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You receive a call from a school about a boy who is your patient and asthmatic. They are
immediately about to leave for a camp and wants to know if the child’s asthma management plan
can be given as they could not reach his parents. What will be ur next step?
a. Give the teacher the prescription for management plan
b. Ask them to bring the child to your practice
c. Try contacting his parents
In common law a fiduciary relationship exists in any relationship which gives one of the parties
an opportunity to exercise power to the detriment of the other party who depends on that
person to act in their interest. That is, a ‘fiduciary relationship’ is one where the ‘fiduciary’
undertakes to act on behalf of and in the interest of another person.
A fiduciary duty is therefore an obligation to act in good faith toward someone for whom
responsibility has been accepted in such a way as to confer a benefit on that person. This means
the power of the stronger party ought not be exercised to the detriment of the weaker party. The
notion underlying fiduciary obligations is inherent in the relationship between the state, workers
and the young people.
This can be seen for example in educational institutions. The state legally compels all young
people aged 5 to 16 to attend school. The young people whose parents/guardians have placed
them in the care of the state trust workers to act in loco parentis. This is a fiduciary relationship.
The same applies to young people who are under state guardianship, who are placed in care,
protection or in some form of custody. The fiduciary (ie, the state and/or its representative staff)
is obliged to act in the interest of the young person to the exclusion of the fiduciary’s own
interest. Further, persons subject to this duty are not expected to profit from the relationship, or
to put themselves in a position where the fiduciary obligation and personal interest may conflict
(Butterworth’s Australian Legal Dictionary, 1997: 471). Fiduciary obligations recognise the
position of disadvantage or vulnerability on the part of the weaker party which causes that
person to rely on the other and requires the protection of equity acting upon the conscience of
the other (Batley in PIAC 1997, pp. 50 - 55).
mother came for followup of child. child normal however mother is silent and withdrawn.
wat to ask mother?
-mood
-financial strain
-maritial status
Neonate with skin lesion (described only) with pus .. Organism asked: - Staph - HSV
2) molluscum pic ... No exclusion
3) man from Ethiopia with hx of hCG vaccination now mtx 12 mm no s/s asked next .... Chest Xray
4) swollen inflammed scrotum with black tissue in DMII patient after Antibiotics and IVF what to do:
- blood culture - wound debridement
4) CT IMAGE subdural hge
5) CT IMAGE ICH white rounded lesion next Inv. - CT angio - MRI
6) complete heart block with heart rate of 36 .. Pt on digoxin enalpril n metoprolol .. Mx: pace maker
7) ECG Rapid AF asking Dx
8) ECG mobitz type II what to stop? - Digoxin - ACEI - Apirin
9) 5 sentences about CTG to select which one is the right one !
10) Chest trauma with bilateral # ribs .. Hemothorax is there too .. Patient is vitally stable n maintaing
oxygen saturation .. Not breathing well because of pain .. Next step : morphine
Old man with Fx one leg he will use the walking cane (crutches) where he will put it?!!
same side of affected leg and move it with the healthy leg
The side of the healthy leg and move it with the affected leg
Risk factor for osteoporosis in a 60 year old : early menopause at 35
Patient on treatment for AIDS . Developed Hematuria and dysuria with flank pain : non contrast CT
Ribavirin side effect is hyperuricemia in 38% of its users uric acid stones non contract ct
Noncontrast CT scanning (spiral CT scanning) is the most sensitive and specific study to search for uric acid stone
MEDSCAPE
But there is another scenario when the patient is on indinavir for HIV presented with the same
symptoms ,, choose ct with contrast as the stones here is radiolucent
least 5 yrs survival rate Cx : - testis - lung - pancreas - stomach
Q about staging of colon Cx ?????
MI from 8 months , known AF on warfarin . New X Ray of Cx colon, patient was stable, no
distressing symptoms what to do: - urgent operation - postpone until warfarin effect reversed
If apple core x ray so its not emergency , no need to rush ,,, if x ray or signs of IO then urgent
op. and give FFP
18) Another similar Q but patient with prosthetic valve
apple core x ray so its not emergency , no need to rush ,,, if x ray or signs of IO then urgent
op. but without giving anything
19) Mother brought her daughter claiming that she is behaving differently and some troubles with
father , sitting alone , lack of interest asking which Q (interviewing the daughter alone) will help you
know if she has depression ? - ideas about suicide - does she feel satisfied about herself - lack of
sleep
there is a missing option for mood and appetite
20) recurrent candidal vaginitis treated every time with clotrimazole this time when you swab the
surface bleed asking what to do ? - cervical swab for culture - vaginal swab for culture - HIV test
The next step is a pelvic exam. Your doctor will examine your vagina and the surrounding area to see if there
are external signs of infection. They will also examine your vaginal walls and cervix. Depending on what your
doctor discovers, they will take a vaginal culture to send to the lab for confirmation. Tests are usually ordered
only for women that have yeast infections on a regular basis or for infections that won’t go away.
3 or 4 milestones Q one of them 12 months and another 18 months
a) staphylococcal infection
b) streptococcal infection
c) wound dehiscence
• PCR
41years 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
45years old man who’s working in real estate. He used to dress well
but recently he looked in bad shape, shouted on customers and fired
from his job. What’s the cause?
A. Depression
B. Schizophrenia
C. Bipolar
E. Fronto-temporal dementia
A- ECG
B- Electrolyte
D- LFT
E- Bone Density (it is routinely done when low bmi for 6 months or
more, otherwise, it is nonroutine)
Pt 65 yrs ,Xray of chest AP and lateral view given. Looked like right
middle zone consolidation. The lady presented with 5 days history of
fever, cough normal spo2 What will be the most appropriate antibiotic?
a. Amoxicillin clavulanate
b. Fluclox..
c. Penicillin
d. Roxithromycin
e. Erythromycin
Gentam
Nitrofurantion
Trimethop/sulpha
A man with peptic ulcer who is taking triple therapy ( PPI ,Amoxicllin,
metronidazole )for 6 weeks but urease breath test was positive for
H.pylori what is the reason?
A) resistance to metronidazole
B) resistance to amoxcillin
A case of severe UTI. There was chills, high fever and pain . GFR is low
(20 ml/min(
a.trimethoprim
b.vancomycin
c. nitrofurantoin
d. amoxicillin
e. gentamycin
:
Case of stone 9 mm at ureteric orifice in bladder, prepared for surgery,
which investigation must be done before going to surgical table?
a. abdominal xray
b. u/s
c.others
Pt diagnosed with AIDS before 6 months on ribavirin developed severe
loin pain with hematuria..his urine showed +++RBC asking for
investigations
-abdominal x ray
Us
Ribavirin side effect is hyperuricemia in 38% of its users uric acid stones non contract ct
Noncontrast CT scanning (spiral CT scanning) is the most sensitive and specific study to search for uric acid stone
MEDSCAPE
But there is another scenario when the patient is on indinavir for HIV presented with the same
symptoms ,, choose ct with contrast as the stones here is radiolucent
initial side effect of resperidone?
b.weight gain
c. hyperglycemia
FBE
Thrombophilia screen (family history)
Coagulation profile
A. Opioid analgesic
B.chest tube
Intubation
Morphine
Chest strapping
Underwater seal
9years old child, his BMI 20 came with sore throat. All other family
members are overweight. What will you tell his parents?
Mahmoud Hamdalla:
A- Echo
B- Troponin
C- Holter ECG
b.rtpa
old man coming from travel presents with increasing chest pain and
sweating with hypotension and ECG done it showed ST elevation in lead
2 3 and avf with rbbb (rsR pattern) what is the diagnosis?
a- Acute inferior MI
b- PE
C lbbb
D pericarditis
Which study to do to find causality between HTN and MI ?
a. Case control
b. Cohort
c. Cross sectional
e. Case series
A spirometry
B ABG
C)repeat in 18 months
:
A question asking why to screen for chlamydia?
• Chlamydia is asymptomatic
45years old woman came to you complaining that her 16 years old son
is a drug addict and he is beating her
pregnant lady who her husband abuse her and make sure not to leave
any marks what is your next action:
-urgent admission
-reassure
B.admit hospital
C.immediateecg
D.refer to paediatrician
Innocent murmurs
Many normal children have heart murmurs, but most children do not have heart disease. An
appropriate history and a properly conducted physical examination can identify children at
increased risk for significant heart disease. Pathologic causes of systolic murmurs include
atrial and ventricular septal defects, pulmonary or aortic outflow tract abnormalities, and
patent ductus arteriosus. An atrial septal defect is often confused with a functional murmur,
but the conditions can usually be differentiated based on specific physical findings.
Characteristics of pathologic murmurs include a sound level of grade 3 or louder, a diastolic
murmur or an increase in intensity when the patient is standing. Most children with any of
these findings should be referred to a pediatric cardiologist
Any infant younger than one year should undergo echo or referred to a cardiologist once
murmurs were detected because of the high possibility of structural heart disease without
symptoms.
15year female, seprated from boyfriend 6 weeks, now loose wt. , lazy
at work, not good sleep, anxiety attacks & stress?
A. FLuoxetine
C. Start CBT
D refer to psychiatrist
A builder comes to you wd headache and dizziness.labs showed
platelets count double than normal.what is your diagnosis?
a.essential thrombocytosis
b.sun stroke
These results lead us to conclude that: (1) platelet activation is a frequent feature of
heatstroke; (2) in heatstroke altered aggregation responses, whether hyperaggregable or
depressed, occur simultaneously with a consumption coagulopathy.
A. SLE
B. ITP
C. HSP
D aplastic anemia
A. Hypersensitivity vasculitis
B. HSP
C. I.Mononucleosis
Purpura and vasculitis does not blanch (extravascular). Erythma usually
does blanch (intravascular lesions)
a. barium
b. urgent surgery
c. CT scan
adhesion obstruction
sig volvulus
colon carcinoma
Pt with hx of hemicoloctomy for sigmoid volvulus presented with
moderate to sever abdominal pain on the right side with distention, x
ray was typical for cecal volvulus whats mot app treatment
-colonoscopy
baruim enema
-immediate surgery
Gastrograffin swallow
A- Fistulectomy
B- Marsupialization
C- Antibiotic
27femal pt. with infertility for 3 yrs , midcycle sex, 1 child before,
semen 15 million,60%,40% ,tube problem in 1 side only, normal
hormones level, with mild pain during sex, wht is the cause of her
inferti;lity
a. Semen abn.
b. Tube abn .
c. Endometriosis
d. Ovulation problem
14years old female with body mass index 32, complaining of tiredness
a laziness at work. She had menstruation at age of 12 and menses are
regular. She has dark pigmentation on back of her neck and axilla (this
sentence was repeated twice at the start and end of the scenario). Her
grandmother has type 2 DM. diagnosis?
A- Cushing disease
B- Addisson disease
C- Hypothyroidism
D- PCO
E- Metabolic syndrome
Ca level
CT Abdomen
Xray abdomen
b. AROM
c. C-section
a. avoid codein
b. avoid all pain medicines unless it is intolerable
c.Avoid NSAIDS
A-RIMAPRIL
B-ASPIRIN
C-STATIN
D-METFORMIN
:
23yrs old female with very weird symptoms. Says she can't remember
whats happening for full day at a time. Complaints of hallucinations
when she tries to sleep. History of 3 such episodes in last 3 months.
Meningitis
Migraine
Cannabis intoxication
a.temporal metastasis
b.vermis carcinoma
c.frontal meningioma
B- Superannuation fund.
Old female with breast cancer her son doesn't want her to know as she
will be depressed
B Tell her son to bring all family for a meeting except her
D Tell the patient to bring a family member with her next appointment
Colchicine
Allopurinol
Indomethacin
Probenecid
xray of bamboo spine not relieved by paracetamol asking about the
most important management
a.methotrexate
c.HLA B27
D.esr
Us shows normal ovaries with 3- 4 cysts Whats the most likely cause
-PCOS
-POF
A. ECG
B. Echo
A metoprolol
B warfarin
C digoxin
-repeat ct
-MRI
-cerebral angio
-Repeat LP
B. Tubal damage
C. Infrequent sex
D sperms problem
24yr female had 2 babies before, amenorrhea 2 years, all normal
hormones (prolactin, testosterone,FSH,LH) , estrogen 70, US 3-4
multiple cyst, Dx ?
A. PCOS
B. Hypothalamic dysfn .
C. Pituitary Adenoma
D. POF
37 .yr old woman with secondary amenorrhea normal BMI ,FHS- high
OESTRADIOL low prolactin normal .USG-3 to 4 cyst in ovary.WANT TO
CONCEIVE.Wt is best rx
A)POP
C)OCP
D)Metformin
Man previously presented with loin pain radiating to his groin. Non
contrast CT revealed 9mm renal stones. Patient now presents with
worsening pain. What is the investigation you must do before taking
the patient to surgery:
A. Contrast CT
B. Plain x-ray
C. MRI
D. Ultrasound
A young woman with persistant pain on the lower right side of the face
with redness asking about most probable diagnosis
a.varicella
b. trigeminal neuralgia
C herpes simplex
the fetal head is in the left occiput posterior. What is the cause of ctg
abnormality
a. prolonged labour
b. sedative drugs
6wk boy was ok and increase weight,3 days ago he has increasing
vomiting but he is well hydrated but not increase weight since 1 week
all examintions are normal
A-GERD
B-PS
C-uti
Hand book photo of old pt. who is heavy smoker for many years , had
swelling behind mandibular angle , swelling is fixed , Not changing in
last 12 months, Dx?
a) Metastatic spread
b) Oropharyngealca.
c) Lipoma
d) Lymphoma
E) parotid tumor
Pic of an old female in nursing home with NG tubes and sick looking
and has a left sided parotid swelling and redness asking about cause
c. Parotid infection
Female on venlafaxine?
A-BP
B-LFT
60years old man feels pain when he walks only two blocks and stops to
rest after that. He has a recent history of left buttock and back of thigh
pain, but he has three month history of ischaemia in left leg and foot. A
bruit is present over femoral artery and His limb is pulseless and cold.
Next step?
A- Thrombolytic
B- Angioplasty
C- Bypass surgery
D- Walking program
E- Nefidepine
Case of chronic limb ischemia : 100m claudication & *it go away at rest,
on examination bruits on femoral artery? .
A. Angioplasty
a vit D
b.CBC
c.Hb electrophoresis
Picture of molluscumcontagiosum . exclusion?
.1no exclusion
.2untillscb over
B diathermy
C cryot
herapy
D local excision
E inscional biopsy
.Old pt with alzheimer on antihypertensives, controlled. Wat to give
3years old child comes with complain of cough and mother had hay
fever and father is smoker, what drug is used for prevention of asthma
case here:
a.SCG
b.Fluticasone
c.budesonide
d.salbutamol
A.Fluticasone
B.Oral Steroid
C.LABA (formeterol(
5years old boy with cough from 12 months before, was on Salbutamol
and also taken oral Prednisolone. He has an eczema history, both
parents are smokers,( typical asthma scenario) which one is the best
medication for prevention which is used in “INHALATION MODE ?”
• Chromoglycate
• Salbutamol
• Fluticasone
• Salmetrol
Admitted at 11 pm
A- prednisolone IV
B- adrenaline neb
C-salbutamol neb
D-oral steroid
A pregnant lady 15 weeks was exposed to parvovirus.serology test
revealed positive IgM,positiveIgG.WHAT TO DO?
.3USD
.4fetal haemoglobin
Mass in anterior leg, firm regular, attached to gastrocnemius muscle,
most appropriate inv?
A. MRI
B. U/S
C. CT
D. Biopsy
A boy ate a pizza before few days when he developed diarrhea and
now presented with subconjunctival hemorrhage and epistaxis and rash
a. blood culture
b. stool culture
HI guys these are some recalls ….I think moslty from last 6 months but
with different opionsso it will change answer too so don’t rely only on
recall ans…I also got some new questions too .I Will update later.Be
carefull about time Mx most of the questions with long scenario ,few
only one line quest
http://emedicine.medscape.com/article/454114-overview#a3
http://www.racgp.org.au/afp/2012/april/shoulder-injuries/
21. parents brought 3 yrs old son with c/o room spinning
around with no loss of consciousnesses and lasting for 1-
2minutes every month for last 3 months and subside
spontaneously.No h/o headache or vomiting. Ear
examination normal .What will you do ?
A.EEG and CT scan head
B.Audiology and ENT referral
C.Reassure due to BPPV that it will resolve later. (can’t say
BPPV without EEG first).
Associated nausea
Vomiting
Auditory complaints
Abrupt onset
Central vertigo often produces other neurologic symptoms, although this generalization has many exceptions.
The symptoms are characterized as follows:
Gradual onset
Tend to be much less intense than those associated with peripheral vertigo
For a doctor to diagnose Benign Paroxysmal Vertigo of Childhood, all of these things must be true:[3]
Young girl with pain and menses ocp and NSAIDs fail next?
Usg abdomen
TVS
CT
D&C
Laparoscopy best
A diabetic pt. Had left leg amputation 2 yr ago, now his hbaic is 9,
FBS 7.8, cholesterol 6, hdl,1.1. What shd he do to prevent right leg
amputation
1. Tight glycemic control
2. Start statin
AAAAAAAAAAAAAAAAAA
i am with Bad timing due to Mid coitus ..as it is not accurate for me .. but some gynecologists think that this thinking is applicable in reality but
not for exam ,,, and mid coitus is given to let us exclude bad timing not to allow exaggerated analysis of the word .. and tubal more common !
so this is open for ur discussion
======
most common feature of calcular Cholecystitis:
1 filling defect
2 intrahepatic biliary dilatation
3 thickned wall
4 fluid inside the bladder
Answer: A
Some recalls of june
ECGs of 3degree block,MX
Insert temporary pacemaker all other were drugs in option
, ecg nf. Wall m.I presented in 2 hrs,mx angioplasty
Ecg
bradycardia in pt. On multiple drugs wt to do
1. Stop metoprolol
2.stop meto gv verapamil
3. Stop prindopril
ECG of ventricular fibrillation ,managmnt asked
Defibrilation
Pic of pyogenic granules ma WD snerio
Trauma to finger 6weks ago aftr that gvn painless lesion is increasing in size,tx asked
Cautry
Surgecal excision
Cryo therapy
Incisional biopsy
2.Pic of middle lobe pneumonia in 50 yr old male with fever,cough and malaise from 5 days, tx asked
Augmenton
Benzyl penicillin
Flucloxacillin
A diabetic pt. Had left leg amputation 2 yr ago, now his hbaic is 9, FBS 7.8, cholesterol 6, hdl,1.1. What shd he do to prevent right leg
amputation
1. Tight glycemic control
2. Start statin
45 yr male with malaise 3weks, microscopic hematuria,dysuria, o/e all abdomen normal,on microscopy pus cells positive,no organism on
culture, Dx
1.t.b nephritis
2. C.a bladed
3.rcc
4.bladed stones
Old patient with macroscopic hematuria ,cystoscopy done but no finding was mentioned, also has intermittent loin pain wch radiate to groin
,next most apropriate investigation
1.USG
2.c.t abdomino pelvis
3. Urine microscopy
Obstructive sleep apnea scenario obese with waist n neck circumstances given.asking for long term treatment?
A.wt loss (ans)
B.metformin
C.Cpap
D.surgery
Endoscopic pic of metaplasia but no dysplasia, previous patient had GERDtaken ppi with immediate relief whats next step
Review in 12months(ans) should be 24 months
Endoscopy in 6months
Double the ppi
whats is most imp screening in women above 75 years
a.mamography
b.pap smear
c.FBS(ans)
d.chest x ray
A 44 year old man comes because he is concerned about his health. His father had diabetes at 56.? Next?
A) OGTT 2 yearly…..
B) 6 monthly RBS
C) FBS yearly(ans)
# MAY
A child is cyanotic, apex beat on left axillary line, loud murmur on the left sternal border.
a) ASD
b) VSD
c) TOF(ans)
d) TGA
Husband and wife travelled to Jakarta, stay in CITY HOTELS, DID NOT travel to rural areas. Wife found husband developed jaundice,
malaise, fever and headache.
a) Flavi
b) Malaria(ans) we need inc. period if
c) Hepatitis
d) Japanese encephalitis
man was with his wife inJAKRTA he had a short stay of 3 days then 3 days ago he developed symptoms of fever , RUQ pain , jaundice ,
what should you do to reach diagnosis?
a- Blood culture
b- Thick and thin blood smear films
c- PCR antibodies to rule out HIV
d- Do Japanese encephalitis antibodies
e- Do PCR to diagnose flavi virus (??)
Pt. after doing gastric bypass surgery .now complaint of lightheadedness , diarrhea , bloating 30 min. after meal , this picture is due to ?
A) Hypoglycemia late dumping diarrhea abd cramps
B) hypovolemia(ans)
C) vagal stimulation
A girl comes to you cz she has some abdominal pain and diarrhea and asks you for certificate for her illness but she is ok now..she has been
in the emergency 3,4 times before for suicidal attempts.what is your diagnosis?
a.malingering(ans)
b.borderline
c. schizoph
ﺑﻭوﺭرﺩدﺭرﻻﻳﯾﻥن ﺍاﻛﻳﯾﺩد ﻑف ﺍاﻟﺳﻳﯾﻧﺎﺭرﻳﯾﻭو ﻧﻔﺱس ﺍاﺫذﺍا .. ﻋﻠﻳﯾﻙك ﺍاﺷﺗﻛﻲ ﺭرﺍاﺡح ﻭوﺗﻛﻭوﻟﻙك ﻋﺻﺑﻳﯾﻪﮫ ﺗﺻﻳﯾﺭر ﺷﻲ ﻣﻠﻛﻳﯾﺕت ﺍاﻧﻪﮫ ﺗﻭوﺍاﺟﻬﮭﻪﮫ ﻣﻥن ﺍاﻧﻪﮫ ﺗﻛﻣﻠﺔ ﺑﻲ ﺳﺅؤﺍاﻝل ﻳﯾﺷﺑﻪﮫ
Q.5 An 18 year old case Anorexia Nervosa, which of the following will u find?
A) Tachycardia
B) Low grade pyrexia
C) Delayed relaxation phase of ankle jerk
D) Shivering in a cool environment
E) Loss Of breast development(ans)
Female BMI 18 with repeated treadmill exercise and looks herself every hour in mirror and changes clothes three times per day, dx:
a. Body dismorphic disorder
b. Anorexia Nervosa
c. Obsessive compulsive disorder
A pic of a man with really bad herpes zoster on left flank area. What is the management?
1. Acyclovir
2. Oral antibiotics
3. Oral analgesicsif with in 72 hrs consider acyclovir(ans)
4. Topical antibiotic
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41- Patient with hypothyroidism . Ischemic heart disease and hypertension on levothyroxine 150 mcg daily she developed signs of
hyperthyroidism and labs confirmed it so they decreased her dose to 100 mcg today , when should you follow up TSH level ?
• twice daily
• after 1 day
• after 7 days
• after 2 weeks
• after 4 weeks(ans)
#
# ENDO 23 year old young lady accountant presented with weight loss, nervousness, irritability, frequent palpitations and excessive sweating
of 2 month duration. She describes her appetite as excellent. She is planning to come off her OCP to have a baby. On examination she has
a mild diffusely enlarged thyroid gland, pulse rate was 110, sweaty moist palms, and peripheral tremor. Her thyroid function tests show a
suppressed TSH and raised T4,T3 levels. What is the best management plan you can offer to her?
1. Commence propranolol and carbimazole.
2. Offer anti-thyroid medication and reassure that the drugs are very safe in pregnancy
3. Strongly recommend surgery as immediate therapy.
4. Offer radio iodine treatment and defer pregnancy for 6 months(ans??)
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- schizo p.t on antipscychtc have weight gain, most is the next investigation?
a. TSH
b. FBS
c. Lipid profile(ans)
man with rt sided lower chest pain radiating to rt hypochodrium..febrile..tenderness over rt hypochondrium bt no rigidity..a flu epidemic is
going on..
a. rt empyema
b. cholecystitis
c. sub phrenic abscess(ans)
Patient after influenza epidemic came with resp difficulty and pleuritic chest pain in his right lower lung referred to his upper abdomen A)
Empyema B) subphrenic abscess C) cholecystitis D) pancreatitis
Patient with a trauma you want to give him blood transfusion what will you choose ?
• O group blood
• O negative low titer whole blood
• O negative low titer Packed RBC units(ans)
• Give blood without cross matching
Pic of frost bite in great toe after camping trip Wat to do
Resurrance it's just frost bite
Remove the toe
Review in 4 weeks (ans)
Remove only the nail
30 years old lady came to you because of 8 weeks ago her marriage was broken, 1 year ago she was referred for psychotherapy from work
(Shouting at colleagues) . After finishing her work she cant able to relax at home. What is the diagnosis?
A) Bipolar-II with depression
B) Cyclothymic disorder
C) GAD
D) Major depression
E) Borderline personality disorder(ans)
5.Pancreatic pseudocyst scenario post Pancreatitis episode fullness and stuff
Asking Ix most app
CT (ans)
EUS (endo US)
6.Most earliest complication post pancreatitis :
RF (ans)
Pseudocyst
#
Pancreatic pseudocyst scenario
Asking Ix most app
ERCP e` biliary drugs
endoscopic cystography
open cystography
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man with nasal blockage especially at night & can't sleep well.he has periorbital darkness.allergy test (+).what is ur initial step??
Normal saline wash
Oral cetrizine at night
Oral(another antihistamine) in the morning
Oral steriod at night
Nasal steriod spray at night(ans)
woman her pap smear didn’t show abnormal cells but the endocervical cells were absent. Her previous pap was normal
what would you do?
Reassure that no test are required any more(ans)
b. repeat pap smear now
Woman with pap smear showing LSIL.Previous pap smear 3 yrs back was negative.
A. Repeat pap smear in 6 months
B. Repeat pap smear in 12 months(ans)
C. Colposcopy
Mother brought her 16 year old ballet dancer girl..breast bud stage 2, tsh fsh and prl was NL...amenorrhea present, next?
USG(??)
reffer to adolescence unit or something like
reassure
pap smear
16yr ballet dancer, present with amenorrhoea, BMI 15 and breast bud present, what is
Next management?
FSH
Review in 3-6 months
Refer to adolescent health (??)
most common feature of calcular Cholecystitis:
1 filling defect
2 intrahepatic biliary dilatation
3 thickned wall (ans)
4 fluid inside the bladder
A 64 years old man with incontinence of the urine after a long trip. He have to strain strongly in order to evacuate his bladder.You did rectal
examination, you felt enlargered irregular prostate.
Prostate specific antigen(ans)
CT prostate
MRI
US (TRUS)
Cystoscopy
1.Young man 30-35 yo complains on 2 years history of problem with finish his urination. He states it's feels like smth in urethra. And after
finishing void he still feels his bladder is not empty. No fever, no pain. Just incomplete voiding. What is the best investigation in his case?
1- ct
2- mri
3- cystoscopy
4- uretroscopy(??)
2.young man has difficulty with initiating urination and drippling sometimes how to initially diagnose?
a) venous pyelography
b) transrectal sonography(ans)
c) CT
d) MRI...
49.What the most common cause of infection of gall bladder?
A. staphyloauriusb.E Coli(ans)
Boy when sleep on his back stridor, otherwise ok, stressed tachypnea and cyanosis?
A. Foreign body inhalation
B. Epiglotittis
C. Broncholitis
D. tracheomalacia
Tracheomalacia (from trachea and the Greek μαλακία, softening) is a condition characterized by
flaccidity of the tracheal supportcartilage which leads to tracheal collapse especially when increased
airflow is demanded.
The trachea normally dilates slightly during inspiration and narrows slightly during expiration. These
processes are exaggerated in tracheomalacia, leading to airway collapse on expiration. The usual
symptom of tracheomalacia is expiratory stridor or laryngeal crow.
A 25yo woman with T1DM has delivered a baby weighing 4.5kg. Her uterus is well contracted.
Choose the single most likely predisposing factor for PPH from the options?
a. Atonic uterus LAX
b. Cervical/vaginal trauma
c. Retained POC LAX
d. Large placental site LAX
e. Rupture uterus LAX
55 yr female with breast lump in outer quad. Mammo done , found nothing. Usg done, found hypoechoeic mass. What next ?
A. Core biopsy
B. Reassure
C. Excision biopsy
HERE D
A
C
C
B
IV Ca gluconate
Indapemide
A
RSV
CT
Endometrioses
CT
Pacemaker
3- Woman, came back from a trip to south east Asia 2 months ago , at that time she had
lower right Quadrant pain and tenderness then relieved now she has fever, Pain in right
upper abdomen, with high bilirubin and fever , Diagnosis? A) cholangitis B) Hydatid
disease C) Clonorchiasis D) liver abscess
A child is cyanotic, apex beat on left axillary line, loud murmur on the left sternal border.
a) ASD b) VSD c) TOF d) TGA
TOF is usually presented at the age of 3-6 months when the pulm vasculature starts to
be more resistant with increasing age. Child usually in compensation squatting position.
It is presented with cyanosis, especially on feeding or excertion, with systolic thrill on the
left sternal border with ejection systolic murmurs in pulm area. The condition is
aggrevated by age, infection or feeding.
11- 35 yr woman with amenorrhea, have 2 children at age 31, 34. herbmi 16.past h/o
amenorrhea at age 18-25yr.she is anxious about her menopause.whatinx will be benefit
for her? A) FSH B) BMD C) US D) Oestrogen Leve
Young boy with intermittent pain in flank and radiating to thigh for two years, now pain is
continuos with vomiting, a mass felt below left hypochondrium, dx
I) Wilmstumour
J) Nephroblastoma
K) Ureteropelvic junction obstruction
Middle aged woman who collapsed two times in a mall within a week, with diastolic
murmur best heard on right (or the left not sure), and systolic murmur best heared on
the left (or the right not sure). Whats the cause? A) Asd B) Vsd C) viral cardiomyopathy
D)1ry pulmonary hypertension
There is another stem where mixed aourtic lesion is an option ,, it all depend on
the site of the murmur
Pt came with suspected cancer caecum,wt is in the history made u suspect A. Fatigue
B. Dark stool C. Change in bowel habit
Vit C effect on iron tablets” which study you do ? a) Cohort b) Case Control c) Case
series d) Double blind
Any efficacy choose RCT ,, the option here is RCT with Double blind
.65 3 year old boy with chronic hematuria and proteinuria. NO other abnormality found.
Dx
A)Chronic glomerulonephritis
B) Nephrotic Syndrome
C) thin basement disease
ﻭوﺍاﺣﺩد ﺍاﺭرﻫﮬﮪھﻡم ﻫﮬﮪھﺫذﺍا ﺑﺱس ﺫذﻭوﻟﻪﮫ ﻣﻥن ﻭوﺍاﺣﺩد ﻭوﻻ
Dr.EslamJune Recalls
1. Mass in anterior leg, firm regular, attached to gastrocnemius muscle, most appropriate inv ?
A. MRI
B. U/S
C. CT
D. Biopsy
2. 24 yr female had 2 babies before, amenorrhea 2 years, all normal hormones (prolactin,
testosterone,FSH,LH) , estrogen 70(normal from 75 to something), US 3-4 multiple cyst, Dx ?
A. PCOS
B. Hypothalamic dysfn.
C. Pituitary Adenoma
D. POF
11. Boy when sleep on his back stridor, otherwise ok, stressed tachypnea and cyanosis?
A. Foreign body inhalation if history suggestive go for it
B. Epiglotittis
C. Broncholitis
D. Trachiomalacia
Infants present after a few weeks of life with expiratory stridor (also called laryngeal crow). Expiratory stridor may worsen with supine position, crying,
and respiratory infections. Feeding difficulties are reported sometimes. Hoarseness, aphonia, and breathing also may be reported.
Obtain history of an acquired etiology, such as prolonged intubation, tracheostomy, chest trauma, recurrent tracheobronchitis, cartilage disorder
(relapsing polychondritis), or lung resection.
12. Old female , H/O appendic. 30 years ago, abd distention & vomiting 24 hrs, by
Hx 1 month increase constipation ..
A.sigmoid valvoulus
B.fecal impaction
c.small bowel ob.
D.ca sigmoid
13. farmer U/S liver multiple hypoechoic lesion, had hemicolectomy for ca. colon before 2 year,
most app inv ?
A. Hydatid cyst serology
B. Triphasic CT
15. 80 yr male xray, constipation and vomiting for 3 days, history of appendix 30 years ,Dx?
A. Ca
B. Smal bowel Obst.
16. 38 week preg., cervical dialt. 3cm, 200ml bleed, U/S normal baby, Post. placent ?
A. ARM
B. Obervation
-female with bleeding 200 ml in her 39 weeks of gestation ,, she had stable vital signs ,, stable baby ,, uterus is
soft ,, on speculum exam there was no blood but the cervix was dilated 3 cm and membranes are clearly visible
,Ultrasound was done revealed placenta in fundus in posterior part of uterus whats is your management :-
-urgent C/S
17. 24 female amenorrhea 12 months, pain during sex, on examination uterus size normal, all
examin. normal, what will you suspect?
A. Pregnancy
B. Endometriosis
18. Preg. measles on week 16, IgM +ve after 24 hrs of symptoms rash, rhinorrhea ? (What to do
)
A. MMR Vaccine contraindicated
B. IVIG she is already infected
C. Serology of baby
D. Search doctors and patient who contact her
The story of measles in pregnancy
If contact with someone with the disease within 6 days do serology and give IVIG after the results(except if
immunocompromised don’t wait)
Administer NHIG to measles antibody negative women who are immuno-compromised following the CDNA guidelines
for dosages. If antibody testing is not available for 72 hours (weekend), administer before results are received
If contact with someone with the disease within 6 days and she is 20 weeks or more do serology and give IVIG after the
results(except if immunocompromised don’t wait) and give IVIG to the baby after birth
If already have symptoms or infected (igm+ve ) or beyond 6 days then trace contact
20. 30 year female , 2 babies, now infertility 2 years, did histosalphingography: one tube
problem, did U/S, normal uterus thickness, regular cycles, have sex on 10-14 day, cause ?
A. Luteal phase defect
B. Tubal damage
C. Time of sex
21. old POF scenario: she dosen't want to be preg. & Don't have sex ?
A. OCP
B. HRT
C. POP
D. Estrogen
22. 45 year female, urge incontinence, nocturia, uterus prolapse,on ex no abnormality in pelvic
floor, bladder full then did cough test, no dribbling ,Dx?
A. Urge incontinence
B. Stress Incontinence
C. UTI
23. 49 year female, nocturis, urgency, affect physical life, 1st inv ?
A. Urine culture
B. Urodynamic study
URINARY infection should be excluded; any microscopic haematuria is an indication for investigation of localised bladder
pathology Urodynamics provides the most definitive assessment of lower urinary tract function and is generally well tolerated by
the elderly. Indications include: When a conservative management
regimen has been unsuccessful. When the clinical picture is unclear. Before considering continence surgery. In some patients
with a neurogenic cause of incontinence.
24. Old male present with constipation, have ca with bone metastasis, took 20mg morphine for
pain last week, Inv ?
A. Morphine level
B. AbdXray
C. Serum Ca.
25. 9 month boy chest Xray normal, grunting & 39' fever, weez, given O2 n IV fluid, ?? (same old
recall)
A. RSV
B. Bacterial pneumonia
C. Asthma
26. 23 yr female epistaxis, headache, malaise, dizziness, LABS: Hb-8.5 Ca-1.9 INR-1.5 Ferritin
↓ , Rx?
A- Vit. K
B. Iv Ca
C. Plasma
D. Blood transfusion
27. 35 year female , her mother has breast ca at 60 year, she is afraid to have ca ? (most
appropriate next)
A- Breast screening program
B. Self examin.
C. Reassure
D. Come when you are 49 to start screening program
28. 47 year female afraid from osteoporosis, what is risk factor of Osteopo. in history?
A. Family Hx at 80 years
B. Early menopause at 35
29. Open flial chest, pain, distressed, cyanosed ? (most appropriate next)
A. Morphine if not then negative pressure
B. Needle thoracotomy
C. Cover wound
31. Rupture membrane & meconium, baby PR 144 bpm ,iariability 5 , no decelartion, no
accelaration ?
A. Normal
B. Abnormal & need sampling
32. ECG wide complex , slow af biventricular failure, basal crepitation, E.F=40% on
digoxin,lisnopril,verapamil ?
A. increase digoxin
B. stop all drug and check in 12 hours
C. decrease verapamil
D. Add lasix 20ml/day
33. aborignal female 3 month dyspnea, on examination b/l basal crepitation and diastolic
murmur, not smoker but binge drinker, next step ?
A. ECG
B. Echo
C. alcohol counsel about intake
35. Case of chronic limb ischemia : 100m claudication & it go away at rest, on examination
bruits on femoral artery. ?
A. Angioplasty
B. Femoral bypass graft
C. Intensive walking program
36. 24 yr female, BMI 32, stria on abd, dark pigmentation on neck & axilla, normal cycle, H/O
mother early DM ?
A. Hypothyroid
B. Metabolic Synd.
C. Cushing Synd.
38. 80 yrfemale , her daughter will have baby in 2 days, what to take?
--> DTP vacc.
39.Pic of Baby born with mass in testes &Transillumination test +ve ---> Hydrocele
40. Baby in 7th day of age jaundice, Total Bil. 240, InDirect 120, palpable spleen 2cm below c.m
?
A. Haemolytic Anemia
B. Biliary Atresia
C. Breast Milk Jaundice
It is characterized by indirect hyperbilirubinemia in a breastfed newborn that develops after the first 4-7
days of life
42. 40 yr female tonsilitis, took amoxicillin, after 3 weeks she devloped purpuric rash, not
blenching, painful joint, fever ?
A. Hypersensitivity vasculitis
B. HSP
C. I.Mononucleosis
43. 17 male ate pizza, had diarrhea, s.conjuctivits, hematuria, fever, what to do to dx ?
--> stool culture
44. Female present to you.. her son hit her n he is a drug dealer ?
A. Admission
B. Inform Police
C. Boy to rehabilation
D. Arrange escape plan
45. 30 yr female present to you, her husband hit her but dont leave marks (old one) ?
A. Police
B. Refugee Center
C. Talk to husband
d. circumstantiality
48. female don't want to eat because she think her bowel are rotten, she is dehydrated ?
A. NS until urine output 2ml/kg/hr
B. D5 1L/hr
C. 1/5 NS/ 4hr
D. NS until urine output 1ml/kg/hr
49. Old age , fever sign of pyelonephritis, BP 90/60, confused and dysuris, pus in urine in
urinanalysis, u send for culture, GFR<20 *managment ?
A. Amox
B. Trimeth. &Sulfa
C. Gentamycin
D. Ciprofloxacin
50. Old age male, UTI, culture done, E.Coli was there, he took antibiotic, 4 days after, he
devlopedchill,fever and abd.pain, what is the best inv of choice ?
A- U/S Renal next
B. CT Abd.
C. Retrograde Urethrogram
D- IVP
51. CT given (Ischemic stroke), Old female, Rt side hemiplegia, dysarthia came after 1 hour from
symptom, best Mx ?
A. rtPA
B. Clopidogrel& Aspirin
C. Clopidogrel
D. Warfarin
52. 24 female, sudden loss of conscious attacks, at bed time she have visual and auditory halluc.
, weakness in rt. side ?
A. Rt. temporal lobe
B. Lt. temporal lobe
C. Partial lobe
D. Occipital lobe
Temporal lobe epilepsy. It is a combination of:
1. memory impairment, so ask a witness when the patient can’t remember
2. Aura; could be characterized by auditory hallucinations, visual hallucinations,
emotional flashbacks, de ja vu, or even psychic phenomenon.
Diagnosis by clinical history, EEG and high resolution MRI to show the
calcification of hippocampus.
53. Acalculia, agraphia, dysathria, weakness on the left side
A. Medulloblastoma in Rt. partial lobee
B. Medulloblastoma in Lt. partial lobe
C. Cerebellar tumor
55. 15 yr Drug abuser, shout to his parents, decrease in school performance. Most thing that let
that boy have good psychiatric therapy.
A) To show him similar cases like him and tell him that those case are improved
B) Talk to him about his life
c)to make him confident that all what he says will kept as a secret
56. ***Female insomnia and irritability, psychosis symptoms, she was on some weird drug (
trichloro ----) for 2 years and became good but she stopped itbecause of stiffness, even when
she stopped symptoms came back ?
A. Quitiapine
B. Clozapine
C. Same drug she stopped
57. Old male on antidepressant for 8 year, MMSE score- 23 , now irritable and insomnia, not
socially active, lazy all the time, don’t talk to anyone ?
A. increase antidepressant
B. change antidepressant
C. Add Antipsych with antidepressant
58. You r in family party, your cousin have exam next week, want BZD ?
A. Give BZD
B. Give melatonin
C. Physiotherapy & exercise
D. tell his parents
E. Tell him to see formal doctor for advice
60. Male, pancreatitis two months have tenderness and fullness in Abd. , On CT 10cm
Pseudocyst ?
A. Endoscopic Gastrectomy
B. Laprotomy
C. Percutaenous Gastrostomy
61. Middle age 47 or 48 yr non to have IHD, have RUQ pain, put stent from 2 months, on
clopidogrel, pain resolved, but after 9 week the pain comes back. on U/S stone was in neck of
gallbladder, there was fever n chills n tenderness, no jaundice ?
A. TranscutaenousColycectectomy
B. Antibiotics
C. Stop Clopi n Make operation in 5 day
D. Give hip platlets& Do operation
63. A woman on prosthetic valve, she is takingMarevan( warfarin) and you are checking her INR
every week.
Date INR WARFARIN dose in mg
2nd April she was on 4 mg her INR is 1.5
9th April she was on 5 mg her INR is 1.8
16th April she was on 6 mg her INR is 2.1
23 April 2.1 ?
what is the dose of warfarin will you give for this week?
a. 5 mg
b. 6 mg
c. 7 mg
d. 8 mg
e. 9 mg
64. PE recall, female came from england, after flight low grade fever, dyspnea, chest pain? --->
CTPA
65. Sudden pain in smoker, IHD Hx, PVD Hx, sudden pain and pallor in left Leg, on examination
felt femoral pulse but no popliteal pulse, best Mx ?
A. IV heparin
B. Unfrac. Heparin
C. Warfarin
D. Verapamil
66. Old DVT Hx, now low grade fever, calf muscle redness and tender, ankle redness, best Inv ?
A. Blood culture
B. Lower Limb Duplex
68. 5 yr , symptom of severe asthma, admitted to hospital, nebulized by salbutamol & took oral
steroid, Now want to discharge ? (what to give)
A. Fluticasone
B. Oral Steroid
C. LABA
69. Male immigrant, Chest symp. ,Xray done . its apical tb, sputum +ve bacilli
A. INH 9 months
B. Isolation
70. Periorbital cellulitis, eyelid swelling, orbital redness, fever, he can move eyeball, what is Rx ?
A. IV fluxacill.
B. Oral AMox
C. IV Ceftriaxone
periorbital = preseptal cellulitis
mx:
1.orbital….admission
with
iv
flucloxacillin+3rd generation antibiotics
2. Periorbital cellulitis
a.
mild
(no
fever)….oral
antibiotics
(see
below)
b.moderate
(with
fever)…
admission
and
iv
flucloxacillin
c.
severe….
Admission
with
iv
flucloxacillin
and
3rd generation cephalosporin
72. 24 yr female, no GI symptoms, anemia, IDA pic, Upper GI endo free, next ?
A. HB Electrophoresis if iron normal
B. Colonoscopy
C. Small bowel Biopsy if anemia
74. Male 70 yr want to do check up for insurance , Plasma Protien Increase, s.albumin 3 (n: 3.5-
5.5) , No symptoms ? (what to do next)
A. Serum immunoglobulin
B. Plasma Protein Electrophoresis
C. Bone Marrow Biopsy
MGUS might develop to MM ,, follow up yearly with electrophoresis
74. Young boy have asperger on sertaline , now irritability , cause ?
A. S/E of sertaline
B. Asperger Itself
75. Old Male, unconscious in bathroom, all labs normal, but blood sugar 9, Hx of prostatic
enlargment ?
A. Discharge & Let him see outpatient follow up
B. Admission
C. Insulin
76. Taxi driver, Sumptom of right side weakness for 10 min, resolved, CT normal, carotid duplex
also normanl, he is insisting on discharge to work as driver again.
A. Discharge but sign consent
B. Refer to neurologist to decide about driving
C. Tell him you can drive in 6 month
D. We need to assess driving after more Inv
E.tell him he will be ok and drive after investigation
77. Flu like Sympt. 2 weeks ago, now weakness in lower limb &dyspnea& sensory loss,
whichInv needed ?
A. CT
B. LP
C. MRI spine
D. Vit. B12
78. Spine X-ray bamboo sign, back pain, Now Can't bend, took PCM but not relieved?
A- Physiotherapy &Hydrotherapy
B - Rest
C – Methotrexate if sulfasalazine its right
79. Old male, backpain, Xray done, Little osteoarthritic changes in spine without compression
on spinal cord, he want opoids ?
A. GIve
B. Rest
C. Exercise
D. Tell him morphine is taken only in malignant pain.
80. 8 yr boy, fever 39, Hx of tonsilitis 1 week ago, Now fever n rash, toxic looks pale
1. Blood culture
2. Amox
Should be benzylpencilline or ceftriaxone (meningococcemia)
81. 80 yr female sudden loss of vision, tenderness over scalp, best Ix ?
A. Temporal Artery Biopsy
B. ESR
C. ANA
D. MRI
82. Girl fall, now fever and swelling? (what is next step and best step here )
A- Knee Joint Aspiration
B- Blood Culture
C- Xray Knee
D- Antibiotic
83. Boy 11 yr, BMI 22 , painful limp, impaired internal rotation, your Ix? -->Xray Joint (hip)
84. BMI 25 in boy, came for tonsillitis, you find that parents r obese too (old scenario)
A. Decrease watching tv
B.Wt. Reduction Schedule
C. Reduce Caloric intake
85. male attack of angina and hypertensive, 170/? ,s.cholesterol 5.5, most risk factor for IHD?
A-Angina
B-BP
C-Cholesterol
86. Peripheral vascualar disease & heavy smoker, S.Cholesterol 7.5 (increase), BP increase and
diabetic, after advice to stop smoking, what will decrease peripheral vascular dsz ?
A- BP control
B- Control Cholesterol
C- Control DM
87. old man back pain, no hypercalcemia, difficult in micturation, initial Inv ?
A. Bone Marrow Biopsy
B. PSA
C. Transrectal U/S
D. Serum Plasma Electrophoresis
89. 6 wk boy was ok and increase weight, 1 wk H/O vomiting but he is well hydrated but not
increase weight since vomit started ?
A-GERD
B-PS if increasing vomiting
90. Middle age man ,↑↑ ca, his father 75 yr have ca ↑↑ but didnt take Rx, PTH ↑↑, what is
your Inv ?
A. Urinary ca
B Parath. scan
94. Dumping recall : Pt had ca stomach, did partial gastrectomy, after meal by 1 hour have
tachycardia, sweating and hypotension, Dx?
A- Early dumping
B- Late Dumping
95. Bariatric surgery history 6 weeks, now abdominal pain and vomiting
A barium
102. BMI 14 in female, excessive exercise, you will do all inv, except ?
A- ECG
B- Electrolyte
C- Gonadotropin
D- LFT
E- Bone Density
A child brought by his mother .she complains that he is always obese in the class. On
examination ht. 96 percentile and wt 97 percentile. What will you find in this child
a.increased bone age b. hypothyroidism c . hyper parathyroidism d increased cortisol.
Q.24 Lithium toxicity , levels of lithium given. Tx
A) Glucose
dialysis
C) NaHCO3
Hydration is the first line
The mainstay of treatment is fluid therapy. Give NS to enhance lithium clearance. First step, intubate, to
avoid aspiration as vomiting is very common in lithium toxicity. Next, give IV fluid and maintain that to
achive normal GFR and clear lithium. If lithium level is above 4 mEq/L in acute toxicity or 2.5 mEq/L in
chronic toxicity, initiate hemodialysis. Charcoal is NOT effective at all. If within first hour, whole intestine
irrigation may be helpful.
Q.26 Old lady admitted in hospital, wishes to change her will to donate all her wealth to
animal charity and asks u to sign as witness. What do u do?
A) Sign
refuse
C) Refer to guardianship
D) Assess mental state
Q.36 Retinal detachment diagnosed already in question with blurring of vision.Mx
A) Pilocarpine
Head tilt this is the management after attempting pneumatic retinopexy to keep the
gas buble in con tact with retinal hole.
C) Acetazolamide
Q.45 Old man with Parkinson started haloperidol one month ago now has tremors.
Treatemnt?
A) Decrease Haloperidol better if stoped
Increase Haloperidol
C) Start Sertaline
Q.55 Teenager attends a party last night comes to you with fever tachycardia high bp.
Cause?
A) LSD
MDMA amphetamine
C) Cocain
Q.72 A lady 40 years old present with sever occipital headache and examination
reveals high BP . What next?
A) MIBG
24 hour urine catecholamines next CT abdomen
.103 Chronic diarrhea with foul smelling feaces. Cause
A) Shigella watry, severe diarrhea, abdom pain, fever, tachycardia
Giardiasis
C) Amebiasis Bloody diarrhea
Q.106 A man hits his car with a van complains of chest pain. All blood tests and ecg
normal. What will u give him?
A) Sublingual nifedipine
GTN patch
C) Metoprolol
Q.108 A patient had CABG and on clopidegerl. Diagnosed of pharyngeal pouch.What
will you do?
A) Put him on waiting list its not emergency
Suregry now
C) Surgery now with FFP
D) Surgery now with platelets
an xray of small intestinal obestruction of 60 yrs old pt complain from constipation since 3
days , now he develops nausea without vomiting, abdominal pain , no flatus has hx of
appednictomy 15 yrs ago what is the dx?
A. ca colon
b. sigmoid volovulus
c. intestinal adhesions
Ureteral lithotripsy done 8 hrsback ,pt was given amoxicillin as prophylaxis , developed
fever and unwell , how to manage ?
a. Ceftriaxone
b. amoxicillin clavu
c. genta
1- An old postmenopausal pt. with bloody discharge from one nipple, most probable dx?
-Ductal ca
-Fat necrosis
-abcess/Cyst
-Paget’s dis
2) 45years old man who had a hip replacement 2 weeks ago, present with sudden chest pain and
Hypoxia. O2saturation is 89%. He has aHx of renal disease. What's the appropriate investigation in
this pt
CTPA
V/S scan
ECG
CX-Ray
D-dimer
3- Most important measure for obesity regarding health aspect and risk Assessment
Bmi
Waist circumference
Discharge
Observe 4 hrs
Observe 24 hrs
CT head
35)year old boy with recurrent asthma attacks. What would you reccomend
Budesonide
Fluticasone
Salmeterol/Fluticasone
6)patient with bradykinesia and postural instability. He is taking risperidone for visual hallucinations.
What history will b asked to get Dx?
B recurrent forgetfulness
A7) patient with ischaemic stroke from 3 days , with cholesterol level of 7 and BP 180/100. He is on a
spring tt ... Most appropriate management?
Start statin
Perindopril
Mannitol
8)child with signs and symptoms of meningitis develops seizures, generalised lasting for 5 minutes.
His lab values are normal except for sodium of 120mmol/l. What to do next?
IV mannitol
3% hypertonic saline
Fluid restriction
Diuretics
9)ECGbradycardia with hyperacuteTwave only one strip….Middle age pt c/o light headach and
syncopal attack 3 episode in one month, bp 100/60 0r 90/60 ??he is on multiple drugs.which drug
comination will be tha cause of his problem? Actually confusing scenario not that simple.…
A.Amiodarone +Aspirin
B.frusimide+Aspirin
C.Amlodipin+Amiodaron
D.Aspirin+ Nitrtriglycerite
A – FBS yearly
b – FBS 3 yearly
C – OGTT now
11)PREGNANT LADY 8 WEEKS WITH A FAMILY H/O GDM IN HER MOTHER which become diabetic
later on ... ASKING ABOUT MOST APPROPRIATE NEXT
A OGTT IN 20 WEEKS
stop aspirin
add statin
Adult patient is under dexamphetamine treatment. If stops TTT abruptly which could be the
symptoms
Aggressive
Anhadenia (=dysphoria=dissatisfaction)
Auditory hallucinations
Paraanoia
Homicidal ideation
Patient known case of schizophrenia presents with akanthia, he takes marijuana and is on drugs too.
He want to stop all drugs, what to do now:
atrial fibrillation
,bloody diarrhoea,
abdominal pain
.45pt come with bloody diarrhoea and lt iliac fossa tenderness on examination. he took antibiotic 1
wks ago. wt the dx?
A pic of Ct scan something in liver scenerio was pt went to outside country & then presents with
abdominal pain fever after some days he return wts the dx.
a.hydatid cyst
b.hepatocellularca
Picture of ctbrain , scenario of RTA with no significant neurological symptoms initially, then
developed headache and confusion, asking Dx
-Extradural hge
-Subdural hge
-Intracerebral bleed
-Brain contusion
http://radiopaedia.org/articles/extradural-haematoma-vs-subdural-haematoma
Aboriginal mother brings baby for immunisation and leaves quickly no eye contact what will u do?
cultural and socio
A 26 yr old lady came at 18th week gestation with clear vaginal discharge, however she told that the
pregnancy was unplanned, fetal movement normal heart rate 144/min, her last pap smear was one
year ago. she
a.Fetalfibronectin test usually indicated between 22-35 weeks when there are signs of premature
labur
b. Low vaginal swab (usually to test for GBS at week 36 to know to give penicillin during labour)
e.Repeat Pap
Old age patient male with anemia, raised urea and raised serum creatinine with constipation. What
investigation needed for diagnosis: ( long scenario-I mentioned only abdominal one(
Serum electrophoresis if MM
Contracted pelvis
LOP position
Placenta previa
Cephalo-pelvic disproportion
55y old lady known with insulin dependent DM, has had right leg amputation 5yrs previously, now
blood pressure 175\90, normal regular pulse, BMI 32, LDL 2.8, s. triglyceride 4.5,hba1c was
8.5,fasting glucose was 9.5.Which of the following is important to keep her other left leg from
amputation?
Reduce LDL
A girl with recurrent dizziness vertigo every month. What’s the most important step in
management?
EEG
Ct if child
ENT referral
manual worker with swelling of whole rtul compared to the other side after heavy work
by saw machine:
Muscle sprain
usg
surgical exploration
child found by his parents wandering in the garden, he's disoriented, urine examination shows +++
ketones. what’s the aetiology
a.DKA
ketotic hypoglycemia
.28a univ.student asking for citificate to repeat her exam as she couldn’t sleep the night before due
to anxity
a.refuse
Business man got bankrupt, many financial problems, complaining of late insomnia, lack of pleasure,
loss 15 kg from his weight through 3 months, any many other symptoms of depression, his family
concern about him and the patient refused to take any medication as he doesn’t believe he is sick,
he admit he is tired and exhausted but not depressed, what’s this called?
A Denial
B Reaction formation
C Depersonalisation
D Rationalisation
(78One of ur inpatient woman hv told her brother secretly that she has a plan for suicide, he doesnt
want her to know that he called u
inform police,
.20obese lady comes to you with acne and some other symptoms,she has some visual
problems.what is contraceptive for her.
b.DMPA
c.Barrier
A child with signs and symptoms of meningitis develops seizures, generalised lasting for 5 minutes.
His lab values are normal except for sodium of 120mmol/l. What to do next?
IV mannitol
3% hypertonic saline
Fluid restriction
Diuretics
#SCREENING
42years Patient with colonoscopy negative, father when 55,maternal aunt when 62, what to do?
Fobt 2 yearly
colonoscopy yearly
colonoscopy 2 yearly
colonoscopy 5 yearly
.2child authority
women 3 months after menuause has hot flushes. wants HRT. but doesn't want unpredictable
bleeding. what to give.
cyclical HRT
continuos HRT
Female BMI 18 with repeated treadmill exercise and looks herself every hour in mirror and changes
clothes three times per day, dx:
Anorexia Nervosa
34w pregnant female after MVA the itrus tender abd at 37 w ,all the vital signs is good ,even baby
CTG, What's next
US
blood match
Ct urgently
Fluid
58years old man with painless slowly grieving mass in front of his left ear. He can't close his eye
properly . It's firm and seems fixe to the muscle.whats the appropriate Next investigation?
USG
laryngoscopy
x-Ray
FNA cytolog
wat will u do to find out the association btw melanoma and nevus?
cohort
Rct
case control
case series
E-cross sectional
.case of a ptpersent with foul smelling cough,high fever with rigor.there was no xray but they give
the finding ,it was opacity in middle zone with air fluid level,after giving flucloxacilin what next
.1transpleural drainage
.2waterseal drainage
.3aspiration
Ttt?
Amoxicillin clavulinic
Penicillin
Xray of pa and lateral chest with consolidation between right middle and lower lobe , with crepts on
lower lobe extending to middle of lung , dx?
d. irrelevant
#SURGRY
.after knee replacement surgery creatinin level increase plus oliguria.. next
IVP
B.retrogradepylogram
c.bladder us
player injured in knee...initially there was pain..pain subside rapidly..btthr was effusion..after 1
mon..all goes nor...bt sometimes he feels locking his knee in ful extension & sometimes his leg gives
away..wts the dx
2) History of soccer player injured his Rt Knee .Sudden pain and swelling and locking of
Rt knee
. WOF is the cause.
A Ant. Cruciate Ligament.
B Lateral Collateral Ligament .
C Tear of medial meniscus.
D Medial collateral ligament.
the answer is AAAAA if locking before swelling subsides
1) Football player suddenly feel acute moderate pain in his rt knee while playing after hours
the pain subsides but effusion expanded after some day when the swelling and pain settled
sometimes he felt his leg is giving away some time his knee is locked
Dx
Med meninscial injury
Fracture patella
Med meninscial plus ligamentous lesion
Ant cruciate ligament...
AAAAAAAAAA
Football player has an injury while playing after that there was effusion n he feels his leg
is giving away n some other time his knee is locked dx??
Ant cruciate lig injury
Med meniscal lig
Med meniscal+ ligament lesion
Fracture patella
*if effusion was gradual…the answer is bbbb
*if effusion was sudden and the locking is after
effusion subsides….the answer is CCCC
Engineer 3cm lacerated foot injury, received tt just from one week for another injury. What to give now
Tt
Tig
Tt+tig
No treatment need
55year old patient with low folic acid, howel jolly body, stomatitis, normalbowel, weight loss, inv?
.2colonoscopy
.3vitb12
55y old lady known with insulin dependent DM, has had right leg amputation 5yrs previously, now
blood pressure 175\90, normal regular pulse, BMI 32, LDL 2.8, s. triglyceride 4.5,hba1c was
8.5,fasting glucose was 9.5.Which of the following is important to keep her other left leg from
amputation?
Reduce LDL
A-Oral iron
B-Parentral iron
C-Packed RBC
female 14wks gestation come to ER because she can't void for some hours.she had USG at 10wks &
confirm gestation dates.Ut size 14wks.Abd exam tender mass midway below umbilicus.Dx??
Ectopic preg
Incarcerated ut
Ovarian cyst
Fibroid
A lady came 6 days before for routine PAP smear. After that first 4 days she had no problem. Last 2
days she is having lower abdominal pain, tenderness, fever. What to do for diagnosis?
Blood culture
Endocervical swab
Investigations
A definitive diagnosis is difficult since routine
specimen collection has limitations in assessing the
organisms. Definitive diagnosis is by laparoscopy but
this is not practical in all cases of suspected PID.
• Cervical swab for Gram stain and culture, PCR
( N. gonorrhoeae )
• Cervical swab and special techniques (e.g. PCR
for C. trachomatis
old man who has 3 months history of dysphasia,dyscalculia,Right left disorientation,he is heavy
smoker and drinker.what is diagnosis
C.brain abscess
D.gliblastoma
girl developed soreness down below 2 weeks ago after 2 times intercourse with her new boy friend,
she had mild dischrge and dysuria. now she is fine and her bf go away. wt the dx? (nothing
mentioned about weather itchy or not(
A.HSV
B.Candida
C.Chlamydia
Old pt with known bilateral chronic osteoarthritis, develop parasthesia and numbness in the lateral
side of leg below knee condition worse at night and improve after walking for 10 min, wt is the
important thing to examine in this pt?
Woman with 2 days history of vison problem on left eye and pain behind
the eye,right eye is normal.Left eye with 6/12 and right with totally normal
vision, normal papillary reflex and normal movements of eye particularly
mentioned. What’s the next investigation?
CT head
LP
Relaxation technique
Reassure
Clozapine
Fluxotine
Some lab
-20An X-ray of bamboo spine and mild pain asking about initial treatment?
Codeine
Paracetamol
Naproxen
Infliximab
3year old boy with recurrent asthma attacks. What would you reccomend
Budesonide
Fluticasone
Salmeterol/Fluticasone
young male who felll suddenly in the field of a match , without being touched,after a few MINUTES
he regained consciousness without any intervention and continued playing what is the case?
B)-Jacksonian seizures
C)- arrhythmia
.22scenario of varicose vein and mi and on clopidegral started 7 days before.pt is on stent and
clopidegral..
refer surgery after 12 months and stop clopidegral 10 days before surgery
do surgery now
Pt on antisychotic and diazepam got some side effects which i felt mild , no fever, no rigidity but
asked why he had them:
B.Antipscyhotic
C.benzodiazepam toxicity
Mother came with her 9 years old boy complaints of progressive decline in his school records up on
which mother started to beat him by wooden spoonful and isolate him for hours for
punishment...mother has pat history if depression...what will you do
patient complaints of dysurea and blood in urine, but no fever, urine analysis shows ++blood, ++ pus
cells, bacterial growth is -ve, what’s the aetiology:
TB nephritis
perinephric abscess
cancer bladder
13Mother comes with 10 months infant with height 45 head size 25th at birth then now increase to
75 percentile now .. On examination child is mild hypotonic with open anterior fontanelle ,other
examination normal,feeding well, what to do??
Ct head
Check cmv
C.tsh
Usg head
Another antibpsycotic
Postoperative second day agitated and confused what is next
pulseoximetry
ABG
CXR
electrolytes
Man with urinary retention mass above pubic symphysis, DRE done enlarged prostate, median
sulcus papable, catheter inserted, what next
Transrectal US
PSA
Abdominal CT
A 27 yrs. old lady with pelvic abscess scenario, breast feeding her baby and has allergy to penicillin,
what to give?
Ampicillin +metronidazole
Doxy+ metronidazole
Ceftriaxone
Cephazolin
scenario of coal mine worker 55 yr old man has nocturnal cough and difficulty in swallowing with
long hx of smoking .. what is the next apprpraiteinv
endoscopy
boronchoscopy
ct chest
A patient had chronic limb ischemia. What is the sign most consistent with this?
Dependent rubor
Child with 48 hours rhinorrhoea and lots of absence among his classmates due to influenza like
illnesses, asking best to do? Check influenza 7 days off school (exclusion usually for 2 daysL) Wear
a face mask Oseltamivir (within first 48 hours only) Give vaccine (no prophylaxis for influenza)
Female with fracture in femoral neck, has written consent not to transfer to hospital if seriously ill.
You give morphine and she becomes drowsy, what next to do now:
familymetting
regular analgesics
Pt had colon cancer dukes c operated 1 yr ago and had chemo. What ix to do now. Pt is well. CEA
sent already.
CT colonoscopy
Colonoscopy
Abdct
25years old woman presented with painful mensturation (no menorrhagia mentioned) she is taking
30 mcg OCP and wants to conceive in 12 months
continue OCP
mirena
depoprovera
.5Man with swelling 1.5 cm in scrotum testes & cord palpated normally , no pain or urinary
symptoms , whats is the definitive treatment ?epididymal cyst
B)aspiration by needle
https://www.andrologyaustralia.org/testes-problems/scrotal-lumps-and-inflammation/
Surgical Therapy
Spermatocelectomy via a transscrotal approach is the primary operative intervention for spermatocele, and it may be offered
to any reasonable surgical candidate. Systemic anticoagulation and desire to father children are relative contraindications.
65year old lady nulliparous comes with painless bleed from the nipple on 9ne side..
Intraductal papilloma
Ductal ectasia
Invasive cancer
Paget disease
A 2 year old boy comes with history of harsh unproductive cough for 2 weeks. He is afebrile and all
physical examination is normal. What is to be done for diagnosis?
Chest X-ray
Nasopharyngeal aspirate
Bronchoscopy
Ct chest
E Serology.
ECG of a 6 year old boy complaining of palpitations since four hours.Ecg was of wide complex
tachycardia for sure..it wasn’t like typical SVT. He looked well and respiratory rate was 24/min. What
is the management?
IV sotalol
Iv adenosine
#psych
a patient with some psychotic illness on Dothiepin…asking about the most common side effect of
dothiepin (TCA)?
cardiacarryrhmia
hallucinations
tremor
insomnia
.859Famous recall of child born befor 37 week due to maternal problem, he is now 11 month and
can’t sit with HC, weight and height in 10th percentile
Due to prematurity
CP
Hypothyroidism
Autism
Familial
A patient on peritoneal dialysis who was going well suddenly declined to have dialysis. On
examination she was having slight temperature and mild tenderness in upper abdomen. What
finding you will most likely find in this patient?
A Disorientation
B Depressed mood
C Blunted affect
Pic of cleft lip baby born for 41 years old mother using carbamazepine and alcoholic and ask what is
the cause in this case
Genetic
Alcohol
Carbamazepine
Maternal age
Most teratogenic in last trimester?
a. anticonvulsant b. antipsycotic
case of old woman with vaginal bleeding, she didn't have sex 1 year ago, her menstraution stopped
11 m ago, what is the cause of her bleeding?
-cancer endometrium
-vaginal atrophy
-follicular stimulation
-cancer cervix
A boy came to you with history of ear discharge 2 weeks ago, his tympanic membrane looks dull and
retracted and there’s yellow discharge from his ear. What’s the nest step in management?
Amoxicillin
Ear toilet
Pt on melatonin tt, police has arrested him from 2 days drunk, they take from him urine sample for
drug screening ...he comes today for you to prescribe for him melatonin again..what to do
6years girl presents with urti and urine analysis has protienuria and rbcs, previously she has
episodes of urinary incontinence, what next to do to her
Urine culture
Us
patient was brought to emergency room after a fight causing a stab with a knife in the chest
patientbut O2sat is decreased he is lobular ed speak, he has dyspnea , on examination he has
dullness to percussion , decreased air entry on both sides..
Give O2 Next
- Give O2
- Rescucetate intravascular volume by giving fluid
- Chest tube
- Then after stabilizing the patient, assess the injuries.
- If massive pneumothorax is suspected, proceed with thoracotomy.
P.S for tension pneumothorax, (trachea shifting to the contralateral side, and resonance on the affected
side), place 3 sided dressing to prevent air sucking in, and insert needle in separate space to deflate the
pneumothorax.
Female who did not have sex before ,gonorhea is +ve, what is next
Repeat pcrgonorhea
#OPTHAL
Warm compression
i.vantiobiotics
incision drain
#DERMA
Q.37 Melanoma skin care screening. 4o years old IT guys come for screening. What would be the risk
for him? That’s all given in exam. Nothing mentioned.
INCISIONAL HERNIAS EXAMINATION. Lay the patient down, and put your
hand through the weakened area in his abdominal wall to feel the size and
shape of his hernia. It may be elliptical, or irregular, and he may have
more than one. Ask him to raise his head and shoulders off the couch
without using his arms. This will fill the sac and show you its true size.
If the hernia followed Caesarean Section, ask the patient to contract her abdominal
muscles. If her recti become taut, almost meet in the midline, and grip your fingers,
you should be able to repair her hernia without too much difficulty
Patient with palpitation and fear with idea that he will got HIV from stairs of the mole in spite that
his GP told him that it can’t be transmitted by this way
GAD
Schizo
OCD
patient travelling to endemic area of TYPHOID,, what is ur advice
A Bottled water
C wash hands
Pt has ra she is on chronic steroid tt 10m predinisolonedaily , now came with chest infection with
distress, with iv fluid what you will give
IV hydrochortisone
2years old boy found roaming last night in the hose with altered level of conscious and till now he
don’t react with his parent
DKA
Hypoglycemic ketoacidosis
Meningitis
Cerebral insult
.16pt with neck stiffness, csf findings: lymphocyte 2000,(forget about glucose and protein) rbc 200,
temperature 37''c . wt next?
iv a
1) Pyromania Recall :
Q. In australia almost every year there are sevral indication of bush fire usually it is usually by youn
people which of the following is true ?
A. Junenil pyromania
B. Due to accidant fire caused fire by yongster who get scard after the fire start to speed
uncontrolled
C. It has serious consequences
D. Yongsters like to ingnite and play with fire
E. It is done to hide crimes
Q. pyromania is seen mostly in youth generation. What leads them to do this?
1) to show heroism
2) childhood instinct to fire and fire fighting objects
3) as a display of revenge and anger
2.FTD –I forgot what I choose Both minus 7 and verbal fluency was there
Q.wife brings husband with strange behaviour , recently thrown out of job and he makes silly jokes
and dresses badly etc what will help in detereming the cause
A- minus 7 test
B-copying pentagon intersection
C-disorientation to time
D-verbal fluency test
Q.A scenario which seemed like sarcoidosis young girl with painful nodules on both shins
from 6 weeks,had severe ankle pain and swelling from two weeks,she has dry cough and
exertional dyspnoea and her ace levels are high.Most appropriate investigation
a)respiratory function tests
b)skin biopsy
c)ankle aspirate
4.another sarcoid-loin pain hematuria-CT chest
Q. one chest xray given with reticulonodular shadow..pt complains of 3 months progressive
dyspnea..now intermittent loin pain ndhematuria..calcium raised..next
a. serum ACE
b. CT chest
c. urine microscopy and culture
5.EcG-inf MI,two “I dunnowT hell is it ‘ ecg..pt confused on multiple drugs I choose stop all and
reascess
Q.ECG Not clear one with many ectopics, the old one with biventricular failure & many drugs asking next
?
A. Stop all and reassess in 12 hours
B. Increase digoxin dose
C. Give furosemide
Q. SbOxray with nausea vomiting abd distension and constipation. No medical history, history of
appendicectomy 15 yrs.
a. adhesion obst
b. pseudo
c. ca caecum
7. old man,chronic constipation for 1 month only now with LBO features-no xray-I choose
Volvuluscz (I probably wrong ,Ca was there )
Q.old age pt with hx of constipation for 1 month , now presented for 24hr with colic abdominal pain
with distention…Tympanic sound on abdominal percussion. No previous H/O surgery
No x ray given …. Whats most likely cause ?
-sigmoid volvulus
-ca sigmoid
-adhesion
8. algerian lady with CA cecum
Q.70years Algerian lady with weakness and anaemia and is vegetarian lab inv given typical of
microcytic anaemia.cause
1.hook warm infestation√
2.ca cecum√
3.vit B12 deficiency
4.thalassaemia minor
5.diet
Q.Young age boy with diarrhea, stool feel greasy, anemia was given , anti glidin and others were
normal, what next invest
a.ctabd
b. small bowel biopsy
Q.(related Q) A young girl comes with history of diarrhea , no blood. There is perianal excoriation.
What will lead you to diagnosis?
a) small intestine biopsy
b) biopsy shows flat atopy of intestine
c) biopsy shows granumatous
10. Two trauma scenario, One open flail chest ,at the scene –cover the open wound =opioid
Q. Ctg showed reduced baseline variability and variable deceleration (ctgnot given)
the mother had 4 cm cervical dilation within 14 hours , pethidine was given to her 3 times I guess
the fetal head is in the left occiput posterior. What is the cause of ctgabnormality
a. prolonged labour
b. sedative drugs
c.elevated resting uterine pressure
d. molding of fetal head
Q.female ,39 weeks of gestation,200 ml painless bleeding. on palpation ,uterus is soft ,nontender. on
examination-cervix is 3 cms ,dialated with membranes clearly visible, what to do next-
a. amniotomy
b. admit and observe
c.urgent
d. c.s section
13.renal mass qs, 55 years man with hematuria ,mass 3 cm on ct, no partial nephrectomy I
choose left nephrectomy
Q. (Similar Q) Patint presented with hematuria.On USG there is 3 cm mass on the upper pole of right
kidney.whats your next step of MX
1.Percutaneous biopsy
2.Right nephrectomy
3.Review in 6 month
15.PKD with LUT obstruction,thr was no retroh\grade urethrogram or cystoscopy I forgot wht I
choose
Q. (Similar Q) Case of polycystic kidney disease on annual follow up presented with hematuria and
GFR 20 asking what of the following would help you to find if there is lower urinary tract obstruction
a.renal us
b. CT abdomen (not pelvis)
c. IVP
d. retrograde urethrogram
e. another test with contrast
17.cecal volulushemicolectomy q
Q. pt with hx of hemicoloctomy for sigmoid volvulus presented with moderate to sever abdominal
pain , distention, x ray was typical for cecal volvulus whats mot app treatment
-colonoscopy
-baruim enema
-hemicoloctomy
18.pt has spinal stenosis and on statin,now comes with hip muscle weakenss
wht to do
CPK
Doppler
MRI
Q. man wondering in the shopping ,mall whole day ,peoples house door to door,sometimes raising
his hands and stand or seat aimlessly,dx
1.hepatic pathology
2.schizophrenia
3.manic
20. Post accident husband with anger anxiety having said his wife didn’t die again say he can
hear dead wifs spirit calling hin
temazepum
Q. A young man brought to you.he is distressed,teary and angry on a someone who has killed his
wife by passing a vehicle over her when she was crossing road 3 weeks ago.he says he can see his
wife or listen her voice,also he says his wife is not really dead.
1.temazepam
2.olanzapine
---------------------------------------------------------------------------------------------------------------------------
Xray of fecal impaction .. No flatus n cinstipated for 3 days .. History of surgery 30 years ago…I think this
scenario
[[ Full stem- x ray old Woman 71 years old with constipation and didn’t pass flatus since three days
abdominal distention nausea without vomiting with hx of appendectomy when she was 30 years with
a reducible inguinal hernia , what is the cause
a. colon cancer (my answer)
b. adhesional obstruction
c. obstructed hernia
d.fecal impaction]]]
---------------------------------------------------------------------------------------------------------------------------
Xray of sigmoidvoluvulus once operated comes wid central abd pain .. No stool flatus .Xray image rif was
empty nihaustrationscoffe bean btkying in the lifMangennt next appro asked Surgery hemicolectomy (ans)
.{{ Full stem- A patient who had a history of sigmoid colectomy (or previous similar attack am not
sure) for a previous episode of sigmoid volvulous, now presents with severe abdominal pain and
distension, the X ray Abdomen was given and the typical coffee bean appearance was seen. It was
volvulus! What is the most
appropriate management?
a. Hemicolectomy
b. Enema
c. Colonoscopy
d. NG tube}}
---------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------
Ecg 1st degree heart block Cease meto (ans) Cease meto start verapamil
i think full stem is {{ Ecg of 65years old man on hypertensive treatment & history of MI 3yrs ago ,now
all examination is normal except of soft blowing precordial murmur on the left border of sternum.rate
around 50/min.what to do ?
A. cease digoxin
B. cease metaprolol& commence verapamil
C. add warfarin}}}
---------------------------------------------------------------------------------------------------------------------------
Ecg looked like bigemenybt dig was nirmal was mobitz type 2 hr 35 Temp pacing (ans)!
---------------------------------------------------------------------------------------------------------------------------
Ecg a fib was on dig 0.125 mg and multiple drugs for heart failure htn Option increase dig Other options
irrelevant cant remember nth related to a fib though Dc cardioversion was tehrebt the patient was stable
hr n bp
I think very old recall 2015 .. Full Stem …………… {{{ 7 yrs old lady presents with chest pain. She was
on nitroglycerine, diltiazem 60mg, digoxin 0.125mg, enalapril xxx. On examination she is found with
biventricular enlargement. ECG: (seem to be grade II A-V block & T wave inversions, ventricular
entopic, HR: 50-65/ min). what is the best management?
Stop all medications and review in 12 hours (I think this)
Increase the dose of digoxin
Commence of colvexin
Infusion of potassium
Commence on frusemide }}}}
---------------------------------------------------------------------------------------------------------------------------
Fourniers gangrene pic immediate management Debridemnet (ans) Antibiotics Blood culture
---------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------
Xray sarcoidosis was quite confusion there wws diaphragmatic herniation seemd so sth over the heart
protuding like a arrow presnetwid hematuria loin pain 3 episodes in a week Asked invetsigationi went
widctabd S calcium
I thnkthis Q similar to this stem …….{{ Sarcoidosis xray( bilateral reticular shadowing) with dyspnea for
3 years and episodes of loin pain and hematuria . what is the most appropriate management
a. calcium level
b.ct abdomen }}
---------------------------------------------------------------------------------------------------------------------------
?????
21 yr old went trekking 2 days ago presnetswid painful swelling "over teh inguinal ligament" nonn
reducible no fevr nth Femoral hernia Inguinal hernia Inflammedlykph node i ticked this Saphen varix was
confused betnn two
---------------------------------------------------------------------------------------------------------------------------
Mgus scenario nth on bone xary slightly elevated plasma proteins Managembet asked Bone scam Bm
biopsy Annual review of plasma proteins (went widthis )
---------------------------------------------------------------------------------------------------------------------------
Women on trifluphenazine well controoled left drug when she started developing tremors one yr back
Now thinks has intestinal worms whole over her body initial treatment asked Halo
TrifluphenazineQuietapine (ticked this Depot risperidone conta
---------------------------------------------------------------------------------------------------------------------------
Mother worried child 2 yrs non toilet trained but waked at 12 months says mum dad undresses rest
normal Normal child (ans )
---------------------------------------------------------------------------------------------------------------------------
11 months pre mature delivery ( cant sit unsupported had icu admission Diagnosis Dev dlay due to
prematurity CpansHypothyroid
---------------------------------------------------------------------------------------------------------------------------
Man widstmptoms of bph comes with acute retention dre reveals firm prostate wid clear medina sulcus
after catheterisationPsaBm biopsy Transrectalusg (ticked this)
---------------------------------------------------------------------------------------------------------------------------
Man from afghan bloody sputum chest crackels sputum postive for afb next step Ct chest PcrInh for 6
months Islolation in a negative pressure room( ticked this though negative pressure made me a lil
doubtful )
---------------------------------------------------------------------------------------------------------------------------
A female 3 montshwristbjoint comes widdiplopliahemsturiahtn wat inx to reach diagnosis Esr Ana Rf S
urate Ancai did this
---------------------------------------------------------------------------------------------------------------------------
Charcot marie investigation for diagnosis Child cant climb stairs mither had same wid arch feet reflexes
normal lost muscle bulk Nerve comduction (ticked this Ecg Ct
---------------------------------------------------------------------------------------------------------------------------
Accidnet many ribs farcture patient is severlydyspnei severely cyanoses nth else mentioned one liner ..
Wat will u do at accident site Cover the wound Needle thoracostomy( wentwid this since was severly
cyanosed nth mentioned abtbo pulse ) Morphine
---------------------------------------------------------------------------------------------------------------------------
Anitherct chest given pneumonwws there btni tracheal devuation maintaining spo2 96 innsevre pain inn
breathing Needle thoracistomyMorphinen(at accident site ) went wid this
---------------------------------------------------------------------------------------------------------------------------
Pilonidal sinus ..Recurrent Fustulectomy (ans )Marsupialisation Antibiotics …HB 3.008 JM 382
---------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------
Antenatal women at 39 weeks wid 3 cn cervix 200 ml bleeding uterus softbnon tender vitals stable fhr -
110 .. Wat will u do ??
Send home
Cs
Amniotomy
---------------------------------------------------------------------------------------------------------------------------
Alcoholic abo lady seldom sees doctor brought by her friend has features of dcm(dilated
cardiomyopathy)
Mr diastolic murmur is dyspneic wat is the most appropriate u can do for her managemnt??
Ecg
Xray
---------------------------------------------------------------------------------------------------------------------------
Asthmatic child history of eczema motehr ha shay fever father smokes best preventor
Fluticasone
Budesonide
Oral predni
I think this stem{{ 5 years old boy with cough from 12 months before, was on salbutamole n also tkn
oral prednisolone.. he has an
eczema history, both parents are smokers,( typical asthma scenario) which one is the best
medication for prevention
which is used in “INHALATION MODE”?
a. monteleucast0……oral
b. Chromoglycate
c. Salbutamol
d. Fluticasone
e. Salmetrol }}}}}
---------------------------------------------------------------------------------------------------------------------------
Nebu salbutamol
Oral predni
Inhaler fluti
Intubation
---------------------------------------------------------------------------------------------------------------------------
Child asthma has nocturnal n exrcise inducesymptoms . Kept in hopital 1 day treatment with oral predni
n nebu salbutamol .. Wants to discharge tomorrw .. Most appro in the ongoingbtreatment??
Inhaler fluti
Oral prednisolobe
Montelukast
---------------------------------------------------------------------------------------------------------------------------
Driver alwys late for works wahses all keys nncounts them .. Thrown from job
Obsessional behaviour
Compulsary rituals
Mannerism
Full stem……{{ A truck driver was fired from his job because of always being late. He makes sure that
he wash all the keys one by one so that nothing bad will happen on the road.
What does his behavior denote?
A. Obsession
B. Compulsion
C. Mannerism
D sterotype }}}
---------------------------------------------------------------------------------------------------------------------------
Pregnant lady husband beats twice n doent leave marks tells u abt it next
Urgent admisson
Call police
---------------------------------------------------------------------------------------------------------------------------
A man wife died when hit by a car 2 weeks ago tearful n angry at times cant forget the event cant sleep
properly presents to u wat mext
Temazepam (ans )
Olanzapine
Haloperidol
---------------------------------------------------------------------------------------------------------------------------
Old day post cystoscopy wid epidural agitated accusing of sexual assault on her
Olanzapine
Risperidone
Lorazepam
Diazepam
---------------------------------------------------------------------------------------------------------------------------
Old day presents wid painless hematuria three episodes urine rme shows blood +++ wat next appro
Cystoscopy
Ct abd
Ivp
Xraykub
---------------------------------------------------------------------------------------------------------------------------
One man wid polycystic kidney disease on annual review wat investigationn to detect the lower urinary
trctobstructuon
Cystoscopy
Abdct
Contrast ct
Usg
Retrograde pyelography…
Full StemCase of polycystic kidney disease on annual follow up presented with hematuria and GFR
20 asking what of the following would help you to find if there is lower urinary tract obstruction
a.renal us
b. CT abdomen (not pelvis)
c. IVP
d. retrograde urethrogram
e. another test with contrast
---------------------------------------------------------------------------------------------------------------------------
Young child urti comes with features of urti urine shows hematuria protein + cines fta two weeks urine
analysis unchanged shows blood dx ??
Psgn
---------------------------------------------------------------------------------------------------------------------------
Man comes with progressive bluriing in the left eye fir 2 days no headache no ither features wat invxnxt
??
Mri
Ct head
Ct angio
Esr
Stem {{ 80 year old man present with 2 days h/o blurring of vision.there was no headache and
opthalsmoscopycant be done due to cataract .what is next inv?
1.esr
2.lp
3.carotid artery duplex
4.mri }}}
---------------------------------------------------------------------------------------------------------------------------
Presnislone
Antibiotics
Iv fluids n Lasix (can’t be because of fluid in the option)
Iv hydralazine (not the best, but the only possible option here)
Stem {{ Child with URTI and after two days presents with BP 140/90, edematous face and bilateral
ankle adema, urinalysis show rbc++,protein++, aso titer raised, what to give him:
a.Iv hydralazine
b.furosmide+iv fluid
c.steroid }}
Post strep GN is treated by 1. diuretics and fluid restriction 2. Ace inhibitors and CCB
---------------------------------------------------------------------------------------------------------------------------
Doppler usg
Blood culture
Xray ankle
---------------------------------------------------------------------------------------------------------------------------
15 gal came by herself doenst want to tell her oarents has been feeling low no suicidalmthoughts .. No
interest in stidies ..Mangembet
Cbt
Relaxationntherapy
Fluoxetine
Mirta
---------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------
Testesteronethrapy
Calcutriol
Iv calcium
Similar Q: 1)An 80 year old man came to you following surgery for fracture neck offemur after a fall.
Routine laboratory tests done all normal. Morning testosterone was 8 ng/ml (8-50 is normal) and
calcium was normal, Vitamin D however was very very low (0.12). What will you give for Mx?
A) Alendronate 70 mg once weekly
B) Calcitriol 0.25 gm daily
C) Calcium 1000mg with Vitamin D 600 IU daily (I think, recheck)
d. testosterone replacement.
2)80 years old man with fracture femur. He takes long list of drugs amongst is oral steroid intake
every period to control his COPD. His investigations showed low vit D and calcium, low normal
testosterone. Next step?
Give alendronate
Give calcium
Give vit D and calcium
Give calcitrol
Give testosterone
---------------------------------------------------------------------------------------------------------------------------
Pre op for hystercetomy calcium is 1.8 otehrs normal afta one week still calcium low wat will u do
Iv calcium
Oral tabs
Injvit k
Stem ………a woman was admitted to the hospital for elective hysterectomy. the pre clinic test her
calcium level was 1.8 and now it is still low (nothing mentioned about symptoms)
what is your management
a. iv calcium
b. calcitriol
c. ca carbonate……………..
SimialrQ : 40 yr woman came for precholecystectomy visit, she had thyroidectomy 5 yrs ago her ix
showed Low ca 1.9 Low vit d Tx?
IV ca
Oral ca
Calcitonin
---------------------------------------------------------------------------------------------------------------------------
Fractur femur old lady says has easy bruising bt platelet count n morphi normal has stent on clopidrogel
Urgent surgery
---------------------------------------------------------------------------------------------------------------------------
One man feras getting in train lost 5 kgs is depressed no interest cant sleep at night management initial
Realxationexrcise
Fluoxetine
---------------------------------------------------------------------------------------------------------------------------
Old lady lost 10 kgs severe depression says her instestinerittendoenst eat brought by son .. After giving
iv fluids. Most appropriate management
Ect
Escitalopram
Fluoxetine
Cbt
---------------------------------------------------------------------------------------------------------------------------
Post partum mild depression baby 1 month n she is separated from her husband most imp un her
management??
Cbt
---------------------------------------------------------------------------------------------------------------------------
Obse
Normal
Underweight
---------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------
Stop tv watching
---------------------------------------------------------------------------------------------------------------------------
Went to papua guinea 3 weks back 10 days agi started diarrhoea .. Has weight loss n abdpain ??
Etec e coli
Giradiasi (ans )
Amoebiasis
Camplyo
Shigello
---------------------------------------------------------------------------------------------------------------------------
This one was cifnusing lady 3 weeks gradual headache then she develiped mild neck stiffnes .. No other
features on csf
Monocytes increased
Protein decreased
Glucose decreased
Echo
Mycotb
Listeria
Similar old scenario: Pt, T-37, mild neck stiffness,3 wkheadache. Lp reveals:
PMN 1*10^6(0)
Mononuclear cells 20*10^6(1-2)
Protein: Increased
Glucose:Decreased.What’s the most likely organism:
A.Echovirus
B.ListeriaMonocytogens
C.MycoplasmaPneumoniae
D.Mycobacterium Tuberculosis (no suggestive history)
E.Cryptococcus monocytogens (in HIV)
---------------------------------------------------------------------------------------------------------------------------
Young couple cant conceive for two years female ovulation usg all normal intercouse on evey alt day
..male semen count 15 million abnormal 75% motility 50% cause
Tubal cause
Semen abnormal
Bad timing
---------------------------------------------------------------------------------------------------------------------------
Had that pof scenario fshlh increased oestrogen reduced 3-4 cyst on usg-Dosent want to conceive
then OCP& Want to conceive then HRT
---------------------------------------------------------------------------------------------------------------------------
Another similar wid hypothalamic fshlh normal oestrogenskightkybreduced on usg 3-4 cyst..dysfunction
of unknown origin
Stem.{{ 24 yr female had 2 babies before, amenorrhea 2 years, all normal hormones (prolactin,
testosterone,FSH,LH) , estrogen 70, US 3-4 multiple cyst, Dx ?
A. PCOS
B. Hypothalamic dysfn.
C. Pituitary Adenoma
D. POF
Same above Scenario but ↑↑↑ FSH and ↓↓↓ estrogen, Dx?
A. PCOS
B. Hypothalamic dysfn.
C. Pituitary Adenoma
D. POF }}}}}}}}
---------------------------------------------------------------------------------------------------------------------------
Young gal nullipara wants to conceive in 12 months dysmennorhoes despite 30mcg ocp
Increase ocp
Pop
Iucd
---------------------------------------------------------------------------------------------------------------------------
Pethideneinj slowing of heart rate n ctg shows reduced baseline variability n increased variable
decelrationsprimi 14 hrslabourwid 4cm dikatation
Cause
Prilongedlabour
Caput
Incordinate contraction
Pethidine (ans )
HI guys these are some recalls ….I think moslty from last 6 months but with different opionsso it will
change answer too so don’t rely only on recall ans…I also got some new questions too .I Will update
later.Be carefull about time Mx most of the questions with long scenario ,few only one line quest
9. CHILD WITH ASTHMA HISTORY SIMILER TO OLD RECALL ON SABA 4 HRLY, AND ORAL
PREDNISOLONE TAKING SABA FOR AS A EXERSISE PREVENTER,LONG SENARIO ASKING FOR
MANAGEMENT FOR ONGOING SYPMTOMS?
E. SABA
F. ORAL PREDNISOLON
G. CICLESONIDE
H. BUDESONIDE/
10. SAME RECALLS 9 MONTHS BABY BRONCHEOLITIS …RSV CAUSE
11. MMR AND EGG ALLERGY SENARIO
10.68 year old female have menopause at 55 , present with purulent brown-greenish vaginal
discharge for 6 day , she is sexually active, what is the cause , previous pap smear normal
a. Chlamydia
b.endometrial Ca
c.gonnorea
d.ovarrain ca
12.Pic of middle lobe pneumonia in 50 yr old male with fever,cough and malaise from 5 days,
tx asked
Augmenton
Benzyl penicillin
Flucloxacillin
13Mother comes with 10 months infant with height 45 head size 25th at birth then now
increase to 75 percentile now .. On examination child is mild hypotonic with open anterior
fontanelle ,other examination normal,feeding well,what to do??
Ct head
b. Check cmv
C.tsh
D. Usg head
14.a female had a normal delivary of a normal weight baby , there was perianal tear that was
small and didn't needed suturing , after the delivary she noticed that her locia didn't flow well
in the following days , and at Day 4 she presented with heavy bright red bleed with fever of
37.5 what is the reason for fever
A)endometritis
B)cervical tear
C)infection with perianal tear
D)DVT
15.Male 60 0r 65 ?withho backache had sudden vertebral # at T8/T10 …after lifting of heavy
things..(.no history of ca)
ESR 104, HB 10.4.,low plt.144 wbc normal., ca .normal 2.4..What will do for to rule out
diagnosis?
A)bone marrow
B)PSA
C)testeron
16.A man with rheumatoid arthritis and HTN is on thiazide ,chloroquine ,aspirin ,enalapril,
feeling lethargic and fatigued.
C/F pale, HR ~80bpm BP normal
Lab inv: hb-low, leukocyte-low, platelets-low
What is the cause:
A. Chloroquine
B. Thiazide
C. Aspirin
D. Enalapril
17.bamboo spine. Pic pt on paracetamol+ physiotherapy for ….long time but not getting
better .what will next step Mx?
A.physio
B.mtx
C.sulfasalazine
D.steroids
E.infilixamb
18.female ,pg 18 wks , sudden frontal headache, bp 80/60, pulse 90, on exam: confused and
drowsy, heart normal what inv:
A.Mri
B.Us
C. Echo
D.CTG
19.ECG bradycardia with hyperacuteTwave only one strip….Middle age pt c/o light headach
and syncopal attack 3 episode in one month, bp 100/60 0r 90/60 ??he is on multiple
drugs.which drug comination will be tha cause of his problem? Actually confusing scenario
not that simple….
A.Amlodipin +Aspirin
B.frusimide+Aspirin
C.Amlodipin+Amiodaron
D.Aspirin+ Nitrtriglycerite
20.youngpt 2weaks pain in shoulder with limited abduction and flexion of shoulder after
lifting of heavy things …what is the initial Mx?
a- paracetmol b-MRI c- intrarticular Cortisone injection
21.parents brought 3 yrs old son with c/o room spinning around with no loss of
consciousnesses and lasting for 1-2minutes every month for last 3 months and subside
spontaneously.No h/o headache or vomiting. Ear examination normal .What will you do ?
A.EEG and CT scan head
B.Audiology and ENT referral
C.Reassure due to BPPV that it will resovle later.
22.pyloric stenosis pic from anthology. Pt uop 50ml/hr asking what to give with iv fluid in 24
hours?
a.20mmolkcl
b. 50 mmmolkcl
c. more than 50 mmolkcl
d. no kcl required!
23. 60 yr male pt with 2 days ho intense photophobia with blurring of vision. .vision also
reduced on left side asking diagnosis?
A.conjuctivits
B.gluacoma
C.keratitis
26.old recall old man found collapsed in garden with temp 33.4 + hypothyroidism + heart
block asking cause of collapse? ((((cardiac arrest))
27.Pt on chemotherapy receiving treatment from cvs line , then she developed neck and
facial swelling gradually . What is the next imp mx?
A.Ctchest b. CT head & neck C. Limb angiography
28.ECG. VF…. Pt brought in ER unconsiuos ,CPR on going….what will do immediately?
A. Defib
B.Intubation
29. 60 yr male pt with 2 days ho intense photophobia with blurring of vision. Pain behind
left eye….vision also reduced on left side asking for next investigation ?
A.CT B.MRIC.Carotid Doppler
These are some recalls may be it will help for coming exam….sorry if any mistake I am not very
good recaller….i will upload more recalls once I memorized all hopefully
Please remember in prayers… best of luck to all ..
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
old man coming from travel presents with increasing chest pain and
sweating with hypotension and ECG done it showed unspecific ST
elevation in lead 2 3 and avf with rbbb (rsR pattern) inverted T in lll
and avf what is the diagnosis ?
a- Acute inferior MI
b- PE
C lbbb
D pericarditis
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
B-lactulose .as a laxative to help empty the intestine which is supposed to improve mental
status, here the patient is confused which reflects Hep encephalopathy
A-cholycwystectomy
B-ercp
A-lobar pneumoia
B-bronchiactesis
C-chronic bronchitis
D-lung abcess
C or B according to x ray
Bronchiectasis
chronic bronchitis
Pt with chest tightness dyspnea recurrent syncope what from this ecg
( give 5 ecg )
B-v.f
C- a.f
E- hyperkalemia
B- endoscopy after 12 m
A-duples of calf ms
B-ctpa
C-vq scan
A- diazepam
B-lorazepam
Pt alcohol bing filterate with is huspand ten with you after a while
become agitated,rritable
A-diazepam
A-herpes pcr
B- vdrl
C-vaginal swap
A-vaginal swap
B-vaginal culture
C-blood culture
B-us
Pt with ankle swelling, afebril, stifness for an hour relieved by walk
,xray show periarticular osteopenia and narriw space, other foot joint
is normal
A-osteomylitis
B-rheumatoid arthritis
C-sle
D-septic arthrutis
A-sle
B-sarcoidosis
C-rh.arthritis
Osteoarthritis
Pt leave her job with depression symptom and say i dont want to live
,with alot of suicide attempt
A-dilectal therapy
B-drama therapy
A-add respiredone
B-addmethylphenidate
A-aldara cream
A-fbs/3y
B-fbs/1y
A-epseparation anxity
B-tuprency
C-conduct disorder
A-us
B-fsh
Pt withirregular pulse and abd pain , take digoxin for another reason,
cause
A-digoxin toxicity
B-mesentric embolism
A-subarchnoid hge
B-cerebral abcess
C-exrradural hge
D-subdudal hge
Pt after surgery now well, start drink some fluids but his lap Na
110(low) k 2.5( normal 3.5_5)
A-hypertonic saline
B-k replacement
No option for normal saline
65y with painless haematuria, occasionl loin pain ,what is the invest
of great value
A-cystoscopy
B-urineanalysis
C-ct abdomen
A-us
B- ct abdomen
B- ct head
B-ct
C-needle thorocotomy
1- paient with neck stiffness, csf findings: lymphocyte 2000,monocyte, rbc 200,
temperature 37''c . wt next?
b. iv acyclovir
c.cefotaxime
2-
patient with hypertension c/o recent painless loss of vision for 3hrs.visual acuity
reduced in one eye.what next??
b-Tropical pilocarpine
c-Acetazolamide
3-Old lady with painless hematuria and right loin pain ..most appropriate next
step ??
B cystoscopy
C urine culture
4- Melanoma skin care screening. 24 years old Computer technician come for
screening. What would be the risk for him?
5- female patient 60 years old ,menopause at 45 years, came for clinck for
assesemnt of osteoporosis, her mother has history of hip fracture .what is the
most risk factor for her ?
A. EARLY MENUPAUSE AT AT AGE 35YEARS
A. oral steroid
B. blood culture
C. oral amoxyclave
D. ivpenzylepenicllin
e. iv fluoxacillin
7- female had a normal delivary of a normal weight baby , there was perianal tear
that was small and didn't needed suturing , after the delivary she noticed that her
locia didn't flow well in the following days , and at Day 4 she presented with
heavy bright red bleed with fever of 37.5 what is the reason for fever
A)endometritis
B)cervical tear
8- parents brought 5 years old son with spinning around with no loss of
consciousness and lasting for 1-2minutes every month for last 3 months and
subside spontaneously. No h/o headache or vomiting. Ear examination normal
.What will you do ?
A-ophthalmology assessment
B-assess dynamics
C-auditory assessment
d-family problems
10- man with faintness for twice a week, lethargic. On exam on right side diastolic
murmur, on left systolic murmur.Whats the cause?
A-Asd
B-Vsd
C-viral cardiomyopathy
D-pulmonary hypertension
11- A man with peptic ulcer who is taking triple therapy (PPI, amoxicillin,
metronidazole) for 6 weeks but urease breath test was positive for H.pylori
a. resistance to metronidazole
b. resistance to amoxicillin
A- COHORT
B-CASE CONTROL
C-CROSS SECTION
E-PREVELANCE
13- 3 days ago pt drove his brother from airport to home, yesterday his brother
had rash and was diagnosed with measles , what is your management
A) reassure he is immune
B) Do MMR Serology
A- boilling water
C- wash hands
15- Obstructive sleep apnea,, obese with waist n neck circumstances 110 .asking
for long term treatment?
A.wt loss
B.metformin
C.Cpap
D.surgery
a- twice daily
b- after 1 day
c- after 7 days
d- after 2 weeks
e- after 4 weeks
17- patient with headness and palpitation and gives 5 ecg and wants the right
answer from them
18- schizo p.t on antipscychtc have weight gain, most is the next investigation?
a. TSH
b. FBS
c. Lipid profile
19- man with nasal blockage especially at night & can't sleep well.he has
periorbitaldarkness.allergy test (+).what is ur initial step??
b-Oralcetrizine at night
d-Oralsteriod at night
20- Woman with pap smear showing LSIL.Previous pap smear 3 yrs back was
negative.
C. Colposcopy
21- History of sigmoid colectomy after volvulus presenting again with signs of
obstruction, xraygiven.next appropriate managment ?
A. Colectomy
B. Oil enema
C. Barium enema
22-picture of parotid tumor old man ask about dx same as in hand book
24-
Picture of cleft palate baby born for 41 years old mother using carbamazepine
and alcoholic and ask what is the cause in this case
a. Genetic
b. Alcohol
c. Carbamazepine
d. Maternal age
25- male attack of angina and hypertensive, 170/? , s.cholesterol 5.5, most risk
factor for IHD?
A-Angina
B-BP
C-Cholesterol
26- A boy came to you with history of ear discharge 2 weeks ago, his tympanic
membrane looks dull and retracted and there’s yellow discharge from his ear.
What’s the nest step in management?
a- Amoxicillin
b- Ear toilet
c-amoxyclave
27- young man who is presented with infertility. He had mumps when he was 6
years old. He was on methotrexate before some months or years and he is taking
sulfasalazine now his semen analysis showed motility of 5% , sperm count 1
million /ml and abnormal sperms 90%
a. methotrexate
b. sulfasalazine
c. mumps
28- Cervical spine injury bp 80/55, HR 50,what is the NEXT most appropriate
step??
a-Atropine
b-IVcolloids
a. anticonvulsant
b. antipsycotic
B-wastcirSud<102
31- Pregnant female with genital herpes how to differentiate 1ry From recurrent
herpes simplex:
C- PCR
32- 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
A-prednisolone
B-Nitrofurantion
C-Trimethop/sulpha
D-amoxicillin
34- pregnant lady(G1)come to u with family h/o of mother with DVT at 50age, her
sister has h/o abortion.during antenatal period what inx will be most benefit for
her current pregnancy??
A-Thrombophilia screen
B-Antiphospholipid Ab
C-Coagulation profile
35- Builder with TIA, carotid duplex done normal, ASA given and discharged what
is your advice?
a- Add anticoagulant??
A. Haemolytic Anemia
B. Biliary Atresia
37- pregnant at 37 wks..sprained ankle badly..u applied crepe bandage and and
advised to keep foot elevated..what is the best advice u can give regarding pain
management?..
a. avoid codein
c.Avoid NSAIDS
i had a few recalls,mostly new stem but not so difficult ,among them two were very big stem with lab
value,four were picture,I had much from psychiatry,here some of them……….not much recall so
remembering is little difficult……
1)a 25 yrs old male had an accident with multiple ribs fractures ,difficulty in breathing,with diminished
breath sound in rt side (not mentioned whether there is pain or not),bp 90/60 mmhg,pulse 120 ,after
initiating iv fluid and resuscitation ,what will be mx???
a)watet seal drainage
b)usg
c)neddlethoracocentesis
d)oxygen
2)a 80 yrs old man taking anti parkinsonian drugs ,had a surgery 30 yrsback,complains nausea
,vomiting,and abdominal distension, (picture was twisting) not so much clear supporting SBO and
LBO,dx??
a)pseudoobstruction (I choose it)
b)SBO
c)LBO
4)(pelvic picture given),10 yrs old boy ,limping,esr 10mm in 1sthour,usg 6 mm joint fluid, (no URTI
history)
a)irritabe hip
b)parthesdz
c)juvenile osteoarthritis
d)septic hip
5)( a clear chest xray given)history of firm smooth swelling (complain of this) in the posterior triangle of
the neck,nopain,nofever,what is the next?? Very weired……….
a)excision
b)ct chest
c)xray (of which site not mentioned)
othrs r not relevent
6)a 28 yrs old female complaining of tiredness present after delivery of 3rd child having previous 2 alive
child,with a very long lab value but out of them only low Hb and Low MCV,and rest long lab value are
quite normal……….
a)Iron deficiency anaemia
b)thalassaemia
c)pernicious anaemia
7)a middle aged agitated people brought by police by trolley in ER ,pt saying “I know you taken me in
prison,I know u will kill me”,(no history mentioned he is alcoholic/binge drinker already),what is the
present state of him?
a)delirium
b)delusional disorder
c)dementia
D)drug abuse
8)27 yrscontinuely ecstasy taker reuesting to take sartaline,what would be that effect?
a)synergistic effect
b)drug interaction
c)potntiate the effect
d)enhance the effect
9)a 8 year old boy present with persistant (++) proteinuria,nohaematuria,noHTN,what will be the next
investigation?(no drug histry like prednisolone taking histry is mentioned)
a)renal biopsy
b)C3 C4 level estimation
C)12 hrs urinary protein estimation
d)urine examination
10)an ECG ,cleat st elevation on lead 2,3,aVL,present in 2 hrs, what will be done now?
a)angioplasty
b)aspirin
c)clopidogrel
d)dipyrimadolan
12)an ECG given (wide QRS complex ,regular,tachycardia,no p wave,)history of HTN of 40 yrs ,what is the
Dx?? (no atrial flutter is given in option)
a)ventricular ectopics
b)atrial fibrillation
c)SVT
14)picture of anus showing little something prolapsed with blood stained ,no anal tug for sure,dx asked
?
a)prolapsed internal haemorrhoid
b)anal fissure
c)anal abscess
15)18 yrs old painful reddish scrotum (pic given),what is the probable cause?
a)clamydial
b)gonorrhoea
c)staphylococcal
d)streptococcus
17)a 36 yrs old male alcoholic ,complining pain ,wt loss 3 kg,given a very very long lab value ,among
them HB low,LFTabnormal,bilirubinhigh,ALP was high,what will be the investigation ??
a)ct abdomen
B)xray abdomen
c)USG
18)a scenario of 29 yrs old female there was a choledocolithiasis ,what will be the next Mx ??
a)ERCP
b)MRCP
c)CT
D)USG
19)there was a another very very long lab interpretation given,among them PO2 is 45%,PCO2
65%,hyperinflated lung,dysnoeic,labouredbrething,and rest of the lab value is normal to me, ( in this
case Ca level was also normal)??
a)bronchoscopy with alveolar lavage
b)ct chest
c)CXR
20)4 days after cholecystectomy operation male pt present with dysponea,with no cough,nofever,hat
will be next?
a)chest physiotherapy
b)CXR
d)oxygen
D)salbutamol inhalation
21)25 yrs old lady something drug taking now recently switched to lithium and resperidon,develops acne
and wtgained,what is the effect of this conditions??
a)combined effect of both drug
b)Lithium
c)resperidon
23)12 months old boy presents with his mother with the complaining of general check up,which one of
the following indicates serious developmental delay?
a)don’t able to understand NO
b)don’t able to walk unsupported
c)don’t able to put shoes wire
d)don’t able to draw a human face
24)19 years university student ,complaining by his mother that, now he is sleep mostly in day time
rather than night,playing much more computer game,his academic status are good,lack of social
behave,what is the drug treatment?
a)mirtazapine
B)risperidone
c)some others very weired drug I cant remember them
25)one child 6 yrs ,lack of soial interaction ,prefer to play with her doll in the same manner ,any
alternation ,she crys, (clearly said that her language development are normal),what is the diagnosis??
a)autism
b)ADHD
c)Asperger
26)woman brought her child for vaccination ,does not look into doctors eye,what would be best advice?
a)tell her to bring family member in next visit
b)decline to visit
c)call for assistance
27)16 yrs old girl comes with complaining of recent start of sexual activities and seeking contraception
advice ,what would be best advice beside contraception?
a)chlamydia PCR
b)gonorrhoea
c)syphilis
d)AIDS
28)16 yrs old girl comes and said that she started her sexual relationship with her partner 2 yrs back ,and
she told doctor for chlamydia testing,and doctor advicedher,a few days later her mom ring you and tells
doctor that her daughter told her to follow up the test result,what will you tell that lady?
a)decline to talk with that lady
b)tell that you cant share any information of test result rather than her daughter
c)tells comes with her daughter in next visit
29)a senior told a new doctor to perform (something invasive surgical procedure),and the new doctor
didn’t saw that procedure before and don’t knw about that procedure,what to do now??
a)tell him first one should be done for him first
b)tell the doctor that you cant do that as he don’t know the procedure
c)decline the procedure
30)26 years lady at term presents with the complaining with the pain,cervix 2cm,head 3 cm above the
ischial spine ,fetal heart rate 140/min, about 5 hrs later what is the indication of C/S?
a)cx 3cm ,head still 2 cm above spine
b)Cx 9 cm ,head still 2 cm above the spine
c)remains same after 5 hrs
d)cx 9 cm ,head stil 2 cm above spine,membrane ruptured
31)nurse in a nursing home got needle prick during removal of DJ stent from renal system of known case
of HIV pt,what should be done now??
a)give antiretroviral now
b)give antiretroviral and Immunoglobulin
c)perform IgM and IgG
32)21 yrs medical student got needle prick got needle injury during some procedure (cant remember) of
a known HcV positive patient,what should be done now?
a)do immunological test in 3,6,12 months
b)do antibody test right now
c)perform IgM and IgG
d)give Immunoglobulin
33)30 yrs old present with melaena,to find out the cause there is endoscopy done but nothing is
conclusive,what should be done now??
a)colonoscopy
b)sigmoidoscopy
c)capsule endoscopy (pillcam)
36)a sudanese7 months baby has got (first attack may be) seizure (<1 min),and everything are normal in
physical examination,what to be done now?
a)to estimate vitA,vit D (I choose it one)
b)EEG
c)CT head
d)FBC
37) a traveller from sudan (may be, people don’t miss a single question related Sudan,dot forget AMC
loves Sudan very much) with a very very long lab interpretation,with RUQ pain ,jaundice,norash,return
after 5 days,all were normal except LFT,among them bilirubin is high,but GGT is in normal,so what is the
Dx?
a)Hepatitis C infestion
b)dengue
c)Malaria
d)others are irrevelent
38)a 8 years old boy got acute attack of asthma admitted in hospital,after giving a 6 puff of inhaled
salbutamol,he got little improvement,but he cant speak a full sentence,what to do now?
a)repeat this dose in 20 minutes
b)give fluticasone
c)give SCG
no options for repeat 12 puff more
39)65 years old man present with 38.7 degree temperature,cough ,dyspnoeic ( given a clear chest xray
of middle lobe pneumonia),what to give now?
a)Amoxicillin+clavulunate
b)ceftriaxone
c)flucloxacillin
d)paracetamol
41)a 44 yrs old female has done her mammography that is normal,and also done her usg showing 1.5 cm
hypoechoic shadow in her left outer quardrant of left breast,what to do now next?
a)core biopsy
b)FNAC
c)excision biopsy
others cant remember
42)there was a female 34 yrs having amenorrhoea since 2 yrs ,long lab scenario but everything was
normal,FSH,LH,prolacine ,all are normal,what is the Dx??……………………………………………………..
a)hypothalamic dysfuction
b)pituitary tumer
c)adrenal tumer
And after all keep belief in your “God”, keep me in your prayer that’s enough,only by this we can go a
long way in our respective way.Good luck.
Study advice. Do recalls and recall topics, read JM for diagnosis but for treatments please
keep checking websites like emedicine, uptodate, mercks manual, and Australian
therapeutic guidelines.
Wishing all of you the very best. Please keep me in your prayers.
2. A young man brought to you.he is distressed,teary and angry on a someone who has
killed his wife by passing a vehicle over her when she was crossing road 2 weeks ago.he says
he can see his wife or listen her voice,also he says his wife is not really dead.
1.temazepam
2.olanzapine
3.Child with URTI and after two days presents with BP 140/90, edematous face and bilateral
ankle adema, urinalysis show rbc++,protein++, asotiter raised, what to give him:
a.Iv hydralazine
b.furosmide+iv fluid
c.steroid
4.old man with increasing constipation since one month , now comes with abdominal pain n
distension for 24hours. History of appendectomy 20years ago n now he has reducible
inguinal hernia.Dx?
1. ca sigmoid colon
2, adhesions
3. sigmoid volvulus
4 strangulated hernia
5.middle aged lady with uterine prolapsed..weakness in which of the following structure is
responsible for this?
a. uterosacral ligament
b. transverse cervical ligament
c. pubocervical ligament
6.An immigrant from Afghanistan complaining of fever and prolonged productive cough. He
has no history of vaccination against TB. His mantoux test is positive with induration of 12
mm. his sputum showed acid fast bacilli. Next step:
A- Isolate in negative pressure room
B- Do x ray
C- Do sputum culture
D- Do sputum PCR7
7. 6 years old boy presented to the ER due to asthma attack. He had 6 puffs of salbutamol
and he improved but still has wheezing and speaks in words
a. add salmeterol
b. more 12 puffs of salbutamol
c. ipratropium nebulization
d. oral prednisolone
e. hydrocortisone iv
8. A truck driver was fired from his job because of always being late. He makes sure that he
wash all the keys one by one so that nothing bad will happen on the road.
What does his behavior denote?
A. Obsessive
B. Compulsive rituals
C. mannerisms
9. 40 yr female had tonsilitis, took amoxicillin, after 3 weeks she devloped purpuric rash, not
blanching over her ankles. the joints are not painful
A. Hypersensitivity vasculitis
B. HSP
C. I.Mononucleosis
10. colle's fracture xray with scenario of a lady who falls on her outstretched arm and you do
a below elbow plaster. when to follow up
2 weeks
4 weeks
6 weeks
11. scenario of a patient on levothyroxine 75 mg who had some surgery done. his labs
revealed Tsh low and t4 raised. what to prescribe to him on discharge
25 mg levothyroxine
100 mg
150 mg
12. scenario of a lady with splenomegaly and rash on the legs thrombocytopenia, borderline
anemia and leucocytes decreased also
hb 11 wbc 4000 plat 50000
complaining of fatigue past few months
diagnosis
sle
itp
hsp
aplasticanemia
AML
13. Pt with candida (all the features of soreness brick red vagina white discharge) treated
with clotrimazole ,but recurrent several times , she always responded to topical clotrimazole.
What will be the most important step in her management?
-vaginal swab
-fluconazole
-glucose tolerance test
-hiv antibody test
No option for culture
14. Ctg showed reduced baseline variability and variable deceleration (ctg not given) the
mother had 4 cm cervical dilation within 14 hours , pethidine was given to her 3 times I
guess the fetal head is in the left occiput posterior. What is the cause of ctg abnormality
prolonged labour
elevated resting uterine pressure
increased pressures due to incoordinate uterine action
15. a 45 year old woman, a case of 2yr infertility , her children are 14, 15 and 20 years old,
h/o endometriosis in uterine lig , previous h/o pelvic operation, mid cycle sex. Which of the
following is the cause of her infertility , partner never fathered a child.
16. in the other there was mention of dyspareunia and it was a young couple with all normal
investigations and one sided tubal block endometriosis
17. 6 year old girl with urti and + rbc in urine , all other investigations normal but 1 week
later the urine exam was same
Post strep
IgA nephropathy
Transient hematuria
18. XRay of cecal volvulus, in a patient with a history of sigmoid colectomy, after initial
management with iv fluids, what is the most appropriate initial step
Low pressure NG decompression
Hemicolectomy
Colonoscopy
19. 2 year old child, had episodes of vomiting associated with abdominal pain, mother also
noticed a mass in Rthypochondrium
Diagnosis asked
Wilm’s tumour
Neuroblastoma
Pelviureteric junction obstruction
22. The same scenario without a CT given asking most likely cause
23. XRay of ankylosing spondylitis, asking what will be the best initial management
No nsaids in options
Physiotherapy and hydrotherapy
Methotrexate
Infliximab
24. Xray showing bilateral hilar lymph nodes, asking most appropriate initial investigation
Ca levels
Urine microbiology
Ct abdomen
25. A boy ate a pizza before few days when he developed diarrhea and now presented with
subconjunctival hemorrhage and epistaxis and rash
what is the test that will lead you to diagnosis
a. blood culture
b. stool culture
26. a man who has cough since 6 months and a rash on his legs, he has loin pain and
hematuria, what is the most appropriate investigation to be done
Skin biopsy
Ct abdomen
28. ecg of 1st degree heart block in a man who lost consciousness but is now stable his heart
rate is 35 bpm, asking whats the most important thing to do
Isoprenaline
Atropine
Digoxin
Permanent pacemaker
29.progressive swelling of eyelids with serous discharge and pain in one eye, temp 37.8 hay
fever hx
oral ceftriaxone
ivflucloxacillin
prednisolone
topical chloramphenicol
30. Another growth curve for 18 bmi boy with weight more than 98% percentile for his age
Normal
Obese
Overweight
31. 47 yrs female came concerned with weight loss her bmi is 29 what else you have to do
for her
Bp
Waist circumferance
Tsh
32. Patient on venlafaxine before increasing the dose what will you check
Lfts
Bp
Tsh
33. Man came with 3 cm painful tendermass over inguinal ligament , appeared after he
returned from a hiking trip
inguinal hernia
femoral hernia
Iymph node
34.An old lady lives by herself mmse 28 had fracture of femur, Family wants everything to be
done she also has copd and had to be admitted in the icu many times . This is her 6th time
.Doesnt want further treatment . Lady is competent to make her decisions
A . Psychoneurologicalassessemnet
B. Arrange meeting with the family
C . Inform the hospital ethics group
35. Farmer wid hemicolectomy due to colonic ca, liver usg given which were clearly mets
Triphasicct
Hydatid serology
36. Woman on trifluphenazine well controlled, left drug when she started developing
tremors one yr back
Now thinks has intestinal worms over her whole body, initial treatment asked
Haloperidol
Trifluphenazine
Quietapine
Depot risperidone consta
Clozapine
37. Accident many ribs fractured patient is severely dyspneic severely cyanosedand in a lot
of pain. What will be your best management at the accident site
Cover the wound
Needle thoracostomy
Morphine
38. CT chest of rt sided haemothorax after penetrating trauma, no tracheal deviation
maintaining spo2 96% how will you manage this patient?
Needle thoracostomy
Morphine
Underwater seal drainage
40. 55 year old man with hematuria,mass on the lower pole of kidney 3 cm on CT
left nephrectomy
Biopsy
Surveillance
41. a known case of polycystic kidney disease with lower urinary tract obstruction, what
investigation will you do to evaluate
CT abdomen
US kub
Retrograde pyelogram
Cystoscopy
42.A man with peptic ulcer who is taking triple therapy. PPI,Amoxicillin, metronidazole for 6
weeks but urease breath test was positive for H.pylori what is the reason ?
A) resistance to metronidazole
B) resistance to amoxicillin
C) unreliable urea breath test
D) restested too early
43. Case of stone 9 mm at ureteric orifice in bladder, prepared for surgery, which
investigation must be done before going to surgical table
a. abdominal xray
b. u/s
c.CT
44.Pt diagnosed with AIDS 6 months before, on indinavir developed severe loin pain with
hematuria..his urine showed +++RBC asking for investigations
triple phase ct scan
non contrast ct scan
abdominal x ray
Us
42. 9years old child, his BMI is 20 came with a sore throat. All other family members are
overweight. What will you tell his parents?
A- He will grow and become normal
B- He should reduce hours of watching TV
CHe should start on weight reduction regimen
D- replace sodas with fruit juices
E increase salt intake
43. a scenario of a woman who has repeated hallucinations when she tries to sleep, she also
had few episodes of amnesia in the past few months followed by hallucinations, what is the
cause
Temporal lobe epilepsy
Meningitis
Migraine
Cannabis intoxication
44.Pregnant female with genital herpes how to differentiate primary from recurrent herpes
simplex:
HSV Igm now
HSV type specific serology now
PCR
Check antenatal bloods for serology
Culture
45. 50 year old man who is working in real estate. He used to dress well but recently he
looks in bad shape, shouted at customers and got fired from his job. His wife brought him,
how will you evaluate
A. verbal fluency test
B. minus 7 test
Others irrelevant
47. dementia patient with hypertension and IHD, his bp is 130/90 pulse regular 80
What will you prescribe to him
Rivastigmine
Memantine
Donepezil
48. Taxi driver who had symptoms of right sided weakness for 10 mins, resolved, CT normal,
carotid duplex also normal, he is insisting on discharge to work as a driver again .
A. Discharge but sign consent
B. Refer to neurologist to decide about driving clearance
C. Tell him you can drive in 6 month
D. We need to assess driving after more imaging
49. COPD with severe dyspnea, tachypnea , on 8L O2 , spo2 86%, bilateral good air entry,
whats the most imp Inv to be done
spirometry
ABG
Cxr
Ct
50. an old woman admitted for orthopaedic surgery due to fall, she was alright but the night
before surgery she got agitated and started blaming the staff for sexually abusing her,
which of the following do we expect to find on examination
Fluctuating levels of consciousness
Paranoid delusions
51.A 26 year old woman who is not sexually active since 2 years came for her regular pap
test, question asking why to screen for chlamydia when you want to do opportunistic
screening
53.16 year old female, separated from her boyfriend since 6 weeks, now lost weight. lazy at
work, has insomnia, anxiety attacks &is stressed
Fluoxetine
Female adolescence group
Start CBT
refer to psychiatrist
54. Patient is an outdoor worker, came with low BP (90/60) lab: High platelets, others
normal, dx:
essential thrombocytosis
post splenectomy
myelofibrosis
CML
55. A patient has nausea vomiting, epigastric pain or tenderness (with no signs of
peritonitis). From the history, you knew that the patient had gastric ligation surgery before,
what is you initial management?
a. barium swallow
b. urgent surgery
c. CT scan
56. years old female with body mass index 23, complaining of tiredness and laziness at work.
She had menstruation at age of 12 and menses are regular. She has dark pigmentation on
back of her neck and axilla and abdominal striae. Her grandmother has type 2 DM.
diagnosis?
A- Cushing disease
B- Addisson disease
C- Hypothyroidism
D- PCO
E- Metabolic syndrome
57.Pregnant lady at 39 weeks of gestation presents with bleeding of 200ml, now stopped ,
clinical examination reveals 3 cm dilation and visible membrane, rest is normal vitally, whats
next:
AROM
C-section
58. pregnant at 37 weeks sprained her ankle badly, you applied crepe bandage and advised
her to keep foot elevated. what is the best advice you can give regarding pain
management?
a. avoid codeine
c.Avoid NSAIDS
59.Old female with breast cancer her son doesn't want her to know as she will get
depressed
B Tell her son to bring all family for a meeting except her
-‐PCOS
-‐POF
61. aboriginal female who doesn’t have access to medical facilities with 3 month dyspnea
brought by her friend, on examination b/l basal crepitation and a diastolic murmur, not a
smoker but a binge drinker, next step?
A. ECG
B. Echo
62. 37yr old woman with secondary amenorrhea normal BMI ,FHS- high OESTRADIOL low
prolactin normal .USG-3 to 4 cyst in ovary.Doesn’rwant to conceive and is not sexually
active, What is the best treatment
A)POP
C)OCP
D)Metformin
63. A young woman with persistent pain on the lower right side of the face with redness
asking about the most probable diagnosis
a.varicella
b. trigeminal neuralgia
C herpes simplex
64. 6 weeks old baby well and thriving, 3 days ago he has developed increasing vomiting
but he is well hydrated, no increase in weight since 1 week, all examinations are normal
A-GERD
B-PS
C-uti
65. Pic of an old female in nursing home with NG tubes and sick looking and has a left sided
parotid swelling and redness asking about cause
b. Parotid stone
c. Parotid infection
66.old man feels pain when he walks only two blocks and stops to rest after that. He has a
recent history of left buttock and back of thigh pain, but he has three month history of
ischaemia in left leg and foot. A bruit is present over femoral artery and his limb is
pulseless.Next appropriate step?
A- Thrombolytic
B- Angioplasty
C- Bypass surgery
D- Walking program
E- Nefidepine
B diathermy
C cryotherapy
D local excision
E incisional biopsy
68. 3 year old child came with complain of cough and mother had hay fever and father is a
smoker, what drug is used for the prevention of asthma
a.SCG
b.Fluticasone
c.budesonide
d.salbutamol
69. a 2 year old child presented with stridor, harsh cough, temp 38 degrees and intercostal
recessions, he is alert and active, how will you manage him
Oral prednisolone
Nebulized adrenaline
Iv steroid
Nebulized salbutamol
70. Mass in anterior leg, firm and regular, attached to gastrocnemius muscle, most
appropriate inv?
A. MRI
B. U/S
C. CT
D. Biopsy
71. a25 yr old female complained of Raynaud's phenomenon in cold which started after
pneumonia 2 years ago,ana 1/60, ENA neg. cause
A-primary Raynaud's
C-sle
D-limited sclerosis
72. 3 yr child got pertussis, family got ab prophylaxis but not his 5 month old sister who has
completed her vaccination
a. advise mmr vaccine at 12 months
b. advise dtpa boosters for parents & grandparents
c. give dtpa vaccine to family adults who are of unknown immunization status
d. avoid child care till age of 6years
73. mother comes with her 2 month old child for immunization, the mother is living now
with her parents, the mother has egg allergy. what is your advice for the family
a. advise mmr vaccine at 12 months
b. advise dtpa boosters for parents & grandparents
c. treat with ciprofloxacin if develop symptoms
74. 60 year old man with iron deficiency anemia, he complains of bleed on toilet paper and
mass on straining, on DRE everything is normal, what is the next appropriate investigation
FOBT
Colonoscopy
75. lady feeling faint twice a week, lethargic. On exam on the right side there is a diastolic
murmur in the 2nd intercostal space, on the left side a systolic murmur at apex. Whats the
cause?
Mixed valvular heart disease
Asd
Vsd
pulmonary hypertension
pda
76.during a family gathering your 17 yr old nephew tells you that he is very anxious about
his upcoming exam next week and asked you to prescribe him temazepam. what will you
do?
a-advise relaxation and exercise
b-tell him to go and consult a doctor properly
c.prescribe melatonin
2. 7 days old with jaundice started on fourth day of delivery with total bilirubin 240 & conjugated 120,
asking cause?
A. Hemolytic
B. Biliary atresia
C. Breast Milk Jaundice
3. History of sigmoid colectomy after volvulus presenting again with signs of obstruction, xraygiven(to
me it looks more like fecal impaction than cecalvolvulous) next appropriate managment ?
A. Colectomy
B. Oil enema
C. Barium enema
5. 2 ECGS:
Q.Vent. Fib. clear, started cprwhatsnext ? -->Defebrillation
Q. ECG Not clear one with many ectopics, the old one with biventricular failure & many drugs asking
next ?
A. Stop all and reassess in 12 hours
B. Increase digoxin dose
C. Give furosemide
7. Pic of middle lobe pneumonia not very clear , it was mild by history, asking managment ?
A. Penicillin
B. Augmentin
10. Scenario of alcoholic cardiomyopathy asking most appropriate inv ? --> Echo transthoracic
11. Pt with palpable painful skin rash on the knee, with hemoptysis& very elevated serum levels of ACE
asking to reach Dx ?
A. Skin biopsy
B. ANA
12. Pt on spironolactone, enalapril, no dyspnea on exam. high jvp and lower limb edema and bilateral
basal crepitations& ejection fraction 40% what to add ?
A. Digoxin
B. Metoprolol
C. Warfarin
13. Pt with painful leg on 100 meterwalk, well perfused and warm with absent pedal pulse -->
Graduated walking preg
14. Pt with scenario of acute limb ischemia with no similar incidents before asking hx --> Iv Heparin
15. Pt with scenario of chronic limb ischemia with an acute attack on top, best Hx ?
A. Angioplasty
B. Bypass
C. Intensive Walking Program
16. Pt with chronic limb ischemia, what will be useful to be useful for to be offered for this pt beside
cessation of smoking ?
A. Angioplasty
B. Bypass
17. Driver with scenario of TIA with a similar incident last week, best regarding his return back to job ?
A. After more inv.
B. Discharge on aspirin
18. Clear CT pic of hemothorax with pain on respiration asking appropriate next ?
A. Intercostal Drain
B. Morphine
C. Needle Aspiration
19. Another one with flial chest and painful respiration due to MVA, asking initial at the site of accident -
-> Morphine
20. On the phone son telling you that family is against you telling his mom about her malignant disease
discovered ?
A. Insist to see mother alone
B. Tell him to bring his mother next time
C. See him alone
D. Hold a family meeting without mother
woman after excision of a hyperpigmented area in skin with LA feels tingling in her mouth.
likely cause?
-lignocaine toxicity
-hypocalcemia
i din now so i put A
36 weeks pregnant primi, labor progressed normally.cervix 4cm n effaced after 1 hour into labor.
membrane intact, uterine contraction was 5/15 mins. heart rate 140/min. fetal skull 1cm above ischial
spines.
4hour later same finding but fetal heart rate not heard. ctg not detected.
management?
-cesarean
-oxytoxin
-amniotomy
woman has a 1.5cm on right upper outer quadrant. usg shows hypoechoic.
next management
-fnac
-excisional biopsy
-ct scan
lady came with pain in right upper quadrant. stone in vesicoureter junction. usg shows mild
hydronephrosis in the right side.
management?
-cystoscopy n put stent
-eswl
-refer for open surgery
-urethroscopy with fragmentation or stone removal
mother came for followup of child. child normal however mother is silent and withdrawn.
wat to ask mother?
-mood
-financial strain
-maritial status
56 years male general checkup, is well no history of dm, waist circumferance 101, clinical exam
normal.
how often to screen him?
1.Old lady comes with swelling in front of tragus, pain present before meals. Inv ?
B. Usg
C. Ct
D. MRI
B. Warm compressions
C. Antibiotics
B. Ca parotid
C. Duct stenosis
4.A foreign worker does not speak English brought by his work boss by foreign body in his eye. His boss can speak
English. What to do?
d-Tell the patient to bring an accredited translator and come back later
5.Girl experiences anxiety when goes out in meetings with strange people . Has stress at work cuz of work load. Next
?
B. Relaxation therapy
C. Psychotherapy
6.Maleptnt likes to dress up in female clothes. He says even his family treats him like if he is a girl. Dx ?
A. Transvestism
B. Transsexualism
7.Middle age 47 or 48 yr non to have IHD, have RUQ pain, put stent from 2 months, on clopidogrel, pain resolved, but
after 9 week the pain comes back. on U/S stone was in neck of gallbladder, there was fever n chills n tenderness, no
jaundice ?
A. Transcutaenous cholecystectomy
B. Antibiotics
E. Endoscopic cholecystectomy
8.A school teacher comes with difficulty to initiate sleep every night. He says whenever he goes to sleep he feels he
might have done something wrong so he starts recalling each n every moment of his day. And after he has recalled
his day completely m realised that he has not done any wrong, then only he gets happy n satisfied n sleep . It takes
almost 1 -2 hours each day. T/t asked.
A. Antidepressants
B. Antipsychotics
C. Ssri
D. Antidepressants+ something
E. Bzd
A. Ocd
B. Schizophrenia
C. Major depression
10.39 weeks vid contractions every 3 mins , cervix posterior n 2cm dilated n head 3 cm above IS. After 4 hours cervix
mid position, fully effaced, 4 cm dilated, intact membranes, head 1 cm above IS. Dx ?
A. Spurious labour
B. Incordinate labour
C. Normal labour
D. Obstructed labour
B. Atony
13.55 yr female with breast lump in outer quad. Mammodone , found nothing. Usg done, found hypoechoeic mass.
What next ?
A. Core biopsy
B. Reassure
C. Excision biopsy
14.Male with fever , headache, papilloedema weakness on right side of body , on examination muscle strength
diminished on right side . Dx ?
A. Cerebral abscess
A. Hodgkins
B. Non hodgkins
C. Metastatic ca breast
D. Ca testis
B. Renal failure
17.1.5 cm left lower renal mass . What to do? A. Biopsy b. Partial nephrectomy c. Total nephrectomy
18.One direct q bout hydrocoele, asked inv to differentiate it from others.. Ans: transluminable
19.Pitutary necrosis post deliver Vich was complicated by pph
20.55 yr old female, had radio I t/t for goitre now presents with (features of hypothyroid) ..Tsh t3 t4 were given.
Management asked:
A. Thyroxine 25
B. Thyroxine 100
C. Thyroxine 150
D. Carbimazole
22.Lady brought her husband who is on Parkinson treatment , n haloperidol for psychosis, now vid cogwheel rigidity .
What to do ?
Nitika
23. X Ray of tibia fracture. Deep lacerated wound on fracture site. What is the most imp next step ?
A. Wound debridement
B. External fixation
C. Internal fixation
D. Antibiotics
B. I/v antibiotics
C. Massage
26. Lady fell down while horse riding. Now she has come with pain abd, BP 104/60 . Ct given, dx asked:> rupture
spleen
29. Post partum patient complaining of easy fatiguabilitylathergy breast feeding. Blood picture given, hb low Mcv low
.Next inv?
B. Folate deficiency
C. Pernicious anaemia
A. Ca bladder
B. Rcc
C. Renal stone
D. Pyelonephritis
31. Old lady has plans to go to Europe for a bush walking trip n comes to u for advice . She has been diagonosed vid
Alzheimer's . MMSE 22/30. What will u do ?
32. 55 yr female with breast lump in outer quad. Mammodone , found nothing. Usg done, found hypoechoeic mass.
What next ?
A. Core biopsy
B. Reassure
C. Excision biopsy
A. Hypochondriasis
B. Amputated leg
C. BDD
D. Anorexia nervosa
Alhamdulillah just finished with exam..full of recalls with some option changed
1.20 yr boy with sore throat. What will lead you to think its viral? A)previous tonsilitis,b)exudation in
tonsil c)laryngitisd) temp 37
2.ctg hr 115, variability 10, acelaration ten no deceleration- normal ctg
3.aspergus girl recall
4smoker with tonsiler firm non tender swelling- squamous cell ca
5.dvt scenerio asking rx asked
6.ckd pt with pe asking inv
7)famous scenerio of somalian boy with seizure
8.old scenerio of homeless man with police mafia fear-ask colateral info
9) confused ill man asks to be witness of his will-refuse
10))alchoholic agitated difficult to control- imhalop, oral benz, oral thymin iv bnz
11)) old man smoker with 1 year breathless, hazy lower lung, couging blood-x ray was
oofbtonchietasi
12) man with lacerated wound 3 years ago last tt booster- nothing now
13)same scenerio with last tt 8 years ago- give tt now
14))digitalis toxicity ecg
15)pancreatic pseudocystscenerio asking inv
16)ascending cholengitis asking next inv
17)baby dev delay 12 months-cant stand unsupport,cant understand no...
18) scenerio of hyalinmem disease new born giving high o2 stiĺlhyoxic- pneumothorax
19) old lady with fecal incontinence.. next dre
20) lady 40 years comes for breast screan mother got ca at 57, nothing abnormal in mammo- adv to
do bianualmammo from 50
21) boy 23 yr comes for colon cascrean, father dx at 35 and paternal uncle at 40
22)lady with irregular mens now no mens for 1 year obese fsh low lh normal what test to dx-
testosteron
23)obese lady irregular mens last lmp 7 weeks back. Confirmed preg from home check..now
bleeding.. no other pelvic finding- serial beta hcg, usg pelvis, lap
24) woman with severe abd pain in 6th week lmp normal cycl of 4 to 6 weeks. no other pelvic finding,
no tenderness, no buldging dx-corpus luteal cyst complication??? Ectopic???
25) obstructed labour
26)indication of cs
27) old lady sigmoid volvulus
28) catatonic schizo
29) ca colon rx after surgery
30)nurse with son who had a head injury few days back was wearing helmet no abnormality except
intermittent headache.. reassure or ct??
31) bamboo spine initial rx
32) lady 45 with 4 weeks malaise, fever, wt loss arthralgia, flushing temp 37 after 4 hours 38.8 what
invana,crp,blòodcs, etc
33) old dm lady with painless ulcer yellow exudate redness spreading to whole dorsum of foot after
hosp admit debribementwhats next- mri, xray, oral antibiotic, iv antib
34) 4 or 5 from uti
35) depression
36) gad with insomnia scenerio all benzo in option except mitrazipine
37) boy no interest in study now become veg as he thinks meat is poisonous- tell him to change his
study subj, get help from local mental health group, drug screaning, its normal to have this prob
38) boy 20 yrsdont do any thing watch tx whole nyt sleeps all day- mitra???
39) 40 years painful breast lump mobile round firm dx???
40) copd confused o2 40 co2 60 what mx- intubate
Cant remember any more now... i will post as soon as i can recall, there was no prob in diagnosis
but options were sometimes confusing. . No prob with time mx..dont know how my exam went. But
thanks to all for your support..keep me in your prayers .
2. Post op.3rd day Na. 110 mmol/L, k 2.6, Cl 93, Hco3 16,
pt is allert & take some sips of water& not
confused . Which electrolyte to give initially?
a. Na
b. K+
c.CL
d Hco3
Ans: b
14. A man 64 yr age ,came with cough & sputum & mild
ocassional haemoptysis with childhood H/O pneumonia.
CXR given looks like bronchiectasisasking Dx.
17.HBQ 3.287
1.Ureteric colic scenerio. Pt was little dizzy but otherwise all normal except pain. After adequate analgesia,
what will b next management
1.send him home and ask ti drink plenty of water
2.send him home and ask ti sieve urine for stone
3. Refer to urologist
4. Plain abdominal xray
5.Pt with increasing forgetfulness. Visual hallucinations. Repeated falls. Which feature will b there to help u
diagnose
1. Disorientation
2 repeated episodes of confusion
3 difficulty in face recognition
4 psychomotor slowing
5.Child with vericella treated a few days ago.idont remember name of drug for infected pustules. Now having
ataxia and nystagmus. Most appropriate next investigation will be
1 vericellaIgM
2 LP
3 CT
6.Mass in anterior leg, firm regular, attached to gastrocnemius muscle, most appropriate inv ?
A. MRI
B. U/S
C. CT
D. Biopsy
7.24 yr female had 2 babies before, amenorrhea 2 years, all normal hormones (prolactin, testosterone,FSH,LH)
, estrogen 70, US 3-4 multiple cyst, Dx ?
A. PCOS
B. Hypothalamic dysfn.
C. Pituitary Adenoma
D. POF
8.Same above Scenario but ↑↑↑ FSH and ↓↓↓ estrogen, Dx?
A. PCOS
B. Hypothalamic dysfn.
C. Pituitary Adenoma
D. POF
10. 24 yr female cough, bloody sputum, hematuria, rash on ant.tibia, ACE ↑, Inv ?
A. Skin Biopsy
B. ANA
C. ANCA
12.Old lady in nursing home. Swelling and redness in parotid region. Cause
A.poor oral hygiene
13.24 yr female cough, bloody sputum, hematuria, rash on ant.tibia, ACE ↑, Inv ?
A. Skin Biopsy
B. ANA
C. ANCA
16.old POF scenario: she dosen't want to be preg. & Don't have sex ?
A. OCP
B. HRT
C. POP
D. Estrogen
17.Old male present with constipation, have ca with bone metastasis, took 20mg morphine for pain last week,
Inv ?
A. Morphine level
B. AbdXray
C. Serum Ca.
18.9 month boy chest Xray normal, grunting & 39' fever, given O2 n IV fluid, ?? (same old recall)
A. RSV
B. Bacterial pneumonia
C. Asthma
19.23 yr female epistaxis, headache, malaise, dizziness, LABS: Hb-8.5 Ca-1.9 INR-1.5 Ferritin ↓ , Rx?
A- Vit. K
B. Iv Ca
C. Plasma
D. BT
20.47 year female afraid from osteoporosis, what is risk factor of Osteopo. in history?
A. Family Hx at 80 years
B. Early menopause at 35
21. Open flial chest, pain, distressed, cyanosed ? (most appropriate next)
A. Morphine
B. Needle thoracotomy
C. Cover wound
22. ECG wide complex , slow af biventricular failure, basal crepitation, E.F=40% on digoxin,lisnopril,verapamil
?
A. increase digoxin
B. stop all drug and check in 12 hours
C. decrease verapamil
D. Add lasix 20ml/day
23. aborignal female 3 month dyspnea, on examination b/l basal crepitation and diastolic murmur, not smoker
but binge drinker, next step ?
A. ECG
B. Echo
C. alcohol counsel about intake
25. 80 yrfemale , her daughter will have baby in 2 days, what to take?
A. DTP vacc.
26. Baby in 7th day of age jaundice, Total Bil. 240, Direct 120, palpable spleen 2cm below c.m ?
A. Haemolytic Anemia
B. Biliary Atresia
C. Breast Milk Jaundice
29.Old age , fever sign of pyelonephritis, BP 90/60, confused and dysuris, pus in urine in urinanalysis, u send
for culture, GFR<20 *managment ?
A. Amox
B. Trimeth. &Sulfa
C. Gentamycin
30. CT given (Ischemic stroke), Old female, Rt side hemiplegia, dysarthia came after 1 hour from symptom,
best Mx ?
A. rtPA
B. Clopidogrel& Aspirin
C. Clopidogrel
D. Warfarin
31. Old male on antidepressant for 8 year, MMSE score- 23 , now irritable and insomnia, not socially active,
lazy all the time, dont talk to anyone ?
A. increase antidepressant
B. change antidepressant
C. Add Antipsych with antidepressant
32. You r in family party, your cousin have exam next week, want BZD ?
A. Give BZD
B. Give melatonin
C. Physiotherapy & exercise
D. tell his parents
E. Tell him to see formal doctor for advice
34. Male, pancreatitis two months have tenderness and fullness in Abd. , On CT 10cm Pseudocyst ?
A. Endoscopic Gastrectomy
B. Laprotomy
35.A woman on prosthetic valve, she is taking warfarin and you are checking her INR every week.
Date INR WARFARIN dose in mg
2nd April 1.5 4
9th April 1.75 5
16th April 2 6
23 April 2.1 ?
what is the dose of warfarin will you give for this week?
a. 5 mg
b. 6 mg
c. 7 mg
d. 8 mg
36. Male immigrant, Chest symp. , Xraydone .its apical tb, sputum +ve bacilli
A. INH 9 months
B. Isolation
37 Periorbital cellulitis, eyelid swelling, orbital redness, fever, he can move eyeball, what is Rx ?
A. IV fluxacill.
B. Oral AMox
C. IV Ceftriaxone
38. 24 yr female, no GI symptoms, anemia, IDA pic, Upper GI endo free, next ?
A. HB Electrophoresis
B. Colonoscopy
C. Small bowel Biopsy
40. Male 70 yr want to do check up for insurance , Plasma Protien Increase, s.albumin 3 (n: 3.5-5.5) , No
symptoms ? (what to do next)
A. Serum immunoglobulin
B. Plasma Protein Electrophoresis
C. Bone Marrow Biopsy
41. Spine X-ray bamboo sign, back pain, Now Can't bend, took PCM but not relieved?
A- Physiotherapy &Hyfrotherapy
B - Rest
C - Methotrexate
42. Old male, backpain, Xray done, Little osteoarthritic changes in spine without compression on spinal cord,
he want opoids ?
A. GIve
B. Rest
C. Exercise
D. Tell him morphine is taken only in malignant
43.BMI 25 in boy, came for tonsillitis, you find that parents r obese too (old scenario)
A. Decrease watching tv
B.Wt. Reduction Schedule
C. Reduce Caloric intake
44.male attack of angina and hypertensive, 170/? , s.cholesterol 5.5, most risk factor for IHD?
A-Angina
B-BP
46. 6 wk boy was ok and increase weight, 1 wk H/O vomiting but he is well hydrated but not increase weight
since vomit started ?
A-GERD
B-PS
47. Middle age man , ↑↑ ca, his father 75 yr have ca ↑↑ but didnt take Rx, PTH ↑↑, what is your Inv ?
A. Urinary ca
B Parath. scan
48. Pic of GOUT but renal impairment
A. Stop Allopurinol and give colchine
B. ↑ allopurinol and give colchine
C. Give allopurinol and give stenoroid
D. Stop allopurinol and give steroid
5o. Dumping recall :Pt had ca stomach, did partial gastrectomy, after meal by 1 hour have tachycardia,
sweating and hypotension, Dx?
A- Early dumping
B- Late Dumping
51. Bariatric surgery history 6 weeks, now abdominal pain and vomiting
A barium swallow
55. BMI 14 in female, excessive exercise, you will do all inv, except ?
A- ECG
B- Electrolyte
C- Gonadotropin
D- LFT
E- Bone Density
59. pregnant 24 weeks ,cervical dilated 3 cm & uterine contractions a-IV salbutamol
b-Oral erythromycin
c-IV oxytocine
d-IV methylprednisolone
60.HIV positive patient on antiviral drugs comes with hematuria, what investigation needed:
a. non-contrast CT
b. triphasic CT
c. U/S
61. Features of moderate croup(stridor and accessary muscle usage on rest but alert), what to give:
a. Im methyl predinisone
b. Oral prednisone
64. Young age football player suddenly collapsed without any event and later regain consciousness and returns
to game with 30mins, what is dx:
a.vasovagal
b.arrhthymia
4) A girl afraid to stay at friends home for night stay, don’t want
to get out of car. What’s the most important in history?
• Absence of symptoms in father’s absence
• Night terrors and sleep walking
• Hallucinations
• Irritable bowel
10) 8yr old boy, previously was doing well but last 2yrs
academically not normal, teachers worried that he is not doing
well this year, poor in writing and home works. How to reach
diagnosis?
a.audiometry
b.family dynamics
c.ent refer
d.visual test
e. school performance
15) young male came for insurance check up..on usg there is a 3
cm heterogenous mass on upper pole of rt kidney confirmed by
ct..mx-
a. radical nephrectomy
b. review after 12 months
c. biopsy
29). COPD pt come to ED, o2 88% they give him 6L/o2 and
now his o2 is 96%. what is yr next Mx?
A. V/Q
B. IV Amox
C. Salbutamol
D. Reduce o2 to 2L
33) 8yr old boy, previously was doing well but last 2yrs
academically not normal, teachers worried that he is not doing
well this year, poor in writing and home works. How to reach
diagnosis?
a.audiometry
b.family dynamics
c.ent refer
d.visual test
e. school performance
34) .8 month old child present with fever 39.2'C,
cough,dyspnoea,tracheal tug present but chest was clear.after
admission he was given oxygen and iv access had done ,whats
ur dx?
RSV bronchiolitis
sterp pneumonia
Coxsackie
45) 38 week preg., cervical dialt. 3cm, 200ml bleed, U/S normal
baby, Post. placent ?
A. ARM
B. Obervation
51) algerian Vegetarain lady with labs showing dec, HB, dec
ferritin, dec mcv, dec mchc , complains of malaise and fatigue,
what is the cause of this :
a. Thalasemia
b.Celiac disease
c.Dec Iron in diet
53) pregnant lady who her husband abuse her and make sure not
to leave any marks what is your next action:
-urgent admission
-urge her to call police
-reassure
54) A girl brought an old man who has
dysphasia,dyscalculia,Right left disorientation,he is heavy
smoker(30 pack year) and drinker.what is diagnosis
a.temporal metastasis
b.vermis carcinoma
c.frontal meningioma
d.left parietal glioblastoma multiforme