91 yr old found dead in aged care facility , known case of and ischemic heart disease, you are called to give death certificate, refer to coroner
a) request for autopsy
b) inform director of aged care facility
c) call ambulance
d) one more option( don’t remember)
90 year old bed bound, emaciated, muscle wasted, i think dementia as well admitted
a) discuss end of life care with family
b) nasogastric feeds
lurias test- frontal lobe test, unable to perform, dementia symptoms also mentioned, what inv to help diagnosis serum vit b12
a) blood alcohol
b) urine drug screen
c) no option of ct
6 yr old, father remarried, making excuses to go to school or
a) something,
b) behaviour therapy
c) family therapy
colles fracture, planned for orif on enalapril, metformin, beta blocker,aspirin and thyoxinetfts giventsh low 0.1t4- normalt3- highasking what to do on morning of day of surgerywithhold aspirinwithhold thyroxinecontinue metformincontinue enalapriltooth extraction tomorrow pt on warfarin (for non valvular af?- butnot sure whether this question) inr 2.2continue same dose of warfarin with aim of inr 2- 3reduce warfarin with target inr of 1.8-2.2stop warfarin and start heparin ecg- tachycardia, there was slightly broad qrs complex only at theend, calculated qrs duration- was like 4 small squares if am right)- butdidn’t seem like a vt to me, regular rhythm- rate 150/min on ecgscenario- hypertensive man on angiotensin receptor blocker andthiazide, b9 supine- 118/72supine-90/ something, but sbp difference was 18 mmhg and diastolicwas less than 10 mm hg, complained of lightheadedness andpalpitaions- heart beating fast, it lasted for more than 2 hrs, askingmanagementbeta blockeramiodaroneiv normal salinedc cardioversionguillain barre scnarion with cf- albuminocytological dissociation,most appropriate test for diagnosisa.
a) nerve conduction studies
b) emg
c) both options
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man- sports person h/o multiple neck injuries, diarrhoea 2 weeks ago,difficulty in extending wrist and elbow, numbness in posterior aspectof lower third of arm radial nerve injuryc7 achilles tendon rupture after squash, squeeze test positive- diagnosiswas the question old woman, a widow since 1 year, strange behaviour on and off, wasdigging a grave, when neighbours approached she accused them of something and then agreed to come to emergency, what in history, will help to diagnose thought form
a) orientation
b) memory
c) cognition
d) delusions
man brought by girl friend. he says love you love you girl, am in a whirl mania schizophrenia histrionic personality disorder man with h/o criminal records. now h/o insomnia, agitated, recently charged with minor assault olanzapine diazepam refer to some program depression scenarion of a teen. isolated, posts a sad post on fb, but fulfilled criteria for depression- feeling useless etc. no suicidal ideation, brought by mother
a) fluoxetine
b) cbt
girl has underwent some lip surgery. constantly checks mirror. exercises for 100 mins ( close to it) on treadmill and 200 pushups everyday. bmi-19 anorexia nervosa body dysmorphic disorder normal teenage behaviour or something ballet dancer, recentlt training intensely for past 3 months. Exercising and vomiting. had collapsed one day while practice as well, what to check now
a) urea, electrolytes
b) Ift
c) bone density
mother third trimester, abruption scenario, painful bleeding, what predisposed 15 cigarettes per day smoking snorting cocaine 3 times per week hep c positive, iv drug abuser. aymptomatic, fibroscan normal- no cirrhosis. forgot whether Ifts was given refer for methadone program tell him that you can start treatment only when he stops drug abuse measure cv viral load A male pt was really stressed out and was saying that he should take a diazepam pill to calm down, otherwise he’ll become aggro (aggresive), and there are days that he takes 16, 5mg diazepam a day. He had history of sexual abuse in childhood and had a low self esteem, what is your diagnosis?
a) BZD dependency
b) borderline pd
c) antisocial pd
10 yo boy is brought due to an earache & droopy face. Has episodes of viral illnesses in the past. Difficulty closing the right eye & has a right-sided facial droop. Right otoscopy shows crusted eruptions in the external auditory meatus. Cause?
a) Drug-induced allergic reaction
b) Fungal infection of external canal
c) Reactivation of herpes zoster virus
4 yr-old boy is brought due to fever & pain with urination. History includes a febrile UTI at age 13 mths. Urinalysis reveals positive nitrites & leukocyte esterase. Urine culture shows >100k colony- forming units/mL of E Coli. Symptoms resolved in 24 hrs with antibiotics. Next step?
a) Abdominal and pelvic CT
b) Daily antibiotic prophylaxis
c) Voiding cystourethrogram
A 28w pregnant woman came with rapid distension of abdomen, had no previous prenatal checkups, on ph/e we found out she had twins. In her sono we a 4cm fibroid was seen anterior to her womb, what is the cause of this rapid abdominal distension?
a) red degeneration
b) amniotic fluid discordant
A woman after mva came with neck pain, which on of the following is an indication of imaging?
a) tenderness 3cm lateral to cervical spine
b) pain on extension
c) pain in lateral rotation
d) pain in flexion
A 4y/o boy had a viral upper respiratory tract infection a week ago which was not a concern for her mother. Mother brought to child to you saying that he refuses to walk and when he does he cries. In ph/e rom of knee, ankle and hip were normal. Esr= 14 (nml=10). What is your treatment option?
a) mtx
b) paracetamol
c) prednisolone
d) ivig
A woman came with lower abdominal pain and slight fever, but was reluctant to be examined (pelvic exam) by a male doctor, she asked for an alternative for examination. What will you do?
a) refer her to an obstetrician
b) book an appointment with a female patient tomorrow
c) ask her if she is comfortable to be examined with a female nurse present
A obstetrician 33y/o woman 32w pregnant, her last prenatal scan was normal. In this visit her fundal height was 36w, what is the cause?
a) wrong date
b) iugr
c) polyhydramnios
d) twin pregnancy
A pregnant woman had a pregnancy test in hospital which became positive, his husband called to get the results, what will you do?
a) book an appointment to give him the result
b) we don’t give any patient’s result to anyone
c) we can’t give your wife’s results to you
d) we only give the results to your wife
A pregnant woman with normal first trimester screening and normal for 13, 18 and 21 trisomy, with low PAPP-A, what is your management?
a) Amniocentesis
b) reassure
c) no follow up
d) evaluation of growth by further scans A obstetrician 33y/o woman 32w
pregnant, her last prenatal scan was normal. In this visit her fundal height was 36w, what is the cause?
a) wrong date
b) iugr
c) polyhydramnios
d) twin pregnancy
A pregnant woman had a pregnancy test in hospital which became positive, his husband called to get the results, what will you do?
a) book an appointment to give him the result
b) we don’t give any patient’s result to anyone
c) we can’t give your wife’s results to you
d) we only give the results to your wife
A pregnant woman with normal first trimester screening and normal for 13, 18 and 21 trisomy, with low PAPP-A, what is your management?
a) Amniocentesis
b) reassure
c) no follow up
d) evaluation of growth by further scans
A 4 year old with boy wakes up screaming at nights, doesn’t respond to his parents for 10 minutes, no tonic clonic movements. Diagnosis?
a) Nightmare
b) Night terror
c) Partial Seizure
A 4 year old with boy wakes up screaming at nights, doesn’t respond to his parents for 10 minutes, no tonic clonic movements. Diagnosis?
a) Nightmare
b) Night terror
c) Partial Seizure
A man with hx of gout uric acid level:0.88 under treatment of indomethacin and colchicine and came with complaint of tophi and destructive changes in joints, years ago tried allopurinol but developed rash and allopurinol was discontinued, what do you suggest for tophi and destructive changes in joints ?
a) Probenecid
b) Feboxostate
c) Allopurinol desensitization
A man comes to ED with cc of sob on exertion, jvp increased, edema in legs, central cyanosis , T:38.5, respiratory distress nothing about smoking, abg : Ph 7.45, Po2 46, Pco2 55 hco3:22 after giving o2 and salbutamol, next?
a) intubation
b) cxr
c) ctpa
d) hydro iv
An old man in nursing home with a history of copd comes with increasing SOB. ABG: PH:7.36 PCO2:55 HCO3:33 base excess :+5 PO2:46
a) acute metabolic acidosis
b) Compensated respiratory acidosis
c) Partially compensated respiratory acidosis
d) Mixed respiratory and metabolic acidosis
e) Respiratory alkalosis
A man under treatment with aripiperazol came with feeling of restlessness and unable to sit .Dx?
a) Akathisia
b) Acute dystonia
c) dyskinesia
d) Bradykinesia
A 53 year old developed lower back pain while gardening the pain radiates to right lower limb no paresthesia SLR was positive in 60 degrees, what to do?
a) Ibuprofen
b) Rest and immobilize
c) Spinal xray
d) Spinal CT
e) (No keep active)
A patient with Graves disease. Has been done subtotal thyroidectomy. In specimen pathology, there is PTC microcarcinoma in the middle of the specimen. Mx?
a) Total thyroidectomy
b) Radioactive iodine
c) CT
d) No action needed
A 55 year old patient with a history of graves disease undergone subtotal thyroidectomy. There was a 0.5 cm micro papillary carcinoma in the specimen. Next?
a) Total thyroidectomy
b) No action needed
c) Radioactive iodine
d) Lobectomy
An overweight woman with FBS 6.2 , hyperlipidemia who suffer mild knee osteoarthritis and she doesn’t have physical activity has sedentary life style BMI 33. Management?
a) Exercise physiology assessment
b) 150 min exercise in a week
c) Metformin
d) Statin
e) Roux en Y
Patient with drug history of MTX for 5 yrs, paracetamol for 3 yrs and prednisolone. 14 days after a complete treatment with flucloxacillin comes with the chief complaint of (I think) ichter and RUQ pain. The lab data: Alkp+0 GTT + + AST:40 ALT:45 Which drug is responsible for the above lab data?
a) Mtx
b) Paracetamol
c) Prednisolone
d) Flucloxacillin
A 60 year old man with a history of scc in face comes with the chief complaint of firm painless swelling increasing in size in the mandibular angle (I think during recent 6 to 4 months) . Didn’t mention any increasing pain with swallowing or eating. Diagnosis?
a) Pleomorphic adenoma
b) Warthin’s tumour
c) Scc metastasis
A young woman comes to ED with severe abdominal pain which eventually localized in right lower quadrant. Vomiting and nausia but no anorexia. Uses condom for protection. Her last mense was 6 weeks ago. In PE there was rebound tenderness with guarding. Most pro diagnisis?
a) Appendicitis
b) Ruptured ovarian cyst
c) Salpangitis
d) Ectopic pregnancy
A man with sudden pain in eye comes to ED. There was a fixed semi dilated pupil. Next appropriate management?
a) Timolol
b) Pilocaepine
c) Oral acetozolamide
d) Chloramphenicol
A woman with history of headaches for 5 years comes with chief complaint of decreasing eye sight. In PE visual acuity was 6/60 rt and 6/20 Ift eye. The fundoscopy was like the above picture. diagnosis?
a) Multiple sclerosis
b) Diabetic retinopathy
c) Optic nerve glioma
d) Olfactory meningioma
e) Ant Ischemic Optic Neuropathy(AION)
A man with history of pancreatitis two months ago, now comes with a 10 cm cystic mass with a thin rim exactly posterior to stomach in his ctscan. Next management?
a) ERCP with duct drainage
b) laparoscopy
c) laparatomy
d) conservative management and re evaluation in 6 months
A 25 year old man woke up this morning with a pain in his testis. In physical exam his testis are swollen red with tenderness, the pain reduced when held upward. No secretion and fever. Next management?
a) Chlamydia per test
b) U/c
c) Sonography of testis
d) Swap from pus
e) Needle biopsy
A diabetic man with a history of hypoglycemia after gym. Most appropriate advice regarding driving?
a) Don’t drive for 6 weeks
b) Don’t drive unless your BS is above 3 mmol/l
c) He can drive but check glucose every 2 hours.
A 6 years old adapted boy was bullying classmates, and beat them, at home also annoy family members, his parents must be carefull about him on crowded situation, because he easily wander off with stangers, what to do ?
a) psychosocial assesment
b) Sensoryneural assessment
c) Psychosocial assessment
A 3 years old boy beated her 1year old sister at home , sometime good eating and sometimes not eat his food well, but he was good at day care,what to do?
a) Reffer to pediatrics psychologist
b) Psychososial assessment
c) Behavioral advice to parents
A patient with major depression has indication of ECT, the question asked us what do you say before the consent, about ECT?
a) We have good evidence on effectiveness of ECT
b) ECT is used only for inpatient patient
c) memory loss after ECT is uncommon
d) We use local anesthesia before ECT
18 yr-old woman fractured her distal radius. Has ambiguous external genitalia at birth. Never had menstrual cycle. No breast development & marked clitoromegaly present. Estradiol & estrone undetectable. FSH, LH, testosterone & androstenedione high. Multiple ovarian cysts. Diagnosis?
a) Aromatase deficiency
b) Congenital adrenal hyperplasia
66 yold man on routine follow-up has mild fatigue. History of hypertension, type 2 diabetes mellitus, hyperlipidemia, chronic kidney disease & ischemic cardiomyopathy. A 2/6 holosystolic murmur at the apex. Has trace edema in bilateral lower extremities. 2 mths ago, creatinine was 200. Next step?
a) Administer calcium gluconate
b) Measure serum renin and aldosterone levels
c) Review current medications
4 yr-old girl is brought by her adoptive mother due to concerns about her adjustment to preschool. She does not interact with classmates, speaks infrequently at home & doesn’t like being hugged or picked up. Interacts with physician with little facial expression, but speech is normal. Diagnosis?
a) Adjustment disorder
b) Autism spectrum disorder
c) Reactive attachment disorder
5 day old girl is brought with concerns of her varied breathing pattern. She often takes rapid, shallow breaths followed by 5-10 sec pauses. She lives with her parents, who occasionally smoke a cigarettes. Uses a pacifier for sleep. Greatest impact on safety?
a) Avoidance of pacifier use while asleep
b) Avoidance of passive smoke exposure
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34 yr-old military pilot comes for evaluation of hearing loss. Flown the past 8 years in noncombat zones. Aural exam shows clear, intact tympanic membranes bilaterally with no middle ear effusion. Audiometry reveals a mild, bilateral, high- frequency hearing loss. Cause?
a) Cochlear hair cell damage
b) Decreased ossicular mobility
30 yr-old man comes due to 3 days of dysuria & urinary frequency. Similar symptoms twice over the past 4 mths; both times, has UTI & has complete resolution of symptoms following short courses of antibiotic therapy. Sexually active & has pain with ejaculation. Cause?
a) Chronic bacterial prostatitis
b) Chronic infectious epididymitis
26 yr-old man comes with Ards due to opioid overdose & aspiration of gastric contents. Subsequently, intubated, sedated, and receiving mechanical ventilation. The patient had anesthesia-induced hypotension after intubation, but has been hemodynamically stable after receiving 4L NS. SAO2 is 92%. The patient is receiving low tidal volume ventilation at 8 mL/kg. FiO2 is 50%, PEEP is 12 cm H2O. The patient-ventilator interaction is synchronous. ABG analysis demonstrates pH 7.31, PaCO2 50, and PaO2 64. CXR shows patchy bilateral opacities consistent with pulmonary oedema. Intervention?
a) Avoiding a positive fluid balance to reduce pulmonary edema
b) Increasing tidal volume to avoid permissive hypercapnia
A man comes with motor vehicle accident ( mva) with lacerations on the skin, we just gave him Tetanus Toxoid, whats the next step
a) Internal fixation
b) Iv AB
c) Debridment
A middle aged man (45 i think) came with a sudden severe epigastric pain radiating to back associated with nausea and vomiting he says he had 2 similar attacks in the last 6 months vital signs were normal T:37 BP: 110/80 examination reveals a mild tenderness on epigastric region no rebound or guarding Bowel sound are present , next?
a) Lipase
b) CXR
c) supine and upright abdominal xray
d) Endoscopy
e) Troponin
A 24 yo female came with complaint of ligt headedness and fatigue she had menorrhagia and low hb and was on iron therapy . She was asking if she will be ok to take her exam which is next week BP:120/80 PR: 124 RR:36 T:36.9 SPO2:99% whats the reason?
a) Thyrotoxicosis
b) Hyperventilation
c) Anemia
A middle aged man non smoker, non alcoholic,had nonvavular AF and was on rivaroxaban, now comes with intermittent hematuria, no disuria, no frequency, UA contains : RBC many , WBC: many, no cast , no organism and no epithelial cells, GFR>90 , ct scan of kidney urether and bladder was normal, bun cr normal, what do you do?
a) cystoscopy
b) sease rivaroxaban
c) .change rivaroxaban to enoxaparin
A middle age man smoker and alcoholic, had drug eluting stent(DES) was on aspirin and clopidogrel comes with intermittent gross hematuria, UA: RBC many , WBC many , no cast, no epithelial cell, no organisms,GFR > 90, next step?
a) Ct scan of kidney urether and bladder
b) Cystoscopy
c) stop clopidogrel
d) Stop aspirin
A middle age man was on rivaroxaban, comes with melena ,pr : 90 pb 130/90 T 36.9 TR :melena, got 2 units pack cell for maintaining Hb on 9 the question said the patient is hemodynamically stable.what to do?
a) RBC scan
b) Technessium scan 99
c) ct angiography
d) Visceral angiography
e) capsule endoscopy
A young man was on amitriptyline and serteraline and tramadol. Because of common cold the doctor started dextromethorphane for him, now comes with agitation, fever, diaphoresis,hyperreflexia, what is the cause ?
a) SS
b) MNS
c) pneumonia
52 yr-old man comes due to abnormal liver chemistry results. Exam shows palmar erythema & multiple spider angiomas. US reveals a coarse, nodular-appearing liver with no masses, mild ascites & splenomegaly. Endoscopy demonstrates medium- sized nonbleeding esophageal varices. Next step management?
a) ACE inhibitors
b) Beta-adrenergic receptor blockers
26 yr-old man in the burn unit is being evaluated for nutritional needs. Partial- thickness burns to the face & neck & full- thickness burns to the anterior chest, abdomen & both upper extremities. Receiving IV crystalloid resuscitation titrated to an adequate urine output. Appropriate nutrition?
a) Dextrose-containing fluids now
b) Enteral nutrition after 72 hours
c) Enteral nutrition now
32 yr-old man is brought due to confusion & fever for 2 days. History is significant for bipolar disorder. Treated with lithium & an antipsychotic medication & the doses have not changed over the last 2 mths. Muscle tone markedly increased. Mild dysarthria & hand tremors present. Next step?
a) Discontinue antipsychotic
b) Discontinue lithium
A 25 yo marathone runner came with lightheadedness (No FH and no PMH was mentioned) (PR interval was short delta wave wide QRS V1 lead QRS was negative )
a) Accelerated AV conduction
b) hocm
c) Long QT
d) Pericarditis
e) RBBB
An intern wants to know relationship between nutritional suplemets and OA pain, what is the best study form?
a) Meta analysis
b) Case study
c) Cohort
d) RCT
e) case series
Two case of measels has been find in a school and a doctor wants to prevent further outbreak ,our actions?
a) close the school for 7 days
b) exclude unvaccinated people
c) children that have fever and rash Quarantine for 7days
d) administer immunoglobolin to all staff and children
Two case of measels has been find in a school and a doctor wants to prevent further outbreak ,our actions?
a) lose the school for 7days
b) exclude unvaccinated people
c) children that have fever and rash Quarantine for 7days
d) administer immunoglobolin to all staff and children
A man has come for routine check up , he has DM and HTN ,he was undertreatment he has 75% left carotid stenosis ,25%right carotid stenosis managment?
a) left carotid stent
b) bilatral endarterectomy
c) cvd risk assesment control
21 yr-old man comes for painless vision loss in the right eye & headaches. BP 190/100. Has retinal & cerebellar hemangioblastomas. His father had very high BP & significant hearing impairment & died of an intracranial hemorrhage at age 48. Cause of elevated BP?
a) Aldosterone overproduction
b) Catecholamine overproduction
34 yr-old gravida 3 para 0 aborta 2, at 18 wks gestation routine prenatal visit. Prior pregnancies ended in 2 dilation & curettage procedures for spontaneous abortions due to fetal aneuploidy. Placenta is anterior & low-lying with numerous lacunae & myometrial thinning. Greatest risk?
a) Abruptio placentae
b) Intraamniotic infection
c) Postpartum hemorrhage
7 yr-old boy is brought to follow-up on a flare of atopic dermatitis. 10 days ago, he was prescribed a medium-potency topical corticosteroid for 2 eczematous plaques on the left leg that were intensely pruritic. Medication & topical emollients applied twice a day. Next step?
a) Add oral prednisone
b) Add topical mupirocin
8- mth-old boy is brought due to fever & decreased appetite. Patient awake only 2 hrs today; most of that time, he was crying. Appears sleepy & has a high-pitched cry when roused. Anterior fontanelle is bulging. Next step?
a) CT scan of the head
b) Dexamethasone therapy
c) Lumbar puncture
17 yr-old girl comes due to a rash. She joined the high school cross country running team 2 mths ago & has had a progressive itchy rash on her feet since. Symptoms continued despite replacing her running shoes & socks. I think tinea pedis dx. Treatment?
a. Cephalexin capsules
b. Miconazole cream
45 yr-old man is evaluated for severe right flank pain. History of hypertension, hyperlipidemia & diet-controlled type 2 diabetes mellitus. BMI is 43. 5-mm stone in the right ureter & several smaller stones in both renal pelvises. Stone composed of 100% uric acid. Prevent recurrent stones?
a. Calcium-restricted diet
b. Furosemide
c. Potassium citrate
35 yr-old woman comes due to a 2-day weakness in her right hand. History of herpes labialis. Recently taking vitamin D supplement, oral contraceptive pills & completed covid-19 vaccines. Type 2 diabetes mellitus in her mother & hypertension in her father. Cause of sx?
a) Covid-19 vaccination
b) Failure to use barrier contraception
c) Vitamin D deficiency
19 yr-old woman comes for evaluation of chronic acne. History of attention-deficit hyperactivity disorder & mild intellectual disability. Her mother has seizure disorder & maternal grandmother died of kidney failure. Several elliptical, hypopigmented macules on the trunk. Cause?
a. Congenital adrenal hyperplasia
b. Fabry disease
c. Tuberous sclerosis
6 yr-old girl is brought for evaluation of right knee pain after her gymnastics class. When supine, the right hip is held flexed with the knee pointed laterally. There is limited internal rotation & extension of the right hip. Ultrasound of the hips shows small, bilateral effusions. Diagnosis?
a. Juvenile idiopathic arthritis
b. Osgood-Schlatter disease
c. Transient synovitis
10 yr-old boy is brought due to 2 days of rhinorrhea, congestion, cough & wheezing that worsened. X-ray reveals hyperinflation & bronchial wall thickening. Given continuous nebulized salbutamol, IV terbutaline & non invasive ventilation. Next step?
a. Continued noninvasive ventilation with close observation
b. Endotracheal intubation
4 yr-old boy is brought due to sore throat. 2 days ago ill with fever & rhinorrhea. Has type 1 diabetes mellitus & DKA. No childhood vaccinations. 99th percentile for weight. Oropharyngeal exam shows multiple dental caries. The tonsils are mildly erythematous & 1+ bilaterally. Risk factor?
a. Childhood obesity
b. Inadequate dental hygiene
c. Lack of recommended immunizations
65 yr-old woman screening DXA scan revealed osteoporosis. Has occasional back & hip pain. Her mother has osteoporosis. She walks 1-2 miles daily & consumes a balanced diet. Physical exam reveals nonlocalized bony tenderness of the spine. Next step?
a. 24 hour urinary calcium level
b. Celiac serology testing
c. Serum protein electrophoresis
35 yr-old man crashed his motorcycle into a guardrail at high speed. Riding without helmet & briefly lost consciousness. Now wearing a cervical collar. Chest wall bruising & tenderness. Loss of pain & temperature sensation in both legs. Cause of neurological deficits?
a) Anterior spinal cord
b) Central spinal cord
56 yr-old man hospitalized with acute myocardial infarction & a drug-eluting stent was placed in the left anterior descending artery. Patient later experienced sharp chest pain radiating to left shoulder. ECG shows sinus tachycardia & widespread PR- segment depression. Next step?
a. Coronary angiography
b. CT pulmonary angiography
c. Echocardiography
16 yr-old boy sustained eye injury from paintball game. Exam shows rock-hard induration, periorbital edema & ecchymosis with proptosis of the left eye. Visual acuity is 20/100 in the left eye. Relative afferent pupillary defect in the left eye. Next step?
a) Cool compress and ibuprofen only
b) CT scan of the face and orbits
c) Emergency orbital decompression
A prospective cohort study was conducted to evaluate the long- term effects of a high-fat diet on the incidence of colon cancer. 5-yr relative risk of 1.60 for people who consumed a high-fat diet compared to individuals who consumed a low-fat diet. 95% confidence interval 1.02 to 2.15. p values?
a) 0.04
b) 0.06
48 yr-old torres islander woman comes for a follow-up for abdominal swelling. Has been taking lactulose, spironolactone & furosemide. Drank 12 beers daily for 15 years. Exam reveals mild jaundice, palmar erythema, a slightly distended abdomen & spider angiomas. Immunizations recommended?
a) Hepatitis A, hepatitis B, and influenza
b) Hepatitis A, hepatitis B, and dTpa
c) Hepatitis A, hepatitis B, influenza, pneumococcal, and dTpa
55 yr-old man is brought due to acute-onset agitation. Became angry during a meeting, throwing his laptop against a wall & accusing coworkers of conspiring against him. ECG reveals sinus tachycardia & a prolonged QT interval. Convinced that other patients are stealing money from him. Medication?
a) Anti -beta adrenergic
b) Antidopaminergic
c) GABA-ergic
on venlafaxine for depression, well controlled. now with mania symptoms
a) withdraw venlafaxine
b) start risperidone
c) sodium valproate
64 yr-old man with sudden severe chest pain accompanied by nausea. Has hypertension & type 2 diabetes mellitus. Dissection of the ascending aorta extending up to the arch. Before urgent surgery, develops increasing shortness of breath. Bibasilar crackles appears. Cause of shortness of breath?
a) Acute respiratory distress syndrome
b) Aortic valve insufficiency
15 yr-old girl is brought due to pain in her arms, legs & lower back. Has sickle cell disease & in the past hospitalized for pain crises & pneumococcal sepsis. Suddenly unable to move her left side 1 hr after morphine is given. Exam shows 1/5 strength in the left upper & lower extremities. Next step?
a) Antiplatelet therapy
b) Blood culture and antibiotic therapy
c) Exchange transfusion
35 yr-old man comes due to severe abdominal pain for the last 4 hrs. Pain started in the periumbilical area but shifted to the right lower quadrant. Has nausea & 2 episodes of vomiting. Palpation of the left lower quadrant produces pain in the right lower quadrant. Imaging study?
a) CT scan of the abdomen and pelvis
b) MRI of the abdomen and pelvis
c) selective mutism question
51 yr-old man comes with difficulty swallowing solids but not liquids. Has GERD for the last 12 yrs. Diagnosed with Barrett’s esophagus 6 mths ago. BMI 38. Barium swallow now shows an area of symmetric, circumferential narrowing affecting the distal esophagus. Diagnosis?
a) Achalasia
b) Esophageal adenocarcinoma
c) Esophageal stricture
39 yr-old woman comes due to vaginal spotting & a positive pregnancy test. Cesarean delivery 8 yrs ago. Quantitative 3- hCG level increased. No pelvic pain or cramping. D&C performed & exam of the intrauterine contents reveals benign endometrial tissue & no chorionic villi. Cause of presentation?
a) Complete spontaneous abortion
b) Ectopic pregnancy
32 yr-old man comes for a routine preemployment physical. His father died suddenly at age 54. BP 175/103 mm Hg in the right arm & 180/105 mm Hg in the left. Bilateral, nontender, upper abdominal masses are palpated on exam. Next step?
a) 24 hour urine cortisol
b) Abdominal ultrasound
63 yr-old man with sudden-onset right-sided weakness. Has hypertension & resected early-stage sigmoid colon. Takes lisinopril. Left carotid bruit. Carotid duplex ultrasonography & follow-up CT angiography show 80% stenosis in the left internal carotid & 40% stenosis in the right. Next step?
a) Bilateral carotid artery revascularization
b) Left carotid artery revascularization
54 yr-old man comes due to worsening low back pain. Has non-small cell carcinoma of the lung treated with surgical resection a r ago. Smoked a pack of cigarettes a day for 30 yrs & quit a yr ago. Exam shows local spinal tenderness at the L4- L5 level. Cause?
a) Disc herniation
b) Lumbar muscle strain
c) Metastatic cancer
54 yr-old woman with fever, chills after dialysis session. Has end-stage kidney disease, sigmoid diverticulosis & symptomatic gallstones. Studies reveal neutrophilic leukocytosis & elevated lactic acid level. IV fluids & antibiotics started via peripheral IV catheter. Additional interventions?
a) CT scan of the abdomen and pelvis
b) Dialysis catheter removal
65 yr-old man with abnormal reading during screening tonometry. Has asthma; takes inhaled fluticasone/salmeterol routinely & inhaled salbutamol. Intraocular pressure is 28 mm Hg. Funduscopy reveals thinning of the optic disc rim & asymmetry of the cup/disc ratio between the eyes. Next step?
a) Advise to stop glucocorticoid therapy
b) Begin atropine eye drops
c) Start latanoprost ophthalmic solution
a girl has moderate bleeding every cycle. cycle irregular 26-35 days. what mirena helps?
a) failure rate less than 1%
b) regulates the cycle
c) reduces dysmenorrhoea
woman obese, has undergone some abdominal surgery now have to do laparoscopy for diagnosis whats the risk you need to explain before labaroscopy
a) viscus injury
b) small sub umbilical hernia
c) post op aspiration/pneumonia
42 yr old bmi- very high. trying to conceive for 10 months. abdomen and pelvis exam normal. what to do now for infertility weight reduction
a) bariatric surgery
b) ovum induction
c) semen analysis
3cm swelling on the introitus, non tender, firm, there for one month, what to do
a) aspirate
b) incision and drainage
c) excision
d) marsupialisation
woman written plan before labor- no epidural, now in labor for 6 hrs in distress, wants epidural. husband and nurse don’t want to go for any intervention
a) give epidural
b) refuse
c) discuss with patient
2 year old, irritable, fever, abdominal pain. vomiting, grunting. ausculatiion- lungs clear. rr- 30/min. abdominal tenderness +, no rigidity what will help in diagnosis
a) urine microscopy and culture
b) blood culture
c) chest xray ( not sure whether xray abdomen was there)
2 year old, irritable, vomiting, abdominal pain. xray abdomen- dilated bowel loops. what investigation to diagnose? usg abdomen( i chose us suspecting intususception) forgot other options.
a) bronchiolitis scenario, what next
b) abg
c) nasopharyngeal aspirate
d) no option of chest xray
testicular swelling confirmed on usg. tumor markers elevated, next ct abdomen inguinal orchidectomy third day jaundice. total was 200. conjugated 20 (normal 10).
a) mothers group o
b) asking cause.
c) immature liver
diabetic foor ulcer – plantar aspect of foot. dorsalis pedis not felt bilaterally. xray- shows erosion of bone corresponding to ulcer. what will guide management swab of ulcer and culture
a) blood culture
b) bone scan
c) duplex doppler usg
a male pt was really stressed out and was saying that he should take a diazepam pill to calm down, otherwise he’ll become aggro (aggresive), and there are days that he takes 16, 5mg diazepam a day. he had history of sexual abuse in childhood and had a low self esteem, what is your diagnosis?
a) bzd dependency
b) borderline pd
c) antisocial pd
a woman after mva came with neck pain, which on of the following is an indication of imaging?
a) tenderness 3cm lateral to cervical spine
b) pain on extension
c) pain in lateral rotation
d) pain in flexion
Carbamazepine toxicity with erythromycin; ataxia, reflexes are normal; finger nose test are past-pointing. Options are
a) Carbamazepine toxicity
b) Cerebellar
c) lesion
d) Lateral medullary syndrome
e) Diabetic peripheral neuropathy
Pt taking Warfarin with previous h/o PE; CT shows retroperitoneal haematoma. INR 5.2. How to manage?
a) IV Vit K
b) PCC
c) FFP
d) Oral Vit K
Patient taking warfarin with h/o DVT; now comes with black colour passing stool (seems GI bleeding); PR 90; INR 9.8. How to manage?
a. Tranexamic acid and FFP
b. PCC and FFP
c. FFP
d. Platelet and FFP
e. Vit K
Pt taking warfarin planning to undergo for dental procedure in one week. Now INR 2.4. Which of the following is correct?
a. Can continue warfarin with the aim INR 1.8-2.2 before the procedure
b. Can continue warfarin with the aim INR 2-3 before the procedure
c. Change to LMWH
d. Give IV vit K before procedure
e. Stop warfarin and check INR one day before the procedure
2-4 HPV screenings as in previous day recalls (mplus)37 yrs old requests for OCP. She had chlamydia infection treated 10 yrs before. What is the SE of OCP to explain the patient?
a. Risk of hypertension
b. Increased risk of chlamydia
c. Reduced risk of cervical cancer Other 2 options irrelevant. (no stroke in option)
Pt comes with anaphylaxis having salad including bacon, egg, vege 2 hrs ago. And also mentioned took diclofenac 6 hrs ago. He also has urticaria and skin itching. What is the cause? Sulphite Diclofenac Egg Pt XR is not given; just mentioned widespread pachy infiltrate. Asking Tx?
a. Ceftriaxone
b. Doxycycline
c. Coamoxiclav
d. CPZ
Too many liver questions hard to interpret. LFT. Pt has no h/o of smoke and drinking alcohol. AST >300 ALT> 300 ALP also v v high GGT also increased Bilirubin also increased No Hep B and C. What is the next step to check? Options are
a. AMA.
b. HCC
A man ls brought to you his girlfriend because she noticed that he changed recently. During the Interview the patient says “I love you, you look good, good Is world,..l do..i do … Timbuktu …I love you” What could be the possible diagnosis? (This stem is quite similar)
a. Mania
b. Schizophrenia (circumciality)
c. Conduct disorder
Male 65 yr old unilateral tender breast lump; taking spironolactone to control his heart failure. Also have h/o mother and sister breast CA. Next step?
a. cease spironolactone
b. breast USG
c. FNAC
Oral contrast CT can’t identify; Pt taking warfarin come to ED with abdominal pain Option are
a. Appendicitis
b. Rectus sheath haematoma (don’t see see)
c. Incisional obstructed hernia
Pt comes with lower back pain. Most important sign for spinal imaging? Urinary retention Tinel test +ve Radiculopathy Vertebral tenderness old male came is painless retention of urine for 12 hrs. has been having symptoms of hesitancy and change in flow of urinary stream as well. Has back pain for 10 days after he bend forward to pick something up. Has been taking muscle relaxant and painkiller since then and also has h/o receiving treatment for lung carcinoma. p/r examination prostate smooth enlarged and median sulcus palpable. what is the reason for painless retention?
a. lumber vertebral collapse
b. neurogenic bladder
c. intervertebral disc prolapse
d. ca prostate
e. BPH
MI with AF BP 95/75 after MONA what to do?
a. BB
b. CCB
c. Cardioversion
d. PCI
2nd D Ht Block ECG Mobitz type 1 (progressive elongation of PR interval), girl taking white tablets of Aunty who is taking amitriptyline for post herpetic herpes and Ht failure medicine. Which medicine can cause above ECG?
a. Amitriptyline
b. Verapamil
c. Digoxin
d. K+ tablet
SVT with orthostatic hypotension 90/50 on standing and 110/70 on sitting. Tx?
a. IV fluids
b. DC cardioversion
Snake Bite ; What next appropriate ?-
a. CBC
b. CPK
c. LFT
d. No coagulation
Aborgines girl 13 yrs at rural area and didn’t complete childhood immunisation. Her last immunisation is at 12 months of her age. What will you do for her age for immunisation?
a. give immunisation for her recent age
b. give the previous vaccination about 2 yrs ago
c. give the catch up immunisation
Colleague of us taking drugs during hospital work but doesn’t change his performance what should you do (ethics qs) Epileptic pt on carbamazipine, had a sezuire what to do next? Increase dose of carbamezepine(dose was mentioned dont remember, but please look up) Add phenytoin Dog phobia.. what u will do?
a. show the pic
b. Pet a dog
Child after eating peanut, developed wheals,urticaria.. management.
a. im epinephrine
b. Antihistamines
psych one pt with depression. Started venlafaxine. Now controlled suddenly developed elevated mood, euphoria, now treatment?
a. Add olanzapine
b. Add escitalopram
c. Add clozapine
d. cease venlafaxine
e. (no option for add risperidone
Anaphylactic Shock – Mx 40 yr old creamy green discharge from breast Mammary duct ectasia A child presents with multiple small and large bruises on abdomen and limbs with fine small petechiae as well. What will you investigate to confirm diagnosis?
a. Factor VIII
b. Von Willebrand factor
c. Liver function tests
d. Coagulation studies
e. FBC
Psychotic pt on olanzapine, gained 10kgs….now asking for change of drug… what u will give?
a. fluoxetine
b. aririprazole
c. risperidone
A woman came with lower abdominal pain and slight fever, but was reluctant to be examined (pelvic exam) by a male doctor, she asked for an alternative for examination. What will you do?
a. refer her to an obstetrician
b. book an appointment with a female patient tomorrow
c. ask her if she is comfortable to be examined with a female
d. nurse present
11 year old Child injury during game. Focal tenderness anterior tibia. Fever.
a. Osteomyelitis
b. Osgood Schlatter
c. Septic arthritis
16yr old with theralche at 12 years and amenorrhea but having pain in the abdomen dx?
a. Imperforate hymen
b. Septate vagina
c. Atresia vagina
d. Atresia uterus
A 34-year old woman presented with the 3-month history of pelvic pain. On examination, she was found to have a mass in her right iliac fossa. An ultrasound shows an ovarian cyst measuring 8 cm X 12cm. What is the next step in management?
a. Repeat ultrasound in 10 weeks
b. Laparotomy with excision of the cyst
c. Obtain blood for tumour markers and refer to a gynecologist
d. Laparoscopy with aspiration of the cyst
e. Reassurance
Which of following drug group is mainstay of therapy in diastolic HF?
a. Acei + BB
b. BB + ccb
c. Ccb+ diuretic
d. Are+ BB
e. BB + diuretics
32 years old lady presented to you at 28 weeks gestation with recurrent vulva warts previously treated with cryotherapy. Which one of the following options would be the most appropriate management option?
a. Electrocautery
b. Surgical excision
c. Pap smear
d. Podophyllum
e. Cryotherapy
5 yr-old boy having persistent ear discharge in the right ear canal. born with a cleft palate that was repaired in infancy. retraction of the superior portion of the TM & a pearly white mass. conductive hearing loss on the right side. cause?
a. Acute middle ear effusion with concurrent tympanic membrane inflammation
b. Chronic foreign body impaction with external ear canal abrasion
13 yr-old girl has frequent headaches. have progressively worsened in severity & now occur almost daily. mild optic disc edema. MRI of the brain would most likely show?
a. Enhancing lesion in the internal auditory canal
b. Parietal lesion with air-fluid levels and a hyperdense rim
A man has come for routine check up , he has DM and HTN,he was undertreatment he has 75% left carotid stenosis ,25%right carotid stenosis ,managment?
a. left carotid stent
b. bilatral endarterectomy
c. cvd risk assesment control
A 34 wks pregnant lady came to GP with H/O intense itching which becomes worse at night. She has no rash, non icteric. Only scratch mark present in whole body. No fever, abdominal pain and no organomegaly. LFT and other investigations all normal. What is your most probable diagnosis?
a. Cholestasis
b. Obstructive jaundice
c. Bile salt causing itching
d. Scabies
e. Allergic dermatitis
man with 10% pneumothorax. mild dyspnea and chest pain.
a. repeat chest xray in 6-24hr
b. admit and observe
c. other options about ctt insertion
A woman had lump below inguinal ligament and medial to femoral artery without any tenderness. She had past history of hip osteoarthritis which she recently didn’t need to take analgesics, but last night she woke up with pain. In ph/e internal rotation was restricted and flexion of hip was painful, what is the cause of the pain?
a. femoral hernia
b. chronic septic arthritis of the hip
c. bursitis
d. oa of hip
Patient with tangentiallity, asking about what he most likely has
a. Dissociation
b. Depersonalisation
c. Depression
d. Disorganised behaviour
Molluscum contagiosum topical treatment Photo of internal bleeding hemorroids. Diagnosis. Male, difficulty swallowing solids but not liquids. Food would regurgitate at night when laying flat in bed. Diagnosis?
a. Eosinophilic esophagitis
b. Achalasia
c. Pharyngoesophageal diverticulum
d. Submucosal something
Male 44 years old, fell on outstretched hand. Reduced sensitivity of little and middle finger. Image of Xray that looked like a pisiform fracture. Management?
a) Wrap in something….
b) Aspirate joint
c) Open surgery
d) Fix with “schist”screw?
7 or 8yo Child, hip pain & limping. x of viral infection a week ago. No radiological signs, normal bloods. Diagnosis?
a) Legg-calve perther disease
b) Transient synovitis
c) Hip dislocation
6 day old boy, breast feeding normally for 4 days, non-bilious vomiting last 2 days. Mildly dehydrated, murmur in heart, no masses in abdomen passing meconium. Baby looks fine, and hungry. Management?
a) Barium enema
b) IV fluids
c) Transesophageal endoscopy
75yo husband viciously murdered his 72yo wife with brain cancer after 50 years married. He killed her by hitting her on the head multiple times with a rock. The Police picks him from the crime scene and brings him to the ED. What is the reason why he killed his wife?
a) Problems with wife
b) Wife had separate secret wealth
c) The wife had brain metastases
d) They have been separated for a long time before this.
You are giving Trimeptropim-sulfa to a patient in elderly care. Nurse says he gets diarrhea with those antibiotics. What would you do? Continue antibiotics + loperamide. Report nurse to council. Change antibiotics. Tell the nurse you are the doctor and you make the decisions. (Photo of newborn with cleft palate) 16yo has decided to have the baby with cleft palate, will care for him and won’t give him for adoption. She’s got her mother’s support to keep the baby. After the baby is born, she changes her mind, she doesn’t want to see the baby, she decides she does not want to breastfeed him and wants to give him for adoption. What would you do next?
a) Arrange the adoption documents
b) Tell her she can’t give the baby for adoption and must take care of the baby
c) Encourage her to breastfeed to create a bond with baby a
d) Call the hospital social worker
e) Appeal to the court for child protection (something like that)
Graphic showing groups of columns of different diseases per year (diabetes (green), cancer (gray) , Heart Disease (red), and a blue column which I can’t remember. Years 2018, 2019, 2020 and 2021. You are the GP at the GP practice and want to calculate the prevalence for each year through the years. Options were:
a) There is a linear increase of prevalence for heart disease.
b) There is a non-linear decrease for diabetes
c) There is a linear increase for cancer.
d) Bla blab bla
All the options where either linear/non-linear increase/decrease. The graphics where a group of columns per year (not lines). You had to check the top of each column and compare it to see if it was a yearly increase/decrease. You want to do a study of XYZ in Australia. Which group of people would you choose for an un- biased study?
a) People in your GP practice
b) University students
c) English students in Australia
d) The nurses and doctors in the war
Xray of Ankylosing spondylitis. The scenario said: “young male, hx of back pain, red /watery eyes, alopecia, diarrhea, currently taking NSAIDs+Steroids…. etc etc…. Which sign/symptom would is most related to confirm diagnosis?
a) Alopecia
b) Uveitis
c) Chrohns disease.
Middle aged female Sudden eye pain, injected scleras/conjunctiva. Pupil non- reactive, halos around ligts, blurry vision. Diagnose? open angle glaucoma Management? Timolol Case of another 50+yo female with Wavy vision – Macular degeneration Red ligh reflex positive in elderly woman. retinal detachment? Cataract? Macular degeneration? Management of pleomorphic adenoma (It was the picture of an old lady) Management of lentigo maligna Management of melanoma in face, on cheekbone, just below hte eye. There was no option for Plastic Surgeon referral. I went with Mohs surgery Baby from Sudan with ictericia with low Calcium. What to give to increase the Calcium levels?
a) Calcitonin
b) Hidroxy 25 something
c) Serum calcium
Farmer who had an accident + history of melanoma over a decade ago. Comes with pain, decreased sensitivity and pretty much ascending paralysis. Test for diagnosis? (most likely Guillain Barre).
a) CT of back and legs
b) CSF analysis in the options.
c) Antibiotics
d) XYZ tumor marker.
