)'

t'

MAY 2
J

An old lady is brought to the A & E dept. with sore wrists after a \{!$. On examination, there is loss of peripheral vision and cataract. Thepil on Rt side inegular. What is your

2.

s'i,nl

Yt t'h'P t 5 elos-''P5 '-, " tJ

she starts to drive again'

fr eu*Lyt*

lT!98

55 year old is brought in ER with complains of higgrade fever and vomiting since laSl2

days. On examination: Necidity: present;Temp.:39.5; pulse:

nHg.CSF analysis: lncrased lyrphqcfes, Normal glucose, is the diagnosis?

a) Bacterialmeningitis

1 i "-"'l' tl l' +

:130/90 n. What

bi sAH

9
3.

;"t;"'4-''":rj yg*ffilllnl" 'lt'a

':;'" ri-*1

.LLL'

^.,n^d

fL,t's

.- /., -.J-u ..,i

Elderly man complains of sever headache which started before 2 hrs.Pt describes the headache as 10/10 intensity. No history of similar episode in the past. Relatives

to changes in the patient's functional status. Before these last few days, the patient has been healthy and independent. Her past medical history includes hypertension, treated for the last 2 years with hydrochlorothiazide and triamterene. The patient also suffers from bilateral cataracts, scheduleffior removal in the next few months. According to the About ?yeeks ago the daughter, the patient has had ruise, but d-d nfls patient fell in the living room and Consciousness.and has since recovered well. Vital signs and physical examination, with the exception of the neurologic exam, are normal. Neurologic examination reveals no obvious gross lesions, but the patient is oriented only.to self and place, and seems to

sustaine

have trouble with short-term memory. Which of the following studies will most likely reveal the cause of this patient's altered mental

( crhead Y) EEG c) Mini-mentalstatusexam

d)
Serum sodium level

/ o

,7.

An old ladv comes with a history of pain in Rt wrist which has developed after a minor past week. on eiamination you fnd that she has peripheral loss of vision "".o"niilthe arare of. She also has cataract. What is your management? *n"h she is noi a) Tell her that everything is fine and send her home' b) Treat the wrist injury onlY. lmmediate CT scan d) Refer her for cataract surgery

6,

g. A lady presents is brought in A & E dept. after a_MVA Examination

/

of the patient is pupil on Rt side. What is the next step in compietely normal excpt constricted
V-rd/-

. ,'u s /''

10.

A 6 year old boy was brought to the emergency dept. with fever and irritability.

On

spots examination he was lethargicnd ther was a mild degree of neck stiffness and red on llis body. What is the immediate next step in management? fa Start lV antibiotic P"tforrn Lumbar Puncture c) Observation d) Antipyretic drugs

'6i

babY 11. A baby is brought to the emergency dept. by his parents. TheY complained that the causes extension of has episodes of fun turns where he bends the bodY forward and during these funny turns What is the the limbs probable diagnosis? t1 UT ,,, a) lnfantile myoclonus -1L-r-'^ lnfantile spsrn {w- }-tj^{r ,4 P c) Petit malepilePsY

'--

uz[

hc;rut

r'*

.fv,

.{o ca

d)

#J-ii,

g c''r--*

--)

Meningitis

12. diarrhea

before developing symptoms but has otherwise been healthy. Examination shows a normal mental status. He has bilateral lower extremity weakness. Reflexes are a@ent. Which of the following tests would be appropriate in the initial

cal history c that began i up to his u et because

3 weeks

evaluation of this Patient?

.-L"Lt

clu':-L ,o{7t -s -t..'r'{ :t

yv-cti

? Lo

Els

q-^ J
(\
L

c.tnr,,'VuYl
)>-)

t"

v5 /zr"

u*-', laL*u
'
i'at .i.;;br.a
Poif

|.,lrJ,,,.,-e{Ltcr ' *\ "1.1,r. (*LJri $i-*r r Lc,-r,q.t,= -.de^a ?c"f .4 ,, ., $fr.ti^. a)

*,.r1

e)

MRlbrain b) Visual evoked potentials EMG and nerve conduction studies CT brain
EEG

, \-

t l:'cl;"l yL'< ( t x"']6',

e 't
'
':>

\J

'

VtiJ ,',,

13. A boy was brought by to your clinic with complains of funny movements of his face while watching TV. During these episodes it appears that child is not able to hear anything happening around him. What is the most probable diagnosis? a) lnfantile myoclonus

b)

Infantile spasm

@'

d) ADHD

eetit mal epilepsy

- c1

ui', {}-i-.ra"'iii

lrv'1t'c<-'

14. Previously healthy child has developed weakness of his feet and ankles before 1 wk. At present he has weakness of both lower limbs. Examination shows absent reflexes in
ankles and decreased reflexes in knees. The child was given his last dose of vaccination a week ago. What is the cause of this condition?

a)
b)

Poliomyelitis

Myasthenia gravis
GBS Botulism

d)

15. Clinical picture: headache, neck stiffness, vomiting. Lab results of CSF showed that increased protein, increased lymphcytes, normal glucose. No bacterial growth on culture. the most likely diagnosis? Viralmeningitis Bacteria meningitis c) Cryptococcal meningitis d) TB meningitis

2-year-old woman comes to the ER at 2 AM with a severe headache and nausea lasting 12 hours. She reports that she had a headache the day before his current symptoms started, but that it resolved with "an aspirin and a smoke," and that she has otherwise felt fine. The cunent headache is worse and is rated a 10 on a pain scale of I 10. lt is mainly occipital and extends to the base of his neck. Aside from a history of essential hypertension, her past medical history is unremarkable The patient is afebrile, BP 168/105mmHg, pulse 72lmin, and RR 20/min. Her head and neck examination is remarkable for nuchal rigidity. You order an urgent CT scan without intravenous contrast that shows no evidence of an intracerebral bleed. WOF is the most appropriate next
diagnostic test? Repeat CT scan of head without contrast Lumbar puncture and urgent spinalfluid analysis Magnetic resonance imaging (MRl) d) CT of head with iodinated contrast e) X-ray of skull

a) @ c)

17.30 years old lady complains

occurred 3 days ago. The pain xamination there is a sli the fount of the aura. Biochemistry is o

left

o is

lasted 12 hours which m the occipital region to

"j uJ^rLoid hemorrhage

!

, u-.

-[

r. ;-'l'-'v\ re
l

1g. An old retired accountant is living alone and receiving home care twice per week. He has lasix and Beta blockers for his blood pressure and celgrex for his arthritis. Which of the fdffowing is tmost important factor contributing to falls in this patient? a) Livinq alone

61 ii"edicatons -- 7c{' l^o*rr'"t<u\ v

'

Y)

d)

lnfrequent visit from home care

agency

Dementia

*A

middle aged female presents with complaints of polyuria and polydypsla of recent bnset. Sne pieters cold beverages to quench her thirst. Her vitals are P 8S/minute, BP 110/70mm Hg and RR 15/minute;she is afebrile.
Lab results are:
14 g/dL Hb 6,000/cmm WBC Platelets 280,000/cmm BloodGlucose 110 mg/dL 143 mEq/L Serum Na 4.1 mEq/L Serum K Bicarbonate 26 mEq/L 17 mgldL BUN Serum Creatinine 1.0 mg/dL Serum uric acid 10 mg/dL

Serum.osmotatitv

floj.r,r*n

a) Primary polYdYPsia b) Primaryaldosteronism c) Osmotic diuresis d) srADH e) Diabetes insiPidus

UrineosmolalitY Lflrn.,iltg Based on these, which of the following is m ,st consistent with this patient's findings?

19. A 3O-vear-old woman comes to clinic concerned about pain and weakness in her legs' tingling in ,/ Sn siates that initially, about 2 weeks agc, she had alternating burning andweakness, The sensation, along with severe lower extremity her toes on both of hei feet. then spread up her legs, moving from calf to thigh. She is now beginning to have weakness in hr arms,-and is having trouble supporting her weight or using her legs. Before this she has been heatthy and never had these symptoms. Vital signs are remarkable for orthostatic hypotension. Physical examination reveals no evidence of sensory loss, but severe wekness and areflexia are present in the lower extremities' The patient is admitted to the hospital, where she intensive care unit. Eventually, she requires intub recovers. Which of the following is a likely eve

eatTt'
Y)
c) d)

nteritis

malignancY History of eating canned fruits Use of illicit intravenous drugs

- Gtz

*)\

20. A boy weighing 4200 gm at bith, delivered vaginally with an apgar score,of 7 at 1 min and -S g at min-. Th child ws found jiery t hr fter birth and he was found to be cyanosed. What is the immediate

,nosis feduced-frp+le-.ultgive@ lni6tigation required in this case?

a) Rectal bodY temPerature

atooO sugar estimation

c) Urine examintion d) Chest X ray

/21

anteri

chest

Anabolic

,+,
L.f-

Inhaled corticosteroids lU

steroids

19 year boy presents to your clinic with complaint of n3!n in He is otherwise normal and plays basketball for his school' He is on for asthma. What is the cause for this condition?

,4 -l

.t

Testicular cancer d) Liver failure

e)

,6')

Normal

22. A5 yearold boywasfound confused by his parents in his room. Parentsfound the boy very tired last night when he went to bed early. O/E the child was very confused and lethargic. What is the most appropriate examination? a) CT head

b) FBE @ AtooO sugar estimation d) MRI

ZZ. T2years old lady , BMI 19 , diabetic for 10 years Gliclazide 40 mg daily. HbalC 12%.Whatwould

, on metformin 1 gram twice a day,

M\'

a) start acarbose b) lncrease dose'of metformin cJ lncrease dgse glicazide ,I shifthert,.,t,1gn;*r tp @

24. A41-year-old male comes t yu for his routine medical check up. He has been smoking one pck of cigarettes for the last twenty years. He reveals that his mother and one of his maternal uncles have diabetes. He is 5'7" inches tall and his weight is 70 Kg. His vtal signs are: BP 122180 mmHg, PR 80/min, RR 16/min and T 37C(98F). You decide to screen him for diabetes mellitus. After an overnight fast, a blood sample)r{rawn which the most appropriate next step in the shows

t"ffi
v b)

t
Start therapy with oral hypoglycemic agents Start therapy wth insulin Recommend life style changes

. - L,3

c) d) e)

:t'frr.lrl. L4'O

1@4^fl
<z'3 7'E- tr' l >it'l

N L5 ' ;r7'0

25. A 59 years old lady who has a history of DW comes to you complaining 9f pain in calf muscles. What would be the most appropriate investigation to rule out D\,tf?

q
c) d)

/"^
H

37C(98.6F); PR: 75lmin; BP: 11ol7o; neurological examination is non-focal. Cardiovascular examination is unrevealing and no

ankle edema or ascites is found. Lab studies show: serum sodium of 115 meq/L; potassium 3.7 meq/L; bicarbonate 22 meqlL; blood glucose 100 mgidl; blood urea nitrogen 9 mg/dl; seium uric acid 3 mg/dl. Serum osmolality is 265 mosm/kg while that of

the urine is S00 mOsm/kg. Chest x+ay shows mass in the right hilar region. What will be next step in the management of this patient? most appropriate
a)
b)

Normalsaline
0.9% saline Water restriction Hypertonic saline

c) d) e)
27

Demeclocycline

/
,{oy'-

J
I

{(

A 46-year-old woman is found to have an inegul arly inegular pulse during her annual physical exam ination. The patient has no current complaints and is unaware of her irregular pulse. She does not have chest Pain or any noticeable palpitations. An * -_ ---. electrocardiogram is ordered and snows amal fibrillation with a ventricular rate of 86/min Aside from asthma requiring occasional use of an albuterol approximately inhaler, she has no significant past medical history. The rest of her physical examination is unremarkable. Her other vital signs are within normal limits. At this time, which of the followi ts an appropriate outPatient Pharm aqg19gpyjo consider?
Aspirin
Digoxin

^il"
1

$ ur^. rulor: "t

prsl.,."ro ,. e>p J rr\

49,ft

-*

1.

\v

c!;t' V

. r-CS *-(,

e)

Meioprolol Warfarin

,\ ',ojt"L'^., -Y c\-t5t (J)

28. A 24 yr old boy presented

of fever and nodes on fingers and redness on palms. An erythematous rash is also found on the back. ECG shows: ProlongedPR.Which one of the following is the useful investigation to establish the ASO titer and DNase B
Echocardiogram Full blood examination Urine analYsis

*> Loclt

>

- 6 l') c) d)
29

diag_nosisf

nfil\
T

30.

arterialocclusion in lower limbs is: a) Common femoral artery tp'

)

@ o)

Poplitealartery Superficial femoral artery

External iliac

artery

a:

"-"v

=> 0-t^[-{t " -\ iz-t ',*'-J'

31. A child has a continuous murmur on the left porasternal region, and radiating to the left axilla. The child is acynotic , the chest x-ray shows pulmonary plethora what is the most probable diagnosis?

6 -c)

a) VSD

d) TGA
32. ECG-atrial fib.A 60 year old man was on atenolol .otherwise normal.The best long term management for the old man?

PDA ASD

6
c)
d)
b)

Warfarin
Digoxin Heparin Aspirin

33. A middle aged, coming in for routine check up, with cholesterol level ralv?scular disease : familq
a)

of

5.5 mmol/L,with

O Y)n
d)

assessment

lncrease activity

34. A middle aged man presents to Emergency department with complaint of chest pain which started before 12 hrs but has increased since last 2 hrs. Patient is very anxious and according to him pain is relieved by leaning forward, He has a history of pharyngitis 1 wk ago, Vitals are stable. ECG and cardiac enzymes are normal. What is the most probable diagnosis? a) Myocardial infarction

b)

G "-t ng.

a
-4

c)

Epiglottitis Esophagitis

Paricarditis

-- 'J ' {

-[

f ,trt

v,i/"l)

A middle aged man presents to emergency dept with compliant of severe pain left leg. He is a chronic s moker and develops pain on walking for a distance of 200 m. O/E no peripheral pulse in Lt leg, pallor, tenderness, tingling sensations below knee on Lt side' The Lt leg feels cold below knee. Doppler examination show-s occlusion of the popleteal arterv. What is the next step in management? Embolectomy lV heparin Warfarin Subcutaneous heparin

36. A neonate ids found to be tachypnic , tachicardic, and has a widened pulse pressure . He has no cyanosis and there is a continuous machinery murmur, best heard at the left upper chest. X-ray shows pulmonary plethora. What is the most probable diagnosis:

a)

VSD ASD PDA

TOF

37. A7'-year-old man is brought to emergency room complaining of severe muscle pains and cramps. He has a history of end-stage renal disease due to long-standing hypertension and diabetes, and is well known to the emergency room staff. Because he is often noncompliant with his medications and dialysis treatment, he requires frequent hospitalizations. A quick review of his records indicates that he has missed his last two hemodialysis appointments, and has a creatinine of 8.8 mg/dl. An urgent is ordered to know the severity of his electrolyte abnormality. Chemistries are pending. Which of the following is the first change likely to be seen on the ECG in this patient's electrolyte
abnormality? a) Diffuse P-wave flattening b) Prolonged PR interval

c)

Prominent U waves Sinusoidal-appearing QRS /-\ Tall, peaked T waves (!-J

f \)

,5f I

4rry
s(%
r

Y F/.tjt
7

\vt)

J^"*",

pain' 3g. A 60 year old patent was admitted to hospitalwith the complaint of a dull aMominal vague mass in the hypogastrium,a bruit On examination there is tenderness and a What is the next immediate step in the management of this present on "u."uittion. condition? v\ At" r/>s USG at the patients bed side urgently--' l -Aortogram patient to operating theatre c) Send d) X ray standing Z-\ el CT abdomen without contrast - It Lril, Scr.t'u:u.+{ fr. o-,,',^ Lt 1s cardiac failure found to have 39. An elderly patient in the hospital treated for congestive treatment hyperkalemia during the course of the treatment. What is tlte most approPriate with? to Calcium gluconate - \ Glucose and insulin' 7'c) Sodium bicarbonate

r[

) fo1vs

fi

(/\)

3'*

-*u,{J'

-'

r'i-,. 1,1+t4

a)

Resonium

40.

5 a b management: qI Low dose statin GDNo medication needed

-c) Add insulin d) Change to Losartan

utin ars. nor

ars

I'
in--r'vt.Lt

n*-)

ng-''

,/

41. ECG: Pulmonary embolism this lady 12 lead-ECG shws typical PE, 51Q3T3, accompanying with description: of breath. She just came from an overseas suOOnty developed 'hest pain and shortness
triP.

pericarditis. 42. ECG: 12lead ECG shows ST depression in almost all the leads:

L.atr

(anterolateral Ml), what is 43. ECG: ECG of an elderly lady presenting with chest pain for 3h the most appropriate management? ,.,

GY 9 Sfi**',
.-!4'
44.

AsPrin

- j)O q1'*-- -

U)

t".ou4*.+
D

di

AcEi

t[-, du.--

,n

palpitations for the past A 57 years old patient comes with the history of chest pain and pain. Choose the few dys. His pl" 't" r 50/min and BP isnormal. o history of chest conect ECG strip. 5 ECG strips given

presents with 45. A man returned to Australia recently after a short business trip USA management? dV"pna an breathlessness. What is the immediate a) Warfarin G; lV heparin

c) Antibiotics d) lnhaledBronchodilator

46. What would be the most ominous sign in a child with a croup? a) Degree of stridor lncrease in temPerature SuU"oastat retrction and use of accessory respiratory muscle

l) @

d)
47.

Loudness of the cough

A4 year child presents to the emergency dept. with 36 hr history of cough, inspiratory strid-or and intercostal retraction. His temperature is 38.2 'C and you found that the cough
has barking quality. What is the diagnosis? a) Epiglottis Foreign body at the level of trachea Croup

Asthma

48. X ray of lung shows a mass near right hilum Clinicalpicture was that he reqently had (q sweats, fever, and lethargy, and he lost 1kg. TB i'/\-^/\ b) Lung cancer " 3 "uP' c) Lung abscess

-'

16]'Jt s

,slJ
D

N)

d)

Hodgkin's lymphoma

- q
+

iri''l t

"{
't,

Ag.

Ayoung man was involved in a Motor Vehicle Accident and sustained multiple injuries inouiris both tibia and pervis' t";?,H'^T,".1iJ,i*?i3lr*lt"on2'3 davs rater'

l;."

r'l),u\)

SO.A 4 year old child presents with fever and 12hrs history of stridor and harsh cough. How
wilJ you

treat him?

,,J,

q)
c) d) e)

Nebulise adrenalinelV antibiotics Nebulise salbutamol Nebulise corticosteroid Oxygen

positive 51. An overseas student comes to you because he was found to have a positive skin op.acity skin test for TB, although he does not have any symptoms or signs. An apical was found on chest X-y. Sputum examination was positive for acid fast bacilli- Which of the following is the appropriate management? a) lsoniazid Rifampicin, lsoniazid, pyrizinamide & ethambutolc) Mantoux test d) lsolation

,-,2,82.4 ./'// labrato[ resuts would you confirm the diagnosis of a panic attack? ,a) PaOZ'|OZ PaCO228 PH7'48 i) eaoz p PaCO2 30 pH 7.5 c) PaO2lO PaCO2 60 pH7'4 d) PaO2 60 PaCO2 55 oH 7.3

young man presents with shortness of breath. OiE everything is normal' What

53. A 3 years old child has cough and fever. On chest x-ray he is found to have bilateral

patc
a)

diagnosis?

r.ir g*t

( r-i, .

rr*r1 -
o

h-er 'l{*

Lr-'v{t

54. A young healthy woman runs everyday for more than half an hour' She developed snrtneis of breath recently but reiieved by resting .She noticed that her shortness of breath has been increasing with exercise. What do you prescribe her prior to exercise to

help: a) lnhaled budesonide lnhaled salbutamol

c) Oralsteroids d) lM salbutamol e) lnhaled steroids

be ,t 55. A 9 month old infant develoPed wheezing, dyspnea and cough 3 days ago. What could ,,-._kJi-,., U't ,,ffi-,.1-{c-\l vthe probable diagnosis? ,1 tn 'nffi-t Lu1 .*-l,\ a) Asthma

Bronchiolitis c) Foreign body d) Pneumonia

t tnt

elza ,M^

$*

,1

t lr\
:;rPY -.

'rorV

''J
.+ "U"pl.r?-,^

i.-1->

in the 56. A young male had motor vehicle accident, had on urethral meatus. Physical examination is suggestive of scalp, had blood be your first prioritY in ma nagement of this Patient? L>

',..,$ta 9+-d--

e*4

c) Hemothorax d) Blunt abdominal injury

57. A concerned mother brings her

I month old daughter to you. You find out that the

nd now presents with paFglJggr+g..,fse by is afebrile and seemsibffi'een the

c) Asthma d) Pneumonia e) Foreign bodY

the boY?

you recommend for Sg.A boy has been diagnosed with exercise induced asthma. What would

\i c) d)

lnhaled salbutamol before exercise lnhaled corticosteroids before exerci

OralcorticosteroidsnightlY lnhaled salbutamol after exercise

nts to You regarding her carcinoma aithe age of r family histories of YearlY mammograPhY YearlY endoscoPic examination Rectal examination now ColonoscoPy now

,
a) b)

I cance

breast Ca
?

c)
d)

and 60. 45 year old man presented to the emergency dept. after three bouts of haematemesis The patient was started with lV fluids and resuscitated. What als gives history of malena. is the initial management? a) Urgent USCG

b) CT abdomen EndoscoR,J'

10

d) MRI
61.The most common use of diarrhoea in bed ridden elderly patient is

a) b)

Ca colon Crohn's disease Ulcerative colitis Facal impactation

62.6-7 days after surgery patient presents with serosanginous discharge from the wound site' What is the cause of this presentation? a) Wound infection Wound dehiscence

d)

Pelvic abscess Fistula formation

.L*-T purmonaryemborism K ! u'Lt; Y'ltt, A?:; c)

,

was given 3 days antibiotics and stayed rge he developed high fever, LIF pain

.' -.
L)\,;\ I

64. An elderly man presented with upper abdominal pain, jaundice, fever . Physical exam found

that there was a mass at RUQ (4OO), ALT, AST slightly increased. What is

Lab tests showed, diagnosis?

cholecystitisu--

tf\ ,. lr.u -\1i.*{

I
d)

1 Cholestasis ' \)'r' fu4 "'r"'-'"L. :t HepatitisB ' '

Pancreatic ctfcor

,4

/.,-ta-;l-4,^,-.

65. Patient presents with hematemesis and melena. He was given cimetidine. Endoscopy showed a bleeding ulcer. What is next appropriate management? a) lntravenous adranaline

-.) &ongterm c) B blocker d) Ranitidine

iv' y3-+" t ?-1).() v-i) b s]

i ,*

\ l-,
Lct
l-

''t

-66. A 19 yrs male preciously feeling wellpresented with scleral icterus. His hemogloUnl4'likelY total bilirubin 80, unconjugation bilirubin 70, alkal ine phosphatase normal. What is the ,*-* c' \' ^l , u-" v ^t'T'^q\o V. \'"

,.(-

\*\/'-"

67. A patient arrives in casualty and gives a history of persistent vomiting for 5 days. The vomtus contains food injusted 48 hrs previously. On examination he is weak, has a dry tongue, decreased skin iurgor, pulse 128bpm,_BP-.!ffpmmHg. Which of the following lV fluid would you choose as your initial infusion fluid? a) 5% Dextrose ,,V*''

: @,
)

solution
n

n --\'v 'iH"L ' 47o dextrose

11

68. Man complains of soiling his underwear.on inspection you find a draining fstula .this has

\.t'\-

2-r tv

,<)
been going on for the past 3 months.what ids the most probably diagnosis?

(l-

V*)-1,' 4\ '

c) Ca rectum d) Haemorrhoids
6g. An old man has stenosing carcinoma of rectosigmoid junction. What is the mode of Presentation:

-^ ^ J\.v'./

bl lntestinalobstruction @ Rectalbleedins
d) PalPable mass
70. A young man presented with history of diarrhoea, no abdominal pain, no rectal bleeding, with

a)

Altered bowelhabit

t;,

,t
\

-c

6 c)

M#p

p{-c'-131.4

l' ,
i

A, ilrrl,n,

W" r*
A

d)

Crohn's disease
conside

d)

Liver size

LT-

l,*
6

5L

72. Aman came to You comPlaining that whenever he goes to the toilet, there is fresh blood stain on the toilet paper after defecation and blood mixed stool. On s iomoidoscoov vou your next found that there was no lesion throughout the 25 cm of length. What would bh step? a) Fecal Occult blood test Reassure and tell him to come back when symPtoms Presents Colonoscopy lnspection PR

,il/"**- bd'*<'Lyl

oL-s '+a--i, ,f o

73. A young man had an aPPendectomY The appendix was gangrenous but not Perforated recovery was uneventfu I and was discharged home 3 He was on lV antibiotics cames to see You because of fever (39 C) with abdominal soon. cause of this Presentation?

c) Wound infection d) Pneumonia

T4.Xrayabdomen: 56

*:a:[T::ll'
c) lngunal hernia
d)
Theca cellCa.

year

with abdominal pain, distenton. Appendectomy

"'"il" "-'9*
q,''t12

y*":";iwil"''';^

J"B"ffi= *ntt
lrf

75. An elderly man Presents with a sudden onset of swelllgg in his scrotal region and hat is the most likely cause?

-LU

fto,
(

Ur-'.--

wd

+4r t

#"-e" h
v-A

^*-l*

\A,.-lr

76. A 25 yr old male was involved in a MVA. X-ray showed pelvj*facture. Now he is complaining inability to pass urine. There was blood visibleo--nurqllqeatus. What

.\\

;i @m?
d)
77

wo

"@

'

"-J

*-?

c) d) Hemorrhoid
78.

most common cause of blood stained stool in an otherwise normal infant is: Analfissure Analfistula lntussusception
in the left side of scrotum. On examination

tender

d) lngunal hernia

't

,,jA. '

A previous well nine month old boy is noted by the mother to have a swelling in the right groin for a few hTi7ffiany other symptoms. Examination the following dayfailed to ievealthe swelling. Both the testis are in scrotum and the right spermatic cord is thicker
tha

@ b) ,

tment is necessary Arrange a surgical consultation with the parents in order to carry out herniotomy

d)

80. A child with undescented testis. Most commoly associated abdnormality is:

@ lngunalhernia bt Mlignancy- - t.--ii uJ-' c*-' c) Trauma d) Torsion

81. A man presents to your surgery with a swelling in the right side of scrotum which he noticed before few weeks. ON examination you can feel the spermatic cord above the swelling and cystic mass is found above the testis. What is the appropriate management? a) FNAC USG Refer to a surgeon

d)

Antibiotic

92. A5 month old child presents with fever, poor feeding and decrease normal weight gain. e following is the most appropriate investigation?

/ 293.A renal pelvic. What is the most appropriate manamgement? ll in 1/ @ rtut Ettb) Drink plenty water
c)
Anesthetics

patient presents with colic pain with hematuria. X ray showed that there is a 2 cm stone

13

d)

Surgery

g4. AT4

years old male has transurethral reaction for his benign hypertrophy prostate. The biopsy shows that 5% undifferentiated cancer cells. Which of the following is the best

manaoement for him? @ nassure and follow up observation b) Radial prostatectomY c) Complete transurethral resection of prostate d) Radiation e) ChemotheraPY
BS. Young boy presents with painless swelling of the scrotum .not reducible.cord

6l 'us F) cr c) FNAC
d)

palpable.what's the next best investigation?

Totalorchidectomy

86. Young adult presents with pain in scrotum. Tender on palpation.PR examination was painful.what's your diagnosis? a) Varicocele Hydrocele Epididimy-Orchitis

Testicular tortion

A patient was on warfarin and was well controlled. On routine check up you found her lNRwas 4.9. The doctor had prescribed antibiotics to her few weeks ago. What is the possible cause of her raised INR? ()t- *i Overdose of warfarin
Roxithromycin

L-.l/L",.',-

r ,+ . / .3 I'i* tt'uT ci-o-f

1

Amoxycillin
Non-compliance

88. Patient was about to be taken for an emergency condition and the patient is on'wa

't*7
INR 2.0 1 2.5 2 3.5 3 4.0 4 What is your management on the 4 a) Stop warfarin b) Give FFP c) Give Vitamin K (' Skip the dose of warfarin Dav 90

*{*o

*fo[,r:

I orT* v

is on warfarin. INR was done and it shows the

Warfarin

? day?

-DoJJ

>2-

H'U t' cf 'KP.

D"-.c

3.-

h{./

-l-+--r

L--,

i't

*"'

q{i'

I
a)

Folate deficiency Pernicious anemia c) lron defciency anemia d) Anemia of chronic disease

'. A patient with a history of rheumatoid arthritis has pain in_her small joints of

the hand.

Which of the following is the least important management? Send her to physiotherapist for pain relief b) Occupational theraPist Rh factor estimation

d d)

Analgesic

92. A child was brought to you with complaints of lethargy and pallor On FBE , there is a decrease in MCB and Hb . his parents said that they got their house recently renovated and it the child began to deteriorate in his condition not long after that. What is the most diagnosis lron defciency anemia Thallasemia
Lead poisoning Anemia of chronic disease A lady was planned for an elective cholecystectomy. She had a hip replacement surgery six mnths ago and is on warfarin. What should you N a) Delay the sur peration, restart warfarin immediately after surgery O') Stop 1 week ci Stop mediately, start warfarin immedately after surgery Oi Sto

do?

warfarin warfarin warfarin,

('

An 82 yr old woman with a known history of chronic alcoholabuse and a partial eal gastretomy for peptic ulcer disease weak months of cognitive impairment, hands and feet. Physical examination slightly icteric. There n. His hemoglobin is 6'5 g/dl, r.eieats decreased 135 fL, and reticulocyte count is 1'3% is hematocrit and indirect bilirubin of 4.5 mg/dl. which of the following is the most likely additional laboratory finding?

vi 19.5%,

inding capacity level

95

96. A 65 year old man presents with a complaint of tiredness since last 2 months. He was diagnsed of Rheumatoid arthritis 6 years ago since that time he is taking NSAIDS for the pai relief. He is on omeprezole for the peptic ulcer disease which was diagnosed 3 years

15

you f ration

t' Lab values: Low Hb,Serum lron,

is the most Probale cause of

& e)
I ,, O

a) lron deficiency anemia b) Sideroblasticanemia

Megaloblastic anemia Anemia of chronic desease Folate deficiency g spogdylitis' What is treatm-ent?

tiredn

--

.- 5t-"--t--.4-t ,r.={La L"a 1 - Qt

v/ cJ"is-:-'.

sulphate
98. Picture shows black spot on the inner side of the little toe. The patient noticed it recently iagnosis:

7lt'tllW'.LL*-

"'

v 5 r'

) , ^LJ ''- [ D(

99. Pic of keratoacnthoma: What is the

diagnosis?

4F<-\\ t'c^
"*'g1'bl<
^,O
5

100. Picture of an old lady showing swelling bglo* t[g-e!g!t$9-jaw. What is the next
management?
.L

rlf

L,-s
'

FNAC USG Sialogram Cone biopsy

a{-\

4,,

j^'* * \/ Y. ,-Y:f:.:*,qr z-*r'r,1

'-

)'\ l _)

->
f

SI^L.^^A , - o4i4

w*-A1"Jo-. "L

101. An old lady with slow growing mass anterior to the ear, with facial asymmetry noted when

smiling, eys close symmetrially. There was noted difficulty of opening mouth . diagnosis: a) Warthing tumor b) Mixed parotid cYstic tumor c) Mixed parotid tumor of deep lobe parotid d) Chronic parotitis Adenoid cystic carcinoma

102. An old man who has several years' history of smgbing presents with an ulcer in the mucosal surface of mouth. He is also using dentures and recently he is experiencing problems using them. What is the most probable cause of this presentation?

a) Ulcers due to dentures b) Leukoplakia d)

Basalcellcarcinoma

@l

Sqamous cell carcinoma

103. A patient presents to emergency dept. after a MVA with clear discharge from nose' What is your first step in management? a) lnsert a nasogastric tube ' tu-{-- L--J' 'v-' bi lnsertorogasirictube'-

c)

Tamoonade the nose

'f

V"ntibot"s

- i
I

Lxrc''iov's'

104. A boy was involved in a fight with his classmate and presents to you with a blow injury to

16

3"r,"
zygoma.Whatwillyoyfin!?.,,

v-

,l

C'ltl

t v1o

@ Diplopia {i"{f}* b) EnoPthalomos

,rl ,.,L '.\ '" r

\

,,

*F^

'

c) lnabilitY to oPen mouth d) DifficultY in uPward gaze

10S. A lady presented with complains of flashes of lights and black particles in her visual field.The possible cause is: a) Migraine b) Transient lschemic attack RetinatChchment d) Retinalvein occlusion

'/

106. A diabetic patient with third nerve palsy will have which of the following featues?

a) b)

Ptosis DiploPia c) Optic atrophy

Normalpupil

-. //

102. A male patient presents with ptosis, lll 4erve palsy, pupil normal. Which of the following is

the oossible cause?

@'oiauetes

b) Cataract c) Glaucoma d) Retrobulbar

tumor.

1Og. A middle age lady complains of flashes in

the left eye, moving in front of eYe, episode of resolvig n -3 mins. On the third day, she suddenly developed loss of vision: blindness l4aeular and retinal detachment b) Macular degeneration c) Retinal artery thrombosis d) Cataract e) Carotid ischemia

<.1og'orbitalcellultis-DiagnosisL3.7ts.8,,,nL"J\ry,,*1:W
-)
of 10. A patient presents with a loss of vision in outer aspect of the right eye and inner aspect
his left eye. Where is the lesion?

i F!i:=?i:!", c) Left occipitallobe ^l>

d)
Optic chiasma

t) _ t o( (ii-ir I l2
L

e-\uL,o4,'.

'l.A6yr

old lady presents at your surgery with a painful breast mass, What is the probable diagnosis? a) Ca breast b) Fibroadenoma c) Breast abscess

11z.ffiSyr
b

/'ij1.,")Zi;+

old lad presents with green tooth paste like secretions from her right nipple. What probable diagnosis? is the a) Duct PaPilloma

fibroqsh'c '

Ductalcarcinoma
Duct ectasia Paget's disease of breast

17

113. A 45 year-old women presents with painful lump in her right breast, it is firm, mobile. What is the most appropriate management? a) FANC Mammography c) Excision d) Biopsy

114. Awoman present to you with a solid breast lump around 2cm in size. There is no pain and tenderness on palpation. What would be your next step in management?

6 <

a) Mammography b) usc d)
FNAC
tsxclslon

115. A patient presents with signs of hyperthyroidism. looks like Grave's disease .weight loss an palpittions. On lX,deqgggg|1f of radioiodine.palpation reveals an enlarged and soft thyroid. Grave's disease (, Subacute i

-d

thYroiditis - i"1 \P" d) Hyperthyroidism

Hashimoto'ithyroiditis

you 16. You are considering an operation for a patient with thyroid cancer.what would make

defer the surgery due to suspected inoperability a) Extremely large goiter Hoarseness of voice @, lncreased serum T4 c)

117.
c) Neurological effects of lithium d) Pituitary failure

lethargy and irritation. On further questioning patient

e for many years. What is the cause of his condition?

118. A patient presents with a midline neck swelling which moves with swallowing. What is the most probable diagnosis? @ Thyroid gland enlargement

c) Cystic hygroma d) Lymph node enlargement

1

b)

ThryoglossalcYst

19. A patient is hospitalized for an ulcer on his right legjust above the medial malleolei. He is a known diabetic for 15yrs and on examination you find varicose veins in the left leg. What is the cause of the ulcer?

a) TroPhiculcr).',^[a-ue-i''t9
b) d)
Diabetic ulcer venous ulcer

Arterialulcer

120. A12yr old boy presents with a painful knee. On examination you find the joint is warm,

a) Prescribe

tendei, red and swollen. What is the next step in management? antibiotics b) Advise him to immobilize his legs
Asptration of the joint

18

d)
121.

X+ay of the Jolnt

A 2 W old child is admitted with a fever of 40 C. O/E the child has limited knee movment and does not allow anybody to touch it. There is an area of pgi0lrulerness over the medial side of the distalfemur. What is the probable diagnosis?

6 c)

a)

d) Undisplacedfracture

Osteomyelitis Osteogenic sarcoma

122. A child was brought to your surgery with history of pain in her elbow. Parents do not

remember the child being infected. The child was found to be seated on her father's lap with her forearm held close to the body in the mid prone position. There was no sign of swelling or redness. Probable diagnosis is: a) Supracondylar fracture (D Putleo elbow -O Greenstick fracture d) Juvenile arthritis

1Zg. Young football player comes with a history of painful knee. O/E the knee is tender. The patienl gives history of givingaway sensation in knee and few episodes of locking of

a) Ant. Cruciate lig. injury b) Post. Gruciate lig. lnjury

knee in flexion and unable to extend it later on. The most probable diagnosis is:

d)

nleOial meniscal injury

Lateral meniscal injury

124. A picture showing a young man with shoulder dislocation.

a) Acromioclavicular (AC) dislocation b) Glenohumeral Dislocation

c) Fracture clavicle d) Muscle atropy e) Brachia plexus injury

5. {ray spine: collapsed Osteoporosis b) Osteomalcia c) Disc prolapse d) Paget's disease e) Osteopenia

5H-

t<ql

vertebra. What is the diagnosis?

,/

126. A 13 year old boy is brought to your clinic bt hi parents with complaint of pain in knee

(9) Slipped capital femoral epiphysis b) Osteochondritis of tibial tubercle

int.Patient walks with a limp His BMI 32. What is the diagnosis?

c) Leg-calve Perth's disease d) OsteomYelitis

e)
Transient sYnovitis

127.

Picture of shoulder dislocation, which one is affected? Gtenohumeral dislocation b) Acromioclacicular dislocation c) Neck of humerus fracture d) Rotator cuff tear

61 old lady with history of non healing leg ulcer. Community nurse had been visiting a

19

few weeks, came to a) Wound swab Blood culture Urine culture

c)

'12g. A basketball player comes to after a match and compains on severe pain and swelling of
the distal inteipnangeal joint of his left forth finger . a diagnosis of m_allet fracture is made. What would th basketball player be able to do in his situation? a) Fullv inability to actively extend the injured DIP joint ted finger -c) On

@ nOf a

'--' / ,2130. A newly married couple grandfather had hemophilia. What will you advise them? in rstry you find th wife's a) Advi-s to terminate pregnancy Xi-t'"-i I L? . \ lnform them it affects only male child b) s
c)
Tellthem it skiPs generations tntorr them 1 in 2 males are affected,l in2females are carriers
131. A patient after a MVA with multiple injuries in a very critical state comes to the emergency dept. Which of the following will you treatfirst? a) Fracture of femur Injuryto the orbit

who wants to have a baby comes to you for genetic counseling.

G)') Pneumothorax
't32.

d) Hollow viscus ruPture

Corr-t

133

&
1U.

intubation? Puffiness of his face and liPs Hoarseness of voice Swollen tongue d) Excessive salivation Apregnant lady at 18 week of gestatio'n presents to your clinic with a history of coming in contac.-t with a cfil witn Roseol infantum. She asks you about the risk of the disease being transmitted to her baby. What would you advise

Pl ya^9

(tf-

)J

n6r-l

her?

ginU:::?ti:":.immunosroburin f.;"--c) tnform her chances are high in first trimester d) lnform her that disease does not get transmitted at all
,'

u^ I q't- f

vv+^'{ (Q.c'r
n\

,r

.r^,q
.

action 135. A patient has a history of allergic reaction to various foods. What is the appropriate

to prevent worst outcome of such attacks? a) Take a prophylactic dose of adrenaline b) Advise him to keep a card with his history of allergy 6 vise him to carry self injectable adrenaline (Epipen) fafe prophylactic oral antihistaminics
136. A young boy presents with fever with petechial rash on buttocks.diagnosis?

20

ooo."7.1r,11i R y:l*-pu+-'v+t t rntrq Ne t il.o | - ,,.-J.:ff-'l'^";h<t'ta@-f'^ ', t v c:'-( t ne

.(Dl,HSP

d) a)

Ross river fever

137. A man went for business triP on the way back he stopped in Thailand for 2 weeks for a is the most likely diagnosis? pleasure trip,came back with flul ike

Leprosy b) lnfectious mononucleosis @ HIV infection d) Viral hepatitis

rr'u-ih'J

L{"T+""

133. A chef from lndia went home to india for holiday.came back with diarrhea.he was diagnosed w1h Salmonella.he asks you when he can return to work.your advise to him a) He has to quit his job He mav return to work after one month n" may return after having 3 consecutive negative stoolculture He may return to work after2 weeks

bl d l

139. A patient who was diagnosed with infectious mononucleosis .now collapses suddenly.what

could be the cause? a) Acute respiratory distress @ Spontaneous splenic ruPture

140. A young manied couple planning for their frst pregnancy. They were both normal, but the wife's father had haemophilia. What is the risk of them having haemophilia-ilL-lhCirfirst

baby: *fo
)

0.5 regardless of the @'O.S males, not in the d) 0.1 perinatal loss

D t ,. 7:: "'lf *\ r-ot p v*+" " 1l.t females :i c' "/' vv\--rt' ' gende
,ij

severe A t ,.141. theyoung patient hadthe mostallergy , sign? ominous following will be
a)

urticaria after ingestion of a known allergen. Which of

@
c)

d) ,142.

Severe pruritus

After surgery 62 year old man , with total input-2600 L total output 3800 L. Cause? ()\ 'tZP a) Diabetes insipidus b Resolved paralytic ileus > Wrong charting

u,4

D'1 "r'Tr-

143. An elderly lady presents to you the right sided hip pain . she has been

on

for many years diagnosis: a) Septic arthritis @ Avascular necrosis

/144. A man ./ childrencomes to ask about achoJdroplasiahat will you tell him? as his wife had achondrplasia. ! There is a 50% chance of her children having the disease

(dwarfism) and how it may affect his future

-bi c)

There is NO chance of her children having the disease

Tft"r" is a25o/o chance of children having the disease

was given . he had been staying indoors /,145.A picture of a man with shingles on his abdomen

21

t'

(/ ,/

6 !@

for 2 weeks before the time he came to visit you because he was scared of what the vesicular , painful eruptions may cause . he wants to know when he can start going back to work and interacting with other people. What will you tell him? a) He can never go back to work and he must stay indoors for the rest of his life b) He must avoid contact with pregnant women le can make contact with people once all the vesicles have started to crust He can go back to his normal life once allthe lesions have healed

'-

146. A young woman who is a known heroin addict is brought to the emergency room by the paramedics. She was found unconscious . her boyfriend admits she had been drinking alcohol, smoking marijuana, snorting cocaine and using methadone. What would be the most likely cause of her contricted pupils ?

a)
b)

ci @
/

Mar'tjuana Alcohol

.-"- D,l
D'
I

Cocaine

Methadone

Lon-f

147. Auniversity student presents you to admitting that he has become addicted to morphine.
He refuses to enter a rehabilittion clinic because he does not want to miss dabses and he has many assignments to hand in . What would you recommend ? a) That he ceases morphine intake at once You recommend he goes to rehab clinic He should begin visiting methadone injection clinic until he is ready to go to rehab

148. 4patient was found to have hyponatremia .what would be the best management?

@/ b)

Normalsaline

c)

Hartman's solution Dextrose

paramedics 6 after she Awoman was t!9. paracetamol. brought in byclaims that s he hourshave takenconsumed 40 pills ofShe is them with alcohol. may .// Her boyfriend , I your next^step in her manaoement? drowsy. What would be 112 f.u Du \,.u charcoal a) Activated l-/L.,ts*) ".f

b) N-acetylcysteine c) Gastric lavage d) Liver transplant

-iJvra LTT -o.]*u'*l \_-' TIu' N/)c

7+ lo '

150. A case presents to you in the ED .the patient was brought in by the paramedics after eating at a restaurant . he has a known allergy to nuts and was not carrying his Epi-Pen. What would be the most ominous sign? a) Worsening urticaria b) Tongue swelling

c) Lip swelling (6) Hoarseness

of voice

151. A Jehovah 's Witness is in tCU due to heavy blood loss. However, she has stated that she does not wish to be treated with any form of blood transfusion. What would you do? a) lgnore her wish and give her blood b) Give her haemacel Give her normalsaline Give her Hartman's solution

22

Obs & Gvn

1) young lady at 3e weeks of gestation presents ' examination

ml

ualift

with .10 ml vaginal bleeding. Past history of 50 Uteeding lat wk but no abnormalities detected at that time. Currently on vitals: ormal, cervix: closed, uterine contraction: absent. What is nest

management? a) Reassure her & send her home b) Blood transfusion 6nm t her for observation v cl) lnfuse lV saline e) lnduce labour

2)

A woman comes to your clinic for advice regarding her next pregnancy. She is concerned
because her 1s baby was born with spina bifida. What will you advice her?

G, Folate suPPlementation Smg/daY b) Folate supplementation 0'5mg/day c) Vit 812 d) vit c e) lronsuPPlementation
3)

A pregnant lady at 18 wks of gestation presents to your clinic with a history contact w|th. a of the child who had Roseola lnfantum (Sixth dz). She is concerned about the transmission

oot

[*'*''t \

l"?f!^-ttul'

6)

t transmitted to fetus & it doesn't cause congenital

defects'

trimester

4) A
c) d)

primigarvid woman who delivered

Diazepam Methyldopa

dars ago developed seizure. What

is

the

Management? Magnesium sulphate

e}'b1Y"

Carbamezapine

'.

'r

ls

'a-

->

It.{.-

1,^e-1

-)

rel- t L,,-^_

5)

a)

@
6)

Primigravid woman complains of lumbar pain while walking. What do you suggest? Pelvic harness b) Lumbar support garment Refer to physiotheraPY d) Leg stockings

pubic area A woman in 2nd trimester of pregnancy complains 9f pail^il lower abdomen and are normal. which gets aggravateJ on walking. Lb inv'estigation, USG and CTG findings What could be the possible diagnosis?

c) @

a) Gystitis b) Appendicitis

PlacentalabruPtion Separation of Pubic sYmPhYsis

pressure. Z) E-wks pregnant lady complains of pelvic pain and pelvic tendernessUterine fibroid was ' 6cted'durng the 1d trimeter USG. On examination, vague in lower abdomen;

23

vitals are stable, no signs of fetal distress. Only clinical finding is pain. What is the probable

fibroid

- N V> --

8)

24 yto woman presents with pain in right lower quadrant abdominal pain and 6 wks amenorrhea. Prior to that, her menstrual cycle has been regular. On USG, there was no mass in uterus. However, there is 5 cm mass in the Rt ovary. Serum B-HCG=1500.Most

^<

fn '
g)

a)

likely diagnosis? Ovarian cyst b) Red degeneration of fbroid

q,
e)

z ) L v\.r. n fum'comes to you complaining of amenorrhea formonths. She also gives history of decreased libido, gaactorrhoea & Wt gain. Amenorrhea started few months after she was
prescribed resperidone. What is the next investigation? a) Serum prolactin opvvY-^/\'\R I v'---a'L b) CT head Serum B-HCG d) TSH

Ectopic pregnancy Ovarian torsion Hydaditiform mole

J pHtL^ >

prt*

\-Iv ,..--rv* r^-/

l^'+

10) A pregnant lady at 28 weeks of gestation presents to you with complaint of .bleeliEffv. ' (Aprx. 100 m-l).ln the past wk she presented with the same problem for which USG was done and placeta was iound in the posterior position in uterus. Now after admitting the pt and securing the lV lines what is the appropriate management? a) Give lV fluids. b) lmmediate LSCS

@ crc
e)

c)

USG Blood transfusion

wk of gestation complain_s_of abdoqel p.ain, more towards.Rt.iliac tosa]Rppendicectomy-ias don 2 yrs before. USG: no abnormality detected. No-g!g!lof f-tl distress. What is the cause of lower abdominal pain?
A pregnant woman at

1f

)--lT

-Q

rr placental A silent nraanrar c) Uterine myoma tton organic pain of unknown origin

b)

ah.rnrinn abruption

"-

> z o ''*li'-

/X

/' t4

c in 3d trimester with complaint of pain on lumber

13) '

A couple presents to your clinic wit complaint of inability conceive after 6 months

of

a) Semen analYsis b) HysterosalPengiogram

unprotected sex, What is the first step in management?

nst about the frequency

and time of sexual intercourse

24

d)

Serum testosterone/estrogen

14) young woman presents with complain of inability to conceive and she wants to know if her ' menst-rual cycles are ovulatory. Which of the following lnvestigations will confirm that she is

@ Serum progesterone in the lutqal phase ---) b) Rise in plasma LH at mid-cYcle c) Serum estrogen peak at mid-cycle
d)
Thickening of cervical mucous

qvulating?

'& "*t-'

r;tz(g-t{-' r--

15)A22 yearwoman presents to yu at 11am aftershe missed her daily OCP last g.ft.9fR '

Gr ci di

usually takes it at about 10 pm every night. She has regular 2815 cycle and today is the 14"' day of the cycle. What would you recommend? a) She should take the Pill now. Sne should take the missed pill now and continue with the current OCP regimen She should stop using the current OCP pack and start a new pack. She should stop all forms of OCPs and use condom till the cycle ends

16) A young woman on OCP presents to you. She is distressed as she recently fbund out that ' sn s plegnant despite following the OCP regimen. She is also on treatment for migraine and acne. Which drug would concern you as far as this pregnancy goes?

a) OCP b) Paracetamol t o@ lsotretinoin - v' {- r-l J'\i14-p-tr \d) SumatriPtan

17) '

differenifrom her classmatej. You find that the young girl has breast growth and secondary sexual characteristics but she has not started menstruating yet. Upon questioning, you discover the mother stated menstruating at the age of 10. What is the most probable diagnosis? (gf ffris is normalvariant b) Precocious PubertY c) Pituitarytumor d) Primary amenorrhea

A nine year old girl is brought to you by her mother who is wonied that her daughter

is

8) A patient presents to you with a history of amenorrhea, On examination, FSH increased, LH normal; estrogen decreased. What is the most likely diagnosis?

';(
atory?

(^-*i+_,{

ol infertitity. Which of the following features

: ,J-'-*"y.ie

,,,d1---

7Jr,,'-'ii-uv- d"'--,

dys---. ' 20) A woman who delivered vaginally prfsgnfs sexual life because she was a$vlsed[ ( her difficult course of labour and th'e epidiotomy appointment with her gynecologist for the next 2 a) Refer her to another gynecologist. @
Fact that she has a regular cycle

o!28

her
had t an

25

c
a)

Advise her to wait for 2 wks till the next visit with her gynecologist. c) Advise her to have intercourse because it is 6 wks postpartum. Advise her to have intercourse after vaginal examination only if it is normal.
b)

) A lady presents with profuse greenish What is the probable diagnos

discharge. Clue cells are found on microscopy.

Candidiasis Trichomonas vaginalis Gardenella vaginalis

6*f

ffitu^-;s

dt Vaginalatrophy

@ It .i x",

1',-J.r,*
t)

22) A14 years old girl comes to see you for advice regarding contraception. She has not started '
sexul life yet ad does not have a boyfriend. What would be your advice to her? a) Contact her parents b) Prescribe her OCP q) Refuse to give her prescription due to her age eve her OCP and advise her partner to use condom as well

(O

23) Contraindications of OCP include all of the following except: @ aenign breast disease

b) Migraine with aura c) Severe hypertension d) Recent abortion

) A woman who is 48 years old , his grandfggr had colon ca 4t-24 y/o,aunt had breast cancer at 68 years old ,brother had diabetes at age 55 year old ,mother had hypertension at 65 year old, who is very concerned. What will you advice: a) Begin annual colonoscopy at age 50 b) -AnnualmammogBphy

c) Annual colonoscoPY d) Reassure that nothing needs to be done

'-' 'c* | - >n'*t

86 yearsold lady presents with complains of unwanted urinary leakage and feeling of incomplete emptying of bladder. S he also complains of loss of small amount of urine when
she co,qgh_s-adsnae9s. O/E you find cystocele which is up to the opening of vagina. What
ts

i* "1i'o' ,l'--t "{

the.:

jement?

-('1J-*''f

'T*-

a) Pelvic floor exercise b) Pessary \'. @ Surgery d) Reassure

l-l",ti (fti
+ (b-k'-'1

\Jrr 'oW -) lon!tu"-^ .,-( r'-!il--t+s *-Ll v\r(yl .-._t L

r

L,L'Y__- --)

('t---'\ -l

i;2,.-./.,- l& -- v'

--l"L
-F"

'/ ,,'''*-J''-'
.)

(L'Y')

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26

PEDIATRICS

1) A 16 year old boy came to your clinic for general annual check-up. His BMI is 32. On -

d
2\ .

examiation you find his BP to be 160/90 mmHg. What is your management? a) Prescribeantihypertensivedrugs Reassess after 1 wk Check the cuff size Advise to loose weight

Child presents with pain in abdomen and lethargy for few wks. On examination you find enlarged liver. The child has opotf:lheJens. Reducing substances are found in urin examination. What is the most probable diagnosis? a) Lactose intolerance ,

i v9tic. Fibrosis S Galactosemia

a) STD b) Foreign body
q)

b)

Coeliac

disease

cli,^a I-L,',nS

"

h x-

t\ -7^/Ua,+19vn{X

3) A 3 year old girl is brought to you clinic by her concerned '

mother with the complaint of vaginal discharge for 2 wks What is redness of vagna associated with swelling and whitish the most likely diagnisis?

0
,4) / ' {

Sexual abuse Vulvovaginitis h his parents. Parents are worried about the growth of the child. They s not appropriate for his age. Father's height: 170cm; Mother's height: the child's development is at tanner stage '1.What is the reason of the

parent's concern?

) Familial short stature b) Constitutional delaY c) Hypothyroidism d) Achondroplasia

5) A woman who is a known mazijuana addict gives birth to a healthy baby. What would concern
you the most when considering them from the hospital? a) The mother will smoke marijuana in front of the baby b) The mother often falls unconscious while smokng marijuana c) The mother will get hungry after smoking marijuana The mother wont be able to breastfeed the baby.

O
6) '

Y)

13 year boy has been brought to your clinic by his father. He is worried that his son is too short for hi age. On examiation iou find thai tne boy is at the 7 percentile for his height and atSgth percentileforhis weight. The average heightof his parents is 168cm. Whatcould be the most probable diagnosis? Familial short stature b) Pubertal delay GH deficiency Achondroplasia

a)

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T'i

27

(1,-

l)

A neonate develops mild jaundice on the first day after birth. The labour was uneventful and normal. Apart from tne mil jaundice the baby seems healthy and is suckling well' The mother's blood group is A negtive. The baby's blood group is B negative. What could be the possible diagnosis?

(B)

a)
d)

Rh incomPatibilitY

neO incompatibility
Neonatalsepsis Physiological jaundice

An lB month old child was brought to you with a history of 6 months. oJ dianhea. The child stopped gaining weight from 'll monts. On examination of the child there is wasting of
buttocks nd protuberant abdomen. What is the next investigation? a) Sweat chloride test

@
c)

d)

Small bowel biopsy USG of abdomen Fecalfat estimation

g) An infant was born at 36 weeks gestation. 4 hours later was found to have respiratory

n) O

distress. He was kept on 45o/o 02 vi fread box. Which of following is the most likely cause of his condition? a) Trauma during labor Meconium aspiration Hyaline membrane disease Transient tachypnoea of newborn d)

10) A child of a 6 years age has been brought to you by p.ar91ts for night time bed wetting. He has been hygine traind and has been dry during the daytime from the age of 4 years' What is the piece that you are most likely to find in the history? a) Night terrors b) History of urinary tract infection History of UTI in mother while pregnant Positive family history of similar complaints.

c) @

1l) A baby of diabetic mother was born with 4400g,with NVD ,all was well.Apgar at 1 min was 5 to ,at 5 min apga, T.Peripheral cyanosis was )resent. After a few hours the baby was found

Gl i

a) ECG b) CT head

be jittery. What is the investigation of choice?

Blood sugar level Scalp PH

28

PSYCHIATRY
you as her . 1\,,6 are told to visit an old lady at her home. When you arrived, she recognizedagitated and becomes was \-/ d^ughter. Her house was messy and appearance your neglected. She

attaks you and threatens to kill you. What will be Sedate her Leave c) Defend yourself vigorouslY

next step?

d)

Callpolice

hile working in the hospital You found that one of your colleagues has been self-prescribing antipsychotic medicine. What should be your next steP? -a) He should be seen by a specialist ,?bl lnform the medicalboard Force him to stoP taking the drugs He should be refrained from seeing the patients until he is asymptomatic

Y di

ln A & E department a young man is brought in by paramedics with GCS of 10. He is suspected of having taken maiy illegal drugs and his breath smells of alcohol. 30 minutes after initial treatmnt pt becomes abusive and agitated. What is the appropriate

a) b) c) d)

management? lV thiamine lV diazepam lM haloperidol PO diazePam

An old lady who is mentallY sound and well oriented develops pneumonia. You fnd that she

has written a formal document stating that she does not wish to receive any resuscitation or active treatment. She is now very ill and unable to speak. What will You do? a) lgnore her letter and continue treatment Consult herfamily Respect her wishes and send her for palliative care to ethical committee.

An qflp
V Y)
d)

world country recalls his traumatic experience being at else could be associated with his behavior?

c)

Mania

disorder

man is brought to you his girlfrie nd because she noticed that he changed recently. During the interview the patient saYs 'l love you, you look good, good is world,..'.1 do...l do .Timbuktu...l love you" What coul d be the possible diagnosis?
a)

@
c)

Mania Schizophrenia Coduct disorder

29

d)
/1

Bipolar disorder

is an ly' irn 1B vear old male has a history of using his mother's clothes when he was young. Heof his female clothes. Despite ,,/' ;;;"'" ;irniat university. Rcently h started buying more in this kind of activity only at Y h;", ;siotfrer is not concerne because he i involved

vI
d)

home.

What does this behavior indicate? a) Transsexualism Transvestism/Fetishism Gender identity disorder
Histrionic personalitY

A mother presents to You with her one year old son and wants to talk to you about the immunization of her child. After discussing about immunization and its importance,

you do? mother decides that she does not want to have her child immunized. What will a) lmmunize the child Respect her wishes c) Callthe child protection services lnform the local health department

d)

has met with an accident and she is hospitalized' her hospitalization. On examination you find that
You do?

by the pt until consent is obtained from her parents.

d)

lnform Pt's Parents r clinic with the me her son in compute owed playing for

c ju games.

to deal with

s quiet onlY
nnoYed and

bi Advice to kee'p the child involved in activities other than playing games on computer. c) GrouP theraPY Q Ootain school performance record.

a)

Prescribe amPhetamines

fl Rationalization lJ Suppression c) Sublimation

d)
Subtraction

everyone A patient with features of myocardial infarction is admitted to ICU and he is telling in the hospital is very nice' around him that he is confident, he is i n good hands and everyone lA/hat is the defense mechanism involved here?

with A you ng woman who recentlY broke up with her boYfriend is presenting to Your clinic a situation to the doctor.After compl iant of headache and anxietY She explains her current lot and she few minutes while the doctor is eliciti ng the history, suddenlY she starts to cry a
? ask for a hug form the doctor, What should be the doctor's response a) Tell her rudely to behave herself her b) lmmediately get uP from the chair without wasting time and hug aPProPriate for doctors to hug the Patient her that it is not Deny politely, show emPathY and trY to calm her down

with one of his A colleague of yours comes to you for the advice regarding his relationship coffee initially and the kept on meeting patients.-The ptent invited yor colleague for a

30

afterwards in hospital and outside as well. Now your colleague wants to have a relationship with her. What will be your advice? a) Go out with her and enjoy your life. b) Go out with her but advice her to change the doctor ntinue to be her doctor spital as her doctor and discontinue any kind of eridol) for 5 years. Her symptoms have been well topped medication due to increased involuntary povements. What is the proper management?

b,
c) d)
'l

b)

Quetiapine Clozaline Ghlorpromazine

ne

agitated young woman has been treated in the hospital for a particular disease Everything was fne. Before discharge, she becomes agitated and says that if you discharge her.she.will.comm it.suicid e..What.will.you.do? a) Discharge her. b) Admit her to psychiatry department. @ Keep her in the hospital until her suicidal intentions have subsided. d) Provide antidepressants and discharge her'

ALL THE BEST

31