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A 37yr old woman with persistent nausea & vomiting. Has well- controlled chronic hypertension & hypothyroidism. Dry mucous membranes & CRT is delayed. Thyroid diffusely enlarged. Urinalysis positive for ketones. US reveals 8-wk intrauterine twin gestation. Risk factor for current sx?

a) Chronic hypertension
b) Hypothyroidism
c) Multiple gestation
d) Maternal age

3-wk-old girl is brought due to apnea & cyanosis. Mother reported multiple episodes of gagging and gasping for air past 48h. Child cough harshly while feeding and stop breathing. Has a weeklong history of clear rhinorrhea & increasing cough followed by episodes of emesis. Empiric pharmacotherapy?

a) Amoxicillin
b) Azithromycin

17yr-old boy complains of intense left flank pain that radiates to the groin. Experienced “so many times since childhood.” His uncle has same problem. Urinalysis shows hexagonal crystals. Urinary cyanide nitroprusside test is positive. Cause?

a) Amino acid transport abnormality

b) Parathyroid adenoma

50+-yr-old man comes due to a cough. 40x-pack-yr smoking history but quit a mth ago. Experienced weight loss, anorexia, constipation, increased thirst & fatigue, which he attributes to depression. Lost his wife 4 mths ago. Oxygen saturation is 92%. X- ray reveals a hilar mass in the left lung. Next step? Urea 17, Creat 17x.

a) CT scan of the head
b) Emergency hemodialysis
c) Saline hydration

55-yr-old man has difficulty achieving & maintaining erection. Medical history includes hypertension & hypercholesterolemia, for which he takes amlodipine & atorvastatin. Drinks 2 or 3 glasses of wine daily. Frequently driving grass cutter. BMI 45. Responsible for increased hematocrit?

a) Carboxyhemoglobinemia

b) Clonal proliferation of myeloid cells
c) Increased erythropoietin production

54yo lady Para 2. comes for evaluation of leakage of urine. Had 3 UTI treated with antibiotics. BMI 33. No leakage with Valsalva & the vagina is dry & atrophic. A 2-cm tender anterior vaginal mass is present & palpation expresses a bloody discharge from the urethral meatus. Cause?

a) Abnormal tract between the bladder and vagina

b) Acute infection of the lower urinary tract

c) Localized outpouching of urethral mucosa

32 yr-old man comes for routine check. Recently placed on probation for poor work performance. Misses work at least once a wk because he stays up all night playing poker online & lost a lot of money. Started borrowing to pay bills. Explanation for behavior?

a) Adjustment disorder with disturbance of emotions and conduct

b) Bipolar disorder

c) Gambling disorder

52 yr-old man comes due to upper extremity weakness, pain in his shoulders & upper back since shoveling snow 3 wks ago. Has hypertension & hypothyroidism. Moderate weakness of left shoulder abduction. Decreased sensation to light touch & pinprick on the left lateral forearm. Next step?

a) CT scan of the brain

b) MRI of the cervical spine

65 yr-old man returns for follow-up 10 days after receiving a subacromial corticosteroid injection for right-sided rotator cuff tendinopathy. Has type 2 diabetes mellitus & gout. Mild swelling in the lateral right shoulder. Range of motion is limited in multiple axes due to significant pain. ?iatrogenic cause. Next step?

a) Image-guided aspiration
b) ROM exercises and analgesic therap

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15 yr-old girl underwent menarche at age 12. Menses consist of 4 days of light bleeding. Past 3 mths developed malaise & dizziness 2 days prior to menstrual period & had associated, continuous lower abdominal pain that radiates to her thighs. Resolved on the 2nd day of menses. Next step?

a) Copper IUD
b) RH agonist
c) Nsaids

28 yr-old man with progressively worsening shortness of breath. Has 2 prior hospitalizations for asthma, one of which required intubation. Uses budesonide- formoterol inhaler twice daily. Prominent bilateral inspiratory & expiratory wheezing & prolonged exhalation. Risk factor?

a) Age

b) Characteristics of wheezing

c) Prior history of intubation

14 yr-old girl with hand tremors. Occurs at rest or during activities & can be interrupted only by either grasping an object or clenching the hand. Patient has flat affect. Low-frequency tremors at rest. Tremors cease during exam, but at the end, a bilateral coarse tremor observed. Diagnosis?

a) Cerebellar tremor

b) Essential tremor

c) Functional tremor

7 yr-old boy is brought for an annual checkup. Has no friends & prefers to play computer games by himself or organizing card collection. Moved to a new school this yr because being bullied. Unusual food rituals. Poor eye contact & answers in a polite but formal manner. What to do next?

a) Explain that his behavior is characteristic of high-functioning autism, but no intervention is necessary if he is otherwise doing well
b) Explain the spectrum of developmental disorders and recommend

c) further evaluation

34 yr-old woman with a rash & pruritus. Had sore throat for several days & took amoxicillin left over from 1 yr ago. Itchy rash developed 20- 30 min after the 1st pill. Multiple urticaria & mild excoriations over the upper & lower extremities & upper body. Tonsils mildly erythematous. Next step?

a) Administer IV glucocorticoids
b) Administer IM epinephrine
c) Treat with antihistamine

29 yr-old gravida 1 para 1, comes for a preconception visit. After delivery 2 yrs ago, she was diagnosed with peripartum cardiomyopathy with a left ventricular ejection fraction of 21%. Recent echocardiograms consistently show 28%. Patient like to attempt another pregnancy. What do you say to her?

a) “Another pregnancy poses significant risk to ur health & I cannot recommend that you get pregnant.”

b) “Given the improvement in your symptoms & cardiac function, you can now safely carry another pregnancy to term.” (exact same words)

24 yr-old woman comes due to a mth of progressive exertional dyspnea. Exam shows mucosal pallor & bilateral cervical lymphadenopathy. CXR reveals bilateral mediastinal lymphadenopathy. Cause?

a) Immune-mediated hemolysis

b) Increased inflammatory cytokines

6 yr-old boy with new-onset chest pain. A wk ago, he developed a low- grade fever with nasal congestion & a dry cough. Had paroxysms of coughing. Clear rhinorrhea. Posterior oropharynx & tonsils are erythematous. Mild swelling of the neck & crepitus over the anterior chest. Next step?

a) Bronchoscopy
b) Chest x-ray

4 yr-old boy is brought for worsening ear pain that started after completing a course of antibiotics for otitis media 2 wks ago. Recurrent ear infections since infancy. Left tympanic membrane is bulging, erythematous & opaque. Left mastoid is tender, erythematous & swollen. Next step?

a) Antibiotics & follow-up in 2 days
b) Lumbar puncture
c) MRI of the brain

44 yr-old obese woman undergoes an open cholecystectomy for complicated acute cholecystitis. Receiving IV hydration, hydromorphone & antibiotics. Oxygen saturation is 89% on room air. Cause of hypoxemia?

a) APO

b) Alveolar hypoventilation

16 mth-old girl with breathing problems. Simple febrile seizure at age 11 mths & an upper respiratory tract infection 6 wks ago. Learning disorder in her older brother. Has a brief period of hyperventilation followed by hypoventilation. Repeatedly twists her fingers & has an unsteady gait. Diagnosis?

a) Dilated cardiomyopathy

b) Happy demaner??? not sure what is this
c) Head growth deceleration

42 yr-old man comes due to an itchy rash. Rash began 3 mths ago during summer & since then has enlarged & spread across his back, chest & abdomen. Exam reveals scaly, annular plaques. Potassium hydroxide microscopy of skin scrapings from one of the lesions shows segmented hyphae. Next?

a) Antinuclear antibody assay
b) Hepatitis C serology
c) HIV screening test

68yo man fall down. become forgetful, forgets to go to bathroom, urinated on himself. history of hypertension and osteoarthritis. MMSE score 21 of 30. findings?

a) Clinically unrecognized infarctions on brain MRI
b) Cord compressing vertebral mets on spine MRI

c) Large ventricles with normal sulci on CT scan of the brain

14yo boy rash lasting 3 weeks. red spots on arms and legs that itched. lost 3.6 kg in 4 months. conjunctival pallor and an erythematous. Fecal occult is blood testing is negative. next step?


b) Colonoscopy
c) Tissue transglutaminase lgA antibody level

44yo man slashed on thigh. intoxicated and distress. deep laceration wound. patient repeatedly uses offensive language toward the treating physician. physician’s ethical duty?

a) Duty to treat all patients entering a clinical setting regardless of behavior

b) Duty to treat all patients when the patient-physician relationship has been established

c) Duty to treat all patients with potentially life-threatening symptoms

7yo boy, 2 days sore throat & malaise. no cough or nasal congestion. tonsils are swollen. Small, tender anterior cervical lymph nodes are palpated. next step?

b) Heterophile antibody testing
c) Throat culture

32yo primigravid woman at 21 weeks gestation. discharge turned bloody. no abdominal pain or heavy vaginal bleeding. scant blood. bulging bag is protruding through the cervix. Nitrazine testing is negative. diagnosis?

a) Abruptio placentae
b) Cervical insufficiency

65yo woman 2-month shortness of breath. no chest pain, palpitations, or syncope. takes chlorthalidone and lisinopril for chronic hypertension. ECG shows left atrial enlargement. predisposing factor?

a) Alcohol use

b) Hereditary mutation in sarcomere gene

c) Obesity and sedentary lifestyle

65yo man, postprandial epigastric pain. smokes 1 pack of cigarettes daily and drinks alcohol occasionally. Fecal occult blood test is positive. next step?

a) CT scan

b) Exploratory laparotomy

60 yo man chest pain. pain occur when he walks quickly or climbs stairs. coronary artery bypass surgery 7 years ago. hypertension and hyperlipidemia. Treadmill stress test develops chest pain. pain relief?

a) Coronary vasodilation

b) Decreased left ventricular contractility

c) Decreased left ventricular wall stress

36yo primigravid woman at 34 weeks gestation found unconscious. increasing nausea and vomiting and frontal headache. history for migraines. abdomen is nontender, and uterine fundus measures 34 weeks gestation. CT scan of the head reveals bilateral frontal lobe edema. next step?

a) CT venography
b) Lumbar puncture
c) Magnesium sulphate infusion

45 yo man, altered mental status. agitated and disoriented. takes aspirin for chronic arthritis and famotidine for acid reflux. smoked for 25 years and drinks heavily. Urinalysis shows square, envelope-shaped crystals.cause?

a) DKA
b) Ethylene glycol poisoning

37 yo woman, gravida 2 para 2, dysuria, suprapubic pain, and increased urinary frequency. sexually active with a new male partner. has a history of sexually transmitted infection. no costovertebral angle tenderness. mild uterine prolapse. next step?

a) Contraception modification

b) Daily cranberry tablets

16yo boy, jaundice. emergency appendectomy, perforated appendicitis. medications are intravenous morphine and piperacillin-tazobactam. mild scleral icterus. dx?

a) Acalculous cholecystitis

b) Deficiency of glucose-6-phosphate dehydrogenase

c) Deficiency of hepatic glucuronosyltransferase

29yo woman, cramping abdominal pain. history for Crohn disease that required an ileocolectomy 3 years ago. has type 2 diabetes, morbid obesity, and generalized anxiety disorder. smoked for 15 years.

a) Cigarette smoking
b) Diabetes mellitus

66yo man, prostate cancer. painful, bony metastasis in the pelvis, treated with hormonal therapy and radiotherapy. insomnia due to pain. drug monitoring program database reveals no irregularities. recommendation?

a) “Bone pain is especially difficult to treat. Let’s try a medication called calcitonin.”

b) “I’ll prescribe you clonazepam every night to help with sleep.”
c) “I’ll prescribe naloxone in case of overdose and talk to your family
d) about how to use it.”

35yo man, sharp pain in the low back radiating to the posterior aspect of the left calf and foot. Lifting the left leg to 60 degrees with the knee held straight causes burning pain. next step?

a) MRI of the lumbar spine
b) Nerve conduction studies

c) Trial of nonsteroidal anti-inflammatory drugs

28yo woman, depressed mood, disorganized behavior, and hearing voices. worsening auditory hallucinations. preoccupied with paranoid delusions. no suicidal ideation. diagnosis?

a) Delusional disorder

b) Major depressive disorder with psychotic features

c) Schizoaffective disorder

68yo woman, decreased vision in the left eye. history of ovarian cancer and treated with chemotherapy. admitted to the hospital with small bowel obstruction. had floaters and progressive blurring of the vision in the left eye. no eye pain or headache. cause?

a) Cerebral metastasis

b) Drug-induced glaucoma
c) Fungal endophthalmitis

23yo woman, gravida 1 para 0, light vaginal bleeding. no nausea, vomiting, or pelvic pain. diagnosed with type 1 diabetes mellitus at age 5 and has an insulin pump. Ultrasound shows a twin intrauterine gestation. next step?

a) 24 hour urine collection for total protein
b) Cerclage placement

29yo man, epistaxis requiring anterior nasal packing. Often headaches and fatigue. ECG shows normal sinus rhythm, high-voltage QRScomplexes, downsloping ST-segment depression, and T wave inversion in leads V5 and V6. next step?

a) Ambulatory blood pressure monitoring

b) Bilateral arm and leg blood pressure measurements

Police brought agitated patient from street. What will u do? Scenario is little changed but same meaning.

a) Droperidol IM( I choose this one

b) Look for midazolam im (short acting). ( not given in my stem


d) TCA

Football injury. The important clinical sign u will assess? Not exactly, but almost look like The young boy got football injury to the face and he got especially black eye on right side and came to ED and he got upward grazed horizontally and cheek numbness on ipsilateral side and so what is the fracture on his face?

a) inferior orbital fracture(answer )
b) Haemorrhage in the right eye

c) Rupture of the lateral rectus

A 17-yr-old female has not started her period. She is 4 ft 10, has no breast budding & pubic hair. The examinations all are normal. What is your appropriate investigation to reach diagnosis?

a) karyotype
b) FSH and LH -primary amenorrhea.,.
c) TSH & GH
d) us ( my answer)

e) prolactin

18 year-old girl came with father with a with 10 week pregnancy she don’t want you to tell this to her father she has right arm fracture and not speaking in front of her father what in history suggest physical abuse by father? H/O of # arm. ( the same questions) Fracture of right arm68-year-old lady on multiple drugs blood sugar 5.7 . all LFT including GGT are slight raised above normal which were given in the scenario, creatinine, and lipid are all in normal ranged. Asprin 81 onc a day, metformin 1 g once a day, amlodipine 10 mg once a day, atorvastatin 20 mg are given to this patient, what will you next.

a) continue same treatment
b) give metformin
c) change to low does atorvastatin( my answer)

d) change to atorvastatin to pravastatin

History of resection of colon cancer few years before now presented with nausea and vomiting and abd pain? Her abdomen is descendent and tense but not guarding Little long sentence and ask the first appropriated investigation in ED?

a) Plain X ray abdomen(my answer)

b) Usg

c) Ct

68y Hip fracture, comes for Third day with SOB?

a) Lung -crepitations

b) Confused and rash on both legs
c) Fat embolism traid–skin, lung, cns involvement. ( my answer)
d) pulmonary embolism

Scenario of a man came to you after travelling over sea for diarrhea 3 weeks without bloody diarrhea and no fever but malaise. stool culture done and showed that Salmonella and the management for this patient is No azithromycin in here

a) No antibiotic

b) Metro ( my answer)
c) Trimethoprim plus Suphonamide
d) Dissoluble sulphonamide
e) Repeat stool culture

Patient complained and already done in stool culture on 3rd weeks showed salmonella. DDH x-ray Management of DDH

a) Reduction with Pin fixation (my answer)
b) Surgery

Alcoholic with motor weakness with absent ankle joints without sensory involvement and no cellebellar signs and What is the diagnosis for this?

a) Peripheral neuropathy

b) Motor neurone disease

c) Gb $ *

Four-year-old swelling on lateral side of neck? Cystic Hygomna and pic is given. Investigation asked? US of neck

a) RA treatment complete scenario? treatment

b) Methotrexate plus folic acid

6 years old child with loosen diarrhoea for 2 months

b) Giardiasis
c) Amoebasis
d) E. coli

e) Shigella

Four-year-old with haemangioma on face and pic is from the JM. it is present from birth time plus not increase in size asked

a) treatment-Reassure.
b) pic is given

c) asking for Acne vulgaris treatment?

Melanoma in eye, pic is given – treatment?

a) Send plastic surgeon

15-year primary amenorrhea with thelarche and got suprapubic swelling and Dx?

b) Imperforate hymen (my choice)

c) Septate vagina

d) Atresia vagina

e) Atresia uterus without vagina

19 year-old man with BL lower limb swelling ankle swollen plus bruised. what will you do for appropriate investigation?

a) CT Angio

b) Doppler (my answer)

Redeye with history glucoma. First emergency management asked?

a) Atropine
b) Pilocarpine
c) Acetazolamide (IV + oral – not mentioned)

Hematuria on dipstick prostate palpable next investigation?

a) Urine test
b) urine culture and sensitivity
c) cystoscopy

Sudi boy with vitamin D deficiency ,What will it cause?

a) Rickets
b) Osteomalacia

Endometriosis already diagnosed and ask risk factor ?

a) Age,

b) Family history (my answer)

c) breast ca
d) dysmenorrhea

Hypertension and haemophilia plus traumata leg has closed fracture tibia swollen neck newer vascularities impact IV access done next management?

a) Urgent surgery for fracture correction
b) fasciotomy

c) IV antibiotics

Eight weeks pregnant and abdominal pain plus slight vagina bleeding ultrasound show no sac BHCG positive next management?

a) Repeat ultrasound in nine week
b) Methotrexate im( my answer )

Chest pain to back SOB white mediastinum heart rate 114 blood pressure 170/100 after analgesia next treatment?

a) TEE
b) Ct PA

c) IV nitroprosamide

d) Iv alteplase

old man come, with weight loss within one month with jaundice call cholestatic picture. Diagnosis?

a) choledocholithiasis

b) Metastatic liver disease

c) CA pancreas ( my answer )

d) Hyadatid cyst

Patient with anxiety symptoms divorce after physical violence with history of court order and all exam normal. Diagnosis?

b) Panic attack
c) malingering

23 ur old MVA in ER laceration at tibia which is clearly deformed foot well perfused next step?

a) IV antibiotic
b) fracture reduction
c) Lavage
d) surgical debridement-
e) tetanus toxoid Administration

The old woman with No trauma knee pain symmetrical moderate swelling noted for meteor local features initial treatment?

a) Paracetamol
b) Glucosamine

c) Chondiotin

d) Sulphate

e) Indomethacin

Colon screening? 51 year patient no symptom brother 53 yearscolon cancer diagnosed

a) Colonoscopy now.

Surgeon commits mistake perforates intestine switcher it tells register to not inform patient what will you do?

a) Tell the surgeon to confess

b) tell head of surgeon tell

25 year daughter with intellectual disability patient with three children, mother wants to get her sterilize. Has history of migraine not on medication was little menstrual bleeding what to do next?

a) Sterilization procedure
b) hysterectomy

c) OCP low dose
d) no treatment
e) look for court

Pregnant mother exposed to varicella by other child with a rash 24 hours no previous exposure or immunity next step?

a) Serology
b) vaccine
c) acyclovir

New intern senior invites for dinner offers cocaine to him and other colleagues no duty in the next few days what will you do?

a) Nothing

b) tell Hospital director

c) tell baord

Hypertension haematuria used indomethacin 25 TDS for LBA diagnosis?

a) Drug induced intestinal nephropathy

b) glomerular nephritis

Patient on warfarin 5 mg, and sc enoxa 1ml/kg 12hours for one day and pain and swelling not relied on leg and INR 1.7 , mx?

a) Increase dose warfarin -my answer
b) Increased dose of enoxa
c) Bot increased dose of warfarin and enoxa

d) Serotonin syndrome with tramadol

Patient with melanoma coming with headache with nausea and vomiting in early morning Indication for CT

a) Headache
b) Others are not relevant

Young girl with breast lump, what next?

a) USG

15, Young girl, first cervical cancer screening. Hpv negative, LSIL what to do? Repeat at 12 months Endometrial CA- 45 year old with BMI 40 what is the highest risk factor DM

a) obesity (my answer)

b) smoking

c) nuliparity

patient with chronic smoker for 40 years and smoked 20 cigarrete per day with presenting Radiating pain along UL with intrinsic muscle wasting what to do first investigation?

a) MRI,

b) chest xray ( my answer )

Old woman with headache, ESR 110 , but no visible on temporal arteries, no jaw claudication in this case and What is the best feature to suspect Temporal arteritis?

a) Tenderness on temporal artery ( my answer )
b) jaw claudication
c) Headache

Low back ache osteoporosis with fracture L4 L5 with anaemic leukopenia increase protein increase SR diagnosis?

a) Uremic osteodystrophy
b) Multiple Myeloma ( my answer )

G1 po with 10 weeks pregnant with palpitation and tremors TSH is 0.1 and free T3/T4 is normal and no underlying disease and treatment ? Reassure

a) propanlol
b) carbamazepine
c) look to repeat test.

15% pneumothorax with smoker aged 25 years and ask initial treatment?

a) Reassure

b) needle thoracotomy

c) chest drain

Septic arthritis case positive diplococci in aspirated fluid and ask treatment?

a) Fluclox

b) Vancomycin

c) Benzoylpenicillin

The young guy wants to go oversea and ask advice for vaccine for salmonella before he leaves ?

a) trsdVaccine
b) Doxycycline
c) avoid street food
d) Drink bottle water

ST Diagnosed chylamdia and gonorrhoea positive with urethral discharge on RX what is next step?

a) Provision of condom
b) Contact tracing

Why do you notify salmonella?

a) To research
b) To prevent spread

Mother is worried about her baby whom cry every 2 hours? 2 Mother suspect inadequate milk production

a) infrequent feeds (my answer )
b) Inadequate time In each breast

Mother came with 4 years old child and said there is Meningococcemia case who attends from Monday to Wednesday in class .her child only attends on Friday to Saturday and she concern about transmitting about this meningococcemia and wants to get antibiotics for prophylaxis?

a) Give antibiotics

b) Nothing

c) Tell information about meningococcemia

d) Refer to Ed for assessment ( my answer )

Thoractomy indications almost old recall (from mplus) Development of four month old baby CT of liver given shows hepatocellular carcinoma ( secondary ) underlying malignant melanoma last 3 years

a) Metastatic melanoma my answer
b) Primary tu
c) Liver cyst

X ray of hand given and I see no facture but patient came with swelling and painful

a) IV antibiotics
b) Lavage

c) Reduction

d) Elevation and splint ( my answer )

Mental retarded patient 20 years plus mother request for sterilisation patient has three children?

a) Refer to court

b) do sterilisation

Breastfeeding Baby got jaundice on Third day and to reach on diagnosis and no serum bilir given ?

a) ABO incompatibility

b) G6PD deficiency
c) Do conjugated and unconjugated biru ( my answer )

GP already Lady with advise not to drive at night time and only ask day driving for her eye disease and noticed driving on the road at night time ?

a) Inform family member
b) talk to patient
c) inform Road traffic authority ( my answer )

Young guy felt chronic knee joint pain especially on lateral side while playing football and ask DX

a) chronic tendon injury
b) Fracture

70 male, recent travel to jarkata for 3 days golfing with his wife and complained now rash, fever, joint pain and malaise. They didn’t go to anywhere except staying in hotel What test will you do

a) HIV/
b) syphilis serology/
c) malaria

d) JB virus my answer , I am not sure

1 yr old, ant fontanelle bulge, 24 hrs of fever-. Meningitis asking investigation for the cause

a) Chest x ray

b) Urine c &S my answer

c) Ct

85 years old lady with 1 cm lower pole kidney mass- surveillance my answer Mother brings her baby after 2 weeks of birth and on brest feeding, baby has jaundice, total bil.350(<200), conjugat bil 20. What is abnormal?

a) G6PD def./

b) neonatal hepatitis/

c) ABO incompatibilicy

d) Breast milk jaundice my answer

How do you diagnose vertical transmission after 36weeks of pregnancy and already on hepatitis C viral therapy. and ask HCV investigation for baby?

a) Viral load at birth
b) HCB antibody at 18 months.

Patient said that a surgeon whom do Elective cholecystectomy for her and patient know that surgeon has a lot of complications after surgery and want to change the surgeron. What next?

a) Refer to another surgeon=my answer
b) Talk her out of getting a Sx

Short of breath after coughing in a teenager boy. He was dyspnoic at GP, sO GP referred him to ED with CXR (15% pneumo right side) but he feels fine now when he got to ED. Next?

a) admit & observe
b) Send him back to GP to arrange followup
c) Needle drain
d) Tube drain

5 y/o Child with meningitis: blood culture shows Gram –ve diplococci. Tx?

a) penicillin-answer

b) Cefotaxime

c) Ampicillin + Genta

Patient frequently abuses drug, He is on multiple drugs for epilepsy & depression for 1 year. Comes to ET after seizure episode: confused & disoriented. Pupils dilated, no nystagmus, BP 105/60. Cause?

a) post-ictal stage

b) BD toxicity

c) TCA toxicity

d) Carbamazepine toxicity

Eosinophilic esophigitis( 24 yrs boy with previous x of asthama, progressive dysphagia, aggravate after eating specific food and relieve without mediation ,concentric rings on endoscopy)Chronic smoker wants to quit smoking but cant and what u will give to quit

a) Nicotine replacement
b) Bupiro

Patient came with walking pain relive by rest , cant walk more than 200 m , feeble pulse , htn, dm , smoker, what next step ?

a) MRI,
b) CT angio,
c) doppler,

Patient came with recurrent OE with glumet , 25 year old, today came with painful ear and discharge, topical ax improve pain and fever , follow up discharge came out , DDx?

a) OM media my answer

b) OM externa

c) Perf TM,

74 yo , HTN, AF, no ischemia, will underwent prosthetic valve repair post 5 days , what to give ?

a) clopidogrel,

b) warfarin, * I think more suitable

c) aspirin
d) clopidogrel and aspirin

Adult patient c/o breathlessness, hoarseness, wheeze on examination, no allergy history or asthma ?

a) Upper resp tract obstruction my answer
b) pneumonia ,

c) pneumothorax

PROM at 29week, taken swab and abx prophylaxis , gave steroid , did ctg baby well , USG no liquor height fundal lower than 29 ( 1 week lower ) , what to do ?

a) Induce labor now,
b) CTG every week ,
c) give tocolysis,

d) home temperature monitoring

e) tocolytic -my answer Fundamental of OG

f) Check for crp, cbc, CTG 2D – no option in this option

Neonatal jaundice, 3 weeks baby came with, mom noted jaundice on sclera, otherwise good wt gain, breast feeding well

a) Abo,

b) g6pd ,

c) biliary atrasia,

d) breast milk jaundice =my answer

Old age man 75 yo , p/w abdomen and epigastric pain radiate to back, loss of weight and appetite, h/o perforated duodenal ulcer -almost look like Myanmar question.

a) Cancer pancreas ,
b) cholecystitis,

Pt 7y, diff in swallow, high fever, b/l joint pain, large tonsil. Dx?

a) Rheumatic fever ===my answer (Tx : Phenoxymethl , IM b) benzathine pn)
c) Scarlet fever

prolactinoma 2500 . tumor SiZe 3 mm upto optic charm?

a) Bromoctiptine===my answer
b) Radiotherapy
c) Transphenoidal

Single Mother saw her 17 years old son wearing his girlfriend underwear/ female clothing in my scenario . what to advice?

a) he iS woman trapped in man

b) this normal===my answer

c) common consequence in life and out male role model

d) he is homosexual hiding

e) Look for counselling option-no given in this ooption

(old recall I got this one in exam, Mother comes asking you about her 17 year old son because she saw him wearing his girlfriend’s underwear. She is divorced and her son lives with her. Your advice regarding her son’s behavior:

a) He is a woman trapped in a man’s body
b) Its a normal thing at his age==my answer
c) its a consequence of lack of a male role model in his life
d) (something like to counsel him

the infant is crying all the time and neglected by parents who ask sleeping pills for the baby and they don’t want to hear its cry Give drug

a) Reassure
b) Look for CPS option ====my answer
c) Nothing

peripheral facial palsy all sensations are normal. Point for d for facial palsy

a) unable to move eyebrow (frontalis involvement)====my answer

b) Loss of nasolabial fold

c) Salivation

d) Loss of sensation on face

pregnant lady with previous CS, Now delivered vaginally presented with 1000ml bleeding after syntocine given Dx? Baby had tachycardia and resuscitated. Placenta delivery complete. Dx?

a) Cervical rupture

b) uterine rupture
c) uteroverted uterus
d) Coagulopathy
e) Retained placenta
f) ( I already write this one ?)

got the following Similar questions OCD treatment and refuse medical Rx?

a) Exposure Prevent
b) response
c) mitrazipire + tramadol -> seretonin

pt on Indomethacin Presented worh increase renal function? Drug induced interstitiΓ€l nephritis OA with Renal and HTN?

a) Paracetamol

b) Colixemab

4 months milestone’s?

a) Roll from side to side

b) infantile colic Case Dx

Female 21, for breast lump. Ask investigation=== Reassure

a) follow up after 6 months

b) follow up after 12 months
c) mammogram
d) USG==my answer

Teenager on fluxetine since 2 yr.Now mother say She is happy in her new school & she Saw on TV that fluxetine is bad. She Want to stop?

a) Psychiatry assessment

b) stop
c) tapering then stop==my answer

Young male, with appendectomy, has tattoo and gone for transfusion for operation He comes for operation he comes for advice for screening before operation

a) Hep c.==my answer
b) Smoking

Pt post treatment with non Hodgkin lymphoma, presents with 38.9 fever, coughing, sat 94 shortness of breathing, decreases air entry, crepitation at base, apart from covid, next investigation to confirm diagnosis.

a) Blood culture

b) Pr swab for nasopharyngeal swab -multiple (serial)

c) Pc for pneumocystic (Bactrim and cotrimoxazole)

Pt came after mva , chest ct given hypotension 90/30, tachycardia, sat 94 resp distress, dull over t chest, everything normal in ct shows heamothorax, most appr in initial step in ED

a) Pericardiocentesis

b) Repeat ct

c) Chest tube
d) Iv fluid ==my answer

MVA, present with hemothorax, drained 1.5lit blood immediately, sat normal, hypotension 90/60 indication for thoracotomy -amount of volume in the drain ===my answer Intubate (next)

a) Thoracotomy (best) ==

b) (Penetrating 1000 Blunt 1500)
c) Look for more appropriate options ( eg IV fluids )

Underlying Hepatitis C; treated with one anti-viral (not given – brand name, just giving targeting action), Presenting – lots of melanotic frackles (naevi) in foot. What to check before surgery?

a) Refer to hepatologist for assessment
b) Check viral load
c) do excision

d) Do Surgery without needing further tests

e) treat cv and go to sx == my answer

Middle age man – presenting with vomiting clear fluid with partially digested foods for months, had loss some weights. His wife noticed yellow coloration of his eyes. He had history of duodenal ulcer off & on. On examination – succussion splash is elicited. What is the diagnosis?

a) CA head of pancreas

b) Cholangiocarcinoma

c) Chronic DU

d) Carcinoma of lower part of stomach

aboriginal Pt admitted to hospital , asked for smoking, he thinks he was owner of land on which hospital was build

a) Ask senior
b) Refuse
c) Give to smoke

Patient got pneumothorax & chest drain was done. But the drain was inserted to the correct position but mal replacement How to manage?

a) Check patency & -replace

b) Use Heimlich valve

c) Insert new one to ipsilateral side

d) Insert new one to contralateral side

e) Insert drainage tube to both side

Young male after an episode of severe bout cough developed chest pain. After 12 hours, he went to ED. It revealed 15% pneumothorax, & where they gave him morphine after analgesia. What initial management will you do?

a) Reassurance
b) Admit and review in 24 hours
c) Aspirate and review
d) Chest tube insertion with water seal

6 years old girl with hereditary spherocytosis(AD) came with marked pallor and palpable spleen, history of URTI last week lasting for 3-4 days.

a) HB – reduced (more than 8.5)
b) WBC – normal
c) Platelet – normal

Retic count – 0.1 % (not increased compared to given normal value)

a) Adeno virus
b) Cytomegalovirus

c) Parvo virus =my answer

18 years old girl with MCP and PIP joint pain, ANA is 1/160 – homogeneous pattern asking treatment. No other skin menifestations.

a) Paracetamol

b) Hydroxychloroquine

c) Methotrexate

d) Prednisone

e) Salfasalazine

Long scenario but just ask 2 Best method for smoking cessation ( I got this one exactly)

a) CBT – in non dependant
b) Nicotine replacement therapy – if dependant
c) Verinicline
d) Bupropion

Trachoma recall. About 5 cases with 20 something contacts in 240 people community. How will you mgt after treating the index case? ( I got this one exactly )

a) antibiotics drops to contacts
b) antibiotics drops to community
c) treatment of contacts
d) treat whole community

35 years old woman with overdose of medications & found collapse presenting at ED. Taken history – took all 3 bottles of amitriptyline, sertraline & another drug (cardiac one, I’m not sure). After stabilization, got ECG. What’s the cause of this presentation? ( I got exactly this one ) Following ECG is nearly similar one (sorry, can’t find identical one in Google) – Real ECG is far more chaos & complicated. I’m sure that’s not VT in real Q ECG in exam.

a) Amitriptyline – tachycardia , wide QRS(>2.5small box) ===my answer I don’t have ECG

b) Sertraline – prolonged QT Digoxin – btardycardia, prolonged PR ,

Middle age man with sudden chest pain, dyspnea & cough. History smoking & alcohol drinking present. OE – crackles are present right lung bases. ECG not given. In ECG, found only QI1I & T III; NOT SI & no PVC investigation for initial


b) V/Q Scan
c) D-Dimer
d) CT chest
e) chest XR in scenario==my answer

Woman with seeing visual flashes on & off for few months; & found shimmering light in front of her vision now; presenting with global headache. Nausea & vomiting present. She had some few premenstrual head ache present. What is the cause?

a) Migraine with aura
b) Migraine
c) GCA

Scenario with features of GCA. Most sure clinical finding?

a) Unilateral Headache
b) Jaw Claudication
c) Tenderness over the temporal artery

d) Painless vision loss

e) Papilloedema

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