September 2011

Medicine
1. A man was scratched by a cat and there is a red rash extending from arm to forearm. no tender lymphadenopathy. A) Cat scratch B) Cellulitis 2. A 20 year old man presented with weakness of the left arm. On examination the left arm is oedematous. His axillary lymph nodes are enlarged but not tender. He also reported that his pet cat is unwell. What is the cause? A) Cellulitis b) Axillary vein thrombosis C) Cat Scratch fever 3. A case describing cellulitis. which the most common organism? a. staph b. strepto pyogen 4. Patient clinical features: chemosis, blurring of vision, painful, photophobia, pupils semidilated fixed and irregular when compared to the other side. He has been having similar attacks in the past. What is the long term management of his condition? (A) Acetazolamide (B) Pilocarpine (C) Trabeculectomy (D) Peripheral iridotomy (E) Sotalol 5. A picture shows a patient with chemosis, congested red eyes. He also has history of recurrent genital and aphthous ulcers. What's the treatment of this condition? (A) Amoxicillin (B) IV prednisolone (C) Oral prednisolone (D) Antiviral (E) Chloramphenicol drops 6. 65 year old male patient comes with typical chest symptoms and temperature 37.8C. ECG was given, shows anterior lateral MI. (The stem didnt mention anything about the initial MI MONA treatment). What is the next most appropriate management? (A) PCI (B) IV GTN (C) IV Prothrombin 7. 52 year old male patient, onset of chest pain 1 hour ago, was brought to the hospital. ECG was given s/o an anterior inferior MI. GTN and O2 were given immediately. Tertiary hospital is 3 hour away. What is the next step in management? (A) Transfer for PCI (B) IV streptokinase 1 Sept. 2011

8. 35 year old nurse working in a rural hospital, smokes 40 cigarettes a day. Presented with productive cough, sweating, malaise, other GPE was normal, temperature was 37.8C. (A) HIV (B) TB (C) Pneumonia (D) Bronchial carcinoma 9. Pyloric Stenosis: USG done. Whats long term management? A. Pylorymyotomy B. Endoscopy 10. Diabetic foot, Tx: A. Gentamycin with metromedazole B. Doxcy C. Erythmycin 11. 18 year old present with thirst, polyuria (4-5 Litres per hour), normal 24 hour urinalysis, urine osmolality (?), urine sodium 137mmol/L. A. Diabetes insipidus B. SIADH C. primary polydipsia 12. 65 year old diabetic patient complains of two days history of pain in lower limbs with redness, tenderness in calf, absent pulses in ankle with reduced sensation below knee? A. Cellulitis B. Embolism C. DVT 13. Picture of amoxicillin induced rash. Patient with sore throat on amoxicillin developed the rash in picture. Next step in management? A. Stop amoxicillin B. Penicillin IV 14. 55 year old male with complain of 30 pack years of smoking, mine workers now complains of cough, Dyspnoea, pleural tap is blood stained, what is the diagnosis? A. Mesothelioma B. SCC C. Small Cell Ca of Lung 15. 60 year old male with redness scrotum and pain, whats the next best investigation? a. USG b. urine culture c. FNAC 16. 50 year old male with C/O severe right eye pain, whats best treatment? a. paracetamol b. Sumatriptan c. High dose steroids. 17. Normal looking X-ray, H/O green sputum, cough and occasional blood. WOF is best long term Rx? 2 Sept. 2011

a. Tetracycline for ? b. Anti-TB Rx c. Physiotherapy d. Reassure. 18. X-ray of upper lobe (L) cavity. Pt form Vietnam. What is the best Mx? a. Anti-TB for 6 months b. antibiotics c. CTPA. 19. A long stem regarding the wrist and finger movements. Patient cannot extend wrist and fingers. All other small muscles are normal, where do you think the lesion is? A) Median N B) Ulnar C) Posterior interossei D) Ant interossei E) Radial nerve 20. An old man was found wandering in neighbourhood, with poor attention to self care, forgetful. He was well 2 weeks ago, no h/o trauma, drinks alcohol occasionally. What is the best diagnosis? A) Lewy body dementia B) Vascular dementia C) Alzheimer dementia D) SDH E) SAD 21. Stem similar as above, but forgetful for past few months, now acutely disoriented in the past two weeks. He is living alone, no trauma, moderate alcohol. Dx: A) Lewy body dementia B) Vascular dementia C) Alzheimer dementia D) SDH E) SAD 22. Stem similar as above, but now more acute disorientation for 2 days. A) Lewy body dementia B) Vascular dementia C) Alzheimer dementia D) SDH E) SAD 23. A poor quality CT scan was given, which shows one bowel lumen on left side with a fluid level. patient has h/o pain. Clinical features: bloating and no bleeding. Dx: A) Diverticulitis B) Appendicitis C) Some other options 24. Patient comes with cough with expectoration. His sputum is greenish with occasional blood. WOF is the long term Rx for the condition A) Tetracyclines for 9 months 3 Sept. 2011

B) Anti TB RX C) Physiotherapy D) Reassure 25. 65 yrs old man comes with complaints of loss of ankle and knee jerk. He has a h/o Gastrectomy few years back. His blood test results are as follows: Hb 109 RBC 3.5 WCC 4.5 Platelets 180 MCV 110 MCHC 27 What is the most appropriate diagnosis? A. Iron deficiency anaemia B. Age related anaemia C. Vit. B-12 Deficiency D. Alcholism E. Hypothyroidism 26. 45 yrs old smoker comes with complaints of Rt. Eye ptosis, Vertigo, loss of sensations on the lower half of face, b/l visual blurring, ataxic movements Rt.hand and foot. O/E there is sensory loss of the Rt.upper and lower limbs. What is the most appropriate reason? A. Rt. Anterior communicatinr artery obstruction B. Horners syndrome C. Rt. Vertebral artery Thrombosis D. Post Cerebral artery E. Temporal Arteritis 27. A 35 yrs old smoker comes to you with complaint severe hematemises and epigastric pain for the last 3 hrs. His BP is 80/50 and HR 110. After resuscitating him with 2 Litres of normal saline. Which one of the following will alleviate his condition? A. Oral Ranitidine B. I/V Omeprazole C. Adrenaline I/V D. Long term PPIs 28. 80 yrs old pt. came to ED with complaints of Dysuria, Nocturia and recently developed Back pain which is getting worsening by each week. Following investigations: Hb. 90 RBC 3.1 WCC 5.0 ALP 300 PSA 10 (<5) What is the most probable cause? A. BPH B. Prostate Cancer C. UTI D. Renal Calculi

Sept. 2011

29. 55 yrs old pt. Known case of Rheumatoid Arthritis on long term treatment on Methotrexate weekly, Celecoxib, Ca+Vit D analogues developed ill health, Anorexia and generalized discomfort. On investigating: Hb 85 RBC 3.0 WCC 3.5 Plat 30 ALT, AST both High What is the most appropriate diagnosis? A. Autoimmune Hepatitis B. Cirrhosis C. Methotrexate induced Hepatitis D. ITP 30. 80 Yrs old lady with h/o Hypertension, DM. She is on Amlodipine, Enalapril, Metformin. She is having difficulty from rising from the chair for the last few months which was previously ok. All physical examination is normal. What can be done for her? A. Send her for Psychiatric analysis B. Put Brick under her chair C. Motor neuron disease D. Diabetic neuropathy 31. 45 yrs old Business came for the Medical examination for Insurance Company. All his investigations were normal except ECG (it was of A.fibrillation?). Which one of the following is most beneficial for his long term treatment? A. Warfarin B. Aspirin C. Digoxin D. Amiodarone 32. A fundus picture of arteries occluded with emboli, 55 yrs old pt. presented with few episodes of Visual Blurring. Which investigation is most beneficial in diagnosing his condition? A. Urgent CRP and ESR B. Carotid Doppler Duplex Studies C. MRI brain D. Trans esophageal Echo 33. A Young Female patient comes with long standing history of hypertension. O/E She has absent peripheral pulses. What is the most appropriate diagnosis? A. Aortic Aneurysm B. Vasovagal Shock C. Takayasus Arteritis 34. Which condition is not associated with Lymphomas? A. Sjogrens Syndrome B. Infectious mononucleosis C. Wegners Granulamatosis 35. A young male patient came with Complaints of recently occurrence of joint pains, hematuria and abdominal Pain. He has H/o Tonsillitis 2 weeks back for which he was treated

Sept. 2011

with antibiotics? He has also developed purple nodules on the buttocks. Which medications you would like to prescribe for his abdominal pain? A. NSAIDS B. Omeprazole C. Corticosteroids D. Bowel loops dilators 36. A 50 yrs old pt. long standing Diabetic came with rt. Ankle swelling and pain one month. She has no symptoms of CCF. On X-ray there is increased joint space and Peri-articular thickening along Metatarsals. Cause? A. Diabetic Amyotrphy B. Gout C. Osteoprosis 37. A 32 year old fit healthy male comes to you after an accident. He is a motor mechanic and presents to your clinic with a deep penetrating wound which he sustained when he fell against the dirty metal plate of a car he was repairing. He has received his 3 tetanus shots and the last one was 3 years ago. After appropriate wound debridement what else would you do: a. Give him a booster dose of DTP b. Give him a booster dose DTP and Tetanus Immunoglobulin c. Reassure and advice regarding wound care d. Give him Tetanus immunoglobulin e. Ask him to come a week later for a booster of DTP 38. An elderly lady presents with complaint of loss of central vision in her left eye and lines appear wavy to her. Fundoscopy image is given. What is the diagnosis? a. b. c. d. e. Retinal detachment Cataract Macular degeneration Glaucoma Diabetic retinopathy

39. A lady presents to you with complaints of floaters and fall in visual acuity. What is your initial treatment? (An picture was given the question and options are exactly the same as written) a. Pilocarpine drops b. Acetazolamide c. Atropine d. Chloramphenicol e. Retinal reattachment 40. Which of the following is the least likely presentation in a patient of Temporal arteritis. a. Headache b. Visual loss c. Elevated ESR 6 Sept. 2011

d. e.

Fever Jaw claudication

41. An old lady who had a hysterectomy done years ago now complains of lower back ache in the lower lumbar region. Her WCC and platelets are reduced. MRI given. What is your diagnosis? (similar as this one) a. Multiple myeloma b. Osteoarthritis c. Ankyolsing spondylitis d. Osteoporosis e. Spondylosis of L5

42. A man from North Queensland, recently returned from an overseas holiday presents to your clinic complaining of fever, peri-orbital pain, joint pain, lymphadenopathy and rash over the body. What is the most likely diagnosis? a. Leptospirosis b. Dengue fever c. Ross river fever d. Brucellosis e. Malaria 43. An 82 yr old lady living on her own is being treated for hypothyroidism by you. You have prescribed her Thyroxine in titrations of 75 microgram. On follow up after a month the TSH level is elevated and T3 and T4 are decreased. What is your next best step? a. Enquire about adherence to dose and medication b. Ask her to come after a month for follow up c. Increase the dose of thyroxine d. Follow up after a week e. Do blood levels after the next dose 44. A known case of Rheumatoid arthritis who is being treated with sulphasalazine is now pregnant? How will you manage her? a. Continue sulphasalazine b. Replace sulphasalazine with Azithromycin c. Methotrexate d. Paracetamol e. NSAIDS 45. A female presents to your GP clinic with complaints of arthralgia and dry eyes. She also complains of dry mouth and cough. On examination there is salivary gland enlargement. Positive ENA and Ro(SSA). How will you manage the patient? a. Paracetamol 7 Sept. 2011

b. c. d.

Allopurinol Hydroxychloroquine Colchicine

46. What is the most common cancer in non-smokers. a. Squamous cell carcinoma b. Small cell lung carcinoma c. Adenocarcinoma 47. How do you monitor lung function in GBS patient? A PEFR B FVC C FEV1 D O2 SATURATION 48. A man working in the mine industry for 20 years. He had chest pain and dyspnea. CXR as below. What is the next step in management?

a. CT scan b. Bronchoscopy c. Pleural biopsy d. ABG 49. Man is brought to the hospital. He is agitated and irritable. He refuses to co-operate. What will you give him? A haloperidol B diazepam C olanzapine D thiamine 50. A driver from interstate has moved to your locality recently and is stable on lithium for the past 15 years. How do you monitor him? a. Check lithium levels every 3 months 8 Sept. 2011

b. Check lithium levels every 6 months c. Check lithium levels every month d. Do full blood count 51. A man present to ED after having lacerated wound. The fat tissue is seen. He has been immunized 9 years ago. Which one of the following should be given for his wound management after you did debridement? a. Tetanus toxoid and TIG b. Penicillin G c. Tetanus immunoglobulin alone d. ADT 52. Patient with sudden weakness in one side of face including forehead muscles and no other neurological signs, what would you do next for investigation? a. Brain MRI b. Brain CT c. No need for more investigation 53. 60 y.o man comes with severe sudden chest pain and sweating. ECG, chest x ray and Troponin level are normal. Whats the next step in management? a) Check troponin again in 8 h b) Admit patient to ICU c) Discharge pt with B Blocker and Aspirin. d) Discharge pt without any drug 54. While playing cricket, a man was hit in the eye. On examination there is hyphaemia in the ant chamber. What will you do next? a. give analgesic, and ask him to go to GP tomorrow. b. refer to ophthalmology immediately c. refer to Ophthalmology the next morning d. Reassure that hyphaema is likely to subside in a week. 55. A 75 years old lady with constipation since 6 months. She has h/o using senna and appendicectomy. O/E: progressive abdominal distension. Picture as below. What is the most likely diagnosis?

a) Sigmoid volvulus 9 Sept. 2011

b) Small bowel obstruction c) Large bowel obstruction

56. PIC of a lesion shown as below. What is the treatment?

PIC as below. What is the diagnosis? A. Arterial ulcer B. Venous ulcer C. Diabetic ulcer

57. Pic as below. What is the management? A. cold compress B. chloramphenicol ointment C. acetazolemide D. acyclovir

58. Picture of eye. Bacterial conjunctivitis. Management is? A. Gentamycin eye drops B. cold compress C. Chloramphenicol eye drops

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Sept. 2011

59. Picture of eye (everted lower lid, congested conjunctiva), A. Surgical Manipulation B. Antibiotic eye drops C. Cold compression 60. Picture with old man with red eye, excessive lacrimation. What to do next? a. Cold compress b. Antihistamine c. Steroid eye drops 61. Visual field defect as below. Where is the lesion?

a. temporal lobe b. optic nerve c. parietal lobe d. optic chiasma 62. A picture of visual field was shown. Where is the lesion most likely to be? A) Optic chiasm B) Optic nerve C) Parietal lobe D) Temporal lobe E) Cortex 63. Pt who has small cataract, peripheral visual field defect and small pupil next step management is: a. measure intraocular pressure b. slit lamp 64. 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 next appropriate management? a) MRI Knee b) CT knee c) Aspiration joint d) X-Ray joint e) Arthroscopy 65. A man with symptoms of difficulty in plantar flexion ,inversion, dorsiflexion and eversion of the foot. Knee reflex is present. Which of the following is affected ? a) Common peroneal nerve b) L5 c) S1 d) Sciatic nerve e) Tibial nerve

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Sept. 2011

66. 45yr old man, smoker presents with complaints of pain in the thigh and calf on walking 100m. The pain is relieved by resting. The pain appears at 20m with walking on uneven surface and on inclination. What is the most appropriate next step in investigation? a) Arterial angiogram b) CT spine c) MRI lumber spine d) Venous Doppler e) ABI 67. A 38 yr old lady presents with secondary amenorrhoea for 12 months. Her blood results: FSH 50 (high) Ostradiol (low) Prolactin (normal) TSH (normal) What is your diagnosis? a) premature menopause b) pituitary adenoma c) PCOS d) Pregnancy 68. What is the best long term management in a pt. with glaucoma? a. pilocarpine b. acetazolemide c. iridotomy d. trabeculectomy 69. Patient presents with difficulty in extending fingers. Small muscles of the hand are intact. There is no wasting. Where is the lesion? A. ulnar nerve B. median nerve C. radial nerve D. anterior interossei nerve E. posterior interossei nerve 70. Patient presents with a swelling in the midline of abdomen between xiphisternum and umbilicus. Which is the best position to examine him? A. cough while standing B. cough while lying supine C. lift head while supine D. flex head while supine 71. CT Scan as below. Patient on warfarin for A.F. Was given roxithromycin for URTI. INR 4.9. Patient has weakness in arm since few days. What is diagnosis? A. cerebral infarct B. cerebral haemorrahage C. brainstem stroke D. subdural hematoma

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Sept. 2011

72. Patient post cholecystectomy noted palpable mass in midline. a. Cough when lying b. Cough when sitting c. Ask patient to voluntary raise hand d. Passive raise patients legs 73. Pt 47 years old, drinks about 6 STD alcohol per day presented with tender Rt hypochondria, hepatomegally 3 finger below costal margin, ascites. What is the most common cause: a. fatty liver b. alcoholic liver cirrhosis 74. Pt has DM presented with MI his coronary angiography revealed LAD tow stenotoic lesion and one lesion in CXL the next appropriate management is: a. diluting stinting b. coronary bypass graph c. Thrombolytic 75. Infected Bartholian gland treated by: a. surgery b. antibiotic c. resolve spontaneous 76. Pt 25 years brought to EM department in agitated state on examination febrile, needle marker, murmur, next appropriate management is: a. transeosophageal echo b. blood culture 77. Pt work in the mining presented cough, CXR picture Lt pleural effusion, the diagnosis is : a. sequamouse cell carcinoma b. mesothelioma 78. Pt 85 years presented with RT tight and leg pain after fall, the picture fracture of the head of femur. Her investigate creatinine .15, ca 3.5, urea10 most commonly cause: a. osteoporosis b. Vit D toxicity c. Primary hyperparathyroidism d. hypercalcemia secondary to malignancy 79. Pt has bone pain due secondary metastasis which well control by oral morphine 10 ever 4 hours and he took metaclopramid tablet 10mg every (?). He developed intractable nausea and vomiting. which next appropriate step? a. reduce morphine to every 6h b. cease morphine for few days c. increase the metaclopramid to (?) 80. Pt with pain during eaten in mouth, picture (submandibular gland enlarged) cause: a. Submandubilar calculi 81. Pts has HPT on thiazid 25mg, aspirin, B blocker, presented with polydipsia, polyuria. His blood glucose 17mmol/l next management: 13 Sept. 2011

a. Cease thiazed and reassess after b. start insulin immediate 82. Pt on warfarin, INR 4.5, CT reveals intracranial haemorrhage. Next step in management is: a. FFP b. prothamine sulphate c. Vit.k IV 83. Pt has diluting stent and he is on aspirin, clopedgrile presented with irreducible inguinal hernia, which become tender next step management: a. reduce and observe b. stope aspirin and clopedegril one week before surgery c. surgical immediately 84. Pt from Sudan as visitor presented with non-productive cough for 2 months, loss of weight 3kg. next step of management a. isolated in hospital b. isoniazid c. rifmp+ethamp+ison+pyrt 85. Pt has history of road traffic accident and Lt Thoracotomy with mammogram picture of Brest calcification most common cause? a. adenocarcenoma of Brest b. fat necrosis 86. Pt known to have COPD on 8 liter O2. his condition deteriorated, become breathlessness. ABG: pH decreased, PaCO2-increased, SaO2 85%. Next step in management is: a.) Lower Oxygen to 2 liter b.) Increase oxygen c.) CPAP 87. Pt presented with obesity (BMI=33) after trying exercise and diet control without any benefit next step in management is a. liposuction b. restrict diet control c. medical treatment (...) 88. Pt known case of HPT well control on prindapril (ACEI). his cholesterol level=6.5 with low HDL, high LDL. next step in management is to protect this pt from stroke is: a. Exercise b. start simvastatine c. fibronate 89. Lady 24 years old come to ask you,as her friend has glandular fever, O/E she has enlarged tonsil and submandibular lymph node enlarged, her investigations are given ,the clear abnormality is lymphocytosis,also IgG+,IgM- for infectious mononucleosis. She infected with a. viral pharyngitis b. streptococcal infection c. infectious mononucleosis

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Sept. 2011

90. Principal of the school is misbehaving with the kids with sexual remarks, colleagues are concerned and speak to him but he doesnt care. He cannot change the topic when talking to someone but hygiene is good. Which of the following will help to diagnose him? a) Ask him to remember last 3 numbers. b) something about the 3 sentence rule c) Ask him the name of prime mister of the country. d) some even more stupid option 91. Patient being taken to the Operation theatre and suddenly develops sort of allergy/hypotension. Cause? a) Latex b) Unknown medicine given to him c) anxiety 92. A 45 year old woman is presented with abrupt left eye blindness and right hemiparesis (the stem was not that clear but the patient is symptomatic). Right carotid Doppler shows 50% stenosis and left side shows 60% stenosis. What is the next appropriate management? A) left carotid endarterectomy B) ASA C) warfarin 93. Old patient with abdominal pain, constipation, what is the cause? X-Ray is given (you can see the gallbladder stone) A) Mechanic bowel obstruction B) Sigmoid volvulus C) Pseudo obstruction 94. Picture of ingrown nail. What is the management ? A) Local exision B) Wedge excision C) IV injections 95. A young girl syncope while playing hockey in the field. Father died suddenly 25 years ago. What's causing the symptom? A) HOCM B) Drugs C) Cerebral problem d) Meningitis 96. Young girl was jogging and sudden LOC. A passer-by perfomed CPR. At ER, patient has stable VS. Father died at 28 y/o, whats next management? a. Echocardiogram b. ECG c. CT head d. CXR e. Troponin 97. A young adult presents with history of sudden syncope and dyspnea. ECG findings show sign of LVH. Patients father had a sudden death at a very young age. Initial treatment? a. Verapamil b. Septal myomectomy 15 Sept. 2011

c. d. e.

Defibrillation LMWH Adenosine

98. An Obese lady (it mentions obese) with problems of DM and Hypertention, says how many medicine she is on for DM and Hypertension. Her last menstruation was 3 weeks back. She came to the hospital because she her Bp is 140/95. What is the management? a) recheck her tablets/medicines
b) Ask her to lose her weight

c) some HT medicine d) Do bHCG 99. Toxic shock syndrome caused by Staphylococcus Aureus is associated with: A) Super-absorbent sanitary pad B) Endotoxin production 100. A young patient of 20 years came in to the ED with Afib and he had similar episodes 8 years back, what will you do? a) Cardioversion b) Metoprolol c) Warfarin d) Digoxin 101. A long stem about a patients history about working in mine for 30 years with 50 pack cig in 10 months. Then an picture was given of abdomen with little protruding and vesicles/veins visible! a) Mesothelioma b) CA Stomach 102. A MCQ absolutely same regarding a lady travelling by air and with flu like symtoms, diarrhea and crackles on the base of the lungs. Dx: a) Pneumonia b) H1N1 c) PE 103. Psoriasis: what is the best long term management/treatment? a) Tar b) Methotrexate 104. Pt with DM HTN with INR 4.9 RIF pain, CT show Retus shleath Heamatoma. a) Give FFP 105. Old male patient h/o jaundice with dark urine (no mention of pale stool) and mass was present in the right upper abdomen with move with respiration has no h/o alcohol intake, what is the most probable cause for this presentation? A) Cholangitis B) Mucocele of gall bladder (I choose you) C) Cholecystitis D) Choledocholithiasis E) Ca pancreas

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Sept. 2011

106. Old woman patient h/o jaundice with dark urine, pale stool, and mass was present in the right upper abdomen with move with respiration. Dx: A) Choledocholithiasis B) Cholecystitis C) Ampullar vater (I chose you) D) Mucocele of gall bladder E) Cholangitis 107. Man from Sudan coming with c/o cough for 1 month. Greenish sputum and haemoptysis. Most appropriate management? a) Isoniazid b) Isoniazid, Pyrazinamide, Rifampicin, Ethambutol c) Amoxicillin 108. Picture of man with blocked nasolacrimal duct. Patient c/o watering of eyes. Most appropriate Mx? a) plastic surgery referral b) antibiotics 109. Construction worker c/o watering of eyes & redness after hamerring a nail at work. Mx? a.) Antibiotics b.) Local anaesthetic and probe the eye 110. 83 yr old woman c/o redness of eyes & blurring of vision. Mx? a.) Dilate pupil & fundoscopic examination b.) Slit-lamp examination 111. Mouth ulcers in patient with RA on Celecoxib. Mx? a.) Folic acid b.) Cease Celecoxib c.) Folinic acid 112. Clinical picture of exacerbation of acute gout. Initial Mx? a.) Allopurionl b.) Colchicine c.) Naproxen d.) Codeine 113. Indigenous boy who c/o thick purulent material coming out of ear and nose. Mx? a) Ear swab b) nose swab 114. Man sustained industrial work injury. Received full vaccination for tetanus 9 years ago. O/E laceration of leg. Most appropriate Mx? a.) Tetanus toxoid + Ig b.) aDPT vaccine +Ig c) DTP + Ig 115. Clinical picture of Diverticulitis. Mx? a.) CT abdomen b.) USG abdomen c.) Sigmoidoscopy 17 Sept. 2011

116. All of following are causative factors of cancers EXCEPT: a.) fat b.) alcohol C) smoked food d) aflatoxin e) monosodium glutamate 117. Picture of HSP (purpuric lesions on the legs). What would you do next? a. Immunoglobulin b. prednisolone 118. Severe episode of asthma. Which ABG is most likely? a.) pH 7.21, PaCO2 61, PaO2 80 b.) ph 7.31, PaCO2 58, PO2 60 119. An alcoholic man with pain radiating to the back (?pancreatits). WOF is he least likely to present with? a) constant pain b) regurgitation of food 120. A pic of BCC. Asking management? A. Local Excision B. Wide excision C. Wide Excision with Lymph node resection D. Imiquad 121. A picture of a man with Lesion on the lips (does not mention anything with sunny area or absolutely nothing shortest mcq of the exam). a) BCC b) SCC c) Herpes simplex d) sun exposure

(THIS WAS THE EXACT SAME PICTURE) 122. Picture of ulcerated lesion behind ear. Most likely Dx? a) SCC b) BCC 123. Long stem regarding a patient with so many diseases and a picture showing a carcinoma BCC. what is the most appropriate management? A)Local incision + LN clearance B)Wide local incision C)Local incision 124. A man with enlarged superficial inguinal lymph nodes and histology shows SCC (same as June recall). Where is the primary lesion?

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Sept. 2011

A. anus B. penis C. lungs 125. Patient with calf pain yesterday, diagnosed with DVT by Doppler, now presents asymptomatic. What is the next step in management? a. In patient treatment with LMWH and compression stockings b. In patient treatment with LMWH and leg elevation c. Out patient treatment with LMWH and compression stockings d. Out patient treatment with unfractionated heparin and leg elevation 126. Patient with weakness of the forehead on right side, shallow nasal fold on the right, no headache, no vomiting, had viral infection days ago, whats the next investigation? a. CT head b. MRI head c. No intervention needed 127. Worker in an insulating factory for 30 years, smoking for 40 years with 15 sticks a day, came with shortness of breath and hemoptysis. CXR given: a. Squamous cell CA b. Mesothelioma 128. True of cluster headache except: a. Duration less than 2 hours b. Accompanied by vomiting c. Common in males d. Aggrevated by alcohol e. Happens 2-3 hours after sleep 129. Old lady had hemicolectomy. 1st 3 days post op were unremarkable. On 4th day, she became confused and agitated. Whats the reason for this? a. Lack of sleep b. Alcohol withdrawal c. Hyponatremia 130. Old patient had pain felt in buttocks and thighs yesterday. He is on Atorvastatin, Amlodipine and Allopurinol. At the ER, patient is asymptomatic. But on PE, noted tenderness on muscles of the arm. What will you investigate on? a. Nerve conduction studies b. Creatinine and electrolytes c. EMG 131. Man came in at ED pale, tachypneic and hypotensive. He was found to have bleeding duodenal ulcer with wide margin on endoscopy. Vital signs were quickly stabilized with 1 liter of crystalloid. What will be the next step in investigation? a. IV omeprazole b. Suturing of bleeding ulcer c. Intraluminal injection of adrenaline to the ulcer 132. Patient who is hypertensive, hyperlipidemic well controlled with Atorvastatin, Amlodipine, Perindopril, Imipramine and Warfarin. He was recently diagnosed with DM and 19 Sept. 2011

was prescribed Gliclazide. He developed 2 hypoglycaemic episodes recently. What caused these attacks? a. Perindopril b. Imipramine c. Atorvastatin d. Amlodipine e. Warfarin 133. Patient with CCF maintained on Hydrochlorthiazide and Digoxin. He came at ER with lower abdominal pain and nausea. Labs given Na 135 K 3.1 Crea and Urea were normal. What is the next management? a. Cease digoxin and give oral K supplement b. Stop Hydrochlorthiazide and give oral K supplement c. IV potassium 134. Patient complained of lower back pain. On PE noted lumbar spine is not in its normal curvature, decrease in ankle jerk. What to do next? a. Lumbosacral X-ray b. MRI c. Nerve conduction study 135. Worker after hammering a metal spike suddenly had acute pain on 1 side of the eye with conjunctival injection. What will you do next? a. Eye drop antibiotics and follow up the next day b. Put eye patch and follow up after 3 days c. Wash with local irrigation d. Put local anaesthetic and probe the eye 136. Biker fell from his bike splitting his helmet into half. CT head was given. What to do next? a. Biopsy of lesion b. CT cerebral angiogram c. Lumbar puncture 137. Patient came in with hematuria, dysuria. Urinalysis showed many rbc and atypical nuclei. What to do next? a. Renal Ultrasound b. CT scan of abdomen c. Urine culture and sensitivity 138. Patient with recurrent epigastric pain radiating to the back. Which of the following can be seen except? a. Nocturia b. Diarrhea c. Weight loss d. Constant pain e. Regurgitation of food 139. Party girl suddenly became confused and agitated. Next step in management? a. IV thiamine and hydration b. Diazepam c. IV hydration 20 Sept. 2011

140. Man with scrotal swelling. Noted palpable cord and is thickened on PE. What is your investigation? a. Ultrasound b. CT scan c. FNAC d. AFP 141. An old lady in a nursing home fell from her bed. On P/E, noted externally rotated and shortened hip. What will be your management? a. Surgical repair b. Put her on cast c. Return to nursing home with 1 to 1 nursing car 142. Man with impotence. He is a smoker, alcoholic and obese with BMI-35. What would you advise him? a. Stop smoking b. Reduce drinking c. Diet and lifestyle modification d. Give Viagra 143. Lady with BMI-33, had lost 1.5kg on last month, depressed of her progress in weight loss. She is also in a controlled diet supervised by a dietician. What will you advice her? a. Sibutramine b. Liposuction c. Eat only 2x a day 144. A woman noticed a lump on her breast after a dog jumped on her chest. which of the following is the most appropriate next step in management? a. (Ca breast?) 145. Which of the following statements is false? a. Association of EBV with lymphoma b. Chewing beetle nut and oral ca c. Schistosomiasis and Ca bladder d. Promiscuity and cervical ca e. Nickel and liver ca 146. 43 lady Whilst gardening she suddenly noticed the whole right thumb "went into a cramp ". Five minutes later she noticed that she had lost extension of the terminal phalanx of this thumb. Thirty minutes later she felt a tightness in the mid-forearm. Two weeks later while taking off a pullover, she felt a sudden cramp in the muscles of her left forearm, and immediately noticed that the left thumb had become flexed at the terminal phalanx, and that she had lost the power of active extension there. sHe was seen in the Outpatient Department she had no other deformity other than the mentioned. She shows features of rheumatoid artheritis. the x-ray of hand shows an old colles fracture and some level of osteoporosis. Which pathology has most likely contributed to her condition? a. Osteoporosis b. Rheumatoid artheritis c. Old colles fracture d. Idiopathic e. Trauma while gardening 21 Sept. 2011

147. A patient came with a complaint of 3 episodes of transient blindness on right eye which then resolves. What is the condition? Which artery is affected? 1. Left internal carotid artery 2. Right internal carotid artery 3. Right common carotid artey 148. A patient, immigrant refugee, c/o mild evening fever, generalized weakness, weight loss and cough with expectoration. On chest X-ray, he had miliary pattern tubercles (x ray was given ) and a lump on left leg. What will confirm the diagnosis? a. Biopsy of lump b. Sputum microscopy and acid fast bacilli c. Mantoux test d. Sputum bronchoscopy 149. A patient diagnosed with idiopathic pulmonary fibrosis (cryptogenic fibrosing alveolitis). what is less likely seen? a. Digital clubbing b. Hilar lymphadenopathy c. Unexplained dry cough d. Dyspnoea e. Degreased total lung capacity 150. Amc blue book question 2.126 picture of an old man with deformity. Which of the following problem has caused the underlying deformity? a. thickening and fibrosis of the palmar fascia b. chronic infection with mycobacterium leprae 151. Which of the following is the most common found in hepatoma patient? a. liver cirrhosis b. liver carcinoma c. haematomacrosis 152. Patient returning from a trip to Singapore, c/o fever head ache and myalgia for the last 3 days. What is the probable diagnosis? a. dengue fever b. malaria c. infectious mononucleosis 153. A 75 year old complains of back pain, x-ray of spine was given, shows a compression fracture. which of the following is the diagnosis? a. Osteoporotic fracture b. Metastatic lesion 154. Patient had an acute attack following eating peanuts. Dx? a. Type 1 hypersensitive reaction b. Type 2 hypersensitive reaction c. Type 3 hypersensitive reaction d. Type 4 hypersensitive reaction

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Sept. 2011

155. A patient presented with sudden onset of abdominal pain and tenderness over the right iliac fossa region, examination revealed perforated appendix and urgent surgery needs to be done patient was on warfarin increased INR. What is the management? a. Give FFP b. Stop warfarin and change to heparin c. Give Vitamin k injection 156. A young girl with a dark rash around her neck. She complains of tiredness. Her BMI is 33. (Handbook of MCQ 3.283). What is the treatment? a) Metformin 157. An elderly is brought by his child. He recently loss memory, decline in hygiene and complains that see a person enter his house. What is the diagnosis? a) Lewy body dementia 158. A man has developed rash (picture given for petechiae rash on both lower legs) after the GP has given him amyoxicillin for his cold with sore throat. He also has spleenomegaly and lymph adenopathy. Dx? b) A. EBM c) B. Malaria d) C. drug reaction 159. A patient with 40% block on Rt side, 50-60% block on Lt side and with some motor weakness , BP= 150/90. What is your management? A. treat hypertension B. Carotid endarterectomy C. give anti-platelet treatment

ECG questions
160. Known WPW syndrome patient, with wide QRS complex changes in ECG. What is the management?

A. adenosine B. verapamil C. cardioversion D. amiodarone E. sotalol 23 Sept. 2011

170. ECG with the stem reading as patient came in with WPW syndrome and arrhythmia. What is the treatment of choice? a)Adinosine b)Verapamil c)Ablation d)Amiadarone 171. An elderly brought to ED with chest pain. Whilst feeling her carotid pulse, he felt light headed. ECG is given. What is the management?

A) B) C) D)

Not to repeat the carotid massage Adenosine Digoxin Verapamil

172. Patient 65 years old, collapsed on the ground. The cause is (4 ECGs given) a. CHB b. AF 173. A patient came to you with a history of sudden loss of consciousness after which he recovered. He has no other relevant history. Which of the following ECG would be the correct one for him? A. AF B. Heart block with HR~ 55/min C. SVT D. VT 174. 65 year old man with syncope at emergency Department, (ECG shows VT), Treatment. A. Adenosine B. Amioderone C. Digoxin D. Verapamil 175. A 10 year old boy is brought to ED with complains of dizziness and palpitations during sports. Pulse is regular, rate increased. ECG given. What is the initial treatment? (typical ECG of SVT just looked a bit faded) a. Valsalva manoeuvres b. Amiodarone c. blockers d. Adenosine e. Verapamil

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Sept. 2011

176. There is an ECG given. As old woman was hospitalised because of TIA several days before and now she is improving for her slurring of speech and motor weakness. On 5th day, she fainted while she was in toilet and get the following 177. ECG. BP-low, PR-low and RR-high. whats the next investigation ? A. CXR B. ECG C. Holter monitoring D. Troponin 178. ECG of Ventricular fibrillation was given. What is the next best management? (A) sodium bicarbonate (B) verapamil (C) metaprolol (D) amiadarone (E) lignocaine 179. ECG LBBB typical chest pain (no previous ECG mentioned), What is next step Mx? a. Thrombolyse b. troponin c. PTCA d. cABG 180. ECG given (showing PE). A patient came with shortness of breath, pain on inspiration. what is it? a) PE b) Pericarditis c) Posterior MI d) Inferior MI 181. ECG of Atrium Fibrillation & history of Abdomen Pain & Cramping What is the diagnosis? a) Mesenteric vascular occlusion 182. Young male, soccoer player brought by her mother, with a heart racing. ECG given as SVT. Most appropriate management A) Amiodarone B) Adenosine C) Verpamil D) Beta blocker E) Manuvure of carotid 183. ECG of SVT, typical history: young person playing and his heart beating fast presented with palpitations and hemodynamically stable, BP 130/70. Most appropriate initial Mx? A. Adenosine B. B. Blockers C. Carotid Sinus massage D. Verapamil I/V

25

Sept. 2011

Pharmacology 184. Beta interferon - What's the side effects? (A) Delusion (B) Depression (C) Dementia (D) Anxiety (E) Hypomania 185. 22 year old male, presenting at ED with overdose of fluoxetine, fever, tremor, diarrhoea, shivering. Which of following treatments. A. Cyproheptadine B. Bromocriptine C. Dantroline 186. Hypertensive encephalopathy is a complication of treatment with which one of the following? A. Benzodiazapine B. MAO-I C. TCA D. Lithium 187. Which of the following medication leads to impotence? a. Amitriptyline b. Gabapentine c. Enalapril d. Diazepam e. Digoxin 188. A depression man on amitriptyline for some time, complains of erectile dysfunction. He smokes 20 packs/per day and he drinks 5 standard drinks per day. Mx? A. Stop medication immediately B. change amitriptyline to sertraline C. Give sildenafil and continue medication D. cease smoking E. reduce alcohol 189. Patient accidentally took 25 tablets of amitriptyline, whats the next management? a. Intubation and IV NaHCO3 b. Insert IV access c. Gastric lavage 190. A young patient with shoulder dislocation and needs reduction, which is the most appropriate agent used? a. tramadol and midazolam b. fentanyl and midazolam c. fentanyl and morphine d. tramadol and fentanyl

26

Sept. 2011

Surgery
191. A man alleged a major car accident. He presented to the emergency department with hoarseness of voice. Chest X-ray showed widened mediastinum and loss of aortic knuckle. What is the next step in management? A) Pericardiocentesis B) Intubation and ventilation C) Oxygen D) CTPA 192. A picture given of a patient with Para-umbilical hernia which is tense,swollen, red, with also some content taken out showing omentum with some black spots. What is the next step in management? (A) IV antibiotics (B) Debridement + antibiotics (C) Surgical repair (D) Other two choices were conservative measures 193. A patient complains of lower abdominal pain. She was given amoxicillin for URTI two days back. She was already on warfarin. Picture of oral contrast CT was given. WOF is the most likely diagnosis? (Picture clues: contrast was seen just beneath the rectus sheath muscle. I think there was a gas pocket on top of it ) (A) Diverticulitis (B) Obstructed incisional hernia (C) Rectus sheath hematoma (D) Twisted ovarian cyst 194. A patient retired plumber, 75 years old, c/o shortness of breath, weight loss. He has history of working in mining industry for ~28 years. Chest X-ray was given: (it was a poor quality x-ray) shows a certain whitening of pleura- s/o thickening of pleura. What do you do next to diagnose this condition? (A) CT chest (B) Bronchoscopy with BAL (Bronchoalveolar lavage) (C) Pleural biopsy (D) Thoracocentesis (E) *** 195. An X-ray for diagnosis: s/o sigmoid volvulus CT was given. A patient was on enoxiparine has developed a large rectus sheath hematoma. The patient is in pain. What is the most appropriate next step in management? (A) Reassure and discharge (B) Urgent aspiration (C) Immediate cessation of enoxiparine (D) IV Vitamin K (E) Platelet 196. A 26 year old woman fell down from her horse and fractured 4-11 ribs and fractures to femur and tibia on left side as well. (She was stabilized or not? ) a plaster was applied to the leg (assumed stabilized before putting the plaster ) and air ambulance was arranged to take her to a tertiary hospital. Before air transport what is the most appropriate next step to do? (A) Underwater seal drainage 27 Sept. 2011

(B) (C) (D)

Firm bandage over the fractured side of chest Chest X-ray Intubation and ventilation

197. A seven year old girl was rescued from a room in a burning house. The room was not filled with smoke. She did not have any superficial burns and was fully conscious. On examination soot was found. What is the most appropriate next step? (A) Reassure and discharge (B) Oxygen by mask (C) Intubation and ventilation (D) Admission and observe 198. Pt with h/o emergency splenotomy with a midline incision, c/o mass in midline. Dx? a. Ask pt to cough in lying position. b. Ask pt to lift head in lying position. c. Ask pt to cough in standing position. 199. 50 yrs old female pt. diagnosed as having Ovarian carcinoma? Where could be the primaries most probably from? A. Pancreas B. Liver C. Thyroid D. Breast E. Lungs 200. What can cause metastasis to ovary? a. Breast b. Pancreas c. Lung d. Liver e. Kidney 201. Patient with inguinal lymph nodes swelling said was drained and found to be SCC and which could be the primary? A)Kidney B)Breast C)Lung D)Rectum E)Prostate 202. A pt had Abdominal Surgery for Perforated Diverticular disease. On fourth Post-op day She developed agitation, Confusion and restlessness. What could be the most probable reason? A. Alcohal withdraawl B. Send her for CTPA C. Atelectasis D. Encephalopathy 203. Patient on 2nd day post-op suddenly developed confusion. What to do next: a. CT head b. Pulse oximetry 28 Sept. 2011

c. d.

Electrolytes CXR

204. A patient has been planned for TURP, which one is the most common Post-operation complication he will probably be suffer from? A. Urethral Rupture B. Retrograde Ejaculation C. Erectile dysfunction D. Infertility 205. Patient was 50 years of age had sudden severe breathlessness, more on breathing in. Sever chest pain, cough. He is in the post-op room and had undergone a surgery three days before, then the symptoms appeared. Blood gas analysis was pH, CO2, O2 was given. Dx? a. Pulmonary embolism b. ?? 206. A patient with shortness of breath in day 1 post-operation. Chest X-ray is given. What is the management? a) Chest physiotherapy 207. A patient who has had a recent abdominal surgery has fever of ?38C, 36 hours post op. What is the cause of the fever? a. DVT b. Hypostatic pneumonia c. Abscess d. Wound dehiscence e. Wound infection 208. Which of the following is the correct procedure for CPR? a. Compression to breathing ratio is 20 to 2 b. Compressions per minute should be 100/min c. Chest depression during CPR should be 1-2 cm d. Hands should be placed in the middle of the sternum e. Compression cycle should be 2 cycles/min 209. Which of the following is True about CPR? a. At least 100 compressions in a minute b. 2 breaths:5 compressions c. Depth is 2 cm d. Site is at the middle of the sternum 210. A young male involved in a MVA presents to the ED. He appears to be shaken but has no history of loss of consciousness. A contrast and non- contrast CT is given. What is your diagnosis? (p425 Blue book non-contrast image) a. Epidural haematoma b. Extradural haematoma c. Cerebral infarction d. Subarachnoid haemorrhage e. Cerebral abscess

29

Sept. 2011

211. MVA, 2 CT scans shown (2 small white dots near ventricle). The patient is fine except for minor bruises on scalp. A. EDH B. Closed Head Injury 212. A young patient involved in a MVA is brought to the ED. He has severe swelling in his neck and has difficulty breathing. Management? a. Cricothyroidotomy b. Nasogastric tube c. Oxygen d. IV cannulation e. 2 drugs given dont remember the names and tracheal intubation 213. Patient comes to Emergency Dept. Post MVA with fractured anterior ribs on right side. He has hoarseness of voice and mild shortness of breath. Vitals stable. BP is normal, not hypotensive. Chest X-ray was given shows widening of mediastinum, loss of aortic knuckle. What is the MOST APPROPRIATE next step in management? (A) 2nd ICS needle aspiration (B) Mid anterior axillary line ICD ( inter coastal drainage ) (C) Pericardiocentesis (D) CT and angiogram (E) USG chest 214. A young man with MVA injury admitted to emergency has multiple Rib fracture, also has hoarseness of voice, what do you do next? a. Intubation and mechanical ventillation b. Pericardiocentesis c. Needle in the 2nd ICS d. Chest drain e. Oxygen by mask 215. ED Young male in MVA, multiple fracture 5-8 rib, dypnea, what is the most appropriate management? A) Needle thoracentaesis B) Oxygen C) Intubate + D) Under water sealed draiangage 216. A farmer fell from his horse causing rib fracture 4-5 years ago. Suddenly had shortness of breath. PE: dullness on percussion. CXR given: (with loculations on the left) a. Congenital eventration of diagphragm b. Loculated pleural effusion c. Pulmonary hydatid d. Lower middle lobe collapse 217. Old patient fall from the roof, with rib facture, dypsnea, left chest dull sound, 2cm JVP, before send to tertiary hospital what is the most important management. Nasal intubate Oral intubate + Left thorcaotomy (no underwater drain or thoracocentesis) 30 Sept. 2011

After a car accident patient with bruising of the eye lid, rhinorrhea (clear fluid), A. Anterior cranial fossa fracture B. Foramen Magnum fracture C. Temporal bone fracture 218. A patient is brought into ED with signs of severe dehydration? Treatment? a. Colloids b. Crystalloids c. FFP d. Hartmans solution 219. A 25 year old male presented with a painless swelling of the left scrotum. What is your initial investigation? a. Ultrasound b. FNAC c. Serum HCG and alpha fetoprotein levels d. CT chest e. Surgical exploration 220. Patient in the ward presents with respiratory distress after a thyroid operation. What is the next step in management? A. Remove skin suture B. Inform Senior Registrar C. Give oxygen D. Remove all sutures in operation theatre E. Open the wound in the ward 221. A patient had a subtotal thyroidectomy 2 days ago. She developed shortness of breath and stridor. What is the most appropriate management? A) Give Oxygen B) Nebulized salbutamol C) Remove the superficial sutures D) Remove all sutures in the ward E) Call the operation theatre 222. Whats most urgent sign in acute limb ischaemia indicative of surgery? a. Pain b. Paralysis c. Colour d. Temperature 223. What of the following would be an absolute indication for surgical intervention in a case of limb ischemia? a. pain b. pallor c. paraesthesia d. paralysis 224. Which is the following is the most characteristic sign of chronic limb ischaemia? A) Pain relieved by walking 31 Sept. 2011

B) Rubor C) Colour of the limb improved after hanging the limb at the end of the bed D) Numbness 225. amc handbook q. 3.051 (pic of fracture surgical neck of humerus) What is the complication.? A. wrist drop B. loss of sensation in the inner side of arm C. loss of sensation over deltoid muscle D. weakness of hand muscle 226. A patient comes with orthostatic hypotension and pulse rate of 120 and acute bleeding. What is the estimated percentage of blood loss? a)10% b)15% c)20% d)25% e)30% 227. Patient on Warfarin and a CT shows Rectus Sheath Hematoma. Mx? a)FFP b)Vitamin K c)Blood transfusion d)IV NS 228. A patient on Clopidrogrel has been on stent for last 4 months for 3 main vessel occlusion ,and is now posted for elective surgery for uncomplicated varicose vien surgery after 2 weeks. He is now meeting you for surgical assessment, What is the appropriat management ? a) Reasses the need for surgery b) Stop Clopidrogrel for surgery before 10 days c) Do not stop CLopidrogrel d) Ask him to wait for 42 days. 229. Cancer pt came to ED, lab test chow hypercalcaemia (2.8mmol), nxt management? A) 0.9% NS B) Hartman solution C) Calcium gluconate 230. Patient undergone Surgery for Achalasia 5 yrs ago. Since 1 month hoarseness of voice, dysphagia. Mass at thoracic inlet. Dx? a.) Ca larynx b.) Ca oesophagus 231. Ischemic strangulation is an important complication associated with hernias. Which of the following is the most often associated with strangulation of its contents? a. Indirect inguinal b. Direct inguinal c. Femoral hernia d. Paraumbilical hernia e. Oesophageal hiatus hernia 32 Sept. 2011

232. What is the most associated with undescended testis a. Indirect inguinal hernias b. Testicular torsion c. Testicular carcinoma d. Infertility 233. Mother phones the ED says her son had spilled hot water from a kettle to chest and neck what is the next initial management to tell her a. Bring to ED immediately b. Leave it and nothing c. Put the child under a tap and put running cold water d. Put ice over the burned areas 234. A lady fell on a outstretched hand and the X-ray shows a colles fracture, what is the most common complication associated with this.. a. stiffness of wrist b. malunion 235. A question on spontaneous pneumothorax with the trachea deviated to affected side and decreased breath sounds on the affected areas, which of the following is the most appropriate management? a. Needle thoracotomy MISC Pt 75 years old with obstructive jaundice, Cause? (A) ca of ampulla ovate Fracture of Tibia and Fibula. Picture of Mallet Finger. Asking what is it. Picture of Mallet finger. What is the cause? a)Hyperflexion injury while finger was extended Pt post operative about 48h not pass urine next step in management (A) give normal saline IV Hyponatrimia was given and asking for cause of electrolyte disbalance. (A) Indapamide Cause of Hyperkalemia? (A) ACE Inhibitors Woman develops backache after bending down in garden. Dx? (A) Compression wedge fracture. Symptoms: Hyperemesis gravidarum-lots of vomiting. Dx: (A) Molar pregnancy WOF is most suggestive of ruptured ectopic pregnancy? (A) Lower abdominal rigidity amc handbook q. 3.111 (pg 458) pic of sigmoid volvulus. Ask for diagnosis. A patient diagnosed with polycythemia vera. what could be the lab findings? How would you follow up a case of duodenal ulcer? (A) Urea breath test A pregnant lady 24 weeks of GA found GB positive on examinations. What is the management? (A) antibiotics during labour. The site of insertion of needle thoracostomy? (A) 5th intercostal space What is the symptom of Colon cancer in Caecum? (A) Pallor Result of Joint aspiration with Negative birefringence. What is the diagnosis? (A) Gout Management of Snake bite. (A) Avoid any movements An elderly woman with Uterus prolapsed. What is the management? (A) Ring pessary Radiation per capita (RECALL question). (A) natural background history Exact same question about the 3rd Nerve palsy as in the blue book P.389 picture.

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Sept. 2011

OBGYN
1. WOF is most likely to predict endometriosis? a.) nodularity of uterosacral ligaments b.) bilateral palpable adnexal mass 2. A pregnant woman of 8 weeks GA with severe migrainous headache and vomiting. Tx? (A) Aspirin + metoclopramide (B) Morphine+ metoclopramide (C) Paracetamol + codeine (D) Ergotamine + metoclopramide (E) Morphine + *** 3. A baby was born at term vaginally without any complications. On the 4th day before discharge, physical examination shows a reddened scrotum which is non-tender on palpation. Temperature 37.8C and other physical findings were normal. Mx? (A) Reassure and discharge (B) FNAC (C) Ultrasound (D) Blood culture (E) Observe for a few days 4. A 35 years old woman who has 4 healthy children and doesn't want to have children again, consults getting HPV vaccine. Both her ovaries were removed after finding to have CIN III(?) and subsequently she had undergone a Hysterectomy as she was diagnosed with fibroids. Following the hysterectomy at histopathology of the uterus there was a CIN presentation. What is your advice regarding if she should get the HPV Vaccine and its benefits for her? (A) Tell her no need of the vaccine as she has undergone hysterectomy (B) HPV vaccine prevents cervical cancer (C) Vaccine can not help her at this stage (D) Vaccine will definitely prevent cervical cancer 5. Female 39 weeks gestation (not in labor), 1000 ml blood loss. Hand held Foetal heart beat detector, no heartbeat. Next step in management. (Patient is in pain) A. Amniotomy B. caesarean section C. Syntocinon infusion 6. Pregnant woman with all s/s suggestive of PE, 34 weeks GA, has been travelling by air, chest pain on breathing, breathlessness, hemoptysis. Which is the next step in management? A. D-dimer B. CTPA C. V/Q scan D. X-ray 7. 18 week GA lady presents to you with pain in abdomen. Cervix closed, no bleeding or discharge per vaginum. Which investigation will indicate a complication in her situation? a) Presence of fibronectin b) USG to see the cervical length c) bHCG d) ? 34 Sept. 2011

8. 26 years old lady came at 13 weeks gestation on her first Ante-natal visit with h/o severe headache for the last 12 hrs. What could be the most likely cause? A. Migraine B. Cluster Headache C. Pituitary Apoplexy D. Sub-Arachnoid Hemorrhage E. Raised ICP 9. 24 yrs old lady came with h/o premature delivery at 24 weeks of gestation resulting in death of the infant immediately after birth due to respiratory distress syndrome. Now she came at 8th Week of gestation on her first Antenatal visit. She is worried whether she will again going to have Preterm labour. Which one is the most appropriate investigation to carry out between 18 to 22 weeks of gestation to counsel her for chances of preterm labour this time. A. Anomaly Scan at 18 weeks B. Amniocentesis C. Cervical length at 20 weeks D. Fetal fibronectin Test E. PV examination 10. 25 Yrs old pregnant lady 13 weeks gestation came on her first Antenatal visit. She has been found to have BP 130/90, Pulse 90. Her Thyroid Profile is as below: TSH 6.0 (0.4-5) T3 TD Slightly raised What is the most appropriate treatment? A. Commence her on Carbimazole B. Commence her on Propranolol C. Commence her on PTU D. Observe 11. A 35 yrs old lady comes to GP for advice about OCPs. She has h/o benign breast lesion operated few years back and has a strong family h/o CA Breast. Which Contraceptive you would prescribe her keeping in view of her history. A. Spermicidal Gel B. Estrogen and Progesterone pills C. Implanon 12. Which Site is at greatest risk for cancer in women using OCPs? A. Endometrium B. Cervix C. Vulva D. Breast E. Ovary 13. An 18 yrs old girl comes with severe emotional stress after being embarrassed by the involuntary expression of milk from her Rt. Breast during Tennis play. She embarrassed in b/w her friends. She is using OCPs. What will u most appropriately do? A. CT Brain B. Serum Prolactin levels C. Cease OCPs D. Prescribe Bromocriptine E. Prescribe Sertraline 35 Sept. 2011

14. A lady on who was on Sodium Valproate throughout her pregnancy develops seizures 2 days post-partum. What is the cause of her seizures? (This is recalled exactly, no other info was given). a. Epilepsy b. Eclampsia c. Pre-eclampsia d. Febrile seizures e. Hypertension of pregnancy 15. A woman previously diagnosed with grand mal epilepsy taking phenytoin becomes pregnant and she continues the medication throughout pregnancy. At 28th week gestation, she becomes diagnosed with gestational diabetes according to OGTT and was on diet and metformin. At 30th week of gestation, she has a seizure. At that time, BP is 135/85 (exactly like that) and urine protein is +++. What is the cause of her seizures? A. Eclampsia B. Grandmal seizure C. Hypoglycemia 16. A 28 wk pregnant lady comes to you with labour pains. Which of the following is a contraindication for tocolytic therapy? a. Placenta praevia b. Ante partum haemorrhage c. Cervical incompetence d. Pre-eclampsia 17. A 47 year old lady who has had a hysterectomy 5 years ago complains of hot flushes and dyspareunia. How will you manage the patient? a. Oral contraceptive pills b. IUCD ( Mirena) c. Conjugated equine oestrogen 0.625mg d. Continous Oestrogen and Progesterone therapy e. Cyclical therapy with Oestrogen and Progesterone from day 13 18. A 10 wk pregnant patient comes to you for her first antenatal visit. On examination you can see the strings of the IUCD. What is your next step? a. Leave the IUCD in place b. Remove the IUCD in the second trimester c. Remove the IUCD now d. Remove the IUCD after delivery 19. 55 yr old lady presented with a rectocele no cystocele. What is your next step? a. Pessary b. Pelvic floor exercise c. Surgery d. Bladder training 20. 8 weeks pregnant patient with fibroid what in her history would concern you the most? a. APH b. Vesicular mole c. Red degeneration of fibroid 36 Sept. 2011

21. A women 32 wk of gestation in her 2nd pregnancy, wants to know how she can protect her child from familial atopy. She has asthma and her 1st child has flexural eczema. a. Breast feed for 6 months b. Breast feed for 1 year c. Give multivitamins d. Regularly vaccum her house e. House mites control 22. A primigravida at 39 weeks gestation presented with labour pain. Her cervix is 4cm dilated and fully effaced. After 4 hours she is 5cms dilated cervix well effaced. What is your diagnosis? A. Normal labour B. Obstructed labour C. Latent phase of labour D. Slow progress of labour 23. Primigravida presented at term for labour at 2 stage where foetal heart drop to 80 bpm then return to normal. What the next step : (A) foetal scalp PH (B) caesarean in section 24. Pt 24years female presented with 9mounth infertility ,her spouse sperm investigation reveals Sperm count 2 million Abnormal sperm 50% Next management to get pregnancy (A) sperm donation (B) IVF 25. Pt has hysterectomy and wants to start HRT because her bone density scan reveal osteopenia. a. continues estrogens HRT b. combined estrogens and progesterone thereby c. implanon 26. Pt presented for advice about pap smear , she is post-hysterectomy b/c of CIN III this pt should do it a. every year b. biannually c. only if there is vaginal bleeding d. no need 27. Premature baby delivered at 32weeks, weight 1.5Kg, at 1month=2.5kg, 2month=3kg,...at 6month=6kg. This result reflects her baby: a. well development b. underweight c. obese 28. Pt 78years, women, has urine incontinence on cough next appropriate step: a. pelvic floor exercise b. surgical intervention c. vaginal pessary

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29. Pt has plugging from her intorise on strain (I understand as vaginal prolapsed), not on HRT, what the most appropriate management? a. pelvic exercise b. HRT c. vaginal pessary 30. Pt about 48years on HRT, her Bp =180/110, obese, cholesterol high, the most important to protect her from stroke is: a. cease HRT b. control BP c. exercise d. fibronate 31. Primigravida presented at term for delivery, after 4h cx well effaced and dilated about 3cm, head of foetus -2. What's the next step in management a. aminiotomy b. oxytocins c. wait another 4h and reassess d. cs 32. Lady 23years presented with Lt iliac fossa pain, O/E there is guarding and tenderness.LMP 4 weeks before. next step in management a. BCG b. US abdomen c. urine microscopic examination 33. A pregnant lady with all the features of Hyperthyroidism. Mx? A) PTU B) Pronolol C) Carbimazole D) Observe 34. Besides folate, What will you give to a pregnant lady to prevent congenital spinal cord deformity? a) Iron b) Iodine c) Vitamin B complex d) Vitamin B12 e) bet-Carotene 35. Ig M +ve for CMV at 4 weeks of pregnancy. Mx? a.) Do IgG now b.) IgG & IgM at 4th week of pregnancy 36. A woman is advised by her GP to take combined OCP for next 5 years. Which of the following is applicable considering that she has no risk factors? a.) Increased risk of breast Ca. by 25% b.) Increased risk of stroke by 10% c.) Decreased risk of Gall bladder disease by 2% d.) Increased risk of osteoporosis by 5% e.) Increased risk of heart disease <1% 38 Sept. 2011

37. A pregnant lady having seizures. Most likely cause of fetal bradycardia? a.) Compression of fetal head b.) Strong uterine contractions c.) Maternal hypoxia d.) Cord prolapsed 38. Menorrhagia and anorexia, fatigue in a woman who was previously found to be CIN 11 & has previous h/o PCOS. Mother died of colon Ca. at age of 49 years. Which is the first choice in management? a) Endometrial thickness of USG b) Colposcopy c) Colonoscopy 39. Clinical picture of Pelvic inflammatory ds. Patient febrile. Rx? a.) Amoxicillin + Gentamicin + Metronidazole b.) Metronidazole + Doxycycline + Ceftriaxone 40. GA 18 wks. Previous Pap smear normal 12 months ago. Came with vaginal discharge that is clear. Mx? a.) Repeat PAP smear b.) Endocervical swab c.) Culture of low vaginal swab 41. Pregnant lady noted painful vesicles on vulva. She had a urinary catheter inserted for her urination. What will you give her? a. Oral acyclovir b. IV acyclovir c. Oral Famciclovir 42. 80 year old lady with large cystocoele. This gives discomfort but still feels ok. What will you give her? a. Ring pessary b. Colposuspension c. Surgical repair 43. A couple came in for infertility work up. Wife has irregular cycle with 35-42 days. What would be the most appropriate test to determine the cause of the infertility? a. Serum progesterone on day 21 of cycle b. Pelvic ultrasound c. Sperm analysis d. Hysterosalphingogram 44. True of Bartholin cyst. a. Asymptomatic b. Treat with antibiotics if infected c. Caused by gonococcal infection 45. A c/o premature ovarian failure, which of the following is significant to rule out the condition? a. Usg of abdomen b. Very high FSH level 39 Sept. 2011

c. d. e.

?? very low FSH level FSH/LH ratio

46. Diagnosis of an ectopic pregnancy, Beta-hcg was done and was positive. Which next finding will rule out ectopic? a. Laparotomy b. Empty uterus on usg c. ?? 47. A 90 year old woman in a nursing home was brought to you by a nurse, as she found blood in her incontinent nappy. On examination you found an irregular ulcer in her introitus. What is the most common condition? a. vulval carcinoma b. ca of cervix 48. A girl with E.coli results of 0.1 x 106. What is the management? (Handbook of MCQ 3.297) a) No treatment is necessary 49. Pregnant lady presented with frontal headache which is very severe, BP is low, 60/80 A. SAH ( but that give occipital HA) B. Cerebral thrombosis C. Migraine 50. Pregnant woman with smoking 15 packs per day, benign breast lesion and history of breast cancer in mother (recalled exactly). Whats the MOST SIGNIFICANT contraindication for OC pill (exact as such)? A. Premenstural headache B. Breast cancer C. benign breast disease 51. A nurse who is 12 weeks pregnant comes to your GP clinic for advice. She has been asked by her employer to take the influenza vaccine which she has been taking for the last 5 years. What advice would you give her: a. Influenza vaccine is contraindicated in pregnancy b. She does not need to take the vaccine as she has been taking it for the last 5 years c. She should take it after the baby is born d. She should take in the 2nd trimester e. She should take it now 52. A pregnant nurse in her 2nd trimester comes to you for advice regarding influenza vaccination. Her employer is offering free vaccines before winter. What would you as her GP recommend: a. Defer taking the vaccine till the baby is delivered b. Take it now c. Take it in the last trimester just before the expected date of delivery d. She does not need to take it e. Take it 10 days postpartum

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Paediatrics
53. Mother comes with a child of around 3 years old, who was recently treated for URTI with c/o - refusing to walk, pain over the calves. What is the treatment of this condition? (A) Antibiotics (B) Prednisolone (C) Antivirals (D) Ibuprofen (E) Immunoglobulins + aspirin 54. 5 years old child with 3 episodes of nephrotic syndrome now is steroid resistant. He has hypertension and microscopic hematuria. what is the most likely diagnosis? (A) IgA nephropathy (B) Superimposed PSGN (C) Focal Segmental Glomerulosclerosis (D) Membranous Nephropathy 55. Same stem. What is the likely cause of this patient's nephrotic syndrome becoming steroid resistant? (A) IgA nephropathy (B) PSGN (C) Focal segmental glomerulosclerosis (D) Membranous nephropathy 56. Parents brought to you an 18 month year old baby, complaining not gaining weight. Baby born at term without any complications. Birth weight was 3kg. For the last 9 months, the baby had 6-9 episodes of passing loose stools. Baby is not irritable nor dehydrated. What is the diagnosis? Which is the diagnostic test to confirm this condition? (repeated question in the same test) Aboriginal 3 year old baby, excoriation of buttock. A. Lactose intolerance B. Coeleic dis. 57. 2 year old male, aboriginal child brought to you with clinical features of discharge from ears, speaks 4-5 words also has yellow greenish discharge from nose. What is the next best investigation? A. Swab from ear discharge B. Swab from nasal discharge C. Audiometry 58. (Is it both sided or one sided? What are the features of foreign body in nose? Infection in one or both ears?) Child brought with complains of blood in stools, opening bowels once in 3-4 days. What is the treatment? A. Laxatives and fibre rich diet B. Increase fluids C. ?? 59. Mum comes to see you as she doesnt know how to handle her child, who has been behaving naughty at home. She pumishes him by spanking with a wooden spoon and locking him out of the house for a few hours when he is naughty. Yet his behaviour isnt improving. What is the next most appropriate step? 41 Sept. 2011

A) report to the child protection program B) refer to the effective parenting course C) Call the police D) Call social worker E) Ask the parents to bring the child and have a family meeting F) Inform the child welfare department 60. Infant with two day h/o cough and fever etc., with intercoastal retraction, wheezing and sweating. Child is irritable. Which of the following is the best treatment for the condition. (Spo2 not mentioned ) a) Salbutamol nebulisation b) IV fluids c) Observe d) Antibiotics e) Antivirals 61. 2 yrs old child came with the mother with complaints of Rt. Ear pain, fever and irritability for the last 2 days. Which organism is most commonly associated? A. Streptococcus Pyogenes B. Streptococuss pneumonae C. Satpylococus Epidermidis D. H.Influenzae E. Moraxella Caterhalis 62. A mother brings her 14 months old child. She can Play peek-a-boo, can transfer objects from one hand to another, sits without support, and waves good bye. His hearing tests are normal but he only babbles with inappropriate words. What could be the reason? A. Normal development B. Language delay C. h/o Maternal Diabetes should be taken D. constitutional delay 63. A 16 months child presents with the mother with irritability, subcostal recessions, tracheal tug and a loud inspiratory stridor. He h/o URTI. What is the most appropriate management. A. Prednisolone B. I/V adrenaline C. Nebulised Adrenaline D. Nebulised Salbutamol E. Intubation 64. Mother brings her 2 year old child with complaints of not developing like normal children and on investigation he has found to have Bitemporal Hemianopia. What is the most common lesion associated. A. Pituitary Microadenoma B. Temporal lobe lesion C. Craniopharyngioma D. Medulloblastoma E. Hemangioma

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65. A mother brings her 4 months old child (pic of child given with pink lesion on chest) gradually increasing in size, Treatment? A. B. C. D. Observe Intralesional steroid Sirgical excision Biopsy

66. 2 yrs old boy presented with fever, cutaneous rash on palms and soles, redness of both eyes, and swelling in cervical region. What is the most appropriate management of the above condition? A. Plasmapharesis B. I/V Benyl Penicillin C. Hydroxycholoquine D. Immunoglobulins E. Aspirin only 67. 6 weeks old child brought by mum in ED with c/o repeated vomiting after feeds, irritable and has lost weight upto 400g since birth. The child looks lethargic. Following are the investigations carried out; Serum K 2.5 Serum Cl 85 pH 7.8 PCo2 35 68. Which one is the most suitable resuscitation fluid for this child A. 0.9% Normal Saline B. Hartmans Solution C. Dextrose with 0.45% Saline D. 5% Dextrose 69. 12 yrs old child came with excruciating pain in Rt. Scrotum for the last eight hours, O/E his epididymis is not palpable and Testis is lying high up in the Scrotum. What is the cause? A. Acute Epididymis B. Torsion of Testicular Appendage C. Testicular Torsion D. Strangulated Indirect Inguinal Hernia 70. 14 months child brought by mum with h/o Diarhoea 3 weeks with few undigested particles in stools and Mucucutaneous rashes on Buttocks. He is gaining weight and no muscle wasting. Which condition is most likely? A. Coeliac Disease B. Lactose Intolerance C. Cow milk Intolerance

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71. A 10 year old child presents to your clinic complaining of bilateral weakness in the calf and thigh muscles since a few days. He has been previously well with no complaints, except for a viral upper respiratory tract infection 2-3 weeks ago. He has no weakness in the upper limbs. On examination deep tendon reflexes in the upper limbs are normal but in the lower limbs reflexes are absent. On investigation what are the most likely findings: a. Proteins elevated glucose elevated and cells 8x109/L ( normal value 4.0 11.0x109/L) b. Proteins normal glucose normal and cells 12x109/L ( normal value 4.0 11.0x109/L) c. Proteins elevated glucose normal and cells 8x109/L ( normal value 4.0 11.0x109/L) d. Proteins low glucose elevated and cells 11.5x109/L ( normal value 4.0 11.0x109/L) e. Proteins normal glucose low and cells 4x109/L ( normal value 4.0 11.0x109/L) 72. A young mother comes with her 6 month old baby for his scheduled immunisation. She is not sure whether she should immunise the child now as last time he had a big swelling on his thigh. His pulse is 110/min, respiratory rate 30/min and temperature 37.2C.The baby looks well cared for and happy. What advice would you give the mother: a. Immunise the child as scheduled minus the pertussis component b. Ask her to come after a month c. Immunise the child as per the schedule d. Give the injection on the other thigh e. Do not immunise the child 73. 10 year old boy who regularly plays soccer comes with pain in his right knee. He thinks he injured himself while playing two days ago and his knee seems to give away? Which anatomical structure is affected? a. Medial meniscus tear b. Anterior cruciate ligament c. Patella fracture d. Lateral meniscus tear e. Collateral ligament tear 74. An 18 month old child has diarrhoea 2-3 times a day since a few days, which consists of undigested food particles. The child is otherwise well. Weight and development are normal for his age. What is the cause for his diarrhoea? a. Celiac disease b. Gastroenteritis c. Lactose intolerance d. Toddlers diarrhoea e. Intussusception 75. An infant is brought to the ED. He appears to be irritable and lethargic. He has sunken eyes and capillary return is 3 secs. What is your initial management? a. 0.9% normal saline b. 0.9% normal saline and 5% dextrose c. Hartmanns solution d. 0.45% normal saline and 5% dextrose e. 4% dextrose and normal saline 76. A mother brings her child who is having frequent diarrhoea and excoriation of the buttocks. What is the initial test for diagnosis? a. Hydrogen urea test b. Tissue transglutaminase and Anti-endomysial antibodies 44 Sept. 2011

c. d. e.

Endoscopic small bowel biopsy Reducing substances in stool Stool microscopy and culture

77. A young child who just used her salbutamol spacer for her asthma, and who has been recently treated with Erythromycin for an URTI is brought to the ED by her parents after she developed a rash and swelling over her face with complaints of pain in her stomach. She just had some dip and chips. What is the cause for this reaction? a. Nut allergy b. Asthma c. Erythromycin d. Rotavirus 78. A young child who is a known asthmatic and is being treated with salbutamol presents to the ED with a rash and swelling over her lips, coughing and wheezing and belly cramps. She was recently treated with antibiotics for an URTI and just had some peanut cookies. What is the initial treatment after giving oxygen? a. 1:1000 adrenaline IM b. 6 puffs of salbutamol c. Promethazine d. Normal saline e. Dexamethasone 79. An 8 yr boy was brought by his mother for soiling of underwear with faeces for past 2 month. He used to be well trained. What is your initial Mx? A punishment B laxative C sigmoidoscopy 80. A 6wk old child with sunken eyes,reduced skin turgor,reduced capillary permeability.WOF should be given? A. 0.9 % normal saline B. Hatmann solution C. 2.5% dextrose and 0.45% normal saline D. 8% dextrose and 0.18% normal saline 81. Mother brings her 5 yr old girl who is sore down below. On examination the vulva is reddened and no other signs. What is your management? a. report to child protecting authority b. Examine under general anesthesia c. Avoid bubble bath d. Full blood count 82. An Indian boy who visited india 6 months ago now has c/o diarrhoea, 4 kg wt loss. Stool culture is negative. What could be the cause for his presentation? a. Giardia lamblia b. Coeliac disease c. E.coli d. Salmonella 83. Regarding language development of a 24 month old boy, which of the following is true?. a. combines 4 syllable in a sentence 45 Sept. 2011

b. name colours c. tell surname d. combine 2 words in a sentence 84. Child of 5 years of age presented with primary enuresis and delay speech he not attend school yet, most appropriate diagnosis is: a. mental disability b. asperge syndrome 85. Child with pitchi and bruises after URTI next step to diagnose is: a. FBC b. ANA c. Urine microscopy 86. Infant age about 3 month age his mother told you that my baby has constipation,she stopped breast feed him and she introduces for him Bootle and rice once a day weakly, the cause of constipation is: a. cow milk allergy b. solid food c. low fluid intake 87. A 2 year-old boy presented to your clinic with bilateral conjunctivitis, fever, redness of the tongue and lips, peeling of the palms and soles. What is the most appropriate management? A) Intravenous immunoglobulin and aspirin B) Paracetamol C) Cephexin D) Prednisolone 88. A 2 year old boy presented to your clinic with red palms and soles , red shot eyes, fever of 7 days which does not seems to wean off after paracetamol therapy .what is the most appropriate management? a)Morphine b)Paracetamol higher dosage c)Amox antibiotic d)IV gama globulins 89. A boy has a 3rd episode of nephrotic syndrome. He is treated with prednisolone but his recovery is slower than expected. He also has hematuria. Blood pressure is 120/80mmHg. What is the cause? (Exactly same question as in July 2011 word to word) A)Superimposed post-streptococcal glomerulonephritis B)Renal calculi C)Focal segmental glomerulosclerosis D)Renal tubular acidosis 90. Eight year old girl with fever, first knee pain, then ankle joint pain. Rash on back. Mx? a.) Penicillin b.) i.v. immunoglobulin Child who had URTI 3 weeks ago, now presents with petechiae, bruises. Platelets decreased. Most appropriate Mx? (A) ?? 46 Sept. 2011

91. Boy with oedema, HTN. No haemturia. Most likely Dx? a) Minimal change nephritis b.) Focal segmental glomerulosclerosis 5 month old infant with intermittent screaming & drawing up his knees. Blood red stools. Most appropriate mx? a.) USG abdomen b.) Ba enema 92. Mother comes with daughter age 5 yrs. C/o clear vaginal discharge. Most appropriate: a.) dont do bubble bath b.) Examination of vagina 93. 10 month old boy with irritability, vomiting and abdominal distention. Noted pulling up of his legs occasionally. PR 160 RR 60. What will be your initial management? a. Abdominal x-ray b. Barium meal and follow through c. Establish IV access d. Laparoscopy e. Laparotomy 94. 18 months old girl, at 12 months started to walk, go up the stairs one foot at a time. Came in at the clinic because mother noted difficulty in her gait, walking with her toes in. What will be your advice? a. Do nothing b. Refer to specialist c. Hip X-ray or foot xray d. MRI 95. Aboriginal boy with ear pain. Noted yellowish discharge on right ear, Tympanic membrane ruptured and dull. Also noted yellowish greenish discharge on nose, what to do next? a. Get swab from ear discharge b. Get swab from nose discharge c. CT head d. Give oral antibiotics 96. A 3 year old boy after having viral infection a week ago had petechiae, non blanching on his trunk. No noted bleeding. Platelets were 35. What would be your initial management? a. Immunoglobulins b. Platelet transfusion c. High dose steroids 97. 6 month old infant presenting with lethargy, mottling, poor feeding. Urinalysis: (+) wbc, (+) bacteria. How will you manage this patient? a. Ceftriaxone b. Oral amoxicillin c. Ampicilllin d. Gentamicin

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98. An indigenous girl comes with chronic otitis media. Shes 13 years old she has never had any immunisation since 12month of age. Which is the best management for her regarding immunization? a. Give pneumococcal and homophilus influenza vaccinefor her b. Start immunization regimen from the beginning c. Do the recommended scheduled immunization for her age d. Continue to catch up the immunisation regimen 99. A child presented with swelling on right groin which is the next investigation? a. Ultrasonography b. CT scan c. X-ray pelvis d. FNAC 100. A child with (Erythema) of the Oral cavity & desquamation of fingertips. What is the treatment? a) Aspirin & Immunoglobulin 101. A child with history of Neonate jaundice. Blood smear shows spherocytes. What is the treatment? a) splenectomy b) IV immunoglobulin c) high dose steroids

Psychiatry
102. A 16 year old girl came see her GP because her parents wanted. She finds it very difficult to concentrate for 6 months and previously did well in academic studies. Her appetite hasn't changed. She prefers to be alone in her room most of the time when she's at home. She goes out with her friends but she finds it very hard to entertain herself. Probable Dx? (A) Major depression (B) Normal adolescent behaviour (C) Prodromal schizophrenia (D) Attention deficit disorder 103. High risk of suicide is associated with which of the following scenarios? A. Married, less than 30 years B. attempting suicide for a secondary gain C. Single, more than 60 years. 104. Patient replied when asked about his improper diet as Moon is cheese coloured, My farm is full of shaw . What is your diagnosis? A. Depersonalisation B. Delirium C. Formal thought disorder 105. Patients wrote a letter to his doctor I do not want take this medicine. I am going on holiday What is it? A. Derailment

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106. Mum called her GP that her daughter 18 yrs old is not getting out of bed and saying she has no ability to stand and feeling like she will fall down as she will stand. She has a h/o URTI 4 weeks back? What could be the most appropriate cause behind this girls illness? A. Post infectious irritability B. GBS C. Conversion disorder 107. A fit 73 yr old widower living in a nursing home is found masturbating in the privacy of his room by the nurse. The nurse asks you to intervene. What is the best step? a. Refer for counselling b. Do nothing as it is his private affair c. Tell the patient that his behaviour is inappropriate 108. An 83 year old woman living in a rest home complains of insomnia. On asking she says she is not depressed and does not suffer from any other ailment and is not on any medication. What is your next step? a.) Sleep hygiene advice b.) Sleep promoting adjuvants c.) Relaxation therapy and meditation d.) Fluoxetine e.) Sleep counselling (may not exact but it was related to counselling) 109. A young patient who is a known heroin addict comes to you requesting you for a prescription of Diazepam as he wants to kick of his heroin addiction. What is your next step? a. Prescribe him a dose of Diazepam for 10 days b. Tell him you cannot fulfil his request c. Prescribe the medication and it will be collected on a daily basis from a pharmacy d. Refer him to a drug rehabilitation centre 110. A mother brings her 6 year old daughter who has patches of hair loss on her head. The hair in the affected region is of varying lengths and the patch is irregular in shape. The childs parents are recently divorced. Diagnosis? a. Alopecia areata b. Trichotillomania c. Tinea capitis 111. A young man comes to you and tells you that he thinks everyone is talking about him on the radio and television and someone is telling him what to do. Diagnosis? a. Thought broadcasting b. Idea of reference c. Thought insertion d. Mania e. Schizophrenia 112. A patient with a known psychotic disorder who is being treated with Risperidone complains of generalised restlessness especially of the legs. What is the problem? a. Parkinsonism b. Ekboms syndrome c. Akathisia d. Tardive dyskinesia

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113. A young man is agitated and presents to ED with a knife in his hand. He has been seeing a psychiatrist in the past and refuses to give any details regarding his past illness. Once patient is calm, what will you do next ? A. Restrain him B. Talk to him regarding his psychiatric illness once he is ready to talk to you C. Talk to the psychiatrist against the patients wish 114. Boy 14 years , his mother concern about his behaviour as he is disagree with his sibling all the time and he is very caring about the environment, he has: a. schizophrenia b. normal development 115. A lady comes to the Hospital, says she has health insurance, asking for better room with nice mirror and clean bathroom and shouting at the nurses as they dont know anything. When you comes in, says you understand better because you are good and a doctor. a) Splitting b) Delusional c) Frontal lobe d) reaction formation e) regression 116. A husband call you that his wife stoped breast feed 3 month child because she fears that something wrong will happen for him and she cries all the time. This family moved recently to rural area due to husbands work. In addition the husband cannot take care of child because of his work. Next step? a. visit the family in their a new house b. take the child from the mother c. describe for her treatment 117. An inmate who has come in from Mental health home with a IQ of 60 and has a swollen arm which was due to a fight with other inmate for a remote control of TV. He is shouting and abusive and not sitting still for an X-ray, What is the best management ? a) Call the carer of the Mental health home to calm him down b) IM Olanzapine c) Call the security and restrain him d) Call Police e) involuntary admission 118. Psychodynamic psycotherapy given in which of the following conditions a) OCD b) Sczephrenia c) Autism d) Specific phobias 119. Patient who has feelings of suspiciousness. C/o does not feel like self, feeling that something is not right. Dx? a.) depersonalization b) delusional mood 120. Young man lost his job recently broke up with girlfriend. H/o drug abuse & violent behavior. WOF is he most likely to benefit from? 50 Sept. 2011

a.) behavior therapy b.) motivational therapy 123. Child always fighting with his father, not going to class and not listening to his parents. What is the best approach to management? a. Family therapy b. Psychosocial dynamics c. Cognitive behavioral therapy d. Report to school principal 124. 18 year old Teenager living away from home since 13 years old. He was an intermittent cannabis and marijuana user. Had been in jail for several times. Does not want to talk about his past events. What is this? a. Major depression b. Drug dependency c. Conduct disorder d. Oppositional deviant disorder 125. Who is the most likely to be harmed by psychotic patient during the outbreak of psychotic symptoms? a) Nurse b) Parents c) Strangers d) Siblings 126. A 16 year old child was brought to the department by his mother he had inability to concentrate on one subject for long and very aggressive and mother is worried. child is constantly shaking the legs and tapping while waiting in the room. mother says that the child was behaving similar in school and the school report showed that his participation and progress in school was very poor. His verbal intelligence was poor. What further history should you ask the mother to diagnose his condition? a. Ask of the family situation b. Ask if the child was ever prescribed with methylphenydate c. Ask if she suspects him of taking drugs d. Ask about the community and his friends in school, his relationship with people. 127. A lady lawyer, given evident details of how independent she is and financially stable, suddenly her husband dies and she is now all miserable and cant sleep at nights, daily chores are not being attended, not going to job. She has few friends with whom she talks about it. What is the best appropriate management/advice you shall suggest? (Husband died 3 months back) a) Carbamazepine b) Psychiatric hospitalization c )ask her to make new friends d)CBT 128. A mother visits a doctor. She complains that her son drawings now are only in black and white. She just got divorced with her husband a) Refer the son to a psychiatrist b) Ask the son about his drawings

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Population health and Ethics

129. Co-intern was stealing drugs from the hospital. What will do next? A. Inform intern coordinator B. Inform nurse manager. C. Inform pharmacy. D. Inform police. 130. Colleague stressed and complains of insomnia, you find out that he is taking sleeping pills and coming to work, what will you do? A. Advise him of the side effect B. Do nothing C. Report to the medical board 131. Colleague stressed and complains of insomnia, he says he has an assessment in two weeks. He asks you to prescribe some medication for him. What would you do next? a. Advice to seek another doctor b. Give him prescription c. Report to medical board 132. You see your colleague prescribing antipsychotics for himself. What is the most appropriate action that you will take? a. Advice your colleague against self-prescribing b. Report to the department head c. Report to the medical board d. Do nothing as it is his personal affair e. Write an incident report 133. Your colleague is an established case of Bipolar Disorder and She has started prescribing Psychiatric medications for herself. What is the most appropriate step you would do? A. Report to the Hospital Management B. Ask her to seek specialist for the prescriptions C. Report the medical Board of General Practitioners D. Dont report any where as she is your colleague 134. Mean systolic BP of a population of patients was 115mm Hg, standard deviation is 15. With a confidence interval of 95%, the BP of this population ranges from: (A) 120 -140mm Hg (B) 85-145mm Hg (C) 70-160mm Hg 135. Which is the best study to find out the state of Vitamin D deficiency in Australia? (A) cohort (B) case control (C) case study (D) Cross-sectional study 136. Which is the most important in preventing neonatal mortality (disease?) a. Antenatal check up b. First visit of baby and mother c. Pap smear. 52 Sept. 2011

137. A CT scan Head of a 70 year old man was shown. He is admitted to the hospital and is unconscious. His condition deteriorates and the son wants the doctors to perform any surgery that may save the old man. Wife says not to do surgery. What do you do? a. Apply to guardianship court b. Do as per the son wishes c. Do as per the wife wish d. Do what is best for the patient 138. What is the cardiovascular risk in a diabetic pt, smoker, 54 yr, systolic BP156, HDL 6. A. 25-29 B. 16-19 C. 10-15 D. 20-24

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139. A lady with COPD, 90 yr old. MMSE 28/30 with no depression no mental illness. She's in great health has told you not to resuscitate if she falls ill. Children are not allowing you to oblige her and ask you to do all possible to help her if she falls sick. what will you do? a) Call the social worker b) Call a family meeting c) Call at pscy analyst 140. A lady is posted for surgery, the nurse in the ward calls you and say that an informed consent has not been taken. What will you do? a. Look up on the internet about the operation, and take consent. b. Explain the procedure and obtain consent. c. Ask the head nurse to take the consent. d. Call the surgeon and ask him to take the consent. 141. 32 yr old patient presented to you concerned because her mother had breast cancer at 45 yr age, older sister was recently diagnosed to have ovarian cancer at 35 yrs of age. What is the chance that she will get breast cancer? a) 0 b) 0.25 c) 0.5 d) 0.1 142. Pt 35 years presented to discuss with you the risk of breast cancer as her mother diagnosed with ca of breast at 47years and her older sister at 37 years. a. 1.0 b. 0.6 c. 0.5 d. 0.25 143. Pedigree analysis was given. It showed that it skipped generations first and second and third and then was affected 3 Females and 1 male in next 2 generations. a) Auto Recessive b) Auto Dominant c) Mitochondrial d) X-linked recessive 144. Pedigree shown below. What is the most likely mode of inheritance? a.) Autosomal dominant b.) Autosomal recessive c.) X-linked recessive d.) Polygenic inheritance, multifactorial e.) mitochondrial inheritance (Black indicates disease) 145. One parent is a carrier for cystic fibrosis. Other parent is not affected, not a carrier. Chances of having child with CF? a.) 0 b.) 0.5 c.) 0.25

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146. In Cystic Fibrosis, if 1 parent has the trait, what is the chance of a child having the disease? a. 0 b. 0.25 c. 0.5 d. All males are affected 147. Child with Hereditary spherocytosis. Chances of next sibling having disease? a. 0.5 b. 0.25 c. 50% males are carrier 148. Hemochromatosis, patients relative die from this disease, chance of children getting it? (A) ? 149. A recently married couple asked for advice regarding hemiphilia. Wifes father has haemophilia. what is the chance that her child could get haemophilia? a. 0 b. 0.25 c. 0.5 of boys 150. A new screening test is to be launched in community. Which is the most important factor to consider? A. High sensitivity B. High specificity C. High positive predictive value D. No adverse outcomes 151. A new screening test was developed for a disease. According to the survey, there is an increase in percentage of people who are taking the screening test. However, there is no increase in number of people diagnosed with the disease. Whats the underlying cause? A. Because of the cultural limitation, the number of Indigenous women who take the test are few. B. There is not enough access to the test for the community C. The test has low sensitivity value 152. A study testing Drug B reveals significant benefit of Drug B > Drug A with probability <0.01. This means: a. The difference B/w drug B and A occur by chance b. drug B is better than A c. drug A is better than B Which report provides the least information ? A) Case control B) Cohort study C) RCT D) Case report 153. You are a GP taking care of a community of 100 people and the following is the number of people with specific diseases for two years that you have.

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2009 BP>140/90 40 Hyperglycemia 20 Hyperlipidemia 30 What is the point prevalence of hypertension and there is no answer for 500) A. 50 B. 40 C. 250 D. 475

2010 50 25 40 (per 1000 people) for 2010? (exactly as such

154. Which is the most appropriate situation for case study and case control study? (A) ?? 155. Lady broke her wrist after a car park accident. PE: noted cataracts with left homonymous hemianopia. What would you advise her regarding her driving? a. Wear prescription glasses b. Needs removal of cataract first c. Never can drive again 156. pt has stroke with recover, but he has Lt heminopous hemianopia and the vision is 6/9. He asks you about driving: a. correct by glass then can drive b. drive now c. never drive d. referred to occupational work health assessment 157. Two QUESTIONS ON: Person with visual field defect (bitemporal hemianopia). Regarding driving: a.) Can never drive b.) Can drive after 6 months c.) After 12 month d.) After 2 years. 158. Lady who has first time seizure. Regarding driving? a.) Can never drive b.) After 6 months c.) After 1 year d.) After 2years 159. Bus driver who suffered a stroke 2 months ago with no residuals. VA 6/9, PE: bilateral temporal hemianopsia. What will you advice him regarding his driving? a. Never drive b. Can drive with glasses Two questions on driver with homonymous hemianopia, what is your advice? a. Never drive again. b. Drive after 6 months.

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160. Question on driving: a woman c/o single episode of epilepsy following a history with involuntary muscle spasms on waking up for a few months. GPE was done on her and she was otherwise normal. For how long will you have to restrict her driving? a. 6months b. 9m c. 3m d. 12m e. 24m 161. Jehovah lady comes in after a MVA and she has 3 fractures of ribs and blah blah. What to do? a) IV NS b) Blood transfusion as its important to save her life c) Get a signed consent form for no blood transfusion even if she might die. 162. 38 yr travelling to Africa, what advice is important for tape worm? a. avoid swimming in lake b. make sure the meat are cook well, try not to eat raw meat. c. avoid walking barefoot d. avoid getting bite by mosquito 163. A man who wants to travel to Africa, is worried that he might get Schistosomiasis (snail fever), as his friend was diagnosed of the condition a few months ago, following a trip to Africa. Which advice is the most important to give him? a. Do not walk barefoot outside b. Drink only boiled water or mineral water from bottle c. Caution on exposure to blood and body fluids during travel d. Avoid bathing in water lagoons and other water bodies e. Eat only freshly prepared food 164. Patient travelling to Sleeping sickness (African trypanosomiasis) endemic area. Whats your advice? a) Do no go to areas with tsetse flies. 165. As a GP in rural area, you notice that recently more cases of Hepatitis C has been diagnosed and want to do a research to find out the incidence of Hep C in the community with a population of around 3000. How will you get the information you need for the research? a. Find the number of all patients with current Hepatitis C antibody positive b. All patients with current Hepatitis C antigen positive c. All patients with current Hepatitis C PCR positive c. All cases diagnosed as Hepatitis C positive for the past 5 years 166. You are a doctor in an international flight. You had 6 standard drinks on board. A passenger had an emergency and flight steward was looking for a medical practitioner on board. What would you do? a. Help patient even when you had 6 drinks b. Tell the flight attendant that you had 6 drinks and look for others who can help c. Do nothing

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167. Husband gets a call from you because the bill of his wifes STD screening came. What will you do next? a. Tell her results b. Tell him to talk with his wife c. Tell him nothing 168. A 50 year old man with high alcohol intake, what is the possible cause of death 10 years later? A. coronary heart disease B. accident C. liver disease D. depression 169. Patient came in for check up for sore throat. He has no appointment and the receptionist told you that he hasnt paid for his last 2 visits. What will you do? a. Ask for payment in advance b. Book for the next available appointment c. Leave a prescription in the reception d. Refer to another doctor e. Refer to local hospital 170. A new screening program in Aboriginal population is to be started for prevention of blindness due to scarring and opacity of lens. What condition are they screening for? A. alcohol B. visual acuity C. trichiasis D. conjunctivitis 171. GP noted increase incidence of cataract formation in an indigenous community. This corneal scarring secondary to repeated abrasions may be due to what? a. Diabetes b. Trichiasis c. Cataract d. Herpetic keratitits 172. A 45 yr. old male came to you for screening of colon cancer. His father was diagnosed at 67 yr age for colon CA. and maternal aunt at age of 62 yr. What is your most appropriate next step regarding to his situation? A) Fecal Occult Blood Test 2 yearly B) sigmoidoscopy 2 yearly C) colonoscopy yearly D) reassurance 173. 38 year old man asking for prostate CA screening. His father was diagnosed with prostate CA at 80 years old. Neighbour at 50 years old was also diagnosed with prostate CA. He mentioned about PSA screening. On PE: DRE was normal, no lymph nodes palpated. What advice would you give? a. Reassure b. Do PSA in 2 weeks c. DRE annually d. Do UTZ of prostate 58 Sept. 2011

174. A lady of 53 years came to the clinic and speaks about maternal aunt having Breast Ca at age 72 and now being worried about it. What is your advice? a) Ultrasound rite now b) Ultrasound 2 yearly c) Ultrasound and mammography 2 yearly d) Mammography 2 yearly e) You are fine go home. 175. Breast cancer screening in a woman age 40 year old with her mum diagnosed with breast cancer at age 65 year? A) Mammography every 2 year B) Mammography & Ultrasound every 2 year

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