{

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fnau

MCQ

REGALLS

21 SEPTEMBER 2OO9

1,

c. Encephalilis
d. Cerebral infarct

.ir

e. EDH
a. Gout

@r:r+,-

al^';lis 7

b. Psoriatic arthritis

came from overseas (Thailand) complaining of dyspnea. CXR was normal. is the next most appropriate investigation:

c. Rheumatoid arthritis

NB.

- i'r-f--" No oseudooout ootion '---:-'

'-':S"$
c. Sputum

2.

Lpa@{reurned

from ovetseas trip (asia), complains of headache, fever,

examination

ahdoyi/nal pain, I nitial investigaton?

fi}

a. Blood cullure

He

,r' 8. pfi with hislory of chronic

diagnosis: a. Syphilis

dianhea, axillary & inguinal lymphadenopathy, what's

(!etooorirm
c. FBE

@Hrv
c. Crohn's dis

d. Abdominal Ultrasound

with classic DKA. What s the initial Rx: (lab results given

ffiaAage
,he

@rvituics
b. lnsulin lM

i\

./

comes with chest pain for several hours with respiratory tract infection, pain getting better when he lean forward, ECG given (showed ST elevation) What is the diagnosis?

el t-

(ericarditis
b. PE

c. Dextrose 5% c. Ml
d. Calcium

d. Endocarditis

4.A
do:

old patient wilh parkinsonism on treatment of levodopa & carbidopa for Now he presents with flickering movements on his mouth. What would

10.

Ply'rural area with history of t hour chest pain, given aspirin & morphine.
inferior Ml. nearest hospital is 3 hours away. What will you do next:

,/

,/

ECG

y"

fi.Decrease levodopa/carbidopa
b. lncrease levodopa/carbidopa

b. angiography

c. Add benztropine

c, referral to hospital.

d. Propranolol

Alcoholic ot confused '----)--nt'a. Oral glucose

_b.rought

to ED lV thiamine is

do next:

e. Benzhexol

./t

Nyears -atment
lime:

of metformin \ "thiamine then

alcoho & discharged

old

confused, history of DM on with same history & given now. What will you give this

{$v
c

gtucose.s%

Naloxone

d. NS tv 0.9%
a. thiamine

e. lV glucose 4%
b. insulin

+lV

NS 0.9%

12

with history of easy bleeding. Her father & brother are called "bleeders" s the investigation:

re showing dilated ventricles), brought with complains of last few hours. Neck stiffness and confusion was found

a. Factor Vlll

($
@ sAH

Von Willebrand factor

,z\

,r't

r}

,\f
I t

,.]
i: \

t e"l-L {-,.,{'t
c. LFT

Meningiti*s

f2i7r:.,i -r

l.*"*-!.- f I y..,.'

l,

() \\

d.haEt. i';n Proflle

c. Rt MCA given thiamine & 02 but didn't improve. whals

fitrlt,: "-5.,lrrt io D with

::ii 'c..0

the

d. Lt MCA

r,t,lcxone

-'
b,

.oN
d^ o-l-(i'c
ated for chqigl,g,ueration treated by communily nurse present with confusion, what is your investigation?

lady presents with thyrotoxicosis signs whats the management while for the result of TFT?
a. Propylthiouracil

ilaltrexone

b. Carbimazole

Pronanolol

a Blood culture

Dy

tl

2}Tfalienl with fever, rash, neck stiffness and initable what's the initial

-,,rlanagement? @lV penicillin bLP

d.

f,mbar puncture
CT an

c. Acylclovir lV

e,

A.yng woman who is known heroin addict is brought to the ED by her rgdiredics. She is found unconscious, with pin point pupils and shallow breathing tlb boyfriend admits that she was on prescription drugs as well as alcohol smoking :rnjuana cocane, methadone/heroin. What would be the most appropriate drugs l.'d causes constriclion of pupils?
a. $4aijuana,

ffi

/ryo^**it
b. B blockers

7,/e"ti"ntwith

DM and HT what do you do prescribe?

c9;-i

P-*'^J-'rJa

c. CCB (Ca Channel blockers)

d. Diuretics

.,Alcohol.

lady with mild fever,picarditis and history of PE) What wll help you

;.'C.mine,
heroin.

\ \

].&thadone/
Wi-

uic^r.rs 9->D' a. Echo -T4

b. ECG

:-a

-...

a f'U'TJlr)'
to,
-$,

.-,

-- 't-,-/

'p 1t*"^J

-f*

lftirl with syncope has a history of father and grandfather died in rly age
old) due to unknown cause. What is the next investigation?

"&rs

!r.no J --a.

\ ,l
u[l^ \1

.?

(r,

\-*',

'l-

c. Xray
.

@nrun
with lymphadenopathy. Blood tests showed blast cells
What is the diagnosis?

tllfuasounsd

t0"P'l'r+

'

;.ECG l-

tif'

_1

-("r-<-tl

UOy witn history of migraine with aura,

/mowarness Hna'n

comp@lers.

ow presents with bluning of vision

&

bo when is she allowed to drive

wn?

a. b.
24.

CLL Mu

ft"&e' Lt L

fr

L L^zu/'

frn

L-s,

r:lll1 0.f''-u
I
t{ever drlve again
;. Continue drving

\I

old

chance

folwing a minor injury, What -------: condition?

29 rlsca
i

@1\1 ? -ol: gted*ain

b. 1 in 4 children affected

rr e

L,After 4 weeks

c, All boys affected, all girls canier d. All boys unaffected, all girls canier history of e. All boys affected, all girls unaffected

r-

Contlnue to drive on the day light in the neighbourhood

n f#..t came with weakness

\,yPedension.dx?

of the right sided

@ anftglwith

l Right sided lacunar

$Lett
siOeO lacunar

infarct

1.

HTJ

infarcl

1 i\
.-ol
'

,tu--

,.-)n

J,.l^"n

nh as i a. ( ref

ni n s

to Vo n Willebrand)^ How would you treat her

C{ ef'l

Fa

l<\

i-

CJ-\

,l l:hrf v\
a,

' fi vlt
-)

41

cryoprecipitate

o-l^n
a+

@ ootl1
A

nOui.. the patient to loss weight

26 atient with status asthmaticus, WOF indicate poor out come?

Hx of severe attack requiring steroid Hx of severe attack requiring intubation

treatment

w'--V'-d4J

,V

Q/nOoriginatman wilh typical hx of scarlet fever (fever, lymphadenopathy

$ndpaper like rash etc), ECG showed prolonged PR interval.

What is the treatment?

and hepatitis C canier, develop lung abcess, What is the

lV Penicillin

lV

Ceftriaxone

h Amitriplylin poisoning (?came in 30 mins ) ECG showed widened

the management?

lV Penicillin

lno,oof the abdominalwall of DM lady given shows large area of redness le umbilicus. She was started on lV Penicillin and lv Metronidazole, After 12 " she did not improve.
lllhat is the managemenl?

below b. GSlric lage wit phnytoin hours, . [;:l'r1'fi:,.''

Patient with ataxia, Horner's syndrome, What is the diagnosis? Occiusion of vertebral artery

HC03

a. b, c.

Add lV gentamycin
Change the antibiotics to lV penicillin and lV gentamYcin Debridement Add Tobramycin Continue same treatment

d.

\/) (t a+;l]\
39rPt with
What is the diagnosis?

lcft

Ca and decreased PO4 What is the shows increased 29.!lood result of a oatient --=---.' investigation? -+ .yat F !"ur
PTH

-J

f.H ,t

frr:filf

r,

Myopalhy MND (motor neuron dse)

30.pM patien with history of DVT present with acute painful leg. Physical exam
shws redness over calf with venous pigmentation. What is the most appropriate "rnvestlgatton?

c,
\/

Nephrotic syndrome

35. Obese patient wilh lypical symptoms ol GORD. No history of weight loss. Management:

y o man, supervisor in some mining field, is complaining of extreme tiredness. was bed ridden for a month after he played a cricket game. After that he gave up all activities. Dx? A

,'f,
Ve,

E r.
e,ali',tterirg

--4_,

-!.

/?rA Aspirin
ui.
tpn

lady came to AED complaining and TNG. Whal is the n

She was

dtr,ic ;atigue syndrome

,
g

... -F3CiIl0uS

> * *4^" /^).-" tX*

t-"
I

ftLt1
a. Angioplasty

during climbing stairs, proximal muscle weakness, CK

(.

@subcutaneous
ng man wants to travel to a place which West Nile River encephalitis is What would you advise him?

hlhat is the investisatioi? i!t-?Q

CF

l
f

.*a*

I,

@ b.
/ /t

l\'luscle biopsy

rj

EMG

-\- a

a Avoid flies

-)

49 Aque aboul syphilis.

SO./f"OV cgmes with her 10 y o girl because her father has Hungtinton D and she knows that she's having the genes. She brought her daughter along request

b. Take prophylaxis

t'\
bleeO
in a net and use mosquito repellent

g#dictesting.

4try

4rAnange for genetic check for the

girl

&p, '

d.Vaccination

..

Give him Doxycycline

arange for genetic counseling for the girl alone for genetic counseling for mother and girl together

^"n,hx {octrnS-sensog loss to all modalities,

Sfio

of burning pain in feet, unsteadiness of legs, areflexia, gloves &

DX?

&rang.

-t ,i ywJ

(oi"O"ti"

perl pheral neu ropathy

S. {4atient

had a altack of syncope after getting out of bed to go to the bathroom an operalion. BP 80/40, Pulse 60/min. What is the likely cause?

puasovagal attack
5Z A Chest ray was shown( apical fibrosis and right lung haziness) and the history u,qiven as a refuqee c/o night sweats, feve, blood stained sputum. What si the sjt next appropriate investigation to do?

fw
b.
Protinuria more than 1 gram per day

uo*, aged obese male with difiiculty in sleeping

Obstructive sleep
,r '/\

@
b)

c)

Mantoux test Sweat test Anti gliadin test

']
'S3.

\--!l'f^lo [/ rtP^1

*'$esso ?
"/

and frequent awakening with uring the day. What is the most likely diagnosis

apnea

\4 'i u '

(: 1\i'

p)

o'>'

61,,4 known cirrhotic and hemochromatosis patient came with history of feYqr with

A patient complain of dv$hia and ? exophalthmos. She is on lcng term tlryoxine and NSAID ( can't remember which one) for HT and multinodular goitre.
ll-tat would your manage her?

'trlute distension of abdomen. What is the diagnosis?

a. Heart failure b.Portal hypertensin'

a Stop NSAID
',1.

c. Pancreatistis

r, Ferform endoscopy
:, lncrease the dose of thyroxine

// \)' ___-_
)

@SPonttn.ors

bacterial peritonitis

,
/1,

i4. Pregnan! Pt from Africa with VDRL+, FTA-ABS+, denies having STD. what is the

,l

w<t step?

-,^

cri/' t\^ u.b\'t

0&G
M a!_a q e m e

,-'"' r.

),\

' ,.r
'

re
b. L-

lM penicillin Dark field microscopy Reassure

,( Itt'"

i-!i

nt of f ,q{-c$if egqrtcy

/__L,l

lady with

+fi6f

, wfricn one is

lhe treatment of
:.^ I^'{-

( v
b.

oalAcvclovir

.- \u\ \qk

-)
r
Phosphate

h '4n"d

C,

oral Famcyclovlf

r)

2 A patient on Hormone repl acement therapy. After 2 years she is likely to have:

a. Endometrial

ctat

--z

-r'5

Biphcspnonate b. Breast cancer

D

i. vit

c. Ovarian cancer

9.pld age lady with pre menopausal symptoms complaining of vulval pruritus ant
dness. What lo rule out first ? a. Oestrogen deficiency

dsease

y*'

ndication for OCP:

ss

"---*>

furLt o J- 't*u*'':f '

a. Premenstrual headache

c. Diabetes mellitus
b. Family Hx of breast Ca d. c. Family Hx ovarian

Candida

Ca

t I ,p
lt*10.

->

4wr*,r)y_

Simplex

@Famly

Hx of

DVT

-$r*8

is the cause of cyclic vulvilis?

B streptococcus

l. ryO#-ntafter
Yrnotvarerate

hysterectomy, which HRT will you give

initially:

(rgnqvafs

- Z.q

'.a {- "$; ")

1'1

o
lvifils
Vagnosis?

b.

Bacterial vaginosis Candidiasis

IfiEoniuqated equine oestroqen oremarin 0.625

V-----^:

4,'

.patient al 12 week gestation presented wilh painless vagnal bleeding. 0n exam,

stable, cervical os closed, no abd mass felt, uterus not enlarged. What is the

c. Conjugated eslrogen

0,625 ;"

d. Combined estrogg/progesterone

b.

Threatened abortion lncomplete abortion

b. don't give OCP

LH
i

$rh

rom boRhi ri a screen

-,,
'

O,

d.progesteronepill

r.r,,4', i,,"1 ";, r i#,1, .1'nA /t --' ' -K

lr.^^ r,

'rt
, lyliayr

I FSH _-' L''i't ')''l-i' |;I v'' '' -\ oestrodiol ---:J' ' l="- H{f'

l- *!',

-' r-"*{:l

Yevelops convulslon. What

old pregnant lady ,Hx of epilepsy. Bf-ls/S. urine for protein -r+. She is the cause of convulsion?

tY?'ff

liT -

>tV

/c

\'l-

a.

Ecterrpsia

-V

, | . , ,.1*{ar*o''-' t1 ,*

,)

'

Tt

c)give hCG to him

d) Testosterone for husband

t',i!ry!ry.
c- iiypoglycaemia

,t,l

3',6

at investigation would you do to confirm that the patient has no uterus?

rJ.

hypocalcaemia lady came for prenatal screening

@uterosat

prng0gram

Question about PCOS and

USG for nuchal translucency and blood tests done n the 1st trimester

7/.

ZOyowomen comes for investigation for ferlility. Examination reveals PCOS,

./Serum prolactin normal. Mosl appropiate mx?

Clomiphene citrat
Bromocriptine

Chance of trisomy 21 1: 200000

I
.*dring

Chance of trisomv

18.1j99L

28/56 year oldpregnant female had a positive culture for group B streptococcus
what is the most appropriate managemenl

She came back for FU in the 2nd trimester for painless vaginal bleeding. What is eason for pelorming an USG for her this time?

lil',v'<l
a, Treat her before labour

@Treat

her during labour

{ f"1 1* ,^',r \{

.\ -1,'

lnJorm the paediatrician

premature ovarian failure. V, Onequestion that explained the scenario of PCOs or (LH, FSH high ovaries with what test you will do next.

4-6

cysts of 4 to 5 mm size) The question was asked

' given MgSO4, her tendon reflex is .21/A pregnanl had eclampsia and was Wminishe. what is the management. Z'i uJ ,( tL.tJ -r' Msso4 )stop
b. Decrease MgSO4

@Estrogen

on

Prolactin

,Amf:ru4ii,'iJillJ1:i'lil,i:Jii.li
ruptured yet. What is the next most appropriate step in

not

@
b)

Amniotomy

|
l/'

ie-
la.

22,.,iemalepatient's PAP smear result said "y-east effect, inconclusive study". She h"ad another Pap smear one year ago which shoed low grade cervical lesion,
What will you do now?

c)

Start on Syntocin drip'

Caesarean section Do nothing

>

-l 7a/:>';Q I I t1.'\ (,*^ / ln + _.=\ l,?*, \LI

li ln.,1 *

i+ ,.-*

A 38-week lady with GBS. What is lhe most appropriate management?

.4.i
^/F)

a, f6-) v c, d, g.
you do?

Refer for colproscopy Treat the Candida infection and repeat Pap smear Repeat Pap smear now Repeat Pap smear in 6 months Repeat PAP smear in 1 year 38 weeks, Hx of rash. Now rash has gone oniy itching. What do

a)

@
c)

d)

Antibiotic now Antibiotic during labour Give streptococcus vaccine to the infant Foetal blood sampling

'.,l
t

]f'Pregnantlady,

6) c
,

topical steroid Emollient cream Antihistamine

young female caught for shopliftir'g. How would you treat her;

a. Aversive therapy

Female came for routine PAP smear on speculum examination she had two -iagina and two cervix. What is the next appropriate investigation?

]*,

b. Psychoiherapy therapy colleag ue doctor comes to you foi' sickness certificate, He missed work times. When you ask him about the reason he became agitaled. What is the mosl important question to ask:

a, b,

IVP

Renal ultrasound

normal size

6:rvr .i.l,oin'r*n .\./

,o

n.,
.\..

-tl
l\

')

\v I t,

@}Jurgelrldlil]q'r
b. feeling of worlhlessness

l. Clomephine for husband

c. marital issues

/,,,

d. significant stressful life events

hallucinalion

ql-

@Auditorv
b. Blunt affect

e. Seconds thoughts about his medical career

&

Dx:

fg,.ign school student with history of drug abuse, he threatens to kill the teacher on further examination, you find out the reason he's doing that is the Tv is telling him to
kill people, Whats the dx?
a. Thoughl insertlon

r.@O
c. Depression
d. lrnpulsive disorder"-

ldea or rererence

c. Telepathy

d. Though broadcasting e. Normal teenage behaviour

fi/Otman
4. Afignal person brought to hospital agitated & threatening to kill others. He has

who doesn't wanl to get resuscitated but his family is distraught with his

Mdsions

as they beleve he'll be left to die in the hospital. What do you do next?

ni$ry of marijuana \J
,

use. Hx of previous admission. What do you do next:

flAsk

Ratient to sisn DNR

form

,f )@

i"-*

-*t'

l*."

police to remove him from the premisses @Cat tne

b. give him anti-psychotic

b .Arrange a family meeting and discuss the situation

treatment compulsorily c, Resuscitate patient (this option is not given!)

c. Talk to him about marijuana abuse

d Admission and observation

,at

Ptient taking Sertaline complaints of centrat abdominal pain for few months. is the management?

I
5.4 rybman was diagnosed with breast cancer . She had some marital discord with herliusband. Her husband came later to enquire about her condition so what do you

B
S.

Switch to other drugs. Stop Sertaline

*1"

lur{ext?
a. Call wife to ask for permission to tell the husband

Demented man with low mood and agg!9sqle behqviour. His wife is planning to send him to an old age home. What treatm'nt can you give to improve his condition.

@ell

husband to discuss with your wife

c. Give result to the husband

a, rT) v

citralopram Olanzapine

d. arrange him a meting with the consultant

f
lhe y.
f

Prisoner with b,r4gj:re writinO on the wall,

e. arrange him lo talk with the laboratory 6. Patient threatened to kill himself after his gf dumped him,he was admitted into [,S.nd he was agitated and said that no one is fit to treat him as he says that he

( -l

Psychotic disease Delusional disorder

Lithium lx, how long is the follow up

wnts a qualified psychialrist. Whats the dx? Borderline personality

*ii: 9 c.
d,
e.
1 week

2-4 weeks

b. Narcissistic

c. Histrionic
I

2ontns
Depressio

t
16

Ptierrlwith nsomnia

'v"wt-u': "L;l and ..gjlJ rgli.lgyg!rung,

l:t';Y"'' r\
Diagnosis?

Psvch opath

-4

t^ +"'l

J"*

1
7. Gfrlwith

umiffioks

at lhe mirror often,goes to gym daily and exercise daily Dx

'@, saw father attacked by others... f "r'

.? ,'
Diagnosis:

a.Aneroxia.-

>
@
Post traumatic stress synd ent with recurrent anterior shoulder dislocaton. She was susPected to her shoulder for some reason,

Body dysmorphic disorder

c. tsullfnra

S dviolent man in hs ED with voices telling him to kill people . What symptoms rrcdnfirm the dx?

will

What's the dagnosis?

.6J

i ,ru\'r^

Facticious

-?

")t
PCt\
Reassurance

IVP

Surgery
1 cm stone was found in the renal pelvis. What is the management?

Don't have children

His wife has terminal illness

,-ffswi

,,r-trrw,,

c,

t/U

0ther stupid answer!

5. Two football players collided, pain on LUQ radiating to tip of left shoulder' His pulse rate was increasing & BP decreasing gradually. Next management:

20.

met your patient in a shopping mall. Patient invites you to come for a coffee will you do? are not socialize with

a, CT abdomen

b. Laparoscopy

il,'

sisters living together. One sister suffering from one psychiatric illness her sister about neigh bour' attacking on house. The other apparently sister is now dislressed when she is with her sister with psychiatric illness, is fine when her sister is not with her. What is it?

d. Diagnostic peritoneal lavage

A Folie a

pregnant came with her boy friend and mother. Not attending time now. What will you'do?
a. Offer her aborlion

4t.

ic-&

involved in a MVA she was sittng in the back seat and wearing a 2 points It . After MVA, the patient had some bruise from seatbelt her GCS is 15 , BP PR 69/min. CXR showed air under diaphragm' Whal's the mosl lkely
source of the air: a. Splenic rupture

{6';refer to socia worker at hospital

Report education authority d. Report to police e. Report. to community care servces

l
L

@ntestinal

rupture

c. BlarlCei'rupture d, Ruptured diaphragm e. lntestinal pneumonitis

0 days after

/Sursery

,t

1. Pt with neck lump on the posterior triangle, FNA done & it was indefinite. CXR picture given (mediastinal lymphadenopathy), What's the next step:

'rExcision of the lump

b. CT chest

tppg_ggn'ty

operation, patient presents witl diarrhoea, Dx ?

br

f1.-1,1

I r.i f,i-t'

r'

Abcess
b, Subdiaphragmatic abcess

-,.tr r, l,-j

c. BM examination d. Staging laparotomy

tr'1',
c. Atelactasis d. Wound

L'

,
' i-'

IL{r_ Itj

,1, 'v
li

e. CT head & neck 2. Pt presenl with right adrenal mass on examination. CT also showed stone in the renal cayx measures 1 cm, what will you do: (No other symptoms or complain other than the mass) the end of micturition what is the man presents with panless hematuria at # appropriate investigation?

a, CT

b. X ray abdomen

Y
c
Reassurance &

c. PSA t

t
uL't

hydration 4

LtiJL*
\<

Kr"Jr"i

fd)Cystoscopy
e, IVP

d. IVP

l"L L=v >2

3. Pt with renal stone measures 2.5 cm, Rx: (pt symptomatic, renal stone symp +ve)

eatlent with was the best investigation?

cholelithiasis and USG was done and stones shown(pic given)' What

),
a

rsw!

2 /r-s-

ffi\

ace ?

L.ITF
16. Pt with chest injury after MVA, iqcrease{[VP, 4gffed heart sound. CXR showed loss of aoriic'knuckle ano wdffioiasti-num.T-h'ts the next most c. HIDA scan appropriate

d. Cholangiography

( t^--v ''*-c'h a. Echocardioorm 6) Pericardiacntesis +

UAK grven

management'

- both breasts, the red areola, skin on the I an ischemic hearl cond hey tried to position
Meast condition?

righ the

17. Man involving in MVA, left sided chest

the

k)
b.

atic

a. Chronic Breast abcess

18, Patient with history of abdominalUrgery presented with intestional obstruction symptoms. AXR given, What is thftgnosis?

b. Phyllosarcodes tumour

a. <'

small bowel

obstruction

^
l/\-\)

\,t

Pagets disease

&,43

*) i'J

t1.L*u^

\J\

d.infiltratinq carcinoma .
e. Carcinoma in situ

fl. p
0.',,..{+"

r:h-r"rra

n*

-'I

19. Man complaints of calf pain after walking for 300 m, what is the next step of investigation?

DopplerU-SG
Angiography

Ar'

l\
(.

'l'!. Patient with hypovolemic shock after MVA with BP 100/80 lying down to
E5/60.sitting, PR 120, What is the percentage of blood loss?

c.

Doppler USG veins

>,

(J',

a"5o/o

'\ - \ / / \ ,) -u
/_4

.-2',

r\----'

,' l tr{ --'-- i*c '>/):,1

b.15To

,^': oL
C.V-,,"
tJ

f''-'*4
.

20. A two years old child presents in ED after ingestion o-f a batterv ofh grandfathe/s hearing aid. Urgent chest x-ray showed the batlery is located at the lower end of the oesophagus. What will you do? @lmmediately remove by oesophagoscopy

/. wait
t(.

another day

c. Bronchoscopy
d. Wait for seven days and then remove

c.10%

u:--)'\
v/|ut.,,

@rn
e.25%

, has tenible epigastric Pain and y was done and an ulcer is found close to the The biopsy shows H Pylory infection. What is

"12.24 hours post throidectomy patient presents with fever,tachycardia. Pulse Rate: 110/mn

A triple medication (PPl and two antibiotics)

B surgery

fflt.turtrrit
b. Thyroid

crisis -

-"- lt

'.

.,zi
,7-

f?,r-;rt

C vagotomy
D

a Wound infection
13 46 years old

@ man who underwent thyroidectomy post operatively developes

Gto".aline

injection in ulce/s eoges

i7f,'l'Fv1 -/ f

silidor. What would you do now?

,Q. Management of acute GU

<-

Qoo:n

alr1gu1!s.i1gard

b. Take patientto OT and remove it

o
a.

/,.

inhibior

,lt'

c. Remove only superficial sutures

d.slart oxygen
14 42 y o lady with clear watery disch arge from her breast, that comes out any time

23. Most common complication of

TUS.

he breast is squeezed.

G) ll

Inraductalcggjoma
Paget's disease Ductus ectasia Breast abscess fibroadenoma

,l\'rt )'\
C'izi-

'

|u"'tlL) \' u"" (-

a. 6\ fl

lmoolence Retrooradeeiaculation

'' ----r't" ?-* ----

I'

Patient wlth fra chest. Management;

c. d e,

fur)
S. t.

lntuUation and positive pressure ventilation

et witn 7 ribs fracture, what should you do before intubation?

15. Bloody nipple discharge, What is the diagnosis?

(i

d
0.

Ductal palloma

1V a* of chest drain insertion. . -.. t\ (, .rv'r,1]

cnest drain

insertion

\\

.\

A-\'llit,t, tt

ar

q 'sth

'.
lCS. Anterior axillary line

6rh lCS, anteror

axillary line

\dall ^\., ROominal

Y c.
e.

27

. ilicltre of a patient with lump in the post triangle of neck and there are no

d csattliadder
Chronicpancreatitis-

aortic aneurysm Splenic artery aneurysm hydatic cyst

ccrnpiaints.

/
/
LymphadenoPathY Submandibular gland swelling

1l{-

,\[ [,, /"f-dnfe Vnt' ?L "rt,

-

t) Y c, d.

Liooma Cystic hydroma

,7. An elderly patient from the nursing home had constipation. AXR showed dilated
bowel. What is the next step of

management?

a. Gastrograffin enema Repeat question aboul calf Pain at

28. Piciure of a pl wilh submandibular mass. Calculi confirmed on bimanual examination. WOF is most accurate in arriving in the diagnosis?

thigh pain, ominous sign?

;--:_,+^^*_

I
a. d,

sialogram CT Skull X+ay

- o{tL .X- 'n"l .

XR normal. What is the

rest

39. Eldery pt come to ED complaining crampy abdo pain, vomiting. He stayeo in nursing home, Hx of appendiseclomY. Abdo Xray given

---{dfs5i6 and obstruction

sigmoid vorvurus

I
r

29. Pt with hx of breast cancer, presenls with thigh pain, next investigation?

)\

I {r' - YoA t\* \, =- i '* I #

-t-

Fecal impaclion 40. Old lady present with a lump on her breast, WOF suspect you of carsinoma?

=
30. 80 year old woman vith sudden onsel of LBP after bending down to pick up a cat. Hx of Ca colon at the age of 65 with OT done. Whal is the cause of the

LS lnvertednipple '3i' __-=)

b Skin dimpling

\z*

sYmPtom?
a

Metastasis lesion in

spine

(L' +tJ
-.p'{ a \
I

fr

L'(lor-..

Redness & tenderness on skin above the lump f . n)ageO male with acute right scrotal pain with vomiting. on examination tendetdwelling at upper pole of testis, Prostate is enlarged. Urine showed pus cells, What is the cause a. actue epididymoorchitis

io'n,.rrion fracture
c inter-vertebral disc protrusion

irr
epdydimoorchitis with{rostatitis

d. dorsal spinal ligament rupture

e. multiple myeloma

31. Most ominous signs of acute ischaemia of limb?

ta.

Paralysis

\?
n'

.:

"y'

42, A lady with left supraclavicular lymph nodes. where it is arising from a. Ca breast stomach c. Ca lung d. Ca thyroid e. Ca colon 43. Middle aged male with left sided lower PR what is the likely diagnosis a. Diverticulitis

32. Patient with few weeks

Ciagnosis?

,n

What is the

@a

i ii-: " .=,r.,?lil(iJ

a.
[$+

Mesenteric adenitis Mes enteric schaem

i

33. Burn victim, Carboneous sputum. Management:

lntubation

j4. Young girl, mother /witlypu do?

noticed inguinal sw

A fireman was rescued from Tire. The pt was in a state of drowsiness,. WOF is rue?
14.

k\ J .

Refer to surgeon Wait for 6 months Reassure

) 1
c
d

CarboxrheemoslohiLl s'/,
Pa2 is reduced PaCO2 is increased Blood count abnormal

45. A74 years old man had transurethral resection for his benign hypertrophy e prostate, The

followino is

b the , Rea b, Radicalprosiatectomy c, Complete transurethral d, Radiation

Chemotherapy

qdllfeielt him?

,'!--

V''
resection of

fu.
(,

;: *f;
1b

15. MVA, blood in urethra, lnvestigation?o

{'t'

prder, ibelow xphoisternum. / '1 '

ft.

Farmer with epigastric pan, AXR shows a lqund

c/o bleeding per rectum On sigmoidoscopy - normal internal haemonhod anal verge. What would be the next management? Diet

* I

LA

b) c) d)

Sclerotherapy Banding Stapling

Piclure Dx ? (rlame shaPed)

n1

'

r:'oscoPY
b. HT

47, picture of xray hand (scaphoid fracture). What's the Rx:

a. internal fixation because risk of non-reunion

c. Renal disorder

b. plasterelbow &

rest
. { l'4 '

Fundoscopy picture( bluish,dull)

Qplasterwrist&

thumb

oltJ
true: t'e'J >:{\t t
b
CRAO

48. scaphoid fracture. Which of the following is

a. avascular necrosis of

.,r

drta{agmenl

', ?J_,_Y"YJ

c. Raised ICP d, Retinalvein

49. Lady came with history of pain in hand. 0/E ruptured extensor pollicis tendon. What is the most likely cause?

thrombosis

'\ J,.tr ' 4

cornea( acute glaucoma),

a. 6'f X d,

SLE

Rheumatoidarthritis
Scleroderma Polymyositis

ii,1lfil','','J,lei i:,x

L+i:li,'i ltri'J

50. Flexion deformity of the distal phalyx of the thumb which he can not extent. Edension possible passively. What is it Flexor pollusis rupture Extensor pollusis longus rupture

An adolescent boy complains of slighl pain in the right knee which gets worse der exercise, On examination, you find'a lump on the tibial tubercle with slight Hderness, The boy can'l remember has had any recent trauma, Dx?
5'1.

A 4 yr old child was brought by her parents c/o of severe eye pain,, Physical ,,1. v examination showed erythematous and swelling over uper eyelid, she can't open lhe eye and c@gg"!trye. What is lhe diagnosis?

@ossooo
b. RA

schlate/s disease

d, Osteomyelitis

f v b. c, d.

oriialcellultis Periorbitalcellulitis
Glaucoma Retinal detachment ns of unilateral ear pain

2. Patient after OT, presented with foot drop, weakness of evertion and /Corsiflexion
Ankle and knee jerks normal, What nerve is injuried?

Whal is the best management,

L4
b

t
Tibials
L5

,q
s

c,

Acyclovir Prednisolone paracetamol

t
il

Common peroneal nerve

about bluning of vision

53-Supracglylarfracture. Treated by cast . developes acute pain in hand. What

rc diagnosis

\[)mpingement of brachial artery

8, Aborignal boy wilh bilateral ourulent ear discharoe and soeech delav. How would

manage him'i

\-

Miscelleneous
-r/
1A

(-' \/ -U\ ' /

a
b

c,

Hearing Send dscharge for cullure ?Tympanogram

tesl <--

/ -\\ . t,'- uL.7 /t L,

woman came with retinal detachment. What history to ask about:

9 Patient with vertgo, no hearing loss

* j f
uv--e>'
,-tLn

a. amarousis fugax

(}nuco*
c. dplopia

in the

eyes ,,'

.(L,^it-".

H!,krjO

done nistagmus +ve while tilting head to the Ieft

What is the diagnosis

(7v
\/ \

'@abrinVnitis lelt ear

b.Labrinynitis right ear

d. visual view defect

,olv teftr".c
o

iPr,t

" d,
f

BPPV right Meniere disease

,
f.

1 -"') ''' S:-:::;:'::i"

l-'a-'l
12 d. Start antibiotic

, )zf\"t ;k t ' .':|"il, l)'t

a) give anti-venom for black snakes

I't
L)

Acouslic neuroma

e) observe him for 2 hours then send him home Peadiatrc

8, Baby wlth sepsis

l. O munln-t baby with lymphadenopathy , spleenomegaly, dianhoea and FTT with

rat'flrush. Whats the diagnosis?
a. Lymphoma

9. Mother wonies about her 12 month old child's development.

1O.She can row over and sit on herself, but can't walk with assistance. C Peekaboo, say mama, dada and 2 words. What is the diagnosis

!-Hrv
c. EBV

o
by mother,in school he was teased because of his weight,he has of weight , 507" height, so what do you do next ? ,
d.
A

a.

No developmental delay Gross motor delay Fine motor delay Social skill delay Language problem

{i

a. Refenal to family dietician

b. Gastric banding

ir

r'

l''"t

a { { 1.',u
ti
-4a\

\/t

,,lh t

11 6 month old child can

flcrrto

"YJ
-1

\J
c

1 inch obiect with both hands

$,,,,,.,n.,
3.cni#t1

"\

b. Stand Say mama and papa

absence seizure,with EEG 3 herts spike what will you advice the

fl"

-g

'12. Child with

typical history of intussuception, What is the management.

gObserve child$ngr+dsd$fl{puxn

r. Don't give loo much info to the school to avoid stigmatism

t. Boy yifBP 150/90 edema over ankle rbc casts

-+-r-+

proteinuria ++ what is the Stop breast feeding Continue breast feeding and increased fulid intake Expressed breast mild and diluted with water,

i\gnsis?
r. Nephrotic syndrome
GN

QAcute

14. Child with febrile convulsion, his cousin is being lreated with phenytoin for epilepsy, WOF is true? High risk of seizure in case of high fever in the future Need prophylaxis pheytoin EEG needed 1-2o/o chace of epilepsy 2-4 % recunence within 24 hours

;. Papillary
,

).

old girl with a 1cm disc shape firm lump behind her nipple what do you do

b. c,

1- FNAC

@ e.

l- Ultrasound

15. Management of child wth bronchiolitis

18. Chld presented with pelechia and bleeding tendency. What is next investigatio't?

TGA PDA

t.

_a:

FBE

t,
VSD

19. An African 18-month-old child was brought to you with a h/o of 5 month of

22. A diabetic mother gave bilth to a full lerm baby. After 2 days, the baby becomes

unwell and t$.9.ry, Wnat is the diagnosis?

@Hypoglycaemia
23. A new born baby with

Tcnft .4F
Diagnosis?

t,/-r"

,1,,tr

l2

left heqlr

Trli'

';

l''l,,v,L1IL t,L,l,J_

24.3 year old child with limping. On Exam, general condition good, limited
mov'fment of one hip. Knee exam normal. What is the next investigation?

&aw|l.i

a. Joint aspiration

b. USG hip

<>1-rX
reason of the

j.tr.t
png?

t'L{'

25. A 14 yr old boy is brought by mother for c/o her son limping with one shortened lo'rer limb. O/E the boy's wt was in 90th% and height was 50th%. What could be the

Slipped capital ier epiphysis

s)
h)

Jk"^rJ/"J.

Osteomyelitis Septic Arthritis Fracture neck of femur

26. A recall que about

-:hlb
as_ah

. WOF is

true?

--

L'tJ"

lz

l-

Ht ,totd

a. His falher had similar problem

27.Baby born with C-Section, after 2h become breathless, repiratory rate >60/m, intercostal recession. He is maintain on 02 45%, after4h still unwell, dx?

-:\ -/ TTN *\ -HMD

( 1'2]^.yu-Q.-

-('*

I-r, \4
on@ay ay

[/econium aspiration

28.Baby delivered noi'mal vaginal delivery, well after birth in cot, cyanotic, no murmur. Dx? TOF

fi^;;x-'l

185, A 5 y o boy gets drowned and his mum calls 1 1 1 then starts CPR. Which is the most important factor to influence the outcome of this boy's resuscitation?

A how good his mum is doing the CPR

B if the water was salty or not a) left temporallobe
b) frontal

C when he had his first

D

breath

-PP\

ffi'#
@
?

oz

CLf- q32
soon the ambulance anived

&"^il'M,
IrQ ^ f" IV t tU
\l)

c) left parietal

@r"*

Nl

@rightparietal
e) occipital

186. .** The pre-menstrual vaginal discharge is commonly due to:

@candida
1il). Unlversity youns girlcomes to you with inflamed ph??^Tg

;dte is concerned she might have mononucleosis coz a friend of her had it.....Dx?
C viral pharingitis

P^lili" lljrt

D bacreroides vasinalis

186. . Wife brings her husband in ED coz the right half of his tong is swollen. He had a treatment with ampicYllin?? Mx?
tn

Qe

glandular fever

tto
,NO

B prednisolone iv

181.29 y o African lady in labor, complete dilated cervix, fetus head +1, 0/E you see she had "f-emale circumci,sion". her vagina alloty

C antihistamine po
187

***'

J{

Abmedio-lateralepisiotimy

/'

tl'ztyJ

( <t

$is
D posterior episiotomY

known alcoholic, broughtin ED because some mental to remain in the hospital, His father, 62 y o wants to and has also "some mental problems". The GP is an alcoholicto take him home, He or social worker says that their house is insalubrious/dirty, with rodents feces, etc What should you do?

182. 12 hours a*er a assisted derivery (ventouse), morher experiences

continuous

uinaryincontinence
A pelvic frour B retrograde

Mx?

#t:i:::: i:i::il;::t
1gg.6modhsoldbaby,breastfed,broughtbyhisparents,veryconcernedand

exercise
u

distredzihe

baby cries every day, starting late evening till midnight when he fall

retrogram

r@ttreter

insertion 89. 82 y o lady, from nursing home, found to have colon/cervical? Cancer for which surgery is necessary, She refuses to start any treatment for this Ca. She seems to undlrstands this health issue, ever she's having few other health conditions, What should you do?
1

transvaginal scan

E cystoscopy

e1'u$u
'N83.

'-"0-'"'n
9

After successfully treated first urinary infection, with antibiotcs, in a 6 or

A ask for a mental check up

her

ago hecarrse of heavy bleeding, now

A defer till he gets 21 y o

do it coz is reversible
Picture of second finger with a big (0.5 cm), round, red tumor instead of nail, Bethadine/ yellow iodine solution/ stains could be seen around it
19.1 .

C talk with his girllriend, convince her.. D perform surgery after u have a signed consent

(!enO

C excision with margins

him for a second opinion

biopsy
E amputation of distal Phalange

\h\
t-Y \qt

_--

%,