April day 4 part 2

🔴pregnant pt came to GP for 1st antenatal visit. Other than that mild
nausea vomiting uneventful. Her weight today 107kg. Pre pregnancy
weight 109kg. Her height 162cm.
What is the goal of her weight through this pregnancy
a) not more than 500gm per week
b) not more than 9kgs weight gain through out the pregnancy
c) continue same weight throughout the pregnancy
d) maintain pre pregnancy weight
e) weight loss 1kg per week

🔴52 years old man came to you following attempted to end his life. He and
his wife successfully running a interior design company. On further quiry
he is telling recently he is not interested in work, not going to golf with his
friends on weekends and worried that he got delayed with new projects
completion, pending works. And crying now he has lost his house and no
where to go after discharge. What is the condition led him to this
presentation?
a) ruminations of guilty
b) delusion of poverty
c) Paranoid delusion

🔴pt was admitted following RTA rib fracture, you prescribed sc 10mg
morphine, shortly pt again complaints that pain not settled. When
checking upon that you noticed nurse not given the morphine as she
thinks that dose was too high for him and she gave paracetamol. What will
be the next action?
a) complete the incident form
b) talk to nurse and explain the effects on patient because of her action
c) inform hospital director
d) inform APHRA
e) Confront her

🔴24 years female with rheumatoid arthritis on methotrexate and hcq

wants to get pregnant.
What will you do?
a) stop methotrexate and continue hcq
b) stop methotrexate & add leflonamide
c) stop both drugs
d) stop methotrexate
e) stop methotrexate and add adalimumab
🔴A woman with osteoporosis experiences a motor vehicle accident (MVA)
but initially reports no neck pain. The following day, she develops neck
pain, bilateral neck tenderness 3 cm away from the midline, and pain with
neck extension. What is the reason for further investigation? shahriar amc
a. Presence of osteoporosis
b. Painful neck extension
c. Painful lateral movements
d. Bilateral neck tenderness
e. Lack of improvement with conservative measures

🔴 16 years old returned from recent trip to thailand, presented with

erythematous rash in body and limbs. Red eyes, fever 40°. Vitals stable
Wbc 3.1
Hb 12.1
Plt 250
Next step?

a) blood culture
b) broad specterum antibiotics
c) discharge and follow up with GP
d) c xray
e) isolation

🔴18 years old girl with BMI 20, Thin built, recurrent chest infection. FBC,
LFT, SE normal. Serum globulin low, albumin lower margin. Diagnosis?

a) cystic fibrosis
b) celiac disease
c) crohn's disease
d) anorexia nervosa

🔴78 years old female in nursing home mostly in wheel chair presented
with BL ankle edema, reddish, flushed, warm. Inguinal lymphadenopathy.
DM, HTN, dementia on followup. Medial sides of legs dark pigmentation.
Diagnosis?
a) Lymphadema
b) cellulitis
c) chronic venous insufficiency
d) renal failure
e) malignancy

🔴 12 years old girl with wide base gait, tip toe walking, loss of vibration
and proprioception, and upgoing planter.
Diagnosis?
a) Charcot mary tooth disease
b) fredrich ataxia
c) vitamin B12 deficiency

17) 3 years old child having yellow teeth, he is younger one out of three
children. What is the next step?
a) refer to dentist
b) supervised brushing
c) reassure as this is deciduous teeth
d) prescribing whitening paste
e) malnutrition assessment

18) 26 years old male presented with complaint of reduced interest in sex.
He went to gym and improved his muscle tone and gain some confidence
compared to his puny appearance before. Now he is thinking that getting
progesterone injections will improve his male appearance with masculinity
and sex drive. What will ne the next step?
a) refer to sex therapy
b) prescribe testosterone
c) prescribe sildenafil
d) advice about adverse effects of testestelevel
e) check testesterone level

16) 25 years old boy met with an accident 6 weeks back, after that he
used to count til 20 every few hours, unless he feels something bad gonna
happen.

He tried to avoid this ritual yet difficult to control. He is distressed and

difficult to find sleep.
What is the mx?
a) Sertaline
b) benzodiazepine
c) olanzepine
d) Sertaline plus benzodiazepine
e) olanzepine plus Sertaline

14) 26 years old female on etonogestrel implant for last 2 years and
having 18 months of amenorrhea. Now she is on relationship with new
partner for last 6 months and using condoms. Presented with 2 episodes
of post coital bleeding. Her cervical screening 2 years back was normal. In
addition to repeating cervical screening what should be done?
a) topical estrogen
b) Endometrial bx
c) replacement of implant
d) partner screening
e) USS

16 years old girl, used to wipe thrice with serviette after each mouthful
feed. Otherwise she feels something going to happen to her mother. On
further inquiry she knows that this is absurb but she can't avoid, therefore
she feels frustrated and avoiding family gatherings and social events.
What is the mx?
a) Sertaline
b) benzodiazepines
c) olanzepine
d) Mirtazepine
e) sodium valproate

11) 25 years old female admitted following RTA, she was on driver seat
with safety belt on. A van hitted on back of the car at 30km/hr. No LOC,
vitals stable. Discharged after observation. Next day morning she had
difficulty in extension and lateral flexion of neck. No issues with flexion.
What is warranting you for prompt action
a) difficulty in extension
b) difficulty in flexion
c) delayed onset pain

12) 72 years old male admitted with right hypochondrial pain, USS -
gallbladder shows lobules.
Admitted and started on antibiotics, pt started to deteriorated.
Consciousness dropping, oliguria and vitals dropping drastically. What will
be the NEXT APPROPRIATE step?

a) broad spectrum antibiotics

b) ERCP
c) Percutaneous cholecystectomy
d) open Cholecystectomy
e) Haemodialysis

13) 58 years patient, who is a keen golf player came with difficulty in
flexion, internal rotation of shoulder joint. Further investigation reveals
rupture of biceps tendon, and tear of supraspinatus identified. What is the
next step?
a) open tendon repair
b) MRI
c) physiotherapy
d) Corticosteroid

🔴A young female with a history of cocaine use presents with a seizure

attack and is diagnosed with an intracerebral hemorrhage (ICH). What
could be the likely cause of the intracerebral hemorrhage?
A) Hypertensive encephalopathy
B) Cerebral amyloid angiopathy
C) Arteriovenous malformation
D) Coagulopathy due to chronic liver disease
E) Ruptured aneurysm

🔴 pain in back during opening window and point tenderness.what to do

next
1.paracetamol
2.x ray
3.mri

🔴52 years old schizophrenic patient brought to ED by neighbors, saying he

was agitated in day and night and suspecting others are trying to steal
things from his house and shouting at times. Locking himself and cooking
after switch off fire alarm. He is on olanzepine 20mg daily.
What will you do?
a) add risperidone
b) add tamazepam
c) add sodium valproate
d) switch to haloperidol
e) switch to aripilrazole

🔴16 years old girl with hx of traumatic ICH following RTA 2 years before
come to GP to get prescribed COCP.
She had 5 seizures episodes following ICH and on carbamazepine 200mg
bd and fit free now.
What will you do?
a) Stop carbamazepine and add OCP
b) increase carbamazepine dose and low dose OCP
c) Increase carbamazepine dose and high dose ocp
d) switch to another antiepileptic and add ocp
e) advice on Condoms

🔴pt was admitted following RTA rib fracture, you prescribed sc 10mg
morphine, shortly pt again complaints that pain not settled. When
checking upon that you noticed nurse not given the morphine as she
thinks that dose was too high for him and she gave paracetamol. What will
be the next action?
a) complete the incident form
b) talk to nurse and explain the effects on patient because of her action
c) inform hospital director
d) inform APHRA
e) Confront her

🔴your colleague was attempting intubation on a dead patient due to

metastatic cancer. What will your action?
a) Ask him to get consent from family

b) its inappropriate to attempt intubation

c) can practice once transferred to morgue
d) send the relatives out of sight first
e) Inform APHRA

🔴6 yrs old having non itchy rash in back of neck. Fever, posterior cervical
lymph nodes. Otherwise examination normal. Management? Pic given
impetigo
a) topical mupirocin
b) cephelxin
c) prednsilone
d) Betamethasone

🔴5 yrs old child having rash on hand and foot. He is going to nursery thrice
a week. Fever, but vitals normal.
Pic given - hand foot mouth i guess
Mx?
a) paracetamol
b) aciclovir
c) cephelxin
d) flucloxacillin

🔴 52 years old man came to you following attempted to end his life. He
and his wife successfully running a interior design company. On further
quiry he is telling recently he is not interested in work, not going to golf
with his friends on weekends and worried that he got delayed with new
projects completion, pending works. And crying now he has lost his house
and no where to go after discharge. What is the condition led him to this
presentation?
a) ruminations of guilty
b) delusion of poverty
c) Paranoid delusion

🔴 25 years old on Mirtazepine, prescribed with tramadol for back pain. And
presented with anxious state
Which one of the following ensure the diagnosis ( symptoms and signs of
serotonin xn)
a) hyperreflxia
b) hypo mania

🔴 24 years female with rheumatoid arthritis on methotrexate and hcq

wants to get pregnant.
What will you do?
a) stop methotrexate and continue hcq
b) stop methotrexate & add leflonamide
c) stop both drugs
d) stop methotrexate
e) stop methotrexate and add adalimumab

🔴 pregnant pt came to GP for 1st antenatal visit. Other than that mild
nausea vomiting uneventful. Her weight today 107kg. Pre pregnancy
weight 109kg. Her height 162cm.
What is the goal of her weight through this pregnancy
a) not more than 500gm per week
b) not more than 9kgs weight gain through out the pregnancy
c) continue same weight throughout the pregnancy
d) maintain pre pregnancy weight
e) weight loss 1kg per week

🔴pt had schizophrenia now worse almost was on psychosis he was on

olanzepine
1.Inc olanzepine
2, add sodium valporate
3 heliperodol
4 resperidone

🔴48 y Female came with a breast lump RIS. on Ex- Arm tamp (Uss -given
castic lamp ¿ regular margmet) mamogram.Dense breast tissuet.
Dragnosis?
1.Fibroadenoma.
2. Fat Necrosis.
3. Carcinoma.
🔴38y male with fertility, decreased libido for em, came with
gynaecomastia. His Testosteron, FSH, LH - Normal what is the next
Investigation.
1. prolactin
2. TSH
3. MRI brain
4 LFT.

🔴 56 y female came with 3 episodes of mild vaginal bleeding

She is on HRT for hot flushes. was on ocP. No children. What is the most
likely cause for her vaginal bleeding
1.Nulliparity
2.HRT
3 .0CP

🔴Pt with osteoporosis had some vertebral fracture, minimal trauma. Urea
and create raised. What's the cause for the fracture
Renal osteodystrophy,
Osteoporosis
Malignancy
Multiple myeloma

Q. Patient Brought to hospital by his GF while investigating he says I love

you, Hove you l do do do do love you you are my life. What is the
diagnosis?
1. Hypomania
2. Mania - aggressive behaviours, flight of ideas, goal directed activities
3. Histrionic
4. Paranoid

Q. 52 years old Woman has post-menopausal symptoms, flushing,

increased pain on sexual intercourse etc. she has undergone
hysterectomy what would you prescribe her?
1. cops
2. topical estrogen
3. transdermal estrogen patch
4. estradoil (like

Q. Lower git bleeding. Endoscopy and colonoscopy done. Patient stable

but needs 2 pints of blood daily. Next?
1. Ct angio -
2. Capsule -
3. Catheter angio
4. RBC scan -

Q. Meningococcal exposure. Given prophylactic medicine. Reason?

1. To prevent symptoms developing in exposed
2. To prevent carriage of organism in exposed

Diagnosed pt with AAA on surveillance. Found 4 cm aortic aneurysm and

>3.5cm
infrarenal aneurysm. What to do?
a. Semi urgent repair-due to infrarenal aneurysm
b. Surveillance (every 6 months)
(need further intervention as 2nd aneurysm noted)

Q.

Patient on isotretinoin and on Implanon and no stock now wants to renew

her contraceptive but GP is away for 3 months.
hat's next?
1. Give condoms
2. Give Mirena
3. Give IUD
4. Give cocp
5. Depo

🔴Man is planned to travel to somewhere, endemic for .

Hookwarm infection 4 came to visit you asking precautions he can take,
1. Dont go bare foot 4 wear a footwear .
2. Avoid bath in common places.

Q. 29-year-old woman, gravida 1 para 0, comes to the office to establish

prenatal care.
Twhe patient is at 16 weeks gestation by a sure, regular last menstrual
period. She had nausea and vomiting for a few weeks, but her symptoms
have gradually improved. She has had no vaginal bleeding or cramping.
The patient has no chronic medical conditions and has not been taking a
prenatal vitamin bebuse she thinks it caused her nausea. She underwent
a cone biopsy 2 years ago for cervical intrepithelial neoplasia 3 but has
had no other surgeries.
Family history is significant for her sister developing gestational diabetes
mellitus during her last pregnancy. Temperature is 37C, blood pressure is
100/64 mm Hg, and pulse is 72/min. BMI is 22 kg/m'. Fetal heart rate is
140/min by Doppler ultrasound.Cardiopulmonary examination is normal.
The abdomen is soft, nontender, and nondistended. On pelvic
examination, there are no cervical lesions or abnormal discharge.
Uterine size is consistent with 16 weeks gestation. In addition to routine
prenatal care, which of the following additional interventions is indicated
in this patient?
A. Transvaginal cervical length measurement
B. No additional interventions indicated
C. High-dose (4 mg) folic acid supplementation
D. 24-hour urine protein collection
E. Early glucose challenge test

🔴Male presented with two day hx of melena, UGIE shows non bleeding
peptic ul He is on Asprin 100mg for cardiac stenting (duration not given),
and also has underg total hip replacement 7 days ago and not on any
medication for that but resolving & s to walk most appropriate mx plan
A. Stop aspirin
B.Stop aspirin and start LMWH
C. Change aspirin to rivaroxaban
D. Continue aspirin with follow up UGIE in 3month

🔴23 yr old motor cycle rider is brought to ED following accident , 6cm

laceration over the anterior aspect of tibia which is cleared deformed
Foot is well perfused,
Most app initial step in management?
a )iv antibiotics
B) fracture reduction
C)lavage
D)surgical debridement
E) tetanus toxoid

🔴Patient had waldenstrom macroglobulinemia in past now presenting with

cough and weakness that was treated with ampicillin. On follow up
granulomatosis on CXR. No pic given. Asking for cause?
a.sarcoidosis
b.Waldenstrom granulome as reactivation of previous condition
c. Tuberculosis d.Ampicillin induced reaction e.Pneumocystis

🔴 A Post sx of acute perforation appendicitis day 5 tenderness on medial

of wound incision. No fluctuation. Fever, tachycardia. What next?
A.CT abdomen
B.US abdomen
C.Blood culture
D.IV flucoxacillin

Q. Newly introduced mine which disposed waste in river caused new

cancer in children. What study
Case control
Cohort
Rct

Q. H/o melanoma male. Now avoids sun exposure. Got veg AFTER
melanoma diagnosis. What to check
Vit d
Calcium
vit d

Q. 38 F nulliparous stopped using ocp since 18 months. Now complaint of

menorrhagia. Menses after 21 days for 7 days? Fibroids present. No
mention of retaining fertility or desiring to get pregnant. Next step?
Myomectomy
Iucd
Endometrial ablation

Q. Ecg Tachycardia. C o chest pain now resolved. What to do next

24 hour ecg
Observe
Send home

🔴Male breast lump UL. Breast cancer in mother and maternal aunt
What to do
Usg
Fnac
Mammography

🔴 man is undergoing a vale replacement surgery because of severe mitral

regurg, what to do before surgery
1 - dobutamine perfusion scan?
2 mri heart
3 exercise induced testing
4 coronary scan or something
🔴A young female with a history of cocaine use presents with a seizure
attack and is diagnosed with an intracerebral hemorrhage (ICH). What
could be the likely cause of the intracerebral hemorrhage?

A) Hypertensive encephalopathy
B) Cerebral amyloid angiopathy
C) Arteriovenous malformation
D) Coagulopathy due to chronic liver disease
E) Ruptured aneurysm

child who has adhd features but history also included autism like features
that’s why not responding to stimulants and discontinued
methylphenidate

40 yr old lady on quetiapine, h/o psychiatric admission 3 months ago with

discharge with quetiapine after 15 days, now having delusions and
hallucinations again.

X-ray of hip joint.

She had pain on standing when she woke up in the morning.
What to give her that will help her .
Resperidone
Calcium
Vit d

65 f not passed urine since 8 hr , not passed stool since two days due to
pain during defecation. What best inv to diagnose

Picture looked like pyloric stenosis, passed urine 50ml/hr after intial
resuscitation. How much potassium supplement?

Metaplasia of 6cm. On repeat endoscopy and biopsy high grade

metaplasia what will you do?

Pregnancy related anxiety

Metastatic ca lung.severe electrolyte imbalances. Ca 3.6 despite

correction. What will you give additional to iv fluids

Same male complaining about aboriginal ppl being lazy qsn

Impetigo qsn

35yo with father with ca colon before 55 and materal aunt with ca colon.
What will you do

Adhd

Ant social

Hyphema . Appropriate step before optho consult

Concentric rings on endoscopy. Appropriate management

Preganant female with high bp

Bleeding of 1000ml in female. Which of the following confirms diagnosis

-increased maternal hr
Increaded fetal hr
Decreased maternal bp
Abnormal placentation

Bartholin cyst

Gangrenous appendicitis underwent ot uneventful post op and discharged

on pod3 present after 1 week with fever and tachycardia
Mild basal crepts
What next inv ?

stat qsn i think vape user of more than 5 days per week is associated
respiratory symptoms was answer
It was forrest plot

Submandibular swelling without symptoms. Next best inv?

25yo with back pain after lifting wt. tenderness on palpation. No other
symptoms. Appropriate mx?
Lichen sclerosis. Inv?

8 yr Child with mother. Mother asking when can vaccinate?

-now
-after 10yr age
-after menopause
-after 1st intercourse

Nodular lesion in penis. Similar lesions on hands and groin. Diagnosis?

Heavy menstrual bleeding in 35yo. Previous fertility inv reveal submucosal

fibroid. Next best management?

Vestibular neuritis

Uppper pole stone of 1.5 cm

Psgn

80yr old male with uti. Mx

Icu pt. Central catheter inserted. Decreased bp. Deviation of trachea

towards right. Dull on ant and post percussion on left side. Diagnosis?
⁃ hemothorax?

1. Same question about woman taking cocaine:

A) Hypertensive encephalopathy
B) Cerebral amyloid angiopathy
C) Arteriovenous malformation
D) Mycotic aneurysm

2 Child was on methylphenidate, whats the diagnosis: ADHD

3 Impetigo: School exclusion

4 Impetigo: Treatment

5 The case about racist, what to do:

A. Freedom of speech
B. Tell him keep your opinion is not welcome
6 Case about 2 years with Depo but amenorrhea for 18 months: what to
do - I answered replace depo

7 Barrett’s Disease- high grade dysplasia

8 Barrett’s Disease- monitoring of 4cm with no dysplasia

9 Multiple myeloma versus Uremic Dystrophy

10 6 weeks post partum mother, discontinue breastfreeding 2 weeks ago,

having signs of psychosis, what to give?
A: Quetiapine
B. Lithium
(I forgot the others)

11 Metastatic lung cancer having mass on right lung field for surgery, Ca-
2.9, what will you add to patient before surgery?

12 Post Operative Fever Day 5, after gangrenous appendicitis, what’s the

diagnosis?

13 Post Operative Fever Day 10, after gangrenous appendicitis having

bilateral crackles, next investigation?

14 Forrest plot

15 8 year old child when to give HPV vaccine

16 Submandibular swelling without symptoms. Next investigation?

17 28 years old, Submucosal myoma, best treatment?

18 15 years old boy, BMI of 20- 95th percentile

19 abdominal aortice aneurism surveillance. 4.8

20 lesion between the 4th and 5th toes: - i answeres small vessel
disease