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Medicine and general:

1. Picture of mouth with –what looked to me like a- small cyst underneath the tounge?
a) Ranula
b) haemangioma

2. Picture of hand with flexion contracture mainly IV and V th. digit. Dx (Diagnosis)?
a) Duyptren’s contracture

3. Female 28yr, neck stiffness, no focal or other neurology, head CT normal, CSF
picture: 200 red cells, protein slightly increased to 70, Dx?
a) SAH
b) Meningitis
c) nothing serious/normal headache

4. CSF: picture bacterial meningtitis. Dx?


a) Bacterial meningitis

5. Blood picture with increased AP, ALT (>AST), AST, hep B and C negative. Dx?
a) viral hepatitis

6. Blood picture increased AP, ALT, Bilirubin. Dx?


a) Cholelithiasis
b) Cholecystitis

7. 85 years, ductus hepaticus mass or palpable gallbladder, also cardiomegaly and


hepatomegaly in medical history. Tx (treatment)?
a) biliary shunt
b) whipple op

8. Bloods with increased ESR

9. Cant recall question anymore but it contained all this: patient with rash on tonsils. Dx:
viral - swab, ASO titre, WCC, fever , LN

10. Anaemia blood picture with decreased iron and increased transf. Dx?
a) Normocytic anaemia

11. Status asthmaticus proper treatment in ED?


a) Rehydrate, inh. Salbutamol, parenteral steroids
b) rehydrate, salbutamol inh., ipratropium inh.
c) theophylline and…

12. Vit. B12 deficiency picture (at least my impression). Sx (symptoms)?


a) PNP
13. Leucaemia definitive diagnosis? LAD, fatigue, increased LUC, Hb 110 and

14. PE (pulmonary embolism) proven with V/Q scan in a young girl. Tx?
a) Iv heparin
b) Warfarin
c) Thrombolysis

15. 80yr old lady with PE post a long distance flight. Tx?
a) Iv heparin
b) Warfarin
c) Thrombolysis

16. PE postv a rectal surgery. Tx?


a) Iv heparin
b) Warfarin
c) Thrombolysis

17. Acute drop of thrombocytes to 50.

18. Patient develops oedema and HTN (hypertension), Hx: ESRF (end stage renal failure)
and diabetes mellitus. Treatment?
a) Start ACE-I
b) Thiazide
c) beta-blocker

19. Tx with thiazide and ACE-I in combination. Can cause the following changes:
a) Insulin increase
b) insulin decrease
c) glucose increase
d) potassium decrease

20. Alcohol, now acute confusion

21. Wernicke patient develops low BSL in ED. Tx?


a) Thiamine, ten Glucose infusion
b) 10ml of 50% (or 20ml of 10%) Glucose stat
c) Glucose infusion
d) Glucagon

22. Alcohol

23. Culture came back positive for salmonella infection on the 4th day after travelling.
Patient already received a 3-day treatment of metronidazole. His symptoms haven’t
changed since. Mx (management)?
a) Metronidazole for 3 weeks
b) do nothing
24. Alcohol abuse now with acute nausea and vomiting. Abdominal pain also to back. In
ED Shock. Dx?
a) Pancreatitis

25. 10 years history of acidity/reflux, well controlled with medicine, no history of weight
loss. Now dysphagia/swallowing preoblems especially for meat. Dx?
a) Oesophagus carcinoma
b) stricture of esophagus
c) barrets esophagus
d) side effects of drugs

26. Bleeding ulcer on endoscopy and test positive for helicobacter pylori. Mx?
a) Adrenalin injection on endoscopy
b) iv omeprazole

27. Best test to re-check post 7days of triple therapy for H. pylori?
a) Urease breath test

28. Fluids resuscitation for burn victim with 15% surface affected, 80kg? (my addit
4x15x80=4800ml)
a) give 3 l Hartmans and 2 l dextrose
b) same with blood products and Hartmanns
c) N/Saline and Hartmanns

29. Burns with…. Mx?


a) Intubation

30. 15yr old girl with Crohn’s disease. Comes with faecal soiling. No pain/ no blood. On
examination you will find?
a) Vesicle or so
b) Fistula
c) Fissure

31. Rash on legs

32. Patient with haemoptysis and haematuria and Epistacsis. Dx?


a) Wegener’s

33. Patient with haemoptysis and haematuria. Investigation?


a) Antimembr. Ab
b) ANA

34. 78 yr old wife with cognitive changes, confusion. Ix?


a) CT
35. Fecal impectation rectum

36. Alcoholic male found behind bar, previous episode of binch drinking, speech…? Dx?

37. Man /boy collapsed during rugby/football game on the field. No contact to other
players before on field. Now loss of consciousness for 30 minutes. Dx?
a) Vasovagal
b) SAH
c) Seizure

38. congestive heart failure

39. Long-standing smoker, age around 80 presents with frothy sputum, pleuritic chest
pain, tachycardic, clear chest on auscultation, post flight. Dx?
a) PE
b) Cancer

40. Long-standing smoker, age around 80 presents with haemoptysis, pleuritic chest pain,
tachycardic, clear chest on auscultation, post flight…some other question about it

41. Longstanding smoker presents with neurological signs on hands and arms

42. Patient with PE szenario. ECG normal but tachycardia 100bpm. What do you expect
to see on CXR?
a) Nothing
b) Effusion

43. WPW history. Now tachycardic with (no ECG was given, only description) broad
complexes in ECG and it looks like AF. Tx?
a) Electrocardioversion
b) Digoxin

44. ECG ST elevation in V1-V3, SVT (only describtion, no ECG given). Most likely
diagnosis?
a) PE

45. Patient with SVT and low BP and decreased level of conciousness. Treatment?
a) Verapamil
b) Sotalol
c) Valsalva maneuver
d) Cold water

Surgery:
1. Patient with rectus muscle pain and mass on the side of abdomen when strained.
Nothing to palpate when lying down. Dx?
a. Rectus strain
b. hernias with several names which I never heard of

2. Ruptured AAA

3. Wound of patient’s fist/hand 14 hours post injury. What to do after debridement?


a. Suture and antibiotics
b. Suture and drain
c. Leave open

4. Empty rectum but blood (? Can’t remember what I meant by that in my notes)

5. Bowel motions every 4-5 days only?


a. Normal

6. Mass in right upper quadrant that moves with breathing. Dx?

7. When do you do an explorative laparotomy post accident at work (explained the whole
szenario)?
a. Retroperitoneal air
b. (?retroperitoneal) Bleed
c. blood collection in liver
d. blood collection in spleen

8. Patient with fracture presents with pain on forearm and hand, increased on extension,
slight swelling. Extension fixation. Cause?
a. Haematoma
b. Damage median nerve
c. Carpaltunnel syndrome

9. MVA (motor vehicle accident) with fractured ribs 2-7 (bilateral?). Now presents with
difficulty breathing and pain. Mx?
a. Strapping ribs
b. Nerval block of ribs at…
c. Intubate and ventilate

Paediatrics:

1. Picture of child with generalised icterus. Which investigation would you perform to
confirm the diagnosis? (Nothing like bili or so given)

2. Pictures of a child’s back showing pink scaly patch, about 2 x 1 cm?


a. Rosacea

3. Picture of CXR of a child with left upper lobe consolidation and some round shaped
lesions, (?pneumatocele). (Not 100% sure if this was the question but I think it was:)
Which treatment?
a. Flucloxacillin

4. CSF given. I think viral picture. Child post birth, developes vesicles somewhere. Tx?
a. Acyclovir

5. Child with 3 days of fever then develops a rash. Dx?


a. 3 day fever

6. Child with scaly rash on neck, macular, mouth pink tounge, sore throat. Dx?
a. Scarlet fever
b. Mumps

7. Child younger than1 yr., soft palpable mass behind nipple. Tx?
a. Reassurance and monitoring

8. Leucaemia, lethargy for 3 months, Lab. shows leuocytosis with mainly functioning
leucos. What is the investigation to confirm most likely diagnosis?
a. LN aspiration
b. Philadelphia chromosome

9. Child 13 or 18 months old, SSRI ingested, as per parents “quite some amount”. How
can you evaluate the risk of toxicity?
a. ECG
b. EUC
c. Level

10. Asthma 10-13yr old child, 2 attacks in the last year, now for general check-up in your
surgery. Mother states child had cough all winter. Mother concerned. Currently on
ventolin PRN. Mx?
a. Start PEF monitoring and measure regularly
b. start preventer (name given)

11. Asthma exacerbation again in child. Mx?


a. Fluticasone
b. salmeterol inh.
c. Ipratropium
d. 6hrly ventolin

12. Ikterus

13. Preterm baby develops respiratory distress a few hours after birth. Dx?
a. RDS

14. Toddler was at birthday party of family member. Sudden onset of cough and wheeze.
Mx?
a. In-and epiratory CXR
b. Bronchoscopy

15. Similar question, can’t recall the difference: Toddler was at birthday party of family
member. Sudden onset of cough and wheeze. Mx?
a. In-and epiratory CXR
b. Bronchoscopy

16. 2 yr. old swallowed a 2.5cm long screw. AXR shows the screw in the RUQ. Mx?
a. R/V in 2 days
b. Endoscopy
c. Follow-up ultrasound

17. Child with burns and stridor. Mx?


a. Intubation

18. CF (cystic fibrosis) sweat test. Child with recurrent respiratory infections, no weight
gain

19. *Milestones question. Child can roll, hold head up, sit bending forward, babble, grasp
palm, stand when hold. Age?
a. 5 months
b. 7 months
c. 10 months
d. 12 months

20. SIDS. Parents are coming to you telling you this is all they are doing now and want
advice. What can be most effective after 1st affected child to prevent?
a. Baby alarm
b. Stop smoking
c. Breast feeding only
d. Lay supine
e. Lay on belly

21. What is APGAR if child HR 140, moves all limbs, cries, arms cyanosed and maybe a
few more hints?
a. 9

22. Lateral CXR of a child with stridor. Dx?


a. Epiglotitis
b. Laryngomalazia
c. Croup

23. Child, bowel obstruction

24. Neonate with respiratory distress

25. Intussuseption szenario

26. Child 3 yr. old with laceration on scalp. Clean and not contaminated. Child not
immunised. Mx?
a. Antibiotics
b. Tetanustoxin
c. Tetanusimmunoglobulin
d. TDPertussis vaccination
e. TD vaccination

27. Hirschsprungs

28. Child with decreased femoral pulses, Dx?


a. Coarctation
b. Hypoplastic left heart

29. Child 12 hours post birth, cyanotic, no murmur

30. Neonate at 1.5hours. Nurse states did turn blue on hands and feet. On examination
normal heart and lung examination. What is true?
a. Seizure
b. Start giving oxygen
c. Early resp. distress signs

31. Child around 3 yrs with abdominal mass and haematuria. Dx?
a. Wilms tumour

32. Child 14yr, pain on side of knee. Limb shortened, limps, hib abducted. (Note: not
given obese in history) Dx?
a. Slipped epiphysis
b. Perthes disease
c. Osteochondrosis

33. Child with cough and dyspnoea. On auscultation crepitations on the right and dull on
percussion over right middle lobe. Dx?
a. Effusion
b. Pneumonia

34. Child with haemophilus meningitis and pneumonia gets exposure to other child (age
<4yr) without immunisation. Mx of the exposed child?
a. Amoxicillin orally for 4 days
b. Rifampicin for 4 days
c. Cefachlor oral for 4 days
d. Chloramphenicol shot im
e. Penicillin iv

35. Child born and not able to take breath. What u will do first?
a. phryngeal suction
b. intubation and ventilation
c. wait and watch
d. x-ray

36. Parents asking about risk for their future child, as mother’s brother has
arachnodactily?
a. The risk for the child is same as in normal population
b. 50% change of having
c. 50% change of being a carrier

37. parents came to physician, they have a child with the cleft palate and want to know
what is the probability of cleft palate in their second child
a. 3%
b. 7%
c. 0.4%
d. 4. 4%

O&G:

1. Galactorrhoea 4 months post breast-feeding was stopped, child now 8 months old. Tx?
a. Reassurance
b. Bromocriptine

2. Women 30-32 weeks gestation comes in with symptoms of preeclamsia. Fetus seems
well. Management?
a. Hydralazine
b. Induce labour
c. CS

3. Girl on OCP (oral contraceptive pill) for 2 months, not working as she has no regular
menstruation and co. Mx?
a. Continue for 2 more months

4. 15 yr old girl has collected information about depot contraception and requests it.
Management?
a. Re-educate her about options and risks, then give it to her if she still insists on it
b. Ask mother for permission
c. It is contraindicated in that age group

5. Vagina dry, cyclic (pre)menopause

6. Vaginal/vulva swelling and pain Dx?


a. Barthol. Abscess
b. Bart. Cyst

7. Rash vaginal or so Dx?


a. Secondary to syphilis
b. Ulcer vulva

8. Vaginal itch

9. Absolute contra indication (CI) for IUD?


a. Previous cervix
b. STD
c. Uterus malformation

10. IUC using female, now amennorhoea. Result shows she is pregnant. Mx of IUD?
a. Leave in
b. Take out immediately by pulling on the wires you can see
c. Scope

11. 45 yr old female with positive FNA for cancer. What do you do to decide for
conservative Tx?
a. Check LN axillary manually to exclude spread
b. Mammogram
c. US of breast (comment: no option for MRI or CT given)

12. Mother 18 weeks of gestation with bacterial vaginosis. Mx?


a. Tell her to check again at 28 weeks and if still there treat with…
b. Metronidazole now
c. No need for action

13. Mother, GBS (Group B strep.) positive at 30 weeks gestation. When to give IV
penicillin?
a. In labour
b. Perform CS and give during CS
c. Start with first cut of CS
d. To baby after birth

14. Primary amenorrhoea in a 18yr old girl. No breast development. Mx?


a. Karyotyping
15. Parents with 3 previous miscarriages. Mx?
a. Karyotype of both parents

16. Uterus umbifig. What’s true about pregnancy?


a. Will never be pregnant
b. Tell her normal chances
c. Most likely infertile
d. Increased risk for miscarriage

17. Mother who is breast-feeding gets mastitis. Mx?


a. Stop breastfeeding until she is well to prevent contamination
b. Stop on affected side
c. Stop feeding from affected side and use breast pump there

18. Mother Hepatitis B positive

Psychiatry: (there were many psych. questions but those are the ones I just can’t
remember!)

1. Middle aged women presents low mood. Sounds like depression. Started St. John’s
Worth 300mg and it helped a bit but still not enough and still depressed. Not suicidal.
Mx?
a. Increase St. Johns Worth to 600mg
b. Add SSRI (name and dose given, think Fluoxetine 75mg)
c. Wash out period for St. John’s Wrth, then start SSRI (name and dose given)

Ethics & Co:

1. Primary prevention means?


a. Decreased prevalence
b. Dcreased incidence and preterm death

2. Old man with dementia with new diagnosis of untreatable cancer. His wife is the carer
and asks you not to tell him about diagnosis as he would get depressed and then she
couldn’t care for him anymore at home. Which allows you most not to tell the diagnosis
to the patient?
a. You made the decicion that patient would not understand the diagnosis
b. Wife can’t care for him anymore if he hears diagnosis
c. Treatment of dementia plus depression is very difficult

3. Old man lives with daughter and son in law. Comes to you as a GP with bruises. He
tells you about some abuse/violence by the son in law but asks you not to tell the son in
law or his daughter. Mx?
a. Call police and tell them
b. Cll daughter to talk about it
c. Tll ptient to come for regular visits at you surgery from now on to check-up on him

Surgery at night, an emergency operation is getting ready to start. The surgeon walks in
ataxic with symptoms of being drunk/current ETOH abuse. You talk him but he replies
“mind your own business”. Then what u will do next
4. Mx?
a. Call security to stop him and take him out of theatre (?or police)
b. Call your bosses/ CMO stat
c. Call ethic commun. Or board stat
d. Call someone tomorrow morning
e. Find other surgeon to replace him/ talk to another colleague that he will take charge

5. Study about HIV. Blind study.


a. Tell people the test results
b. As it is a blind study you can’t tell the patients but advise them to do HIV test
themselves afterwards

6. GP can be involved in clinical study. What is your main responsibility?


a. To be familiar with the Helsinky
b. Make sure it fits the ethics
c. Make sure your patients get paid

7. which one can decrease the prevalence of a disease in the population? herd immunity/
treatment/ health programme