55 lady w/ persistent SOB, difficulty in climbing stairs/household chores, fatigue w/o CP, cough, syncope, or LE swelling. Med hx of CTS, hypothyroidism on levothyroxine. Additional physical findings?

1. Clubbed fingers
2. Opening snap
3. S3
4. forgot the others

49 year old man who is a known case of HTN and DM on Captopril, Metformin, Aspirin and sildenafil. Came with acute anterior MI, what will be your next step for reducing his chest pain?

1. Naproxen
2. Morphine C. Nitrates
3. Paracetamol
4. Beta blocker

Old man with BPH taking doxazosin. symptoms are not relief what to add:

1. Tamsulosin
2. Dutasteride
3. finasteride
4. Prazocin
5. Nifedipine

40 woman who has no pregnancy till now want to have a child. She try for 12 month without any positive result her wt is130 kg and has some irregular periods. Asking advise. Which is the next first step in her management?

1. life style modification and diet
2. semen analysis
3. bariateric surgery
4. metformin
5. clomiphen

A man with atypical chest pain that lasts more than one hour and in heart a systolic murmur in right second intercostal area that radiates to carotid. Whats your next step?

1. Troponin
2. Echo
3. Coronary angiography
4. Myocardial perfusion scan
5. Stress test

51 man w/ long-standing schizophrenia, agitated w/ oppositional behavior after moving to group home. On clozapine, uses alcohol. Presenting w/ pacing, yelling, hand tremors, diaphoresis. next step?

1. Add benztropine
2. Prescribe benzodiazepine

22 male w/ dark urine, recovering from URTI w/ ibuprofen use. Unremarkable medical and family history. Elevated BP and normal complement levels. Likely diagnosis?

1. Acute interstitial nephritis
2. Hereditary nephritis
3. IgA nephropathy

Old man with BPH taking doxazosin. symptoms are not relief what to add:

1. Tamsulosin
2. Dutasteride
3. finasteride
4. Prazocin
5. Nifedipine

Acute Upperlimb swelling and pain, then the patient developed with dyspnoea and pleuritic chest pain, what abnormality predisposed to the condition?

1. CRP: 138
2. Anti cardiolipin ab
3. Anti lupus anticoagulant
4. D.dimerb

40 lady G3P2, 33wks, leakage of clear vaginal fluid, type 2 DM, polyhydramnios, BMI 35. Closed cervix, clear fluid on posterior fornix w/ ferning. Fetus in vertex presentation w/ minimal amniotic fluid. next step?

1. Nifedipine tocolysis
2. Prophylactic latency antibiotics

36F G2P2 w/ 2d R breast pain, fever, chills, muscle aches, fatigue. Delivered 6wks ago & breastfeeding. 5cm erythema, tenderness on R upper outer quadrant w/ R axillary lymphadenopathy. Next step?

1. Discontinue breastfeeding and prescribe antibiotic therapy
2. Prescribe antibiotic therapy and continue breastfeeding

15yr girl with 15 year bf presents for termination of pregnancy. GP doesn’t want to terminate the pregnancy and explain his reasons. patient does not want to inform parents.

1. inform Cps
2. Encourage to inform parents
3. Terminate asap
4. Refer to another GP
5. Schedule another appointment for discussion

44 -year-old man with left side pic of varicocele with urine with blood. What is the best evaluation for this patient?

1. testis sonography
2. abdominopelvic CT scan
3. no evaluation is needed

45M w/ 3 wks fever, malaise, foul-smelling, purulent sputum. Head injury 6 wks ago, discharged 4 wks ago. Leukocytes: 18,000/mm3. Chest X-ray done. Next step?

1. Ampicillin-sulbactam empiric therapy
2. Bronchoscopy and biopsy

9yo boy w/ seizure at school, sustained flexion of arms followed by clonic movements. Decreased muscle strength on L, brisk deep-tendon reflexes in L. Likely responsible?

1. Craniopharyngioma
2. Glioblastoma
3. Low-grade astrocytoma

5 boy w/ exposure to chickenpox, no symptoms, vaccinated in infancy but not after age 1. Lives w/ mother, father, and 1yo brother. Mother pregnant and immune to varicella. Next step?

1. Administer varicella immunoglobulin
2. Administer varicella vaccine

35 female w/ palpitations, decr. exercise tolerance, “racing heart” for 6 mo. 37.2 C temp, 125/75 mm Hg BP. Early diastolic sound + middiastolic murmur on exam. ECG shown. Likely finding on echo?

1. Atrial septal defect
2. Left atrial dilation

72 y/o man who is musician and right-handed with cc of pain and decrease range of motion of the shoulder. in imaging mild small rupture of supraspinatus muscle and tear of long head of biceps. what is the initial best management?

1. Surgery
2. Physiotherapy
3. NSAIDS
4. Steroid injection

A 17 y/o boy with cc of dark urine hand tremors Mood depression, Personality change And Kayser fleischer rings What is the confirmation test ?

1. Serum cu and ceruloplasmin
2. Mri brain
3. A 24 hr Urine collection test
4. liver biopsy

67 male w/ R-sided weakness. Hx of HTN, hyperlipidemia, DM type 2, PAD, 45-pack-yr hx. Awake, alert w/ R-sided weakness, hemisensory loss. CT head: L hemispheric infarction. eyes deviated to L. next step?

1. Blood cultures and empiric antibiotics
2. MRI of the head
3. Repeat CT scan of the head

76 man w/ 2wks cough, worsening SOB, R chest pain, fever, and weight loss. Hx of T2DM, HTN, and Alzheimer’s. Decr respiratory excursion. CXR moderate pleural effusion, RLL infiltrate. Organism responsible?

1. Mycobacterium tuberculosis
2. Oral streptococci and anaerobes

2 year old child with watery diarrhea who visits day care 2 days per week had several past history of loose stools growth normal. cause for the loose stools

1. Viral gastroenteritis
2. Giardiasis

A 77 years old Chinese man who has emigrated to Australia with his son, now came with complaint of impaired short memory. you had done MMSE for him and the score was 21/30. his interpreter for the test was his son. what is the next step?

1. perform Chinese language MMSE
2. Evaluate the Geriatric Depression scale
3. advise him to perform brain activating practices
4. treat his depression

68M w/ 10-yr history of ESRD due to diabetic and hypertensive nephropathy, on intermittent hemodialysis. Meds: losartan, metoprolol, amlodipine, insulins. Calcium acetate and calcitriol stopped 3 months ago. Likely cause?

1. Ectopic production of parathyroid hormone
2. Hyperplasia of parathyroid glands

27F, 8 wks pregnant, unplanned, works part-time as a restaurant server, IV heroin user for 5 yrs, last injection 6 hrs ago, no known allergies, intrauterine gestation w/ HR of 150/min. Next step?

1. Begin naltrexone treatment immediately
2. Initiate methadone maintenance treatment

A woman came with coplaint of confusion with HTN, HLP, DM and CKD who used asprin, rosovastatin, diltiazem ,enalapril ,metoprolol,metformin,indapamide, lab tests given:

Crt: 160(nl range up to 100) Serum Na: 134 K 6.6 Cause of drug

1. indapamide
2. metformin
3. rosovastatin
4. enalapril
5. metoprolol

Carpenter with pain and limited movement in flexion abduction internal rotation of shoulder joint he had previously same history and was relieved by physiotherapy now what to do?

1. Intraarticular injection
2. Physio
3. Arthroscopic

14F w/ no menstruation, no pain, takes topical retinoid. Last visit 3 mos ago for gastroenteritis. Sisters menstruated at 13. Not sexually active. Tanner 4 breasts, Tanner 3 pubic hair. Best next step?

1. MRI of the brain
2. Reassurance and reevaluation
3. Pelvic ultrasound

66F w/ rough, dry, scaly skin that worsens in winter, mild itching, no erythema/exudates. Medical history unremarkable, normal vital signs. Most likely diagnosis?

1. Atopic dermatitis
2. Ichthyosis vulgaris

37M w/ history of substance abuse found naked, cursing & assaulting pedestrians. Epilepsy & type 2 diabetes mellitus. Highly agitated, repeating delusions of persecution. Ataxia, nystagmus. Next step?

1. Dexmedetomidine
2. Dimercaprol
3. Lorazepam

6wk F w/ rash on hands, feet, buttocks that spreads to arms and legs. Breastfeeding well, no fever. Small nonblanching erythematous maculopapular spots on arms, legs, dorsal/ventral surfaces of hands/feet. next step?

1. Blood culture
2. Parvovirus serology
3. Rapid plasma reagin

65M w/ sudden-onset dyspnea, unable to lie flat. Hx: HTN, CAD, TIAs. Previous diuretic therapy effective. JVD, bilateral lung crackles, soft abdomen. Improved w/ diuresis, antihypertensive. Next step?

1. Dexamethasone suppression test
2. Renal ultrasound with Doppler

19M w/ eye injury from racquetball, hit in L eye, immediate pain. Eye exam shows abnormality. Complication risk?

1. Cataract formation
2. Intraocular hypertension
3. Subconjunctival hemorrhage

7year old girl noted a sense of food stuck on her throat while eating chicken nuggets. Patient drank some water and noted relief of symptoms. This has already happened a couple of times previously and has always been relieved by drinking water. Patient noted to have history of mild eczema. Exam normal. What is the diagnosis?

1. Achalasia
2. Anxiety (globus pharyngeus)
3. Esophageal stricture
4. Eosinophilic esophagitis
5. Vascular malformation causing constriction

An Elderly man with hearing aids and bilateral cerumen impaction positive bilateral Rinne test and Weber’s lateralise to the right ear. Dx?

1. left otosclerosis
2. right acoustic neuroma
3. presbycusis more in right ear
4. otosclerosis more in right ear
5. conductive deafness more in right ear

26yr old man presented with right inguinal pain for 2 days after weekend trekking. On examination there’s tender swelling over the inguinal ligament. The lump is non reducible & doesn’t show expansive cough impulse. He doesn’t have any lower limb wounds. What is the diagnosis?

1. Inguinal lymphadenitis
2. Subcutaneous abscess
3. Femoral hernia
4. Indirect inguinal hernia
5. Direct inguinal

A lady comes to you with weakness of lower limbs. She drags her foot while walking, dorsiflexion and plantar flexion is weak. Reflexes are exaggerated. Equivocal plantar response. Diagnosis asked?

1. Cervical spine MS
2. Motor neuron disease
3. Spinal canal stenosis
4. Lesion in cerebral cortex

tool for research on dementia in Italian speaking elderlypopulation – design of the tool?

1. Because Italian have more dementia
2. Because dementia early detection leads to better prognosis
3. Because its easy to study dementia in elderly

22 lady w/ vaginal bleeding, abdominal pain, positive β-hCG. No intrauterine gestational sac, 1.5-cm right adnexal cyst, fluid in cul-de-sac. Probable diagnosis?

1. Abruptio placentae
2. Complete abortion

29 lady, 30wks gest., increasing pruritus on palms, has nausea, difficulty sleeping, and back pain. Takes diphenhydramine & acetaminophen to sleep. Chronic hypertension. Multiple excoriations on abdomen & thighs. next step?

1. Emergency delivery
2. Topical corticosteroids
3. Ursodeoxycholic acid

65yo man w/ recurrent hematemesis, melena, exertional dyspnea, dizziness, and fatigue. Takes ibuprofen for knee osteoarthritis. Bilateral crackles on exam. Diagnosis?

1. Anaphylactic transfusion reaction
2. Transfusion-related acute lung injury

50 years old man presented with diarrhea, weight loss, foul-smelling stools, abdominal distension. Gen lymphadenopathy, skin hyperpigmentation, diastolic murmur in aortic area. Small bowel biopsy shows villous atrophy, PAS+. Diagnosis?

1. Celiac disease
2. Whipple disease

38 years old female complained of severe headache and vomiting with RT sided paresis known case of HT on ACEI. BP is 160/100 with CT head given asking for next inv. no LP in choice

1. CT cerebral angiography
2. MRI
3. ecg of Af stable pt mamgement

man frequent traveler to Africa, this time went to Kenya travel vaccines up to date. has Jaundice, fever and abdominal pain after 3 weeks returning. He doesn’t take prophylaxis.

1. Hep A
2. Giardiasis
3. hep e

Book pelvic fracture long bone fractures ect. after MVA bp low stabilized with fluids and resuscitation. Cause for low bp

1. external iliac artery damage
2. venous plexus damage
3. femoral fractures

limping in one year old baby difficult abduction and rotauion of the hip,

1. pelvik-harness
2. Surgery some

old man with 4 episodes of UTI in 6 months following urinary catheterization for urinary retention for constipation. Examination unremarkable. DRE smooth soft prostrate – USG 250 ml urine culture shows e coli

1. TURP
2. Exclude other infection sources

74 yo lady came to clinic. Examination as follow: BP 130/80, HR 85, RR 16, T 36.9’C She is a smoker with 30 pack years Mother had anaemia in her later years. Laboratory tests reveal pancytopenia. Which of the following is the most likely diagnosis?

1. Acute leukaemia
2. Aplastic anaemia
3. Brain tumour
4. Folate deficiency
5. Vitamin B12 deficiency

17 man w/ cough, difficulty breathing x 3 wks. Cough worsened, fatigue x 2d, no chronic med hx or meds. Diminished breath sounds bilaterally, no wheezing. Anterior mediastinal mass. Likely diagnosis?

1. Acute lymphoblastic leukemia
2. Acute myeloid leukemia

graph on noncompliance of covid protocols selected similar 3 populations, group A did not follow the covid protocols of social distancing and handwashing, what about B?

1. B followed the protocols late
2. Increasing testing
3. followed the protocols early
4. no sufficient quarantine protocols

53 man w/ weakness, dyspnea x2d, unresolved upper respiratory illness x3wks. No chest pain or palpitations. Father died of MI at 55. Clear lungs, muffled heart sounds. Likely cause?

1. Decreased cardiac contractility
2. Decreased left ventricular preload

2hr old boy w/ cyanosis, born at 38wks via spontaneous vaginal delivery to a primigravida mother. Cyanosis appeared around lips and face during breastfeeding, turned pink when removed. Likely diagnosis?

1. Choanal atresia
2. Laryngomalacia

she has one son, 27years lady in monogamous relationship, use condoms,haven’t done cervical screening, sexually active since 25years, strongest in advising HPV vaccine to this patent.

1. monogamous relation
2. she uses condom
3. already sexually active.
4. Not doing cervical screening

26 adult man w/ bipolar I disorder. 1st manic ep 7yr ago, responded well to lithium. Noncompliant w/ med, 2nd manic ep 9mo later, 3 manic eps, 2 depressive eps, 1 suicide attempt over 5yr. Next step?

1. Continue long-term lithium maintenance pharmacotherapy
2. Discontinue lithium gradually over the course of several months

14 teenage girl w/ heavy vaginal bleeding, irregular menses since age 13, current menses for 7 days soaking thick pads every 2-3 hours and bled through clothing overnight. Cause?

1. Cervical inflammation
2. Hypothalamic-pituitary-ovarian axis immaturity

11 girl w/ 2-day history of rapid-onset abnormal movements: bilateral UL, trunk, then LL. Difficulty in daily activities. irregular/jerky movements w/ generalized hypotonia. next step?

1. Antistreptolysin O titer
2. Cerebrospinal fluid analysis
3. Psychiatric assessment

24 young adult man w/ self-inflicted laceration on L forearm. has hx of depression and anger issues since teenage years. ineffective medication trials w/ fluoxetine and sertraline due to sexual side effects. Appropriate treatment?

1. Bupropion
2. Couples counseling
3. Dialectical behavior therapy

surgery of patient, he smokes and drinks a lot. Recentlyhad nose bleed, platelets 90,000 only, awaiting hernioraphy what need to do to avoind bleeding during the suergery?

1. transfuse platelets
2. vit k
3. ffp
4. iv tranexamic acid

27 lady unconscious at fire scene, placed on O2, unresponsive w/ black soot near nares/mouth. Clear lungs, reddish skin, 4 sec cap refill, no cutaneous burns, 100% SpO2 on nonrebreather mask. Empirical treatment?

1. Cyanide poisoning
2. Methamphetamine exposure

22 man w/ difficulty concentrating, sleeping. Lost job, moved in w/ parents 2 mo ago. Easily loses focus, worried about future. Eating more, gained 3 kg. 2-3 hrs to fall asleep. psychotherapy, what med?

1. Quetiapine
2. Zolpidem

67 female w/ LLQ pain, nausea, poor appetite, loose BMs. Hx of similar episode 3 yrs ago, hysterectomy, and salpingo-oophorectomy. L sided tenderness w/ palpable mass. WBC 16.5k/mm3. Next step?

1. CT scan of the abdomen
2. Flexible sigmoidoscopy

postnatal depression in last pregnancy, the lady was taking paroxetine since then, now planning another pregnancy what to do –

1. cease paroxetin start citalopram
2. Start citalopram on confirmation of pregnancy
3. Double dose of paroxetine on confirmation of pregnancy.

28 female w/ rash on L foot, painful w/ walking/standing. oral contraceptive use. 2 sexual relationships past 3 yrs, current boyfriend 6 mo. Normal vitals, skin exam shown. Likely etiology?

1. Human papillomavirus infection
2. Lichen planus

48M w/ progressive exertional dyspnea, worsens past 2 mo. SOB after climbing 1 flight of stairs. Chest exam: harsh systolic murmur heard at R 2nd ICS w/ carotid radiation. Likely cause?

1. Myxomatous valve degeneration
2. Bicuspid aortic valve

60F w/ hx locally advanced breast cancer, post-lumpectomy, radiation therapy, chemo 6mo ago. On aromatase inhibitor. Persistent fatigue, poor sleep, difficulty focusing, weight loss. Anxiety re: cancer recurrence. Likely explanation?

1. Aromatase inhibitor side effects
2. Illness anxiety disorder
3. Major depressive disorder

23F, 37wks pregnant w/ contractions, fluid leakage for 8hrs. Had prenatal care until 20wks, prior vaginal birth w/ infection, infant had sepsis. 30% effaced, fetal vertex -1 station. Indication for GBS prophylaxis?

1. Current fetal gestational age
2. Neonatal sepsis in prior pregnancy

73M w/ dementia, moaning, gripping lower abdomen x36hrs, no BM x2d, hx: BPH, diverticular bleeding, external hemorrhoids, HTN, hyperlipidemia. Meds: amitriptyline. initial management?

1. Abdominal CT scan
2. Urinary catheterization

nurse with montoux 12mm, who had bcg before igra positivechest Xray has patch suggestive of tb features- AFB negative,management

1. start Rifampicine only
2. start quad therapy
3. observe
4. chest xray after one month

36M w/ RUQ pain, fever x1wk. Hiked Nepal 3mo ago, diarrhea, unprotected sex w/ woman, no prophylaxis. Palpable liver, tender smooth edge, hypoechoic lesion R lobe. Likely cause?

1. Polymicrobial liver infection
2. Protozoal infestation

10 severity, ecg normal, trop negative- sudden onset sever chest pain

1. Paracetamol
2. morphine
3. nitrates

father mother both covid -PCR positive, daughter negative, now daughter is having fever vomiting and diarrhea rash over the trunk and heard new murmur with st elevations on ecg, cause?

1. Atypical Kawasaki
2. MIS C- multisystem inflammatory syndrome in children

Rugby player presented with a vertical diplopia mono ocular ophthalmology normal no any ither nerve involvement cause?

1. Trauma
2. Cranial Tumour

33 weeks pregnant vaginal bleeding O negative, what nextbest step?

1. Reassure
2. Give antibodies
3. Observe
4. Obstetric ultrasoud

pregnant lady 28 weeks pregnant came for antenatal visit SFH 36 cannot palpate the fetal parts mother o negative mother ddn’t came for previous antenatal visits and haven’t done uss scan since the 1st scan cause?

1. Fetal oesophageal atresia
2. Hydrops fetalis

leg swelling from the site of vein harvest one month back for CBAG- now swelling redness and pain on harvest site, next?

1. Doppler us if the leg
2. wound site US

lady fell down and had fracture of wrist because carrying bag of trash at that time, daughter says hoarding at home,

1. OCD
2. Shizophrnia
3. hoarding syndrome
4. Alzhemiers
5. finger pyogenic granuloma,
6. excision
7. excision with graft.

3 cm tender mass in introitus right side, no image given.

1. I&D
2. Marsupialization
3. reassure

lady came to complain about her treatment in previous visit to same hospital. she was restrained and she was assaulted –

1. compelte an incident report
2. tell her complaint proper channel
3. Tell her it was done on her benefit
4. Tell her her recollection of the event is incorrect.

pt with af sudden onset of leg pain rt leg pulses present left leg pulses not present ? next management?

1. angiography
2. embolectomy

5 years old boy asthma moderate, cant complete sentences, given 6 puffs Salbutamol? Whats next?

1. more salbutamol 6 puffs
2. start ipratropium 4 puffs

congenital absent vas defrens. wants to conceive.

1. Vas differns anastomosis
2. IVF from insiprated sperms
3. Collect sperm and freeze for multiple attempts
4. Borrow sperms and perform IVF
5. Intrauterine insemination from inspirated sperms.

lady wants to conceive but she cant. She is 49, husband never had a child, he is 60, reason of infertility:

1. oligospermia
2. maternal age

unilateral headache and eye symptoms normal temporal area – diagnosis can be made by?

1. CT,
2. 100% Oxygen

vomiting will cause what?

1. sodium low potassium low, Bicarb, low PH high
2. sodium high potassium high, Bicarb high, PH high
3. sodium high potassium low, Bicarb low, PH low

child with several symptoms- proton urea, dark urine what in the history –

1. infection 2 weeks before
2. trauma last week
3. fall and hurt abdomen last week

venous phasic scan of abdomen showing 3rd degree kidney rupture after MVA – management?

1. observe
2. Laparotomy and nephrectomy

mother does not want to feed, says baby is evil mother agitated. delirius Diagnosis:

1. postnatal psychosis
2. postnatal depression
3. postnatal blues

post-surgery, silent abdomen, no stool passed, next investigation –

1. abd xray.
2. US
3. CT scan

pregnant lady BHCG 830995, diagnosis?

1. hydatid
2. ectopic

child 5 years old with nocturnal enuresis, going to camp, what to do?

1. use pads there
2. restrict water at night
3. Medication
4. Avoid the camp

barret oesophagus – low dysplasia 1 year back, high dysplasia now-

1. endoscopic ablation
2. oesophagectomy
3. give PPI only

delivery done, all normal, 700 ml bleed. Uterus 2cm above umbilicus placenta delivered fully what to do first? Iv cannulation

1. check for laceration
2. uterine massage.

drug A and Drug B are different from each other P=.05, means?

1. drug a is 5% better than drug b.
2. drug B is better than drug A
3. drug B cannot be given as proved lesser

recurrent pilonidal sinus treated but again formed, prevention?

1. keep the area shaved,
2. continuous antibiotics

child with mild learning disability recently downgraded the class due to poor performance. soiling underpants, constantly has abdominal pain.

1. bullying in school,
2. sexual abuse

woman recently came out of the prison has 1 day history of VZV on flank, met her children 1 week back who stays with their maternal grand parents.

1. stop meeting her perents,
2. contact tracing in prison

Girl plays with same toys sit same place always no eye contact with school teachers and doctor.

1. Autism
2. Other disorders

Risk percentage of radiation in CT scan

1. 10%
2. 20%
3. 50%
4. 80%

Labour with 9cm dilated & fhr 60bpm, next management?

1. Delivery by ventouse
2. Delivery by forceps
3. Delivery by c section

Spina bifida patient came for advice with 8 weeks pregnancy. She didn’t realise she was pregnant and has not taken any supplements. She is worried if baby will be born with spina bifida.

1. Prescribe 0.5mg folic acid–5 mg FA
2. Chorionic villous sampling
3. Refer to genetic counse
4. USG

Patient with heart failure he has stopped smoking. Taking salt 3g per day.but not going out of home bcs of worry of worsening symptoms. What to do?

1. Grdual increase in exercise
2. Further reduce salt
3. Cease alcohol

P value of a study between efficacy of Dryg A and B. How to interpret Case history similar to lateral epicondylitis – investigation

1. Uss
2. MRI
3. X-ray
4. No Ix

Case on Prostate CA of a elderly man with a PCI done 18 months ago

1. Management
2. Radical prostatectomy
3. Surveillance
4. Radiotherapy

Old man avoiding social engagement due to urge to pass urine. Cause

1. Detrouser instability
2. Pelvic muscle weakness
3. Infection

One week baby presenting with biliary vomiting.

1. Next Investigation
2. Uss
3. X-ray
4. CT

Post party’s bleeding 750 ml blood. Placenta was delivered completely What is to be done next

1. Syntocinon
2. Fundal massage
3. Look for lacerations

After CABG – erythema and tenderness at the femoral vein site after 1 week What is the next step

1. Doppler
2. CT
3. Flucloxacillin
4. Postpartum psychosis

Hx similar to post partum depression around 8 weeks post partum- what will you look for?

1. Mood
2. Sleep pattern
3. Premorbid personality

PCOS – 26 y – unable to conceive 6 months. High BMI

1. Clomiphine
2. Weight reduction
3. Metformin

Patient has GI CA. Father had Hepatic CA. Aunt/grand mother had endometrial CA. 2 brothers and pts children all normal. What CA syndrom?

1. Non polyposis colorectal CA
2. Familial adenomatous polyposis
3. Peutz jeghers xn

7year old girl noted a sense of food stuck on her throat while eating chicken nuggets. Patient drank some water and noted relief of symptoms. This has already happened a couple of times previously and has always been relieved by drinking water. Patient noted to have history of mild eczema. Exam normal. What is the diagnosis?

1. Achalasia
2. Anxiety (globus pharyngeus)
3. Esophageal stricture
4. Eosinophilic esophagitis
5. Vascular malformation causing constriction

Patient on abs for some serios infection, i think pyelonephritis with acute kidney injury.Symptoms resolving but still mild symptoms there Culture becomes positive for coagulase negetive staphylovoccus What to do

1. Continu same antibiotics
2. Increase amoxicillin dose
3. Stop amoxicillin add benzylpenicillin
4. Add vancomycin

A man with severe depression treated with Venlafaxine now presents with speech euphoria and mania. Asking the most appropriate next step?

1. Add sodium valproate.
2. Add Clozapine
3. Add Olanzapine
4. Withdraw Venlafaxine
5. Add Risperidone

One kid with diarhea mucosal labs given hb dec Also inc infection history Abd pain and weight 10 percentile

1. Cystic fibrosis
2. Celiac
3. Ibs
4. Ibd

One lady with abd pain constipation relived by opening bowels no other symptoms have adviced diet modification nit kuch relief diagnosis

1. Cystic fibrosis
2. Ibs
3. Ibd

One man with painful erection 8 weeks cavernouse cavernosa swelled i guess no previous history of any drug i think what to do next

1. Sidenafil
2. Inj adrenaline dilutes
3. Inj phenypherine diluted
4. Surgery

A baby with 2 urine spot + what to do next Morning urine sample

1. 24 hour urine
2. Kidney function tests
3. Electrolytes
4. Usg abdomen
5. Ct abdomen

One man with cirhosis alcohol withdrawal i guess symptoms what to give

1. Lorazepam
2. Diazepam
3. Temezepam
4. Naltrexone

One lady 25 yrs planning for baby unseccessful for 6 months bmi 29 pcos symptoms what to do next

1. Weight loss
2. Clomiphene
3. Metformin
4. Cocp

One lady came with symptoms of insomnia and depressive symptoms what substance abuse to check before prescribing treatment

1. Diazepam
2. Cannabis
3. Heroine

One lady come 3 week after baby birth saying baby is devil and not feeding him

1. Postpartum psychosis
2. Postpartum depression
3. Other 3 don’t remember

One lady 2 weeks after delivery come with baby that he cry too much and was worried but baby exam normal and breast feeding normal established what to check in mother

1. Premorbid personality
2. Sleep pattern
3. Depressive symptoms

One man presented with sob diagnosed with Aortic stenosis ef 35 percent but minimal pedal edema and no crackles on lung auscultation murmur 3/4 radiating to carotids what to do

1. Aortic valve replacement
2. Percutaneous intraortic
3. Frusemide

One lady with multiple hand and wrist symetrical joint involvement causing pain x ray osteosclerotic feature dip swelled and metacarphophalangeal pain dx

1. Primary degenerative osteoarthritis
2. RA
3. Sle
4. Sjoogrens

man came to hospital angry demands his medical records as he thinks his family is trying to frame him- give? refuse?

1. A young man with 3 week history of persisten cough
2. Worse in night and with activity ass with vomiting sometimes not relieved with abx and inhaled salbutamol diagnose
3. Asthma
4. Gerd
5. Pertussis
6. One other option can’t recall

Patient chronic low back ache on oxycodone pain not relieving now taking heroine with it mild relief what to dose of oxycodone

1. Stop oxycodone give naloxone for withdrawal
2. Refer for pain specialist to clinic

Lady with multiple joints pain dsDna mild positive ana + ccp negative sm antibodies positive diagnosis

1. Sle
2. Ra
3. Sjogren
4. Mixed connective tissue

Person depression severe not eating food refusing anything to eat next

1. Mental tribunal for ect
2. Ect after permission husband
3. Ng feed and give ssri through ng feed

One man 55 yr old painful breast swelling on spironolactone and other drugs family history of breast ca his mother and sister both had ca what to do next

1. Abx
2. Usg
3. Fnac
4. Reassure
5. Nothing

A lady with Brca positive and planned for matectomy and history of multiple cancers in family what else you need to check

1. Ct abdomen and xray
2. Pelvic usg
3. Sigmoidoscopy
4. Pelvic scan usg
5. Sigmoidoscopy

One with flail rib fracture oxygen given pain 9/10 but sob worsening what next

1. Epidural analgesia
2. Rib analgesia
3. Intubate

One copd scenario on oxygen

1. Abg
2. Ph 7.36
3. Po2 65
4. Pco 60
5. What to do next
6. Inc oxygen
7. Dec oxygen
8. Ventilate

Pt on one week IM haloperidol. Developed extrapyramudal side effects. Actives schizo symptoms. Whatto give.

1. IM risperidone
2. Im Aripriprazole
3. Stop haloperidol

One pregnant lady post trauma saturation low bp low after giving oxygen was maintaining oxygen what to do

1. Give warm colloids
2. Iv line Bg cross match
3. C section
4. Left lateral position

One with intense vaginal itch,not responding to cotrimazole papery vagina what to give

1. Fluconazole
2. Betamethasone propionate ointment
3. Hydrocortisone
4. Estrogen cream
5. Tool to develop dementia
6. screen what to see
7. Early screening effect prognosis

There were other options but i picked that that’s why can’t remember other options One cervical screening test test rate is increasing from 40-60 percent but incidence not increasing

1. Specificity low
2. Cervical ca affect latent stages

Pt bleeding PR. Blood given. Still bleeding. (Colonoscopy havent done yet) what to do?

1. Colonoscopy
2. CT angio

Brocho pneumoniae signs of dehydration what else to encourage after antibiotics

1. Oral hydration

An intern want to atudey efficacy of drug which study

1. Rct
2. Cohort
3. Cross sectional

Patient on 12 unit glargine night only how to write in the medication chart

1. Cease
2. 12 unit subcu
3. 12 unit s/c
4. 6 unit sc

The one vericoele question repeated

1. Inv
2. Usg
3. Ct
4. Mri

One lady with parotid swelling fnac done malignant cells what’s next

1. Ct
2. Mrsialogram
3. 1 kidney injury grade 3 with blood in urine

2 diabetic ,pulse less,puss discharge aftter debridement what what will you consider next

1. Mri iv antibiotics oral abx

A young man with 3 week history of persisten cough

Worse in night and with activity ass with vomiting sometimes not relieved with abx and inhaled salbutamol diagnose

1. Asthma
2. Gerd
3. Pertussis
4. One other option can’t recall

16 year old, argues with parents, hates going to school, wakes up late, cries when confronted, recently became a vegetarian:

1. Odd
2. Normal
3. Ocd
4. Histrionic

42 yr lady sob for 2 days chest xary clear ecg given that was of pul embolism Q3T3 What to do next

1. Ctpa
2. V/q
3. D dimer

Couple trying to conceive for 5 months, woman delivered 11 months ago, not breast feeding, no contra, did d&c and some medication (forgot what) what to do?

1. Review in 6 months
2. Induction of ovulation
3. Forgot the other options

66 yr female, visited south east Asia, on coming back had a single episode of diarrhea with RUQ pain which resolved on its own, now presented 3-4 weeks later with RUQ pain fever malaise and jaundice. Diagnosis?

1. Hydatid cyst
2. Cholecysitits
3. Cholangitis
4. Hepatitis
5. Liver abscess

Boy with history of melanoma, .3mm excised with no residual margins, highest risk for second melanoma:

1. Past history of melanoma
2. Depth
3. 3 thickness
4. Margins

Depression patient not eating not wanting to get ECt done. What to do?

Give NG feed

1. Tell mental health tribunal
2. Take consent from husband
3. Do ect without consent

Man with recurrent shoulder pain uses intra articular steroid injection to relieve pain comes with painful abduction and limited movement what’s the immediate management:

1. Refere to physiotherapy
2. Oral steroids
3. Intra articular cortisol injection

Pt on one week IM haloperidol. Developed extrapyramudal side effects. Actives schizo symptoms. Whatto give.

1. IM risperidone
2. Im Aripriprazole
3. Stop haloperidol

8 weeks pregant. Hcg 88000. She is anyway young to abort. Tsh low. Many investigations given. Everything else normal. Whats the diagnosis?

1. Molar pregancy
2. Hcg induced low tsh

Young pt. Open laparoscopy for appendix with lavage. 700ml fluid drained during surgery. Was given IV ANTIBIOTICS. Then 5days oral antibiotics. Now has diarrhoea. Fever of 37.5. Gerenalized tenderness on rectal exam. Reason

1. Pelvic abscess
2. Giardiasis
3. C diff
4. Leaking stump

nih/o trauma 1 month ago, BP160/100, enalapril, statin. c/o sudden loss of vision cant see when close right side diagnosis? ?CRVO, glaucoma, retinal detatchemt, VH A boy travelled to India. Got vaccinated for Hep A before travel. No drug or sex abuse or sex intercaourse hx, Now developed fever chills and jaundice. Diagnosis?

1. Hep A
2. Hep B
3. Hep C
4. Hep D
5. Hep E

66 yr female, visited south east Asia, on coming back had a single episode of diarrhea with RUQ pain which resolved on its own, now presented 3-4 weeks later with RUQ pain fever malaise and jaundice. Diagnosis?

1. Hydatid cyst
2. Cholecysitits
3. Cholangitis
4. Hepatitis
5. Liver abscess

Chronic back pain, taking oxycodone recently started taking heroine bcs of inadequate pain control. What to do?

1. Report
2. Urine assessment
3. Increase dose of oxycodone
4. Continue regular drug

Which study to see the effect of nutritional supplements on OA?

1. Cohort
2. RCT
3. case series

Mother brings a child with strange behavior, uses phone all the time isolated and agitated, increased sleep, diagnosis?

1. Depression
2. Sleep disorder
3. Psychosis

Young aboriginAl girl with recurrent respo infections. Now has rash. How will you diagnose?

1. Aso titre
2. CBC

Young pt with urethral discharge, rash on palms and soles. sausage digits. RF NEGATIVE DISCHARGE GRAM STAIN NEGATIve. What is the diagnosis

1. Reiters
2. Psoriatic rash
3. Gonorrhea
4. Autoimmune disease

Old women travelled to Kenya/Bali : wt loss jaundice. Has been taking doxycycline.

1. Raised Bilirubin, ggt alk phosphate and alt.
2. AST was very mildly raised.

What’s the Diagnosis ?

1. Malaria
2. Yellow fever
3. Pancreatitic cancers
4. Ross river fever
5. Choledocholithiases

Young boy with school performance, sleep issues. Doesn’t pay attention in school. Difficult to wake from sleep. Fussy about food at home.

What to give

1. Quietapine
2. Risperidone
3. Propanolol
4. Alprazolam

Pt with PCOS. Infertility. How will you treat.

1. Clomiphene
2. Metformin
3. Ovarian drilling

Women presented with left flank rash after getting out of prison she has history of visiting her children two weeks ago who live with their maternal grandmother the rash is itchy and is maculovesicular and has been present for it 3 weeks she also has history of IV drug abuse how will you manage

1. Immunization of the children
2. Isolate her from her parents
3. HIV serology

Man presents with headache nausea vomiting for couple of weeks he works in his garage with a chainsaw which operates on petrol there is history of upper respiratory tract infection in his child one week ago how will you diagnose

1. Carboxyhemoglobin
2. CT head
3. Blood culture

CT abdomen man after MVA grade 3 laceration of kidney vitally stable what is your next appropriate management

1. Urgent laparotomy
2. RFTs
3. Observation

Homeless girl uses IV drugs and cocaine recently found out she was pregnant is very unsure about whether to continue pregnancy or not

1. Send to pregnancy counselling centre
2. Advice against drug usage
3. Involve parents

Pregnant woman presents after car accident with bruises on abdomen vitally stable foetal heart rate is normal generally okay

1. Admit and observe
2. CTG
3. Biophysical profile
4. Reassure and review in 24 hours

Patient presents with abdominal pain a bit relieved after a while CT scan done shows in cm mass on the blood bowl of kidney what is your management

1. Partial nephrectomy
2. Total Nephrectomy
3. Observation

Woman presenting with signs of PCOS BMI is 29 trying to conceive for the last 6 months what is your most appropriate management

1. weight loss
2. Metformin
3. clomiphene citrate
4. hysteroscopy

42 years old women cycles of 27 to 35 days bleeding for 5 days present with inability to conceive for the past 6 months she has a child from a previous husband now married to a man of 47 years old has no symptoms on any previous medical history what is the cause for infertility

1. Woman’s age
2. Anovulation
3. Oligospermia
4. Antisperm antibodies

Old man with chronic alcohol intake and spirits use presents with blood stained saliva and recurrent earache on examination no findings in ear submandibular lymph nodes are swollen examination of which will tell you the diagnosis

1. teeth and gums
2. tongue
3. submandibular salivary gland