ALLAH AKBER

AUGUST (DR.NAORIN)

DM patient with injury to left index finger prior 2 days. Which indicate deep tendon involvement?

Clear vesicle on finger tip

Pain on extensor tendon sheath

Flexion posture of finger

Pain on passive flexion of left index finger

Fusiform formation of finger

You are a doctor in a remote area where a study is conducted to determine the prevalence
of Hep B the study included 200 patients and showed the following results 2008/ 2009
Patients with Hep B Ag +ve only- 10 / 12
Patients with +ve Hep B core antibody and HepB Ag- 50/ 70
Patients with Hep B core antibody +ve only- 20/ 60
Calculate the incidence in 2010 in 1000 patients from this population
75
50
300
375

Best for Health risk in obesity

Weight circ
BMI
wais hip

Which of these increase the risk of endometrial ca

A. Smoking
B. Obesity
C. Something (i forgot, maybe continuous) cylical hormone therapy
D.
E. cervical hyperplasia

Like this, but there is no colon option, instead they put lungs

ovarian ca diagnosed , where is primary site?

breast,
colon
stomach
kidneys,

Case of old woman with iron deficiency anemia, no symptoms no complain, cause?

B. Carcinoma of caecum

C. Carcinoma of.....

D. Carcinoma of stomach

E. nutritional deficiency
Acute angle closure glaucoma asking about long term management
a) Iridotomy
b) Open trabeculotomy next temoolol
c) Next iv acetozlmaide

Pt BP 110/50 mmHg, on exam a pulsatile abdominal mass felt in midline, with severe pain
radiating to back. Most appropriate next?
a) Urgent laprotomy
b) USG
c) CT
d) Aortogram
e) NS

17 .y.o. Aboriginal boy with agitation and threaten to kill everyone in ED. History of
marijuana use. Asking next step?------------HB:3.374------IM MIDAZOLAM
A. checking urine for non-prescribe drugs
B. IM diazepam---------Never given IM
C. Ask aboriginal worker
D. (I forgot, i think about giving antipsychotic)
E. hospitalize

Similar to this --> 19.Aboriginal boy smokes marijuana, threatens everyone in ED to kill
them, after calling security, what to do? a.Ask aboriginal worker,
b.discharge him,
c.call police,
d.hospitalize him

35 y.o man treated with cephalexin for sore throat, 6 days later presents with rash
A. Delayed type 4 hypersensitivity [Delayed (nonimmediate) reactions – Delayed
(nonimmediate) reactions usually appear after more than one dose of drug and typically
after days of treatment. For example, delayed cutaneous maculopapular eruptions to
amoxicillin classically start on day 7 to 10 of treatment and may even begin 1 to 3 days
after cessation of treatment. The symptoms typically begin several hours after the last
administered dose, although the timing relative to the last administered dose is variable.
However, symptoms should not begin within one hour of the initial dose of a medication.
There are different mechanisms underlying various forms of delayed reactions, but they
are not IgE-mediated.]
B. SJS
C. TEN
D. Post streptococcal psoriatic gutattae
E. (i forgot)

mother brought his young child who presented with four lesions on his right face. She tried
antiseptic but the ulcers like lesions showed no improvement. What is your most
appropriate treatment? ( ring picture left cheek of Handbook )
A.mupirocin (bactroban)
B.topical hydrocortisone
C.topical acyclovir
D.topical idoxuridine
No option for clotrimazole
pt had recurrent episodes of renal calculi proved to be calcium oxalate, this time coming
with hematuria. what's ur management
A. Thiazide (if recurrent renal stone )
B. Low salt diet
C. Allopurinol
D. Spironolactone
E. Low calcium diet

Pt had recurrent episodes of renal calculi proved to be calcium oxalate what's ur

management
Low salt diet ans
Low calcium diet
Spironolactone
Furosemide
One more option

A patient on Warfarin for AF came with rectal bleeding, INR 9, hypotension and
tachycardia. Initial management:
A. Give Vitamin K
B. Give FFP
C. Cease warfarin
D. Give platelet

CT head (white lesion)

Mild headache for 3 weeks, sever in morning, focal sign (+), fever 37.3’C, melanoma
history (+) last 3 yr
A. ICH
B. SDH
C. Metastasis melanoma
D. Brain abscess
E. Glioma

Farmer came with left swelling in a groin. U did fnac and it shows sqaumous cells. Where is
the leision
A.Left leg
B.Anus
C.Rectum. D.testis. E.penis

Women feels pain in abdomen during gardening. pain settles down but happens again and
again for half hour episodes..on USG examination dialted small bowel loops and air in
biliary tree..what is the most likely diagnoisis?
a. Cholelithiasis [Pneumobilia]
b. Pancreatitis
c. Crohns ileitis

Study on Aspirin effects on preventing MI on 100 people. Of those who took aspirin of the
100 ppl only 1 person had a MI. Of those who didn't takeaspirin 2 ppl had MI. What is the
decrease in relative risk given by aspirin
1%
10
50%
100%
200%

Pacemaker syndrome with difficulty in breathing with faint heart sounds investigation of
choice needed.
A. Chest xray.
B. CTPA.
C. ECG.
D. ECHOCARDIOGRAM.
E. SERUM TROPONIN

35year old man married with 1 kid, presents with arthralgia, fever 38.9, splenomegaly for 2
weeks.FBC normocytic normochromic anemia.What is diagnosis?
A. SLE [NORMOCYTIC AMEMIA]
B. HIV
C. CMV [HEMOLYTIC ANEMIA]
D. Hodgkin lymphoma
E. Acute ....leukemia [AML=NORMOCYTIC ANEMIA]

No EBV option like in old recalls(B.. HIV has atypical lymphocytes , spleenomegaly,
lymphadenopathy, fever during the sero conversion phase of illness JM 261)

Couple come for infertility problem for the last 12 months. On testing examination and
tests of the female are unremarkable. Male has azospermia. And bilateral absence of vas
deferens. Which of the following is most appropriate before the starting the treatment of
infertility?
a. No testing required as they can not have a child
b. Testing of both male and female for cystic fibrosis
c. Refer for IVF

40 year male had fatigue lethargy joint pains decrease libido and small testes ..what to do
nest investigation?
A. Testosterone
B .fsh
C. Lh
D. Pituitary
E .Iron

yes twelve Pregnant young women with DM type 1, comes with vomiting and ketones ++,
Hba1c 16%. What to do?
A. Infusion of dextrose and insulin
B. Insulin 10 unit
C. Cek ketones in urine
D. IV saline 1L in 12 hours ( hours)

Pneumonia child 2 yr , RR 30 /min , HR 120/min , fever 39 degree , no respiratory distress ,

what initial treatment?
A. Oral amoxicillin / clavilunate
B. IV flucoxallin
C. IV benzyl penicillin
D. Oral roxithromycin
E. IV ceftriaxone

pregnant woman at 12 weeks gestation presents with heavy bleeding had an ultrasound
Nuchal translucency at 11 weeks Abdomen rigidity, tenderness. Maternal hypotension and
tachycardia. Asking diagnosis
a. incomplete abortion
b. threatened Abortion
c. Ectopic pregnancy
d. Placenta previa
e. molar pregnancy

Patient’s RPR 6 months back was 1:200, now its 1:2. antibodies were
positive 6 months back and now.
a. Patient is syphilis carrier
b. Patient has syphilis now
c. Patient doesn’t have syphilis now

Old man with history of fall 6 weeks ago, headache since 3 weeks. Now come with seizure.
Nothing mentioned about ca history, no fever. Normal neurological examination. Ct scan
like this (it looks like small sdh with some bleeding/ischemia/ edema intracranial? No
midline shift, I'm sure. I gave up looking at ct and just answered based on the stem)
Diagnosis?
A. Brain abscess
B. Subdural hematoma
C. Ischemic stroke
D. Primary brain lesion
E. MetastasisChronic subdural hematoma

10 minutes weakness of right side of body with some speech trouble. Return to normal with
no carotid bruit and blurring of vision. What it could be?
a. Lacunar infarct (can progress after 24hrs-JM)b. Vertebro basilar
c. ischaemia caotid artery----RAKIB
d. hypoglycemia
e. hyperglycemia

40yr man .he feels deadness and numbness?? of back of thigh and calf. he feels that
walking 100m or go upclimbing..what proper invetigation. bilateral pedal or tibial a is well.
1. spine MRI
2. arteriography
3. ct angiogram
4. further sensory assessment

35 yr old lady presented to you for breast CA screening as one of her paternal aunt is
with Breast and ovarian ca. What will u advice her?
A.2 yarely mammography
B.2 yarely ultrasound
C. conduct Genetic risk assesment
D. order BRCA1 gene mutation
E. 6 monthly self breast examinations

That lady with meningitis. Child had rash and fever. CSF protein 0.45, glucose 3.5, cells-
Monocytes.With typical features of meningitis, Cause?
A. HSV
B. Enterovirus
C. Meningococcus
D. Pneumococcus

Gout scenario with chronic renal failure and ccf, now presents with acute symptoms, what
to give?
a) paracetamol
b) codeine
c) naproxen
d) allopurinol
e) colchicines

Patient with weakness of the left upper limb, weakness of interosseous muscles and right
plantar response is equivocal, left is increased; reflexes are normal. What investigation will
you do to reach diagnosis?
A. MRI cervical spine
B. Ach receptor antibodies
C. EMG
D. CT brain
E. Nerve conduction study

Funduscopy of hypertensive retinopathy and central retinal vein occlusion.

ECG: SVT and VT (both unstable)

patient presented with macroscopic hematuria. 6 months back he diagnosed as c-ANCA

positive vasculitis causing hematuria and started on Prednisolone and Cysclophosphamide.
The RBCs on examination are 20% dysmorphic and 80% normal, what is the most
appropriate next step? [WG]
a. Repeat renal biopsy
b. Stop cyclophosphamide

c. CT abdomen
d. Renal USG
e. Cystoscopy

woman, post femoral surgery develops painless distention. Xray of huge dilated bowels.
Initial tx.
A. Nasogastric aspiration and IV fluid
B. Rectal flatus tube
C. Colonic compression

Heart failure case man with AF on Ramipril, metoprolol, digoxin. Went on trip for 2 weeks
and stopped his medication. Now with bilateral oedema up to knee in legs. And ankle
swellings Lungs is clear. And the patient is not dyspneic,
What is the most appropriate management?
A- Frusemide
B- Recommence all his medications
C- Ramipril
D- Digoxin

3 yr old from Bangladesh, fever cough for 1 month...asking next inv

Xray already done
I went next mantoux
No Igra...others don't remember
Old px underwent surgery of femur fracture, 7 days after had dyspnea and confusion. On
auscultation, there is crepitation in right lower lobe.
A. PE
B. fat embolism
C. pneumonia
D. aspiration syndrome

Pt hears a popping sound in ear before that mild vertigo the nystagmus and then fall down
now have rt horner syndrome and right ear total sensory neural hearing loss(SNHL).
Probable cause?
a. Acoustic neuroma
b. Acute labyrinths
c .Meningioma
d. Meinners disease
e. Basilar infarction

2 years Child with abdominal symptoms and vomiting and high

fever, there is abdominal tenderness also,, giving CXR of left
lung effusion asking about investigation to reach the diagnosis
A.. Blood culture
B.. Urine microscopy and culture
C.. Pneumococcal pcr
D.. Pleural fluid aspirate

3. lady presented with pain and tenderness supraorbital was

diagnosed to have sinusitis, she has fever and then she
developed neck stiffness, LP revealed polymorphonucleocytes
.what is the diagnosis :
A. Frontal sinusitis

B. Meningeococcal meningitis
C. Pneumococcal meningitis

D. Stretococal meningitis - Gram+ve diplococcic (if sinusitis with mastoiditis)

4. Old man came with his wife.she complains that he gets

confused sometimes and has stopped reading news paper.He
still drives, sometimes at night .mmse 26/30 .what are you
gonna do about it?
a- Cease driving at night
b- Repeat mmse after 3months
c- MRi of brain
d- advice to do more mental and physical activities
e. assess him for treatable demential conditions.
5 A farmer not doing well, had recent losses, cant eat or sleep. He
wantsto commit sucide and end it all .He is not accepting that he is
depressed and says that its just because of his financial problems that
he is feeling like this. What does it reflect? (the scenario pointed him
towards being very depressed and he was in denial.)

a) Denial
b)Rationalisation
C)suprresion

*increase report cases of childhood cancer d/t waste production from

a factory in river. Which study?

A- RCT

B- Cohort

C- Case-control
D- Cross-sectional

*You are a doctor in a hospital and want to do research about the

outcome of babies born to diabetic mothers and want to compare the
result with the babies born to non diabetic mothers.Which study will
be the best study?

a) Cross sectional study

b) Cohort study
c) Case control study
d) Randomized control trial
e) Case study
7. Middle aged man presents with pain from sole to great toe of right
foot,which awakes him from his sleep. O/E: inflammation from sole
to great toe, non tender, active and passive movements are painless
and free. No sensory loss, SLR- positive @30 degree. Pedal pulses
normal. No h/o dm/gout/arthritis. Reflexes are normal. What
investigation is most important for diagnosis?
a) Serum urate
b) MRI lumbarspine
c) FBE
d) angiography
e) usg
10 year old boy who has recent onset of enuresis.the doctor calls his
parents for assesment.they have separated for 3 months.in the
interview father tells you that he is intending to hide assets from his
ex wife even before the divorce.what should you do?
A.inform the mother
B.do nothing
C.inform registrar at the family court
D.tell father it is because of him the boy wa affected
e.inform police
9.Mother booked an appointment for daughter for some leg pain or something. but she
couldn’t attend with her. Daughter after the examination asks to be tested for chlamydia
you took a swab and the result was negative.Second day mother called and asked about
the results of her daughter.what to do?

a) tell the mother that test for chlamydia was negative

b) tell her no test was performed
c) tell her to ask her daughter to make an appointment
d) Ask the mother and daughter to come together for appointment
e) ask her daughter to call for the results
10. some girl having 1 year daughter come to you to consulting about
meningococcal vaccine. her neighbor(cousin) lost her 4 month
even though getting the vaccine. so she wants to know about vaccine
option

a. her daughter's age is apt to get viral meningitis

b. the best way to protect meninogcoccus is get the vaccine

c. the neigbor's case is unlucky bcz the vaccine's efficiency is close to

100%

d. the most prevelent orgarnism is type c meningococcus

#a scenario about gout. No thiazide in hx. But according to symptoms, I

diagnosed it as gout.q asked investigation. joint aspiration[uric acid
crystal]

14. CT with a large R side cerebral infarction with secondary

haemorrhage. Asked what to do.[Aspirin,Warfarin,Clopid]

19. CVS risk factors:Hyperlipidemia; Strock:HTN; PVD:SMOKING

20. guidelines about cancer screening.. and post op management. Ca

colon.. ca cervix. (refer to red book)

Hereditary sphero scenario. Cause of abd pain

A. Renal stone. Gall stones. Splenic enlargement

21. Boy left uq inj with pain and tenderness. Usg n. What next. Discharge. Xray abd.
Ct abd. Mri

22. 2 question with ammenorhea. One with nause vomit no bleed and RIF
pain..options acute appendicitis. Ruptured ectopic. Ovarian torsion. Ovarian cyst.
Fibroids.
The other scenario with bleed
The other question asked for investigations abd usg

23. That question with slight pneumothorax has to be transferred by air. What to do
before..Water seal drainage
24. Choelithiasis with duct perforation. Asking treatment. .laporatomy
Old lady. sudden headache. Asking inv.. CT
25. Best inv asked for hemochromatosis-- iron study best –genetic /liver biopsy
26. Vegetarian pregnant. What to give other than folic acid. Options Thiamine. Iron.
Ferritin. Zinc

a lady her boyfriend left her. She feels sad for long time bored at times. Can't
manage her anger sometimes. Now angry as many course of antidepressants
didn't work. Now sleeps and eats well.what in history will help?
A.unemployment for 6 months.
b.alcohol abuse.
C.repeated self harm.
Preg lady antinatal visit with anemia
Hb 9
Mcv low from range ,taking multivitamins already what adv :
Iron infusion
Green leafy vegetable
Hb electrophoresis

27. Diabetic pt with 3 month ulcer ,pulses not palpable ,X-ray done erosion
showing ,what ll do for next for management :
Ulcer swab
MRI
Leg ultrasound for arteries

Pt with cough and breathlessness,on many drugs ,X-ray done shows intertisial lung
disease ,cause :
Amiodarone
Rosiglitazone
Ramipril
A man with dyspnoea and SOB, taking metformin and rosiglitazone for diabetes,
amiodarone for recurrent ventricular tachyarrhythmias, enalapril and metoprolol.
Which drug may have caused these symptoms?
A. Amiodarone
B. Metformin
C. Rosiglitazone
D. Enalapril
E. Metoprolol
28. Man came with hx of exertional dyspnea and palpitation,jvp raised X-ray given
with pleural effusion what ll do next :
ECG
BNP>400 HF <100 unlikely
29. Lady with bmi 31 came for antenatal visit,returned from social volunteer
work,last menturation 20wks before ,on exam all are normal except abdomen palpable
at just above the pubic sym,what could be the cause :
Wrong date
Iugr
Oligomenorrhae

30.
31. A woman comes at 30 weeks gastation , her fundal height at 33 cm . her ogtt at 24
weeks was normal. her dates confirmed at 10 weeks. Her last usg at 19 weeks normal.
Rest of tests were normal. What is the reason of fundal height?

Polyhydramnios----------------------------------Anubha group
Full bladder(3cm +- in full bladder) -------All
Wrong dates
Fibroid
INTRA-UTERINE GROWTH DISORDERS
Fundus greater than dates
Consider the following causes:
• polyhydramnios
• multiple pregnancy
• macrosomic baby >90th percentile—diabetes or
history of large babies

32. Sudan’s pt 42 yrs with some month soiling and Perianal pain,otherwise normal no
complain (mentioned in ques ),on examination anal fistula,likely cause:
Crohn s
Anorectal abcess

63 years old male presented with VF cardiac arrest.first shock delivered on

artival in ED after 2 min CPR done.still in VF.what is the most appropriate
step?
A.feel for presence or absence of pulse
B.give adrenaline 1ml 1:1000 i/v
C.deliver a second shock 200 j then adrenaline
D.give amiodarone 300mg i/v
You are a general physician in a village, where the prevalence of colon cancer is
60%. A colonoscopy can test for colon cancer, and it has a sensitivity of 75% and
a specificity of 90%. The positive predictive value (PPV) of this test is about __
and the negative predictive value (NPV) is about ___.
a 17%, 80%
b 99%, 65%
c 75%, 67%
d 60%, 80%
e 92%, 70%

15 yr old boy appendicitis with peritonitis need urgent appendectomy he is very ill his 18 yr
old sister is with him on call with her parents who will give the consent
The parent on call----------AMEDEX-----DO SURGERY
The patient
Sister

An old lady came in for medical review, she is on pension for 8yrs becos of chronic and
fatigue she leave school to interest in hemeopathy and neuropathy she used to spend time
with aregular client who has similar interest. She said she is being persecuted by the staff
from govt office and who told her that she must either seek medical review or her pension
will be affect.
What are you asses as a consultant
Activity restriction in daily life assessment
Ask exagerated factor of pain( ans is not here)
Child present with 40c temperature creck lips rash on body and genital also on hand feet
bleed with scratch what most appropriate initial investigation
Blood culture
Urine culture
Abdominal us
Echo
Old woman 75 years of age is admitted to the hospital following a community acquired
pneumonia. She received antibiotics and is well on the 5th day. She suddenly developed
rigors, chills and high 39C fever and crackles on Right Lower lung. What is the most likely
explanation? 7 -10 days required to develop abcess
a. Hospital acquired pneumonia
b. IV cannula related bacteraemia
c. empyema
d. Pulmonary embolis
Primigravida gave birth at term to 3200 g baby, normal vaginal delivery without any
complications and there was slight meconium staining of liquor. Baby was normal at birth
with normal heart rate. After 1 minute, suddenly stopped breathing.HR 40.Cyanosed. No
response on stimulation. What is the most appropriate next step?
a. Intubate
b. Nasopharyngeal aspiration of meconium
c. Bag and mask ventilation

Men taking daily diazepam after 2 days of withdrawal there is a symptoms of severe tremor
agitation and sweating
Cause
Drug seeking behaviour
Drug abuse
Intoxication
Benzodiazepines withdrawal

Young girl presented to you with heavy menstruation since 2 years. She also complains of
pain during her periods. She is pale on examination.
You told her that multiple investigations are required but she
refused and asked for something to help with the bleeding.
A. Ocp
B. Tranexamic acid
C. Mafenamic acid
D. Mirena

Testicular Swelling there is no hx of trauma on examination redness swelled my and tender

what next
Ct scan
Urine culture
Chlamydia pcr if <35 years
Us if scrotum

Age is factor !!
<35 - Chlamydia - Urine PCR (* STD)
>35- E Coli - Blood culture(UTI)
Urine Testing for Bacterial STDs. The gold standard for diagnosing bacterial STDs, such as
chlamydia and gonorrhea, used to be bacterial culture. That involved attempting to grow
bacteria out of samples that were taken directly from the cervix or urethra. These days,
bacterial DNA testing is considered a better option.

Cause of anorectal fistula with disturbance of vowel habit -----Mel:354

Chrons
Perianal fistula
Diverticular ds

Patient with weakness of the left upper limb, weakness of interosseous muscles and right
plantar response is equivocal, left is increased; reflexes are normal. What initial
investigation?
A. MRI cervical spine
B. Ach receptor antibodies
C. EMG
D. CT brain
E. Nerve conduction study

Men with nocturia amd difficulty passing urine psa 3.8 now on Dre no palpating of
enlargement of prostrate but on biopsy one foci show the edenocarcinoma sore is 4 what to
do
Ebrt
Continue survilence
Radical prostatectomy

1-a man concerned with his counting rituals, is on d verge of expulsion frm his job due
to his lateness and impaired work performance, asking for d most appropriate
immediate management along with relaxation technique

A- exposure and response prevention

B- citalopram---------Commonly used
C- olanzapine
D- diazepam
First-line pharmacologic treatments consist of 5-HT reuptake inhibitors, such as the SSRIs (fluoxetine, fluvoxamine, sertraline, paroxetine, citalopram,
escitalopram),

2-old lady living alone ,her son has been taking care of her health issues, wen u
examine her mmse is 12, wen asked she denies any forgetfulness and tells that she
does not want to talk anything abt it, wat is ur next step
A-ask d son to wait outside and interview her alone
B- arrange nursing home care for her
C-ask son to deal with her financial affairs

16 yr old girl staying with parents came for routine checkup , states dat she s abt to start
sex life soon ,apart frm advice regarding safe sex and contraception wat to advises

A- chlamydia 6 monthly (12 monthly)

B- Pap smear frm age of 25

One stat question, asking to calculate the false negative rate of chalmydia( sorry I
don’t remember d values) my abs was 2/172 ( Other options were 2/27 2/28)

13 yr old boy, stealing , swearing, destructing furniture, violent towards teachers and
classmates, diagnosis
A- ODD
B-conduct disorder
C- borderline
45 yr old male, migrated frm Somalia 6 months back, presented with soiling and fistula, wat
s d cause??
A-actinomycosis
B-whipworm
C-anirectal abscess
D-Crohn s
E-ca rectum

U r on duty of conducting interviews of doctor for a certain post in hospital, u come to kno
dat one of ur colleagues is assessing d medical reports of applicants, wat s ur immediate
action
A-Tel doctor it s not correct
B- inform ur superior
C- inform ApRAH

Lady who was an athelet now presenting with muscle weakness, recurrent falls and inability
to walk without support,recent history of divorce frm an abusive husband, she is supporting
her mother by working so hard, diagnosis
A- adjustment disorder
V- MDD
C- conversion disorder
D-somatisation

A lady, she is on medication for htn and hypercholestrolemia, she is staying dat she has bn
taking d drugs regularly and hasn’t visited d doctor for 8 months, but wen u check u realise
dat she was supposed to finish d medications 2 months bac, her mmse is 24 with
impairment in recall. Wat is ur next step??

A- Tel her dat she need to b assisted by a practice nurse

( I don’t remember rest now)

6 year old child presenting with abdominal pain , vomiting , no diarrhoea and dehydrated,
glucose high, wat is d initial investigation
A-ABG(if hyperosmolar coma )
B- HBA1c
C- urine ketone-------------CONFIRM FROM WIKI

In what situation not mandatory requirement to report to authority?

A.woman presenting with neck abrasion who admits of being assaulted by partner
B.sewage worker with leptospirosis
C.healthy driver dx epilepsy who needs job to support his family.

That lady presented with meningitis.her Child had rash and fever few days back
resolved.ladys CSF protein 0.45, glucose 3.5, cells- Monocytes. Cause?
A. HSV -------If RBC present
B. Enterovirus
C. Meningococcus

52 years old male present for screening of ca colon because of his father diagnosed with
cancer colon at the age of 58 years??
A. Colonscopy
B. FOBT
C. ?

Case of restless leg syndrom examination normal and normal blood examinations ask
treatment ??
A .ferrous gluconate
B. “Benzobexol ??
C. Pramibexol

Case of old patient with hypertension and diabetes and gout with milld renal impairment
present with knee pain that awake her in the night with erythema and tenderness and
unable to move ??
A allopurinol
B colchecin
C paracetamol
No antibiotic and no aspiration

Boy suffer from diarrhea work in resturant were sallmonella outbreak in the community other
family grandmother mother and sister and the other is normal ??
A. Prevent him from go to school till the end of diarrhea
B. Wear gloves when handling food
C. Cease work until the diarhhea resolve
D antibiotic prophylaxis for the family
E I can’t remember

young had history of fever 40 degree and muscle ache with history of travel to combodia
Examination shows thrombocytopenia and elevated lever enzymes about 200 and more
each of them with elevated urea and yellow eye sclera and no rash and no neck stiffness
What the diagnosis??
Malaria
Hepatitis A
Staphyloccos scalded skin syndrom
Dengue fever [Dengue you have petechiae ]

Female admitted, overdosed on indapamid , was admitted and not able to sleep
despite benzodiazepam . Now nurse found her staring at the ceiling and other
times agitated. Cause?
A. Dementia
B. Delirium
C. Depression
D. Catatonia

what is the least affect from lead poisoning

neurological abnormalities

A.Abdominal pain

B.Liver abnormalities
C.Behavioral problems

Child has diarrhea +_____for 4 days, mother doesn't mind until the child develops
a limp and stops walking, then she brings the child to you. Pain and tenderness
in left hip. No fever. Diagnosis?
A. transient tenosynovitis
B. Septic arthriti

. Slipped femoral capital epiphysis

4.image like this.55yr male,smoker,h/o surgery for ca

oesophagus;swelling in the lateral neck for 3 weeks,non tender,smooth,sof,free ffrom overlying
skin.oropharyngeal examination normal.whts Dx?

a.branchial cyst-

b.pleomorphic adenoma of parotid-

c.submandibular duct stone

d.metastasis

hyperkalemia in ECG shows

A.flat t wave
B.U wave
C.Wide QRS
7.32 weeks pregnant lady's child got varicella. Was tested earlier to have no
immunity against varicella. What to do now? (No option for check ig)
A.Do u/s
b.Give zoster Ig
c.Give Acyclovir
d.Give Varicella Zoster vaccine

8.in a community survey is being conducted for 200 people.Following data 2009
2010 Bp >145/85 45 50 Fbs values I forgot High cholesterol Calculate incidence
of bp in 2010
A.5
b.25
c.50
d.225
c.250
old man in a nursing home...nurse complains he s masturbating frequently...he is
widow.rest he is fine wat next n controlled on his htn medications(bt no drug
mentioned in qs).what's most appropriate next
a.No change in medications
b.give antipshycotic
c.give anxiolytic

Baby with hematuria, urea creatinine normal,had similar episode before which
resolved within 48 hrs. Now prot 1+ rbc 4+ dx?
Iga neph-------We solved it in our renal file.
Acute psgn
Hus
Nephrotic syndrom
Hemorrhagic cystitis

11.14 years old boy begin soiling his pants his mother was concerned before 4
month he suffered from abdominal pain and diarrhea but she doesn't know if
associated with weight loss??
A constipation with soiling
B sexual abuse

Regarding hierarchy study,which is the least effective study?

A. case report
B. case control
C. cohort
D. RCT

13.Pt with cough and breathlessness,on many drugs ,X-ray done shows intertisial
lung disease ,cause :
Amiodarone
Rosiglitazone
Ramipril

19. A 72 yrs old woman presents with confusion and O/E she was found to be
afebrile and nothing abnormal was detected. She has an ulcer on the lower part
of her leg, which has been treated by the community nurse for several months.
What will assist in the diagnosis?
a. Urine test
b. Swab of the wound
c. Blood culture
d. CT scan
e. Lumbar puncture

22.Read regarding gilbert syndrome[Gilbert syndrome - May manifest only as jaundice on clinical examination; at least 30% of
patients with Gilbert syndrome are asymptomatic, although nonspecific symptoms, such as abdominal cramps, fatigue, and malaise, are common]
27.one ECG was there seems to be st depression with bundle branch block
asking for the initial management?

30.mitral stenosis murmer? DIASTOLIC,DECRECENDO PRESYSTOLIC CRECENDO

1.25Yr female BMI31F,smoker,grandmother diagnosed with breast cancer at the age of 64.her only
medication is OCP.She mdoesn’t have any lump in herbreast.
What isthe bestadviceregarding on preventionofreastcancer(pre menopausal-stop smoking, post
menopausal-obesity)

1.stop smoking
2.loseweight
3.selfbreastexamination.
4.lowdoseOCP

2.SIDS.Two consequent deaths ofchildren in a familyat5 months and4 months.most important

thing to beasked.
1.Extended familyhistory of SIDS(Previous h/o SIDS in family)
2.Immunisation history of kids
3.Parental age
4.Ethnicity

3.Aboriginal child with acute otitis media

1.amoxicillin
2.amoxicillin/clavulante
3.ciprofloaxacin

4.Herpes in a pregnant woman.urinary spasm and perineal oedema and redness.

1.IV aciclovir
2.Oralacilclovir [tingling, pain or itching at the infection site are common symptoms]
3.IV famciclovir
4.Oralfamciclovir

5.Choiceof HRTfora52year oldfemalewith hotflushes.Menopause8 monthsago.

1.Continousoestrogenandprogesterone
2.Continousestrogen and progesteronefrom 12 th day of cycle
3.Continousoestrogenonly
4.Contnous progesteroneonly

11.A patient with tubulovillous adenoma with high grade dysplasia.management.

Note:If surveillance present then ans or CT COLONOSCOPY

1.Colonoscopyin1year(immediate would be ans)detection of polyps and is the first-line procedure of

choice. The sensitivity for detecting polyps by colonoscopy compared to double-contrast.
Three-year follow up is recommended for patients considered to be at high risk (at least three
adenomas, adenoma ≥ 1 cm, villous or high-grade features). Our study focused on patients diagnosed
with high-grade dysplasia with
 2.CT abdomen/chest
https://www.ncbi.nlm.nih.gov/m/pubmed/20718835/

12.HPVdetected,not16,18.report mentioned as lowgradedysplasia.

What’s next?
1.cotestin——- (duration)
2.colposcopyin1 month
3.papsmear in1year

which of the following is asso with polycystic kidney disease?

DM type 2

incarcenated hernia???

nocturia and polyuria

Dont remember other 2 options

[Missing Options are ~~
➡High Blood P
➡ Eclampsia
➡ Uremia
➡ Berry Aneurysm
➡ Mitral Valve Prolapse
➡ Diverticulosis
➡Renal Stone
➡Renal Failure !!]

45 female, laproscopic cholecystectomy before 6 months.now elevated ALT, aspartet aminotrans.,.

cholesterol.. Abdo pain and dyspepsia. Most appropriate Investigation?

contrast CT abdo and chest

ercp with manometry

mrcp

oral cholecystogram
Late Post cholecystectomy syndrom Present after month and year US ERCP CT

Question about adult girl came with respiratory distress now o2 saturation is 85 % whats best way to
deliver o2? (old recall, just saw on amedex)

A) CPAP 30 % oxygen

B) Venturi mask 28 % o2

C) Endotrachial intubation 100 % o2

D) Helio mask with 40 % o2 (not sure about spelling)

E) Nasal cannula 2L

Adult girl with bilateral pneumonia , O2 saturation 85% , alert .. how to give oxygen ?
A)nasal 100 % O2 2L
B)Venture
C)Cpap
D)intubation
E) ppv

A woman comes to you with symptoms of depression, she is obese and hirsute. What will help in
diagnosis?

FSH

high tsh

LH

Cortisol

42 female with recurrent candidiasis from 12 months. Rx JM:1158

topical miconazole

nystatin

oral ketoconazole

oral fluconazole

Increase incidence of cervical carcinoma inspite of increased inclusion of population from 68 to 85%.
Reason?

Lack of specificity

Inadequate Rx of low grade Carcinoma

Inadequate number of people included

Cervical cancer is rapidly fatal

A 28 yrs old lady presented with flight of ideas, pressure of speech and delusions and four months
pregnant.How to treat her?(old recall)

a.Lithium Carbonate [1ST trimester a CI and brest feeding a dea jabe na]

b.Na Valproate

c.Clozapine

d.Some Benzodiazepines

e.Carbamazepine

Alcoholic patient present with ascites, gynecomastia, spider nevi, parotid gland enlargement and
flapping tremors and confusion (not mention about abdominal pain).38.9 fever. What
investigation to do?
a. Ammonia level
b. Full blood examination
c. Liver function test
d. Abdominal scan
e. Abdominal paracentesis
Alcoholic patient present with ascites, gynecomastia, spider nevi, parotid gland enlargement and flapping
tremors and confusion (not mention about abdominal pain). Vitals given. What investigation to do?
a. Ammonia level
b. Full blood examination
c. Liver function test
d. Abdominal scan
e. Abdominal paracentesis

3. Alcoholic patient present with ascites, gynecomastia, spider nevi, parotid gland enlargement and
flapping tremors and confusion with fever and abdominal pain). Vitals given. What investigation to do?
a. Ammonia level
b. Full blood examination
c. Liver function test
d. Abdominal scan
e. Abdominal paracentesis

A man is brought for assessment following car accident. His car is rear-ended at traffic light spot.
Although air bag is not activated, he complaint of chest pain, breathing difficulty and dizziness.
On examination, he is agitated, flushed and palpitation. PR 110/min.BP 135/80 mmHg.Breath
sound normal and other physical examinations are normal. What next? Dx alcohol intoxication
Blood alcohol
Blood glucose
CXR [But also complaints of chest pain, breathing difficulty, cant we do xray to exclude chest trauma ?
May be accident occur due alcohol here..]

Echo
15year old girl having difficulty in concentrating. She constantly fights with father, recently
stopped ballet class – ask why “ what’s the point of all this ? “ , what is the most important in
management?
A)Liase with father
B)Discuss the safety plan with her and her parents
C)Give SSRI
D)CBT
E)Tell school to support her more
Woman with 2-month h/o affected mood, in customer service role, missing work, can’t be
bothered to go to work, gets teary eyed often, recently hit her car to the pole, not paying
attention, worries in the night about losing her job, does not listen to her favorite music in the
car, married to a caring person recently
a) Adjustment disorder

b) Dysthymia

c) Major depressive episode

d) Generalized anxiety disorder

e) Borderline Personality disorder

young mother with 10wks old attending clinic many times within 2 weeks complaining baby
cries a lot and difficult to settle. Baby is growing well and all normal. What will u find in her
history for diagnosis?
Premorbid personality
Whether she consider harming the baby
Past obstetric history
Thought about care of baby
Confidence of caring baby
Scandinavian female 35years BMI 30 (consumption of snus+  can develop DM type2) for first
antenatal check-up . What will you do?
OGTT as soon as possible
OGTT @ 24-28 weeks
RBS @28weeks
Egyptian woman who doesn’t understand English have to do endoscopy procedure. Her
daughter can speak English fluently and husband understand the procedure well. Who
should interpret?

a) Her daughter
b) Her husband
c) official interpreter
d) non medical staff from hospital
e) 2 outside general practitioners

Patient presents with neck swelling for 2 months (exactly). The patient is now complaining of
hoarseness of voice for last 3 weeks (exactly) Difficulty in breathing when he lies down. There
is dullness to percussion at the base of sternum. Most likely diagnosis?
a)Multinodular goiter with retrosternal extension
b) Papillary carcinoma
c) Anaplastic carcinoma
d) hemorrhage of multinodular goiter
e) follicular cyst

GP working at a remote aboriginal community where STD increasing.what will u do do reduce incidence
of STD?

a.tv campaign

b.lecture in community health centre regarding effect of STI

c.arrange community wide progamme directed well behavior and knowledge(by excluding other options)

d.educate school age child

e.arrange peer education for aboriginal male

A patient was sent on a stess leave after employer finds him using cocaine. The patient admits
using cocaine and also has memory impairment, agitation and is also irritable, what is the next
step
a. urine drug screen---------------------------AMEDEX
b. collateralhistory from em

Lawyer who is a perfectionist, recently fall in performance after miscarriage, affect sleeping,
crying, can’t concentrate her work and problem with husband. don’t want to take medicine coz
it might be habit forming. what is suitable management at this stage?
a) CBT -------AMEDEX and NAORIN
b) SSRI
c) Interpersonal therapy
d) Diazepamployer
c. history of sexual abuse
d. past history of drug use

a lady in 22 week of pregnancy, came with fever, and abdominal pain in right quadrant and
nausea, she has a history of appendectomy, what is the likely diagnosis?
a. Ectopic pregnancy
b. Abortion
c. Red degeneration
d. Corpus luteal cyst
e. Ovarian torsion

Young male complaining of pain in groin after lifting a heavy object. By exam no Lump but US
revealed 1cm defect in inguinal ring with fat herniation. But No visible lump. What to do next?
a- open laparotomy mesh
b- laparoscopic repair
c- check again if lump appears
Hereditary sphero scenario. Cause of abd pain
Renal stone.
Gall stones.
Splenic enlargement

Carotonemia q(YELLOW COLOUR SKIN,B-CAR0TIN IN BLOOD)

I.m and mild hepatitis q

Pt started on propanol and hyperthroid . What to do next. Carbimazole.Throid iodine.Surgery.
(IF propilethiorracil present than 1st priority)
Hypothyroidism treatment asking thyroxine 50 or 100.
Pt hyperthr and on treatment but after few months levels chrcked and tsh very high and t3t4
still very low. Asking treatment now.Options.Throxine.50. Or 100 and dont remember rest
Dm foot ulcer cause asked?.Macroangiopathy.Neuropathy.

Young man with fever and generailsed weakness 2 days. What to do. Antibitocs.Reassure.
Admit. Cxr

One with menorhagia and regular cycles but increaed in 3 months and presents at 3rd week
with lower abd tenderness. Not pregnant. Again one q askedcause(FIBROID) and the other
investigation(USG)
That question with slight pneumothorax has to be transferred by air. What to do before..chest
drain (emergency-neddle aspiration)

Best inv asked for hemochromatosis liver biopsy initial Iron study

Vegetarian pregnant. What to give other than folic acid. Options Thiamine.Iron.Ferritin.Zinc

3- A 32 or 37 week pregnant patient present with right iliac fossa pain.she vomited twice.there
was no abdominal tenderness or rigidity,.what is the cause of her pain
1.acute appendicitis?
2.intraabodominal adhesion
3. red degeneration of unrecognized fibroid[In red degeneration there should be lower abdominal pain
plus fever. No vomiting and no Rt Lower quadrant pain]
4- Placental abruption

4- pregnant woman 10 weeks starts to have pain in the right iliac fossa specially when she
stands up or cough she had appendectomy when she was 12 year old , No rebound tenderness
and guarding. wts most likely the diagnosis
a. Round ligament pain …….get better with walking
b. Complex ovarian cyst
c. Unrupture Ectopic pregnancy
d. Intestinal obstruction

Q182432- Pregnant patient present with RLQ pain in 22week. She vomited twice, NO abdominal
tenderness or rigidity. She has past history of appendectomy, when she was 19 years old. What
is the cause of pain?
A.Intraabdomiَnal adhesion
B.red generation of unrecognized fibroid
C.round ligament strain
D.Cholecystitis
E.Adnexal Torsion

rosetta an 18 years opd lady is on ocp.presented with first time seizure.she had muscle
twitching for last 4 years.now started on sodium valproate.advice about driving?
A.cant drive 3 months.
B.cant drive 6 months
C.cant drive 1 year
D.cant drive 2 yrs
E.cant apply for license.

2-which modality of treatment is most useful for nasopharyngeal CA?

A.chemotherapy
B.radiotherapy
C.surgery
D.harmonal therapy
E.immunotherapy
3-NNT is the number of people that must be treated?
A.according to sample size
B.to make study valid
C.from sample population
D.to get 1 positive outcome-------------CONFIRM
E.to get 1 adverse outcome

13 yr old boy, stealing , swearing, destructing furniture, violent towards teachers and
classmates, diagnosis
A- ODD
B-conduct disorder
C- borderline
Pharmaceutical company approaches u with results of comparison between 2 drugs for hyper
cholesterolrmia, what is d important question u will ask?
A- wether same dose of dugs wer used--------MOU FILE
B- wether 2 grp s contained d same no of people
C- how did u equalise d dietary factors------------------MAXIMUM--------FINAL
You are a doctor in a remote area where a study is conducted to determine the prevalence of
Hep B the study included 200 patients and showed the following results 2008/ 2009
Patients with Hep B Ag +ve only- 10 / 12
Patients with +ve Hep B core antibody and HepB Ag- 50/ 7
Patients with Hep B core antibody +ve only- 20/ 60
Calculate the incidence in
2010 in 1000 patients from this population
75
50
300
375
19.Aboriginal boy smokes marijuana, threatens everyone in ED to kill them, after calling
security, what to do? a.Ask aboriginal worker,
b.discharge him,
c.call police,
d.hospitalize him

Q182262-mother brings her 12 yr old girl because she has stop going school on asking girl says
she doesn't want to go high school, she was very outstanding in the class girl told that her
mother was diagnosed with ca 6 months ago on further conversation she is cheerful and happy
what could possibly be the cause,
A bullying in school,
B her mothers illness,
C depression

Diabetic pt with 3 month ulcer ,pulses not palpable ,X-ray done erosion showing ,what ll do for
next for management :
Ulcer swab
MRI
Leg ultrasound for arterieslish a diagnosis?
a. Her mood
b. Her relationship with her

26ys male. Forklift driver working in a confined space, having headache, lightheadedness,
nausea and abdominal cramps. What to do next?
A. Check O2 saturation before giving O2.
B. Hyperbaric chamber O2 therapy.
C. Nasal prong O2 3L.
D. High flow O2 mask
c. Her sleep
d. Her premorbid personality
Man whose hand deeply injured by screw driver,5 weeks ago, he found supercial laceration and
give diphtheria tetanus toxoid , now , the hand is swollen and painful. What to do beside
antibiotics?
a) Elevation
b) Aspiration
c) Tetanus toxoid
d) Tetanus immunoglobulin only
e) Dpt

Women on paroxetine well controlled on it since 2 yrs now wants to conceive but concerned
about post partum depression due to previous pregnancy what advice you will give
A. Cease paroxtine
B. Cease paroxtine replace it with escitalopram
C. Use both paroxtine and escitlopram
D. Use escitlopram
E. No medication (may be not sure) No option of pros and cons of
Medicine(2 yrs stable, so should we stop)

1 Old age pt presented with c/o epigastric burning and regurgitation his investigations shows followin
result what will you do for most appropriate management?

1.oesophageal dilation

2 laproscopic cardiomyotomy

3 nifedipine

2 A known type 2 diabetic man with history of AF , now presents with painful and swollen leg for 12
hours, on examination he has a temperature of 38.2 and calf redness, what's your initial investigation?

A. Blood culture jm755

B. Fasting blood sugar

C. Doppler ultrasound of the affected leg.Jm1437

D. Chest xray .

E. D-dimer

3 A lady present to you and she tells that God tell her `Fast 40 days and time so that World

War end .She is orientated and decline her to test other function. What is your first line of

management?

A) Zuclopenthixol

B) Diazepam
C) Quietiapine

D) Risperidone Consta [DX:PHYCOSIS]

E) Clozapine

4.Pregnant woman come with HSV infection. What investigation will you do to differentiate this is
primary or secondary infection?

(A) HSV Ig M now

B) Do HSV culture from HSV lesion

(C) Do HSV PCR from HSV lesion

D) Review her HSV immune status from the blood taken at 12 week of gestation

(E) Do HSV type specific from the blood taken now

An immunoglobulin G (IgG) antibody avidity assay which uses protein-denaturing agents and a
modification of an enzyme-linked immunosorbent assay have been investigated for their usefulness in
distinguishing primary genital herpes simplex virus (HSV) infections from nonprimary infections

A 46 years female presented with lower abdominal pain for 2 days. Her last menstrual cycle was normal
n three weeks ago. On examination there is mild tenderness n fullness in right adenexa. Usg shows cystic
mass of 10 cm in right ovary whats the diagnosis?

A. Krukunberg tumor

B. Luteal cyst ---------Saima yunus

C. Serous cystadenoma

D. Cystoadenosarcoma

E. Mucinous cyst------.35 to 55y,unilateral,rarely malignant,obes,post manupose,hrt,ascitis,>10cm

A young man MVA fractured his ribs and has minimal left pneumothorax,peritoneal lavage is positive for
blood and laparotomy is planned for interperoneal hemorrhage, whats the most important thing to do

A-Assesing of nasogastrics

B-Incerting of intercostal drainage tube

C-determine PaO2

D-insessing of central venous pressure line

homosexual man with two partners. He uses condoms, Not iv drug abuser, HIV and othet STDs negative.
Everything was ok 12 months ago too. When u chek again?
In 12 month

In 3 months

Never again

A man living with his father alone at home . has a complain of seeing ghost of his father in his bedroom
every night, when he move his hand or do something then ghost disappears and does nothing with him.
his father died 6 months ago. What is the imp reason to reach diagnosis?

a. delusion

b. He takes 760ml alcohol daily night

c. He had strong relation with his father

A 10 year old male child is brought by his mother with complaints of ongoing exercise induced asthma
despite being on a maximum dose of inhaled corticosteroids. Which of the following is most appropriate
next step in management?

A. Refer to chest physician

B. Add leukotriene antagonists

C. Cease Inhaled corticosteroids and start Iv steriods

D. Add long acting B2 agonists

E. Add short acting B2 agonists.

A mother recently changes her job to a night shift and child doesn’t go to school for weeks complaining
of an abdominal pain and no organic cause of abdominal pain is found. He looks very happy on
weekends.

Reassure and say self-limited

Tell mom to stop working

Liaise with school to arrange a returned plan

RA case for 10 years,with c/o sudden pain for last 2 days in the following two fingers that turned black.
Which investigation will lead to diagnosis?

a. Anticardiolipin Antibody(if DVT)

b. ANA

c. ANCA

d. Anti-dsDNA

e. Anti topoisomerase

You are a rural GP. You are known to both husband and wife and have good social relationships with
them. At a gathering, Wife secretly confesses to you that her marriage is not working. What will be your
action?

a.Arrange appointment for a long interview b.Arrange a couple interview c.Send her to another GP
d.Console and embrace her now.

Guys help out with differential diagnosis between scleroderma and bergeur disease in this question:
[Because if it was berguer's diseases moking has to be positive . Its a differenciating point between the
two]

Buerger’s disease usually starts with pain in the areas affected, followed by weakness. The symptoms include:

pain in your hands and feet, or your legs and arms, which may come and go

open sores on your toes or fingers

inflamed veins

pale toes or fingers when in cold temperatures

Picture of hand given tip of all fingers were amputated History of pain and color change
present.Especially during winter. No history of smoking. Asked Cause..?

A. Rheumatoid arthritis

B. SLE

C. Scleroderma

D. Berguer’s disease

A 78 year old man with depression being treated with sertraline comes to you, his wife is complaining
that his memory has been poor he has become more withdrawn and he has become more irritable and
sometimes very aggressive. You decide to increase his Sertraline dosage and after 1month review him to
see his symptoms have improved dramatically. What was the Dx?

A. Major depression

B. Pseudodementia

C. Vascular dementia

D. Fronto-temporal dementia

A fit 19-year old man notices a neck swelling whilst he is shaving.On examination, there is a smooth,
round and mobile lump not tethered to underlying structures. Fluid aspirated from the swelling contains
cholesterol crystals. The most likely cause of the swelling is:

1Dermoid cyst

2Branhial cyst

3Thyroglossal cyst

4Cystic hygroma

5Ranula

45 year old soldier from Iraq has persistent drycough for 2 weeks. O/E his chest is clear. But

he has a systolic murmur at the apex. A CXR is given I couldn’t see anything on it. Whats the

diagnosis?

a) pulmonary TB

b) lung ca no murmur

c) sarcoidosis

d) pneumonia
Patient from Iraq.Gives history of dry cough.No fever not hemoptysis.You notice pan systolic

murmur at apex.Chest x ray given.Diagnosis?

Tb

Mycoplasma Pneumonia

Rheumatic fever

Ca.Bronchus

8.old man had back pain, sometimes it wakes him up from sleep. No injury history.what is the cause.

A)mechanical back pain

b)lumber disc prolapse

35ys old man brought by wife, presented with confusion, ataxia, right upper abdominal pain, changed
behavior, memory loss, weakness, pt drink alcohol and smoke some per day, T 37.5, vitals normal.

He has his father and paternal aunt has same history when at his age. Asked what investigation to reach
[Dx WILLSON DISEASE] MB:270

a.CT brain

b.CT abdomen

c.MRI brain

d.Check serum ceruloplasmin

You have selected a community people to give PCV7 and people are vaccinated and some are
not vaccinated; the graph given below
A. Patient are resistant to vaccine
B. Vaccine is not working
C. Vaccine serology
D. Vaccination is non specific
 A locum at private gp service finds patient record incomplete and some orders about patient
treatment are not followed what you should do?
a.Maintain records and patient call up system
b.Ask consultants when they return
c.Urge patients to go to some other doctor
d.2 more options

Patient went intramedullary wire fixation for tibia fracture..pain exaggerated on passive
dorsiflexion of his big toe..which management should proceed
-review after weeks
-put more analgesic
-leg elevation-elevation contraindicated in compartment syndrome
-4th option forgot may b invx like xray-
-stabilize with plaster cast

pt has colles fracture treated 2 months ago. Her xray at follow up at 6 weeks was normal. Now c/o
pain and tingling sensetions at the site of fracture what u will do next?

1. repeat xray

2.Mri to see ligaments-to rule out vic colles # may lead to median nerve compression....sometimes hemotoma under the ligaments may cause MN
compression...So MRI is needed to confirm the Dx

3 exercises

4.analgesia-regional pain syndr

5.brace

Young boy, accident with slipped fall during skiing. Very marked swollen elbow, very painful.On
examination, absent peripheral pulses, numbness cold and clammy. At emergency department,
what is your next step of management?
A. Ulnar nerve decompression
B. Reduction
C. Refer to OT
D. Simple analgesic-then x ray,then rx based on the type of #
E. X ray
Middle aged woman with pain in right thigh worse at night n morning. But gets better after 10 mins of
walk.Hx of bilateral knee OA.Next Investigation?

a. X ray right hip

b. Bone scan

c. X ray lumbosacral spine*** [AS]

D. MRI
E. Doppler Usg

70 yrs lady has previous 2times H/o vertebra# or something like this and now again with the same
issue..all her vitD,Ca, Albumin all level ok, she is on raloxifene 25 mg, what to do now

A.continue current treatment

B. increase Raloxifene dose to 50 mg

c.stop raloxifene and start Alendronate

D. continue raloxi and add Alendronate

E. once weekly injection

33 year of woman who had done TAH and BSO, t score femur -2.5 and vertebra -1.5, what to give

1. oestrogen therapy

2. oestrogen and progesterone

3. vit D and Ca

4. alendronate

spine x ray of bamboo spine.history of not responding to paracetamol and paracodeine

Treatment asked?
Naproxen –NSAIDS first,then TNF blockers and IL1 and finally MXT and sulphalasize
Infliximab****
Methotrexate
Prednisone

Old man with back pain.Xray given which shows collapse of L4 or L3 as well as osteopenic
bones. Lumbosacral x ray was done. Which of the following is the next best step?
a. MRI-first exclude mm
b. PSA
c. DEXA*** ( if osteopenia is mentioned in ques and to see any mets from asymptomatic prst
cancer)-----Confirm
d. Bed rest
—(.Osteoblastic : prostate, Osteopenic : osteoporosis, Lytic lesion plus punch out :
MM,lung plus renal ca)

A lady whose mother has osteoporosis and had Fx. Femoral head asking advice for herself. She
works as a receptionist and not having healthy diet.
Check Ca level
Check vit D level-bcos she is comin under risk for low vit d
Bone mineral density
Better to go with C.
BMD is recommended for healthy women aged
over 50 with all the risk factors for osteoporosis of:
• postmenopause
• fracture after age 40 with minimal trauma
• family history of osteoporosis, smoking habit or
low BMI (<18) 2
JM 985 page
15 years Boy previously a good student now present with agitation , violent , admit to
occasional marijuana use, multiple needle marks on forearm but don’t want to talk about it.
a) Respiridone
b) Paroxetin
c) Methylphenidite

Women came with infertility.has irregular period of avg 48days. Sex 3 times weekly. Asking
cause –
1.Anovulation****
2.Endometriosis
3.Wrong time of intercourse

24 weeks pregnant lady with condyloma alumianta treated with cryotherapy, but the warts
appeared again and increasing in size most appropriate next step in mx?
a) termination of pregnancy
b) surgical removal of warts
c) diathermy [surgical removal, diathermy is not the treatment of condylomata
acuiminata]
d) pap smear

24 weeks pregnant lady with condyloma alumianta treated with cryotherapy, but the warts
appeared again and increasing in size most appropriate next step in mx-
termination of pregnancy,
surgical removal of warts -it will induce preterm labour
diathermy, -CI in pg
Pap smear -not helpful
Operative cryao/repeat cryotherapy
wait untill delivery -best answer

52 y/o female has 1y amenorrhea, 2 years ago pap smear was normal but 4 years ago pap
smear was cervical wart, she has had sexual contact after 1 year, during sex, she had not any
discomfort or pain. After that she developed 24 hour vaginal bleeding. Cause?
a. vaginal atrophy
b. cancer cervix
c. cancer endometr
d. relapse of condyloma
e. menstrual cycle

9. Young female schizophrenic patient in psychiatric ward suffers ulcer in right arm, you where
informed by the nurse that the patient will not accept any intervention for this ulcer. What will
be your action ?
A call her parents for consent
B obtain medical board power order to treat the patient
C refer to surgical team
D take a swab
E neglect the ulcer

Woman comes to see a male physician. She need to get pelvic examination but she is reluctant
to get it done from male doctor, what should be your appropriate action?
a) Ask her if presence of female nurse would help
b) Ask her to come when female physician available
c) Send her to some another physician
d) Others irrelevant

A company want to do a study regrding effectiveness of a drug.what will be null hypothesis of

this study?
a.no change in efficacy between two drug
b.signiificant dif in efficacy if p value >.05
c.signiificant diff in efficacy if p vaue <.05
d.no type1error of study people morethan 50 each

A 30 yr old female comes to your clinic at 26 weeks gestation. She is worried as she came into
contact with a child with chicken pox 24 hours back. You checked her IgG antibodies and is
found to be negative. She was not vaccinated also and has no symptoms. What is the best
management?
A Give vaccine for chicken pox.
B Give varicella zoster immunoglobulin.JM1181
C Reassure.
D Check for antibodies after 3 weeks.
E Give varicella vaccine.

A 20 yr old pregnant lady comes to your office at 10weeks of gestation with history of exposure
to rubella 3 days back. She had not been vaccinated for rubella and is not symptamatic. What
will you do next?
A Check IgG and IgM for rubella.
B Give intravenous immunoglobulin.
C Give MMR vaccine.
D Give only rubella vaccine.
E Terminate pregnancy

A 23 y/o diagnosed with schizoaffective disorder since he was 18. Since then he has used all his
disabled pension for tobacco and marijuana. He was on treatment and condition stable. For the
past 6 months he was on….(not antipsychotics, a drug that I don’t know) And lithium carbonate.
He came to you to ask stop all his medication because he has developed akathisia (intermittent
motor restlessness).What to do?
1.Encourage to do more physical exercise to improve akathisia
2.Report to a council (related to psychiatry) to stop his medication
3. Give him benztropine in addition to his current medication(next??) [We cant stop this drug
suddenly]
4.Suggest him to stop marijuana and tobacco because they can trigger akathisia and consider
his long-term health issue.(long term mx)

101.22 years old person left home when she was 13 after sexual abuse. Since then she left
school, take drugs, went to jail few times. He was a good student with excellentresult in school
before sexual abuse. What is your diagnosis?
A. Antisocial
B. Post Tramatic Stress Disorder
C.Conversion disorder
D. Borderline

Parents of a 6 yr old boy complain that their son is overactive, not cooperative with other
children at school & sometimes displayed destructive behaviour. He does not like to follow
rules. But when kept alone, was found to be playing happily with toys and other children. WOF
is correct in his Dx?
a. It is a normal variant
b. ADHD [symptoms must be present before age of 12]
c. Autism
d. Poor parenting
e. Oppositional defiant disorder [evident before age of 8;they argue but not
destructive;gradual onset]

30 yrs old woman was found to be RPR positive. What is the next appropriate management?
a. treat her with benzathine penicillin
b. rule out other STI

60yr old patient presented with constipation. Urea high ,creatinine high, ionized calcium level
high in blood with all other normal values .What will be your next step of investigationa
b)CTabdomen
c)Parathyroid Scan [Renal failure due to hyper parathyroidism]
c. repeat RPR

Kamruddin august flash back

a man who was smoker and drinks alcohol was having complaint weakness on walking. On
further inquiry there was history of intermittent claudication from back thigh to legs
bilateral. Distance was decreased to 200m as compared to previous distance. Right ABI 0.8
left 0.9 On examination after exercise weak dorsiflexion.
What ix u will do
A.mri lumbosacral spine
b. Doppler veinous for DVT
c. arterial Doppler lower limbs
d. angiography

A 10month old male baby brought by mother with complaint of meatal yellow discharge and
she noticed that prepuce is partially retractable over glans. How will you treat?
a.Topical mupirocin
b.oral antibiotics
c. topical steroidslower limb arteries

cancer head of pancreas investigation asked next?

a. CT abdomen
b. ERCP
c. MRCP
d. USG abdomen

A man travelled to south east Asia 3 months ago. Presented with fever with rigors and pain
right upper quadrant. Similar pain he experienced while there but no fever at that time. No
jaundice on examination. Whats most likely cause ?
a. Hydatid cyst
b. Amoebic liver abscess ?
c. Acute cholecystitis

Breast lump painful in a 40 yr old . Asked dx

a. Cyst
b. Fibroadenoma
c. Carcinoma

A 65yr old nulliparous came to you with blood stained discharge from nipple. Her cousin has
breast cancer . What is the commonest possible cause of discharge in her ?
a. Benign duct papilloma
b. Invasive ductal carcinoma
c. Paget disease of nipple
d. Fiboadenoma

One patient of SLE and complaint of arthralgia only. Asked was besides prescribing her
NSAID whatelse u will prescribe?
a. Hydroxychloquine
b. Cytotoxic azathioprine
c. Methotrexate for sever joint pain JM 306
d. Cyclosporin
e. Infliximab

A young man came with sharp farming tool injury yesterday. Commonest cause asked
a. Strep pyogenes
b. Staph aureus??
c. Pseudomonas
d. C.Tetani
e. C. perfringens

A child born with head circumference less than first centile. Eyes showed no cataract but
retinitis. Low birth weight.Hepato- splenomegaly. Small eyes . Likely cause
a. CMV---------NAORIN
b. Rubella
c. Down syndrome
d. toxoplasmosis

A case of a young lady bought for psychiatric assessment,on asking her what is wrong with
her,she saysoh isnt that a long story,the trains always run on rails,the birds keep flying up
the mountains,i must remember to count my chickens before they hatch….she did not get
back to the question…..
derailment?
flight of ideas?
pressured speech?
circumstantiality?

6 yo child presents with asthma attack. Mom has given 6 puffs of salbutamol for him. He
improved, but now is worse again. He talks in words. Next management?
• give steroids orally
• give ipratropium puffer
• give inhaled steroids
• give another 12 puffs of salbutamol
 blue hand on cold exposure with pneumonia before 3 years ,,,, with +ANA and – ENA asking
dx
-limited scleroderma
-primary raynouds
-cryogloblinemia
-SLE

pic of old lady with painful swelling infront of tragus with redness.Cause?
a) duct stenosis
b) duct stone-----Uncommon
c) coxakie virus
d) poor oral hygiene
e) parotid duct Ca

Lab – pancytopenia, Ana 1/60, RF 16 what finding will see in Xray?

A periarticular osteopenia [The most common radiographs in SLE show periarticular osteopenia and soft-tissue swelling without
erosions.]
B periarticular erosion
C punched out lesion

PCM poisoning with 20 tab of 500 mg comes after 4 hrs what next
1. NAC
2.charcoal
3. check PCM levels

what is the ligament that is responsible for uterine prolapse

a.uterosacral ligament
b. broad ligament

56YRS woman was admitted to the hospital for elective hysterectomy. the pre clinic test her
calcium level was 1.8 and now it is still low (nothing mentioned about symptoms)
what is your management
a. iv calcium
b. calcitriol
c. ca carbonate

Pic of CRAO after 3hr with painless loss of vision-----JM:884

A.iv acetazolamide
B. Ocular massage
C. Topical pilocarpine
D. Hyperparic oxygen

2 year old boy comes in with measles presentation has started on treatment what is the next
step to be done?
Inform authorities
Give prophylaxis
No restriction

A woman with history of DM she had a painless ulcer of her 5th toe dorsal side. PE revealed
1 cm ulcer with yellow pus discharge. erthyma, mild swelling were noted over the while
dorsal part of foot. Surgical debridement was done and the affected limb was immobilized.
whats the next appropriate management ?
1. Doppler U/S
2. MRI foot
3. Oral amoxycillin/clavulanate
4.IV ticarcillin/clavulanate
5. Chest xray

A 63-year-old Aboriginal Australian with ulcer on the foot is admitted to the hospital
for one week. He has type 2 DM and hypertension. Foot ulcer is 1 cm deep and is
not healing after debridement and dressing. Wound continued to have yellow
colored discharge. What will you do next?
1.Ask podiatrist to review
2.Oral amoxicillin/clavulanic acid
3.MRI
4.Ticarcillin/clavulanic acid
5.Continue wound dressing

y/o boy had respiratory distress, tracheal tug, wheezing, intercostal recession. Auscultation
reveled bilater rhonci and crepitation. What is the next management
1.Nebulized salbumatol
2.Nebulized adrenaline
3.Oral antibiotics
4.Oxygen and IV fluid
5.Observe

h/o of mva and xray was given wd medistinal widening and loss of aortic knuckle..ask for
diagnosis?
1pneumothorax.

2.hemothorax

3.ca lung

4.pneumonia

4.rupture thoracic aorta

which one of the following leads u to do a surgery in a pt with calculus in pelvi-ureteric

junction
1.severe pain persist for more than 48hr
2.stone near bladder
3.more than 5mm
4.high grade fever

years female , with fracture vertebrae. Hypochromic microcystic anemia .ferritin decrease
with angular stomatitis and thin skin with pigmentation.....clubbibg... normal bowel habit and
normal stool consistency. She also have clubbing..next
a. small bowe biopsy coeliac disease
b. colonoscopy
c. b12 level
D. bone marrow studies

a woman with secondary infertility after 3years birth of her child. Mid cycle sex and regular
cycle.Cause?
A short luteal phase
B sperm antibodies
C sperm abnormality
D tubal damages

A medical condition is present in 12 out of 100 in one population. Relative risk is 25 %. A

new drug is under investigation & desired to decrease the condition by 1/3. How many
patients are needed for the study?
a. 200
b. 100
c. 33
D. 6
12%
12 x 25/100 = 12/4 =3
RR in this population is 3%
Decrease condition by 1/3rd = 3x 1/3 =1
NNT = 100/1= 100

Husband brought his wide, recently mood swing, flirting with neighbours, what to start?
a. Olanzapine----------------HYPOMANIA
b. Diazepam
c. Lithium

renal failure pat.with GFR 30,..with history of travel ..he developed SOB..ask invest
-CTPA
-D-Dimer
-V/Q scan

Family going on vacation by airtravel. Child has had chickenpox for 48 hrs. what to advise?
a) Take acyclovir
b) Delay the trip
c) Get vaccinated

Alzheimers patient diagnosed 4 years ago became increasingly annoying to live with. Wakes
up early, goes through drawers and blames everyone for stealing their things. Diagnosis:
a) Worsening AD
b) Frontal lobe lesion
c) Delirium

Green grey foul smelling discharge from woman. Bacterial cells noted in the culture
a) Bacterial vaginosis
b) Trichanella
c) Gonorrhea
d) Chlamydia

a pt who is astmatic, has dyspepsia , thinking that related to food, but then no dyspepsia
1) candidiasis
2) eosinophilic oesophagitis
3) oesophogal stricure

Barnini august recall

An elderly man with SAH. Initially he needed ICU support. But for last few days he is
aggressive, shouts at the staff, want to get rid of IV canula. What to do?
A. give him separate room
B. give him sedation(MIDAZOLAM,LORAZEPAM,DIAZEPAM-SEVERE AGITATION)

In which of these presentations of bowel disease is infliximab most beneficial?

A. fulminent colitis
B. crohn's with fistulas
C. ulcerative colitis resistant to Rx

For which of the following presentations of inflammatory bowel disease is

infliximab of most beneficial?

a. Fulminant ulcerative colitis

b. Small bowel Crohn’s disease with previous stricturoplasty
c. Crohn’s disease with perianal fistulas
d. Ulcerative colitis refractory to treatment with azathiaprine
e. Pouchitis refractory to antibiotic treatment
For which of the following presentations of inflammatory bowel disease is infliximab of most beneficial?

a. Fulminant ulcerative colitis

b. Small bowel Crohn’s disease with previous stricturoplasty
c. Crohn’s disease with perianal fistulas
d. Ulcerative colitis refractory to treatment with azathiaprine
e. Pouchitis refractory to antibiotic treatment
which of these presentations of bowel disease is infliximab of most beneficial.

fulminnt colitis

crohn's with fistulas

ulcerative colitis resistant to Rx

(NCBI- azathioprine, infliximab offers an important approach for induction and maintenance of remission
for refractory chronic ulcerative colitis as well as for select cases of refractory acute UC. Cyclosporine use
is an alternative medical approach for the refractory acute UC)

Urologist and RMO did surgery of urethral operation. Urologist suggest a drug that is not
prescribed by hospital for this patient. As a RMO what to do next?
A.tell pharmacist to discuss with urologist
B.you as a RMO discuss with urologist

7.38 YRS OLD LADY, already diagnosed BRCA1+.Beside breast and tumor marker screening
what will you do?
a. Usg 6 monthly
b. Ct 6 monthly
c. Bimanual pelvis examination 6 monthly

A man several times attempted to suicide. Police arrested him.he was in police custody. In
emergency agitated, non co-operative, don’t want to talk about it. What to do?
a. Send him to police custody
b. I/M haloperidol------------AMEDEX
c. Observe him until obtain history from him
A patient has taken lots of tablets of venlafaxine. Was on depression treatment. One year
back she was given psychotherapy for anxiety and insomnia. After stabilization of the
patient what next to add.

A. Lorazepam
B. Risperidone
C. Mirtazapine
D. Add Olanzapine.

Patient had amenorrhoea for past 12 months and wants to conceive. H/0 previous irregular
menstruation with 5-6 times per year. Further hormonal details were given
LH and FSH low, some other hormones mentioned all normal.
What will help you with the diagnosis?
a. MRI to diagnose pituitary atrophy
b. Estrogen and Progesterone levels
c. Thyroid investigations

Female pregnant come for antenatal care all ex normal admit that her husband hit her a lot
of times when he drink alcohol and he take care that not making any bruises in her body
what the action
A- inform police
B- arrange couple meeting
C-make escape plan with her
D- talk with her husband alone
E- urgent admition

man travelled to south east Asia 3 months ago. Presented with fever with rigors and pain
right upper quadrant. Similar pain he experienced while there but no fever at that time. No
jaundice on examination. Whats most likely cause ?
a. Hydatid cyst
b. Amoebic liver abscess ?
c. Acute cholecystitis

Patient on fluxetin for depression and nifedipin we for htn.one month ago Fluoxetine was
decrease. Now palpitation and sinus tachycardia. Bp 135/ 75.cause HB-3.355
Drug interactions---------NASMI APU+ROMANA GROUP
Niphidipine
Fluxetin toxicity
Neuroleptic malignant syndrome

2. patient on fluxetine for depression and nifedipine for htn. one month ago fluxetine dose was
increased, now pilpitations, and sinus tachycardia, bp 135/75 cause:
a- drug ieraction
b- nifidepine
c- fluxetine toxicity -------NASMI APU+ROMANA GROUP
d- neuroplastic malig. Syndrome

what is the least affect from lead poisoning

A.neurological abnormalities
B.Abdominal pain
C.Liver abnormalities
D,,behavior problem
Pt has hypercapnia. Ph acidic. Bicarb levels normal. Asking cause

Metabolic acidosis with decompensated resp

Met alkalosis without decompensation

Resp acid with met decompensation Resp alkolosis

Resp acidosis without decompensation

a woman with FBS 7.8 & BMI 29. in addition to maintain weight and regular exercise what
else you will do? a. refer to endocrinologist b. give insulin c. give metformin

An old lady came in for medical review, she is on pension for 8yrs becos of chronic and
fatigue she leave school to interest in hemeopathy and neuropathy she used to spend time
with a regular client who has similar interest. She said she is being persecuted by the staff
from govt office and who told her that she must either seek medical review or her pension
will be affect.What do you asses as a consultant?
A.Activity restriction in daily life assessment
B.Ask exagerated factor of pain

history of meningitis without skin rash in a woman.what is the most appropriate next step
a.blood culture
b. iv penicillin
c. CT
d. LP

orbital floor fracture A ball hits right eye in a 23 years young boy. visual acuity decreased on affected
side. u suspect blow out fracture . what is the most consistent finding with your diagnosis?

a) subconjuctival haemorrhage of eye

b) Hyperaesthesia of cheek of that side

c) Diplopia [VIRTICAL DIPLOPIA]

d) enopthalmous