vomits Migraine
4. Headache comes at night, lasted for 2 weeks. Had the headache every 3 months with tearing of the eye
Cluster
5. Headache with jaw pain when eating. Scalp is tender on palpation. Giant cell arteritis

Nerve palsy : CN III, IV, V, VI, VII, VIII, IX, X, XI, XII palsy
1. Tongue deviated XII
2. Facial asymmetry, unable to close eye VII
3. Unable to shrug shoulder and turn neck to one side XI
4. Affected eye is higher than the normal eye and when asked to turn to the right side, the abnormaility is more
pronounced, ptosis IV
5. Unable to abduct eye VI

Respiratory condition : which is the following investigation? Foul smelling sputum, Reversible on lung spirometry,
FEV/FEC
1. Asthma reversible on lung spirometry
2. Acute exacerbation of chronic bronchitis FEV/FVC
3. Interstitial lung disease FEV/FVC
4. Bronchogenic carcinoma Foul smelling sputum
5. Lung abcess Foul smelling sputum

Liver diseases (Primary sclerosing cholangitis, Chronic Hepatitis C, Hepatocellular carcinoma, Cholecyt, primary bilary
sclerosis, cholelithiasis)
1. Lady had blood transfusion 10 years ago. Now hepatomegaly Hep C
2. Lady with autoimmune antibody Primary sclerosing cholangitis
3. Hep B man now with LOW and LOA. On palpation, a nodular mass is felt on the lower border of the liver Hep
ca
4. Anti-mitochondrial antibody positive Primary billiary sclerosis
5. Obesed, asymptomatic woman with hypertension, diabetes. Raised liver function test: ALT: 80unit
cholelithiasis

Obstruction: Sigmoid volvulus, Incarcerated Indirect Inguinal Hernia, Obstruction of indirect inguinal hernia,
Obstruction of obturator hernia, Pyloric stenosis, Intussusception, Rectal carcinoma, Paralytic ileus
1. Child presents with acute abdomen with sudden onset. Curls up when sit and crying, after a while no pain,
then pain recur again intussusception
2. Male noticed the swelling become irreducible incarcerated of indirect inguinal hernia
3. Lady with vomiting. Percussion: tympanic, hyperactive bowel sound Obstruction of inguinal hernia
4. Man altered bowel habit, blood and mucus in stool. Sudden inability to pass bowel and flatus. Rectal Ca
5. 80 year old man altered bowel habit. Suddenly cannot pass bowel and flatus. X ray showed dilated loop of
bowel volvulus

Swelling:Varicocele, Dermoid cyst, Dermoid tumour, Inguinal Hernia, Epididymis cyst, sebaceous cyst, cystic hygroma
1. Bag of Worm Varicocele
2. Transilluminate like Chinese lantern Epididymis cyst
3. Swelling that can be compressed Cystic hygroma
4. Swelling with slippery edge
5. Swelling with a punctum sebaceous cyst

Ulcer : Venous ulcer, Ischemic ulcer, Neuropathic ulcer, Pressure ulcer, syphilitic ulcer, Rodent ulcer (BCC), Marjolin
ulcer (SCC),
1. Painless ulcer Syphilitic ulcer
2. Leg ulcer with medial hyperpigmentation Venous ulcer (deposition of hemosiderin)
3. Ulcer with rolled-in edge Rodent ulcer
4. Painful ulcer at toe? Ischemic ulcer
5. A known diabetic diabetic presents with ulcer at heel Neuropathic ulcer
 OSPE

1. *Picture of a child's nostril*

Child has nasal discharge yellow in colour, epistaxis, no previous history of upper respiratory tract infection.
a) History: Name 2 that is significant any foreign body inserted into the nose, any trauma (nose picking)
b) Describe the findings:
c) Test to confirm the diagnosis nasal endoscopy for polyps and sinusitis, skin prick test for allergic rhinitis, CT
scan for tumor, nasal inspiratory flow test
c) Diagnosis:
d) Management: (1st line and second line)

Rhinitis: avoid allergen,

2. *Lab Result: Total cholesterol, TG, HDL, LDL, Fasting blood glucose: 6.9mmol/l*
Patient with waist cricumference of 100cm. BMI 30
a) What is your diagnosis? - Metabolic syndrome
b) Support your diagnosis (high LDL, bordeline HDL, high TG)
c) What other test/invesitagtion you would like to do to confirm your diagnosis? Blood pressure,
d) Name 2 conditions that patient might be predisposed to in the future coronary heart disease, diabetes
e) Non-pharmalogical management weight loss, diet of low sugar and salt, exercise,

HDL
IFG (>5.6), IGT
TG
Waist circumference
Hypertension (130/85)

3. *Picture of acanthosis nigrican*

Patient of newly diagnosed HTN.
a) Name the condition acanthosis nigrican
b) What conditions would you have this skin condition? Name 4 idiopathic, obesity, diabetes, Cushing Disease,
hypothyroidism, gastric cancer
c) Investigations with justification. Name 4 blood sugar level, endoscopy, thyroid function test, skin biopsy

4. *A chest X-ray & a picture of the chest*(CXR most prob showing enlarged pulmonary vessels, hyperinflated lungs,
and tear drop heart - emphysema?)
30 year-old male presented with difficulty breathing & cough for 3 weeks. He was noticed to have noise during
inspiration.
a) What is the finding in chest X-ray?
b) What is the finding of the chest
c) Correlate the findings
d) What is the noise & cause?
e) Name 2 likely diagnosis

5. * Picture of hands* - swollen joints? areas of hypopigmentation, skin tightening, shiny skin? no palmar crease?)
Patient feels pain and numbness with bluish discolouration when exposed to cold.
a) Describe the photo
b) Diagnosis: Scleroderma?
c) Explain why the patient has pain and discolouration?
d) What you expected to find in this patient’s X ray calcium deposition, erosion and resoprtion of turf of the distal
phalanx

6. *Picture of a lady with facial asymmetry*- bell's palsy

a) Describe the findings. Name 4.
b) What other clinical examinations you would like to carry out. Name 2. taste of ant 2/3 of tongue, palatal and ear
vesicles
c) Diagnosis:

7. * Picture of proctoscope with reddish mass*(probably hemorrhoid)

50 year old with PR bleed
a) Name the procedure proctoscopy
b) Describe the picture
c) Diagnosis with stage
d) What other clinical features? bleeding, pruritus ani, flatus incontinence
 8. *Picture of a 2-way urinary catheter (item A) & a 3 way urinary catheter (item B)*
a) Name item A 2-way foley catheter
b) Name item B 3-way foley catheter
c) What is the size you use in adult? for A: female is 12-14, male 14-16,
d) What are the indications of item A? Name 2 To drain urine of bed ridden patients, on patient with acute urinary
retention, for patients who are anesthesized for surgery
e) What is the indication of item B? For irrigation of the bladder for hematuria patients
f) What is the contraindication of item A? patients with traumatic injury of lower urinary tract,

9. *Picture of a breast cancer & chest X-ray with white patches in both lungs (canon ball appearance)*
a) Describe the photo
b) Describe the X-ray
b) Name 2 investigations
c) What is the diagnosis & stage