84-year-old woman with the history of MI and stent insertion six months ago was found to

have a lower pole renal mass of 1cm during CT scan done after treatment of pancreatitis. She
is on adual antiplatelet. What is the appropriate action?
A nephrectomy
B partial nephrectomy
C surveillance
Ans D

Pic of brownish freckles around mouth and lips was given. Look like peutz jeghers
Man came with pain distension of abdomen. Cause? Forgot whether acute presentation or
not?
A intussuception
B caecal cancer
C adhesion obstruction
D volvulus

Xray hemi hip arthroplasty

Old lady developed painless distension of abdomen six hours after hemi hip arthroplasty for
#NOF. On examination, boel sounds are spares. What is next?
A- NGT aspiration
B- Rectal tube insertion
C- Colonoscope
D- Ct scan
E- Barium study

8-year-old boy has long history of nocturnal cough and breathlessness after exercise at
school. On examination, he is well but there is scattered rhonchi on auscultation. What is the
best initial investigation? Not seems to be acute presentation
A PEFR
B spirometry
C CXR
D skin prick test

8-year-old boy has long history of nocturnal cough, breathlessness and after exercise at
school. Yesterday he came with acute breathlessness and was given treatment. Today he is
ready to be discharged. What is the ongoing treatment upon his discharge?
Inhaler fluticasone
Inhaler budesonide
Oral prednisolone
Cromoglycan

20 y o came to terminate her pregnancy of 12weeks. The pregnancy is normal and no

abnormality found. You are strong believer that termination should be reserved if for lethal
congenital malformation. Whats next appropriate management?
A) refer her to another gp who shared similar value for second opinion
b) refer to local ethic committee of hospital
C) refuse her in view of your value
D) refer to tertiary centre for further care and assessment

20 year old woman had a termination of pregnancy. She and her boyfriend didn’t want kids
for at least three years. She got pregnant this time because she missed several OC pills. What
contraception should be given to her that could be started now?
A- POP
B- COC
C- Depo condom
D- mirena

CXR – left sided pleural effusion. Man came with shortness of breath. On examination, dull
on left lower zone. Few crackles are found on left lung. invx
A pleural aspiration
B CT chest
C FBC

Similar pleural effusion CXR as above.

Man smoker after short respiratory tract infection that resolved by itself now came with
dypnoea. On examination, dull on left lower zone. Few crackles are found on left lung.
Cause?
A- Pneumonia
B- Ca lung

Months old Child with developmental delay(speech and gross motor delay described). Lower
limb tone increased and hyperreflexic. History of prem for PPROM. After delivery ABGA
was 6-7. Was given O2 and surfactant and given antibiotics Genta and something else.
A intra partum hypoxia
B RD$
C gentamicin toxicity
D prematurity

Scandinavian ,,bmi 22 ,,no family H/O of DM ,,COMES IN FIRST ANC ,,what next
appropriate --
a. OGTT NOw
b. OGTT 24-26 week
c. FBS 3 yeraly
d. RBS 1 yearly

Waldenstorm and MD$- antibiotic given for chest infection. Had chickenpox when he was a
kid. Now vesicular rash on abdomen and chest with crusting. What is the cause?
A- Varicella zoster virus
B- Drug allergy
C- Disseminated candida
Post partum woman came with vaginal bleeding. Antibiotic. Febrile
Penicillin+genta+metro
Amoxicillin+metro
Genta +metro
Pencillin + sth else

polyMyocitis
lady had difficulty climbing stairs. Reflexes are normal
High CK

Male taking quetiapine. Low libido and low testosterone level. Prolactin is 5400 mU/l. no
increased ICP symptoms. Cause?
Prolactinoma
Antipsychotic

Woman with all liver enz high. Afebrile with itchiness (+). Had flucloxacillin injection for an
infection(pneumonia?) 10 days ago. no history of similar attack.
Flucloxacillin induced hepatitis
Cholelithiasis
Choledocholithiasis
Ca head of pancreas

20ish man had single episode of fit at work as witnessed by his coworkers to have had jerking
limbs. No history of epilepsy.
Alcohol level
eeg
Ct head

School age kid febrile grunting no chest symptoms or sign. Look pale and ill. Cause
Pneumonia
ALTB
Acute epiglossitis

What is most useful examination technique for incisional hernia above umbilicus? Incision
was upper paramedian.
Cough on standing
Cough on lying flat
Active head raising
Passive foot raising

Man with pain in right abdomen for several hours. Now radiating to right groin. All
examination are normal apart from small swelling in right inguinal area that comes and goes.
Patient looks to be in severe pain. Investigation
Xray KUB
Ct adomen
Usg right groin

Painless groin swelling with no cough impulse, not reducible in woman. Lump in pic is
nearer to ASIS. Cause
Inguinal node
Inguinal hernia
Femoral hernia

Man with 10 years history of retrosternal heart burn. What is most diagnostic investigation?
Oesophageal PH
Oesophageal manomery
Endoscope
Barium study

Woman with pruritus during pregnancy for all of her three pregnancy. What is future
implication
Oc pills should be avoided
Pregnancy is contraindicated
Need psot partum USG
Nedd post partum ERCP

Man pruritis , dark urine , upper abdominal pain, fever. Bp is low. What to do next.
ERCP
MRCP
Usg
Ct

Young man in bike accident. Got hit to chest with pole. Given morphine due to pain by
paramedic. Combined dose is about 20 mg. now drowsy and difficulty breathing. What
should be given now?
Ph low, pco2 high p02 low
Naloxone
Ventilation
Chest tube

Copd patient with dypnoea. Given 02 6 l/min given.Pa02 is 80, ph low, paco2 high. Next
Reduce o2 to 2l/min
Sedate intubate ventilate
Cpap

Three people in closed room fainted. What is best method of o2 delivery

Hyperbaric chamber
Venturia
HF nasal prong
One volunteer worker to asian country (vietnam?) show features of communicable disease
(forgotten symptoms). She said other three co worker with similar sypmtoms. What should be
done
Do influenza test
Inform public health
Send patient to ED for assessment

Man burned. Hair singed near mouth and nose. Face cherry red, dyspnoic and hoarse voice.
Next?
Hyperbaric o2
Intubate

Plumber, chronic smoker of many pack year but stopped 5 yrs ago, came with progressive
shortness of breath, bilateral clubbing, crackles in bilateral mid zone posterior lobe. No x ray
given diagnosis
Copd
Sarcoidosis
Alveolar fibrosis
Ca lung

Antepartum hemorrhage blood loss 1000ml. uterus tense tender. bp 110/50, pr 120, fetal heart
rate absent with doptone. Next
O2
Iv fluid
Usg?

Newborn cyanosis after first feed. Look rigorous but dyspneic. color not improved by o2.
Collection of saliva in mouth
O2 (forgotten method of delivery)
Nasogastric tube
Orogastric tube
Positive pressure ventilation
Watch feeding technique

Cyanosis hours after birth. Cra show mild pulonary plethora (CXr not given)
Prostagladin e2
Atrial septostomy

Infant frequent effortless vomiting not bile stained. Height and weight centiles are in normal
range. Kid looks ok otherwise
GERD
pylorostenosis
AF ECG with unstable BP
Cardiovert
Metoprolol

Man 1hr constricting chest pain relived by itself. ECG appear to be normal with no St and t
changes or q waves. Trop normal. What to do
Repeat ecg and trop
Angiogram
Admiting for continuous monitering of Ecg
Tell him to contact GP for next attack

Girl came with hours history of hallucination. Her friends says she is ok when she came to
party
Serum amthamine
Breath cannabinoid
Urine drug screen
alcohol level

Man has persecutory delusion against a friend. Tell you not to tell anyone
Warn that friend
Tell police
Maintain confidentiality

Teen boy came in for offense against a classmate. His class performance drops this year due
to much focus on detailed sketch drawing. On being asked to explain his recent behaviour
change, wasn’t able to do so avoiding eye contact and being uncommunicative. Deny
recreational drug use.
Asperger
Drug use
Schizophreniform

16 or 19 yr old girl said her drink was ‘spiked’ in school 6months ago. She started reading
information about poisoning and ……. She stopped school, reduce eating and inducing
vomiting. BMI 19 and always in her room alone
a. Major depression
b. Prodromal schizophrenia
c. Eating disorder

Young child abdominal pain and nausea mostly in the morning. No other symptoms. In the
evening he is well and eat fine. Mostly stay at home due to symptoms.
Ask about anxiety symptoms
Contact school teacher
Young girl poor performance on group work, doing fine on individual work. Doesn't want to
come to school, play well at school playground during recess. Talk normally at home with
family member
Separation anxiety
Selective mutism
Social phobia

You see a Facebook post by former patient mentioning how disappointed he is with your
treatment approach. What should be your correct response?
Ignore him
Try to justify your action on Facebook by writing post
Ask him to make a appointment so u can clarify your treatment

Old man with diagnosed Alzheimer. He can navigate around his house during day time pretty
much easily. He can manage his financial matter with some assistance. MMSE is 24(round
about).what to advise driving authority?
Limiting his license to conditional with ?km2 in day light hrs
Unconditional driving license
Should be assessed formally by trained occupational therapist

Old woman becoming forgetful. Leave stoves open, forget words when talking with friends
seems frustrated by it. Area of lesion
Angulate gyrus
Medial temporal lobe
Frontal lobe

Woman with unilateral weakness for 2 days, recovered by itself. Soft carotid bruit. On carotid
doppler both right and left is aroun 50 – 60%. Bp is very high (forget no). what to give for
future prevention of CVA.
Antiplatelet
Carotid enarterectomy
BP control

Architect student on opioid dependence. Want to avoid time consuming maintenance

program becauses she want to attend next semester.
Methadone maintainace
Naltrexone maintainace
Join heroin anonymous group
Join rehab in between terms

Pyogenic granuloma diagnosis

Coronary event No coronary event
Aspirin 1 99
No aspirin 2 98
ARR?
17 years old girl came for contraception what else should be advisd

chlamydia 6 monthly

all STI yearly

5 yearly HPV vaccine

cervical screening from 25 years

47 years old women has two kids 15 and 17 from previous marriage husband is 60 years old
having two kids 10 and 16 as well but after trying for three years they cannot concieve asking
the cause

Azoospermia

Paternal age

Anoulatory cycles

Size and number of oocytes

man got wound while working in a farm he fot a tt 5 weeks ago due to a laceration on hand
rest of his vaccination history is not known to him

Give Pencillin

DTa and TIG

DTa
TT and IG

Old man with pelvic rami fracture

Activity as tolerated
Activity with brace
Bed rest for x ?wk

Women whose grand has serious accident one month ago she believes its all because of him
and is guilty she couldn’t sleep. she believes police will come and arrest her

Acute stress disorder

PTSD

Complicated bereavement

Young man with multiple joint pains usually going to victora for treking asking cause.
Noticed rash before joint pain
 Ross river

Rhematiod arthritis

Aus tick typhus

Obese Patient on thiazide polyuria, polydipsia rbs is 17

Do ogtt
Start insulin therpy
Review after stopping thiazide

Patient with ankle swelling. Pain, tenderness, afebrile, aspiration done. What sould be found
CPP crystals
Urate crystals
Just inflammatory fluid
Bacteria

Diabetic woman ankle xray (xray not given) juxta articular osteopenia,loss of joint space
c/o mild pain and swelling
RA
OA
Neuropathic joint

65 years old with no history of VTE or any other rish Post op diverticular disease asking
about anticoagulation

Enoxaparin till discharge

Enoxaparin till 14 days

Enoxaparin till 28 days

Kid with pertussis sypmtoms x 2 wk.When to go to school

Give antibiotic and go now
Give antibiotic and go 14 days
Vaccine

post op cholon cancer with 27 nodes resected out of which 2 were positive histopath was of
adenocarcinoma what approprate step should be taken

Chemo alone

Chemoradio combine

resection od all nodes

radiotherapy only
T3N0M1 prostate cancer asking treatment (dont remembet the age of pateint)

B/L orchiedectomy

Androgen ablation

Radical prostatectomy

Schizophrenia patient funded by govt becasue he cannot work now his condition is getting
worse and his bills are also paid by govt what in mmse will be declined

Orientation

Visiospatial
Proverb interpretation

women with pregnancy having low iron asking next step

iv iron infusion

hb electrophoresis
5 year old boy woith bleeding from moth which is not stopping and many bruises on legs and
head asking cause

factor 8 def

factor 9 def

ITP

Vonwillibrand
Thrombin def

Man with VWB doing surgery

Factor viii
Desmopressin
Factor vii

taxane side effects