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

1 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?

2 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
A) Tetracyclines for 9 months

3 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
D. Renal Calculi

4 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

5 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

6 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?
a. Paracetamol

7 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?
a. Check lithium levels every 3 months

8 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?

a) Sigmoid volvulus

9 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
C. Chloramphenicol eye drops

10 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

11 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

12 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:

13 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

14 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
b. Septal myomectomy

15 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

16 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

17 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?

18 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

19 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

20 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
e. Trauma while gardening

21 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

22 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

23 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

24 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

25 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

26 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

27 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
b. Pulse oximetry

28 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

29 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
(no underwater drain or thoracocentesis)

30 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

31 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

32 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
Exact same question about the 3rd Nerve palsy as in the blue book P.389 picture.

33 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
d) ?

34 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

35 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
c. Red degeneration of fibroid

36 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

37 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%

38 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

39 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
e. Take it 10 days postpartum

40 Sept. 2011
Paediatrics
53. Mother comes with a child of around 3 years old, who was recently treated for URTI with
c/o - refusing to walk, pain over the calves. What is the treatment of this condition?
(A) Antibiotics
(B) Prednisolone
(C) Antivirals
(D) Ibuprofen
(E) Immunoglobulins + aspirin

54. 5 years old child with 3 episodes of nephrotic syndrome now is steroid resistant. He has
hypertension and microscopic hematuria. what is the most likely diagnosis?
(A) IgA nephropathy
(B) Superimposed PSGN
(C) Focal Segmental Glomerulosclerosis
(D) Membranous Nephropathy

55. Same stem. What is the likely cause of this patient's nephrotic syndrome becoming
steroid resistant?
(A) IgA nephropathy
(B) PSGN
(C) Focal segmental glomerulosclerosis
(D) Membranous nephropathy

56. Parents brought to you an 18 month year old baby, complaining not gaining weight. Baby
born at term without any complications. Birth weight was 3kg. For the last 9 months, the
baby had 6-9 episodes of passing loose stools. Baby is not irritable nor dehydrated. What is
the diagnosis?
Which is the diagnostic test to confirm this condition? (repeated question in the same test)
Aboriginal 3 year old baby, excoriation of buttock.
A. Lactose intolerance
B. Coeleic dis.

57. 2 year old male, aboriginal child brought to you with clinical features of discharge from
ears, speaks 4-5 words also has yellow greenish discharge from nose. What is the next best
investigation?
A. Swab from ear discharge
B. Swab from nasal discharge
C. Audiometry

58. (Is it both sided or one sided? What are the features of foreign body in nose? Infection in
one or both ears?)
Child brought with complains of blood in stools, opening bowels once in 3-4 days. What is
the treatment?
A. Laxatives and fibre rich diet
B. Increase fluids
C. ??

59. Mum comes to see you as she doesn’t know how to handle her child, who has been
behaving naughty at home. She pumishes him by ‘spanking’ with a wooden spoon and
locking him out of the house for a few hours when he is naughty. Yet his behaviour isn’t
improving. What is the next most appropriate step?

41 Sept. 2011
A) report to the child protection program
B) refer to the effective parenting course
C) Call the police
D) Call social worker
E) Ask the parents to bring the child and have a family meeting
F) Inform the child welfare department

60. Infant with two day h/o cough and fever etc., with intercoastal retraction, wheezing and
sweating. Child is irritable. Which of the following is the best treatment for the condition.
(Spo2 not mentioned )
a) Salbutamol nebulisation
b) IV fluids
c) Observe
d) Antibiotics
e) Antivirals

61. 2 yrs old child came with the mother with complaints of Rt. Ear pain, fever and irritability
for the last 2 days. Which organism is most commonly associated?
A. Streptococcus Pyogenes
B. Streptococuss pneumonae
C. Satpylococus Epidermidis
D. H.Influenzae
E. Moraxella Caterhalis

62. A mother brings her 14 months old child. She can Play peek-a-boo, can transfer objects
from one hand to another, sits without support, and waves good bye. His hearing tests are
normal but he only babbles with inappropriate words. What could be the reason?
A. Normal development
B. Language delay
C. h/o Maternal Diabetes should be taken
D. constitutional delay

63. A 16 months child presents with the mother with irritability, subcostal recessions,
tracheal tug and a loud inspiratory stridor. He h/o URTI. What is the most appropriate
management.
A. Prednisolone
B. I/V adrenaline
C. Nebulised Adrenaline
D. Nebulised Salbutamol
E. Intubation

64. Mother brings her 2 year old child with complaints of not developing like normal children
and on investigation he has found to have Bitemporal Hemianopia. What is the most
common lesion associated.
A. Pituitary Microadenoma
B. Temporal lobe lesion
C. Craniopharyngioma
D. Medulloblastoma
E. Hemangioma

42 Sept. 2011
65. A mother brings her 4 months old child (pic of child given with pink lesion on chest)
gradually increasing in size, Treatment?

A. Observe
B. Intralesional steroid
C. Sirgical excision
D. Biopsy

66. 2 yrs old boy presented with fever, cutaneous rash on palms and soles, redness of both
eyes, and swelling in cervical region. What is the most appropriate management of the
above condition?
A. Plasmapharesis
B. I/V Benyl Penicillin
C. Hydroxycholoquine
D. Immunoglobulins
E. Aspirin only

67. 6 weeks old child brought by mum in ED with c/o repeated vomiting after feeds, irritable
and has lost weight upto 400g since birth. The child looks lethargic. Following are the
investigations carried out;
Serum K 2.5
Serum Cl 85
pH 7.8
PCo2 35

68. Which one is the most suitable resuscitation fluid for this child
A. 0.9% Normal Saline
B. Hartman’s Solution
C. Dextrose with 0.45% Saline
D. 5% Dextrose

69. 12 yrs old child came with excruciating pain in Rt. Scrotum for the last eight hours, O/E
his epididymis is not palpable and Testis is lying high up in the Scrotum. What is the cause?
A. Acute Epididymis
B. Torsion of Testicular Appendage
C. Testicular Torsion
D. Strangulated Indirect Inguinal Hernia

70. 14 months child brought by mum with h/o Diarhoea 3 weeks with few undigested
particles in stools and Mucucutaneous rashes on Buttocks. He is gaining weight and no
muscle wasting. Which condition is most likely?
A. Coeliac Disease
B. Lactose Intolerance
C. Cow milk Intolerance

43 Sept. 2011
71. A 10 year old child presents to your clinic complaining of bilateral weakness in the calf
and thigh muscles since a few days. He has been previously well with no complaints, except
for a viral upper respiratory tract infection 2-3 weeks ago. He has no weakness in the upper
limbs. On examination deep tendon reflexes in the upper limbs are normal but in the lower
limbs reflexes are absent. On investigation what are the most likely findings:
a. Proteins elevated glucose elevated and cells 8x109/L ( normal value 4.0 – 11.0x109/L)
b. Proteins normal glucose normal and cells 12x109/L ( normal value 4.0 – 11.0x109/L)
c. Proteins elevated glucose normal and cells 8x109/L ( normal value 4.0 – 11.0x109/L)
d. Proteins low glucose elevated and cells 11.5x109/L ( normal value 4.0 – 11.0x109/L)
e. Proteins normal glucose low and cells 4x109/L ( normal value 4.0 – 11.0x109/L)

72. A young mother comes with her 6 month old baby for his scheduled immunisation. She is
not sure whether she should immunise the child now as last time he had a big swelling on
his thigh. His pulse is 110/min, respiratory rate 30/min and temperature 37.2C.The baby
looks well cared for and happy. What advice would you give the mother:
a. Immunise the child as scheduled minus the pertussis component
b. Ask her to come after a month
c. Immunise the child as per the schedule
d. Give the injection on the other thigh
e. Do not immunise the child

73. 10 year old boy who regularly plays soccer comes with pain in his right knee. He thinks
he injured himself while playing two days ago and his knee seems to give away? Which
anatomical structure is affected?
a. Medial meniscus tear
b. Anterior cruciate ligament
c. Patella fracture
d. Lateral meniscus tear
e. Collateral ligament tear

74. An 18 month old child has diarrhoea 2-3 times a day since a few days, which consists of
undigested food particles. The child is otherwise well. Weight and development are normal
for his age. What is the cause for his diarrhoea?
a. Celiac disease
b. Gastroenteritis
c. Lactose intolerance
d. Toddlers diarrhoea
e. Intussusception

75. An infant is brought to the ED. He appears to be irritable and lethargic. He has sunken
eyes and capillary return is 3 secs. What is your initial management?
a. 0.9% normal saline
b. 0.9% normal saline and 5% dextrose
c. Hartmanns solution
d. 0.45% normal saline and 5% dextrose
e. 4% dextrose and normal saline

76. A mother brings her child who is having frequent diarrhoea and excoriation of the
buttocks. What is the initial test for diagnosis?
a. Hydrogen urea test
b. Tissue transglutaminase and Anti-endomysial antibodies

44 Sept. 2011
c. Endoscopic small bowel biopsy
d. Reducing substances in stool
e. Stool microscopy and culture

77. A young child who just used her salbutamol spacer for her asthma, and who has been
recently treated with Erythromycin for an URTI is brought to the ED by her parents after she
developed a rash and swelling over her face with complaints of pain in her stomach. She just
had some dip and chips. What is the cause for this reaction?
a. Nut allergy
b. Asthma
c. Erythromycin
d. Rotavirus

78. A young child who is a known asthmatic and is being treated with salbutamol presents to
the ED with a rash and swelling over her lips, coughing and wheezing and belly cramps. She
was recently treated with antibiotics for an URTI and just had some peanut cookies. What is
the initial treatment after giving oxygen?
a. 1:1000 adrenaline IM
b. 6 puffs of salbutamol
c. Promethazine
d. Normal saline
e. Dexamethasone

79. An 8 yr boy was brought by his mother for soiling of underwear with faeces for past 2
month. He used to be well trained. What is your initial Mx?
A punishment
B laxative
C sigmoidoscopy

80. A 6wk old child with sunken eyes,reduced skin turgor,reduced capillary
permeability.WOF should be given?
A. 0.9 % normal saline
B. Hatmann solution
C. 2.5% dextrose and 0.45% normal saline
D. 8% dextrose and 0.18% normal saline

81. Mother brings her 5 yr old girl who is sore down below. On examination the vulva is
reddened and no other signs. What is your management?
a. report to child protecting authority
b. Examine under general anesthesia
c. Avoid bubble bath
d. Full blood count

82. An Indian boy who visited india 6 months ago now has c/o diarrhoea, 4 kg wt loss. Stool
culture is negative. What could be the cause for his presentation?
a. Giardia lamblia
b. Coeliac disease
c. E.coli
d. Salmonella
83. Regarding language development of a 24 month old boy, which of the following is true?.
a. combines 4 syllable in a sentence

45 Sept. 2011
b. name colours
c. tell surname
d. combine 2 words in a sentence

84. Child of 5 years of age presented with primary enuresis and delay speech he not attend
school yet, most appropriate diagnosis is:
a. mental disability
b. asperge syndrome

85. Child with pitchi and bruises after URTI next step to diagnose is:
a. FBC
b. ANA
c. Urine microscopy

86. Infant age about 3 month age his mother told you that my baby has constipation,she
stopped breast feed him and she introduces for him Bootle and rice once a day weakly, the
cause of constipation is:
a. cow milk allergy
b. solid food
c. low fluid intake

87. A 2 year-old boy presented to your clinic with bilateral conjunctivitis, fever, redness of
the tongue and lips, peeling of the palms and soles. What is the most appropriate
management?
A) Intravenous immunoglobulin and aspirin
B) Paracetamol
C) Cephexin
D) Prednisolone

88. A 2 year old boy presented to your clinic with red palms and soles , red shot eyes, fever
of 7 days which does not seems to wean off after paracetamol therapy .what is the most
appropriate management?
a)Morphine
b)Paracetamol higher dosage
c)Amox antibiotic
d)IV gama globulins

89. A boy has a 3rd episode of nephrotic syndrome. He is treated with prednisolone but his
recovery is slower than expected. He also has hematuria. Blood pressure is 120/80mmHg.
What is the cause? (Exactly same question as in July 2011 word to word)
A)Superimposed post-streptococcal glomerulonephritis
B)Renal calculi
C)Focal segmental glomerulosclerosis
D)Renal tubular acidosis

90. Eight year old girl with fever, first knee pain, then ankle joint pain. Rash on back. Mx?
a.) Penicillin
b.) i.v. immunoglobulin

Child who had URTI 3 weeks ago, now presents with petechiae, bruises. Platelets decreased.
Most appropriate Mx? (A) ??

46 Sept. 2011
91. Boy with oedema, HTN. No haemturia. Most likely Dx?
a) Minimal change nephritis
b.) Focal segmental glomerulosclerosis

5 month old infant with intermittent screaming & drawing up his knees. Blood red stools.
Most appropriate mx?
a.) USG abdomen
b.) Ba enema

92. Mother comes with daughter age 5 yrs. C/o clear vaginal discharge. Most appropriate:
a.) don’t do bubble bath
b.) Examination of vagina

93. 10 month old boy with irritability, vomiting and abdominal distention. Noted pulling up
of his legs occasionally. PR 160 RR 60. What will be your initial management?
a. Abdominal x-ray
b. Barium meal and follow through
c. Establish IV access
d. Laparoscopy
e. Laparotomy

94. 18 months old girl, at 12 months started to walk, go up the stairs one foot at a time.
Came in at the clinic because mother noted difficulty in her gait, walking with her toes in.
What will be your advice?
a. Do nothing
b. Refer to specialist
c. Hip X-ray or foot xray
d. MRI

95. Aboriginal boy with ear pain. Noted yellowish discharge on right ear, Tympanic
membrane ruptured and dull. Also noted yellowish greenish discharge on nose, what to do
next?
a. Get swab from ear discharge
b. Get swab from nose discharge
c. CT head
d. Give oral antibiotics

96. A 3 year old boy after having viral infection a week ago had petechiae, non blanching on
his trunk. No noted bleeding. Platelets were 35. What would be your initial management?
a. Immunoglobulins
b. Platelet transfusion
c. High dose steroids

97. 6 month old infant presenting with lethargy, mottling, poor feeding. Urinalysis: (+) wbc,
(+)
bacteria. How will you manage this patient?
a. Ceftriaxone
b. Oral amoxicillin
c. Ampicilllin
d. Gentamicin

47 Sept. 2011
98. An indigenous girl comes with chronic otitis media. She’s 13 years old she has never had
any immunisation since 12month of age. Which is the best management for her regarding
immunization?
a. Give pneumococcal and homophilus influenza vaccinefor her
b. Start immunization regimen from the beginning
c. Do the recommended scheduled immunization for her age
d. Continue to catch up the immunisation regimen

99. A child presented with swelling on right groin which is the next investigation?
a. Ultrasonography
b. CT scan
c. X-ray pelvis
d. FNAC

100. A child with (Erythema) of the Oral cavity & desquamation of fingertips. What is the
treatment?
a) Aspirin & Immunoglobulin

101. A child with history of Neonate jaundice. Blood smear shows spherocytes. What is the
treatment?
a) splenectomy
b) IV immunoglobulin
c) high dose steroids

Psychiatry
102. A 16 year old girl came see her GP because her parents wanted. She finds it very
difficult to concentrate for 6 months and previously did well in academic studies. Her
appetite hasn't changed. She prefers to be alone in her room most of the time when she's at
home. She goes out with her friends but she finds it very hard to entertain herself. Probable
Dx?
(A) Major depression
(B) Normal adolescent behaviour
(C) Prodromal schizophrenia
(D) Attention deficit disorder

103. High risk of suicide is associated with which of the following scenarios?
A. Married, less than 30 years
B. attempting suicide for a secondary gain
C. Single, more than 60 years.

104. Patient replied when asked about his improper diet as “ Moon is cheese coloured, My
farm is full of shaw” . What is your diagnosis?
A. Depersonalisation
B. Delirium
C. Formal thought disorder

105. Patients wrote a letter to his doctor “I do not want take this medicine. I am going on
holiday” What is it?
A. Derailment

48 Sept. 2011
106. Mum called her GP that her daughter 18 yrs old is not getting out of bed and saying she
has no ability to stand and feeling like she will fall down as she will stand. She has a h/o URTI
4 weeks back? What could be the most appropriate cause behind this girls illness?
A. Post infectious irritability
B. GBS
C. Conversion disorder

107. A fit 73 yr old widower living in a nursing home is found masturbating in the privacy of
his room by the nurse. The nurse asks you to intervene. What is the best step?
a. Refer for counselling
b. Do nothing as it is his private affair
c. Tell the patient that his behaviour is inappropriate

108. An 83 year old woman living in a rest home complains of insomnia. On asking she says
she is not depressed and does not suffer from any other ailment and is not on any
medication. What is your next step?
a.) Sleep hygiene advice
b.) Sleep promoting adjuvants
c.) Relaxation therapy and meditation
d.) Fluoxetine
e.) Sleep counselling (may not exact but it was related to counselling)

109. A young patient who is a known heroin addict comes to you requesting you for a
prescription of Diazepam as he wants to kick of his heroin addiction. What is your next step?
a. Prescribe him a dose of Diazepam for 10 days
b. Tell him you cannot fulfil his request
c. Prescribe the medication and it will be collected on a daily basis from a pharmacy
d. Refer him to a drug rehabilitation centre

110. A mother brings her 6 year old daughter who has patches of hair loss on her head. The
hair in the affected region is of varying lengths and the patch is irregular in shape. The child’s
parents are recently divorced. Diagnosis?
a. Alopecia areata
b. Trichotillomania
c. Tinea capitis

111. A young man comes to you and tells you that he thinks everyone is talking about him on
the radio and television and someone is telling him what to do. Diagnosis?
a. Thought broadcasting
b. Idea of reference
c. Thought insertion
d. Mania
e. Schizophrenia
112. A patient with a known psychotic disorder who is being treated with Risperidone
complains of generalised restlessness especially of the legs. What is the problem?
a. Parkinsonism
b. Ekboms syndrome
c. Akathisia
d. Tardive dyskinesia

49 Sept. 2011
113. A young man is agitated and presents to ED with a knife in his hand. He has been seeing
a psychiatrist in the past and refuses to give any details regarding his past illness. Once
patient is calm, what will you do next ?
A. Restrain him
B. Talk to him regarding his psychiatric illness once he is ready to talk to you
C. Talk to the psychiatrist against the patients wish

114. Boy 14 years , his mother concern about his behaviour as he is disagree with his sibling
all the time and he is very caring about the environment, he has:
a. schizophrenia
b. normal development

115. A lady comes to the Hospital, says she has health insurance, asking for better room with
nice mirror and clean bathroom and shouting at the nurses as they don’t know anything.
When you comes in, says you understand better because you are good and a doctor.
a) Splitting
b) Delusional
c) Frontal lobe
d) reaction formation
e) regression

116. A husband call you that his wife stoped breast feed 3 month child because she fears
that something wrong will happen for him and she cries all the time. This family moved
recently to rural area due to husband’s work. In addition the husband cannot take care of
child because of his work. Next step?
a. visit the family in their a new house
b. take the child from the mother
c. describe for her treatment

117. An inmate who has come in from Mental health home with a IQ of 60 and has a swollen
arm which was due to a fight with other inmate for a remote control of TV. He is shouting
and abusive and not sitting still for an X-ray, What is the best management ?
a) Call the carer of the Mental health home to calm him down
b) IM Olanzapine
c) Call the security and restrain him
d) Call Police
e) involuntary admission

118. Psychodynamic psycotherapy given in which of the following conditions

a) OCD
b) Sczephrenia
c) Autism
d) Specific phobias

119. Patient who has feelings of suspiciousness. C/o does not feel like self, feeling that
something is not right. Dx?
a.) depersonalization
b) delusional mood

120. Young man lost his job recently broke up with girlfriend. H/o drug abuse & violent
behavior. WOF is he most likely to benefit from?

50 Sept. 2011
a.) behavior therapy
b.) motivational therapy

123. Child always fighting with his father, not going to class and not listening to his parents.
What is the best approach to management?
a. Family therapy
b. Psychosocial dynamics
c. Cognitive behavioral therapy
d. Report to school principal
124. 18 year old Teenager living away from home since 13 years old. He was an intermittent
cannabis and marijuana user. Had been in jail for several times. Does not want to talk about
his past events. What is this?
a. Major depression
b. Drug dependency
c. Conduct disorder
d. Oppositional deviant disorder

125. Who is the most likely to be harmed by psychotic patient during the outbreak of
psychotic symptoms?
a) Nurse
b) Parents
c) Strangers
d) Siblings

126. A 16 year old child was brought to the department by his mother he had inability to
concentrate on one subject for long and very aggressive and mother is worried. child is
constantly shaking the legs and tapping while waiting in the room. mother says that the child
was behaving similar in school and the school report showed that his participation and
progress in school was very poor. His verbal intelligence was poor. What further history
should you ask the mother to diagnose his condition?
a. Ask of the family situation
b. Ask if the child was ever prescribed with methylphenydate
c. Ask if she suspects him of taking drugs
d. Ask about the community and his friends in school, his relationship with people.

127. A lady lawyer, given evident details of how independent she is and financially stable,
suddenly her husband dies and she is now all miserable and can’t sleep at nights, daily
chores are not being attended, not going to job. She has few friends with whom she talks
about it. What is the best appropriate management/advice you shall suggest? (Husband died
3 months back)
a) Carbamazepine
b) Psychiatric hospitalization
c )ask her to make new friends
d)CBT

128. A mother visits a doctor. She complains that her son drawings now are only in black and
white. She just got divorced with her husband
a) Refer the son to a psychiatrist
b) Ask the son about his drawings

51 Sept. 2011
Population health and Ethics
129. Co-intern was stealing drugs from the hospital. What will do next?
A. Inform intern coordinator
B. Inform nurse manager.
C. Inform pharmacy.
D. Inform police.

130. Colleague stressed and complains of insomnia, you find out that he is taking sleeping
pills and coming to work, what will you do?
A. Advise him of the side effect
B. Do nothing
C. Report to the medical board

131. Colleague stressed and complains of insomnia, he says he has an assessment in two
weeks. He asks you to prescribe some medication for him. What would you do next?
a. Advice to seek another doctor
b. Give him prescription
c. Report to medical board

132. You see your colleague prescribing antipsychotics for himself. What is the most
appropriate action that you will take?
a. Advice your colleague against self-prescribing
b. Report to the department head
c. Report to the medical board
d. Do nothing as it is his personal affair
e. Write an incident report

133. Your colleague is an established case of Bipolar Disorder and She has started
prescribing Psychiatric medications for herself. What is the most appropriate step you would
do?
A. Report to the Hospital Management
B. Ask her to seek specialist for the prescriptions
C. Report the medical Board of General Practitioners
D. Don’t report any where as she is your colleague

134. Mean systolic BP of a population of patients was 115mm Hg, standard deviation is 15.
With a confidence interval of 95%, the BP of this population ranges from:
(A) 120 -140mm Hg
(B) 85-145mm Hg
(C) 70-160mm Hg

135. Which is the best study to find out the state of Vitamin D deficiency in Australia?
(A) cohort
(B) case control
(C) case study
(D) Cross-sectional study

136. Which is the most important in preventing neonatal mortality (disease?)

a. Antenatal check up
b. First visit of baby and mother
c. Pap smear.

52 Sept. 2011
137. A CT scan Head of a 70 year old man was shown. He is admitted to the hospital and is
unconscious. His condition deteriorates and the son wants the doctors to perform any
surgery that may save the old man. Wife says not to do surgery. What do you do?
a. Apply to guardianship court
b. Do as per the son wishes
c. Do as per the wife wish
d. Do what is best for the patient

138. What is the cardiovascular risk in a diabetic pt, smoker, 54 yr, systolic BP156, HDL 6.
A. 25-29
B. 16-19
C. 10-15
D. 20-24

53 Sept. 2011
139. A lady with COPD, 90 yr old. MMSE 28/30 with no depression no mental illness. She's in
great health has told you not to resuscitate if she falls ill. Children are not allowing you to
oblige her and ask you to do all possible to help her if she falls sick. what will you do?
a) Call the social worker
b) Call a family meeting
c) Call at pscy analyst

140. A lady is posted for surgery, the nurse in the ward calls you and say that an informed
consent has not been taken. What will you do?
a. Look up on the internet about the operation, and take consent.
b. Explain the procedure and obtain consent.
c. Ask the head nurse to take the consent.
d. Call the surgeon and ask him to take the consent.

141. 32 yr old patient presented to you concerned because her mother had breast cancer at
45 yr age, older sister was recently diagnosed to have ovarian cancer at 35 yrs of age. What
is the chance that she will get breast cancer?
a) 0
b) 0.25
c) 0.5
d) 0.1

142. Pt 35 years presented to discuss with you the risk of breast cancer as her mother
diagnosed with ca of breast at 47years and her older sister at 37 years.
a. 1.0
b. 0.6
c. 0.5
d. 0.25

143. Pedigree analysis was given. It showed that it skipped generations first and second and
third and then was affected 3 Females and 1 male in next 2 generations.
a) Auto Recessive
b) Auto Dominant
c) Mitochondrial
d) X-linked recessive

144. Pedigree shown below. What is the most likely mode of inheritance?
a.) Autosomal dominant
b.) Autosomal recessive
c.) X-linked recessive
d.) Polygenic inheritance, multifactorial
e.) mitochondrial inheritance

(Black indicates disease)

145. One parent is a carrier for cystic fibrosis. Other parent is not affected, not a carrier.
Chances of having child with CF?
a.) 0
b.) 0.5
c.) 0.25

54 Sept. 2011
146. In Cystic Fibrosis, if 1 parent has the trait, what is the chance of a child having the
disease?
a. 0
b. 0.25
c. 0.5
d. All males are affected

147. Child with Hereditary spherocytosis. Chances of next sibling having disease?
a. 0.5
b. 0.25
c. 50% males are carrier

148. Hemochromatosis, patient’s relative die from this disease, chance of children getting it?
(A) ?

149. A recently married couple asked for advice regarding hemiphilia. Wife’s father has
haemophilia. what is the chance that her child could get haemophilia?
a. 0
b. 0.25
c. 0.5 of boys

150. A new screening test is to be launched in community. Which is the most important
factor to consider?
A. High sensitivity
B. High specificity
C. High positive predictive value
D. No adverse outcomes

151. A new screening test was developed for a disease. According to the survey, there is an
increase in percentage of people who are taking the screening test. However, there is no
increase in number of people diagnosed with the disease. What’s the underlying cause?
A. Because of the cultural limitation, the number of Indigenous women who take the test are
few.
B. There is not enough access to the test for the community
C. The test has low sensitivity value

152. A study testing Drug B reveals significant benefit of Drug B > Drug A with probability
<0.01. This means:
a. The difference B/w drug B and A occur by chance
b. drug B is better than A
c. drug A is better than B
Which report provides the least information ?
A) Case control
B) Cohort study
C) RCT
D) Case report

153. You are a GP taking care of a community of 100 people and the following is the number
of people with specific diseases for two years that you have.

55 Sept. 2011
 2009 2010
BP>140/90 40 50
Hyperglycemia 20 25
Hyperlipidemia 30 40
What is the point prevalence of hypertension (per 1000 people) for 2010? (exactly as such
and there is no answer for 500)
A. 50
B. 40
C. 250
D. 475

154. Which is the most appropriate situation for case study and case control study?
(A) ??

155. Lady broke her wrist after a car park accident. PE: noted cataracts with left
homonymous hemianopia. What would you advise her regarding her driving?
a. Wear prescription glasses
b. Needs removal of cataract first
c. Never can drive again

156. pt has stroke with recover, but he has Lt heminopous hemianopia and the vision is 6/9.
He asks you about driving:
a. correct by glass then can drive
b. drive now
c. never drive
d. referred to occupational work health assessment

157. Two QUESTIONS ON: Person with visual field defect (bitemporal hemianopia).
Regarding driving:
a.) Can never drive
b.) Can drive after 6 months
c.) After 12 month
d.) After 2 years.

158. Lady who has first time seizure. Regarding driving?

a.) Can never drive
b.) After 6 months
c.) After 1 year
d.) After 2years

159. Bus driver who suffered a stroke 2 months ago with no residuals. VA 6/9, PE: bilateral
temporal hemianopsia. What will you advice him regarding his driving?
a. Never drive
b. Can drive with glasses

Two questions on driver with homonymous hemianopia, what is your advice?

a. Never drive again.
b. Drive after 6 months.

56 Sept. 2011
160. Question on driving: a woman c/o single episode of epilepsy following a history with
involuntary muscle spasms on waking up for a few months. GPE was done on her and she
was otherwise normal. For how long will you have to restrict her driving?
a. 6months
b. 9m
c. 3m
d. 12m
e. 24m

161. Jehovah lady comes in after a MVA and she has 3 fractures of ribs and blah blah. What
to do?
a) IV NS
b) Blood transfusion as its important to save her life
c) Get a signed consent form for no blood transfusion even if she might die.

162. 38 yr travelling to Africa, what advice is important for tape worm?

a. avoid swimming in lake
b. make sure the meat are cook well, try not to eat raw meat.
c. avoid walking barefoot
d. avoid getting bite by mosquito

163. A man who wants to travel to Africa, is worried that he might get Schistosomiasis (snail
fever), as his friend was diagnosed of the condition a few months ago, following a trip to
Africa. Which advice is the most important to give him?
a. Do not walk barefoot outside
b. Drink only boiled water or mineral water from bottle
c. Caution on exposure to blood and body fluids during travel
d. Avoid bathing in water lagoons and other water bodies
e. Eat only freshly prepared food

164. Patient travelling to Sleeping sickness (African trypanosomiasis) endemic area. What’s
your advice?
a) Do no go to areas with tsetse flies.

165. As a GP in rural area, you notice that recently more cases of Hepatitis C has been
diagnosed and want to do a research to find out the incidence of Hep C in the community
with a population of around 3000. How will you get the information you need for the
research?
a. Find the number of all patients with current Hepatitis C antibody positive
b. All patients with current Hepatitis C antigen positive
c. All patients with current Hepatitis C PCR positive
c. All cases diagnosed as Hepatitis C positive for the past 5 years

166. You are a doctor in an international flight. You had 6 standard drinks on board. A
passenger had an emergency and flight steward was looking for a medical practitioner on
board. What would you do?
a. Help patient even when you had 6 drinks
b. Tell the flight attendant that you had 6 drinks and look for others who can help
c. Do nothing

57 Sept. 2011
167. Husband gets a call from you because the bill of his wife’s STD screening came. What
will you do next?
a. Tell her results
b. Tell him to talk with his wife
c. Tell him nothing

168. A 50 year old man with high alcohol intake, what is the possible cause of death 10
years later?
A. coronary heart disease
B. accident
C. liver disease
D. depression

169. Patient came in for check up for sore throat. He has no appointment and the
receptionist told you that he hasn’t paid for his last 2 visits. What will you do?
a. Ask for payment in advance
b. Book for the next available appointment
c. Leave a prescription in the reception
d. Refer to another doctor
e. Refer to local hospital

170. A new screening program in Aboriginal population is to be started for prevention of

blindness due to scarring and opacity of lens. What condition are they screening for?
A. alcohol
B. visual acuity
C. trichiasis
D. conjunctivitis

171. GP noted increase incidence of cataract formation in an indigenous community. This

corneal scarring secondary to repeated abrasions may be due to what?
a. Diabetes
b. Trichiasis
c. Cataract
d. Herpetic keratitits

172. A 45 yr. old male came to you for screening of colon cancer. His father was diagnosed
at 67 yr age for colon CA. and maternal aunt at age of 62 yr. What is your most appropriate
next step regarding to his situation?
A) Fecal Occult Blood Test 2 yearly
B) sigmoidoscopy 2 yearly
C) colonoscopy yearly
D) reassurance
173. 38 year old man asking for prostate CA screening. His father was diagnosed with
prostate CA at 80 years old. Neighbour at 50 years old was also diagnosed with prostate CA.
He mentioned about PSA screening. On PE: DRE was normal, no lymph nodes palpated.
What advice would you give?
a. Reassure
b. Do PSA in 2 weeks
c. DRE annually
d. Do UTZ of prostate

58 Sept. 2011
174. A lady of 53 years came to the clinic and speaks about maternal aunt having Breast Ca
at age 72 and now being worried about it. What is your advice?
a) Ultrasound rite now
b) Ultrasound 2 yearly
c) Ultrasound and mammography 2 yearly
d) Mammography 2 yearly
e) You are fine go home.

175. Breast cancer screening in a woman age 40 year old with her mum diagnosed with
breast cancer at age 65 year?
A) Mammography every 2 year
B) Mammography & Ultrasound every 2 year

59 Sept. 2011