COMPILATION QUESTIONS OF THEORY AND OSCE PART ONE 04/14 & 05/14

First of all, I would like to thank all universities for contribution! Team work is so important.
Hope can keep it up until we graduate even we become family medicine specialist in future..

SHARING IS CARING!!!!

MEDICAL

Q 12. 38 years old man presented with muscle weakness for 3 months. On examination BP is
140/90 mmHg and there is purplish striae noted on the abdomen. What is the appropriate
investigation?

A. Fasting blood glucose

B. Serum electrolyte
C. Low-dose dexamethasone suppression test
D. MRI brain
E. CT abdomen

Q14. 50yo man c/o right sided weakness. Bp:160/100.pr90 regular. Power 4/5 rul/rll
hyperreflexia.ct brain small hypodense area at internal capsule.allergic to aspirin. Appropriate
treatment

A. Cea
B. clopidogrel
C, heparin
D. Warfarin
E, streptokinase

Q 20. 68 years old women presented with bilateral knee pain for 6 months

She has DM and stroke on Metformin and statin

On examination, there is bilateral knee swelling and crepitus

Investigations normal

What is the best medication for her pain ?

A) Acetaminophen
B) Ibuprofen
C) Glucosamine
D) Chondroitin sulphate
E) Topical
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 Q 22. 45yo male c/o epigastric pain for 1 week. Urease test positive in private GP. What is ur
next step of management.

A) do H. pylori serology

B) long Term PPI

C) MMT

D) OGDS

E) start H2-antagonist

Q . 76 years old gentleman with COPD, presented with sore throat, joint pain and cough. No
SOB.

O/E afebrile. Blood pressure normal. throat injected. No cervical lymph node palpable. CVS
and Lungs normal.

what is ur diagnosis?

A. acute bronchitis

B. pleurisy

C. mycoplasma pneumonia

D. flu like illness

E. pneumococcal pneumonia

Q25. 37 yo woman recently diagnosed with PTB and started on fixed dose combination
therapy, noted to be jaundiced. O/E vitals sign stable, icterus, palpable liver 2cm nontender.
Deranged LFT with ALT 200, bili 30. AntiTB withheld.
What is the next mx?
a) Do coag profile
b) Order USG liver
c) Repeat LFT in 2/7
d) Give vitamin E
e) Give Essential

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Q26. 26 years old SLE patient with right groin pain for 2 months. She appeared to be cushingoid
clinically on T. prednisolone 10mg od. Right hip Xray appeared to be normal. What is the
next step of investigation
A. Bone density scan
B. CT scan
C. MRI
D. Ultrasound

Q27. 40 years old lady with Hypertension and Type II diabetes; blood pressure 130/80 with
following lab results
- urine microalbuminuria +ve
- Total Cholestrol 5.3
- HDL 1.2
- Triglycerides 3.4
- Creatinine 110
- LDL 2.3

what is the best treatment option

A. insulin
B. dihydropyridine CCB
C. ACE inhibitor
D. ARB
E. aspirin

28. A 45 year old man presenting with history of muscle cramps and fatigue. On examination,
vital signs are stable. Physical examinations are unremarkable. Below is his biochemistry
results:

Sodium 140 (136-145)

Potassium 4.5 (3.5-5.1)

Urea 6.0 (3.0-7.0)

Creatinine 100 (83-106)

Calcium 2.0 (2.04-2.39)

What is the next important investigation for further management?

A. Serum magnesium
B. Serum parathyroid
C. Serum albumin
D. Thyroid function test
E. Serum phosphate

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Q29. A 29 yr old female, previously healthy presented for her pre-employment check. She is
asymptomatic, not taking alcohol, no high risk behaviour, no history of blood transfusion.
BMI is 31.No jaundice. There is hepatomegaly. Ultrasound showed enlarged hyperechoic
liver. No other abnormality. ALT to AST ratio is raised. Other investigations are normal.
What is the best management?

A- Advise to reduce weight

B- refer for liver biopsy
C- screen family members for similar disease
D- start metformin
E- start statin

Q .32yo malay man, coming for follow up. He is well. No active complaint. His results as
below :

HbS Ag Reactive ( 3 months ago) Reactive (now)

Hbe AG NR ( 3 months ago) Reactive (now)
Anti-Hb Negative( 3 months ago) Reactive (now)

What is the next appropriate management?

a) Arrange HbV RNA

b) GGT
c) Repeat 3 months investigations as above
d) Give vaccination
e) Check alpha feto protein

Q. A 40 YEAR OLD LADY PRESENTED WITH PROGRESSIVE FATIGUE OF UPPER

AND LOWER LIMBS TOGETHER WITH THE BILATERAL EYE WEAKNESS THAT
SEEMS WORSENING FROM DAY TO DAY AND INCREASING IN INTENSITY
THROUGHOUT THE DAY. NO FAMILY HISTORY AS SUCH AND NO PRIOR
HISTORY OF ILLNESS.
O/E : BILATERAL PTOSIS AND PROXIMAL WEAKNESS OF UPPER LIMB
POWER AND TONE ARE NORMAL

WHAT IS THE LIKELY DIAGNOSIS?

A) UPPER MOTOR NEURON LESION
B) MYASTHENIA GRAVIS
C) GUILLAN BARRE SYNDROME
D) HYPERTHYROIDISM
E) LOWER MOTOR NEURON LESION

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Q34. 32 y.o woman presented with severe diarrhoea and muscle weakness. She was
diagnosed with Grave's disease 6 months ago. However she missed her medications since 2
weeks ago.

On examination the patient was anxious, having tremor, BP: 160/100, PR: 120, T: 39 degree
There is goitre with bruit. CVS: presence of flow murmur

What is the initial management?

A. Dexamethasone
B. Lugol's iodine
C. Enalapril
D. Propylthiourecil (PTU)
E. Propanolol

Q37. 56 year male,presented with right sided abdominal pain with fever,chill and rigor for
2days.on examination: T: 37.8 BP:128/78 HR:104.there is right flank tenderness.
Investigation:
URine; protein:trace
: nitrate/keton : - ve
: leuco; +ve
Microscopy; RBC: 2 /HPF
: WBC; 1/HPF
;Bact/cast/others:nil

What is your likely diagnosis:

A: acute cystitis
B: acute prostatis
C: acute pyelonephritis
D: renal tuberculosis
E: retrocaecal appendicitis

Q. 32 y/o man came in with swinging fever, night sweats, rigors and jaundice for 10 days. He
had a history of jungle trekking 2 months ago.
He looked lethargy and pale with mild tender hepatomegaly. Temp 39 degrees, Bp 110/70
and HR 116bpm.

What is the most likely diagnosis?

A. Atypical pneumonia
B. Dengue Fever
C. Falciparum malaria
E. Leptospirosis
F. Liver abscess

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Q .45 yo lady, presented with facial puffiness and pedal edema. investigation was as below.
she is also known case of rheumatoid arthritis on gold therapy.
urine protein 2+
albumin 19
T.cholesterol 5.2

what do you think is the diagnosis?

A. focal segmental glomerulosclerosis
B. rapidly progressive glomerulonephritis
C. membranous nephropathy
D. minimal change nephropathy
E. thin basal membrane glomerulonephritis

Q44. 35 years old, Abdominal pain, blood and mucus in the stool. Arthralgia, loss of weight 5
kg. On examination mild pallor, nodules skin bilaterally. Lower abdominal tenderness.

What is your diagnostic test/ best management? (tak sure soalan nk apa.. tak ingat..)

A.

B Barium enema

C. Colonoscopy

D.CT Abdomen

E Ultrasound abdomen

Q45. 78 yo lady complain of no bowel opening x 2/12 with last BO a week ago. She also has
painful defecation. On exam noted perianal skin tags and impacted stools. What is the
management?

A. Liquid Paraffin

B. Lactulose

C. Fibre supplement

D. Glycerin enema

E. Oral bisacodyl

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Q47. 17yo girl with Type 1 DM complaints of vomiting and epigastric pain since morning.
She is stable on regular insulin. She just recovered from acute exacerbations of bronchial
asthma. On examination she is febrile BP 100/60 P110/min and dehydrated

What would be the most possible cause for her symptoms

a) concomittent thyroid disease

b) corticosteroid therapy
c) intercurrent illness
d) tak ingat
e) tak ingat

Q48. 48-year-old male who is a known case of peptic ulcer disease currently diagnosed to
have osteoarthritis of the knee. which of the following is preferable for his painful knee?

A:Aspirin,

B:Naproxen,

C:Diclofenac,

D:Paracetamol,

E:Prednisolone

Q49. In chronic Hepatitis B patient, the most sensitive and specific investigation for
surveillance HCC is:

a) Alpha-fetoprotein

b) Hepatobiliary ulstrasound

c) Liver transaminase

d) CT scan liver

e) Viral load

Q50. 45 years old man had constipation for 1 year with occasional loose stool for 3/12. BP
130/80, PR 70bpm. Abdominal examination is normal. What is your next management?

a. colonoscopy

b. stool culture

c. fecal occult blood

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d. sigmoidoscopy

e. barium enema

Q51. A 16 years old girl, come with history of fever, rhinorrhea and cough. Came with
complaint of joint pains. Initially had history of left knee and elbow pain which resolved. The
pain then migrating to the right knee at presentation. What is your diagnosis?

A. Systemic lupus erythematous

B. Acute rheumatic fever

C. Reactive arthritis

D. Juvenile idiopathic arthritis

E. Septic arthritis

Q54. 65 years old man with hypertension on treatment presented with breathlessness and
exertional dyspnoea for 3 days.His BP 160/95, regular heart rate 100bpm. He is mildly
tachypnoeic. Spo2 93% under room air. JVP is raised. Lungs bilateral crepitations. What is
the most appropriate investigations for him?

A. CXR

B. ECG

C. ECHO

D. Pulse oxymetry

E. Cardiac marker

Q55. 28 year old woman, develop sudden onset of abdominal pain and diarrhea, 1 hour after
eating rojak at mamak stall. Her friend who also eat together with her at the mamak stall also
develop similar symptoms. What is the most likely aetiology for the above symptoms:

a) Enterotoxigenic E.coli

b) Shigella

C) Salmonella

d) Staph aureus

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e) Vibrio cholera

Q57. 46 y/o, Hypertension, c/o severe diarhhea for past 3 days. He was afebrile and have
reduced urine output. His Blood pressure was 125/70, P 102

Investigations was:

Na 140

K 5.4

Urea 20

Creat 320

Most appropriate treatment is:

a. Dialysis
b. B. Oral resonium
c. IV Normal saline
d. ORS
e. Anti diarrheal drug

Q. 50 years old gentleman presented with painless hematuria. physical examination as well as
bone and lung scan are normal. diagnosis of renal cell carcinoma was made by biopsy of the
local mass. what will you counsel to patient about treatment option?

A. chemotherapy
B. radiotherapy
C. immunotherapy
D. hormone therapy
E. surgical resection

Q. 27 yo female. headache.unilateral weakness.ct brain hypodense lesion in the brain.she has

a cat as pet. what is most likely organism?
A. Aspergilus
B. Criptococus
C. Cmv
D.Toxoplasmosis
E.---

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Q. 70 years old.fever n urti.social drinker.confused and can see yellow spiders. what is dx?

A. Delirium
B. Delirium tremens
C. Dementia
D. Alzheimers ds
E.---

Q. 55 year old was admitted for stroke. His BP maintained at 155 -150/99-90mmHg. What is
the best antihypertensive for him?

A. ACE-I
B. ARB
C. CCB
D. Thiazide
E. B-blocker

Q. 28 year old lady underlying SLE presented with SOB and chest pain. She had cough, but
no fever.on examination, RR - 18/min, BP - 90/80mmHg, with soft heart sound. ECG - ST
elevation all lead.

What is the next appropriate investigation?

A. CXR
B. Cardiac syntigraphy
C. Holter
D. Stress test
E. Echocardiogram

Q. 40 yr old lady came to the office for check up. She had history of PTB 20 years ago and
completed treatment. She was asymptomatic and was well.

CXR done revealed minimal blunted right costophrenic angle.

What is your next step of management?

A. Sputum AFB x 3
B. Mantoux Test
C. ESR
D. Right lateral decubitus CXR

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Q. 60 years old man, day 2 post esophagectomy. He developed bleeding tendencies. On
examination noted bruises and stage 1 shock. Investigation result showed prolonged PT/aPTT,
INR, low platelet, and positive D-dimer.

What is the diagnosis?

A. HUS
B. DIVC
C. Pulmonary embolism
D. Peritonitis
E. Thoracic aorta aneurysm

64. 18 years old sexually active woman complaint of persistent copious and frothy vaginal
discharge since 4 months ago. It is associated with pruritus and dysuria. On examination, her
vulva appeared erythematous and excroriated. SE revealed punctuate haemorrhage ulcer at
cervix with greenish discharge.

What is the most appropriate test?

A. Gram stain
B. HVS C&S
C. Pap smear
D. KOH test
E. Sterile wet mount test

65. 25 y/o man presented with penile lesion for 4/7. Noted single painful ulcer, irregular
border about 1cm in diameter with slough base.

What is the most likely diagnosis?

A. Bechet's disease
B. Chancroid
C. Herpes Simplex
D. Lymphogranulomatous venereum
E. Syphilis

66. 65 man came d/t lethargy. Physical examination was unremarkable.

FBC : Hb - 6.9 TWBC - 35 Plt - 900

What is the most likely diagnosis?

A. ALL
B. AML
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 C. CML
D. CLL
E. MDS

72. 24 y/o man, recently diagnose with epilepsy. What is the side effect of medication that
should be emphasized on the patient?

A. Dizziness

B. Acne

C. Gingival hyperplasia

D. Rashes

Q99. 30 yo came for AEBA.took sabutamol mdi 2x in 1 hr. O/e tacypneic rr28. Spo2 93% on
5 liter/o2. Bp 110/70 pr 120bpm. Auscultation: generalized ronchi.pefr 60% bpv. Appropriate
next step

A. iv adrenalin
B. iv hydrocort
C. iv theophyline
D. sc terbutalin
E. High flow mask

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OBSTETRIC

Q5. G5P4 at 36 weeks came with regular abdominal pain for 6 hours.

BP is 120/80, HR is normal.

Abdominal examination revelaed singleton fetus, fetal head at the mother's right flank.

Fetal heart rate is 120

What is Next investigation :

A) Cardiotocograph
B) Urinalysis
C) Vaginal examination
D) Ultrasound
E) Full blood count

8. Primid at 35w POA presented with bilateral leg swelling. Previous BP was normal. Her BP
was 140/90mmHg,PR - 80/min. examination was unremarkable.

Urine - no protein.

What is the most appropriate management?

A. Arrange for regular BP monitoring

B. Prescribe anti-HPT
C. Take LFT, BUSE, UA, Coagulation profile
D. IV MgSO4

10. 30 years old G2P0+1 at 18w POA, with Blood Group A-‘
ve. She has history of abortion
2 years ago and was given anti-D immunoglobulin.

What is the most appropriate management at this stage?

A. To give anti-D immunoglobulin

B. To check her anti-D level
C. Indirect Coomb's test
D. Her risk of antepartum haemorrhage was low.

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Q. A PARA 2 WOMAN, WHO IS AT HER 14TH DAY POSTPARTUM, DELIVERED A
BABY BOY VIA VENTOUSE DELIVERY PRESENTED WITH PV BLEEDING THAT
SOAKED HER PAD FULL WITHIN ONE HOUR , AND FOUL SMELLING LOCHIA
COME TO YOU FOR FURTHER INVESTIGATION....
O/E : BP : 100/70, PULSE : 90 BPM, P/A : SOFT, MILD TENDERNESS AT THE LOWER
REGION

WHAT IS THE LIKELY DIAGNOSIS ?

A) ENDOMETRITIS
B) RETAINED PLACENTA
C) DEEP VAGINAL TEAR
D) URINARY TRACT INFECTION POST PARTUM
E) SUBINVOLUTION OF THE UTERUS

Q13. 30 years old primigravida at 26 weeks is referred for uterus smaller than dates. She is
sure of dates and regular menses. On examination, BP 128/82 and uterus at 22 weeks.
Ultrasound scan shows head circumference at 26 weeks and abdominal circumference at 22
weeks.

What is the most important investigations?

A. Amniocentensis
B. Order chromosomal analysis
C. Order MGTT
D. Order umbilical artery doppler
E. Screen TORCHES

Q14. 48 year old woman having regular menses with abdominal pain and lethargy for 4
days.On examination noted bulky uterus.

What is the initial investigation:

A. ultrasound pelvis
B. thyroid function test
C. dilatation and curretage
D. pipelle sampling
E. hysteroscopy

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Q. 60 yo lady diagnosed with overactive bladder, failed bladder training
Which drug therapy to be used?
a) anticholinergic
b) alpha-adrenoreceptor
c) botulinum injection
d) tricyclic antidepressant
e)

Q17. 39 years old with DM on T.MTF 500mg bd and T.Pioglitazone plans for pregnancy.
Her HbA1c is 8.5%. What is your advice?

A. Avoid pregnancy
B. Off OHA and start insulin
C. Off OHA
D. Off pioglitazone and increase MTF dose
E. Advice weight loss

Q 24 38yo lady, 1/52 copious frothy greenish malorodious vaginal discharge. + vaginal
soreness +dysparenia. What is the expected finding of examination?

A) +very wiff test

B) vaginal discharged pH >4.5
C)curdy hypae on KOH
D) clue cell on wet moth
E) motile protozoa on wet moth

Q. 38 years old primigravida at 35 weeks POA came for routine antenatal follow up. Noted
BP 140/90mmhg, mild pedal oedema, reflex normal, urine protein normal. What is the most
appropriate next step?

A. BP monitoring
B. LFT/ FBC/ PT/ PTT
C. Admit, refer
D. Start methyldopa
E.-

Q. 31 years old married female come to gynae clinic. she is unable to conceive for few years.
her menses irregular and associated with dysmenorrheal.
ultrasound showed uterus retroverted and adnexa cyst.

What is your diagnosis?

A. endometriosis
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B. pelvic inflammatory disease
C. endometrial CA
D. ectopic pregnancy
E.---

Q19. 60 y.o lady with no known medical illness and no drug history was recently diagnosed
with overactive bladder. She was not responded to bladder training. Examination revealed
normal abdominal and vaginal examination. What is the most important drug to start?

A. Apha adrenoreceptor antagonist

B. Anticholinergic
C. Detrusor Iinjection with botulinum toxin
D. Topical estrogen cream
E. Tricyclic Antidepressant

Q. 25 years old primigravida in active phrase of labour for 8 hours. ARM was done 3 hours
ago. contraction is 2-3 times per 10 minutes in moderate strength.
O/E: height is 166cm. Per abdomen is singleton , cephalic with EFW 3kg.
what is the cause of aove problem?

A. cord prolapsed
B. maternal pelvis dispropationate to fetal weight
C. fetal malposition
D. poor maternal effort
E. poor uterine contraction

Q. 31 yo G2P1 at 35weeks, with previous scar and pregnancy induced hypertension.

complaint of sudden onset of sharp abdominal pain and per vaginal spotting for 4 hours. on
exmination, her temperature is 37.2, blood pressure is 150/90, pulse rate is 100. on palpation
of abdomen, there is generalised tenderness over the uterus but no guarding. there is no fetal
heart appreciated.
whats your diagnosis?

A. abruptio placentae
B. uterine rupture
C. placenta praevia
D. premature labour
E.---

Q. 24 years old presented to ED. Her LMP was 1 week ago. presented with abominal pain
with tenderness on palpation. cervical excitation positive
A. cervicitis
B. cystitis
C. appendicitis
D. Pelvic inflammatory disease

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E. ovarian torsion

Q. 30 yo malay lady, G2 P1 at 30weeks POA, referred to you for uterus smaller than date.
She do not have any medical problem.

O/E : not pale, SFH at 26/52 POA

What is the best to describe regarding IUGR?

a)Decrease ratio of BPD to AC

b) decrease ratio FL to AC

c) increase ratio HC to AC

d) oligohydramnios

e)polyhydramnios

Q21. 35 year old para 2+2 c/o amenorrhea for 6 months with ERPOC done the last 2
pregnancies with the latest one complicated with transfusion and endometritis. She has no
other complaints. She looks well, thin and pink. Abdominal and vaginal exam are normal.
FSH 16.3
LH 21.4
TSH 2.9
Prolactin 8.3 (all 4 normal)
What is the most likely diagnosis?
A. Asherman syndrome.
B. normal physiological response
C. PCOS
D.premature ovarian failure
E. Sheehan syndrome

Q22. 36 years old G5P3+1@28wk presented with headache and epigastric pain for the past 3
days.her BP: 160/100mmhg, BMI: 30kgm2.systemic examination unremarkable.her urine
protein 1+ve
What is your next step of management?
A: ultrasound abdomen
B: renal profile and SUA
C: start on Aspirin
D: commence on MgSo4
E: start her on antihypertensive drug

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Q 29. 18yo, single pregnant at 8month pregnancy. she had her first pap smear done and the
result showed Atypical Squamous Cell of Undetermined Significant.

What's the next management?

A. Repeat

B. Defer repeat after 6/52 postpartum

C. HPV testing

D. Endocervical currettage

E. Repeat 1year

Q30. 23 years old, Lady, Left Iliac fossa pain for 2 days. Regular menses and LMP 6 weeks
ago. V/S stable. On examination mild tenderness at left iliac fossa.

What is the most important investigation?

A. B HCG
B. B. Transabdominal Ultrasound
C. Transvaginal Ultrasound
D. Urinalysis
E. Urinary Pregnancy Test

Q31. 39 yo Para 2 with last child birth 3 years ago. She has DM on T Metformin 1g BD and
Gliclazide MR 60mg OD. FBS 8mmol/L and HbA1C 8.5%. She has IUCD inserted 3 yrs ago.
She wants to conceive. What is the best advice?

A. Keep IUCD and maintain current DM meds

B. Keep IUCD and increase DM meds

C. Keep IUCD and change to insulin

D. Remove IUCD and increase DM meds

E. Remove IUCD and change to insulin

Q32. 26yo, G2P1 at 28w, had a contact with her daughter who is having chicken pox. She
doesn't recall of having chicken pox before this but definitely remember that she previously
had a contact with her sister who had chicken pox when she was young.

What is Next appropriate management?

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A. Check IgG antibody

B. give Acyclovir

C. give VZIg

D. Reassuarance

E. Vaccination varicella

Q33. 29yo primigravida at 30 weeks complaint of shortness of breath for 3 weeks.

Antenatally was uneventful. On examination BP 110/70 P84 +bilateral pitting edema, Abd 36
weeks size uterus, difficult to palpate fetal part. Ultrasound reveals singleton fetus,
parameters correspond to date, no congenital abnormality notedWhat is the best
investigations to suggest the cause of the problem

a) thyroid function test

b) pre prandial and 2 hours post prandial blood glucose monitoring

c) MOGTT

d)---

e)---

Q35. 32 years old lady, nulliparous and has irregular menses since menarche. She is married
for 5 years. She is otherwise well. BMI is 30kg/m 2 . BP: 124/70. PR: 80bpm. There is
extensive hair over her legs and arms.

OGTT: Fasting : 6.4 mmol/L

2 hours post prandial : 8.4 mmol/L

T4 : 9.4 µg/dL

TSH : 0.8 mIU/L

What is the most likely diagnosis?

a) Cushing's syndrome
b) Diabetes Mellitus
c) Hypothyroidism
d) Idiopathic hirsuitism
e) Polycystic Ovarian Syndrome

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Q36. 43 years old para 5 had PV bleed that wet her sarong. She gave birth via SVD at 12 H
ago. Labor prolong due to poor contraction. Baby weight is 3.8 kg. She is pale, T 37.8, BP
110/82 PR 84, P/A Soft non-tender.

Ultrasound: blood clots in uterus.

PT: 13.5, INR 1.0.

What is the cause of the vaginal bleeding?

a. coagulopathy

b. endometritis

c. retained placenta

d. uterine rupture

e. uterine atony

Q39. 36 years old, nulliparous with h/o 3 consecutives miscarriage. Previous karyotyping
done and normal. She has recurrent fever and arthralgia.

What is the most appropriate ix?

A. Antiphospolipid ix

B. Repat karyotyping

C. Echocardiogram

D. Abdominal ultrasound

E.--

Q40. 45 years old Para 2 with no known medical illness. She has normal regular menses, no
intermenstrual bleeding, no dysmenorrhea. She had bilateral tubal ligation 10 years ago. Her
sister recently diagnosed with endometrial carcinoma. She came to seek advice whether she
needs screening for endometrial carcinoma. What is the most appropriate screening test for
her?

A. Endometrial biopsy

B. Hysteroscopy

C . Ultrasound

D. Pap Smear

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E. CA 125

Q41) 28 year old, primigravida at 16 weeks POA come for booking. Following are the results:

Hb 9.0

MCV 75

MCH low

MCHC low

Platlet: 400

TWC: 8

What are your next step of investigations for causes of anaemia:

a) Peripheral blood film

b) Bone marrow aspiration

c) serum ferritin

d) serum iron

e) Hb electrophoresis

Q42. 40 years old, G3p2@12 wk POA came to screen for Down Syndrome. Her previous
children were well. What is the investigations to be done:

a. USG for nasal bone

b. Quadruple test

c. Triple test

d. Triple test and USG for nuchal translucency

e. USG for nuchal translucency

Q43. G1P0@ 20 week with hyperthyroid on T. Carbimazole 15mg daily. Her BP 125/80, P
100. Her investigations are:

TSH 0.8

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T4 24

Most appropriate management:

a. Reduce to 10 mg daily
b. Increase to 20 mg daily
c. Continue same treatment
d. Start on T. Propanolol
e. Change to PTU

45. 23, primid at 38w POA had contraction 1:10 for 1H. Patient is in distress

BP: 120/80mmHg PR: 83/min

VE: Os 6cm

CTG : Reactive

What is the best analgesics?

A. Deep breathing technique

B. Ethanox
C. Epidural
D. Pethidine
E. TENS

50. 26 year old woman at 12 weeks POA with severe vomiting and weight loss for 2 weeks.
O/E she is mildly dehydrated. BP - 100/70mmHg , PR - 110/min. urinanalysis showed ketosis.
She was given IVD and metoclopromide and had a little improvement. Other investigations
as below

fT4: 25.5 (9.1 - 24.4)

TSH : 0.35 (0.35 - 5)

Hb : 11.8

USG : single viable fetus

What is the best treatment for her?

A.
B. Ginger root powder
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 C. Ondasetron
D. Promethazine
E. Vit B6 (pyridoxine)

Q. 29 years old gravida 1 lady.asx. did urine feme.results as followed

Glucose negative
Bilirubin negative leucocyte 5/hpf
Nitrite negative
Gravity:1.0007
Cast -ve
Rbc -ve

What is your plan?

A.increased fluid intake
B.repeat urine culture after 1 week
C.repeat urine culture at 2nd trimester
D.start antibiotic and rpt culture after 1 week
E.take urine culture.treat with abiotic if positive

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PAEDIATRIC

Q7. 4 month old boy, constipation since birth. Only pass motion 2/7 after birth. Since then no
soil in diapers. Rectum examination - empty rectum.
What is the Likely diagnosis?

A) functional constipation

B) Hirschprung disease

C) hypocalcemia

D) hypothyroidism

E) spinal muscular atrophy

Q. 4 weeks old boy has history of constipation since birth, only opens his bowel on day 2 of
life, come in with similar problem, not soiling his diaper, most likely diagnosis will be:
A. hypocalsemia
B. Hypothyroid
C. Hirshsprung
D. Intestinal obstruction
E.-

Q. You are examining D1 of baby. baby was delivered term, spontaneous delivery, birth
weight 3kg. Apgar score 9 in 1 minute, 10 in 5 minute. You noted cephalohematoma 4x3cm
at the parieto-occipital region. Mother informed you that baby is sucking well. BO and PU
are normal.
What is your appropriate management?

A. take FBC
B. take serum bilirubin
C. reassurance
D. observe hematoma until size reducing
E.do skull x-ray
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Q35. 8 years old girl was brought in by teacher for frequent dropping pencils asoociated with
blank stare. What is the criterion for the diagnosis?

A. Association with unawareness of the surrounding

B. Lip smacking
C. Aura
D. -
E. ---

Q.4yo boy, can only speak few 2 word phrases. there is no dysmorphic features on
examination. what is the next most appropriate step?
A. audiometry
B. brainstem evoked response
C. otoacoustic emission test
D.
E.

Q30. A 8 year old boy presents with two days history of pain on micturition. On examination,
he is clinically well and mild suprapubic abdominal tenderness. Urinalysis as below:

Leucocyte esterase 2+

RBC negative

Protein negative

Nitrite negative

What is the next important management?

A. Order urine culture and sensitivity

B. Order urine culture and sensitivity and prescribe antibiotic immediately
C. Prescribe empirical antibiotic and review symptoms
D. Prescribe empirical antibiotic and repeat urinalysis 1 week later
E. Wait for urine culture and sensitivity before prescribing antibiotic

Q. A 8 YEAR OLD GIRL, PRESENTED WITH THE THIRD EPISODE OF DYSURIA

AND FEVER AND HAS BEEN TREATED WITH A COURSE OF ANTIBIOTICS IN THE
PAST. HER PREVIOUS INFECTION HAS BEEN UNCOMPLICATED AND
REOCCURED WITHIN 1 YEAR.

WHAT IS THE NEXT STEP OF MANAGEMENT ?

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 A) START ANTIBIOTICS - CEFUROXIME FOR 7 DAYS COURSE
B) PROCEED WITH MCUG
C) OBTAIN A URINE C&S
D) PROCEED WITH USG KUB
E) START ANTIBIOTICS AFTER URINE C/S

Q. 5 years old girl presented with vomiting 1 day ago. She is unable to tolerate food and
drinks. O/E: she is crying with tears, good capillary refilling time. Her temperature is 38
degree celcious. What is your appropriate management?
A. Advise probiotic
B. prescribe antibiotic
C. prescribe ORS
D. reassurance patient and come back on next day
E. refer for admission

Q22. A child with leukemia currently on chemotherapy. He hasa sibling who is

currentlydiagnosed with Varicella zoster infection

Your next management for the leukemic child would be :

A) Admit to ward
B) Isolate patient
C) Give vaccine to patient
D) Give varicella IgG
E) Prophylactic acyclovir

Q31. A 5 yr old girl known case of Asthma complaining of nocturnal cough and wheezing for
2 days. She has been having exacerbation twice a week for 2 months. She is on Fluticasone
50mcg od.

What is the best management?

A. broad spectrum antibiotic for 5days
B. Montelukast
C. change to beclomethasone inhaler
D. change to salmeterol
E. increase dose fluticasone

Q39. 15mth/girl came for developmental assessment.her birth weight is

term,4.3kg,spontaneous vertex delivery. The child required resusitation upon delivery with
the Apgar score: 3(in 1) 4(in 5) 7(in 10).she was given ventilated for 3 days and was admited
to NICU.currently she having global delay developmental(GDD)
what is the likely cause of her GDD?
A: inborn error metabolism
B:
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C: hypoxia ischemic enchepalopathy
D: intracranial Haemorhage
E: meningitis

Q. 4 m/o presented with crying for 2/7. Funduscopy revealed retinal haemorrhage.

What is the appropriate ix?

A. Coagulation profile
B. CT brain
C. UFEME
D. LP
E. Reassure mother

51. 4 yr old presented with h/o fever x 2/7. On inspection noted multiple nodules over post
auricular area with maculopapular rashover neck area.

What is the possible diagnosis?

A. Erythema nodosum
B. Measles
C. Roseola infantum
D. Rubella
E. Scarlet fever

52. 14 year old girl came for primary amenorrhea. The breast was developed however, there
was widely space nipple, with skin folds at neck. Lung and CVS findings were normal.
However, the pulse of the LL was slower than the UL.

What is the most likely diagnosis of this girl?

A. AS
B. MR
C. Coartation of Aorta
D. MS
E. PS

60. 7 Year old girl presented with SOB x 1/7. On examination her BP was 130/90mmHg, zpr
- 72/min, SPO2 94% under RA. There was periorbital swelling and mild pitting edema of foot.
Chest revealed reduced air entry from mid zone to lower zone with fine crepts bilaterally.

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 Urinalysis:

RBC - 3+, Prot - 1+, Nitrate -‘

ve

What was the initial management?

A. IV Furosemide
B. IV Ig
C. Bed rest
D. Oral Nifedipine
E. Spironolactone

61. 3 yr old presented with 1 week history of perianal itching mostly at right side. There is no
fever, vomiting, diarrhea. His weight and appetite was normal.

On examination, the perianal area was red and excoriated. Anal tone was normal.

What is the best management for him?

A. Advice for perianal hygiene

B. Prescribe HCT cream
C. Prescribe anti-histamine
D. Prescribe albendazole
E. Refer SCAN team

Q87. 5 yo boy with walking difficulty, has calf hypertrophy, limb girdle weakness and
waddling lordotic gait
What is the likely diagnosis?
a) Duchenne muscular dystrophy
b) Motor neuron disease
c) Guillian barre syndrome
d) Spinal muscular atrophy
e) --

Q. 18 month old weight at 50th centile. during the next check up she weighted at 25th centile.
she is otherwise a happy child. father is jobless. she has 10 siblings at home.
what is the most likely diagnosis?

A. GH deficiency
B. emotional deprivation
C. inadequate nutrition
D. child abuse
E. (cant recall this option)

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Q86. 6 y.o boy presented with fever for 1 week with multiple joints pain. It started with
lower limb then upper limb. He had history of sorethroat 2 weeks ago.

On examination: Temperature was 39 degree, BP: 120/80, RR: 20. The left elbow was
swollen and tender and presence of multiple subcutaneous nodules on the elbow. There was
multiple erythematous rashes with pale centre on the limbs.

WCC: 12
Hb: 11
ESR: 35

What is the most important treatment?

A. Benzathine Benzylpenicillin
B. Corticosteroid
C. Aspirin
D. Erythromycin
E. NSAIDS

Q. 8 years old, malay, girl. No known any medical illness before. C/O fever for 4 days
associated with headache. No URTI symptom. On examination, not plae, not in respiratory
distress, no bleeding tendency.

T: 37.2%

Bp : 80/64

PR: 80/min

Ix: TWC 3.2, Hb 12.4, HCT 45.2%, Plt 80x10 /L

What is your immediate appropriate management?

a) Reassurance and allow discharge

b) Immediate IV fluid and admit
c) Observe in casualty for 24 hours
d) Prescribe paracetamol
e) To give platelet transfusion

Q 88. 2 year old girl brought in by her parents pale but no jaundice. She has no koilonychia or
angular stomatitis. Abdominal exam showed no hepatosplenomegaly.
Hb is 10g/dlr
Rbc 5.6 (upper limit 5.4)
Mcv 62.6
Mch 20.5
Mchc 32.6
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Ferritin 142 ( upper limit. 200)

What is your most likely diagnosis?

A. anemia of chronic disease
B. hereditary sideroblastosis
C. hereditary spherocytosis
D. autoimmune hemolytic anemia
E. thalassemia trait

Q96. 8 year old boy come with scrotal swelling for 3 days. He also presented with bilateral
facial puffiness, ankle oedema and ascites. What is the most likely diagnosis:

a) Interstitial nephritis

b) FSGS

c) Minimal disease nepjropathy

d) Post strep AGN

e) Membranous nephropathy

Q97. An abandoned newborn baby was brought to you for feeding intolerance. His sucking is
good but will vomit after small amount of milk. His weight is 2.5 kg, appear dehydrated. He
has upslanted eye brow with flat nasal bridge. Abdomen not distended and no mass palpable

What is the possible cause?

a. Biliary atresia
b. Duadenal atresia
c. Pyloric stenosis
d. Intestinal obstruction
e. Intussesception

Q98. 5 y/o came with h/o lip smacking for 10 secs, about 10 times per dy for past for 4
months. Most possible diagnosis is :

a. Absence seizure

b. Benign Rolandic seizure

c.Temporal Lobe seizure

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d. Partial seizure

E. parietal lobe seizure

100. 4 year old child presented with cough and noisy breathing for 2 days. On examination,
she has a stridor and hoarse voice. Pharyngeal wall was erythematous without exudates. CXR
given.

What is the most likely diagnosis?

A. Diphtheria
B. Epiglotitis
C. Foreign body
D. Larygomalacia
E. Croup

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OSCE 1st year part one exam in May 2014

Total 12 stations. each station entitle 10 marks.

1. CVS
- mitral regurgitation
- VSD
-prosthetic mitral valve

2. Respiratory
- bronchiestasis
- lung fibrosis
- pleural effusion

3. Abdomen
- hepatomegaly
- spleenomegaly
- hepatospleenomegaly
-kidney transplant with scar

4. Child developmental assessment ( 6-18months)

5. CNS
- right or left paralysis/ paresis with Right or left CVA

6. Obstetric
- uterus larger than date
- uterus smaller than date

7. MDI technique counselling

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8. Lumbar puncture consent

9. History taking of headache. Dx is medication overuse headache

10. A 21 years old single lady come to you and said that : Dr, I don't want pregnant". She just
had unprotected SI on 3am with her boyfriend. please procede your counselling.
* * hint: counsel ECP, explore history and screen for STD, counsel other contraception
methods

11. You are a medical officer in emergency department. A patient referred from health center.
A 54 years old gentleman with underlying hypertension on antihypertensive medication. He
is not compliance to medication. he complained of headache.
O/E comfortable
BP 160/100mmgh

Funduscopy: hemorrhage .exudates

other systems are normal.

Given Tab Captoril stat before patient coming to hospital.

please procede with your management

**hint( from our university feedback): tell patient need to get admitted. Patient refused.
Explore why patient do not want admit. Management is not just AOR discharge. other
options need to given to patient like:
-observe in ED for 6-8 hours for BP
- check BP in nearest clinic
-TCA day after
-Tell the patient safety net and come stat to hospital if worsening

12. A 35 years old lady comes to review her result. Please procede your counselling and
management

Hepatitis surface antigen positive

Hepatitis surface antibody negative
Hepatitis E antigen negative

LFT
Parameters are normal except ALT mildly raise

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