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November 2022 Recalls

45yo man sudden onset skin rash, oral lesion with fever. Not able to eat. Conjunctivae inflamed. Erosion at oral mucosa. Rash at trunk and thigh. Prescribed TMTSFX 5 days ago. Dx?

a) Staphylococcal scalded skin syndrome

b) Stevens-Johnson syndrome

1month boy poor feeding. Breathing hard and fast during feed. 4/6 holosystolic murmur at left sternal border with thrill. Lungs rales bibasal. Liver palpable. Cause?

a) Increased left ventricular afterload

b) Increased pulmonary blood flow

34yo lady fatigue become tired easily after walking short distance. Difficulty combing hair. Father die of stroke. Mother dm. she has tachycardia. Awkward drop into chair when ask to sit. Decreased shoulder muscle mass. Cause?

a) Cerebellar dysfunction

b) Neuromuscular junction disorder

c) Thyroid disease

Around 40 y, conjunctiva pale, alcohol h/o can’t remember. Clad Features but no pedal edema, all the LFT markers bilirubin, album, glob, Get, alt, sat elevated… Ds?

a) Clad

b) metastatic from colon,

c) Other can’t remember

Child with headache, vomiting, small palpable cervical lymph node on Rat side. Head also tilt towards the same side. Mom has h/o recurrent headache Investigation?

a. Us
b. Ct
c. 3.biopsy

d. Mir

17 yrs. female, Recurrent rasp infection, fatigue, lab, glob both decrease…

a) Coeliac dis
b) Sled

Boy who failed in exam and now threatened to kill his teacher. Thinks That he deserve great marks. I got that ques. But ask about which Features if present will help to dx?

a) Rapid speech

b) Poor concentration
c) Pts.

d) Cannot remember all options

A lady with h/o dental procedure few days back. Now c/o 4hrs stridor, With rat sided neck swelling, there is red swelling from from Preauricular area to ramus. Ask mx? Young woman. Panic attack. Severe anxiety. Trembling sweating chest Tightness SOB when giving presentation. Concern lose job resulting Poor asleep. Avoids eye contact. Ds?

a) Generalized anxiety disorder

b) Social anxiety disorder

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4month girl. Fussiness and persistent fever 2 days. 1 episode of Vomiting. Not finishing breast milk. Still wet diapers but urine no smell Or blood. Exam shows tired baby. Next step?

a) Abdominal ultrasound
b) Urinalysis and urine culture

Snake bite + no fangs marks + linear scar. What to do next?

a) Take swab and pressure bandage/
b) anti-venom kit/
c) transfer to hospital/
d) serve antivenin

This time at 39w, placenta prevail and undergo planned caesarean section under GA. Otherwise, antenatal no other problem. IMMEDIATE upon delivery of baby, patient BP drop to 60/40mmHg, profuse bleeding, not clotting

a) Anaphylaxis to anaesthesiological medication

b) Amniotic fluid embolism

c) Retained placenta

d) Uterine inversion

e) Extended year to the uterosacral ligament

PCV (polycythemia rubra Vera) what is the physical examination finding: splenomegaly/cardiomegaly after delivery of baby, bleeding and not clotting?

a) AFE

b) retained placenta

This time at 39w, placenta prevail and undergo planned caesarean Section under GA. Otherwise, antenatal no other problem. IMMEDIATE Upon delivery of baby, patient BP drop to 60/40mmHg, profuse Bleeding, not clotting Floater increasing, Fundoscopy: white band ring? Diagnosis?

a) idiopathic floaters/
b) retinal detachment/

c) vitreous hemorrhage

ASTHMA: given three puff of salbutamol, what’s next to give?

a) Jptrapium bromide
b) hydrocortisone inhalation
c) oral Prednisolone

8Ankylosing spondylitis 1st line = NSAID ankylosing spondylitis. Pt. was Having stomach problem, 57 yrs. and mild pain from 20yreas. What you choose:

a) Parracetamol

b) Naproxen

c) Methotrexate

d) sulfasalazine

e) Infliximab

Enclosing spondylitis x-ray asking for best treatment. Patient already on Paracetamol and codiene but no relief

a) Sulphasalazine

b) Methotrexate

c) Indomethacin

d) Infliximab

Pediatrics: nephrotic syndrome, immunisation, 5mth old, full-term boy is brought due to fever, runny nose & intermittent coughing. His 3yrold brother had an upper respiratory tract infection last wk. Takes vitamin D. Exam shows crusted rhinorrhea at the nares. Marked on chest radiograph

a) Right upper lobe atelectasis
b) Right upper lobe infiltrate

25 yo woman comes due to chest pain that began 2 days ago. Unable to sleep prone because of pain. Last menstrual period was 3 wks ago. Takes a daily folic acid supplement. Palpation demonstrates bilateral, nonfocal chest tenderness diffusely nodular, dense breasts. Diagnosis?

a) Fibroadenoma
b) Fibrocystic changes

Teenage girl is brought for a preparticipation sports physical. She is planning to play lacrosse, which she had played the previous schoo yr. Posture seemed abnormal. Physical exam shows a right-sided lumbar prominence during forward bend test. Next step?

a) MRI of the spine

b) Surgical fixation

c) X-ray of the spine

43yr old woman comes with abdominal pain & dark urine. Physical exam shows right upper-quadrant tenderness without guarding or rebound. Further workup, including MRI of the abdomen, shows hepatic vein thrombosis. Diagnosis?

a) Acute intermittent porphyria

b) Paroxysmal nocturnal hemoglobinuria

Elderly woman is brought for lethargy & drowsiness. Medical history is significant for hypertension, chronic kidney disease, chronic low back pain & frequent constipation. Strength in the upper & lower extremities is 2/5 & deep tendon reflexes are absent. Serum creatinine 200. Diagnosis?

a) Cerebellar infarction
b) Hypermagnesemia

21yrold man being stepped on the chest by a bull approx 30 min ago. BP 75/50. Bilateral chest tubes with 1.5 L of blood is returned from each side; Vital signs do not improve. 4 units of packed red blood cells are prepared for transfusion. Blood products to be administered?

a) 4 units of cryoprecipitate only
b) 4 units of fresh frozen plasma and 4 units of platelets
c) 4 units of platelets only

Delusional disorder: is a type of mental health condition in which a person can’t tell what’s real from what’s imagined. There are many types, including persecutory, jealous and grandiose types. It’s treatable with psychotherapy and medication. Hypochondriasis: Illness anxiety disorder, sometimes called hypochondriasis or health anxiety, is worrying excessively that you are or may become seriously ill. You may have no physical symptoms.

a) dementia
b) Parkinson

Patient under clozapine treatment for resistant schizophrenia, bi 42, what is the best opción to treat obesity

a) Aripiprazole

b) Acromioclavicular dislocation picture given

c) intestinal obstruction

Positive predictive value in a depression scale, data given. PPV=


b) Lichen sclerosis treatment

c) Local potent steroids (clobetasol)
d) Screening for Prostate cancer

A mother came to your office with complaints of her son having rut from past 3 days and asking for med certificate for past 3 days as she had to take care of him on examination only mild symptoms. Of rut present

a) give med certificate (better give certificate like a career)

b) give med certificate for the present day

c) call her supervisor to tell about the condition

Paed-6 yr. old with dark urine U – protein 2+ RBC 4+ Urea and creatinine elevated Albumin and globulin normal Cause?

a) IgA

b) pagan

Another question Greenish discharge from 3 spots of one breast 3 Cause?

a) Duct ectasia
b) Intraductal papilloma
c) Invasive CA

6 weeks return from Thailand, complain of fever, fatigue. Physical Examination normal. What’s the next investigation?

a) HIV (because the time 6 weeks after the travel)

b) Malaria
c) Dengue

56yold man comes due to an episode of transient right eye blindness that lasted a hr. Smoked a pack of cigarettes daily for 30 yrs. BP 160/94. BMI 32. Facial plethora is present. Abdominal exam reveals splenomegaly. Best therapy?

a) Anticoagulation
b) Phlebotomy

Meningococcal meningitis: antibiotic of choice for 5 years old

a) Ceftriaxone

b) Ampicillin

c) Gentamicin

d) Metronidazole

Middle age car mechanic comes due to a 4-wk history of right elbow Pain. Tenderness on palpation around the lateral distal homers. Pain is Reproduced when testing grip strength & with resisted wrist Extension. Next step?

a) Elbow counterforce brace

b) Elbow x-ray

Basilar skull fracture; raccoon eyes, CSF leaking, what to do next?

b) oral gastric tube
c) NG tube
d) Ax

Hoarding: what to look for?

a) Substance abuse
b) social anxiety
c) mood/
d) alcohol abuse

Paramedic placed an ET tube in ambulance after coming to ER you have Following Caphnography (etCO2). What is the reason?

a) Tube leakage
b) Chine strokes
c) Proper placement

d) Synchronized breathing

e) Asynchronies breathing

Old man with severe difficulty speaking, right visual field defect & severe right lower facial droop. Weakness & sensory loss in right arm & leg. Has transient ischemic episode with 30% stenosis in carotid arteries. Has hypertension, hyperlipidemia, type 2 diabetes mellitus & ADPKD. Cause?

a) Cardiogenic emboli

b) Carotid artery atherosclerosis

Man with intermittent right knee pain for the last few MThs. Has type 2 diabetes mellitus. BMI 36. Right knee has bony enlargement & a small effusion. Synovial fluid shows a leukocyte count of 1,800/mm3 with no crystals. Medication for relief?

a) Colchicine
b) Diclofenac

Middle age man x of travelling cruise to Indonesia. Presented to you now with fever, nonproductive cough & shortness of breath for the past2 days. Also has headache, abdominal pain & diarrhea. History of type 2 diabetes mellitus & smoked a pack of cigarettes/day for 20 yrs. Lung crackles bilaterally; interstitial infiltrates. Sodium 128. Antibiotics?

a) Legionella infection.
b) Ceftriaxone
c) Clindamycin
d) Levofloxacin

20 you woman comes due to hearing loss. Trouble with balancing poses during yoga. Her mother also developed hearing loss in her 20s. Standing on 1 foot is difficult, especially with closed eyes. Audiogram shows bilateral sensor neural hearing loss. Cause?

a) Multiple sclerosis

b) Neurofibromatosis

26yo woman comes due to pulsatile headaches associated with nausea over the past 6 wks. Has transient episodes of blindness lasting 2-3 sacs. 16-kg weight gain over the past yr. BMI 43. Fundus copy shows bilateral papilledema. Feels better after the lumbar puncture. Treatment?

a) Acetazolamide

b) Cerebral venous sinus stenting

c) Corticosteroids

51 you old man comes due to frequent itching, especially after bathing. Occasional headaches & dizziness. His sister has bipolar disorder. BMI 30. Face has a ruddy cyanotic appearance. Spleen is palpable 4 cm below the left lower ribs. Likely seen on further workup?

a) Low resting arterial oxygen saturation
b) Low serum erythropoietin level

75 you man in end-stage multiple myeloma. Severe pain due to pathologic vertebral compression fractures & osteocytes rib lesions. Continuous IV morphine infusion; infusion rate has been increased several times. Pulse oximetry 89%. Patient is drowsy but constantly moans in pain. Next step?

a) Continue morphine at the same dosage and reevaluate in 48 hours

b) Increase morphine until adequate pain control is achieved

Young woman with sudden-onset blurry vision, numbness & tingling in the legs. Stressed at school & worried about her mother’s health. 2 episodes of urinary incontinence. MRI shows multifocal, white matter, hyper intense T2 lesions in corpus callosum & periventricular area. Likely to develop?

a) Dementia
b) Depression
c) Psychosis

A 30 year old woman, pregnant, 36 week gestation, SFH 32 weeks. Fetal parts palpable. Everything normal, regular follow up, cause of discrepancy

a) lug

b) Constitutional small baby

c) Renal agencies

d) Wrong dates

Lady 33 year, have body pain, and many point tenderness. Every test is normal. ANA, CRP, ESR etc. What is the best treatment?

a) Sertraline

b) Amitriptyline

c) Clonazepam

18 months old boy is brought due to developmental concerns. Does not walk independently. His older brother began walking at age 12 MThs. Speaks in 2- to 3 word sentences & follow simple commands. Height, weight & head circumference track at the 20th percentile. Next step?

a) Brain imaging
b) Creative kinase level

38 Old man, 70. With on and off constipation for 6 months. Now Obstipation for 3 days. On x-ray, bowel is dilated, no gas in rectum, DRE Normal. Cut off point at sigmoid. Diagnosis

a) Sigmoid cancer
b) Sigmoid volvulus

75 y old female. Post op day 5. Painless distension of abdomen. Rectal examination unremarkable. X- Ray given. Looks like small bowel distention. Next management

a) NG tube and decompression

b) Rectal tube and decompression
c) Colonoscopy

Women 24. 2 children. 4 y and 8 months. Husband 26 y. comes asking for tubal ligation as she doesn’t want any more kids. What’s the best advice?

a) Husband should do vasectomy.

b) Tell her about other contraceptive methods.

c) Do tubal ligation

d) Tell her she should not do that

e) Tell her that it’s irreversible.

Trucker comes with bloating, diarrhea and nausea. Had a similar Episode 1 year back. Colonoscopy and other investigation at that time Was all normal. What to do next.

a) Colonoscopy
b) Fiat
c) Dietary advices
d) Stool for ova, parasite

A man came, asking about prostate disease. He had symptoms of urgency and urinary obstruction. DRE was done. Moderately enlarged prostate was found. Next most appropriate

a) Tell him about pros and cons of test
b) Do spa (if he is >40YO and family with prostate CA)

c) Us (if he is <40YO or without family with Prostate CA)
d) Ct scan abdomen

A 35 year old man, came from India, had joint pain, tenosynovitis, swollen joints. Have vesicular eruptions in arms. Diagnosis

a) Reactive arthritis

b) Gonococci arthritis

Trucker comes with bloating, diarrhea and nausea. Had a similar episode 1 year back. Colonoscopy and other investigation at that time was all normal. What to do next.

a) Colonoscopy

b) Fiat

c) Dietary advices

d) Stool for ova, parasite

Women comes with sued onset chest pain. Left side lower chest dullness+. History of vomiting. BP 90/60. HR 100. What to do next

a) Gastrograffin
b) ECG
c) Echo
d) CXR

A boy, 13 year. Knee pain. All examination normal. Tenderness over tibia tuberosity, range of movement normal. Diagnosis

a) Traction apophysitis (Osgood-Shatter disease)
b) Pre patellar bursitis
c) Patellar tendonitis

53yo man comes due to persistent fatigue. Started a therapeutic dose of fluoxetine 2 MThs 2 ago after being diagnosed with major depressive disorder. Medical history includes hypertension treated with enalapril. 4-kg weight gain over the past 2 MThs. Appears depressed & speaks softly. Next step?

a) Continue fluoxetine and add methylphenidate

b) Discontinue fluoxetine and begin bupropion

34yo woman with worsening difficulty hearing, especially in the left ear. When environment is noisy, she can understand speech better than when in a quiet room. Hears ringing. Her mother had surgery for hearing loss in her 40s. A slight reddish hue behind the left tympanic membrane. Cause?

a) Bony overgrowth of the icicles

b) Degeneration of neuronal cell bodies

30+ you man comes due to lack of sexual desire & erectile dysfunction for 3 MThs. Medical history is significant for opioid use disorder, for which he has been taking methadone for 2 yrs. Gained 4.5 kg over the past 6 MThs. BMI is 24.5 kg/m? Testes are small & soft. Cause?

a) Klinefelter syndrome
b) Medication adverse effect

Teenage girl of short stature with height <3rd percentile & weight at 20th percentile. Not yet undergone menarche. A 2/6 systolic ejection murmur heard loudest in left infraclavicular area. Breast development is Tanner stage 1 & pubic hair development is Tanner stage 4. Present?

a) High estrogen
b) High FSH
c) High inhibit A

Middle age woman slipped & fell backward down half a flight of Stairs. Has right-sided back & chest pain. X-ray reveals a minimally Displaced, posterior fracture of the right sixth rib & bilateral basilar Atelectasis. Essential for preventing pulmonary complications?

a) Adequate analgesia

b) Continuous positive airway pressure

Middle woman is evaluated for fatigue & exceptional dyspnea. Difficulty walking for more than 1 or 2 blocks without becoming short of breath. Significant for hyperlipidemia, hypertension & type 2 diabetes mellitus. BMI 55. There is trace bilateral lower-extremity edema. Cause of dyspnea?

a) Airway inflammation and bronchospasm

b) Alveolar hypoventilation

4 yr-old boy is brought due to concerns about his vision. Born at 34 wks. Gestation & takes no daily medications. Visual acuity is 20/30 in the Right eye. In the left eye, the patient is unable to see the visual acuity Chart & is able to count fingers only at a close distance. Cause?

a) Retinopathy of prematurity
b) Uncorrected refractive error

Middle age woman comes due to bloating, flatulence, abdominal cramps & explosive watery diarrhea. These symptoms occur after ingesting dairy products. Physical exam shows abdominal distention & borborygmi. Further investigation test results observed?

a) Decreased stool osmotic gap

b) Positive hydrogen breath test

Man with history 6 MThs ago, diagnosed with papillary thyroid cancer & underwent total thyroidectomy, followed by radioactive iodine treatment. Since then, takes levothyroxine. Significantly elevated serum thyroglobulin concentration compared with the previous level 6 MThs ago. Explanation?

a) Excessive thyroid hormone replacement

b) Recurrence of the thyroid malignancy

5- mth-old girl is brought due to abnormal body movements started an MTh ago. During exam, the patient suddenly flexes at the hips & elbows for approx. 2 sacs. Skin exam shows several hypo pigmented, elliptical macules on the chest. The mother has similar lesions. Cause?

a) Acoustic schwannoma

b) Sub ependymal giant cell tumor

39 yr-old woman with worsening urinary symptoms. Diagnosed with multiple sclerosis 3 yrs. ago. Has hypertension & glucocorticoid-induced hyperglycemia. Hyperreflexia of lower extremities & mild intention tremor. Scan reveals a contracted, small bladder. Cause?

a) Obstruction of bladder outlet

b) Over activity of detrusor muscle

25 yr-old homeless man with a history of schizophrenia, destroyed a television set at a local electronics store & then became extremely agitated & violent. Given haloperidol, which calms him down. Physical exam shows a sustained contraction of his neck to the right side. Next step?

a) Dantrolene
b) Diphenhydramine

52 hr-old girl with abdominal distension. Loops of small bowel with Paucity of air in large intestine & rectum. Left lateral decubitus view Shows free air above liver & emergency laparotomy is Performed. Thick, sticky stool evacuated from ileum & colon appears Diffusely narrow. Risk?

a) Bicuspid aortic valve
b) Chronic rhino sinusitis

47 R/ hand thumb and index finger weakness. Improved when raising Arm above head. Thana muscle wasting. Brachioradialis jerk normal. Diagnosis

a) Cervical radiculopathy
b) Carpal tunnel syndrome

c) Thoracic outlet obstruction

48- pt on atorvastatin, have myositis, cu and cry normal. Stop atria. After repeat lipid profile TG rising. What drug to be start

a) No option of re start atavist

b) Gemfibrozil

c) nicotinic acid,

d) eczema tide,

e) pravastatin

49- Pt with erectile dysfunction, depression, emphysema, HTN, MI, heavy Smoking > 40, alcoholic. Most appropriate of mx

a) Sildenafil

b) Cease smoking
c) Cease alcohol
d) Increase dose of hen drug

A- university student present for sick certificate that he missed exam Yesterday due to muscle aches, headaches and fever starting last three Days and he is now well. What will you do?

a) Decline the request as his illness is not confirmed

b) Decline the request as he is not present during the exam day
c) Confirm his illness from third party
d) Dating the certificate with today date
e) Dating the certificate with the exam date

51 Lady took olanzapine and stable with that, complain about wt. gain what to give BMI 42

a) risperidone
b) Clozapine
c) Aripiprazole

d) Other antidepressants .

e) Refer to dietitian

f) Refer to endocrinologist

g) Advice exercise

52- Ptn coming with intense photophobia, painful red eye but pupils reacting normally.

a) diagnosis

b) Keratitis

53-. Mother brings her son who is not doing well in his studies… he threatens her to harm her, going out of house, herd he talking to himself Schizophrenia 24yo adult developing flu like symptoms and rashes over face neck trunk. Diagnosis?

a) Measles
b) Rubella
c) Scarlet

d) Carotid stenosis 70%…carotid endartrectomy
e) Baby 6 has jaundice
f) Hemolytic anemia
g) Biliary atresia

Pant on Parkinsonism medication levodopa still has eye gliding and lip Licking.

a) Increase dose of levodopa

b) Decrease dose of levodopa
c) better to decrease or stop anti-psychotic like haloperoild

d) Female failure to breastfeed

e) Pit necrosis

f) Sherman syndrome

Child on chart high fall to 10% but wt. is on 95% Growth hormone ass Pant presented with jaundice with normal exam

a) Gilbert

b) Enlarge epididymis

c) E coli (if Young)

d) Chlamydia

Pt. diabetic has painless foot ulcer

a) Neuropathy
b) Infection

Pant pneumonia 10d medication still has symptoms

a) Un treated pneumonia

b) Pneumothorax 15%
c) aspiration

Pant back returned to normal after evacuating the mole no came with Amenorrhea and back is 600…

a) Recurrent mole
b) New pregnancy

Snake bit kid no compression done 2 hours later he feels pain at site.

a) No further investigation
b) Cubic

Pant on antipsychotic develop restlessness can’t set in his place.

a) Reduce the medication dose
b) Nurse didn’t give correct medication
c) incident form

A 30 year old woman, pregnant, 36 week gestation, SFH 32 weeks. Fetal parts palpable. Everything normal, regular follow up, cause of discrepancy


b) Constitutional small baby

c) Renal agencies

d) Wrong dates

40 year complaint of persistent chest pain for 24 hour medial to left Nipple area. Otherwise all normal, ECG normal. Next

a) Exercise ECG
b) Repeat ECG and troponin

c) Ask him to go to GP if pain recurs

Patient treated with amoxicillin-clavulanate for bone? Severe? Infection for 14 days. After 3 day patient developed fever, maculopapular rash. What will you dx?

a) idiosyncratic drug reaction
b) amoxicillin drug reaction
c) leg E serology

Man previously well came in due to intermittent cough with chest Tightness and wheezing This started when he began to work in a horse camp. What is the most appropriate initial diagnostic?

a) Blood I.e. level

b) Spirometer with bronchodilator

c) Skin allergy testing

Got an x-ray with coffee bean shaped colonic expansion Stem talks About colonic obstruction. Asking for definite management

a) Ng tube

b) Rectal tube

c) Colonoscopy

Agitated man confused, took by police, always keeping a knife with him because he is believing that someone will kill him. He also took the knave to ED but he put it down in a safe place when the doctor request. He didn’t not give any history of his previous psychiatric or medical illness. What is the best way to obtain collateral history for this patient?

a) Ask the police records
b) Ask about his illness for relatives
c) Wait for the patient until he stable

d) Ask for Guardianship board

Old man taking Temazapam, He came to GP for prescription of temazema. He has to take 3 tablets of temazapam to fall asleep well. When he reduced the dose, he can’t sleep well. What would you give him?

a) Give temazapam as he requested
b) Give Oxycodone

c) Sleep hygiene and relaxation

d) Reduce Tempazepam dose
e) Change to Diazepam and Wean slowly

3 yr old child, came for upper respiratory tract infection. Doting physical examination grade 2-3/6 Ejection Systolic murmur in left sternal border+. What is your next action?

a) Refer for pediatric cardiologist

b) Review 2 weeks later

c) give amoxicillin

2.5 year boy can do which of the following?

a) Button his shirt

b) Kick a ball

c) Make a sentence with 4to 5 words
d) Copy n draw a ladder

64 yr-old woman with a neck lump. Significant for obesity, type 2 diabetes mellitus & nonalcoholic fatty liver disease. 2-cm, hard, contender cervical lymph node close to the right submandibular gland. Mild hepatomegaly. Fine-needle aspiration reveals squamous cell carcinoma. Most helpful?

a) Abdominal CT scan

b) Colonoscopy
c) Laryngopharyngoscopy

Middle age presented to the ER, with complaint of seizure. Diagnosed as a case of generalized tonic clinic seizures. He has a history of stroke and hypertension and takes warfarin and other drugs. What will be your best drug of choice for him?

a) amiodarnone
b) sodium valproate
c) carbamazepine
d) phenytoin

e) topiramate

Plain radiography is the most common first-line radiological Investigation for underlying osteomyelitis Magnetic resonance imaging is the best imaging modality to diagnose osteomyelitis Boy with hereditary spherocytosis. What are the chances of his siblings to get the disease?

a) 25% of sibling will have the disease

b) 50% of the siblings will have the disease

Woman of some age with sudden buttock pain, radiation to foot. What clinical symptoms do u expect?

a) Weakness extension of knee
b) Loss of sensation of lateral thigh
c) Loss of sensation medial aspect of thigh
d) loss of ankle reflex
e) loss of knee reflex

Old lady came with persistent pain at back of left eye and headache. Apart from proposes, ESR -65, no loss of vision was seen. Ds?

a) retro bulbar tumor
b) temporal arteritis

Snakebite, adult male from rural area. Big black? Brown? Snake, even though they search couldn’t find. No bite marks, but lateral thigh laceration, pt. stable. Management?

a) antivenin
b) swab from wound
c) send home

d) reassure

Female 1st trimester. Trying to stop smoking. How will you help?

a) Nicotine patch

b) Bupropion

Elderly-old man is agitated & confused after surgery for a right hip fracture. History of mild cognitive impairment, hypertension, gout & benign prostatic hyperplasia. Faint mid-systolic murmur heard over the left sternal border. Lower abdomen is tender & palpation exacerbates the agitation. Next step?

a) Abdominal x-rays

b) Bladder ultrasound

Boy is brought due to right knee swelling after a fall. Last wk. he fell & developed a large bruise to his left hip. Pain with knee movement & limited range of motion. Scattered ecchymosis to the anterior shins. Radiograph of the right knee shows a large an effusion. Next step?

a) Bone marrow evaluation
b) Coagulation studies

Woman came for elision on her vulva (I am not sure she is pregnant or not), then you took viral swab tests and syphilis serology. Then the patient loss follow up for 1 month. Then she came back again and there are no more vulvar elision, her spills Abs you previously done show RPR -1:64, what is your next action IM Benzythinepenicillin now

a) Inform health authority
b) Trace her pervious partner
c) Reassure

6 year old child, concerned by the teacher that she is not cooperating well in class and not talking with other friends, eat lunch in recess alone. But her school records in school grades are Okay. She has some anxiety when she have to go for school. She is normal at home and talk with relatives normally too. Asked for Ds?

a) Separation Anxiety Disorder

b) Selective Mutes

Woman has done chorionic villus sampling at 12 weeks for which the USG show nuchal translucency, the results show 46XY. What is your next action?

a) Termination of Preg

b) Amniocentesis at 16 weeks

c) USG again at tertiary hospital with special (maternal care or sty?) unit

d) Continue Normal Antenatal Care

14 foot ulcer in a diabetic patient, picture given, what’s the next step in management after antibiotics started swab and send for culture Boy with hereditary spherocytosis. What are the chances of his siblings to get the disease?

a) 25% of sibling will have the disease
b) 50% of the siblings will have the disease
c) x-ray
d) other

19yo gravid 2 para 1, at 38 wks. Gestation comes due to severe abdominal pain & vaginal bleeding. Prior pregnancy is cesarean delivery at 24 wks. gestation for placental abruption. Uses cocaine multiple times a wk. FHT shows multiple prolonged decelerations to 100/min. Risk factors?

a) Maternal age
b) Prior uterine surgery

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