17 March 2018, Bangalore ( India ) Recalls

#Trial Q

1. Melanoma eye pic --- Refer to Plastic Surgeon

Exactly this pic

2. baby after 6 hours of delivery develops jaundice. Asking Cause

A) Neonatal sepsis

B) Hemolytic anemia

C) Beast feeding

#Exam Q
#New Q
1. 38yrs old female presented with ascending weakness from distal to proximal in lower limbs &
decreased lower limb reflexes + weakness. Asking diagnosis.
A. Multiple Sclerosis –
B. Transverse Myelitis
C. MND
D. Inflammatory ….. ( sorry, forgot the name )
E. Myasthenia Gravis.
( No option for GBS )

2. About 30 yrs old male, presented due to pain in the arm, few days back, he had injury in the
trailbike, post surgery. Now c/o severe pain & skin MOVING away ( looked like gas gangrene
scenario ). WBC : 38, Plt : 560, Febrile. After Antibiotics, what next appropriate step you will take?
A. CT of arm
B. X-Ray of arm
C. Surgical debridement
D. Hyperbaric O2

3. Elderly lady, presented with confusion, dizziness. She was on vacation for 3 months, her meds got
over so didn’t take it for last 2 weeks. Was on multiple drugs like Hydrochlorothiazide, perindopril &
some more….. Labs given. Na: 130, K : 5.2, Glucose : Low Normal . Wat is the cause of her
presentation?
A. Dehydration
B. Hyponatremia
C. Hypocalcemia
D. Hypoglycemia

4. #AF ECG- CHADS Score

 72yrs old male patient known case of DM, HTN, on meds, presented with dizziness, pulse irregular .
ECG given of AF ( can identify AF ). Vitals Stable. What medication to give?
A. Warfarin
B. Aspirin
C. Metoprolol.

5. Man healthy, presents with swelling on right side of neck, no other symps. O/E swelling on right
supraclavicular area, mobile, firm ( No Pic ) . What is next Inv?
A. FNAC
B. Bronchoscopy
C. Gastroscopy
D. CT Head

6. 70 yrs old Italian lady, admitted with Jaundice. Son thinks she has Ca, calls to meet the Dr. urgently &
tells not to reveal the diagnosis to the mother. What will you do in this situation?
A. I can’t agree to family requests
B. Tell the patient a different diagnosis
C. Involve other family members.
D. Inform the hosp ??defence dept
E. Ask your colleague to speak to pt

7. 35 yrs old male pt, known case of Schizophrenia, well controlled on meds since last 15 yrs, admitted
due to some injury, needs operation. But pt refused. What is the appropriate step?
A. Take informed consent
B. Autonomy
C. Go ahead with the surgery

8. 81 yrs old female wants to change her will, MMSE was 20 or 24, but daughter told her that she cant
change due to her memory impairment. Dr. checked her MME, showed mild memory impairment,
same as before, No changes in MME. What will you advise her?
A. You can change the will
B. you should speak to your lawyer about it
C. You can’t change the will
D. Refer to Neurophysiologist/ Neurologist for review

9. 50 yrs old male, presented with sudden retrosternal chest pain & severe vomiting proceeded by
pain. He has hypertension & controlled with thiazide. O/E, dullness over the lower left lung &
reduced breath sounds on left lower zone of lung ( no pic, only scenario given ). Which of the
following inv to reach the diagnosis?
A. CT Abd
B. Gastrogaffin
C. Ultrasound
D. Echo
E. Chest Xray

10. Female presented with c/o fear, anxiety, was on diazepam 20mg mane. Stopped diazepam few days
back. What to give now?
 A. Diazepam
B. Naloxone
C. Flumazenil

11. Scenario of borderline personality, female separated from boyfriend, gets angry & fights in office.
What in h/o will lead you to diagnosis?
A. h/o self harm
B. Excessive gambling
C. Use of marijuana

12. 60 yrs old male presented with complaints of right sided headache since last 6 hrs. He never
experienced such headache before. No abnormality O/E, except as given in pic ( right sided very very
mild ptosis with meiosis ) . Next inv…
A. CT Head
B. Right sided Carotid doppler

Similar pic
13. #Bilateral gynecomastia pic.
Young man about 30-34yrs old, presented with this condition as shown in the pic, he is a smoker,
drinks alcohol daily, on ranitidine for dyspepsia. O/E parotid enlargement, Testicular swelling U/L –
can’t get above the swelling. What is the most likely diagnosis?

Similar pic
A. Teratoma
B. Leydig cell tumour
C. Alcoholic liver disease
D. Ranitidine

14. 5 months old child, presented with fever, pus cells 50x10^9, Nitrites +. Management?
A. Oral Amox
B. Oral Amox + Clauv
C. Oral Cipro
D. IV. Gentamycin
E. IV. Cephatholin
15. 40 yr old woman with known social phobia, now comes with her brother for the
assessment. Whenever she goes out, She feels anxious, palpitations. she has a plan to
 attend her cousin wedding ceremony next week. She sleeps well and at home she enjoys
gardening n painting. What is your appropriate tx for her?
A. Temazepam
B. Olanzapine
C. Propranolol
D. Venlafaxine
E. Citalopram

16. Female patient not going out for 10 yrs , anxious – Propranolol ( sorry , forgot the complete
stem )

17. Not a new Q, But new options

52 yrs old, post menopausal lady, C/O hot flushes. What to give?
A. Continuous Estrogen + Progesterone for 12 days
B. Continuous Estrogen Alone
C. Continuous Progesterone Alone
D. Continuous Estrogen + Testosterone
E. Continuous Estrogen + Progesterone throughout

18. Lady working in a daycare center, 7 weeks pregnant. Exposed to rubella child. She was fine, but after
researching on internet, she is worried now. What to advice her?
A. Do IgG Ab Rubella
B. Detailed h/o exposure to rubella
C. Gv Rubella Vaccine
( No option for reassure )

19. 2 year old child presenting, mother concerned as he still doesnt walk. On neuro exam he
had hypertonia & exaggerated reflexes of lower extremity. He was born gestation age 26
weeks. At birth weight was 1.1kgs. he was given gentamycin and dexamethasone for
respiratory. Cause of his current symptoms?
A. Gentamycin toxicity
B. Antenatal infection
C. Prematurity
D. Antepartum/intrapartum hypoxia

20. 45 yrs old male known case of COPD, presents with white sputum. o/e crackles and wheeze
at the base of both lungs. He has a history of MI and HTN. Chest –ray was given. diagnosis
asked?
A. heart failure ( mild enlargement + straight left heart border )
B. COPD ( no tubular heart, clearly CXR not of COPD )
C. asthma
D. pulmonary embolism
E. pneumonia
 Similar pic with more straight
heart border

No eye & ear pics, No CT Brain pics

#Recalls
21. 55 yrs old male, K/C/O Hep C, not using IV Drugs since last 5 yrs. Alcoholic. On presentation, he is
drowsy but answers /obeys commands. O/E gynecomastia, flapping tremors, fever 38’C, mild
ascites, spider nevi, parotid gland enlargement. What is the most initial inv?
A. FBC
B. Ammonia
C. Abd. Paracentesis
D. LFT

22. 80 year old man presented with loin pain on the right side, urine examination showed
hematuria. What is the most appropriate next step?
A. X-Ray
B. Abd ultrasound
C. CT Abdomen
D. Right retrograde pyelography
E. Urine culture

23. Lady brought her husband, c/o pain in the right side of tongue since few hrs. He is on
Ramipril & other drugs. Recently started on Amox for some infection. O/E tongue sis
protruding out, swollen, when he tries to speak, makes noises ( not able to speak properly )
& points towards the tongue. What is the cause of his presentation?
A. Ramipril
B. Amox
C. Hydrochlorothiazide
D. Metformin
E. Vitamin C tabs
24. 32 yr old asymptomatic woman present with 25mm swelling in her right lower thyroid lobe
which was found incidentally on CT scan for whiplash injury. After taking FNAB, there was
(Psammoma bodies) and what management?

A. review with USG next 6 mths

B. review with thyroid function tests next 6 mths
C. radio iodine scan
D. right lobectomy
E. total thyroidectomy

25. breast cysts, patient (already found in the medical record that its already a cyst for 12
months),why there is delay at management? Since 12 months breast cyst, now increase in
size, what to do?
A. tell her it is not imprtant now to focus on mistake now
B. ask her physician who said it is cyst
C. give her more information
D. ask her to go the lawyer to revise her medical report
E. tell her that we dont have her file any prove that she had cancer before

26. a man presents with c/o left leg pain, can walk upto 100 meters , due to pain has to rest
for sometime. relieved by rest, on examinations there was , right leg good peripheral
pulses, left leg weak pulses , ABI done and it was 0.25. what is the most appropriate test
leading you to the diagnosis?
A. Arteriography
B. Ct angiography
C. compression Doppler ultrasound
D. MRI
E. X-ray

27. #Gout scenario ( only scenario, no pic )

65 yrs old female, on thiazide, c/o severe pain in the ankle with swelling, red, tender.
Aspiration done. What will you find?
A. Crystals of Mono-sodium urate.
B. Pyrophosphate crystals
C. Ca calciuria
D. Non-inflammatory fluid

28. Gout scenario, now presents with acute symptoms. Lab results show urate level little
increase and creatinine is 1.8 (Normal 0.6 – 1.2) not mentioned renal failure just given
creatinine value. What to give?
A. Prednisolone
B. Codeine
C. Naproxen
D. Allopurinol
E. Colchicine
29. Previously healthy woman 39 wks gestation, presented with complaints of blood loss of 1 L.
@ 18 weeks scan, she had placenta previa @lower segment, she did not follow up for later
scans. On exam: bp 100/70, Hb - slightly low. Which will help u for dx?
A. Pain with bleeding
B. Uterus TENSENESS
C. Absence fetal heart sound
D. Uterine contraction
E. High head

30. #SIDS
Parents come for Normal review of 6 weeks old baby. They ask advice, how to avoid cot death
( SIDS )?
A. Keep baby in supine position
B. Keep baby on bed with parents
C. Bottle feeding

31. A 15year old girl having difficulty in concentrating. She constantly fights with father, recently
stopped ballet class – ask why “what’s the point of all this? “, what will you do?
A. Liase with father
B. safety plan with parents
C. Give ssri
D. CBT
E. Tell school to support her more

32. #Prompt relief- Temazepam

65 years woman after death of her husband due to prostate cancer 6 weeks back, is
brought to you. She lives alone , presented with loss of appetite, thinks he died because of
her infidelity. She sleeps badly and had similar episodes after her miscarriage at age 23.
What to give for Prompt relief.
A. Temazepam
B. Venlafaxine
C. ECT
D. Mirtazapine
E. Escitalopram

33. Aboroginal female has mitral stenosis and daily fever from 6 weeks, lung basal crakles, she
presented with dyspnoea. (Xray looks like pulmonary hypertension. Batwing very visible)
C xray given. it had bilateral middle lobe opacity. Whats is the diagnosis.
A. Pulmonary Hypertension.
B. Pulmonary Fibrosis
C. LVF
d. TB
 Similar pic, very clearly given

34. #Mamu Q
Young aboriginal male presents to you with insomnia, fear of darkness and seeing “mamu”. He
has been having these symptoms after the death of his mother. Which of the following should
be next step in his treatment?
A. give him benzodiazepine
B. consult to aboriginal health worker
C. urine drug screen
D. antipsychotic
E. drug and alcohol abuse counseling

35. Young boy, post MVA, c/o pain, O2 sat 96%, other vitals normal, CT given, showed mild
Hemothorax. After giving O2, What next?

Similar pic
A. Morphine
B. Intubate
C. chest drain
D. Observe
E. needle thoracostomy
36. Patient with weakness and lethargy. Following investigation shows T4 decreased, TSH
normal.
1. MRI brain
2. Thyroid scan
3. Give thyroxine 25 microgram
4. Thyroid autoantibodies
5. FNAC

37. #CT Ca Pancreas ( Not the usual CT pic, little diff )

An elderly lady presented with jaundice, fatigue, she is afebrile. with LVEF 20% has raised
ALP, ALT,GGT but bilirubin is normal, she has pruritus and and has lost 4 kg in 3 months,
what is the most appropriate management?
A. ERCP
B. Percutaneous cholangiogram drainage
C. cholecystectomy

Similar pic, not exactly same.

38. #Ca. Sigmoid with CT.

75 years of age has 3 weeks history of progressive constipation. History of appendectomy
and cholecystectomy. He presents with mild abdominal tenderness and BS exaggerated on
rectal examination there is no faeces in the rectum. Which of the following is the most
likely diagnosis?
a. Sigmoid volvulus
b. Caecal volvulus
c. Ca sigmoid
d. adhesive IO

39. Ca. Sigmoid without CT.

40. Oliguria in pt post surgery, no mention of FC, IVF given = Bladder Scan
Post op oliguria in a patient with cholecystectomy 12 hrs before. fever 37.9, BP and pulse
normal, fluid running at 80 ml/hr but urine output only 100 ml. no mention of
catheterization. what to do next:
a. bladder scan b. Ct scan c. Serum urea creatinine

41. Oliguria in pt post surgery with FC, IVF given = S/Urea, Creat
42. Oliguria in pt post surgery with FC, IVF given, asso with diffuse abdominal tenderness = USG
Abd
Post laparotomy opt pt oliguria with indwelling catheter. fever 38.5.There was generalized
abdominal pain. most appropriate mx?
A. And xray
B. blood culture
C. S electrolyte and creatinine
D. abd usg

43. #Suprapubic distension-2 Q

Man with urinary retention mass two fingers above the pubic symphysis. DRE showed
enlarged prostate with smooth median sulcus palpable. Catheter was inserted. What is the
most appropriate next step?
A. Urine Cytology
B. PSA
C. bladder scan
D. CT
E. S/Creatinine

44. Man with urinary above retention mass two fingers the pubic symphysis. DRE showed
enlarged prostate with smooth median sulcus palpable. Catheter was inserted. What is the
most appropriate next step?
A. Urine Cytology
B. PSA
C. TRUS
D. CT
E. S/Creatinine ( No option for Bladder scan )

45. 8 days old infant presented to u complained with poor feeding and bile stain vomiting his
birth was at 38 weeks gestation and weight 2600g he is breast feeding with no immediate
post natal complications. The child has history of Meconium passing on day 4th of birth
now he has mild jaundice and abdominal distension and is irritable on examination
abdomen distended and tender what is appropriate diagnosis?
A) Meconium Ileus
B) Hirschsprungs disease
C) duodenal atresia
D) necrotizing enterocolitis
E) volvulus
46. 12-year-old girl at foster care. she's having difficult time in school in reading and writing.
She has a collection of her own toys and plays with them with her imaginary friend. Her
foster carers are irritated because she's picky at food. what immediate danger for her?
A. OCD
B. Sexual abuse
C. Drug abuse
D. Anorexia nervosa
E. Schizophreniform psychosis

47. Old man came with his wife. he gets confuse sometimes and forgetful. He still drives,
sometimes at night. mmse 26/30 .what are you gonna do about it?
A. Cease driving at night
B. Repeat mmse after 3 months
C. MRi of brain
D. ask for more social and mental activities

48. #CTG Strip given, 39 wks gestation, pt didn’t feel the fetal movements for last 2
days. CTG given- Review in next visit

Q. Normal CTG pic and woman 39 weeks complaint of no fetal movements for 24 hours
and CTG is done. What will you do?
A. Admit and observe
B. Review in next AN visit
C. Review in next 2 days with CT
D. CS
E. Amniotomy

49. Stop Synto- 2mins Q, No CTG

?weeks pregnant have labour induced , synto given , cervix 8cm dilated , fetal head
at ischial spine level , CTG show HR drops to 70/min & came back to 145/min in 4
min. Asking next ?
A. Cease Syntocinon
B. Fetal scalp pH
C. CS
D. Ventous Delivery
E. O2 to mother
50. Stop Synto- 4mins Q- Both Q only scenario, no CTG
?weeks pregnant lady came with labour pain. she was put in left lateral position
having oxygen mask in place. iv fluids with syntocinon is running. Ctg was done
which shows heart rate of 140 which dropped to 70 and came back to 140 in 4 min.
asking next appropriate treatment.
A. Fetal scalp sampling
B. Continuuous ctg monitoring
C. Stop syntocinon
D. C section

51. #Hernia pic from Xiphisternum to Umbilicus- Mesh repair

Huge epigastric hernia picture of a 56 year old man which extends from umbilicus
to xiphisternum. He looked morbidly obese and had a waist circumference of 110
cm Asking for appropriate management for the patient.
A. Weight loss therapy
B. Abdominal binder
C. Herniorraphy with mesh repair
D. Hernioplasty
E. Observation and Reassurance

similar pic
52. Hernia- 110 cms waist circumference, wat advice- Weight loss

53. LBP 58yrs, localized pain- Continue activity

54. LBP 40 yrs with pain radiating to legs- Next Spinal Xray
40 years lady with sudden severe pain while gardening. Pain is radiation to thigh and leg
with no neurological deficit what will you do as next?
A. Spine X-ray
B. MRI
C. Bed rest
D. Observation
E. Refer to orthopedic
55. Pt came with back pain & tenderness in L4 L5 region. On history it was found that
he used to be iv drug abuser & there was history of hep c asked inv
A. cxr
B. Mri
C. Ct scan
D. Observe

56. #Lipase Inhibitor- BMI 35 Q

A lady with BMI of 35 how will u manage her in addition to exercise, weight reduction and
diet?
A. Involve in sports B. Low carb food always
C. Lipase inhibitor D. Diuretics
E. Surgery

57. #Systemic review Q

A pharmaceutical company comes with some drugs introduced in market. What u check
the drug is efficacy and safe?
A. System review
B. Double blind study
C. Cohort
D. Case Control
E. Case study

58. #Relationship between fatigue & MVA in truck driver – Case Control
What is the best method of study for studying the relation between fatigue
and accident in truck driver?
a. RCT b. Cohort
c. case-control study d. Case report e. systemic review

59. #Pharma company, new drug intro – Side effects

Pharma company approaches u, claims new drug reduces risk of stroke in af pts by 40%,
and has less GI side effects. Most imp thing to ask regarding the information given?
A. length of follow up of pt after the trial
B. common side effects
C. absolute risk reduction
D. no of study participants

60. #Old man Beats wife – Dementia Q

a 84 yr old man brought by 82 yrs old wife. she tells u that he beats her and gets aggressive
over small things. He gets angry when stressed. not a very long history and and recent
change in behavior. he gets aggressive to u as well asked diagnosis ?
A. dementia
B. temporal lobe epilepsy
C. antisocial personality
D. elder abuse
61. A patient with chronic lung disease develops cough and fever was admitted to hospital.
Ipratropium and salbutamol given 8 hourly. Oral prednisolone, oral roxithromycin and IV
amoxicillin given. ABGA done showing: pH 7.35, PaO2 80mmHg, PaCO2 50mmHg, HCO3-
35mmHg. What is your next management?
A. Give IV hydrocortisone
B. Increase bronchodilator to 4 hourly
C. CPAP
D. Admit to ICU
E. Change to IV Cefotaxime

62. A Sudanese boy had sex with his girlfriend. After a few days, he found urethral discharge
from his penis. He has other sexual partners. What specimen will help you make a diagnosis
of the STI?
A. 1st catch urine PCR B. Midstream urine PCR
C. Urine culture D. Urethral swab gram stain and culture
E. Tell him use condom

63. 7 days old baby presented with jaundice since 4 days of life, his birth was at term, not
complicated and he is breast feeding, serum bilirubin level was 240 (normal <200) with 120
direct bilirubin, his liver is 1 cm palpable below costal margin. What is the most appropriate
next step? (Direct bilirubin for 120, that’s sure)-
A. Thyroid function test
B. Abdominal ultrasound for liver and biliary tree
C. Coombs test
D. Stop breastfeeding and follow up
E. Phototherapy

64. 2yrs old Indigenous child presents with earache, both ears with purulent ear discharge.
After ear toileting what will u do? ( No pic of TM )
A. Oral Amoxicillin B. Oral Augmentin
C. Ciprofloxacin ear drop D. Paramycetin with steroid ear drops
E. Hearing aids

65. A patient 23 years old who had a normal pap smear 6 months ago was advised to do a
screening test for chlamydia. She wants to know why or if the test is necessary?
A. Chlamydia causes infertility
B. Chlamydia is asymptomatic
C. Reassure her the test is not important because the PAP smear was negative
D. Give her a human papilloma vaccine

66. Young couple with infertility. Female with one child in previous marriage and female
investigations were normal, what in history you will ask the male patient that will be most
useful to guide u to cause of infertility?
A. how much alcohol do u consume?
B. Did u get chicken pox infection for once while u were young?
C. Do you use Marijuana?
D. ecstasy and other drug use
67. A woman comes to your clinic. She was prescribed trifluoperazine for her condition. She
was taking it for 3 years with improvement of her condition. She says that she discontinued
taking her medication for the last 3 weeks because her doctor was not present for he was
in trip, she also said that trifluoperazine makes her hand or some muscle part stiffness,
rigid, and restless. Now she presents with voices in her head. What is the most appropriate
initial choice in management?
A. Trifluoperazine
B. Risperidone
C. Quetiapine
D. Respa depot
E. Stop trifluperazine

68. 14 years old girl lives with family has now become sexually active comes to you for
contraception advice and tells you not to inform her parents. What will u do?
A. Give her prescription of contraception
B. Ask her about identity and age of her sex partner
C. Tell her she needs parents’ permission
D. Inform parents
E. give her prescription and Tell her to use condom to her partner

69. #Medical Student – Inform the supervisor Q

Medical student. care for patient under supervison, reported that he publisihed medical
information about a patient in facebook, what to do?
A. nothing, its not your responsibility
B. take to him that his action is wrong
C. Inform the supervisor
D. ask him to remove it from facebook

70. There was girl having social phobia prob reluctant to go to places came with Friend with
fear, trearful but happy at home doing painting and all other work what in history will help
us reach diagnosis-
a. School refusal
b. Night terror
c. family history
d. Alcohol abuse

71. Poorly controlled Diabetic pregnant woman with mild renal impairment asking about the
risk of effect of her diabetes on this baby?
A. IUGR
B. Macrosomia
C. Renal agenesis
D. Intrauterine fetal demise
E. low Birth weight
72. A child with fever and hx of sore throat. He developed pain in wrist later developed
arthralgia n swelling in ankle joint. skin rash present . what's the most initial step of
management ? No Murmur mentioned.
A. ESR
B. Full blood examination
C. throat swab
D. USg
E. ECG

73. #refuse to witness recall

You are intern. Patient wishes you to witness her will in the presence of lawyer.
What should you do?
A. Witness the will
B. Refuse to witness
C. Ask surgical register if he can do it
D. Seek legal advice

74. #Down synd diagnostic inv at 15 weeks asked. Amniocentesis

15 wks pregnant comes for definitive diagnosis of Down syndrome
A. amniocentesis
B. CVS
C. nuchal fold thickness
D. serum screening

75. Incomplete abortion recall

pregnant woman at 12 wks gestation presents with heavy bleeding had an ultrasound
Nuchal translucency at 11 wks Abd rigidity, tenderness .maternal hypotension and
tachycardia. Asking diagnosis
A. incomplete abortion
B. threatened Abortion
C. Ectopic pregnancy
D. Placenta previa
E. molar pregnancy

76. #check insulin at 3am (somogyi effect recall) –

girl with type 1Dm ,on intermediate insulin at night, short acting insulin in the morning, her
parents concerned about her high glucose levels of 15 at morning, what next?
A. increase intermediate insulin at night
B. increase short acting insulin in the morning
C. prevent fruit in evening
D. measure glucose levels at 2am and 3am

77. #Ovarian Ca Scenario- No pic

 Lady 50 years with constipation and back pain Mass extending from pubic tubercle to the
umbilicus it was free and present lateral to uterus not attached to the uterus or others on
examination. Diagnosis asked.
A. GSIT
B. Retroperitoneal sarcoma
C. Endometrial cancer
D. ovarian cancer

78. #Cluster Headache Q

Pt presented with left sided headache, Unilateral, in the periorbital, retro-orbital, Suddenly
started at night, peaking in 10-15 minutes lasting for 5 minutes. O/E Ptosis. What is Imp to
make diagnosis ? ( No mention of Unilateral Rhinorrhea & Lacrimation )
A. Confirm with 100% oxygen by face mask-
B. CT Scan

79. 52 yrs Female with stress incontinence. Pelvic exercise done. Feeling little better with
exercises there was little incontinence now but still embarrassed. What to do next for this
woman..
A. Imipramine
B. weighted vaginal cones
C. colposuspension

80. 17yrs old girl has dyspareunia, she is worried about endometriosis because sister has
infertility because of this. Examination: nodule on ligament on vaginal palpation and some
other description, what is important to diagnose endometriosis:
A. nodule on uterosacral ligament
B. dyspareunia
C. menorrhagia
D. family history

81. Lady comes on 10th postpartum day with pain due to perineal tear. Now on examination
there is perineal wound that is 2 cm long, 1cm wide and 1 mm deep. It was clean just
serous discharge was there. What to do next?
A. Apply local antibiotics
B. Put on oral antibiotics
C. Simply keep the wound clean
D. Suture the wound under local anaesthesia
E. Suture the wound after cutting the edges

82. A 42yo woman who smokes 20 cigarettes/d presents with complains of heavy bleeding and
prolonged menstrual period. Post D& C. What is the most appropriate tx for her?
A. Tranexemic acid D. COCP
B. Mefenemic acid E. Levonorgestrel IUCD
C. Norethisterone
83. Young girl presented to you with heavy menstruation since 2 years. She also complains of
pain during her periods. She is pale on examination. You told her that multiple
investigations are required but she refused and asked for something to help with the
bleeding.
A. Ocp
B. Tranexamic acid
C. Mefenamic acid
D. Mirena

84. A 40yrs old woman on cocp for 8years. She is a smoker and her BP is high. She doesn't want
to get off pills. What is your advise?
A. Stop pills and rely on condom
B. Copper IUD
C. Implanon
D. POP

85. Farmer came with left swelling in a groin. You did fnac and it shows squamous cells. Where
is the lesion
A. Left leg
B. Anus
C. Rectum
D. Testis
E. Penis

86. A man comes with clumsiness of hands and tripping over. Upper limb weakness and
fasciculation. Lower limb muscles also has weakness, increased tendon reflexes. Ankle
reflex is not increased in one side. No wasting. No sensory loss is given. What will help to
reach the diagnosis?
A. EMG
B. MRI Spine
C. CT scan
D. CSF examination
E. Cervical spine X-ray

87. A man comes with clumsiness of hands and tripping over. Upper limb weakness and
fasciculation. Lower limb muscles also has weakness, increased tendon reflexes. Ankle
reflex is not increased in one side. No wasting. No sensory loss is given. What is the initial
investigation?
A. EMG
B. MRI Spine
C. CT scan
D. CSF examination
E. Cervical spine X-ray
88. 3 years old child with fever 39 and history of cough unwell for 3 days. He has wheeze but
minimal lung signs on exam. Which investigation will you do for further assisting in
diagnosis? (Not given chest X-ray, not already give any antibiotic in scenario.)
A. Pneumococcal PCR
B. Pleural Aspirate
C. Trans-pleural drainage
D. Blood culture
E. Full blood count

89. A mother come with her 8 months old child complaint of continuous bleeding after fall
from coffee table. On examination there is bleeding frenulum and some old bruise in
forehead and leg. There was no petechiae, lymphadenopathy, hepatomegaly. What is the
cause?
A. ITP
B. Non accidental injury
C. VWD
D. Hemophilia A
E. Hemophilia B

90. Primigravida gave birth at term to 3200 g baby, normal vaginal delivery without and
complications and there was slight meconium staining of liquor. Baby was normal at birth
with normal heart rate. After 1 minute, suddenly stopped breathing. HR decreased 40.
cyanosed and not breathing. No response on stimulation. What is the most appropriate
next step?
A. Intubate
B. Nasopharyngeal aspiration of meconium
C. Give oxygen therapy with bag and mask ventilation

91. Patient complaining of soreness on lateral epicondyle at the end of work, the patient
attributes it due to computer mouse clicking. On examination, tenderness on lateral
epicondyle. What is the most appropriate treatment?
A. Lateral epicondylectomy
B. Finger immobilization splint
C. Lateral epicondyle immobilization splint
D. Bracing under lateral epicondyle
E. Analgesic

92. 18 year old male with bloody diarrhea, you made sigmoidoscopy which shows
10cm friable mucosa. What is the initial management?
A. Sulfasalazine
B. Rectal Corticosteroid
C. Injection Corticosteroid
D. Lopramide
E. Methotrexate
93. A patient with peptic ulcer with H. pylori positive, took triple therapy
(amoxicillin+metro+PPI) for two weeks. After 6 weeks, urea breath test still positive after
completion of course. What is the reason for this case?
A. Resistant to metronidazole
B. Resistant to amoxicillin
C. Unreliable urea Breath test
D. Improper timing of test after treatment

94. Old woman with GERD history and taking Proton pump inhibitor, T score given -2.5 in
vertebra and -2.5 in femur, Lab results were given, calcium and vitamin D was normal.
What is the best treatment?
A. Alendronate
B. HRT
C. Strontium ranelate
D. Parathyroid hormone
E. Vitamin D supplement

95. Old woman with GERD history and taking Proton pump inhibitor, T score given -2.5 in
vertebra and -2.5 in femur, Lab results were given, calcium and vitamin D was normal.
What is the best treatment?
A. Alendronate
B. HRT
C. Zolindronic Acid
D. Parathyroid hormone
E. Vitamin D supplement

96. A patient of CKD and hypertensive, patient taking ramipril, carvedilol with many other
drugs presents with confusion labs urea is 18 creatinine very elevated about 10x upper
limit, raised calcium 3.1, phosphate also raised sodium 128 potassium 5.7. What is the
cause of confusion in this patient?
A. Uremia
B. Hyponatremia
C. Hyperkalemia
D. Hypercalcemia
E. Hyperphosphatemia

97. #Copd with respiratory distress in ed. Sats 88% on oxygen.

Patient known case of chronic lung disease, Heavy smoker, drinks alcohol, presents with
chronic cough, dyspneic and speak in phrases. on examination bilateral wheeze with basal
crackles. what Initial investigation should you perfrom?
A. Spirometry
B. Pefr
C. Ct chest
D. abgs
98. A young male travelled to Asia and upon arrival he developed a of cough and mild fever as
well as epigastric pain for a duration of 2 weeks, what is the likely cause? X ray given
A. viral pneumonitis (exact words)
B. pneumonia pneumococcal
C. fungal infection
D. tuberculosis (No Mycoplasma pneumonia in options)

99. An 18 year old girl presents with epistaxis, malaise and tiredness for months. No other
symptoms. Hb is 8.5, serum ferritin is 35, INR is 1.5. Calcium is 1.9. Long question. What to
do next ?
A. Blood transfusion
B. IV calcium
C. Injection vitamin k
D. Fresh frozen plasma
E. Vitamin D tablets

100. #Restless leg syndrome scenario. Investigation asked?

A 55-year-old woman presented with discomfort in her both legs with an urge to move for
last 4 months. She remains awake at night due to creeping & crawling sensation at night
and sometimes electric current-like sensations. Relieves after walking & massage of leg.
Her current medication include paracetamol, oxycodone and multivitamins. Blood tests
show normal renal function, normal electrolytes and slightly low haemoglobin. What inv
you do next?
A. Iron studies
B. Sleep studies
C. Nerve conduction test
D. Serum Calcium level
E. Cease oxycodone

101. Woman with osteoporosis and taking HRT for 6 years, bone density score for spine
vertebra is -1.7 and for femoral head is - 1.2. What is next? Vit: D and calcium level are
given Normal level.
A. Cease HRT
B. Continue same
C. Change HRT to Alendronate
D. Add Alendronate
E. Vitamin D and Calcium supplement

102. A patient with spiking fever, Shortness of breath and was inserted prosthetic heart
valves 3 months ago. And diagnosis as due to Staph aureus IE, and given Flucloxacillin for
treatment. The fever subsides after 2 weeks of treatment, but SOB still persists, new
diastolic murmur at the left sternal edge. What will you do for investigation?
A. Transthoracic Echo
B. Chest xray
C. Troponin
D. Blood culture for every week E. CT scan
103. Patient with history of DVT, HTN with DM patient on warfarin, metformin, statin and
then add amiodarone, 2 days later suddenly got swelling at right thigh and become painful,
redness and Temp 37.8. Right thigh size is 4 cm larger than left. Diagnosis?
A. Rhabdomylosis
B. Hematoma
C. DVT
D. Cellulitis
E. Drug reaction

104. 38 years old man with renal transplant 8months back, presented with Neck stiffness and
meningitis sign start 3 days ago, nothing mentioned about respiratory symptoms, no fever.
On chest xray there is well defined round opacity in “middle right lung” ( chest xray not
given, just mentioned secenario ). What is the cause?
A. Aspergillous
B. TB
C. Pneumocystis Pneumonia
D. Lymphoma
E. Nocardiosis

105. Old woman 75years is admitted to the hospital following a community acquired
pneumonia. She received antibiotics and is well on the 3rd day after discharge she suddenly
develops rigors, chills and high grade fever. Had crepitations on chest. What is the most
likely diagnosis?
A.Hosp acquired pneumonia
B. Iv cannula related bacteraemia
C. Empyema
D. Pulmonary embolism

106. A 6 month old child came with recurrent upper respiratory infection. The immunization
history reveals that the child has received his hepatitis B vaccination at his birth and no
further immunization history at 2 and 4 month of age due to recurrent upper respiratory
infection. Now the child has fever 37.8 and clear nasal discharge. What is your
management regarding immunization?
A. Give hepatitis B immunization and institute catch up schedule
B. Give hepatitis B immunization and recommence standard schedule
C. Investigate underlying cause of URTI
D. Give hepatitis B immunization after fever subside
E. Give hepatitis B immunization at now

107. year child was complaining of colicky abdominal pain and anorexia for 7 days, then
2 days of diarrhea and other feature now presented to you his there was tenderness
all over the abdomen with guarding, temperature 39. What is the most likely diagnosis?
A. perforated appendicitis D. mesenteric adenitis
B. norovirus gastroenteritis E. giardiasis
C. campylobacter gastroenteritis
108. #Recall of hep c in pregnant mother advice? - avoid fetal scalp electrode
 A pregnant lady with hep C comes to you for advice, what will reduce the risk of
transmission of hep C to her baby
A. C section
B. Avoid Fetal scalp electrodes sampling

109. Recall of hep c Ab at 18 mths

You want to know the Hep C in newborn baby born to HepC positive mother. How to
investigate?
A. Antibody of baby at birth
B. Antibody of baby at 18 months
C. Antibody of baby at 12 months

110. Pt with active RA on methotrexate with chronic pyelonephritis , feels tired and lethargic
labs done showed the ff Hb 9.5 g/dl, Mch low normal, Serum iron decreased , S. ferritin
normal , Tibc decreased . What is treatment of choice
A. packed RBCs B. iv iron
C. low dose corticosteroid D. erythropoietin injection

111. 52 yr old woman whose son is a drug addict, beats her every day. She is afraid &
presents to you. What will u do for the safety of the woman?
A. tell her that she is obliged to inform the police
B. informs the police
C. urge her to go to the refugee center
D. send the son to correctional facility
E. advise female support group

112. ‘The moon is made of cheese, I came by bus’ Q .

On interview. Asking about the appetite. Patient told “That is concern with food. Food
which does not comes from moon, moon made of cheese. But I came her by bus”. Which of
the following will have in this patient?
A. Depression
B. Dissociation
C. Disorganized behavior
D. Delusion
E. Depersonalization

113. An old women who is widow who seems well in past but since she became a widow and
she moves to the house and start to stay alone one of neighbor had noticed her strange
behavior. She starts to dig some ground in front of the house and when neighbor reached
near her and looked at her, she then aroused him and get aggressive and accused him and
all neighbors as imposters. After that she became calm down and agreed to be seen at the
medical clinic. What will you check to get a diagnosis?
A. Thought forms B. Mood C. Orientation
D. Delusion E. Memory
114. 26 years old man was brought to ED as he beat his wife. Which one of the following will
indicate that he has a personality disorder?
A. past history of beating his wife two weeks ago
B. cruelty to animals during his adolescence
C. history of childhood sexual abuse

115. Woman 25 years old is going to travel to India presented asking advice about
vaccination. She has previous 1 dose of polio vaccine, had DPT at birth, 2 and 4 months age,
1 dose of MMR at 13 month , and tetanus booster at 15 year age. What vaccines should
she received before travel?
a. MMR, diphtheria and tetanus
b. polio, diphtheria and tetanus
c. polio, MMR, diphtheria and tetanus
d. polio, MMR
e. MMR

116. DTPa + Ig Q- five years old child fell, had superficial abrasions and lacerations. He had hx
of 2 doses of tetanus vaccine at 2 and 4 months of age. Next?
A. start benzylpenicillin
B. DPTa and immunoglobulin
C. DPT and booster after 2 months
D. tetanus toxoid and immunoglobulin

117. Concerning a mother asking for Antibiotics for her son who is feverish - Her son visited
child clinic which was visited by a girl documented as Meningococcal Meningitis. The girl
came to the clinic from Monday- Wednesday. The child came on Friday. Hospital gave
Rifampicin to all contacts of girl as prophylaxis
A. Give her son Rifampicin
B. Ask her to get her son to ER for review
C. Reassure

118. A dementia patient taking donepezil and mobeclomide at elderly care, masturbates near
nurse station and tries to cuddle nurses who help bathe him. What causes him this?
A. Frontal lobe SOL
B. Progression of Alzheimer
C. SE of drugs

119. Patient with RA she takes ibuprofen and methotrexate to control her disease, they
mention the time it was years for both of drugs, patient complains of upper abdominal
pain, and her labs are given ALT, AST, GGT, even bilirubin all were high, which of the
following cause this condition?
A. Methotrexate induced hepatitis
B. Ibuprofen induced hepatitis
C. Autoimmune hepatitis
D. Viral hepatitis
E. Alcoholic hepatitis
 120. #Hutchison Freckle Q
hutchinson's freckle on face for the past 6 years, size is increasing now, next step of
management?
A. Local excision
B. Excision with a 2 cm margin.
C. Fluorouracil cream
D. Review in 12 months

Similar pic

121. Mother of two children presented because her brother was diagnosed with
haemachromatosis, she is worried her 3 and 5 years old children will be affected, what
advise?
A. Has an appointment with mother and her husband
B. Test mother but not her children
C. Test bother mother and her children
D. Offer iron study to both mother and child
E. Speak to both mother & father before testing

122. #Old man. Afib. Abdominal pain. Wat other test with ct- serum lactate
A scenario of an old man with history of atrial fibrillation and now comes with severe
abdominal pain. What other than CT angiography will you do?
A. CT abdomen
B. Serum lipase
C. Serum lactate

123. #Non pitting edema- CT Abdomen

Lady with c/o increase in size of her limbs. O/e bilateral lower limb edema NON-PITTING
EDEMA from foot to groin. What next Ix?
A. Urine protein
B. Ct abdomen pelvis
C. Echo heart
D. Liver function
E. Ultrasound Abdomen
125. #gleason score 4 Q
 A 74 year old man is being screened for prostate Ca. His PSA 2 years ago was 1.5ng/ml; now
PSA is 3.8ng/ml. Only %5 of biopsy done showed adenocarcinoma, Gleason score is 4. How
will you manage this patient?
A. TURP
B. Radical prostatectomy
C. External beam radiation therapy
D. Androgen therapy
E. Active surveillance

126. A child with left kidney smaller than the right, what is the best measurement for renal
function?
A. DMSA - dimercaptosuccinic acid to see anomaly scar tissue due to vesico reflux
B. DTPA
C. IV urogram
D. USG

127. #Temporal Lobe epilepsy recall

8yr old brought due to behavior changes. Noticed to have blank stare, with fidgeting of
right hand, head twitching to right side, sometimes chewing. These occurs in clusters for 3-
4 days in a week, for 3O to 60s, Post ictal confusion, then symptoms free & back to normal
for several weeks. Asking Diagnosis?
A. absence seizure
B. Juvenile myoclonic epilepsy
C. Temporal lobe epilepsy
D. Tourette syndrome

128. DM 1 pt after garden injury developed swelling of ring finger, it was tender esp on flexor
side pt had problem with extension of the finger. Patient kept the finger in slight flexion..
What to do as definitive treatment?
A. IV cephalothin
B. Iv flucoxacillin
C. Surgical exploration
D. Iv cephalothin with physiotherapy
E. Iv flucoxacillin with physiotherapy

129. #Lactose Intolerance

18 Month baby. Diarrhea for 6 weeks. Stool tests normal. First copious watery diarrhea
now undigested food particles in stool. Wat to do-
A. Gluten free diet
B. lactose free diet
C. reduce red meat in diet

130. #Undisplaced scaphoid fracture xray (from middle)- Plaster cast

 Similar pic
34 year old male with a history of fall on an outstretched hand with pain and swelling. XRay
was given, (showed scaphoid fracture. Very clear fracture line through the middle)
What is the best treatment option for this patient?
a. Crepe bandage
b. Plaster cast
c. Analgesics
d. Compression screw
e. Plate fixation

131. A patient with a painless neck swelling moves with swallowing. hoarseness and difficulty
in breathing at night…gradually increased over 3 weeks. O/E smooth swelling in the
anterior triangle of neck. dullness of percussion at upper sternal border. most likely dx?
A. MND goitre
B. papillary carcinoma
C. anaplastic cancer.
D. haemorrhage in nodule of MND
E. follicular CA

132. The patient comes with morning stiffness of both wrists for 1 to 2 hours and both wrists
pain since 8 yrs (not mention other joint pain). Now patient is concern and comes with this
wrist joint pain. Her lab results as follow. Hb - reduced , MCV - slightly reduced (nearly
below lower margin level) , ESR - 70 (sure for this level) . Best Management?
A. NSAIDs –
B. Prednisolone
C. Hydroxychloroquine
D. Methotrexate
E. Etarnarcept

133. 9month child crying a lot. 1 episode of billious vomiting...tender abdomen on inspection,
no mention of fever, his elder 2 yr brother has urti/gastro Dx - Intussuseption
A. csf B. mri
C. laprotomy D. admit and observe
E. Usg
134. #2yrs- 2Pronouns Q
 24 months old baby brought by his parents for development assessment. What should he
have achieved?
A. Can pronounce 2 personal pronouns
B. Know family name
C. Know 4 colours

135. #Couple inferitlity. Male with absent vas def. - check cf in both male female
Couple come for infertility problem for the last 12 months. On testing examination and
tests of the female are unremarkable. Male has azospermia. And bilateral absence of vas
deferens. Which of the following is most appropriate before the starting the treatment of
infertility?
A. No testing required as they can not have a child
B. Testing of both male and female for cystic fibrosis
C. Refer for IVF
D. serum fsh and lh for male

136. An old woman taken many tablets, now unconscious, pinpoint pupil, his son brought her
to hospital, and also tablets she might have taken, methadone, oxycodone, buspirone
patch
A. methadone B. oxycodone C. buspirone

137. #Child with urti. Found glucose and ketones in urine. Rbs was 9. Follow up with- hba1c
A child 6 YEARS old with history of asthma presented with upper respiratory tract infection,
urine examination showed very high serum glucose and ketonuria of 2+. what is the most
appropriate test to follow up this child?
A. HbA1C
B. serum creatinine and electrolyte
C. FBS
D. OGTT .
E. Blood gases

138. Pregnant women 28 wk oral glucose tolerance test 8.9 ( normal-8) what to do?
A. Dietitian B. Start metformin
C. Start insulin D. Do hba1c

139. #Mother bringing baby 5 times-

A lady presented with her baby 5 times in 2 weeks at 10 weeks following delivery - all
normal, established breastfeeding, baby growing well on 90th percentile. What relevant
info will you ask the mother?
A. Past obstetric history
B. premorbid personality
C. history of psychosis
D. Thoughts of harming her baby
140. #Orbital floor fracture- loss of sensation of cheek
 A man is brought to the ER after brawl hit to the side of left eye. On examination, you have
found an orbital floor fracture. Which of the following is the accurate predictor of this
diagnosis?
A. Sub conjunctival haemorrhage
B. inability to open his mouth
C. loss of sensation of his cheek
D. decreased visual acuity

141. #Not feeding frequently Q

Most Common cause of low milk production
A. Low fluid intake
B. Less adequate baby feeding
C. Baby is not put on breast feeding frequently

142. #Kawasaki Q – ECHO

3yrs old child with fever, conjunctivitis, red mucosa, rash, lymphadenopathy, abdominal
pain. Initial Investigation asked? ( long scenario )
A. Aso titre
B. ESR
C. Echo
D. Ana
E. Urinalysis

143. patient with history of claudication, smoke 30 pack cigarette per day, drink alcohol ,
obese with diabetic history . he is not fit for surgery. He asked you for the appropriate
advice that will improve his symptoms of claudication?
A. Reduce smoking
B. reduce alcohol drinking
C. supervised exercise
D. control his hypercholesterolemia

144. #history of hysterectomy and dvt Q- transdermal estrogen

Woman with a history of hysterectomy 3yrs back, complicated with left sided DVT. Now
complaining of hot flushes and insomnia. What will you give her?
A. Oral low dose estradiol
B. Transdermal estradiol
C. Progestogen only pills
D. Hrt
E. sertraline(paroxetine

145. #Dupuytrens Pic- asking cause – Alcohol

 Similar Pic

146. #Lead level 0.72- educate mother

Mother living in mining town comes with her daughter for normal blood test. Her
daughter’s test show lead level 0.72 what will be your next appropriate step?
A. Assess IQ testing of child
B. Educate mother about environmental risks
C. Refer for chelation therapy
D. Move the family to another town
E. Urine test to confirm dx

147. patient taking amisulpride, complaints of gynaecomastia and sexual dysfunction. What
to give?
A. Aripiprazole
B. Olanzapine
C. Clozapine
D. Quetiapine

148. #Drug Rebound Headache Q

A woman works at a part-time job ( office cleaner ), and complaints of early morning
headache, frontal & bilateral, dull in character, varying in intensity, she takes paracetamol
& ibuprofen, which only cause relief for 2-3 hours. What is the cause?
A. Drug rebound headache
B. Migraine
C. Tension headache
D. Cerebral tumor
E. Pre-menstrual headache
149. A 30 years old woman with increasing dyspnea, dry cough since 2 yrs with painful lumpy
red swelling/skin lesions on legs and shins. On examination, there are red, painful, lumpy
lesions in leg and bilateral ankle swelling. ACE level ( 120 ) increased. Which inv for
confirming diagnosis? (No given X-ray)
A. CT scan chest
B. Skin biopsy
C. Blood culture
D. Aspiration
E. ANA

150. Girl 16 years history of weight loss of 10 kgs, BMI 15. Her school performance is good
and recently fall in grade. What in history will help in diagnosis?
A. Episodic fatigue
B. Sleep disturbances
C. Feeling of worthlessness
D. Feeling of inferiority
E. Idea of guilt
( No Suicidal idea in options )