1. 40 male after dvt. Started on warfarin 5 and enoxaparin 1mg/kg (?), wears stockings. After 5 days still in pain. Next management?
A. Continue same regimen
B. Cease enoxaparin, increase warfarin
C. Increase enoxaparin
D. Increase warafrin
2. Women, OCP. Pain in labia. Photo of bartolinitis. Mx?
Incision and drainage
3. Profylactic ATB before cholecystectomy. 2-3 questions about ABT regiment before surgery
4. Child with bruising and gingival bleeding (seems like von Willebrand disease). Initial Ix?
A. APPT (my choice)
B. Factor VIII
C. Bleeding time
5. Pt from alderly facility with fractures of both forearms after fall. Next Ix?
CT
6. Young woman, SOB over 2 weeks, 20 week pregnant. CXR: something like mild venous blood stasis. Next inv?
V/Q
7.62 man, gradual confusion over 2 days. Many comorbidities and medications. Mild hypernatremia, mild hyperkalemia, mild hypochloremia, mild decreased HCO3. Mx?
A. Dialysis (my choice)
B. PO resonium
C. Ca IV
D. NaCl bolus
8. Infant with translucent scrotal swelling. Mx?
A. Observe for 1-2 years
B. Surgery
9. 2 questions about inguinal hernia initial inv.
A. US
B. FNA
10. Photo of a child with a lump just above the belly button. Not painful, not tender. Dx?
A. Lipoma (my choice)
B. Umbilical hernia
C. Epigastric hernia (probably right)
11. 60 yo, dysphagia, nausea, vomiting over 3 weeks, weight loss (not stated how much). Hx of DM and HTN. Recently vomit is clear and sometimes with food. He became depressed. Dx?
A. Oesophageal carcinoma
B. Pancreas carcinoma
C. Pylorus stenosis
D. Gastric ulcer
E. Gastroparesis
12. Accidentally hot water fell on the baby and there is burn parents had placed him under shower for 15 mins… what will assess after intial resuscitpatient
13-patient has hiv and as gp what will u advice the patient to prevent hiv to his partner
14-Patient family history has melanoma for his father now patient is having small intredermal nevus.. asked for the risk factor
15’Left ventricular hypertrophy
Ventricular tachycardia
Atrial fibrillation management
16- Patient was gardening earlier, now presented to the GP with swelling over the biceps as shown in the picture. History of taking apixaban daily. What is the diagnosis. The picture showed a popeye sign, no bruising around the swelling. It was not the handbook pic but similar.
– Biceps tendon rupture
– Muscle hematoma
17’Acute dacryocystitis picture and they were asking for management
– Warm compress
– Penicillin
18-. Mother brought her 14 year old girl with concerns about still not starting her periods. On examination, her breasts are at Tanner stage II. The girl did not allow us to examine her genitals. What investigation can we do to find the cause of the amenorrhea?
– FSH, LH
– USG Abdomen and Pelvis
– Estradiol
– Prolactin
19. 30 yr old woman travels a lot for her work, although they are short trips. She goes to Asia and Africa frequently. She has been having fever on and off for the past one week. Few episodes of diarrhea too during the week. No hepatomegaly or splenomegaly. Which of the following is the cause?
– Zika
– Malaria
– Hepatitis A
–
20-A girl comes after an episode of choking after eating beef stir fry. She has a history of peanut anaphylaxis in the past. She is also on psychiatric treatment (They purposely did not mention anything about it). She also mentioned that she has been having episodes of dysphagia for solids and liquids are easier to consume. What will you do now?
– Oesophagoscopy
– Omeprazole
– Prednisolone
– Citrezine
21-Man presents to the GP with history of drinking 1 bottle of wine every night. They shared a picture of gynecomastia. Also mentioned that he has parotid swelling, testicular swelling and when palpating, you cannot go above the mass. What is the cause of this presentation?
– Testicular teratoma
– Alcoholic liver disease
– Leydig cell tumor
– Oestradiol
22-. Female 35 years old presented to the GP. She had an uneventful delivery and her child is 2 years old now. She was planned for an elective cholecystectomy which she decided not to do when she found out she was pregnant. Now she is planned for surgery and she will be staying in the hospital for 1 day post procedure. What thromboprophylaxis will you give her?
– Enoxaparin on the day of the surgery upto discharge
– Enoxaparin 1 week before the procedure and during the procedure
– Enoxaparin after the procedure and then continue for 14 days
– Enoxaparin after the procedure and then continue for 28 days
23- Man came to the emergency with stab wound on the right side of the chest. Auscultation reveals diminished sounds on right side and there is dullness on percussion. Chest X Ray shows a Hemopneumothorax, trachea was in midline. Vitals were HR 100, BP 90/66, RR 30. What is the immediate management?
– Intubate and shift to ICU
– Underwater seal drain
– Needle Thoracotomy
– Argyle Seal™
24-. Patient was just shifted from the post op care to the ward after cholecystectomy. He was on a drip of fentanyl which is stopped now. Paracetamol 1g is continued in the ward as well. He is complaining of pain in the right hypochondriac region and is very restless due to the pain, not even able to stand because of it. What is the next management?
– Oxycodone
– Naproxen
– Morphine
– Increase dose of Paracetamol
25-. 60 years old woman presented to the GP, she has been on HRT for the past 8 years. She has been having minor vaginal bleeding for all these years except for the past one year. She was initially started on them for control of vasomotor symptoms which are well controlled as soon as she was started on them. What should you do now?
– Stop HRT now
– Continue with the HRT
– Reduce the dosage
26-Woman just delivered baby. The baby is healthy, APGAR score is 9. The placenta has been removed as well. You notice 600ml PV bleed. What will you do next?
– Look for vaginal lacerations
– Uterine massage
– Oxytocin
27-. Chronic case of peptic ulcer, ppi therapy unsuccessful. He was endoscopically managed with some injections to stop the bleeding. The bleeding has recurred now. What will you do next?
– Endoscopic Ablation
– H2 Receptor Antagonist
– PPI
– Suturing the ulcer
28. Woman complains of heavy menstrual bleeding since past few months, she was fine before. She is on birth control – OCP 14 days and sugar pills for 12 days. On ultrasound Adenomyosis is seen. She would like to concieve within 11-12 months. What is the most appropriate management?
– NSAIDs during the time of periods
– Increase Estradiol component of OCP by 30
– Endometrial Ablation
– Mirena IUD
– GnRH
29. Child brought by mother to the pediatrician due to multiple episodes of encoparesis. There is a small mass in the right side of the abdomen and the abdomen is distended. He has already been prescribed oral laxatives. What should be the next step?
– Lactulose
– Senna
– Repeated Enema
– Osmolax
30. A woman presented with tiredness and fatigue. Her TSH was normal, T4 was decreased and T3 was normal. Repeated tests after 1 month showed the same findings. What will you do next to establish the diagnosis?
– MRI brain
– Thyroid scan
– Anti-TPO antibodies
– Thyroglobulin antibodies
31-. 22 year old woman presented to the GP in an anxious state. She says that she has been in a monogamous relationship for the past few years. Last time she visited was 3 months ago when STD screening was done and all the tests were negative. What should you do now?
– Refer to Psychiatrist
– Council her that all the tests were normal last time so no need to do them again
– Repeat all the tests again
32-. A woman comes to the GP to test for Chlamydia. She has just started a new relationship. What is the right reason for testing Chlamydia?
– Partner can be an asymptomatic carrier
– Chlamydia is usually asymptomatic
33-. A man presented with one sided weakness. He had fallen on the floor at home and while being brought to the hospital he had a seizure with resolved by itself. On doing a CT (It was not MRI, CT- something), it revealed increased blood flow to the temporal and frontal regions. The one sided weakness is still there. What is the cause?
– TIA
– Todd’s Paralysis
– Lacunar stroke
– Cerebral embolism
34-. 10 year old girl with home blood sugar readings between 5.6 and 5.8. She measures regularly but did not bring her machine today to the office. Her last appointment was 3 months ago. The HbA1c is 13% taken from the lab.
– Lab values are wrong
– Girl is lying
– Girl is taking high carbohydrate diet
– Strips have expired
35-Late 30’s married woman with 11month old baby, has been trying unsuccessfully to get pregnant for past 5 months ithink. Last pregnancy had a retained cotyledon which i think had a D&C done for this. She doesnt breastfeed and not on any family planning but yet up to now still hasnt had her periods. Ur management?
Hysterosalpingogram
Hysteroscopy
Metformin ovulation induction
Review in 6 months
36-Baby girl- 6 weeks, family going to Uganda, concerned about malaria. Only child, breastfed, good health, no travel history. Advice on preventing mosquito bites?
a No insect repellent for baby; use pram netting, light-colored long-sleeved clothes.
b Use roll-on mosquito repellent with 10% DEET for baby.
37-Lady- palpitations, tremor, heat intolerance, tachycardic, irregular HR. R-sided thyroid nodule, brisk reflexes, AF on ECG. TSH <0.05, free T4 48. Next step for thyroid nodule?
a Perform radionuclide imaging, refer to endocrinologist.
b Order CT scan of neck.
38-Old lady, frail, bed bound, no appetite, difficult swallowing meds. End-of-life care planned, comfort-focused. Nurse reports distress, SOB, no pain, midazolam given, cooling room. Advise staff?
a Give morphine for dyspnoea, 1-2.5mg subcut 1 hourly as needed.
b Apply 2L oxygen via nasal specs to reduce dyspnoea sensation
39-Male hot flushes, periods ceased at 51, interested in MHT. Discussed benefits/risks, screened for contraindications. Possible contraindication to MHT?
a Established cardiovascular disease
b Treated hypertension
40-Male, teeth discoloration, recently tired, diarrhea at times. Dentist suggested GP check-up. Test for diagnosis?
a Serum transglutaminase-IgA (tTG-IgA) and deamidated gliadin peptide-IgG (DGP-IgG)
b Serum ferritin
c Hydrogen breath test
41-27 lady w/ rash on legs for a wk, initially thought from netball, now painful lumps. Feels tired and achy. Meds that could cause this?
a Trimethoprim
b Cephalexin
c Frusemide
42-lady with severe Alzheimer’s, disruptive behavior, assaulted staff/resident. Tried non-pharmacological strategies. Nurse asks for medication order. Most appropriate management?
aObtain consent from medical POA, order low dose antipsychotic, review tomorrow.
b Order temazepam 20mg nocte, review next week.
43-Ex-smoker with COPD, diagnosed via spirometry, FEV1 70%. On ipratropium, not controlling symptoms of cough/breathlessness. Next medication?
a Add formoterol 12mcg 1 inhalation twice daily
b Add tiotropium 18mcg 1 inhalation once daily
44-man with right sided open chest wound due to stab injury. Tachypneic & SOB but can tell u
full history of what happened. Spo2 95% , p 115 or so, Bp 90/60 ish. Auscultation there is
dullness on right side with reduced AE . Next best mx Valve bandage or sth Endotracheal
intubation & ventilation Needle thoracostomy Underwater seal intercostal tube
45’4mo boy with asymmetric red reflex in eyes during well-child check. Statements about this condition?
A Retinoblastoma, cataracts, and refractive errors can cause abnormal red reflex.
b Retinoblastoma is never fatal.
1
46- ER pt 10 hours after RTA , coming with Abd pain over the epigastrium and RHC , CT given that of liver with a black shadow inside asking diagnosis
1) extrahepatic hge
2) intrahepatic hematoma
3) subcapsular spleen hge 4) rupture spleen
5) peritoneal something
47-3 year old came for some other issue, parents say relatives have noted his right hand
coordination isn’t good? What will you do to see if it’s age appropriate.
1. Make him draw a circle.
2. Button his shirt.
3. Can make a stack of blocks.
48-A lady who just delivered is committed to breastfeeding for 12 months. She wants to have another baby after stopping to breastfeed
A. Continue breastfeeding
B. POP
C.COCP
49. Picture of of hetersocopy with tubal blockage and history of STD
N.gonorrhea
E. Coil and other organisms
50. Patient was gardening earlier, now presented to the GP with swelling over the biceps as shown in the picture. History of taking apixaban daily. What is the diagnosis. The picture showed a popeye sign, no bruising around the swelling. It was not the handbook pic but similar.**
– Biceps tendon rupture
– Muscle hematoma
51. Mother brought her 14 year old girl with concerns about still not starting her periods. On examination, her breasts are at Tanner stage II. The girl did not allow us to examine her genitals. What investigation can we do to find the cause of the amenorrhea?**
– FSH, LH
– USG Abdomen and Pelvis
– Estradiol
– Prolactin
52. A girl comes after an episode of choking after eating beef stir fry. She has a history of peanut anaphylaxis in the past. She is also on psychiatric treatment (They purposely did not mention anything about it). She also mentioned that she has been having episodes of dysphagia for solids and liquids are easier to consume. What will you do now?**
– Oesophagoscopy
– Omeprazole
– Prednisolone
– Citrezine
53. Man presents to the GP with history of drinking 1 bottle of wine every night. They shared a picture of gynecomastia. Also mentioned that he has parotid swelling, testicular swelling and when palpating, you cannot go above the mass. What is the cause of this presentation?**
– Testicular teratoma
– Alcoholic liver disease
– Leydig cell tumor
– Oestradiol
54. Female 35 years old presented to the GP. She had an uneventful delivery and her child is 2 years old now. She was planned for an elective cholecystectomy which she decided not to do when she found out she was pregnant. Now she is planned for surgery and she will be staying in the hospital for 1 day post procedure. What thromboprophylaxis will you give her?**
– Enoxaparin on the day of the surgery upto discharge
– Enoxaparin 1 week before the procedure and during the procedure
– Enoxaparin after the procedure and then continue for 14 days
– Enoxaparin after the procedure and then continue for 28
55. Patient was just shifted from the post op care to the ward after cholecystectomy. He was on a drip of fentanyl which is stopped now. Paracetamol 1g is continued in the ward as well. He is complaining of pain in the right hypochondriac region and is very restless due to the pain, not even able to stand because of it. What is the next management?**
– Oxycodone
– Naproxen
– Morphine
– Increase dose of Paracetamol
56. 60 years old woman presented to the GP, she has been on HRT for the past 8 years. She has been having minor vaginal bleeding for all these years except for the past one year. She was initially started on them for control of vasomotor symptoms which are well controlled as soon as she was started on them. What should you do now?**
– Stop HRT now
– Continue with the HRT
– Reduce the dosage
57. Woman just delivered baby. The baby is healthy, APGAR score is 9. The placenta has been removed as well. You notice 600ml PV bleed. What will you do next?**
– Look for vaginal lacerations
– Uterine massage
– Oxytocin
58. Chronic case of peptic ulcer, ppi therapy unsuccessful. He was endoscopically managed with some injections to stop the bleeding. The bleeding has recurred now. What will you do next?**
– Endoscopic Ablation
– H2 Receptor Antagonist
– PPI
– Suturing the ulcer
59. Woman complains of heavy menstrual bleeding since past few months, she was fine before. She is on birth control – OCP 14 days and sugar pills for 12 days. On ultrasound Adenomyosis is seen. She would like to concieve within 11-12 months. What is the most appropriate management?**
– NSAIDs during the time of periods
– Increase Estradiol component of OCP by 30
– Endometrial Ablation
– Mirena IUD
– GnRH
60. Child brought by mother to the pediatrician due to multiple episodes of encoparesis. There is a small mass in the right side of the abdomen and the abdomen is distended. He has already been prescribed oral laxatives. What should be the next step?**
– Lactulose
– Senna
– Repeated Enema
– Osmolax
61. A woman presented with tiredness and fatigue. Her TSH was normal, T4 was decreased and T3 was normal. Repeated tests after 1 month showed the same findings. What will you do next to establish the diagnosis?**
– MRI brain
– Thyroid scan
– Anti-TPO antibodies
– Thyroglobulin antibodies
62. 22 year old woman presented to the GP in an anxious state. She says that she has been in a monogamous relationship for the past few years. Last time she visited was 3 months ago when STD screening was done and all the tests were negative. What should you do now?**
– Refer to Psychiatrist
– Council her that all the tests were normal last time so no need to do them again
– Repeat all the tests again
63. A woman comes to the GP to test for Chlamydia. She has just started a new relationship. What is the right reason for testing Chlamydia?**
– Partner can be an asymptomatic carrier
– Chlamydia is usually asymptomatic
64. A man presented with one sided weakness. He had fallen on the floor at home and while being brought to the hospital he had a seizure with resolved by itself. On doing a CT (It was not MRI, CT- something), it revealed increased blood flow to the temporal and frontal regions. The one sided weakness is still there. What is the cause?**
– TIA
– Todd’s Paralysis
– Lacunar stroke
– Cerebral embolism
65. Chronic case of peptic ulcer, ppi therapy unsuccessful. He was endoscopically managed with some injections to stop the bleeding. The bleeding has recurred now. What will you do next?
– Endoscopic Ablation
– H2 Receptor Antagonist
– PPI
– Suturing the ulcer
66. Patient with symptoms of mild cholecystitis. Uss showed multiple stones with mild thickness. Vitals normal. A febrile. He is scheduled to do lap chole tomorrow. What is the correct choice regarding antibiotics.
Antibiotics from admission to 5 days after surgery
Antibiotics from admission to day of discharge
One dose of antibiotics before the surgery
Does not require antibiotics
67. 60y old Teacher saying bad words to students and inappropriate sexual language and insults , Poor self care . What will be deranged in Mmse ?
inability to recall 3 objects
inability to name prime minister
right side neglect
68. 70y Patient with PMR, DM, HTN came with unsteady gait
Lower Abdominal distension and pain
Difficulty in voiding and back pain
O/e lower abdomen tender and reduced power and reflexes in LL
Patient was on tamoxifen,metoprolol and prednisolone.
Most appropriate next investigations
CT spine
MRI spine
pelvis uss
lumbosacral xray
69. 14 yr old living at home with parents, recently started sexual relationship , come to get COCP prescription, but she doesn’t want to let her parents know. what will you do?
Refuse to give
Ask about her partners age
Call her parents
Ask her to return with her parents
70. Aboriginal pregnant lady came with excertional tiredness for some duration. Examination, heart failure signs . What is most appropriate investigation to identify the cause of her presentation?
ECHO
ECG
FBC
TFT
71. 12 months Child with down syndrome features, appropriate screening test at this time ?
TFT
Some other blood investigations
72. Child with the history of Hay fever came with exercise induced asthmatic symptoms, what’s the most appropriate test to diagnose his condition?
CXR
PEFR
Spirometry
73. Women with the history of childhood multiple ear infection with multiple grommet insertion. Had ear infection with discharge but it settled with antibiotics few days back . Again came with ear discharge and hearing impairment. What is the appropriate investigation to find out her underlying problem?
Audiogram
CT temporal bone
74. Scenario of NMS , asking for most Next step to do ?
No option to cease all the drugs
Cease Fluoxetine and Zuclopenthixol
75. Scenario of AN
Asking to most appropriate investigation ?
Electrolytes
FBC
76. Young female typist came with multiple joints pain with no swelling or redness, only redness.pain worse throughout the day. What’s the best investigation to rule out underlying autoimmune condition?
ANA
ANCA
Anti CCP
Anti ds DNA
No ESR or CRP in the options
77. MVA , patient came in with peri orbital hematoma and CSF rhinorrhea (? Basal skull fracture ) what’s the next step to do ?
Nasal pack
Hydrocortisone
Ab
78. Child with Pneumonia, HD stable .CXR upper lobe shadow . Sputum culture gram positive cocci.
Cefotaxime
Azithromycin
Benzyl penicillin
79. Patient came with patient with RHC pain.scenario describes ascending cholangitis, in the background of stone in the neck of gall bladder. HD stable.condition worsening despite of antibiotics of 2 days. Past history of PCI two months ago, Most appropriate next action?
Endoscopic sphinterotomy
Cholecystectomy
Percuteous cholecystostomy
Per cutaneous common bile duct stent insertion
80. Young man came with a scenario describes R/LZ pneumonia with moderate para pneumonic effusion. Ex : SPO2 92 on RA. Ix : Exudative pleural effusion,
What’s the next step ?
Intercostal tube insertion
Intubation and ventilation
Video assisted thoracostomy and drain
