Feb 19 2011 Recalls

in

1) A 17 year old female long distance runner presented with pain on the shin after running. O/E: Her BMI is 16.8. no other significant findings. What is your Mx? a) b) c) * d) e) OCP HRT Increse milk intake Biphosphonates Give Calcium supplement

2) A 5 year old boy came with high fever 40 C. Two days later he developed rash over the dorsum of hands, fingers. O/E; He developed new murmur, lymphadenopathy (neck). What is the most likely diagnosis? a) b) c) d) e) Dengue fever Infectious Mononucleosis Kawasaki disease Roseola infantum Rubella

3) Handbook of MCQ 2.034 picture

4) A man from north Queensland came with fever, periorbital pain, joint pain, lymphadenopathy and rash over the body. What is the most likely diagnosis? a) & b) c) d) e) Leptospirosis Dengue fever Ross River fever Brucellosis Malaria upper

5) A 5 year old child came with bilateral calf tenderness follow^ respiratory tract Infection. What would you do? a) Oral steroid o b) Ibuprofen c) Do nothing

6) A 75 years old lady with constipation since 6 months. She has h/o using senna and appendicectomy. O/E: progressive abdominal distension. What is the most likely diagnosis?

a) Sigmoid volvulus . b) Small bowel obstruction 7) A man came to rural hospital with loss of consciousness after falling from tree. Tertiary hospital is 2 hours far away with air ambulance. As an ED doctor what will be your next step of Mx? a) b) c) d) t e) Nasogastric tube Nasal packing Orogastric tube IV Antibiotics CT Brain

8) An alcoholic man was taken to emergency department by police, O/E: he is drowsy and confused. Serum electrolytes are given below: Serum Na: 120 mmol/l Serum K : 3.0 mmol/l What will be the next step of Mx? a) * b) c) d) CT brain Serum and urine osmolality Do nothing Give Normal Saline 0.9%

9) Patien with hoarseness of voice since 3 weeks. On physical examination he is normal and healthy.(No swelling on the neck and chest). Which investigation should be done to put the diagnosis? a) b) c) d) Chest X-ray Indirect Laryngoscopy CT scan of chest and neck Endoscopy

10) A man claimed that he is going to kill himself if he will stay more at home. He is sad. Nurse noted that he always came with different complaints and registered under different identities since 5 years. What is your diagnosis? a) b) c) d) Malingering Factitious disorder Major depression Schizophrenia

11) Mother worries about her 18 months boy. Boy is able to turn to voice but unable to do pee-ka-boo and pull to sit with head lag, only able to babble. What is the diagnosis? a) b) c) d) ^ e) Fine motor delay Gross motor delay Language delay Personal social delay Global development delay

12) A 18 years old male patient presented with painless swelling of scrotum. USG was done which found solid mass. What to do next? a) b) c) d) FNAC Surgical exploration Serum HCG and alpha fetoprotein CT chest

Cix

13) Question about Rectus Sheath Hematoma.( CT abdomen was given) 14) Pic of SCC (Handbook of MCQ)

15) Father and mother both have schizophrenia. How many chances to inherit this disease to their kids? a) b) , c) d) Minimum (< 1%) 2-5%(<1G%) 50% 100%

16) A male patient 55 years old coming to regional hospital which is 3 hours far away from tertiary hospital. Patient is having chest pain since 1 hour. ECG was given: Inferior wall Ml. Patient was given oxygen and aspirin. What is your next step of Mx? a) b) c) d) IV Streptokinase rTPA PCI Observation

17) ECG about Pulmonary Embolism (S1Q3T3 pattern was there)

18) Pic was given about maile patient aged 65 years with left sided parotid swelling. He was on medications for DM since 20 years. He had eye dryness and mouth dryness since 6 years. He was complaining of agitation, joint pain and fatigue. His BP was 150/80 mmHg. What is the diagnosis? a) b) c) d) Left salivary duct stones Sjogren's syndrome Parotid carcinoma Chronic parotitis

19) One question related to Thalassemia. It was about chances for inheritance to kids especially in males.

20) Question related to orbital cellulitis. Patient was unable to move her left eye. Patient was c/o pain, headache and sweating. What is your next step of Mx? a) IV Amoxycillin * b j CThead e) Observation 21 )A female patient aged 55 years with cystocele and rectocele. What will you do? a) Pessary b) Pelvic floor exercises c) Surgery
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22) A female patient aged 17 years having 4 cm left ovarian mass. She doesn't have other symptoms except lower abdominal pain sometimes. Her vitals are: HR- 80/min, BP-130/80 mmHg, Temperature- Normal. What is your next step of Mx? e a) b) c) d) Rescan in 6 weeks Laparotomy USGnow Observation and do nothing

23) A male patient married since 4 years. He is healthy and otherwise well. He is trying to conceive since 2 years. His all vitals are normal. His wife is also healthy and all laboratory values are normal. What do you think why he can't conceive? a) Previous surgery of indirect inguinal hernia

 b) Previous history of mumps 24) Boy aged 12 years playing sports regularly. He came with c/o pain in his right knee. He thought that he had injury while playing the game on his knee. His knee is often locked. What is the reason behind it? a) b) c) d) Tear of medial meniscus Tear of anterior cruciate ligament Tear of collateral ligament Patella fracture

25) Question no. 312 from Handbook of MCQ 26) Question about superficial thrombophlebitis. What is the Mx? , a) Bed rest and limb elevation b) Apply cream on skin 27) Observe A 50 years old man has fever 38.5 C.He has pain on the left side of the scrotum for 2 days. O/E: tenderness on the posterolateral part of the left testis and scrotum was red. What is the most appropriate next step of Mx? a) b) c) d) Per rectum examination Full blood count Urinalysis USG of scrotum

28) A 25 years old female patent has multiple sexual partners over the last six months. She came with h/o vaginal discharge and you diagnosed her with Chlamydia infection. What is the most appropriate advice you would like to give her?
t

a) Trace all her sexual contacts over the last six months and treat them. b) Ask her most recent sexual partner to come for examination and treat him with Azithromycin. c) Ask her to practice safe sex. d) Tell her not to use IUCD till there is no infection.

29) A 28 years old female patient who is not sexually active came to you and wants to be done PAP smear from a female gynaecologist. What is your most appropriate Mx? a) Ask a nurse to do the PAP smear in your clinic.

. b) Tell her it is not necessary to do a PAP smear. c) Refer her to a gynaecologist. cO Do the PAP smear yourself. 30) Pic of finger with tophi. A male patient 40 years old already on allopurinol 100 mg/day and occasional colchicine. His renal function is normal. What is your most appropriate Mx? a) b) c) d) Thiazide diuretics X-ray of hand increse dose of allopurinol Probenecid

31) A 26 years old female patient fell down while horse riding. She got multiple rib fractures on her left side from 5 to 11 ribs. Her Sp02 is 98% with room air. She is conscious and well. Her CXR was taken and she was found to have 10% pneumothorax on her left side. She is going to be shifted to the nearest hospital by air ambulance. What is your next step of Mx? a) b) c) d) Insert a cheat tube and drain. Intubate and ventilate. Do nothing. Needle thoracocentesis.

32) A 20 years old male patient comes with pain on the vertex of the scalp. He has nausea and vomiting. One week ago he fell down of his bicycle and the force of the impact split his helmet. He didn't lose consciousness and no ante or retrograde amnesia. O/E: there is tenderness over the vertex. Neurologicsl examination is normal. He only has a bruise on the left lower eye lid. What is the most likely diagnosis? a) b) , c) d) Subarachnoid hemorrhage Subdural hematoma Extradural hematoma Concussion

1. A 18 month old child with URTI symptoms and unwilling to walk when put to stand, along with calf tenderness. What would be the ideal treatment? a) Amoxycillin b) IV prednisolone c) IV immunoglobulin d) Ceftriaxone

2. A woman 50 years underwent cholecystectomy 3 days ago with c/o pain in right shoulder tip and exertional dyspnoea. Chest X-ray findings, ECG all normal. What would be the next appropriate investigation? a) CTPA b) troponins * c) CT abdomen

3. Picture of a man with 4-5 pruritic spots on gfans penis and shaft. What's the diagnosis? Q, a) Scabies b) Syphilis c) Herpes

4. Picture of a woman with reddened lower eyelids with excessive lacrimation. What would be the management? a) Cold compress b) Surgery c) Promethazine

5. A woman 32 weeks pregnant and has a child who has chicken pox active with IgM positive for varicella. What would be your next step in management? a) Ultrasound of fetus b) Check IgG titres of mother again c) Check fetal IgM titres d) Give her varicella Ig

6. A Sudanese man with c/o unproductive cough with fever of 37.5 C, chest XRay findings of Rt upper lobe consolidation. What would be the appropriate management? a) Amoxycillin b) INH
9

e) Drug for anti TB treatment d) Ceftriaxone

7. Child with symptoms of kawasaki disease. Whats the management?

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a) IV immunoglobulins b) Prednisolone c) Ceftriaxone d) Penicillin

8. A 22 y/o woman who is 8 weeks pregnant with c/o bleeding after intercourse. What's the probable cause?
a

a) Cervical ectropion b) CA cervix c) Endocervical polyp

9.A 70 y/o man with HT and DM has irregular pulse. What would be the most appropriate management? a) Aspirin . b) Warfarin c) Metoprolol d) Metformin

10. A 70 y/o man with h/o HT-180/110 with c/o TIA with RT carotid bruit with irregular pulse also has 50% stenosis of Rt carotid and 60% stenosis of Lt carotid. What drug or management would be most appropriate in preventing embolic phenomenon? a) Controlling HT b) Aspirin c) Warfarin d) Carotid endarterectomy

11. A 68 y/o woman with sigmoid colectomy and endcolostomy with input chart 2100ml, output chart-3600 ml. What would be the probable cause? a) Wrong fluid chart method b) Dehydration c) Excess iv fluids

12. A woman underwent a operation for bowel obstruction and was postoperatively seen with input chart of 2600 ml and output chart 4000ml.what would be the cause? a) Resolved paralytic ileus

13. A woman with previous h/o premature delivery of a baby at 24 wk weighing 500 gm which died of IRDS. She now comes enquiring whether she will have a premature delivery this time. What will be the ideal method to find out preterm delivery b/w the gestation of 18-22 weeks? a) Serum relaxin 8 b) Fibronectin levels c) Ultrasound

14 A15 y/o boy with h/o sudden outburst of anger who is currently in a special school is now at verge of expulsion. What would be the drug management for this case? a) Sodium valproate b) Risperidone c) Olanzapine d) Haloperidol

15. An old woman with c/o early morning headaches for past 3 weeks with temp 37.3 Celsius with picture of CT brain showing something similar to cerebral tumor. What is the diagnosis? a) Cerebral abcess b) Glioma c) SDH d) Cerebral tumour e) Cerebral mass

1.6. A old lady with c/o fatigue, tiredness and lassitude with peripheral smear picture of MCV,Hb,RBC-all decreased with increased plasma cells. What is the most appropriate investigation to come to a diagnosis? a) Serum electrophoresis

17. A child with symptoms of bitemporal hemianopia. What would he be having? a) Optic glioma * b) Craniopharyngioma c) Medulloblastoma

18. In metastasis to ovary, where would the primary site be? a) Liver b) Kidney . c) Breast d) Spleen e) Pancreas

19. A woman with RT SCLN enlargement showing SCC +. Where would be the primary site be? a) Breast o b.) Lung c) Liver d) Colon 20. A 18 month child with symptoms of bronchiolitis. What would be your advice to parents to prevent him from being exposed to cigarette smoke? 21. A 10 week old child which was apnoeic and brought by the parents which revealed that there was no pulse/respiration. What would be your next step ? . a) Inform coroner b) Arrange autopsy at hospital c) Give a death certificate stating the death to be sudden infant death syndrome J*

22. A man with symptoms of OCD brought by his wife. He says that he isn't willing to try out medications. What would be an appropriate management? a) Exposure and response prevention b) ECT c) Counselling 23. A 92 y/o man who is admitted after an attack of Ml requests that he doesn't want any interventions on him if he goes terminal again. His MMSE is 23/30.what would be your next management? a) Psychiatric evaluation b) Contact medical board for intervention

24. A 16 y/o girl who ran away from home had a traffic accident and now requires emergency laparotomy. She requests that her parents not be informed. What would be your management? a) Get her consent and proceed with operation b) Call parents up for consent c) Call medical board for consent

25. A 80 y/o woman who tried to open a window had sudden severe back pain, X-Ray showed vertebral collapse. What would be your next step in management? a) Bone densitometry b) Bone scan c) MRI d) CT

26. What is the most urgent sign in acute limb ischemia indicative of surgery? a) Pain

b) Paralysis c) Colour d) Temparature e) Swelling

27. A picture of f undoscopy with signs of dot and blot hemorrhages with h/o HT-180/110.DM. What is the diagnosis? , a) HT retinopathy b) Diabetic retinopathy

28. A fundoscopic picture of several small emboli in the retina which were in favour of embolic phenomenon. What is the diagnosis? a) CRF b) Embolic occlusions c) DM d) HT

29. A woman with features of refusal to go out into public areas because a man had exposed himself to her about 2 months ago and now she prefers to stay at home and do gardening, What is the cause? p a) PTSD b) Social phobia c) Malingering

30. A case of achalasia cardia. What would be the best long term management option? v>^' a) Pyloromyotomy b) Pneumatic dilatation ^

c) Botulinum toxin

31. Picture of a man with gradual swelling in the neck and puffiness of face with redness. What would be your investigation of choice to confirm diagnosis? a) CT chest b) Thyroid ultrasound c) GT head

32. A 22 y/o man with abdominal pain, purpuric rash on buttocks, lethargy and fever. What is the diagnosis? a)HSP

33. A man with symptoms of upper and lower limb weaknes of proximal muscles with normal deep tendon reflexes. What is the diagnosis? a) Myasthenia gravis b) GBS c) Polymyositis 34. A case of myasthenia gravis with diplopia and muscle weakness. What is the initial investigation to do? a) Tensilon test b) Nerve conduction study c) EMG

35. A child with symptoms of GBS. Another name for it? a) Acute post infectious demyelinating polyneuropathy

36. An old lady with features of carcinoma caecum. What would be the most easily found symptom? a) Tiredness, fatigue, lassitude b) RIF mass c) Altered bowel habits d) Bleeding PR e) Melena

37. A 5 y/o child previously toilet trained with symptoms of soiling of underwear with faeces with a h/o constipation and diarrhoea for past 2 months. What would be your initial management? a) Laxatives b) Sigmoidoscopy c) Behaviour therapy

38. A man with symptoms of auditory hallucinations came for regular checkup in psych OPD. He has symptoms such as voices telling him to strangulate red haired girls and to verbally abuse blonde girls. What would be your next management? a) Involuntary admission b) Increase dose of medication c) Change the antipsychotic

39. A picture of lung with pulmonary metastasis and slight left sided pleural effusion obliterating CP angle.

40. A picture of lung with left sided pleural effusion. A man who is a non smoker had worked in a coal mine and had non productive cough for several years. What the diagnosis a) Mesothelioma

b) Silicosis c) Asbestosis

41. A 80 y/o man with h/o Ml and on clopidogrel to be taken up for emergency surgery. What would be your next management? a) Give platelets b) DDAVP c) Cryoprecipitate d) Stop clopidogrel

42. A 80 y/o woman with dribbling of urine on coughing. She is on treatment with ACE inhibitor for HT and well controlled. What would be your next management? a) Surgery b) Ring pessary c) Pelvic floor exercises

43. A man on warfarin to be taken up for elective cholecystectomy. What is the management? a) Stop warfarin and change over to LMW heparin b) Stop warfarin add F.FP c) Continue with warfarin

44. A girl who visited SE Asia 6 months ago now has c/o diarrhoea, 3 kg wt loss, loss of appetite. Stool results: Blastocystis hominis and Giardia lamblia positive. What could be the cause for her presentation? a) Blastocystis hominis b) Giardia lamblia

c) Goeliac disease d) Rotavirus

45. A woman with symptoms of hemochromatosis with massive ascites. What wouid be your most appropriate investigation? a) Diagnostic ascitic tap b) CT Abdomen c) USG liver

46. A man with symptoms of PE 3 days post operative. What would be the most appropriate investigation? a) CTPA b) VQ Scan c) D-dimer

47. A 60 y/o woman with c/o hemoptysis who had in her childhood undergone surgery for bronchial adenoma. What could be the best method to come to a diagnosis? a) Bronchoscopy b) Sputum cytology c) CT chest

48. A 70 y/o female with ECG looking like wide QRS with no p waves, and tall R waves in most leads with c/o exertional breathlessness, h/o HT and chest pain. Her troponins and markers were all found to be normal. What would be the best investigative procedure? a) Stress ECG b) VQ Scan c) D-dimer

d) CTPA

49. A man on treatment with warfarin for MI, 2 days ago roxithromycin was added and now INR-9.what would be the next initial management? a) Stop roxithromycin. b) Give FFP c) Stop warfarin d) Cryptococcus

50. In case of dehydration, what would be the next fluid resuscitation to be given? a) 1VNS .9%

51. What would be an indication for ERCP in a woman with h/o cholecystitis to be taken up for lap cholecystectomy? a) Dilated bile duct >7mm b) Small gallstones c) Thickened gallbladder

52. A 65 y/o woman with h/o jaundice with dark urine, pale stools and palpable gall bladder which moves with respiration, has no h/o alcohol intake, no h/o pancreatitis. What would be the cause? a) GA ampulla of vater b) Cholangitis c) Choledocholithiasis d) Cholecystitis

53. A woman with urine analysis showing normal bacterial growth. What would be your advise? a) Reassurance

54. A 35 y/o lady who smokes, has premenstrual headache and h/o benign breast disease and family h/o ovarian and breast CA. Which one of this is an absolute Contraindication to OCR? a) Premenstrual headache b) Breast CA c) Ovarian CA d) Smoking

55. Which would be the best option OCP for a smoker female? a) Norethisterone b) Medroxyprogesterone c) Combined OCP d) Implanon

56. A 70 y/o man with parkinsons. What advise would you give him? a) His condition has no definitive cure b) L-Dopa can prevent progression c) This is a degenerative condition and it will worsen over a period of time

57. A 70 y/o man with gradual 18 months progressive memory loss, confusion and recurrent falls is brought by his son. What is the diagnosis? a) Alzheimer's disease b) Multiinfarct dementia

c) Lewy body dementia

58. A c/o Wernicke's encephalopathy. What is your next initial management? a) Diazepam b) Thiamine c) Glucose d) Naloxone

59. A man with previous h/o being extremely rude, impolite and verbally abusive to other doctors now schedules an appointment with you. What will be your response? a) Examine him in the presence of another staff b) Refer him to another doctor c) Refuse his case

50. A woman with X-Ray of anterior dislocation of shoulder.

61. A man with h/o trauma to knee joint in a sports game of rugby resulting in tenderness, swelling, redness of knee joint. What is the appropriate management? a) MRI Knee b) CT knee c) Aspiration joint d) X-Ray joint

62. A case of sepsis happening after hysterectomy in a 40 y/o lady. She is allergic to penicillin. What would be the appropriate management?

a) Ticarcillin with clavuianate b) Ampicillin c) Ceftriaxone d) Vancomycin

63. A case of puerperal sepsis in a 30 y/o female occuring 5 days post partum. What is the management? a) Ampicillin+Gentamycin b) Doxycycline + Metronidazole c) Amoxycillin + Metronidazole

64. A man with DM.HT who is treated with ACE inhibitors, thiazides and beta blockers develops hyperJipidernia. Which drug is responsible? a) Hydrochlorothiazide b) Captopril c) Metformin d) Atenolol

65. A case of severe croup. How will you manage? a) IV adrenaline b) IV prednisolone c) Nebulised adrenaline d) IV antibiotics

66. What is the contraindication to tocolytic therapy in a woman with preterm labour and bleed? a) H/o previous APH

b) Asthma c) CHF

67. A chest X-Ray with upper lobar blood diversion in a man with dyspnoea and chest pain. What would be the next initial investigation? a) CTPA b) D-Dimer c) Chest CT d) VQ Scan

68. A 50 y/o woman with intermittent pain in epigastrium radiating to back for past 2 months. What is the cause? a) Duodenal ulcerations b) Pancreatitis c) Perforated peptic ulcer

69. A 32 y/o female who is 8 weeks pregnant with severe bouts of vomiting since 3 weeks. What would be the most relevant in history? a) A previous history of hydatidiform mole b) Vomiting not relieved by metoclopramide

70. A boy at a Trance/Rave concert took drugs and had dilated pupils and tactile hallucinations. What drug is responsible for this? a) Cocaine b) LSD c) Morphine d) Marijuana

e) MDMA

71. A child is brought by his mother with c/o ability to walk holding on and inability to speak words at 14 months. He only babbles, has pincer grasp normal. What could be the developmental delay? a) Language delay b) Gross motor c) Fine motor d) All normal & reassurance

72. A man with symptoms of difficulty in plantar flexion and inversion, normal dorsiflexion and eversion and no loss of ankle jerks. What is the nerve root affected? a) Common peroneal nerve b) L5 c) S1 d) Sciatic nerve e) Tibial nerve

73. A man with h/o epilepsy on treatment with valproate had h/o intermittent seizures every month for past 5 years. Since 1 month he is on carbamazepine and well controlled. What would you advise him on driving? a) He can only drive after 2 years of seizure free period b) He can drive after 6 months c) He can never drive

74. A man with involvement of left anterior descending coronary artery and circumflex artery occlusion. What would be your most appropriate management?

a) CABG b) Aspirin c) Thrombolysis d) Diet and exercise

75. A lady with superficial inguinal LNs enlargment on biopsy showed SCC. Where is the primary lesion? a) Anal Ca b) Rectal Ca c) Testis Ca d) Colon Ca

76. A man with symptoms of urinary retention since 6 hours. O/E has an enlarged prostate and also has difficulty in micturition. He has been started on antibiotics but still unable to pass urine after 6 hours . What would be your immediate next step? a) Suprapubic catheterization b) Indwelling catheterisation c) TURP

77. A girl who is 19 y/o wants to start a sexual life and asks to be screened for STDs. What would be the reason to screen for chlamydia in this girl? a) Most women are asymptomatic carriers b) Chlamydia causes infertility in untreated cases c) Chlamydia is the most common STD in Australia.

78. A mother with a child who had previous h/o oedema of legs due to some vaccination now comes for routine immunisation of DPT , has temp of 37.5. What will be your management?

a) Give all vaccines now b) Administer the pertussis component after oedema settles c) Do not give the vaccine now

79. A child with grade 4 VUR. What is the management? a) Surgery b) Do nothing c) ESWL

80. A 52 y/o woman who had an aunt with breast CA at 70 years now requests for screening. What would be your investigation of choice? a) Mammography 2 yearly b) Mammography + ultrasound c) Mammography yearly d) Ultrasound 81. A 70 y/o woman with COPD was admitted with acute shortness of breath, was given high flow oxygen, now she is unresponsive with decreased respiration. What would be the next step? a) Reduce oxygen to 2L b) Endotracheal intubation and ventilation c) Salbutamol nebulisation

82. A child with symptoms of hematuria, proteinuria, hypertension after 2 days of URTI. What's the diagnosis? a) IgA nephropathy b) Post Streptococcal Glomerulonephritis c) Nephrotic syndrome

d) Minimal change disease

83. A 45 y/o male smoker with HT, DM, hyperlipedemia and obesity comes for a regular checkup. What would be your first line in management? a) Advise him to quit smoking b) Antihypertensives c) Metformin d) Diet and exercise e) Statins

84. A question on normal grief reaction in an old man whose wife passed away 1 year ago. What would be your initial management? a) Send him for counselling bJSSRI c) CBT d) Admit in hospital

85. What study would you do if you want to find out the efficacy of a vaccine on a group of people? a) Randomised controlled trials b) Cohort study c) Case control study d) Cross sectional study

1. 35yr old male had spleenectomy a year ago, he now presents with reducible epigastric swelling. There is no pain. Which of the following is the best position to examine him in

a) b) c) d) e)

standing erect and asking him to cough standing erect lying down and ask him to cough lying down and asking him to raise his head lying down and asking him to raise his legs

2. 27yr old man presents complaining of diarrhea and bloating following meals. What could be the possible reason

a) b) c) d) e)

lactose intolerance Coeliac disease Giardiasis Corhn's disease Ulcerative colitis

3. picture from the new MCQ book of a lady with right eye looking to her left and the left eye looking straight. What is the reason for this picture.

a) b) c) d) e)

3ed right nerve palsy 4 right nerve palsy 6 left nerve palsy 4 It. nerve palsy 6 rt. Nerve palsy
th th th th

4. 50yr old man with a history of surgery for esophageal aclesia now presents with hoarseness of voice for the last 6wks, dysphagia for the last 4wks. On examination he is found to have paralysis of the rt. Vocal cord. Imaging shows mass at the thoracic inlet. What is the possible diagnosis.

a) b) c) d) e)

ca thyroid caupperoesophagus ealartnx ca vocal cord ca lung

5. A 4yr child presents with his parents. His BMI is 18 A plotting table is given with age in x axis and BMI on y axis and curves given showing 50 centile, 75 centile, 90 centile, 95 centile, 97 centile .
th th th th th

The BMI of this child if plotted according to his age falls above the 95 centile.
th

What will you tell his parents This child is

a) b) c) d) e)

slightly overweight is obese is healthy is under weight BMI is not have a very goodcorrelation in children

6. A chil was born at 32wks with 1.6kg, at 6mth of age he weighs 6kg this has to be plotted on the weight curve. What is your assessment

a) b) c) d) e)

the child is malnourished the child is underweight the child is not growing well the child has picked up good weght the is still under weight but has grown satisfactorily

7.40yr old man who is a smoker presents with complaints of pain the thigh and calf on walking 100m. the pain is relieved by resting with a cushion under his leg. The pain appears at 20m with walking on uneven surface and on inclination. What is the most appropriate next step.

a) b) c) d)

Arterial angiogram Gt spine MRI lumber spine Venous Doppler

8) Picture of back of the hand with severe swelling of the DIP joints of index and middle finger with a small ulcerating lesion on either joints. This patient is on allopurinol 10Omg daily(l'm not very certain about the dose mentioned in the MCQ), he is also on intermittent colchesin. He now presents with the following clinical picture. What is your next step in management

a) b) c) d) e)

increase the dose of allopurinol advise regular colchesin stop allopurinol advise steroids adviseindomethasin

9.Picture of CT brain. The patient presents with headach, fever, vomiting, since a few days. Whats the likely cause

a) b) c) d) e)

meningioma glyoma cerebral infarct cerebralabcess cerebral tumor

(the picture has a well circumscribed lesion with an air fluid level)

10) A man is presents to ED with history is threatening to kill him self after his girlfriend left him. He tell the doctor that he is a highly educated person with a lot of contacts in high places. What kind of a person is he a) Narcissist personality b) Borderline c) Avoident d) schizotypal e) Histrionic

11, A lady is fully dilated with fetal head at +1 station. The labor is progressing normally. The membranes rupture and you examine her and find a loop of cord in the vagina. What is the next appropriate step you will take

a) b) c) d) e)

try to replace the cord back immediately immediate forceps delivery immediate CS immediateventose delivery wait and watch

12. A primigravida was examined and found to be fully dilated at +1 station with baby in cephalic LOA position , 2hrs later she is +2 station with mild caput and moulding and head in LOA position. What is the next appropriate management

a) b) c) d) e)

Oxytocin infusion Rotational forceps Outlet forceps Ventousedelivary CS

13. A primigravida at 39wks contacts via phone she has "not felt her baby move as much tody", what will be your advise to her

a) b) c) d)

Keep a kick chart Not to worry as fetal movements reduce near term Come in for a check up immediately Observe for another day and come in if the baby has not moved adequately

14. A lady presents at 36 wks of gestation with 900mls of PV blood loss, she has abdo pain with abdomen tence and tender on examination. Fetal heart sounds are not audible by hand held Doppler. Cervix is 3cm dilated and fully effased. Pulse is 110/m and BP is 100/70 What is the next appropriate management

a) CS b) Oxytocin infusion c) Amniotomy

15, A primigravida presents at term in labour. She is found to have a cervix with 3cm dilation which is fully effaced. FHS are 144bpm. What is the next appropriate management

a) b) c) d)

observation oxytocin infusion amniotomy Intravaginai prostaglandins

16. A 30 yr old lady presents with secondary ammenorrhoea her FSH is 44 LH is 40 Ostradlol is 70 (which is low) Prolactin is 300 (normal) TSH is 3(normal)

What is your diagnosis

a) b) c) d)

ovarian failure pituitary adenoma PCOS Pregnancy

17. A 22yr old lady presents with a weight of 125kg, she is on OCPS and is a smoker. In councilling her regarding her risk for breast cancer what poses the greatest risk

a) b) c) d)

her weight her smoking her use of OCP She is not at increased risk

18. IN a patient with GBS which is ah appropriate way to monitor his oxygenation

a) b) c) d) e)

forced vital capacity in 1sec forced expiratory capacity in 1 sec blood gases pulseoxymeter Oxygen saturation

19. A 30yr old lady presents with 12hr history of abdo pain bloody diarrhea and fever. What could be the likely cause

a) b) c) d)

corhn's ds ulcerative colitis diverticulosis giardiasis

20. Senario of a female patient flirts with her GP what is the likely diagnosis

a) Borderline personality b) Histrionic c) Avodiaht

21. 70yr old man brought in by his daughter say that he has become very forgetful, and is confused, he has also been behaving inappropriately in public and has seem to have lost his inhibitions What could be the most likely cause

a) b) c) d) e)

frontal lobe dementia subdural hematoma Alzheimer's Senile dementia Wernikes encephalopathy

22. 1yr old boy is brought in by his mother complaining she noticed a swelling in his groin which has disappeared now, your examination of the child is completely normal What should you do

a) b) c) d)

Advised mum all is well Call them next week Surgical referral Organize ultrasound

23. 25yr old man presents with a painful, dusky, swollen and inflamed rt upper limb. It has happened after his cat scratched his cat scratched his arm. What is the possible diagnosis.

a) cellulitis b) cat scratch fever

24. A 25yr old man presents with palpitations ECG is done which shows WPW syndrome. His pulse rate is 150/m BP is 100/70mm of hg. ECG strip is given with a diagnosis of WPW syndrome in the stem. What is your next step in management.

a) b) c) d) e)

Adenosine Verapamil Amioderon Metaprolol Digoxin

25. A young man injured his left knee in a game of football. He is brought to the hospital with an extremely painful knee which is swollen, and extreamly tender which is the next best test in this case

a) b) c) d) e)

CT of the knee MRI knee Arthroscopy of the knee joint Joint aspiration ....cant remember (x ray not an option)

26. A 65yr old lady presents with colles fracture on further investigation she is found to have osteoporosis. She also has a history of being successfully for breast cancer. What is an appropriate way to manage her osteoporosis.

a) b) c) d) e)

Premarin Biphosphonate Temoxiphen Reloxifen High dose calcium

27. A 30 yr old computer operator complaints of pain in the right side of the elbow along with pain in his fingers what is a reasonable way to manage this condition

a) b) c) d) e)

strapping his fingers strapping the wrist and fingers strapping the elbow giving pain killers advise him to stop using the computer

28. 65 yr old lady had requested for no tube feeding if she were to deteriorate. He husband and children are all aware if her decision and have accesspted her decision. She has MS and now presents with sroke. She is unable to speak or swallow. What will you do.

a) NG tube feeding

b) Put in a parenteral tube c) Give iv fluids d) Fulfill her wishes compassionately

29.45yr old lady complaints of menorrhagia since the last 6mths. She is scheduled to see her gynaecologist soon. In the mean time what can you give her for het bleeding

a) b) c) d)

norethisteron marina OCP Medroxiprogesteron

30. 13yr old presents complaining of heavy pv bleeding since she started her menstrual cycles which was 3 mths ago. She has bleed for 10days every month. What is next appropriate step. There is no family or personal history of excessive bleeding

a) b) c) d) e)

Full blood count OCPs Coagulation profile Ultrasound Observe for another couple of months

31. Alady presents with a fluctuant, painful, tender swelling in her right brest. She has delivered 2wks ago and is breast feeding the baby. What is the best advise.

a) bj c) d) e)

feed from the normal side formula feed the baby continue to feed from both breasts feed from the affected side after it has been surgically corrected express in the bottle and then feed the baby

32. A 65yr old man presents with abdopain , tenderness, abdo distension, and constipation. He has had appendisectomy long time ago. X-ray erect

abdo was done and showed distended decending, transverse and ascending colon. What might be the likely cause of his presentation.

a) b) c) d)

sigmoid volvulus obstruction due to adhesions ca sigmoid colon psudobstruction

33. 70yr old man presents with history of constipation. He has now developed abdodistension , and localized tenderness with absent bowel sounds. What is the most likely cause

a) b) c) d)

Sigmoid volvulus Ca colon Adhesions Impacted stools

34. A 25yr old lady who is a lawyer presents with loss of interest in her job, she is also irritable and loses temper easily, she has poor sleep and has lost some wt. recently. (Some more thing which suggested she is not herself). She has recently been married and has a very caring husband.

a) b) c) d)

depression PTSD Adjustment disorder GeneralisedAnxity disorder

35. Another stem with the stem mentioning a very flirtasious patient

a) b) c) d)

histrionic Borderline Avoident Antisocial

36. A young man who is an immigrant to Australia presents with yellow cough in the morning, night sweat, wt loss, His chest X ray is given (which shows cavitating lesion in the Apex of left lung). His Montox test is 10cm. What is the best management

a) ATT as per the protocol b) Further tests to confirm the diagnosis c) INH for 6mths 37.what are the likely symptoms a person with Ca Cecum will present with

a) b) c) d) e)

Right side abdo mass Altered bowel habbit Bleeding and mucus PR Tiredness and easy fatiguability Wt. loss

38. Man is brought to the hospital with with agitation, irritability. He is an alcoholic. What will you give him

a) b) cj d) e)

Halloparidol Diazepam Olanzipine Thiamine Another short acting BZ cant remember the exact name

39. A man presents with blow out fracture of the orbit and now complaints of reduced visual accuty. What is the most likely cause

a) b) c) d)

blood in the anterior chamber diplopia vitreous bleed retinal bleed

40. there was a question on prevalence 41. Another question on what type of study has been described.

There are 2 groups and we r trying to study the effect of diabetes in the population

a) b) cj d) e)

RCT Case control Cohort Cross sectional Survey

42. A patient had thyroid surgerg and few hrs after developed stridor what should be your immediate step in managing him

a) b) c) d)

Remove all stitches Take him to theater Intubate him Gall for anastetist

43. A child is found to have lice and eggs in the hair how will you treat this child. Treat with

a) b) c) d)

Benzyl per oxide Permithrin Benzyl hecidine Ketoconizol

44.60yr old man has palpitations, collapses and regains consciousness in a few mins. He is brought to ED and is found to have the following ECG. (complete ECG given with obvious Atrial fibrillations, no 'p' waves in the rethyme strip with no regularity of QRS complexes). His pulse is 1507m and BP is 100/70 What will you give this patient now

a) b) c) d)

Amioderone Digoxin Metoprolol Aspirin

e) warfarin

(1) A patient was on warffarin and a ct scan was given? (a) I found that CT scan was of Rectus sheath Heamatoma (b) Did not remember the other options (2) X ray chest - obvious intestinal loop was there in lung area (a) Diphragmatic hernia (b) Multiple abscess (3) A 16 year old girl came with her older sister for some illness (did not remember what exactly it was), she does not want to inform her parents who do not stay togatehr, now about her illness to whom you will inform? (a) to patient (b) her older sister (c) Her school principal (d) Father (e) Mother (4) A pregnant lady was detected to have down's to her child in all tests they did. At 16 wk usg also it was confirmed. Now patient was again called at 20 wks for further usg, this ultrasound is for what? (a) to detect soft symptoms of down syndrome (b) To detect congenital heart defects (5) Description about sudden painless loss of vision in one eye Picture of CRAO was given (Magnified image) (a) (b) (c) (d) CRVO CRAO Macular degeneration Papilledema

(6) A picture was given - looked like self inflicted injury marks Associated with which personality disorder? (a) Paranoid personality (b) Schiozoid (7) Venous ulcer picture - As per Anthology book

February 2011 Recall Review Hi everybody! I hope you are all doing well - or at least coping! I have identified a little bit of the stem for each question as the numbering for this recall is not great. I have gone in order of how the paper was given to me and also followed the numbering on the recall. Just double check each question with the stem please. The references quoted as JM are from John Murtagh 4th edition and OXF means oxford clinical medicine or clinical specialties. Hope this helps, it took me a long time! All the best

1. 17 year old with shin pain : ANSWER D She is a long distance runner (this explains her BMI to me). Her long distance running suggests the diagnosis is stress fracture, especially as the most common site for stress fractures is the tibia. However the treatment for shin splints or tibial stress fracture is rest and gradual exercise. (JM 1414) The therapeutic guidelines only mention rest as well and NSAIDS for pain. However, as her BMI is low and osteoporosis predisposes to stress fractures I would like to consider bisphosphonates for her treatment now. (also Emedicine said ONE trial showed bisphosphonates to be helpful for managing stress fractures. Not great but its something!) HRT is no longer first line for treating osteoporosis according to Oxford pg 674. Bisphosphonates are for prevention and treatment of osteoporosis. 2. 5 year old boy with high fever: ANSWER C 3. Handbook MCQ 2.034 SCC of the hand 4. A man from Queensland with fever: ANSWER (B) Dengue Fever 5. A 5 year old child with bilateral calf tenderness: ANSWER B Dx acute benign post-viral myositis. It is self-resolving in weeks. Just needs pain relief. 6. A 75 year old lady with constipation since 6 months: ANSWER B She has a history of abdominal surgery hence the answer B. Also the question says progressive abdominal distension. Volvulus would be within hours. 7. A man came to a rural hospital with LOC: ANSWER E 8. An alcoholic man was taken to ED: ANSWER B 9. Patient with hoarseness for 3 weeks: ANSWER C JM page 615. Invasive laryngeal cancer. 10. A man claimed he is going to kill himself: ANSWER B (Facticious) {Malingering primary benefit) 11. Mother worries about her 18month old boy: ANSWER E This is global because peek-a-boo is expected by 8 months and by 18 months the child should be able to say 2-6 words. Head lag, social and speech delays constitute global delay. 12. 18 year old male patient presented with painless scrotal swelling: ANSWER C JM1087. The order for investigating a painless scrotal swelling is ultrasound, serum HCG/FP, CT abdomen, pelvis and chest then surgical exploration. All MUST be surgically explored. Avoid scrotal

needle biopsy because of the potential risk of tumour implantation in the scrotal wall. Avoid scrotal incision for surgery use inguinal approach. 13. 14. 15. 16. Rectus Sheath question unknown SCC - Handbook MCQ 2.034 Parents both have schizophrenia: ANSWER C A 55 year old male with inferior wall MI: ANSWER B Because there is no facility at the regional hospital for PCI, thrombolysis is the answer here. PCI should be done within 1 hour.

17. ECG of Pulmonary Embolism 18. Picture of 65 year old man with left sided parotid swelling: ANSWER B Sjgren syndrome is a systemic chronic inflammatory disorder characterized by lymphocytic infiltrates in exocrine organs. Most individuals with Sjgren syndrome present with dry eyes, dry mouth and parotid gland enlargement. In addition, numerous extra-glandular features may develop, such as arthralgia, arthritis, pulmonary disease and Raynauds phenomenon. Treatment for Sjgren syndrome is largely based on symptoms, but patients must be monitored carefully for the potential development of lymphoma. 19. Inheritance of Thalassemia: ANSWER autosomal recessive 20. Orbital cellulitis: ANSWER CT CT is done to rule out intra-cranial abscess. Also, the antibiotics given should be IV cefotaxime and IV dicloxacillin until the patient is afebrile, followed by oral amoxyclav. 21. 55 year old female patient with cystocele and rectocele: ANSWER C JM page 833-4. Surgery is the best definitive option for her. Pelvic floor exercises will definitely be advised initially but will probably not help her symptoms. Pessaries are for those who are not fit for surgery, awaiting surgery, those who do not want surgery or are young and have not completed their families. If she is asymptomatic then pelvic floor exercises is all that is needed with weight reduction and treatment of aggravating factors such as constipation, menopause and COPD. 22. 17 year old female with 4 cm ovarian cyst: ANSWER A Conservative management for cysts up to 4cm. If larger, then USG guided aspiration. JM page 997 23. A male patient trying to conceive for 2 years: ANSWER B JM page 1108. The first male factor is congentital cryptorchidism. 2 nd is inflammation such as mumps orchitis. Here the option A is not specific for maldescent and also, if he had been operated on for inguinal hernia which is associated with then you assume it was done at the appropriate time before his sperm were affected. 24. Boy aged 12 years complains of knee locking: ANSWER A 25. Handbook MCQ 312 ( not sure which question because could be 3.012 or 3.120 or 3.312) 26. Superficial thrombophlebitis management: ANSWER A Best rest, limb elevation and firm bandaging. 27. 50 years old man with left scrotal pain: ANSWER D

Here the likely diagnosis is epididymo-orchitis and urine culture is required which will show leukocytosis, although it is common for there to be no positive findings in the young. However, the most appropriate next step should Doppler ultrasound. In epididymo-orchitis it shows a high blood flow in contrast to the ischaemia of torsion. 28. A 25 year old female patient diagnosed with Chlamydia: ANSWER A JM page 1129 All sexual contacts need treatment. 29. A 28 year old female patient who is not sexually active: ANSWER B 30. Picture of finger with tophi: ANSWER C The dose is usually between 100-300mg/day. Hence the dose can be increased for this patient. 31. 26 year old female patient fell down while horse riding: ANSWER A This is not a flail chest (no sign of paradoxical ventilation) chest tube Oxford page 754 air travel is an indication for intubation for a patient with pneumothorax. 32. 20 year old male with pain at vertex of scalp: ANSWER C Although there is no lucid interval, there was a large force created by the fall (which caused the helmet to break) and this points towards EDH. Not all EDH present with a lucid interval as the lucid interval represents a re-bleed which may not have occurred yet. His current symptoms of nausea and vomiting suggest that a rebleed has started but not enough to cause a drop in consciousness. SDH usually present with fluctuating consciousness and the force is usually trivial. The neurological deficits and changes in GCS are more acute in SDH. Oxford 474. 1. 18 month old child with URTI and calf pain: ANSWER I feel the answers given are wrong. For acute benign myositis the only management advocated is rest and pain relief. It is self-resolving. All the books and online material support this answer. 2. 50 year old woman underwent cholecystectomy 3 days ago: ANSWER C Anastomotic leak probable. 3. Picture of man with pruritic spots on penis: ANSWER A 4. Woman with reddened lower eyelids: ANSWER A Diagnosis viral conjunctivitis because it usually becomes bilateral, red and causes watering of eyes. Bacterial conjunctivitis will be purulent discharge. Other causes of red eye have more symptoms than these 2. Management: 1. Prevent cross-infection 2. Symptomatic relief such as cold compress and topical lubricants 3. Do NOT pad the eye. JM page 555. 5. A woman 32 weeks pregnant has a child with chicken pox: ANSWER B 6. A Sudanese man with unproductive cough: ANSWER C There is a high suspicion that he has TB. In these instances he will need full anti-TB drugs. You must NOTIFY. Monthly follow-up is needed with sputum smear and culture on each visit. There is NO need for hospitalization 7. Child with Kawasaki: ANSWER A

8. A 22 year old woman who is 8n weeks pregnant: ANSWER A 9. A 70 year old man with HT, DM and irregular pulse: ANSWER B His CHADS2 score is more than 2, hence he is a candidate for warfarin. CHADS2 Congestive heart failure, Hypertension, Age 75 years, Diabetes = 1 point each; prior Stroke or transient ischaemic attack = 2 points. If there are no contraindications 2 points generally indicates warfarin therapy. 10. A 70 year old man with carotid artery stenosis: ANSWER C This patient does not yet qualify for carotid end arterectomy as he only has 50% - 60% stenosis. But seeing that he has a history of TIA, hypertension with atrial fibrillation he would need warfarin therapy to prevent cardiac embolisation. 11. 68 year old with sigmoid colectomy: ANSWER A 12. Woman who underwent bowel obstruction operation A 13. A woman with previous history of premature delivery: ANSWER B The first investigation for threatened preterm labour on Royal Womens is the fibronectin levels. A negative result indicates that the woman is most unlikely to proceed to labour and birth. 97-99% of women testing negative for fFN will not give birth within 7 days. Fetal fibronectin is a substance produced by the uterus during pregnancy. It is normally found in vaginal fluids at term but not before this time. The presence of fetal fibronectin in vaginal fluid between 22 and 34 weeks gestation may predict the onset of preterm labour. Prior to 20 weeks it is considered a miscarriage. 14. A 15 year old boy with sudden outburst of anger: ANSWER D Diagnosis: Autism. Aggression and irritability can be a feature of autism, especially during adolescence. JM page 497. As this question is asking for the management of the anger, Haloperidol is used as a sedative for the anger. The question is not asking for treatment of autism. He has been diagnosed and has been in a special school, presumably since childhood. JM page 917 15. An old woman with early morning headache: ANSWER A She has a low grade temperature hence abscess must be considered. Abscesses and tumors may look similar because of the ring enhancing mass, surrounding vasogenic edema and mass effect. OXF 732 16. Lady with fatigue ANSWER A 17. A child with bitemporal hemianopia: ANSWER B A craniopharyngioma is a benign tumor that develops near the pituitary gland. This tumor most commonly affects children 5 - 10 years of age. The most common presenting symptoms are headache (5586%), endocrine dysfunction (66-90%), and visual disturbances (37-68%). Optic gliomas are rare but can also present with bitemporal hemianopia if the tumor is at the chiasma. Otherwise it presents with unilateral signs. Medulloblastomas are cerebellar tumours and will present with cerebellar signs. 18. Metastasis to the ovary: ANSWER C Handbook MCQ 3.221 answer will apply here. But they have not given colon as an answer so the best option is to pick breast cancer. 19. A woman with right supra-clavicular LN: ANSWER B

Although she is female, small cell carcinoma of the breast is an uncommon neoplasm. It would be more likely that the SCC cells are from a lung carcinoma. Lung cancer is more common than breast cancer as well. 20. 18 month old boy: ANSWER - avoid smoke exposure 21. 10 week old baby presents with apnoea: ANSWER A Although the likely cause of death is sudden infant death syndrome, every case must be seen by a coroner for autopsy. JM page 941 22. A man with symptoms of OCD: ANSWER A 23. A 92 year old man who is admitted after MI: ANSWER - A MMSE is only a screening tool. The steps are as follows for assessing an elderly who you suspect has dementia: 1. Full medical history 2. Mental state examination (note: this is not MMSE, it comes under psychiatric examination) 3. Physical examination 4. Investigations. After these steps, if he has been declared medically unable to make decisions you contact the medical board. 24. A 16 year old girl requires emergency surgery: ANSWER - A 25. A 80 year old woman who tried to open a window: ANSWER C This is needed to look for spinal cord compression 26. Urgent sign in acute limb ischaemia: ANSWER B Pain is a misleading sign of improvement. The most ominous is paralysis and muscle compartment pain or tenderness. JM page 716 27. Fundoscopy picture: ANSWER A 28. Fundoscopy picture: ANSWER - C I think the person mistook emboli for haemorrhages as it would be hard to see emboli on the retina. It could be diabetes or central retinal vein occlusion with haemorrhage. 29. A woman with features of refusal to go out in public: ANSWER A (?) not a life threatening condition! 30. Achalasia cardia long-term management option: ANSWER B The best long term management is pneumatic balloon dilation or cardiomyotomy (NOT pyloromyotomy) Botulism is only if invasive methods are not possible. OXF page 232. 31. Picture of a man with gradual swelling in the neck: ANSWER A Diagnosis is SVC obstruction. This most commonly is secondary to a lung cancer. 32. A 22 year old man with abdominal pain and purpuric rashes: ANSWER HSP 33. A man with symptoms of upper and lower limb proximal muscle weakness: ANSWER A 34. A case of myasthenia gravis with diplopia: ANSWER A Tensilon test is initial test - OXF 504

35. A child with GBS: ANSWER A 36. An old lady with carcinoma caecum: ANSWER A JM page 240 and 439-40. These symptoms are a result of anaemia. 37. A 5 year old child previously toilet trained: ANSWER A It is secondary to anal fissure. 38. A man with symptoms of auditory hallucinations: ANSWER A 39. A picture of lung with metastatic lesions 40. A picture of left sided pleural effusion: ANSWER A The left-sided pleural effusion points to a mesothelioma. JM 535. (Hx of smoking + mining 1. Bronchial ca 2. Mesothelioma) 41. A 80 year old man with MI on clopidogrel for emergency surgery: ANSWER A 42. A 80 year old woman with dribbling urine on coughing: ANSWER C 43. A man on warfarin scheduled for elective cholecystectomy: ANSWER A 44. A girl who visited SE Asia 6 months ago now has symptoms: ANSWER C Although she returned from SE Asia 6 months ago she is only having symptoms NOW. This is very unlikely to be the clinical picture with A and B. Giardia lamblia in the chronic setting, can cause diarrhea for more than 3 weeks. But it presents with abdominal cramps, bloating, foul smelling faeces and flatulence. The triad of diagnosis for coeliac disease is diarrhea, weight loss and iron deficiency. This option seems to fit much better than the others. However, Giardiasis can mimic coeliacs disease. * If the question did not state NOW, then I would choose Giardia Lamblia. JM 474-77. 45. A woman with haemochromatosis and massive ascites: ANSWER B Diagnostic triad for haemochromatosis = lethargy, tiredness and arthralgia. JM 167-9 1. Key diagnostic sensitive markers are serum transferrin saturation and the serum ferritin levels 2. CT or MRI is used to show the iron deposition in the liver. So this is the best answer here. 46. A man with symptoms of PE: ANSWER A 47. A 60 year old woman with haemoptysis in childhood: ANSWER A OXF page 162 48. A 70 year old female with ECG looking wide QRS: ANSWER D 49. A man on treatment with warfarin and on roxithromycin: ANSWER C Usually we always say stop the offending agent as the answer for questions asking for NEXT step. But according to the guidelines, when the INR is even more than 4 we should withhold warfarin. So it seems odd picking option stop roxithromycin for this question. It is up to you to decide on this one.

Patients with an INR between 6-9 should be given vitamin K 1-2.5 mg subcutaneously or orally. More than INR of 9 needs hospitalization, vitamin K 5 mg IV or subcutaneously, fresh frozen plasma 2 Units and recheck INR in 6 hours. Many interactions are unpredictable, so the INR should be tested more frequently after starting a new medication and similarly when stopping a medication or changing the dose. It takes about five days for enzyme induction to take place, so that an INR measured about one week after a change in medication should reflect any interaction. In one study, recent antibiotic use was the second greatest risk factor (after age) for over-anticoagulation. For this question use the information I have given you above if you are not happy with my answer. Refer to http://www.australianprescriber.com/magazine/24/4/86/9/ if you want to! 50. Dehydration fluid management: ANSWER - A 51. Indication for ERCP: ANSWER A A common bile duct more than 7mm suggests obstruction. More than 11mm is strongly suggestive of obstruction by stone or a tumour. 52. A 65 year old woman with obstructive jaundice and palpable gall bladder: ANSWER A A distended gall bladder may be palpated under the right costal margin and this sign in a patient with painless obstructive jaundice is strongly suggestive of a malignant pancreatic cause. This is Courvoisiers Law. (Tjandra page 144) A PAGE MISSING HERE!! THE NEXT QUESTION I HAVE IS 58. 58. Wernickes Encephalopathy: ANSWER B This is urgent administration to avoid Korsakoffs encephalopathy. OXF 706 59. A man with previous history of being extremely rude: ANSWER - A 60. A woman with shoulder dislocation 61. A man with trauma to the knee while playing rugby: ANSWER D 62. A case of sepsis after hysterectomy: ANSWER C 63. A case of puerperal sepsis in 30 year ols female: ANSWER C Therapeutic guidelines 64. A man with DM, HT and on ACE inhibitors, thiazides, beta blockers: ANSWER A 65. A case of severe croup: ANSWER C JM page 937 66. Contraindication to tocolytic therapy: ANSWER Options missing A PAGE MISSING HERE!! *MY PAPER GOES STRAIGHT TO QUESTION 75 NEXT [From Ekaterina]: 67: a

68: probably DU 69: a 70. {She answered LSD based on JM/ 204- but I searched the net and tactile hallucination is a part of cocaine toxicity} its up to you! Choose whatever you want! 71. a pincer grasp: 9-15 m Babbling: 8 m 10 months: 2 words (without meaning) 12 months: 1-3 words 72. e 73.e 74. CABG: 1. Triple vessles 2. 2arteries + DM 3. Mainstem stenosis 4. PTCA cant be performed Back to Sharans answers: 75. A lady with superficial inguinal LN showing SCC: ANSWER A Explanation given in the Handbook MCQ page 484 (Q 3.149) 76. A man with symptoms of urinary retention: ANSWER B HMCQ-p 485 (Q 3.151)

77. A girl who is 19 years old and wants to start a sexual life: ANSWER A ??? JM page 1129 78. A mother with a child who previously had oedema of the legs after a vaccination: ANSWER C /???? Anaphylaxis (?) is an absolute contraindication for repeating a vaccination. If it is not repeated, and the only issue was the temperature, then the vaccination can be given. Only if the temperature is more than 38 then you withhold the vaccine. 79. A child with grade 4 VUR: ANSWER A 80. A 52 year old woman who had an aunt with breast cancer: ANSWER A MCQ handbook page 629 (Q 3.395) 81. A 70 year old woman with COPD: ANSWER B 82. A child with symptoms of haematuria after 2 days of URTI: ANSWER A 83. A 45 year old male smoker with HT, DM, hyperlipidaemia: ANSWER D JM page 93. Nutrition and weight control is first for health promotion. 84. Normal grief reaction: ANSWER A 85. Efficacy of a vaccine study: ANSWER A 1. 35 year old male with splenectomy a year ago: ANSWER C

2. 27 year old man presents with diarrhea and bloating: ANSWER B 3. MCQ handbook Q 3.015 right 3rd nerve palsy ( page 389 HMCQ: left 6th nerve palsy) [May 2011 as well] 4. 50 year old man with history of surgery now presents with hoarseness: ANSWER C 5. 4 year old present with BMI 18: ANSWER E JM page 850 and 876 6. Child born at 32 weeks with weight 1.6kg: ANSWER D For the first 4 months he should have put on 3 kg. For the next 2 months he should have put on 500g/month = 1 kg. So in total it would be satisfactory if he was 5.6kg now. So he has been gaining well as he is 6 kg.

7. 40 year old man who is a smoker has claudication: ANSWER A Most appropriate is to rule out ischaemia. Neurogenic claudication pain is exacerbated by standing erect and downhill ambulation and is alleviated with lying supine more than prone. If it were neurogenic claudication then MRI would be the imaging of choice. 8. Picture of the back of the hand with tophi: ANSWER A 9. Picture of CT brain: ANSWER D 10. A man presents to ED with history of threatening to kill himself: ANSWER A

Obs & Gyn (form Ekaterina)

PDF: page 30 11. Cord collapse: suspect if severe bradycardia or severe variable deceleration after rupture of memberane Mx: if fetus is dead-- can await delivery If fetus is alive--- look at the stage of labour 1st stage: 1/ place woman in knee to chest position 2/ stop oxytocin (if present) immediadte delivery// C/S nd 2 stage: (fully dilated) Primy para: C/S Multigravida: instrumental delivery (head at spine or below)

Instrumental delivery: [RWHG]

NOT IN THE FIRST STAGE

Indications: fetal distress [(CTG or PH measurement) + stage 2] Placental abruption at the 2nd stage Cord collapse (second stage) [multigravida] Maternal indications: avoid strong pushing HTN

Inadequate progress

Normal duration for stage 2: Stage 2 Without epidural With epidural nullipara >2 >3 multipara >1 >2

Criteria to use: cervix fully dilated Membrane: ruptured Head at level of ischial spine or below Forceps: Outlet: fetal scalp is visible (out) Low: leading point (lowest point) of skull below station (+2cm) and not on pelvic floor Mid: leading point of skull below 0+2 station [fetal head palpable no more than 2 cm per abdomen] For premature: forceps not vacuum

Prior assisting delivery: Primi: use oxytocin Multi: no oxytocin------- increased risk of uterine rupture 12. A moulding and caput dont mean obstruction Transverse lie/ position----- C/S (not rotational forceps) Oblique: forceps/ vacuum placenta abruption- fetus dead- amniotomy Normal- observe ovarian failure FVC in 6 second then ABG {for monitoring GBS} bloody diarrhea- UC (more than CD)

13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29.

C C A A A A B B A C

Ingunial Hernia- JM: rules of 6-2 A for Cat scratch-- JM/1379 Tx: doxy/ erythro/ roxithromycin C [ this was a question in May 2011 as well] no radio ablation among options In WPW ------ Neither verapamil nor adenosine, nor metaprolol nor Digoxin. Because they block AVN B MRI B E (tennis elbow) D C

30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44.

A C ? A A A A anti-TB treatment D (came in May 2011 as well) B (withdrawal - Rx: diazepam) ? D A B A