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COMPILATION OF JUNE 2019 RECALLS

1) Prostatitis scenario , on DRE tenderness present. What is your treatment

• Trimethoprim
• Nitrofurantoin
• ceftriaxone

2) 23 year old lady 32 weeks of gestation clear fluid

• PPROM

3)34 years old lady complaining of 6 months of amenorrhea since child birth. She has two children born
vaginally and breastfed exclusively for 12 months. During her 3rd pregnancy she had normal vaginal
delivery with manual removal of placenta and dilatation and curettage done. She didn’t get enough mil
to feed this baby. What is the cause ?

• Pitutary necrosis
• Pitutary tumour
• Asherman syndrome
• Ovarian failure
• hypogonadism

4) 62 years old man complaining of abdominal distension and vomiting , xray of abdomen given

• Ureteric calculi
• Faecolith
• Hydatid cyst
• Stones in bladder

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5) Burn patient was admitted for treatment he had 10% burns he overheard you saying something to
nurse which he did not like so now nurse calls you and tells that he wants to leave --------
---discharge him
--go and talk to him
---Ask supervisor

---Call burns unit and explain them the situation

6) patient is on amoxicillin and after 2 weeks of treatment developed rash..

Diagnosis- HSP???

Hypersensitivity vasculitis

-7) 5yrs boy presented with severe asthma, cant speak in sentences.. 6 puffs of salbutamol already given
what next?

Another dose of salbutamol

Ipratropium bromide

Adrenaline

-8) Smoking in pregnant lady in 3nd trimester.on ultrasound fetal femur length >50th percentile, fetal
head >50th percentile and fetal abdomen <3 percentile.. What may be the cause for this?

Small for gestational age

fetal

-9) Cmv in neonate

-10) lady with depression on Aspirin nd sertraline since 2 years, came with rashes on legs and arms..
When asked about it she has no explanation and tells you that it occurred due to bumping into things

Domestic violence

Self injury

Stop aspirin

Stop sertraline

-10)lady with 28weeks gestation came for glucose test, all her tests before were good , she has no other
complaints. On examination her fundal height is 32cms.

Polyhydramnios

Renal agensis

Wrong dates

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Full bladder-acc to hina

-11) pregnant lady 25 weeks of gestation came with light pink vaginal discharge. Which indicates
immediate transfer her to teritary hospital?

Fibronectin test

Pelvic ultrasound

-12) lady 39weeks of gestation came with contractions and cervix is 5cms dilated and fetal head is at
station +1 , after 4 hrs on examination there is umbilical cord compression. Apart from pushing fetal
head what do we need to do?

Oxytocin infusion

Perform lscs

Instrumental delivery

13) women had bee sting and developed anaphylaxis . What is the treat ment given?

-adrenaline 1ml in 1000ml ns im

Adrenaline 0.5ml in 1000ml ns im

Adrenaline 0.1ml in 1000ml ns im

Adrenaline 0.5ml in 1000ml ns iv

Adrenaline 1ml in 1000ml ns iv

14)-Post menopausal women with bleeding,on examination there is atrophy of cervix, invg?
Hysteroscopy

Endometrial sampling

colposcopy

-15)Relation between smoking and heart diseases

-16)Copd question, x ray given

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-17)pt with vomiting and obstruction scenario, abg values given in options

18)3yrs child with vomiting and diarrhea - treatment for rehydration

-19)couple came with infertility , male had Absence of vasdeferens treatment?

• Donor sperms
• Surgery for vas deferens
• Ivf

20)patient on digoxin since 2 years and recently added spironolactone. Now came with enlargement of
breast. Treatment

Caese digoxin

Caese spironolactone

Tell him that it subsides on its own

21) 53years old female on routine mammography there is breast calcification . Fnac done which shows
atypical ductal hyperplasia. There is family history of breast cancer. Treatment

Excision

Repeat fnac

22)Hb low..!! Pain in left shoulder Endoscopy ans

23)Lewy body dementia

24)Aboriginal female with ckd doesnt want to go for dialysis— wht else we check disorientation blunt
effect needle phobia culture

25)Nerve block at elbow question

26)10 year old boy who has recent onset of enuresis. the doctor calls his parents for assesment. they
have separated for 3 months. in the interview father tells you that he is intending to hide hide assets
from his ex wife even before the divorce. what should you do?

A. inform the mother

B.do nothing

C. inform registrar at the family court

D. tell father it is because of him the boy was affected

e. inform police

27)Limb ischemia abi given in both legs 0.8 left and 0.6 right, indication for surgery

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• Rest pain
• Pallor
• Based on abi values

28)Patient on risperidone with decreased libido as side effect- what do we do? Change to quietapine???

29)Sternocleidomastoid tumor

30)Headinjury patient, loss of consciousness present. GCS 3. Only xray available, transfer to teritary
hospital takes 3 hours . treatment now?

Burr hole?

Iv mannitol

Xray head

31)Pregnant lady with hight tsh what next? Antibodies??

32)Post menopausal women with flushes sleep distrbances.!.! Breast cancer history now treatment?
Paroxetine

clonidine

Cocp

oestrogen

33)Obstructive sleep apnea in a child with tonsilitis.. treatment?

34)Recurrent pilonidal sinus.!.! Treatment

35)Pid scenario invg- cervical swab

36)eye- frequent watering from eyes with normal vision treatment-

Chloramphenicol

prednisolone

hypermellose drops

37)2 yrs child with yellow ear discharge and yellowish green nasal discharge ,cant talk only speaks few
words. On examination tympanic membrane is retracted.The next sequelae

hearing loss

Cholesteatoma

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38)Fracture of lower radius in 9 yr kid..!! Cast applied .. wht to give for pain...

Paracetamol

codeine

rectal paracetamol

oxycodine infusion

nothing

39)spontaneous Pneumothorax treatment

40)Hemothorax case

41)Avascular necrosis of femur in man

42)Schizophrenic pt with benzhexol and a anti psychotic brought by his mother complaining of flu like
symptoms.!.! On examination patient is drowsy and confused invg to order?

Creatinine

chest xray

blood culture

wbc count

43)man came from thailand , tested for hiv positive, and he doesn’t want to tell his wife about his test
and he also says that he is having unprotected sexual intercourse with his wife what to do now?

• Call his wife and inform

• Test his wife
• Call and inform public heath authortiy

44)a lady came for cervical cancer screening, on examination she is positive for cancer. She now came
with her daughter and the lady doesn’t understand english, on asking she said she is not comfortable
with male interpreter.

• Ask her daughter to translate

• Put female interpreter on phone

45)new born presented withdyspnea even after giving oxygen her 100%oxygen cyanosis is still
present,on examination there is no murmur and everything is normal

• TGV
• TOF

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• VSD
• LVH

46)After finishing duty you went to pub with your colleagues, saw few nurses and other staff having
illicit drugs what to do?

Inform APHRA

Inform emergency board

Do nothing

- Functional adrenal mass 5cms treatment-Adrenalectomy

65 year old man has 1cm solid mass at the lower pole of the kidney , what is the most appropriate next
step of management? A/ partial nephrectomy B/ct quide biopsy C/x ray D/totally nephrectomy

...a pic of payogenic granuloma the most appropriate treatment? A/local excision B/diathermy C/topical
steroid

19th June 2019, MELBOURNE

Pt compliant of abd distension, constipation, weight loss of 4kg ,mass extending from pelvic region to
umbilicus which is freely move and not attach to underlying structure. In VE , mass is felt separated from
uterus,a little beside right midline abdomen no other finding, asking management? A. GIST B.
Retroperitoneal sarcoma C. Endometrial cancer D. Ovarian cancer E. Leiomyoma

2 Man with scenario of claudication in left calf. On exam, all peripheral pulses palpable on right side. Left
side all pulses palpable but dorsalis pedis weak and hardly palpable. Bilateral weakness of ankle reflex
and loss of sensation in foot. side ABI on right side 1, left 0.75. Appropriate investigation?
A. Conventional angiogram

B. CT angiogram

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C. CT spine
D. EMG
E. Arterial Doppler

3 extradural hematoma ct pic, diagnosis asked

4 Old woman 75 years of age is admitted to the hospital following a community acquired pneumonia. She
received antibiotics and is well on the 5th day. She suddenly developed rigors, chills and high grade fever
on the 4th day. What is the most likely explanation?
a. Hospital acquired pneumonia
b. IV cannula related bacteremia
c. empyema
d. Pulmonary embolism
5 39yrs old lady with blood discharge from nipple . There’s a 8mm lump too in the Areola. Dx?
6 27 years old come with green brown nipple discharge . On examination ,no palpable mass and discharge
is expressed from 3 opening of nipple.What is the most appropriate test to get diagnosis?
A.biopsy of nipple
B.ductogram
C.FNAC of nipple
D.USG
E.mammogram
7 fundus of hypertensive retinopathy
8 There was a patient who undergone stress ECG for ischemic cardiac disease. his results came positive.
Positive predictive value 55%
Negative predictive value 90%
Chances of patient having the cardiac disease
A)55 B)90 C)45 D)35
9 head of department smells of alcohol. registrar tells you to ignore. you are an intern. what to do?
a. report to the director of hospital
b. document the incident
c. confront the doctor in question
d. inform a senior colleague
note: there was no option for report to medical board.
10 Young women with Hx of past 3 early miscarriage.She works as a nurse in the renal unit where there
was many cases of CMV..Most likely cause of Miscarriage?
A. CMV infection B.Chromosomal abnormality C.Maternal anticardiolipin Ab
11 new born presented withdyspnea even after giving oxygen her 100%oxygen cyanosis is still present,on
examination there is no murmur and everything is normal, diag asked
TGV

12 doubt regarding prostate cancer screening

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13 Schizophrenic pt with anti-psychotics brought by his mother complaining of flu like symptoms.drowsy
and confused inv?
Creatinine
chest xray
blood culture
wbc count-not sure

14 Hemothorax mngt
15 A case of lateral epicondylitis. Treatment?
16 bacterial vaginosis
17 mobitz 2 mngt
18 cvs risk assessment chart
19 4 years old girl. Mother noticed blood in her underwear for 10 days. On examination , there is small
amount of blood stained in vulva. What is ur first step in the management? Not developed any pubic hair
and no breast development.�a) Report child protective service immediately for sexual abuse.�b)
Microsopic blood culture of the Swab from the vulva�c) oral Amoxicillin
d. cease bubble bath
e. examination under anaesthesis
20 incontinence. heart disease history and stroke history, lower limb weakness, mngt?
21 pregnant, tsh low,t3 t4 normal mngt?
22 boy - head-on collision MVA - loss of consciousness, was brought to the ED. On arrival, he was not
opening the eyes but could withdraw to painful stimulus.. mngt
23 varicose vein- only surgical management options given, asked best
24 9 year old patient was brought to you due to headache and frequent vomiting for the past few
days. On examination, you noticed patient walking with head tilted to right, nodules palpated on the
right side of her neck. Neck was stiff. Limping gait was also observed. what is your INITIAL
investigation?
A. ct scan
B. Neck ultrasound
C. Lumbar puncture
D. Blood culture
E. Chest xray

25 4 year old girl with ear discharge and pain. Organism responsible?
A- Staphylococcus pneumonia
B- Hemophilus influenza
C-Streptococcus pneumo
D- moraxella catarrhalis

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26 0 yr old child who used to live with mother has been having a history of loose
stools with bloody diarrhea and is now brought by his father who does not know
much about the child who in himself is a poor historian. Management?
A- Colonoscopy
B- Blood culture
C- Stool for ova and cysts
D- Endoscopy
E- call mother for examination
27 meconium passed 4th day, inv
28 post op oliguria scenario
29 cant speak for 30 mins, conscious, calcified carotid arteries, mngt
30 severe anaphylaxis,senior prescribed iv adrenaline and nurse about to give, you are an intern, what to
do
31 assessment of progress of labour
32 down synd lady brought by care taker, intermenstrual bleeding history is there but carer says they
wants treatment only for tooth ache. What next
Order usg
Examine under anaesth
Talk about her understanding about intermenstrual bleeding
33 brown vaginal discharge, post menopausal lady, cause
34 diabetes screening - obese man
35 HRT choice, post menopausal since 2 years, h/o stroke
36 post menopausal 8 yrs,now with fracture, what inv next
37 lady with depression on Aspirin nd sertraline since 2 years, came with rashes on legs and arms.. When
asked about it she has no explanation and tells you that it occurred due to bumping into things
Domestic violence
Self injury
Stop aspirin
Stop sertraline
38 child presented with multiple bruises in back,X ray_periosteal bone formation multiple
sites.cause?
‐Nonaccidentalinjury
Osteogenesis imperfecta
39 child- severe asthma attack at school, parents are not available on phone, teacher calls you, what to do
40 patient is on amoxicillin and after 2 weeks of treatment developed rash

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41 severe pneumonia in child- Rx

42 45 yr, amenorrhoea since 6 months, h/o D&C with infection, what is important in symptoms?
43 new born presented withdyspnea even after giving oxygen her 100%oxygen cyanosis is still present,on
examination there is no murmur and everything is normal diag

1) 50 year old man who has been coughing for the past week had developed a rash. It initially appeared
on his arms but has now spread to the torso. What's the diagnosis?

a) Myclopasma Pneumonia

b) Haemophilius Influenzae

c) Legionella Pneumophilia

d) Staph Aurues

2) Partogram

3) ECG - Pericarditis next mx, SVT, VF best mx, Vt next mx

4) CTG - Early deceleration mx

5) HSP pic, asking the next Rx

6) Girl with dog phobia. Pictures already shown. Improving now whats next?

a) Listen to Dog sounds

b) Take dog out with boyfriend

c) keep dog photos

d) Breathing and relaxation therapy

e) Sleep hypnosis

7) pt smoke loosing wt 8 kgs for past 2 months has ho cough ankle swelling and myocardial infection
history too on exam there was dec sounds in one lung focal dec sounds plus dull on percusiion plus on
the other side there was basal crackles

a. Bronchogenic cancer

b. LHF

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c. Cor Pulmonale

8) Lady with 36 hours of muscle weakness and tingling sensation is present, weakness more in lower
limbs, no other sensory loss, no other symptoms mentioned

a) acute inflammatory polymyopathy

b) multiple myeloma

c) myastinia gravis

d) transverse myelitis

9) A patient present with ptosis of left eye, left side sensory loss of face. Left side gag reflex was absent,
Right. Sided hemiparesis and incoordination of Right. Upper and lower limb.Where is the lesion?

A. Middle Cerebral Artery

B. Internal Carotid Artery

C. Vertebral Artery

D. Multiple Sclerosis

E. Post. Cerebral Artery

10) Biostat specific sensitivity curve

11) An old man is complaining of confusion and drowsiness for 5 days. HTN on drugs. On Warfarin. BP
normal. No CT given. Whats the Dx?

a) subdural hematoma

b) intracerebral hge

c)meningioma

d) Middle cerebral artery infarct

12) A patient presents with sensory motor impairment on right half of the trunk and upper right limb. He
also has dysarthria and dysphagia. Which of the following is the correct side of the lesion?

A.Anterior cerebral artery

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B.Middle cerebral artery

C.Vertebro-basilar artery

D.Posterior cerebral artery

13) 19 year girl went to party drank took alcohol, cocaine n ecstasy. Now presenting with hyperreflexia,
tremors, irritability, drowsiness, agitation, temp 37.8, bp 150/? What next investigation?

a) Alcohol level

2)Drug screen

3) Lithium level,

4)Ck level

5)Lithium

14) 19 year old girl at was at party- brought to emergency intoxicated. given iv diazepam and
“apparently slept well overnight “

next morning accusing of sexual assault by unidentified staff memeber-

inform police

inform ed supervisor

management by sexual assault unit

check mental state

15) CXR - TB asking Rx;

16) CXR with effusion asking dx a) LVF b) Lobar pneumonia

17) Man came for prostate checkup. PSA was 1.5mg/ml, now PSA is 3.5mg/ml, then biopsy is done
which only one foci showed adenocarcinoma. Gleason score is 4. How will you manage this patient?

a.Androgen therapy

b.radical prostatectomy

c.ERBT

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d.active surveillance

e. TURP

18) Picture of ascites abdomen with cellulitis treated with oral amoxycillin+ clavaunate. After a few days,
cellulitis became more severe. Wt to give?

A) change to amoxycillin

B) only change to ciprofloxacin

C)do debridement

D) change to IV penicillin

E) change to iv ticarcillin/ pipercillin

19) waldenstorm macroglobenemia patient came with rigors and fever and right lower lobar pneumonia
or some infection like this admitted and started ampicillin and after minimal time generalised vesicular
rash appeared asking management

prednisolone - immunoglobulin - cease ampicillin –antiviral

20) Girl had bee sting and developed anaphylaxis. What is the treat ment given?

Adernaline 1ml in 1000ml ns im

Adrenaline 0.5ml in 1000ml ns im

Adrenaline 0.1ml in 1000ml ns im

Adrenaline 0.5ml in 1000ml ns iv

Adrenaline 1ml in 1000ml ns iv

21) 2 years old baby with intercostal recession, tracheal tug, cough and audible wheezes. By
examination>> crepitations and rhonci. Fever 38.5

Most appropriate next ?

A. Oxygen and fluids

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B. Inhaled adrenaline

C. Inhaled salbutamol

22) A 60 years old woman says she has to take at least 3 temazepam to sleep. Otherwise she is unable to
fall asleep without it. She feels anxious and agitated during the day if she doesn’t use Temazepam. She
says he cannot find work and spends her time gardening. Whats the dx?

a) benzodiazepine Use disorder

b) MDD

c) Adjustment disorder

d) Circadian sleep-wake rhythm disorder

23) Medical test was performed on a man wishing to enlist in the army, where numerous red cells were
seen in his urine. Further testing showed all RBCs belong to glomerulus. Likely cause

a. thin basement membrane nephropathy

b. IgA nephropathy

c. Minimal change

d. FSGN

24) Female patient pours out in tear that her boyfriend is irritated from having no sex for 8 weeks after
her NVD. she tells you that her gynecologist advices her to be out of sex until her follow up visit as she
got a lot of surgical interference during the labor. But today she found the gynecologist is in leave for 4
weeks

a. report for the hospital manager

b. tell her she has to wait for her gynecologist

c. examine her and permit sex if she is normal

d. refer her for another gynecologist

e. report to the board

25) 22 year old arrives in your clinic to pick up a prescription of Risperidone for her boyfriend, who's
been suffering from schizrophrenia. Boyfriend isn't able to come. What should you do?

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a) Refuse

b) Give her the prescription

c) Talk to the boyfriend over the phone

26) 6 year old child at surgery with complain of joint pains. you find out that he also suffers from iron
deficiency anemia. what could be the most appropriate diagnosis?

a)juvenile rheumatoid arthritis

b)thrombocytopenia

c)haemophilia

d)hsp

27) 26 year old woman who just gave birth wants to conceive within the next 12 months. What to
advice?

a) LAM

b) pop

c) ocp

28) The most urgent sign in acute limb ischemia indicative of surgery?

A.pain

B.paralysis

C.color change

D.temp

E.swelling

29) Mother comes asking you about her 17 year old son because she saw him wearing his girlfriend's
underwear. She is divorced and her son lives with her. Your advice regarding her son's behaviour:

A He is a woman trapped in a mans body

B Its a normal thing at his age

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C its a consequence of lack of a male role model in his life

D bring him in for a interview

30) 26 year old. Cyst in ovary 3.8cm. no family h/o. What to do?

a) aspiration

b) review

c) clompihene

## partograph given. patient in labour, amniotmy done, Irregular contraction..CTG given BHR DROP
to 80..for few min.Diagnosis asked
1:Amniotc fluid emoblism
2:Placenta abruption
3:cord prolapse
4:vasa previa
## This pic (almost similar) was given (2 question from same picture)

One question asked diagnosis

Another question asked initial investigation-Vasculitis (blood C protien-)

## a new screening procedure has been introduced. which point indicates 100% sensitivity

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Ans B

## Lady came for mammography screening ,asking wht are the chances tht cancer being missed ,so
what will you tell her
A. False positive of mammogram
B. Negative predictive value of mammogram
C. Specificity of mammogram

## Bilateral gynecomastia pic.

Young man about 30-34yrs old, presented with this condition as shown in the pic, he is a smoker,
drinks alcohol daily, on ranitidine for dyspepsia. O/E parotid enlargement, Testicular swelling U/L –
can’t get above the swelling. What is the most likely diagnosis?
Similar pic
A. Teratoma
B. Leydig cell tumour
C. Alcoholic liver disease
D. Ranitidine

## A 60 year-old man presents with bilateral watery discharge, tearing and red eye. Picture given
showing senile ectropion. What is the best management?
A Options all are eye drops

Hypomellose

## Scenario of transient synovitis in 4 year old child. Asked treatment?

A. Paracetamol
B. Aspirin
C. Ibuprofen
D. Intensive exercise

## SCFE scenario, asking diagnosis

## ECG with SVT, asking management

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## ECG of SVT middle aged man presented to ER with breathlessness, palpitation and dizziness
after running for some time. he has travelled from abroad 5 days back..ecg given..what wud u do
next?.
a. troponin
b. holter
c. ctpa

## WPW ECG, asking management

## Your friend Nurse of psychiatric dept. She admitted that she has physical relationship with her ex-
patient. What to do?

a. Inform AHPRA
b. Inform the hospital authority
c. Ask the friend to discuss this issue with hospital authority
d. Document this incidence for your reference

## A 12 years old girl presents with a sudden of loss of sensation on the lower limbs associated with
decreased reflexes and progressive ataxia. Which of the following is most likely the cause of her
condition
A. B12 deficiency
B. Friedreich´s ataxia
C. Charcot marie tooth disease
D. Dermatomyositis

## 14 years boy does not wat to take ADHD medicine. What to do?
## One antisocial guy scenario
## Newborn apgar score 8 in 1st and 5th minute. Both because of cyanosis. Given 100% oxigen
with no improvement. Diagnosis?
A) Respiratory distress syndrome
B) Aspiration of meconium
C) Transposition of the great vessels
## A sheep farmer with h/o anaemia, weight loss, fatigue, RUQ pain, jaundice comes to ur clinic with
fever, itching, shortness of breath. Asking for causative organism?
a. Echinococcus granulosus
b. Coxillaburnetii
c. Brucella melitensis
d. Saccharopolyspora

## A 38 year old man comes to the physician because of slowly progressive visual problems that
make him “bump into objects” on both sides. He also reports that while driving he has trouble
switching lanes because he needs to turn his head all the way backward to look for other cars.
Ocular examination shows bitemporal field loss with preserved visual acuity. Examination of the
fundus is unremarkable. Which of the following is the most likely diagnosis?

Pituitary adenoma
Occipital lobe meningioma
Optic glioma

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Optic nerve atrophy

Retinal detachment

## CT shows 5 cm adrenal mass. Abdominal pain only. Adrenal gland function ok. Asked next
management?

a. Repeat CT in 12 months
b. Adrenectomy
c. MIBG
d. Reassure

## 39 week primi, Sudden PV loss of 1000ml blood. Uterus hard and tender. Fetal heart rate not audible
with auscultation? Next?

a. USG
b. CS
c. Wide bore channel
d. Syntocin

## Women after delivery wants contraception. Breast feeding established. Wants child in 1 year.

a. POP
b. COCP
c. Depo
d. Mirena

## Child with enuresis wants to go campaign

a. Ask not to go
b. Imipramine
c. Desmopressin nasal spray
d. Bell and clock

## Pic of SCC. Asking Dx

## Scenario of absent seizure, asking management

## Consultant is checking Patient’s personal documents. As registrar, what to do

## Medical student checking patient’s documents. After asking he says patients daughter lives in
another country, she asked for these. As an intern what will be your responsibility?

a. Ask the student not to do such work further

b. Inform AHPRA
c. Inform university authority
d. Inform consultant

## Nurse told you that she got chronic hepatitis. Your next step

a. Terminate the nurse

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b. Remove her from direct patient contact

c. Ask her to inform every patient about this condition before any procedure
d. Ask her to continue as it is

## smoker and alcoholic, horner syndrome scenario. Asking for next investigation

a. CT neck
b. CXR-pancoast
c. CT brain
d. Bronchoscopy
e. Carotid Doppler

## Sponteneous pneumothorax. Breathlessness, Xray given and shows 15% pneumothorax. Mx

a. Admit and observe

b. Review in 24 hours
c. Aspirate and follow up in 24 hours
d. Water seal drainage

## Prisoner reluctant to give history. Non specific upper abdominal pain. Xray given (could not
understand). Asking manament

a. Endoscopy
b. Laparotomy
c. Barium enema

## Epicondylitis scenario. Asking manament

## JIA scenario. Asking long term complication

## Prostate malignancy patient Radical prostatectomy done but in one year again psa elevated so
radiotherapy done but still after one year PSA 9.1 (3.2) earlier, what to do next

a. CT
b. Mri
c. pet
d. repat psa in three months

## Hitch hiking for few days. After then develop painful swelling in the groin/ inguinal ligament,
painful but no coughing pulse.
a. Inguinal hernia
b. Femoral hernia
c. Limph node
d. Lypoma

Greenstick fracture child came after 2wks. Imp indicator for healing?
A. Normal xray

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B. Wide range of movement at wrist

C. No tenderness at wrist
D. No pain on straining

Dog phobia recall.Already showing pics of dogs and improving.what is

the next ??
a.take dog out with boyfriend
b.listen to sound of dogs
c.Keep diary of dog sightings

10 days old baby

Ask about ttt:
A- Wash with saline
B- ceftrixone
C- topical azthromycin

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weakness of dorsiflexion lateral rotation impaired inward movement

reflexes ankle knee intact
a sciatic nerve
b tibial nerve
c c.p. nerve
d l4 involvement
e l5 involvement

dacrocystitis image of rx asked

a) Warm compression
b) i.v antiobiotics
c) incision drain

40 year old female with tonsillitis,took Amoxicillin,after 3 weeks she

developed purpuric rash,not blanching .She had fever and painful
joints.Diagnosis?
Hypersensitivity vasculitis
Henoch Schonlein Purpura I
nfectious Mononucleosis

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A woman with soft swelling in the neck which is fluctuant and non
tender.
Brachial cyst
Thyroglossal cyst
Thyroid cyst
Epidermoid cyst

55yr anemic wt loss angular stomatitis,no hx of diarrhea or git

symptoms mcv count also given that clearly show iron def of anemia.
1.endoscopy
2.electrophoresis
3.small bowel biopsy
4.colonoscopy
5.B12

A patient comes with history of stricturoplasty for Crohns disease. Six

months ago he was started on warfarin after an episode of pulmonary
embolism. Now presents with right iliac fossa tenderness. Rest of the
examination is normal. (CT was given of full abdomen-wasn’t able to
identify-thought it to be rectus sheath hemat)
What is your diagnosis?
Mesenteric adenitis
Rectus sheath haematoma I
ntestinal obstruction
Peritonitis

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What is the treatment?

1-miconozole
2-nystatin
3-chlorhexidine

Women on paroxetine well controlled on it since 2 yrs now wants to

conceive but concerned about post partum depression due to previous
pregnancy what advice you will give
A. Cease paroxtine
B. Cease paroxtine replace it with escitalopram
C. Use both paroxtine and escitlopram
D. Use escitlopram
E. No medication

Arsenic posioning question.Definitive treatment asked-

A-iv charcoal
B-Iv saline
C-Succimer
D-Penicillin

Flecainide overdose.What is your next step in management?

A-adrenaline
B-ecg
c-charcoal

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d-dont remember

Truck driver was on amphetamine all this while.now foes to doctor who
tell him to stop taking them at once. what will u observe in this pt?
(No Aggression in option)
a. Homicidal tendency
b. Anhedinia
c. paranoid delusion

Old lady..schizophrenia diagnosed treated on anti psychotic..she is

now in alzheimers old home..son has her power of attorney..she keeps
packing hers stuff..she is constantly wants to go out. When asked why.
She says I have to scale the fence..what is the most important
instruction to give to nursing staff?
- call son as he has power of attorney..
-tell them to keep her busy with social activites…
-keep her stuff back in her room
-one option was of psychiatric review/change med/ or dose of anti
psychotic

3) Patient with CHF taking B-blocker , furosemide , perindopril , K

supplement , Metformin for DM , started Amiodarone due to arrythmic
problems , now complain of lightheadedness and palpitation & feeling
like syncope. Potassium level was given about 6.5 and other lab values
were within normal range
A.Metformin & amiodarone
B.Metformin & K supplement
C.Frusemide & Perindopril
D.Frusemide & Metformin
E. Amiodarone +Perindopril

A 68 years old man came for prescription for tamazepam. He says he

has to take at least 3 temazepam to sleep. Otherwise she is unable to
fall asleep without it. He feels anxious and has tremors during the day
if he doesn’t use Temazepam. Whats the management?
a) prescribe tamazepam
b) switch to diazepam and wean
c) prescribe SSRI
d) prescribe mirtazapine

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46 years female (premenopausal ) with lower abdominal pain in the

past few hours. o/e adnexal mass is palpated. USG shows a uniocular
cyst 10cm in diameter in right ovary. What is the diagnosis?
1- mucinous cystadenoma
2- serous cystadenoma
3- corpus leuteal cyst
4-teratoma
5epidermoid cyst

68 yr old female presenting with fatigue , jaundice and abdominal pain

for past few months. o/e tenderness over right upper quadrant and a
mass felt. On usg examination no stone in gallbladder or bile duct. Bile
duct 10mm dilated. What is the most appropriate next investigation?
1-ERCP
2- CT scan of abdomen
3-MRCP
4-laprotomy

8 year old male child brought by parents for the complaints of

episodes of starring in space with lip smacking and limb movement
(focal not generalized) for past few months. Episodes lasts 3-5
minutes and the child appears drowsy after wards. There are around 3
episodes per day for 2-3 days followed by absence of episodes for the
next week. No history of trauma to head or vomiting. What is the most
appropriate medication for this child?
1- sodium valproate
2- ethosuximide
3- lamotreigene
3- Levetiracetam
man asking to ur clinic asking about travel precaution.He is going to
Bali and what will u advice him?
A.Avoid piercing and tattooing
B.Avoid mosquito bite
C.take all the appropriate vaccines

80 year old women at a hospital, taking risperidone. she asked the

stuff daily to open the back door coz she wants to measure the yard
fence .The stuff have to collect her belongings to prevent her from
leaving , her son has power of Anthony. What should you advise to the
stuff? Exact scenario
a. Ask the staff to lock the back door ( exact )
b. Inform her son

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c. Increase the dose of risperidone

d. Return her belongings
e-distract her with social activities

30 year old male patient presenting to your GP clinic complained about

having to sit next to a talkative patient in the waiting room. The
talkative patient happened to be a schizophrenic patient. What will be
your response to his complain?
1- acknowledge the patients concern
2- explain him that the talkative patient has schizophrenia and its part
of the disease
3- make separating waiting area for psychiatry and patients and other
patient
4- bring the schizophrenic patient last at the end of the day so that he
won’t disturb other patients
old patients with MI and stent 2months ago. Now he is on clopidogrel
now falls and has a fracture of neck femur FBC and platelet
morphology normal,INR-1.5, but has bruises on the body what should
be done?
A. stop clopidogrel immediately and do surgery in 1 week if there is
no stent
B .give platelet and do surgery now
c. do surgery now
d.Vitamin K and surgery
(no option for ffp)
A 2 years old healthy child complains of frequent cough and wheeze
not improved by antibiotics and inhalers.
Next investigation?
CXR
Serum electrolytes
Sweat chloride test
Skin prick test
Spirometry

Mr. and Mrs. Smith have come to your clinic for pre- conception
counseling. Mrs. Smith has a history of rheumatoid arthritis. His RA is
well controlled on methotrexate and hydroxychloroquine. They want to
plan a child.Which of the following advises would be appropriate? Stop
both medications Stop methotrexate and continue hydroxychloroquine
Stop hydroxychloroquine and continue methotrexate Continue both
medications and add folic acid Stop both drugs and start leflunomide

8 year old boy comes with a complaint of joint pain and treated with
NSAID
Ana +ve
Ena-ve

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Rf-ve
What is the most likely complication that will develop in this boy?
A-uveitis
B-cardiomyopathy
C-Bronchitis
D-fibrosis of lungs

A child din’t pass meconium for the first 4 days(hirschprung scenarion)

Asking for next investigation.
A-Xray
B-CT
C-Ultrasound
D-Barium swallow

In what situation not mandatory requirement to report to authority?

A.woman presenting with neck abrasion who admits of being assaulted
by partner
B.sewage worker with leptospirosis
C.healthy driver dx epilepsy who needs job to support his family
D.A child crying all the time with bruises on back

what is the least affect from lead poisoning

A.neurological abnormalities
B.Abdominal pain
C.Liver abnormalities
D,,behavior problem

a scenario of mesenteric ischemia , what most useful to confirm ur

diagnosis beside CT ?
1-abd x ray
2- abd us
3- serum lactate
4-serum lipase
45 year old soldier from Iraq has dry cough for 2 weeks. O/e his chest
is clear. But he has a
systolic murmur at the apex. A cxr is given I couldn’t see anything on
it. Whats the diagnosis
A) pTB
B) lung ca
C) sarcoidosis
D) pneumonia

A 29-year old woman, 6 months previously had pleurisy, in the last 2

years mouth ulcers, now develops stiffness and oedema of the wrist
and MCP joints; in the morning which disappears afterwards. The most
likely cause?

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a) Rheumatoid arthritis
b) Crohn's disease
c) Ulcerative colitis
d) SLE
e) Dermatomyositis

An 45 year old man with progressive abdominal distension and

constipation for 5 days.What is the diagnosis?
1-diverticulosis
2-Cancer colon
3-Sigmoid volvolus
4-Crohn’s
5-ulcerative colitis
A 23-year-old who is 10 weeks pregnant is reviewed by the midwife at
the booking visit. This is
her first pregnancy and she is well apart from some sickness which is
worse in the morning and
a generalised pruritus. Bloods tests including the full blood count,
hepatitis B, C and HIV
serology are normal. A slight yellow tinge of her sclera is noticed and
liver function tests are
ordered:
Bilirubin 31 μmol/L
ALP-160 U/L
ALT-25 U/L
Albumin 34 g/L
What is the most likely diagnosis?
1-Gilbert's syndrome
2-Gallstones
3-Acute fatty liver
4-Intrahepatic cholestasis of pregnancy
5-Primary biliary cirrhosis

Prisoner reluctant to give history. Non specific upper abdominal pain.

Xray given (could not understand). Asking manament
a. Endoscopy
b. Laparotomy
c. Barium enema

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Woman 30 years old comes to the clinic for screening of colon

cancer.Family history of familial non polyposis colorectal cancer.
What to advice regarding screening?
A-Genetic screening
B-colonoscopy every 5 yrs
C-Fobt every 2 years
D-Fobt after 50 years

Pic showing mucous membrane of inner lower lip showing pin point
lesions. 35 year old man with abdominal pain for 6 hours. (no features
of bowel changes such as constipation is given) Associated with
a. Intussusception
b. Adhesive obstruction
c. Volvulus
d. CA caecum
History of travel, headache , jaundice, RUQ pain, full blood count given
HB ↓
Platelet ↓
Liver Enzyme ↑
What is the diagnosis
a. dengue
b. Hep. A
c. Malaria
d. Other

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Bbbb
https://brainfoundation.org.au/disorders/friedreichs-ataxia/

2.b if it happen at his job-B, if no-c

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3. rectus sheath hematoma

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4.a

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5.a

6.A

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7a

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8a

9a

10 c

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12:c

13:acute prostatis…. Gonococcal/clamydia….ceftriaxon+azithromycin (single) oral doxi . If severe

ceftriaxone

Chronic ………n chlamydia.. floroquinolone , trimethoprim sulpha

14:b

15:a

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16: b(quadaequin syndrome)

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17:a

19:mri spine

21:a

23: a

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24:c?

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June 2019
5th June
1. PPH HB case
2. 9 month old brought in by mum with fever: 38 deg. Take hx (not eating solids
but breastfeeding as usual, only fever +, everything else normal) Ask PEFE (all PE
normal: only Urinalysis: nitrites +, lymphocytes+ protein+, no RBS) Explain dx to
mum with reasons
3.12 year old girl brought in by mum with cough for 6 months. Trial of antibiotics
and asthma medications done. No response. Long list of Investigations: all bloods-
ve, CXR: no findings. Take hx Explain dx to mother with reasons
4.22 year old brought in by friends with SOB, dizziness and chest tightness an
hour ago in a movie theatre. Some history of marijuana use+, social drinker. No
other sig history. Take history(worries about having the breathlessness again)
Explain dx and other differentials with reasons
5.32 year old unwell since yesterday. One episode of vomiting yesterday morning.
Take hx (fever, tummy pain- not pointing to any specific area- pain relieved on
passing motion, brown watery loose stools for 2 days, one episode vomiting,
urine: dark coloured,sick contacts: his son had similar loose motion just for one
day- four days ago, son’s now fine,no SADMA) Ask for PEFE Card(card says left
iliac fossa and epigastrium deep tenderness, and fever 37.8 or thereabouts, all
other systems neg I think) Explain dx and other differentials
6. 33 year old young man comes with cough and blood in phlegm yesterday. Take
history (cough 4 months, when I asked if anything happened 4 months ago he said
no, when I asked towards end of hx if any travel, he said yes, cough started before
he left Cambodia, no sick contacts, got worse in the last week, unintentional
weight loss +) Explain diagnosis and differentials
7.55 year old had acute urinary retention after hernia surger . Needs
catheterisation. Take consent for procedure Explain procedure to patient. Gather
the equipment needed to perform the catheterisation. (Foley’s catheter, sterile
pack, sterile gloves, gauze, saline on table)

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8.72 year old man comes to you with headache and ____. BP: 140/88mm Hg and
PR: 90 pm given in stemPerform relevant examination (as I said I’d like to do
Cranial nerves PE, examiner took up card and began to read out findings, fundo
normal, she asked me to do otoscope, I put on speculum and started explaining
otoscopy to patient and examiner said its normal, proceeded with temporal
arteries PE, checked ENT- did use tongue depressor and did cervical lypmhnodes
check) Explain diagnosis and differentials.
9. Serotonin syndrome. Mirtazepam started 2 days ago, Escitalopram 6 weeks
ago. Take hx. (Patient in distress: pain, sweaty, fever, examiner asked what pain
relief I would like to give. I said I’ll start with panadol- later may require
morphine) Explain diagnosis Explain management
10. 22 year old male brought in by friends to ED. Acute change in behaviour,
inappropriate, words and confused. Can’t remember SADMA. All PE done and
normal. NO NECK STIFFNESS. Sons agreed to let me talk to mum. Long list of
investigations done: Bloods -ve Urine drug screen pending. All Ix negative except
for lumbar puncture: Protein high, Lymphocytes high, glu normal. -Explain hx and
PE to mum -Explain dx and differentials and reasons
11. 12 months amenorrhea patient is unconcerned, husband brought her in.
Pregnancy test -ve yesterday. Take hx Explain dx Management
12. 66 year old woman comes with breast lump she found yesterday. Explain
examination to her Perform PE on the dummy Explain dx and differentials to
examiner with reasons (Single hard lump in left outer quadrant of left breast,
Examiner told me cervical ln -ve, perform axillary ln: single hard ln+ in left axilla)
13. Patient came with two times high BP Perform cardiovascular examination
Explain dx with reasons
14. 25 year old woman well controlled SLE for 5 years. Wants prgnancy in the next
6 months. Take hx Explain what further investigations you will do Immediate
management
15. 55 year old has been diagnosed of diverticulitis. Turned into an abscess?
Suregery needed and surgeons say may do surgery in next 2-3 days. You are
intern. His atrial fibrillation is well controlled and he is on apixaban. Also
atorvastatin and atenolol. He is concerned about bleeding and very worried. Ask

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about his concerns (What if I bleed to death? What if I have stroke? I dont trust
the surgeons. My cardiologist not available right now its the weekend, cant get
hold of him.) Summarise his concerns to him Explain how you will address his
concerns.
16. Active 13 year old with pain below both her knee caps. Active in sports and
been intensively training for a tennis tournament in the last week. Perform
relevant PE Explain diagnosis and differentials with reasons
1. Breast PE
2. 28 years old female is unwell for 2 days. Hx ,tell or PDx and DDx
##Gastroenteritis##
3. 42 years old male has high BP. Do relevant CVS exam and tell pt about Ddx
4. 13 years old male with pain in both knees. Do PE and explain Dx to patient
5. 12 years old female with cough for 6 months. Antibiotics and inhalers are
not working. Blood tests, xray, spirometry are normal. Take Hx from Mom and
explain her condition
##Psychogenic cough##
6. 68 years old male with chronic headache with throbbing jaw pain on
chewing. Do PE and tell Ddx
##Temporal Arteritis##
7. 72 years old male presents 6 hours after inguinal hernia repair with acute
urinary retention. Get consent for urinary catheter, explain the procedure and
prepare the equipment to perform.
8. 72 years old hypertensive patient had with acute diverticulitis and abscess.
He was started on antibiotics which is not working. He is on apexiban for
underlying AF. The specialist is considering emergency surgery. Talk to pt and
explain.
9. 9 months old baby is unwell and has vomited once. Take Hx, pefe and
explain dx and management
##Fever - UTI##
10. 22 years old male had seizure and is abusive. He is brought by friends. h/o
alcohol intake positive. Vitals stable, no neck stiffness, CT normal, bsl 4.5,
lumbar puncture shows normal sugar, increased WBC with lymphocytosis.
Explain everything to father

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##Alcohol / Meningitis##
11. 22 years old female has chest tightness while watching movie. Ask hx and
explain Dx
12. Amenorrhoea 1 yr. Hx and explain Dx
13. Telephone call with midwife for primary postpartum hemorrhage
14. Patient with SLE for 5 yrs and now wants to get pregnant. Last Dr visit 6
months ago where RFT and antibodies checked and normal. On regular
prednisolone. Take Hx and tell her immediate management
##Pre-pregnancy Counselling##
15. 45 years old female coughed up blood at dinner. Take Hx explain the
possible cause and other causes. Had some weight loss 3-4 kg.
##Malignancy##
16. 35 years old male is unwell, previously diagnosed with major depression
and started on SSRI and recently another SSRI has been added. Hx and explain
condition and immediate mx
##Seretonin Syndrome##

6th June
1. MSE video: plumber known history of schizophreniform illness. He has
stopped taking his medicines and has been brought by his partner for
change in behavior. Present MSE to examiner
2. Shortness of breath and lethargy in 42 years old female. Bloods provided
showed microcytic anemia with low MCV. Explain results to patient, take
history and DDx
##Iron deficieny anaemia – Medicine induced##
3. Hip pain in 42 years old female, for 3/52 after completing 10km run.
Observations given afebrile. Take history and give DDx with reasons
4. 4 months old comes in with dehydration and 2 day hx of cough. Hx, PEFE
(had wheeze), and immediate Mx
##Bronchiolitis##
5. 21month old comes in with being unable to walk. Take hx and give Mx
##Developmental Delay##
6. Hematuria in 62 years old male. Take Hx, PEFE and DDx

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##Pyelonephritis##
7. Father brings his 2year old child as he is worried that the child is not
putting on weight. Hx, PEFE, Dx with Mx
##Fuzzy Eater##
8. 27 year old come in with 34 weeks pregnancy, usual GP not around. US at
18 weeks prior showed larger than dates but otherwise normal. PE with Dx
9. Acute abdomen in LIF. Vitals given and patient febrile 38 with diarrhoea. PE
and DDx
##Diverticulitis##
10. 42 years old lady had 3 kids already, currently on COCP but wants to
change to Mirena. Take relevant Hx, explain the mirena coil and counsel
appropriately
11. 22 years old female comes in wanting referral to plastic surgeon for her
nose. Take Hx, explain likely Dx and Mx.
##Body Dysmorphic Disorder##
12. Post cholecystectomy day 1 fever. Observation chart given outside rest
normal only Temp: 38. Take focused Hx, PEFE, Dx with Mx
##Pulmonary Atelectasis##
13. Comatose patient found in hotel by housekeeper. Vitals normal afebrile.
Real patient acting to be comatose. Ask you to assess GCS. Perform relevant PE
and give 4 or more likely causes of coma. Knee hammer, Opthalomoscope,
otoscope placed on table.
14. 27 yo lady on COCP comes in for 4th time for vaginal thrush that started 3
months ago. Take Hx, PEFE and Mx.
##Recurrent Candidiasis##
15. 32 years old male comes in with headache. Vitals provided only HR and
BP. Had to ask for Temp. Take Hx and DDx
##Migraine##
16. Patient is taking short acting benzodiazepine, 3 times a day as son was
recently diagnosed with ALL but is now in remission and patient’s stressors
are better. Patient comes to you as friends say she is taking large amount and
she is keen to stop. Take Hx, explain how to manage her diazepam and counsel
her

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7th June
1. Cough and sob in a 3 years old boy for 24 hours. Father is very anxious,
pacing around the room
##Foreign Body##
2. Breast lump – pe
3. Respiratory examination – pe, for sob
4. Peripheral nerve entrapment in upper limb
##Cubital Tunnel Entrapment##
5. 34 weeks pregnant lady with headache
##Pre-eclampsia turning into eclampsia##
6. CT liver metastasis with microcytic hypochromic anaemia
7. 72 years old lady with haematamesis and mild epigastric pain going to back
##Peptic ulcer##
8. 28 years old male with dysuria
##Sexually Transmitted Infection – Chlamydia / Gonorrhoea##
9. Pap smear- hpv 16 positive
10. 37 years old wants hysterectomy (menorrhagia for 6 months)
11. Post natal blues / irritable baby
12. MSE video
13. 9 months old baby with crying and vomiting since this morning
##Intussusception##
14. Unwell lady for a month
##Hepatitis##
15. 3 years old boy with generalised jerking of limbs
##Idiopathic seizure##
16. Medication chart - Pneumonia

12th June 2019

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1. Paediatric abdominal pain

##Testicular torsion##
2. Palpitations
3. Ocp counselling
4. MSE video: diagnosis and dds, management
5. Paediatric difficulty in breathing
##Anaphylaxis##
6. Paediatric burns
7. HIV in pregnancy counselling
8. Male dysuria
9. Unwell with fever and night sweats
##Lymphoma##
10. Ulcerative colitis counselling
11. Pre op assessment before colon surgery – patient is on warfarin ,
arorvastatin , ramipril
12. Gynaecomastia pe
13. Facial trauma pe
14. Risperidone induced tremors -hx, do examination n dx
15. Back examination n d/dx
16. Pregnancy induced hypertension

13th June
1. Refractive error PE
2. Wrist cut PE
3. Acute abdomen PE
##Pyelonephritis##
4. Post partum PE
5. Drug chart (paracetamol,ramipril,pentoprazole)
6. Abruptio Placentae
7. Spirometery explanation
8. Knee pain
##Meniscal Tear##
9. Syncope
##Hypoglycaemia##
10. Pain on swallowing

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11. Obstructive sleep apnoea (Paediatrics)

12. Diarrhoea and vomiting (Paediatrics)
##Gastroenteritis (Viral)##
13. Tiredness
##Tuberculosis##
14. Girl refered by her teacher due to falling grades
##Depression##
15. Failure to conceive
16. Mom is concerned about daughter watching pornography

14th June
1.Recurrent falls/ postural hypotension
2.CVS examination murmur
3.Chronic morphine use with Pericarditis not responding to morphine
4.Cystic fibrosis with intestinal obstruction
4.Chronic Kidney Disease with hyperkalemia
5.PE abdominal and dre, male with previous urine retention
6.Video of behavioral and anger issues in a guy on admission
7.Pulled elbow
8.Pprom @ 35wks
9.Drug chart severe cellulitis
10.Menorrhagia (fibroids) PE
11.Back examination sciatica
12.Hay fever management
13.Uncontrolled Type 1 dm prenatal counselling
14.Ptsd truck driver
1. Recurrent falls
##Postural hypotension##
2. CVS examination
3. Chronic morphine use with Pericarditis not responding to morphine
4. Cystic fibrosis with intestinal obstruction
5. Chronic kidney disease
##Hyperkalemia##

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6. PE abdominal and dre, male with previous urine retention

7. Video of behavioral and anger issues in a guy on admission
8. Pulled elbow
9. Pprom @ 35wks
10. Drug chart severe cellulitis
11. Menorrhagia PE
##Fibroids##
12. Back examination -history of lower back pain.
##Sciatica##
13. Hay fever management
14. Uncontrolled Type 1 dm prenatal counselling
15. Ptsd truck driver

June 2019
5th June
1. PPH HB case
2. 9 month old brought in by mum with fever: 38 deg. Take hx (not eating solids
but breastfeeding as usual, only fever +, everything else normal) Ask PEFE (all PE
normal: only Urinalysis: nitrites +, lymphocytes+ protein+, no RBS) Explain dx to
mum with reasons
3.12 year old girl brought in by mum with cough for 6 months. Trial of antibiotics
and asthma medications done. No response. Long list of Investigations: all bloods-
ve, CXR: no findings. Take hx Explain dx to mother with reasons
4.22 year old brought in by friends with SOB, dizziness and chest tightness an
hour ago in a movie theatre. Some history of marijuana use+, social drinker. No
other sig history. Take history(worries about having the breathlessness again)
Explain dx and other differentials with reasons
5.32 year old unwell since yesterday. One episode of vomiting yesterday morning.
Take hx (fever, tummy pain- not pointing to any specific area- pain relieved on

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passing motion, brown watery loose stools for 2 days, one episode vomiting,
urine: dark coloured,sick contacts: his son had similar loose motion just for one
day- four days ago, son’s now fine,no SADMA) Ask for PEFE Card(card says left
iliac fossa and epigastrium deep tenderness, and fever 37.8 or thereabouts, all
other systems neg I think) Explain dx and other differentials
6. 33 year old young man comes with cough and blood in phlegm yesterday. Take
history (cough 4 months, when I asked if anything happened 4 months ago he said
no, when I asked towards end of hx if any travel, he said yes, cough started before
he left Cambodia, no sick contacts, got worse in the last week, unintentional
weight loss +) Explain diagnosis and differentials
7.55 year old had acute urinary retention after hernia surger . Needs
catheterisation. Take consent for procedure Explain procedure to patient. Gather
the equipment needed to perform the catheterisation. (Foley’s catheter, sterile
pack, sterile gloves, gauze, saline on table)
8.72 year old man comes to you with headache and ____. BP: 140/88mm Hg and
PR: 90 pm given in stemPerform relevant examination (as I said I’d like to do
Cranial nerves PE, examiner took up card and began to read out findings, fundo
normal, she asked me to do otoscope, I put on speculum and started explaining
otoscopy to patient and examiner said its normal, proceeded with temporal
arteries PE, checked ENT- did use tongue depressor and did cervical lypmhnodes
check) Explain diagnosis and differentials.
9. Serotonin syndrome. Mirtazepam started 2 days ago, Escitalopram 6 weeks
ago. Take hx. (Patient in distress: pain, sweaty, fever, examiner asked what pain
relief I would like to give. I said I’ll start with panadol- later may require
morphine) Explain diagnosis Explain management
10. 22 year old male brought in by friends to ED. Acute change in behaviour,
inappropriate, words and confused. Can’t remember SADMA. All PE done and
normal. NO NECK STIFFNESS. Sons agreed to let me talk to mum. Long list of
investigations done: Bloods -ve Urine drug screen pending. All Ix negative except
for lumbar puncture: Protein high, Lymphocytes high, glu normal. -Explain hx and
PE to mum -Explain dx and differentials and reasons

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11. 12 months amenorrhea patient is unconcerned, husband brought her in.

Pregnancy test -ve yesterday. Take hx Explain dx Management
12. 66 year old woman comes with breast lump she found yesterday. Explain
examination to her Perform PE on the dummy Explain dx and differentials to
examiner with reasons (Single hard lump in left outer quadrant of left breast,
Examiner told me cervical ln -ve, perform axillary ln: single hard ln+ in left axilla)
13. Patient came with two times high BP Perform cardiovascular examination
Explain dx with reasons
14. 25 year old woman well controlled SLE for 5 years. Wants prgnancy in the next
6 months. Take hx Explain what further investigations you will do Immediate
management
15. 55 year old has been diagnosed of diverticulitis. Turned into an abscess?
Suregery needed and surgeons say may do surgery in next 2-3 days. You are
intern. His atrial fibrillation is well controlled and he is on apixaban. Also
atorvastatin and atenolol. He is concerned about bleeding and very worried. Ask
about his concerns (What if I bleed to death? What if I have stroke? I dont trust
the surgeons. My cardiologist not available right now its the weekend, cant get
hold of him.) Summarise his concerns to him Explain how you will address his
concerns.
16. Active 13 year old with pain below both her knee caps. Active in sports and
been intensively training for a tennis tournament in the last week. Perform
relevant PE Explain diagnosis and differentials with reasons
1. Breast PE
2. 28 years old female is unwell for 2 days. Hx ,tell or PDx and DDx
##Gastroenteritis##
3. 42 years old male has high BP. Do relevant CVS exam and tell pt about Ddx
4. 13 years old male with pain in both knees. Do PE and explain Dx to patient
5. 12 years old female with cough for 6 months. Antibiotics and inhalers are
not working. Blood tests, xray, spirometry are normal. Take Hx from Mom and
explain her condition
##Psychogenic cough##

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6. 68 years old male with chronic headache with throbbing jaw pain on
chewing. Do PE and tell Ddx
##Temporal Arteritis##
7. 72 years old male presents 6 hours after inguinal hernia repair with acute
urinary retention. Get consent for urinary catheter, explain the procedure and
prepare the equipment to perform.
8. 72 years old hypertensive patient had with acute diverticulitis and abscess.
He was started on antibiotics which is not working. He is on apexiban for
underlying AF. The specialist is considering emergency surgery. Talk to pt and
explain.
9. 9 months old baby is unwell and has vomited once. Take Hx, pefe and
explain dx and management
##Fever - UTI##
10. 22 years old male had seizure and is abusive. He is brought by friends. h/o
alcohol intake positive. Vitals stable, no neck stiffness, CT normal, bsl 4.5,
lumbar puncture shows normal sugar, increased WBC with lymphocytosis.
Explain everything to father
##Alcohol / Meningitis##
11. 22 years old female has chest tightness while watching movie. Ask hx and
explain Dx
12. Amenorrhoea 1 yr. Hx and explain Dx
13. Telephone call with midwife for primary postpartum hemorrhage
14. Patient with SLE for 5 yrs and now wants to get pregnant. Last Dr visit 6
months ago where RFT and antibodies checked and normal. On regular
prednisolone. Take Hx and tell her immediate management
##Pre-pregnancy Counselling##
15. 45 years old female coughed up blood at dinner. Take Hx explain the
possible cause and other causes. Had some weight loss 3-4 kg.
##Malignancy##
16. 35 years old male is unwell, previously diagnosed with major depression
and started on SSRI and recently another SSRI has been added. Hx and explain
condition and immediate mx
##Seretonin Syndrome##

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6th June
1. MSE video: plumber known history of schizophreniform illness. He has
stopped taking his medicines and has been brought by his partner for
change in behavior. Present MSE to examiner
2. Shortness of breath and lethargy in 42 years old female. Bloods provided
showed microcytic anemia with low MCV. Explain results to patient, take
history and DDx
##Iron deficieny anaemia – Medicine induced##
3. Hip pain in 42 years old female, for 3/52 after completing 10km run.
Observations given afebrile. Take history and give DDx with reasons
4. 4 months old comes in with dehydration and 2 day hx of cough. Hx, PEFE
(had wheeze), and immediate Mx
##Bronchiolitis##
5. 21month old comes in with being unable to walk. Take hx and give Mx
##Developmental Delay##
6. Hematuria in 62 years old male. Take Hx, PEFE and DDx
##Pyelonephritis##
7. Father brings his 2year old child as he is worried that the child is not
putting on weight. Hx, PEFE, Dx with Mx
##Fuzzy Eater##
8. 27 year old come in with 34 weeks pregnancy, usual GP not around. US at
18 weeks prior showed larger than dates but otherwise normal. PE with Dx
9. Acute abdomen in LIF. Vitals given and patient febrile 38 with diarrhoea. PE
and DDx
##Diverticulitis##
10. 42 years old lady had 3 kids already, currently on COCP but wants to
change to Mirena. Take relevant Hx, explain the mirena coil and counsel
appropriately
11. 22 years old female comes in wanting referral to plastic surgeon for her
nose. Take Hx, explain likely Dx and Mx.
##Body Dysmorphic Disorder##
12. Post cholecystectomy day 1 fever. Observation chart given outside rest
normal only Temp: 38. Take focused Hx, PEFE, Dx with Mx

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##Pulmonary Atelectasis##
13. Comatose patient found in hotel by housekeeper. Vitals normal afebrile.
Real patient acting to be comatose. Ask you to assess GCS. Perform relevant PE
and give 4 or more likely causes of coma. Knee hammer, Opthalomoscope,
otoscope placed on table.
14. 27 yo lady on COCP comes in for 4th time for vaginal thrush that started 3
months ago. Take Hx, PEFE and Mx.
##Recurrent Candidiasis##
15. 32 years old male comes in with headache. Vitals provided only HR and
BP. Had to ask for Temp. Take Hx and DDx
##Migraine##
16. Patient is taking short acting benzodiazepine, 3 times a day as son was
recently diagnosed with ALL but is now in remission and patient’s stressors
are better. Patient comes to you as friends say she is taking large amount and
she is keen to stop. Take Hx, explain how to manage her diazepam and counsel
her

7th June
1. Cough and sob in a 3 years old boy for 24 hours. Father is very anxious,
pacing around the room
##Foreign Body##
2. Breast lump – pe
3. Respiratory examination – pe, for sob
4. Peripheral nerve entrapment in upper limb
##Cubital Tunnel Entrapment##
5. 34 weeks pregnant lady with headache
##Pre-eclampsia turning into eclampsia##
6. CT liver metastasis with microcytic hypochromic anaemia
7. 72 years old lady with haematamesis and mild epigastric pain going to back
##Peptic ulcer##

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8. 28 years old male with dysuria

##Sexually Transmitted Infection – Chlamydia / Gonorrhoea##
9. Pap smear- hpv 16 positive
10. 37 years old wants hysterectomy (menorrhagia for 6 months)
11. Post natal blues / irritable baby
12. MSE video
13. 9 months old baby with crying and vomiting since this morning
##Intussusception##
14. Unwell lady for a month
##Hepatitis##
15. 3 years old boy with generalised jerking of limbs
##Idiopathic seizure##
16. Medication chart - Pneumonia

12th June 2019

1. Paediatric abdominal pain
##Testicular torsion##
2. Palpitations
3. Ocp counselling
4. MSE video: diagnosis and dds, management
5. Paediatric difficulty in breathing
##Anaphylaxis##
6. Paediatric burns
7. HIV in pregnancy counselling
8. Male dysuria
9. Unwell with fever and night sweats
##Lymphoma##
10. Ulcerative colitis counselling
11. Pre op assessment before colon surgery – patient is on warfarin ,
arorvastatin , ramipril
12. Gynaecomastia pe
13. Facial trauma pe

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14. Risperidone induced tremors -hx, do examination n dx

15. Back examination n d/dx
16. Pregnancy induced hypertension

13th June
1. Refractive error PE
2. Wrist cut PE
3. Acute abdomen PE
##Pyelonephritis##
4. Post partum PE
5. Drug chart (paracetamol,ramipril,pentoprazole)
6. Abruptio Placentae
7. Spirometery explanation
8. Knee pain
##Meniscal Tear##
9. Syncope
##Hypoglycaemia##
10. Pain on swallowing
11. Obstructive sleep apnoea (Paediatrics)
12. Diarrhoea and vomiting (Paediatrics)
##Gastroenteritis (Viral)##
13. Tiredness
##Tuberculosis##
14. Girl refered by her teacher due to falling grades
##Depression##
15. Failure to conceive
16. Mom is concerned about daughter watching pornography

14th June
1.Recurrent falls/ postural hypotension
2.CVS examination murmur
3.Chronic morphine use with Pericarditis not responding to morphine
4.Cystic fibrosis with intestinal obstruction

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4.Chronic Kidney Disease with hyperkalemia

5.PE abdominal and dre, male with previous urine retention
6.Video of behavioral and anger issues in a guy on admission
7.Pulled elbow
8.Pprom @ 35wks
9.Drug chart severe cellulitis
10.Menorrhagia (fibroids) PE
11.Back examination sciatica
12.Hay fever management
13.Uncontrolled Type 1 dm prenatal counselling
14.Ptsd truck driver
1. Recurrent falls
##Postural hypotension##
2. CVS examination
3. Chronic morphine use with Pericarditis not responding to morphine
4. Cystic fibrosis with intestinal obstruction
5. Chronic kidney disease
##Hyperkalemia##
6. PE abdominal and dre, male with previous urine retention
7. Video of behavioral and anger issues in a guy on admission
8. Pulled elbow
9. Pprom @ 35wks
10. Drug chart severe cellulitis
11. Menorrhagia PE
##Fibroids##
12. Back examination -history of lower back pain.
##Sciatica##
13. Hay fever management
14. Uncontrolled Type 1 dm prenatal counselling
15. Ptsd truck driver

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1) 30 years drug addictar admitted to the hospital because

of increasing fatigue, malaise, chills and low-grade fever
over the last 2 weeks. He uses heroin, his temperature is
38.8 C, blood pressure 85/60 mm Hg, palpitation and heart
rate 120/min. On physical examination, the patient
appears gaunt, malnourished and dehydrated. He has
systolic murmur is audible on cardiac auscultation.
Petechiae are noted across his back and splinter
hemorrhages are found under the nail. Treatment: IV
Nafcillin.
What microorganism are infected IV drug users?
a) Sterp. Pneumonia
b) Staph. Aureus
c) Staph. Viridans
d) Staph. Pyogenes

2)
Patient with myocardial infarction ST elevation complains
fatigue, sweating, palpitations ( heart rate 150), chest
pain, 80/60 mm Hg. The patient was given IV morphin ,
300mg aspirin, Lisinopril,extra…..
What is the most appropriate management?

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a) Metoprolol
b) Amiodaron
c) Digoxin
d) Laboratory catheter
3) Man from Somalia comes to you with soiling. On
examination you notice a fistulous tract. Which of the following
is the most likely cause?
A) Crohn’s
B)Ulcerative Colitis
C) Schistosomiasis
D) Perianal Abscess
4) 45 yr old male, migrated frm Somalia 6 months back,
presented with soiling and fistula, wat s d cause??
A-actinomycosis
B-whipworm
C-anirectal abscess
D-Crohn s
E-ca rectum
5) 50 yrs man with no family history of prostate cancer comes
for screening advice and counselling. He scared because his
friend was diagnosed prostate cancer. You have done DRE(
normal size, median sulcus extra….all good).
What is next step of the investigation?

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a) Serum PSA
b) USA
c) TRUS
d) Genetic counselling
6) 38 years woman with no family history of breast cancer
comes for screening advice and counselling. Her friend was
diagnosed breast cancer, she scared. You checked her breast ,
no lumps.
What is your additional advice to mammography from 50 years
once per 2 years?
a) Self-examination each 6 months( I am not sure)
b) Examination by a doctor once per year
c) USA of breast each year
d) USA once per 2 years
e) Mammography each year
7) pic of red eye. F/h/o ankylosing spondylitis. what
investigation is the best for him to diagnose?
1. HLA b27
2. CT scan
3. MRI L5 spine
4. xray
8) . An 80 years old lady come with large enterocele. It was
giving discomfort but no urinary and bowel symptoms.. n
no bleeding or pain.. some more history features to
suggest she’s not fit for surgery I think.. asked
management..

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A. Pelvic floor exercise

B. No treatment needed..
C. Vaginal repair( I am not sure, maybe D)
D. Ring pessary
9) Schizophrenic patient female was treated risperidone,
appears galactorrhea. Which antipsyhotic drug do you
switch?
a)haloperidol
b)quetiapine
c) clozapine
10) Handbook 3.105 page 250
11) Male short stature gynecomastia, small testicules,
azoospermia. What is the most appropriate investigation?
a) karyotype( I am not sure)
b) serum testosterone
c) usa
12) A 5day old baby born at term suddenly collapse and
was severely dyspnoeic
while still in the hospital. Examination reveals a centrally
cyanosed baby,
tachycardic HR164b/m and tachypneic RR %56cpm,
temperature was normal,
spO2 78%. No murmur heard on cardiac auscultation.
What is your diagnosis?
PDA
Transposition ofgreat vessels with associated VSD
Left ventricular hypoplasia

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Patent foramen ovale

Tetralogy of Fallot
Hypoplastic left hear
13) The patient with RA , chronic renal failure GFR= 40…
What drug is contraindicated?
a) Methotrexate
b) Azothioprine
c) Naproxene

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14) Pt left upper limb, weakness of interosseous muscles

and right plantar response is equivocal, left is increased;
reflexes are normal. What investigation will you do to
reach diagnosis?
a MRI cervical spine
b Ach receptor antibodies
c EMG
d CT brain
15) Similar question 36- 64 year old man presents to
hospital with his first epileptic seizure whilst sat reading a
newspaper at home. Drug history – Nil clinical examination
reveals the following: •Temp
371•BP 182/102 •O2 Sats 99% Air •GCS 15/15 •Finger
prick blood glucose 3.9 mmol/l •No
Jaundice, Anaemia, Clubbing, Cyanosis, Lymphadenopathy
•CVS,RESP,GI: (-) Neurological
examination: including cranial nerves and Fundoscopy (-
)His blood tests show the following:
His chest X-ray shows a ill defined lesion in the left mid
zone.
What is the most likely aetiology of his seizure?
a. Brain Metastases
b. Hypercalcemia
c. Syndrome of inappropriate ADH secretion (SIADH) d.
Hyponatraemia not caused by SIADH
Repeat paraneoplastic syndrome!!!

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16) Q7 a patient presents with 3 months history of nausea

and epigastric discomfort he has icteric sclera he
consumes 50-60 grams of Alcohol. Lab investigations
were given all liver enzymes including total and conjugated
bilirubin were raised and serum lipase was also raised on
Usg there was dilatation of intrahepatic channels not
extrahepatic no other abnormality what you will do?

A. ERCP

B. CT abdomen

C. MRCP

D. Endoscopic ultrasound
Repeat serum osmolarity and blood gases!!!
17)A patient who is known case of COPD has diminish
breath sounds and increased resonance to percussion ..he
is likely to develop
A.metabolic acidosis
B.metabolic alkalosis
C.respiratory acidosis
D.respiratory alkalosis
E.mixed disorder

19)Patient on several medications has difficulty breathing

Labs : pH 7.1 PCO2 18 HCO3 8.What does this show?

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a)Metabolic acidosis with respiratory compensation

b)Respiratory alkalosis with metabolic compensation
c)Mixed metabolic and respiratory acidosis
d)Metabolic alkalosis with respiratory compensation

20)In a man undergoing surgery, it was necessary to

aspirate the contents of the upper
gastrointestinal tract. After surgery, the following values
were obtained from an arterial
blood sample: pH 7.55, PCO2 52 mm Hg and HCO3
- 40 mmol/l. What is the underlying
disorder?
a) Metabolic Acidosis
b) Metabolic Alkalosis
c) Respiratory Acidosis
d) Respiratory Alkalosis

21)post operative day 4 presented with confusion.on

evaluation:
urine osmolality low
serum osmolality low
na: 123
k:3.5
other parameter normal.what is your next management?
1.1.8% hypertonic saline infusion in 1 hour
2.0.9% ns in 24 hours

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3.restrict fluid intake for next 24 hours

Post op, hyponatremia, SIADH scenario asking for
diagnostic inv?
a. serum osmolality
b. urine osmolality
c. serum electrolytes

21)Pt submitted for hemicolectomy but didn't do the

operation. (Didn't mentioned why) she is very well and her
labs Na 110 (135-145) K 2.5 (3.5 - 5) Chloride is low
Osmolality slightly high 291 (upper limit 290) Glucose is 60
(4.5- 7)
A)urine culture
B)Urine osmolality
C)Repeat labs
D)Give LMWH
22)Man coming back after short trip from endemic area for
only 5 days with severe Jaundice ..fever ..on examination you
find tender liver and enlarged 5 cm under costal margin ..you
do investigations Found Very high ALT , AST , GGT,ALP
Diagnosis- a) Active viral hepatitis A b) Active viral hepatitis B c)
Malaria d) INFECTIOUS mononucleosis e) choledolitiasis
23)child with spherocytosis,,,
What cause
a) Parovirus
b) Genetic…

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c) Mumps
d) Rubella
24)MANY QUESTIONS CHEST INJURIES!!!
25) SCENARIO MULTIBLASTOMA MULTIFORME

26)

Mullirian agenesis

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