MAY 2007 Adelaide

1. Insulinoma A. high insulin, low glucose, high peptide C B. low insulin, high glucose, high peptide C C. high insulin, low glucose, low peptide C D. high insulin, low glucose, high pro insulin E. low insulin, high glucose, low peptide C 2. *Which drug has negative ionotropic effect? A. Furosemide B. Digoxin C. Dopamine D. Isoprenaline E. Diltiazem 3. Which of the following is aggravated by topical steroids? A. Psoriasis B. Atopic eczema C. Discoid eczema D. Perioral dermatitis E. SLE 4. AA anonymous alcoholics means: A. self help group for alcoholics, at which members obtain support from one another. 5. Endometriosis the most common site: A. Pouch of Douglas B. Rectum C. Uterosacral ligament D. Ovary E. Broad ligament 6. Patient with impaired plantar flexion and inversion, he has normal dorsiflexion and eversion. Which nerve is damaged? A. L 4 B. L 5 C. Sciatic nerve D. Common peroneal nerve E. Tibial nerve 7. Left homonymous hemianopia. The lesion is: A. Left optic nerve B. Occipital lobe C. Right optic radiation

D. Left optic radiation E. Optic chiasma 8. A young man has been having epilepsy for 10 years and has been treated with Carbamazepine for last 3 years. He has developed fits in the morning. What is the most appropriate management? A. Increase the dose of Carbamazepine B. Decrease the dose of Carbamazepine C. Add Phenytoin D. Check Carbamazepine plasma level E. EEG 9. A 2 year old child has been having foul smelling stools for 12 months. Which of the following is the best test for diagnosis? A. Barium enema B. Endoscopy C. Duodenal biopsy D. Anti endomysial antibodies E. Antigliadin antibodies 10. A man returned from a holiday in Queensland with arthralgia, fever, dark urine. A. Ross river fever B. Dengue 11. Thyroid scan cold lesion (Anthology of medical conditions, page 281). What do you expect? A. Symptoms of thyrotoxicosis B. Single lump on the neck C. Myxoedema D. E. 12. * Patient presents with dark urine, pruritus, jaundice. Blood exam shows a mild increase in alkaline phosphatase, high AST, ALT. Which of the following is the most likely diagnosis? A. Viral hepatitis B. Cholangitis C. Choledocholithiasis D. E. 13. A young woman presents with 3 cm mass in the vaginal introitus, 4 cm anterolaterally from the opening. This is the most likely a remnant of: A. Wolffian duct B. Mullerian duct C. Bartholin duct 14. Copying a drawing of a pentagon. Which area of the brain is tested?

A. Frontal lobe B. Dominant parietal lobe C. Non dominant parietal lobe D. Temporal lobe E. The anterior part of the corpus callosum 15. A patient with upper respiratory tract infection. After 24 hours he developed hematuria +++, proteinuria +++ and hypertension. Which of the following is the most likely diagnosis? A. Post streptococcal glomerulonephritis B. IgA nephropathy C. Minimal change nephropathy D. Acute pyelonephritis 16. A 60 years old woman presents with bilateral thrombophlebitis and recurrent DVT, which are difficult to control with medications. Which of the following is the most likely reason? A. Ovarian cancer B. Pancreatic cancer C. Colon cancer D. Lung cancer 17. A patient before entering your office stands at the door and salutes three times. Which one of the following describes this behaviour? A. Mannerism B. Previous military service C. Dystonic reaction to medication D. Tourette's syndrome E. Obsessive compulsive disorder 18. A 2 year old boy with recurrent urinary tract infection and vesico-ureteric reflux 2nd degree. What is the most effective management in preventing future infections? A. Intermittent antibiotics B. Continuous antibiotics C. Circumcision D. Hygiene procedure 19. A patient is treated with warfarin. He has been diagnosed with resectable colon cancer. What is the most appropriate management? A. Substitute heparin for warfarin and operate when INR is normal B. Stop warfarin 1 week before admission for surgery C. No operation, medical treatment 20. A 7 year old girl has been having intermittent headaches for 2-3 years. She has had several attacks recently. Her mother said that she had similar attacks when she was younger and the headache be gone after a good sleep . What is the most appropriate management?

A. Paracetamol B. Ct scan C. Reassure

21. What is the percentage of detection of duke stage A1 colonic carcinoma after screening with faecal blood test? A. <5% B. 15% C. 25% D. 50% E. 75%

22. A young patient presents with a neck nodule above the suprasternal notch which moves with swallowing. The most likely diagnosis is: A. Thyroglossal cyst B. Thyroid nodule C. D. 23. You were called fro a young patient of yours who has stopped taking his medication and was very agitated and waiving a sword. What is the BEST COURSE OF action? A. Talk to him in a calm voice to convince him to give you the sword and conduct a mental examination B. Talk to him firmly that he should lay down his sword C. Withdraw from the situation and call the police to help you transfer him to hospital D. Try to hypnotize him E. Disarm him skilfully 24. *A child with bee sting presents with respiratory distress. The initial management is: A. Adrenaline SC B. Antihistamine C. Corticosteroids 25. *A child with hypoglycaemia, BSL 1.1 mmol/l. A. Sweet drinks B. Glucagon IM C. Glucose in gel applied on the gum D. Dextrose IV 26. A young woman presents with thyroid nodule. The most appropriate investigation is: A. US B. Scintigraphy C. FNAB 27. Similar question to: Husband 33-year-old, wife 25 years old. They have three children. The wife is not allowed to go anywhere alone to socialize. Nor is she allowed to leave home without relatives. Husband hires detectives to spy on his wife, even though she is loyal. This morbid jealousy is an example of:

A. Paranoid delusions B. Schizophrenia C. Overvalued idea 28. A woman presents with history of sudden onset of pain attacks in her left cheek and minor sensory loss. The most likely diagnosis is: A. Trigeminal neuralgia B. TM joint disease C. MS 29. *Coma scale. On painful stimulus the patient opens eyes, localizes pain and mumbles incomprehensible sounds. GCS: A. 6 B. 7 C. 8 D. 9 E. 10 30. Where is the first site of action of progesterone only pill? A. Pituitary gland B. Hypothalamus C. Ovary D. Uterus E. Cervix 31. In psychodynamic therapy, when the patient understands the conflicting factors that contribute to his psychological problem, this is called: A. Insight B. Intuition C. Intellectualization 32. A research group offers people with borderline personality with history of self harm to join a trial and offers 1000$ to entry the trial and 200$ per session joined extra. This is: A. Overpay B. Informed consent C. Good medical ethics D. Inducement 33. A patient presents with a 2 cm stone in the left renal pelvis. There is no obstruction. The most appropriate management is: A. Increased fluid intake B. ESWL C. Reassurance 34. A patient presents in Emergency Department with renal colic. The most useful investigation: A. Abdominal X ray B. US

C. Abdominal CT scan D. IVP 35. A middle aged man with hypercalciuria presents with renal stone. It is the third episode. All the previous stones were reported to be calcium oxalate. How can we prevent the stone formation? A. Low calcium diet B. Low salt diet C. Hydrochlorothiazide D. ACE inhibitors E. Allopurinol 36. A man with shoulder dislocation presents in Emergency Department within an hour. You want to reduce the joint in ED. Which drugs do you use? A. Fentanyl and midazolam B. Suxamethonium and pethidine C. Rectal Paracetamol D. Morphine and 37. A 6 week boy presents with undescended testis. What will you do? A. Do an immediate orchidopexy B. Wait till 4 years and then do orchidopexy C. Encourage the mother to massage the inguinal region to milk down the testis and review in 2 months D. Review in 6 months *38. A patient with pneumothorax. Where do you put a chest drain? A. 5th intercostal space in the axillary line B. 5th intercostals space in the midclavicular line C. 6th intercostals space in the midclavicular line D. 6th intercostals space in the axillary line 39. All of the following are associated with pulmonary embolism except: A. Bronchial breathing B. Syncope C. Pleuritic pain D. Reduced P2 E. Dyspnoea 40. Definitive diagnosis of ectopic tubal pregnancy: A. Increased hCG B. Laparoscopy C. US D. Vaginal examination 41. Which one of the following is not associated with scaling? A. Solar keratosis B. Discoid eczema

C. Squamous cell carcinoma D. Basal cell carcinoma E. Pityriasis versicolor 42. Primary lactose intolerance, all of the following are true, except? A. Failure to increase glucose in serum > 100mg/L after 50g. B. Common in Asian community C. Steatorrhoea D. Normal villi in small intestine 43. A woman with panic attack. A. ph 7.50 PO2 70 mmHg PCO2 23 mmHg B. ph 7.30 PO2 80 mmHg PCO2 60 mmHg C. ph 7.49 PO2 110 mmHg PCO2 22 mmHg 44. Which part of the limbic system is responsible for affect? A. Hippocampus: B. Thalamus C. Amygdala 45. A soccer player with knee injury. On exam anterior drawer sign positive. What is the diagnosis? A. Rupture of median meniscus B. Rupture of anterior knee cup C. Rupture of anterior crucial ligament D. Rupture of posterior crucial ligament 46. Intermittent claudication. The most commonly affected artery is: A. Iliac artery B. Posterior tibial artery C. Superficial femoral artery E. Popliteal artery 47. Pulmonary embolism. Best investigation: A. X ray B. ECG C. CT pulmonary angiography 48. Lung abscess, except: A. Mycobacterium tuberculosis B. Pneumocystis carinii C. Klebsiella pneumoniae D. Staphylococcus aureus E. Bacteroides 49. A patient with history of cholecystectomy presents with dark urine, jaundice, mass in the right upper quadrant moving with respiration. A. Pancreatic cancer

B. Choledocholithiasis C. Cholangitis 50. A woman, vegetarian, with history of anencephalic baby comes for her first antenatal visit. How much of folic acid will you advice her to take every day? A. 10 mg/day B. 4-5mg/day C. 0.4-0.5 mg/day D. Increase intake of green leafy vegetables daily 51. In a patient with massive ascites, all of the following are possible findings except: A. Shifting dullness B. Eversion of the umbilicus C. Hepatomegaly E. Dullness in the base of the lung 52. A 18 month old girl with breast enlargement. The most likely cause is: A. Precocious puberty B. Idiopathic premature thelarche C. Adrenal hyperplasia 53. *A patient after trauma, presents with symptoms of tension pneumothorax (respiratory distress, increased jugular venous pressure). What is the initial management? A. Intubation B. Insert large bore needle into 2nd intercostals space C. Insert tube into 5th intercostals space D. Tracheostomy 54. A patient presents with left varicocele, which developed rapidly. The most likely diagnosis: A. Left testicular cancer B. Left renal cancer 55. A17 weeks pregnant woman presents with proteinuria +++ and hypertension. The most likely diagnosis is: A. Pre eclampsia B. Pre existing renal disease 56. Young woman with bleeding tendency increased bleeding time. Males in family have similar problem. What is the best management before cholecystectomy to decrease the risk of bleeding? A. Factor VIII B. Cryoprecipitate C. Fresh frozen plasma D. Whole blood E. 57. A 37 year old woman comes for her first antenatal visit and asks for the most

accurate, not invasive method of diagnosis Down syndrome. A. Serum exam at 16 weeks B. Nuchal thickness at 11-12 weeks C. Amniocentesis D. CVS 58. Baby born at 34th week of gestation with respiratory distress (tachypnoea, expiratory grunting, cyanosis), improves after giving 45% O2. A. Transient tachypnoea of the newborn B. Hyaline membrane syndrome 59. A 17 week pregnant woman with history of recent contact with a child, who had fever, rash. What is the best next step in her management? A. To give rubella vaccine B. To measure rubella antibodies C. Reassure D. Do her counselling regarding disease. E. Do blood tests on daughter. 60. A child took 20 iron tablets. His signs and symptoms can be, except: A. Abdominal pain B. Signs and symptoms can develop after 24 hours C. Cerebellar ataxia D. Hepatic failure E. He can develop signs and symptoms within 4 hours 61. A patient received a human bite on his arm, on presenting to you ordered a blood test for Hepatitis B. The next morning biters doctor called you and asked whether you have ordered a blood test for Hepatitis C & HIV because some of the victims blood has entered to biters mouth. The victim is unwilling to give consent for testing his Hepatitis C and HIV. What you will do next? A. Get the public health unit force victim to give her consent B. Ask the doctor to treat biters prophylactically C. Ask the biters to contact the victim request and convince him to give consent for testing. D. Order laboratory to perform the test without patients knowledge E. Do nothing, assuming victim is not caring Hepatitis C and HIV virus. 62. Young man presents with diabetes mellitus, hepatomegaly, darkening of the skin, arthritis. Which one of the following is the best investigation? A. Serum iron B. Serum ferritin C. Serum transferrin D. US E. Albumin 63. *The most common cause of painless hematuria in 65 year old man is: A. Renal cancer

B. Bladder cancer C. UTI D. Renal stones 66. A 65 year old woman presents with left sided chest pain and dyspnoea 10 days after an operation. What is the best initial investigation? A. ECG B. Chest X-ray C. D-dimers D. Venography E. Doppler sonography 67. A woman presents in ED with incomplete miscarriage. Fragments of conception protrude from the cervix. What is the most appropriate initial management? A. IV fluids B. Immediate removal of fragments from the cervix in ED C. Curettage in the operating theatre in an hour D. 68. A 21 year patient with complains of cough and pleuritic pain on the right side. On percussion, there is dullness over the right lower zone. On auscultation absent breath sounds over the lower zone and bronchial breathing was heard above this area. What is your provisional diagnosis? A. Collapse of the lung B. Consolidation C. Pleural Effusion D. Pneumothorax 69. A patient presents with 4th acute attack of gout within last 2 years. The most appropriate management at this time: A. Allopurinol (dose) in 24 hours B. Indomethacin (dose) in 24 hours C. Steroids 70. Time of ovum implantation (from ovulation) A. 6 hours B. 24 hours C. 2-3 days D. 5 days E. 8-10 days 71. Which one of the following is not characteristic for vertebro - basilar insufficiency? A. Memory loss B. Blurring of vision C. Monocular loss of vision D. Dysarthria E. Nystagmus

72. A 3 month old baby presents with fever. Examination of urine from the urine bag showed mixed growth, leucocytes (I dont remember how many). Next step: A. Examination of the next sample from the urine bag B. Examination of the urine sample from the urinary catheter C. Urinary tract infection is proven D. Antibiotic 73. An 80kg male suffered 15% burns to his body. He will need as fluid replacement in the first 24h: A. 2L normal saline and 1L 5% Dextrose B. 3L Hartmanns solution and 2L 5% Dextrose C. 2L normal saline and 1L normal saline D. 3L Hartmanns solution and 2 L Blood E. Blood and saline solutions 74. What is the most common early complication of haemorrhagic pancreatitis? A. Pseudocyst B. Infection C. Obstructive jaundice D. Pancreatic fistula E. Renal failure 75. A 6 week old baby presents with unilateral eye discharge since birth. A pathology result shows polymorphonuclear cells. Which is the most likely diagnosis? A. Gonococcal infection B. Chlamydia infection C. Syphilitic infection D. Closed naso - lacrimal duct E. Herpetic infection 76. Question similar to: Parents of a 5 months old infant are anxious about attacks of stiff tonic jerks with drawing up the legs on the abdomen, which occurs during day time for several weeks now and some decline in milestones. What is your diagnosis? A. Febrile seizures B. Infantile spasms C. Benign infantile convulsions D. Intussusception E. Urinary tract infection 77. Pseudobulbar palsy, except: A. Dysarthria B. Loss of gag reflex C. Fasciculation D. Dysphagia E. Extensor reflexes 78. An old woman with high ESR, proptosis of the left eye. The most likely diagnosis is: A. Retroorbital tumour

B. Temporal arteritis C. Trauma D. Thyrotoxicosis E. Infection of frontal sinus 79. *Which drug produces hyperkalemia? A. Captopril B. Propranolol C. Digoxin D. NSAID 80. An elderly woman, from nursing home, with long history of constipation presents with symptoms of large bowel obstruction. Which of the following is the most likely cause? A. Sigmoid volvulus B. Sigmoid colon cancer C. D. 81. An old man had barium enema which showed an apple core like change. The most important reason of doing colonoscopy is: A. To find other synchronous tumours B. To obtain tissue sample for histopathology C. To assess the extend of the lesion D. 82. A woman with bipolar disease, treated with lithium for 10 years. She has noticed weight gain, slowness. The most likely reason is: A. Lithium toxicity B. Relapse of bipolar disorder C. Hypothyroidism 83. A 72 year old man had a trans-urethral prostate resection. Histopathology revealed 5% undifferentiated carcinoma cells in the specimen. Which of the following is the best management for this condition? A. Do nothing B. Radiation C. Radical prostatectomy D. Chemotherapy E. Hormonal treatment 84. In diabetic neuropathy, you will find all of the following except: A. Urine retention B. Impotence C. Bradycardia D. Diarrhoea 85. *A child with respiratory distress. How do you assess severity at bed?

A. Intercostals recession B. PEF 86. A young man comes to you with some problem. After some days he returns to you and says that he was drunk the first time. You will ask all the following questions except: A. Attempt to cut down in the past B. Anger on enquiry C. Guilty about drinking D. Eye opener E. Do you think you are alcoholic? 87. Which of the following is not a contraindication to oral contraceptive therapy? A. History of DVT B. Migraine C. Not diagnosed genital bleeding D. Previous benign breast disease 88. After delivery of placenta, the patient suddenly became shocked, very low BP. The most likely diagnosis is: A. Uterine inversion B. Amniotic fluid embolism C. Uterine rupture 89. A 65 year old nulliparous woman, with family history of breast cancer (cousin) presents with bleeding from the nipple. . In the past no problems with breasts. The most likely diagnosis: A. Intraductal papilloma B. Ductal carcinoma C. Pagets disease D. 90. Why women in Australia prefer to use Yasmine contraceptive pill? A. Jasmine does not increase weight B. There is no risk of thromboembolism 91. A child with second episode of febrile convulsions. His cousin has epilepsy. Which of the following is correct? A. Phenobarbital should be started B. He has high risk of epilepsy C. He has significant risk of convulsions in the future. 92. A woman presents with bone pain caused by metastases from breast cancer. The most appropriate management: A. Morphine B. Radiation C. NSAIDs 93. Eradication of Helicobacter pylori for duodenal ulcer:

A. Increases ulcer healing rate B. Influence relapse rate C. Decreases rate of gastric lymphoma D. Decreases local gastritis E. Decreases cimetidine dosage 94. Why we change from warfarin to heparin during pregnancy A. Heparin is easy to reverse B. Heparin does not cross the placenta C. D. 95. A 56 year old woman with palpable breast mass which seems to be benign cyst. What is the next step? A. Reassure B. FNAC C. CT scan 96. A patient with pain and swelling around the knee. Aspirated fluid contains neutrophils, no organisms or crystals found. The most likely diagnosis: A. Septic arthritis B. Rheumatoid arthritis C. Gout D. Pseudogout 97. the most common cause of limping in 5-10 year old boys is: A. Perthes disease B. Slipped femoral epiphysis C. Juvenile chronic arthritis D. 98. Question similar to: 40 year old woman comes to you with a 3 month history of arthritis, night sweat and low grade fever. She lost 1 kg for this time. Her body temperature is 38. There are no more clinical signs. What is the next step to confirm diagnosis? A. ANA antibodies B. Rheumatoid factor C. CRP D. ESR 99. How to differentiate between hypercalcemia caused by malignancy and primary hyperparathyroidism? A. Alkaline phosphatase B. PTH C. D. 100. The most effective way to prevent dental caries:

A. Toothpaste with fluoride B. Water with fluoride C. D. 101. A patient, smoker with GORD, oesophagi tis, obesity, alcohol abuse. What is the most appropriate management? A. Stop alcohol, smoking, reduce weight B. Stop alcohol, smoking C. Stop smoking D. Proton pump inhibitors 102. A 37 year old woman comes for her first antenatal visit. Her first baby died at 28th week of pregnancy. The most appropriate investigation is: A. Chromosomal studies B. Antiphospholipid antibodies C. D. 103. Antiphospholipid antibodies occur in: A. Arrhythmia B. Liver disease C. Stroke D. 104. A 50 year old man presents with pain, redness and swelling of testis, discharge from urethra, enlarged prostate. The most likely diagnosis is: A. Acute epididymitis B. Torsion of testis C. Gonococcal infection of testis and prostate 105. Cluster headache, except: A. Waking at night B. Episode lasts about 2 hours C. Lacrimation D. Vomiting 106. Not compressed by pituitary adenoma: A. Optic chiasm B. Optic nerve C. Other part of pituitary gland D. Cavernous sinus 107. 2 weeks after URTI, a young woman has developed progressive symmetrical weakness in her legs and reduced reflexes .What is your initial investigation? A. Chest X Ray B. MRI C. CT Scan

D. CSF E. FBC 108. A school age child with vague, recurrent peri umbilical pain .Otherwise normal. The most likely cause of pain is: A. Chronic appendicitis B. Meckel diverticulum C. UTI D. Hydronephrosis E. Psychogenic 109. *What is the most common cause of death in the second week after burn in children in Australia A. Haemorrhage B. Septicemia C. Hypovolemia 110. A player has been hit by a cricket on the left side of his face. He presents with diplopia and is unable to open his jaw. The most likely cause is: A. Orbital fracture B. Maxillary fracture C. Zygomatic fracture 111. *Chest X ray of 50 year old smoker, who worked in a mine for 10 years. He presents with cough and haemoptysis. The most likely diagnosis is: A. Bronchogenic carcinoma B. Mesothelioma C. Pneumonia 112. A 45 year old woman presents with tender, painful mass in the breast. The most likely diagnosis: A. Breast cyst B. Fibroadenoma C. Breast cancer *113. A 5 year old boy presents with lacerated wound after falling in the garden. He had just two vaccines dtpa at 2 and 4 months. What will you do? A. Give antibiotics B. Give immunoglobulins C. Give dtpa and Ig D. Dtpa and booster after 2 months E. Give dtpa 114. *A child presents with clean wound. He hasnt had immunization (dtpa). What will you do? A. Give DTPa B. Antibiotic C. Tetanus toxoid

115. What is the finding in ECG for hyperkalemia? (No ECG given) a) Peaked P wave and prolonged P R interval b) Wide QRS complex c) Presence of U wave. d) Bigeminy e) Inverted T wave. 116. A patient with ascites. Examination of fluid revealed malignant cells. What can you find? A. Supraclavicular lymph node B. Palpable lymph nodes on rectal examination C. Hepatomegaly D. Splenomegaly 117. *26-Leg ischemia. Urgent intervention is necessary if there is: A. No pulse, B. Loss of sensation C. Paralysis D. Pale leg 118. A patient presents with pain and redness on the medial side of the leg. The most appropriate management is: A. Anticoagulation B. Analgesia and movement C. Elevation 119. A patient on dialysis .He has developed dyspnoea 5 days after dialysis. What is the most appropriate management? A. Give Furosemide B. Call dialysis centre C. ECG D. Chest X Ray 120. A patient with repeated syncope, heart rate 44/min. Diagnosis: A. Complete heart block B. Arterial stenosis 121. *A child presents with a systolic murmur which radiated to the back and to the axilla. Femoral pulse is weak. The most likely diagnosis is? A. Coarctation of the aorta B. VSD C. AS D. Transposition of great vessels E. ASD 122. *A baby, cyanotic after birth. There is no response to O2, no murmur. Diagnosis: A. Transposition of the great arteries

B. Coarctation of the aorta C. Hypoplastic left heart D. VSD E. Tetralogy of Fallot 123. A 3 day old baby suddenly has become cyanotic. There is no response to O2, no murmur. Diagnosis: A. Transposition of the great arteries + VSD B. Fallot tetralogy C. Hypoplastic left heart 124. Similar question to: A lady with history of insomnia for few months, irritability and weight loss. She and her husband are working and had a lot of expenses including hire purchase. They cant afford to go for holiday. A. Refer to Psychiatrist B. Refer to social worker C. Refer to marriage counsellor D. Interview husband 125. A woman with rupture of membranes at 24th week of pregnancy 16 hours ago. There is no infection. Management: A. Antibiotic till birth B. Tocolytic till birth C. D. 126. DVT after surgery. At what time does it develop usually? A. within 24 hours B. 24 to 72 hours C. After 72 hours 127. Pyromania - motivation in teenagers : A. Seek appreciation of peers B. Criminal activity C. Curiosity and fascination of fire D. Get panic attack 128. Common cause of rupture of extensor polices longus. A. RA B. Fracture of lunate 129. *A 12 week pregnant woman with CIN 2 (Pap smear). What will you do next? A. Colposcopy + conization B. Colposcopy + loop excision C. Colposcopy + punch biopsy 130. *A 13 week pregnant woman with CIN 3 (Pap smear). What will you do next? A. Colposcopy

B. Colposcopy + biopsy C. Colposcopy + loop excision D. Repeat after 36th week 131. A 25 year old woman presents with mobile breast mass. The most likely diagnosis is: A. Fibroadenoma B. Breast cyst C. Breast cancer 132. *A 36 week pregnant woman with symptoms of severe preeclampsia. Management: A. Magnesium sulphate B. Deliver baby 133. Leg ischaemia. Which of the following is correct? A. Ankle: Brachial Index > 1 B. Relieve by elevation C. Relieve by walking D. Muscle pain 134. Which one of the following indicates carrier state of Hepatitis B? A. HbsAG B. HbsAB C. HbcAG D. HBeAB 135. Chest X ray was given. A patient with sudden onset of chest pain after vomiting. X ray showed tracheal deviation to the right side. The most likely diagnosis is? A. Pneumothorax B. Rupture of oesophagus C. Rupture of diaphragm 136. A 55 year old woman with family history: father died of colon cancer at the age of 69, grandmother died of breast cancer at the age of 55, Grandfather died of colon cancer ( hereditary polyposis) at the age of 56. What investigation will you do for screening ? A. Mammography B. Colonoscopy C. CT scan D. MRI 137. *A child can say 4 words (mum, dad), can stand and walk with support. The age of the child is: A. 6 months B. 9 months C. 12 months D. 18 months 138. *18 month old child can do:

A. Undo button B. Build tower of 2-3 blocks C. Copy circle D. Run well 139. *You have been asked to do seminar for mothers about the child development. Which of the following questions will concern you? A. My child is 10 months old and doesnt have teeth B. My child is 7 months old and is frightened of people C. My child is 2 months old and doesnt smile when I smile 140. *A 2 year old child with delayed development. The child can crawl and walk with hand. What stage of development is the child at? A. 6 months B. 9 months C. 12 months D. 18 months 141. A patient who is a smoker and heavy alcoholic presents with symptoms of heart failure has murmur (?) and 3rd heart sound. The diagnosis is: A. Alcoholic cardiomyopathy B. Mitral incompetence as a result of rheumatic heart disease 142. Myclonic jerks occur in all of the following except? A. Normal sleep B. Epilepsy C. Encephalitis D. Uraemia E. Parkinson disease 143. A child with UTI. Treatment: A. Furantoin B. IV Ceftriaxone C. Gentamycin D. 144. A patient with kidney transplant presents with symptoms of meningitis. CSF exam showed normal glucose and protein. A. Viral meningitis B. TB C. Cryptococcus meningitis D. Bacterial meningitis 145. A 13 year old boy is on 3rd percentile. His parents are on 50th percentile .Parents are concerned. A. He will be on less than 50th percentile B. Do karyotype C. He is normal.

D. E. 146. A man with past history of peptic ulcer disease presents with haematemesis. On gastroscopy, there is one shaggy ulcer. Histology and cytology negative. What will you do next? A. Omeprazol B. Biopsy again C. Breath urea test for H. pylori D. IV fluid E. Antibiotic 147. CT scan of the liver (Anthology of Medical Conditions, page 36). Diagnosis: A. Hepatocellular carcinoma B. Metastases C. Hydatid cyst 148. A 25 year old man with family history of colon cancer. His father died of colon cancer at the age of 35; his cousin is 40 years old and has colon cancer. The most appropriate management is: A. Colonoscopy now B. High fibre diet and colonoscopy every year. C. FOB test 149. A 14 year old girl asks for oral contraceptive pills. She lives with parents. A. Consult with parents B. Give OCP and recommend condom for her boyfriend.. C. Prescribe OCP D. Talk to her boyfriend 150. Complication of severe emphysema: A. Compression of larynx B. Compression of pharynx C. Compression of oesophagus D. Cardiac compression 151. A man walked on rusted nail with his foot and there are signs of inflammation. What will you give him? A. TT and immunoglobulin B. Antibiotics and TT 152. An overweight man with lump (or swelling) in the abdomen, 2/3 from xiphisternum. What is your diagnosis? A. epigastric hernia B. para - umblical hernia 153. A man with swelling in inguino testicular region that disappear completely when lying down. What is the most likely diagnosis? A. Direct inguinal hernia

B. Spigelian hernia C. Obturator hernia D. Saphena varix E. Epigastric Hernia 154. Which of the following increase the risk of tuberculosis? A. Silicosis B. Asbestosis C. Berylliosis 155. A 18 year old woman presents in your surgery. She got drunk yesterday and today she woke up with abdominal pain. She vomited twice. On examination there is tenderness in the lower abdomen. P/R and FBC are normal. The patient is taking OCP. What is the appropriate management? A. Give her antimimetic and review next week B. Review tomorrow C. Explain that her diagnosis is unclear and review in 4 hrs D. Tell her that her symptoms are related to alcohol and will subside by itself. 156. Student girl has failed examination. She noticed that she feels weird, down, can not concentrate. She feels she is not being herself and she feels herself unreal Thought disorder was not recognized during testing. No perceptual defect was found A. Prodromal schizophrenia B. Bipolar disorder, type 2 C. Antisocial personality disorder D. Depression E. Adjustment disorder with atypical features