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SHAKOREE'S NOTES OF
AMC MCQ RECALLS

FEBRUARY MARCH APRIL
2017
Dr. Omar Shakoree
Dr. Omar M. G. Shakoree(MBChB)

SHO A&E Surgery
Department of Emergency
Sulaymaniah teaching hospital
Sulaymaniah, Iraq.
E-mail: omarshakoree@gmail.com
www.facebook.com/Dr.OmarShakoree
For my family
For my teachers
For my colleagues
For my patients
For better care
I collected these notes
Omar Shakoree
In these notes you may see a non-solved MCQs, this happen because these MCQs are not completely written by the recallers,
never mind you can just pass it and go for the next, you will find it in next few papers.
Here, you will find bulks of MCQs collected from every website and social media, and brings together.
The recalls for passing AMC MCQ Exam are very important, some will get 90% of recalls during their exam, others may get
10%, the average of repetition of recalls is about 45-60% of your exam.
In this book you may see MCQs with deferent numbers this happen because of selection the most important and repeated MCQs
of 2017 each months.
FEBRUARY
Young pt. With BMI 29 had a small boil on his arm, he admits drinking 3 to 4
soft drinks every day . Increased urine frequency.
Blood glucose 19
Hba1c 11
Mx
1. Metformin
2. Insulin pump
3. Insulin gargline
4. Gleclazide
5. Another oral Hypoglycemic
33333333333333333333
Pt with high sugar high cholesterol low HDL, ALT

raised obese Dx.
1.Metabolic syndrome
2. Cushings
3. Diabetes
AAAAAAAAAAAAAAAA
Patient had history of pancreatitis. Some time ago .now presented with
distension tenderness visible vessels percussion positive 37.8 temp liver
enzymes raised, confused and slightly drowsy. Dx
1. Bud chiari
2. Pancreatitis
3. Alcoholic cirhosis( dont remember other options)
4. Spontaneous bacterial peritonitis
444444444
Patient had RUQ pain . Palpable mass under right intercostal mid
clavicular area. Wt loss
Ca head of pancreas
Gall stones
Other irrelevant options
AAAAAAAAA
patient had abdominal pain liver enzymes elevated. Pancreatitis dx treated.

Now she is normal . On USS she had multiple gall stones a and cbd 10mm
next mx
A ercp
B Mrcp
C Elective cholecystectomy in current admission
D elective cholecystectomy after 3 months
AAAAAAAAAAAAAA
patient on multiple drugs for parkinsons disease now has constipation for 4
days. Bowel sounds decreased ,Tympanic sound on abdomianl percussion ...
abd. Distended and also has vomiting. Next investigation
A barium enema
B erect supine xray
C barium series
D ct with oral contrast
BBBBBBBB............PSUDO-OBSTRUCTION
Another abdominal obstruction asked for next appropriate step..patient

vomiting pain tenderness present. Rectal exam normal.
Patient had AF. .. ( points toward mesentric ischemia) xray was there. Next
step
A oral series
B xray
C ct scan
4 barium enema
5 NG intubation
(No test for mesentric ischemia )
CCCCCCCCCCCCCCCCCCCCCCCCCCCCCC...............ct angiography is
the 1st step
. Computed tomography (CT) angiography (CTA) and magnetic resonance
angiography (MRA) have become the cornerstones of modern diagnostic
approach, allowing prompt laparotomy in patients with suspected AMI
All cases of mesenteric ischemia with signs of peritonitis or possible bowel
infarction, [85] regardless of etiology, generally warrant immediate surgical
intervention for the resection of ischemic or necrotic intestines
http://emedicine.medscape.com/article/189146-treatment
newly married couple comes to u says his mom had schizophrenia what is
chance of schizo in his children
A 15 %
B 10 %
C high chance of schizo
D no risk of schizo
CCCCCCCCCCCCCC.............6%
nurses in an old home complaint of an 80 year old woman that she masturbates
privately in her room frequently otherwise she is normal.
A inform family
B transfer in a ward of 4 people
C do not do anything as she has a right to privacy
CCCCCCCCCCCCCC
Child fell..had a fx arm. Swelling and numbness in fingers. Next ( recall)

A fasciotomy
B reduction
bbbbbbbbbbbbbbbbbbbb
...............BOTH are correct depending on whole scenario
CTG of lady 37 weeks She didnt feel movements for 36 hours. Ctg showed
some deceleration to 80 ... for 1.5 to 2 min. Next step
A send her home
B ask to come back on next appointment
C admit and observe
D oxytoxin
CCCCCCCCCCCCCC..........ABNORMAL CTG......
ADHD kid .14 years .missed medications ..doesnt attend school regularly..
recently has symptoms again.
A give him medications so he can take them by himself
B appoint a nurse to give him regularly
C change to long acting
CCCCCCCCCCCCCCCCCCCCCCCCCCCC
If starting on immediate-release stimulants, consideration should be given to
changing to an extended-release form once the optimal dose has been
established. This can help to avoid the stigma and inconvenience of taking
medication at school.
https://www.racp.edu.au/docs/default-source/advocacy-library/pa-australian-
guidelines-on-adhd-draft.pdf
Pt 15y.He was normal before but now school grade fall, bunksclasses. had
several offence against him. difficultbehaviour.what in the history will lead to
diagnosis?
A-family history
B-mother took amphetamine during pregnancy
C-history of pouring petrol in neighbor's DOG
D-patients view on making those offences
AAAAAAAAAAAAAA...............family dynamics is the most important in
kids with behavioral or personality changed
Psychiatric patient with unstable relationship..hx drugs and alcohol. Etc... said
he wants to kill his girl friend. What will u do
A Inform police
B counsel him
C involuntary admisssion
D another psycho therapy
AAAAAAAAAAAAAAAAAAAAAAA
Where there is no time to use the police and the risk to others is serious and
imminent Police assistance in contacting neighbouring practices may not be
practicable in all instances, such as where a neighbouring practice needs to be
urgently alerted to an imminent threat. If you have just encountered a patient/
individual who presents a serious and imminent threat, and you are genuinely
afraid for the safety of another practitioner or neighbouring practice (eg. you
believe that the patient has ‘targeted’ a specific doctor, person or practice), the
following factors are relevant to consider:
• Is the danger imminent? Is it serious? By this, we do not mean credible, but
rather that there is a risk of serious harm. If so, identify which practitioners are
particularly vulnerable and prioritise contact accordingly
• Telephone or email the other practitioner/s and: – advise that you have
ust experienced a violent episode in your practice involving the named
person who is the perpetrator – if applicable, advise that the person was
demanding drugs with violence or is under the influence of drugs or alcohol.
This conveys a lot of information and, unless you indicate a relationship with
your practice, does not breach any doctor-patient confidence – advise that you
have called the police to remove the person from the premises or to report a
violent incident – advise the practitioner you have contacted that they may need
to consider taking preventive measures such as locking the front door. It is
desirable for neighbouring practices to co-operate in formulating the most
effective means of communication and to discuss concerns. Consider taking the
proactive step of telephoning local practice principals or medical directors and
discussing the way practices in your area would respond. Consider safeguards
such as ensuring you have the mobile phone number and email address of local
practitioners who may need to act with you in a coordinated manner.
15 yrs old by school dur to misconduct behaviour with teachers and kids..
With hx of drugs jails school expulsion truancy etcetc .. with multiple scars
on arms... said he wants to die...
A inform parents
B involuntry admission
C send for psychotherapy
D some medical therapy
BBBBBBBBBBBBBBBBBBBBBBBBBBB
Patient on multiple drugs had raised cholesterol of 7. Cause of raised

cholesterol
A metformin
B arb
C thiazide
D allopurinol
E clopidogrel
CCCCCCC,,,,,,,,,hyperlipedemia is very common with thiazide
patient with AF... pain in legs.. right leg is pallor absent pulses... ix
A ct angiogram
B uss veins
C uss leg
D d dimer
CCCCCCCCC..........US arterial..........acute limb ischemia
patient returned from london 2 days ago ... came with flu.. suddenly started to
cough and fell. Became unconcious. HR normal BP 90/80
Dx
A PE
B cough syncope
AAAAAAAAAAAAAAAAAAA
patient with hx of dvt... has dyspnea chest pain. Vq scan shows no perfusion in a
lung segment .Mx
Aenoxapirin SC
B Thrombolysis
C warfarin
AAAAAAAAAAAAAAAAAAAAAAAA
Lump under the angle of mandible. Hx of smoking. Dx.

A lung ca
B tonsillar ca
C metastasis
CCCCCCCCCCCCCCCCCC...............tongue cancer with metastasis
X ray of a smoker with cough for 3 weeks and some sputum blood stained.
There was opacity on left uoper lung lobe... and lymph node enlargement left
supraclavicular region. What another finding u will have on physical
examination
A horner syndrome
B dullness on percussion of chest
Decreased breatg sounds
AAAAAAAAA.............tumour at lung apex causes pancoast tumour
33 weeks pregnant lady. Comes with hx of vagibal bleeding. 1000 ml loss. Bp

110/50 HR 90... abdomen exam. Uterus 38 weeks... no fetal heart sound. Next
mx
A iv fluids
B USS
AAAAAAAAAAAAAAAAAAAAAAA.then
BBBBBBBBBBBBBBBBBBB..........huge loss of blood 1000 cc
looss....immediate resus even if her vitals are stable.....this female may collapse
at any moment
Old recall, depressed man, with bad business, saying wants to suicide, all
these happened not because of him but because the go vernment is not good.
A- Rationalization
B- Displacement
AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
Husband brought his wife, insomniac, drinks alcohol, flirtatious to his friends,
cleaning house a lot. She is flirting you & later becomes angry.
A- Hypomania
B- Histrionic personality disorder
C- Alcoholism
Man brought to hospital after throwing brick at windows. He said last thing
he remembers is leaving work form rural farm
A- Dissociative fugue
B- Fictitious disorder
C- Malingering
AAAAAAAAAAAAAAAAAAAAAAAAAA…………..typical
scenario
15yr male, scrotal pain 24hour, tender, restless, red scrotal skin
A- USD
B- CT
C- Aspiration
D- Sx
DDDDDDDDDDDDDDDDDDDDDDDDDDDDD
If NO fever ………….points to Torsion testis ( however duration
of pain is against)
Young male, scrotal pain, fever, thick cord. Which will help for Dx
A- UD
B- CT
C- FNAC
D- Urine PCR
DDDDDDDDDDDDDDDDDDDDD………..epididimoorchitis
Had kidney transplant from cadaver. No urine output up to 7 post op days,

requiring dialysis. What is the cause
A- Acute rejection
B- Block catheter
C- Ureteric obstruction
D- Donor venous thrombosis
AAAAAAAAAAAAAAAAA…………….most common cause
Post op day3, old lady, confused H/O dvt , pulled out IVA, SpO2 88%, Invx
A- CTPA
B- CXR
C- Blood glucose
AAAAAAAAAAAAA…………high risk of pulmonary
embolism
Post op day 10, Sx stomach cardia, left chest pain, on Xn reduced chest
sound on left lung with dullness,
A- CXR
B- CT
C- Sputum
BBBBBBBBBBBBBBBBBBBBB………leak
6mth child with wheezing, fever, tracheal tug, sub costal recession, nasal
discharge. What will you do to make Dx
A- CXR
B- Sputum Cx
C- Blood Cx
D- Nasopharyngeal as pirates for PCR
dddddddddddddddddddddddddd………..bronchiolitis
http://www.racgp.org.au/afp/2015/june/the-wheezing-child-an-
algorithm/
http://www.rch.org.au/clinicalguide/guideline_index/Bronchiolitis
Preganant lady, sudden severe headache, at vertex, vomit once, BP 160/95.

What next immediate?
A- Ophthalmologic Xn
B- LP
C- CT
…………….none …………MRI
Down’s syndrome patient come with her caregiver, with the complaint of
intermenstrual bleeding for about 4 months. She has the recent history of skin
infection. She doesn’t want you to allow to examine her and just want to talk you
about her skin infection.. What will you do?
A- Examine her under GA
B- Ask her about the knowledge of intermenstrual bleeding
C- Arrange for ultrasound
Old recall: Chronic gout patient who is

already on allopurinol 100 mg and intermittent colchicine. The patient has renal
impairment. His Urate level is within normal limit. What will be next
appropriate management?
A- Daily colchicine
B- Indomethacin
C- Paracetamol
D- Increase dose of allopurinol
E- Naproxen
DDDDDDDDDDDDDDDDDDDDDDDD…..tophi
Lady with tremor to right hand which stop when she looks appears at rest
a- Propranolol
b- Benzhexol
AAAAAAAAAAAAAAAAAAAAAAAAAAAA
51 yr old lady came to ask for colon cancer screening. Her brother is Dx
with colon cancer at 53yr old.
A- Do colonoscopy annually from now
B- Colonoscopy 5yr
C- FOBT
BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB
http://www.racgp.org.au/your-practice/guidelines/redbook/9-early-detection-
of-cancers/92-colorectal-cancer/
Heroine user on methadone programme, now difficult to wake, hypersomnia,
slow breathing
A- Naloxone
B- Intubation
Bbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbb
The patient may develop severe hypoventilation, despite being in

a rousable state (ie. Glasgow Coma Scale >12). Thus, providing
airway and ventilatory support takes priority in all patients suspected
of opiate poisoning.
http://www.racgp.org.au/afp/2013/july/illicit-drug-overdose/
Mother came with Girl previously doing well, now skipping class, problem
with father, failing grades
A- Ask school to support her
B- Ask history from father
BBBBBBBBBBBBBBBBBB…………the best accepted here
Child with abdominal pain, not wanting to go to school, all these occur after
new baby
A- School support
B- Give special role to take care of baby
C- Tell parents to give more time for him
BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB
Ask your toddler for help and advice
Involve your toddler in looking after the baby
There are plenty of little jobs your toddler can help you with, and he may
surprise you with his enthusiasm. He can help you hold towels at bathtime, or he
can fetch nappies.
When your baby cries, your toddler could sing to her or talk gently to her. If
your toddler begs to hold his new sibling, sit him in an armchair, well propped
with pillows on either side. Then put your baby into his lap and stay nearby.
https://www.babycentre.co.uk/a553839/sibling-rivalry-why-it-happens-and-
what-to-do-about-it#ixzz5328wRSBB
Jelly fish sting at Queensland beach, before removing tentacles what next
( didn't mention about which kind)
A- Give anti-venom
B- Wash with alcohol
C- Wash with vinegar
D- Immerse leg in hot water
DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD
First aid for jellyfish includes tentacle removal, application of vinegar for box
ellyfish, and hot water immersion (45°C for 20 min) for bluebottle jellyfish
stings.
https://www.racgp.org.au/afp/2015/januaryfebruary/marine-
envenomations/
Lady with abdominal pain and fever, Dx as UTI, started amoxicillin and
gentamicin. Improve but still pain + & low grade fever. Culture came back
coagulate –ve staph
A- Continue
B- Add vancomycin
C- Switch to fluclox
D- Increase dose of amoxicillin
Bbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbb
Old recall: Scenario of restless leg syndrome asking for treatment

A- vit B12 injection
B- oral steroid
C- benzhexol
D- amitryptylline
E- pramipexole
EEEEEEEEEEEEEEEEEEEEEEEEEEEE
http://www.racgp.org.au/download/Documents/AFP/2009/May/200905yee.pd
Patient diabetic develop gradual vision impairment which increase by daylight
1 diabetic retinopathy
2 cataract
3 open angle glaucoma
4 macular degeneration
222222222222222222222222
Patient on antithyroid and now euthyroid want to conceive

1 continue carbimazole
2 replace carbimazole with propranolol
3 stop carbimazole
4 give iodine
No option for surgery
.........................best is replace carbimazole with propyluracil
Carbimazole during pregnancy has been associated with birth defects,
including aplasia cutis and 'carbimazole embryopathy', characterised by choanal
atresia or oesophageal atresia.14 Therefore, during pregnancy it is recommended
that propylthiouracil be used in the first trimester and then changed to
carbimazole in the second trimester.4 Antithyroid drugs can be stopped in about
30% of women by the third trimester.
http://www.racgp.org.au/afp/2012/august/evaluating-and-managing-patients-
with-thyrotoxicosis/
A patient has pneumonia. His hip muscles become weak. CT shows a spinal
stenosis. He is on statins and multiple other drugs. On examination knee jerk is
absent, lower limb power is 3/6, absent dosalis pedis pulses and sensation over
thigh is loss. Next investigation?
A) Mri
B) Xray.
C) Arterial duplex
D) CK
E) LP
Weakness and sensory affection here I will go to AAAAAA
You read Article for case control study about ct role in diagnosis of acute
appendicitis said it has no role in diagnosis and you attend a lecture of a
consultant doctor in prestigious north American medical college and he said that
upon his own experience ct is very good in diagnosis of his acute appendicitis
patients , what will you do ?
1 perform ct for all your patients with acute appendicitis
2 wait for another evidence to make sure before you start performing it
3 no ct for all your patients with acute appendicitis
I can't remember other choices
222222222222222222222222222
Mother come with her baby for mmr vaccine and baby has egg allergy ,
advice
1 egg allergy is contraindication for vaccine
2 we can give vaccine
3 skin prick test before vaccine
222222222222222222222222222222222222222222
hereditary spherocytosis hemolytic crisis (retics high) cause

1 Parvo virus
2 hepatitis
3 endocarditis
4 other infection I don't remember
333333333333333333333333333………..this is hemolytic crisis
endocarditis is very common to cause hemolysis
Full term lady with bishop score 2 what is the most appropriate
1 induce ROM then give cyntocinon
2put pg pessary on vagina and Rom after 4hours
3 put pg cream on cervix and rom after 12-24hours
4 cs
5 cyntocinon drip now
33333333333333333333333333333333333
8month baby came with neurological manifestations what will help u to

diagnose
A. His mother continue smoking throughout pregnancy
B ventose assisted delivery
C history of chills and irritability after vaccination
D deterioration of previously learned skills
DDDDDDDDDDDDDDDDDDDD
28 yrs old male after an accident he developed echymosis around the eyes
bilaterally with csf leakage from nose and ears , what is your best next
management:
A/ packing
B/ Iv ceftriaxone
C/ Iv dexamethasone
No specific management is required. There is usually a dural tear with CSF
leak. Prophylactic antibiotic treatment has little
effect on the development of bacterial meningitis and is no longer used.
from Australian doctor website
Resolution within 7 days – These patients do not typically require

prophylactic antibiotics but need to be followed closely by a
neurosurgeon and advised to seek medical attention if fever or other
signs of meningitis develop.
Based upon retrospective observational studies in children,
prophylactic antibiotics are not recommended initially for patients
with basilar skull fractures after nonpenetrating head trauma, even
when they have CSF leakage
•No resolution within 7 days – If otorrhea or middle ear effusion
has not resolved within seven days, additional measures are
determined by the otolaryngologist, often in cooperation with a
neurosurgeon, and may include:
-Prophylactic antibiotics
-Lumbar drain to stop the leak by reducing intrathecal
pressure
https://www.uptodate.com/contents/skull-fractures-in-adults?
sectionName=Basilar%20fractures&anchor=H15&source=see_link#H15
16years old femake had birth of child(picture of cleft palte) she decided to
keep him ..her mother supporting her .few days later she is well but refuse to
look to the child and not willing to breast feed him and demanding leaving him
to adoption ehat is the most appropriate action u take
1suport her wish for adoption
2 arrange meeting with social worker for counsling
3ask her mother to participate in taking care of him
4encourage her to breatfeed him
5ask her to listen to aurgeon who says the baby
will look good after reconstruction surgery
BBBBBBBBBBBBBBBBBBBBBBBBBBBB
relation between fatigue in truck driver and road accident

cohort
case control
cross sectional
BBBBBBBBBBBBBBBBBBBBBBBBBBB…………..Cohort can NOT be
applied here
18 moth old child recurrent URTI and LRTI . normal growth , absent tonsils
wht test to choose ?
sweat chloridr
immunoglobulin
NBT
CD4, CD8
BBBBBBBBBBBBBBBBBBBBBB………..X- linked aggamaglobulinemia
severe upper gi bleeding u gave 4 units blood and salaine and 2 FFP but not
stoping his bl p was 110 /70 now 80/ 40 and bleeding increase , from mouth and
nose what is ur immediate action ?
ballon
endosopy and ligation

bb
octeriotide
AAAAAAAAAAAAAAAAAAAAAA
If bleeding is ongoing and unco ntrollable, patient will require
Balloon Tamponade (Foleys Catheter if child <15kg or Sengstaken
Blakemore tube if child >15kg)
Transfer to PICU or theatre for management as clinically
appropriate
AAAAAAAAAAA………1st step
Typical pic , asking about best management

Wipple procedure
ERCP
MRCP
Cholecystectomy
AAAAAAAAAAAAAAAAAAAAAAAAA…………pancreatic cancer
People with lung cancer over age 70 the prevalence becomes decrease but
incidence is still increasing.what statement below can explain.
A) increase survival
B) good treatment
C) mortality increase with age
D)CCCCCCCCCCCCCCCCCCCC…………increased
decrease survival in old age people mortality
45 yrs old farmer complaints pain with weakness to both legs.smoke 40

cigarettes per day.On examination reflex increased,tone normal,EPR
equivocal.Dorsiflex and planter flex 4/5 in both legs.pulses intact.Investigation
A)angiogram
B)MRI
BBBBBBBBBBBBBBBB………….weakness with hyperreflexia,,,,,,spinal
cord compression
Female 80 yrs old history of hospitalization for ? 5 days because of URTI with
complaint of unable to stand up from chair.Examination weakness of proximal
arm and thighs bilaterally.Reflex decrease.sensory normal.
History of diabetes and hypertension.investigation
A)CK
B)EMG
C)LP
D)Ach antibody
cccccccc. GBS ………..weakness and decreased reflexes after URTI
90 female hernia Sx,12 hrs later becomes restless,confuse and remove IV

access.
SpO2 89%? BP 90/60 PR increased ,RR increased.X ray was given ( bad
looking lung (not quality) increase radioopacity at right mid zone from hilar to
periphery and same but less extant from left hilar).next management
A)intubation
B)IV anticoagulation
C)antibiotic
AAAAAAAAAAAAAAAAAA…………..here just 12 hours after the
surgery…atelectasis….1st priority to saturation
H/O fibroids ? Week of pregnancy. USG earlier week was normal.came with
pain, uterus correlate to week or 2 cm larger. No bleeding.FHR normal.
A) abruptio
b) red degeneration
BBBBBBBBBBBBBBBBB……..H/O fibroid + uterus is enlarged
schizophrenic pt , what u ’ll assess to confirm Dx ?

1-orientation and concentration
2- languague and writing
3-proverb interpretation
33333333333333333333
old age pt living alone wz mms 24 ,was found by his son in bad situations , he
sometimes forgets to close his front door , forgets the food in the oven , what
will u check in him ?
1-fluctuation forgetfulness
2- his mood
pt admitted in hospital wz history of pschiatric illness, agitated , looking at the

roof , she becomes calm when lying on bed , urDx ?
1- delirum
2-catatonia
2222222222222222222222222222222222222
ECG with VF, patient irresponsive, no pulse, started rcp anf gave one 200j
shock , rytm still the same, what to do next
A 2 minute compression
B- desfibrilate again
C adrenaline
D amiodarone
AAAAAAAAAAAAAAA
Case of 74 yo patient with cancer and surgeon and oncologyst decided for
surgery as best treatment. Patient has minimental of 20/30 (>24). Patient
understands pros and cons of surgery and accepts surgery.One of the
daughters tells you that she doesnt want surgery because of the mental state of
mom.What to do.
A- patient want surgery, do surgery
B- daughter has power of attorney so dont do surgery
19 years old girl presented with mild abdominal pain with urine examination
showing wbc 30 (N<50) and e.coli 10^5 . What will u do next
A) Trimethoprim
b)cipro
c) alkanizer
d) cephalexin
e)repeat urine culture
AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
3 years old girl presented with fever during examination ejection systolic
murmur(3/6) was founded at left sternal border ur immediate step
Refer to cardiologist
Review after 2 weeks
Bbbbbbbbbbbbbbbbbbbbb
If a doctor detects a heart murmur, during an illness when the child has a
temperature, he will often ask to see the child again after an interval (e.g. when
the temperature has returned to normal )
http://www.rch.org.au/cardiology/parent_info/Innocent_Murmur/
9 months old child present with slowly groing swelling in left side of a neck
for 5 weeks. Montoux done and it was negative. What will u do next
Fnac
Ct neck
Usg neck
Sputum culture
BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB
A contrast CT scan is the best imaging technique for evaluating a neck mass.
http://www.australiandoctor.com.au/cmspages/getfile.aspx?guid=f370393f-
8612-4ddc-ae36-bffb020491ae
9 months old child ritable screeming bile stain vomiting and diarrhea. Her sis is
suffering from gastroenteritis. Usg shows shadows in right upper quadrant
What to do next
Air enema
Stool cuture
Urine culture
Observe
AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
Protein 4+in 6 years old child with all symptoms of nephrotic like puffy eyes
abdominal distention and ankle edema next appropriate
Urine exam and culture
Blood biochemistry
Renal biopsy
AAAAAAAAAAAAAAAAAAAAAAAAAAAAA
4 years old child and mother went to store. Child asked for something but
mother refused later child hold his breath then fell to ground then become
cynosed and later have fits. After that child get up and remained fine
A) Breath holding attack
B) Tonic clonic seizure
C) Absence seizure
D) Malingering
AAAAAAAAAAAAAA
20 years old girl presented to you with pain in left iliac fossa and with
loose mucoid stool from last 6 months. She has lost 10kg weight in this
period. Whats the dx
A) IBD
B) IBS
C) Ca colon
MS.. risk of recurrence in next 10 yrs

A. 10%
B. 70%
C. 90%
CCCCCCCCCCCCCCCCCCCCCCCCCCC
Approximately 85 percent of people with MS are initially diagnosed with
Relapsing-remitting MS (RRMS)
. http://www.nationalmssociety.org/What-is-MS/Types-of-MS
Schizophrenia pt under your inpatient care. Her brother calls u that she intends
to do suicide
tomorrow but asking not to tell the pt that he has told u
A. Inform police
B. Ask brother to ask his sister to tell u about her plans
C. Tell the patient what her brother told
BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB
Patients who eventually commit suicide are more likely to tell their families of
their suicidal plans than they are to tell their physicians.7 In patients who have
denied suicidal ideation, the clinician should ask the family member if the
patient has made direct or indirect statements about suicide to them.
https://www.aafp.org/afp/1999/0315/p1500.html
Carmazepine induced siadh. Na 112. Next

A. Stop carba and give hypertonic saline.
B. Stop carba and start normal saline
C. Continue carbamazepine
Old patient with backache, hematuria, nitrite positive on urine dipstick.

Wbc high on RE.
Diagnosis.
A. Uti
B. Bph
C. prostate ca
AAAAAAAAAAAAAAAAAAAAAAAAAA
Encoparesis in 6 year old girl. Hides her underwear when she has accidents.
Fights with brother when he says she is smelly. Tells lies about accidents. What
is it.
A. Part of opp defiant disorder
B. Regression
C. Normal development
D. Delayed development
A boy with herpes. Was given iv antibiotic(some cephalosporin) when he

improved, he was fine but had ataxia and nystagmus. What could be cause.
A. Post herpes cerebellitis,
B. encephalitis.
AAAAAAAAAAAAAAAAAAAAAAAAAA
A child at 1min after birth, got jittery, drowsy and cyanosed. Improved awith
oxygen. What will u check.
A. Glucose
B. ABGs
Lady came for mammography screening ,asking what are the chances that
cancer being missed ,so what will you tell her
A. False positive of mammogram
B. Negative predictive value of mammogram
C. Specificity of mammogram
bbbbbbbbbbbbbbbbbbbbbbbbbbbbb
End stage liver disease. Whats next.

A. Fluid and salt restriction
B. Lactulose.
C. Give albumin
BBBBBBBBBBBBBBBBBBBBBBBBBB
52 old female was adopted &now knew that her biological mother had
huntington in age of 48 and died from it now she is not married or have
children, worried and terrified about having the ds what will u tell here
A. Reassure that if she would be affected she whould have it by this age
B. Take DNA sample now to detect affected or not
C. refer to genetic counseling
D. Tell her she has 50% chance to get the disease
CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC
Huntington’s disease can occur at any age, however symptoms often don’t
appear until middle age.
https://www.healthdirect.gov.au/huntingtons-disease
A pic of a hand with amputated fingers....asking associated disease:

A)Bronchiactasis
B)Chronic liver disease
C)Interstitial lung disease
CCCCCCCCCCCCCCCCCCCCC…………scleroderma
A pic of swelling in the floor of mouth....asked next

appropriate ix:
A)MRI
B)CT
C) Orthopantomogram
CCCCCCCCCCCCCCCCCCCCCCC
Hereditary Hypercholesterolemia...which is found?

A)Corneal arcus
B)Tendon xanthelesma
C)Periorbital xanthelesma
D)Fatty liver
BBBBBBBBBBBBBBBBBBBBBBBBBBBBB
72 old person killed his 70 ye ars old wife what in history will help you know
the cause?
A) she has intependent wealth
B)he became preoccupied with wife wereabouts
C)history of multiple periods of seperation between the couple
Scenario of DM on insulin glargine 40 unit /day now he is not eating well and
loosing wt.and isolate himself in the room even won't go to school what to do
a. Add short acting
b. Increase glargine
c. SSRI
d. temazepam
CCCCCCCCCCCCCCCCCCCC……….symptoms of depression
Another case of PSA was 3.5 increase to 5.5 and DRE I don't remember but
sulcus present what to do
a. US
b. transperineal prostatic biopsy
c. Radical prostectomy
BBBBBBBBBBBBBBBBBBB
30 years old female came back to australia from london 2 days ago now
presented with dizziness during work. On examination there was systolic
murmur at right sternal border radiating to neck and apex. Asking for
diagnosis
A) Aortic stenosis
B) Pulmonary embolism
C)HOCM
AAAAAAAAAAAAAAAAAAAAA
what is the starting dose of ALLOPURINOL in gout
a. 25 mg
b. 100 mg
c. 200mg
d. 500mg
e 300mg
BBBBBBBBBBBBBBBBBBBBBBBB
Man with poor dental hygiene and alcoholic presents with dystonias
a. Neck abscess
b. Parotitis
AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
pt with unstable walk, fluctuating gait, u see urine on his clothes, he forgets
alot what is ur Dx?
1-normal pressure hydrocephalus
2-LBD
3-parkinson disease
MARCH
AF,rate was 250,ECG treatment-Asked As initial-
Verapamil
amiodarone
AAAAAAAAAAA...........BB and CCB are usually the 1st lines of rapid AF
pt taking carbamazepine comes with hyponatremia(na-112),wat to do-

stop carba
stop carba and gv hypertonic saline
BBBBBBBBBBBBBBB…..provided there are neurological symptoms
Young boy who was kicked by a friend,while playing football,Noticed

Redness & with swelling of right scrotum.Rt testes & spermatic cord are
palpable,Lt Scrotum & Spermatic cord are palpable.Next Inv-
A.USG
B.Biopsy of Scrotum
C.Sample for tumour marker
AAAAAAAAAAAAAAAAAAAAAAAAAAA
http://www.rch.org.au/clinicalguide/guideline_index/Acute_scrotal_pain_or_s
Young man who has travel around asia,he spends 3 months in Berma.Has
patches of loss of hair
on his head & Rashes on palm & sole & feet .Whats is dx-
a.Syphilis
b.Zinc allergy
Q of C1 esterase deficiency- 8.Child developed allergy,following cake

ingestion.Cause-
A.Gluten
B.Nuts
Bbbbbbbbbbbbbbbbbbbbb
Mother brings 10 month old boy after noticing some white discharge at
meatus and prepuce only partially retractable. What is your management?
- Topical hydrocorticone
- Topical mupirocin
- Oral amoxicillin
AAAAAAAAA….Balanitis AAAA
More severe inflammation of the glans penis

Topical hydrocortisone 1% cream or ointment may help in mild cases.
Topical antibiotics creams are sometimes used but are of unproven efficacy.
http://www.rch.org.au/clinicalguide/guideline_index/The_penis_and_fores
41 years old man has headache and is accusing neighbors as they use
insecticide excessively. He mentioned he had frequent trouble with them as they
are very noisy.he changed his living place two times before as he was unlucky
with his neighbors Thinking that they hate him and want to harm him .other
persecution thinking was there.
A)delusion
B)depression
C)schizophrenia
D)Paranoid personality disorder
72 years old woman came for ER with chest pain you ordered ECG. During
ECG you found this picture.... ask about diagnosis:
A- candida
B- mastitis
C- invasive breast cancer
ccccccccccccccccccccccccccccccccccccccccc
Old lady 85 years old living alone, diagnosed as hypothyroidism she was
started on thyroxine replacement the dose now 75 mcg after 3 months TSH:
16,6 ( high) and throxine low wt to do :
A. Confirm her compliance to medication
B. Increase dose to 100 mcg
C. Repeat the labs
D. Send nurse to give her the dose
AAAAAAAAAAAAAAAA ……1st then BBBBBBBBBBBB
Middle aged man come with cough muscle pain, by examination you find an
infalmmed cord with firm nodules under the skin what to do:
A. Heparin
B. Analgesic and mobilization
C. Corticisterois and rest
This is superficial thrombophelebitis:
BBBBBBBBBBBBBBBBBBBBBBBBBB
• Compression of the lower limb with graduated stockings.
• ‘Active rest’.
• Use of NSAIDs.
patients should be encouraged to maintain their mobility to limit clot
progression
. Interestingly, studies show that oral NSAIDs are equivalent to low-
molecularweight heparin in DVT prevention in the setting of STP .
The anti-inflammatory actions of NSAIDs reduce the release of inflammatory
mediators that can lead to further clotting.

http://www.australiandoctor.com.au/cmspages/getfile.aspx?guid=6522a6e7-
60ce-44f3-9f5f-d3b6a962251e
patient had cholecystectomy 2 days back and transferred to medical word, you
was called because he became unresponsive, on examination : Bp: 130/85 HR:
75. RR: 12 SO2: 88 % wt next:
A. put him on nasal canula
B. start face mask
C. call the rapid response team
D. Jaw thrust chin left and ampu
DDDDDDDDDDDDDDDDDD,…………….first step protect the airway as
the patienr is NOT responsive
similar abdomen and limbs asking what investigation will confirm diagnosis
cord prolapse present asy=tion and they decided to go for vaginal delivery
whats in the ctg will change the plan
early
late
variable deceleration
Physical activity at 30 month
CCCCCCCCCCCCCCCCCCCCCC………..Most serious sign is variable
deceleration indication ischemia
That recall about bleeding per rectum and inr is 9,8 what to give
FFP + platelet
FFP+PROTHROMBIN
BBBBBBBBBBBBBBBBBBBBBBB
Table 1. ASTH recommendations for patients on warfarin experiencing
bleeding
Clinical setting Recommendations
INR ≥ 1.5 with life- Stop warfarin and

threatening (critical administer:
organ) bleeding,
including intracranial vitamin K1 5.0–10
bleeding mg IV
and
Prothrombinex-VF
50.0 IU/kg IV*
and fresh frozen
plasma 150–300
mL
if Prothrombinex-
VF is unavailable,
administer fresh
frozen plasma 15
mL/kg
INR ≥ 2.0 with Stop warfarin and
clinically significant administer:
bleeding (not life
threatening) vitamin K1 5.0–10
mg IV
and
Prothrombinex-VF
35.0–50.0 IU/kg
IV, according to
INR
if prothrombinex-
VF is unavailable,
administer fresh
frozen plasma 15
mL/kg
http://www.nps.org.au/publications/health-professional/health-news-
evidence/2013/managing-warfarin-and-bleeding-risk
An infant brought with bulius vomiting abd. tenderness and dissension,

passed meconium, good suckling, what to do
A) continue breast feeding
B) observe
C) nasogastricsuccion
CCCCCCCCCCCCCCCCCCCCCCC…………IO
Left sided swelling anteriorly of left ear in 62 years old man. Swelling is
fixed with muscles. The man spitted blood stained sputum and is a heavy
smoker. He cannot close his mouth properly on the affected side. Dx:
a.Parotid pleomorphic adenoma
b.Parotid carcinoma
c.Metastatic lung cancer
d.Cancer in lateral of tongue
e.Carcinoma larynx
BBBBBBBBBBBBBBBBB………parotid cancer with facial nerve
infiltration
Disabled child in a shared house attacked someone, whom to inform-

mother,
carer,
GP
BBBBBBBBBBBBBBBBBBBBBBBBB
A middle aged man who was previously

diagnosed with wegenersgranulomatosus and on azathioprine comes
complaining of cough for 2 days with blood streaked sputum. He also has
some mild exertional dyspnea . Physical exam is unremarkable
Azathioprine induced interstitial pneumonitis
Bronchopneumonia
Reactivation of wegenersgranulomatosus
Atypical pneumonia
Pneumocystis infection
AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
https://www.ncbi.nlm.nih.gov/pubmed/6380265
Scenario of cut off sign at sigmoid colon- next-

Barium enema,
colonoscopy,
colonograpy,
CT abdomen
DDDDDDDDDDDDDDDDDDDDDDDD
You are a GP taking care of a community of 100 people and the following is
the number of people with specific diseases for two years that you have.
BP>140/90 40(2009) 50(2010)
Hyperglycemia 20(2009) 25(2010)
Hyperlipidemia 30(2009) 40(2010)
What is the point prevalence of hypertension (per 1000 people) for 2010?
A. 50
B. 40
C. 250
D. 475
E.500
EEEEEEEEEEEEEEEEEEEEEEE
50-year-old woman, who has recently been diagnosed with hypertension,

complains of pain in her knees. She feels tired and her memory is poor. She
has lost her appetite recently and feels nauseated most of the time. Urinalysis
is normal.
Which is the SINGLE MOST likely diagnosis?
A Chronic fatigue syndrome
B Chronic renal failure
C Coeliac disease
D Cushing’s syndrome
E Hyperparathyroidism
AAAAAAAAAAAAAAAAAAAAAAAAAAA…………
58.2yrs old kid, drinks from guests drinks, now confused, drowsiness-
check blood glucose,
drug screen,
ABG
Female with history of CS with lower abdominal incision before,

admitted at 32 weeks with labour pain by examination cervix was dilated and
uterus level was 32 and baby presentation was cephalic (not remembering the
rest of examination) she was admitted for observation , suddenly she passed 1 L
of fresh blood from the vagin a( not mentioning tender uterus ), what is the
cause:
A. placenta previa
B. placenta accreat
C. rupture uterus
male had sex with new partener male ( well with no issues ) came with
lymphadenopathy and ulcers
herpes
cmv
hiv
A 72 year old man is admitted with a 5 day history of confusion, lethargy

and fecal incontinence.He has a dense hemiplegia as a result of a stroke 3 years
earlier and is using hydrochlorothiazide and amiloride for hypertension.He
stopped smoking 5 years earlier when he presented wjth a squamous cell
carcinoma of the lung which was successfully treated.His supine BP is 155/85. A
CT brain scan revealed evidence of past infarction and chest film revealed no
evidence of recurrence of malignancy.Initial biochemistry results show sodium
115, potassium 3.6, urea 8 and creatinine 0.11.Plasma osmolality 256 and
urine osmolality 366 Urinary sodium is 52. Which of the following is correct?
A. The BP indicates that he is not hypovolemic.
B. The urinary sodium indicates that he is not hypovolemic.
C. He has SIADH
D. He has diuretic-induced hyponatremia
E. He should have a water deprivation test
ccccccccccccccccccccccccccccccccccccc….serum osmolality is 275–295
mosm/kg
Lose wt Obese man on metformin, verapamil, thyroxine presented with

palpitation at night ECG : PR interval increased along the strip 2nd degree
heart block , wt to do:
A. Cease metformin
B. Cease verapamil
C. Increase thyroxine
Cease all medication
yr old child who used to live with mother has been having a history of loose
stools with bloody diarrhea and is now brought by his father who does not
know much about the child who in himself is a poor historian. Management?
A- Colonoscopy
B- Blood culture
C- Stool for ova and cysts
D- Endoscopy
E- call mother for examination
EEEEEEEEEEEEEEEEEEEEEE..............then CCCCCCCCC
It is logic to call some one who knows more information about the kid
..........may be the kid has already chronic disease that will direct you which inv
should be done 1st
Blow out fracture of orbit while playing squash What would you see
A-hyphaema
B-horizontal diplopea
C-enophthalmos
D-depressed zygomatic arch
CCCCCCCCCCCCCCCCCCCCCCCCCCCC
A female patient(~40 years)came for her routine breast checkup.clinical

exam’
normal.But on USG and confirmation from mammography showed a
calcified lesion in the
upper outer quadrant in the right breast.Diagnosis?
A. Ca breast
B. Fibroadenoma
C. Cyst
D. Papilloma
Age + site ( upper outer quadrant ) + calcifications = suspicion of cancer

Naltreaxone is often used as :
A- short acting so quick effects
B- long term maintainence
C- substitute for methadone
D- Heroin withdrawl
E- Cardioprotective
http://www.health.nsw.gov.au/mentalhealth/Publications1/naltrexone-users.pdf
4 yr boy with hematuria,proteinuria and hypertension now who initially

responded to steroids. Diag?
A- PSGN
B- Minimal change disease
C- FSGN
D- Anti GBM disease
CCCCCCCCCCCCCCCCCCCCCCCCC
A 49 yo man presents to your clinic because of fatigue for the past 4 months.
He been having trouble sleeping because of night sweating and has lost 5 kg
without dieting; he also complains of blurred vision. On examination he is pale
and thin, with multiple ecchymosis, has a systolic flow murmur (II/VI) and an
enlarged spleen. Labs:
WBC: 95,000/mm3
15% blasts Haemoglobin: 7.4
15% bands Platelets: 88,000/mm3
51% PMN
13% Lymphos
Which of the following is the next step in diagnosis?
Coagulation studies
Cytogenetic studies
Iron studies
No further studies needed for diagnosis
Bone marrow biopsy
EEEEEEEEEEEEEEEEEEEEEEEEEE
40 yo alcoholic and smoker complains of a 2 cm painless lump on the left

tonsil. No other
signs and symptoms described. What is the most likely dx?
a. Squamous cell carcinoma
b. nasopharyngeal cancer
c. body/aneurism on the carotid artery
d. mts from some place
e. non-Hodgkin lymphoma
year old woman complains of itchiness in the scalp. Upon checking her
record, patient has been seen by dermatologist and noted normal findings.
Patient now tells you there are worms in her head and it needs frequent
medicated shampoo to get rid of it. She asks for prescription. What is your
diagnosis?
A. Schizotypal disorder
B. Schizophrenia
C. Delusional disorder
D. OCD
E. Munchausen Disorder
CCCCCCCCCCCCCCCCCCC
A 15 year old patient has a complain of right upper abdominal pain after
being kicked in the abdomen during his football game. Vital signs stable,
abdomen soft, non tender, no bruises noted. abd us normal. What is your next
step of investigation?
A. Plain abd ct scan
B. Chest xray
C. Abdominal xray
D. Lateral thoracolumbar spine xray
E. Send patient home with analgesics
EEEEEEEEEEEEEEEEEEEEEEEEE
An anxious patient presents with status asthmaticus. Best acute treatment:

a. Parenteral steroids, inhaled B agonist, sedationb
B. Theophyline, B agonist, hydration
C. Hydration, B agonist, iv steroids
D. B.agonist, hydration, ipratropium
CCCCCCCCCCCCCCCCCCCC
Main lines:
b-agnosit
iv steroid
theophyllin
anticholinergic
magnesium sulphate
hydration
http://www.racgp.org.au/download/documents/AFP/2011/JanFeb/201101corra
A 56-year-old man with H/O of chronic smoker come for dyspnea.O/E

dullness on percussion left lower zone of chest and auscultation.. absent
breath sound on left lower zone and bronchial breath sound on left middle
zone of chest.Dx?
a.left pneumothorax
b.left pleural effusion
c.left lower lobe collapse
d.left lower lobe consolidation
e.pericardial effusion
DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD
Dullness + absent breath sounds + BRONCHIAL breathing = pneumonia

AF patient , DM , HTN
How to assess the risk of stroke
CHADS score
BP ampulatory
HIGH BLOOD PRESSURE
High blood pressure is the leading cause of stroke and the most significant
controllable risk factor for stroke. Many scientists attribute our current decline
in stroke-related deaths to the successful treatment of high blood pressure.
http://www.strokeassociation.org/STROKEORG/AboutStroke/Understanding
Stroke-Risk_UCM_308539_SubHomePage.jsp
Breast mass biopsy showed malignant cells what to do before operation

Examine the axilla for LN
Estrogen and progesterone receptors
Man phone you asking to take baby from his wife because she doesn’t feed
properly what to do
Manage to see family at home
Involuntary admission to the mother
Call social authority to remove the child from the mother
AAAAAAAAAAAAA…………..only accepted here………talk tto mom 1 st
Elderly with urge incontinence like scenario.Management?

Bladder training
Oxybutynin
Pelvic exercise
AAAAAAAAAAAAAAAAAAAAAAAAA
GB syndrome what to do
FEV1
FVC
Pulse oximetry
BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB
Ct of Brain given shows metastasis Hx of chronic smocking ,quit 5 years

back.patient comes with cough .malaise dont remember whether there was
horner syndrome.irregular pulse .Askd whats the most intial investigation ...
a.Bronchoscopy
B.Echocardiograhy
C.Reapet usg
D.CXR
Dddddddddddddddddddd………….lung cancer
st
Old age patient with TIA 1 inv:
CT
Duplex
Echo
47 year old male comes to you for consultation due to decrease libido. He has
decreased libido and hardly any erections during masturbating and also
complains of occasional early morning headaches on awakening. He has led a
good life and has 2 children aged 15 and 17. His BMI is 38 and his BP is 130/80
mm Hg. Lab investigation values for tests done to evaluate his problems are as
follows
FSH – 3 (1-18)
LH – 1.8 (2-20)
Prolactin 11 (<20)
Testosterone 200 (280 – 800)
TSH 2.0 (0.5 – 4.0)
What further investigation would you advise to this patient ?
a. MRI
b. Karyotyping
c. USG testis
d. Sleep Studies
e. Thyroid scan
DDDDDDDDDDDDDDDDDD
APRIL
30 (Aprox) yr old lady recently divorced from second marriage. She had
problems with first husband who left her after 4 year of marriage. She
occationally go to gambling,(some other bad things). She feels better when she is
at home with her mother and currently she is living with her mother.
A.Antisocial Personality Disorder
B.Borderline Personality Disorder
C.Bipolar Personality Disorder
D.Dependent Personality Disorder
BBBBBBBBBBBBBBBBBBBBBBBBB
5) middle age women came due to c/o depressed mood, insomnia after her
divorce of second marriage due to abuse ..all I can remember sometimes she
became so euphoric ,did party a lot that time she felt like her soul is out of her
body something like that. her first husband was abusive too. When she was
bullied a lot in school . now she lives with her mother to whom she is very
comfortable..dx:
a)bi polar
b)borderline
c)ptsd
AAAAAAAAAAAA…………here scenario goes with bipolar NOT
borderline
13) a man came with pain on elbow after a long work in a kitchen diagnosed it
as lateral epicondylitis ..what is the mech ?
a) flexion wrist
b) extension wrist
c) extension of elbow
d) rest two opt were movement of wrist.
8. Lady 75 years old has HTN, DM, well controlled on drugs. She has an
episode of chest pain during walking for 15 mins which is relived after rest. Her
current medications include ramipril, metformin, metoprolol. Now the b.p is
130/85, Heart rate is 54bpm. Which of the following investigationswill you
consider next?
a. Serum Troponin
b. Thalium scan
c. Holter monitoring
d. CT angiogram
Bbbbbbbbbbbbbbbbbbbbbbbbbbbbb...........stable coronary heart disease
9. A lady was admitted for radiation to breast cancer. She received her
radiotherapy and was placed a central line during her hospital stay. After her
chemo/radio her central line was removed. The next day she noticed some
dyspnea and facial edema which worsened in 24 hours. Which of the following
tests will accurately define the lesion?
a. Duplex Doppler vascular studies
b. CT scan of neck
c. Chest x-ray
d. ECG
e. D-dimer
Aaaaaaaaa................but best is CT angio as it is NOT easy to do duplex study
over thoracic vessels
20. A young woman comes to you saying that she is hearing a popular song in
her head all day. She wants the sound to stop. What will help you reach a
diagnosis?
a.her appearance and behaviour
b. Her insight
c. Her suicidal ideation
d. h/o drug abuse
BBBBBBBBBBBBBBBBBBBBBBBBBBBBB......TO exclude shizo
.......young female with delusions
24.Scenario of a girl with interpersonal conflicts, severe anger management
issues, Fights and argues with father. Which of the following maybe helpful?
a. Involve father to the therapy
b. Family therapy
c. Dialectical therapy
d. CBT
ccccccccccccccccccccccccc...............BPD
Therapy
Psychotherapy is often the first type of treatment used for BPD. The nature of
BPD can make it hard to forge the trust essential in a psychological relationship,
but it can be established.
The following treatment may be beneficial:
• Dialectical behavioural therapy (DBT) is a treatment specifically developed
for BPD and includes individual and group therapy. Techniques such as
mindfulness are used to help manage intense and difficult feelings.
• Psychodynamic therapy is long-term individual therapy that helps you
understand your behaviours, moods and disruptive thoughts through a
therapeutic relationship with a single therapist.
35. Female 42 years of age presents with mild hypertension for which she was
started on ramipril. After 2 months she presents with B.P 170/100 , nocturia and
Blood chemistry showing increase in urea and creatinine well above baseline.
Which of the following will point towards her disease?
a. Presence of 3 cysts in left kidney and 2 cysts in the right
b. Increase in VMA in urine
both wrong RAS
40. Woman presents to clinic for recurrent vaginal herpes. She has had 5 such
episodes by now. Earlier she was treated with recurrent vaginal candidiasis. Now
on examination you find a white plaque in the vagina when you scrape it, it
bleeds. Which of the following should you test in this woman?
a. Biopsy the lesion
b. HIV antibodies
43. A young boy is brought to you in the rural ER. Neurosurgery unit is 1
hours away. Earlier today he was hit during football where he lost consciousness
and fell to the ground. A few minutes he regained his consciousness and walked
out of the field. His family brought him to you complaining that he has
developed headache after the incident. His GCS is 10/15. What is the next plan
for him?
a. Do a ct scan
b. Transfer to neurosurgery unit
c. Hyperventilation and mannitol infusion
d. Burr hole
e. Craniectomy
AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
if distance is less than 2 hour.............CT
If more than 2 hours.............burr hole
45. You have taken over a new clinic. The previous doctor has left. One of the
patients presents to show saying that he is talking sodium valproate and
clozapine for his brain. He says he has been feeling well after the previous
doctor started his treatment. Which of the following things you will do before
continuing treatment of the patient?
a. CT scan
b. Sodium valproate level
c. Clozapine level
CCCCCCCCCCCCCCCCCCCCCCCCCCCCC
that valproate may slightly increase serum clozapine levels and levels
of clozapine ...
https://www.drugs.com/answers/taking-clozapine-depakote-together-
620738.html
46.A woman comes to your clinic. She was prescribed trifluphenazine for her
condition. She says she went on a trip and forgot to take her medicine with
her.She also says that she occasionally forgets taking her medicines. But this
time she did not take it for 3 weeks because of her trip. Now she presents with
voices in her head. What will you consider giving to this woman?
a. Continue trifluphenzine
b. Respa Depot
c. Olanzapine
d. Discontinue trifluphenazine
BBBBBBBBBBBBBBBBBBBBBBBBB..............
47. Woman comes to you with vaccinations regarding a low self budget trip.
She says she had taken one oral polio , 1 dose of MMR , 2 doses of DPT. What
will you consider giving this patient?
a. MMR
b. Tetanus
c. MMR and diphtheria and tetanus
d. Polio, MMR, Diptheria and tetanus
DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD
52 . Pregnant lady presents at 37 weeks of gestation with sudden abdominal

pain and vomiting. She has tenderness in the right upper quadrant on
examination. Her temperature is 37.8, pulse is 80bpm, Blood pressure is
100/70. Which of the following is the most likely diagnosis?
a. Preeclampsia
b. acute cholecystitis
c. onset of labour
54. A woman brings her husband after prostatectomy saying that he has been
getting extremely angry and agitated on most trivial things after the operation.
Which of the following questions will help you identify an immediate need to
hospitalize this patient?
a. History of drug abuse
b. History of domestic violence
c. History of self harm
CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC
57.30 year old lady comes to you complaining of blurring of vision for last 3
days. On examination of the eyes you found left eye is 6/12 and right eye is 6/6.
There is also pain behind the left eye on moving the eye. Which of the following
is the diagnosis?
a. Intracranial haemorrhage
b. Tumor of eyeball
c. optic neuritis
CCCCCCCCCCCCCCCCCCCCCCC............MS
60. 1 week old infant is brought to you with bile stained vomiting. The child
has a history of passing meconium on day 4 of birth. What is the appropriate
diagnosis?
a. Meconium ileus
b. Duodenal atresia
c. Hirschprung disease
d. Mid gut volvulus
62. 54 year old female with weakness of the shoulder girldle and hip girldle
presents to you. There is also mild tenderness of the joints. On blood tests ESR
is 62 mm/hr. Which of the following drugs will you consider next in the lady?
a. Paracetamol
b. Naprosen
c. Prednisolone
CCCCCCCCCCCCCCCCCCCCCCCCCCCC...........PMR POLY MALYGIA
RHEMATICAZ
63. Young indigenous male presents to you with insomnia, fear of darkness
and seeing “mamu” . He has been having these symptoms after the death of his
mother. Which of the following should be next step in his treatment?
a. Give him benzodiazepine
b. Counselling with an indigenous counsellor
c. antipsychotic agents
BBBBBBBBBBBBBBBBBBBBBB
76. Old man with back pain. (Xray given which shows collapse of L4 or L3
as well as osteopenic type bones). Lumbosacral xray was done. Which of the
following is the next best step?
a. MRI
b. PSA
c. DEXA
d. Bed rest
CCCCCCCCCCCCCCCCCCCCCCCCCC
77. Old woman 75 years of age is admitted to the hospital following a

community acquired pneumomnia. She received antibiotics and is well on the
4th day. She suddenly developed rigours, chills and high grade fever on the
4th day. What is the most likely explanation?
a. Hospital acquired pneumonia
b. IV cannula related bactermia
c. empyema
d. Pulmonary embolism
AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
79. Old woman with atrial fibrillation and multiple drugs including warfarin
presents with sudden onset pain. She was given opiods but her pain did not
relieve from any drug. Which of the following will accurately determine the
cause of her pain?
a. Serum lipase
b. Serum LDH
c. digoxin levels in her blood
BBBBBBBBBBBBBBBBBBBBBBBBBBBB...........ACUTE
ISCHEMIAFROM Af,.....better is lactic acid
) 4.Lady with known case of goiter undergo some kind of surgery (I think
PAD disease) and now back again for followup. She’s losing more than 10kg
weight and have fatigue. Her previous (three months ago) lab results show
reduced TSH and T4 within normal range, anemia (normocytic), blood sugar 7.
Now which investigation would you do?
- TSH
- OGTT
AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA………..SHE already
had before subclinical thyrotoxicosis
5. Lady 36/7 years who smokes 15 cigarettes per day. She has family history
of breast cancer and ovarian cancer. Which of the following makes her
unsuitable for OCP?
- age
- smoking
- family history of breast cancer
-family history of ovarian cancer
Bbbbbbbbbbbbbbbbbbbbbbbbbb…………discussed before
Contraindications to the OCP
Absolute contraindications
< 6 wks postpartum
smoker over the age of 35 (>15 cigarettes per day)
hypertension (systolic > 160mmHg or diastolic > 100mmHg)
current of past histroy of venous thromboembolism (VTE)
ischemic heart disease
history of cerebrovascular accident
complicated valvular
atrial fibrillation, heartof
histroy disease (pulmonary
subacute bacterial hypertension,
endocarditis)
migraine headache with focal neurological symptoms
breast cancer (current)
diabetes with retinopathy/nephropathy/neuropathy
severe cirrhosis
liver tumour (adenoma or hepatoma)
48..young age man, brought to emergency departement after fight with

another person in the bar, history of drug abuse, and history of beeing a victim of
sexual abuse when he was child,, his teacher said that he was
exemplary(excellent) student before sexual abuse, wt is the diagnosis:
A..antisocial personality
B..post traumatic stress???
C..borderline personality
D.. no mention about conduct disorder or adjustment
35 mother watched her son 15 y o wearing his girlfriend underwear , his.

Father left her alone while she was pregnant and she take ocp during pregnancy
she comes to you very sad what will you say
It's normal as he grown
Ocp may be the cause
He May be a woman in man body
This occurs due to the man role of his father absent
This is normal
CCCCCCCCCCC
Man with normal bp what will decrese stroke , he has hypercholesterolemia

-aspirin
-statin
BBBBBBBBBBBBBBBBBBBBB
A man who had surgery and now has passed 15 ml urine in 24 hours. His
JVP is 15. His BP is 70/40. What will you do to improve his urine output?
a. Give 500 ml N/S
b. Give 500 ml D/S
c. Give dopamine
d. Give adrenaline
CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC
Pt responding to metformin and solfonamide intialy now stopped responding .

hba1c is 11 % what is the cause
A,insulin resistanse
B,insulin deficinct
Pt became HTN after dialysis,mangment which drug is given

1.losartan
2.amlodipine
3.prazosin
4.furesemide
5.carvedilol
AAAAAAAAAAAAAAAAAAAAAAAAAAAAA mainly acih
Picture brain ct with hypodense area in parietal lobe reaches the the ventricle
but not touching the meninges(not epidural ,not subdural) .. a man with hx of
trauma and after 3 months started to develop morning headache increasing
in each day ,now presented with fluctuating conciousness he has chest
crepitation with decreased air entry
A. Epidural hematoma
B. Metastasis
BBBBBBBBBBBBBBBBBBBBBBB.............epidural hematoma DOESNOT
cause delayed manifestation so only bbbbb is accepted here
Pain in the wound:

Morphine infusion
Paracetamol and codiene ( i think tab)
Oxycodiene
Fentanyl patch
Xray given with strange large circular shadow of rt ilaic or lumber region
Pt on warfarin inr 2.9 then attack of cough and (i think dyspnea) no mention
for present history dx:
Rectus sheath hematoma
Cecal volvulous
bbbbbbbbbbbbbbbbbbbbbbbbbbbb
Neck mass( I swaer no mention about site) female 34yrs old smooth soft cyst
dx
Thyrogossal cyst.
Thyroid cyst
AAAAAAAAAAAAAAAAAAAA
Old pt wt loss apical shadow elevated rt diaphragm what next
Xray
Colonoscopy
ABG
Old pt with dyspnea and tachypnea

Ph 7.25
PCo2 60
Bicarb normal dx
Resp acid
Met. Acid.
You met your patient in a shopping mall he has been treated by you from
some mild psych. problem and he wants to treat you for a drink or coffee
what to do:
You can socialize with your patient.
You r not allowed
You can but refer to another gp
You can but refer to another specialty
You should take permission from something.
BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB……….Donot socialize
with patients
Old male brought his old wife for the hospital 4 times in a month she walks
with pijamas in the garden 2 am dx
Dementia
Uti
Dissiociation
Bbbbbbbbbbbbbbbbbbbbb…………most common cause of delirium is UTI
No thing suggestive of dementia
=============
#Female patient 53 years came for routine check up , as her brother died from
cancer colon at age of 64 years, she did not do any routine screening for the
last 5 years what will you do
Breast ultrasound (not mammo)
Colonsocopy
Cervical smear
Ecg or ... other irrelevant choices
Bbbbbbbbbbbbbbbbbbbbbbb…………she is over 50 with (+) family history
#Patient came from strange place ( i donot remember ) s ince 2 weeks she got
now 2 days abd pain and diarrhea with also right ankle itching and scratching
marks since
Lot of investigations done only esinophilia
What the cause

Gardia
E coli
Strangoloidus
Enterovirus
cccccccccccccccccccccc………..itching + diarrhea + esonophilia
http://emedicine.medscape.com/article/229312-clinical
Female with drug abuse chest xray now suffers from cavitary lesions mx
Iv ceftriaxone
Augmentin
Penicillin
…………….none ………..best is vancomycin ………..most common
organism in iv drug addict causing cavitations in the lung is MRSA
Pt with mitral stenosis murmur :

a-Systolic heared maximum at apex
b-Systoloc heared at neck
c-Diastolic heared at apex
d-Diastolic at lt parastetnal
e-Diastolic at rt parasternal
CCCCCCCCCCCCCCCCCCCCC………….Mid diastolic at apex
Patient with # pelvis and bleeding through meatus next

Ascending urethrography
Insrt catheter
Iv pyelography
AAAAAAAAAAAAAAAAAAAAAAAAA………….Injury urethra
1. A pt. went to northern Thailand, spent 6 weeks, 4 weeks after returning
developed fever, abd pain and fatigue diagnosis?
a. hiv
b. hepatitis b
c. EBV
d. malaria
AAAAAAAA??????...........but stem not cimplete
80 yr old with h/o bipolar disorder since 20 yrs well controlled on

lithium,sodium valproate.h/o DM n Hypertension on metformine and ramipril
now comes with confusion,tremors,brisk reflex,fever.she was started on
diclofenac and PCM a week ago for pain in knee.which of the following drug is
responsible for the present symptoms
1diclofenac
2.lithium
3.metformin
4.sodium valproate
2222222222222222222222222222
Male patient came with this PIC what is most likely the cause
A. Melanoma
B. Heavy smoking
C. Burn
D. Diabetes
DDDDDDDDDDDDDDDDDDDDD
Young lady will start her new jop (night shift)
Worry regarding vit.d deficiency
A.startvit d
B.assessment of vit d
C encourage diet rich in vit d
BBBBBBBBBBBBB????
When should 25-hydroxyvitamin D be measured?
The Royal College of Pathologists of Australasia published a position
statement to clarify the role of vitamin D testing in vitamin D deficiency, with
guidelines for who should be tested, and when repeat testing should be
performed
Major risk factors for vitamin D deficiency
Signs, symptoms and/or planned treatment of osteoporosis or
osteomalacia
Increased alkaline phosphatase with otherwise normal liver function
tests
Hyperparathyroidism, hypo- or hypercalcaemia, hypophosphataemia
Malabsorption (e.g. cystic fibrosis, short bowel syndrome,
inflammatory bowel disease, untreated coeliac disease, bariatric
surgery)
Deeply pigmented skin, or chronic and severe lack of sun exposure
for cultural, medical, occupational or residential reasons
Drugs known to decrease 25-hydroxyvitamin D (mainly
anticonvulsants)
Chronic renal failure and renal transplant recipients
https://www.nps.org.au/australian-prescriber/articles/measuring-vitamin-
d#b1
Patient with penetrating trauma to his hand by screw after more than 3 days he
came with pain and swelling after antibiotic what you will do :
1_Incision and drainage
2_ TD
AAAAAAAAAAAAAA
Picture of vertebral fracture,old female presented in Er
Appropriate management
A.rest&analgesia
B.dexa scan
C.Other imaging options
AAAAAAAAAAAAAAA............1st step then bbbbbbbbbb
2.Pt in labour, HR deceleration 70/min fo 2 min

A stop syntosin
B CS
C IV fluids
ccccccccccccccccccccc...........most accurate answer
left lateral position than fluid than stop oxytoxin
Child 5 yrs fell on garden bed has multiple superficial lacerations he has hx of
2 doses of vaccine at 2 nd 4 mntgswht next
Dpt and booster after 2 mnths
Tetnus toxoid ndig
Dpt and ig
AAAAAAAAAAAAAAAAA............only accepted among these
options/////.............igg not given in kids
Antibiotic in option go for it local if superficial ,oral if deep
9)you are gp in a rural area.In that area..there is predominance of violence due
to excessive alcohol consumption..a committee comes to you and tell you to do
something to help them to overcome this problem..what you will do as gp?
a.say them no..as this is not your task
b.give a public lecture to tell the people medical consequences of excessive
alcohol consumption
c.say them to.report to police station
bbbbbbbbbbbbbbbbbbbbbbbbbbbbbbb
new7)woman come with her child for some illness…later you came to know
that she is against vaccination..you try to tell her but she refused she said she
done a lot research everything against favour of vaccination..what will you do?
1]refer her to social workers for counseling
2)refuse as it is her wish
IAM WITH AAAAAAAAAAAAAAAAAA 1ST
schizo lady 78 YO, admitted for smoething or presented idk, diagnosed with
cancer of caecum. surgeon said only way to tx is to operate(in more sophiticated
way). lady's MMSE: 20/30. same details given . bt one of her daughter wanted
to ask u if it is fair to operate on this mentally something patient! but u have
talked to the pt about the condition & she said yes to operate. wt to do?
a. as pt not able to give consent dnt operate
b. call for family meeting with sergeon
c. pt has giveconsent ,go for sx
BBBBBBBBBBBBBBBBBBBBBBBBBBBB..............patient is dementia and
does NOT seem to understand the procedure
The best is look first for advanced directives

d. listen to daughter n not do sx as she has the attorny or smthn
MilindRawal
*Diabetic pregnant female.....most essential supliment for her
1-iron
2-folate
3-vitamin b
2222222222222222...........most important for female to prevent neural tube
defect
*Pregnant women at 34 week BP is 160/90 and +1 protienurea...after 30
min her BP is 130/70 and no protienurea..no edema or other physical
finding.. her BP at 1st antenatal visit and untill now was
normal...cause of hypertension
1-PIG
2-pre eclampsia
3-essential hypertension
AAAAAAAAAAAAAAAAAAAAAAAAAA...........
Her bp was normal at first antenatal visit so this is NOT chronci HTN
No proteinuria ...........so this is NOT preeclampsia
*Photo of duptutryncontracture progressively increasing for two years...cause

1-thinkning of palmer aponurosis
2-flexor retinaculum thickning
AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
*Figure with huge neck swelling with
incresingdyspnea,tremor,tachycardia...
Diagnosis
1,multinodulargoiter
2,.ca thyroid
3,lymphoma
4,thyroglosal duct cyst
Cancer or lymphoa does NOT cause thyrotoxicosis manifestations
Thyroglossal cyst is begnin and also does NOT cause thyrotoxicosis
manifestations
*Scenario of hyperthyroidism what vill u give beside propranolol
1,lugol iodine
2,radio active iodine
3,subtotaltyroidectomy
4,propylethyouracil
Depends on whole scenario
If pregnant then DDDDDDDDDDD
1. You have been sent to a school to give sex education. What else would
you give advices about?
A.Regular cancer screening
B.Prevention of acne
C.Chalmydial infection
D.Pap Smear.
CCCCCCCCCCCCCCCCCCCC
2. gp to give a education in school for 13 yrs old girl, sex education has
covered,which one to give next?
a.sunscreen
b.pap smear
c.skin cancer
d.bullying
CCCCCCCCCCCCCCCCC… c include a ……..but best is alcohol
Pap smear start at age of 18 ys
6- what is the ecg presentation of hyperkalemia?

a) wide QRS complex
b) narrow Qrs complex
c) short PR interval
(Peaked T waves not mentioned)
16- 17 years old girl comes with her sister. She cut her wrist. Parents
separated. Lives with her mother but wants to live with her father. Whom to
inform?
a) mother
b) father
C) both parents
23-lady comes to emergency with wrappers of amitriptyline and another drug(
can't remember). Seeing coloured snakes. Dx asked
a) delirium
b) anticholinergic delirium
c) some weird syndrome
d) drug interaction
Visual, auditory, or other sensory hallucinations
Warping or waving of surfaces and edges
https://en.wikipedia.org/wiki/Anticholinergic
Cancer pt ef 20 % -
ercp –
whiple –
prcutenous drainage
cccccccccccccccccccccccccc
TTT of arthralgia in sle scenario with and dna psotive Chloroquine

Nsaids
Prednisolone
Symptoms of loss coordenatin. Slurred speech. Imbalance. Asking for
cause
Lt cerrebellar infarction
Carba toxci
Something else
Balerina including someshow for 2 month had an ankle sprain or # and she is
afraid of gaining weight suffers from fatigue inv.
TFT
LFT
Electrolytes and. Creat
CCCCCCCCCCCCCCCCCCCCCCCC…………..most imp in patient with
anorexia nervosa
Female feeling dicomfort with sex started sexual activity 2 mounth ago by
exam there is cystc swelling in vagina from hymenal remnants till cervix :
Mullarian cyst
Wollfian cysy
Bartholin abscess
Pelvic inflammatory disease
AAAAAAAAAAAAAAAAAAAAAAAA……….typical site of mullerian
cyst
New born baby fully cyanosed in 100% o2 box

No dstrress, no murmur, 100% sat
Hr normal, everything normal except cyanosis
Not reduced with o2,
Wat next
Pge2( prostaglandin) infusion
Atrial ostostomy
Intubation
AAAAAAAAAAAAAAAAAAAAAAAAAA……..to main ductus arteriousus
open ……….it is a case of transposition of great arteries
Q) The daughter of a rather confused 78 yrs old woman asks if administration

of her mother’s
drugs could be simplified by taking them with meals. Which one of prescribed
drugs should
not be taken at meal time?
a- Digoxin (Lanoxin)
b- Frusemide (Lasix)
c- Potassium chloride (Slow K)
d- Glibenclamide (Daonil)
e- Phenytoin (Dilantin)
EEEEEEEE(dr NASR) Especially phenytoin solution with enteral feeding
should be 2 hours free before and after phenytoin ( to avoid seizures)
In addition, using phenytoin together with food may alter the effects of
phenytoin ( drugs.com)
Pt. Female 55yrs With chills mild jaundice fever right hypoch. Pain slight
elevated LFT HIGH alk ph.
Cholangitis
Acute cholycystitis
Pancreatitis
Cancer head panc
.AAAAAAAAAAAAAAAAAAAAAAAA
Caucasian Child with pallor hb 8.5
Mcv 60 very long scenario inv.
Blood culure
Osmotic frag.
Hb electroph.
Bone marrow biopsy
CCCCCCCCCCCCCCCCCCC
U r asked to see child in foster nursery when he enter room play with toys
every one for a very short time and play with certain toy that have lashes
for long time does pay attention to any one of the room . Histoty of tantrums
dx
Autism spectrum disorder
Oppositional dd
Adhd
AAAAAAAAAAAAAAAAAAAAA
Child presented with bilateral knee joint pain on examination mild

tendeness, no other significant No fever, ESR high low platlets low HB wbc
Management
- us knee
- Bone marrow
Aspiration
BBBBB!!!!!!!
Child presented with abdominal pain , joint pain and purpura ( henoch line
purpura) what will you do
- Urine microscopy
- Us abdomen
- D dimer
AAAAAAAAAAAAAAAAAAAAAA…………..look for hematuria
Male patient came naked to the ER he said that he became paranoid since he
started his new job , and some bizarre delusions Treatment
Clozapine
Olanzapine
Quitiapine
BBBBBBBBBBBBBBBBBBBBBBBBBBBB……….DELUSIONS is ttt by
antipsychotics
You noticed too much obesity in you rural area what is the. Best measure to
decrease obesity among children –
increase in the food –
Open children obesity clinic –
Screen all children for weight and hight –
Decrease their time of watching tv
DDDDDDDDDDDDDDDDDDDDDDDDDDDDD
The most important strategies for preventing obesity : healthy eating
behaviors
regular physical activity
reduced sedentary activity (such as watching television and videotapes, and
playing computer
games)https://www.health.ny.gov/prevention/nutrition/resources/obparnts.htm
3.A man brought by police from correctional facility with complints of
abdominal pain and constipation. He says himself “Poor historian” (exact
words) and pain started suddenly. On examination you found mild upper
abdominal tenderness. Whats the next step of management.
(X-ray given, seemed to me normal)
A. I/V fluid
B. Analgesics
C. Watchfull waiting
D. Lactoluse
DDDDDDDDDDDDDDDDDDDDDD……….only symptoms here is
constipation and abdominal pain and mild tenderness
4.A patient on Amisulpride(some antipsychotic) 800mg well controlled now
after developing psychotic and hypomanic feature 2 years ago. (some other thing
ust forgot). Which one of following suggests poor prognosis of this patient?
A. Past self harm
B. High dose of Antipsycotics
C. lost job in 06 months
5.Old patient 70+ had TURP for BPH. 02 days after he went home he
become agitated and agreesive. His wife come to you(without patient). Which
one of the following will help you to reach Diagnosis?
A. Aggressive
behavior to his pets
B. Past insomnia
C. family disharmony
bbbbbbbbbbbbbbbbb………….delerium ….
9.13 year old girl came with her mother. During History taking she told She
was raped at a party beside reporting to child assault service what will you do?
A. Give antidepressant
B. Refer for Sexual Counselling
C. Some Psychotherapy, Others irrelavent
Management
being aware of local resources – for example, sexual assault
counsellors, group support
http://www.racgp.org.au/your-practice/guidelines/whitebook/chapter-9-
sexual-assault/
10.57 yr Man complain of anorexia and weakness....known case of CCF on

digoxin .25 , frusemide/hydrochlorothiazide...lab value cbc-normal..Na -131, K-
3.1
Ecg (not given)....atrial rate 180...ventricular rate 110
A. Increase frusemide
B. Stop hydrochlorothiazide
C. Stop Digoxin and add K
D.defibrillation
E. Cardioversion
CCCCCCCCCCCCCCCCCCCCCCCCCC……….unless the patient is vitally
unstable then it will be EEEE
12.70+ year old man on Ramipril 5mg for hypertension. On Examination Bp-
150/?, pulse – normal Cholesterol 6.?(normal range given around 2). Rest
investigation with in normal limit. Which one will reduce his risk of stroke?
A. Low dose Aspirin
B. Clopid
C. Increase Ramipril
D. Atorvastatin
CCCCCCCCCCCCCCCCCCCCCC………controlling BP is the most
important factor to decrease risk of stroke
this guidelines recommends that all those requiring antihypertensive
drugs
should be treated to a target of less than 140/90
in those with high risk the target systolic blood pressure is less than 120
https://www.heartfoundation.org.au/images/uploads/publications/PRO-
167_Hypertension-guideline-2016_WEB.pdf
13.40 year old Mother Had MI and now on Aspirin, father has DM. His BP
found 160/100 mmHg. His Bp normally varies from 170/? To 120/70. What
will you do?
A. Echo
B. 24 hour BP
C. Ecg
D. anti HTN
DDDDDDDDDDDDDDDDDDDDDDDDDDDDD….patient is stage 2 HTN
……..needs immediate ttt
In this guideline the following definitions are used.

Stage 1 hypertension Clinic blood pressure is 140/90 mmHg
Stage 2 hypertension Clinic blood pressure is 160/100
If the clinic blood pressure is 140/90 mmHg or higher……offer
ambulatory blood pressure
Initiating and monitoring antihypertensive drug
Initiating treatment
1.5.2 Offer antihypertensive drug treatment to people of any age with stage 2
hypertension.
https://www.nice.org.uk/guidance/cg127/chapter/1-
Guidance#initiating-and-monitoring-antihypertensive-drug-
treatment-including-blood-pressure-targets-2
*Women with history of hyperthyroidism taking

carbamazipine,noweuthyroid...comes to u for OCP advice
1,stop carbamazipin and start OCP
2,increasecarbamazipine,give OCP
3,increasecarbamazipine with high dose OCP
4, decresecarbamazipine and low dose OCP
5,decresecarbamZipine and high dose OCP
11111111111111111111............BBUT BEST IS CONTINUE
CARBIMAZOLE AND INCREASE OCP
*Old lady with vaginal ulcer refuses for any biopsy or sampling even if it is
CA...but her daughter insisits to sample the ulcer what to do
1,perform sampling
2,listen to patient
22222222222222222............provided she is competent to make such a
decision
6.. Young man athlete with syncopy and No family history of heart disease wt
to see in clinical exam:
A..Continuosmurmer in second left intercostal space
B.. Right second systolic murmer
Bbbbbbbbbbbbbbbbbbbbbbb
22.. 2 years Child with abdominal symptoms and vomiting and high fever,
there is abdominal tenderness also,, giving CXR of left lung effusion asking
about inestigation to reach the diagnosis
A.. Blood culture
B.. Urine microscopy and culture
C.. Pneumococcal pcr
D.. Pleural fluid aspirate
aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa.................only accepted...........here he
mentioned effusion
Infants present with:

Cough (the most common symptom after the first four
weeks).
Tachypnoea (according to severity).
Grunting.
Chest indrawing.
Feeding difficulties.
Irritability and poor sleep.
Breathing, which may be described as 'wheezy' (but usually
upper airway noise).
History of preceding URTI (very common).
In this age group beware:
Atypical and viral infections (especially pneumonia) may
have only low-grade fever or no fever.
Toddlers/preschool children:
Again, preceding URTI is common.
Cough is the most common symptom.
Fever occurs most noticeably with bacterial organisms.
Pain (chest and abdominal) occurs more often in this age
group.
Vomiting with coughing is common (post-tussive vomiting).
Be aware that:
Lower lobe pneumonias can cause abdominal pain.
Blood cultures Severe infections

are seldom will
positive in compromise breathing
pneumonia (fewer thanmore.
10%
are bacteraemic in pneumococcal disease).
https://patient.info/doctor/lower-respiratory-tract-infection-in-children
Microbiological investigations are generally not needed and should only be

considered in children with severe pneumonia or complications:
Blood culture
Testing for viral pathogens (nasal swabs and nasopharyngeal
aspirates for PCR and viral culture)
29.. Patient around 60 with gleson score 4 and after 12 biopsies you were
only to achive one biopsy with adenocarcinoma..
A.. Total prostatectmoy
B..Watchfull waiting
     BBBBBBBBBBBBBBBBBBBBBBBBBBB...............
 positive
Table 1. Patients suitable for active

surveillance protocols
Patients with low risk disease: men with low

volume malignancy (one of four cores positive
or less) of Gleason score 3+3 with a PSA of
less than 10 ng/mL on presentation and either a
non-palpable tumour on DRE or a small
tumour occupying less than half of one lobe
(stage T1c–T2a)
http://www.racgp.org.au/afp/2013/januaryfebruary/prostate-cancer/
Treatment options Active surveillance Some patients with l ow grade

(Gleason score ≤6) and low volume disease detected on biopsy will never
progress to a higher stage or grade. These patients may be suitable for active
surveillance
http://www.racgp.org.au/download/documents/AFP/2011/October/201110duc
31.. Papillay carcinoma of the thyroid confined to left lobe

A.. Radical thryroidectomy
B.. Left lobe thyroidectomy
Total thyroidectomy is considered by many to be the surgical treatment of
choice for papillary tumors of the thyroid,
http://emedicine.medscape.com/article/282276-treatment#d8
45 bipolar patient on lithium and controlled, now has tremor of hand mild at
rest, increasing with activity
A ..lithium level
B.. Change to valproic acid
C.. Add propranolol
D.. add benztropin
When a distressing tremor persists despite dosing changes, modest doses of a
-blocker are indicated
http://primarypsychiatry.com/wp-content/uploads/import/1202PP_Coryell.pdf
http://www.racgp.org.au/afp/2013/ januaryfebruary/just-a-repeat/
4. Man brought to ER because he was acting in a bizarre manner at a shopping

centre parking area. His partner reports that he has been normal before this. In
the ER the patient and severe mood swings and agitation. He bends down, runs
his fingers through the ground and says that there are bugs running around on
floor. Which of the following is the likely diagnosis?
a. Acute schizophrenia
b. Acute intoxication
c. Delusions
29.Man with 5 cm mass on adrenal gland found incidentally on CT. On further

tests the mass is found to be non-functioning. What is the most appropriate
action?
a. Adrenalectomy
b. Follow up the mass in 6 months on CT
bbbbbbbbbbb
Nonsurgical treatment
Conditions that do not warrant surgery include bilateral adrenal diseases such
as corticotropin-dependent Cushing disease or bilateral hyperaldosteronism.
Nonfunctional (hormonally silent) adrenal cortical adenomas are not
premalignant, and surgical excision is not indicated.
http://emedicine.medscape.com/article/116587-treatment
8. lady (age is young around 35-45) with radiculopathy pain from recent
injury and no neurological deficits (no red flag at all) Ask management.
- MRI
-CT
-Xray
-Observation (no NSAID in options, just observation)
DDDDDDDDDDDDDDDDDDDDDDDDDDDD
19. Man went to Asia for a trip recently (there’s some gap between trip and
symptoms) and now having cough, low grade fever for two weeks. Xray given
and asked diagnosis.
- Tuberculosis
-Aspergilosis
-PE
AAAAAAAAAAAAAAAAAA……….ONLY ACCEPTED
28. Woman, 39-40 years, taking OCP for 15 years, now high BP and doctors
suggests to stop OCP now. She doesn’t want to change the pill which works for
her for a long time. She doesn’t want to conceive.
- POP
-Copper IUCD
-Implanon
33. Postop 12 hours and no urine output. Catheter in situ. NS is given 100ml/
hour. Investigation asked.
- Renal USG
-Doppler bladder
- Electrolytes creatinine
44. Another old woman with GERD history and taking PPI,T-score given
and asking treatment.
- alendronate
- HRT
- Strontium ranelate
BBBBBBBBBBBBBBBBBBBBBBBB………….H/O GERD…………..HRT
will be the best for the menopausal symptoms and the osteoporosis
IF NO FLUSHING OR Menpousaz; ……strontium ranelate
53. Woman with long history of RA and blood test given as anemia
(normocytic). Asked management.
- Erythropoitin
- Iron injection
- low dose steroid
57. Teenage girl (around 16years)with anorexia nervosa BMI 13 refusing

tube feeding. On which occasion tube feeding can be given without her consent?
- consent from her parents
- permission from director of hospital
- recommendation of two psychiatrists
the Mental Health Act permits an authorised psychiatrist to make a treatment
decision for a patient who:
does not have capacity to give informed consent to the treatment
proposed by the authorised psychiatrist or
has capacity to give informed consent to the treatment proposed by
the authorised psychiatrist but has not given informed consent to
that treatment.
https://www2.health.vic.gov.au/mental-health/practice-and-service-
quality/mental-health-act-2014-handbook/recovery-and-supported-decision-
making/informed-consent
69. Young mother with 10 week old baby attending clinic many times within
two weeks complaining that baby cries a lot and difficult to settle. Baby’s
growing well and all normal. What would you find in her history for diagnosis?
- premorbid personality
- any intention to harm baby
BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB……….MOST IMP
72. Patient with DM long history taking metformin. BP is around 130-80/90.

Cholestrol is 4. A few lab values given (not much relevant). There’s proteinuria
too.
Asked which management is best?
- Statin
- Ramipril
- Insulin
- BBBBBBBBBBBBBBBBBBBBBBBB……….DM + PROTEINURIA
2. recall of infected hematoma. Pt on warfarin with fever. Swelling in

thigh. What investigation to do
d dimer
ct angio
Doppler
CCCCCCCCCCCCCCCCCC
19. Man brought to the rural clinic after he was bitten by a snake through his
trouser. There are two bite marks on his leg. Which of the following is the most
appropriate management?
a. Give antivenom
b. Apply torniquete and leave it for 2 hours
c. send the patient home as there are no signs and symptoms
d. Tell the patient that it is more likely to be a non-venomous snake bite
e. Observe the patient and give antivenom if s/s

EEEEEEEEEEEEEEEEEEEEE...............best develops.
action
1. A lady with geriatric scale 6/27...normal less than 5 ... comes with
features of low mood lack of sleep tearful. Sensihtivity of geriatric
scales is 90 specificity 80 Ppv is 50 npv is 90 What is the Dx on this
basis
a) Mild depression
b) Moderate depression f
c) no depression esnj
d) refer for further assessment
(Score 1 for answers in block capitals: 0-4 normal, 5-9

Mild depression, 10-15 More severe depression)
2. 14 yr old girl bought by parents , abnormal menstrual cycle

heavy bleeding when it occurs. on some bruises on legs history of
easy bruising
a. platelet count
b. protein s def
c. haemophilia
d. vwd
DDDDDDDDDDDDDDDD………..most common cause of long history of
bleeding tendency in females is VWD
3. A 26 yr old woman presented on the 17th day of a 24 day cycle with

primary amenorrhoea. Which of the following will inform you that
ovulation has occurred?
a. FSH & LH
b. Prolactin
c. Progesterone
d. Oestrogen
4. Meningitis in a baby 2 month neck stiffness, CSF low glucose, high

protein, leucocytosis and have commenced antibiotic. What next
will you add?
a. dexamethsone
b. i.v ceftriaxone
c. antiviral
AAAAAAAAAAAAAAAAAAAAA……….to decrease brain edema
1. A patient on Thyroxine. TSh is low. What investigation to do?

a. CT scan
b. T3
c.T4
d. Glucose
d. Electrolyte and cr
T4 I stha main mointer in pregnant
monitoring thyroxine (levothyroxine) therapy
Response to thyroxine (levothyroxine sodium) is best monitored
biochemically.
Thyroid function should be assessed every 6-8 weeks until the patient is
euthyroid and then rechecked annunally, aiming to maintain T4 and TSH
within the normal range (1).
Elevated T4 with TSH suppression may suggest overtreatment
http://gpnotebook.co.uk/simplepage.cfm?ID=-1804926956
1. A case of a 18 yr old girl with no menstration. Oestrogen and

progesterone challenge test done with no response. What next?
a. FSH
b. b. LH
c. c. Ultrasound
d. d. Prolactin
CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC
A negative estrogen/progestogen challenge test typically indicates an outflow
tract obstruction.
http://www.aafp.org/afp/2006/0415/p1374.html
if progesterone only negative,,,,,ovulation
2. A baby presented with ear pain and fever. After giving PCM for 3
days, the fever continues. What to give?
a. Oral amoxicillin
b. b. IV benzylpen
c. c. X-ray
d. d. Ct scan
AAAAAAAAAAAAAAAAAAAAAAAAA
3. A woman with HTN, DM on ACEI, Biguanide and other medicine
develop calf pain. Ultrasound calf DVT. You commenced Heparin.
How will you continue to treat this patient?
a. Heparin for 3 week
b. b. Warfarin for 3 weeks
c. c. warfarin for 6 months
d. d. clopidogrel and aspirin for 6months
4. A patient believe that his life is in danger. He said that God spoke to
him and that someone is putting thought in his mind. Diagnosis?
a. Thought insertion
b. b. Paranoid delusion
c. C. idea of reference
d. d. Thought broadcasting
e. e. Mental telepathy
5. A child had jaundice on the 3rd after birth, now baby is 6weeks and
still having jaundice. What is the cause?
a. Gilbert’s disease
b. b. Biliary atresia
c. c. Physiologic jaundice
6. Lady took 120 tablets of PCM, who presented with fx of

encephalopathy
Liver transplant
continue N-acetyl
low benzodiapines& low Antipsychotics
AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA.......encephalopathy is
an indication for transplantation in case of paracetamoltoxicity
woman on HRT what will you tell her of the risks:

cancer
gallbladder disease
heart disease
thrombosis
DDDDDDDDDDDDDDDDDDDDDDD
NICE says:
taking combined HRT (oestrogen and progestogen) is associated
with a small increased risk of breast cancer
NICE says:
HRT doesn't significantly increase the risk of cardiovascular
disease (including heart disease and strokes)
Blood clots
Blood clots can be serious if they become lodged in a blood vessel and block
the flow of blood.
NICE says:
taking HRT tablets can increase your risk of blood clots
there's no increased risk of blood clots from HRT patches or gels
It's thought the risk of developing a blood clot is about two to four times
higher than normal for women taking HRT tablets
http://www.nhs.uk/Conditions/Hormone-replacement-
therapy/Pages/Disadvantages.aspx

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SHAKOREE'S NOTES OF

AMC MCQ RECALLS

Dr. Omar Shakoree

Dr. Omar M. G. Shakoree(MBChB)

Pt with high sugar high cholesterol low HDL, ALT

patient had abdominal pain liver enzymes elevated. Pancreatitis dx treated.

Another abdominal obstruction asked for next appropriate step..patient

Child fell..had a fx arm. Swelling and numbness in fingers. Next ( recall)

Patient on multiple drugs had raised cholesterol of 7. Cause of raised

Lump under the angle of mandible. Hx of smoking. Dx.

33 weeks pregnant lady. Comes with hx of vagibal bleeding. 1000 ml loss. Bp

Had kidney transplant from cadaver. No urine output up to 7 post op days,

Preganant lady, sudden severe headache, at vertex, vomit once, BP 160/95.

Old recall: Chronic gout patient who is

The patient may develop severe hypoventilation, despite being in

Old recall: Scenario of restless leg syndrome asking for treatment

Patient on antithyroid and now euthyroid want to conceive

hereditary spherocytosis hemolytic crisis (retics high) cause

8month baby came with neurological manifestations what will help u to

Resolution within 7 days – These patients do not typically require

relation between fatigue in truck driver and road accident

endosopy and ligation

Typical pic , asking about best management

45 yrs old farmer complaints pain with weakness to both legs.smoke 40

90 female hernia Sx,12 hrs later becomes restless,confuse and remove IV

schizophrenic pt , what u ’ll assess to confirm Dx ?

pt admitted in hospital wz history of pschiatric illness, agitated , looking at the

MS.. risk of recurrence in next 10 yrs

Carmazepine induced siadh. Na 112. Next

Old patient with backache, hematuria, nitrite positive on urine dipstick.

A boy with herpes. Was given iv antibiotic(some cephalosporin) when he

End stage liver disease. Whats next.

A pic of a hand with amputated fingers....asking associated disease:

A pic of swelling in the floor of mouth....asked next

Hereditary Hypercholesterolemia...which is found?

pt taking carbamazepine comes with hyponatremia(na-112),wat to do-

Young boy who was kicked by a friend,while playing football,Noticed

Q of C1 esterase deficiency- 8.Child developed allergy,following cake

More severe inflammation of the glans penis

mediators that can lead to further clotting.

Clinical setting Recommendations

INR ≥ 1.5 with life- Stop warfarin and

An infant brought with bulius vomiting abd. tenderness and dissension,

Disabled child in a shared house attacked someone, whom to inform-

A middle aged man who was previously

Scenario of cut off sign at sigmoid colon- next-

50-year-old woman, who has recently been diagnosed with hypertension,

Female with history of CS with lower abdominal incision before,

A 72 year old man is admitted with a 5 day history of confusion, lethargy

Lose wt Obese man on metformin, verapamil, thyroxine presented with

A female patient(~40 years)came for her routine breast checkup.clinical

Age + site ( upper outer quadrant ) + calcifications = suspicion of cancer

4 yr boy with hematuria,proteinuria and hypertension now who initially

40 yo alcoholic and smoker complains of a 2 cm painless lump on the left

An anxious patient presents with status asthmaticus. Best acute treatment:

A 56-year-old man with H/O of chronic smoker come for dyspnea.O/E

Dullness + absent breath sounds + BRONCHIAL breathing = pneumonia

Breast mass biopsy showed malignant cells what to do before operation

Elderly with urge incontinence like scenario.Management?

Ct of Brain given shows metastasis Hx of chronic smocking ,quit 5 years

52 . Pregnant lady presents at 37 weeks of gestation with sudden abdominal

77. Old woman 75 years of age is admitted to the hospital following a

48..young age man, brought to emergency departement after fight with