Get more from MplusX QBank (https://member.mplusx.

com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

July 2019 recalls.

5 year old boy with history of soiling. Mother complaint that he soiled his pants every day for the past 2
months. Teacher said he acts immaturely compared to other children. What's the most likely diagnosis?

A. Constipation

B. Sexual abuse

C. Gross developmental delay

D. Autistic spectrum disorder

As an intern, you find out that a medical student is getting information about a patient through the
patient's medical records. When asked, he said the patient's relative who lives oversea wants to know
about it. What will you do?

A. Counsel the medical student that this is not allowed

B. Inform the medical board

C. Report to medical university

A general practitioner is doing a research related to the unprotected sex. She is asking for the medical
record from the nearest other general practitioners. What will you do as a general practitioner?

A. Ask for the research study approval

B. Give de-identified records

C. Consent from the patients must be obtained first

Patient with diabetes mellitus for many years come with blurring of vision. Fundoscopy of the both eye
shows as the following pictures (right and left eye) respectively.

A. Multiple sclerosis

B. Diabetes retinopathy

C. (Something) Glioma

D. Occipital tumour

E. Optic nerve (something)

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

32 week gestation pregnant woman presents with low level of Anti D antibodies. She received ant D
immunoglobulin at 28 week gestation. What's the next management?

A. Give the anti D immunoglobulin

B. Review in 2 weeks

C. Fetal ultrasound

Patient with purulent discharge from the perianal region. On examination, seen as the picture
(following) and the anus in the right lower region of the picture. What's the diagnosis?

A. Crohn's disease

B. Pilonidal sinus

C. Thrombosed external hemorrhoid

D. Chronic anal gland sepsis

A woman with dizziness showing ECG. She is taking digoxin, ramipril,

atorvastatin and aspirin. What's your next step in management?

A. Cease digoxin

B. Permanent pacemaker

C. Cease ramipril

(No temporary pacemaker in option)

Woman with central chest pain radiating to the back. She has hypertension. On radiology, aortic
dissection is seen from the left subclavian and re-emerge into femoral artery. What's your next
management?

A. IV nitroprusside

B. IV beta blocker

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

https://emedicine.medscape.com/article/2062452-treatment#d8

A study in a population of 200 about Blood pressure (, blood glucose level and another) in 2009 and
2010. What's the incidence of the blood pressure (>140/90) in population of 1000 in 2010?

2009 2010

Blood pressure (>140/90) 45 50

Blood glucose level (53) (64)

A. 5

B. 25

C. 50

D. 225

E. 250

Patient with loss of vision for 4 days. No history of trauma. He has hypertension on examination, BP is
160/90 mmHg. What's the most likely diagnosis?

A. Retinal detachment

B. Cerebral artery infarct

C. Chronic retinal vein occlusion

D. Vitreous hemorrhage

A patient is waiting next to talkative schizophrenia patient. He complains about that to you. What
should you do?

A. Make the schizophrenic patient wait in severe psychiatric patients waiting room

B. Arrange the different schedule for each of them

C. Confronts patient's concern

D. Tell him that the patient is schizophrenic

A 32 year old woman is planning to get pregnant. Milky discharge can be expressed on squeezing the
nipple. On CT, there is 1.5cm mass seen in pituitary area. What's next best step?

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

A. Transphenoidal surgery

B. Clomiphene citrate

C. Bromocriptine

Patient with low grade fever, cough for 3 weeks and weight loss of 3 kg over 2 months presents to clinic.
X-ray of the patient. What's your next step?

A. Mantauox test

B. TB quantiferon gold test

C. Sputum for AFB

D. CT chest

A woman come to clinic for screening of thrombophilia. She turns

out positive for factor V Laiden deficiency. What's your
management?

A. Aspirin

B. IV heparin

C. Subcutaneous enoxaparin

D. Warfarin
No treatment if asymptomatic

july 2019
Long flight history of 35 years man with chest pain .ECG —-sinus tachycardia or may be RBBB but
no st elevation
A.troponin
B.ctpa
C echocardiography
B d dimer

July 2019

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

18/07/2019
Patient had chest pain and SOE.All other test normal.Troponin normal.chest normal. Ask management?

Patient had chest pain and SOE.All other test normal.Troponin normal.chest normal. Ask management?

Also like chronic or acute lymphoma, Hematology questions, Got the q about comparing two
Hypercholesterol drug study.

Man with wrist pain at night for 12 months, pins and needles, also had feeling defect on inner palm and on
three fingers of the hand, Pain on wrist flexion.Diabetes controlled by dietary What Is next?

MRI brachial plexus.

CT spine

Nerve conduct

HbA1c /

3 year child chest cray shows right lower job pneumonia. Physical signs and symptoms consistent to
pneumonia.Asking organism?

S pneumoniae

S aureus

Mycoplasma

etc.

What drug to stop one week before surgery?

ibuprofen

Statins

One ACE drug

metformin

Vetenarian, Malaise, only lymphadenopathy in axillary region.No fever no sore throat mentioned No H/O
travel or sexual contact. What's Do?

Cat scratch disease

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

Lymphoma

Infectious mononucleosis

One Dr need to do some research and need clinical access of your patients. What should you do?

1Inform your patient about study

2 give the access

3 only can review clinical record at clinical under supervision

24 years old woman Amenorrhea for 12 months. Menarche 13 years. Previous regular menstruation. FSH and
LH greatly increased. Estrogen decreased. TSH normal. Prolactin normal.Ultrasound 3-4 cysts each side.Ask
Dx?

POCS

Premature menopause

Pituitary adenoma

Primary hypothyroidism.

Old man schizophrenia or Almezeimer brought to ED die to confusion and high BP. A few weeks ago he was
admitted and had BP is 170/90 and 155/ 80 with 5 mins interval. When he was discharged in his record
saying follow up with mental health team.

What cause his Hypertension treatment delay?

Stigma

He doesn't have GP

His discharge record didn't mention follow up

Women with Parkinson was taking levodopa. Abdominal pain, distension and no flatus. HAd H/O
appendicectomy 30 years ago.Had X Ray showing Bowel obstruction. What is the cause?

Adhesion obstruction

Drug induced pseudo obstruction

Cancer of colon

A 60yrs of age man was found fallen on bathroom floor with dizziness but was conscious with a

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

history of poor stream urine and difficulty in micturition and brought by his wife to ER.He has a

history of HTN and DM..his BP is 165/85 and pulse is irregular.ECG showed AF.what

investigation will you do as next most appropriate?

A.blood glucose

B.troponin

C.holter monitoring

D.echo

2 year child h/o fever since 1 day dry cough, mother concerned about infection.

O/e- child afebrile, no wheezing, mild dry cough, nasopharynx looks normal. Management

A- oral amoxicillin

B- salbutamol nebulisation

C- observe at home, consult if gets worsening

D- nasopharyngeal aspirate for viral screen

ECG-AF Question, Next investigation

2D ECHO

REPEAT ECG

TROP

STRESS TEST

Ethical question scenarios

1- man got tested positive for gonorrhea, what is the best way to manage his partner

1-ask pt to share his results wid partner

2-inform partner yourself

3- write a prescription for the partner and hand over to patient

4- ask the patient to bring his partner so you can test her

Boyfriend got German Shepherd, your patient has fear of dogs and wishes to get better. Mx?

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

Tell her to:

A)Watch video of dogs

B)Listen to dog baking audios

C)Look at dog pictures

D)Volunteer at dog shelter

Nurse confides to you a romantic patient relationship. What do you do?

A)Inform APHRA

B)tell her to stop

C)Write a diary with details

MI 2hr evolution, given o2 morphine and nitrate. Very taquicardic on ECG. Next management?

A)transfer to catheterization

beta block

C) Amiodarone

D) Adenosine

Tracoma Treatment of index case

A) azithromicin

Doxicilin

C) Metronidazole

D) throughly wash hands and face

Immigrant with suspected TB, O2sat 93%, dyspnea, dehydrated.

Already did x-ray and sputum for culture. Asking for next best managemtne.

A) ABG

MANTOUX

C) MRI

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

20 year man consulting asking for yellow fever vacvine before his travel, you have adviced him to take other
vaccines as well but he insists only on yellow fever vaccine. What will you do

A- give him onoy yellow fever vaccine

B- give him written text about other risks and vaccination and arrange for another consult

C- ask him to consult another doctor

D- insist on explaining benefits about other vaccines

Pneumothorax 15% asymptomatic. Mx?

A)Review in 24h

B)Admit for observation

C)Chest tube

Red inside under lids, no pain, no itch, tearing up a lot. Treatment? (Photo on comment)

A)Prednisolone

B)Hipemellose

C)Chloramphenicol

Graph asking where would there be no false negatives at the top limit of Antigen level from certain study
analysis. (Photo on comment)

Partogram as soon you open membrane

Drop FHB by 40bpm

Cause

Cord prolapse

Uterine rupture

Placental abruption

Maternal hemorrhage

...

36 woman with breast biopsy atypical ductal cells. Management?

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

A) Mass excision

Mamography in 3 months

C) Usg in 3 months

D) Mamography 1 year

E) repeat biopsy

Male with breast lump, usg with hipoecoic mass 3cm.

Management?

A) biopsy

Fine needle aspiration

C) follow up 3 month w usg

D) follow up with mamography

Guy with gynecomasty, chronic alcoholic, liver palpate 4cm from margin, and a miscelania of sx... cause for
gynecomastia?

A) testicular teratoma

leyg testicular tu

C) Alcoholic liver Disease

---------------------------------
25 years Female with genital herpes, completely treated by famciclovir. What will b ur advise?

A. Abstinence of sex for 3weeks

B infective for future partners ??????

C treating all partners she have relationship with them

D continue antiviral 2 weeks more

E nothing to be done

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

Old man schizophrenia or Almezeimer brought to ED due to confusion and high BP. A few weeks ago he was
admitted and had BP is 170/90 and 155/ 80 with 5 mins interval. When he was discharged in his record saying
follow up with mental health team.

What cause his Hypertension?

A. treatment delay

B.Stigma

C.He doesn't have GP

D.His discharge record didn't mention follow up

Man with wrist pain at night for 12 months, pins and niddles, also had feeling defect on inner palm and on
three fingers of the hand, Pain on wrist flexion.Diabetes controlled by dietary What Is next?

MRI braquial plexus.

CT spine

Nerve conduct

Hactb1

History of delivery of 2.5 kg baby, had first degree perineal tear that did not require repair, complete
placenta was extracted and lochia was gradually decreasing,suddenly she developed fresh bleeding on fifth
day post partum, no fever. Cause asked?

a. Retained products of placenta

b. Endometritis

c. Vaginal tear

d. Cervical trauma

e. Infected wound

A 58 year old male with Churg Strauss Syndrome presents with a cough productive of green sputum with
occasional haemoptysis. He has chronic kidney disease stage 3. He is currently on long term steroids. On
examination he appears relatively well. There is evidence of left basal crepitations and bronchial breathing
and he has a respiratory rate of 20. His temperature is 37.8. Oxygen saturations are 97%. His heart rate was
90 and Blood pressure 120/70 mmHg. A Chest Xray reveals left basal consolidation. Given the most likely
diagnosis, what is the most appropriate management?
A Oral Amoxicillin and Increase steroid dose

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

B IV amoxicillin and Increase steroid dose

C IV steroids
D Oral Co-amoxiclav and Increase steroid dose
E Oral Co-amoxiclav and Clarithromycin

6mth child with wheezing, fever, tracheal tug, sub costal recession, nasal discharge. What will you do to make
Dx

A- CXR

B- Sputum Cx

C- Blood Cx

D- Nasopharyngeal aspirates for PCR

A patient in labour had cord prolapse, you pushed cord inside with your finger and planned to move the
patient to emergency operation theatre, but you get to know that the theatre is busy meanwhile what will be
your next step?
a. Antibiotics
b. Salbutamol inhalation
c. Subcutaneous terbutaline
d. Dexamethasone
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6109652/

4 yr old child with mild symptoms of URTI. Urine analysis showed RBC ++, no leucocytes. No other complains

Next?

a. Repeat test in 2 weeks

b. Dexamethasone

c. Ultrasound

19 year old boy having problem in staying calm from a day, when he sits he wants to get up & move
around.he is receiving his fortnightly zuclophenxitol injection. Management??

1-diazepam 2-methyaphenadite 3-benztropine

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

There was single lead Ecg showing normal rate and rhythm and then a long drop and then normal again.
Patient was a suspected case of aortic stenosis and Ecg taken while pressing over the carotid artery. What
should be your immediate step ?

a. Immediate cardiac catheterization

b. Echocardiography

c. Troponin

d. Holter monitoring

https://emedicine.medscape.com/article/150638-workup

scenario of severe croup with harsh cough and stridor and use of accessory muscles at rest,,o2 saturation is
95% at room air what is your NEXT APPROPRIATE INITIAL MANAGEMNT:

-supplemental o2

-iv mythelpredinsolone -oral steroid -nubulized sulbutamol

32 year old woman presented to you asking your advice .she told you that she is about to start working
permanent night shift .she worried if she will have vitamin D deficiency , previously she was a very active and
sports in solar days .she is fair in complexion. what is your most appropriate action?

A-prescribe her oral vitamin D

B-measure her vitamin D level

C-advise her about appropriate level of sun exposure

D-ask her to eat vitamin D rich food

A 28 year old married female complains of difficulty conceiving. Normal PE. FSH –low Estrogen- normal,TSH-
low,LH-low,Prolactin-normal, All blood chemistry normal

A. Pituitary macroadenoma

B. Pituitary microadenoma

C. Hypothalamic axis dysfunction

D. PCOS

baby in foster care from 6 months. Now he is 3 years old. He plays with his toys and plays by

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

himself. Throws tantrums. When he sees you he comes and hugs u. Dx?

A) ADHD

B)Asperger

C) Autism spectrum disorder

7. Old woman with a history of type 2 diabetes presents with an ulcer on great toe that is oozing yellow fluid
with pigmentation on dorsum of foot. What is the next step in management:

A. MRI

B. Oral antibiotics

C. IV antibiotics

D. Topical cream

6month old baby with dilated bilateral PUJ. Investigation

a. Micturating cystourethrogram

b. IVU

c. DTPA

d. DMSA

Patient with loss of vision for 4 days. No history of trauma. He has hypertension on examination, BP is 160/90
mmHg. What's the most likely diagnosis?

A. Retinal detachment

B. Cerebral artery infarct

C. Chronic retinal vein occlusion

D. Vitreous hemorrhage

A 32 year old woman is planning to get pregnant. Milky discharge can be expressed on squeezing the nipple.
On CT, there is 1.5cm mass seen in pituitary area. What's next best step?

A. Transphenoidal surgery

B. Clomiphene citrate

C. Bromocriptine

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

25 years Female with genital herpes, completely treated by famciclovir. What will b ur advise?

A. Abstinence of sex for 3weeks

B infective for future partners

C treating all pateners she have relationship with them

D continue antiviral 2 weeks more

E nothing to be done

A-71-year-old male with significant cardiac history presented with painful, erythematous, oedematous and
warm right

lower leg. He does remember walking over a piece of glass in the bush three days ago. He is not allergic to
anything.

On examination right lower leg feels warm and looks erythematous without calf tenderness. What will you do
next?

a. Intravenous flucloxacillin

b. Oral flucloxacillin

c. Co-amoxiclav

d. Metronidazole, gentamicin and ceftriaxone

e. Topical antibiotics and daily dressing

18months old child with harsh cough, inspiratory stridor, fever of 38C. how will u manage’

a. Nebs with salbutamol

b. Oral prednisolone

c. Antinbiotic

d. Iv dexamethasone

U will give a lecture to a class, 13 y, sex already was covered wt will u give

A. Alcohol

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

B. Avoidance of acne

C. Regular check for skin cancer

A)An 18 years old girl came to your clinic Monday morning with history of missed pill on Friday and had
sexual intercourse early morning Saturday with split condom. Today is 17th of her cycle and she was on
combined pill. She asked for emergency contraception. How you will advise her?

1.Give her emergency pills

2.Reassure her as it is only one pill

3.Mirena (LNG-IUS)

4.Copper IUCD

5.Advise to come later for TOP

A 35-year-old man is admitted to intensive care unit with severe sepsis. Thyroid function tests suggest the
presence of a sick euthyroid state.

Which of the following is the least likely finding in this situation?

a. High T4

b. High T3

c. Low T3

d. High TSH

e. Low TSH

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

https://www.msdmanuals.com/en-au/professional/endocrine-and-metabolic-disorders/thyroid-
disorders/euthyroid-sick-syndrome

Food allergy occur at the party where 20 people attended.

Food items Symptom Occurred Non-symptom No. of people
BBQ chicken 2 9 11
Cheese cake 10 2 12
@@@ 10 8 18
Egg salad 7 10 17
Frozen berry smoothie10 10 20

Which is the likely source of food poisoning?

A- BBQ chicken
B- Cheese cake
C- @@@ (sorry can’t remember this one)
D- Egg salad
E- Frozen berry smoothie

Patient taking warfarin. Now have cough since two

Days. And pain and swelling in right iliac fossa. There were no bowel symptoms mentioned.

Whats the most likely diagnosis

a. Rectus sheath heatoma

b. Cacal volvulus

c. Colonic cancer

Long flight history of 35 years man with chest pain .ECG —-sinus tachycardia or may be RBBB but no st
elevation

A.troponin

B.ctpa

C echocardiography

B d dimer

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

Patient is planning a trip to Bali. Which of the following advice will reduce the mortality?

a. Eat cooked food

b. Avoid mosquito bites

c. Advice to get all vaccines

Man who smokes 35ciggerates per day, 6 standard drinks per day, presented with dealy bilateral pain in
bilateral legs on walking 100m on even ground 20m on irregular ground, pulses are palpable, investigation?
a. MRI lumbosacral spine
b. Xray spine
c. Arterial doppler
d. Arteriography

A child 5 years old presented in general practice with history of fall, onset of severe headache and vomiting.
What will your next step in management?

a. Ct scan

b. Arrange ambulance and refer to hospital immediately

c. Keep him in clinic for few hours in observation

A Caucasian female presented with pain in upper abdomen. Investigation has shown solid lump of 3cm in the
left lobe of liver. Whats the most likely diagnosis?

a. Hepatoma

b. Metastatic deposit from stomach

c. Metastatic deposit from colorectal cancer

d. Hydatid liver disease

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

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

C. Use both paroxtine and escitlopram

D. Use escitlopram
E. No medication

old Woman 71 years old with constipation and didn’t pass flatus since three days abdominal distention
nausea without vomiting with hx of appendectomy when she was 30 years with a reducible inguinal hernia ,
what is the cause

a. colon cancer

b. adhesional obstruction

C. obstructed hernia

d.fecal impaction

DM patient with ulcer on foot since two months. Bilateral dorsalis pedis not palpable.

Again presented with purulent discharge from the wound. What will u do next?

a. Duplex ultrasound legs

b. Swab for culture and sensitivity

c. ESR

d. MRI foot

A young man with history of stab wound in chest presented in ER. He was conscious and answering your
questions, his breathing become faster and labored, bp 85/69 and pulse 125. There was a laceration on back
of left side of chest between 5th and sixth rib. Dullness on Ieft lower chest. IV line passed and resuscitation
started. What’s next step?
a. Oxygen
b. Endotracheal intubation
c. Chest tube with underwater seal
d. Cover the wound with occlusive dressing
A man with sudden onset of severe pain since few days in right hand at night, and he feels his hand weak.
And numbness in lateral part of hand, whats the most likely diagnosis?

a. Carpal tunnel syndrome

b. Axillary vein thrombosis

c. Brachial plexus injury

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

There was single lead Ecg showing normal rate and rhythm and then a long drop and then normal again.
Patient was a suspected case of aortic stenosis and Ecg taken while pressing over the carotid artery. What
should be your immediate step ?
a. Immediate cardiac catheterization
b. Echocardiography
c. Troponin
d. Holter monitoring

women 30weeks of gestation urine culture positive for grp b streptococcus at 30wkgestation no urinary prb
frequency, dysuria urgency nothing nxt mx

a.penicilin during labour

b.nitrofurantoin

c.cephalexin

d.do vaginal swab

e.follow up

10yr old boy who has recent onset of enuresis. The doctor calls his parents for assessment. They have
separated for 3 months. In the interview, the father tells you that he intends to hide his assets from his ex
wife during the divorce. What should you do? a. Inform the mother b. Do nothing c. Inform the registrar at
the family court d. Tell the father, it is because of him that the boy was affected

Pharmaceutical company approaches u with results of comparison between 2 drugs for hyper
cholesterolrmia, wat is d important question u wil ask A- wether same dose of dugs wer used B- wether 2
grp s contained d same no of people C- how did u equalise d dietary factors

there was another option d) is there a placeboWomen 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 Young girl 14 requesting for contraceptives ...boyfriend 15
years,no contraception A.give contraceptives B.inform mother C.assess risk of std D.refuseYoung girl

Sickle cell trait 24 yrs old after airplane travel severe pain in all joints and muscles no resp symptoms
,what next

A) O2

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

B)Analgesic

C)Lmvh plasma pharesis

D) red cell transfusion

Child with harsh cough 3 weeks, no wheeze. . What should be done now?

a.Nasopharyngeal PCR
b.Pertussis serology
c.Throat culture

A pregnant lady came with severe frontal headache at 26 weeks. Her BP was 80/50.No uterine tenderness
or bleeding.

A. SAH

B. Pituitary apoplexy

C. Abruption D.
Preeclampsia

https://emedicine.me
dscape.com/article/1
198279-clinical#b5

Man complainted of 3 months history of progressive dyspnea and cough intermittent flank pain and
heamaturia. Increased serum calcium. most app next inv?

1.ace 2.ct chest 3.urine calcium 4.anti gbm ab

An old woman came with complaint of centre abd pain, vomiting. On examination abdomen is not
distended .She was on anti parkinson drugs levodopa carbidopa and had surgery appendectomy 20yrs
ago. Xray showed following. What could be the likely cause?

a. Drug induced Pseudo obstruction b.

Adhesions c. Sigmoid volvulus D.sigmoid
cancer

Truck driver having on and off abdominal pain and bloating for the last 12 months , sometimes he has a foul
smelling diarrea , he had a colonoscope since 1 year and it was normal wts best nest step ?

a. Repeat colonoscopy b. Stool culture

for ova and parasite c. Abdominal
ultrasound d. Sigmoidoscopy e. CBC

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

Truck driver having on and off abdominal pain and bloating for the last 12 months , sometimes he has a foul
smelling diarrea , he had a colonoscope since 1 year and it was normal wts best nest step ?

a. Repeat colonoscopy b. Stool culture

for ova and parasite c. Abdominal
ultrasound d. Sigmoidoscopy e. CBC

MVA scenario of young male with a duration of unconsciousness after accident but he is alert now,BP
70/40 and after resuscitation was the same 70/40,next step?

A)FAST B)ct
abdomen
C)laparotomy
D)laparoscopy

19 year old boy having problem in staying calm from a day, when he sits he wants to get up & move
around.he is receiving his fortnightly zuclophenxitol injection. Management??

1-diazepam 2-
methyaphenadite 3-
benztropine

To evaluate a lady for psychiatric disorder you ask about family history of similar problem She says... let me
tell you something about whales,describes features ,my father did fishing and then says wait,what were
you asking me,oh we were all sane in the family So comes back to the question asked.

A. derailment B.
Tangential C.
Circumstantialty D.
Irrelevant talk E.
Dossociation

35 yr old lady came with features of depression , recently divorced from second marriage as her husband
abused her. She had problems with first husband who left her after 4 year of troubled marriage. She feels
better when she is at home with her mother and currently she is living with her mother. A.Antisocial
Personality Disorder B.Borderline Personality Disorder C.Bipolar Personality Disorder D.Dependent
Personality Disorder The question did not say anything about her behaviour of self harm or splitting but said
bad things about both husbands

A girl brought an old man who has dysphasia,dyscalculia,Right left disorientation,he is heavy smoker(30
pack year) and drinker.what is diagnosis

a.temporal metastasis
b.vermis carcinoma c.frontal
meningioma d.glioblastoma
multiforme

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

https://www.ncbi.nlm.nih.g
ov/pmc/articles/PMC40066
25/

Smoker pt with enlarged submandibular gland..asked examination of which will help in diagnosis
A.tongue
B.submandibular gland

15month Child missed vaccinations because of urti

A.recomence all missed vaccines and review after 3 months

Mva pt came with severe chest pain bp norma.cxr showing widened mediastinum and tracheal deviation
A.pneumothorax
B.aortic rupture

Child with dehydration signs.next?

A.iv fluids
B.ng feeding

Stab wound q from amedex qbank

Chest injury with knife penetrating the chest wall .managment?
A.cross match
B.take out knife

Sigmoid volvulus sceneio.ioc?

A.gastrografin
B.ct abdomen

Af ecg.bp unstable
Dc cardioversion

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

Placntal abruption scenario,next step in managment

A.resusitation
B.urgent c-sec

Smoker with raynaud phenomenon.diagnosis

A.beurgers disea
B.scleroderma

Pt on sertaline for months or yrs ,recently taking tramadol folling some accident.secnerio of serotonin
syndrome
A.stop tramadol
B.stop sertaline
No option for stopping both

Dumping Syndrome scenario fro amedex qbank

Nnt q on stats

Vitamin c q stats
A.random sampling
B.randomisation

Psychiatric pt asking u to witness his will

A.refuse
B.witness in the presence of lawyer
C.take legal advise

Crao fundo image,pt presented after two hrs i gues

A.iv acetzolamide
B.massage

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

Girl pulled out all of her eyebrows saying she feels relieved after doing that
A.obssesion
B.complulsive rituals

52 male saying that he is worried he might have prostate cancer

A.do psa
B.pschiatric assessment

Ct scan with apple core,pt on warfarin

A.give ffp and do urgent surgery
B.give vit k and do urgent surgery
C.elective surgery

Pituarty adenoma 3mmsize i guess

A.bromcriptin
B.trans sphenoidal surgery

2 scenarios on diabetes screening

1. Young patient with a hx of upper Gi bleeding secondary to oesophageal varices, band ligation
already done twice. Which of the following will be the procedure of choice with least chances of
hepatic encephalopathy?
a. Octreotide
b. PPI
c. Transjuglar intrahepatic shunt
d. Distal splenorenal shunt
e. Re-endoscopy

2. picture of erythema nodosum. Patient had fever, cough and development of erythematous
lesions on legs, whats the most likely diagnosis?
a. Ca lung
b. Sarcoidosis

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

3. Scenario of man with agraphia, acalculia, left right disorientation,

Whats the most likely diagnosis?

a. Azheimers
b. Lewy body
c. Vascular infarct
d. Tumor in parietal lobe

4. Patient is planning a trip to Bali. Which of the following advice will reduce the mortality?
a. Eat cooked food
b. Avoid mosquito bites
c. Advice to get all vaccines

5. Female with the history of broken relationship. Had attempted suicide. What is going to help her
the most?
a. Interpersonal therapy
b. CBT
c. Dialectical behavioural therapy

6. 57 year old man on thiazide, metoprolol and lisinopril, presented in ER. Ecg done, showing third
degree heart block. What will be your next action
a. Cease metoprolol
b. Start digoxin
c. Stop all meds

7. Ecg showing inf wall MI. what will be your next step in management
a. Oxygen
b. GTN
c. Angiography and angioplasty
d. Thrombolysis

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

8. Two siblings in a family developed whooping cough, they have 2weeks baby in their family.
Parents are against giving vaccines or medications to their children. What will be your advice to
the parents
a. Bring baby to hospital if he develops cough
b. Isolate the two siblings having cough
c. Isolate the baby

9. 18months old child with harsh cough, inspiratory stridor, fever of 38C. how will u manage’
a. Nebs with salbutamol
b. Oral prednisolone
c. Antinbiotic
d. Iv dexamethasone

10. There was single lead Ecg showing normal rate and rhythm and then a long drop and then
normal again. Patient was a suspected case of aortic stenosis and Ecg taken while pressing over
the carotid artery. What should be your immediate step ?
a. Immediate cardiac catheterization
b. Echocardiography
c. Troponin
d. Holter monitoring

11. 67 year old lady while applying eyeliner, noticed that there is a spot in front of her eyes and
some lines too. What will be your next step?
a. Tonometry
b. Amsred grid
c. Slit lamp examination
d. Peripheral eye field exam

12. Baby with dry cough since two weeks. Scenario looked like of pertussis. Investigation asked
a. Serology
b. Nasophryngeal aspirate
c. CBC
d. Chest xray

13. Patient with left upper quadrant pain. Was alright before. Ct scan done showed. Whats the
diagnosis?

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

a. Ca head of pancreas
b. Adrenal hemorrhage
c. Cholelithiasis
d. Left kidney tumor

14. Patient had a trip to Thailand, she also developed dark coloured urine and jaundice. What will u
order next?
a. Ultrasound of abdomen
b. MRCP
c. ERCP
d. CT scan abdomen

15. 68 year old man with bilateral cogwheel rigidity, bradykinesia. Also had hx of visual
hallucinations. What’s the most likely diagnosis?
a. Parkinson’s disease
b. Frontotemporal dementia
c. Lewy body dementia
d. Alzheimer’s disease
e. Brain infarct

16. A 60-year-old woman presents after an episode of sharp pain under her right costal margin. The pain was
constant and lasted several hours before resolving spontaneously. The woman enjoys good health and does not
take any medications. She has a twenty pack-year smoking history and drinks about two glasses of wine most

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

days. The physical examination is normal. An abdominal ultrasound

examination is performed and is pictured. Which one of the following is the
most likely diagnosis?
a. Hepatic focal nodular hyperplasia.
b. Hepatic metastatic deposits.
c. Hepatic hydatid cysts
d. Hepatic simple cysts.
e. Gallstones in the gall bladder

(this q from Hb was exactly the same)

17. DM patient with ulcer on foot since two months. Bilateral dorsalis pedis not palpable.
Again presented with purulent discharge from the wound. What will u do next?

a. Duplex ultrasound legs

b. Swab for culture and sensitivity
c. ESR
d. MRI foot

18. 3.5 year old child with bilateral pain in the legs
Mostly during night. Now presented with upper

Respiratory tract infection. No fever no pain no

Limping. Whats the investigation?

a. Xray bilateral hip

b. CBC and CRP
c. No investigation required

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

19. Patient taking warfarin. Now have cough since two

Days. And pain and swelling in right iliac fossa. There were no bowel symptoms mentioned.

Whats the most likely diagnosis

a. Rectus sheath heatoma

b. Cacal volvulus
c. Colonic cancer

20. A question on choice of contraception in a patient taking phenytoin

a. DMPA
b. COC
c. POP
d. Mirena

21. A man with sudden onset of severe pain since few days in right hand at night, and he feels his
hand weak. And numbness in lateral part of hand, whats the most likely diagnosis?
a. Carpal tunnel syndrome
b. Axillary vein thrombosis
c. Brachial plexus injury

22. A man with pain in the shoulder, limited abduction, sensory loss on lateral part of arm. Whats
the cause?
a. C5 nerve root
b. Brachial nerve injury
c. Polymyalgia rheumatica

23. A young man with lower back pain , no improvement in pain with naproxen and physiotherapy,
xray given. Whats the appropriate advice?
a. Methotrexate
b. Infliximab
c. Prednisolone
d. Codeine

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

24. An old aged man taking antiparkinsons drug, presented with abdominal distension, no
tenderness. Xray looked like colonic psuudoobstruction to me

25. Man who smokes 35ciggerates per day, 6 standard drinks per day, presented with dealy bilateral
pain in bilateral legs on walking 100m on even ground 20m on irregular ground, pulses are
palpable, investigation?

a. MRI lumbosacral spine

b. Xray spine
c. Arterial doppler
d. Arteriography

26. 36year old man with hx of trauma to left knee, immediate pain swelling ldeveloped later and
then resolved but later had locking, what test will elicit the injury?
a. Anterior drawer test
b. Posterior drawer test
c. Sag test
d. Grinding test
(ACL injury)

27. A 56 yr old man with hx of cholecystectomy and appendicectomy, now presented with
abdomninal distension and constipation since 3weeks, he had been well previously. On
examination abdomen is distended and empty rectum Imaging done showed dilated
ascending,transverse and descending colon. Whats the most likely cause
a. Colonic volvulus
b. Ca cecum
c. Adhesive small bowel IO

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

d. Sigmoid colon cancer

28. Patient presented with palpitations and anxiety, ECG given that showed atrial fibrillation. What
wil u test next?
a. Troponin
b. Echocardiography
c. TSH
d. Angiography

29. Postmenopausal lady presented with bleeding per vaginum. Her pap done six month back was
normal. What can be the cause?
a. HPV
b. Endometrial cancer
c. Chlamydia trachomatis

30. A nurse had undergone hpv test, it showed LSIL. Whats next?
a. Repeat hpv after 12months
b. Pepeat hpv and co test after 12 months
c. Colposcopy

31. Xray showing sigmoid volvulus

32. A young man with history of stab wound in chest presented in ER. He was conscious and
answering your questions, his breathing become faster and labored, bp 85/69 and pulse 125.
There was a laceration on back of left side of chest between 5th and sixth rib. Dullness on Ieft
lower chest. IV line passed and resuscitation started. What’s next step?

a. Oxygen
b. Endotracheal intubation
c. Chest tube with underwater seal

33. 67 year old lady with tiredness and shortness of breath, labs showed iron deficiency anemia.
What will u do next
a. Iron supplememnts
b. Blood transfusion
c. Multivitamins
d. FOBT

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

34. 4 yr old child with mild symptoms of URTI. Urine analysis showed RBC ++, no leucocytes. No
other complains
Next?

a. Repeat test in 2 weeks

b. Dexamethasone
c. Ultrasound

35. 6month old baby with dilated bilateral PUJ. Investigation

a. Micturating cystourethrogram
b. IVU
c. DTPA
d. DMSA
e.
36. A diabetic male, controlled on insulin since 7years, had an episode of hypoglycemia 2 days back.
Asked about if he can drive/
a. He cannot drive
b. He may drive with another person with him
c. He may drive if fbs remains above 3mmol/l

37. Child with hx of fall resulting in greenstick fracture, what will help u determine if the fracture
has healed?
a. wide range of movement at wrist
b. Normal xray
c. No tenderness at wrist
d. No tenderness fracture has healed?

Pharmaceutical company approaches u with results of comparison between 2 drugs for hyper
cholesterolrmia, wat is d important question u wil ask
A- wether same dose of dugs wer used
B- wether 2 grp s contained d same no of people
C- how did u equalise d dietary factors
a/b?

1. HB question 3.148

A 64 year-old man with three-month history of increasing frequency, nocturia and dysuria undergoes a cystoscopy. Instrumentation is difficult. Six
hours after the procedure he has a rigor and develops a temperature of 40˚C. Which one of the following is the most likely explanation for this
complication?

a) Acute pyelonephritis

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

b) Rupture of the bladder

c) Gram-negative bacteremia

d) Rupture of the prostatic urethra

e) Rupture of the membranous urethra

2. 6 year-old girl had a fracture of forearm after falling down from tree. During the follow up of her fracture in the afternoon, there is a presence of
protein in the urine. 3 days later, there is no urine in her morning sample of urine. What is the cause? (I was really confused which one to choose cuz the follow up
for fracture usually is in 2week, and they provide the exact time of the day like “afternoon” and “in the morning” which leads more to orthostatic proteinuria)

a) Orthostatic proteinuria

b) Response of body to the injury

3. A young adult male present with proteinuria in his routine examination for military entrance. These are my words not the exactly the same from
exam. What is your next step of investigation?

a) Repeat urinalysis

b) 24 hour urinary protein

c) Urine Protein Creatinine Ratio

d) 12 hour sequential urinary protein

4. 35 year old woman presents with painless lump in her right breast in upper outer quadrant. The lump is firm and mobile. USG was given. What is your
next investigation?

a) Mammography

b) FNAC

c) Core biopsy

d) Excisional biopsy

A middle age man came with the complaint of painful defecation with blood in the stool. Pain
relieved after half an hour. Otherwise , he has no problem. On ex: , PR can’t be performed as he
has anal pain. What next appropriate ?
A. GTN ointment
B. Lateral sphincterotomy
C. Saline bath and high fiber diet

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

D. Corticosteroid cream
E. Sth with high fiber diet

Solider return after doing a tour . Has persistent headache and one other symptom. Become
reclusive . Has nightmare of battle combat and don’t want to watch videos and movies about
military combat. And other pointers for PTSD. Which of the following conditions he is most
likely to develop?
A. Major depression
B. Brief psychotic disorder
C. Opioid dependence
D. Anxiety disorder

Diagram Like this:

Patient present with visual field defect as shown in diagram. General exam otherwise normal. No
headache and no neuro symptoms given . Cause?
A. Pituitary Tumor
B. Occipital glioma
C. Cerebral Hemorrhage

52 yr old lady came after screening of breast cancer . Her mammogram result shows no
abnormal finding. But she is still concerned about her result. What would you explain to her
regarding mammogram?
A. False positive rate of the test
B. Population prevalence of breast cancer
C. Specificity of the test
D. NPPV of test
E. Reliability of test

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

A child present with sore throat , fever, rhinorrhea and cough for a few days. He is known
asthmatic. He used inhaled salbutamol two times in last year . Now he has no wheeze and
respiratory distress.Mgt?
A. Diphenhydramine cough mixture(exact words)
B. Oral cetirizine
C. Oral amoxicillin
D. IV ceftriaxone
E. Inhaled salbutamol
Pic of very hairy natal cleft with reddish opening at 11 o’ clock position.

Young man with _ wks of mucopurulent discharge in perineum. Otherwise past med h/o normal
.No other problem. Pic shown above.Possible cause?
A. Pilonidal sinus
B. Chronic anal gland sepsis
C. Thrombosed external hemorrhoid
D. Crohn’s disease
E. UC
Fundo pic: Very much like this one.

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

Middle age lady complaint of seeing a spot and bent lines while applying make up. Other neuro –
normal. What next?
A. Tonometry
B. Visual field testing
C. Slit lamp
D. CT head
E. Amsler grid

35 yr old female with 4 episodes of visual symptom ( Blurring? Not sure). Previously resolved
after few days. She also say shimmering of light when attack happen. This time came with the
same symptom but not resolved. No headache or pain on eyeball m/m.Fundo pic above. Possible
Dx?
A. MS
B. Migrainous ischaemia (exact words)
C. Carotid stenosis
D. CRF
Middle age lady present with several episodes of pain (2-10min) at jaw and cheek on left side.
On exam, reduced sensation on that painful area. What is Dx?
A. Trigeminal neuralgia
B. MS
C. Giant cell arteritis
D. Herpetic neuralgia

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

Pregnant lady with previous history of DVT after first delivery and second episode after taking
OCP for a few months. Second episode was 12 months ago. Each time she was treated with 1 wk
heparin and 6 month warfarin . This is her 2nd pregnancy. She was screened for thrombophilia
and Anti thrombin deficiency was detected. What to do in this pregnancy?
A. Low dose aspirin now until 6 wk postpartum
B. Low dose heparin now until 6wk postpartum
C. High dose heparin now until 6 wk postpartum
D. Low dose heparin postpartum
E. Warfarin now until 6 wk postpartum
Young girl with factor 5 leiden heterozygous status with previous DVT. Asking for
contraception for 5 yr.
A. POP
B. COCP
C. Implanon
D. Depo
E. Mirena
Woman on phenytoin with well controlled epilepsy. Want contraception for 2 year. What to
give?
A. POP
B. COCP ( 30 mcg E2)
C. Mirena
D. Implanon
E. Depo
Old lady came for total hip replacement. Asking DVT prophylaxis after initiating with heparin?
A. Warfarin for 3 mth
B. Warfarin for 1 month
C. Warfarin for 3 wk
D. Rivaroxaban for 1 mth

X ray pics are very clear. Those radiolucent areas stand out

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

Woman with 2 days of constipation , abd distension . On exam , distended abd, slightly tender.
Previous h/o appendicectomy present. Abd X ray shown above. Dx?
A. Sigmoid volvulus
B. Sigmoid colon cancer
C. Adhesive LBO
(no cecal volvulus)

Can’t find similar x ray. X ray has two radiolucent area above like in the pic and one
longitudinal one on the left with tapering. Those three are distinct.

Woman with constipation , abd distension and not passing flatus. There is increase bowel
sounds on exam. (nth written about wt loss, or altered bowel habit). Abd x ray shown
above.Asking possible Dx?

A. Sigmoid colon cancer

B. Chronic peptic ulcer disease
C. Adhesive IO
D. Fecal impaction

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

USG pic of liver: like this but one elliptical shape one in the middle and two small ones
underneath

Woman present with sharp pain at RUQ which resolved after 8 hours. No other symptoms.
Exam- normal findings . Dx?
A. Gall stones
B. Simple cysts
C. Focal nodular hyperplasia
D. Metastatic deposits

CT pic coronal view: Like this

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

Old woman. Patient taking warfarin. Develop cough. Last week took amoxicillin x 1 wk for
respiratory infection. Now abd pain and RIF tender mass. Dx?
A. Appendicular abscess
B. Rectus sheath hematoma
C. Ovarian cyst(exact words)
D. Volvulus
CT pic (couldn’t find similar pic . please bear with my drawing)

One big variegated mass at left renal region and one irregular one at midline . Gall bladder has
no stones in it. I think this one is RCC with IVC extension ?

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

Patient present with RUQ pain (yes, RUQ) no radiation for a few hours. Stable vitals .No
jaundice. Wt loss present. CT shown above. What is possible Dx?
A. CA left kidney
B. CA head of pancreas
C. Gall stone
D. Hydatid cyst
ECG of ST elevation in II, III, avf with Q waves and normal T( not inverted, not flat) and LBBB.
Middle age man with epigastric pain , nausea , vomiting for 2 hours. ECG done and shown
above. What is the next mgt?
A. Thrombolysis with Rtpa
B. Angiography and angioplasty
C. Metoprolol
D. Heparin
ECG of sinus tachy with T wave inversion in II, III, avf with LBBB or RBBB pattern. Middle
age man presents with awareness of his heart beat and lightheadedness after exercise. 1 wk ago
he has h/o air travel.DM, HT present. On exam, PR- increase, other vitals normal. (no pain
mentioned).Next inv?
A. Troponin
B. TSH
C. D-dimer
D. CTPA
E. Transthoracic echo
ECG of multiple PVC (not bigeminy)(irregular rhythm, no P)
Patient came for follow up. He is taking digoxin, perindopril , thiazide. No dyspnea, JVP not
raised. What to do next?
A. Increase digoxin dose
B. Increase Perindopril
C. Give frusemide
D. Stop all drugs and reassess in 12 hours
ECG of sinus brady with prolonged PR interval. No other abnormality.
Patient is taking metoprolol, hydrochlorothiazide-irbesartan for his hypertension and heart
failure. Mgt?
A. Cease metoprolol
B. Switch metoprolol to verapamil
C. Start digoxin

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

Child came with multiple bruises. Mother bring him.On exam, petechiae and bruises present.
Invx?( Q is short. Only 2 lines. Do no give other clues about possible abuse. previous URTI and
other bleeding present or not is also not written)
A. Coagulation profile
B. FBC
C. Skeletal survey
D. U&E , Cr
Patient 3 days after knee replacement : oliguric . No fever. Creatinine – increase. Invx?(catheter
not mention)
A. USG bladder
B. CT ab
C. Cystoscopy
D. Blood culture
Patient 12 hour after op- oliguric . Nurse get him to sit up but still not able to pass
urine.Distended suprapubic mass on exam.USG shows 700 ml urine. But he doesn’t want to pass
urine. So they try 12 fr catheter. But couldn’t insert. What to do?
A. Use narrower bore catheter
B. Use same bore catheter with introducer
C. Use larger bore
D. Retrograde pyelogram
Patient with left flank pain radiating to the groin. CT shows 1 cm stone at pelvic brim . After
giving analgesic , what is the most appropriate?
A. Open ureterolithotomy
B. Percutaneous ureterolithotomy
C. ESWL
D. Strain urine until stone passes
(no option with ureteroscopy)

Man play net ball. Had ankle injury. A few hours later he has swelling at the ankle. What
indicates radiological inv?

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

A. Only able to bear weight for 20 meters (exact words. Say nth about at ED or immediately
after injury)
B. Bony tenderness of fibula
C. Tenderness at lateral aspect of ankle
Child fall from bicycle. Hit left abdomen with handlebar. Wear helmet. Neurological exam-
normal.No LOC, no vomiting. On exam, LUQ tender. No hematuria . What next?
A. USG ab
B. CT ab
C. U and E , Cr
D. CT head
Boy fall from 5 meter height . Now severe headache and vomit 1 time. No LOC. Otherwise
normal. What next?
A. CT head
B. Refer to local hospital
C. Observe at clinic for 4 hours
D. D/c and follow up
Pharmaceutical company comes to you about cholesterol lowering drugs. Study includes two
drugs. What to ask about new drug study for it to be valid?
A. If equivalent doses of 2 drugs are used
B. Is there a placebo arm
C. Is same number of people are allocated in each group
D. Is there a crossed over period
E. Is the diet factor controlled
(nth about SE and ethics committee)

Pregnant woman previously had written plan that she doesn’t want any med intervention
and surgery for labour. Now in labor , strong contractions and she is in distress. She
requests epidural block. But her husband and midwife are against it. What to do?

A. Do as patient request
B. Don’t do epidural block as per husband and MW
C. Consult senior
D. Em Caesar
When asking a patient about family history of psychiatric illness she said: ‘Oh now you ask
about that, you know whales, whales are good, them oil are useful. Lit up the whole city.
Grandpa worked on the whaler , and then , of course we are all very sane’ ( this is the
approximate reconstruction from what I can recall). What is this condition called?

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

A. Derailment
B. Tangentiality
C. Circumstantiality
D. Flight of ideas
10 yr old girl came with mother . Grandpa has Huntington disease. Mother said she’s a carrier.
Mother want to do genetic test for the daughter . What to do?
A. Wait till daughter is 16 (sure about age)
B. Do genetic test for the girl now
C. Do genetic counselling for the daughter
D. Do genetic counselling for the daughter with the mother
E. Do family meeting to discuss whether or not to do genetic test
19 yr old boy with mild intellectual disability , lives in a group home. Brought by his carers. He
threatens to kill his roommate. That’s why they brought him. No previous aggressive behaviours.
What to do?
A. Relocate his roommate
B. Inform police
C. Give quetiapine (the only med option)
D. Do group counselling
Patient took risperidone for visual hallucination then develops rigidity , bradykinesia. What is
dx?
A. Parkinson disease
B. Alzheimer disease
C. Vascular dementia
D. FT dementia
E. Cortical Lewy body dementia
Patient presents with rigidity , bradykinesia and other parkinsonism symptoms. He was taking
haloperidol . now has visual hallucination and memory loss. What is dx?
A. Lewy body dementia
B. Alzheimer disease
C. FT dementia
D. Vascular dementia
(These two scenarios are not next to next. Quite far apart)

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

Old lady with crawling sensation on leg at night. She can’t sleep and had to walk and massage
and stretch the leg. Those relieve the sensation. Inx?
A. Serum Creatinine
B. Iron studies
C. CT head
D. Doppler USG
Patient was taking zuclopenthixol fortnightly started last night. Now presents with restlessness,
pacing, can’t sit still. Tx?
A. Benztropine
B. Diazepam
C. Methylphenidate
D. Bromocriptine
E. Physostigmine
62 yr old lady with memory loss. Difficult managing finances. Has well controlled HT.
Otherwise all normal.Dx?(2 sentence Q)
A. Alzheimer disease
B. Vascular dementia
C. FT dementia
D. Lewy body dementia
Patient experiences 10 min lower limbs weakness. Now resolve. Neuro -UL and LL all
normal.Med h/o – HT, DM . What is dx?
A. Carotid stenosis
B. Lacunar infarction
C. Hyperglycemia
D. Hypoglycemia
E. Cerebral hemorrhage
Patient with type 1 DM. Hypoglycemic attack after gym relieved with oral sugar given by wife.
Ask about driving
A. Can’t drive for 6 wks
B. Can’t drive after vigorous exercise
C. Can drive with accompany

Patient with type 1 DM. Came for driving advice. What is the most important?
A. Cant drive if hypoglycemic episodes in previous week
B. Can drive if check blood sugar before drive and 2 hourly during drive
C. Can drive if check blood sugar hourly during drive

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

D. Can drive if sugar above 3mmol/l

Pics of nipple discharge from left breast: like this

48 yr old female with nipple discharge from left breast only on squeezing . It’s green in color(Q
mention that). What is the probable cause?
A. Intraductal papilloma
B. DCIS
C. Duct ectasia
D. Paget disease
62 yr old man with behavior change and personality change. Wife brought him saying he’s
poorly groomed and not like the one in the past. On exam, patient is slovenly dressed. He also
cracked a crude joke. (2 other things he appears or he does . I cannot remember those)
What can help dx?
A. Serial sevens
B. Ability to name animals in the zoo
C. Ability to remember previous Olympics venue
Patient injured while playing football. Got tackled. Kept playing. Got swelling at knee at that
time. A few days passed. Now complaint of locking and on exam, limited extension. What to do
next? ( not mention giving away)
A. Ant drawer test
B. Post drawer test
C. Do sagging test
D. Do grinding test

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

Patient football player. Got injuries around neck before. Watched TV last night and fall asleep on
chair. Now painful mm of shoulder in all range. Weakness of shoulder shrugging and
abduction. Decreased sensation on outer upper arm.Dx?
A. Brachial neuritis
B. C5 nv root injury
C. Radial nv injury
D. Axillary vein thrombosis
(no axillary nv injury)

MVA case . Passenger side crash. Pt complain of ab pain. BP 70/50 despite 2L colloid on the
way and 1L at ED. What to do?
A. CT ab
B. FAST USG
C. Laparotomy
D. Drain ( just Drain)
RA patient with ulnar deviation , swan neck deformity . Taking MTX and eternercept. Has HT
and DM (well controlled). Cardiac, neuro, chest exam all normal. Now came for
cholecystectomy. What to invx?
A. U & E , Cr
B. Ct ab and pelvis
C. X ray C spine
CA stomach case . Endoscopically proven. For staging, CT done. Nth found. What to do next?
A. MRI
B. PET scan
C. Bone scan
D. Chest X ray
Woman with breast cancer diagnosed. A single lump, no lymph node enlargement.Post
menopausal. She does not want any Surgery.What to do next?
A. Letrozole
B. Tamoxifen
C. Interstitial brachytherapy
D. Single drug chemo
E. Combined chemo
Old man come with visual loss . On fundo exam, pale optic disc. (yes optic disc). RAPD
present. No headache or no carotid bruit. What to do next to find the cause?
A. Carotid doppler

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

B. ESR
C. CT head
D. MRI
Child present with fever , lethargy. Also has sorethroat, rhinorrhea and ant, post cervical
lymphadenopathy. On exam, neck stiffness and Kernig sign present. What is the dx?
A. Torticollis due to cervical lymph node enlargement
B. Viral meningitis
C. Bacterial meningitis
D. Acute viral encephalitis
Lady taking paroxetine for 2 year after postnatal depression. Now want to conceive, what to do?
A. Cease paroxetine
B. Change paroxetine to citalopram
C. Cease paroxetine when pregnant
D. Increase the dose of paroxetine when pregnant
E. Continue same treatment
Woman with gential herpes treated with famciclovir of 2 weeks. Now come for follow up, what
to do?
A. Abstain sex for another 3 weeks
B. Continue treatment for another 7-10 days
C. Tell her she may still be infectious for future partner
D. Notify health department
E. Treat sexual contact
Man comes with pain around the eyes for 5 days. On Exam, he has numerous pustules and
vesicles around the eyes on right side. Tx?
A. Acyclovir
B. Carbamazepine
C. Oral corticosteroid
(no TCA, para , gabapentin or pregabalin)

Middle age man come with chest pain radiating to left shoulder and jaw. He is diagnosed
with STEMI . Now 4 hours have passed since symptom started and pain is 4/10 now. He is
given aspirin, metoprolol. Vitals stable.What is the next step in mgt?
A.Clopidrogrel
B. morphine
C. GTN

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

D. Thrombolysis

A young woman come to you and say ‘I want to take a bottle of paracetamol and just be done
with all of it’. On further enquiry , she says her favorite professor at uni has left the job and she
is very sad. She has history of sexual abuse as a child by her older brother . What is the most
likely dx? (just 3 points, no other clues : Wish to suicide/self harm , the professor issue and
sexual abuse)
A. Persistent depression
B. GAD
C. Borderline personality disorder
D. Bipolar disorder
2 yr old child present with 2 weeks of harsh cough, fever and irritability. There is no vomiting.
What next for invx?
A. Nasopharyngeal aspirate
B. Serology ( yes just serology)
C. Chest x ray
D. Blood culture
A patient present with fever , cough, dyspnea and ab pain and diarrhea. On exam , lungs are clear
and no abnormal findings. What can establish dx?
A. Chest x ray
B. Ab x ray
C. Blood culture
D. CT ab
Patient went for a trip to Thailand. Now he has jaundice and itchiness. (Nth mention about fever
and pain). Dark color urine present.Has 10 kg wt loss over 6 wks (sure about number). He is still
on malaria prophylaxis.On abdominal examination , nth abnormal detected. Possible Dx?
A. Malaria
B. CA pancreas
C. Cholangitis
D. Liver abscess
60 yr old man complaint of pain and deadness in his posterior thigh and calf. It happens while
walking 100 m on level ground, 10 m on rough ground or on incline (exact words). He has 35
pack year smoking history and drinks 2-3 units of alcohol a day. Pedal pulses are palpable
bilaterally. What to do to establish dx?
A. MRI spine
B. Arterial doppler
C. Arterial angiography

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

D. CT angiogram
Man presents with pain in his leg at rest. Initially crumping pain on walking. More severe on
right and only on the right initially. ABPI on right- 0.6 , on left- 0.8. Pedal pulses: weak. Weaker
on the right. Which of the following is the indication of arterial reconstructive surgery?
A. Rest Pain
B. His ABPI
C. His intermittent claudication
Child present with bilateral leg pains at night. He also has URTI symptoms. On exam, all
movement normal and no swelling and tenderness. What is the cause?
A. Growing pain
B. Septic arthritis
C. Perthes disease
D. Irritable hip

X ray like this except it’s L3,4 . No lytic lesion, no sclerosis

Old man present with back pain after fall. On exam, he has tenderness on L4, no neuro deficit. X
ray done, shown above. He also has prostatism . His PSA one month ago was 4.8 mcg/dl or liter

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

(not the usual ng/ml but range given. Within normal range. I think range is 0.3-5.5) ( No PR
exam info given). What to do for dx?
A. DEXA
B. Whole body bone scan
C. PSA
D. MRI spine

X ray like this: more radio opaque ( whiter) on the right hip.
Old woman present with pain in the right hip over months. She’s been taking paracetamol but no
relieve. On exam, extension , flexion, external rotation restricted .(internal rotation not
mentioned). X ray done, shown above. What to do next?
A. CT guided biopsy
B. Diclofenac
C. Bone marrow biopsy
D. Bone scan

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

62 yr old man , diabetic , non smoker with total cholesterol – 6.2, HDL-1 and BP
122/82mmhg.CVD risk?
A. 10-15%
B. 30%
C. 25-29%
D. 16-19%
Man present with constant worrying, palpatation, fearfulness (not mention for how long). He is
a farmer and is in severe debt due to drought. At night, he worries and can’t sleep and lately he
becomes reclusive. What is possible Dx?
A. GAD
B. Panic disorder
C. Depression
D. Agarophobia
Teen brought by mother,in recent years, he becomes socially withdrawn. Stay in his room and
watch TV. No social life and friends and hobbies. But academic perfomance are good. On exam,
he is reluctant to talk. Dx?
A. Agarophobia

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

B. Social phobia
C. GAD
D. Major depression
Girl with present with URTI and urinalysis shows RBC +++ , protein ++, no nitrites and
esterase.What to do next?
A. Urine culture
B. Blood culture
C. Urinalysis in two weeks
D. Chest x ray
Boy has history of greenstick fracture at left distal radius. Now for follow up. What to assess to
know healing?
A. General range of motion of wrist
B. Tenderness of bone
C. Normal X ray
D. Pain on resisted movement
E. Swelling
Child present with behaviour change , abd pain and diarrhoea. The family just moved into old
house and they are renovating it. What to investigate next?
A. Stool culture
B. EEG
C. CT head
D. Blood lead level
Pic of diastasis recti
Man present with swelling at abdomen. It becomes prominent on coughing and more so when
raising his head and shoulder off the floor. Dx?
A. Diastasis recti
B. Epigastric hernia
C. Umbilical hernia
Pic of a child with abdomen shown. A lump just above umbilicus.No punctum. Round to oval.
2 year old child with a swelling as shown in the pic. It is soft .Otherwise normal.No pain.Dx?(not
mention about anything with cough or crying and size changes)
A. Umbilical hernia
B. Paraumbilical hernia
C. Lipoma
D. Epigastric hernia
E. Epidermoid cyst

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

6mth old baby has intermittent groin swelling especially when he cries.On exam, nth abnormal
detected on inguinoscrotal region.What to do next?
A. Ask surgical opinion for inguinoscrotal hernia
B. Review when swelling appears
C. USG of inguinoscrotal region

Patient with DM present with foot ulcer for 3 mths. On exam , no pain and no sensation below
knee bilaterally. X ray done and shows erosion of underlying bone. What to do to guide the mgt?
A. Culture of the bone biopsy
B. MRI
C. Swab from ulcer
D. Bone scan
E. Blood sugar
Patient with prostate cancer T1c.Gleason score was 3+4=7. Radical prostatectomy done. After
that PSA increased again and EBRT done. Now after twelve months , PSA rises again and very
high can’t remember the number, doubling time is 3.3 months.What to do next?
A. PET scan
B. CT ab,pelvis and chest
C. MRI ab
D. Bone scan
15 month old child with diarrhea, foul smelling and contains undigested food particles. He is
otherwise growing well and on exam , all normal. What to do next?
A. Gluten free diet
B. Lactose free diet
C. Soy based meal
D. Maintain on usual diet
E. Reduce red meat from the diet

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

19 yr old male with anger issues for 4 months. He is recently released from youth detention
center. He keeps thinking of being neglected and abandoned during childhood.He don’t want to
to go back to detention center. What to do next?
A. Anger mgt
B. Vocational skills training
C. Social exercises
D. Relaxation training
Patient has short term memory loss. Difficulty managing her daily life and daughter complains
she mixes things up. On exam, PR- 52/min . BP -120/80. Tx?
A. Donepezil
B. Rivastigmine
C. Memantine
D. Bromocriptine

Pregnant woman come to you in her first trimester. She has history of spinal bifida . Now she
worries her baby will have it. What to do?
A. Give folic acid 0.5mg now till 20 wk gestation
B. USG at 12 wk
C. Reassure and follow up
(no 5mg option and only one folic acid option)

Aboriginal male with bmi 29 , Waist circumference 110. Bp -120/70. What to advice?
A. Low fat diet to reduce weight
B. Attend to environmental and social issue
C. Lose weight and target waist circumference is less than 102
D. Exercise

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

Patient had URTI and sore throat one week ago and was treated with amoxi. Now he presents
with polyarthralgia , diarrhea , lethargy and rash as shown in the pic.What is possible cause?
A. EBV
B. CMV
C. Scarlet fever
D. Serum sickness like reaction
Child presents with diarrhea. She is irritable and lethargic. Mom says she appears
dehydrated.Which of the following indicates severe dehydration?
A. Dry mucous membrane
B. Sunken eyes
C. Reduced skin turgor on pinch
D. Central capillary refill > 3s
(no neuro manifestations ,cyanosis in options)

Parents bring baby with complaint of poor head control . They say his development is later than
child of same age. On exam, there is poor head control with head lag , hypotonia and reduced
reflexes but he smiles brightly. Mom also says she noticed reduced m/m while pregnant with this
baby.Dx?
A. Infantile Myasthenia gravis
B. Hypotonic CP
C. Infantile Botulism
D. Spinal muscular atrophy

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

E. ALS
Patient presents for routine check up and has HT treated with thiazide-irbesartan. Electrolyte are
normal . Non fasting labs of sugar and cholesterol given. Sugar is normal and cholesterol is 5.5
(normal is < 5.5).What next?
A. Glucose tolerance test
B. ECG
C. Fasting HDL and LDL

19 year old girl came with complain of jaundice. She noticed it this morning and last night she
ate little and drank alcohol. She also has previous episode of jaundice when she was fasting to
lose weight. LFT done and only GGT and bilirubin is raised. What next?
A. Genetic testing
B. Unconjugated bilirubin
C. Liver biopsy
D. USG abd
Patient brought by friends after a rave party where he took alcohol , ecstasy and cocaine. He is
on lithium and risperidone for schizoaffective disorder. On exam, he is aggressive , restless , has
hyperreflexia , muscle rigidity and tachycardia and HT. What to check?
A. Urine drug level
B. Blood alcohol level
C. Lithium level
D. Serum CPK
Patient present with HMA, Howell jolly bodies , decreased folate level and has angular stomatitis
and glossitis. He has no diarrhea and bowel m/m are normal. What to invx for dx?
A. Serum B12 level
B. Small bowel biopsy
C. Bone marrow biopsy
D. Iron studies
80 yr old lady has acute pain in the knee with swelling, redness and tenderness. He also has HT,
CRF and CHF. Joint aspirate done and gram stain shows no organism.Mgt? (nth mention about
crystals)
A. Naproxen
B. Codeine
C. Allopurinol
D. Prednisolone
E. Colchicine

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

Pregnant woman presents with swelling in the neck. She has pain in the neck and on exam , there
is tenderness.(no hypo, hyper symptoms). What to do for dx?
A. Antithyroid antibodies level
B. TSH
C. Thyroglobulin level
D. USG

Young lady present with menstrual pain. Her period is 4-6 weekly and regular. She usually has
pain before menstruation but not as severe as this time. Her LMP is 6 weeks ago. There is no
mass, no ab tenderness, no adnexa mass and tenderness .What is possible dx?
A. Dysmenorrhea
B. Corpus luteal cyst complication
C. Endometriosis
D. Appendicitis
E. Ectopic

35 yr old Woman present with secondary amenorrhoea for 12 months. BMI is 40 and she has
hirsutism. Otherwise – normal. What to inv for dx?
A. Serum FSH LH E2
B. Pelvic ultrasound
C. Pregnancy test
D. Prolactin level

Breast CA patient with metastasis present with constipation with one episode of semi liquid
diarrhea. She is on morphine 20mg bd for pain .What to investigate?
A. Serum morphine level
B. Serum calcium level
C. Serum electrolyte level
D. Bone scan
Girl present with ab pain and one other symptom . Urinalysis was done and shows 10 WBC/ml.
E coli 10*4/ml (sure about numbers).Mgt?
A. Trimethoprim
B. Nitrofurantoin

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

C. No treatment
D. Ceftriaxone

63 yr old lady with purulent brown green vaginal discharge. She is sexually active with her
husband, vagina is mildly atrophic and her cervical screening test 6 mth ago was normal
.Possible cause?
A. Chlamydia trachomatis
B. Gonorrhoea
C. CA endometrium
D. Atrophic vaginitis
Young woman come with fever , arthralgia , headache, lethargy and ulcer in posterior part of the
mouth. She is sexually active with a male partner. On exam, there is tonsillar and upper cervical
lymph node enlargement. Possible cause?(splenomegaly not mention)
A. CMV
B. EBV
C. HIV
D. Toxoplasmosis
E. Herpes
Patient present with a few weeks of cough. CXR is normal . Sputum AFB is positive. What to do
next?
A. Mantoux test
B. INH for 9 mth
C. Repeat CXR
D. Isolate in negative pressure room
(no option for RIPE)

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

CT like this but brain is atrophic and there is lesion not at the lower part but at frontal
region with marked surrounding edema.

70 year old male patient present with headache and vomiting and LOC. CT was done,
shown above. What is dx?

A. Cerebral infarct
B. Cerebral Hemorrhage
C. Brain met
D. Brain abscess
E. Glioma
Autistic male with normal IQ . Started to have pressured speech, reduced sleep and drinks coffee
and gamble excessively. On exam, he says he is fine. What to give?
A. Start lithium
B. Give risperidone
C. mindfulness
D. Dialectical behavioural therapy
35 year old male present with retrosternal pain for 2 year duration . Exacerbated on bending
forward. Relieved by antacids. He drinks 4 beers per day and smokes 20 cigarette per day.Mgt?
A. Smoking cessation
B. Omeprazole
C. Endoscopy

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

Child with rhinorrhea , sore throat and cervical lymphadenopathy brought by mom as she is
worrying about meningitis. Mom says many of the girl’s friends have meningitis . On exam, the
child has fever, red pharynx (yes , red pharynx) , cervical lymph node enlargement , no neck
stiffness and is otherwise well.What to do next?
A. Blood culture
B. LP
C. Amoxicillin
D. Throat swab for rapid viral diagnosis
2 year old child comes with cough and dyspnea and wheeze. On exam , he has crackles at the
base of right lung. Previously he was treated with asthma meds and antibiotics with no
improvement.(child growth not mention). Mgt?
A. Sweat electrolyte
B. Oral prednisolone
C. Blood culture
D. Inhaled salbutamol
Man present with cough and dyspnea. JVP is increased with peripheral edema. 35 pack year
smoking history.Blood gas:
pH: 7.45
Po2: 45mmHg
Pco2 : 50mmHg
Hco3: 22
Salbutamol already given with oxygen, what next?
A. Hydrocortisone
B. Antibiotics
C. Frusemide
Child with peripheral edema , hypertension.Urine; RBC ++, protein + , no nitrites. Lab: sodium
normal ,potassium – 5.5 (normal up to 5.5), Cr and urea increased, ASO +.Asking treatment:
A. IV hydralazine
B. IV normal saline with frusemide
(no bb, nifedipine)

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

Woman with multiple bruises and laceration. Previous similar history as well. This time she says
her husband is becoming more violent and she fear of going back. Husband is in the waiting
room demanding to take wife back. What to do?
A. Inform police
B. Inform family protection service
C. Admit her for her safety
You are a registrar. You found out a consultant is checking unit staffs’ personal details for his
personal motives.(to make unwelcomed calls or sth). What will you do?
A. Talk to the consultant
B. Inform senior health department
C. Do nothing
Parents brought their daughter who has been standing on the roof for a long time. They say she
has become socially withdrawn. What will help you to diagnosed her condition?
A. Auditory hallucination
B. Impaired insight
C. Depressed mood
Young woman came with complaint of not satisfied with her body size and weight.Her BMI is
24. What is the dx?(no compensatory behavior and binge eating mention)
A. Anorexia nervosa
B. Bulimia
C. Body dysmorphic disorder
A child with fever, rhinorrhea , cough brought by mother. Mild fever. 2-3/6 murmur on
precordial exam(sure about given range and location) . Red tympanic membrane present. Other
exam and vitals normal. What to do next?
A. Oral amoxi
B. Reassure and follow in one week
C. Refer to pediatrician

Old man brought by his wife after she heard a thud in the bathroom. He was found unconscious.
Later, he regain consciousness quickly but remained drowsy. All his vitals and neuro exam are
normal. BP – standing 135/85, supine 126/79.What to do next?
A. Holter
B. IV fluid and electrolyte

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

C. EEG
D. CT head
E. Blood sugar
A man with foot surgery last week for left foot ulcer came with complaint of lower back pain
and urinary incontinence. He was given antibiotics after surgery.On exam , there is tenderness in
lower back area and his foot wound is oozing and erythematous. He also complain of pain at
foot. Temp : 38.5, Vitals – normal.Mgt?
A. Blood culture
B. MRI spine
C. Swab from foot wound
D. Change antibiotics tx
E. Continue same antibiotic
33 yr old lady with swelling in the neck(no pic just mention at the neck only).On exam, no fever,
swelling is soft and fluctuant, remaining exam is normal. What is possible dx?
A. Thyroglossal cyst
B. Thyroid isthmus nodule
C. Lipoma
D. Branchial cyst
E. Submandibular gland duct stones
(nth mention about m/m tongue or swallowing or pain )

DM patient present with pain and redness at right leg. On exam , she is febrile and there is
tenderness at right leg and is erythematous . there is reduced sensation below the knee. What to
do next?
A. Blood culture
B. Skin swab for culture
C. Doppler USG

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

CT pic similar to this

Patient present with pain in RIF with fever. On exam, there is tender mass at RIF. He also
complaint of ab distension and constipation . CT done, shown above. What next?(no
history of surgery mention)

A. Laparoscopy
B. CT guided drainage
C. Antibiotics
D. MRI
Menopausal woman present with bed wetting at night. She says she drinks 4-5 coffee during the
day and 7-8 cans of beer at night (yes , that many cans, may be even more , not less).On exam
,there is mildly atrophic vagina with mild uterine prolapse. What is the possible cause? (daytime
symptoms not mention)
A. Stress incontinence
B. Urge incontinence
C. Alcohol intoxication (exact words)
D. UTI
Patient underwent aortic value replacement a week ago due to IE. Now still febrile with EDM at
left sternal border. Blood culture done and antibiotics given. What next?
A. Transthoracic echo
B. Blood culture weekly for 3 weeks
DM patient present with pain and swelling at left leg. On exam, there is tenderness at left calf
with erythema and swelling. USG doppler done shows thrombus in left popliteal vein extending
into tibial vein.What to do next?

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

A. SC enoxaparin
B. IV heparin
C. Thrombolysis
13 year old girl come with unwanted pregnancy. She has 25 year old boyfriend. She wants
abortion . What to do?
A. Advise her to inform the parents
B. Do abortion as she request
C. Counsel both the girl and her boyfriend
D. Inform police
Best answer wd be to inform sexual assault services

16 year old girl with anorexia nervosa. She is now refusing NG tube feeding . What would allow
NG tube feeding against her wish ?
A. Consent from parents
B. Agreement between 2 psychiatrists
C. Order from ethics committee
D. Order from court
Old man with frequency , urgency and nocturia and unable to pass urine now.On exam,
distended bladder and he was catharized. On PR exam, enlarged smooth prostate , median sulcus
palpable.What to do next?
A. Serum Ele and Cr
B. Cystoscopy
C. PSA
D. TRUS
Pregnant Lady at 8 wk gestation present with nausea and severe vomiting. On exam , she is
dehydrated and urine ketone +++. Her husband has GE.What to do to reveal the cause?
A. Pelvic ultrasound
B. Stool culture and microscopy
C. Urine culture and microscopy
D. Blood culture
A lady come with nausea , breast soreness and vaginal spotting of blood.Her menstrual cycle is 4
week and last menstrual period was 4 week ago. On exam, no abd tenderness, no adnexa mass
and cervical os is closed. Serum hcg level is 700IU/l. Temp and vitals are normal.What next?
A. Hcg again in 48 hours
B. Pelvic USG
C. Abd USG
D. Abd X ray

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

Yound lady come with dyspnea and pleuritic chest pain on left side. No nausea , vomiting ,
dizziness and radiation of pain . On exam, there is tenderness beside the left sternal
border.Otherwise, vitals normal and no murmur.Normal breath sound present on both sides.
What is the possible cause?
A. PE
B. MI
C. Costochondritis
D. Acute pericarditis
Patient screened for colon cancer and FOBT is positive. Colonoscopy done and shows 1.2cm
polyps , several polys(number not given), high grade dysplasia, tubulovillous.Polypectomy done.
What next?
A. CT colonoscopy
B. 3 yearly colonoscopy
C. 5 yearly colonoscopy
D. Yearly colonoscopy
Primigravida in spontaneous labor. On VE, cervical length is 1 cm and 1 cm dilated, posterior
and soft.Fetal head is at -1 station . Having contractions every 3min. 4 hours later, cervix is fully
effaced , 3 cm dilated and fetal head is at 0 station. What to do next?
A. Em CS
B. Amniotomy
C. Reassess in next 4 hours
D. Oxytocin infusion
Pregnant lady at 32 week gestation. At 12 wk, she was found out to be O Rh – and given anti D
at 28 wk gestation. Now at 32wk on inv, there is mildly elevated serum anti D. At 28 wk , serum
antiD was negative. What to do next?
A. Give anti D now
B. Reassess in 2 weeks
C. USG
D. Amniocentesis
E. Termination of pregnancy
Pregnant lady at 12 wk gestation , this is her second pregnancy.On indirect Coombs test, anti D
was positive. Mildly elevated. Her first pregnancy was uneventful. What to do next?
A. Check partner blood gp
B. Give anti D
C. Fetal USG
D. Monitor anti D level

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

Scenerio of asymptomatic bacteriuria treatment

1)trimethoprim

2)amoxicillin

3)no treatment don’t remember odr options

U r an intern,called to witness will ,patient very agitated,pulling out iv lines

1)decline

2)witness in presence of a lawyer

don’t remember odr options

skin lesion excised clark level 1 or 2(one of these don’t remember fr sure)excised wd 2 mm
margins.margins wr clear what to do next
1)wider excision
2)snl biopsy don’t remember odr options

aboriginal woman wd clinical features of depression fr 6mo,6mo back her brother n mdr died,she says
spirits wr involved in causing death wt to do 1)explore abt aboriginal culture from aboriginal colleague 2)
screen for drugs causing psychosis

recall of lil child who hugs n beats u n hugs n beats others,but rest of scenerio n options wr not the same

isplaced open fracture of tibia n no pedal pulse.nxt best step in management 1)debridement 2)tetanus
prophylaxia 3)iv antibiotics 4)reduction don’t remember fifth but m sure it wos not analgesics

scenerio of diverticulitis (not severe)what next 1)ct abdomen 2)ultrasound

one scenario wd dilated bile duct n abnormal lfts n pancreatitis clinical presentation:ansr most likely
ercp,anodr wd acute cholangitis cbd dilated no stone asking next step in management 1)percutaneous
drainage 2)ercp odr options more relevant don’t remember

pt wd aortic dissection confirmed on ct high bp wt next 1)endovascular repair 2)b blocker

smoker patient long scenario,patient had erectile dysfunction,wt to do 1)stop smoking 2)prescribe sildenafil
odr options also bit relevant

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

warfarin related rectus sheath hematoma but the hematoma wos large n appeared to b reaching centre of
abdomen near aorta,n the options also included aortic aneurysm leak but still i did rectus sheath
hematoma bcz she wos hemodynamically very stable n clinical picture looked like hematoma

women 52 yrs old lmp 2 years back,now bleeding what to do 1)hysteroscopy 2)endometrial biopsy
3)cervical sth 4)serum fsh

screening recall patient worried abt prostate cancer,examination normal wt to do 1)return if there r any
symptoms 2)dre after 1 year
pt wd high psa,acute urinary retention,scenario looked like prostate cancer,asking investigation 1)cytology
2)prostate biopsy don’t remember odr options but they seemed less likely

ca lung scenerio x ray showed central lesion next1)bronchoscopy 2)ct

enstrual pain worse wd beginning of period this tym more severe,menses r after every 4-6 weeks,now 6
weeks since start of lmp diagnosis 1)dysmenorrhea 2)endometriosis 3)pid

Most likely to cause infertility 1)surgery for endometriosis 2)chlamydia infection

patient wd deep dysperaunia what to do 1)psychoeducation don’t remember rest options but they wr
relevant too

12/14 child wd ataxia upgoing plantars odr features too 1)b12 deficiency 2)freiderich ataxia

q on somatization disorder,asking management,hypochondriasis n somatization r very important

h/o recent perianal abscess surgery,now discharge,every 3-4 days a week,this q wos a lil weird but i did
fistula

chronic pancreatitis scenerio diagnostic investigation

A 36-year-old man comes to the emergency department with a weakness of both legs and diplopia
for last 6 hours. On examination there is hyperreflexia, increase tone and reduced power in both
lower limbs. This is consistent with upper motor neuron lesion.He is vitally stable.
A non-contrast CT scan of the head is performed which excluded any haemorrhage and raised
intracranial pressure.His mother was diagnosed with primary progressive multiple sclerosis at the
age of 50.

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

Which of the following is the best next step in the management of this patient?
a. Lumbar Puncture
b. MRI scan of brain and spinal cord
c. CT scan is the only investigation recommended in this case
d. Admit to hospital for intravenous steroids
e. Start thrombolytic therapy

A 40-year-old male truck driver comes to your office with his wife for assessment. His wife is worried
about him as he snores every night so loud that they sleep in the separate room. He feels sleep all day
and reports falling asleep while waiting at traffic signals.
On examination, his blood pressure is 140/90 mmHg. His BMI is 46.
You advise him to no to drive the truck until a sleep physician completes the further assessment. He is
declining to do that as he does not want to lose his job.
What will you do next?
a. Explain him about the danger of driving associated with his condition
b. Tell him to surrender his driving licence now
c. Prescribe modafinil
d. Inform local driving licencing authority
e. Advice to lose weight as this will reduce the risk of accidents
33

A 76-year-old male presented with a history of an episode of light-headedness and shortness of breath
while bicycling his daily uphill. He denied any chest pain, palpitations and loss of consciousness. His
symptoms improved after resting on the side-road.
Past medical history includes ischaemic stroke 2 years ago with no res. Regular medications include
aspirin 150 mg daily and multivitamins. The examination is unremarkable.
Electrocardiogram and chest X-ray both are normal. Full blood count shows haemoglobin 84 g/L (120-
160 g/L).
What is the next best step in the management?
a. Transfuse 2 units of red blood cells
b. Given iron transfusion
c. With-hold aspirin until haemoglobin is stable

AfraTafreeh.com
Get more from MplusX QBank (https://member.mplusx.com/)
Facebook Page: (https://www.facebook.com/mplusxqbank/)

AfraTafreeh.com