.

A young medical student, who has started his clinical postings, comes to because his
colleagues noticed a yellowish, tinge to his sclera. On examination he is normal except for the
yellow sclera. Investigations showed:
Total bilirubinElevated
Direct bilirubin Elevated
Direct bilirubin > (Total Direct bilirubin)
Which of the following is most likely?

a) Gilberts syndrome
b) Haemolytic jaundice
c) Ca Pancreas
d) Hepatitis
e) Carotenemia

2. A young man has a syncopal attack while weight lifting. He has had similar episodes twice
before. His father died of cardiac disease. What is the most appropriate management?

a) Holter monitor
b) Echocardiogram
c) Stess test
d) BP in supine & lying down
e) CT scan

3. A 23-years old young lady complaints of lethargy and weakness. She has sore throat and 3
days ago she has returned from JAVA where she suffered from fever recently. Her weakness is
due to --

a) TB
b) Tonsillitis
c) Post viral fever fatigue
d) Infectiuos mononucleosis

4. A 29-year old woman, 6 months previously had pleurisy, in the last 2 years mouth ulcers,
now develops stiffness and oedema of the wrist and MCP joints; in the morning which
disappears afterwards. The most likely cause?

a) Rheumatoid arthritis
b) Crohns disease
c) Ulcerative colitis
d) SLE
e) Dematomyositis

5. Which of the following most commonly causes pulmonary hypertension & corpulmonale?

a) Emphysema
b) Bronchiectasis
c) Pulmonary embolism
d) Pneumothorax
e) Foreign body

6. Which of the following is a common side effect of calcium channel blockers?

a) Peripheral oedema
b) Angio-oedema
c) Headache
d) Insomnia
e) Cough

7. In diabetic neuropathy you can find each of the following except?

a) Bradycardia
b) Urine retention
c) Impotence
d) Diarrhoea at night
e) Foot ulcer

8. All of the following are true about duodenal ulcer ,except?

a) Hunger pain
b) Loss of appetite
c) Weight gain
d) Pelapses & remissions
e) Relief by antacids

9. An 18-year-old student presents with jaundice, sore throat and dark urine. There was no
hepatitis contact, no IV drug use, and no recent travel history. Bilirubin 80, elevated Gamma-
GT, AST 300, ALT 400 and albumin normal. What is the most likely diagnosis?

a) Hepatitis A
b) Hepatitis B
c) Infectious Mononucleosis
d) Cholangitis
e) Acute Cholecystits

10. How would you differentiate between haemolytic anaemia and anaemia of chronic blodd
loss?
a) Decrease haptoglobin
b) Increased reticulocyte count
c) Megaloblastosis
d) Polychromasia
e) Raised ferritin

11. A 65-years old presents with confusion. The blood test show rerum Na 165, Urine
osmolality 205. The most likely diagnosis is?

a) SIADH
b) Diabetes Mellitus
c) Diabetes Insipidus
d) Water intoxication
e) Renal failure

12. A 70-years old woman presents with a 3-month history of fatigue, generalized
lymphadenopathy, and hepatosplenomegaly. What is the most likely diagnosis?

a) Hodgkins lymphoma
b) Non Hodgkins lymphoma
c) Acute lymphocytic leukaemia
d) Chronic lymphocytic leukaemia
e) Chronic Myeloid leukaemia

13. Regarding immunology, which of the following is correct?

a) Natural killer cells are a subset of T cells

b) B cells produce first Ig M and later Ig G
c) Ig E is involved in mucosal protection
d) Opsonization
e)
14. A 60-years old obese man, on ACE inhibitors for hypertension, Metformin & glibenclamide
for diabetes, benzodiazepines & TCAs for depression & insomnia, now complaints of
impotence. Which drug is the most likely responsible for the impotence?

a) Glibenclamide
b) Metformin
c) Tricyclic antidepressants
d) Benzodiazepine
e) ACE inhibitors

15. A 30-year old bisexual male, presents with clear urethral discharge, mouth ulcers,
arthralgia, fatigue and sausage like fingers. Culture was negative. What is the most likely
diagnosis?

a) Reiters disease
b) Bechets disease
c) Ankylosing spondylitis
d) SLE
e)

16. A 56-year old man presents confused. He cannot abduct his eyes, there is a slight problem
with elevating his eye and nystagmus is present throughout. Most likely diagnosis is?

a) Wernickes encephalopathy
b) .
c) .
d) .
e) .

17. A 23-years old university student has fever, arthralgia, lymphadenopathy & malaise. ALT,
AST & GGT are elevated. Peripheral smear shows atypical lymphocytes. The diagnosis is?

a) Hepatitis A
b) Hepatitis C
c) Infectious mononucleosis
d) CMV
e) ALL
18. Hypokalemia occurs in all except?

a) Thiazide diuretics
b) Pyloric stenosis
c) Chronic renal failure
d) Laxative abuse
e) Hyperaldosteronism
19. A 22 year old man developed haematuria and slight swelling of the face. On examination
BP-150/80 mmHg, RBC & hyaline casts are present in the urine. Most likely diagnosis?

a) Nephrotic syndrome
b) Glomerulonephritis
c) Pyelonephritis
d) Ig A nephropathy
e) Renal tubular necrosis

20. A 37-years old woman has unilateral exopthalmos. Which of the following is the most
likely cause?

a) Glaucoma
b) Nasophryngeal tumour invading the orbit
c) A neoplastic lesion in the lamina cribrosa
d) Thyrotoxicosis
e) Infection of the frontal sinus
f) Maxillary antral tumor

21. All of the following are side effects of prednisolone except?

a) Hirsutism
b) Lymphopenia
c) Leucocytosis
d) Osteomalacia
e) Weight gain

22. A patient you treated for duodenal ulcer with Helicobacter pylori for 1 week with treiple
therapy. He is asymptomatic now. Which of the following is the best follow up?

a) Urea breath test

b) Endoscopy
c) Serology
d) Histological examination
e) Culture

23. A 20-year old man is found to have HIV. What does this indicate?

a) He has AIDS now

b) He has got lifelong infection & infectivity
c) He needs to start pneumocystis carinii prophylaxis
d) He requires to start AZT therapy
e) He can transmit through saliva now

24. A 70-year old woman complaints of fatigue. Blood picture---

MCV 118, Hb decreased, WBC decreased, platelets decreased, Hypersegmented polymorphs
present. The most likely diagnosis?

a) Autoimmune haemolytic anaemia

b) Pernicious anaemia
c) Anaemia of chronic disease
d) Anaemia due to silent gastrointestinal bleeding
e) Leukaemia(CML)

25. A 68 years old man with COPD was brought to your surgery from nursing home by
ambulance. On his way to hospital he received O2, 10 L/m by mask. He is still unarousable
and his ABG most likely--

a) Ph 7.29 PaCO2 65 PaO2 85

b) Ph 7.15 PaCO2 50 PaO2 68
c) Ph 7.25 PaCO2 25 PaO2 100
d) Ph 7.35 PaCO2 40 PaO2 40
e) Ph 7.45 PaCO2 85 PaO2 40

26. A 24-year old female has abdominal pain every week. Sometimes she has face & lip
swelling. Her mother and sister also have this. What would you do to establish a diagnosis?

a) Measure Cl esterase
b) Check for food allergies
c) Check Pb levels
d) Ig A deficiency

27. A patient complaints of headache, vomiting & papilloedema. Which of the following is the
most likely cause?**

a) Giloma of the frontal lobe

b) Tumour obstructing the 4th ventricle
c) Pituitary tumour
d)

28. An elderly patient has acute onset unilateral deafness, tinnitis & vertigo. What is the
diagnosis?

a) Menieres disease
b) Acoustic neuroma
c) Vestibula neuronitis
d)

29. A patient has calcium oxalate renal stones. What is the most appropriate managemant?

a) Allopurinol
b) Alkalinize the urine
c) Stop taking food with calcium
d) Give calcium

30. Heparin therapy is monitored by which of the following tests?

a) APTT
b) INR
c) Bleeding time
d) Serum fibrinogen

31. A middle-aged man is brought to your surgery with a history of being bitten by a black
snake. On examination there are scratch marks on the lower leg and no other symptoms.
What is your management?

a) Reassure and send him home

b) Excise wound
c) Administer antivenin immediately
d) Apply Tourniquet
e) Observation and antivenoum if necessary
32. Opening snap indicates:

a) Mitral valve mobility

b) Atrial fibrillation causes disappearance of the opening snap
c) Replaces S3
d) Best heard at 2nd right intercostals space
e) Remains unaltered despite progression of the disease

33. A man presents with a history of treatment with Sulphasalazine. The least likely
complication for the condition he was treated for would be?**

a) Pericholangitis
b) Iritis
c) Erythema nodosum
d) Peripheral neuropathy
e) Ankylosing Spondylitis

34. In contact dermatitis, which is common?

a) Contact with plants

b) Can be treated by topical steroids
c) Can be treated by oral steroids
35. All of the following are present in interstitial fibrosing alveolitis except?

a) clubbing is common
b) Normal FEV1/FVC does not exclude the diagnosis
c) Diffuse expiratory crackles
d) Decreased VC

36. A 72-year old man with a history of non-small cell lung cancer now complains of lethargy,
constipation and thirst for the past few weeks. What is the most likely problem?

a) SIADH
b) Ectopic parathormone production from the cancer itself
c) Metastasis to the brain
d) .
e)

37. A 64-year-old male complaints of pain behind the right eye, associated with lacrimation,
which appears every morning & disappears in the afternoon, for the past 2 weeks. Had similar
episodes previously. Which is the prophylactic treatment?**

a) Methysergide
b) Ergotamine
c) Acetozolamide
d) NSAID
e) Sumatriptin

38. A patient has diarrhoea, fatigue and pallor. Blood picture shows MCV 110. What is the
diagnosis? (DAV 642)

a) Pernicious anaemia
b) Crohns disease
c) Gluten-sensitive enteropathy
d) Tropical sprue

39. A 60-year-old man, who smokes 60 pack per year, presented with shortness of breath,
was given 28% oxygen by mask. 30 minutes later, his ABG was PaO2 68, PaCO2 60. What
would you do next?

a) Stop oxygen and check ABG after 30 minutes

b) Continue oxygen until normal PaO2 is eached
c) Immediate intubation & ventilation
d) Give immediate antibiotic cover against gram negative bacteria
e) Start aminotryptillin iv infusion

40. Which of the following conditions is most likelyto become chronic?

a) HAV
b) HBV
c) Hepatitis C virus
d) EBV
e) Cholecystitis

41. A young man presents with pleuritic chest pain and cough. On examination there is
dullness on percussion and brochial breathing over the right lower zone, posteriorly. Which of
the following is the most likely diagnosis?

a) Right lower lobe consolidation

b) Right lower lobe collapse
c) Pleural effusion
d) Asthma
e) TB cavity

42. Erythema nodosum occurs in all except?

a) Steptococcus infection
b) Rheumetic fever
c) TB
d) Leprosy
e) SLE

43. A young man, who had taken some intravenous drug, was found unconscious, with 3
breaths per minute and constricted pupils. Which of the following would be the most
appropriate treatment?

a) Naloxone
b) Atropine
c) Scopalamine
d) Methadone
e) Naltraxone

44. Amyloid can occur in each of the following except?

a) Rheumatoid arthritis
b) TB
c) Leprosy
d) Chronic active hepatitis
e) Multiple myeloma

45. A 68-years old female presents with a 2-week history of unilateral headache and an ESR
80 mm/hr. The most appropriate treatment is?

a) NSAIDs
b) Aspirin
c) Carbemazepine
d) Prednisolone
e) Ergotamine
46. A female aged 23 years, presented with proteinuria. There is a previous history of enuresis
till 13 years of age. Her sister also had enuresis as a child. The history is suggestive of which
of the following?

a) Chronic glomerulonephritis
b) Reflux nephropathy
c) Congenital nephritis
d) Polycystic kidney disease
e) Analgesic nephropathy

47. A patient, who had been taking a particular drug, now presents with haematuria. The drug
is most likely?

a) Calcium channel blocker

b) Digoxin
c) Naproxen-NSAID
d) .
e)

48. A person presents with alpha antitrypsinogen deficiency. What is the most likely
association?**

a) One parent has died of emphysema

b) Limited to bronchioles
c) Uninhibited protease action
d) .
e)

49. A 65-year-old man presented with confusion. Laboratory findings showed hypercalcaemia,
calciuria, and phosphates within normal limits. Which is the most likely diagnosis?

a) Malignancy(osteolytic metastasis)
b) Primary hyperparathyroidism
c) Idiopathic hypercalcaemia/hypercalciuria
d) Pagets disease myeloma

50. A 28-year old male presents with distal weakness and atrophy of the small muscles of
both hands(interossei, lumbricals, thenar & hypothenar). What is the most likely diagnosis?

a) Multiple sclerosis
b) Bilateral median nerve palsy
c) Syringomyelia
d) Bilateral ulnar nerve palsy
e) Brainstem infarction

51. A person with severe aortic stenosis has a systolic gradient of 55 mmHg. What other
feature required suggesting the severity?

a) LV ejection fraction
b) LV end diagnosis pressure
c) Cardiac output
d) LV hypertrophy
e) LV end systolic pressure

52. An elderly man presents to the emergency dept with chest pain. No ECG changes and
cardiac enzymes are normal. What is true?

a) If ECG is normal he does not have a cardiac problem

b) He should have an immediate stress test done
c) Intravenous nitrates & heparin are not indicated
d) No follow up ECG is required
e) Streptokinase is indicated if there are ECG changes

53. The most common cause of travellers diarrhoea is?

a) Salmonella Typhi
b) Shigella
c) Enterotoxic E. Coli
d) Staphylococcus
e) Giardia Lamblia

54. Taste sensation of the anterior 2/3 of the tongue is carried by which nerve?

a) V
b) Facial nerve(VII)
c) IX
d) X
e) XII
55. Which of the following is least likely to cause facial nerve palsy?

a) Skull fracture
b) Mastoiditis
c) Chronic parotitis
d) Parotid tumour
e) Acoustic neuroma

56. A patient has massive ascitis and in the fluid malignant cells are found. Which of the
following is a possible finding?

a) Splenomegaly
b) Hepatomegaly
c) Supraclavicular swelling
d) On digital rectal examination, nodules can be palpated

57. The single most reliable test for Haemochromatosis is?

a) Red cell mass

b) Serum iron
c) Serum ferritin
d) Serum Transferrin
e) Transferrin saturation

58. In which of the following, is administration of immunoglobin as a prophylaxis not useful?

a) Hepatitis A
b) Hepatitis B
c) Rubella
d) Mumps
e) Varicella

59. In Von Willebrandts disease you will find:

a) Increased platelet count

b) Increase bleeding time ( Bleeding time is prolonged, platelets show reduced adhesion and
levels of Factor VIII are low )
c) Normal APTT
d) .
e)

60. 12 years old boy came with severe dyspnoea and afibrile condition. O/E you found R/R-
40/min, Pulse- 130/min. There is O2 saturation at room air of 85%. WOF will be appropriate--

a) Give salbutamol $ hourly at home

b) Give salbutamol and aminophyllin 4 hourly at home
c) Give him O2 and send him to hospital by an ambulance.

61. All the following drugs are proven to decrease the marality in myocardial infection, except?

a) Aspirin
b) ACE inhibitors
c) Beta blockers
d) Nifedipine
e) Streptokinase

62. A patient with COPD came in the emergency department with severe dysponea, 28% O2,
8 liter was given by mask. After one hour you did arterial blood gas & you found that PaO2
level was 42 mm Hg, and Pa CO2 level was 68 mm Hg. WOF you will do now?

a) Increase O2 inhalation by mask

b) Increase I/V fluid
c) Repeat arterial blood gas level
d) Ask the patient for intubation and ventilation

63. A 50 yrs old lady admitted with Atrial Fibrillation.Blood tests show :

a) TSH : decrease (Note:DxThyrotoxicosis

b) T3: increase if all decrease, Dx pituitary disease)
c) T4: increase
Your management will be

a) Total thyroidectomy
b) Subtotal thyroidectomy
c) Radioactive iodine
d) Neomercazole(Carbimazole)
e) Echo

64. An office clerk with high blood pressure. He is obese and he takes 3-4 cups of coffee
everyday. WOF is not correct---

a) Consumption of coffee contributes greatly to his BP

b) Reducing body weight will help to reduce his BP
c) In 90-95% cases no cause is found for BP.
d) He should be advised about safe level of drinking alcohol.

65. A male presents with a sudden onset of vertigo and nausea. During the attack he has
deafness. WOF is your diagnosis is --

a) Positional vertigo
b) Acoustic neuroma
c) Labyrinthitis
d) Basilar artery infection

66. Photograph 1: Shows a skin lesion on the forearm. Slightly raised, red plaque, slightly
scaly. What is the diagnosis?

a) Lichen planus
b) Discoid eczema
c) Squamous cell carcinoma
d) Psoriasis
e) Contact Dermatits

67. Photograph 2: Shows a skin lesion, pinkish brown colored lump. The lesion in the picture
was found on the forearm of a young male. 2 weeks later he develops pneumonia associated
with crepitation through out both lungs.WOF organism is causing this lesion-

a) Staphylococcus pneumonia
b) Staphylococcus Aureus
c) Mycoplasma Pneumonia
d) Pneumocystis carnii
e) Mycobacterium Avium

68. Photograph 3 : X-ray showing an open fracture of the fibula & tibia. A young man, after an
accident on his motorcycle, presented with 3 cm of bone protruding through the skin of his
leg. What is your next line of management?

a) Internal fixation of the fracture immediately

b) Skin closure of the wound immediately to prevent infection
c) Reduce the fracture and apply plaster of paris
d) Give tetanus toxoid IM & antibiotics iv
e) Debribement is only indicated when the wound is severely contaminated

69. Photograph 4 : A diabetic man comes to see you. His right leg below his knee is red &
shiny. What is the best initial management?

a) Penicillin & flucloxalillin

b) Metronidazole
c) Ampicillin
d) Ampicillin & gentamicin
e) Ampicillin, gentamicin & metronidazole

70. Photograph 5: Shows the head & neck of a female. There is a large swelling at the center
of the neck and no exophthalmos of the eyes. What is the most likely diagnosis?

a) Multinodular goiter
b) Ca thyroid
c) Sub acute thyroiditis
d) Thyroid cyst
e) Graves disease
71. Photograph 6: Shows a red hemispherical lesion on the back of a hand. Some
brownish/necrotic tissue present at the border of the lesion, no visible punctum. What is the
diagnosis?
a) Malignant Skin Lesion
b) Inflamed keratoacanthoma
c) Infected lipoma
d) Lichen planus
e) Solar Keratosis

72. Photograph 7: X-ray showing colles fracture.

An elderly person sustained a fall on an outstretched hand. What is true?

a) Median nerve function should be assessed

b) The plaster cast is not suitable to correct the fracture in the elderly
c) Immediate internal fixation
d) Plaster cast from below elbow to MCP joint, for at least 10 weeks
73. Photograph 8 : showing a deformed hand(swan neck deformity).
Which of the following is true?

a) It is due to erosion & rupture of the flexor tendons

b)It is more common in rheumatoid arthritis than oseoarthritis
c) It is due to Ulner nerve compression

74. Photograph 9 : A young child with a patch of hair loss on the scalp. Some small flakes of
skin are present. What is your diagnosis?

a) Tinea
b) Psoriasis
c) Alopecia areata
d) Trichotillomania
e) SLE

75. Photograph 10 : A man came with his wife. A slow growing soft large lump on his back in
between the scapulae remains in that position for last 10 years. WOF is your MX ----

a) Observation and reassurance

b) Opinion from specialist
c) Radiotherapy
*********

1. A man is suffering from back pain, so he is sleeping on a hard wooden bed for last three
weeks. Now he complains of pain in his right elbow. WOF is the cause of the pain in elbow--

a) Olecranon bursitis
b) Injury to the insertion of flexor muscles
c) Injury to the insertion of extensor muscles

2. During an operation spleen was accidentally injured and spleenectomy was done to
minimize the complications. Next morning the patient asked you about the success & progress
of that operation. As an intern you will tell him----

a) Every thing has gone smoothly

b) Your spleen has been removed
c) During the operation procedure complication arised and to minimize further complication it
was necessary to removed your spleen.
d) Only the surgeon could tell you about your operation.

3. A young man injured in a road traffic accident (RTA) has fractures of three ribs anteriorly on
the left and a minimal left pneumothorax. Peritoneal lavage is positive for blood, and
laparotomy is planned for intraperitoea hemorrhage. The most important step prior to
laparotomy is ----

a) Insertion of a nasogastric tube.

b) Insertion of intercostals drainage tube
c) Determination of PaO2 and PaCO2
d) Insertion of a central venous pressure line on the right side.
e) Delay surgery until BP comes to normal

4. After an operation for aortic aneurysm/aortography, there is uncontrollable bleeding from

the site of the grafting. WOF is best to transfuse----

a) Fresh blood
b) Desmopressin
c) Fresh frozen plasma
d) Cryosipitate
e) Factor VIII

5. A man came to you complaining of pain in the leg. O/E you could not find pulse in his leg.
You clinically become sure that there is atherosclerasis or atheroma in the peripheral artery.
This is due to ----

a) Stenosis of femoral artery

b) Thrombosis of Femoral artery
c) Polyarteritis nodosa(PAN)
d) Rupture aneurysm

6. A 42-years old man complaints of pain in his right hand. He tells you that the previous day
he used a chainsaw for long hours to cut trees. O/E you found his right arm is slightly swollen
than other arm, and there is pain too. WOF is most appropriate investigation--

a) Venogram
b) Lymphanogram (Dx: Raynauds phenomenon; due to use of vibratory tools)
c) CT Scan
d) MRI
e) Arteriogram

7. Regarding unilateral undescended testis, which of the following is most commonly

associated?
a) Malignancy
b) Varicocele
c) Ingiunal hernia(Indirect)
d) Hydrocele
e) Torsion of the testis
f) Direct Ingunal hernia

8. A 64-years old man presents with profuse bright red bleeding per rectum. What is the most
like cause?

a) Ca colon
b) Polyp
c) Diverticulosis
d) Duodenal ulcer
e) Haemorrhoids

9. A 50-year old man presents with sudden onset of severe abdominal pain. Which of the
following is least likely to be the cause?

a) Acute appendicitis
b) Perforated peptic ulcer
c) Acute pancreatitis
d) Ruptured abdominal aortic aortic aneurysm
e) Renal colic

10. Which of the following disseminated malignancies has the worst prognosis?

a) Metastatic beast cancer

b) Metastatic choriocarcinoma
c) Metastatic seminoma
d) Hodgkins lymphoma
e) Non-Hodgkins lymphoma

11. Which of the following is the most common cause of bloody discharge from the nipple?

a) Intraductal carcinoma
b) Intraductal papilloma
c) Pagets disease of the braest
d) Fibroadenoma
e) Duct ectasia

12. Hutchinsons melanotic freckle. Which of the following is not correct?

a) Mostly occurs in the elderly

b) Mainly occurs in covered parts of the body
c) Malignant
d) Irregular border
e) Irregular colour (from black to brown)

13. A diabetic patient with an ulcer at the head of the 2nd metatarsal on the sole of the foot.
Which of the following would be the most likely cause?

a) Macrovasclar disease
b) Diabetic neuropathy
c) Infection
d) Varicose venis
e) Hyperglycaemia

14. A 60-year old man presents with 3 days vomiting and loss of weight (3 kg.). Six years ago
he was treated with cimetidine. Over the last 3 months he has had epigastric pain
intermittently, for which he takes aspirin. Vomitus is clear in colour with identifiable food
particles. The likely diagnosis is?

a) Drug induced gastritis

b) Chronic duodenal ulcer disease
c) Ca pancreas
d) Cancer of the cardia of the stomach
e) Pyloric stenosis

15. The most common cause of diarrhoea in bedridden elderly patients is?

a) Ca colon
b) Crohns disease
c) Ulserative colitis
d) Diverticulosis
e) Faecal impaction

16. A female had mastalgia for the last 1 year. Conservative treatment has not worked. How
would you manage this patient?

a) Bromocriptine
b) Danazole
c) Clomiphene
d) OCP
e) NSAIDs

17. With fat embolism, petechiae are most to be seen where?

a) All over the body

b) Pressure dependent areas
c) Subungual
d) Upper part of the body
e) Lower body

18. A 65-year old woman develops acute abdominal pain with distension. There is a history of
12 hours of vomiting and cramping pain. On examination, irregular pulse 120/min, BP-100/60
mmHg, abdomen is tender with guarding and bowel sounds are absent. Rectal examination
reveals a dark bloodstone on the finger. Which of the following is most likely?

a) Perforated peptic ulcer

b) Messenteric arterial occlusion
c) Diverticulosis
d) Perforated appendicitis
e) Ca colon

19. A 21-year old man presents with increasing dysponea, tachypnoea a hyperinflated left
hemithorax with evidence of a mediastinal shift. Your immediate management would be?

a) Insert a water sealed chest drain

b) Intubate
c) Insert a venflon into 4th intercostals space midaxillary line
d) Insert a wide bore needle into the 2nd intercostals space, midclavicular line
20. Which of the following is most likely to be associated with otosclerosis?

a) Normal tympanic membrane

b) Red & inflamed tympanic membrane
c) Tense & transparent tympanic membrane with fluid level behind
d) Blue gray sclera
e) Obstruction of the Eustachian tube

21. Which of the following is true regarding carcinoma of the nasopharynx?

a) Arises from the lymphatics

b) Not sensitive to radiotherapy
c) Responds well to chemotherapy
d) Caused by EBV
e) Locally destructive lesion

22. All are seen in ischaemia of the leg, except?

a) Claudication
b) Pallor
c) Pain on walking
d) Shooting pain down the posterior aspect of the thigh

23. Which of the following is least likely to cause metastasis to the brain?

a) Prostate cancer
b) Melanoma
c) Small cell carcinoma of the lung
d) Breast cancer
e) Renal carcinoma

24. Which of the following is not a feature of uncomplicated haemorrhoids?

a) Bright red bleeding

b) Prolapse of mucosa
c) Purities
d) Pain
e) Mucous

25.Which of the following nerves would be damaged in a mid-humerus fracture?

a) Axillary nerve
b) Radial nerve
c) Musculocutaneous nerve
d) Ulner nerve
e) Median nerve

26. A female complaints of bloating & belching. She is found to have gallstones, which is
subsequently treated by cholecystectomy. Cholangiogram was done during the operation and
was clear (nothing was found). She was symptom free for 1 week, but then the same
symptoms returned. What is the most likely?

a) Pancreatities
b) Cystic duct stump syndrome
c) Stone left in the common bile duct
d) Symptoms are not related to the gallstones
e) Post cholecystectomy syndrome

27. All are true about gallstones, except?

a) Usually asymptomatic
b) Stone in the bile duct presents with clinical sepsis
c) Ususally radiolucent
d)

28. Which of the following is true regarding mammography?

a) More sensitive in premenoposal than postmanuposal women

b) Painless
c) Most useful in woman with a palpable breast lump
d) It has a better pick up rate than self examination
e) Can differentiate between a solid & cystic tumour

29. All of the following would be expected after splenectomy for spherocytosis, except?

a) Transient leucocytis
b) Persistence of anaemia
c) Same osmotic gragility
d) Persistence of spherocytosis
e) Normal life span of the erythrocytes

30. What is the most important aspect in managemant of an open fracture?

a) Antibiotics
b) Intenal fixation
c) Debridement
d) Tetanus toxoid
e) Immobilisation

31. A 35-years-old woman having severe sudden abdominal pain throughout the night wakes
up and passes dark urine in the bathroom. She immediately goes to see the doctor.
Investigations showed:
- bilirubin 5 times normal
- Alkaline phosphatase 3 times normal
- AST & ALT 4 times normal
- S.amylase 2 times normal
What is the most likely diagnosis?

a) Acute cholelithiasis
b) Acute cholecystitis
c) Ca gallbladder
d) Acute choledocholithiasis
e) ?

32. What is true about fistulas?

a) It is a communicating track between 2 epithelial surfaces

b) It is lined by granulation tissue
c) It is a blind track leading from the surface down to the tissue
d) A kind of ulcer
e) ?
33. What is true regarding pain management?

a) Pethidine is best given by calculating mg/kg body weight

b) Pethdine is better than morphine
c) Pethidine should not be repeated within 4 hours
d) Older patients require less, because they tolerate pain better
e) ?

34. You are performing external cardiac massage on a patient who has just suffered a cardiac.
Which of the following provides best indication that resuscitation is effective?

a) ECG
b) Palpation of the radial pulse
c) Color of skin & mucous membranes
d) Size & reaction of the pupils
e) Response to stimuli

35. All of the following are risk factors for breast cancer, except?

a) Early artificial menopause

b) First pregnancy after 35 years of age
c) Early menarche
d) No breast feeding
e) Cancer of the other breast

f) age - peak incidence 45-75 years but any age postmenarche >> 4x
g) country of residence - high in West > 4x e.g. UK, low in East e.g. Japan
h) previous breast cancer > 4x
i) irradiation of chest - shows a linear dose-response relationship 2-4x
j) social class (I vs. V) 2-4x
k) race - more common in Caucasians < 2x
l) previous ovarian or endometrial cancer < 2x
m) early menarche or late menopause < 2x
n) nulliparity or older than 30 years before first child < 2x
o) hormonal supplementation < 2x
p) obesity - oestrogen synthesis in adipose tissue
q) alcohol consumption
In the male, Klinefelter's syndrome is a risk factor for breast cancer.

36. A 32-years old man felt pain in the maxillary area at night, which radiates to the side of
his head. There was water inside his nostrils during the attack. WOF is your diagnosis---

a) Migraine
b) Cluster headache
c) Maxillary sinusitis

37. A 35-years old female came with complaints of wake up during the night with pain in her
right hand & a shooting pain up the arm. She has difficulty using her right hand when carrying
a shopping bag. Examination shows slight thenar wasting. What is your diagnosis?

a) Brachial neuritis
b) Thoracic outlet obstruction
c) Cervical spondylosis
d) Carpal tunnel syndrome
e) Cervical rib

38. A man presents with history of an inguino-scrotal swelling, which disappears on lying
down. What is the most probable diagnosis?

a) Hydrocele
b) Saphena varix
c) Femoral hernia
d) Varicocele
e) Direct inguinal hernia

39. A 25 years old man is awakened during night very severe pain in his right loin. He notices
bright blood in his urine. Next morning he comes to you- you found him a febrile and plain X
ray shows calcium oxalate stone in his bladder. WOF you will advice --

a) Not to take calcium containing food

b) Avoid red meat
c) Avoid all kind of drinks, tea, coffee

40. Most common cause of death in severe burns, in Australia is?

a) Irreversible shock
b) Septicaemia
c) Respiratory failure due to respiratory tract burns
d) Unable to maintain positive nitrogen balance

41.All of the following cause acute pancreatitis,Except--

a) Alcohol ( Note: Dr. SusanGET SMASHED)

b) Mumps virus infection 1. gall stones
c) Diabetes Mellitus 2.ethanol
d) Gall stone 3.trauma
e) Pancreatic islet cell tumour 4.steroids 5.mumps
7.autoimmune 8.scorpion venom
9.hyperlipidaemia 10.ERCP 11.DM/drugs: azathioprine,pentamdine

42. When is the best time to administer prophylactic antibiotics?

a) 1 day before operation

b) 1 hour before operation
c) At the time of incision
d) After the infection

43. A female pt. Complaints of fullness fat indigestion after fatly meals. In an ultrasound
stones seen in gallbladder, but there is no sepsis. After surgery no stone left in the gall
bladder and free of symptoms for few weeks, then symptoms recur. What is the explanation--

a) Pancreatitis after cholecystitis

b) Stone was left in CBD
c) It is a result of removal of gall bladder-Fat indigestion
d) Gall stones were not her symptoms
e) Cystic duct stump syndrome
f) Recurrence of stone formation after cholecyctectomy

44. A middle aged female complaints of morning diarrhoea and cramps. On examination there
are no remarkable findings. Which is the most likely diagnosis?

a) Irritable bowel disease

b) Ca Colon
c) Crohns disease
d) Ulcerative colitis

45.A patient came with weakness in extension of hand and pronation.On examination there is
no wasting of hand muscles.Flexion normal, Biceps & Triceps reflexes also normal.No
Brachioradialis jerk.Where is the lesion?

a) Median nerve
b) Radial nerve
c) Ulner nerve
d) Nerve to Posterior interoseus
e) Nerve to Anterior interoseus

1. A couple came to your GP surgery to know about the mode of inheritance/number of

incidence of cystic fibrosis in the population. Your answer will be

a) 1 in 2
b) 1 in 4- mode of inheritance
c) 1 in 25
d) 1 in 100
e) 1 in 2500- number of incidence

2. A 15 months old child was found with ambiguous genitalia, while in cerotype analysis 46xy
was diagnosed. WOF is the next appropriate IX ?

a) X- ray ( Kumar & C-1024/1054 )

b) 17 hydroxyprogesterone---increased in Congenital Adrenal Hyperplasia
c) CT Scan
d) US of pelvic region
e) Testosterone level

3. An 8-year-old boy presents with photophobia, irritability & neck stiffness. Lumbar puncture
findings show 50 neutrophils, 100 lymphocytes, proteins normal, glucose normal. Which is the
most likely diagnosis?

a) Tuberculosis meningitis
b) H. influenza
c) Echo virus
d) E. Coli
e) HSV encephalitis

4. A 5 month old baby unwell for a week is noticed by his parents to have episodes of leaning
forward and shaking his arms. His parents are concerned, because he is not responding as he
used to. What is the likely cause?

a) Infantile spasm
b) Febrile seizures
c) Breath holding spells
d) Infantile myoclonic seizures
e) Petit mal epilepsy

5. A 2 month old child has strawberry naevus on its back between the scapulae, 2 cm in size.
What is the most appropriate management?
a) Cryotherapy
b) Lase therapy
c) Observation
d) Injection of a sclerosing agent
e) Simple excision

6. A child with perorbital oedema and anararca, BP is normal. All of the following are true,
except?

a) Steroids are useful in treatment

b) Focal glomerulonephrits is the commonest cause
c) Proteinuria more than 3 grams/day is usual
d) This is commonest between 1 and 4 years of age
e) ?

7. A fully breast feed baby, from a mother on a healthy, balanced diet, can have deficiency of
which vitamin?

a) Vitamin A
b) Vitamin B complex
c) Vitamin C
d) Vitamin D
e) Vitamin K

8. You can see an infant with subdural haematoma, bruising and multiple subperiosteal
sclerosing zones on x-ray of the limbs. What do you first think of?

a) Rickets
b) Vitamin C deficiency
c) Pagets disease
d) Non accidental injury
e) Haemophilia

9. What is true about phenylketonuria inheritance?

a) Only boys are affected

b) Only girls are affected
c) 1 in 2 chance of any sex being affected
d) 1 in 4 chance of any sex being affected
e) Sporadic
10. An 8-week-old baby presents with unilateral sticky eye. Similar episode before was treated
with antibiotics for 3 days and resolved. What is the most likely diagnosis?

a) Gonococcal conjunctivitis
b) Allergic conjunctivitis
c) Inadequate antibiotic treatment
d) Decreased Ig A in the tears
e) Blocked naso-lacrimal duct

11. A neonate was born at full term with a birth weight of 1500 grams, was jittery on handling
noticed to have cyanosis on the hands & feet. The infant had normal temparature; respiratory
rate 40/min and lung & heart were normal on examination. The neonate has been given
oxygen. Which of following is your step in management?

a) Reassure the infants mother and check the infant later

b) Check blood calcium
c) Give high concentration oxygen via mask
d) Take blood sample for blood sugar test
e) Take blood for full blood examination

12. A child was recently vaccinated for polio, now presents with 1-week history of fever,
flaccid paralysis of both lower limbs with no reflexes. The most likely diagnosis is?

a) Infection with wild poliomyelitis

b) Complication of the polio vaccine
c) Gullian Barre syndrome
d) UMN lesion
e) Acute polyneuropathy

13. Which of the following is the least likely cause of iron deficiency anaemia in children?

a) Cows milk
b) Thalassemia
c) Prematurity
d) Coeliac disease
e) Multiple pregnancy (e.g. Twins)

14. A baby delivered by normal vaginal delivery, is well after birth. On the 4th day, the baby is
found collapsed in the cot, breathless and floppy. On examination there are no murmurs.
Possible cause could be--

a) TOF
b) PDA
c) TGA with VSD
d) Pulmonary stenosis
e) L. Ventricular Hypertrophy

15.A 9-day-old baby with projective vomiting and dehydration with K 7.1, Na 125, Cl 80, &
HCO3 20. What is your diagnosis:
a) Pyloric stenosis
b) Dlactosemia
c) Sepsis
d) Hypoglycaemia
e) Congenital adrenal hypertrophy

16. A child with profuse diarrhoea for 5 days develops convulsions. Which of the following
blood test results would most likely cause this convulsion?

a) K 2.2
b) K 6.5
c) Na 132
d) Na 156
e) Cl 100

17. A 37-year-old female gives birth to her 2nd child. At the 10th day the child becomes
jaundiced. His mother tells the doctor that her first child had jaundice after birth and then
developed bilateral cataract after the jaundice. What is the diagnosis?

a) Congenital rubella
b) Neonatal hepatitis
c) Diabetes Mellitus
d) Syphilis
e) Galactosaemia

18. A child has trouble seeing the black board at school, but no problems when using the
computer. His vision is improved with pinhole test. What is your diagnosis?
a) Myopia
b) Hypermetropia
c) Cataract
d) Glaucoma
e) ?

19. A child with headache and morning vomiting, ataxia and nystagmus for 6 weeks. His
school had a chicken pox 2 weeks ago. He has a family history migraine. What is the most
probable diagnosis?

a) Migraine
b) Varicella cerebellitis
c) Infratentorial Tumour
d) Friedrichs ataxia
e) ?

20.In Downs syndrome, aside from the cardiac complications, all of the following are
associated with Downs syndrome, except-
a) Acute leukaemia
b) Myopia
c) Hypothyroidism
d) Vesicoureteric reflux
e) Deafness
f) Alzheirmers disease

21. A 15-month-old child is brought to you by his parents. He was born at 36 weeks by normal
vaginal delivery. At 8 months a mother child health center test for hearing was done, which
was normal. The parents say that he babbles, but does not speak 2-3 word phrases yet. On
physical examination, the child appears normal. What will you do?

a) Reassure the parents that this is a normal variant

b) Reassess at 18 months
c) Repeat mother child test for hearing
d) Arrange for audiometry testing
e) Rt. Orchidopexy

22. A mother notices a lump in the right groin of her 2-year-old son, which disappeared after a
few hours. Despite a thorough examination you are unable to discover anything. The most
appropriate management would be?

a) reassurance & send home

b) Admission into hospital for surgery
c) Request the mother to bring the child to you immediately when the lump reappears again
d) Review after 1 week
e) ?
23. An 8-year-old boy was stung by a bee. He had difficulty breathing and facial oedema.
What is the best treatment?

a) Adrenalin 1:1000 IM/SC

b) Adrenaline I/V
c) Antihistamine iv
d) Hydrocortisone iv
e) Intravenous fluids

24. A child has tenderness & pain at upper tibia of the left leg and swelling of the knee which
is warm. He is febrile(39 degrees Celsius) and gets pain at 30 degrees flexion. What is your
diagnosis?

a) Osteomyelitis
b) Osteosarcoma
c) Septic arthritis
d) Fracture tibia
e) Irritable hip (Transient synovitis)
f) Thrombophlebitis/Cellulitis

25. A 2-year-old child presents with a clean superficial laceration on the forehead. The child
has never been immunized. What is the most appropriate management?

a) Give antibiotics
b) Tetanus Toxoid
c) Tetanus Immunoglobin
d) DTP vaccination
e) Reassure & send home

26. The commonest cause of hip pain in a 3-yearold child?

(DH-288)
a) Transient synovitis
b) Perthes disease
c) Slipped upper femoral epiphysis
d) Arthritis
e) Tuberculosis

27. A 2-week-old baby gained 200 grams/week since birth. The mother complaints that the
child vomits milk soon after feeding, otherwise okey. What will you do?

a) Reduce the time between feeds

b) Shorten the duration of feeding
c) Give water before feeding with milk
d) Endoscopy
e) Urine microscopy

28. A child was born premature(30 weeks gestation), via vaginal delivery. APGAR 5 at 1 min.
& 8 at 5 min. At 18 months, the child is brought by the mother with moderate mental
retardation. Which family history would be likely cause of the mental retardation?

a) Uncle has mental retardation

b) Sister has febrile convulsions
c) Mother has 2 caf au lait spots
d) Father is an alcoholic
e) Paternal grandmother has hypothyroidism

29. A 4-year-old child presents with sudden onset of cough, unilateral wheeze and decreased
respiratory movement on one side. There is no family history of atopy. What is the most
appropriate management?

a) Chest X ray
b) Full blood examination
c) CT of chest
d) Ultrasound
e) Inspiratory & expiratory chest X ray

30. An obese 8 yrs. Old boy came to you. O/E his weight was 48 kg, which is more than 98th
percentile and the height was 140 cm, which is more than 90th percentile, otherwise normal.
WOF is correct in relation to this boy---
a) Advanced bone age
b) Increased blood sugar level
c) Thyrotoxicosis
d) Hypothyroidism
e) Primary hyperaldesteronism

31.A baby is born a normal full term delivery. On examination of the newborn, which of the
following may normally be seen?

a) Breast enlargement in male infants

b) Enlarged clitoris in female infants
c) Fusion of labia
d) Enlarge lever more than 5 cm and palpable
e) Cleft plate

32. A mother brings her baby who is babbling and squeaking, is able to hold his head, move
from prone to supine position, is able to sit up unsupported, can reach for objects and when
supported, can stand and bounce. What is the possible age of this child?

a) 5 weeks
b) 2 weeks
c) 7 months
d) 10 months
e) 12 months

33. During 12 weeks of pregnancy Ultrasound shows nuchal thickness of the fetus. Keriotype
also done. Now your advice should be---

a)Terminate the pregnancy at 12 week

b)Repeat Keriotype test
c)Serum fetoprotein test at second trimester
d)Full blood test

34.After a difficult forceps delivery, it is noticed that the baby hangs his arm to the side, and
cannot move it. What is the likely cause?

a) Fracture humerus
b) Erbs palsy
35. Six week old child initially was normal but after 3 wks she was not sucking milk. She
appeared as a floppy child, which was progressively getting worse. WOF is your diagnosis--

a) Botulism
b) Werdnig-hoffman disease(spinal muscular atrophy)
c) Cerebral pulsy
d) Myasthenia gravis
e)

36. A 6 week old infant vomiting intermittently since birth. She looks thin, not gaining weight.
No abnormality on physical examination. What is your Dx :

a) cystic fibrosis
b) pyloric stenosis
c) subdural haematoma
d) phenyl ketonuria
e) regurgitation
f) UTI

1. While doing hysterectomy in lithotomy position WOF nerve is prone to injury---

a) Pudendal nerve
b) Sciatic nerve
c) Common peroneal nerve

2. A woman is challenged with combined oestrogen & progesterone, but does not get
withdrawal bleeding. Which organ is most likely to be affected?

a) Overies
b) Uterus
c) Pituitary
d) Hypothalamus
e) Fallopian tubes

3. The most appropriate OCP for a 24-year-old woman taking phenytoin is?

a) Microgynon 30
b) Microgynon 50
c) Diane 35
d) Clomiphene
e) Oestrogen 85 micrograms
4. A 20-year-old female presents to you with amenorrhoea. On ultrasound, a cyst(1.8 x 1.3 x
1.0 cm) is found on the right overy. What is the most appropriate management?

a) Laproscopy to find cytology

b) Repeat ultrasound in 4 weeks time
c) Do nothing
d) OCP
e) Oophorectomy

5. Regarding oxytocin, which of the following is true?

a) Has an anitdiurectic effect

b) It is a steroid
c) It is produced by the posterior pituitary
d) It has an action on most of the involuntary muscles
e) It causes milk production
6. A female, 17 weeks pregnant, has acute right iliac fossa pain. Which of the following is the
least likely cause of the pain?

a) Pyelonephritis
b) Red degeneration of a fibroid
c) Ectopic pregnancy
d) Acute appendicitis
e) Torsion of an ovarian cyst

7. Depo provera can cause all the following, except?

a) Mild hypertension
b) Amenorrhoea after the 3rd injection
c) Fertility problems for 6-12 months after stopping the treatment
d) Menstrual irregularities
e) Weight gain

8. An 8-week gestation primigravida, presented with slight vaginal bleeding. You will do an
ultrasound examination for all of the following, except?

a) To see if the sac is within the uterus or not

b) To see if the foetus is alive or dead
c) To check for any congenital anomalies
d) To look for a clot inside the uterus
e) To look for the position of the placenta
9. A 25-year-old female presents with galactorrhoea and amenorrhoea, CT scan shows the
presence of pituitary adenoma, 3 mm in diameter, 1.6 mm from the optic chiasma, with no
visual disturbances. Prolactin level is high(4250). What is the most appropriate management?

a) Trans-sphenoidal surgery
b) Phenothiazine
c) Bromocriptine
d) Clomiphene
e) OCP

10. A primigravida, 14 weeks gestation, is found to have proteinuria(+++), BP 150/95 mmHg

and swelling. What is true?

a) She has pre-eclampsia(24 wks)

b) She has UTI
c) She will not be carry on with the pregnancy
d) Renal hypertension
e) Pre-existing renal disease

11. In a postmenopausal woman, what is the least likely cause of greenish foul smelling
vaginal discharge?

a) Trichomonas vaginalis- long standing cases discharge is greenish and frothy

b) Gardnerella vaginalis strong fishy smell, grayish discharge
c) Chlamydia may be mucopurulent
d) Foreign body
e) Cervical carcinoma

12. what is true regarding carpal tunnel syndrome in pregnancy?

a) Relieved by use of splint with hand in extended position

b) Causes severe pain in the thenar eminence position
c) Rarely requires surgery
d) Diuretics should be given
e) Becomes better as gestation progresses

13. A woman comes to you 2 years after her menopause asking for something to relieve her
postmenopausal syndromes. You decide to give her combined HRT. You explain to her that all
of the following are the effects of progesterone, except?
a) She will have pre-menstrual like symptoms
b) She will have withdrawal bleeding every month
c) Progesterone will oppose the action of oestrogen on the endometrium
d) Progesterone will potentiate the action of oestrogen in increasing HDL
e) Progesterone will augment the action of oestrogen for prevention of osteoporosis

14. Which of the following is not true, for a woman having antenatal care?

a) Presence of Anti-Rho means that the baby can have permanent heart block
b) A platelet count of 100000 is a risk for developing intracranial bleed in the infant
c) The presence of ANA could cause growth retardation of the foetus
d) ?

15. Which of the following occurs in pregnancy by progesterone?

a) No renal changes
b) Dilatation of the ureters & calyces
c) Dilatation of the calyces only
d) Dilatation of the ureter only
e) Reduce incidence of infection

16. Which of the following CTG patterns indicates foetal distress?

a) Acceleration with foetal movements

b) Early decelerations with uterine contractions
c) Decelerations when the foetus is sleeping
d) Accelerations on sound stimulation
e) A beat to beat variability< 5 beats/min

17. Regarding administration of anti-D gamma globulin in Rh -ve women, which of the
following is true?
a) It is a form of active immunization
b) Administration in the 2nd trimester of pregnancy has been shown to decrease
autoimmunization in the mother
c) It increase the risk of HIV transmission
d) It should be given within 24 hours of the delivery-2nd
e) It is not necessary to give it in cases of ABO incompatibility-1st
18. A young woman, pregnant for 14 weeks, uterine size corresponding to 16 weeks, now
presents with bleeding and passing out grape like material through a dilated cervix. Which of
the following is the best follow up?

a) weekly monitoring of urine HCG, until it comes to normal level

b) Ultrasound
c) Chest X ray for metastasis
d) Check placenta for signs of malignancy
e) Observation & reassurance

19. A 32-years woman became pregnant. She had 5 pregnancies before, of which she lost 3
spontaneously between 8-10 weeks & 2 were stopped by intervention at 12 weeks. What is
the most likely cause?

a) Cervical incompetence
b) Chromosomal abnormalities
c) Hormonal imbalance
d) Ovarian tumor
e) Valvo vaginitis

20. All of the following are true about neural tube defect, except?

a) Decrease in alpha fetoprotein

b) Polyhydramnios
c) Folic acid prophylaxis can decrease the risk of neural tube defects
d) There is a 4% chance of neural tube defect in the 2nd pregnancy
e) Can be detected by amnio centesis

21. A 19-year old primigravida, 38 weeks gestation, with hyper-reflexia, hypertention and
oedema, might be expected to have elevated blood levels of all of the following, except?

a) Platelets
b) Uric acid
c) Creatinine
d) SGOT
e) BUN

22. Which of the following is an absolute contraindication for OCP use?

a) Migraine with hemiplegic aura

b) Smoking
c) Varicose veins
d) Diabetes mellitus
e) Gall bladder disease

23. All of the following are used in dysmennorhoea, except?

a) D & C
b) Progesterone
c) Mefnamic acid
d) OCP
e) Bromocriptine

24. A 62-years-old female complaints of bleeding per vagina. After examination and
investigation, endometrial hyperplasia was found and a solid mass (5 cm in diameter) was
found in one of the ovaries. Possible diagnosis is?

a) Teratoma
b) Ovarian ca
c) Fibroma
d) Granulosa cell tumor

25. A pregnant woman, 34 weeks-gestational age, presents with antepartum haemorrhage.

You diagnose abruptio placenta. All of the following are possibly seen, except?

a) Tense & tender uterus

b) BP of 180/110 mmHg
c) Shock out of proportion with the bleeding
d) Foetal head mobile above the pelvic brim
e) Dead foetus

26. OCPs mainly affect which site?

a) Hypothalamus
b) Pituitary
c) Ovaries
d) Endometrium
e) Cervical mucous
27. On clinical examination, how do you differentiate an ovarian tumor from ascitis?

a) Dullness in the periphery & central tympanetic note, on percussion

b) Tympanetic note in the periphery & central dullness, on percussion
c) Shifting dullness
d) Decreased bowel sounds
e) Fluid thrill

28. A 26-years old primi, 152 cm tall, with vertex presentation, head at 0 station, cervix
effaced completely and dilated to 4 cm, with intact membranes at 37 weeks. What is the most
approprate management?

a) Lower segment caesarean section

b) Oxytocin to induce labour
c) Ultrasound to detect foetal abnormalities
d) X-ray pelvimetry
e) Trial labour

29. A 24-year old woman came with secondary amenorrhoea & was diagnosed to have Poly
Cystic Ovarian Syndrome. WOF is true about her conditions--
( Note: In PCO
a) Immediate laparoscopic removal of cysts Testosteronne-increase LH:FSH-increase
b) FSH:LH ratio will be 3:1 LH-increase Insulineincrease)
c) Increase androstenedione also Testosterone LJ-223
d) 17-hydroxy Progesterone will be normal
e) USG will show echo density over the affected part of the ovaries--Echofree

30. In a twin pregnancy, after delivery of the first twin, you do all of the following, except?

a) Vaginal examination
b) External version if the second twin is breech
c) Oxytocin infusion if contractions dont start
d) Check foetal heart rate
e) Check lie of the second twin

31.Regarding uterine rupture after previous Lower segment Ceasarian Section WOF is most
likely indication?
a) Incidense is increased by 5%
b) Increase with prostaglandin induction
c) Increase with oxytocin augmentation
32. Which of the following cancer is most common to metastasize to bone ?

a) Prostate Cancer [ Murtagh-GP:247 B-P-L: Breast-Prostate-Lung]

b) Stomach Cancer
c) Breast Cancer
d) Lung Cancer
e) Cerebral Cancer

33. Regarding contraception, all of the following are correct except-

a) It is absolutely contraindicated in women with migrainous aura [ GP-961]

b) It should not be prescribed for a patient with DVT
c) If patient is on 20 microgram there is no need to stop pre-operatively
d) 50 microgram should only be started if 30 microgram causes irregular bleeding

34. A 26 yrs old young lady with 10 weeks of amenorrhoea. WOF test will affect her
management after the diagnosis of her pregnancy?

a) Varicella Antibody
b) HIV
c) Glucose Challenge test

35. WOF is not true regarding neural tube defects-

a) Decrease alpha feto protein
b) Folate intake can decrease the incidence
c) Can be detected by amniocentesis
d) Socioeconomic factor is an important factor

1. While shopping in a shopping center a lady found that everything is moving around her. At
that time she felt herself separated from this world. These happened several occasions in the
past. In one occasion this happened when she was talking with her relatives and uttered some
un-recognizable words, which could not understood by them. WOF is next appropriate step---

a) talk to her relatives

b) CT scan of head
c) MRI of Brain
d) Measure BP in lying and standing position
e) EEG

2. A youngman was found by his parents agitated at night in his room. They told you that
their son did not sleep for last 3 nights and also has not taken food for 3 days. He used
cannabis and he is on lithium. The young man told you that he was complying with lithium
prescribe by the doctor. O/E you found tremor, agitation, arrythmias and ataxia. WOF is your
next step----

a) Electrolyte estimation
b) Urine test
c) Serum lithium level estimation

3. About Core group to help alcoholics and addicts. WOF is correct---

a) Ask opinion and help from non-professionals

b) Co-operation and skill should be increased among members of the group.

4. Schizophrenic patient has good prognosis if they had---

a) Prolong onset
b) Affected symptom
c) Family history
d) If all the relative help in psychotherapy

5. A 60-year-old with Wernickes encephalopathy present to casualty. On examination he is

found to be hypoglycaemic, has nystagmus, drinks 6gm alcohol per day. What is your initial
management?
a) Normal saline (0.9%) & dextrose solution
b) Glucagon iv
c) 50% dextrose iv
d) Intravenous thiamine followed by dextrose solution
e) Insuline & dextrose iv

6. A man is brought to the hospital by the police. How will you different whether he has
schizophrenia or delirium?

a) Fluctuating level of consciousness

b) Hallucinations
c) Confusion
d) Irritability
e) Agitation

7. A 33-year-old lady comes to see you at your practice with complaints of insomnia. In the
last 2 months she has lost 2 Kgs. She has 3 children aged 10,7& 4 yrs. In the past few months
she doesnt feel as close she used to, to her husband. She feels more distant from him. They
have been living in a rented house for the last 10 yrs or so and have not been able to go for a
holiday due to financial difficulties. She also complains of heavy periods. You did a FBC (full
blood count), thyroid hormone levels, etc and all came out within normal range. Physical
examination was unremarkable. What is your next step in management for this woman?
a) Refer to gynecologist
b) Refer to psychiatrist
c) Refer to marriage counselor
d) Interview husband
e) Suggest that she takes a holiday

8. Which of the following is reversible inhibitor of monoamine oxidase?

a) Phenelzine
b) Flouxitine
c) Moclobemide
d) Mianserin
e) Tranylcyclomine

9. Anorexia Nervosa will have all except?

a) Flight of ideas
b) Hypokalemia
c) Lanugo hair
d) Mainly seen in females
e) Depression

10. The Mental health Act was introduced approximately 20 years ago. Of the following, which
is true?
a) It is the same in all States & Territories in Australia
b) It can save lives
c) It takes away the individuals freedom
d) It can be involuntarily imposed on everyone
e) It needs six people to impose it

11. The parents of an adopted girl, who has been diagnosed as schizophrenic, have come to
consult you about their own biological child. They inquire about the possibility of schizophrenia
developing in their child. You should tell them?

a) Nil
b) Less than 2%
c) 10%
d) 50%
e) 75%

12. In which of the following conditions is there dejavu?

a) Occipital lobe tumour

b) Temporal lobe tumour
c) Frontal lobe tumour
d) Raised intracranial pressure
e) Korsakoffs syndrome

13. A young woman who is an accountant in a bank, after experiencing bank robbery in which
she was taken as a hostage for several hours. After 3-4 weeks she returned to work. What
should you expect on her?

a) Erotic memories of the event

b) A brief psychotic reaction
c) Visual Hallucination of the event
d) Irritability and outbursts of anger
e) Hypersomnia

14. A 36 years old engineer is due to give an speech soon and is reluctant to be exposed to
people. At the same time, he does not want to sign cheques or write anything in public. He
also thinks his boss is controlling what he is doing although he knows that there is no motive
for that because he is a very good worker. He realizes there is no reason to act this way.
Lately he has been avoiding to go to the canteen with his mates and takes alcohol to cope
with the situation. What he is suffering from---

a) Social phobia
b) Agoraphobia
c) Antisocial personality disorder
d) Panic disorder
e) Paranoid disorder

15. What is incorrect concerning Gille de la Tourette syndrome?

a) Associated with tics

b) Patient is not distressed by the tics
c) Patient utters obscene words in less than 10% of cases

16. WOF is most likely associated with Bulimia?

a) Cachexia
b) Induced vomiting
c) Hallucination
d) Sexual disorder
e) Disturbed body image

17. A person with hypnologic hallucinations:

a) A feeling of insects crawling over the skin

b) Usually occurs at the beginning of sleep
c) Seen in schizophrenic patient
d) Seen in amphetamine entoxication
e) Seen with cannabis use

18. All the following can cause serotonin syndrome except?

a) Haloperidol
b) L Tryptophan
c) Clonazepam (benzodiazepine)
d) Moclobemide
e) Dextromethorphan

19. Defense mechanism have been classified as mature andimmature. Which of the following
is an immature defense mechanism?

a) Projection
b) Sublimation
c) Identification
d) Dissociation

20. Concrete interpretation of a proverb is characteristic of?

a) Dysthymia
b) Depersonalisation
c) Dementia
d) Delusional disorder
e) Depression

21. Bulimia nervosa

a) Hyperkalemia
b) Never occur in male
c) Associated with depression

22. Contraindication to tricyclic therapy:

a) TCA
b) Alcohol
c) Lithium
d) MAOI
e) Antipsychotic drug

23. Halucination of miniature object or animal crawling occurs in

a) Schizophrenia
b) Generalized Epilepsy
c) Delirium Tremens

24. Which of the following would give a better prognosis in Schizophrenia?

a) No precipitating features
b) Abrupt onset
c) Schizoid personality
d) Drug abuse
e) With affective symptoms

25. A 21 yrs old young girl was brought to you by her parents. She tells you that her friends
are putting message in her brain trying to disturb her. Today when she has appeared in the
tutorial class they tried to lock her thought and tried to influence her. WOF is your next step?
a) CT scan
b) X-ray
c) Olanzapine
d) OCP
e) Full blood test

26. WOF is formal thought disorder?

a) Thought echoing
b) Over inclusiveness
c) Delusions
d) Hallucinations
e) All of the above
27. Which of the following is correct regarding Baby Blues?

a) Is present in more than 50% of women

b) Postpartum blues lasts for at least 3 months
c) Predisposes to postpartum psychosis
d) She requires antipsychotic medication
e) She requires ECT

28. A lonely man was found to be semiconscious and had bilateral six nerve palsy. Likely
diagnosis is---
a) Alcoholic toxicity
b) Delirium tremen
c) Wemickes encephalopathy

29. Panic disorder: Exept---

a) Is equally frequent in men & women

b) Patient should avoid trigger factors
c) Starts in the 20s

30. A 28-years old male presents with grandiose beliefs of his own importance, over concern
for his appearance and extreme sensitivity to others criticism. He likewise has unrealistic
fantasies of unlimited success, capabilities and power. He also lacks empathy and uses other
people for his own benefit. This history is suggestive of what type of personality?

a) Schizotypal personality
b) Antisocial personality
c) Narcissistic personality
d) Borderline personality