1. A skin lesion was suspected to be melanoma 2.7mm depth. Excised. A pathology report says that margins of 2.

6 mm width are clear. What is the best next step in management? a. Wider Excision b. radiation therapy of the scar c. 3monthly follow up. 2. A 52 year old menopausal woman came is bleeding per vagina for 24 hours. Her last menses were 1 year ago. Yesterday she had intercourse after 2 years of sexual rest. Her last PAP smear 2 years ago was normal. Whats the most probable diagnosis ?? a. Endometrial cancer b. Cervical cancer c. Vaginal atrophy d. Menses e. Endometrial hyperplasia 3. A lady has been feeling depressed for the last 4 years, she was in an abusive relationship for 6 years her alcoholic husband left her one year ago. She was a victim of bullying and was raped at school in high school. She complains of feeling insomnia sometimes, increased appetite and depression. (Sounded like she was abused all her life by whoever she meets). As soon as she started to live with her mother who supports her, she feels better. a. Post traumatic stress disorder b. Borderline personality c. Dependent personality disorder 4. Picture of slapped cheek disease. There are lot of pregnant moms in the school where this child is studying. What to do?

a. No exclusion required b. Call to school and notice them c. Exclusion for 7 days until all the rash disappears. 5. Picture of chickenpox or molluscum contagiousum (1 element was with central dimpling). School exclusion?

a. Not required b. When the lesions scab over. c. When all rash disappears. 6. Mom brings her 12 month old child. WOF will signify developmental delay? a. Cannot understand no 7. 1 year old child. UTI suspected. How will you collect the urine for analysis? a. MSU b. Suprapubic aspiration c. Clean catch d. Urine bad e. Catheter 8. Patient with known Waldenstrm's macroglobulinemia is admitted with fever. He has a history of glandular fever infection and varicella infection in childhood. He is given ampicillin and azythromycin. The next day he develops rash. Picture: rash is on the abdomen and chest. It doesnt look like erythema multiforme at all. Most of the elements are raised papules, but couples of them are pustules. What would you do to determine the cause of rash? a. swab from the lesion b. biopsy of the lesion c. bone marrow biopsy d. drug allergy test 9. Pregnant lady at term, fetal head 4/5 per abdominally, no height of history given. What is the most likely reason? a. contracted pelvis b. placenta praevia c. cervical incompetence d. macrosomia e. occipito-posterior view 10. A 35 year old man came with severe back pain over years that is worse when he wakes up in the morning , the pain and stiffness makes him stays in the bed for at least 30 min. Then he gets better somehow along the day , it is getting worse now , whats the best initial treatment for him ? (Xray of bamboo spine)

a. Naproxen b. Azathioprine c. Aspirin d. Prednisolon e. Methotrexate 11. A farmer had an injury while working in the farm, his knee fat is appearing out of the wound and it is contaminated with soil, he had TT 5 months ago for a similar injury. He doesnt recall having any other vaccination. What would you give him now? a. TT b. TT and Igs c. double-dose TT and Igs d. Antibiotics e. Just clean and dress the wound 12. An 8 year old boy with enuresis going to a camp with school, what is the best treatment ? a. Nasal desmopressin 13. A smoker man with bilateral leg pain when walking for 100 m. distance, although he has no dorsalis pedis pulse, ABI is not given, but limbs are well perfused and warm on examination. What is the treatment? a. Surgical intervention b. Walking program c. Start B-blocker d. Start nifedipine 14.How would you screen the woman after gestational diabetes? a. Fasting blood glucose every 3 years b. OGTT every 2 years c. Random blood glucose every 3 years d. Fasting blood glucose every year 15. 25 y.o. woman with PAP smear showing LSIL. What is the next management?

a. repeat PAP smear in 1 year b. repeat PAP smear in 2 years c. colposcopy d. LLETZ 16. Mentally retarded girl with menorrhagia and non-complience of OCP. Management? a. Implanon b. Depo-provera c. IUCD (Cu) d. Mirena e. Endometrial ablation 17. An aboriginal woman comes with her 12 month old baby for appointment, she doesnt look at you, coming out without saying anything. What do you think the reason for this behavior? a. Cultural issues 18. A middle-aged woman complaining of burning pain in the maxillary region during last 24 hours. There some redness over the area of the projection of the maxillary sinus. Nothing said about nasal symptoms. Dx? a. Maxillary sinusitis b. Trigeminal neuralgia c. Cluster headache d. Varicella infection e. Herpes simplex infection 19. A 25 yo man with dyspnea, ankle oedema, ascitis. On auscultation - bilateral crackles. On CXR bilateral infiltrates, although heart shape is normal. In urine blood +++, protein +++. Dx? a. SLE b. IgA nephropathy c. poststrep GN d. polyarteritis nodosa e. anti-glomerular basement dx. 20. 17 y.o. girl with primary amenorrhea. Breast development is Tanner 2, although she has axillary and pubic hair of adult type. O/e no palpable masses in the abdomen, vaginal examination is not performed. She is short (like 140 cm?). a. Mellerian dysgenesis b. Ovarian dysgenesis c. Pitutary tumor d. PCO 21. G2,P1 who had previous child delivered by CS, just gave birth per vaginum for the second child. 5 minutes before this delivery FHT dropprd to 70 per min, newborn was not well, resuscitation started. Woman is still bleeding. Despite normal separation of placenta, she has lost 1000 ml already. BP 100/60, pulse 115. What is the cause? a.inversion b.rupture c.atony

22. A 68 yo comes for a routine visit and says her daughter is pregnant. What vaccination would you recommend? a. DTPa b. Hemophilus influenzae vaccine c. Pneumococcal vaccine 23. A mother brings her child for MMR and is worrying that her son is allergic to eggs. What is your advise? a. MMR is grown not on the eggs b. hospitalize her son and administer vaccine in parts under supervision c. Cancel vaccination 24. A 25 yo man comes for routine for some reason. It is a good time for what screening? a. Testicular tumor b. Non-melanotic skin cancer c. BP d. DM 25. A 13 year child was removed from biological parents for some reason. Now she is with foster family. She is playing most of the day with her imaginary friend. She doent talk a lot. She is very picky with food and eats only particular dishes. At this moment she is at risk of developing what? a. substance abuse b. sexual abuse c. anorexia nervosa 26. 40 yo alcoholic and smoker complains of a 2 cm painless lump on the left tonsil. No other signs and symptoms described. What is the most likely dx? a. Squamous cell carcinoma b. nasopharyngeal cancer c. body/aneurism on the carotid artery d. mts from some place e. non-Hodgkin lymphoma 27. A child with small VSD goes for tonsillectomy. No allergy. What is prophylaxis? a. amoxicillin Other options are antibiotics. No option of no prophylaxis. 28. How would you establish correlation between a large number of naevi in population and development of melanoma? a. case- control b. cohort c. RCT d. case study e. cross-sectional 29. 45 yo woman with painful, round, firm 2 cm lump in the breast. What is the most likely dx? a. carcinoma b. lipoma c. fibroadenoma d. cyst

30. Patient with coxarthrosis. What is your advice about walking stick? a. keep in R arm, advance it with the R leg stepping forward b. keep in R arm, advance it with the L leg stepping forward c. keep in L arm, advance it with the R leg stepping forward d. keep in R arm, advance it with the L leg stepping forward 31. A child has fever and purpuric rash a few days ago. Today his mom is feeling unwell, fever, slight neck stiffness. CSF analysis of mom shows 15*10^6 mononuclears, glucose 3.2 mmol/L, protein 0.45 g/L. What is the most likely cause? a. Meningococcal meningitis b. Pneumococcal memingitis c. Viral meningitis 32. Neonate with hyaline membrane disease. Dyspnoea after birth, O2 requirement increased from 40% to 85% during last hours. Nothing said about cyanosis. a.cyanotic heart disease b.pneumothorax c. hyperviscocity syndrome 33. 13 y.o girl with intermittent abdominal pain. Urine analysis shows 10 WBC (N<20). Culture gave pure growth of E.coli 10^5. Management? a. oral nitrofurantoin b. nitrofurantoin cefaclor (I have red few times, and its written like this) c. ciprofloxacin d. no treatment required 34. 65 y.o. woman with occasional urine incontinence. Urinalysis no WBS, culture E.coli growth 10^6. Management? a. 4 options of antibiotics b. no treatment required 35. A 25 yo man with inguinoscrotal swelling that disappears almost completely when he is supine. Dx? a. Varicocoele. b. Direct inguinal hernia 36. 65 y.o. lady has frequency, urgency occasional urine incontinence (nothing sid aboud dysuria). WOF most likely will determine the cause? a. Urine microscopy and culture b. urodynamic studies c. Blood glucose 37. A 60 yo man with no complaints (?). On DRE prostate is normal. PSA is 3.0 (n<4.0) On 12direction USG-guided biopsy 1 locus pathology showed adenocarcinoma of Gensel (?) 4 stage. What is the management? a. continue surveillance b. transurethral prostatectomy c. radical prostatectomy d. radiotherapy e. brachitherapy

38. What part of brain do you test on MMSE with overlapping pentagons? a. Non-dominant parietal lobe 39. A lady sees ocean waves coming towards her and then stares blankly. In what part of brain MRI is most likely to find pathology? a. Posterior occipital lobe b. Non-dominant temporal lobe c. Dominant temporal lobe d. Frontal lobe e. Temporal lobe 40. a 60 y.o. patient complains of fatigue and tiredness. Some non-specific symptoms described. To tell you the truth, I do not remember the stem, because there was huge blood analysis: Hb low RBC low PLT low WBC 5.0 (N 4.0-10.0) Different forms of neutrophils from metamyelocytes to mature forms. Lymph, Eo, Bas, Mon normal. If I am not mistaken, in this question they mentioned rouleux cells formation after blood count. Dx? a. Chronic aleukemic leukemia b. multiple myeloma 41. Athlete had a blow out trauma of abdomen. Pain in LUQ. Stable. In few hours complains of shoulder pain and BP starts dropping like 100/60, tachycardia. WOF is the next step in management? a. USG abdomen b. CT abdomen 42. A 4 y.o. boy comes with intermittent abdominal pain. Usually it lasts for 12 hours, sometimes he is vomiting during this time, then the pain goes away spontaneously. O/e no abnormalities mentioned. Today he is also complaining of the left flank pain. WOF will help you in dx? a. CT abdomen b. Erect and supine X-ray of abdomen c. USG abdomen during the episode d. Micturition cystogram e. Barium meal and follow through 43. A 50 y.o. patient after knee replacement. On the 4th POD the develops chest pain and dyspnea. ABG: pO2 90 (N 95-100 mm) p CO2 31 (N 35-45) HCO3 21 (N 22-28) pH 7.32 (N 7.35-7.45) What is the next step in management? a. Oxygen by Hudson mask b. CTPA c. ECG d.CXR 44. Patient presents with a red eye and photophobia. Dx?

a.Keratitis 45. Patients ate chicken and a small bone stuck in his throat and he feels somewhere on the neck. What to do? a. Indirect laryngoscopy 46. A 4 y.o. girl fell out from the tree. At that moment urinalysis showed proteinuria +, that disappeared in 1 week. What could it signify? a. a reaction of the body to trauma b. hidden pathology of urinary tract c. kidney disease 47. Mom brings her 16 yo daughter for an appointment about knee pain. You see the girl privately and she requested a test for chlamydia which you did. The test came back positive. In few days mom call to your clinic as her daughter asked to organise follow up on appointment (?). What would you say? a . tell her test result b."I cannot discuss anything about your daugher results with you" (There was no please). c. "Please, ask your daughter to call for results" d. "Please, bring your daughter for another appointment" 48. A young lady with depression refuses to eat and drink. You have to do ECT. She doesnt dive you consent. Management? a. Take consent from husband b. Take consent from Mental Health Tribunal c. no need of consent as it is life-saving procedure d. insert a nasogastral tube and feed her through this 49. A 4 y.o. girl presents with URTI. In urinalysis protein or blood +. What is your next step? a. Renal biopsy b. Creatinine, urea, electrolytes c. Repeat analysis when she gets better. 50. A man slept on his arm all night in the chair, In the morning it doesnt move properly and hurts. Site of lesion? a. Brachial plexus 51. A 65 y.o. complains of pain in the anterior aspect of the pelvis after the fall. On X-ray fracture of one of the anterior pubic rami. What is the management? a. Bed rest for 2 weeks b. Mobilize with brace c. Mobilize as tolerated d. Surgical fixation 52. Picture of anterior glenohumeral dislocation. Treatment? a. Close reduction b. Paracetamol c. Sling 53. A 35 y.o. lady complains of hot flushes. Hormonal profile: Estrogene low FSH high

Other hormones i did not even look at. Treatment? a. HRT 54. A 35 y.o. woman with intermittent hot flushes that do not disturb her a lot. (And I had an impression that it is not a primary urogenital pathology). Menses are regular. Her hormonal profile shown and all E is low, other hormones (TSH, LH, FSH, Prolactin) are either borderline low-normal or low. What of the following will determine the dx? a. Vaginal USG b. MRI of the head all the option were related to OB&G, no option of TFT or smth like that 55. A 17 y.o. football player presents with gynaecomastia. He is on inhaled steroids for asthma. What is the cause of his gynaecomastia? a. normal adolescence b. steroids c. anabolic 56. A young athlete presents with palpitations after marathon. What ECG would you expect? (5 ECG strips given) a. sunis arrhythmia (not SVT, as different RR intervals, and P wave is present before every QRS) b. atrial flutter with variable block c. VTach d. AFib e. 1st degree heart block 57. A patient presents with chest pain of 2 hours onset in the metropolitan hospital. ECG showing lateral STEMI in I, AVL and V5,V6. Morphine, Oxygen, Nitrates, Aspirin given. What is the next step? a. tPA b. Coronary angiography 58. A 60 y.o. man develops lightheadedness and palpitations. He has hx of thyroid disease and wellcontrolled heart failure. He is on thyroxine, ACEI, diuretic. ECG is given clearly showed AFib. What is the next step? a. Cease thyroxine b. Start digoxine c. Start b-blocker d. Start verapamil 59. ECG of 1st degree heart block given and bradycardia around 50-60. A 30 yo lady complains of proximal shoulder girdle pain bilaterally. What is the next management? a. Pacemaker b. TFT c. Atropine 60. A lady in her 20s with lightheadedness (and ECG given heart block 1st degree, I think). When you perform a table test (?) after head tilt for few minutes her pulse drops to 50 and BP to 70/40. What is the management? a. Pacemaker b. Atropine c. b-blocker

61. An ECG strip from one lead given. I have seen this ECG when pericarditis was described smiley face ST elevation. Also, it seems that bradycardia is present. Anyway, I didnt get what pathology they want me to see: bradycardia, ST elevation or tall T-wave (although it was not peaked T wave of hyperkalaemia).

Patient is on numerous medications: aspirin, amiodarone, nitrites, amlodipine. What is the offensive drug combination? I tried to figure out what combination could cause either brady or hyperkalaemia. But none of them was suitable. I even will not provide you any options because I do not remember them, I just picked one randomly. 62. A young guy with schizophrenia. What is the best option to start the Tx? a. Olanzapine 63. A middle-aged lady had psychosis for 12 months. Olanzapine was prescribed and she develops DM. WOF will you check? a. Fasting lipids b. Urea&creatinine c. TFT 2 other incomprehensible options 64. A 50 y.o. woman complains of loss of interest in life, she is tearful. She also admits of cutting herself. In the conversation she mentions that life is not worth living. (You cannot clearly understand if she is suicidal or not). After treating caring her wounds on the wrist, what is the management? a. Start sertraline b. Contact local mental health crisis team c. Involuntary admission d. Organise regular follow up 65. A young man sleeps all day long, doesnt want to do anything or socialize. It is going on for 6 weeks after his girlfriend broke up with him after 3 months of dating. He also has a very stressful job that drives hes fed up with. What is the management? a. discuss benefits and risks of antidepressants b. advise him that his feeling are quite normal and understandable c. advise to change the job 66. Stem clearly describing autism with language delay, repetitive acts and social isolation in a toddler. 67. OCD case. SSRI prescribed, partial response. Patient would like to try some non-medicament therapy. What is you advice? a. refer him for long-term insight-oriented psychotherapy b. advise him that compulsions are the form of anxiety reduction behaviour no option of exposure-control therapy or smth similar.

68. A young man has depression. Partial response to SSRI but he still complains of anhedonia. What would you recommend? a. scheduled pleasures therapy b. some well-sounding form of psychotherapy 69. A patient with recently placed stent and started on clopidogrel presenting for varicose vein surgery. Management? a. defer the surgery for 12 months, continue clopidogrel and then stop it 2 weeks prior the surgery b. stop clopidogrel, proceed to surgery b. stop clopidogrel 7 days prior to surgery, PLT transfusion, proceed to surgery c. continue clopidogrel, proceed to surgery 70. Elderly patient on clopidogrel (not mentioned for what reason) is admitted with neck of femur fracture. PLT count is normal, although easy bruising. Management? a. Stop clopidogrel for 7 days and then proceed to surgery b. Immediate surgery c. Stop clopidogrel, PLT transfusion, then proceed to surgery 71. A lady is admitted to hospital and she is very demanding, verbal behaviour, unhappy about the ward. Tells you I am sure you as a doctor understand me and will be able to organise me a private ward, these nurses do not understand. What do you suspect here? No option of splitting. a. Narcissistic personality disorder b. Borderline personality disorder c. Passive-aggressive d. Dissociation e. Some mental illness 72. Mom brings her girl with lead poisoning. They live in the mining city. Lead in blood twice higher than normal. Your advice? a. Move the family from the city b. Refer to chelation 73. Where could be the primary malignancy in 60 yo woman assessed for anemia? a. Caecum 74. A 40 yo man asks for prostate cancer screening. Management? a. DRE+PSA b. Discuss pros and cons of screening 75. A 9 month old with fever, dry cough, breathlessness, grunting, wheezes. Admitted, oxygen and IV fluids given. What is your next step? a. steroids b. nebulised adrenaline c. antibiotics d. observation 76. Pt with fever, cough. Chest auscultation: crepitations in the base of the right lung. Xray right lobar pneumonia . Treatment? a.amoxiclav

b.doxycycline c. procaine penicillin d.azithromycin 77. Agitated patient with alcohol withdrawal to the point when the security is struggling to keep him. What is your management? a. IV diazepam b. IV thiamine c. IM haloperidol 78. 13 yo girl living alone comes for abortion. Admits that she was raped. What is next? a.refer to pregnancy termination b.inform police c.inform sexual assault agency 79. A patient with vision 6/24. You prohibited him to drive. He went to another doctor who permitted him to drive. Now he comes to you again and asks you to change your conclusion. Your management? a. Call to police b. Call to this doctor to discuss the issue c. Report the case to Road and Traffic department d. Ask him to drive only is someone else is in the car 80. A 4 y.o. fell of the tree. No LOC. Vomited on the spot. On presentation he is ok, no neurological signs. What is the next step? a. Admit him for 24 h observation b. CT head c. Discharge him as no pathological sings found d. Observe for 4 hours and let him go home 81. Patient is on sertraline and nifedipine. When he stands up tachycardia. What is the cause? a. Drug interaction 82. Patient is on risperidone and lithium. Acne and weight gain. Cause? a. Lithium b. Risperidone c. Lithium and risperidone d. Diabetes insipidus 83. Patient is on multiple medications. Blood count shown Hb low, MCV 70. What is the cause? a. Aspirin b. Diclofenac c. Chloroquine 2 options I do not remember as I picked one randomly. 84. A young girl collapsed after exercise. Hx of fathers death at 28. What is next Ix? a. ECHO

85. Patient presents with preauricular swelling. Sometimes it hurts when he eats. Also he developed dry eyes and poliarthritis 2 years ago. USG done no specific findings, just swelling, FNAC inflammatory cells, nothing specific. What is the next Ix? a. Sialography b. MRI face c. CT head d. Biopsy of the swelling 86. Patient comes from some trip with fever and chills, jaundice and RUQ pain. In blood ALP& GTT high. What is the management? a. ERCP 87. 78 y.o. resident suddenly developed diarrhea of 4 days duration. Stool culture is negative. Few days later authorities announced Salmonella outburst. You patient is not improving despite the treatment. What is your next step? a. Stool culture b. Blood culture c. Colonoscopy 88. A medical student sustained needle-stick injury. Blood from patient and student is taken. Result of student: HbSAg positive. Management? a. Immunoglobulin b. Immunoglobulin and vaccine c. Vaccine d. Lamivudine e. Nothing, but refer to counseling 89. Patient on dialysis is well during dialysis but between the sessions hast HTN. What would you give give? a.antihypertensive b.frusemide 90. Patient on dialysis presents with dyspnea. What would you do initially? a. Contact dialysis team b. Give 100 mg frusemide 91. Afrer MVA patient is short of breath, blow out trauma to the chest. BP 90/60, pulse 110. On auscultation breath sound diminished, dullness (not hyperresonant) on percussion. What is ne next step? a.needle thoracocentesis b.chest tube under-water seal drainage 92. Elderly man with difficulty initiating urination and dribbling at the end. No night frequency. Dx? a. BPH 93. You are intern. Patient wishes you to witness her will in the presence of lawyer. a. Witness will b. Refuse to witness c. Ask surgical registrar if he can do it d. Ask the patient if he is happy with intern witnessing his will

e. seek legal advice 94. A 20 yo patient is complaining that smth funny is going on around him, but he doesnt understand exactly what. Smth is about to happen. What is the reason? a. schizophrenia prodromal b. idea of reference c. depression 95. What of the following drugs have the highest potential of fetal anomaly? a. methadone b.diazepam c. methamphetamine d. marijuana 96. Mother bring her child for consultation because he behaves and doesnt listen to her, makes her to lose her temper. She beats him with the stick as a punishment and locks his door for hours. What will you do? a. report to child protection agency b. send her for good parenting programme c. ask further what could be the cause of childs misconduct. 97. What is the most common reason of not having enough milk for breastfeeding in a new mom? a. not putting a baby to the breast to eat frequently enough b. not putting a baby to the breast to eat long enough 98. 6 yo child presents with asthma attack. Mom has given 6 puffs of salbutamol for him. He improved, but now is worse again. He talks in words. Next management? a. give steroids orally b. give ipratropium puffer c. give inhaled steroids d. give another 12 puffs of salbutamol