CONJOINT EXAM PART II SBA (AM and PM) APRIL 2016(UKM-UM-USM-UITM-UIA-UPM)

Hi..thank you for your co-operation. Hope this compilation benefit to everyone. Good luck
for exam..

Q2) 35yrs old lady c/o anterior neck swelling. She has heat intolerance. She had fever and
URTI recently. On examination palpable tender goitre. No other cervical lymphadenopathy.
Results of TFT given - TSH low, FT4 and T3 high.

What is your management?

a) Repeat TFTs
b) Start Carbimazole
c) Send thyroid autoantibodies
d) Give NSAID
e) Give antibiotic

**answer is NSAIDs to treat thyroiditis.

Q 8. An 18 months old child having intermittent severe abdominal pain for the past 6 hours.
He had 1 episode of passing out red bright stool. There was no fever, no URTI sx/ vomiting
or diarrhea.

On examination, T:37.2, PR 118, RR 24. Current weight 11kg. Child not dehydrated.
Abdomen soft,Bowel sound normal, no mass palpable. Other system unremarkable

What is the most appropriate investigation?

A- Barium enema
B- Plain abd Xray
C- Stool culture + sensitivity
D- Stool ova and cyst
E- Ultrasound abdomen

4. 45yo women, c/o epigastric pain. Scope noted gastric ulcer and positive for H. Pylori.
What is your management?

A. bismuth+clarithro+amoxy+PPI
B. cephalosporin+amoxy 2wks+PPI 4wks
C. cephalosporin+flagyl 2wks +PPI 4 wks
D. Clarithro+amoxy 2wks +PPI 4wks
E. levofloxacin+amoxy 2wks + PPI 4wks

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Q9) G5P4 at 34 weeks gestation. Her scan 2 weeks ago showed transverse lie, with normal
AFI, and placenta is at upper segment. Today her USS showed longitudinal lie with breech
presentation.
What is your management?
a) Plan for elective C-Section
b) Arrange for external cephalic version
c) Allow breech delivery
d) Repeat USS in 1/52
e) Admit the patient

**post exam, we discussed with Dr Tan (HUKM), answer is repeat ultrasound in 1 week
time.

Q13. 32 year old gentleman presents with sort throat, fever, cough and hoarseness of voice
for 5 days.

On examination, temp 38.5 degrees Celsius, bp 130/80, hr 90 bpm. Noted cervical

lymphadenopathy. Below is throat examination( this one I search from internet, the real
picture in exam is so blur)

What is your best management for this patient ?

A. Admit for iv antibiotics

B. Admit for surgical intervention

C. For oral augmentin

D. For oral penicillin

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 E. For nsaids prescription

**post exam, we discussed with Dr Syahnaz (HUKM), answer is quinsy, refer for surgical
intervention.

Q 11) 30 years old primigravida asked you regarding meningococcal vaccination as she plans
to go to umrah next month.

What is your best management?

A) Administer vaccination today.

B) Advice to delay the trip until delivery.
C) Go to umrah without vaccination.
D) Chemoprophylaxis.
E) Refer infectious disease specialist.

11. 23yo, LMP 7 weeks ago. Presented with abdominal pain and suprapubic pain. History of
D&C done 4 weeks ago. OE febrile, abd tender at suprapubic region, T 38, speculum; foul
smelling blood discharge. Bimanual examination showed parametrial tenderness. What Is
the most approriate management?

A. HVS swab
B. Start oral antibiotics
C. Refer hospital
D. repeat the ultrasound
E. x ingat

12. A 56 years old gentleman who has hypertension and DM jst diagnosed with heart failure
1 month ago and discharged from ward with T. Clopidogrel 300mg OD, T. Metformin 1g BD,
s/c Insulatard 10u ON, T. Lovastatin 20mg ON, T. Frusemide 40mg OM and T. Perindopril
4mg OD. Patient is currently asymptomatic and stable.

O/E BP: 130/85, PR: 86 beats per minute. Lungs has bibasal crepts.

HbA1C 7.5%

LDL 2.7, TG 1.3, HDL 1.2

What is the most appropriate management

A. Increase insulatard

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 B. Change lovastatin to atorvastatin
C. Increase perindopril
D. Reduce frusemide
E. Start bisoprolol

Q 14) 78 years old man presented with intermittent epigastric pain for the last 6 months. It
is worse after meal and night. Associated with nausea. He has been diagnosed having DM x
6 months ago and was started on Metformin. He also has LOA and LOW 5kg in 1 month.
Physical examination reveals no significant findings.

What is the most appropriate management at this stage?

A) CT abdomen
B) USG abdomen
C) Start PPI
D) Refer for OGDS
E) Withhold metformin & monitor

**post exam, we discussed with Prof Tong (HUKM), answer is OGDS. Think of
commonest 1st, the common malignancy is gastric cancer. It cant be pancreatic cancer
because when people develop late onset diabetes mellitus unless the whole pancreas is
gone, so unlikely pancreatic cancer in this scenario.

Q 15. A 42 y.o man c/o numbness and pain over his left lower lim for 2/12. He has been on
Lamivudine, Starvudine, and niverapine for 5 months

O/E : There is loss of sensation over the lateral aspect of the left lower limb.

CD4 count 440

Viral load undetected

What is the next appropriate management?

A. Give amitryptylline
B. Start Gabapentine
C. Stop lamivudine
D. Stop Starvudine
E. Stop Nevirapine
**Post exam, we discussed with Dr Syahnaz (HUKM), answer is stop starvudin because this
drug cause peripheral neuropathy.

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Q 15. 54 years old, female, with underlying diabetic mellitus complaint of gradual worsening
of right shoulder pain for few months. She has difficulty to dress herself and combing the
hair. She has tried taking sodium diclofenac to relief the pain but not resolved.

Hba1c: 6.5%
o/e: Right shoulder: reduced active and passive range of movement of right shoulder.

What is the next management of the patient?

a) IM triamcinolone
b) Ketoprofen patch
c) Ultrasound therapy
d) Oral prednisolone
e) TENS

Q16. 54 years old lady presented with right hand numbness for 2 years.

The pain has become worst lately and wakes her up at night. She has difficulty to grip and
unable to do household chores.

O/e: there is flat thenar muscle

Nerve conduction test: positive for median nerve compression

What is the best management option?

A. Inject steroid
B. NSAIDS
C. Surgery
D. Ultrasound treatment
E. Wrist splint at night

Q 18) 48 years old man complained of intermittent chest pain for 6 months associated with
meals and activities. He is a smoker. BMI is 28 kg/m2. BP – 140/80, PR – 85, SpO2 98%.

What is the most appropriate management at this point?

A) UGI endoscopy
B) Angiogram
C) FSL
D) Echocardiogram
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 E) PPI

Q 20. 55 year old gentleman presents with reduced hearing in his left ear for 1 month after
experiencing a urti one month ago. He also has left nasal block and occasional bloody nasal
discharge.
He has no ear pain, tinnitus or ear discharge.
On examination, otoscopy revealed bubbles behind a dull left tympanic membrane.Anterior
rhinoscopy was normal.there was a single enlarged cervical lymph node. Rinne test was
negative on the left side and weber lateralize to the left. Other examinations were normal.

What is the most appropriate investigation you would do at this stage?

A. FNAC of the cervical lymph node

B. MRi of the head and neck
C. Nasal endoscopy
D. Pure Tone audiometry
E. Tympanometry

Q 22. 30 years old, female, presented to your clinic with a complaint of headache, shoulder
pain, multiple joint pain and abdominal pain for many years. She also complained of
difficulty in climbing the stairs due to weakness of lower limbs. She has visited to many GP
but was told her investigations were normal.

o/e: kempt MMSE: normal.

What is the most likely diagnosis of the patient?

a) Conversion disorder
b) Somatisation disorder
c) Fibromyalgia
d) Depression
e) Hypochondriac disorder

Q23: A 50 years old man complaining of chest pain since 3 hours ago. This is the first
episode and associated with shortness of breath and palpitation. He took sildenafil last
night.

On examination, he is alert, conscious and in pain.

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BP: 140/90

PR: 100

ECG: ischemic changes at anterior leads.

What is the best next management for this patient?

A. Bisoprolol
B. GTN
C. Heparin
D. Morphine
E. Perindopril

Q24) 30-years-old gentleman presented with persistent nasal congestion with yellowish
discharge associated with cough and runny nose for 10days. He has uncontrolled allergic
rhinitis. He was prescribe T.amoxycillin for 3 days but with minimal improvement.

On examination, BP 120/70, PR 80, T 37.8. Noted maxillary sinus tenderness.

What is the most appropriate management at this stage?

A) Prescribe nasal saline irrigation

B) Change to T. augmentin
C) Prescribe intranasal steroid
D) Prescribe topical decongestant
E) Refer for antral washout

Q25.10 year old boy came to you complained fever, myalgia and headache for 4 days
duration. He started to have vomit and diarrhoea today. He has no other symptoms. He is
taking orally well.

On examination

He is pink, no jaundice, and conscious. No sepsis looking

Hydration status good, CRT <2 seconds

BP: 100/70mmHg

PR: 90bpm

RR18 breath per minute

T: 37.5

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Lungs clear. No hepatospleenomegaly

Investigation as below

WBC 3, Hb 11, Hct 47%, NS1 antigen negative

What is your most appropriate management at this stage?

A. Admit the patient

B. IV normal saline bolus
C. Give IV maxalon
D. Repeat FBC coming morning
E. Advice to increase oral intake

48 year old rubber tapper came to you and complained he feels there is something flied into
his eyes. Otherwise he has no other symptoms.

On examination, the conjunctiva is red. Pupils reactive, red reflex present. Both eyes visual
acuity 6/6.

What is your most appropriate management?

A. Apply eye pad

B. Put on flurosceine stain
C. Put on topical steroid
D. Put on topical lignocaine
E. Normal saline eye irrigation

A 35 year old lady came to clinic for health check-up. She has no other medical illness. She is
well and healthy, no acute complaints. She revealed her mother was diagnosed breast
cancer at age of 55 years old.

What is your most appropriate screening test for her?

A. Mammogram
B. Ultrasound
C. MRI breast
D. Mammogram and ultrasound of breast
E. Annual clinical breast examination

**Post exam, we discussed with Prof Tong (HUKM), answer is mammogram and
ultrasound. The positive predictive value is higher compared to ultrasound or
mammogram alone, in Malaysia MRI not yet so feasible.

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52-years-old man had been diagnosed to have advanced lung carcinoma. He has syrup
morphine 15mg 4 hourly for pain management with syrup morphine 10mg PRN about 2-3
times per day for breakthrough pain for the last 1 week.

What is your appropriate management at this stage?

A) Add Celebrex
B) Change to fentanyl patch
C) Increase regular syrup morphine
D) Increase breakthrough syrup morphine
E) Change to morphine sustained release

**post exam, we discussed with Dr Tan (HUKM), answer is increase regular syrup morphine,
even though patient already on regular morphine, but he is still having pain and
breakthrough pain morphine usage. Morphine has no ceiling dose. How to increase his
syrup morphine in this scenario? ([ 15x6=90mg] + 3 episode breakthrough 10x3=30mg] total
is 120mg per day , then divide into 6, so increase syrup morphine to 20mg 4 hourly.

Q35) 54yrs old man presented with confusion and unable to stay focused. No known
medical illnesses. Has hx of chronic alcohol intake for more than 10 yrs. On examination pt is
confused, has ataxic gait. T 36.7 BP 110/60 PR 90. Other examinations are unremarkable.
What is the most important investigation?
a) CT Brain
b) B12 level
c) TFT
d) Urine for drug screening
e) Urea and electrolytes

Q45) a mother brings her 3yrs old son to clinic. He was delivered at home and did not
receive any immunizations. He was also recently treated as nephrotic syndrome with
corticosteroids 4 weeks ago. Now the mother wants his son to get immunized. What will
you give today?
a) BCG
b) MMR
c) Pentavalent DTAP/Hib/IPV
d) Rotavirus
e) Varicella Zoster

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A 15 year old boy, diagnosed Type 1 diabetes mellitus , he has no target organ damage. He
is on subcutaneous mixtard 10u in morning, 14 unit in evening. Recently, he joined his
school football activities and going for competition. He complained of frequent
hypoglycaemia symptoms post excersise.

His sugar monitoring showed pre breakfast range 5-7mmol/L, his pre dinner blood sugar
range 9-11mmol/L.

What is your most appropriate management for him?

A. Reduce morning mixtard dose

B. Reduce evening mixtard dose
C. Change to basal bolus regime
D. Advice post exercise snack
E. Give glucagon

**post exam, we discussed with Prof Tong (HUKM), answer is advice give snack post
exercise. The best management should be check sugar prior the exercise and give small
snack prior exercise.

4 years old boy brought by mother noted squinting on and off. Right eye were noted to have
inward deviation at times. Red reflex present. Vision acuity showed right 6/24, left 6/12, PH
both eyes 6/6.

What is your most appropriate management?

a. refer ophthalmology
b. corrective surgery
c. corrective lenses
d. prism adjustment
e. ?

7 years old boy is brought in by his father with complaint of inability to focus in class.

His class teacher complaint that he likes disturbing other students in class.

His mother claims that his behavior is also the same at home, and she also notices that he is
more active as compared to his siblings.

He is unable to obey command.

Examination reveals the boy to be fidgety and he touches everything in the clinic room.

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He is unable to recognize numbers or alphabets yet.

What is your management?

A – Refer for psychological assessment

B- Send to special school

C- Start pharmacological therapy

D – For behavioral therapy

60 year old man with underlying DM and HPT came enquiring regarding need for testosterone
therapy.

He has no sexual dysfunction. Physical examination is normal.

He had done a blood test in GP. Results are as below:

Total testosterone : 9.4 (Normal > 10.4)

What is your next management?

A- Repeat serum testosterone

B- Send free testosterone

C- Reassure that this is not testosterone deficiency syndrome

D – Consider testosterone therapy

20 years old, male, come with restless, agitation for 2 days. He keep on brushing his thigh
and say “ there is spider crawling on me”. O/E : flushed, sweaty. BP : 150/90, PR : 100,
regular. What is the most likely cause :
A. barbiturate intoxication
B. cannabis withdrawal
C. cocaine intoxication
D. heroine overdose
E. glue sniffing
** answer is cocaine intoxication after discussion

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32 years old, G2 P1 at 12weeks POA, complaint left leg pain on prolonged standing. The pain
is felt over her medial calf, where she has prominent tortous veins

On examination: BMI : 35, tortous dilated superficial veins over her left medial calf with
oedema up to her left knee. What is the most appropriate treatment for this patient:

A. injection sclerotherapy
B. oral daflon
C. surgical treatment
D. use compression stockings
E. weight loss

A 35 year old gentleman comes to clinic and complained of he has difficulty in erection. His
wife started not happy with their sexual life. Further history noted he has weak morning
erection. He also claimed he is stress recently for his work. He has no significant medical
illness.

On examination, medium built body. Vital signs normal. Systemic examination including
genitalia examination are normal.

What is your best treatment for him?

A. Give testosterone hormone supplement

B. Give phosphodiesterase 5 inhibitor
C. Refer for stress management
D. Refer for marital therapy
E. Refer sexual counselling

**post exam, we discussed with Prof Tong (HUKM), answer is B.

40 year old lady comes to you and complained discoloration of her fingers especially when
she expose to cold. She also complained of painful over her fingers. Otherwise she has no
other systemic symptoms.

On examination, she is pink. Systemic examination are normal.

Below is her both hand examination (this picture I search from internet, but in real exam
picture is so blurred)

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What is your best diagnosis?

A. CREST syndrome
B. Rheumatoid arthritis
C. SLE
D. Scleroderma
E. Marfan syndrome

**post exam, we discussed with Dr Syahnaz (HUKM), answer is scleroderma)

46. 28 years old, Para 3 come to your family planning clinic for advice. She is on Mercilon 21.
Ten days ago she has missed her first two pills of the starter pack. She continue subsequent
pills. She has sexual intercourse 2 days ago. What is the most appropriate management?

a. Continue current pack and continue pill free period.

B. Continue current pack and continue condom
C. Continue current pill and ..(don’t remember)
D. (don’t remember..)
E. Prescribe emergency contraceptive pills.

47. 10yo boy brought by mother for immunization. He has underlying Nephrotic syndrome
on T prednisolone 5mg od stop 2 months ago. He was born at home, bothe parents refused
immunization during childhood before. What immunization are you going to give today?

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 A. BCG
B MMR
C. pentaxime
D. rotavirus
E varicella

A 43 years old gentleman complains of severe right flank pain for the past 3 hours. The
pain did not resolve with oral diclofenac which he usually takes for his gouty attack
previously. He had similar pain last week which resolved after he was given IM diclofenac by
his GP. No history of trauma prior. No fever or vomiting

O/E he is distress in pain. BP 130/90. Abdominal examination reveals tenderness over right
flank but no mass noted.

UFEME: RBC 2+, Prot 2+, Leu and nitrite –ve

What is the most appropriate immediate management management for the patient at this
point?

A. IM diclofenac
B. Ultrasound KUB
C. Xray KUB
D. Urine C+S
E. Renal profile

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 Below are SBA questions in April 2016 exam as well, the questions below were provided
by our UM candidate(Azam), he is so great and remember almost 70 questions by his
memory.

1. Osteoporosis FRAX score 13%. Hip of femur T score 2.8. No family history of
osteoporosis or pathological fracture.
A) Calcium supplement
B) Strontium
C) Bisphosphonates
D) Raloxifene

2. 8 month old baby with diarrhoea. Good hydration and moist oral mucosa
A) ½ the formula milk
B) Oral rehydration salt
C) Admit hospital
D) Probiotics
E) Oral diosmectite (SMECTA)

3. 36 years old. Para 2, PV spotting. Normal menstruation. No dyspareunia. No

dysmenorrhea. No menorrhagia. Pap smear done 3 month ago was told normal. O/E
No discharge. Cervix look redness. No foul smelling. No growth
A) Cervical dysplasia
B) Cervical cancer
C) Cervical ectropion
D) Cervical polyps
E) Cervicitis

4. Patient with epigastric pain and melena. What next most important management?
A) Full blood count stat
B) Intravenous line
C) Hydration
D) Group and crossmatch
E) Admit hospital

5. HIV patient on Stavudine, Lamivudine and Nevirapine having neuralgic pain. What is
your management?
A) Give Gabapentin
B) Give Tricyclic antidepressant
C) Off Lamivudine
D) Off Starvudine
E) Off Nevirapine

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 6. Patient on intensive phase anti PTB, presented with gouty arthritis. Uric acid 800.
A) Give Colchicine
B) Give Aspirin
C) Off Pyrazinamide
D) Off Ethambutol
E) …………………….
7. 36 years old with LOW, tiredness, oral ulcers, photosensitivity rash and multiple joint
pain. O/E knee joint pain, tender and swollen. FBC- low Hb, low PLT. How to confirm
diagnosis. What is the best investigation?
A) Complement
B) Rheumatoid factor
C) ESR
D) P…..
E) Urinalysis

8. Photo. Herpes labialis. Treatment?

A) Antifungal
B) Antibiotics
C) Antiviral
D) …………..
E) ……………

9. Photo. Tinea versicolor/ Pityriasis Alba.

A) Hydrocortisone and miconazole
B) Clindamycin
C) ……………..
D) …………….
E) …………….

10. ECG: Tall tented T wave. Hyperkalaemia. What to do next?

A) Electrolytes
B) Troponin T
C) ………………
D) ……………..
E) ……………..

11. UV prolapse
A) Surgical management
B) Ring pessaries
C) ……………………
D) …………………..
E) ……………………

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 12. Colle’s fracture. Best treatment for it?
A) Casting
B) Close reduction and external fixation
C) Operation
D) …………….
E) ……………..

13. Carpal tunnel syndrome with thenar muscle wasting. C/o night time neuralgia. Best
treatment?
A) Splinting
B) Surgical
C) Steroid injection
D) Gabapentin
E) ……………….. (painkiller)

14. Frozen shoulder with underlying DM. Limited movement of frozen shoulder. Best
treatment?
A) Intraarticular triamcinolone acetonide
B) Celecoxib
C) U/s therapy (physiotherapy)
D) Cold patch
E) ……………………

15. 4 years old with lazy eyes/ strabismus. Hirschberg test showed esotropia. Patient
have refractive error. Best treatment for the eye?
A) Refractive error correction lens
B) Prism
C) Botulinum toxin
D) Surgical
E) Refer eye team

16. Photo. …….. with eyelid stye/ chalazoin. Best treatment?

A) Incisional and curettage
B) Hot compression
C) Antibiotic eyedrop
D) ……………………
E) ………………..

17. 26 years old footballer. Sustained injury with popping sound while playing football.
Knee giveaway much worse on going downstairs. O/E knee swollen. Tender
at ?median joint line. Anterior drawer test negative. Mc murray positive. Most likely
structure involve?
A) Median meniscus

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 B) Lateral meniscus
C) Anterior cruciate ligament
D) Posterior cruciate ligament
E) ……………………

18. Patient with lower abdominal pain and scrotal swelling. Having difficulty to urinate.
Need to strain to urinate. Each time strain will develop scrotal swelling. O/E
reducible scrotal swelling. Non tender. Prostate enlarge and smooth. What is the
best treatment?
A) Give alpha blocker Prazosin
B) Give alpha blocker Doxazosin
C) Refer surgery – early
D) Refer surgery – emergency
E) Refer surgery – elective

19. Post cataract surgery. Lift up something heavy. Having pain and blurring vision. O/E:
steamy and congested cornea. Diagnosis?
A) Endopthalmitis
B) Lens subluxation
C) Corneal edema
D) Acute close angle glaucoma
E) …………………………

20. Photo. Hand with sclerodactyly

A) Scleroderma
B) CREST
C) SLE
D) Rheumatoid arthritis
E) Sjogren syndrome

21. Patient with URTI. Had rash and abdominal pain. Rash at lower limb. URFEME: RBC,
cast and protein. What is next?
A) Renal function test
B) Ultrasound kidney
C) …………………………
D) ………………………..
E) …………………………

22. Lady with thrombocytopenia, took painkiller. PLT low

A) Drug induce thrombocytopenia
B) Idiopathic thrombocytopenia
C) ……………………..
D) ……………………

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 E) ……………………..

23. Develop Cushing features. Purpleish striae. What is the best test?
A) Urine 24 hours cortisol
B) Morning serum cortisol
C) Morning plasma ACTH
D) …………………..
E) ………………………

24. Lady with right temporal headache. Extremely in pain. Best treatment?
A) Carbamazepine
B) Gabapentin
C) Oral corticosteroid
D) ……………
E) …………….

25. 26 years old lady with foul smelling discharge. Monogamous relationship. Treatment
for bacterial vaginosis?
A) Miconazole pessary
B) Azithromycin
C) Doxycillin
D) …………….
E) Metronidazole
26. Patient who missed pill 2 days earlier 10 days back. Had unprotected sex 3 days ago.
What is your advice?
A) Continue pill as usual
B) Discard and start a new one
C) Continue pill as usual, omit free period pill
D) ……………….
E) ………………

27. History of stone. Presented with renal colic. Took IM injection last week. URFEME
RBC ++. What is the best investigation?
A) Ultrasound KUB
B) Renal function test
C) ………………
D) ………………
E) …………….

28. Eyelid oedema and redness. Palpable lymph node post auricular. T: 37.5. No sticky
eyelid
A) Admit
B) Give topical antibiotics

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 C) Give oral antibiotics
D) …………..
E) …………..

29. Pregnant 26 weeks POA. BP 170/90. Headache. URFEME: protein 2+, leg oedema.
A) IV Labetolol
B) IV Magnesium sulphate
C) Oral antihypertension
D) Monitor serial BP
E) ………………..

30. 56 years old. HPT/IHD . LDL 2.9. on amlodipine, perindopril, aspirin, statin 40 mg
A) Increase antihypertension medication
B) Change to atorvastatin
C) Change to ARB
D) …………..
E) ……………..

31. Jaundice and splenomegaly. Retic raised transaminase

A) Cold agglutinin
B) Coombs test
C) ………….
D) ……….
E) ……….

32. Pregnancy related. Known case of epilepsy on carbamazepine. Lately has recurrent
of fits
A) Increase carbamazepine
B) Change to Lamotrigine
C) Continue the same dose
D) Don’t encourage to pregnant
E) Administer folic acid

33. 22 weeks POA with hyperthyroid on carbimazole 10 mg od. 1st trimester T4 30  24.
TSH 0.1  3
A) Continue carbimazole
B) Increase dose carbimazole
C) Change to PTU 100 mg OD
D) ……………
E) …………..

34. Type 1 DM on premix insulin. SMBG morning 5-8, evening 7-9. Playing football.
Frequent hypoglycaemia at 10 am

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 A) Reduce pre-breakfast dose
B) Change to basal bolus
C) Encourage meal after exercise
D) ………………
E) ………………….

35. Palpitation. Conscious, presence of carotid bruits. Previously well. ECG:

supraventricular tachycardia.
A) IV Verapamil
B) Cardiac synchronization
C) IV Adenosine
D) IV Amiodarone
E) …………..

36. Pneumonia. Came to you with cough and fever. Completed one course of antibiotic.
What next antibiotic most appropriate?
A) Augmentin
B) Azithromycin
C) Ciprofloxacin
D) Cephalosporin
E) ……………

37. Flare of joint pain at right knee. Recent URTI. ESR normal
A) Reactive arthritis
B) Transient synovitis
C) JRA
D) ……………
E) ……………

38. Precocious puberty. Enlarge breast no menses. What investigation to take?

A) LH
B) Serum oestradiol
C) Testosterone
D) Growth hormone
E) ………………
39. Patient with lung cancer. Unable to PU. Hypocalcaemia/hypokalaemia/hyponatremia

40. Pregnant lady wanted to go Umrah. Vaccine meningococcal ACWY

A) Go umrah after delivery
B) Give the vaccination
C) ………….
D) …………..
E) …………….

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 41. Vaccine safe to be given for nephrotic patient on corticosteroid
A) Measles
B) Mumps
C) Rubella
D) DTaP
E) Hepatitis B

42. Patient on combivent

A) Add ICS
B) Add ICS +LAMA
C) ……….
D) ………….
E) ………….

43. Work in factory, smoker. Best investigation?

A) CXR
B) Sputum AFB
C) Spirometry
D) ………
E) ………….

44. Ear discharge. No tinnitus. No loss of balance. No fever. Otoscope: perforated TM

A) Topical antibiotics
B) Steroid
C) Tymphanoplasty
D) …………
E) ……………

45. Patient have hypertension. Regular check BP. Unable to sleep at night
A) Prescribe sleeping pill
B) Start SSRI
C) Refer psychotherapy
D) Sleep hyegiene
E) ……………

46. 1 month post-natal mother. Not enough breast milk. Feeling low/depressed,
psychotic, did not hurt baby.
A) Start SSRI
B) Aprazolam
C) Cognitive behavioural therapy
D) …………
E) …………..

PREPARED BY HUKM 2016

 47. Post stroke. Came for followup. On amlodipine, aspirin
A) Start ACEI
B) ………
C) ……….
D) …………
E) …………

48. IVDU with fever. Subcutaneous nodules. Investigation: Blood culture 3 spots,
ASOT/ESR

49. Abdominal distension. Both lower limb swelling. URFEME 2+ protein. Best
investigation for nephrotic syndrome? 24 hrs urine protein

50. Paediatric case, poor capillary refill, temperature high, RR: 40, septic shock. Medical
management:
A) IV Benzyl penicillin
B) Sub PCM
C) Iv hydration

51. Cocaine abuse

52. Organophosphate poisoning management: atrophine

53. Post herpetic neuralgia

A) Carbamazepine
B) Gabapentin
C) Painkiller

54. Patient started on SSRI :

A) Add benzodiazepine
B) Add alprazolam

55. ADHD features

A) Start medication
B) Refer psychiatric assessment

56. Quinsy management

A) For surgery
B) IV antibiotics
C) Urgent tonsillectomy

PREPARED BY HUKM 2016

 57. Encephalopathy  give thiamine and check serum B12
58. OGTT, DM , obese  orlistat vs metformin
59. Gout, DM, CKD  celebrex vs indomethacin or colchecine
60. Foot ulcer: silver alginate dressing

61. Hospis  patch vs sy morphine

62. T: 38.5, Fever D1, injected pharynx, Hyperaemic tympanic membrane, no discharge.
Child is well:
A) Sy Ibuprofen
B) Sy Amoxicillin

63. Pap smear x 1 normal. ASCUS +LSIL. HPV –ve: Repeat pap smear 6 month

64. 12 weeks vomiting. Loss of weight 5 kg. Ketone 2+, UPT +ve.  admit for hydration

65. Baby with features of congenital hypothyroidism

66. Married. Para 2. Dysmenorrhea. Regular menses:

A) COC
B) Danazol
C) GnRH antagonist

67. Diffuse thyroid painful thyroid nodules:

A) T4/TSH
B) Start RAI
C) Send APO antibody

68. Premenopausal , hot flush, palpitation: HRT, Calcium

69. Acne
70. Blood donor, Hep B, Hep C, HIV neg  repeat HIV/Hep B and Hep C in 3 month

PREPARED BY HUKM 2016