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REVIEW 120616
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REVIEW SERIES

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120616
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Medicine 120616

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 REVIEW 120616

CONTENTS
Medicine ...........................................................................................3
Surgery & Orthopaedics ................................................................... 23
Pediatrics ......................................................................................... 35
OBGyn ............................................................................................. 42
Psychiatry and Medico Legal Dilemmas ............................................ 48

Medicine 120616

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MEDICINE
01.Which ophthalmic condition requires major attention to prevent blindness among
indiginous communities?

A. Herpetic Keratitis
B. Trichiasis
C. Bacterial conjunctivitis
D. Glaucoma
E. Cataract

02. Patient which c/o of racing heart have the above ECG pattern, patient was previously
diagnosed WPW syndrome. What is your Mx ?

A. Amiodarone
B. Adenosine
C. Digoxin

Medicine 120616

03. Patient presented with SVT following carotid massage shows the above ECG pattern
with dizziness and confusion. What is your manangement?

A. Adenosine
B. Cardiac Pacemaker
C. Amiodarone
D. Avoid future carotid massage

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04. 25year female with C/O dark stool for 1week .She had 3 episodes of dark semisolid
stools in the past 12 hours.O/E vitals stable.tender epigastric region.Next step in Mx?

A. Triple therapy
B. Gastroscopy
C. USG abd+pelvis
D. Colonscopy

05. Patient takes an overdose of Paracetamol. Presents to the ED after 4 hours. Next step in
Mx?

A. IV N-acetyl cysteine
B. Gastric lavage+activated charcoal
C. IV fluids

06. Pic of an elderly male with a hyperpigmented lesion on the cheek for 2years.diagnosis?

A. Melanoma-hutchison freckle
B. BCC
C. SCC

07. For a COPD patient, what is the reason for you to prescibe domicillary O2?

A. Increased pCO2 levels

B. Reduced pCO2 levels
C. Recurrent infections
Medicine 120616

08. A 60years old male patient coming with c/o dry cough, night, sweats. He has a h/o
working in a gold mine for >20yrs.diagnosis?

A. Mesothelioma
B. Emphysema
C. Bronchopneumonia
D. Bronchogenic carcinoma

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09. Patient 60 years old male with history of working in gold mine till 50years old. Now
works in petrol station. He also have history of severe episodes of acute silicosis. Reason of
presenting is purulent cough with night sweat. He notice that, he has lost about 5kg. What
is the reason of he presentation now?

A. Empyema
B. Brochitis
C. Pulmonary Tuberculosis
D. Mesothelioma
E. Pneumonia

10. A patient with c/o dry mouth +dry eyes.Rx?

A. Prednisolone
B. Hydroxychloroquine

11. Lady with following fundoscopy pic c/o of floaters and Filmy vision, What is your next
Mx? (This was the exact AMC terminology, I don’t know why they ask for Mx and gave
the Dx in the options. (This fundoscopy of Retinal Detachment is about 70% similar to
what I had, mine was a bit more inferior and the lateral aspect was spared)

A. IV acetazolamide
B. Macular degeneration
C. Retinal detachment
D. Pilocarpine eye drop
Medicine 120616

12. A young female with h/o collapse during exercise. Received CPR. Brought to the ER
with a h/o uncle dying with a heart disease. Mx?

A. CABG
B. ECG
C. CXR

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D. Echocardiography

13. A known patient of RA on long term Methotrexate therapy c/o weakness

+anorexia.AST + ALT increased with peripheral blood smear s/o anaemia. Mx?

A. Folinic acid
B. Vitamin B12
C. Folic acid
D. Vitamin C
E. Vitamin A

14. Initial ECG finding of a patient with hyperkalemia?

A. Widening of QRS complex

B. Widening of PR interval
C. Appearance of U waves
D. Small P wave.
E. Peaked and tall T waves

15. Initial Rx?

A. Amiodarone
B. Warfarin
C. DC cardioversion
D. Carotid massage

16. A female brought her aunt who is living alone. c/o recent forget fullness. She is not a
K/C/O any other illness. What is the next step in Mx?
Medicine 120616

A. CT scan
B. Serum electrolytes
C. Alcohol breath test

17. A man with c/o abdominal pain for 2 months radiating to the back. What
symptoms/signs will not be present?

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A. Nocturia
B. Regurgitation of food
C. Diarrhea
D. Constant pain

18. ECG given with ST depression in antero-lateral leads on a patient with chest pain.
Initial step?

A. Cardiac enzymes now and 8hours

B. PCI
C. CABG
D. Beta blockers
E. Aspirin

19. A man admitted to the Metropolitan hospital with 4hours h/o retrosternal chest pain.
BP 90/60 ECG shows inferior wall MI. Mx?

A. Thrombolysis
B. Cardiac Catheterization
C. GTN
D. Adrenaline

20. What happens next?

A. Spread to LNs
B. Grows fast
Medicine 120616

C. Resolves

21. A female has joint pain, malaise, rash on face.WOF will help in determining the
diagnosis?

A. ANA
B. ANCA

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C. RF
D. Anti ds-DNA
E. C-ANCA

22. A middle aged man with h/o cough with CXR of middle lobe consolidation. Mx?

A. Oral Amoxicillin+Clavulanate
B. Oral Azithromycin
C. IV Ampicillin
D. Oral Flucloxacillin

23. A middle aged man with ataxia, vomiting, vertigo, Horner’s syndrome. Diagnosis?

A. Posterior Cerebral Artery Occlusion

B. Vertebral Artery Occlusion
C. Anterior Cerebral Artery Occlusion
D. Middle Cerebral Artery Occlusion

24. A 32 year old male c/o of headache was brought to ED with the above ECG strip. What
is your next step?

A. Atenolol
B. Verapamil
C. Amiodarone
D. Valsalva Manuever
E. Carotid Massage

25. Antiphospolipid antibodies is best associated with what condition?

A. Penicillin drug reaction

B. SLE
C. RA
D. Scleroderma
Medicine 120616

E. Temporal Arteritis

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26. A 35 year old male involved in a MVA was brought to ED. He lost consciousness for a
few minutes and recovered. P/E showed slight bruises and rest of findings normal including
neuro exam. He wanted to go home however ECG given below. What is the next step?

A. Adenosine
B. Amiodarone
C. Flecainide
D. Pacemaker

27. A 72 year old female patient , consulted because of difficulty of climbing stairs for about
2 months. She has esophagitis. An x-ray film given of the pelvic bones which showed typical
oesteoporitic changes (for me). What is the next step?

A. Alendronate
B. Methotrexate
C. Zolendronic acid
D. Paracetamol/codeine

Medicine 120616

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28. A case of a 62 year old female with chronic type2 DM who is on and off on her
medication complains of photosensitivity and blurry vision a few weeks ago. What the next
step?

A. Laser pheoemulsification
B. Topical pilocarpine
C. 2 other options I can’t recall

29. A 74 year old female patient consulted because of 2 weeks dysuria with nausea and
vomiting. She has chronic RA and is on Methotrexate and Prednisolone. While waiting for
the culture and sensitivity results what is best step?

A. Ceftriazone
B. Ciprofloxacin
C. Trimetoprim
D. Amoxicillin/clavulanic
E. Amphotericin

30. Patient with ECG above present with diffuse abdominal pain. What is your diagnosis?

A. Abdominal Aortic Aneurysm

B. Mesenteric ischemia
C. Myocardial Infarction
D. GI Bleeding
E. Pulmonary Embolism Medicine 120616

31 .Asthmatic patient at ER , how to assess improvement

A. Improvement of retractions
B. Spirometry
C. X-ray
D. Pulseoximetry

32. Loss of peripheral vision. What is best long-term management?

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A. Iridotomy
B. pylocarpine drop
C. some other options (drugs)

33. Patient present with eye as above and Hx of genital/oral ulcers

A. Oral Ampilicin
B. Oral prednisolone
C. Chloramphenicol eye drop
D. Amoxiclin+Clavulanic Acid
E. Oral Chloramphenicol

34. Patient brought to ED after a MVA. He sustained multiple rib fractures. On

examination the chest wall is falling in during inspiration. What are your initial step in
Mx?

A. CPAP
B. Underwater Drainage
C. Sandbag on the chest wall
D. Compression bandage

35. Regarding Staphylococcus Toxic Syndrome. What is right

Medicine 120616

A. caused by highly absorptive pads

B. caused by endotoxin production
C. other options – some of the terms mentioned did not understand even...

36. What is right about naltrexone

A. used for long-term therapy

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37. Patient comes with sudden vision lost, on examination fundoscopy shows

A. Central Retinal Artery Occlusion

B. Macular Degeneration
C. Optic Neuritis
D. Central Retinal Vein Occlusion

38. Patient on digoxin and warfarin because of AFib, Also on thiazide diuretics for
hypertension. Blood examination reveals increased level of urea, creatinine, potassium

B. N saline
C. Dextrose
D. Stop digoxin
E. I.V. Insulin

39. Patient on amlodipine , diuretic, beta-blocker. AT 150/90, HR 90, breathless.

A. add perindopril
B. add digoxin
C. some other options
Medicine 120616

40. What is absent in pseudobulbar palsy

A. Absent gag reflex

B. Speech is slow
C. Spastic Tongue
D. Jaw jerk is brisk

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41. Mx?

A. UV
B. oral prednisolone
C. cotrimazole
D. no options of TAR, calcipotriol...

42. Ambulance brought a man who worked in lift shaft for few hrs

A. give 2L of oxygen through nasal catheter

B. 2. give 6L of oxygen through some kind of mask
C. give oxygen through mask (some another kind!) only if saturation less 90%
D. Organize urgent hyperbaric oxygenation Medicine 120616

43. 37yrs old, no history of diabetes. Came to your practice concerned about her health as
she is aging, What screening will you consider at this stage?

A. Fasting Blood Sugar

B. Mammography
C. Colonoscopy
D. Ca 125
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E. HbA1c

44. An elderly patient, had a sudden episode of lost consciousness, Now have
recovered. What is the most like ECG finding

A.

B.

C.

D.

E.

45. Carpet layer comes to you with painful swollen knee

A. X-Ray
B. Ultrasound
C. Arthroscopy
Medicine 120616

D. Punctuate a knee

46. Patients presents to you with jaundice, malaise and joint pain.,...

A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. Cholelithiasis
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Medicine 120616

47. Based on the table above estimate Risk Level of a 55years old non-smoker male with BP
142/92, cholesterol 4.

A. >30%
B. 25-29%
C. 20-24%
D. 10-15%
E. < 5%
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49.Patient returned from Sudan. Being in Sudan about a year ago she had a pain in
epigastrium, which moved to right fossa illiac, pain stopped than. Now she has pain in
abdomen and impaired bowel motions.

A. Gardiasis
B. Ameabiasis
C. Ascariasis
D. Coeliac Disease
E. Appendicitis

50.Question on treatment of bacterial conjunctivitis.

A. Chloramphenicol eye drop

B. Ampilicin oral
C. Cotrimoxazole

51.Aboriginal boy started to behave strange, deteriorated his school performance...

A. Petrol sniffing
B. Marijuana
C. Cocaine
D. MDMA

52.An ambulance brought you a young lady who lost consciousness with body temperature
of 40° and BP was 155/90 when they found her collapsed at a friends birthday party.
What is next in Mx?

A. Naloxone
B. Benzodiapines
C. IV Normal Saline.
D. Cold blanket and Cool N saline

53.Patient brought to ED because of an episode of blurry vision during 20 min. During this
period he also felt weakness in his body, now he is Ok. What is next step in management
Medicine 120616

A. Endarterectomy
B. Carotid artery sonography
C. CT head
D. Troponin levels

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54. Middle age woman compliant of pain hip after walking short distance. She have pain in
shoulder. She is previously well, no Hx of DM or altered consciousness. She recently notice
rash on the neck and lower face. What is her diagnosis??

A. SLE
B. Polymyositis
C. Dermatomyositis
D. Scleroderma
E. Rheumatic Arthritis

55. Patient known case of DM, is taking Metformin 1g/day. She had a episodes of Afib in
the past due to which she is on warfarin. Her other medication include Metoprolol,
Indapandine, perindropril, and amplodipine. Due to her uncontrol DM she recently was
commenced on gliclazide. She comes to your GP practice today complaining of two
episodes of hypoglycaemic attacks which of the medication is the likely cause of the events?

A. Amlodipine
B. Metoprolol
C. Indapamide
D. Perindopril
E. Warfarin

(yup, neither gliclazide nor metformin was given)

56. 73 years old Patient presented with continues vomiting for pass 3day. He have the
history of PUD in his 40s, which was was treated by Omeprazole. He have been on Aspirin
due to heart condition since 50s. What is his reason of presentation??

A. Ca Stomach
B. Ca duodenum
C. Ca Oesophagus
D. Lymphoma
E. PUD Medicine 120616

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57. A 16 year old Athlete has a history of Asthma. He is on salbutamol and fluticasone.
Develop changes as in the pic. Which of the following is the most apporiate Management??

A. Reassure.
B. Change the medication for treating asthma.
C. Measure testosterone level

58. Patient with AFib, who is on warfarin develop weakness and altered confusion. On
examination INR is 3.9. CT head was done. What is the most likely diagnosis?(This CT is
similar to the one in exam except in exam the background ischemic area was much larger,
there is a similar question without INR value in blue book no. 3.066 where I picked this CT from.

Medicine 120616

A. Cerebral Haemorrhage
B. Cerebral Infarction
C. SDH
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D. Extradural Hematoma

59. What is the most appropriate treatment?

A. Tobramycin oilment.
B. Cloramphenicol eye drops.
C. Clean the lower eyelid by NS.
D. Ciprofloxacin eye drops.

60. A male patient with night sweat and weight loss for 2 months. On examination, there is
bilateral cervical lymphadenopathy. What is the Diagnosis?
Medicine 120616

A. Sarcoidosis.
B. Lymphoma
C. Squamous cell carcinoma.

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61. A woman with fever and cough after traveling by air to England.. Chest X Ray shows
consolidation in the right upper lobe. What is the most likely diagnosis?

A. Pneumonia.
B. H1N1.
C. PE.
D. Swine flu.

62. ECG is given. What is the most appropriate medication?

A. Sotalol.
B. Amiodaron.
C. Digoxin.
D. Adenosine.
E. Verapamin.
64 After a conference meal, a man feels floating, forced vomiting then suddenly pain in
retrosternum and collapse. He has got ischaemic heart disease before. An ECG and
chest X Ray are given. After resuscitation, which one of the following is the most
appropriate step?
A. Lateral chest X Ray.
Medicine 120616

B. CTPA.
C. Nasogastric decompression.
D. Insert chest drain.
E. CABG.

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65. A CT Scan is given as follows. What is the diagnosis?

A. Hepatocellular carcinoma.
B. Hemangioma of liver.
C. Hepatic hydatid.
66. An obese patient with diabetes review at his GP. He complaints of daytime
sleepiness when driving at work. His wife asks him to stop driving. What’s your
appropriate management?

A. Advice him to have sleep hygiene.

B. Diet and exercise.
C. Check HBA1C

Medicine 120616

67. What’s the most appropriate step?

A. Wide excision.
B. Local excision.

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C. Wide excision and local lymphadectomy.

68. A 45 year old male patient with a history of asbestos exposure at work for more
than 20 years now presents with short of breath and weight loss. A picture is given.
Which one of the following is the most likely diagnosis?

A. Mesothelioma.
B. Cancer of pancreas.
C. Liver cirrosis
69. A female patient presents with tremor, palpitation and weight loss. She also has had
insomnia. Her pulse is irregular with a rate of 110/min. Addition to propranolol,
which one of the following is the most appropriate treatment?

A. Carbimazole.
B. Radioactive iodine therapy.
C. Lugol’s iodine.
D. Subtotal thyroidectomy Medicine 120616

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SURGERY & ORTHOPAEDICS

01.Middle aged patient with backache.He now complains of increasing numbness + tingling
sensation in the LL .Which one of the following is the next step in Mx?

A. MRI
B. Physiotherapy
C. C-.Spinal manipulation
D. Strict bed rest+analgesia

02.A middle aged man with a h/o pain in the right calf. Pain increase by walking + initially
relieved by resting. More recently rest pain in right leg. His BP increased. Right femoral
pulses reduced, dorsalis pedis not felt. Urinalysis is normal. Mx?

A. Stop smoking, ACE-I

B. Arteriogram +review
C. Duplex doppler venous studies +review

03.Patient underwent surgery for post pharyngeal pouch 24hrs ago.Now has difficulty
breathing,swelling in the surgery site+stridor.what is the next best Mx?

A. Remove the sutures

B. NG tube
C. Remove skin staples
D. Cricothyroidectomy

04.A child with increasing severity of projectile vomiting. He is loosing weight + not on any
medication. No difficulty in swallowing. Long term Mx?

A. Correct dehydration + electrolyte disturbance

B. IV Atropine
C. Lap. Pyloromyomectomy
D. Inj. Botulinum toxin
Surgery 120616

05.A man presented with the painful defecation + blood on stool. Pain persistent for
>30min. after he opens bowel.Mx?

A. DRE
B. Colonoscopy

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C. steroid ointment
D. Glycerine trinitrate ointment
E. Observe

05.Elderly woman with h/o colicky abdominal pain, distension , constipation .Her past
medical h/o unremarkable .has taken senna for constipation. Most likely cause?

A. Sigmoid volvulus
B. Ca sigmoid
C. Diverticular dis.of sigmoid colon
D. Small bowel obstruction

06What is the feature of complication of above X-ray?

A. Gross abdominal distention.
Surgery 120616

B. Difficulty of endoscopic decompression

C. Diameter of the sigmoid is more than 10 cm

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08.Elderly woman with h/o colicky abdominal pain, distension , constipation .Her past
medical h/o unremarkable .has taken senna for constipation. Most likely cause?

A. Sigmoid volvulus
B. Ca sigmoid
C. Diverticular dis.of sigmoid colon
D. Small bowel obstruction

07.A man comes to the ER with a h/o sharp cut injury on the right hand. Gives h/o full
immunization. Also has a h/o DTP for previous injury a week ago. Next step?

A. TT+Ig
B. DTP
C. Penicillin
D. ADT
Surgery 120616

09.Patient comes with c/o swelling under jaw-more after food .Bimanual palpation done.
Next appropriate Mx?

A. Intraoral xray
B. CT scan

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C. OPG
D. Sialogram
E. USG

10. Mx?

A. Plaster cast from wrist excluding thumb

B. Plaster cast up to elbows
C. Pain relief
D. Surgery

11.A 24 year old male athlete had an injury while playing, hitting his right knee. Brought to
ED with patient complaining of knee locking. What is the most likely condition?

A. Tear of medial meniscus

B. Tear of lateral meniscus
C. Tear of anterior cruciate Lig.
D. Tear of posterior cruciate Lig.

12.Patient with vague abdominal pain, no localizing pain, unable to lie down the bed. P/E
soft abdomen, pregnancy test – negative. How to diagnose?

A. Urinalysis
B. Ct scan of abdomen
Surgery 120616

13. Patient has pain in an inguinal area. CT with small black oval lesion there

A. CT-guided draining
B. Explorative Surgery

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14. Patient on Warfarin presented with abdominal discomfort. CT was done. What is the
diagnosis?

A. Mesentric Ischemia
B. AAA
C. Retroperitoneal Hematoma
D. Splenic Rupture

15.A young patient with severe Haematemesis and epigastric pain. BP reduced and PR
increased after resucitating with NS, endoscopy done which showed an active bleeding.
Next step?

A. Oral Ranitidine
B. Adrenaline intralesional
C. IV Omeprazole
D. Explorative lapratomy
E. Long term PPI

16.Post hartmanns surgery. On 3rd post op day, seeing insects crawling on his bed

A. Alcohol withdrawal
Surgery 120616

B. Atelectasis
C. Narcotic withdrawal
D. Benzodipines abuse

17.Young patient with abdominal distension, s/p appendectomy. Underlying cause

A. Cancer

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B. Adhesions

18.What is the most common compication?

A. Stiffness
B. non union
C. AVN
D. Infection

19.A case of a 45 year old man who is a chronic smoker with Hx of DM. What is the
diagnosis?

A. Buerger’s Disease
B. Gangrene
C. DVT
D. Atherosclerosis
Surgery 120616

20. 42 female on check up. Family history – grand pa , at 80 years old had colon ca, grand
ma, at 65 years old had breast ca, brother has dm at 60 years old.what to request?

A. Mammography
B. Colonoscopy
C. FBS

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21.Ominous sign of acute ischemia

A. Paralysis
B. Pulseness
C. Rubor on dependency
D. Pain
E. Pale Limps

22. Ominous sign of Chronic Ischemia

A. Paralysis
B. Pulseness
C. Rubor on dependency
D. Pain
E. Pale Limps

23. A patient ask you her changes to have Ca breast as her sister and mother have Ca
breast.

A. 25%
B. 50%
C. 100%
D. 1%
E. 10%

24. You got a call about a child who spilt boiling water on his body. Your advice:

A. immediately transfer to hospital

B. put ice
C. cold shower

25. Parents present to your surgery for advice regarding son’s condition. Their son born
from the first pregnancy at term through SVD, Apgar score is 6 at 1st min and 8 at 5th min,
developed jaundice at 18th hour of life. Blood smear showed spherical cell. Parents
concerned about his condition. What is the best long term treatment?
Surgery 120616

A. Prednisolone
B. Splenectomy
C. Ceftriaxone
D. Bone Marrow Transplant

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26. What is next management??

A. endoscopic decompression
B. colonoscopic decompression

27. Patient with horseness of voice for 1 month, dysphagia for 2 wks, history of surgery
because of High Grade Dysplasia caused by Barrett’s Esophagus.

A. Ca larynx
B. Ca upper 1/3 of eosophagus
C. Ca Cordae vocalis
D. other options

28. 35 yrs old worries about CA breast

A. Reassure.
B. USD.
C. Mammography.
D. Do mammography after 50years old.

29. AN Elderly present with complain of palpable mass in left inguinal area, What is next
step in your management?
Surgery 120616

A. Sigmoidoscopy
B. Colonscopy
C. Surgical Exploration
D. USD
E. CT Scan

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30.Patient came to you because worried about having Prostate Cancer. His Uncle recently
got diagnosed with Prostate Cancer. Neighbor 50 years old has Ca prostate also, Dog is
also unwell. Digital Rectum Examination revealed normal prostate. What is next in your
Mx?

A. repeat DRE annually

B. PSA in 6weeks
C. do nothing
D. Transrectal Biopsy
E. TURP

31. Patient known case of DM had stroke two years ago. He is on warfarin . He now present
to hospital in right iliac fossa with pain...

-rectal sheet hematoma

32.A man is arranged to have an elective surgery for reducible inguinal hernia. Suddenly
he got DVT a week before the operation. He is on warfarin and stable now. WOF is the
most appropriate step?

A. Continue warfarin then delay surgery.

B. Stop warfarin, start Heparin and do surgery.
Surgery 120616

C. Stop warfarin in next 5 days and do surgery.

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33.A patient complains of dragging and numbness of his left foot. On examination there is a
weakness of plantar flexion and inversion of his left ankle. The reflex is normal. A lesion of
which one of the following nerve root is the most likely cause of his presentation?
A. Common peroneal nerve.
B. Tibia nerve.
C. Sciatic nerve.
D. L5.
34.A 14 year old complains of sudden onset of pain on the left side of the scrotum. On
examination left hemiscrotum is red and swollen. Which of the following is the next step in
management?
A. Surgery exploration.
B. Urine PCR.
C. FNAC.

35.A 45 year old complains of pain on the right side of the scrotum. On examination right
hemiscrotum is red and swollen. Which of the following is the next step in management?
A. Urine culture.
B. FNAC.
C. Ultrasound the scrotum

36.A woman is on HRT therapy. She suddenly felt intermittent of blurred vision affected
her right eyes. Investigation shows right carotid stenosis 40 – 50% and left carotid stenosis
50 – 60%. Which is the most likely factor that can reduce risk of stroke?

A. Cease HRT therapy.

B. Carotid endarectomy.
C. Start Transdermal Oestrogen

37. An elderly non smoking patient with AF suddenly felt pain in his left leg. On
Surgery 120616

examination, his leg is cold, pale and pulseless. Which one is the most likely cause of these
finding?
A. Femoral artery thrombosis.
B. Femoral artery embolism

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C. Thromboangitis obliterants

38.A patient is unable to grasp thumb with fore finger and tingling sensation at the wrist.
Sudden onset of pain happens at night, which wakes patient wake. Patient shakes his hand
to relief the pain. What is the most likely cause?
A. Carpel tunnel syndrome.
B. Anterior interosseous nerve injury.
C. Mallet’s Finger.
D. Scaphoid Fracture.
39.A 29 year old woman presents with a painless lump in the left breast. Breast exam
confirms a discrete and mobile 2cm lump. Ultrasound shows a hypoechonic cyst. Which
one of the following is the most likely diagnosis?
A. Breast cyst.
B. Fibroadenoma.
C. Breast cancer.

40. A lesion at the helix. What is the most appropriate way to do biopsy?

A. Excision.
B. Incision.
C. Punch biopsy.
D. Shave biopsy

41.A patient suddenly has a short of breath, pain in left chest with haemoptysis on the 6th
post operative day. Which one of the following is the most appropriate investigation?
A. Chest X Ray.
B. CTPA.
C. V/Q
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42.A male patient presents to the ED after vomiting a large amount of fresh blood. In his
history, he drinks alcohol everyday and has never had anything like this before. After given
IV fluid, which one of the following is the most likely next step?

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A. Perform endoscopy and inject adrenalin into the lesion of peptic ulcer.
B. Start H.pylori therapy

43. A man presents with submandibular swelling and pains particular after meal. Which
one of the following is the most appropriate investigation?

A. Intraoral plain radiography.

B. CT Scan.
C. Ultrasound

44.72 years old presented with the lump as above. She complains of constipation for 2 days.
On examination she have temp of 37.4° and a upon palpation of the mass tenderness was
revealed. What is your next Mx?

A. CT scan
B. USD
C. Biopsy
D. Antibiotics and Observation
E. Surgical Exploration
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PEDIATRICS
01.A child had peanuts suddenly developed stridor with swelling of face. BP reduced, PR
increased. Mx?

A. Intubation
B. IM Adrenaline
C. O2 by mask
D. Bronchoscopy

02.A woman delivered a preterm baby in her 2nd pregnancy with 3100gm weight. Apgar at
1st min is 6 and at 5th min is 9. Over the next few hours he develops grunting and tachypnea
and subcoastal recession. He was started on o2 at 4 hours of age. What is the most likely
cause?

A. Birth asphyxia
B. Meconium aspiration
C. Tension pneumothorax
D. Transient tachypnea of newborn
E. Hyaline membrane disease

03.Infant born with jaundice within 24hours of his life. Most common cause?

A. Hemolytic disease of the newborn

B. Physiological jaundice
C. Hereditary spherocytosis
D. Neonatal hepatitis

04.A child with reduced urine output and bloody diarrhoea. What is the diagnosis?

A. HUS
B. Renal failure
C. HSP

05.A young child with pain in knee after injury over tibial prominence. Concerned parents
Pediatrics 120616

want to know what will be the outcome?

A. Complete Recovery after 1-2years

B. No recovery at all
C. Need steroid injections

06.A child with URTI 3 weeks ago. Presents with petechiae, bruises. PLT reduced other Ix
are normal. Mx?

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A. Steroids
B. Antibiotics
C. Gammaglobulins
D. Strict bed rest

07. 8 year old girl with a mass behind her nipple.Mx?

A. FNAC
B. USG
C. Check Serum Oestrogen level
D. Reassurance

08.A 5year old presented with periorbital swelling. O/E she was not able to open her
affected eye there was slight decrease in the movement of the eye, pupils are normal, there
is pain on movement of the eye. Diagnosis?

A. Periorbital cellulitis
B. Orbital cellulitis
C. Conjunctivitis
D. Iritis
E. Keratitis

09.A 6 year old boy was brought by mother because of fever. The patient is a known case
of atopic dermatitis then lately developed crusting of lesion on his legs some with erythema
and some with purulent discharge. Suddenly developed a systolic murmur on the sternal
area. What is the next step toarrive at the Dx?

A. FBE
B. Lumbar Tap
C. ECG
D. Echocardiogram

10.A mother bought her 6 year old son for evaluation because she noted him to be non-
responsive to her calls most of the time. The boy loves playing by himself ( and other
description of Autism etc.etc.) and love to play BOB THE BUILDER. What is the likely
evaluation of the child?

A. ADHD
B. Autism
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C. Asperger’s
D. One last option I can’t recall

11.Young patient with failure to thrive , loss of subcutaneous tissues

A. Celiac disease

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B. Cystic fibrosis

12.A week after sore throat child presents with swollen painful knee, later – ankle. Has
rash on back.

A. give prednisolone
B. give immunoglobuline
C. give penicilin oral

13.A child with rash over body 10 days after respiratory infections

A. Strict bed rest

B. Prednisolone
C. Penicilin
D. Reassure

14.A teenage girl with a 3day h/o vomiting-severe,persistent.it was asso. With recurrent
URTI.She also complained of lack of energy + tiredness for previous 3-4 months.o/e BP
reduced PR increased.Serum sodium +chlorine both reduced.Which of the followed is the
most likely diagnosis?

A. Chronic fatigue syndrome

B. Hyperthyroid crisis
C. Addison’s disease

15.A boy come in contact with patient with chickenpox and presents at your GP practice.
Which one of the following is the most appropriate management?

A. Reassure.
B. Check antibody.
C. IM VZIG.
D. aDPT + booster dose 2 months later.

16.A 5 year old boy is seen in the ED with a penetrating wound in the leg. The patient has
Pediatrics 120616

been previously immunized 2 doses against tetanus. Apart from performing wound
debridement which one of the following should be given for tetanus prophylaxis?
A. aDPT + Penicillin IM.
B. Tetanus toxoid. + TIG.
C. aDPT + antibiotics orally in 5 days.

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17.A previous healthy girl has developed progressive weakness, areflexia of her legs and
respiratory insufficiency. The most likely diagnosis is:
A. Polyomyositis.
B. GBS
C. Botulism.

18. A young female post-viral infection, who developed progressive ascending weakness,
was admitted. Who will be asses the respiratory function? (exact terminology)

A. PEFR
B. FEVɪ/FVC
C. FVC
D. O2 Saturation
E. ABG

19.An infant with a temperature of 390C. Otocopic examination show a dull inflamed
tympanic membrane in both ears but no bulging. Which one of the following is the most
appropriate treatment?
A. Paracetamol.
B. Amoxycillin

20.An 8 week old infant was brought to your clinic. The mother asked you about his
development. Which of the following is the normal sign that you can find out in this infant?
A. Head lag when pulled to sit.
B. Roll over.
C. Turn to his mother’s soft voice.
D. Turn to his mother when she moves.

21. A 4 year olds chills presents to ED with 36hrs h/o cough, Inspiratory stridor and
intercostal retraction. His temperature is 38.2° and you found that the cough has barking
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quality. What is your diagnosis?

A. Epiglottis
B. Foreign body at the level of trachea
C. Croup
D. Asthma

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22. A 4 year old child presents with fever and 12hrs history of stridor and harsh cough.
How will you treat him?

A. Nebulised Adrenaline
B. IV antibiotics
C. Nebulise Salbutamol
D. Nebulised Corticosteriod
E. Oxygen

23.A 3years old child has cough and fever. On chest X-ray revealed bilateral patchy
consolidation. What is the diagnosis?

A. Streptococcus Pneumonia
B. Staphylococcus Pneumonia
C. Mycoplasma Pneumonia
D. Viral Pneumonia

24. A 9 months old infant developed wheezing, dyspnea and cough 3 days ago. What could
be the probable diagnosis?

A. Asthma
B. Bronchiolitis
C. Foreign Body
D. Pneumonia.

25.A boy has been diagnosis with exercise induced asthama. What would you recommend
for the boy?

A. Inhaled salbutamol before exercise

B. Inhaled corticosteroid before exercise
C. Oral corticosteroid nightly
D. Inhaled salbutamol after exercise

26.A child with undescented testis. Most commonly associated abnormality is:
Pediatrics 120616

A. Trauma
B. Malignancy
C. Torsion
D. Inguinal Hernia
E. Testicular Feminization (Androgen Insensitivity Syndrome) AIS

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27.A 2yr old child is admitted with a fever of 40°. P/E of the child revealed limited knee
movement and does not allow anybody to touch ot. There is an are of point tenderness over
the medial side of the distal femur. What is the probable diagnosis?

A. Septic Arthritis
B. Osteomyelitis
C. Osteogenic Saccoma
D. Undisplaced Fracture.

28.A 13 year old boy is brought to your clinic with parents complaining of pain in the knee
joint. Patient walks with a limp. His BMI is 32. What is the diagnosis?

A. Slipped Capital Femoral Epiphysis

B. Osteochondritis of tibial tubercle
C. Leg-calve Perth’s Disease
D. Osteomyelitis
E. Transient Synovitis

29.A young boy with petechial rash on the buttocks. Diagnosis?

A. Meningococcemia
B. HSP
C. RF
D. Ross River Fever

30.A patient with infectious mononucleosis fainted suddenly two weeks after recovery.
What is the cause?

A. Hypoglycemia
B. Splenic Rupture
C. Encephalitis
D. HOCM Pediatrics 120616

31.Child presents with pain in abdomen and lethargy for few weeks. On examination you
found enlarged liver. The child has opacity of the lens. Reducing substances are found in
urine examination. What is the most probable diagnosis?

A. Lactose intolerance
B. Coeliac Disease
C. Cystic Fibrosis

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D. Galactosemia

32. 2week old infant presented with fever and neck stiffness. Meningitis was diagnosed. On
further examination no organism was found on gram staining. Which is the most likely
causative organism?

A. E.Coli
B. Group B Strep
C. Klebsiela
D. Aseptic Meningitis
E. Viral Meningitis

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OBGYN
1.A young woman comes to the ER due to severe lower abd pain.BP reduced and LMP 6
Weeks ago.Which will lead to the diagnosis of ectopic pregnancy?

A. Postural hypotension
B. PV bleeding
C. Low HB
D. Lower abd guarding

02.Pregnant lady Rh-ve was given RhD during the 1st pregnancy.Underwent orthopaedic
surgery 12 months ago.She is pregnant now and found to be sensitized.What is the cause?

A. Blood transfusion
B. Previous pregnancy
C. Recent pregnancy

03.Middle aged female with DUB scheduled to see her specialist in a week. She is suffering
from menorrhagia now. Vitals stable. Mx?

A. Reassurance
B. Refer to hospital
C. OCP
D. Progesterone
E. Estrogens

04.A young female patient got married and planning on getting pregnant came due to
menorrhagia for 2 months.LMP 10days before. O/E uterus upto umbilicus.USG-Confirmed
myoma. Mx?

A. GnRH analogue
B. OCP
C. Hysteroscopic myomectomy
D. BT
E. Hysterectomy

06.Young female with BMI of 34. Father with a K/C/O DM2. Her 1st baby weighs 3.25kg.
and pregnancy-uneventful. What is a risk factor for GDM in current pregnancy?
OBGyn 120616

A. BMI
B. Age
C. Family history
D. weight of the 1st baby

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07.A female patient(~40 years)came for her routine breast checkup.clinical exam’
normal.But on USG and confirmation from mammography showed a calcified lesion in the
upper outer quadrant in the right breast.Diagnosis?

A. Ca breast
B. Fibroadenoma
C. Cyst
D. Papilloma

08.60year postmenopausal woman came for HRT.Which one is the most appropriate
advice?

A. Conjugated equine estrogen(0.625 mg)

B. Oestradiol
C. Oestradiol implant
D. Oestradiol cream

09. A 35 year female pregnant 24 weeks AOG brought to ED because of abdominal pain in
the R upper quadrant. Two years ago had biliary stones removedWhat is the most
appropriate step?

a. ERCP
b. Laparoscopic cholestectomy
OBGyn 120616

c. Cholestectomy
d. Do nothing until after delivery

10.Young patient who is keen to get pregnant came because of manorrhagia for 2months.
On examination the uterus is at the level of umbilicus and Hb is 60g/l. What is the best
management right now?

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A. GnRH agonists
B. OCP then myomectomy
C. Blood transfusion
D. Hysterectomy
E. Hysteroscopic myomectomy

11.Pregnant lady in second half of pregnancy came in contact with rubella. IgG is –ve. No
IgM was given. Mx?

A. MMR doesn’t play any role, if the patient has been infected with rubella previously
B. Gives MMR now
C. Give MMR after birth before she leaves hospital
D. Give MMR once breast feeding is stopped
E. Reassurance

12.34 wks pregnant just flew in from England, develop tachycardia, shortness of breath
and anxious. What is the Best Management?

A. D-dimer
B. CTPA
C. ECG
D. Aminotomy
E. C-sec

13. Patient with menorrhagia during 10 days for 2 month, now started bleeding again 12
days after previous bleeding stopped. She has made an appointment with gynecologist.
What will you do now? The cause of current bleeding:

A. DUB
B. Normal Menstruation
C. Uterine Fibroid
D. IUD

14.The same question with treatment options:

A. GnRH agonists
B. OCP then myomectomy
OBGyn 120616

C. Blood transfusion
D. Hysterectomy
E. Hysteroscopic myomectomy

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\15. 24 yrs old patient with amenorrhea for 6month. Presented to your practice worried
about her ability to conceive. On examination of abdomen is unremarkable. Blood test
shows as follows
Type Levels

Estradiol Low

FSH High

LH High

FSH:LH 1:1

On USD examination there 3-4 cysts were found. What is the cause of amenorrhea:

A. Premature ovarian failure

B. Polycystic ovarian disease
C. Hypopituitarism

16.After cessarian section you find lump in an inguinal area. Best option for now

A. observe
B. send to surgeon

17.Woman with 39weeks of Gestation present to ED after a fall, which follow by abdominal
pain and PV bleeding. On examination abdomen is tender, estimated blood loss is 1000ml.
On auscultation no fetal heart sound found. On further fetal assessment, no FHR was
found. What is your next Mx?

A. Observation
B. C-Section
C. Amniotomy
D. Fetal Scalp pH
E. Syntocinon infusion

18.What is the most common complication of Maternal Infection during pregnancy?

OBGyn 120616

A. Miscarriage
B. Premature Delivery
C. Fetal Hypoxia
D. Fetal Demise
E. Septicaemia

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19.A pregnant in her 32 weeks of gestation has an intermittent abdominal pain. The cervix
is long and opens 3cm. What is the contraindication of tocolysis?

A.Asthma.
B.Diabetes.
C.Pre eclampsia.
D.Antepartum haemorrhage

20A female patient who is in carbamazepine now require OCP. What is the most
appropriate management?
A. Advice her use condom because it is as effective as OCP.
B. Give her OCP.
C. Don’t give OCP because the interaction between carbamazepine and OCP will decrease
her libido.

21.A 12 week pregnant contacts CMV. What is the management?

A. Check Ig.
B. Amniocentesis.
C. Fetal blood sampling.
D. Check IgM and IgG with the blood sample 4 week previously.
E. Check fetus after delivery
22.A pregnant has unclear due date. She remember her last menstrual period was on
4/2012. She had US 2 times at 19th and 31st week. Which of the following is the most
appropriate way to calculate her gestational age?
A. Last menstrual period (4/2012)
B. US on 19th week (18/1/2012).
C. US on 31st week (30/1/2012)
D. Between 18/1 and 30/1.
E. Fundus length.
OBGyn 120616

23.A 9 week pregnant vomits for one week and progressing increase in 2 days. Which one
of the following feature in her history that is necessary to ask her?
A. Previous molar pregnancy.
B. History of no response to drugs.

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C. Peptic ulcer.
24.A pregnant has been given acid folic. What is the next supplement that is necessary to
give her for prevention congenital abnormality?
A. Iodine.
B. Iron
C. Vit E
D. Vit A
E. Vit D.
25.A pregnant with 18 – 20 week gestational age. She had a history of pre term delivery
and baby consequently died. She asks for what we can do to predict the premature labour?
A. US length of cervix.
B. Fetal fibronectin.
C. Cervical surlage

26. A 22y/o primigravida presents to the emergency department of a regional medical

centre at POA of 26wks. She had clear discharge PV. Speculum exam confirm active loss of
fluid, consistent with amniotic liquid, through cervix. Transfer to tertiary hospital has been
arranged, What else should be done before transfer.

A. Tocolysis
B. Per Vagina exam
C. Steriods injection
D. Induction of Labour
E. CTG

27.Primigravida presented with painless bleeding per vagina at 26th week of POA. On
examination no tenderness of abdomen . BP 140/90, other systems are normal. Fetal Heart
can be heard and cervix is closed. What is the diagnosis?

A. Placenta Previa
B. Placenta Abruptio
C. Vasa Previa

28. Women presented to your ED with 39weeks POA. She complain of pain in the abdomen
OBGyn 120616

and PV bleeding. On examination, uterus is up to date, tender on palpation. Estimated

blood loss is 1000ml. On fetal assessment there is no fetal heart sound auscultated and on
further examination no FHR . What is your management?
A. C-sec
B. Aminotomy

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C. Syntocion
D. Blood transfusion

PSYCHIATRY AND MEDICO LEGAL

DILEMMAS
01.A couple comes for counselling with a h/o the girl’s father having Haemophilia. Both of
them are normal. What is the percentage of the offspring having the disease?

A. None
B. 0.25
C. All males + no females

02.Child with irregular patches of hair loss in the head. No h/o any problem at home.
Diagnosis?

A. Trichotillomania
B. Tinea capitis
C. Allopecia areata

03.Lithium monitoring in chronic stable driver who has moved interstate?

A. I month
B. 3 months
C. 1year
D. 2years

04.A diagnosed patient with schizophrenia on medication. h/o not taking medicine
regularly with residual symptoms. Next best Mx?

A. Change to resperidone
B. Change to olanzapine.
C. Continue same medication
D. Change to another class of antipsychotic
E. Admit + ECT
Psychiatry 120616

05.A child began soiling his undergarments which were semisolid. According to the mother
he was well toilet trained before. What is most important to come to a diagnosis?

A. h/o family stressor

B. h/o food from outside
C. Travelling history

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06.A patient comes to the ED screening that she is consulting to some prophet + says that
all the patients are going to die today. Next step in Mx?

A. Call security
B. Call police
C. Offer tea and biscuit

07.You decided to start a agitated patient with Sertraline. He is now on Sertraline. Today
he came back after 3days of commencing the medication. What is your next step of
management ?

A. Change to another medication

B. Continue for 3-4 weeks and rechecks
C. Stop the medication

08.A female patient c/o insomnia. She is also concerned that she is very anxious and has
difficulty in concentrating at work. How will you treat her?

A. SSRI
B. Psychodynamic psychotherapy
C. CBT
D. Sleep hygiene

09.Co intern stealing drugs. Next step?

A. Complain medical board

B. Complain interns director
C. Advice him not to do it

10.A teenage girl left home after she was sexually abused. Since the she had a lot of
convictions of breaking the law. What in the history will help in diagnosis?

A. Flashbacks
B. Suicidal thoughts
C. USG now
D. Observation + Do nothing
E. Laparoscopic surgery
Psychiatry 120616

11.A young lady planning a low budget trip to India, has been vaccinated with tetanus,
measles, mumps, rubella, diphtheria, Hep A. Now comes asking for advice. What should
you give her?

A. DPT+MMR
B. TT Booster
C. Pneumococcal vaccine

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D. Poliomyelitis vaccine

12.A young male patient diagnosed as having Typhoid ask you when can he be discharge
and when can he resume his work?

A. He can resume his work

B. After WBC normalize
C. After normal LFT
D. After 3 serial Culture –ve

13.Patient on Clozapine coming with recurrent infections. Next step in Mx?

A. Check FBC
B. Change the drug

14.A lady comes to the ED very agitated +abusive asking for a special room + says that the
nurses do not understand her but only doctors understand her.diagnosis?

A. Splitting
B. Malingering
C. Histrionic

15.A female patient invites you for a drink and chat with clear romantic intensions. What
should you do?

A. Decline the invitation and say that it is inappropriate

B. Send to another doctor
C. Go for the drink and chat

16.A young girl is brought to your GP by the mother complaining about her behavior.She
talks rudely to her father,does not attend classes,school authorities are planning to expel
her.Rx?

A. CBT
B. Psychotherapy
C. Antidepressant

17.A 25year female ballete dancer with a BMI 17 presented with weakeness.She says that
Psychiatry 120616

she is engaged in self induced vomiting and spends 3-4 hours everyday for exercise. What
is the next step in Mx?

A. Serum electrolytes
B. LFT
C. TFT
D. BSL

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E. Iron studies

18.A male fashion designer wants his nose done for the 4th time with a plastic surgeon. He
always looks in the mirror about the defect of his nose. He claims that his nose is ugly and
is even uglier now and wants it redone. What is the most ominous sign of this patient?

A. That he will sue his surgeon

B. OCD
C. Depression
D. Dysmorphic disorder

19. A male patient diagnosed as HIV consulted at your clinic and refused to reveal his
condition to his male partner. What is the most appropriate step?

A. Tell his partner

B. Talk to the patient regarding HIV and its facts and transmission
C. Public health and safety
D. Hospital Board

20.A 24 year old female from Bosnia, a refugee consulted for the third time in six months
period because of abdominal pain, nausea and vomiting and dizziness. She is very secretive
about her past and does not like to talk anything about her past in Bosnia. What condition
best describes her?

A. Denial
B. Depression
C. OCD
D. Somatisation

21.A 45 year old patient complaints of forgetting events that happened a month ago. He
also can not remember his holiday trip last year. He’s just received ECT for major
depression. Which of the following is the most appropriate reason?
A. Onset of dementia.
B. Adverse effect of ECT.
Psychiatry 120616

C. Multi-infarction
22.A woman goes to a lot of hospitals many times with many different names. She was a
migrant and sexual abused by her sponsors. She gave birth one time and her baby died
because of premature. Which one of the following is the most likely diagnosis?
A. Adjustment disorder.

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B. Anxiety disorder.
C. Factitious disorder
23.A patient is on Zuclopenthixol 200mg fortnightly. He‘s got some adverse effects. He also
had the prior poor response to Risperidone. What’s the management?
A. Change to Risperdal Costa® intermediately.
B. Change to Quetiapine.
C. Change to Risperdal Costa® and continue Zuclopenthixol 3 doses.
24.Cannabis ‘s effects:
A. Euphoria, floating then sleepiness and wandering mind.
B. Anxiety, panic, sweating, teeth grinding and hallucination.
C. Drowsiness, watery eye, running nose and loss of appetite.
25.A patient is on trifluoperazine presents with muscular rigidity gradually. Now he has
high fever, high blood pressure agitation, delirium. What ‘s the most likely cause for these
findings?
A. Serotonin syndrome.
B. Neuroleptic malignancy syndrome.
C. Alcohol intoxication

26.A woman complaints her son who is a university student about his “cross - dressing”.
He’s also your patient and has never complaints about his health. Which one of the
following is the most likely explanation?
A. Offer to counsel him.
B. Explain that is a variant normality.
C. Onset of schizophrenia
27.How to choose sample for a research of obesity in the community?
A. Snowballing
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B. From shopping center.

C. Random in general population.
D. From news advertisement.
E. From website
28.The least effective research is:

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A. Case control.
B. Case report.
C. RCT
D. Cohort
29.A woman presents at your clinic and wants to help her withdrawing alcohol. Which one
of the following is the most appropriate management?
A. Arrange a counseling program.
B. Give her literature of the harmful risk of drinking alcohol.
30.Patient with advance directive of no tube.
A. Don’t feed
B. IV nutrition
C. Send to old folks home.

31.Patient does not want resuscitation if there will be need

A. sign consent

32.Patient with depression, 3 days ago started on Sertraline. Now agitated.

A. change to other SSRI

B. decrease dose of sertraline
C. continue treatment on sertraline

33.In Australia psychodynamic therapy is used more common for

A. Borderline personality disorders

B. Obsessive-compulsive personality disorder
C. some other options – not personality disorders
Psychiatry 120616

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