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2012 Recalls
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1.A pt with duke c colon cancer, had left colectomy, for 5 yr survival what can be done a.total colectomy. b.Abd.radiation. c.5 fluoro uracil 2.Gambling is more prevalent in Australia because a.Easy access b.Melbourne cup day encourages it. c. 3.7 yr boy presented with hematuria. 5 days back he had sore throat and rash in the back 1.post streptococcal glomerulo nephritis. 2. Ig A nephropathy picture qns 4.Picture showing whitish aspirate from paritid duct 1.parotitis 2. Calculus 5.Whitish ecogenic lesion on mammographic picture of 60 yr lady. she admits she had an accident of hitting with a steeing wheel on the same breast year ago 1.focal fat necrosis 2. carcinoma breast Fundoscopy pictures 6.? Central retinal artery/ vein occlusion 7. 50 yr man c/o flashes and floaters in vision 1.?Retinal detachment 8.CT picture ? pulmonary embolism[ in the history pt had shortness of breath] what is the treatment? 1.Aspirin 2

3 2.Warfarin 3. Heparin 9.A pt was found to have peau de orange while taking an ECG what is the diagnosis

1.Ca breast. 10. picture of venous ulcer on the medial malleolus of leg. what is the cause. 1.previous tibia fibula fracture. 2.Arterial insufficiency 11.picture showing ulcer near thenar eminence of hand ?? Epithelioid sarcoma 12.A pt diagnosed with sigmoid volvulus. what is the feature suggestive of ischemic change? 1.Gross distension of abd. 2. 10 cm dialatation osf sigmoid 3.focal pain 4.colicky pain 13. A boy with moderately swollen tymphanic membrane and pain .what to do 1.Amoxycillin 2.Acyclovir 3.paracetamol 14. commonest cause of strangulated hernia 1inguinal 2.femoral 3. umbilical 4. spigelion 15. A 45 yr male presented with swollen inguinal lymph node. where could the primary found? 1.Rectum 2.testes 3. Anal canal 4.colon 3

4 16.A pregnant lady at 26 wks gestation presented with swollen the treatment? 1.Aspirin 2. Warfarin 3. Enoxaparin 17.A 26 yrs female with right iliac fossa pain do 1. ultrasound 2. CBP 3. Colonoscopy 4.urine beta hcg. 18.OCP has least effect on 1. breast cancer 2. ovaian ca(40%less) disease 3.encometrial ca(50%less) 4. benign breast , her Lmp 3 wks back, what should you , tender leg. what is

19.A 30 yr lady came to EMD asking for Dr. Z , if not seeing drz she will die. what the probable diagnisis 1. Mania 2. schizophrenia 3. borderline personality 20. difference between delusion and delirium 1. lack of insight 2.auditory hallucination 3.

21 A pt came with left eye pain of 6 m duration ,? comes for about 1 hr every day, now increasing intensity, fundoscop shows arterial injection. what RX? 1. Acetazolamide(to reduce the ocular pressure from glaucoma) 3.topical pilocarpine(1st if glaucoma) 2.hydrocotisone

22. A 20 yr female presented with malar rash, joint pain what test wil u do? 1. ANA(sensitive) 2 . Compliment assay 3. anti ds DNA(specific) 23.A 30 plus pt presented with swelling in front of neck moves with swallowing and putting out tongue. what is correct 1. usg(1st do u/s or CT) 2. FNAC 3. excision

24.A pt presented with inabilit to do eversion and dorsiflexion. where is the injury? 4

5 1. S1 2 Tibial ny 3. common peroneal nv 4.

25.MI pt , ECG showed st elevation in v2 v3 v4 v5 , tertiary hospital 300 km away. pt was given o2 , morphine, aspirin what should u do 1. PCA 2. t PA 3.streptokinase 4

26. A 15 yr sudan pt found to have low calcium , what will u give him? 1. ca tab 2. vit d 3. cholicalciferol ?

27. A female pt from Bulgaria, having frequent visits to GP . On each visit examination appears to be Normal, when asking about her past history she breaks into tears and not want to talk about it. what is this? 1.Transverse 28.A pt him? 1. Hbs Ag 2 suppression 3.

is has been a chronic carrier of hep B for 6 months, what will yuo find on

2. Hbs Ab

3. Hb e Ag

4 circulating DNA.

29. A boy had hep A infection and 10 days after he became physically fit, when can he go back to school. 1. Now and use separate toilet(2wks before symptoms appear and 1 wk after symptom appear) 2 After 3 days 3. once the enzymes come to Normal 30.Who is most likely to get coxiella bunetti inf 1. Dairy workers 2. Fresh water fisherman 3

31A lady presented to EMD in a drunk state, with black around eye , what is the important thing to rule out? 1. Fall 2. Alcohol over dose 3. domestic violence

32.A pt with rt upper quadrant pain , mild jaundice, all enz elevated bilirubin 40 1.cholangitis 2 Acute cholilithiasis 3.hepatitis

33. A pt was given Morphine, what will be the blood gas analsis picture? Resp Acidosis. 34.A pt G2p1 PH fall , Po2 fall pco2 high found to have breech presentation at 33 wks. what should u do? 5

6 1.ECV(External Cephalic Version)now 2proceed to normal labour 3. c.s 35 A pt had sports injury, not able to move his leg, what is to be done to get the diagnosis 1. x ray 2 Aspiration 3 MRI ut 8

36.10 wk pregnant lady came with h/o abd pain and bleeding. on examination wks sze cervical os open. what is next step 1. usg 2. preg test 3 D&C

37.A 80 yr lady was brought by her daughter that mom is more forgetful, depressed....... on examination there was bruise on left temple what is the Dx 1. Alzhiemers 2. parkinsons dis 3. subdural hematoma

38.16 yr came for primary amenorrhoea, what is appropriate for. her? 1. when was mom's menorrhoea [ no options about breast or axillary or pubic hair development] 2. hormone tests 38.A pt had bitemporal hemianopia? where is the lesion 1. optic tract 2 optic chiasma 2 optic nv

39. qn on osteoporosis 40A pt who is a smoker had underwent surgery for achalasia in the past came with abd pain x ray showed air under diaphragm what is the next step? 1. endoscopy 2 laparotomy

41. A 40 female came with h/o food getting stuck in the throat, regurgition of undigested food 1 Ca oesophagus 2. Zenkers diverticulum

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. 6

7 ---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 7

8 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* 1. X-ray of hip osteopenia ALP is 800 ( that is the only information given ) Rx a. Biphosephanate b. Ca c. Vita b12 d. Radiotherapy 2. Pic of both lwoer limbs showing red rash. 34y old male with diarrhoea and admitted in the hospital Dx a. HSP 8

9 3. Mallert finger pic. Which type of injury will occur a. Hyperflexion occur due to extension b. Rupture of tendon 4. CXR night sweat, dry cough, wt loss, enlarge bilateral cerviacal lymphnode Dx a. Sacodosis b. Tb c. Lymphoma d. CLL 5. 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 6. SVT ECG a) Adenosing b) Amiodarone c) Verapermil d) Dogoxin 7. 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 9. A infected batholian cyst a) Antibiotic will resolve it b) Cause by gonnorrhoea c) It is asymptomatic 10. A pt who had aninjury to eye due to hit from metalic spike what will you do a) Use local anaesthetic and removed 11. A girl comes with 6 week ammenorrhoea diagnosed she is preg. After home preg test. Now develop lower abdominal pain and slight vaginal discharge a) Quntitative serial BHCG b) USG c) P/V exam 12. 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 a) Incidental finding of red degen of ut fibroid b) Round lig pain. 13. 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 9

10 14. Abd x-ray 5th POD due to hip replacement a) Pt rectus tube b) Gastro graffin enama c) Colonscopy 15. 5th POD for input output chart given. 16. In both recall output is more than input. One is 1400 is differnt, other recall 2100. a) Resolved paralytic ilius b) Wrong chart 17. 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 18. A couple comes telling that one child diagnosed as cystic fibrosis concern about next child incidence a) 0.5 b) 0.25 c) 100 19. 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 20. 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. 21. Ovarian Ca where is the primary site? a) Breast b) Lung 22. CT head show hemorrhage. Pt on warfarrin and INR 4.5 what will you do a) giveFFP b) give platelet 23. CT head showing same lesion like infaction a) Multi infarct dementia b) Cerebral hmg c) Cerebral abcess 24. A prg lady came to with you are 18weeks. Her last preg is a premature delivery what to konw the outcome his a) Cervical length b) Fibronectin 25. VT ecg a) Adenosin 10

11 b) Amiodaerone c) Adrenaline 26. 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. 27. 80 lady comeing with rectocele a) Pessary b) Sx c) Pelvic exercise 28. 50 old man coming with sccrotal pain which is reddened what ill you do a) Urine catha b) b/d culture c) FNAC 29. 50 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 30. Fundoscopy pic, HTN ployuria, ploydypsia, what is dx a) DM b) HTN c) CRAO d) CRVO 31. 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 32. 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 33. A down syndrom under go surgery develop hypersensitive a) Latex b) Anaestheic drugs 34. A 34yr male havin, ACEI Statin b-blocker develop calf pain tenderness in calf a) Check ck level creatin b) Check FBC 35. A pic both eye increase tearing who will you do a) Refer plastic surgery b) Cold compression 11

12 36. CXR given and ask of diagnosis a) Pul edema b) Metastasis c) Carcinoma 37. 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 38. 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 39.

MEDICINE 1 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 d. e. --2 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 3 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 4 A ECG w WPW + vent tachycardia .Wht us the mx? a) adenosine b)amiodarone c)b blocker d)verapamil 5A 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 12

13 b)laproscopy c)cystoscopy 6Patient 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 7Patient 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 Q8;which feature would be absent in pseudarbulbar palsy? a)Dysarthria b)Dysphagia c)Absent Gag Reflex Q9)30 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 Herpes strep 10 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 11 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 12A 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 13A 30 year old lady comes with a bruise on the left cheek and a cut on the lip. If you 13

14 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 14Chest 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 15A 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 16A 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 17 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 18. 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 19 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 20 .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 21.Sixth nerve palsy picture given.Diagnosis? 14

15 22.Amitriptyllin intoxication.What is the management? a. IV fluids b. Intubation and Sodium bicarbonate c. Gastric lavage d. Activated charcoal 23. COPD patient received 6L oxygen and get worse. What is the next step? a. Immediate Cxray b. Reduce oxygen c.Increase oxygen d CPAP 24.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 25. 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 26.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 27. 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 28.35 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 29. 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 15

16 -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 30.Pt with Osteoporosis and oesophagitis. What is the treatment? A. alendronate B. zoledronic acid c) Increse milk intake d) risedronate e) Give Calcium supplement. 31.What is best treatment child with petit mal. - Carbomazepine - Na valproate - Barbiturates - Diazepame - No option with ethosuccinate

Q32; 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 Q33; 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 Q34; 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. Q35; WPW syndrome with ventricle ectopic. What is your next step in management. a) Adenosine b) Verapamil c) Amioderon 16

17 Q36; .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 Q37; Which feature would be absent in pseudarbulbar palsy? a)Dysarthria b)Dysphagia c)Absent Gag Reflex Q38; 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 Q39; 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

40. 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 41. 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 42. A lady on warfarin developed Rt iliac fossa pain.CT scan given. Dx a)rectus sheath haematoma b)appendicitis c)mesentric eschemia 43.acute limb ischemia .what sign would require for urgent surgery? a) paresthesia 17

18 b)paralysis c)rubor 44. A 65 year old male patient with a history if Ischaemic Heart Disease and Sliding hiatal Hernia attends a dinner conference. Half through the meeting he suddenly developed retrosternal pain and collapse. He was seen within an hour at the A&E. After Oxygen via nasal and IV fluids were given, what is the next appropriate step to do: A. Barium Swallow B. Echocardiogram C. Insert Intrathoracic drainage D. ECG E. Ultrasonograhy 45. 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 46. 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 47. 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 48. 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) 49. 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. 18

19 50. 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 51. 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 52. 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 53. Picture of venous ulcer, which one of the following are the risk factors? a. smoking b. Previous history of DVT c. Coronary aretery disease 54. Mallet finger Mechanism of injury a. flexion injury b. hyperflexion injury c. hyperextention injury 55. 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 Q56; Patient with earache, swelling in the cheek. On examination earN,What is the next intial investigation? a. OPG b. Head CT c. sialogram d.CT e. X-ray mandibulae 57. 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 19

20 b. tortion of testes c. Hydrocele 58. 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 59. 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 60. 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 61. 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 62. 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 63.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 64. 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 20

21 c) Aspiration of the knee e) X-ray 65. 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 66. Pt w 15% pnemothorax. Mx. a. Reassurance and observe b. Drainage under seal water c. Oxygen d. Intubation e. aspiration

PADIATRICS 67. 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 68. 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 69. 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 70. 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 21

22 71. 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 72. 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 73. 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 74. 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 75. 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 76. 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 77. 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% 22

23 78. A pregnant woman with vesicles in the vagina, have difficulty in micturition. On lab invHerpes infection. What is the management? a. oral acyclovir b. IV acyclovir c. Interferon d. Oral fancyclovir 79. DX for FT ectopic preg a.US of visral organ b. Bhcg c. Laproscopy d. CT abdo 80. Preg lady 10 wks uterus size 14 wk best Dx method. a. B hcg b. USG c. CT 81. 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 . 82. 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 83. 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 84. Young women came to ER for severe lower abdominal pain, low BP-90/50, pulse-110,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 85.Management of abruptio placenta with death foetus: - cesarean -amniotomy -expectant ( Observe ) 23

24 86. 2 weeks postpartum lady present with psychotic episodes. She is breast feeding. Best treatment: -Olanzapine - Lithium -diazepam 87. 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 MEDICOLEGAL & PSYCHIATRY 88. A patient has been taking Sertaline for several years now. He developed Muscle cramps, lethargy, and tiredness. What would have been the cause of his recent condition? A. Hypokalemia B. Hyponatremia C. Hypocalcemia D. Serotonin insensitivity E. Malignant syndrome 89. Mother brings her 6 year old child for an upper respiratory tract infection. Mother has lost contacts with the father of the child. Shes asked to bring the child for followup after 1 week. Mother doesnt bring the child for the followup. What would you do next? a) wait for 14days for the mother to bring the child. b) call the child protection services. c) Ring the mother and ask why she couldnt make for the appointment 90. An young lady 16 yrs old is brought to your Gp clinic by her mother complaining about her daughters behaviour. She talks rudely to her father. She doesnt attend her classes regularly and since she has poor attendence , school authorities has are planning to expel her from school. What treatment is recommended for her? a.Antidepressants b.Cognitive behaviour therapy c. family therapy d. psychotherapy 91. A mother brought her child due to some problem.On your examination she required further investigation with CT. Parents are separated. You arrange for Ct in a nearby hospital.But mother didnt turn up for the appointment.What is next step? a. Call the child care b. Call mother to enquire c. wait till 14 days for mother to respond d. inform the child protection authority e. inform family welfare group 92. Who is the most likely to be harmed by psychotic patient during the outbreak of 24

25 psychotic symptoms? a. Nurse b. Parents c. strangers d. Siblings 93. 19 year old dx with first episode of schizophrenia . mxa.olanzapine b.resperidone c.quetipine d.clozapine 94. A lady admitted to the hospital for elective surgery the next day. You were called because she is having conflict with the nurses because of the room. she told you that you are a doctor and you understand me not like the stupid nurses. Which disorder is she having: -Narcistic PD -Hypochondriac -Splitting -Denial 95. Patient that likes to gambling, spend a lot of money. Then he is depressed a couple of days later. After another days he is gambling again. Dx -Bipolar disorder -Schizophrenia -Depression -PTSD 96. A patient being anxious, active all the time, euphoric type of behaviour. Dx -Mania -Generalised Anxiety Disorder -Panic Disorder 97. Aboriginal adolescent boy. Recent Hx of aggressive behaviour. Complains of Hallucinations. Hx of leaving family. What can be the cause? -Alcohol -Mariuana -Psyzophrenia -Petrol sniffing 98. Patient Dx with Schizophrenia. Which history is contributory to this diagnosis? -Sibling Autistic -Hx of marihuana addiction during adolescence -Feeling of victimisation at work 99. Patient with History of 15 yrs Schizophrenia. Comes to GP for some minor problem. Doctor notices Melanoma on his elbow for which urgent excision/ biopsy needed. Pt refuses to undergo Tx for melanoma and becomes angry. Just wants Tx for his presenting problem. What is your next Mx? -Stop consultation -Explore reason for his refusal 25

26 -Send him for Psychiatric evaluation -Send letter to his home advising Tx for melanoma

Feb12 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 Old man with Hx of confusion and forgetfulness. He is driving at night. What is your advice? a. Stop driving AFlatter: full ECG Dx? Pt with dizziness + palpitation + elevated JPV. 5 ECG strips: a. VT b. AFlatter c. SVT NB: no AFib option! 23y.o. male c/o tenderness of left scrotum. Transillumination (-)ive. Next Ix? a. USG b. Urine culture c. Biopsy d. FNA 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! Carpet layer presents with pain and tenderness in one knee. Tx? a. Corticosteroids intra articular b. Rest for 2 wks c. Compression bandage ans- A 26

27 Prepatellar bursitis Repetitive low-grade direct trauma, such as frequent kneeling, can cause inflammation with swelling of the bursa which lies between the anterior surface of the patella and the skin. Housemaid's knee, or carpet layer's knee, can be difficult to treat if rest from the trauma does not allow it to subside. If persistent, drain the fluid with a 23-gauge needle and then introduce 0.5 - 1 mL of long-acting corticosteroid. The presence of a bursa mouse and persistent bursitis usually means that surgical intervention is required. 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

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 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

Ans- BScreen first-degree relatives (serum ferritin levels and serum transferrin saturation in older relatives and genetic testing in younger ones). No need to screen before adulthood.

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 Ans- 0(AR) Pt complains of developing digital ulcers when exposed to cold in winter. Tx? a. Hydroxychloroquine b. Oral prednisolone c. IM prednisolone What are the risk factors of endometrial Ca? 27

28 a. b. c. d.

Obesity Smoking OCP Multiparity Ans A Risk factors:

o o o o o o o o o

age obesity nulliparity late menopause diapetes mellitus polycystic ovary diabetes mellitus drugs, eg. Unopposed oestrogen tamoxifen family history - breast, ovarion, colon cancer

Pt agitated and confused, brought in to ED. What will you give? a. Haloperidol b. Olanzepine c. Diazepam d. Fluoxetine 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 Ans- A Table 20.2 SAD PERSONS Index: Suicide risk assessment17 Risk factor Criteria Score Sex Male 1 Age < 20 years; > 45 years 1 Depression Major (e.g. depressed mood) 2 Psychiatric history Previous attempts 1 Excessive drug use Ethanol or other drug abuse 1 28

29 Rationality loss Psychosis, severe depression 2 Separated Loss of spouse or other single 1 Organised plan Determined suicide plan 2 No supports No community back-up; generally isolated 1 Sickness Chronic illness 1 Score > 7 high suicide risk

Pic of Staphylococcal pneumonia. ECG of VT. Mx? a. Carotid massage b. Amiodarone c. Verapamil Ans- B Ventricular tachycardia non-sustained Lignocaine IV amiodarone Lignocaine IV if stable sustained - if not: DC shock Ventricular DC IV adrenaline if fine VF fibrillation cardioversion then DC cardioversion

Class III drug DC cardioversion amiodarone (maintenance) Class III (if recurrent)

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 ans-B 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.

29

30 Pregnant lady with hyperthyroid findings. What to prescribe to her? a. PTU (propylthiouracil) b. Carbimazole Ans- A 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 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 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 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 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 WPW + VT. Mx? a. Sotalol b. Amiodarone c. Adenosine 30

31 Pic of venous ulcer. a. Arterial ulcer b. Venous ulcer 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 Pic of apical TB in lungs. A rural nurse comes with hemaphtysis. Dx? a. Bronchitis b. TB c. Bronchogenic Ca A girl becomes dizzy few times while at the market. Becomes ok in 2-3 minutes. Dx? a. Migraine b. Arrhythmia 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 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 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 Bone pain. Very high ALP/ALKP; no Ca ++ given. Next Ix? a. Ca ++ b. Electrophoresis Mallet finger. Mechanism of injury. Rash on amoxicillin. 31

32 a. Stop amoxicillin Big stem: Pt with Hx of gastrectomy; all lab tests are given: low Hb + high MCV. Dx? a. Fe deficiency b. Vit B12 deficiency Woman with vaginal discharge, no fever, cervical excitation. a. PID Pic: Tinea capita Pseudobulbar palsy which feature is absent? a. Absent Gag reflex Nephritic syndrome becomes steroid resistant. Dx? a. IgA nephropathy b. Post-streptococcal GN c. Focal segmental GS Q8 from Peads Nov11: 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 Pt with weakness in one hand + headache. Dx? a. Atypical migraine b. Migraine 32y.o. pt with rash on buttocks + fever + a. HSP b. ITP c. Hemolytic uremic syndrome 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 10 month old unhappy baby. Wt - 10th percentile, Ht - 25percentile. a. Celiac disease b. Cow-milk allergy c. Cystic fibrosis 32

33 Child, normal delivery, presents to GP for a checkup. On exam: pansystolic murmur. Dx? a. Tetralogy of Fallot b. ASD c. VSD d. TGA Psychodynamic psychotherapy is used in Tx of: a. Borderline personality disorder b. Specific phobias c. OCD 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 Which one of these disorders is affected by/ related to culture? a. Schizophrenia b. Anorexia nervosa c. Agoraphobia 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 Old lady in a nursing home masturbates privately. What do you do? a. Complain to nurses supervisor b. Leave her alone 33wks primigravida. Cx is 3cm dilated and 1cm long. Brow presentation. Mx? a. CS b. Beta-mometasone c. Tocalytics d. IV a/b e. CTG PV bleeding @ 8wks gestation. Past h/o SIN II by exision. P/E is N. speculum: the sac is 33

34 intact, the cervicx is closed, minimal bleeding is coming through vagina. Dx? a. Placenta previa b. Vasa previa c. Ca cervix Another question on PV bleeding at 34 wks gestation. Cause? a. Placenta previa Child with 5-9% dehydration. a. NG dehydration HIV , 2 homosexuals. Best method for protection. a. Condom Fundoscopy: 76y.o. Pt with CRAO 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 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 Several faintings in old Pt. P/E: HR 44; BP 180/110; ejaculating murmur. What is the cause for fainting? a. AS b. CHB 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) 34

35 BBC (pinna of ear) Colles # Ulnar distal # Spine # (osteoporosis) Pictures from Blue Book: Acanthosis nigricans Bulemia nervosa Female Pt right hip. How to use stick? a. Hold in left hand and put your right leg forward 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 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 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 Tocolytics contraindications: a. Antepartum hemorrhage b. Previous C-section 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 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)

35

36 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 ECG od SVT. Rx? a. Amiodarone b. carotid massage c. adenosine Pt with VFib, ECG given. Mx? a. Atropine b. Adrenaline c. Lignocaine Pt with sore thoat treated with amoxicillin. After 4 days presented with rash. Dx? a. Allergic reaction b. SLE 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 Chronic PID Mx? IV drug user arrives to hospital with high fever. Dx? a. Rheumatic fever b. Endocarditis c. Pneumonia 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 1) which of these you r are least likely to give a man presenting with features of Schizophrenia a) risperidone, b) olanzapine, 36

37 c) quetiapine, d) clozapine, e) amisulpride 2) A doctor prescribed 10mg Morphine for a post operative patient but the nurse gave him 2mg. After giving the patient the remaining dose, what do you do about the dose? a) Talk to the nurse b) Report to health department c) Report to nursing supervisor d) Report to the head of her nursing group 3) An old man was well before and suddenly confused and agitated with memory loss in two weeks times thoughts on n off mmse score 26/30 brought by his family as sx getting worse.Wht is the diagnosis ? a)dementia b)delirium 4) A lady admitted to the hospital for elective surgery the next day. You were called because she is having conflict with the nurses because of the room. she told you that you are a doctor and you understand me not like the stupid nurses. Which disorder is she having: -Narcistic PD -Hypochondriac -Splitting -Denial 5) A lady is hep B positive she is coming for advice regarding the hep B transmission to her unborn baby what will you advice her a) she should have CS for delivery b) she yould not breast feed her child as risk is great c) the baby should receive hepB immunoglobulin and vaccination at delivery

6) Young girl, whose parent just divorced. And the mother recently got married to some other man She's been found to have patches on her scalp of no hair. Probable Dx? a)- trichotillomania -b) Alopecia areata -c) Mania d) Separation anxiety 7) Aboriginal adolescent boy. Recent Hx of aggressive behaviour. Complains of auditory and visual hallucination. Hx of leaving family. What can be the cause? -Alcohol -Mariuana -Psyzophrenia -Petrol sniffing 8) 35 yr old lady w mother having breast cancer at 47 yrs n sister diagnosed w ovarian cancer at 30 yrs.what is her percentage of developing breast cancer?. a)0.25 37

38 b)0.10 c)0.50 d)0 ;9) 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 10) A Rh ve patient(G2P0) at 34weeks old was found to be mildly Rh sensitised . Her first pregnancy was with a Rh+ foetus. She was given anti-Rho after and a miscarriage Ensued. She had an Orthopaedic operation a few weeks ago. Her current pregnancy, it was found out that her foetus was again Rh- at her first vist at 13 wk of gestation she was not sensitized . What was the reason for the patient having mild sensitisation? A. Anti-Rho given at 19 weeks AOG B) this pregnancy C. From previous pregnancy D. Blood Transfusion E. As a result of the miscarriage 11) A pregnant woman at 30 weeks gestation comes with severe headache. what would you prescribe best choice? a) Morphine and metoclopropamide b) Ergometrine c) Paracetamol and Codeine d) morphine IM 12) pic of pilonedal sinsus in blu book page 207 asked diagnosis exect same pic 13) Female 28 years old lawyer presented with depressive symptoms recently her boy friend has abandon her. Unable to sleep at night and with early morning wakening. She states she states it is very difficult to concentrate at her work. She states that she doesnt want to take any medication as she is concerned that these may be addictive and habit forming. How will you treat her? a) tell her that her symptoms are due to recent separation with her boy friend. B) CBT c) Psychodynamic psychotherapy d) SSRI e) family therapy 14) a man who is very aggressive and agitated brought in the hospital by paramedics but he is willing to take medication . How will you treat him? a) call the security b) CBT c) Involuntary admission under mental health act health act d) IM olanzapine, 15) A 35 years old women BMI 3 2, had a child previously. Now presented with 12 months of infertility after trying hard to conceive, her husband sperm analysis is normal . now on usg found to have 18-20 small cysts in her ovaries. 38

39 How will you treat her now. a) Advise regular exercise b) Laparoscopic drilling of the ovaries c) Hysteroscopy d) Metformin e) Wait reducing meds 16) A 55 year old postmenopausal women presented with symptoms of hot flushes, she had a previous surgery for fibroids and hysterectomy was performed 10 years ago. While recovering from the surgery she also developed DVT. How will you treat her . a) oestradiol , PO b) oestradiol + progesterone oral c) oestradiol + medroxyprogestron skin patches d) oestradiol patches 17 ) 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 19 ) 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 20) 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 21) 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 39

40 22) A picture of psoriasis of the leg with extensive lesions. What is the treatment of choice? a)UVB light b) calcitriol 22) A pic of SCC at lower lip, what is most common cause? a) Smoking b) Sun exposure c) Mets d) Unknown cause 23) 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 24) a man brought his girlfriend, he reports that she has been flirting with his friends and when you interview her she was very seductive to you. What is your dx A) nascicaset personality b) Depression c) Histrionic personality d) GAD 25) 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% 26) 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 27) ECG of SVT from blue book asked diagnosed 28) 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 40

41 d) adhission 29) ecg of WPW asked for rx a) Carotid message b) amidrion c) digoxin d) adenosine 30) SVT ECG from blue book and dx asked.

31) 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. 32) venous ulcer asked about the most common association a) smoking b) DVT c) long bone fracture 33) a pic of ulcer o the medial meallolus what the diagnosis a) arterial ulcer b) venous ulcr c) diabetic ulcer 34) Q about the CTG interpretation what is more likely associated with foetal hypoxia. Ca not remember the option 35) 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 36) 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

37 ) acute limb ischemia .what sign would require for urgent surgery? a) paresthesia b)paralysis c)rubor 38) A lady of a certain age had Subtotal Thyroidectomy several hours ago. She was noted 41

42 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 39) 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) 40) 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 41) pic of the old lady with a red swollen check like cellulites what is the mx. a) Incision and drainage b) Antibiotic c) OPG 42) 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 43) 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 44) 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 45) pic of red eye with watery discharge , two weeks earlier pt had oral and genital ulcers what the rx a) antibiotics b) chlormphencol ointment 42

43 c) oral steroids d)steroid drops 46) Q on leukaemia with blast cells 47) 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 48) 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 49) 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 50) ct of intra cerebral bleed dx asked 51) typical Presentation of ITP initial test asked 1) FBC 2) Aptt c) INr d) bleeding time 52) 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 53) 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 54) 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 55) All are S/E of corticosteroid therapy except: 43

44 - hirsutism - ecchimosis - leucocytosis - osteomalasia - lymphopenia 56) 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 57) 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 58) 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 59 ) 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 60) 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 61) 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

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45 62) A pregnant lady at 16 wk of gestation came with a minor bleed, which of the following is the will you do to confirm that the abortion will happen. a) fibronecton test b) Vaginal examination c) USG for cervical length d) Abdominal pain 63) a postmenopausal women in came what will you find her test a) low oestrogen, low FSH b) Very high oestrogen, low FSH c) Very low estrogens, very high FSH d) Very high oestrogen, very high FSH e) normal oestrogen, normal FSH 64) A 12 years old boy h/o Nephrotic syndrome not responding well to high dose cortico-steroid therapy, urine protein-++,hypertension, hematuria with red casts. WOF can be the cause: A .Ig A nephropathy B .PSGN C .focal glomerulosclerosis 65) 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. 66) a lady is in early labour, you noticed the late deceleration on the CTG trace of this women , what is significance of late deceleration seen on CTG of the pt. a)placenta praevia b) pl abruption c ) cord compression d ) normal variant

67) 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 68) 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 45

46 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 69) Bacterial meningitis, viral meningitis, encephalitis please read all about them. 70) History of eye injury blowout what will you find in the signs a) diplopia b) hyphemia c) fracture zygoma 71) SCC of lung and mesothealeoma do these topic 72) Diabetic pt on metformin, endepamide having hypoglycaemic attacks whats the reason for hypoglycaemia a) metformin b) endepmide 73) 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. 75) Q on intestinal obstruction 3 ecg Question 3 ct scan Q 2 Xray chest 4 skin condition with pic

A 28-year old male presents with distal weakness and atrophy of the small muscles of both hands(interossei, lumbricals, thenar & hypothenar). What is the most likely diagnosis? a) Multiple sclerosis b) Bilateral median nerve palsy c) Syringomyelia d) Bilateral ulnar nerve palsy e) Brainstem infarction

nephrotic syndrome not responding to steroids. cause a.PSGN b.IGA nephropathy c.minimal change ds d.reflux nephropathy

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SUREGRY AND PUBLIC HEALTH 1.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 2.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
A patient who presents with this diagnosis of posterior interosseus syndrome may have a history of vague proximal posterior forearm pain with no weakness in more mild cases. In more severe cases, the patient may present with weakness in the wrist and finger extensors. Because the extensor carpi radialis longus and in some cases the extensor carpi radialis brevis are innervated before the radial nerve passes into the supinator, there is usually some sparring of wrist extension. Also because of lack of extensor carpi ulnaris, there may some radial deviation of the wrist with extension with the remaining innervated ECRL and ECRB. There will be no sensory loss as this nerve carries motor fibers only. In mild cases posterior interosseus syndrome may be difficult to delineate from lateral epicondylitis and may be considered only after a failed resolution of lateral epicondylitis. There will be no changes with electro diagnostic studies with lateral epicondylitis

3 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 4.ct scan on cerebral tumor,cerebral h'ge 5 -75 yr presented with post prandial abdo pain....othr thng norml....diagnosis? a)Ca duodenum b)Ca cardia c)cholecystitis d)????????????? 47

48 6-biker fell frm bike 1week back.....no h/o unconsciousness...now presenting with occipital headache....diagnosis?? a)EDH b)SDH c)post traumatic headache 7-)sign of acute limb ischemia indicative of surgery a)pain b)paralysis c)color 8-sign of chronic limb ischemia a)pain b)paralysis c)rubor 9-A pt with duke c colon cancer, had left colectomy, for 5 yr survival what can be done a.total colectomy. b.Abd.radiation. c.5 fluoro uracil 10- Picture showing whitish aspirate from paritid duct 1.parotitis 2. Calculus 11- Whitish ecogenic lesion on mammographic picture of 60 yr lady. she admits she had an accident of hitting with a steeing wheel on the same breast year ago 1.focal fat necrosis 2. carcinoma breast 12- picture of venous ulcer on the medial malleolus of leg. what is the cause. 1.previous tibia fibula fracture. 2.Arterial insufficiency 13-.picture showing ulcer near thenar eminence of hand ?? Epithelioid sarcoma 14-.A pt diagnosed with sigmoid volvulus. what is the feature suggestive of ischemic change? 15-. commonest cause of strangulated hernia 1inguinal 2.femoral 3. umbilical 48

49 4. spigelion 16-. A 45 yr male presented with swollen inguinal lymph node. where could the primary found? 1.Rectum 2.testes 3. Anal canal 4.colon 17- A 30 plus pt presented with swelling in front of neck moves with swallowing and putting out tongue. what is correct 1. usg(1st do u/s or CT) 2. FNAC 3. excision 18.A pt presented with inabilit to do eversion and dorsiflexion. where is the injury? 1. S1 2 Tibial ny 3. common peroneal nv 4. 19-40A pt who is a smoker had underwent surgery for achalasia in the past came with abd pain x ray showed air under diaphragm what is the next step? 1. endoscopy 2 laparotomy 20. A 40 female came with h/o food getting stuck in the throat, regurgition of undigested food 1 Ca oesophagus 2. Zenkers diverticulum 21- Woman when she defecates a mass is noted to bulge out of her introitus.Most likely diagnosis. ---Rectocoele 22-. situation about testicular sweeling. What do you do next? --ultrasound --FNAC 23- question about painless hematuria --bladder tumor --renal tumor 23- 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 24- what is the most important sign to indate for immediate embolectomy --paralysis --pain --rubor 25-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 26- patient just had cricothyroidectomy and developed stridor while she was still in the recovery room. What will you do? --call the surgeon 49

50 --explore the wound in the ward --remove the skin sutures 27- 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 28-. xray given. Man coughing, smoker and working in the mine industry. What is the most probable diagnosis? --brochogenic CA 29- Mallert finger pic. Which type of injury will occur c. Hyperflexion occur due to extension Rupture of tendon 30- Abd x-ray 5th POD due to hip replacement a) Pt rectus tube b) Gastro graffin enama Colonscopy 31- In both recall output is more than input. One is 1400 is differnt, other recall 2100. a) Resolved paralytic ilius b) Wrong chart 32- 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. 33- 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 PUBLIC HEALTH 1-.Gambling is more prevalent in Australia because a.Easy access b.Melbourne cup day encourages it. 2-Boy having balck and white drawings. Parent just separted. What is the most appropriate Mx? --ask the boy about his drawing 3-. question about domestic violence. Pregnant lady with bruises. What do you do? -- give the numbers 4-. woman with 3 children wants space, but in file said do not give OCP as Stand by husband 50

51 -- its her opinion and give her OCP 5- 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 c) Talk with nurse durin her break d) Report nurse manager e) Do as she told f) 6-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 g) Complain nurse manager h) Go to nurse board i) Complain to the sup in age care. 7-50 male taken to a research and during it he become dementia and his primary carier is his son what will you do j) Ask from son k) Gardianship l) Ethic and comity 8-indigenous boy brought,,unconscious...cause a)petrol sniffin b)alcohol c)marijuana

` Feb12 Coal miner, working since 40 years, no smoking Hx. CXR : pleural effusion. Dx? Infected Bartholin cyst? Mx 51

52 Pt with Pagets disease. What is it associated with? Infected Bartholin cyst. What is true? d. Is asymptomatic e. Treated by a/b f. Caused by gonococcus Old man with Hx of confusion and forgetfulness. He is driving at night. What is your advise? b. Stop driving AFlatter: full ECG Dx? Pt with dizziness + palpitation + elevated JPV. 6 ECG strips: d. VT e. AFlatter f. SVT NB: no AFib option! 23y.o. male c/o tenderness of left scrotum. Transilumination (-)ive. Next Ix? e. USG f. Urine culture g. Biopsy h. FNA Big stem: old man, with many co-morbidities + polypharmacy, falls every morning. Most appropriate Ix? d. CT e. ECG f. Echo NB: no BSL option! Carpet layer presents with pain and tenderness in one knee. Tx? d. Corticosteroids intraarticular e. Rest for 2 wks f. Compression bandage Big stem: 32y.o. female with a lot of complains and Hx. CXR: patchy infiltrates (but looked normal to candidate). Tx? e. Azithromycin f. Prednisolone g. Clotrimazole h. Ticaracillin 52

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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? c. Case control study d. Randomized study Husband is diagnosed with hereditary haemochromatosis. Wife is healthy. They have two children: 9y.o. and 18y.o. Whom are you going to screen? d. 9y.o. e. 18y.o. f. Both How many children will be affected by Cystic fibrosis, if one of the parents is a career? d. 0 e. 0.5 f. 0.25 Pt complains of developing digital ulcers when exposed cold in winter. Tx? d. Hydroxychloroquine e. Oral prednisolone f. IM prednisolone What are the risk factors of endometrial Ca? e. Obesity f. Smoking g. OCP h. Multiparity

Pt agitated and confused, brought in to ED. What will you give? e. Haloperidol f. Olanzepine g. Diazepam h. Fluoxetine Old man living alone, wife died few years ago. Doesnt want to live. WOF would be of more concern? d. He is looking for suicidal methods on internet e. His any previous suicide attemts 53

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f.

He is living alone

Pic of Staphylococcal pneumonia. ECG of VT. Mx? d. Carotid massage e. Amiodarone f. Verapamil Mother brought the child with some problem. Doctor ordered CT. mother couldnt bring her child for the appointment. What do you do? d. Dont do anything e. Call her in 14 days f. Send her home a formal follow up letter 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. d. Ask the son to go to medical legal board e. Follow patients wishes f. Discuss with the son pros and cons of the operation and convince him Pic of Erythema Multiforme Pic of drug rash on legs.

Pregnant lady with hyperthyroid findings. What to prescribe to her? c. PTU (propylthiouracil) d. Carbimazole Pt agitated and breathless immediately after operation. What to do? e. Remove superficial sutures f. Explore wound in the ward g. Call the surgeon h. Do nothing 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? d. Send him to nearest hospital on ambulance e. Air ambulance the Pt f. Tell the Pt you cant do CT 54

55 Jehovah witness Pt needs blood transfusion for Ph incompatibility. Relatives say no. What do you do? e. Transfuse the Pt f. Do not transfuse the Pt g. Discuss the situation with relatives h. Ask the Pt to sign No transfusion form 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? d. Pull sides of his bed up e. Restrain f. Do one to one nursing Pt comes with peripheral weakness and has difficulty seen at night. What would you give her initially? d. Folic acid e. Iron supplements f. Vit B12 WPW + VT. Mx? d. Sotalol e. Amiodarone f. Adenosine Pic of venous ulcer. c. Arterial ulcer d. Venous ulcer A man with a low visual acuity, which becomes worse in sunlight. Pic is given. g. IOL (intraocular lenses) h. Phacoemulsification i. Pilocarpin j. Keratoplasty k. Acytozolamide l. Trabeculectomy Pic of apical TB in lungs. Rural nurse comes with hemaphtysis. Dx? d. Bronchitis e. TB f. Bronchogenic Ca 55

56 A girl becomes dizzy few times while at the market. Becomes ok in 2-3 minutes. Dx? c. Migraine d. Arrhythmia A plumber comes with cough. He is a smoker. CXR given: changes in pleura. What is definitive Ix? d. Bronchoscopy and Bronchoalveolar Lavage e. Pleural biopsy f. CT chest 6y.o. girl comes with pubic hair and breasts in Tanner stage 1. What will you do? c. Reassure and see her in 6 month d. Do FSH and LH A 6y.o. girl is very scared vigilant anxious; low grades at school. Her teacher is worried. Next step? d. Talk to mother alone e. Open discussion with both parents f. Take more information from the teacher Bone pain. Very high ALP/ALKP; no Ca ++ given. Next Ix? c. Ca ++ d. Electrophoresis Mallet finger. Mechanism of injury. Rash on amoxicillin. b. Stop amoxicillin Big stem: Pt with Hx of gastrectomy; all lab tests are given: low Hb + high MCV. Dx? c. Fe deficiency d. Vit B12 deficiency Woman with vaginal discharge, no fever, cervical excitation. b. PID Pic Tinea capita Pseudobulbar palsy which feature is absent? b. Absent Gag reflex Nephritic syndrome becomes steroid resistant. Dx? d. IgA nephropathy e. Post-streptococcal GN f. Focal segmental GS 56

57 Q8 from Peads Nov11: 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 Pt with weakness in one hand + headache. Dx? c. Atypical migraine d. Migraine 32y.o. pt with rash on buttocks + fever + d. HSP e. ITP f. Hemolytic uremic syndrome 10 month old child has been weaning + started cow milk and solids. On presentation pale and unhappy + lost 2 kg. Dx? d. Celiac disease e. Cow-milk allergy f. Cystic fibrosis 10 month old unhappy baby. Wt - 10th percentile, Ht - 25percentile. d. Celiac disease e. Cow-milk allergy f. Cystic fibrosis Child, normal delivery, presents to GP for a check up. On exam: pansistolic murmur. Dx? e. Tetralogy of Fallot f. ASD g. VSD h. TGA Psychodynamic psychotherapy is used in Tx of: d. Borderline personality disorder e. Specific phobias f. OCD 4y.o. aboriginal child speaks 5 words only + nose and ear discharge. What do you do next? e. Nasal swab f. Ear swab 57

58 g. Hearing test h. Tympanometry Which one of this disorders is affected/related by/to culture? d. Schizophrenia e. Anorexia nervosa f. Agoraphobia 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? d. Frontal lobe dementia e. Alzheimers disease f. Lewy body dementia Old lady in a nursing home masturbates privately. What do you do? c. Complain to nurses supervisor d. Leave her alone 33wks primigravida. Cx is 3cm dilated and 1cm long. Brow presentation. Mx? f. CS g. Beta-mometasone h. Tocalytics i. IV a/b j. CTG PV bleeding @ 8wks gestation. Past h/o SIN II by exision. P/E is N. speculum: sac is intact, cervics is closed, minimal bleeding is coming through vagina. Dx? d. Placenta previa e. Vasa previa f. Ca cervix Another question on PV bleeding at 34 wks gestation. Cause? b. Placenta previa Child with 5-9% dehydration. b. NG dehydration HIV , 2 homosexuals. Best method for protection. b. Condom Fundoscopy: 76y.o. Pt with CRAO For H. pillory medications: a/b with PPIs will help to: 58

59 c. Increase the replse time d. PPIs help a/b to penetrate the ulcer 2y.o. child with bloody diarrhea, n & v, swellings, petechiae, low urine output. Now lethargic. Dx? d. Hemolytic uremic syndrome e. Salmonella diarrhea f. Bacterial septicemia Several fainting in old Pt. P/E: HR 44; BP 180/110; ejaculating murmur. What is the cause for fainting? c. AS d. CHB Pt comes with h/o of treatment of osteoarthritis with Celecoxib, develops mouth ulcers. Mx? c. Cease d. Celecoxib

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