February 2012 Medicine:

1. 2yrs old child come with parents having rash on arm and trunk and cervical
lymphadenopathy for 4 days . WOF is the Dx? a. Vaccination of the child is fully done b. His siblings are fully vaccinated. c. They are having pet in their home. 2. Picture o fundoscopy of retinal vein thrombosis 3. Picture of pyogenic granuloma given..What is the treatment ( Local excision) 4. ECG given related to Digoxin toxicity 5. 30 yrs old lady travelling from Singapore complicated about cough, fever, no symptoms of shortness of breath given, on examination bilateral basal crackles . What is the Dx? a. Pulmonary embolism b. Chronic Fatigue syndrome. c. Pneumonia d. Tuberculosis 6. Which one of the following drug has ionotropic effect? a. Digoxin b. Digitalis c. Frusemide d. Deltiazem 7. CT scan of man of 74 yrs old given .According to his son he was normal 14 days back and suddenly developed confusion, drowsy . No history of fall given clearly , no other neurological signs and symptoms were given . WOF is Dx? a. Subdural Haematoma. b. Extradural Haemorage. c. Subarachnoid Haemorage. d. Cerebral infarction. 8. History of soccer player injured his Rt Knee .Sudden pain and swelling and locking of Rt knee . WOF is the cause. a. Ant. Cruciate Ligament. b. Lateral Collateral Ligament . c. Tear of medial meniscus. d. Medial collateral ligament. 9. Old women with history of shunt of common bile duct , 2 weeks back now complaining of sweeting, dark color urine, no symptoms of fever, Rt Upper quadrant pain given. WOF is the Dx.? a. Pancreatitis b. Cholangitis c. Rupture of bile duct. 10. Picture of man given with SCC of hand. 11. Worker in insulating factory for 20 yrs, with history of smoking for 30 yrs and 15 packs per day, complaints of SOB, 6 Kg Wt loss and haemoptysis. What is the Dx? a. Mesothelioma. b. SCC c. Tuberculosis.

12. All are true for Cluster headache , except: a. Duration less than 2 hours b. Rhinorrhoea. c. Lacrimation d. Happen 2-3 hours after sleep e. Accompanied by vomiting.

13. Old lady develop sudden back pain after closing window, she is complaining of
tenderness of lower back area, after investigation, it was noted that she is having osteopenia. WOF is the cause of her presentation. a. Osteomyelitis b. Multiple myeloma. c. Osteoporosis. d. Stress fracture.

14. 22 yrs old girl had MVA, 5-11 ribs fractured, she is having SOB, tachypnoea,WOF is
the most immediate management for her air travel? a. Needle aspiration at 2nd intercostal apace. b. Underwater seal drainage. c. Intubation and ventilation 15. Picture of tinea capitis. 16. Picture of Scaphoid fracture given and question about how to apply the cast. 17. Treatment of keratoacanthoma given and treatment asked. 18. 35 yrs old man complaining of pain in testes, USG was done and normal. WOF is the cause? a. Vericocele b. Epididymitis c. Tortion of Testes 19. 60 yrs female come with history of abdominal distention, constipation and decreased bowel sound , PR was normal, previous H/O appendisectomy at 44 yrs old of age .X-Ray given WOF is the cause? a. Sigmoid Volvulus b. Small intestine obstruction c. Ca Caecum. 20. ECG was given. After MI patient develop Arrhythmia, WOF is the drug of choice? a. Digoxin b. Amiodarone c. Atropine

21. 25 yrs old man develop SVT , vagal manuver done , still he was having increase heart
rate, he didnt want adenosine, WOF is next drug to administer? a. Digoxin. b. Atenolol c. Verapamil 22. 10 yrs old boy had minor wounds with no past H/O vaccination for tetanus, on examination wound was not contaminated too much. Most appropriate management? a. Ig b. DPT

c. Tetanus toxoid+Ig.

23. Pic of abdominal mass give protruding out of umbilical area and treatment was asked.
a. Debribe b. Surgical intervention. 24. 64 yrs old woman complaining of weakness and fatigue for last few days , there is no family history of any malignant condition . WOF investigation sud be performed? a. Colonoscopy b. FBC c. FOBT d. Sigmoidoscopy 25. 28 yrs old man with a history of URTI , after 1 week there is haematuria, HTN, Proteinuria. WOF is the cause? a. Ig A nephropathy b. Nephrotic Syndrome. c. Renal failure d. FSGS. 26. Pt going for cholecystectomy is on warfarin , INR 2.2, how you proceed and adjust Warfarin? a. Delay surgery for 3 days b. Stop Warfarin and start Heparin and do surgery c. Stop Warfarin , give FFP and proceed to surgery. d. Continue Warfarin. 27. 46 yrs old woman H/O thyroidectomy few hours ago , nurse noted pt is suddenly having difficulty in respiration, and condition was deteriorating . what is your next step in Mx? a. Call the senior surgeon. b. Shift patient to operation theatre. c. Give her bedside O2. d. Open sutures in ward.

28. 29 yrs old had MVA , tibia fractured , after few hours there is redness and absent
pulses at lateral malleolus , what will be your next step investigation. a. Doppler USG b. Arteriography. 29. 62 yrs old lady noticed lump in her breast, after a dog jumped on her chest, WOF is the cause of her lump? a. Fibroadenosis b. Fat necrosis c. Ca Breast. 30. 26 yrs old patient having Diarrhoea and vomiting for last 2 days, O/E drosy and lethargic. WOF is the nest step in Mx? a. Colloids. b. Hartmans solution c. Crystalloids

31. A 20 yr old presented with weakness and edema of left hand,with h/o cat scratch 4 days ago..lymph nodes enlarged and non tender...what s the cause? a) cellulitis b)cat scratch c)axillary vein thrombosis 32. patient cannot extend wrist and fingers...all other things normal...lesion... a)anterior interosseous nerve b)ulnar nerve c)radial n d)posterior interosseous n 33. 23 yr old nurse working n rural hospital presented with c/o cough, foll by hemoptysis for 1 mnth....crr given....(?apical lobe affected) diagnosis a)hiv b)tuberculosis c)lung ca d)pneumonia 34. bacterial conjuctivitis pic given....treatment a)symptomatic b)ciprofloxacin drops c)chloramphenicol eye drops 35. man with symptoms of difficulty in plantar flexion,inversion,dorsiflexion,eversion of foot...knee reflex present..where s the lesion. a)sciatic n b)L5 c)tibial n d)common peroneal n 36. ct scan on cerebral tumor,cerebral h'ge 37. stem on heparin induced thrombocytopenia...wht to do next?he s on low mol wt heparin a)change to unfractionated heparin b)change to another anticoagulant other than heparin grp c)?????

38. 75 yr old with c/o bloating ,abdo distension, diarrohea alternating with
constipation....no blood n stools...colonoscopy done 12 mnths back,,came out norml....wht to do nxt? a)repeat colonoscopy b)diet advice c)?????????????

39. 75 yr presented with post prandial abdo pain....othr thng norml....diagnosis? a)Ca duodenum b)Ca cardia c)cholecystitis d)????????????? 40. management of tennis elbow a)no option for rest b)elbow immobilisation splint c)brace below elbow. 41. typical qs on bells palsy 42. biker fell frm bike 1week back.....no h/o unconsciousness...now presenting with occipital headache....diagnosis?? a)EDH b)SDH c)post traumatic headache 43. ECG of wpw syndrome wth wide qrs...management a)amiodarone b)adenosine c)cardioversion 44. sign of acute limb ischemia indicative of surgery a)pain b)paralysis c)color 45. sign of chronic limb ischemia a)pain b)paralysis c)rubor 46. qs on trichotillomania 47. 2 week infant presented with fever,neck stiffness..qs abt meningitis....causative organism... a)E.COLI b)strep.pneumonia c)kleibsiella 48. pic of scc.....wht happens next a)involutes b)grows fast

c)spread to lymph nodes 49. child with petechia and bruises after URTI....diagnosis and inv.......... 50. Pic of psoriasis Tx. 51. pt on metformin,perindopril,diuretic......amox was tkn fr urti 3 days back....dvlpd swelling and itching of rt side of tongue.....cause fr tht a)mox b)perindopril c)diuretic 55. indigenous boy brought,,unconscious...cause a)petrol sniffin b)alcohol c)marijuana 52. qs on serotonin syndrome 53. treatment of alopecia areata a)application of hydrocortisone on tht area b)injection of steroid on tht area c)???????? 54. qs on conduct disorde and adhd 55. mre qs on peptic ulcer ds,,Ca duodenum,,Ca Cardia 56. Indigenous boy brought,,unconscious...cause a)petrol sniffin b)alcohol c)marijuana 57.What is the risk of conceiving a child with Down Syndrome for a 38 year old female. A. 1:10 B. 1:100 C. 1:200 D. 1:400 E. 1:700 58. 19 year old boy complains of having difficulties in playing sports at school. His height is at 97th percentile for his age and weight is at 3rd percentile. What is your next step in management a) Karyotyping b) bone scan c) growth hormone test d) CT Scan e) Cardiac ultrasound 59.A pt who worked in a gold mine for 20 years and is smoker and history of working in petrol station for 20 years now presents with hematemasis and cough. Xray was given, how would diagnosis him A) Bronchoscope B) USG C) Ct scan D) Needle aspiration

60. A Ct scan of a 80 years old man was given ( massive bleed with displaced ventricles, is admitted to the ICU, pts wife want a calm ending for him while the Son want to do want ever it takes to save his father. Who would decide on the treatment? a) Follow the wife wishes b) Follow the son wishes c) Decide by your own using the doctor power d) Arrange family meeting e) Guardian ship court 61. A middle aged lady w hx of pain over distal fingers - more on palpation with no obvious deformity for 20 years + Anaemia + CXR shows enlarged heart .what is the diagnosis? a) scleroderma b)SLE 62. A picture of psoriasis of the leg with extensive lesions. What is the treatment of choice? a)UVB light b) calcitriol 63. A pic of SCC at lower lip, what is most common cause? a) Smoking b) Sun exposure c) Mets d) Unknown cause 64. A critically ill pt who mad advance directives when he was in good health now no tubes Now he has a massive stroke and critically ill. His family also agreed with his decision previously made. How will you decide on his rx now a) Intibuate and ventilate b) IV line and feed c) Cvp and fluid d) Oral small sips of water e) Send him for terminal care 65. A pt had an accident his pulse is 120 BP is 120/80 laying and 90/70 standing what is the percentage of blood loss a) 10 % b) 20 % c) 25% d) 35% e) 40% 66. a 18 month old has head circumference 25th percentile at birth 50th percentile at 6 moth 75th percentile at 1 year and 97th percentile at presentation what is the best way to diagnose. a) Cranial USG b) MRI c) No need to investigate 67.ECG of SVT from blue book asked diagnosed 68. old home pt with off and on constipation and Xray of the sigmoid volvulus on blu book page 458 was given and asked for diagnosis a) sigmoid volvulus b) lage bowl obstruction c) small bowl obstruction d) adhission

69. ecg of WPW asked for rx a) Carotid message b) amidrion c) digoxin d) adenosine 70. SVT ECG from blue book and dx asked. 71. ECG of an old lady with SVT and then sudden a systole after carotid message . asked for tx a) amioderon b) adenosine c) shift her to ICU d) atropine i/v e) do not do carotid message again. 72. venous ulcer asked about the most common association a) smoking b) DVT c) long bone fracture 73. a pic of ulcer o the medial meallolus what the diagnosis a) arterial ulcer b) venous ulcr c) diabetic ulcer 74. Patient complains of jaundice with dark urine and pale stools. Pain in right upper quadrant. There is a mass which moves with respiration. Most likely diagnosis? a) Choledocolithiasis b) Carcinoma of ampulla of pancreas c) Mucocele 75.An old pt on who just had drug elucidating prosthetic valvein place is on clopidrogril came in to preoperative clinic for evaluation. He has a non complicated vericocele. Wht will you advise him regarding the operation a) reacess the nedd for durgery b) stop clopidrogil and shift to heparin one week before surgery c) give FFP before surgery d) stop clopidrogril few days before surgery e) giv vit K 76. A 60 year old man with a long history of diabetes, comes to the hospital with ulcer in each dorsum of the toe, in both the legs. There is foul smelling discharge from the right side ulcer. What would be the most appropriate next step in management? a) Amputate the toes. b) Do Doppler Ultrasound c) Give antibiotics (Amoxicillin and Clavulonic Acid) 77. A 30 year old man with multiple rib fractures following a motor vehicle accident. Having paradoxical breathing. what would be the most appropriate next step in management? a) strap the chest well b) CPAP with Ventilation c)no option for intubation and ventilation

78. pic of red eye with watery discharge , two weeks earlier pt had oral and genital ulcers what the rx a) antibiotics b) chlormphencol ointment c) oral steroids d)steroid drops 79. Q on leukaemia with blast cells 80. a pt after being drinking and sudden pain in and vomiting in the epigastria area and shock, the pain came after bout of vomiting what is mx. a) endoscopy b) gastro graffin c) Ct chest 81. a young male came as one of his friends recently has been diagnosed with the testicular cancer. You examined him and found that one testicle is slightly large the other no other abnormality detected. How will you advice him. a) reassure him as nothing is wrong b) advice him monthly self testicular examination c) annual AFP d) regular review with USG 82. ct of intra cerebral bleed dx asked 83. typical Presentation of ITP initial test asked 1) FBC 2) Aptt c) INr d) bleeding time 84.which of the following is true regarding Naltrexone A. Short acting b. Given for chronic marijuana users c. Ideal for IV drug user since it is long acting. d. A substitute for Methadone e) . Generic name for naloxone 85.A middle aged women with calf pain from few days came to hospital. her investigations showed Deep vein thrombosis. What is the management? a. IP management with compression with compression socking and LMWH b. IP management with elevation and LMWH c. OP management with compression and LMWH d. OP management with leg elevation and LMWH 86.Middle aged man with history of cough.CXR showed, lower lobe consolidation. What is the management? a. oral amoxicillin and clavulanate b. oral azithromycin c.IV ampicillin d. Oral flucloxacillin 87. All are S/E of corticosteroid therapy except: - hirsutism - ecchimosis - leucocytosis - osteomalasia - lymphopenia

88. IN a patient with GBS which is the appropriate way to monitor his oxygenation? a) Forced vital capacity in 1sec b) forced expiratory capacity in 1 sec c) blood gases d) pulse oxymeter e) Oxygen saturation 89. A 14 yr old boy separated from his parents n currently living w his father since 3 months having bloody diarrhoea .no fever .what is the best investigation to come to a diagnosis? a) colonoscopy b) sigmoidoscopy c)celiac serology d)FBC 90. A 2 week old child with temp of 40'c came to hospital w hx of seizure + looking ill. Mother very concerned as child not feeding well. What is the diagnosis? a) febrile convulsion b) septicaemia c) encephalitis d)epilepsy 91. A man presented with the painful defecation and blood on stools. Pain persist for almost 30 min after he opens bowls. What the MX? a) DRE b) colonoscopy c) high fibre diet d) high fibre diet and glyceraltrinitrate ointment e) Steroid ointment 92. A 12 years old boy h/o Nephrotic syndrome not responding well to high dose corticosteroid therapy, urine protein-++,hypertension, hematuria with red casts. WOF can be the cause: A .Ig A nephropathy B .PSGN C .focal glomerulosclerosis 93.You are a medical officer in tertiary hospital, a pt is about to undergo abdominal surgery. Just before the surgery when the pt is being shifted to the operation theatre, the nurse told you that the consent for surgery has not been taken. What you do about the consent now? a) Send the pt to surgery, as the anaesthetist can do this just before anaesthesia b) Take the consent and send the pt for surgery c) Download information from internet provide it to pt and take the consent. d) Call the operating surgeon and ask him to take the consent e) Ask the attending nurse to take the consent from the pt while sending him to OT. 94. What is the characteristic sign of chronic limb ischemia a ) pain relieved by walking b) rubor c ) color of limb improved after hanging limb at end of bed d ) numbness

95. a girl is coming to the gp for evaluation with her parents as she is unable to concentrate on her studies. Although she go out with her friends, she dose not seem to enjoy much of the activities, she also experiences some sleep disturbance, which of the following piece of information in the history is most helpful to reach a diagnosis. a) mother also experience sleep disturbance b) Brother has ADHD c) She has suicidal ideation d) She use drugs at school e) She is being bullied at school 96. Bacterial meningitis, viral meningitis, encephalitis please read all about them. 97. History of eye injury blowout what will you find in the signs a) diplopia b) hyphemia c) fracture zygoma 98. SCC of lung and mesothealeoma do these topic 99. Diabetic pt on metformin, endepamide having hypoglycaemic attacks whats the reason for hypoglycaemia a) metformin b) endepmide 100. another q on diabetes controlled at the moment but HBA1c increased 7.5 asked the rx, cannot remember the options. 101.Q on sodium low 120 asked the reason cant remember the full Q. 102. Q on intestinal obstruction 3 ecg Question 3 ct scan Q 2 Xray chest 4 skin condition with pic 103.23 yr old nurse working n rural hospital presented with c/o cough, foll by hemoptysis for 1 mnth....crr given....(?apical lobe affected) diagnosis a)hiv b)tuberculosis c)lung ca d)pneumonia 104.bacterial conjuctivitis pic given....treatment a)symptomatic b)ciprofloxacin drops c)chloramphenicol eye drops 106.ct scan on cerebral tumor,cerebral h'ge 107.stem on heparin induced thrombocytopenia...wht to do next?he s on low mol wt heparin a)change to unfractionated heparin b)change to another anticoagulant other than heparin grp c)?????

108.75 yr old with c/o bloatin,abdo distension,diarrohea alternating with constipation....no blood n stools...colonoscopy done 12 mnths back,,came out norml....wht to do nxt? a)repeat colonoscopy b)diet advice c)????????????? 109.75 yr presented with post prandial abdo pain....othr thng norml....diagnosis? a)Ca duodenum b)Ca cardia c)cholecystitis d)????????????? 110.18 weeks pregnant who s a known c/o cin2 with compalins of clear vaginal dischrge....wht u do next.... a)do pap smear now. b)cervical length measurement.. c)????????? 112.typical qs on bells palsy 113.management of tennis elbow a)no option for rest b)elbow immobilisation splint c)brace below elbow 114)biker fell frm bike 1week back.....no h/o unconsciousness...now presenting with occipital headache....diagnosis?? a)EDH b)SDH c)post traumatic headache 115)ECG of wpw syndrome wth wide qrs...management a)amiodarone b)adenosine c)cardioversion 116.2 week infant presented with fever,neck stiffness..qs abt meningitis....causative organism... a)E.COLI b)strep.pneumonia c)kleibsiella 117.pic of psoriasis....treatment

118.pic of scc.....wht happens next a)involutes b)grows fast c)spread to lymph nodes 119.child with petechia and bruises after URTI....diagnosis and inv.......... 120.pt on metformin,perindopril,diuretic......amox was tkn fr urti 3 days back....dvlpd swelling and itching of rt side of tongue.....cause fr tht a)mox b)perindopril c)diuretic 121.indigenous boy brought,,unconscious...cause a)petrol sniffin b)alcohol c)marijuana 122.treatment of alopecia areata a)application of hydrocortisone on tht area b)injection of steroid on tht area c)???????? 123.qs on conduct disorde and adhd 124.mre qs on peptic ulcer ds,,Ca duodenum,,Ca Cardia 125..17 years old jogging then collapsed.somebody did CPR and was revived when she arrived at ER. Has history that father died suddemly. Which is the likely diagnosis? --HOCM 126. ECG on V tach. Identify and Treatment --Amiodarone 127.Woman when she defecates a mass is noted to bulge out of her introitus.Most likely diagnosis. ---Rectocoele 128. child with constipation. What is the next management --laxative 129. child with bruises and petechiae after a viral infection weeks ago.most likely diagnosis? --ITP 130.ct scan of rectus sheath hematoma 131. situation about testicular sweeling. What do you do next? --ultrasound --FNAC 132. question about painless hematuria --bladder tumor --renal tumor

133.. question about a man 35years old asking about his risk of developing prostate CA. Father diagnosed prosteate CA at 85 years old. --reassure? --FOBT --colonoscopy 134. what is the most important sign to indate for immediate embolectomy --paralysis --pain --rubor 135. 6weeks old infant with fever. Mother notes some twitches before. What is the most likely diagnosis --septiceamia --febrile convulsion 136.old man was found by police and brought to hospital. Daugther has many complaints about father. She said he has been living in squalor and eating rubbish.what kind of dementia? --frontal lobe dementia --lewy body dementia 137. what to give to pregnant woman aside from folic acid to prevent NTD? --iodine 138. question july 2010 #101 139.question july 2010 #110 140. question july 2010 #111 141. question about an old lady after closing the window (?) sustained a crush fracture on her vertebrae. She had a history of opertation for CA of ceucum --metastasis from primary cancer --osteoporosis 142. patient just had cricothyroidectomy and developed stridor while she was still in the recovery room. What will you do? --call the surgeon --explore the wound in the ward --remove the skin sutures 143. xray given. Man is a non-smoker and working in the mine industry (did mention the years, think it was more than 20years). Has been coughing --mesothelioma 144. question about percentage passing the disease to their children with cystic firbosis -- 0% 145. xray given. Man coughing, smoker and working in the mine industry. What is the most probable diagnosis? --brochogenic CA 146. a child with fever. What is the indication that she has a severe bacterial infection --unresponvie to mother --pallor 147.. xray of sigmoid volvulus

148. Boy having balck and white drawings. Parent just separted. What is the most appropriate Mx? --ask the boy about his drawing 149. question about domestic violence. Pregnant lady with bruises. What do you do? -- give the numbers 150. woman with 3 children wants space, but in file said do not give OCP as Stand by husband -- its her opinion and give her OCP 151.NALOXONE is -- Short acting 152. 17yo wants OCP. She had seizsure whihc is controlled with carbamepine and subdural haematoma -- GIVE OCP --GIVE OCP AND USE CONDOM* 153.X-ray of hip osteopenia ALP is 800 ( that is the only information given ) Rx a. Biphosephanate b. Ca c. Vita b12 d. Radiotherapy 154.Pic of both lower limbs showing red rash. 34y old male with diarrhoea and admitted in the hospital Dx a. HSP 155.Mallert finger pic. Which type of injury will occur a. Hyperflexion occur due to extension b. Rupture of tendon 156.CXR night sweat, dry cough, wt loss, enlarge bilateral cerviacal lymphnode Dx a. Sacodosis b. Tb c. Lymphoma d. CLL 157.A patient who started hydrochlorothiazide with digoxin develop nausea electrolyte pic given only potassium decrease a. Stop digoxin and give K suppliment b. Stop hydrochlorothazide and give K supp 158.SVT ECG a) b) c) d) Adenosing Amiodarone Verapermil Dogoxin

159.ECG . a pt who had stroke came to hospital on 5# day she collapsed in the toilet. BP pulse?? What will you do next to dx his condition? a) Ctpa b) Echo cardio 8. A boy came with bloody diarrhea with less urine output what is the dx a) Renal failure b) HUS

160.A infected batholian cyst a) Antibiotic will resolve it b) Cause by gonnorrhoea c) It is asymptomatic 161.A pt who had an injury to eye due to hit from metalic spike what will you do a) Use local anaesthetic and removed 162.A pt 70 yrs old man came to the hospital think that he is having serial illness coming to doctor with different names. What is it a) Facticious dis b) Depression c) Normal grief 163.Abd x-ray 5th POD due to hip replacement a) Pt rectus tube b) Gastro graffin enama c) Colonscopy 164.5th POD for input output chart given. 165.In both recall output is more than input. One is 1400 is differnt, other recall 2100. a) Resolved paralytic ilius b) Wrong chart 166.A lady and husband came to you recently dx cystic fibrosis concern abouthe their child getting it a) 0.25 chance b) 0.5 chance 167.A couple comes telling that one child diagnosed as cystic fibrosis concern about next child incidence a) 0.5 b) 0.25 c) 100 168.You went to old house to trat a person and prescribe b-blocker and asprin. The nurse told that he is not responding to B-blocker what ill you do a) Talk with nurse durin her break b) Report nurse manager c) Do as she told 169.You consider to old care notice that it is written in their chart telling dont crash the medicine. But nurse use to crush the medicine to pt as it is hard for him to swallowing what will you do a) Complain nurse manager b) Go to nurse board c) Complain to the sup in age care. 170.CT head show hemorrhage. Pt on warfarrin and INR 4.5 what will you do a) giveFFP b) give platelet 171.CT head showing same lesion like infaction a) Multi infarct dementia b) Cerebral hmg c) Cerebral abcess

172.VT ecg a) Adenosin b) Amiodaerone c) Adrenaline 173,A lady comeplain loss of finger grip in index and thumb what nerve is having. a) Radial n. b) Carpal tunnel c) Ant. Intoressisis d) Ulner n. 174.80 lady comeing with rectocele a) Pessary b) Sx c) Pelvic exercise 175. 50 yrs old man coming with sccrotal pain which is reddened what ill you do a) Urine catha b) b/d culture c) FNAC 176. male taken to a research and during it he become dementia and his primary carier is his son what will you do a) Ask from son b) Gardianship c) Ethic and comity 177.Fundoscopy pic, HTN ployuria, ploydypsia, what is dx a) DM b) HTN c) CRAO d) CRVO 178.A male who use to work in mine in 20yr smoker 40yr what is the dx. CRX given a) Smallcell carcinoma b) Squamous cell carcinoma c) Metho 179.A chinese lady come to your. Husband is recenly dx as hemochromatosis having 9 & 18 year kid. Wife is not screen for heamochromtosis. What will you do a) Check wife only b) Check 9 yr only c) Check 18 year d) Check both children 178.A down syndrom under go surgery develop hypersensitive a) Latex b) Anaestheic drugs 179.A 34yr male havin, ACEI Statin b-blocker develop calf pain tenderness in calf a) Check ck level creatin b) Check FBC

180.A pic both eye increase tearing who will you do a) Refer plastic surgery b) Cold compression 181.CXR given and ask of diagnosis a) Pul edema b) Metastasis c) Carcinoma 182.A 2nd POD a person develop agitated confusion. Temp normal and pulse and BP normal what is the cause a) Alcohol withdrawal b) Pulmonary atelectesia c) Electrolyte imbalance 183.A yong boy comes with rashes in both hand and arthralgia. What will you do to dx it a) CRP and ESR b) Echo c) CXR 184.Coal miner, working since 40 years, no smoking Hx. CXR : pleural effusion. Dx? Infected Bartholin cyst? Mx Pt with Pagets disease. What is it associated with? Infected Bartholin cyst. What is true? a. Is asymptomatic b. Treated by a/b c. Caused by gonococcus 185.Old man with Hx of confusion and forgetfulness. He is driving at night. What is your advice? a. Stop driving 186.AFlatter: full ECG Dx? 187.Pt with dizziness + palpitation + elevated JPV. 5 ECG strips: a. VT b. AFlatter c. SVT NB: no AFib option! 188.23y.o. male c/o tenderness of left scrotum. Transillumination (-)ive. Next Ix? a. USG b. Urine culture c. Biopsy d. FNA 189.Big stem: old man, with many co-morbidities + polypharmacy, falls every morning. Most appropriate Ix? a. CT b. ECG c. Echo NB: no BSL option!

190.Carpet layer presents with pain and tenderness in one knee. Tx? a. Corticosteroids intra articular b. Rest for 2 wks c. Compression bandage 191.Big stem: 32y.o. female with a lot of complains and Hx. CXR: patchy infiltrates (but looked normal to candidate). Tx? a. Azithromycin b. Prednisolone c. Clotrimazole d. Ticaracillin 192.Husband is diagnosed with hereditary haemochromatosis. Wife is healthy. They have two children: 9y.o. and 18y.o. Whom are you going to screen? a. 9y.o. b. 18y.o. c. Both 193.How many children will be affected by Cystic fibrosis, if one of the parents is a career? a. 0 b. 0.5 c. 0.25 194.Pt complains of developing digital ulcers when exposed to cold in winter. Tx? a. Hydroxychloroquine b. Oral prednisolone c. IM prednisolone 195.Pt agitated and confused, brought in to ED. What will you give? a. Haloperidol b. Olanzepine c. Diazepam d. Fluoxetine 196.Old man living alone, wife died few years ago. Doesnt want to live. WOF would be of more concern? a. He is looking for suicidal methods on internet b. His any previous suicide attempts c. He is living alone 197.Pic of Staphylococcal pneumonia. ECG of VT. Mx? a. Carotid massage b. Amiodarone c. Verapamil 198.Mother brought the child with some problem. Doctor ordered CT. Mother couldnt bring her child for the appointment. What do you do? a. Dont do anything b. Call her in 14 days c. Send her home a formal follow up letter

199.Old man with a terminal illness agrees to receive supportive treatment. His son, who is not living with him and is not his attorney of medical advice, wants Sx for him. a. Ask the son to go to medical legal board b. Follow patients wishes c. Discuss with the son pros and cons of the operation and convince him 200.Pic of Erythema Multiforme 201.Pic of drug rash on legs. 202.Pregnant lady with hyperthyroid findings. What to prescribe to her? a. PTU (propylthiouracil) b. Carbimazole 203.Pt agitated and breathless immediately after operation. What to do? a. Remove superficial sutures b. Explore wound in the ward c. Call the surgeon d. Do nothing 204.Boy fell from the tree; he is having a clear fluid discharge from the nose. CT is needed. Big hospital is 4 hours away by road. What will you do? a. Send him to nearest hospital by ambulance b. Air ambulance the Pt c. Tell the Pt you cant do CT 205.Jehovah witness Pt needs blood transfusion for Ph incompatibility. Relatives say no. What do you do? a. Transfuse the Pt b. Do not transfuse the Pt c. Discuss the situation with relatives d. Ask the Pt to sign No transfusion form 206.Pt on warfarin, INR 4 (2.5-3.5) came to hospital with pain in left side of the chest. There is tenderness in LIF, no gardening. CT: rectus sheath hematoma. Dx? Pt after trauma becomes agitated at hospital and wants to run around. What will you do? a. Pull sides of his bed up b. Restrain c. Do one to one nursing 207.Pt comes with peripheral weakness and has difficulty seen at night. What would you give her initially? a. Folic acid b. Iron supplements c. Vit B12 208.WPW + VT. Mx? a. Sotalol b. Amiodarone c. Adenosine 209.Pic of venous ulcer. a. Arterial ulcer b. Venous ulcer

210.A man with a low visual acuity, which becomes worse in sunlight. Pic is given. a. IOL (intraocular lenses) b. Phacoemulsification c. Pilocarpin d. Keratoplasty e. Acytozolamide f. Trabeculectomy 211.Pic of apical TB in lungs. A rural nurse comes with hemaphtysis. Dx? a. Bronchitis b. TB c. Bronchogenic Ca 212.A girl becomes dizzy few times while at the market. Becomes ok in 2-3 minutes. Dx? a. Migraine b. Arrhythmia 213.A plumber comes with cough. He is a smoker. CXR given: changes in pleura. What is definitive Ix? a. Bronchoscopy and Bronchoalveolar Lavage b. Pleural biopsy c. CT chest 214.6y.o. girl comes with pubic hair and breasts in Tanner stage 1. What will you do? a. Reassure and see her in 6 month b. Do FSH and LH 215.A 6y.o. girl is very scared vigilant anxious; low grades at school. Her teacher is worried. Next step? a. Talk to mother alone b. Open discussion with both parents c. Take more information from the teacher 216.Bone pain. Very high ALP/ALKP; no Ca ++ given. Next Ix? a. Ca ++ b. Electrophoresis 217.Mallet finger. Mechanism of injury. 218.Big stem: Pt with Hx of gastrectomy; all lab tests are given: low Hb + high MCV. Dx? a. Fe deficiency b. Vit B12 deficiency 219.Woman with vaginal discharge, no fever, cervical excitation. a. PID 220.Pic: Tinea capita 221.Pseudobulbar palsy which feature is absent? a. Absent Gag reflex 222.Nephritic syndrome becomes steroid resistant. Dx? a. IgA nephropathy b. Post-streptococcal GN c. Focal segmental GS

223.Q8 from Peads Nov11: 224.A 2 week old child with temp of 40'c came to hospital w hx of seizure + looking ill. Mother very concerned as child not feeding well. What is the diagnosis? a) febrile convulsion b) septicaemia c) encephalitis d)epilepsy 225.Pt with weakness in one hand + headache. Dx? a. Atypical migraine b. Migraine 226.32y.o. pt with rash on buttocks + fever + a. HSP b. ITP c. Hemolytic uremic syndrome 227.10 month old child has been weaning + started cow milk and solids. On presentation pale and unhappy + lost 2 kg. Dx? a. Celiac disease b. Cow-milk allergy c. Cystic fibrosis 228.10 month old unhappy baby. Wt - 10th percentile, Ht - 25percentile. a. Celiac disease b. Cow-milk allergy c. Cystic fibrosis 229.Child, normal delivery, presents to GP for a checkup. On exam: pansystolic murmur. Dx? a. Tetralogy of Fallot b. ASD c. VSD d. TGA 230.4y.o. aboriginal child speaks 5 words only + nose and ear discharge. What do you do next? a. Nasal swab b. Ear swab c. Hearing test d. Tympanometry 231.Which one of these disorders is affected by/ related to culture? a. Schizophrenia b. Anorexia nervosa c. Agoraphobia 232.Lewy body dementia: short stem (4-5 sentences) mentioning visual hallucinations. Elderly Pt in nursing home is abusing nurses while they shower him, masturbates a front of the nuking station. What do you do? a. Frontal lobe dementia b. Alzheimers disease c. Lewy body dementia 233.Old lady in a nursing home masturbates privately. What do you do? a. Complain to nurses supervisor

b. Leave her alone 234.Child with 5-9% dehydration. a. NG dehydration 235.HIV , 2 homosexuals. Best method for protection. a. Condom 236.Fundoscopy: 76y.o. Pt with CRAO 237.For H. pillory medications: a/b with PPIs will help to: a. Increase the relapse time b. PPIs help a/b to penetrate the ulcer 238.2y.o. child with bloody diarrhea, n & v, swellings, petechiae, low urine output. Now lethargic. Dx? a. Hemolytic uremic syndrome b. Salmonella diarrhea c. Bacterial septicemia 237.Several faintings in old Pt. P/E: HR 44; BP 180/110; ejaculating murmur. What is the cause for fainting? a. AS b. CHB 238.Pt comes with h/o of treatment of osteoarthritis with Celecoxib, develops mouth ulcers. Mx? a. Cease Celecoxib b. Give folic acid Viral meningitis: CFS findings? % of burns in a child (picture is given). Ischemic abdo pain. Mx? Pictures from Anthology: HCC Rectus sheath hematoma RA XR Burns (p.112) BBC (pinna of ear) Colles # Ulnar distal # Spine # (osteoporosis) Pictures from Blue Book: Acanthosis nigricans Bulemia nervosa 239.Female Pt right hip. How to use stick? a. Hold in left hand and put your right leg forward 240.Pt coming with pain on defecation, pruritis and hemorrhoids seen only on anal wedge. Mx? a. Increase fiber in diet b. Rubber band ligation c. Sclera therapy

241.Pt with dementia + critical illness. Conflict between wifes and sons wishes. a. Go with wife b. Go with son c. Pros and contras of the condition 242.A girl comes for an OCP prescription, wants to have safe sex. Periods are just started. She tells mother and sister has menorrhagia problems. What do you do? a. Prescribe OCP b. Screen her for coagulopathy c. Tell her to use OCP and condom 243.Tocolytics contraindications: a. Antepartum hemorrhage b. Previous C-section 244.Pt doesnt want resuscitation. What do you do? a. Write DNR sign on his bad b. Check his mental status c. Ask him to sign the form 245.Pt diagnosed with colon Ca Duke C stage. After Sx what do you do? a. Pelvic examination b. ChemoTx c. Colectomy d. 5-FU (5-fluorouracil) 246.Pt underwent appendectomy. Histology showed carcinoid tumour of 2cm. What do you next? a. ChemoTx b. RadioTx c. Rt hemicolectomy d. Leave it as it is 247.ECG od SVT. Rx? a. Amiodarone b. carotid massage c. adenosine 248.Pt with VFib, ECG given. Mx? a. Atropine b. Adrenaline c. Lignocaine 249.Pt with sore thoat treated with amoxicillin. After 4 days presented with rash. Dx? a. Allergic reaction b. SLE 250.Female Pt presents with peripheral vascular disease. H/o DM and HT + was a smoker, till 3 years ago she developed DVT syndrome and quitted. Dx? a. Bergers disease b. Raynauds phenomena c. SLE

251.Chronic PID Mx? IV drug user arrives to hospital with high fever. Dx? a. Rheumatic fever b. Endocarditis c. Pneumonia 252.The nurse in a nursing home advises you what to prescribe to the Pt. What do you do? a. Talk to the nurse during the break b. Talk to the nurse supervisor c. Write a formal complaint to the nursing home administration 253.Coal miner, working since 40 years, no smoking Hx. CXR : pleural effusion. Dx? Infected Bartholin cyst? Mx 254.Pt with Pagets disease. What is it associated with? 255.Infected Bartholin cyst. What is true? a. Is asymptomatic b. Treated by a/b c. Caused by gonococcus 256.Old man with Hx of confusion and forgetfulness. He is driving at night. What is your advise? a. Stop driving 257AFlatter: full ECG Dx? 258.You are running investigation/survey: how many people in the area are having a particular disease (DM or Hypertension). WOF will be the best method? a. Case control study b. Randomized study 259.Husband is diagnosed with hereditary haemochromatosis. Wife is healthy. They have two children: 9y.o. and 18y.o. Whom are you going to screen? a. 9y.o. b. 18y.o. c. Both 260.How many children will be affected by Cystic fibrosis, if one of the parents is a career? a. 0 b. 0.5 c. 0.25 261.Pt complains of developing digital ulcers when exposed cold in winter. Tx? a. Hydroxychloroquine b. Oral prednisolone c. IM prednisolone 262.What are the risk factors of endometrial Ca? a. Obesity b. Smoking c. OCP d. Multiparity

263.Pt agitated and confused, brought in to ED. What will you give? a. Haloperidol b. Olanzepine c. Diazepam d. Fluoxetine 264.Old man living alone, wife died few years ago. Doesnt want to live. WOF would be of more concern? a. He is looking for suicidal methods on internet b. His any previous suicide attemts c. He is living alone 265.Pic of Staphylococcal pneumonia. ECG of VT. Mx? a. Carotid massage b. Amiodarone c. Verapamil 266.Mother brought the child with some problem. Doctor ordered CT. mother couldnt bring her child for the appointment. What do you do? a. Dont do anything b. Call her in 14 days c. Send her home a formal follow up letter 267.Old man with a terminal illness agrees to receive supportive treatment. His son, who is not living with him and is not his attorney of medical advice, wants Sx for him. a. Ask the son to go to medical legal board b. Follow patients wishes c. Discuss with the son pros and cons of the operation and convince him Pic of Erythema Multiforme Pic of drug rash on legs. 278.Pregnant lady with hyperthyroid findings. What to prescribe to her? a. PTU (propylthiouracil) b. Carbimazole 269.Pt agitated and breathless immediately after operation. What to do? a. Remove superficial sutures b. Explore wound in the ward c. Call the surgeon d. Do nothing 270.Boy fell from the tree; he is having a clear fluid discharge from the nose. CT is needed. Big hospital is 4 hours away by road. What will you do? a. Send him to nearest hospital on ambulance b. Air ambulance the Pt c. Tell the Pt you cant do CT

271.Jehovah witness Pt needs blood transfusion for Ph incompatibility. Relatives say no. What do you do? a. Transfuse the Pt b. Do not transfuse the Pt c. Discuss the situation with relatives d. Ask the Pt to sign No transfusion form 272.Pt on warfarin, INR 4 (2.5-3.5) came to hospital with pain in left side of the chest. There is tenderness in LIF, no gardening. CT: rectus sheath hematoma. Dx? 273.Pt after trauma becomes agitated at hospital and wants to run around. What will you do? a. Pull sides of his bed up b. Restrain c. Do one to one nursing 274.Pt comes with peripheral weakness and has difficulty seen at night. What would you give her initially? a. Folic acid b. Iron supplements c. Vit B12 275.WPW + VT. Mx? a. Sotalol b. Amiodarone c. Adenosine 276.Pic of venous ulcer. a. Arterial ulcer b. Venous ulcer 277.A man with a low visual acuity, which becomes worse in sunlight. Pic is given. a. IOL (intraocular lenses) b. Phacoemulsification c. Pilocarpin d. Keratoplasty e. Acytozolamide f. Trabeculectomy 278.Pic of apical TB in lungs. Rural nurse comes with hemaphtysis. Dx? a. Bronchitis b. TB c. Bronchogenic Ca 279.A girl becomes dizzy few times while at the market. Becomes ok in 2-3 minutes. Dx? a. Migraine b. Arrhythmia 280.A plumber comes with cough. He is a smoker. CXR given: changes in pleura. What is definitive Ix? a. Bronchoscopy and Bronchoalveolar Lavage b. Pleural biopsy c. CT chest

281.6y.o. girl comes with pubic hair and breasts in Tanner stage 1. What will you do? a. Reassure and see her in 6 month b. Do FSH and LH 282.A 6y.o. girl is very scared vigilant anxious; low grades at school. Her teacher is worried. Next step? a. Talk to mother alone b. Open discussion with both parents c. Take more information from the teacher 283.Bone pain. Very high ALP/ALKP; no Ca ++ given. Next Ix? a. Ca ++ b. Electrophoresis 284.Big stem: Pt with Hx of gastrectomy; all lab tests are given: low Hb + high MCV. Dx? a. Fe deficiency b. Vit B12 deficiency 285.Woman with vaginal discharge, no fever, cervical excitation. a. PID Pic Tinea capita 286.Nephritic syndrome becomes steroid resistant. Dx? a. IgA nephropathy b. Post-streptococcal GN c. Focal segmental GS Q8 from Peads Nov11: 287.A 2 week old child with temp of 40'c came to hospital w hx of seizure + looking ill. Mother very concerned as child not feeding well. What is the diagnosis? a) febrile convulsion b) septicaemia c) encephalitis d)epilepsy 288.Pt with weakness in one hand + headache. Dx? a. Atypical migraine b. Migraine 289.10 month old child has been weaning + started cow milk and solids. On presentation pale and unhappy + lost 2 kg. Dx? a. Celiac disease b. Cow-milk allergy c. Cystic fibrosis 290. 10 month old unhappy baby. Wt - 10th percentile, Ht - 25percentile. a. Celiac disease b. Cow-milk allergy c. Cystic fibrosis

291.Child, normal delivery, presents to GP for a check up. On exam: pansistolic murmur. Dx? a. Tetralogy of Fallot b. ASD c. VSD d. TGA 292.4y.o. aboriginal child speaks 5 words only + nose and ear discharge. What do you do next? a. Nasal swab b. Ear swab c. Hearing test d. Tympanometry Fundoscopy: 76y.o. Pt with CRAO 293.For H. pillory medications: a/b with PPIs will help to: a. Increase the replse time b. PPIs help a/b to penetrate the ulcer 294.2y.o. child with bloody diarrhea, n & v, swellings, petechiae, low urine output. Now lethargic. Dx? a. Hemolytic uremic syndrome b. Salmonella diarrhea c. Bacterial septicemia 295.Several fainting in old Pt. P/E: HR 44; BP 180/110; ejaculating murmur. What is the cause for fainting? a. AS b. CHB 296.Pt comes with h/o of treatment of osteoarthritis with Celecoxib, develops mouth ulcers. Mx? a. Cease b. Celecoxib 297.What is true about HIV. a. Antibodies appears after 9 years b. Risk transmission to foetus is 50% c. Ratio CD4 to CD8 is more than 5 300. A middle aged lady w hx of pain over distal fingers - more on palpation with no obvious deformity for 20 years + Anaemia + CXR shows enlarged heart .what is the diagnosis? a) scleroderma b)SLE 301.A man post gastrectomy 3 years ago c/o lethargy. On examination, pallor+ .blood ix: hb 9.0 mcv:110 all other normal range .Wht is the diagnosis? A) iron def Anemia b) vit B def Anemia c) chr Anemia

302.A ECG w WPW + vent tachycardia .Wht us the mx? a) adenosine b)amiodarone c)b blocker d)verapamil 303.A women w hx of passing small quantities of urine after bouts of cough each time was sent fr investigation.Wht is the best investigation to come to a diagnosis? a)ct abd n pelvis b)laproscopy c)cystoscopy 304.Patient complains of jaundice with dark urine and pale stools. Pain in right upper quadrant. There is a mass which moves with respiration. Most likely diagnosis? a) Choledocolithiasis b) Carcinoma of ampulla of pancreas c) Mucocele 305.Patient with mass above the umbilicus . She cannot reduce the swelling anymore and it is painful. She is on warfarin and posted for surgery. INR is 2.9. What will you do ? a) Stop warfarin, start heparin and do surgery b) Stop warfarin, give FFP and do surgery c) Give vit k and delay surgery for 7 days d) Delay surgery for 3 months 306.which feature would be absent in pseudarbulbar palsy? a)Dysarthria b)Dysphagia c)Absent Gag Reflex 307. Year old man, was scrathed by his cat, and 7 days after there was a pustules from humerus to thumb and oedema of arm at the site of the scrath . What could be the diagnosis? a)Cellulitis b)cat scrath fever c.Herpes d.Strep 308.Inferior Wall MI , Of a 55 year old man, with history of Hyperension. Patient is in a Metropolitan Hospital. Patient has been given Oxygen, Nitrates , Morphine and Aspirin. Patient came to the hospital after 4 hours of symptoms. what would be the most appropriate next step in the management of this patient. a) Check Troponin right now and 8 hours later b)Coronary Angiography 309.Patient who was on digoxin for atrial fibrillation was given hydrochlothiazides for Hypertension. About 3 days later patient complains of nausea, vomiting, diarrhoea and patient complains of palpitations. What would be the most appropriate next step in management? a) stop hydrochlothiazides and give pottassium supplements. b) stop digozin and give pottassium supplements

310.A 30 year old woman comes to your clinic with complaints of a seizure like activity which occurred last night. She said her seizures were well controlled the past 3 years with the antiepileptic medication and again they reappeared since recently. How long should she wait to drive? a) 6 months seizure free period b) 2 years of seizure free period c) she can drive straight away 311.A 30 year old lady comes with a bruise on the left cheek and a cut on the lip. If you check which system would you be able to come to a diagnosis? a) CVS b) Respiratory System c) Central Nervous System d) Musculo skeletal system 312.Chest Xray showing a cavitary lesion at the apical part of the right side lung in a tourist coming from sudan. he comes with fever and night sweats. sputum doesnt show any acid fast bacilli. what would be the most appropriate step in the management? a) Isoniazid prophylaxis b) Isoniazid, Rifampacin, Pyrazinamide and ethanbutamol c) Amoxicillin 313.A HIV pt came to your clinic along with partner and asking for the best prophylactic measures they should take a. Use condom and safe sex b. both should use anti HIV drugs 314.A driver from interstate has moved to your locality recently and is stable on lithium for the past 15 yrs.How do you monitor him? a. check lithium levels every 3 months b. check lithium levels every 6 months c. check lithium levels every month d. full blood count 315.Picture of man w normal eyes.History of watery discharge.what is the management? a. Chloramphenicol ointment b. cold compress c. Acetazolamide d. Acyclovir drops 316.85yr old patient presented with right thigh and leg pain after fall.Investigations are as followsCa 3.5,Urea 10.Most common cause a. Osteoporosis b.Vit D toxicity c. Primary hyperthyroidism 317.A middle aged women with calf pain from few days came to hospital.her investigations showed Deep vein thrombosis.What is the management? a. IP management with compression with compression socking and LMWH b. IP management with elevation and LMWH c. OP management with compression and LMWH d. OP management with leg elevation and LMWH

318.Middle aged man with history of cough.Cxay showed---lower lobe consolidation.What is the management? a. oral amoxicillin and clavulanate b. oral azithromycin c.IV ampicillin d. Oral flucloxacillin 319.Sixth nerve palsy picture given.Diagnosis? 320.Amitriptyllin intoxication.What is the management? a. IV fluids b. Intubation and Sodium bicarbonate c. Gastric lavage d. Activated charcoal 321.COPD patient received 6L oxygen and get worse. What is the next step? a. Immediate Cxray b. Reduce oxygen c.Increase oxygen d CPAP 322.A patient on following medications---thiazide 25 mg, B-blocker presented with polyuria, polyuria. His blood sugar 17 mmol/l. What is next management? a. Stop thiazide and reassess b. Start on oral hypoglycemic c. insulin treatment 323.patient with severe chest pain with half an hour history. Ecg was done which was normal, cardiac markers were normal too. what is most appropriate step in management of this patient? a.send him home b.give GTN c.do pci d.stress test 324.Young slim marathon runner with a hx of 2 hour sudden onset of left sided chest pain and shortness of breath on mild exertion. dxa.MI b.spontaneous pnemothorax c.cardiomyopathy 325.A man came from Sudan for a visit; Came to your practice complaining of dry cough, weight loss, night sweating. chest X-ray given that shows right lung apical cavitation. WOF is the most appropriate management: -Isoniazid -Quadri-TB therapy -Chest CT 326.35 years old women with h/o headache and bi-lateral homonymous hemianopia. She recovered from headache but the h/h still persist after 6 weeks. She came to your practice asking when she can drive her car : -after 3 months -after 6 months -never drive again

-after 1 year 327.Young lady presents to GP early morning with history of 8 glasses of spirits last night, with history of nausea since last night. Today morning nausea with vomiting. P/E normal. Next step in Mx? -Review in 4 hours -Review later in the day -explain this is due to excess alcohol and no need to worry -prescribe anti-emetics and review if symptoms recur 328.Pt with Osteoporosis and oesophagitis. What is the treatment? A. alendronate B. zoledronic acid c) Increse milk intake d) risedronate e) Give Calcium supplement. 329.What is best treatment child with petit mal. - Carbomazepine - Na valproate - Barbiturates - Diazepame - No option with ethosuccinate 330.A man on treatment with warfarin for DVT, 2 days ago roxithromycin was added and now INR-9.Pt has mild rectal bleeding, what would be the next initial management? a) Change to another antiboitic. b) Give FFP c) Stop warfarin d) Cryptococcus 331.IN a patient with GBS which is ah appropriate way to monitor his oxygenation? a) forced vital capacity in 1sec b) forced expiratory capacity in 1 sec c) blood gases d) pulseoxymeter e) Oxygen saturation 332.A young lady had headache after she wake up this morning, she vomited once 10am and abdominal pain 1200. She had alcohol drinking last night. Your examination is normal. What is the next step. A) tell her is normal, and send her home. B) Tell her it is alcohol related. And send her home C) Tell her the diagnosis is uncertain, review her after 4 hours. 333.WPW syndrome with ventricle ectopic. What is your next step in management. a) Adenosine b) Verapamil c) Amioderon 334.A pt came with headache and tightness on the scalp. All vital sings and physical, neuro examination are normal. What is the next step management. A) temporal artery biopsy. B) prednisolone C) CT

335.Patient who was on digoxin for atrial fibrillation was given hydrochlothiazides for Hypertension. About 3 days later patient complains of nausea, vomitting, diarrhea and patient complains of palpitations. What would be the most appropriate next step in management? a) stop hydrochlothiazides and give pottassium supplements. b) stop digoxin and give pottassium supplements 336.A 30 year old lady comes with a bruise on the left cheek and a cut on the lip. If you check which system would you be able to come to a diagnosis? a) CVS b) Respiratory System c) Central Nervous System d) Musculo skeletal system 337.Patient complains of jaundice with dark urine and pale stools. Pain in right upper quadrant. There is a mass which moves with respiration. Most likely diagnosis? a) Choledocolithiasis b) Carcinoma of ampulla of pancreas c) Mucocele 338.Patient with mass above the umbilicus. She cannot reduce the swelling anymore and it is painful. She is on warfarin and posted for surgery. INR is 2.9. What will you do ? a) Stop warfarin, start heparin and do surgery b) Stop warfarin, give FFP and do surgery c) Give vit k and delay surgery for 7 days d) Delay surgery for 3 months 339.A lady on warfarin developed Rt iliac fossa pain.CT scan given. Dx a)rectus sheath haematoma b)appendicitis c)mesentric eschemia 340.A picture of Keratoacanthoma. [ Lifted from the AMC Anthology book- exactly the same in the eye] What is the Diagnosis? A. Pyoderma granulosa B. SCC C. BCC D. Nodular Melanoma E. Keratoacanthoma 341.Same picture as above. What is the next step in management. A. Wide local excision of at least 4mm margin B. Local incision C. Local excision with sentinel node biopsy D. Refer to plastic surgery E. Review after 6 weeks 342.Ct scan showing Intercerebral Haemorrhage , patient was on warfarin and his INR at the moment is 4.9. What would be the most appropriate next step a) give vitamin K b) GIVE protamine sulphate c) Give FFP

343.A 60 year old man with a long history of diabetes, comes to the hospital with ulcer in each dorsum of the toe, in both the legs. There is foul smelling discharge from the right side ulcer. What would be the most appropriate next step in management? a) Amputate the toes. b) Do Doppler Ultrasound c) Give antibiotics (Amoxicillin and Clavulonic Acid) 344.A 50 year old man comes with a swelling in the groin region. its reducible on lying down and patient says its slightly tender. patient was put on aspirin and clopidogrel 3 months back for atrial fibrillation. what would be the most appropriate next step in the management? a) five vitamin k and send the patient immediately for surgery b) give ffp and surgery c) stop aspirin and clopidogrel for 1 week and then proceed with the surgery. d) no need of any medications , just refer the patient immediately for surgery. e) nothing needs to be done. 345. Patient comes to you with complaints of swelling under the jaw, and its more prominent after food. Bimanual Palpation was done and what would be the most appropriate next step? a) Intraoral Xray of mandibula b) CT scan c) Sialogram d) OPG E) US 346. A 70 year old woman of Ca colon, comes with lethargy , feeling tired ,and altered bowel habits. which feature would appear 1st in cancer of the caecum? a) palpable mass b) altered bowl habbits c) Anaemia 347. 35 year old man comes saying, his father was diagnosed with prostate cancer at 85years age, and neighbour was diagnosed with the same condition recently. hes worried he might get prostate cancer. On digital Rectal Examination, his prostate was smooth ,soft and median sulcus was felt.He has no symptoms suggestive of prostate cancer. What would you advice to this patient? a) Reassuarance b) PSA c) DRE annually 348.Picture of venous ulcer, which one of the following are the risk factors? a. smoking b. Previous history of DVT c. Coronary aretery disease 349.Mallet finger Mechanism of injury a. flexion injury b. hyperflexion injury c. hyperextention injury 350.History of foreign body in the eye. What is the initial management? a. remove the foreign body with the needle b. Local anaesthetic drops and irrigate with fluids c. antibiotic drops d. miotic drops

351.Patient with earache, swelling in the cheek. On examinationearN,What is the next intial investigation? a. OPG b. Head CT c. sialogram d.CT e. X-ray mandibulae 352.35 yr old male who noticed his right testes was bit swollen and larger than left one. on exam everything looked ok. Dxa. epididymo orchitis b. tortion of testes c. Hydrocele 353.24 years old with severe knee pain. On examination you found effusion around the knee.. pain on knee movements. dx a.anterior cruciate ligament injury b.post. cruciate ligament injury c.medial meniscus injury d.lateral meniscus injury 354. 5 yo child had lower limb injury until the fat layer. He has 2 boots his anti-tetanus vaccination. What is the most appropriate management after wound debridement: -toxin and Ig -aDTP and Ig -Ig -reassure 355.An executive undergone major surgery. After 72 hours Post-op, agitated, disturbed. Says strangers entering his room, while you know, nobody entered his room. Whats the cause? -S/E of medication -Alcohol withdrawal -Psychotic exacerbation -Chest infection 356.Elderly patient with history of anaemia and respectively symptoms of it, no other history or symptoms. What is the next step investigation? - gastroscopy and colonoscopy -sigmoidoscopy -colonoscopy 357.Middle age man after binge drinking in a party suddenly presents with pain abdomen, vomittings. P/E P-110, BP 90/40, tenderness and guarding Lt hypochondriac region, reduced breath sounds & dull percussion at Lt lower chest . What is the cause? -oesophageal tear -ruptured peptic ulcer -spontaneous pneumothorax -Hiatus hernia 358.A 18 years old male patient presented with painless swelling of scrotum which he realized after sport. But no injury was recorded. What is the diagnosis? a) Hydrocele. b) teratoma c) Seminoma d) Torsion of testis

359.A teenage boy came with pain in his right knee after knee injury in the sport game. His knee is red, swollen, hot, painful. What is the diagnose tool? a) CT b) MRI c) Aspiration of the knee e) X-ray 360.A female patient had trauma. She got multiple rib fractures on her left side from. She is conscious and well. Her physical examination is dull on percussion on the left side, and decrease the breath sound on the same side. What is your next step of Mx? a) Insert a cheat tube and drain. b) Intubate and ventilate 361.Pt w 15% pnemothorax. Mx. a. Reassurance and observe b. Drainage under seal water c. Oxygen d. Intubation e. aspiration 362.A 2 week old child with temp of 40'c came to hospital w hx of seizure + looking ill. Mother very concerned as child not feeding well. What is the diagnosis? a) febrile convulsion b) septicaemia c) encephalitis d)epilepsy 363. A 18 month old girl who was started on solid foods and cow's milk since 10 months ago is seen not well and had lost considerable weight at presentation. How will a confirmatory diagnosis be expediently achieved? A. Cow's milk cessation B. Doudenal biopsy 364. A child is brought with complaints of rectal bleeding, history of opening bowels once 4 to 5 days.What is the treatment? a. Laxative and diet rich in fibre b. Increase fluids c.proctoscopy d. colonoscopy 365. Child with history of URTI 3 weeks ago,now presents with ptechiae,bruises.Platelets decreased. All other on investigations Normal. What is the management? a. Strict bed rest b.gamma globulin c. steroids d.antibiotics 366. A 14 years old boy h/o nephrotic syndrome not responding well to cortico-steroid therapy, urine protein-++,hypertension, hematuria with red casts. WOF can be the cause: A .Ig A nephropathy B .PSGN C .focal glomerulosclerosis OBS & GYN

367. Wht is true regarding infected bartholin cyst? a)maybe caused by gonococcal infection b) treat w antibiotics c) surgical removal d) caused by Stahp e) caused by Strep 368. A women w hx of passing small quantities of urine after bouts of cough each time, was sent for investigation. Wht is the best investigation to come to a diagnosis? a)ct abd n pelvis b)USG pelvis c)Cystoscopy 369. A lady on sodium valproate w hx of well controlled seizure during pregnancy and BP 165/85.post delivery day 2-developed generalised seizure .protein +3 in urine. what is the diagnosis? a) generalised seizure b)eclampsia c)hypoglycaemia 370. A long stem wanted to know what would indicate the delivery is most likely to occur before 16wks of gestations. a. Fetal fibronectine test on cervical secretion is positive b) Vaginal discharge c) Absent Fetal heart sounds d) US of cervix length 371. A lady 37yrs old comes for prescription for OCPs. She is known smoker, no other systemic illness. What advice would give this lady about smoking? a. Give her bupropion tablets. b. give her nicotine chewing gums or patch c. advise her about the benefits of quitting smoking d. refer her to de-addiction centre 372. A women is advised by her GP to take OCP for next 5yrs.Which of the following is applicable considering that she no risk factors? a. Increased risk of breast Cancer by 25% b. Increased risk of stroke by 10% c. Increased risk of osteoporosis by 5% d. Increased risk of heart disease <1% 373. A pregnant woman with vesicles in the vagina, have difficulty in micturition. On lab inv Herpes infection. What is the management? a. oral acyclovir b. IV acyclovir c. Interferon d. Oral fancyclovir 374. DX for FT ectopic preg a.US of visral organ b. Bhcg c. Laproscopy d. CT abdo

375. Preg lady 10 wks uterus size 14 wk best Dx method. a. B hcg b. USG c. CT 376. pregnant lady detected with HIV , viral load undetected.CD4 count was given otherwise well , on no medication .which is inappropriate advice? a. highest risk of transmission is likely with low CD4 count. b. high maternal plasma HIV RNA increases transmission risk. c. transmission risk to foetus is high during antenatal period . 377. 21 year old at 26 week gestation with lower abdominal pain n tenderness (Rt iliac fossa). Appendectomia was done 10 y. Ago dxa. pyelonephritis b. appendicitis c. degeneration of unknown uterine fibroid d. ectopic pregnancy e. uknown cause 378. 52 years old women with a BMI-33 , h/o amenorrhea since 12 months what do you expect to find in her lab analysis: a. high estrogen and low FSH b. very low estrogen and very high FSH c. slightly low estrogen and slightly high FSH 379. Young women came to ER for severe lower abdominal pain, low BP-90/50, pulse110,PV bleeding,Hb-90,last menstrual period was 8 weeks ago. WOF will leads you to suspect ectopic pregnancy: a)low BP b)lower abdominal guarding c) PV bleeding d) low Hb 380.Management of abruptio placenta with death foetus: - cesarean -amniotomy -expectant ( Observe ) 381. 2 weeks postpartum lady present with psychotic episodes. She is breast feeding. Best treatment: -Olanzapine - Lithium -diazepam 382. Young lady with DVT comes to GP for contraception. Apart from condom advice, what else you will add? -spermicidal gel -continuous OCP -Estrogen patch -Progesteron only pill

383. pic of pilonedal sinsus in blu book page 207 asked diagnosis exect same pic 384.19 year old boy complains of having difficulties in playing sports at school. His height is at 97th percentile for his age and weight is at 3rd percentile. What is your next step in management a) Karyotyping b) bone scan c) growth hormone test d) CT Scan e) Cardiac ultrasound 385.a pt who worked in a gold mine for 20 years and is smoker and history of working in petrol station for 20 years now presents with hematemasis and cough. Xray was given, how would diagnosis him A) Bronchoscope B) USG C) Ct scan D) Needle aspiration 386.A Ct scan of a 80 years old man was given ( massive bleed with displaced ventricles, is admitted to the ICU, pts wife want a calm ending for him while the Son want to do want ever it takes to save his father. Who would decide on the treatment? a) Follow the wife wishes b) Follow the son wishes c) Decide by your own using the doctor power d) Arrange family meeting e) Guardian ship court 387.A middle aged lady w hx of pain over distal fingers - more on palpation with no obvious deformity for 20 years + Anaemia + CXR shows enlarged heart .what is the diagnosis? a) scleroderma b)SLE 22) A picture of psoriasis of the leg with extensive lesions. What is the treatment of choice? a)UVB light b) calcitriol 388. A pic of SCC at lower lip, what is most common cause? a) Smoking b) Sun exposure c) Mets d) Unknown cause 389.A critically ill pt who mad advance directives when he was in good health now no tubes Now he has a massive stroke and critically ill. His family also agreed with his decision previously made. How will you decide on his rx now a) Intibuate and ventilate b) IV line and feed c) Cvp and fluid d) Oral small sips of water e) Send him for terminal care

390.A pt had an accident his pulse is 120 BP is 120/80 laying and 90/70 standing what is the percentage of blood loss a) 10 % b) 20 % c) 25% d) 35% e) 40% 391. a 18 month old has head circumference 25th percentile at birth 50th percentile at 6 moth 75th percentile at 1 year and 97th percentile at presentation what is the best way to diagnose. a) Cranial USG b) MRI c) No need to investigate 392. ECG of SVT from blue book asked diagnosed 393. old home pt with off and on constipation and Xray of the sigmoid volvulus on blu book page 458 was given and asked for diagnosis a) sigmoid volvulus b) lage bowl obstruction c) small bowl obstruction d) adhission 394. ecg of WPW asked for rx a) Carotid message b) amidrion c) digoxin d) adenosine 395.SVT ECG from blue book and dx asked. 396. ECG of an old lady with SVT and then sudden a systole after carotid message . asked for tx a) amioderon b) adenosine c) shift her to ICU d) atropine i/v e) do not do carotid message again. 397.venous ulcer asked about the most common association a) smoking b) DVT c) long bone fracture 398. a pic of ulcer o the medial meallolus what the diagnosis a) arterial ulcer b) venous ulcr c) diabetic ulcer 399.Q about the CTG interpretation what is more likely associated with foetal hypoxia. Ca not remember the option

400.Patient complains of jaundice with dark urine and pale stools. Pain in right upper quadrant. There is a mass which moves with respiration. Most likely diagnosis? a) Choledocolithiasis b) Carcinoma of ampulla of pancreas c) Mucocele 401.an old pt on who just had drug elucidating prosthetic valvein place is on clopidrogril came in to preoperative clinic for evaluation. He has a non complicated vericocele. Wht will you advice him regarding the operation a) reacess the nedd for durgery b) stop clopidrogil and shift to heparin one week before surgery c) give FFP before surgery d) stop clopidrogril few days before surgery e) giv vit K 402. acute limb ischemia .what sign would require for urgent surgery? a) paresthesia b)paralysis c)rubor 403. A lady of a certain age had Subtotal Thyroidectomy several hours ago. She was noted to have stertous respiration in the ward. There is some swelling and redness on the post-op site. What is the next step in the management? A. Perform bedside Ultrasound B. Remove the deep muscle sutures. C. Call the Surgeon and arrange intra-op exploration of the wound site D. Request CXR urgently E. Remove the skin staples 404.A 60 year old man with a long history of diabetes, comes to the hospital with ulcer in each dorsum of the toe, in both the legs. There is foul smelling discharge from the right side ulcer. What would be the most appropriate next step in management? a) Amputate the toes. b) Do Doppler Ultrasound c) Give antibiotics (Amoxicillin and Clavulonic Acid) 405.A 30 year old man with multiple rib fractures following a motor vehicle accident. Having paradoxical breathing. what would be the most appropriate next step in management? a) strap the chest well b) CPAP with Ventilation c)no option for intubation and ventilation 406. pic of the old lady with a red swollen check like cellulites what is the mx. a) Incision and drainage b) Antibiotic c) OPG 407.A teenage boy came with pain in his right knee after knee injury in the sport game. His knee is red, swollen, hot, painful. What is the diagnose tool? a) CT b) MRI c) Aspiration of the knee d) antibiotic

408.an old pt after surgery uneventfull recoveryafter five-six days suddenly developed chest pain and severe short of breath. What the initiation step. a) CXR B) CTPA C) ECG d) Cardiac enzymes 409. a lady 30 y old with 4 weeks amenorrhea and clear vaginal discharge presented to ER what is the initial step. a) USG b) Antibiotics c) BHcG d) vaginal exam 410. pic of red eye with watery discharge , two weeks earlier pt had oral and genital ulcers what the rx a) antibiotics b) chlormphencol ointment c) oral steroids d)steroid drops 411.Q on leukaemia with blast cells 412.a pt after being drinking and sudden pain in and vomiting in the epigastria area and shock, the pain came after bout of vomiting what is mx. a) endoscopy b) gastro graffin c) Ct chest 413. a young male came as one of his friends recently has been diagnosed with the testicular cancer. You examined him and found that one testicle is slightly large the other no other abnormality detected. How will you advice him. a) reassure him as nothing is wrong b) advice him monthly self testicular examination c) annual AFP d) regular review with USG 414.A pregnant lady with typical migrant came to you what is best rx you give her. a) I/m pethadene b) Morphine and metaclapramide c) morphine d) paracetamol and codine 415. ct of intra cerebral bleed dx asked 416.typical Presentation of ITP initial test asked 1) FBC 2) Aptt c) INr d) bleeding time 417.which of the following is true regarding Naltrexone A. Short acting b. Given for chronic marijuana users c. Ideal for IV drug user since it is long acting. d. A substitute for Methadone e) . Generic name for naloxone

418.A middle aged women with calf pain from few days came to hospital. her investigations showed Deep vein thrombosis. What is the management? a. IP management with compression with compression socking and LMWH b. IP management with elevation and LMWH c. OP management with compression and LMWH d. OP management with leg elevation and LMWH 419. Middle aged man with history of cough.CXR showed, lower lobe consolidation. What is the management? a. oral amoxicillin and clavulanate b. oral azithromycin c.IV ampicillin d. Oral flucloxacillin 420.All are S/E of corticosteroid therapy except: - hirsutism - ecchimosis - leucocytosis - osteomalasia - lymphopenia 421. IN a patient with GBS which is ah appropriate way to monitor his oxygenation? a) Forced vital capacity in 1sec b) forced expiratory capacity in 1 sec c) blood gases d) pulse oxymeter e) Oxygen saturation 422.The mean Bp of a population is 115 mmhg what would be the rage for 95% CI to include 95% population in it with a slandered deviation of 15. a) 150- 175 b) 100- 130 c) 70-160 d 85-145 423.you are planning to conduct a study what would be the best method to sample the study participants. a) Take study sample from university b) Take study sample from your hospital c) Take study sample from old house d )Take study sample the register of general population E) Snowball sampling 424 A 14 yr old boy separated from his parents n currently living w his father since 3 months having bloody diarrhoea .no fever .what is the best investigation to come to a diagnosis? a) colonoscopy b) sigmoidoscopy c)celiac serology d)FBC

425.A 2 week old child with temp of 40'c came to hospital w hx of seizure + looking ill. Mother very concerned as child not feeding well. What is the diagnosis? a) febrile convulsion b) septicaemia c) encephalitis d)epilepsy 426.A man presented with the painful defecation and blood on stools. Pain persist for almost 30 min after he opens bowls. What the MX? a) DRE b) colonoscopy c) high fibre diet d) high fibre diet and glyceraltrinitrate ointment e) Steroid ointment 427.What is the characteristic sign of chronic limb ischemia a ) pain relieved by walking b) rubor c ) color of limb improved after hanging limb at end of bed d ) numbness 428. a girl is coming to the gp for evaluation with her parents as she is unable to concentrate on her studies. Although she go out with her friends, she dose not seem to enjoy much of the activities, she also experiences some sleep disturbance, which of the following piece of information in the history is most helpful to reach a diagnosis. a) mother also experience sleep disturbance b) Brother has ADHD c) She has suicidal ideation d) She use drugs at school e) She is being bullied at school 429. Bacterial meningitis, viral meningitis, encephalitis please read all about them. 430. History of eye injury blowout what will you find in the signs a) diplopia b) hyphemia c) fracture zygoma 431. SCC of lung and mesothealeoma do these topic 432.Diabetic pt on metformin, endepamide having hypoglycaemic attacks whats the reason for hypoglycaemia a) metformin b) endepmide 433.another q on diabetes controlled at the moment but HBA1c increased 7.5 asked the rx, cannot remember the options. 74) Q on sodium low 120 asked the reason cant remember the full Q. 434. A 12 years old boy h/o Nephrotic syndrome not responding well to high dose corticosteroid therapy, urine protein-++,hypertension, hematuria with red casts. WOF can be the cause: A .Ig A nephropathy B .PSGN C .focal glomerulosclerosis

435. A 2 yrs old child , parents complaining of his loss of wt for few days with abd. distension and Diarrhoea and failure to thrive after weaning started . WOF is the DX? a. Cystic fibrosis b.Coeliac disease c.Whipple disease 436. Stem abt Kawasaki disease given and asking abt treatment. Other recalls 1. A patient with Duke C colon cancer, had left Hemicolectomy. For 5 year survival rate, what can be done? a. Total Colectomy b. Abdominal radiation c. 5-fluorouracil 2. A picture showing whitish aspirate from parotid duct a. Parotitis b. Calculus 3. Whitish echogenic lesion on mammography picture of 60 y.o. woman. She admits she had an accident of hitting with a steering wheel on the same breast a year ago. What is the likely diagnosis? a. Focal fat necrosis b. Carcinoma of breast 4. Fundoscopy pictures of central retinal artery occlusion/ central retinal vein occlusion 5. 50 y.o. man complains of flashes and floaters in vision a. retinal detachment 6. CT picture of pulmonary embolism. In the history, patient has a shortness of breath. What is the treatment? a. Aspirin b. Warfarin c. Heparin 7. A patient was found to have Peau de orange while taking an ECG. What is the diagnosis? a. Carcinoma breast 8. A picture of venous ulcer on the medial malleolus of leg. What is the cause? a. Previous tibia/fibula fracture b. Arterial insufficiency 9. A picture showing ulcer near thenar eminence of hand? a. Epitheliod sarcoma 10. A patient diagnosed with Sigmoid volvulus. What is the feature suggestive of ischemic change? a. gross distention of abdomen b. 10 cm dilatation of sigmoid c. focal pain d. colicky pain

11. A 45 y.o. male presented with swollen inguinal lymph node. Where could be the primary? a. Rectum b. Testis c. anal canal d. colon 12. A patient came in with left eye pain of 6 min duration? comes for about 1 hour every day, now increasing intensity, fundoscopy shows arterial injection. What is the treatment? a. Acetazolamide b. Hydrocortisone c. topical pilocarpine 13. A 20 y.o. female presented with malaria rash, joint pain. What test will you do? a. ANA b. Complement assay c. Anti DS DNA 14. M.I. patient, ECG showed ST elevation in V2,V3,V4,V5. Tertiary hospital 300 km away. Patient was given oxygen, morphine, aspirin. What should you do? a. PCI ( percutaneous coronary intervention) b. t-PA c. streptokinase 15. A 15 y.o. patient from Sudan found to have a low calcium. What will you give him? a. Calcium tablet b. Vitamin D c. Cholecalciferol 16. A patient has been a chronic carrier of Hepatitis B for 6 months, What will you find on him? a. HBS Ag b. HBS Ab c. HBE Ag d. circulating DNA 17. A boy had hepatitis A infection and 10 days after he became physically fit. When can he go back to school? a. Now and use separate toilet b. after 3 days c. once the enzyme comes to normal 18.Who is likely to get Coxiella burnetti infection? a. Dairy workers b. fresh water fisherman 19. A lady presented to EMD in a drunk state with a black around eye. What is the most important thing to rule out? a. Fall b. Alcohol c. Domestic violence

20. A patient with right upper quadrant pain, mild jaundice, all enzymes elevated, bilirubin 40. What is the diagnosis? a. Cholangitis b. Acute cholelithiasis c. hepatitis 21. A patient was given Morphine. What will be the blood gas analysis picture? a. Respiratory acidosis b. respiratory alkalosis 22. A patient had bitemporal hemianopia. Where is the lesion? a. Optic tract b. Optic Chiasma c. Optic nerve 23. Question on Osteoporosis 24. A 40 y.o. female came with history of food getting stuck in the throat, regurgitation of undigested food. What is likely diagnosis? a. Carcinoma Oesophagus b. Zenker Diverticulum 25. 17 years old jogging then collapsed.somebody did CPR and was revived when she arrived at ER. Has history that father died suddenly. Which is the likely diagnosis? --HOCM 26. ECG on V tach. Identify and Treatment --Amiodarone 27. Woman when she defecates a mass is noted to bulge out of her introitus. Most likely diagnosis? ---Rectocoele 27. question about painless hematuria a. bladder tumor b. renal tumor 28. question about a man 35 years old asking about his risk of developing prostate CA. Father diagnosed prostate CA at 85 years old. a. reassure b. PSA c. USG d. DRE annually 29. Old man was found by police and brought to hospital. Daughter has many complaints about father. She said he has been living in squalor and eating rubbish.what kind of dementia? a. frontal lobe dementia b. Lewy body dementia 30. question july 2010 #101 31. question july 2010 #110

32. question july 2010 #111 33. question about an old lady after closing the window (?) sustained a crushed fracture on her vertebrae. She had a history of operation for CA of caecum a. metastasis from primary cancer b. osteoporosis 34. patient just had Cricothyroidectomy and developed stridor while she was still in the recovery room. What will you do? a. call the surgeon b. explore the wound in the ward c. remove the skin sutures 35. Xray given. Man is a non-smoker and working in the mine industry (did mention the years,think it was more than 20years). Has been coughing. --mesothelioma 36. question about percentage passing the disease to their children with cystic fibrosis -- 0% 37. Xray given. Man coughing, smoker and working in the mine industry. What is the most probable diagnosis? --bronchogenic CA 38. Naloxone is: a. short acting 39. X-ray of hip osteopenia ALP is 800 ( that is the only information given ) Rx a. Biphosphonate b. Calcium c.Vitamin b12 d. Radiotherapy 40. Pic of both lower limbs showing red rash. 34 year old male with diarrhoea and admitted in the hospital Dx? - HSP 41. CXR night sweat, dry cough, wt loss, enlarge bilateral cervical lymph nodes. What is the likely diagnosis? a. Sarcoidosis b. Tb c. Lymphoma d. CLL 42. A patient who started hydrochlorothiazide with digoxin develop nausea electrolyte pic given only potassium decrease a. Stop digoxin and give K supplement b. Stop hydrochlorothiazide and give K supplement 43. SVT ECG. Treatment? a. Adenosine b. Amiodarone

c. Verapamil d. Digoxin 44. ECG . a pt who had stroke came to hospital. on 5th day, she collapsed in the toilet. BP pulse?? What will you do next to diagnose his condition? a. CTPA b. Echo cardio 45. A boy came with bloody diarrhoea with less urine output, what is the diagnosis? a. Renal failure b. HUS 47. A pt who had an injury to eye due to hit from metallic spike, what will you do? Use local anaesthetic and removed 48. A lady and husband came to you recently dx cystic fibrosis concern about their child getting it a. 0.25 chance b. 0.5 chance 49. A couple comes telling that one child diagnosed as cystic fibrosis concern about next child incidence a. 0.5 b. 0.25 c. 100 51. CT head show hemorrhage. Pt on warfarin and INR 4.5 what will you do? a. give FFP b. give platelet 52. CT head showing same lesion like infarction a. Multi infarct dementia b. Cerebral hemorrhage c. Cerebral abscess 54. VT ecg a. Adenosine b. Amiodarone c. Adrenaline 55. A lady complain loss of finger grip in index and thumb what nerve is affected? a. Radial nerve b. Ant. Interosseous c. Ulnar nerve 57. 50 year old man coming with scrotal pain which is reddened, what will you do? a. Urine catheter b. blood culture c. FNAC 58. Fundoscopy pic, HTN, polyuria, polydipsia, what is dx? a. DM b. HTN c. CRAO

d. CRVO 59. A male who used to work in mine industry for 20 years and smoker for 40 years. What is the dx? ( CXR given) a. Small cell carcinoma b. Squamous cell carcinoma c. Mesothelioma 60. A chinese lady comes to your clinic. Husband is recently diagnosed having haemochromatosis. They have 9 y.o. and 18 year old children . Wife is not screen for haemochromatosis. What will you do? a. Check wife only b. Check 9 y.o. only c. Check 18 year old only d. Check both children 71. A down syndrome underwent surgery and developed hypersensitivity. What is the cause? a. Latex b. Anaesthetic drugs 72. A 34 y.o. male having ACE inhibitor, Statin, b-blocker develop calf pain, tenderness in calf. What is the next step? a. Check CK level b. Check creatinine c. Check FBC 73. A pic both eye increase tearing. What will you do? a. Refer to plastic surgery b. Cold compression 74. CXR given and ask of diagnosis a. Pulmonary oedema b. Metastasis c. Carcinoma 75. At 2nd Post Op day, a person developed agitation and confusion. Temp normal, pulse and BP normal. What is the cause? a. Alcohol withdrawal b. Pulmonary atelectasis c. Electrolyte imbalance 76. FUNDOSCOPY PICTURE ( + microaneursym seen) : patient has a history of Diabetes Mellitus type 2 later on positive blurring of vision and sought check up. What is the likely cause? a. Diabetic retinopathy b. hypertensive retinopathy c. retinal detachment d. macular degeneration 77. FUNDOSCOPY PICTURE ( + drusen): 78 y.o. woman had a gradual onset of bilateral visual loss. What is the diagnosis? a. CRVO

b. CRAO c. Diabetic retinopathy d. Retinal detachment e. Macular degeneration 78. A 60 + y.o. man presents with cough and productive sputum, weight loss of 3 kg ( forgot the duration). He had a history of working in a gold mine industry and was diagnosed before of moderate silicosis. The patient is a NON-SMOKER. What is likely the diagnosis of present symptom? a. mesothelioma b. exacerbation of silicosis c. pulmonary tuberculosis d. bronchogenic carcinoma 79. A picture of chest X-ray and ECG in one stem. A patient with a history of ischemic heart disease and hiatus hernia attends a dinner conference. After eating, he suddenly developed retrosternal pain and collapse. He was rushed to ED and given oxygen and iv fluids. What is the next management? a.Pulmonary angiography b. Nasogastric decompression c. Chest tube drainage d. Emergent laparotomy e. Ultrasonography ( no options for ECG) 80. a 70 y.o. woman diagnosed of cancer of the caecum. What is the first symptom noted in this patient? a. palpable mass b. altered bowel habits c. tiredness and fatigue d. bowel obstruction e. dyspepsia 81. A 30 y.o. man with multiple rib fractures following a motor vehicle accident. He is noted of having paradoxical breathing. What would be the most appropriate next step in management? a. strap the chest wall b. controlled and positive ventilation c. insert chest tube d. 100 % oxygen via bag mask 82. Old lady comes to the ED following MVA with a wrist fracture and confusion. What would be the most appropriate next step? a. Urgent CT head b. Xray wrist c. Wrist plaster cast

93. A 55 y.o. man comes to your clinic and concerned of his family history which his father was diagnosed of having prostate cancer at 85 y.o. and neighbor was diagnosed of same condition recently. He is worried he might get prostate cancer. On DRE, his prostate was smooth, soft and median sulcus was felt. No other symptoms. What would you advice? a. reassurance b. PSA for the next 4 weeks c. DRE annually d. Ultrasound 94. Patient has an ulcer at medial malleolus of left leg. What could be the risk factor? a. smoking b. previous history of DVT at same leg c. diabetes mellitus d. malignant change 95. Man had lower limb injury involving the fat layer. He had a complete vaccination history and last dose was 9 years ago. What is the most appropriate management? a. aDTP b. aDTP and Ig c. Ig d. reassure 96. A 27 y.o. man had a major motor vehicular accident which liver and spleen have lacerations. multiple wounds and fractures. He received 15 units of blood during resuscitation. Few hours after, it was noted positive bleeding in all sites. What is the cause? a. transfusion reaction b. hypocalcemia c. spleen rupture d. DIC e. dilutional thrombocytopenia 97. A young patient had a fall injury. PO2 60 and PCO2 55. Patient has breathlessness but conscious. Whats the next step management? a. paralyze, intubate and ventilate b. 100% oxygen via bag mask c. controlled oxygen d. Chest xray e. chest tube and drain 98. A patient is diabetic and was scratched by a cat in the arm and few days later, + red rash at arm, forearm and anterior shoulder ( no LAD, No fever mentioned in the stem). What is the likely diagnosis? a. Cat scratch fever b. Cellulitis

99. A boy with long ears and large forehead. ( this is a long stem mentioning uncle also has same features) What is the diagnosis? a. Down syndrome b. XYY c. Klinefelters d. Fragile X syndrome 100. What is the chance of having a child affected of cystic fibrosis if one parent is a carrier? a. 0 b. 25 c. 50 101. A pedigree pattern of Autosomal recessive. 102. Picture : exactly the same page 206 anthology of medical condition. what is the diagnosis? a. tinea capitis b. pityriasis capitis ( dandruff) c. pityriasis versicolor d. seborrheic dermatitis 103. . Old patient has history of syncope 3 episodes. Choose ECG that fits: a. ecg of Atrial fibrillation b. ecg of Atrial flutter c. ecg of ventricular ectopic beats d. ecg of Complete heart block e. ecg with tall t waves ( Hyperkalaemia?) 104. Which one of the following studies is LEAST useful? a. Cohort b. case control c. cross sectional d. case report e. systematic review 105. A picture of psoariasis at both lower legs with extensive lesions. What is the treatment of choice? a. UVB light b. calcipotriol c. steroids ( no dithranol, no methotrexate, no tar in the options) 106. A long stem about patient has dryness in the eyes and mouth. Anti RO and Anti La POSITIVE detected. Whats the management? a. Hydroxychloroquine b. Steroids c. Methotrexate 107. A patient was diagnosed of having colon cancer ( i forgot the stage) , surgical operation done and chemotherapy should be started. whats the management? a. 5 Fluorouracil b. Cisplatin

c. Methotrexate 108. A picture of patient having redness in the eye ( anterior uveitis). He had a history of mouth ulcer and genital ulcers. Whats the treatment? a. topical hydrocortisone b. oral steroids 109. WOF features would be absent in pseudobulbar palsy? a. dysarthria b. dysphagia c. absent gag reflex 110. A 24 y.o. lady has one episode of seizure. She experienced of having muscle jerks in her right arm few months ago. She asks you on advice for driving? a. can drive after 6 months b. can drive after 3 months c. can drive after 12 months d. can drive after 24 months 111. Patient with a maintenance of digoxin for AF and thiazide for HTN. Recently, she complains of nausea, vomiting. and palpitations. What would be the most appropriate step? a. stop digoxin and give potassium supplements b. stop thiazide and give potassium c. give potassium 112. Chest X-ray showing a cavitary lesion at the upper right lobe. Patient came from Sudan. He comes with fever and night sweats. Sputum negative for acid fast bacilli. What would be the most appropriate management? a. Isoniazid prophylaxis b. Isoniazid, rifampicin, pyrazinamide and ethambutol c. Amoxicillin d. Ceftriaxone e. no treatment necessary 113. A driver from interstate has moved to your locality recently and is stable on lithium for past 20 years. How do you monitor? a. check lithium every 3 months b. check lithium every 6 months c. check lithium every 1 year 114.85 y.o. woman presented with right thigh and leg pain after fall. Investigations are: calcium 3.5 ( 2.1-2.6), Urea- 10 ( phosphate level not given). Most common cause? a. Osteoporosis b. Vitamin D toxicity c. Primary hyperparathyroidism d. Hypercalcemia of malignancy

115. A middle aged woman with calf pain and tenderness from few days came to hospital. Her investigations showed DVT. She has no other associated symptoms. What is the management? a. inpatient management with compression stocking and LMWH b. IP management with elevation and LMWH c. outpatient management with compression and LMWH d. OP management with leg elevation and LMWH 116. Middle aged man complains of cough and productive sputum. CXR showed patchy infiltrates. What is the management? a. Oral amoxicillin and clavulanate b. Iv ampicillin c. oral flucloxacillin d. Oral azithromycin e. tetracycline 117. Young girl collapsed in a party brought to ED. She is confused. fever of 40 deg C. Noted muscle jerks. BP: 157/98. What is the initial management? a. Thiamine and oral hydration b. cold saline infusion and cold blanket c. diazepam d. haloperidol 118. ALL are side effect of steroids EXCEPT: a. hirsutism b. ecchymosis c. osteomalacia d. lymphopenia e. increase WCC 119. 65 y.o. man had a headache with tenderness on the scalp especially on the right side. Positive history of headaches for few days. What is the next management? a. temporal biopsy b. oral steroids c. CT scan ( no ESR or FBC options) 120. In a patient with GBS which is appropriate way to monitor his oxygenation? a. forced vital capacity b. ABG c. pulse oximeter d. O2 saturation 121. A man complains of cough productive with green sputum and occasional blood. No fever. WOF is the best long term management? a. low dose tetracycline for 12 months b. anti tb drugs c. postural drainage d. reassure

122. Patient has a right LAD when biopsy + squamous cell ca. Where is the primary site? a. breast b. thyroid c. bronchus d. kidney 123. Toxic shock syndrome caused by staphylococcus aureus is associated with: a. super absorbent sanitary pads b. endotoxin production 124. Construction worker complains of eye redness and lacrimation after hammering a nail at work. + metal spikes seen. Whats is your management? a. antibiotics b. irrigation of fluids c. local anesthetic and probe the eye 125. an indigenous boy complains of greenish discharge coming out from the ear and also has green nasal secretions. What is the appropriate management? a. swab ear discharge b. swab nasal discharge c. audiometry ( no option antibiotic) 126. An alcoholic man with pain radiating to the back. Diagnosed of acute pancreatitis. WOF is the LEAST likely to present with? a. constant pain b. nocturia c. diarrhoea d. regurgitation of food 127. A patient complains of lower back pain. On PE noted lumbar spine is not in its normal curvature. NO numbness or decrease ankle jerk. What to do next? a. lumbosacral xray b. MRI c. Nerve conduction study 128. A patient came in with haematuria, 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 129. An elderly patient brought to ED with lightheadedness and palpitations. was diagnosed of Aortic stenosis. ECG is given. What is the management? a. adenosine b. digoxin c. verapamil d. not to repeat the carotid massage

130. A 42 y.o. Nulliparous woman has a bulging mass in the perineum especially during straining on defecation. What is the likely cause? a. cystocoele b. rectocoele 131. A 38 y.o. man was attending a party and ate some peanuts in the cake, suddenly had hoarseness of voice and difficulty of breathing. Whats the immediate management? a. Adrenaline IM b. intubate and ventilate c. Antihistamine d. administer Oxygen 132. A 50 y.o. woman complains of pain at maxillary area and some redness. ( no rashes mentioned). What is the appropriate management? a. Carbamazepine b. Acyclovir c. Famciclovir 133. A GP is in rural area, you notice that recently more cases of Hepatitis C has been diagnosed and want to do research to find out the incidence of hepatitis 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 b. All patients with current hepatitis C PCR positive c. All patients with current Hepatitis C antigen positive d. All cases diagnosed as hepatitis C positive for the past 5 years 134. A man with heavy alcohol intake brought to ED. BP 180/100 HR 120, + tremors ( fine) bilateral in both hands. No confusion, not agitated. What is the appropriate management? a. Propanolol b. Benztropine c. Diazepam d. Haloperidol 135.Naltrexone is: a. short acting b. easily absorbed orally c. substitute for methadone in treating drug dependence 136. A 20 y.o. presented with weakness and oedema of left hand with history of cat scratch 4 days ago. Lymph node enlarged and non tender. Whats the cause? a. cellulitis b. cat scratch c. axillary vein thrombosis

137. A patient cannot extend wrist and fingers. All other normal. What nerve is affected? a. anterior interosseous nerve b. ulnar nerve c. radial nerve d. posterior interosseous nerve 138. A 23 y.o. Nurse working in Rural hospital presented with cough followed by hemoptysis for 1 month. CXR given ( apical lobe affected) What is the diagnosis? a. HIV b. Tuberculosis c. Lung CA d. Pneumonia 139. A bacterial conjunctivitis picture given. What is the treatment? a. symptomatic b. ciprofloxacin drops c. chloramphenicol drops 140. A man with symptoms of difficulty in plantar flexion, inversion, dorsiflexion, eversion of foot. Knee reflex is present. Where is the lesion? a. Sciatic nerve b. L5 c. Tibial nerve d. Common peroneal nerve 141. CT SCAN of cerebral hemorrhage and cerebral tumour 142. A question on Heparin induced thrombocytopenia. The patient is on low molecular weight heparin. What will you do next? a. change to unfractionated heparin b. change to another anticoagulant other than heparin group 143. A 75 y.o. with complains of bloating, abdominal distention, diarrhea alternating with constipation. No blood in stools. Colonoscopy done 12 months ago and came out normal. What to do next? a. repeat colonoscopy b. diet advice 144. A 75 y.o. presented with postprandial abdominal pain. No other assoc. symptoms. What is the diagnosis? a. Carcinoma duodenum b. Carcinoma cardia c. cholecystitis 145. 4 other questions on GIT 146. typical question on Bells Palsy 147. Management of Tennis elbow a. no option for rest b. elbow immobilisation splint

c. brace below elbow 148. Biker fell from bicycle 1 week back. No history of unconsciousness. But now presenting with occipital headache. What is the diagnosis? a. Epidural hemorrhage b. Subdural hemorrhage c. Post traumatic headache 149. ECG of WPW syndrome with wide QRS. What is the management? a. Amiodarone b. Adenosine c. Cardioversion 150. Sign of acute limb ischemia indicative for surgery? a. Pain b. paralysis c. color 151. Sign of chronic limb ischemia? a. Pain b. paralysis c. rubor 152. A picture of SCC. what will happen next? a. involutes b. grows fast c. spread to lymph nodes 153. A patient is on Metformin, Perindopril and diuretic. Amoxicillin was taken 3 days ago for URTI. He developed swelling and itching of right side of tongue. what is the cause? a. Amoxicillin b. Perindopril c. Diuretic 154. Treatment of Alopecia Areata? a. application of hydrocortisone on that area b. injection of steroid on that area 155. MORE questions on Peptic Ulcer disease, CA duodenum, CA cardia 156. An old man was well before and suddenly confused and agitated with memory loss in 2 weeks time thoughts on and off. MMSE score 26/30 brought by his family as symptom getting worse. What is the diagnosis? a. dementia b. delirium 157. A lady is hepatitis B positive. She is coming for advice regarding the Hepatitis B transmission to her unborn baby. What will you advice her? a. She should have CS for delivery b. She should not breastfeed her child as risk is great c. the baby should receive Hepatitis B immunoglobulin and vaccination at delivery

158. A 35 y.o. lady with mother having breast cancer at 47 years and sister diagnosed with ovarian cancer at 30 years. What is her percentage of developing breast cancer? a. 0.25 b.0.10 c. 0.50 d. 0 159. What is the risk of conceiving a child with Down syndrome for a 38 y.o. female? a. 1:10 b. 1:100 c. 1:200 d. 1:400 e 1:700 160. A 19 y.o. boy complaining of having difficulties in playing sports at school. His height is at 97th percentile for his age and weight is at 3rd percentile. What is your next step management? a. Karyotyping b. Bone scan c. Growth hormone d. CT scan e. Cardiac ultrasound 161.A patient who worked in a gold mine for 20 years and is a smoker and history of working in petrol station for 20 years now presents with hematemesis and cough. Xray was given. How would you diagnose him? a. bronchoscope b. USG c. CT scan d. needle aspiration 162. A middle aged lady with history of pain over distal fingers, more on palpation with no obvious deformity for 20 years, +anaemia. CXR shows enlarged heart . What is the diagnosis? a. Scleroderma b. SLE 163. A picture of SCC at lower lip, what is the most common cause? a. smoking b. sun exposure c. metastasis d. unknown cause 164. A patient had an accident, his pulse is 120, BP is 120/80 lying down and 90/70 standing. What is the percentage of blood loss? a. 10% b. 20% c. 25% d. 35%

e. 40% 165. Old patient at nursing home with on and off constipation. Xray of the abdomen ( Blue book page 458). What is the diagnosis? a. sigmoid volvulus b. large bowel obstruction c. small bowel obstruction d. adhesion 166. ECG of WPW. Asking for treatment? a. carotid massage b. amiodarone c.digoxin d. adenosine 167. ECG of an old lady with SVT and then suddenly asystole after carotid massage. What to do next? a. amiodarone b. adenosine c. shift her to ICU d. atropine e. do not do carotid massage again 168.Venous ulcer asked about the most common association? a. smoking b. dvt c. long bone fracture 169.A picture of ulcer of the medial malleolus. What is the diagnosis? a. arterial ulcer b. venous ulcer c. diabetic ulcer 170.A patient complain of jaundice with dark urine and pale stools. Pain in right upper quadrant. There is a mass which moves with respiration. Most likely diagnosis? a. choledocholithiasis b. carcinoma of ampulla of pancreas c. mucocoele 171. An old patient who had drug eluting at prosthetic valve place, clopidogrel. and came to you for preoperative clinic evaluation. He has non complicated varicocoele. What will you advice him regarding the operation? a. reassess the need for surgery b. give FFP before surgery c. stop Clopidogrel few days before surgery d. Give vitamin K 172. A lady of a certain age had Subtotal thyroidectomy several hours ago. She was noted to have stertorous respiration in the ward. There is some swelling and redness in the post op site. What is the immediate management?

a. perform bedside ultrasound b. remove the deep muscle sutures c. call the surgeon and arrange intra op exploration of the wound site d. request CXR urgently e. remove the skin staples 173. A 60 y.o. man with a long history of diabetes comes to the hospital with ulcer in each dorsum of the toe in both legs. There is foul smelling discharge from the right side ulcer. What would be the most appropriate next step in management? a. amputate the toes b. do doppler ultrasound c. give antibiotics ( amoxicillin and clavulanate) 174. A 30 y.o. man with multiple rib fractures following a motor vehicular accident. He's having a paradoxical breathing. What would be the most appropriate next step in management? a. strap the chest wall b. CPAP with ventilation 175. A picture of an old lady with a red swollen cheek like cellulitis. Whats is the management? a. incision and drainage b. antibiotic c. OPG 176. A teenage boy came with pain in his right knee after knee injury in the sport game. His knee is red and swollen, hot, painful. What is the investigation? a. CT b. MRI c. aspiration of the knee d. antibiotic 177. An old patient after uneventful recovery from surgery, 5 or 6 days post op, suddenly developed chest pain and severe short of breath. What is the initial step? a. CXR b. CTPA c. ECG d. Cardiac enzymes 178. A picture of red eye with watery discharge, 2 weeks earlier, patient has oral and genital ulcers. What is the treatment? a. antibiotics b. chloramphenicol ointment c. oral steroids d. steroid drops 179. Question on leukemia with blast cells 180. A patient after binged drinking and sudden vomiting and pain in the epigastric area later on, + shock. What is the

management? a. Endoscopy b. Gastro graffin c. CT chest 181. A young male came to you asking for advice because one of his friends has been diagnosed with testicular cancer recently. You examined him and found out that one of the testicle is slightly larger than the other. No other abnormality detected. What will you advice him? a. reassure him as nothing is wrong b. advice him monthly self testicular examination c. annual AFP d. regular review with USG 182. CT scan ( looks like intra cerebral bleed) What is the diagnosis? 183. Typical presentation of ITP. what is the initial test? a. FBC b. APTT c. INR d. bleeding time 184. WOF is true regarding Naltrexone? a. short acting b. given for chronic marijuana users c. ideal for IV drug user since it is long acting d. a substitute for methadone e. generic name for Naloxone 185. Middle aged man with history of cough. CXR showed lower lobe consolidation. What is the management? a. oral amoxicillin and clavulanate b. oral azithromycin c. IV ampicillin d. Oral Flucloxacillin 186. In a patient with GBS which is an appropriate to monitor his oxygenation? a. forced vital capacity in 1 sec b. forced expiratory capacity in 1 sec c. blood gases d. pulse oximeter 187. A 14 y.o. boy separated from his parents and currently living with his father since 3 months having bloody diarrhea. No fever. What is the best investigation to come to a diagnosis? a. colonoscopy b. sigmoidoscopy c. coeliac serology d. FBC 188. A man presented with the painful defecation and blood on stools. Pain persist for almost 30 mins. after he opens his bowel. What is the management?

a. DRE b. colonoscopy c. high fibre diet d. high fibre diet and glyceryl nitrate ointment e. steroid ointment 189. What is the characteristic sign of a chronic limb ischemia? a. pain relieved by walking b. rubor c. color of the limb improved after hanging limb at the end of the bed d. numbness 190. Bacterial meningitis, viral meningitis, encephalitis- please read all these topics 191. History of eye injury, blowout injury. What will you find? a. diplopia b. hyphema c. fracture zygoma 192. SCC of lung and mesothelioma- please read these topics 193. Diabetic patient on Metformin, Indapamide having hypoglycemic episodes.What is the reason for the hypoglycemia? a. Metformin b. Indapamide 194. Another question on Diabetes and is controlled at the moment But later on HBA1C increased to 7.5. Asked for the treatment? ( cannot remember the options) 195. A case of hyponatraemia ( Na- 120). Stem asked for the reason. ( can't remember the full question and options) 196. Question on intestinal obstruction 197. 3 ECG questions, 3 CT scan, 2 CXR, 4 skin condition with pics. 198. What is true about HIV? a. Antibodies appear after 9 years b. Risk transmission to foetus is 50% c. Ratio CD4 to CD8 is more than 5 199. A middle aged lady with history of pain over distal fingers more on palpation with no obvious deformity for 20 years , + anaemia, CXR shows enlarged heart. What is the diagnosis? a. scleroderma b. SLE 200. A man post gastrectomy 3 years ago complains of lethargy. On examination, + pallor. Blood Investigation: Hb 9.0, MCV 110. All other normal range. What is the diagnosis? a. Iron deficiency anaemia b. vitamin b 12 deficiency anaemia c. Chronic anaemia 201. A woman with history of passing small quantities of urine after bouts of cough each time was sent for investigation. What is the best investigation to come to a diagnosis?

a. CT abdomen and pelvis b. Laparoscopy c. Cystoscopy 202. A 30 y.o. man was scratched by his cat and 7 days after, there were pustules from humerus to thumb and oedema of arm at the site of the scratch. What could be the diagnosis? a. cellulitis b. cat scratch fever c. Herpes 203. Inferior wall MI of a 55 y.o. man with hx of HTN. Patient is at Metropolitan hospital. Patient has been given oxygen, nitrates, morphine and aspirin. Patient came to hospital after 4 hrs of symptoms. What would be the most appropriate next step in the management of this patient? a. check troponin right now and 8 hours later b. coronary angiography 204. A 30 y.o. woman comes to your clinic with complaints of a seizure like activity which occurred last night. She said her seizures were well controlled the past 3 years with antiepileptic medication and again it reappeared since recently. How long should she wait to drive? a. 6 months seizure free period b. 2 years seizure free period c. she can drive straight away 205. A 30 y.o. lady comes with a bruise on the left cheek and a cut on the lip. If you check, which system would you be able to come to a diagnosis? a. CVS b. Respiratory system c. Central Nervous system d. Musculo skeletal system 206. An HIV patient came to your clinic along with partner and asking for the best prophylactic measures they should take: a. Use condom and safe sex b. both should use anti HIV drugs 207. Picture of man with normal eyes. History of watery discharge. What is the management? a. Chloramphenicol ointment b. cold compress c. Acetazolamide d. acyclovir drops 208. 6th nerve palsy picture given. Diagnosis? 209. Amitryptilline intoxication. What is the management? a. IV fluids b. intubation and sodium bicarbonate c. gastric lavage d. activated charcoal

210. COPD patient received 6 L of oxygen and get worse. What is the next step? a. Immediate CXR b. reduce oxygen c. increase oxygen d. CPAP 211. A patient is on following medications, thiazide 25 mg, Beta blocker, presented with polyuria, polydipsia. His blood sugar level is 17 mmol/L. What is the next management? a. Stop Thiazide and reassess b. Start on oral hypoglycemic c. insulin treatment 212. A patient with severe chest pain with half an hour history. ECG was done which was normal, cardiac markers were normal too. What is the most appropriate step in management of this patient? a. send him home b. give GTN c. do PCI d. stress test 213. A young slim marathon runner with a history of 2 hour sudden onset of left sided chest pain and shortness of breath on mild exertion. Diagnosis? a. MI b. spontaneous pneumothorax c. cardiomyopathy 214. A 35 y.o. woman with h/o headache and bilateral homonymous hemianopia. She recovered from headache but the visual defect still persists after 6 wks. She's asking when she can drive again? a. after 3 months b. after 6 months c. never drive again d. after 1 year 215. A young lady presents to GP early morning with history of 8 glasses of spirits last night, with history of nausea since last night. In the morning, still positive nausea with vomiting. P.E. normal. Next step in management? a. review in 4 hours b. review later in the day c. explain this is due to excess alcohol and no need to worry d. prescribe anti-emetics and review if symptoms recur 216. Patient with osteoporosis and oesophagitis. What is the treatment? a. alendronate b. zoledronic acid c. increase milk intake d. risedronate e. give calcium supplement 217. WPW syndrome with ventricle ectopic. What is your next step in management? a. adenosine b. verapamil c. amiodarone

218. A picture of keratoacanthoma. What is the diagnosis? 219. Same picture as above. What is the next step in management? a. wide local excision of at least 4 mm margin b. local incision c. local excision with sentinel node biopsy d. refer to plastic surgery e. review after 6 weeks 220. CT scan showing intracerebral hemorrhage, patient was on warfarin and his INR at the moment is 4.9. What would be the most appropriate next step? a. give vitamin K b. give protamine sulfate c. give FFP 221. A 50 y.o. man comes with a swelling in the groin region. Its reducible on lying down and patient says its slightly tender. Patient was put on aspirin and clopidogrel 3 months back for atrial fibrillation. What would be the most appropriate next step in management? a. give vitamin K and send patient immediately for surgery b. give FFP and surgery c. stop aspirin and clopidogrel for 1 week then proceed with surgery d. just refer the patient immediately for surgery e. nothing needs to be done 222. Patient comes to you with complaints of swelling under the jaw and its more prominent after food. Bimanual palpation was done and what would be the most appropriate next step? a. intraoral X-ray of mandible b. CT scan c. sialogram d. OPG e. USG 223. History of foreign body in the eye. What is the initial management? a. remove the foreign body with the needle b. local anesthetics drops and irrigate with fluids c. antibiotic drops d. miotic drops 224. Patient with earache, swelling in the cheek. On examination, ear is normal. What is the next initial investigation? a. OPG b. Head CT c. Sialogram d. CT e. Xray mandible 225. A 24 y.o. man with severe knee pain. On examination, you found effusion around the knee, + pain on knee movements. Diagnosis? a. anterior cruciate ligament injury b. posterior cruciate ligament injury

c. medial meniscus injury d. lateral meniscus injury 226. Elderly patient with history of anaemia and respectively symptoms of it, no other history or symptoms. What is the next step investigation? a. gastroscopy and colonoscopy b. sigmoidoscopy c. colonoscopy 227. A patient with 15 % pneumothorax. Management? a. reassurance and observe b. drainage under seal water c. oxygen d. intubation e. aspiration 228. ( Big stem) Old man with many comorbidities, + polypharmacy, falls every morning. Most appropriate management? a. CT b. ECG c. Echo ( no BSL option) 229. Carpet layer presents with pain and tenderness in one knee. Treatment? a. corticosteroids intra articular b. rest for 2 weeks c. compression bandage 230. A patient complains of developing digital ulcers when exposed to cold in winter. Treatment? a. Hydroxychloroquine b. Oral prednisolone c. Im prednisolone 231. Picture of Erythema multiforme 232. Picture of drug rash on legs 233. A patient comes with peripheral weakness and has difficulty seeing at night. What would you give her initially? a. Folic acid b. Iron supplements c. Vitamin B 12 234. A man with a low visual acuity which becomes worse in sunlight. Pic is given. a. Intraocular lenses b. Phacoemulsification c. pilocarpine d. keratoplasty e. acetazolamide f. trabeculectomy 235. A plumber comes with cough. He is smoker. CXR given: + changes in pleura. What is the definitive investigation? a. Bronchoscopy and bronchoalveolar lavage

b. pleural biopsy c. CT scan 236. Bone pain, very high ALP, no calcium given. Next IX? a. Calcium b. electrophoresis 237. Nephrotic syndrome becomes steroid resistant. Dx? a. IgA nephropathy b. Post streptococcal GN c. Focal segmental glomerulosclerosis 238. A patient with weakness in one hand and headache. Diagnosis? a. atypical migraine b. migraine 239. A 32 y.o. patient with rash on buttocks, + fever. DX? a. HSP b. ITP c. HUS 240. Fundoscopy 76 y.o. with CRAO 241. For Helicobacter pylori medications: antibiotic with PPI will help to: a. increase the relapse time b. PPIs help antibiotic to penetrate the ulcer 242. Several syncope in old patient. PE: HR 44 BP 180/110, + murmur. What is the cause? a. Aortic stenosis b. Complete heart block 243. A patient comes with h/o of treatment of osteoarthritis with Celecoxib, patient develops mouth ulcer. Mx? a. cease celecoxib b. give folic acid 244. Viral meningitis. CSF findings? 245. Ischemic abdominal pain. What is the management? 246. Pictures from Anthology of Medical Condition: HCC, rectus sheath hematoma, RA Xray, Burns ( page 112), BBC ( pinna of ear), Colles fractures, Ulnar distal fractures, Spine fractures ( osteoporosis) 247.Pictures from Bluebook: Acanthosis nigricans, Bulemia nervosa 248. Patient with ventricular fibrillation. ECG given. MX? a. atropine b. adrenaline c. lignocaine 249. A patient with sorethroat treated with amoxicillin. After 4 days developed a rash. DX? a. Allergic reaction b. SLE

250. A female patient presents with peripheral vascular disease. History of DM and HTN, she was smoker until 3 years ago, she developed DVT syndrome and stopped smoking. DX? a. Buergers disease b. Raynauds phenomenon c. SLE 251. IV drug user arrives to hospital with high fever. DX? a. Rheumatic fever b. Endocarditis c. Pneumonia Feb 18, 2012 1. Acute limb ischemia, what sign would require urgent surgery ? a. paresthesia b. paralysis c. rubor d. swelling 2. Ct scan of Rectus sheath haematoma. Patient has increasing abdominal pain at right side. No bleeding. Patient has INR of 2.9. What is the next management? a. observation b. drainage c. laparatomy d. laparoscopy e. aspiration 3. Patient has maintenance of enoxaparin and he is schedule for a surgery. What will you give? a. Vitamin K b. FFP c. Protamine Sulfate d. Dimercaprol 4. FUNDOSCOPY PICTURE ( + microaneursym seen) : patient has a history of Diabetes Mellitus type 2 later on positive blurring of vision and sought check up. What is the likely cause? a. Diabetic retinopathy b. hypertensive retinopathy c. retinal detachment d. macular degeneration 5. FUNDOSCOPY PICTURE ( + drusen): 78 y.o. woman had a gradual onset of bilateral visual loss. What is the diagnosis? a. CRVO b. CRAO c. Diabetic retinopathy d. Retinal detachment e. Macular degeneration 6. A 60 + y.o. man presents with cough and productive sputum, weight loss of 3 kg ( forgot the duration). He had a history of working in a gold

mine industry and was diagnosed before of moderate silicosis. The patient is a NONSMOKER. What is likely the diagnosis of present symptom? a. mesothelioma b. exacerbation of silicosis c. pulmonary tuberculosis d. bronchogenic carcinoma 7. A patient had a Subtotal thyroidectomy few hrs ago. She was noted to have stridor and difficulty of breathing. Noted swelling and redness in the neck area. What is the immediate management? a. Call the surgeon b. remove the skin sutures c. explore the wound in the ward d. arrange intra-op exploration of the wound site 8. A picture of chest X-ray and ECG in one stem. A patient with a history of ischemic heart disease and hiatus hernia attends a dinner conference. After eating, he suddenly developed restrosternal pain and collapse. He was rushed to ED and given oxygen and iv fluids. What is the next management? a.Pulmonary angiography b. Nasogastric decompression c. Chest tube drainage d. Emergent laparotomy e. Ultrasonography ( no options for ECG) 9. a 70 y.o. woman diagnosed of cancer of the caecum. What is the first symptom noted in this patient? a. palpable mass b. altered bowel habits c. tiredness and fatigue d. bowel obstruction e. dyspepsia 10. A 30 y.o. man with multiple rib fractures following a motor vehicle accident. He is noted of having paradoxical breathing. What would be the most appropriate next step in management? a. strap the chest wall b. controlled and positive ventilation c. insert chest tube d. 100 % oxygen via bag mask 11. Old lady comes to the ED following MVA with a wrist fracture and confusion. What would be the most appropriate next step? a. Urgent CT head b. Xray wrist c. Wrist plaster cast 12. A 55 y.o. man comes to your clinic and concerned of his family history which his father was diagnosed of having prostate cancer at 85 y.o. and neighbor was diagnosed of same condition recently. He is worried he might get prostate cancer. On DRE, his prostate was smooth, soft and median sulcus was felt. No other symptoms. What would you advice?

a. reassurance b. PSA for the next 4 weeks c. DRE annually d. Ultrasound 13. Patient has an ulcer at medial malleolus of left leg. What could be the risk factor? a. smoking b. previous history of DVT at same leg c. diabetes mellitus d. malignant change 14. Man had lower limb injury involving the fat layer. He had a complete vaccination history and last dose was 9 years ago. What is the most appropriate management? a. aDTP b. aDTP and Ig c. Ig d. reassure 15. A 27 y.o. man had a major motor vehicular accident which liver and spleen have lacerations. multiple wounds and fractures. He received 15 units of blood during resuscitation. Few hours after, it was noted positive bleeding in all sites. What is the cause? a. transfusion reaction b. hypocalcemia c. spleen rupture d. DIC e. dilutional thrombocytopenia 16. A young patient had a fall injury. PO2 60 and PCO2 55. Patient has breathlessness but conscious. Whats the next step management? a. paralyze, intubate and ventilate b. 100% oxygen via bag mask c. controlled oxygen d. Chest xray e. chest tube and drain 17. A patient is diabetic and was scratched by a cat in the arm and few days later, + red rash at arm, forearm and anterior shoulder ( no LAD, No fever mentioned in the stem). What is the likely diagnosis? a. Cat scratch fever b. Cellulitis 18. 18 month old boy has bilateral calf tenderness, he refused to stand. Hx of viral infection. Next step in management? a. steroids b. immunoglobulins c. antibiotics 19. A week old neonate was apnoeic and brought by parents to the ED. Noted of no pulse and respiration. What would be your next step? a. Inform coroner b. arrange autopsy at hospital c. give a deatch certificate stating SIDS

20. A 2 week old neonate with temp of 40 deg C came to hospital with poor feeding and irritability, + seizure. What is the likely diagnosis? a. febrile convulsion b. septicemia c. encephalitis d. epilepsy 21. A 10 y.o. girl is brought by her mother for severe headache associated with nausea. This occurs 3 episodes in a month. Her mother also mentioned she had same history with the child when she was young. What is the most appropriate management? a. sumatriptan b. paracetamol c. methylsergide d. ibuprofen e. morphine 22. A child with a history of URTI 2 weeks ago now presents with petechiae, bruises in ant trunk and upper and lower ext. labs given: only platelet count is decreased. What is the management? a. strict bed rest b. gamma globulin c. steroids d. antibiotics 23.A boy with long ears and large forehead. ( this is a long stem mentioning uncle also has same features) What is the diagnosis? a. Down syndrome b. XYY c. Klinefelters d. Fragile X syndrome 23. What is the chance of having a child affected of cystic fibrosis if one parent is a carrier? a. 0 b. 25 c. 50 24. A pedigree pattern of Autosomal recessive. 25. Primigravida at 28 weeks AOG, placenta low lying. and scheduled of repeat ultrasound at 34 weeks and now placenta is not low lying but seen one loop of cord around babys neck. what is the management? a. repeat ultrasound at 37 weeks b. CS at term c. tocolysis d. wait and reassure e. instrumental delivery 26. What is true regarding Bartholin cyst? ( not mentioned infected) a. can be asymptomatic b. maybe caused by gonococcal infection c. treat with antibiotics ( no option of surgical removal) 27. Patient 18 weeks AOG. What is the management to indicate premature labor?

a. fibronectin test b. USG of cervical length 28. An RH negative woman ( G2P0) at 34 wks AOG was found to be mildly RH sensitized. Her first pregnancy was with an RH + foots. She was given anti-RHo after and miscarriage ensued. She had an orthopedic operation which underwent blood transfusion. Few weeks earlier, She had antibody test which was found negative. Her current pregnancy was found out the foetus is RH +. Whats the reason for patient having mild sensitization? a. Anti-Rho given b. blood transfusion c. from previous pregnancy d. occult feto-maternal transfusion 29. long stem but only ask in the end: What is the most likely sign to indicate ectopic pregnancy in this patient? a. low abdominal rigidity b. profound anaemia c. Hypotension 30. 47 y.o. woman with a BMI of 30. History of amenorrhoea since 12 months. What do you expect to find in her labs? a. high estrogen and low FSH b. very low estrogen and very high FSH c. slightly low estrogen and slightly high FSH d. High estrogen and High FSH 31.A middle aged man watching tv about Australian Airforce going to Iraq. He was found boarding the plane and was held and detained. When he was asked questions, He told that the TV is telling him to go. What is this? a. Thought broadcasting b. auditory hallucination when he fall asleep c. depressed mood d. history of drug abuse 32.In Australia, psychodynamic psychotherapy is mostly recommended for which one of the following? a. schizophrenia b. personality disorder c. autism d. specific phobia e. OCD 33. A young lady 16 y.o. was brought by her mother to your GP clinic complaining of her daughters behavior. She talks rudely to her father. She skips classes, school authorities plan to expel her. What is the recommended management? a. antidepressant b. cognitive behavior therapy c. family therapy d. psychotherapy 34. A lady admitted to the hospital for elective surgery. You were called because she's having conflict with the nurse. She told you that " you

are a doctor and you understand unlike this stupid nurse". What is the diagnosis? a. Narcissistic PD b. Hypochondriasis c. Splitting d. Denial 35. A 14 y.o. aboriginal boy had history of good school performance but recently had problems with it, had auditory and visual hallucinations at times. Hx of leaving family. What could be the cause? a. alcohol b. marijuana c. metamphetamine d. petrol sniffing 36. Picture : exactly the same page 206 anthology of medical condition. what is the diagnosis? a. tinea capitis b. pityriasis capitis ( dandruff) c. pityriasis versicolor d. seborrheic dermatitis 37. Husband brought his wife for check up. His wife had history of excessive cleaning the house. He also noticed his wife becomes flirtatious to his friends and drinks alcohol. When check up by a doctor, she also flirts to the doctor and became abusive. What is likely the diagnosis? a. Histrionic personality disorder b. Hypomania c. substance abuse d. Borderline personality disorder 38. Old patient has history of syncope 3 episodes. Choose ECG that fits: a. ecg of Atrial fibrillation b. ecg of Atrial flutter c. ecg of ventricular ectopic beats d. ecg of Complete heart block e. ecg with tall t waves ( Hyperkalaemia?) 39. Which one of the following studies is LEAST useful? a. Cohort b. case control c. cross sectional d. case report e. systematic review 40. A picture of psoariasis at both lower legs with extensive lesions. What is the treatment of choice? a. UVB light b. calcipotriol c. steroids ( no dithranol, no methotrexate, no tar in the options) 41. A long stem about patient has dryness in the eyes and mouth. Anti RO and Anti La POSITIVE detected. Whats the management? a. Hydroxychloroquine b. Steroids c. Methotrexate

42. A patient was diagnosed of having colon cancer ( i forgot the stage) , surgical operation done and chemotherapy should be started. whats the management? a. 5Fluorouracil b. CIsplatin c. Methotrexate 43. A picture of patient having redness in the eye ( anterior uveitis). He had a history of mouth ulcer and genital ulcers. Whats the treatment? a. topical hydrocortisone b. oral steroids 44. WOF features would be absent in pseudobulbar palsy? a. dysarthria b. dysphagia c. absent gag reflex 45. A 24 y.o. lady has one episode of seizure. She experienced of having muscle jerks in her right arm few months ago. She asks you on advice for driving? a. can drive after 6 months b. can drive after 3 months c. can drive after 12 months can drive after 24 months 46. Patient with a maintenance of digoxin for AF and thiazide for HTN. Recently, she complains of nausea, vomiting. and palpitations. What would be the most appropriate step? a. stop digoxin and give potassium supplements b. stop thiazide and give potassium c. give potassium 47. Chest X-ray showing a cavitary lesion at the upper right lobe. Patient came from Sudan. He comes with fever and night sweats. Sputum negative for acid fast bacilli. What would be the most appropriate management? a. Isoniazid prophylaxis b. Isoniazid, rifampicin, pyrazinamide and ethambutol c. Amoxicillin d. Ceftriaxone e. no treatment necessary 48. A driver from interstate has moved to your locality recently and is stable on lithium for past 20 years. How du you monitor? a. check lithium every 3 months b. check lithium every 6 months c. check lithium every 1 year 49.85 y.o. woman presented with right thigh and leg pain after fall. Investigations are: calcium 3.5 ( 2.1-2.6), Urea- 10 ( phosphate level not given). Most common cause? a. Osteoporosis b. Vitamin D toxicity c. Primary hyperparathyroidism d. Hypercalcemia of malignancy

50. A middle aged woman with calf pain and tenderness from few days came to hospital. Her investigations showed DVT. She has no other associated symptoms. What is the management? a. inpatient management with compression stocking and LMWH b. IP management with elevation and LMWH c. outpatient management with compression and LMWH d. OP management with leg elevation and LMWH 51. Middle aged man complains of cough and productive sputum. CXR showed patchy infiltrates. What is the management? a. Oral amoxicillin and clavulanate b. Iv ampicillin c. oral flucloxacillin d. Oral azithromycin e. tetracycline 52. Young girl collapsed in a party brought to ED. She is confused. fever of 40 deg C. Noted muscle jerks. BP= 157/98. What is the initial management? a. Thiamine and oral hydration b. cold saline infusion and cold blanket c. diazepam d. haloperidol 53. ALL are side effect of steroids EXCEPT: a. hirsutism b. ecchymosis c. osteomalacia d. lymphopenia e. increase WCC 54. 65 y.o. man had a headache with tenderness on the scalp esp on the right side. Positive history of headaches for few days. What is the next management? a. temporal biopsy b. oral steroids c. CT scan ( no ESR or FBC options) 55. In a patient with GBS which is appropriate way to monitor his oxygenation? a. forced vital capacity b. ABG c. pulse oximeter d. O2 saturation 56. A man complains of cough productive with green sputum and occasional blood. No fever. WOF is the best long term management? a. low dose tetracycline for 12 months b. anti tb drugs c. postural drainage d. reassure 57. A 38 y.o. woman presents with secondary amenorrhoea for 12 months. her blood results showing FSH increased and Oestradiol

decreased, prolactin normal and TSH normal. USG has 3-4 cysts in the ovary. What is the diagnosis? a. Premature menopause ( exact option not written as premature ovarian failure) b. pituitary adenoma c. PCOS d. pregnancy 58. A patient had history of surgery and noted palpable mass in midline. a. cough when lying b. cough when sitting c. ask patient to voluntary raise hands d. passive raise patients legs 59. Patient has a right LAD when biopsy + squamous cell ca. Where is the primary site? a. breast b. thyroid c. bronchus d. kidney 60. Toxic shock syndrome caused by staphylococcus aureus is associated with: a. super absorbent sanitary pads b. endotoxin production 61. Construction worker complains of eye redness and lacrimation after hammering a nail at work. + metal spikes seen. Whats is your management? a. antibiotics b. irrigation of fluids c. local anesthetic and probe the eye 62. an indigenous boy complains of greenish discharge coming out from the ear and also has green nasal secretions. What is the appropriate management? a. swab ear discharge b. swab nasal discharge c. audiometry ( no option antibiotic) 63. An alcoholic man with pain radiating to the back. Diagnosed of acute pancreatitis. WOF is the LEAST likely to present with? a. constant pain b. nocturia c. diarrhoea d. regurgitation of food 64.A patient complains of lower back pain. On PE noted lumbar spine is not in its normal curvature. NO numbness or decrease ankle jerk. What to do next? a. lumbosacral xray b. MRI c. Nerve conduction study 65. A patient came in with haematuria, dysuria. Urinalysis showed many rbi and atypical nuclei. What to do next? a. renal ultrasound

b. ct scan of abdomen c. urine culture and sensitivity 66. A 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 67. An elderly patient brought to ED with lightheadedness and palpitations. was diagnosed of Aortic stenosis. ECG is given. What is the management? a. adenosine b. digoxin c. verapamil d. not to repeat the carotid massage 68. A 39 y.o. woman came to see you, and asking for HPV vaccination. What will you advice? ( this is longer stem) a. HPV is not indicated b. Give HPV vaccine now 69. An 18 month old infant has in toeing. what will you advice the mother? a. reassure b. refer to ortho 70. 5 month old infant had constipation. Started solid foods given 3x a week. still continuous breastfeeding. What is the cause of constipation? a. inadequate fluid intake b. starting solids 71. A primigravida presented at term for delivery, IE during admission: 1 cm cervical dilatation, 30-40 % effaced, no rupture of membranes, station 0. After 4 hrs, IE done with 4 cm dilated cervix, fully effaced and station +2. Whats the next step? a. amniotomy b. oxytocin infusion c. wait another 4 hrs and assess d. CS 72. A 42 y.o. Nulliparous woman has a bulging mass in the perineum especially during straining on defecation. What is the likely cause? a. cystocoele b. rectocoele 73. A pregnant woman ( forgot the AOG, its on 2nd or 3rd tri, 24 wks or 30 plus) has cervical ectropion. What is the management? a. Pap smear now b. Pap smear 4 weeks postpartum c. do nothing 74. A woman ( forgot the age) was diagnosed of having CIN II. whats the most appropriate management? a. Cone biopsy b. LEEP

c. reassure d. hysterectomy 75. Infant with 2 day history of cough and fever temp of 37.8 deg C, wheezing heard. Child is irritable, + episodes of vomiting. WOF is the next step in management? a. IV fluids b. Salbutamol nebulisation c.Observe d. antibiotics 76. A mother brings her 5 y.o. girl who has sore down below. On PE, the vulva is reddened and no other signs. What is your management? a. report to child protection authority b. examine under general anesthesia c. avoid bubble bath d. full blood count 77. A 38 y.o. man was attending a party and ate some peanuts in the cake, suddenly had hoarseness of voice and difficulty of breathing. Whats the immediate management? a. Adrenaline IM b. intubate and ventilate c. Antihistamine d. administer Oxygen 78. A child had a URTI last 2 weeks ago. Her mother noticed of few bruises and petechiae. No other abnormalities seen, PE is normal. What is the next step? a. FBC b. ANA c. Urine microscopy 79. A 10 y.o. boy has fever and knee pain at first then later on, has ankle pain. Few rashes on the back. What is the management? a. Penicillin b. IV immunoglobulin c. steroids 80. A 6 month old infant presents with lethargy, poor feeding, No fever, tachypnoea ( this is a long stem forgot other infos). What is the next investigation? a. ABG b. electrolytes c. chest xray 81. A 16 y.o. girl came to see her GP. She finds it difficult to concentrate for 6 months and previously did well in academic studies. Her appetite hasn't change. She prefers to be alone in her room most of the time when she's at home. She goes with her friends but she finds it very hard to entertain herself. Probable diagnosis? a. Major depression b. normal adolescent behavior c. prodromal schizophrenia d. Dysthymic diorder

82. An 89 y.o. woman living in a nursing home is found masturbating in the privacy of her room by the nurse. The nurse asks you to intervene. What is the best step? a. refer for counselling b. do nothing as its her private affair c. tell the patient that his behavior is inappropriate 83. An 83 y.o. 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 illness and is not on any medication. What is your next step? a. Sleep hygiene b. antidepressant c. relaxation therapy and meditation 84. A colleague fed up with work told you he drinks to fall asleep. What to do? a. tell head of the intern b. Hospital director c. Advice him to seek professional advice d. Tell medical board 85. 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 illness. Later on, patient is calm and handed you the knife. What will you do next? a. restrain him b. talk to him regarding his psychiatric illness c. talk to the psychiatrist against patients wish d. ask his relative about his mental history 86. Young man lost his job recently broke up with girlfriend. History of drug abuse and violent behavior. WOF is he likely to benefit from? ( the stem is much longer than this) a. Behavior therapy b. motivational therapy c. psychotherapy 87. A 50 y.o. woman complains of pain at maxillary area and some redness. ( no rashes mentioned). What is the appropriate management? a. Carbamazepine b. Acyclovir c. Famciclovir 88. A study testing drug B reveals significant benefit of drug B> drug A with probability of < 0.01. this means: a. Drug A is better than B b. Drug B is better than A c. The difference between drug A and drug B occur by chance ( ? not the exact option) 89. A GP is in rural area, you notice that recently more cases of Hepatitis C has been diagnosed and want to do research to find out the incidence of hepatitis 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 b. All patients with current hepatitis C PCR positive c. All patients with current Hepatitis C antigen positive

d. All cases diagnosed as hepatitis C positive for the past 5 years 90. A man with heavy alcohol intake brought to ED. BP 180/100 HR 120, + tremors ( fine) bilateral in both hands. No confusion, not agitated. What is the appropriate management? a. Propanolol b. Benztropine c. Diazepam d. Haloperidol 91.Naltrexone is: a. short acting b. easily absorbed orally c. substitute for methadone in treating drug dependence 92. A case of 45 y.o. woman having menorrhagia. was diagnosed of intramural fibroids, has enlarged uterus. What is the management? a. low dose Oral contraceptive pill b. Oral oestrogen and progesterone hormone replacement therapy c. norethisterone d. Depo provera 93. A picture of CTG ( looks like early deceleration). What is the next management? a. CS b. Amniotomy c. ultrasound d. repeat CTG after 24 H e. continuous CTG monitoring

Extra
1.17 years old jogging then collapsed.somebody did CPR and was revived when she arrived at ER. Has history that father died suddemly. Which is the likely diagnosis? --HOCM 2. ECG on V tach. Identify and Treatment --Amiodarone 3. Woman when she defecates a mass is noted to bulge out of her introitus.Most likely diagnosis. ---Rectocoele 4. woman with increased LH and FSh. Most likely diagnosis ---ovarian tumor --pitiutary tumor 5. child with constipation. What is the next management --laxative 6. woman with hot flushes. Had hysterectomy years ago. What isthe most appropriate treatment? --conjugated equine estrogen 0.625 7. child with bruises and petechiae after a viral infection weeks ago.most likely diagnosis? --ITP 8. ct scan of rectus sheath hematoma 9. july 2010 question number 53 10. situation about testicular sweeling. What do you do next? --ultrasound --FNAC

11. question about painless hematuria --bladder tumor --renal tumor 12. question about a man 35years old asking about his risk of developing prostate CA. Father diagnosed prosteate CA at 85 years old. --reassure? --FOBT --colonoscopy 13. what is the most important sign to indate for immediate embolectomy --paralysis --pain --rubor 14. 6weeks old infant with fever. Mother notes some twitches before. What is the most likely diagnosis --septiceamia --febrile convulsion 15. old man was found by police and brought to hospital. Daugther has many complaints about father. She said he has been living in squalor and eating rubbish.what kind of dementia? --frontal lobe dementia --lewy body dementia 16. what to give to pregnant woman aside from folic acid to prevent NTD? --iodine 17. question july 2010 #101 18. question july 2010 #110 19. question july 2010 #111 20. question about an old lady after closing the window (?) sustained a crush fracture on her vertebrae. She had a history of opertation for CA of ceucum --metastasis from primary cancer --osteoporosis 21. patient just had cricothyroidectomy and developed stridor while she was still in the recovery room. What will you do? --call the surgeon --explore the wound in the ward --remove the skin sutures 22. xray given. Man is a non-smoker and working in the mine industry (did mention the years, think it was more than 20years). Has been coughing --mesothelioma 23. question about percentage passing the disease to their children with cystic firbosis -- 0% 24. xray given. Man coughing, smoker and working in the mine industry. What is the most probable diagnosis? --brochogenic CA 25. a child with fever. What is the indication that she has a severe bacterial infection --unresponvie to mother --pallor 26. xray of sigmoid volvulus 27. Boy having balck and white drawings. Parent just separted. What is the most appropriate Mx? --ask the boy about his drawing 28. question about domestic violence. Pregnant lady with bruises. What do you do? -- give the numbers 29. woman with 3 children wants space, but in file said do not give OCP as Stand by husband -- its her opinion and give her OCP

30. NALOXONE is -- Short acting 31. 17yo wants OCP. She had seizsure whihc is controlled with carbamepine and subdural haematoma -- GIVE OCP --GIVE OCP AND USE CONDOM* X-ray of hip osteopenia ALP is 800 ( that is the only information given ) Rx Biphosephanate Ca Vita b12 Radiotherapy Pic of both lwoer limbs showing red rash. 34y old male with diarrhoea and admitted in the hospital Dx HSP Mallert finger pic. Which type of injury will occur Hyperflexion occur due to extension Rupture of tendon CXR night sweat, dry cough, wt loss, enlarge bilateral cerviacal lymphnode Dx Sacodosis Tb Lymphoma CLL A patient who started hydrochlorothiazide with digoxin develop nausea electrolyte pic given only potassium decrease Stop digoxin and give K suppliment Stop hydrochlorothazide and give K supp SVT ECG Adenosing Amiodarone Verapermil Dogoxin ECG . a pt who had stroke came to hospital on 5# day she collapsed in the toilet. BP pulse?? What will you do next to dx his condition? Ctpa Echo cardio A boy came with bloody diarrhea with less urine output what is the dx Renal failure HUS A infected batholian cyst Antibiotic will resolve it Cause by gonnorrhoea It is asymptomatic A pt who had aninjury to eye due to hit from metalic spike what will you do Use local anaesthetic and removed A girl comes with 6 week ammenorrhoea diagnosed she is preg. After home preg test. Now develop lower abdominal pain and slight vaginal discharge Quntitative serial BHCG USG P/V exam A prenant lady 22 week developed lower abd pain tenerness in the left iliac fossa and supra pubic region. Appendicitemy done when she is tennager. Dx Incidental finding of red degen of ut fibroid Round lig pain. A pt 70 yrs old man came to the hospital think that he is having serial illness coming to doctor with different names. What is it

 Facticious dis Depression Normal grief Abd x-ray 5th POD due to hip replacement Pt rectus tube Gastro graffin enama Colonscopy 5th POD for input output chart given. In both recall output is more than input. One is 1400 is differnt, other recall 2100. Resolved paralytic ilius Wrong chart A lady and husband came to you recently dx cystic fibrosis concern abouthe their child getting it 0.25 chance 0.5 chance A couple comes telling that one child diagnosed as cystic fibrosis concern about next child incidence 0.5 0.25 100 You went to old house to trat a person and prescribe b-blocker and asprin. The nurse told that he is not responding to B-blocker what ill you do Talk with nurse durin her break Report nurse manager Do as she told You consider to old care notice that it is written in their chart telling dont crash the medicine. But nurse use to crush the medicine to pt as it is hard for him to swallowing what will you do Complain nurse manager Go to nurse board Complain to the sup in age care. Ovarian Ca where is the primary site? Breast Lung CT head show hemorrhage. Pt on warfarrin and INR 4.5 what will you do giveFFP give platelet CT head showing same lesion like infaction Multi infarct dementia Cerebral hmg Cerebral abcess A prg lady came to with you are 18weeks. Her last preg is a premature delivery what to konw the outcome his Cervical length Fibronectin VT ecg Adenosin Amiodaerone Adrenaline A lady comeplain loss of finger grip in index and thumb what nerve is having. Radial n. Carpal tunnel Ant. Intoressisis Ulner n.

 80 lady comeing with rectocele Pessary Sx Pelvic exercise 50 old man coming with sccrotal pain which is reddened what ill you do Urine catha b/d culture FNAC 50 male taken to a research and during it he become dementia and his primary carier is his son what will you do Ask from son Gardianship Ethic and comity Fundoscopy pic, HTN ployuria, ploydypsia, what is dx DM HTN CRAO CRVO A male who use to work in mine in 20yr smoker 40yr what is the dx. CRX given Smallcell carcinoma Squamous cell carcinoma Metho A chinese lady come to your. Husband is recenly dx as hemochromatosis having 9 & 18 year kid. Wife is not screen for heamochromtosis. What will you do Check wife only Check 9 yr only Check 18 year Check both children A down syndrom under go surgery develop hypersensitive Latex Anaestheic drugs A 34yr male havin, ACEI Statin b-blocker develop calf pain tenderness in calf Check ck level creatin Check FBC A pic both eye increase tearing who will you do Refer plastic surgery Cold compression CXR given and ask of diagnosis Pul edema Metastasis Carcinoma A 2nd POD a person develop agitated confusion. Temp normal and pulse and BP normal what is the cause Alcohol withdrawal Pulmonary atelectesia Electrolyte imbalance A yong boy comes with rashes in both hand and arthralgia. What will you do to dx it CRP and ESR Echo CXR

All The best .