1) Aim of cardiac cauterization – Gradient or LEDV

2) Young girl Chorea with prolong PR – Rheumatic fever

3) Bifasicular block ECG
4) HOCM ECG
5) Young man with narrow complex tachycardia Rx . Betablocker, Flecanide, Amirodrone
6) Descending aortic dissection CT
7) Heart failure with speckle features- ?Amyloidosis
8) HTN with ACEI and CCB next step – Indapamide, Spironolactone
9) Holiday heart syndrome post heavy drinker night palpiation – Afib, SVT
10) Stable MI investigation – CT Angio
11) Tall guy, low testosterone and murmur – ?Murfan , Gigantism
12) Tall guy with primary hypogonadism – Klineferter
13) Well demarcated facial rash – Strep . Staph
14) Scaly rash after sorethroat – Guttate Psoriasis Rx – UV therapy, Prednisolone
15) Dermato picture with facial rash around middle age -Rosacea / SLE
16) Dermato picture – BCC , Keratoacathosis, Hemangioma
17) Type 2 Error – ?Large sample size
18) Hypercalcaemia with renal involvement – Multiple myeloma
19) Dementia with urinary incontinence – Lewy Body Dementia
20) Teacher from India with night sweats and fever MRI brain was given - ?Tuberculous M
21) Hemoptysis with raised creatinine – ANCA
22) Elderly patient with MMSE 9 – Memantine, Donazepil, Rivastigmine
23) ECG with torsade – IV MgSO4
24) Cardioversion procedure on pacemaker- Recheck pacemaker after procedure
25) Wafarin like poisoning – Coumarin
26) Severe GB with FVC -1.3 and RR 30 – Intubation
27) Prolong fever with rash, and joint pain – Still’s disease
28) Rash and fever after rituximab infusion – Cytokine release syndrome/Hypersensitivity reaction
29) Hemato question with polychromasia - ?PNH
30) Pregnant woman with hyperamniotic fluid – Parvo, Rubella
31) Overactive bladder – Oxybutynin
32) Initial management IIH – PO Acetazolamide
33) Raised glucose and anion gap and ketone 2+- Ethanol. DKA. Aspirin
34) Alcohol abuse – Pseudo Cushing
35) LIF mass with bleeding and raised WCC and CRP – Diverticulitis
36) CT scan with hydroureter- Retroperitoneal fibrosis
37) Post Renal biopsy hematuria next step Mx- ?USG
38) Young girl with BMI 16 and vomiting – Anorexia / Body dysmorphic
39) Venous ulcer picture – Compressive bandaging
40) Pregnancy 16 week with E. Nodosum – Ibuprofen, compression, Topical steroids
41) Lentigo melena Rx – Excision
42) 30 years old man with B symptoms - ?Lymphoma, CA lung
43) CT chest - ? mesothelioma
44) CT chest tumor with spine metastasis pain Rx – Radiotherapy
45) MRI head with left frontal lesion - ? Herpes/ Abscess
46) Painless ulcer with lymphadenopathy – Chlamydia / Syphilis
47) Multiple ring enhancing on CT finding – Toxoplasmosis
48) Alopecia Areata
49) Blood culture resistant to penicillin and erythromycin – Change or add Vancomyin
50) Lumber puncture 2 attempts with RBCs- ?Traumatic LP
51) Chronic smoker Obese man with Obstructive pattern – Emphysema/Obesity
52) DDI packer for sick sinus with no spikes on sinus rhythm - ?No action
53) Acute flare of UC with absent bowel and megacolon – Infliximab/ Surgery
54) Predictor of near fatal asthma- Cats/ Smoking/ Duration of asthma
55) SLE patient with psychiatric symptoms – ?Organic psychosis
56) Carbamazepine question low serum level– Change to brand/ Change Valporate or levetiracetam
57) SIADH with hyponatremia 125 – Fluid restriction
58) ?Pseudo gout with picture
59) Arthritis with anti dsDNA and RO positive – SLE
60) Fever and abdominal pain with pale patch in retina Mx- Malaria film/CT scan/Rickettsia
61) CXR abscess with recent RTA knee injury– Staph
62) Patient with abdominal pain and sweating on antiTB – ?Methadone with rifampicin
63) Hypothermia with Afib 30/min ?PEA – Chest compression
64) Cardiogenic shock – Dopamine/ Dobutamine
65) Unconscious patient with high anion gap & lactate with low BP & HR– CCB toxicity / Sepsis
66) Post Thyroidectomy with raised right diaphragm picture -? Reassure/ USG neck
67) Migraine with aura
68) Facial palsy with forehead sparing - ?Atypical migraine/ Lyme ?
69) Meningitis in pregnancy – Ceftriaxone+amoxiciilin / Ceftriazone and acyclovir
70) Pregnancy constipation – Isphagal
71) Heart failure with increased HR – Add ivabradine/ Increase lasix/ Add losartan
72) Diarrhoea with pus and inflammation below dentate line – HSV/ Crhons
73) Patient with pneumothorax and hypermobile joints- Marfan/ Ehlar danlos
74) Sickle cell with low retic count – Red cell aplasia
75) JAK2 mutation – primary myelofibrosis
76) AF with bleeding per rectum and LIF pain next step- MR for mesenteric / CT for diverticular
77) Hemiparesis on warfarin – SDH / Acute infarct
78) CT head picture- EDH
79) Allopurinol and Azathioprine reaction
80) Alpha 1 antitrypsin type- PIZZ/ PISZ
81) MRCP test for PSC
82) Tacrolimus toxicity with clarithromycin
83) Tonsillitis in carbimazole – check CBC
84) Bitemporal hemianopia – Non functioning ademoa/ Craniopharygioma
85) Painless visual loss with reduced red reflex – retinal detachment/ Viterous/ CRVO
86) COPD for exercise tolerance – Pulmonary rehab/ LTOT
87) Cluster headache prevention – Verapamil
88) CT of bronchiectasis – Postural drainage
89) Jaw stiffness and dog bite – Tetanus/ Rabies
90) Increased IgE and eosinophil with asthma – ABPA
91) Swimming and got liver and renal impairment – Leptospirosis
92) Reactive arthritis – Doxycycline
93) PE with stable BP – LMWH
94) Xray collapsed – Right Middle/ Lower lobe collapse
95) CA breast radiation on methotrexate – Radiation fibrosis / Methotrexate fibrosis
96) Stroke with AF treatment – Rivaroxapan after 2 weeks
97) High Calcium and non cessating granuloma – Sarcoidosis
98) Hepatic Abscess after bloody diarrhea – Entamoeba histolytica
99) Hand tremor improved with alcohol and torticollis Rx – Propranolol/ Botox
100) Hepatitis C with rash – Cyroglobulinemia
101) Right handed woman with flower picture – Right parietal lobe
102) HONK management – 0.9 % NS
103) Na 102 with symptoms and dehydration and seizure – 3% NS
104) Benzodiazepam withdrawal
105) Wernicke encephalopathy
106) Low fecal elastase – pancreatic exocrine deficiency
107) IE with valve <6 months – Vanco + Genta
108) Esophageal carcinoma palliative- stent/Debulking/ Ryle tube
109) Headache with low platelet and hemolysis – TTP
110) Bloody diarrhea together with students – Campylobacter/Norovirus/Yersinia
111) Proptosis with normal TFT and anti tPO positive- ? Dysthyroid
112) Diarrhoea on thyroid – ?Secretory diarrhea
113) Young hypertension resistant treatment – Renin:aldosterone/ Urine Cortisol
114) Multiple myeloma RTA with low phosphate level – Proximal RTA
115) Another one with renal stones- Distal RTA
116) Post RTA with honor syndrome – MRA head and neck
117) Acoustic neuroma and meningioma – NF type 2 / TS
118) Tongue bite and thrown out and shivering hands – Partial / GTC seizure/ Syncope
119) Anal sex with HIV man with anti HBc +ve Rx – HARRT/ Hep B vaccination / No action
120) PCOS with Hirsutism - COC / Metformin
121) ESBL Rx – Meropenam
122) SAH complication – Hydrocephalus
123) Hyperventilation ABG – answer E
124) Chemo increased risk of cancer – AML/ Melanoma
125) ?MODY treatment – Gliclazide/ Insulin SC or IV
126) DM eye – Neovascularization picture
127) Abdominal pain relieved by defecation – No further investigation
128) Temporal scalp tenderness and DM with sudden loss of vision – AAIO/ CRVO
129) Primary carcinoid lesion – Ileum
130) Pregabalin – check eGFR
131) Pregnancy contraindication – ACEI
132) High FSH LH with amenorrhea- Premature Ovarian syndrome
133) Skin. Liver and Gut involvement – GVHD
134) Dyslipidemia with CVD risk <8 % - Lifestyle / Statin
135) High lipids including LDL and TG- Statin
136) CKD with renal scarring – Reflux nephropathy
137) Adrenaline emergency route – Intraosseous
138) Incontinence scan – Post Micturition scan/ PSA/ Urodynamic
139) Overactive bladder – Oxybutynin
140) Bipolar with increased water intake – Nephrogenic/ Primary Polydipsia
141) Woman with 6 month baby -Post-partum thyroiditis
142) CT brain with NPH – Shunt
143) Levofloxacin taking and ankle erythema and pain – Achilles tendonitis
144) Dizziness worse on head turning – BPPV
145) Muscle pain with irritable bowel – Fibromyalgia
146) QTC prolongation – Ondansetron
147) Amyl nitrate usage and SP02 90 % with PaO2 – 11.2- Methemoglobinemia
148) Padget disease treatment – Zolendronic acid / Calcitonin
149) Fever with Eschar – Doxycycline
150) Picture with buccal and lip pigmentation test- Short Synacthen
151) Diabetic amyotropy and sensory pain with mildy raised CK Rx – Duloxetine/ predisolone
152) Hand grip weakness and swallowing problem – IBM/ MND
153) Inclusion body finding Rx – Vanciclovir
154) Fresh blood on paper with Painless rectal bleed – Hemorrhoids / Angiodysplasia
155) Low iron with ferritin 300 Rx – Iron/Epoietin/Pyrodoxin
156) Anti RNP positive – MCTD
157) Chest Xray with mixed tube- NG tube
158) Pancreatitis – ARDS
159) Left limb pulseless – Takayasu
160) RA with obstructive spirometry – Bronchiolitis obliterans
161) Milky white pleural effusion –test- Triglyceride (chylous)
162) Gonorrhoea Rx with penicillin allergy – Cipro/ Doxy
163) Pneumonia with reduced PaO2 and bilateral infiltrates- PCP
164) ?procedure with platelet 60 – Tranexamic / FFP / Platelet
165) CT head with fever and increased CRP –? Cerebral abscess/ Glioma
166) Malena High INR with bleeding – dried PCC
167) Sleep apnea – Polysomnography
168) Flow volume loop problem – Psychiatric assessment/Nasogastric scope
169) Morphine breakthrough dose – 30 mg
170) Hepatorenal syndrome – Albumin and terlipressin
171) Gonococal with mild skin rash after 5 days of oral penicillin - ?test dose/full regime
172) Ileum resection and diarrhea – Cholestyramine
173) Alcohol history but increased ALT and hyperecho liver- NASH
174) Buttock and thigh pain with normal ABPI – Aortic angiogram
175) Hospital acquired pneumonia Rx –Amoxi+Ceft/ PTA
176) Liver prognosis test- PT/ AFP