1 Sept. 2011
September 2011
Medicine
1. A man was scratched by a cat and there is a red rash extending from arm to forearm. no tender lymphadenopathy.
A) Cat scratch B) Cellulitis
2. A 20 year old man presented with weakness of the left arm. On examination the left arm is oedematous. His axillary lymph nodes are enlarged but not tender. He also reported that his pet cat is unwell. What is the cause?
A) Cellulitis
b) Axillary vein thrombosis C) Cat Scratch fever
3. A case describing cellulitis. which the most common organism? a. staph
b. strepto pyogen
4. Patient clinical features: chemosis, blurring of vision, painful, photophobia, pupils semi-dilated fixed and irregular when compared to the other side. He has been having similar attacks in the past. What is the long term management of his condition?
(A) Acetazolamide (B) Pilocarpine (C) Trabeculectomy (D) Peripheral iridotomy (E) Sotalol
5. A picture shows a patient with chemosis, congested red eyes. He also has history of recurrent genital and aphthous ulcers. What's the treatment of this condition?
(A) Amoxicillin (B) IV prednisolone (C) Oral prednisolone (D) Antiviral
(E) Chloramphenicol drops
6. 65 year old male patient comes with typical chest symptoms and temperature 37.8C. ECG was given, shows anterior lateral MI. (The stem didn’t mention anything about the initial MI MONA treatment). What is the next most appropriate management?
(A) PCI (B) IV GTN
(C) IV Prothrombin
7. 52 year old male patient, onset of chest pain 1 hour ago, was brought to the hospital. ECG was given s/o an anterior inferior MI. GTN and O2 were given immediately. Tertiary hospital is 3 hour away. What is the next step in management?
(A) Transfer for PCI (B) IV streptokinase
2 Sept. 2011
8. 35 year old nurse working in a rural hospital, smokes 40 cigarettes a day. Presented with productive cough, sweating, malaise, other GPE was normal, temperature was 37.8C.
(A) HIV (B) TB
(C) Pneumonia
(D) Bronchial carcinoma
9. Pyloric Stenosis: USG done. What’s long term management? A. Pylorymyotomy
B. Endoscopy 10. Diabetic foot, Tx:
A. Gentamycin with metromedazole B. Doxcy
C. Erythmycin
11. 18 year old present with thirst, polyuria (4-5 Litres per hour), normal 24 hour urinalysis, urine osmolality (?), urine sodium 137mmol/L.
A. Diabetes insipidus B. SIADH
C. primary polydipsia
12. 65 year old diabetic patient complains of two days history of pain in lower limbs with redness, tenderness in calf, absent pulses in ankle with reduced sensation below knee? A. Cellulitis
B. Embolism C. DVT
13. Picture of amoxicillin induced rash. Patient with sore throat on amoxicillin developed the rash in picture. Next step in management?
A. Stop amoxicillin B. Penicillin IV
14. 55 year old male with complain of 30 pack years of smoking, mine workers now complains of cough, Dyspnoea, pleural tap is blood stained, what is the diagnosis?
A. Mesothelioma B. SCC
C. Small Cell Ca of Lung
15. 60 year old male with redness scrotum and pain, what’s the next best investigation? a. USG
b. urine culture c. FNAC
16. 50 year old male with C/O severe right eye pain, what’s best treatment? a. paracetamol
b. Sumatriptan c. High dose steroids.
17. Normal looking X-ray, H/O green sputum, cough and occasional blood. WOF is best long term Rx?
3 Sept. 2011 a. Tetracycline for ?
b. Anti-TB Rx c. Physiotherapy d. Reassure.
18. X-ray of upper lobe (L) cavity. Pt form Vietnam. What is the best Mx? a. Anti-TB for 6 months
b. antibiotics c. CTPA.
19. A long stem regarding the wrist and finger movements. Patient cannot extend wrist and fingers. All other small muscles are normal, where do you think the lesion is?
A) Median N B) Ulnar
C) Posterior interossei D) Ant interossei E) Radial nerve
20. An old man was found wandering in neighbourhood, with poor attention to self care, forgetful. He was well 2 weeks ago, no h/o trauma, drinks alcohol occasionally. What is the best diagnosis?
A) Lewy body dementia B) Vascular dementia C) Alzheimer dementia D) SDH
E) SAD
21. Stem similar as above, but forgetful for past few months, now acutely disoriented in the past two weeks. He is living alone, no trauma, moderate alcohol. Dx:
A) Lewy body dementia B) Vascular dementia C) Alzheimer dementia D) SDH
E) SAD
22. Stem similar as above, but now more acute disorientation for 2 days. A) Lewy body dementia
B) Vascular dementia C) Alzheimer dementia D) SDH
E) SAD
23. A poor quality CT scan was given, which shows one bowel lumen on left side with a fluid level. patient has h/o pain. Clinical features: bloating and no bleeding. Dx:
A) Diverticulitis B) Appendicitis C) Some other options
24. Patient comes with cough with expectoration. His sputum is greenish with occasional blood. WOF is the long term Rx for the condition
4 Sept. 2011 B) Anti TB RX
C) Physiotherapy D) Reassure
25. 65 yrs old man comes with complaints of loss of ankle and knee jerk. He has a h/o Gastrectomy few years back. His blood test results are as follows:
Hb 109 RBC 3.5 WCC 4.5 Platelets 180 MCV 110 MCHC 27 What is the most appropriate diagnosis?
A. Iron deficiency anaemia B. Age related anaemia C. Vit. B-12 Deficiency D. Alcholism
E. Hypothyroidism
26. 45 yrs old smoker comes with complaints of Rt. Eye ptosis, Vertigo, loss of sensations on the lower half of face, b/l visual blurring, ataxic movements Rt.hand and foot. O/E there is sensory loss of the Rt.upper and lower limbs. What is the most appropriate reason?
A. Rt. Anterior communicatinr artery obstruction B. Horner’s syndrome
C. Rt. Vertebral artery Thrombosis D. Post Cerebral artery
E. Temporal Arteritis
27. A 35 yrs old smoker comes to you with complaint severe hematemises and epigastric pain for the last 3 hrs. His BP is 80/50 and HR 110. After resuscitating him with 2 Litres of normal saline. Which one of the following will alleviate his condition?
A. Oral Ranitidine B. I/V Omeprazole C. Adrenaline I/V D. Long term PPIs
28. 80 yrs old pt. came to ED with complaints of Dysuria, Nocturia and recently developed Back pain which is getting worsening by each week. Following investigations:
Hb. 90 RBC 3.1 WCC 5.0 ALP 300 PSA 10 (<5)
What is the most probable cause?
A. BPH
B. Prostate Cancer C. UTI
5 Sept. 2011
29. 55 yrs old pt. Known case of Rheumatoid Arthritis on long term treatment on Methotrexate weekly, Celecoxib, Ca+Vit D analogues developed ill health, Anorexia and generalized discomfort. On investigating:
Hb 85 RBC 3.0 WCC 3.5 Plat 30
ALT, AST both High What is the most appropriate diagnosis?
A. Autoimmune Hepatitis B. Cirrhosis
C. Methotrexate induced Hepatitis D. ITP
30. 80 Yrs old lady with h/o Hypertension, DM. She is on Amlodipine, Enalapril, Metformin. She is having difficulty from rising from the chair for the last few months which was previously ok. All physical examination is normal. What can be done for her?
A. Send her for Psychiatric analysis B. Put Brick under her chair C. Motor neuron disease D. Diabetic neuropathy
31. 45 yrs old Business came for the Medical examination for Insurance Company. All his investigations were normal except ECG (it was of A.fibrillation?). Which one of the following is most beneficial for his long term treatment?
A. Warfarin B. Aspirin C. Digoxin D. Amiodarone
32. A fundus picture of arteries occluded with emboli, 55 yrs old pt. presented with few episodes of Visual Blurring. Which investigation is most beneficial in diagnosing his condition? A. Urgent CRP and ESR
B. Carotid Doppler Duplex Studies C. MRI brain
D. Trans esophageal Echo
33. A Young Female patient comes with long standing history of hypertension. O/E She has absent peripheral pulses. What is the most appropriate diagnosis?
A. Aortic Aneurysm B. Vasovagal Shock C. Takayasu’s Arteritis
34. Which condition is not associated with Lymphomas? A. Sjogren’s Syndrome
B. Infectious mononucleosis C. Wegners Granulamatosis
35. A young male patient came with Complaints of recently occurrence of joint pains, hematuria and abdominal Pain. He has H/o Tonsillitis 2 weeks back for which he was treated
6 Sept. 2011
with antibiotics? He has also developed purple nodules on the buttocks. Which medications you would like to prescribe for his abdominal pain?
A. NSAIDS B. Omeprazole C. Corticosteroids D. Bowel loops dilators
36. A 50 yrs old pt. long standing Diabetic came with rt. Ankle swelling and pain one month. She has no symptoms of CCF. On X-ray there is increased joint space and Peri-articular thickening along Metatarsals. Cause?
A. Diabetic Amyotrphy B. Gout
C. Osteoprosis
37. A 32 year old fit healthy male comes to you after an accident. He is a motor mechanic and presents to your clinic with a deep penetrating wound which he sustained when he fell against the dirty metal plate of a car he was repairing. He has received his 3 tetanus shots and the last one was 3 years ago. After appropriate wound debridement what else would you do:
a. Give him a booster dose of DTP
b. Give him a booster dose DTP and Tetanus Immunoglobulin c. Reassure and advice regarding wound care
d. Give him Tetanus immunoglobulin
e. Ask him to come a week later for a booster of DTP
38. An elderly lady presents with complaint of loss of central vision in her left eye and lines appear wavy to her. Fundoscopy image is given. What is the diagnosis?
a. Retinal detachment b. Cataract
c. Macular degeneration d. Glaucoma
e. Diabetic retinopathy
39. A lady presents to you with complaints of floaters and fall in visual acuity. What is your initial treatment? (An picture was given – the question and options are exactly the same as written) a. Pilocarpine drops b. Acetazolamide c. Atropine d. Chloramphenicol e. Retinal reattachment
40. Which of the following is the least likely presentation in a patient of Temporal arteritis. a. Headache
b. Visual loss c. Elevated ESR
7 Sept. 2011 d. Fever
e. Jaw claudication
41. An old lady who had a hysterectomy done years ago now complains of lower back ache in the lower lumbar region. Her WCC and platelets are reduced. MRI given. What is your diagnosis? (similar as this one)
a. Multiple myeloma b. Osteoarthritis
c. Ankyolsing spondylitis d. Osteoporosis
e. Spondylosis of L5
42. A man from North Queensland, recently returned from an overseas holiday presents to your clinic complaining of fever, peri-orbital pain, joint pain, lymphadenopathy and rash over the body. What is the most likely diagnosis?
a. Leptospirosis b. Dengue fever c. Ross river fever d. Brucellosis e. Malaria
43. An 82 yr old lady living on her own is being treated for hypothyroidism by you. You have prescribed her Thyroxine in titrations of 75 microgram. On follow up after a month the TSH level is elevated and T3 and T4 are decreased. What is your next best step?
a. Enquire about adherence to dose and medication b. Ask her to come after a month for follow up c. Increase the dose of thyroxine
d. Follow up after a week
e. Do blood levels after the next dose
44. A known case of Rheumatoid arthritis who is being treated with sulphasalazine is now pregnant? How will you manage her?
a. Continue sulphasalazine
b. Replace sulphasalazine with Azithromycin c. Methotrexate
d. Paracetamol e. NSAIDS
45. A female presents to your GP clinic with complaints of arthralgia and dry eyes. She also complains of dry mouth and cough. On examination there is salivary gland enlargement. Positive ENA and Ro(SSA). How will you manage the patient?
8 Sept. 2011 b. Allopurinol
c. Hydroxychloroquine d. Colchicine
46. What is the most common cancer in non-smokers. a. Squamous cell carcinoma
b. Small cell lung carcinoma c. Adenocarcinoma
47. How do you monitor lung function in GBS patient? A PEFR
B FVC C FEV1
D O2 SATURATION
48. A man working in the mine industry for 20 years. He had chest pain and dyspnea. CXR as below. What is the next step in management?
a. CT scan b. Bronchoscopy c. Pleural biopsy d. ABG
49. Man is brought to the hospital. He is agitated and irritable. He refuses to co-operate. What will you give him?
A haloperidol B diazepam C olanzapine D thiamine
50. A driver from interstate has moved to your locality recently and is stable on lithium for the past 15 years. How do you monitor him?
9 Sept. 2011 b. Check lithium levels every 6 months
c. Check lithium levels every month d. Do full blood count
51. A man present to ED after having lacerated wound. The fat tissue is seen. He has been immunized 9 years ago. Which one of the following should be given for his wound management after you did debridement?
a. Tetanus toxoid and TIG b. Penicillin G
c. Tetanus immunoglobulin alone d. ADT
52. Patient with sudden weakness in one side of face including forehead muscles and no other neurological signs, what would you do next for investigation?
a. Brain MRI b. Brain CT
c. No need for more investigation
53. 60 y.o man comes with severe sudden chest pain and sweating. ECG, chest x ray and Troponin level are normal. What’s the next step in management?
a) Check troponin again in 8 h b) Admit patient to ICU
c) Discharge pt with B Blocker and Aspirin. d) Discharge pt without any drug
54. While playing cricket, a man was hit in the eye. On examination there is hyphaemia in the ant chamber. What will you do next?
a. give analgesic, and ask him to go to GP tomorrow. b. refer to ophthalmology immediately
c. refer to Ophthalmology the next morning
d. Reassure that hyphaema is likely to subside in a week.
55. A 75 years old lady with constipation since 6 months. She has h/o using senna and appendicectomy. O/E: progressive abdominal distension. Picture as below. What is the most likely diagnosis?
10 Sept. 2011 b) Small bowel obstruction
c) Large bowel obstruction
56. PIC of a lesion shown as below. What is the treatment?
PIC as below. What is the diagnosis? A. Arterial ulcer
B. Venous ulcer C. Diabetic ulcer
57. Pic as below. What is the management? A. cold compress
B. chloramphenicol ointment C. acetazolemide
D. acyclovir
58. Picture of eye. Bacterial conjunctivitis. Management is? A. Gentamycin eye drops
B. cold compress
11 Sept. 2011 59. Picture of eye (everted lower lid, congested conjunctiva), A. Surgical Manipulation
B. Antibiotic eye drops C. Cold compression
60. Picture with old man with red eye, excessive lacrimation. What to do next? a. Cold compress
b. Antihistamine c. Steroid eye drops
61. Visual field defect as below. Where is the lesion?
a. temporal lobe
b. optic nerve c. parietal lobe d. optic chiasma
62. A picture of visual field was shown. Where is the lesion most likely to be? A) Optic chiasm
B) Optic nerve C) Parietal lobe D) Temporal lobe E) Cortex
63. Pt who has small cataract, peripheral visual field defect and small pupil next step management is:
a. measure intraocular pressure b. slit lamp
64. A man with h/o trauma to knee joint in a sports game of rugby resulting in tenderness, swelling, redness of knee joint. What is the next appropriate management?
a) MRI Knee b) CT knee c) Aspiration joint d) X-Ray joint e) Arthroscopy
65. A man with symptoms of difficulty in plantar flexion ,inversion, dorsiflexion and eversion of the foot. Knee reflex is present. Which of the following is affected ?
a) Common peroneal nerve b) L5
c) S1
d) Sciatic nerve e) Tibial nerve
12 Sept. 2011
66. 45yr old man, smoker presents with complaints of pain in the thigh and calf on walking 100m. The pain is relieved by resting. The pain appears at 20m with walking on uneven surface and on inclination. What is the most appropriate next step in investigation?
a) Arterial angiogram b) CT spine
c) MRI lumber spine d) Venous Doppler e) ABI
67. A 38 yr old lady presents with secondary amenorrhoea for 12 months. Her blood results:
FSH 50 (high) Ostradiol (low) Prolactin (normal) TSH (normal)
What is your diagnosis? a) premature menopause b) pituitary adenoma c) PCOS
d) Pregnancy
68. What is the best long term management in a pt. with glaucoma? a. pilocarpine
b. acetazolemide c. iridotomy d. trabeculectomy
69. Patient presents with difficulty in extending fingers. Small muscles of the hand are intact. There is no wasting. Where is the lesion?
A. ulnar nerve B. median nerve C. radial nerve
D. anterior interossei nerve E. posterior interossei nerve
70. Patient presents with a swelling in the midline of abdomen between xiphisternum and umbilicus. Which is the best position to examine him?
A. cough while standing B. cough while lying supine C. lift head while supine D. flex head while supine
71. CT Scan as below. Patient on warfarin for A.F. Was given roxithromycin for URTI. INR 4.9. Patient has weakness in arm since few days. What is diagnosis?
A. cerebral infarct
B. cerebral haemorrahage C. brainstem stroke D. subdural hematoma
13 Sept. 2011
72. Patient post cholecystectomy noted palpable mass in midline. a. Cough when lying
b. Cough when sitting
c. Ask patient to voluntary raise hand d. Passive raise patient’s legs
73. Pt 47 years old, drinks about 6 STD alcohol per day presented with tender Rt hypochondria, hepatomegally 3 finger below costal margin, ascites. What is the most common cause:
a. fatty liver
b. alcoholic liver cirrhosis
74. Pt has DM presented with MI his coronary angiography revealed LAD tow stenotoic lesion and one lesion in CXL the next appropriate management is:
a. diluting stinting b. coronary bypass graph c. Thrombolytic
75. Infected Bartholian gland treated by: a. surgery
b. antibiotic
c. resolve spontaneous
76. Pt 25 years brought to EM department in agitated state on examination febrile, needle marker, murmur, next appropriate management is:
a. transeosophageal echo b. blood culture
77. Pt work in the mining presented cough, CXR picture Lt pleural effusion, the diagnosis is : a. sequamouse cell carcinoma
b. mesothelioma
78. Pt 85 years presented with RT tight and leg pain after fall, the picture fracture of the head of femur. Her investigate creatinine .15, ca 3.5, urea10 most commonly cause:
a. osteoporosis b. Vit D toxicity
c. Primary hyperparathyroidism
d. hypercalcemia secondary to malignancy
79. Pt has bone pain due secondary metastasis which well control by oral morphine 10 ever 4 hours and he took metaclopramid tablet 10mg every (?). He developed intractable nausea and vomiting. which next appropriate step?
a. reduce morphine to every 6h b. cease morphine for few days c. increase the metaclopramid to (?)
80. Pt with pain during eaten in mouth, picture (submandibular gland enlarged) cause: a. Submandubilar calculi
81. Pts has HPT on thiazid 25mg, aspirin, B blocker, presented with polydipsia, polyuria. His blood glucose 17mmol/l next management:
14 Sept. 2011 a. Cease thiazed and reassess after
b. start insulin immediate
82. Pt on warfarin, INR 4.5, CT reveals intracranial haemorrhage. Next step in management is: a. FFP
b. prothamine sulphate c. Vit.k IV
83. Pt has diluting stent and he is on aspirin, clopedgrile presented with irreducible inguinal hernia, which become tender next step management:
a. reduce and observe
b. stope aspirin and clopedegril one week before surgery c. surgical immediately
84. Pt from Sudan as visitor presented with non-productive cough for 2 months, loss of weight 3kg. next step of management
a. isolated in hospital b. isoniazid
c. rifmp+ethamp+ison+pyrt
85. Pt has history of road traffic accident and Lt Thoracotomy with mammogram picture of Brest calcification most common cause?
a. adenocarcenoma of Brest b. fat necrosis
86. Pt known to have COPD on 8 liter O2. his condition deteriorated, become breathlessness. ABG: pH –decreased, PaCO2-increased, SaO2 85%. Next step in management is:
a.) Lower Oxygen to 2 liter b.) Increase oxygen c.) CPAP
87. Pt presented with obesity (BMI=33) after trying exercise and diet control without any benefit next step in management is
a. liposuction
b. restrict diet control c. medical treatment (...)
88. Pt known case of HPT well control on prindapril (ACEI). his cholesterol level=6.5 with low HDL, high LDL. next step in management is to protect this pt from stroke is:
a. Exercise
b. start simvastatine c. fibronate
89. Lady 24 years old come to ask you,as her friend has glandular fever, O/E she has enlarged tonsil and submandibular lymph node enlarged, her investigations are given ,the clear abnormality is lymphocytosis,also IgG+,IgM- for infectious mononucleosis. She infected with
a. viral pharyngitis b. streptococcal infection c. infectious mononucleosis
15 Sept. 2011
90. Principal of the school is misbehaving with the kids with sexual remarks, colleagues are concerned and speak to him but he doesn’t care. He cannot change the topic when talking to someone but hygiene is good. Which of the following will help to diagnose him?
a) Ask him to remember last 3 numbers. b) something about the 3 sentence rule
c) Ask him the name of prime mister of the country. d) some even more stupid option
91. Patient being taken to the Operation theatre and suddenly develops sort of allergy/hypotension. Cause?
a) Latex
b) Unknown medicine given to him c) anxiety
92. A 45 year old woman is presented with abrupt left eye blindness and right hemiparesis (the stem was not that clear but the patient is symptomatic). Right carotid Doppler shows 50% stenosis and left side shows 60% stenosis. What is the next appropriate management?
A) left carotid endarterectomy B) ASA
C) warfarin
93. Old patient with abdominal pain, constipation, what is the cause? X-Ray is given (you can see the gallbladder stone)
A) Mechanic bowel obstruction B) Sigmoid volvulus
C) Pseudo obstruction
94. Picture of ingrown nail. What is the management ? A) Local exision
B) Wedge excision C) IV injections
95. A young girl syncope while playing hockey in the field. Father died suddenly 25 years ago. What's causing the symptom?
A) HOCM B) Drugs
C) Cerebral problem d) Meningitis
96. Young girl was jogging and sudden LOC. A passer-by perfomed CPR. At ER, patient has stable VS. Father died at 28 y/o, what’s next management?
a. Echocardiogram
b. ECG
c. CT head d. CXR e. Troponin
97. A young adult presents with history of sudden syncope and dyspnea. ECG findings show sign of LVH. Patients father had a sudden death at a very young age. Initial treatment? a. Verapamil
16 Sept. 2011 c. Defibrillation
d. LMWH
e. Adenosine
98. An Obese lady (it mentions obese) with problems of DM and Hypertention, says how many medicine she is on for DM and Hypertension. Her last menstruation was 3 weeks back. She came to the hospital because she her Bp is 140/95. What is the management?
a) recheck her tablets/medicines b) Ask her to lose her weight c) some HT medicine d) Do bHCG
99. Toxic shock syndrome caused by Staphylococcus Aureus is associated with: A) Super-absorbent sanitary pad
B) Endotoxin production
100. A young patient of 20 years came in to the ED with Afib and he had similar episodes 8 years back, what will you do?
a) Cardioversion b) Metoprolol c) Warfarin d) Digoxin
101. A long stem about a patient’s history about working in mine for 30 years with 50 pack cig in 10 months. Then an picture was given of abdomen with little protruding and vesicles/veins visible!
a) Mesothelioma b) CA Stomach
102. A MCQ absolutely same regarding a lady travelling by air and with flu like symtoms, diarrhea and crackles on the base of the lungs. Dx:
a) Pneumonia b) H1N1 c) PE
103. Psoriasis: what is the best long term management/treatment? a) Tar
b) Methotrexate
104. Pt with DM HTN with INR 4.9 RIF pain, CT show Retus shleath Heamatoma. a) Give FFP
105. Old male patient h/o jaundice with dark urine (no mention of pale stool) and mass was present in the right upper abdomen with move with respiration has no h/o alcohol intake, what is the most probable cause for this presentation?
A) Cholangitis
B) Mucocele of gall bladder (I choose you) C) Cholecystitis
D) Choledocholithiasis E) Ca pancreas
17 Sept. 2011
106. Old woman patient h/o jaundice with dark urine, pale stool, and mass was present in the right upper abdomen with move with respiration. Dx:
A) Choledocholithiasis B) Cholecystitis
C) Ampullar vater (I chose you) D) Mucocele of gall bladder E) Cholangitis
107. Man from Sudan coming with c/o cough for 1 month. Greenish sputum and haemoptysis. Most appropriate management?
a) Isoniazid
b) Isoniazid, Pyrazinamide, Rifampicin, Ethambutol c) Amoxicillin
108. Picture of man with blocked nasolacrimal duct. Patient c/o watering of eyes. Most appropriate Mx?
a) plastic surgery referral b) antibiotics
109. Construction worker c/o watering of eyes & redness after hamerring a nail at work. Mx? a.) Antibiotics
b.) Local anaesthetic and probe the eye
110. 83 yr old woman c/o redness of eyes & blurring of vision. Mx? a.) Dilate pupil & fundoscopic examination
b.) Slit-lamp examination
111. Mouth ulcers in patient with RA on Celecoxib. Mx? a.) Folic acid
b.) Cease Celecoxib c.) Folinic acid
112. Clinical picture of exacerbation of acute gout. Initial Mx? a.) Allopurionl
b.) Colchicine c.) Naproxen d.) Codeine
113. Indigenous boy who c/o thick purulent material coming out of ear and nose. Mx? a) Ear swab
b) nose swab
114. Man sustained industrial work injury. Received full vaccination for tetanus 9 years ago. O/E laceration of leg. Most appropriate Mx?
a.) Tetanus toxoid + Ig b.) aDPT vaccine +Ig c) DTP + Ig
115. Clinical picture of Diverticulitis. Mx? a.) CT abdomen
b.) USG abdomen c.) Sigmoidoscopy
18 Sept. 2011 116. All of following are causative factors of cancers EXCEPT: a.) fat
b.) alcohol C) smoked food d) aflatoxin
e) monosodium glutamate
117. Picture of HSP (purpuric lesions on the legs). What would you do next? a. Immunoglobulin
b. prednisolone
118. Severe episode of asthma. Which ABG is most likely? a.) pH 7.21, PaCO2 61, PaO2 80
b.) ph 7.31, PaCO2 58, PO2 60
119. An alcoholic man with pain radiating to the back (?pancreatits). WOF is he least likely to present with?
a) constant pain b) regurgitation of food
120. A pic of BCC. Asking management? A. Local Excision
B. Wide excision
C. Wide Excision with Lymph node resection D. Imiquad
121. A picture of a man with Lesion on the lips (does not mention anything with sunny area or absolutely nothing shortest mcq of the exam).
a) BCC b) SCC
c) Herpes simplex d) sun exposure
(THIS WAS THE EXACT SAME PICTURE)
122. Picture of ulcerated lesion behind ear. Most likely Dx? a) SCC
b) BCC
123. Long stem regarding a patient with so many diseases and a picture showing a carcinoma BCC. what is the most appropriate management?
A)Local incision + LN clearance B)Wide local incision
C)Local incision
124. A man with enlarged superficial inguinal lymph nodes and histology shows SCC (same as June recall). Where is the primary lesion?
19 Sept. 2011 A. anus
B. penis C. lungs
125. Patient with calf pain yesterday, diagnosed with DVT by Doppler, now presents asymptomatic. What is the next step in management?
a. In patient treatment with LMWH and compression stockings b. In patient treatment with LMWH and leg elevation
c. Out patient treatment with LMWH and compression stockings d. Out patient treatment with unfractionated heparin and leg elevation
126. Patient with weakness of the forehead on right side, shallow nasal fold on the right, no headache, no vomiting, had viral infection days ago, what’s the next investigation?
a. CT head b. MRI head
c. No intervention needed
127. Worker in an insulating factory for 30 years, smoking for 40 years with 15 sticks a day, came with shortness of breath and hemoptysis. CXR given:
a. Squamous cell CA b. Mesothelioma
128. True of cluster headache except: a. Duration less than 2 hours b. Accompanied by vomiting c. Common in males
d. Aggrevated by alcohol
e. Happens 2-3 hours after sleep
129. Old lady had hemicolectomy. 1st 3 days post op were unremarkable. On 4th day, she became confused and agitated. What’s the reason for this?
a. Lack of sleep b. Alcohol withdrawal c. Hyponatremia
130. Old patient had pain felt in buttocks and thighs yesterday. He is on Atorvastatin, Amlodipine and Allopurinol. At the ER, patient is asymptomatic. But on PE, noted tenderness on muscles of the arm. What will you investigate on?
a. Nerve conduction studies b. Creatinine and electrolytes
c. EMG
131. Man came in at ED pale, tachypneic and hypotensive. He was found to have bleeding duodenal ulcer with wide margin on endoscopy. Vital signs were quickly stabilized with 1 liter of crystalloid. What will be the next step in investigation?
a. IV omeprazole
b. Suturing of bleeding ulcer
c. Intraluminal injection of adrenaline to the ulcer
132. Patient who is hypertensive, hyperlipidemic well controlled with Atorvastatin, Amlodipine, Perindopril, Imipramine and Warfarin. He was recently diagnosed with DM and
20 Sept. 2011
was prescribed Gliclazide. He developed 2 hypoglycaemic episodes recently. What caused these attacks? a. Perindopril b. Imipramine c. Atorvastatin d. Amlodipine e. Warfarin
133. Patient with CCF maintained on Hydrochlorthiazide and Digoxin. He came at ER with lower abdominal pain and nausea. Labs given Na 135 K 3.1 Crea and Urea were normal. What is the next management?
a. Cease digoxin and give oral K supplement
b. Stop Hydrochlorthiazide and give oral K supplement c. IV potassium
134. Patient complained of lower back pain. On PE noted lumbar spine is not in its normal curvature, decrease in ankle jerk. What to do next?
a. Lumbosacral X-ray
b. MRI
c. Nerve conduction study
135. Worker after hammering a metal spike suddenly had acute pain on 1 side of the eye with conjunctival injection. What will you do next?
a. Eye drop antibiotics and follow up the next day b. Put eye patch and follow up after 3 days c. Wash with local irrigation
d. Put local anaesthetic and probe the eye
136. Biker fell from his bike splitting his helmet into half. CT head was given. What to do next? a. Biopsy of lesion
b. CT cerebral angiogram c. Lumbar puncture
137. Patient came in with hematuria, dysuria. Urinalysis showed many rbc and atypical nuclei. What to do next?
a. Renal Ultrasound b. CT scan of abdomen
c. Urine culture and sensitivity
138. Patient with recurrent epigastric pain radiating to the back. Which of the following can be seen except? a. Nocturia b. Diarrhea c. Weight loss d. Constant pain e. Regurgitation of food
139. Party girl suddenly became confused and agitated. Next step in management? a. IV thiamine and hydration
b. Diazepam c. IV hydration
21 Sept. 2011
140. Man with scrotal swelling. Noted palpable cord and is thickened on PE. What is your investigation?
a. Ultrasound b. CT scan
c. FNAC
d. AFP
141. An old lady in a nursing home fell from her bed. On P/E, noted externally rotated and shortened hip. What will be your management?
a. Surgical repair b. Put her on cast
c. Return to nursing home with 1 to 1 nursing car
142. Man with impotence. He is a smoker, alcoholic and obese with BMI-35. What would you advise him?
a. Stop smoking b. Reduce drinking
c. Diet and lifestyle modification d. Give Viagra
143. Lady with BMI-33, had lost 1.5kg on last month, depressed of her progress in weight loss. She is also in a controlled diet supervised by a dietician. What will you advice her? a. Sibutramine
b. Liposuction c. Eat only 2x a day
144. A woman noticed a lump on her breast after a dog jumped on her chest. which of the following is the most appropriate next step in management?
a. (Ca breast?)
145. Which of the following statements is false? a. Association of EBV with lymphoma b. Chewing beetle nut and oral ca c. Schistosomiasis and Ca bladder d. Promiscuity and cervical ca e. Nickel and liver ca
146. 43 lady Whilst gardening she suddenly noticed the whole right thumb "went into a cramp ". Five minutes later she noticed that she had lost extension of the terminal phalanx of this thumb. Thirty minutes later she felt a tightness in the mid-forearm. Two weeks later while taking off a pullover, she felt a sudden cramp in the muscles of her left forearm, and immediately noticed that the left thumb had become flexed at the terminal phalanx, and that she had lost the power of active extension there. sHe was seen in the Outpatient Department she had no other deformity other than the mentioned. She shows features of rheumatoid artheritis. the x-ray of hand shows an old colles fracture and some level of osteoporosis. Which pathology has most likely contributed to her condition?
a. Osteoporosis
b. Rheumatoid artheritis c. Old colles fracture d. Idiopathic
22 Sept. 2011
147. A patient came with a complaint of 3 episodes of transient blindness on right eye which then resolves. What is the condition? Which artery is affected?
1. Left internal carotid artery 2. Right internal carotid artery 3. Right common carotid artey
148. A patient, immigrant refugee, c/o mild evening fever, generalized weakness, weight loss and cough with expectoration. On chest X-ray, he had miliary pattern tubercles (x ray was given ) and a lump on left leg. What will confirm the diagnosis?
a. Biopsy of lump
b. Sputum microscopy and acid fast bacilli c. Mantoux test
d. Sputum bronchoscopy
149. A patient diagnosed with idiopathic pulmonary fibrosis (cryptogenic fibrosing alveolitis). what is less likely seen?
a. Digital clubbing
b. Hilar lymphadenopathy c. Unexplained dry cough d. Dyspnoea
e. Degreased total lung capacity
150. Amc blue book question 2.126 picture of an old man with deformity. Which of the following problem has caused the underlying deformity?
a. thickening and fibrosis of the palmar fascia b. chronic infection with mycobacterium leprae
151. Which of the following is the most common found in hepatoma patient? a. liver cirrhosis
b. liver carcinoma c. haematomacrosis
152. Patient returning from a trip to Singapore, c/o fever head ache and myalgia for the last 3 days. What is the probable diagnosis?
a. dengue fever b. malaria
c. infectious mononucleosis
153. A 75 year old complains of back pain, x-ray of spine was given, shows a compression fracture. which of the following is the diagnosis?
a. Osteoporotic fracture b. Metastatic lesion
154. Patient had an acute attack following eating peanuts. Dx? a. Type 1 hypersensitive reaction
b. Type 2 hypersensitive reaction c. Type 3 hypersensitive reaction d. Type 4 hypersensitive reaction
23 Sept. 2011
155. A patient presented with sudden onset of abdominal pain and tenderness over the right iliac fossa region, examination revealed perforated appendix and urgent surgery needs to be done patient was on warfarin increased INR.
What is the management? a. Give FFP
b. Stop warfarin and change to heparin c. Give Vitamin k injection
156. A young girl with a dark rash around her neck. She complains of tiredness. Her BMI is 33. (Handbook of MCQ 3.283). What is the treatment?
a) Metformin
157. An elderly is brought by his child. He recently loss memory, decline in hygiene and complains that see “a person enter his house”. What is the diagnosis?
a) Lewy body dementia
158. A man has developed rash (picture given for petechiae rash on both lower legs) after the GP has given him amyoxicillin for his cold with sore throat. He also has spleenomegaly and lymph adenopathy. Dx?
b) A. EBM c) B. Malaria d) C. drug reaction
159. A patient with 40% block on Rt side, 50-60% block on Lt side and with some motor weakness , BP= 150/90. What is your management?
A. treat hypertension B. Carotid endarterectomy C. give anti-platelet treatment
ECG questions
160. Known WPW syndrome patient, with wide QRS complex changes in ECG. What is the management? A. adenosine B. verapamil C. cardioversion D. amiodarone E. sotalol
24 Sept. 2011
170. ECG with the stem reading as patient came in with WPW syndrome and arrhythmia. What is the treatment of choice?
a)Adinosine b)Verapamil c)Ablation d)Amiadarone
171. An elderly brought to ED with chest pain. Whilst feeling her carotid pulse, he felt light headed. ECG is given. What is the management?
A) Not to repeat the carotid massage B) Adenosine
C) Digoxin D) Verapamil
172. Patient 65 years old, collapsed on the ground. The cause is (4 ECGs given) a. CHB
b. AF
173. A patient came to you with a history of sudden loss of consciousness after which he recovered. He has no other relevant history. Which of the following ECG would be the correct one for him?
A. AF
B. Heart block with HR~ 55/min C. SVT
D. VT
174. 65 year old man with syncope at emergency Department, (ECG shows VT), Treatment. A. Adenosine
B. Amioderone C. Digoxin D. Verapamil
175. A 10 year old boy is brought to ED with complains of dizziness and palpitations during sports. Pulse is regular, rate increased. ECG given. What is the initial treatment? (typical ECG of SVT – just looked a bit faded)
a. Valsalva manoeuvres b. Amiodarone
c. β blockers d. Adenosine e. Verapamil
25 Sept. 2011
176. There is an ECG given. As old woman was hospitalised because of TIA several days before and now she is improving for her slurring of speech and motor weakness. On 5th day, she fainted while she was in toilet and get the following
177. ECG. BP-low, PR-low and RR-high. what’s the next investigation ? A. CXR
B. ECG
C. Holter monitoring D. Troponin
178. ECG of Ventricular fibrillation was given. What is the next best management? (A) sodium bicarbonate
(B) verapamil (C) metaprolol (D) amiadarone (E) lignocaine
179. ECG LBBB typical chest pain (no previous ECG mentioned), What is next step Mx? a. Thrombolyse
b. troponin c. PTCA d. cABG
180. ECG given (showing PE). A patient came with shortness of breath, pain on inspiration. what is it?
a) PE
b) Pericarditis c) Posterior MI d) Inferior MI
181. ECG of Atrium Fibrillation & history of Abdomen Pain & Cramping What is the diagnosis?
a) Mesenteric vascular occlusion
182. Young male, soccoer player brought by her mother, with a “heart racing”. ECG given as SVT. Most appropriate management
A) Amiodarone B) Adenosine C) Verpamil D) Beta blocker
E) Manuvure of carotid
183. ECG of SVT, typical history: young person playing and his heart beating fast presented with palpitations and hemodynamically stable, BP 130/70. Most appropriate initial Mx? A. Adenosine
B. B. Blockers
C. Carotid Sinus massage D. Verapamil I/V
26 Sept. 2011
Pharmacology
184. Beta interferon - What's the side effects? (A) Delusion
(B) Depression (C) Dementia (D) Anxiety (E) Hypomania
185. 22 year old male, presenting at ED with overdose of fluoxetine, fever, tremor, diarrhoea, shivering. Which of following treatments.
A. Cyproheptadine B. Bromocriptine C. Dantroline
186. Hypertensive encephalopathy is a complication of treatment with which one of the following?
A. Benzodiazapine B. MAO-I
C. TCA D. Lithium
187. Which of the following medication leads to impotence? a. Amitriptyline
b. Gabapentine c. Enalapril d. Diazepam e. Digoxin
188. A depression man on amitriptyline for some time, complains of erectile dysfunction. He smokes 20 packs/per day and he drinks 5 standard drinks per day. Mx?
A. Stop medication immediately B. change amitriptyline to sertraline C. Give sildenafil and continue medication D. cease smoking
E. reduce alcohol
189. Patient accidentally took 25 tablets of amitriptyline, what’s the next management? a. Intubation and IV NaHCO3
b. Insert IV access c. Gastric lavage
190. A young patient with shoulder dislocation and needs reduction, which is the most appropriate agent used?
a. tramadol and midazolam b. fentanyl and midazolam c. fentanyl and morphine d. tramadol and fentanyl
27 Sept. 2011
Surgery
191. A man alleged a major car accident. He presented to the emergency department with hoarseness of voice. Chest X-ray showed widened mediastinum and loss of aortic knuckle. What is the next step in management?
A) Pericardiocentesis
B) Intubation and ventilation C) Oxygen
D) CTPA
192. A picture given of a patient with Para-umbilical hernia which is tense,swollen, red, with also
some content taken out showing omentum with some black spots. What is the next step in management?
(A) IV antibiotics
(B) Debridement + antibiotics (C) Surgical repair
(D) Other two choices were conservative measures
193. A patient complains of lower abdominal pain. She was given amoxicillin for URTI two days back. She was already on warfarin. Picture of oral contrast CT was given. WOF is the most likely diagnosis? (Picture clues: contrast was seen just beneath the rectus sheath muscle. I think there was a gas pocket on top of it )
(A) Diverticulitis
(B) Obstructed incisional hernia (C) Rectus sheath hematoma (D) Twisted ovarian cyst
194. A patient – retired plumber, 75 years old, c/o shortness of breath, weight loss. He has history of working in mining industry for ~28 years. Chest X-ray was given: (it was a poor quality x-ray) shows a certain whitening of pleura- s/o thickening of pleura. What do you do next to diagnose this condition?
(A) CT chest
(B) Bronchoscopy with BAL (Bronchoalveolar lavage) (C) Pleural biopsy
(D) Thoracocentesis (E) ***
195. An X-ray for diagnosis: s/o sigmoid volvulus CT was given. A patient was on enoxiparine has developed a large rectus sheath hematoma. The patient is in pain. What is the most appropriate next step in management?
(A) Reassure and discharge (B) Urgent aspiration
(C) Immediate cessation of enoxiparine (D) IV Vitamin K
(E) Platelet
196. A 26 year old woman fell down from her horse and fractured 4-11 ribs and fractures to femur and tibia on left side as well. (She was stabilized or not? ) a plaster was applied to the leg (assumed stabilized before putting the plaster ) and air ambulance was arranged to take her to a tertiary hospital. Before air transport what is the most appropriate next step to do? (A) Underwater seal drainage
28 Sept. 2011 (B) Firm bandage over the fractured side of chest (C) Chest X-ray
(D) Intubation and ventilation
197. A seven year old girl was rescued from a room in a burning house. The room was not filled with smoke. She did not have any superficial burns and was fully conscious. On examination soot was found. What is the most appropriate next step?
(A) Reassure and discharge (B) Oxygen by mask
(C) Intubation and ventilation (D) Admission and observe
198. Pt with h/o emergency splenotomy with a midline incision, c/o mass in midline. Dx? a. Ask pt to cough in lying position.
b. Ask pt to lift head in lying position. c. Ask pt to cough in standing position.
199. 50 yrs old female pt. diagnosed as having Ovarian carcinoma? Where could be the primaries most probably from?
A. Pancreas B. Liver C. Thyroid D. Breast E. Lungs
200. What can cause metastasis to ovary? a. Breast
b. Pancreas c. Lung d. Liver e. Kidney
201. Patient with inguinal lymph nodes swelling said was drained and found to be SCC and which could be the primary?
A)Kidney B)Breast C)Lung D)Rectum E)Prostate
202. A pt had Abdominal Surgery for Perforated Diverticular disease. On fourth Post-op day She developed agitation, Confusion and restlessness. What could be the most probable reason?
A. Alcohal withdraawl B. Send her for CTPA C. Atelectasis D. Encephalopathy
203. Patient on 2nd day post-op suddenly developed confusion. What to do next: a. CT head
29 Sept. 2011 c. Electrolytes
d. CXR
204. A patient has been planned for TURP, which one is the most common Post-operation complication he will probably be suffer from?
A. Urethral Rupture B. Retrograde Ejaculation C. Erectile dysfunction D. Infertility
205. Patient was 50 years of age had sudden severe breathlessness, more on breathing in. Sever chest pain, cough. He is in the post-op room and had undergone a surgery three days before, then the symptoms appeared.
Blood gas analysis was pH, CO2, O2 was given. Dx? a. Pulmonary embolism
b. ??
206. A patient with shortness of breath in day 1 post-operation. Chest X-ray is given. What is the management?
a) Chest physiotherapy
207. A patient who has had a recent abdominal surgery has fever of ?38C, 36 hours post op. What is the cause of the fever?
a. DVT
b. Hypostatic pneumonia c. Abscess
d. Wound dehiscence e. Wound infection
208. Which of the following is the correct procedure for CPR? a. Compression to breathing ratio is 20 to 2
b. Compressions per minute should be 100/min c. Chest depression during CPR should be 1-2 cm d. Hands should be placed in the middle of the sternum e. Compression cycle should be 2 cycles/min
209. Which of the following is True about CPR? a. At least 100 compressions in a minute b. 2 breaths:5 compressions
c. Depth is 2 cm
d. Site is at the middle of the sternum
210. A young male involved in a MVA presents to the ED. He appears to be shaken but has no history of loss of consciousness. A contrast and non- contrast CT is given. What is your diagnosis? (p425 Blue book non-contrast image)
a. Epidural haematoma b. Extradural haematoma c. Cerebral infarction
d. Subarachnoid haemorrhage e. Cerebral abscess
30 Sept. 2011
211. MVA, 2 CT scans shown (2 small white dots near ventricle). The patient is fine except for minor bruises on scalp.
A. EDH
B. Closed Head Injury
212. A young patient involved in a MVA is brought to the ED. He has severe swelling in his neck and has difficulty breathing. Management?
a. Cricothyroidotomy b. Nasogastric tube c. Oxygen
d. IV cannulation
e. 2 drugs given don’t remember the names and tracheal intubation
213. Patient comes to Emergency Dept. Post MVA with fractured anterior ribs on right side. He has hoarseness of voice and mild shortness of breath. Vitals stable. BP is normal, not hypotensive. Chest X-ray was given shows widening of mediastinum, loss of aortic knuckle. What is the MOST APPROPRIATE next step in management?
(A) 2nd ICS needle aspiration
(B) Mid anterior axillary line ICD ( inter coastal drainage ) (C) Pericardiocentesis
(D) CT and angiogram (E) USG chest
214. A young man with MVA injury admitted to emergency has multiple Rib fracture, also has hoarseness of voice, what do you do next?
a. Intubation and mechanical ventillation b. Pericardiocentesis
c. Needle in the 2nd ICS d. Chest drain
e. Oxygen by mask
215. ED Young male in MVA, multiple fracture 5-8 rib, dypnea, what is the most appropriate management?
A) Needle thoracentaesis B) Oxygen
C) Intubate +
D) Under water sealed draiangage
216. A farmer fell from his horse causing rib fracture 4-5 years ago. Suddenly had shortness of breath. PE: dullness on percussion. CXR given: (with loculations on the left)
a. Congenital eventration of diagphragm b. Loculated pleural effusion
c. Pulmonary hydatid
d. Lower middle lobe collapse
217. Old patient fall from the roof, with rib facture, dypsnea, left chest dull sound, 2cm JVP, before send to tertiary hospital what is the most important management.
Nasal intubate Oral intubate + Left thorcaotomy
31 Sept. 2011
After a car accident patient with bruising of the eye lid, rhinorrhea (clear fluid), A. Anterior cranial fossa fracture
B. Foramen Magnum fracture C. Temporal bone fracture
218. A patient is brought into ED with signs of severe dehydration? Treatment? a. Colloids
b. Crystalloids c. FFP
d. Hartmans solution
219. A 25 year old male presented with a painless swelling of the left scrotum. What is your initial
investigation? a. Ultrasound
b. FNAC
c. Serum HCG and alpha fetoprotein levels d. CT chest
e. Surgical exploration
220. Patient in the ward presents with respiratory distress after a thyroid operation. What is the next step in management?
A. Remove skin suture B. Inform Senior Registrar C. Give oxygen
D. Remove all sutures in operation theatre E. Open the wound in the ward
221. A patient had a subtotal thyroidectomy 2 days ago. She developed shortness of breath and stridor. What is the most appropriate management?
A) Give Oxygen
B) Nebulized salbutamol
C) Remove the superficial sutures D) Remove all sutures in the ward E) Call the operation theatre
222. What’s most urgent sign in acute limb ischaemia indicative of surgery? a. Pain
b. Paralysis c. Colour d. Temperature
223. What of the following would be an absolute indication for surgical intervention in a case of limb ischemia?
a. pain b. pallor c. paraesthesia d. paralysis
224. Which is the following is the most characteristic sign of chronic limb ischaemia? A) Pain relieved by walking
32 Sept. 2011 B) Rubor
C) Colour of the limb improved after hanging the limb at the end of the bed D) Numbness
225. amc handbook q. 3.051 (pic of fracture surgical neck of humerus) What is the complication.?
A. wrist drop
B. loss of sensation in the inner side of arm C. loss of sensation over deltoid muscle D. weakness of hand muscle
226. A patient comes with orthostatic hypotension and pulse rate of 120 and acute bleeding. What is the estimated percentage of blood loss?
a)10% b)15% c)20% d)25% e)30%
227. Patient on Warfarin and a CT shows Rectus Sheath Hematoma. Mx? a)FFP
b)Vitamin K
c)Blood transfusion d)IV NS
228. A patient on Clopidrogrel has been on stent for last 4 months for 3 main vessel occlusion ,and is now posted for elective surgery for uncomplicated varicose vien surgery after 2 weeks. He is now meeting you for surgical assessment, What is the appropriat management ?
a) Reasses the need for surgery
b) Stop Clopidrogrel for surgery before 10 days c) Do not stop CLopidrogrel
d) Ask him to wait for 42 days.
229. Cancer pt came to ED, lab test chow hypercalcaemia (2.8mmol), nxt management? A) 0.9% NS
B) Hartman solution C) Calcium gluconate
230. Patient undergone Surgery for Achalasia 5 yrs ago. Since 1 month hoarseness of voice, dysphagia. Mass at thoracic inlet. Dx?
a.) Ca larynx b.) Ca oesophagus
231. Ischemic strangulation is an important complication associated with hernias. Which of the following is the most often associated with strangulation of its contents?
a. Indirect inguinal b. Direct inguinal c. Femoral hernia d. Paraumbilical hernia e. Oesophageal hiatus hernia
33 Sept. 2011 232. What is the most associated with undescended testis a. Indirect inguinal hernias
b. Testicular torsion c. Testicular carcinoma d. Infertility
233. Mother phones the ED says her son had spilled hot water from a kettle to chest and neck what is the next initial management to tell her
a. Bring to ED immediately b. Leave it and nothing
c. Put the child under a tap and put running cold water d. Put ice over the burned areas
234. A lady fell on a outstretched hand and the X-ray shows a colles fracture, what is the most common complication associated with this..
a. stiffness of wrist b. malunion
235. A question on spontaneous pneumothorax with the trachea deviated to affected side and decreased breath sounds on the affected areas, which of the following is the most appropriate management?
a. Needle thoracotomy
MISC
Pt 75 years old with obstructive jaundice, Cause? (A) ca of ampulla ovate Fracture of Tibia and Fibula.
Picture of Mallet Finger. Asking what is it.
Picture of Mallet finger. What is the cause? a)Hyperflexion injury while finger was extended Pt post operative about 48h not pass urine next step in management
(A) give normal saline IV
Hyponatrimia was given and asking for cause of electrolyte disbalance. (A) Indapamide Cause of Hyperkalemia? (A) ACE Inhibitors
Woman develops backache after bending down in garden. Dx? (A) Compression wedge fracture.
Symptoms: Hyperemesis gravidarum-lots of vomiting. Dx: (A) Molar pregnancy WOF is most suggestive of ruptured ectopic pregnancy? (A) Lower abdominal rigidity amc handbook q. 3.111 (pg 458) pic of sigmoid volvulus. Ask for diagnosis.
A patient diagnosed with polycythemia vera. what could be the lab findings? How would you follow up a case of duodenal ulcer? (A) Urea breath test
A pregnant lady 24 weeks of GA found GB positive on examinations. What is the management? (A) antibiotics during labour.
The site of insertion of needle thoracostomy? (A) 5th intercostal space What is the symptom of Colon cancer in Caecum? (A) Pallor
Result of Joint aspiration with Negative birefringence. What is the diagnosis? (A) Gout Management of Snake bite. (A) Avoid any movements
An elderly woman with Uterus prolapsed. What is the management? (A) Ring pessary Radiation per capita (RECALL question). (A) natural background history
34 Sept. 2011
OBGYN
1. WOF is most likely to predict endometriosis? a.) nodularity of uterosacral ligaments
b.) bilateral palpable adnexal mass
2. A pregnant woman of 8 weeks GA with severe migrainous headache and vomiting. Tx? (A) Aspirin + metoclopramide
(B) Morphine+ metoclopramide (C) Paracetamol + codeine
(D) Ergotamine + metoclopramide (E) Morphine + ***
3. A baby was born at term vaginally without any complications. On the 4th day before discharge, physical examination shows a reddened scrotum which is non-tender on palpation. Temperature 37.8C and other physical findings were normal. Mx?
(A) Reassure and discharge (B) FNAC
(C) Ultrasound (D) Blood culture
(E) Observe for a few days
4. A 35 years old woman who has 4 healthy children and doesn't want to have children again, consults getting HPV vaccine. Both her ovaries were removed after finding to have CIN III(?) and subsequently she had undergone a Hysterectomy as she was diagnosed with fibroids. Following the hysterectomy at histopathology of the uterus there was a CIN presentation. What is your advice regarding if she should get the HPV Vaccine and its benefits for her?
(A) Tell her no need of the vaccine as she has undergone hysterectomy (B) HPV vaccine prevents cervical cancer
(C) Vaccine can not help her at this stage
(D) Vaccine will definitely prevent cervical cancer
5. Female 39 weeks gestation (not in labor), 1000 ml blood loss. Hand held Foetal heart beat detector, no heartbeat. Next step in management. (Patient is in pain)
A. Amniotomy B. caesarean section C. Syntocinon infusion
6. Pregnant woman with all s/s suggestive of PE, 34 weeks GA, has been travelling by air, chest pain on breathing, breathlessness, hemoptysis. Which is the next step in management? A. D-dimer
B. CTPA
C. V/Q scan D. X-ray
7. 18 week GA lady presents to you with pain in abdomen. Cervix closed, no bleeding or discharge per vaginum. Which investigation will indicate a complication in her situation? a) Presence of fibronectin
b) USG to see the cervical length c) bHCG
35 Sept. 2011
8. 26 years old lady came at 13 weeks gestation on her first Ante-natal visit with h/o severe headache for the last 12 hrs. What could be the most likely cause?
A. Migraine
B. Cluster Headache C. Pituitary Apoplexy
D. Sub-Arachnoid Hemorrhage E. Raised ICP
9. 24 yrs old lady came with h/o premature delivery at 24 weeks of gestation resulting in death of the infant immediately after birth due to respiratory distress syndrome. Now she came at 8th Week of gestation on her first Antenatal visit. She is worried whether she will again going to have Preterm labour. Which one is the most appropriate investigation to carry out between 18 to 22 weeks of gestation to counsel her for chances of preterm labour this time.
A. Anomaly Scan at 18 weeks B. Amniocentesis
C. Cervical length at 20 weeks D. Fetal fibronectin Test E. PV examination
10. 25 Yrs old pregnant lady 13 weeks gestation came on her first Antenatal visit. She has been found to have BP 130/90, Pulse 90. Her Thyroid Profile is as below:
TSH 6.0 (0.4-5) T3 TD Slightly raised
What is the most appropriate treatment? A. Commence her on Carbimazole B. Commence her on Propranolol C. Commence her on PTU
D. Observe
11. A 35 yrs old lady comes to GP for advice about OCPs. She has h/o benign breast lesion operated few years back and has a strong family h/o CA Breast. Which Contraceptive you would prescribe her keeping in view of her history.
A. Spermicidal Gel
B. Estrogen and Progesterone pills C. Implanon
12. Which Site is at greatest risk for cancer in women using OCPs? A. Endometrium
B. Cervix C. Vulva D. Breast E. Ovary
13. An 18 yrs old girl comes with severe emotional stress after being embarrassed by the involuntary expression of milk from her Rt. Breast during Tennis play. She embarrassed in b/w her friends. She is using OCPs. What will u most appropriately do?
A. CT Brain
B. Serum Prolactin levels C. Cease OCPs
D. Prescribe Bromocriptine E. Prescribe Sertraline
36 Sept. 2011
14. A lady on who was on Sodium Valproate throughout her pregnancy develops seizures 2 days post-partum. What is the cause of her seizures? (This is recalled exactly, no other info was given). a. Epilepsy b. Eclampsia c. Pre-eclampsia d. Febrile seizures e. Hypertension of pregnancy
15. A woman previously diagnosed with grand mal epilepsy taking phenytoin becomes pregnant and she continues the medication throughout pregnancy. At 28th week gestation, she becomes diagnosed with gestational diabetes according to OGTT and was on diet and metformin. At 30th week of gestation, she has a seizure. At that time, BP is 135/85 (exactly like that) and urine protein is +++. What is the cause of her seizures?
A. Eclampsia B. Grandmal seizure C. Hypoglycemia
16. A 28 wk pregnant lady comes to you with labour pains. Which of the following is a contraindication for tocolytic therapy?
a. Placenta praevia
b. Ante partum haemorrhage c. Cervical incompetence d. Pre-eclampsia
17. A 47 year old lady who has had a hysterectomy 5 years ago complains of hot flushes and dyspareunia. How will you manage the patient?
a. Oral contraceptive pills b. IUCD ( Mirena)
c. Conjugated equine oestrogen 0.625mg
d. Continous Oestrogen and Progesterone therapy
e. Cyclical therapy with Oestrogen and Progesterone from day 13
18. A 10 wk pregnant patient comes to you for her first antenatal visit. On examination you can see the strings of the IUCD. What is your next step?
a. Leave the IUCD in place
b. Remove the IUCD in the second trimester c. Remove the IUCD now
d. Remove the IUCD after delivery
19. 55 yr old lady presented with a rectocele no cystocele. What is your next step? a. Pessary
b. Pelvic floor exercise c. Surgery
d. Bladder training
20. 8 weeks pregnant patient with fibroid what in her history would concern you the most?
a. APH
b. Vesicular mole
37 Sept. 2011
21. A women 32 wk of gestation in her 2nd pregnancy, wants to know how she can protect her child from familial atopy. She has asthma and her 1st child has flexural eczema.
a. Breast feed for 6 months b. Breast feed for 1 year c. Give multivitamins
d. Regularly vaccum her house e. House mites control
22. A primigravida at 39 weeks gestation presented with labour pain. Her cervix is 4cm dilated and fully effaced. After 4 hours she is 5cms dilated cervix well effaced. What is your diagnosis?
A. Normal labour B. Obstructed labour C. Latent phase of labour D. Slow progress of labour
23. Primigravida presented at term for labour at 2 stage where foetal heart drop to 80 bpm then return to normal. What the next step :
(A) foetal scalp PH (B) caesarean in section
24. Pt 24years female presented with 9mounth infertility ,her spouse sperm investigation reveals Sperm count 2 million Abnormal sperm 50% Next management to get pregnancy (A) sperm donation
(B) IVF
25. Pt has hysterectomy and wants to start HRT because her bone density scan reveal osteopenia.
a. continues estrogens HRT
b. combined estrogens and progesterone thereby c. implanon
26. Pt presented for advice about pap smear , she is post-hysterectomy b/c of CIN III this pt should do it
a. every year b. biannually
c. only if there is vaginal bleeding d. no need
27. Premature baby delivered at 32weeks, weight 1.5Kg, at 1month=2.5kg, 2month=3kg,...at 6month=6kg. This result reflects her baby:
a. well development b. underweight c. obese
28. Pt 78years, women, has urine incontinence on cough next appropriate step: a. pelvic floor exercise
b. surgical intervention c. vaginal pessary
38 Sept. 2011
29. Pt has plugging from her intorise on strain (I understand as vaginal prolapsed), not on HRT, what the most appropriate management?
a. pelvic exercise b. HRT
c. vaginal pessary
30. Pt about 48years on HRT, her Bp =180/110, obese, cholesterol high, the most important to protect her from stroke is:
a. cease HRT b. control BP c. exercise d. fibronate
31. Primigravida presented at term for delivery, after 4h cx well effaced and dilated about 3cm, head of foetus -2. What's the next step in management
a. aminiotomy b. oxytocins
c. wait another 4h and reassess d. cs
32. Lady 23years presented with Lt iliac fossa pain, O/E there is guarding and tenderness.LMP 4 weeks before. next step in management
a. BCG
b. US abdomen
c. urine microscopic examination
33. A pregnant lady with all the features of Hyperthyroidism. Mx? A) PTU
B) Pronolol C) Carbimazole D) Observe
34. Besides folate, What will you give to a pregnant lady to prevent congenital spinal cord deformity? a) Iron b) Iodine c) Vitamin B complex d) Vitamin B12 e) bet-Carotene
35. Ig M +ve for CMV at 4 weeks of pregnancy. Mx? a.) Do IgG now
b.) IgG & IgM at 4th week of pregnancy
36. A woman is advised by her GP to take combined OCP for next 5 years. Which of the following is applicable considering that she has no risk factors?
a.) Increased risk of breast Ca. by 25% b.) Increased risk of stroke by 10%
c.) Decreased risk of Gall bladder disease by 2% d.) Increased risk of osteoporosis by 5% e.) Increased risk of heart disease <1%
39 Sept. 2011
37. A pregnant lady having seizures. Most likely cause of fetal bradycardia? a.) Compression of fetal head
b.) Strong uterine contractions c.) Maternal hypoxia
d.) Cord prolapsed
38. Menorrhagia and anorexia, fatigue in a woman who was previously found to be CIN 11 & has previous h/o PCOS. Mother died of colon Ca. at age of 49 years. Which is the first choice in management?
a) Endometrial thickness of USG b) Colposcopy
c) Colonoscopy
39. Clinical picture of Pelvic inflammatory ds. Patient febrile. Rx? a.) Amoxicillin + Gentamicin + Metronidazole
b.) Metronidazole + Doxycycline + Ceftriaxone
40. GA 18 wks. Previous Pap smear normal 12 months ago. Came with vaginal discharge that is clear. Mx?
a.) Repeat PAP smear b.) Endocervical swab
c.) Culture of low vaginal swab
41. Pregnant lady noted painful vesicles on vulva. She had a urinary catheter inserted for her urination. What will you give her?
a. Oral acyclovir b. IV acyclovir c. Oral Famciclovir
42. 80 year old lady with large cystocoele. This gives discomfort but still feels ok. What will you give her?
a. Ring pessary b. Colposuspension c. Surgical repair
43. A couple came in for infertility work up. Wife has irregular cycle with 35-42 days. What would be the most appropriate test to determine the cause of the infertility?
a. Serum progesterone on day 21 of cycle b. Pelvic ultrasound
c. Sperm analysis
d. Hysterosalphingogram 44. True of Bartholin cyst. a. Asymptomatic
b. Treat with antibiotics if infected c. Caused by gonococcal infection
45. A c/o premature ovarian failure, which of the following is significant to rule out the condition?
a. Usg of abdomen b. Very high FSH level
40 Sept. 2011
c. ??
d. very low FSH level e. FSH/LH ratio
46. Diagnosis of an ectopic pregnancy, Beta-hcg was done and was positive. Which next finding will rule out ectopic?
a. Laparotomy
b. Empty uterus on usg
c. ??
47. A 90 year old woman in a nursing home was brought to you by a nurse, as she found blood in her incontinent nappy. On examination you found an irregular ulcer in her introitus. What is the most common condition?
a. vulval carcinoma b. ca of cervix
48. A girl with E.coli results of 0.1 x 106. What is the management? (Handbook of MCQ 3.297) a) No treatment is necessary
49. Pregnant lady presented with frontal headache which is very severe, BP is low, 60/80 A. SAH ( but that give occipital HA)
B. Cerebral thrombosis C. Migraine
50. Pregnant woman with smoking 15 packs per day, benign breast lesion and history of breast cancer in mother (recalled exactly). What’s the MOST SIGNIFICANT contraindication for OC pill (exact as such)?
A. Premenstural headache B. Breast cancer
C. benign breast disease
51. A nurse who is 12 weeks pregnant comes to your GP clinic for advice. She has been asked by her employer to take the influenza vaccine which she has been taking for the last 5 years. What advice would you give her:
a. Influenza vaccine is contraindicated in pregnancy
b. She does not need to take the vaccine as she has been taking it for the last 5 years c. She should take it after the baby is born
d. She should take in the 2nd trimester e. She should take it now
52. A pregnant nurse in her 2nd trimester comes to you for advice regarding influenza vaccination. Her employer is offering free vaccines before winter. What would you as her GP recommend:
a. Defer taking the vaccine till the baby is delivered b. Take it now
c. Take it in the last trimester just before the expected date of delivery d. She does not need to take it